\ \ \ \ SoS 
XX aN 
\\ \ MRR : 
CA \ 
ON 


WY 

AS 

\ NY 
LAMY 


WN 


SN 
\ 


WR S 

AK 
ANY 
\ \\\ 


AX 
\\ 
\ A % IS 
I 


\ AK 
NY \ 
AY 


WAN \\ AK \\ \ - AK A 
A \ \\ \ 


A 

AN \\\ \ AY \ 
\\ \\ \ 
\\ AY 


\ AY A 
\ QQ \ \ 
AX A \\ \ 
\ ~~ \ \ 


= 


Z 
Serie 


i “ns Pus, 


MOLLER’S 


OPERATIVE VETERINARY SURGERY 


TRANSLATED AND EDITED FROM THE SECOND ENLARGED 
AND IMPROVED EDITION OF 1894 


SMES yd io 
JNO. A. W. DOLLAR, M.R.C.V.S. 


F Cay 


0 g 
x 2A 
Meet Ren “Sp 
CCT ZO\4: AM 22” 
30 4205 | 
eae New Yorr: 


“WILLIAM R. JENKINS, 
VETERINARY PUBLISHER AND BOOKSELLER, 
851-853 SIxTH AVENUE. 

1895. 


CoPpYRIGHT 1895, By WILLIAM R. JENKINS. 
(All Rights Reserved.1 


TO 


Bo oe oC hARKE, 


M.A., M.B., CANTAB, ETC., 


This Wolume is Dedicated, 
AS A 


TOKEN OF SINCERE FRIENDSHIP AND IN GRATEFUL REMEMBRANCE 
OF MANY ACTS OF KINDNESS, 


’ BY 


THE TRANSLATOR. 


TRANSLATOR’S PREFACE. 


Professor Moller’s work is so well known and appreciated through- 
out Europe that no words of mine could at all enhance its reputation. 
Nor would it be appropriate in me to offer any remark either in justifi- 
cation or extenuation of the translation now placed before the public— 
the work must be judged on its merits. But whilst fully conscious of its 
many shortcomings—-shortcomings doubtless more conspicuous to other 
eyes than even to my own—I venture to express a hope that they may 
be found in no material respect to detract from its usefulness, and that 
the labor, which has occupied the spare moments of two busy years, 
may prove not altogether misapplied. The long delay in publication 
was due to the appearance of a second edition at a time when the 
translation of the first had already made considerable progress, necessi- 
tating the whole beimg rewritten. Certain deviations have been made 
from the original; and, in a few instances, portions which were con- 
sidered of minor interest to English veterinary surgeons have been 
omitted. 

The task of translation has at times proved hard, but a more difficult 
remains—that, namely, of sufficiently thanking my several helpers. 
And, firstly, I should acknowledge the generous co-operation and 
-assistance I have always received from Professor Moller. My obligation 
to him dates from my residence in Berlin in 1892-93, when he not only 
admitted me to his demonstrations and clinique, but entrusted me with 
the preparation for English readers of his recently issued work. From 
that time onward he has never ceased to afford me every encouragement 
in his power. To Mr. Finlay Dun I am under a large debt of gratitude 
for revising my proof-sheets, for placing at my disposal his extensive 
technical knowledge of books, and for the kind interest he has always 


4 


Vill TRANSLATORS PREFACE. 


taken in the success of this, my first serious literary effort.j [Lastly,. 
Professor M‘Queen, of the Royal Veterinary College, London, has, by 
reading many of my final proofs, and by advising me on points of ana- 
tomical and surgical importance, rendered me greatly valued assistance, 
for which I desire to tender him my most hearty thanks. 


JNO, A. W. DOLLAR. 


56 NEw Bonp STREET, LONDON, 
Sept, 12, 1895. 


PREFACE TO FIRST EDITION. 


Tur present work aims at furnishing a complete, if necessarily con- 
densed, account of the latest advances in the treatment of the Surgical 
Diseases of Domestic Animals. In preparing a book for the use both of 
students and busy practitioners, it was of the utmost importance to 
exclude all matter of secondary or doubtful interest, while setting forth 
and explaining the main facts in the light of modern science. 

I have therefore supplemented my own experience by reference to 
the most recent literature, at the same time by no means neglecting 
older sources of information which are too numerous and important to 
be altogether overlooked; but, in face of the vast amount of material at 
my disposal, I have found it necessary to to confine myself to the more 
important German and foreign publications, from which I have selected 
and turned to account as much as proved appropriate. To facilitate the 
work of those who wish to devote themselves to special subjects, each 
chapter is prefaced with a bibliography. 

The most important problems of Veterinary Surgery naturally centre 
around the Horse, and to the study of these I can claim to bring a wide 
personal experience. For assistance in the preparation and correction 
of those parts of the work dealing with ruminants and swine, I have to 
express my thanks to Professor Dr. Esser, of Gottingen, who has kindly 
placed at my disposal his extensive store of information, so that I hope 
this department also may be found to have received due attention. 

Particular care has been devoted to that hitherto neglected but 
most important subject, lameness in horses, which is here treated on the 
principles laid down in my Diagnostic der dusseren Krankheilen. On 
' the other hand, I have been compelled to omit from this work any 
lengthened reference to diseases of the eye, partly because of my having 
already published a work on this subject, partly because veterinary 
ophthalmic surgery more and more inclines to become a specialty. For 


x PREFACE TO SECOND EDITION. 


similar reasons, diseases of the hoof are only shortly discussed, and are. 
associated with diseases of the claws in ruminants and carnivora. 

Many of the illustrations are drawn from photographs taken in my 
clinique ; for figs. 36 and 89 I am indebted to the courtesy of Professor 
Dr. Esser; others are copied from well-known manuals and journals ; 
whilst those representing instruments have, for the most part, been 
kindly furnished by Herr Hauptner, specialist in the manufacture of 
veterinary instruments. 

To facilitate reference, a very full table of contents and index have 
been added. | 

Diseases have been classified according to the portions of the body 
which they affect—this arrangement not only facilitating study, but 
most fully conforming to practical! requirements. . 


H. MOLLER. 


PREFACE TO THE SECOND EDITION. 


The first edition of this work having been so favorably received by 
the veterinary world and taken up with such unexpected rapidity, a 
second has become necessary, which it has been thought wise to prepare 
on the same lines as its predecessor. Certain sections—such as Diseases 
of the Teeth—have, however, been recast so as to include recent ad- 
vances, and others have been enlarged and rendered more complete. 
To meet an often expressed wish, I have written an altogether new 
chapter on the Acute Diseases of the Mammary Gland. i 

The appearance of the General Surgery—the first part of this work 
—yjustified many abreviations in the present volume, the scope of which 
has in this way been greatly augmented without increase of bulk. 
Many new illustrations have also been added. 


H. MOLLER. 


CONTENTS. 


I.—DISEASES OF THE HEAD. 


I. Diseases of the Lips and Cheeks, 


. Wounds and Bruises, 

. Acute Inflammation of the ‘Lips and Cheeks, 
. Tumors of the Lips and Cheeks, é 
Paralysis of the Lips. Facial Paralysis, 


ow wr 


II. Diseases of the Mouth, 


1. Foreign Bodies in the Mouth, 
2. Diseases of the Tongue, 
A. Mechanical Injuries, 
B. Acute Inflammation of the ‘Tongue, 
C. Chronic Inflammation and New Gr owths in the Tongue 
(Makroglossia), 5 : : 
D. Paralysis of the Tongue (Glossoplegia), 
E. Ranula, 
F. Fracture of the Hyoid Bone, 
3. Fracture of the Premaxillary Bone, 
4, Injuries in the Interdental Space, 
5. Diseases of the Teeth, 
A. Irregularities in the Dev elopment ‘of the Teeth, . 5 
a “Super numerar y Teeth (Polyodontia, Hyperdenti- 
tion), . ; 
b Irregularities i in Replacement of the Teeth, 
c Displacement of the Teeth, 
B. Irregularities of Wear in the Teeth, 
a The Angular or Sharp Mouth, the so-called Prog- 
nathous Jaw, : 
b The Shear-like Mouth, 
ce The Wave-formed Mouth, 
d The Step-formed Mouth, 
e Premature Wear of the Teeth, 
f The Smooth Mouth, 2 
C. Diseases of the Tooth Proper, 
a Dental Caries (Caries Dentium), 
b Fissures and Cavities in the Teeth, 
e Dental Tartar (Cremor Dentium), 
D. Diseases of the Alveoli, ; 
a Alveolar Periostitis (Periostitis Aly eolar is), 
a Inflammation of the Alveolar Periosteum in 
Herbivora, 
b Inflammation of the Alveolar Per iosteum in 
Carnivora, : ‘ ‘ ; 
b Dental Fistula, 
ce Neoplasms of the Gums and Alveoli (Epulis), 


xi CONTENTS. 


PAGE 
III. Diseases of the Nose, Nostrils, and the Spaces Communicating with 
them, ; : : : : : : : : 53 
1. Wounds of the Ale of the Nostrils, é : : ‘ 53 
2. Fracture of the Nasal Bones, : : : 54 
3. Foreign Bodies and Tumors in the Nostrils, ‘ : : 59 
4. Empyema of the Facial Sinuses, . ; 58 
Trephining of the Superior Maxillary and Frontal Sinuses, ; 59 
5. Necrosis of the Turbinated Bones, : ‘ : . 64 
6. Epistaxis (Bleeding from the Nose), : : ; , 65 
IV. Diseases of the Salivary Glands, . : , : ; < 66 
1. Wounds and Injuries of the Salivary Glands, . ; é 66 
2. Inflammation of the Salivary Glands (Parotitis) ; ii 
3. Abscess Formation in the Sub-Parotid ei mph Glands, ' 7 
4. Salivary Calculi and Concretions, ; ; : 71 
5. Salivary Fistule,  . ; : : ; ? 72 
6. Tumors of the Salivary Glands, F : : , ‘ 7 
7. Actinomyces Tumors (Actinomy cosis), . ; ; : 7 
V. Diseases of the Face and Lower Jaw, . ; ‘ ; ’ 80 
1. Fractures of Bones of the Face, . . : : ; 80 
2. Fracture of the Lower Jaw, : : ; 82 
3. Dislocation (Luxation of the Low er J aw), : : : 84 
4, Inflammation of the Articulation of the Jaw, . 85 
5. Paralysis of the Under Jaw (so-called). Paralysis ‘of the 
Muscles of Mastication, 86 
6. Periostitis and Exostoses on the Posterior Border of the 
Lower Jaw, F 3 : . : 3 88 
7. Tumors on the Lower J aw, ; : : 88 
8. Actinomycosis of the Maxille, Spinaventosa, : 89 
9. Inflammation and New Growths in the Sub-Maxillary Ly mph 
Glands, . i : : cC : 91 
VI. Diseases of the Ear and Guttural Pouches, y : : ; 92 
1. Injury of the External Ear, : . ; : 92 
2, Gidema of the Free Border of ‘the Ear—External Canker 
(Othematoma), . ; : : 93 
3. Inflammation of the External Auditor y Meatus (Otitis 
Externa). Otorrhcea, . : : . : ; 94 
4. Fistula of the Ear, . ; ‘ : 96 
5. Chronic Catarrh of the Guttur al Pouches, H : , 97 
6. Tympanites of the Guttural Pouch, F : 3 é 104. 
WII. Diseases of the Skull, ; ; : : : 5 : 105 
1. Fractures and Injuries to the Cranial Bones, _ . : ; 105 
2. Concussion of the Brain (Commotio cerebri), —. ; : 107 
3. Fractures of the Frontal Bone, . : : : : 108 
4. Loosening of the Horns, . : 3 ; : 110 
5. Wounds and Injuries to the Skull, : 110 
6. Trephining the Cranial Cavity in Sheep or Cattle, and Opening 


by the Trochar, F : : y 2 : 111 


CONTENTS. 


II.—DISEASES OF THE NECK. 


. Wounds and Bruises of the Tissues of the Neck, 
. Fractures of the Cervical Vertebra, 
. Distortion of the Neck (Torticollis, Caput OlEpan). 


. Goitre Struma, 


Inflammation of the Bursa of the Ligamentum Nuche, 


. Phlebitis. Inflammation of the Jugular Vein, . 
. Diseases of the Pharynx and CHsophagus, 


1. Foreign Bodies in the Pharynx and (Esophagus, . 


A. Foreign Bodies in the Pharynx and (Esophagus of the 
IETORSe eae : ‘ 

B. Foreign Bodies in the CEsophagus of Cattle, 

C. Foreign Bodies in the Gésophagus of Swine, 

D. Foreign Bodies in the Pharynx and (Esophagus of Car- 
nivora, . : : : 

E. Impaction of the Crop i in Bir ds, 


. Injuries to the Pharynx and Cisophagus (Esophagus Fistula), . 
. Ectasiz, Diverticula, and Ruptures of the Gisophagus, . 

. Stenosis and Compression of the Gsophagus, 

. Paralysis of the Pharynx and Gisophagus, 

. Tumors in the Pharynx and Csophagus, . 


S> OT CO 09 


VIII. Diseases of the Larynx and Trachea, 


VI. 


1. Injuries, Inflammations, and Tumors in "the Larynx (Laryn- 
gitis, Perilaryngitis), 

. Neuroses of the Larynx—Spasm of the Rima Glottidis— 
Spasmus Glottidis — Laryngismus Stridulus — Laryngo- 
Spasmus—Hemiplegia and Diplegia Laryngis, : 

. Fractures, Deformities, and Stenosis of the Trachea, 

. Foreign Bodies, Tumors, and Parasites in the Trachea, . 

5. Tracheotomy, : : 

6. Laryngotomy. Laryngo-Fissure, . 


cis) 


He CO 


I1I.—DISEASES OF THE THORAX. 


. Fractures of the Ribs—Fracture Costarum, 

. Costal Fistule, : : 

. Sternal Fistule and Fracture of the Sternum, 

. Wounds and Bruises of the Soft Parts of the Chest-Wall, 


1. Wounds of the Chest-Wall without Perforation. 
2. Wounds of the Pleura and Thoracic Cavity, 


. Shoulder Abscess. 


Saddle and Collar Galls—Injuries from Pressure, 
1. Injuries Produced by the Saddle—Saddle-Galls, 
2. Bruises Produced by the Collar or other Portions ‘of the 
Harness, : Z : : : 


xill 


XIV CONTENTS. 


PAGE 
VII. Tumors of the Breast, : : 5 ; ; : 2 208 
VIII. Tapping the Chest (Paracentesis Thoracis, Thoracocentesis), . 209 
1. Puncture of the Thorax for Removal of Serous or Pleuritic : 
Exudate, . 209 
. Puncture of the Thorax for Removal of Pur ulent or Putrefac- 
factive Exudate, : : 6 5 : ; 211 
IV.—DISEASES OF THE ABDOMEN. 
I. Bruises of the Abdominal Parietes, 213 
II. Wounds of the Abdomen, 215 
Ill. Bowel Fistula (Anus Preternaturalis), : 221 
IV. Paracentesis Abdominis (Puncture of the Abdi men). . 223 
V. Hernia, : ; : 225 
VI. Umbilical-Hernia (ompHaibgaa, Exomphalos), s i 235 
VII. Inguinal Hernia, Scrotal Hernia (Hernia Inguinalis, Hernia 
Scrotalis), : : : ; . F 242 
1, Inguinal Hernia in the Horse, j : 243 
i, Treatment of Non- Strangulated Inguinal Her nia, . : 247 
ii, Treatment of Incarcerated Inguinal Hernia, . 251 
2. False Inguinal Hernia (Hernia Inguinalis Interstitialis), ‘ 254 
3. Inguinal Hernia in Ruminants, . : : : F 256 
4. Inguinal Hernia in Swine, . : : ; : ; 256 
5. Inguinal Hernia in Dogs, . ; ; : : : 258 
‘VIII. Crural Hernia (Hernia Cruralis) , 259 
IX. Perineal Hernia, . : : , : : : : 260 
X. Ventral Hernia (Hernia Ventralis), § : 262 
XI. Pelvic Hernia, Internal Abdominal Hernia, Peritoneal Hernia, 
““Gut-Tie’’ (Hernia Interna Abdominalis), : 3 ; 266 
XII. Diaphragmatic Hernia (Hernia Diaphragmatica), . : : 268 


V.—SURGICAL DISEASES OF THE STOMACH AND BOWELS. 


I, Foreign Bodies in the Digestive Tract, . ; : : ‘ 270 
II. Puncture of the Bowel in Horses (Punctio Intestini), . ; ‘ 274 
III. Puncture of the Rumen and Rumenotomy, : : ° : 278 
IV. Intussusception or Invagination of the Bowel, . : : . 284 
V. Twist or Rotation of the Colon in Horses, ; ‘ ; ‘ 286 


VI.—DISEASES OF THE POSTERIOR PORTIONS OF THE 
RECTUM AND OF THE ANUS. 


I. Congenital Malformations. Absence of the Anus and Formation 
‘of Cloacze (Atresia Anti et Recti, Fistula Recto Vaginalis), : 290 


II. Injuries to the Rectum and Anal Region, , : : : 293 


avT. 


iT, 


Vile 


: CONTENTS. 


Inflammation of the Mucous Membrane of the Rectum and Anus 
(Proctitis), é 


. Inflammation of the Connective Tissue Surrounding the Rectum 


(Periproctitis or Paraproctitis Apostematosa) , 


. Prolapse of the Rectum and Anus (Prolapsus Recti et Ani),. 
. Dilation, Stenosis, and Paralysis of the Rectum and Anus, 

. Anal Fistula and Recto-Vaginal Fistula, 

. Tumors in the Rectum and Anus, 


VII—DISEASES OF THE URINARY ORGANS. 


. Congenital Malformations, 


1. Fissuring of the Male Meatus Beanie (Hy pospadtia aa 
Episapadia), 
. Pervious Urachus, 
Urinary Calculi, - 
1. Urinary Calculi in the Hons 
2. Urethral Caleculi in Ruminants, 
8: Urinary Calculi in Swine, . 
4. Urinary Calculi in the Dog, 


. Puncture of the Bladder (Punctio Vesicz), 


Injuries, Inflammation and Strictures of the Urethra, 


. Paralysis of the Urinary Bladder (Cystoplegia). Catheterism, 
. Inflammation of the Urinary Bladder (Cystitis), : 
. Prolapse and Inversion of the Urinary Bladder in Female Animals 


(Prolapsus et Inversio Vesice), 
Tumors in the Urethra and Bladder, 


VIII.—DISEASES OF THE MALE ORGANS OF GENERATION. 


Tr 


i. 


III. 


ti 
Vi, 
VE 


Inflammation of the Prepuce (Balanitis), 
1. Inflammation of the Prepuce in the Horse, 
2. Inflammation of the Prepuce in Oxen, 
3. Inflammation of the Prepuce in Swine, 
4, Inflammation of the Prepuce in Carnivora, : : 
Phimosis, Paraphimosis Paralysis of the Muscles of the Penis, 
Injuries to the Penis, . , : 
Tumors on the Sheath and Penis, 
Amputation of the Penis, 


Diseases of the Prostate, . : - 
Diseases of the Scrotum, 


Diseases of the Testicle. Castration of Cryptorchids, 


1. Congenital Defects and Retention of the Testicles, 

2. Inflammation of the Testicle and Epididymis. Orchitis, Peri- 
orchitis. Epididymitis, ; 

3. Tumors of the Testicle (Sarcocele) and of the Epididymis, 


xvi CONTENTS. 


PAGE 

VII. Hydrocele, Heematocele, and Varicocele, : : 3 F 368 
VIII. Inflammation of the Spermatic Cord. Scirrhous Cord. Funiculitis 

Chronica, : 5 : . : 4 : 370 


IX.—DISEASES OF THE FEMALE ORGANS OF GENERATION. 


I. Injuries and Inflammation of the Vulva, Vagina, and Uterus, : 376 
II. Prolapse of the Vagina (Prolapsus Vagine), . : : é 380 
III. Prolapse of the Uterus (Prolapsus Uteri), : ; : : 381 
TV. Tumors of the Vagina and Uterus, 2 ; ‘ : : 386 
V. Diseases of the Mammary Gland, ; : : ; ‘ 388 
1. Wounds and Bruises, ‘ : 389 

2, Acute Inflammation of the Udder (Mastitis Acuta). Its Patho- 
logy and Varieties, : 2 390 

A. Traumatic Inflammation of the Udder. Mastitis Trauma- 
tica, j : 2 394 
B. Phlegmonous Mastitis. Mastitis Phlegmonosa, 4 : 394 

C. Parenchymatous Inflammation of the Udder. mapas 
Parenchymatosa, 5 396 
a Catarrh of the Udder. Mastitis Catarr halis. ‘ 396 

b Purulent Inflammation of the Udder. Mastitis Paren- 
chymatosa Apostematosa, 398 

ec Gangrenous Inflammation of the Udder. Mastitis 
Gangrenosa, : : ; 400 
3. Stenosis and Closure of the Mammar y Duct, ; ‘ 403 

4, Chronic Inflammation of, and Tumors in, the Udder. Mastitis 
Chronica, . , “ ; : 5 : : 405 


X.—DISEASES OF THE SPINAL COLUMN AND PELVIS. 


I. Fractures, Luxations, and Sub-Luxations of the Dorsal and Lumbar 


Vertebree. Commotio Spinalis, ‘ j : P : 410 

Il, Fractures of the Sacral and Caudal Vertebre, . : ; j 415 
III. Curvature of the Spine, . : : 6 : : ; 417 
IV. Fracture of the Pelvis, . : : : 3 ‘ ; 420 
V. Diastasis or Luxation of the Sacro-Iliac Articulatior, : 2 428 
VI. Luxation of the Symphysis Ossium Pubis, : ; : : 430 
VII. Paralysis of the Hind Extremities. Farap!e sia, A : : 430 
VIII. Diseases of the Tail, : 3 5 : : c : 439 
IX. Necrosis of the Lumbo-Dorsal Fascia, . : : : ‘ 441 


XI—DISEASES OF THE FORE-LIMB. 
A. DISEASES OF THE SHOULDER REGION. 


I. Fractures of the Scapula, . AE d . é é : 443 
II. Fractures of the Humerus, 1. NOU, ? : : : 445 
III. Diseases of the Shoulder-Join®,, raat : : é : 447 


EY. 


Ill. 


TV. 
Wie 


lawl 


Il. 
III, 
EV 

V. 
WL: 


VII. 
VIII. 
IX. 


°.@ 


CONTENTS. 


Inflammation of the Bursa of the Biceps, Flexor Brachi or Coraco 
Radialis Muscle (Bursitis Inter-Tubercularis, 


. Inflammation of the Tendon of the Postea-Spinatus Muscle and of 


its Bursa, 


. Paralysis of the Suprascapular Nerve, : : 

. Paralysis of the Radial Nerve (Paralysis Nervi Radialis), 
. Paralysis of the Bracial Plexus, . 

. Shoulder Lameness, 


B. DISEASES OF THE ELBOW AND FOREARM. 


. Fracture of the Ulna, 

. Fracture of the Radius, 

. Luxation of the Elbow Joint, 

. Inflammation of the Elbow-Joint, 


Capped Elbow in the Horse, 


. Wounds and Bruises of the Forearm, 


C. DISEASES OF THE KNEE. 


. Fractures of the Bones of the Knee, 
. Injuries to the Anterior Surface of the Knee, . 


i. Injuries to the Knee in the Horse, 
2. Tumors of the Knee in Uattle, 


Chronic Inflamation of the Knee-Joint, 

Inflamation of the Bursa of the Flexor Pedis, ; ‘ 

Enlargement of Articular and Tendinous Synovial Cavities in the 
Fore-Limb, : : ‘ ‘ 


D. DISEASES OF THE METACARPUS, 


. Fractures of the Metacarpus, 


Wounds of the Metacarpus, : . 

Rupture of the Flexor Tendons and Suspensory Ligament, 
Inflammation of the Flexor Tendons (Tendinitis), 
Contracted Tendons (Knuckling) in Foals 

Splints, 


E. DISEASES OF THE PHALANGES. 


- Luxation of the Phalanges, 

. Distortion of the Coronary Joint, 

. Fractures of the Phalanges, 

. Ring-Bone, P ; 2 - 


Inflammation of the Posterior Ligaments of the Coronet Joint, 


I. Fractures of the Sesamoid Bones, 


Sesamoid Lameness, 

Fracture of the Navicular Bone, 
Navicular Disease, 

Grease, 


546 


XVili 


CONTENTS. 


XI, THE DISEASES OF THE HIND-LIMB. 


A. DISEASES OF THE QUARTER. 


. Injuries to the Soft Structures of the Quarter, 

. Fracture of the Femur, 

. Luxation of the Femur, 

. Inflamation of the Hip-Joint (Coxitis), : : : 
. Inflammation of the Tendon and Tendon Sheath of the Gluteus 


Medius Muscle. Bursitis Glutaei Medii vel Trochanterica, 


. Paralysis of the Hind-Limb, 


A. Paralysis in the region served by the ischiatic nerve, 
B. Paralysis of the crural nerv e, : f 
C. Paralysis of the obturator nerve, 


. Thrombosis of the Posterior Aorta and of its Branches, 
. Displacement of the Biceps Femoris Muscle, 


. Hip Lameness, 


B. DISEASES OF THE STIFLE-JOINT. 


. Luxation and Sprain of the Stifle-Joint, 

. Displacement of the Patella. Luxatio Patella 

. Rupture of the Straight Ligaments of the Patella, 

. Fracture of the Patella, : : : : 

. Injuries and Acute Inflammation of the Stifle-Joint. Gonitis, 


VI. Chronic Inflammation of the Stifle-Joint. (Gonitis Chronica Sicca) 
VII. Bursitis Preepatellaris, 
C. DISEASES OF THE THIGH. 
TI. Wounds and Injuries, : ° 
Il. Fracture of the Thibia, 


. Rupture of the Tibio-Fibular Interosseous Ligament, . 
. Rupture of the Flexor Metatarsi Muscle, : 
. Rupture of the Tendo Achillis and Gastrocnemii Muscles. 


D. DISEASES OF THE HOCK-JOINT. 4. 


. Fracture of the Bones of the Hock-Joint, 
. Luxation and Sprain of the Hock-Joint, 
. Wounds and Acute Inflammation of the Hock-Joint, 


Thoroughpin, 


. Chronic Inflammation of the Hock. Spavin. Arthritis Chronica 


Deformans Tarsi, 


. Enlargements of the Outer Saneen of the Hock, 


PAGE 
d72 
DT4 
tate 


Ors 


581 


582 
584 
585 
N87 
590 
591 
598 
596 


601 
601 
607 
607 
608 
609 
611 


612 
614 
617 
617 
620 


623 
625 
626 
629 


630 
646 


CONTENTS. 


VII. Curb, 
VII1. Capped Hock, : : 
IX. Luxation of the Flexor Pedis Perforatus Tedon, 


E. DISEASES OF THE METATARSUS, 


I. Diseases of the Tendons and Tendon Sheaths in the Tarsal and 
Metatarsal Regions, 


II. Stringhalt, : ; 3 : ‘ : 
III. Injuries produced by Striking (Interfering) and their Complica- 
tions, 


F. DISEASES OF THE HOOF, 
(A) Acute Iflnammation of the Podophyllous Membrane. Pododermatitis 
Acuta, 
I. Pricks or Stars in Shoeing, 


II. Picked-up Nails. Purulent Celtulititis of ie Fibro- we Frog. 
Resection of the Flexor Pedis Perforance, 


III. Treads on the Coronet. Purulent Inflammation of the Subcoronary 


Connective Tissue, . 
Inflammation of the Subcornary Connective Tissue, 


IV. Corns, 
V. Quittor, : 4 ‘ 
VI. Laminitis. Inflammation of the Sensitive Lamine, 


(B)  Cronic Inflammation of the Sensitive Laminxw. Pododermatitis 
Chronica, 


I. Keratoma, : : : 
II. Chronic Inflammation of the Sensitive Laminx, 


Ill. Canker of the Sole and Frog (Podoermatitis Chronica yaaa 
vel Migrans), 


G, DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 


I. Bruises of the Sensitive Sole and Bulbs of the Foot in Oxen, 
Il. Wounds of the Soft Tissue of the Claw, 
Ill. Whitlaw of the Claw, Joint Felon, Panaritium, 
IV. Amputation of the Claws in Oxen, 

V. Footrot in Sheep, 


H. DISEASES OF THE CLAWS IN CARNIVORA. 


I. Growing-in of the Claws (Incarnatio Unguis). Dislocation of the 
Claws. Chronic Inflammation of the Claw Matrix. Loss of the 
Claws, 


II. Bruises and wounds of the Pads of the Sole and Toe. 


Index, 


oF 


meet 


By i 
a ‘ 
sk: 
” . 4 x 1 ue a 
ep fed f 
%, tig 
es f 
Ae, Hy 
tah in 
{ oh ; 
‘ 7 
; ts 
' Ms a fi 
% a i io ; Sy tae 1 
: Pals aA ‘ ; pa) 
o ’ fi) : Pere sc J a 4 ea 
“ t Ae " i | Pk ah fe) aos) 
‘ i aa ae ws ae oe teva ee 
1% A ‘ 
é 
, 


eS AE ONS 


. Atheroma of the false nostril, 

. Right-sided facial paralysis (central), 

. Double-sided facial paralysis Garten : : : : 
. Position of nostrils and nose in double-sided (peripheral) facial 


paralysis, 


. Supernumerary tooth Goes 

. Normal position of the molars in the horse, 

. Tooth rasp, 

. Tooth chisel, 

. Tooth chisel, 

. Tooth cutter, 

. Left-sided shear-mouth, : : 
. Grinding surfaces in sheae mouth and in noeiial rapuitit : 
. Tooth Shears, 

. Tooth Screw, 

. Metznik’s Tooth Shears, : 

. Central dry caries of a horse’s upper somali 

. Necrosis of a dental alveolus, with dislocation of the ast nla anal 


extensive periostitis of the lower jaw (horse), 


. Giinther’s Forceps for upper molars, 

. Giinther’s Forceps for lower molars, 

. Giinther’s Exporteur, 

. Giinther’s beaked Forceps, 

. Giinther’s Forceps for first lower aalkie: 

. Giinther’s Forceps for first upper molars, 

. Frick and Hauptner’s Forceps, 

5. Showing upper and lower molars 7 s7tu, 

. Tooth Pickers, 

. Fulera, : 

. Giinther’s Forceps an the incisors, . 

. Ordinary Forceps for the incisors, . 

. Curved dental Forceps for dogs, 

. Straight dental Forceps for dogs, 

. Periostitis alveolaris ossificans of the third ee Gorey 
. Facial cedema after injury, . 

. Stock Trephine, 

5. Hand Trephine, 

. Bone Elevator or screw, : : : : : : é 


45 


46 


50 


57 


XXll LIST OF ILLUSTRATIONS. 


37. Chisel, 

38. Half-round Knife, 

39. Periosteum Knife, 

40, Exfoliative Trephine, 

41. Perforating Trephine, 

42. Head of a horse, 

43. Actinomycosis of the Parone eiawan in an ox, 


44. Incomplete union of Fracture of the body of the Lower Jaw, 


45. Mykofibroma of the Lower Jaw, 
46. Osteoporosis of the Upper Jaw, 
47. Giinther’s Catheter, . : 

48. Splint for Fracture of Horn Core, 
48a. Form of above Splint, 

49. Zehden’s Syringe, 

50. Zehden’s Trochar, 


51. Sub-luxation of the 3rd Cer ical Ve er ae as seen Dori the left aide: 
52. Sub-luxation of the 3rd Cervical Vertebra, as seen from the right side, 


53. Knudsen’s Iron Splint for distortion of the Neck, 
54. Probang and Mouth Gag for Cattle, 

55. Delvos and Hertwig’s oe Uae Forceps, 
56. Tampon-canula, 

57. Hayne’s Tracheal Tr echan ; 

58. Method of performing Tracheotomy, 

59. Barthélemy’s Canula, 

60. Position of Tracheal Canula, 

61. Leblane’s Jointed Canula, 

62. Leblane’s Jointed Canula, 

63. Peuch’s Canula, 

64. Double-tube Canula, 

65. Scalpel for resection of arytenoid, 

66. Course of incision, 

67. Forceps for grasping the snuanstl, 


68. Curved Needle for suturing layne mucous Perel 


69. Transverse Section through Horse’s Thorax, 
70. Dieulafey’s Aspirator, 
71, 72. Showing Mechanism of Incar verter of Tntesane. 
73. Bordonnat’s Clam, 
74. Combe’s Clam, 
75, Incomplete Inguinal ern 
ce Inguinal Hernia of the Horse, 
7. Herniotome, 
a Peritoneal-scrotal Peas 
79. Ventral hernia in a mare, 
80. Gely’s bowel suture, 
81. Lembert’s bowel suture, 
82. Walfler’s bowel suture, ; 
83. Friedberger’s intestinal trochar for thorees, : 
84. Briuer’s Trochar, ¢ 
85. Sheath of Brauer’s Trochar, 


PAGE 


FIG. 
. Congenital malformation—atresia ani in the bitch, 

. Congenital malformation—atresia ani et recti in the bitch, 
. Prolapsus recti with invagination in the bitch, 

9. Prolapsus recti with invagination in the horse, 

). Stockfleth’s Wooden Ring, 


LIST OF ILLUSTRATIONS. 


92. Method of ligation in prolapsus recti, . 


. Calculus Forceps, ‘ 

. Bouley’s Calculus Forceps, . 

. Course of the Urethra in the Ox, 

. Flourant’s Trochar, : : 

. Prolapse of the bladder in a mare, . 

. Carcinoma of the testicle in a horse, 

. “Champignon ” formation in the horse, 4 

. Apparatus for prevention cf fracture in oper Aine on a horse, 
. Schema illustrating fractures of the pelvis in the horse, 

2. Lameness from Bursitis inter-tubercularis, 

. Complete paralysis of the Radial nerve, 

4. Fracture of the ulna in a horse, 

. Knee tumour (cutaneous form), 

. Distension of the flexor pedis bursa eat pared on the oitee side a 


the limb), . : 
. Schema of the more important Paden denis md bursee a the Ceniee Tria, 
seen from in front and without, 


. The same, as seen from the front, : ; 
. Rupture of the Flexor pedis perforans behind the fetloc es in conse equine 


of suppuration in the tendon sheath, 


. Rupture of the superior sesamoidal or suspensory ligament, 
. Excessive “knuckling over” (Stelzfussbildung) in a horse, 
. Excessive dorsal flexion after section of the ee and penearatan 


tendons, 


3. Double-sided une (telmasebildune) in a two-year- “ail cole, 

. Friebel’s extension apparatus, 

. Fracture of os suffraginis, ‘ 

}. Fracture of os suffraginis with fom a: exostosis, 

. Transverse fracture of os suffraginis, 

. Double fracture of upper end of os suffraginis, 

. Longitudinal fracture of os suffraginis, 

. Articular ring-bone, 

. Periarticular ring-bone, : 

. The flexor pedis perforans and peroen tendons in a case of seenmnead 


lameness, 


. Navicular bone in pirate SER ISL disease, : 

. Flexor pedis perforans tendon in chronic navicular disease, 

. Sewell’s Seton Needle, 

j. Paralysis of tibial nerve, 

. Incomplete crural paralysis, 

. Left-sided chronic inflammation of the Sie qacat (Gonitis snaiee 

. Bilateral chronic inflammation of the stifle-joint (Gonitis chronica 


bilateralis), 


XX1V LIST OF ILLUSTRATIONS. 


FIG. PAGE 
130. Rupture of flexor metatarsi muscle, : : : ., GEO 
131. Rupture of the tendo Achillis, : ; .. 622 
132. Exuberant granulation in front of the fea : ; 9 O2K 
133. Periosteotomy knives, : : : : : : . G45 
134. Curb, : . 649 
135. Tendon sheaths ond bene see of the hind- ee the hore seen from 
without, . : : ». ) a5 
136. Tendon sheaths and bursie of the fade sa seen ‘hom ae : 9 (1655: 
137. Distension of bursz of flexor tendons in right hock, 2 ., 666 
138. Distension of sheath of flexor pedis perforatus,  . -. hi 
139. Position of the limb, in infectious inflammation of the Asa neue per- 
foratus sheath in the fetlock region, : : : : «| 1659 
140. Rupture of the flexor pedis perforans tendon, : : : . 660 
141. Vertical section of an ox’s claw, . : Ae 


142. An ox’s claw, ; f : : 2 FHS 


DISEASES OF THE HEAD. 


—DISEASES OF THE LIPS AND CHEEKS. 
(1.) WOUNDS AND BRUISES. 


In horses, wounds of the lips most frequently result from bites 
or kicks, from collisions and falls on hard ground, or from animals 
catching on sharp points about the harness, or on nails fixed in 
stable racks and mangers. JBruises are produced in a similar manner, 
and by the severe and repeated appleation of the twitch. The corners 
of the mouth may be injured by sharp or badly-fitting bits, especially 
in young and hard-mouthed horses, or in those suffering from brain 
disease, whilst the cheeks are sometimes wounded by kicks, horn 
thrusts, and, on their inner surfaces, by the sharp edges of the 
molars. The great mobility of the injured parts, and the constant 
soiling which occurs during mastication, almost always interfere with 
the healing of bruises and contused wounds. On the other hand, 
reparative processes are assisted by the richness of this region in 
blood-vessels and loose connective tissue, and healing may sometimes 
take place by primary intention, even when wounds are extensively 
bruised, their edges already dry, and their flaps dissected from 
underlying tissues over considerable areas. Deep wounds in the corner 
of the mouth, where the mucous membrane is divided and the 
opening of the mouth lengthened, give most trouble. Perforating 
wounds of the cheek also heal with difficulty, and sometimes produce 
fistule. Injuries to the great venous plexus in the cheek occasion 
considerable bleeding, which, however, is seldom dangerous. The 
division of Stenson’s duct often results in salivary fistula. Emphysema 
of the facial region frequently accompanies wounds of the cheek, but 
calls for no special treatment and usually disappears spontaneously. 
Death of the margins of wounds may produce defects in the lips and 
cheeks, which both injure the animal’s appearance and interfere with 
feeding and drinking. Such defects frequently follow wounds in the 

A 


2 WOUNDS AND BRUISES OF THE LIPS. 


corner of the mouth, where the buccal opening becomes lengthened 
(Makrostomy). 

Treatment.—In surface injuries, small flaps of skin can be 
removed with scissors, when healing usually follows. To prevent 
deformity after extensive injuries, attempts must be made to bring 
about healing by first intention. After removing loose shreds, the 
wound, which is usually dry, must be freshened, ze., the surface 
removed with scissors, to furnish the moist or bleeding flaps necessary 
for immediate union. The wound and its surroundings are then 
cleansed, the neighbouring long hair removed, the parts flooded with 
some fluid disinfectant (corrosive sublimate, creolin or carbolic solution), 
and the edges brought together as evenly and completely as possible. 
On account of the great mobility of the lips and their neighbourhood, 
pin sutures are here preferable. The pins should be inserted deeply 
and at distances of about 4 to 1 inch, being secured by a con- 
tinuous thickish thread appled in a figure of 8. Ordinary sutures 
sometimes suffice. For further security, and to fix the edges, the 
wound may be smeared with collodion or wound gelatine,’ over 
which may be placed tow or jute or strips of gauze. Deep wounds 
at the corners of the mouth or on the cheeks require particular 
precautions. Button sutures are most useful here, and the ligature, 
which must be strong, should be passed right through the cheek ; 
lead or brass wire is also suitable. Injury to the wound can be 
avoided by putting the horse on the pillar reims. Where healing 
by primary intention is desired, water alone must be given for the 
first 24 hours, and during the followmg few days only gruel or bran 
mash. After six to eight days the stitches can be removed from 
the lips, but those in the corners of the mouth or in the cheeks 
should be left a couple of days longer. In fistulee about the cheeks 
the hardened walls are removed by caustics or the actual cautery, 
and a purse-string suture inserted. The inner opening of the fistula 
may sometimes be closed by passing a suture through the mucous 
membrane. 


1J employ ‘‘ wound gelatine” as a substitute for the ordinary ‘‘ occlusive” dressing. It 
a « D 


was first described by Frick as ‘‘sublimate glycerine gelatine” (Arch. fiir pract. wu. wiss. 
Thierheilkunde, 1886, p. 897). To prepare it, ordinary sheet gelatine is soaked in sufficient 
1 per cent. sublimate solution to cover it. After it has become quite soft, it is melted by 
gentle heat, and a quantity of glycerine equal to one-tenth of the weight of the dry gelatine 
added. ‘This gives the material an elastic character. To use it, it is melted on a slow fire 
and painted over the wound. It sets in a few seconds, adheres equally well to moist or dry 
surfaces, and is much preferable to collodion. The surface can be strengthened by laying 
on it, while moist, shreds of tow or strips of gauze, 


DISEASES OF THE LIPS AND CHEEKS. 3 


(2.) ACUTE INFLAMMATION OF THE LIPS AND 
CHEEKS. 


Acute inflammation of the lips in the domesticated animals is fre- 
quently caused by licking blistermg ointments, by partaking of irritating 
materials, by infectious disorders, such as aphtha or stomatitis pustulosa, 
or by such injuries as have previously been referred to. 

Specific inflammations are treated of in works on internal disorders. 
Dogs, bemg much exposed to infection, sometimes show phlegmonous 
swellings of the upper and lower lps after slight injuries. I have 
frequently seen diseases of the skin, like eczema and mange, transmitted 
to the lips as a result of licking the diseased spots. ‘Thence they 
generally spread to the bridge of the nose, producing a dermatitis 
chronica apostematosa, which gives great trouble, especially if the area 
involved is too great to permit of all diseased skin being removed with 
knife and scissors. In dogs and cattle, spontaneous gangrene of the 
cheek occurs, resembling noma of children. In dogs the disease begins 
with formation of an almost invisible eschar at the corner of the mouth; 
the great swelling which simultaneously appears indicating the character 
of the malady. Gangrene makes rapid progress, often attaining the 
size of a florin in afew days. The skin is soft, greyish-brown, and easily 
removable ; the sub-maxillary lymph glands are swollen, and fever and 
severe salivation exist. In dogs the process seldom terminates before 
destroying a large portion of the cheek. The appearance of granulations 
and of pus formation on the boundary indicate the commencement of 
healing. After the gangrenous portion sloughs, the molars may become 
visible, and great difficulty exist in taking fluids. In spite of this, 
complete recovery usually occurs; difficulty in feeding disappears, and 
even the animal’s outward appearance does not permanently suffer. The 
disease is rare in dogs, and its cause is as little understood as that of 
noma in the human subject, though it probably consists in infection by 
a specific micro-organism. 

Treatment.—The parts should at once be disinfected, preferably 
with the cautery. Where this is impossible, lotions of permanganate of 
potassium or carbolic acid, sublimate or creolin can be applied. Thin fluid 
nourishment is indicated, and may be given from a bottie. As soon as 
the defect in the cheek interferes with feeding, fluid or semisolid nutri- 
ment becomes indispensable. If required, animal broths may be given. 
Stockfleth has described a similar disease in cattle, resulting from injuries, 
but this does not extend as in dogs. Most commonly an abscess forms 
in the cheek, and recovery occurs in a few days. The treatment of other 


4 DISEASES OF THE LIPS AND CHEEKS. 


inflammatory processes should be adapted to their special features. The 
cause must be removed and care taken that the affected part is not 
irritated more than necessary, either by rubbing or by mastication. 
Attention is accordingly required in selecting and preparing the food, 
and in the management of the animal. Complications are treated on 
general surgical principles. In suppurative forms of skin inflammation, 
diseased parts should be promptly removed with the knife. 


(3.) TUMOURS OF THE LIPS AND CHEEKS. 


(A) Warts.—In dogs and horses the lips are not infrequently the 
seat of great numbers of small pedunculated warts. These new growths 
occur both on the mucous membrane and on the skin, and vary from 
the size of a pin’s head to that of a grain of linseed. Their covering is 
often wanting in pigment, in consequence of which they appear red on 
the surface and are often thought by laymen to be parasites. They are 
almost always found in young animals, cause no particular inconvenience, 
and may disappear after a short time without apparent cause. Attempts 
to inoculate other animals have proved ineffective (Garcia). If masti- 
cation be interfered with, they can be removed with scissors ; but if 
they cause no inconvenience it is better to await their spontaneous 
disappearance. 

(B) Encysted tumours also occur frequently on the lips of horses; 
they lie close under the mucous membrane, sometimes attain the size of 
a pigeon’s egg, and contain a thick, fluid, honey-like material. They are 
really retention tumours, produced by obstruction of the ducts of mucous 
glands. So long as they attain no considerable size, nor become the 
seat of inflammatory changes, they are seldom observed. To detect 
them, the thumb is laid on the external skin, the fingers on the 
mucous membrane of the lp, which is allowed to glide slowly 
through the fingers. When such tumours become inflamed, they cause 
enlargement of the sub-maxillary lymph glands, displace the lips, and 
impart to the face somewhat of the appearance of facial paralysis. 
If they become inflamed, or interfere with feeding, treatment will be 
required. It is generally sufficient to lay open the parts and dress the 
interior with nitrate of silver, sulphate of copper, 2 per cent. corrosive | 
sublimate solution, or 10—20 per cent. solution of chloride of zine. 

A typical tumour develops above the base of the false nostril in 
horses, usually resulting from occlusion of a sebaceous follicle. It is 
filled with a granular matter. It may become as large as a hen’s egg, is 
round, painless, and freely movable, but seldom causes any difficulty in 
breathing. By passing the finger into the false nostril, it may be readily 


TUMOURS OF THE LIPS AND CHEEKS. 5 


felt, and is sometimes visible from without (fig. 1). Such growths | have 
seen oftenest in young foals. They are easily removed. The animal is 
cast—though in very quiet subjects this is scarcely necessary—and an 
incision made through the skin in the long direction of the head. The 
tumour is then grasped with forceps and freed from its surroundings, care 
being taken not to incise it, as its removal is thus rendered more difficult. 
Should such an accident happen, 
a dark-grey, granular matter is dis- 
charged, and the inner wall of the 
tumour comes in view. The nasal 
mucous membrane being firmly 
adherent to the swelling may be 
injured, when froth from the nostril 
will appear in the wound. But 
even where the mucous membrane 
has been cut, healing by primary 
intention occurs. The wound is at 
once sutured, and finally covered 
with iodoform collodion or wound 
gelatine. 

New growths, excepting those 
above mentioned, are seldom met with on the lips and cheeks of the 
domestic animals. The comparatively thick mucous membrane, with its 
abundant epithelial covering, forms an effective protection against the 
entry of specific contagia, although even here carcinomata, sarcomata, 
and tumours produced by actinomyces and bothryomyces are some- 
times met with. I have seen many cases of the two latter in horses 
and cattle. Swellings form at the junction of the skin and mucous 
membrane of the lips, generally near the corner of the mouth, and may 
become as large as a man’s fist. They resemble fibromata, are as a rule 
sharply defined, and often ulcerate. temoval is easy, recurrence rare. 

In dogs, carcinoma of the upper lip can be surgically treated with 
success. A commoner position for it is the cheek. In ruminants, 
tumours caused by actinomyces are very common. They are most 
frequent in the buceal mucous membrane, and will be noticed elsewhere. 
Klozow of Moscow found actinomycosis of the lips in 5°6 per cent. of 
2000 oxen examined. Swellings, varying from the size of a pea to that 
of a hazel nut, occurred in the mucous membrane of the lower lip. 
They were very hard and movable, and actinomyces could be detected 
in the pus which they contained. Treatment consists in careful removal 
of the new growths, and presents no great difficulty if skilfully done. 


Fra. 1.-—-Atheroma of the false nostril. 


6 DISEASES OF THE LIPS AND CHEEKS. 


(4.) PARALYSIS OF THE LIPS. FACIAL PARALYSIS. 


Lit.: Trofimow, Zeitschrift fiir vergl. Augenheilk., 1883, p. 158. Gotze, 
Dresd. Ber., 1861, p. 105. Zahn, Oesterr. Vierteliahresschrift., 1865, p. 
79. Ginther, Vix u. Nebel. vol. 1. p. 325. Ellen-berger, Archiv 
fiir wissenschaftl. u. pract. Thierheilkunde, vol. vu. p. 311. Schéne- 
berger, Schweizer Archiv, 1883, p. 181. S6hngen, Thierarztl. 
Mitthlg., 1874, p. 136. Degive, Rec. de méd. vét:., vol. xxxii. p. 2. 
Lydtin, Jahresbericht., 1881, p. 70. Grebe, Jahrb, 1884, p. 81. 
Thomassen u. Hamburger, Jahrb., 1889, p. 88. Voigtlinder, 
Dresd. Ber., 1860, p. 51. 


The facial is the motor nerve of the muscles of the ears, eyelids, nose, lips, 
and cheeks. Arising from the pons, it enters the inner ear with the N. acousti- 
cus, passes through the Fallopian canal, and outwards through the stylomastoid 
foramen of the petrous temporal bone, penetrates the parotid gland, and then 
passes over the posterior border of the lower jaw, on the external surface of 
which it divides. According to their points of origin, the following three 
portions may be differentiated. 


I. In the Fallopian canal arise : 
(1) A nerve for the stapedius muscle. 
(2) A nerve for the chorda tympani. 


II. At the stylomastoid foramen : 

(1) The posterior auricular nerve giving twigs to the cervico auriculares, 
and the parieto auricularis externus and internus. 

(2) The middle auricular, distributed to the skin lining the interior of 
the ear. 

Ill. Thence to the point of termination : 
(1) Nerve to the occipito-styloid, stylo-hyoid, and digastricus muscles. 
(2) The zygomatico temporalis nerve gives off— 
(a) The anterior auricular nerves. 
(>) Twigs to the temporalis muscle. 
(c) Twigs to the orbicularis palpebrarum and the external levator 
palpebrarum. 

(3) The cervical branch, which gives off motor twigs to the depressor of 
the ear and the superficial cervical muscles, afterwards passes over 
the external surface of the lower jaw, and, as a motor nerve, 
supplies the muscles of the nose, lips, and cheeks. 


Paralysis of the facial nerve occurs rather frequently in horses; is 
commonly confined to one side, often to the nerve supply of the upper 
lip; the deformity consequently is slight, and the mischief may be over- 
looked. But double-sided paralysis interferes very noticeably with 
feeding. 

The cause is most frequently external injury impairing the con- 
ductivity of the nerve. The malady is therefore common in horses 
suffering from such illness as colic or injuries from shoeing, and which, 
in consequence, lie a great deal. Siedamerotzky first noted that this 


FACIAL PARALYSIS. if 


nerve often becomes bruised at the point where it winds round the 
lower jaw. The cheek-straps of the head-collar, and especially the 
buckle at the left side, may easily injure the nerve when the animal is 
lying. The double-sided paralysis described by Grebe, and erroneously 
regarded as reflex paralysis, is similarly produced. In earlier times, facial 
paralysis was often caused by inserting hair setons in the cheeks as a 
remedy in diseases of the eye. It occurs during the progress of serious 
infectious disorders, such as influenza, petechial fever, &c., and may also 
be produced, as in man, by severe chills. The paralysis is mostly con- 
fined to the facial muscles. The lips are distorted, the nostrils narrowed, 
the upper lip, and sometimes the under, are drawn towards the sound 
side. The condition is best recognised by looking at the lips from in 
front. So long as one side alone is affected, feeding is little interfered 
with; but in double-sided paralysis the lips hang flaccid, a ecndition 
best seen in the under lip, and feeding now becomes extremely difficult. 
The food can only be grasped with the teeth, and in drinking, the 
corners of the mouth must be immersed in order to prevent the water 
flowing back. Even when carefully tended, the animals rapidly lose 
condition, for they have difficulty not only in grasping food, but, owing 
to the paralysis of the cheeks, also in masticating it. The bit cannot be 
grasped by the lips, but Jies between the cheek and the molars. These 
are the appearances when injury has occurred, at the point where the 
nerve passes round the under jaw ; but where in addition the subzygomatic 
nerve is involved, sensation is lost in the skin of the affected side. 

Facial paralysis due to central injury is different both in its symp- 
toms and consequences. Should the lesion be sufficiently near the 
brain to involve the zygomatico-temporalis nerve, then, in addition to 
the above appearances, paralysis affects the levator palpebrarum, as well 
as various muscles of the ear. The upper eyelid will droop (ptosis) 
whilst the orbicularis palpebrarum will be unable to properly close the 
eye, and the ear on the affected side will hang imply. Zahn found the 
bulbus of the affected side smaller, and the cornea cloudy. Disturbance 
of hearing could also be detected. (Fig. 2.) 

The causes are various; I have frequently found that melanotic 
tumours, developing in the parotid, as well as swellings in the Fallopian 
canal, had pressed on the nerve. Occasionally the origin is central. 
Thus the post-mortem of a horse, sent to my clinique for double-sided 
paralysis, disclosed sarcoma of the pons. Gotze noted paralysis of the 
lips and ears in a horse after influenza, and found on section an abscess in 
the cerebellum. In another case, Lydtin saw sarcoma on the petrous 
temporal bone, the growth extending from the posterior convolutions of 
the cerebrum to the point of origin of the twelfth nerve. Thomassen 
and Hamburger found hemorrhage in the facial nerve centre. It is 


8 DISEASES OF THE LIPS AND CHEEKS. 


difficult to say if rheumatic paralysis of the facial nerve occurs in 
animals as well as in men. The greater number of cases at any rate 
are of traumatic origin. Disease of the middle ear being rare in the 
horse, it cannot often be a determining agent, and I have never yet 
seen a case of facial paralysis in dogs, though in them middle ear 
disease is comparatively common. But Trofimow relates that a bitch 
showed one-sided paralysis in consequence of catching cold; the upper 
eyelid was involved; cure was effected in two months, but a relapse 
is said to have oceurred later. Cattle seldom suffer from facial paralysis, 
probably because the nerve is protected against mechanical injury by the 
horns. In double-sided paralysis both nostrils fall in, but a sufficient 


Fie. 2.—Right-sided facial paralysis Fic. 8.—Double-sided facial paralysis (peripheral). 

(central). The protrusion of the 

tongue is accident —it does not 

necessarily oceur in facial paralysis. 
opening remains for ordinary quiet respiration. Immediately, however, 
that breathing is hurried, from such causes as excitement or rapid move- 
ment, a snoring sound becomes audible during inspiration. As _ the 
horse breathes only through the nose the narrowed opening becomes 
insufficient, the edges of the nostrils are pressed inwards, and inspiratory 
dyspneea ensues. That asphyxia is always caused, as Claude Bernard 
states, has not been borne out by the experiments of Giinther and 
Ellenberger. My own observations support those of Ellenberger, but it 
must be allowed, as shown in a case related by Schoneberger, that an 
animal affected with this form of paralysis, if excited and forcibly driven, 
may not only suffer from severe dyspnea but may even die outright. 


FACIAL PARALYSIS. 9 


In one case of double-sided peripheral paralysis I found the breathing 
of a snoring character, even when the patient was at rest, whilst during 
inspiration the nostrils became contracted and the false nostrils collapsed. 
(Fig. 4.) 

Diagnosis of central paralysis is not difficult, though determination 
of the cause and its exact position require much care. Should the 
paralysis be confined to one or both lips, it is peripheral; where 
the muscles both of the eyes and ears are affected at the same time 
the injury is above the point where the nerve winds round the jaw. 
Central paralysis may sometimes be recognised 
by the continued existence of reflex irrita- 
bility in the affected parts, showing that 
conductivity of the nerve is not destroyed. 

Most cases of peripheral paralysis recover 
in from four to six weeks. Return of irri- 
tability on faradisation points towards re- 
covery, and this usually occurs little by little. 
When the animal is in a state of rest, it may 
be noted that the lip is returning to its 
normal position ; should it be excited, however, 
the distortion again becomes visible. A prog- 
nosis is, therefore, best arrived at while the 
patient stands quietly in the stable. Cases of 
incomplete paralysis generally recover; those 
where the eyes and ears are affected are not pig 4 Position of nostrils and 
hopeful, and where tumours are the cause a  0se in double-sided — (peri- 

: pheral) facial paralysis (from 
cure is not to be expected. Further, when a photograph). 
the paralysis has been in existence for more 
than two or three months, the prognosis is always unfavourable. 
Double-sided is generally less hopeful than single-sided paralysis, 
while, if the appearances point to some central cause, little hope of 
cure can be entertained. 

Treatment.—In one-sided incomplete paralysis the food which 
has accumulated in the cheek must be removed after each meal. 
Nothing further is necessary. In complete paralysis of one side, soft, 
easily masticated tood should be given, and the surface on the upper 
margin of the lower jaw, where the nerve emerges, rubbed with some 
resolvent material (Uget. hydrarg.). Such measures serve to satisfy the 
owner, and the rubbing certainly appears to alleviate inflammatory 
action. The frequently recommended injection of veratrine into the 
cheeks has been of no value in my experience. Electricity is 
inapplicable, owing to the excessive sensibility of the horse to this 
agent. In double-sided paralysis the principal point is attention to 


10 DISEASES OF THE MOUTH. 


the food, which should consist of mashes, gruel, and green stuffs. Corn 
should be given crushed and in a deep receptacle, so that the animal 
can more easily seize it with the teeth (Ellenberger). To avoid 
the tendency to dyspnoea, Schéneberger advised that wire sutures be 
passed through each nostril, and brought together over the nose— 
a suggestion he first made in 1874.  Tracheotomy is sometimes 
useful. 


Voigtlander observed periodical attacks of cramp in the region supplied by 
the N. facialis in a horse; “‘on the right side the upper eyelid began to 
twitch, a sight contraction like a shadow ran across the masseter as far 
as the lip, and then began powerful contractions, which drew the right half 
of the upper lip upwards and outwards, and set in motion the entire half of 
the head behind the eye.” These attacks came on every five minutes, and 
occurred even during feeding. The owner stated that the disease had been in 
existence for several years. Degive in two cases noticed paralysis of the tongue 
and lips, a disorder which is said to be frequent in Belgium, and which has a 
certain resemblance to bulbar paralysis in man. He found general progressive 
paralysis of the bulbar nerves, especially the hypoglossus and facialis, which 
was attended with salivation, paralysis of the muscles of the tongue, lips, and of 
mastication, with consequent difficulty in eating, portions of the food falling 
out of the mouth. Paralysis of the soft palate and pharyngeal muscles was at 
times present and interfered with swallowing. The malady always ended 
in death, generally in five to six months, sometimes later. Post-mortem showed 
gangrenous pneumonia (mechanical pneumonia, schluckpneumonie), atrophy of 
the roots of the bulbar nerves (hypoglossus, vagus and facialis), and degeneration 
of the muscles of the tongue and cheeks. 

The cause is clearly a morbid process in the medulla, leading to the 
degeneration and atrophy of the motor roots of the hypoglossus, facialis and 
vagus, which arise here. To the best of my knowledge the disease has not 
yet been observed in Germany. 


Il.—DISEASES OF THE MOUTH. 


(1.) FOREIGN BODIES IN THE MOUTH. 


Lit.: Lindenberg. Mag. v. Gurlt u. Hertwig, vol. xi. p. 436. 
Kirchner, ibid., vol. xviii. p. 339. Barrier, Bulletin, 1885, p. 
1938. Carrucci, La Clinica vet., 1885, p. 458. Kitt, Berl) Th: 
Woch., 1890, p. 293. 


In domesticated animals, and especially in dogs and cattle, foreign 
bodies taken into the mouth along with the food, or picked up in play, 
are apt to become fixed. In dogs, bones and needles are the most 
common objects, in cattle, pieces of wood, which le between the teeth 
or the teeth and cheeks; while needles usually get fixed in the 
tongue. The animals slobber, and chew when the mouth is apparently 


FOREIGN BODIES IN THE MOUTH. Ii 


empty ; some shake the head or make cautious attempts to swallow; 
and, if the foreign body is not removed, they become thin from 
insufficient nourishment. Where such symptoms are met with, the 
mouth should always be carefully examined. The objects being often 
very small, like needles or splinters of wood, it is necessary to 
search closely. Where hard bodies become fixed between the upper 
and lower teeth, the mouth can sometimes neither be closed by the 
animal itself nor by external force. In dogs and cats sewing needles 
are often fixed in the base of the tongue. 

Apart from difficulty in feeding and loss of condition, other symptoms 
may supervene. I have seen a horse die of bleeding from the palatine 
artery, primarily brought about by a needle penetrating the tongue. I 
have also frequently removed pieces of bone from between the molars in 
dogs, which were unable to close their mouths, and in consequence had 
been suspected of rabies. Lindenberg saw epileptiform attacks in a cow 
result from a sharp molar injuring the tongue; attempts to eat imme- 
diately produced an attack. To remove a foreign body the mouth should 
be forced wide open, and the object seized either with the hand or with 
forceps. Needles are always found penetrating the tongue from behind 
forwards, assuming this position in consequence of the struggles of the 
animal when choking, or the attempts it makes to remove the needle 
with the tongue. For this reason, when extracting a foreign body, the 
tongue should be powerfully drawn forward, and the object thrust 
upwards and backwards. From neglect of this principle, attempts to 
pull out the needle by means of the thread which it often contains are 
always unsuccessful. 

Injuries to the hard palate are sometimes complicated with severe 
bleeding, and require most careful attention. When the palatine artery 
is wounded, animals may bleed to death, as the movements of the 
tongue interfere with the formation of thrombi. In venous bleeding the 
following treatment is generally sufficient : after covering the tongue with 
flour to the thickness of an inch, the mouth is firmly bound and the 
horse left at rest for 6—8 hours (Hertwig). In severe arterial bleeding, 
which often follows penetration of the vessel, the horse should be cast, 
the mouth kept open with a gag, and the artery ligatured. Under some 
circumstances pressure may be employed, as, for instance, in injuries of 
the anterior parts of the palate. After placing on the bleeding spot a 
hard pad of tow or jute, preferably soaked with perchloride of iron solu- 
tion, a bandage or handkerchief is passed round it, and firmly tied over 
the nose, leaving the nostrils free. This should remain in place for 12 
hours. A piece of thick leather or board will further ensure its not 
shifting. Stoppage of the bleeding may at times be effected by burning 
the part with a round-headed iron, but this treatment is not reliable; 


12 DISEASES OF THE MOUTH. 


the bleeding usually stops for a few seconds and then recoimences, 
and it is better to occupy this interval in applying a bandage. Under 
any circumstances, hard food must not be given during the ensuing 
24 hours. In spite of the unpleasant smell, the above described 
wounds usually heal rapidly after removal of the foreign body. Where 
deep cuts exist, the mouth should be cleansed after each meal and the 
animal prevented, either by muzzling or tying up short, from again 
fouling the parts. 

The tongue is sometimes strangulated by a cord being tied round 
it, and this I have repeatedly seen, both in horses and dogs. Either 
from ill-will and a desire to injure the owner, or with the view of 
keeping the horse quiet during cleaning, or preventing his protruding 
the tongue, a piece of string is tied round it. Kirchner relates a 
remarkable case of the kind in a cow, where the tongue became snared 
in consequence of chewing some string. In dogs and cats, sections of 
blood-vessels or elastic bands sometimes slip on to the tongue and 
remain fast. In one of the two cases described by Barrier, a section of 
aorta was found encircling the tongue, which was necrotic. Carrucci 
relates a similar case, where the tongue was swollen to four times its 
normal size. Kitt, when making a post-mortem examination of a goat, 
found an iron ring, ~ inch broad and 2# inches in circumference, firmly 
fixed round the tongue. The animal had shown difficulty in eating and 
was finally killed. Such a condition is recognised at the first glance 
by the great swelling and bluish-red colour of the tongue. The affected 
portion is sharply defined posteriorly and the adjoining part is still 
perfectly normal: closer examination discovers the encircling object, 
which may at first be covered by the swelling. The condition is one 
of strangulation, and, if not relieved, necrosis of the tongue results from 
interference with circulation and nutrition. But this necrosis does not 
always set in rapidly, and healing sometimes occurs, even where the 
tongue is already insensible and cold, and exhibits a bluish-black colour. 
In these cases, however, the surface of the mucous membrane is destroyed 
and sloughs away later. 

Treatment.—tThe first thing is to remove the foreign body. Some- 
times this is sufficient, but not always so, for the mucous membrane, 
being relatively thick and strong, is unable to yield to the extent 
required by the excessive swelling, and the tongue runs a risk of becom- 
ing necrotic. In such cases,’ scarification is advisable, longitudinal 
incisions being made with the bistoury over the whole swelling, and to 
the extent of half its thickness. Deeper incisions might wound the 
hypoglossal artery, and give rise to profuse and dangerous bleeding. 
The swelling generally subsides rapidly after this operation, but at times 
may continue for several days. Bathing with alum solution assists 


STRANGULATION OF, THE TONGUE. 13 


healing and checks putrefactive changes. As long as much swelling 
remains, fluid nourishment must be given, and in cats and dogs this 
may appropriately be administered as a drench, 


(2.) DISEASES OF THE TONGUE. 
(A) MECHANICAL INJURIES. 


Lit.: Osborne, The Veterinarian, 1841. Steffen, Ad. Woch. 15. p. 13. 
Graf, Zeitschr. fiir Vet. Kunde, 1892, p. 359. Lidecke, ibid, p. 304. 


With the exception of those previously described wounds produced 
by foreign bodies, injuries to the tongue occur most frequently in horses. 
The use of the bit sufficiently accounts for this. Moreover, stablemen, 
in order to control unruly or sensitive horses during cleaning, not 
infrequently pass a cord around the tongue. If this be sharply pulled, 
the tongue may easily be cut through, and the thinner the cord the 
more easily does the accident occur. Snattle bits produce the same 
effect, especially if worn. The tongue may also be injured in horses 
and ruminants by sharp or displaced teeth. 

Rupture of the freenum linguie sometimes occurs in horses, result- 
ing in suppuration, abscess formation, and the production of fistulee. 
In oxen the dorsum of the tongue is abraded by rough fodder. Steffen 
saw the point of a foal’s tongue become gangrenous and slough, after 
having been violently handled during some dental operation. His 
report of the case points to a blood-vessel having been ruptured. 

Diagnosis presents no difficulty. The irritation in the mouth, 
salivation, want of appetite, or slow, cautious mastication readily indicate 
the nature of the injury and its extent. Healing is usually rapid 
and certain, though transverse wounds of the tongue may leave a deep 
depression. But even this is no great drawback, and is only worth 
notice inasmuch as the animal wastes food in eating, and the tongue 
may be lacerated if forcibly handled during examination. But a portion 
of the tongue may be torn away in the first instance or later, and 
if the frenum lineue be involved, mastication will be rendered 
difficult. 

The attempts to cure protrusion of the tongue have shown that in 
horses the removal of 3—4 inches cause no inconvenience. But where 
more is lost the animals are unable to bring the food between the back 
teeth. At times they seek to effect this by holding the head in the 
air like chickens when drinking, but at best some food must be wasted, 
and mastication takes longer. 

Graf records that a horse, which had lost the point of the tongue, 


14 DISEASES OF THE TONGUE. 


had severe swelling of the remainder, accompanied by salivation and 
inability to eat solid food: only fluids and mashes could be taken. 
When the wound had cicatrised, the stump only extended about ¢ of an 
inch beyond the first molar. In three weeks the horse could again 
eat ordinary food, but took three times as long as formerly to do so. 
Liidecke described a similar case, in which the tongue was lost as far 
as the commencement of the frenum, but nevertheless the horse could 
eat as usual. 

In dogs defects in the tongue interfere especially with drinking, as 
some of the water flows back. But in time both dogs and horses learn 
to eat and drink in the usual manner. The superficial vessels sometimes 
are torn, but the arteria lingue profunda may not be divided, and in 
this rare contingency the nutrition of the anterior part of the tongue 
is not interfered with. When, however, the profunda is torn, necrosis 
of the point of the tongue may easily follow. Severe bleeding after 
the injury is, therefore, an unfavourable symptom. 

Treatment consists in carefully cleansing the cavity of the mouth 
after each meal. The horse is then either muzzled or tied up, to 
prevent it soiling the wound by eating. Clean water should always 
be kept in the stall. Deep wounds, ie. such as reach nearly halt 
through the tongue, must be carefully sutured. Very strong silk is the 
best material, and the stitches are inserted deeply and close together, 
otherwise they are liable to tear out. Sometimes it is even possible 
in this manner to bring about healing by first intention. If in trans- 
verse wounds the point of the tongue is already gangrenous, it will be 
needful to amputate, but there must be no haste, and the operation 
should be deferred until unmistakable signs of necrosis have appeared, for 
not infrequently the tip may be preserved, even where the cut extends 
three quarters through the thickness of the tongue. Profuse bleeding 
results on division of the hypoglossal artery, but if the horse has 
been cast for operation the vessel can easily be taken up with forceps 
and tied. Injury to the frenum often leads to formation of abscesses, 
which may require to be opened. Under any circumstances, the parts 
must be kept scrupulously clean. 


SEPTIC INFLAMMATION OF THE TONGUE. 15 


(B) ACUTE INFLAMMATION OF THE TONGUE. 


Lit.: Ollmann, Th. Mitth., 1880. Singard, The Veterinarian, 1883, p. 
340. Gresswell, The Vet. Journal, 1886, p. 321. Rehrs, Mag. v. 
Gurlt u. Hertwig, 1841, p. 227. Anleitg. z. Verbannung und Heilung d. 
Zungenkrebses, Detmold, 1787. Kolb, Adams Woch., 1886. Fiir- 
stenberg, Th. Mitt., 1867, p. 163. 


Compared with injuries produced by external agencies, acute inflam- 
matory processes in the tongue are seldom seen; but specific inflamma- 
tions, the result of infection, occasionally occur, especially in cattle and 
horses. The condition termed gloss-anthrax, formerly regarded as a 
form of anthrax, occurs also in “ wildseuche,” a peculiar epizootic show- 
ing many points of resemblance to anthrax. Infection is particularly 
favoured by hard prickly fodder. Cattle and horses usually suffer in 
consequence from acute glossitis which often becomes enzootic (Tholke, 
Ollmann), and is clearly due to the entrance of pathological micro-organ- 
isms. That septic and phlegmonous processes may extend from the 
pharynx to the tongue is shown by Fiirstenberg’s observations on sheep. 

The tongue swells at some particular spot and becomes hard and 
painful. The swelling increases, feeding becomes difficult, and salivation 
soon sets in. In cattle, excessive oedema about the pharynx occurs at 
an early stage, and the lymph glands become swollen. Singard observed 
a similar disease in young cattle leading to necrosis of the tongue; 
and reports finding bacilli in the necrotic parts, which even after 
many cultivations, remained active. Gresswell described an enzootic 
glossitis terminating in necrosis, and stated having found bacilli which 
were identical in appearance with those of malignant cedema. Stockfleth 
also gives an account of gangrenous glossitis in cattle and horses. Even 
in 1787 the municipality of Detmold gave directions concerning the 
measures to be taken to check a disease of the tongue in horned cattle 
and horses, which, from the description given, appears to have been an 
exceedingly acute and rapid gangrenous process. The animals were said 
frequently to die in 24 hours. Scarifications were recommended. Kolb 
noticed in cattle an inflammation of the tongue characterised by severe 
salivation and cedema of the pharynx, with painful swellings on the 
frenum lingue varying in size from a pigeon’s to a hen’s egg. The 
swellings where scarified soon healed, otherwise they formed abscesses 
with foetid contents. Rehrs reports a similar condition in horses. 

Diagnosis and treatment must be founded on the character 
and extent of the disease. In general, scarification is indicated, to allow 
disease products to escape and prevent necrosis. Should fluctuation 
appear, recourse must at once be had to the knife. 


16 DISEASES OF THE TONGUE. 


(C) CHRONIC INFLAMMATION AND NEW GROWTHS IN THE 
TONGUE (MAKROGLOSSIA). 


Lit.: Gerlach, Mag. v. Gurlt u. Hertwig, vol. xx. p. 297. Hollmann, 
ibid., vol. xxiii. p. 40. May, ibid., vol. xxiv. p.+324. Eberhardt, 
ibid., vol. xxix. pp. 447 and 449. Schleg, Dresd. Ber, 1884, p. 97. 
Siedamgrotzky, ibid, 1875, p. 24. Johne, Deutsch. Zeitsch. fiir 
Thiermed., 1882, p. 169. Bollamger, Ad. W., 188i.) “homme. 
sen u. Strebel, Schweizer Archiv, 1890, p. 16. Lesbre, Ree. de 
méd. vét., 1886, p. 605. Bass, Th. Rundschau, ii. 36. Fiirthmeyer, 
Monatsch. d. Vereins osterr. Th., 1887. Pflug, Deutsche Zeitschrift fiir 
Thiermed., 1890, p. 190. Imminger, Deutsch. Zeitschr. fiir Thiermed., 
1888, p. 423. Ostertag, Monatshefte f. p. Thierh, 1893, p. 208. 
Truelsen, B. T. W., 1893, p. 39. Henschel u. Falke, Zeitsehr: 
fiir Fleisch- u. Milchhygiene, 1892, p. 167. 


Under the names of tuberculosis of the tongue, degeneration of the 
tongue, wooden tongue (Holzzunge), and chronic inflammation of the 
tongue, many different conditions have been described, which have a 
certain similarity, inasmuch as in all the tongue gradually becomes 
larger and thicker, and eating and breathing are rendered difficult. 
The nature of these processes until lately was doubtful. Numerous 
foci being found in the lungs, they were described as tubercular. In 1875 
Siedamerotzky, in view of their pathological and anatomical appearances, 
suggested that they were due to the entrance of some irritant. More 
recently they have been thoroughly investigated and defined, and it is 
clear that several diseases have been confounded. Micro-organisms 
such as actinomyces (Bollinger) and bothryomyces have frequently been 
found, and less often psorospermia (Siedamgrotzky). The latter, however, 
cannot always be viewed as pathological, inasmuch as they are sometimes 
found in perfectly healthy parts of the tongue. At times no cause 
whatever can be assigned for the chronic inflammatory process by 
which the tibrous tissue of the tongue increases at the expense of the 
muscles. Probably malignant new growths oceur, but owing to the 
want of proper investigations nothing certain can be said on this head. 
Tumours, at any rate, are much less common in animals than in men, 
in whom carcinoma and syphilis furnish a large number of tongue diseases. 
The ox is the most frequent sufferer, and in it disease is generally due 
to actinomyces or bothryomyces. Pflug has urged, however, that chronic 
indurating ¢lossitis does not always result from actinomycotie infection, 
but may be due to hyperplasia of the muscular connective tissue. 
Imminger has found only 4 to 8 per cent. of these tongue diseases 
to be due to actinomycosis. Probably bothryomyces and _ staphy- 
lococci are sometimes the cause. Truelsen detected actinomyces in a 
horse’s tongue. 


ACTINOMYCOSIS OF THE TONGUE CURABLE. 17 


Appearances and Progress.—The tongue gradually becomes 
thicker and larger, especially at its base, and, on account of its 
stiffness, feeding is rendered difficult, whilst in swallowing, the head 
and neck are abnormally extended. Salivation frequently exists, and 
difficulty in breathing may appear, particularly during mastication 
and swallowing. At the same time respiration becomes audible, 
whistling or rattling. These symptoms slowly becoming aggravated, 
the mouth is examined, and the tongue found thickened, its base 
bemg unusually stiff and hard (Holzzunge). The veins are ab- 
normally large, and the surface has a dark blue colour, as in stran- 
gulation, but acute inflammatory symptoms (pain and cedema) are 
absent. Hard swellings, which vary from the size of a pea to that 
of a pigeon’s ege, are occasionally visible on the surface, and may show 
signs of ulceration. They are best felt when the tongue is allowed to 
glide through the hand. In other cases the tongue is simply increased 
in size. After a time the laryngeal lymphatic glands swell, and at a 
later stage cedema is present. The difticulty in swallowing prevents 
the animals taking anything but fluid nourishment, and slow wasting 
ensues. 

Henschel and Falk saw actinomycosis of the tongue at the Berlin 
slaughter-houses appearing as white or yellow hard swellings, varying in 
size from a pin’s head to a bean, sometimes lying in the mucous membrane, 
sometimes in the deeper tissues. The disease always started from the 
lower (anterior) border of the dorsum. They think that a certain 
connection exists between the localisation of the disease and the manner 
in which oxen gather their food. In grazing, the tongue is rotated 
and passed sideways round the blades of grass. Injuries are thus 
inflicted which afterwards allow the entrance into the tissues of 
actinomyces or of particles of food. Of the total animals slaughtered, 
9-1 per cent. showed such excoriations, and 7:2 per cent. were affected 
with actinomycosis. 

Treatment.—Prognosis is unfavourable, and animals fit for the 
butcher had best be slaughtered. Fluid food is indicated. Although 
hitherto looked upon as incurable, some cases are said to have recovered 
after local scarification and the use of iodine (Strebel and Ostertag). 
Bass, Thomassen, Ostertag, and others recommend iodide of potassium 
internally, 1 to 24 drachms in a quart of water for six succeeding days. 
This is said, however, to have occasionally produced a kind of poisoning, 
Actinomycosis may not only be checked but absolutely cured by deep 
searification and painting with iodine solution (Thomassen, Ostertag, 
and others). Of 100 cases Strebel claims to have completely cured 
one-third and to have so improved others that they could be successfully 
fattened; only 50 per cent. he regards as incurable. To these belong 

B 


18 PARALYSIS OF THE TONGUE. 


the advanced cases, and those in which the root of the tongue is 
principally involved. Where the point and middle alone are invaded, 
the prognosis is much more favourable, for in these parts deep incisions 
may be made without danger. 

Dressing with tincture of iodine may take place two or three times 
a day after eating. Ostertag, however, assigns most importance to 
careful application of the drug; after laying open all swellings, he 
applies the tincture personally, using a stiff brush. The application 
is renewed once a week. Bass noted a relapse after iodine treatment. 
The later observations of Thomassen, Nocard, Ostertag, and others give 
a high value to the administration of iodide of potassium internally, and 
the local use of tinct. iodi. Under any circumstances it is better, when 
dealing with an infectious disease, not to place too much reliance on 
complete or lasting recovery, and as soon as sufficient improvement is 
declared to prepare the animal for the butcher. Such animals fatten 
most readily on distillers’ and brewers’ grains, which only make slight 
demands on their masticating powers. 


(D) PARALYSIS OF THE TONGUE (GLOSSOPLEGIA), 


Lit.: Gerke, Gurlt u. Hertwig. 5, p. 93. Jitrgens, ibid., 12, p. 356. 
Kater, Thierarztl, Mitth., 1870, p. i71. Hallander, Monatschr. 
fur dhe ps oly: 


Inflammatory processes may interfere with the movements of the 
tongue; but its paralysis depends on injury to the hypoglossal nerve, 
which supplies with, motor filaments the collective muscles of the 
tongue and most of those of the hyoid bone. 

Wounds, abscesses, or inflammatory processes may affect the nerve 
at some point of its course, or at its origin on the inferior surface of the 
medulla, and thus produce glossoplegia. Kater saw one-sided paralysis 
oecur in a foal which three months before had been wounded in the 
throat with a knife. On the left side the muscles of the tongue had 
so completely disappeared that at the point the upper and lower 
coverings of mucous membrane were in contact. This paralysis is also 
seen during severe infections, as of contagious pleuro-pneumonia of the 
horse (brustseuche). In central paralysis both nerves usually suffer, 
and, of course, both sides of the tongue, for the two hypoglossal nerves 
arise very close together. In the horse paralysis of the tongue some- 
times accompanies acute meningitis or hydrocephalus. But all double- 
sided paralysis is not necessarily central. Diplegia occurs in horses 
whose tongues have been roughly handled, and where both nerves have 
been injured. In dogs double-sided paralysis is regularly observed during 


RANULA. 19 


rabies, but it also appears without any preceding illness, and is some- 
times accompanied by masticatory facial paralysis. Here the cause is 
probably central. Jiirgens thinks that numbers of the observations 
published in veterinary literature as glossoplegia really relate to inflam- 
matory affections; but I have certainly seen paralysis of the tongue 
result from acute inflammation of that organ. 

The symptoms of one-sided paralysis are displacement of the tongue 
and difficulty in mastication and deglutition. In double-sided paralysis 
both acts become nearly impossible, particularly the latter. The 
tongue generally hangs from the mouth. In protracted cases the 
“muscles atrophy, though, of course, in single-sided paralysis only those 
of the paralysed side suffer. The disease must not be confounded 
with the so-called “ protrusion” (zungenstrecken), where the tongue is 
voluntarily lolled out of the mouth. Paralysis is shown by distortion 
and inability to retract the tongue. 

Prognosis is generally unfavourable in double-sided paralysis. The 
animals cannot be fattened, and therefore, if the case is persistent, 
it is better to slaughter. Monoplegia is of little consequence as the 
animals can still feed well. 

Treatment can do little. Should the disease be caused by external 
injuries, these must be dealt with on general principles, otherwise 
one can only await developments or slaughter. In fat animals the 
latter course is preferable, as condition is rapidly lost. 


(E) RANULA. 
Lit.: Hohenleitner, B. T. W. 1892, p. 346. 


Ranula is commonest in dogs and cattle. Under the point of the 
tongue, on the frenum lingue, a long roundish swelling develops, 
which may attain the size of a pigeon’s, or even of a hen’s, egg. It 
is greyish-yellow, soft, and not inflamed. When opened, a yellow, 
thick fluid escapes, and the walls collapse. The swelling, if of any 
considerable size, interferes with feeding, and’ produces salivation. In 
man the voice at times assumes a harsh, croaking tone, hence the 
German name “ Froschgeschwulst ” (Frog swelling). The pathological 
cause has not yet been determined even in man. It was thought to 
be due to occlusion of Wharton’s duct, but this is generally found 
to be clear. More recently it has been regarded as stoppage of a 
mucous duct (retention tumour). 

Prognosis is favourable, though simply laying the cyst open is 
ineffective, as it always fills again. But this can easily be prevented 


20 FRACTURE OF THE HYOID BONE. 


by removing the thin wall with scissors and forceps. Stockfleth has 
described as ranula in cattle an entirely different condition, which takes 
a much more troublesome course, and must be regarded as a malignant 
inflammation of the sub-maxillary lymph glands (compare with affections 
of lymph glands). Hohenleitner states having seen two cases of ranula 
caused by actinomyces. The ranula disappeared after painting with 
iodine, though stiffness of the tongue persisted. 


(F) FRACTURE OF THE HYOID BONE. 


Lit.: Schade, Gurlt u. Hertwig. 6, p. 316. Herraud, The Vet., 1853. 
Rupprecht, Berl. Th. Woch, 1890, p. 329. Zipperlen, Rev. vét., 
1880, p. 380. Bolle, Th. Mitth., 1881, p. 86. Siedamgrotzky, 
Dresd. Ber., 1875, p. 26. 


On account of its sheltered position, fractures of the hyoid bone are 
rare, but have nevertheless been observed. In horses and eattle they 
are produced by thrusts with the horn, and blows with the feet, or even 
by violent traction on the tongue. In dogs they result from roughly 
seizing them by the throat, as is sometimes done by the police in 
securing stray animals. 

The Appearances comprise salivation, prolapse of the tongue, 
difficulty in eating and especially in swallowing, accumulation of food in 
the mouth and swelling in the throat. In complicated fractures there 
may also be bleeding from the mouth, possibly of a severe character. 
Crepitation on moving the tongue can seldom be detected. 

Union of subcutaneous fractures is usually complete in four weeks. 
But it not infrequently happens. that fragments of bone perforate the 
mucous membrane. Intense inflammatory swelling then develops, which 
may quickly prove fatal (Herraud); or mastication and swallowing are 
interfered with, and death occurs from inanition, or the patients have 
to be slaughtered. Fatal bleeding sometimes results from splinters of 
bone injuring neighbouring blood-vessels. Rupprecht relates that the 
broken hyoid of a horse perforated the guttural pouch and caused death 
by lacerating a large vessel. Asphyxia caused by such _ bleeding 
occurring into the larynx and trachea is spoken of by Bolle. But 
even cases rendered complicated by exfoliation of large pieces of the 
hyoid may recover in from six to eight weeks, as Schade’s experience 
shows. 

Treatment in simple fracture is confined to supplying suitable food, 
which must be easily digestible and require little mastication. At the 
commencement, water may be given per rectum, especially if deglutition 
is difficult, and soluble nourishment may be administered in the same 


FRACTURE OF THE PREMAXILLARY BONE. Pal 


way. In complicated cases the wound must be frequently cleaned. 
Should the skin be wounded by perforating fragments (an exceptional 
occurrence), ordinary antiseptic treatment must be adopted, and loose 
pieces of bone removed. 


(3.) FRACTURE OF THE PREMAXILLARY BONE. 


Such fractures are caused by falling or running against obstacles; in 
horses by kicks, in dogs by blows. Sometimes the nasal process 
alone breaks; sometimes the alveolar portion with one or more incisor 
teeth is involved; sometimes the bodies of both bones are broken 
through. 

Diagnosis is based on the painful character of the swelling, and on 
the result of examination of the bone, which lies almost immediately 
under the skin. ‘Transverse fractures of the body of this bone produce 
results similar to those of the body of the under jaw; the upper incisor 
teeth and the alveolar margin of the bone appear movable, or are more 
or less displaced backwards. The upper lip often hangs down obliquely, 
so that on casual examination this injury might be mistaken for facial 
paralysis. So long as the fracture is confined to a single alveolus or 
to the nasal process, it heals rapidly and completely. Transverse 
fractures of the body give greater trouble, and especially when the 
alveolar margin and the incisors are movable, or when a complicated 
fracture exists. In such cases treatment is only advisable in valuable 
or favourite animals. Where the free edge is firm, recovery is much 
more certain. 

Treatment aims at fixing the fragments in position with wire 
in the same way as in the lower jaw. In complicated fractures 
strict antiseptic precautions must be observed. In some cases the 
incisor teeth, which have been dislocated backwards, can only be 
replaced in their normal position after the lapse of some time, and by 
exercising considerable force. But as soon as they are brought into 
position, so that the upper and lower teeth come into contact, the 
movements of mastication usually suffice to complete replacement. In 
horses I have often seen transverse fractures of the inter-maxillary bone 
just behind the alveolar process: in one case the upper incisors had all 
been thrust downwards and backwards in consequence of the animal 
falling on the mouth. Reduction can often be effected, even several 
days after the accident, by using as a lever the thin handle of a hammer. 
Sometimes strong pressure with the thumbs is sufficient. 


22 INJURIES IN THE INTERDENTAL SPACE. 


(4.) INJURIES IN THE INTERDENTAL SPACE. 


Ger. Ladendruck. 


The interdental space is that portion of the jaw which intervenes 
between the corner incisor and the first molar tooth. The bone here 
presents a more or less sharp border,and is covered with periosteum and 
strong, thick mucous membrane. On this part the pressure of the bit 
comes. The latter usually rests on the tongue and edges of the lips, 
but the action of the reins presses it against the jaw, and thus, especially 
in riding-horses, produces wounds. The sharper the bit, and the lower 
it is fixed, the more easily this happens. Such injuries are also more 
frequent with a high and sharp conformation of the bone, a thin tongue 
and relaxed lips, and with riders whose hands are heavy. 

The diseased processes so produced are of various kinds, and may be 
distinguished as follows :— 

(1) The simplest injury consists in erosion of the mucous membrane 
covering the interdental space. The epithelium being removed by the 
rubbing of the bit occasionally makes sensitive riding-horses trouble- 
some, but yields to treatment in a few days. 

(2) Should the force be greater the mucous membrane itself may be 
bruised or wounded. Simple bruises without penetration are seldom 
very troublesome, but actual wounds may easily lead to periostitis and 
its results (necrosis). 

(3) The severe use of sharp bits ends in disease of the periosteum 
or of the bone. Sometimes this takes the form of periostitis ossificans, 
which goes on to the formation of exostoses, often seen in the skeletons of 
old riding-horses. Purulent periostitis, always met with where the wound 
has extended to the bone, produces necrosis, which may lead to purulent 
affection of the medulla (osteomyelitis suppurativa). The diseased 
products later find exit on the lower margin of the jaw, and necrotic 
portions of bone, as large as a finger, may be discharged. Though in 
such cases recovery is naturally slow, it is always complete, and no 
permanent injury is left. 

Attention is often first directed to an erosion of the mucous membrane 
by the excitability of the horse when reined in. Bruises are recognised 
by the local swelling, by redness and pain; wounds are directly visible. 
The parts are best examined by introducing the forefinger into the 
mouth ; and should pain, swelling, or tears in the membrane be detected, 
the diagnosis can be confirmed by visual inspection. Periostitis ossi- 
ficans can only be discovered by touch, otherwise it often remains 
unnoticed, the horse’s pulling being assigned to bad temper, either on its 
part or on that of its rider. Moderate pressure on the inflamed spot 


TREATMENT OF TENDER-MOUTHED HORSES. 23 


produces marked pain. Wounds in the mucous membrane or necrosis 
of the bone are easily detected with the finger or a metallic probe. 
Osteomyelitis is recognised by swelling of the bone, usually extending 
from above downwards towards the lower edge of the jaw. When the 
enlargement breaks a sanguineo-purulent discharge escapes, mixed with 
necrotic bone fragments, and emits the peculiarly unpleasant smell of 
bone pus. The probe often passes from the lower edge of the jaw 
right into the mouth. Salivation and painful mastication, though they 
sometimes occur, are not essential characteristics. 

Treatment must be based on the anatomical changes. If the 
parts are merely abraded, it will be sufficient to rest the horse, or use 
a simple nose-band or smooth snaffle, in place of a more severe bit, 
until the epithelium has again grown, or the bit may be fixed higher 
in the mouth. In wounds of the mucous membrane, rest or absolute 
avoidance of bar bits is necessary. The parts must be cleansed after 
each meal, and the horse muzzled or tied up. The wound should 
subsequently be treated according to its character. Immediately the 
bone or periosteum begins to suffer, the bit must certainly be laid on 
one side. In periostitis ossificans recovery usually follows this treat- 
ment in a few weeks; but in purulent periostitis and myelitis improve- 
ment will only occur after removal of the necrotic bone. This can 
sometimes be effected through the mouth by using dressing forceps, 
otherwise the swelling should be allowed to rupture, and the bone taken 
away from without. Both the external wound and the opening in the 
bone must be kept as clean as possible. Syringing with solutions of 
earbolic acid, creolin, or diluted hydrochloric or sulphuric acid is here 
indicated. In caries of the lower jaw Greiner injects the fistula with 
concentrated solution of lactic acid, and then introduces tampons soaked 
in the same fluid. The wound requires cleansing after each meal, and 
treating as above indicated. In some eases good results follow the use 
of a pointed cautery. 

Unfortunately, wounds are often discovered only when the jaws 
are considerably swollen. Injuries to the interdental space are very 
common in the army after general manceuvres, and when cavalry ride 
great distances without veterinary superintendence. Under such circum- 
stances the mouths require to be examined as recularly as the backs 
and saddles. In tender-mouthed horses leather or rubber covered bits 
prevent this injury, and should be used for some time after healing ; 
but as long as wounds exist they are of little service, and in erosion 
of the mucous membrane are positively hurtful. 


24 DISEASES OF THE TEETH. 


(5.) DISEASES OF THE TEETH. 


This chapter will take cognisance of all pathological conditions of 
the teeth, and of all irregularities in the conformation of the mouth, 
which interfere with mastication. Without this wider knowledge 
abnormalities of the teeth cannot be understood, nor can a reliable 
diagnosis be. made. Diseases of the molars are most important in 
herbivora, because these teeth perform the whole duty of grinding 
the herbage, while the incisors only cut it. The dental disorders of 
vegetable feeders will, therefore, first receive attention. Reference 
may be made, with advantage, to Kitt’s excellent work on diseases of 
the teeth in Frohner’s Monatsschrift fiir practische Thierhieilkunde, 1892, 
parts 8, 9, and 10. 

The clinical appearances, although varying in the different condi- 
tions, generally show marked agreement. In horses (of which we are 
now more particularly speaking), the following symptoms are usually 
present :— 

(1) Deliberate cautious mastication, subject to sudden interruptions 
and rolling of the tongue, the head being held on one side. 

(2) Dropping of food from the mouth; balls of hay are found in the 
manger ; in popular phrase the animal “ quids” its food. 

(3) An important symptom is the presence of food in the mouth, 
generally in the cheek, some considerable time after eating. Grinding 
the teeth when no food is in the mouth is also significant. 

(4) At a later stage wasting and loss of strength. In cattle 
epileptiform convulsions have been seen as a result of dental disease 
(p. 11). In dogs salivation should always draw attention to the state 
of the mouth, and especially of the teeth. 

(5) Alveolar periostitis is the most common dental disease in animals, 
and always gives the mouth an extremely offensive smell. 

Immediately any such symptoms are present, the mouth, and especially 
the teeth, should be thoroughly examined. In some horses irregularities 
of the teeth can be detected through the thickness of the cheeks by 
palpation from without. Sometimes the bone swells and fistula form. 
The incisors are easily inspected, but examination of the molars requires 
certain precautions varying in the different classes of animals. These 
are more particularly described in my work on diagnosis.‘ Deviation 
of the teeth from their absolute or relative positions likewise points to 
disease. 


1 Klinische Diagnostik der déusseren Krankheiten der Hausthiere, by Prof. Dr H. Moller, 
Stuttgart, Ferdinand Enke. 


SUPERNUMERARY TEETH. 25 


Diseases of the teeth may be clinically divided into the following 
four groups :— 
A. Irregularities in development. 
B. Irregularities in wear. 
C. Diseases of the tooth proper. 
D. Diseases of the alveolar periosteum. 


(A) IRREGULARITIES IN THE DEVELOPMENT OF THE TEETH. 


Lit.: R611, Wien. Vierteljahrschrift., vol. iii, p. 102. Walther, Dresd. 
Ber., 1889, p.70. Giinther, Exterieur des Pferdes. Kitt, Monatsschr. 
mepelmernn. isea,)p. sole “Dreckerhotft Spec. Path. u.” Ther, 
p. 165. 


(a) SUPERNUMERARY TEETH (Polyodontia, Hyperdentition). 


Kollmann (quoted by Kitt) states that in man during fetal life 
more enamel germ is sometimes formed than is required for the normal 
number of teeth, and that this determines the production of super- 
numerary teeth. Kitt looks on hyperdentition as a result of atavism, 
and points to the fact that in former ages 
foals had more teeth than at present. The 
same theory explains the appearance of the 
pre-molars in the horse, whose ancestors 
(Hipparion, &e.) always had four pre-molars. 
Kitt describes as a typical hyperdentition 
the apparently purposeless excess of teeth, 
an example of which is cited by Goubeaux, 
where a certain horse had double the normal 
number of incisors. Giinther, Stockfleth, and 
others have noted supernumerary molars. 
Their commonest situation seems to be 
behind the third molar, but they may lie 
alongside the normal teeth, being either in 
contact with the tongue or cheek. At times ; 
milk teeth may be retained by becoming Ste a eae too 
fixed between the permanent successors. 

Excess teeth seldom cause trouble until, by continued unopposed 
growth, they come in contact with and wound soft tissues. Roll and 
Dieckerhoff have seen cases where a tooth in the lower jaw has become 
so long as finally to penetrate the opposite bone. The nasal cavity 
may even be pierced, and a suspicious discharge produced (Dieckerhoff). 
I myself have seen two such cases. Supernumerary molars, when on 
the inside of the row, are apt to wound the tongue, and, when on the 
outside, the cheek. Walther speaks of two accessory molars in the 


26 IRREGULAR DEVELOPMENT OF THE TEETH. 


horse which appeared, one on the imner side of each of the third upper 
molars. The horse had difficulty in chewing. I have seen two cases 
where a supernumerary tooth .was present on the inner side of the 
fourth upper molar (fig. 5). Both teeth suffered from alveolar 
periostitis, penetrated the maxillary sinus, and produced chronic nasal 
discharge. In another case the excess tooth was on the inside of the 
third pre-molar, and interfered with eating. 

Treatment consists in shortening or removing the offending molar. 
Extraction is difficult where the tooth stands close to another, and 
therefore cannot be grasped. In these cases it may either be shortened 
or punched out. I have removed such teeth by using forceps with 
sufficiently thin jaws to pass between the two. In the front of the 
mouth the two teeth may sometimes be thrust asunder with a strong 
chisel. 


(b) IRREGULARITIES IN REPLACEMENT OF THE TEETH. 


Occasionally the milk teeth remain fixed in position, and cause 
the permanent teeth to grow irregularly. Such milk teeth may be 
removed with ordinary forceps, though Giinther’s are preferable (fig. 
28). It should be noted that the milk tooth is always in front, the 
permanent behind. In extracting the first tooth the projection in front 
of the jaws of the forceps should le on the permanent tooth. The 
eruption of the molars seldom gives rise to trouble, though at times 
severe pain accompanies the process, and soft food may be required. 


(c) DISPLACEMENT OF THE TEETH. 


The molars may become displaced in consequence of disease of the 
alveolar periosteum and loosening of the teeth. This will be noticed 
later. Abnormalities occur in development; one or other of the 
permanent incisors, instead of appearing in the site of the deciduous 
tooth, sometimes makes its appearance at a point further back and 
wounds the tongue. Stockfleth mentions a case of Hoyer’s of this kind. 

In horses an incisor is sometimes rotated on its axis, the convex 
surface being turned inwards, or it les horizontally, and grows beyond 
the lips, injuring the animal’s appearance (Giinther). The molars may 
be similarly displaced. Kitt describes a mouth in which the first molar 
lay with its crown alongside the outer aspect of the second and fourth, 
whilst its root projected from the jaw on the inner side at a point 
about an inch and a half below the alveolar ridge. 

Kitt ascribes such deviations from normal position either to temporary 
or permanent want of space at the time the tooth appears, or to 
abnormal conformation of the mouth, or incidence of pressure. A milk 


DISPLACEMENT OF THE TEETH. Ar | 


tooth may thus give an abnormal direction to a permanent tooth just 
developing, or this abnormal direction may exist from the first. 

False position, due to irregular development of the jaw, may be 

considered under this heading. Either jaw may be affected. If the 
upper is too long (Prognathia superior), or the lower too short 
(Brachygnathia inferior), the so-called “overshot jaw” is the result 
(Karpfenmaul, lit. carp’s mouth); whilst an opposite conformation 
produces “undershot jaw” (Hechtmaul, ze. pike’s mouth). These 
variations result from faulty development of the bones, and are often 
accompanied by corresponding changes in the molars. In undershot 
jaw the lower rows of molars are displaced anteriorly so that the first 
lower molar projects beyond that of the upper jaw, whilst the last 
upper molar does not come in contact with its fellow of the lower jaw. 
In overshot jaw the case is reversed. The teeth consequently either 
partially or entirely escape wear, and thus become too long and 
impede mastication. The nose, or even the entire head, may be distorted, 
producing displacement of the teeth. This is termed by Gurlt campylor- 
hinus. (Fig. 11.) Leisering saw such a case during life. Dose noted 
a peculiar abnormality in a cow. ‘The incisors stood in pairs, one 
behind the other. Although the animal was three years old, no teeth 
had been shed. The under jaw was deformed, and Gurlt considered 
this to be the real and primary cause of the peculiarity. 
_ When slight, these changes are of little importance, but immediately 
they become pronounced they produce various undesirable results. The 
animal has difficulty im grazing, can no longer tear off the short grass, 
and where the incisors are much affected mastication even of cut food 
may prove difficult and painful. If the molars fail to correspond, the 
grinding surfaces wear away unevenly, and the overlapping part grows 
until it either wounds the opposite gum or even the palate, and thus 
produces pain in chewing. 

Schrader found a horse in which the first left upper molar was 
immediately behind the tush, while the second lay at the inner side of 
the third, so that the first molar was separated from the others by a 
space of 2 inches. ‘The two first lower molars had grown into this 
space and perforated the palate, and in drinkine the water passed 
through this aperture and was discharged by the nostrils. The horse, 
being much wasted, was slaughtered. Too great a space between the 
teeth is at once abnormal and injurious, especially in the case of the 
molars. The crowns of the teeth should stand close together, so as 
to afford mutual support, and prevent food entering the interspaces. 
Where intervals occur food is driven into them, penetrates even the 
alveoli, and may produce inflammation there. Such alveolar periostitis is 
not uncommon in young animals. 


28 IRREGULAR WEAR OF THE TEETH. 


Treatment consists in shortening or removing the offending tooth. 
In young animals too much of the tooth must not be removed at once, 
as the pulp cavity may be exposed, and alveolar periostitis set up. 
Where intervals occur between the teeth the evil is palliated by giving 
soft food, so as to lessen or remove the need for mastication. 


(B) IRREGULARITIES OF WEAR IN THE TEETH. 


In the horse’s under jaw the rows of molars form two almost straight 
lines, which posteriorly diverge slightly. In animals of average size 
the first pair lie about 2 inches, the last about 4 inches, from each other. 
In the upper jaw the space between the two rows (which are bowed 
outwards) is considerably greater, the two first molars on either side 
standing about 3 inches, the last molars about 4 to 44 inches from each 
other. At the boundary between the pre-molars and molars the cross 
measurement in the upper jaw is about 44 to 4% inches, in the under 
jaw about 32 inches. It will thus be obvious that during rest the 
grinding surfaces of the upper and lower rows do not cover one another ; 


Fic. 6.—Normal position of the molars in the horse. 


the upper row overhangs the outer edge of the lower; while, on the 
other hand, the inner edge of the lower row projects farther inwards 
than that of the upper. (Fig. 6.) Moreover, the grinding surfaces, when 
viewed from in front, are horizontally inclined, their outer borders being 
;%; to 2 of an inch lower than their inner. If the lines of the grinding 
surfaces are prolonged, they meet in an obtuse angle below the palate. 
(Fig. 6.) Baume places the teeth of the horse in a class between those 
which grow continuously, and have an open pulp cavity, and those like 
the teeth of men and carnivora, whose pulp cavity is closed, and which 
grow from the root. Giinther states that the normal rate of wear, 
which in herbivora is very considerable, amounts to about 2 mm. (nearly 


THE ANGULAR OR SHARP MOUTH. 29 


one line) per year. In consequence of this continued wear, the grinding 
and cutting surfaces should eventually attain perfect contact. But where 
they do not, certain areas are insufficiently worn, and grow abnormally 
fast (Exsuperantia dentis, Kitt), while certain others wear too quickly. 
Hence arise the following irregularities :— 


(a) The angular or sharp mouth. 

(6) The shear-like mouth. 

(c) The wave-formed mouth, where the row of teeth, seen from 
the side, appears undulatory (Wellenformiges Gebiss). 

(d) The step-formed mouth, where, from similar irregular wear, 
the row is composed of alternate high and low teeth 
(Treppengebiss). 

(ec) Premature wear of the teeth. 

(f) The smooth mouth, 


(a) THE ANGULAR OR SHARP MOUTH, THE SO-CALLED 
PROGNATHOUS JAW. 


Lit.: Jessen, Gurlt u. Hertwig. 36, p. 401. Lorge, Her. Rep. 31, p. 46. 
Giinther, Exterieur des Pferdes. Kitt, Monatssch. fiir pr. Thierh., 1892, 
p. 343. 


Under ordinary circumstances mastication causes general wear of the 
entire grinding surface of the molars, but if any part fails to be worn, 
that portion will become too long. Owing to the peculiar relations of 
the two jaws, the points which generally escape wear are on the inner 
side of the lower row and on the outer side of the upper. Kither single 
teeth, an entire row, or even several rows, may be involved. If the two 
rows do not terminate at the same point, the upper molar being too far 
forward, or the first lower molar too far back, the unopposed points will 
continue to grow until their sharp elongations may injure the opposite 
gum. This irregularity is caused by a narrow formation of the lower 
jaw, as was shown by Defay (Jessen), and later by Giinther and others. 
It is assisted by limitation of the movements of mastication, which in its 
turn is said by Lorge to be dependent on faulty development of the 
muscles of the jaw. As soon as sharp edges form on the teeth, the 
inside of the cheeks may be wounded. ‘The further limitation thus 
placed on movements of the jaw aggravates the production of sharp 
edges, and the mischief increases. It is easy to operate on the sharp 
edges and points of the teeth, but this does not remove the cause, and 
the malady is liable to recur. The sharp edges of the lower teeth 
lacerate the tongue, while those of the upper injure the cheek. These 
injuries may eventually induce general wasting and loss of power. Such 
a condition is seen especially in old horses, seldom in other animals. 


30 SHARP OR ANGULAR MOUTH. 


The animal feeds badly, chews slowly and cautiously, and holds the 
head to one side. Food is often dropped from the mouth into the 
manger; portions also remain between the teeth and cheeks; while 
movements of the jaws or tongue are as much as possible avoided. 
Wounds of the mucous membrane produce copious salivation. Jessen 
remarked that this condition was formerly often overlooked; but that 
its importance is apt nowadays to be over-estimated, and the diagnosis 
of “sharp teeth” is sometimes used as a cloak for ignorance. lrregu- 
larities, however, frequently produce no mischief, and can only be 
regarded as causes of imperfect mastication when they occasion wounds 
of the tongue or cheeks, Unless where very marked, they are unim- 
portant in young animals. 

Treatment.—Sharp points or edges can either be removed with the 
rasp (fig. 7) or one of the several forms of chisel (figs. 8,9, and 10). If 


Fic. 7.—Tooth rasp. Fires. 8, 9.—Tooth chisels. Fic. 10.—Tooth cutter. 


requisite, perfectly efficient instruments can be made from an ordinary 
foot-rasp. Animals often show an instinctive desire to break off the 
points of the teeth by biting the tooth-rasp when introduced into the 
mouth. Large projections require the use of the chisel and mallet or 
hammer. In the case of the back molars the chisel must be used with 
caution, so as to avoid injuring soft structures. The blow must be 


SHEAR-LIKE MOUTH. 31 


sharp but short; while, to prevent the chisel travelling too far forward, 
the left hand, in which it is held, can be rested against the incisor teeth. 
The skilled practitioner can dispense with instruments having rounded 
guards near the cutting edge, and also with Brogniez’s “ odontriteur,” a 
chisel in which the blow is produced by an iron bolt sliding on the 
handle. The rasping or chiselling of the teeth sometimes produce their 
good results indirectly, by loosening one or more teeth, and by throwing 
the patient off its feed, give time for recovery from gastric affections. 

In old horses, chewing on one side of the mouth sometimes shortens 
the incisors of that side. This condition, described by Giinther as 
“oblique mouth,” seldom causes trouble, but is interesting because often 
associated with irregular wear of the molars. 


(bo) SHEAR-LIKE MOUTH. Ger. Scherengebiss. 


Lit.: Gtinther, Exterieur. p. 584. Esser, Thier. Mitth., 1877. Kitt, 
Monatssch. fiir pr. Thierh., 1892, p. 348. 


Shear-like mouth consists in a considerable increase in the obliquity 
of the wearing surfaces of the molars. Their outer edges in both jaws 
are too low, the inner too high, so that the wearing surfaces, if prolonged, 


Fic, 11.—Left-sided shear-mouth Fia. 12.—Grinding surfaces 


(from a photograph). : SS . 
in shear mouth. in normal mouth. 


would meet in an acute angle above the palate. In other words, the 
erowns lie not over, but alongside, one another, so that the mouth 
resembles that of a flesh feeder. (Figs. 11 and 12.) The rows of teeth, 
therefore, do not crush, but cut, meeting one another like the limbs of a 
pair of great shears, in which the inner blade is formed by the lower 
molars, the outer blade by the upper. When confined to single teeth, 
this change most frequently affects the 4th molars, because they are 


32 SHEAR-LIKE MOUTH. 


more liable to lateral displacements; but, as a rule, one whole row is 
affected, constituting simple shear mouth; occasionally both sides sufter 
(double shear mouth). 

The condition is brought about thus: The inner edge of the lower 
molars and the outer edge of the upper are not worn away ; both continue 
to grow until the former meets the hard palate, while the latter injures 
the gums of the lower jaw. Coupled with impaired mastication, such 
wounds prevent the horse either taking or chewing food. The overgrown 
teeth sometimes penetrate the bone above, and I have even seen the 
hard palate completely perforated. The side thrust on the teeth loosens 
them, while wounds of the gum are apt to produce inflammatory changes 
in the alveolar periosteum. Hence, “shear mouth,’ especially in old 
horses, generally produces alveolar periostitis. 

Its causes are the same as those of angular or sharp mouth. <A 
narrow jaw and limited movement are notable predisponents. It is 
unnecessary to discuss the correctness of Lorge’s supposition that the 
muscles of the jaw are imperfectly developed; or Giinther’s, that the 
affection is due to variations in hardness of the molars. Esser saw 
shear mouth result from the articulation of the jaw being wounded, 
lateral movement in one direction being shortened, and irregular wear 
thus induced. 

Prognosis depends on the degree of development, condition of the 
teeth, and existing complications. The earlier stages escape notice ; it is 
only when chewing becomes difficult that its presence is suspected. Pro- ° 
vided the teeth are still sound and firm, temporary relief may at all events 
be given; but where they are loose, or alveolar periostitis has already 
set in, the chances of recovery are slight, and in long-standing cases a 
cure is impossible. 

Treatment was formerly confined to removing the sharp edges with 
the rasp or chisel, and lightening the work of mastication by giving soft 
food. Even nowadays nothing more can be done if the teeth are loose 
or shear mouth is moderately developed. But where the patients are 
young and valuable, and the teeth still firm, relief may be assured, for 
some time at least, by removing the projections with tooth shears. I have 
operated on several cases in this way, and the animals have immediately 
afterwards been able to take their food and masticate quite satisfactorily. 
If several teeth have to be shortened, the horse must be cast, but the 
operation is not difficult, and I have more than once operated on double 
shear mouth in a quarter to half an hour, and had most excellent results. 
As to the use of the shears, compare page 34. 


THE STEP-FORMED MOUTH. 33 


(c) THE WAVE-FORMED MOUTH. 


The wearing surfaces of the several molars on each side above and 
below are normally of similar height, and le on the same plane; but 
variation of this plane surface produces the wave-formed mouth. It is 
generally bilateral, the fourth lower molar being the shortest, the corre- 
sponding upper tooth the longest in their particular rows. The molars 
in front and behind these become respectively longer or shorter. In 
the lower jaw they are usually too long, in the upper jaw too short. 
Sometimes the state of things is reversed. This form of mouth usually 
depends on unequal durability of the individual teeth, and sometimes on 
disease of the alveoli. Sheht inequalities cause little discomfort ; but 
when well developed, and especially if the alveoli are involved, mastica- 
tion is greatly impaired, and the sharp points and edges wound the 
opposing soft parts. Certain teeth may be worn down level with the 
gum, and mastication made exceedingly painful. The disease occurring 
in early life is especially serious, as it becomes aggravated with age. 

Treatment.—Sharp points and edges must be removed. Excessively 
long teeth which injure soft structures should be shortened or extracted ; 
and the diet consist mainly of crushed food and slops. 


(dq) THE STEP-FORMED MOUTH. 


This irregularity is closely allied to the foregoing. The only 
difference between them is that the neighbouring molars vary in 
height, not gradually but suddenly, a short one being followed by a 
much longer one, or vice versa. ‘The same cause, viz., unequal hardness, 
seems at work here. The condition may be due to some unknown con- 
stitutional peculiarity, as evidenced by its attacking both sides of the 
mouth. The spaces resulting from loss of teeth are often responsible for 
its production. The prognosis depends on the degree and extent of the 
irregularity. Mastication is usually more impeded by this than by the 
wave-formed mouth, because lateral movement of the jaws is here more 
difficult. The disease is gravest where the animals are young, the soft 
tissues wounded, or where several teeth have been lost. 

Treatment is merely palliative. Soft food will assist mastication. 
The longest teeth must be reduced or removed. The crowns can be 
shortened with my tooth shears. This is preferable to extraction, which 
often presents great difficulties on account of want of room (p. 47), 
whilst the use of file and chisel demands too much time and care. 


The shears designed by me (fig. 13) have been frequently varied, but, in my 
opinion, not much improved. ‘The central screw lying between the limbs of the 
C 


34 PROFESSOR MOLLER’S TOOTH SHEARS. 


instrument ensures great power without disturbing the position of the instru- 
ment. Every part must be fashioned very strongly and carefully of the best 
steel, for, owing to the immense power of the screw, they might otherwise break 
or bend. With quiet horses, one or more front molars may be cut without 
previous casting. But it is better to lay the patient down where it is sensitive 
or troublesome, or where several teeth or any of the back molars are to be dealt 
with. After inserting a rather large mouth gag, and drawing the tongue away 


( 


ml 


a 


Fic. 13.—Tooth Shears. Fic. 14.—Tooth Screw. 


from the part to be operated on, the shears are adjusted on the tooth to be 
shortened, and the screw turned, while the instrument is held by one or two 
assistants. After a few turns, made as quickly as possible, the desired portion 
of the tooth will spring off with a loud noise. At this moment the horse usually 
makes a movement with its head, but, as the shears are already free, this is of 
no importance. I have cut many strong upper molars without ever having an 
accident. The tooth breaks smoothly off. In old horses, it may happen that 
the movement of the head loosens the tooth, and it comes away with the shears, 
affording, however, the desired relief. Most difficulty is met with in back 
molars, and where the sides of the teeth have been worn away obliquely. The 
gag must be wide enough to allow the open shears to be easily introduced. 
When the shears slide off the sides of the teeth, the tooth screw (fig. 14), which 
IT have devised for the purpose, may preferably be employed. In this instru- 
ment the power of the screw acts directly on the cutter. The upper arms are 
for holding the instrument in position. It is used in the same way as the 
shears, and will be found very useful. 


THE SMOOTH MOUTH. 35 


Metznik has invented a pair of shears in which the strength of the hands, 
acting through a series of levers, is found sufficient to cut teeth without having 
recourse to a screw (fig. 15). I have lately used it and find it practical, though 
it would be better if the limbs were narrower and more easily movable. Even 
when using double cheek pieces, it is occasionally found too 
narrow for broad teeth and too broad for narrow ones. 


(e) PREMATURE WEAR OF THE TEETH. 


Defective resisting power in the teeth and the con- 
sumption of hard food sometimes produce premature 
wear, so that the animal becomes unable to grind its 
food properly. This condition is met with in herbivora 
as well as in carnivora. Dralle found all the molars in 
a twelve-year old horse so much worn and so loose, that 
they could be partially withdrawn from their sockets 
with the fingers. Pallin wrongly described this con- 
dition in a thirty-year old horse as periodontitis. Only 
exceptionally in middle-aged horses are the molars 
worn down to the root and mastication impeded. 
Cases occurring in early life are usually serious. They 
clearly result from individual idiosyncrasy, consisting 
in defective hardness of the enamel and dentine. The 
only useful treatment consists in giving soft and 
crushed food to assist mastication and prolong the 
workable period. 


(f) THE SMOOTH MOUTH. Fic. 15.—Metznik’s 
Tooth Shears. 


Enamel and dentine being of unequal hardness, the 
latter wears away more rapidly and produces the roughened fold-like 
appearance on the grinding surface of the molar, requisite for effec- 
tively triturating the food. But when enamel and dentine wear at the 
same rate the surface becomes even and polished. In advanced age 
this normally occurs, because in the deeper portions of the tooth the 
enamel ceases. It also occasionally occurs in young animals on account 
of insufficient hardness and durability of the enamel, and is more serious 
than in older horses. The smooth mouth during mastication resembles 
an uncut millstone during grinding. Mastication is of course less impeded 
when singie teeth are affected than when the condition is general. 

Treatment is confined to palliatives, giving crushed or ground 
grain, gruel, or bran mashes, and allowing longer time for feeding. 

The opposite condition in horses is termed “ ruminant’s mouth ” 
(Wiederkiuergebiss), The grinding faces become exceedingly uneven. 


36 DISEASES OF THE TOOTH PROPER. 


This is normal, however, so long as the molars have not come into wear ; 
but it rarely persists, and is seldom troublesome. 


(C) DISEASES OF THE TOOTH PROPER. 
(a) DENTAL CARIES (CARIES DENTIUM). Ger. Zahncaries, 


Lit.: Giinther, Beurtheilungslehre. Lafosse, Her. Rep., 26, p. 323. Var 
nell, The Vet., 1866. Wulff, Gurlt u. Hertwig, 19, p. 437. Stock- 
fleth, Chirurgie, p. 154. Kitt,, Monatsheft fiir pr. Thierh., 1892, 
p. 414. 


? 


The term “Caries” is used to describe the process which results in 
the gradual destruction of the cement and dentine of the teeth, the 
enamel remaining intact. In veterinary surgery this term is often erro- 
neously used to describe alveolar periostitis. I was formerly doubtful 
whether caries occurred in animals, but Kitt’s observations and my own 
later experience show that this opinion was not strictly correct, and I 
have lately seen some cases of undoubted caries in the molars of horses. 
Kitt has pointed out that in animals it takes the form of dry chronic 
caries, and Baume has noted the same fact in connection with ruminants 
and dogs. He states that the process starts either in the cement of the 
enamel folds, or in the centre of an “island” of dentine. Stockfleth and 
Kitt believe that caries starts in the remains of the osteo-cement pulp, 
that is, in the tissue, which in the embryo forms the cement. This 
material, or at least the space left by its contraction, is seen when a 
tooth is cut through with the shears. It begins just below the grinding 
surface, and reaches downwards as far as the involution of the enamel 
(Kitt). Sometimes it is even visible on the grinding surface, and food 
then penetrates, filling the cavity with a black powder. This decom- 
poses, micro-organisms develop in it, and the surrounding cement and 
dentine become carious; a hole thus gradually burrows in the tooth, 
and increases in size (fig. 16). The process, therefore, usually starts at 
the wearing surface, and, having destroyed the crown, extends to the 
base of the enamel cavity, and even to the pulp. The pulp cavity may 
then be crammed with particles of food (Stockfleth), and purulent 
alveolar periostitis result, with its attendant symptoms. The tooth 
itself takes a darker colour, and becomes loose. It may then split 
lencthways during mastication (spontaneous fracture), or pieces may 
break off (Kitt). 

Symptoms.—The disease is seldom recognised at first, the only 
sign being a scarcely appreciable darkening, generally on the wearing 
surface. At this point a cavity forms which gradually imereases in 
size (fig. 16), its walls, formed of the remains of the dentine, being of a 


DENTAL CARIES. ol 


black-brown colour. This stage is rarely noticed, and the disease only 
receives attention when the tooth has split and mastication becomes 
difficult, or when alveolar periostitis has set in. On attempting to 
extract the tooth it is found to be soft and fragile. 

The process may continue for long periods, and finally lead to more 
or less complete destruction of the affected tooth, though the production 
of alveolar periostitis or splintering usually necessitates extraction. 
When removed, one or more deep cavities are found in the dentine. 
Stockfleth says the disease occurs even at six or seven years of age, 
though it is commoner at nine or ten; but in older horses it is less 
frequent. 


Fira. 16.—Central dry caries of a horse’s upper molar (Kitt). 


Causes.—In man, caries is caused by decomposition of the fluids of 
the mouth, or of food remaining between the teeth. This process, without 
doubt, is assisted by micro-organisms, perhaps by the Leptothrix buccalis, 
and may extend to neighbouring teeth. In animals the disease probably 
depends on similar causes, but it is exceedingly rare. It is not known 
whether this rarity is due to the more rapid wear of the teeth in animals, 
or to some peculiar property of the saliva. Stockfleth considers that a 
predisposition to caries is often inherited. 

Prognosis depends entirely on the extent of the caries. In man its 
extension can be checked by “stopping” the tooth. With this object 
the cavity is drilled, cleared of all carious matter, thoroughly disinfected, 
and filled with some material which will protect the still healthy parts 
from further attack. This “filling” consists either of metal, like gold 
or amalgam, or of some other hard substance, such as cement. Very 
rarely, however, can this be done in animals, least of all in horses, It 
is, therefore, impossible to save a tooth when once attacked, the more 


38 DENTAL FISSURES AND CAVITIES. 


so as the condition is usually only noted when the disease is extensive. 
It then becomes a question whether the animal is able to masticate 
sufficiently with the teeth that will remain after those which are diseased 
are extracted. In the horse, caries seldom affects a number of teeth, 
hence this question is usually determined in the affirmative. Varnell 
states having used a stopping of gutta-percha, and Wulff a resin com- 
position. The details of both cases are, however, so meagre that it is 
impossible to say whether the condition was really one of caries. 
Possibly the stoppines served to replace lost teeth. Stoppings can 
certainly be used for this purpose (comp. p. 49). 

Treatment consists in early extraction. Care is, however, required 
in using the forceps, as the softened crown is liable to break off. The 
“Universal” forceps (p. 46) must not be screwed up too tightly, and 
if the tooth be loose particular care is necessary. Extraction is easiest 
where purulent alveolar periostitis exists, or where the tooth is splintered. 
In sueh ease Giinther’s pointed forceps are sometimes sufficient. 


(b) FISSURES AND CAVITIES IN THE TEETH. 


Fissuring is commonest in the molars. The fourth, which stands in 
the centre of the fan-shaped row, and suffers most under the severe 
friction of one grinding surface on the other, is most frequently affected. 
Without doubt want of hardness, which is often produced by caries, 
ereatly favours splitting, while other causes may lower the resistance 
of the tooth, Such conditions may possibly originate during feetal 
life, a view which receives confirmation from corresponding teeth on 
either side being often splintered. Hard substances accidentally present 
in the food also produce splitting, especially in animals which masticate 
energetically. Sometimes only a piece of the crown breaks off, but very 
frequently the crack extends as far as the root. The tooth may be 
broken into several pieces, which separate, injure the tongue or cheek, 
and make chewing painful. While fissuring is confined to the crown 
no serious consequences ensue; but should the fracture extend to the 
alveolus, particles of food and fluids may enter and inflame the alveolar 
periosteum (p. 40). 

Treatment consists in removing the splintered tooth, and is seldom 
difficult. Sometimes the pieces are too small to be grasped by ordinary 
forceps, and in such cases Giinther’s pointed forceps are useful. (Fig. 
21.) 


(c) DENTAL TARTAR. (Ger. Zahnstein, Weinstein ; Zaft. Cremor Dentium. 


Alike in animals. and men the fluids of the mouth deposit on the 
teeth a grey-brown coating called tartar. It is commonest in dogs and 


DENTAL TARTAR. 39 


vegetable feeders, but very rare in cats. Pet dogs suffer oftener than 
others. According to Fiirstenberg’s investigations tartar in dogs and horses 
consists principally of phosphate of calcium, carbonate of calcium, car- 
bonate of magnesium, and organic substances. Microscopical examination 
shows that the material is formed chiefly of vegetable particles, various 
bacteria, epithelium from the cavity of the mouth, and several salts of 
calcium held together by salivary mucus (Kitt). The deposit is oftenest 
seen on the outer surface of the crown, turned towards the cheek. 
It commences in the neighbourhood of the gums, and gradually spreads 
upwards and downwards. Incisors and molars are alike affected, the 
latter more frequently, but in horses the tushes are the commonest seat. 

A pale-yellow or ereenish-brown chalk-like substance, rather rough on 
the surface, covers that portion of the crown lying nearest the gum. In 
the dog it stands out clearly on the shining white surface of the tooth. 
Hertwig states that in goats tartar sometimes appears black and metallic 
from admixture of oxide of iron. 

The deposit spreading may completely encapsule the crown above ; 
while, as it increases below, it produces atrophy and necrosis of the gum. 
Here lies the chief danger. As soon as the alveolus is laid bare, it 
becomes inflamed by the fluids of the mouth. This is by far the com- 
monest cause of alveolar periostitis in dogs, and is especially frequent in 
house dogs (p. 50). 

The food decomposes in the alveolus, producing a grey slimy material 
which can be partly squeezed out by pressure, and has a peculiarly pene- 
trating odour. The eum is bluish-red and swollen, bleeds easily, and is 
sometimes studded with little abscesses. The disease has hence been 
named “scurvy ” by Hertwig, whilst, on account of the offensive smell, it 
is also known as “ mouth rot.” 

The black coloration, produced by feeding on husks and brewers’ 
grains, must not be confounded with tartar. Its exact nature is not yet 
known, but it affects only the surface of the crown. The significance of 
tartar lies in the possibility of its exciting alveolar disease. Provided 
the alveolus is healthy, recovery follows removal of the deposit ; but teeth 
already much loosened can only be extracted. The smell is often so 
offensive that the dog cannot be tolerated in the house. 

Treatment.—The deposit is removed with a blunt knife or similar 
instrument, avoiding injury of the gum or alveolus. In order to get 
rid of the incrustation, I often cause the teeth to be regularly cleansed 
for some time with pumice. Sporting dogs being the usual patients, 
these measures can be carried out thoroughly. The gum is protected by 
placing the instrument close to it, and working towards the top of the 
tooth. Immediately the tooth becomes loose, extraction is the only 
resource. 


40 ALVEOLAR PERIOSTITIS. 


(D) DISEASES OF THE ALVEOLI 


(a) ALVEOLAR PERIOSTITIS (PERIOSTITIS ALVEOLARIS). 


This is by far the commonest dental disease of herbivora and carnivora, 
and especially of dogs. As its development, appearance, and causes 
vary considerably in different classes of animals, it is advisable to study 
it separately in each class. 


(a) INFLAMMATION OF THE ALVEOLAR PERIOSTEUM IN HERBIVORA. 


Lit.: Giinther, Nebel u. Vix. 1, p. 330, u. Beurtheilungslehre. Bouley, Ree. 
de méd. vét., 1843. Haubner, Gurlt. u. Hertwig, 25, p. 362. Schindler, 
ibid. 28, p. 252. Plasse, Rec. de méd. vét., 1832, p. 30. Garen geot, 
Herings Operationslehre, p. 147. Lafosse, Her. Rep. 16, p. 323. Bouley, 
Ree. de méd. vét. prat. 185. Suth, Thierirztl. Mitth., 1856, p. 139, N. N. 
Her. Rep. 13, p. 178. Degive, An. de méd. vét., Bruxelles, 1887. Voigt- 
linder, Dresd. Ber., 1890, p. 39. Frick, Ad. Woch., 1891, p. 409. 


The roots of the teeth are fixed in the alveoli by the alveolar perios- 
teum or alveolar dental membrane. The outer layer of the periosteum 
lines the alveolus, the inner layer the root of the teeth. At the point 
where the periosteum becomes continuous with the outer surface of the 
jaw-bone, the gum is attached, and its function is to prevent foreign bodies 
like food entering the alveolus. 

Alveolar periostitis may be defined as inflammation of that portion of 
the periosteum lining the alveolus. It almost always results from injury 
to the eum, or its separation from the tooth. Fissures of the tooth 
reaching to the root, and laying open the root-canal, occasionally produce 
it. Portions of hard food, especially hard chaff, easily insinuate them- 
selves between the tooth and the gum, and remain fast, movements of the | 
tongue and cheeks not sufficing to remove them. Purulent periostitis, 
with separation of the periosteum from the tooth, supervenes. Masses 
of food penetrate into this enlarged space, widening the division between 
the alveolar wall and the tooth, and increasing inflammatory action. 
Separated from the periosteum, the tooth loses its firm seat in the 
alveolus, and, yielding to the pressure of its neighbour, is diverted from 
the common line, and may be so displaced that it can be removed with 
the fingers. Its root appears completely denuded of periosteum, and 
bathed in pus. Similar results are produced by the entrance of food 
between the teeth, as happens especially when the crowns are not in close 
contact. In dogs and horses I have repeatedly seen alveolar periostitis 
result from epulis, the tumour, either a sarcoma or carcinoma, having 
loosened the tooth and allowed food to enter. The disease develops 


GENERALLY AFFECTS THE THIRD AND FOURTH MOLARS. 41 


more rapidly when the tooth has been fissured, allowing food or fluid to 
enter the alveolus, and when compound fractures of the jaw extend to 
the alveolus. Less frequently the malady arises from the root canal. 
During wear of the tooth the canal is progressively closed with cement 
substance. But should wear outstrip this protective process, the root 
canal and pulp are laid bare on the grinding surface; food or decompos- 
ing buccal secretions enter, and occasion purulent inflammation of the 
pulp (pulpitis purulenta). This may extend downwards to the base of 
the alveolus, reach the alveolar periosteum, and finally produce purulent 
periostitis. 

Kitt states that in the molars of old horses the central invaginated 
portion of enamel becomes worn away and the pulp chamber exposed. 
Food then enters and produces pulpitis, which extends to the alveolar 
periosteum. 

In the front molars alveolar periostitis is sometimes due to external 
injury to the lower border of the jaw, but in such cases it usually 
remains localised. A predisposition to alveolar periostitis is observed in 
various forms of faulty mouth, especially in the shear mouth, and where 
the teeth are far separated. In consequence of their shehter make and 
lesser strength, the lower molars are oftener diseased than the upper. 
The third and fourth molars are most commonly affected, which Giinther 
ascribes to their central position in the fan-shaped arrangement (fig. 25), 
and to their consequent exposure to powerful compression both from in 
front and from behind, 

Alveolar perostitis of the mcisors is very rare in horses and ruminants, 
is generally of a secondary nature, and due to injury of the interdental 
space or compound fracture of the alveolar process. 

Though single teeth are often affected, it is common for several to 
become diseased together, frequently corresponding teeth, ike the two 
third lower molars. The cause of this symmetrical occurrence is not 
quite clear, though it may be due to abnormalities during development. 
Where several neighbouring alveoli are diseased, and especially where 
the teeth are very loose, a suspicion of some new growth is always 
justified. Many cases remain confined to the alveolus. The tooth may 
be loosened and finally fall out. Sometimes inflammation seizes on the 
thin plate of bone which forms the alveolus and extends to the medulla. 
Osteomyelitis thus results. This irritates the periosteum of the outer 
surface of the bone, and produces periostitis, which causes the bone to 
swell. Finally the pus breaks through the bone, and a dental fistula 
results. After discharge of the pus, granulations form, and the point 
of perforation heals up, until only a narrow channel remains communi- 
cating with the root of the tooth. This persists (compare “dental 
fistula”). In disease of the upper molars, the pus sometimes breaks into 


42 ALVEOLAR PERIOSTITIS. 


the superior maxillary sinus. Perforation into the nasal cavity may 
follow disease of the pre-molars and produce a chronic nasal discharge. 
F. Giinther has described cases of this kind in horses. Occasionally the 
alveolar wall becomes necrotic, and extensive periostitis ensues. Fig. 17 
shows how much a tooth may be displaced. The last molar lay hori- 
zontally, and under it a piece of bone of the size of a hen’s egg had 
become necrotic. 

The appearances consist in slow, interrupted, one-sided mastication, 
rolling of the tongue, slobbering, and dropping food from the mouth. 
Even from the outside it may be discovered that one or other of the 
teeth are displaced ; while the buccal pouches are distended with masses 


Fic. 17.—Necrosis of a dental alveolus, with dislocation of the last molar and extensive 
periostitis of the lower jaw (horse). 


of food. On passing the hand into the mouth, the exact displacement 
is ascertained. The pecular, repulsive so-called “carious” smell, 
especially noticeable in the retained masses of food, is quite character- 
istic of alveolar periostitis. In dogs the smell, whilst very offensive, is 
somewhat different to that in horses. Closer examination shows that the 
gum has receded from the affected tooth, which is so loose as sometimes 
to be movable by the fingers. It is usually pushed out of line or hes 
deeper than the others. As might be expected from the direction of 
their wearing surfaces, the upper molars are generally displaced 
outwards, the lower inwards. 

In cattle, epileptiform seizures occur. In chronic cases the animal 
wastes. In the lower jaw the bone sometimes swells and fistulee form, 
indicating the position of the diseased tooth. If the interior of the 
mouth be illuminated by a mirror, changes in the teeth as well as in the 
gums may usually be very plainly seen. 


EXTRACTION OF TEETH. 43 


Extraction is the only certain method of dealing with alveolar peri- 
ostitis. This is comparatively easy in old subjects, whether horses or 
oxen, but may be more difficult in younger animals, especially when the 
crown of the tooth is broken, as not seldom happens. Several teeth 
may be simultaneously diseased, or one soon after the other, and under 
such conditions the prognosis is less favourable. It may then be a 
question whether the animal, with its still remaining teeth, can chew 
sufficient food, and vegetable feeders frequently cannot do so. 

The treatment and only cure for alveolar periostitis in the larger 
animals lies in extraction of the faulty tooth. Operating on man and 
small animals requires considerable strength, and a vastly greater degree 
is needed in herbivora, and especially in horses. The two Giinthers 
have rendered their profession valuable service in constructing the 
necessary instruments for operations on the teeth of horses, and laying 
down the general principles for their use.' Punching out the diseased 
tooth, as adopted in former times, is now employed only where the 
forceps cannot be used, owing to the loss of the crown. Where the 
anterior molars of the upper jaw are diseased, it is still employed. The 
operator commences by trephining the jaw bone as nearly opposite the 
root of the affected tooth as possible. The success of the operation 
depends on the choice of the proper spot. In the upper jaw the land- 
mark is the lower end of the zygomatic ridge of the superior maxillary 
bone, which hes at the division between the third and fourth molars. 
Alterations in the diseased tooth or its gum may usually be detected by 
introducing the hand into the mouth. Should the tooth be displaced 
and loose, there need be no doubt as to its condition. A round punch 
about one half to three quarters of an inch thick and with a flattened 
end is now placed on the root of the diseased tooth, care being taken 
that the punch points in the general direction of the tooth itself. A 
few strong blows on the punch with a rather heavy hammer drive the 
tooth from its socket and it falls into the mouth. The pain of the 
operation makes the use of an anesthetic desirable, and even in deep 
narcosis some animals react to the blows of the hammer. Only the 
pre-molars and the two first molars of the upper jaw can be removed by 
punching. The last molar having its root in the hindmost portion of 
the superior maxillary sinus cannot be so reached, nor can the molars of 
the lower jaw, lying as they do too far from the lower edge of the bone. 
Care should be taken in using the punch only to strike the affected 
tooth, otherwise neighbouring teeth, or even the maxillary bone may 
be split. During extraction a mouth gag must be used to allow 


‘T cannot refrain from drawing attention to the work done in this field by the late 
Principal Robertson, and by Mr Gowing of London, who have rendered equally valuable 
services to their English colleagues.—[TRANSL. ] 


44 GUNTHER’S DENTAL INSTRUMENTS. 


of the hand being introduced to catch the tooth and prevent its being 
swallowed. Bouley and Stockfleth, by performing an cesophageal opera- 
tion, succeeded in removing teeth which had been swallowed; but in 
another case the tooth produced perforation of the ceecum and death. 
In the upper jaw it is necessary to avoid injuring the seventh nerve, in 
the lower jaw the fifth. After removing the tooth the socket is plugged 
with a piece of antiseptic tow or jute, which, if possible, should be renewed 
daily. The opening usually closes in three to six weeks, but sometimes 
not till later; occasionally a fistula remains. Bad results seldom follow 
skilful removal, but where the tooth or jaw bone are splintered serious 
bleeding or pus formation may ensue. 

The use of the forceps is much preferable to the above described 
process. It is simpler and less painful, although requiring some prac- 
tice, strength, and judgment. Drawing a tooth is much less difficult 
in old than in young animals, in which the molars, having been little 
worn, are still long. 


In such eases attention must be paid to the following points :— 

1. Choice of Forceps.—Those designed by F. and K. Giinther, and described 
by them in their “ Exterieur des Pferdes,” are amongst the best. They must be 
very strong, so as not to spring much, but not very thick in the jaws, as this 
makes adjustment difficult. As the horse’s molars do not lie parallel to one 
another, attention must be given to the direction of the pull, and Giinther there- 
fore constructed especial forceps for each tooth. Forceps acting as levers of the 
first class, and those as levers of the second class, must be distinguished. In the 
former the jaws are at the end (figs. 18 and 19), in the latter at some distance 
from it (figs. 22 and 23). As the molars are arranged in a fan shape, the 
crowns of the pre-molars look backwards, those of the molars forwards; and as 
it is of the greatest importance that the pull should come in the direction of the 
axis of the tooth, it is clear that the second class lever forceps are suitable for 
the pre-molars, the first class lever for the molars. For the upper pre-molars 
the forceps must be somewhat bent just in front of the jaws, so that in pull- 
ing their legs may not strike against the incisors of the lower jaw (fig. 23). 
Forceps for the upper molars require wider jaws or removable joints. The 
limbs of the molar forceps must be very long. In using them force has to 
be exerted in two ways—firstly, to grasp the tooth, and secondly, to remove 
it. Attempts have therefore been frequently made to assist the operator by 
special arrangements in the forceps. The simplest addition is an S-shaped hook, 
but as this must be provided of many different sizes, it is not very practical. 
Wendenberg fixed to one leg of the forceps an iron chain, with links perforated 
with holes, so that after placing one leg of the forceps in position these 
could be pushed over the other limb. Gowing constructed forceps operated by 
a screw, like Plasse’s. These arrangements are, however, too complicated and 
difficult to handle. Pillwax tried to lessen the exertion required by a contriv- 
ance, which Haubner, however, declared useless. Schindler’s forceps, like those 
made by Trautwetter, are too complicated. It is to be hoped that some device 
will yet be discovered to replace or assist the excessive exertion of power 
required. Up to the present, however, none of the discoveries tending to this 
object can be described as practical. Frick and Hauptner have lately con- 


CHOICE OF FORCEPS. 45 


structed forceps in which the power required for gripping the tooth is furnished 
by a screw. This instrument has the further advantage that it can be used 
either as a first or second class lever forceps. Fig. 24 shows its construction. 
The two limbs are turned on their long axis by the screw at the end, and the 
mouth of the forceps closed. 

The use of the double lever forceps requires fulcra or pivots of different 
thicknesses. In young horses the pre-molars and their crowns are directed 
backwards, the molars forwards (the second and third more than the first), and 


Fic. 18. — Giinther’s Fic. 19. —Giinther’s Fic. 20.—Giinther’s Fic. 21. — Giinther’s 
Forceps for upper Forceps for lower Exporteur. beaked Forceps. 
molars. molars. 


these facts must be kept in sight both in applying the forceps and in choosing 
fulera. The direction of the pull or traction line must follow the longitudinal 
axis of the tooth. As will be seen from fig. 25, which shows the teeth of a 
middle-aged horse, the roots of the pre-molars point more or less forwards, whilst 
those of the molars take an opposite direction. The pre-molars accordingly must 
be grasped deep down and a thick fulcrum selected. In drawing molars the 
practice is reversed ; the tooth is gripped just below its upper surface ; the pivot 
should be thin ; better still, a pair of second class lever forceps may be used. 
‘In old and quiet horses the tooth may be drawn standing ; younger and 
fidgety animals are better cast. A halter is put on and a mouth-gag inserted. 


46 ADJUSTMENT OF THE FORCEPS. 


An assistant sitting on the horse’s neck directs its head towards the light, whilst 
another passes a cord across the upper interdental space, and draws the head 
upwards and backwards. 

The operator having satisfied himself as to the condition of the mouth, and 
provided the proper forceps and fulcrum, performs extraction, which may be 
divided into the following three stages :— 

(a) Adjustment of the forceps.—In carrying this out, the above facts must be 


Til th 
NAT 


Fic. 22.—Giinther’s Forceps Fic. 23.—Giinther’s Forceps Fic. 24.—Frick and Hauptner’s 
for first lower molars. for first upper molars. Forceps. 


remembered. Difficulties often arise at once; sometimes room is wanting 
between tooth and cheek, either because the jaws of the instrument are too thick, 
or because food has accumulated ; or, finally, because the crown of the tooth has 
been pushed against the cheek. In the first case another pair of forceps is 
selected ; in the second, the food is removed with a toothpick (fig. 26) ; in the 
last the tooth should be pushed back, if possible ; or if this is impracticable, the 
opening of the gag must be diminished, and the jaw pushed sideways in the 
direction of the displaced tooth. 

Sometimes room is wanting between the upper and lower row of teeth. 
Should the size of the forceps be to blame, they should be changed ; where the 


DIAGRAM OF POSITION OF HORSE’S TEETH. A7 


opposite tooth is too long, it must be cut shorter or removed. In placing the 
forceps in position, care is required not to grasp more than the diseased tooth. 
In extracting pre-molars, one hand is introduced into the mouth to guide the 


Fic. 25.—Showing upper and lower molars 7 situ. 


instrument. The displacement of the tooth often simplifies the determination 
of its position and the adjustment of the forceps. In using the Frick-Hauptner 


Fic. 26.—Tooth Pickers (Giinthey). Fic, 27.—Fulera. 


forceps (fig. 24), the correct position is assured by counting the teeth in front of 
the jaws of the instrument. 
(b) Teeth that are still firm can be loosened by light side movements of the 


48 PRECAUTIONS IN EXTRACTING HORSES’ TEETH. 


instrument. But to avoid breaking the crown of the tooth or fracturing the jaw, ' 
it is needful to proceed slowly and cautiously. 

(c) Adjustment and selection of the pivot.—When using a first class lever 
forceps, as already stated, the selection of the fulcrum must be made with a 
knowledge of the general direction of the axis of the tooth, to which the fulerum 
should be brought as near as possible, in order to give greater leverage. 

(d) Now follows the extraction of the tooth.—The operator takes up a firm 
position, with his elbows on his sides, and giving the word to hold fast, exercises 
a steady but strong pull on the forceps, throwing on them the weight of the 
body. The power required to draw a tooth in the prone subject is developed 
by the muscles of the thigh, the power of the arms not being usually sufficient. 
The arms, or rather the hands, are employed in grasping the limbs of the forceps, 
so as to retain hold of the tooth. Should the attempt be successful, the tooth is 
felt to yield, and a loud hissing noise may sometimes be heard, due to the air 
rushing into the alveolus. In such case the tooth ts still firmly held, but the 
pull is relaxed for an instant. A deeper fulcrum is slipped under the forceps, 
and a light pull will now generally remove the tooth. As in young animals the 
teeth are longer, a fresh and deeper hold is often needful. Short teeth can be 
removed directly with the forceps, but longer ones may require the assistance of 
the hand or exporteur (fig. 20). The opposite teeth sometimes prevent removal 
of the loosened molar. In such cases more room must be made, either by 
opening the gag further, or by closing it and pushing the lower jaw to one side, 
in order that the two rows of teeth no longer oppose each other. The tongue, 
however, should not be loosened, for fear of the tooth falling into the mouth and 
being swallowed. If, during extraction, the animal makes violent movements 
with the head, the operation is stopped, but the movements are followed by the 
forceps. This is especially necessary when operating on horses standing. If the 
forceps are held rigidly, the jaw may easily be fractured by the animal’s own 
movements. If the forceps are not firmly held they may slip off the tooth and 
require to be readjusted. Should this happen repeatedly, and, even after con- 
siderable efforts, no loosening of the tooth occur, endeavour must be made to 
discover the cause of failure, which most frequently results from an improper 
hold having been taken, the pull being in a wrong direction, or several teeth 
being grasped. A change of forceps or of pivot is often desirable. It may be 
repeated, that the direction of pull should correspond with the axis of the tooth, 
otherwise power is lost by the tooth grasped being forced against its neighbour. 
In certain cases, like dental fistula, exostoses, either in the alveolus or on the 
tooth, render extraction very difficult, or even impossible. For extracting molars, 
Plasse, Gilmeister, Delafond, Garengeot, and others recommend a tooth-key, 
resembling that formerly used in human dentistry. But Lafosse has very rightly 
pointed out that, unless for removing the short teeth of old horses, this instru- 
ment is useless. The extracted tooth generally shows evidence of pathological 
processes. Where purulent periostitis has existed, the root is roughened and 
denuded of periosteum. Other portions of the root exhibit shreds of periosteum, 
and sometimes exostoses. 

Treatment after extraction is seldom necessary, but when cleansing the partsa plug 
of tow or jute soaked ina disinfectant may be introduced into the tooth socket. It 
is particularly useful where dental fistulze have existed, but must be renewed daily. 

In drawing several teeth at one time, it is well to first extract the lowest and 
most posterior. This minimises the difficulties caused by bleeding. Cases of 
unusually large teeth have been reported. Degive extracted a horse’s tooth which 
weighed 15 ounces. Teeth are recorded to have been successfully transplanted, 
but such reports must be received with caution. South describes having, in 


PRECAUTIONS IN EXTRACTING HORSES’ TEETH. 49 


1886, replaced a carious third molar by a similar tooth removed from a dead 
horse. How long this remained in position is not stated. In 1887, in the 
clinique of the Berlin college, the first upper molar of a cart-horse was removed 
by punching, as the tooth crown was broken away. In 1890 the horse was 
brought back, the owner stating that it had for a long time suffered from an 
offensive nasal discharge. An examination showed that the left nostril was 
blocked with masses of food, which had entered by an opening in the now 
empty alveolus. The passage was large enough to admit the little finger. The 
upper maxillary sinus proved healthy on trephining. After carefully removing 
every particle of food from the nostril, and cutting down the overgrown first 
molar of the lower jaw, the alveolus was thoroughly cleansed and stopped 
with a mass of gutta percha, softened in 
hot water. To give it a more secure hold, 
I had previously filed a few grooves on the 
teeth on either side. The nasal discharge 
ceased after this operation, and several weeks 
afterwards I found the gutta percha still 
in position, and quite fulfilling its object. 
Mastication appeared in no way disturbed, and 
the horse lived for several years in the same 
condition. Voigtlander describes a similar case, 
though the horse had finally to be killed. 

As a curiosity, I may relate a communication 
from Paris describing the extraction of an ele- 
phant’s tusk which measured 14 yards in length. 
This was first sawn off, and the root, which 
weighed 18 lbs. (?), then drawn with forceps. 
The elephant suffered a good deal, but is said 
to have completely recovered. (Her. Rep. vol. 
xa ps 178.) 

It is seldom needful to extract incisors, though 
the operation is often done by horse-dealers to p,, 98 _ Gun- Fre. 29.—0 einone 
give horses the appearance of greater age. The  ther’s Forceps for Forceps for the 
operation is called for where milk teeth remain — the incisors. incisors. 
confined between the permanent incisors, or 
where the inter-maxillary or sub-maxillary bone is fractured and the alveoli exposed- 

Giinther’s forceps are the best (fig. 28). The projection just in front of the jaws of 
the instrument serves asa fulcrum, and should be rested on one of the neighbour- 
ing teeth. Incisors can also be pulled with human forceps made rather longer 
and stronger than usual (fig. 29). The same instrument serves as an exporteur. 


(}) INFLAMMATION OF THE ALVEOLAR PERIOSTEUM IN CARNIVORA. 


Dogs, especially those kept in the house, are the most frequent suf- 
ferers. Compared with that in herbivora, the disease differs both in its 
advent and progress. A large number of teeth are usually attacked, 
sometimes nearly all; both molars and incisors suffer, and old dogs may 
be reduced to an absolutely toothless condition. 

Symptoms.—The edges of the gums are swollen, more or less 
reddened, and bleed on the least touch. At points where the tongue 


cannot reach, as along the external borders, the gums are moist with a 
D 


50 ALVEOLAR PERIOSTITIS IN CARNIVORA. 


grey slimy fluid of a particularly penetrating odour. The crowns of the 
teeth are partly covered with grey chalky masses of tartar, which 
intrude under the gum in the direction of the alveolus, loosening the 
tooth, and causing it to fall out. Where the disease is extensive, the 
animals salivate freely, eat badly, and either avoid gnawing bones, or 
whine occasionally during the process, whilst 
the mouth emits a most offensive smell. 

The condition was formerly regarded as 
systemic, and received such names as scurvy, 
mouth-rot, &e. But no fever or other consti- 
tutional symptoms are present, and recovery 
takes place as soon as all diseased teeth are 
removed. The formation of tartar, as already 
stated, is the immediate cause of alveolar 
periostitis. It is deposited on the teeth, 
and continually advances towards the gums, 
producing inflammation and necrosis. The 
alveolus is finally exposed, putrefactive or- 
ganisms enter from the mouth and keep up 
Curved and straight dental Forceps ‘Me inflammatory action. The grey stink- 

for dogs. ing material discharged when the tooth is 
pressed upon consists almost entirely of putrefactive bacteria. A pre- 
disposition to this formation of tartar exists in certain small races of 
dogs, possibly caused by inappropriate feeding. 

Preventive treatment calls for the removal of tartar before alveolar 
disease has appeared. The incrustation can be scraped off in the 
manner described (p. 59). It is advised to paint the diseased spot 
with a 2 to 5 per cent. solution of alum or permanganate of potassium, 
which is further useful in removing smell. All loose teeth must be 
removed, otherwise success will never be attained. 

In dogs, extraction presents no difficulty: an assistant holds the 
animal, and human forceps may be used. The tooth is seized with 
forceps of suitable size, and a rapid drawing movement made, usually 
towards the tongue. Operating on the right side, torsion is made 
towards the left, and vice versa. The crown is usually firm, but the 
root loose. The tooth key may be used if thought suitable. 


Pia. 30: 


(bo) DENTAL FISTULA. 


Lit.: Reul, Annal. de Belg. 1885, p. 61. Hertwig, Gurlt u. Hertwig. 25. 
p. 510. Greiner, Oestr. Monatschr. 1890. 


This may be defined as a tube-like canal communicating at one end 
with the external air and at the other with a tooth root or socket. It 


DENTAL FISTULA. oi 


almost always results from alveolar periostitis, the inflammatory pro- 
cess extending and producing an osteomyelitis purulenta, which finally 
leads to perforation externally. Inflammation then abates, until the 
alveolus alone remains inflamed. The small quantities of pus produced 
find exit through the communicating sinus. 

Dental fistula occurs oftenest in young horses. It affects the first and 
second pre-molars, seldom the third, and is com- 
moner in the lower than in the upper jaw. Fistula 
is very rare in the molars, because their roots are 
covered by thick masses of muscle, and in the upper 
jaw project into the superior maxillary sinus. 
Despite these facts, such fistule do occur. They 
open into the superior maxillary sinus or into tie 
nostril producing empyzema of the sinus and chronic 
nasal discharge, which betrays the peculiarly offen- 
sive smell of alveolar periostitis. In dogs, dental 
fistulae originate most frequently from the upper 
molars. The outer opening is usually near the 
lower eyelid, and might be mistaken for that 
of a lachrymal fistula, were it not that probing 
shows it to communicate with a molar tooth. 

Causes.—Fistule, though generally preceded 
by alveolar periostitis, may be produced by com- 
plicated fractures or injuries of the maxilla. Hert- 
wig believed pre-molar fistule in the lower jaw 
to be commonly caused by wounds inflicted by 
narrow and inclined mangers. I can support this py. 32,—Periostitis alveolaris 
view, having seen many cases of pre-molar fistula eee abcelesttnicel ap lar 
exhibiting no disease of the alveolus, but traceable 
to external injury of the posterior border of the lower jaw. The 
root of the tooth is often thickened, surrounded by actively-grow- 
ing granulation tissue, which becomes covered with fresh cement; 
a periostitis alveolaris ossificans results, with formation of hyperos- 
tosis radicis (fig, 32), and extraction is rendered difficult, or even 
impossible. 

The, Appearances consist of a little funnel-shaped depression in the 
skin, either of the lower margin of the under jaw, or of the upper jaw at 
the height of the roots of the pre-molars. A fine sound, about half a line 
in thickness, being introduced, meets with a hard substance—tooth, bone, 
&c. Round the external opening and over the course of the canal the 
bone is rarefied and swollen. Mastication is not always impeded. 
Examination usually betrays signs of alveolar periostitis in the affected 
tooth. Sometimes the fistula possesses a second opening in the gum. 


Ly DENTAL FISTULA. 


Prognosis.—Removal of the diseased tooth is essential. Hertwig 
describes a cure after application of the actual cautery and mopping with 
tincture of aloes, but such recoveries are exceptional. When the lower 
pre-molars have become diseased from external injury, recovery sometimes 
takes place without removal of the tooth. But even here the earious 
root often continues to promote pus formation, and regenerative processes 
are unequal to the task of separating the necrotic tissue—a condition 
obviously very unfavourable to healing. Moreover, in such cases there 
is generally a difficulty in extracting the tooth. With fistula affecting 
the upper jaw a radical cure is impossible without removal of the tooth. 
In prognosis account must be taken not only of the disturbances 
caused by the diseased tooth, but also of the dangers of extraction. 
Where inconvenience is slight, it may appear advisable to refrain from 
treatment. If, however, the fistula opens into the upper maxillary 
sinus or nostril, the tooth must be removed and the sinus trephined. 
Where perforation into the nostril is attended with necrosis of the 
turbinated bones, which I have often seen, the prognosis is unfavour- 
able. The nasal discharge continues after extraction of the tooth, 
and betrays the peculiar smell of bone pus. After a time pieces 
of the turbinated bones become loose, and are discharged with the nasal 
fluids. Where, however, pus formation and necrosis have not taken 
place, recovery usually occurs soon after removal of the tooth. But it is 
unwise to prophesy the termination—time alone can determine. To 
detect perforation into the nostril, Giinther’s catheter for the guttural 
pouch may be employed. On introducing it into the lower meatus, 
the point where the fistula opens will be felt as a raised and uneven 
patch. 

Treatment may be attempted without sacrifice of the teeth if the 
fistula has resulted from an external injury, and produces no serious 
inconvenience, and if the teeth in question give no evidence of disease. 
Proceeding on general surgical principles, the canal is washed out, and 
its walls scraped with the curette, or cauterised with the pointed iron, or 
with such caustics as chloride of zinc (1-10). If the alveolus is diseased 
the tooth is removed, and little further attention is required. Healing 
is hastened by inserting a plug of tow, saturated with a disinfectant. 
This may be renewed daily. The cork advised by Lafosse is not to 
be recommended. 


(c) NEOPLASMS OF THE GUMS AND ALVEOLI (EPULIS). 


Lit.: Dammann, Gurlt. u. Hertwig. 31. p. 290. Roloff, das. vol. 34. 
Keiper, das. 33. p. 53. 


Under the common title of epulis are grouped all tumours originating 


- 


NEOPLASMS OF THE GUMS AND ALVEOLI. 53 


in the gum or alveolus. The special neoplasm is indicated thus: epulis 
sarcomatosa, carcinomatosa, &c. Dammann saw in horses cancerous 
tumours of considerable size, which sprang from the necks of the incisors. 
Roloff has deseribed an epulis sarcomatosa in horses and cattle, and [ 
have repeatedly seen such cases both in horses and dogs. The swell- 
ings found on the gums or on the neighbouring mucous membrane in 
herbivora, and especially in horses and cattle, which result from invasion 
by actinomyces or bothryomyces, are nearly related to these growths. 

Diagnosis is not difficult. The new growth may attain such 
dimensions as to hinder mastication; then the teeth at the affected spot 
become loose and fall out, while symptoms of alveolar periostitis are 
present. Where in herbivora several neighbouring teeth are loose, one 
should always look for epulis formation. Keiper observed a rapidly 
growing neoplasm in a foal after fracture of the lower jaw, which he 
regarded as sarcoma. In fourteen days it attained the size of a child’s 
head, and, owing to its position near the incisors, interfered with feeding. 
As it recurred after removal, the foal was killed. The prognosis is 
usually unfavourable. As soon as the new growth spreads beyond the 
alveolus its complete removal beomes very difficult. From any portions 
remaining the tumour is apt to grow again. 

Treatment consists in complete extirpation, which, owing to the 
position of the tumour, is difficult. As the operation is very painful, 
an aneesthetic should be given. ‘The growth may then be dissected 
out, the last traces being removed with the curette or actual cautery, 
Paquelin’s form being the most useful. 


IIl—DISEASES OF THE NOSE, NOSTRILS, AND THE 
SPACES COMMUNICATING WITH THEM. 


(1.) WOUNDS OF THE ALA OF THE NOSTRILS. 


Lit.: Giinther, Nebel u. Vix, Zeitsch. vol. i. p. 321. Dusseau, Her. Rep. 
13, p. 344. 


These occur most frequently in horses, which, when rapidly moving the 
head, may chance to catch the nostrils on such objects as hooks or nails. 
Sometimes they result from bites from other horses. Some savage tribes 
slit the false nostril, thinking to assist breathing. Injuries to the nose 
are less frequent in other animals, Though they generally take the form 
of torn wounds, they heal steadily and quickly owing to the abundant con- 
nective tissue in their neighbourhood. But immediately the cartilaginous 
portions of the nose are injured, healing becomes difficult. Inflam- 


54 WOUNDS OF THE ALA OF THE NOSTRILS. 


mation of the cartilage is apt to result, causing chronic inflammation 
and thickening. In this way stenosis of the nostrils may be produced 
and the breathing affected, as happened in a case recorded by F. 
Giinther. | 

Treatment of fresh wounds, especially of the nasal cartilage, should 
aim at healing by first intention. The parts must be cleansed, the 
edges of the wounds freshened and disinfected, and brought together 
with pin sutures, so as to lie firmly in apposition. The wound should 
then be painted with collodion or wound gelatine, and the horse put on 
the pillar reins to prevent his rubbing out the stitches. In working- 
horses small flaps of skin may simply be cut off. Healing is usually so 
perfect that neither the area of the nostril, and consequently the 
breathing, nor even the horse’s appearance suffers. 


(2.) FRACTURE OF THE NASAL BONES. 


These fractures generally occur in horses from their running away, 
and the nose being brought in collision with some hard object. Falls, 
kicks, or powerful blows also produce them. In other animals the 
accident is rare. The fracture may be single or double-sided, longi- 
tudinal or transverse, subcutaneous or complicated. Fragments of bone 
may perforate either the skin or mucous membrane, and thus produce a 
compound fracture. 

Diagnosis is not difficult. There is usually deformity of the nose 
and the neighbouring parts, bleeding from the nostrils, and sometimes 
difficulty in breathing, produced by narrowing of the nostril or accumu- 
lation of blood. Injuries to the Jachrymal duct are indicated by the 
appearance of blood-stained tears and ecchymoses in the inner canthus 
of the eye. Diagnosis only becomes difficult where much swelling exists. 

Prognosis is seldom unfavourable. So long as the fracture is sub- 
cutaneous and no great displacement exists, complete recovery may be 
looked for. In severe displacements, and especially where both nostrils 
are fractured, an asthma nasale may remain. Caries of the turbinated 
bones sometimes follows compound fractures. 

Treatment of subcutaneous fractures without much dislocation 
requires nothing more than some days’ rest. Complicated fractures 
must, as far as possible, be antiseptically treated, loose splinters of bone 
removed, and dislocated bones replaced. Where portions of bone have 
been driven inwards, replacement is most difficult, but in large animals 
may be effected by introducing into the nostril a stick, with the rounded 
end wrapped in lint or tow, and therewith pressing the bone forcibly 
outwards. But care must be taken not to convert a simple into a com- 


FOREIGN BODIES AND TUMOURS IN THE NOSTRILS. 55 


pound fracture. In some cases it is advisable to trephine, and remove 
pieces of bone which have been pushed into the nasal meati. It must 
not be forgotten that dyspnoea may be produced by general swelling of 
the nasal mucous membrane, and that during the first forty-eight hours 
tracheotomy may become necessary. The owner should be warned of 
this contingency, especially when the practitioner lives at a distance. 
In certain cases it may be advisable to at once perform the operation. 


(3.) FOREIGN BODIES AND TUMOURS IN THE 
NOSTRILS. 


Foreign bodies occasionally obtain entrance to the nostrils of horses 
and cattle, and remain for long periods 7 situ. Sponges or similar 
objects have even been inserted into the nostrils of horses in order to 
conceal a discharge, such as that of glanders. Hermann found a wisp 
of straw, Korner a piece of ribbon, in a horse’s nostrils. In a horse I 
had under treatment the lower meatus was discovered to be full of 
food, which had entered through the alveolus of a molar tooth (p. 49). 
Dusseau, in making the autopsy of’a horse, found in the nostrils forty 
bean-like, hard white bodies, consisting of dried mucus and epithelium, 
and believed them to have been formed in the guttural pouch. 

New growths, in the form of polypi, often occur in the nostrils. 
According to Ercolani, Cato and Absyrtus were acquainted with nasal 
polypi; and in 1784, Icart is said to have removed one weighing 13 lbs. 
from a horse. The growths are most commonly fibromata and myxo- 
mata, though lipomata and carcinomata have been found (R6ll). They 
often originate from the cribriform plate of the ethmoid or the lateral 
wall of the nostril. Gurlt has seen them develop from the nasal 
septum, Rizot from the turbinated bones. Hamburger discovered an 
extensive myxofibroma in the septum nasi, whilst Lammers met with 
a case where the mucous membrane was thickened, and showed cavities 
containing numerous examples of strongylus armatus; Kitt observed a 
sarcoma in the nostril of a dog. Strerath found tuberculosis of the nasal 
mucous membrane in a calf. The animal had shown difficulty in 
breathing after taking food or water, and usually breathed through the 
mouth, making a snoring noise. ‘The growths were of varying size, 
some as large as grains of corn, some like peas, others again were 
confluent and gave the membrane a fatty appearance. Strebel 
described a cyst containing a piece of bone, which he found in an ox. 
He considered it had originated in the ethmoid bone. New growths 
oceasionally extend into the nostril from the brain cavity and maxillary 


sinuses, 
Symptoms.—Both tumours and foreign bodies in the nostrils pro- 


56 FOREIGN BODIES AND TUMOURS IN THE NOSTRILS. 


duce a muco-purulent discharge, which is generally one-sided, and often 
accompanied by bleeding. The pharyngeal glands are usually swollen. 
The air-stream from the affected nostril is weaker, and not infrequently 
a loud breathing sound is present, constituting asthma nasale. Com- 
pression of the lachrymal duct produces overflow of tears. When the 
condition becomes further developed, the nasal bones appear swollen. 
More exact information as to the nature of the case is obtained on 
examination with a speculum, with a sound, or merely with the finger. 
Polypi sometimes become so long as to protrude from the nostril. Where 
they start from high in the meatus, the earliest symptoms are the 
before-mentioned asthma nasale and swelling of the nasal bones, but 
if their origin is low down, they may be felt and even seen soon 
after dyspnoea begins to be apparent. When in the latter position they 
usually grow from the outer wall of the meatus, just over the base of 
the false nostril. This is a fact to be remembered both in diagnosis 
and treatment. 

Treatment, to be successful, requires the removal of the foreign 
bodies or new growths. Necrosis of the turbinated bones and such 
complications are frequently irremediable. Foreign bodies can, as 
as a rule, be seized and removed with a pair of dressing forceps. 
Sometimes it is sufficient to wash out the nasal cavity with a powerful 
jet of water. In men, foreign bodies can be removed by blowing 
forcibly into the other nostril. New growths, seated in the lower part 
of the nostril, may be extracted with the help of the so-called polypus 
forceps or Leverett’s hooks (decapitating hooks). When somewhat 
above this, and especially if on the outer wall of the meatus, they may 
be removed thus :—An incision is made at the point of junction of the 
nasal and inter-maxillary bones and on the inner side of the false 
nostril parallel with the nasal bone, and the finger inserted to ascertain 
the size and position of the polypus. The growth may then be removed 
either with the fingers, with a wire snare, or with the ecraseur. But 
if the polypi are higher placed, the nostril must be trephined.  Dift- 
culty is often experienced in diagnosing the seat of the growth; this 
may sometimes be effected with a long sound, or with Giinther’s catheter 
for the guttural pouch. Trephining, if adopted, is better performed too 
high than too low. The growth, if possible, is removed by tearing or 
ligaturing. Where the base of the polypus is broad, a curette is 
often of considerable service, but whatever the means employed, the 
principal object is to completely remove the growth. If bleeding prove 
severe, the head may be placed in a pendent position, or the superior 
meatus or the upper part of the posterior nares be filled with tow or 
jute, in order to check flow of blood into the larynx. But the tampons 
must be secured by strong tape, that they may not fall into the pharynx 


FOREIGN BODIES AND TUMOURS IN THE NOSTRILS. 57 


and produce danger of suffocation. Under such circumstances it is 
advisable to perform tracheotomy and insert a tampon canula. One of 
my patients died from cerebritis, owing to the inflammation extending 
from the point of operation to the brain. 


The term ‘‘rhinoscleroma” was formerly given to a disease of the nose in 
man, usually following nasal catarrah, and producing general swelling both of 
the nasal mucous membrane and the external skin. The swelling, as the name 
indicates, is distinguished by its hardness, 
and may be of such dimensions that the 
nostrils are completely occluded. The 
schneiderian membrane appears livid. Ana- 
tomically, the thickening is like that of 
elephantiasis, and, according to later investi- 
gations, is caused by a specific infection-—a 
micro-organism, similar to Friedlinder’s pneu- 
mococcus, has been found in the growth. 
Whether this condition occurs in the lower 
animals has yet to be determined. The cases 
hitherto reported show peculiarities indicat- 
ing other than micro-organismal causes. This | 
view seems to be supported by a reported 
case of Jacobi’s, where recovery followed the 
injection of Lugol’s solution of iodine into 
the subcutaneous tissue. A similar case was 
given in the Zeitschrift fiir. Veterindrhunde. 
It cannot be denied that the nasal mucous 
membrane and the nostrils do become swollen 
as in elephantiasis, but whether such swellings 
should be looked upon as rhinoscleroma can- 
not be determined without a fuller knowledge 
of their nature. Thickening occurring about ee oy) 
the nose in glanders might, however, be !¢ 38.—Facial edema after injury. 
mistaken for rhinoscleroma. 

Extensive cedema of the head sometimes occurs in the horse in petechial 
fever and influenza, and in cattle in malignant catarrhal fever; and appears 
both about the head and neck as the result of wounds in these regions. Where 
the head is held low for considerable periods, as after bruising or sprain of the 
muscles of the neck or painful disease of the cervical vertebra, marked cedema 
may develop, completely transforming the appearance of the animal, while 
swellings affecting the nasal mucous membrane and adjacent structures induce 
difficulty in breathing. A photograph of such a case is presented in fig. 33. 

This condition demands attention, as, being often accompanied by fever, it 
may, on superficial investigation, be mistaken for a symptom of certain infectious 
disorders. Such an error is, however, avoided by consideration of the history 
of the case and the condition of the neck muscles, or the cervical vertebre. 
Marked dyspnoea may necessitate tracheotomy. As soon as possible the head 
should be raised and so maintained. The result is often astonishing; a large 
swelling of this kind disappearing in a few hours. Massage is useful to 
promote resorption of the extravasated fluid. 


58 EMPYEMA OF THE CRANIAL SINUSES. 


(4.) EMPYEMA OF THE CRANIAL SINUSES. 


Lit.: Firstenberg, Th. Mitth. 1869/70. Gurlt, Gurlt-Hertwig. 4. p. 
508. Voigtlander, Dresd. Ber..64. p. 66. Probstmayer, Ad. 
W. 9. p. 201., Deupser, B. F. W. 1891. .Samd, Monatsh gor 
Thierh. 1893. p. 193, 


The mucous membrane of the facial and maxillary sinuses is in direct 
connection with that of the nostrils. In the sinuses it is closely attached 
to the bone, to which it acts as periosteum, and contains numerous small 
mucous glands. From its sheltered position this membrane is seldom 
diseased. But when ecatarrh or inflammation arises, the disease readily 
becomes chronic, for the secretion, finding no regular outlet, remains in 
the cavity and decomposes, irritating the mucous membrane. This 
tendency to chronicity is induced by various causes. Not infrequently 
the superior maxillary sinus becomes the seat of empyema in consequence 
of pus proceeding from purulent periostitis of a molar. | New growths 
and foreign bodies also rank as causes. 

Stockfleth found in this cavity a piece of bone, the result of unskilful 
trephining. Stenersen found pieces of sand-sedge, which had obtained 
entrance through the socket of a diseased upper molar. Decomposed food 
may enter in the same way. Fractures of the frontal and superior maxil- 
lary bones, and in eattle, injury of the horn-core, also act as causes. Voigt- 
linder records an injury to the horn of a cow, leading to purulent disease 
of the facial sinuses, and eventually to perforation at the base of the 
horn-core. In elanderous lesions, the mucous membrane lining the cavity 
appears thickened, exceedingly vascular, rough on the surface, and not in- 
frequently covered with proliferations or ulcers. The contents consist 
of intermingled mucus and pus. Not infrequently the mucous membrane, 
which acts as periosteum, produces, under the influence of chronic 
irritation, deposits of bone, which encroach on the normally existing 
space. Fiirstenberg and Deupser have seen that unusual phenomenon, 
dropsy of the superior maxillary sinus. — Fiirstenberg’s case occurred in 
afoal. Although the mucous membrane was not diseased, he found the 
sinus filled with a serous fluid. Sand looks on the condition as a cystic 
degeneration of some tumour-like new growth—analogous cases are seen 
inman. Widespread exostoses, especially in the frontal sinuses of cattle 
and sheep, and in the superior maxillary of horses, are, however, not 
uncommon. Gurlt has described several cases. In one, the left superior 
maxillary and part of the frontal sinus were filled with a mass of bone 
about 7 inches long and 44 inches thick. It was of stony hardness, 
had a smooth surface, and an interior filled with small holes. The 


TREPHINING THE FACIAL SINUSES. 59 


turbinated and ethmoid bones were pressed out of shape, the frontal and 
nasal bones atrophied and almost perforated by the continuous growth of 
the exostosis (see fig. 61 of my General Surgery). Probstmeyer 
diagnosed a caucerous growth of the antrum in an eleven year old 
mare. 

The diagnosis can often be made only by the method of elimination. 
The first symptom is a one-sided mucopurulent and sometimes. ill- 
smelling nasal discharge. If the disease has been caused through 
alveolar periostitis, the peculiar odour of a decayed tooth will be notable. 
The sub-maxillary glands of the same side often swell, and the case may 
be suspected to be glanders. At a later stage the bones inclosing the 
sinus become swollen, and on percussion over the diseased spot emit a 
duller, less resounding tone. In making this test the horse’s mouth 
must be closed, and the sinus on each side struck in turn over exactly 
corresponding points, using the plain end of the percussion hammer or a 
strong key. 

Treatment must be preceded by trephining. The contents of the 
sinus are then washed out, a disinfecting solution, such as carbolic, 
sublimate, or creolin, injected, and the opening closed with a plug of tow 
or jute. Irrigation must be repeated daily, until the nasal discharge 
ceases. The operation wound soon closes completely. 


TREPHINING THE SUPERIOR MAXILLARY AND FRONTAL 
SINUSES. 


Trephining the super-maxillary and frontal sinuses has been under- 
taken from very early times. It was frequently vainly employed for 
the cure of glanders, and has occasionally been of service in aiding 
diagnosis in cases of suspected glanders, for which purpose it is com- 
mended by Haubner as affording evidence of the condition of the lining 
‘membrane of the sinuses, and explaining any dubious discharge. But 
trephining is still more useful in the treatment of such local affections 
of the facial sinuses as chronic catarrh, in removing tumours and foreign 
bodies, and in punching out certain molars. 

Various instruments are used for removing portions of bone from 
the walls of the skull. 

(1.) The trephine, a circular-shaped saw, which is either affixed to a 
stock similar to a carpenter’s (stock trephine, fig. 34), or to a handle 
(hand trephine, fig. 35). Usually the latter simple form is used. 
The crown, a steel cylinder of varying size, which forms the saw, is 
smooth on its external surface, differing in this respect from those 
formerly in use, which were conical, and provided externally with sharp 
saw teeth to allow of their entering the bone. In the centre of the 


* 


60 TREPHINING INSTRUMENTS. 


crown stands the centre pin, a piece of steel which can be fixed by 
means of a screw, and caused to project somewhat beyond the cutting 
edge of the crown. 

(2.) The elevator (fig. 836) carries at one end a ring, by which it is 
held. The other end is fashioned into a conical screw, which can be 
inserted in the piece of loose bone to remove it: under certain cireum- 
stances the elevator nay be used to bring dislocated fragments of bone 
into their former position. (P. 54). 

(3.) The half-round knife (fig. 58), With this the sharp edges of the 


Fia. 34.—Stock Trephine. Fic. 35.—Hand 'Trephine. 


opening left by the trephine are removed, to prevent the finger being 
injured when introduced during examination. 

(4.) The so-called “ periosteum knife ” (fig. 39) is for scraping the peri- 
osteum from the point of operation, but may be replaced by a blunt knife 
or similar implement. The set of instruments usually comprises a chisel 
(fiz. 37) to remove pieces of bone such as those between two trephine 
apertures, and is useful in making large openings. Where a trephine is 
not to hand, the opening may be made with an ordinary borer (exfolia- 
tive trephine, fig. 40), but if it is merely necessary to make an aperture 


POSITION FOR TREPHINING. 61 


in the bone, the perforating trephine is used (fig. 41). The last named 
instruments can, however, generally be dispensed with. 

Trephining the facial and superior maxillary sinuses of the horse. 

In opening the facial sinus, the frontal bone is trephined at a point 
on a level with the supra-orbital process of the frontal bone, and about 
1 inch from the middle line. Here the skin lies almost immediately on 
the periosteum. The superior maxillary sinus in the horse is generally 
divided by a thin plate of bone into an upper larger and a lower smaller 
division. Lanzilotti describes this plate as having been present in 52 


Fic. 36.— Frc. 37. — Fic. 38.- Fig. 39.— Fic. 40.— Fic. 41.— 
Bone Elevator Chisel. Half-round  Periosteum Exfoliative Perforating 
on screw. Knite. Knife. Trephine. Trephine. 


out of 74 cases operated on. It lies nearly in the centre of a rectangle, 
whose longer sides are formed by the zygomatic ridge, and a line drawn 
parallel with it, starting from the inner angle of the eye, and whose 
shorter sides are bounded by the rim of the orbit, and a line drawn 
perpendicularly to the lower end of the zygomatic process of the 
malar bone. According to Lanzilotti, the septum is always wanting 
in the ass, and often in the mule. Trephining about 14 inches above 
the lower end of the zygomatic ridge, and 2 to 14 inches away from 
it, this division is cut into, and both portions of the sinus are 
opened. Where one sinus alone has been opened, the dividing wall 
can be broken down. In foals one operates somewhat further from the 
edge of the zygomatic ridge, in order not to injure the roots of 
the fourth and fifth molars which lie in the lower division of the 
superior maxillary sinus. The horse had better be cast, though 
quiet animals may be operated on standing. After removing the hair 


62 TREPHINING THE FACIAL AND MAXILLARY SINUSES. 


from a space about 2 to 24 inches in circumference, a longitudinal 
cut 2 to 3 inches in length is made through the skin. This should 
be parallel with the middle line, and 3—4 cen. removed from it. 

In trephining the superior maxillary 
sinus, the cut should be parallel 
with, and about 1 inch above, the 
zygomatic ridge. A “T” or “V” 
shaped incision was formerly recom- 
mended, but Gerlach has rightly 
condemned this procedure, because 
the loose flaps of skin retract and 
give rise to excessive granulation. 
In the middle of each edge of the 
wound a stitch is inserted, by which 
the flaps are drawn asunder. The 
skin is separated from the sub-lying 
tissues with the knife in order to 
make room for the trephine crown 
between the two edges of the 
wound. Should the operation on 
the superior maxilla be performed 
rather higher than above described, 
the belly of the levator labii su- 
perioris is encountered, and must 
be pushed to one side. The tre- 
phine crown is now placed in 
position, and to facilitate removal 
of the pieces of periosteum a cut 
is made around it with a guarded 
bistoury, and the membrane se- 
parated with a scraper or blunt 
knife. The trephine, with its centre 
pin in advanee, is replaced in posi- 
tion, and by light rotary move- 
ments caused to enter the bone. 
The instrument in case of need 
(lll boundaries of the frontal sinus. is supported by the thumb and 
——— ,, nasal meati. index finger of the operator’s left 
a of ;, Superior maxillary sinus. hand. The teeth of the saw 
soon begin to act, but, before the piece of bone to be excised is 


Fic. 42.—Head of a horse. 


1 The late Professor Robertson recommended removing a circular patch of skin. Cicatrisa- 
tion is much more perfect after this procedure, and in one or two months no visible wound 
remains.—[TRANS. ] 


TREPHINING THE SUPERIOR MAXILLARY SINUS. 63 


loosened, the elevator should be inserted. The trephine, being again 
placed in position, is used as before described until the bone is per- 
forated. Where the latter is very thick it will be necessary from time 
to time to clean the teeth of the trephine with a brush. An increased 
sense of yielding gradually becomes apparent, whereupon sawing is 
more cautiously proceeded with. As soon as the bone is thought to 
be bored through, the elevator is applied and the piece lifted out. 
But if this cannot be effected, recourse must again be had to the 
trephine. The lining mucous membrane generally remains in situ, or 
hanging in shreds to the sides of the cavity. After removing sharp 
edges with the half-round knife,‘ the finger may be introduced for 
examination. © Bleeding is usually slight. If it renders examination 
difficult, the sinus is syringed out with water and dried with a small 
sponge, when the mucous membrane may be more closely examined. In 
empyema, pus usually flows from the opening spontaneously, and what- 
ever remains can be removed by washing. Any new growths can also 
be taken away. 

The opening is closed with a plug of tow or jute, and after- 
treatment must depend on the nature of the diseased processes. 
In chronic catarrh, flushings of the affected sinus, with antiseptics like 
carbolic solution, are indicated. Where putrefactive processes are 
actively going on, 3 per cent. permanganate of potash, or solutions 
of astringent materials—such as alum 2 per cent., tannin 2 per cent. 
may be used. The opening is then closed with a plug, so that the 
mucous membrane be not exposed to the direct influence of the air. 
Treatment should be continued as long as any nasal discharge is present. 
The wound is afterwards encouraged to heal, only soft plugs being used 
in the trephine opening. In about three or four weeks it closes 
completely, and after the lapse of two or three months scarcely a trace 
of the operation can be observed. Where large tumours are to be 
removed from the frontal or superior maxillary sinuses a simple opening 
may not be sufficient; a second is bored in the neighbourhood of the 
first, and the intervening bone removed with the assistance of the 
chisel (fig. 37) and the hammer. I have frequently had occasion to 
trephine the nostril in this way in order to remove tumours or necrotic 
portions of the turbinated bones. A saw similar to a key-hole saw is 
useful here in order to enlarge the trephine opening. Although diseases 
of the frontal sinuses occur in herbivora, they are less common than in 
horses. In sheep, on the other hand, the presence of oestrus ovis may 
require the opening of the frontal and maxillary sinuses. This is 
usually done in the middle line, in order that both sides can be opened 
simultaneously, and washed out by injections. The frontal sinus, as in 
other ruminants, is connected with the horn core, and may be opened by 


64 NECROSIS OF THE TURBINATED BONES. 


sawing through the horns; but this operation is not only more painful, 
but is also accompanied by greater loss of blood, which in cattle already 
weakened may be attended with undesirable consequences, 


(5.) NECROSIS OF THE TURBINATED BONES. 


Lit.:J essen, Dorpat. Klinik. 1860/61. Hering, Operationslehre. Haubner, 
Dresd. Bericht, 1861. Stockfleth, Chirurgie. Lanzilotti, Jahrb. 
1883, p. 145. Gund, Berl. Arch. 1891. Sand, Monatshefte f. pr. 
Thierh. 1893, p. 193. 


After Jessen’s description of a pecuhar disease of the turbinated bones 
of the horse, accompanied by chronic thickening, Stockfleth and others 
published descriptions of similar cases. The condition is not common in 
North Germany, and usually appears after strangles, while a few cases 
in my experience have been caused by disease of the upper molars. 
Sand, on making the post-mortem examination of an old horse which 
had shown an offensive nasal discharge, found the mucous membrane 
was thickened, and the surface of the ethmoid cells necrotic. The bony 
plates had broken down, forming a grey, grumous material. 


Sand describes a peculiar disease of the turbinated and neighbouring bones 
which he terms mucous degeneration (schleim-degeneration),. The disease was 
seen oftenest in foals, and was distinguished by dyspnoea, swelling of the bones 
of the face, and a muco-serous discharge. The post-mortem showed the bones 
of the face to be much thinned, partly perforated, and the sinuses of the head 
greatly dilated. The remains of bone structure in the turbinated bones could 
only be recognised microscopically ; the latter appearing to be almost transformed 
into a mucoid tissue. The walls of the superior maxillary and frontal sinuses 
showed the same changes, and the cavities themselves were greatly increased in 
size. Their contents were sometimes purulent, sometimes muco-serous. 


The early symptoms consist of a stinking discharge from one nostril, 
snoring breathing, and diminution in the stream of air of the affected 
side. At a later stage the nasal bones become swollen, and not 
unfrequently the thickening in the turbinated bones can be directly 
seen, or felt by the finger. As swelling of the pharyngeal glands is 
usually present, the condition is sometimes difficult to distinguish from 
nasal polypus, and is occasionally only recognised exactly after 
trephining. 


Hoyer, in a case of necrosis of the turbinated bones, removed the diseased 
part with a muscle hook and secured healing, whilst the cases described by 
Jessen were also cured by resection of the diseased turbinated bone through a 
trephine opening. Hering and Jessen recommend making an incision through 


NECROSIS OF THE TURBINATED BONES. 65 


the skin close to the middle line, and extending the entire length of the nasal 
bone. At the upper end of this cut the trephine is inserted, and a piece of the 
nasal bone an inch broad arid as long as the cut through the skin removed by 
a key-hole saw. Through such an incision the diseased turbinated bone could 
also be removed. But a case of caries treated in my own clinique in this way 
was still uncured after the lapse of eight weeks. Complete resection of the 
turbinated bones is attended with no slight difficulty ; any fragments left behind 
are apt to renew the diseased processes. Sand recommends, in cases of mucoid 
degeneration of the turbinated bones, to trephine early, and having established 
free drainage, to wash the parts out regularly with antiseptic solutions. This 
is said to usually check or completely cure the disease. In August 1888 a 
four year old mare was sent to hospital after suffering for some weeks from ill- 
smelling nasal discharge. She was well nourished, and had no appearance of 
bodily illness, but an offensive muco-purulent discharge, smelling of bone pus, 
was discharging in moderate quantities from the left nostril ; the sub-maxillary 
glands of the left side were somewhat swollen. The use of Giinther’s catheter 
disclosed the existence, on the floor of the left meatus, of a slight unevenness 
and swelling at the height of the third molar. The resulting examination of 
the mouth disclosed the fact that the third upper molar on the left side had lost its 
crown, and that all the appearances of purulent periostitis of the alveolus ex- 
isted. Scars left by previous trephinings were visible on the temporal and 
superior maxillary bones of the left side. After removing the diseased tooth by 
punching, the operation wound healed regularly, but the nasal discharge con- 
tinued. Trephining the nostril was undertaken, when it was found that the 
turbinated bones were necrotic, and denuded of mucous membrane at several 
points. Attempts to remove these portions were not successful; and on ac- 
count of the comparatively small value of the horse, the owner decided to have 
it killed. 


(6.) EPISTAXIS (BLEEDING FROM THE NOSE). 


Lit.: Schindelka, Weiner Viertelj. 1886, p. 121. Bigoteau, Jahrb. 
1886, p. 102. Sohngen, Th. Mitth. 1882, p. 50. Jost, Th. Mitth. 
1868, p. 91. Deigendesch, Her. Rep. 43, p. 202. 


Extensive venous plexuses (centrum venosum) exist in the mucous 
membrane of the nostril of the horse, and especially in that investing 
the septum nasi. Injuries of these plexuses may give rise to consider- 
able bleeding. Hence nasal bleeding is most frequently seen in this 
animal. It may be caused by external injuries, such as carelessly wiping 
out the nose with a rough cloth, by fractures of the nasal bone with 
dislocation of the fragments internally, by other accidental wounds, 
occasionally from foreign bodies and tumours in the nostril. Schindelka 
noted severe bleeding after fracture of the septum. In a fifteen 
year old horse, which for ten years had suffered periodically from 
epistaxis, especially after severe exertion, Deigendesch found an angioma 
of the septum which had become ulcerated. Great exertion, like racing, 
sometimes occasions bleeding, us do dusty irritating folders. Bigoteau 
observed nasal bleeding in a great number of horses which had been fed 

E 


66 BLEEDING FROM THE NOSE. 


with dusty sainfoin. It is further noteworthy that ulcerative changes 
like those of glanders give rise to repeated and profuse bleeding. When 
nasal bleeding continually recurs in horses without visible cause, it must 
awaken very great suspicion, particularly in animals which have been 
exposed to glanders infection. The quantity of blood so lost, and the 
time of bleeding, are exceedingly varied. In glanders, and other 
ulcerative processes, bleeding is occasionally so severe as to threaten 
immediate death. 

Treatment.—Immediately bleeding becomes of a character to require 
therapeutic treatment, cold applications are made to the head, and the 
nostril of the affected side washed out by means of the irrigator, with 
cold water, to which tannin or vinegar may appropriately be added. 
In bleeding from the lower portions of the nostril, plugging may be 
necessary, but where this is resorted to the patient must be carefully 
watched, and the plugs removed immediately the breathing is difficult. 
Or tracheotomy can be performed, a tampon canula inserted, and both 
nostrils plugged. Even this, however, will not invariably stop the 
bleeding. Insufflation of finely powdered alum has been recommended, 
and is worth trying when the blood comes from the lower portions of 
the nostrils. Where fatal results threaten, secale cornutum (ergot) may 
be tried. Sohngen saw recovery in the horse after subcutaneous injec- 
tion of 12 grains extr. secal. cornut. The cause must be removed. 

Vapour of vinegar, recommended by some authorities, has been 
declared useless by others. Although fatal bleeding has been repeatedly 
observed in horses, the flow usually ceases when the animal is kept 
quiet, and when hemorrhage has lowered blood pressure. The head 
should be kept elevated. 


IV.—DISEASES OF THE SALIVARY GLANDS. 


Lit.: Bassi, Il méd. vét. Turin, 1873. 


(1.) WOUNDS ANDINJURIES OF THE SALIVARY GLANDS. 


Owing to the position of the parotid it suffers from external injuries 
more frequently than the other salivary glands. As long as important 
blood-vessels are not injured, wounds of this gland are not particularly 
serious. If proper treatment be adopted at once, even the danger of 
salivary fistule is not great. The injuries most to be feared are those 
in which the ducts of the gland, and especially Stenson’s duct, are 
injured. In sheep and dogs Stenson’s duct passes obliquely across the 
cheek, while in horses and cattle it lies protected below the jaw, and 
hence is less exposed to external wounds. The duct is more frequently 


WOUNDS AND INJURIES OF THE SALIVARY GLANDS. 67 


injured by sharp objects occasionally during the course of the so-called 
mumps (Feifelbrechen). The condition may be recognised by the posi- 
tion of the wound, and the outflow of clear saliva, the secretion of 
which is increased by feeding, and even by the sight of food. In many 
cases the wounds heal completely ; in others a small opening is left from 
which saliva discharges (salivary fistula). To avoid this result, healing 
by first intention must be sought for; the flow of blood checked, the wound 
carefully cleansed and sutured: during twenty-four to forty-eight hours 
the animal should receive no food, and should be placed by itself in order 
that the secretion of saliva be not excited by the feeding of its fellows. 
Small doses of atropine may also be given, which check or altogether 
stop salivary secretion. Further treatment must be based on the 
general principles of surgery. 


(2.) INFLAMMATION OF THE SALIVARY GLANDS 
(PAROTITIS). 
Lit.: Bettinger, Sor. Rep. I. p. 306. Thiernesse, Annal. de méd. vét. 
1853. Meyer, Oesterreich. Vierteljahrsschrift. 1885, p. 87. 

The salivary glands at times become the seat of inflammation. The 
parotid is most frequently affected, the sub-maxillary and sub-lingual 
only occasionally. Foreign bodies obtaining access to the glands may 
produce inflammation. But many cases result from causes not clearly 
recognised, some of them apparently of an infectious nature. They pro- 
duce their effects either by irritating the gland ducts directly, or through 
the blood stream. In men, as in animals, endemic parotitis sometimes 
shows itself. That in man is clearly of an infectious character, and is 
vulgarly known as mumps. Animals, and especially dogs, suffer from a 
similar disease. Not infrequently parotitis appears symptomatically 
during the course of equine strangles and influenza, and of distemper in 
dogs, and I have also seen it repeatedly in cats. The inflammatory 
condition arises in the parenchyma of the gland. The organ swells, 
its divisions appear dark red, and their epithelium turbid in small 
areas. The process soon spreads to the connective tissue, which, after 
a short time, is infiltrated with organisable lymph. Finally pus forma- 
tion takes place both here and in the alveoli. By confluence of small 
abscesses greater ones are formed, extensive areas of the gland and its 
connective tissue become necrotic, and the abscess finally perforates, not 
infrequently destroying a large piece of skin. The contents of such 
an abscess contains necrotic shreds, and possesses an exceedingly 
offensive smell. 

Symptoms.—Acute parotitis, the most frequent disease of this kind, 
is accompanied by the early appearance of a diffuse swelling in the 
parotid region. The gland appears. hard, hot, and painful; the head 


68 INFLAMMATION OF THE SALIVARY GLANDS. 


is extended, and inclined towards the sound side; salivation exists, and 
not infrequently fever. When the swelling is great, dyspnoea and 
ditticulty in swallowing may be present. At times facial paralysis is 
produced owing to pressure on the nerve, or to extension to it of inflam- 
matory processes. The swelling gradually becomes fluctuating at its 
most prominent point, and if not opened a large quantity of ill-smelling 
egrayish-red fluid, mixed with flakes of dead connective tissue, will be 
spontaneously discharged. The swelling seldom becomes absorbed. Once 
necrosis has taken place, abscess formation usually results in eight to ten 
days; but in fourteen days to three weeks complete healing may be 
expected. Recovery is the most common termination ; septiceemia and 
pyzmia with fatal results are rare. Owing to high fever and disturbance 
of appetite the animals fall off in condition, and milk secretion abates. 
Salivary fistulae: and facial paralysis are seldom observed as sequel of 
this affection. In a case of mine the optic nerve was involved and 
optic paralysis with amaurosis remained, having evidently resulted 
from retrobulbar neuritis, produced by extension of inflammation into 
the orbit. Extensive burrowing of pus may also be followed by fatal 
consequences. 

Parotitis may easily be mistaken at the commencement for swelling 
of the sub-parotideal lymph gland, which does not, however, remain 
confined to the parotid region, but is more diffused. From distension 
of the gnttural pouches parotitis is distinguished by the presence of 
inflammation, and by the absence of the purulent nasal discharge which 
is so diagnostic of disease of the guttural pouch. Tumours in the 
parotid region are unaccompanied by inflammation, and never develop 
so rapidly as the swelling of parotitis. The sub-maxillary and sub- 
lingual glands also become diseased, but less frequently. Parotitis 
usually originates in the mucous lining of the ducts, the inflammation 
extending from eatarrhal conditions of the buecal membrane. Such 
outbreaks of an enzootic type are recorded in horses. A long flattish 
swelling appears in the throat, which extends under the parotid, 
and salivation is present. The termination of Wharton’s duct on the 
septum lingue not infrequently appears stopped. Should pus formation 
result, the abscess commonly breaks into the mouth, less frequently 
externally, but in fourteen days convalescence is established. 

Stoeckfleth has described, under the name of “ranula,” a disease in 
cows, which presents the appearances of virulent inflammation of the 
sub-maxillary gland. There is cedema of the throat, and an elastic 
swelling as large as a hen’s egg is found on the frenum lingue. If this 
be opened early, the symptoms soon disappear, but if not, the head and 
neck rapidly swell, and breathing and swallowing are so disturbed that 
the animals often die in a few days. 


INFLAMMATION OF THE SALIVARY GLANDS. 69 


Inflammation and abscess formation occur in the ducts of the salivary 
glands, especially in Stenson’s and Wharton’s ducts. Meyer found in 
Stenson’s duct in a horse a head of Timothy’s grass. Concretions may 
also inflame the gland duct, producing pus formation and salivary 
fistula, 


Cattle, especially in low-lying situations, are liable to chronic inflammation of 
the parotid glands ascribed by Stockfleth to bad pastures, but his description 
rather points to actinomycosis or some musculo-fibromatous condition. In such 
cases inflammatory appearances develop slowly; hard, indurated, slightly 
painful swellings first appear, scarcely increasing the size of the part, but later 
abscesses form and discharge a thick pus; the adjoining lymph glands swell, 
contributing to the serious difficulty in breathing and swallowing which finally 
sets in. The patients rapidly go back in condition, and are disfigured by the 
formation of salivary fistule. Even with liberal feeding complete recovery is 
uncertain, and it is generally desirable to prepare the animals for slaughter. 
Thiernesse described a disease in dogs similar to parotitis, but withstanding all 
ordinary curative methods, and for which he recommended complete extirpation 
of the gland. In similar disease occurring in horses, the same surgical treatment 
must be adopted. A case of chronic inflammation of the sub-maxillary gland in 
a horse occurred in my own clinique. The swelling appeared slowly in the 
region of the larynx, produced perforation and a permanent fistulous wound. 
A long, hard, painful swelling was found extending upwards in the course of the 
sub-maxillary gland, and a fistulous opening below in the throat, from which a 
canal ran throughout the greater part of the swelling. Healing was effected by 
passing a seton needle upwards through the swelling, making an opening, and 
inserting a drainage-tube. 


Treatment.—Owing to the specific character of acute parotitis, cold 
applications are usually contra-indicated ; while warmth, in the form of 
Preisnitz’s poultices, inrubbing of oil, and warm applications, are to 
be recommended. Warmth either leads to dispersal or abscess formation, 
and, in any case, shortens the progress of the disease. When marked 
fluctuation appears the part had better be opened, but this may be 
needful earlier if dyspnoea threatens; and where breathing is much 
interfered with, tracheotomy becomes imperative. In ordinary circum- 
stances distinct fluctuation is waited for, thus avoiding the danger of 
the incision wounding large blood-vessels or nerves, and of producing 
salivary fistule. The cut is made parallel with the large blood-vessels 
and nerves, and the proceeding conducted as in opening a sub-parotideal 
abscess (p. 71). Caution is required in employing the often recommended 
trochar, for injuries to large blood-vessels and considerable bleeding 
are not altogether avoided, even by its careful use. As the contents of 
the abscess are often under high pressure, and spurt out in a stream, 
Stockfleth recommended making the opening from the opposite side, 
and standing on a block of wood during the operation. I prefer the 
method described on page 71. With chronic parotitis, little can be 
done. Cattle should be prepared for slaughter without delay, because 


70 INFLAMMATION OF THE SALIVARY GLANDS. 


difficulty in breathing and swallowing often appear later, and make 
feeding absolutely impossible. Abscesses should be opened and _ their 
cavities washed out with 10 per cent. chloride of zine, or similar 
disinfectant. In valuable animals, or such as have no slaughter value, 
total extirpation of the parotid may be adopted (p. 75). In acute 
inflammation of the sub-maxillary gland and in chronic diseases, 
extirpation of the gland may be necessary, but is attended with great 
difficulty, especially in ruminants. In inflammatory diseases of the 
ducts of these glands endeavour should be made to render patent the 
buccal opening of the gland, give exit to its contents, and thus diminish 
the risk of abscess and fistula formation. 


(3.) ABSCESS FORMATION IN THE SUB-PAROTID 
LYMPH GLANDS. 


The lymph glands lying below the parotid often become diseased, 
especially during the course of strangles, sore-throat, and other com- 
plaints, a phlegmonous inflammation developing, and gradually leading 
to abscess formation. 

Symptoms.—Swelling appears in the parotid region, sometimes 
close under the ear, more frequently, however, in the lower posterior 
border of the gland, and usually spreads over the upper portion 
of the neck. The swelling increases, producing difficulty in breathing 
and swallowing, while the head is extended and held towards the sound 
side. Slight fever exists. Where both sides are affected, dyspnoea often 
develops to such a degree, especially during inspiration, that suffocation 
threatens, and tracheotomy becomes necessary. The difficulty in 
swallowing is attended by the danger of mechanical pneumonia. 

At first the swelling appears hard and firm, and painful on pressure. 
Gradually the centre bulges, and in eight to fourteen days unmistak- 
able fluctuation may be detected. Failing an artificial opening, perfora- 
tion occurs spontaneously in a few days. ‘This commonly takes place 
externally, but at times the abscess breaks into the pharynx, and danger 
ensues of pus flowing into the trachea and bronchi, and producing fatal 
pneumonia. In a few cases rupture takes place both inwardly and 
outwardly. From the external wound there then flows pus, mixed with 
necrotic material, saliva and particles of food and water, and the forma- 
tion of a pharyngeal fistula becomes possible. — 

The disease resembles parotitis and distension of the guttural pouch. 
From parotitis it is distinguished by the swelling bemg now diffused, 
and not confined to the parotid region; from disease of the guttural 
pouch, by the special characters of such attacks, by the progress of 
the case and the presence of fever. 


ABSCESS FORMATION IN SUB-PAROTID LYMPH GLANDS. 71 


Treatment.—Early opening of the abscess is desirable, but the use 
of sharp instruments for the purpose is contra-indicated, as the parotid 
may be wounded, producing salivary fistula, or the great blood-vessels 
injured, causing fatal bleeding. 

Viborg describes the following excellent method, which is simple 
and without danger. A twitch having been applied, and the seat 
of operation cleansed and disinfected, an incision is made through the 
skin over the highest point of the swelling, and if possible below the 
edge of the parotid, the underlying fascia divided, and the forefinger 
inserted. The thick connective tissue or gland structure is now broken 
down, the free hand meanwhile pressing on the swelling and guiding 
the inserted finger towards the abscess. This attained, a strong thrust 
breaks it and allows the escape of a stream of thick creamy pus, which 
often spurts to a distance of several yards. ‘To avoid being struck, it 
is better to place oneself on the opposite side. It may be necessary to 
operate on both glands. With drainage of the abscess, fever falls, 
and difficulties in breathing and swallowing disappear. Healing occurs 
in eight to fourteen days, but complete closure of the abscess sometimes 
requires from three to six weeks. Warmth and moist applications 
(Preissnitz’s poultices) further the breaking down of the swelling; the 
pus is removed by pressure and washing out the cavity with carbolic 
or sublimate lotion ; further treatment is not usually necessary. This 
procedure, as already stated, is preferable to the use of sharp instru- 
ments, and especially to the oft recommended trochar. 


(4.) SALIVARY CALCULI AND CONCRETIONS. 


Lit.: Duschaneck, Monatschrift fiir ostr. Th. 1887, p. 125. Kleuch, 
Amer. Rev. 1882, p. 359. Portal, Journ. de méd. vet. 1852. 
Schumann, Gorlt and Hertwig. 1, p. 26. Bayer, Oester. Zeitschsr. 
f. wiss. Vetk. 1892, p. 207. 


Calculus deposits are sometimes encountered in the ducts of the 
salivary glands, especially of the parotid, in horses and cattle, and may 
attain the size of a goose’s ege. They are commonest in the horse, 
ass, ox and sheep. Schumann discovered one in a horse which weighed 
over 7 ounces, and Stockfleth a similar one of 123 ounces. Their 
form is oval, colour grayish-yellow, surface usually smooth, but where 
several are together they show facets. In herbivora, according to 
Lasaigne, they consist of 80 to 90 per cent. carbonate of calcium, 
3 per cent. phosphate of calcium, and 9 to 10 per cent. of organic 
substances, composed chiefly of salivary corpuscles and bacteria. In 
men and carnivora, phosphate of calcium is an important ingredient. 


72 SALIVARY CALCULI AND CONCRETIONS. 


Foreign bodies entering the salivary duct, or injuries of the mucous 
membrane, are the usual immediate causes. The cut surface of such 
concretions often presents a stratified appearance, and a central nucleus 
of ground straw, &c. 

The concretion is only remarked after it has attained a certain 
size. It appears as a hard, sharply defined, slightly movable swelling, 
generally lying on the outer surface of the under jaw, close in front of 
the buccal opening of Stenson’s duct, but sometimes on the posterior 
border of the under jaw. The salivary duct is usually distended behind 
the swelling, and when the flow of saliva is entirely shut off the gland 
is enlarged. Inflammation is seldom present, but may appear and lead 
to formation of abscesses. 

Treatment consists in operative removal. Small concretions may 
perhaps be forced through the duct, which will necessarily be somewhat 
fissured; the larger require an incision to be made in the duct. In 
this case a transverse cut is preferable to a longitudinal one, on 
account of its healing more easily, and not so frequently leading to 
salivary fistula. Recovery is hastened by carefully suturing the wound, 
and withdrawing food for one to two days. Bayer removed a concretion 
from the duct through a longitudinal incision, and after closing the 
wound with Lembert’s suture, effected healing by first intention. 


(5.) SALIVARY FISTULAs. 


Lit.: Reynal, Her. Rep. Il. p. 332. F. Ginther, Han. Ber, 1872, p. 88 
Harms, ibid., 1873, p. 74. Siedamgrotzky, Dresd. Ber. 1874, p. 
63. Wiistfeld, Gurlt. and Hertwig. IV. p. 263. Lindenberg, p. 
A471. Haubner, ibid., vol.:15, p. 248... Wannowius, ibid,, vol. 
23, p. 236. Delamotte, in Labat. Rev. vet. 1887, p. 257. Brissot, 
Recueil. 1887, p. 487. André, Journ. de méd. vét. 1851. Diekens, 
The Veterinarian, 1852. Harms, Her. Rep. 1871, p.1. Lafosse, Jahrb. 
1860; p: 49. Harms, Her: Rep: 1871, p. 2.- Bo We 1892) pee 
Bergeron, le progres, 1892. 


Wounds of the salivary glands and their ducts often fail to heal, 
because the continual flow of saliva pushes aside the granulations and 
hinders closure. The gland epithelium finally unites with that of the 
outer skin, and through the opening so formed saliva flows continuously 
(salivary fistula). A distinction must be made between fistule of the 
salivary gland and of the salivary duct. The latter occur most 
frequently in Stenson’s duct. Although the general condition of the 
animal is only slightly affected, much saliva escapes during eating and 
mats the hair of the cheek, finally producing a blemish.  Fistuli of 


SALIVARY FISTULA. iis 


salivary glands heal more easily than those of salivary ducts;—sometimes, 
indeed, without treatment of any kind, 

Treatment aims at closing the external opening. This may be 
done by cauterising with nitric acid, silver nitrate, concentrated carbolic 
acid (Brissot), or the actual cautery. A scab is thus formed, which 
checks the outflow of saliva, allows the formation of granulations, and 
promotes cicatrisation. These methods sometimes fail at first, and 
require to be repeated. The draw-purse suture may prove useful. 

The treatment of fistulee of the salivary duct is more difficult. | Before 
recovery can take place, it is necessary to provide for the exit of saliva 
into the mouth. Where stricture of the duct occurs, as it often does, at 
a point between the fistula and the natural opening, this must be 
remedied. Lindenberg recommends passing a strong probe, and then 
attempting to reclose the walls of the fistula by caustic or the cautery. 
The resulting inflammatory swelling may close the wound, but healing 
will be more assured if a stitch be inserted. The purse-string stitch is the 
best. With a strongly curved needle a thread is passed through the 
skin around the opening of the fistula, and the margins thus brought 
together. Where the natural opening into the mouth cannot be 
renewed, an artificial conduit must be provided. Stockfleth recommends 
exposing the duct behind the fistula, and piercing the cheek in an oblique 
direction with a trochar. The free portion of the salivary duct is 
introduced into this opening, and made fast with a suture. Lafosse and 
Hering pass a thread through the cheek by means of a trochar, and 
fasten the ends together in the corner of the mouth. After the thread 
has remained in position for some weeks it is removed, and the opening 
closed with a suture. In mana thin drainage-tube or piece of lead- 
wire has been used in a similar way (Kaufmann). Labat, in a horse, 
kept the artificial opening free by means of a simple plug of tow, and 
so produced healing. Should this procedure not be attended with 
success, destruction of the function of the gland alone remains. For 
this purpose one of the following methods may be adopted :— 

(1) Tying the salivary duct above the fistula (Viborg), The duct is 
isolated between the fistula and the gland, and tied with a stout thread. 
A strong ligature is essential. The animal should fast for the next 
twenty-four to forty-eight hours, and then receive only fluid nourish- 
ment. Soon afterwards swelling of the gland appears (tumor salivalis), 
and is followed by gradual atrophy. 

(2) Transverse section of the duct, after being tried by Reynal and 
F. Giinther, was again recommended by Gerlach, while Siedamgrotzky 
and Harms have also tested it, though Harms has lately questioned 
its usefulness. They found that the end of the duct became closed 
through inflammatory processes, and that the duct itself afterwards 


74. SALIVARY FISTULA. 


atrophied. . In my experience, however, even this method sometimes 
fails. 

Harms very appropriately points out that experiments, although successful on 
healthy horses, do not demonstrate the efficacy of similar treatment in diseased 
ones. Reynal found that it was not always possible to produce adhesion of the 
duct by section. The fact must not be lost sight of that in fistula of the 
salivary duct the opening of the duct into the mouth is generally occluded. 
Permanent closure of the duct gradually leads to atrophy of the parotid. A short 
time ago I saw a horse whose right Stenson’s duct was dilated to the thickness 
of a man’s thumb, and was without opening into the mouth. The gland had 
entirely disappeared, and the parotid region presented a marked depression. 


(3) Injection of irritant fluids into the gland. Haubner recommends 
liquor amm. caust. 10 to 15 per cent. ‘Tincture of iodine, creosote, 
nitrate of silver, &c., have since been used. Bassi injected 30 per cent. 
of alcohol; Labat the following mixture,—20 to 40 per cent. of tincture 
of iodine, 1 per cent. iodide of potassium, and 60 per cent. of water. 
Delamotte, 50 per cent. tincture of iodine; Bergeron, a 20 per cent. 
solution of lactic acid. Concentrated tincture of iodine usuaily 
produces severe inflammation of the gland, sometimes ending in necrosis, 
and therefore diluted solution of iodine in iodide of potassium is to be 
preferred (Labat). The injection can be repeated if necessary. Abscesses 
often result, but in no way interfere with success. 


(6.) TUMOURS OF THE SALIVARY GLANDS. 


The nature of new growths occurring in the salivary glands of 
animals has not hitherto been fully or sutticiently investigated. In 
man, connective tissue tumours, such as sarcomata, fibromata, and 
enchondromata, are most frequent. The tumours so common in grey 
horses are usually melano-sareomata, and in cattle actinomycosis. 
As little is known of the causes of these new growths as of other 
tumours. Cohnheim refers the development of enchondroma to carti- 
laginous fragments of the branchial arch. Actinomycosis depends on 
infection (p. 76). 

Their sharply defined appearance, slow development, and the absence 
of inflammatory symptoms, render the diagnosis of tumours comparatively 
easy. Their precise nature, however, can usually only be determined by 
microscopical examination. As to actinomycosis, see p. 89, 

Treatment must clearly be of an operative character. Simple, 
sharply defined tumours can easily be removed with knife or scissors. 
By careful suturing and appropriate treatment of the wound, it is easy 
to avoid producing salivary fistule. Large and extended tumours may 
necessitate removal of the entire gland. Total extirpation of the parotid 


TUMOURS OF THE SALIVARY GLANDS. 75 


is attended with danger, and therefore should only be resolved on in 
case of pressing necessity, as when dyspnea is produced by the tumour, 
or when exceptionally valuable animals, which cannot be slaughtered, 
have to be dealt with. Leblanc is said to have first performed this 
operation, and to have employed it both for removal of tumours and for 
the cure of salivary fistula. Important vessels and nerves—the carotid 
and jugular, with their branches—and the great nerve stems (nervus 
facialis) must be avoided. Provision must, however, be made for 
ligaturing vessels. The operating place should be well lighted, and 
antiseptic precautions are, of course, necessary. 

The skin is divided from the upper to the lower end of the parotid, and 
where adherent to the tumour, is removed. In large animals a second 
incision is usually carried in a backward direction perpendicular to the 
former, and starting from about its centre. The fascia underlying the 
skin is divided and separated as far as possible from the parotid. The 
gland, thus exposed, is now separated from its surroundings, beginning 
at the lower end, so that large bleeding vessels may be more easily 
dealt with. For the same purpose a thread may be passed around the 
carotid, which, in case of need, can be used as a ligature, though the pre- 
caution is almost unnecessary if two or three torsion forceps are at hand. 
As the recurrent nerve may easily be injured, it is better, in valuable 
horses, to avoid exposing the carotid. The gland should as far as possible 
be separated with blunt instruments, assisted by the fingers. Vessels 
are ligatured as exposed, the larger doubly ligatured and then cut through. 
In this way, and by free use of sponges or dossils of lint, the field of 
operation is kept clear, and the gland removed without dangerous 
bleeding. The wound is then cleansed with antiseptic fluids, dusted 
with iodoform, covered with jute or wood wool, and the edges brought 
together with sutures. In twenty-four to forty-eight hours the 
stitches are loosened, the dressings removed, the wound washed out, 
dusted with iodoform and tannin, and the whole treated as an open 
wound. Healing will be complete in three or four weeks. To 
allow the air free entrance to the wound surface, the flaps should 
be drawn back with a few stitches, and pledgets of wood-wool wadding 
inserted in the depths of the wound,so as to take up the secretions 
rapidly. The external skin should also be divided, to permit dis- 
charges to escape rapidly. The insertion of a drainage-tube may be 
required. If during the next few days portions of the wound appear 
damp, they should be dried with wadding, and powdered with a mixture 
of iodoform and tannin (1-3). Where a dry seab has formed, the wound 
is better left undisturbed. Dry scabs, firmly adherent to the underlying 
tissues, should under no circumstances be removed. 


76 ACTINOMYCES TUMOURS. 


(7.) ACTINOMYCES TUMOURS (ACTINOMYCOSIS). 


Lit.: Bollinger, Deutsch. Zeitschr. f. Thiermed. 3. p. 334. J ohne, ibid., 
7.p.141. Bang, ibid. 10. p. 249. Claws, ibid, p. 290. Dunker, 
ibid., p. 236. Siedamgrotzky, Dresd. Ber. 1877, p. 28. Esser, Berl. 
Th. Woch. 1889, p. 307. Preusse, ibid, 31890, p. 17. * Emmis 
Adams. Wochenschr. 1888, p. 143. Grawitz, Fortschr. d. Med. 1891, 
p. 175. Fischer, ibid. Stienon. Annal. de Méd. Vét. 1890. Hohen- 
leitner, Zimmer, Herman. Ad. Woch. 1892. Thomassen, Journ. 
of Comp. Path. 1892. Ziegler, Miinch. med. Woch. 1892. Ostertag, 
Monatsh. f. pr. Th. 1893, p. 208. Perinni, Oestr. Monatsh. 1893, p. 
168. Iterson, La Semaine Méd. 1893, No. 64. 


Swellings, whose infectious nature has only recently been determined, 
often occur about the head and upper parts of the neck in cattle; less 
frequently in horses, pigs, and carnivora, Bollinger, in 1887, first drew 
attention to this disease, and ascribed it to the presence of the ray 
fungus (actinomyces). His observations soon found universal support. 
Johne, Siedamgrotzky, Bang, Esser, Preusse, and others have made 
valuable contributions to our knowledge on this subject. Johne 
describes the tumours under the general title of actinomycosis. In 
cattle they occur most commonly about the head. Two typical positions 
have been described,—the posterior border of the pharynx, and the 
upper and lower jaws. The tongue, moreover, often shows chronic 
inflammatory action (wooden tongue, holzzunge; makroglossia), while 
the tumours are also frequent in the parotid region. The so-called 
wooden tongue may be produced by other causes than actinomyces 
(p. 16). The parotideal and retropharyngeal cases are of special 
interest, as operative treatment, impossible in disease of the jaw- 
bones, is here practicable. Sharply defined swellings appear in the soft 
parts, develop slowly but continuously, after some time fluctuate at 
certain spots, and eventually break and discharge a purulent fluid, in 
which careful examination detects small hard sulphur-yellow particles, 
like grains of sand. The mass of the tumour consists for the most part 
of firm connective tissue; less frequently it shows a cellular character. 
On the surfaces nodules may be seen, which often attain the size of 
peas, and contain a greasy pus-like fluid, in which the before-mentioned 
particles may be found. Sometimes these centres unite and form: an abscess 
as large as a walnut. The contents may be washed out, and the tumour 
then shows the characteristic spongy formation (Bollinger). Under the 
microscope it is seen that the little yellow grains consist of agglomerations 
of actinomyces, distinguished by their ray-like formation, whence the name, 

These parasites are without doubt the cause of this new formation. 
They are probably taken along with the food, and find entrance into, the 
mucous membrane and deeper-lying tissues through wounds caused by 


ACTINOMYCES TUMOURS. FETE 


the rough character of the food. The circumstance that herbivora most 
frequently suffer from the disease, supports the theory that infection 
results in this way. Johne detected vegetable material invaded by 
actinomyces in the tonsils of swine; Grawitz found portions of a head 
of corn in the lower jaw of a calf, which were surrounded by granula- 
tion tissue. Bang found the disease more widely distributed where 
much barley straw was given as food. Fischer describes a wound of 
the human tongue produced whilst 
chewing some barley; ray fungi 
were found in the abscess which 
resulted, and the portions of grain 
discharged were also covered with 
them. According to Imminger, 
epizootics of aphtha favour infec- 
tion, for he found that after these 
actinomycosis broke out over large 
areas. Later observations have also 
established the occurrence of the ¢ 
disease in horses and swine. In 
the latter, actinomyces were found 
scattered throughout the muscular 
system (Dunker and others). In 
horses the disease has been seen in ee 
ihenymph,elands.of the head and ims 1 4. Sctinomycosis of the Parotid Gland 

: : an ox, from a photo by Esser. 
the skin. IJ myself saw an actino- 
mycosis growth arising from the alveolus of a tooth, and occasioning a 
form of epulis. Although the disease is found throughout Germany, it 
is observed more frequently in some districts than in others. According 
to Preusse, the cattle in the Marienburg and Elbing lowlands suffer 
particularly ; more than 20 per cent. of the animals were affected with 
the disease. It has been suggested that flooding the fields with lake- 
water favours its spread. 

Stienon has, during the last five years, seen many cases of actino- 
mycosis of the jaw and base of the ear and of the salivary glands in 
a large stud which he supervises. Disinfection of the stable diminished 
the number of cases. Zimmer thinks the disease is sometimes associated 
with certain localities, because very often almost all the animals in a par- 
ticular stable are affected with it, whilst those in neiehbouring stables 
remain exempt. Of 75 tumours seen by Zimmer in the course of a 
year, 54 turned out to be actinomycosis. Of these, 31 were located in 
lymph glands, and 23 in the maxilla. Fourteen cases proved incurable, 
40 were treated, and 36 completely cured. 

The symptoms consist of a small, sharply defined, and somewhat 


78 ACTINOMYCES TUMOURS. 


hard tumour, from which a cord-like thickening extends into the parotid 
gland. The swelling gradually becomes larger, fluctuation appears, and 
if the skin is without pigment, the yellow-coloured contents may 
show through. Incision liberates a thick, muco-purulent fluid, in which 
careful examination discovers the above-mentioned yellow grains. If 
not opened, the tumour breaks spontaneously. This, according to Bang, 
is diagnostic of the disease. Cicatricial contraction very seldom brings 
about healing. As a rule, the growth proceeds, sooner or later producing, 
according to its position, functional disturbance, difficulty in swallow- 
ing, dyspnoea, and finally, in consequence of advancing exhaustion, 
death.' The swellings in the parotid region occasionally attain a great 
size, sometimes becoming as large as a child’s head, but such growths 
require several months. 

Prognosis must depend on whether the new formation can be com- 
pletely removed, which is seldom the case. Lasting improvement can 
only be expected where treatment has been commenced early, that is, 
before infection has become general, and treatment is more successful in 
disease of the skin or subcutaneous tissues than where deeper-seated 
structures or the pharynx or tongue are involved. Disease of the 
bones of the upper or lower jaw, said by Esser and others to arise from 
the first molars, is always very intractable. Reference should be made 
to the sections dealing with these structures. Cases affecting the 
parotid region, unless recent, are generally regarded as hopeless. | Whilst 
Esser supports this view, Preusse has observed recovery in forty-one out 
of forty-five animals. It is of prime importance to remove the tumour 
early, before it has attained, say, the size of the hand, and while it is 
still cireumscribed. If left longer, the growth recurs, even after careful 
removal. The results of iodine treatment have lately proved so remark- 
ably favourable, and been so well spoken of by different practitioners, 
that the prognosis of this disease must now be looked on as immensely 
more hopeful than formerly. 

Treatment.—Prophylaxis demands the avoidance of suspicious 
fodder; but this is troublesome and scarcely practicable, on account of 
the difficulty of recognising whether such suspicious materials are 
infected with actinomyces. Special care must, however, be taken that 
the tumours and their contents do not contaminate any food. Although 
direct infection has not been clearly proved, actinomycosis occurs in 
man, and veterinarians and those handling infected subjects should 
hence exercise due caution. 

A case is related by Meyer where the son of a peasant who tended 
some cows affected with actinomycosis himself became the subject of 


1 For the symptoms, &c., of pharyngeal actinomycosis compare p. 155, of actinomycosis of 
the tongue p, 15, of the jaw p. 89. 


ACTINOMYCES TUMOURS. 79 


actinomycosis of the jaw. Owners and attendants of diseased animals 
should therefore be warned. 


Since Nocard and Thomassen in 1885 first recommended the administration 
of iodide of potassium, this treatment has found many supporters. Cattle 
receive 14 drams daily, dissolved in a pint of water. Improvement is generally 
noticeable in about nine days, when the dose is diminished to 1} or to 1 dram. 
Complete recovery is said to have occurred in four weeks. Lighty cases treated 
by Thomassen all appeared to recover, Ostertag has lately declared in favour 
of iodide of potassium. He treated cases of laryngeal and pharyngeal actino- 
mycosis in cattle, giving 14 drams twice daily, dissolved in a quart of water, 
and generally effected a cure in fourteen days. Where the tumours are directly 
accessible, as for instance in the tongue, Ostertag makes cross-shaped incisions, 
and paints the parts with tincture of iodine every week. He considers iodine 
a specific in actinomycosis. Iodide of potassium has also been successfully 
employed in man for the same purpose (Iterson). 


Injection of the tumour with iodine or carbolic acid has not given 
reliable results (Esser), but Preusse states having produced recovery 
by injecting tincture of iodine into the parenchymatous tissues. Such 
treatment should be confined to cases where, for anatomical reasons, 
the knife cannot appropriately be employed. 


Hohenleitner recommends injecting 1 per cent. sublimate solution, or tincture 
of iodine into the parenchymatous tissue, and repeating the operation several 
times at intervals of a few days. Zimmer pierces the tumour with a hollow 
needle, removes as much of the purulent contents as possible by injecting luke- 
warm water, and then forces in caustic potash solution, which produces active 
inflammation. In the course of six to eight days, the swelling is isolated 
and can easily be removed by incision. The wound heals in two to three 
weeks, Though worth a trial, this method requires caution to avoid grave 
complications, 

Very varying views are held of the efficacy of Lugol’s solution (iodine in 
iodide of potassium). Stienon states that in many cases the further growth of 
the swelling is prevented by iodine ointment, In man, cases have lately been 
treated with tuberculin, and the protein of staphylococcus pyogenes aureus 
(Ziegler). Ziegler noted a slight reaction in the diseased cheek after each 
injection, and healing is said to have occurred after twenty-five injections. The 
same material might be worth trying in animals. 


In operating, Esser casts the animal, places the head on one side, 
and forces the nose downwards. He works round the tumours, always 
operating in the still healthy tissue, and removes the growth as far as 
possible with the fingers, assisted by knife and scissors. In this way 
severe bleeding is avoided, and small vessels can afterwards be liga- 
tured. For checking parenchymatous bleeding, Esser and Preusse 
recommend the actual cautery, which has the additional advantage of 
destroying at the same time any infectious material that may have 
remained. The wound is washed out with carbolic solution, filled with 
some aseptic material (salicylic wadding, Esser), and the skin sewn up. 


80 FRACTURES OF BONES OF THE FACE. 


When the stitches are removed next day, the parts are washed out with 
earbolic solution or dusted with powdered charcoal (Esser), and treated 
as an open wound. Should the condition return, repetition of the 
operation is seldom of any use. 


V.—DISEASES OF THE FACE AND LOWER JAW. 


The face is here reyarded as comprising that section of the head 
whose base is formed by the upper jaw and the malar and lachrymal 
bones. 


(1.) FRACTURES OF BONES OF THE FACE. 


Fractures of the upper jaw, on account of its sheltered position, 
seldom oceur. In horses they are most frequently produced by dental 
operations, and in dogs by their being bitten; less frequently, by such 
external violence as kicks, or collision with fixed objects. During the 
progress of dental operations they result when the animal, especially 
when operated on standing, suddenly moves, and the operator does not 
follow the movements of the head with his forceps. Incautious attempts 
to loosen the tooth with the forceps may also produce fracture of the 
sub-maxilla (p. 47). 

The Appearances consist of swelling, salivation, defective and 
painful mastication ; the molars are found to be loose, and the gums 
wounded ; crepitation may sometimes be detected. Prognosis depends 
chiefly upon whether the fracture is subcutaneous or complicated. In 
the former instance, recovery generally occurs in three weeks; in the 
latter, a much longer time is required. Complications result both from 
injury to the skin, and to the mucous membrane of the mouth and 
gums. 

Treatment of subcutaneous fractures only requires restriction to soft 
food. Removal of loosened teeth, which may easily convert a simple 
fracture into a compound one, should be deferred. When the gum 
remains attached, and the root is not exposed, loose teeth again become 
firm. Fractures of the superior-maxilla, complicated with cutaneous 
wounds, must be treated by antiseptic methods. If pus formation has 
commenced, strict cleanliness must be enforced, and loose splinters of 
bone removed. Complicated fractures, involving wounds of the gum, 
require similar precautions. Even with abundance of soft food, animals 
rapidly lose condition, and economical considerations often suggest that 
cattle be killed rather than treated. In a thoroughbred mare I saw 
transverse fracture of the superior-maxilla occur nearly above the roots 
of the incisors. The fracture was caused by falling on the mouth, and 


FRACTURES OF BONES OF THE FACE. 81 


all the incisors were displaced downwards and backwards towards the 
tongue. As the fracture had already existed for several days, replace- 
ment could not be immediately effected, but was at length attained by 
the attendant, according to my instructions, daily exercising pressure on 
the dislocated teeth. Being gradually brought into normal contact with 
the lower incisors, the act of mastication helped to maintain them in 
position, and complete recovery resulted. The gravity of fractures of 
the malar bone depends on their position. When involving the 
orbital process, they resemble those of the orbital process of the frontal 
bone and the zygomatic process of the temporal bone. When affect- 
ing other portions, they may open the superior maxillary sinus, or 
loosen the insertions of the masseter and other masticatory muscles, 
causing difficulty in feeding, while the fragments may become separated, 
and muscular contraction prevent their being replaced in position. 

Diagnosis of fractures of the malar, caused by external violence, 
is only difficult when much swelling exists. If not due to cellulitis, to 
the presence of new growths, or disease of the superior maxillary sinus, 
such swelling should arouse suspicion of a fracture, especially if there be 
any considerable difficulty in mastication. Where the superior maxillary 
sinus is laid open, or the zygomatic ridge injured, doubt can no longer 
exist. Dainage to the alveoli of the upper molars, or extensive tearing 
of muscular insertions, give rise to difficulty in feeding. Subcutaneous 
fractures of the malar bone, which are of rare occurrence, unite easily, 
and compound fractures only cause difficulty when the alveoli of teeth 
are exposed, and purulent alveolar periostitis results. 

Treatment of subcutaneous fractures merely requires regulation of 
diet. Compound fractures heal most rapidly under antiseptic treat- 
ment. Should purulent alveolar periostitis supervene, the affected teeth 
must be removed. In endeavouring to replace the fragments dislocated 
by the pull of the muscles of mastication, it has been recommended first 
to perform myotomy. But this entails the danger of making a simple 
subcutaneous fracture into acompound one; while, if already compound, 
exfoliation of bone may ensue. Further treatment is regulated by 
general principles. Reference may be made to fractures of the frontal 
bone (p. 108), and diseases of the superior maxillary sinus (p. 58). 


82 FRACTURE OF THE LOWER JAW. 


(2.) FRACTURE OF THE LOWER JAW. 


Lit.: Gielen, Gurlt u. Hertwig. 24. p. 375. Vormeng, ibid., 8. p. 4. 
Mador, The Veterinarian. 1844. Hering, Her. Rep. 15. p. 4. 
Passerini, Jahresbericht. 1883, p. 109. Popow, ibid., 1884, p. 112. 
Delamotte, ibid., 1887, p. 84. Littlewood, ibid. 1891, p. 125. 
Grin, BLT W. lso3ep: v. 


Of all the bones of the head the under jaw is the most frequent seat 
of fracture: this is true of all classes of animals, and notably of the 
horse. The causes are external violence, kicks and falls; occasionally 
the excessive action of the muscles of mastication, as when the mouth 
gag is applied to horses suffering from brain disease, or in the simul- 
taneous application of the mouth gag and twitch. Hertwig considers 
that, under these circumstances, the animals are unable rightly to 
estimate the degree of contraction of the masseter muscles. Hering saw 
a case in the horse, caused by the clumsy use of the tooth chisel. In 
dental operations fractures may occur under the same circumstances as 
in the upper jaw (p. 80). Griin saw transverse fracture of the body of 
the jaw in a calf result from violent manipulation during delivery. In 
staghounds they result from the prey striking out at the moment when 
the dog has fastened on to the hind-limb. The fracture is sometimes 
subeutaneous, and remains confined to one branch of the lower jaw; but 
not infrequently both branches break, and usually at the neck, where 
teeth are wanting. Vormeng noted breakage of both branches in the 
middle line, an accident which occurs more frequently in foals than in 
older animals. Fractures of the border of the alveoli of the lower 
incisors are often seen, in consequence of the animal biting, being kicked, 
or falling and striking fixed objects. Fractures of the joint or coronoid 
process, although occasionally reported, occur less frequently. 

Symptoms.—In transverse fractures of the body of the bone the 
chin and lower incisors hang limply and are abnormally mobile, while 
crepitation may be detected. Fractures of the coronoid process or joint, 
or in their neighbourhood, often interfere seriously with mastication, 
and may be mistaken for inflammation of the articulation. The broken 
fragments of the coronoid process are drawn upwards by the temporalis 
muscle, and can be detected on palpation. 

Prognosis. —Fractures in the median line and subcutaneous injuries 
of one branch unite regularly and completely in from three to five weeks. 
Double-sided fractures present the greatest difficulty, and often affect 
mastication so seriously that condition is lost in a marked degree. 
Transverse fractures of the body are difficult to set, and sometimes 
eventuate in formation of callus fibrosus, with sinking of the alveolar 
margin and protrusion of the tongue (fig. 44). Griin cured the above 


SPLINTS FOR FRACTURE OF THE LOWER JAW. 83 


transverse fracture in a calf by applying a suitable splint and giving 
nourishment through an cesophageal canula. The case recovered rapidly. 
Fractures of the articulatory process, or in its neighbourhood, are the 
most serious. Those of the coronoid process unite, but sometimes by 
the formation of a callus fibrosus. 

Treatment in simple one-sided fracture consists merely in the 
administration of soft food. Dislocated fragments must be brought into 
position. As long as the fracture remains confined to one branch no 
mechanical appliance is necessary; but when double-sided, considerable 
ingenuity is required. Prince recommends a wedge-shaped splint of 
wood, which fits into the sub-maxillary space, and is fastened with straps 
passed over the animal’s neck and head. In small patients, and in 
valuable large animals, a similar splint formed of gutta-percha is pressed 


oh 


Fic. 44.—Incomplete union of Fracture of the body of the Lower Jaw, froma 
photograph. 
into the space whilst soft, so as to form an exact reproduction of 
it; its posterior broad end is supported against the animal’s throat. 
Another arrangement is due to Mazza. Girard arranged two bars of 
iron, bound together at an angle, corresponding to the direction of the 
posterior borders of the lower jaw, and carrying at their point of union 
a spoon-shaped extension for supporting the chin. The other ends were 
provided with rings for attachment to the halter or to a neck strap, 
while a strap passed over the animal’s nose, about half-way up, secured 
the under portion of the splint in place. Instead of rods, Marrot used 
a gutter-like splint, formed of tinned iron, which fitted the posterior 
border of the lower jaw. On the lower part were four rings for fasten- 
ing to the halter and to the animal’s nose and head. Fractures in the 
inter-dental space of the lower jaw may sometimes be reduced and fixed, 


84 DISLOCATION OF THE LOWER JAW. 


by using the teeth as points @appuwi. Thus Delamotte bored a hole 
between the first and second molars, and carried a wire thence around 
the incisor teeth. The wire having been in position for three and a half 
months, the fracture was found to be united. In treating fractures at 
the height of the first molars, Ohlsen inserted an iron splint the shape 
of an ordinary magnet, which was pushed into the mouth legs-foremost, 
and embraced the back teeth, holding both splint and bone in position: 
unfortunately this method is hable to loosen the teeth. After attending 
to diet, treatment of fractures in the neighbourhood of the articulatory 
process becomes expectant. Hence it is generally advisable to slaughter 
cattle early, rather than await an uncertain healing process. It need 
scarcely be added, that all compound fractures must be treated on 
antiseptic principles. 

Littlewood saw double fracture of the lower jaw in a horse, the 
maxilla being broken near the symphysis, and between the second 
and third incisor teeth. The pieces of bone were replaced during 
anesthesia, a hole drilled through them, and a metal wire so inserted as 
to fix them in position. The operation was completely successful. 


(3.) DISLOCATION (LUXATION) OF THE LOWER JAW. 


This oceurs only in carnivora: the long coronoid process and limited 
mobility of the joint render it impossible in herbivora. Staghounds, 
sporting and drovers’ dogs most frequently suffer; the first often, from 
being struck by the hind-foot of the animal they are pursuing.  Dis- 
location is frequently complicated with fracture. Sometimes it 1s con- 
fined to one side, but double-sided luxations also occur, thus resembling 
the condition usual in man. 

The mouth hangs open, and can neither be closed voluntarily nor by 
external assistance. Salivation, protrusion of the tongue, and inability 
to eat are also present. Sometimes the ball of the eye is pushed 
forward by pressure of the dislocated coronoid process (exophthalmus). 
In one-sided dislocation the jaw hangs towards the sound side. The 
condition may be mistaken for paralysis of the lower jaw, and for the 
presence of foreign bodies in the mouth or between the teeth. But in 
paralysis, the lower jaw is passively movable, and the mouth can be 
closed by pressure, whilst the presence of foreign bodies is determined by 
local examination. A favourable course is insured if professional 
assistance is sought early and no complications exist, but recurrences 
nevertheless occur, and animals should therefore not be used for some 
time after apparent recovery. Where much bleeding has taken place into 
the orbit, replacement of the prolapsed eye sometimes proves difficult. 

Reduction is most easily effected by inserting a stick about # of an 
inch in thickness transversely into the mouth, and pushing it well back. 


INFLAMMATION OF THE ARTICULATION OF THE JAW. 85 


The operator then seizes the front of both jaws and presses them together, 
the stick acting as a fulcrum to the two-armed lever. The coronoid 
process is thus drawn downwards, and can be brought into normal posi- 
tion by pushing the dislocated jaw sideways towards the middle line. 
Im small animals both jaws are seized, and the dislocated coronoid 
process moved first downward and then backward; but care is required 
to avoid being bitten, and for this reason the first method deserves 
preference. Recurrence is prevented by giving soft food, interdicting 
bones, and applying a muzzle. 


(4.) INFLAMMATION OF THE ARTICULATION 
OF THE JAW. 
Lit.: Bésenroth, Gurlt u. Hertwig. 26. p. 343. Gurlt, ibid., p. 350. 


Siedamgrotzky, Dresd. Bericht 1874, p. 43; ibid., 1879, p. 85. 
Weiss, Ad. Woch, 3. p. 113. Delamotte, Rev. vétér. 1891, p. 465. 


This articulation, on account of its exposed position, is often injured 
by blows or treads, and purulent inflammation so caused. Cellulitis 
affecting neighbouring structures may extend to the joint, or it may 
become inflamed in horses which, in consequence of painful affections, 
he continuously (decubitus). Gurlt found the joint immobile in a goat, 
on account of the formation of extensive exostoses. The condition had 
resulted from severe bruising. 

Symptoms.—lImpaired mastication is the most frequent accompani- 
ment. The mouth cannot be properly opened, whence the condition is 
sometimes mistaken for trismus, from which it may be distinguished by 
a swelling affecting one or other, but seldom both articulations. The 
lower jaw is generally displaced sideways, so that the grinding surfaces 
of the teeth do not exactly correspond, and patients, in consequence, 
quickly fall off in condition, and sometimes cannot take any food at all. 
They often develop the shearlike mouth (p. 31). 

Bosenroth saw a case of this kind in a horse, and has described the 
post-mortem appearance. Several similar cases have occurred in my own 
practice. In a dog, which suffered from inability to open the mouth, and 
showed extensive atrophy of the muscles of mastication, | found forma- 
tion of new bony material in both articulations. This had been produced 
by an arthritis chronica. Siedamerotzky has described a similar case. 

The disease is of a very grave character, especially in animals which 
have to consume much food, such as working-horses and milch-cows. 
Cases like that described by Weiss, where a horse was able to masti- 
cate regularly after displacement of the inter-articular cartilage, are 
exceedingly rare. An error in diagnosis may possibly have occurred in 
the case described. The patient’s strength must be conserved, suitable 
diet provided, wounds and inflammatory processes properly treated, 


86 PARALYSIS OF THE JAW (SO-CALLED). 


and the ill effects of decubitus guarded against. So long as no 
purulent arthritis exists, recovery, as in Siedamgrotzky’s case, may be 
expected. Delamotte recommends injecting the cavity with carbolic or 
sublimate solution, and limiting the movement of the lower jaw as far as 
possible by means of a tightly applied nose strap. Fluid nourishment 
alone is indicated. 


(5.) PARALYSIS OF THE UNDER JAW (SO-CALLED). 
PARALYSIS OF THE MUSCLES OF MASTICATION. 


Ger. Kaumuskillahmung, Masticatorische Gesichtslahmung. 


Lit.: R61], Spec. Path. u. Th. vol. 1. p. 70. Lydtin, Bad. Mitth. 1881, 
» 20. Koérber, Gurlt- u. Hertwig, I. p.. 453. , Waltrup eae 
Mitth. 1867, p. 147. Frohner, Monatshefte fiir pr. Th. 1893, p. 310. 


A condition in animals has been described where, in consequence of 
diplegia of the masticatory muscles, the mouth cannot be closed. It 
may more correctly be termed paralysis of the muscles of mastication, 
or masticatory facial paralysis, as it is styled in man. According to 
present information, it seems almost entirely confined to dogs and eats, 
but Roll, Waltrup, and Lydtin have also seen it in the horse. Both the 
masseters and the temporal muscle are supplied with motor twigs 
from the third branch of the fifth cranial nerve, which arises in the pons 
varolii. One-sided paralysis of this nerve is much less frequent in 
animals than double-sided paralysis, but double-sided paralysis in eats 
and dogs has been repeatedly described. The condition occurs almost 
invariably during the progress of rabies, in fact is seldom seen unassoci- 
ated with it, and therefore its presence always awakens suspicion. 
Although Gerlach insisted on its acceptance as a sure sign of mad- 
ness, I have found dogs and cats thus affected which were not rabid. 
The animals often recover completely, the surest proof that Gerlach’s 
statement is incorrect. Korber and Frohner have noticed the same 
thing in dogs. The anatomical changes causing the disease are at 
present unknown; they are probably due to some diseased condition in 
the pons varolii. As a great number of nerve centres originate in this 
portion of the brain, it is not remarkable that this disease is frequently 
accompanied by other nervous disorders. In the case described by 
Korber, paralysis of the pharynx and muscles of the throat and breast 
supervened. But that isolated paralysis of these motor nerves occurs, 
and may recover, is shown by the following illustrations :— 


A grey pointer was sent to hospital on the Ist February 1883, with the report 
that it had received an excessive quantity of beer some days previously, and 
had afterwards slept for a long time. When it awoke next day, its mistress 
remarked that its tongue was protruding, and that it was unable to close its 


MASTICATORY FACIAL PARALYSIS. 87 


mouth. The animal appeared low-spirited ; the under jaw hung flaccid ; and 
when pressed into position again fell. The tongue was dry and hung out ; 
food could not be taken, though pieces of meat placed in the mouth were 
swallowed with great relish. During the next few days the dog appeared quiet, 
somewhat apathetic, and lay continuously in a corner of his kennel. Five days 
later, the disease had already so far yielded to expectant treatment that the 
animal could again take nourishment regularly. A similar case, which, however, 
appeared incurable, occurred in my practice in 1884. A nine months old dog, 
used for drawing a barrow, showed complete paralysis of the nerve, could not 
withdraw the tongue, the mouth remained continually open, and in taking fluid 
nourishment or water, the head was thrust into the fluid as high as the eyes. 
The muscles of mastication, and particularly the temporal muscles, showed 
marked atrophy. The tongue and buccal membrane were insensitive to injuries ; 
twitchings occurred in the muscles of the rump, like those often seen following 
distemper ; no improvement appeared after lengthened observation and faradisa- 
tion. As the owner objected to have the animal killed, a post-mortem unfor- 
tunately could not be made. Roll and Lydtin saw cases of one-sided trigeminal 
paralysis in the horse. Roll states having found all three branches paralysed ; 
the skin and mucous membrane of the affected half of the head and the cornea 
being insensitive. Salivation, difficulty in chewing, and accumulation of food 
between the cheeks and teeth existed. The mucous membrane of the nose, 
mouth, and conjunctiva was hyperemic. Owing to inability to close the lids 
and protect the eye, corneal ulcers formed. Post-mortem discovered fatty 
degeneration of the roots of the nerve and meningitis at the base of the brain. 
Lydtin observed the disease inan old horse. Marked atrophy of the masseter and 
temporalis muscles of the right side had been developing for ten years, swallow- 
ing was difficult, salivation existed, the molars showed partial shear-mouth. The 
animal was regarded as incurable, and killed. Post-mortem showed the masseter, 
temporalis, and pterygoid muscles completely atrophied; their weight being 
only one-eighth of those of the healthy side. At the base of the petrous tem- 
poral bone, and just over Gasser’s ganglion, lay a fibro-sarcoma as large as the 
cerebellum, which must be regarded as having caused the paralysis. Froéhner con- 
sidered one case occurring in his experience to have been caused by catching cold. 


The Symptoms consist of salivation, protrusion of the tongue 
(which is often dry on the surface), and inability to take nourishment, to 
masticate, or to close the mouth completely. These symptoms, and the 
fact that the mouth can easily be closed by pressing on the lower jaw, 
distinguish this condition from dislocation of the lower jaw, or from 
foreign bodies lodged between the molars. Masticatory paralysis, as stated, 
is a constant symptom of rabies in the dog, Prognosis must be based 
on general principles. Where the paralysis has only existed a short 
time, and is incomplete, some hope may be given. Under other cireum- 
stances, and especially where extensive atrophy and degeneration have 
set in, treatment is of no value. In Waltrup’s case in the horse, and 
Frohner’s in the dog, improvement occurred gradually. Treatment calls 
for appropriate nourishment, food must be placed in the mouth, and the 
stomach tube is sometimes serviceable. The induced or constant electric 
current should be tried, the poles being applied to the masseter and 
temporalis muscles. 


88 TUMOURS ON THE LOWER JAW. 


(6.) PERIOSTITIS AND EXOSTOSES ON THE POSTERIOR 
BORDER OF THE LOWER JAW. 


Circumscribed periostitis sometimes occurs in the horse on the 
posterior border of the lower jaw at the height of the first molar, 
and induces exostoses. The most frequent cause is external violence, 
especially striking against narrow mangers while feeding. The peri- 
ostitis seldom produces disturbance ; pain is sometimes indicated by 
careful mastication, but the presence of exostoses usually first attracts 
notice. On the posterior border of the lower jaw a hard, sharply 
defined, round, sometimes knobby, painless swelling appears, firmly 
attached to the bone. Sometimes the swelling is flatter, and may then be 
mistaken for that produced by alveolar periostitis, in which, however, 
the rarefaction of bone and the swelling are on the lateral surface of the 
lower jaw, and mount upwards. Periostitis caused by local mjury, on 
the other hand, remains confined to the posterior edge. Prognosis is 
favourable, the mature exostosis only producing an wnimportant blemish. 

Treatment must conform to general principles. Prominent exostoses 
may be removed: a circular cut is first made through the skin and 
periosteum, and the chisel or saw then applied. Flat swellings are 
better left alone. 


(7.) TUMOURS ON THE LOWER JAW. 


Lit.: Keiper, Gurlt and Hertwig. 33. p. 53. 


Tumour-like new growths, arising either from the molars or from 
the interdental space of the lower maxilla, occur both in larger and 


Fic. 45.—Mykofibroma of the Lower Jaw. 


smaller animals. Keiper observed an osteo-sarcoma (?) in the horse, 
springing from the point of fracture of the lower jaw, between the 


ACTINOMYCOSIS OF THE JAW. 89 


incisors and pre-molars. This rapidly recurred after extirpation, and in 
twenty-two days attained a height of six and a breadth of four inches. 
I have several times removed similar growths, which have proved to be 
mykofibromata (fig. 45). They usually appear on the buccal membrane, 
and possessing a narrow base, are easily extirpated. They must not be 
mistaken for those new growths which arise from the alveolus of the 
tooth (epulis), and are much less easy to deal with (p. 53). It is 
important to note from what point the tumour arises and whether 
swelling of the sub-maxillary glands already exists. Tumours originating 
in the mucous membrane are easily removed, but those attached to the 
bone present greater difficulty. To the latter variety belong— 


(8.) ACTINOMYCOSIS OF THE MAXILLA, 
SPINAVENTOSA. 
Ger. Winddorn. 
Lit.: Pilz, Zeitschr. f. Vet.-Kunde 1893, p. 12. 


Infection with actinomyces following injuries to the gums often causes 
osteomyelitis and rarefying ostitis of the jaw. This generally attacks 
the lower jaw, but sometimes the upper in addition, and is frequently 
seen in ruminants, particularly in cattle, but also in goats. The disease 
usually arises from one or other pre-molar. Pilz saw a tumour of this 
kind in a horse: it had developed in the neighbourhood of the 1st and 
2nd lower molars, and had four fistulous openings, from which a 
yellowish pus was discharged. 

Symptoms.—A hard, firm swelling develops on the lower jaw, which 
careful examination shows to be caused by an increase in the volume 
of the bone. The swelling spreads and increases In size; and although 
it is at first only slightly painful, the animal soon shows difficulty 
in chewing, masticating slowly, holding the head obliquely on one side, 
and even allowing food to fall from the mouth. Closer examination 
discloses the presence of purulent alveolar periostitis of one or several 
molars, those, namely, at the point where the swelling appears externally. 
The diseased teeth le deeper in the jaw than usual, or are pressed out 
of line. The masticated food collected around them possesses a 
peculiarly penetrating and unpleasant smell, always noticed in alveolar 
periostitis of herbivora. The external skin increases in thickness, and 
gradually becomes adherent to the swelling. Later, perforation takes 
place, and a thick fluid yellow pus is discharged, in which actinomyces 
may be found (p. 77). A probe penetrates deeply into the bone, and 
easily breaks down its thin trabecule. Granulations form around the 
wounds, and bleed readily when touched. As a rule, feeding is disturbed, 
and loss of condition sets in. 

The nature and position of the diseased processes make it evident 


90 ACTINOMYCOSIS OF THE JAW. 


that little can be done therapeutically.’ Actinomyces possess considerable 
powers of resistance, and when within the bone, are exceedingly difficult to 
come at. The disease must almost always be incurable, though Pilz and 
others claim to have had recoveries after giving iodide of potassium inter- 
nally, and applying tincture of iodine locally. It is better to slaughter, im- 
mediately the general condition begins to suffer. Post-mortem shows the 
bones to be perforated with granulation masses and pus cavities. The exist- 
ing osteoporosis is most clearly seen after macerating the bone (fig. 46).’ 


Frc. 46.—Osteoporosis of the Upper Jaw. 


Treatment, even when early adopted, offers little hope. Loose 
teeth must be removed under any circumstances, the alveoli afterwards 
washed out with a disinfecting fluid, and plugged with tow saturated 
with tincture of iodine. Where abscesses have already perforated, anti- 
septic injections may be tried. Tincture of iodine seems to deserve pre- 
ference (p. 79). But more important than these therapeutic measures is 
the administration of such food as makes little call on mastication, as 
brewers’ or distillers’ grains (Esser). 

Pilz gave an eighteen months old foal 4 to 5 drams of iodide of potassium, 
and injected the swelling with tincture of iodine daily. In five weeks symptoms 
of poisoning occurred, appetite and condition were lost, the coat was dry and 
staring, the limbs swollen, and pulse accelerated, but these symptoms disappeared 
after the material had been discontinued for a fortnight. Iodide of potassium 
was afterwards given for periods of fourteen days at a time, until two pounds of 
iodide of potassium and one pound of tincture of iodine had been used. At the 
same time the parts were regularly washed out with different materials. Great 
improvement was noted ; but as the foal was soon afterwards sold, the final result 
of the treatment could not be determined. 

1 Recent experiments with iodide of potassium show that this view may be considerably 
modified, and that even where the bone has been attacked, provided the disease has not made 
very great progress, recovery follows the administration twice or thrice daily of iodide of 
potassium in drachm doses. —[TRANSL. ] 

2 The illustration is from a photograph kindly lent to me by Professor Esser, 


INFLAMMATION, ETC., IN THE SUB-MAXILLARY LYMPH GLANDS. 91 


(9.) INFLAMMATION AND NEW GROWTHS IN THE 
SUB-MAXILLARY LYMPH GLANDS. 


Lit. Siedamgrotzky, Berl. Arch. 1891, p. 300. 


Infectious processes in the lips, nose, cheeks, or nostrils usually cause 
swelling of the sub-maxillary lymph glands. This is especially noted in 
glanders, strangles, certain forms of cellulitis, and also in some malig- 
nant new growths, such as carcinoma, mykofibroma, and actinomy- 
cosis. In the last-named disease chronic lymphadenitis, accompanied 
by marked swelling, pus formation, and ulceration, may also occur. 

The swelling, which is slightly painful and moderately firm, sometimes 
appears as a circumscribed new growth, sometimes as a diffuse enlargement 
of the whole gland, or of single sections of it. It develops slowly, finally 
breaking in several places. So soon as the ray-shaped fungi of actino- 
mycosis or the well-known bothryomyces forms are discharged, the 
nature of the disease may be recognised. In the horse I have, however, 
repeatedly found chronic disease of these lymph glands, with ulceration 
of the skin and multiple abscess formation in the glands, without the 
presence of the above-named parasites; but in such cases pyogenic 
cocci were present. 

Treatment requires extirpation of the gland, or of those portions 
affected by the new growth. Resorbent or disinfecting materials 
are never satisfactory. In the horse I have frequently removed 
the collective sub-maxillary lymph glands, and even a portion of the 
sub-lingual, and recommend proceeding as follows :—The horse should 
be cast, chloroformed, and laid on its back. The skin is now cut 
through at the point where it has become adherent to the under- 
lying structures. The connective tissue which surrounds the gland is 
thus exposed, and the tumour divided from the sound structures by 
the fingers, aided by scissors and knife. Great care must be taken 
not to injure the external facial artery and vein, or Stenson’s duct. If 
this seems unavoidable, they should previously be ligatured. | Wher- 
ever practicable, the operation should commence at the posterior part, 
in order that the injured vessels be more conveniently ligatured. If 
the sub-lingual gland is diseased, it must also be removed. The seat 
of operation is then washed out, its surface sprinkled with iodoform 
and tannin, and, in order to check bleeding, a mass of tow or jute firmly 
inserted before sewing up the wound. This tampon is removed after 
twenty-four hours, and the wound treated as an open one, when regular 
healing usually follows. The appearance of normal or blood-stained 
saliva is unimportant. The discharge ceases with the appearance of 
granulation. 


9? INJURY OF THE EXTERNAL EAR, 


VI.—DISEASES OF THE EAR AND GUTTURAL 
POUCHES. 


(1.) INJURY OF THE EXTERNAL EAR. 


Lit.: Lindenberg, Gurlt and Hertwig. 13, p. 212. Pofeld, Thierarztl. 
Mitth. 1885, p. 139. 


Injuries of the muscles of the ear are commonest in dogs, though 
seen in other animals. They are produced in cropping the ears and 
from bites. In long-eared varieties, shaking the head persistently may 
lead to injuries. Larger animals meet with wounds of the ears by 
bringing the head forcibly against nails or hooks, and occasionally by 
being bitten by their companions. The practice of applying a twitch 
to the ear, more common formerly than now, was also a frequent cause. 

The wound, when confined to the skin, is unimportant ; but the cartilage 
being closely attached to the skin, often suffers, and may be more or 
less injured. In a horse I saw a torn wound extending from the base 
of the ear to its summit, and dividing it into two exactly equal portions. 
Transverse wounds occur, or pieces of the cartilage (recognised by its 
white colour) may be entirely lost. | In long-eared dogs, the cartilage does 
not reach to the point of the ear,but is continued by a fascia-like membrane. 
Healing, easily effected if the parts are undisturbed, is often checked by 
the animal continually rubbing or shaking the ears. Longitudinal 
wounds heal better than transverse ones. Injuries to the point, produced 
by shaking the head, are difficult to heal, because the animal is prone to 
irritate them afresh. After a time thickening results, and ulceration 
of the edges of the wound occurs, laying the cartilage bare and produc- 
ing exfoliation. The surfaces are usually invested with a brown crust, 
and bleed easily. This condition, termed “external canker,” is indica- 
tive of chronic mischief, and is usually a sequel of otitis externa. 

Treatment.— Loose shreds, brought into apposition with sutures 
and treated antiseptically, will often adhere; but where appearance is 
not regarded, they may be removed with the scissors. After cleans- 
ing and freshening the edges with scissors, the bare and projecting 
margins of the cartilage are pushed back as far as possible, and pin 
sutures inserted on both the external and internal surfaces. It is 
usually sufficient to pass the pins through the skin, but it may be 
desirable to insert a few through the cartilage. After another thorough 
cleansing, the wound should be covered with gelatine and wadding, and 
in large animals a thin bandage passed round the ear. In dogs, the 
ears may be bound together on the sides of the head; whilst in 
horses movement can be prevented by placing the animals on the pillar 


EXTERNAL CANKER. 93 


reins. If the dressing remains dry, it should be left in position for about 
a week. In ulceration of the cartilage, it is of first importance to 
prevent the head being shaken. This can be effected by bandaging the 
ears to the head, but preferably by the treatment recommended in 
inflammation of the external auditory meatus (p. 95). Sections of skin 
which have lost their blood supply are removed. 

Lindenberg saw a peculiar case of auricular necrosis in a pig, which had 
suffered for about fourteen days from gastric fever, complicated with obstruction 
of the bowels. The points of the ears were black, dry, and parchment-like, but 
subsequently became hard as leather; the condition spread in three or four 
days to within half an inch of the base of the cartilage ; dissection then began, 
was complete in six days, and cicatrisation gradually commenced. (This 
may have been a case of poisoning with secale cornutum.) A cow which 


came under Pofeld’s treatment lost a large portion of both ears from septic 
cellulitis. 


(2.) @DEMA OF THE FREE BORDER OF THE EAR 
—EXTERNAL CANKER (OTHAIMATOMA), 
(er. Blutohr. 

Rupture of blood-vessels, and extravasation of blood between the 
cartilage and skin of the external ear, is often brought about in long- 
eared dogs by the ears being rubbed or bitten, but more frequently from 
their being vigorously shaken to allay irritation consequent on otitis. 
As a rule, the rupture occurs under the perichondrium, and the con- 
dition, therefore, in the dog consists of sub-perichondrial blood extra- 
vasation. This usually remains fluid for a lengthened period, appears 
oftenest on the inner surface, less frequently on the outer, at times on both. 
From the position of the lesion, absorption is slow and usually incomplete. 

Symptoms.—Hoffmann, misled by the above facts, looked on the 
extravasate as consisting of lymph. I have never seen such. 

The dog holds its head on one side, and examination reveals a slightly 
painful, fluctuating swelling, sharply defined, rounded or longish, and 
varying in size from a bean to a pigeon’s egg. An incision liberates 
fluid or clotted blood, and displays the yellow white surface of the 
cartilage, which later becomes covered with granulations, which appear 
as little discrete red flecks, and gradually, during perhaps several weeks, 
spread over the exposed surface. Healing is tardy, and the parts 
generally remain thickened. Where the swelling is not opened it may 
persist indefinitely, and produce marked distortion. 

Treatment.—In slight hematomata, absorption may be produced 
by massage, though early opening of the swelling in the direction of 
the length of the ear is preferable. To prevent too early union of the 
skin after opening, a small plug of tow or jute is inserted. If this is 
not done, the skin wound may heal by primary intention, the cavity 


94 INTERNAL CANKER, OTORRH@A, OR 


again fill with blood-stained serosity or pus, and require to be opened 
anew. ‘l’o keep the edges of the wound clean, and bring about rapid 
healing, the wound may be painted with tincture of iodine and dusted 
with iodoform. Healing is further assisted by binding the ears close 
to the head with a broad bandage, or by using a net. This disease 
must be distinguished from the next in series, 


(3.) INFLAMMATION OF THE EXTERNAL AUDITORY 
MEATUS (OTITIS EXTERNA). OTORRHGA. 


Lit.: Nocard, Rec. de méd. vétér. 1891. Ostertag, Jahrb. 1890, p. 92. 
Schiitz, Virchow’s Arch. vol. 60. Siedamgrotzky, Dresd. Br. 1878, 
p- 11. Butel, Her. Rep. 1893. 


This is termed in Germany “internal canker” (Inneren Ohrwurm), 
in contradistinction to the ulcerative and chronic inflammatory pro- 
cesses of the cartilage of the ear, which have been described as 
‘external canker” (Ausseren Ohrwurm). To avoid mistakes, it would 
be better to discontinue the use of the terms otitis externa and interna. 

The meatus extending from the auditory opening to the tympanic 
membrane has externally a cartilaginous foundation, internally a bony 
one. It is lined by skin, rich in large spherical wax glands. 

Causes.—In dogs with long ears, occasionally in other animals, the 
waxy secretion decomposes in consequence of exclusion of air, high tem- 
perature, and restricted evaporation, and its products irritate the skin 
lining the meatus. Inflammation is seldom caused by the entry of 
foreign bodies into the external auditory opening, though Hering has met 
with acari of sarcoptes cynotis, or more properly dermatophagus canis. 
Although examining many dogs suffering from otitis externa, I have 
never found acari in the external meatus, but have seen the disease 
caused by dermatocoptes cuniculi in rabbits, and Ziirn states that derma- 
tophagus cuniculi produces the same result. Ostertag found bird-lice 
(Gamasus auris) in the external meatus of a cow: attention was drawn 
to the animal by its violently shaking its head. In dogs facial eczema 
sometimes invades the external ear, and, on the other hand, otorrhoea 
may produce eczema on the ear. 

Two kinds of otitis externa are distinguished—the acute and chronic. 
The acute develops in the dog as a sequel to eczema of neighbouring 
parts, or following the entrance into the meatus of secretions froin 
neighbouring wounds. A yellowish-brown secretion, usually mixed with 
pus, flows from the ear, and produces eczema of the skin below. Proper 
treatment often induces recovery in eight to fourteen days. In 
neglected cases chronic otitis develops. It may be divided into a super- 
ficial and deep form. The first is commonest in dogs, and owes its 


INFLAMMATION OF THE EXTERNAL AUDITORY MEATUS. 95 


origin to irritation produced by decomposing secretions. Abnormal 
pruritus is present; the unpigmented skin of the meatus is reddened, 
and covered with a blackish-brown fatty material; light pressure at the 
base of the cartilage produces an agreeeble sensation, the animal leaning 
towards the operator, and holding the head on one side. A bubbling 
sound may perhaps be heard, owing to motion of the fluid contents of 
the ear. After some time the secretions become yellowish-brown, and 
excoriated spots appear in the depths of the meatus. In the deep form 
one meets with a purulent discharge (otorrhcea); granulations appear 
on the surface of the diseased meatus, and caries of the petrous temporal 
bone may ensue. Sometimes pus formation preponderates ; sometimes 
formation of granulations. The latter may obliterate the external 
opening. Perforation of the tympanum and otitis media are rare. 
Whilst irritation disappears early in the chronic superficial form, the 
deep form is usually accompanied by greater pain. Frohner records 
vomiting in dogs, which he referred to irritation of the ramus auricularis 
of the vagus nerve. Implication of the middle ear or brain may pro- 
duce fits and other brain symptoms; but, considering the frequency of 
such ear diseases in dogs, these complications are seldom observed. 

In order to view the largest possible portion of the meatus, the head is 
placed downwards, the cartilage grasped with both hands, and held in such a 
position as to direct the passage, which lies sideways, somewhat towards the 
front. The aural speculum is of no great value in dogs, as the tympanum is not 
visible. The resistance of the animal, moreover, interferes both with the inser- 
tion of the instrument and the examination. 

While acute otitis is easily curable, chronic otitis externa presents great 
difficulty in treatment. In the superficial form care and patience may 


succeed, but the deep form must generally be regarded as incurable. The more 
profuse the discharge of pus, the less the chance of recovery. 


The Treatment of acute otitis can usually be effected by repeated 
cleansing of the meatus and the use of mild astringents. A small soft 
sponge fastened to a stick is dipped into lukewarm water or solution of 
acetate of lead, gently squeezed and inserted into the meatus. Slow rotary 
movements remove the secretion, when the meatus may be washed out 
with a solution of acetate of lead, care being taken to thoroughly remove 
all traces of fluid with a sponge. Excoriations can be painted with a 
2 per cent. solution of nitrate of silver. Where pain is excessive, 
lukewarm oil of henbane dropped into the ear often gives relief. The 
washing of the meatus must be repeated at least once a day, and 
continued until the discharge has completely disappeared. 

In chronic superficial otitis the first requisite is careful cleaning 
of the meatus with lukewarm soap and water and an ear-sponge, 
followed by washing with a 10 per cent. lotion of equal parts of tannic 
and salicylic acids in spirit. Alcohol is also of service. Batel 


96 INFLAMMATION OF THE EXTERNAL AUDITORY MEATUS. 


recommends a 6 per cent. solution of boric acid in alcohol. This 
treatment must be repeated daily; and where the disease has been 
neglected, and to prevent its return, must be continued for some 
weeks. No fluid must be left in the ears. If great pain be 
present, henbane oil is useful. Beyer, after cleansing, powders the ears 
with boric acid, while resorein, iodoform, and other materials have been 
recommended; but less depends on the materials used than on their 
careful application. Nocard recommends using night and morning an 
ointment consisting of 10 parts of salicylic acid, 100 parts of vaselin, 
and 20 drops of tincture of benzoin. <A piece the size of a hazel-nut is 
placed in the ear. Exuberant granulations are removed with a curette, 
and, on account of their often possessing a neck, this is easy. In- 
flammation of the middle ear—that is, of the tympanum—is termed 
otitis media; that of the labyrinth, otitis interna ; but neither are usually 
recognised during life. They occur from the spread of inflammation 
from the external meatus, or the entrance of foreign bodies. Attacks 
of delirium have been observed by Stadler and Schumacher in cattle, 
produced by acari in the middle ear (dermanyssus avium). Schiitz and 
Siedamerotzky detected tuberculosis of the middle ear in pigs. In 
rabbits, formation of pus in the middle ear has produced epileptiform 
attacks, and I have also observed dermatocoptes in the meatus and 
middle ear, causing cerebral symptoms. The animals sometimes made 
rotary, sometimes rolling movements. J/anéege movements have been 
seen in tuberculosis of the middle ear in pigs. 

A horse showed powerful cramp-like movements immediately a finger was 
introduced into one or other ear. Passing it into the left ear, the horse at once 
endeavoured to bring the left hind-foot as near the ear as possible, and rapid 
movements were made with the muscles of the hind-foot and of the neck. 
Pressure on the base of the ear immediately produced these cramp-like move- 
ments. The same happened on the right side. Pressure of the bit caused 
similar symptoms, so that the animal was useless for work. Examination of the 
ears and auditory opening during life showed no change; hearing was undis- 


turbed. Unfortunately I was unable to make a post-mortem, but during life I 
was unable to detect the slightest change in the ears. 


(4.) FISTULA OF THE BAR. 
Ger. Ohrfistel, Halskiemenfistel, Zahnbalgcyste. 


Lit.: Verwey, Jahrb. 1886, p. 88. Kitt, Monatsch. f. prakt. Thierhk. 1894, 
p. 401. 

Fistulee are sometimes seen in the horse at the base and near the 
anterior surface of the cartilage, extending downwards towards the malar 
bone for a distance of 1 to 14 inches. A little serous fluid discharges on 
pressure. On introducing a probe, a hard body may be discovered at the 
bottom of the canal, which, if the latter be laid open, will be recognised 


FISTULA OF THE EAR. 97 


as a tooth. Sometimes several small teeth are found in the swelling. 
Strictly speaking, the condition is not a fistula, but represents the 
remainder of the incompletely developed branchial arch. On _ this 
account the fistula sometimes communicates with the guttural pouch. 


The phenomenon must be reterred to the development of embryonic branchial 
arches and clefts. Sometimes the lateral plates of these visceral cavities are 
ruptured, and remain so, thus giving rise to fissures in the ear, pharynx, 
cesophagus, and neck (fistula auris et colli congenita), whilst partial persistence 
of the unruptured embryonic furrows produces blind sacs and dermoid cysts. 
The dental furrow which occurs in this portion of the embryonic apparatus 
results from a primitive fold of the buccal epithelium, which, as in the jaw, can 
produce enamel. The teeth are oftenest found in the squamous portion of the 
malar bone. Several—z.e., from 2 to 4—may be present ; they resemble molars. 
Sometimes a cyst alone is present, and the tooth wanting. 


Such teeth may be present (abnormally) in other positions, as 
the gums, the superior maxillary sinus, the testicle, and the ovary. 
In the malar bone they often remain long unremarked, until either 
acute inflammation produces swelling and prominence, or until attention 
is accidentally directed to the fistulous opening. The swelling is hard, 
and firmly connected with the malar bone, over which the skin is freely 
movable. Sometimes phlegmonous inflammation develops, followed by 
abscess formation, but producing no great disturbance. In horses of 
little value objection is accordingly raised to removal of the teeth. 
Where treatment is necessary the swelling is opened to the bottom, the 
tooth removed, the interior cauterised with chloride of zine or chromic 
acid, 1 to 10, and recovery usually occurs in four to six weeks. Ligature 
of vessels is rarely necessary. The disease occurs very seldom in animals 
other than the horse. Verwey found a dental cyst on the petrous 
temporal bone of a dog, which suffered in consequence from otitis 
externa. 


(5.) CHRONIC CATARRH OF THE GUTTURAL 
POUCHES. 


Lit.: Kivitt, The Veterinarian 1872. Rosenkilde, Ekemann, Stock- 
fleth Chirurgie. Giinther, Nebelu. Vix. l. p. 389. Uhlich, Dresd. 
Ber. 1881, p. 56. Degive, Jahresbericht. 83. p. 84. Weber, Berlin. 
thierarztl. Wochenschrift. 1890, p. 75. Hahn, Ad. Woch. 21. p. 157. 
Schlampp, ibid. 28. p. 21. Savarese, Jahrb. 1889, p. 97. Hal- 
lander, ibid., p. 86. Thomassen, Annal. de méd. véter. 1891. Johow, 
Thierarztl. Mitth. 1870, p. 109. 


In the horse the mucous membrane of the guttural pouch consists 
of an extension of that of the pharynx. ‘The eustachian tube is about 
+ of an inch in thickness, rich in mucous glands, and lined with 


ciliated epithelium. The pouches possess a considerable area, and are 
G 


98 CHRONIC CATARRH OF THE GUTTURAL POUCHES. 


attached to the neighbouring parts by quantities of connective tissue. 
From their protected position they seldom suffer from inflammatory 
disorders ; but when these do occur, they are generally of a chronic 
character. Secretion is retained, becomes decomposed, and then irritates 
the membrane. The fluid part is mostly resorbed, while the solid, from 
the movement of the pouches, becomes fashioned into chestnut-like 
bodies, which sometimes attain the size of a hen’s egg. ‘Their surface 
appears yellowish-brown, their interior yellowish, and on account of 
their cartilaginous consistency they have been described as chondroids. 
I found great numbers in the guttural pouch of a certain horse. Uhlich 
counted 317 small chondroids, weighing collectively 17 ounces. Savarese 
removed 240; they weighed from 5 grains up to 1} drams. In other 
cases a turbid, porridge-like fluid, contaming great numbers of greyish- 
white grains, sometimes mixed with food materials, occupy the dis- 
eased sac. Thomassen describes dropsy of the guttural pouch in a two 
months old foal; Johow found the pouch filled with thick mucus; the 
entrance to the pharynx was displaced by the swelling. The distended 
pouch presses on the larynx and trachea, and causes dyspnoea ; thicken- 
ings or polypoid growths are often seen on the surface of the mucous 
membrane. Generally only one pouch is diseased, seldom both. 

The causes include inflammatory processes extending from the 
mucous membrane of the pharynx through the eustachian tube during 
the course of sore throat and strangles, and foreign bodies and food 
passing into the pouch (Kivitt, Rosenkilde, Ekemann). Whether in 
such cases congenital defects exist in the eustachian tube cannot be 
determined by the communications of observers (Schlampp). Possibly 
a swollen condition of the entrance to the eustachian tube may cause 
the entry of food into the guttural pouch. Schlampp found 27 ounces 
of food in the pouch of a horse. Ruprecht (p. 20) records injury to the 
sac from a piece of bone derived from a fracture of the hyoid. Hering and 
Hahn discovered in a glandered horse cicatrices, small abscesses and 
ulcers in the mucous membrane of the sac; the latter was distended 
with a mucoid secretion. Hallander found a sarcoina in the guttural 
pouch. It had broken into the spinal canal and caused hemiplegia. 
The pouch showed signs of catarrh. 

Symptoms.—(1) The nasal discharge is one-sided, muco-purulent, 
generally without unpleasant smell, occasionally appears for a time in 
considerable quantity, and may then entirely disappear. Pressure on 
the guttural pouch, placing the bit in position or lowering the head, 
increase the discharge. 

(2) The swelling is sometimes slight, sometimes well marked. In 
one horse, whose. right sac held more than 2 pounds of concretions, 
searcely any swelling could be observed from the outside. In another, 


CHRONIC CATARKH OF THE GUTTURAL POUCHES. 99 


swelling occurred in a marked degree in the parotid region, especially 
when the head was lowered. Occasionally the swelling of one side is 
also appreciable on the other, and may give the impression that both 
pouches are diseased. The greater the swelling, the more marked its 
fluctuating character. Entrance of air or gases into the diseased pouch 
causes a churning sound when the horse moves its head, and percussion 
reveals pretty clearly the division between fluid and gases. Should the 
horse eat from the ground, or be ridden or driven, a portion of the 
contents of the sac is discharged, and the swelling visibly diminishes. 

(8) Severe distension compresses the larynx, trachea, and pharynx, 
and produces difficulty in breathing and swallowing. Inspiration soon 
begins to produce a rough sound, and at a later stage expiration becomes 
loud. The seeming contradiction between clinical observations and the 
experiments of Giinther, in which filling the sac with a mass of 
plaster of paris produced no difficulty in breathing, is explained by the 
fact that the dyspnoea is not produced by the filling of the sac, but by 
its distension and pressing on the larynx and trachea. Filling the 
pouch with large quantities of fluid or gases is usually accompanied by 
dyspnoea, whilst filling with hard materials, such as chondroids, produces 
no such result. My own experience confirms this statement, which also 
agrees with most of the cases reported. 

(4) In severe distension the animals hold the head towards the sound 
side—a condition particularly pronounced when the horse is ridden. 

Giinther’s catheter for the guttural pouch gives absolute information 
as to the presence of the disease. 

The disease is sometimes mistaken for swelling of the parotid or 
sub-parotideal lymph glands, in which the swelling is, however, less 
sharply defined. Ulcerative processes in the pharynx produce similar 
discharges. 

Diagnosis must be confirmed by the use of Giinther’s catheter. After 
a little practice it may even be inserted whilst the animal is standing, 

Prognosis is, as a rule, unfavourable. The condition is not usually 
recognised until the mucous membrane of the sac has undergone con- 
siderable anatomical changes, and become adherent to neighbouring 
structures, when cure is impossible. 

Appropriate treatment is sometimes followed by recovery. Although 
Giinther describes one case, spontaneous recovery seldom occurs. 

Treatment.—Vapour baths, so frequently recommended, are, as 
Haubner has pointed out, quite worthless. Their reputation is due to 
error in diagnosis. Recovery is only obtained by complete removal 
of the contents of the pouch, and by direct treatment of its lining 
membrane. Entrance to the pouch may either be obtained through 
the eustachian tube (Giinther), or by an operative wound. The first 


100 GUNTHER’S CATHETER IN CHRONIC CATARRH OF THE GUTTURAL POUCHES. 


method is 


Fie. 47.— 
Giinther’s 
Catheter. 


rarely successful, for it does not remove such solids as 
chondroids, nor provide sufficient exit even for fluid 
contents. Giinther’s tube or catheter is hence more valu-. 
able for diagnostic than for therapeutic purposes. 


It consists of a brass tube about 20 inches in length: one end is 
closed, but is provided with two lateral openings, and is somewhat 
curved. The other end is also slightly bent, possesses a long 
opening to take the so-called index, and receives the screw of 
an iron handle. The index consists of a spring, about 8 inches 
long, and serves to fix the distance of the eustachian tube from 
the entrance to the nostril. By marking with the spring the dis- 
tance of the temporal canthus, which les at an equal distance from 
the entrance to the nostril, one knows, on introducing the instru- 
ment, when the upper end has attained the eustachian tube. To 
use the catheter the patient’s head must be moderately extended. 
After applying the twitch and fixing the spring, the tube is passed, 
the bent end directed towards the palate, into the lower meatus 
of the nostril, until the index shows that the end of the instru- 
ment has attained the entrance of the eustachian tube. A quarter 
turn is then made with the handle of the instrument, so that the 
point is directed to the side, and the handle of the catheter 
pressed towards the septum nasi, probing movements being made, 
until the sound passes into the guttural pouch. Unopposed progress 
of the instrument, without back pressure, shows that it has entered 
the pouch. The handle is now removed, and the contents of the 
sac allowed to flow through the tube. In a similar manner fluids 
may be injected into the sac through the tube. Where the catheter 
is passed in an animal which has been cast, the mouth should be 
placed rather higher, in order to bring the bent point of the 
catheter sideways into the eustachian tube, by moving the handle 
towards the septum nasi. 


For OPENING THE GUTTURAL POUCH various operations 
have been recommended, all of which have their advantages 
and their drawbacks. Although quiet horses may be 
operated on standing, I prefer the prone position. Where 
excessive dyspnoea exists it may, however, be aggravated by 
casting, and Leblanc and others recommend that tracheotomy 
should first be performed; but, with Hertwig, I consider 
that this is undesirable, and it suffices if the instruments 
for tracheotomy are at hand. 

(1) Schabert, in 1779, propounded the oldest method, viz. 
hyovertobrotomy, where the pouch is penetrated through the 
stylo-maxillaris muscle. The hair in front of the wing of the 
atlas for an area of 2 to 4 inches is shaved ; an Incision is 
made through the skin about 2 of an inch in front of the 


anterior border of the wing, and parallel with it. Just in front of 


OPENING THE GUTTURAL POUCHES. 101 


the wing lies the auricular nerve, arising from the second cervical 
nerve, which must be avoided. 

Separating the sub-cutis by a few light strokes, the parotid, recognised 
by its light-yellowish appearance, appears, and is laid forward. The fascia 
of one of the muscles of the neck, now in view, is divided in the direction 
and to the extent of the skin incision. The stylo-maxillaris muscle 
thus exposed is pierced with a pointed bistoury, the back of the 
knife being turned towards the wing of the atlas, and the handle a 
little inclined towards it. In this way the point of the knife enters the 
angle made by the 9th and 10th cerebral nerves with the inner carotid, 
and without injuring these. Throueh this opening the finger can be 
inserted into the guttural pouch. This operation has the disadvantage 
of endangering the nerves and vessels mentioned, nor is the opening 
into the sac sufficient for the removal of such solid contents as chon- 
droids. 

(2) Lecocq recommended that the sac should be entered through 
the stylohyoid muscle. The procedure is the same as Schabert’s 
method, but the incision is made rather higher. This operation is even 
more objectionable than the last. Not only the external and internal 
carotids, but also the facial and lingual nerves are endangered. The 
risks of such injury are increased by the great swelling and consequent 
abnormal relation of the parts. Such operations, especially in dead 
animals, can, however, be easily carried out experimentally. 

(3) Viborg recommended opening the sac below from the triangle 
which is formed by the tendon of the sterno-maxillaris muscle and the 
sub-maxillary vein, with the border of the lower jaw. In the middle 
of this triangle, and parallel with the muscle named, an incision is 
made in the skin, about 2 to 4 inches in length, and reaching to the 
border of the lower jaw. After separating the panniculus of the neck, 
and dividing the connective tissue, the guttural pouch is perforated 
with a trochar, and the opening can then be enlarged with the fingers. 
This method has the advantage of opening the pouch at its deepest 
point, thus more easily removing both fluids and solids. The pouch, 
when distended, is easily reached by this method, which, however, is not 
always free from difficulty. As has been shown by Hering, some 
cases of supposed hyovertobrotomy have only been the evacuation of 
a parotid abscess. 

(4) Dieterich’s method, according to my experience, is the best. The 
method of procedure is at first like Schabert’s, but the cutaneous incision 
is carried a little further, extending over the lower end of the wing of 
the atlas. The parotid is pushed to one side. The fascia of the throat 


muscles are cut through, bringing in view the posterior border of the 
stylo-maxillaris muscle. 


102 EVACUATING THE GUTTURAL POUCHES. 


Without pushing aside the guttural pouch from the internal surface 
of this muscle, the two forefingers are inserted, the connective tissue 
pushed on one side, and the angle formed by the giving. off of the 
occipital artery from the carotid discovered. The vessels are easily 
recognised by their pulsating. The forefinger of the left hand is intro- 
duced, with its volar surface turned towards the point of division, and a 
sharp bistoury slid along the dorsal surface of the finger into the guttural 
pouch. Without removing the left hand, the right forefinger is inserted 
in the sac, and the left immediately follows to enlarge the opening by 
tearing if found necessary. 

To pass a seton or drainage tube through the euttural pouch, an: 
opening must be made in Viborg’s triangle. For this purpose Dieterich 
employs a curved trochar. But it is more easily managed with a blunt 
seton needle pressed outwards from the guttural pouch towards this 
triangle, the incision being made according to Viborg’s directions. This 
method no doubt deserves preference ; it lessens the danger of injuring 
large vessels or nerves, and gives a large opening, allowing easy exit of 
secretions, and insuring complete evacuation of the sac. Where, on 
account of much distension of the sac, there is difficulty in finding the 
blood-vessels, a blunt seton needle is inserted at the point of division of 
the vessels. Following Dieterich’s directions, I have succeeded in passing 
the entire hand into the guttural pouch, and examining from this point 
the eustachian tube. After-treatment consists in flushing out the sae 
with disinfectants, astringents, and other therapeutic agents. Too much 
fluid must be avoided, as it may enter the pharynx, trachea, or lungs by 
way of the eustachian tube. Degive lost a horse in this way from a 
solution of potash entering the lungs and producing pneumonia. 


On 11th of March 1886 an aged grey working-mare, showing no constitutional 
symptoms, was sent into hospital on account of swollen throat. The head was 
held extended, and side movements avoided. <A thick yellowish-white frothy 
fluid ran from the nose, and was increased and became purulent on depression 
of the head. A snoring inspiratory sound could be heard when the horse was 
resting, which, on the slightest excitement or movement, became audible also in 
expiration. Deglutition visibly caused difficulty ; part of the water taken flowed 
back through the nostril. A swelling existed in the parotid region, most marked 
on the right side, where it was pear-shaped, the smaller end lying ‘at the base of 
ine ear, the lower border overpassing the anterior edge of the neck by about 

2 inches, and extending over the trachea. The swelling was 14 inches long and 
14 inches broad at its greatest breadth. On the left side it presented a rounder 
form, was of less size and less sharply defined. Its length was 4? inches and 
greatest breadth 6 inches. The skin on both sides of the neck showed traces of 
the application of irritants. Distinct fluctuation could be detected, percussion 
produced in the lower sections of the right side a hollow note, which was dis- 
tinctly tympanitic in the upper part. The percussion sound on the left side was 
everywhere resonant. Movement of the head and rapid pressure on the swelling 
produced on both sides a distinct splashing sound. The cicatrix of a tracheotomy 


ANTISEPTICS IN GHRONIC CATARRH) OF OTHE GUTTURAL POUCHES. 103 


wound was visible in the middle of the neck. The larynx seemed to have 
retained its normal position, though the trachea was bent at a point below 
the swelling. No doubt could exist as to the diagnosis, and operation was 
decided on by Dieterich’s method, with the modification that the incision was 
made with a seton needle. The great swelling and displacement of the organs 
rendered it impossible to discover ‘the point of division of the arteries. Imme. 
diately on incision a quantity of unpleasantly smelling gases were discharged. 
After making an opening in Viborg’s triangle, about five pints of turbid fluid, 
containing white lumps, flowed out. The cavity was washed, and a thick 
drainage tube inserted. When the horse got up, the swelling had disappeared 
on both sides, the breathing was regular, and food could be taken without 
difficulty. From March 13th the guttural pouch was washed out once daily, 
either with 3 per cent. solution of tannic acid or of permanganate of potash. 
‘The running from the nose decreased greatly, though a muco-purulent discharge 
continued to flow from the lower operation wound. The condition now remained 
at a standstill for a long time, and a lotion of acetate of aluminum was used for 
rinsing the guttural pouch. The wound closed after removal of the drainage 
tube, but had to be re-opened on April 22nd, because the sac had again filled. 
Washings with permanganate-acetate of aluminum and one per cent. of corrosive 
sublimate were without success. The discharge continued, though in smaller 
quantities. On June 9th the patient was cast, and the operation wound, 
especially the upper part, so enlarged that the hand could be passed into the 
pouch and the fingers introduced into the eustachian tube. The finger of the 
left hand, introduced from the mouth, could also be passed into the eustachian 
tube, so that both hands met here. The tube appeared very wide, but) the 
centre wall was divided with a guarded tenotome, in accordance with Bassi and 
Niebuhr’s suggestions. The sac continued to be washed out, and from time to 
time painted throughout with a 2 per cent. solution of sublimate. But this 
treatment remained unsuccessful. The discharge continued. No marked con- 
traction occurred in the mucous membrane, and the guttural pouch preserved its 
abnormal size. When it was seen on June 17th that the horse showed no 
dyspnoea, even on movement, treatment was discontinued, and the animal sent 
to grass. In December 1886 the horse was quite capable of work; the operative 
wound was not then closed, though it had become smoothed off. The secretion 
was slight, and the guttural pouch markedly smaller. 


This case shows how obstinate the disease may be. Such difficulties 
are to be expected. Where the condition has existed for a long time, 
and the sac has been much dilated, it cannot, owing to its connection with 
neighbouring parts, readily resume its normal volume. Possibly dilata- 
tion of the eustachian tube produced by the lasting discharge also forms 
an obstacle to healing. 

Thomassen’s case of hydrops of the pouch also showed swelling, slight 
respiratory dyspnoea, and want of appetite. An experimental opening 
was made, and four pints of amber-coloured serum allowed to escape. A 
drainage tube was inserted, and recovery occurred in three months. 


104 TYMPANITES OF THE GUTTURAL POUCH. 


(6.) TYMPANITES OF THE GUTTURAL POUCH. 

Lit.: Niebuhr, Her. Rep. 21. p. 74. Bassi, Her. Rep. 23.p.347. Friebel, 
u. Kiihnert, Thier. Mitth. 1882, p. 52. Stockfleth, Chirurgie. 
Thomassen, Annal. de méd. véter. 1891. Gerlach Topogr. 
Myologie des Pferdes v. Giinther, p. 75. Perosino, Her. Rep. 15. p. 
169. Prince abid; f6-p 53. 

The disease described by French authors, and especially by Vatelle 
and Gohier, as a guttural tympanites, has been observed repeatedly by 
others (Bassi, Niebuhr, Friebel, Degive, Moller). Friebel and Kiihnert 
found this condition in foals soon after birth. It consists in the 
accumulation of abnormal quantities of air or gas in the guttural 
pouches, which become so dilated as to cause severe dyspnoea, A 
swelling appears in the region of the parotid which is resonant on per- 
cussion, and on strong pressure sometimes produces a whistling sound 
in consequence of alr escaping from the eustachian tube. It usually 
occurs in young animals, foals (Niebuhr, Stockfleth, Friebel), and affects 
both guttural pouches. If the sae is opened the gases escape, but 
reaccumulate as soon as the opening closes. Reported cases show that 
tympany may be due to either of two causes. 

(1) Atmospheric air enters through the eustachian tube and gradually 
accumulates in the guttural pouches. This probably occurs during 
deglutition, and is caused by deformities in the tube allowing its opening 
to act as a valve, which admits air but prevents its exit. Even in normal 
subjects, exit of air appears to be difficult. Degive injected air through 
a trochar into the guttural pouch of a dead animal, and noticed that it 
was retained for a long time. Gerlach referred the condition to para- 
lysis of the elevator of the soft palate, which he considered should close 
the eustachian tube, because in one of his cases these muscles seemed 
atrophied on the diseased side. KR. Giinther also considered that the 
pouch might become distended in this way. The air which has so 
entered, according to Gerlach, is unable to return, because the tube 
closes like a valve at its point of entry into the guttural pouch.  In- 
vestigations in the horse, carried out with the pharyngeal speculum, do 
not, however, support this idea. The open end of the eustachian tube 
can be directly observed with the instrument. Closure by the soft palate 
may certainly occur during swallowing, and entrance of air be caused by 
the soft palate not properly covering the opening of the eustachian tube. 

The significance of the guttural pouches has been variously interpreted. 
Franck looks on them as safety valves to control the air pressure in the 
middle ear, and prevent excessive tension of the tympanum by alteration of 
pressure. The suggestions that they are involved in voice production, or that 
the respiratory air is warmed during its stay in them, seem scarcely probable. 


Perosino discovered, by experiment, that during expiration the pouches were 
dilated, and during inspiration collapsed again. He introduced a tube con- 


TREATMENT OF TYMPANITES OF THE GUTTURAL’ POUCH. 105 


taining alcohol into the pouch through a trochar, and noticed that the fluid 
rose during expiration and fell during inspiration. The phenomenon was 
exaggerated during violent expiration. Perosino therefore considered the 
guttural pouches were intended to moderate the stream of inspiratory air during 
violent exertion. Prince, on the other hand, supports the view first suggested 
by Prange, viz., that the guttural pouches serve to assist movements of the 
head by acting as elastic cushions. Perosino states that, in animals suffocated 
by stopping up the nostrils, the guttural pouches are enormously dilated. 

(2) Other published observations ascribe the condition to the develop- 
ment of gas during catarrhal disease of the guttural pouch (Bassi, Degive, 
Moller). Cases associated with disease of the mucous membrane and 
accumulation of fluid secretion must be viewed and treated according to 
the principles previously described (p. 97). 

Treatment.—Where atmospheric air accumulates, Giinther’s catheter 
is used; and if the condition recurs, the guttural pouch is opened, and a 
seton or drainage tube inserted. Stockfleth employed this method 
successfully. Friebel pierced the cavity with a trochar, and injected 
astringents like 2 per cent. solution of sulphate of zinc. Where such 
methods are unsuccessful, it is better to divide the eustachian tube, as 
was done by Niebuhr with good results. Possibly the valve-like action 
of the tube is thus done away with. Thomassen recommends opening 
the sac at the posterior border of the under jaw, dilating the opening 
with the forefinger, and washing out with some antiseptic fluid. On 
account of the dyspnoea often present, the same principles obtain as 
in treatment of eatarrhal affections of the guttural pouch. 


VIL—DISEASES OF THE SKULL. 


In animals the brain and portion of the head described as the skull 
have a much less extensive development than in man. One portion, 
especially in ruminants, is covered by the frontal sinuses. Injuries to 
this portion are of less importance than in the human subject. 


(1.) FRACTURES AND INJURIES TO THE CRANIAL 
BONES. 


Lit.: Meyer, Gurlt u. Hertwig. 17: p. 178. Becker, ibid. 4. p. 261. 
Curdt, ibid., 17. p. 300. Uebelen, Her. Rep. 38. p. 597. Fidhn, 
Th. Mitth. 1879, p.97. Mariot, Quarterly Journ. of Vet. Scien. in India, 
1887. Textor, Vet. Sanit.-Berichte, 1877/78. Grodning, Zeitschr. fiir 
Veteriniirkunde. II. p. 8. Conti, Rec. de méd. vétér. 1892. Pflug, 
Deut. Zeitschr. f. Thiermed. 1893. 


The cranial cavity is formed by the parietal, temporal, and occipital 
bones, the upper section of the frontal and the lower surface of the 


106 FRACTURES AND INJURIES TO THE CRANIAL BONES. 


sphenoid, in front by the ethmoid. Fractures of the cranial bones 
are caused by falls (either forwards or backwards), collisions, kicks, 
horn-thrusts, and in carnivora by bites from other animals, kicks, and 
similar injuries. The sphenoid is sometimes broken by the contrecoup 
resulting from collisions. Subcutaneous fractures of the above-named 
bones occur, but complicated fractures are most common. In some 
cases concussion exists simultaneously with injury of the brain or spinal 
cord produced by dislocated fragments of bone. 

Prognosis is uncertain. As longas only the external plate is injured, 
the fracture goes on well, especially if no dangerous complications exist. 
But where the inner plate is divided the condition becomes exceedingly 
grave, doubly so where the fracture is complicated. Recovery occurs, how- 
ever, even in such cases. Uebelen saw a dog and Meyer a cow recover, 
in both of which the brain was exposed and injured. I have many times 
seen injuries in horses and dogs successfully treated where both skull 
and brain were injured. In a dog deafness remained, and its behaviour 
suggested that sensation was also defective. Some years later death 
resulted, and post-mortem showed a well marked injury to the temporal 
bone and to the subjacent portions of the hemisphere of the cerebrum. 
Where the wounds become infected the animals usually die of purulent 
meningitis (Fischer). In horses I have repeatedly treated injuries of the 
parietal bone caused by animals running against sharp objects. In one 
the dura mater was exposed. As the patients came for treatment soon 
after injury, and antisepsis was carefully carried out, healing was effected 
by primary intention in from three to four weeks, without either con- 
stitutional disturbance or formation of pus. It is often impossible to 
discover the extent of the injuries produced by the fracture. Prognosis 
must aceordinely be guarded, notably when brain symptoms make their 
appearance, and especially when these have existed for several days, or 
have appeared after the lapse of some time. <A favourable termination 
is to be expected when no brain symptoms like dulness, irritability, 
spasms, &e., appear during the first eight days after injury. Until this 
lapse of time prognosis must always remain doubtful. 

Groning observed fracture of the left parietal in a horse through falling over 
backwards. Some days later slight improvement set in, but, though feeding was 
not interrupted, periodical excitement and fright were present. On the sixth day 
epileptiform attacks occurred, and death followed on the seventh. Post-mortem 
showed a small extravasation of blood in the cranial cavity, 3 drams of a clear 
light-red fluid in the ventricle, and a linear fracture of 23 inches in length in 
the left parietal bone. Conti saw fracture of the skull produced by casting. 
The animal remained unconscious for a short time, and then struck out violently 
with the feet. It died on the fourth day, and a post-mortem showed three lines 
of fracture starting from the occipital bone. One ran from the left condyle to 


the foramen lacerum-basis cranii ; the second reached to the base of the right 
condyle; whilst the third divided the occipital from the temporal bone. 


TREATMENT OF CRANIAL FRACTURES AND INJURIES. 107 


The bodies of the occipital and sphenoid bones were further fractured in several 
places. Pflug saw fracture of the skull in the horse caused by falling over 
backwards. The animal died on the spot. Post-mortem showed the cranium to 
be completely divided in a transverse direction into two parts. The medulla 
was torn away from the brain. 


Fractures of the sphenoid and of the occipital, and even of the other 
bones of the skull, usually produce death in a short time, often after a 
few seconds. Fractures of other cranial bones may prove fatal if attended 
with much bleeding into the brain cavity. Mariot saw a horse, after 
falling, die with loss of consciousness and advancing dyspnma. Becker 
records that a horse, after having struck his head against a wall, imme- 
diately died. Post-mortem showed a comminuted fractureof the occipital, 
with severe extravasation of blood on the medulla oblongata. 

Treatment.—In subcutaneous fractures, without much dislocation, 
rest alone is required. Cold applications, laxatives, and spare diet ward 
off brain symptoms, and suffice in small fractures where dislocation of 
the fragments is only slight, and the brain functions are not disturbed. 
Replacement should be attempted where it can be effected without 
making a wound, and thus endangering aseptic healing. Strict anti- 
sepsis must be adopted in compound or complicated fractures where 
the injury is still recent, ie. has not existed for more than twenty- 
four hours. The hair is cut or shaved, the wound examined with a 
disinfected finger, splinters of bone and foreign bodies removed as far 
as possible, and the entire surface carefully washed out. Plenty of 
disinfecting fluid must be used, preferably in the form of a strong 
stream. No harm is done if the fluid penetrates the connective tissue 
and produces oedema. Loose shreds of tissue are removed with the 
scissors, the wound sutured with sterilised material (catgut or silk), and a 
dressing applied, kept in place in the horse with the help of the halter, 
to which the turns of the bandage are fastened. The horse should then 
be placed on the pillar reins, so that it cannot rub off the bandage, as it 
frequently attempts todo, During the first forty-eight hours the patient 
must be watched, and the usual measures taken to ward off brain symptoms, 
Rest, restricted diet, and laxatives are also to be recommended. 


(2.) CONCUSSION OF THE BRAIN (COMMOTIO 
CEREBRI). 
Ger. Gehirnschiitterung. 
Lit.: Wilhelm, Dresd. Bericht. 1887, p. 67. 
Concussion is induced in horses by falls or collisions, and less fre- 


quently by kicks from a shod foot. Wilhelm diagnosed the condition 
in a cow which had fallen a distance of 14 feet off a wall. Dogs 


108 CONCUSSION OF THE BRAIN. 


and cats suffer from falls from windows as well as from blows on the 
skull. 

The symptoms consist of loss of consciousness, inability to stand 
and walk, sometimes pallor of the mucous membrane of the head, and a 
small, infrequent pulse. In carnivora vomiting may be present. Respir- 
ation is sometimes irregular. Various views are held concerning the 
alterations produced in the brain: molecular displacement is scarcely 
sufficient explanation, nor do the experiments of Koch and Filehne 
demonstrate the precise pathological conditions. 

Where concussion is not associated with fractures of the skull, bleed- 
ing into the cranial cavity, or further injuries, the symptoms usually 
disappear in a short time, often after a few hours, at latest after some 
days. A so-called reaction sometimes follows, the mucous membranes 
become red, the pulse more frequent and wiry—conditions indicating 
febrile mischief. 

Medical interference is usually contra-indicated, and if adopted must 
be confined to treating symptoms. The drugs oftenest employed are 
heart stimulants. 

Absolute rest and easily digestible food in moderate quantity are 
desirable. In a case reported by Wilhelm, complete recovery occurred 
after two days. 


(3.) FRACTURES OF THE FRONTAL BONE. 


Lit.: Hendrickx, Annal. de méd. vétér. 1890; p. 245. Hulford- 
Haslemere, The vet. rec. 1893. 


When occurring on the upper portion (cerebral surface), prognosis and 
treatment are the same as in fractures of the skull. It is otherwise 
where the wall of the frontal sinus or the external plate of the bone are 
alone involved. Fractures here have a different signification according 
to their position. In those of the orbital process of the temporal 
bone the eye may be endangered, as in fracture of the orbital pro- 
cess of the malar bone, either on account of dislocated fragments or 
extravasated blood pressing on the bulbus and producing exopthalmos. 
Swelling of the orbit may, moreover, extend to the optic nerve, and 
through its atrophy produce blindness. Sometimes the lower jaw is 
also endangered (p. 85) 

The guides to diagnosis are the displacement of the fractured process, 
the position and extent of the swelling, and the appearance of the connective 
tissue of the eye, but where there is much swelling diagnosis may be doubtful. 

Subcutaneous fractures of the orbital process, without marked disloca- 
tion, only require cold applications to minimise bleeding, and consequent 
danger to the eye. The animal should receive no food during the first 


FRACTURE OF THE HORN CORE. 109 


twenty-four hours, for masticatory movements are not only painful but 
produce bleeding. Any considerable displacement should be rectified, if 
needful, with the help of the bone elevator. Hendrickx recommends 
trephining. Antiseptic measures must be adopted from the outset, non- 
uritant fluids being selected. A bandage is then applied. 

Fractures of the horn core are not uncommon in ruminants. They 


are recognised by abnormal mobility of the horn, and swelling, or even 


Fic. 48.—Splint for Fracture of Horn Core. 


erepitation. Their course is generally favourable; union goes on regu- 
larly in subcutaneous and often in complicated cases, especially if anti- 
septic treatment is early applied. In neglected and bad eases it is often 
advisable to remove the horn core entirely. In cows grave consequences 
are sometimes observed. ‘Textor describes the occurrence of epileptiform 
seizures, which, however, disappeared when the sanguineo-purulent con- 


Fic, 484.—Form of above Splint. 


tents of the frontal sinus had been removed by trephining. After such 
fracture, a bull was unable to cover cows; erections occurred, but the 
animal, when attempting to spring, fell towards the diseased side, and 
was useless for stud purposes. In compound fractures pus formation 
may involve the brain, and bring about death from meningitis. 
Treatment in subcutaneous fractures requires fixation of the 
horn core, which may be effected by a suitable splint passed over both 


110 FRACTURE OF THE FRONTAL BONE. 


horns, and secured by bandages (fig. 484). Skin injuries must be 
previously disinfected. The animal is tied up so that the horn cannot 
be displaced. Where the core is so completely separated that union 
is not probable, it should be removed with the saw, and a dressing 
applied. Fractures of those portions of the temporal bone which cover 
the brain are often attended with dislocation of bone and injury to the 
mucous membrane of the frontal sinus, and are indicated by swelling, 
depression on the forehead, a nasal discharge, at first blood-stained, and 
later purulent. These fractures, although usually healing without dis- 
turbance, are sometimes followed by chronic purulent disease of the 
frontal sinus. When the fracture remains subcutaneous, and no blood 
is discharged from the nose, recovery occurs without trouble. 

Compound fractures are treated antiseptically ; any cutaneous injury 
requires complete asepsis; where the mucous membrane of the frontal 
sinus is injured, as indicated by blood-stained discharge, complete 
asepsis is more difficult. But even here healing may be effected, and 
often before this is complete the animals may be returned to work. 
Severe dislocation inwardly may be remedied by the use of the bone 
elevator, or by trephining; the latter used, however, only when nasal 
discharge continues after union of the fracture. Other symptoms are 
treated according to general principles. 


(4.) LOOSENING OF THE HORNS. 


Loss of one or both horns occurs under similar circumstances to frae- 
ture of the horn core. Sometimes the connection between horn and 
horn core is only loosened. Sometimes the horn, although completely 
divided from the core, can be replaced, but the new horn never attains 
the natural form, and a blemish results. Otherwise, loss of the horn 
scarcely exercises any other visibly injurious effect. Where the horn is 
loosened, its exterior is thoroughly cleansed, and a bandage smeared 
with tar appled. If completely loosened, the horn is removed, and the 
same treatment applied. 


(5.) WOUNDS AND INJURIES TO THE SKULL. 


Wounds and injuries, unaccompanied by fracture, require no par- 
ticular treatment. Concussion may be produced by severe shocks, and 
is recognised by deafness, uncontrollable movements, and staggers (p. 108). 
During phrenitis, horses sometimes have their heads injured, and it may 
be difficult to determine whether the brain affection or the injury stood 
first in order. In the horse, the skin carrying the forelock is sometimes 
extensively torn by sudden awkward movements of the head against 
fixed objects, and union is often difficult. Where primary union. cannot 


WOUNDS AND INJURIES TO THE SKULL. Lil 


be effected, the divided flap contracts, causing a blemish and deprecia- 
tion of value. I have over and over again seen pus formation in the 
temporal muscles of dogs kept up by foreign bodies. From a hunting- 
dog I removed a splinter of wood 34 inches long, said to have been in 
position for nine months. It had caused continually recurring abscess 
formation. The wounds in cattle resulting from pressure of the yoke 
will be described under the head of pressure injuries. 

The prognosis and treatment are simple. Attention must be given 
to concussion of the brain, which is sometimes present. Rest and anti- 
phlogistic laxative treatment are indicated. After careful disinfection, the 
edges of the wound are brought together with button sutures, or by deep 
sutures placed at some distance from the margins, and a bandage applied. 
When pus formation has set in, retraction of the lappets may sometimes 
be prevented by inserting deep stitches with a thickish thread. Where 
pus formation is seen in the temporal muscles of dogs, examination of 
the face should be made, to insure the removal of such foreign bodies 
as shots or particles of wood. 


(6.) TREPHINING THE CRANIAL CAVITY IN SHEEP 
OR CATTLE, OR OPENING BY THE TROCHAR. 


Lit.: Moller, Piitz, Zeitschrift. 1877, p. 65. Nocard, Jahresbericht 1886, 
p. 85. Ziirn, Thierische Parasiten. Stodhr, Th. Mitth. 1868, p. 119. 
Kuhlmanzg, ibid., p. 122. Scholz, ibid. 1871, p. 147. Dammann, 
Gurlt u. Hertwig. 1869, p. 18. Fiirstenberg, Thierarzt. 1866, p. 8. 
Cooper, Jabrb. 1865, p. 152. Bertholdt, Compt. rend. de lécole 
d’Alfort ou de Lyon. 1885. Hartenstein, Jahrb. 1887, p. 52. 


The cysticercus form of the parasitic tape-worm of dogs (Tenia 
ccenurus) often develops in the brain of the sheep, and occasionally in 
that of cattle and other animals. It usually attains the size of a duck’s 
egg, and animals may die from the resulting disturbance. So-called 
gid or sturdy generally appears in the first or second year of the sheep's 
life, producing significant phenomena. No treatment short of operation 
is effectual. Picric acid and other chemicals, cauterisation (Neirac), and 
refrigeration of the skull with ice, recently recommended in England, 
and usually requiring to be persisted with for three weeks, are of no 
avail. Trephining or opening the skull with a trochar is the only satis- 
factory treatment. Even in the previous century this was attempted by 
laymen in a primitive way with the pocket-knife, but success could only 
be satisfactorily attained when proper instruments had been constructed. 
These consist of a small trephine (Rueff) about 2 of an inch in breadth, 
or of a special set of trochars. which have been perfected by Zehden. 

It is of primary importance to fix the position of the cysticercus. 


This is usually in the neighbourhood of the surface of one hemisphere 


ah} DIAGNOSIS OF POSITION OF CQANURUS CEREBRALIS. 


of the brain. Sometimes it can be recognised by the softness and yield- 
ing of the bone on strong pressure. Percussion gives a dull, less loud 
sound over the affected spot, a symptom to which Villborg directed 
attention last century. But these appearances are often entirely want- 
ing, and the position of the parasite can only be conjectured from 
noting the disturbances in the patient’s movements. 

(1) Where the patient shows rotary movements, the cyst generally 
lies on the surface of one hemisphere, and on that side towards which 
the animal turns, though this symptom, according to my experience, 
is not always the most reliable. Exceptions occur, especially where 
the cyst is large, and presses on the deeper-lying portions of the brain. 

(2) Twisting of the head towards the hind-quarters poimts to the 
eyst lying in the depth of the hemisphere of the same side, or in the 
base of the opposite ventricle. 

(3) A depressed position of the head, with a desire to make trotting 
movements, and abnormal raising of the fore-limbs, suggests that the 
site is towards the front of the hemisphere, or in the depths of the 
hemisphere towards the corpus striatum. 

(4) Staggering, with general uncertainty of movement, points to the 
cerebellum or posterior portions of the cerebrum as the position of 
the cyst. 

(5) The base of the cerebellum, or the pons varolii or medulla 
oblongata, is affected where the animals fall down and make rolling 
movements around the long axis of the body. 

(6) Stumbling, and frequent falling, and holding the head high 
(Segler), suggest the growth to be between the cerebrum and cerebellum. 

These conclusions are evidently not very reliable. Experience, 
however, testifies that in most cases the skull over the hemispheres 
must be selected as the site of the operation. The bladder being of 
considerable size, it is not necessary to discover its central point. 
Accordingly, when the skull gives no direct evidence of the precise site, 
most operators trephine about 2 of an inch behind the inner border of 
the horn in rams, and in ewes about 3 to 4 of an inch behind the horn 
core. The centre of the posterior lobe will be met by operating about 
3 of an inch from the middle line (Dammann). To avoid injuring the 
sinus longitudinalis, the point of operation must not approach nearer than 
33; of an inch to the middle line. The best possible antiseptic precau- 
tions must be adopted. After opening the cranial cavity the thinned 
and protruding dura mater must be divided, and the bladder, which will 
generally be found lying below it, removed with forceps. The skin is 
then closed with catgut or silk sutures, powdered with iodoform, and 
covered with turpentine or tar. Wound gelatine (p. 2) is also suitable. 

My experience with trephining has not been favourable, and I. prefer 


REMOVAL OF CQZNURUS CEREBRALIS. 113 


the trochar. The following is the method of procedure :—The animal 
is laid on its side on a table, the surface of the skull shorn, the wool 
removed, and the skin disinfected. In rams having large horns, where 
the skin inclines to form folds, this is rather difficult. The trochar is 
provided with a canula suitable to the thickness of the skull, that is, 
one in which the round shield is not much further from the end of the 
eanula than the thickness of the skull, so that the instrument shall not 
enter the brain too deeply (fig. 50). With some care and_ practice, 
however, this appliance is not required. It must be remembered that 
the thickness of the skull varies considerably; in ewe lambs it may 
only be a few lines; in rams with large 
horns it is often more than 2 of an 
inch. The point of the trochar, being 
directed rather towards the middle 
line and backwards, is driven through 
the roof of the skull by a few light 
blows from a hammer. The stilette is 
then removed, and if the bladder has 
been struck its clear serous contents 
are discharged. After spontaneous dis- 
charge has ceased, the empty syringe 
(fig. 49) is inserted through the canula, 
and any remaining fluid removed. The 
eanula is now withdrawn, but the skin 
in the neighbourhood of the wound fixed 
by an assistant, so that the opening 
in the bone may be more easily found 
if the syringe has to be subsequently 
inserted. Where this precaution is not ob- 
served, the search for the trochar opening 


. , Fie, 49.— Fig. 50.— 
often takes much longer than would be Zehden’s Fehien’s 
expected. The syringe is held in the — Syringe. Trochar. 


right hand with the thumb in the ring of 

the piston, and the point towards the little finger. Inserting it about 
as far as the canula penetrates, the piston is slowly drawn up by the 
thumb. Any water in the sac enters the syringe and is removed, and 
the operation is repeated as often as required. A portion of the sae 
wall may enter the syringe, when resistance will be felt to the with- 
drawal of the piston. In such case the pull is maintained, and the 
syringe, drawing with it the sac and contents, are cautiously removed, 
until the sac wall comes in sight and can be grasped with blunt forceps 
and completely taken away. If the bladder remain full of serum, and 


prove difficult to abstract, it may be pierced with a thin steel probe, but 
H 


114 DIFFICULTIES IN REMOVING C(ENURUS CEREBRALIS. 


bladder and parasite must both be completely removed. The skin wound 
is disinfected, covered with turpentine, collodion, or tar, and usually heals 
satisfactorily. 

Difficulties, however, are sometimes met with. Animals apparently 
successfully operated on die frequently after a few hours, and post- 
mortem shows bleeding from some of the larger meningeal vessels. 
Where careful antisepsis is not carried out, inflammatory processes may 
also result. Injury to a lateral ventricle is especially dangerous, being 
apt to be followed by fatal hydrocephalus purulentus, running its course 
in a few days. Frequently the ecenurus is in the cerebellum, when its 
removal is almost impossible. When several parasites exist in different 
positions in the brain the case presents serious difficulties. Sometimes 
the bladder is not met with when the trochar is introduced, no fluid 
discharges after removal of the stilette, and it becomes a question 
whether to introduce the trochar more deeply or to operate at another 
point. When antiseptically treated from the first, the wound seldom 
gives much trouble, and no objection exists to renewing the attempt in 
another place. Sometimes the sac lies so deep as to be impossible of 
removal, and little good can be done, even with the explorer first 
designed by Stiirig, and improved by Lehmann. The injuries insepar- 
able from the use of this instrument do not, however, occasion any 
particular danger. 

Rams with large well-developed horns give most trouble. In 
them the frontal sinuses are large, and cover so much of the 
skull that only the posterior folds of the cerebrum can be directly 
reached from the exterior. I have endeavoured, in such cases, firstly, 
to trephine the frontal sinuses, and thence to open the roof of the 
cranium with a trochar. It is difficult, however, to make the frontal 
sinus aseptic, and, in rinsing it out, large quantities of fluid pass into 
the nostrils, producing difficulty in breathing. Hence, during operation, 
the head should be pendulous, though this is attended with considerable 
discomfort to the operator. The thin mucous membrane can hardly be 
kept aseptic, and from it inflammatory processes are easily propagated 
to the cranial cavity. The easiest subjects are ewes, in which both skin 
and bone are alike thin. 

At best the losses are heavy. Generally only 10 per cent. are saved, 
and of these some die later of the sequel of the disease. The operation 
is usually confined to rams and specially valuable animals. The 
percentage of cures claimed varies greatly. Englehart records 6 per 
cent. ; Stohr, 15 per cent.; Scholz, 25 per cent.; Dammann, 33 per cent. ; 
Reboul, who operates in primitive style with a cobbler’s awl and feather 
quill, states that he has saved 50 per cent.; and Siitner, even 70 per 
cent. Kuhlmann claims to have saved from one-half to one-fourth of 


DIFFICULTIES IN REMOVING CGENURUS CEREBRALIS. 115 


those operated on, exclusive of the cases in which no bladder could be 
found. These variable results depend partly on accident, and partly on 
the skilfulness of the operators. 


The failures, in recent years, depend in part on the formation of skull and 
condition of skin in the modern races of sheep, and in part on the fact that 
many operators do not remove the bladder, and thus obtain only temporary 
relief. The prevention of such parasitism is secured by close observation of 
dogs and their treatment with vermicides, and the stall feeding of lambs and 
young sheep. Preferable to operation is the prompt feeding and early slaughter 
of all subjects so soon as they manifest any appearance of the disease. 

In cattle, sturdy is rare in North Germany, but occurs more frequently in the 
South. Cysticerci were found in the Salzburg slaughter-houses in large numbers 
of cattle, and sturdy is said to be rather common in cattle throughout Steiermark, 
Karnten, the Tyrol, Bukowina, and Dalmatia. Differing from sheep, in which 
the disease almost always appears during the first two years of existence, cattle 
suffer at more advanced ages. The symptoms are essentially the same in both 
classes of animals, and consist of the peculiar position of the head, dilatation of 
one or both pupils, and abnormal movements, similar to those in sheep. 

In operating, the marked differences in the skull formation of the two classes 
of animals must, however, be borne in mind. In cattle the frontal sinuses extend 
over the greater part of the cranium, and only through them can the cerebral 
hemispheres be reached. Hence diagnosis and treatment meet with the same 
difficulties as in large-horned rams. Softening of the external cranial plates 
evidently cannot occur here; but the inner temporal plates are sometimes so 
bulged that they come in contact with the external plates. This may be dis- 
covered by percussion, and the position of the parasite localised by sounding the 
frontal and superior maxillary sinuses, using the metallic end of the percussion 
hammer. 

If an operation be deemed desirable, the frontal sinus must first be trephined, 
a soft point in the bony covering of the cranium may be discovered, and tre- 
phining or the trochar resorted to according to the rules previously given. 

In cattle the disease often takes an acute course, rendering operation useless. 
Nor if performed does it insure success, the result often depending on accidental 
circumstances. Although observations of successful operations have been 
published (Cooper, Bertholet, and others), reports of unfavourable results are 
not wanting. 

As the result is always uncertain, it is better to slaughter affected animals 
early, though treatment may be attempted in particularly valuable breeding 
animals. 


Il. DISEASES OF THE NECK. 


Anatomy.—In the domestic animals the cervical vertebra, which are compara- 
tively long, are surrounded by well-developed muscular tissues, and thus pro- 
tected from injury. Anteriorly, z.e. below the cervical portion of the vertebral 
column, lie the trachea and cesophagus, the jugular and carotid, with the large 
nerve trunks of the vagus and sympathetic ; behind the vertebra, the ligamen- 
tum nuchex, which gives attachment to many of the muscles of the neck. The 
latter consists of a round portion forming the upper border of the neck, and a 
flat portion which extends in the middle line from the vertebre to the cordi- 
form portion. The collective muscles of the neck are surrounded by two fasciz 
or aponeuroses, which extend to the withers and back, and become attached to 
the cordiform portion of the ligamentum nuche. In cattle the skin is folded 
at the lower end of the neck to form the so-called dewlap. 


I—WOUNDS AND BRUISES OF THE TISSUES OF 
THE NECK. 


Wounps confined to the skin are of no great consequence. Deeper 

ng injuries may involve important organs. To this class belong— 

(1) Bruises and wounds of the fascia of the neck and of the 
ligamentum nuchee.— When healing results by primary intention, these 
cases are also unimportant, but should pus formation occur, the tendinous 
structures (fascia, ligamentum nuche) usually become necrotic. Separa- 
tion of dead particles requires a long time, and during the process fresh 
tracts of tissue are often destroyed. Healing is thus retarded and rendered 
difficult. This is especially frequent in injuries to the poll, withers, 
ligamentum nuche, or adjacent fasciz, which lead to chronic pus forma- 
tion and fistule. The process often starts at the withers and extends 
thence to the ligamentum nuche and muscles of the neck ; these condi- 
tions are treated of under “Diseases of the Back.” It is here only 
necessary to remark that all such cases are treated by thorough asepsis, 
and preventing as far as possible the burrowing of wound secretions. 

(2) Injuries to the large blood-vessels of the neck, carotid 
and jugular.—Injuries to the carotid by sabre cuts, thrusts from lances 
or other sharp objects, as well as those inflicted during venesection may 
endanger life, by producing fatal bleeding or suffocation. Injuries 
to the jugular vein are less grave, though its complete section may lead 
to fatal hemorrhage; while there is also a danger of air entering the 


COMPLICATIONS OF WOUNDS IN THE NECK. 117 


blood stream, an accident which is favoured by the negative blood 
pressure in this vessel, and by its lability to gape in consequence of 
attachment to neighbouring tissues. The escape of dark-coloured blood 
in a strong steady stream points to injury of the jugular vein, and calls 
for its complete section, or secure ligation, which latter must be performed 
on both sides of the wound; on the peripheral side to stop bleeding, 
on the central side to prevent entrance of air into the blood stream. 
Free bleeding in jerks indicates injury of the carotid or of some other 
of the larger arteries, and necessitates ligation of the injured vessel. 
The closure of small skin wounds in no way removes the. danger, 
because the blood accumulating under the skin and loose connective 
tissue of the throat presses on the posterior surface of the trachea, and 
may cause suffocation. There should, therefore, be no hesitation in 
ligaturing the carotid. A cut must be made in the skin at the point of 
bleeding, parallel with and a little behind the jugular. The loose con- 
nective tissue is pressed to one side with the index finger, and the 
vessel, easily recognised by its distinct pulsation, sought, drawn forward, 
separated from the vagus, sympathetic and recurrent, and after being 
twice ligatured, cut through between the two threads. The _ peri- 
pheral ligature is necessary on account of the collateral communication 
with arteries of the other side of the neck (occipital and innominate 
arteries). Section of the vessel is intended to prevent tearing away at the 
point of ligation, which is favoured by the natural tension of the carotid. 
It is necessary to remark that the blood may flow in a regular stream, and not 
in jerks, even in injuries of the carotid. This is the case where the blood does not 


find exit directly, but flows under the skin or into the cavities of the connective 
tissue. A red colour and powerful stream always suggest injury to the carotid. 


(3) The larger nerve trunks, like the vagus, sympathetic 
and recurrent, may be injured.—One-sided division of the vagus, or 
even of the sympathetic and recurrent, do not endanger life, but cause 
unilateral paralysis of the larynx. From such injuries I have repeatedly 
seen roaring result in the horse. Where injury to the nerve exists, or 
is suspected, the strictest antiseptic précautions must be observed to 
prevent extension of inflammatory processes to the nerves named, and to 
bring about as regular an union of the nerve endings as possible. 

(4) Wounds in the neck may be complicated with perforation of 
the trachea; and though such a condition is seldom directly fatal, it 
occasionally leads to death, from blood entering the trachea and lungs and 
producing suffocation. The emphysema often seen about the neck after 
injuries to the trachea is an unpleasant, if not an actually dangerous, 
complication. Tracheal injuries are recognised by the blood-stained 
discharge from the nose, the frothy condition of the wound secretions, 
or of the blood discharge from the wound, as well as by emphysema 


118 COMPLICATIONS OF WOUNDS IN THE NECK. 


in the neighbourhood of the wound. Bloody discharge from the nose, 
coughing, rattling in the throat, and dyspncea point to the entrance of 
a large quantity of blood into the trachea. Where these symptoms 
occur, the bleeding vessels must be immediately tied and patients with 
injuries to the trachea, or in its neighbourhood, should not be left 
unattended. Extravasations on the neck sometimes lead to compression 
of the trachea and death from suffocation, and, where this threatens, 
tracheotomy becomes necessary. It is also called for where much blood 
has entered the lungs. A tampon canula is inserted, or the trachea 
plugged above the canula to prevent the blood passing downwards. 
In such cases the tracheal tube must be fixed with especial care to 
prevent the tampons falling into the trachea. or this purpose, and 
in order to be able to remove the tampon more easily, it is well to 
encircle it with a piece of tape, which can be fastened round the neck. 
For further information, refer to the article on tracheotomy. 

(5) Injuries to the cesophagus are not so frequent. They 
usually occur in the lower third, on the left side of the throat. 
(Esophageal mischief is shown by the presence of chewed food or saliva 
in the wound. Though such wounds are not dangerous to life, they 
require a long time to heal. (For treatment see p. 144.) 

(6) Wounds lower down on the neck, usually produced by the 
carriage pole, or by running against obstacles, may extend 8 to 12 
inches deep between the shoulder blade and thorax, and cause exten- 
sive destruction of the muscular tissues of the shoulder and _ breast. 
They are still more serious when they extend to the first ribs, or the 
space between them. I have repeatedly seen complicated fractures of 
the ribs produced in this manner. 

The wound, if confined to the muscular tissue, requires no particular 
attention, although fatal results occasionally ensue from extensive 
burrowing of pus, or from septicemia. The extent of such injuries is 
sometimes difficult to ascertain at first, and for a few days diagnosis 
should be guarded. Where one or other of the ribs are injured, 
purulent pleuritis and death can seldom be averted. arly and con- 
tinuous irrigation should be adopted, and the wound in the skin and 
muscles laid open to allow free exit of discharge. This is even more 
requisite where the injury extends to the muscular tissue of the breast, 
and under the shoulder. With free opening and the use of drainage 
tubes such wounds, however, usually heal satisfactorily. Injuries involv- 
ing the sternum are dangerous, because this bone is hable to be come 
necrotic, producing so-called sternal fistula, which seldom or never heals. 
To prevent such complications the wound must be carefully cleansed, 
continuously irrigated, or frequently rinsed out, and drainage tubes or 
setons used. 


FRACTURES OF THE CERVICAL VERTEBR. 119 


I.—FRACTURES OF THE CERVICAL VERTEBRA. 


Lit.:: Schumann, Thierarztl. Mitth. 1869, p. 148 (1. Halswirbel). K ohne, 
Gurlt u. Hertwig. 27. p. 431 (1. Halswirbel). Hering, Her. Rep. 14. 
p- 11 (3. und 4. Halswirbel). Percival, ibid., 14. p. 328 (2. Halswirbel). 
Adenot, ibid., 15. p. 53 (3. Halswirbel). Armbrecht, Miiller-Réll 5. 
p. 68 (2. Halswirbel). Vives, Her. Rep. 16. p. 58 (Luxation?). Rabe, 
Ad. Woch. 1879, p.1. Niklas, Miinch. Ber. 1855, p. 29. Wilhelm, 
Dresd. Ber. 1890, p. 83. Labat, Rev. vétér. 1889, p. 105. 


The above fractures are not uncommon in horses. Fractures of the 
atlas, of the condyles of the occipital bone, and of the other vertebrie 
of the neck occur, sometimes singly and sometimes together. The 
usual cause is falling on the racecourse—or in steeplechasing—or being 
driven over, or, in the case of refractory jibbers, from a rope or chain 
being passed around its neck and another horse harnessed to it. I have 
frequently seen riding-horses in violently bucking or falling over back- 
wards, or even in arching the neck excessively, fracture a cervical 
vertebra, usually the third or fourth. In bucking or leaping, if the fore- 
limbs are not rapidly extended, the animal comes to the ground on its 
mouth, and thus falling, even on soft ground, may fracture the third or 
fourth vertebra. Hertwig states having seen fracture of the odontoid 
process of the second cervical under these conditions. But such fractures 
are rare. Vertebral fractures are seldom produced by kicks or thrusts 
with the carriage pole. Cattle cause them by violently tilting at each 
other. In small animals they result from blows with heavy sticks 
or attempts to crawl through narrow openings in which they become 
fixed and struggle to get free. 

Symptoms.—In horses, death usually occurs instantly from arrest 
of respiratory and cardiac action, a result of the implication of the 
phrenic and other nerves of respiration. But in fractures of the first 
or of the last two cervical vertebre, the animals may live for some time. 
Fractures of the last two are often followed by paralysis of the muscles 
of the shoulder, while fractures of the oblique processes produce torti- 
collis (p. 122). 


A riding-horse, injured by falling, was ridden for some miles, but died four days 
later, and post-mortem revealed fracture of the sixth cervical. O. R. Scharfen- 
berg reported to me personally: A horse, after running against a door, fell, 
rose again, and worked for three hours. Next day paralysis set in, death 
occurred on the third day, and post-mortem showed the body of the second 
cervical broken completely across (Niklas). A horse, examined after death by 
Rabe, had fractured the first cervical on 21st August by falling, carried its head 
awry, showed swelling in the neighbourhood of the atlas, and threatened to fall 
immediately any attempt was made to raise the head. After standing quietly in 
the stable until the 8th September, it was moved, rapidly became worse, and 
in consequence was killed. An ox thrown down whilst struggling with another 


120 DISLOCATION OF THE CERVICAL VERTEBR. 


could still run; on being placed in a stall, however, it soon became paralysed, and 
the second cervical vertebra was found, on post-mortem, to be broken into four 
pieces. 

Kohne records fracture of both wings of the atlas in a horse which had 
fallen. On the following day it showed difficulty in breathing, rolling gait, 
and marked stiffness of the neck, muscular twitchings and great pain on moving 
the latter. These symptoms continued ; and having fallen on the twenty-second 
day, the horse was unable to rise again, and died three days later. Post-mortem 
showed formation of callus on the broken wings, and inflammatory processes in 
the meninges of the medulla oblongata. A cow whose horns had become fast in 
an iron rack was found unable to stand, to move the head, or to eat. Post- 
mortem discovered fracture of the second cervical vertebra, and bleeding into the 
vertebral canal (Wilhelm). 


During the year 1891 the following vertebral fractures were noted amongst the 
Prussian army horses :—Thirty cervical fractures, six dorsal, and seven lumbar. 

Injuries to the spinal cord in man are generally accompanied by abnormal rise 
in temperature, reaching 43 to 44 centigrade ; but in animals no: observations 
are available on this point. 

The course of the disease is, then, similar to that in man, although 
in him death occurs somewhat later, because the medulla oblongata or 
the spinal cord is not so often injured. Displacement of the pieces of 
bone, bleeding into the spinal canal, or inflammatory processes generally 
disturb the function of the spinal cord later, and bring about death. In 
fractures of the 3rd to 6th cervical vertebre, death usually occurs imme- 
diately, with appearances of suffocation. As the diaphragmatic nerve is 
formed by the 5th, 6th, and 7th cervical nerves, its action is soon 
destroyed in fractures of the last cervical vertebrae, and asphyxia must 
necessarily result. Ii the fracture is confined to one or other of the 
vertebral processes, the animal may live for a time, or even recover. 

Treatment of fracture of the body of a vertebra is usually impos- 
sible, because death is almost immediate. Otherwise, especially in 
animals worthless for slaughter, it is of the first importance to prevent 
displacement of the broken fragments. Where such a fracture, or one 
affecting any of the processes, is believed to exist, the animal is 
placed in a condition of absolute rest, and measures adopted to pre- 
vent, as far as possible, all movements of the head and neck. If soft 
parts are injured, antiseptic methods must be employed to prevent pus 
formation, necrosis and spread of inflammatory processes. Complete 
displacement of the cervical vertebra, said to occur in the horse, may 
here be mentioned. As it usually causes immediate death, there is 
seldom opportunity for a precise diagnosis. Conditions described as 
luxations of the vertebrae have doubtless often been merely fractures. 
This is true of a case described by Vives. A mule, which shortly before 
had been actively galloping about, was observed standing immovable, with 
head sunk, extended, and turned to the left. Attempts to lift the head 
produced much pain, the neck was swollen, and the occipital region dis- 


DISTORTION OF THE NECK. At 


torted. The right wing of the atlas extended further forward than usual ; 
the left could not be felt. Next day severe swelling of the head had set 
in. On the thirty-fifth day the condition remained essentially the same. 


HI—DISTORTION OF THE NECK (TORTICOLLIS, 
CAPUT OBSTIPUM). 


Ger. Schiefhals. 


Lit.: Immelmann, Thierarztl. Mitth. 1873, p. 172. Fambach, Dresd. 
Ber. 1889, p. 71. Schrader, Zeitschr. von Busch. vol. iti. p. 30. 
Youatt, The Veterinarian. 1839. Lebel, Rec. de méd. vétér. p. 391. 
Hurtreld’Arboval, Dictionnaire, deutsch von Renner. vol. iii. p. 108. 
Gohier, Mémoires et observations, vol. ii. p. 106. Ammon, Handbuch 
fiir angehende Thieriarzte. 2. Aufl. p. 29. Auszug aus den Rapporten der 
Armee. 1887, 1. Quartal. p. 24. Guitaud, Journal de Vétérinaires du midi. 
XXXI. Hering, Her. Rep. 29. p. 211. Gerlach, Gurlt u. Hertwig. 20. 
p. 203. Stohr, Th. Mitth. 1876, p. 95. Spooner, The Vet. 1838. 
Jons, ibid., 1839. Busse, Gurlt u. Hertwig. 15. p. 14. Klench, 
Jahresb. 1884, p. 112. Uebele, Her. Rep. 43. p. 194. Fambach, 
Dresd. Ber. 1890. p. 71. Leisering, ibid., 1868, p. 10. Wilden, 
Zeitschr. f. Vet.-Kunde. 1892, p. 260. Lanzilotti, Clin. vet. 14, p. 
74 (ref. Jahrb. 1891, p. 128). Labert, Rev. vétér. 1889, p. 105. 


The collective term torticollis, or caput obstipum, has been used in 
human medicine since olden times to describe many different conditions, 
which, on careful examination, have nothing in common with that now 
under consideration. In animals, distortion of the neck sometimes 
occurs, but the precise anatomical changes on which the abnormality 
depends are not recognised. On this account, while adopting the 
above designation, I shall endeavour to point out the nature of the 
more frequent of these curvings or distortions. 

(1) Cramp or contraction of the muscles of the neck occurs 
both in men and animals. In men the most frequently affected muscle 
is the sterno-cleido-mastoideus; its shortening is often congenital, or 
develops through cicatrisation after birth. Such conditions have not 
been observed in animals. But Uebele records that an eight days foal 
showed at short intervals attacks of cramp in the left cervical muscles, 
drawing the head to the left; when not supported, it fell; the condi- 
tion disappeared in fourteen days. I have repeatedly seen temporary 
displacement of the head and neck in horses, consequent on rheumatic 
affections of the above-named and other muscles. These abnormalities 
were accompanied by a lameness, most marked when the limb was being 
lifted (Hangbeinlahmheit). In dogs similar rheumatic contractions in 
the muscles of the neck also occur, usually on both sides; can be 
recognised by local pain and swelling, and may exist only for a few hours. 
In pugs, in which it is common, I have found such attacks recurrent. 


1 DISTORTION OF THE NECK. 


(2) Paralysis of the muscles of the neck.—Whilst the diseased 
conditions causing the above-named distortions are to be sought on the 
concave side of the curvature of the neck, the cause of paralytic torti- 
collis exists on the convex side, as may be seen in dogs and rabbits 
during the course of diseases of the middle ear. In the German Army 
Reports a horse is mentioned in which paralysis cf the muscles and 
production of torticollis resulted from a carcinomatous growth on 
the petrous temporal bone. Torticollis appears in horses as an accom- 
paniment of the general paralysis of meningitis cerebralis, and in 
diseases of the medulla oblongata and medulla spinalis in the neck. 
Wilden speaks of a horse which showed torticollis during an acute 
brain attack, but recovered as the cerebral symptoms disappeared. 
Leisering saw a dog which suffered from torticollis, and simultaneously 
from hemiplegia and paralysis of the ear and eye, with softening of the 
pons varolii, medulla oblongata, and cerebellum. In birds—hens and 
ducks—I have often seen the head bent in a semicircle (so that the 
beak was turned backwards) in consequence of brain disease, or following 
intoxication produced by coal gas. The same is noticed in canaries, 

(3) Inflammation of the soft parts, especially of the muscles, 
consequent on severe strains and lacerations, is produced in horses 
by falling, and is often described as sub-luxation of the cervical verte- 
brae. Fambach had under observation a horse which, by hanging 
back in the halter, produced rupture of the round portion of the lga- 
mentum nuche just behind the occiput; pus formation and necrosis 
occurred, and were followed by death. 

(4) Sub-luxations and fractures of the cervical vertebree.— 
Complete luxations of the body of the vertebra, as above stated, are 
almost always fatal. On the other hand, sub-luxations, accompanied by 
distortion of the neck, may occur without injury to the spinal cord. In 
France the condition is described as “entorse vertebro-cervicale,” and 
consists in sub-luxation of one or other of the oblique processes of the 
bone. As the bodies of the vertebree are attached to one another by 
cartilage, their division 1s more appropriately described as diastasis, but 
this is a condition not infrequently complicated with fracture of the 
oblique processes. According to Schrader, Hippocrates declared that 
the conditions described as displacement of the cervical vertebra were 
often only muscular diseases, and that Absyrtos, in his contemporary 
History, expressed himself in the same sense’ Lebel, Hurtrel 
d’Arboval, and others combated the possibility of displacement of the 
cervical vertebree, and supported their contention by citing cases of 
spontaneous recovery. 

Hertwig has shown, however, that such displacement may occur in 


1 Sed te nolo latere, non luxationem esse sed perversionem (Schrader). 


DISTORTION OF THE NECK. 23 


consequence of rupture of the ligaments of the oblique processes. 
Williams found degenerative processes in the inter-articular ligaments. 
In other cases the oblique processes are fractured. Guitaud and 
others could even detect distinct crepitation. Busse states having 
directly felt the broken oblique process of the vertebra. I myself have 


Fie, 51.—Sub-Iuxation of the 3rd Cervical Vertebra, as seen from the left side. 


detected this fracture on post-mortem examination. In 1892 I treated 
a horse which had been found one morning cast in its stall and unable 
to rise even with assistance. In spite of all efforts it was only got up 
next day and then showed unmistakable symptoms of torticollis. The 


Fic. 52.—Sub-luxation of the 3rd Cervical Vertebra, as seen from the right side. 


neck was bent at its middle point, at a rather sharp angle, and directed 
downwards and towards the right side. The head could certainly 
be pushed towards the left, producing crepitation, but immediately 
fell back into the abnormal position when released. Post-mortem 


124 VARIETIES OF DISTORTION OF THE NECK. 


showed the oblique processes of the 4th and 5th cervical vertebrae to 
be fractured, and their surroundings infiltrated with blood. There was 
no injury either to the bodies of the vertebra, the spinal cord, or its 
covering, nor had bleeding occurred into the vertebral canal. The 
torticollis was clearly not the mere result of fracture, but of hemorrhage, 
producing paralysis of the cervical nerves. Labat saw a similar case. 

In the same year a thoroughbred was sent to me which had fallen 
and produced distortion of the neck in the region of the 2nd and 3rd 
vertebree. The swelling, which had at first been considerable, had 
mostly disappeared. On the left side, between the 2nd and 3rd cervical 
vertebree, a distinct prominence was seen (fig. 51); whilst at the 
corresponding point on the right, a depression existed sufficiently large 
to accommodate the two hands when extended (fig. 52). ‘The condition 
was doubtless due to sub-luxation between the 2nd and 3rd cervical 
vertebree. Hering’s failing to produce the condition artificially in the 
horse does not disprove the occurrence of such sub-luxations and fractures, 
but only shows that simple injuries to the muscles produce changes in 
the manner of carrying the neck. Gerlach observed the disease in cows 
and horses, and described it as distortion of the cervical vertebre. 
With incomplete displacement of the latter, the head is directed 
sometimes to one side (abduction-luxation); but sometimes the neck 
undergoes more or less pronounced rotation (rotation-luxation) which, 
strictly speaking, alone corresponds with torticollis. The condition is 
seen most frequently in horses, which, when scratching the head, get the 
hind-foot fixed in the halter and are thrown, or in jibbers, around whose 
neck a rope or chain is passed, to which another horse is harnessed. 

The conditions described cannot always be differentiated, even on careful 
examination. Cognisance must be taken not only of the symptoms, but 
of the history of the case. Distortion produced by muscular diseases is 
usually distinguished by pain, swelling, and other inflammatory changes, 
while the neck, although it may be brought into its normal position, re- 
verts to its distorted state when force or pressure are removed. _Cicatrices 
are a rare cause in the lower animals. When inflammatory appearances 
are absent, paralysis of the muscles on the convex aspect of the neck may 
be suspected, especially if cicatricial contraction is clearly not at work. 

Distortions arising from fractures and sub-luxations may be distin- 
guished from those connected with muscular lesions by crepitation, and 
still more notably by the fact that the parts, even if difficult to bring 
into position, retain that position when once reduced. Many observers 
state that in sub-luxation the neck is excessively mobile; but although it 
may be so in certain directions, general freedom of movement is diminished. 
Kgelling saw what he considered to be persistent luxation of the cervical 
vertebree. The horse could even be ridden—(personal communication). 


RESULTS OF DISTORTION OF THE NECK. '25 


Slight curvatures usually produce little inconvenience, but considerable 
displacement of the head leads to difficulty in movement, and the 
animal is sometimes unable to get up or to stand, though it can do both 
immediately the head is supported in its normal position. Others make 
“circus movements” towards the side to which the neck is curved. 
Where curvature becomes excessive, as is frequently the case in dogs and 
rabbits, the animals attempt to rise, but at once fall back, and make 
rolling movements around the long axis of the body. I have also seen 
this in dogs with disease of the middle ear, and in rabbits affected 
with mange of the ear. Sometimes, in horses which have suffered from 
severe strain of the collective muscles of the neck, the head is carried 
very low, producing considerable cedematous swelling, and causing the 
animal’s head to resemble that of a hippopotamus (p. 57). 

Ruptures of the funicular portion of the ligamentum nuche can be 
directly felt and recognised by the head being carried very low. The 
same position is assumed in disease of the upper vertebra, and of their 
joints. I had a horse with purulent arthritis between the first and 
second cervical vertebrae, produced by breaking through of a retro- 
pharyngeal abscess. The horse held the head and neck stiff, and 
threatened to fall when attempts were made to lift the former. In 
purulent arthritis fever usually exists, but is altogether wanting in 
diseases of the muscles produced in a mechanical way. 

Course and Prognosis.— Distortion of the neck due to rheumatic 
disease of the muscles usually disappears in a few days. It often 
continues only a few hours, although in certain individuals it may 
recur, and is signalised by great pain, which causes whimpering or 
erying. Though caput obstipum caused by paralysis may disappear 
in a short time, it sometimes remains, for long periods, or even proves 
incurable. In forming a sound prognosis, it is important to discover the 
cause of the paralysis. In my practice, cases connected with ear disease 
have all proved incurable. Paralysis which has occurred suddenly, or 
existed only a short time, and is due to rheumatic or traumatic 
causes, may generally be expected to disappear earlier than that which 
has developed more slowly, and depends on disease of the central 
nervous system. In the latter case, prognosis is always doubtful, and 
is still graver when the condition is complicated with convulsions. 
On the other hand, distortion of the neck produced by muscular strain 
is cured in eight to fourteen days, or even earlier. 

Herting emphasises the fact that diagnosis must be cautious during 
the first few days; a safe judgment cannot be formed from early 
appearances ; severe disturbances often disappear quickly, whilst appar- 
ently slight cases may take an unfavourable course. Conditions caused 
by muscular disease seldom leave any lasting ill results, though exten- 


126 TREATMENT OF TORTICOLLIS. 


sive ruptures may later be recognised by depressions. Schrader found, 
on the neck of a three year old colt, a furrow in which the fist could be 
laid. After luxations or fractures, cicatricial thickenings are often 
observed. Harvermann noted these in horses, on the concave side 
of the diseased neck. It is important to note whether the animals can 
stand and take food; if not, they may die of decubitus,’ or lose 
condition and value. As a rule, in such cases slaughter is to be 
recommended, especially where no considerable improvement has resulted 
within several days after the attack. Still more unfavourable is the 
prognosis where purulent disease invades joints like that between the 
occiput and the first cervical vertebra. 

Treatment of rheumatic torticollis comprises warm coverings, friction 
with volatile stimulants,and administration of salicylic acid, antipyrine, and 
similar drugs. It is especially desirable to keep the animal standing where 
distortion depends on sprains of the muscular tissues or disease of the 


Fic. 53.—Knudsen’s Iron Splint for distortion of the Neck. 


spinal column. The neck may usually be kept straight by a girth, 
cradle, or narrow piece of wood, fastened with the roller and a strong 
halter to the concave side of the neck; sometimes by simply fastening 
up the head. Where luxation is present, replacement must be attempted. 
In heavy horses contra-extension may be effected by the weight of the 
body. Where this is impracticable, the animal may be fixed with 
the help of a horse collar, while, with a strong, well-fitting halter, 
extension may be effected by several strong assistants, or by the 
help of a compound pulley. Godine states having thus produced an 
extension of 34 inches in the neck of a horse. Immelmann passed a 
strong hop sack, doubled, round the head of the horse, and allowed 
fifteen persons to pull on it. During extension, the operator endeavours 
to effect reduction by pressing or turning the neck at the middle 

1 Decubitus,—This is a convenient German term, signifying the continued assumption of the 


recumbent position which often accompanies debilitating or painful diseases like laminitis. — 
(TRANSL. ] 


VARIETIES OF GOITRE. aA) 


of the convexity. This attempt generally succeeds, the distortion 
immediately disappearing. Busse laid his patient on the ground, with 
the concavity of the neck downwards, placed a board on the convex side, 
and exerted strong pressure on it. The displacement, even when reduced, 
may recur on the horse rising. In such cases fracture of the oblique 
process usually exists, and the application of a bandage is necessary. 
Hertwig recommended two splints of wood or tin, which fitted exactly 
the side of the neck and reached from the shoulder to the posterior 
border of the lower jaw, and were fastened together at the upper and 
lower ends of the neck by bands. Stockfleth recommends an iron 
splint (fig. 53) constructed by Knudsen. Owing to its yielding nature, 
it is easily fitted. The splint, when applied to the convex side of the 
neck, must be padded with tow or wadding to prevent bruising. The 
horse is supported on rising, and afterwards fastened up short to the 
wall. The use of slings may be desirable. Cattle can be treated in the 
same way. ‘The setting should remain in position eight to fourteen days, 
sometimes a little longer, care beimg taken that the animal does not lie 
down, and that the splints are kept carefully padded. Inflammatory 
processes sometimes require the use of cold applications. Massage may 
be used later to bring about absorption. Where the head is sunk and 
cedematous swellings result, producing dyspneea by narrowing the nostrils, 
tracheotomy may be performed if necessary. Swelling usually disappears 
on raising the head and supporting it with a girth. 


IV—GOITRE STRUMA. 


Ger. Kropf. 


Lit.: Lydtin, Bad. Mitth. 1888, p. 11. Cadiot, Veter. Journal. 1892. 
Gurlt (Haubner), Mag. v. Gurlt u. Hertwig., vol. 6. p. 37. Massot, 
Schweiz. Arch. 1881, p. 181. Breisacher, Archv. fiir Physiol. 1890, 
p- 509. Schmidt, Mill. Roll, vol. 16. Jewsejenko, Jahresber. 
1888, p. 126. Johne, Dres. Ber. 1863, p. 88. Rydygier, Arch. fiir 
kl. Chir. 40. Heft 4. Johne, Dresd. Ber. 1880, p. 44. 1881, p. 31. 
Massot, Kochs Revue. 1887, p. 63. Honert, Zeitschr. fiir Veter.-K. 
1890, p. 228. Brisot, Oestr. Monatschr. 1892, p.29. Truelsen, B. 
T. W. 1892, p. 210. Lanzilotti, Jahrb. 1891, p. 104. Zschokke, 
Schw. Archiv. v. Eiselsberg, Deutsch. Med. Zeit. 1892. 


The thyroid gland, though not so frequently the seat of disease in 
domesticated animals as in man, does become affected, especially in carni- 
vora,—less frequently in horses and cattle. Acute inflammation (thy- 
roiditis) is unknown in animals, though transitory swellings of the gland, 
without other inflammatory appearances, are seen in horses and dogs 
during the progress of catarrhal affections of the pharynx, but disappear 
during convalescence. More frequently new growths, whose nature is 
not precisely understood, invade the glands. Hyperplastic processes, 


128 GOITRE. 


since olden times named Struma, also occur. New growths resembling 
these develop in the gland, but being difficult to precisely identify, are 
included in the clinical term Goitre. The following varieties can be 
distinguished : — (1) Real goitre, dependent on hyperplasia of the 
follicles of the thyroid gland, with colloid change of their contents, 
which are chiefly albuminous. ‘The swelling is maimly due to enlarge- 
ment of the follicles, and is termed struma follicularis, It may attack 
the entire organ or only one-half, less frequently it is confined 
to certain sections. (2) In fibrous goitre the connective tissue is 
specially increased, the follicles, on the other hand, being little affected. 
This form is generally confined to single portions of the gland, and 
seems more often to be of an inflammatory character. (3) The gland is 
exceedingly rich in blood-vessels, and these, especially the veins, become 
greatly dilated, causing varicose goitre (struma varicosa). (4) At times 
single follicles undergo distension, producing the so-called cystic goitre 
(struma cystica). Specific new growths, like carcinoma, have been seen 
in dogs by Bruckmiiller, Zschokke, and others. Zschokke says that at 
least thirty to forty per cent. of old dogs suffer from goitre, and whilst 
in young animals the condition consists simply of hyperplasia of the 
gland, the goitre of old dogs is almost always of a cancerous nature, and 
is prone to degeneration and bleeding. Gerlach and Honert found sarcoma 
of the gland in horses. Tuberculous swellings have been met with by 
Bruckmiiller and others in cattle. Johne has described carcinoma of the 
thyroid, accompanied by secondary carcimona in the lungs of a horse. But 
the older reports of these growths are not absolutely reliable, as the 
classification of tumours was not then so precise as now. 

The causes of goitre are just as little known as those of other 
tumours. Endemic outbreaks are stated to have occurred in animals as 
in men (Baillanger in mules, Worz in cattle). French veterinarians 
have further insisted that in regions where goitre frequently occurs in 
men, it is also common in animals. That locality has some predisposing 
effect seems undeniable, but complete uncertainty exists as to the imme- 
diate cause of the disease. Whether the existence of magnesia or the 
absence of iodine and bromine in the soil exercise any influence, as has 
been asserted, is at present undecided. Little is known of the connec- 
tion of goitre with cretinism, no veterinary statistics being available. In 
animals, and especially in carnivora, goitre appears most frequently 
during the earlier years of life. Without doubt it may, under certain 
circumstances, be inherited, and I have repeatedly seen almost all the 
puppies of one litter affected. Lydtin related the case of a stallion which 
transmitted goitre to five of his offsprmg. Johne saw a case of inherited 
goitre in the dromedary. According to Haubner, the lambs of one flock 
were attacked enzootically in certain years: In one season six, and in 


ITS CAUSES AND SYMPTOMS. 129 


the following, ten new-born lambs were affected, and the disease, it was 
believed, was transmitted by the ram. Similar observations have been 
made by Gurlt in goats. It should, however, be noted that the size of 
the thyroid varies considerably in certain animals, especially in horses. 
Not infrequently its lobes, normally the size of a chestnut in the horse 
and ox, become as large as a duck’s egg, whilst the commissure remains 
little affected. This liability to variation is widely observed in particular 
families, and appears, to a certain degree, to be inherited. Such 
conditions cannot consistently be described as goitre, for the gland, 
although abnormal, does not continue to grow larger. Many references to 
inheritance and enzootic outbreaks of goitre in animals are clearly to be 
referred to this condition. 

Symptoms.—The most striking feature is the swelling close under 
the larynx, and towards the side of the trachea. In horses the gland on 
either side, usually not larger than a chestnut, attains the dimensions of a 
man’s fist. It sometimes becomes as large in dogs. As the gland grows 
in size and weight, it sinks, and becomes more prominent. Either 
one or both sides may be affected. In dogs it is easily displaced, 
and may descend as far as the lower portion of the neck, and lie im- 
mediately in front of the chest; but it seldom exhibits inflammation, 
pain, or increased temperature. 

As long as the size of the thyroid is not much increased, goitre in 
animals is only a blemish. In the horse, however, Massot and Truelsen 
have observed dyspncea from the swelling pressing on the trachea. This 
occurs more often in dogs, which I have seen unable to lie down, on 
account of the swelling compressing the trachea and interfering with 
breathing. The animals live for some time continuously supported on the 
extended front legs, until finally it becomes necessary to kill them. The 
trachea may be narrowed until it closely resembles a scabbard. 
Zschokke found carcinomata in dogs invading the trachea and cesophagus, 
and producing difficulty both in breathing and swallowing. Johne 
reports the case of a dromedary calf which died at birth from suffocation 
produced by a goitre swelling weighing nearly 13 pounds. In a horse, 
sarcoma of the thyroid spread entirely over the larynx during the 
space of a year and a half, and finally caused death by suffocation (Honert). 

Prognosis.—Jn animals, and especially in young dogs, goitre is not 
merely a blemish. Some varieties occurring in horses cause no dis- 
turbance. The significance of the case depends upon the size of the 
swelling and its rate of increase, but our knowledge of the condition 
does not justify very sanguine expectations. Extirpation entails not 
only the danger of excessive bleeding, but also the development of peculiar 
symptoms described as cachexia (strumipriva), which are frequently 
seen in young dogs. Some weeks after removal of the thyroid, marked 

I 


130 RESULTS OF EXTIRPATING THE THYROID GLAND. 


weakness appears, accompanied by anemia and wasting, from which the 
animals finally die. Goitre,in man, is associated with cedema in different 
portions of the body (myxcedema) and with sensorial disturbances (cre- 
tinismus). But the exact relation these have to disease or removal of 
the thyroid is not yet explained. 


Von Eiselsberg observed the disease in lambs. Two months after extirpation 
of the swelling, the animals’ growth became checked. They remained much 
smaller, weaker, and of less weight than the control animals. The anterior 
portion of the head was shorter, the posterior portion enlarged, the abdomen 
distended, the testicles atrophied, the wool badly developed. One of the sheep 
suffered from catarrhal attack of the lungs, but von Eiselsberg regarded this as an 
accidental symptom. The temperature was 1°5 to 2 degrees Cent. below normal. 
Von Eiselsberg noted similar symptoms in a goat whose thyroid had been 
removed at the age of six weeks. 

It was formerly believed that this gland was a secretory organ, which could 
be dispensed with without danger to life. But Griitzner demonstrated that, 
although one-twentieth the size of the brain, the thyroid has as large arterial 
vessels. Horsley testifies to its important secretory functions, and points out 
that myxcedema does not appear, if half or a part of the gland be left. Others 
(Munk) believe that the disturbances caused by extirpation result from unfavour- 
able wound healing, and moreover are aggravated by feeding the patients on 
flesh. Breisacher tested this question by a series of experiments on dogs, and 
found that the strumous symptoms, especially the clonic and tonic muscular con- 
tractions, and respiratory cramp receded, when the animals were restricted to 
milk diet ; but reappeared when they were again fed on meat and soup; boiled 
meat, however, appeared not to be injurious. 


Other dangers of extirpation are the risk of injuring the recurrent 
nerve or vagus, and of causing dangerous bleeding. But operations are 
sometimes successful. Massot removed the thyroid in two horses 
without bad results, and in one of them the dyspnoea consequent on 
pressure disappeared after operation. I myself once performed the 
operation in a horse without the results described, but operating on dogs 
I have repeatedly observed cachexia (strumipriva). Removal of a 
portion of the gland is, however, not attended with serious consequences. 
Haubner stated that lambs affected with goitre were sometimes born 
dead, sometimes died soon after birth. A lamb operated on by Haubner 
remained healthy, though for how long is not said. Carcinomatous 
goitre can be recognised by the uneven, knotty character of the surface 
of the swelling. It is very dangerous. 

Treatment.—Medicines administered internally, or applied by infric- 
tion, are usually without suecess; but iodide of potassium may be pre- 
scribed or used as ointment. Painting with tincture of iodine has been 
recommended, but I have only seen this serviceable when the thyroid 
was acutely swollen in consequence of disease of the pharyngeal mucous 
membrane. Siedamgrotzky suggests infriction with iodoform and 
unguentum hydrarg. Truelsen recommends rubbing in three times a day 


TREATMENT OF GOITRE. Lat 


an ointment of 1 part of pure iodine, 5 parts iodide of potassium, 30 parts 
sapo virid., and gives internally iodide of potassium and nitrate of potassium 
in doses of 30 grains of each, A marked diminution of the swelling and 
removal of the dyspnoea is said to occur in three weeks. In true goitre 
more active results are obtained by intraparenchymatous injections 
made with a Pravatz syringe, the needle being inserted into the tissues 
of the gland, and from 5 to 15 drops of tincture of iodine passed in. 
Inflammation usually develops, but disappears in eight to fourteen days, 
when the injection may again be used and repeated at intervals. I 
obtained favourable results in a dog from intraparenchymatous injection 
of a watery solution of papain (1 to 10). The swelling in forty-eight 
hours was uniformly soft; on incision the digested parenchyma of the 
gland was discharged as a milky fluid, and although it did not com- 
pletely disappear, the swelling markedly decreased and the dyspnea 
became less. In dogs the gland sometimes undergoes cystic changes, 
producing a swelling outwardly resembling an abscess. Should it be 
laid open, however, death generally results (Zschokke), 


Rydygier, in human patients, recently tried ligature of the arteries of supply, 
but their simultaneous ligation was only favourable in parenchymatous goitre. 
In struma fibrosa et cystica the operation was useless. Schmidt used the 
“ecraseur” for extirpation in the horse. Massot exposed the gland, drew it 
forward with the fingers, and resorted to torsion before ligaturing. After dis- 
secting back the skin, I lay free the gland with the fingers, and ligature the visible 
vessels, finally applying a still stronger ligature and removing the gland above it. 
Care should be taken not to divide the gland too closely, as the ligature may 
slip off. It is better to leave some gland tissue, so as to give the ligature a 
better hold. After-treatment must be regulated according to general principles. 
Lanzilotti removed a goitre swelling as large as a child’s head from a horse. It 
had developed in six months. The right section of the gland was as large as a 
potato, and was retained, The animal returned to work after a month’s rest. 
Examination of the tumour showed it to be a simple adenoma. Munk’s and 
Breisacher’s experiments seem to indicate milk diet as a valuable means of 
treatment. Where only one side of the gland is diseased, removal of this 
portion can be undertaken without serious consequences, In man goitre is 
often accompanied by so-called Basedow’s disease (exophthalmic  goitre), 
which Jewsejenko and Cadiot state having observed also in the dog 
and horse, A three year old female pug had a sudden epileptic fit, showed 
marked frequency of the pulse and disturbance of digestion, with swelling 
of the thyroid, exophthalmus and ulceration of the cornea, The eyes were 
treated with sublimate lotion, the introduction of eserin, and the application 
of compresses moistened with 2 per cent. boric acid; 8 drops of tincture of 
iodine were injected into the thyroid, and iodide of potassium given internally ; 
improvement was noted and recovery occurred in six weeks. Jewsejenko 
reported the case of a four year old English thoroughbred mare, which lost 
appetite after a race and showed great thirst, weakness, palpitation of the heart, 
and frequency of pulse, with swelling of the thyroid and eyelids and reddening 
of the conjunctiva. Fourteen days later exophthalmus occurred, the thyroid 
gland showed pulsation, and death occurred in four weeks, with symptoms of 
anemia and exhaustion. Whether paralysis of the sympathetic, thought to be 


132 INFLAMMATION OF BURSA OF LIGAMENTUM NUCH. 


the cause of Basedow’s disease in man, was also present here cannot be decided. 
A horse in Cadiot’s practice was found to be much wasted, low in condition, and 
to have one fore foot painfully swollen. Cidematous swellings were present at 
different points on the body, and the left half of the thyroid was much enlarged. 
The arteries lying near the surface, amongst others the carotid, the posterior 
auricular, and the metatarsal arteries, showed powerful rhythmical movements ; 
the frequency of the pulse was from 70 to 80 per minute. In the cardiac 
region the labouring action of the heart was distinctly noticeable, the thoracic 
wall visibly moving. Examination of the blood showed no tendency to 
leukemia. The patient died on the third day without having shown exophthal- 
mus. The heart weighed 14 lbs., and the great blood-vessels were twice the 
normal diameter. Brisot observed marked enlargement of the thymus gland in 
a two year old cow. The swelling extended from the 3rd ring of the trachea 
to the sternum, and transversely from one jugular to the other. It was hard, 
painless, and weighed at the time of death 134 Ibs.! 


V.—INFLAMMATION OF THE BURSA OF THE 
LIGAMENTUM NUGHA. 


Iv. Talpa, Mai de nuque. Ger. Genickbeule, Maulwurfgeschwulst. 


Lit.: Lafosse, Her. Rep. 16, p. 323. Vincent, ibid., 9, p. 164. 

In the horse the funicular portion of the lgamentum nuchee 
forms on the summit of the second cervical vertebra a mucous bursa, 
which attains the size of an apple, and is covered on both sides of the 
ligament by the complex muscles. Loose connective tissue attaches the 
inner surfaces of these muscles to the bursa. Inflammatory processes in 
this bursa have since olden times been described by the term poll-evil 
(genickbeule, genickfistel, or maulwurfsgeschwulst), the swelling pre- 
senting the size and form of a mole. It is due, then, to a bursitis, 
produced by bruises, less frequently by metastatic inflammation lke that of 
strangles, and which, though usually acute at first, tends to become 
chronic. The first injury may be caused by the animal striking its head 
against a rack or low door; by a fall, or blow with a heavy whip-handle ; 
less commonly from pressure of the halter, or, as Hertwig believed, from 
violently bending the neck when being reined up. Among animals 
at grass, this bursitis is more generally caused by external injuries than 
by straming the muscles of the neck during grazing (Hertwig). 

Symptoms.—A characteristic longish round swelling, about 4 to 6 
inches long, appears over the first two cervical vertebra close to the 
middle line, is accompanied by inflammatory symptoms, and sometimes 
affects one side, sometimes both. At first fluctuating and sharply defined, 
resembling a mole in form and size, it soon extends to the surrounding 
soft parts, becomes diffuse and less yielding. The condition primarily 
consists in the outpouring of inflammatory exudate or blood into 


f=) 


! Goitre, and the condition resulting from it—myxcedema—are now treated with perfect sue- 
cess by the subcutaneous injection of thyroid extract, or feeding with throid gland.—[TRANSL,] 


POLL-EVIL. 133 


the bursa. Later parabursitis sets in, and the swelling loses its 
sharply-defined form. The accompanying pain generally causes the 
animal to hold the head extended, sunk and stiff. Sometimes brain 
symptoms, like those of staggers, appear (dummkoller). Slight fever either 
accompanies the condition from the outset, or develops subsequently. 

The course of the disease depends chiefly on whether the parts 
remain aseptic or become infected. If by appropriate treatment asepsis 
can be maintained, the material poured into the bursa may _ be 
reabsorbed, and recovery occur in four to six weeks. But more fre- 
quently infection, produced through skin abrasions caused when the 
bursa was injured, extends. The bursa takes on chronic inflammation, 
its walls and surroundings become thickened; small spherical growths, 
proceeding from the inner surface of the bursa, separate after a time, 
so that the cavity may become filled with a great number of rice-like 
grains. I have frequently removed large masses of these corpora 
oryzoidea. Vincent erroneously considered them to be entozoa. When 
chronic inflammation has occurred, recovery is slow; but the working 
usefulness of the horse may not greatly suffer. The swelling in such 
cases becomes smaller, harder, and less movable with the lapse of time. 
In most cases, however, infectious inflammation of the bursa sets in; 
the inflammatory appearances increase greatly, spread to the neighbouring 
connective tissue and muscles (parabursitis), and finally, after acute 
pain and fever, end in abscess formation and perforation of the skin. 
The finger, introduced into the abscess cavity or bursa, detects necrosis 
of the ligamentum nuche and purulent inflammation of the bursa, which 
may continue for months and baffle the best of treatment. Sometimes 
inflammatory symptoms, and especially pus formation, abate, although 
purulent fluid, mixed with synovia, continues to flow from the small 
fistulous opening. Necrosis may extend to the deeper lying portions of 
the ligamentum nuche and cause inflammatory intermuscular swelling 
in the throat, and sometimes necrosis of the ridge of the second cervical 
vertebra. Recovery is most tedious, especially if proper treatment is not 
adopted, and, unless in valuable subjects, slaughter may be advisable. 
The thickening left produces no difficulty in moving the neck; but 
permanent stiffness occasionally results from adhesion between two 
vertebre (Lafosse); and fatal cases occur from embolism, from the con- 
tinuation of the fever, or finally, from pus breaking into the vertebral 
canal. Death then occurs suddenly, with general paralysis and 
epileptiform seizures. 

Treatment.— In recent aseptic conditions of the bursa, inflammation 
should be combated by cold applications, made with a towel folded 
several times and fastened to the mane. To prevent infection, the 
fluids used may appropriately contain disinfectants. Slight steady 


134 POLL-EVIL. 


pressure also favours reabsorption of extravasated material. The halter 
must be removed, and the animal placed loose in a box, and kept from 
work. Where a box cannot be obtained, a neck strap may be applied 
instead of a head collar. As soon as acute inflammatory symptoms 
have somewhat receded, stimulating applications are indicated. To 
combat infection, an ointment of sublimate with lard or vaseline in the 
proportions of 1 to 10 may be used. The swelling of the skin thus 
produced exercises a regular and even pressure on the bursa, distended 
with inflammatory products, and favours absorption. This application 
may be renewed after some time, or the actual cautery employed. As 
soon as abscess formation reveals infection, it is advisable to provide for 
discharge of pus at the earliest possible moment, but care must be taken 
not to injure the occipital artery. Should this or one of its branches 
be cut, bleeding may generally be stopped by ligature or compress. 
The incision must be wide and deep enough to allow free exit to the 
matter, and, if necessary, counter openings may be made and setons or 
drainage tubes inserted. Necrosis of the hgamentum nuche has usually 
already taken place, in which case section of the funicular portion is 
indicated, and is easily effected with a tenotome even in the stand- 
ing position. The necrotic material is removed, and the pus washed 
from the abscess and bursa once or twice daily. Subcutaneous sec- 
tion of the ligamentum nuchie, recommended by Lafosse, can only be 
advised where there is no prospect of maintaining asepsis. Where pus 
formation already exists, the operation should not be carried out subcu- 
taneously. Under any circumstances, division of the skin transversely 
is to be avoided, as it gives rise to wounds, which heal with difficulty. 
In disease at the side of the neck, the knife must be employed in a free 
manner, and, where possible, the fistula laid open to its termination. 
The same courageous use of the knife is called for in providing exit for 
pus burrowing amongst the muscles of the neck. 


VI—PHLEBITIS, INFLAMMATION OF THE JUGULAR VEIN. 


Ger, Aderfistel or Aderlassfistel. Zat. Phlebitis Ven Jugularis, 


Lit.: Peters, Gurlt u. Hertwig. 6, p. 318. Schleg, Dresd. Ber. 1890; 
p. 74. 

In former times, when bleeding was much more general, horses and 
cattle frequently exhibited this sequel of the operation. It was 
described as venous fistula, but its nature remained long unrecognised. 
Lafosse and Hunter had drawn attention to thrombus formation occur- 
ring in the vein; but until Virchow’s experiments, the relation of this 
coagulation to phlebitis was not understood. The ordinary wound in the 


INFLAMMATION OF THE JUGULAR VEIN. 135 


vein, caused by lancet or fleam, closes by the edges coming together 
and uniting. Apposition is favoured by the negative blood pressure in 
the jugular, and no visible change is usually left in the vessel. The skin 
wound, if closed by pin sutures, commonly heals by first intention. 

Causes of venous fistule are,—Ilst, blood coagulating in the vein; 
and 2nd, purulent breaking down or septic softening of the thrombus. 
The following circumstances favour thrombus formation :— 

The venous wound, if inflicted by blunt fleams or lancets, and not 
smoothly cut, but torn through, may be followed by coagulation of blood 
on the bruised surface and complete thrombosis of the vessel. The same 
occurs if the wound is not made exactly in the longitudinal course of 
the vein, but somewhat obliquely, or when, owing to repeated use of 
the instrument, a double wound has been formed. Injury to the valve 
in the vein can also induce coagulation, though Hertwig has declared 
that the danger so produced is not great. Venous fistule, further, arise 
from any circumstance which prevents proper approximation of the 
edges of the venous wound, and most notably from considerable sub- 
cutaneous bleeding. The extravasation displaces the edges of the vessel, 
and the subcutaneous clot extends into the vein. Extensive extravasa- 
tions at the point of bleeding are produced by pressure of the collar on 
the unhealed wound, by animals, suffermg from staggers (dummkoller), 
leaning against the manger, by those with disease of the feet continuously 
lying, or by openings being made in the vein, as was formerly done to 
introduce drugs into the blood stream. Viborg, who practised intra- 
venous administration of medicines by means of a funnel, had extensive 
opportunities of observing this disease. Unclean instruments probably 
do not cause phlebitis so frequently as has been supposed. 

The thrombus, howsoever caused, usually undergoes purulent disin- 
tegration or septic softening, and induces inflammation in the intima of 
the vessel, which soon spreads to the media and adventitia, and leads 
to perforation of the walls at different points, producing discharge of 
the offensive purulent contents. Clotting and subsequent organisation 
seldom occur; the thrombus usually breaks down. In this case the vein 
is also permanently occluded. Organisation only takes a short time, 
but is very seldom seen. The disease scarcely ever occurs without a 
wound of the vessel, though it must be allowed that inflammatory 
processes may extend from without to the wall of the vein. Sucha 
case has been described by Peters. 

Symptoms.—On removing the pin a day or two after blood-letting, 
the skin wound, instead of being closed and dry, is swollen, and dis- 
charges a somewhat dark fluid blood. Within the next few days the 
swelling enlarges, and the vein is now found to consist of a round, firm, 
fixed cord, which extends from the wound in the skin to a varying 


136 INFLAMMATION OF THE JUGULAR VEIN. 


distance above and below. The latter symptom proves the existence 
of a thrombus. The discharge of blood may be produced by extrava- 
sation under the skin, and, therefore, it is important to examine the vein. 
Filling of the vein on pressure at the base of the neck and collapse on 
removal of the pressure prove the non-existence of a thrombus. The 
use of a probe for diagnosis is not only superfluous but dangerous, 
because clotting and embolism in the lungs may thus be produced. 
During the next few days the wound discharges decomposed blood, 
which is later mixed with clots and pus. The swelling increases 
towards the head, and more or less severe bleeding may take place, 
especially during feeding. If thrombus formation is rapid, cerebral 
disturbance resembling staggers may be produced, because the blood is 
unable to escape freely from the brain. Endophlebitis septica rapidly 
involves the several venous coats and surrounding connective tissues, 
producing multiple abscesses. Septic decomposition of the thrombus 
may produce pyemia, but this seldom occurs, for the blood usually 
coagulates quickly within the vessel, completely closing it before septic 
decomposition can set in, or emboli be carried to the heart or lungs. 
Embolic pneumonia is, however, occasionally produced, and is invariably 
fatal. Where this complication is averted the disease usually takes a 
favourable course. The thrombus undergoes purulent or septic degenera- 
tion, the thickening of the venous wall finally leads to complete occlusion ; 
obturation or obliteration usually occurring in three to four months. 
Inflammatory processes, the repeated abscess formation, and circulatory 
disturbances gradually disappear, collateral circulation being set up by 
dilatation of the vasa vasorum. Skin veins sometimes become as large 
as a man’s finger, thus completing the communication between the still 
patent portions of the vessel. 

So far as the animal’s life is concerned, the disease usually takes a 
favourable course, unless where pulmonary embolism supervenes, pro- 
ducing dyspnoea, high fever, &c. Although obliteration of the vessel 
produces no lasting bad results, the animal cannot be worked during 
the active stages of the disease, nor can a horse with obliterated 
jugular usually be grazed, as from its depressed position the head swells 
owing to interference with the return blood stream. 

Treatment.—It is desirable after blood-letting to rest the animal, 
and avoid any pressure on the vein, especially below the wound, hence for 
twenty-four hours the collar must not be worn. Moreover, everything 
likely to produce extravasation must be avoided, and the fleam or lancet 
never applied twice at the same spot. Where the wound has not 
closed after removal of the pin, it should be washed with sublimate 
or carbolic solution, to prevent decomposition of the extravasated blood. 
Once the vein is thrombosed, it must not again be opened, otherwise 


INFLAMMATION OF THE JUGULAR VEIN. 137 


septic change can seldom: be prevented. Further mischief may.some- 
times be checked by repeated disinfection of the skin wound and of 
the extravasation with the above named or similar antiseptics. Should 
inflammatory reaction or swelling become very marked, moist warmth 
will remove tension and pain, and infriction with unguentum hydrar- 
gyrum may be found useful. In applying the oimtment severe pressure 
and rubbing must be avoided, lest the thrombus be broken and emboli 
set free. Abscesses should be opened, and free exit given to secre- 
tions by increasing the size of the skin wound. In France a seton is 
passed through the vein. Under certain circumstances, as when severe 
bleeding occurs repeatedly, it may be advisable to ligature the vessel 
below, and if the thrombus does not extend too far upwards, it may also 
be ligatured above. The operation is performed according to general 
principles, and the vessel divided above the point of ligation. If it has 
been ligatured above the diseased point, the isolated section of the vein 
can be completely laid open. French surgeons remove the degenerated 
portion of the vein. For some days after ligation the animal must be 
kept perfectly quiet, while, to avoid bleeding, only fluid nourishment 
should be given. 

Schley recommends washing the vein out with sublimate solution. 
In removing the diseased portion of vein a ligature must first be applied 
above and below. The vein is then divided transversely at the upper 
end, and completely separated from neighbouring structures. No danger 
results if the wound be treated as an open one, but care is required to 
avoid injuring the carotid, and, therefore, the knife should be sparingly 
used, and the fingers or blunt end of the scissors used in prefercnee. 
Sometimes the vein tears cleanly away from surrounding tissues if 
moderate traction be exercised. 


ViI.—DISEASES OF THE PHARYNX AND GESOPHAGUS. 


(1.) FOREIGN BODIES IN THE PHARYNX AND 
CSOPHAGUS. 


Lit: Dandrieux, Journal de méd. vét. 1876. Mollereau, Jahrb. 1882, p. 
16. Immelmann, Berl. Th. Woch. 1890, p. 125. Tainturier, Lyon. 
Journ. 1886, p. 88. Philippi, Dresd. Ber. 1886, p. 103. Dette, Thier. 
Mitth. 1875, p. 144. Schmidt, Vortriige fiir Thierirzte. I. Serie. Heft. 5. 
Walther, Dresd. Ber. 1888, p. 76. Dinter, ibid., 1879, p. 132. L. 
W. Semmer, Die Schlundmuskeln der Hausthiere. Inaug.-Diss. 1865. 
Rubeli, Ueber den (sophagus der Menschen und verschiedener Haus- 
thiere. Inaug.-Diss. Bern 1890. Lothes, Beitriige zur Anat. u. Physiol. 
des Schlundkopfes vom Schweine. Berl. Th. Woch. 1890. Schafer, Berl. 
Arch. 12, p. 280. Walther, Dresd. Ber. 1890, p. 72. Michalski, 


138 DISEASES OF THE PHARYNX AND QiSOPHAGUS. 


B, T. W. 1892, p. 211. Graf, Zeitsch, 4 Veti-Kunde 1892; p, 210% 
Strebel, Schweiz. Arch. 33. Mauri, Rev. vétér. 1879, p. 278. 
Willach, D. T. W, 1893; p39: 


Foreign bodies in the pharynx are most frequently found in carnivora. 
Bones, fish spines, needles, pieces of wood, taken with the food, or picked 
up in play, sometimes stick in the pharynx. In dogs and cats, sewing 
needles are often found at the base of the tongue close in front of 
the epiglottis. Pieces of potato or of other roots get lodged in the 
pharyngeal pouch of swine (Franck, Lothes). In herbivora, pieces of 
wood, bones, hair-pins, and the like may become fixed in the mucous 
membrane of the pharynx, but more frequently lodge in the cesophagus. 
In ruminants, especially in cattle, the offending substances are generally 
pieces of potato, fruit, or turnip; in horses, linseed cake or hay; whilst 
occasionally the obstacle is a tooth, a hen’s egg, a bolus, a portion of a 
prickly plant, or a piece of wood or bone. 


Grimm found a piece of a lamp chimney in the wsophagus of a cow. Mobius 
found a thorn about 5 inches in length. I myself removed a whip handle about 
3 feet long from a horse’s cesophagus. Dandrieux extracted a snake 10 inches 
in length from the gullet of a cow. Iwersen found a hair ball in the cesophagus 
of an ox, eructated from the stomach. 


Foreign bodies remain fixed either because they are sharp and 
penetrate the mucous membrane, or are too large to pass the narrow 
portion of the cesophagus, or because the cesophagus has undergone 
contraction, which interferes with their passage. In horses, stoppage 
of the cesophagus with hay results from swelling of the bronchial 
glands, from the presence of tumours in it (melanosarcomata), and from 
external compression. In moribund animals, the food taken sometimes 
remains in the esophagus, and occludes long sections of it. Whether 
paralysis of the tube ever occurs, is questionable (p. 153). The 
portions of the cesophagus where bodies are usually arrested are— 


(1) The commencement of the tube immediately behind the 
pharynx. 

(2) The lower portion in the neck. 

(3) The point where it perforates the diaphragm. 


Diseased conditions which produce obstruction will be dealt with 
elsewhere. At this point only the two first of the above conditions will 
be considered; and as obstruction produces different results in different 
kinds of animals, it will be considered separately in each. The obstruc- 
tive bodies are divisible into two classes :—(a) Wound-producing foreign 
bodies which pierce the mucous membrane, and remain in position in 
consequence of their rough surface; and (>) mere mechanical obstructions 
which, on account of their size, are unable to pass through the tube. 


FOREIGN BODIES IN PHARYNX AND (&SOPHAGUS OF HORSE, 139 


The first are most frequently found in the pharynx, the latter in the 
cesophacus, though the first variety are also met with here. 


According to Rubeli’s experiments, the striped muscular fibres, which in man 
are confined to the first two-thirds of the csophagus, are in animals continued 
almost to the stomach. In ruminants the csophagus possesses no unstriped 
muscular tissue whatever. This first appears in the rumen. In all animals the 
mucous membrane is invested with a thick stratified epithelium, covered with 
numerous papilla, and the mucosa possesses lymph follicles together with mucous 
glands. The area of the cesophageal tube stands in inverse proportion to the 
strength of its muscular coat. In the region of the cardiac opening a thickening 
and narrowing occur in all domesticated animals, with the exception of cattle 
and dogs. The cesophagus of the horse is absolutely and relatively the longest, 
but also the narrowest. According to Franck, its length is nearly 49 inches, 
Rubeli found it to be from 50 to 52 inches, measured in position, and in larger 
animals even 56 to 60 inches. Its walls are strong, and become so much 
thicker between the diaphragm and the cardiac opening that the lumen of the 
tube almost entirely disappears, explaining the frequent occurrence in this 
region of diverticula, stenoses, and obstructions. The cesophagus of ruminants 
and carnivora is more cylindrical. In oxen a contraction occurs at the lower end 
of the upper third, and from this point onwards the diameter increases, while 
the wall is comparatively thin, and decreases in strength from above down- 
wards. In sheep the thickness increases from below upwards, but the muscular 
wall is very thin in comparison with the surface of the mucous membrane. The 
narrowing at the middle of the cesophagus, remarked in the goat, is wanting in 
the sheep. Swine have also a contraction at the middle of the tube, which from 
this point enlarges both above and below. In dogs the narrowest point lies at 
the height of the lower portion of the cricoid cartilage, the width being about 
1? inches. The tube increases from here to a circumference of 2? inches, then 
narrows to 2 inches, dilates for a second time, and, about 6 inches behind the 
pharynx, attains a circumference of 3 inches. The last contraction, some 22 inches 
in front of the cardia, measures 2} inches. From here the cesophagus widens like 
a funnel, until it enters the stomach (the figures refer to the width of the mucous 
membrane). In cats two contractions exist: the upper les # inch behind the 
pharynx, the lower at the point where the cesophagus pierces the diaphragm. 
The latter is the more distinct, the circumference only measuring about 2 lines. 

The views with regard to the mechanism of swallowing are very varied. It 
was formerly believed that the masticated food was advanced by peristaltic 
movements of the cesophagus, but Kronecker and Meltzer have ascribed this 
duty to the muscles of the pharynx, especially the broad hyoid by which the 
soft fluid nourishment is injected into the stomach. Hard substances, as well as 
any materials remaining in the pharynx, are passed forward by the constrictors, 
The process is a reflex act produced by stimuli from the glosso-pharyngeal nerve 
and transmitted by the superior laryngeal (Wasilieff). 


(A) FOREIGN BODIES IN THE PHARYNX AND C&SOPHAGUS OF 
THE HORSE. 


In horses foreign bodies very seldom become fixed in the pharynx, but 
are more frequent in the esophagus. As stated, they generally consist of 
pieces of oil-cake, potatoes, hay, boluses, eggs, or grass. Greedy feeders 
supplied with soft hay are common sufferers. A considerable section of 


140 FOREIGN BODIES IN THE PHARYNX AND (:SOPHAGUS OF HORSE. 


the cesophagus is sometimes blocked, and the condition may recur at 
short intervals. Mollereau observed several recurrences within fourteen 
days. Graf found the cesophagus filled with hay throughout. The 
thoracic portion, or lower cervical portion, is usually the seat of the 
stoppage. Walther saw a horse whose cesophagus became occluded in 
consequence of its swallowing a safety pin which had perforated the 
cesophagus transversely. 

Symptoms.—Animals cease feeding, slobber at the mouth, make chok- 
ing movements, and stand with extended neck, and strained, anxious coun- 
tenance. Any food or water taken is discharged from the nose. Not even 
the saliva can be swallowed, and cough is often distressing. Considerable 
quantities of fodder accumulated in the thoracic portion may press on the 
trachea and produce dyspnoea. Foreign bodies in the neck portion may 
sometimes be recognised by swelling, or can be detected by palpation. 
In the horse the condition is seldom dangerous, as the material generally 
softens, and passes downwards, and boluses and pieces of oil-cake, as well 
as hay and grass, may thus be removed without external assistance. 
The condition becomes graver, and I have repeatedly seen horses die, when 
such hard substances as eggs, boluses, &c., remain fixed in the thoracic 
portion, producing pressure on the trachea, and consequent suffocation, or 
mechanical pneumonia (Schluckpneumonie). Food or drink attempted to 
be taken are returned into the pharynx, and thence may enter the trachea. 

Treatment must take cognisance of this danger. All food should be 
removed, but, after a time, a little water may be given to discover if the 
animal can swallow. Foreign bodies, fixed in the upper portion of the 
cesophagus, can be directly removed by drawing them back into the 
pharnyx with the fingers. Immelmann administered pilocarpine, which 
produced excessive salivation, lubricating both the obstruction and its 
surroundings, thus facilitating the former being swallowed. This remedy 
increases, however, the danger of mechanical pneumonia, and caution is 
required in employing it. The probang or cesophageal tube can be used 
in quiet horses without casting them, but with somewhat greater difficulty 
than in oxen. Walther removed a potato with it, but hay often presents 
considerable resistance, and injury may be done if force be used. It is, 
therefore, best to wait quietly for twenty-four to forty-eight hours, when the 
material generally passes downwards. Further treatment in horses is much 
the same as in cattle, and under that heading fuller details are given. 


(B) FOREIGN BODIES IN THE CG&SOPHAGUS OF CATTLE. 


From the nature of the feeding, and narrowing of the gullet from the 
pharynx to the lower part of the neck, choking is more common in the 
ox than in the horse. Obstructions, as a rule, all occur close behind the 
pharynx, but are also tolerably frequent in the neck or thoracic portion. 


FOREIGN BODIES IN THE (2SOPHAGUS OF CATTLE. 141 


Symptoms, broadly the same as in the horse, comprise inability to 
swallow, attempts at eructation, difficult breathing, and, in ruminants, 
the addition of a grave symptom—tympanites. A portion of the gases 
formed in the stomach are normally discharged through the cesophagus ; 
but immediately the cesophagus is obstructed, these gases accumulate in 
the stomach and bowels, causing dangerous inflation. Increasing dis- 
tension interferes with breathing, and may cause suffocation. These 
symptoms can be completely developed in a few hours, and hence it is 
necessary to at once carry out appropriate treatment. Death is often 
caused by cows swallowing the after-birth (Schifer), a portion of the 
membranes becoming arrested in the pharynx, closing the opening of the 
trachea, and causing rapid suffocation. 

Treatment may be by one of the following methods— 

(1) Return of the foreign body into the pharynx, usually 
successful where roots have remained fixed close behind the pharynx. 
The operator places himself on the left side of the animal, passes 
his right arm over the neck, and with both hands (preferably with 
the thumbs) endeavours to push the obstructing body upwards by pres- 
sing in the esophageal furrow. This usually,succeeds if the animal’s 
head be left free. But, if firmly held, the animal becomes disturbed, and 
stretches out its head, and even if the foreign body is forced into the 
pharynx its further outward passage is arrested. Where the first 
attempt fails, it can, however, be repeated, and, with a little dex- 
terity, usually succeeds. In cattle, foreign bodies may be reached and 
removed from the pharynx or cesophagus by introducing the hand 
through the mouth. The head must be carefully fixed, and a mouth gag 
applied. The hand, protected with a glove, unprovided with fingers, is 
introduced rapidly and energetically, but it must not be kept too long in 
the pharynx, as pressure on the rima glottidis may produce dyspnoea and 
struggling. In the horse, the narrowness of the space between the rows 
of molars and the soft palate render this procedure difficult, and it 
should not be attempted unless the patient is cast, when the hand may 
be introduced as far as the pharynx. 

(2) Reduction in size of the foreign body in situ may be 
effected in the case of potatoes and other boiled roots when they lie in 
the neck portion of the cesophagus by powerful pressure with both 
hands. Pieces of oileake, masses of hay, and boluses can sometimes be 
moved in this way, and caused to gravitate towards the stomach. It is 
recommended to place a piece of wood against one side of the neck, and 
to break down the foreign body from the other side with a hammer. In 
doing this, however, care must be taken not to injure the cesophagus or 
produce solutions of continuity in the trachea.’ 


1 A very rough and ready procedure, deprecated by all British teachers.—[TRANSL, } 


142 FOREIGN BODIES IN THE CGSOPHAGUS OF CATTLE. 


(3) Forcing the foreign body onwards into the stomach.— 


Fic. 54.—Probang and Mouth Gag 
for Cattle. 


Where the above-described methods are un- 
successful, efforts should be made to pass the 
foreign body on into the stomach. This must 
not be attempted with sharp substances, such 
as bones, but may be successful with bodies 
having smooth surfaces or of soft con- 
sistence, as, for instance, roots, oileake, and 
hay. For this purpose Munro’s cesophageal 
sound is used in horses ; failing this, a flex- 
ible cane may be selected, and the thin end, 
to avoid injury, surrounded with several 
folds of cloth firmly secured with whip-cord, 
or a strong, carefully oiled rope may be used. 
Although more easy and successful in oxen, 
I have repeatedly convinced myself that 
this procedure may also be used in horses 
even in the standing position. A mouth 
cag is applied; in cattle, a simple piece of 
wood with a hole in the centre may be 
used (fig. 54). In the absence of a gag, 
the tongue is held by an assistant (best 
with the help of a cloth), and drawn well 
towards one side (Ksser). A cordathis 
passed round the horns, and the head drawn 
up to a cross-beam, and extended as far 
as possible (Esser). In horses a twitch 
should be applied. The cesophageal sound 
is passed over the base of the tongue into 
the pharynx, and thence into the cesophagus. 
To avoid injury, it must be introduced with 
caution. The only danger is that the mstru- 
ment may pass into the larynx and trachea, 
but this accident is immediately evidenced 
by coughing and difficulty im breathing. 
Should it occur, the probang must be drawn 
back and the attempt repeated, until the 
instrument passes freely forward, and can be 
felt at the left side of the neck in the 
cesophageal furrow—a proof that it has 
entered the cesophagus, down which it is 


slowly pushed until it reaches the foreign 


body, where further progress is resisted. Cautious attempts are made 


FOREIGN BODIES IN THE (SOPHAGUS OF CATTLE. 


143 


to push the obstacle onwards. The entry of the sound into the stomach 


is attested by the cessation of resistance, as well as by the 
length of the instrument passed. In horses, foreign bodies 
like hay are sometimes so firmly impacted, that even this 
instrument cannot move them. 

(4) Extraction of foreign bodies by means of instru- 
ments.—Amongst these is Meier’s wire snare. It consists of 
a piece of brass or copper wire, about {th of an inch in thick- 
ness, doubled and fastened by the ends to a handle, and works 
somewhat like the string snare, used for removing corks from 
the interior of bottles. It is introduced like the probang, 
the loop thrust behind the foreign body, which may sometimes 
be extracted by turning and pulling on the instrument. But 
this device succeeds only where the obstruction lies in the 
upper portion of the tube, and is of such a character that 
it can thus be snared and held. The methods already 
described are, however, usually more successful, and the 
snare is therefore little used. The so-called cesophageal screw, 
for transfixing pieces of potato or turnip, is not of much 
service. The oesophageal forceps constructed by Delvos and 
Hertwig are more useful (fig. 55). They are introduced 
closed, but when the foreign body is felt, the jaws are opened 
by a screw, the instrument advanced, and the substance 
grasped and removed. These appliances have, however, only 
a narrow field of usefulness. Although their working is often 
interfered with by the curvature of the cesophagus at the 
entrance of the chest, notable especially in horses, one or other 
may be tried where the foreign body is low down and can- 
not otherwise be forced on. Dinter deprecates the forcible 
use of the cesophageal sound, and when it is unsuccessful, per- 
forms rumenotomy, and awaits the passage of the foreign body, 
which almost invariably occurs in six to eight hours. Strebel 
confirms this, but in one case had to wait forty-eight hours 
for the passage of the obstruction. He also suggests giving 
small doses of oil. Wellach also recommends this expectant 
treatment. 

(5) Incision into the cssophagus. Césophagotomy 
(Ger. Schlundschmitt)—This operation can only be performed 
in the neck portion of the cesophagus, and is only indicated 
where the measures above described fail. It is the last 
possible resource, where one has to deal with sharp sub- 
stances, as bones, &c. Its difficulties and dangers are usually 
exaggerated; it is not dangerous to life, and is only occa- 


Fic, 55,—Delvos and Hertwig’s Hosphageal Forceps. 


144 FOREIGN BODIES IN THE GiSOPHAGUS OF CATTLE. 


sionally followed by bad results. Quiet animals, such as cattle, may 
be operated on in the erect position. After clipping the hair from the 
left side of the neck, over the foreign body, and rather below than above 
this, an incision is made through the skin, about 4 inches in length, on 
the anterior or under border of the jugular vein, and parallel with it. 
After dividing the muscles of the neck or their fascia, the loose connec- 
tive tissue encountered must be torn through by means of the two 
forefingers. The carotid is first sought, and will be immediately recog- 
nised by its pulsation. The finger is then passed forward in the 
direction of the posterior aspect of the trachea, where the cesophagus can 
easily be found, especially if a foreign body is fixed in it. It is drawn 
forward, and its two coats divided as far as seems necessary for removal 
of the foreign body. As Dette has correctly remarked, it is desirable to 
make the incision in the skin under the jugular vein, and not over it, as 
is often described, in order that wound secretions and any portions of 
food may flow away as easily as possible. Further, the operation wound 
should not be larger than is absolutely necessary ; whilst the cesophagus 
should be separated as little as possible from its surroundings. Under 
certain circumstances the potatoes or roots may be broken down within 
the cesophagus and the pieces removed through a smaller wound. The 
parts must be sutured, as far as possible, with catgut, first bringing the 
mucous membrane together, and then the muscular coats. The skin 
wound is better left unsutured, as healing by primary intention cannot 
be expected. The catgut threads need not be removed, as they become 
absorbed. The wound is treated on general principles. For the first 
twenty-four hours food and drink must be completely withdrawn, though, 
if absolutely necessary, pure water may be given. During the next few 
days soft food or hay may be supplied. ‘Tainturier gives nothing but 
hay and pure water to cattle, and in one case obtaimed healing in thirty- 
five, and in another in twenty-five days. Although the animals fall 
away in condition, bad consequences are rarely observed. The subcu- 
taneous breaking down of the foreign body, suggested by Lafosse, is 
liable to injure the jugular, and is usually followed by pus formation, 
necessitating enlargement of the wound. Mauri has, nevertheless, 
recommended this treatment recently. Should difficulties or delays 
occur in removing the foreign body, and considerable tympanites result, 
as is frequent in cattle, the rumen must be punctured to ward off 
suffocation. 

If the removal of the offending substance by the described methods 
fails, as is usually the case when it lies in the thoracic portion, drench- 
ing with thick oily materials may be tried, if no difficulty in breathing 
exists. Caution, however, is necessary to prevent the fluid passing into 
the trachea and producing mechanical pneumonia. Small quantities 


FOREIGN BODIES IN THE GSOPHAGUS OF SWINE. 145 


must be given at a time and the animal watched, so that, if coughing 
occurs, the administration may at once be stopped. After puncture of 
the rumen, it is desirable to- wait for twelve to twenty-four hours for 
softening and dispersal of the foreign body. Michalski gave a bull 13 
grains of veratrine dissolved in 24 drams of spirit subcutaneously, pro- 
ducing violent cesophageal spasms in fifteen minutes and the disappear- 
ance of the obstruction. Immelmann’s statements point to the possible 
usefulness of subcutaneous injections of pilocarpine (p. 140), which 
provoke profuse salivation. Apomorphine favours cesophageal peristalsis 
and eructation, although this latter act is only produced exceptionally. 


(C) FOREIGN BODIES IN THE GSOPHAGUS OF SWINE. 


In Germany swine are usually fed on boiled roots, carefully cut 
potatoes, or semi-fluid gruels, so that food rarely causes obstructions. 
But where roaming in great herds, and fed on uncut potatoes or other 
roots, pieces sometimes stick in the pharyngeal pouch or in the ceso- 
phagus, and provoke symptoms similar to those in other animals. 
According to Lothes, foreign bodies in the pharyngeal pouch of swine 
produce difficulty in swallowing, salivation, and a peculiar change in the 
voice; instead of grunting, a shrill shrieking sound is produced, and if 
the subjects are in poor condition, the obstruction may be detected by 
palpation. Foreign bodies fixed in the cesophagus sometimes induce 
vomiting, and are thus ejected; but, where long retained, tympanites 
develops, and death ensues from suffocation. arly assistance is 
necessary, but in pigs little can be done manually. If the obstruction 
is in the pharyngeal pouch, pressure must be exercised simultaneously 
on both sides directly over the region of the larynx, and an effort made 
to push the contents of the pouch upwards into the pharynx. Where 
the foreign body is fixed in the top of the pharynx or just beyond it, 
Stockfleth advises that the pig be laid on a table, when removal may 
sometimes be made with a blunt hook, but if the object is deeper 
seated it may be pushed downwards with a flexible stick. Apomorphine 
can be tried as an emetic; if this does not at once succeed fat pigs had 
better be slaughtered. Csophagotomy may be performed in those in 
poorer condition; it is scarcely more difficult or dangerous than in 
other animals. Hering reports two successful cases; the wound healed 
without being sutured. 


146 FOREIGN BODIES IN THE PHARYNX AND C:SOPHAGUS OF CARNIVORA. 


(D) FOREIGN BODIES IN THE PHARYNX AND GSOPHAGUS OF 
CARNIVORA, 


Attention has already been given to the occurrence and treatment of 
foreign bodies in the pharynx of dogs and cats (p. 10). They occur 
usually at the base of the tongue, often close under the epiglottis, though 
sometimes behind the soft palate in the posterior wall or in the sides of 
the pharynx. Removal must be effected according to the directions 
before given. Bones, particularly vertebre of birds and game, fish-bones, 
needles, and other sharp objects, are liable to get fixed immediately 
behind the pharynx and occasionally just before the cardiac opening. 
They produce restlessness, anxiety, choking and vomiting, avoidance of 
food and drink, and most notably discharge of ropy saliva. Pressure 
on the cesophagus sometimes gives pain. 

Sharp substances perforating the cesophagus in the neck portion cause 
swelling and inflammation, in the thoracic portion, rapidly fatal pleurisy. 
They can be successfully extracted only by way of the pharynx, as de- 
scribed on p. 12. The foreign body, when in the lower portion of the 
cesophagus, may be pushed onwards with a flexible catheter. This failing, 
emetics, such as apomorphine subcutaneously, may be tried, and, if 
unsuccessful, cesophagotomy, which in dogs as in other animals is with- 
out danger, must be performed. I have often operated successfully. In 
one case the cesophagus was perforated at two points, but the piece of 
bone was removed, and healing followed without stricture or other bad 
result. 


(E) IMPACTION OF THE CROP IN BIRDS, 


Lit.s Friedberger u. Frohner, Spec. Path. Il, Aut. p, 41. “Arm 
Krankheiten des Hausgefliigels. 


The crop is a physiological diverticulum of the cesophagus, in which 
the food is prepared for digestion as in the first compartments of the 
ruminant’s stomach. Impaction results. from excessive distension with 
dry foods, or with indigestible foreign bodies, and from compression of 
the cesophagus in diseases of the lungs. 

Symptoms comprise excessive fulness and distension of the crop, 
which feels hard and firm, want of appetite, and sometimes discharge of 
offensive fluid from the beak, which is usually held open. If the con- 
dition persists for long or frequently recurs, the crop becomes greatly 
dilated, the animals gradually waste, and may die. The condition is seen 
in fowls, ducks, geese, and pigeons, and by recurrence becomes chronic. 

Treatment consists in massage. Attempts should be made to empty 
the crop or to break down the hardened contents by pressure and 


IMPACTION OF THE CROP IN BIRDS. 147 


kneading. Ziirn recommends hydrochloric acid. If this proves useless, 
as in distension with foreien bodies like sand and_ stones, the crop 
must be emptied by operation, which is well sustained by most 
birds. After removing the feathers, the crop is divided in the long 
direction of the neck far enough to allow of the finger entering and the 
contents being withdrawn. The wound is cleansed and sutured, and 
generally heals by first intention. According to Ziirn, pigeons are not 
good subjects for operation, especially during breeding, the mucous 
membrane of the crop being swollen and very rich in blood-vessels. 


(2.) INJURIES TO THE PHARYNX AND GiSOPHAGUS. 
(ESOPHAGEAL FISTULA.) 


Lit.: Guilmot, Her. Rep., vol. 16. p.72. Braun, Gurlt u. Hertwig. 33. 
p- 881. Laser, Th. Mitth. 1874, p. 160. Haubold, Dresd. Bericht. 
1887, pp. 62 u. 68. Stamm, Th. Mitth. 1882, p.57. Graf, Zeitsch. f. 
Vet.-Kunde, 1892, p. 211. 

Injuries of the walls of the pharynx occur all in large animals, but most 
commonly in horses. When rasping the teeth the chisel or rasp, if care- 
lessly handled, may severely injure the pharyngeal wall, and even produce 
death from bleeding or acute inflammatory processes. Like injuries 
result from the use of sticks in giving balls ; from awkward employment 
of pharyngeal sounds, forceps, and other instruments; and in all 
animals, and notably in carnivora, from sharp foreign bodies. Merk] 
found a hairpin in a horse’s pharynx. Injuries to the cesophagus 
are almost invariably caused by sharp foreign bodies, or by cesophageal 
instruments used for their removal. Injuries from without are rare 
(p. 117), though Graf and Braun have both seen injuries to the cesophagus 
in horses caused by kicks from other animals. 

The course of such injuries depends entirely upon their extent. As 
already stated, fatal bleeding may occur, or suffocation from passage of 
blood into the trachea. Where the inflammatory processes are super- 
ficial, and foreign bodies have been promptly removed, healing often occurs 
quickly ; but phlegmonous inflammation of the mucous membrane of the 
pharynx and adjacent parts may supervene (angina phlegmonosa), threaten- 
ing suffocation. Foreign bodies injuring the mucous membrane of these 
regions sometimes produce extensive inflammation and the formation of 
abscesses, which may break externally and cause cesophageal fistula, or 
into the thorax or abdomen, inducing fatal septic pleuritis or peritonitis, 
and rapidly leading to death. Laser records, in a remount horse, the rare 
case of double rupture of the cesophagus—one in the neck portion, the 
second in the thorax; death ensued. External perforation is most 
frequently met with at the upper end of the cesophagus, close behind 
the pharynx; this I have several times seen in horses. The abscess 


148 INJURIES TO THE PHARYNX AND C&SOPHAGUS. 


breaks and discharges an exceedingly offensive pus, often mixed with 
food, after which saliva, food, and water escape during swallowing, 
proving beyond question that the disease has originated in the cesophagus 
or pharynx. The wound closes gradually, but a small fistulous canal 
remains, discharging water and saliva, and healing often with the greatest 
difficulty. This constitutes cesophageal fistula. The inflammatory 
processes and consequent swelling produce difficulty in swallowing, and 
not infrequently feverish symptoms (angina). A swelling develops on 
the left side, gradually increases, becomes soft, and finally breaks, when 
the difficulty in swallowing and the fever disappear. Guilmot has seen 
abscess formation in the lumen of the cesophagus of a calf, causing 
difficulty in swallowing, vomiting, and tympanites ; on introducing the 
cesophageal sound, about two pints of pus were discharged, the symptoms 
disappearing some days later. Haubold saw an cesophageal fistula pro- 
duced in the horse by abscess formation in the retro-pharyngeal lymph 
glands; the animal recovered in three weeks. Stamm had a similar 
case following strangles. Injuries of the walls of the pharynx by ball- 
ing-guns or tooth instruments, indicated by salivation and disturbance 
in swallowing, may heal, provided they do not take a fatal course from 
bleeding or inflammation. In small animals their position and extent 
can be determined by direct inspection. 

Treatment.—aAs already indicated, care must be exercised in the 
use of oesophageal and tooth instruments, and sharp balling-guns or 
sticks avoided. The course of abscess formation in the throat may 
be shortened by early and cautious opening, by washing out the abscess, 
and making provision for regular discharge of the contents, inflam- 
matory products, and saliva. Césophageal fistule sometimes give much 
trouble. Definite closure may often be produced by passing a thread 
steeped in sublimate, or by applying the actual cautery, but is not always 
successful. In a horse under my treatment these and other measures 
were used without result. Widening the fistula and suturing the opening 
in the cesophagus generally produces healing, though the operation is by 
no means easy, and does not in every case produce the desired effect. 


(3.) ECTASIA, DIVERTICULA, AND RUPTURES OF THE 
GSOPHAGUS. 


Lit.: Langrehr, Berl, Archiv. 1886, p. 285. Roloff, Th. Mitth. 1874, 
p. 161. Reichel, Gurlt u. Hertwig. III. p. 306. Schwerdtfeger, 
Dresd. Ber. 1858, p. 100. Reinemann, Th. Mitth. 1858, p. 160. 
Moisant, Jahrb. 1869, p. 45. Laurent, Jahresbericht. 1886. p. 109. 
Dr S. and Fuchs, ibid., 1860, p.11. Hartenstein, Dresd. Ber. 1875, 
p. 104. Kehm, Berl. Thier. Woch. 89, p.11. Harms, Han. Ber. 1876, 
p. 57. Schleg, Dresd. Ber. 1889, p. 75 u. 1891, p. 9. Leisering, 
Dresd. Ber. 1861, p. 21. Schafer, Berl. Archiv. 1887, p.364. Munkel, 


ECTASIA), DIVERTICULA, AND RUPTURES OF THE CiSOPHAGUS. 149 


Th, Mitth. 1882, p. 56. Graf, Zeitsch. f. Vet.-Kunde, 1892, p. 211. 
Wagner, B. T. W. 1892, p. 326. Griinwald, block. Monatsschrift. 
1888. Schellenberg, Schw. Arch. 1891. 


The term ectasia is applied where the skin, muscular and mucous 
tissues have undergone dilatation. Kctasiz sometimes result from 
stricture of the cesophagus, and, like it, usually develop slowly. They 
occur both in large animals and in carnivora. 


Langrehr saw a cow which for three months had always vomited after taking 
food, and especially when drink was given soon after feeding. The cow was 
very thin, and when slaughtered exhibited a dilatation of the oesophagus close under 
the diaphragm, produced by distension of all its coats, and capable of holding 
nearly three litres of fluid. Wagner examined a horse which had a dilatation of the 
cesophagus in front of the 4th cervical vertebra, and also just before its passage 
through the diaphragm. The condition had led to an attack of mechanical 
pneumonia and death. 


Sometimes dilatations take a spindle form, sometimes they are 
sharply defined. Where greatly developed, difficulty in swallowing 
occurs, and wasting afterwards sets in. 

Diverticula are here taken to mean ruptures of the muscular coat of the 
cesophagus, and passage of the elastic but unbroken mucosa through the 
opening. This has been described as cesophagus ventriculosus, or 
cesophagocele, and is oftenest met with in horses and cattle. I have 
seen it result from greedy consumption of rough and prickly clover, and 
Munkel has had the same experience. It sometimes occurs in the neck 
portion of the tube, but more frequently close to its entrance into the 
stomach (Schiifer). 


Fuchs discovered a dilatation of the cesophagus after death, where the neck 
portion had a circumference of 94 inches, the thoracic portion of 12}? inches, 
and the portion in front of the diaphragm was distended to 203 inches. 
Dr S. describes a diverticulum in the horse formed in consequence of the 
muscular coat being ruptured for a distance of 11 inches in the thorax. The 
sac-like dilatation held five pints of water, and the horse suffered from symptoms 
of broken wind. Schellenberg saw a similar diverticulum in the dog, produced 
by a bite and subsequent abscess formation. On post-mortem, six months later, 
a diverticulum was discovered as large as a man’s fist. It had resulted from 
cicatricial contraction. 


Of twenty-six cases collected by Rubeli, the diverticulum was, in 
eleven, close before the diaphragm, in seven in the thoracic portion, and 
in eight in the neck portion, usually in the lower part of it. The ana- 
tomical disposition of the cesophagus in horses explains this distribution 
(p. 139). The mucous membrane may subsequently be ruptured. 
Illustrations of these several classes of cases are recorded. 


Ruland relates that a horse which had suffered from colic, with severe attacks 
of vomiting, was found to have the csophagus ruptured close in front of its 


150 ECTASI#, DIVERTICULA, AND RUPTURES OF THE CSOPHAGUS. 


passage through the diaphragm. Leisering describes a diverticulum in a horse 
employed in transport duty, and which died from suffocation: 3 feet from the 
pharynx the distended cesophagus had a circumference of about 16 inches, 
8 inches lower the circumference was 12 inches, 13} inches higher it measured 
124 inches; close in front of the cardiac opening was a second diverticulum. 
Griinwald saw a horse which died a day after suffering from a shivering and 
“blowing” attack. The post-mortem discovered a quantity of turbid fluid 
mixed with food in the thorax. The cesophagus was ruptured for 44 inches 
close in front of the diaphragm, and in front of this again was dilated for a 
distance of 16 inches, its walls being more than 3 inch thick, and its circum- 


ference 6 inches. At the point of rupture the mucous membrane formed a cavity 
as large as a hen’s egg. This communicated with the rupture. Grunwald con- 
sidered that an abscess had formed in the cesophageal wall and caused the 
rupture. But it also seems possible that the condition was a simple diverticulum. 
Harms, Hartenstein, and Roloff describe cases of cesophageal diverticula in cows ; 
one detailed by Harms situated 2? inches in front of the rumen. 


The symptoms of these conditions bear a general resemblance to 
one another. EKctasiz and diverticula are recognised by choking and a 
tendency to vomiting, usually appearing soon after taking food. Where 
the lesion is in the neck portion of the cesophagus, a swelling appears 
on the left side of the neck during feeding, is not painful, or only 
slightly so, shows no inflammatory symptoms, and usually disappears after 
one to two hours. When pressed on, it produces symptoms of suffo- 
cation and attempts at vomiting. It is commonly more prominent after 
consumption of dry chaff than after hay or water. It may continue for 
a long time without impairing general health, but when large, especially 
if situated in the thoracic portion, or when distended with food, such 
swellings compress the trachea, and may produce dyspnoea. The horse 
described by Leisering, if smartly exercised, especially after feeding 
with hay, exhibited dyspnoea and coughing, which disappeared later. 
The animal eventually died from suffocation. A similar case is described 
in the Jahresbericht 1860, p.11. The symptoms may continue for a long 
time without causing more than loss of condition and slowness in feeding, 
though the dyspnoea sometimes produces death, as shown by the cases 
reported by Leisering, Fuchs, and others. Finally, obstructions may lead 
to mechanical pneumonia and death in consequence of interference with 
swallowing, as in Wagner’s case. In complete rupture of the cesophagus 
symptoms are produced similar to those of severe injury to the ceso- 
phagus. If in the cervical portion, they comprise emphysema in the 
neck and formation of abscesses, which by-and-bye perforate and discharge 
pus mixed with food. These may heal like cesophageal wounds. Spon- 
taneous healing in a cow is related by Schleg; but death may ensue 
from excessive burrowing of pus and sepsis, as Laurent’s and Graf’s 
observations show. Grat’s case was caused by a kick from another 
horse. Should the cesophagus become ruptured in the thorax or abdomen, 


ECTASLE, DIVERTICULA, AND RUPTURES OF THE GSOPHAGUS. 151 


death soon follows from septic pleuritis or peritonitis. Kehm and 
Griinwald report such cases in the horse. The condition is, however, 
seldom recognised before death. Accumulation of food may cause 
inflammation and destruction of the mucous membrane, especially during 
the earlier stages and before it becomes gradually thickened and more 
resistant. 

Prognosis in these cases is usually unfavourable. If ectasia does 
not endanger life, it seriously interferes with nutrition and the use of 
the animal. By regulating the diet it may be possible to keep the 
animals at work; fat cattle should be prepared for slaughter. 

Treatment.—In ectasia, which sometimes extends over large areas, 
therapeutic treatment scarcely promises any good result, but in diver- 
ticula in the cervical portion of the cesophagus something may be done, 
both in horses and cattle, by operation, as is shown by the cases related 
by Reinemann, Schwerdtfeger, Moisant, Reichel, and others. The 
dilated portion of the mucosa may be replaced or removed altogether, 
and the rupture in the muscles brought together by sutures. With 
antiseptic precautions, the operation is not attended with much danger. 
This is the most promising treatment in animals, but in chronic cases 
is more easily described than carried out, especially if the rupture in 
the muscular coat is already cicatrised and fixed to the neighbouring 
parts by much cicatricial tissue. The operation can, however, he 
tried. 

Procedure is similar to that of incising the cesophagus (p. 148). 
After returning the mucosa, the muscular coat is, where practicable, 
carefully sutured with catgut or silk ligatures inserted close together ; 
bad results naturally follow if the stitches tear out. Where this 
course is impossible, the diverticulum must be opened, a piece of the 
dilated mucous membrane excised, and the parts brought together in 
the above fashion. Mboisant applied a sort of clamp during eating and 
drinking, and attained good results in a horse, and afterwards in two 
cows. Careful stitching of the muscular and mucous coats is, 
however, not only simpler, but equally successful. Reinemann 
effected a cure, although the stitches tore out in two days, owing to 
inappropriate feeding. Granulations gradually close the opening. 
Reichel operated on oxen in the standing position. To prevent the 
stitches tearing out, nothing more than water should be given during 
the ensuing twenty-four hours, and during the next few days only fluid 
nourishment. In complete rupture of the cervical portion of the 
cesophagus, the same treatment is recommended as in injuries from 
sharp substances. Nothing can be done in ruptures of the thoracic and 
abdominal portions. 


152 STENOSIS AND COMPRESSION OF THE (ESOPHAGUS. 


(4.) STENOSIS AND COMPRESSION OF THE GSOPHAGUS. | 


Lit.: Andersen, Stockfleth Chirurgie. p. 302. Friedenreich, Mag. v. 
Gurlt u. Hertwig. 16. p. 282. Johne, Dresd. Ber. 1886, p. 56. Kohne, 
Mag. v. Gurlt u. Hertwig. 26. p. 424. Bailliet, Jahresbericht. 1886, p. 
110. Felisch, Adams W. 1883, p. 345: 


Stenosis of the cesophagus may result from chronic inflammatory pro- 
cesses in its walls. Andersen relates that a horse had for four months 
repeatedly suffered from impaction of the cesophagus, and on post-mortem 
showed a ring-like contraction, about 8 inches below the pharynx; the 
portion above this point was widened (ectastic). Kohne describes as 
stricture what appears to have been a diverticulum. 

A similar case is described by Friedenreich ; a horse, after suffering 
for a long time from difficulty in swallowing, finally died from hunger, 
and on post-mortem a duplication of the mucous membrane was dis- 
covered arising from the upper pharyngeal wall, reducing to one-third 
the dimensions of the pharynx. The mucous membrane did not appear 
diseased. 

Compression of the cesophagus is caused by tumours in the thorax, 
or by swelling of the bronchial lymphatic giands (compression stenosis). 
Johne and others report such cases in oxen, in which tuberculous bron- 
chial glands compressed the cesophagus, and caused difficulty in swallow- 
ing and disturbance of nutrition. Animals are not so frequently affected 
as men, either by contraction of the mucous membrane, from the 
swallowing of irritants, or by narrowing of the lumen of the tube by 
tumours or parasites like spiroptera sanguinolenta, constituting obtura- 
tion stenosis. These conditions can seldom be diagnosed with certainty. 
Their chronic course distinguishes them from the disturbances produced 
by foreign bodies or by diverticula of the cesophagus. Cattle often show 
chronic tympanites, and where this is accompanied by coughing and 
wasting, suspicion of tuberculosis must occur. 


(5.) PARALYSIS OF THE PHARYNX AND GiSOPHAGUS. 


Lit.: Anacker, Gurlt u. Hertwig. 19. p. 478. Cadeac, Jahresber. 1888, 
p: 113. Straub, Her. Rep. 1841, p.179. FPriedbergeru Frohner 
Spec. Path. IL Aufl. p. 39. Wassilleff, Mitth. aus der naturforsch. 
Gesellschaft in Bern. 1888, p. 170. Puschmann, Thierarzt. 1869, 
p. 210. Dieckerhoff, Spec. Path. p. 805. Kronecker u. 
Meltzer, Dubois-Reymond’s Archiv. 1883. Schmidt, Berl. Th, 
Woch. 1889, p. 145. Leitenstern, Forsch. d. Med. 1891, p. 766. 


The muscles of the pharynx and of the upper two-thirds of the 
cesophagus receive their motor nerves from the 9th pair, the last third 
of the oesophagus is supplied by the 10th pair. (For the innervation 


PARALYSIS OF THE PHARYNX AND (ESOPHAGUS. 153 


of deglutition, see p. 159.) Paralysis of these nerves may induce 
functional disturbance. Records are numerous of so-called paralysis of 
the cesophagus, but the descriptions are not always reliable or complete, 
and some of the cases depend not so much on paralysis as on structural 
changes or the presence of foreign bodies. No strict division or sufficient 
points of distinction can be made between paralysis of the pharynx and 
cesophagus. Conditions viewed as paralysis of the cesophagus must some- 
times be referred to the pharynx. Whether paralysis of the muscles of 
the pharynx, especially of the constrictors, can produce difficulty in 
swallowing, and of what particular form, is not at present known. In 
serious diseases, especially in brain disorders and rabies, as well as 
towards the end of life, innervation of deglutition often suffers, and food 
consequently remains fixed in the esophagus. Hence post-mortem 
examination of horses often discovers accumulation of food in the 
cesophagus, without any apparent obstruction in the Iumen of the tube ; 
but these cases have no further clinical interest. 


I treated a horse which showed difliculty in swallowing for a long time; no 
cause could be discovered, no other morbid symptoms were present—even on 
post-mortem nothing abnormal could be detected. In another horse, recovery 
from a laryngeal injury was followed by difficulty in swallowing, and though 
food was chewed as usual, no attempt was made to swallow it, but the horse 
allowed it to fall from the mouth again. The tongue appeared normal, both in 
appearance and function. It, therefore, seems probable that paralysis of the 
pharynx existed, though the strict proof was wanting. I have seen similar 
difficulty in deglutition several times after resection of the arytenoid cartilage : 
in one case caused by great increase in the connective tissue about the larynx 
and pharynx ; in another case the symptoms completely disappeared after some 
weeks. Possibly this case depended on inflammatory swelling in the pharynx, 
though the animal showed no other disturbance. Dieckerhoff saw a similar case 
ina horse. That inability to swallow may be caused by impaction in the ceso- 
phagus appears evident from Puschmann’s record of a horse which had the tube 
packed tightly with hay 2 inches from the cardiac orifice. The cases described 
by Cadeac and others as cesophageal cramp may probably be referred either to 
impaction of the cesophagus or other hindrance to the passage of food (diver- 
ticulum, stenosis). Complete blocking of the cesophagus naturally prevents 
the possibility of swallowing. This is easily explained if one adopts Kronecker 
and Meltzer’s view, that food is injected immediately into the stomach from the 
pharynx. 


Schmidt has lately indicated the possible occurrence of one-sided 
paralysis of the pharynx and cesophagus. An old mare had a left- 
sided nasal discharge ; the left nostril was filled with food, and on 
drinking, a great part of the water flowed back through the nose. She 
soon died, and examination showed the left superior maxillary sinus 
filled with food, mechanical pneumonia existed, and the left half of the 
soft palate was atrophied (“ only rudiments existed”), while the wall of 
the pharynx on the left side was dilated in a pouch-like form. Pharyngeal 


154 PARALYSIS OF THE PHARYNX AND (ESOPHAGUS. 


paralysis was also seen in an army horse (Zeitschrift fiir Veterindrkunde, 
1889, p. 214), but disappeared after eight days treatment with strychnine. 

Reports as to inability to swallow appear enigmatical. The horses can take 
food, chew, and swallow in the usual way, but are unable to make drinking 
movements. They go greedily towards the water, make snapping movements 
with the lips, and move the tongue without being able to take a single swallow 
of water. Friedberger and Frohner believed that a congenital defect existed in 
the nervous centre (sucking centre). But it is remarkable that the animals under 
these circumstances had lived so long, the one mentioned by Friedberger being 
eight years old. Leitenstern reports cases of slowly developing cramp of the 
cardia inman. <A person who had regularly vomited the food swallowed without 
its being mixed with gastric juice was, after death, found to have dilatation of 
the entire esophagus, but no mechanical obstruction could be found. 

Symptoms.— Inability to swallow, especially if associated with stop- 
page of the cesophagus with food, reveals the nature of the case. It is 
often noted in rabid dogs that the animals attempt to drink, but that 
little or none is swallowed. It is difficult to determine whether the 
inability to swallow depends alone on the masticatory facial muscle 
paralysis (p. 86), or in part on paralysis of the pharynx. 

Treatment.—It is of primary importance to attempt the removal of 
the frequently existing obstruction in the cesophagus, and for this end the 
probang is most useful. Appropriate diet must also be given. Drugs 
are of little use, though strychnine might be tried. It is more hopeful 
to treat the general conditions to which the disease is sometimes due. 


(6.) TUMOURS IN THE PHARYNX AND GSOPHAGUS. 


Lit.: Fessler, Deutsche Zeitschr. fiir Thiermed. 1886, p.37. Harms, Th. 
Mitth. 1877, p. 131. Beel, Jahresber, 1888, p.113. Ziirn, Parasiten. 
II. Aufl. Degive, Jahresber. 1881, p. 56. Schitz, Berl. Arch. 1875, 
p. 66. Prietsch, Dresd. Ber. 1888, p. 70. Esser, B. I> Wo iseo 
p. 307. Lorenz, Zeitschr. fiir Vet. 1890, p. 415. Diericx, Her. Rep. 
16. p. 73. Moeni, Rev. vétér. 1892. Labat, Koch’s Monatsschr. 
1892; po: 

Such tumours are more common in cattle than in other animals. New 
growths in this region have long been recognised; their gravity depends 
upon their nature. Roloff considered them to be retention tumours, 
arising from the mucous glands of the pharynx. Harms declared them 
to be lymphomata, but recently the conviction has gained ground that 
they are usually cases of actinomycosis. They generally develop singly 
on the posterior upper wall of the pharynx, under the sphenoid bone, 
or close above and behind the larynx. Harms named the former, which 
usually attain the size of an apple, “anterior,” the latter, which are 
commonly much larger, “ posterior pharyngeal actinomycomata.” Con- 
sidering their frequency in cattle, infection is doubtless often produced 
by food containing spores of actinomyces. The comparatively thin, 


TUMOURS IN THE PHARYNX AND CESOPHAGUS. 155 


tender mucous membrane injured by the passage of hard sharp forage 
is easily infected. As the growths enlarge, the following symptoms 
appear :— 

(1) Dyspnea. The respiration is snoring and rattling, attended with 
cough, and the dyspnoea occurs particularly during feeding, and sometimes 
at every effort to swallow. When the head is bent, this disturbance 
is more marked, a circumstance valuable in diagnosis. (2) Difficulty 
in swallowing. The tumour, as it becomes larger, interferes with 
deglutition. The head is extended, and food entering the pharynx 
excites coughing. (3) Palpation from without sometimes discovers 
filling in the region of the pharynx. In making this examination, the 
head must be extended as much as possible, and the two hands pushed 
upwards above the larynx. Harms once found dislocation of the larynx. 
On introducing the hand into the pharynx, the condition, size, character, 
and position of the new growth can be fully determined. 

This examination is necessary to differentiate the condition in question from 
other diseases of the tongue like makroglossia, or from swelling of the retro- 
pharyngeal lymph glands, though the latter is not very frequent in oxen. 
Nevertheless, it has been several times observed, and Prietsch describes a case. 
A well-nourished cow gradually developed snoring respiration four to five 
months after the first calving. It was most marked when eating hay, and some- 
times became so severe that chewing was interrupted, the head extended, and 
the tongue thrust out of the mouth. The larynx was swollen and enlarged. 


Post-mortem showed tuberculous changes in the lungs and retropharyngeal lymph 
glands. 


According to Harms, the anterior pharyngeal swellings contain a greyish-red 
material, sometimes calcified, in the interior of which actinomyces can be 
detected. The posterior have a smooth fibrous form, and contain a greenish 
decomposed material. They develop slowly. Harms states that the swelling 
may exist for five months or more, without producing danger of suffocation, but 
the symptoms, and especially the respiratory disturbance, generally increase. 
He further remarks that in the posterior pharyngeal swellings arrest of growth 
may occur, so that clinical symptoms remain stationary. 

Prognosis is unfavourable ; complete recovery improbable, although 
improvement may be secured for a long time by operative treatment. 

Treatment.—Harms casts the animal, raises the neck, and makes 
a longitudinal incision in the middle line under the larynx, through 
which the hand is introduced, the connective tissue at the side of the 
larynx is then divided, the tumour reached and removed by breaking down 
the tissues around it. Meier casts the animal on the right side, inserts 
a mouth gag, raises the head, introduces the right hand into the mouth 
and pharynx with its volar surface towards the palate, and grasps and 
tears off the anterior actinomyces swellings. The posterior growths, on 
account of their firm coating of connective tissue, cannot thus be dealt 
with, and, therefore, Meier pierces these with the finger, allowing the 
contents to escape. Harms prefers the former of these methods, and 


156 TUMOURS IN THE PHARYNX AND (ESOPHAGUS. 


of the latter remarks that it is difficult to carry out, and does not 
always remove the dyspnwa. According to my experience, the 
“ecraseur” is here indicated. With it the entire tumour, under certain 
conditions, may doubtless be removed. Esser, after extensive experience, 
has come to the conclusion that the operation seldom produces lasting 
good results. Lodide of potassium may be tried. 


Tumours in the pharynx of horses are rare, and little is at present known 
as to their nature. The symptoms resemble those in oxen, and the methods. 
for removal are similar; but it is not always possible to introduce the hand 
into the pharynx. Degive, on making the post-mortem of a horse which had 
repeatedly suffered from sudden attacks of dyspnoea, threatening death from 
suffocation, observed a cystoid tumour as large as a hen’s egg on the floor of 
the pharynx close in front of the epiglottis. Labat operated on a horse 
which had suffered from nasal bleeding and difficulty in breathing and swallow- 
ing. By opening the larynx, and dividing the soft palate, he succeeded 
in removing a tumour from above the larynx by the ecraseur. The growth 
proved to be an epithelioma (compare with p. 159 as to occurrence of laryngeal 
tumours). Such tumours are rare in carnivora. Diericx removed from the 
pharynx of a dog, with the help of a snare, a double polypus 2 inches long, 
which, on microscopical examination, proved to be a fibroma. In spite of 
extended practice, I have not yet seen similar disease in dogs. Tumours of the 
pharynx are most frequent in ruminants, especially in cattle, and may be due 
either to actinomyces (Siedamgrotzky, Dijon) or be simple papillomata (Schiitz). 
The former are usually single, the latter multiple. Fessler describes a case of 
multiple papilloma in the cesophagus of an ox. The entire surface of the 
cesophageal mucous membrane was covered with warty brush-like outgrowths, 
which were only the size of a grain of barley in the neighbourhood of the 
pharynx, but became as large as a bean in the middle of the cesophagus, and 
formed bristle-hke tufts. Lower down they were not so numerous. These 
papillomata resembled bunches of bristles, numbering thirty or more, which grew 
from a conical base in the form of a brush. Microscopical examination showed 
the following appearances :—The propria mucosa, below the papilloma, contained 
spherical masses of blood-vessels, in which the veins formed large cavernous 
spaces, The papilloma was provided with a solid root containing loops of blood- 
vessels from which processes of connective tissue extended into the threads and 
bristles. ‘The connective tissue was covered with epithelium. eel noticed a 
case of multiple papilloma in the cesophagus of an ox, marked by difficulty in 
deglutition, swelling on the left side of the neck, difficulty in introducing the 
probang, chronic tympanites, and reduced condition. Post-mortem showed 
“‘intra-cesophageal stenosis,” with dilatation in front of the contracted spot. The 
latter, which was of uniform width, began below the pharynx, was 6 inches in 
length, and ended at the height of the second rib; its greatest circumference 
was 9} inches, the thickness of the muscular coat }th inch, The mucous mem- 
brane was covered with a great number of wart-like papillee of varying size, some 
not exceeding that of a pin’s head, others as large as a hazel nut ; forty-five of them 
were from | inch to 1} inches long; it was contracted at the ‘level of the second 
rib, but still allowed the probang to pass. Beel believed that the periodicity of 
the symptoms was caused by masses of food inducing occasional occlusion at this 
spot. Microscopical examination gave similar results to those described by Fessler. 

Psorospermia have repeatedly been met with in the cesophageal walls in 
goats and sheep, but seem to produce no difficulty in swallowing. Possibly 


DISEASES OF THE LARYNX AND TRACHEA. 157 


some of the cases described as paralysis of the pharynx are due to such parasites. 
Koch found tuberculous abscess in the cesophageal walls in cows. In tropical 
countries (Java) cysts have been discovered in the oesophageal walls of dogs, 
which were filled with spiroptera sanguinolenta, and had completely occluded 
the wsophagus. Harms, during the autumn, found female filariz below the 
esophageal epithelium in sheep. These have been stated by Ziirn to be identical 
with spiroptera scutata cesophagea bovis. In dogs spiroptera sanguinolenta often 
occurs in the esophagus. These new growths, varying in size and form, produce 
greater or less difficulty in deglutition ; often only fluids can be swallowed, and 
that with great effort. Sometimes suffocation and vomiting occur ; wasting is a 
regular result. Curability depends on the condition and number of the growths, 
and on whether they can be reached. Polypi with narrow pedicles may be torn 
off and discharged during violent vomiting. In carnivora, asin man, these usually 
have their seat in the pharynx or close behind it, and during vomiting may be 
thrown forward into the pharynx, and can then be removed, as shown by a case 
reported by Diericx, Where the swelling in the neck portion of the cesophagus 
can be detected externally, which, however, is seldom the case, it may be removed 
by performing cesophagotomy. The uncertainty of diagnosis during life generally 
prevents rational treatment. Lorenz saw a horse die from pleurisy, and found a 
carcinoma which had led to rupture of the esophagus. Molni detected a tumour 
in the left cesophageal furrow in a cow, which, after each feeding time, showed 
tympanites. He regarded the case as one of goitre. 


VIII—DISEASES OF THE LARYNX AND TRACHEA. 


(1.) INJURIES, INFLAMMATIONS, AND TUMOURS IN 
THE LARYNX. (LARYNGITIS, PERILARYNGITIS.) 


Lit.: Kiihnert, Berl. Arch. 1889, p. 294. Hutchinson, Jahresber. 
1888, p. 103. Gurlt, Gurlt u. Hertwig. 17. p. 446. Werner, Thier- 
airztl. Mitth. 1876, p. 102. Lee, Jahresber. 1889, p.98. Mecke, Gurlt u. 
Hertwig. 5. p. 258. Meer, Thierarztl. Mitth. 1860, p.168. Eh rhardt, 
ibid., 1860, p. 168. Gurlt, Gurlt u. Hertwig. 33. p. 23. Peschel, 
Dresd. Ber, 1885, p.56. J ohne, ibid., 1880, p. 48. Dieck, The Veter. 
1842, p. 3. Rowland, Jahresber. 1884, p. 91. Prietsch, Dresd, 
Ber, 1888, p. 70. Besnard, Jahrb. 1885, p. 75. Degive, ibid., 1886, 
p. 102. Giittler, Th. Mitth. 1881, p. 42. Gurlt, Guilt u. Hertwig, 28. 
p. 287. Gerlach, ibid., 20, p. 307. Siedamgrotzky, Dresd. Ber. 
1873, p. 13. Hink, Jahresber, 1889, p. 98. Benjamin, ibid, 1883, 
p. 88. Leisering, Dresd. Ber. 1863, p. 18. Lee, Jahrb. 1890, p. 98. 
Lehnhard, Zeitschr. fiir Vet.-Kund. 1892, p. 168. 


Only in carnivora is the larynx accessible to direct inspection. This is effected 
for clinical purposes by drawing out the tongue and depressing it with some 
blunt instrument (scissors). The laryngeal mirror used by Nawratil and 
Schmidt is of little value, and is seldom used on account of the animal’s resist- 
ance. Until recently, inspection of the larynx in the larger animals appeared 
impossible, but Polansky and Schindelka, with the assistance of the genial Vienna 
optician Leiter, have constructed instruments forexamining the larynxand pharynx 
of the horse, and amongst others the rhino-laryngoscope, which affords not only 
clear but extensive views of this region. The instrument is described in the 
dester. Zeitschrift fiir wissenschaftliche Veterindrkunde, vol. ii. p. 295. Its con- 


158 DISEASES OF THE LARYNX AND TRACHEA. 


struction is complicated, its use requires the electric light, and its application in 
veterinary practice has accordingly as yet been limited; but it is very service- 
able for clinical observation and for teaching. 

On account of its protected position between the branches of the 
lower jaw, the larynx seldom suffers from injuries from without, though 
sharp foreign bodies swallowed with the food may pierce and inflame 
the mucous membrane. Rowland removed from the pharynx of a 
horse a fish-hook, which had penetrated the larynx. Injuries of the 
larynx occur oftener than is supposed, but not so frequently as those of 
the pharynx, and produce either acute or chronic inflammatory pro- 
cesses. The acute are clinically comprised under acute laryngitis, and 
are considered in the text-books on special pathology and therapeutics. 
The chronic lead to proliferation of connective tissue in the neighbour- 
hood of the laryngeal cartilages (perilaryngitis chronica fibrosa) or pus 
and abscess formation. 

Kiihnert saw a case of perichondritis suppurativa laryngea in a pig. 
An abscess had formed in the submucous tissue of the right arytenoid 
cartilage, and markedly narrowing the glottis, caused dyspnoea; the 
animal was slaughtered. Leisering detected swelling of the vocal 
chords and of the mucous membrane of the laryngeal pouches in a dog, 
which had suffered from severe cough; and Hutchinson makes a similar 
report of a pig, killed on account of dyspnoea. Necrosis of the cricoid 
cartilage had occurred. 

Perilaryngitis chronica fibrosa is commonest in horses. Progressive 
increase of connective tissue occurs, which sometimes undergoes ossifica- 
tion; its retraction fixes the arytenoid cartilages, narrowing the glottis, 
and producing more or less severe dyspnoea. Gurlt reports this con- 
dition in a horse which had suffered from broken wind. The larynx 
was ossified. Werner speaks of an ox, which, after suffering for over a 
year from gradually increasing difficulty in breathing, was found to have 
a laryngeal growth which extended into the trachea. I have repeatedly 
seen chronic perilaryngitis in horses. in four cases no cause could be 
discovered ; another happened after resection of the arytenoid cartilage, 
causing failure of the operation. Chronic inflammatory diseases of the 
mucous membrane of the larynx are not very rare. In cows tubercu- 
lous processes occur (Giittler). In horses and dogs chronic catarrh of 
the larynx is occasionally seen, though it seldom requires surgical treat- 
ment. Chronic irritation in the deep layers of the mucous membrane, 
causing thickening and proliferation, occurs oftenest on the vocal cords, 
which I have repeatedly found thickened in places. Lee found both vocal 
cords in a horse covered with cartilaginous growths. 

Symptoms.—Chronic laryngitis and perilaryngitis are recognised 
primarily by dyspnoea, which ensues more rapidly in cases where pus 


CHRONIC LARYNGITIS AND PERILARYNGITIS. 159 


formation is proceeding than in those where connective tissue is being 
formed. At first inspiratory dyspnoea is alone recognisable, but diffi- 
culty in expiration may also be noted later. So long as the difficulty is 
confined to inspiration, the disease cannot easily be distinguished from 
paralysis of the recurrent nerve, and is clinically included under the 
term “ whistling” or “ roaring.” External examination seldom discovers 
any structural changes, but if the process has extended to the outer 
surface of the cricoid and thyroid cartilages, the larynx appears of 
unusual size, although its outlines seem less sharply defined. Ossifica- 
tion is recognised by an unusual hardness and resistance to pressure, 
usually first remarked on attempting to make the horse cough by squeezing 
the larynx. Laryngitis chronica, with thickening in the mucous mem- 
brane, gradually produces dyspnoea, whistling sets in, sometimes in 
aggravated form, may be noted both in inspiration and expiration, or 
may not differ from that produced by paralysis of the recurrent nerve. 
A further symptom of disease of the vocal cords is marked hoarseness 
or loss of voice (aphonia). 

Tumours are most frequent in oxen, though also found in horses and 
other animals. Their nature has not yet been sufficiently investigated ; 
a large number have been described as atheromatous (Mecke, Meer). 
Their general position at the base of the epiglottis makes it probable 
that many are actinomycotic. The new growths described as cystic 
tumours of the larynx are possibly of this character (Ehrhardt). Gurlt 
describes the majority of the tumours in the larynx as polypi. Some 
may be mycotic, especially those associated with pus formation. <A 
laryngeal tumour of the ox, discovered by Peschel, was stated by Johne 
to be adenoma of the mucous glands. 

Lee removed a cartilaginous growth from the vocal chord of a horse which 
had suffered from broken wind and was unable to neigh ; recovery was complete 
in six weeks, Besnard lost a six year old mare by suffocation produced by 
a pedunculated cystic polypus, as large as a walnut, which had its seat at the 
base of the epiglottis, and caused difficulty in swallowing, together with severe 
dyspnoea and attacks of coughing. Degive believed that apnoea arose from the 
epiglottis being pushed into the larynx by the swelling during deglutition, and 
not by the latter being swallowed, as Besnard thought. Lehnhard found a reten- 


tion cyst, as large as a hen’s egg and full of clear fluid, on the anterior surface 
of the epiglottis in a horse which had suddenly died from suffocation. 


Tuberculosis of the larynx is common in oxen. Confusion with 
actinomycosis tumours often occurs, but a case of tuberculous new growth 
in the larynx of an ox was described by Johne, who had already 
drawn attention to the similarity of the two diseases. Prietsch and 
others noted tuberculosis of the larynx in cows on post-mortem. 

Symptoms and Progress.—tThe first stages in the development 
of new growths are naturally beyond the field of clinical observation, 


160 DISEASES OF THE LARYNX AND TRACHEA. 


Dyspneea and, under certain circumstances, disturbance in swallowing, are 
only produced after they have reached a certain size. On the epiglottis, 
however, they may attain considerable dimensions before marked symptoms 
appear; but difficulty both of breathing and swallowing are then noted. 
As in diseases of the tongue (p. 15), and in the so-called pharyngeal 
lymphoma (p. 155), dyspneea may occur, particularly during feeding. 
The disturbed respiration and deglutition are not uniform in their 
appearance, as Fricker and Dieck have noted in horses. Pedunculated 
tumours on the base of the tongue, dropping on to the larynx, suddenly 
produce symptoms of severe inspiratory dyspnoea, from which the 
animals sometimes fall and occasionally die of asphyxia. The sudden 
appearance of dyspnoea, without febrile or other constitutional disturb- 
ance, denote the presence of such tumours. The condition may be easily 
mistaken for cramp or cedema of the glottis. 

The exterior of the larynx is seldom visibly altered. Only where the 
new growth has spread to the exterior, or has produced marked changes 
in the wall of the trachea, does the region of the larynx appear fuller 
and swelling show itself. Prietsch also observed this in cows which 
suffered from laryngeal tuberculosis. 

Examination through the mouth often gives more definite imforma- 
tion. In carnivora, by drawing forward the tongue with a_ cloth, 
and pressing down its base with a pair of scissors or the handle cf a 
spoon, it is possible to view the interior of the larynx and determine 
the presence of tumours on its upper borders. In horses this may be 
effected with the laryngoscope constructed by Polansky and Schindelka 
(p. 157). When this instrument is not available, the pharynx may 
sometimes be examined when the horse is cast, provided the position of 
the molars and the soft palate allow the passage of the hand. Such 
examination is more easy in oxen, and, if the head is fixed, may be made 
while the animal is standing. 

In doubtful cases the larynx can be opened and a view of its interior 
obtained, an operation entirely without danger, and to be made use of 
wherever it is important to remove doubts. 

Tumours in the trachea are first remarked when they narrow 
the lumen of the tube considerably, and produce dyspnea. This is 
generally accompanied by loud breathing sounds, which occur both 
during ins- and ex-piration, though occasionally only during one portion 
of the act. It is characteristic of tumours in the trachea that the noise 
appears especially or exclusively during expiration. The position and 
nature of the new growth explains this peculiarity. Dyspnoea increases 
with the growth of the swelling, and may terminate in suffocation. 
Only where malignant tumours perforate the wall of the trachea and 
extend outwards can their presence be directly recognised. Diagnosis 


CHRONIC LARYNGITIS AND PERILARYNGITIS. 161 


is rarely aided by palpation of the trachea; but pressure on the diseased 
spot may, perhaps, increase or decrease the dyspneea. 

Prognosis is in general unfavourable. Pus formation and the 
discharge of abscesses into the trachea may occasion pneumonia. 
In chronic laryngitis with thickening of the mucous membrane, 
resection of the vocal chords may be serviceable. Prognosis of 
perilaryngitis fibrosa, and other diseases, depends in great part on the 
degree of dyspnoea. Tracheotomy is certainly a palliative. The 
prognosis of most laryngeal tumours is 
unfavourable; but pedunculated growths, 
situated even in the larynx, may sometimes 
be removed without recurrence, section being 
made of the cricoid cartilage and first rings 
of the trachea. Where the operation is 
unsuccessful, tracheotomy will still render 
the animals workable for some time. 

Treatment.—Tumours on the epiglottis 
can sometimes be removed in the same 
way as pharyngeal tumours (p. 155) in 
cattle, by tearing them away with the 
hand; in dogs, with the assistance of instru- 
ments. Diek removed a swelling as large 
as a hen’s egg from the epiglottis of a horse 
with a specially-constructed instrument in the 
form of a hooked knife. Thickenings and 
tumours on the vocal chords can be excised. 
The horse should be cast, and, if restless, 
aneesthetised. The hair over the larynx is 
shaved, and a cut made through the skin in 
the middle line, from the thyroid to below the 
Ist, 2nd, or 5rd tracheal rings. After ligatur- 
ing any bleeding skin vessels, the second cut 
is made, dividing the subscapulo-hyoideus and 
the sterno-thyro-hyoideus exactly in the middle 
line. This exposes the cricoid cartilage and 
trachea, which are then incised. The edges of the wound are held 
apart with broad hooks or retractors. Where a tampon-canula (fig. 56) 
is available, it should be inserted in the trachea to prevent danger of 
suffocation from entrance of blood. The finger is introduced into the 
larynx, the vocal chords examined, and either of them exhibiting 
the above-described changes is excised with scissors. The chord is 
previously fixed by grasping it with a torsion or clamp forceps; or, in 
their absence, it is made tense by a ligature passed with a curved 

L 


Fic. 56.—-Tampon-canula. 


162 NEUROSES OF THE LARYNX. 


needle over its lower anterior end. Bleeding is slight, as I have 
repeatedly noted, and is of no importance if a tampon-canula 1s 
inserted. Should it occur, it can be checked by plugging the 
larynx (p. 181). The tampon-canula and tampons can be removed 
next day, but, for security, the canula is better left in position for 
some days, especially when the animal is not under the eye of the 
operator. Serious swelling of the mucous membrane and dyspnoea 
occasionally occur, but are rare. 

When tumours are within the laryngeal cavity, their size and 
character are ascertained by opening the larynx, and their removal, 
especially if pedunculated, is effected with the scissors and the “ ecraseur.” 
In dealing with new growths, Paquelin’s cautery, in certain cireum- 
stances, does good service, and also checks bleeding. Where marked 
dyspnoea exists, or occurs periodically, tracheotomy must either be 
performed before casting the horse, and a canula inserted; or the 
instruments must be in readiness, so that, in case of need, a tube can be 
inserted. In the treatment of perilaryngitis chronica fibrosa, or of new 
growths with broad bases in the larynx, tracheotomy below the growth 
is the only means of removing dyspnea. 


(2.) NEUROSES OF THE LARYNX—SPASM OF THE 
RIMA GLOTTIDIS—SPASMUS GLOTTIDIS—LARYN- 
GISMUS STRIDULUS—LARYNGO-SPASMUS-—HEMI- 
PLEGIA AND DIPLEGIA LARYNGIS. 


Lit.: Ebinger, Berl. Arch. 1886, p. 281. Neumann, Th. Mitth. 1877, 
p. 86. Holzendorf, ibid, 1875, p. 102. Esser, ibid, 1883, spa 
Ginther, D! T. W. 1893, 4p. 145: 

These terms are applied to attacks of difficult breathing, occurring 
periodically, and apparently caused by spasmodic closure of the rima- 
glottidis. As a rule, the dyspnoea is inspiratory, and may occasionally 
be so severe as to constitute apnoea,—that is, temporary cessation of 
respiration. 

The causes consist either in direct irritation of the mucous 
membrane of the larynx, or in reflex irritation of the vagus and 
recurrent nerves supplying the constrictors of the larynx. Records 
of many such cases have been published, but are seldom sufficient 
to determine the exact cause of the attack. Acute inflam- 
matory changes, catarrh, edema of the glottis, food materials, or 
foreign bodies in the upper air passages, have all been assigned as 
causes. Post-mortem examination has discovered tumours in the 
pharynx, larynx, or trachea, but true neuroses of the larynx are 
oceasionally met with. 


PARALYSIS OF MUSCLES OF THE LARYNX. 163 


Ebinger describes a horse suddenly attacked by severe dyspnoea, threatening 
suffocation, and accompanied by roaring. When at rest, the breathing was 
normal and the health undisturbed, but the slightest work or pressure on the 
larynx, or indeed on any point of the neck above the jugular furrow, caused imme- 
diately severe dyspnoea and marked roaring, which continued during the next 8-10 
respirations. Light pressure sufficed again to produce the attack. The symptoms 
disappeared after eight days’ treatment with subcutaneous injections of acetate of 
morphine. Ebinger, not without justification, believes this to have been a 
neurosis of the recurrent nerve. The cases described by Holzendorf and Neumann 
as spasm of the larynx, or cramp of the muscles of the glottis, may have been 
due to other causes. In that recorded by Holzendorf, inflammatory disease of 
the larynx was clearly present ; while the obstinate dyspnoea treated by Neumann 
does not appear to have been neuropathic. 


When danger of suffocation is associated with these conditions, 
tracheotomy must be resorted to at once (p. 169). It is further note- 
worthy that the inspiratory dyspnoea is increased by the anxiety and 
unrest associated with it. All excitement must, therefore, be avoided, 
the horse placed in a quiet stall, and care taken that the air be pure 
and the temperature suitable. Caution must be observed in the use of 
morphine; doses over 8 grains often cause excitement. Clysters of 
chloral hydrate deserve preference. Preisnitz’ poultices* may be applied 
to the throat and neck, but must not be heavy, and may sometimes be 
preferably replaced by dry coverings. 

Myopathic paralysis of single muscles, or of groups of laryngeal 
muscles, is not known in animals, but may possibly occur. Neuro- 
pathic paralysis of the muscles of one side of the larynx (hemiplegia 
laryngis) is, however, very frequent in horses. The greater number, 
if not all the muscles of the larynx, which move the vocal chord are 
supplied by the recurrent nerve. Of late a second branch of the 
vagus has been recognised by Exner as a motor nerve to the larynx, 
but it has not yet been determined what influence it exerts on the 
function of its muscles. From the construction of the larynx, 
as a valve opening outwards, it is clear that simultaneous paralysis 
of the constrictors and dilators must cause disturbed breathing during 
inspiration. Cramp of the constrictors alone might produce expiratory 
dyspneea, but this very rarely occurs, for the expiratory muscles, as- 
sisted by abdominal pressure, are almost always sufficiently powerful to 
open the larynx, even against the constrictors. It is otherwise in inspira- 
tion. Should the dilators of the larynx become paralysed, the arytenoid 
cartilage is forced towards the opening of the glottis by the instreaming 
air, and roaring results. With a few exceptions it is caused by para- 
lysis of the recurrent nerve, and is so described in the text-books, as 
well as in another section of the present work. This paralysis is 


* Preisnitz’ poultices are prepared by dipping poroplastic or thick felt in hot water. They 
are sometimes medicated. —[TRANSL. ] 


164 FRACTURES OF THE TRACHEA. 


usually incurable, but the associated dyspnoea may be relieved either by 
removing the arytenoid cartilage, which has fallen below its position in 
the larynx, or by tracheotomy, thus providing a direct entrance for the 
air below the larynx. Both operations are fully described on pp. 169 and 
179. Roaring is also occasionally seen in other animals besides the 
horse ; Utz and Ollmann found it in cows. Esser has described paralysis 
of the recurrent in a dog, and I have noted the disease in two dogs. 
I have seen several cases of double-sided paralysis of the larynx (diplegia 
laryngis) in horses and dogs producing severe inspiratory dyspnoea. 
After being walked for a short time, whistling or roaring was produced. 
The condition generally pursues a chronic course, and may be taken for 
chronic inflammation or tumour formation in the larynx. Diagnosis of 
roaring belongs to the province of special pathology, but the detection of 
double-sided paralysis of the larynx and its distinction from chronic 
inflammation or tumour formation may call for operative interference, or 
for the use of the rhino-laryngoscope (p. 157). By using the latter 
instrument one sees clearly at the moment of inspiration that the two 
arytenoids sink downwards and approach each other, and in paralysis 
may even come in contact, completely closing the larynx. If not pro- 
vided with the instrument, one may divide the cricoid cartilage and 
erico-thyroid ligament, and by introducing the forefinger through the 
opening, directly examine the arytenoid cartilages. Whilst in the 
normal larynx they make distinct to and fro movements, especially 
during forced inspiration, in diplegia laryngis they are found to sink 
downwards in the larynx. In this disease tracheotomy alone can 
restore the animal’s usefulness 


(3.) FRACTURES, DEFORMITIES, AND STENOSIS 
OF THE TRACHEA. 

Lit.: Lafosse, Her. Rep. 14. p. 237. Cajory, Th. Mitth. 1874, p. 184. 
Schwanefeld, ibid., 1876, p. 156. v. Bockum-Dolffs, ibid., p. 156. 
Gurlt, Gurlt u. Hertwig. 33. p. 23. Harms, Th. Mitth. 1879, p. 41. 
Hagen, ibid., 1866, p. 132 u. 169. Johne, Dresd. Ber. 1881, p. 57. 
Bartenstein, ibid. 1885, p. 33. Johne, Dresd. Ber. 1885, p. 35. 
Richolson, The Veter. 1839. Vigezzi, Jahrb. 1882, p.68. Bru, 
ibid., 1891, p. 88. Tiede, Th. Mitth. 1881, p. 42. Dietrich, The 
Mitth. 1866. 

Injuries to the trachea having already received attention (p. 117) as 
complications of wounds in the neck, it only remains to consider those 
subeutaneous solutions of continuity which, when affecting the carti- 
laginous rings, are described as fractures. These injuries result from the 
forcible action of blunt bodies on the air tube; in horses are caused by 
the impact of the carriage pole, by rushing against projecting bodies, or 
by falling whilst haltered tightly. Fractures of the cartilages, or rupture 


DEFORMITIES AND STENOSIS OF THE TRACHEA. 165 


of the inter-annular ligaments, are caused in dogs by their being captured 
with a wire snare. 


Bru noted rupture of the ligaments between the first three trachea rings in a 
mule, Cajéry found the trachea almost completely torn from the larynx in a 
horse which had died in the stall after a sudden attack of dyspnoa. Von 
Bockum-Dolffs saw a horse suffer from emphysema of the neck and severe 
dyspnoea, in consequence of having run against the pole of a passing carriage. 
Tracheotomy removed the difficulty in swallowing and breathing, and the 
animal again became fit for work. 


But such injuries cannot always be successfully treated; deformities 
of the trachea sometimes result; extensive cicatrices produce stenosis of 
the trachea, accompanied by dyspnoea. Schwanefeld describes a horse 
in which the trachea was flattened about the middle of the neck and 
greatly narrowed. The presence of a stallion in the stable excited it 
and induced suffocation. Some deformities of the trachea are clearly 
congenital. Occasionally the posterior ends of the tracheal rings are 
bent inwards, or flattened so that the lumen forms merely a narrow 
fissure. 


Gurlt saw a dog with marked flattening of the air tube. Harms and Hagen 
note similar cases in cows. Johne describes two instances of dilatation in horses, 
one about 24 inches in length, and a similar condition was recorded by Barten- 
stein, Vegezzi found the dorsal surface of the air tube of a horse presenting a 
furrow produced by bending inwards of the ends of the cartilages and rupture 
of the inter-annular ligament. In this furrow lay the cesophagus, carotid, vagus, 
and sympathetic. 


The intact condition of the mucous membrane and the extension of 
the change throughout the trachea showed the disease to be congenital. 
Compression, with narrowing of the trachea, may also result from goitre, 
from enlargement of the bronchial glands, or from tumour formation. 
Johne relates such a case in a giraffe, and Dietrich in a foal which had 
died with symptoms of suffocation. Between the first pair of ribs was 
a diseased gland, which had compressed the trachea and caused suffoca- 
tion. Stenosis of the trachea is not an infrequent result of tracheotomy, 
especially in foals, or where the tube, worn for a long period, does 
not fit well. Chronic perichondritis resulting from the continued 
irritation, induces formation of cicatricial tissue, which sometimes 
ossifies, and narrows the lumen of the tube, firstly by pressing on 
it, and afterwards by contracting around it. Thus Tiede found the 
trachea narrowed to the size of a goose quill. Stenosis is not always 
a result of unskilfulness in performing tracheotomy or selecting 
a tube. I have several times seen stenosis recur in horses where 
tracheotomy had been performed below a previous contraction, so it 
seems likely that some animals are predisposed to such conditions. 


166 STENOSIS OF THE TRACHEA. 


The symptoms of such injuries are difliculty in breathing and 
emphysema on the neck, with localised inflammation, swelling, and pain. 
The degree to which the lumen of the tube is narrowed in consequence 
of hemorrhage, dislocation of its cartilages, or inflammatory swelling, 
determines the extent of the respiratory disturbance, which may become 
so great as finally to produce suffocation (Cajory, Bru). In other cases 
a loud sound is heard both during ins- and ex- piration. Very slight 
changes in the trachea are sufficient to produce it. Sometimes the 
noise may be increased or diminished by pressing on a particular part 
of the trachea. Laying the ear on the wind-pipe, the position of 
the stenosis may be more exactly fixed, but this method does not 
always prevent mistakes. During the next few days the emphysema 
usually spreads over the body, especially when coughing exists, but 
disappears later, generally without bad results. The course of the 
disease depends.on the extent of the injuries and of the resulting 
bleeding. The animal may be completely restored to usefulness, or 
difficulty in breathing may remain (asthma tracheale). The dyspnoea 
depends partly on the degree of stenosis, partly on the character of 
work performed. In spite of marked deformity, dyspnoea may be absent, 
whilst apparently unimportant changes sometimes produce greatly dis- 
turbed respiration ; indeed Schwanefeld’s case shows that they may cause 
death. These diversities are explained by the fact that the respiratory 
difficulty is determined, not by the external deformity of the trachea, 
but by the degree of stenosis. The gravity of such cases is gauged by 
the state of the respiration during severe work. In stenosis of the 
upper portions of the trachea, tracheotomy usually affords relief, but is 
not available when the lower portions in the neck or thoracic cavity 
are affected. Such conditions, however, are often mitigated by lapse 
of time. 

Treatment.—Where great dyspneea follows fresh injuries of the 
trachea, tracheotomy not only removes the threatened danger of suffoea- 
tion, but, if a tampon-canula is used, also prevents the entrance of blood 
into the trachea. A tampon-canula may be extemporised by carefully 
wrapping the stem of a Barthélemy’s tracheal tube with cloth, but 
care must be taken that the bandage material, tow, wadding, or piece of 
sponge used for this purpose does not fall into the trachea. Severe 
emphysema, although seldom endangering life, may sometimes necessitate 
tracheotomy. Stenoses of the trachea are only occasional reasons for 
direct treatment. In man it is possible to dilate the trachea with 
elastic tubes introduced from the larynx. In animals the use of tubes 
is more difficult, the time for tardy healing would be grudged, while 
frequently the cicatrices, as well as portions of the tracheal rings, are 
ossified. The position and extent of the stenosis must determine whether 


FOREIGN BODIES IN THE TRACHEA. 167 


tracheotomy is applicable, or likely to be successful. It is generally 
serviceable when carried out below the stenosed spot. Richolson, by 
removing a dislocated portion of cartilage, permanently relieved the 
dyspnoea. Similar cases are rare. 

The interesting communication of Lafosse and Sticker show that 
“tubage ” of the trachea is possible, and may be successful. Lafosse 
divided the trachea below the narrow point caused by tracheotomy, 
thrust a cork cylinder, bound round with tow, into the trachea, and fixed 
it with tape. In ten days the cylinder was replaced by a tube, the latter 
was removed after six weeks, the trachea being then so far dilated as to 
admit of easy respiration without a canula. Sticker dilated the trachea 
and larynx by means of a metallic spiral, which was left permanently in 
position, and is said to have finally been covered by the tissues. 


(4.) FOREIGN BODIES, TUMOURS, AND PARASITES 
IN THE TRACHEA. 


Lit.: Henderson, Jahresber. 1862, p.57. Paulicki, Gurlt u. Hertwig. 
38. p.43. Grill, ibid. 10.p.117. Werneru Leisering, Th. Mitth. 
1857, p. 189. Rost, Dresd. Ber. 1888, p. 70. Hink, Jahresber. 1889, 
p- 98. Gerlach, Gurlt u. Hertwig. Mag. 20. p. 306. 


Foreign bodies seldom enter the trachea during lfe. Owing to the 
excessive sensibility of the mucous membrane of the larynx, they imme- 
diately produce coughing, and are ejected. Masses of food have never- 
theless been repeatedly found in the trachea both in oxen and horses. 
Tumours of the pharynx, which are common in cattle, sometimes interfere 
with swallowing, and favour the entrance of food into the trachea. In 
horses fluid medicines unskilfully administered occasionally pass into 
the trachea and bronchi. Fatty oils are particularly dangerous in this 
respect. Linseed oil, formerly much used as a laxative, has been 
thought to produce a specific pneumonia, but its effects merely de- 
pend on its entering the trachea. Dust enters with the inspired air, 
and may produce mechanical pneumonia, especially in horses, the 
subjects of severe disease, which le continuously. Abscesses in the 
walls of the pharynx or trachea, perforating the mucous membrane, may 
pour their contents into the air passages, and produce fatal pneumonia. 
Rost saw a cow die thus from suffocation. In animals suffering from 
tetanus, saliva and medicine not infrequently find their way into the 
respiratory passages, and produce the same effect. Blood derived from 
wounds or operations in the mouth, trachea, or neck may enter the air 
passages and clot there, producing suffocation. Badly made tracheal 
tubes sometimes break, and a portion falls into the trachea. This is 
common with Barthélemy’s canule, where the tube is not always firmly 


168 FOREIGN BODIES IN THE TRACHEA. 


fitted to the shield. Henderson reports such a case. During trache- 
otomy, if care is not taken, the piece of divided cartilage may easily 
fall into the trachea (p. 173). Tracheal tumours are rare, though they 
have been seen—principally in oxen. They are usually pedunculated, 
probably in consequence of being continually moved by the air stream. 
Gurlt, Gerlach, Hink, and others found tracheal polypi in oxen, Rieck 
and Hink sarcomata. Siedamgrotzky describes a colloid cyst in a horse’s 
trachea. It was found embedded in loose connective tissue just below 
the cricoid cartilage. Benjamin discovered in the anterior wall of the 
trachea a tumour, which had formed after an attack of sore throat, and pro- 
duced difficulty in breathing. Besides the varieties of strongylus, usually 
occurring in quantities in the bronchi of ruminants and swine, acari have 
been seen in the trachea. Paulicki found them in a long-tailed monkey. 

The symptoms are very varied. Dust or fluids obtaining entrance 
into the bronchi cause mechanical pneumonia sometimes with fatal issue. 
Larger objects remain in the trachea or bronchi, and may produce death 
from suffocation. A cow described by Griill, which, till the moment 
of seizure had been perfectly healthy, suddenly died in the stall with 
symptoms of suffocation, and post-mortem showed the bronchi to be 
filled with food. Similar cases have repeatedly been observed. But 
Leisering has drawn attention to the fact that, in animals with incom- 
plete closure of the cardia, and especially in ruminants, portions of the 
food after death may be forced through the cesophagus into the pharynx, 
thence into the trachea and bronchi, completely plugging them. This is 
most likely to occur where the stomach has been full, or its contents 
in a state of fermentation, or the carcase has been moved. A ease 
described by Werner was clearly produced in this way. The distinctive 
features are absence of inflammatory appearances and complete stoppage 
of the trachea, which could never have been so packed had the material 
entered during life. 

Dyspnoeea results immediately the foreign body in any way narrows 
the lumen of the trachea. The movement of the foreign body can 
sometimes be heard or felt from without. The narrowness of the 
rima-glottidis renders it difficult for solids that have entered thus 
far to make their exit. In Henderson’s case, as reported, the tube of a 
tracheal canula, which had slipped into the windpipe, was said to have 
been ejected through the mouth; but such a conclusion is very 
exceptional. Tumours in the trachea only attract attention when they 
become large enough to obstruct the air passage and produce dyspneea. 
A loud sound is then heard, both during ins- and ex-piration. It is 
particularly characteristic of tracheal tumours that they cause a marked 
sound during expiration. The position and form of the new growths 
explain this peculiarity, and their slow development accounts for the 


TRACHEOTOMY. 169 


gradual increase of dyspneea, which may finally cause suffocation. The 
presence of a tumour can only be directly detected when it originates on 
the outer surface of the trachea, and thence breaks through the tracheal 
wall, as malignant new growths generally do. Otherwise the position of 
a tumour may be determined by palpation, pressure at a particular spot 
increasing or decreasing the dyspnoea and noise. This symptom is quite 
peculiar to tumours. 

Prophylactic treatment requires that in giving fluids to dogs and horses 
particular care should be taken, especially if the animals are restive. The 
head must neither be raised too high, nor turned on its own axis. It is 
easy to judge of the action of such abnormal positions of the head by 
attempting to swallow whilst the head is either turned much towards 
the right or left. Such positions are, however, less dangerous in oxen. 
Very great care is required if the drugs are not in complete solution, or 
if they contain fatty oils or irritants. Should the animal cough during 
the administration of fluids, the process should be stopped. Rubbing 
the neck is not only useless, but also dangerous, as coughing is thus 
easily induced. In operations, during the course of which blood may 
find entrance into the air tubes, a tampon-canula (fig. 56) should be 
used, or the operation performed with the head pendent—a procedure 
which has, however, the disadvantage of allowing the animal to move. 

Large, firm objects can usually be removed from the air passages only 
after tracheotomy. Removal is sometimes possible with the help of 
suitable forceps. When necessary, the fissure in the trachea can be 
lengthened, when the body is forced out by the pressure of the expiratory 
current (Henderson). Tumours may be removed in a similar fashion. 


(5.) TRACHEOTOMY. 


Lit.: Giinther, Myologie. p. 88 u. 91. Lafosse, Dictionnaire d’hip. 
1775, p. 161. Damoiseau, Ree. de méd., vét. 1828, p. 585. Brogniez, 
Chir. vét. Tom. III. p. 246 u. 264. Leblanc, Journal de méd. vét. 
1838, p. 65. Dieterichs, Beitrige. 1844, p.100. Renault, Rec. 
de méd. vét. 1848, p. 884. Hilmer, Zeitschrift von Vix u. Nebel 1843, 
p. 283. Degive, Annal. de méd. vét. 1871, p. 376. Vachet, Peuch 
u. Toussaint. II. Aufl. p. 473. Peuch, ibid, p. 475. Strauss, 
Chirurgie. p. 114. Krieshaber, Acad. de méd. vét., séance. 29./10, 
1878. Wohlthat, Gurlt u. Hertwig. 39. p. 444. Schuemacher, 
Thierirztl. Wochenschr. 1890. 


Where obstacles to the passage of air exist in the upper air-tract 
(nose, larynx, or upper portion of the trachea), a direct entrance to 
the lungs may be provided by opening the trachea. This operation 
(tracheotomy), formerly wrongly termed bronchotomy, has been carried out 


170 TRACHEOTOMY. 


in man from the earliest times (Asclepiades); has, however, repeatedly 
fallen into disuse, and has recently again come into fashion in men and 
animals. Viborg especially, showed its simple character. Tracheotomy 
consists in surgical opening of the trachea, in which is generally 
placed a tube or canula permitting passage of air. The operation is 
adopted for the following purposes :— 

(1) To ward off suffocation resulting from swellings in the schneiderian 
membrane, in the larynx, or from other obstacles in the upper air 
passages. 

(2) To restore to usefulness animals suffering from chronic dyspneea 
produced by stenoses of the air passages. To this category belong 
horses suffering from hemiplegia laryngis. 

(3) To remove foreign bodies from the trachea, and prevent the 
entrance into it of blood or inflammatory products. 

(4) More rarely to carry out direct treatment of the larynx and 
mucous membrane of the trachea. 

Tracheotomy is almost invariably restricted to horses, in which animals 
impaired respiration is commonest, and interferes most seriously with 
usefulness. In ruminants diseases of the larynx are rarer, and when they 
occur the animals are generally slaughtered. Owing to the comparatively 
long neck, and exposed position of the trachea, the operation offers less 
difficulty in horses than in cattle, where the trachea is covered by 
the dewlap. The isthmus of the thyroid glands in the horse is so 
slightly developed that no particular notice need be taken of it. In 
man, however, the operation is distinguished as superior, inferior, or 
medial, according as the operation is performed above, below, or through 
the isthmus. In animals, and especially in horses, there is, therefore, 
a wide field for operation, comprising the space from the upper end of 
the trachea to near its entrance into the thorax. The upper third is covered 
by the panniculus of the neck, by the subscapulo-hyoideus, sterno-thyro- 
hyoideus, and sterno-maxillaris, but the last named passes on to the lateral 
aspect of the neck at the lower border of the upper third, thus leaving the 
anterior wall of the trachea covered only by the first-named muscles be- 
low this spot. Giinther, therefore, prefers for the operation a point about 
one-third of the distance from the larynx to the chest, though he admits 
that it may be carried out higher or lower without disadvantage. 
Lafosse chooses the space between the third and fourth tracheal rings; 
Krieshaber, that between the larynx and trachea (p. 177). As a rule, the 
space between the upper and middle thirds of the neck is the point 
selected, because it is convenient, interferes less with the appearance of 
the animal, and in the event of stenosis supervening, the operation 
may be repeated at a lower point. The prejudice existing in 
human surgery against tracheotomy as a dangerous operation has led 


TRACHEOTOMY BY PUNCTURE OR INCISION. 171 


to modifications, few of which, however, are practical. The various 
complicated tracheotomes and bronchotomes proposed by Brogniez, 
Marty, Thompson, and others, and intended to simplify and facilitate 
the operation, are not needed by practised operators, and are of little use 
in unpractised hands. Two operation methods can be eetaueuiehed: 
(1) Puncture ; and (2) Incision of the trachea. 

(1) Puncture of the trachea has been recommended 
by Pilger, Gowing, Hayne, and others. Hayne’s method 
meets with most approval, and consists in passing a trochar, 
provided with a canula having lateral openings, transversely 
through the trachea (fig. 57). This operation requires 
some skill and care, particularly in horses having well- 
developed necks, in order to avoid injuring the jugular 
and carotid; while even the large canula, used for heavy 
working-horses, does not admit sufficient air. The origin 
of this procedure, which does not possess even the advan- 
tage of being rapidly carried out, could only have been 
fear of using the knife. The same remark applies to 
Thompson’s tracheotome and similar instruments. 

(2) Incision into the trachea is most generally practised. 
The trachea may either be split or a portion excised from 
one or more rings. The splitting, although it increases 
the difficulty in introducing the canula, is sometimes 
preferred where the tube is likely to be only temporarily 
used, is less apt to cause deformities and stenosis, and hence 
is generally commended in acute diseases like strangles 
for foals and race-horses, in which even slight stenosis is 
dreaded. The excision of a portion of the trachea facilitates 
the introduction and removal of the canula for cleaning, 
and is specially desirable in such chronic cases as paralysis 
and contraction connected with the nose, larynx, or trachea. 
My experience does not justify the belief that stenosis is 
more apt to result when the cartilage is excised than when 
it is split. 

Trachectomy is conveniently performed whilst the horse 
is standing; casting usually aggravates any dyspncea present. 


3 Fic. 57.— 
The animal should be placed so that the front of the Hayne’s 


Tracheal 


neck is well lighted. A twitch is applied, and the horse,  qyochar. 


if still restless, has each ear held by a strong man. The 

head is moderately raised, and the hair clipped from the seat of opera- 
tion in a narrow strip, 3 to 4 inches in length, in the middle line of the 
neck, The operator grasps the skin with the left hand, and with the aid of 
an assistant lifts a horizontal fold about ¢ inch high, and exactly in the 


— 


172 TRACHEOTOMY. 


centre of the shorn patch; an incision is then carried through the fold. 
This prevents the skin wound being made larger than intended, in 
consequence of the animal suddenly stretching the neck, though in 
phlegmatic horses, and those suffering from severe illness or dyspncea, 
the precaution is not so necessary. The skin is divided, and any bleed- 
ing vessels are ligatured, the panniculus is cut through, and the pairs of 
muscles lying below it are separated in the middle line, the proper point 
being indicated by its lighter colour (connective tissue). Where the 
middle line is exactly encountered scarcely any bleeding results, and 
the trachea is exposed. In thin horses with slightly developed necks 
this procedure is very simple; but in fat horses with thick necks there 
may be a little more difficulty, though no danger. The edges of 
the wound are held apart with a pair of broad hooks, with the fingers 
of the left hand, or with a so-called retractor. Up to this point the 
procedure is the same in both methods. In the operation without 
removal of tissue, the trachea is now divided either perpendicularly 
through the third and fourth rings, or a horizontal cut made in the 
intervening lgament; or a vertical incision providing more room is. 
made by thrusting the knife, with the cutting edge upwards, into 
the trachea at the lower edge of the wound, and carrying the cut 
upwards through three or four tracheal rings (fig. 58, >). The hooks 


za 


| a 


Fie. 58.—Method of performing Tracheotomy—(a) Square Opening ; (0) Simple Incision ; 
(c) Oval Opening (Hering). 


are now introduced into the trachea, or the index and middle fingers 
of the left hand hold the edges of the wound apart, and the canula 
is inserted. The trachea in the horse being of considerable size, little 
difficulty is met with, even when dealing with the firm textures of old 
subjects. 


TRACHEOTOMY. by a) 


When the canula is to be worn for a considerable period, and must, 
therefore, be removed every few days to be cleaned, a square, oval, or 
occasionally a round piece is excised from the anterior wall of the air- 
tube. Viborg, who first recommended the square opening (fig. 58, a), 
directs the knife to be inserted between two cartilages, and a horizontal 
cut made about # inch in length. This cut should extend an equal 
distance on either side of the middle line. From each of its ends a 
vertical cut is next made downwards, and the piece of cartilage which 
now hangs by the intercartilaginous band below is grasped with dissect- 
ing forceps and cut away, care being taken to prevent it falling into the 
trachea. The canula is then placed in position. Lafosse, Brogniez, and 
Giinther have expressed themselves in favour of the oval opening, which 
may be produced by first dividing the intercartilaginous ligament and 
then excising a half-round piece from the cartilages above and below, 
without, however, quite dividing these (fig. 58, ¢). Bending of the 
tracheal rings and stenosis of the trachea, which result from completely 
eutting through the cartilages, are thus avoided. Brogniez’ broncho- 
tome likewise produces an oval cut, but can be replaced by a bistoury, 
deftly manipulated. The same remark applies to other instruments, such 
as Marty’s tracheotome, which cuts a circular piece from the two carti- 
laginous rings, like a trephine. 

Tracheotomy is one of the simpler of equine operations, and is easily 
carried out with a little care. Its success depends greatly on the 
canula used. 


Many of those recommended can only be employed in connection with their 
appropriate tracheotomes, and, therefore, may be disregarded. ‘The oldest 
(Barthélemy’s) consists of a metal tube, 4 to 8 | 
inches in length and # to 2 inches in width, ANT 


| it 


| 
| 
bent at one end, and provided with a plate to wil 
prevent its entering the trachea too far. The 
edges of the plate and those of the lower end 
of the tube must be carefully rounded off to 
prevent their abrading the skin or mucous 
membrane. The tube, while nearly filling the 
tracheal space, must not press on the mucous 
membrane, nor must the soft tissues of the 
neck be pinched. The bend must be confined 
to the upper end, and must be suited to the 
thickness of the parts between the skin and 
front wall of the trachea. Where the bend is 
too short, not only will the skin and muscular 
tissues be bruised, but the lower end of the tube 
will press against the posterior wall of the trachea 
and produce inflammation with proliferations, 
leading to stenosis (fig. 60, c). Where the bent 
portion is too long, there is undue space between the plate and the skin, and if 
such a tube be pressed home by tapes or straps, it becomes displaced and liable 


Fic. 59.—Barthélemy’s Canula. 


174 TRACHEOTOMY TUBES OR CANULA). 


to injure both walls of the trachea (fig. 60, >). Tracheotomy tubes, formerly 
made of tin plate, are now much better manufactured of German silver. 

Vartel’s objection to Barthélemy’s canula, that it falls out easily, may be 
obviated by well-fitting tapes or straps (with buckles), fastened in the eyes of 


Fic. 60.—Position of Tracheal Canula--(#) Normal ; (6) When too much Curved ; 
(c) When insufficiently Curved. 


the plate and passed transversely round the neck. They should not be carried 
too far forward, as the tube is then liable to fall out during coughing or violent 
expiratory movements. Barthélemy’s tube somewhat disfigures the ‘animal ; 


atu] = = 


Tssss—s—5— SS 


Fic. 61.--Leblane’s Jointed Canula. 


expectoration of mucus, pus, or blood is rendered more difficult; and where used 
for long periods very careful fitting is necessary to prevent thickening and 
narrowing of the trachea. To meet these disadvantages models have been 
recommended by Damoiseau, Dieterichs, Brogniez, Leblanc, Hertwig, Reynault, 


JOINTED TRACHEOTOMY TUBES. 175 


Hilmer, Degive, Vachetta, Trasbot, Peuch, and others. Doing away with the 
straps lessens disfigurement without interfering with the secure fixing of the 
canula, and diminishes risk of bruising and irritation. The trachea remains un- 
obstructed in an upward direction as far as the larynx, whilst the canula is very 
easily cleaned. Leblanc has constructed a jointed tube said to be adapted to 
every form of neck (figs. 61 and 62), but one of the halves sometimes becomes 


Fic. 62.—Leblane’s Jointed Canula. 


detached and drops into the trachea. According to my experience, the tracheal 
tubes of Degive, Vachetta, Peuch, and Trasbot, which correspond in principle, are 
amongst the best (fig. 63). They consist of two pieces, which are inserted 
singly by first pushing the wider tube into the trachea and afterwards the 
narrower one, so that the projections point upwards and downwards in the 


a = 


Be 


Fra. 63.-—Peuch’s Canula. 


lumen of the trachea without pressing on its mucous membrane. The tube 
constructed by Vachetta has the longest, that by Degive the shortest projec- 
tions. I prefer the latter, because its introduction is easier without endangering 
its firm hold. Naturally, the length of the canula, that is, the distance between 
the plate and the curvature of the projections, must correspond to the thickness 
of the anterior wall of the neck. I have seen this tube worn by horses for 


176 TRACHEOTOMY TUBES OR CANUL&. 


several years without producing difficulty in application or stenosis. Haubner 
has recently somewhat modified Trasbot’s tube. The inner portion is made 
lighter and can be more easily introduced ; but, on the other hand, it has not so 
wide a basis, and, therefore, more easily produces proliferations. To introduce 
the tube the index finger of the left hand should first be passed into the trachea, 
when the tube itself may easily be slid along it, the finger acting as a guide. 
Afterwards the second portion may be inserted. 

Canule must be light and durable, and their edges, as already stated, 
well rounded off. They are usually made of German silver, but their weight 
may be reduced by using aluminium, which has been employed in making 
canule on Peuch’s model. These seem to be well suited for race-horses. 
Where it is necessary to combat suffocation occurring in diseases of an 
infectious character, a canula of a long form is selected, in order to avoid 
bruising the swollen soft parts in the neighbourhood of the point of operation. 
In anticipation of swelling supervening, the steadying of the canula may be 
effected by placing one or more leather shields below the plate, or enveloping 
the projecting portion of the tube in jute or tow. 


Fic. 64.—Double-tube Canula. 


The tube gradually becomes stopped by secretion from the mucous mem- 
brane and the operation wound, and must, therefore, be frequently cleansed, at 
first, indeed, daily. As the secretion diminishes, cleansing is required at intervals 
of three or four days. Hence it is well to have two similar canulz, so that whilst 
one is in use, the other can be cleansed or, if need be, repaired. Such precautions 
are necessary, because the wound contracts very rapidly, indeed after the lapse 
of one night the introduction of the canula may be difficult, or even impossible. 
Whilst the horse is in the stable, the opening of the instrument may be stopped 
up with a cork, which will check secretion and blocking of the tube. Double 
tubes have been recommended to obviate the necessity for changing the canula. 
They are generally used in man (fig. 64). Whilst the outer tube lies in the 
trachea, the inner can be cleaned from time to time. But this form, shown in 
fic. 64, must be condemned, because the curvature of the upper part is 
too slight, and that of the lower part too great; the lower portion, as already 
stated, should be quite straight. In double tubes this curvature cannot be 
avoided; hence they are unsuitable, and can only be used where the 


DANGERS OF TRACHEOTOMY. 7 


trachea is very near the surface. This model also possesses another fault—its 
opening lies at the side. Injuries from its lower border are certainly thus 
avoided, but the lateral opening coming in contact with the mucous membrane, 
the passage of air is interfered with. 

To obviate the necessity for a canula, Strauss recommends cutting out an oval 
piece from the trachea, with precautions against injuring the mucous membrane, 
which is sutured to the skin. But Hering doubts whether this process can be 
successfully done, and my experience causes me to agree with him. With 
the object of replacing canule, hooks are introduced on either side into the 
tracheal opening, and held apart by tapes passed round the animal’s neck. 


As a temporary expedient, the neck of a bottle, or a pair of strong 
wires bent to a spoon-handle shape, may be inserted. To save animals 
from threatened suffocation, there is often insufficient time to proceed 
according to rule. I have repeatedly had to operate in a dark stable, 
and, furnished merely with a bistoury, to find the middle line of the 
neck as I best could, and insert a tube. Despite these difficulties, I 
have generally had good healing. Krieshaber has recommended 
an operation under the title of “tracheotomie sous-cricoidienne,” in 
which an incision is made immediately under the cricoid cartilage ; 
the crico-tracheal ligament, which is about 1 inch in breadth, divided, 
and a double-armed canula introduced (Vachetta’s, Peuch’s, or Degive’s). 
The position of this ligament is easily discovered by palpation, especially 
in horses, where the muscles of the neck are not greatly developed. With 
the head extended, the operation is not difficult in quiet animals. This 
method has the advantage of only slightly impairing the animal’s appear- 
ance, and facilitates direct examination and treatment of the larynx, while 
the action of the tube, moreover, widens the larynx, and I have been in- 
formed that, after wearing the canula for a long time, animals sometimes 
cease roaring altogether. This may perhaps result from the irritative pro- 
cesses produced by the canula causing anchylosis of the articulation of 
the arytenoid cartilage on the paralysed side. Bouley fears that horses 
thus operated on may injure the larynx by violently bending the head. 
From my own experience I should doubt this, provided the canula fits 
well to the neck. 

The evil results of tracheotomy comprise— 

(1) Mechanical pneumonia, produced by aspiration of inflammatory 
secretions in such diseases as petechial fever and acute laryngitis, 
or from abscesses breaking into the pharynx or trachea. These com- 
plications are prevented by the use of the tampon-canula, made on 
the pattern of Trendelenburg and Harn’s human canula. The former 
carries an india-rubber balloon, which, after being placed in position, may 
be inflated with a pair of bellows (fig. 56). Where foreign materials 
are present in the trachea, they should, as far as possible, be removed 


with a feather, a soft bottle-brush, or a sponge carefully fastened to a 
M 


178 LARYNGOTOMY. 


wire. Such implements may without danger be passed as far as the 
division of the trachea. The tampon-canula may then be placed in 
position and moderately inflated, that is to say, until the balloon fills 
the lumen of the trachea without exercismg much pressure on the 
mucous membrane, which might produce necrosis. Another pattern is 
Harn’s tampon-canula, which has a sponge tent. A substitute may be 
improvised by wrapping Barthélemy’s canula with tow, jute, or sponge, 
such substances being carefully secured with string or thread, so that 
they shall not become loose and fall into the trachea. 

(2) Proliferation and thickening of the mucous membrane with nar- 
rowing of the lumen of the trachea (tracheal stenosis). Sclerotic inflam- 
mations occasionally occur in the skin and the soft tissues lying beneath, 
and usually follow cellulitis. Proliferation producing tracheal stenosis 
results from faulty formation of the canula, from its being too heavy, 
badly made, or not fitting the form of the neck. The canula cannot 
fit well if it be too long, too narrow, too little or too much bent 
(p. 174), or if the opening in the trachea be too large. I have often 
noted a pronounced tendency to such growths in heavy horses, and 
though the canula was perfect in every respect, the contraction recurred 
after each fresh insertion. When stenosis occurs, the introduction of 
the tube becomes gradually more and more difficult, and finally impos- 
sible. The tracheal opening must then be increased, a procedure some- 
times rendered difficult by ossification of the newly formed materials. 
Where there is room, a second opening may be made lower down. 
It is in view of such a contingency that tracheotomy, specially in 
young horses, should be performed in the upper divisions of the neck. 


(6.) LARYNGOTOMY. LARYNGO-FISSURE. 


Lit.: Giinther, Myologie des Pferdes u. D. T. W. 1893, p. 145. Stock- 
fleth, Chirurgie. Moller, Das Kehlkopfpfeifen der Pferde, Stuttgart 
(Enke), 1888. Fleming, Roaring in Horses. Cadiot, Traitement chir. 
du Cornage chron. 1891. Siedamgrotzky, Dresd. Ber. 1892, p. 17. 
Labat, Rev. vétér. 1892, p. 129. Butler, Jahrb. 1892, p. 92. 


Section of the larynx in man has lately been much employed, par- 
ticularly for the removal of tumours. As already stated, such growths 
in the larynx are rare in animals (p. 159). But the operation has been 
practised on horses in hemiplegia of the larynx, otherwise termed roaring, 

K. Giinther, who made the first experiments, hesitated to divide 
the ericoid cartilage, because he feared stenosis, and therefore operated 
from the trachea. Stockfleth later recommended dividing the cricoid 
cartilage, thus introducing larnygotomy into veterinary practice. Thyroid- 
otomy and cricotomy are now distinctive terms, designating respectively 


LARYNGOTOMY. 179 


division in the median line of the thyroid and cricoid cartilages. 
Where the upper rings of the trachea are also divided, the operation 
is styled crico-tracheotomy ; while the division of the ericoid and thyroid 
cartilages, together with the connecting crico-thyroid ligament, is 
entitled crico-thyroidotomy. 

Crico-tracheotomy, as adopted in the treatment of hemiplegia laryngis, 
has been fully described in the brochure which I published in 1888. 

The animal is chloroformed and placed on its back; the operator 
kneels on the right side of the neck, shaves the hair from the larynx 
and upper portion of the trachea, and disinfects the site of operation. 
The position of the cricoid cartilage is easily determined by palpation. 
An incision, exactly in the middle line, is carried from the body of the 
ericoid cartilage over the crico-thyroid ligament, the cricoid cartilage, the 
erico-tracheal ligament, and as far as the first two or three rings of the 
trachea. After ligaturing any bleeding vessels, the muscles lying below 
the skin are divided exactly in the middle line. The trachea and 
cricoid cartilage are thus exposed with scarcely any bleeding, but any 
vessel spurting must at once be ligatured. A tampon-canula provided 
with a bellows is held in readiness. An incision is made through the 
first two rings of the trachea with a pointed bistoury, turning the cut- 
ting edge towards the animal’s head, and’ extending the opening by 
carrying the knife up to the thyroid cartilage. In case of vessels bleed- 
ing at this stage, the tampon-canula should be inserted, inflated with 
air, and the vessels ligatured. Entrance of blood into the trachea 
must in any case be prevented. The wound is now held open 
with a pair of blunt hooks or retractors, and after removal of any 
blood, the interior of the larynx can be seen. Where tumours 
have to be excised, little ditticulty is encountered, if their bases 
are not broad. Resection of the vocal chords has already been described 
(a 161). 

Where there is paralysis of the recurrent, the arytenoid cartilage on 
the paralysed side is removed. While Giinther and Stocktleth had 
practised partial resection, I proposed total removal of this cartilage, and 
I still prefer this method. With a specially-constructed scalpel (fig. 65), 
the mucous membrane at the periphery of the arytenoid cartilage is 
divided. Beginning at the point of union of the arytenoid cartilages, 
the knife, carried through the mucous membrane and the inter- 
arytenoid ligament in an upward direction, close beside the middle line, 
follows the posterior border of the arytenoid cartilage upwards as 
far as the vocal processes (in fig. 66 the dotted line shows the course of 
the incision). With scissors the vocal cord is divided at its point of 
union with the arytenoid, and the cartilage separated from the muscles 
covering its outer surface with the fingers, scissors, or scalpel. 


180 LARYNGOTOMY. 


By keeping close to the cartilage the bleeding is slight. The mucous 
membrane is then divided from the anterior upper border of the 
arytenoid cartilage, care being taken to spare it as much as_ possible. 
For this purpose the index finger of the left hand is introduced into the 
sacculus laryngis, and the membrane cut through with scissors close 
to the border of the cartilage. In this procedure. one is specially 
euided by the indications afforded by the left hand. The arytenoid 
cartilage is now cut through with the scalpel, as near as possible to its 
articular surface, so that only a thin fragment of cartilage remains. 


Fic. 65.— : Fic. 66.—Course of incision. 

Scalpel for Horse’s Larynx (seen from below)—Sk., Thyroid cartilage ; R.S.B., Crico- 
resection of thyroid ligament ; S8.b., Vocal cord ; S.bf., Vocal process of arytenoid ; 
arytenoid. R.k., Cricoid cartilage; £.G.k., Left arytenoid; Z.R. (I., I., II.), 


First, second, and third rings of the trachea. 


This portion of the operation is the most difficult; especially in old 
horses, where the articulatory portion of the cartilage is often ossified. 
The knife must be inserted within and below, and the cut made upwards 
and outwards. As considerable force is often necessary in dividing the 
cartilage, it requires care to prevent the knife slipping off unexpectedly. 
Although I have frequently performed the operation, I have never, 
however, had an accident of this kind. As soon as the arytenoid 
cartilage is divided it may be easily freed from the neighbouring 
soft parts, and removed with the help of a long and sharply-bent 
pair of scissors. In this case, also, it is necessary to follow carefully 
the borders of the cartilage, holding the latter with a pair of lion 


LARYNGOTOMY. 181 


forceps (fig. 67). Throughout the operation the larynx must be cleared 
of blood by the use of small sponges fastened to thin sticks, and 
wielded by an assistant; and in the same way the field of operation 
must be cleared after removal of the arytenoid itself. Bleeding is 
usually slight, though in rare eases a spurting vessel may require to be. 
closed by torsion. After bleeding is somewhat checked, the surface of the 
wound is swabbed with 10 per cent. chloride of zinc solution applied 
with a sponge, and is then powdered with 1 of iodoform to 3 of tannin. 
During the last few years I have 
attempted to stitch the mucous mem- 
brane, using a curved needle (fig. 68). 
It can be very well managed after a little 
practice. The needle, threaded with cat- 
cut, is first passed through the upper 
fold of the membrane, which is then 
drawn downwards and fastened to the 
under border of the wound. Silk should 
be avoided, as in the larynx it remains 
unabsorbed for months. Three sutures 
usually suffice to fix the membrane in 
position, to assist cicatrisation, and pre- 
vent the loose plice aryepiglottice inter- 
fering with breathing after healing. I 
consider Fleming’s method of removing 
the vocal chord unnecessary and injurious. 
A tampon properly fitting the larynx, 
or an indiarubber balloon, is introduced 
and adjusted. To secure the tampon 


Fic. 67.— Forceps Fic. 68.—Curved 


for grasping the Needle for 
and tube a couple of temporary sutures = @”ytenoid. suturing laryn- 
> gea, mucous 

are passed through the skin, and two membrane. 


pieces of tape over the seat of operation and round the neck. 

The horse is now placed on its side and the hobbles removed ; while, to 
prevent straw or other foreign bodies being inspired through the 
tracheal tube, a clean cloth should be laid under the neck. The animal 
is allowed to lie until it rises of its own accord, when it should be placed 
in a box, receive only soft hay and water, and not be tiedup. Formerly 
I used to remove the tube and tampon after twenty-four hours and 
change the former; but I now consider this unnecessary. Both may 
remain in position three to four days without bad consequences, 
provided no marked fever results. I think this method is to be 
preferred to changing the canula. Any discharge occurring may be 
soaked up with a piece of sponge, some wadding, or wood wool, and the 
wound, if dry, moistened with carbolic lotion. Drinking water should 


182 LARYNGOTOMY. 


be kept constantly in the box, and given in a pail placed rather low or 
on the ground. The diet should consist of soft hay and a small 
quantity of oats mixed with bran. 

On the fourth day the surface of the wound is carefully cleansed, and 
the stitches in the skin loosened. The tampon can then be removed, 
and the larynx swabbed out with small sponges wrung out of carbolie 
solution ; but the sponges must be nearly dry to prevent fluid running 
down the trachea. Any secretion or blood found above the tube must 
be carefully soaked up. The canula is then removed, and the animal's 
head tied up high. After cleansing the larynx several times, fresh water 
may be given from a pail held about 2 feet from the ground, and note 
taken whether much water returns through the nose. If in drinking, 
say a quarter of a pailful, not more than a half-pint returns by the 
nose, the tube may be discarded. On the other hand, if fluid flows 
freely from the nostrils, or if dyspnoea appears after the tube is removed, 
the latter must be replaced. The skin wound should be cleansed from 
discharge daily until a dry scab forms, when, unless such complications 
as fever and dyspnoea appear, neither skin wound nor larynx will 
require treatment. The wound, as a rule, after eight days requires no 
special attention. The horse, however, should still be confined in a 
well-ventilated box, and receive easily-digestible food. 

The external wound usually closes completely in three to four weeks. 
It leaves a cicatrix, which contracts so far in five to six months that even 
au expert has difficulty in discovering it. In about four weeks after 
the operation, provided the weather be favourable, the animal may be 
exercised daily, though for another month it must be kept from work 
of every description. After this time it may be ridden or driven until 
breathing becomes audible; but, as the forcible entrance of air stretches 
the cicatricial tissue, and may endanger the success of the operation, it 
should not be pushed beyond that point. Too early or injudicious work 
Injures the animal and may produce failures. In summer it is well 
to turn the patient out to grass for six or eight weeks. Dyspnoea 
sometimes disappears in about eight weeks after the operation, but the 
process of cicatrisation often takes longer. 

Until I have completed my statistics, which I hope to do shortly, I 
am not in a position to give a final judgment as to the success of the 
operation. I am, however, convinced that the greater number of horses 
which, owing to roaring, have seriously suffered in the performance of 
work, can by this operation be restored to usefulness. A large number 
of those I have operated on are still at work, although several years 
have passed since the operation. Some are used for riding, and even for 
racing. <A race-horse, operated on in 1891, won £1500 the next year, 
the roaring having completely disappeared. It cannot be denied that 


LARYNGOTOMY. 183 


the operation is justified. No other remedial measures are known. The 
use of a tracheal canula, apart from the discomfort it causes, is absolutely 
unreliable for many purposes; on the other hand, the operation does not 
ensure removal of the loud breathing. Cadiot, adopting the method 
described, has operated on a large number of animals, and considers the 
results very encouraging. In those cases which have succeeded, recovery 
was not only complete, but lasting. Of four operations performed by 
Siedamgrotzky one was completely successful, and three rendered 
the horses capable of work. lLabat operated on five horses by my 
method. The first two died; of the remaining three, two completely 
recovered, and one was much improved. In face of such experiences, 
isolated cases of failure are of little significance. 

I cannot here deal with Giinther’s recent cases, partly for want of 
space, partly on account of the subject being inappropriate to such a 
work as this, and shall, therefore, consider them at another time. 


I. DISEASES OF THE THORAX. 


|.—FRACTURES OF THE RIBS—FRACTURA COSTARUM. 


Lit.: Stockfleth, Her. Rep. 15, p. 266. Charpentier u. Lafour- 
cade, Jahresber. 1884, p. 110. Kohne, Gurlt u. Hertwig. 33, p. 262. 
Grosswend, Berl. Thierarzti. Wochenschr. 1889, p. 9. 


FRACTURES of the ribs are usually produced in the larger domesticated 
animals by external violence, by thrusts from carriage poles, kicks, fall- 
ing on uneven hard ground, unskilful casting, and in the case of run- 
aways by collisions with obstructing objects; in ruminants, from blows 
with the horns; and in smaller animals, from treads with the foot, or 
falling from considerable heights. Contused fractures are most common. 
Breakage seldom results from excessive muscular action, though 
Stockfleth has seen fracture of the first ribs produced in horses drawing 
heavy loads. Fractures of the ribs seem most frequent in swine, but 
are usually discovered only after death. Charpentier and Lafourcade, 
from observations in the slaughter-houses, found that 15 per cent. 
of swine had suffered fractures of the ribs, many of which had 
completed united. Simple cross fractures are most common; but 
sometimes the fracture is incomplete, the concave surface bending 
inwards, and the periosteum occasionally remaining uninjured (sub- 
periosteal fracture), Less frequent are complicated fractures, involving 
injury to the skin. In such fractures the pleura and lungs, or the | 
peritoneum and abdominal wails, are sometimes injured. In a case of 
Grosswend’s, a horse’s last rib having been fractured, the fragments per- 
forated the omentum and stomach, 

The Course taken is determined by the form and variety of the injury. 
Partial and simple subcutaneous fractures of the anterior ribs usually 
unite completely without marked symptoms. The great mobility of the 
posterior ribs interferes, however, with their union; a callus fibrosus, or 
pseudoarthrosis forms, but does not impair health, and, indeed, is often 
only discovered after death. Complicated fractures, involving perforation 
of the skin, may lead to pus formation and necrosis of bone; but healing, 


FRACTURES OF THE RIBS. 185 


even though long delayed, occurs. Should the sequestrum not be 
removed, a costal fistula may, however, develop (see next page). 

When the pleura, lung, or peritoneal cavity is involved, the conse- 
quences are much graver. In injuries of the thorax, air from the lungs 
frequently enters the pleural sac, but is commenly absorbed as quickly as 
the emphysema; for it has been found that air does not contain infectious 
materials in as large amount as was formerly believed, and portions of 
what it does bear are deposited on the surface of the respiratory mucous 
membrane. Hence, both in man and animals, unexpectedly good results 
not infrequently occur, especially where the skin is not perforated. <A 
further danger occurs from injury to thoracic blood-vessels (arteriz 
intercostales. et thoracice interne), which may lead to death from 
bleeding; and in this connection fractures of the first ribs are espe- 
cially dangerous, as other large vessels may easily become damaged 
from this point. I met with a case in which a runaway horse 
came into collision with a tree, broke several ribs, and died in a 
few minutes; the post-mortem showed not only rupture of the blood- 
vessels at the anterior opening of the thorax, but injury to the heart 
by fragments of bone. Collisions with the carriage pole cause similar 
injuries. 

Koéhne treated a horse with complicated fracture of the ribs, caused by 
collision with the pole of a carriage ; though a large wound existed in the skin, 
both fracture and wound united in two months. Six months later a new swell- 
ing appeared, which broke, and discharged freely; the finger, introduced 


between the 9th and 10th ribs, discovered a large cavity from which the matter 
had come. The animal recovered, but was troubled later with chronic cough. 


Injuries and ruptures of the diaphragm occasionally happen as com- 
plications of costal fractures. When broken ribs perforate the abdominal 
walls, fatal peritonitis is apt to ensue. 

Symptoms.—In partial and subcutaneous fractures there may only 
be somewhat hurried breathing, without further disturbance. Crepitation 
may sometimes be heard during breathing, and is the most reliable 
evidence of fracture. When the pleura is injured, there is a tendency to 
cough, and more rapid respiration ; whilst where the lung is involved, the 
cough may be accompanied by blood-stained discharge from the nose 
or mouth, and subcutaneous emphysema. Fractures of the first ribs are 
accompanied by marked disturbance in the movement of the forelimb and 
greater difficulty in breathing, because of the attachment of the muscles 
of the limb, and those of respiration of this pomt. Where the skin is 
perforated the broken fragments can often be directly seen. Dogs with 
multiple fractures of the ribs usually show more pronounced disturbance, 
especially if many ribs are broken. The severity of the symptoms 
increases with the number of ribs broken and the degree of displacement. 


186 COSTAL FISTULA. 


Treatment in simple and partial fractures consists in keeping the 
animal quiet, and guarding it against work and movement. Even in 
complicated fractures, with injury of the pleura and lungs, nothing 
further may be necessary. Reduction in such cases is difficult. Hertwig 
recommends placing large animals with the sound side against a tree, 
and endeavouring to bring about reposition by drawing the hind-quarters 
towards this side. If the skin be broken, fragments of bone dislocated 
inwardly may be replaced by pushing a finger or hook under the anterior 
border of the rib, thus avoiding the vessel and nerve which pass down 
the posterior border. Antiseptic precautions should be observed, and a 
dressing applied to guard the wound against infection. Injury of the 
skin greatly increases danger, and under no circumstances should a 
wound be artificially produced for the object of reposition; it is much 
better to adopt an expectant treatment. Charpentier and Lafoureade, in 
100 slaughtered swine, found 15 with united fracture of the ribs, 10 
without further injury, 5 with adhesion of the lungs, and 3 with pleuritic 
thickening. Cases of one broken rib were rare; and two or three were 
usually affected. The fracture occurred in the middle of the rib or in 
its lower portion; according to Stockfleth, the first ribs seem especially 
prone to break at their upper end. 


Il.—COSTAL FISTULA. 


Ger, Rippenfisteln. 


Lit.: Her. Rep. 5, p. 373. Schwalenberg, Gurlt u. Hertwig. 35, p. 419. 
Ferguson, ibid., 5, p. 373. 


Chronic inflammatory processes in the thoracic wall, with formation 
of fistule, are more frequent in horses than in other animals. They 
usually result from necrosis of one or more ribs due to direct injuries or 
cellulitis, occasionally to burrowing of pus in fistulous withers, or 
formation of strangles or glanders abscesses. When depending on 
necrosis of bone, the sequestrum, if allowed to remain, causes chronic 
inflammation, with pus formation and thickening of the ribs and of 
their surroundings, which may persist for months and even years. The 
condition seldom leads to pleurisy, the fascia endothoracica and pleura 
becoming thickened, and preventing complication. 

The symptoms consist in a swelling more or less extended, seldom 
sharply defined, but hard and firm, without evidence of acute inflamma- 
tion. A narrow opening exists in the centre of the swelling, and a probe 
passed through this is arrested by the hard, rough surface of the rib. 
General disturbance is commonly wanting; symptoms of pleurisy 


STERNAL FISTULA. 187 


only occasionally occur, but when they do almost invariably result in 
death. 

Prognosis.—The sequestrum prevents healing; whether it can be 
removed depends on its size and position, and to ascertain this, operative 
interference is usually necessary. Prognosis is more favourable where 
the process is confined to the external surface of the rib: but where it 
extends to the inner surface the condition becomes chronic, and pleurisy 
may supervene. The latter condition is indicated by the difficulty in 
breathing and the relatively copious discharge. But, even with chronic 
necrosis of the outer surface, animals may remain useful for a long time. 

Treatment.—tThe direction and extent of the fistula has first to be 
discovered, bearing in mind that the middle point of the swelling is the 
spot beneath which the chief alterations exist. The fistula should be 
laid open freely, especially if it trends downwards, care being taken 
not to wound the external thoracic vessels. The exposed rib is scraped 
with a curette, the necrotic bone removed, and healing encouraged. 
In fistule which cannot be laid open setons may be used, or they 
may be treated with antiseptics and astringents, such as liquor Villati,! 
carbolic, or sublimate solutions. When the fistula extends to the 
inner surface of the rib, non-irritant substances are selected. After 
removal of large pieces of bone, deep scars often remain in the chest- 
wall. The resection of a piece of rib, although not easy, and involving 
danger of perforating the pleura, was effected in the horse by Ferguson 
fifty years ago, and may occasionally be necessary. 


II.—STERNAL FISTULA AND FRACTURE OF 
THE STERNUM. 


Ger. Brustbeinfistel. Lat. Fractura Sterni. 


Lit.: Marcoux, Hering Rep. 14, p. 328. Landel, ibid., 16, p.211. Bril, 
Jahresber. 1886, p. 136. Dette, Thierarztl. Mitth. 1876, p. 98. Lari, 
Rec. de Méd. vétér. 1892, p. 55. Sand, Deutsche Zeitschr, fiir Thiermed. 
1893, 


The sternum consists of a mass of spongy bone, and in horses is 
especially liable to be injured by falls on uneven hard ground, by the 
sharp heels of a front shoe, or by the animal being run into. It is 
either directly injured, purulent periostitis established, and necrosis ensues; 
or it is indirectly affected from cellulitis extending to it from neigh- 


1 Liquor Villati or Villat’s solution consists of :— 


Sulphate of copper, ; : 1 part. 
a5 5 ANG, Ve : : 1 part. 
Acetate of lead, ; : : 2 parts. 


Vinegar, . : ; : ae i2rparts, 


188 TREATMENT OF STERNAL FISTULA. 


bouring textures. The thick muscular covering of the breast bone renders 
the removal of any necrotic portions difficult and tedious ; pus meanwhile 
burrows, and new necrotic points are formed, thus protracting the process 
for months or indefinitely. From time to time acute inflammation sets 
in, producing pus formation, and either disappearing or bringing about 
increased sub-sternal thickening. The disease is most frequent in horses, 
and is not uncommonly met with. 

Brill described a sternal fistula with two openings below and three at 


the height of the costal cartilages in a foal 24 years old. Similar con- 


ditions have occasionally been seen in cattle. Dette mentions that a cow 
swallowed a splinter of glass, which perforated the rumen and lower 
wall of the chest, and produced sternal abscess and fistula. The glass 
was removed, and recovery occurred in five months. 

Symptoms.—A semi-soft, slightly painful swelling appears between 
the forelimbs, sometimes exhibiting fistulous openings, from one or 
several of which ill-smelling bone pus discharges. A probe intro- 
duced far enough strikes on the roughened surface of the necrotic bone. 
When the movements of the forelimbs are interfered with by the severe 
swelling, lameness may be noted, the animals straddling, while inflam- 
matory action or acute pyrexia may exist. 

Treatment.—tThe disease is always chronic, recovery rare. Laying 
the parts open, scraping necrotic portions of the sternum, careful washing 
out, followed by the use of iodoform and other materials, I have found 
useless. Grinther testifies to the inveteracy of the disease. It is seldom 
worth while to carry out a tiresome, costly, and rarely effectual treatment. 
Isolated recoveries may, however, occur. Marcoux reports a case which, 
after prolonged and fruitless treatment with liquor Villati and the 
actual cautery, was said to be healed by the use of opodeldoc. Landel 
tried opodeldoc without effect, but recovery followed the repeated use of 
the actual cautery, a farrier’s poker being heated white hot and thrust 
into the opening, which was then washed out with spring water; the 
report does not indicate whether recovery was lasting. In a long- 
standing case treated by Lari the inflammatory process at last extended 
to the pleura and pericardium. 

Free exit for pus must be provided. Where it is necessary to 
lay open the lumen of the fistula, this should be effected as far as 
possible in the longitudinal axis of the body. Disinfectant injections 
may assist healing. Where possible, the diseased bone should be scraped 
with the curette. For this purpose it will often be necessary to cast 
the animal, The actual cautery under certain circumstances may be 
useful, as Landel’s case shows. Where acute inflammation occurs, 
warm poultices will hasten recovery, and minimise swelling; abscesses 
must be opened. In the acute stages, the animal, having difficulty 


WOUNDS OF THE CHEST-WALL. 189 


in walking, must remain idle; but in chronic cases, it is generally 
better at slow work. 

Fracture of the sternum, which is rare in horses, was observed by 
Sand. The horse had run away and fallen violently to the ground. 
It rose, however, and after galloping a further distance of about 400 
yards, suddenly fell once more, and immediately died. Death was 
found to have been due to injury to the internal thoracic artery, 
which had been torn by a fragment of the sternum. Sand thinks 
that the horse had fallen on its shoe. 


IV.—WOUNDS AND BRUISES OF THE SOFT PARTS OF 
THE GHEST-WALL. 


Lit.: Thienemann, Dresd. Ber. 1862, p. 108. Hitibner, ibid., 1879, p. 131. 


(1.) WOUNDS OF THE CHEST-WALL WITHOUT 
PERFORATION. 


Wounds associated with injuries of the sternum have already been 
discussed, and consideration has now to be given to those of the soft 
parts; injuries due to collar pressure will be considered elsewhere. 
Such wounds in horses are caused by collisions with the pole of the 
carriage, by two animals meeting violently; in the army by lance 
thrusts, or by falling on uneven hard ground or on the rider’s spur. 
When the injury is on the anterior surface of the chest, the trachea, 
the great vessels, and the first ribs may be endangered. Injuries to 
the sides may consist of extensive gashes in the chest and shoulder 
muscles, or an offending body may force its way between chest-wall 
and shoulder, severely damaging the larger blood-vessels and nerves. 

Thienemann records that a horse, which had received a wound over 
the elbow and died two days afterwards, had the axillary vein torn 
through. Hiibner describes a case in which the horse fell; a fluctuat- 
ing swelling immediately appeared, in consequence of rupture of the 
axillary artery, gradually extended over the neck and chest, and proved 
fatal forty-five minutes later. 

Prognosis depends chiefly on the position and degree of the injury. 
Wounds involving only the skin and superficial layer of muscle usually 
heal well, especially if the secretions find ready exit; but deep-pene- 
trating wounds to the lower border of the neck are very grave; the 
discharges are liable to burrow in the loose connective tissue which 
surrounds the great vessels, the trachea, and cesophagus, and may 
extend into the chest, causing septic pleuritis. Wounds complicated 
with fracture of the first rib often produce similar results. The 


190 TREATMENT OF WOUNDS OF THE CHEST-WALL. 


great vessels of the neck and the nerve-stems (vagus) may, more- 
over, be affected, endangering fatal bleeding or paralysis of the 
larynx. Violent shocks to the chest-walls may injure the axillary 
vessels and nerves and produce paralysis, while similar conditions 
also occur in fractures of the scapula and humerus. Coldness and 
paralysis of the affected limbs point to thrombus formation in the 
vessels, while paralysis alone suggests injury of nerve-stems. Such 
serious results are, however, in great part prevented by the pro- 
tection afforded by the stout thoracic fascia. Where the shoulder- 
joint is not injured mere muscular wounds often heal well. Even 
where the wound passes under the shoulder, as far as the anconei, 
recovery usually occurs without affecting the movement of the limb. 
The lameness is important in forming a prognosis: as long as it is 
not marked, and no severe symptoms of fever exist, healing may be 
expected, even where the muscles are extensively lacerated. Danger 
of pleurisy is not great. The emphysema sometimes occurring in 
these muscular lesions must not be supposed to depend upon the 
thorax being perforated; nor must moderate acceleration of breathing, 
determined by injury of the accessory respiratory muscles, be mistaken 
for pleurisy. 

Treatment.—Atter bleeding has ceased, the wound should be 
carefully examined to discover its extent and the possible presence in 
it of foreign bodies, which, if present, should be carefully and thoroughly 
removed. The parts are then cleansed; in deep injuries of the anterior 
surface of the chest, extending towards the middle line, particular pro- 
vision must be made for the escape of wound discharges in order to 
prevent the formation of sternal fistulae. It is well to lay open any 
pockets or make counter openings. Drains or setons are introduced if 
required. Where larger vessels, especially veins, are exposed, after- 
bleeding may result during the first three days, but seldom later. It is, 
therefore, advisable to watch valuable animals continually, and if at all 
possible, to provide for permanent irrigation with lukewarm antiseptic 
solutions, continued for several days (sublimate 1 in 3000, carbolic acid 
or creolin 1 in 50). Cold solutions should only be used while bleeding 
persists. Where continual irrigation is unattainable, the wound must 
be rimsed out carefully every hour or two with a disinfectant. Similar 
methods of examination and checking hemorrhage are applicable in 
wounds extending under the shoulder. Arrangements must be made 
for the easiest exit of discharges, and incisions, counter openings, drains, 
&e., combined with effectual irrigation, adopted as above indicated. 


WOUNDS: OF THE PLEURA AND THORACIC CAVITY. 191 


(2.) WOUNDS OF THE PLEURA AND THORACIC 
CAVITY. 


Lit.; Perosino, Her. Rep. 15, p. 169. Wiesner, Zeitschr. fur Vet. 
1890, p. 508. 

Punctured or penetrating wounds of the chest are usually caused by 
thrusts with the bayonet, lance, or sabre; in war by projectiles; by 
falling on harrow teeth, or on the rider's spur; in oxen by horn-thrusts, 
by splinters of wood, or by the aspirating needle used to drain the 
pleural sac. Such wounds may extend through the pleura costalis, and 
even injure the thoracic or abdominal organs. Besides the dangers of 
bleeding and infection, such injuries may lead to pneumothorax, hemo- 
thorax, pleurisy, and pneumonia. 

(1) Pneumothorax.—Air may enter the pleural sac either from 
without, or from the lung. As soon as a considerable wound pene- 
trates the pleura costalis, the distended elastic lung generally 
collapses, air is drawn in through the opening in the pleural sac, 
and breathing ceases in the affected portion of lung. The walls 
of the chest continuing their respiratory movements, however, the 
air streams outward during expiration, and re-enters during inspira- 
tion. Should the opening in the thoracic wall be partly or entirely 
closed during expiration, emphysema results from the retiring air 
being forced into the loose connective tissue in the neighbourhood 
of the wound. Injury to lung or a bronchus also causes pneumo- 
thorax, usually attended with severe bleeding and collapse of the 
affected portion of lung. Air in the pleural sac is not necessarily 
fatal, so long as both lungs do not collapse. It is reabsorbed in a com- 
paratively short time, as has long been known in man; and more recently 
been demonstrated in horses by the experiments of Trousseau, Leblanc, and 
Perosino. Perosino opened the pleural sac in a horse between the 10th 
and 11th ribs, and allowed air to enter through a tube until the difficulty 
in breathing threatened death from suffocation ; but, on the evening of the 
day of experiment all untoward appearances had vanished. Pneumo- 
thorax is, nevertheless, a very grave condition, because infectious 
material, entering with the air, may produce severe inflammation. Air, 
entering the thorax through wounds, is more apt to be infective 
than that admitted through the lungs, which is purified as it passes 
over the respiratory mucous membrane, much in the same way as air 
entering a bottle may be filtered by a cotton-wool plug. The emphysema 
in the neighbourhood of chest wounds is usually of little importance. 

(2) Heemothorax, or the presence of blood in the pleural sac, arises 
either from rupture of vessels (intercostal) in the wall of the thorax, 


192 DIAGNOSTIC SYMPTOMS OF THORACIC INJURIES. 


or from injury of the lung or heart. Large quantities of blood in the 
thorax may certainly produce sudden death by compressing the lungs 
and inducing suffocation; but even a small quantity is dangerous, 
because it putrefies, and produces materials likely to bring on septic 
pleurisy. The simultaneous existence of hematothorax and pneumo- 
thorax accordingly render prognosis doubly grave. 

(3) Pleurisy results from the injury, and from the wound becoming 
infected. It may thus arise either from the external or the lung 
injury, and will evidently be favoured by foreign bodies remaining in 
the wound, and by difficulties in carrying out antisepsis. 

Symptoms.—In determining whether a penetrating wound of the 
chest exists, one must not immediately have recourse to probes, nor 
should one, under any circumstances, proceed to explore with uncleansed 
fingers. As perforation of the still uninjured pleura costalis may be 
produced with a probe, such examination may introduce infectious 
materials into the thoracic cavity where the wound has not been first 
carefully cleansed. The question must therefore be answered by first 
considering the other symptoms. One should make— 

(1) An examination of the position and condition of the wound and of 
the body which has produced it, as well as the method of its production. 
This may sutfice to indicate whether the chest-wall has been 
penetrated. 

(2) The breathing must be watched. Dyspnoea may be the result of 
pneumothorax, hematothorax, or pleurisy, and occasionally in slighter 
degree, of injury to the muscles of respiration. Septic pleuritis is 
associated with high fever. Percussion determines the existence both 
of pneumothorax and of hematothorax, and allows of their being 
distinguished. 

(3) Blood-stained discharge from the nose or mouth generally points 
to injury of the lung, though its absence does not establish the contrary. 

(4) The passage of air through the wound during breathing is strong 
evidence of a penetrating wound of the chest; but, as above stated, 
passage of air, as well as emphysema of neighbouring parts, occur in 
some non-penetrating wounds of large extent. 

(5) Pulmonary prolapse sometimes occurs after large openings in the 
thoracic wall, and the piece of lung is hable to be strangulated and 
become necrotic. | 

(6) If these observations do not determine whether the wound is a 
penetrating one, it may be disinfected, and further examined with the 
aseptic finger or probe; or, in default of an accurate diagnosis, the 
treatment for a penetrating wound may be adopted. Bleeding vessels 
should be ligatured, and any fragments of broken ribs replaced under 
antiseptic precautions. 


PROGNOSIS AND TREATMENT OF THORACIC INJURIES. 193 


Animals with such wounds sometimes bend the hind-quarters instinc- 
tively towards the injured side, and thus prevent the wound gaping 
(Viborg, Hertwig). 

Prognosis.—Every penetrating wound of the chest should he 
viewed as a possibly fatal injury, but all do not necessarily take a fatal 
course. They are more grave in horses than in cattle, but less so in 
carnivora. According to my experience, the risk of pleurisy is greatest 
in horses. When thoracic wounds are of a serious character, most horses 
require to be supported in slings, otherwise they sometimes die in two 
or three days. Incised wounds produced by scythes or lances heal more 
easily than penetrating bruised wounds made by manure-forks or the 
tines of harrows. Complications materially affect prognosis; pneumo- 
thorax, hemothorax, or pleurisy is unfavourable. Moderate fever from 
wound infection does not necessarily prevent recovery. 

Numerous recorded cases testify that such injuries in animals take a 
favourable course if treated expectantly. Jacobin records the satisfac- 
tory recovery of a horse from a penetrating wound caused by a spur, 
which had perforated the thoracic wall and injured a rib. I have 
seen recovery in cases in which the finger could be introduced into 
the pleurai cavity, and the movement of the lung distinctly felt. On 
the other hand, apparently slight wounds may prove rapidly fatal. 
This is especially true of insignificant-looking penetrating wounds, like 
those produced by manure-forks, in which danger of infection occurs 
during the first three or four days. When pus forms, if mean- 
while no threatening symptoms have appeared, the prognosis becomes 
more favourable. 

The principles of treatment are clearly apparent, the first and 
most important being thorough antisepsis. After checking the flow of 
blood by ligaturing with sterilised material the injured vessels, the 
wound is carefully disinfected, and where healing by first intention 
seems possible, sutured. Where much discharge is to be expected, 
drains must be inserted and counter-incisions made. Over the ordinary 
dressings an air-tight bandage should be applied. For the larger animals 
moss wadding is suitable, but where this is not obtainable a straw mat, 
or a cloth folded several times, can be substituted, and the compress 
kept in place with a roller. In small animals, as in man, bandages are 
usually serviceable. Where proper dressings cannot be improvised, 
arrangements may be made for continuous irrigation with disinfectants ; 
but if penetrating wounds exist, care must be taken that fluid and 
air do not enter the pleural sac. Sometimes both the dry and moist 
methods are associated or alternated by allowing disinfecting fluids to 
pass through the dressing and wound, from whence they are suitably 
drained. Such irrigation, or frequent moistening with antiseptic solu- 

N 


194 SHOULDER ABSCESS. 


tions, is useful. Dressings must be changed as soon as soaked with 
discharge, or where high fever has set in. Little can be done in 
combating pneumothorax; and in hematothorax the blood, being 
already clotted, is difficult to remove. In septic pleuritis in horses and 
carnivora the thorax is sometimes rinsed out with 1 part of corrosive 
sublimate to 3000 of water; for ruminants, a solution of 1 in 700 of 
boric acid, or a lotion of alum. acet. of similar strength may be used. But 
such treatment is seldom effectual. Weisner, experimenting on two horses 
with 1 per cent. solution of salicylic acid, was not successful. 


V.—SHOULDER ABSCESS. 


Ger. Brustbeule or Schulterbeule. 


Lit.: Schimmel, Oesterr. Monatschr. 1888, p. 135. Sehmidt, Berl. 
Thierarztl. Wochenschr. 1890, p. 47; u. 1891, p. 105. Neuse, Zeitschr. 
fiir Vet.-Kunde, 4. Schmidt, Berl. Arch. 17, p. 105. Schilling, 
B. T. W. 1891, p. 319. Block, ibid., 1892, p. 255. Esser, Ber. tiber 
die Naturforscherversammlung in Halle, ref. in Zeitschr. fiir Vet.-Kunde. 
1892, p. 77. Gtinther, B. T, W.-1893, p. 61. - Siedampronz kee 
Dresd. Ber. 1889, p. 21. 


Hertwig describes two varieties of shoulder abscess—one superficial, 
consisting of inflammation of the sub-cutis, and presenting the features 
of such swellings in other parts of the body; another of a special type, 
almost peculiar to horses employed for draught. 

Symptoms and Progress.—A sharply defined, hard, slightly 
painful tumour, as large as a child’s head, lying either in or below the 
mastoido-humeralis muscle (levator humeri). The skin is sound and 
movable; lameness is scarcely ever present, though Giinther states 
having observed it. 

For some time no marked changes occur in the swelling, except 
possibly an increase of circumference, and it remains stationary for 
weeks or months, during which steady work may be done. Usually 
after some months, fluctuation appears at the most prominent part, and 
on incision thick fluid pus is discharged. The earlier the swelling 
is punctured the more quickly it disappears. If operation is long 
delayed permanent thickening may remain. 

Opinions differ as to the origin of these tumours, though it is charac- 
teristic of them that soon after their formation a small suppurating 
point may always be found at their centre. 

Franck believes that they are associated with injury of the prescapular 
glands. Hertwig, who is supported by Esser, considers that they are 


SYMPTOMS AND PROGRESS OF SHOULDER ABSCESS. 195 


caused by continuous pressure of badly-fitting collars, as indicated by 
their occurring only in draught horses, usually in those drawing heavy 
loads. Viborg views them as complications of strangles. In this 
clinique every year many draught patients are treated for shoulder 
abscess, but I have never seen riding-horses affected. Stockfleth, how- 
ever, reports a case in a horse which had been confined for several 
months to the stable on account of lameness; but this may be regarded 
as the exception which proves the rule. It is specially noteworthy that, 
even from their earliest beginning, these abscesses contain pus, in which 
pyogenic cocci are invariably present. This fact has been amply proved 
by the large number of these abscesses containing staphylococci opened 
in this clinique during the last few years, though steptococci were some- 
times found instead. 

But how does the infection occur? Though it is clear that infection 
with cocci must be associated with the mechanical injury caused by the 
collar, it is by no means clear how the cocci penetrate to the deep-lying 
seat of abscess through uninjured skin. Schimmel urges that they proceed 
from the lower portions of the limbs by the lymphatic vessels; and in support 
of this view adduces the case of a horse which suffered from a suppurating 
sandcrack, from which discharge of pus was prevented by applying a 
bandage, when abscess on the shoulder was shortly developed. 

Two factors are at work—collar-pressure and infection. The former 
certainly favours development of micro-organisms in the mastoido- 
humeralis muscle or prescapular glands, but the method of infection is less 
clear. It seems possible that micro-organisms may enter the injured 
lymph-glands with the lymph-stream, or that they may be poured 
into the disease-focus along with the extravasated blood. Schmidt 
inoculated several oxen with Kitt’s symptomatic anthrax lymph, but 
only one animal, which had been struck with a stick, developed anthrax 
and showed the characteristic swellings. Rosenbach broke the tibie of 
rabbits, into whose blood-stream he had previously injected cultures of 
bacteria, and noted severe inflammation at the injured spot (comp. my 
General Surgery, p. 35). Still it is possible that infective materials 
may set up inflammatory changes and swelling in the lymph-glands 
directly, and thus render them more liable to bruising. 

In many of my own cases the disease has started in the lower 
tracheal glands, and shown the character of a lymphadenitis chronica 
suppurativa. The process, according to my observations, either arises 
from the common mastoido-humeralis muscle, and is of the nature of a 
myositis apostematosa, or the underlying lymph-glands are the primary seat 
of disease, and in such cases it should be described as lymphadenitis 
suppurativa; while from this, the inflammation extending to the muscles 
produces a myositis chronica fibrosa. Other growths, however, occur 


196 PROGNOSIS AND TREATMENT OF SHOULDER ABSCESS. 


here; thus I have seen in a grey horse a melano-sarcoma, which had 
been mistaken for abscess on the shoulder, and Giinther reports a 
similar case. The slow development of melano-sarcoma, however, differ- 
entiates it from the condition now in question. 

Prognosis is favourable where treatment is early adopted. When 
delayed, inflammation becomes chronic, firm masses of connective tissue 
are produced, and when these have existed for months complete extirpa- 
tion, which is always difficult, is the only remedy ; otherwise the swell- 
ing is again bruised by the collar and becomes inflamed, leading to 
further formation of fibrous tissue. Extirpation of the glands is the 
only means of dealing with chronic lymphadenitis. 

Treatment.—Formerly blisters were recommended as the first appli- 
cation, and the abscess was punctured in eight to ten days. Stockfleth 
inserted the actual cautery into the cavity of the abscess after dividing 
the skin. Others allow the abscess to mature. Block has lately recom- 
mended the following compound: Unet. cantharid. off., 30 parts; tinct. 
cantharid. and tinct. euphorb., of each 15 parts (evaporated to half their 
bulk); ol. croton, 1:20; hydrarg. biniod., 4; fresh butter, 30. After clipping 
the hair and applying the ointment, Block holds a red-hot iron a short 
distance from the skin so as to heat it. The animal is then fastened 
up for three days. Extensive experience leads me to recommend 
immediate opening and removal of the pus. The abscess sometimes 
lies as muchas 4 inches below the surface, but this should not prevent 
operation. By thrusting the knife towards the centre of the swelling 
dangerous bleeding is avoided and the abscess opened with certainty, 
though the knife must not pass beyond this point on account of 
endangering large vessels. As in other such operations, the hair is 
removed, the skin cleansed, the position of the swelling determined 
by palpation, and the horse twitched. A pointed bistoury, with its 
eutting edge directed upwards, is inserted from 2 to 3 inches. The 
pus usually then discharges; but if not, the finger is introduced, the 
fluetuation localised, and the wall of the abscess divided with either 
knife or finger. After discharge of the pus, the swelling should be 
laid open in its entire length, if possible, by a vertical incision, thus 
completely exposing the cavity of the abscess. Bleeding may be 
checked by means of tampons, and single vessels ligatured. 

To promote dispersal of the swelling, moist warm applications, wetted 
from time to time with hot water, are employed for eight to fourteen 
days; they are kept in position with a cloth doubled two or three times, 
and fastened to the neck by a bandage. Schmidt recently reeommended 
the injection into the swelling of a saturated solution of common salt. 
Active suppuration and perforation are said to follow; but a case 
treated in this way by Schilling soon afterwards died from gangrene. 


TREATMENT OF SHOULDER ABSCESS. 197 


Injection of common salt certainly hastens suppuration, especially if not 
sterilised, but as it possesses the disadvantage of exposing the animal to 
grave infection, the use of the knife is always preferable. 

Where these abscesses have existed for several weeks, and contain no 
large cavity, extirpation becomes necessary. This may be either (1) 
partial, which is only adopted where no sharp margin divides the swell- 
ing from the sound textures, and is seldom effectual; or (2) total, which 
is specially indicated when the duration of the case has been considerable, 
and there is hence no prospect of reabsorption of swelling after opening. 
The horse should be cast, for even if quiet, bleeding or other complication 
may ensue, which cannot be properly dealt with if he is standing. The 
animal is laid on the healthy side, placed in a good light, and the hair 
removed from the swelling. Spring artery forceps, thick and thin liga- 
tures, and some tow tampons must be provided. An incision is 
made in the direction of the neck over the tumour; the skin on 
either side is drawn back, which, on account of the looseness of the sub- 
cutis, is not difficult, and any portion of skin adherent to the swelling 
taken away. In order to exert traction on the tumour, a piece of tape 
is passed through it, and the loose connective tissue surrounding it is 
separated with the fingers or scissors, beginning at the lower and inner 
side in order to avoid the carotid and its branches, or in ease of injury, 
to facilitate their being ligatured. At the upper portion of the swelling 
this may become impossible, and grave bleeding may accordingly result. 
Similar danger occurs if the swelling is cut into, or a portion of it is 
allowed to remain. Vessels cut through sometimes retract into the 
masses of connective tissue, their ligation becomes impossible; and as 
the actual cautery often belies its reputation, the operator may see 
the animal bleed to death before his eyes. This danger is avoided 
if the operator carefully separates the loose connective tissue as far 
as possible with the fingers, and at once ligatures the exposed vessels 
in two places. The tumour secured, if necessary, with a strong 
thread, is then cut away. After rinsing out the cavity with a dis- 
infecting fluid, and ligaturing any bleeding vessels, the surfaces should 
be powdered with 1 part of iodoform to 3 of tannin, the cavity 
plugged with carbolised jute, the skin sewn up, and the animal 
allowed to rise. 

In twenty-four hours the sutures may be loosened and the wound 
rinsed out with sublimate solution. A couple of stitches may be inserted 
into the margins of the wound, on either side, and fastened to a roller or 
to the mane, thus allowing free entrance of air. Dressing with iodoform 
and tannin is persevered with. To prevent interference with the wound, 
the animal should be placed on the pillar reins, or a side-stick applied in 
the recognised manner. After a few days a dry black scab covers the 


198 SADDLE AND COLLAR GALLS. 


surface of the wound, and, if it become loose in spots, should be removed 
and the antiseptic powder re-applied. Towards the edges of the wound 
a small quantity of discharge may appear, which can be dried up with 
wadding or wood wool and the surface again powdered with iodoform 
and tannin. During the first six days the wound shows no marked 
change under this treatment, but gradually becomes smaller, and in 
about three weeks the cavity, which was as large as a child’s head, will 
have completely filled up. 


An abscess of the shoulder, extirpated on 16th July, left behind a cavity 
7 inches long, 4 inches broad, and 2# inches deep. Until the 22nd no 
marked change had occurred, but subsequently the dimensions were reduced 
as follows :— 


Day. Length. Breadth. Depth. 
July 23. 64 inches. 3% inches. 21 inches. 
” 2. 63 ” 3% ” 24 ” 

” 25. 64 ” 2f ” 2 ” 

oo 20: 5 5 2S ae 2 Ke 
5B) 27. 43 3 23 ” lg ” 

He" ail) 3% Wes ae 
es) Bi ate e ane 1? 


In such cases open wound treatment is not only the quickest, but 
the most convenient. When a dry scab is produced over the entire 
wound nothing further is necessary. The margins of the wound 
being laid back obviously prevents their being drawn inwards by 
cicatricial contraction, which is apt to interfere with healing. 


Vii—SADDLE AND COLLAR GALLS—INJURIES FROM 
PRESSURE. 


Ger. Satteldruck, Geschirrdruck. 
hit.: Peters, Berl. Arch. 2, p. 237. 


The saddle and collar exercise heavy pressure on the tissues below, 
and may produce injuries to the skin or subjacent textures. These are 
usually of the nature of bruises, seldom of excoriations ; and as those 
produced by the saddle possess the greatest imterest, they will be first 
considered. 


(1.) INJURIES PRODUCED BY THE SADDLE— 
SADDLE-GALLS. 


To prevent the pressure of the saddle injuring the back, the following 
precautions must be observed :— 

(1) Pressure should be distributed as evenly, and over as large a 
surface as possible. 

(2) Pressure must be confined to parts fitted to bear it. 


INJURIES IN THE SADDLE-BED. 199 


(3) Those portions of the saddle which bear on the body must be 
properly stuffed, or the back covered with a folded rug, &c. Weight 
can only be borne where muscles or fat underlie the skin, as is the 
case along both sides of the vertebral column in the dorsal region. 

In the middle line of the back and on the withers, where the bones 
are not cushioned, any considerable pressure causes bruising. Saddles 
are, therefore, made to bear on the protected parts only. 

The anatomy of that portion of the horse’s back carrying the 
saddle may be briefly described as follows (fig. 69):—(A) In the 
middle line of the withers and back, under and closely adherent to the 
skin (a), lies the fascia of the dorsal panniculus (6) (Wiederristbinde 
Franck). Below it extends the scapular fascia, or Schulterarmbeinfascie ot 
Franck (¢), which is applied closely to the termination of the liga- 
mentum nuchze, covering the superior spinous processes of the 5th—10th 
dorsal vertebre (¢). This is not covered with muscular padding. (B) 
On either side of the vertebral column, in the “saddle-bed,” or surface 
on which the saddle rests, the skin is provided with a strongly developed 
sub-cutis, and covers the fascia of the dorsal panniculus (/), which is 


Fic. 69.—Transverse Section through Horse’s Thorax (semi-diagrammatic, after Franck)—a, 
Skin; 6, Fascia of panniculus; c, Scapular fascia; 7, Muscular layers ; ¢, External fascia 
of withers ; 7, Muscular layers ; g, Subscapular fascia. 


attached by soft connective tissue to the scapular fascia (¢). Below 
this lies a pad of muscle, comprising the lattissimus and longissimus 
dorsi, the spinalis and semispinalis dorsi, the trapezius rhomboideus 
posterior and the ilio-costalis (retractor coste) muscles. 

Injuries in the saddle-bed occur most frequently from irregularly dis- 
tributed pressure continued for a considerable time. Limited areas of 
skin are compressed, leading to vascular distension and rupture ; but while 
pressure continues little extravasation occurs. So soon, however, as the 
saddle is taken off, blood and lymph are passed from the ruptured vessels 


200 THE FORMATION OF SADDLE-GALLS. 


into the perivascular spaces. As in other bruises, if the skin were not 
pigmented, reddening might be noticed. At first a serous fluid accumu- 
lates in the interstices of the cutaneous tissue, and at a later stage, 
more and more white corpuscles appear, with plastic infiltration. Where 
serious bruising occurs, plasma and blood are effused.. The gall consists 
of a circumscribed firm swelling, not unlike that of urticaria, caused by 
extravasation into and infiltration of the cutis. It may be soft, occa- 
sionally fluctuating, and without sharp borders, as when blood and lymph 
are freely poured into the loose sub-cutis. Should this condition develop 
under the fascia, the swelling is less sharply defined and more tense. 

The lesion, when situated on the withers or spine and caused, 
as indicated, by bruising of the skin covering the superior processes of 
the vertebre, is less sharply defined, more dispersed, and often shows 
fluctuation. Although it may not be painful at first, it becomes so 
if the vertebree are injured. While lesions of the withers and spine 
are generally subcutaneous, those of the saddle-bed are generally 
cutaneous. From pressure and friction of the girths and other parts of 
the harness, hair and epidermis are often rubbed off. If bruising also 
occurs, cutaneous swelling ensues, The condition is one of cutaneous 
or subcutaneous bruising, which sometimes consists in rupture of the 
tissues and smaller vessels, less frequently in injury of larger vessels 
and consequent extravasation. 

Symptoms.—Saddle-galls are best discovered half an honr to one 
hour after unsaddling; it usually takes this time for their appearance. 
They generally vary in size from a sixpence to a five-shilling piece; are 
tense, hard, painful, warm, and sharply marginated. The larger are 
always flat. Should the hair over the saddle-bed be wet, these points 
of pressure dry first, producing isolated dry spots. Not infrequently 
they are itchy, and the animal bites or rubs them. Bruises of the sub- 
cutis are diffuse, sometimes cedematous, sometimes fluctuating, and are 
usually more painful, especially on pressure. Saddle-galls are best 
detected by passing the hand over the withers, spine, and the saddle-bed, 
when thickening, firmness, or tenderness may be discovered. When the 
tender spot is touched or pressed the animals bend the back or move 
away. This is specially noteworthy in the region of the withers, for 
the detection of such swellings in this site is otherwise somewhat difficult. 
Disease implicating the ligamentum nuche is characterised by great 
swelling and profuse pus formation, swelling of the neighbouring lymph 
vessels, and of those on the shoulder and over the ribs. Suppuration 
and necrosis in the depths is indicated by exuberant, flabby, dark- 
red granulations, which bleed easily; whilst implication of the superior 
spinous processes is shown by the greater degree of pain. Necrosis of 
these processes, or of the cartilage covering them, can often be detected 


PROGRESS OF SADDLE-GALLS. 201 


by palpation. Where the skin has become necrotic, it is hard and leather- 
like, and the hairs on the affected spot are usually erect. Excoriations 
produced by rubbing are easily seen. 

Progress.— Where extravasation has been slight, cutaneous swell- 
ings usually disperse rapidly. The blood serum and lymph poured into 
the interstices of the cutis are reabsorbed; the aggregated leucocytes 
re-enter the circulation, and the ruptured membrane undergoes repair. 
The status quo ante is thus restored. Proper treatment may remove 
such a swelling within a few days; but, as formed elements gradually 
replace the earlier infiltration of blood or serum, the longer such swellings 
have existed the longer will be the time occupied in their reabsorption. 

Subcutaneous extravasations of blood and lymph do not become 
absorbed so rapidly, and frequently last eight to fourteen days or longer. 
The larger the fluctuating swelling, the longer it persists. Sub-fascial 
extravasations are still more tedious, and hence those on the withers are 
always more difficult of removal than those on the saddle-bed. 

Cutaneous swellings are frequently followed by necrosis of the skin. 
Owing to defective local nutrition, it is most common on the site of old 
cicatrices, and also where the surfaces, while still tender, are again sub- 
jected to severe pressure. The living processes are thus arrested; the 
fluids are to a great extent pressed out of the tissues and vessels, and 
mumunification or dry gangrene results. Demarcation generally takes 
two to three weeks, sometimes even longer; it is first completed in the 
loose sub-cutis, later in the corium. 

The third termination is suppuration: it seldom or never occurs 
in the cutaneous swellings, but is common in the subcutaneous, 
especially in those associated with extensive extravasation. This 
termination is met with, when the skin is broken as well as bruised, 
and also when the knife has been unnecessarily used. Fluctuation 
sometimes exists, and should it be mistaken for a sign of suppuration 
and incised, grave consequences are likely to result, especially in the 
region of the withers. Pus formation may lead to necrosis of the 
neighbouring fascia of the ligamentum nuche, and even of the superior 
spinous processes, producing fistulous withers. The burrowing pus 
excites inflammation, which increases the difficulty of free discharge, 
brings about a circulus vitiosus, and greatly delays recovery. Hiibner, 
during such a case affecting the occiput and the shoulder, counted 200 
abscesses, from the size of peas to that of a child’s head. 

In severe injuries, like bruising of the skin and soft parts and 
erushing of the spinous processes, putrefactive processes and other grave 
conditions may occur, which results, however, are not very frequent. 
Disseminated pus formation and lymphangitis are lable to ensue as 
complications, sometimes spreading in the sub-cutis, and not infrequently 


202 CAUSES OF SADDLE-GALLS. 


also under the fascia. Necrosis of the ligamentum nuche, of the 
superior spinous processes, and even of the deeper portions of the 
vertebree may occur, and in exceptional cases necrosis of the ribs and 
of the shoulder-blade is seen. 

In a case occurring in my own experience, pus formation had ex- 
tended along the fascia of the back as far as the pelvis, producing 
necrosis, and also invaded the under surface of the longissimus dorsi, 
separating the latter to a great extent from the bodies of the ribs. 
Several ribs afterwards became necrotic. Pus also burrowed under the 
serratus anticus major muscle. 

The prognosis depends on various factors. It is modified by-—— 

(1) The position of the swelling. The cutaneous is more hopeful 
than the subcutaneous, especially if situated in the withers, 

(2) The duration of the swelling. The longer swelling has existed, and 
the harder and more resistant it appears, the further has _ plastic 
infiltration proceeded, and the more tardy will be resolution. Fistule 
of the withers of long standing are usually difficult of cure. 

(3) Cellulitis or lymphangitis adds to the gravity of the ease. 

In prognosing fistulous withers, particular note must be taken of 
the degree of swelling and pain, and the amount of pus. Swelling 
indicates burrowing of pus, if the discharge takes place only on 
pressure from without, or during movements of the animal. Intense 
pain points to injury of the superior spinous processes. 

Causes.—Certain horses suffer more than others, depending on 
greater vulnerability of the skin, or on the presence of cicatrices or 
scabs, or on peculiarities in form interfering with the fitting of the 
saddle. Amongst these may be included abnormally high, or low, short 
withers, flatness of the ribs, keel-shaped breast and short sternum, 
and distension of the abdomen, causing the girth to slip easily forwards 
or backwards. Old horses sometimes have the muscles in the saddle-bed 
atrophied, and are therefore more liable to contract saddle-galls. Vicious, 
irritable, and restless horses which cannot be carefully saddled often 
suffer, as also do those which have irregular action. Lame horses 
frequently have saddle-galls, especially on the withers, on account of the 
unequal incidence of the body weight shifting the saddle towards the 
side of the sound foot. Saddle-galls are often caused by horses sweating 
profusely, or by the skin being soaked in rainy weather. The mechanical 
causes may be divided into three groups— 

(1) Faulty construction of the saddle. The best preventer of saddle- 
galls is a skilful and careful saddler. Though it appears easy in 
principle to distribute the pressure equally over the largest possible 
surface, in practice it is really very difficult. The saddle must neither 
be too narrow nor too wide, and provision must be made for changes in 


TREATMENT OF SADDLE-GALLS. 203 


the condition of the animal. A saddle, when too wide, endangers the 
withers; when too narrow, it bruises the bodies of the ribs with the 
outer edges of the bearers. The front portion must conform to the 
height of the withers, which are injured if it be too low. Fractures or 
bends in the bearers or branches of the saddle-tree, badly-stuffed panels, 
or repeated soaking of them, easily lead to saddle-galls. Parts of the 
saddle or collar, which do not fit closely to the body of the animal, 
sometimes produce skin excoriations. 

(2) Faults in saddling, or in putting on the collar. Folds or foreign 
bodies in the padding, however small, often produce bruises. The 
padding, if it shifts upwards, may injure the withers. The practice of 
applying the saddle-blanket so that it shall be pushed slightly back- 
wards when the saddle is placed in position is recommended, because 
the hair of the saddle-bed will thus be smoothed in its proper direction. 
The saddle, if too far forward, may directly bruise the withers; if too 
far back, it works forward, the girth becoming loose and easily causing 
bruises. Loose girths, and irregular tightening of the component parts of 
the girth in the German saddle, also give rise to saddle-galls. 

(3) Errors in riding. An awkward position in the saddle, sleeping 
on horseback, and continual shifting forward, displacement of the saddle 
in mounting, and injudicious riding, are frequent causes of injury. These 
injurious influences must, however, be in operation some considerable 
period before serious saddle-galls are produced; they seldom result from 
short excursions. 

Treatment.—To prevent the condition, general experience suggests 
leaving the saddle on for half to one hour after dismounting. Where an 
injury has taken place, the vessels are compressed and almost bloodless. 
If pressure be now suddenly and completely removed, blood is vigorously 
forced into the paralysed vessels, and may thus rupture their walls. On 
the other hand, if the saddle is allowed to remain some time in position, 
circulation is gradually restored without injury. The fact that the swelling 
first appears after removal of the saddle supports this explanation. 

In cutaneous swellings further extravasation is most surely checked 
by cold, which causes the vessels to contract; while reabsorption of 
extravasation, which has already taken place, is most favoured by moist 
warmth. According to my experience, the use of cold is indicated in 
fresh cases—that is, in those seen immediately after the appearance of 
the swelling. In twelve to twenty-four hours, on the other hand, moist 
warmth deserves preference ; and, where cold cannot be carefully and con- 
tinuously applied, Preisnitz’s poultices should be employed. The use 
of cold may be associated with gradual slight pressure, or, even better, 
with massage. <A cloth folded several times, or a bag filled with little 
pieces of ice, is very useful in fresh cases. The old practice of binding 


204 TREATMENT OF SADDLE-GALLS. 


a flat stone on the swelling leads to necrosis of the skin; the application 
of a turf soils the back, and thus predisposes to new bruises. Massage, 
in the form of gentle stroking with the fingers, greatly hastens reabsorp- 
tion. Most cutaneous swellings of recent appearance can be removed in 
twelve to twenty-four hours by cold, associated with massage. When of 
longer standing, moist warmth in the form of Preisnitz’s poultices 
deserves preference, and can be assisted by massage. Where necrosis. 
does not result, this method of treatment always succeeds. Tincture of 
arnica, often used, has no effect ; even its antiseptic properties are nullified 
on account of the excessive dilution to which it is generally subjected. 

Where necrosis has appeared, separation of the dead portions is 
facilitated by Preisnitz’s poultices, or warm cataplasms of linseed 
meal. Portions of necrotic skin, as they become loose, should be 
removed with dressing forceps. Some power may have to be exerted. 
Should this not succeed, the heat and moisture must be persevered 
with. Extraction of the mummified piece of skin does not assist 
healing greatly, because the division between the living and dead 
tissue is seldom lighted upon. After separation of the piece of skin, the 
wound is gradually filled up by granulations. The general principles of 
asepsis must be strictly enforced. As soon as a dry scab has formed, 
interference should be avoided. Where the wound has filled up, 
cicatrisation advancing, and the neighbouring swelling disappeared, 
the saddle may again be used, with such precautions as a smooth piece 
of waxed linen sewed into the flaps, where they overlie the damaged 
spot. This protects the tender surface while it is denuded of hair and 
only covered with a thin epidermis. 

Injuries to the withers, particularly those complicated with effusion 
and extravasation into the sub-cutis, require quite different treatment. 
In fresh cases cold is useful, but without pressure and without massage. 
Any considerable pressure usually causes pain, while massage favours 
further bleeding into the sub-cutis. After twenty-four hours, moist warmth 
is to be preferred. To prevent infection and pus formation, an anti- 
septic can be added to the poultices, which may be prepared with 1 per 
1000 sublimate solution. Where the tenderness is less, and large 
hematomata exist, massage may later be used. Artificial removal of 
the contents may here be recommended, using a Pravaz’s syringe 
(Peters), though antiseptic precautions must in such case be observed very 
carefully. Both the skin and instrument must first be strictly dis- 
infected; and, after removal of the extravasation, which is frequently 
lymph, moderate pressure should be maintained by means of 
antiseptic dressings to prevent recurrence. Particular care is required 
in using the knife, and fluctuating swellings must only be opened when 
it is quite clear that pus exists. It is preferable, in doubtful cases, to 


TREATMENT OF SADDLE-GALLS. 205 


employ a blister of cantharides, sublimate, or biniodide of mercury, by 
which a swelling is caused and moderate pressure produced on the 
extravasated material, bringing about resorption, 

Pus formation in the region of the withers renders treatment very 
difficult. Removal of pus and necrotic material, and prevention of fresh 
pus formation and necrosis are the chief objects to be sought in these 
cases. The knife must often be used freely. Fistulee should, if possible, 
be laid open to their extremity, pockets exposed, and necrotic pieces of 
lig. nuche, of fascia and of superior spinous processes removed as soon as 
possible. Setons and drainage-tubes assist the escape of the discharge, 
and prevent fresh burrowing of matter. In the event of pus forming 
beneath the muscles, these are laid open, but care must be taken not to 
divide the skin crosswise over the middle line of the back, because in 
this way wounds result, which heal with difficulty on account of their 
edges turning inwards. Sometimes suppuration extends to the muscular 
tissue of the neck, which must then be laid open usually as deeply as 
the lig. nuche, which, as in poll-evil, requires to be divided. The 
greatest difficulty is experienced where necrosis has attacked the superior 
spinous processes of the vertebre. Separation takes a long time, and 
during this process new pockets may form and fresh structures become 
necrotic. Should the diseased points be removed with the curette, fresh 
necrosis usually occurs on the surface of the bones, so that with this 
operation no progress is made. Removal of the diseased spinous 
process is only successful where permanent irrigation can be provided 
for, and perfect asepsis attained; but, in such cases, the results are 
often astonishingly successful. Unfortunately the inflammation and pus 
formation only occasionally allow of this. Good recoveries can only be 
expected where pus formation has almost entirely disappeared, and where 
no marked swelling exists. 

Still graver is burrowing of pus under the scapula. In such cases 
necrosis of the scapula and its cartilage readily occurs, and great diffi- 
culty is found in effecting the escape of pus. The process may involve 
the inner surface of the scapula on account of the extension of purulent 
processes and necrosis of the fascia of the serrati muscles, and the disease 
thus become further removed from the possibility of direct treatment. In 
such cases counter openings at the posterior border of the scapula, and the 
insertion of drainage-tubes may be tried, though such treatment often fails. 

In bruises of the withers, inflammatory disease of the bursa mucosa, 
lying on the superior spinous processes of the 5th to 7th cervical verte- 
bre, may occur. In such cases a flat fluctuating swelling appears on 
the withers close to the middle line, sometimes on one, sometimes on 
both sides; often attains the size of a small cheese-plate, and is attended 
by moderately developed symptoms of inflammation. The condition 


206 BRUISES PRODUCED BY THE COLLAR. 


consists of bursitis with extravasation of serum or blood (hydrops or 
hematoma of the bursa), and may be easily mistaken for extravasation 
or abscess. Its slow progress and its appearing on both sides, distin- 
guish it from lymph or blood extravasations, which usually develop 
rapidly. It is easier, but more dangerous, to regard it as an abscess, 
because incision always produces pus formation, which it is desirable to 
avoid. The hard swelling produced by infiltration, appearing around 
an abscess, distinguishes it from the soft surroundings usually met with 
in bursitis. Should difficulty occur in diagnosis, an exploratory punc- 
ture may be made under antiseptic precautions. After carefully disin- 
fecting the skin, a sterilised needle or an exploratory trochar may be 
passed. Should serum or blood alone be discharged, it is clear that 
the case is one of bursitis or extravasation. After removing the con- 
tents, compresses should be applied to keep up moderate pressure on 
the diseased spot, and prevent recurrence of the exudation; while to 
avoid infection, disinfectants are used in the poultices. Where these 
cannot be applied, infriction with sublimate ointment (1 to 8) is adopted. 
Excoriations of the skin must be carefully cleansed, and the surface 
powdered with iodoform conjomed with tannin or starch flour, or 
smeared with a neutral fat or ointment (ungt. vaselini). The latter 
should be applied when swelling attends the excoriation, and after 
applying the fat or ointment, either cold or Preisnitz’s poultices may be 
used. When such places have healed, the collar must be provided with 
a soft covering (hare skin), or a small piece of waxed cloth, in order to 
prevent injury. The active movements of the muscles of the skin some- 
times prevent the healing of surface injuries. This occurs especially in 
summer, when flies abound. In such cases the application of blistering 
ointment in the neighbourhood of the affected spot is of excellent service. 


(2.) BRUISES PRODUCED BY THE COLLAR OR OTHER 
PORTIONS OF THE HARNESS. 


The horse collar consists of the housing, the two lmbs, usually 
formed of iron, the padding, and the upper and lower open groove. 
The collar must lie parallel with the scapula without touching it, which 
it is apt to do if too wide, producing excoriations of the skin over the 
scapular region. Most frequently the upper groove causes injury ; if 
too narrow it bruises, if too wide the skin is rubbed. As a rule, when 
the collar is in position there should be sutticient room to allow of the 
hand passing between it and the withers. The collar besides must be 
wide enough to be easily pushed over the horse’s head, and, moreover, 
fit the shoulder, so that it is neither pushed towards the left nor right. 


TREATMENT OF BRUISES BY THE COLLAR. 207 


Injuries caused by the collar are in all essentials similar to those 
caused by the saddle. Those in the neck region have the same signifi- 
cance as injuries to the withers, that is, they are only grave when the 
subeutis is injured. As long as the swelling is movable and remains 
sharply defined, the cutis alone has been damaged. In diffuse swellings 
pus formation easily extends to the lig. nuchee, producing cellular 
inflammation and necrosis, and burrowing of matter between the cervical 
vertebree—a condition which offers great difficulty in treatment. This 
is particularly true of necrosis of the membraniform portion of the lig. 
nuche. Such diseases are always obstinate, sometimes incurable, 
because cellulitis, set up between the muscles of the neck, leads to 
abscess formation, and renders it impossible to make counter openings 
for exit of pus. Extensive swelling and profuse pus formation are 
amongst the gravest symptoms, 

Treatment must be based on the same principles as are laid down 
for fistulous withers. The skin must not be divided transversely across 
the top of the neck, but the lateral surfaces need not be spared, and 
muscles undermined with pus must be freely laid open. Cutaneous 
swellings produced by collar pressure are to be diagnosed and treated in 
the same way as similar injuries caused by the saddle. The injuries 
produced by traces, tail straps, girths, and surcingles usually consist of ex- 
coriations of the skin, are caused by the harness not fitting accurately and, 
during the animal’s work, moving continually over the surface of the 
skin, and so rubbing off hair and epidermis. Such injuries are natur- 
ally favoured by a hard and rough condition of the harness. 

To protect the injured spots, the portions of the harness causing 
the injury should be covered with smooth waxed linen which is 
preferable to hare or rabbit skins, sometimes used. In cattle similar 
injuries are caused at the upper part of the neck, by the collar or 
yoke. The diagnosis and treatment must be as above indicated. 
In those animals deep-seated suppuration occurs in the region of the 
poll, giving rise to intermuscular inflammation and further pus 
formation, and sometimes producing conditions which are very difficult 
to treat. Bruises on the head in cattle are also caused by yokes, 
especially if the horns are placed low, or the forehead is markedly convex. 
Such inflammatory processes readily extend to the periosteum, lead to 
necrosis of the temporal bone, and may extend to the horn core, pro- 
ducing loosening and loss of the horns. Swelling, increased warmth, 
and pain occur to a varying extent and degree. The diagnosis, however, 
is usually favourable, if the animals can be laid off work for some time. 
As to treatment, the general principles of surgery must be pursued. 
Necrotic bone or loosened horns are to be removed, and the spread of 
inflammation checked by antisepsis. 


208 TUMOURS OF THE BREAST. 


ViI.—TUMOURS OF THE BREAST. 


Lit.: Wilhelm, Dresd. Ber. 1883, p. 84. Pflug, Oesterr. Monatsschr. fiir 
Th, 1891, p. 293, 


In draught horses tumours occur in and under the skin, chiefly from 
friction of the collar. They are either single or multiple, and may 
attain considerable size. Those in grey horses are generally melanotic ; 
in horses of other colours they may be mycofibromatic, or result from 
infection with bothryomyces, staphylococci, and other pyogenic 
cocci, sometimes introduced by dirty collars. Wilhelm found 
enlargements in the skin of the breast, each containing a small pus 
centre. They had been treated with iodine and preparations of mercury 
without effect. Pflug has lately described certain diseased processes of 
the skin of the shoulder as tylomata. The cut surface in recent cases 
often appears oedematous, and on casual examination, may easily be 
mistaken for a myxomatous growth; the older swellings are firm and 
hard (tylomata fibrosa, Pflug). Nor is it astonishing that new growths 
often rise from the cutis or sub-cutis, considering the chances of 
infection here on account of the epidermis below the collar being 
macerated and not infrequently injured. Many horses in the same 
stable have been seen to suffer from this disease, the tumours appearing 
under the collar and producing inflammatory swellings from bruising. 
In horses, local centres of inflammation occur in the shoulders, forming 
little nodules. They originate in the sebaceous and hair glands, and 
are commonest during warm weather. If they remain unnoticed, and 
the animals be kept at work, inflammation spreads and abscesses form 
in the site of the glands. 

Prognosis of such enlargements depends on their extent and position, 
usually determined by careful palpation. Small tumours are extirpated 
with the scissors, large with the knife; when taken in hand early, 
recovery is usually complete, although recurrence is not infrequent. If 
the neglected swelling attains a considerable size, possesses a broad base, 
or extends to the pre-scapular lymphatic glands, removal is more difficult. 
When convinced that these glands are implicated, I have repeatedly 
excised them without particular trouble or danger. The “heat bumps ” 
require the animal to be kept from work, or the collar to be eased. 
Moist warmth favours their absorption. ‘Those suppurating must be 
opened early. 


TAPPING THE CHEST. 209 


VIII—TAPPING THE CHEST (PARACENTESIS THORACIS, 
THORACOCENTESIS). 


Ger. Bruststich. 

Lit.: Ribaud, Rec. de med. vétér. 1892, ref. B. T. W. 1892, p. 272. 

This operation, practised in man since the earliest times, was first 
introduced into veterinary surgery by Lafosse in 1772. It is adopted 
to remove fluids, especially pleuritic effusions, seldom to get rid of air. 
The diagnosis of such conditions is explained in the text-books on special 
pathology, and can usually be determined without the explorateur. 
- In detecting empyema, however, the exploring needle is serviceable. 
Pleuritic effusions compress the lungs and diaphragm, and, interfering 
with respiratory movements, and the heart and great vessels, impair 
circulation. Tapping relieves those untoward conditions, but does not 
always arrest outpouring of fluid or save life. Hence the operation is 
often regarded as an experiment, and is only occasionally performed. 
Its timely adoption is frequently useful where the pleural cavity con- 
tains pus or septic materials, especially if the pus can be washed out 
with disinfectants. No permanent benefit results from removing blood 
from the pleural sac, because if the membrane is not seriously diseased 
absorption rapidly occurs. In perforating wounds of the chest, the 
early injection of antiseptics, and performance of paracentesis, may 
prevent injurious effects from decomposition of extravasated fluid ; but in 
chronic hydrothorax, which has resulted from impaired circulation or 
change in the composition of the blood, it only hastens death. 


(1.) PUNCTURE OF THE THORAX FOR REMOVAL OF 
SEROUS OR PLEURITIC EXUDATE. 


The trochar used for the larger animals has a diameter of + inch; 
but one of smaller calibre is usually preferable. Side openings in the 
canula are not of particular value. Various precautions require to be 
observed :— 

(1) Careful disinfection of the instrument and site of operation. 

(2) Prevent entrance of air into the thorax. 

(3) Remove contents slowly, to minimise interference with cir- 
culation. 

The patient, if possible, should stand, as the recumbent position 
only adds to the difficulty of the operation. This applies equally to 
the smaller animals especially if there is much dyspnea. I have 
known a dog with hydrothorax die in a few minutes from being 


placed on his side. The operation is not now performed as low 
O 


210 PUNCTURE OF THE THORAX. 


down as formerly. The trochar is introduced between the ensiform 
cartilage of the sternum and the cartilage of the last sternal rib, 
avoiding entering the peritoneal cavity. In all animals the opening 
should be made either slightly above or slightly below the vena thoracica 
externa, keeping clear of the large pectoral muscle, which lies still 
lower. The upper position deserves preference. Where both pleural 
sacs contain fluid, the operation should be performed on the right side, 
to prevent injuring the heart. The vertical boundary for punctures lies 
in the horse between the 5th and 8th ribs; in oxen, between the 6th 
and 9th; in swine, between the 7th and 9th; and in carnivora, between 
the 5th and 9th. 

The hair is first shaved from the site of operation, the skin washed . 
with soap and rinsed with ether, and finally saturated with such 
disinfecting fluid as diluted sublimate. Similar care must be taken 
in disinfecting the trochar. In private practice this is most easily and 
safely effected by boiling the instrument in water, or laying it in a 3 
to 5 per cent. solution of carbolic acid. ‘To facilitate the entrance of the 
instrument, often difficult in animals with thick skins, an incision is 
first made with a bistoury or lancet. The trochar, grasped with the 
handle in the hollow of the right hand, is supported with the thumb 
and fingers, while the index finger, more or less extended, is fixed 
on the canula at the point to which the trochar is to enter. This 
distance varies according to the thickness of the thoracic wall, and in 
the larger animals varies from 1} to 24 inches. Should the skin be 
movable on the sub-lying tissues, it may be pressed upwards, and the 
trochar introduced perpendicularly to the chest-wall until the index 
finger meets the skin. The stilette is now withdrawn with the right 
hand, whilst the left supports the canula, and the left index finger is 
held ready to close the opening against entrance of air, which may occur 
when the flow of fluid ceases, when inspirations are specially deep, or when 
coughing ensues. If the discharge of fluid is prematurely checked by 
clots of lymph or blood, or by apposition of the lung, a few slight lateral 
movements should be made with the canula, and the stilette or a 
carefully-disinfected probe passed through it. To facilitate the discharge 
of fluid and prevent access of air, various arrangements have been proposed. 

Schuh has devised a trochar, carrying at its outer end a reservoir 
(trough or bath), so that the opening of the canula is always immersed 
in fluid; but this arrangement is not reliable, and is little used. The 
so-called aspirator (fig. 70) consists of a rubber tube, hollow needle, and 
large syringe provided with a tap. The hollow needle is inserted, the 
piston raised, and when the syringe has become full, the tap is turned, and 
the contents discharged. The process is then repeated. The aspirator. 
however, has been little used in veterinary surgery. The same object 


PUNCTURE OF THE THORAX. PAA 


is more easily attained by pushing one end of a suitable indiarubber 
tube over the free opening of the canula, and dropping the other end 
into water. This syphon-like arrangement exerts an aspirating action on 
the contents of the thorax, but has the disadvantage that the outflow 
cannot be exactly controlled, while forcible aspiration may rupture 
pleural vessels. 

While using the ordinary instrument, if it be required to check the 
outflow of fluid, or prevent entrance of air, and 
especially if excitability, dyspnoea, and coughing 
set in, the trochar must be removed. The 
necessity of removing pleuritic effusion gradu- 
ally, points to the use of trochars of moderate 
calibre. Rapid discharge of large quantities of 
fluid are liable to produce sudden changes of 
intra-thoraciec pressure, determining grave distur- 
bances of circulation, which may occasion not 
only fresh extravasation, but pulmonary bleeding, 
syncope, or even sudden death. The danger is 
greatest in left-side extravasations, by which the 
heart has been pushed towards the right side. It is, 
therefore, advisable in horses and cattle to remove 
only 6 to 12 pints at one time, and a further 
quantity some hours later, or on the following day. 
From the position of the tapping, the complete 
evacuation of the pleural sac is impossible; but 
even if it were possible, as already pointed out, 

: : Hie? 70— 

it would not be desirable. In too many cases _pijeulafoy’s Aspirator. 
fresh extravasation soon takes place. When 

sufficient fluid is believed to have been removed, the stilette, pre- 
viously cleansed, is again introduced, and the canula carefully re- 
moved, ‘the wound rinsed with a disinfectant, powdered with iodoform, 
and closed with wound gelatine or collodion. A simple application of 
tar may be sufficient; a suture is sometimes inserted, and the actual 
cautery has been recommended, but not very wisely (Hoffmann). The 
benefits of paracentesis mainly result from its modifying intra-thoracic 
pressure, relieving compression of the lungs, and improving conditions for 
absorption. 


(2.) PUNCTURE OF THE THORAX FOR REMOVAL OF 
PURULENT OR PUTREFACTIVE EXUDATES. 


Thoracic puncture for purulent or putrefactive collections, or for 
abscesses in the lungs, is not often employed and rarely proves suc- 


212 PUNCTURE FOR EMPYEMA. 


cessful. The procedure is the same as in pleuritic effusion, particular 
attention being paid to antiseptic precautions. Exploratory punctures 
may sometimes be needful for diagnosis. 

After complete removal of the contents, it may be desirable to wash 
out the cavity, or the abscesses between the layers of the pleura, or in 
the lung. For this purpose Lafosse used aromatic fluids. Hoffmann 
employed the tube used for carrying off the fluid, for introducing into 
the thorax chloride of sodium, 5 per cent.; sublimate, 1 m 5000; 
earbolic acid, 5 per cent., or concentrated salicylic acid, or thymol 
solutions, warmed to 98° Fahr. What success was attained is not 
recorded. In man, an incision 1s sometimes made into the thorax 
(thoracotomy), a portion of one rib removed, and the sac freely irrigated. 
No such operation, so far as I am aware, has been tried in our 
patients, in which treatment is generally a question, not so much of 
saving life, as of restoring usefulness. Under these circumstances the 
operation is burdened with conditions, which it is unable to satisfy, 
and which render it difficult to carry out in private practice. The 
same is largely true of the surgery of the lung, lately introduced in 
man, which aims at direct operative treatment of diseased processes in 
the lungs and in other organs of the chest. 


IV. DISEASES OF THE ABDOMEN. 


Introduction,—The abdominal walls consist mainly of the skin, yellow 
fibrous aponeurosis, particularly strong in herbivora, the muscles, a layer of fat, 
and the peritoneum. The muscular fasciculi overlie and cross one another, and 
have numerous tendinous expansions. In herbivora the stout, thick abdominal 
walls, which always appear distended, have to support the bulky digestive 
organs, effectually protect them from external injury but render an ex- 
amination of them almost impossible. The abdominal walls are externally 
clothed with skin, possessing a well-developed sub-cutis, whilst their inner 
surface is covered with peritoneum, which both lines the cavity and invests 
its contained organs. The uninjured peritoneum is smooth and shining, 
allowing the abdominal viscera to play easily over each other; but when in- 
flamed, exudation occurs, and the surfaces may become adherent. Excepting from 
penetrating wounds, and more rarely from bruises, the abdominal organs are rarely 
injured from without. Voulton (Stockfleth) found, however, the rumen of 
an ox ruptured by a blow from a horse’s foot. Death rapidly followed from 
peritonitis. 

In horses, ruptures of the spleen have been observed. 

The abdominal walls receive their blood from two sources: the lumbar 
arteries enter between the lumbar muscles, pass obliquely across the abdomen, 
between the outer and inner oblique abdominal muscles, and between the 
latter and the transverse abdominal muscle, and communicate frequently with 
the vessels of the abdominal parietes. The anterior abdominal artery arises 
from the internal thoracic artery and passes backwards. The posterior abdo- 
minal artery, arising from the prepubic artery, takes a course close below the 
peritoneum in the middle line, passes the inner abdominal ring in a forward 
direction, and anastomoses with the anterior abdominal and with the lumbar 
arteries. 


I—BRUISES OF THE ABDOMINAL PARIETES. 
Lit.: Curdt, Gurlt u. Hertwig. 3, p. 456. 


These occur rather frequently in the domestic animals, and are caused 
by kicks, thrusts with the horn, treads, by animals rushing together, or 
by collisions with vehicles. The nature of the injury mainly depends 
on the character of the injuring body, and the force with which it is 
appled. Sometimes the walls are ruptured,—a condition described 
later; whilst the skin, on account of its greater elasticity, remains 
intact. Sharp objects produce surface wounds, sometimes perforate the 
abdominal walls, and may even penetrate the internal organs; these 


214 BRUISES OF THE ABDOMINAL PARIETES. 


last accidents will also be considered later. Bruises of the soft portions 
of the abdominal parietes from horn-thrusts, &c., are frequent in herbivora, 
on account of the tension of the abdominal walls ; and, as in other regions, 
are characterised by a subcutaneous solution of continuity in the vessels 
and tissues. When small blood-vessels and limited tracts of tissue are 
ruptured, more or less hard, firm, inflammatory swellings result. When 
larger vessels are ruptured, swellings (hematomata) resembling hernie 
are produced. In large animals extensive extravasations commonly 
develop in the sub-cutis, or under the panniculus, but are rarely seen 
under the slightly elastic, yellow abdominal tunic. The tunica abdo- 
minalis may likewise be divided, and the rupture mistaken for a hernial 
opening. But such faulty diagnosis is less serious than when a hernia 
is taken for an extravasation, and treated as such. 

Progress.—Simple inflammatory swellings, even when of moderate 
size and situated on the yellow abdominal tunic, are more easily reab- 
sorbed than large hematomata. But when the swelling disappears, a 
portion of the abdominal contents may present itself under the skin. From 
its fluctuating this may be mistaken for an abscess, which, however, is 
distinguished by the periphery of firm solidified tissue, and the softening 
centre. When abscess supervenes, it generally perforates outwardly, 
seldom discharges into the peritoneal cavity or into the intestine, and, when 
opened, usually heals. Inflammatory processes invading the peritoneum 
cause thickening, and occasionally lead to adhesions limiting the move- 
ments of the bowel, the walls of which may give way, as Curdt has noticed 
in the horse. Hematomata undergo a course similar to that of inflam- 
matory swellings, but their resorption is less probable. On their perforat- 
ing or being opened, they discharge offensive fluids and sometimes gas. 

In cattle, less frequently in the other domestic animals, there occur 
in the walls of the abdomen so-called cold abscesses. Their cause may 
escape observation, the injury itself fora considerable period may remain 
unrecognised ; as in strangles, they may have a metastatic origin. In cattle 
especially, months may elapse before any change is noticed, but then the 
swelling suddenly and rapidly increases, becomes painful, sometimes con- 
tains gas, may produce high fever, and, if not opened, soon perforates. 

The appearance of the swelling, as before stated, may vary. It 
may be firm, hard, and painful; sometimes it is fluctuating. When 
recent, it is often associated with cedema, especially in deeper lying 
neighbouring parts, under the belly. As pointed out, it may be 
mistaken for a hernia, and the rule should be observed not to operate 
before being perfectly convinced of the absence of rupture. The com- 
pressibility of the hernia is certainly characteristic, but nevertheless 
mistakes easily occur. In doubtful cases, an exploratory puncture may 
be made with antiseptic precautions. | 


WOUNDS OF THE ABDOMEN. PA Ws 


Treatment.—Newly developed swellings are first treated with cold 
applications to prevent further extravasation ; subsequently moist warmth 
is used to assist dispersal. Disinfectants, conjoined with the other 
applications, will check infection and pus formation. Where this has 
already occurred, early opening is advisable; indeed, the sooner this is 
done the sooner will the swelling disappear. The so-called cold abscesses 
are best opened as soon as it is clear that no hernia is present, and 
that incision can be made without fear of severe bleeding. 


Il—WOUNDS OF THE ABDOMEN. 


Lit.: Rodloff, Gurlt u. Hertwig. 18, p. 212. Parkes, Koénigs Chirurgie. 
II. p. 125 (V. Aufi.). Kleinpaul, Berl. Arch. 1890, p. 221. Kaden, 
Zeitschr. fiir Vet. 1890, p. 368. Drolshagen, Th. Mitth. 1854, p. 73. 
Humbert, Rec. de Méd, vét. 1885, p. 54. Popow, Jahrb. 1884, p. 
96. Herbet, ibid., p.96. Jewsejenko, ibid., 1884, p.95. Richter, 
Gurlt u. Hertwig. 20, p. 341. Chaput, Arch. général. de Mid. 1892. 
Walthard, Centralbl. fiir Bakter. u. Paras. 12 ref. in Zeitschr. fiir Vet.- 
Kund. 1892, p. 411. 


Wounds of the abdominal parietes may, from a clinical standpoint, be 
thus divided :— 


(a) Surface wounds; those that do not divide the abdominal walls. 

(6) Penetrating wounds, dividing the parietal portion of the peri- 
toneum. 

(c) Abdominal wounds, with prolapse of internal organs. 

(2d) Abdominal wounds, with injury to internal organs. 


(a) Surface wounds, if not of great extent, and not likely to be fol- 
lowed by further laceration of the abdominal walls, merely require to be 
kept clean, and are usually covered with a tar plaster. Bandages are 
difficult to retain in position, and can generally be dispensed with. 
Clean straw must be provided for bedding. Where the wound dis- 
charges freely, it is dressed with disinfecting fluids. If pus - burrows, 
counter-openings, drains, or setons are resorted to. Where the walls are 
extensively lacerated, and further laceration is possible, the wound should 
be carefully sutured, and supported with a bandage. Strong and deeply- 
inserted stitches are required, pin sutures may be necessary, and thorough 
rest should be enforced. 

(6) Penetrating wounds are usually caused by thrusts with the 
horns, by sharp instruments like manure- or hay-forks, lances, bayonets, 
knives, or scissors, by gun-shots, by injuries from leaping over hedges or 
fences, or by falling on sharp objects, as harrows, spurs, &c. The bites 


216 PENETRATING WOUNDS OF THE ABDOMEN. 


of dogs may also penetrate the peritoneal cavity. The perforating 
character of the wound can sometimes be determined, or at least guessed, 
from the appearance of the body producing the wound. The probe 
should not at once be used, as there is risk of its conveying infectious 
material into the peritoneal cavity. Besides, its value for diagnosis in 
such cases is small, owing to the layers of muscle being often dis- 
placed, and thus occluding the channel of the wound. Where perfor- 
ation is suspected, the case should be dealt with as if it were proved to 
exist. Penetration of the peritoneum may shortly be demonstrated by 
symptoms of peritonitis, the small, weak, frequent pulse, paleness or 
dirty red colour of the visible mucous membranes, slight or con- 
tinuous colic, and, in carnivora, vomiting. Perforation, however, may 
occur without peritonitis, It may be disclosed by protrusion of 
abdominal organs, or discharge of the contents of the bowel. 

Every penetrating wound of the abdomen must be regarded as 
dangerous. The abdominal cavity is now, however, frequently laid open, 
with greatly reduced risk, in surgical operations undertaken for the 
relief of enteric tympanites, abdominal ascites, and the castration of 
females and cryptorchids. Numerous accidental injuries with per- 
foration often heal, even in circumstances apparently unfavourable 
to recovery. Stockfleth reports that a dog, pierced transversely through 
the abdomen with a hay fork, recovered without pus formation. Hum- 
bert saw a mare with an abdominal wound, 2 inches in leneth, com- 
plicated with the prolapse of 20 inches of epiploon, recover. The 
wound lay 4 inches behind the xyphoid cartilage. Kaden reports a 
similar case. Popow had a cow recover of a penetrating wound, 6 
inches in length, situated behind the last rib. He also records that a 
foal had a wound, 9 inches in length, between the umbilicus and the 
udder, close to the linea alba; the peritoneum was thrust forward, was 
dirty, became necrotic, a portion was protruded and pinched by the 
edge of the wound; yet healing occurred in four weeks. I have 
repeatedly seen such injuries recover, although complicated with prolapse 
of the bowel or epiploon ; and numerous cases of the kind can be discovered 
in the literature of the subject. Usually the lower part of the abdominal 
wall is injured, and the colon or ceecum prolapsed. 

Prognosis principally depends on whether prolapse of the intestine 
and peritonitis can be prevented. Unlike men, animals cannot be kept 
for any considerable period lying on their back, or even quietly in the 
recumbent position, and there is thus greater danger of prolapse of the 
bowels. Peritonitis can be prevented by antiseptic treatment of the 
wound. So long as asepsis is maintained, recovery need not be de- 
spaired of. Even where pus formation has occurred, this is not impos- 
sible. The peritoneum varies in sensitiveness in the various classes of 


TREATMENT OF ABDOMINAL WOUNDS. PAG | 


animals. Wounds penetrating it are less serious in carnivora and 
ruminants, but more so in horses, in which the risks of peritonitis are 
greater. 

Treatment.—The chief indications are to maintain asepsis, and 
prevent prolapse of internal organs. The first is attained by careful 
cleansing and disinfection of the wound and its neighbourhood. If 
necessary, bleeding must be checked, by ligaturing injured vessels, and 
blood prevented accumulating in the wound, but tampons are only 
employed in case of need. Foreign bodies, and loose shreds of soft 
tissue, hkely to become necrotic, should be removed. The wound is 
washed out very carefully with disinfectants, of which my experience leads 
me to prefer corrosive sublimate. It may then be sutured with steril- 
ised silk; cat-gut is not sufficiently strong. The abdominai muscles 
and the skin should be brought together separately with deep stitches, 
so that should washing out afterwards become necessary the outer 
stitches need alone be loosened. On account of the great strain which the 
stitches must endure, particularly in herbivora, it is better in bringing 
together the abdominal walls to employ quilled sutures. Where pocket- 
ing of considerable quantities of wound discharge is probable, drains must 
be inserted, and the parts once more rinsed with disinfecting fluid. The 
sterilised material (wadding, wood wool, or jute, &c.) may, in larger 
animals, be held in position with soft cardboard or a straw mat; where 
these are not available, a sack or woollen rug may be used. The several 
dressings are kept in place by bandages or girths passed between the 
animal’s forelegs, and over its neck in the long axis of the body. 
Bandages also are sometimes introduced between the layers of dressings. 
In small animals, to prevent displacement from breathing movements, 
the bandages are wound around both the thorax and abdomen. 

Should it subsequently become necessary to cast a large animal, in 
order to insert stitches or adjust dressings, care will be required to 
prevent prolapse and to protect prolapsed organs. For these purposes 
it may be necessary to apply a provisional dressing. Under certain 
circumstances anesthesia is of assistance. After adjusting the dressing, 
the animal must be kept as quiet as possible. Dogs are often trouble- 
some, and as they try to tear off the dressing, must be continually 
watched, or receive a full dose of morphine, so that they shall sleep for 
several hours. The larger animals may, if necessary, be placed in slings. 

For several days the food chosen should be digestible, nutritious, and 
small in amount, and water given only in small quantities. During 
this time fever may supervene; if not marked and if symptoms of 
colic are absent, a favourable termination may be expected. The dress- 
ing is left undisturbed, unless it become saturated with discharge, or 
fever or other untoward symptom appear, when it is removed, the 


218 ABDOMINAL WOUNDS, WITH PROLAPSE OF INTERNAL ORGANS. 


wound cleansed and disinfected, and the dressing replaced. Where from 
any cause dressings cannot be employed, the wound, after being cleansed 
and sutured, is irrigated with antiseptic fluids. Danger of wound 
infection is greatest during the first three days. 

(c) Abdominal Wounds, with Prolapse of Internal Organs.— 
The prolapse of portions of omentum, bowel, uterus, or other abdominal 
organs, constitutes a dangerous complication. The prolapse per se is not so 
dangerous, but there is much difficulty in retaining it in position, prevent- 
ing soiling and injury, and the entrance of infectious materials into the 
abdominal cavity. Omental prolapse is least dangerous, because, in the 
event of its return being impossible, a large piece may be removed 
without bad consequences. This is often done with impunity in cas- 
trating horses and other animals. Where the omental protrusion is 
large and contains important blood-vessels, a sterilised ligature is applied, 
the portion below cut off, and the remainder thrust back into the 
peritoneal cavity, or still better, into the abdominal wound, to which it 
becomes attached, preventing egress of other organs and entrance of 
infective wound secretions. The portion of omentum thus detained in 
the wound shows no great tendency to set up inflammatory processes. 
If the protruded omentum has become soiled or necrosed, its removal is 
still more imperative. All experienced practitioners recommend its 
being further withdrawn and cut off. I have repeatedly seen abdo- 
minal wounds in dogs and eats, in which the prolapsed omentum was 
converted by injury into a black greasy mass with an offensive smell, 
but when this was excised, healing quickly ensued. 

Prolapse of the bowel is more dangerous, because the viscus must be 
returned to the peritoneal cavity. Recoveries nevertheless occur in all 
animals, provided the protruded portion be carefully cleansed and 
replaced, and fresh prolapse prevented. Prolapses of the colon are 
generally least troublesome. In the horse, prolapse of the colon or 
ezcum, following injury to the under portion of the abdominal walls, is 
more easily reduced and kept in position than that of the small intestine, 
because the colic mesentery is shorter than that of the small intestine, and 
the viscus projects less, hence there is less risk of infectious organisms 
being introduced into the abdominal cavity. Drolshagen treated a foal, 
which had been wounded by a horn thrust; the omentum and bowel were 
prolapsed, the extruded bowel, which was as large round as a_bee-hive, 
hindered the animal’s movements, and compelled it to lie down frequently. 
After thorough cleansing the bowel was returned, a portion of the 
omentum cut off, the wound sutured, and a dressing applied. Though 
it had a few slight attacks of colic, the patient appeared restored to 
health in three weeks, but four months afterwards it died. Post-mortem 
showed that the small intestine had passed through a rupture in the 


ABDOMINAL WOUNDS, WITH INJURIES TO CONTAINED ORGANS. 219 


mesentery, and become strangulated. Kleinpaul saw a_ penetrating 
abdominal wound in the umbilical region of a mare, caused twelve hours 
previously by injury from the teeth of a harrow. <A portion of the 
small intestine, as large as a man’s fist, was prolapsed, cedematous, and 
swollen. This was replaced, an iodoform dressing applied, and food 
being withheld for four days, perfect healing resulted. Fourteen days 
later the mare gave birth to a foal and did well. 

In treatment of prolapsed bowel, uterus, or other abdominal viscus, 
the chief point is to prevent injury and soiling. For this purpose, if 
large animals have to be cast, a broad cloth soaked in disinfectant fluid 
is passed round the body. ‘The wound and its neighbourhood, together 
with the protruding portion, are then carefully cleansed with a luke- 
warm disinfecting fluid (carbolic, salicylic, or sublimate solution), and 
endeavours made to replace the prolapse, which effected, the wound is 
once more cleansed, any foreign bodies carefully removed, and the parts 
stitched up. The after treatment is similar to that described in pene- 
trating wounds. Should the protruded bowel have become necrotic 
recovery 1s rare, and resection, which is worth attempting, offers the 
only chance of saving life (compare Foreign Bodies in the Bowel). 

(d) Abdominal Wounds, with Injuries to contained Organs. — 
In herbivora the colon is most frequently injured, on account of its great 
area, its distension with hard food, and its fixed position. The more 
mobile small intestine being generally filled with fluid frequently evades 
the object producing the injury. In this way, as experiments have 
shown, pointed instruments, and even projectiles, may penetrate the 
abdomen deeply without injuring this intestine. The escape of the 
dog transfixed, as above described, is thus explained. Horses frequently 
recover from injuries of the colon and cecum. Guilhelm (Stocktleth) 
saw a horse with a wound 54 inches in front of the umbilicus, 
produced by a horn thrust, and through which the under portion of the 
double colon protruded in a mass as large as a man’s head. A wound in 
the bowel, 34 inches in length, discharged food material. This was 
stitched, the bowel cleansed and replaced, the wound in the abdominal 
wall sewn, and a dressing applied over all. In spite of great swelling, 
recovery occurred in twenty-five days. 

In this connection, Herbet made experiments in pigs. In castrating 
a sow, he intentionally thrust his finger through the colon, drew the 
injured spot into the skin wound, and sewed it up with waxed thread. 
The animal received no food for several days and recovered. The extent of 
the recuperative powers is further illustrated by a case reported by Richter. 
Whilst endeavouring to insert a seton under the belly of an excitable horse, 
he was forced to use a probe-pointed bistoury and divide the skin with a 
seton needle. Immediately the operation was completed, a yellow dis- 


220 TREATMENT OF INJURED BOWEL. 


charge of food issued from the wound. Examination with the finger 
Sorel that the caecum had been divided to the extent of # of an inch. 
Within a short time 6 to 7 quarts of fluid were dine the horse 
during several days having received only gruel. Richter expected that 
the animal would die, but the owner determined not to lose its service, 
and yoked it into a heavy manure waggon. Light days later Richter 
found his patient working in a plough and perfectly well; in twenty 
days, the seton was removed, and the horse remained perfectly healthy. 
Such favourable conclusions are unfortunately exceptional, but they 
emphasise the importance of always attempting treatment. 

Treatment consists in suturing the injured bowel or uterus with 
sterilised cat-gut or silk. (For further particulars, compare Bowel 
Suture). The injured organs must then be carefully cleansed and 
disinfected, the wound and its neighbourhood being next attended to. 
Sometimes it may be possible to cleanse the peritoneum with a 
disinfectant. In more extensive infection of the peritoneum, the cavity 
may be rinsed out with lukewarm salicylic solution, or with 1 in 5000 
of sublimate. The subsequent treatment has already been described. 
The rumen may be incised without danger, as in rumenotomy and 
puncture; but, in horses and dogs, injuries of the stomach are serious ; 
more so, in fact, than those of the bowel and uterus. In carnivora 
they are attended with vomiting, but, although serious, are not always 
fatal. The successful use of Haynes’s stomach trochar also testifies that 
horses sometimes survive wounds of the stomach. The treatment of 
injuries of the stomach is similar to that in wounds of the bowel. 

Abdominal wounds, complicated with injury of the kidneys, are distin- 
guished by the passage of bloody urine, and are generally accompanied by 
paraplegia. In such cases early slaughter is advisable. Injuries to the 
bladder allow urine to enter the abdominal cavity, and are recognised by 
anuria, sometimes by urine flowing from the abdominal wound. They 
almost invariably result in death; but recovery occasionally occurs, 
especially in carnivora, as shown by Rodloff’s case. A dog had a pene- 
trating abdominal wound, associated with prolapse of the bowel, which 
was replaced, and the wound sewn up by a layman. In subsequently 
operating for the rupture, the bladder was cut into. After it had been 
sewn up and a ligature passed round the hernial sac, both healed. 
Ponfik’s latest researches show that, although most injuries to the liver 
end in death, yet they are not necessarily fatal. 

Stockfleth has collected statistics concerning the progress of abdo- 
minal wounds, complicated with prolapse of the bowel. In twenty-seven 
abdominal wounds, prolapse was noticed fifteen times. Of fourteen 
horses, two mules, two cows, and one dog, two horses, one cow, and one 
mule died. This result gives, however, no indication of the relative 


BOWEL FISTULA. ail 


gravity of these abdominal wounds, the successful cases apparently having 
been selected for publication. The course is usually less favourable. 
Jewsejenko saw thirty-one abdominal wounds in the horse during the 
Russo-Turkish war. Those caused by large projectiles were the gravest. 
The smaller the projectile, the less the danger. Of eight horses with 
shot-wounds injuring the bowel, five died with peritonitis; three 
recovered after suturing the wound. Two wounds of the stomach, 
produced by splinters of granite, led to death. One wound of the 
stomach from a ball was sutured and healed. Of four wounds of the 
liver, three were fatal; one case recovered. Of three wounds of the 
_ spleen, two ended fatally ; one recovered after the projectile had been 
removed with dressing forceps. After penetrating wounds of the 
abdomen, animals, like men, sometimes die rapidly from collapse. It 
was formerly believed that this peracute progress was owing to shock ; 
but more recently it has become evident that the active agent is profuse 
bleeding into the abdominal cavity. This must be borne in mind, and 
in recent injuries the pulse and mucous membranes must be examined 
before giving a prognosis, or attempting operative interference, which 
may be blamed for the animal’s unlooked-for death. In order to study 
the effect of injuries produced by pistol bullets discharged into the 
abdomen, Parkes experimented on thirty-seven dogs; three died imme- 
diately from bleeding from the aorta, or from the renal or splenic 
arteries; twelve lived for one day, and then died from bleeding, with 
appearances of shock. The others lived longer; but in almost all the 
bowel contents obtained entrance into the peritoneal cavity, though they 
could not be detected in the skin wound. Of the twenty-one which did 
not immediately perish, two died from peritonitis. Of twenty-one 
treated by laparotomy, ten died in from three days to three weeks, and 
nine were cured. 


IIl.—BOWEL FISTULA (ANUS PRETERNATURALIS). 


Lit.: Howard, The Vet. Journal, vol. xxvii. p. 329. K6érber, Gurlt u. Hert- 
wig. 2. p. 82 u. 380. Arndt, ibid., 3. p. 356. Lindenberg, ibid., 8. 
p- 55. Dammann, Adams Wochenschr. 1877, p. 309. Fiirsten- 
berg, Rindviehzucht. II. Aufl. vol. i. p. 140. Urban, Buschs Thier- 
heilkunde. vol. 1. Heft 3, p. 128. Haubner, Ueber Magenverdauung 
der Wiederkiuer. 1837. Bayer, Miiller Roll. 1885, p. 27. Napp, Th. 
Mitth. 1876, p. 146.. Strecker, Th. Mitth. 1877, p. 117. Curdt, 
Gurlt u. Hertwig. 3. p. 456. 


The term bowel fistula is applied to a direct communication between 
the lumen of the bowel and the external air through the intestinal wall. 


Dy iave BOWEL FISTULA. 


A probe introduced into the fistula passes through the abdominal 
walls directly into the bowel. The opening may occur at different 
points, but is generally found on the lower surface of the abdomen, in 
horses often close behind the last rib. 

3owel or gastric fistulee—not infrequently produced for physiological 
objects—amay also result from accidental injuries penetrating the abdo- 
minal coats, and Curdt related cases of the kind both in the horse and the 
ox. Howard produced fistula of the colon in a sucking pig, which was 
suffering from atresia ani, in order tosave the animal. If, in penetrating 
abdominal wounds, the intestine is laid open, its edges may unite to 
the abdominal wound and external skin, and produce a bowel fistula. . 
Arndt, Lindenberg, Dammann, and others have described such cases 
in horses and oxen. The injury, however, sometimes originates in the 
gastric or intestinal mucous membrane. The serosa becomes inflamed 
and firmly adherent to the wall of the abdomen, and if now abscess 
formation occurs, the abdominal walls may be perforated and a bowel 
fistula produced. Korber saw a horse suffer in this way after an attack 
of colic. Perforation had occurred close to the middle line of the 
abdomen behind the umbilicus, Urban reported a similar case in 
a foal, in which an umbilical hernia had been opened, producing 
bowel fistula. Bayer noted a like accident after dressmg an umbili- 
eal hernia with nitric acid. Fiirstenberg describes a fistula of the 
abomasum in a cow. Seven to ten minutes after receiving water, a 
stream of fluid mixed with food was projected more than a foot beyond 
the wound. Flourens produced fistule of the rumen artificially (Haub- 
ner) for the purpose of studying rumination in oxen and sheep, and 
Haubner saw gastric fistule in sheep result from giving arsenic insuffi- 
ciently powdered. Foreign bodies swallowed by cattle often perforate 
the wall of the abdomen, or that of the thorax close behind the elbow, 
and produce gastric fistule, but these generally heal (Napp, and my own 
observations). Strecke found one half of a pair of scissors in the 
abscess. Dammann describes a case complicated with hernia in 
a nine-year-old mare. The fistula had resulted from an external 
injury. 

Symptoms and Progress.—Animals, with intestinal fistula, may 
survive a long time, and, if liberally fed, may even remain in good con- 
dition, though the constant discharge constitutes a blemish. Urban 
kept a foal under observation for two years. In spite of generous feed- 
ing it remained thin, and was finally killed on that account. In 
another case (Korber) recovery took place. 

Treatment should be directed to preventing discharge of bowel 
contents, which is the chief obstacle to healing. Korber succeeded by 
passing a red-hot wire into the fistula, after which cicatrisation occurred 


TREATMENT OF BOWEL FISTULA. 225 


in twelve days. Lindenberg recommends a purse-string suture, inserted 
as deeply as possible so as to bring together the inner end of the fistula, 
i.¢., the opening into the intestinal wall. It is not sufficient to close 
the external opening by bringing the skin together, as uew abscesses 
continually form. Dammann used sutures in one case, but attacks of 
eolic occurred and caused the ligatures to tear out, and as the animal 
was no better after five months’ treatment, it was killed as incurable. 
Where the opening is small, dressing with irritants, or the use of the 
actual cautery, may cause swelling of the edges and union; but should 
this fail, a strong thread may be passed through the muscular walls of 
the abdomen. Dammann cured the second case in two months by using 
hiquor Villati, appled on a mass of tow and kept in position with a 
bandage. 


IV.—PARAGENTESIS ABDOMINIS (PUNCTURE OF 
THE ABDOMEN). 


Ger. Bauchstich. 


Serous fluid collects in the peritoneal sac in consequence of chronic 
inflammation of the peritoneum, or more frequently of disease of the 
kidneys or disturbance of circulation, and may require to be removed by 
tapping. The peritoneum certainly possesses the power of rapidly taking 
up large quantities of fluid and returning them to the circulation, as 
clinical observation and the experiments of Wegner have shown; and 
these facts accord with our conception of the peritoneal cavity as a great 
lymph-sac. When, therefore, fluids remain for long unabsorbed, some 
special cause must be at work, and as that cause is not removed by 
draining away the fluid, the latter usually returns after a short time. 
For this reason the operation has, at the most, only a symptomatic im- 
portance. It may, by relieving pressure on the diaphragm, lessen the 
danger of suffocation, and mitigate difficulty in breathing, but it seldom 
produces lasting improvement. In hydrops ascites the operation must 
generally be repeated after a short time, and as the already weakened 
constitution loses more albumen on each occasion, it often only hastens 
a fatal termination. 

Diagnosis of ascites is seldom difficult where so much fluid is present 
as to call for puncture. The disease is commonest in dogs, whose soft 
abdominal walls allow the internal organs to be readily examined. 
Such an examination gives valuable information as to the causes of 
dropsy. One often finds chronic changes (tumours, &c.) in the liver, 
which render exceedingly improbable any lasting favourable results from 
operation. The same is true where the dog suffers from heart mischief. 


224. PARACENTESIS ABDOMINIS. 


In such eases the abdomen often shows unmistakable distension, which 
is sometimes attended with dyspnea. When the animal is standing, 
the wave-like movement of the fluid may be felt by placing the left 
hand on one side of the abdomen and tapping the other side with 
the right. This phenomenon, termed “Sucussio Hippocratis,” is the 
most reliable symptom of dropsy. 

Tapping the peritoneal sac—a very simple operation—is effected 
with a trochar of the same strength as is employed in puncturing the 
intestine. There being no danger here, as in puncture of the intestine, 
of infecting the peritoneal cavity from the bowel, and it being easy to 
disinfect the skin, the operation, when carefully carried out, is quite 
simple, and not likely to give rise to peritonitis. Indeed, in former 
times, when the principles of strict asepsis were not understood, the 
operation was usually performed quite successfully without antiseptics. 

The puncture was formerly made at various points. Those through 
the rectum and vagina were soon given up because of the risk of infec- 
tion, and the operation is now performed either in the neighbourhood of 
the umbilicus, close to the linea alba, or on one side of the abdominal 
wall, the former being usually selected in small animals. In large 
animals, which are operated on in the standing position, the side of the 
abdominal wall is found a more convenient spot. In cattle the right 
side is chosen, so as not to injure the rumen, which lies on the left ; in 
horses the left side, because the cecum is on the right. 

The bowels, being partly filled with gas, float on the fluid, and- the 
latter therefore occupies the lower portion of the abdominal cavity, 
which is consequently the point selected for puncture. To make sure, 
the proposed seat of operation should first be percussed, when portions 
of bowel will be recognised by the hollow sound, and fluid by the com- 
pletely dull tone which they respectively give. 

In large animals the operation is performed as follows:—The hair being 
shaved from the point of operation, and the latter disinfected (washed 
with soap and rinsed with a disinfectant), an incision is made through the 
skin with a pointed bistoury or lancet to assist the passage of the trochar. 
This precaution is most useful in excitable animals and those with thick 
skin. Puncture is then effected in the same way as puncture of the 
thorax. The trochar is carefully disinfected and held with the handle 
in the operator’s palm, whilst the forefinger, lying on the canula, limits 
the distance to which the instrument may penetrate. In larger animals, 
14 to 2 inches may be allowed; in smaller ones, 3 to 14 inches. As 
soon as the trochar has entered, the stilette is withdrawn, and the fluid 
allowed to discharge. Sometimes a check occurs, and the canula requires 
to be moved in various directions, or cleared of clots by passing 
the stilette or a probe, The precautions required in paracentesis 


HERNIA. 225 


thoracis are not so imperative here, and as soon as the fluid ceases to 
flow, the trochar may be removed, and the wound treated as in operating 
on the chest (p. 211). 

It is better to lay dogs on the side for operation, as when placed on 
the back, portions of the bowel may come in contact with the lower 
part of the abdominal wall. Large dogs, if quiet, may be operated on 
standing. Lither side may be chosen, provided one keeps close to the 
middle line. The posterior portion of the abdomen is usually preferred, 
and the puncture made between the umbilicus and the anterior portion 
of the os pubis, it being thought that this position offered less danger of 
injuring the stomach or liver, which is often increased in size on 
account of disease. The under surface of the abdomen is disinfected, 
and the operation performed as above described. 

After operation, bandages may be applied to increase intra-abdominal 
pressure and prevent secretion of fresh fluid, though unfortunately in 
dogs they can seldom be kept in place, but slide backwards, even if 
passed over the chest. 

To prevent the return of ascites, the injection of spirit or solution of 
iodine into the peritoneal sac has been recommended, after allowing the 
fluid to discharge; but the uselessness and danger of this procedure have 
already been shown in human surgery, and it is now scarcely ever used. 
In animals it is not infrequently necessary to repeat the operation. 


V.—HERNIA. 


Ger. Eingeweidebruch. 


Hernia or rupture is a condition in which portions of the abdominal 
contents have passed through the abdominal walls, and lie under the skin. 
Should they pass through the skin, the condition is termed prolapse. 
Under the older system of nomenclature, the passage of abdominal organs 
through the diaphragm into the thorax was also described as hernia 
(diaphragmatic hernia), and in cattle strangulation of the bowel by 
the spermatic cord was termed internal hernia, conditions which will 
be noticed here, although in the true sense of the word they belong less 
to the herniz than to the incarcerations. 

The cause of hernia is sometimes a congenital defect, like too wide 
an inguinal ring or an open umbilicus. Such herniz are, therefore, 
either congenital, or develop soon after birth. Increase of intra- 
abdominal pressure, frequent coughing, dyspncea, pressure on the 
abdomen, or development of gas in the bowel (tympanites), all assist 


their formation, while rupture of the abdominal wall directly produces 
P 


226 ESSENTIAL CONSTITUENTS OF HERNIA. 


them. Such rupture may be produced during parturition, or by excessive 
exertion, severe pressure on the abdomen, or the violent impact of 
blunt bodies. In men external influences, such as the pull of Lpomatous 
new growths on the abdominal walls, may induce local pocketing and 
pave the way for ruptures; but, to the best of my knowledge, such 
cases have not been seen in animals. 

The essential constituents of a rupture are :— 

(1) The opening in the abdominal wall through which the viscus 
has left the abdominal cavity, and which may either be a normal opening 
like the umbilicus, or one abnormally dilated, as the inguinal canal 
sometimes is, or a rupture in the abdominal coats, without solution of 
continuity in the skin. 

The rim of this orifice is termed the hernial ring. Its form and size 
vary greatly. Sometimes it will only admit the little finger, but in large 
animals it may be the diameter of a man’s fist. Sometimes it 1s 
round, sometimes oval or slit-like. In umbilical and inguinal herniz it 
is lined with peritoneum. In fresh abdominal herniz the edges of the 
ring are formed by the abdominal coats. 

(2) The hernial swelling, which may vary from the size of a hazel 
nut to that of a man’s head or more, consists of the portion of protruded 
viscus, the hernial “contents,” and its coverings, the hernial “sac.” 
The latter is divided into neck and base. The hernial sac consists of 
skin and sub-cutis, the latter usually thickened, sometimes of layers of 
muscle and abdominal fasciz. Under certain circumstances other coats 
may exist, as, for instance, in inguinal hernia, the tunica vaginalis 
communis and the scrotum. Such special coverings are also termed 
accessory coats of the hernia. 

The sacs of umbilical, inguinal, and femoral herniz, and those whose 
openings consist of abnormally dilated physiological apertures, are 
lined with peritoneum. In those produced by tearing of the abdominal 
walls, the peritoneum is usually divided; the internal organs may then 
lie under the sub-cutis, and only be covered by the Jatter and the skin. 

The contents consist either of a loop of intestine or of omentum consti- 
tuting respectively enterocele or epiplocele. Only very occasionally are 
other internal organs like the stomach (gastrocele) or liver found in the 
hernial sac. Sometimes the sac also contains a serous fluid (bernial fluid). 

In reducible ruptures the contents lie free in the sac, and may be 
returned to the peritoneal cavity (reposition, taxis); but sometimes the 
hernial contents and sac become adherent to one another, and complete 
reposition can only be effected after division of the attachment. This 
forms irreducible hernia. The irreducible character may also be due to 
strangulation or other causes, like excessive distension of the protruded 
portion of intestine by hard masses of feces. 


DIAGNOSIS AND PROGNOSIS OF HERNIA. 227% 


Diagnosis.—A hernia is seldom difficult to recognise, provided it be 
reducible. In such case it has the following characteristics :— 

(a) It is free from inflammatory symptoms (especially pain), is soft, 
elastic, and compressible, that is, it may be diminished by pressure. 

(6) It varies in size from time to time; coughing or severe exertion 
increase abdominal pressure and render it larger; but it decreases when 
intra-abdominal pressure again falls. 

(c) It is reducible, that is, the swelling may completely disappear on 
pressure, or on placing the animal in a suitable position, but it returns 
on removal of pressure or alteration of position. 

Diagnosis only becomes absolute when the hernial opening is dis- 
covered. It can generally be felt by thrusting a finger into the depth 
of the sac, especially after reducing the hernia. Some care is required 
to differentiate hernia from abscess or hematoma, an error which might 
have grave consequences, as already pointed out in speaking of bruises 
of the abdomen (p. 214). 

Prognosis.—Hernia itself is not fatal, but immediately strangulation 
occurs it becomes exceedingly dangerous. Prognosis chiefly depends on 
the probability of strangulation, a factor which will be considered in 
speaking of the various hernie. The smaller the hernial aperture com- 
pared with the size of the sac, the greater the danger of strangulation. 
Small intestine becomes more easily strangulated than colon or omentum. 
The size of the aperture, and the use to which the animal is put, must be 
considered, whilst it should be remembered that strangulation occurs 
more easily in working-horses, and that large herniz may interfere with 
usefulness. 

Many herni, and especially umbilical and inguinal herniz in young 
animals, disappear without treatment, and others may last the animal’s 
whole life without interfering with its use. 

Irreducible herniz are more dangerous than reducible, recent than 
old, and intestinal than omental, because in each case the former are 
more likely to become incarcerated than the latter. I shall speak further 
on this head in describing the various hernie. 

Strangulation or incarceration is the condition in which the hernial 
ring presses on the contents and interferes with normal circulation of 
blood and passage of ingesta through the intestinal loop. It consists, 
then, in ligation of the contents by the hernial ring, producing stasis of 
feeces and disturbance of circulation and nutrition. In consequence of the 
pressure of the hernial ring on the contents, return of blood through the 
venous vessels is first checked. In them blood-pressure is lower, and 
the walls weaker, and therefore circulation is more easily interfered with 
than in the arterial vessels, whose strong walls and high blood-pressure 
oppose considerable resistance to compression. Blood continues, there- 


228 PROGNOSIS OF STRANGULATED HERNIA. 


fore, to enter by the arterial vessels even after strangulation, and soon 
produces a severe venous congestion, usually associated with more or less 
extensive rupture of small vessels and hemorrhage. Blood-stained serum 
is exuded, the hernial fluid increases, and in consequence of mixture with 
blood becomes red in colour. The hernial contents, especially the serosa 
of the intestine, is dark red or black, and this coloration is distinctly and 
usually sharply bounded by the ring-like circle of compression, which is 
erey and anemic. Both this anemia and the venous congestion im- 
pair nutrition in the strangulated parts, and may finally produce 
necrosis. 

The fecal stasis adds to the disturbance thus produced, because the 
imprisoned intestinal contents putrefy, irritate the mucous membrane, 
and co-operate with defective circulation in producing necrosis of the 
mucous membrane. Infectious materials and their products possibly play 
a certain role here. ; 

Necrosis first shows itself at two points, viz. in the deepest portion 
of the hernial contents, where circulation suffers most, and at the line 
of strangulation. It is well to remember, from the clinical standpoint, 
that dark colour is not always a proof of necrosis. The latter is usually 
typified by the presence of grey spots or patches on the surface of the 
peritoneum, or of ulcerative changes in the hernial contents. The 
anterior portion of the bowel—that is, the part nearest the stomach 
—appears greatly distended with food, whilst the posterior portion is 
empty and narrower than normal. 

Prognosis.—Strangulated herniz usually kill in a short time, not 
infrequently in twenty-four hours, and as reposition is often difficult or 
comes too late—that is, when necrosis has already set in—the condition 
must always be viewed as dangerous. Spontaneous reduction is exceed- 
ingly rare, partly on account of the accumulation of fecal material in 
the sac, which increases with time, and partly because the incarcerated 
section of bowel soon becomes paralysed in consequence of defective 
circulation, and is then unable to discharge its abnormal contents, even 
when the causes of strangulation have been removed. 

Diagnosis is seldom difficult. As a rule, symptoms of colic appear, 
and in carnivora vomiting. The pain is regular and lasting. In cases 
of colic in ruptured horses care should therefore invariably be taken to 
first examine the hernial sac. ' If strangulated, the hernia will be found 
to have increased in size, become hard, painful, and tenser than formerly. 
Sometimes symptoms of peritonitis set in, and the animal soon dies if 
reposition is not effected. The appearance of albuminuria in strangu- 
lated herniz is certainly interesting from a scientific standpoint, but not 
clinically. 

Strangulation was formerly believed to be produced by spasmodic 


DIAGNOSIS OF STRANGULATED HERNIA. 229 


contraction of the hernial ring; but, apart from the fact that in most 
ruptures such contraction seems scarcely possible, it is not to be imagined 
that active contraction could continue so long. Such views are no 
longer entertained, and the cause of strangulation is to be sought rather 
in the character of the hernial contents. Inflammatory swelling near 
the neck of the hernia may in exceptional cases cause incarceration, but 
is exceedingly rare. The primary factor in incarceration is usually 
increase in the hernial contents; conversely this increase may be a 
result of mcearceration. Let us imagine a case: A horse affected with 
hernia suffers from tympanites; the increased intra-abdominal pressure 
thrusts a large portion of bowel and omentum from the abdominal cavity 
into the hernial sac; on account of the increase of the hernial contents 
the ring becomes too narrow; it presses on the enlarged contents 
and interferes with circulation in the parts which it surrounds, and 
incarceration results (fig. 71). Or let us fancy that in the posterior 


S CU 


Fics. 71, 7 
(2) 


D 


2.—Showing Mechanism of Incarceration of Intestine— 
Afferent, (z) Efferent, portion of Intestinal Loop. 


portion of the intestinal tube—that is, in the portion through which the 
intestinal contents is returned from the hernial sae into the abdominal 
cavity—some check occurs, causing fecal stasis. Necessarily the hernial 
sac must become more or less filled with intestinal contents, which enter 
through the anterior portion of the intestinal tube, but cannot escape. 
Distension may finally become so great that the hernial ring acts as a 
ligature, and incarceration results after this fashion. The forward move- 
ments of intestinal contents may be variously impeded. Thus the 
posterior portion of intestine not infrequently becomes twisted either in 
the hernial sac or in the peritoneal cavity, particularly at its point of 
exit from the ring, and the twist, which acts like a kink in an india- 
rubber tube, may produce fecal stasis in the hernial sac and incarcera- 
tion (Busch’s theory). In the same way gradual distension of the 
anterior portion of the loop of intestine lying in the hernial sac may 
displace or compress the posterior portion, and bring about fecal stasis 


230 TREATMENT OF NON-STRANGULATED HERNIA. 


and inearceration. According to Rose, folds of mucous membrane in the 
posterior portion of the loop diminish the passage under certain circum- 
stances, and produce similar results. In man extensive statistics have 
been accumulated on the mechanism of strangulation, and attempts have 
also been made to solve the question of its origin by experiments on 
animals. But both in men and animals the first causes may be so 
varied that they cannot usually be explained, and therefore the question 
is here of no great importance. 

The views on omental strangulation are just as varied, though all 
coincide in declaring that omental herniz are much seldomer strangu- 
lated than intestinal. Some, like Rose, altogether doubt its occurrence, 
and have supported their opinions by experimentally ligaturing the 
omentum. Others allow its occurrence, and insist that its symptoms 
are similar to those of strangulation of the intestine, but less pro- 
nounced, because the circulation alone is interfered with, and fecal 
stasis does not occur. 

Treatment of non-strangulated hernie. In many cases, particularly 
in slight herniz in young animals, no treatment is required, because 
spontaneous recovery is usual, strangulation rare. Peculiarities of treat- 
ment will be described in connection with each of the various hernie, 
and therefore I confine myself here to general considerations. One 
differentiates a palliative cure, and a radical cure. The first consists in 
bringing about a gradual diminution in the hernial sac; the radical cure 
in closing the hernial opening. 

The palliative cure depends on suitable dietetic precautions, supplying 
concentrated and easily digested food, avoiding hard work, and in larger 
animals on the preservation of a suitable position, that is to say, a position 
in which, whilst the animal is in the stall, the viscera will be as far as 
possible removed from the position of the hernia. These measures are 
supplemented by the following :-— 

(1) Hernial truss. Although much used in men, trusses cannot be 
employed to the same degree in domestic animals. Trusses for inguinal 
herniz in animals, other than foals, are impracticable, and it is only 
in exceptional cases that they can be continuously worn in other abdo- 
minal hernie, though the male hippopotamus in the Berlin Zoological 
Garden wore such a truss for a considerable time. These appliances 
will be described in speaking of inguinal hernie. 

(2) Diminution in the hernial sac and return of the hernial contents 
into the abdomen, by inflammatory and cicatricial processes in the skin 
of the sac produced by infrictions with sulphuric, nitric, or chromic acid, 
or the application of the actual cautery, or subcutaneous injections of 
common salt, alcohol, &c. The artiticial inflammation is accompanied 
by swelling in the skin and sub-cutis, and the contents of the hernia are 


METHODS OF CURE IN HERNIA. Bou 


said to gradually return to the peritoneal cavity. Cicatricial contraction 
of the cutis follows, and thus diminishes the size of the hernial sac, and 
even of the hernial aperture. The cautery, lately recommended by 
Lustbaum in man, has the same effect. Radical treatment consists 
in removal of the sac and closure of the hernial aperture by caus- 
ing the hernial ring or the neck of the hernial sac to unite, or by 
other methods. This procedure presents much greater difficulties in 
animals than in men, because it is neither so easy to attain asepsis, nor 
to keep the animal in the necessary dorsal position after operation, and 
when the many other dangers incidental to such operations are con- 
sidered, few cases justify interference, 

The following methods of radical cure are employed :— 

(1) Ligation of the hernial sac. This can only be resorted to where the 
sac possesses a narrow neck. To prevent displacement of the ligature, 
it has been recommended to pass needles transversely through the neck 
of the sac, and to apply the ligature over them. It need scarcely be 
said that the hernia must first be reduced. 

(2) In herniz with broad bases interrupted ligatures may be 
employed. After returning the hernia, strong threads of sterilised silk 
are passed through the neck of the sac in the neighbourhood of the 
hernial opening. The procedure consists thereafter in multiple ligation ; 
the skin of the hernial sac can then be cut through and separated from 
underlying tissues, the other coats of the hernia similarly treated, and 
the skin brought together over them. This method is frequently 
employed, and usually allows of healing by first intention, which greatly 
tends to ensure success. ‘Sometimes, after dissecting away the skin, 
it is possible to close the hernial sac by ligatures apphed round 
its neck, 

The hernial sac may also be opened, and after multiple ligation of its 
neck be removed, following which the skin should be closed with sutures. 
Healing is often completed without pus formation. But in large 
animals, and especially in herbivora, suturing the hernial ring often 
presents insurmountable obstacles, because the abdominal walls are too 
firm and resistant to allow of approximation and union. Where the 
aperture is slit-like, further trouble is often caused by the hernial con- 
tents having become adherent to the abdominal walls, and dissection is 
both difficult and very dangerous. After freeing the bowel, or cutting 
off the omentum, or, if necessary, ligaturing it, the hernial contents is 
returned to the abdomen and the ring sutured. To assist union of the 
cicatrised edges of the hernial ring, they can be pared with the knife or 
scissors, or numerous superficial incisions made. In inserting sutures, 
the left hand holds back the viscera to protect them from the needle. 
The edges are brought together with strong, carefully sterilised silk, the 


232 TREATMENT OF STRANGULATED HERNIA. 


hernial ring being as far as possible closed. Where tension is great, 
quilled sutures are useful. The skin is afterwards brought together with 
strong material, a deep hold being taken. 

It is scarcely necessary to add that the most strict antisepsis must 
be observed, without which there is always danger of peritonitis, and 
closure occurs far less rapidly and certainly. The special precautions 
necessary will be mentioned in speaking of different ruptures. 

Finally, a radical eure may be effected by applying clams to the neck 
of the hernial sac, a method generally employed in umbilical hernie, 
which will, therefore, be described under that head. 

Treatment of strangulated herniz. It has already been stated that 
incarceration is always dangerous, and that treatment should at once be 
resorted to. The latter consists primarily of attempting reduction. 
For this purpose the animal should be placed so that the hernia is as 
elevated as possible, as the contents then tend to return to the abdo- 
minal cavity by their own weight. The restlessness of horses, and 
the tendency they have when cast to contract the abdominal 
muscles, often cause difficulty in reposition. To avoid this, anesthesia 
should be produced, without which reposition cannot be effected in 
larger animals. In horses, I employ chloroform, in dogs, morphine. 
In oxen it is often preferable to slaughter the animal, because the use 
of chloroform may make the flesh unfit for consumption. 

It should be remembered that the obstruction always les near the 
hernial ring, and therefore that any attempts at reduction must be 
directed to this point, pressure at the base of the hernial sac being 
mere waste of time. In extensive herniz, the sac is grasped with both 
hands, the points of the fingers lying near the hernial opening. 
Attempts are then made to diminish or return the contents lying 
immediately over it, and by gradually applied pressure, to get rid of 
the obstruction. 

Where the bowel is thought to be twisted on the abdominal side of 
the ring, the sac should be moved sideways, so as to lift the twist and 
set free the bowel contents. This must be done slowly but continu- 
ously and in different directions, because it is impossible to tell exactly 
where the obstacle lies. A gurgling sound may then sometimes be 
heard, indicating the evacuation of the imprisoned intestine. Diminution 
of the swelling under the fingers is a still more favourable sign. 
Attempts should be made to again bring the animal into the position 
in which these symptoms have occurred, and to further diminish the 
size of the sac. 

Failing reduction by this method within half an hour, an incision 
must be made, or, under certain circumstances, may be resorted to at 
first. Should it be clear that the displaced intestine is already semi- 


INTERNAL HERNIOTOMY. 233 


necrotic or is ruptured in the hernial sac, one dare not proceed to 
reposition on account of setting up peritonitis. The longer, therefore, 
strangulation has continued, the more careful should we be in attempt- 
ing it. Inflammation of the hernial sac and emphysema of the skin 
clearly point to rupture of the bowel having taken place, a condi- 
tion which is usually fatal in animals. 

Incision (herniotomy) is resorted to, to remove strangulation, and 
may be carried out in various ways. In human surgery a distinction 
is made between hernial incision without opening the peritoneal cavity, 
so-called herniotomia externa, and a similar operation with division of 
the peritoneum (herniotomia interna). External herniotomy offers great 
difficulties, but was formerly more resorted to than at present, because 
now-a-days the use of antiseptics has greatly diminished danger from 
peritonitis. The same is true in animals. The procedure in per- 
forming the external operation is as follows:—The seat of operation is 
carefully disinfected, the animal anzesthetised and placed in a suitable 
position, and an incision, which must extend the entire length of the 
sac, carried through the skin covering the hernial swelling, in the 
longitudinal axis of the body. After dividing the panniculus to a 
similar extent, both skin and panniculus are thrust to one side, and an 
attempt made to attain the hernial ring. Large vessels are ligatured 
to keep the field of operation clear, firm portions of connective tissue 
divided with the scissors or knife. By introducing the finger into the 
depths, one can discover the narrowest, that is, the strangulated spot, 
which is then widened with a herniotome or tenotome without injuring 
the peritoneum. This effected, taxis becomes easy, and the wound is 
at once carefully cleansed and stitched up. 

Internal herniotomy requires similar preparations. The incision is 
made through the skin in the same way, and the hernial coats lying 
beneath divided with a knife as far as the peritoneum. A little fold of 
the latter, at the base of the hernial sac, is then raised with forceps, and 
cut through close below the forceps with a knife held horizontally, pro- 
ducing a small opening. By means of blunt-pointed scissors this opening 
is enlarged, the index finger pushed into the hernial sac, and the peri- 
toneum incised with scissors as far as the neck of the sac, the finger 
meanwhile pressing back the hernial contents and protecting them from 
injury. ‘The finger is now passed into the hernial opening, the hernio- 
tome introduced alongside it, and the ring or neck of the hernial sac 
divided at the point of strangulation. A slight incision suffices to enable 
the contents of the sac to be returned to the abdomen, unless the hernia 
is adherent. 

In umbilical and abdominal herniz, hernia knives are replaced by 
blunt-pointed tenotomes, which have been constructed of various forms. 


234 INTERNAL HERNIOTOMY. 


A special herniotome is only necessary in inguinal hernize in the horse 
(compare p. 253). 

Internal herniotomy has the advantage over the external operation 
that one can determine the condition of the strangulated bowel, and 
should the latter prove to be necrotic, can either proceed to further 
treatment or resection of the necrotic portion. Reposition, under these 
circumstances, would destroy any chance of recovery. It should, how- 
ever, be repeated that dark coloration does not always indicate 
necrosis. 

It is necessary in such cases to promptly decide whether to attempt 
resection of the necrotic bowel, a proceeding which, though certainly 
offering greater chance of success in carnivora than in herbivora, especially 
in horses, is even in them eminently fatal. Incarcerated portions of 
omentum, which, however, are seldom met with, are first ligatured with 
aseptic material and then cut off, and the wound treated as before 
described. It is of the highest importance to secure asepsis and prevent 
prolapse of the intestine. Perfect cleanliness ensures the first, and care- 
fully-inserted quilled sutures lead to proper union of the edges of the 
wound. 

Should resection of necrotic portions of intestine be determined on, 
it is very important to avoid infecting the peritoneal cavity with intes- 
tinal contents, and to carefully provide for union of the ends of the cut 
portions. The intestine is drawn forward as far as necessary, and protected 
by layers of cloth dipped in warm disinfectant solutions. 

After separating the necrotic portion with scissors, the ends must be 
rinsed with carbolic or sublimate solution, and their contents, as far as 
possible, removed without soiling the wound. An assistant compresses 
the intestine to prevent further passage of contents from the anterior 
end, and the parts are then so brought together that the two surfaces of 
serosa are in apposition. To effect this, the free edges of the posterior 
portion are turned inwards, the anterior portion pushed into this, and 
the two sewn together with closely applied stitches. After once more 
carefully cleansing the intestine, it is returned, the wound disinfected, 
and stitches inserted as above described. Experiments made many 
years ago with the simplest apparatus in cases of invagination show 
that under some circumstances, especially in oxen, resection of the 
intestine may prove successful (compare with the section on Suturing 
the Intestine) 


UMBILICAL HERNIA. 235 


VI.—UMBILIGAL HERNIA (OMPHALOCELE, EXOMPHALOS). 


Ger. Nabelbruch. 


Lit.: Kaiser, Vet. Sa. Ber. 1876-77. Kolling, Th. Mitth. 1854, p. 74. 
Esser, ibid., 1883, p. 47. Hupe, Vet. San. Ber. 1875-76. Dagot, 
Réc. de méd. vet. 1848. Storry, The Veter. 1839. Roche-Lubin 
u. Weber, Réc. de méd. vet. 1849. Marbot, ibid., 1857, p. 681. 
Mangot, Journal pract. 1826. Imminger, Deutsche Zeitschr. fiir 
Thiermed. 1890, p. 298 und Zeitschr. fur Vet.-Kund. 1891, p.41. Sanson, 
Réc. de méd. vét. vol. 10. Siedamgrotzky, Dresd. Ber. 1879, p. 86 
ielecon paso. Wiiesmer) bo Ta WwW. 1so0)'p. Tm Hendricks, 
Annal. de méd. vét. belg. 1890, p. 367. Degive, Her. Rep. vol. 46, p. 
69. Frohner, Adams Wochenschr. 1884, p. 105. Cagny, Jahresber. 
1886, p. 111. Piitz, Oesterr. Zeitschr. fiir wiss. Vet. 1891, p.65. Lucet, 
B. T. W. 1892, p. 164. Pathe, Bad. th. Mitth. 1892. 


By union of the visceral plates in the linea alba, the abdomen closes 
during uterine life as far as the annulus umbilicalis, which remains open 
for the umbilical cord, and after birth ceases to exist on account of 
obliteration of its vessels. In new-born animals the umbilical ring not 
infrequently appears abnormally large, so that the umbilical cord does 
not completely fill it, in consequence of which the skin and peritoneum 
either immediately, or in the first few weeks after birth, yield to the 
pressure of the abdominal contents, and allow the latter to pass through 
under the skin. This condition, which occurs in different classes of 
animals, though most frequently in horses, oxen, and dogs, has been 
termed umbilical hernia, and is divided into two forms,—viz., congenital, 
which is apparent at birth, and acquired, which appears during the first 
few weeks thereafter. 

As a rule, a portion of the colon or cecum, and sometimes of 
omentum, is found in the hernial sac, which is composed of skin and 
peritoneum, and which varies in size from a hazel-nut to that of a 
man’s head. Pathe saw an umbilical hernia in a calf, containing a 
portion of the abomasum. 

The division usual in human surgery between umbilical herniz and 
herniz of the umbilical cord, has at present no practical importance in 
animals. In the latter, the viscera lie in a dilatation of the umbilical 
cord, and are only partially, or not at all, covered by the skin, and 
prognosis is therefore usually less favourable than in the ordinary form 
of umbilical herniz. When cases occur no treatment is possible, and 
even in man they generally lead to death. 

Symptoms.—Umbilical hernia is recognised by the presence of a 
swelling of the size above-mentioned, which lies below the umbilicus, is 
elastic, soft, sharply defined, and free from inflammatory symptoms. It 


236 CAUSES OF UMBILICAL HERNIA. 


usually takes the form of a larger or smaller hemisphere, and seldom 
possesses a neck. By thrusting one or two fingers upwards into the 
swelling, the umbilical ring can be discovered in the depth. Sometimes 
it scarcely admits a finger, sometimes the entire hand can be thrust into 
it. By laying the animal on its back, or pressing on the swelling with 
the open hand, it disappears. 

No mistake can well occur, except in young animals with inflam- 
matory disease of the umbilicus; but caution is required in using the 
knife, because such hernie have often been incised with the idea that 
they were abscesses. Where the umbilical ring cannot be felt, and its 
complete closure ascertained, every fluctuating swelling must arouse 
suspicion of umbilical hernie. 

Causes.—The disease is always due to abnormal size of the umbilical 
ring. The larger this is the more easily does rupture occur. This 
explains the hereditary character of umbilical herniz, as observed by 
Viborg and Eléonet in horses, and Benkert in dogs (Stockfleth). In con- 
genital umbilical herniz, the abdominal viscera have often never been 
in the abdominal cavity, because they have not been surrounded by the 
visceral plates. After birth, umbilical hernie result either from over- 
stretching of the skin covering the umbilicus, ¢.q., from violent tearing away 
of the umbilical cord; or they may be caused by any circumstance pro- 
ducing increase of intra-abdominal pressure, such as tympanites, excessive 
action of the abdominal constrictors during constipation (¢.g., atresia ani), 
exertion during heavy draught, and continuous coughing. They seldom 
develop in old animals. 

Prognosis.—Inearceration of umbilical herniw is rare, appa- 
rently because the contents are formed by colon and omentum. For a 
similar reason, spontaneous recovery is common, and is favoured by 
small size of the rupture, narrowness of the ring, and youth of the 
animal. In herbivora, small umbilical herniz generally disappear as 
soon as the animals begin to receive more hard food, because this 
produces not only distension of the colon, with firm masses of 
food, but also dilatation of the abdominal walls and tension of 
the peritoneum and skin, by which the hernial contents are pressed into 
the peritoneal cavity. As these causes act principally during the first 
short period after birth, spontaneous healing in foals and calves 
occurs during the first six months of life if at all, seldom after the age 
of one year. 

Prognosis depends, first, on the age of the animal, and then on the 
size of the sac and of the umbilical ring. Incarceration is only 
exceptionally seen in animals, and then only in such as suffer from 
tympanites, in greedy feeders, in those inclined to digestive disturbances 
associated with the formation of gas, or in horses in very heavy draught. 


TREATMENT OF UMBILICAL HERNIA. Dat 


Treatment.—The most varied applications, most of them useless, 
have been recommended in umbilical hernize. Amongst these are local 
astringents (Jacobs) and the subcutaneous injection of solutions of 
common salt. Such treatment is only followed by recovery where the 
latter is almost a foregone conclusion, as in small ruptures in young 
animals and particularly in herbivora. Amongst the palliatives most 
resorted to are— 

(1) Trusses, which are, however, only of real use in cattle and horses, 
and even then to a limited extent. A tampon of tow, smeared with 
Venice turpentine to retain it in position, is placed on the hernia and 
fastened by a girth passed round the body. Kolling in this way cured 
umbilical herniz in foals in six weeks. Marbot states having cured 
ten cases of the kind in thirty-two days by means of bandavyes. 
As a substitute for the bandage, a pitch plaster may be applied, or the 
sac painted with collodion after reducing the hernia, but neither method 
is reliable, especially on the very elastic skin of dogs, and plasters 
seldom remain a sufficient time in position to have any permanent good 
effect. 

(2) Caustic and blistering substances, lke sulphuric or nitric acid or 
cantharides ointment, applied to the hernial sac, have been recom- 
mended in the larger animals (horse and ox). In France nitric acid 
was first recommended in 1848 by Dagot, and about the same time it 
was used in Germany in common with sulphuric acid. The latter is 
generally diluted with 3 to 5 parts of water or spirit, and rubbed into 
the hernial sac daily for five to eight days. Concentrated sulphuric or 
nitric acid is applied with a glass rod in the form of lines. The lines 
must be at least 2 to # of an inch apart, and the acid can seldom be 
used more than twice. Others apply the concentrated sulphuric acid 
with a brush to the entire surface of the sac twice, beginning at the 
periphery, and taking care that the lowest portion of the sac does not 
receive too much. Particular care is required in applying con- 
centrated nitric acid, and it should never be left to the owner, but 
be used by the practitioner himself. The irritant effect is some- 
times too great, and owing to excessive swelling and tension, the 
skin tears through or becomes necrotic before union has taken place 
at the neck of the hernial sac. Prolapse of the bowel then occurs, as 
noted by Weber in foals and Roche-Lubin in dogs. The thinner the 
sac and the skin covering it, the greater the care required in apply- 
ing concentrated acids. Duriaux and Cagny have recently recom- 
mended sinapisms instead of acids, stating that mustard produces the 
same effect as acids, but is less dangerous. Acids are useful for this 
purpose, because they do not soften the structure of the skin like alka- 
lies, but give a firm scab. Nitric acid produces a stronger effect than 


238 TREATMENT OF UMBILICAL HERNIA. 


sulphuric, and is, therefore, more painful and dangerous, while chromic 
acid and bichromate of potash (1 to 3) often affect deep-seated struc- 
tures too much. The swelling which appears is the best guide, and 
immediately it seems sufficient, further applications should be avoided. 

The actual cautery has been recommended with the same object and 
is applied in the form of lines. 

In France and Belgium bandages and blistering ointments have been 
simultaneously used. Degive recommends a bandage constructed by 
Martin for use in the horse, which carries a plate of tinned iron, 14 
inches long and 4 broad, whose form responds to that of the lower 
surface of the belly, upon which it is fastened by two rollers. The plate 
has a rounded prominence about 2 inches high on the side next the 
abdomen, which fits into the hernial rmg and keeps back the contents. 
This truss is worn for four to eight days, when swelling of the ring 
occurs, and it may be removed to see whether the hernia returns. 
Should this happen, the parts can either be dressed all over with diluted 
nitric acid or be fired, after which a second bandage is applied, whose 
girth carries a similar plate 14 inches long and 9 inches broad, covered 
with a tarred linen compress. Three days later Martin blisters the 
parts with cantharides oil to assist the separation of the eschar, which 
is said to occur eight days afterwards. The girth is then loosened a 
little and reapphed, after smearing the rupture with tar. Martin states 
having cured umbilical herniz in this way within twenty days. 

Without doubt the pressure of the bandage on the inflamed hernial 
sac assists its contraction and the return of the contents, but necrosis 
of the sac is apt to occur, and the truss must, therefore, be frequently 
examined. 

Imminger recommends injecting subcutaneously 1 to 15 ounces of a 
15 per cent. salt solution about an inch in front of, and also behind the 
rupture. One injection is said to be sufficient to cure small herniz in 
four to six weeks. Thickening remains for some time, but this is 
thought to close the ring. Lucet injects from 2 to 7 ounces of a similar 
solution all round the ring. These methods assist return of hernial 
contents to the abdominal cavity by the swelling they cause, an 
action which is continued by the subsequent cicatricial contraction of 
the skin. Acids are preferable to blistering ointments, as, eg., cantha- 
rides; and Hupe states that inguinal hernize in foals can be cured 
with certainty during the first six months of life by smearing with 
acid. sulphur. angl. 

This treatment is only suitable to small hernize in young animals; in 
larger herniz it is of no value, and Degive restricts its use to cases where 
not more than two fingers can be introduced into the hernial opening, 
and where the sac is not greater than a hen’s egg. Where irritants 


TREATMENT OF UMBILICAL HERNIA. 239 


have failed, the hernial contents often become adherent to the sac, and 
may later cause difficulty in operative treatment. 

(3) The following methods of radical treatment have been employed :— 

(a) Simple or multiple ligation of the sac. In herniz not possessing 
too broad a base the parts are first carefully replaced (the animal having 
been placed on its back and the hind legs bent), and a ligature passed 
around the neck of the sac. Esser recommends for this purpose the 
elastic ligature. When, ten to twelve days later, this falls off, together 
with the hernial sac, a cicatrix has formed in the position of the latter, 
which prevents prolapse of the bowel. The elastic ligature should, how- 
ever, not be drawn tight enough to cut rapidly. ‘To prevent its sliding 
off, a strong needle may be passed through the sac below it. 

Degive takes up as much as possible in the ligature, and draws this 
quite tight. According to him the method is very successful in ruptures 
where the abdominal opening is not of greater diameter than the thumb. 
Where the base is broad the cord easily slips off, and removal by 
multiple ligature, 7.¢., ligation in sections, is preferable. I have repeatedly 
practised this method in foals and older horses with good results. Pro- 
cedure is as follows:—The animal is cast, placed on its back, the hind 
legs bent and drawn outwards, the hair shaved from over the hernial 
sac, and the latter washed and rinsed with a disinfecting fluid. After 
complete replacement, the folds of the sac are gathered together in the 
direction of its long axis, and, beginning at one end, transfixed close to 
the abdominal wall with a slightly bent needle, provided with a strong 
sterilised double silk thread. The threads, when drawn through, are 
divided close to the needle, and the ends of the one half tied tightly 
together, whilst an assistant draws the sac gently upwards. The needle 
carrying the second half of the thread is again passed through the sac 
about ? of an inch from the first point of incision, and this section liga- 
tured in a similar way. The same process is continued until the entire 
sac is ligatured. Should the animal struggle whilst the needle is being 
passed, the fingers of the left hand are placed on the umbilical ring to 
prevent the intestine protruding and being transfixed, or one waits until 
the animal is again quiet. The entire sac is then once more rinsed with 
sublimate or carbolic solution, and the ligatures on both sides of the sac 
powdered with a mixture of iodoform and tannin (1 to 3), or the entire 
sac may be painted with wound gelatine and covered with wadding. 

The animal is now allowed to rise and placed in a stall pro- 
vided with good clean straw. Should the above described precautions 
be taken, the wound generally heals aseptically. In from ten to 
fourteen days the ligatured portion of the sac sloughs away, and the 
wound appears healed. The operation is performed in a similar way 
at Brussels, but instead of silk strong waxed cords or hemp threads are 


240 TREATMENT OF UMBILICAL HERNIA. 


employed. To facilitate the work of ligation French veterinarians use an 
iron clam (Hamont, Bernard and others), which is applied over the empty 
hernial sac close to the abdominal walls. It prevents the portions of 
bowel which enter the sac when the animal struggles being penetrated 
by the needle. This may just as easily be avoided by chloroforming 
the animal, or by carrying out the above described method. 

To prevent prolapse of the viscera during multiple ligation, Mangot 
employs a long rectangular plate of lead, which has an opening in the 


Fic. 73.—Bordonnat’s Clam, 


centre through which the empty sac is drawn and then 
ligatured. Two wooden pegs are then thrust through 
the skin below the thread, the sac is cut off, and the 
plate of lead fastened over the animal’s back by four 
straps, which pass through suitable holes at the corners 
of the plate. [mminger has lately introduced this method 
in foals, but he employs silver wire for ligation. If 
the wire is not too thin, and not too strongly pulled, 
prolapse of bowel does not occur. 

(6) Removal of the sac by clams. The clams 
act like multiple ligatures and are most useful in 
hernize with broad bases; but, although this method 
is simpler than ligation, it usually prevents healing 
by first intention. A further difficulty in using clams 
is the fact that they easily fall off. To prevent 
this, pegs are thrust through the sac below the clam, 
or the clam itself penetrates the sac. Bordonnat constructed for 
this purpose the iron clam shown in fig. 73, and Combe invented a 
perforated clam (fig. 74) allowing the passage of ligatures or strong 
needles. After reducing the hernia, the clam is applied to the neck of 
the sac, as near as possible to the under surface of the belly, and in the 
direction of the linea alba, and fastened by screws, or as in castration, by 
a cord. The portion of sac below the clam can be cut off or left until 
the whole falls away, which happens after ten to twelve days. The 
latter is the better way where danger exists of the clam becoming loose. 


Combe’s Clam. 


TREATMENT OF UMBILICAL HERNIA BY HERNIOTOMY. 241 


For some time after its application the animal seems very much upset, 
but this ceases on the second day. In cases of very wide umbilical 
ring, recurrence of the hernia was noted even after the above treat- 
ment (Sanson). 

The chief points in using clams are to grasp sufficient skin, and to 
fix the clam firmly and evenly; and therefore wooden clams fastened 
with cords are less satisfactory than iron ones with screws, because, on 
account of their one-sided fastening, pressure cannot be so evenly applied. 

In using wooden clams one is sometimes applied over the other to 
prevent the first falling off. Degive recommends this, especially in large 
herniz, when the upper clam should be about 12 inches long, the under 
one some 4 inches less. The upper is applied as close as_ possible 
to the belly, so that after the animal rises, the sac appears to have 
vanished. Hernize as large even as a man’s head may be completely 
cured by this method. Demesse states having thus cured a case where 
two hands could be passed through the umbilical ring together. Should 
the sheath in male animals reach so far forward that it would be 
touched by the clam, the latter may be applied at right angles to the 
long axis of the body. 

(¢) Herniotomy. When, as in very large herni, the above methods 
fail, a cure may possibly be effected by suturing the hernial ring. The 
operation is carried out as previously described, and under antiseptic 
precautions. The animal is chloroformed, laid on its back, the entire 
surface shaved, rinsed free of soap, and disinfected. The skin is then 
divided in the long axis of the hernia or of the hernial ring. From this 
point the operation may be completed either with or without opening 
the peritoneal cavity. Siedamgrotzky prefers the latter way, and next 
separates the skin from the hernial sac, which he thrusts into the hernial 
opening. The edges of the umbilical ring are then freshened, brought 
together with strong cat-gut or silk threads, and the flaps of skin, after 
being shortened to the necessary extent, united above them. An anti- 
septic dressing is secured over all by means of bandages or a few threads, 
and healing takes place completely in from twenty to thirty days. 

Storry proceeded in a similar way. After dividing the sac from the 
skin, he sutured it with a strip of white leather, then cut it off and 
sewed the skin together. 

This method is to be preferred to herniotomia interna (which neces- 
sitates opening the peritoneal sac), if for no other reason than that the 
chances of peritonitis are slighter, and success is not endangered by 
prolapse of portions of intestine or omentum. 

But the peritoneum may also be incised without grave risk, as is shown 
by various observations: Degive operates in this way; Wiesner lately 
reported such a case, though it is clear that healing is not so simple as 

Q 


2492 TREATMENT OF UMBILICAL HERNIA. 


in Siedamegrotzky’s method. The foal operated on was very unwell for 
the next few days, whilst in herniotomia externa, scarcely any feverish 
disturbance was noticeable. Frohner operated under strict antisepsis, 
sutured the abdominal wound, and effected healing by first intention in 
ten days. 

Should the hernia be adherent, which is not uncommon after the use 
of acids or other irritants, it is better not to open the peritoneal 
cavity. Degive (Hendrickx) proceeds as follows :—The hernial sac is 
opened under antiseptic precautions and the peritoneum cut through 
far enough to admit the finger, so as to separate the adherent portions ; 
scissors may also be used. The sac is afterwards ligatured in sections, 
as above described. The cutting operation is not suitable in large 
herniz, especially if the rupture be circular, because of the difficulty in 
uniting the edges of the ring; in such cases it is better to use irritants 
supplemented by bandages. 

The animal should be prepared for operation by reducing the diet, 
giving easily digestible and concentrated food, and administering a purga- 
tive to empty the bowel Similar dietetic precautions should be continued 
for some days after operation. The bed should be of good clean straw, 
and it may be necessary to tie up the horse for several days. In small 
animals (dogs) irritants cannot be employed on account of their being 
licked off. Operative interference is here easier, but it must not be 
forgotten that many animals will not endure bandages, clams, threads, 
&e., but will at once tear them off. In such animals I therefore prefer 
the radical operation, and as far as possible avoid opening the peritoneal 
cavity. Dogs may receive a strong dose of morphine to quiet them, 
following which they generally sleep for twenty-four hours. The 
greatest pain has then disappeared, but it may occasionally be necessary 
to watch the animal continuously. 


VII—INGUINAL HERNIA, SCROTAL HERNIA (HERNIA 
INGUINALIS, HERNIA SCROTALIS). 


Ger. Leistenbruch, Hodensackbruch. 


Passage of abdominal contents through the inner abdominal ring into 
the processus vaginalis constitutes inguinal hernia. Should the viscus 
attain the scrotum, the condition is termed scrotal hernia. As the inner 
abdominal ring only remains open in male animals and in bitches, they 
alone suffer from inguinal hernie. ‘The horizontal position of the body 
in domestic animals is less favourable to the production of inguinal 
hernia than the perpendicular one in man. It occurs in horses and 
pigs, less seldom in ruminants and dogs, and the sac usually contains. 


INGUINAL HERNIA IN THE HORSE. 243 


intestine, less frequently omentum. As inguinal hernia exhibits certain 
peculiarities in the different classes of animals, it will be considered 
separately in each. 


(1.) INGUINAL HERNIA IN THE HORSE. 


Lit.: H. Bouley, Dictionaire, p. 224 u. Peuch-Toussaint, Chirurgie 
vét. p. 493. Degive, An. de méd. vet. 1890, p. 129. Berdez, Ency- 
clopaed. p. 419. Vogel, Hering’s Operationslehre. p. 463. Gerlach, 
Gerichtliche Thierheilkunde. II. Aufl. p. 705. Lafosse, Journ. de Méd. 
vét. de Midi, 1850. Gross, Her. Rep. 43, p. 104. Jessen, Gurlt u. 
Hertwig. 6, p. 20, 240 u. 400. Kruckow, Berl. Arch. 1886, p. 285. 
Lindquist, Jahresber. 1886, p. 83. Lorensen, Stockfleth Chirurgie, 
p. 428. Klingan, Miiller Roll. 18, p. 45. Reiser, Her. Rep. 39, 
p. 284. Colson, Annal. de méd. vét. belg. 1889. Sieger, Peuch- 
Toussaint Chirurgie vét. p. 494. Strecker, Thierarztl. Mitth. 1887, 
p. 119. Brimhal]l, Jahresb. 1890, p. 108. Mauri, ibid., 1891, p, 109. 
Lindquist, ibid., 1892, p. 83. Hammerschmid, Oesterr. Zeitschr. 
fiir wiss. Vet. 1892, p. 195. Humann, Ad. Wochenschr. 1891, p. 342. 


In stallions and geldings the inguinal canal consists of a flat funnel-shaped 
passage about 4 inches in length, whose upper opening (annulus abdominis) is 
from # to 1} inches in length, but occasionally much wider. It extends in an 
oblique direction from behind outwards and forwards, is situated 1 to 2 inches 
from the oblique branch of the os pubis, and 4 to 6 inches from the linea alba. 
Anteriorly and inwardly the abdominal ring is bordered by the posterior edge of 
the inner oblique abdominal muscle, posteriorly and outwardly by the cremaster 
or spermatic cord. The vessels supplying the posterior portion of the abdominal 
walls pass about } of an inch from its posterior angle, and on its inner side. 
The inguinal ring or outer abdominal ring (annulus inguinalis) consists of a slit 
between the inner and outer tendinous heads of the external oblique abdominal 
muscle, whose posterior inner angle lies 1} inches in front of the branch of the 
os pubis, and somewhat further from the middle line of the abdomen. Its 
normal length is about 4 inches; it likewise passes forwards and outwards, and 
opens when the thigh is directed backwards and abducted. The anterior inner 
wall of the inguinal canal is largely formed by the inner oblique abdominal 
muscle, the outer by the crural arch or Poupart’s ligament. 


Causes.—lIn stallions with abnormally wide abdominal rings, and 
less frequently in geldings, the small intestine or omentum may enter 
the inguinal canal. According to Berdez, Vogel, Stockfleth, and others, 
the condition is always caused by excessive width of the ring; whilst 
Lafosse, H. Bouley, and Gerlach declare that inguinal hernia may occur 
even where the aperture is of normal width. But even if we allow 
this, there is no doubt that in by far the greater number of cases the 
condition is due to abnormal width of the ring, which sometimes 
measures 4 to 6 inches. I have, however, also seen inguinal hernia in 
horses in which the inner ring scarcely allowed the entrance of two 
fingers, though, as a rule, two easily pass in addition to the spermatic cord. 


244 INGUINAL HERNIA IN THE HORSE. 


It is therefore difficult to fix a normal width and settle this question, 
which requires numerous measurements to be made in different races 
of animals. Inguinal hernia is generally congenital, or appears during 
the descent of the testicle. The tendency to it seems to be inherited. 
Its production is favoured by all circumstances which cause increased 
abdominal pressure, such as tympanites, severe exertion, hard draw- 
img on soft ground (where the action of the muscles in lifting the 
feet also produces dilatation of the abdominal ring), or struggling in 


Fic. 75.—Incomplete Inguinal Hernia. (The fig. Fic. 76.—Inguinal Hernia of the 
shows the position of the inner part and the ex- Horse (Hering). 
ternal nature of the protrusions. ) 


hobbles. _Hammerschmid’s case shows that difficult labours may pro- 
duce inguinal hernize in the foal, particularly if the hind quarters 
present; the foal in question showed an inguinal hernia as large as a 
child’s head on the third day after birth, All movements which cause 
dilatation of the abdominal ring, like violent kicking or slipping, espe- 
cially slipping outwards and backwards, may give rise to inguinal hernie. 
The same result may be produced by dragging on the spermatic cord 
during castration, by the pull of heavy clams, or of largely developed 
testicles in old stallions. In the latter, inguinal herniz sometimes result 
during copulation, the erect position causing the viscera to be pressed 
towards the pelvis and into the inguinal canal, which is dilated in 
consequence of the thighs being turned outwards. 


SYMPTOMS OF INGUINAL HERNIA. 245 


The condition occurs seldomer in geldings, because it is either cured 
by castration or leads to the death of the animal, and because dilatation 
of the abdominal ring very seldom happens late in life. The earlier 
the gelding is castrated the smaller does the inner abdominal ring 
become, and this explains why it is so small in most geldings, though 
the latter also suffer from inguinal hernia at times. The swelling of 
the spermatic cord after castration distends the canal and favours hernia ; 
the contents are usually omental, but intestinal hernie also occur, and 
in stallions constitute the rule. Sometimes both intestine and omentum 
are present in the sac, which is formed by the processus vaginalis, 
tunica dartos, and skin. 

Course.—In foals, spontaneous recovery often occurs (Girard, 
Stockfleth, Herrmann, and others), though seldom later than the first 
year of life. Grosse believes that good feeding favours recovery, by 
producing a better muscular tone; and distension of the intestine 
with firm contents, consequent on hard diet, certainly assists 
reduction. On the other hand, the rupture may gradually increase, 
particularly if work is heavy and the food bulky, and in such cases 
incarceration often occurs. Cases like Brinhall’s in a three-year-old 
stallion are, however, very rare. He saw a scrotal hernia suddenly 
develop, and two weeks later break, in consequence of necrosis of the sac. 
An intestinal fistula was thus produced, but closed again in a month with- 
out any assistance. Perhaps this was a ease of strangulation, but the 
result was certainly very extraordinary. In exceptional cases inguinal 
hernia appears in old animals (“hernies inguinales recéntes,” in opposition 
to the “ hernies inguinales anciennes ” of the French) and generally soon 
becomes strangulated. Such cases are probably often due to a simple 
inguinal hernia developing into the scrotal form, the former having been 
overlooked. In stallions scrotal herniz may become so large as even to 
interfere with movement of the hind-limb, or be injured by it. As the 
disease is difficult to treat and endangers the animal’s life, inguinal hernia 
must always be regarded as a grave condition. 

Symptoms.—The scrotum is increased in size by the entrance of 
viscera, but to a very varying degree; in cases a careful search may 
be required to detect the rupture, while in others the swelling extends 
below the hocks, and attains the size of a sugar loaf. Degive saw a 
hernial sac, 16 inches in depth and 8 in width, containing 27 pints of 
fluid, and I have seen others as large. 

The swelling has the general characters of a rupture, is elastic, soft, 
and, if omental, somewhat doughy. It is yielding and disappears on 
pressure, or on the animal being placed on its back, leaving the sac 
empty except for the testicle, which, in old inguinal herniz, is usually 
atrophied and flaccid. A coil of intestine may sometimes be detected 


246 DIAGNOSIS OF INGUINAL HERNIA. 


in the scrotum, and, according to Boulet, always lies on the inner side 
of the spermatic cord. The swelling is increased by exertion, by the 
action of the abdominal muscles, or by coughing. A tympanitic tone on 
percussion and rumbling betray the presence of air or gases. In geld- 
ings the neck of the hernial swelling is of considerable size, and appears 
firmer, in consequence of being surrounded by omentum. 

The detection of so-called incomplete inguinal herniz is very difficult. 
In these cases the spermatic cord is usually abnormally thickened, either 
from cedema following pressure by the hernial contents on the vessels of 
the cord, or from hypertrophy of the cremaster in consequence of 
increased work. The former is therefore commoner in recent inguinal 
herniz, the latter in old ones. 

Doubtful cases can be cleared up by a rectal examination. 

In recent inguinal herniz, the hind-limbs are generally moved stiltly, 
the toes dragged, and the limbs turned outwards, the breathing is 
rapid, the animal stretches out, shows slight colic, and draws up the 
testicle of the affected side; Girard regards the latter symptom as 
pathognomonic. These signs either vanish in a few days, or symptoms of 
strangulation set in. 

In inguinal, as in other herniz, strangulation is generally first signal- 
ised by attacks of colic, and therefore it is a good practical rule always 
to examine the scrotum in stallions sufferme from colic. The horse, 
under these circumstances, usually stretches out or sits on his hind- 
quarters like a dog. Jessen saw vomiting, and though, as a rule, this 
only occurs in rupture of the stomach, it must not be forgotten that 
such rupture is tolerably frequent in this disease. 

A second group of symptoms indicative of incarceration are found in 
the changes undergone by the scrotum. The hernial swelling becomes 
larger, harder, tenser, and more painful, and can no longer be compressed 
or replaced. In several of such cases I have found the cauda epididymis 
very prominent close to the testicle. 

Diagnosis of inguinal and scrotal herniw and of strangulation is 
therefore seldom difficult. The conditions most resembling it are— 

(1) So-called interstitial inguinal hernie. I shall refer to this disease 
later on (p. 254). 

(2) Sarcocele, though the greater hardness of the entire swelling 
scarcely allows of mistake. 

(3) Hydrocele. Collection of fluid in the vaginal sac may be recog- 
nised by the swelling being easily displaced and more confined to the 
lower portions of the scrotum. Hydrops of the spermatic cord may be 
at once recognised by its greater firmness and immobility, and can only 
be mistaken for incarcerated hernia. 

(4) Heematocele, that is, distension of the scrotum, or of the tunica 


PROGNOSIS OF INGUINAL HERNIA. 247 


vaginalis, with blood, presents the same appearances as hydrops, but is 
often associated with cedema of the scrotal skin. 

(5) Inflammation of the skin covering the scrotum may, under certain 
circumstances, give rise to suspicion of inguinal hernia, and in all such 
doubtful cases examination per rectum must be resorted to, when it is 
at once easy to determine both the size of the abdominal ring and the 
condition of viscera which have entered it. 

(6) In geldings fistule or other diseased swellings of the spermatic 
cord may lead to mistakes, unless a careful examination be made. 

Prognosis. —Inguinal hernia is always dangerous, because treatment 
is difficult, and death often follows strangulation. The most important 
elements in forming a prognosis are the age of the animal, and the size 
and character of the hernia. . 

Although spontaneous recovery may occur in young animals, it is 
exceptional (Stockfleth). The condition produces difficulty in castrating 
foals, and renders this generally simple operation dangerous, whilst fresh 
eases of inguinal hernie in old animals are doubly grave, on account of 
the risk of incarceration. Extensive ruptures, and especially those with 
large apertures, not only injure the appearance of the animal and inter- 
fere with its use, but at the same time offer the greatest difficulty to 
treatment. 

Omental are usually less grave than intestinal hernie, and on this 
ground geldings are more hopeful subjects, though even in them the 
intestine sometimes descends and becomes strangulated. In a gelding 
I replaced an incarcerated inguinal hernia four times during a period 
of six weeks. Irreducible hernize are doubly dangerous, because 
of the difficulty in operating. Finally, it should be remarked that 
incarceration does not necessarily depend on the size of the hernia. 
Small and incomplete inguinal herniz are more frequently strangulated 
than extensive hernia with wide abdominal ring. 

Treatment.— Operation is rendered difficult by the length of the 
inguinal canal and the position of the hernia. Schering very shrewdly 
advises leaving well alone, and not operating unless obliged. ‘This, how- 
ever, becomes necessary when a stallion has to be castrated, and incar- 
ceration not infrequently necessitates operation. As, in the latter case, 
procedure differs from that in non-strangulated ruptures, the treatment 
of the simpler condition will first be dealt with. 


I. TREATMENT OF NON-STRANGULATED INGUINAL HERNIA. 


Various methods have been proposed; amongst the most important are— 
(1) Closure of the inner abdominal ring by inducing inflammation of 
the spermatic cord and adhesions with neighbouring structures. If, after 


248 TREATMENT OF NON-STRANGULATED INGUINAL HERNIA. 


successful reposition of the hernia, the spermatic cord be caused to 
swell, it may completely fill the abdominal ring, or so far occlude it as 
to prevent the passage of intestine or omentum. 

(a) In Spain, according to Stockfleth’s description, the scrotum and 
spermatic cord are continuously rubbed. The stallion is starved for two 
or three days, the rectum emptied by means of clysters, the animal cast, 
placed on its back, and the hind-quarters drawn up. The testicle is 
now drawn forward with one hand, whilst the thumb, index, and middle 
finger of the other are employed in rubbing the spermatic cord until 
marked swelling appears. The animal is allowed to rise quietly, and 
during the first three days is sparingly fed, and only walked when 
exercised. Animals are said to be cured in twelve days; but though 
this is possible, it is certain that failures often result. 

(>) Bagge’s method is similar. After replacing the hernia, a woollen 
band is tied round the scrotum, in the neighbourhood of the inguinal 
ring, and allowed to remain on for eight hours, when a swelling is 
found to have been produced, and the band is removed. Recovery 
occurs in six to eight days. Bagge states having thus cured nine 
stallions in one day (?). 

In this connection, Kruckow’s procedure may be referred to even 
though the method be not usually possible. In a fresh case of inguinal 
herma Kruckow thrust the displaced portion of intestine, together with 
the testicle, back into the intestinal cavity, after which the intestine 
did not return. The scrotum was rubbed with diluted sulphuric acid. 
This report is open to question, for two reasons—firstly, it is certainly 
only in exceptional cases possible to thrust the testicle into the 
abdominal cavity through the inguinal canal, and even if this were 
always practicable, the absence of the spermatic cord from the abdominal 
ring must greatly favour recurrence. 

(2) Treatment by closure or narrowing of the processus vaginalis. 

(a) Foelen has recommended the application of irritants to the 
scrotum in the neighbourhood of the inguinal ring, as in treating umbili- 
cal hernie. The ointment he uses consists of 1 part of cantharides, 
2°5 parts of euphorbium, 15 parts of fat, and 1°5 parts of verdigris; it 
may be applied without coating the animal by drawing the testicle 
downwards, thus rendering the skin of the scrotum tense. The appli- 
cation should be made once daily, until the epidermis becomes loosened, 
which usually happens in ten to twelve days. The parts are then washed 
with lukewarm water, and when the inflammation has disappeared the 
infrictions are recommenced, until in four to six weeks the rupture has 
disappeared. Degive also recommends this method, though it is of little 
use in animals more than four to six months old. 

(6) The application of clams. This is very generally practised, and 


BY CLAMS AND SUTURES. 249 


resembles the covered method of castration. The hernia is reduced 
and the clams applied as high, that is, as near to the inguinal ring 
as possible, and over the tunica vaginalis and spermatic cord. In 
order to be able to apply the clams very high it has been recommended 
to give them a bent form, but this is not desirable, because the centre 
portion does not press sufficiently on the tunica vaginalis. A simpler 
and more effectual way of closuring the tunica vaginalis above the clam 
is to give a half turn, which may later be made a complete one, to the 
tunica vaginalis and the spermatic cord before applying the clams. As 
far as I am aware this method was first practised by Pfuscher, and 
described by Curdt in 1856. Hering warmly recommended it a few 
years after. It appears only to have become known in Belgium at a 
later date, for Degive, in 1890, ascribes this new “ procédé ingenieux” to 
a French veterinarian. 

Displacement of the abdominal viscera is said to be prevented 
by the closure of the processus vaginalis, but this is dependent on 
the size of the abdominal ring; and where the latter is large the 
viscera not only interfere with closure, but may even cause rupture 
of the processus vaginalis. Though this danger is certainly decreased 
by twisting the processus vaginalis, it is not entirely removed, and, 
therefore, I have lately somewhat modified the process. The operation 
should be performed antiseptically under chloroform. As the chief 
difficulty in applying the clams high is occasioned by the outer skin 
and soft parts lying below it, I select a short but carefully disinfected 
pair of clams, and make an incision through the skin, large enough 
to allow the clams to be pushed to the bottom of the wound, and to he 
just under the inguinal ring. ‘The skin is then brought over them and 
sutured, thus retaining them in the wound. If neither fever, swelling, 
nor other disturbance is marked during the next few days, I allow the 
clams to remain in position for a week. On removal, healthy granu- 
lations will be found unaccompanied by pus formation, and the wound 
heals in a short time under aseptic precautions. 

J. F. Stockfleth operated in a similar way. He drew the lappets 
of skin over the clams, by means of purse-string sutures, but loosened 
the latter next day, and applied a ligature around the processus vagi- 
nalis and above the clams. If this be not done, it is well to fasten the 
clams to the neighbouring skin by a ligature. 

The clams must not be removed too soon. The longer they remain, 
the better the union between the surfaces of the processus vaginalis. 
Jessen found three days too little, and in his later cases left the clams 
on for five days. In the above operation they may remain in position 
still longer without disadvantage, and need not be removed, even though 
pus forms, provided fever does not set in. In any case, the clams 


250 TREATMENT OF NON-STRANGULATED INGUINAL HERNIA. 


should not be removed before the fourth or fifth day. A bandage and 
dressing similar to that used in castration of cryptorchids (compare with 
this) can be applied, to assist in supporting the weight of the clams 
and preventing the tunica vaginalis tearing. 

Dieterichs recommends using a sponge to temporarily close the processus 
vaginalis. He opens the latter, hgatures the spermatic artery, and then 
thrusts a sponge, provided with a central hole, over the spermatic cord, and 
as high up as possible, so as to occlude the abdominal rmg. The clams 
are then applied to the spermatic cord, but removed again after twenty- 
four hours, whilst the sponge is left in position until it comes away 
spontaneously. The disadvantage is, that should the sponge not be care- 
fully sterilised, which is very difficult to ensure, peritonitis often occurs, 
as shown by the experience of Bassi and others, and for this reason this 
method cannot be recommended; that above described is certainly to 
be preferred. 

Sorensen (Stocktleth) and others apply a ligature above the clams 
for a similar purpose. The clams are removed next day, but the 
ligature is left in position until it falls off. Tetanus is, however, said 
to be a common sequel. 

(c) The method of ligaturing the tunica vaginalis, together with the 
spermatic cord, has not found many supporters; though a few (Reiser, 
Jessen) recommend it. It certainly cannot produce such perfect occlu- 
sion as the clams, though, if aseptic materials lke silk be employed 
it may render it possible to close the processus still higher in the 
inguinal canal. 

(d) Bouissy’s plan of multiple ligation of the scrotum is inadvisable, 
because of the danger of including a portion of bowel, and to prevent 
this (even when using the clams over the processus vaginalis), it has 
been suggested to first incise the processus, and, by introducing the 
finger, to make sure that no intestine is present. This may be useful 
in doubtful cases, but an external examination generally suffices. 

(3) Closure of the abdominal or inguinal ring. Many operators 
deseribe having sutured the inner abdominal rig (Verrier, Colson, 
Hammerschmidt, and others), but as the modus operandi is never suf- 
ficiently well described to convince one of the correctness of the asser- 
tion, my observations on the anatomy of the part oblige me, like 
Degive and Hendrickx, to doubt the correctness of these assertions. 
In old stallions the narrowest portion of the inguinal canal lies 4 to 14 
inches below the abdominal ring, and presents an almost insuperable 
difficulty. If the inner abdominal ring has ever been sutured, an 
abnormal condition of the parts has clearly existed, to begin with. On 
the other hand, the position of the inguinal ring (ze., the outer ring) 
would easily allow of its being sutured, but the rigid character of the 


TREATMENT OF INCARCERATED INGUINAL HERNIA. 251 


edges (tendinous head of the external oblique muscle) effectually prevent 
union. Certainly the same success could not be obtained as by the 
above described methods, and this probably explains its slight popularity. 

In the gelding, operative measures must be somewhat modified. 
Here the processus vaginalis must first be feund, which is most easily 
effected in the following way :—The horse is cast, chloroformed, and 
laid on its back; the castration cicatrix discovered, and an elliptical 
incision made through the skin around it, so that the skin which is 
adherent to the base of the processus or to the end of the spermatic 
cord can be lifted, together with the sub-lying tissues, by means of a 
narrow tape passed through it. The processus vaginalis is then sepa- 
rated as in the operation for scirrhous cord, and exposed for a consi- 
derable extent in an upward direction. The clams are now applied 
over the processus and spermatic cord in the manner above described, 
provided no intestine is present in the processus; but as one must, in 
the gelding, always be prepared for adhesions, it is best where the 
slightest doubt exists to open the processus vaginalis, and by introduc- 
ing the finger to make sure of the absence of intestine or omentum. To 
prevent injury, the intestine must be separated with the greatest care. 
For this purpose I prefer using the scissors, and endeavour as far as 
possible to find the border of the adherent bowel, and where this cannot 
be clearly made out, I leave a portion of the processus adherent to the 
surface of the bowel and replace them together. Pieces of omentum 
may be ligatured with sterilised material and cut off, or they may be 
included in the clams without danger. It is also advisable to half or 
wholly rotate the processus vaginalis, or to apply a small pair of clams 
as high as possible within the wound, allowing their weight to be 
carried by the skin. Strecker, in operating on a gelding, used a ligature 
to close the processus vaginalis. 


Il, TREATMENT OF INCARCERATED INGUINAL HERNIA. 


This must be carried out as early as possible, and in conformity 
with the general precautions given on p. 232. 

The horse is carefully cast, chloroformed, and laid on its back, the 
hind-quarters being higher than the fore, which Jessen effects by 
laying the fore-part in a hollow; the hind-legs are bent, and, if 
possible, that of the affected side is drawn outwards and backwards. 
One then endeavours, by pressing on the neck of the hernial sac, and by 
drawing and turning as above described (p. 252), to effect taxis, the 
testicle being meanwhile drawn forward. Reposition may be effected by 
introducing the hand into the rectum and cautiously pulling on the parts 
in the inguinal canal, but caution must be used in manipulating the 


252 TREATMENT OF INCARCERATED INGUINAL HERNIA. 


hernial sac, and the older the strangulation the greater the care 
required. 

After complete reduction, the animal is allowed to roll on to the sound 
side; the hobbles are loosened, and if the animal remains quiet, it may 
be allowed to he for a quarter to half an hour, though it must not be 
forcibly prevented from rising. 

If, after trying for half an hour, reduction cannot be effected, as a rule 
herniotomy is the only resource. For this purpose anesthesia should be 
reinduced or rendered complete; the hoofs of the hind-legs carefully 
cleansed and covered with moistened cloths, and the hair and under- 
surface of the legs also moistened to prevent dust falling on the point 
of operation. If the latter has been cleansed, disinfected, and all the 
requirements of antisepsis complied with, the skin and tunica dartos are 
carefully cut through as far as the base of the scrotum and separated 
from the processus vaginalis with the fingers, assisted by scissors, up to 
the spot where the neck of the hernial sac appears most markedly 
strangulated. This point lies in the inguinal canal an inch or so below 
the abdominal ring, as Hering and French veterinarians have noted. 
Reduction may now sometimes be effected by introducing a finger into 
the inguinal canal and pressing and kneading this point, especially if an 
assistant pass his hand into the rectum and pull gently on the bowel. 
I prefer to carry out this accessory manipulation myself, because, whilst 
it is important to exercise a steady and regular pull on the portion of 
bowel in the inguinal canal, the spermatic cord must not be grasped, as 
it would limit the pull. With a little practice the parts may easily be 
distinguished through the rectal wall. Should these attempts come to 
nothing, the operator must proceed to herniotomia interna, that. is, 
incision of the processus vaginalis together with the abdominal ring. 
The seat of incarceration may generally be felt by introducing the 
finger, and division must be made at that point. 

According to my experience, strangulation occurs in old stallions about 
an inch below the abdominal ring. In geldings, on the other hand, I 
have generally found the annulus abdominalis the narrowest point. 
Possibly the heavy pull of the testicle on the spermatic .cord, which 
becomes fan-shaped in the abdomen, exercises some influence on the 
funnel-shaped, or, as the French call it, the “hour-glass” dilatation of 
the processus vaginalis, which is most noticeable towards the inner abdo- 
minal ring. The continuous pull can without doubt produce a dilating 
influence of that kind, which would explain the greater disposition 
of old stallions to protrusion of the bowel at the point indicated. 

Girard constructed for this operation:a pair of long hernia knives, 
one in the form of a greatly enlarged straight tenotome, and the other 
in that of a bent tenotome. The ordinary herniotome (fig. 77) may 


BY HERNIOTOMY. 253 


also be employed, or in case of need, a blunt-pointed bistoury. The 
abdominal ring must be incised near its anterior angle, and the cut be 
made in an outward direction. Towards the middle line, and in the 
neighbourhood of the posterior angle, are the vessels of the abdominal 
walls, which must be avoided, and any lengthening of the anterior angle 
is apt to be followed by tearing of the inner oblique abdominal 
muscle. Even when the point of incarceration has only 
been incised to the extent of a line or two, reposition 
becomes easy, and indeed usually results from the pull 
of the abdominal viscera themselves. Paty recommends 
pouring extract of opium and belladonna dissolved in 
oil into the processus vaginalis. This certainly lubricates 
the contents of the hernial sac and assists reposition ; 
but plain oil sterilised by boiling would serve the same 
purpose. After reduction, treatment is the same as 
in non-strangulated rupture, that is, a pair of clams are 
adjusted as high up as possible over the spermatic cord 
and tunica vaginalis, which latter should be rotated once 
on its long axis. 

Where it is important to preserve the testicle, the 
subcutaneous operation, recommended by Bouley, can 
be carried out, though the strictest asepsis must be 
observed. The scrotum and tunica vaginalis are cau- 
tiously divided at the outer side, in the neighbourhood 
of the inguinal ring, so that a hollow probe may be intro- 
duced into the narrowest part of the processus vaginalis, 
which is then divided with the hernia knife. Others 
(Siegen) use the fingers instead of a probe, and pass 
the hernia knife along these to divide the abdominal 
ring. Siegen states having thus rendered a horse fit 
for work in twelve days. The second wound is sewn 
up and a suitable antiseptic dressing applied. Unless 
strictly antiseptic, this method is open to grave objection, 
as Peuch has already pointed out. 

In other respects the operation for inguinal hernia bate 
is not so grave. Bouley states having effected a cure Beas 
after strangulation lasting twenty-four hours. According 
to Stockfleth, of 55 horses, 13 died after dilatation of the abdominal 
ring ; in Alfort, 8 out of 20 died; but Benjamin only lost 5 out of 28 
operated on. 

Reported cases of the successful use of hernial trusses are rare. 
Klingan states having succeeded in curing foals by means of a complicated 
bandage ; but in all probability much was due to the intervention of nature. 


254 FALSE INGUINAL HERNIA. 


(2.) FALSE INGUINAL HERNIA (HERNIA 
INGUINALIS INTERSTITIALIS). 


Lit.: Hildach, Gurlt u. Hertwig. 13, p. 83. Stockfleth, Chirurgie, 


This term is used to describe inguinal or scrotal herniz where the 
hernial contents le outside the processus vaginalis. The small intestine 
or rectum, or very occasionally a portion of omentum, pass into the 
inguinal canal or scrotum, not through the inner abdominal ring, but 
through a pathological opening which usually hes close in front of the 
abdominal ring. At this point a lacuna exists in the abdominal muscles 
of the horse, which is filled with connective tissue, and is therefore less 


Fic. 78.—Peritoneal-scrotal Hernia (Hering). 


resistant. This section of the abdominal wall is lined with peritoneum, 
and is considered by Franck to be a tendinous expansion of the oblique 
abdominal muscle; by Schmalz it is termed the inguinal ring. 

After rupture of the peritoneum and of this connective tissue, intestine 
or omentum may pass into the inguinal canal outside of the processus 
vaginalis, a condition which is termed peritoneal-scrotal hernia (fig. 78). 
The condition clearly has a great resemblance to genuine inguinal hernia ; 


TREATMENT OF FALSE INGUINAL HERNIA. 255 


but the swelling appears higher up, close under the inguinal ring, because 
the hernial contents are not confined by the processus vaginalis, in conse- 
quence of which the base of the hernial sac appears more pointed, and 
may take the form of a peaked night-cap (Hildach). Taxis is more 
difficult than in the previous condition. In doubtful cases examination 
per anum may give reliable information as to the hernial character of 
the swelling. 

The condition was discovered by Hildach during a post-mortem on a 
stallion, and has been described by H. Bouley in France as “hernie 
extra-vaginale.” Sometimes it is first recognised when performing the 
operation for inguinal hernia, the contents of the hernia, and not the 
processus vaginalis, coming in view on incising the skin of the scrotum 
and the tunica dartos. Stockfleth saw it in boars, but it seems unknown 
in other animals. The first change consists in rupture of the above- 
described portion of the abdominal wall, resulting from abnormal increase 
in intra-abdominal pressure, or possibly from violent movement. Hildach 
saw this form of hernia suddenly occur after the animal had been 
ridden. 

Prognosis is even less favourable than in true inguinal hernia, the 
danger of incarceration being greater, and recovery attended with more 
difficulty, because the processus vaginalis cannot be drawn forward to 
effect closure of the hernial opening. 

Treatment.—Where strangulation has not set in, operation should 
be avoided. Reduction of incarcerated hernize may be attempted in the 
standing position, but usually fails, even when assisted from within by a 
hand introduced into the rectum. But under no circumstances should 
operation be attempted until every effort to effect taxis has failed. For 
this purpose the same measures may be adopted (casting, dorsal position, 
narcosis) as in true inguinal hernizw. Should herniotomy prove abso- 
lutely necessary, the scrotum is cautiously opened under antiseptic 
precautions. After dividing the skin and tunica dartos, the hernial 
contents appear, and must be protected from soiling by cloths dipped in 
disinfecting fluids. The hernial opening is then sought for with the 
index finger, which is guided by the processus and the hernial contents ; 
and should it prove impossible to dilate the ring with the finger, and 
return the intestine to the abdominal cavity, the opening must be 
widened with a herniotome, after which taxis becomes easy. An attempt 
may then be made to suture the abdominal ring with sterilised catgut or 
silk. The skin is closed with numerous button sutures, the surroundings 
of the wound cleansed, dusted with iodoform, and covered with a dressing, 
as after castration of cryptorchids. I have proved that, in the case of 
eryptorchids, sutures of the kind described may be inserted in the 
inguinal canal. Lund operated on an interstitial inguinal hernia with 


256 INGUINAL HERNIA IN SWINE. 


success (Stocktleth): but Hering noted prolapse of the bowel, and death 
after operation. 


(3.) INGUINAL HERNIA IN RUMINANTS. 


Lit.: Loble, Her. Rep. 15, p. 221. Youatt, Stockfleth’s Chir. Hess, 
Schweiz. Arch. 1892. 


Inguinal hernia is rare in ruminants, and only a few recorded cases 
exist. Youatt saw it in a steer, Loble in an ox, Hess in a calf. 

The symptoms and course of the disease are similar to those in 
horses, though the condition is far less grave than in the latter—the value 
of the animal not being diminished to the same extent, and it being 
possible, even where the hernia has become incarcerated, to slaughter 
without very great loss. 

Treatment is much as above described. Should the hernia become 
strangulated, Loble’s method of operating through the right flank may 
be tried. He thrust the ox against a wall, cut through the skin and 
muscle below the external angle of the ilium, passed the hand into the 
abdominal cavity, and found a double loop of intestine strangulated in 
the left inguinal canal. As this could neither be freed, nor could a 
finger be introduced into the inguinal canal, Loble inserted a straight 
bistoury (whose point was guarded with a strip of plaster), holding 
it between the index finger and thumb, and thus enlarged the abdo- 
minal ring. A tenotome is recommended for this purpose, which should 
be fastened by a cord, so as not to be lost in the abdominal cavity. After 
freeing the bowel the abdominal wound was sutured, and recovery 
occurred in six weeks. It should not be forgotten, however, that the 
hernia can often be reduced via the rectum, without opening the 
abdomen. 


(4.) INGUINAL HERNIA IN SWINE. 


Lit.: Stockfleth, Chirurgie. Gerlach, Gurlt u. Hertwig. 20, p. 307. 
Eberhardt, ibid. 17, p. 266. Meyer, ibid. 15, p. 440. Degive, 
Her. Rep. 38, p. 177. Storch, Oesterr. Zeitschr. f. Vet.-Wiss. 1889, 
p. 161. 


Both boars and castrated swine often suffer from inguinal hernie. 
The hernia is generally one-sided, very seldom double-sided, and its con- 
tents usually consist of a portion of bowel which, in castrated animals, is 
often adherent to the sac. Omental herniz are rarer. In swine inguinal 
hernia is usually congenital and hereditary, or develops during the first 
few weeks of life, seldom later. 


TREATMENT OF INGUINAL HERNIA IN SWINE. 257 


Symptoms and Course.—In sucking pigs the swelling may be 
the size of a goose’s egg. The testicle lies at the bottom of the scrotum, 
which, in consequence of the thin and yielding character of its skin, may 
be greatly enlarged. Raising the fore-quarters increases the swelling, 
raising the hind-quarters diminishes it; whilst thrusting the finger 
upwards into it, discovers the existence of dilatation of the abdominal 
ring. Sometimes the rupture is so small as only to be detected on 
castration. The little animals fail to develop, whilst the rupture 
gradually increases in size; but spontaneous recovery is sometimes seen. 
Though strangulation is not frequent, it occasionally happens both in 
boars and castrated animals, and is associated with the same symptoms 
as in other animals—colic, increased hardness and pain in the swelling, 
and difficulty in replacing the hernia. 

Prognosis is more favourable in pigs than in horses, the peritoneum 
being less sensitive, and not resenting operative interference to the same 
extent, though castration of a ruptured boar requires particular care, 
and sometimes ends fatally. 

Treatment.—lIn castrating ruptured sucking pigs, the animals are 
placed for some days on short rations, and starved for ten to twelve 
hours beforehand. The covered operation is selected and the ligature, 
which should be rather thick, applied as high as possible, and 
drawn moderately tight, but not sufficiently to cut through the tunica 
vaginalis, which might lead to prolapse of the bowel. To avoid this 
danger Stockfleth sutured the skin, whilst Gerlach inserted a deep 
interrupted suture. 

Should the hernial contents be adherent to the processus vaginalis 
they must be carefully separated, injury to the bowel being avoided. A 
case of Eberhardt’s shows that even incision into the bowel is not 
always fatal in pigs. Meyer, in cutting through an adhesion, left a 
portion of processus vaginalis adherent to the bowel, but had good 
results. On account of such adhesions the operation is usually more 
difficult in castrated animals than in boars. The second testicle may 
be removed at the same time. Stockfleth recommends examining 
the abdominal ring first; when this is too small to admit the finger, 
the usual method of castration may be adopted, otherwise the covered 
operation is preferable. In double-sided inguinal herniz in sucking 
pigs, both testicles may thus be simultaneously removed. 

Old ruptured boars are castrated by the covered operation, clams 
being used, and either left until they fall off spontaneously, which 
occurs in one to two weeks, or after a similar time removed. The 
clams, which should be rather small, and applied as high as 
possible, must be used on both sides, even though the rupture be 
only one-sided. Degive opens the processus vaginalis to make sure 

; R 


258 INGUINAL HERNIA IN DOGS. 


of the complete return of the bowel, and applies the clams as high as 
possible. 

After operation, the animals are placed in a dry stall provided with 
clean straw, and for some time receive short rations. Local treatment 
is not necessary, nor, on account of the excitement of the animals, is it 
to be recommended. 

Stockfleth saw a case of peritoneal scrotal hernia in a boar; on 
operating, the bowel was found outside the processus vaginalis. He 
therefore enlarged the skin wound, replaced the hernial contents, and 
ligatured the inner coats of the hernia (which consisted of firm con- 
nective tissue) at the same time as the tunica vaginalis. The animal 
made a good recovery. The case shows that, in opening the hernial 
sac, care must be taken to avoid injuring the bowel, in case a rupture 
of this sort should exist. 


(5.) INGUINAL HERNIA IN DOGS. 


Inguinal herniz, although rare in dogs is common in bitches, in 
which the abdominal ring remains open to give passage to the round 
uterine ligament covered by its peritoneal sheath. The hernial 
contents generally consist of uterus, sometimes containing embryos. 
Stockfleth found four fully-grown puppies. Sometimes, however, portions 
of intestine and omentum, and even of the urimary bladder and 
spleen, are found in the sac, which is formed by peritoneum, udder, 
and skin. 

Inguinal herniz are only seen in bitches, which have already borne 
young, the increase in length of the round uterine ligament, and the 
widening of the abdominal ring, necessary to hernia formation, being 
effected by muscular action during delivery. 

Symptoms and Progress.—The hernial swelling is least character- 
istic in bitches, being covered by the udder. It is harder, but less 
sharply defined than in males, is often as large as a man’s fist, lies 
towards the back of the udder, and appears, both when single and 
double-sided, as a regular diffuse swelling. In thin animals, and where 
the udder is only slightly developed, the uterus may sometimes be felt 
in the depths; in fat animals, having well-developed mamme, diagnosis 
is often rather difficult. The possibility of reduction, and the disappear- 
ance or decrease of the swelling in the dorsal position, are the most 
important symptoms. 

It is only possible to mistake this condition for tumour of the udder 
on superficial examination, and it should be remembered that tumours 
scarcely ever lie so deep as does the hernial swelling. It is more difficult 
to distinguish it from thickened round uterine ligament, though the 


CRURAL HERNIA. 259 


latter appears as a hard cord connected with the anterior border of the 
os pubis. 

In doubtful cases the vagina must be examined. Where the uterus 
lies in the hernial sac the vagina appears lencthened, narrowed, or drawn 
towards the diseased side or downwards, and often scarcely admits the 
finger, whilst the anterior portions of the vagina are less movable than 
usual. 

Incarceration and other complications threatening life are seldom met 
with. Even delivery is usually easy (Stockfleth). Strangulation, how- 
ever, when occurring, produces symptoms similar to those in other 
animals. Vomiting is occasionally seen. 

Treatment.— Unless incarceration (the symptoms of which should 
be made known to the owner) occurs, treatment is, as a rule, confined 
to regulation of diet. In France, the injection of iodine was formerly 
tried, though Lafosse had doubtful success with it; severe inflammation 
occurred, leading to death. When surgical interference becomes absol- 
utely necessary, the radical operation is recommended, though it is more 
difficult to carry out than in male animals. It consists in ligation of 
the hernial sac, or of its inner coat, and of the peritoneum and surround- 
ing connective tissue. Narcosis and antiseptic precautions are necessary. 
An incision is made through the skin and udder; the inner coat of the 
hernia is then separated and ligatured as near as possible to the hernial 
ring. Should it prove impossible to replace, the uterus can be amputated. 
Operation should be avoided during pregnancy, soon after delivery, and 
during cestrum. 


ViII—CRURAL HERNIA (HERNIA CRURALIS). 


Ger. Schenkelbruch. 


Lit.: Girard, Arch. général de méd. vét. III. p. 67. Tiedholm, Stockfleth, 
Chirurgie. Lafosse, Cours dhip. 1112. Lafond, Journ. de méd. vét. 
1823, p. 41. Dandrieux, Rec. de méd. vét. 1827, p. 594. 


Crural hernia is so rare that Girard altogether doubted its occurrence 
in animals, and in spite of an extensive experience, I myself have never 
seen it. Lafosse, however, states having several times had to operate 
for crural hernia; and usually it is said to have been seen in horses and 
dogs. 

The crural canal (canalis cruralis) consists of a triangular space between the 
sartorius and iliacus muscles and Poupart’s ligament, and lies somewhat nearer 
the mesial line of the body than the inner abdominal ring, but close behind it. 
It is usually occupied by the crural artery and vein, by lymph glands, and con- 


nective tissue, and is covered by the outer tendinous head of the inner oblique 
abdominal muscle, and by the peritoneum, by which the passage of abdominal 


260 TREATMENT OF CRURAL HERNIA. 


viscera into the canal is prevented. Should, however, this covering become 
dilated and a portion of bowel or omentum enter the canal, a crural hernia results. 
The latter consists of an abdominal hernia, to whose covering the fascia cruris 
further contributes; sometimes a slit exists in the fascia through which the 
hernial contents have passed. 


Symptoms.—tThe hernial swelling, which is usually small and flat, 
is found on the inner aspect of the thigh, at the point where the vena 
saphena leaves the surface. It can be repiaced in the dorsal position, 
often causes straddling gait, and when incarcerated, may produce lame- 
ness, colic, &e. Examination per rectum leaves no doubt as to its 
existence. 

Causes and Progress.—The condition is either congenital or 
arises during delivery, from the hind-quarters of the foetus remaining a 
long time in the maternal passages, and the abdomen being powerfully com- 
pressed. In later life it may be caused by slipping, drawing heavy loads, 
or by very severe labour pains. Dandrieux saw a cow develop crural 
hernia during labour. Spontaneous recovery scarcely ever occurs, and 
incarceration, which produces the same symptoms as in other hernie, 
is not uncommon. Crural hernia must, therefore, be considered as at 
least as dangerous as inguinal hernia. 

Treatment.—Lafosse attempted taxis after casting the horse, but 
if the hernia be strangulated and taxis fail, he recommends operation. 
An incision is made through the sac large enough to enable Poupart’s 
ligament to be sewn with the sartorius muscle after reduction’of the 
hernia. 

In non-strangulated herniz the use of irritants, like cantharides oint- 
ment, has been frequently recommended. After operation the animal 
should be tied up for a week, and fourteen days later may be quietly 
exercised, 

Tidborn opened an incarcerated hernia in a foal, replaced the loop of 
small intestine, which had already become adherent, and sewed up the 
wound; the animal, however, died. Lafond states having cured crural 
hernia in the she ass by using clams. In Germany the disease appears 
to be very rare. Whether the different food or the heavy. work is the 
cause of its more frequent occurrence in France is uncertain. 


IX.—PERINEAL HERNIA. 


Lat, Hernia perinealis, Ger, Mittelfleischbruch, 
Lit.: Siedamgrotzky, Dresd. Ber. 1877, p, 63. 


The posterior wall of the pelvis possesses in male animals only 
one dilatation—the excavatio recto-vesicalis; but in female animals 


TREATMENT OF PERINEAL HERNIA. 261 


there are two—the upper the excavatio recto-uterina, the under the 
excavatio vesico-uterina. Distension of one or other of these boun- 
daries of the pelvis and entrance of abdominal viscera into the space so 
caused is termed perineal hernia. 

The disease is most frequently seen in dogs, less in the cow, ewe, 
and bitch, in which animal it usually consists of a dilatation of the 
excavatio vesico-uterina, which is more exposed to strain on account of 
its lower position. In male animals either the intestine or urinary 
bladder is found in the excavatio recto-vesicalis, in females the hernia 
consists of small intestine. 

Symptoms.—As a rule only one side is affected. In dogs a swelling, 
varying from the size of a man’s fist to that of a child’s head, and 
possessing the known characteristics of a hernia, occurs close to the root 
of the tail and just over the ischial tuberosity. In ewes it may be as 
large as a goose’s egg, and appears alongside the vulva. In the cow 
a round swelling, sometimes as large as a man’s head, arises close under 
the vagina, and presses forward the labie. The hernia can be reduced 
and the swelling dispersed by pressure, by raising the hind-legs, or by 
walking the animal down-hill; whilst it is increased by raising the 
fore-legs, or by any cause which increases intra-abdominal pressure. 
Incarceration very seldom occurs, though Siedamgrotzky noticed stran- 
gulation of the urinary bladder in a dog. 

Causes and Progress.—Continuous contraction of the abdominal 
muscles, difficult labours, heavy draught, walking on the hind-legs (dog), 
and standing with the hind-quarters low (cows), are known to favour 
production of perineal hernia, but its immediate cause is a mystery. It 
may exist for long periods without causing trouble, for, on account of 
the great width of the hernial opening, incarceration is exceedingly 
rare, though, according to Stockfleth, it sometimes impedes. delivery 
in ewes, because the vagina is pressed into the hernial sac during the 
pains, and becomes bent at an angle. Cows with this disease should 
not be used for breeding. 

Treatment.—<As a preventive measure, cows should not be placed 
with the fore-feet higher than the hind. Unless strangulation occurs, 
all treatment should be avoided; the difficulties during labour are said 
to be lessened by dilating the vagina. Another reason for avoiding 
operation is that the hernial contents are often attached to the sac, 
a condition indicated by the latter being markedly drawn inwards, 
when the hind-quarters are raised. Should incarceration necessitate 
operation, or the owner desire it, the animal is chloroformed, an incision 
made under antiseptic precautions, and the hernial sac ligatured in 
sections, that is, if the contents of the sac are clearly non-adherent. 
Otherwise the inner coats must be cautiously cut through, the 


262 VENTRAL HERNIA. 


intestine or bladder separated, the sac brought together with several 
stitches, and the skin first shortened sufficiently and then sutured. 
A case treated in the Dresden clinique shows that it is possible to 
effect a cure, even under unfavourable circumstances. The urinary 
bladder had been incised, but was immediately sutured, and recovery 
followed. The purse-string suture may sometimes be used to advantage 
(Siedamgrotzky). 


X.—VENTRAL HERNIA (HERNIA VENTRALIS). 


Ger. Bauchbruch. 


Lit: Rademacher, Gurlt u. Hertwig. 7, p. 476. Jiirgens, ibid, 14, p. 
494. Meyer, ibid., 17, p. 88: Gerlach, ibid., 7,p.211. Schmiele, 
ibid., 15, p. 324. Noack, Dresd. Ber. 1890, p. 83. Deffke, Mon- 
atsschr. f. Th. 1891, p. 65. Guitard, Le Progrés vétér. 1891. 


Whilst the herniz hitherto described are due to dilatation of openings 
normally present, all others caused by solutions of continuity in the 
abdominal walls (but not of the skin) are described as ventral hernia. 
Such breaches are either caused by external injuries, like kicks, treads, 
thrusts, the impact of blunt bodies, collisions with the carriage pole, 
staking of the abdomen, and falling on blunt objects, or they may result 
from excessive muscular contraction during parturition, &e. Sometimes 
they attain very large dimensions, as shown by Eberhardt and Dette’s 
cases, and by a mare I had under observation (fig. 79). Hertwig believed 
that congenital fissures in the walls of the abdomen sometimes caused 
ventral herniz. 

As a rule, the sac consists of skin and panniculus, the contents 
(intestine or omentum, or both) having passed through a rupture in the 
abdominal muscles, to which they later become adherent, the peritoneum 
is generally torn through. The hernia usually contains intestine, 
though Noack reports two cases in the cow where it was above 
the udder, and contained portions of the uterus. One,. operated on 
by Guitard, was in the right flank, and contained the abomasum. 
Gerlach and Schmiele have seen herniz containing portions of the 
liver. 

Symptoms.—In recent ventral herniz two sets of symptoms exist, 
those of hernia proper, and those of rupture and bruising of tissue ; 
the latter may, indeed, appear the more important and mask the 
hernia. Ventral hernize are found most frequently near the last rib, 
cattle on the right, in horses on the left side. The parts are acutely 
inflamed, painful on pressure, and, in consequence of cedema, either firm 
or doughy; if much blood has been poured out, there may be fluctua- 


DIAGNOSIS OF VENTRAL HERNIA. 263 


tion. Older herniz fail to display such symptoms, but will be recog- 
nised by their compressibility, fluctuation, softness, varying size, &c. 
(p. 227). In the depths, the hernial opening may usually be felt as a 
round or elongated aperture. 

The swelling varies within wide limits; in small animals being often 
only the size of a pigeon’s egg, while in cattle and horses it may exceed 
that of a sugar loaf. In the horse the hernial swelling seldom exceeds 
the size of the clenched fist or, at the most, of a man’s head, but greater 


Fia. 79.—Ventral hernia in a mare (from a photograph). 


dimensions are occasionally reached, as in the case of a mare I had 
under treatment, shown in fig. 79. According to its position, it is termed 
hernia lineze albee, hernia iliaca, or hernia perumbilicalis. The contents 
are usually formed by intestine or omentum, seldom by other abdominal 
organs (Gerlach, Schmiele). 

Differential Diagnosis.—Recent cases may be mistaken for inflam- 
matory swellings or hematomata in the abdominal walls. In those of 
old standing the hernial aperture can always be discovered by palpation, 
provided accidental inflammatory processes are absent from the neigh- 


264 STRANGULATED VENTRAL HERNIA. 


bourhood of the sac. The sudden appearance of the swelling and its 
compressibility must arouse suspicion of a rupture. Im any case, 
caution is required in operative interference, and, in doubtful cases, 
sharp instruments should not be used before making certain of the 
absence of hernia. Rectal examination is sometimes useful, and, if 
needful, the parts can be punctured with a trochar, under antiseptic 
precautions. 

Particular caution is indicated in presence of colic, which may proceed 
from incarceration, but in fresh injuries may also be caused by the pain 
associated with peritonitis ; though the latter is the exception, the former 
the rule. 

Strangulation is not at all common; Wollstein denies its occurrence 
altogether; but I have repeatedly convinced myself, like Hertwig, that 
both recent and old ventral hernie do occasionally become strangulated, 
though the danger is much less than in either the umbilical or inguinal 
forms. The symptoms are similar in all. The necessary conditions 
are a small opening and a large sac. The immediate cause may 
be heavy work, tympanites, colic, or parturition, and it is common 
experience that the small intestine becomes more readily strangulated 
than the colon. Small ventral herniz sometimes disappear spontaneously, 
and even large ones diminish with lapse of time. 

Ventral are thus usually more hopeful than inguinal hernize, though 
they may seriously interfere with the use of hard-worked horses, and are 
always a danger in the event of the animal suffering from colic or tym- 
panites, or becoming pregnant; and, for this reason, female animals with 
ventral herniz should not be used for breeding. 

Treatment is best confined, in recent cases, to counteracting inflam- 
matory symptoms, unless strangulation has occurred. Under favourable 
circumstances, the hernial contents may be retained, or further egress 
prevented, by a carefully applied compress; but it must not be forgotten 
that any considerable pressure may cause necrosis of the skin and favour 
prolapse. Old ventral herniz seldom receive treatment, unless they 
interfere with the animal’s work, when the same means may be 
employed as were formerly described (p. 237). Trusses can seldom 
be used, and treatment is then practically confined to the following :— 

(1) Application of irritants or inorganic acids. The same principles 
apply here as were described in umbilical herniz. Rademacher recom- 
mends sulphuric acid. 

(2) Simple or multiple ligation, or the application of clams. This 
method presupposes the absence of adhesion, which, as already stated, 
is somewhat rare. Simple ligation is seldom successful, on account 
of the large base of the hernia, and therefore recourse must be had 
either to multiple ligation or to clams, after making sure of the 


VENTRAL HERNIOTOMY. 265 


absence of adhesion. Either wooden clams (castrating clams) or the iron 
ones described on p. 240 may be used, and the process is the same as in 
umbilical hernia. 

(3) Herniotomy. This only succeeds where the rupture is slit-like, 
and can be sutured. Jiirgens reported several successes—in one the 
cow calved without any difficulty soon after operation; in another cow, 
showing symptoms of incarceration, Meyer sutured a recent ventral 
hernia in the neighbourhood of the’udder. The colon and a convolution 
of the small intestine were replaced, and both the abdominal ring and | 
the skin brought together. It is, however, often very difficult to suture 
tissues already saturated with blood and inflammatory products, and 
such treatment is much less successful in horses than in cattle and 
carnivora. In old ventral herniz extensive adhesions often exist 
‘between the contents and the sac, and occasion great difficulty to the 
operator; and whilst he must be prepared for this, he should ‘use the 
greatest care in endeavouring to break them down. The external 
operation, described on p. 233, sometimes succeeds, but not always, the 
inner hernial envelope, which has been retained in the hernial opening 
by means of the purse-string ligature, sometimes failing to become 
adherent and the hernia reappearing later. In general, the larger the 
aperture the slighter is the hope of cure. 

Incarcerations may sometimes be reduced by steady pressure from 
without, and assistants may even be entrusted with the treatment. It 
has been stated that in ruptures occurring in the posterior portion of 
the abdomen, reposition may be assisted in large animals by passing the 
hand into the rectum. 

Gerlach and Schmiele operated on a dog suffering from fractured 
ribs, and a hernia containing part of the liver. A firm but com- 
pressible swelling, almost as large as a man’s fist, had suddenly appeared 
in the left subcostal region. The hernial sac was divided, one lobe of 
the liver, which was found between the ribs, was replaced, the wound 
sutured, and a cure effected. 

The mare shown in fig. 79 foaled without any help, in spite of the 
extensive nature of the rupture, the animal instinctively lying on the 
abdomen; it was then, however, killed, and the post-mortem showed 
that the straight abdominal muscle was ruptured a hand’s-breadth in 
front of the os pubis, and that an aperture existed, measuring 20 inches 
in one and 24 inches in the other direction. Both the oblique and 
transverse abdominal muscles were torn away. In the rupture lay a 
great part of the cecum, its point directed backwards. Connective tissue 
had formed in all directions in large quantities, and the fascia of both 
thighs was greatly thickened as far down as the hocks; lameness had 
not been observed during life. 


266 PELVIC HERNIA. 


Guitard operated on a ventral hernia containing a portion of the 
abomasum, by incision through the flank. After thrusting back the 
abomasum the muscles were brought together, a dressing and compress 
applied, and the case terminated successfully. 


XI.—PELVIG HERNIA, INTERNAL ABDOMINAL HERNIA, PERI- 
TONEAL HERNIA, “GUT-TIE” (HERNIA INTERNA 
ABDOMINALIS). 


Ger. Innerer Bauchbruch, Bauchfellbruch. Ueberwurf, Verschniiren, Knopf. 


Lit.: Oesterlen, Teuffels Mag. 1. Eisele, Her. Rep. 1, p. 217. Lin- 
denberg, Gurlt u. Hertwig. 13, p. 413. Reicherter, Her. Rep. 35, 
p. 830. Gierer, Th. Wochenbl. 1855. Schenk, ibid, 1854. Anker, 
Prakt. Abhandl, 1824. Lebrecht, B. T. W. 1892, p. 147. 


This affection occurs most frequently in hilly regions, like Switzer- 
land, but has been seen in England and Denmark. Though first 
described by Oesterlen, it was left to Anker to explain the nature of 
the condition and its mode of origin. It almost always affects two- to 
three-year-old oxen, occurs on the right side, and results from a por- 
tion of the colon, or less frequently of the small intestine or omentum, 
becoming strangulated by passage through a rupture in the peritoneal 
covering of the spermatic cord. The bowel usually becomes fixed 
in an aperture of the peritoneum in the neighbourhood of the sacrum 
and strangulated, though in other cases the free end of the spermatic 
cord returns into the abdominal cavity, and may encircle portions of 
the bowel in the neighbourhood of the abdominal ring. 

Causes and Progress.—The immediate cause is a solution of 
continuity in the peritoneum covering the cord, or displacement of the 
cut end of the cord, though this is rare. Both conditions are due to 
unskilful castration, especially to pulling on the cord, without previously 
grasping it above, as in forcibly tearing off the testicles, a custom still 
common in the south. 

The initial rupture is also favoured by heavy work in hilly districts. 
In climbing slopes, the viscera are pressed backwards, part may pass 
through the rupture existing in the peritoneum of the cord, or may 
possibly even cause rupture, and then become incarcerated. As the 
size of the rumen, which lies on the left, ensures it against strangulation, 
it is easy to explain the frequent occurrence of the condition on the 
right side. Failing early assistance, the animals die in four to eight 
days from incarceration, rupture of the bowel, and peritonitis. Prognosis 


TREATMENT OF PELVIC HERNIA. 267 


is only favourable during the first few days, but as long as symptoms of 
peritonitis are absent, proper treatment generally leads to recovery. 

Symptoms.—tThe condition is announced by colic, loss of appetite, 
striking with the feet towards the abdomen, moving backwards, frequent 
lying-down followed by suddenly springing up, and general restlessness. 
Where much green food is given, tympanites may also be observed. 

After twelve hours an apparent improvement sets in. The animals 
are quiet, again masticate, and possibly take food. During the next 
few days, however, they relapse; colic returns, the animal passes 
blood-stained feces, has difficulty in breathing, and the pulse becomes 
small and frequent. As soon as these symptoms of peritonitis have 
appeared, the condition is in the highest degree threatening. 

Sometimes pain is shown on pressure in the right flank, and on 
examination per rectum, a swelling about as large as a man’s head, which 
is painful and doughy, at first soft, but later becomes hard, may be 
detected close in front of the entrance to the pelvis, and near the wall 
of the abdomen. Towards the middle line it is bordered by a tensely 
stretched cord. In strangulation by the free end of the cord a similar 
swelling may be recognised on the lower abdominal wall, near the 
abdominal ring. 

These symptoms leave little doubt as to the nature of the disease, 
though occasionally it may be confused with invagination of the bowel 
(compare with this), or with other kinds of incarceration. Anker saw 
strangulation caused in one case by a hole in the round uterine liga- 
ment. Lindenberg states having seen similar symptoms from rectal 
obstruction. Examination of the rectum always gives the necessary 
information. 

Treatment.—In fresh cases reposition may be attempted by raising 
the hind-quarters or walking the animal down-hill, but little time should 
be lost in such attempts, because taxis becomes more difficult and 
dangerous the longer the malposition exists. 

(1) Reicherter and others have suggested performing taxis through 
the rectum. When the incarcerated portion of bowel is not much 
distended, this may succeed, but later becomes impossible. Whilst 
Reicherter states having thus cured sixteen animals, others have 
altogether questioned the efficiency or possibility of the operation. In 
making the attempt, the animal must be placed with the fore-legs lower 
than the hind; the loins pressed upon, to prevent arching of the back, 
the hand introduced into the rectum, and efforts made to thrust the 
strangulated bowel forward and so to free it. 

(2) Eisele, Metzger, Schenk, and others recommend rupturing the 
spermatic cord from the rectum. Schenk states having grasped the 
cord with the extended left hand, and having drawn it so far backwards 


268 DIAPHRAGMATIC HERNIA. 


that it broke in two; others recommend placing the thumb against it 
and pressing forwards to effect rupture. In any case, it is of import- 
ance to protect the rectum, which is best effected by Schenk’s method 
owing to the broad surface employed. 

(3) Whilst Anker states having thus invariably succeeded, others 
have failed to produce the desired rupture, and have proceeded to open 
the abdomen. For this purpose an incision, about 4 to 5 inches in 
length, is made in the skin of the right flank, following the direction 
of the outer oblique abdominal muscle. After dividing the other 
muscles to the same extent, the peritoneum is broken through; the 
hand introduced into the peritoneal cavity, the omentum perforated, 
and a search made for the incarcerating spermatic cord, which is 
divided either with a bistowri caché or with a specially constructed 
knife in the form of a hook. When the operator has convinced himself 
of the absence of a similar condition on the other side, the wound is 
sutured and treated according to general principles. If performed 
early, the operation is stated not to be dangerous. Strauss lost only 
11 animals out of 110 subjected to operation. 


XII.— DIAPHRAGMATIC HERNIA (HERNIA DIAPHRAGMATICA). 


Ger. Zwerchfelbruch. 
Lit.: Lehnhardt, Gurlt u. Hertwig. 15, p. 325. Schraery, ibid., 27, p. 97. 


Rupture of the diaphragm is commonest in horses, but also occurs in 
dogs and other animals, and is caused by sudden falls, by rearing and’ 
falling over, and by severe tympanites; in exceptional cases, it occurs 
as a complication of fractures of the ribs. Abdominal organs may then 
pass into the thorax, a condition termed diaphragmatic hernia. Lehn- 
hardt saw the disease in a cow; the reticulum had entered the thorax. 
Provided the bowel does not become strangulated in this opening, 
respiration is little affected. 

Symptoms and Progress.—Large masses of abdominal viscera 
entering the thorax may cause sudden asphyxia by compressing the 
lungs, whilst strangulation produces the usual symptoms, and taxis being 
impossible, soon leads to death. In the absence of such fatal complica- 
tions, difficulty in breathing is marked, the animals become broken-winded, 
and ruminants show digestive disturbance. 

It has been stated that the condition may be diagnosed with certainty 
by auscultation, but such is seldom the case. It is always difficult to 
say whether the peristaltic sound originates in the abdomen or the 


PROGNOSIS OF DIAPHRAGMATIC HERNIA. 269 


thorax, and, therefore, beginners may easily form an erroneous diagnosis. 
Nor car a tympanitic percussion sound be regarded as evidence of the 
disease, because this accompanies a series of changes in the lungs, and 
in short no absolute diagnosis can be founded on clinical examination. 
The character and course of the symptoms and the absence of fever, 
though never pathognomonic, are perhaps the most reliable guides. 

Prognosis is always unfavourable and treatment unavailable, because 
even though reposition could be effected, the condition would probably 
recur, it being impossible to close the diaphragmatic opening. 

Schrader saw an uncommon complication in the horse. The 7th rib 
was broken and a fragment had perforated the diaphragm, producing an 
opening through which portions of bowel, omentum, and spleen had 
passed into the thorax, and making their way through the thoracic wall 
and under the skin, had produced a hernia as large as a man’s head just 
below the left elbow. The horse lived for several years, bnt finally 
died in consequence of the hernia becoming strangulated. 


V. SURGICAL DISEASES OF THE STOMACH 
AND BOWELS. 


|—FOREIGN BODIES IN THE DIGESTIVE TRACT. 


Lit. Hahn, Adams Wochenschr. 1874. Iwersen, Thierirztl. Mitth. 
1871-72, p. 187. Berger, Bad. Mitth. 1888, p.94. Meyer, Gurlt u. 
Hertwig. 30, p. 257. Obich, Miiller Roll. 20, p. 157. Eppele n. 
Seloz, Stockfleth. p. 496. Siedamgrotzky, Dresd. Ber. 1887, p. 62. 
Nichoux, Her. Rep. p. 101. Adam, Ad. Woch. 20, p. 364. Avril, 
ibid., 21, p. 409. Frohner, Monatshefte f. pr. Thierh. 1892, p. 481. 
Marquardt, Bad. Mitth. 1892. 


SHARP substances like needles, wire, nails, &c., accidentally present 
in the food, are sometimes swallowed by oxen, less often by sheep and 
goats, and give rise to injuries both of the digestive tube and of other 
parts, like the pericardium and heart. Horses are not so often affected, 
though in one case a quantity of nails, buttons, and screws were found 
in the colon of a horse, their abraded condition showing they had already 
lain there for a long time (The Vet., 1875, p. 508). 

Dogs often swallow stones, corks, balls, or coins which they have 
picked up or had given them to carry; whilst in the stomachs of oxen 
and horses portions of probangs or boluses are sometimes found. 


Hahn, while making a post-mortem of a horse, found an abscess in the 
spleen, containing a piece of wood 13 inches in length and $ an inch in thick- 
ness. In one case a pig swallowed a castrating knife 4 inches in length, 
which remained lying in the stomach for two months without producing any 
marked disturbance, A similar experience in the dog is related by Iwersen. A 
sporting dog swallowed a pocket-knife while carrying it to its master, but vomited 
it again nineteen days later. Seven stones, of a collective weight of 54 ounces, 
were found in the stomach of a Newfoundland dog. The organ was greatly 
distended, its mucous membrane thickened and covered with warty growths. 
The dog had been accustomed to play with stones, tossing them into the air and 
again catching them, and this had at length proved fatal, a piece of coal having 
blocked the ileo-czecal valve and occluded the bowel. A cat swallowed a glass- 
headed hair-pin, 45 inches long. The head had entered the stomach, but the 
sharp end remained in the cesophagus, and led to perforation and death. 


The danger thus occasioned is of a double nature: sharp foreign 
bodies, like needles, nails, &c., perforate the wall of the stomach or 
bowel, and lead to fatal peritonitis, or they penetrate the diaphragm and 


FOREIGN BODIES IN THE DIGESTIVE TRACT. Dilek 


produce septic pericarditis. This is the rule in cattle, where such 
bodies enter from the reticulum. It often happens that, at the point of 
injury, the stomach or bowel becomes adherent to the abdominal wall, 
leading to perforation outwardly and escape of the foreign body. The 
discharge of needles, hair-pins, and portions of wire has often been 
observed in cattle, and usually occurs on the left side, close behind the 
elbow. Avril removed a tobacco pricker, which had lain for six months 
in the ox’s rumen, from this point. Recovery is generally perfect, 
stomach or bowel fistula being seldom produced (p. 222). Sometimes the 
foreign body enters other organs, such as the spleen, and induces abscess 
formation, and death from peritonitis. Sheep and goats are less 
frequent victims, though cases of perforation of the abdominal walls and 
fatal peritonitis have also been seen in them. 

Smooth foreign bodies, in consequence of their weight or size, remain 
lying in the stomach or lumen of the bowel, though heavy objects, like 
metal balls, knives, &c., often fail to pass the stomach. Sometimes they 
produce no discomfort, as in the case of a dog which swallowed a grape- 
shot, and in Nichoux’s case, where the animal carried a silver five-franc 
piece and a large sou in his stomach for twelve years ; but sometimes 
digestion is disturbed. Lighter foreign bodies enter the bowel and are apt 
to become fixed at the ileo-cxecal valve. Bottle corks are particularly 
dangerous, on account of their swelling in the bowel. 

Symptoms and Course.—Patients are seldom directly observed 
when swallowing foreign bodies, and the presence of the latter in the 
digestive tract can only be discovered by the symptoms they give 
rise to. In cattle, the first sign of injury to the stomach is sudden 
unaccountable disturbance in digestion, with periodic colic and 
tympanites; dyspncea soon follows, in consequence of injury to the 
diaphragm and lungs; irregularity in the action of the heart sets in 
later, the cardiac beat becomes laboured and intermittent; auscultation 
reveals pericardial murmurs, whilst the heart sounds themselves still 
appear normal. To these are added rubbing, scraping, buzzing, or creak- 
ing sounds, or fluid sounds, like gurgling and bubbling. Circulation is 
impaired, oedema is present below the breast and in the dew-lap, and the 
jugular vein betrays pulsation (venous pulse). And lastly, palpation of 
the abdomen on the left side, close to the ensiform cartilage towards 
the site of the reticulum and in the heart region, may cause pain. 

In dogs, obstruction of the bowel caused by foreign bodies shows itself 
by vomiting and complete loss of appetite. The animals vomit all kinds 
of nourishment—even pure water—soon after receiving it. Severe 
febrile symptoms, which generally accompany inflammatory diseases 
of the mucous membrane of the stomach or bowel, are here wanting. 
Under such circumstances diagnosis can scarcely be doubtful. 


272 FOREIGN BODIES IN THE DIGESTIVE TRACT. 


By palpation of the bowel the foreign body may sometimes be felt. 
For this purpose the dog is placed on his hind-legs, the body grasped 
from above, and the viscera allowed to glide between the fingers of the 
two hands, by moving these with slight pressure from the under portion 
of the abdomen towards the vertebre. But such manipulation often 
requires to be frequently repeated to discover the foreign body. Some- 
times the latter is not felt on the first attempt, but may be discovered 
after a short interval, say an hour; sometimes it is so far forward, and 
so sheltered by the ribs, as to altogether escape palpation. 

It is easy to avoid mistaking masses of feces in the rectum, or the 
kidneys or abdominal tumours, for foreign bodies. The first will be 
recognised as long sausage-shaped cords of a softish character. <A 
foreign body is differentiated from a kidney by the fact that it may be 
pressed towards the lower abdominal wall, which cannot be done with 
a kidney. The greatest difficulty is in distinguishing foreign bodies 
from tumours, but as these are very rare in the anterior part of the 
abdomen, they may almost be left out of account. 

Dogs with stoppage of the bowel generally die in eight to ten 
days, with symptoms of extreme weakness; oxen. with injuries to 
abdominal and thoracic organs after an illness of varying length. Re- 
covery is rare, except where the foreign body perforates the abdominal 
wall. 

Treatment usually comes too late. In oxen, repeated attempts have 
been made to remove sharp foreign bodies by rumenotomy. Obich 
cured four cases out of thirteen; in three, abscesses formed, and in five 
help was too late. Meyer has operated with success. After making 
an incision into the rumen in the usual way, the operator inserts his 
arm in a forward and downward direction to discover the reticulum, 
which lies on the right, searches this carefully, and endeavours to remove 
the foreign body. The chief difficulty is the impossibility of certain 
and early diagnosis. Provided the foreign body has not injured the 
diaphragm and pericardium, its presence is of no consequence. Disturb- 
ance of digestion and breathing, caused by injury to the wall of the 
stomach and to the diaphragm, are not sufficient to warrant operative 
measures, whilst, should the pericardium be already injured, operation 
can scarcely procure recovery, and slaughter is generally preferable. 
Meyer, however, states having succeeded, even after pericarditis had 
set in. Eppele and Seloz removed a piece of probang and gloves from 
a cow’s stomach by rumenotomy (for a description of this operation 
compare p. 281). 

Dogs are sometimes seen to swallow the foreign body, and in such 
case an emetic should first be tried, but not before giving a considerable 
quantity of firm food (flesh), so as to distend the stomach. Fecal stasis, 


LAPAROTOMY. 978 


if already existent, may be overcome, and the foreign body brought away 
by injecting lukewarm water into the rectum. Plenty of fluid should 
be used, so as to distend the bowel, and open the way for the foreign 
body. Sometimes the hypodermic injection of eserine produces powerful 
peristaltic action and passage of the offending object, but purgatives given 
per os ave useless, and are always vomited, 

As a last resource, laparotomy may be tried, though it generally 
comes too late, the animal’s strength being gone before operation is 
determined on. Siedamgrotzky, however, was successful with a dog 
which had swallowed a large flint stone. Adam removed a grape shot 
from the stomach by gastrotomy, and effected a cure. The strictest 
antisepsis is, however, necessary. After narcotisine the dog with 
morphine, followed by ether, the lower surface of the abdomen be- 
tween the umbilicus and sheath or the ischium is shaved and disin- 
fected. The skin is then cut through close to the linea alba, and the 


Fic. 80.— Fic. 81.— Fic. 82.— 
Gely’s bowel suture. Lembert’s bowel suture. Wolfler’s bowel suture. 


muscular tissue divided for a distance of 2 to 3inches. The peritoneum 
is next incised by the method described at page 233, the finger 
introduced into the cavity to prevent injury to the bowel, and the 
peritoneum finally divided to the same extent as the abdominal walls. 
Two or three fingers are now introduced into the peritoneal cavity, and 
the foreign body sought. To prevent prolapse of the bowel, the left 
hand or, preferably, a cloth saturated with disinfecting fluid, is laid on 
the wound. 

It often takes some time to discover the affected piece of bowel, and 
one must not lose patience. As soon as the part is felt, it should, if 
possible, be drawn through the abdominal wound. The portion of bowel 
coming from the stomach (afferent portion) is immediately recognised by 
its being distended, and should be kept closed by an assistant pinching it. 
The bowel is now incised immediately over the foreign body, and in its 
long axis, as far as seems necessary. After taking away the foreign 

Ss 


274 PUNCTURE OF THE BOWEL. 


body, the wound in the abdominal wall is closed. At this time it is 
important to keep the afferent portion of bowel closed to prevent advancing 
ingesta soiling the wound, and, in case of need, a provisional ligature may 
even be applied, but must not be drawn very tight. Finally the intes- 
tinal wound is closed with bowel sutures (figs. 80 to 82). As it is very 
important to bring the serosa of both sides into contact, and to make the 
closure as perfect as possible without piercing all the intestinal coats, 
which would perhaps lead to peritonitis, one of the methods recommended 
by Gely, Lembert, or Wolfler may be employed. Thereafter the surface 
of the intestine and of the wound is once more cleansed, the abdominal 
muscles and skin are sutured with sterilised material, and a proper 
dressing applied. Where the animal is particularly valuable continuous 
watching may be necessary to prevent the dressing moving or being 
torn off. A dog which I operated on pulled off the dressing and 
loosened the sutures, occasioning prolapse of the bowel and death. 


Il—PUNCTURE OF THE BOWEL IN HORSES (PUNCTIO 
INTESTINI). 


Ger. Darmstich. 


Lit.: Bourgelat, Instruct. et Observ. von Barrier u. Herrouard. 1780, v. 
p. 321. Rainard, Lyoner Klinik 1831. Schaak, Journ. des Vet. du 
Midi. 1839, p. 238. Friedberger, Kolik der Pferde. Fohringer, 
Ad. Wochenschr, 1880, p. 31. Peters, ibid., 1883, p.443. Brogniez, 
Traité de chir. vét. iii. p. 82. Imminger, Ad. Woch. 1890, Nr. 41. 


In horses, colic is often accompanied by active production of gas in 
the colon and cecum, by which the diaphragm is pressed forward and 
respiration impaired, in consequence of the lungs being pressed on and 
the posterior ribs fixed. Suffocation may even be threatened, and 
circulation in the abdominal viscera so affected as to endanger life. 
The animal’s recovery, therefore, depends on speedy removal of the 
gas. The more marked the respiratory disturbance, the shallower and 
more frequent the breathing, the greater is the danger. In extreme cases 
the animals become unsteady on their legs, stagger about, fall down, and 
die in a few minutes. Crib biting induces the same symptoms though 
in a minor degree, and seldom leads to death, but tympanitic colic, pro- 
duced by fermentation in the intestinal canal, often takes a fatal course, 
the reason being that in the one case air ceases to be swallowed as soon 
as the animals experience discomfort or pain, whilst fermentive changes 
and production of gas still continue, even under considerable pressure. 


GUIDES IN PUNCTURING THE BOWEL. 275 


Internal medicaments, supposed to neutralise or absorb intestinal 
gases, act too slowly, and lke those given to prevent fermentation, enter 
the colon too late to be of benefit. As the natural passages for 
discharge of gas may be filled with solid matter, the only method of 
staving off suffocation often resolves itself into removal of gas by 
trochar. 

The operation acts hke puncture of the rumen; but puncture of the 
bowel in the horse is more dangerous, even though recent cases, like 
Friedberger’s, show that risk of peritonitis is greatly diminished by 
careful antisepsis. The precise cause of the greater vul- 
nerability of the peritoneum in horses is still unknown, 
though it is clear that peritonitis is only caused by the 
introduction of infective materials into the peritoneal sac. 
It therefore becomes the chief task of the operator to 
prevent such infection; but though it is easy to guard 
against soiling from without, it is impossible to prevent 
it from within, ze¢., from the bowel itself, at the moment 
of withdrawal of the trochar. To minimise risk, the 
instrument must be of small calibre, as small, indeed, as 
will allow of free discharge of gas. Fredberger’s model 
has met with wide approval (fig. 85). Canulee with side 
openings are to be avoided on account of their favouring 
infection of the peritoneal sac. 

As, however, puncture is never without danger, it is only 
justified by such pressing necessity as dyspnoea threaten- 
ing life. 

In the horse a large portion of the colon is not directly 
in contact with the abdominal wall, but is covered by coils 
of small intestine, and is, therefore, not easily reached in 
the erect posture; though, as animals thus sutfermmg soon 
cue of suffocation when lying, puncture of the bowel ice 
is usually only undertaken in the upright position. me. 33. — 
It must also be remembered that the lower lying Ptiedberger’s tn 
portions of the colon usually contain firm masses of food, for horses. 
while the gases collect in the upper parts, whence their discharge, 
by means of the trochar, is both easier and less dangerous. For 
these reasons, the seat of operation should be in the cecum, as 
its base is fixed at the height of the right external angle of the 
ium, and can be found with certainty with the trochar. The 
field of operation, which is fairly extensive, is trianeular in form, 
bounded above by the transverse processes of the lumbar vertebrae, in 
front by the posterior edge of the last rib, and below by a line 
drawn from the middle of the last rib. The point to select is that 


276 PUNCTURE OF THE BOWEL THROUGH ABDOMINAL WALLS. 


which projects most prominently, and returns a tympanitic sound 
on percussion, but should these signs for any reason be wanting, or 
appear more distinctly at another spot, the latter may be selected 
without disadvantage. The important matter is to alight on a fold of 
bowel filled with gas; the larger this is the better. 

The chief difficulty les in observing antisepsis, and, therefore, both 
the trochar and skin around the point of puncture must first be care- 
fully disinfected, provided there is time. The instrument should be 
boiled for five to ten minutes in water or soda solution, the hair shaved 
off with a razor, the skin washed with soap and rinsed with a disin- 
fectant (such as sublimate solution). If possible the field of operation 
should be washed with ether or spirit preparatory to washing with the 
disinfectant. 

The trochar, prepared as above, is then thrust through the abdominal 
wall at the pomt indicated. To render its passage easier, an incision 
may first be made through the skin with a small pair of forceps or 
pointed bistoury, and when distension is not so great as to prevent it, 
the skin should be drawn a little to one side, and the puncture 
made so that the abdominal wound will afterwards be covered by the 
skin, In passing the instrument it is directed perpendicularly to the 
surface and slightly towards the left elbow, and introduced far enough 
to be sure of perforating the bowel; the distance depends on the thick- 
ness of the abdominal wall. Asa rule, the trochar can be introduced 
for 35 to 4 inches, or even further, without danger. The stilette being 
removed, the abdominal gases discharge through the canula_ with 
a whistling noise; the canula is left in position until the distension 
subsides and gas fails to reaccumulate. To test this pomt the canula 
should be stopped with a cork. If tympanites does not recur, and 
the animal shows no further restlessness, the instrument may be 
removed. 

The wound is now cleansed, disinfected, powdered with iodoform, and 
covered with adhesive plaster or collodion. As long as the canula 
remains in position, the animal must be watched to prevent it rolling, 
or the instrument falling out. 

Both the skin and intestinal wounds generally close by first inten- 
tion, if antisepsis has been carefully carried out. 

To prevent the bowel falling away from the canula, and to check the 
entrance of bowel contents into the peritoneal sac, Brogniez has con- 
structed the so-called enterotome, which consists of a trochar, whose 
canula is provided with a pair of projections capable of being opened 
by pressure after insertion; but, as Hertwig has already pointed out, 
it is unnecessary, as the wall of the bowel can only fall away on account 
of other portions of bowel becoming insinuated between the punctured 


PUNCTURE OF THE BOWEL THROUGH THE RECTUM. Zhe 


bowel and the abdominal wall, or because of gas forming in the same 
position, an accident which can scarcely occur if, after removing the 
stilette, the canula is thrust far enough in. As Brogniez’s enterotome 
is of great diameter, and its surfaces are not smooth and continuous like 
those of the trochar, the instrument is not only inefficient, but posi- 
tively dangerous, on account of its favouring the passage of intestinal 
contents into the peritoneal cavity and wound, and increasing the risk 
of peritonitis. In some cases the wings of the trochar have refused to 
collapse, and removal of the instrument from the peritoneal cavity has 
been attended with great difficulty (Cartier). 

The method proposed by Bourgelat, Chabert, and others, and recently 
revived by Fohringer and Imminger, of puncturing the bowel from 
the rectum, presents a great risk of infecting the peritoneum from the 
mucous membrane of the bowel, a danger which cannot be entirely 
overcome even by careful antisepsis. 

In the case described by Imminger, rotation of the colon on its long 
axis possibly existed, and after discharge of the gas, underwent spon- 
taneous reduction. In such cases, reposition should certainly be first 
attempted (p. 288), and only where this fails does puncture of the colon 
appear indicated, though even then I should prefer the abdominal walls 
to the rectum, especially as the position of the colon can generally be 
discovered from the rectum. 

If for any reason puncture through the rectum be considered un- 
avoidable, the bowel should as far as possible be emptied. and most 
carefully rinsed out with sublimate solution, as recommended by Im- 
minger. The left hand is then passed into the rectum, whilst the right 
introduces the trochar (with the stilette drawn back), and, guided by 
the left hand, places the instrument on the pelvic flexure of the colon, 
which will be found distended with gas. The stilette is then thrust 
forward with a slight jerk, and the trochar caused to enter the colon. 
For this operation a long curved trochar is indispensable. The one 
used by Imminger has a length of nearly 9 inches, and a diameter of 
4 of an inch, and corresponds to Flourant’s instrument, except in being 
somewhat thinner. Further procedure is similar to that in punctur- 
ing through the abdominal wall. 

Pus sometimes forms at the point of operation, by which the danger 
of peritonitis is increased and recovery delayed, though not necessarily 
prevented. In cases seen by Rainard and Schaak, pus burrowed as far 
as the scrotum. Brogniez lost a case after enterotomy, owing to 
injury of, and fatal bleeding from, a cecal artery. 

Even at the present day the best authorities hold very conflicting 
views as to the admissibility of puncture of the bowel: and as opera- 
tion does not remove the primary diseased condition, it must always 


278 PUNCTURE OF THE RUMEN. 


fail in some cases. In the Lyons clinique the results were bad, but 
that this was not the fault of the operation is shown by the fact that 
twenty-five horses experimentally operated on were little the worse. 
Sometimes local peritonitis, with abscess formation, occurs at the point 
of operation, and may only produce death after an illness of several 
weeks (Peters). 


IIl.—PUNCTURE OF THE RUMEN AND RUMENOTOMY. 


Lit.: Brauer, Dresd. Ber. 1879, p. 1382 u. 1889, p. 75. Reiset, Thierarzt, 
1868, p. 112. Roche-Lubin, Rec. 1849, p. 921. Obich, Miller Roll. 
20, p. 157. Meyer, Gurlt u. Hertwig. 30, p. 257. Hayne, Oesterr. 
med. Jahrb. 1839. Fischer, B. T. W. 1892, p. 111., Lume yee 
Berl. Arch. 1892. 


In sheep and oxen gas often increases rapidly in the rumen, distends 
the abdomen, and presses so strongly on the diaphragm as to interfere 
with respiration and endanger the animal's life. This is generally due 
to rapid consumption of large quantities of fermentescible materials. 
Red clover, eaten whilst covered with dew, or in a withered or heated 
condition, and rapidly grown juicy green food, particularly that grown 
on heavy ground, are especially dangerous. But any other food which 
easily ferments, like brewer’s grains, wet bran, and roots, &c., may lead 
to rapid development of gas and distension of the stomach. A frequent 
cause of tympanites is the presence of foreign bodies in the cesophagus, 
which prevent the regular discharge of gases formed in the rumen. 

Reiset’s experiments on oxen, rendered tympanitic by feeding on clever, 
show that these gases consist of 74 per cent. of carbonic acid, 24 per cent. 
of carburetted hydrogen, and 2 per cent. of nitrogen; in wethers of 76 
per cent. of carbonic acid gas. Lungwitz’ analysis gave 80 per cent. 
carbonic acid, a certain quantity of marsh gas, nitrogen, oxygen, and traces 
of sulphuretted hydrogen. Lungwitz thinks that the composition of the 
gas depends not only on the nature of the food, but also on the stage which 
digestion has attained. At first more carbonic acid gas is found. The 
small quantity of gas found in the stomachs of hungry animals consists 
principally of marsh gas with some nitrogen and oxygen, but contains 
little carbonic acid. 

The symptoms of acute tympanites are unmistakable, the most strik- 
ing being more or less rapidly developed swelling, particularly in the left 
flank, which, under certain circumstances,rises above the level of the lumbar 
vertebree. The abdominal walls are often distended to the utmost, and 
on percussion give. forth a hollow sound, feeding ceases, the animals 
are restless, show colic, and dyspnoea keeps pace with the advancing 


TREATMENT OF ACUTE TYMPANITES. 279 


distension ; the respirations become shallow, the countenance is anxious, 
the veins about the head, neck, and abdomen (milk vein) are greatly 
distended, the pulse grows more frequent and smaller, the action of the 
heart tumultuous, and, after staggering movements, the animal falls to 
the ground and rapidly dies. 

The course of the disease is acute; death may occur within an hour ; 
sometimes the attack continues for twelve to twenty-four hours, seldom 
longer. The more rapid the rate of distension, the greater the danger. 
The condition is particularly grave where the right flank also appears 
distended, a token that the colon is filled with gas. Slight cases may 
recover of themselves, but severe ones are always fatal if speedy help be 
not afforded. Large numbers of animals when under similar conditions 
may simultaneously become affected. 

Treatment.—Internal remedies such as lime water, spirits of 
ammonia, oil of turpentine, petroleum, chlorate of potassium, hypo- 
sulphite of soda, &c., have been recommended to assist absorption of gas 
and to prevent its further development. Lunewitz, on the basis of his 
laboratory researches, recommends 4 per cent. magnesia usta suspended 
in water, milk of lime, and 2 per cent. of spirits of ammonium, or, in 
emergencies, soapy water. These materials are seldom of much service, 
and are only used in semi-acute tympanites. 

Fastening a piece of plaited straw smeared with tar in the mouth, or 
drawing the tongue strongly forward, is said to assist eructation and 
give relief, and the use of the probang has been recommended. 

Strong pressure on the left flank is more effective. The gases are 
directly discharged, and movements of the paunch at the same time excited. 

Though such measures may prove sufficient in slight cases, time 
should not be lost in making trial of them in severe attacks; and as 
soon as dyspnoea is marked, the probang or trochar ought at once to be 
employed. 

The probang for cattle generally consists of a spiral of steel provided 
with a coating of leather (fig. 54), though the simple steel spiral is 
sometimes used (Frauenholz). In sheep the vesical catheter used for 
horses forms a sufficiently effective probang. As the patient cannot be 
cast, passage of the probang in an excited animal suffering from severe 
dyspneea is often no easy matter, but cattle are usually better subjects 
than sheep. 

To ensure the instrument taking the right direction, a piece of wood 
provided with an opening (mouth gag) is first inserted in the mouth, 
and through this the tube is passed. The animal’s head is then extended 
and the rounded end of the probang pushed along the palate into 
the pharynx, whence it glides over the superior pharyngeal wall, and 
enters the cesophagus. Care is required to prevent it passing into the 


280 PUNCTURE OF THE RUMEN. 


larynx and trachea, an accident which is announced by violent coughing 
and dyspnea; in such case the tube must immediately be withdrawn. 
Should it have safely gained the cesophagus, it passes easily downwards 
without any untoward symptom, and can be felt on the left side of the 
neck. As soon as the end reaches the stomach the stilette is removed, 
and the accumulated gases allowed to escape through the hollow tube. 
But this does not always follow; sometimes the tube becomes stopped 
up and the probe must again be introduced; often the gases are not free 
on the surface of the contents of the rumen, but are mixed up with 
masses of fermenting food, and this explains why even the probang has 
not always the desired effect. 

Puncture of the rumen forms another means of treatment, the rumen 
being pierced in the left flank with the trochar to allow exit of gas. 
The operation is very simple and is often carried out by laymen when 
danger of suffocation threatens. In the case of cows and sheep even a 
pocket knife can be used, should a trochar not be at hand. 

At the present time round trochars without side openings are almost 
exclusively used ; the largest, having a diameter of 2 to 4 lines, is used 
for oxen, and a somewhat smaller one, 1 to 2 lines, for sheep. 

The seat of operation is the centre of the left flank, which becomes very 
prominent in the tympanitic animal. In fixing the spot, one imagines a 
line drawn forwards through the outer angle of the ilium parallel with 
the vertebre. In cattle the trochar is inserted on this line about 4 to 
6 inches, and in sheep about 2 to 24 inches, in front of the outer angle 
of the ilum. As delay is often dangerous, there may be no time for 
cleansing the point of operation, otherwise the usual precautions are 
taken. Where the skin is thick, it is best to make the primary 
incision with a bistoury; older practitioners were in the habit of using 
the fleam for this purpose. The trochar is now moistened and thrust 
through the walls of the abdomen and rumen, being directed slightly 
towards the right. Considerable force is required, and a slight rotary 
movement should be made. If the operator is of slight stature,it may 
sometimes be easier to give a smart blow on the instrument with the 
open hand. On account of the size and distension of the rumen, it 
is of no importance how far one thrusts the trochar; no injury is likely 
to result, and therefore it may be allowed to enter almost up to its 
shield. : 

When the stilette is removed the gas rushes out, sometimes under 
high pressure and mixed with particles of food, which are apt to 
block the canula, and require to be removed with the stilette or a 
probe. 

The canula remains in position until fermentation ceases and danger 
of suffocation disappears, To make sure of this the canula is closed 


RUMENOTOMY. 281 


with a cork and the animal watched; if tympanites fail to recur, the 
instrument can be removed. Before doing so, however, the stilette is 
reintroduced. The skin is then held in position with the fingers of 
the left hand, and the whole instrument slowly withdrawn. 

The skin wound requires no particular treatment, though it may be 
cleansed and covered either with a pitch plaster, some tar, or collodion. 
When time serves it is best to disinfect the skin and trochar before 
operation. 

Bad results seldom follow the use of the trochar in oxen, though 
digestion may sometimes be impaired by the rumen becoming adherent 
to the abdominal wall. 

The operation is more dangerous in sheep, though it becomes neces- 
sary in cases of threatened suffocation. If possible, the long wool should 
first be clipped away. Where the rumen is punctured with a knife, a 
thin tube, an elderberry stem, or even a couple of strong straws may be 
used as a canula to allow of escape of gas, being introduced into the 
rumen alongside the blade. The animal must be watched during the 
whole time these remain in position to prevent their being displaced. 

Rumenotomy.—lIn dealing with a rumen distended with masses of 
fermenting food containmg much gas, when the trochar is no longer 
of value, rumenotomy, which cattle tolerate very well, can alone give 
relief. 

The animal is placed with the right side against a wall and fastened 
up short. A piece of wood held in a sloping direction in front of the 
left hind-foot, or a stake driven into the ground, will shield the operator 
from injuries by this foot. 

The hair over the left flank is now clipped, the skin cleansed, and 
a strong bistoury introduced at the point where the rumen is usually 
punctured, with its back towards the animal’s vertebrae (Hertwig’s 
method); the blade should be thrust in as far as the handle. With a 
strong, drawing movement, the wound is now carried downwards, in 
oxen for a distance of 4 to 6 inches, in sheep 14 to 4 inches. To 
prevent food entering the peritoneal sac, it is necessary to avoid making 
the skin wound smaller than that in the wall of the rumen. 

The operation may also be carried out by first cutting through the 
skin at the point indicated, dividing the abdominal muscles, and finally 
incising the peritoneum and wall of the rumen. 

Immediately the rumen is opened gas and fermenting masses of 
food often rush out with considerable force. To prevent the rumen 
collapsing after evacuation and allowing food to enter the peritoneal 
cavity, a handkerchief, or serviette, is so placed that one portion extends 
from the lower angle of the wound into the rumen, and the other lies 
on the outer surface of the abdominal wall. With the same object, 


282 RUMENOTOMY. 


Horsburgh and Roche-Lubin stitched the rumen to the abdominal wall. 
The latter operates like Hertwig, by thrusting a bistoury through the 
walls of the abdomen and rumen, a little above where the trochar 
is inserted. After allowing gas and some food to escape, the in- 
cision is carried downwards about 4 inches; tapes are passed through 
both rumen and abdominal wall on either side, and about 1 inch from 
the edge of the wound, by means of a bent needle. The tapes are 
introduced from within outwards, and each carries at its end a mass of 
tow, which acts like a knot; the free ends, being drawn apart, open the 
wound and prevent the rumen collapsing. 

Whichever method is adopted, the rumen should be emptied as far as 
possible, either with the hand or a pair of forceps; but this must be 
done gradually to prevent the animal becoming unconscious and falling 
down. Certain operators state that stimulants, ike wine or brandy, 
produce a good effect in such cases, and recommend pouring through 
the opening in the rumen four to six pints of wine, or a suitable 
dose of ether, alcohol, &c. 

After the rumen has been emptied, the wound cleansed, and care 
taken that no food has entered the peritoneal cavity, or that what has 
entered has again been removed, the wound in the rumen is closed with 
catgut or silk, interrupted sutures being used. These are placed so close 
that no food can pass, and it is very important that the edges of the 
wound lie in close apposition. The opening in the abdominal muscles 
is sutured in a similar way, though that in the skin may be left patent 
without disadvantage (Haubner). If, however, healing by first intention 
is desired, the skin should also be sutured. Sometimes the wound 
heals in a few days, but may take weeks and even months, or leave 
behind a fistula of the rumen. 

Obich recommends suturing the wall of the rumen to that of the 
abdomen, and leaving the stitches in for seven or eight days. Meyer is 
opposed to this, and states that it causes tearing. Extensive adhesion of 
the rumen to the wall of the abdomen certainly interferes with digestion. 

To prevent food infecting the peritoneal cavity, Sajoux had as early as 
1839 employed a trochar with movable wings by which to fix the rumen 
to the abdominal wall (Hering); about the same period three instru- 
ments termed “ gastrotomes” were constructed by Brogniez. 

In Germany this complicated piece of apparatus was never much used, 
because it by no means absolutely prevents infection of the peritoneal 
cavity ; on the contrary, as it requires great care and cleanliness to keep 
it in perfect condition, it is frequently unavailable when most wanted. 

The trochar constructed by Brauer (fig. 84), on the contrary, appears. 
simpler and more practical. Its canula is so wide that the food may 
be removed throuch it from the rumen by using a pair of forceps. The 


INSTRUMENTS FOR RUMENOTOMY. 283 


handle and the greater part of the stilette consist of wood, the latter is 
flattened and ends in a cutting part, which is formed by the union of 
two knife-shaped portions of steel, which come together in a point. The 
canula is of tinned iron, and has at its upper part 
an opening 45 inches long in one direction and 
1$ inches in the other; below, the aperture 
measures 4 inches in the one, and 12 in the other 
direction (fig. 85). The hair is cut from the 
seat of operation, the skin cleansed, and the 
instrument applied like a trochar, but as it 
requires considerable force to thrust it into the 
rumen, a moderately heavy hammer or mallet 
is employed. 

After removing about a third of the contents of 
the rumen with a pair of spoon-shaped forceps, 
whose blades are 4+ inch (6 mm.) broad, and i6 
inches long, Brauer attaches a funnel to the 
canula, and pours in 10 to 15 quarts of salt 
water. 

Treatment of the wound, in rumenotomy and 
after the use of Briiuer’s instrument, is conducted 
on general principles. 

As this operation is most frequently performed 
in summer, when flies are common, it is best to 
apply a dressing which guards against insects 
and injury and soiling by the tail or mouth. 
Smearing the parts with tar serves a similar 
purpose. To prevent relapse some care is required in feeding after 
operation. For further information on this point, handbooks on special 
pathology should be consulted. 

Heyne, in 1836, recommended “ punctio ventriculi” in the horse to 
remove gases from the stomach. Apart 
from the fact that diagnosis is very difficult 
in these cases, gastric tympanites very seldom 
occurs in the horse, and generally only as a 
consequence of fecal stasis in the small 
intestine, in which case the operation cannot E Fic, 85.— 

: : Sheath of Brauer’s Trochar. 
have lasting results. Add to this that 
puncture of the horse’s stomach is always dangerous to life, and it will 
be understood why it has not been practised. 


Fic. 84.—Briiuer’s Trochar. 


284 INVAGINATION OF THE BOWEL. 


IV.—INTUSSUSCEPTION OR INVAGINATION OF THE 
BOWEL. 


Lit.: Meyer, Gurlt u. Hertwig. 8, p. 122. Ruchte, Her. Rep. 14, p, 312. 
Meyer, Gurlt u. Hertwig. 29, p.64. Heseler, Th.Mitth. 1873, p.171. 
Siebert, Thierarzt. 1869, p.261. Merten, Gurlt u. Hertwig. 36, p. 325. 
Degive, Annal, de Brux. 1870. Taccoen, Jahrb. 1882, p. 79. 
Hiibner, Dresd. Ber. 1891, p. 89. Riedinger, Ad. Woch. 1892. 


In oxen invagination of the bowel forms one of the most frequent 
causes of fatal colic. Excessive and irregular peristalsis may cause 
several feet of the small intestine to become intussuscepted. The outer 
(invaginating) portion strangulates the inner (invaginated), and disturbs 
circulation; the onward movement of ingesta is stopped, and broadly 
viewed the same conditions obtain as in strangulated hernia. Oxen may 
survive for five to ten days or even longer, but horses die rapidly. In ex- 
ceptional cases the invaginated portion is said to become necrotic, pass 
forward through the invaginating piece, and be discharged with the feces. 
Invagination is commonest in the rectum or small intestine, but in the 
horse Merten, Hiibner, and others have observed passage of the ceeeum 
into the colon, 

Symptoms.—The disease begins with a sudden attack of colic, 
which may last twelve hours, and is followed by subsidence of pain, 
though appetite is wanting. Rumination ceases, discharge of blood-stained 
mucus sets in, or obstinate stoppage of the bowel occurs; peristalsis is 
in complete abeyance; the pulse becomes frequent and small, but the 
temperature seldom rises. On examination per rectum, the invaginated 
spot may sometimes be felt as a cord-like, painful swelling. Slight 
colicky symptoms, straining to pass feces, and discharge of small 
quantities of mucus or blood continually recur. Merten says the 
animals show a desire to lie on the back. 

Treatment.— Medical treatment is worthless, and purgatives cannot 
of course reduce the invagination. 

Siebert attempted reduction by generating carbonic acid gas in the 
body. After giving aloes with sulphate of soda in linseed tea, he injected 
25 ounces of bicarbonate of soda suspended in water into the rectum, 
which had previously been emptied as far as possible, with the hand 
and tobacco clysters. Diluted hydrochloric acid was then passed in, and 
the anus closed with the hand. In a short time the right, and later 
the left side became greatly distended, and the animal strained so much 
that it was difficult to keep the anus closed. After a time the hand 
was removed, a large quantity of carbonic acid gas and feces escaped, 
and the animal recovered. Siebert states having thus cured a cow of 


TREATMENT OF INVAGINATION OF THE BOWEL. 285 


invagination of five days’ standing; but his treatment is scarcely recom. 
mended by the fact that he afterwards found the cast-off portion of 
bowel in the dung. If invagination had really existed, recovery was 
due less to the treatment than to the vis medicatrian nature. The 
method may, however, be tried when operation is out of the question, 
and other means are ineffectual. 

Surgical treatment consists in opening the peritoneal cavity from the 
right side with antiseptic precautions, and reducing the invagination or 
resecting the affected piece of bowel. Meyer, when operating, places 
the animal with the left side against a partition, and fastens it with 
cords and planks. The hand is introduced into the abdomen, the 
diseased spot discovered, drawn forward, and an attempt first made to 
reduce the invagination, but this often fails because the apposed portions 
of serosa have become firmly adherent. Degive’s experience shows, 
however, that there need be no hesitation in effecting it when possible. 
The abdominal wound should then be closed with the usual precautions. 

Reduction failing, resection becomes the only alternative, and has 
been performed by Meyer with success in oxen. Bleeding, after cutting 
through the bowel or mesentery, can be stopped by torsion, or the vessels 
may be ligatured with sterilised material. Great difficulty is caused by 
the continual passage of ingesta through the anterior section of bowel, 
which accordingly should be compressed by bowel clamps, or lightly 
ligatured during operation. After removing the invaginated portion, the 
ends of the bowel are brought together by the bowel stitch (p. 273); 
the abdominal walls and skin are sutured each to each, and the wound 
antiseptically treated. 

Taccoen operated on two cows, from one of which he removed 10 
inches of bowel, but had no bad consequences. Thirty-five days later 
the external wound was healed, and, on slaughter, the incision in the 
bowel was found to be completely cicatrised. In a second case an 
incurable anus preternaturalis formed, but did not impair the animal's 
health. 

Riedinger treated, during 1890, ten cases of invagination of the bowel 
in oxen. Seven animals had to be slaughtered on account of the opera- 
tion being done too late; in the other three, laparotomy was carried out 
and the invagination reduced. The portion of bowel was cleansed with 
‘Ll per cent. of sublimate solution, replaced, and the wound closed with 
button sutures. After-treatment consisted in giving purgatives. Five 
to six hours after operation, action of the bowels occurred. In one of 
the animals peritonitis occurred five days after operation, rendering 
slaughter necessary ; the other two recovered in fourteen days. 


286 TWIST OR ROTATION OF THE COLON. 


V.—TWIST OR ROTATION OF THE COLON IN HORSES. 


Lit.: Jelkmann, Berl. Th. W. 1890, p. 313. Mdller, Monatshefte f. pr. 
Thierh: 1891, p. I. Immingexr, Ad Woch. 1890, p. 41. Mal keumearay 
Monathefte f. pr. Thierh. 1891, p. 7. Jelkmann, ibid., 1892, p. 145. 


At the Natural Science Congress at Bremen in 1890, Jelkmann first 
indicated the possibility of recognising during life and of surgically 
treating torsion of the colon, which not infrequently occurs in horses, 
and always leads to death. The importance of this question is shown 
by the constant occurrence of the disease. According to Jelkmann, 
70 out of every 192 horses dying of colic in Munich had twist or dis- 
placement of the colon. Of 23 post-mortems after colic, made in the 
year 1887-8, twist of the colon was found in 10; Jelkmann, therefore, 
concludes that the disease occurs most frequently in Middle and South 
Germany, which may perhaps be referred to the heavy breed of the 
~ horses. According to the statistics given by the Veterinary Sanitary 
Reports of the Prussian army, in 1886, 13 horses; in 1887, 27 horses ; 
in 1888, 37 horses; and in 1889, as many as 84 horses died from dis- 
placement or twist of the colon. Great credit must be given to 
Jelkmann for having directed attention to this point, and, though his 
statements have in certain quarters been met with distrust, this may be 
explained in part by the fact that practitioners had not made themselves 
sufficiently acquainted with the anatomical conditions or methods of 
surgical treatment. In 205 colic patients Jelkmann found displacement 
13 times, and effected recovery by retroversion. During 1890, 63 cases 
of rotation of the colon were met with in the horses of the Prussian 
army, and during 1891, 52 cases. 

Jelkmann says the twist is usually towards the right, and is produced 
by distension of the upper portion of the colon and its displacement 
from the left lower wall of the belly at the same time that portions of 
the rectum are forced towards this spot. If the animals rise after lymg 
on the right side, the upper portion of the bowel, which has been dis- 
placed towards the middle line of the belly, is thrust downwards and 
finally twisted around its long axis. This explaims many cases, but 
just the opposite sometimes occurs, and twist takes place towards the 
left, as | have myself seen, and as is shown by the reports of post- 
mortem examinations in the Pathological Institute of this college. 
Sometimes the upper layer of the colon is displaced towards the centre 
line, sometimes towards the left abdominal wall. The comparatively 
great length of the portion of bowel filled with food, and its freedom to 
move, explain the frequent occurrence of rotation, 

The symptoms are not characteristic, but a rectal examination 


DETECTION OF TWIST OF THE COLON. 287 


generally removes any doubt. When colic, at first shght, is accom- 
panied by continued pain and becomes worse hour by hour, the bowel 
sounds weaker, the pulse smaller and more frequent, and some form of 
stoppage of the bowel seems certain, a rectal examination will generally 
clear up the point. Close in front of the anus, one feels the distended 
colon, which may for the moment be mistaken for the over-filled urinary 
bladder, but careful examination reveals its real nature. The longitu- 
dinal muscular bands can be distinctly felt, and show, not only that we 
have to deal with the colon, but also in what direction torsion has 
occurred. When the bowel is in its proper position, they run nearly 
parallel with the long axis of the body; but in twists, a change in their 
course is distinctly appreciable. In torsion towards the right, they run 
backwards and inwards; in torsion towards the left, backwards and outwards. 
According to Jelkmann, the rectal mesentery, whose fixed border can be 
felt below the lumbar vertebre, appears greatly stretched, and in right 
rotation does not pass perpendicularly downwards, but towards the left, 
and pressure on it causes the animal pain. Careful examination of the 
direction of the bands of the colon seems to me of more importance in 
diagnosis, and no doubt can exist either as to the presence or direction of 
the torsion if they can be discovered, but the posterior bands of the cecum, 
which can be distinctly felt when the latter is distended with food, must 
not be mistaken for those of the colon, Such an error is avoided by 
remembering that the cecum runs from the outer angle of the right 
ilium in a bow directed backwards and ends near the left stifle. 

By removing that portion of the left abdominal wall lying between 
the last rib, the outer angle of the ilium, and the transverse processes of 
the lumbar vertebrae, whilst the dead subject was supported in an erect 
posture, I have confirmed the anatomical relations of the organs lying 
in the posterior section of the abdomen and in the pelvis; the colon can 
be greatly inflated in situ, or after successful rotation, filled with water. 
The hand introduced into the rectum allows of the experiment being 
easily controlled, and the experimenter may convince himself which 
portion the hand is touching. Carried out before students, such a 
demonstration 1s exceedingly instructive. 

After artificial rotation the change in position of the organs could be 
recognised, and replacement attempted from the rectum. The experi- 
ment shows that the position of the bands is very important, especially 
as torsion of the posterior sections of the colon displaces the attached 
border of the great and rectal mesentery only very slightly. Examina- 
tion of the bands left no doubt as to the displacement, or the facility 
with which diagnosis should be effected in cases met with in practice. 

Prognosis.—In very exceptional cases torsion may be reduced by 
the animal rolling, but, as a rule, the only chance of recovery lies in 


288 REDUCTION OF TWIST OF THE COLON. 


early manual treatment. Though the question whether reduction is 
possible in every case, or how often it may be effected, cannot yet be 
settled for want of published observations, it is clear, from Jelkmann’s 
communication, that it often succeeds, and I have convinced myself that 
it is practicable, though I find it certainly requires considerable muscular 
power in the arms and ability to withstand fatigue. This would probably 
become less after practice. 

Treatment is commenced by giving a clyster of lukewarm water in 
order to clear the rectum as far as possible, and to obtain sufficient room 
for introducing the hand. Jelkmann inserts the left hand, presses 
forward towards the left abdominal wall, and endeavours to thrust the 
left portion of the colon with the convolutions of the rectum forwards 
from this point towards the middle line of the abdomen. Once the 
bowel is brought into this position, Jelkmann passes the hand slowly 
upwards, when the colon falls back over it into its normal position ; he 
considers that the convolutions of rectum, displaced towards the left 
lower abdominal wall, having been thrust upwards, leave room for the 
colon to return to its normal position. My own experiments tend to 
support this explanation. 

I replaced a left rotation of the colon in the following way :—After 
emptying the rectum, the right hand was introduced, and discovered the 
bands of the colon running from in front backwards and outwards or 
towards the left. I now employed the bands of the colon lying above 
to bring about reposition. Whilst the hand in the rectum was strongly 
adducted, I laid its volar surface or the fingers against the bands, and 
after repeated careful attempts finally succeeded in drawing these so far 
towards the right that the colon again took up its position parallel with 
the middle line of the body. As I had discovered by my experiments 
on dead animals, in torsion towards the left, the bands of the lower 
section of the bowel offer a purchase for retroversion. After effecting 
this, the pelvic flexure of the bowel, until then filled with gas, at once 
collapsed, the symptoms of colic disappeared, peristaltic action, which 
had almost completely ceased, again set in, the small, frequent pulse 
altered its character, and half an hour later the recovery of the animal 
could be confidently foretold. 

It is clear that all torsions of the colon cannot be treated by one and 
the same method; differences in displacement will render modification 
necessary ; but when attention has been directed to the point, experience 
will give valuable indications for procedure. Puncture of the over- 
distended colon might possibly assist reduction (p. 275). Jelkmann was 
compelled to puncture the cecum five times in thirteen cases, after 
which retroversion succeeded; the use of the trochar caused no bad 


results. 


TREATMENT OF TWIST OF THE COLON. 289 


In support of what has been said above, I append the following case 
from my own practice. 

On 8th June 1890, I was called to see a heavy cart-horse which had 
been suffering from colic for twenty hours. There was moderate but 
continued restlessness; the animal lay down frequently, but soon rose 
again, moved about in various directions, and showed all the symptoms 
of obstruction of the bowel. The pulse was sixty-five per minute, small 
and weak, the mucous membranes dirty red, respirations thirty and 
shallow, the flank moderately distended with gas, peristalsis occasionally 
slightly audible at the right side, general perspiration. Defécation 
had been in abeyance for twenty hours, only three hard portions of 
dung having been passed, the appetite had decreased during the same 
period, and drink was only taken in small quantities. Examination 
per anum discovered the pelvic flexure of the colon greatly distended 
with gas, which caused it to be pressed towards the posterior wall of the 
pelvis. On the outer surface of the colon a tense cord could be felt 
which passed from above downwards and inwards, from behind upwards 
and outwards. A similar cord passing in the same direction could be 
detected on the inner surface of the colon; the urinary bladder was only 
partially filled. 

The hand introduced into the rectum, was laid in the above described 
manner against the outer cord, and after several attempts it was found 
possible, by very considerable exertion, to move the bands of the colon 
towards the middle line of the abdomen. Active peristalsis and passage 
of gas at once followed, after which firm excreta were passed. The 
restlessness decreased, and after a short time entirely disappeared, whilst 
the pulse recovered its normal condition, and the mucous membrane 
lost its redness. In an hour, pain was entirely gone. 


VI. DISEASES OF THE POSTERIOR PORTIONS 
QF THE RECTUM AND OF THE ANUS. 


In large animals the posterior end of the rectum to the extent of 
8 to 12 inches, and in smaller ones to a correspondingly less extent, is 
not covered by peritoneum, but attached to the surrounding structures 
by loose connective tissue. This portion lies, therefore, beyond the 
peritoneal cavity, and is connected above with the sacrum, and below 
in males, with the bladder, in females, with the uterus. 

The thin and hairless skin of the anus possesses many sebaceous and 
sweat glands. In carnivora a small gland, about the size of a hazel-nut, 
exists on either side of the anus, and is surrounded by the sphincter 
ani; it contains a greenish fatty fluid. In addition to sebaceous glands, 
carnivora possess flask-shaped anal or perineal glands which contain a 
yellow substance. 


—CONGENITAL MALFORMATIONS. ABSENCE OF THE 
ANUS AND FORMATION OF CLOACA (ATRESIA ANI 
ET RECTI, FISTULA RECTO-VAGINALIS). 


Lit.: Waltrup, Thierarztl. Mitth. 1877. Landel, Gurlt u. Hertwig. 8, p. 
252. Bull, ibid., 6, p. 83. Burmeister, ibid., 21, p. 248. Howard, 
The Vet. Journal, vol. xxvii. p. 329. Johne, Dresd. Ber. 1877, p. 71. 
Volk, Gurlt u. Hertwig. 11, p. 329. Piepenbrok, Thieriirztl. Mitth. 
1874, p. 182. Rotter, Oesterr. Monatsschr. 1892. Varoldi, B. T. W. 
1893, p. 30. 


During early intra-uterine life, the anus is formed by invagination of 
the outer coverings. In the horse and ox this happens during the 
eighth week, in sheep, goats, and swine in the seventh, and in carnivora 
in the fifth. In dogs and swine, less frequently in ruminants and 
horses, the process sometimes remains incomplete, and in consequence 
the new-born animal possesses no anal opening. This vitiwm primae 
Jorimationis may be confined to the anus (tig. 86), or the posterior por- 
tion of the rectum may also be closed (atresia recti, fig. 87); less fre- 


ATRESIA ANI ET RECTI. 291 


quently the anus appears open, but a portion of the rectum closed. 
The sphincter ani then develops regularly, and a depression occurs at its 
middle point in place of the anal opening. 


Fria. 86.—Congenital malformation—atresia ani in the bitch (semi-diagrammatic). 


In females the rectum sometimes opens into the vagina, a condition, 
described as recto-vaginal fistula (anus vaginalis or cloaca formation) ; 
Rotter saw it in a six months pig. Less frequently a communica- 


Fia¢. 87.—Congenital malformation—atresia ani et rectiin the bitch (semi-diagrammatic). 


tion exists with the bladder (anus vesicalis). Varoldi saw atresia recti 
with cloaca formation and open urachus in a calf, 
Symptoms.—The want of an anal opening is seldom noticed in 


2:92 PROGNOSIS AND TREATMENT OF ATRESIA ANI. 


animals immediately after birth ; as a rule, it is only discovered when the 
results of suppressed defeecation become well marked; the little animal’s 
abdomen appears distended, colic sets in, the patient stops sucking, 
strains and attempts to pass feces, and when the anus is examined, it 
is found there is no opening. If the anus alone is imperforate, the skin 
projects at the centre of the sphincter, rectal contents may even be dis- 
tinctly felt beneath it; but, in simultaneous closure of the rectum, this 
projection is wanting, and either the anus is visibly closed or, on intro- 
ducing the finger or a probe, an obstruction is felt not far from the 
external orifice. In recto-vaginal fistula excrement escapes by the 
vagina, and the communication between the upper vaginal wall and 
rectum can usually be discovered with the finger or probe. 

In the latter case the animal may live, provided the ano-vaginal 
opening is large enough to allow discharge of bowel contents. Bur- 
meister saw an ano-vaginal fistula of the size of a straw in a six weeks 
pig. Pieperbrok found recto-vaginal fistula and imperforate anus in 
a pregnant sow. 

In atresia ani or recti the animals sooner or later die, if provision be 
not made by operation for discharge of excrement, though, as the milk 
forms comparatively little feces, the animals may continue to live for 
several weeks. Atresia ani was seen by Waltrup in a twenty-six days 
sucking pig, and by myself in a puppy of the same age. Ruminants 
seldom live so long; in them severe disturbance results from suppressed 
defecation after four to eight days; in a case described by Bull, a calf 
lived five days: the post-mortem showed the rectum closed for a distance 
of 5 to 6 inches. 

Prognosis is in general favourable, provided operation is not too long 
deferred. It depends principally on whether the anus alone or both anus 
and a considerable piece of rectum are simultaneously closed; in the 
latter case there is always great difficulty in laying open the bowel, and 
in keeping it patent. ‘The artificial anus tends strongly to contract and 
interfere with defeecation, whilst the rectum becomes paralysed on account 
of severe distension, and may even be ruptured; in such case operation 
gives no relief. In man, clysters of tobacco smoke have been used 
(Hiiter), and may be tried in animals. Where they fail eserine may be 
given, though in cautious doses if the animals are already weak. 

Treatment.—Operation is the sole resource. Some recommend 
delaying it for a day or two after birth, because moderate distension of 
the rectum is rather advantageous, but as a rule the surgeon’s attention 
is not demanded at this time, often not till much later, when death is 
unavoidable. In atresia ani the anus is only closed by a layer of skin 
which is simply grasped with forceps and cut through with the scissors. 
Feces are usually discharged at once; if not, the subcutaneous tissue, 


INJURIES TO THE RECTUM AND ANAL REGION. 293 


which sometimes contributes to the obstruction, must be thrust on one 
side. Reunion of the edges may generally be prevented by smearing the 
parts with some mild ointment. For a similar purpose the mucous 
membrane of the rectum is in man united with the outer skin by incis- 
ing the skin from above downwards right over the anus, dividing the 
subeutis on either side of the projecting end of the rectum, cutting 
through the mucous membrane in the same direction, and uniting it 
with the outer skin by several interrupted sutures. Stenosis is thus 
prevented. 

The operation for atresia recti is more difficult, particularly if the 
rectum is extensively adherent to neighbouring parts. The less promi- 
nent the anus from pressure of bowel contents, the more unfavourable 
the condition. In such eases the adhesions must be broken down, 
taking care in males to protect the urethra and bladder, and in females 
the vagina. In males a catheter should be introduced into the urethra, 
in females the index finger of the left hand inserted in the vagina 
during operation. The first incision is then made, as above described, by 
either removing a piece of skin with scissors, or making a cross-shaped 
cut through the skin over the anus, and gradually thrusting a finger or 
probe into the depths until the lumen of the rectum is attained. The 
position of the probe or finger indicates the proper direction, 

In animals the trochar has been recommended for opening the occluded 
rectum, but in my estimation the above method deserves preference. 
After discharge of feces, an attempt should be made to suture the 
mucous membrane to the skin, and reunion may be prevented by fre- 
quently smearing the parts with oil. Clysters assist the bowels in acting 
for the first few days. 

Howard produced a colic fistula ina sucking pig with atresia recti. 
The same operation has been practised in man, but being as a rule of 
no practical value, is now seldom adopted. For treatment of recto- 
vaginal fistula, compare p. 309. 


H.—INJURIES TO THE RECTUM AND ANAL REGION. 


Lit.: Frick, Thierarztl. Mitth. 1875, p. 187. Mozer, Her. Rep. 30, p. 12. 
Kirchner, Gurlt u. Hertwig. 16, p. 423. Wilhelm, Dresd. Ber. 1887, 
p. 64. Hengst, ibid., 1885, p. 77. Martin, Miinch. Jahrb. 1884-85, 
p. 53. Schwanefeld, Thierirztl. Mitth. 1877, p. 139. Jansen, ibid., 
1874. Kirchner, Gurlt. u. Hertwig. 12, p. 78. Hiippe, B.T. W. 
1892, p. 483. 


Injuries to the rectum in mares and cows are often caused by the 
penis during the act of coition, while perforations result from incautious 


294 INJURIES OF THE RECTUM. 


exploration of the rectum with the hand, and by the attempts sometimes 
made by laymen to remove blood from the mucous membrane of the 
rectum in order to cure colic. The incautious use of clyster syringes 
may produce wounds; and injuries are occasionally inflicted on the 
rectum by persons desiring to revenge themselves on the owner of the 
animal (Frick). 

Less frequently the rectum is ruptured by abnormally large and hard 
masses of feces (Mayer, Stockfleth), but in mares and cows during 
parturition, injuries caused by the fcetus, or by violent and awkward 
attempts at assistance, are very common; the colt’s feet sometimes 
penetrate the upper wall of the vagina or uterus, and the lower wall of 
the rectum. 

Finally, any hard substance accidentally consumed with the food may 
penetrate the mucous membrane of the rectum or anus, and produce 
proctitis. In dogs, animal or fish bones are a frequent cause. Ina 
horse which had swallowed a large number of fir-needles, Kirchner found 
inflammation of the rectum caused by the needles penetrating the 
mucous membrane. Stocktfleth removed from the anus of a cat, a fish- 
hook, which had passed through the entire digestive tract. Jansen found 
the skull of a sucking pig in a sow’s rectum; the skull had, during 
parturition, penetrated from the vagina into the rectum. 

The anus is also liable to be injured during delivery. The perimeum 
and, under certain circumstances, the sphincter ani may be simultaneously 
ruptured; in oxen, horn-thrusts are often responsible for these accidents. 

The progress of such injuries depends principally on their seat and 
extent. Wounds penetrating the peritoneal cavity always end fatally ; 
and those caused in mares and cows by pressure of the penis are nearly 
as dangerous, though a few cows have been seen to recover. On the 
other hand, sudden death attributable to shock has sometimes been 
noted. Mares usually die within twenty-four hours, cows may survive 
longer. Passage of the penis into the rectum is not, however, always 
followed by rupture; injury depending chiefly on the degree to which 
the rectum is filled with feces. Wounds from the clyster syringe 
generally end fatally, and particularly if drugs are at the same time 
injected into the peritoneal cavity. 

Injuries of the posterior portion of the rectum lying beyond the peri- 
toneal cavity, though certamly not so dangerous as the above, are yet 
apt to lead to septic cellulitis in the connective tissue around the rectum 
(paraproctal connective tissue), which may be followed by fatal conse- 
quences. But Hiippe’s case shows that in the horse even extensive 
injuries at this point may heal. Injuries of the vagina are less 
dangerous, though sometimes followed by formation of recto-vaginal 
fistulee (p. 309). 


TREATMENT OF WOUNDS OF THE RECTUM. 295 


Diagnosis is at once settled by examination of the rectum, to which 
the colic, tenesmus, and blood-stained discharge draw attention. But 
before proceeding to thus determine the seat and extent of the injury, 
it should be ascertained whether manipulation of the parts has already 
been practised, and the owner should be informed of the possible 
existence of a fatal injury, so that the operator may not be suspected 
of having caused it. Complication with peritonitis is characterised by 
fever, small and frequent pulse, and slight but continuous colic, and in 
horses death occurs in a few days, often even in a few hours. 

-Wounds of the anus are only grave if the sphincter or perineum is 
divided. If no difficulty occurs in closure of the anus, wounds of this 
kind heal easily and completely; only exceptionally does anal fistula 
result (p. 309). The healing of ruptured perineum offers greater diffi- 
culty and, in mares, may result in sterility, but a cure is usually effected 
by suturing the wound early and cautiously, or even at a later period if 
the cicatrix be freshened. 

Treatment.—Treatment of perforating wounds of the rectum is 
seldom desirable. Oxen and sheep are best killed at once. Should the 
attempt be made, the rectum must first be carefully emptied, food with- 
held, and water given only in small quantities. Clysters are better 
avoided, because they favour the entrance of bowel contents into the 
peritoneal cavity and peritonitis. Opium might possibly be of service 
on account of its checking the movement of bowel contents towards the 
injured spot. 

In injuries of the pelvic portion treatment is more hopeful; the diet 
should be as above. The wound may be cleansed by clysters (which at the 
same time wash out the contents of the rectum), followed by disinfecting 
materials like salicylic acid, carbolic acid, or creolin; in horses, by diluted 
sublimate solution (1 in 5000). 

Wounds in the neighbourhood of the anus may sometimes be sutured 
and bleeding vessels ligatured. Cold water clysters serve to check 
bleeding from the anterior parts of the bowel. It has also been sug- 
gested to introduce a bladder or rubber balloon into the rectum, and to 
exercise pressure on the bleeding vessels by inflating it or filling it with 
water; but its use is much limited in animals on account of its causing 
severe straining, and thus often proving more dangerous than useful. 
The same is true of tamponing the rectum, though in extreme cases 
one might certainly try it. 

As regards abscess-formation after injury to the rectum, compare 


p.297. 


296 PROCTITIS. 


II.—INFLAMMATION OF THE MUCOUS MEMBRANE OF THE 
RECTUM AND ANUS (PROCTITIS). 


Lit.: Schwanefeld, Thierarztl. Mitth. 1877, p. 139. 


Apart from inflammation of the rectum and anus, produced by grosser 
injuries, inflammatory processes are seen in severe intestinal catarrh, in 
dysentery, and after continuous diarrhea, particularly in young pigs 
and dogs. The same result may be produced by clysters of too irritating 
a character, or administered too hot, and by very large masses of feeces. 
Schwanefeld found a piece of broomstick, 8 inches in length, in the rectum 
of an ox. In dogs, bones and firm masses of faeces often produce inflam- 
mation of the mucous membrane. 

Inflammatory disease of the anus in the horse has been seen after 
tearing away the larvee of cestra, in carnivora in consequence of rubbing the 
anus to allay the irritation of pruritus ani. In long-coated dogs the hairs in 
the neighbourhood of the anus sometimes stick together, close the anus, 
and produce inflammatory irritation, or the animals may suffer from 
inflammation of the anal glands (Siedamgrotzky). 

Symptoms.—Inflammatory disease of the mucous membrane of the 
rectum is characterised by tenesmus, that is, repeated but unsuccessful 
attempts to pass feces. The animals stand with the back arched, and 
the continuous severe straining often leads to prolapsus ani or recti. 
The mucous membrane is more or less intensely reddened. 

Injuries to the anus may be directly seen; and where the hairs have 
become adherent and occluded the orifice, the neighbouring skin appears 
reddened and often excoriated. 

Disease of the perineal glands may be recognised by inflammatory 
swelling ; defecation is painful and often repressed; after some time 
fluctuation and perforation occur, and the swelling subsides, though 
relapses are common and sometimes cause laymen to suspect hemor- 
rhoids. 

These conditions are seldom dangerous, but occlusion of the rectum 
and of the anus may result from chronic catarrh in young animals. 
Injuries sometimes lead to inflammation of the perineal or paraproctal 
connective tissue and thus cause trouble. 

Treatment.—Inflammation of the rectal mucous membrane is treated 
with mucilaginous and oily clysters; in larger animals starch paste is 
suitable. In dogs, lukewarm oil may be used, and when tenesmus is 
marked, opium can be added. Foreign bodies and hard masses of faeces 
should be removed cautiously. The long adherent hairs about the anus 
must be cut away with scissors, the anus cleansed, and powdered with 
some material like iodoform and tannin. 


PERIPROCTITIS. 297 


Suppurating swellings of the anal glands must be opened, the 
contents removed, and, after thoroughly cleansing, the surfaces of the 
wound strewed with iodoform powder. For inflammation produced by 
removal of cestrus larvee, lukewarm lotions and dusting powders are 
recommended. In all these diseases it is of importance to render 
defecation as easy as possible. For this purpose suitable nourishment 
should be given, and clysters and laxatives administered. 


IV.—INFLAMMATION OF THE CONNECTIVE TISSUE SUR- 
ROUNDING THE RECTUM (PERIPROCTITIS OR 
PARAPROCTITIS APOSTEMATOSA). 


Lit] Bachstadt, B. T. W. 1889, p. 82: Roloff, Thierarztl, Mitth.Jé7/1, 
p. 174. Schmidt, ibid. 1887, p. 141. Wilke, ibid., 1868, p. 144. 
Wilhelm, Dresd. Ber, 1887, p. 64. Kriger, Thierarztl. Mitth. 1857, 
p. 125. 


This disease, though not common, is sometimes seen in large animals, 
and is caused by wounds of the posterior portion of the rectum becoming 
specifically infected. Metastatic abscesses have been seen here during 
the course of strangles (Bachstidt). In females peri- or para-proctitis 
may result from injury of the vagina. 

The loose connective tissue surrounding the end of the rectum appears 
particularly liable to cellulitis, and it depends principally on the action 
of the infecting material what course the disease takes. In general, 
however, septic cellulitis is rarer than one would expect, perhaps because 
septic infectious material is destroyed in the digestive tract. Published 
cases, and those which I myself have observed, have been due to simple 
purulent cellulitis, leading to formation of abscesses. 

The course of the disease depends principally on where the abscess 
perforates; should it discharge into the peritoneal sac, death from 
purulent peritonitis is inevitable; but when perforation occurs into 
the rectum, or the abscess is punctured from this point, recovery often 
follows. The case is still more favourable where the discharge occurs 
outwardly beside the anus. Wilke succeeded in opening the abscess 
from the vagina,a method which deserves preference, as avoiding the 
bad results of perforation outwardly or into the rectum. In the latter 
case there is always danger of the formation of an anal fistula. 

Symptoms.—Periproctitis is first announced by interference with 
the passage of feeces, caused by swelling and abscess formation. The 
animals show slight but continued symptoms of colic; defecation is 


298 TREATMENT OF PERIPROCTITIS. 


ditficult and painful, and is either suppressed or accompanied by groaning. 
There is usually shght fever. Only where cellulitis extends to close 
under the outer skin does swelling occur in the neighbourhood or at the 
side of the anus. From here pus may burrow along the muscles of the 
thigh (Bachstiidt, Wilhelm), and cause emphysematous swelling and 
lameness. 

Exploration per rectum determines the extent and position of the 
disease. The posterior portion is empty, but in front of this the bowel 
is swollen and its lumen narrowed. Im a ease of mine in a horse, a 
painful fluctuating swelling, almost as large as a child’s head, could be 
detected on the upper wall of the rectum, about 8 inches from the anus. 
This had so diminished the passage that there was scarcely room below 
to pass two fingers. The rapid development of the symptoms, the soft, 
fluctuating, painful character of the swelling, and the moderate fever, 
distinguish the condition from tumour formation. 

Treatment.—When an abscess has already formed, and attention 
been called to its existence, nothing usually remains but to give exit to 
the pus, and as it is of importance to effect this in the least dangerous 
way, the path usually chosen is that through the vagina or the skin 
and tissue lying around the rectum. The latter is preferable, if the 
abscess be close to the anus, and the puncture must be made as low as 
possible to favour drainage. Division of the sphincter ani must be 
avoided at all cost. In females the vagina forms a convenient and safe 
route for arriving at abscesses lying below the rectum. Wilke per- 
forated the abscess wall through the vagina with the finger, and emptied 
an abscess the size of an ostrich egg, which lay about 12 inches from 
the anus. 

In purulent cellulitis affecting the upper wall of the rectum, drainage 
into the bowel should only be chosen when the abscess cannot be 
punctured from without. In the above described case, I opened the 
abscess with a bent trochar (Flourant’s), and gave exit to about 2 litres 
of thick offensive pus, containing fragments of necrotic tissue. As the 
abscess had refilled next day, the opening was lengthened with a button- 
pointed tenotome, introduced into the rectum with its cutting surface 
covered by the hand. Complete recovery took place in three weeks. 

After incising the abscess, the cavity must be carefully washed out 
with a strong stream of disinfecting material, so as to remove necrotic 
portions of tissue, and precautions taken for securing drainage of pus. 


PROLAPSE OF THE RECTUM AND ANUS. 299 


V.—PROLAPSE OF THE RECTUM AND ANUS (PROLAPSUS 
RECTI ET ANI). 


Lit.: Frey, Gurlt u. Hertwig. 15, p. 320. Wells, Her. Rep. 13, p. 331. 
Grolt, Thierarztl. Mitth. 1774, p. 145. Weber, Dresd. Ber. 1871, 
p. 125. Volk, Gurlt. u. Hertwig. 11, p. 329. Haubner, Dresd. Ber. 
1858, p. 46. Johne, ibid., 1877, p. 71. Tetzner, Zeitschr. f. Vet. 
1890, p. 421. Mauri u. Savourin, Jahresb. 1890, p. 105. 


Permanent protrusion of the mucous membrane of the rectum through 
the anus is described as prolapsus ani, As the membrane appears after 
each act of defecation, prolapsus ani really consists only in the abnormal 
continuance of a physiological condition. This protrusion of the mucous 


Fig. 88.—Prolapsus recti with invagination in the bitch (semi-diagrammatic). 


membrane is most distinctly seen in horses, and in them prolapsus ani 
is rather frequent, but it also occurs in dogs and other domestic 
animals. 

When not merely the mucous membrane but the entire intestinal 
wall passes the anus, the condition is termed prolapsus recti. The pos- 
terior end of the bowel can only pass the anus after rupture of the 
periproctal connective tissue, but those portions of bowel normally clothed 
with peritoneum sometimes pass through the pelvic portion and anus, 
after becoming invaginated in the last part of the rectum, constituting a 


third condition—prolapse with invagination. We therefore distinguish— 
(1.) Prolapsus ani. 


(2.) Prolapsus recti. 


300 SYMPTOMS OF PROLAPSE OF THE ANUS. 


(3.) Prolapsus recti cum invaginatione. 

Prolapse of the anus and of the rectum generally results from severe 
diarrhoea, particularly if accompanied by tenesmus. The disease is 
favoured by weakness, with relaxation or paralysis of the sphincter ani. 

As a rule, the immediate cause is increased abdominal pressure, 
though inflammatory swelling of the mucous membrane of the rectum 
may cause prolapse, and both these have been seen after use of irritant 
or excessively hot clysters. They also appear during colic or obstruc- 
tion of the bowel, sometimes in difficult parturitions ; in cows in connec- 


Uji 
; Y] 


Frc. 89.—Prolapsus recti with invagination in the horse. 


tion with prolapse of the vagina, and in horses which struggle violently 
when cast with hobbles (Larsen, Mauri). In two cases noticed 
by Mauri, which occurred during castration, the prolapsed rectum 
was ruptured, and coils of small intestine protruded through the opening 
in the perineum. 

Symptoms.—In prolapsus ani, a red, slightly painful, hemispherical 
swelling of the mucous membrane appears behind the anus, which shows 
at its centre a shallow depression ; sometimes only a few folds appear at 
one side. In simultaneous prolapse of portions of the rectum (prolapsus 
recti) the swelling is larger and harder, but even then does not attain 
the size usual in prolapse complicated with invagination, where portions 


PROGRESS OF PROLAPSE OF THE ANUS. 301 


of bowel a yard in length may protrude through the anus. In dogs, I 
have repeatedly seen prolapses 12 to 20 inches in length. On account 
of the tension on the mesentery, the prolapsed portion sometimes becomes 
twisted upwards in horses (fig. 89). 

When the prolapse attains such dimensions no doubt can exist in 
diagnosis, but it is otherwise when only small portions of bowel project 
beyond the anus. In simple prolapsus ani et recti the ring-shaped 
swelling shows an opening at its centre, through which feces are 
discharged ; at its periphery it is impossible to pass the finger towards the 
pelvis. The case is different where prolapse is complicated with invagi- 
nation; then the finger, and in large animals the entire hand, can be 
introduced alongside the prolapsed part into the pelvic portion of the 
rectum. It is of importance to note this, as it at once differentiates 
the two conditions, and affords important indications for treatment. 

Progress.—Prolapse of the anus is usually reduced by laymen with- 
out skilled assistance, and only when it continually recurs and the 
mucous membrane becomes greatly swollen, or when it has persisted for 
a long time, does it become the subject of skilled treatment, Frey saw 
a horse which had difficulty in defecation in consequence of prolapse ; 
others (Wells) have erroneously described chronic prolapses as heemor- 
rhoids. The mucous membrane undergoes change from continued 
exposure to the air; it becomes thickened, dry, necrotic, and may even 
slough, thus eventually bringing about spontaneous recovery from the 
prolapse. Groll saw a pig with prolapse; twenty days later the 
protruded part sloughed away spontaneously, and recovery followed. 

The above is also true of prolapse of the réctum with invagination, 
except that as a rule defecation is difficult, the passage of material being 
interfered with in the invaginated portion of bowel. The animals strain 
severely, causing further portions of intestine to protrude, these soon 
become cedematous, the folds in their mucous membrane disappear, 
and the surface of the prolapsed portion consequently appears smooth. 
The surface of the bowel, which is dirty and not infrequently injured 
by the animal rolling or lying, gradually becomes dry and presents a 
dark red or black colour. Pigs sometimes reciprocally bite off the 
prolapsed portions. 

Death is generally due to the consequences of complete obstruction 
of the bowel acting on animals which are already weakened. Only 
exceptionally has rupture of the paraproctal connective tissue and pro- 
lapse of other portions of the bowel been seen; it is differentiated 
from prolapse of the rectum by the surface of the protruded bowel 
exhibiting a serous covering. 

It requires no particular demonstration to show that prolapsus ani 
involves less danger than prolapsus recti, especially when the latter is 


302 TREATMENT OF PROLAPSE OF THE ANUS. 


complicated with invagination, and though spontaneous healing some- 
times occurs, by the necrotic portion of bowel sloughing, it is very ex- 
ceptional. Prolapses of the anus are most easily healed, when they 
have persisted for a short time only, and the mucous membrane of the 
protruding part is not much altered. Should prolapsus recti be com- 
plicated with invagination, and have existed for several days, reposition 
becomes impossible, because the peritoneal surfaces have already become 
either adherent or united. 

Herbivora withstand the condition far better than carnivora. In dogs, 
according to my experience, invagination is very general, and the 
commonest subjects are weakly animals, or those whose constitutions 
have been lowered by continued diarrhcea (Kunze), as Haubner has 
already noted. Pigs bear prolapse better, and the larger animals still less 
frequently die of it. Horses and oxen generally recover completely, 
though Tetzner saw a horse with prolapsus recti die with symptoms of 
colic; the post-mortem showed the cause to be a leiomyoma. 

Treatment.—lIn recent prolapse the mucous membrane is cleansed 
and replaced by regular and steady pressure with the hand, or in small 
animals with a finger. Sometimes this requires to be repeated, and the 
owner or attendant may be instructed how to carry it out. Tenesmus 
is combated by clysters of mucilaginous or oily fluids, containing, if 
needful, opium; cocain may also be worthy of trial. Diarrhoea must be 
treated by suitable diet and internal medication. Should the prolapsed 
mucous membrane be swollen, scarification and bathing with such 
astringents as 2 to 5 per cent. alum solution, will facilitate reposition. 
Continued recurrence or structural change in the mucous membrane 
may necessitate surgical removal of the protruded part. 

The procedure is the same in simple prolapsus recti, but prolapsus 
recti with invagination offers greater difficulty. In such case reposition 
must be effected as soon as possible, for the longer prolapse exists, the 
greater the difficulty and the less the chance of success, though even in 
these cases cure is occasionally effected. Larsen (Stockfleth) immedi- 
ately reduced a prolapse, about 32 inches in length, which occurred 
during the castration of a horse, caused an assistant to keep the anus 
closed, and completed the interrupted operation. When the animal rose, 
the prolapse had disappeared and did not recur. In reposition care 
must be taken to simultaneously reduce the invagination. For this 
purpose it is not sufficient to thrust the protruded bowel through the 
anus, but the extreme end must be carried forward at least twice the 
length of the prolapsed part. In large animals this is best effected with 
the arm, in the smaller (dogs) by means of a tallow candle. Stock- 
fleth uses a stick; the end covered with tow and rubbed with fat. 
Infusions of warm water injected whilst the hind-quarters are raised 


LIGATION. 303 


may also assist reduction. The animal should be laid with the hind- 
quarters high; if small it may be lifted by the hind legs. When 
the animals strain violently, narcosis must be resorted to, for which 
purpose, in dogs, I recommend the use of morphine. The greatest 
obstacle to reposition and permanent cure hes in this severe strain- 
ing. Large animals should, therefore, be watched for some hours, and 
if it sets in, pressure should be exerted over the loins. Mild clysters 
and the application of cold combat inflammatory symptoms about the 
anus and rectum. 

To ensure retention, the anus may be sutured. Strebel inserts two 
strips of leather in the neighbourhood of the ischial protuberances, and 
crosses them over the anus; by applying tow or sponges below these the 
intestine is held back; in horses, the tail has been fastened so far 
forward with a pair of straps as to exercise pressure on the anus. 
Andre’s “ tobacco-pouch ” suture has been recommended. ‘This is a con- 
tinuous suture, made by passing a narrow tape in and out under the 
skin, and working in a circle; it should be left in position for twenty- 
four to thirty-six hours. To allow of defecation the tape is, when 
necessary, loosened, and afterwards again drawn tight and knotted. It 
is clearly not to be employed in cases of invagination where its use 
would be irrational. Cocain may be tried in severe straining. 

When prolapse with invagination has already existed for several days, 
reposition becomes impossible, nor should it be attempted if structural 
change has occurred. Nothing, then, remains but to remove the pro- 
truded portion, for which purpose one of the following means may be 
employed, viz. :— 

(1.) The use of irritants. Jessen powders the protruded parts four 
or five times a day with sulphate of copper and pulverised charcoal in 
equal parts; inflammation results, and in a few days a scab forms 
(necrosis), after which the prolapsed part sloughs off in eight to 
fourteen days. Danish practitioners have used this material with 
success in large animals and swine (Stockfleth), but others consider 
it useless; Weber, after trying it in foals, was finally forced to 
operate. It can, of course, only be used in prolapsus ani et recti 
without invagination. Apart from the uncertain action of this treat- 
ment, it must be remembered that it is often followed by extensive con- 
traction of the anus and difficulty in defsecation, and most practitioners, 
therefore, prefer amputation. 

(2.) Ligation has been adopted by Viborg and Stockfleth in the case 
of pigs, dogs, and foals. As it is necessary to keep the anus open for the 
passage of feces, Stockfleth binds a ring of wood, 1 to 24 inches in diameter, 
in the anus; to prevent the ligature shipping off, the ring has a shallow 
groove on its surface (fig. 90). The prolapse is divided up to the anus 


304 MULTIPLE LIGATION. 


the ring then thrust in, anda stout ligature passed around it and the pro- 
lapsed bowel, which slowly cuts through, until finally the portion of intes- 
tine beyond the ring is cut off. During the next few days defecation 
must be assisted by clysters, and bulky and indigestible foods avoided. 
The tube falls away spontaneously in five or six days, and as a rule 
healing is then complete. Sorensen (Stockfleth) in this way amputated 
a piece of bowel, weighing 23 ounces, in the horse. 
A case of Johne’s, however, in the pig, shows that after 
ligation stenosis, and even complete occlusion, may 
oceur. 

(3.) Multiple ligation. If the layers of bowel are 
not completely united to one another, or at any rate 
not firmly adherent, there is considerable risk of 
opening the peritoneal cavity when practising this 
method. 

The simple cobbler’s stitch is often recommended. 
A transverse incision is made through the upper half 


Fic. 90,— of the protruded bowel, close behind the anus, and 
Stockfleth’s Wooden ; : BR c 
Ring. the two layers of tissue in front of the incision 


united by closely applied ligatures. The lower half 
is then divided and the ligaturing continued, until finally the protruded 
portion of bowel is completely divided and removed. The simultaneous 


Fras. 91, 92.--Method of ligation in prolapsus recti. 


division and ligation prevents the end of the bowel not yet firmly fixed 
by sutures slipping back into the peritoneal cavity, and producing fatal 
peritonitis. 

In dogs, I have frequently employed the following method. The 
protruded piece of bowel is transfixed close behind the anus with two 
needles arranged crosswise, and provided with two long threads (fig. 91). 
The prolapsed part is then cut through, about 4 to $ of an inch behind 


DILATATION, ETC., OF RECTUM AND ANUS. 305 


the threads, which are then drawn forward out of the intestinal opening. 
By dividing these in the centre, one has four threads (fig. 92), which 
when united form four stitches, and are generally sufficient. Should it 
be seen on cutting away the posterior part of the bowel that union is still 
incomplete, another pair of stitches can be inserted between each two 
of those previously existing, thus forming eight ligatures, which are 
sufficient even in large animals. Savourin saw a horse in which the 
rectum had already become necrotic, but by ligaturing it in two portions 
he effected complete healing in twelve days. It is scarcely necessary to 
add that, both in selecting the ligature and in carrying out the operation 
and after-treatment, it is necessary to practise antisepsis as far as 
possible. 

(4.) In old cases of prolapse, where union between the layers of peri- 
toneum is complete, and no chance exists of opening the peritoneal cavity, 
simple removal of the prolapsed part is sufficient. This method has 
been used in swine, but caution is required; simple or multiple ligation 
is greatly preferable. 


VI.—DILATATION, STENOSIS, AND PARALYSIS OF THE 
RECTUM AND ANUS. 


Lit.: Johne, Dresd. Ber. 1877, p. 71. Volk, Gurlt u. Hertwig. 11, p. 320. 
J ohow, Thierdrztl. Mitth. 1876, p. 146. Johne, Dresd. Ber. 1881, 
p- 62. Rogerson, Gurlt u. Hertwig. 7, p. 492, u. 8, p. 482. Meyer, 
ibid., 17, p. 88. Gurlt, ibid., 17, p. 449. Hengst, Dresd. Ber. 1885, 
p. 77. Martin, Miinch, Ber. 1884-85, p.53. Stockfleth, Chirurgie. 
Friedberger, Adams Wochenschr. 1889, p. 193. Peters, Gurlt u. 
Hertwig. 10, p. 76. Schwarznecker, ibid, 30, p. 225. Deigen- 
desch, Her. Rep. 43, p. 192. Hohnisch, Thierarztl. Mitth. 1858, p. 
ito. saris, Han, Ber Tet, p.-56: 


After operation for atresia ani, amputation of prolapsed portions of 
the rectum, and injury to the anus, cicatricial contraction sometimes 
occurs, causing marked stenosis and difficulty in defeecation. Sometimes 
the anus is completely closed, as in Johne’s case, in a six months old 
pig after ligation of the prolapsed rectum, or in Volk’s, in a pig, where 
the same accident was followed by spontaneous sloughing. Occlusion of 
the rectum occurs, both in pigs and dogs, in consequence of chronic 
diarrhoea, particularly during the first years of life; the epithelium is 
lost, the opposing mucous surfaces become adherent, and finally unite. 

Cicatricial contraction of the rectum may also result after injury 
or ulceration of its mucous membrane, and cause stenosis, or new 
erowths, within or without the bowel, may compress it and narrow its 
lumen. 

U 


306 STENOSIS OF THE RECTUM. 


Johow saw a cow which stood with the back arched and continually 
attempted to defecate; a ring-shaped stenosis of the rectum existed 
at the entrance to the pelvis, and was barely large enough to admit 
two or three fingers; the rectum was greatly distended in front of the 
spot, which was about half an inch wide. After incising the stenosis 
and using clysters, a cure was effected. The nature of the case seems 
obscure. 

Rogerson diagnosed in a mare and a foal, which both suffered from 
stoppage of the bowel, well-marked stenosis of the rectum about 20 
inches in front of the anus; the post-mortem examination showed the 
rectum to be greatly thickened, of cartilaginous consistency, and to some 
extent ossified. Johne saw the same condition in a cow, Meyer in a 
horse. rurlt found the rectum of a foal so narrow that only a good- 
sized goose-quill could be passed through it. 

Pathological dilatations of the pelvic portion of the rectum are not 
infrequent in horses. They are seldom partial—so-called diverticula—but 
usually the entire pelvic portion is dilated. They are oftenest seen in old 
horses which have long been fed on bulky food, and in dogs which have 
suffered from habitual constipation or enlargement of the prostate, which 
interferes with defecation; dogs also show this dilatation in hernia 
perinealis. Old horses often suffer from extended dilatation of the 
pelvic portion without showing distress, though they have difficulty in 
defsecation, especially if paralysis of the rectum accompanies dilatation. 

Hengst speaks of an old horse which suffered from colic, and showed 
a rectal sacculation 12 inches in front of the anus, which was the size 
of two fists and filled with feeces. After emptying and washing this 
out, the colic disappeared. Martin noted the formation of a diverticulum 
in a horse after injury to the rectum; 16 inches in front of the anus 
was a wound about 6 inches long and 2 broad, which caused severe fever 
and colic ; it was washed out with solutions of boric acid and perman- 
ganate of potash, and later of carbolic acid. Cicatrisation occurred, but 
a diverticulum as large as a man’s fist formed, from which the dung had 
to be daily removed. Stockfleth described in a horse a diverticulum 
which lay on the upper wall of the rectum about 52 inches from the 
anus, and opened into the lumen of the bowel by means of a narrow slit. 
I found one about the size of a hen’s egg in a Dalmatian dog on the left 
wall of the rectum, close in front of the anus, which was thrust forward 
during defecation, and was filled with soft feeces. This was possibly an 
enlarged anal pouch; but as the dog was only seen during life, I cannot 
say definitely. 

Paralysis of the rectum is generally associated with paralysis of the 
tail, or of the bladder and hind legs, and apart from the general paralysis 
caused by fractures of the vertebra, &c., occurs most frequently in the 


PARALYSIS OF THE RECTUM, 307 


horse. It is particularly common in mares. Harms found rectal 
paralysis in a cow to be due to fracture between the sacrum and first 
vertebra of the tail. Though this paralysis is usually spontaneous, the 
immediate cause can often be traced to severe bruising or injury by the 
crupper. In the army reports, the following case occurring in a seven- 
teen-year-old mare is given:—The animal showed paralysis of the 
rectum and bladder, with atrophy of the muscles of the quarter and 
thigh, and was found, on post-mortem examination, to have thickening 
of the dura mater spinalis from the 3rd lumbar vertebra backwards. 
The grey substance of the spinal cord appeared lighter in colour, and 
softer than usual. A considerable quantity of red fluid was found 
between the meninges of the spinal cord. Friedberger saw the con- 
dition during the course of contagious pleuro-pneumonia in the horse. 
I have repeatedly seen paralysis of the rectum develop spontaneously 
and quite gradually, and affect the rectum, tail, bladder, and later, the 
hind-quarters, but only in non-pregnant mares; generally in well-bred 
animals. In my opinion, the first change is paralysis of the lumbar 
nerves, followed by accumulation of feces in the rectum, and 
gradual dilatation of that bowel. The rectum receives its nerves from 
two points: the n. hemorrhoidalis medius, a branch of the pubic nerve, 
gives twigs to the curvator coccygis and retractor ani; the n. hemorr. 
posterior arises from the 4th and 5th lumbar nerves, and supplies the 
terminal portion of the rectum and the retractor penis muscle. The 
depressor coccygis derives its motor twigs from the 5th lumbar nerve, 
while the levator coccygis is supplied from the last twigs of the spinal 
nerves, the so-called cauda equina. In the cases I have noted the dis- 
ease began with paralysis of the levator coccygis, but the rectum and 
bladder were only affected after several months. Finally, the general 
paraplegia necessitated slaughter or total withdrawal of the animal from 
work. I have, unfortunately, not been able to make post-mortem 
examinations, but the course of the disease points to progressive degene- 
ration of the posterior portions of the spinal cord. The observations of 
others and the above-described post-mortem appearances support this 
view. Peters saw the disease associated with paralysis of the bladder 
ina mare. Schwarznecker observed the same thing in a pregnant mare, 
which later died from paraplegia; the post-mortem gave a negative 
result. Deigendesch reports a similar case ; the mare died from rupture 
of the bladder. 

Symptoms.—Abnormal dilatation of the rectum first attracts 
notice on account of the large quantities of feces which are passed, 
and the long intervals between the acts of defecation which only 
becomes difficult when actual paralysis has occurred; the rectum is 
then distended with dung, which requires to be removed manually. I 


308 TREATMENT FOR PARALYSIS. OF THE RECTUM. 


have seen horses which require to be daily assisted in this way. Some- 
times paralysis of the levator coccygis exists simultaneously, and then 
the tail swings to and fro as the animal walks, and the hair becomes 
soiled with urine and feces. After a certain time incontinence of urine 
sets in, the bladder becomes distended, and urine flows away continuously 
(ischuria paradoxa); still later sacral paralysis with atrophy of the 
muscles of the haunch occurs (compare with sacral paralysis). Some- 
times pruritus exists about the hind-quarters. 

The disease takes a chronic course and treatment has no visible effect, 
but however slow its progress, the animals finally become useless, and 
may even die of the disease. 

Dilatation of the anus is commonest in animals which have long 
suffered from severe diarrhoea, or been much weakened by internal dis- 
eases. Even after prolonged rectal examination, when the arm has 
been in the bowel for a considerable time, paralysis of the sphincter ani 
may persist for several days; the anus remaining open, and the air, 
which streams in and out during breathing, producing a loud noise. 

Stenosis of the anus and rectum soon impedes defecation and attracts 
notice; the position, degree, and extent of the condition is at once 
recognised on local examination. Honisch saw a horse which had long 
shown difficulty in passing feeces ; it placed the hind feet as far forward 
as possible and discharged single small, hard masses. The post-mortem 
discovered cicatricial stricture and thickening of the rectum, which 
extended about 5 inches forwards from the anus. It has been said 
that chronic inflammation in the paraproctal connective tissue may 
causes stenosis, but as a rule the cases published throw no light on the 
question. 

Prognosis is guided by the above-mentioned facts. Though usually 
unfavourable, the animal’s usefulness depends on the primary disease 
and the work to be done. Complete and lasting cure is seldom to be 
expected, but Harms’ case of paralysis of the rectum in a cow, resulting 
from fracture between the sacrum and first coccygeal vertebra, recovered 
in a month. 

Treatment.—Cicatricial stricture of the anus and posterior sections 
of the rectum may be temporarily relieved by forcible dilatation; in 
man, bougies are employed, but their use in animals is attended with 
difficulty, and is only justified when, for instance, a favourite and very 
valuable dog is in question, for whose recovery every means must be 
employed. Bougies consist of cylindrical hollow or solid rods, formed 
of hard rubber, or of material similar to that of which catheters are 
made. To be successful they require to be very frequently passed. 
Another method is to forcibly dilate constrictions with forceps. Johow 
relates having, after incision, dilated with the hand a firm ring-shaped 


ANAL FISTULA AND RECTO-VAGINAL FISTULA. 309 


stricture in the rectum of a horse. Volk cured a pig whose anus had 
closed, after prolapse of the rectum, by making a cross-shaped incision 
over the anus and breaking down the adhesions. 

Constipation, following either constriction or dilatation, is treated by 
suitable diet and the use of purgatives or clysters; the intestinal con- 
tents bemg softened by copious injections of lukewarm water. In 
advanced cases of dilatation or paralysis, the rectum requires to be 
emptied once or twice daily. To combat paralysis I have employed the 
most varying drugs, the induced electric current, &c., but without any 
success whatever. Deigendesch also tried strychnine without good 
result. : 


VII—ANAL FISTULA AND RECTO-VAGINAL FISTULA. 


Ger. Afterfistel and Afterscheidenfistel. 


Lit.: Schrader, Gurlt u. Hertwig. 3, p. 361. Meer, ibid., 5, p. 395. 
Munkel, ibid. 16, p.64. Roupp, Re. de. méd. vet. 1824, p. 261. 


All fistulee in the neighbourhood of the anus are described as anal 
fistule. Where a communication exists between the skin and rectum, 
the fistula is termed “complete,” where one end is blind, “incomplete.” 
The latter is sometimes congenital, but also results from injuries, par- 
ticularly during delivery. 

Injuries and cellulitis of the paraproctal connective tissue are the 
common causes of anal fistula, but the condition may be congenital and 
associated with atresia ani. Operation is the only effective treatment, 
and in the case of recto-vaginal fistule frequently fails. 

Schrader, in a six-year-old mare, observed recto-vaginal fistula of a 
diameter of i+ inches, about 4 inches in front of the anus. Meer 
found a similar one, which had appeared after delivery, 3 to 4 inches 
in front of the anus in a mare. Munkel observed in an ox a 
“complete” anal fistula, the rectal opening 6 inches in advance of the 
anus, the second on the lower surface of the tail. “Incomplete” anal 
fistule in horses have been seen by Hertwig; one was 12 inches, 
the other 16 inches in length, and both had resulted from abscess 
formation. 

Diagnosis is confirmed by passing a probe or the finger, or both, 
into-the rectum, and discovering the opening of the fistula. 

Treatment.—To prevent anal fistula, proper treatment of wounds, 
&c., is very important, and injuries of the vaginal walls during delivery 
must receive special attention. 

It is seldom possible to bring about closure by injecting with irritants 


310 TUMOURS IN THE RECTUM AND ANUS. 


like liquor Villati or disinfecting fluids ; and when fistule extend into the 
rectum, or far forwards in the paraproctal connective tissue, the use of 
irritants is dangerous, on account of the possibility of their reaching the 
peritoneal cavity. Operation and free exposure of the fistula are there- 
fore preferable. If possible, the sphincter ani must be spared, though 
its section often produces no lasting inconvenience, and union becomes 
quite perfect. Munkel divided the sphincter without bad results ; 
Hertwig endeavoured to spare it as far as possible. In laying open a 
“complete ” anal fistula a hollow probe is inserted, the end of the fistula 
discovered by inserting the index finger of the left hand in the rectum, 
and an incision then made down to the finger, care being taken to spare 
the soft parts as much as possible, and so regulate the cut as to favour 
wound drainage. Roupp passed a lead wire through a “complete” rectal 
fistula, drew one end back through the anus, and laid open the fistula 
by daily tightening the wire about an inch. Short recto-vaginal fistula 
may sometimes be closed by passing a seton; the larger lying near the 
vulva may be sutured. This treatment failing, they generally prove 
incurable. 


VIII.—TUMOURS IN THE RECTUM AND ANUS. 


Lit.: Frey, Gurlt. u. Hertwig. 15, p. 320. Kéhne, ibid., 32, p. 60 u. 29, 
p. 372. Siedamgrotzky, Dresd. Ber. 1879, p. 86. Truelsen, B: 
T. W. 1892, p. 241. 


In dogs fibromata, sarcomata, carcinomata, and adenomata are not 
infrequently seen in the paraproctal connective tissue; while horses, 
particularly those of a grey colour, suffer most from melano-sarcomata 
and melano-carcinomata. Various tumours are also found in the 
rectum. 

Symptoms and Course.—Tumours near the anus and close below 
the skin may be directly seen and felt, but the veterinary surgeon is seldom 
called in until stenosis or displacement of the rectum or anus sets in and 
interferes with defecation. Tumours in the posterior portion of the 
rectum sometimes protrude during defecation, and occasionally cause 
prolapsus ani. When further forward, they are either accidentally 
discovered in examining the rectum, or the continuous and gradually 
increasing disturbance in defecation draws attention to them. 

Manual examination determines their size, form, and position ; 
sometimes the rectal or vaginal speculum is useful. 

Inflammatory swelling of the anal glands, common in dogs, may be 
mistaken for tumour formation, though the local pain sufficiently indi- 


TREATMENT OF TUMOURS IN THE RECTUM. SLE 


cates its nature. Rectal and anal tumours, especially when malignant, 
are often accompanied by secondary growths and swelling of the lymph 
glands in the abdomen. 

Prognosis depends chiefly on the difficulty of extirpating the 
tumour. Not only must the nature of the new growth, and its position 
and size, be borne in view, but the question whether secondary growths 
or infection of lymph glands has occurred considered. Tumours near 
the anus may easily be removed if not adherent to the mucous membrane 
of the rectum, a point which can at once be settled by introducing the 
finger or hand. Pedunculated tumours within the rectum offer no 
difficulty in removal, but those with broad bases are often impossible to 
deal with. 

Treatment.— Warts and other benign growths originating in the skin 
are simply removed with knife or scissors. Those growing from the 
subeutis or paraproctal connective tissue, if only small and not attached 
to the mucous membrane of the rectum, are treated in the same way. 
After incising the skin with the usual precautions, the tumour is drawn 
well forward, either with forceps or by passing a tape through it, and 
dissected out without injuring the rectal mucous membrane. Tumours 
in the rectum itself are extirpated either by ligation or “ ecraseur.” 
Serious bleeding is rare, and such as occurs can be controlled by cold 
clysters or tampons. 

Frey states having noted in the horse two sarcomata (?) as large as a 
hen’s egg close in front of the anus, which produced prolapsus ani. 
Kohne removed from the rectum of a horse by ligature a polypus whose 
seat was 4 to 5 inches in front of the anus, through which it protruded 
during defecation. In a second horse Kohne removed with the 
“ ecraseur ” a polypus the size of a man’s fist, which lay about 16 inches 
forward from the anus. Stockfleth states having seen cancer of the 
rectum in old cattle. Siedamgrotzky discovered in a gelding a cyst as 
large as a man’s fist lying on the lower wall of the rectum 6 inches from 
the anus; it discharged a clear fluid on perforation with the trochar. 
After injecting tincture of iodine, healing occurred. A similar case is 
described by Hierholzer. 

Truelsen removed from the rectum of a foal several polypi, which lay 
about two hands-breadths from the anus, and had repeatedly caused 
constipation and colic. An improvised “ ecraseur” was constructed of 


a canula and wire, with which Truelsen removed the growth, and effected 
a cure. 


VIL. DISEASES OF THE URINARY ORGANS. 
I—CONGENITAL MALFORMATIONS. 


Lit.: Frick, Berl. Arch. 1885, p. 466. Burmeister, Gurlt u. Hertwig, 
21, p. 248. Lancelot u. Greve, Gurlt pr. Anat. p. 213. Herbet, 
Kaufmann u. Blane. Jahrb. 1883, p. 145. Storch, Oesterr. Zeitschr. 
f. wiss. Vet. 1890, p. 29. Guinard, Journ. de Méd. vétér. et de zool. 
1891. March, Schw. Arch. vol. 33. 


(1.) FISSURING OF THE MALE MEATUS URINARIUS 
(HYPOSPADIA AND EPISPADIA). 


In consequence of arrested foetal development the meatus urinarius 
may fail to entirely close at some point in its course, and thus present 
the appearance of an open channel. When this occurs in the posterior, 
lower wall the condition is termed hypospadia, when in the upper, anterior 
wall, epispadia. In animals, neither condition has the same significance 
as in men, as the patients, which are usually dogs or sheep, are either 
destroyed or left without treatment. Horses are seldom affected. The 
abnormal opening may lie just behind the glans, or in the course of the 
meatus nearer the bladder; where it occurs close below the anus, the 
animals are sometimes mistaken for hermaphrodites. Hypospadia is not 
infrequently associated with cloaca formation, as I noted in the case of 
a dog which appeared to suffer continuously from sexual excitement. 
Guinard saw hypospadia in a three-year-old cryptorchid bull. 

Treatment is seldom invoked unless the condition is accompanied by 
difficulty in urination. The natural opening of the meatus urinarius 
may not exist, and if the fissure is insufficient for the discharge of urine, 
it may require enlargement. To prevent reunion of the parts the 
meatus is divided from below upwards in the form of a “ Y,” and the 
edges attached to the skin. 


(2.) PERVIOUS URACHUS. 


Up to the time of birth urine is discharged through the urachus, but 
when that closes the urine passes through the meatus urinarius. Ina few 
cases the urachus remains open even after birth, and urine is discharged 
through it. Burmeister saw this in a three-weeks-old foal ; when staling, 


URINARY CALCULI. as 


some urine always flowed from the navel. In a colt described by 
Herbet urine was only passed by the urethra in drops, but flowed in a 
stream from the opening in the navel, which was about + inch across. 
Kauffmann and Blanc found the fellowing conditions existing in a 
thirty-seven day old calf—atresia ani; hernia, as large as a child’s head, 
in the linea alba, between the navel and os pubis; a fissure 2 inches long, 
in the umbilical region, through which both the open meatus urinarius 
and the urachus opened; feces were discharged by the latter; a canal, 
the size of a goose-quill, existing between the occluded rectum and the 
bladder, whence the material made its way into the urachus. The 
latter also received the ends of the ureters and spermatic ducts. 
Lancelot saw in calves and goats swelling of the navel, which to the 
touch gave the impression of an umbilical hernia. Several animals died 
because the urine found no exit through the urethra, and as the umbilical 
cord was also closed, the urine accumulated in its dilated end below the 
skin of the umbilicus. Greve found pervious urachus in a filly. 

The primary cause of disease is the obstacle to discharge of urine 
through the urethra, and attention should, therefore, first be directed to 
this point. When obstruction can be detected, blistering the parts will 
close the urachus; Burmeister succeeded in this way. Should it prove 
impossible to lay open the urethra, the urachus may be further divided 
and the urine thus allowed to escape, a method which does well enough 
in animals intended for early slaughter. Herbet effected healing in 
five days by powdering the parts with burnt alum; March, in the case of 
a calf, by applying a ligature. 


I].—URINARY CALCULI. 


Urinary calculi have only a surgical interest when occurring in the 
urethra or urinary bladder. They result from materials deposited through 
the urine accumulating around hard substances, foreign bodies, clots of 
blood, masses of mucus, &c., which have accidentally found their way 
into the urinary passages; catarrh or inflammation of the urinary 
passages, therefore, often give the first impulse to their formation. 
Calculi are also said to be due to an abnormally high percentage of salts 
in the urine, produced by food and water rich in lime, and to a specific 
tendency (lithiasis). Of more importance is the fact that retention and 
decomposition of the urine are lable to cause an alkaline reaction 
and calculous deposit. Such conditions are, therefore, to be provided 
against or removed as soon as possible, and care taken to disinfect 
catheters, &c., before use, and so prevent micro-organisms being carried 
into the bladder. Sometimes deposits occur in the pelvis of the kidney, 


314 URINARY CALCULI IN THE HORSE. 


pass into the bladder, there become enlarged, or being discharged 
with the urine remain fixed in the urethra. This explains why the 
symptoms of urethral calculus generally appear suddenly and are apt to 
recur, and why the stone is almost always found at the narrowest point 
of the tube. Urinary calculi are seldom single, generally they occur in 
large numbers, or as so-called gravel. 

In herbivora, urinary calculi most frequently contain triple phosphate 
and carbonate of calcium; in sheep, some have been found to consist of 
silicic acid, with phosphates of calcium and magnesium. Urinary 
caleuli in herbivora are sometimes coloured red by iron salts; their 
surface is generally smooth, though those covered with oxalate of calcium 
are rough and uneven. In carnivora one distinguishes: 

(a) Uric acid caleuli, which consist of phosphate and carbonate of 
calcium and of urate of ammonium. These often attain considerable 
size, and appear smooth and white on the surface. V. Ratz believes 
they result from acid formation in the urine leading to deposit of calcium 
salts or to a basic condition of the urine. 

(b) Oxalie acid calculi consisting of oxalate of ammonia are usually 
coloured yellow; their surface is rough, resembling a mulberry; Ratz 
considers that oxalates are excreted when the food contains quantities 
of oxalic salts, but they may also be found in the body by the decom- 
position of urinary acids. The excretion of oxalic acid in consequence 
of diseases of the organs of respiration and digestion, which has often 
been suggested, is denied by Ratz. 

(c) Cystin ealeuli are principally formed of cystin, are yellow, soft, 
and when dried are friable, and feel greasy to the touch. As urinary 
calculi are of varying importance in the different classes of animals, and 
from a surgical point of view require particular treatment, we shall 
here view them under separate heads. 


(1.) URINARY CALCULI IN THE HORSE. 


Lit.: Landvatter, Her. Rep. 39, p. 285. Reicherter, ibid., 35, p. 30. 
Hertwig. Mag. v. Gurlt u. Hertwig, 25, p. 227. Gnerich, ibid., p. 
348. Kramer u. Rotter. Oesterr. Monatsschr. 1892. Siedam- 
grotzky, Berl. Arch. 1891, p. 301. Peuchu. Toussaint, Chirurgie. 
II. Aufl. Schmitz, Zeitschr. f. Vet. 1890, p. 432. Siedamgrotzky, 
Dresd. Ber. 1890, p. 20. Likisin, Jahrb. 1891, p. 108. Kutzner, 

Zeitschr. f. vet. Kund. 1882, p. 499. Fehsenmair, B. T. W. 1899, p. 

39. 


Urinary calculi rarely occur in_ the ureters or bladder of the horse, 
still less frequently in the comparatively wide urethra. According to 
Bang the circumference of the latter in male animals is as follows :—In 
the pelvic portion 1 to 14 inches, in the abdominal portion 4 to 2 inch, 


TREATMENT OF URINARY CALCULI. 315 


behind the external opening 4 inch. In mares the urethra is very wide 
and caleuli never remain fixed in it, and therefore in them vesical 
calculi alone claim consideration. 

Urethral calculi may be recognised in the stallion and gelding by 
difficulty in urination. The animals place themselves in position to 
urinate, but can only discharge fluid in drops or in a small stream. 
Sometimes the upper sections of the urethra are abnormally distended, 
or may be felt to contain a stone, and the catheter, when intro- 
duced, strikes on a hard substance. Examination per anum discovers 
the urinary bladder to be greatly over-filled, but on pressure, urine 
either fails to be discharged or issues in drops. 

Vesical calculi take longer to produce obstruction in staling; the 
urine is passed more frequently, but in small quantities, often in drops. 
When the animal has been driven fast, the fluid may be blood-stained 
on account of the stone injuring the mucous membrane, Hertwig saw 
sexual appetite excited in a mare by vesical calculus. Exploration per 
rectum generally reveals the stone as a firm, hard substance; in mares 
it can be directly felt by passing the finger through the urethra. 
Gravel is rarer in the horse, though I have once been obliged to remove 
a large quantity of it by operation. 

Treatment.— Internal medication is useless for dissolving the stone, 
and surgical removal alone can cure. Though it is certainly easier to 
remove a stone from the urethra than from the bladder, neither operation 
is easy nor unattended with danger, especially in carnivora; herbivora 
bear operation much better. 

Cutting for stone was first practised in man. In veterinary surgery 
it is said to have been introduced by Lafosse, who made the first experi- 
ment ona horse. LErcolani contends that even in the 14th century 
similar attempts had been made; but Bouley was probably the first to 
successfully employ the operation in the horse as a means of treatment. 

Several methods formerly employed are now obsolete, such as cysto- 
tomia rectalis, in which the urinary bladder was incised through the 
lower wall of the rectum, and the stone removed through the rectum. 
Severe cystitis often resulted, and caused this method to be given up 
both in men and animals. 

The bladder may also be reached through the lower portion of the 
abdominal wall, close in front of the os pubis, a method which in man has 
been called cystotomia suprapubica, or sectio alta, and is still used at 
the present day, but as in animals this necessitates opening the perito- 
neal cavity there is considerable danger of peritonitis, while the hori- 
zontal position of the body favours prolapse of bowel, and it is of course 
impossible to keep the animal continuously lying on the back. It is, 
therefore, necessary to resort to a third method, namely, section through 


316 URETHRAL CALCULI IN THE HORSE. 


the perineum (cystotomia perinealis). Or alternatively the urethra may 
be incised (urethrotomy) at one of various points in its course. 

Urethral calculi in the horse are only exceptionally found close behind 
the glans. They may be removed without much difficulty or bleeding, 
by the operator standing on the left side of the animal, drawing the 
penis forward by means of a cloth, or allowing an assistant to hold it, 
and then grasping the calculus with dressing or ordinary forceps. Some- 
times strong pressure on the penis with the hand is suflicient, or 
the urethral oriffce may be enlarged, and the calculus thus removed. 
Urine then generally flows away in large quantities, if not, a catheter 
must be passed, to discover whether other calculi remain in the 
urethra. 

Landvatter removed from a gelding, by means of forceps, a calculus 
about 14 inch in length and # inch thick, which lay in the terminal 
portion of the urethra. Two years later he took from the same animal 
a still larger one, which was fixed in the urethra 4 inches from the 
anus. Reicherter grasped a calculus, lying 14 inches in front of 
the opening of the urethra, with a pair of dressing forceps and 
broke it down; fragments were afterwards passed with the urine. In 
a case seen by Rother, the calculus, which lay about 24 inches behind 
the glans, had caused ulceration and perforation of the urethra, in con- 
sequence of which urine had extensively infiltrated into the neighbouring 
tissues. The animal died from rupture of the bladder. 

As a rule, in the horse, the calculus lies at the height of the ischial 
arch, where the urethra turns downwards and forwards. As casting an 
animal with distended bladder is open to danger, it is usual to operate 
in the standing position, the patient being controlled by twitches and its 
hind legs extended. To prevent accidents it is best to place the animal 
in slings or stocks, so that it cannot lie down. Should a really dangerous 
horse require to be cast every precaution must be taken, and a very thick 
straw bed provided. It is best to operate with the animal on the 
left side or back; I myself prefer the latter. 

After plaiting the tail and cleansing the skin, a catheter is passed, 
and an incision 14 to 24 inches long made through the skin 
immediately over the urethra, that is, in the middle line of the 
body and over the point where the calculus can be felt. This is 
successively carried through the retractor penis muscle, the accelerator 
urine, the corpus cavernosum of the penis, and, finally, the urethra 
itself. The incision should gradually become smaller as it penetrates 
deeper, so as to favour the free exit of wound discharges and of urine. 
The incision into the wall of the urethra must be as small as will allow 
exit of the calculus, which may sometimes be removed by simply press- 
ing upon it with the finger ; if not, by employing forceps, a catheter, or 


7 


AFTER-TREATMENT FOR URETHRAL CALCULI. 317 
the end of a blunt pair of scissors. Immediately the urethra is clear 
urine flows away in large quantities. The urethral wound may be 
sutured with catgut or silk, though this is not absolutely necessary, 
for healing also occurs without it. 

After-treatment is very simple; one leaves the wound either com- 
pletely to itself, possibly powdering it with iodoform, or cleanses it 
once or twice daily. Union is somewhat quicker after suturing, but 
even without it is complete in two to three weeks. 

Bad results seldom follow this operation, though healing by first inten- 
tion is very rare. Provided the incision be properly made, infiltration of 
urine need not be feared, nor is severe inflammation seen, unless the 
parts were injured before operation. Altogether progress is favourable, 
and if the operation be performed exactly in the middle line there is 
little bleeding. 

In quiet animals cystotomy may also be performed in the standing 
position, the procedure being as above described. Many persons re- 
commend operating with the animal on its left side, but I, like H. 
Bouley, prefer the dorsal position, and give chloroform. The urethra 
is divided over the ischial arch, as in urethrotomy, but as the urethra 
is not easy to find unless filled with fluid, an elastic catheter should first 
be passed into the bladder. After incision the catheter is withdrawn, 
and a grooved director inserted as far as the neck of the bladder. The 
probe must be introduced immediately the catheter is withdrawn, as 
otherwise the urethra will prove difficult to find. 

If only a small calculus or gravel has to be removed, an attempt 
should first be made to pass the forceps into the bladder and reach the 
calculus without a second incision. By gradually opening the forceps, 
whilst still in the neck of the bladder, the latter may without danger be 
so dilated as to allow removal of calculi of considerable size; if not, a 
tenotome or bistoury is passed along the director into the bladder and 
the neck of the bladder incised during withdrawal. A special instrument 
has been made for this purpose, but is not absolutely necessary. In 
France a lithotome, which corresponds in construction to the herniotome 
(fig. 77), is employed. To prevent injury, the rectum is emptied before 
operation and the incision made, not exactly in the middle line, but a 
little to the left or right. In dealing with large calculi, the neck of the 
bladder may be incised in two directions. 

The forceps (fig. 93) are now passed, and attempts made to grasp the 
stone; the operation wound being meanwhile closed to prevent the 
bladder emptying; otherwise the wall of the bladder is apt to become so 
closely applied to the calculus that the greatest difficulty is experienced 
in seizing the latter. As soon as a hard body is felt the forceps are 
opened, and an effort made to grasp the stone. Though often suggested, 


318 AFTER-TREATMENT FOR URETHRAL CALCULI. 


it is seldom necessary te manipulate the stone from the rectum. Once 
erasped, the forceps are rotated around their long axis to make sure that 
the mucous membrane has not been included ; and if no great resistance 
is felt the stone is drawn forward and removed, the rush of urine which 
takes place assisting the process. The instrument should be reinserted 
or the bladder examined from the rectum, to make certain that no other 
calculus or gravel is present, which would require to be at once removed, 
otherwise one proceeds as in urethrotomy. Suturing 
the wound is not absolutely necessary, though it somewhat 
hastens recovery; but if unskilfully performed, so that 
the urethra is left open while the skin is closed, infiltra- 
tion of urine occurs and leads to grave consequences. 
Healing occurs in the same time as in urethrotomy. 
For a short time urine escapes in part by the operation 
wound ; but this svon closes, and only occasionally does 
urethral fistula result. 

After-treatment consists in washing out the bladder 
once daily with a lukewarm 2 per cent. solution of 
acetate of alumina, by means of a rubber tube. This 
prevents decomposition of urine. If treatment must be left 
to laymen, a tube may be fixed in the urethra (Siedam- 
grotzky), otherwise I should condemn the practice as 
favouring infection of the bladder. The tube must be 
cleansed or placed for a short time before insertion in 
the lotion to be injected. 

In removing large stones, the neck of the bladder 
can be dilated to such an extent as to admit the entire 
hand, as I discovered on one occasion when I removed 
a cystic calculus weighing over 20 ozs. The bladder 
Fic, 93.—Caleulus Must not be completely emptied, however, as its walls 

Honcens. cling to the stone and render extraction difficult. If 
such an accident has happened, lukewarm fluids, ike 5 per cent. car- 
bolic lotion, may be injected, but are not always retained, particularly 
where the opening resulting from division of the neck of the bladder 
is of great size. 

The danger of operation increases with the size of the calculus, though 
stones of considerable magnitude may be safely removed, as shown by 
my extracting two calculi from the bladder of a nine-year-old gelding, 
one weighing 24 ozs. and the other 204 ozs. The operation wound took 
three weeks to heal. In a second horse from which I took a stone 
weighing 20 ozs., gangrenous cystitis with septic paraproctitis and peri- 
tonitis resulted, from which the animal died on the fifth day after 
operation, 


URETHRAL CALCULI IN RUMINANTS, 319 


Large calculi may be crushed, though the instruments intended for 
this purpose are not constructed for calculi of the above size. Calculi 
indeed often yield to powerful pressure from the forceps and fall to 


pieces; Bouley’s forceps (fig. 94) may be em- 
ployed as a lithotrite. They have the advantage 
that they can be fixed after grasping the stone, 
thus rendering easier the extraction of large 
concretions, I myself recommend Bouley’s 
instrument, though in most cases the older 
calculus forceps are sufficient (fig. 93), and a 
pair of farrier’s tongs are even said to have been 
used (Schmitz). 

Urethral calculi are rare in mares, whilst 
vesical calculi may generally be removed without 
incision; by dilating the urethra I have thus 
removed calculi the size of hens’ eggs. Forceps 
are used, and the urethra slowly enlarged. Until 
the stone can pass through it, considerable 
exertion of power is necessary, and complete 
dilatation often occupies half an hour or more; 
an assistant may be required. Not long ago I 
removed by this method from the bladder of a 
mare a stone the size of a hen’s egg and weigh- 
ing nearly 24 ozs. Hertwig divided the urethra 
laterally, Kutzner the upper wall; Fehsenmeir, 
after dividing the urethra for the space of 2 
inches in an upward direction, withdrew by hand 
a stone weighing 7 ozs. Kramer removed one of 


Fie, 94,—Bouley’s Calculus 
Forceps. 


154 ozs.; the urethra was dilated throughout, so that Kriimer was able 
to remove the stone by hand. Recovery occurred in twenty-eight days. 


(2.) URETHRAL CALCULI IN RUMINANTS. 


Lit.: Stohr, Thierartzl. Mitth. 1867. Jacobi, Gurlt u. Hertwig. 18, p. 
218. Reichle, Her. Rep. 35, p. 30. Pflug, Krankh. der uropoet. 
Organ. Peuch-Toussaint, Chirurgie. II. Aufi., p. 547. Bader, 
Her. Rep. 3, p. 366. Deisinger, Stockfleth Chirurgie, p. 588. Dam- 
mann, Her. Rep. 36, p. 427. Read, Her. Rep. 6, p. 482. Liithens, 
ibid., 36, p. 449. Hermann, Deutsche Zeitschr, fiir Thiermed. 1890, 
p. 229. Schell, Thierarztl. Mitth. 1876, p. 107. Meisel, Ad. Woch. 
1877, p. 28. Reiber, Schw. Arch. 1. Esser, Th. Rundschau. 1888, 


Pi Ciant Jakep lool. 110. 


Of all animals the bull suffers most from calculi, Formed in the 
bladder, they enter the urethra during urination, and partly on account 


320 DIAGNOSIS OF URETHRAL CALCULI IN RUMINANTS. 


of its comparatively narrow lumen, partly of its peculiar course, remain 
fast (fig. 95). 

The pelvic portion resembles that in other animals and has a width 
of 75 to 7% of an inch, but in the abdominal portion the passage con- 
tracts to 4 inch, and at its orifice even to yy. In the neighbourhood of 
the scrotum it makes with the penis the so-called “S”-formed turn. 
At the first bend near the front of the scrotum (/), the penis turns once 
more backwards, making about 3 imches behind and over the posterior 
surface of the scrotum a second bend (7); at the height of the latter the 


Fic, 95.—Course of the Urethra in the Ox—(after Hering). 


a, Urinary bladder ; 6, Ureter, cut off; c, Vesicule seminalis; d.d, Pelvic portion of urethra; 
7, Commencement of the corpus cavernosum of the penis; g, Ischial curve of the urethra ; 
h, First bend ; 7, Second bend ; &, Anterior extremity of the penis; 7, Retractor penis muscle. 


retractor penis (/), which is very strong in cattle, becomes attached. 
The sinuous course and slight diameter of the urethra explain why even 
small calculi or concretions, weighing only a few grains and not 
exceeding the size of a pea, may remain fixed in the urethra and 
obstruct it. The stone is usually lodged in the first bend (A), less fre- 
quently in the second or near the end of the organ. 

Diagnosis.— Urethral calculus first attracts notice by the difficulty 
which exists in passing urine. The animal is fretful, stamps with the 
hind feet and moves to and fro, lifts the tail and makes frequent short 
side movements with the root of it (Jensen); it les down, but imme- 
diately rises again, and strikes with the hind feet towards the body. 

In oxen slight symptoms of colic should always arouse suspicion of 
urinary caleulus and lead to examination of the bladder and urethra. 
The bladder and sometimes the upper portions of the urethra are found 


OPERATION FOR URETHRAL CALCULUS IN RUMINANTS. 321 


excessively distended, and may show pulsative movements as the animal 
strains whilst a few drops of urine are sometimes passed. Passing the 
finger along the course of the urethra causes the animal to show pain 
and uneasiness at the spot where the stone lies, though the latter can 
seldom be directly felt. Retention of urine for twelve to twenty-four 
hours may result in rupture of the bladder and death after a few days. 
After rupture the pain diminishes, the animals may even begin to feed 
again, but tympanites soon sets in, and death takes place with symptoms 
of peritonitis and ureemia (frequent pulse, giddiness). Cases are reported 
where oxen have still lived for some weeks after rupture of the bladder. 
Stohr mentions an ox which lived six weeks, and Jacobi states having 
seen recovery after rupture, but as a rule animals in this condition are 
at once slaughtered, to avoid injury to the flesh, which takes on an 
unpleasant smell from resorption of urine from the abdominal cavity. 
Franck therefore recommends removing the urine by a trochar passed at 
the deepest point of the abdomen. 

In oxen it is important to operate early, and, on account of the peculiar 
course of the urethra, one method alone, viz., urethrotomy, is available. 
With few exceptions the calculus is found at the first curve, and can be 
reached most directly from the anterior surface of the scrotum. As, 
however, it is less convenient to operate here, most practitioners make 
the incision behind, and about a hand’s-breadth above the scrotum. 
For this operation the animal should be cautiously cast and laid on 
the left side, though quiet oxen may be operated on standing. The 
right hind foot is drawn forward with a cord, exposing the field of 
operation. 

After making sure by rectal examination that the bladder is not 
ruptured (Esser), and having once more carefully determined the position 
of the stone by palpation, and found that it is not contained in the 
superficial portion of the urethra, the skin is incised for 2 to 4 inches in 
the direction of the urethra, either at the point where the greater sensi- 
tiveness or hardness of the swelling indicates the calculus to be, or a 
hand’s-breadth behind and above the scrotum. The retractor penis 
muscle, which is much more developed in the ox than in the horse, is 
then divided to the same extent. The urethra can then be felt, and if 
one operates at the point where the calculus is fixed the latter may be 
detected within it. After incising the corpus cavernosum, and the 
urethra itself, the stone is easily removed. 

Where, however, the calculus is situated in the first bend of the 
urethra (i) the retractor penis is divided, and an attempt made to draw 
forward the penis with the finger; the bulbo-cavernosus muscle and 
urethra cut through, and the stone removed by pressure with the 
fingers, or if necessary, by means of forceps. The stone when rough 

x 


322 OPERATION FOR URETHRAL CALCULUS IN RUMINANTS. 


sometimes becomes so firmly fixed in the swollen mucous membrane 
that even the knife must be employed to free it. The cut in the 
urethra should be as small as possible, to facilitate healing and prevent 
stricture. Should the stone be the sole obstruction to passage of urine, 
an immediate discharge occurs on removal partly through the opera- 
tion wound and partly from the orifice of the urethra, but in any 
case it is necessary to examine the lower portion of the urethra with a 
catheter, to discover whether other stones are present and require removal. 
The urethral wound need not be sutured, though Reichle and Pflug recom- 
mend inserting a few silk sutures to assist healing; Ciani suggests divid- 
ing the urethra from the side, and closing it with close-set sutures, to 
prevent infiltration of urine. The penis is then allowed to return to its 
natural position. To prevent infiltration the outer wound is not sutured, 
but it often occurs in spite of this precaution. Esser, therefore, provides 
for escape of urine and wound discharges by passing a drainage-tube 
forwards, and allowing its anterior end to project in front of the 
scrotum. He says this prevents infiltration of urine, which not only 
checks healing, but constitutes a grave danger to the animal’s general 
health. The operation wound heals in about fourteen days. 

When the calculus cannot be discovered, Ciani recommends com- 
pletely dividing the urethra above the obstruction, producing fistula, 
to allow passage of urine, and fattening the animal. 

II. Urethrotomy in front of the scrotum. 

As already remarked, the calculus almost always lies in the tirst bend 
of the urethra, just in front of the scrotum, and, therefore, next to the 
skin. This position is inconvenient for operation, and is not often 
selected in Germany; it seems to be more in use in France. <Accord- 
ing to Peuch and Toussaint, the animal is laid on its left side, the nght 
hind foot drawn towards the shoulder, the operator’s left hand passed into 
the sheath, and the penis drawn forward so as to extend the “S-shaped 
bend. Should the stone now be felt, a longitudinal incision is made in 
the urethra and the caleulus removed with forceps or a hollow probe. If 
not, the hair is cut away in front of the scrotum, a cross fold of skin pinched 
up, and together with the prepuce is divided. The index finger of the left 
hand is passed into the opening, the penis grasped with the bent finger and 
drawn forward through the wound. The rest of the operation is as above. 
Dupont (Peuch) divides. the urethra immediately after cutting through 
the skin. If, after removing the stone, no considerable quantity of 
urine is discharged, the urethra must be explored, and, if necessary, the 
operation repeated again at a higher point. Bouley thinks infiltration 
of urine need scarcely be feared, and if it should appear, can be cured by 
making deep incisions; abscesses, when occurring, are similarly 
treated. 


URETHROTOMY IN RUMINANTS. 323 


III. Urethrotomy in the ischial region. 

On account of the considerable diameter of the urethra, calculi seldom 
become fixed at this point, and operation is usually performed at the 
ischial arch only to give relief more rapidly and remove the imminent 
danger of rupture of the bladder. Operation here is also easier for the 
unpractised. After providing an exit for the urine, the stone, which 
hes at a lower point, is allowed to remain. The operation is, therefore, 
most useful in animals nearly ready for slaughter, though it may he 
replaced by puncture of the bladder (p. 327). 

This method may also be resorted to if the stone cannot be found, or 
if found, cannot be removed, or if such changes have occurred in the 
urethra as are likely to prevent passage of urine. 

The general procedure and after-treatment are similar to those in the 
horse. If the animal is not destined for early slaughter a tube should be 
fastened in the urethra to keep the wound open, but this measure is 
only of temporary benefit on account of inflammatory swelling setting in 
and preventing discharge of urime. Dupont (Peuch) therefore  re- 
commends, in the event of a calculus being found at this point, to thrust 
it back into the bladder, thus obviating the necessity for such a large 
urethral wound. 

Bader, who performed one hundred lithotomies in the ox, almost 
always found the calculus in the first (lower) curve of the urethra. 
Most of the animals were in the first or second year of life, a few in 
the third, and only one in the fourth. In 24 out of 25 cases, 
Deisinger found the stone in the lower curve of the urethra. 
Diani states having seen 300 cases, and having found the stone in 
the upper curve, or between it and the lower one, in 98 per cent. of 
these. In 2 it lay in the pelvic portion, and in 5 or 6 near the glans. 

Urethrotomy in the sheep. 

The ram’s narrow urethra les embedded for the most part in fatty 
tissues, and is therefore still more difficult to find than that of the ox. 
Calculi and deposits are not common in sheep, and when occurring are 
usually found close behind the opening of the urethra, which extends 
beyond the penis, is free, and as a rule curved into the shape of an “8.” 
Dammann has described several cases of the kind. 

The symptoms are similar to those in cattle. Retention of urine 
renders the animals restless, they stand with the back arched straining 
to pass urine, and examination per anum shows the bladder to be 
greatly distended. By closing the nostrils with the hand a healthy sheep 
can be caused to pass urine, but here the attempt is unsuccessful, or 
only a few drops are passed. 

According to Peuch, it is usual in France, as in Germany, to remove 
the free end of the urethra in cases where calculi or concretions cause 


324 SEQUELS OF URETHROTOMY IN RUMINANTS. 


retention of urine. The same is recommended in England; Read saw a 
case where 11 to 12 pints of urine were afterwards passed. 

If the obstruction lie further back, Peuch recommends, in valuable 
animals, passing a catheter or sound. The sheep is placed on its back 
and the penis drawn forward out of the prepuce so as to obliterate the 
“$”-formed curve. A fiexible metallic sound is then passed into the 
urethra, which has previously been laid open transversely close behind 
its free end. It is said to be thus possible to displace the sediment 
and effect an exit for the urine. 

Others recommend laying open the urethra at the ischial arch, a 
method which also admits of the removal of vesical concretions. 
Luthens opened the urethra of a ram at the “S” bend as is done in the 
ox; the animal, however, died from further formation of caleuli. 

Complications of urethrotomy in herbivora— 

(1) Unless the bladder is ruptured before or during operation, an 
abundant discharge of urine follows removal of the calculus. Some- 
times, however, the detrusor urine having been greatly over-extended 
and failing to contract, the bladder appears paralysed. In such cases, in 
oxen, the hand should be introduced into the rectum and attempts made 
to empty the bladder by exercising slow and steady pressure upon it. 
Meisel recommends moving the animals, but altogether considers the 
condition very grave. 

(2) A second unfavourable complication consists in the formation of 
stricture of the urethra at the point of operation, though this only occurs 
if the animal lives for a considerable time afterwards, which is seldom 
the case in oxen. Relapse being probable, the animal should be imme- 
diately prepared for slaughter. Such strictures are common in the 
horse, and necessitate the re-performance of urethrotomy at a spot 
lying nearer the bladder. Riber suggests keeping a metal tube in the 
urethra, but this is of no permanent service, the irritation produced 
causing fresh stenosis. 

(3) Abscesses which form at the point of operation are laid open and 
treated on general principles. 

Cystic calculi are rare in ruminants, and are generally found quite 
accidentally after slaughter, not having caused any disturbance during 
life. They seldom produce noticeable symptoms, as the average life of 
oxen is too short to allow of their attaining any considerable proportions. 
But all the necessary conditions for their production exist, as is shown 
by the frequent occurrence of urinary calculi. Hermann found in the 
bladder and urethra of a three months calf caleuli of a collective weight 
of 5 drachms. 

The symptoms in the ox are similar to those in the horse. In 
operating, the same general principles are observed in both animals. 


URINARY CALCULI. 320 


(3.) URINARY CALCULI IN SWINE. 


In swine this disease is of less interest. Serious cases are best 
slaughtered. As in oxen, calculi and concretions are sometimes found 
in the bladder after death; Schell met with a collection of white 
earthy concretions weighing 13 drachms in the urinary bladder of an 
eighteen months pig that had always appeared healthy. 


(4.) URINARY CALCULI IN THE DOG. 


The urethral calculi not infrequent in old dogs can likewise be 
referred to the bladder. They almost always become fixed in the gutter 
of the os penis or close behind it. Straining to pass urme, passage 
of a few drops, uneasiness, &c., sufficiently indicate the nature of the 
condition. 

A metal catheter, which is easily introduced into the urethra, will at 
once reveal the presence of the caleulus and its position. In this 
examination the dog is laid on its back, with its left side towards the 
operator. The prepuce, which should be grasped about an inch behind 
its termination, is then thrust back with the fore-finger and thumb 
behind the corona glandis, the latter firmly pressed upon, and the penis 
thus caused to protrude. The catheter is then introduced into the 
opening of the urethra, which is easily seen, and passed onwards until 
checked by contact with the calculus, readily recognised by its hardness. 
By now removing the left hand from the prepuce, the end of the 
catheter and the stone may at once be felt below the skin. 

In spite of this the operation offers greater difficulties than in other 
animals, is often followed by severe strictures, and not infrequently 
proves fatal. I therefore recommend, when possible, thrusting the stone 
back into the bladder, which may sometimes be effected with the help 
of an elastic catheter; but if, in consequence of the rough nature of the 
stone and the already existing swelling of the urethral mucous mem- 
brane, this prove impossible, early operation alone offers a chance of 
saving life, for rupture of the bladder in dogs leads to death in twenty- 
four to forty-eight hours, and is the more to be feared the more com- 
pletely the passage of urine appears to be interfered with. 

Urethrotomy is carried out in dogs in the above described dorsal 
position. A catheter is passed into the urethra and held by an assistant ; 
the skin is then incised for a length of # to 14 inches immediately over 
the stone, and a second incision made exposing the stone. The diffi- 
culties only begin at this point. As the gutter in the os penis is 
narrower below, and forms a kind of tube split along its inferior margin, 


326 URINARY CALCULI IN THE DOG. 


it is often impossible to remove the stone, even when completely exposed. 
It is often necessary to employ a powerful but narrow pair of forceps, 
so as first to break down the calculus and then to remove the fragments 
from the swollen urethra, a proceeding often entailing injury to the 
latter. Several more calculi may be lodged behind the first and cause 
great difficulty in removal; and therefore, if urine is not at once voided 
in considerable quantities after removing the stone, the urethra should 
be examined with a sound, or elastic catheter. 

More serious embarrassment is caused by the infiltration of urine, 
which regularly happens in dogs, and is almost always followed by 
gangrenous inflammation. Possibly the acid reaction of the urine in 
carnivora plays an important part in effecting this, or it may be caused 
by decomposition products resulting from alkaline fermentation of the 
urine. Simon has noted that though acid human urine injected into the 
subcutis produces no inflammatory change, it is quite otherwise when 
alkaline fermentation has set in. Whatever the cause, the fact remains 
that infiltration of urine in the dog always causes inflammation, which 
tends to take on a gangrenous character. In such cases I have often 
seen good results from vegetable diet and the free administration of 
alkalies. Repeated washing of the wound with alkaline lotions like 
5 to 10 per cent. sod. carb., or powdering with a mixture of sod. bicarb. 
and iodoform, also appears useful. Should these complications be safely 
escaped, cicatricial contraction of the urethra occurs after some time, and 
greatly impedes the discharge of urine. As a rule, operation in car- 
nivora for urethral calculus must be classed amongst the least thankful 
exercises of the healing art. 

Of cystic calculi in the dog the same may be said as of cystic calculi 
in ruminants and swine. In spite of an extended experience in canine 
practice, I have never yet found opportunity to carry out lithotomy in 
these animals, though I have repeatedly met with cystic caleuli in 
making post-mortem examination. 


III.—PUNGTURE OF THE BLADDER (PUNCTIO VESICA). 


Ger. Harnblasenstich. 


When the discharge of urime by the natural passage is hindered, 
the urinary bladder becomes enormously distended, and puncture by 
trochar is resorted to to prevent. rupture. The operation was first 
practised in man, and is still employed in dysuria, particularly 
when following enlargement of the prostate. The trochar used for 


PUNCTURE OF THE BLADDER. All 


the horse is an enlarged copy of that constructed for the above 
purpose by Flourant (fig. 96). Pilger described the operation more 
exactly, and later it was frequently employed in oxen which suffer from 
urethral calculi. Before attempting it, the diagnosis of over-distended 
bladder must be verified by rectal examination. In the horse the 
distended bladder extends downwards and forwards, that is, towards the 
abdominal cavity. In oxen and bulls the extension takes place more 
towards the sides. Even in the horse, however, the 
bladder does not reach the lower wall of the abdomen; 
this condition is only seen in swine and carnivora, in 
which the bladder, when filled, hes to a great extent 
in the abdominal cavity. It need scarcely be said 
that, before making the attempt, all simpler means, as, 
for instance, the use of the catheter, should have been 
tried. 

The bladder may be reached from different points if 
Flourant’s form of trochar, which is moderately bent 
(fig. 96), be employed. These different methods of 
puncture are distinguished. 

(1) The punctio vesicze suprapubica, which is now 
most generally used in man, is impracticable in herbi- 
vora, because in them the lower part of the bladder is 
not attached to the wall of the abdomen, and in the 
horse and ox the bladder would be only reached 
through the peritoneal cavity. In swine and dogs it 
ean, however, be approached from the lower abdominal 
wall, and this path is to be preferred because the more 
convenient method of operation through the rectum 
employed in larger animals is here attended with 
difficulty. Hering, who recommends this operation for 
dogs, places the animal on its side, and, after making 
an incision through the skin, passes a thin trochar 
into “the tensest portion of the swelling in the lower 
region of the flank.” In man the operation is done 
in the dorsal position and close to the linea alba, and 
the same procedure has been recommended in dogs. 
Hering states having completely cured a dog by his 
method, though he does not say what caused the difficulty in urination. 

(2) In large animals puncture is effected from the rectum (punctio 
rectalis). 

This is the easiest method and that usually followed when it is 
desired, as often happens in oxen, promptly to remove the danger of 
ruptured bladder, and it is intended to slaughter the animal in a short 


IDigeh BY — 
Flourant’s Trochar. 


328 PUNCTURE OF THE BLADDER. 


time. The canula, guided by the left hand and with the trochar 
drawn back (covered), is introduced into the rectum, and directed as 
nearly as possible perpendicularly to the surface of the bladder. It is 
well not to go much beyond the neck of the bladder, but rather to pierce 
it close behind the neck, so as to avoid opening the peritoneal sac. 

(3) Punctio perinealis deserves preference in large animals unless 
when destined for early slaughter. Inflammation of the urimary bladder 
is less likely than in punctio rectalis, where it readily occurs in con- 
sequence of infection from the rectum. The skin is incised close below 
the anus and somewhat to the side of the urethra, and efforts are made to 
penetrate thence as far as the neck of the bladder by working with the 
fingers, assisted when needful with knife and scissors. As soon as the 
distended urinary bladder is felt, a straight trochar with the point 
covered is introduced, placed on the bladder and the stilette pressed 
forwards. On withdrawal, urine is discharged through the canula, 
which is slowly thrust forward so as to follow the movement of the 
collapsing walls of the bladder. Should a single evacuation suftice, the 
trochar is at once removed; it is not necessary to suture the skin 
wound. Hering recommends, after making the cutaneous incision, to 
thrust the trochar directly forwards in the direction of the urethra, as 
far as the bladder, without dividing the connective tissue. When con- 
siderally distended, the bladder can scarcely be missed. 

Should the prostate or vesicule seminales be injured little harm 
results, especially in castrated animals, On the other side, however, 
there is no reason against providing, as far as possible, a safe passage 
for the trochar, saaells if antiseptic precautions be taken. If it is 
desired that the animal shall live for a considerable time after operation, 
this method certainly deserves preference, as, in the event of a repetition 
of the operation becoming necessary, it will be much easier. 

The canula may remain in position for one to two days; in oxen 
intended for slaughter this is to be recommended, and an additional 
advantage is that the trochar may here be more easily fixed in position 
than in fine rectal operation. 

In quiet animals the above operations may be performed standing, by 
extending the hind feet and applying a twitch. Rychner eeoneee 
the dorsal position, because it allows the bladder to be still more easily 
discovered from the rectum. It has already been remarked that where 
the bladder is much distended, casting must be effected cautiously. 


INJURIES TO THE URETHRA. 329 


IV.—INJURIES, INFLAMMATION AND STRICTURES OF THE 
URETHRA. 


Lit.: Adam, Ad. Wochenschr. 1877 u. 1888. Bluhm, Thierirzt]. Mitth. 
1877, p. 1389. Moussu, Jahresber. 1887, p. 17. Fuchs, Thierirztl. 
Mitth. 1891. 


Save by operation, the urethra is seldom wounded. Adam describes 
a case of injury in the horse by an iron hook. Healing was difficult. 
Fuchs saw a severe case in a horse that had fallen in front of a tramway 
ear. The urethra was almost completely torn out of the penis by a 
hook: a small portion remained hanging to the glans; the rest was only 
connected with the bladder. About 16 inches was cut away and the 
wound disinfected. Some hours later bleeding occurred from the 
corpus cavernosum, but was checked by ligature, and though severe 
swelling occurred it disappeared in eight days. Recovery was sufficiently 
advanced in four weeks for the horse to return to work. The urethra 
opened somewhat below the perineum. 

Inflammation of the urethra may be caused by foreign bodies 
entering it accidentally, or being introduced by way of treatment. 

Should foreign bodies lke awns of wheat (Bluhm) obtain access, the 
minute spines they possess cause them gradually to pass upwards and pro- 
duce injuries of the mucous membrane and inflammation. Specific con- 
ditions like gonorrhoea of man have not yet been recognised in animals, if 
we except dogs, which occasionally suffer from chronic purulent urethral 
eatarrh. Many cases are really only purulent preputial catarrh (p. 347). 

Stricture of the urethra is commonest after operations like urethro- 
tomy and amputation of the penis, but it may also result from 
accidental injury (Adam). 

Perforating wounds of the urethra are recognised by urine escaping 
through them during micturition. They are often associated with 
symptoms of infiltration of urine, such as inflammation, severe swelling, 
and a tendency to gangrene. Such a complication is most to be feared 
when the wound in the mucous membrane is greater than that in the 
skin, or when the latter is not divided at all as in bruises. 

Swelling of the mucous membrane of the urethra consequent on 
inflammation produces symptoms like those of urethral calculus (p. 314). 
In oxen the urethra is said to be sometimes ruptured by the passage of 
urethral calculi. 

Foreign bodies in the urethra produce a like train of symptoms. 
Bluhm describes the case of a horse which suffered from colic and 
retention of urine, and allowed the penis to protrude from the sheath. 


330 INJURIES OF THE URETHRA. 


Careful examination discovered in the urethra a head of straw 4 inches. 
in length with awns. 

Strictures are recognised by the gradually increasing difficulty im 
urination. The stream of urine gradually becomes smaller as time 
elapses, the act is more and more protracted; finally fluid can only 
be discharged in drops. Passage of the catheter reveals the position 
and extent of the stricture. The symptoms produced by urethral calculi 
generally appear suddenly (p. 320). 

Purulent catarrh of the urethral mucous membrane in dogs can be 
recognised by laying the animal on its back, drawing forward the penis. 
(p. 325), and passing a sound over it with moderate pressure from the 
corona glandis to the opening of the urethra, when, if urethritis exist, a 
purulent secretion will be discharged. 

Prognosis is very varied. In injuries, it depends on whether 
urination is impeded, and whether infiltration of urine exists or 1s to: 
be expected. Impeded urination may be due either to inflammatory 
swelling or stricture. The less the inflammation and infiltration of 
urine, the more favourable the prognosis. Injuries of the urethra in 
carnivora are grayer than in herbivora, because they readily lead to: 
gangrenous cellulitis (. 326). 

Intra-urethral injuries, caused by careless management of the catheter, 
are seldom dangerous, for the wound opens forwards and hence is not 
favourable to infiltration of urine. On the other hand, injuries by foreign 
bodies easily induce retention of urine and inflammation in the mucous 
membrane, with the formation of urethral calculi, because such bodies. 
carry with them organisms likely to determine decomposition of urine. 
‘Stricture is always grave, especially in horses, as it becomes aggravated 
with time; the greater the interference with urination, the greater the: 
danger. 

Treatment.—The chief indications are to prevent retention and 
infiltration of urine, and to assist union. The more regularly and 
rapidly healing proceeds, and the less cicatricial tissue produced, the- 
shehter the chance of cicatricial contraction and stricture formation. 
The wound is treated on general principles, and protected as far as. 
possible from discharge of urime. Clean-cut wounds of the mucous 
membrane may be brought together with catgut or silk, and in herbi- 
vora sometimes heal by first intention. In carnivora it is still more 
important to suture the mucous membrane, in order to prevent infiltra-- 
tion. For the same reason the skin wound is best left open. Under 
these circumstances healing by first intention occurs in exceptionally 
favourable cases. If not, the skin wound, when not already larger than. 
that in the mucous membrane, may be increased in size. In carnivora the 
injured spot should be washed every hour or two with an alkaline fluid, 


INJURIES OF THE URETHRA. Spill 


(5 per cent. carbonate of soda), or powdered with iodoform and bicar- 
bonate of soda (equal parts), and vegetable diet enforced until the wound 
is healed. The greatest care is necessary during the first few days ; 
after granulations have formed, infiltration of urine is less likely to 
occur. Injuries produced by the catheter must also receive close atten- 
tion. If during the first twenty-four hours great swelling and retention 
of urine result, urethrotomy or puncture of the bladder may become 
necessary to prevent rupture. Foreign bodies should be removed as 
soon as possible from the urethra, and the injury they may have caused 
treated according to existing circumstances. 

When urine has infiltrated the tissues, careful provision must be 
made for its exit, either by inserting setons, or, better still, drainage- 
tubes. Scarification may be of assistance. 

Though strictures of the urethra may be dilated by passing the catheter 
or a bougie, and urination thus assisted, the effect is seldom permanent, 
and the method not of practical value. Nor is urethrotomy much more 
reliable. In large animals it may temporarily relieve the difficulty, but 
new strictures soon form. Strictures near the free end of the urethra 
may sometimes be cured by freely laying them open. 

Urethral fistula is caused by an injury healing incompletely, and 
leaving a little opening in the wall of the urethra, through which urine 
is from time to time discharged. It may sometimes be closed by 
applying irritants or the actual cautery ; but often it gives much trouble 
to the practitioner, and ends by producing stricture of the urethra. 
Moussu saw such eases in dogs after injuries to the urethra. 


V.—PARALYSIS OF THE URINARY BLADDER (CYSTOPLEGIA). 
CATHETERISM. 


Lit.: Barts, Jahresber. 1887, p. 77. Grintzer, ibid., 1887, p. 77. 


Long-continued retention of urine, due sometimes to urethral caleulus, 
causes over-distension of the bladder, paralysis of the detrusor urine, 
and inability to eject the urine. 

Paralysis of the sphincter vesicte produces involuntary discharge of 
urine (enuresis, incontinentia urine). Not infrequently retention and 
involuntary discharge exist together, eg., im severe internal diseases, 
puerperal apoplexy, brain diseases, hemoglobinuria, &c. In diseases of 
the spinal cord, fractures of the dorsal and sacral vertebrie, paralysis of 
the bladder may occur, and is sometimes associated with paralysis of the 
tail and paraplegia. Calculi and gravel may also produce paralysis of 
the urinary bladder. 


aon PARALYSIS OF THE URINARY BLADDER. 


Symptoms.—When the detrusor is alone paralysed, the bladder 
eradually fills, and urine is discharged in small quantities (ischuria). If 
paralysis of the sphincter is also present, involuntary discharge occurs, 
the bladder overflows like an over-filled vessel, and the condition is 
described as ischuria paradoxa. The bladder can then be emptied by 
pressure from the rectum, or by contraction of the abdominal muscles, 
as happens during defecation, At each act a variable quantity of 
urine is discharged. When the sphincter is completely paralysed urine 
also flows away in an uninterrupted stream, even when the bladder is 
incompletely filled (enuresis); nevertheless, in male animals the bladder 
always fills to a certain extent. 

The prognosis depends on the active cause. In general it is the 
more unfavourable the longer the condition has existed without visible 
improvement. 

Treatment.—At first an attempt should be made to remove the 
cause. Strychnine, cantharides, &c., may be given internally; when, in 
consequence of paralysis of the detrusor, the bladder is greatly distended, 
it may be emptied by pressure through the rectum; or should this fail, 
by the catheter. 

The use of the catheter (catheterisation) calls for two precautions : 
the urethra must not be injured internally, nor must infectious or 
decomposing material be introduced into it. Failure to observe the 
latter precaution may result in decomposition of the urine, inflammation 
of the bladder (cystitis), or even often fatal pyelonephritis, on account of 
the inflammatory processes spreading as far as the pelvis of the kidney. 

In Germany elastic rubber tubes are generally employed, whose outer 
opening is somewhat dilated, whilst the opposite end possesses one or 
two lateral openings (eyes), by which the urine may enter the catheter. 
A suitable stilette serves to assist the introduction and cleansing of the 
instrument. 

In large male animals one large catheter generally suffices; in dogs, 
catheters of varying calibre must be kept. For mares and dogs a 
straight or slightly bent tube with a well-rounded end is used, though 
in case of need the index or middle finger may replace the catheter. 
The introduction of the catheter is seldom difficult in these animals, if it 
be borne in mind that the outer opening of the urethra lies on the lower 
wall of the vagina, over which the instrument is allowed to glide 
forwards until it enters the urethra. In stallions and geldings the 
operator stands at the side of the abdomen on the animal's left, and 
draws the penis forwards out of the sheath. In order to grasp it more 
firmly a cloth is passed round the penis, and the catheter is then intro- 
duced. The instrument must, however, have been previously carefully 
cleansed to prevent the introduction of organisms into the bladder, and, 


PARALYSIS OF THE URINARY BLADDER. 333 


to allow of its easy passage, the surface smeared with oil or water. 
This is absolutely necessary. In the anterior sections of the urethra 
the catheter glides easily forwards under slow, steady pressure. The first 
difficulty is on passing the bend of the urethra at the ischiatic notch. 
Here an assistant must direct the end of the catheter forwards towards 
the bladder by pressing on it, whilst the operator thrusts the instrument 
cautiously on, and gradually retracts the stilette. Violent movements 
at this time are lable to injure the urethra, and must be strictly avoided. 

Immediately the front end of the catheter has passed this point it 
again glides easily forwards, and finally attains the neck of the bladder, 
which seldom opposes any great resistance to its entrance. The stilette 
is then withdrawn and the urine allowed to escape. 

In bulls and oxen only the forward end of the urethra as far as the 
“S”-shaped curve can be catheterised, and even this seldom becomes 
necessary. The same is true of rams, though in them the entrance is 
rendered still more difficult by the free portion of the urethra. In case 
of need, the end may be cut off or the urethra incised behind this 
point (p. 525). 

Catheterisation is easiest in the dog. The animal is placed on a 
table in the dorsal position, with the left side towards the operator. 
The penis is then exposed by the method described on p. 325, and the 
catheter, previously carefully prepared, passed into the urethra. To 
prevent injuring the canal at its curve over the ischial arch, the in- 
strument is passed as far as this point, and the steel stilette then drawn 
back at the same rate as the catheter advances; when the bladder is 
reached, the stilette is removed entirely. 

By means of the catheter not only can decomposed urine, &c., be 
removed, but fluids may, if necessary, be introduced into the bladder and 
its mucous membrane directly treated. Baertz, in a case of strangury, 
injected infusion of belladonna with good results. Grintzer states having 
cured contraction of the neck of the bladder which impeded catheterisa- 
tion in a horse by clysters of chloral hydrate, renewed at intervals of a 
quarter of an hour. 


VI.—INFLAMMATION OF THE URINARY BLADDER 
(CYSTITIS). 


Lit.: Oeben, Thierirztl. Mitth. 1858, p. 171. Siedamgrotzky, Dresd. 
Ber. 1886, p. 23. Friedberger, Miinch. Ber. 1877/78, p. 110. 
Fiinfstiick, Dresd. Ber. 1869, p. 27. Roéder, ibid., 1891, p. 96. 

Inflammation of the mucous membrane of the urinary bladder 
usually results from decomposition of the urine (alkaline fermentation), 


334 INFLAMMATION OF THE URINARY BLADDER. 


and irritation produced by products of such decomposition ; or from 
mechanical lesions produced by hard bodies like cystic calculi. In 
females infectious processes, ¢.g., diphtheritic or septic inflammation of 
the uterus and vagina, extend to the bladder, especially soon after birth. 
Roder saw such a case in the cow. Finally, irritant substances, 
cantharides, oil of turpentine, and the like, may be excreted from the 
blood through the medium of the urine, which if long retained may 
cause inflammation of the cystic mucous membrane. Cystitis may 
perhaps be produced in this way during the course of infectious 
cliseases. 

Inflammation of the outer surface of the bladder, that is, of the 
serosa covering it (pericystitis), occurs as a diffuse peritonitis after 
castration and similar causes. It may, however, appear locally in con- 
sequence of chronic inflammation spreading from the uterus, rectum, or 
spermatic cord. 

In a horse deseribed by Oeben, which had suffered for four days from 
colic, and had died after passing large quantities of feeces and exhibiting 
continuous straining, the wall of the urinary bladder was found to be nearly 
2 inches thick, the walls of the rectum and of the ilac arteries were as 
thick as a man’s finger, but showing no diminution of their lumen; pro- 
bably the inflammatory process had started from the rectum. 

Siedamegrotzky was able, by washing out the bladder, to remove a 
ereat quantity of sediment from a horse which had suffered from 
enuresis paralytica, and which, though continually straining to pass 
urine, could only eject small quantities in jerks, whilst at other times 
discharge occurred involuntarily. The horse, however, died, and on post- 
mortem was found to have suffered from purulent diphtheritic cystitis, 
pyelonephritis, and peritonitis. Friedberger reports a case of chronic 
hemorrhagic purulent cystitis in the horse, caused by cystic calculus. 
Catarrhal diseases of the cystic mucous membrane may probably also be 
produced by chills. 

Symptoms.—Repeated attempts to discharge urine and the passage 
of small quantities, sometimes pathologically altered, point to the 
presence of the disease. The animals often stretch out and draw the 
testicles upwards ; male animals may exhibit erections, and females con- 
traction of the vagina. Pressure through the rectum on the almost 
empty bladder causes acute pain. Carnivora exhibit pain on pressure 
over the posterior portions of the abdomen, and often seem to suffer from 
slight colic. The urine discharged is turbid, and shows on microscopical 
examination much cystic epithelium, blood, pus corpuscles, flakes of 
mucous membrane, and not infrequently crystals of triple phosphate in 
the well known coffin-lid shaped form. In carnivora the urine gives an 
alkaline reaction. 


INFLAMMATION OF THE URINARY BLADDER. DOD 


Pus in any considerable quantity produces a yellow sediment, whilst 
in diphtheria of the bladder croupous membranes are discharged with 
the urine. Infectious disease of the bladder is usually associated with 
fever, the intensity of which indicates the nature and significance of 
the disease. Cystic calculi are often indicated by discharges of blood, 
especially after work (p. 315). 

Chronic pericystitis seldom produces marked symptoms, but leads to 
eradual thickening of the bladder wall; and post-mortem shows a con- 
dition greatly resembling those hypertrophic processes resulting from 
long-standing obstruction to urination (dysuria), which are associated 
with abnormal distension of the bladder itself. Fiinfstiick, when making 
the post-mortem of a goat, found the bladder of enormous size and con- 
taining 52 pints of fluid. The cowrse of this disease varies; for whilst 
purulent diphtheritic cystitis, either directly or in consequence of com- 
plication with pyelonephritis, soon proves fatal, pericystitis and chronic 
inflammation, caused by cystic calculi or sediments, may endure inde- 
finitely if the cause of the disease be not removed. 

Prognosis, and indeed treatment, therefore depend on the indica- 
tions furnished by a careful examination of the urine, which must 
be considered in conjunction with the symptoms. It should be remem- 
bered that many of these diseases have a great tendency to recur. 

Treatment.—Some benefit results from the administration of 
medicines which, excreted with the urine, exert a curative effect on 
the cystic mucous membrane, but direct treatment is always more 
effectual. Borie acid, salicylic acid, biborate of soda, chloride of 
potash, tannin (which is excreted as pyrogallic acid), and other 
materials have been used, and may prove of service in simple catarrhal 
inflammation. 

But immediately putrefactive changes, especially alkaline fermenta- 
tion of the urine, appear, local treatment must be resorted to. The 

ladder should be washed out by means of the catheter—in mares and 
cows through a rubber tube,—either with salicylic acid (concentrated 
watery solution), carbolic acid (0°5 per cent.), sublimate (0°5 per 1000), 
boric acid (2 per cent.), creolin (1 to 3 per cent.), nitrate of silver (0°5 
to 1 per cent.), or tannin (1 to 2 per cent.), at least once a day. The 
chief difficulty is, that in male animals the treatment can only be carried 
out by experts. The lotions should, of course, be warmed to body 
temperature. Concretions and sediments are removed by vigorously 
washing out the bladder, or by surgical operation. Chronic cystitis in 
man has lately been treated with salol, which renders the alkaline urine 
once more acid, clear, and free of offensive smell. It is well borne 
by the stomach, and is decomposed by the pancreatic juice in the small 
intestines into salicylic acid and phenol. 


336 PROLAPSE AND INVERSION OF THE URINARY BLADDER. 


VII.—PROLAPSE AND INVERSION OF THE URINARY BLADDER 
IN FEMALE ANIMALS (PROLAPSUS ET INVERSIO VESICA). 


Lit.: Charlot, Gurlt path. Anatom., p. 211. Criiger, Gurlt u. Hertwig. 
14, p.78. Linnecker, ibid., 31, p.16. Hurzawa, Thierarztl. Mitth. 
1874, p. 145. Leistikow, Jahrb. 1887, p.77. Riviére, Her. Rep. 
28, p. 329. Mann, Thierdrztl. Mitth. 1859, p. 161. Holgen, Her. 
Operationslehre. III. Aufl, p. 291. Degive, Her. Rep. 39, p. 177. 
Gaullet, Gurlt. path. Anatom., p. 211. Rauscher, Her. Rep. 47, 


p. 9. 


In cows and sows, infrequently in bitches, the lower wall of the 
vagina is ruptured during delivery, the urinary bladder passes through 
the opening, and may even project beyond the vulva (prolapsus vesice). 
The condition is distinguished by the prolapsed viscus being covered 
with serosa. Gradually it becomes distended, and assumes an almost 
spherical form; small quantities of urine are discharged on pressure. 
By introducing the hand or finger into the vagina close to the prolapsed 
portion, the rupture in the lower wall can be felt. 

Diagnosis of prolapse is seldom difficult ; but as the condition occurs 
during parturition, the swelling might possibly be mistaken for the pre- 
senting foetal envelopes, and grave results ensue if perforated under this 
erroneous idea (Charlot). 

Inversion of the urinary bladder is a condition in which the bladder 
is turned inside out, passing through the urethra something like a 
reversed pocket ; the disease has up to the present almost always been 
observed in mares during or soon after parturition, Griiger saw it ina 
mare which had shortly before aborted, and suffered rupture of the 
perineum. Loénnecker noted inversion in mares both during pregnancy 
and after parturition. Esser (verbal communication) diagnosed the 
condition in sows, also after parturition. It therefore seems that about 
this time the urethra is abnormally dilated, a condition necessarily 
antecedent to inversion of the bladder. Mann saw a mare in which 
the disease did not occur until three weeks after parturition. Rauscher 
speaks of a two-and-a-half-year-old filly which suffered from inversion. 
Forcible dilatation of the urethra in mares, practised for the removal of 
cystic calculi, may occasion the disease if the constrictors of the abdomen 
contract powerfully. In geldings I have repeatedly dilated the neck of 
the bladder sutficiently to admit the whole hand for the purpose of 
removing cystic calculi, but in spite of this have never noticed the 
condition. 

Inversion of the bladder is distinguished by the presence of a spheri- 
eal swelling, either in the vagina or protruding beyond the vulva (fig. 97). 


» 


PROLAPSE AND INVERSION OF THE URINARY BLADDER. 307 


The swelling appears elastic, is covered by the mucous membrane of the 
bladder, and two folds appear in it, the orifices of the ureters. By lift- 
ing up the swelling, or pressing on it, or by movement on the part of 
the animal, urine is discharged in two streams (fig. 97). 

The mucous membrane gradually dries by continuous exposure to the 
air, is soiled by dirt and dust, and may finally become necrotic. When 
the condition has existed for a long time stenosis of the urethra may 
lead to strangulation of the bladder, which is shown by severe con- 
gestion, and sometimes ends in rupture. Injury to its walls causes the 
swelling to subside. 

Prognosis.—Prolapsus vesice is evidently graver than inversion, as 
the peritoneal cavity is opened and peritonitis is hable to occur, a danger 


Fic. 97.—Prolapse of the bladder in a mare. 


which is absent in inversion. Reposition is only possible in recent 
prolapse, where the serosa of the bladder has undergone no considerable 
change. Otherwise septic peritonitis occurs, and invariably proves fatal. 
The prognosis is more favourable in inversio vesice ; the mucous mem- 
brane of the bladder possesses greater resistance, and even when, after 
successful reposition, irritation is marked, a cure need not be despaired 
of. The animal’s progress depends principally on the condition of the 
y 


338 PROLAPSE AND INVERSION OF THE URINARY BLADDER. 


mucous membrane and on the calibre of the urethra. As long as these 
allow of reposition, the operation must be attempted, as, in the event of 
its failing nothing remains but amputation of the bladder. In distinguish- 
ing the inverted bladder from foetal membranes, the directions given under 
“ Prolapse of the Bladder” must be borne in mind. Failure to distin- 
euish inversion of the bladder from fcetal membranes has sometimes 
led to awkward consequences both for patient and operator. 

Treatment.—Provided the serous coat of the prolapsed bladder is 
little changed, it should be carefully cleansed with disinfectants and 
attempts made to replace the viscus. At the same time the wound in 
the vagina must receive attention. Unless the animal strain much, a 
repetition of the prolapse need scarcely be feared, and can be provided 
against by injecting lukewarm fluid into the replaced bladder. Riviere 
diagnosed prolapse of the bladder in a cow soon after birth. The 
rupture in the vagina was 3, inches in length. After discharge of the 
contents, the bladder was replaced by using a piece of hollow elder stick, 
and though severe straining ensued, the condition did not recur. Recovery 
was complete. When the rupture in the lower wall of the vagina hes 
not far from the vulva an attempt might be made -to suture it, to pre- 
vent recurrence and to guard against the passage of urine into the 
abdominal cavity. 

In inversion of the bladder, also, the first point is to effect reposition 
before the mucous membrane is much altered. After emptying the 
bladder by pressure and cleaning the prolapsed part, the animal is 
placed with the hind-quarters high and a twitch applied. The urethra 
is sometimes so wide that the displaced bladder can be passed through 
it with the hand (Mann, Lonnecker, Hurzawa), but should it prove too 
narrow, a blunt stick, well rounded off at one end to prevent injury to 
the bladder, may be employed. Lonnecker employs a probang for this 
purpose. The hand or stick is placed on the base of the bladder and 
the latter thrust through the urethra. One proceeds here in the reverse 
order to that observed in replacing a prolapse. By injecting a lukewarm 
fluid like diluted alum lotion (1 to 5 per cent.) or tannin (1 to 2 
per cent.), recurrence may be prevented and inflammatory reaction 
checked; such solutions also favour contraction of the urethra. By slow 
exercise, pressure on the loins, or by watching the animal, the straining 
and consequent eversion may be obviated. 

Lonnecker replaced an inversion, but as it reappeared five days later 
he sewed up the orifice of the urethra, grasping and raising the mucous 
membrane with the left hand, and passing a lead wire through it, after 
which recovery took place. Holgen successfully effected reposition five 
weeks after the first appearance; probably the bladder was not continu- 
ously exposed. The same applies to the case related by Degive, in 


AMPUTATION OF THE BLADDER. 339 


which reposition or reversion was successful fourteen days after the 
viscus first protruded. 

As-a rule, however, the surface of the mucous membrane is so much 
injured during prolonged exposure as to become necrotic, in which case 
reposition is contra-indicated, and amputation of the bladder offers the 
only chance of recovery. Though this certainly deprives the animal of the 
natural reservoir for the urine, which, therefore, flows continuously or is 
discharged in small quantities from the vagina, yet as it does not render 
ordinary working-horses and cows useless its employment is sometimes 
justified. 

Amputation of the bladder is generally effected by ligation, best by 
using the elastic ligature. As the ligature tends to slide forwards off 
the spherical swelling and over the orifice of the ureters, two different 
methods of operation have been suggested. Some recommend transfixing 
the bladder and ligaturing on both sides, that is, applying two ligatures ; 
in this case the peritoneal sac is opened and the danger of peritonitis 
increased. Others prefer the simple lature, transfixing the bladder 
with a metal needle in front so as to secure the ligature in position. 
Bang passes a second ligature in front of and at right angles to the first, 
and after cutting away the bladder carrying the ligatures backwards and 
tying them in the form of a cross. The same result is more simply 
attained, without transfixing the bladder, by laying a tape with its two 
ends above and below the neck of the bladder, the rest of the tape 
extending over the bladder in the middle line; the ligature is then 
applied, embracing the tape, and the two free ends are carried backwards 
and tied at the back of the swelling. If the bladder be not immediately 
cut off after ligation, it sloughs away in some days, though, unless elastic 
ligatures are used, it is necessary to tighten the ligatures a few times 
during the next few days; the elastic ligature is, however, much prefer- 
able. When adhesions have already occurred between the layers of 
peritoneum covering the bladder, it may be simply cut away, as 
was done by Gaullet in the case of a mare. The bleeding was insig- 
nificant and recovery soon occurred. As, however, it is never certain 
that the adhesions are firm, the ligature deserves preference. The 
portion of bladder not included in the lgature gradually retracts into 
the vagina after the free portion has sloughed, and the external appear- 
ance of the animal is not much injured. 


340 TUMOURS IN THE URETHRA AND BLADDER. 


VIII.—TUMOURS IN THE URETHRA AND BLADDER. 


Lit.: Matthias, Thierarztl. Mitth. 1875, p.147. Vorberg, ibid., 1858, p. 
140. Pflug, Krankh. der. uropoet. Organ, p. 266. Siedamgrotzky, 
Dresd. Ber. 1877, p. 42. Stolz, Jahresber. 1886, p. 123. Esser, 
Thierarztl. Mitth. 1875, p. 170. Wulff, ibid, p. 171. Leisering, 
Dresd. Ber. 1863, p. 30. Gurlt, Path. Anat, p. 116. Schmid, 
Miinch. Ber. 1862. Mogford, The Veterinar. 1843. Schmid, Jahrb. 
1862, p. 57. Heyne, B. LT. W. 1890, p. 396. Barnick; Zeisenr 
f. Veter. 1890, p. 322. Van Tright, Jahrb, 1885, p. 105. Demeur- 
isse, Rec. de Méd. vétér. 1892. Levens, B. T. W. 1893, p. 1138. 


New growths in the urethra soon impede urination; hence the 
animals are either slaughtered or die of the condition, and opportunities 
of noting or treating tumour of the urethra during life are rare. 
Matthias, however, found a polypus of the urethra in a_ gelding. 
Vorberg, 10-12 polyp-like new growths in an ox; they were 14 
to 14 inches in length, and closely packed together at one spot. 
The polypus noted by Matthias was 6 inches long, 15 broad, and had 
its seat not far from the orifice of the urethra, so that it could be 
grasped with dressing forceps and removed. 

New growths in the bladder are more frequent; they may either be 
innocent, like fibromata, hpomamata, mixomata, or malignant (cancer). 

The collection in Copenhagen contains the bladder of a cow with 
fibrous cancer (Bang). Pflug has seen carcinoma of the bladder in a 
horse. Siedamgrotzky described epithelioma of the bladder in the 
horse; the disease had extended to the peritoneum and caused secondary 
erowths in the omentum. He also found in oxen leucocythemic infiltra- 
tion of the wall of the bladder, the uterus, and the ligaments of the 
uterus. Esser was able to diagnose by manual examination from 
the rectum during life a large papilloma in the bladder of a cow. 
Wolff and Leisering discovered myxomata in the same region. Cows 
appear to suffer from new growths in the bladder oftener than horses, 
not infrequently from carcinomata, probably tuberculous growths also 
occur; tuberculous tumours are common near the openings of the 
ureters in the Trigonum Lieutaudii. Barnick discovered a tumour 
twice as large as a man’s head in the bladder of a horse which had died 
with symptoms of difficulty in urination and colic. Tright found a 
myoxma of the bladder in a dog. 

Demeurisse diagnosed cancer of the bladder in a bitch suffering from 
cancer of the mamma; the growth could be recognised as a painful 
swelling on examination per anum. ‘The animal showed progressive 
emaciation and died in a short time; on post-mortem a perforation was 
found in the upper wall of the bladder, through which urine had flowed 


TUMOURS IN THE URETHRA AND BLADDER. 341 


into the abdominal cavity. Near the neck of the bladder lay a 
carcinoma which had prevented the passage of urine. 

Symptoms.—Tumours in the urethra are recognised, like strictures, 
by their gradually causing increased difficulty in urination. During the 
act the stream of urine becomes smaller and smaller, until finally drops 
alone are passed. Displacement of the tumour, slight swelling of the 
mucous membrane, or the formation of a blood clot may tend to the 
sudden development of symptoms. On passing the catheter the obstruc- 
tion is found to be more or less soft, which differentiates a tumour from 
a urinary calculus. 

The growth of tumours in the bladder gradually diminishes its 
capacity and causes urine to be passed more frequently. New 
growths sometimes cause profuse bleeding; the urine takes on a bloody 
character, usually blood clots of various sizes are discharged; dysuria 
may also occur, especially if the tumour lie near the neck of the 
bladder. Purulent inflammation in some cases accompanies new 
growths; the urine appears turbid, and on standing deposits a sediment. 
The presence of tumours in the bladder is often signalised by the 
deposit of salts and the formation of precipitates, hence microscopical 
and chemical examination may be necessary to discover the origin of 
turbidity. These symptoms having suggested tumour formation, the 
diagnosis can be verified by examination per rectum or per vaginam. 
As soon as the new growth attains a considerable size, and only then, 
does it give rise to disturbance; a soft mass may be felt in the bladder, 
just as a hard mass may be felt when a calculus is present. In mares 
and cows the swelling may sometimes be felt from the urethra. 

Inflammatory swellings of the mucous membrane of the urethra and 
calculi may sometimes be mistaken for tumours. 

The prognosis is usually unfavourable. Only when the new growth 
is near the exit of the urethra and can be removed is prognosis hopeful. 
Though tumours in other parts of the urethra may occasionally be 
removed by performing urethrotomy, yet their position can so seldom be 
exactly determined and their presence recognised as to justify operation, 
especially as more or less serious consequences always ensue. Removal 
of tumours from the bladder is likewise very difficult, and this of itself 
sufficiently explains the unfavourable character of the prognosis. 

Treatment.—Pedunculated tumours near the free end of the urethra 
may be torn away with dissecting or dressing forceps. Where in male 
animals the growth cannot be grasped, the lower wall of the urethra is 
laid open. ‘The position of the tumour and the practicability of opera- 
tion having been ascertained, removal may sometimes be effected by 
opening the urethra. Urethrotomy may be resorted to as a palliative 
when animals have to be kept alive for some time to gain condition or 


342 TUMOURS IN THE URETHRA AND BLADDER. 


require to be sent on a journey. Cystic tumours are seldom removed, 
being generally recognised too late, and success appearing doubtful. 
Schmidt and Moeford have, however, recommended everting the bladder 
in mares to remove tumours. Schmidt states having carried this out in 
the horse, and having removed a tumour weighing 40 ounces. Mogford 
declares eversion of the bladder to be easy in horses. After removing 
the tumour the bladder is washed out, and the concretions which often 
occur here removed. Moeford, however, does not give any satisfactory 
description of his method. 

Nevertheless, both in mares and cows, it is worth trying, to dilate the 
urethra (p. 518), so as to be able to enter the bladder with polypus. 
forceps or the hand. Though the method is certainly not easy there 
seems no doubt that where it succeeds tumours may be removed and 
recovery effected. Levens thus removed a fibroma as large as a goose’s 
egg, which lay at the neck of the bladder in a cow. Eversion of the 
bladder would probably often follow dilatation of the urethra if the 
animal were not chloroformed. Anesthesia is, therefore, advisable in 
horses, and even in oxen, especially if not intended for immediate 
slaughter. Schmidt removed a cystic polypus from a gelding by per- 
forming urethrotomy at the sciatic notch, and breaking down intervening 
tissues as far as the neck of the bladder; he was then able to excise 
and extract the pedunculated tumour; the operation wound healed in 
eighteen days. Heyne describes a case of fistula between the small 
intestine and bladder, a rather rare condition. The small intestine was 
adherent to the base of the bladder, with which it communicated by an 
opening 3 to 1 inch in width. The animal had suffered from weakness, 
defective appetite, diarrhoea, and great emaciation. 


VII. DISEASES OF THE MALE ORGANS OF 
GENERATION. 


I—INFLAMMATION OF THE PREPUCE (BALANITIS). 


Lites, beaer, Han. Ber L871, p. 126. 


THE prepuce, consisting of a duplicature of the skin, is hable to 
inflammatory changes, which present very notable differences in appear- 
ance, course, and results, in the various classes of animals. 


(1.) INFLAMMATION OF THE PREPUCE IN THE 
HORSE. 


In the horse the covering of the penis is peculiar in that it consists of a double 
involution of the skin, that is, it is formed of an inner fold (prepuce in the 
narrow sense of the word) and of an outer, the so-called sheath. The visceral 
portion of the first covers the end of the penis, clothing it closely, and lying, 
when the penis is not erected, in folds, but these disappear on erection. The 
outer fold forms a swelling as thick as the finger, attached to the under surface 
of the member by the inner fold of the sheath ; the latter presents a second con- 
siderably thicker covering, which is reflected backwards at the entrance to the 
sheath, to become continuous with the skin of the scrotum. The inner lining of 
the sheath and the outer fold of the prepuce are provided with numerous sebaceous 
and sweat glands, the secretions of which together with the loosened masses of 
epidermis, form a blackish-grey fat-like material (smegma preputii). 


In horses inflammation of the prepuce is not infrequently produced 
by the animals failing to extend the penis during urination, and passing 
the urine into the prepuce. This produces continuous irritation, 
thickening and subsequent contraction of the folds of skin, and finally 
stenosis of the outer folds of the sheath, which renders it impossible for 
the animal to expose the penis (phimosis). As in this condition more 
smegna always accumulates, the escape of urine may finally be seriously 
interfered with. Sometimes a large quantity of the material accumu- 
lates around the corona glandis, exerts pressure on the urethra, and 
renders urination difficult. Esser saw a case of the kind in a gelding. 


344 INFLAMMATION OF THE PREPUCE IN THE HORSE. 


Colic, distension of the bladder, and ineffectual straining to pass urine 
set in; sometimes urine is only discharged in drops. As a rule, 
geldings alone suffer from this condition. 

Local examination discovers contraction of the opening of the 
sheath and accumulation of preputial smegma. 

The condition may be cured by early treatment, put if delayed the 
animals either die from rupture of the bladder consequent on inability 
to pass urine or from exhaustion. 

In many districts horses suffering from colie or difficulty im urination 
are treated by rubbing the penis and sheath with irritant substances 
like pepper, which afterwards produce extensive painful swelling of 
the penis and sheath, exudation from the surface, and finally ulcer- 
ation. If applied freely and energetically they may even cause 
necrosis of the skin; the penis then protrudes from the sheath in a 
more or less swollen condition, while the preputial fold may be as large 
as a goose’s egg. ‘The inflamed parts are doughy, painful, of increased 
temperature; and if the penis itself, or the prepuce covering it, is 
greatly swollen, the pressure on the urethra may interfere with 
urination. Inquiry generally reveals the nature of the substance 
employed. 

The inflammatory symptoms generally disappear without having 
caused permanent damage, though the sequel depends largely on their 
degree and extent. Provided urination is unimpeded, no very bad 
results need be apprehended, but when paraphimosis sets in, as is some- 
times the case, treatment becomes difficult. 

Treatment consists in cleansing the prepuce, particularly the 
corona glandis, so as to allow free exit for urine. Injections of luke- 
warm soap and water assist the removal of smegma. As a rule, 
this causes temporary improvement, and if the sheath be regularly 
cleansed the case usually does well. When symptoms of violent 
inflammation are already present, the injections should consist of 
mucilaginous materials, oil, or astringents hike alum; while to combat 
excessive swelling of the sheath a suspensory bandage may become 
necessary (p. 350). 

Inflammation of the prepuce and penis produced by irritants like 
pepper calls for careful cleansing of the parts and bathing with 
astringents such as the above mentioned alum lotion. Excoriated 
parts may be covered with a non-irritant fat, with zinc or lead ointment, 
or powdered with iodoform, tannin, lycopodium, or similar materials. 
To assist resorption and removal of swelling, a suspensory bandage may 
be applied, and the animal placed in a clean dry stall. 

Where the opening in the sheath is much diminished in ealibre, it 
may require to be laid open, which in quiet animals can be done stand- 


INFLAMMATION OF THE PREPUCE IN OXEN. 345 


ing. To prevent the edges of the wound reuniting, they can be held 
open by sewing them to the neighbouring skin, an operation which is 
not difficult if the sheath be divided on its under surface. 

Hering divided the cutaneous portions of the prepuce in a stallion 
which had difficulty in erection ; four months later he completely excised 
them; but as the prepuce contracted and caused the penis when in a 
state of erection to be directed backwards the animal had difficulty in 
covering, which was only removed by once more dividing the cicatrices 
and preventing reunion. 


(2.) INFLAMMATION OF THE PREPUCE IN OXEN. 


Ger. Raumschlauch, Nabelgeschwulst. 


Lit.: Lanotte, Gurlt u. Hertwig. 7, p. 32. Gurlt, ibid., 22, p. 326. 
Pflug, Die Krankheiten der uropoet. Organe. p. 550. 


The prepuce of the ox, formed by a simple infolding of the skin, presents a 
long narrow sheath, the entrance to which is small, and is provided with a bunch 
of long strong hairs. The inner fold consists of mucous membrane, presenting 
some resemblance to the cutis, and displaying numerous follicles and papilli. It 
lies in longitudinal folds, The prepuce is moved by two muscles, so as to render 
the act of urination easier. 


The chief sufferers from inflammation of the prepuce are oxen, bulls 
are very seldom affected. Oxen do not usually extend the penis during 
urination, especially if the opening of the prepuce has already become 
painful and constricted on account of inflammation. The smegma, 
usually decomposed and soaked in urine, accumulates in increasing quan- 
tities under the prepuce, until finally it impedes urination. Accidental 
injuries to the sheath may also prevent protrusion of the penis, and give 
rise to this disease. Gurlt found a head of wheat in the inflamed sheath. 
An abnormally irritant condition of the urine has also been regarded as 
a cause. 

Symptoms and Course.—A longish swelling, which is hot and 
painful, first appears at the front of the sheath, and may extend as 
far as the scrotum. Urination is difficult, and the urine is passed in 
drops or in a fine stream. The prepuce cannot be drawn back over the 
penis; phimosis exists. In the prepuce a grey-black smegma is found, 
the removal of which gives pain. The bladder, when examined per 
anum, is found greatly distended and painful on pressure. Colic soon 
sets in. The animals stop feeding, may show fever, and if help be not 
soon afforded may die. 

The risks are numerous. There is, firstly, the chance of necrosis of the 


346 INFLAMMATION OF THE PREPUCE IN OXEN. 


prepuce and penis; sloughing of large portions of the penis has often 
been observed. Then there is the danger of infiltration of urine into 
the subcutaneous tissues, causing septic cellulitis, gangrene, and severe 
general disturbance from absorption of inflammatory and septic pro- 
ducts. Finally, rupture of the bladder may be threatened.. The con- 
dition is, therefore, in no way trivial, and imperatively calls for early 
treatment. 

Treatment consists in cleansing and making patent the orifice of the 
prepuce to allow of urine escaping; if the entrance is too much swollen 
and no urine is passed, the prepuce must be laid open. As the animal 
strikes out furiously when the penis is handled, it should be placed in 
stocks, or some restraint apphed. If stocks are unavailable, restive 
animals may be placed against the wall and held in this position by 
several strong men (Hsser); Pflug recommends casting such animals. On 
account of the great pain, it is often impossible to free the entrance to 
the sheath in the standing position. The bunch of hairs must first be 
cut away, and lukewarm oil injected into the prepuce, whilst its outer 
surface is rubbed with the same material. If urination is moderately 
free, the animal may then be allowed to rise, and the task of emptying 
the prepuce left until next day (Pflug). To facilitate this, Pflug first 
injects lukewarm water, solution of acetate of lead or Goulard’s solution. 
Others recommend a milky solution of chloride of lime. Permanganate 
of potash (8-5 per cent.), sulphate of zinc, tannic acid (3—5 per cent.), are 
also useful. The points to be kept in view are to cleanse the sheath as 
completely as possible, to remove decomposing material, or destroy its 
injurious properties by disinfectants, and to combat the inflammation. 
Bathing the sheath, or frequently washing its surface with lukewarm 
water, is therefore first indicated. Necrotic parts should be removed, or 
their separation assisted by bathing with lukewarm aromatic fluids, or 
frequently washing them with warm carbolic lotion. 

In most cases it is necessary to lay open the prepuce (Hsser). A 
strong probe-pointed tenotome is introduced, and the cut made either 
downwards or to one side. Pflug prefers .the latter direction on account 
of the parts not being so easily moistened by urine, which is likely to 
produce fresh strictures. 

When the subcutaneous tissue about the sheath is infiltrated with 
urine, incisions are made, the parts pressed to remove the contents, and 
the skin and wounds frequently cleansed. 


(3.) INFLAMMATION OF THE PREPUCE IN SWINE. 


The prepuce of the boar consists of an inversion of the skin, but the 
inner surface is formed of mucous membrane containing numerous lymph 


INFLAMMATION OF THE PREPUCE IN SWINE AND IN CARNIVORA. 347 


follicles. On the upper wall of the sheath, and close in front of its 
opening, is the “umbilical pouch ” (nabelbeutel) formed by folding of 
the mucous membrane; when distended it often attains the size of a 
hen’s ege. It is lined by squamous epithelium, and contains numerous 
sebaceous and sudoriferous glands, hence smegma not infrequently 
accumulates at this point, and, becoming inspissated, may produce “ pre- 
putial calcul.” 

In swine, as in the ox, only the castrated animal seems to suffer 
from inflammation of the prepuce; the causes are similar to those in 
the oxen. They consist: in accumulation of smegma in the prepuce, 
or in the above-mentioned appendix; if swine were not slaughtered so 
early in life, the condition would probably be seen more frequently. 

Symptoms.—The prepuce is swollen, painful, hot, its orifice con- 
tracted, and not infrequently there is difficulty in urination. <A_ stink- 
ing sebaceous material escapes on pressure. This material sometimes 
stops up the prepuce, and fills the umbilical pouch, causing it to protrude 
as a round swelling above the end of the penis. 

Treatment is on the same principles as in cattle, and consists in 
evacuation of the sheath and pouch, cleansing and disinfection as far as 
possible. The same materials may be employed as in oxen; sometimes 
it is necessary to lay open the sheath. 


(4.) INFLAMMATION OF THE PREPUCE IN CARNIVORA 


Presents somewhat different features to the same condition in other 
animals. Apart from accidental injuries, preputial inflammation is rare 
in these animals, but dogs suffer frequently from chronic catarrh of the 
inner surface of the prepuce; indeed, most suffer from it to a limited 
extent. 

Symptoms.—tThe hairs clustered round the opening of the sheath 
appear gummed together, and a purulent material discharges from the 
prepuce. Animals are inclined to lick the affected parts, but apart from 
this there is little disturbance, and no difficulty exists in urination. 
Neither the mucous membrane of the prepuce nor of the glans is much 
altered, and the disease seldom requires treatment except in house-dogs. 
The causes are unknown. The popular idea that the disease is related 
to similar affections in man appears unfounded. 

Treatment demands a good deal of patience. Injections of astrin- 
gents (sulphate or sulphocarbolate of zinc, 1-2 per cent.; tannic acid, 
3—5 per cent.) diminish the secretion, which, however, returns as soon 
as the treatment ceases. Even painting the inner surface of the prepuce 
with 1-5 per cent. nitrate of silver solution is seldom of permanent 


348 PARALYSIS AND INJURIES OF THE PENIS. 


benefit. The owner or attendant may be entrusted with the application 
of the solution, and instructed to use it three or four times a week. 


Il.—PHIMOSIS, PARAPHIMOSIS PARALYSIS OF THE 
MUSCLES OF THE PENIS, INJURIES TO THE PENIS. 


Lit.: Cagni, Jahrb. 1885, p. 92. Haubner, Dresd. Ber. 1863, p. 48. 
Haase, B.T. W. 1890, p. 285. Bang, Stockfleth Chirurgie. Kirillow, 
Jahrb. 1885, p. 98. Rédiger, Th. Mitth. 1881, p. 69. Grinzer, 
Jahrb. 1887, p. 28. Gallimore, Her. Operationslehre, III. Aufl. p. 276. 
Lambert, Th. Mitth. 1871, p. 158. Kober, Her. Rep. 39, p, 286: 
Miller, The Journ. of comp. Pathol., 1892. Haase, B. T. W. 1890. 


Phimosis consists in an abnormally narrow condition of the preputial 
opening preventing exposure of the glans. This contraction may finally 
cause difficulty in urination, or render it impossible. Phimosis seldom 
occurs congenitally in animals, but is produced by inflammatory swelling 
of the prepuce or cicatricial contraction (compare with p. 343 et seq.). 
Under certain circumstances, it may form the primary disease, 
and lead to retention and inspissation of smegma with formation of 
so-called preputial caleuli. Miller saw phimosis in a bull with 
adhesion between the penis and prepuce, caused by a layer of strong 
connective tissue. After dividing the adhesion, the bull was incapable 
of coitus. 

Paraphimosis is a condition in which the glans cannot be retracted 
into the prepuce, either because the opening is too narrow or the 
glans too large. The peculiar formation of the penis and prepuce 
in the dog explains why it is so frequent a sufferer. In horses the outer 
fold of the sheath presents a wide opening through which the penis is 
easily retracted, though, when the preputial folds are greatly swollen, | 
its return is sometimes impossible,—a condition which has been 
described indifferently as paraphimosis or paralysis of the penis. 
Whether simple paralysis of the muscles concerned in withdrawing the 
penis into the prepuce ever occurs is doubtful. In such case the 
retractor penis, which derives its motor filaments from the 4th and 5th 
lumbar nerves and from the N. hemorrhoidalis posterior, would probably 
be affected. In disease of the spinal cord, we certainly sometimes see 
paralysis of the muscle in question. 

Ruminants and swine very seldom suffer from paraphimosis, because 
in oxen the glans is very small, and in sheep and swine is altogether 
wanting. 


PARALYSIS AND INJURIES OF THE PENIS. 349 


In dogs the condition is favoured by the presence of long hairs 
around the prepuce, and it is often seen after coitus. Should the hairs 
become adherent to the penis during erection, their ends are apt to be 
afterwards drawn back into the prepuce. The edge of the latter is 
rolled round its outer surface, is turned inwards, and the further return 
of the penis prevented. The glans then begins to swell, which of 
course aggravates matters. Swelling of the glans from inflammation or 
new growths may also produce the condition. Bang found a ribbon 
twisted round the penis of a dog; the parts were much swollen. 

The glans is exposed and shows more or less cedematous swelling ; 
its surface is shining, bright red, sometimes of a darker tint, often 
covered with dirt and dust, and not infrequently dry. The prepuce is 
tightly applied behind the swollen glans, strangulating it. When the 
disease has existed for some time, the parts may be injured or ulcerated. 
Haubner once had to remove the glans and os penis on account of necrosis ; 
recovery followed in fourteen days. Apart from those caused by malig- 
nant new growths about the glans or by severe wounds to the penis, 
the greater number of cases progress favourably without very elaborate 
precautions. 

Treatment.—After thoroughly cleansing the glans and prepuce, 
the displaced hair must be withdrawn or cut off with scissors. <A 
few drops of oil can then be placed on the glans and strangulated pre- 
puce, the animal placed on its back, the prepuce grasped on each 
side with the forefinger and thumb, and attempts made to draw it over 
the glans. The attempt generally succeeds; slight pressure with the 
finger on the glans is sometimes of assistance. Failing reposition in 
this way, the lower border of the prepuce may be laid open, when the 
penis will return of itself. Any subsequent inflammation is combated by 
bathing with solution of acetate of zinc, alum, &c.; this is, however, 
seldom necessary. 

In the horse, inability to retract the penis is rarely caused by con- 
traction of the outer folds of the prepuce. Their width and disposition 
are unfavourable to the production of paraphimosis ; but swelling of the 
inner folds may in these animals cause prolapse of the penis and 
inability to retract it. Such swelling, incorrectly described as paralysis 
of the penis, occurs temporarily during inflammation of the sheath and 
neighbouring parts, as, for example, after castration or injury to the 
penis. Slight wounds are sometimes followed by cellulitis in the sheath, 
as Haase noted after a blow from a whip. I have repeatedly seen this 
condition after irritant substances like pepper had been rubbed into the 
penis and sheath. Bang noted it in a gelding, following thrombosis of 
the veins of the sheath. 

Swelling of the prepuce often remains after subsidence of the inflam- 


350 PARALYSIS AND INJURIES OF THE PENIS. 


mation, and interferes with the return of the penis. Inflammatory 
symptoms being absent, such cases have erroneously been looked on as 
paralysis of the penis. Cases do occur, however, where nothing 
abnormal can be detected either in the penis or prepuce, and yet, despite 
this, the glans cannot be retracted, or if replaced within the prepuce, 
at once falls forward. In such case the retractor penis may be 
paralysed. Paralysis may also afford an explanation of the cases which 
follow severe infectious diseases like purpura hemorrhagica (Cagny) ; 
but at present we have no accurate information on the point. Injury 
and ulceration of the penis often occur as sequele of paralysis, as the 
penis occasionally protrudes to such an extent as to be struck by the 
hind-feet and wounded during movement. 

Local examination does much to differentiate the nature of the case. 
When no change is visible, and the penis is insensitive to pricks or 
pinches, paralysis may be surmised. In paralysis of the retractor 
penis, sensibility remains unimpaired. Particular attention must be 
paid to the prepuce; it suffers more frequently than is generally 
supposed. 

Prognosis depends on the nature of the disease. Paralysis of the 
penis or of the retractor penis are generally incurable. Only those 
forms occurring during severe infectious diseases disappear with the 
lapse of time. The longer, therefore, the condition has existed, the less 
the chance of recovery. Swelling of the prepuce is often very obstinate, 
and old standing cases are most difficult of treatment. Hard, firm 
swellings are less easy to get rid of than those which are soft and 
cedematous. 

Treatment.—Inflammation of the prepuce is to be treated as 
described on p. 344. Should the outer coats of the sheath be already 
contracted, they may be divided (p. 345). Application of a suspensory 
bandage will assist absorption and removal of cedema, and is also useful 
in swelling of the prepuce. The bandage is formed of a triangular piece 
of linen similar to that used in dressing the wound after castration of 
eryptorchids. One angle les on either side of the penis, and is con- 
tinued by a broad slip of linen, which is passed over the animal’s back 
and tied in a knot. The angle of the bandage, directed backwards, is 
stitched to two pieces of linen which are passed between the hind-legs, 
brought upward and forward, and finally united with the transverse 
strips. 

It is advisable to place a pad of tow, jute, or wadding next the penis 
to prevent injuries. The pad must be renewed when soiled with urine, 
and the linen cleansed or replaced from time to time. The pad may be 
soaked in acetate of lead or alum solution, and occasionally moistened 
with the same fluids. 


PARALYSIS AND INJURIES OF THE PENIS. 35 


In old painless swellings, especially swellings of the prepuce, massage 
is recommended. The swelling can be kneaded daily for five to ten 
minutes at a time; but to avoid injury, the parts should previously be 
smeared with fat. Attempts can then be made to return the penis, 
and if it again prolapses it may be held in position by passing a couple 
of stitches through the sheath (Rodiger). 

The elastic bandage recommended by Kirillow produces the same 
effect. The parts are cleansed, several turns of the bandage applied to 
the glans, and left in position for a few minutes. In very severe 
swelling this may need to be repeated two or three times. The glans 
is then either drawn back or, after being laved with cold water, may be 
returned to the prepuce. A case of my own supports Kirillow’s 
statement as to the success of this method. 

In case the preputial swelling still persists, benefit sometimes results 
from scarification and bathing with such astringents as solution of alum 
or acetate of lead. Needless to say, a suspensory bandage must be worn 
during massage treatment. Failing improvement by any of these methods, 
a portion of the prepuce may be amputated; I have repeatedly seen this 
operation performed with the best results. The animal is placed on its 
back, the penis drawn forwards as far as possible, the prepuce cleansed, 
and the swelling isolated by multiple silk ligatures in the manner usual 
in ruptures and new growths; the swelling itself is then removed with 
knife or scissors. I have frequently seen the best results from this 
treatment; the penis remained in position, and the inflammation conse- 
quent on operation was so slight as to require no treatment. Haase has 
had a similar experience. 

In paralysis, massage of the retractor penis muscle between the anus 
and scrotum may be tried; injections of veratrin, strychnine, or similar 
nerve stimulants might possibly prove useful. The paralysed penis is 
shielded from external injury by applying a suspensory bandage. In 
case of need, it can be amputated. 

In the horse, injuries to the penis are most frequently caused during 
prolapsus by accidental blows, as with the whip. Extensive wounds 
are sometimes caused in stallions during coitus. In bulls, injuries may 
likewise be caused by the penis failing to enter the vagina and striking 
against the ischia of the cow. In such cases fracture sometimes takes 
place, the corpora cavernosa are ruptured, bleeding occurs, and marked 
bending and distortion ensue; the condition has also been seen in the 
horse (Grinzer). Similar injuries have also been caused by ignorant 
castrators applying clams to the penis, instead of the testicle. 
Lambert and Kobert report such cases, in one of which the testicle lay 
in the abdomen. As the horse suffered from colic on the following 
night, and made fruitless efforts to pass urine, the clams were removed, 


Soe PARALYSIS AND INJURIES OF THE PENIS. 


and recovery occurred, but amputation of the penis was found necessary. 
In dogs, injuries of the penis are caused by bites and violently separat- 
ing the animals during coitus. 

The first serious symptom which occurs is difficulty in urination. 
Fither the injury itself or the inflammatory swelling consequent on it 
compresses or displaces the urethra and produces obstruction. Such 
injuries sometimes produce cicatricial strictures. Fractures of the 
penis generally do well, that is, the distortion or bending disappears 
along with the inflammatory symptoms, though cases have been seen 
where it persisted, and rendered the animal useless for stud purposes. 
Gellimore reports a case where the end of the penis no longer became 
erect. 

Treatment must be based on general principles. To assist circula- 
tion, and repair and prevent the wound becoming soiled, a suspensory 
bandage is employed, and may be made the vehicle for the application 
of drugs, cold astringent lotions, creolin, &c.; the swelling which 
usually remains will thus be most rapidly removed, and for the same 
purpose massage will be found of service. 


III—TUMOURS ON THE SHEATH AND PENIS. 
AMPUTATION OF THE PENIS. 


Lit.: Roloff, Gurlt u. Hertwig. 34, p. 185. Schiitz, ibid. 32, p. 319. 
Vavre, ibid. 6, p. 107. Bayer, Mill. u. Roll. 1885, p. 86. Fellen- 
berg, Gurlt u. Hertwig. 5, p, 320. Rubinski, Jahrb. 1885, p. 93. 
Leisering, Dresd. Ber. 1864, p. 36. Hering, Operationslehre. III. 
Aufl. p. 126. Nocard, Jahrb. 1885, p. 92. Harrison, Jahrb. 1885, 
p. 92. Hasse, R. T. W. 1890, p. 285. Giittler, Th. Mitth. 1881, p. 
70. Laurent, Jahrb. 1887, p. 48. Piovesau, Rec. de Méd. véteér, 
1892. Eber, Deutsche Zeitschr. fiir Thiermed. 1891. J ohne, Dresd. 
Ber. 1891, p. 45. 


Fibromata (warts) are often seen on the horse’s sheath ; according to 
my own experience, carcinomata also occur here, and melano-sarcomata 
and melano-carcinomata (Roloff) have been reported. Piovesau removed 
a fibro-sarcoma as large as a child’s head from a stallion’s sheath. Warts 
occur on the prepuce of the dog and of other animals, not infrequently in 
great numbers. They are generally situated on the inner folds, but fre- 
quently on the penis also. Whether condylomata occur here, as Bayer 
believes, I am unable to say. 

The simultaneous appearance of warts on the mouth does not prove 
the specific nature of the new growths, because warts are also frequent 


TUMOURS ON THE SHEATH AND PENIS. 353 


about the lips. Fellenberg saw a knobby (knotenformig) swelling on the 
penis of the dog; Rubinski found in this situation cancer in geldings ; 
Laurent a melanoma weighing about 50 lbs. in a horse; Johne and Eber 
primary tuberculosis in an ox, 

The significance of these conditions depends chiefly on their nature 
and extent, which require to be carefully considered in delivering a 
prognosis. Tumours on the prepuce rapidly produce stenosis and 
phimosis or paraphimosis (Giittler); they may also press on the urethra, 
or attack its walls and impede urination, whilst malignant tumours lead 
to disseminated secondary growths. 

Treatment.—Pedunculated warts are snipped off with scissors, any 
slight bleeding being checked with the cautery or with lunar caustic, 
which at the same time tends to prevent reproduction. Large peduncu- 
lated tumours may be ligatured or removed with the ecraseur. The elastic 
ligature is also recommended. Warts and other benignant tumours 
with broad bases may, unless very large, be destroyed by irritants such 
as chromic, nitric, or sulphuric acids; the larger, and particularly those 
suspected to be malignant, are better excised. Malignant growths on 
the penis may necessitate amputation, to save the animal or to render it 
capable of work for some time. 


AMPUTATION OF THE PENIS. 


The greater part of the penis consists of the corpora cavernosa, which, together 
with the urethra and blood-vessels, are surrounded by the firm fibrous tunica 
albuginea, At the lower border of the penis lies the urethra in a furrow, sur- 
rounded by the cavernous bodies and muscles. The arteria and vena dorsalis 
penis form the large blood-vessels. In dogs the os penis must also be considered 
in operating. 


In amputation of the penis, three factors are to be reckoned with, 
V1zZ. :-— 

(1) The bleeding. 

(2) The after-contraction of the urethra. 

(3) The pain. 

Amputation may be rendered necessary, as described, by the presence 
of tumours, by paralysis, and by inflammation and necrosis of the penis 
The following methods have been proposed :— 

(1) Ligation. This gives the greatest security against bleeding, is, 
however, very painful, and requires particular care to preserve the 
urethra. To prevent its occlusion from pressure of the ligature, the 
urethra must previously be dissected out, or a metal tube thrust into it 


to keep it open. ‘The elastic ligature is particularly valuable, as it 
Z 


354 AMPUTATION OF THE PENIS. 


overcomes the necessity for tightening the cord during the days following 
operation. Hertwig recommends the castrating loop. By daily tighten- 
ing the cord, the penis is cut through in from six to eight days. When 
the ligature has to be applied high up. the prepuce must previously be 
laid open. 

Ligation is, of course, useless in dogs over the region of the os 
penis. 

(2) The actual cautery. To prevent bleeding, a knife-shaped cautery 
has been recommended. Its application is very painful, but the pain 
may be avoided by narcosis. The urethra is exposed, and the penis 
cut through with the cautery. In order to fix it conveniently, two 
ligatures are passed around it, and the division made between them ; 
particular care is required in severing the dorsal vessels. Nocard 
recommends the galvano-cautery for small animals, though, as it is a 
very expensive piece of apparatus, it is not always to be found even in 
large cliniques. 

(3) Simple section. It has often been remarked that even in large 
animals simple section produces no dangerous bleeding. Some operators 
first ligature the dorsal vessels, others cut through them at once; 
Barthélémy and Charlot operated in this way in the horse, Fellenberg in 
the dog. Two lgatures are applied, between which the amputation is 
made ; the upper ligature prevents bleeding. That even this is not always 
necessary is shown by a case of Hunting’s, where a pony’s penis was 
simply cut through, the stump compressed by an assistant for half an 
hour, and no particular bleeding ensued. If the horse is cast for opera- 
tion, that portion of the prepuce covering the penis may be drawn 
together with sutures in front of the stump. Haase operated in this way, 
using catgut, and states having had healing by primary intention. In 
such cases it 1s necessary to expose the urethra, and divide its mucous 
membrane, which is stitched to the tissues on either side to prevent 
stenosis (Charlot). 

If the animal is cast, the actual cautery may be employed after 
section to check bleeding. It is better to ligature each bleeding vessel 
separately, and in the horse to draw the prepuce over the stump and 
suture it in that position. 

(4) The ecraseur. This method and removal by galvano-cautery or 
ligature are the most painful, but the operation only lasts a short time, 
and an anesthetic can be given. 

After cleansing the penis and sheath, a piece of tape is tied around 
the end of the former to furnish a good hold. The urethra is then dis- 
sected out for 1 to 15 inches and cut through, after which the ecraseur 
is applied at the point to be divided and slowly turned. There is little 
resistance whilst the corpora cavernosa are being compressed and cut 


AMPUTATION OF THE PENIS. 355 


through, but towards the end of the operation it becomes greater, 
because the tunica albuginea is then undergoing division, and, in my 
experience, the chain at this period has occasionally been broken. In 
such cases I have passed a ligature around the remainder, and simply 
removed the end of the penis with a knife; the operation was perfectly 
successful, and healing occurred rapidly and uninterruptedly. Since 
then I have always operated in this way, and can recommend it. Not 
only is injury to the instrument avoided, but bleeding is very slight and 
the wound heals rapidly. The urethra may be sutured to the tunica 
albuginea, and if sterilised catgut or silk be used its edges soon become 
adherent, and the danger of stricture is reduced to a minimum. 

Nevertheless, whatever method be employed, strictures form the most 
frequent and most troublesome sequele of amputation of the penis. 

The insertion of a metal tube in the urethra during the first week or 
two certainly obviates difficulty in urination consequent on inflammatory 
swelling, but later it operates in exactly the opposite way, and it is, 
therefore, better to avoid such tubes. Stricture may even lead to rupture 
of the bladder, as Cagny has shown. In dogs, amputation can be effected 
either behind the os penis by using the knife or ecraseur, or the bone 
can be sawn through. After the latter method strictures and closure of 
the urethra are certainly commoner, though, in my hands, amputation 
behind the os penis by ligaturing blood-vessels, and exposing and 
sewing the urethra to the neighbouring parts, and amputation by sawing 
through the os penis, have been equally successful. A dog operated on in 
the latter manner died a year later from disease of the bladder. On post- 
mortem, the stump was found cicatrised without any considerable 
stricture of the urethra. After-treatment is in all methods the same, 
and consists in washing or syringing out the sheath with disinfecting 
fluids. 


IV.—DISEASES OF THE PROSTATE. 


Lit.: Johne, Dresd. Ber. 1884, p. 28. Bang, Stockfleth Chirurgie, p. 597. 
Haubner, Dresd. Ber. 1863, p. 49. Forster, Path. Anat. II. p. 368. 
Simonds, Caust. Jahrb. 1847, p.29. Sickert, Th. Mitth. 1879, p. 70. 
Cadiot u. Fournier, Jahrb. 1888, p. 129. Frauenholz, Th. 
Mitth. 1881, p. 69. Reinemann, ibid., 1882, p. 65. 


The prostate gland consists in the horse of two lobes about 3 inches 
long and 2 broad. The gland is little developed in oxen and swine, but 
is large in carnivora, in which it appears to surround the urethra. In 
animals disease of this gland is much rarer than in man, but both 
acute inflammation and abscesses form (Johne, Bang), and chronic 


356 DISEASES OF THE PROSTATE. 


thickening, with formation of new growths, have been seen in dogs. 
The first clearly results from inflammation spreading from the urethra. 
Haubner opened an abscess in the gland through the urinary passages ; 
Reinemann (in a steer) operated from the anus. Bang saw acute 
prostatitis in the horse; Frauenholz tuberculosis of the gland in 
oxen. 

Hypertrophy of the prostate, which often occurs in elderly people, 
and consists of new growth of glandular and muscular connective tissue, 
is, amongst animals, almost entirely confined to dogs, and even in them 
is seldom seen; Forster has, however, examined several cases of the 
kind. Simonds states that in a certain dog the prostate weighed 
103 lbs., whilst the entire dog, without this growth, only weighed 
154 lbs.(?). Sickert made the post-mortem of a horse in which the 
prostate weighed 24 Ibs. 

Tumours are common in the prostate ; Cadiot found cancer. 

In sheep, Gurlt described a so-called prostatic calculus, consisting 
partly of a precipitate from the secretion of the gland, partly of gravel 
from the bladder. 

The gravity of these conditions depends on the fact that the urethra 
is pressed upon, and urination rendered difficult. Acute inflammation 
may extend to the urinary passages, cause disease of the urethra, and 
prove fatal from pyelonephritis. 

Symptoms and Progress.—Difliculty in urination first directs 
attention to the disease. The animals strain, sometimes without result, 
sometimes with the discharge of urine in a thin stream or in drops, 
sometimes urine is discharged involuntarily. If in dogs thus suffering 
urethral calculus is absent, a rectal examination must be made, when 
the swollen prostate will be felt close behind the bladder. When 
acutely inflamed, the swelling is soft and painful, but in chronic con- 
ditions it is hard and painless. Prostatic calculi sometimes cause the 
gland to feel almost like a shot-pouch. Abscesses occasionally discharge 
into the urinary passages under the pressure of the finger. Haubner 
examined a dog in which the prostate gland was as large as a hen’s egg; 
pressure caused the discharge of a purulent, ill-smelling fluid through 
the urethra, after which recovery occurred; but in the case noted by 
Reinemann in a steer the animal died from cystitis. 

Hypertrophy of the prostate and tumours generally cause death by 
interfering with urination, or they may necessitate slaughter of the 
animal. 

Treatment.—In acute cases, laxatives and clysters remove the 
pressure on the urethra resulting from a distended rectum. Abscesses 
in the gland can be evacuated through the rectum. Disinfectant fluids 
may be injected through the catheter. In chronic disease the only 


DISEASES OF THE SCROTUM. 307 


resort is extirpation—an operation which, to the best of my knowledge, 
has not yet been carried out in animals, but which may perhaps be 
possible." 


V.—DISEASES OF THE SCROTUM. 


Lit.: Reinard u. Schaak, Journ. de méd. vét. de Mid. 1889. Bang, 
Stockfleth Chirurgie. Rosenbaum, Gurlt. u. Hertwig. 12, p. 148. 
Eberhardt, ibid., 14, p. 381. Harms, Th. Mitth. 1868, p. 145. 


(a) Apart from those caused by operative interference, injuries, 
wounds, and bruises are comparatively rare in animals, in consequence 
of the sheltered position of the scrotum. In dogs, however, the scrotum 
is sometimes bitten, and injuries may be caused in other animals by 
fragments of glass and wood, and, during attempts to surmount hedges, 
by thorns. In horses the scrotum is sometimes injured by the carriage- 
pole, and decubital gangrene readily occurs in dogs after lying long 
in one position, as during paraplegia or distemper. In delivering a 
prognosis, it should be particularly noted whether or not the injuries 
are of a penetrating character, and have affected the testicle. By 
penetrating wounds are meant those which extend to the processus 
vaginalis or peritoneal cavity. But even in penetrating wounds the 
prognosis and chance of recovery are favourable, provided there is no 
diffuse peritonitis, though the testicle can seldom be saved, on account 
of the danger of infection extending to the peritoneum. Severe 
bruises and injuries followed by extensive gangrene must be viewed 
as dangerous. Superficial wounds, on the other hand, generally heal 
readily. 

Treatment.—The parts are first thoroughly cleansed, and then 
carefully examined, to determine the area of the injury. If the testicle 
is to be saved, strict antiseptic treatment will be required. In large 
animals the suspensory bandage described on page 350 should be used. 
In deep wounds penetrating the processus vaginalis, pus formation and 
peritonitis are likely to ensue unless the parts are at once rendered 
aseptic. Castration is often necessary, and in such case the scrotum 
should be freely divided to give the freest possible exit to discharge, 

1 Within the last two years (June 1893) castration has been warmly recommended as a 
cure for enlarged prostate in man. To J. William White, of Philadelphia, is probably due 
the credit of first suggesting this treatment. Since then a number of cases have been operated 
on with the most marked success, cases where the catheter had been used for years showing 
immediate improvement, and patients being able to urinate without assistance in five days 
after operation. Nevertheless, final judgment should be reserved, though the operation is 


more likely to prove satisfactory in dogs, which occasionally suffer from enlarged prostate, 
than in men.—[{TRANSL. ] 


358 DISEASES OF THE SCROTUM. 


otherwise the usual principles are followed. Superficial injuries are 
treated like similar wounds in other parts. 

(b) Inflammation of the scrotum occurs in northern countries 
(Bang), from travelling bulls im snow-drifts. On reaching the stable 
the skin of the scrotum becomes red and swollen, and the folds dis- 
appear. Exudation soon sets in, and superficial necrosis of the skin 
may take place. 

Though the course of the disease is almost always favourable, yet at 
times a troublesome eczema remains, which bids defiance to treatment, 
especially when the discharge is profuse. When large areas of the 
scrotal skin have sloughed, cicatrisation occurs with difficulty. 

In exceptional instances, inflammation extends to the scrotum from 
neighbouring structures. Rainard saw such a case follow puncture of 
the bowel. 

In dogs an acute eczema sometimes extends over the entire scrotum, 
and is characterised by swelling, reddening of the skin, exudation, pain 
or itchiness, causing the animals continually to lick the parts, and thus 
interfere with treatment and healing. The swelling sometimes causes a 
peculiar straddling gait. 

Treatment of frost-bite of the scrotum consists in bathing the parts 
with disinfectants and applying dry dressings. Wheat flour, tannic 
acid, or tannic acid and iodoform are all useful. In eczema the powder 
may consist of lycopodium, tannin, and iodoform, which will prevent the 
animal licking the diseased spot. When exudation is not excessive, the 
parts may be brushed over with iodoform collodion with advantage ; 
cocain might also be tried. 

(c) New growths are not infrequent in the skin of the scrotum. 
rosenbaum found a swelling on the scrotum of a steer, and Eberhardt 
describes a tumour nearly 16 inches in length in an eighteen months 
bull. The nature of these new growths cannot, however, be ascer- 
tained from the description given. I have seen extended varicose 
conditions of the skin in dogs (diffuse dilatation of the veins), which was 
attended with ulceration of the skin, profuse bleeding, and a tendency 
to recur. 

It is impossible to determine the nature of that condition in bulls, 
described by Anacher as pneumatose of the scrotum. Probably it was a 
case of hernia. Neither does the description of Eberhardt of an “over- 
long scrotum” in a bull give any accurate picture of the diseased con- 
dition. In dogs, a pendulous condition of the scrotum and failure to 
retract the testicles when the scrotum is grasped is a grave symptom 
seen near the termination of severe internal diseases, and may some- 
times be observed in other animals. 

The treatment is almost self-evident. New growths, unless possess- 


DISEASES OF THE TESTICLE. 359 


ing too broad a base and extending to the tunica vaginalis, are generally 
easily removable. The mobility of the tumour gives sufficient indica- 
tion on this point. If needful, the entire scrotum can be removed along 
with the testicles without danger, as the primitive methods of castrating 
ruminants clearly show. 

Various parasites, which also occur in the peritoneal cavity, are seen 
in the scrotum and tunica vaginalis, such as Sclerostomum armatum, 
Filaria papillosa, &c. (Cresswell). They have no particular significance, 
and are accidentally encountered in castration or when making post- 
mortems. 


VI.—DISEASES OF THE TESTICLE. CASTRATION OF 
CRYPTORGHIDS. 


lit.: Leisering, Dresd. Ber. 1882, p. 27, u. 1864, p. 35. Kaiser, Th. 
Mitth. 1879, p. 72. Cox, Guilt u. Hertwig, 10, p. 383. Olivier, ibid., 
ip 29s Gaur ltd: 6225p: 326s lt, py 99 un6,p. S9ln Preussie, 
Jahrb. 1878, p. 110. Wallraff, Her. Rep. 7, p. 219. Ludwig, Dresd. 
Ber. 1866, p.54. Lowack, Th. Mitth. 1858, p. 161. Hess, Jahrb. 
1888, p. 129. Knese, Th. Mitth. 1879, p. 72. Johne, Dresd. Ber. 
1885, p. 24. Meissner, ibid., 1885, p. 34. Hertwig, Gurlt u. Hert- 
wig. 25, p. 488. Finfstiick, Dresd. Ber. 1862, p. 12. Fambach, 
ibid., 1889, p. 78. Siedamgrotzky, ibid., 1871, p. 78, u. 1873, p. 25. 
Martin, Miinch. Ber. 1892/93, p.119. Trasbot, Jahrb. 1885, p. 92, 
w. ec. de) Med. veter. 18920 p.-129. Putz, Ad. Woch. 1891, p: 410: 
Gresswell, ibid, 1886. Peters, Gurlt u. Hertwig. 7, p. 43. 
Wesche, ibid., 19, p. 476. Moller, Monatshefte, f. pr. Th. 1890, p. 
385. Paugoue, Her. Rep. 14, p. 47. Hess, Jahrb. 1891, p. 109. 
Levens, B. T. W. 1891, p. 19. Imminger, Ad. Woch. 1891, p. 423. 
Cadiot, De la Castration du Cheval Cryptorchide. Paris, 1893. Asselin 
et Houzeau, Jansen u. Koch, B. T. W. 1892, p. 368. 


(1.) CONGENITAL DEFECTS AND RETENTION OF 
THE TESTICLES. 


In the horse and dog, less frequently in other species, the testicles 
are sometimes either absent or in a state of rudimentary develop- 
ment. Leisering found the testicles of a stallion which had ineflectu- 
ally covered forty mares almost normal in size but flabby in texture ; 
wanting the tense normal character. Their arteries were distended, 
their connective tissue thickened, the semen watery, transparent, and 
containing many round cells, but only isolated spermatozoa, Testicles 
which have been retained in the abdominal cavity often show similar 
appearances. This condition (retentio testis) is not infrequent in 


360 CONGENITAL DEFECTS AND RETENTION OF THE TESTICLES. 


stallions of the coarse, heavy variety, but is also seen in other animals. 
Leisering and Gurlt found the testicles of a dog still in the abdominal 
cavity, Preusser has seen the same thing in pigs, and Kaiser in bulls. 
Imminger considers the eryptorchid condition as common in bulls as in 
horses, and he was able to establish the hereditary character of the 
condition in certain cases. This abnormality is termed retentio abdo- 
minalis when the testicle les near the upper wall of the abdomen, 
retentio iliaca when it is near the inner abdominal ring, and retentio 
inguinalis when it is within the inguinal canal. The apparent absence 
of one or both testicles thus produced is termed monorchismus or cryptor- 
chismus. During the first few months of life in the foal the testicles 
certainly lie in the inguinal canal, but towards the end of the first year 
they again descend into the scrotum. 

Gurlt saw a horse in which the testicles occupied a very rare posi- 
tion, viz., in contact with, and adherent to, the diaphragm. Sometimes 
they lie outside the abdominal cavity, but not in the scrotum (ectopia 
of the testicle); thus the testicles have been found below the diaphragm 
or in the crural canal: the first condition is termed ectopia abdominalis, 
the latter ectopia cruralis. In dogs I have found one or both testicles 
lying beneath the skin next the glans penis; in a bull, one testicle was 
met with in the subcutis of the flank. 

Supernumerary testicles are said to have been seen in horses and 
mules. Cox found three testicles in a certain horse, and Olivier as 
many as four in a mule. The accuracy of these observations may, 
however, be questioned, as a thorough description of the supernumerary 
organs is wanting, and one cannot help thinking that these were cases 
of mistaken diagnosis. 

The significance of all these conditions is self-evident. Both anor- 
chiditis and defective development of both testicles makes the animal 
useless for stud purposes. The same is usually also true of cryptor- 
chismus, for testicles when retained in the abdominal cavity are generally 
atrophic, lax,and either contain degenerated spermatozoa, or none at all ; 
on the other hand, I have often seen horses with retained testicles which 
yielded abundance of spermatozoa. The question of the fertility of eryptor- 
chids was first raised by Gurlt when studying the function of the sperma- 
tozoa: his experiments seem to deny fertilising power under such circum- 
stances, for he was unable to discover spermatozoa in the retained 
testicle. Since then the same question has been variously answered. 
Peters considers such animals not fertile, though quite capable of coitus. 
Wesche, on the other hand, states having seen tertile cryptorchids; he 
refers, however, to a case of eryptorchismus inguinalis. A final answer 
can scarcely be given. The animal’s fertility clearly depends on the 
development of the testicles. The great majority of retained testicles 


CASTRATION OF CRYPTORCHIDS. 361 


certainly appear degenerated, and contain no spermatozoa. Paugoué speaks 
of a stallion in which both testicles were retained, and whose progeny 
numbered amongst them five ecryptorchids or monorchids; thus 
apparently proving the condition to be hereditary. 

The retained testicle is often the seat of diseased and not infrequently 
malignant new growths like sarcoma, carcinoma, &c. Leisering, in the 
case of a dog, found the retained testicle attacked with cancer; the 
same condition has been seen in horses. In man, such testicles still 
more frequently become diseased, so that early removal is generally 
necessary. 

The same necessity does not exist in the horse, though removal often 
becomes desirable on account of sexual excitement (particularly in 
spring), often greatly interfering with the animal’s usefulness. Many 
eryptorchids are too vicious for use. The flesh of cryptorchid swine 
(Binneneber) has usually a repulsive taste (Jansen), which, according 
to Koch, is retained even by the salted meat, and is more intense the 
more completely the testicles have developed. 

Castration of cryptorchids requires some practice and careful anti- 
sepsis. Since it has been so much practised by Stockfleth and Nielsen 
in Denmark and Degive in Belgium, Bang and Cadiot have taken it up. 
At one time Hering considered it altogether unjustifiable. With anti- 
septic precautions the operation loses much of its danger, and is often of 
great service. 

In former times, and occasionally even of late years, the flank opera- 
tion was recommended, but almost all surgeons now operate by the 
inguinal canal, and I include myself among them. I here describe the 
method I adopt outside my own clinique, referring the reader for the 
modifications of the operation to my General Surgery and writings in the 
monthly journals. Wherever possible, I operate in the open air. The 
straw used as bed should be spread out the evening before to prevent 
causing dust. The operation is easiest in horses which have been kept 
low for some weeks and are in thin condition. Some days before opera- 
tion a dose of physic is given to empty the bowel, and from that time 
the animal receives only a limited amount of concentrated food, like 
oats, with a little hay, but no straw. 

Thus prepared, the horse is cast on the side opposite the seat of 
operation; the hind-quarters are half-rolled over, and lie somewhat 
higher than the fore. The upper hind-foot is then drawn forward and 
fixed in a position of abduction and flexion, as in ordinary castration. 
By previously cleansing the hoofs and surrounding them with moist 
cloths, and by moistening the hair on the upper part of the thigh the 
point of operation is protected against infection. 

Three dishes, each containing 2 to 3 per cent. carbolic solution, are 


362 CASTRATION OF CRYPTORCHIDS. 


necessary. The instruments are placed in one, the ligatures and needles 
in the second, the third is used by the operator for moistening his hands 
before introducing them into the abdominal cavity; in a fourth empty 
dish, pledgets of tow are in readiness. It is also well to have at hand 
a vessel with a lip, to use as an irrigator. 

All being ready, the animal is chloroformed, during which time the 
seat of operation is washed with soap and disinfected with carbolic or 
sublimate solution. As soon as narcosis is complete, the assistants, 
holding the dishes, place themselves near the operator, who has carefully 
disinfected his hands and thrust his sleeves back above the elbow. The 
position is the same as in castration. The operation is divided into the 
following stages :— 

(1) Incision. An incision is made through the skin, about 2 to 
3 inches long, over the outer inguinal ring (perhaps slightly nearer 
the middle line) and parallel with it, and the subcutaneous tissue and 
fascia lying at this point are divided to the same extent. Any bleeding 
vessels are at once ligatured, and blood removed with sterilised pledgets 
of tow. 

(2) Opening the inguinal canal. The loose connective tissue in the 
inguinal canal must now be thrust on one side, both index fingers and 
possibly the thumbs being employed, and an entrance effected in the 
direction of the inner abdominal ring. The index and middle fingers of 
the hand corresponding to that particular side of the animal are then 
passed into the inguinal canal to make sure whether the processus 
vaginalis and remainder of the spermatic cord le there. Should the 
testicle be met with at this stage (retentio inguinalis), the operation 
becomes very simple, being, in fact, just like ordinary castration. Some- 
times a more or less degenerated process of the tunica vaginalis, perhaps 
as large as the finger of a glove, together with the end of the epididymis, 
may be felt in the inguinal canal. In that case the inner abdominal 
ring must be examined by introducing the index finger, and its width 
discovered. Generally it is very narrow, and would not even permit 
the passage of the rudimentary testicle. As it is difficult to dilate, 
I prefer in such cases to ignore the process of the tunica vaginalis, and 
seek an entrance to the abdominal cavity alongside of it. When the . 
inner abdominal ring appears wider, the processus vaginalis is to be 
divided, and the operation continued as after-perforation of the abdo- 
minal walls. 

(3) Perforation of the abdominal walls. By passing the fingers, 
nearly to the last knuckle, into the inguinal canal, the abdominal wall 
can be felt in the depths. The posterior border of the obliquus 
abdominis and the fibres of the obliquus internus can be clearly 
distinguished. Close behind the latter is a mass of loose connective 


CASTRATION OF CRYPTORCHIDS. 363 


tissue. Degive makes his perforation at this point. Like Bang, I 
prefer entering through the inner oblique abdominal muscle at the inner 
wall of the inguinal canal, somewhat nearer the median line than the 
inner abdominal ring. This produces a “ button-hole wound,” which 
does not gape, but, on the contrary, soon comes together again and 
prevents prolapse of the bowel. A vigorous thrust with the index and 
middle fingers during inspiration carries them through the abdominal 
wall into the peritoneal cavity. Different animals, however, present 
great differences in this respect ; in some perforation is easy, in others 
it requires considerable force. 

(4) Finding the testicle or spermatic cord is always the most difficult 
part of the operation for the unpractised ; nevertheless, it can generally 
be effected with the two first fingers, and without introducing the entire 
hand. As soon as the abdominal wall is perforated, search is made on 
all sides for the testicle, epididymis, or spermatic cord. The testicle 
may easily be mistaken for an empty loop of bowel, but is distinguished 
by its sharper outline and greater firmness; pressure on it causes 
struggling. The end of the epididymis is recognised as a soft mass, 
containing harder, firmer cords. The spermatic duct can be felt as a 
hard cord, and is very useful for discovering and drawing forward the 
testicle, for its slight size and thread-like hardness render it easily 
recognised. It can, moreover, be brought forward with much less diffi- 
culty than the testicle itself, which, when grasped and pulled on, causes 
struggling. The object to seek, then, is a very small body, possessing a 
hard, string-like cord (spermatic cord). As a large mesenteric artery 
might be mistaken for it, the cord should be examined to detect pulsa- 
tion. It is much easier to discover the spermatic cord than the testicle. 
When drawn forward, the spermatic cord is recognised by its light 
colour. By gently pulling on it the testicle is drawn upwards through 
the opening, though, in exceptional cases, the testicle may be so large 
as to offer considerable resistance. As soon as the testicle appears 
outside the wound, two, or if it be very large, three carefully disinfected 
catgut or silk ligatures are passed round the spermatic cord, which 1s 
then cut off half an inch below the point of ligation, and allowed to 
return to the inguinal canal. The wound is closed with 5—8 threads of 
silk or hemp. I then powder the wound with iodoform-tannin (1-3), 
and cover it with a layer of wood-wool or carbolic wadding. Only when 
the spermatic cord or wound has been soiled is it necessary to wash out 
with sublimate solution. 

This completes the operation, and the animal can be allowed to rise. 
‘Once on its feet, a bandage like the suspensory described on p. 350 is 
applied, but may be omitted if the animal be restless. The patient is 
tied up for four days and kept on half rations, after which it may be 


364 CASTRATION OF CRYPTORCHIDS. 


allowed to lie down, still wearing the dressings, which are removed, 
however, after six to eight days. 

As a rule, little or no pus is formed; but should it appear, the front 
and back stitches in the skin wound may be loosened, and the latter 
washed out once daily with carbolic, creolin or sublimate solution. 
Provided fever or loss of appetite is not marked, after-treatment is 
unnecessary, and the animal may return to work in about fourteen 
days. Since publishing the results of the sixteen operations performed 
in 1892, I in 1893 operated on twenty animals—in all cases with 
good results. Those treated outside the hospital made the best 
progress. 

It is sometimes dificult and requires patience to find the testicle. 
If needful, the other hand can be introduced into the rectum, and 
attempts made to force the testicle through the opening. Thus exposed, 
it is secured with a cord covered with wool, the hand which has been 
introduced into the rectum at once cleansed, and the operation proceeds 
as above described. 

When the spermatic cord is very short, it renders ligation particularly 
difficult. Degive told me personally that under such circumstances he 
employs the ecraseur. 

In one case the testicle could not be found. I therefore introduced 
the entire hand into the abdominal cavity, and discovered a soft body 
the size of two fists. This I at first took to be the urinary bladder, 
which further examination showed, however, to be in its normal} 
position, whilst the soft body lay near the inner abdominal ring, was 
movable, and carried at one end a firm object which resembled a 
testicle. Convinced that I had to deal with a degenerated testicle, 
I extended the opening in the skin and abdominal walls sufficiently 
far to allow the testicle and spermatic cord to be ligatured. After 
removing the testicle and suturing both the skin and abdominal walls 
with strone silk (interrupted sutures), recovery occurred without com- 
plication. 

A closer examination showed that the testicle had almost entirely 
disappeared, and a cyst containing 16 ounces of serum, and having a 
circumference of 14 inches, had formed in the spermatic cord. At the 
lower end of the cord lay a lipoma, about the size of a duck’s egg, and 
partly ossified. I was inclined to regard this tumour as the degenerated 
testicle, until my attention was directed by Degive, who has repeatedly 
seen similar cases in his extensive practice, to hydrocele of the sper- 
matie cord. Degive scratches the hydrocele with the finger-nail until 
it discharges into the abdominal cavity, when the testicle can easily be 
removed. 

Castration of cryptorchid boars is similar to that of horses, with the 


INFLAMMATION OF THE TESTICLE AND EPIDIDYMIS. 365 


one exception, that a flank incision is preferable. Levens describes a 
case where the castrator had removed the boar’s kidney instead of the 
testicle, as was discovered on slaughtering the animal. The other 
kidney had undergone compensatory hypertrophy. 


(2.) INFLAMMATION OF THE TESTICLE & EPIDIDYMIS. 
ORCHITIS, PERIORCHITIS, EPIDIDYMITIS. 


Inflammation of the testicle is certainly not frequent, though it has 
been seen in different animals. Inflammation of the epididymis, com- 
mon in man during gonorrhcea, is seldom seen in animals. 

Orchitis sometimes results from external violence, from bruises and 
injuries produced, as described on page 357, sometimes from inflamma- 
tion extending from the urinary passages to the spermatic ducts, and 
thence to the testicles; metastatic inflammation of the testicle is met 
with in pyzemia, glanders, &e. Walraff insists on having seen enzootic 
orchitis with abscess formation in horses and oxen, but nothing specific 
is known of its cause. Ludwig found in a horse suffering from brain 
mischief abscess of both testicles ; Knese saw a similar affection in pigs. 
Inflammatory processes and caseous nodules have been found in the 
testicles of tuberculous horses. Hess describes a case of tuberculosis 
of the epididymis in a breeding bull. The end of the epididymis formed 
a swelling as large as a goose’s egg, which was distinctly divided from 
the testicle by a circular depression. 

Symptoms and Progress.—The first symptom consists in swelling, 
sometimes slow, sometimes rapid, but always very painful, especially in 
acute inflammation ; the gait is, therefore, often straddling, and sometimes 
the pain produces symptoms of colic. The scrotum escapes as long as 
the processus vaginalis remains intact, but if periorchitis also occur, 
oedema of the scrotum sets in. Infectious orchitis is always accom- 
panied by fever. 

Aseptic inflammation of the testicle resulting from bruises generally 
takes a favourable course. Bleeding may certainly occur, and produce 
hematocele (p. 368), but the blood seldom fails to be readily absorbed, 
and normal function to be restored. But that form of orchitis con- 
veyed through the medium of the urinary organs or produced metas- 
tatically often produces pus formation or necrosis. The testicle is 
especially prone to necrosis, as is seen after subcutaneous ligation of the 
spermatic cord for castration. In ruminants and horses, calcification 
and ossification of the testicle have also been seen. These processes, 
however, are not dangerous to life in the same degree as pus formation, 


366 INFLAMMATION OF THE TESTICLE AND EPIDIDYMIS. 


which readily extends to the spermatic cord and produces fatal purulent 
peritonitis. The commonest result is periorchitis, adhesion of the testicle 
to the tunica vaginalis, or perforation outwardly through the skin of 
the scrotum (Lowack). Hess saw periorchitis plastica hemorrhagica in 
a sucking-pig and in a stud bull. Periorchitis often results in hydrocele 
or hematocele (p. 368). 

Treatment.—Rest is very necessary, especially if serious swelling 
interferes with the animal’s movements. In such cases a suspensory 
bandage may be applied (p. 350). In fresh traumatic orchitis, applica- 
tions of cold water, solution of acetate of lead, or similar fluids may be 
made. In human medicine, orchitis is treated by compresses of adhesive 
plaster, which may be tried in larger animals, or in dogs can be replaced 
by painting the scrotum with collodion. Scarification, though often 
recommended, is worthless ; if only applied to the surface it is without 
effect, if it reaches the processus vaginalis it is identical with castration. 
The latter may certainly appear indicated, especially in infectious orehitis, 
with simultaneous disease of the spermatic cord. Should signs of 
abscess formation appear in the scrotum, an incision must be made; and 
if high fever, &c., result, castration must be resorted to, and can be 
earried out in the usual way. As far as possible, any diseased portions 
of spermatic cord should be removed. Hertwig has seen recovery from 
spontaneous orchitis in the horse after low diet, withdrawal of blood, and 
the use of laxatives. Mercurial oimtment with iodide of potassium and 
belladonna poultices were applied externally. 


(3.) TUMOURS OF THE TESTICLE (“SARCOCELE) AND 
OF THE EPIDIDYMIS. 


Since olden times every abnormal swelling of the testicle has been 
termed sarcocele. The condition is seen in various domesticated animals. 
In swine and cattle tuberculous growths occur in the testicle (Fam- 
bach); in horses sarcomata (Bang and Moller), carcinomata (Stocktfleth 
and Trasbot), myomata (Siedamgrotzky), dermoid cysts (Martin, Bang), 
with hair and teeth (Gurlt) have been met with, and in dogs both sarco- 
mata and carcinomata (Siedamgrotzky, Moller). Hess saw tuberculosis 
of the epididymis in a steer: the end of the epididymis formed a 
swelling as large as a goose’s egg, and was divided from the testicle by a 
distinct furrow. 

Symptoms and Course.—One or both testicles slowly increase in 
size, the swelling appearing painless. Sometimes the surface of the 
testicle retains its smooth character, sometimes it appears lobulated or 
knotted. The swelling may become very considerable ; at Alfort a horse 
was seen that had a testicle weighing 20 lbs. 


TUMOURS OF THE TESTICLE AND EPIDIDYMIS. 367 


Malignant new growths often spread to the spermatic cord, causing it 
to swell and become hard, uneven, or lobulated. Where carcinomata 
exist, the lymph glands of the lumbar region also become swollen, 
and in the case of carcinoma of the testicle shown in fig. 98, I found 
them so greatly enlarged as almost to prevent the hand passing into 
the abdominal cavity. Provided new growths remain confined to the 
testicle, recovery follows castration, which, so long as it still appears 
practicable, should not be delayed if the swelling rapidly increases, or 
takes on a malignant character, even if the spermatic cord is already 
affected. 

Treatment.—In such cases castration is the only resort, and even 


Fic. 98.—Carcinoina of the testicle in a horse—(after photograph). 


where the growths are of a benignant character it is to be recommended 
if they have attained a large size. As the spermatic vessels are often 
abnormally dilated, clams should be used, as they most surely prevent 
bleeding. If, however, the upper part of the spermatic cord be much 
diseased, the application of clams is sometimes impossible, and it is better 
to ligature the cord with catgut, and allow the ligatures to hang from the 
wound, removing them after five or six days. Should the new growth 
have already reached the abdominal cavity, the animal must be pre- 
pared for slaughter, or worked until advancing disease renders it 
useless. 


368 HYDROCELE, H/SMATOCELE, AND VARICOCELE. 


VIIL—HYDROCELE, HAMATOCELE, AND VARICOCELE. 


Ger. Wasserbruch, Blutbruch und Krampfaderbruch. 


Lit.: Richter, Th. Mitth. 1863, p. 183. Steffen, ibid., 1874, p. 144 
Steiner, Gurlt u. Hertwig. 2, p. 253. Martin, Jahrb. 1884, p. 106. 
Hess, ibid., 1888, p.129. Prinz, Gurlt u. Hertwig. 2, p.425. Meyer, 
ibid., 15, p. 428. Gurlt, ibid., 39, p. 186. 


On account of its resemblance to inguinal hernia, dropsy of the pro- 
cessus vaginalis has, since olden times, been described as hydrocele. 
Instead of the few drops of fluid usually present, one finds large quan- 
tities of serum between the parietal and visceral coats of the tunica 
vaginalis propria. The condition, therefore, in its nature resembles 
hydrops ascites, and may result from inflammation of the tunica vaginalis 
propria. Sometimes the fluid accumulates in the spermatic cord, and 
then lies between the folds of the tunica vaginalis propria, a condition 
which has been termed hydrocele of the spermatic cord. 

Both conditions have repeatedly been seen in horses, oxen, and rams. 
Steiner found hydrocele of the spermatic cord in young geldings; the 
serous fluid was contained in several small sacculations. Richter has 
described the same disease in goats and horses. I have met with hydro- 
cele of the spermatic cord containing more than 16 ounces of a reddish 
serum in castrating a cryptorchid. This complicated the operation and 
rendered it much more difficult, but nevertheless I succeeded (p. 364). 
Steffen saw hydrocele of the processus vaginalis in a ram. 

Causes.—Hydrocele may result from inflammation of the processus 
vaginalis of the testicle or of the spermatic cord, and may take either 
an acute or chronic course. In a sucking-pig and a stud bull Hess 
found not only serum, but fibrin and blood in the tunica vaginalis (p. 366). 
External injuries, like bruises, are doubtless sometimes responsible for 
disease of this character. When they lead to severe bleeding from the 
spermatic cord or processus vaginalis, we speak of heematocele. Hydro- 
cele of the processus vaginalis occurs in connection with hydrops ascites 
and hydrothorax as a local symptom of the general dropsical condition. 
Martin concluded that the occurrence of filaria papillosa in the dropsical 
vaginal process was a cause of hydrocele, but this view cannot be upheld, 
as the parasites are seen in by far the greater number of cases unaccom- 
panied by hydrocele. 

Symptoms.—Hydrocele with hematocele of the processus vaginalis 
sometimes presents a striking resemblance to inguinal hernia. The 
swelling is often very marked (Steffen saw a goat in which the scrotum 
reached nearly to the ground), but is soft, elastic, painless, and free from 
inflammatory symptoms. The condition is distinguished from rupture 


HYDROCELE, HASMATOCELE, AND VARICOCELE. 369 


by the fact that swelling is confined principally to the lower part of the 
scrotum; above, the scrotum tapers away, and shows no abnormal 
distension, because the fluid is easily displaced. By compressing the 
upper part of the scrotum fluctuation may easily be detected at the 
base. 

In large animals the presence of inguinal hernia can also be deter- 
mined by examination per anum. In hydrocele of the spermatic cord 
such examination may be necessary to confirm the diagnosis, as the form 
of the swelling often greatly resembles that of a hernia. If absolutely 
necessary, an exploring needle may be passed into the scrotum. 

This disease is distinguished from sarcocele by the less firm swell- 
ing, and by the smaller size of the testicle, which as a rule appears 
atrophied. 

Prognosis is in so far favourable that life is not threatened, but 
recovery and conservation of the testicle are generally doubtful. Early 
treatment of hematocele and hydrocele is often successful ; complication 
with inguinal hernia renders the condition doubly grave. 

Treatment.—Velpeau was the first to employ injections of iodine for 
hydrocele, and they are still used in man. Simple puncture seldom 
succeeds. Stephen emptied the tunica vaginalis of a ram fourteen times, 
but it always filled anew; nor was puncture and injection of Lugol’s 
solution more successful. Antiseptic precautions must, of course, be 
observed. When employing this method, the tincture of iodine should 
be freshly prepared, the processus vaginalis emptied of its contents, and 
the solution injected and allowed to remain. Great swelling follows, 
but subsides after six to eight days. 

Castration is more certain if the diseased portions of the spermatic 
cord be removed together with the testicles; if properly done, healing 
generally results. Operation must, however, be delayed until acute 
inflammatory symptoms have disappeared. In castrating four sucking- 
pigs affected with periorchitis and hydrocele, Hess lost two; it was 
remarkable that of five of a litter, four suffered from hydrocele. 

Varicocele, or cirsocele, consists in abnormal dilatation and lengthen- 
ing of the veins of the spermatic cord. It occurs oftenest in old animals, 
but only exceptionally calls fer treatment; it is usually only discovered 
on castration, and even then requires no particular precautions. Prinz, 
Meyer, and Gurlt observed aneurysmal varix in oxen, the spermatic 
arteries emptying into the spermatic veins. The dilatation of the plexus 
pampiniformis, associated with variocele, is sometimes so severe that the 
scrotum appears as much enlarged as in inguinal hernia, or in the above- 
described conditions. Aneurysmal varix is sometimes denoted by pulsa- 
tion in the scrotum (Wagenfeld), or the passage of blood under the skin 
may be felt; both symptoms disappear, however, immediately the scrotum 

ZA 


370 INFLAMMATION OF THE SPERMATIC CORD. 


is compressed above; Meyer was able to feel the artery. Castration is 
the only treatment, and care is required to prevent rupture of the 
greatly distended vessels: the vessels can either be ligatured with stout 
cord, or clams employed. 


VIIIL—INFLAMMATION OF THE SPERMATIC CORD. 
SGIRRHOUS CORD. FUNICULITIS CHRONICA. 


Ger. Samenstranefistel. 


Lit.: Rosenbaum, Gurlt u. Hertwig. 12, p. 143. Johne, Dresd. Ber. 
1884, p. 40, u. 1885, p. 41. Deutsch. Zeitschr. fur Thiermed. 12, p. 73. 
Rabe, ibid., 12, p. 137. Trianon, Jahrb. 1887, p.78. Ringk, Th. 
Mitth. 1876, p. 80. Henninger, Bad. Mitth. 1890. Johne, Jahrb. 
SOL p. LOS: 


On account of its sheltered position the spermatic cord rarely becomes 
inflamed, unless the scrotum be opened, though bruising or hyper- 
extension may produce acute inflammation and hematocele. It has 
already been stated that chronic inflammation may occasion hydrocele. 
But all these conditions are rarities in comparison with scirrhous cord, 
which in itself is rather common, though only seen in castrated animals, 
for it is invariably a consequence of castration. 

A portion of the cord is removed in castration, and the remainder 
then swells, partly in consequence of disturbed circulation, partly of 
inflammatory irritation. This swollen condition generally disappears 
completely in eight to fourteen days, sometimes a little later. In horses, 
and occasionally in oxen and other animals (Rosenbaum), the disappear- 
ance, however, is sometimes incomplete; the swelling increases, and the 
stump of the spermatic cord may become as large as a man’s head. The 
enlargement may be confined to the extremity, but generally extends 
further upwards, even beyond the inguinal canal and into the abdominal 
cavity. Ringk noticed an extraordinary development in a horse, the 
left spermatic cord on post-mortem weighing 24 lbs. and the right 30 lbs. 
In such cases the operative wound refuses to heal; a slight opening 
remains, from which small quantities of pus are discharged, and through 
which a probe can be introduced for a distance of 4 to 8 inches into 
the spermatic cord; hence the German name, Samenstrangfistel (lit. 
spermatic cord fistula). 

It was long known that the disease was due to chronic inflammation 
of the spermatic cord, though its cause has only lately been discovered. 
Rivolta, in 1871, suggested that it consisted in infection with micro- 
parasites (discomyces equi), and a short time afterwards Johne inde- 


INFLAMMATION OF THE SPERMATIC CORD. a71 


pendently came to the conclusion that it was a funiculitis antinomy- 
cotica. Later, however, he declared micrococci to be the cause, named 
the disease mykodesmoid or mykofibroma, and ascribed it to infection 
with a micrococcus, which Johne describes as M. ascoformans, and Rabe 
as M. bothryogenus. 

From this it is clear that the disease is of an infectious nature, and 
may possibly be caused by more than one organism. (The scirrhous 
cords removed in my own clinique were generally found to contain 
bothryomyces and staphylococci.) Its varying progress also points to 
infection. Sometimes the growth and thickening occur rapidly, and 
the spermatic cord may attain the diameter of a goose’s eve in a few 
months; sometimes the condition may exist for indefinite periods 
without any marked increase in size. 

Scirrhous cord is commoner in certain districts, in part perhaps because 
the necessary conditions for infection are more favourable; but the style 
of castration is important, inasmuch as certain methods favour infection. 

The following indirect causes of scirrhous cord are recognised :— 

(1) Exposure of the cord after castration, and its projection beyond 
the tunica vaginalis or skin wound. Sometimes this is the result of 
applying clams too low, using too heavy clams, or cutting off the vas 
deferens. More frequently the spermatic cord is not carefully returned 
to the processus vaginalis after removing the clams. Exposed to the 
air the cord swells, and sometimes becomes strangulated in the narrow 
skin incision and in the processus vaginalis, The portion lying beyond 
the castration wound then begins to proliferate, and a condition results 
which has been described as ‘‘Champignon,” and which often leads to 
scirrhous cord (fig. 99). In other cases the infected cord is returned 
to the tunica vaginalis, but in consequence of the presence of micro- 
organisms, becomes inflamed, and proliferation is set up. Unless strict 
asepis be observed, which is almost impossible, scirrhous cord may result, 
and, as Johne has remarked, it appears unjust to hold the castrator 
alone answerable, as Henniger has done. 

(2) All influences favouring pus formation and inflammation in 
the operation wound favour development of scirrhous cord. Such are, 
too short an incision, or incision too far to one side of the scrotum, both 
of which conditions impede drainage; too small a wound also favours 
strangulation of the cord and formation of ‘ Champignon,” as shown by 
Trianon’s experiments. Castration by ligature is doubly dangerous if 
performed with non-absorbable materials, or with common and un- 
sterilised string. The lgature often remains in position a long time, 
promotes pus formation, and therefore the danger of infection. 

The inflammation spreads to the inner surface of the processus 
vaginalis, which soon becomes adherent to the spermatic cord; but the 


ote INFLAMMATION OF THE SPERMATIC CORD. 


connective tissue lying between the tunica vaginalis and tunica dartos 
is seldom affected. 

Symptoms and Course.—The swelling of the testicular cord does 
not completely subside after castration, but continues to discharge pus 
and slowly increases in circumference. This seldom receives early 
attention, and expert assistance is only called for when the owner 
fancies the discharge has lasted too long, or when acute cellulitis sets 
in and recurs from time to time. As soon as the fistulous aperture has | 


Fig. 99.—‘* Champignon ” formation in the horse—(a) thickened spermatic cord ; 
(6) processus vaginalis ; (c) thickening external to processus vaginalis. 


closed, the swelling suddenly increases, spreads to neighbouring tissues, 
including the connective tissue around the processus vaginalis, often even to 
the sheath itself, and only subsides when a new opening has been established. 
This acute cellulitis returns at varying intervals. It may, however, 
never occur, and the disease exist for an indefinite time without making 
much progress or occasioning disturbance, indeed without ever being 
recognised. The swelling, which is firm, hard, and slightly painful, 
sometimes remains confined to the lower end of the spermatic cord, but 
sometimes extends further upwards, and may even reach the abdominal 


INFLAMMATION OF THE SPERMATIC CORD. aie 


cavity. Less frequently the lower end escapes, and the swelling begins 
an inch or two above. At the point where the swelling is in contact 
with the skin, it is always attached to the base of the scrotum. 

The fistulous opening is small and funnel-shaped, and discharges a 
slight quantity of purulent fluid; a probe can be passed 2 to 4 inches 
into it. 

Prognosis.—As cure depends on complete excision, it is necessary 
to ascertain whether it is possible to operate, how far the cord is dis- 
eased, and then whether all diseased parts can be removed. Extension 
of diseased processes as far as the abdominal cavity renders the con- 
dition incurable. Examination from without and from the rectum will 
determine this; of 100 cases submitted to me, all proved amenable to 
treatment. 

When disease is less extensive, the swelling small and confined to the 
lower sections of the cord, the new growth can be destroyed by caustics, 
but where the inflammation and new tissue formation have extended to 
the outer surface of the processus vaginalis, greater difficulty is encoun- 
tered. These changes are indicated by extensive adhesions between the 
skin and new growth, and extension of the growth towards the inguinal 
region. 

Treatment.—Preventive measures are of great importance; the 
clams should be properly shaped, and, in applying them, the posterior 
part of the cord should not be cut through; ligatures are better avoided. 
After removing the clams, the spermatic cord should be completely 
returned to the tunica vaginalis, and exit of discharges favoured by 
moving the animal. 

When chronic inflammation has once set in, injections, setons dressed 
with sublimate, or the use of the actual cautery, seldom succeed, though 
they may be tried where operation is impossible. According to my 
experience, sublimate setons and the cautery are more efficient than 
injections ; but when the spermatic cord is extensively diseased, removal 
of the diseased part is alone useful. Though the period of acute cellulitis 
must be avoided, there should be no hesitation in performing the opera- 
tion, which is simple, and, if precautions against bleeding are taken, not 
dangerous. 

The horse is cast, the feet of the affected side fastened together, 
and the animal placed on its back. The operator then kneels behind it. 
The seat of operation is cleansed, and an oval piece of skin, sufficiently 
large to allow of the tumour passing easily through it, removed with the 
knife. Any skin adherent to the tumour must also be taken away, and 
care taken to favour drainage of wound discharge. 

A tape is passed through the subcutis of the isolated piece of skin 
and through the tumour, and is handed to an assistant, who pulls gently 


374 INFLAMMATION OF THE SPERMATIC CORD. 


on the spermatic cord. The operator now breaks down the tissues sur- 
rounding the diseased cord, which is covered by the processus vaginalis. 
Any bleeding vessels are at once ligatured. The tunica vaginalis, recog- 
nised by its bluish colour and smooth surface, soon comes in view, and 
is divided from the connective tissue surrounding it by thrusting the 
latter away with the fingers, assisted by the knife and scissors. The 
processus vaginalis must be exposed at least as far as it is adherent to 
the spermatic cord, and, if a pair of clams are to be applied over it, up 
to the highest point the disease has attained. I prefer this method ; 
and as soon as the upper end of the swelling is exposed, I apply a 
strong pair of clams over the spermatic cord and tunica vaginalis, and 
proceed, as in castration, by the covered method. In dealing with 
extensive swellings, a short pair of clams, which can be introduced into 
the operative wound, should be applied to the cord, so that, after removal 
of the degenerated part, they may remain, just as in the operation for 
inguinal hernia (p. 249). 

Where the disease extends so far upwards as to prove beyond easy 
reach, the tunica vaginalis is divided where it seems movable over the 
swelling ; the spermatic cord can then be drawn down, and the healthy 
portion included in the clams. In other cases the ligature or ecraseur 
must be used. I prefer a stout ligature, tying it as tightly as possible, 
and allowing the ends to hang below the skin wound, so that it may be 
removed if it does not fall away of itself. The elastic hgature is also 
valuable. The ecraseur does not prevent bleeding, and to avoid this, 
the wound, after being cleansed, is powdered with iodoform tannin and 
stuffed with carbolised jute, a few sutures being inserted to retain 
the tampons in position. The same means will control after-bleeding 
caused by the altered position of the blood-vessels when the horse rises. 

Dressing and clams remain in position for forty-eight hours; after 
removing them, the parts are washed out with sublimate or carbolic 
solution, again powdered with iodoform tannin, and treated as an 
open wound, After about eight days the ligature may be removed, if 
it has not come away spontaneously. Daily exercise favours drainage. 
Recovery generally occurs in fourteen days to a month, without com- 
plications. I have operated in the manner described on 100 horses, and 
have always had good results. 

If the new growth has spread outwards beyond the processus vaginalis, 
the subeutaneous connective tissue, which is infiltrated with small 
abscesses, must, as far as possible, be removed. Any remaining abscesses 
or fistule should be scraped out the curette, or dressed with con- 
centrated solution of chloride of zinc. 

New growths of the spermatic cord outside the processus vaginalis, 
termed “Champignon,” can sometimes be removed by ligature and 


INFLAMMATION OF THE SPERMATIC CORD. 375 


caustics. It is often possible to cut through the growth with a ligature 
or to scrape it away with the finger, though this is not satisfactory 
unless the cause, ae. the strangulation of the cord by the scrotum 
or processus vaginalis, be at the same time removed. Fig. 99 shows a 
“Champignon” formation caused by the protruding spermatic cord being 
strangulated by the scrotal wound. It was removed by ligature three 
months after castration. As a rule, however, it is best to remove the 
lower end of the spermatic cord in the above-described manner, otherwise 
scirrhous cord almost always develops. Degive passes a metal rod 
through the swelling after the ecraseur has almost cut through the 
spermatic cord, turns that portion of the cord lying within the ecraseur 
chain once or twice around its long axis, and then completes the opera- 
tion. This he terms “torsion bornée.” 


LX. DISEASES OF THE FEMALE ORGANS OF 
GENERATION. 


As the greater number of these diseases are considered in works on 
special pathology and obstetrics, I confine myself to a short review of 
those which necessitate surgical interference. 


I—INJURIES AND INFLAMMATION OF THE VULVA, 
VAGINA, AND UTERUS. 


Lit.: Giese, Th. Mtth. 1876, p. 95. Buhl, Gurlt. u. Hertwig, 8, p. 489. 
Siedamgrotzky, Dresd. Ber. 1885, p.20. Baumgiartel, ibid., p. 79. 
Hess, Schweiz. Arch. Bd. 37, Cook u. Awde, Jahrb. 1891, p. 111. 
Dieckerhoff, B.T. W. 1890. Geyeru. Schmidt, Ad. Woch. 1892. 
Dieckerhoff, B. T. W. 1891, p. 347. 


In cows, the labia pudendi are most frequently injured by horn- 
thrusts ; in mares, occasionally, by their being run into by vehicles ; in 
all species of animals, during delivery by violent and unskilful mani- 
pulations. In such cases rupture of the permeum is common. In 
cows, the vagina is sometimes wounded, though seldom seriously, by 
the application of the vaginal truss for the purpose of retaining the 
prolapsed vagina or uterus; sometimes, however, severe diphtheritic 
inflammation results, and extends over the vagina (Siedamgrotzky). 
These conditions seldom require surgical interference, and must be 
treated on general principles. Sometimes wounds require opening up 
to allow of better drainage ; sometimes healing can be assisted by care- 
fully applied stitches. 

Extensive wounds and excoriations of the mucous membrane of the 
labia pudendi may lead to occlusion of the vulva. Apropos of this, a 
case of Giese’s may be quoted :—An 18 months filly exhibited occlusion 
of the vulva from its upper angle as far almost as the clitoris, where an 
opening the size of a goose-quill remained, from which urine was dis- 
charged in a thin stream. Giese divided the adhesion ; but as it recurred 


INJURIES AND INFLAMMATION OF THE VULVA, ETC. BVA 


several times, it was found necessary to pass the hand into the vagina 
daily and dilate the vulva. Under this treatment perfect recovery 
occurred. 

Geyer noticed occlusion of the vagina in three calves two to three 
weeks after birth; im two cases it was possible to break down the 
adhesions. After the discharge of several quarts of a reddish, turbid, 
ill-smelling fluid, Geyer washed out the vagina with 1 per cent. creolin 
solution, and recovery followed. In the third calf the entrance to the 
vagina was too narrow to admit even a single finger. After repeatedly 
passing the trochar, the animal was fattened for slaughter. 

Schmidt describes a calf which had eight days previously been 
bulled, and had immediately bled freely ; the vagina was closed by a 
membrane in front of the opening of the urethra. Excessive dilata- 
tion of the vagina rendered the passage of feces difficult. After per- 
forating the membrane with a trochar, increasing the opening with 
the finger and hand, and washing out the parts with creolin solution, 
healing occurred in fourteen days. In this case also four to five quarts 
of a whitish, ill-smelling fluid were discharged. The hymen was probably 
unusually resistant. 

Wounds of the vagina in cows are commonest after prolapse 
(p. 380), or after parturition, especially in primipare. Sometimes the 
surface alone is injured or the mucous membrane excoriated, though 
deep tears in the tissues, and even perforating wounds of the vagina, 
are also seen, particularly in the large animals. Baumgiirtel saw a per- 
forating wound of the vagina caused by the penis of the stallion during 
coitus. It must be remembered in these cases that the posterior part of 
the vagina is surrounded by loose connective tissue, which connects it 
above with the rectum, and below with the os pubis. In the mare, this 
connection extends about 5 inches in a forward direction, and below 
rather farther (Franck). Perforating vaginal wounds, therefore, lie 
farther forward, and must always be regarded as serious, both on account 
of the danger of peritonitis and of prolapse of the bowel. In mares, 
peritonitis is most to be feared. Prolapse of the bowel is particularly 
favoured by straining, which is almost always present after such injuries, 
and by the entrance of air into the peritoneal cavity, which sometimes 
causes very great distension. 

Hemorrhage is less grave, unless the blood passes through a perforating 
wound into the peritoneal sac, when it decomposes, and leads to purulent 
peritonitis. Surface injuries require attention only in pregnant animals, 
in which decomposed infectious substances, always developed in the after- 
birth, readily initiate such septic disease as puerperal fever. The danger 
is greater in summer than in winter, particularly if the after-birth is long 
retained. For the same reason, wounds of the lower vaginal wall are 


378 INJURIES AND INFLAMMATION OF THE VULVA, ETC. 


graver than those of the upper, but even perforating wounds generally 
heal without bad results, as is well shown by the results of castrating 
animals after Charlier’s method. 

The treatment of non-perforating wounds of the vagina requires 
particular care in pregnant animals, and soon after parturition. The 
placenta must be removed as soon as possible, and the vagina and 
uterus repeatedly washed out with creolin, carbolic, or alum solution ; in 
mares, diluted sublimate solution (1 in 5000) may also be employed. 
Injuries to the vulva or its neighbourhood should be swabbed with 10 
per cent. solution of chloride of zine, so as to form an eschar, and 
diminish the chance of absorption through the wound. It is better to 
avoid washing out perforating wounds, because of the danger of thus 
causing peritonitis. If within reach, as for example in prolapsed organs, 
such wounds may be sutured before reducing the prolapse. 

Wounds of the uterus are caused, during parturition, by instru- 
ments or the little animal’s feet, and in cases of prolapse, by external 
violence ; rupture of the pregnant uterus has also been seen. Whether, 
as has been stated, rupture is produced by dropsical conditions of the 
membranes seems doubtful; more frequently it results from violent 
interference when the foetus is in an awkward position. 

Buhl found the uterus of a young pregnant cow completely torn away 
from the vagina, and adherent to the rectum, between which and the dis- 
placed uterus a communication existed ; feces had entered the uterus, 
whilst the bones of the foetus were almost completely exposed by decom- 
position of the soft parts, and some had penetrated into the rectum. 

Hess saw a similar case: a three-year-old cow which had been 
covered in February, did not calve by November, and was therefore 
fattened ; in the following spring, on its being slaughtered, the neck of 
the uterus was found to have been ruptured, and to have again united 
in a globular form. The uterus containing the calf lay in the left 
lower flank, suspended by the broad uterine ligament. It was 20 
inches in length, and weighed nearly 40 Ibs. The skin already showed 
erowth of hair, and the two nipping teeth were distinctly developed ; 
the foetus, when separated from the uterus, was therefore about eight 
months old. Hess thought that torsion of the uterus was responsible for 
the rupture. 

The principles laid down in speaking of wounds of the vagina 
apply equally to the prognosis and treatment of uterine injuries. As 
long as the cervix uteri remains closed to infection, injuries like ruptures 
of the uterus seldom produce grave results. Certainly they are some- 
times followed by abdominal pregnancy and death during parturition, 
while extensive ruptures may also take a fatal course in consequence of 
excessive bleeding. It is quite otherwise in injuries occurring during 


INJURIES AND INFLAMMATION OF THE VULVA, ETC. 379 


parturition. Even slight wounds of the uterus then become grave ; and 
in mares, perforating wounds almost always prove fatal. 

The gravity of injuries to the prolapsed uterus is determined by their 
extent and character, and the degree of general disturbance. When 
colic, fever, and continuous severe straining exist, and when in carnivora 
vomiting occurs, little can be done, though even such cases should not 
be abandoned. 

The prolapsed parts should be carefully cleansed, bleeding checked 
as far as possible (for the greater the quantity of blood which accumulates 
in the uterus when replaced, the greater the danger of decomposition), 
any remaining after-birth removed, wounds sutured, and the organ then 
replaced (p. 383). 

Inflammation of the vagina or uterus most generally results from 
parturition, and is treated of in the study of obstetrics. Certain forms 
of purulent inflammation occur, however, in non-pregnant animals, 
especially soon after coitus, and in young cattle, and are apt to take a 
chronic course. Such conditions have repeatedly been described by 
English veterinarians (Cook, Awde). Recovery is stated to rapidly 
follow washing out the vagina and uterus with carbolic solution or other 
antiseptic fluid. 

Cases of infectious fluor albus in oxen (vaginitis, kolpitis purulenta) 
have often been described in Germany (Martens, Wilhelm, Dieckerhoff). 
Martens found the disease throughout a certain district, and believed it 
was spread during coitus. He recommends irrigation of the vagina with 
dilute acetate of alumina, which is also said to be a useful prophylactic 
-against infection, and for this purpose is syringed into the bull’s prepuce. 
Wilhelm gives 75 grains of salicylic acid in about 12 pints of linseed 
tea once daily, discontinuing it on the fifth or sixth day, and later 
repeating the course two or three times. 

Dieckerhoff noted a severe infectious vaginitis in cows and mares. 
Cows affected by it invariably perished ; and though the disease was less 
severe in mares, some of them also died. The disease (kolpitis per- 
niciosa, D.) set in with fever, and the vaginal inflammation was 
associated with a tendency to the formation of blisters and ulcers. <A 
blood-stained exudation was found in the abdominal cavity on post- 
mortem. The disease developed after a short incubation period (twelve 
to twenty-four hours), and generally proved fatal in a few days. Dis- 
infection of the vagina with carbolic or creolin solutions had no visible 
effect. In this case also the disease must principally be combated by 
protective measures. 


380 PROLAPSE OF THE VAGINA. 


Il.—PROLAPSE OF THE VAGINA (PROLAPSUS VAGINA). 
Lit.: Koepke, Berl. Archiv. 1891. 


Prolapse of the vagina is most frequent in cows and swine, rarer in 
horses ; Koepke, however, describes a case in a three-year-old filly. The 
prolapse occurred suddenly, was as large as a man’s fist, and later dis- 
appeared spontaneously. 

The disease depends on displacement of the uterus backwards and 
extension of its ligaments,—conditions usual after repeated pregnancies. 
It is favoured by tympanites, distension of the abdomen, continuous 
stall-feeding on distillers’ grains (Bang); distension of the abdomen, 
pressure of the foetus, severe straining on the part of the animal, and 
particularly by standing in sloping stalls; it is seldom seen when 
animals are in the open. It is commonest in pregnant subjects, especi- 
ally during the latter period of pregnancy, though it also occurs after 
parturition. In pregnant animals the vagina appears beyond the vulva 
when the animals are lying down, but disappears immediately on rising. 
Strictly speaking, the disease consists of eversion of the vagina, in which 
the upper wall is most frequently displaced. When the vagina only attains. 
the vulval opening, a round red swelling of varying size, covered with 
mucous membrane, appears (incomplete prolapse). Less frequently a 
large portion of the vagina protrudes beyond the vulva, in which case 
the opening of the uterus is visible in the middle of the swelling, which 
is about as large as a man’s head, and displays, on its lower surface, the 
opening of the urethra. In prolapse of some duration, the surface of 
the mucous membrane, previously of a rose-red colour, gradually dries, 
and not infrequenly meets with injury from the animal lying down, or 
from the parts being trodden upon, sometimes from attempts to replace 
it. During this time the patient strains continuously, and frequently 
passes urine. Prolapse occurring after delivery seldom disappears of 
itself, the vagina remaining continuously displaced until it receives 
proper attention. : 

Prognosis.—Incomplete prolapse is usually only of importance in 
breeding animals, but here demands attention on account of its recurring 
after every pregnancy, and interfering both with the animal’s con- 
dition and milking qualities. Injury may also cause inflammation of 
a dangerous character. 

Complete prolapse is always grave, doubly so in pregnant animals, 
because of its almost invariably interfering with parturition. Prolapse 
in non-pregnant animals often occasions injury and inflammation of the 
vagina, which reduce the production of milk, and greatly lower the breed- 
ing value of the animal. 


PROLAPSE OF THE VAGINA. 381 


In swine, the prognosis is still more unfavourable, because of the 
difficulty in treatment. 

Treatment.—As a preventive, the animal must be placed in a 
proper stall, so arranged that the hindquarters are at least as high as 
the fore. Most other precautions necessitate increased outlay, thus 
rendering their adoption out of the question. The most important is, 
of course, to prevent the animal breeding. 

In reducing a complete prolapse—the incomplete form generally 
returns of itself—the cow is placed with the forelimbs lower than the 
hind. By introducing the finger into the urethra, the bladder is first 
emptied, the parts then cleansed as far as possible, any existing wounds 
sutured, and endeavours made to return the vagina through the vulva 
by placing the open hand against the swelling and gradually pressing 
it forwards. On attaining the vulval opening, the hand should be 
closed without relaxing the pressure, and the prolapsed vagina thus 
returned to its normal position. The operator takes advantage of the 
intervals between straining, and retains the hand in the vagina until 
these efforts stop. 

To ensure retention in pregnant animals, trusses are employed, 
which partly close the vulva. Sauberg’s vaginal ring is of the same 
character, a metallic ring, which is passed through the lips of the vulva. 
When these are not available, a couple of wire sutures may be passed 
through the vulva. The wire must be thick enough to prevent tearing 
out or injuring the vagina when it is pressed forwards. 

In sows, reposition is assisted by holding up the hind-legs. The 
prolapsed parts are cleansed, and an attempt made, during an interval 
when the animal neither strains nor cries, to thrust back the swelling. 
The vulva can be closed with a couple of sutures. 

If the prolapsed vagina be greatly swollen, bathing with 2 to 3 per 
cent. solution of alum will assist reposition. 

In bitches, partial prolapse of the upper wall of the vagina occurs, 
which is very frequently mistaken for a tumour (p. 386). 


IIl—PROLAPSE OF THE UTERUS (PROLAPSUS UTERI). 


Lit.: Favereau, Rec. de Med. vétér. 1892, p.16. Becker, B. T. W. 1892, 
p. 304. Geiger, Ad. Woch. 1890. Krautheim,’ ibid. 1890. 
Franck, Bad. Mitth. 1890, p. 161. Strebel, Schweiz. Arch. Bd. 33, 
p. 49. Borgeaud, ibid., 1891, p. 115. K6rner, Ad. Woch. 1882. 
Wiesner, Zeitsch. f. vet. Kund. 1892, p. 497. Neidhardt, Ad. 
Woch. 1892. 


This disease, frequently seen in cows and swine, but very seldom in 
other animals, really consists in eversion of the uterus, the surface of 


382 PROLAPSE OF THE UTERUS. 


the prolapsed organ appearing covered with mucous membrane. The 
condition, therefore, is somewhat like eversion of the bladder, but can 
only occur when the cervix uteri is relaxed, and in consequence its 
occurrence is almost exclusively confined to the period of parturition. 
Partial displacement of the uterus is certainly imaginable, even with a 
closed cervix, if the extremity of one or other horn should become 
intussuscepted (like the finger of a glove). Though the process cannot 
be detected in the living animal, it probably represents the first step 
towards prolapse, the straining it occasions finally causing displacement 
of the entire organ. 

Such invagination may remain after prolapse if the uterus and its 
cornua are not completely returned. In mares, the anterior portion of 
the displaced uterus is sometimes strangulated in the cervix uteri, 
generally producing fatal issue. A similar accident has been seen by 
Neidhardt in cows. 

In any case, prolapse of the uterus presupposes elongation of the 
uterine ligaments, and therefore the factors predisposing to prolapse of 
the vagina predispose to this disease. They consist in too high a posi- 
tion of the fore-limbs, repeated pregnancy, &c.; the immediate causes are 
generally severe straining and excessive labour pains. Retention of the 
after-birth is one of the chief, partly because the cervix then remains 
open for a long time, partly because the manipulation necessary to 
remove the after-birth favours inversion. Violent interference during 
parturition may also give rise to it. Relaxation of the cervix is the 
second necessary condition ; the disease is therefore rare, except soon 
after delivery. 

Symptoms.—aAs already remarked, incomplete prolapse, 7.e., inver- 
sion of a portion of the uterus, is seldom directly observed, though it 
sometimes causes metritis and death; usually, however, it may be 
detected by introducing the hand into the uterus. 

In complete prolapse of the uterus, a swelling, covered by mucous 
membrane, and similar to that in prolapsus vagine, appears beyond the 
vulva. In cows, it resembles a half-filled sack; in. mares, its form 
is more cylindrical, the organ sometimes reaches as far downwards as 
the animal’s hocks; the surface is not infrequently covered by after- 
birth, but if the latter has already been removed, the cotyledons, 
which in cattle have a mushroom-lke form, are exposed. The surface 
gradually dries, and often becomes soiled and wounded. In swine, the 
prolapsed uterus is not infrequently bitten by the other occupants of 
the sty. 

The prognosis is most favourable in cows, provided the uterus is 
not much injured... Reposition, though certainly not easy, is yet 
generally possible, and if not, the animal’s life can, as a rule, still be 


PROLAPSE OF THE UTERUS. 383 


saved by amputation. In other animals, and particularly in mares, the 
disease takes a graver, and usually fatal, course, especially if the uterus is 
much damaged. Fenner, however, cured a mare after suturing a wound 
about 4 inches in length, involving the mucous and muscular coats. 
Korner removed the uterus in a mare by ligature, and had good results. 
Violent pains and delirious attacks certainly occurred, but only lasted 
one day. 

Not infrequently the uterus or vagina is ruptured, leading to prolapse 
of the rectum, in which case the animals always die unless assistance is 
promptly afforded, and often even when it is. 

Treatment.—The organ must first be protected from injury by 
applying a clean cloth. Provided the parts are not much injured, and 
the tissues have undergone no great change, reposition should be 
attempted. The operation is assisted by placing the animal with the 
front quarters lower than the hind; but if it cannot stand, it is placed 
on its back, with the hind-limbs as high as possible. 

Anesthesia greatly assists reposition. Bang recommends giving the 
cow 7 to 20 grains of morphine, and a further dose of 6 to 10 drachms 
of chloral hydrate, by the mouth or in a clyster. Failing this, 1 to 2 
pints of brandy may be given. To diminish the severe straining as 
much as possible, continuous powerful pressure must be exercised over 
the loins; if the animal is standing, a sack full of sand may be laid on 
the back (Esser). 

After carefully cleansing the prolapsed parts with 3 per cent. creolin, 
or, if much swelling exists, 2 per cent. alum solution, and removing 
any traces of placenta, the operator must discover whether any deep 
injuries exist. The first portions to be replaced are those lying nearest 
to the vulva, particularly the upper sections, the other prolapsed parts 
being meanwhile supported; an attempt is then made to thrust these 
through the vulva into the vagina, and to pass the entire mass as far 
forward as possible. To prevent ruptures and to assist replacement, the 
manipulations are made when the animal is not straining. By stretching 
out the fingers within the uterus, the folds may be completely got rid 
of—the same object is served by injecting luke-warm water; in cows, 
several bucketsful may be required. 

Becker uses Giinther’s parturition crutch. Using the half-closed 
hand, he thrusts the lowest portions of the uterus as far as possible into 
the vagina and pelvis, then introduces the previously well-oiled rounded 
end of the crutch along the arm as far as the hand, and, whilst retaining 
the crutch with the other hand, withdraws the arm from the vagina. 
An assistant holds the crutch firmly, without thrusting it further 
forward, while the operator, by using both hands, passes any portion 
of the uterus still in view into the vagina, reintroduces the right arm, 


384 PROLAPSE OF THE UTERUS. 


removes the crutch, and endeavours to bring the uterus into its proper 
position. The assistant then passes his left arm into the vagina or 
uterus alongside the operator’s right, closes his hand, and whilst the 
operator removes his arm, that of the assistant remains for an hour in 
position. The cow is watched for the next ten to twelve hours to pre- 
vent her again straining, in which case the hand should be pressed 
against the vulva. If possible, the animal should, after reposition, be 
kept standing. 

In order to ensure retention, the arm must be kept some time in the 
vagina, and only be withdrawn when straining stops. The animal is 
then placed with the hind parts higher than the fore; it is even better 
if it be kept standing, or be slowly moved. By introducing small 
pieces of ice or a little cold water, contraction of the uterus is excited, 
and fresh prolapse prevented. The measures recommended in prolapse 
of the vagina may be tried; for example, the truss, the vaginal ring, and 
the suture, though Favereau has rightly remarked that they are seldom 
of much use. Complete reposition, and the return of the entire uterus 
and its horns to their proper position, is of much greater importance. 
Closure of the vulva is only of value in preventing injury to the pro- 
lapsed parts; and, according to Strebel and Borgeaud, is most easily and 
securely effected by using brass-wire sutures. Borgeaud passes a thin 
trochar from right to left through the lips of the vulva. After drawing 
back the stilette, a brass-wire suture, provided at one end with a leather 
button, is passed from left to right through the trochar, the trochar 
removed, and a leather button adjusted on the other end of the wire to 
prevent its tearing out. Two or three sutures of this sort are suffi- 
cient. 

When reposition is impossible, or the tissues of the prolapsed organ 
are much damaged, amputation is the only resort. In cows it is 
simple, and not particularly dangerous. St Cyr lost six animals of a 
total of twenty-five; Franck describes thirty cases of amputation, of 
which four (two cows and two goats) had to be slaughtered. When the 
animal is not cast, precautions must be taken against its lying down 
or kicking the operator. The surface is then cleansed, and care taken 
to discover by palpation that no portion of bowel is included in the 
inverted uterus. A strong tape or cord, in the form of a surgical snare, 
is then passed round the neck of the uterus, avoiding the urethra, and 
drawn very tight. In this case, as in all where large masses of tissue 
have to be ligatured, it is necessary to proceed slowly. ‘The ends of 
the cord are tied to pieces of stick to ensure a better purchase, and the 
ligature is drawn tight; the operator then waits a few seconds to allow 
the tissue fluids to filter away, and again tightens the cord; if the 
prolapsed uterus is much swollen, the procedure requires repeating 


PROLAPSE OF THE UTERUS. 385 


several times. Esser and Brugel recommend the elastic ligature. 
Krautheim operated on swine, and Franck on sheep and swine, by 
means of the elastic ligature, both with success. After applying the 
ligature, the organ is cut away. 

In large animals, and where swelling is great, amputation by multiple 
ligature is to be recommended, or the mucous membrane can be divided 
and the ligature applied to the muscular and serous coats. These 
methods, however, have no particular advantage over that above de- 
scribed. Bang also prefers the ligature; the portion thus tied off can 
at onee be cut away, but should movement of the ligature be feared, or 
further tightening become necessary, amputation may be postponed till 
next day. In such cases care must be taken that the weight of the 
uterus does not cause it to tear away, as such complications are often 
difficult to deal with. Hering recommends, where the animal is able to 
stand, to lay the prolapsed parts on its quarter. Without question, 
however, 1t is better to remove them at once, if for no other reason than 
the fact that this allows of reposition of the vagina. To remove inflam- 
matory products, discharges from wounds and from the ligatured stump, 
the vagina must be repeatedly washed out during the following days. 
If swelling is severe, it may be necessary to pass the catheter. Should 
further prolapse of the vagina result from severe straining, either the 
truss, one of Sauberg’s vaginal rings, or a few metallic stitches may be 
passed through the vulva. 

In bitches, the uterus has repeatedly been amputated with success. 
In them also the displacement of the pregnant uterus, in inguinal hernia, 
may render the operation necessary. Antisepsis must, as far as possible, 
be practised, as in abdominal injuries, though in prolapse of this nature 
its complete observance is impossible. 

In small animals, and especially in goats, Geiger reduced prolapse of 
the uterus by injecting water. The animal’s hind-legs were held up, the 
smaller horn of the uterus reduced and filled with lukewarm water. 
The weight of the water carried back the horn or the uterus to its 
normal position. After the second horn has been replaced by the same 
method (though great difficulty is often met with here), the uterus is 
also filled with water, and after replacement, the fluid is allowed 
to escape by placing the animal in the horizontal position. Geiger 
sutures the lips of the vulva with a loose button suture, which he leaves 
in position for three days. 


bo 
ise] 


386 TUMOURS OF THE VAGINA AND UTERUS. 


IV.—TUMOURS OF THE VAGINA AND UTERUS. 


Lit.: Heckmann, Her. Rep. 12, p. 335. Zipperlen, ibid., 14, py Lie: 
Leblane, Gurlt u. Hertwig. 1, p. 252. Martin, Berl. Th. Woch. 1890, 
p. 657. Franck, Geburtshilfe, p. 246. Miiller, Dresd. Ber. 1884, p. 
36, u. 1887, p. 18. Stephan, Gurlt u. Hertwig, 1, p. 106. Linden- 
berg, ibid. 12, p. 84. Eggeling, Th. Mitth. 1882, p. 67. Esser, 
ibid., p. 27. Roder, Dresd. Ber. 1889, p. 77. Gratia, An. de Med. 
vétér. 1890, v. Bockum-Dolffs, Thiermed, Rundschu. 1891, p. 146. 
Eckhardt, Ad. Woch. 1890. Briller, Jahrb. 1891, p. 111. Hege- 
lund, ibid., p. 114. 


As a rule, diseased new growths in these organs are commoner in 
the human species than in animals. Fibromata in particular seldom 
attain the extensive development here which they do in the human 
subject, though fibromata, carcinomata, sarcomata, and especially reten- 
tion cysts have repeatedly been seen in the vagina of cows. Such 
tumours also occur in bitches (fibromyomata, Miiller), but are rare in 
other animals. 

In dogs, partial prolapse of the upper wall of the vagina sometimes 
occurs, attended with severe swelling in the prolapsed part, and is 
generally regarded, and even treated, as a fibrous new growth. A pale 
red ovoid swelling suddenly appears in the vulva, generally attains the 
size of a hen’s egg, and cannot be returned, or if returned, soon appears 
again, The disease is commonest during the time of heat, and after 
successful coitus. 

Heckmann found in the vagina of a bitch a pedunculated polypus, 
which arose from the right wall, and was removed by  lgation. 
Zipperlen describes a polypus on the cervix of a cow; Leblanc a similar 
erowth in a bitch. 

In cows, the most common growths are cysts, which occur in the 
vestibule of the vagina, particularly on the left side. They result, 
according to Miiller and Roder, from blockage of Bartholin’s glands, 
while those occurring close behind the opening of the urethra are 
regarded by Marten as due to occlusions of Wolff’s duct. Eggeling 
detected, in a cow’s vagina, a sarcoma telangiectodes, which led to death 
by bleeding during parturition. I have repeatedly found ulcerating 
carcinomata both in cows and bitches; Bang saw carcinoma of the - 
vestibulum vaginz in a cow. 

Apart from tuberculosis, the urethra is seldom the seat of tumours, 
and still less frequently does it call for surgical treatment on their 
account. The changes, often described as schirrous, probably result 


TUMOURS OF THE VAGINA AND UTERUS. 387 


from endometritis chronica, though polypoid new growths occur, and are 
sometimes of considerable extent; Bedenberg found in the uterus of a 
cow a tumour which weighed between 28 and 30 lbs. I have repeatedly 
seen carcinomata and sarcomata in bitches; Esser found a fibroid of the 
uterus in a cow. 

In a cow which had suffered from periodical bleeding from the vulva, 
Eckhard found a fibroma of the uterus, weighing 52 lbs. Gratia, in a 
cow, discovered a large fibromyoma that had existed for several years, 
and had repeatedly caused profuse bleeding. As the new growth 
rendered parturition difficult, it was removed by ligature, but the 
animal died from acute peritonitis. Von Bockum-Dolffs found tuber- 
culosis of the uterus in a cow which had been regarded as pregnant. 
The animal was found, on slaughter, to have general tuberculosis, the 
uterus being greatly distended with caseous material. 

Symptoms.—Tumours of the vagina sometimes appear beyond the 
vulva during urination, and becoming strangulated, are at once recog- 
nised; their position and extent are detected by palpation. ‘The same 
is true of new growths within the vagina. They seldom give trouble 
unless when of large size, and then because they injure the animal’s 
appearance, or interfere with parturition or urination. They frequently 
produce bleeding or chronic discharge from the vagina, which, in the 
case of ulcerating new growths, takes on a purulent character. The 
cysts which occur in cows sometimes protrude from the vulva, appearing 
as bladders about the size of a hen’s egg, and containing clear or turbid 
fluid. 

Tumours of the uterus are seldom recognised until they produce 
difficulty in parturition; they often render animals barren. In the 
larger species they can be discovered by rectal examination. Tuber- 
culosis sometimes produces great increase in size, either in one horn or 
in large tracts of the uterus. The Fallopian tubes then appear like 
hard cords as thick as a man’s finger, arranged in curves. 

Prognosis depends chiefly on whether the growth can be entirely 
removed. This is, of course, easier in vaginal than in uterine tumours. 
In pregnant animals uterine tumours become much more dangerous ; 
and those which produce severe straining, and thus favour prolapses, are 
particularly troublesome. Vascular tumours may cause death by bleed- 
ing (Eggeling),. 

Treatment consists in operative removal. Pedunculated tumours 
can be ligatured, and multiple ligation is also the best method of dealing 
with partial prolapse of the vagina in bitches. Tumours lying further 
forward may sometimes be grasped with the ecraseur, cysts are burst by 
the pressure of the hand; if necessary, the operation can be repeated, 
and the base of the tumour cauterised. 


388 DISEASES OF THE MAMMARY GLAND. 


Miiller treated a bitch with fibromyoma, complicated with prolapse of 
the vagina, by injecting ergotin (extr. sec. corn. grs. vil, spirit. dil. et 
glycerin. a. m. lxxv.): of this fluid m. xv. were hypodermically injected 
at the most convenient spot. In four weeks the swelling had greatly 
diminished, and complete recovery finally occurred. 


V.—DISEASES OF THE MAMMARY GLAND. 


Lit.: Fiirstenberg, Die Milchdriisen. 1868. Bang, Stockfleths Chirurgie. 
Docter, Gurlt. u. Hertwig. 19, p. 443. Deupser, Berl. Th. Woch. 1891, 
p. 107. Kunze, Dresd. Ber. 1891, p. 99. Eggeling, Thierarail 
Mitth. 1891, p. 71. Schwarz, B. T. W. 1892, p. 69. Sand, Deutsch. 
Zeitschr. f. th. Med. Bd. 19. Svend Larsen, Monatsschr. f. pr. Th. 
1893, p. 289. 


The mammary gland consists of parenchymatous tissue and stroma. 
The formation of the former is partly alveolar, partly tubular. In the 
connective tissue of the stroma le variously shaped spaces, lined by a 
membrana propria, which (like the alveoli of the lung in the smallest 
bronchi) open by gland ducts. Both are lined with low cylindrical 
epithelium, and together form the milk-secreting tissue. The milk 
flows thence into the milk ducts, to pass either directly outwards 
through the teat (man and carnivora), or in herbivora, into a large 
cavity at the base of the teat, termed the galactophorous sinus. The 
ruminant’s udder possesses only one galactophorous sinus and teat for 
each division ; in the mare’s udder every teat is supplied by two sinuses 
From the galactophorous sinus a narrow canal, lined with mucous 
membrane, leads to the outer air, and in mares two of these, therefore, 
exist in every teat, in ruminants only one. In swine, each teat may 
sometimes have two delivery ducts. In herbivora, then, each teat 
corresponds to a particular division of the udder; in cows, to a 
quarter; in sheep and goats, to one-half of the udder. In carnivora 
the divisions of the udder are, externally, not so sharply bounded, 
and each is connected with the 8-12 openings on its corresponding 
teat. 

The stroma consists of connective tissue and elastic fibres, which form 
a capsule under the skin, and surround the udder. From this capsule 
the stroma is continued inwards into the gland, filling the space between 
the alveoli and ducts of the gland, and is analogous to the interstitial 
connective tissue of the lungs. The quantity of stroma varies. 
During lactation it diminishes, and in place of it alveoli develop. In 
the udder of young animals, connective tissue predominates. Between 


WOUNDS AND BRUISES OF THE MAMMARY GLAND. 389 


the larger divisions of the gland and their ducts lie considerable masses 
of connective tissue, which often contain elastic fibres and fat. 

A double system of lymph vessels exists in the udder ; the one lying 
near the surface arises from the capsule, and is connected with the 
lymph vessels of the skin; the other invests the alveoli, which are 
surrounded by fine lymph vessels. Fiirstenberg distinguished between 
the surface lymph vessels arising close under the skin of the udder, which 
pass into the depths along with the chief veins, and those which arise 
from the plexus in the interior of the gland, and accompany the deeper- 
lying venous branches. Fiirstenberg states that during lactation the 
lymph vessels appear to be distended with lymph. He also succeeded 
in filling them with air from the milk ducts, and discovered a valvular 
arrangement in them. 

The alveoli are directly surrounded by lymph capillaries, which in their 
turn are surrounded by capillary blood-vessels; according to Rauber 
these lie partly in the lymph spaces, into which they pour fluid contents 
and leucocytes, particularly during lactation. The white blood-corpuscles 
are stated to pass hence even into the alveoli of the gland. This inti- 
mate relationship between the alveoli and the blood and lymph vessels 
is of the greatest importance in studying the development of disease of 
the udder. 

The skin covering the udder shows no special peculiarity ; it possesses 
few or no hairs, but, on the other hand, has in places well-developed 
sebaceous glands and large papillary bodies. 

In cattle, the skin of the teats is free of glands, and has no hair. In 
the teat of the mare, especially near the opening of the milk canal, 
many glands are found. In sheep and goats, the skin of the teat is 
covered with a soft hair, and is rich in glands, particularly at its lower 
end. In swine, the teat is devoid of hair and glands; but in dogs, single 
hairs and sebaceous glands exist. 

1. Wounds and bruises of the udder and the teats are most 
frequent in cows, and are caused by treads; animals with large pen- 
dulous udders may even tread on their own teats when rising. Similar 
injuries are also caused by bites (from dogs) or by sharp objects like 
thorns, when the animal leaps through or over hedges. Sometimes the 
skin is divided, sometimes only bruised. 

Surface wounds—that is, such as neither penetrate the glandular sub- 
stance nor the milk ducts—are of no particular importance, and may be 
treated on general principles. Considerable bleeding sometimes occurs 
at the base of the teat; and should the wound open into the gland, there 
is some danger of the formation of milk fistule. Though healing then 
appears to proceed satisfactorily, cicatrisation fails to occur, on account 
of the milk continuously flowing away. The wound nearly closes, but 


390 DISEASES OF THE MAMMARY GLAND. 


leaves a little funnel-shaped opening, termed a milk fistula. This is, 
however, only to be feared during lactation. Injuries of the teat may 
produce cicatricial contraction, and consequent difficulty in milking. 

Bruises of the udder cause bleeding, either into the gland ducts, the 
milk then being mixed with blood, or into the tissue of the gland, the 
skin, and subcutaneous tissue. The blood may be absorbed, as in other 
soft parts, or lead to formation of pus or to putrefactive changes. 

Treatment.—In all deep wounds of the udder the first object 
should be to obtain healing by first intention, which will most certainly 
prevent the formation of milk fistula. Provided the injury be still 
fresh, and seem to warrant such an expectation, the edges of the 
wound are carefully disinfected and sutured. The gaping of wounds on 
the teats and escape of milk can sometimes be prevented by applying a 
well fitting india-rubber ring, which, however, must not be too tight ; 
adhesive plaster, collodion or wound gelatine may be employed for the 
same purpose on the hairless or previously shaven udder. Hertwig re- 
commends a liniment of alum and albumen, which should be applied 
to the thickness of an eighth of an inch or more. During lactation, 
however, every means may fail, because the udder is continually filling 
and emptying, and the skin changing in position. The use of a 
milk catheter, however, by allowing the milk to discharge from the 
affected section, often gets over the difficulty and ensures healing by 
primary intention. If healing by first intention be no longer possible, 
treatment must follow general principles. By observing careful relative 
antisepsis, the burrowing of matter and cellulitis can be prevented. 
Closure of fistule may be sought by using caustics or the actual 
cautery ; during treatment a milk catheter should be inserted. All 
other methods failing, the end of the lactation period must be awaited, 
when the fistula can generally be closed by cauterising with nitrate of 
silver, 

Bruises, accompanied by the passage of blood-stained milk, require the 
udder and the teats to be most carefully kept clean, so as to prevent 
infection. The removal of the blood and milk is best effected by 
catheter. Moist warmth in the form of poultices assists resorption. 


(2.) ACUTE INFLAMMATION OF THE UDDER (MASTITIS 
ACUTA). ITS PATHOLOGY AND VARIETIES. 


Lit.: Fiirstenberg, Die Milchdriisen. Leipzig. W. Engelmann 1868. Ger- 
lach, Gurlt u. Hertwig. 20, p. 299. Franck, Geburtshiilfe. Kitt, 
Deutsche Zeitschr. f. Thiermed. 2, p. 21, 12, p. 1, u. Jahrb. 1890, p. 117. 
Schlosser, Deutsch. Zeitschr. f. Thiermed. 9, p. 260. Dieckerhoff, 


ACUTE INFLAMMATION OF THE UDDER. oul 


Ad. Woch. 1878 u. Jahrb. 1885, p. 94. Strebel, Schweiz. Archiv. 
1881 res. im Jahrb. 1882, p. 84, u. 1888, p. 130. Johne, Dresd. Ber. 
1880p: 22. eo, 1883, p. 41, u. 29, 1884, p. 107.) Noeard u. 
Mollereau, Jahrb. 1885, p. 95, us 1887, p. 79. Weigenthaler. 
Ad. Weoeh, 1886: u. 1888. Trachsler, -Jahrb. 1886; p. 126. 
Tolstouchow, Jahrb. 1886, p. 126. Faletti, Jahrb. 1887, p. 79. 
Bossi, ibid., 1888, p. 131. Bang, ibid. 1889, p. 121. Guillebeau, 
Landwirthschafil. Jahrb. der Schweiz. 1890, p. 27. Angerstein, 
Bota wWelsweep ik. Gouquain, sabrb. 1892, p. 121. Aten, 
Deutsch. Zeitschr. fiir Thiermed. III. p. 381. Hock, Jahrb. 1891, p. 
113. Deubser, ibid., p. 113. Brusasco,. Jahrb. 1885, p. 94. 
Hess a. -borceaud, Jahrb, 1883, p, 129. .Kickhafer, B.- T.. W. 
1892, p. 82. Voigtlander, Dresd. Ber. 1867, p. 54. Enke, Berl. 
Arehsvon polo, Kohl, B. Ty W. 1893, p: 416. 


Although acute inflammation of the udder is not essentially different 
from inflammation in other parts of the body, yet it exhibits certain 
peculiarities, which are favoured by particular injurious influences. 
The milk secreting cavities and milk ducts being lined with mucous 
membrane and communicating directly with the outer air, their diseases 
closely resemble those of the respiratory and digestive tracts. 

During lactation acute inflammation of the udder is most common, 
but at other times isolated cases are seen, and under very rare 
circumstances inflammation of the udder has been noticed in virgin 
cows. Guillebeau says that cows most frequently suffer from mammitis 
between the 5th and 6th year. 

The physiological activity of the milk glands in many respects favours 
the development of inflammation. The early processes of lactation, 
particularly the congestive stage, so closely resemble acute inflammation, 
even in their outward manifestations, that it is difficult to draw a sharp 
line between the two, and the inflammatory non-infectious cedema 
noticed by Kitt is probably of this nature. Both the vascularity of 
the gland and the processes necessary for the development of secretory 
activity clearly favour the appearance of disturbances which readily 
take on an acute inflammatory character. It is, therefore, very natural 
that most diseases of this kind occur during the years of parturition. 

The anatomical formation also favours acute inflammation. The 
milk forms an excellent cultivating medium for bacteria, to which the 
ducts offer an easy poimt of entrance. Finally, the position of the 
udder is exceedingly favourable to the entrance of infectious material ; 
and as injuries to the skin of the udder, and especially to the teats, are 
frequent in animals, they easily form the point of origin for infectious 
inflammation. 

The causes of acute inflammation may be divided into mechanical, 
chemical, thermal, and specific. In cattle the first takes the form of 


392 ACUTE INFLAMMATION OF THE UDDER. 


horn thrusts and similar injuries; large udders may be trodden on by 
other animals, or by the cow herself when rising. This division there- 
fore includes bruises and wounds, as already described. 

Chemical or thermal irritants are much less frequent though the 
milk may undergo changes within the udder; irritant substances form 
and produce acute mastitis: our knowledge of such conditions is, how- 
ever, still very limited. Frost-bite seldom attacks more than the skin, 
though it is possible the udder may sometimes “catch cold.” As we 
find in other mucous membranes that inflammatory processes are often 
caused by chills, it may possibly be the case in the udder also. 

But more important than any of these are the specific irritants. 
After Franck had directed attention to the point, Kitt, Bang, Nocard, 
and others commenced investigations, and described different bacteria as 
the cause of acute inflammatory processes in the udder. Infection may 
occur by three paths. 

(1) The skin, in which, as already remarked, slight injuries often 
occur, and may form the starting-point of infection. We see, therefore, 
why cows are more frequently affected with disease of this character 
than mares, the reason being that their teats are more often injured 
during milking and simultaneously infected. Disease once produced 
spreads, especially in the course of the superficial lymph vessels of the 
udder, and therefore first affects the skin and subcutaneous tissue. 
This method of spread (lymphogenous mastitis, Kitt) is, however, less 
frequent than the next in order, as Johne, in opposition to Schlesser’s 
statements, has shown. 

(2) Infection from the mammary duct. In many cases a drop of 
milk remains hanging at the mouth of the duct, and forms a favourable 
cultivating medium for pathological bacteria, which pass hence into the 
galactophorous sinus, and finally into the smallest divisions of the 
affected portion of the gland, producing, according to their degree of 
virulence (galactophorous mastitis, Kitt), a more or less violent inflam- 
mation of the parenchyma of the udder. At the first glance it appears 
astonishing that inflammatory processes are not more frequently pro- 
duced in this way. The apparent rarity is explained, however, by the 
fact that an effectual closure mechanism exists in the milk duct, and 
that the milk seldom remains pent up in the udder for any long 
time. Numerous experiments made by Franck, Nocard, Kitt, Bang, and 
others, in which pure cultures of particular bacteria have been injected 
into the galactophorous sinuses, show, however, that inflammation may 
start here. Kitt even produced mastitis by painting the teat with a 
pure culture. 

Of late it has been much disputed whether inflammation of the 
udder can be caused by not milking the animal. Whilst this was 


s) 


ACUTE INFLAMMATION OF THE UDDER. 39: 


Y 


formerly regarded as a frequent cause of mastitis, the general view now- 
adays is, that retention of the milk alone never produces disease of 
this description. It is clear that neither view is quite right. The 
retention of milk, as such, certainly does not produce mastitis, but 
it favours its production, because of the readiness with which decom- 
position and the growth of bacteria occur in the retained milk, and 
secondarily produce inflammation. 

This explains why mastitis is most common during hot weather ; 
Strebel says most cases occur between March and September. Other 
factors may also be at work, such as the animal’s condition, the atten- 
tion it receives, and the time during which the ealf is with it; but this 
much is unquestionable, that warm weather favours decomposition of 
the milk, and the multiplication of bacteria in it. 

(3) Finally, infection through the blood stream appears possible 
(hematogenous mastitis), though it is probably very rare. 

It also seems possible that when the disease is widely spread, or con- 
ditions are favourable for the transmission of the specific microbe, 
mastitis may take an epizodtic form; the infected material being easily 
earried from animal to animal during milking. It is not astonishing, 
considering the varying virulence of pathogenic microbes, that many 
different forms of udder infection occur, so that sometimes only slight 
irritation, sometimes severe inflammation, or sometimes gangrene results. 
We divide the acute inflammatory processes in the udder into two 
eroups, viz. :— 

A. Inflammation of the stroma—the interstitial tissue of the gland— 
and term this Mastitis interstitialis, This, again, falls into two groups— 


(a) The traumatic. 
(b) The phlegmonous form. 


A. Inflammation of the parenchyma of the gland and of the lining 
membrane of the milk ducts,—Mastitis parenchymatosa. Inflammatory 
processes, confined to the surface of the milk canals, comport themselves 
like catarrh of other mucous membranes. Where, on the contrary, they 
extend to deeper tissues, and lead to abscess formation or gangrene, they 
may be divided into the following forms :— 


(a) Mastitis parenchymatosa catarrhalis. 
(>) Mastitis parenchymatosa apostematosa. 
(¢) Mastitis parenchymatosa gangrenosa. 


Considering the intimate relationship between the parenchyma and 
stroma of the gland, it is scarcely surprising that acute inflammatory 
processes often extend from one to the other, that in inflammation of 
the parenchyma the stroma, and in disease of the stroma the paren- 
chyma, often suffers. The former occurs the more readily, because the 


394 TRAUMATIC INFLAMMATION OF THE UDDER. 


blood-vessels of the udder ramify without exception in the stroma. 
Although, therefore, no sharp line can be drawn between diseases of 
the parenchyma and those of the interstitial connective tissue, it is yet 
generally possible, having regard to the development and course of the 
disease, to indicate its point of origin, and clinically to observe this 
distinction, which affords exceedingly important indications both in the 
treatment and prognosis of the diseases now in question. 


\ 


(a) TRAUMATIC INFLAMMATION OF THE UDDER. MASTITIS 
TRAUMATICA. 


Only surface injuries remain confined to the connective tissue of the 
udder; the deeper-reaching involve the real gland tissue. Animals are 
particularly exposed to injuries of this kind, which have already been 
described at p. 389. 


(B) PHLEGMONOUS MASTITIS.!| MASTITIS PHLEGMONOSA. 


This disease, previously described as superficial inflammation of the 
udder, affects the skin, subcutis, and interstitial connective tissue. It 
generally starts from the teats, which in the cow very frequently suffer 
from surface injuries, the rough hands of the milker abrading the skin, 
and possibly conveying infectious material; the straw may also cause 
injury and infection. The micro-organisms first enter the skin and sub- 
cutis and set up inflammation, which generally extends to the capsule 
and the stroma of the gland. 

The process, therefore, seldom remains confined to one quarter, but 
extends to several, or may even attack the entire udder. ‘The isolated 
course of the lymph vessels of the separate teats, however, sometimes 
causes the disease to remain confined to single sections of the gland. 
The skin and subcutaneous tissue are at first oedematous, and later 
become infiltrated with plastic material; slight exudation of blood is not 
uncommon. We have to deal, then, with an erysipelatous or phleg- 
monous disease, of which the skin or subcutaneous tissue forms the 
special seat. 

Symptoms and Course.—The condition is introduced by swelling 
and redness, which is generally diffuse, and seldom limited to particular 
portions of the gland. It appears suddenly: the skin is injected; at 
first it appears bright red, afterwards bluish. The swelling is then soft 

‘The term ‘‘phlegmonous inflammation” is no longer used in human medicine. It is, 


however, so convenient that I retain it here to indicate inflammation of the subcutis or of 
connective tissue, frequently associated with pus formation.—[TRANSL. ] 


PHLEGMONOUS MASTITIS. 395 


and doughy, but later becomes hard and firm, and requires some force to 
indent it. The skin is often exceedingly hot, but pain, as in sub- 
cutaneous inflammation, is seldom severe, nor does the milk show much 
change in quality, though the total quantity certainly falls off. At the 
commencement, slight fever is present; the lymph glands of the udder 
swell, and the tumefaction spreads. 

The condition may disappear in four to eight days, the symptoms 
gradually recede, the redness disappear, the swelling collapse, and the 
secretion of milk become normal. In other cases abscesses form. In or 
just beneath the skin, less frequently in the superficial portions of 
the gland, several fluctuating points develop, which after a short time 
break and discharge pus. Such abscesses are distinguished from those 
occurring during parenchymatous mastitis (p. 398) by their super- 
ficial position (antemammary abscesses) and slight size. ‘This disease 
may also lead to other complications, like gangrenous inflammation 
(p. 400). 

Differential Diagnosis.—The present affection is distinguished 
from disease of the parenchyma by the little change in the milk, by the 
involvement of several sections of the udder, and by the marked simul- 
taneous changes in the skin. It is more likely to be mistaken for the 
cedema occurring in the udder at the time of parturition. In the latter 
condition, however, the well-developed inflammatory symptoms, such as 
increased warmth, reddening, and pain, are wanting. 

Causes.—We clearly have to deal with phlegmonous or erysipelatous 
inflammation, caused by infection through shght fissures and cracks in 
the skin, particularly of the teats. The disease is probably caused by 
pyogenic cocci or other microbes; Kitt produced the disease in cows by 
infecting with the bacillus of malignant cedema. 

The prognosis depends on the virulence of the micro-organisms, as 
shown by the violence with which the process develops, and by the 
degree of the general disturbance, particularly of fever. As a rule, the 
process is benign, but abscess formation prolongs it. 

Treatment is similar to that in erysipelatous and phlegmonous con- 
ditions in other parts of the body. Cold applications are contra- 
indicated, and the best results follow infriction with mild fats (like oil or 
butter), or with carbolised oil, blue ointment, &e. The parts may also be 
washed with lukewarm solutions of disinfectants, particularly if the 
teats are injured. The udder must be kept warm, and may be covered 
with wadding to assist resolution. 

Local injuries must be kept as clean as possible by washing with a 
disinfecting fluid, after which they are smeared with any suitable 
material, like boric acid omtment (acid boric and ungt. paraffin, 
1 to 10). 


396 PARENCHYMATOUS INFILTRATION OF THE UDDER. 


Johne saw in cows furunculosis of the udder, which spread rapidly in 
the affected herds, and lasted for several months. Hard, red, painful 
swellings, as large as a hazel- or wal-nut, occurred in the skin of the 
udder, generally at the base of the hind-teats. The neighbouring tissues. 
were also inflamed, often appeared livid, and the diseased centre soon 
increased to the diameter of a child’s fist. After three to four days it 
pointed and broke, when a necrotic plug was discharged along with the 
pus, in which, on microscopical examination, a dead hair-follicle could 
be detected. Granulation and healing soon occurred. 

As a precautionary measure, Johne made the attendant wash both 
the udder and his hands twice daily with carbolic solution. Inoculation 
experiments were without result. 


PARENCHYMATOUS INFLAMMATION OF THE UDDER. 
MASTITIS PARENCHYMATOSA. 


This term is not quite correct, for, strictly speaking, the parenchyma 
only consists of the alveoli and their epithelium, whilst we include in 
this group the diseases of the milk canals and galactophorous sinuses.. 
Not infrequently the inflammation is confined to the galactophorous sinus 
and the larger milk ducts, a condition comparable to bronchitis, and 
termed by Gerlach mastitis catarrhalis, or catarrh of the udder. In 
other cases it extends to the alveoli and stroma, and leads to pus or 
abscess formation, or gangrene. We therefore distinguish three forms— 
mastitis catarrhalis, apostematosa, and gangrenoso. 


(a) CATARRH OF THE UDDER. M. CATARRHALIS. 


This disease consists of inflammation of the lining membrane of the 
milk ducts. Sometimes the galactophorous sinuses alone suffer, but 
generally the large milk-ducts are also attacked. The process may also 
extend to the smailer milk ducts, and even into the alveoli of the gland. 
If the process is confined to the galactophorous sinus and larger milk 
ducts, the quantity of milk secreted is little diminished, though, as 
inflammatory exudate from the diseased mucous membrane is mixed 
with it, its quality may be considerably altered. The more the small 
ducts and alveoli are involved, the greater the diminution and change in 
the milk. In consequence, the disease by no means offers a constant 
train of symptoms. 

Symptoms and Progress.—The surface of the udder is little 
changed; swelling is often entirely wanting, while the redness may be 
slight, but pain in the depths can be detected on pressure, and by the 
sensitiveness shown during milking. General condition is little altered. 


CATARRH OF THE UDDER. 397 


The principal changes are to be found in the milk, which contains 
clots of varying sizes, and often drops of fat. Eberhardt found the milk 
exhibiting a yellowish covering of fat after standing; or sometimes it 
appears reddish, from admixture of blood. The reaction is often normal, 
but it may prove acid or excessively alkaline. 

The process sets in suddenly, and attacks sometimes only one, some- 
times several sections of the udder. In most cases it disappears in a few 
days, the milk becoming normal; sometimes, however, it takes a chronic 
character, the muk retains its abnormal appearance, and may be mixed 
with pus, whilst the mucous membrane of the galactophorous sinus 
eradually becomes thickened, and feels on palpation like a firm cord; while 
the swelling extends from the sinus into the other parts of the gland. 
Should the process in the smaller milk ducts become chronic, it occasions 
localised thickening and induration of the udder. In other cases the 
inflammation leads to stenosis or occlusion of the milk ducts, with change 
in the affected sections of the gland, the induration extending as far as 
the skin. Abscess formation, however, is not often seen in this disease. 

Prognosis depends principally on the course of the disease; the 
longer it has lasted the less the chance of recovery. In some cases the 
function of the udder may be destroyed for the whole of one lactation 
period. ‘The outlook becomes very grave when extensive thickening 
and hardening take place, and even small thickenings may cause trouble 
on account of their forming new points of origin for the disease at the 
next milking period. 

Causes.—Without doubt the disease may be caused by chills, or by 
chemical decomposition or other change in the milk whilst in the udder 
causing it to become irritant. The fact that it is generally confined to 
one section of the udder indicates its origin through the sinuses. It is 
probably due to invasion by micro-organisms of slight virulence, which 
find a favourable soil in the milk. Opportunities for such infection are 
very frequent, and this disease is often seen widely disseminated, being 
carried by intermediate bearers (milkers) from one animal to another. 
Finally, microbes have been directly recognised in the diseased udder or 
in the milk, and the disease produced by injections of pure cultures. 
Kitt thus produced catarrh of the udder with various microbes; amongst 
others, those of blue milk, oidium lactis, arthrococcus lactis, and the 
bacillus of malignant cedema. Ziirn found micrococci, mikothrix threads, 
spores of mucor mucedo, and yeast-like cells in the milk. Nocard and 
Mollereau recognised streptococci as the cause of the disease, Bang 
staphylococci and various bacilli. Hock saw the affection during the 
course of foot-and-mouth disease; several portions of the udder were 
often simultaneously affected. 

The disease of the udder, described by Brusasco as agalactia con- 


398 CATARRH OF THE UDDER. 


tagiosa, which occurs in Italy, and affects goats and sheep, should 
probably be inclujed in this category. It occurs in spring, and always 
takes a chronic course. Though not dangerous to life, it destroys the 
milk secretion in the affected sections of the udder until the next period 
of lactation. Keratitis and other diseases of the eye, together with 
inflammation of the knee and hock joints, occur as complications. 

Hess and Borgeaud describe a disease affecting cows, goats, and sheep, 
which is known in Switzerland as “ Gelber Galt.” It takes a chronic 
course, and in spite of all treatment destroys the milk secretion in the 
course of three to four months. A staphylococcus can also be recognised 
in this case. 

Treatment.—With a view to prevention, the greatest care should 
be taken against introducing infected probes, bougies, milk catheters, 
&¢., into the mammary ducts and galactophorous sinuses. In enzodtic 
outbreaks it is best to segregate the diseased, and provide against 
transmission by the milker’s hands. Beyond combating inflammation, 
little more than this can be done. It is very important, however, to 
withdraw the milk frequently, if possible hourly, and at such times 
massage will be found to assist discharge of secretions from the finer 
milk duets. The diseased udder must be kept warm, and may be rubbed 
with fat and covered with cotton wadding. Where the disease is clearly 
infectious, which may be discovered by microscopical examination of the 
milk, disinfectants may be injected (compare p. 402). 


(b) PURULENT INFLAMMATION OF THE UDDER. MASTITIS 
PARENCHYMATOSA APOSTEMATOSA. 


In this form the inflammation also originates in the milk ducts and 
alveoli, but, instead of remaining confined to their surface, spreads to 
the depths and to the interstitial connective tissue. 

The purulent catarrh affecting the lining membrane of the milk ducts 
is accompanied by phlegmonous inflammation of the connective-tissue 
substance of the stroma of the gland. Franck was the first to produce 
the disease experimentally, by injecting a decomposed meat extract into 
the galactophorous sinuses in cows. Next day that portion of the udder 
was inflamed, the milk was curdled, puriform, containing numerous pus 
corpuscles and micrococci, and when injected into the udder of a 
healthy cow reproduced the same disease. Purulent mastitis is clearly 
produced in a similar way, and therefore always remains confined to 
single quarters of the udder. Kitt described the disease very thoroughly : 
he found “excessive cellular infiltration of the entire connective tissue 
of the udder, emigration of cells, even into the lumen of the alveoli, 


9 


PURULENT INFLAMMATION OF THE UDDER. 399 


necrosis and shedding of the epithelium of the gland, ectasia of the 
milk ducts, and concretions, consisting of gland secretions, which had 
undergone necrobiotic change, and exudate, hyperplasia of the connec- 
tive tissue produced by extensive formation of fibroblasts, and atrophy 
of the tubuli of the gland.” 

Symptoms and Progress.—The disease sets in suddenly with pain 
and the other symptoms of mastitis. The swelling originates in the 
interior of the udder, but spreads as far as the skin, which is abnor- 
mally warm and reddened. Functional disturbance soon sets in; the 
secretion of milk diminishes or entirely disappears, the milk is curdled, 
and later appears yellowish from admixture of pus, or red from bleed- 
ing; finally, it may become more and more puriform, and contain 
curdled material, which blocks the milk ducts. 

These symptoms are supplemented by fever, loss of appetite, excessive 
thirst, and depression. The swelling may interfere with the movement 
of the corresponding hind-leg and cause lameness; sometimes complica- 
tions like paraplegia are seen. 

Microscopic examination reveals numerous white and red corpuscles, 
pus elements, and fattily degenerated gland-cells (colostrum bodies) in 
the milk. Chemical examination shows albumen and water to be in 
increased quantity, sugar and casein to be diminished. 

Either resolution occurs, or the disease goes on to abscess formation. 
In the first case, after four or five days, sometimes a little later, the 
symptoms gradually begin to recede, whilst the secretion more and more 
recovers its normal character. In some cases no permanent disturb- 
ance is left, though, as a rule, the affected section of the udder does 
not completely recover its functional activity until the next lactation 
period. 

Abscesses, however, frequently form. Those which occur in the 
interstitial connective tissue either perforate into the milk canals or 
through the skin. They generally lie deep, and when developing in the 
connective tissue above the udder (retro-mammary abscess) may lead 
to the destruction of a large section of the gland, as described by Johne. 
Permanent thickening and milk fistule (p. 389) are not infrequent 
results of this process. 

Hard swellings sometimes result from the accumulation of clots in 
the milk ducts, which gradually become inspissated, and form yellowish 
crumbling masses, surrounded by a capsule of connective tissue. They 
also result from abscesses, and not infrequently form the point of origin 
of disease at a later period. 

Such suppurative processes may entail grave consequences, and at 
times lead to pyzemia or septicemia. Haase found pulmonary emboli 
in a cow which had died from this disease of the udder. 


400 PURULENT INFLAMMATION OF THE UDDER. 


Causes.—There is no doubt that this form of mastitis is caused by 
infectious materials entering through the mammary ducts (galactogenous 
mastitis, Kitt). The experiments of Lister, Roberts, Meissner, Kitt, 
and others show that normal milk contains no organised ferment, and 
therefore, when such is found, it must have entered from without; 
further, as the diseased process always appears in a single section of the 
gland, the natural conclusion is that infection follows through the 
mammary duct. Although infection through the blood stream is 
possible, it is unquestionably very rare. On the other hand, oppor- 
tunities for infection through the milk canal are frequent. The little 
drop of milk left hanging on the teat after milking may facilitate it 
(Franck), or milk catheters or other instruments introduced into the 
mammary duct also act as bearers of infection. The experiments of 
Franck, Nocard, Mollereau, and others have shown beyond cavil the 
possibility of this mode of infection. 

Numerous experiments have been made regarding the nature of 
the infectious material (itt, Nocard, Guillebeau, Bang, and others). 
Guillebeau found ten different microbes (staphylococci, galactococci, 
streptococci, and several bacilli), possessing various degrees of virulence. 
Guillebeau believes the constituents of the milk, particularly the milk 
sugar, are decomposed by the microbes, and irritant materials produced 
which cause inflammation. 

Prognosis.—There is little hope of completely restoring functional 
activity to the udder during the existing period of lactation. Any 
further opinion must depend on the progress of the disease. When 
large tracts of tissue become indurated, full function will not be 
restored even during the next lactation, and in aggravated cases life 
may even be endangered. For treatment, compare with next page. 


(c) GANGRENOUS INFLAMMATION OF THE UDDER. MASTITIS 
GANGRENOSA. 


Considering the varying virulence of the infectious material, it is not 
surprising that gangrene sometimes occurs. ‘This form of the disease is 
commonest in sheep, though it also occurs in cows (Deubser, Kohl, 
Enke) and goats (Voigtlinder), but in the latter it does not take the 
enzootic form generally seen in sheep. 

The nature of the specific poison is at present little understood. 
Nocard isolated a micrococcus from the udder of a sheep suffering from 
mastitis gangrenosa, pure cultures of which, injected into the mammary 
duct of healthy sheep, always reproduced the disease, but in other 
animals only caused slight swelling. 

Symptoms and Course.—The disease starts as a peracute paren- 


GANGRENOUS INFLAMMATION OF THE UDDER. 401 


chymatous mastitis. Severe general symptoms, high fever, loss of 
appetite, great weakness, severe pain, and stiff straddling gait first 
direct attention to the udder. Local examination reveals bluish violet 
spots on the skin, which on palpation are found to be exceedingly soft, 
insensitive, and often abnormally cool. These spots quickly spread. 
They are surrounded by an inflammatory swelling, which may extend to 
the lower part of the abdomen and the thigh. The animals stand with 
the back arched and the hind-legs straddled, exhibit acute pain, groan, 
and after a short time display well-marked symptoms of septiceemia ; 
not infrequently they die within twenty-four hours. 

In exceptional cases the local process is limited. A dissecting in- 
flammation sets in which separates the necrotic tract and may result in 
recovery. This is, however, a rare exception; the greater number of 
animals perish with symptoms of septicemia. 

Esser saw an enzootic outbreak of the disease in sheep. Twelve to 
twenty-four hours after the appearance of the first symptoms, comprising 
pain, and refusal of the dam to let her young suck, local manifestations 
set in, and generally affected one-half of the udder. The skin was dark 
red and showed discrete violet spots about the size of linseed, which 
rapidly increased in size, and felt soft and cold. Finally, the affected 
parts became insensitive, and the animals died in three to four days 
when suitable treatment was not very early resorted to. 

The prognosis is unfavourable, for in many cases not even the 
sacrifice of the udder can save the animal’s life. 

In treatment of the purulent and ganerenous forms of mastitis, 
the first point is naturally to prevent infection, or combat it if 
already existing. The greatest care is required in using milk tubes, 
probes, catheters, and other instruments introduced into the milk 
canals. 

If the disease becomes enzootic, and especially if it takes on the gangren- 
ous form, segregation of the diseased and disinfection of stalls is 
absolutely necessary. Esser bathed the udder and placed the animals in 
fresh stalls under the care of a special attendant. This prevented any 
further cases. He also draws attention to the danger in the gangrenous 
form of transmission by the shepherd. 

In purulent mastitis occurring enzootically, similar precautions are 
required. Jouquain believes it to be intimately connected with the use 
of old, bad straw. Dieckerhoff disinfects the stalls, causes the walls and 
floors to be washed with hot lye and strewn with lime. He also 
attaches great importance to careful and regular removal of the dis- 
eased milk, and cleansing of milk pails and pans. 

A second precaution, frequent milking of the diseased quarter of the 
udder, is just as necessary, for the increase of infectious material occurs 

2C 


402 GANGRENOUS INFLAMMATION OF THE UDDER. 


chiefly in the inilk. Provided the udder is not too sensitive, it should 
be gently rubbed and kneaded to favour the discharge of inflammatory 
products from the acini of the gland. The milk catheter is of little 
service, on account of its becoming stopped by clots. 

The diet should be of such a character as to diminish milk secretion 
toa minimum. For this purpose, in cows, purgatives like Glauber’s 
salt may be used, and under certain circumstances bleeding may be 
resorted to. 

The remaining points are to destroy or render innocuous infective 
material in the udder and to combat inflammatory changes. The former 
may be effected by injecting disinfectants, though practitioners hold very 
different views as to their action; and while some advise their use, 
others consider them of no particular value. In gangrenous inflamma- 
tion they are generally too late and without effect, but, on the other 
hand, they are often exceedingly useful in the purulent form. Their 
effect clearly depends on what tissues require disinfection. Though 
they can penetrate the galactophorous sinuses and large milk ducts, 
they fail to reach the fine milk ducts and alveoli, as Hess and Borgeaud 
have already pointed out. 

Four per cent. boric acid is generally recommended (Nocard, Faletti) ; 
Eggeling advises injecting one-fifth per cent. to one-quarter per cent. 
sublimate solution into the galactophorous sinuses with a rubber 
canula, to distribute it as much as possible by cautious manipulation, 
and remove it in ten to fifteen minutes by milking. Franck uses 2 per 
cent. alum or 2°5 per cent. carbolic solution. Kiekhifer had good 
results from injecting 4 per cent. solution of boric acid and washing 
the udder externally with 5 per 1000 sublimate solution. When the 
healthy quarters still give milk, carbolic acid must be avoided because 
it makes the milk unpotable. 

In purulent mastitis warm poultices or fomentations and wrapping 
the parts in wool will assist in decreasing inflammation. Bang recom- 
mends linseed or oatmeal poultices, and the application of linen or 
woollen cloths wrung out of hot water and kept warm by covering with 
mackintosh. Fomentation with diluted alkali or soap and water have 
often been recommended. Once tension and pain diminish, the parts 
may be smeared with flour paste and covered with wadding. Vogel 
uses a mixture of two table-spoonfuls of water, four of starch, twenty of 
elycerine, and one of turpentine. When warm the mass forms a paste, 
which is applied thickly and left on for fourteen days. From time to 
time it may be removed to allow of massage, which is of considerable 
assistance in this disease. Cold is considered by experienced practitioners 
to be badly borne, a conclusion warranted by the nature of the disease. 
Infriction with unirritating fats or unguentum hydrargyri is useful. 


AMPUTATION OF THE UDDER. 403 


Johne employs a mixture of equal parts of blue ointment, potash soap 
and lard. Franck recommends an ointment of ol. hyoscyam. 8, liquor 
ammon. caust. 2. eamphor 1. As soon as the abscess appears under 
the skin it should be opened and the cavity cleansed and disinfected. 

Local induration can often be dissipated by cautious massage, though 
it is of little value when the swelling is of old standing. 

In gangrenous mastitis early incision into the necrotic parts and 
disinfection are alone serviceable. Jf the process has made much pro- 
gress, even this treatment seldom suffices, and the animal’s life can only 
be saved by amputation of the diseased portion or of the whole udder 
(compare p. 407). 

Esser amputated the diseased portion or the entire organ in several 
sheep at the beginning of the disease. After checking hemorrhage, the 
surface of the wound was powdered with iodoform and smeared with tar. 
Of five sheep thus treated, only one died. Nocard also emphasised the 
uselessness of injections; he recommends amputation, and subsequent 
cauterisation with sulphate of copper. 


(3.) STENOSIS AND CLOSURE OF THE 
MAMMARY DUCT. 


In cows,—and these alone usually call for our attention,— the mammary 
duct only possesses one opening, at which point the skin is reflected to 
cover the lower end of the duct. At the upper end of this canal, which 
is from ;*, to ¢ inch in length, the mucous membrane begins, and lines 
the galactophorous sinuses up to their termination. At the point 
where the skin becomes continuous with the mucous membrane, 17.-., 
about 2 of an inch above the end of the teat, lies the valve, which, like 
the greater part of the teat, consists of muscular fibres. 

Stenosis of the mammary duct in cows results either from pro- 
liferation of the well-developed epithelium lining it, or from con- 
traction of cicatricial tissue. The former of these conditions occurs 
while the animals are “dry,” and stenosis only appears after next 
calving. 

Occlusion of the duct is sometimes congenital in cows (Fiirstenberg), 
or results from inflammation at the lower end of the teat. Diseases of 
the skin, cowpox, aphtha, injuries, &c., may cause adhesion and oblitera- 
tion of the opening of the duct and of a considerable proportion of its 
length. 

In the upper sections tumour formation occurs, and sometimes folds 
of mucous membrane fall into the lumen of the duct and produce 
closure. More frequently chronic inflammation, occurring during 
mastitis, causes stenosis or complete occlusion. Finally, the mammary 


404 STENOSIS AND CLOSURE OF THE MAMMARY DUCT. 


duct and lower portion of the galactophorous sinuses may grow 
together. 

The diagnosis of this condition offers no difficulty. Congenital closure 
will be recognised on the first calving by the excessive distension of the 
udder and teats, and by the fact that no milk flows when the parts are 
pressed. The little piece of skin covering the opening of the teat visibly 
protrudes, and on attempting to pass a probe, no opening can be found 
in the teat; the same is the case in adhesions, in which, however, indi- 
cations of an opening exist. 

In stenosis or occlusion of the duct the probe either passes with great 
difficulty or not at all, The milk escapes in a thin stream, while the 
animals evince pain by kicking or moving about. Stenosis, caused by 
thickening of the epithelium or proliferation of the mucous membrane, 
ean be felt as a cord-like swelling when the teat is rolled between the 
fore-finger and thumb. Induration in the upper portions of the teat may 
similarly be detected, whilst, in closure by folds of mucous membrane, 
palpation gives a negative result, and the probe meets with a somewhat 
yielding obstruction in the depth. This valve-like closure is occasionally 
indicated by those portions of the galactophorous sinus above the valve 
gradually becoming filled with milk and increasing in diameter, whilst 
those below appear small, and are generally occupied by a clear watery 
fluid, which, according to Larsen, always contains bacteria (cocci or 
bacilli). A small quantity of this fluid may from time to time be 
discharged. Sometimes the valve can be thrust on one side with the 
probe, and, for the time being, the milk allowed to flow freely away. 

Treatment.—The stenosed mammary duct may be dilated by 
repeatedly introducing bougies ; thick catgut threads, 1 to 1} inches long, 
provided with a knot at one end, so that they cannot pass completely 
into the mammary duct, can be passed a couple of hours before or im- 
mediately after milking, and allowed to remain in position for some 
hours. They can be used more than once, but, to prevent infection and 
severe mastitis, the bougies should be carefully cleansed and dried on 
each occasion. The same is true of all other instruments, such as milk 
catheters, probes, &c., which must be carefully cleansed and rendered 
absolutely sterile. Particular care is required where the teat is inflamed, 
as in cowpox, aphtha, &e. 

If for any reason dilatation cannot be effected in this way, the mam- 
mary duct may be laid open, or the end of the teat amputated. For 
the former purpose a narrow, straight tenotome, or specially-constructed 
“milk needle,” consisting of a slender double-edged fistula knife, is 
employed. The operation is easiest with the udder distended. The 
animal is twitched (with “ bulldogs”), the teat grasped with the left 
hand, and attempts made to distend it with milk. The instrument is 


TREATMENT OF STENOSIS OF THE MAMMARY DUCT. 405 


then introduced $ to ? of an inch, and the milk duct divided. As the 
milk afterwards flows away in an oblique direction, Bang recommends 
dividing the anterior teats in a backward and the posterior ones in a 
forward direction, to direct the stream in each case towards the 
milking-pail. 

The result of division is often unsatisfactory, the wound growing up 
again, and stenosis becoming, if possible, still more pronounced. Inflam- 
mation of the udder may also follow, being due, according to Larsen, to 
the micro-organisms always found in the mammary duct below the 
valve, and inflammation therefore sometimes occurs, despite antisepsis. 
It is therefore best to disinfect the cavity by injecting a 1 in 1000 
sublimate solution, and then to divide the obstruction with a sterilised 
“milk needle ” (Larsen). Congenital atresia is most easily dealt with ; 
here it is often sufficient to make a cross-shaped incision or puncture 
with an inoculating needle or similar instrument. 

In acquired stenosis which resists other treatment, Bang recommends 
amputation of the lower end of the teat just over the mammary duct ; 
the valve can be distinctly felt here, and its position easily determined. 
The animal’s hind-feet are fastened, and the end of the teat cut away 
with strong scissors, the skin being as far as possible preserved. In 
Denmark special forceps are used (Hahn), and the teat grasped, so that 
the parts can be removed with one powerful cut just below the forceps. 
Bleeding is slight. The parts must be kept as clean as possible, to pre- 
vent inflammation in the affected division of the udder. For a short 
time milk flows away continuously, but this can be prevented by apply- 
ing a suitable rubber ring. During the healine process, the parts 
gradually contract, involuntary discharge ceases, and milking can again 
take place in the usual manner. 

In closure of the upper parts of the teat by indurated masses of 
tissue, a passage may be made by passing a thin trochar, the canula 
being left in position for some time, so as to prevent adhesion, whilst 
the milk is prevented flowing away by stopping the canula with a cork. 
The trochar is also useful in occlusion of the duet by folds of mucous 
membrane, though success is often only temporary. It has been 
suggested to remove such obstructions by dividing them with the 
“milk needle” (Stockfleth, Bang). In this ease also relief is rarely 
lasting. 


(4.) CHRONIC INFLAMMATION OF, AND TUMOURS 
IN, THE UDDER. MASTITIS CHRONICA. 


Chronic inflammatory processes often result from acute diseases, and 
may give rise to localised induration, or to diffuse proliferation of the 


406 CHRONIC INFLAMMATION AND TUMOURS OF THE UDDER. 


interstitial connective tissue (mastitis chronica interstitialis). The latter 
are generally produced by micro-organisms, especially by tubercle bacilli, 
actinomyces, and other organisms, and possess a surgical interest on 
account of their forming a connecting link with tumours of the udder. 
Sand discovered bothryomycosis of the udder in a mare. 

Tuberculosis of the mammary gland is commonest in cows, and _ prin- 
cipally affects the posterior quarters, being rare in the anterior (Bang). 
Sometimes infection occurs through the mammary duct, sometimes 
through the blood stream. In any case, hard, moderately painful, 
deeply-seated swellings develop either in one, in occasional instances in 
several portions of the udder, and gradually increase in size, becoming 
hard and firm. When one of the posterior quarters is affected, the 
lymph glands above are generally distinctly swollen. At first the milk 
is little altered either in quantity or quality, but later it diminishes, 
becomes flocculent, and finally presents the appearance of a turbid 
yellow fluid, in which tubercle bacilli may be detected with the micro- 
scope. The animals waste, suffer from cough, and if not slaughtered, 
die, with hectic symptoms. 

Tuberculous mastitis is distinguished from chronic mastitis by its 
progressing not gradually but by leaps, so that the patient sometimes 
appears better, sometimes worse. Uncontrollable diarrhoea usually 
precedes death (Eggeling). Occasionally there is simultaneous preli- 
minary tuberculosis. 

The symptoms of actinomycosis of the udder, which is also seen in 
cows and swine, and which Johne produced in cows by inoculation, are 
quite different. The udder enlarges and indurated patches develop, 
which sometimes project under the skin and give the surface of the 
udder a lobulated appearance. After some time fluctuation occurs at 
different points, and when these are opened or break of themselves a 
muco-purulent fluid is discharged, containing little sulphur - yellow 
bodies, about the size of grains of sand, which consist of masses of 
actinomy ces. 

Actinomycosis of the udder somewhat resembles the mycofibromatous 
disease, which I have repeatedly seen in mares, and which is caused by 
infection with bothryomyces and staphylococci. The surface of the 
organ appears uneven, lobulated, and in places firm and hard, at other 
points it is softer, sometimes fluctuating, and incision liberates a thick 
pus. When the disease has existed for a long time numerous fistule 
form, extending more or less deeply into the udder. Those which heal 
leave a distinct cicatrix, but, in consequence of the progress of the 
inflammation, new fistulee continually form. 

The prognosis is clearly unfavourable, especially when the lesions 
are tuberculous; for not only does tuberculosis most rapidly and 


REMOVAL OF MAMMARY NEW GROWTHS. 407 


certainly lead to death, but it renders the consumption of the milk 
dangerous to man. Actinomycosis and bothryomycosis also offer little 
chance of recovery unless the udder be sacrificed. On the other hand, 
the animal’s life and working usefulness can be saved by operation, and 
in valuable animals amputation of the diseased quarter or of the whole 
udder is a practicable operation. 

In mares, I have repeatedly operated with success in the following 
manner :— 

The mare is cast, the feet are bound to the sides, and the point of 
operation is thoroughly cleansed. Wherever the skin appears adherent 
to subjacent tissues, it must be removed by cutting round the affected 
spot. The non-adherent portions of skin are separated from the udder, 
and the latter or its diseased quarters separated from their adhesions 
to the abdominal wall by breaking down the loose connective tissue 
with the fingers. Any large vessels must be ligatured. To facilitate 
examination of the depths of the wound, and discover and ligature large 
arterial branches lying there, all bleeding must be carefully checked by 
ligaturing vessels as one proceeds. Any remaining adhesions of the 
udder to the abdominal walls may then be included in one large ligature, 
and the organ cut away. 

The parts are afterwards rinsed out with carbolic or sublimate solu- 
tion; vessels still bleeding are tied, the cavity filled with carbolic jute 
or similar substance, and the outer skin brought together with a few 
stitches, so as to keep the dressing in position. The stitches and 
tampons are removed next day, any blood washed out, and the surface 
of the wound, which is then left open, powdered with iodoform tannin. 
The wound often dries up rapidly and a dry scab forms, under which 
healing takes place without difficulty, and without requiring further 
interference, in about fourteen days. Considering how favourable the 
position is for drainage, it will readily be understood why wound fever 
so rarely occurs. Deupser amputated a cow’s udder in the above way 
on account of gangrenous mastitis. 

Tumours of the udder are seen in cows and dogs, but seldom in 
other animals. They usually take the form of warts, and are much 
commoner on the teats than on the udder. Frequently they are pedun- 
culated, and from 1 line to 4 an inch or more in length. Those on the 
surface of the udder are usually larger and have broader bases ; in cows, 
they have even been seen as large as a man’s head (Fiirstenberg). Their 
surface is rough, horny, and sometimes moist, and inflamed from injury 
during milking. Kunze found the udder of a four-year-old cow covered 
with numerous warts 4 inches long and # inch thick, so that it resembled 
a large cauliflower growth; the warts were removed by ligature, and by 
swabbing with pure sulphuric acid. 


408 CYSTS AND TUMOURS OF THE UDDER. 


Less frequently polypi occur on the mucous membrane of the 
mammary or milk ducts, and may interfere with the discharge of 
milk. 

Cysts, varying from the size of a hazei-nut to that of a hen’s egg, are 
sometimes discovered in the udder after slaughter. They are generally 
retention cysts, caused by closure of single gland ducts; their contents 
are sometimes clear, sometimes turbid from contained masses of fat. 
They are difficult to detect during life, only those which are superficial 
exhibiting fluctuation ; those in the depths can scarcely be differentiated 
from indurations. 

According to Fiirstenberg, sarcomata are seen in cows. ‘They are 
certainly a frequent source of trouble in bitches, which also suffer from 
carcinomata and enchondromata of the udder. Carcinomata are also 
stated to have been seen in the mare (Docter). Such malignant 
tumours occur in a multiple form, and carcinomata are usually accom- 
panied by swelling of the lymph glands. In bitches, the skin is often 
under great tension, the swelling sinks and forms a pendulous tumour, 
and its position then favours injury and ulcerations. 

In forming a prognosis, the nature, seat, and size of the new growth 
must all be taken into account. In cows, warts on the teats give pain 
during milking, thus rendering the animals restless, and do not disappear 
spontaneously as in other positions, ike the mouth. Operative removal 
is not difficult, but the pain during milking is not diminished but rather 
increased on account of the wound. It is therefore best to wait until 
lactation ceases. If this cannot be done, pedunculated warts must be 
removed close to the skin, using scissors, and the surface cauterised with 
nitrate of silver, which will also check any slight bleeding. In case of 
subsequent pain during milking, the milk must be removed from the 
affected quarter by the teat syphon. 

Warts on the surface of the udder only require treatment when they 
interfere with milking. In attempting enucleation, the gland substance 
must be carefully avoided, and therefore it is well to put off operation 
until after lactation, or remove the milk by syphon, bearing in mind 
the precautions mentioned on page 404. 

In bitches, malignant tumours, even when extensively developed, may 
generally be removed without danger to life. The general rules for 
such cases are to operate in the loose connective tissue, remove second- 
ary growths as far as possible, and, after inserting tampons, stitch the 
skin together. A dose of morphine prevents the animal loosening the 
stitches, which may be removed next day, after which the parts are 
treated as an open wound; the fact that the dog licks it usually renders 
cleansing of the wound unnecessary, and healing almost always occurs 
without difficulty, even after removal of malignant tumours. Secondary 


INFLAMMATION AND TUMOURS OF THE UDDER AND OVARY. 409 


growths certainly often occur, but the operation may be repeated. Even 
though recovery is not complete, the owner is often contented if the 
animal is saved for some years, which is generally the case. 

Diseases of the ovary in animals have, up to the present, received 
little attention; the ovary seldom appears to become inflamed, whilst 
tumours are only discovered on slaughter. Various writers, among 
them Hegelund and Briiller, recommend, however, in nymphomania of 
cattle, to crush the cysts sometimes met with in the ovaries by operating 
through the walls of the rectum, from which point also the diagnosis 
is made. 


X. DISEASES OF THE SPINAL COLUMN 
AND PELVIS. 


I.—FRACTURES, LUXATIONS, AND SUB-LUXATIONS OF 
THE DORSAL AND LUMBAR VERTEBRA. COM- 
MOTIO SPINALIS. 


Lit.: Rauschning, Gurlt u. Hertwig. 39, p.91. Ercolani, Jahrb. 1860, 
p. ll. Degive, Jahrb. 1889, p. 127. Moussu, Réc. de méd. vét. 


Oo 


1889, p. 788. Thtimmler, Dresd. Ber. 1868, p.110. Lehnert, 
ibid., 1871, p. 126. Gotze, ibid, 1861, p.119. Bouley, Her. Rep. 
13, p. 140. Spinola, Spec. Path. u. Ther. p. 1474. Thieme, Th. 
Mitth. 1881, p. 86. Trasbot, Jahrb. 1889, p. 1389. Demarbaix, 
Her. Rep. 14, p. 325. Lebel, ibid., p. 46. Rey, ibid., p. 131. Vives, 
ibid., 16, 0. 325. Voigtlander, Dresd. Ber. 1864, p. 66. Thieme, 
Th. Mitth. 1881, p. 86. K6rber, Gurlt u. Hertwig. 16, p. 393. 
Dieckerhoff, Adams Woch. 24, p. 107. Mittmann, Zeitschr. f. 
Vet. 1889, p. 352. Straube, Zeitschr. f. Veterindirk. 1891, p. 451. 
Schmaus, Arch. f. Chirurg. vol. 42, p. 112. Hirzel, Schweiz. Arch. 
1895p Og: 


In the horse, fractures of the dorsal and lumbar vertebre are not un- 
common, either single processes being broken off, or the body and arch of 
the vertebra fractured. The first are rare and of no great consequence, 
though Bouley and Gotze describe fracture of the superior spinous process 
of dorsal vertebre. Fractures of the transverse and oblique processes 
rarely occur apart from injuries to the body of the bone. Fracture of 
the body is serious, because bleeding takes place into the vertebral canal 
and causes pressure paralysis. It is commonest in the horse, and may 
be due to various causes, but is oftenest caused by the animal getting 
below some fixed object which prevents its rising. Vertebral fractures 
may also be caused by collisions (Rauschning), by the animal rearing 
and falling over backwards, and being violently stopped or started 
(Trasbot). Haubner. saw fracture of the lumbar vertebrae result from 
the horse striking out violently with both hind-feet, and Mittmann 


FRACTURES OF THE VERTEBRA. 411 


whilst a horse was galloping. They are still more frequently produced 
by muscular action when horses are cast, hence they often form complica- 
tions after important operations. In France and Belgium the general 
opinion is that fracture is produced at the moment of casting by exces- 
sive curvature upwards of the spinal column (Degive), but my own 
opinion inclines to the belief that they mostly occur after the animal 
has been cast and is awaiting operation, a view supported by Moussu 
and Lebel. A dull, crunching sound is often heard at the moment. 
Two movements are especially dangerous, and should, if possible, be 
prevented :— 

(1) Violent arching of the back. When the animal’s head is placed 
against the sternum, the longissimus dorsi is passively extended. Ii it 
and the ilio-psoas now contract energetically, the pressure on some one 
of the dorsal or lumbar vertebree may be so severe as to cause fracture 
(“ crushing fracture”), which is usually comminuted; the body of the 
bone is almost always broken. 

(2) The second action likely to produce this accident is the excessive 
lateral thrust on the spinal column produced by unilateral contraction 
of the dorsal muscles. It occurs from lifting the hind-quarters from the 
bed, and is probably favoured by anchylosis of the vertebra or ossifica- 
tion of the inter-vertebral discs. Ercolani, Camillo, Demarbaix, and 
others have drawn attention to the predisposing influence exerted, under 
these circumstances, by bony union of the vertebre. In my opinion 
this is the chief reason why old horses so often suffer from fracture of 
the vertebre. Such fracture is commonest during dental operations and 
the castration of thoroughbred horses. The necessity for dental operations 
is greatest in old horses, whose bones are less resistant than those of 
younger animals. In castration the fracture generally occurs at the 
moment when the clams are applied to the spermatic cord, and in this 
ease is due to the violent muscular movements. Fractures of the 
vertebree occur most frequently when the animal is lying on its side, 
seldom when on its back; I have only met with one of the latter, and 
of Dieckerhoff’s fourteen cases only one was produced in the dorsal 
position. 

Fractures may perhaps be favoured by disease of the spinal column. 
Thiimmler describes abnormal fragility of the ribs and vertebre in a 
ten-year-old mare; Lehnert, a case of vertebral fracture, favoured by 
caries, resulting from an abscess. Degive also recognises such a pre- 
disposition. 

With few exceptions the fracture occurs either in the last dorsal or 
first lumbar vertebra, which are not only the weakest but he in the 
middle of the mobile column, which, like a stick, if excessively bent, 
breaks most readily in the centre. But falling over backwards, and 


412 FRACTURES OF THE VERTEBRA. 


other accidents, may also cause fracture of the anterior dorsal or lumbar 
vertebree. 

Vertebral fractures in oxen occur during coitus, fracture in the cow 
being caused by too heavy a bull, and in the bull by falling. Small 
animals may be run over, or violently kicked or struck. 

Luxation, that is displacement of the articular surfaces, and sub- 
luxation (displacement of the vertebra from rupture of the inter- 
vertebral ligaments), cannot clinically be distinguished from fracture. 
Voigtlinder and Gillmeister saw sub-luxation between the last dorsal 
and first lumbar vertebre in a cow, Thieme in a horse. 

Symptoms and Course.—Fractures of the vertebral processes 
produce no particular general disturbance. Swelling occurs at the spot, 
and may sometimes lead to pus formation (Gotze); while fracture of the 
Superior spinous processes in the region of the withers, which give 
attachment to various muscles of the fore-limb, greatly interfere with 
movement, as Bouley mentions in describing a case in the horse. The 
head and neck, and also the back and loins, were held stiff as in 
tetanus ; the position of the fore-feet suggested laminitis; swelling, pain, 
and crepitation existed in the region of the withers. The animal could 
not le down for a month; and although ability to move gradually 
returned, yet for some time the feet were not properly lifted. 

Fractures of the body of the vertebra are generally followed by dis- 
placement of the broken fragments and injury to the spinal cord, or by 
bleeding into the vertebral canal, and paraplegia. The animals cannot 
rise, and even when they can move the fore limbs, the hind remain 
powerless. Under some circumstances injury to the spinal cord is 
delayed, and it is certainly possible for the vertebre to be merely 
fissured. Spinola, Rauschning, Dieckerhoff, and Moller have all seen 
cases where the animal could still move, though the back was held 
stiffly, and where symptoms of paraplegia only set in after several days. 
Spinola has seen a case where the animal could still be ridden and 
could perform heavy work, though he believed it to be suffering from 
fissure of a vertebra. Straube describes a horse with-a similar fissure, 
or fracture without displacement, which could nevertheless be hunted 
and jumped. In rare cases the animals can stand, but cannot move, as 
when the ischiatic nerve is paralysed and the crural escapes. Bombach 
saw this condition after fracture of the second lumbar vertebra; I 
have found functional activity of the crural retained after fracture of 
the 15th dorsal vertebra. 

Local examination gives negative results in large and well-nourished 
horses. Crepitation, pain, or displacement of the superior spinous 
process of the affected vertebra can seldom be detected, except in small 
thin animals with slight muscular development. Anesthesia of the 


INJURIES TO THE VERTEBRA. 413 


hind-quarters, which anteriorly is sharply marginated, accompanies 
paraplegia; convulsive attacks have also been noticed. The difficulty 
in diagnosis is the more important because prognosis is always un- 
favourable, and slaughter of the animal must be recommended as soon as 
fracture of a vertebra is recognised. 

In horses, the condition is oftenest mistaken for so-called hemoglo- 
binuria. The history generally clears up this point, otherwise the urine 
must be examined, though it should not be forgotten that the urine 
occasionally appears normal in hemoglobinuria; the presence of blood, 
colouring matter, or albumen would, however, point to the latter disease. 
In hemoglobinuria the muscles are abnormally hard and firm, especially 
in the dorsal region, but in pressure paralysis there is pronounced 
relaxation. And again, in hemoglobinuria the visible mucous mem- 
branes are more or less reddened, which, during the early stages at least 
of fracture of the vertebre, is certainly not the case. Diagnosis is 
more difficult if the animal is unable to rise, and suffering from 
fever. 

Plugging of the posterior aorta or of the iliac arteries produces similar 
symptoms, but is, at first, usually accompanied by clonic and tonic 
contractions; at a later stage, the impaired action sets in gradually, 
and is only seen when the animal is exercised. In doubtful cases 
examination per anum will settle the point. 

Fractures of the vertebre are more difficult to distinguish from 
injuries to the cord, produced, for example, by violent concussion. In 
the latter case the cord may be ruptured, or bleeding into the vertebral 
canal produced, without the vertebre being displaced; finally, con- 
cussion of the medulla may exist without visible lesions or anatomical 
changes, a condition clinically described as commotio medulle spinalis. 
I have repeatedly seen it in dogs and cats, which have fallen out of 
windows, or been run over, or struck with a heavy stick. When 
injuries of this sort are accompanied by rupture of the cord or 
hemorrhage into the vertebral canal they take the same course as 
vertebral fractures, and therefore their exact diagnosis is of no especial 
importance. It is otherwise in commotio medull spinalis, which is 
generally followed by symptoms of complete paraplegia, but disappears 
again in a short time, sometimes even within a few hours. In many 
cases, therefore, the diagnosis must be extremely cautious, and further 
progress awaited. According to my experience, the symptoms due to 
concussion of the cord disappear in eight to fourteen days, and during 
this time recovery is not out of the question. It should be borne in 
mind that concussion of this kind is rare in the horse, but fairly frequent 
in small animals like dogs and cats. 

Schmaus’s observations and experiments show that in concussion of 


414 INJURIES TO THE VERTEBR. 


the cord, bleeding, softening, swelling, and degeneration of single axis- 
cylinders oceur. It is evident that the course of such injuries depends 
on the kind and extent of the anatomical changes; and as these cannot 
be exactly defined during life, prognosis is always doubtful. 

In fracture of the vertebra the last hope of recovery vanishes as soon 
as paraplegia is complete. Provided the animals can stand, treatment 
may be attempted, although, as paraplegia may still occur, recovery is 
uncertain; Korber saw it set in as late as five days after the injury. 
As, however, the diagnosis in such cases can never be perfectly certain, 


Fic. 100.—Apparatus for prevention of fracture in operating on a horse. 


it is advisable to wait, particularly if the animal’s slaughter-value-is 
slight, or if it be valuable for breeding. Isolated cases are said to have 
recovered, though the descriptions given (Vives) throw some doubt on 
the correctness of the observation, But though possible, recovery 
(in horses) depends on so many circumstances that it can never be 
confidently anticipated. 

In these cases prevention is better than treatment. The stall 
should be so constructed that the animal cannot injure itself in rising, 
and great care must always be taken in casting. The first matter is 
beyond our province ;. but in regard to the second, the following points 
must be observed :—In casting the larger animals, a soft bed, preferably 


FRACTURES OF THE SACRUM. 415 


of straw, is necessary to prevent fractures of the ribs and of the bones 
of the pelvis. The horse should first fall with the chest towards the 
earth, and whilst lying the head and neck should be kept extended by 
several powerful assistants. As a further precaution, especially in well- 
bred horses with strongly-developed vertebre, I have employed with 
good results Bernadot and Butel’s apparatus (fig. 100), consisting of a 
strong head-collar with padded straps, and of a girth and crupper. The 
head-collar and girth are connected by thick straps, rendering it impos- 
sible to bend the head and neck beyond a certain point. 

Hirzel employs for the same purpose a girth provided with a ring 
above the animal’s back, from which leather straps pass to a strong 
head-collar. He considers this absolutely prevents any danger of fracture 
ot the vertebree (compare with Moller’s Allgemeine Chirurgie, p. 435). 

To prevent side-movements of the spinal column when the horse is 
cast,a man should seat himself on the quarter, and, with the same object, 
it is well to place the animal with the quarters below the feet. In 
painful operations like castration, particularly in well-bred horses, I have 
latterly used chloroform, and have never since noted a case of vertebral 
fracture. It is also best to avoid castrating aged race-horses when in 
full condition, as the muscular development is, of course, then at its 
greatest. Such animals should previously be rested for eight to fourteen 
days in the stable. 

In suspected fissure of a vertebra, the animal must be kept from 
work, and prevented lying down for a month, either by being placed 
in slings or fastened up. In commotio medulle spinalis treatment is 
expectant. The animals should have a deep straw bed, and be turned 
from time to time to prevent decubitus." In simultaneous paralysis of 
the rectum, the feeces must be periodically removed; and if the bowels 
are confined, clysters of lukewarm soap and water may be resorted to. 


Il.—FRACTURES OF THE SAGRAL AND CAUDAL VERTEBRA. 


Lit.: Harms, Han. Ber. 1871, p..56. Palagi, Jahrb. 1887, p. 85. 
Albrecht, Gurlt u. Hertwig. 29, p. 235. Wiener Klinik, Miiller 
u. Roll. 1858, p. 125. Vet. San. Ber. der Preuss. Armee. 1891, p. 167. 


Fractures of the sacrum are commonest in cows, and are caused either 
by external violence, falling on hard objects, or from a height (Palagi), 
and in the foetus, by clumsy violent efforts at assistance during parturition. 
Albrecht saw fracture between the sacrum and last lumbar vertebra in 

1 Decubitus is a term used in Germany to describe the ill effects attendant on the animal 


continuously lying in one position. It includes the formation of bed-sores, the production 
of hypostatic congestion, etc.—[TRANSL. ] 


416 FRACTURES OF THE SACRUM. 


a bull after mounting a cow. In the Vienna clinique a horse was seen 
suffering from fracture of the first and second lumbar vertebre after 
collision. In an army horse a fall was followed by fracture of the 
fourth and fifth lumbar vertebree. 

Fractures of the caudal vertebra in dogs and cats are most frequently 
produced by the animals being run over or having the tail nipped in a 
door ; in larger animals, by falling over backwards, if at the moment the 
tail is lifted. To induce oxen to move, the tail is sometimes violently 
twisted, with the result of producing fracture of the caudal vertebre. 
In the tail region the inter-articular cartilages are sometimes torn 
through. Treatment is very similar to that of fracture. 

Symptoms and Course.—The plexus, formed by the last lumbar 
and two first sacral nerves, provides the muscles of the hind-limbs 
with motor fibres, and fracture of the first sacral vertebra or of the 
lumbar vertebre is therefore followed by paralysis in this region. 
The plexus pubo-coccygeus, which leaves the vertebral canal through 
the third and fourth sacral notch, gives motor and sensory fibres to the 
rectum, penis (N. dorsalis penis), and permeum. Fractures of the sacrum 
are therefore always attended with paralysis of the tail and rectum, and 
sometimes of the bladder, in addition to paraplegia. The symptoms 
depend on the position of the fracture and the consequent changes. 
The bleeding, which often occurs into the vertebral canal, explains why 
fractures occurring further backwards than the last sacral vertebra are 
often attended with extensive disturbance. Most fractures of the sacrum 
in cattle are accompanied by weakness in the hind-quarters, some with 
complete paralysis. The fragments of bone are generally displaced 
downwards, voluntary defecation is always impossible, and sometimes 
urination as well. Fractures of the caudal vertebrae only paralyse the 
tail when the first vertebree are affected. The tail is generally exceed- 
ingly mobile, and crepitation may be audible; not infrequently the 
skin is injured (compound fracture); sometimes the end of the tail 
remains hanging by a few tendinous shreds of the caudal muscles. 

So long as an animal with fracture of the sacrum is able to stand 
recovery may occur, but cure is out of the question in complete para- 
plegia, especially in horses; in cattle and carnivora paraplegia renders 
prognosis doubtful. Paralysis of the urinary bladder is a very unfavour- 
able symptom, as, on account of the difficulty in emptying the bladder, the 
urine decomposes, and severe cystitis may set in. A cow, however, with 
paralysis of the rectum, consequent on displacement between the first caudal 
and last sacral vertebra, recovered completely (Harms). Fractures of the 
upper caudal vertebree may also cause deformity and limitation of move- 
ment in the tail. I saw a calf in which, in consequence of fracture, the 
tail was twisted to one side and could no longer be freely moved. Com- 


FRACTURES OF THE SACRUM. 417 


pound fractures of the tail vertebre are readily followed by necrosis ; 
this always happens when the vertebra are crushed ; the tail then feels 
cold, showing that the blood-vessels are thrombosed. Permanent 
paralysis is another frequent consequence, and is especially trouble- 
some, because the tail becomes soiled by faces, and in cows by the 
urine. 

An army horse, the subject of fracture between the fourth and fifth 
sacral vertebre, showed a swelling as large as a man’s fist over the 
sacrum, and suffered from rolling gait, paralysis of the tail, and difficulty 
in passing feces. After five weeks’ rest in slings, the swelling increased 
to the size of a child’s head, and became harder ; seven months later the 
animal could carry a light rider; but as sacral paralysis gradually set in, 
the animal had finally to be killed. The post-mortem revealed the 
presence of a callus as large as a child’s head, and fresh bleeding into 
the vertebral canal. 

Treatment.—Attempts at treatment are seldom justifiable in frac- 
ture of the sacrum accompanied by complete paralysis, or if made, must 
be confined to preventing decubitus. When, in consequence of com- 
plete paraplegia, the animals lie continuously, the usual precautions must 
be taken. The discharge of feces and urine requires to be assisted. 
In repeatedly using the catheter, the precautions recommended on p. 
332 must be borne in mind. 

Fractures of the caudal vertebree, with severe local bruising or crush- 
ing, necessitate amputation of the tail; and in compound fractures it 
is generally the quickest method of cure. Only in valuable horses is it 
worth while resorting to antisepsis or applying dressings. 


II.—CURVATURE OF THE SPINE. 


Lit.: Vives, Her. Rep. 16, p. 325. Gurlt, Pathol. Anat. IIL. p. 368. Piitz, 
Deutsch. Zeitschr. fiir Thiermed. 13, p. 161. Rehrs, Gurlt u. Hertwig. 
13, p. 805. Goubaux, Rec. de méd. vet. 1851, u. 1886. Vatel, Jahrb. 
1882, p. 90. Preusse, Berl. Th. Woch. 1889, p. 403. Hess, B. T. W. 
1892, p. 53. 


The most frequent form of this disease is the so-called hollow-back 
(Senkriicken), a condition known as lordosis.’ Curvature upwards is 
called kyphosis,” and towards the side skoliosis.* Simultaneous curva- 
ture upwards and sideways is termed kypho-skoliosis. 

) Aédpdwo.s curvature. 


(; 
(7) nig@wots =crookedness. 
(°) oxoAtwous =crookedness. 


418 CURVATURE OF THE SPINE. 


One class of these abnormalities arises during intra-uterine life. 
Animals born crippled (Kriippel) are generally at once killed. Marked 
curvature of the spine, immediately after birth, has been often seen in 
pigs; Rehrs noticed curvatures (hump-back) during rhachitis. Curva- 
ture of the spine also results in these animals from their being trodden 
on by the other occupants of the sty. Piitz describes kypho-skoliosis 
in an eighteen months’ foal. The dorsal vertebree were bent towards 
the right, the lumbar vertebre towards the left, and the back was 
depressed in places. The condition described by Preusse (kypho- 
skoliosis) in a foal appears to have been congenital. Vives noticed a 
horse in which the lumbar vertebrae were bent downwards almost at a 
right angle, and the thorax and abdomen in consequence so low placed 
that the latter almost touched the ground. A tree had fallen on the 
animal’s back, causing symptoms of vertebral fracture. After some 
time recovery took place, but the peculiar bending of the vertebral 
column continued. The causes of such abnormalities cannot always 
be explained, but the conditions may be grouped as follows :— 

(1) Hereditary deformities. 

(2) Results of fractures and luxations of the spine. 

(3) Rhachitis, osteomalacia, caries, and other local diseases of the spine. 

The first are of the greatest interest, and are typified in the horse by 
lordosis. Although little amenable to treatment, this condition has a 
special interest from the prophylactic point of view. 

Lordosis develops during the first years of life, though occasionally 
it may appear later. The predisposing cause lies in abnormal length of 
the back, a fact explained by the weakness inherent to this form. The 
extrinsic causes include all influences leading to continuous or excessive 
strain on the spinal column. Amongst these are the weight of the 
rider, distension of the colon by bulky food, or enlargement of the 
uterus consequent on pregnancy; mares which have repeatedly been 
bred from are therefore frequent sufferers from lordosis. 

In foals, the condition has been found to result from feeding from 
high mangers and racks, which throws increased strain on the extensors 
of the back and depresses the spinal column. 

The collective result is to bend the spinal column downwards. The 
ventral surfaces of the vertebrae become extended, the dorsal surfaces 
compressed, The animals being still young, the lower portions of the 
vertebre grow, while growth in the upper is checked by the increased 
pressure, and therefore, as time elapses, the spine tends more and more 
to take that particular form. This explains why work leads in man 
to kyphosis, in animals to lordosis. Special disease processes, like 
rhachitis, may favour the development of such deformities, but at present 
are little understood in animals. 


CURVATURE OF THE SPINE. 419 


A second factor in the production of spinal curvature is local disease of 
the vertebra, like caries, 7.c., some chronic process accompanied by inflam- 
mation (osteomyelitis), Tuberculosis is, perhaps, the principal cause of 
such disease in man, but actinomycosis has also been recognised. 
Exact observations are wanting in animals, but Hess saw kyphosis in 
a steer, in consequence of tuberculous disease between the second 
and third lumbar vertebre. Fractures and luxations may also be 
responsible for spinal curvature, as shown by Vives’ case; but as the 
animals are usually killed, such cases seldom have an opportunity 
to develop. Finally, disease of the intra-vertebral discs may cause 
deformity. 

Vatel describes a twenty-five-year-old horse which had suffered for 
many years, and in increasing degree, from this curvature. On _ post- 
mortem, his spine was found markedly convex as far as the third 
lumbar vertebra. The aorta, which was aneurysmal and had very thin 
walls, followed this curvature; the articulation between the last 
lumbar vertebra and the sacrum showed signs of arthritis. The 
centres of the intra-vertebral cartilages, between the dorsal and lumbar 
vertebre, had disappeared; their circumferences were ossified, and 
exostosis existed both in the vertebral canal and on the under sur- 
face of the bones. A rarefying ostitis also existed on the superior 
spinous processes of the dorsal vertebree, which had diminished move- 
ment. The bodies of the lumbar vertebr were firmly united by bony 
material. 

Symptoms and Course.—It is only when the above described 
changes become greatly developed that they excite attention. The rate of 
development of lordosis is very varied. Where it appears suddenly it 
may be followed by difficulty in respiration. As a rule, however, it 
oceurs gradually, and only in exceptional cases does it become so well 
marked as to interfere with the animal’s usefulness. Most of the 
dorsal and lumbar vertebre are usually involved in the curvature. 
Where single vertebre are diseased, ey., where the deformity is due to 
caries, the flexion develops slowly, whereas that resulting from fracture 
is of sudden onset. This generally enables the nature of the disease 
to be distinguished. 

Treatment.—Reduction of displaced vertebree is seldom possible in 
animals. The only means (orthopedia) is difficult of employment, and 
takes a long time, so that the results are robbed of their value by the 
time and expense involved. Prophylaxis is more important, especially 
in foals. Up to a certain point lordosis can be prevented, by taking 
proper precautions. Thus young horses with long backs should never 
be heavily loaded. It is also best to give concentrated food, and to 
place it in low mangers or on the earth. Grazing exercises a beneficial 


420 FRACTURE OF THE PELVIS. 


influence, on account of the back having to be bent upwards as the 
animal crops the grass. 


IV.—FRACTURE OF THE PELVIS. 


Lit.: Laser, Th. Mitth. 1877, p. 119. Brauer, Dresd, Ber. 1889, p. 21. 
Hess, Her. Rep. 78, p. 299. Ehrmann, ibid., 46, p.171. Trasbot, 
Jahrb. 1888, p. 139. Nocard, Peuch u. Toussaint, Chir. p. 447. 
Savre, Jahrb. 1888, p. 139. Prietsch, Dresd. Ber. 1883, p. 83. 
Noack, Dresd. Ber. 1890, p. 76. 


Fracture of the pelvis is seen most frequently in the larger animals, 
particularly in horses, and is caused by falls on smooth pavements, by 
collisions, sometimes by the legs slipping from under the animal, or by 
its making sudden turning movements when being ridden. Since 
asphalte has been laid down in Berlin fractures of the pelvis in horses 
have greatly increased in frequency, and often occur even without the 
animal falling. Trasbot saw fracture of the ilium in a race-horse 
produced while galloping. Fracture of the pelvis may also be caused 
by casting animals on hard ground, if the pelvis falls first ; the animal’s 
chest should first touch the bed. Stocktleth noted a case of fractured 
pelvis from violent struggling in hobbles. Fractures of the outer angle 
of the ilium are also caused by kicks or by heavy objects falling on the 
bone ; the skin is often simultaneously injured, and a compound fracture 
results ; with few exceptions, other pelvic fractures remain subcutaneous. 
In the mare, however, I have seen perforation of the vagina by a splinter 
of the ischium. 

In cows, fractures of the pelvis may be caused by violent attempts 
to assist parturition. Similar injuries occur during coitus and from 
falls, 

Whilst in the large animals the weight of the body or violent muscular 
action is responsible for these fractures, in smaller animals and in man 
they generally result from external violence, as from being run over, 
severely kicked, or crushed in narrow passages or in doorways. This 
explains why multiple fractures of the pelvis are frequent in small 
animals, but comparatively rare in the larger ones. 

For the purposes of diagnosis and prognosis, fractures of the pelvis 
may be divided into two groups :— 

(1) Pelvic fractures without division of the pelvic girdle (fig. 101). 
These comprise fractures of the external (1) or internal (2) iliac angle, 
fractures of the tuber ischii (6), transverse portion of the os pubis (4), 
and external portion of the ischium (4). The external angle of the 


FRACTURE OF THE PELVIS. 421 


ilium is the most frequent seat. It need scarcely be said that such 
injuries are less grave than the following group, though they may, 
nevertheless, cause incurable lameness—as, for example, when they 
involve the acetabular margin of the hip-joint (Prietsch). 

(2) Fractures of the pelvis with division in the pelvic girdle. These 
include fractures of the shaft of the ilium (3), through the cotyloid 
cavity (5), through the obturator foramen, 7.c., simultaneous fracture of 
the oblique branch of the os pubis and of the external branch of the 
ischium (4 and 4a), and finally, fractures through the os pubis and os 
ischii, parallel to the symphysis pubis (7). Multiple or comminuted 


Fic. 101,--Schema illustrating fractures of the pelvis in the horse. 
Fracture of (1) external iliac angle ; (2) internal iliac angle; (3) shaft of the ilium ; (4) transverse 
portion of the os pubis ; (4a) external portion of the ischium ; (5) cotyloid cavity ; (6) tuber 
ischii ; (7) symphysis pubis. 


fractures of the pelvic bones sometimes occur. I have often seen 
fracture of the ilium complicated with fracture through the obturator 
foramen ; and one case showed simultaneously double-sided fracture of 
the inner angle of the ilium and fracture of the femur. It must not 
be forgotten that such multiple fractures do not always appear together, 
but may only be developed by moving the animal. Immediately the 
pelvic girdle is divided, there is danger of further fractures occurring 
from the entire weight being thrown on the diseased side; this is com- 
monest after injury to the inner angle of the ilum. 

Symptoms.— Diagnosis of fractured pelvis is easy when crepitation 


422 FRACTURE OF THE PELVIS. 


exists. Otherwise careful search is required, including examination by. 
the rectum or vagina. The most important symptoms are :— 

(1) Lameness. This sets in suddenly, is seldom absent in recent 
pelvic fracture, but varies greatly in character. In fractures in front 
of the cotyloid cavity, particularly of the external angle of the ilium, 
there is marked interference with the movement of the swinging limb,’ and 
the forward stride is shortened. ‘This is ascribable to the fact that one of 
the muscles extending the thigh is attached to the external angle of the 
ium. A similar lameness is noticed in fracture of the tuber ischii. 
In either case equal weight is placed on both feet. Fractures behind 
the cotyloid cavity with division of the pelvic girdle produce marked 
lameness when weight is placed on the leg (supporting leg lameness) ; 
those into the cotyloid cavity produce lameness, both when the leg is 
swinging and when weight is placed on it (mixed supporting and 
swinging leg lameness). In fractures of the ischium and pubis there is 
often a tendency to place the thigh in a position of adduction. Even 
when these fractures are uniting, and in fractures of the ischium, I 
have repeatedly seen supporting leg lameness and abduction of the thigh. 
In fractures into the cotyloid cavity, especially when complicated with 
rupture of the ligamentum teres, the thigh is more or less relaxed, whilst 
the foot during one stride is abducted, and during the next adducted, 
thus causing the animal to stumble. 

Supporting leg lameness also follows fracture of the foramen ovale 
and of the transverse branch of the os pubis. In three cases which I 
noticed lameness was absent: once in a fracture of the transverse branch 
of the os pubis, once in fracture through the os pubis and os ischii 
parallel to the pubic symphysis, and once in fracture of the external 
branch of the os ischii. The latter two fractures may not produce 
lameness ; and if the animal is worked, the pieces of bone are repeatedly 
thrust apart by its movements, and union is attended with great difficulty, 
or may never occur. 

Nocard describes a peculiar lameness consequent on fracture through 
the foramen ovale. The foot was advanced stiffly (tout d’un piece), the 
thigh alone was normally moved, whilst the other parts of the leg seemed 
passively to follow it. The foot described a circle outwards, the stride 
being greatly shortened. This lameness, which Nocard ascribes to 
pressure of the callus on the nerves in the obturator foramen, shows a 
great similarity to that described by me as paralysis of the tibial nerve. 


1 The German idiom has forced me, very reluctantly, to introduce a new term into English 
veterinary phraseology. German veterinary surgeons employ two very convenient words, 
which have no equivalent in English, to differentiate lameness most marked when weight is 
thrown on the limb, and lameness most marked when the limb is carried. The former term is 
in German Stiitzbeinlahmheit (literally, ‘‘supporting leg lameness”), the latter Hangbein- 
lahmheit (literally, ‘‘ hanging or swinging leg lameness ”’). 


FRACTURE OF THE PELVIS. 423 
It is not surprising, under the circumstances, that the nerve should suffer 
disturbance of function. 

A mare had fallen six days before, and, on being brought to my 
clinique, showed marked supporting leg lameness and abduction of the 
thigh. In this case the right hind-foot was abducted even when at 
rest. On post-mortem, a fracture was found on the inner and outer 
branches of the os pubis, and extended over the symphysis pubis to the 
other side, The outer branch of the right os ischii was fractured close 
behind the capsule of the joint; the inner branch divided from the os 
pubis, from which point the fracture extended forward towards the 
symphysis pubis. 

In a gelding, slight lameness, accompanied by very distinct crepita- 
tion, occurred after a fall. Even when trotted, the only point obsery- 
able was slight stiffness of the back and moderate abduction of both 
hind-feet; but by placing the hand on the crupper and causing the 
slightest movement, distinct crepitation could be produced. Examina- 
tion per anum showed the case to be fracture parallel to the symphysis 
pubis. 

(2) Crepitation. This is particularly noticeable in fractures of the 
pelvis with division of the pelvic girdle, and may even be audible 
several steps away. In fractures of the ischium and pubis it is less 
marked, though sometimes quite audible; in those of the external and 
internal angles of the ilium it is wanting. In making the examination, 
one hand is placed on the outer angle of the ilium, the other on the 
buttock in the region of the tuber ischii, and attempts made to move 
the rump from side to side so as to throw the weight from one hind-foot 
to the other, or the hand is placed on the outer angle of the ilium and 
the horse made to move. In mares and cows, crepitation, especially in 
fractures of the os pubis and os ischii, can be felt from the rectum or 
vagina by laying the hand on the ischiatic notch, and as the sensation is 
better conveyed by the bones than by the soft parts, it is best to examine 
from this point. Very slight crepitation.can also be detected by applying 
the ear against the quarter. When the animal is lying down, crepitation 
may sometimes be produced by pressing on the outer angle of the ilium, 
or by moving the hind-leg forwards; the latter is more successful in 
fractures of the tuber ischii. 

In fractures extending through the cotyloid cavity, crepitation can 
even be heard when the horse is standing by merely pressing on the 
muscles of the quarter, or by causing weight to be placed on the 
affected leg. This is explained by the fact that the muscles of the 
quarter are inserted partly in front of and partly below the point of 
fracture, and, in alternately contracting, displace the pieces of bone—a 
symptom that is of value both in prognosis and diagnosis. 


424 FRACTURE OF THE PELVIS. 


(3) Apparent deformity of the quarter is, as a rule, only seen in 
fractures of the ilium. In fractures of the outer angle, the loose piece 
of bone is drawn forwards and downwards by the oblique abdominal 
muscle, and by the tensor vaginz femoris, and lies in the abdominal wall, 
so that the outer iliac angle seems to be wanting. To detect this, the 
animal is placed with the hind-feet level, and the operator, standing 
behind, compares the relative positions of the outer iliac angles. The 
larger the broken portion, the more marked, of course, will be the 
asymmetry. 

In fractures of the shaft of the ilium, the entire ilium, and especially its 
outer angle, sinks; this symptom can almost invariably be detected if 
the horse can be made to stand equally on both feet. 

A peculiar change in form follows fracture of the external branch of 
the ischium; the buttock is flattened at the height of the tuber ischii, 
whilst the region of the hip-joint appears considerably swollen, and the 
ilium slightly depressed. The abnormality is discovered by standing a 
few steps behind the animal and regarding the pelvis. Fractures 
through the acetabulum or os pubis are not generally followed by 
changes of form in the quarters, though in fracture of the acetabulum a 
slight depression may sometimes be seen over the hip-joint. 

(4) The bones of the pelvis are seldom abnormally mobile, except 
when the external and internal angles of the ilium are simultaneously 
fractured, though in exceptional cases it is present after fracture 
of the shaft and body of the ilium. In such cases the outer angle 
of the ilium yields when pressed on, and crepitus may sometimes be 
detected. 

(5) In fractures of the pubis, cedematous swelling sometimes occurs 
under the belly in the region of the udder or scrotum, but its 
absence does not exclude the possibility of such fracture. Fractures of 
the os pubis are often followed by swelling about the vagina; fragments 
of bone from the pubis and ischium may penetrate the vagina and pro- 
duce bleeding from the vulva. After fractures of the tuber ischii, 
swelling may also occur in the neighbouring thigh muscles. On the 
other hand, in fractures of the ilium, external swelling is not usually 
visible, but can be discovered by rectal examination. 

(6) Unusual mobility of the thigh. All fractures which divide the 
pelvic girdle behind the cotyloid cavity, as well as those into the acetab- 
ulum, with rupture of the lgamentum teres, are characterised by 
abnormal freedom in abduction, sometimes also in adduction, of the 
thigh of the affected side. 

(7) Examination per anum or per vaginam gives further information 
in fractures of the ilium and pubis, particularly when the shafts are 
broken. Local swelling can be detected; and if the animal’s quarters 


FRACTURE OF THE PELVIS. 425 


be moved to and fro, a hand inserted in the rectum easily follows the 
movements of the fragment of bone. 

(8) In fractures of the pelvis, as in other fractures, fever may occur, 
or symptoms of bleeding follow injury to large blood-vessels. This 
danger is perhaps greatest in fracture through the obturator foramen. 
The following are the distinctive symptoms of the most commonly- 
occurring fractures of the pelvis :— 

(1) Fractures of the lateral angle of the ilium (fig. 101), adduction 
of the stifle, swinging leg lameness, absence of crepitation, sometimes 
swelling and pain on pressure. 

(2) Fracture of the shaft of the ilium (3). Depressed position of the 
affected quarter. Swinging leg lameness, crepitation when standing on 
the foot of the affected side. Examination per anum gives more in- 
formation. This fracture is seen in cows during parturition or after 
falls (Hess, Ehrmann). 

(3) Fracture through the acetabulum (5). Severe swinging leg and 
supporting leg lameness, often accompanied by painful groaning. 
Crepitation without moving or placing weight on the limb, deformity 
slight, sometimes sinking of the hip region and abnormal mobility in the 
hip-joint. 

(4) Fracture through the obturator foramen (4 and 4a). Supporting 
lameness, crepitation, no deformity, sometimes anemia. 

(5) Fracture of the os pubis. Supporting leg lameness, with a 
tendency to adduction of the limb, pain on forced abduction, produced 
by moving backwards or sidewards. Crepitation sometimes absent, 
sometimes slight, sometimes distinct. Swelling below the abdomen 
may be wanting. Examination per anum gives further information. 

(6) Fracture of the ischium (a); of the tuber ischii (6). Swinging 
leg lameness, swelling of the vagina or rectum, frequently of the 
muscles of the thigh. After union is complete the gait often remains 
shuffling, the feet being dragged and the toes excessively worn, as in 
animals suffering from partial lumbar paralysis. Deformity of the 
point of the buttock sometimes exists, the latter when seen from 
behind appearing abnormally broad ; when from the side, not reaching 
so far back as the sound buttock. Crepitation on moving the hind- 
limb. (0) In fractures of the lateral branch of the ischium (47), the 
vagina may be perforated, and bleeding occur from the vulva. Crepita- 
tion on moving the hind-limbs is often marked. Slight lameness, or (if 
the pubis remain intact) absence of lameness, accompanied, however, 
by marked crepitation, point to fracture of this bone, especially if the 
above-described pelvic deformity exists. 

A knowledge of these facts, assisted by careful rectal or vaginal 
exploration, will in the larger animals usually ensure accurate diagnosis 


426 FRACTURE OF THE PELVIS. 


not only of the position but also of the extent of fractures of the: 
pelvis. When crepitation is marked and the femur known to be 
intact, broken pelvis can be confidently diagnosed. 

The prognosis varies exceedingly, according to the position and. 
extent of the fracture and the nature of existing complications. The 
danger increases somewhat in the following order :— 

(1) Fractures of the angles of the ilium. In fracture of the 
internal angle, provided the pelvis does not separate from the sacrum, 
movement is not interfered with and recovery always occurs. The 
significance of fractures of the external angle depends on the size of the 
broken off portion and the amount of deformity of the quarter. When 
only the anterior or posterior tuberosities are broken, lameness disappears 
completely in three to six weeks; and even after fracture of both or 
detachment of a large fragment of bone, the lameness may also subside 
in six weeks, but not infrequently recurs after work. Fractures involv- 
ing the flat portion of the ilum may sometimes permanently interfere 
with movement, the swinging leg lameness that remains preventing the 
animal going beyond a slow walk. Compound fractures of the ilum,, 
ie., those associated with injury to the skin, generally reunite under 
proper treatment, though sometimes only after a considerable time (six 
to ten weeks). The form of lameness frequently described as rupture 
of the M. tensor fascize latee (Noack) may perhaps be sometimes due to 
fracture of the external angle of the illum. 

(2) Fracture of the shaft of the ilium without much displacement 
may in quiet animals be followed by complete restoration to usefulness ;. 
otherwise lameness remains, or continually returns after severe exertion, 
and restricts the animal to walking work. As the result depends on the 
amount of displacement and the nearness of the fracture to the joint, 
prognosis should be preceded by rectal examination. Prognosis is, 
however, generally doubtful, and is the more unfavourable the more 
patent the deformity of the crupper, the greater the depression of the 
ilium, and the nearer the fracture to the acetabulum. Marked atrophy 
of muscle is also an unfavourable symptom. Stockfleth saw continuous 
lameness due to formation near the joint of a large callus, which 
interfered with the movements of the upper trochanter. 

(3) Fractures of the transverse branch of the os pubis or external’ 
branch of the os ischii are also of a grave character. Union takes 
place slowly, and is often incomplete, resulting in the formation of a 
callus fibrosus; fractures of the pubis often recur, especially if the 
animal soon afterwards becomes pregnant. Fracture of the external 
branch of the ischium often fails to unite, and the animals are only of 
use for slow work. In one ease I saw there was still marked crepita- 
tion after eight weeks, but complete union occurred in four months, and 


FRACTURE OF THE PELVIS. 427 


the animal could be put to trotting work. The slight degree of pain 
favours movement and displacement of the fragments, and interferes 
with recovery. 

(4) Fractures of the tuber ischii generally require months to unite, 
and sometimes result in the toe being dragged and the M. biceps 
femoris thrust out of position during movement. 

(5) Fractures through the obturator foramen are most dangerous on 
account of the risk of injury to the larger blood-vessels and of fatal 
bleeding. Otherwise they are rather more hopeful than the following, 
because, though rare, yet union may occur, and the animal become 
capable of slow work. Many horses, however, are unable to bear 
the continual weight on the other foot, and if not killed, die from 
decubitus. 

Division of the pelvic girdle close to the symphysis pubis and 
parallel with it sometimes produces little disturbance; but union is 
always slow and incomplete, while in many cases it altogether fails to 
occur. Laser saw a case where the bladder had been nipped between 
the pieces of bone. Such fractures tend to recur, especially if the 
animal be moved too early, or give birth to a foal. 

(6). Fractures of the acetabulum are the most dangerous, because as a 
rule the margin of the cotyloid cavity is broken into several pieces, 
hence prognosis is always unfavourable. 

Fracture of the pelvis through the sacro-iliac symphysis is also 
generally incurable, the danger being that, although only one side may 
be at first affected, the body-weight is apt to break down the union 
between the sacrum and the ilium on the other side, or that the inner 
angle of the ilium may become fractured; the animals are then unable 
to stand, and always die from decubitus. Complete fracture in or near 
the ilio-pubic symphysis also appears to be incurable in horses. 

Treatment.—TIf treatment is to be attempted, complete rest is a 
primary necessity. In fractures of the angle of the ilium, it is sufficient 
to keep the animal from work for a time, but if unable to stand on 
the foot of the affected side, it should be slung. ‘This is a very neces- 
sary precaution, because of the grave risk of further fractures or dis- 
placement of the broken pieces occurring when the horse lies down. 
Special care is required in fractures through the obturator foramen, 
to prevent fatal bleeding. 

In four to six weeks the patients may be moved a little, but if unable 
to bear weight ou the foot, should be returned to the slings. Stiffness 
in movement is less important, because it depends to some extent on 
the long rest, and gradually disappears with exercise. Provided pain 
is not excessive, the muscles of the quarter and thigh may be massaged 
to prevent that rapid atrophy which follows severe lameness. Daily 


428 LUXATION OF THE SACRO-ILIAC ARTICULATION. 


kneading of the parts will promote nutrition of the muscles. Atrophy 
disappears with the return to regular work, being only due to inactivity. 

Cold poultices are not only superfluous, but indeed injurious; they 
soften the skin, favour injury by the lining of the slings (which irritates 
the patient), and have no effect in removing pain. 


V.—DIASTASIS OR LUXATION OF THE SACRO-ILIAC 
ARTICULATION. 


Lit.: Golis, Her. Rep. 20, p. 119. Berdez, Schweiz. Archiv. 1882, p. 
188. Albrecht, Gurlt u. Hertwig. 20, p.35. Guillebeau, Schweiz. 
Archiv. 1887, p. 155. Stockfleth, Chirurgie. 


The union between the sacrum and ilium is formed by a stiff, almost immobile, 
joint, the short capsular ligament of which extends from the upper surface of the 
wing of the sacrum to the under surface of the ilium. The inferior sacro-iliac 
ligament, assisted by the upper and lateral sacro-iliac ligaments, contributes to 
this union. 


In horses, this ligamentous apparatus unites the bones so firmly that 
they are very seldom dislocated, it being easier to break the ilium. In 
cattle the union is less firm, the upper sacro-iliac ligament being some- 
times absent (Berdez). For this reason these animals occasionally suffer 
incomplete or complete disunion of the sacrum from the ilium, especially 
during parturition. Stockfleth and Berdez have thoroughly studied the 
condition, and I follow their description here. Berdez, considering the 
mode of origin of this dislocation, lays particular stress on the atony of 
the abdominal muscles which occurs at the time of parturition. Of 
these the rectus abdominis appears to act in opposition to the liga- 
mentous apparatus described, and fixes the joint. When, therefore, it 
is relaxed, as during parturition, danger of displacement becomes immi- 
nent. Stockfleth believes that movement in the symphysis pubis 
favours displacement. If division occurs in the symphysis pubis, the 
sacro-iliac joint is endangered, hence the simultaneous occurrence of the 
two conditions as related by Golis. It will also be clear that disloca- 
tion on one side may readily lead to a similar accident on the other. 
It is even the rule to meet with double-sided dislocation, as noted by 
Albrecht, Guillebeau, and others. 

According to Stockfleth, incomplete luxation is often occasioned in 
pregnant cows by pulling on the tail to assist them in rising, and 
complete luxation then follows.. It may also be caused by violent 
muscular exertion. The ilio-psoas and longissimus dorsi, together with 
one group of the thigh muscles, draw the sacrum downwards, whilst 
the glutei and other muscles of the thigh move the inner angle of the 


LUXATION OF THE SACRO-ILIAC ARTICULATION. 429 


ilium outwards. Powerful contractions in these muscles, produced by the 
animal rising or walking, may thus occasion dislocation of the bones. 

In incomplete luxation, the union between ilium and sacrum is not 
completely broken down. The muscles are partly torn through, and, 
like the sheaths of the great nerve stems, saturated with blood, but the 
ligaments are only partly divided. In complete luxation, on the other 
hand, all the hgamentous structures are ruptured, and the sacrum sinks 
between the inner angles of the ilium, its anterior portion especially, so 
that the articulatory surfaces may sometimes be 2 to 4 inches below 
the inner angle of the ilium. In consequence, the abdominal organs 
are compressed and sometimes injured; even the passage of feces may 
be interfered with. 

Symptoms and Course.—After incomplete dislocation, the animal 
inclines to rest continuously, rises with difficulty, and when moving the 
hind-legs, takes short stumbling steps. Sometimes large quantities of 
feces are passed, a symptom which Stockfleth considers characteristic 
of dislocation. Pressure between the inner angles of the ilia produces 
pain, and the separation can sometimes be felt through the rectum. 

Complete luxation is characterised by marked depression of the 
sacrum, and by the anterior edge of the ilium being unusually sharply 
defined. The swelling and tenderness in the middle line, and the inability 
to rise or to stand, render the condition unmistakable. On examina- 
tion per rectum, the pelvic cavity is felt to be narrowed, both in its 
perpendicular and transverse diameters. Defsecation is sometimes inter- 
fered with, in consequence of compression of the rectum. 

In incomplete dislocation, recovery may occur in three to four weeks, 
but double-sided dislocations take much longer, and many never reunite. 
Paraplegia generally sets in on the second or third day. The patient 
is unable to stand, and if parturient, will require active assistance, 
because labour pains are generally weak. Not infrequently fatal peri- 
tonitis occurs. 

According to Stockfleth, complete luxation is less to be feared, for 
the animals sometimes recover sufficiently to be useful for dairy 
purposes, even though, on account of the narrowness of the pelvis, they 
cannot be bred from. With sufticient rest the bony union is replaced 
by a fibrous joint, which enables the animal to walk well enough for 
erazing purposes. 

Treatment is essentially similar in both conditions. In incomplete 
luxation, rest is above all else necessary. A good bed must be provided, 
and any open drains covered up to prevent the animal stepping into 
them and producing further injury. Where there is difficulty in rising, 
assistance must be afforded, but the tail should never be used for this 
purpose ; assistance is also required during parturition. 


430 LUXATION OF THE SACRO-ILIAC ARTICULATION. 


Complete luxation also calls for a lengthened rest, and cases always 
do best if the animals lie continuously. Plenty of straw should be 
given, and help only afforded if the animal attempts to rise. The 
patient must not be driven for at least two to three months, nor again 
used for breeding. Complications often occur during recovery, and carry 
off the animals. 


VI.—LUXATION OF THE SYMPHYSIS OSSIUM PUBIS. 


Lit.: Golis, Her. Rep..20, p. 119: ; Prietsch, Dresd. Ber. 1859. 


This disease, almost invariably confined to cattle, is still rarer than 
the last named. The fracture appears during parturition, or sometimes 
not until afterwards. Golis saw it in connection with luxation of the 
sacrum. 

An eight-year-old cow, nearly at full term, suddenly became lame 
during work, and a few hours afterwards could neither rise nor, when 
lifted, stand on the hind-legs. On her attempting to move, the inner 
angle of the ilium on the affected side rose and sank. Displacement of 
the os pubis and os ischu at the symphysis pubis could also be felt. 
The cow was slaughtered, and the post-mortem showed luxation of the 
sacrum and fracture through the symphysis pubis. 

Prietsch saw a similar accident in a two-year-old heifer, which slipped 
with its hind-legs on a smooth pavement. The animal was unable to 
rise, and on post-mortem the symphysis pubis was found separated 
throughout its entire length. 

In horses, the symphysis pubis becomes completely ossified, and 
therefore in them fracture is commoner than separation. 

The diagnosis becomes absolute on examination per anum. The 
incurability of the disease renders immediate slaughter advisable. 


VII.—PARALYSIS OF THE HIND EXTREMITIES. 
PARAPLEGIA. 


Ger. Kreuzlihmung. 


Lit.: Axe, Jahresber. 1885, p. 66. Comény, Jahresber. 1888, p. 95. 
Signol, Her. Rep. 15, p. 229. Kitt, Jahresber. 1883, p. 80. Nocard, 
Jahresber. 1885, p. 66. Friedberger, Zeitschr. fiir Veterinirwiss. 
1873, p. 121. Dieckerhoff, Spec. Path. p. 673. Aruch, Jahrb. 
1889, p. 88. Hagen, Gurlt u. Hertwig. 39, p. 381. Damitz, Gurlt u. 
Hertwig. 11, p. 49f. Hiirlimann, Jahrb, 1888, p. 95. Prodger, Dresd. 
Ber. 1886, p. 110. Vatel, Jahrb. 1882, p. 30. Haubner, Dresd. Ber. 


PARALYSIS OF THE HIND EXTREMITIES. 431 


1860, p. 52, u. 1861, p. 61. Voigtlander, ibid, p.64. Hertwig, 
Gurlt u. Hertwig. 2, p. 354. Dieckerhoff, Ad. Woch. 32, p. 1. 
Siedamgrotzky, Dresd. Ber. 1871, p. 31, u. 1873, p. 37. Johne, 
ibid., 1879, p. 15, u. 1885, p. 40. Wolff, Th. Mitth. 1867, p. 148. 
Kampmany, Gurlt u. Hertwig. 5, p. 484. Vollers, Th. Mitth. 1878, 
p. 35. Johow, ibid, p. 95. Pfister, Schw. Archiv. 1884, p. 18. 
Friis, dahrp. 1888, p. 141. Hess, B. T. W. 1892, p. 33. Harms, 
ibid., p. 482. 


Strictly speaking, paraplegia means double-sided paralysis, and in 
general is used to describe disease of the spinal cord. For further 
information on this point, compare with my General Surgery,’ p. 231. 
Two forms, complete and incomplete paraplegia, are recognised. The 
former is seen :— 

(1) In injuries to, or pressure on, the spinal cord, following fracture 
of vertebre in the dorsal, lumbar, or anterior sacral regions (pp. 410 and 
415). Hess saw paraplegia in a steer caused by caries between the 
first and second lumbar vertebre. The spinal column presented an 
elbow directed upwards, and the vertebral canal had become narrowed. 
As the animal was suffering from tuberculosis of the epididymis (p. 365), 
these changes were regarded as tuberculous. 

(2) In inflammation of the spinal cord and its membranes in the 
regions indicated, usually a sequel of some other disease, especially of 
an infectious disease like parturient fever, influenza, strangles, or 
distemper. 

On the other hand, that form of paralysis affecting the hind-quarters 
during hemoglobinuria is dependent less on change in the spinal cord 
than in the muscular tissue. The fact that hemoglobinuria is always 
accompanied by paralysis of the hind-quarters has not only led to the 
incorrect description “ rheumatic paraplegia,” but also to the erroneous 
view that disease of the kidney may produce paraplegia. 

Idiopathic inflammation of the spinal cord and of its membranes has 
also been seen in horses. Friedberger found two areas of softening a 
little in front of the lumbar swelling of the spinal cord, and a watery 
fluid in the sub-arachnoid space in an eighteen to twenty year old horse 
which had been affected with incomplete paraplegia for some days, and 
had later shown symptoms of paralysis about the head (lips and tongue). 
Dieckerhoff describes a case of meningitis spinalis purulenta in a horse. 
Axe discovered, on making a post-mortem of a horse that had suffered 
from paraplegia after recovering from strangles, ceedema and capillary 
hemorrhage in the pia mater spinalis and infiltration of the spinal cord, 
with pus corpuscles, whilst the spinal column itself was quite intact ; 
possibly in such cases metastasis may sometimes have occurred. Johne 


1 Moller, Lehrbuch der Chirurgie fiir Thierirzte, 1. Band, Allgemeine Chirurgie und 
Operationslehre, Stuttgart, Ferdinand Enke.—[TRANSL. ] 


432 PARALYSIS OF THE HIND EXTREMITIES. 


reports having seen hemorrhagic pachymeningitis and leptomeningitis 
of the lumbar portion of the cord in a horse which had become com- 
pletely paralysed in its hind-quarters whilst standing in the stable, and 
which died twenty-four hours later. The spinal cord was more than 
half torn through between the first and second lumbar vertebrie, though 
the vertebree themselves were free of injury. The epizootic paraplegia 
described in books is probably to a great extent only hemoglobinuria. 
This seems also true of the condition described by Comény, which 
occurred in isolated divisions of a troop, and appeared mostly to affect 
mares. Signol reports an epizootic form of paraplegia amongst horses 
of Arabian blood, which also generally affected mares. The post-mortem 
gave no indications of the cause, 

In dogs affected with paraplegia, anesthesia of the hind-quarters, and 
paralysis of the bladder, Kitt and Stoss found circumscribed pachy- 
meningitis externa chronica, with formation of cartilaginous material, 
thickening of the dura, dilatation of arterioles, accumulation of spinal 
fluid, leading to excessive distension of the dura mater; though in the 
spinal cord itself no change whatever could be detected. 

(3) In consequence of tumour formation in the vertebral canal. 
Pfister found in a cow, which had shown gradually increasing symptoms 
of paraplegia, a lipoma 34 inches long and 1+ thick in the anterior 
end of the sacral portion of the vertebral canal, which was dilated, 
whilst the spinal cord appeared flattened. Johne detected meningo- 
myelitis tuberculosa in the spinal cord of an ox, whilst Hertwig found 
a melanotic tumour in a horse which had died with symptoms of para- 
plegia. It had originated in the lymph glands in the lumbar region, 
had partly destroyed the last three lumbar vertebree and the sacrum, 
and penetrated into the vertebral canal. 

(4) As a secondary symptom, paraplegia accompanies general 
paralysis caused by meningeal inflammation and other inflammatory 
changes in the brain, medulla oblongata, and spinal cord. Dieckerhoft 
found a gastrus larva in the cervical portion of the spinal cord in a 
horse. 

The reports of psychic paraplegia or nervous apoplexy of the spinal 
cord seem completely inexplicable. Failure to discover diseased con- 
ditions on post-mortem examination of animals dead of paraplegia in no 
way proves that such have not existed, and this is especially true of 
paraplegia due to concussion of the spinal cord. Aruch describes three 
cases of psychic paralysis in dogs following punishment. Hagen saw 
paraplegia in an old horse after fright by a locomotive. The condition 
disappeared in three days. Probably other unexplained causes were 
at work in these cases. The same is true of those cases in which para- 
plegia is said to have resulted from the presence of parasites in the 


PARALYSIS OF THE HIND EXTREMITIES. 433 


bowel (Hiirlimann by flat worms and Damitz by lumbricoid worms). 
Complete paraplegia has been seen in horses after powerful electric 
shocks produced by lightning (Proger). 

Since olden times every permanent disturbance of function in the 
hind-limbs has been described as incomplete chronic paraplegia. As a 
rule such disturbances are accompanied by peculiar irregularities in 
movement and rolling gait, but these symptoms cannot be viewed as 
characteristic of any one disease; they may be caused in various ways. 
Without doubt change in the spinal cord plays a chief part, but un- 
fortunately in this disease thorough post-mortems have not been made. 
The difficulty in movement and the course of the disease point to 
chronic morbid processes in the spinal cord. In horses, there is usually 
a difficulty in co-ordinating movement termed ataxia, similar to that in 
tabes dorsalis in man. The separate groups of muscles do not act 
together; harmony of function is wanting. 

The diseased conditions, however, to which these symptoms are due 
cannot merely be, as Dieckerhoff believes, over-extension of the fascie. 
In “maladie du coit” which is followed by progressive paralysis of 
the hind-quarters, Thanhoffer states having found changes in the spinal 
cord. Hemorrhagic myelitis with formation of cavities in the spinal 
cord (syringomyelitis) and degenerative processes occurring at isolated 
points were met with. In other varieties of paraplegia changes could 
doubtless be found in the spinal cord, provided examinations were 
made in advanced stages and by proper methods. Wolff saw the 
hind-legs trailed in horses in consequence of fracture of the caudal 
vertebre ; here the change had clearly extended to the spinal cord 
from the point of fracture. On the other hand, it must be allowed 
that incomplete paraplegia is not always the result of primary 
disease of the cord, nor even of changes in it produced by in- 
fectious conditions (like influenza or strangles); it may also follow 
diseased processes of the vertebre. In France, paraplegia (leffort 
de reins) is generally considered to result from injury to the spinal 
column in the dorsal or lumbar region, and is described, therefore, 
as vertebral displacement (entorse dorsolombaire). Vatel has given a 
thorough description of the post-mortem of a horse affected with this 
disease. According to Peuch and Toussaint, the inter-vertebral discs 
in the dorsal or lumbar region sometimes appear yellowish-green 
and partly destroyed; in advanced stages they quite disappear, 
granulations form on the ends of the individual vertebre, become 
adherent, ossify, and so lead to the formation of a synostosis. Some- 
times exostoses form in the vertebral canal and press on the spinal cord. 
These changes may be associated with rupture of the muscles. Rigot 
states having found hemorrhages in the psoas muscles, and Goubaux 

25 


434 PARALYSIS OF THE HIND BXTREMITIES. 


abscesses in the longus colli. In these cases it certainly seems that the 
condition has been confused with other diseases. 

In horses, I have repeatedly seen incomplete paralysis occur from 
catching cold, but disappear after a short time. In such cases muscular 
rheumatism was probably the cause. 

Periodic paralysis of the hind-limbs, owing to obstruction of the 
blood-vessels of the thigh and pelvis, has been seen. Tumours may 
also develop in the vertebral canal or extend into it, press on the cord, 
and produce paraplegia. In a horse brought to the Alfort clinique, 
carcinomata were found to be pressing on the spinal cord and causing 
paralysis. Secondary carcinomata existed in the abdomen. Kampmann 
saw paraplegia in a foal from perforation of the second lumbar verte- 
bra by a cyst which had discharged its contents into the vertebral 
canal. 

In cows, a condition which occurs during the last period of preg- 
nancy, but generally disappears after parturition, has been deseribed as 
incomplete paraplegia. It is really due to insufficient. muscular power 
to raise the greatly increased body load, and is favoured by advanced 
age, defective nutrition, very fat condition, or continuous confinement to 
the stable. In these animals, lesions in the spinal column and _ pelvis 
(fissures) resulting from parturition occasionally cause complete or in- 
complete paraplegia. Whether so-called reflex paralysis occurs as 
Franck suggests seems doubtful. A great number of bovine diseases 
described as paraplegia are clearly due to mistaken diagnosis of painful 
conditions in the hind-legs and digits. 

In sheep, paraplegia results from the presence in the medulla of 
ccenurus cerebralis, a parasite, which has also been seen in the ox. 
In the later stages of sturdy, sheep always suffer from creeping 
paralysis of the hind-quarters and irregular movements of the hind- 
feet. 

In dogs, paraplegia is sometimes caused by injury (concussion) of 
the spinal cord or fracture of vertebrae, but generally results from 
distemper, and depends on chronic disease of the brain or spinal cord. 
Acute or chronic myelitis and atrophy of the cord have been detected ; 
Siedamgrotzky found cedema of the cord, and Johne yellow points of 
softening in it. 

Complete and incomplete paraplegia have also been seen in swine. 
Complete paraplegia is commonest in sucking-pigs on account of the 
little animals being trodden on by the mother ; in older swine rhachitis 
may produce it. Paraplegia has also been seen in birds; Siedamgrotzky 
noted it in parrots. Its cause is little understood, 

Symptoms and Course.—It is clear that conditions differing so 
much in their anatomical causation are not likely to agree in their 


PARALYSIS OF THE HIND EXTREMITIES. 435 


symptoms. Nor do the clinical appearances usually exhibit such well- 
marked peculiarities as to admit of a definite anatomical diagnosis. The 
nature of these conditions has already been determined to some extent 
in man, but in animals it still remains obscure. Researches are specially 
needed in incomplete paralysis ; exact diagnosis of the causative condition 
in complete paralysis of the hind-quarters is less interesting on account 
of the animals being killed as incurable, or dying in consequence of 
decubitus (a complication which can seldom be prevented), though 
exceptions occur even here, as, for example, in commotio medulle 
spinalis, and the course of the disease must, therefore, be carefully 
watched. Complete paralysis of the hind-quarters is distinguished: 

(1) By inability to stand. The animals lie, and are unable to raise 
themselves or to walk. In exceptional cases, the function of the crural 
nerves, and therefore the ability to stand, is preserved, though the 
animal is unable to walk. This may be due to the fact that the solution 
of continuity in the spinal cord occurs behind the exit of the nerve 
referred to (4th to 6th lumbar vertebre). The same peculiarity also 
occurs in fracture of the spinal column in the dorsal region, as I have 
seen in horses. Dogs sometimes learn to walk on the fore-legs, as 
related by Nocard ; they lift the hind-quarters into the air by powerfully 
contracting the longissimus dorsi, &c., after the manner of circus 
dogs. 

(2) Reflex irritability 1s completely in abeyance, and the animals 
make no resistance to the operators manipulations. This is always 
the case where the seat of disease is in or behind the lumbar portion 
of the cord. Where in front of this spot, that is, in the dorsal region 
or further forward, reflex irritability is not only retained but may often 
be abnormally pronounced, so that stimulation of the skin, ligaments, 
or bones (slight blows or pricks with the needle) cause active contrac- 
tions in the paralysed muscles. Continuous contraction (cramp) may 
thus be caused (spastic paralysis). Nocard saw increase of the tendon 
reflexes in a dog (compare with my General Surgery, p. 228). 

(3) In grave lesions of the cord, sensibility appears to be completely 
lost; in myelitis spinalis it is at first not much interfered with; its 
continuance points to injury of the posterior columns and of the grey 
posterior cornua. In pressure paralysis, sensibility may sometimes be 
increased, as shown by Nocard’s reported cases in dogs; movement of 
the paralysed hind-quarter produced acute pain (paraplegia dolorosa). 
The examination of large animals is more difficult, because sensation 
cannot be exactly gauged, reflex movements being so difficult to distinguish 
from those caused by painful sensations. 

(4) To the above cardinal symptoms of paraplegia are added those of 
paralysis of the bladder, rectum, and tail (p. 440). There is often 


436 PARALYSIS OF THE HIND EXTREMITIES. 


incontinence of urine, and feces cannot be discharged without assistance. 
This grouping of symptoms generally accompanies pressure paralysis 
from fractures of vertebre or of the sacrum, from extravasation of blood 
into the vertebral canal, in rarer instances from tumours, but may also 
occur in concussion of the spinal cord, The diagnosis must be based on 
the history of the case, its manner of origin and course. In fractures 
of the vertebrae, displacement of fragments or crepitation may be 
detected. 

The symptoms of incomplete paralysis show still greater variety ; 
but even though it is not possible, in every case, to form an accurate 
diagnosis, it is well, from the clinical standpoint, to distinguish two 
kinds :-— 

(1) Paraplegia incompleta vera, vel spinalis (true incomplete or spinal 
paralysis); and 

(2) Par. incompleta spuria (incomplete spurious paraplegia). The 
causes of the first lie within, those of the second without the vertebral 
canal. Paraplegia of the first kind, due to acute or chronic inflammation 
of the spinal cord and its membranes, or to pressure and degenerative 
processes in the medulla spinalis, declares itself by the following 
symptoms :— 

1. Disturbance in movement, distinguished :— 

(a) By loss of strength, and 

(b) By irregularity in movement, The animals show weakness, 
and rapidly become tired; the hind-limbs, though able to 
sustain the weight of the body, only shghtly assist in forward 
progress, and, during walking, make irregular ataxic move- 
ments. 

Ataxia is a form of interference with movement arising from defective 
co-ordination. The proper innervation of the separate groups of muscles 
is interfered with, in consequence of which their contractions are not 
harmoniously combined. Single groups contract too much or too little, 
others too early or too late. 

In horses and dogs, such symptoms accompany incomplete paraplegia. 
The hind-feet are lifted hesitatingly and incompletely from the ground ; 
the toe is dragged, and gradually becomes worn. In the next stage 
the foot is lifted suddenly and to an abnormal height, is set down 
awkwardly and with a tapping movement, and often describes a 
semicircle outwardly; the feet are placed crosswise over one another, 
while the hind-quarters roll first to one side and then to the other (plaiting 
the legs). These ataxic movements are particularly well seen when turn- 
ing; the animal has difficulty in backing. 

2. Sensibility and reflex irritability are generally retained, the latter 
may even be increased, causing exaggeration of the tendon reflexes. In 


PARALYSIS OF THE HIND EXTREMITIES. 437 


general the same remarks apply here as were made in reference to 
complete paraplegia. 

3. Muscular atrophy. This is seldom seen in spinal paralysis, or is 
confined to gradual slight atrophy of both sides in consequence of 
inactivity. Degenerative atrophy and signs of degeneration never 
occur, 

The non-appearance of atrophy in the spinal form of incomplete para- 
plegia shows that the cause lies in front of the trophic centre of the 
muscles, that is, in the posterior columns of the medulla, as paralysis 
due to brain injury generally takes the form of hemiplegia (compare 
p. 231 of General Surgery). 

The several causes of paraplegia incompleta spuria lie outside the 
spinal cord or spinal column. They sometimes consist in fissuring of 
vertebre, disease of the inter-vertebral discs (p. 433), or still more 
frequently muscular disease, which may be of a rheumatic character 
due to chill, or of purely mechanical origin. In the horse the latter 
is more frequent, because in it violent, intrinsic or extrinsic, over- 
extension of muscle produced during heavy and unwonted exertion is 
common, When animals are continuously overworked, permanent inter- 
ference with muscular function in time results, causing their mechanical 
efficiency to become impaired. The resulting disturbance has been 
referred to disease of the fasciw, but the truth of this statement has 
never been satisfactorily proved. The pathological changes would here 
be similar to those in tendons, but, as the disease is so much more 
obdurate, it appears to me doubtful whether the fascize plays such an 
important part. 

Vollers describes a form of paraplegia which suddenly developed in 
a mare after parturition, and simultaneously with deformity of the 
spinal column, between the 14th and 15th dorsal vertebre;: The 
animal could stand, but could only walk with difficulty ; it made rolling 
movements with the hind-quarters. At first, movement was greatly 
interfered with, but afterwards improved, though the spinal deformity 
continued. Johow saw a fifteen-year-old horse which had suffered from 
weakness of the hind-quarters for a period of six months. The 
difficulty was greatest in the morning on getting up and making the 
first few steps. One day complete paraplegia suddenly set in. The 
body of the first lumbar vertebra was found, on post-mortem, to be one- 
third thicker than that of the others. The thickening encroached on 
the vertebral canal and pressed on the spinal cord, which had corre- 
spondingly diminished in thickness. 

Harms found the connection between the anterior ends of the glutei 
maximi and the longissimus dorsi torn away on both sides in a four- 
year-old horse. When resting, nothing remarkable could be seen, but 


438 PARALYSIS OF THE HIND EXTREMITIES. 


during movement, the hind-quarters rolled from side to side. <A large 
cavity could be seen on either side of the spinal column, at the point 
where the large gluteus arises from the longissimus dorsi. In front 
of the ilium an elevation was noticeable. After movement, the anterior 
end of the large gluteus returned to its normal position, as could easily 
be seen. No improvement occurred. 

Prognosis in complete paraplegia is unfavourable, and only those 
cases due to concussion of the cord have any chance of recovery. In 
large animals the prognosis is much less favourable than in small ones, 
the former always dying at an early stage from decubital gangrene, and 
horses even sooner than cattle. 

In incomplete paraplegia, the prognosis naturally depends principally 
on the nature of the causative disease process. Recent and sudden 
cases, especially those resulting from chill, offer more hope of recovery 
than the more chronic, which are generally due to some incurable dis- 
ease. All forms of paralysis, distinguished by degenerative changes of 
tissue and well developed muscular atrophy, are unfavourable ; in these 
recovery is exceptional. The condition usually becomes gradually 
worse, though at times it seems to remain nearly stationary, and allows 
animals to be used for considerable periods at a walking pace. 

Treatment.—In paralysis, the animal must have a suitable soft bed 
and be frequently turned over to prevent decubitus. Easily digested 
food is indicated. The bladder and rectum must be emptied from time 
to time, and sometimes purgatives are allowable. Further treatment 
must depend on the nature of the cause ; rest and cold applications are 
indicated in superficial mechanical injuries; Preistnitz’ poultices or 
applications of hot sand or bran in rheumatism ; at the same time the 
muscles may be rubbed with stimulant lotions, &e. 

In incomplete paralysis, treatment must be based on a knowledge 
of the original cause; when this is mechanical, the animal should be 
placed in slings. Rheumatic conditions are to be treated as above. 
When inflammation of the spinal cord or its membranes is  sus- 
pected, irritants like mustard poultices or cantharides can be employed. 
To combat atrophy of the muscles, gentle exercise should, as far as 
possible, be given, and the parts massaged by kneading or striking 
(tapotement). In horses, I have repeatedly seen good results follow 
subcutaneous injection of veratrin. 

In dogs, the continuous or induced electric current may be employed. 
The induced current can scarcely be used in horses, on account of their 
great sensitiveness to it and the resistance they offer. 


DISEASES OF THE TAIL. 439 


VITL—DISEASES OF THE TAIL. 


Lit.: Prietsch, Dresd. Ber. 1884, p. 105. Kaiser, Gurlt u. Hertwig. 31, 
p. 436. Cumlander, ibid., 33, p. 329. Popow, Jahrb, 1884, p. 129. 
Schwarznecker, Gurlt u. Hertwig. 30, p. 225. Peters, ibid., 16, 
p. 76. Deigendesch, Her, Rep. 43, p. 193. Friedberger, Ad. 
Woch, 1889, p. 193. Lenhardt, Gurlt u. Hertwig. 9, p. 472. 
Rosenbaum, ibid. 27, p. 124. Gabbey, Th. Mitth, 1878, p. 93. 
Block, Berl. Th. Woch. 1891, p, 215. Roder, Dresd. Ber. 1891, p. 88. 


(1) Putting on one side operative wounds, injuries of the tail are 
most frequent in dogs and oxen. In the former they are caused by 
blows, treads, striking against the wall of the kennel or other objects, 
or by the tail being run over. Defective sensibility seems to play a 
certain role here. Pareesthesia, that 1s, abnormal subjective sensibility, 
sometimes causes dogs to gnaw the point of the tail so as to lay 
bare the vertebre; Prietsch saw this in a lion. 

In cows, bruises are produced by blows from sticks, by violently 
bending the tail to make the animal proceed, or by squeezing it 
between two sticks, which is done for the same object, and often in a 
very rough way. In former days the root of the tail was often injured 
by operations destined to eradicate disease. At present such injuries 
are often inflicted on swine for the purpose of bleeding. In oven, 
pleuro-pneumonia inoculation sometimes produces severe inflammation 
in the tail, especially if impure material is employed. Sometimes the 
tail whilst soiled with dung is accidentally wounded. Injuries of this 
kind in oxen, when not promptly treated, readily produce cellular 
inflammation, owing to infection, or ulceration, and may extend to 
the vertebrz, producing a chronic disease which was formerly viewed 
as specific. Ulceration, caries, or necrosis, resulting from cellulitis, 
may set in and lead to sloughing of portions of the tail. The outer 
skin being closely applied to the caudal vertebre, severe swelling 
at the root of the tail is lable to be followed by necrosis, just as in 
other organs, ¢e.g., the tongue; the pressure exercised by the greatly 
distended skin impedes and finally stops circulation. The accident is 
common after inoculation with instruments or lymph conveying septic 
substances, or in cases where the animals are not well looked after. 
Its wide distribution in certain stables formerly led to its being 
regarded as a specific disease. In Finland, official precautions have 
even been taken against it (Cumlander). 

Symptoms and Course.—Injuries to the tail are easily detected. 
Cellulitis is marked by diffuse swelling, which often extends to the 
body, causing feverish symptoms, and even death. In other cases the 


440 DISEASES OF THE TAIL. 


inflammatory swelling leads to partial gangrene of the tail, or to necrosis 
of skin, liable to be followed by caries of the caudal vertebre. 

In dogs, the point of the tail is often raw from continually strik- 
ing against neighbouring objects ; it may either be covered with a scab, 
or present a discharging surface. The animal which licks may even 
gnaw or bite, continually exposing the last caudal vertebre. The con- 
dition is commonest in short-haired or large dogs. Recovery may follow 
proper treatment, but frequently amputation of the extremity of the tail 
is necessary, and even this may fail to stop the process, for the animals 
gnaw the exposed stump, and the difficulty arises de novo.  Prietsch 
performed amputation twice on a lon before healing ensued. 

Treatment.—Preventive treatment consists in cleanliness; where 
the parts are already infected antisepsis should be adopted. 

To check cellulitis it may be necessary to scarify the skin of the tail 
lengthwise, and to follow this by the application of an antiseptic 
surgical dressing. Block scarifies as deep as the periosteum, and rubs 
in common salt or turpentine. 

In dogs it is best to smear the wound with iodoform, collodion, or tar, 
or to cover it with a dressing to prevent the animal licking and gnawing 
the point of the tail. Should this fail, the part must be amputated. 
Sometimes it is useful to cauterise the stump. 

I can only refer shortly to the so-called rat-tail produced in horses by 
the gradual loss of the long hairs of the tail. Up to the present the 
exact cause is unknown, nor is there any sure means of preventing the 
loss of hair, or of assisting its return. Popow recommends scarification 
of the skin of the tail, but its efficacy requires further confirmation. 

(2) Paralysis of the muscles of the tail. Difficulty in moving the 
tail may be caused by fractures of the sacrum, and by inflammation and 
new growths, but primary nerve disease of the caudal muscles also 
occurs in horses and dogs, both as an accompaniment of paraplegia and 
independently of it. I have repeatedly seen the disease in mares, and 
judging from recorded cases it seems to affect them particularly 
(Schwartznecker, Deigendesch, Friedberger, Roder, Peters). Gabbey 
and others have seen the condition in geldings. The disease generally 
commences slowly ; at first the tail is not carried in the ordinary way, 
but hangs more or less limply between the hind-legs, swinging to and 
fro as the animal moves, and becoming soiled by urine and feces. 
After the lapse of several months, paralysis of the bladder (incontinentia 
urine) and habitual constipation may appear, and manual assistance 
become necessary to empty the rectum, the last portion of which is 
gradually dilated. If relief be not afforded, the animal suffers from 
colic. Finally, paraplegia incompleta appears, with atrophy of the 
muscles of the quarter and of the hind-leg. 


DISEASES OF THE TAIL. 441 


Prognosis is unfavourable, as treatment has hitherto proved power- 
less against this gradually progressive disease. In the cases I have 
seen, neither stimulants nor the use of strychnine, nor of electricity, have 
been of any use. Roder gave strychnine without success, The animal 
gradually becomes worse, finally unworkable, and has to be killed) A 
mare seen by Deigendesch died from rupture of the bladder. 

(3) Tumours on the tail occur in horses, oxen, and dogs. I have 
repeatedly seen carcinomata and sarcomata in horses, and in grey horses 
the so-called melanomata. Lehnhardt and Rosenbaum have seen vascular 
new growths on the tails of oxen. These sometimes start from the skin, 
sometimes from the vertebre of the tail, and produce ulceration, or 
they extend to the perineal connective tissue, and lead to obstruction 
of the bowel (p. 310). 

Diagnosis is easy, but it is otherwise with treatment. Superficial 
tumours, that is, those having their seat in the skin, may easily be 
removed with the knife, but if they arise from the vertebre amputation 
of the tail is the sole resource. Tumours near the end of the tail 
are dealt with by “docking;” those near the base are, however, more 
serious, and in removing them the operator should follow the directions 
laid down on p. 468 of my General Surgery. 


IX.—NEGROSIS OF THE LUMBO-DORSAL FASCIA. 
Lit.: Schmidt, Th. Mitth. 1877, p. 116. 


The lumbo-dorsal fascia (fascia lumbo-dorsalis) lies just beneath the 
panniculus in the region of the back, and covers the dorsal extensors 
like a sheath. Its superficial portion arises from the outer angle of the 
ilium, becomes attached to the superior spinous processes of the lumbar 
and dorsal vertebree and to the ligamentum nuche, is continued back- 
ward in the fascize of the abdominal muscles, and forward in the direction 
of the hgamentum nuche, to become attached to the scapular fascia 
(Franck). Its deep portionis confined to the lumbar region. It connects 
the transverse processes of the lumbar vertebre to one another, and to the 
outer angle of the ilium. The dorsal fascia serves as a point of attach- 
ment to various muscles, and forms the medium of connection between 
the extensors of the back and the muscles of the hind-quarter. It is 
most developed in horses. 

Suppuration in the skin of the back, produced by pressure, sometimes 
causes necrosis of the dorsal fascize; external injuries and cellulitis may 
also produce it. The great strength of this fascia renders dissection of 


442 NECROSIS OF THE DORSAL FASCL#. 


necrotic parts tedious, whilst new portions are continually attacked, and 
die on account of progressive suppuration. Sooner or later, therefore, 
large tracts are destroyed. I have repeatedly seen this in horses, have 
had cases last for weeks, and give the greatest difficulty in treatment. 
Recovery is quickest after surgical removal of the diseased portion ; pus 
formation is checked by continuous irrigation with disinfectants. Schmidt 
saw in a foal purulent necrosis of the fascia, which extended from the 
withers to the pelvis. On incision, necrotic pieces of tissue and ill- 
smelling pus were discharged. Although the ribs could be felt on intro- 
ducing the finger, recovery occurred in six weeks by using carbolic 
lotion, but few cases prove as amenable to treatment as this (compare 
p- 201). 


XI. DISEASES OF THE FORE-LIMB. 


A. Diseases of the Shoulder Region. 
I—FRACTURES OF THE SCAPULA. 


Lit.: Trasbot, Jahresber. 1888, p. 139. Straub, Gurlt u. Hertwig. vol. x. 
p. 444. Binz, Knochenbriiche der Hausthiere, 1824. Strauss, Vet. 
Chirurgie, 1845, 


ON account of the sheltered position and slight mobility of the scapula, 
it is comparatively seldom fractured in domesticated animals, though such 
cases are reported as having resulted from blows with blunt bodies, from 
collisions, kicks, treads, and falls, particularly from falls on the shoulder, 
or with the legs widely straddled. Trasbot saw fracture of the scapula 
from struggling whilst in hobbles; oxen occasionally produce fracture 
when carelessly lying down. The accident is also at times caused by 
violently reining-up animals, the neck of the bone being then generally 
broken. 

Sometimes the supra-spinous or infra-spinous fossa is broken through, 
sometimes the spine or the body, not infrequently the neck or the 
glenoid cavity. The greater number of these fractures are subcutaneous ; 
only occasionally is the skin perforated. Such fractures are commonly 
fissured, but comminuted fractures also occur. I saw one in a horse 
which had worked in a gravel-pit during the winter. The scapula was 
crushed into more than eighty pieces by the falling of a mass of frozen 
earth. 

Diagnosis.—In well-nourished animals, notably in horses, and 
where severe swelling has occurred, diagnosis is difficult. Displacemeut 
of the broken fragments is often slight, and crepitation may be totally 
absent. It is, therefore, clear that every marked, rapidly-produced 
lameness, which is evident both when the animal stands on the limb 
and also when it moves, must awaken suspicion of fracture of the 
scapula, provided there is no other self-evident cause. 

Fracture of the scapular spine is the only one of the above conditions 


444 FRACTURES OF THE SCAPULA. 


in which the foot may be placed on the ground in the usual way, 
though movement is then in the highest degree painful. In fracture 
of the scapular spine, and of the anterior or posterior angle of the 
scapula, the fragments are found to be movable. Fractures of the neck 
of the scapula are attended with excessive mobility of the foot, especi- 
ally in ab- and ad-duction. Fractures of the body of the bone are most 
difficult to diagnose, but may always be surmised when the humerus 
remains intact and crepitation is present. 

Course and Prognosis.—The nearer the fracture to the lower 
end of the bone the graver the condition. This principle, established by 
Binz, must be borne in mind; it rests on the fact that, in fractures of 
the upper portion of the scapula, the fragments are not so easily 
displaced, and the pain is less. 

The prognosis of fracture through the glenoid cavity is most unfavour- 
able in working animals, and especially in horses. Fracture near the neck 
of the scapula does not necessarily prevent the animal again becoming 
useful, especially if the fragments are not much displaced; sometimes 
perfect usefulness is restored. This is oftener the case in fractures of the 
body, and almost always so in fractures of the spine and upper portions 
of the scapula, provided they remain subcutaneous. Compound frac- 
tures are always dangerous, because of the burrowing of pus in the fascia 
of this region. The less the pain and lameness, the greater the chance 
of healing; but when, in horses and cattle, these are marked, it is better 
to kill, unless the patients are of particular value for stud purposes, on 
account of the loss of condition during recovery. Severe pain forces the 
animal to rest on the other foot, and there is then danger of depression 
of the pedal bone, especially if the patient stands continually. Increased 
pulsation in the metacarpal artery, and attempts to rest the foot, point 
to this complication, which is so painful that the animal generally lies 
down and cannot be moved. Death then occurs from decubitus. 

In small animals, particularly in carnivora, subcutaneous fractures of 
the scapula generally unite in four to six weeks, but lameness sometimes 
remains. 

Treatment.—Displacement of fractured parts must, as far as 
possible, be reduced, which is easiest with the patient in the prone 
position and under chloroform. In large animals it is, however, always 
difficult, and, even when effected, retention cannot be assured. The 
bandaging so often recommended is of little use except in small animals. 
In horses, neither the cushions recommended by Binz nor the apparatus 
devised by Strauss are of any service, and the dressings suggested by 
Codine and Delwart, which are fixed by means of turpentine and pitch, 
are little better. When the pain is not sufficient to compel the animal 
to keep the diseased foot quiet, and especially when weight cannot be 


FRACTURES OF THE SCAPULA. 445 


borne on it, early slaughter is preferable to treatment, with its doubtful 
results. Animals which will lie down should have a thick straw bed, 
otherwise they may be placed in slings, and kept as quiet as possible. 
If in complicated fractures treatment be resolved on, attention should first 
be directed to rendering the wound aseptic, and for keeping it so, a 
dressing is indispensable. 

In small animals suitable bandages are more easily applied, and 
should include the thorax and lower part of the neck, so as to ensure 
their remaining in position. 


Il—FRACTURES OF THE HUMERUS. 


Lit.: Peech, Her. Rep. 25, p. 43. Rossignol, Rec, de méd. vét. 1855. 
Meredith, The vet. journal, vol. 27, p. 19. Drosse, Th. Mitth. 1854, 
p- 76, 


Though fractures of the humerus are, as a whole, uncommon in 
animals, they nevertheless occur pretty frequently in dogs, in which 
one or other condyle breaks away from the lower end of the humerus. 
Peuch and Rossignol have also seen double-sided fracture of the humerus 
in horses. The symptoms and prognosis vary according to the position 
of the fracture. Drosser saw fracture of the outer and upper pro- 
tuberance of the humerus (ridge), and removed the piece of bone; 
recovery occurred in fourteen days. Six or seven weeks later the 
animal stumbled and broke the humerus in the direction of its length. 

Fractures of the diaphysis of the humerus are commonest in cattle 
and dogs, and are produced by external violence, kicks, collisions, treads, 
or accidental falls; occasionally in horses by the animals being suddenly 
wheeled round whilst being ridden (Ernes). 

Fractures of the condyles are caused by treads, notably in dogs, 
though I have seen similar cases in horses. Sometimes the external, 
sometimes the internal condyle is broken off in consequeuce of the 
supporting leg making a violent rotary movement, or the free limb 
being excessively ad- or ab-ducted. In dogs such fractures are pro- 
duced by awkwardly jumping or falling from a chair or table. Of 
twenty-six fractures of the humerus in dogs treated by Stockfleth, 
seven were through the diaphysis and nineteen through the condyles. 

As a rule, diagnosis of fracture of the diaphysis offers no difficulty. 
There is severe pain both when the animal stands on the limb and 
when it moves; swelling and abnormal mobility and crepitation when 
the scapula is fixed; the other bones of the limb are found intact. 


446 FRACTURES OF THE HUMERUS. 


In such cases there can be no doubt. It is more difficult to detect 
fracture of the condyle. Sometimes the disconnected condyle is 
movable, and there may be crepitation; diagnosis is easiest in the dog. 
In horses there is severe lameness when the limb is carried, and inability 
to place weight on the foot. The leg is either turned in or out, being 
adducted in fracture of the extensor condyle, and abducted in that of 
the flexor. In the former case the lower joints of the limb are 
excessively flexed, so that the front of the hoof is in contact with the 
ground, owing to the relaxed extensor muscles being loosened from their 
upper points of insertion, During the course of recovery, this abnormal 
position of the limb often suddenly disappears, and if, in fractures of the 
flexor condyle, weight be then placed on the foot, the knee is exces- 
sively extended, so that the anterior surface of the limb appears concave ; 
this is particularly noticeable during trotting at the moment when 
weight is placed on the foot. When accompanying abnormal flexion of 
the elbow-joint, this symptom is explained by the relaxation of the 
flexor metacarpi, consequent on division of its upper point of insertion. 
The same is true of the flexor tendons in fractures of the inner condyle. 
Otherwise this symptom only occurs in rupture of the flexors, or in 
fractures of the pisiform bone, and is, therefore, of particular diagnostic 
value. It does not occur in carnivora. 

Course.—In carnivora, fractures of the condyles almost always unite 
in six to eight weeks, though some interference with movement of the 
elbow may remain. Stockfleth and I have seen such fractures occur 
in dogs in both legs simultaneously, and yet reunite. My own case 
was in a sporting dog, which afterwards regained its usefulness. In 
another case, in the horse recovery took between two and three months, 
and yet the animal was finally quite able to work. Willams appears 
to have had less favourable results, for he declares that union of the 
broken condyle seldom occurs, and that permanent lameness remains in 
consequence. 

In all classes of animals, fracture of the diaphysis is less hopeful, 
especially in draught-horses, and as a rule, no good comes of 
attempting treatment. It is otherwise with valuable breeding-horses, 
particularly if of quiet temperament, and in the smaller domestic 
animals healing is quite possible so long as displacement is not great, 
and the other foot is able to bear weight. Under these circumstances 
recoveries have been noted. Warnecke saw fracture of the humerus in 
a stallion, and Meredith compound longitudinal fracture in a horse, re- 
unite in ten weeks. Numerous fragments of bone were removed and an 
antiseptic dressing applied. Lafosse, Aubry, and Peuch report similar 
cases. Prognosis is more hopeful in small animals, especially when 
the fragments of bone are not much displaced. Not only is reduction 


FRACTURES OF THE HUMERUS. 447 


easier, but in carnivora the position of the humerus allows of applying 
bandages, particularly if the fracture is near the lower end. 
Treatment.—In horses and cattle suitable bandaging can scarcely 
be effected, and recovery must, therefore, be left to nature. The com- 
plicated dressings recommended in France do not seem to assist much 
in retaining the fragments in position. In carnivora, on the other hand, 
the lower portion of the humerus may be bandaged, and it is also 
possible in them to completely fix the broken condyle. A plaster 
bandage is applied from the metacarpus as far up as possible, and care 
taken that the elbow-joint is moderately flexed, so as to avoid bad after- 
consequences. The lower part of the limb should neither be fixed in 
position of excessive supination nor of pronation. In three to four 
weeks the animals commence to place weight on the foot, and the 
bandage may then be removed. At first the elbow-joint cannot be 
freely moved, but this gradually improves, or is at any rate much 
diminished under passive movement. 
Large animals, and notably horses, require slinging. Immediately 
marked pulsation can be detected in the metacarpal artery of the leg 
on which the animal stands, it should be allowed to lie down. The bed 
must be soft and the box roomy. If the animal refuses to lie down, 
there is little hope of recovery. 


III.—DISEASES OF THE SHOULDER-JOINT. 


Lit.: Smith, The Vet. Journal, Mai 1887. Lodezzano, Giornale di vet. 
1855. Delorme, Rec, de méd. vét. 1855. Romant, Oesterr. Viertel- 
jahrsschr. vol. xvii. Williams, The Prine. and Pract. of vet. surg. p. 
236. 


Anatomy.—tThe shoulder-joint, which in all domesticated animals 
is an enarthrodial or ball-and-socket joint, possesses a lax capsular 
ligament. The lateral reinforcement of the capsule by strong connective 
tissue and the application of muscular substance on both sides limit 
movement in the joint, and only allow slight abduction, adduction, and 
rotation, though considerable flexion and extension. Flexion of the 
shoulder-joint is limited by the biceps, extension by the caput muscles, 
abduction by the subscapularis, adduction by the antea and postea spinati, 
so that the shoulder-joint in domesticated animals possesses far less 
mobility than in man. The oval flat glenoid cavity is much smaller 
than the head of the humerus. In swine and carnivora, the size of the 
former is increased by a cartilaginous disc (Labrum glenoideum scapule), 
In these animals the shoulder-joint is also connected with the bursa 
intertubercularis. 


448 LUXATION OF THE SHOULDER-JOINT. 


(a) Luxation of the Shoulder-Joint. 

Incomplete luxation of the shoulder is not infrequent in animals, the 
head of the joint being sometimes displaced over the sharp edge of the 
elenoid cavity. Complete displacement is much rarer than in man, 
though it occurs both in horses, ruminants, and dogs. In swine and 
carnivora, the position of the caput humeri is ensured by the labrum 
glenoideum ; in the horse, by the tendinous biceps muscle. 

Luxation can generally be referred to excessive flexion of the joint, 
and the humerus is, therefore, always thrust forwards and upwards, the 
head of the bone being discovered in front of and above the glenoid 
cavity of the scapula. As the biceps brachii muscle antagonises this 
movement, displacement can only occur when that muscle is relaxed, «.2., 
as it would be during simultaneous flexion of the elbow-joint. For this 
reason luxation of the shoulder-joint results most frequently from falls. 
A sudden check to the movement of the lower portions of the leg may 
also bring it about. Hertwig and Smith’ saw several such displacements, 
on account of the feet striking against some obstruction in leaping. Ex- 
cessive movements of abduction may also result in the head of the humerus 
being displaced inwardly beyond the glenoid cavity of the scapula. 

Symptoms.—tThe accident is distinguished by excessive lameness, 
which appears suddenly, and is most marked when the leg is being 
moved, Passive movement of the joint is also interfered with. Whilst 
there is much difficulty in flexing, and still more in extending, the 
joint, abduction and adduction are abnormally free, and the leg appears 
shortened. Provided swelling be not excessive, palpation will detect 
dislocation of the head of the bone. Pressure on the parts produces 
pain. Complications, like fracture of the scapula or humerus, often 
exist. . 

Prognosis and Course.—tThe results of many observations seem to 
indicate that even complete luxation, if early reduced, can be cured in 
two to three weeks. Smith caused a horse to be moved after reducing 
dislocation under chloroform, and it then showed no distinct lameness ; 
eight days later it was nearly sound. In other cases, however, chronic 
lameness remains. In working-horses, it is best to wait for eight to 
fourteen days after reduction, and if in this time no improvement is 
manifest, the animal should be slaughtered. Reduction being easier in 
small animals, the prognosis is correspondingly more favourable. 

Treatment.—In large animals which stand quietly, attempts may 
be made to reduce the dislocation without casting. Siedamgrotzky 
advises that one man should hold the animal’s head, another draw the 
leg forward, and a third press on the knee-joint to extend it, whilst 


' Too much importance should not be attached to this case. The Mr Smith quoted was 
not an M.R.C.V.S., and, moreover, the diagnosis was doubtful.—[TRANSL. ] 


DISEASES OF THE SHOULDER-JOINT. 449 


the operator endeavours to return the head of the humerus to the joint 
cavity by strong pressure. Should this fail, the animal must be 
cautiously cast and the attempt repeated. A noose is passed round the 
leg, and two or three powerful men effect extension by pulling on it. 
Contra-extension is provided by a girth passed round the animal’s body. 
The operator stands on the joint and supervises the direction of exten- 
sion, whilst endeavouring to replace the head of the bone. Successful 
reduction is notified by the production of a loud sound, and by restora- 
tion of free movement to the limb. Failing reduction by this method, 
the elbow-joint is strongly flexed, and fresh attempts made; if the head 
of the humerus lies in front of the glenoid cavity, this way is more 
likely to be successful. The shoulder muscles retain the parts in 
position, so that bandaging is not usually necessary, Lodezzano, how- 
ever, in the case of a cow, cut away the hair from the shoulder, smeared 
the parts with a mixture of pitch, turpentine, and wax, and applied a 
stiff piece of cloth; when the mass became hard, fresh layers were 
applied. In pronounced inflammation, cold applications are indicated. 
Absolute rest is necessary, and should be continued as long as any trace 
of lameness exists. To prevent return, which is liable to follow on 
attempts to rise, the patient should be placed in a sling. Blistering 
also diminishes free movement of the shoulder and tends to prevent 
recurrence. Bourgelat employed an iron splint like a horse-collar to 
assist retention. The apparatus is generally unnecessary, unless the 
animal be allowed to lie down. 

(b) Contusions and Distortions of the Shoulder-Joint. 

These accidents are in general rare. The absence of firm ligamentous 
structures prevents distortion easily taking place, while the muscles of 
the shoulder, especially the biceps, shield the joint from contusions. As 
long as the limb remains in its normal relationship to the trunk, even the 
violent concussion resulting from falls is not injurious; the displacement 
being guarded against by the well-developed cartilages at the head of the 
joint. On the other hand, both excessive abduction, adduction, and rota- 
tion, produced by slips, falls, or attempts to free the foot which has 
become fixed in some obstruction, often result in distortion of the joint. 
The greater number of diseases described under this head consist, how- 
ever, in injuries to the biceps and to the inter-tubercularis bursa. 

Symptoms.—Inflammatory disease of the shoulder-joint is recog- 
nised by lameness, usually of sudden origin, when lifting the leg, by the 
limb being abducted, and by the animal being unwilling to place weight 
on the foot. The stride is shortened in a forward direction, the move- 
ment of the limb is slow, the backward movement impaired, so that the 
hoof is dragged along the ground. Inflammatory swelling, accompanied 
by increased warmth and pain, appears about the shoulder. Diagnosis 

2F 


450 DISEASES OF THE SHOULDER-JOINT. 


is often doubtful, and the disease then falls under the category of shoulder 
lameness (p. 463). 

Prognosis and Course.—The degree and extent of the injuries 
associated with distortion being very varied, prognosis is equally uncer- 
tain. It must, therefore, be principally guided by the degree of lame- 
ness and the extent of the local symptoms, as well as by the time 
during which these have existed. If pain is slight, complete recovery 
may occur in three to four weeks; gradual improvement during this 
time points to a favourable issue. On the other hand, chronic arthritis 
may sometimes cause lasting and incurable lameness. The more severe 
the lameness, and the longer its period of existence, the less favourable 
the prognosis; marked atrophy of the shoulder muscles is, therefore, an 
exceedingly grave symptom. 

Treatment.—Complete rest must always be the first measure. Cold 
applications, irrigation, or poulticing combat inflammation. At a later 
stage irritants, blisters, and setons can be employed. 

(c) Wounding and Inflammation of the Shoulder-Joint 
(Omarthritis). 

On account of its sheltered position, the shoulder-joint is seldom 
wounded. Romant describes a torn wound of the joint in a mule, where 
perfect recovery followed the employment of sublimate solutions. As a 
general rule, these injuries call for cautious prognosis and treatment. 

Spontaneous inflammation of the shoulder-joint is seen in oxen and 
dogs under the form of rheumatic arthritis, in foals, calves, and lambs 
as a complication of so-called navel-ill. The shoulder-joint is, however, 
not particularly prone to this disease, as Dieterichs thinks. The knee 
and hock are much more frequently attacked. 

That form of omarthritis occurring during septicemia cannot here be 
referred to. Abscesses in the neighbourhood of the jomt seldom break 
into its cavity. 

Chronic omarthritis may either be a sequel of distortion and luxation, 
or be of rheumatic origin. Williams gives two illustrations of chronic 
omarthritis in horses, showing the edge of the jot covered with excs- 
toses; the synovial membrane was thickened, and to some extent 
ossified ; in one case synostosis had even occurred. 

Prognosis,—The variations in the pathological conditions are so 
great that no fixed principles can be laid down either for prognosis or 
treatment. The degree of local change, the severity of the lameness and 
the time it has existed, form the chief indications. Excessive muscular 
atrophy and obstinate lameness are always grave. The symptoms are 
equally varied (compare with “shoulder lameness ”). 


INFLAMMATION OF BURSA OF BICEPS MUSCLE. 451 


IV.—INFLAMMATION OF THE BURSA OF THE BICEPS, 
FLEXOR BRACHII OR CORACO RADIALIS MUSCLE 
(BURSITIS INTER-TUBERCULARIS). 


Lit.: Williams, The Prine. and Pract. of vet. surg. 1886, p. 256. Villate, 
Rec. de méd. vét. 1855. Dieterichs, Gurlt u. Hertwig. 14, p. 15. 
Brauell, ibid., 11. p. 40. K. Gitinther, Myologie. Dieterichs, 
Vet. Chirurgie, 1822. Becker, Gurlt u. Hertwig. 4, p. 274. Dominik, 
Th. Mitth. 1856, p. 96. Ellenberger und Baum, Topoeraph. Anat. 
des Pferdes, 1893. Nesbit, Am. vet. rew. XV. 


Anatomy.—During flexion and extension of the shoulder-joint the tendon of 
the flexor brachii glides over the bicipital groove of the humerus, which is covered 
with cartilage, and forms one of the boundaries of an extensive bursa (bursa 
inter-tubercularis). The bursa extends from the periphery of the cartilage- 
covered tuberosities, over the tendons, clothes a portion of their surface, then 
their sides, and finally their under faces (Ellenberger and Baum), ‘The sides of 
the bursa are covered by the lower points of insertion of the supra-spinatus 
muscle, and its cavity is divided from the capsule of the shoulder-joint by a 
mass of fat (Eichbaum). In swine and carnivora, the bursa is continuous with 
the shoulder-joint (Franck). 


In horses, the extensive inter-tubercular bursa is sometimes the 
seat of acute or chronic inflammation, in which the biceps tendon shares, 
and which almost always results from severe bruises, such as are caused 
by collisions when the shoulder is struck and the biceps receives the 
full shock (p. 455). Runaway horses frequently suffer. 

A chronic bursitis (which may be bilateral) is produced in tramway 
and omnibus horses by continuous rapid driving. Williams states 
having seen the disease oftenest in plough-horses, and on the lee which 
goes in the furrow. 

As in acute inflammation of other tendon sheaths, serous and fibrous 
exudates occur; in infected wounds and metastatic diseases purulent 
inflammation of the sheath of the tendon may set it. Dieterichs saw 
symptoms of acute inflammation, hyperemia, and exudation in horses 
which had shortly before fallen ill, Cario-necrosis of the bursa has been 
seen in the horse. 

Chronic bursitis produces abrasion of cartilage, formation of exostoses 
on the humerus, and ossification of the biceps. Williams and Dieterichs 
found the muscle almost entirely ossified, though in Dieterichs’ case the 
biceps had become adherent to the humerus. The gliding surface of 
the biceps is frequently roughened from friction against the roughened 
bicipital groove. Villate has also seen ossification of the muscle, with 
abrasion of its gliding surface. 


A52 INFLAMMATION OF BURSA OF BICEPS MUSCLE. 


Symptoms.— Acute bursitis inter-tubercularis is shown by excessive 
lameness when the leg is advanced (swinging leg lameness). On 
attempting to move the animal, the foot is not carried forward, but 
remains at a point behind that of the other side, giving the impression 
that the foot cannot be lifted from the ground. When forced to move, 
the horse places absolutely no weight on the lame leg (fig. 102). It 
moves back without much difficulty, and may then be able to lift the 
foot a little. Even after the pain diminishes, the foot still remains 


Fra. 102.—Lameness from Bursitis inter-tubercularis. 


behind when moving, and the forward stride appears much shortened. 
During rest, the foot is placed behind its neighbour, and weight may 
even be put on it, a symptom seen by Brauell and K. Giinther even 
after cutting through the biceps. Inflammatory symptoms (increased 
warmth, swelling, and pain) sometimes appear in the muscle and 
neighbouring parts, though they seldom bear any direct relation to the 
degree of lameness. 

In chronic bursitis inter-tubercularis, inflammatory symptoms are 


RUPTURE OF BICEPS MUSCLE. 453 


wanting, though there is inability to place weight on the leg, and the 
forward stride is shortened. When the disease appears bilaterally, the 
animal seems “tied at the shoulder.” In some cases both atrophy and 
contraction of the muscles occur. 

Prognosis and Course.—Acute bursitis may occasionally take a 
favourable course, but is prone to become chronic. When severe, the 
animals die from continuously lying in one position, otherwise recovery 
occupies several months, and chronic lameness is apt to remain; treat- 
ment is, therefore, only advisable in valuable horses. If there are 
shght local symptoms, if weight is still placed on the foot, and if 
lameness is not severe, recovery may be hoped for in six to eight weeks, 
but sometimes takes several months. 

In chronic bursitis, prognosis is even less favourable, though the disease 
takes a slower course, and the animals continue to some extent useful. 
Williams says they are of no further use for ploughing. 

Treatment must follow general principles, being guided by the 
existing changes. In acute bursitis, it comprises absolute rest, cold 
applications (best in the form of ice poultices), or permanent irrigation 
with cold water; as the pain diminishes, Preisnitz’s poultices, at a later 
stage irritants and blisters, and finally setons. 

Dieterichs says that in horses lameness is sometimes caused by 
dislocation of the biceps brachii muscle. Such a case has never 
occurred in my practice, nor has Hertwig, even in his extensive practice 
of so many years, seen one. Even Dieterichs’ description leaves it 
doubtful whether the condition occurs, and the same may be said of 
Becker and Dominic’s cases. From the latter’s statement, it is clear 
that the scapula was displaced, but probably from muscular rupture. 

Rupture of both biceps muscles was seen in a fourteen-years-old 
gelding which had suddenly gone lame. The neighbourhood of the 
shoulder-joint was swollen and painful. The condition somewhat im- 
proved, and the horse was put to light work; but four months later, 
after being driven about two miles, became suddenly much worse, and 
appeared to have lost control of both fore-limbs. It was placed in 
slings, but gradually wasted, whilst the thorax sank between the 
shoulders, so that four weeks after the last attack the withers were 
4} inches lower than before. The sternum reached to the lower half 
of the fore-arm, and the scapula lay in an almost horizontal position. 
Both shoulder-joints were greatly swollen, but not painful. The animal’s 
movement was passable, though it often stumbled. Post-mortem showed 
extensive periostitis around the shoulder-joint. Instead of the coracoid 
process, there only existed on the scapula a roughened spot, the biceps 
muscles of both sides were torn away from their scapular insertions, and 
their tendons thickened (Nesbit). 


454 PARALYSIS OF SUPRASCAPULAR NERVE. 


V.—INFLAMMATION OF THE TENDON OF THE POSTEA- 
SPINATUS MUSCLE AND OF ITS BURSA. 


Lit.: K. Gtinther, Myologie, p. 273, 


On the external tuberosity of the humerus, above the point of insertion 
of the postea-spinatus muscle, is a bursa, which, together with its tendon, 
sometimes becomes inflamed. K. Giinther first drew attention to this 
affection, and showed that it may be caused by bruises, kicks, collisions, 
falls, or by strain of the tendon. 

Symptoms.—tThe disease produces lameness during the period when 
weight is placed on the limb (supporting leg lameness) and abduction of 
the entire hmb. Weight is certainly put on the foot, but the latter is 
placed as far as possible outwards, by which abduction of the shoulder, 
and consequently painful extension of the diseased tendon, is as far as 
possible avoided. There is pain on pressure over the affected spot, 
together with increased warmth and swelling. Crepitation may some- 
tames be detected by applying the hand (tendovaginitis crepitans). 

Prognosis and Course.—The nature of the disease renders a rest 
of at least four to eight weeks absolutely necessary, but recovery always 
occurs if the patient 1s given sufficient time. 

Treatment,—Acute inflammatory processes are combated by cold 
applications, later moist warm poultices can be used, or, if necessary, 
irritants, setons, or the actual cautery. 


VI.—PARALYSIS OF THE SUPRASCAPULAR NERVE. 


yer. Abbladen. 


Lit.: Siedamgrotzky, Dresd. Ber. 1878, p. 59. Giinther, Gurlt. u. 
Hertwig. 31, p. 215. Williams, The Prine. and Pract. of vet. surg. 
Roloff, Thierartzl. Mitth. 1874, p. 137. Hansen, Jahrb. 1889, p. 89. 
Miiller, Berl. Arch. vol. ii. p. 300. Kattner, Zeitschr. fiir Veterin. 
1S9Tp. a. 


This disease was first observed in 1785 by Rohlwes. In 1864 Bouley 
suggested that it was due to rupture of the tendinous insertion of the 
postea-spinatus muscle. It was first correctly diagnosed and described 
by K. Giinther ; of late years it has been repeatedly seen in horses. 


The suprascapular nerve, an important branch of the brachial plexus, takes 
its origin chiefly from the 7th cervical nerve, and passes between the antea- 


PARALYSIS OF SUPRASCAPULAR NERVE. 455 


spinatus and subscapularis muscles on to the lateral aspect of the shoulder, to 
supply the two spinati and the teres muscles. It therefore supplies with motor 
twigs the above-named muscles, which form lateral ligaments to the shoulder. 


The cause of paralysis of the suprascapular nerve is violent back- 
ward movement of the shoulder or of the leg whereby the nerve is 
stretched. The general causes are running against trees, against the 
manger or other firm objects, or against another horse, as in cavalry 
attacks. It is therefore common in cavalry horses, in runaways, or in 
animals which have been struck by the pole of a carriage. Hansen saw 
a case produced by a door slamming. The causes are therefore similar 
to those of bursitis inter-tubercularis (p. 451). The difference consists in 
this, that violence to the unloaded limb thrusts it back, and is apt to 
cause this paralysis, whereas violence to the limb when supporting the 
body causes contusion of the shoulder, backward movement being then 
impossible. This paralysis is therefore more likely to be produced when 
the shoulder is struck by a heavy slow-moving body than where the blow 
is given suddenly; in the latter case the biceps and its bursa are 
endangered. 

The symptoms are explained by the loss of function in the muscles 
which act as lateral ligaments to the shoulder-joint. Whilst nothing 
abnormal can be remarked as long as the limb is rested, sudden abduc- 
tion occurs immediately weight is placed on it, and at the moment when 
the foot is perpendicularly below the body. The scapula and humerus 
are then jerked away from the wall of the thorax. This movement is 
best seen when the horse is slowly walked in a straight line. 

The disease then is distinguished by lameness when weight is placed 
on the limb (supporting leg lameness), by abduction of the limb, and by 
jerking of the shoulder outwards at the moment when the leg is perpen- 
dicular. Atrophy of the paralysed muscles occurs later, and is most 
marked in the supra-spinatus and the two teres muscles, whilst the 
infra-spinatus, which receives some twigs from the axillary nerve, 
remains intact. The atrophy is accentuated by the increased projection 
of the spine of the scapula. 

Roloff saw a horse which had suddenly exhibited double-sided shoulder 
lameness during heavy work, and found marked atrophy of the supra- 
and infra-spinatus muscles. The shoulder-joint was thrust outwards. 
In this case probably there was double-sided paralysis of the supra- 
scapular nerve. In cattle, on the other hand, a somewhat similar con- 
dition is caused by over-extension or relaxation of the adductor groups 
(MM. subscapularis and teres major). It is seen in particular races, 
such as the Holsteiners, particularly in winter ; in summer, when the 
animals are pastured, it often disappears. 

Prognosis and Course.—Paralysis caused by mechanical influences 


456 PARALYSIS OF SUPRASCAPULAR NERVE. 


is known to be less favourable than the rheumatic forms, and treatment 
is often unsuccessful. As a general rule, prognosis is much less favour- 
able than in paralysis of the radial nerve, though recovery sometimes 
occurs in six to eight weeks. Otherwise, and especially if the lameness 
continue severe,—that is, if the difficulty in movement has not begun to 
disappear,—there is little hope. Of five cases seen by me, three alone 
recovered, though Kattner effected a cure in six weeks. Of ten cases of 
suprascapular lameness seen in this school between 1875 and 1890, three 
were discharged improved and four uncured. Marked atrophy of the 
paralysed muscle is an unfavourable symptom. 

Every means should be employed to assist prognosis. The return of 
irritability under the faradic current is a reliable sign of improvement. 
Though animals affected with this lameness cannot be employed in rapid 
draught, yet they still continue useful for slow work, though this favours 
the disease, because the shoulder is continually displaced. 

Treatment must follow general principles. Little can be done to 
check the progress of the already-existing pathological changes in the 
nerve. At first the patient must be rested, and attempts made to 
increase local nutrition, by kneading or striking the muscles once or 
twice daily, and thus prevent atrophy. Massage may possibly favour 
removal of already-existing anatomical changes in the nerve, and for the 
same purpose veratrin may from time to time be injected. For this 
purpose 14 grains of veratrin (the variety insoluble in water) is rubbed 
down with about 75 minims of water without adding alcohol, and the 
mixture injected beneath the skin over the region of the muscle. Hansen 
has seen good results from the subcutaneous injection of oil of tur- 
pentine. 

On account of the excessive sensitiveness of the horse, the continued use 
of electricity, especially of the induced current, is generally too trouble- 
some to be of service, though it is one of the most effective means of 
restraining loss of muscular and nervous irritability, and may perhaps be 
used in valuable animals. Where similar symptoms follow bruising, 
cold applications are preferable. 

In the spring of 1875, three horses with this lameness were brought 
to me in rapid succession. Two showed traces of violence in the shoulder 
region: one had run away and struck the affected shoulder against a tree, 
the other one had also been in collision. Symptoms of lameness appeared 
shortly after the accidents, and have already been described by me. One 
of the three horses soon became sound; the other two appeared incur- 
able. Later I saw two more cases recover, one of them in spite of the 
fact that there had been considerable rupture of muscle. 

Williams describes, under the name of “shoulder-slip,” a disease said 
to oceur in plough-horses, which are obliged to walk with one foot at a 


PARALYSIS OF SUPRASCAPULAR NERVE. 457 


lower level than the other. According to Williams’ description, this 
appears to be paralysis of the superscapular nerve, though he describes 
pathological changes in the spinati and teres muscles, as well as in the 
shoulder-joint. He especially mentions abrasion in the bursa of the 
postea-spinatus muscle, and rupture of its tendon. It can be proved 
that rupture of this tendon, which sometimes occurs after inflammation 
of its sheath, produces the same disturbance in movement as paralysis. 
Section of the tendon of the postea-spinatus results in precisely similar 
lameness, as I have repeatedly convinced myself, and have demonstrated 
to my students. 

The disease may, of course, be accidentally complicated with other 
injuries. Thus, in a riding-horse which had run away and struck its 
shoulder against a tree, the levator humeri and pectoralis transversus 
were ruptured and there was paralysis of the suprascapular nerve. 
Rupture had probably occurred in other of the breast muscles. Soon 
after the injury the hair fell away from a particular point on the skin, 
and severe eczema developed. The longish oval spot which began about 
a hand’s-breadth below the shoulder-joint extended perpendicularly 
upwards almost to the middle of the neck. At the centre, and just 
over the shoulder-joint, it was about 8 inches broad, and became smaller 
both in an upward and downward direction. The hair which after- 
wards grew on the spot was of a lghter colour, and if the animal was 
excited or slightly pushed active secretion of sweat occurred here whilst 
all the rest of the body remained dry. The spot was also insensitive to 
the prick of a needle. Without doubt this was a ease of simultaneous 
paralysis of the superficial scapular nerve, a twig of the 6th cervical. 
The condition improved, but very slowly. 


Vil.—PARALYSIS OF THE RADIAL NERVE (PARALYSIS 
NERVI RADIALIS). 


Lit.: Béther, Buschs deutsche Zeitschr. f. ges. Thierheilk. 2. part 4, p. 8. 
Harms, Han. Ber. 1871, p. 44. Moller, Berl. Arch. 1, p. 147. Hiib- 
ner, Dresd. Ber. 1884, p. 92. Munkel, Thierirztl. Mitth. 1883, p. 34. 
Lesser, Aus der Volkmannschen Klinik in Halle. 1884. Bormann, 
Berl. Arch. 1886, p. 293. Werner, Thierarztl. Mitth. 1875, p. 148. 
Lustig, Han. Ber. 1876, p. 51. Friis, Jahrb. 1889, p. 423. Hertel, 
Th. Mitth. 1872, p. 157. Strauss, Vet. Chirurgie, p. 141. Brauer, 
Dresd. Ber. 1890, p. 74. Liitbke, Zeitschr. f. Vet.-Kunde. 1892, p. 491. 


The radial nerve arises from the posterior portion of the axillary plexus, and 
passes backwards, first giving off a twig to the biceps muscle, and then divides 
into two branches. The upper provides the extensors of the fore-arm with 


458 PARALYSIS OF RADIAL NERVE. 


motor twigs, the lower gives off nerves to the skin of the outer and anterior 
surfaces of the fore-arm. The stem supplies motor fibres to the coraco humeralis 
and to the extensors on the fore-arm. 


Paralysis of this nerve has often been seen, though not accurately 
diagnosed. Thus in 1831 Bother described a form of lameness in the 
horse which can only be the above-mentioned condition; Strauss 
described it later. Harms states having recognised this paralysis im a 
cow. In 1875 I saw the disease repeatedly in the horse, and then for 
the first time carefully described it; since then it has been frequently 
diagnosed. The lameness described by Hiibner as neurasthenia un- 
doubtedly belongs to this category. Duing the last few years I have 
often seen this lameness in horses and in one case in the dog. 

Even at the present time little is known of the causes of radial 
paralysis. Sometimes it appears in horses which have been cast for a 
long time, especially if lying on sand or on the earth. But it is 
doubtful whether such lameness is not principally myopathic and caused 
by continued pressure on the triceps muscle and consequent impaired 
circulation ; its rapid disappearance supports this view, which seems 
in accord with similar observations in man. Lustig saw radial para- 
lysis lasting thirty-eight days after a tedious dental operation. Since 
I have taken to casting on soft mattresses such cases have seldom 
occurred. 

As a rule, radial paralysis occurs suddenly during heavy draught, 
clearly pointing to a traumatic origim. During a very short period in 
the summer of 1887 I saw many horses with this disease, which is 
generally rare. It, therefore, seemed as though a specific cause were at 
work, a view confirmed by the peculiar clonic spasms of the triceps 
muscle seen in other horses. ‘These spasms ceased during work but 
returned with rest, and could be produced by flicking the muscles with 
the finger. Bormann twice diagnosed radial paralysis in horses which 
set in in the same sudden fashion. One seen by Werner, and 
described as paralysis of the extensor pedis, occurred after violent 
attempts to free the foot, which had been caught in some obstruc- 
tion. Brauer saw this lameness result from long exposure to rain 
during work. Liibke also saw double-sided partial radial paralysis 
caused by chill; the disease was accompanied by fever and proved 
fatal. 

In the year 1890 I saw a case of diplegia of the radial nerve in the 
horse. The disease suddenly appeared in the left limb during a journey, 
and, being painful, caused the animal to lie a great deal, following on 
which the radial nerve of the right limb became affected. Friis de- 
scribes a case complicated with paralysis of the hind-leg of the opposite 
side (hemiplegia cruciata). 


PARALYSIS OF RADIAL NERVE. 459 


The symptoms vary according to the degree and extent of the 
paralysis. When complete, the limb takes a position resembling that 
in very painful affections of the foot. The shoulder and elbow are 
extended, while all the other joints are fixed in a position of volar 
flexion, those of the phalanges often to such a degree that the anterior 
surface of the wall of the foot may be almost in contact with the 
ground (fig. 103), the limb under such circumstances appearing to be 
too long. In attempting to move, the upper portions of the limb are 
carried forward in the ordinary fashion, but cannot support the weight 


Fic. 103.—Complete paralysis of the Radial nerve. 


of the body on account of inability to bring the joints into the necessary 
position. The limb collapses at every attempt to place weight on it. 

The disease is, therefore, characterised by lameness when weight is 
placed on the limb (supporting leg lameness), flexion of all joints from 
the elbow downwards, and inability to bring the foot sufficiently forward 
to enable it to carry weight ; when passively extended, however, the limb 
is able to sustain the body. On moving the horse the triceps muscles 
appear relaxed. They fail to contract, and after some time atrophy. 

In incomplete radial paralysis the weight of the body can be sup- 
ported provided sufficient muscular power exist to extend the joint. 


460 PARALYSIS OF RADIAL NERVE. 


When, therefore, the animal moves slowly and on a smooth surface, 
nothing particular is visible, though lameness appears immediately the 
horse meets with a slight incline or with any obstacle. In such case 
the foot is not sufficiently extended, it strikes against the obstacle and 
the leg collapses, so that the horse may fall, Depending on the degree: 
to which the nerve or muscle is affected, this stumbling occurs more or 
less frequently ; sometimes it is only seen after exertion on soft or uneven 
eround. Where the lameness diminishes after having long existed, the 
animals instinctively adopt a peculiar way of moving, In stepping out 
they slide the foot forwards with exaggerated action of the shoulder 
muscles, so as to compensate for the defect in that of the extensors. 
The lameness is characterised by stumbling, particularly on uneven 
ground, and later by a sliding motion of the foot when the limb is 
extended. 

Not unfrequently paralysis is partial. The greater number of cases. 
seen by me in the summer of 1887, and certain cases observed later, 
were distinguished by the fact that the function of the caput medium 
(M. anconeus externus) and of the extensors lying in the region of the 
fore-arm was clearly retained, whilst the other portions of the caput 
muscle appeared relaxed; when weight was placed on the foot, these 
contracted in the usual way. For this reason the lameness has a pecu- 
liar character: during the period when weight is placed on it, and at 
the moment when the limb is perpendicular, the shoulder is suddenly 
jerked forwards; the scapula and humerus move with a visible jerk, 
causing the disease to present a certain similarity to suprascapular 
lameness. But as these involuntary movements take place in a forward 
direction (best seen by moving the horse slowly and viewing it from 
the side), the disease is readily distinguished from the above lameness 
where the shoulder moves directly outwards (p. 455). The condition is 
characterised by “supporting leg lameness” and jerking of the shoulder 
forwards at the moment when the limb is upright. 

The reason of the caput medium being sometimes unaffected in this. 
lameness must be sought in the distribution of the nerves. From the 
point of origin twigs are first given off for the heads of the caput 
magnum muscle; these are comparatively short fibres, whilst the main 
stem distributed to the caput medium and parvum and extensors of the 
foot lying in the fore-arm region is much longer, and is, therefore, not 
involved to the same extent in any strain occurring here. The correct- 
ness of this view is supported both by the fact that partial paralysis 
oceurs accidentally after mechanical injuries, and that in such cases 
function is always retained in the extensors of the knee, of the fetlock 
and of the foot. 

As already stated, paralysis in these groups of muscles can be 


PARALYSIS OF RADIAL NERVE. 461 


detected during movement both by sight and feeling. Muscular atrophy 
occurs sooner or later, and to an extent varying according to the amount 
of functional disturbance. Sometimes, though not invariably, the skin 
covering the anterior and external surface of the fore-arm loses its sensi- 
tiveness. 

The diagnosis of radial paralysis is therefore easy. 

Differential Diagnosis.—The disease may be mistaken for myo- 
pathic lameness of the anconei group of muscles, or for any of those 
conditions in which they partially or completely fail to act. This is 
particularly true of oblique fracture of the ulna—the lower point of 
insertion of these muscles,—and of rupture of the extensor pedis. 
Hertel saw all the extensors attached to the ulna torn away, but in such 
cases the local examination at once dispels any doubt. 

Diagnosis and Course.—The twenty cases of radial paralysis seen 
by me all eventually recovered, though not with equal rapidity ; incom- 
plete paralysis usually disappears in fourteen days, but the greater number 
of cases of complete paralysis last for five to six weeks. Certain severe 
cases required six to nine months for complete recovery. Three 
cases relapsed after some weeks’ severe work, but finally did well. 
Prognosis is, therefore, generally favourable. Uncertainty of movement 
sometimes remains even after disappearance of lameness, but generally 
disappears in time. The longer lameness continues, the less the chance 
of cure. Well-marked muscular atrophy is therefore unpropitious, but 
return of irritability to the Faradic current must be regarded as a 
favourable sign. Munkel and Briuer have seen recovery in three 
weeks. 

Treatment.—In the greater number of cases seen by me no parti- 
cular treatment was required. Electricity is only worth trying in valu- 
able horses, but massage, especially in complete paralysis, is certainly of 
the greatest value in assisting nutrition of the muscles. Where paralysis 
is incomplete, daily exercise on soft ground and at a slow pace is for the 
same reason advisable. If thought advisable, subcutaneous injections 
of veratrin and strychnine may be employed. ‘The application of power- 
ful douches can only be regarded as a kind of massage. Bormann 
effected recovery in five to six weeks by giving strych. nitr. 3 to ‘6 grain 
subcutaneously ; but in this time the disease would generally disappear 
without any treatment whatever. 

A less frequent cause of intermittent radial paralysis has lately come 
under my notice. A young carriage-horse, which showed nothing 
unusual in the stable, or when beginning work, displayed symptoms of 
radial paralysis in the right fore-leg as soon as it had gone about two 
miles. The condition was first incomplete, as shown by stumbling, but 
gradually became complete, with the above-described characteristic symp- 


462 PARALYSIS OF BRACHIAL PLEXUS. 
toms. By resting the animal, the symptoms disappeared in about half 
an hour, to reappear, however, as soon as work was resumed. I suspected 
thrombosis, either in the arteries supplying the triceps muscle or in one 
of their nerve stems. Although the post-mortem was conducted with the 
greatest care, nothing could be detected, so the cause of this rare dis- 
turbance remained unexplained. There was no muscular atrophy. 


VIH1.—PARALYSIS OF THE BRACHIAL PLEXUS. 


Lit.: Hollmann, Gurlt u. Hertwig. 17, p. 284. Trasbot, Arch. vét. 
d’Alfort. 1884. Wilson, The Veterinarian. 1842. Anacker, Gurlt 
u. Hertwig. 9, p. 488. 


Holmann saw paralysis of the entire muscles of the fore-limb in a 
horse, following on a fall, and found on post-mortem severe bleeding 
around the brachial plexus. From his description it 1s, however, clear 
that simultaneous rupture of the serratus magnus existed, for the horse was 
not only unable to move the foot, but the body sank several inches at 
each attempt to place weight on the foot. The limb was also abnormally 
abducted. 

Trasbot describes a case of paralysis of the axillary plexus where 
hemiplegia appeared later. Recovery occurred in fifteen days. This case 
is also not quite clear. Wilson saw hemiplegia in the horse after rolling 
over backwards, and Anacker has seen it in a sucking-pig. 

In dogs it is commoner, and occurs both as peripheral paralysis and as 
hemiplegia. In the latter condition I have repeatedly seen well-marked 
spastic lameness in all the muscles of the shoulder, most notable in the 
triceps group, and which was followed by long-continued disturbance in 
movement. 

Interesting records regarding paralysis of the brachial plexus are 
given in the Army Reports for 1887. A seven-year-old mare showed 
in December right-sided facial paralysis, in January left-sided hemi- 
plegia. The toe of the left fore-foot was dragged along the ground. Soon 
afterwards a small cataract appeared in the right eye, and gradually 
extended over the entire lens. The post-mortem showed a tumour as 
large as a walnut between the petrous portion of the right temporal 
bone and the cerebellum; it extended to the pons varohi and restiform 
bodies of the medulla. Its interior was occupied by a small quantity 
of pus. 

In another horse, lameness of the right hind-leg suddenly appeared, 
followed in two days by paralysis of the right fore-leg. The post-mortem 
showed hemorrhagic spots in the right half of the cerebrum and cerebel- 


SHOULDER LAMENESS. 463 


lum. Similar symptoms were seen in another case, but disappeared in 
twenty-five days. 

The symptoms which accompany paralysis of the axillary plexus 
depend on whether paralysis is complete. Complete paralysis of the 
entire axillary plexus prevents all voluntary movement in the limb. 
Provided, however, the foot be placed in the proper position, the 
limb, in the horse and dog at least, is still able to support weight, but 
again collapses when relieved of this. The weight of the body is better 
sustained so long as the radial nerve remains unaffected, but there is 
difficulty in advancing the foot. When contraction occurs in the triceps 
muscles, the leg, from the elbow downwards, is continuously fixed in 
extreme extension. This position is retained even during movement. 

Prognosis and Course.—The prognosis must be based on general 
principles, as our knowledge of this lameness is still very incomplete. 
As would be expected from its cerebral origin, spastic paralysis of the 
brachial plexus in dogs generally does well. 

Treatment is similar to that of radial lameness. Massage improves 
nutrition, and prevents atrophy of muscle, and is of more use than 
drugs. 


IX.—SHOULDER LAMENESS. 


Lit.: Bouley, Her. Rep. 13, p. 135. Siedamgrotzky, Landwirthschaft- 
liche Thierheilkunde u. Dresd. Ber. 1874, p. 42. Bassi, Her. Rep. 23, 
p. 847. Pitz, Virchow’s Archiv. vol. 109. Voitlainder, Dresd. Ber. 
1871. Di Nasso, Jahresb. 1883, p. 109. Rigot, Journal de méd. 
vét. 1827, p. 197. Gerke, Gurlt u. Hertwig. II. p. 223. George, Rec. 
de méd. vet. 1862, p. 976. Schraml, Oesterr. Vierteljahrsschr. 1887, 
p- 167. Scholz, Thierirztl. Mitth. 1881, u. Zeitschr. fiir Veterk. 1889, 
p. 116. von Chelchowski, Oesterr. Monatsschr. 1891, p. 412. 
Fambach, Dresd. Ber. 1890, p. 88. Catani, Clin. vét. 1891 ref. in 
B. T. W. 1892, p. 332. Hirsemann, Zeitschr. f. Vet.-Kunde. 1892, 
p- 123. Gtintherberg u. Weinbeer, ibid., p.122 u. 125. Nesbit, 
Am. vet. rew. XV. ref. in Zeitschr. f. Vet.-Kunde. 1892, p. 131. Blen- 
kinsop, The Vet. journ. 1892. 


Besides those above described, other lesions occur in the shoulder 
region, some of which evade even the most careful examination, and 
cannot be exactly diagnosed, nor their results feretold. Lameness is 
the sole symptom, and for want of clearer knowledge these con- 
ditions have been included under the general term shoulder lameness. 
As the chief muscles for the movement of the limb are found in the 
shoulder region, it is not surprising that these lamenesses show a 
certain agreement in symptoms. They are almost always marked by 
lameness when the limb is carried, i.e, movement appears chiefly 


4.64 SHOULDER LAMENESS. 


or solely interfered with durme the forward stride, and the affected 
limb is advanced slowly and incompletely. The lameness varies 
according to the position, nature, and extent of the diseased process ; 
and therefore, in speaking of each condition, we shall go more fully 
into these points. The following are some of the forms of shoulder 
lameness :— 

(1) Disease of the shoulder-joint and its surroundings. As a rule, this 
consists in chronic inflammation which cannot clinically be directly 
recognised. Arthritis chronica, with erosion of cartilage and_peri- 
articular exostoses, is met with in old horses. In cattle and dogs 
rheumatic diseases of the shoulder-joint occur, and often produce lame- 
ness. Sometimes passive movements of the shoulder, raising and lower- 
ing the foot, occasion pain, and by relaxing the muscles of the shoulder 
render the head of the humerus more prominent, Atrophy follows 
long-continued lameness. As a rule, there is pain when weight. is 
placed on the limb, and especially when the animal is turned in short 
circles. 

In a horse which had suffered from chronie shoulder lameness, 
Siedamgrotzky found great thickening of the anterior surface of the 
joint, and chronic inflammation of the bursa inter-tubercularis and of the 
biceps brachii. The synovial membrane was thickened and covered 
with numerous thread-lke proliferations, and the articular surface of the 
scapula increased to the extent of about an inch by a circular bony 
growth. The cartilage covering the articular surfaces, both of the scapula 
and humerus, was abraded. 

(2) Disease of the muscular tissues of the shoulder is sometimes 
traumatic, sometimes rheumatic, in origin. External violence, or violent 
falls or leaps, may produce inflammation, in the muscular tissue of the 
shoulder. Gerlach and Giinther erroneously assigned these conditions 
to the biceps ; but although we are not in a position to absolutely deny 
their occurrence in this position, yet they are exceedingly rare. Nesbit 
lately reported a case in which both biceps brachii muscles were torn 
away from the coracoid process (p. 453). Inflammatory symptoms, 
such as increased warmth, pain on pressure, or on extending the diseased 
muscles, can almost always be detected on careful examination, but care 
and judgment are required in order to avoid error. 

Most horses flinch under strong pressure on the shoulder, nor is 
tenderness a constant symptom even in painful lamenesses, so that it 
is quite erroneous to consider that it is simply a question of unequal 
sensitiveness. Then, again, the affected spot has often been made more 
sensitive by manipulation, or by application of irritants. On the other 
hand, inflammation occurs in single muscles, like the levator humeri, 
and eyen in entire muscular groups, such as the pectoral muscles, in 


SHOULDER LAMENESS FROM RHEUMATISM. 465 


consequence of bruises and sprains, and in young horses following severe 
exertion, and can only be detected by careful palpation. On drawing 
the foot backwards, the animals show pain. 

These conditions are usually accompanied by lameness while the limb 
is being advanced, though none is shown when weight is placed on 
it. After some time muscular atrophy sets in, and is most marked 
in the region of the diseased muscles. 

Rheumatic disease of the shoulder muscles, especially common in the 
levator humeri, produces similar symptoms. Pain generally diminishes 
during movement, and may disappear entirely when the animal. begins 
to sweat. Rheumatic disease is indicated by remittent or intermittent 
lameness, and by unusual pain after slight sudden movement of the 
muscles, such as that produced by flipping the parts with the finger, 
whilst powerful pressure is less painful. Sometimes extensive contrac- 
tion can be induced in single muscles, eg., in the entire levator humeri, 
by a light blow with the finger. In disease of this character in the levator 
humeri, the animal’s neck is drawn downwards and towards the diseased 
side (torticollis), and the muscle appears very tense and prominent 
(Bassi, Moller). 

Piitz saw a peculiar shoulder lameness: movement was difficult, 
though the animal showed no pain on examination. The muscles were 
swollen but relaxed, the body sank between the limbs, and the shoulder- 
joint was pressed away from the thorax. Post-mortem examination 
discovered a myositis chronica fibrosa, produced ‘by the presence of 
parasites. 

Blenkinsop, in Australian horses, repeatedly observed atrophy of the 
pectoralis anticus. A deep depression was present in the pectoral region, 
especially noticeable when the limb was drawn backwards. The dis- 
eased leg was advanced when moving, without, however, being extended. 
The shoulder-joint was turned outwards, the elbow inwards; below this 
point the limb was abducted, and trailed during forward movements. 

Rupture of shoulder muscles has often been seen in horses. Di Nasso 
had a case of rupture of the serratus anticus major, subscapularis 
and pectorales from collision with a tree. On placing weight on the 
limb the shoulder-joint was rotated outwards—a sign of paralysis of 
the suprascapular nerve. <A similar case has already been described on 
p. 455. In horses I have also seen shoulder lameness produced by 
over-extension and partial rupture of the superficial pectoral muscles, 
due to falling or slipping. 

Rigot several times noted rupture of the subscapularis muscle in 
horses, in consequence of the limb slipping outwards. As a rule, the 
tear occurred near the lower insertion, and was followed by formation 


of exostoses on the humerus, Voigtliinder reports rupture of the 
2G 


466 SHOULDER LAMENESS. 


triceps. A riding-horse suddenly fell lame on the off fore-leg when 
turning sharply. The lameness increased with movement, and was 
distinguished by the lame leg being so much adducted that it crossed 
the other leg. Seven weeks afterwards the animal was killed as 
incurable. 

Hirsemann speaks of a horse which four months previously had 
suffered from the thoracic form of influenza, and at the time of narration 
showed cramp of the muscles of one side of the neck and of the fore-limb 
of the same side, best seen in the stable when the animal moved the 
affected parts. It made sudden nodding motions with the head, 
lifted the affected fore-limb, and after some seconds again set it on 
the ground. Oscillating movements, lasting for five minutes at a 
time, sometimes occurred in the muscles of the left side of the neck, 
particularly in the levator humeri. Repeated injections of veratrin 
were followed by recovery in three weeks. There is no difficulty in 
diagnosing such cases, but the prognosis can only be based on a thorough 
knowledge of the local anatomical changes. 

(5) Shoulder lameness may be caused by disease of the scapula or 
humerus. Though fractures are generally easy to recognise (p. 443), 
fissures may elude the closest examination. Feriostitis and the forma- 
tion of exostoses are common on the scapula and humerus. 

Gerke, in making a post-mortem of a horse which had suffered for 
two years from shoulder lameness, found an exostosis on the inner side 
of the head of the humerus. The connective tissue surrounding it 
appeared thickened, and formed, along with the exostosis, an “ extra- 
ordinary articular surface” (eigenthtimliche Gelenkfliiche). The radial 
nerve was smaller than on the sound side. The horse moved the limb: 
in circles, but could still place weight on it. The lameness only 
occurred at a trot, but did not disappear with work. Similar cases 
have repeatedly been seen. 

(4) Thrombosis of the brachial artery produces lameness, which 
regularly recurs with work, and can, therefore, be easily recognised. 
It is very rare, but has several times been seen in horses. 

An old Percheron mare appeared lame on being rapidly trotted or 
worked in a cart. - At first there was only stiffness, but in about 
ten minutes both fore-limbs began to tremble, and thereafter to give way, 
the animal threw the head and neck violently upwards, and seemed 
doubtful which leg to stand on; the respiration and pulse were in- 
creased, and sometimes general sweating followed, though the fore-limbs 
remained dry. These symptoms disappeared after a quarter to half an 
hour’s rest, but always recurred on movement. Post-mortem examina- 
tion showed thrombosis of both brachial arteries, which were much 
thickened (George). 


SHOULDER LAMENESS FROM THROMBOSIS. 467 


I saw a similar case in a seven-year-old mare. When resting she 
showed nothing whatever unusual, though careful examination dis- 
covered hypertrophy of the heart. After ten minutes’ trotting the 
mare began to place the fore-feet abnormally far forward and outward 
and tostumble. The off fore-limb was especially affected ; the toe often 
struck the ground, causing the animal to stumble and fall; on rising, 
the legs were propped out and the muscles trembled, particularly the 
triceps. All these symptoms disappeared after five to ten minutes’ 
rest, to return again on exertion. 

Schraml, Bouley, Giintherberg, and Weinbeer have been able to 
identify similar cases by post-mortem. A horse which suffered from 
obstruction of the femoral artery began to show symptoms of radial 
thrombosis; during movement, the radial symptoms set in later than 
the femoral, but lasted longer, persisting even for half an hour. Post- 
mortem showed thrombi in the arteria sub-clavia, arteria axillaris, 
brachialis and radialis, and even in the metacarpal arteries. The 
muscular coats were thickened, and the intima altered in character 
(endoarteritis). 

Martin saw thrombosis of the axillary artery followed by gangrenous 
inflammation of the muscles of the limb, hypertrophy of the heart, and 
fatty liver. The disease appeared suddenly, with severe feverish 
symptoms, and proved fatal in eighteen hours. The case closely 
resembles septic cellulitis or malignant cedema. 

(5) Inflammatory swelling and new growths sometimes interfere 
with movement. Thus acute or chronic swelling of the prescapular 
and axillary glands, resulting from glanders, strangles, or infectious 
local diseases of the fore-limbs, may all cause shoulder lameness, Gerke 
reports several cases of the kind. 

A horse, lame for two years and a half, showed on post-mortem 
a swelling as large as a man’s fist beneath the shoulder, sur- 
rounding the axillary plexus. Another, which had suffered from 
shoulder lameness for four years, exhibited swelling and degeneration 
of the axillary glands. In both cases there was excessive atrophy, not 
only of the muscles, but even of the hoofs. 

In these conditions the limb is often abducted, both during move- 
ment and when weight is placed on it. I have repeatedly met with 
periodically recurring shoulder lameness in consequence of swelling of 
the axillary glands. Chronic inflammation and suppuration in the skin 
of the shoulder may produce such swelling of the lymph glands. Scholz 
found an abscess near the axillary artery in a horse which had suffered 
from metastatic strangles, and subsequent lameness. 

(6) In addition, shoulder lameness may undoubtedly be produced by 
nervous disease, though reliable observations on this point are not to 


468 DIAGNOSIS OF SHOULDER LAMENESS. 


hand. The case of intermittent lameness, reported on page 461, cannot 
be viewed as of nervous origin without further evidence ; neither can 
those described by Hiibner as neurasthenia (p. 458), and by Catani as 
neuralgia of the axillary plexus. 

The diagnosis of “shoulder lameness ” chiefly depends on the negative 
result of local examination ; the more careful the local examination, the 
rarer will be the diagnosis shoulder lameness. The practitioner should 
avoid basing his opinion on single symptoms, or attaching too great weight 
to the indications of palpation, As the striding movement is chiefly 
dependent on the action of the shoulder muscles, it is naturally much 
interfered with, and therefore shoulder lameness is generally char- 
acterised by difficulty in advancing the swinging limb. The stride is 
shortened, and, as a rule, uncertain. The foot is imperfectly lifted; it 
tends to strike the ground, especially when the surface is uneven, or 
when the foot meets with obstacles. In leading the horse uphill, or in 
circling (especially if the lame leg is outwards), lameness is generally more 
marked. The limb, when being advanced, is not infrequently turned 
outwards. Lameness appears equally on hard and soft ground,—in 
fact, may even be more marked on the latter, When trotting, the head 
is often nodded in a pronounced way, but even this symptom is not 
constant. It is generally present, however, in disease of the levator 
humeri, and of the other levators of the shoulder, because of the pain 
induced by extension of the affected muscle. In moving backwards, 
the lame leg is either lifted or dragged. Disease in the levators 
of the fore-arm produces marked pain when the foot is _ passively 
moved either forwards, backwards, inwards, or outwards. In chronic 
lameness, too great stress must not be laid on atrophy of muscle or of 
the hoof. Both are secondary symptoms, and do not always indicate 
the seat of disease. 

Prognosis and Course.—Our ignorance of the nature of this 
lameness renders prognosis uncertain, and the chief indication is the 
course which the disease takes. The longer lameness has existed and 
the greater the atrophy of muscle, the more serious the condition. 
Inflammation of a single muscle generally takes a favourable course, but 
rheumatic disease is often obstinate. None of the articular diseases 
offers much hope of recovery, especially when of old standing. As soon 
as some improvement can be noted, prognosis may be more sanguine, 
Many cases of shoulder lameness recover in two or three weeks, whilst 
others may continue for an indefinite time. 

The treatment is as varied as the prognosis. In acute inflam- 
mation and mechanical injuries, rest and cold applications in the 
form of irrigation or cold poultices are most useful. Failing marked 
improvement in eight to fourteen days, a powerful douche may prove 


FRACTURE OF THE ULNA. 469 


serviceable. In a later stage, irritants may be tried, and in the event 
of their failing, setons. The long rest thus ensured has a very im- 
portant influence in determining recovery. When massage can be 
properly applied it should have preference, especially in disease of soft 
parts, as it assists resorption of inflammatory products, increases nutri- 
tion of muscle, and prevents atrophy. 

Priessnitz’s poultices are also useful, particularly in the inflammation 
following injury or rheumatic disease. Sometimes both methods may 
be used together. Subcutaneous injections of veratrin are also worth a 
trial (p. 456). There is no doubt that veratrin affects the functional 
activity of muscle, and assists metabolism. In shoulder lameness, due 
to muscular rheumatism, I have often seen exceedingly good results 
from veratrin injections, as have also Gerlach and Liibke. Veratrin 
that is insoluble in water should be used, because it is less rapidly 
absorbed, and therefore produces a local effect. I have seen no 
good results from subcutaneous injection of common salt. A pure 
solution produces no visible effect, whilst if the solution or syringe 
is dirty, extensive pus and abscess formation may ensue, and, in my 
judgment, whatever efficacy the treatment has, depends on its causing 
purulent inflammation. The same objection apples to injections 
of turpentine and ether; and as they occasionally produce violent local 
action and necrosis of the soft tissues, Fambach regards their employ- 
ment as dangerous. 

When the stride remains shortened for a long time, Von Chelchowski 
recommends moving the horse in a small circle, with the lame foot 
outwards. 


B. Diseases of the Elbow and Fore-arm. 


I—FRACTURE OF THE ULNA. 


Lit.: Jansen, Thierarztl. Mitth. 1878, p. 117. Birrenbach, ibid, 1875, 
p. 148. Armbrecht, Vet. Chirurgie. Percival, Lameness in the 
horse, p. 229. Adam, Ad. Woch. 27, p. 133. Lungwitz, Dresd. 
Ber. 1873, p. 34. Kihbne, ibid., 1862, p. 109. Gunther, Exterieur. 
p. 392. Salchow, Berl. Arch. 1889, p. 301. Mann, B. T. W. 1892, 
p. 263. 


Though seen in all species of animals, fractures of the ulna are 
rather rare except in horses. In horses the olecranon is generally 
broken, in other animals the strongly developed body, by external 
violence, in the form of kicks, treads, or falls. Jansen reports three 


470 FRACTURE OF THE ULNA. 


cases, one caused by falling and sliding along the ground and two 
by kicks. Double-sided fracture of the ulna was seen in a horse which 
had passed the fore-feet through a hay-rack. In general the olecranon 
breaks off completely, loosening the lower point of insertion of the 
extensors of the elbow, and producing symptoms like those of radial 
paralysis. 

Birrenbach saw complete fracture about 13 inches below the joint. 
When, as is generally the case, the fracture is lower and extends into 
the elbow-joint, there is severe lameness and pain on placing weight on 
the limb. The displacement of bone can 
sometimes be directly observed. 

Mann noticed permanent lameness and 
symptoms of radial paralysis in a foal which 
had been kicked on the elbow. Post-mortem 
showed that the ulna was completely broken 
off from the radius, and that a space of 
nearly two inches existed between them. 
In this case the ligamenta transversa and 
the ligamentum interosseum must have been 
ruptured. 

Prognosis and Course. — Union of 
fracture of the ulna is rare; most animals 
have sooner or later to be killed. Giinther 
says foals recover more readily. In man, 
transverse fractures of the olecranon only 
reunite by fibrous callus, because, it is said, 
of the displacement of broken fragments 

by the pull of the muscles, and of the 
Bus. aE og eee the ulna failure to form bony callus on account of 

the absence of periosteum. On the other 
hand, A. Cooper has shown by experiments on dogs that in 
longitudinal fracture of the olecranon a bony callus always forms. 
The unfavourable course which transverse fracture of the ulna takes 
in the horse must be referred to the great dislocation produced by 
the pull of the triceps muscles, and to the fact that the fracture almost 
always extends to the articular surface. Fig. 104, drawn from nature 
shows a typical fracture, such as I have several times seen in horses. 
I have never had recovery. Under exceptionally favourable cireum- 
stances, fracture of the ulna may reunite, as reported by Armbrecht. 

Treatment.—In horses and ruminants, as no effective bandage 
can be applied at this point, treatment is confined to keeping the 
animal quiet, or possibly placing it in slings. The action of the triceps 
muscle interferes with healing, and therefore it is best to prevent 


FRACTURE OF THE RADIUS. 471 


animals lying down, which is most easily effected in horses of little 
value by fastening them up short, in others by slinging them. In 
carnivora a plaster bandage certainly assists recovery, but is difficult 


to apply. 


I.—FRACTURE OF THE RADIUS. 
Lit.: Bringard, Rec. de Med. vétér. 1891, p. 605. 


In the horse, fracture of the radius is not usually accompanied by 
fracture of the ulna. In other animals it is sometimes seen with, 
sometimes without, fracture of the ulna. Fracture of the fore-arm most 
frequently results in dogs from being run over, or from being squeezed 
or kicked; in larger animals, from kicks, falls, and slipping whilst 
getting up, «ce. 

In ruminants and carnivora, diagnosis is only difficult when the 
ulna remains intact, and crepitation is wanting. Careful examination 
shows, however, abnormal mobility, crepitation, swelling, and pain. 
Not infrequently the broken ends perforate the soft tissues and produce 
a compound fracture. 

Prognosis and Course.—Subcutaneous fractures of the radius with 
intact ulna unite, in carnivora and ruminants, in three to six weeks. 
Should the ulna be simultaneously fractured, proper treatment may be 
succeeded by recovery in four to eight weeks; and although in 
ruminants and swine repair is more difficult, it is by no means im- 
possible. In horses, however, complete fracture of the radius must be 
viewed as relatively incurable, particularly when near the epiphysis ; 
in the diaphysis, recovery may occur if the animal can be kept quite 
quiet (Salchow), and if able to stand sufficiently long on the other 
leg, 

Bringard saw transverse fracture of the radius with rupture of the 
carpal ligaments in an English thoroughbred mare; the animal recovered 
sufficiently for breeding purposes. 

Compound fractures of the radius must in the horse be viewed as 
incurable, though in small animals they are rather more hopeful. 

Treatment.—Reduction is effected according to the general prin- 
ciples already given, and succeeds best under anesthesia. Before 
applying the plaster bandage, the operator must make sure that the 
leg occupies its normal position, and is neither in a condition of 
supination nor of pronation. In carnivora, the plaster bandage is 
applied directly to the skin, and includes both the elbow- and knee- 
joints. In larger animals it must reach at least to the knee, to prevent 
its sliding down for want of a fixed point. 


472 LUXATION OF THE ELBOW-JOINT. 


Large animals should be kept in slings. Splints are seldom of much 
use, but Salchow has used a felt bandage with advantage. In treating 
an oblique fracture, the animal was placed in slings on the second day, 
reduction effected, and after applying wadding and gauze bandages, a 
piece of moistened felt was fixed in position by linen bandages. Com- 
plete recovery followed in three months. Complicated fractures are 
treated on general principles. 


III—LUXATION OF THE ELBOW-JOINT. 
Lit.: Decroix, Jahrb. 1858, p. 56. 


In large animals, luxation of the elbow-joint is impossible without 
previous rupture of the powerful lateral ligaments; in the horse, 
fracture of the ulna is then usually produced. According to Rigot, 
luxation occurs during flexion, on account of the force acting on the 
ulna. Such luxation is, however, exceedinely rare in animals. 

Distortion also is very uncommon, on account of the effective limiting 
apparatus of the joint—the strong lateral ligaments and beak of the 
ulna. Hertwig insists that in carnivora both complete and incomplete 
displacement may occur in the elbow-joint, and either inwardly or 
outwardly, without fracture. I have only seen such displacements as 
congenital conditions, occurring simultaneously in both limbs, and as- 
sociated with deformity both of the elbow- and knee-joints. The 
animals are generally killed as hopeless cripples. 

The diagnosis of displacement is not difficult, as there is always ex- 
tensive rupture of soft tissues. 

Prognosis and Course.—In carnivora, cases do well provided 
they are treated early and the joint is not involved.  Decroix’s 
statement that he effected reduction in the horse after three and a half 
months can scarcely be taken gravely. Congenital luxation is also 
unpromising, and in direct proportion to the amount of deformity 
present. Even if the bones can be replaced, retention is very difficult, 
and treatment can scarcely be advised. 

Treatment.—Leposition and retention are effected in accordance with 
general principles. In carnivora, the joint may be supported by plaster 
bandages; in large animals this is impracticable. 


IV.—INFLAMMATION OF THE ELBOW-JOINT. 


Acute inflammation of the elbow-joint is seen in all species of animals, 
sometimes from wounds of the joint, sometimes from metastatic disease, 


INFLAMMATION OF THE ELBOW-JOINT. 473 


like “ navel-ill” of young animals, In dogs the joint may be opened by 
bites, in horses by kicks or by injuries from stable-forks. Disease may 
may also be caused by injury to the sheath of the extensor metacarpi 
muscle, which communicates with the elbow-joint. Franck’s opinion, 
which is to some extent corroborated by Eichbaum, is that the sheath 
always opens into the elbow-joint.by a slit about 1 line in breadth. 

Chronic inflammation of the joint is rare. Roloff noticed fungous 
arthritis of the elbow-joint in the horse; Dammann, a eystenchondroma. 
As a rule, tumour formation is not frequent. Arthritis chronica is 
difficult to diagnose with certainty, and is generally included in 
“ shoulder Jameness.” 

Percival noted a form of chronic lameness in the horse which pre- 
sented considerable resemblance to laminitis. Post-mortem showed 
chronic inflammation of both elbow-joints, a portion of the articular 
surface being worn away and covered with granulations. 

Symptoms.—Acute inflammation of the elbow-joint due to wounds 
produces excessive painon movement. The patient may sustain weight 
on the limb, but carefully avoids any movement of the joint, particularly 
at the commencement, when acute synovitis alone exists. Afterwards 
fever and marked swelling of the whole joint set in. 

The course is always unfavourable, acute inflammation of this joint 
almost always ending fatally, and chronic inflammation being followed 
by incurable lameness. 

Treatment is, therefore, chiefly of a prophylactic character, and 
follows general principles, including careful antisepsis of wounds involv- 
ing the joint or tendon sheath above mentioned. In suppuration 
involving the joint, little can be done. The thick muscular tissue 
and unyielding capsular ligament present great difficulties to washing 
out the cavity, and usually render such treatment useless. The form 
of arthritis chronica seen by Percival was also incurable, and, after long 
and unsuccessful treatment, the horse was killed. 


V.—CAPPED ELBOW IN THE HORSE. 


Lit.: Binz, Buschs Zeitschr. vol. I. part 2, p. 20. Stockfleth, Handbuch. 
d. th. Chir. p. 195. Schrader, Gurlt u. Hertwig. 8, p. 213. 


The structure corresponding to the bursa olecrani of man is found in 
the horse and dog at the posterior surface of the elbow-joint, and though 
not constant, generally forms below the skin a bursa mucosa as large as 
a walnut or apple (Kichbaum). Inflammation, generally caused by the 
heels of the shoe, produces a swelling, vulgarly termed “ capped elbow.” 


474 CAPPED ELBOW IN THE HORSE. 


Pathological anatomy.—Bruising leads to acute inflammation of 
the bursa; sometimes bleeding takes place into the bursal cavity; some- 
times bursitis sero-fibrinosa vel hemorrhagica occurs. If pus cocci 
enter, bursitis suppurativa may result. In any case, however, the con- 
nective tissue around the joint also suffers (parabursitis), though in the 
horse this condition is not marked. At first, oedematous swelling of the 
connective tissues sets in, but later gives place to plastic infiltration, and 
finally to extensive formation of fresh connective tissue, which may even 
become ossified. 

The disease, therefore, consists of a bursitis and parabursitis olecrani. 
The swelling is chiefly caused by the latter. 

Symptoms.—tThe clinical symptoms differ somewhat according to 
the pathological changes. The only constant feature is the swelling, 
which is more or less sharply differentiated from its surroundings. 
When recent, it feels abnormally warm, is doughy and slightly pain- 
ful. It afterwards becomes harder, depending on the degree of plastic 
infiltration and induration of parabursal tissue. Occasionally disten- 
sion of the bursa is the more prominent symptom, and the swelling 
is then fluctuating, and on being opened discharges blood-stained 
flud. The bursa may become as large as a man’s fist and contain 
fibrinous clots. If not opened, its contents may be reabsorbed, and 
whilst the parabursitis disappears, the over-stretched skin forms a loose 
fold. Lameness is rare, and the condition can only be mistaken for 
inflammatory changes in the subcutis, which, however, are never so 
sharply defined as the diseased bursa. 

Causes.—The disease is produced by bruises, almost always due to 
the heels of the shoe. Weakness, too short a halter rein, too small 
a box, and, in broken-winded horses, difficulty in breathing, may all 
cause the animal to rest on the sternum, with the legs tucked under 
it; mm animals with short forearms the posterior surface of the elbow 
then comes just against the posterior part of the hoof, and is readily 
bruised by the heels of the shoe. Metastatic disease of the bursa is 
sometimes seen during strangles. 

Course.—The condition is generally produced in a single night. By 
immediate treatment the swelling may sometimes disperse, but more 
frequently it becomes chronic, resorption being incomplete, and induration 
occurring in the parabursal tissue. When a large swelling disperses 
after existing for some time, a loose fold of skin remains, which detracts 
from the animal's appearance. Resorption, however, is not infrequently 
prevented by repeated bruising. The animal may continually he in the 
position described, injuring the bursa and its neighbourhood, and chronic 
thickening may occur in the parabursal connective tissue, rendering 
resorption impossible. 


TREATMENT OF CAPPED ELBOW IN THE HORSE. A475 


When the skin is injured suppuration may occur in the bursa, and 
after some time be followed by fluctuation and perforation. Metastatic 
bursitis produced during strangles is always of this character. As the 
disease seldom causes lameness, prognosis in working-horses is always 
favourable as far as continued usefulness is concerned. The older the 
condition the less the chance of complete recovery, but firm swellings 
may be removed with the knife. 

Treatment.—Fresh swellings are treated by cold applications, and 
if further bruising be prevented, complete dispersal often results. Re- 
sorption is assisted by repeatedly applying irritants, which favour resolu- 
tion and at the same time render the skin sore, and prevent the animal 
lying on the diseased spot and thus renewing the injury. A 10 per 
cent. iodide of mercury ointment may be applied every two or three days. 

Binz has emphasised the fact that the bursa should not be opened 
except when pus is present. Where the lining has been destroyed by 
suppuration, recovery may occur, otherwise granulations do not form 
readily, on account of the peculiar nature of the bursal surface. More 
frequently, serous fluid is actively secreted, prevents the granulations 
healing around the incision, and finally leads to fistula formation. It is 
therefore necessary, when the bursa is opened before suppuration has 
occurred, to destroy the membrane by irritants. 

Stockfleth recommends swabbing out the sac daily with 1 part of 
caustic potash to 4 of water; the other parts of the leg must, of course, 
be protected against the irritant. The use of the actual cautery seems 
simpler. Stockfleth employs it to open the diseased bursa, thus prevent- 
ing the emphysema which sometimes follows incision. The bursa should 
only be opened either when pus exists in it, or when its walls are very 
thin, and the swelling is principally bursal. Hardness of the swelling 
shows that it principally consists of indurated connective tissue, and 
treatment is then limited to destroying or excising the newly formed 
material. At one time the first method was largely adopted, irritants 
being inserted into the swelling. Hertwig recommended arsenic, which, 
in the form of powder or of small particles, was passed through an 
incision as far as the centre of the swelling. Gangrene occurred in the 
bursa and its surroundings; after eight to fourteen days, the swelling 
separated from the skin and sloughed, and the wound was filled by 
granulations and healed. Though this method has the advantage of 
not stopping the horse’s work, yet it may cause serious complications, 
and therefore operative removal, either by dissection or by ligation, 
has latterly received preference. 

Ligation, first recommended by Schrader, is the simpler and easier 
method, and is almost always successful. When operation is at all 
possible, 7.¢., where the tumour is sufficiently pedunculated to allow a 


476 CAPPED ELBOW IN THE HORSE. 


ligature to be applied, itis, in my opinion, the best method. The elastic 
ligature is most useful. After cutting away the hair and cleansing the 
skin, a rubber tube, about the thickness of a quill, is passed round the 
base of the swelling, and drawn as tight as possible. The ends are 
tied together with string. The ligature soon begins to cut in, and 
in four to ten days, according to the thickness of the tumour, it falls 
away. In large tumours it may be necessary to remove and reapply 
the ligature after two or three days. The surface of the wound 
should meanwhile be cleansed daily and washed with disinfectants 
such as sublimate, creolin, or carbolic solution. On account of its 
deodorising qualities, permanganate of potash is especially useful. Cases 
of tetanus are said to have occurred after ligation, but I have seen 
only one. As tetanus is infective, careful disinfection is advisable 
as a preventive measure, while at the same time it destroys the un- 
pleasant smell of the mass of dead tissue. I prefer passing the 
ligature over the skin, which is not previously cut through; the skin 
is thus drawn together, and cicatrisation reduced to a minimum. 
Havemann points out the advantage of the ligature. Should the 
application of an elastic lgature prove difficult, on account of the 
tumour having no neck, a thin cord may first be applied, as it does 
not so readily slip off as the elastic ligature. In a few hours the 
tumour swells, when an elastic hgature can be put on with ease. In 
case of need, slipping may be prevented by passing a long needle 
completely through the swelling in front of the ligature. 

In using the lgature, the remainder of the tumour must not be cut 
away with knife or scissors, as 1t always contains large arterial vessels, 
and bleeding of an unpleasant if not positively dangerous character may 
result. When a cord is used, it will be necessary to tighten or renew 
it after a couple of days. 

After-treatment is simple. As soon as the swelling has fallen off 
(which may be somewhat assisted by torsion slowly performed), the 
surface of the wound should be cleansed daily with disinfectants until 
a dry scab has formed, under which healing occurs in eight to fourteen 
days, without leaving any considerable cicatrix. Formation of a scab. 
will be promoted by powdering the parts with iodoform combined 
with tannin or sugar. 

Enucleation, sometimes recommended, is not so simple as at the first 
glance it appears. In this operation the horse must generally be cast, 
and if restless, placed under chloroform. The foot is loosened and 
drawn forward by two cords, or fastened by a modified “side stick,” 
and a ligature passed through the swelling to afford a better hold. It 
is well to previously remove the hair at the point where the incision is 
to be made, because, on account of the skin being thrust on one side, the 


CAPPED ELBOW IN THE HORSE AND DOG, ATT 


operator may fail to direct the incision properly. The tumour is next 
separated in the ordinary way. Care is required, however, to avoid injur- 
ing the fascia of the fore-arm and the muscular tissue, which might easily 
produce cellular inflammation, nor should the point of the elbow be 
exposed. After removing the swelling, the wound is treated on general 
principles. As asepsis is seldom possible, large vessels should be tied, 
and a firm tampon of tow sewn up in the wound to check bleeding. 
The tampon is removed next day, and open wound treatment proceeded 
with, The horse is rested, and kept standing for eight days, or may 
be placed in slings. 

As a preventive, a pad may be applied to the hoof, or a strap pro- 
vided with points passed round the joint: the latter is only applicable 
to heavy horses; in well-bred animals it is better to use a properly 
constructed leather boot. Similar appliances may be resorted to in 
treating “capped elbow,” as the parts tend to become bruised afresh, 
and the swelling is thus maintained. 

A similar disease occurs in large, heavy dogs, which, when lying on 
hard ground, support themselves on the sternum and elbows. The skin 
alone may be injured and thickened, or callosities form at the affected 
spot, but occasionally the bursa olecrani becomes diseased. The disease 
differs from that in horses, inflammation being almost always confined 
to the bursa, and parabursitis occurring very rarely, consequently the 
swelling is soft and fluctuating. Symptoms of inflammation (warmth 
and pain) are in rare cases present; but, as a rule, there is only a 
fluctuating swelling of an oval or round form, varying from the size of a 
hazel-nut to that of a hen’s egg. 

The swelling is produced by distension of the bursa olecrani with 
serum, which sometimes contains fibrin (bursitis sero-fibrinosa); blood 
is rarely met with. It never interferes with movement, but is a 
blemish which is difficult to remove, the cause being always at 
work. Animals accustomed to lie in the position described cannot be 
broken off the habit, especially as the swelling is painless. Simple 
puncture and removal of contents are therefore not sufficient, and, 
owing to the flatness of the swelling, a ligature cannot be applied. 
If necessary, the enlarged bursa must be surgically removed, though 
operation is difficult, and, as a rule, cicatricial thickening remains, 
Before operating, it is best to give a dose of morphine. ‘The hair is 
removed and an incision made over the swelling in the long axis of the 
limb. The bursa is then separated from neighbouring parts, care being 
taken not to incise it, which would greatly increase the difficulty of the 
operation. The greatest precaution is required in separating the bursa 
from the elbow, with which it is firmly united, and the bone must not 
be exposed, as this would delay healing, and prevent the formation of a 


478 WOUNDS AND BRUISES OF THE FORE-ARM. 


cicatrix. When excision has been successful, it is sometimes possible, 
by observing careful antisepsis, to produce healing by first intention. 
The operation wound is carefully dressed, and thick layers of wadding 
or wood-wool applied to the posterior surface of the elbow to prevent. 
further bruising when the animal lies down. When healing by first 
intention is impossible, the wound must be treated on general principles. 
A soft bed is particularly requisite. Remnants of the bursa, which 
remain after enucleation, may be destroyed by irritants like nitrate of 
silver, and a proper granulating surface so produced. 


VI.—WOUNDS AND BRUISES OF THE FORE-ARM. 


Lit.: Bassi, Her, Rep. 25, p.17. Ellenberger und Baum, 
Topogr. Anat. 


Anatomy.—lIn the horse, the fore-arm (antibrachium) has, as a basis, 
the radius and ulna, which are surrounded by numerous muscles, tendons, 
and fascie. The following surface-markings should be noted :—To- 
wards the lower end of the fore-arm a long depression, slightly inclined 
backwards, and marked at its centre by a prominent cord, the tendon of 
the extensor suffraginis. In front of this runs another cord about. 
one inch in breadth, the tendon of the extensor pedis. Towards the 
front of the limb, and at the boundary of the external and anterior 
faces, another depression, and still further forward and inward, the 
tendon of the extensor metacarpi magnus, about 14 inches in 
breadth. 

Behind the first-named depression hes the flexor metacarpi externus, 
which is bounded behind by the flexor pedis perforans and the flexor 
metacarpi internus. 

The inner surface of the fore-arm displays another depression, at the 
bottom of which can be felt the radius, here only covered by skin. 
Behind it les the flexor metacarpi internus, lkewise readily felt 
below the skin; in front of this furrow, the bone is margined by 
the extensor metacarpi magnus. Between the two depressions, and 
quite clearly visible, runs the internal subcutaneous or radial vein. 

Two fascize cover the fore-arm, (a) a thin superficial and (d) a deeper, 
better developed layer, the fascia antibrachialis, which arises from the 
various muscles of the humerus and shoulder, is attached partly to 
the subcutaneous portions of the radius, becomes partly continuous with 
the tendons of the extensors and flexors, and partly extends to the 
ligaments of the knee. Between the skin and fascie pass the thin 


WOUNDS AND BRUISES OF THE FORE-ARM. 479 


cutaneous nerves; those on the posterior surface of the fore-arm arising 
from the ulnar nerve, those on the exterior from the radial nerve, 
and those on the anterior partly from the median. The cutaneous 
vessels, viz, the internal and anterior subcutaneous veins, correspond 
to these. 

Vertical wounds confined to the skin of the fore-arm are of no 
particular consequence, but horizontal wounds are more apt to cause 
trouble, on account of their gaping. If carefully disinfected, 
primary union may result from applying a proper dressing, which, 
however, is more difficult in large than in small animals. 

Injury of the muscles and fascize of the fore-arm is frequently 
followed by burrowing of pus and other dangers, for which reason such 
wounds must be dressed antiseptically or freely laid open. Sometimes 
setons or drains are useful, especially in penetrating infected wounds 
accompanied by much swelling and pain. Fever is a particularly 
dangerous symptom. 

The edges of horizontal muscular wounds are apt to gape excessively. 
The animals generally walk lame, though they may be able to stand on 
the limb, especially when the extensor muscles are the chief seat of 
injury. Gaping of the wound and contraction in the divided muscles 
alike impede union; and as, in large wounds, the skin soon retracts, it 
is best, even when asepsis seems out of the question, to suture such 
wounds as soon as possible. Tape about + to + of an inch broad forms 
a good suture material, and an attempt should be made to fix the skin 
and prevent it retracting. By passing the sutures through the bodies 
of the muscles a better hold is ensured, and there is less chance of their 
tearing out, whilst the tapes may be used for fastening on a dressing. 
Any tendency to excessive granulation must be repressed early by using 
astringents and caustics. 

Bruises of the muscular tissue and fascie of the fore-arm are com- 
monest in cart-horses, in consequence of kicks or of blows inflicted with 
the pole. They are easily recognised by the pain, swelling, and difficulty 
in that phase of movement when the limb is carried. Resolution gener- 
ally occurs and lameness disappears in eight to fourteen days. In 
other cases abscesses form, and should immediately be incised to allow 
free exit of pus, which may otherwise burrow and cause necrosis of the 
fascize of the fore-arm ; extensive counter-openings are therefore at times 
necessary. The radius is sometimes injured just above the knee. In 
this case also it is important to provide for drainage, either by counter- 
incision, drainage-tubes, or setons. Slight swelling with great pain 
points to disease of the bone (periostitis or necrosis), a complication 
which may occur at any time before pus formation has completely 
stopped. 


480 DISEASES OF THE KNEE. 


In horses, the inner surface of the elbow-joint may be injured by 
straddling across bales, poles, or similar objects. The pain is often so 
acute that the animals are unable to place weight on the limb. In 
these cases the median nerve is bruised; and although the effect of the 
injury may only last a few minutes, it may also continue for a couple of 
days. The pathognomonic symptom is insensibility below the elbow- 
joint, especially at the posterior surface of the limb. The affection soon 
disappears. 

Bassi saw movements of the left fore-foot simulating stringhalt in a 
mule. The front-foot was lifted unusually high, and the animal often 
stumbled; the symptoms were particularly noticeable when the animal 
moved backwards. On the external surface of the fore-arm, just below 
the elbow, was a thickening, the result of a fall; it was not inflamed, 
and had existed for some weeks. Twelve to fifteen days later the diffi- 
culty in movement had diminished. Permanent recovery followed 
division of the flexor metacarpi externus. 


C. Diseases of the Knee. 


Anatomy.—The knee, a complicated joint, consists of three por- 
tions,— 
(1) The radio-carpal articulation. 
(2) The intercarpal articulation. 
(3) The carpo-metacarpal articulation. 


The first two are incomplete ginglymoid joints, because, in addition 
to flexion and extension, they allow of slight lateral movement, and, in 
the flexed position, of some amount of rotation, which is most marked 
in carnivora. The lower row of bones forms with the metacarpus an 
arthrodial joint, the movement of which, in all animals except carnivora, 
is exceedingly limited. 

Each of these three joints is surrounded by its own synovial mem- 
brane, though the lower is connected with the middle by a narrow slit. 
The common capsular ligament arises from the radius, 1s applied to both 
rows, and ends on the metacarpus. Two strong lateral ligaments attach 
the radius to the metacarpus, whilst the bones of the carpus itself are 
united to one another and to the radius and metacarpus by interosseous 
ligaments which limit the movement of the knee-joint. 

The fascia covering the carpus and metacarpus, which is an extension 
of the deep portion of the fascia of the fore-arm, forms, on the anterior 
surface of the knee-joint, sheaths for the extensor tendons, and is in 
close connection with the capsule of the joint. On the outer surface of 


FRACTURES OF THE BONES OF THE KNEE. A81 


the carpus the fascia becomes continuous with the ligaments of the joint, 
with the periosteum of the external surface of the pisiform bone, with 
the tendon of the flexor metacarpi externus, and with the extensor 
pedis. On the inner side of the carpus the fascia becomes attached to 
the ligaments of the joint, to the lower extremity of the radius, and to 
the inner small metacarpal, and covers the flexor pedis tendons, with 
which it becomes continuous. 

The skin lies immediately over the fascia, and,on the dorsal side espe- 
cially, is thick, tense, and provided with a moderately well-developed 
subcutis. Subcutaneous burs are sometimes found on the os magnum, 
as well as on the lower anterior surface of the radius towards the inner 
side of the sheath of the extensor pedis (Eichbaum). 


—FRAGTURES OF THE BONES OF THE KNEE. 


Frequent fracture of these bones is prevented by their small size 
and sheltered position. In large animals like horses, fractures are 
commonest from falls on hard ground. They are almost always seen in 
conjunction with wounds and injuries of the joint, and are, therefore, 
compound fractures. They seldom unite, but when this occurs move- 
ment of the joint is more or less limited, or altogether prevented by 
formation of synostoses. 

On account of its isolated position the pisiform bone is an exception 
to this rule, and I have repeatedly seen fracture of it in horses. One 
‘ease occurred in a draught-horse during heavy work, the immediate 
cause clearly being excessive contraction of the flexors of the knee. 
Rupture of one or other ligament of the pisiform bone may also 
occur. 

The symptoms are, inability to bear weight on the limb which is 
flexed, as in complete radial paralysis, and local pain. Abnormal 
mobility of the pisiform bone and crepitation under pressure fix the 
character of the fracture beyond doubt. 

Course.—Union of fractures of the pisiform bone is difficult. The 
fragments of bone are drawn upwards by the pull of the attached 
muscles, while, as in fractures of the ulna, the conditions are unfavour- 
able to callus formation, A fibrous callus forms, generally of insuf- 
ficient strength, and if put to work too soon the animal relapses. In 
other cases I saw marked dorsal flexure of the knee. Even favourable 
cases take two to three months for recovery; but many horses have to 
be destroyed in consequence of descent of the os pedis, and of the acute 
pain, fever, &c., which result. 

2H 


482 INJURIES TO THE ANTERIOR SURFACE OF THE KNEE. 


Treatment.—The animal should be placed in slings and repositiom 
attempted, though it is seldom successful. In quiet animals a dressing 
may be applied, but is useless in fidgety patients, which can only be 
given a roomy stall or box, with plenty of bedding, and allowed to lie 
as much as possible, thus preventing descent of the os pedis of the other 
foot. 


II.—INJURIES TO THE ANTERIOR SURFACE OF THE 
KNEE. 


In consequence of the anatomical and physiological peculharities of 
the knee, its anterior surface, especially in horses and ruminants, is 
much exposed to injury by bruising. In horses, injury results from 
falling on hard, uneven ground; in cattle, from the continual pressure 
of the body-weight when lying on hard surfaces, and from the peculiar 
way in which the animal lies down and rises. Such peculiarities explain 
the varying character of the injury in different species of animals. 


(1.) INJURIES TO THE KNEE IN THE HORSE. 


When falls occur during movement, horses almost always strike the 
knee, and sometimes cause bruises, «¢., injuries not involving a skin 
wound, but consisting in rupture of blood-vessels in the subcutis, and 
easily recognised by their fluctuating character. Lacerated wounds are 
more common, and vary in gravity according to their extent. Defec- 
tive formation, senile degeneration of muscular tissue or other cireum- 
stances, cause animals to be uncertain on their fore-limbs, and, there- 
fore, inclined to fall; in such case both knees are often injured. The 
commonest injury is superficial bruising of the skin. When animals. 
are going fast and only fall for a moment, excoriations and loss of hair 
may occur, but are of little consequence unless the skin is perforated. 
Serious abrasions, however, require rest and careful treatment, in spite 
of which thickening and hairless spots often result. 

Swelling of the soft tissues in front of the knee at once interferes. 
with movement. If the knee is then forcibly flexed, as for example by 
the animal falling, the cutis and subcutis, infiltrated with inflammatory 
products, may easily be ruptured and a horizontal wound produced, 
which heals very badly. 

Injury or exposure of the fascia is also grave. The wound is then 
much deeper, and shreds of the injured fascia may be seen in it. In 


INJURIES TO THE KNEE IN THE HORSE. 483 


such cases healing is much delayed, though finally arrived at by proper 
treatment. Provided the sheaths of the extensor tendons are not laid 
open, and swelling and pain remain slight, there need be no great 
difficulty, but exposure of the burs constitutes a grave complication. 
Swelling becomes severe, and extends both upwards and downwards; 
jelly-like synovia discharges from the wound, flexion of the limb pro- 
duces great pain, though weight may be placed on it, and in walking 
it may only be held stiffly. 

Falls on sharp stones, or on rough, hard ground, may injure the exten- 
sor tendons, or even one of the three main divisions of the joint. 
Although the knee-joint is included in the category of “indolent” joints, 
a.e., such as only slightly resent mechanical injury, yet severe symptoms 
may follow such accidents. Pain is sometimes so excessive that weight 
can only be borne on the limb intermittently, sometimes not at all. The 
swelling extends over the whole joint, and often far beyond it, and there 
may be fever. The finger or a probe can often be introduced into one 
or other of the joints, and in the later stages it may be possible to feel 
the articular surfaces, which are rough and denuded of cartilage. Some- 
times crepitation can be detected during passive movement of the 
joint. 

Course.—Provided the sheaths of the tendons are not affected, 
bruises disappear in from two to three weeks, though they often 
leave local thickening. Otherwise, and especially if the parts cannot be 
kept aseptic, recovery may take four to six weeks. Injuries to the 
joint may heal (with formation of exostoses), but generally produce so 
much disturbance and fever, and are followed by such obstinate lameness, 
that the animal is either killed or dies of septicemia. The prognosis 
therefore depends chiefly on the extent of the injury. If the parts can 
be kept aseptic, which is seldom the case, there is, of course, a much 
greater chance of recovery, and blemishing is minimised. 

Treatment.—When the injury is confined to the skin, it is sufficient 
to cleanse the abraded parts and smear them with some neutral fat 
like vaseline or lead ointment ; but wounds perforating the skin require 
complete rest, to prevent formation of large cicatrices, and in addition 
general antiseptic treatment. Very careful asepis is required where 
the fascize are injured or exposed. A circular bandage provided with 
a dressing should be passed around the knee, being left rather looser 
above and below, and the animal placed in slings or tied up short 
to prevent its lying down. Wounds which cannot be rendered 
aseptic should be left open. Continuous irrigation with lukewarm 
dilute sublimate or lead lotion is useful during the first few days, 
especially when there is much discharge. At a later stage digestive 
ointments may be employed to assist granulation, though their too early 


484 TUMOURS OF THE KNEE IN CATTLE. 


use is contra-indicated, and care must be taken that the granulations 
develop regularly. Excessive proliferation may be checked by iodoform 
and tannin, or sugar, which produces a dry scab, under which healing 
proceeds. 

The treatment of open joint calls for all the resources of antisepsis. 
Provided purulent or septic disease of the joint has not yet set in, the 
wound must be carefully washed with sublimate or creolin solution, and 
an antiseptic bandage applied; but when such changes have occurred, 
the only chance consists in carefully cleansing the parts and providing 
for permanent irrigation. This may at least be tried, and any special 
complications treated on general principles. In animals of little value, 
and in cases where there is great pain, further treatment is scarcely 
advisable. 


(2.) TUMOURS OF THE KNEE IN CATTLE. 


Ger. Kniebeule or Knieschwamm. 


Lit.: Lafosse, Jahrb. 1868, p. 52. Leisering, Dresd. Ber. 1861, p. 30. 
Johne, ibid., 1879, p. 61, u. 1880, p. 50. Haubner, Gurlt u. Hertwig. 
21, p.414. Rychner, Buiatrik. 1841. Pieschel, Gurlt u. Hertwig. 
21, p. 417. Gurlt, ibid., 22, p. 327. Rosenbaum, ibid., 21, p, 215, 
u. 22, p. 144. 


In lying down and in rising cattle are apt to bruise the knee, and to 
produce chronic inflammation of its anterior surface, which often leads to 
great swelling and thickening of tissue. The same result occasionally 
follows falls on uneven, hard ground, in which ease inflammation is 
acute. 

Tumour on the knee cannot be regarded as a definite diseased con- 
dition like “ capped elbow,” but results either from chronic inflammation 
and thickening of the skin or subcutis, or from inflammation in the 
sheaths of the extensor tendons. In exceptional cases, the swelling 
consists of a “tumor albus,” due to chronic inflammation of the con- 
nective tissue lying around the carpal joint, producing fibrous thickening. 
These swellings were formerly divided into hard and soft forms. L 
prefer to differentiate them as:—(a) cutaneous, (b) synovial, and (c) 
articular or periarticular. This classification, though it cannot always 
be observed clinically, facilitates the study of the condition. 

The cutaneous form consists either in excessive thickening of the skin 
and subcutis covering the front of the knee, not infrequently associated 
with active increase in the epidermis covering it (fig. 105), by which a 
hard swelling, often as large as a man’s head, results, or in the develop- 
ment in the subcutis of cavities filled with serous fluid, which often 


TUMOURS OF THE KNEE IN CATTLE. 485 


contains lymph floeculi. Hence Rychner and Haubner regarded the 
condition as analogous to the retention cysts, and compared it with 
“ capped hock.” The descriptions given by Leisering, Pieschel, Johne, and 
others indicate that in many cases cysts form in the cutis and subcutis at 
the same time that the epidermis undergoes active proliferation. Johne 
describes this condition as “ dermoid cyst, with diffuse keratosis.” 

The synovial form consists in a tendovaginitis chronica serosa or 
fibrosa, which sometimes affects the tendon-sheaths of the extensor 
pedis, but more frequently the sheath of the extensor metacarpi 


Fic. 105.-Knee tumour (cutaneous form), after Stockfleth. 


magnus. The swelling is sometimes chiefly formed by the sheaths of 
the tendons distended with serum (tendovaginitis chronica serosa), some- 
times by the greatly thickened connective tissue of the sheath and its 
surroundings (tendovaginitis chronica fibrosa). 

Consequently a soft and hard form can be distinguished. The tendon- 
sheaths are often greatly distended; in one Gurlt found 17 lbs. of 
fluid. Small papille form on the inner surface of the sheaths, and 
when rubbed off appear like grains of rice; this condition is termed 
hygroma proliferum. Pus formation may also occur. 


486 TUMOURS OF THE KNEE IN CATTLE. 


The articular form presents a true tumor albus, that is, progressive 
nerease and induration in the peri- and para-articular connective tissue, 
and is always associated with exostosis formation on the bones of the 
knee, of the fore-arm, and of the metacarpus. The swellings are of 
variable hardness, and result from chronic inflammation of the knee- 
joint. Ossification in the new connective tissue inereases the hardness 
of the swelling. 

Symptoms and Course.—The chief symptom consists of swelling 
of the front of the knee, which sometimes increases rapidly, sometimes 
slowly, but is continued. The tumour may become immense (as much 
as a yard in circumference), and even reach to the ground. The degree 
of pain varies, sometimes being considerable, and chiefly depending on 
the mode of origin of the disease. When caused by a single violent 
bruise there is generally pain at first; but the slower the develop- 
ment the less the pain. The swelling, though at first soft and fluctu- 
ating, at a later stage becomes firm, and is often covered with thick 
masses of horn. In cutaneous “ capped knee” the tumour remains 
movable on the subjacent tissues for a long time; in the synovial form 
it takes an elongated shape corresponding to the direction of the sheaths 
of the tendons, and extends over the metacarpus from the region of the 
extensor pedis tendon. The articular form is more diffuse; it extends 
to the lateral surfaces of the knee, and is firmly attached to the under- 
lying parts. Ossification is denoted by unusual hardness, and by the 
movement of the joint being more interfered with than in the two 
previous forms. Lameness is usually slight; only when the disease is 
acute and causes great pain, or when the swelling becomes excessive, 
is movement much interfered with. 

Causes.—The chief causes are injuries sustained in lying down and 
rising in badly-paved stalls and on insufficient bedding. The repeated 
bruising may cause extravasation of blood in or under the skin, or into 
the sheaths of the tendons, and proliferation of connective tissue. That 
bleeding often occurs is shown both by the presence of clots in the 
serous fluid, and by the pigmented condition of the newly-formed con- 
nective tissue. A single severe bruise from falling on uneven, hard 
ground, as occurs in working-oxen, may produce the disease. Chronic 
processes, like tuberculosis, invading the carpal joint, may also induce 
such tumours, but the nature of the cases hitherto reported is seldom 
fully explained. 

The treatment of “capped knee” is as varied as its causes, and 
must depend on the nature of the injury and the anatomical changes. 
Fresh bruises and acute inflammation, accompanied by great pain, are 
best combated by cold applications, followed later by applying cloths 
wrung out of warm water. In skin injuries search must be made for 


TUMOURS OF THE KNEE IN CATTLE. 487 


foreign bodies like splinters of glass, fragments of gravel, &c., and the 
dressings should be moistened with disinfecting fluid; in any case 
plenty of clean straw must be given, and it is well to cover the bottom 
of the stall with turf or sand instead of leaving the stones exposed. 

Where fluctuation exists near the surface, cavities should be opened 
at the lowest point. Rosenbaum ties the animal up securely, and directs 
an assistant to grasp it by the nose. The swelling is then opened with 
a bistoury or pointed tenotome. As the leg is generally lifted at this 
moment, the cutting edge of the knife must be directed upwards to 
prevent deep-seated structures being injured. The cavity is freed from 
clots with the fingers, the animal placed on soft, clean straw, and 
the wound cleansed daily. Recovery generally occurs in three to 
four weeks. Hertwig recommends passing a seton through the swell- 
ing, leaving it in position for fourteen days, and following this with a 
blister. 

Although the same treatment may be employed in the synovial form, 
it is better, if the parts are already aseptic, to puncture with the trochar 
under antiseptic precautions, and afterwards inject a solution of iodine 
in iodide of potassium (Lugol’s solution). Should this fail, or should 
purulent inflammation of the sheath of the tendon set in, it may be 
necessary to lay the sheath open and thoroughly cleanse it. 

As a rule, little can be done for the hard form of “capped knee,’ 
unless the swelling is marginated, of slight size, and has not too broad a 
basis, in which case it may sometimes be extirpated, but it is more diffi- 
cult to keep the parts aseptic than Hoffmann would have us believe. 
Perhaps, by repeatedly applying a blister, the parts might be rendered so 
painful that the animal would be obliged, in lying down and rising, to 
spare the diseased leg, and absorption might then occur, as it some- 
times does in “capped elbow.” The introduction of euphorbium or 
caustics like sublimate and acids into the swelling, is liable to injure 
the articulation. 


II.—CHRONIC INFLAMMATION OF THE KNEE-JOINT. 


Lit.: Schrader, Gurlt u. Hertwig. 26, p. 133. Williams, The Principles 
and Practice of vet. surg. II. Aufl. 


Chronic inflammation of the knee, arthritis chronica, occurs oftenest 
in horses, and has been long recognised. According to Schrader, Solleysel 
had previously referred to the disease, but it was first described by 
Cherry under the title of “Inee spavin.” Schrader found the articular sur- 
face more or less “ degenerated,” the cartilage worn away, and exostoses 


488 CHRONIC INFLAMMATION OF THE KNEE-JOINT. 


on the bones. He also described ulceration of the cartilage of the joint, 
caries of and exostoses on the bones, and anchylosis. According to 
Cherry, the os lunare and head of the large metacarpal may alone suffer, 
but the inflammation generally extends further. 

Causes.—Horses with narrow, imperfectly formed knees, short fore- 
arms and upright shoulders, appear most predisposed to suffer, possibly 
on account of the peculiarly exaggerated movement in the knee- 
joint which such formation favours. Russian trotters display this form 
and action most conspicuously, and also very frequently suffer from 
chronic carpitis. Not infrequently the disease is bilateral; it is cer- 
tainly more common in coarse than in well-bred animals (Cherry), and 
is favoured by putting young horses to work too soon. Inflammation 
may extend from the periosteum to the joint, particularly in horses with 
defective formation, which are thus liable to “brush” in going, as is 
often the case in Russian trotters. 

Symptoms.—Swelling is the chief symptom, and is sometimes so 
great that the entire joint may appear deformed. The swelling is 
usually hard and firm, consisting principally of exostoses and new 
connective tissue, but when the sheaths of the tendons are involved, 
and become distended, it is soft and fluctuating. Free movement of 
the joint is often interfered with. When resting, the animals lean 
forward, and if forced to move, go stiffly. Bending the knee either pro- 
duces pain or is attended with difficulty, but in applying this test to 
the two limbs care should be taken to have the elbow-joints in the same 
position. 

Lameness may be altogether absent, but it is not correct, as stated by 
Coleman, and afterwards by Gerlach, that lameness is never produced. 
It occurs more often than is believed, and is shown by the limb being 
advanced more slowly and the stride shortened, whilst the knee-joint is 
imperfectly flexed and the limb abducted when weight is placed on it. 
If both limbs be affected, or if the process be confined to the lower portion 
of the joint, which in the horse is only slightly movable, there may be 
no lameness. According to Cherry, such a horse gives his rider the feel- 
ing that the thorax is pressed out of position and rises with every stride. 
The condition is most liable to be mistaken for navicular disease. The 
limb is extended, and rather turned outward. The quarters of the foot 
often reach the ground first, and on account of the peculiar gait the con- 
dition has in England been termed “chest founder” (Schulterverschlag). 
The pace naturally assumed is a short, unpleasant gallop, which 
shakes the rider. The forward stride of the diseased limb is shortened, 
giving a certain resemblance to shoulder lameness. The difference: 
consists in— 

(a) The circular sweep of the limb when moved forward. 


INFLAMMATION OF THE BURSA OF THE PEDIS. 489 


(0) In the horse placing the quarters of the foot to the ground first. 

(c) In the production of pain by forcibly flexing the joint. 

Course.—The nature of the disease explains why it is so often 
chronic or incurable. The most favourable cases last from four to six 
months, and it is therefore of great importance to know whether or not 
the horse will still be useful. The smaller the exostoses, and the lower 
they are situated, the more favourable the prognosis. The disease is, of 
course, not so serious in heavy working-horses as in hacks. 

Treatment.—Treatment is principally confined to blistering or the 
use of the actual cautery, and though usually ineffective, sometimes 
decreases the lameness in two or three months. Where the growths 
arise from the periosteum of the metacarpus the pointed cautery is of 
use. Division of the median nerve sometimes removes the lameness ; 
I so far cured several cases by neurotomy that the animals became 
perfectly useful even for carriage-work. 


IV.—INFLAMMATION OF THE BURSA OF THE FLEXOR 
PEDIS. 


The large bursa of the flexor pedis, perforans, and perforatus, lying 
at the back of the knee, may become either acutely or chronically 
inflamed. Acute is commoner than chronic inflammation, and is caused 
by bruises or wounds. The sheath of the tendon may be opened by 
the horse getting into the manger, or by the parts being struck with a 
fork or other sharp instrument. Sometimes cellular inflammation 
extends from the metacarpus to this point; the septic inflammation 
following tenotomy is most dangerous. The chronic form generally 
starts from the check ligament of the flexor pedis, and often produces 
distension of the bursa, extending 6 or 8 inches below and as far above 
the knee-joint (fig. 106). As a rule, the swelling appears on the outer 
side of the joint, both above and below, but in the latter situation may 
extend to the inside; in the former it is often as large as a child’s head, 
in the metacarpal region usually smaller. Palpation detects the con- 
nection between the different parts. 

Whilst, then, the chronic form appears as a fluctuating swelling in 
the region covered by the sheaths of the tendons, and is neither accom- 
panied by lameness nor pain, the acute variety shows the following 
symptoms :— 

(1) Marked lameness; the limb held stiffly, is incompletely ex- 
tended. 

(2) Increased warmth; pain on pressure; more or less firm, hard 
swelling, which surrounds the entire joint, and extends for some distance 


490 INFLAMMATION OF THE BURSA OF THE PEDIS. 


beyond it. In purulent inflammation, periarticular abscesses may 
form. 

(3) Discharge from the wound of large quantities of synovia, after- 
wards mixed with pus, and then appearing of a straw-yellow colour, 
sometimes with necrotic fibres of the flexor tendon. 

(4) Usually fever; in septic disease, the temperature may be very 
high. 

Course.—The acute form usually takes an unfavourable course, and 
when caused by extension of septic cellulitis or by wounds, is always 
dangerous; little can then be done, and slaughter is advisable. The 
appearance of fever is, therefore, always threatening. Simple inflam- 
mation is less serious, and recovery generally occurs, though some 
swelling may be left. Though more difficult to treat, the chronic form, 
associated with formation of large swellings, does not as a rule interfere 
with the animal’s working powers. 

Treatment.—In the chronic form blisters or firing may be tried, 
but are rarely successful. Nor is compression or massage of much 
service. If thought desirable, bandages may be firmly applied above 
and below the joint,and changed from time to time. When the tendon- 
sheaths are wounded, every effort must be made to render the parts 
aseptic, and after inserting sutures, a dressing must be put on (p. 483). 
In purulent synovitis, the bursa may be frequently rinsed out with 
antiseptics, though such treatment is seldom successful. The horse 
must, of course, be slung. Where an antiseptic dressing cannot be 
applied, the parts may be permanently irrigated with boiled water or 
antiseptics. If done cautiously, there is little danger in puncturing the 
swelling and giving exit to contents, though the gain is shght, but 
particular care should be taken not to make large incisions, unless they 
ean be kept aseptic, as purulent synovitis generally results, and eventu- 
ally proves fatal. 


V.—ENLARGEMENT OF ARTICULAR AND TENDINOUS 
SYNOVIAL CAVITIES IN THE FORE-LIMB. 


Lit.: Eichbaum, Berl. Arch. 9, p. 76. Siedamgrotzky, Landwirth. 
Thierh. p. 510. Giinther, Beurtheilungslehre. Gerlach, Han. Ber. 
1869, p. 114. Ginther, ibid., 1873, p. 77. Hoffmann, Her. Rep. 
1892. 


In the fore-limb several of the joint cavities and sheaths of tendons 
are so situate that distension is not visible externally. This is the case 
in the shoulder and elbow. On the other hand, other joints, tendon- 
sheaths, and burse, when excessively distended with secretion, form 


ENLARGEMENT OF SYNOVIAL CAVITIES IN FORE-LIMB. 491 


swellings or “ galls.’ To prevent repetition the most important will 
here be collectively dealt with. We may distinguish three varieties,— 
(A) Distension of joints; (B) Distension of the sheaths of flexor tendons ; 
(C) Distension of the sheaths of extensor tendons. 

(A) Distension of articular synovial sacs. 

1. Of the knee. Though the construction of the knee is unfavour- 
able to the production of “ galls,” yet in working-horses distension of 
the capsular ligament lying between the radius and upper row of carpal 
bones is occasionally seen. This 
constitutes a knee gall, and either 
appears on the front of the knee 
as a roundish swelling, divided into 
several parts by the extensor tendons, 
or occasionally as a tumour the size of 
a hen’s egg, lying on the outer surface 
of the limb, behind the radius and 
just over the pisiform bone. 

2. Fetlock galls. These consist of 
roundish swellings between the meta- 
carpus and suspensory ligament, caused 
by distension of the synovial membrane 
and capsular ligament of the fetlock- 
joint. They are divided into two parts, 
are seldom larger than a duck’s egg, 
and extend towards the front of the 
fetlock, appearing on either side of the 
extensor pedis. When the foot is SS 
lifted they may disappear, but imme- Fre. 106.--Distension of the flexor pedis 
diately return when weight is placed ey Hues Siotseeane a 
on the limb. In exceptional cases 
they appear at the posterior part of the fetlock-joint and close below it. 
Hoffmann says they are particularly noticeable when the fetlock is upright. 

(B) Distension of the sheaths of flexor tendons. 

Giinther pointed out that distension of the sheaths of flexors calls for 
greater care in treatment than that of extensors. This I can corrob- 
orate. The first variety may be divided as follows :— 

1. Knee galls. The flexor pedis has at the back of the knee a large 
bursa, which begins about 4 inches above the joint and extends about one- 
third down the metacarpus (fig. 107, c). Eichbaum says that above and 
below the joint its lateral walls are unprovided with fibrous strengthen- 
ing coats, and thus explains why the swelling appears above and below 
the knee, and sometimes on the inner sometimes on the outer side. 
The enlargement may become excessive (fig. 106), but generally takes 


492 ENLARGEMENT OF SYNOVIAL CAVITIES IN FORE-LIMB. 


the form of a longish, soft swelling, the outline of which corresponds 
with the borders of the bursa. When the limb is lifted, the communi- 
cation between the upper and lower portions of the swelling is easily 
detected by its fluctuation. 

2. Wind galls. The above-described tendon-sheath only extends: 
as far as the beginning of the middle third of the metacarpus, the next 
portion of the flexor pedis being surrounded by loose connective 
tissue. At the lower third another tendon sheath begins and extends 
downwards behind the fetlock-jomt as far as the fibro-fatty frog 
(Kichbaum) (fig. 107, d). Its posterior wall is connected with the 
flexor pedis tendon, whilst below the fetlock a fibrous extension 
surrounds it so firmly that swelling can only occur above the fetlock- 
joint, and (on account of the position of the flexor tendons) on either 
side. At this point the sheath is covered with loose connective tissue, 
which favours the production of the two characteristic longish swellings 
lying on either side of the lower end of the metacarpus, close to the 
flexor pedis tendon, and extending upwards towards the middle third of 
the cannon bone. Their size varies greatly ; sometimes they can only 
just be detected, sometimes they are as large as a goose’s egg. Occa- 
sionally they appear below the fetlock in the pastern region, and are 
then of a more flattened form. Wind galls are very common. They 
generally result from chronic synovitis, though in the hind-feet a pecu- 
liar form, termed indurated wind galls, are produced by a tendovaginitis 
chronic fibrosa. 

(C) Distension of the sheaths of extensor tendons. Of the many 
varieties the most important are :— 

(1) Distensicn of the sheath of the extensor suffraginis in the carpal 
region. This consists of a swelling as large as a goose’s egg, which 
appears 3 to 4 inches above the knee, and beginning on the outside, 
extends downwards; in some cases it may even encroach on the front 
of the joint (figs. 107 and 108, e). 

(2) Distension of the sheath of the extensor tendons in front of the 
pedal joint. The extensor pedis, extensor suffraginis, and extensor 
metacarpi are provided with sheaths in front of the knee. These 
sheaths may be mechanically injured, as already pointed out (p. 483), 
but often become distended. The following are the chief seats of such 
“ galls ” :— 

(a) The sheath of the extensor pedis, which begins 6 inches above 
the knee-joint, passes through the outer furrow in the lower end of the 
radius, and over the front of the carpus as far as the upper end of the 
metacarpus (figs. 107 and 108, /). On account of its being clothed in a 
strong fascia, dropsy of this sheath seldom occurs. 

(b) The extensor metacarpi has, at the same height, a sheath which 


ENLARGEMENT OF SYNOVIAL CAVITIES IN FORE-LIMB. 493 


passes through the middle furrow in the radius, and extends as far as 
the lower row of carpal bones (107 and 108, 9). 


one R 
ie 5 
Fi 4 
Le oe i 
a 
: H t 4 
s 
ow : (ia 
aaah Si Te S li ! < Jp 
: 1 a A Les 
; = AE TY 
eee TE 
g HES Tag g 
at aaa H \ 
alt 4 
Ent E 1 
EA | ! 
Bit IA : 
fp all Na 
i 1K \ 
I Lis h 
pt 
Heme 18 
aha 
Werela 
Hee 
nr os a 
il 1 
yee 
a 
i 
1 
! 
1 
1 
1 
} 
4 


Fic. 108.—The same, as seen from 
the front. 


Fic. 107.—Schema of the more important 
tendon sheaths and bursze of the fore-limb, 
seen frum in front and without. «@, bursa 
intertubercularis ; 0, bursa olecrani; ¢, 
upper; d@, lower tendon sheaths of the 
flexor pedis ; e, sheath of the flexor meta- 
carpi ; 7, upper sheath of extensor pedis ; 
g, sheath of extensor metacarpi magnus ; 
h, sheath of extensor metacarpi obliquus ; 
2, bursa mucosa of extensor pedis. 


494 ENLARGEMENT OF SYNOVIAL CAVITIES IN FORE-LIMB. 


(c) The sheath of the extensor metacarpi obliquus begins on the 
outside, 3 inches above the knee, passes obliquely downwards and 
inwards over the anterior surface of the joint as far as the head of the 
inner small metacarpal (figs. 107 and 108, %). Distension of this sheath 
produces a sausage-shaped swelling, extending in an oblique direction 
as described, and divided by the extensor pedis into several portions. 

(d) The bursa mucosa for the extensor pedis lies above the fetlock- 
joint on the anterior surface of the metacarpus. Its upper or anterior 
wall is formed by the tendon of the extensor pedis (fig. 107, 7). When 
healthy it is from ? to 1 inch long, and 2 to ¢ inch broad (Kichbaum), 
but when diseased, may form a swelling larger than a goose’s egg, lying 
on the anterior surface of the metacarpus, just above the fetlock-joint. 
According to Franck, this bursa sometimes communicates with the 
fetlock-joint. To shorten description, I have adopted the following 
classification :— 

(1.) Bursal enlargements on the front of the knee-joint and on the 
fetlock-joint. 

(II.) Bursal enlargements on the outer surface of the knee and so- 
called “wind galls.” 

(IIL) Enlargements of sheaths of extensor tendons in the carpal region. 
These last may again be divided into— 

(a) Superior—sheath of extensor suffraginis above the knee-joint. 

(b) External—sheath of extensor pedis. 

(c) Internal—sheath of extensor metacarpi magnus. 

(d) Oblique—sheath of extensor metacarpi obliquus. 

Those on the anterior surface of the metacarpus and fetlock-joint will 
be considered under the head “bursal enlargements of the extensors in 
the fetlock region,” and may be divided into upper—those of the ex- 
tensor pedis, and lower—those of the extensor suffraginis. 

Symptoms.—The symptoms need scarcely be enumerated after what 
has gone before; and if the anatomy of the parts is borne in mind, 
diagnosis presents no difficulty. Bursal enlargements, both of the knee- 
and fetlock-joints, disappear, however, when the limb is relieved of 
weight or is flexed, whilst those of tendon sheaths become more distinct 
and appear more tensely filled, Swellings due to distension of articular 
sacs are generally horizontal, those of tendon sheaths more or less 
vertical. The presence of acute inflammation is shown by lameness. 

Prognosis and Course.—Chronic dropsy of the synovial cavities 
of joints and tendons results in the horse from chronic irritation; in 
occasional instances from acute inflammation; bursitis of the sheaths of 
the extensor tendons is generally preceded by lameness. Enlargements 
of the upper sheath of the extensor suffraginis often contain fibrinous 
clots—a result of their hemorrhagic origin—even after having been in 


ENLARGEMENT OF SYNOVIAL CAVITIES IN FORE-LIMB. 495 


existence for some time. On the other hand, enlargements developing 
either from joints or from fiexor tendon sheaths are, with few excep- 
tions, due to chronic irritation of the synovial membrane. Sometimes. 
the cavity is filled with light-coloured, clear serum ; less frequently it 
contains small bodies resembling grains of rice; occasionally the tendon 
sheath is more or less thickened (tendovaginitis chronica fibrosa), 
(indurated galls). In such case the tendon is generally involved. 

For the most part, such enlargements in horses are only regarded as. 
blemishes, and are seldom entirely absent. When of fresh growth and 
small size, they may, if properly treated, be cured; but without impair- 
ing the animal's usefulness, may persist for long, and resist all forms of 
treatment. 

Enlargements of the extensor tendon sheaths seldom cause lame- 
ness, are more accessible to operative interference, and are, therefore, of 
less moment. 

Distension of flexor sheaths, especially where near joints, is more 
difficult to remove, still more so are enlargements of the capsular liga- 
ment of the joint. 

Galls on the flexor pedis perforatus, particularly in the hind-limbs, are 
apt to become chronic and indurated. They are even more troublesome 
if accompanied by inflammation of the tendon of the flexor pedis and 
lameness, complications which are also more frequent in hind- than in 
fore-limbs. As a rule, the swelling appears distinctly above the sesamoid 
bones. 

Causes.—lIn the horse, these swellings are, with few exceptions, 
produced by chronic irritation caused by severe continued work, leading 
to dropsy of the joints or tendon sheaths, and are, therefore, almost 
always confined to working-horses. 

A predisposition to them, depending on individual peculiarities which 
are not infrequently inherited, exists in coarse-bred horses and certain 
other animals. The cause is clearly some defect in the tissue, though 
its character is not yet clearly understood. In exceptional cases, ex- 
ternal influences, like displacement or contusion of the joint, occasion 
enlargement of bursal cavities. Thus, bruising may be followed by 
bleeding into the capsule of the joint or tendon sheath, and years after 
the accident flakes of fibrin may be found in the diseased joint or 
tendon sheath. 

Treatment must follow general principles, and it is here only necessary 
to remark that recent painful conditions are best treated by cold 
poultices or irrigations, or by immersing the parts in cold water. This 
should, when possible, be supplemented by bandaging and compression. 
As soon as acute inflammation subsides, Priessnitz’s moist warm applica- 
tions may replace the cold ones, compression being continued, and, if 


496 ENLARGEMENT OF SYNOVIAL CAVITIES IN FORE-LIMB. 


the parts are not painful, massage may be tried. Light work also 
promotes absorption. Though moderate recent swelling may sometimes 
be dispersed in this way, it is seldom for long, for distension generally 
recurs with work, and the practitioner is forced to resort to irritants 
like cantharides ointment, ungt. hydrarg. biniodid. 1:8, sulphuric 
acid, sublimate, &c., or better still, to blistering-plaster, cantharides 
collodion, or the firmg-iron. The effect of these applications is to be 
ascribed to the regular and lasting pressure produced by the swelling 
acting on tendon sheaths or capsules of joints, and assisting absorption. 
On account of the pressure it exercises, blistering-plaster acts more 
energetically than blistering ointments. The firing-iron produces its 
effect by cicatricial contraction. When freely used it is the most 
effective, though, as it leaves scars, and only substitutes one blemish for 
another, it should not be lightly resorted to, though it is one of the 
most valuable remedies in such cases. 

The effect of artificial drainage has been much overstated. Simple 
extraction by trochar is in nowise dangerous if performed with antiseptic 
precautions, but its effect is not lasting, and the tendon sheath or joint 
refills in a few hours, though, after repeated abstraction of fluid, secretion 
sometimes seems to stop. Cure is always uncertain, however, and even 
the after-injection of iodine does not ensure it. Sometimes the tendon 
sheath undergoes slow thickening and its contents become absorbed, 
success or failure appearing particularly to depend on the degree of 
inflammation produced by the injection. It is best to use a freshly- 
prepared solution of iodine, to see that it is completely removed after 
injection, and to follow this with a blister or with firmg; when blistering 
is contra-indicated, a tight bandage may be substituted. In general, this 
treatment is of little value, and when the enlargement is indurated, 
impossible. Masses of fibrin can only be removed by operation, 
and although, in theory, such operation should not be dangerous 
if asepsis be observed, yet there is no certainty that the dressmg will 
remain in position; even when the preliminary dressing, applied for the 
purpose of sterilismg the parts, has not been interfered with, dressings 
applied after operation are often violently rubbed off. The same is true 
in regard to other animals. I must support Giinther’s view that opening 
distended joints or flexor tendon sheaths is in general dangerous, though 
there seems no particular risk in opening extensor sheaths, even when the 
parts cannot be kept aseptic. This need not, however, prevent operation 
being tried, but attention should certainly be previously directed to the 
danger, and the strictest antisepsis observed. With this object, twenty- 
four hours beforehand, I shave the hair from the point of operation, 
wash the skin, and apply a dressing moistened with 1 per 1000 of sub- 
limate. After casting the horse for operation and removing the dressing 


DISEASES OF THE METACARPUS. 497 


an incision is made, under antiseptic precautions, at the highest point of 
the swelling, the finger introduced, the condition of the sheath examined, 
and any masses of fibrin, &c., removed. The cavity is then washed out 
with a solution of iodine and iodide of potassium in water (1:3:16), 
followed by sublimate or carbolic solution. The loose distended skin 
can then be partly cut away, the wound closed with silk, and a dressing 
applied to keep out air and to exercise pressure. This dressing should 
not be changed for about eight days. The wound probably closes in 
three to four days, though the cicatrix is not then sufficiently firm 
to prevent re-opening if the animal be moved. In enlargements 
of the extensor sheaths setons may be used, but personally I prefer 
operation. 

Bosco has recommended opening enlarged tendon sheaths with the 
red-hot iron, and favourable results have since been announced from 
other quarters. The glowing point of a firing-iron is thrust into the 
enlargement, allowing its contents to be discharged. More or less severe 
inflammation results, and recovery may possibly follow. As the point 
of operation itself is sterilised and an aseptic wound produced which 
soon closes by inflammatory swelling, opening by the actual cautery is 
less dangerous than by the knife, but the effect is not always reliable. 
When the exact degree of inflammation necessary to prevent after- 
secretion of fluid occurs a cure may result, but this degree is very diffi- 
cult—indeed, usually impossible—to secure. For more detailed con- 
sideration of this subject compare with my General Surgery, p. 250 
et seq. 


D. Diseases of the Metacarpus. 


The metacarpus in the solipeds consists of the so-called os metacarpi 
tertium, the cannon bone, and the two small metacarpals. The tendons 
of the extensores pedis et suffraginis cover its anterior surface ; behind 
it lie the two flexor tendons, to some extent enclosed by the two small 
metacarpals. The whole metacarpus is covered with a tensely-stretched 
skin, which is only slightly movable on the underlying parts. 

In ruminants the two cannon bones become united soon after birth 
and form only one bone, on whose posterior and outer surface lies the 
rudimentary small metacarpal, which is articulated to the fused meta- 
carpal by means of a small joint. This rudimentary metacarpal does not 
contribute to the formation of the knee. 

In swine the two middle or true cannon bones form, with the external 
or false metacarpals, the metacarpus. The carnivora possess five meta- 


carpals, those of the third and fourth toes being the strongest. 
21 


498 FRACTURES OF THE METACARPUS. 


These peculiarities in the formation of the metacarpus cause consider- 
able diversity in disease processes occurring here .in the different 
species of animals. Especially is this true of fractures. 


I—FRACTURES OF THE METACARPUS. 


Lit.: Bauer, Adams Woch. 1883, p. 393. Stolz, Gurlt. u. Hertwig. 12, 
p. 8329. Pujos, Jahresber. 1883, p. 109. 


In solipeds and ruminants fracture generally involves all the bones 
of the metacarpus. The small metacarpals seldom escape, still less fre- 
quently are they alone fractured. In other animals, particularly in 
carnivora, a single bone may be injured, though it is more common for 
several to be broken at one time. Owing to the want of soft parts the 
closely applied skin is readily perforated by fragments; compound 
fractures are thus produced, which unite with great difficulty. 

The most frequent causes are kicks, falls, and, in small animals, 
blows with heavy sticks, and injuries from carriages. Where all the 
bones of the metacarpus are fractured diagnosis is seldom difficult, the 
abnormal mobility of the parts, the inability to place weight on the leg, 
and the crepitation pointing clearly to fracture. 

It becomes, however, more difficult where single bones are involved, 
but even then careful palpation is generally sufficient, and crepitation can 
almost always be detected. The most difficult to detect are fractures 
confined to one or other of the small metacarpals, or such as have 
already produced severe swelling. On the other hand, fissiring can 
seldom be more than guessed at. bauer saw in the horse fissure of 
the pastern, which some days later culminated in complete fracture. 

Course.—In all the fractures enumerated recovery is possible and 
fairly rapid, particularly in small animals. Compound fracture of the 
cannon bone is, however, seldom hopeful, and in the large domestic 
animals even subcutaneous fracture must be viewed as relatively incur- 
able. Only in valuable and quiet horses is treatment worth attempting, 
but that complete usefulness may be recovered is shown by many reported 
cases (Stolz and others). The course of fracture of the metacarpal chiefly 
depends on whether the animal can bear its whole weight sufficiently 
long on the other foot without descent of the os pedis. Union is readier 
in cattle than in horses, and in them the lameness occasionally left causes 
no inconvenience. In the small ruminants and in carnivora subcutaneous 
fractures unite in three to six weeks. Fractures of the diaphyses 
of the metacarpal bones unite more easily than those in the neigh- 


WOUNDS OF THE METACARPUS. 499 


bourhood of joints, but prognosis is unfavourable when a joint is 
involved. 

Treatment.—Reduction is seldom difficult. Before applying a 
dressing care must be taken to bring the limb into a proper position, 
and especial attention should be given to the position of the hoof or 
claws. A plaster bandage is very useful, especially in small animals. 

Stolz employed an ointment, now named after him, composed of two 
parts of resin and one of wax, which is smeared on linen, and used as a first 
dressing, over which a splint is applied. Horses must generally be slung. 
The stocks recommended by Binz and Tennecker are of no particular value. 
Pujos saw transverse fracture of the cannon bone, just above the fetlock, 
in the horse, which united after applying a plaster bandage. Eight 
days (?) after the accident the animal began to place weight on the 
limb. Forty-five days later, when the bandage was removed, the limb 
could be moved as usual. In sixty-six days the horse was again put to 
work. 


I.—WOUNDS OF THE METACARPUS. 


Lit.: Gerlach, Gurlt u. Hertwig. 20, p. 304. Frick, Berl. Arch. 1888, 
p. 82. 


On account of the skin being so tightly stretched and firmly united 
to the underlying structures, wounds in this region, especially in large 
animals, often take an unfavourable course. It sometimes happens that 
bones, tendons, and tendon sheaths are all simultaneously injured, and 
such cases demand the most careful antiseptic treatment. The hair 
should be removed, along with foreign bodies or any loose shreds of con- 
nective tissue, and the wound and its neighbourhood carefully washed 
with a disinfectant. If possible the parts may be immersed in a bath 
of sublimate, carbolic or creolin solution, and the wound irrigated with a 
powerful stream of sublimate until its edges are thoroughly saturated 
with the solution. Gaping wounds must be sutured with aseptic 
material, and a dressing applied over all. To complete the disinfection 
it is well for some time to moisten the dressing two or three times daily 
with sublimate solution. 

Immediately the dressing becomes wet through with wound secretion 
or blood it should be changed, under antiseptic precautions. Thus treated 
the injury may unite by primary intention, even when tendons ard 
tendon sheaths, or even bones, are damaged, as shown both by Frick’s re- 
ported cases and my own. Similar precautions are required in all injuries 
complicated with much loss of skin, or where large flaps are threatened 


500 WOUNDS OF THE METACARPUS. 


with necrosis. Cicatrisation is difficult in such wounds, for in consequence 
of its firm structure and fixed position the skin cannot stretch ; and even 
when the defect is filled up, the epidermis is wanting. Exuberant 
granulations, liable to result after operation or extensive necrosis of 
skin, must be kept back by the early use of astringents (iodoform 
conjoined with tannin or sugar), by applying a well-fitting pressure 
dressing, or they may be destroyed by suitable caustics. In all cases 
the skin must, as far as possible, be preserved, further necrosis prevented 
by antiseptic dressing, and the fact borne in mind that wounds which 
fail to heal by first intention always produce well-marked cicatrices. 

In horses, the tendons and tendon sheaths in the metacarpal and 
metatarsal regions are often injured, either by the horse lashing out, or 
by falling on sharp objects like broken bottles, scrap iron, sickles, or 
secythes. The flexor tendons are oftenest injured, the extensor pedis less 
frequently, and wounds of the latter are seldom serious, and heal when 
treated on general principles. Injuries to the flexor tendons are, how- 
ever, very dangerous. 

There is no difficulty in diagnosis, though it is not always easy to 
discover the exact extent of the wound. As a rule, blood-vessels are 
divided, and bleeding may prove dangerous, though it is generally checked 
by the attendant applying cloths. The degree of lameness varies. 
When the flexor pedis perforatus, which is most exposed, is alone 
divided, it may only be slight; and weight may be placed on the limb, 
though the toe is directed somewhat upwards, and no longer touches the 
ground. Jivision of the flexor pedis perforans also results in excessive 
dorsal flexion of the coronet-joint on every attempt to stand on the limb. 
When the flexor tendons and suspensory ligament are cut through, all 
the lower joints are in this condition, and distortion is often so marked 
that the fetlock may come in contact with the ground. 

After cessation of bleeding, the divided ends of the tendons may be 
seen in the wound, and the extent of injury be determined by palpation, 
or by probing with the finger. The position of the wound generally 
indicates whether the sheaths of tendons have also been injured. 

Course.—Healing chiefly depends on keeping the parts aseptic. 
When this is possible, wounds heal in two to three weeks, though if 
pus formation occurs they may take four to six weeks, or even months. 
Injuries confined to the flexor pedis perforatus naturally heal more 
readily than those affecting the flexor perforatus. Wounds involving 
the sheaths of flexor tendons are exceedingly dangerous, purulent or 
septic tendovaginitis being liable to set in, especially in horses, and, 
therefore, wounds close above the fetlock or in the pastern region are 
more dangerous than those in the middle of the metatarsus, where such 
sheaths are absent. In the ox the conditions are similar to those in 


WOUNDS OF THE METACARPUS. 501 


horses, though healing sometimes occurs without any particular pre- 
cautions. Gerlach saw complete division of the flexor pedis perforans 
and perforatus in the cow, followed by cicatrisation in four weeks. For 
some time there was very marked dorsal flexion, but this disappeared 
in three months. In small animals injuries of this class generally do 
better, because the limb can be better protected. 

Treatment.—Recent wounds require the strictest antisepsis. In 
many cases, unfortunately, they are already infected by the bandages 
applied to check bleeding, but can generally be efficiently disinfected, 
even twelve to twenty-four hours after injury. Bleeding must be 
checked by ligaturing vessels with sterilised material. The limb must 
then be carefully washed with soap and water, the wound and its surround- 
ings rinsed with sublimate or carbolic solution, all foreign bodies removed, 
and the wound washed out with a powerful stream of antiseptic fluid. 
If asepsis seems possible, the wound, and even the ends of the tendon, 
should be sutured, and a dressing moistened with antiseptics applied, and 
repeatedly wetted during the first day or two with sublimate solution. 
Provided it is not sodden with blood or wound discharge, the dressing 
is left in position until the animal begins to place weight on the limb, 
or the wound is healed, otherwise it must be renewed, under antiseptic 
precautions. 

Failing asepsis, the separation of necrotic portions of tendon must be 
assisted, and excessive proliferation of tissue around the wound checked. 
Portions already partially separated can be removed with the scissors 
and knife. Over-prominent growths may be checked by astringents, 
such as sugar or tannin mixed with equal quantities of iodoform, 
or by alum or sulphate of zine in powder; a well-fitting pressure 
dressing serves the same purpose. Sometimes new growths may require 
removal with the knife or curette. All such surgical wounds require 
to be kept very clean to prevent infection. During recovery the 
patient must be rested. 

Where tendon sheaths are also injured, double attention must be 
given to antiseptic precautions. The case reported by Frick, and others 
in my Own experience, show that even in severe injuries of tendons and 
tendon sheaths careful antisepsis may secure healing. 

Bruising of the metacarpus, due to kicks, &c., often causes formation 
of hemorrhagic or lymph extravasations of the size of a walnut or hen’s 
egg. If soon opened troublesome bleeding may result; on the other 
hand, absorption takes a long time, particularly in injuries about the 
head of the inner small metacarpal, accompanied by extravasation into 
the subeutaneous bursa lying here. Lameness is rare, and animals can 
be worked whilst reduction of swelling is encouraged by continuous 
compression and daily massage. In valuable horses, if operation be 


502 RUPTURE OF THE FLEXOR TENDONS AND SUSPENSORY LIGAMENT. 


attempted, strict antisepsis must be observed, for pus formation may be 
followed by subfascial cellulitis and troublesome consequences. Extrava- 
sations of lymph sometimes excite fistula formation, and therefore should 
not be incised too early. 


II—RUPTURE OF THE FLEXOR TENDONS AND 
SUSPENSORY LIGAMENT. 


Lit.: Schellhase, Gurlt u. Hertwig, 29, p. 241. Johne, Jahresber. 1882, 
p. 88. Smith, The vet. journ. 1881. Kay, Amer. vet. rew. 1884. 
Schram], Oesterr. Mitth. 1888. Saint-Cyr, Her. Rep. 15. Siedam- 
grotzky, Dresd. Ber. 1876, p. 44 u. p. 246; Berl. Arch. 1891, H. 3. 
Maillet, Rec. de méd. vét. 1836, p. 402. Rodet, ibid., 1826, p. 97, 
Gramlich. Zeitschr. f. Veter. 1890, p. 323. Comény, Rec. de méd. 
veter. 1892, p. 96. 


Rupture of the flexor tendons is produced by external violence, 
especially by violent over-extension when weight is thrown on the 
fore-limb ; it is therefore almost entirely confined to solipeds, the great 
strains necessary for its production only occurring during movements 
like jumping or galloping. In ruminants a ligament, extending from 
the knee to the claws, first described by F. Miiller, assists in preventing 
such accidents. Rupture is favoured by changes in the nutrition of 
the tendons, and after infectious diseases, or even after long rest, often 
results from slight exertion. 

Schellhase, and also Comény, saw simultaneous rupture of the lower 
suspensory ligaments of both fore-limbs in horses which had been rested 
for a long time. Johne also observed rupture of this ligament in a foal 
which had been in hospital, and suggested its being due to change in the 
bones, the rupture being accompanied by tearing away of portions of bone. 
In a case of St Cyr’s the upper sesamoidal ligament was ruptured near 
its bifurcation in a horse which had fallen. Smith describes a case 
in the horse where, in consequence of the animal jumping, all three 
flexor tendons of one fore-limb were suddenly ruptured, the metacarpus 
penetrating 4 inches into the earth. 

Kay noted in a horse rupture of the three flexor tendons in three 
separate limbs. The flexor pedis perforans was torn away from the os 
pedis and the flexor perforatus from the sesamoid bones, while portions 
of the bone were also loosened. The horse had previously been lame, 
and for some time incapable of work. In the year 1890 a horse was 
sent to my clinique suffering from recent and sudden lameness; the 
animal could scarcely stand even for a few moments. When forced to 
do so, the hind-feet were placed far forwards and the fore-feet disposed 


RUPTURE OF THE FLEXOR TENDONS AND SUSPENSORY LIGAMENT. 503 


as in laminitis. Post-mortem showed rupture of the flexor pedis per- 
forans in all four feet at and above its point of insertion into the os 
pedis. No exact explanation of the cause could be discovered further 
than that the horse had previously been confined to the stable for some 
days on account of lameness in one limb. A similar case was seen last 
year ; in another I found in both hind-limbs the flexor pedis torn away 
from the os pedis, and, in the same horse, fracture of the sesamoid 
bones in both front-limbs. In these cases, also, the animals had 
previously been unworkable. Maillet, in a horse, saw both the flexor 
pedis perforans and perforatus ruptured. Some old-standing disease, 
such as partial rupture of the tendons, had probably been in existence. 
Rodet noted a similar accident, affecting both fore-tmbs, which had 
occurred during galloping. Schraml describes tearing away of the flexor 
pedis perforans from its imsertion into the os pedis, portions of which 
remained adherent to the tendon; the navicular bone was broken into 
many fragments, which Schraml ascribes to the excessive weight thrown 
on it after rupture of the tendon. 

I have repeatedly seen similar cases. The flexor perforatus is almost 
always torn away from its lower attachment, whilst portions of the bone 
are loosened. In van-horses I have seen rupture of the flexor perforatus, 
even in the hind-lmbs. In front, this rupture is commonest in race- 
and steeplechase-horses, and is generally caused by jumping obstacles. 
Usually the flexor pedis perforans is affected, though the flexor perforatus 
may also be ruptured. Fig. 110 is drawn from a case of rupture of the 
flexor perforatus in a race-horse which fell lame on the race-course and 
had been unsuccessfully treated for a long time. 

Rupture of the flexor tendons also follows disease of their surface at the 
point where they respectively pass over the sesamoids or navicular bone, a 
change which commonly accompanies chronic navicular disease and sup- 
puration in the fibro-fatty frog, terminating in necrosis of the flexor pedis 
perforans. I have repeatedly seen rupture of the flexor perforans and 
perforatus follow purulent inflammation of their tendon sheaths and of 
the gliding surface of the sesamoid bones. In such cases rupture is due 
to inflammation in the sheaths of the tendons; it is favoured by neur- 
ectomy. Fig. 109 shows an almost complete rupture of the flexor pedis 
‘ perforans behind the fetlock, consequent on purulent disease of its 
sheath. During navicular disease the gliding surface of the navicular 
bone becomes rough and produces erosion of the perforans tendon ; the 
peculiar cases following neurotomy result from violent over-extension of 
the tendon. 

I have frequently seen the perforans and perforatus tendons in hind- 
limbs totally ruptured on account of advanced necrosis. Purulent or 
septic cellulitis extending to the flexor tendon sheaths sets up purulent 


504 RUPTURE OF THE FLEXOR TENDONS AND SUSPENSORY LIGAMENT. 


tendovaginitis, which leads to necrosis of the tendon. The animal then 
stands continuously on the other foot, this sometimes causing descent of 
the pedal bone. Pain then increases to such a degree that weight is 
placed on the first affected limb in spite of the disease of the tendon. 
This apparent improvement is, however, suddenly cut short by rupture 
of the tendon, The change in the position of the hind-limbs is generally 
noticed in the morning. 

I have often examined ruptured tendons and detected necrosis as 


Fie, 109.—Rupture of the Flexor pedis perforans behind the fetlock in consequence 
of suppuration in the tendon sheath. 


typified by the dull yellow colour of the structures, and (in cases where 
separation of the dead parts had already set in) by the red granulations 
bordering the normal tendon tissue. 

Gramlich describes a horse which, during the course of thoracic 
influenza (Brustseuche), suffered from inflammation of the tendons of all 
four limbs. In one front-leg the perforans and perforatus tendons were 
both ruptured, and on post-mortem examination were found partly 
necrotic. 


RUPTURE OF THE FLEXOR TENDONS AND SUSPENSORY LIGAMENT. 505 


Rupture of fasciculi occurred in almost all cases of inflammation of 
the flexor tendons produced by severe strains (comp. p. 212, Gen. Sur.). 

Symptoms.—Rupture is at once followed by lameness. Either no 
weight can be borne by the limb, or if weight is placed on it fora 
moment the affected joint is abnormally flexed; the symptom, however, 
is less marked in rupture of the perforatus tendon. In consequence of 
the dorsal flexion of the coronet-joint, the toe of the foot is directed 
upwards. Rupture of the superior sesamoidal ligament produces 
abnormal dorsal extension of the fetlock (fig. 110), but the toe retains 
its normal position. The same is true of ruptures of the inferior 
sesamoidal ligament. In rupture 
of the flexor perforans, all three 
phalangeal joints show abnormal 
dorsal flexion, the hoof sometimes 
only touching the ground at the 
heels. 

Course.—Ruptures of the flexor 
tendons unite regularly and com- 
pletely, provided— 

(1) The ends of the tendons are 
not too far apart, and 

(2) Rupture has occurred out- = 
side the tendon sheath. Ruptures SSS SSS 
within the tendon sheath unite Fie. 110.—Rupture of the superior sesamoidal 
exceedingly slowly, and only incom- +2" StsPensory ligament—-(from a photograph). 
pletely, because here the paratendineum (connective tissue surrounding 
the tendon), which mainly contributes to union, is wanting (comp. 
ten. Surg., p. 210). The extent to which the ends of the tendons are 
displaced may be estimated from the change in position of the fetlock. 
Under favourable circumstances, rupture of the flexor perforans or 
perforatus unites in six weeks, though two to three months may elapse 
before the animal is fit for use. A race-horse which had suffered 
rupture of the flexor perforatus in one fore-limb was no better after 
six weeks. It was killed, and I found on post-mortem that though 
union had begun, yet there was no visible callus formation between the 
displaced fragments of the sesamoid bone. 

Ruptures of one or other insertion of the flexor perforatus unite in 
from six to eight weeks, usually without leaving any lameness. The 
condition becomes grave when the rupture occurs over the sesamoid 
bones. Where rupture of the tendons is accompanied by other 
diseased processes like podotrochilitis acuta vel chronica or necrosis, 
the prognosis is quite hopeless. 

Treatment is confined to bringing the divided parts as near together 


506 INFLAMMATION OF THE FLEXOR TENDONS. 


as possible and fixing them, for which purpose plaster bandages are 
useful. If the animal be quiet, an iron splint fixed to the heel of a bar 
shoe, and of a curve corresponding to the normal position of the foot, 
is useful in rupture of the flexor perforatus. After covering the foot 
with a pad to equalise pressure, the splint is padded and fixed in 
position by means of circular bandages. Slinging is generally necessary 
when using this apparatus. 


IV.—INFLAMMATION OF THE FLEXOR TENDONS 
(TENDINITIS). 


Lit.: Siedamgrotzky, Dresd. Ber, 1876, p. 44, u. Berl. Archaea 
Marheineke, Gurlt u. Hertwig. 7, p. 239. Zschokke, Schweizer 
Arch. 1887, p. 173. Roloff, Gurlt u. Hertwig. 34, p. 271. Tschu- 
lowski, Jahresb. 1884, p.70. Ferguson, The vet. 1838. Fogliata, 
Jahresb. 1884, p. 123. Didot, Her. Rep. 18, p. 219. Schrader, 
Buschs Zeitschr. 2, part 4, p. 111. Gourdon, Jahresb. 1857, p. 61. 
Defay, Annal. de méd. vét. Bruxelles, 1860. Viering, Virchow’s 
Arch: 125, p. 252; Potting, B. To W.-13892. Hotimann, Herken: 
1893, p. 6. 


Inflammation of the flexor tendons is very frequent in the horse, and 
generally occurs in the fore-limbs, on account of their being much more 
exposed to the violent strains which form the general cause of the 
disease. Siedamgrotzky gave a thorough description of rupture of the 
flexor pedis perforans tendon with secondary disease of the tendon 
sheath, and has lately published a most careful article on the 
subject. 

Causes.—Horses with weak flexor tendons, heavy bodies and 
powerful muscles, are most predisposed to tendinitis. The structure 
of the tendon, and consequently its powers of resisting strain, is of the 
greatest importance; its absolute thickness bears no direct proportion 
to its strength. On the contrary, tendons of considerable size and sur- 
rounded by abundant paratendineum suffer more frequently than the 
more sharply defined, and those which are firm to the touch. The 
latter peculiarity shows that the tendons are well provided with firm 
fascicular tissue, whilst in the first case they consist more of connective 
tissue. As already described on page 502, continued rest seems to 
lower the resistance against strains. Rupture and inflammation follow- 
ing severe diseases is, in part at least, to be referred to this fact. 
Further, all conditions which increase the load on the limb and the 
strain on the flexor tendons favour tendinitis. 

Long, weak, and slender fetlocks are especially lable to it. The 


CAUSES OF INFLAMMATION OF THE FLEXOR TENDONS. 507 


strain on the tendons is increased by increased length and obliquity 
of the fetlocks. The more slender the fetlock-joint appears when 
seen from the animal’s side, the greater the mechanical disadvantage at 
which the tendons are placed. For a similar reason, horses with “tied 
in” knees are disposed to tendinitis, this formation being generally 
accompanied with small size of the fetlock. Further, everything which 
favours dorsal flexion of the joint increases risk of inflammation of the 
flexor tendons. Low heels and long toes are therefore apt to cause it. 
Long toes throw a powerful strain on the flexor tendons during the 
latter phase of movement, just before the limb is lifted from the 
ground. The kind of work required of the horse is also important. 
Thus race-horses and hunters, and horses required to trot at a sharp 
pace for long periods, are the most general sufferers. Animals with con- 
siderable powers of endurance suffer most. The greater the muscular 
development of the hind-quarters, the greater the shocks produced in 
the fore-limbs by the violence with which the weight of the body is 
thrown forward on to them. Spirited animals suffer more than phleg- 
matic. For similar reasons, cart-horses show strain more frequently 
in the hind-lhmbs. 

Such strains of flexor tendons are produced either by the body-weight 
falling on the front-limbs when the horse is jumped or suddenly pulled 
up (passive strains), or by continued violent action of the flexor muscles 
(active strains). In the first instance, the flexor perforatus is principally 
involved, its less length causing it to suffer first from forced dorsal 
flexion of the phalanx. The flexor perforans is less likely to be injured. 
The effective length must be reckoned as the distance between the 
lower insertion and the upper one, and in the perforans and perforatus 
tendons from the upper insertion of their so-called check ligaments. 

Inflammation of tendons produced by excessive muscular action 
(active sprains) have, with few exceptions, their seat in the flexor per- 
forans, because the muscular head of this tendon is by far the stronger, 
and its tendon is therefore exposed to the greater strain. But 
passive strains also occur, as shown by the frequence with which the 
check ligament, which extends to the lower portions of the tendon, 
becomes diseased. In the hind-lmbs the portions of the flexor pedis 
perforans tendon which suffer oftenest are those lying just above 
the fetlock or below the hock. Bruises are rare causes of inflammation 
of tendons, though seen in the flexor perforatus, its surface situation 
more readily allowing of injury from kicks, &e. This kind of injury is 
questioned by Siedamgrotzky, but I have repeatedly seen it in riding- 
horses, particularly in race-horses. Inflammation sometimes extends 
from the tendon sheaths or articular surfaces to the flexor tendons ; and 
the form associated with infectious diseases, and occurring during con- 


508 INFLAMMATION OF THE FLEXOR TENDONS. 


valescence from thoracic influenza, always starts in the tendon sheath. 
Schrader, who has carefully described this disease, found that the first 
sign of inflammation is a peculiar semi-soft (weichharte) swelling just 
above the fetlock, which extends thence to the perforans and perforatus 
tendons. One-sixth of all his cases convalescent from thoracic influenza 
showed it, but the disease disappeared again in twelve to twenty- 
four hours; I have often seen a similar appearance, and look on such 
cases as due to secretory metastasis. In convalescents the inflammation 
sometimes originates in the perforans tendon, particularly when animals 
are worked too early, The interference with general nutrition produced 
during the disease 1s probably the predisposing cause. 

The greater number of cases described as inflammation of the tendons 
are, doubtless, really due to reparative processes consequent on partial 
rupture, as shown by their course and termination. The persistence of 
thickening points to extensive damage, and is therefore unfavourable. 
This extra deposit is necessary for recovery, but tendons thus thickened 
never attain their primary strength. 

Symptoms,—Inflammation of the flexor tendons is accompanied by 
the following symptoms :— 

(1) Lameness, which varies according to the position and extent of 
injury. The form seen after influenza is usually the most painful, that 
following mechanical injury of the perforans less so. In tendinitis of 
the flexor perforatus lameness is slight. When only one division of the 
tendon is affected, lameness may be absent. 

Lameness is only shown when weight is placed on the limb. Attempts 
are made to shorten that phase of movement during which the phalanx 
is in a position of volar flexion, 7¢., is upright and under the body. 
Neither passive extension nor rotation appear painful, a fact which dis- 
tinguishes the disease in question from disease of the joint. The 
symptoms are then, supporting leg lameness; shortening of the period 
when the limb is upright, volar flexion of the phalanx, and absence 
of pain when the limb is rotated. Sometimes animals try to place 
weight on the diseased limb by setting the heels on an eminence, 
eg. on a stone, and, by thus bringing the fetlock into an upright 
position, minimise the tension on the tendons. This is well seen in 
the hind-limbs during disease of the flexor perforans. When lameness 
is severe, the animal never stands so completely on the foot, even when 
at rest, as it occasionally does in disease of the joint. 

(2) Local examination detects pain, swelling, and increased warmth, 
which, however, is only seen early in the disease, and even then indis- 
tinetly. It is difficult to distinguish pain in the reinforcing band of. 
the flexor perforatus, though it also occasionally suffers. In applying 
pressure to the tendons, it is important not to be deceived by mere 


INFLAMMATION OF THE FLEXOR TENDONS. 509 


general sensitiveness (compare with my work on Diagnosis of Surgical 
Diseases, p. 1238). 

The swelling varies in degree and extent, being scarcely ever visible 
in the flexor perforatus or reinforcing band, even in “clean” legs, and 
in other cases being only detected by palpation. At first it is soft and 
diffuse, later it becomes harder and sometimes sharply defined. In 
examining for pain and swelling, the foot is lifted ; the reinforcing bands 
can only be properly examined in this position. 

(5) The symptoms enumerated are afterwards followed by shortening 
of the diseased tendon, continuous volar flexion and upright position of 
the hoof. This is differentiated from the volar flexion produced by 
placing weight on the leg, by the fact that it continues even when the 
animal stands fairly on the limb; the point is at once settled by lifting 
the other foot. Whilst contraction of the flexor perforans produces 
volar flexion in all the lower joints, contraction in the flexor perforatus 
and suspensory ligament only affects the obliquity of the pastern; the 
hoof remains in its normal position. 

In race-horses a large number of fasciculi of the flexor perforans may 
be ruptured, producing abnormal dorsal flexion of the phalanges and 
so-called “ break-down.” This is oftenest seen when both limbs suffer, 
or when the animal is forced to stand continuously on the diseased 
limb. 

Similar stretching of the flexor tendons is sometimes seen after 
neurectomy performed whilst the tendons are inflamed. The ordinary 
weight of the body may then cause stretching of the tendon, or of the 
cicatricial tissue newly formed in it. I have seen this after neurectomy 
of the tibial nerve while the tendons were inflamed. 

Course.—The disease always occurs suddenly, and the anatomical 
structure of the tendons explains its subsequent chronic course. After 
strain or rupture, isolated hemorrhages and hyperemia of the tendon set 
in, and are followed by serous infiltration into the interfascicular 
connective tissue and paratendineum. The fasciculi of the tendon are 
thus thrust asunder, and predisposed to further rupture (Siedamerotzky). 
At the seat of serous infiltration more leucocytes afterwards appear 
(plastic infiltration), causing the swelling, which is at first soft, to assume 
a harder character. On section the parts display greyish white, some- 
times greyish red, masses of connective tissue. In consequence of 
extravasation of leucocytes into the cells of the firm connective tissue 
thickening results, which may lead to shortening of the tendon, as the 
newly-formed tissue contracts, whilst the paratendinitis leads to adhesion 
with neighbouring tissues. The tendon gradually becomes permeated 
with blood-vessels ; ossification has sometimes been seen and _ parasites 
met with in inflamed tendons (comp. with p. 212 of my General Surgery). 


510 INFLAMMATION OF THE FLEXOR TENDONS. 


Zschokke describes a case in the horse, in which the sesamoid hgaments 
were ossified. Roloff found the flexor perforatus changed into cartilage. 
According to Tschulowski, these thickenings often contained filaria 
cincinata, which Bassi has also discovered in the subcutis of horses. 
Probably the case described by Ferguson was of this nature. 

“ Knuckling over” may either be brought about by shortening of 
tendons, in consequence of cicatricial contraction, or of contraction of 
muscles. In the first case, only the lower joints take up the position of 
volar flexion ; when muscles are involved, the knee-joint is also bowed 


Fig. 111.—Excessive ‘‘ knuckling over” (Stelzfussbildung) in a horse—(from a photograph). 


over. All cicatricial tissue, whether in tendons or elsewhere, is 
inclined to shrink, but the excessive development of this tendency is 
only seen when the limb is rested and entirely relieved of weight. 
Fie. 111, which is from a photograph, shows to what extent shrinkage 
may occur. Provided weight is placed on the limb, even occasionally, 
it never becomes so excessive. After contraction the fibres of the 
tendons no longer run in a straight direction, but take a tortuous 
course (Siedamgrotzky). 

On account of the peculiar character of the pathological processes, 
tendinitis varies greatly in course and results. Complete reabsorption 


SEQUEL AND TREATMENT OF INFLAMMATION OF THE FLEXOR TENDONS. 511 


of inflammatory products occurs in eight to fourteen days when the 
case is favourable, and when rest and early careful treatment are 
adopted, but im most instances some thickening remains. Though 
lameness usually disappears in three to four weeks, the newly formed 
tissue has not the strength of normal tendon, and a point of less 
resistance results, which explains the frequent relapses. Continuous 
severe pain points to serious local change, and often causes “ knuckling 
over”; the prognosis therefore depends chiefly on the degree of pain. 
The results of strains of the flexor tendons depend very largely on the 
region involved ; the most serious being those which affect the suspensory 
ligament and the reinforcing bands, in which complete resolution is rare. 
Next comes the flexor perforans. Inflammation of the flexor perforatus 
is less troublesome. The animal’s usefulness is not impaired, even 
though considerable thickening remains. Needless to say, the older the 
condition the less the chance of recovery; when lameness is of old 
standing the outlook is bad. The condition is still graver when both 
limbs are affected. In hacks, prognosis is less favourable than in light 
van-horses. When the joints are much shot-over, tenotomy is some- 
times successful, but this depends on whether the flexor tendons are 
adherent to one another or to their lower sheaths. Adhesion of the 
flexor perforans, with the perforatus, is always troublesome, though cure is 
not entirely out of the question. Tendinitis occurring during infectious 
diseases is more obstinate than inflammation mechanically produced in 
otherwise sound animals. Great pain and resistance to treatment point 
to an infectious origin, though such swellings occasionally disappear 
after twelve to twenty-four hours, when the sheath of the tendon is only 
shghtly involved. I saw a case in the horse where the affection 
changed its seat several times in a few days: leaving the hind, it 
attacked the front limbs, and vice-versa. 

Treatment.—The most important point is to stop work; where 
possible, absolute rest should be given, and the shoe removed. Fresh 
cases, due to mechanical injury, are treated during the first twenty-four 
to forty-eight hours by cold applications, the best form being immer- 
sion or irrigation, but after this time little good results from the em- 
ployment of cold. I then prefer moist warmth; supplemented by proper 
bandaging, applied as follows:—After carefully cleansing the foot, two 
longish rolls of tow rather thicker than a man’s thumb are moistened 
and laid lengthwise on either side of the diseased tendon, close to the 
metacarpus, and fixed there by a linen or cotton bandage, wetted and 
applied pretty tightly. Over this a dry woollen bandage is placed, so as 
to exercise regular pressure on the material below and on the diseased 
spot; when available, a piece of rubber tissue or waxed linen may be 
placed between the two bandages. This dressing is changed every four 


512 INFLAMMATION OF THE FLEXOR TENDONS. 


hours; the moist warmth and regular pressure favour reparative changes ; 
excessive extravasation and cellular proliferation are checked, and re- 
sorption assisted. The rolls of tow must exercise even pressure on the 
diseased tendon. 

When pain disappears massage may be resorted to during the interval 
of changing the dressing, the injured tendon being rubbed from below 
upwards with the thumb and fore-finger, using moderate pressure, for 
about five minutes at a time, the parts being meanwhile covered with a 
piece of paper. The operation must not be persevered with if pain or 
swelling follow. 

When early and carefully used, massage cures and removes the 
swelling in cases where, with the antiphlogistic methods formerly . 
employed, thickening almost always remained. The slight vascularity 
of tendons in no way supports the theory of the action of cold; on the 
other hand, moist warmth and methodical compression assist absorption, 
and are certainly not so likely to impede repair as cold. My experience 
shows this treatment to be by far the best. 

Infriction with ointments or fluids act like massage, though the 
specific resolvent effect ascribed to preparations of mercury and iodine 
causes them to be most widely used. I use a mixture of unguentum 
hydrargyri and sapo viridis in equal quantities, with double the amount 
of lanoline where massage seems called for. Warm baths of soap or 
weak potash solution considerably assist absorption. 

The action of blisters is largely due to the mechanical effect of 
infriction and the pressure of the cutaneous thickening on the inflamed 
spot; and when the above-described treatment proves impracticable, it 
is good practice to apply a blister, or better still, a blistering plaster. 
Potting assists the action of the blister by a pressure dressing. About 
the third day, when exudation has ceased, he applies moist wadding 
to either side of the diseased tendon, and passes a woollen bandage over 
all. The first dressing remains on for two days, and is then renewed 
and left in place for three to five days. 

Old thickenings are best treated by firing. In this case the chiet 
effect is produced by the mechanical action of the inflammatory swelling 
and cicatricial shrinkage in the cutis. The lines, running obliquely 
from the front downwards and backwards, should not be wider apart 
than half an inch, nor should they meet at the back of the perforatus 
tendon. After the scab has fallen, the above-described pressure dressing 
can be again applied. 

If, in old thickening of the tendons, firing is out of the question, a 
compress dressing is useful, especially in small swellings, and where the 
animal cannot be rested, but precautions must be taken against dirt or 
sand getting under it and causing chafing. 


TENOTOMY. bs 


The animals must be kept from heavy work for some time, but can be 
put to exercise as soon as lameness is quite gone. During this stage 
riding-horses must be kept from jumping and continued rapid trotting, 
nor should they ever be suddenly pulled up. 

In shoeing horses with disease of the perforans or perforatus, the 
heels should be spared, the toe shortened as much as_ possible, and 
shoes with calkins or thick heels used. For many years it has been 
disputed whether raising the heels by calkins exercises any influence 
on the angle of the phalanges towards the ground; in my opinion 
this is certainly the case, for the pedal and coronet joints at least, and 
for the former to a greater extent than for the latter. The position 
of the fetlock-joint and the fetlock angle are, however, scarcely affected 
by the dorsal flexion so produced in the pedal and coronet joints; 
raising the heels, therefore, has no effect on the suspensory ligament, 
but that it is useful in inflammation of the tendons I have often con- 
vinced myself. 

Tenotomy is the only method of treating contraction of the tendons, 
but is only useful if no joint be involved, and if the contracted tendon 
be not adherent to its sheath at some point below the seat of operation, 
because, in order to allow the fetlock to resume its normal position, the 
lower end of the divided tendon must retract. Where the knee is 
simultaneously bent, the upper portion of the tendon must also be able 
to retract to allow the knee to straighten, but the operation is then 
seldom of use, because the bent position is due to shortening in the 
flexor muscles of the knee and metacarpus. Before operating, lameness 
must be allowed to subside,. one of the conditions of success being that 
the limb shall afterwards carry some weight, without which the tendon 
further contracts. 

Tenotomy aims at lengthening the contracted tendon. It may be 
performed in various ways, though the subcutaneous is the only really 
successful method. Some operate from the outer side, and direct the 
incision either towards the suspensory ligament or towards the skin. I 
prefer to operate from the inside, because of the absolute guarantee this 
gives against injury of the metacarpal artery. The operation is, however, 
only valuable in young and high-priced horses, because recovery and 
restoration to work require at least six to eight weeks. 

At the imner side of the leg, about the middle of the metacarpus, 
the hair is shaved, and the entire metacarpus washed with soap and 
water and rinsed with sublimate solution. A ring of sublimate wood- 
wool is then laid round the point of operation, fixed by a bandage, and 
moistened three times a day with sublimate solution. In this way in 
twelve to twenty-four hours the metacarpus is rendered completely 
aseptic, so that aseptic healing may be reckoned on with certainty 

2K 


514 INFLAMMATION OF THE FLEXOR TENDONS. 


provided the other rules of asepsis are carried out. Hands and instru- 
ments must be disinfected, and sterilised dressings employed. 

The horse is cast on the affected side, the foot to be operated on 
fastened to the cannon bone of the upper hind-leg, and the dressing 
removed. If a stout rod is handy it may be used like a side-stick to 
keep the limb extended. An incision is made throagh the skin with a 
pointed bistoury midway between the knee and fetlock, just above the 
flexor pedis perforans, and is afterwards prolonged into it. If the 
tendon is thickened or adherent at this point to the flexor perforatus, 
the operation is renewed somewhat lower, though the lower tendon 
sheath must not be opened. A blunt tenotome is inserted, with its 
surface lying close to the tendon of the flexor pedis perforans, and 
pushed between this and the suspensory ligament until it can be felt at 
the other side. Its cutting edge is then turned against the flexor per- 
forans, the phalanx extended by a rope, and the tendon divided by 
slowly lowering the hand in the direction of the cannon bone. Should 
the ends of the tendon not contract after complete section, adhesions 
with the perforatus tendon probably exist, and must then be divided in 
a similar way. 

By introducing the tenotome close to the perforans tendon the danger 
of injuring the large metacarpal artery is avoided. Sometimes small 
cutaneous and subcutaneous veins are divided, causing a little bieeding, 
but this is of no consequence. The surface of the wound is then 
washed with sublimate solution, a tampon of jute applied to the little 
incision, the limb surrounded with sublimate wood-wool or similar 
material, a circular bandage applied, and the horse allowed to rise. If 
the operation is to prove successful, the fetlock-joint ought now to 
appear moderately extended. 

Provided the dressing is not wet through by discharge, it may be left 
in position for a week, when the skin wound will be found completely 
closed. The dressing may also be saturated with sublimate solution and 
changed the next day, and, of course, must be changed should it become 
wet through with blood. After removing it the leg should be rinsed 
with sublimate, carbolic or ereolin solution, any blood-clots washed 
away, and a fresh dressing applied. 

With these precautions antisepsis is maintained without difficulty, even 
if the metacarpal artery has been cut through. In the event of such an 
accident, the dressing must be very tightly applied, moistened with 
sublimate, and changed in twenty-four to forty-eight hours, with proper 
precautions. 

As a rule, healing goes on much better where only the flexor perforans 
is divided. The animal’s usefulness is sooner restored, and, in conse- 
quence of weight being placed on the limb at an earlier period, excessive 


TENOTOMY. 515 


contraction of the cicatricial tissue is less to be feared. Where the 
flexor perforatus is also divided excessive dorsal flexion may occur, or 
the animal prove unable to stand on the limb, and fresh contraction 
take place. For this reason tenotomy often fails; but I cannot agree 
with Fogliata, who first divides the perforatus tendon, and when this is 
not sufficient, cuts through the perforans. If the horse, when quietly 
standing, places sufficient weight on the leg, it may be placed in a stall, 
better still in a box: otherwise, on the second day after operation, it 
should be slowly walked for a quarter to half an hour, when possible on 
soft ground. This is almost indispensable to prevent cicatricial con- 
traction, and ensure restoration of the normal fetlock position. The 
frequent relapses noted by Gourdon, Didot, Delwart, and Gerlach are 
due to their having neglected this precaution. For a similar reason, 
operation must be delayed until pain has almost disappeared, otherwise 
the requisite weight cannot be put on the limb. Viering and Busse’s 
experiments show that mechanieal extension of the cicatricial tissue is 
necessary to produce the characteristic spindle-formed cellular elements, 
i.é., to give newly-formed tissue the character of tendon substance 
(compare p. 209 of my General Surgery). 

It almost goes without saying, that, either before or soon after opera- 
tion, the foot must be restored to its proper form by judicious paring. 
As a rule, animals can be returned to work in six weeks; sometimes, 
however, pain continues for some time, preventing them being put to 
rapid work for a longer interval. When it persists, the lameness may 
generally be removed (in animals which cannot be kept idle) by dividing 
the median nerve. I have repeatedly performed neurotomy and tenot- 
omy simultaneously in horses belonging to a large owner in this city, 
who loads his horses heavily, and works them hard; and where lameness 
was still marked, I have treated both contracted tendons and shot-over 
fetlocks, due to contraction of the suspensory ligament, at the same time, 
and have rendered horses workable again even in four to five weeks. 
Neurectomy of the median nerve is first performed, and then tenotomy. 
As the first operation wound rarely heals by first intention, it must, 
during the first few days, be frequently cleansed to prevent discharges 
running down and infecting the lower point of operation. The excessive 
dorsal flexion (fig. 112) following simultaneous section of the perforans 
and perforatus tendons, particularly in heavy horses, may be removed by 
wearing a long bar-shoe. If needful, an iron crutch, with fork-shaped 
arms reaching to a point just below the fetlock-joint, may be affixed to 
the heels, to afford the joint a surface on which to rest. The apparatus, 
constructed in 1859 by Defay, and termed an “ orthosom,” is of similar 
character. Sometimes the suspensory ligament is contracted, causing the 
fetlock to remain upright, even after complete division of the perforans 


516 INFLAMMATION OF THE FLEXOR TENDONS. 


and perforatus tendons, a condition which my experience tends to show 
is incurable. It occurs not only after strain and thickening of the sus- 
pensory ligament, but also after severe and old-standing “knuckling over.” 

Horses which are knuckled over, if worked slowly and on soft 
eround, may be made useful for a long time 
by applying a long-toed shoe, though this will 
not cure or even effect improvement in the 
original disease. Tendinitis occurring during 
infectious disease, especially during influenza, 
requires special attention, while, to prevent 
relapse, such animals should not be too soon 
put to work, or otherwise exerted; during the 
convalescent stage particular caution is called 
for, and the tendons may be bandaged with 
advantage. 

If, during the course of any of these diseases, 
inflammation of the tendons or tendon sheaths 
occurs, mild stimulation and bandaging constitute 
the best primary treatment. When pain is 
severe, lukewarm foot-baths of decoction of oak 
bark or infusion of hay seed often relieve it. In 
other cases, warm moist applications and moder- 
ate pressure on the diseased tendons may be 
resorted to. Sometimes the condition disappears 
with unexpected rapidity, but generally returns 

= in the same or some other spot, and may often 
Tic. 112.— Excessive dorsal . ; ¥ 

flexion after section of the Involve both limbs. The degree of swelling and 

perforans and perforatus Hain forms an index to the gravity of the condi- 


tendons — the knuckling 7) : i : ; : 
over at the fetlock isdue tion, which sometimes resists blistering, and even 


to contraction of the sus- : 3 

pensory ligament—(from firmg, and not infrequently proves incurable. 

a phoiopte Ph). In other cases, and especially where there is 
no marked anatomical change, recovery may occur after many 
mouths. 

Hoffmann’s japparatus, consisting of a long-toed shoe, with a rubber 
tube and leather bandage, appears of no particular advantage in cases 
of contraction, though it might be useful in the excessive volar or 
plantar flexion sometimes seen after rupture or section of the extensor 


pedis. 


CONTRACTED TENDONS IN FOALS. a 


V.—CONTRACTED TENDONS (“KNUCKLING OVER”) 
IN FOALS. 


Ger. Stelzfuss. 


Lit.: Franck, Geburtshilfe. Lafosse, Rec. de méd. vét. 1876. Johne, 
Dresd. Ber. 1883, p. 26. Ehrle, Adams Woch. 1889, Nr. 5. Trager, 
Gurlt u. Hertwig. 6, p. 448. Eichbaum, ibid. 9, p.144. Matz, ibid., 
10, p. 216. Brunet, Rec. de méd. vét. 1881. Foéringeru. Weiskopf, 
Adams Woch. 1888, Nr.8 u. 15. Eassie, The vet. jour., vol. 37, p. 138. 
Hofer, Deutsche Zeitschr. f. Thiermed. 1890, p. 298. Ostertag, 
Jahrb. 1888, p. 140. Moller, Diagnostik chirurgischer Krankheiten, 
p. 155. 


In English pure-bred stock, less frequently in other breeds, 
new-born foals are sometimes unable to move on account of excessive 
knuckling’ on the fore-limbs. The upright position of the fetlock 
prevents the flexors taking their proper part in sustaining weight. 
This peculiar deformity generally affects both front-legs, often causing 
the animals to walk with the front of the phalanx on the ground, 
and preventing their standing upright. It also develops, though 
rarely, during the first two years of life, and pever in such a 
serious form. 

The cause is at present unexplained. Franck considers it due to 
congenital contraction of the flexor tendons existing at the time of birth. 
Others ascribe it to abnormal position of the foetus in utero (Johne), 
whilst Lafosse thinks it arises from disproportion between the stallion 
and mare, the bony framework being excessively developed when the 
stallion is too large. As large animals are especially affected, and as, 
in general, only the phalanges suffer displacement, the cause must lie 
between the point of insertion of the flexor perforans and its reinforcing 
ligaments. There are two possibilities: either the tendons are too short 
or the metacarpus is too long. The first may be referred either to defec- 
tive development or subsequent shortening of the tendons. Whether, in 
such case, the development of the flexor tendons is interfered with by 
the position of the fcetus in utero (Johne), or whether contraction occurs 
(Franck), or whether the long axis of the metacarpus is excessively 
developed, so that the tendons are relatively too short, is for the time at 
least undecided. Perhaps the condition may be caused in more than 
one way. 

Abnormal position in utero would probably interfere with develop- 
ment of the jomts and muscular tissue. Increase of pressure on the 
posterior portions of the joints, caused by continued volar flexion, would 
check the growth of bone, while diminution in the anterior portions of 
the joints would favour its production, and thus tend to thrust the 


518 CONTRACTED TENDONS IN FOALS. 


phalangeal joints more and more into a position of volar flexion, favour 
the development of the disease, and cause it to assume a Certain 
resemblance to “pes equinus” in man. The rapidity with which the 
condition yields to proper treatment, however, seems to contradict this 
theory. Whether the cause is too little space in the uterus (too little 
liquor amnii), or too narrow a maternal pelvis, need not be considered 
here ; but the frequent occurrence of the disease in pure-bred animals 
appears very remarkable. 

Symptoms.—tThe most important symptom is the abnormal volar 
flexion in the fetlock-joint. No disease of the tendons or muscles can 
be detected, though they appear tensely stretched when the fetlock is 
upright. Where the condition is well developed, the limb is incapable 
of bearing weight. The new-born foal rears itself up, but cannot stand, 
and may die from local gangrene produced by lying (bed-sores), or is killed 
as a hopeless cripple. Sometimes the animals stand on the front of the 
fetlock-joint, and thus produce serious injuries. Where the appearance 
of the disease is delayed the animals can stand, but move with difficulty, 
and after some time show excessive uprightness of the hoof. The con- 
dition is distinguished from contraction produced by tendinitis by the 
absence of changes in the flexor tendons. 

Course and Prognosis.—In newly-born foals the abnormal position 
is usually seen on the first attempt to stand, but disappears under 
proper treatment in eight to fourteen days. Not infrequently these 
apparent cripples develop into very useful animals. Sometimes improve- 
ment occurs first in one limb, the other meanwhile retaining its 
abnormal position, as in Johne’s case. When appearing some time after 
birth, and during the first two years of life, the disease takes a less 
favourable course, and may, indeed, never entirely disappear. In other 
cases improvement follows proper treatment, though complete cure, «e., 
recovery of the normal position, is rare. 

Treatment.—The great extensibility of the tendons in new-born 
foals favours early and complete recovery. It is, therefore, important to 
practise forcible extension, and to such a degree that the tendons are 
stretched and the fetlock brought into an oblique position, For this 
purpose the foal is cast, the phalanges extended as far as possible and 
fixed in this position, either by using a plaster bandage or applying a 
strong leather splint. Khrle uses a plaster bandage or a glue bandage 
and splints. The parts are freely padded with wadding to distribute 
pressure. The degree of success is usually astonishing, especially when 
treatment is early resorted to. Weight can often be placed on the limb 
after a few days; the bandage should then be removed, because the 
weight of the body acting through the oblique position of the pastern 
will produce further extension of the tendons, and is quite sufticient to 


CONTRACTED TENDONS IN FOALS. 519 


prevent contraction. Friebel’s extension apparatus (fig. 114) appears 
very practical. It consists of a small leather shoe, provided in front 
with a well-padded iron splint. By means of a screw the splint can be 
so fixed as to exercise pressure on the anterior surface of the fetlock- 
joint and thrust the latter backwards, 1.c., into its normal position. 
I have seen similar arrangements in Hungarian studs. Trager is quite 


Fie. 118.—Double-sided knuckling (Stelzfussbildung) in a two-year-old colt—(from a photograph). 


wrong in saying that it was not worth inventing; on the contrary, it 
has proved exceedingly useful. 

Kassie saw knuckling over in all four limbs in a five-months-old foal. 
In front the disease was cured by tenotomy, behind by proper shoeing. 
Ostertag cured congenital contraction of the tendons in a foal in four 
weeks by applying a wooden splint and plaster bandages, which were 
changed several times. As the dressing accommodates itself to the 
gradually improving position of the fetlock, Ostertag considers it neces- 
sary to change it two or three times. 

Hofer had a gutter-shaped splint made from pine wood which 
reached to the fetlock; he states having seen recovery occur in one to 


520 CONTRACTED TENDONS IN FOALS. 


three weeks. Knuckling which sets in during the first two years of 
life, even when unaccompanied by inflammatory disease of the tendon, 
can seldom be so completely removed as to restore the animal’s working 
powers. Trager, however, states having cured cases by section of the 
perforans and perforatus tendons. 

Eichbaum suggested the use of a long-toed shoe; Rombach, who 
regarded the disease as a secondary matter resulting from uprightness of 


Fic. 114. —Friebel’s extension apparatus. 


the hoof, cured it by freely lowering the heels. Matz applied blisters 
and recommended turning the animal out. 

Brunet used a peculiar extension apparatus, which started from 
the shoe and exercised pressure on the front of the knee-joint. 
Similar contrivances have been made by Foringer, Weiskopf, and others. 
My experience teaches that treatment should depend on the degree of 
displacement; when slight, it is sufficient to freely lower the heels, 
but should this be unsuccessful, a long-toed shoe may be used. If 
needful, tenotomy can be performed, it being sometimes sufficient to 
divide the flexor perforans. Tenotomy is, however, seldom necessary, 
and can only be recommended as a last resort. 


SPLINTS. Gyall 


VI—SPLINTS. 


Lit.: Havemann, Anleitung zur Beurtheilung des Pferdes, 1805. Per- 
cival, Lameness in Horses, 1849, p. 252. Haubner, Gurlt u. Hertwig. 
4,p. 251. Dudfield, The Veterinarian, 1854. Ercolani, Giornale di 
Veterinario, 1855. Dieckerhoff, Adams Woch. 1884, p. 1. Dam- 
mann, Landwirthschaftliche Thierzucht. 1887. Erler, Dresd. Ber. 1860, 
p. Ol. 


Pathology.—Splints are due to a form of periostitis which is fre- 
quent in horses though rare in ruminants, and which develops between 
the large and the inner small metacarpal, or on the inner, rarely on the 
outer, surface of the large metacarpal itself. On account of its fre- 
quency—for splints are met with in most horses—and of its interference 
with usefulness, it is not surprising that even in the earliest times 
this condition received attention both from practitioners and authors. 
Jordanus Ruffus described splints as supraossa, and Solleysel distinguished 
five varieties of them. At first they were regarded as a secretion 
from the bone, and it was only in the present century that their depend- 
ence on periostitis was clearly demonstrated by Haubner and others. 
The real disease, ze, the condition causing lameness, is a periostitis 
ossificans, associated with formation of exostoses. Two periods can, 
therefore, be distinguished: the first that of inflammation——of periostitis ; 
the second that of complete development, in which inflammation is 
absent. During the first, lameness is therefore very general, but dis- 
appears during the second. 

The process usually starts in the portion of periosteum and connective 
tissue which fixes the internal small splint bone to the cannon bone. 
Irritation in its deep layers produces growth of bone and swelling, the 
permanence of which led older writers to view it as an exudate. The 
process of splint formation is completed by ossification of the new-formed 
material. The size of the splint depends on the extent of surface 
involved and the duration of the periostitis, and varies between that of 
a threepenny and a five-shilling piece. It generally assumes a longish 
form, lying parallel with the small splint bone. When the periostitis 
has passed away, and the formation of the splint is complete, pain and 
lameness generally disappear, though the splint itself remains as a 
blemish. In many cases, however, especially in young horses, severe 
work is again and again followed by lameness, causing the disease to 
persist for a long time. The mature exostosis gradually diminishes, 
sometimes by becoming flattened, sometimes by the neighbouring bone 


522 SPLINTS. 


becoming thickened, and under certain circumstances may so far recede 
as to require a careful examination to detect it. 

The cause of periostitis consists in traumatic irritation of the 
periosteum and bones. On account of their almost invariably occurring 
on the inner side, the view was once held that splints were produced 
by striking. Havemann was the first to expose this error, and to point 
out the longish shape of the splint, and the fact that injury of the skin 
is very rare. He directed attention to the construction of the carpus, 
and especially to the position of the small trapezoid bone (os multan- 
gulum minus hom.), and viewed this as a cause of the disease. Whilst 
on the outside the unciform (os hamatum hom.) rests partly on the outer 
small splint bone, partly on the metacarpal bone, on the inside the small 
trapezoid rests almost entirely on the inner small splint bone. This 
explains why faulty action or unequal distribution of pressure in the 
knee may throw an excessive load on the inner small metacarpal, 
and cause ruptures in the periosteum fixing the small to the large 
metacarpal. The incomplete union between the bones in young 
animals explains the frequent occurrence of splints during early life. 
At a later period union is ossific, and the disease therefore seldom 
occurs. 

This explanation of Havemann’s was generally viewed as correct, 
until recently Dieckerhoff raised a doubt about it, and stated that the 
disease of the periosteum was produced by the pull of the fascia of the 
fore-arm. He describes splints so produced as “spontaneous,” 
in contra-distinction to those caused by blows, which he terms “ trau- 
matic.” The lower insertion of the fascia of the fore-arm is partly 
into the metacarpal bones, especially the inner small metacarpal, 
partly into the subcutaneous connective tissue. Ruptures of it, and 
especially of its point of insertion into the bone, are said by Diecker- 
hoff to give rise to disease in the subfascial connective tissue, which 
disease extends to the periosteum. The facts adduced by Dieckerhoff 
in support of this modification of Havemann’s view are, in my estima- 
tion, very insufficient, and by no means conclusive. There is much 
evidence in support of Havemann’s showing. The disease generally 
begins in the interosseous ligament, between the small and large meta- 
carpal bones, whilst no disease processes of any kind can be detected 
in the fascia. Nor can cedematous swelling of the subeutis be regarded 
as an infallible sign of the condition referred to, for it is scarcely ever 
absent in periostitis in other positions. To this must be added that inflam- 
mation may also be caused by violent tension on the other ligaments, 
which become attached to the inner small metacarpal bone, and may 
lead to disease in the spot in question. For prognosis and treatment, it 
is, of course, of little importance which view one takes. The most im- 


THE CONFORMATION PREDISPOSING TO SPLINTS. 523 


portant difference is that, according to Havemann’s view, pressure, accord- 
ing to Dieckerhoff’s, tension, is the cause of the periostitis. In any 
case we may divide splints into two classes—those due to unequal distribu- 
tion of pressure, and those due to blows. The two kinds admit of easy 
clinical distinction. The first is generally of a long shape, and is 
always on the small metacarpal; not infrequently several lie one above 
the other, having been formed simultaneously or soon after one another. 
Those produced by blows are generally further forward and on the 
large metacarpus, «¢., they appear in front of the small metacarpal, are 
generally of a rounded shape, and are discrete. Cicatrices or injuries 
of the skin cannot always be detected. 

Horses with bad action often strike themselves. The weight is 
irregularly distributed in their joints, and therefore such animals have 
a double disposition towards the production of splints. This is par- 
ticularly true of those which turn the toes either outwards or inwards 
excessively, as well as of those which stand with the legs widely extended 
or too close together. Defective shoeing may lead to splint formation 
by its favouring striking and unequal distribution of weight in the 
joints. During military evolutions injuries are often caused by strik- 
ing, by unequal distribution of weight, especially in restive horses, 
and also by the animal being tired or constitutionally weak. Con- 
tinued severe work on stones in large towns favours the production 
of splints. Coarsely-bred animals suffer oftener than well-bred, and 
the splints are usually larger. Inasmuch as defective formation is 
often a cause of their production, the inheritance of a disposition to 
them can be explained without resorting to Didfield’s idea that the 
drinking-water has some influence. 

Many peculiarities of the disease still require explanation, such as 
its simultaneous and exactly symmetrical appearance on the meta- 
carpus of both fore-legs, even in old horses, and the more frequent 
appearance on the left fore-limb. The reports of the Prussian army 
for 1891 show that exostoses occurred twice as often on the left fore- 
limb as on the right. It is possible that the frequently performed 
“right gallop” may afford an explanation of this. 

Symptoms and Course.—(1) Lameness. The pain resulting from 
periostitis produces lameness, which is therefore a regular accompaniment 
of the development of splints. It is seldom absent, but its character 
depends partly on the position, extent, and intensity of the process, 
partly on the work done and on the animal’s sensitiveness. Lameness 
is less common in coarse-bred than in well-bred horses. When periostitis 
is caused by mechanical injury, lameness disappears with its subsidence, 
and only returns if the injury be repeated. In such cases it lasts about 
three weeks. Partial rupture of the imterosseous ligament recurs very 


524 SPLINTS. 


easily, causing the lameness not only to continue for longer periods, but 
also to return, and therefore splints of a longish shape occurring on the 
small inetacarpal continue to interfere with the animal’s usefulness for a 
long time, frequently for many months. In periostitis near the knee 
there is danger of inflammation extending to the knee-joint ; the lame- 
ness then continues for longer periods, sometimes indeed becomes 
chronic, from changes in the knee producing arthritis deformans 
(p. 488), and from mechanical interference with the mobility of the 
jomt by large exostoses in its immediate neighbourhood. I have often 
seen splints at this point follow on injury, and produce chronic lameness. 

Lameness may therefore be caused— 

1. By periostitis. 

2. By inflammation of the knee-joint. 

3. By formation of extensive exostoses near the knee, which inter- 
fere with free movement. The idea that lameness is caused by the 
splint pressing on the flexor tendons is erroneous. 

In general, splints produce lameness in the free limb (swinging leg 
lameness) and abduction of the limb: the lameness is better seen on 
hard than on soft ground. Weight is generally placed on the limb, and 
the hoof in most cases is put down firmly and in the usual manner. The 
excessive tension in the fascia of the fore-arm during the last phase of 
movement, just before the limb is lifted and during its extension, causes 
painful pressure on the inflamed periosteum. 

Abduction is particularly marked when the knee-joint is also involved. 
Extensive exostoses interfering with movement of the knee can be 
detected by passive movement (p. 488); attention is sometimes drawn to 
them by the knee being held stiffly, and only partially flexed during 
movement. 

(2) Local examination. The development of periostitis is character- 
ised by slight swelling, increased heat, and pain on pressure. The 
swelling shows a certain degree of hardness, but in consequence of 
cedema of the skin is at first of doughy consistence. This gradually 
disappears, the swelling becoming firmer and harder. To detect pain 
the foot is lifted and the hand of the same side placed with the thumb 
resting on the outside, the fingers on the inner side, of the metacarpus. 
By passing the fingers from above downwards, it is easy to estimate the 
tenderness of the periosteum. To prevent mistakes, the same process 
should be gone through with the sound limb. In practised hands this 
examination is perfectly easy, though in some cases care is required 
to avoid confusing physiological thickenings on the lower end of the 
small metacarpal with periosteal swellings. On the other hand, inflam- 
mation of the skin is sometimes difficult to distinguish from periostitis, 
though, as a rule, painful lameness is here wanting. 


~ 


TREATMENT OF SPLINTS. 525 


I cannot agree with Giinther’s view that splint lameness is easily 
mistaken for that of navicular disease, because the lameness produced by 
periostitis usually increases with movement ; navicular lameness, on the 
other hand, decreases, and often disappears entirely with exercise. 
Nevertheless, the other portions of the limb should always be carefully 
examined, in order to confirm the diagnosis. This is particularly neces- 
sary when the pain produced by pressure is slight. 

Prognosis is generally favourable, especially where the position and 
character of the periostitis point to mechanical injury. Exostoses of a 
longish form occurring on the small metacarpal and in young horses are 
apt to be troublesome. The chance of recovery is less if, in consequence 
of defective formation of the limb, the parts are likely to be struck by 
the other foot. Prognosis is doubtful when the knee is coexistently 
diseased, or when extensive exostoses have formed close to it, and opinion 
should be reserved even when the patient, after a long rest, shows no 
lameness. In cases of this kind in young horses, the splints which 
remain not infrequently cause renewed lameness on every attempt to 
work, and, as a rule, never disappear completely. 

Treatment may be called for by the presence either of periostitis, 
lameness, or exostosis. The treatment of periostitis first demands the 
removal of the cause. Skilful shoeing is important to prevent striking 
and to effect a proper distribution of weight, but scarcely comes within 
our present province. Rest is essential, particularly when the disease 
is clearly not of mechanical origin. 

Local applications of cold water, blue ointment, tincture of iodine, &c., 
are seldom of use. When the skin is uninjured, a blister may be indi- 
eated. Cantharides ointment, though often recommended, has less effect 
than caustic mercury preparations, especially sublimate, which in 
Hanover has long been employed in concentrated solution. One part 
of sublimate dissolved in four parts of spirit is applied with a feather, 
and sharply rubbed in with a cork. The cutaneous and subcutaneous 
swelling thus produced exercises general pressure on the inflamed 
periosteum, and limits exudation therein. Firing answers the same 
object, though, without doubt, the subsequent rest is of great im- 
portance. 

These methods, when objected to, may be replaced by a pressure 
dressing. A mixture of equal parts of grey ointment and lanolin should 
be rubbed in smartly once a day, and a proper pressure bandage 
applied. 

Periosteotomy, recommended by Sewell, was, according to Ercolani, 
first employed by Rusius in the 13th century, but has not been much 
practised, though Haubner formerly, and Dammann more recently, 
recommended it. The operation sometimes shortens the duration of the 


526 SPLINTS IN THE HORSE. 


pain and tension in the periosteum which causes lameness, as shown 
by a case of Erler’s, but usually it neither diminishes the morbid 
changes nor lessens the lameness, while it sometimes occasions consider- 
able thickening, and even necrosis of bone. Perhaps these troublesome 
complications might be avoided by strict antisepsis, but at present I 
have not had an opportunity of solving the question. 

Removal of exostoses is assisted by massage and methodical compres- 
sion. The former can seldom be continued sufficiently long, though, 
when the necessary assistance is available, the splint may be diminished 
by rubbing it daily with a soft piece of wood, or, as was formerly the 
custom, with an iron spoon. The treatment must, however, be persevered 
with for months. A better plan is as follows:—A piece of lead (a 
leaden bullet, beaten flat) or thick sole-leather is fixed over the 
exostosis with moderate firmness by a bandage. The pressure thus 
produced, if continued for some weeks, often brings about considerable 
diminution in size. Care is needed to avoid causing necrosis of skin, 
and it is therefore well to change the dressing frequently, where 
possible daily, and examine the skin. By employing massage, resorp- 
tion is hastened. 

A peculiar periostitis on the large metacarpus is seen in young race- 
horses, and is in England termed “sore shins.” It always appears 
suddenly after violent gallops. The affected limb is rested, or if both 
limbs suffer, the weight of the body is alternately shifted from one to 
other. When moving, the leg is not properly lifted, and is extended 
stiffly. Soon after, a hot, very painful swelling (periostitis) appears on 
the front of one or other, sometimes of both shin-bones. It usually 
disappears in a few weeks, though necrosis of bone has sometimes 
been observed,— perhaps, in consequence of the treatment. The 
disease occurs almost solely during the first two years of life, is seldom 
seen during the third and fourth years, and never occurs in old 
horses. Williams recommends subcutaneous periosteotomy, which is 
said to shorten the attack, and employs warm moist applications. 
Blisters have also been recommended. As far as I know, the disease, 
though occasionally seen in race-horses, has not been written of in 
Germany. 


ANATOMY OF THE PHALANGES. AE 


E. Diseases of the Phalanges. 


Anatomy.—In solipeds, the phalanx consists of the pastern, coronet, and pedal 
bones, with the two sesamoid bones and the os naviculare. In ruminants, two 
completely developed and two rudimentary phalanges exist, with four sesamoid 
bones and two navicular bones. 

The pig has four phalanges—two true and two rudimentary ; eight sesamoid 
and four navicular bones. 

In the five phalanges of carnivora, the first consists of two, the others of three 
joints. Each has two sesamoid bones, whilst the navicular bone is wanting. 
On the other hand, a small lenticular bone exists in the tendons of the extensor 
pedis, on the anterior surface of the joint between the metacarpus and first joint, 
as well as between this and the skin. 

In the horse, the three joints of the phalanx, 7.e., the fetlock, coronary, and 
pedal, form partly incomplete and partly complete ginglymoid joints. 

The fetlock, a complete ginglymoid joint, possesses a capsular ligament 
strengthened laterally by fibrous bands, and has a dilatation behind which 
extends, for a considerable distance upwards, between the two portions of the 
suspensory ligament and the fetlock, to unite with the tendon of the flexor pedis 
perforans. The strong lateral ligaments, in conjunction with the cylindrical 
form of the articular surface, prevent any side movement. The fetlock-joint is 
further provided with two lateral sesamoidal ligaments which, reinforced by 
the crossed ligaments, connect the sesamoids with the cannon bone and the first 
bone of the phalanx. 

The intersesamoidal ligament connects the two sesamoid bones. The fetlock- 
joint is so fixed by the upper and lower sesamoidal ligaments as to prevent 
excessive dorsal flexion and assist the function of the flexor tendons. The 
superior sesamoidal (suspensory) ligament passes in an upward direction from 
the superior border of the sesamoid bones to the lower row of carpal bones and 
upper end of the metacarpus. he inferior sesamoiden ligaments are three in 
number. The superficial is fixed below to the glenoidal fibro-cartilage, behind 
the articular surface of the os coronz, ascends behind the os suffraginis, and is 
inserted into the base of the sesamoids and intersesamoid ligament. The middle 
ligament is fixed to the back of the os suffraginis and inserted into the base of 
the sesamoids. The deep consists of a few crossed fibres which arise from the 
back of the os suffraginis and are inserted into the sesamoids. 

The pastern is an incomplete ginglymoid joint lying about an inch above 
the upper margin of the hoof. On account of its flat articulatory surface, it 
allows of limited side movements, especially when in a position of volar flexion, 
Its tense capsular ligament is attached anteriorly to the extensor tendons, 
laterally to the lateral ligaments; behind it is expanded, and lies in contact 
with the branches of the suspensory ligament. At the sides are two short, stout 
lateral ligaments, whilst behind, the joint is supported by the inferior sesamoidal 
ligaments in the same way as the fetlock is by the suspensory ligament ; the inferior 
sesamoidal ligaments run from the posterior or lateral borders of the pastern- 
joint to the upper portion of the os corone. The posterior articulatory surface of 
the os corone is enlarged by the glenoidal fibro-cartilage attached at this point. 

The pedal joint lies near the lower border of the coronary band. Its capsular 
ligament extends from the margin of the articulatory surface of the os corone 
to the os pedis and os naviculare. Though in front tensely stretched, it expands 
and becomes thinner in a backward direction, and is in connection with the 
tendon of the flexor pedis. Its two lateral ligaments render the pedal an 


528 LUXATION OF THE PHALANGES. 


incomplete ginglymoid joint. The postero-lateral ligaments are physiologically 
identical with the superior and inferior sesamoidal ligaments. They arise from 
the upper border of the navicular bone, and are inserted on the lateral aspects 
of the os coronz and the lower portion of the os suffraginis. The tendon of 
the extensor pedis passes over the anterior, those of the flexor pedis perforans 
and perforatus over the posterior surface of the phalanges, which here are almost 
entirely surrounded by tendon sheaths. In company with the sesamoidal 
ligaments, these tendons act in fixing the fetlock-joint; with the posterior 
coronary ligaments, and assisted by the postero-lateral ligaments, they also fix 
the coronet and pedal joints, and thus sustain the weight of the body. The larger 
blood-vessels and nerves pass down the outer and inner sides of the phalanges. 

I shall use the terms dorsal and volar flexion to describe the movements 
occurring in the phalanges: the first indicates the movement given by the 
extensor, the second that given by the flexor muscles. 


I—LUXATION OF THE PHALANGES. 


Lit.: Wilhelm, Dresd. Ber. 1889, p. 72. Johne, ibid., 1884, p, 68: 
Schellhase, Th. Mitth. 1859, p. 163. Siedamgrotzky, Dresd. Ber. 
1890, p. 22. 

The union of the three phalangeal joints is so strong that displace- 
ments (luxations) are exceedingly rare, and must always be preceded by 
extensive rupture of ligaments or tendons. Luxation of the fetlock- 
joint is seen in race-horses from complete rupture of the flexor tendons ; 
the lower end of the metacarpus then passes downwards over the 
posterior margin of the articular surface of the os suffraginis, causing 
excessive dorsal flexion of the fetlock-joint. Less frequently, the 
metacarpus is displaced anteriorly ; this indicating rupture of the lateral 
and sesamoidal ligaments. Lateral displacements are exceedingly rare, 
and are necessarily accompanied by rupture of the lateral lgaments. 
They are sometimes produced by violent struggles to free the foot which 
has accidentally become fixed, as, for example, between railway-metals. 
Wilhelm saw lateral displacement in the hind-leg of a horse which had 
run away, and had fallen. The joint was directed outwards. Siedam- 
grotzky has described three similar cases. In other animals luxations 
of the phalanges are still less common. 

The diagnosis is easy. The altered position of the joint, and the © 
changes discovered by manual examination, can leave no doubt. 

The course of luxations is almost always unfavourable, on account of 
the excessive rupture of tissue. The larger animals either die from 
decubitus, or more or less marked lameness remains which prevents the 
animal working. 

Wilhelm records recovery in eight weeks in the above described case. 
He placed the horse in slings, and after reducing the dislocation, applied 
a wooden splint fastened to the metacarpus by straps. Treatment was 


SPRAIN OF THE CORONARY JOINT. 529 


directed to moderating inflammation, and later a dressing and wooden 
splint, provided with a hinge over the fetlock-joint, were applied. 

Schellhase has seen similar cases. In one it was possible not only to 
place the os suffraginis at a right angle with the large metacarpal, but a 
wound existed which admitted the finger between the os suffraginis 
and metacarpal bone; nevertheless, recovery occurred. Such cases are, 
however, quite exceptional. 

Johne gives the result of a post-mortem on a horse after luxation of 
the os pedis, where the lower end of the os corone had been displaced 
backwards and outwards, and lay above the os naviculare, The capsular 
ligament was consequently torn, and the flexor perforans ruptured and 
inflamed. 

Treatment follows general principles. Reposition and control of 
inflammation are, however, very difficult. 


Il.—SPRAIN OF THE CORONARY JOINT. 


Lit.: Percival u. Williams, The principl. and pract. of vet. surg. Aufl. 
VI. p. 288. Mdé6ller, Arch. fiir wiss. u. pract. Thierh. vol. ii. p. 308. 
Fohringer, Adams Woch, 1888, Nr. 8. Siedamgrotzky, Dresd. 
Ber. 1890, p. 22. 


Whilst luxations of the phalanges are rare, sprain is more common, 
particularly in the coronet-joint. It occurs either from excessive dorsal 
or volar flexion, or forced lateral movement in the joint, caused generally 
by slipping to the side, and consists in violent stretching, sometimes 
in partial rupture of the ligaments. 

Such accidents are favoured by— 

(1) Defective formation of the joints. Small articular surfaces offer 
less secure support, and are generally furnished with weak ligaments. 
This is particularly true of joints which appear narrow when seen 
in front. 

(2) Faulty position of the limb. The most important of such faults 
is turning the toes outward or inward. If the axes of the joints are 
not perpendicularly under the centre of gravity, unequal stress must be 
thrown on the ligaments every time weight falls on the limb; in 
addition, unequal weight being thrown on the inner and outer portions 
of the joints, the gait becomes insecure. 

(3) Small hoofs and excessive lowering of the wall. Where one side 
of the wall comes in contact with the ground sooner than the other, the 
load is unevenly distributed, and the articular ligaments are apt to 


suffer. Horses which have worked for a long time under such con- 
») 1 


530 SPRAIN OF THE CORONARY JOINT. 


ditions generally show excessive lengthening of the lgaments, best 
recognised in a position of volar flexion. The immediate cause of 
sprain are slips, falls, or injuries sustained in rising. Such accidents 
are favoured by irregular pavement, high calkins and heels, narrow- 
ness of the chest, and lameness. ‘The condition is therefore commonest 
in large cities, and during the winter. Less frequently the animal is 
caught in deep ground, or between fixed objects like railway-metals. 
The commonest complications are fractures of the os corone; next to 
these come fractures of the pastern. The lateral ligaments of the 
coronet-joint are most exposed to sprain. 

Symptoms.—Lameness appears suddenly following a slip; the 
animal avoids placing weight on the limb, and movement is often 
painful. The foot is rested, and held in a position of volar flexion. 
Pain is evinced, both on passive rotation of the jomt and when the 
animal is turned round. At a later stage, weight may be placed on the 
limb when the animal is in the stable or on level ground, though 
attempts to turn are followed by distinct recurrence of lameness. This 
is due to the fact that moving on level ground produces little tension in 
the articular hgaments. The affected part 1s warm and swollen, and 
there is often marked pain on pressure. 

Careful examination of the separate joints usually reveals the position 
of injury, especially if the fetlock-joint be fixed and the coronet rotated, 
or vice versa. Passive rotation of the fetlock-jomt, however, does not 
produce so marked an effect as that of the two lower joints, because the 
form of its articular surface effectively limits movement. It is often 
difficult to discover whether the pedal or coronet joint is affected, but 
luckily the question is of no practical moment. 

Course and Results.—Sprains and the inflammation resulting 
from them vary greatly in extent and intensity. A slight slip may 
produce violent momentary pain, in consequence of strain of the 
ligamentous apparatus, though such usually disappears with proper 
rest in twenty-four to forty-eight hours, when the condition may be 
regarded as cured. When sprain is complicated with rupture of hga- 
ments, great pain is shown, but often diminishes rapidly, and may even 
disappear for a short time. It returns after some hours, however, and - 
then continues. The second attack results from inflammation, and is 
in direct relation to its intensity and extent.. When the strain and 
rupture are still more severe, pain continues longer, and inflammatory 
symptoms (increased warmth and swelling) appear early. Slight cases 
completely recover in a few days to several weeks, according to their 
gravity, but a disposition to fresh injury exists, which is directly 
proportional to the changes in the joint. Cases of extensive and 
intense inflammation of the joint, consequent on injury to ligaments, 


SPRAIN OF THE CORONARY JOINT. ddl 


generally last four to six weeks, but may be followed by complete 
recovery. In severe cases the diseased ligaments are apt to contract 
and impede free movement of the joint, which is also distorted. Exces- 
sive volar flexion may then occur, especially after inflammation of the 
fetlock-joint. Limitation in the movement of the joint is shown by 
lameness, and by the upright position of the os suffraginis. Inflamma- 
tion of ligaments often extends to bones and produces exostoses, par- 
ticularly where the ligaments are inserted into the os suffraginis and 
OS corone. ; 

The synovial membrane may also be affected, causing distension of 
the cavity of the joint with inflammatory exudate (hydrops articuli) 
and chronic enlargement. Necrosis of bone occasionally occurs, and pro- 
duces severe symptoms, or even death. 

Siedamegrotzky noticed in horses three cases of rupture of the lateral 
hgament of the hind-fetlock, which recovered in three to eight weeks. 

Percival made some anatomical researches on the production of 
articular diseases, and found the fetlock-joint anchylosed in five cases, 
the coronet-joint in forty cases, and the pedal joint in sixteen cases. 
When implicating the coronet-joint, the condition is termed ring-bone 
(compare p. 557). 

The rare occurrence of sprains in the fetlock-joint must be referred 
to the form of its articular surfaces which acts as an effective check on 
movement. Of the ginglymoid joints, the coronet suffers more fre- 
quently. 

Prognosis depends on the extent and duration of injury. The 
degree of pain is generally a fair criterion of the mischief, though 
the early appearance of inflammation is more significant. The after- 
pain, due to inflammation, is of most importance in determining 
the prognosis; when appearing twelve to twenty-four hours after the 
accident it shows that grave injury has taken place, and if accompanied 
by marked fever is a grave symptom. ©The older the condition, the 
more slowly does resolution proceed. Hence the old rule: a sprain 
uncured in two weeks will require not less than four, and if then uncured 
will last at least a further four, and so on. Long duration predisposes 
to fresh attacks. 

Treatment.—The chief point is perfect rest, but in large animals 
is unfortunately difficult to provide for. All movement should be 
avoided, and the limb supported or fixed by firmly applying a strong 
linen bandage. During the first three days cooling applications keep 
down inflammation and modify pain, but after this time the only 
indication justifying employment of cold is continued severe pain. 
After the fourth day, absorbents lke mercurial ointment generally act 
better. Warm inoist applications are of the greatest service, and should be 


jon SPRAIN OF THE CORONARY JOINT. 


supplemented by pressure, which conduces alike to local rest and resorp- 
tion. In many cases this treatment is sufficient. If, after diminution of 
inflammatory symptoms, severe swelling remains, the parts may be 
massaged with a mixture of equal parts of grey ointment and soft soap 
(B.P.), or blisters of cantharides or sublimate may be applied; line 
firing is even better. In obstinate cases this treatment may with 
advantage be alternated, blisters being followed up by moist warmth 
and methodical compression, which is especially useful for chronic 
thickening. 

Rest is necessary throughout the treatment, and even to test his 

soundness the horse should not be moved more than necessary. To 
prevent further strains, the floor of the box should be flat, and the 
animal be provided with abundance of bedding. When lameness dis- 
appears, the animal may be slowly exercised on soft ground—if possible 
on sand—and precautions taken against fresh slips. 
“* The long-toed shoe, formerly recommended against knuckling, 
should be carefully avoided, on account of its aggravating any existing 
inflammation in the injured ligaments. Contraction is best combated 
by slow, cautious exercise during the period of, convalescence. 

The diseased joint may sometimes be fixed by a plaster bandage. 
In the fetlock the best application is a hemp splint, first used by Beely, 
already described. 

Fohringer recommends a very similar appliance. As, however, the 
coronet-joint can scarcely be fixed in this way, strict rest and the 
application of a blister may be substituted. 


III.—FRACTURES OF THE PHALANGES. 


Lit.: Wentworth, Her. Rep. 1861, p. 332. Williams, The prince. and 
pract., p. 136. Peters, Vortrige fiir Thierirzte. Schrader, Gurlt 
u. Hertwig. 3, p. 88. Wiistefeld, ibid, V.S. 289. Slesarewski, 
Jahresb. 1885, p. 112. Popow, Jahresb. 1884, p.112. Halder, Her. 
Rep. 19, p. 37. Kretowicz, Jahresb. 1882, p. 88. Wilhelm, ibid., 
1883, p. 110. Johne, Dresd. Ber. 1871, p. 128. Dressler, Th. 
Mitth. 1867, p. 153. Lemhéfer, Zeitschr. f. Vet.-Kunde, 1891, p. 16. 
Roder, Dresd. Ber. 1891, p. 90. Hohenleitner, Ad. Woch. 1893. 


In the horse, fissures and fractures are commonest in the os suffraginis, 
comparatively rare in the os corone and os pedis. They are often the 
result of violent slips or sudden turns, and therefore are especially 
frequent in race-horses. They may also be caused by jumping or 
falling in races, but in addition occur in heavy van-horses employed for 
slow draught, particularly in winter when the roads are frozen. In 


FRACTURES OF THE PHALANGES. 533: 


riding-horses a frequent cause is sudden turning, simultaneous fracture 
of the os suffraginis in more than one limb being produced in this way. 
Roder saw in a horse, transverse fracture of both front aud of the right 
hind pastern bones following a fall. Wentworth describes fracture 
of both front pastern bones in a mare. Whether a peculiar predisposi- 
tion existed, or whether the cause was the sudden strain thrown on the 
still intact foot in consequence of the first fracture, could not, of course, 
be decided. Tuson, in the above-described case, found a want of inorganic 
substances in the fractured os suffraginis. In solipeds generally, and 
race-horses in particular, fissure of the os suffraginis is not infrequent. 
It was first noted in England, and Williams describes split pastern as 
quite a common occurrence. I have often seen similar accidents in 
Germany, though they are sometimes overlooked, and mistaken for dis- 
tortion of the joint. Peters made a series of observations, and explained 
why fissures of the os suffraginis almost always start from the middle 
depression (figs. 115, 116, 117). According to his view, the split is pro- 
duced by the prominence on the lower articular surface of the metacarpus 
at a time when weight is unequally distributed over the two articular 
surfaces of the pastern lying on either side of it. Violent rotary move- 
ments of the supporting limb act similarly, and explain why fissures 
follow sudden turning on the fore-Jimbs. Sometimes the split extends 
through the entire bone as far as its lower margin, sometimes it passes 
towards one side. Not infrequently it is very short, and ends close 
below the upper articular surface, and is followed by periostitis and the 
production of an exostosis (fig. 116). 

Transverse fractures are also common in the horse, and affect some- 
times the upper, more frequently the lower, end of the os suffraginis. 
They likewise result from unequal distribution of pressure during slips. 
In one case I was able to detect during life that the inner border of the 
upper articular surface had been broken away by the violent pull of the 
internal lateral hgament, the outer border by the pressure of the meta- 
carpus (fig. 118). I have also seen several cases of transverse fracture, 
i.e., cases Where the fracture started from the external lateral lgament 
and extended to a varying distance downwards (fig. 119). This fracture 
had been caused by suddenly throwing the horse on his haunches. Com- 
minuted fractures of the os suffraginis are sometimes seen. Johne saw 
a transverse fracture unite in eight weeks without much callus forma- 
tion; Dressler found a race-horse’s pastern broken into nineteen pieces. 

Diagnosis is seldom difficult in complete fractures, on account of 
there generally being some crepitation. When the lateral prominences 
of the bone are broken off, the fetlock-joimt is abnormally mobile from 
side to side. On the other hand, careful examination is required to 
detect fissures. The sudden severe lameness, associated with volar 


534 FRACTURES OF THE PHALANGES. 
ra] 
\ ee eehe 


flexion" of the fetlock, is apt to give the impression that the case is one 
of distortion, and therefore the limb should always be examined for 
fracture wherever lameness is of sudden onset and severe. When 


Fic. 115.—Fracture of os suffraginis. Fic. 116.—Fracture of os suffraginis 
with formation of exostosis. 


passive rotation of the foot produces no crepitation, the anterior surface 
of the pastern should be firmly manipulated, beginning at the centre of 
the upper end. Starting from here, a line of increased sensibility may 


Fic. 117.—Transverse frac- Fra. 118.—Double fracture of upper FIG. 119.—Longitudinal frac- 
ture of os suffraginis. end of os suffraginis. ture of os suffraginis. 


be traced nearly corresponding to the course of the extensor tendon, and 
passing towards one or other side of the bone. In most cases the fissure 
runs towards the outer side—a fact perhaps due to the smaller size of 


FRACTURES OF THE OS CORON AND OS PEDIS. 535 


the outer division of the articular surface. During this examination 
the limb must of course be at rest, otherwise it would be impossible to 
properly estimate the degree of local pain. It is only after the lapse of 
some time that periostitis or exostosis can be detected at the upper end 
of the bone. 

Fractures of the os corone in solipeds are caused in the same way as 
those of the os suffraginis. They are a common sequel of the foot being 
caught between railway-metals. The bone is either split longitudinally, 
or may be broken into several fragments. Henon saw the os corone 
broken into seven pieces, Schrader into six, and Lafosse into twenty 
pieces. Henon saw a horse with fracture of the os corone in all four 
feet ; sometimes only the ligamentous prominences are torn away. I had 
a case in which the bone was fractured into a number of pieces by a nail 
penetrating through the frog. Fissure and simple fracture of this bone 
are rarer than in the os suffraginis. 

Fracture is detected in the same way as in the suffraginis, and 
when complete offers no difficulty. Crepitation in this region points to 
fracture of the os corone, provided the suffraginis is known to be 
intact. 

Fracture of the os pedis is rare, though it has been seen by Lafosse, 
Havemann, Kersting, Huzard, and others. Schrader reported a series 
of cases. It is caused in the same way as fracture of the other 
phalanges, 7.¢., by slips, particularly when animals are suddenly reined 
up; but fracture of the pedal bone also follows injury by picked-up 
nails. Fracture is common in horses which have been “ unnerved.” In 
this case its occurrence is partly explained by loss of sensation in the 
foot producing abnormal action, partly by alteration in the nutrition of 
the foot and changes in the bone. It’ is well known that after chronic 
lameness the nutrition of the bones of the affected limb generally suffers. 
According to Williams, fracture also results from the heels of the shoe 
being caught in railway-points, and, in heavy horses, from falls. 
Lemhofer saw fissure of the os pedis produced by the horse striking the 
foot against a wall when jumping. This fracture united in four months, 
Schrader also noted fractures of the ossified lateral cartilage. 

Diagnosis is very difficult, crepitation being rare. Only occasionally 
can it be produced by rotating the foot or pressing the heels together 
and in its absence the diagnosis must be arrived at by a process of 
elimination, and by considering the history. Fracture of the os pedis may 
be surmised when severe pain is shown on attempts to place weight on 
the foot, when the lameness is of sudden onset and attended with marked 
volar flexion, and when, at the same time, there is no acute inflammation 
of the flexor apparatus or in the hoof. Increased pulsation in the 
arteries does not occur until twenty-four hours after fracture. Wiiste- 


536 FRACTURES OF THE PHALANGES. 


feld found the superficial veins of the foot greatly swollen. Examina- 
tion with farriers’ pincers generally, though not invariably, causes pain. 
Slesarewsky saw ‘fracture of the os pedis in consequence of a large 
portion of the hoof being torn away by the foot catching in some obstacle. 
Several pieces of bone were pulled off with the horn, but recovery 
followed the use of carbolic dressings. I have seen similar cases. 

Prognosis is most favourable in fissures of the os suffraginis, after 
which many animals recover their usefulness if rested for six to 
eight weeks, provided the other foot does not suffer from the con- 
tinuous standing. Complete fractures of the os suffraginis have also 
been known to reunite (Hohenleitner). Popow describes five cases of 
fracture of the os suffraginis which recovered under the use of the 
plaster bandage, though in two cases the fetlock-joint became anchylosed. 
In two cases the coronet-joint was affected, and in one both joints. In 
the case described by Halder, the animal could be put to hght field- 
work after a month’s rest, though slight lameness and thickening of the 
os suffraginis remained. Both Kretowicz and Wilhelm saw transverse 
fractures of the os suffraginis of hind-feet unite completely in a 
few months. As a rule, it is only worth while treating complete 
fractures when the horses are valuable for breeding, or where they can 
be kept for a small sum. Complicated fractures are almost always 
incurable. 

Fractures of the os corone are still less favourable, recovery being 
incomplete, and lameness remaining even in quiet animals, and where 
the fracture is simple. As a rule, the bone becomes greatly enlarged, 
and excessive volar flexion, particularly of the fetlock-joint, sets in, and 
is followed by permanent lameness. 

Fracture of the os pedis is less dangerous, because the parts are held 
in position by the hoof. Recovery chiefly depends on whether the other 
foot endures the strain of continued standing without suffering from 
laminitis. The prognosis is therefore ruled by the degree of pain. In 
Wiistefeld’s case the hoof became enlarged from pressure exerted by the 
displaced fragments. 

Geno fractures of the os pedis or os coronze, caused, for example, 
by picked-up nails, are generally incurable, on account of the impossi- 
bility of securing asepsis, though, when the case is quite recent, and 
disinfection thorough, healing sometimes occurs in a comparatively short 
time. 

The treatment of fractures of the phalanges consists principally in 
perfect rest and the use of slings. In fissures of the os suffraginis 
a well-fitting linen bandage is generally sufficient, though a_ plaster 
bandage may be applied if the horse be slung. Stolz saw complete 
union of fracture of the os suffraginis follow the employment of his 


= 


TREATMENT OF FRACTURES OF THE PHALANGES. 537 
ointment dressing (p. 499). In valuable horses this method may be 
tried after successful reduction. Cold-water applications are usually 
valueless, and have the positive disadvantage of softening the skin and 
favouring excoriation by the bandage. 

Fractures of the os corone are similarly treated, but, as bandaging 
is here of less value, one is often confined to merely resting the 
animal. Excessive pain may be reduced by cold baths or applications. 
Stripping the sole, formerly practised in such cases in France, is to 
be carefully avoided, as inflammation and suppuration are thereby 
ereatly favoured. 

I have repeatedly seen the lameness which follows fracture of the 
phalanges removed by neurotomy of the median nerve, and the animal 
rendered useful for some time. 

In slinging animals in the above and other conditions, the following 
points should be borne in mind. The slings serve principally to prevent 
the animal lying down, and to temporarily support it in painful con- 
ditions like lameness ; but as in severe lameness of one limb the oppo- 
site limb is continuously loaded, laminitis unfortunately too often occurs, 
and it is therefore better when the animals are in good condition, and 
able to he down without injuring the diseased foot, to favour this by 
giving plenty of straw and abstaining from the use of slings. 

Laminitis and displacement of the pedal bone may be recognised 
by pain and increased pulsation in the metacarpal artery. lmnme- 
diately it occurs the patient should be removed from the slings, pro- 
vided with a soft bed, and allowed to lie down. The practitioner must 
be careful not to mistake the symptom of weight being placed on the 
diseased foot as a sign of improvement. 


IV.—RING-BONE. 
Ger. Schale, Leist. 


Lit.: Trager, Gurlt u. Hertwig. 5, p. 206. Ammon, ibid., 11, p. 60. 
Schrader, ibid., 26, p. lu. 137. Hertwig, ibid., 37, p.94. André, 
Her. Rep. 13, p. 146. Nocard, Jahresb. 1883, 108. Dieckerhoff, 
Der Spat. p. 184. Peters, Berl. Arch. 9, p. 71. Havemann, Beur- 
theilung der Pferdes, II. Aufl Benjamin u. Redon, Rec. de Meéd. 
vétér. 1891, p. 104. 


The term “ ring-bone” has been used since olden times to indicate all 
chronic disease about the coronary joint attended with swelling. At first 
such swellings were regarded as resulting from a single cause, but careful 
anatomical examination shows that they may be due to very different 


538 RING-BONE. 


disease processes. Schrader first threw light on the question, and 
differentiated the following forms of ring-bone. 

(1) Articular ring-bone. This consists in an arthritis chronica, 
Gerlach and Haubner were amongst the earliest to draw attention to the 
condition. Sometimes it consists of an arthritis chronica deformans in 
which the articular cartilage forms the point of origin of the disease, 
sometimes it follows synovitis. The articular cartilage of the os 
suffraginis or os corone is found to be more or less altered according to 
the age of the disease, whilst exostoses occur on the borders of the joint 
(fig. 121). We, therefore, have to deal with an arthritis sicca vel 
deformans as first described by Schrader. In the later stages the 
suffraginis and coronet bones become covered with extensive ossific 
deposits, whilst the articular cartilage is totally destroyed; obliteration 


Fic. 120.—Articular ring-bone. Fic. 121.—Periarticular ring-bone 
melee articulg g ° 


of the joint (synostosis) may even occur, as shown by the cases diagnosed 
and described by Benjamin and Redon. 

(2) Periarticular ring-bone. In consequence of chronic periarthritis 
produced by displacement, or by continued strains on the limiting appara- 
tus of the joint, thickening occurs, particularly at the points of insertion 
of the lateral ligaments, and produces swellings on the inner or outer 
side of the joint. Post-mortem examination shows the articular surface 
to be healthy, but the ligamentous apparatus is thickened, and more or 
less well-developed exostoses exist at its points of insertion, particularly 
at the points of insertion of the lateral ligaments, though they also 


RING-BONE. 539 


occur at the spot where the posterior ligaments of the coronet-joint 
becomé attached to the suffraginis. Sometimes the insertion of the 
capsular ligament is also the seat of exostosis (fig. 121). As the articular 
cartilage is free from disease, this condition has by some been named 
false ring-bone (Williams). 

(3) Rhachitic ring-bone. In young animals suffering from rhachitis, 
thickenings sometimes persist on the lower extremity of the suffraginis and 
at the upper extremity of the coronet bones, and, as they cause swelling 
around the joint, have been described as ring-bones. In such cases, 
however, there is no pathological change either in the joint proper or in 
its ligaments. 

(4) The term “traumatic ring-bone” includes all enlargements about 
the coronary joint produced by periostitis due to other (usually traumatic) 
causes, whether following treads on the coronet or acute inflammatory 
disease of neighbouring parts, gangrene, &c. This classification meets 
practical requirements, for, in clinical diagnosis, it 1s quite possible to 
distinguish the different forms, and to modify the prognosis according to 
circumstances. 

Symptoms.—The common basis of these conditions is chronic 
enlargement around the corcnet-joint, which is sometimes so slight as 
only to be detected hy careful examination and comparison of the two 
feet. In such cases, of course, the limbs must be placed as nearly as 
possible in similar positions. Exostoses on the lateral surfaces of the 
joint are best seen from the front; those on the anterior surface from the 
side, and from the height of the affected foot. Diagnosis is also assisted 
by palpation and comparison of the two joints. 

In articular ring-bone the exostosis extends from either side over the 
anterior surface of the joint, and appears more or less circular, from 
which circumstance it has received its name. The posterior surface is 
covered by the ligaments and flexor tendons, and therefore cannot well 
be examined. The exostosis sometimes arises chiefly from the suf- 
fraginis, and is then rather higher placed, sometimes from the coronet, 
when it is found just above the hoof. In England and France, therefore, 
a high and low form of ring-bone have been distinguished (Formes 
du pituron et formes de la couronne). The swelling is hard, painless 
on pressure, and the skin covering it is movable. 

The periarticular form is similar in appearance, except that the 
enlargement is usually confined to the lateral surfaces of the suffraginis 
and coronet bones, and the anterior surface is usually normal. As in 
the former case, the swelling may appear higher or lower, and in general 
what has been said above also applies to this form. 

Lameness is an almost constant feature of both these forms of ring- 
bone. It occurs principally when weight is placed on the limb, and is 


540 RING-BONE. 


sometimes considerable, sometimes only slight. Lameness is absent in. 
rhachitic ring-bone, and usually in the traumatic form. After a long rest 
it may partly disappear, and in spirited animals slight lameness is often 
lost during movement. When the condition has become chronic, the 
muscles of the limb atrophy, and in proportion to the chronicity and 
severity of the lameness. As a rule, the latter phase of the stride is con-. 
siderably shortened, and the phalanges show volar flexion, i.¢., the fetlock 
is upright. In the periarticular form, lameness is best seen when the 
animal turns in short circles towards the diseased side. It is a conse- 
quence of inflammation of the articular surfaces or of ligaments, though 
at times it results from mechanical obstruction to movement in the 
coronary joint, due either to the formation of exostoses or to contraction 
of ligaments, and adhesions between the articular surfaces. Such 
adhesions are often accompanied by excessive volar flexion. By lifting 
the foot the anchylosis of the joint is directly discovered immediately 
an attempt is made to rotate, to flex, or to extend it. From the 
above it will be clear that the degree of lameness in no way depends on 
the size of the exostosis ; a large exostosis may only produce slight lame- 
ness, and vice versa. 

The diagnosis of ring-bone is very difficult unless the enlargement 
is well developed. In foals the phalangeal epiphyses appear well 
developed, and the coronet-joint lies high in consequence of incomplete 
development of the hoof. The proper distribution of weight on all four 
feet and the absence of lameness show this condition to be normal. 
Thickening of the skin may be recognised by palpation, nor can ossifica- 
tion of the lateral cartilage be easily mistaken for ring-bone if palpation 
is practised with any approach to care. 

It is more difficult to distinguish ring-bone from strain of the 
coronary joint, though the latter is accompanied by acute inflammatory 
symptoms (increased warmth and pain on pressure) which sufficiently 
distinguish it. As, however, chronic disease consequent on strain also 
falls under the designation, ring-bone conditions occur which may be 
described by either term. The disease may be masked by thickening 
of the skin around the joint, a condition induced for purposes of 
deception; the trick succeeding the more readily as laymen are pre- 
disposed to refer lameness to the skin injury. It is always safer to 
take the opposite view. 

Causes.—The cause of the coronet-joint being so frequently the 
seat of disease lies in its anatomical formation. To act as an 
incomplete ginglymoid joint, its area must necessarily be limited, 
aud its articular surface flat. This, however, favours strain of the 
ligament and unequal distribution of weight over the articular 
surface, circumstances which he at the root of the morbid changes, 


HEREDITARY PREDISPOSITION TO RING-BONE. 541 


while they also explain why the periarticular form of ring-bone is the 
most frequent, and why the disease only occurs in solipeds. 

Considering the varied forms of ring-bone, it is not surprising 
that equal variety exists in the immediate causes. The existence 
of the disease in two or more feet suggests hereditary predisposition, 
and may often be traced to small and badly-shaped joints, or faults in 
the formation of the limbs. The greater weight borne by the front 
limbs explains their so frequently becoming diseased. Turning the 
toes in or out causes unequal distribution of weight in joints and 
strain of ligaments, and therefore often produces periarticular ring- 
bone. Such conformation being perpetuated in the progeny, renders 
it easy to understand why the disease is often inherited. Havemann 
drew attention to this, and condemned the use of animals with ring- 
bone for breeding. I see no reason for believing that coarse-bred 
animals suffer oftener than others; but if the statement be true, the fact 
is probably due, in part at least, to the less care taken in selecting 
mares for breeding. 

Both Peters and Williams state that ring-bones are commonest in 
animals with long, weak pasterns, and refer this to the greater strain 
on the ligaments. Peters says the process begins at the middle of the 
dorsal or anterior surface of the joint, as an inflammation of the capsular 
ligament. Percival (see Williams) believes, on the other hand, that 
upright pasterns favour formation of ring-bones, because of the greater 
shock to which the bones are subject in moving. The abnormal forma- 
tion above noted is, however, of more importance. The predisposition 
to ring-bone in young animals is a result of the greater vulnerability of 
the bones and joints. 

The external causes are sprains and all influences favouring sprain, 
such as defective formation of the limb, unequal paring of the hoof, 
using animals at a rapid pace and on rough ground. — Unskilful 
shoeing plays an important part. If one side of the foot-wall is left 
higher than the other, that side will first come in contact with the 
ground, the weight will be distributed unequally in the joints, and the 
external ligaments of the opposite side may be strained. The causes of 
rhachitic ring-bone are little understood, and the same is true of the 
appearance of ring-bone after strangles, as described by Trager and 
others, and its greater frequency in certain breeds. It has not yet 
been shown that it is due to deficiency of calcium salts. Traumatic 
ring-bone is produced by inflammation extending from neighbouring 
parts to the periosteum. 

Dieckerhoff says that rmg-bone results from inflammation of a small 
bursa mucosa lying between the branches of the perforatus tendon and the 
postero-lateral ligaments of the navicular bone (Hufknorpelfesselbein- 


542 RING-BONE. 


bandern). It is quite true that swelling of this bursa may be mistaken 
for ring-bone; but despite careful examination, I have never been able 
to satisfy myself that disease of the joint or lameness was caused 
by it. 

Course and Prognosis.—A<As a rule, the disease is chronic, though 
the different forms of ring-bone exhibit many peculiarities. The 
articular form generally sets in slowly, though at times it results 
from acute synovitis, and is then difficult to differentiate from synovitis 
itself. As complete recovery cannot be expected, the prognosis depends 
on the degree of lameness and the work required of the horse. Lame- 
ness of sufficient severity to prevent work can only be removed by 
neurectomy. Exostoses, involving the front of the joint, offer little 
chance of cure, and those fixing the joint none at all. 

Periarticular rmg-bone sometimes results from acute periarthritis of 
the coronet-joint, or from repeated strain of its ligaments. lmprove- 
ment or cure depends on the nature of the pathological processes, and 
the possibility of removing the active cause. When the joimt is much 
enlarged and the position of the pastern altered, recovery is not to be 
expected. The more nearly the enlargement approaches the joint, the 
more serious the condition; high ring-bones are therefore less dangerous 
than those in the coronet region. The prognosis is also less hopeful 
where conformation is bad. When, on the other hand, errors in shoeing, 
such as unequal paring of the foot, are the cause, their removal will 
be followed by diminution or disappearance of lameness, but the 
exostoses are never completely absorbed. The prognosis is naturally 
unfavourable in anchylosis of the joint. The rhachitic form always 
develops slowly, and is permanent, though it never causes lameness; if 
lameness exists, it may safely be ascribed to other changes, which must 
therefore be considered in delivering a prognosis. 

Traumatic ring-bone, consequent on local inflammation near the 
coronet-joint, only causes lameness in the early stages, which as a rule 
afterwards disappears, but large exostoses near the joint may produce 
permanent lameness. 

The forecast is unfavourable in severe chronic lameness, and marked 
atrophy of muscle is likewise a bad sign. 

Needless to say, the prospect is less hopeful in hacks than in ordinary 
working-horses, though I have known horses with large ring-bones 
perform excellently as steeple-chasers. Special care is required in 
young patients, particularly if ring-bone develop before the animal has 
done much work. If, under such circumstances, the lameness is obstinate, 
there is little prospect of the animal ever proving useful. On the 
other hand, old horses which have shown ring-bones for a long time 
without yoing lame are likely to continue sound, unless exceptionally 


PREVENTION AND TREATMENT OF RING-BONE. , 543 


severe work is demanded of them. It is a general experience that 
ring-bones in hind-feet less frequently cause lameness than those in 
front. | 

Treatment.—Ring-bone can be prevented by care in the selection 
of breeding animals, by proper use and treatment of the young animal, 
by careful paring of the hoof, and later by proper shoeing. In the 
articular form, nothing whatever is gained by ordinary treatment ; 
neurectomy alone is likely to remove lameness, and even it fails when the 
joint has become fixed. In periarticular ring-bone attention must be given 
to preventing sprains and to securing a proper distribution of pressure 
in the articulations. The hoof should be carefuily pared to allow the 
weight to be distributed regularly in the coronet-joint, and to avoid 
strain of its ligaments. The parts of the wall which first meet the ground 
when moving should, therefore, be shortened. Though attention must 
be directed to the sides of the wall, yet the bearing of the toe should 
not be overlooked. Over-long heels should be shortened ; Williams 
recommends plain shoes (7.¢., without calkins), thin at the heels; or, if 
the heels be too low, a shoe with calkins, or better with thick heels. 
As a rule, it is sufficient to properly pare the foot. Care must be 
taken that the pastern hes parallel with the walls of the hoof; if not, 
it must be caused to do so. This is necessary on two grounds: firstly, 
because the position of the pastern is often changed in the disease in 
question; secondly, because such change in position may lead to sprains 
of the ligaments of the joint. Observance of these precautions is of far 
greater value than any local treatment. In this way I have often cured 
old-standing lameness, which had in vain been treated with all manner 
of applications. Cold poultices and absorbents can only be of use on 
account of the rest they render necessary ; In many cases the apparent 
success is due to errors in diagnosis. As long as inflammation of the 
ligaments or periosteum continues, stimulation of the skin may be 
successful, Cantharides and biniodide of mercury ointment, Xc., are of 
little use unless rest is given. When possible, the patient should be kept 
quite quiet for four to six weeks. Failing success by these methods, 
firing may sometimes be successfully resorted to. Puncture firing in 
two or three rows is most efficacious. Sometimes a few punctures over 
the swelling are sufficient. My own conviction is, that deep firing is 
the only effective form in dealing with ring-bone. André cured old 
standing ring-bone by firing several centimetres deep with a white-hot 
button-shaped iron. Deep firing has been recommended in France, but 
care must be taken not to open the joint. 

If after such treatment lameness still persists, or if the animals are 
of little value, and long-continued treatment is objected to on the score 
of expense, neurectomy may be tried. As a rule, branches of the plantar 


544 INFLAMMATION OF POSTERIOR LIGAMENTS OF CORONET-JOINT. 


or the stem of the median nerve must be divided, and the operation is 
generally successful unless mechanical obstruction to the movement of 
the joint exists. Loss of the hoof and other serious results are not 
uncommon sequel, and most frequently result when there are large 
exostoses on the front of the joint, near the coronet. Perhaps loss of 
the hoof is due to the coronary band being bruised between the exostosis 
and the hoof. ‘To avoid this contretemps, I therefore freely pare away 
the toe of the hoof, whilst preserving the heels. If needful, shoes with 
thick heels or high calkins are applied. 


V.—INFLAMMATION OF THE POSTERIOR LIGAMENTS 
OF THE CORONET-JOINT. 


Lit.: Fam bach, Deutsch. Zeitschr, f. Thiermed. 1886, p. 249. Fambach, 
Der Hufschmied. 1887, p. 131. Gutenacker, Jahresb. 1887, p. 90. 


The deep sesamoidean and the postero-lateral ligaments correspond 
physiologically to the suspensory ligament of the fetlock-joint. In 
common with the capsular and-lateral ligaments they fix the coronet- 
joint, the latter also fix the pedal joint when the limb is loaded. On 
account of the slight development and flattened shape of the upper 
articular surface of the os corone, the fixation of the pastern and 
coronet bones throws a severe strain on the limiting apparatus of the 
joints, which is greatest in the case of the lateral ligaments. These, 
therefore, become diseased, forming ring-bone ; the posterior ligaments of 
the coronet-joint also become affected, and more frequently than is 
generally supposed. 

The condition is produced by over-extension, sometimes accompanied 
by partial rupture, resulting from excessive dorsal flexion of the coronet- 
joint. Attention should, therefore, first be given to the position of the 
hoof. Low heels and lone toes are almost always the active causes. 
As first pointed out by Fambach, if the general direction of the phalanges 
(phalangeal axis) be not parallel with that of the walls of the hoof (hoof 
axis), but more upright, there is danger of straining, not only the 
different portions of the inferior sesamoidean ligament and the antero- 
lateral and postero-lateral hgaments, but the tendon of the flexor pedis 
also. I have repeatedly seen such strain when the heels of the shoes 
had become worn down. The condition is favoured by work on hard 
rough ground, especially in riding-horses; animals with upright pasterns 
and narrow hoofs seem particularly predisposed. Guteniicker has 
recently studied it carefully, and has found osteophytes at the points of 
insertion of the ligaments into the os suffraginis. 


INFLAMMATION OF POSTERIOR LIGAMENTS OF CORONET-JOINT, 545 


On post-mortem examination the ligaments on the posterior face of 
the joint are found thickened and ossified at their insertions (fig. 121). 

Symptoms.—tThe disease, which was first described by Fambach, 
is in the early stages signalised by lameness when weight is placed 
on the limb, and by the foot being rested. As the lgaments lying 
behind the coronet bear most weight, and are subject to most strain 
at the time when the limb is directly under the body, the horse avoids 
this position, and in the last phase of movement lifts the foot rapidly 
from the ground, The stride is therefore markedly shortened during this 
last period, and the lameness acquires a certain resemblance to laminitis, 
and especially to chronic navicular disease, in which the pastern is also 
upright. 

A careful local examination will at once dispel any doubts. The 
postero-lateral ligaments, and those lying beside the posterior ligaments 
of the coronet-joint, may be manually examined to detect pain. The 
foot is lifted as in shoeing, and pressure exercised alternately with the 
thumb of either hand. The ligaments le partly under, partly alongside 
of the flexor pedis perforans at the back of the pastern. To prevent 
mistakes, it is well to examine both feet. Sometimes thickening of the 
ligaments can be detected; occasionally this is of considerable extent, 
and may then best be recognised by allowing the horse to stand on 
the limb; a comparison should be made with the other foot. The 
diagnosis may further be assisted by throwing a certain strain on the 
ligaments. To do this the foot is lifted and the toe powerfully thrust 
forwards, ze, in the direction given it by the extensor muscles. Fam- 
bach found in some cases where the toes were turned in that the 
external postero-lateral ligament was alone diseased. 

In chronic navicular disease pain is produced by pressure in the heel, 
over the navicular bone, but is altogether absent in inflammation of the 
posterior coronary ligaments. Contraction of the hoof is also wanting. 
‘The fact that symptoms of laminitis, especially increased pulsation, cannot 
be detected, disposes of the third hypothesis. 

When standing, the animal avoids placing weight on the affected 
limb. To prevent stretching the inflamed ligaments, the foot is some- 
times rested with the heels on the wall of the opposite foot; or, when 
pain is excessive, it may be held off the ground with the joints flexed. 

Course and Prognosis.—Inflammation of these ligaments occurs 
almost exclusively in fore-feet, sometimes affecting one, sometimes both. 
I have also seen it in the hind-feet in heavy draught-horses, The 
‘symptoms may either appear suddenly or quite gradually, the course 
taken varying according to the severity and extent of the pathological 
changes. As in practice these cannot be directly observed, their gravity 


must be estimated from the amount of tenderness or lameness, and from 
2M 


046 FRACTURES OF THE SESAMOID BONES. 


the duration of the disease. Experience shows that severe cases gene- 
rally last six to eight weeks, those of recent origin, in which pain 1s 
slight, recovering, on the other hand, in a few days if the cause be 
removed and the horse properly shod. It is best, before formulating 
a prognosis, to await the results of the new method of shoeing. 

Treatment.—The most useful measures consist in shortening the 
toe, equalising the bearing in the joint, and raising the back of the foot 
by calkins or by thick heels. The animal must be rested. Absorp- 
tion is assisted by bandaging or by warm moist applications. Firing 
and blistering are less useful, the deep-seated position of the ligaments 
preventing their action extending sufficiently far. For some time 
after lameness disappears rapid or heavy draught is to be avoided, and: 
the horse should, as far as possible, be worked on soft ground. 


VI.—FRAGTURES OF THE SESAMOID BONES. 


Lit.: Williams, The Principles and Practice. Howell, The Veterinar. 
1864. Rutherford, The vet. journal, 1888. Schodneck, Berl. 
thier. Woch. 1890, p. 66. Field, Ausziige aus den hinterlassenen 
thieriirztl. Aufzeichnungen. Aus dem Engl. von Boddien, Bautzen 1866. 
Leisering, Dresd. Ber. 1860, p. 29. 


Though rare, these fractures have repeatedly been seen in horses. 
Williams found the sesamoid bones broken in several places after 
galloping in deep sand. Howell saw one of the sesamoid bones broken 
into five portions under similar circumstances. The sandy shore of 
Portobello is stated by him to be notorious for producing such accidents. 
Transverse fracture has been seen by Williams and by Leisering. As it 
is produced by the pull of the upper and lower sesamoidean ligaments,. 
the frequent occurrence of fracture in this place appears very natural. 
Rutherford saw a horse which after making a few bounds went very 
lame; the sesamoid bones of all four feet were afterwards found trans- 
versely fractured. I have several times seen fracture of the sesamoid 
bones accompanied by tearing of the suspensory ligament. Partial 
rupture of the suspensory ligament, with loosening of larger or smaller 
portions of the sesamoid bone, is seen in race-horses. 

I witnessed fracture of both sesamoid bones and partial rupture of 
the superior and inferior sesamoidean ligaments in a working-horse 
which had been kept in the stable for some weeks on account of lame- 
ness. Schoneck describes a similar case in a Russian trotting-horse. 
A cart-horse, which had been rested for a long time on account of 
disease of the tendons, suddenly fell in the street the first time of going. 


FRACTURES OF THE SESAMOID BONES. 5AT 


to work, and could not be got up. I found, on post-mortem, that the 
sesamoid bones of both fore-limbs were horizontally fractured, and that 
in each of the hind-feet the flexor pedis perforans tendon was torn away 
from its point of insertion into the os pedis. 

Continued rest appears to cause change both in bones and tendons 
(p. 502); the suggestion that such accidents are solely caused by the 
animal capering about is scarcely defensible. 

The symptoms are generally pronounced. In horizontal fractures 
the fragments are drawn apart and the fetlock-joint sinks to the ground, 
being no longer fixed by its suspensory ligaments. The accident is 
distinguished from rupture of the flexor pedis perforans or perforatus 
by the normal position of the hoof, the toe of which, in rupture of the 
tendons, is directed upwards, so that it no longer touches the ground. 
Rupture of the suspensory ligament produces the same change in 
position, but is easily detected on palpation. In fractured sesamoid 
there is excessive lameness, pain on pressure over the fractured bone, 
and sometimes slight crepitation. In perfectly fresh fractures a depres- 
sion may be felt between the pieces of bone, 

The prognosis is very unfavourable. Apart from the fact that 
reposition and retention are scarcely possible, it must be remembered 
that the sharp edges of the fragments may not only injure the posterior 
articular surface of the metacarpus, but may wound the flexor tendons 
which are worn through by the raw edges of the broken fragments; in 
addition, callus formation is difficult. 

I treated a race-horse for several months without success, and found 
on post-mortem examination that the broken pieces had not united, 
and that the condition was substantially as above described. Field 
claims to have seen recovery follow longitudinal fracture of both 
sesamoid bones. On account of the great pain accompanying fracture, 
excessive volar (upright pastern) or dorsal flexion (oblique pastern) 
may later result. The first occurs when pain is great and the limb is 
rested for a long time; in other cases, as when pain is slight and 
weight is placed on the foot during recovery, excessive dorsal flexion 
results. Restoration of normal position and of usefulness being very 
rare, treatment is only remunerative in valuable breeding animals. 

Treatment.—lIf treatment is to be attempted, the pastern-joint 
must be fixed in a position of moderate volar flexion by a plaster or 
strong linen bandage. Complete rest is necessary. Light horses, which 
have no difficulty in lying down and rising, do best on a soft bed; 
other patients must be slung. 


548 


SESAMOID LAMENKESS. 


VIIL—SESAMOID LAMENESS. 


Ger. Gleichbeinlihme, 


Lit.: Brauell, Gurlt u. Hertwig. 11, p. 36 u. 52. Mascher, ibid., 21, p. 
360. Giinther, Beurtheilungslehre, p. 419. Schrader, Gurlt u, 
Hertwig. 26, p. 134. James, The Vet, journ. 22, p, 154. Sie- 
damgrotzky, Dresd. Ber. 1876, p. 44. Born u. Méller, Pferde- 
kunde. Levens, B, T. W. 1892, p, 109. 


In solipeds, both the anterior articulatory surface of the sesamoid 
bones in contact with the metacarpus and the posterior surface over 


Fic. 122.—The flexor pedis 
perforans and perforatus 
tendons in a case of sesa- 
moid lameness; at the 
point where it passes over 
the sesamoid bones the 
perforans tendon is fibril- 
lated—(after Brauell), 


which the flexor tendons glide up and down are 
often the seat of acute or chronic inflammation. 
Brauell, in 1845, first drew attention to inflam- 
mation of the posterior surface, and pointed out 
that it was similar in character to that of 
chronic navicular disease. Ten years later 
Regiments-Pferdearzt Mascher described the disease 
for which Giinther introduced the name sesamoid 
lameness (Gleichbeinliihme). Schrader afterwards 
gave a thorough pathological and anatomical de- 
scription of it. Acute inflammation of the posterior 
gliding surface of the sesamoid bones sometimes 
occurs in consequence of acute tendovaginitis of 
the flexor apparatus. 

James states having found an abscess about 
the size of a walnut (?) in the sesamoid bones (?) 
of a draught-horse. It was supposed to have 
been caused by injury, and was accompanied by 
acute inflammation of the tendon sheaths. Prob- 
ably the condition was purulent tendovaginitis. 
In two horses which I treated for local gangrene 
of the skin of the hind-limbs, suppuration occurred 
in the perforans tendon sheath, with rupture of 
the flexor tendon. Post-mortem examination 
showed necrosis of the tendon, of the posterior 
surface of the sesamoid bones, and of the 
navicular bone, The process had extended down- 
wards in the track of the tendons, and attacked 
the navicular bursa. Such acute inflammation 
is of less importance from a clinical standpoint 


than the chronic processes identical in character with navicular disease, 
z.é., Which consist of an arthritis chronica, and which at times are 


SESAMOID LAMENESS. 549 


complicated with disease of the sheath of the flexor pedis perforans just 
above the fetlock. 

Pathological Anatomy.— Changes characteristic of arthritis 
chronica are found affecting the gliding surface of one or other of the 
sesamoid bones; the cartilage becomes eroded, and proliferation of its 
margins occurs. When the anterior surface is diseased, both it and the 
posterior articulatory surface of the metacarpus exhibit abraded and 
eroded spots. In disease of the posterior surface of the sesamoid bones, 
the flexor tendons appear fibrillated (fig. 122), or sometimes completely 
ruptured. Brauell saw a few cases of adhesion of the flexor tendons to 
the sesamoid bones. The sides of the bone show osseous deposits. 
The tendon sheaths and sesamoid ligaments are also thickened; some- 
times detached pieces of bone are found in the sheath (Cox). In the 
cases reported by Levens, the sesamoid bones had probably been 
fractured. 

As arule, both sesamoid bones are affected; Mascher, however, in 
some cases found disease of a single sesamoid and of the corresponding 
metacarpal articular surface. 

Causes.— Any violent strain of the flexor apparatus or increase of 
the pressure normally exerted by the flexor tendons on the sesamoid 
bones may produce this disease, and therefore both Brauell and Mascher 
regard long, weak fetlocks as the chief predisposing factor. This for- 
mation not only throws a greater strain on the tendons, but increases 
the pressure on the sesamoid bones, on account of the more oblique 
angle which the tendons make with the metacarpus (comp. p. 556). 
This probably explains Mascher’s statement that where the toes are 
turned in, the outer sesamoid is affected, and vice versa, for such defect 
of confirmation must necessarily lead to unequal pressure on the 
sesamoid bones. Heavy bodies and weak fetlocks predispose to the 
disease, which is therefore commonest in hacks and heavy draught- 
horses, and occurs without exception in the fore-limbs. Other causes 
are jumping, especially from a height, and suddenly reining up. In such 
cases, partial rupture of the flexor tendons probably occurs and starts 
the disease ; Siedamgrotzky reports an observation of the kind. In such 
exceptional cases the disease may set in with acute inflammation, but 
as a rule it develops slowly, the flexor sheaths being often simultane- 
ously affected at a point close above the fetlock-joint. 

The course is chronic, inflammation seldom subsiding, but continuing 
for long periods, and necessitating slaughter. Lameness becomes worse 
after severe exertion, but tends to disappear with rest. Complete 
recovery is, however, very rare once the disease has become well 
developed. 

Symptoms.—IJn the chronic forms, Jameness is the most apparent 


550 SESAMOID LAMENESS. 


symptom. As in all affections of the flexors, pain is greatest when 
weight is placed on the limb, the phalanges are flexed and the limb is 
rested, Volar flexion is in most cases well marked. Lameness is most 
distinct during the first few steps, but may disappear with exercise ; 
it is decreased by rest, increased by exertion, is more marked on rough, 
hard ground than on sand or grass, and is sometimes. so slight as 
only to be detected by carefully watching the animal whilst trotting, 
though in severe cases it is apparent at a walk. 

Palpation of the back of the fetlock gives pain. After some time a 
bony swelling appears, corresponding in position to the sesamoid bones. 
If the anterior surface of the sesamoids is involved, the swelling 
is close to the metacarpus, ie, at the side of the joint; in disease 
of the posterior surface, it is further back on the volar aspect of the 
joint. After a further variable period, the flexor tendons become 
swollen in the neighbourhood of the sesamoid bones, though such 
swelling may occasionally appear before the other symptoms. The 
acute form is distinguished by local heat, &c., which is absent in chronic 
cases. During the later stages there is “knuckling over” at the 
fetlock-joint, from shortening of the tendons. In one case Brauell 
found the sesamoids, in consequence of the marked volar flexion, thrust 
upwards beyond the articular surface of the metacarpus, and adherent 
in their new position. J have often seen patients in which the move- 
ment of the fetlock-joint was distinctly limited. Crepitation can rarely 
be detected. 

Diagnosis is seldom difficult, the character of the lameness being 
often sufficient, provided there is no other disease of the flexors or 
chronic navicular disease. The swelling is less to be relied on. Thus 
exostoses sometimes occur on the sesamoid bones, particularly on their 
lateral surfaces, without causing a trace of lameness, and, from their 
symmetrical appearance in both limbs, often give the impression of 
being congenital. Before delivering a prognosis, it is best to thoroughly 
examine the flexor tendons, and to make sure whether the fetlock-joint 
can be fully flexed. 

Treatment.—During the stage of acute inflammation, and particu- 
larly where the flexor tendons exhibit recent swelling, the animal should 
be rested, and the fetlock-joint, as far as possible, fixed by a firmly 
applied bandage, which may be moistened with warm water, or, in case 
of great pain, with a continual current of cold water. Mascher has 
sometimes had good results from firing and blistering, though six to 
eight weeks’ rest is then necessary. Old standing cases are not often 
benefited by such treatment. Neurectomy is the only means of remov- 
ing lameness; and, considering the seat of disease, it is better to divide 
the median than the plantar nerve. 


FRACTURE OF THE NAVICULAR BONE. Silt 


VIII.—FRACTURE OF THE NAVICULAR BONE. 


Lit.: Uhlich, Dresd. Ber. 1872, p. 325. Schram], Oesterr. Viertel- 
jahrssch, 1888. Humbert, Rec. de méd. vét. 1885. Bodenmiilley, 
Ad. Woch. 1891. 


Fracture of the navicular bone is rare, though it has been seen after 
suddenly throwing a horse on his haunches, and after movements which 
throw great strain on the flexor perforans, and therefore on the 
navicular bone. Uhlich found the bone broken in three pieces. The 
strength of the navicular bone is lessened, and fracture favoured by 
chronic inflammation like that of navicular disease, particularly after 
neurectomy has been performed. In such cases the action of the limbs 
is in no way modified by the diseased condition of the navicular bone, 
which is then readily fractured, while the flexor pedis perforans may be 
torn asunder. I have repeatedly seen, and Bodenmiiller has described, 
fracture of the navicular bone resulting from treading on nails. In 
cellulitis affecting the sensitive frog, suppuration often extends to the 
perforans tendon and navicular bone, and, if not at once checked, may 
cause necrosis both of the tendon and bone. I have often observed 
this when operating. Schraml saw fracture of the navicular bone and 
rupture or tearing away of the perforans tendon from the os pedis, and 
thinks fracture is caused, after rupture of the tendon, by the excessive 
pressure of the os coronae on the navicular bone. It is much more 
probable that the fracture had caused rupture of the tendon. 

Diagnosis principally depends on the peculiar lameness, though in 
acute inflammation of the gliding surface of the os naviculare the 
movement is similar. The foot is continuously rested, and if weight 
is unavoidably placed on it for a moment, the phalanges show excessive 
volar flexion. The toe is directed obliquely backwards and downwards. 
Marked pain is caused by lifting the foot and extending the coronet- 
joint (dorsal flexion) by pressing on the toe. Inflammatory swelling 
occurs later in the hollow of the heel. 

This fracture is distinguished from acute disease of the navicular 
bursa by the sudden appearance of lameness, and, at the commence- 
ment at least, the absence of swelling from the hollow of. the heel. 

Prognosis is unfavourable, particularly in compound fractures, 
caused by picked-up nails. There is always danger of the perforans 
tendon being injured, and, later, ruptured by the sharp edges of the 
fragments, or by the callus, or of chronic lameness appearing, hence 
complete recovery is extremely unlikely. 

Treatment is only advisable in valuable animals like those used for 
the stud. Complete rest is of first importance if the fracture is sub- 


552 NAVICULAR DISEASE. 


cutaneous. In complicated fracture caused by picked-up nails, resec- 
tion of the perforans tendon may be attempted. Humbert, in such a 
case, claims to have completely resected the navicular bone with success. 
The foot was irrigated night and day for a month after operation. In 
24 months the animal could trot sound. Experiments in this direction 
which I have made have, up to the present, failed to give good results, 
and, for the time being at least, I entertain considerable doubt of the 
possibility of cure by resection of the navicular bone. 


IX—NAVIGULAR DISEASE. 


Ger. Strahlbeinlahmheit. Bursitis podotrochlearis. Podotrochilitis (Brauell). 


Lit.: Gibson, Treat. on the disease of horse, 1751. Bridges, No foot no 
horse, 1752. Coleman, Observations, 1802. Girard, Rec. de méd. 
vét. 1824. Turner, The Veterinarian, 1829. Sticker, Gurlt u. 
Hertwig. 2, p. 184. Hausmann, Ueber Entziindung. 1837. Renner, 
Abhandlungen. Brauell, Gurlt u. Hertwig. 11, p. 1. Gerke, ibid., 
11, p. 218. Matz, ibid., 13, p. 264. Percivall, Lameness in horse, 
1849. Rainsford, The Veterinarian, 1852. Holloway, ibid., 1858. 
Anonymus, ibid., 1859. Schrader, Gurlt u. Hertwig. 26, p. 1 u 
129. Peters, Berl. Arch. 9, p. 55 u. 293. Lersering uu. Lume 
witz, Huf. d. Pferdes, 1886. Fambach, Deutsche Zeitschr. fir 
Thiermed. 1887. Smith, The Vet. Journ. 1886. 


In England, in the latter half of last century, attention was first 
directed to a disease which had become unusually common in thorough- 
bred horses. At first it was regarded as a disease of the pedal joint, 
or mistaken for contraction of the foot. It is now impossible to say 
whether the disease described by Bridges and Gibson as “grain of the 
coffin-jeint ” was identical with that now under consideration. Moor- 
croft states that he had previously seen the disease, though he had 
not directly recognised it. In a letter dated 1804, Moorcroft warns 
his correspondent against mistaking simple contraction of the foot for 
coffin-joint lameness. He describes the first condition, and states that 
it only occurs secondarily in this disease. Coleman and Turner further 
observed and described the condition, at first under the title of “ coffin- 
joint lameness,” and later of “navicular disease,” or “navicular lame- 
ness.” The French “ maladie naviculaire ” is derived from this. 

In Germany the disease was also first termed “ coftin-joint lameness ” 
(Hufgelenklahmheit). Renner endeavoured to more particularly identify 
the seat of the disease by distinguishing an anterior and a posterior 
coffin-joint lameness, and only applied the latter term to the disease 
now in question. Sticker proposed the term “ podarthrocace.” At that. 


NAVICULAR DISEASE. 55S 


time “arthrocace” was a term applied to various chronic joint diseases. 
Brauell first described the disease thoroughly, and named it “ podotro- 
chilitis.” Both names—“ navicular disease ” and “podotrochilitis "have 
the merit of at least indicating the seat of the disease in the tendon 
bursa formed by the perforans tendon at the posterior surface of the 
navicular bone just before its insertion, which Eichbaum named “ bursa 
podotrochlearis.” 

Anatomy.—At the posterior surface of the navicular bone, over which 
it glides, surrounded by a sheath, and just above its insertion into the 
os pedis, the perforans tendon becomes expanded, forming a tendon 
sheath, which sometimes suffers from acute or chronic inflammation. 
Acute inflammation is most commonly the result of some mechanical 
injury to the hoof, either by picked-up nails or by stones becoming fixed 
under the shoe. In the case of picked-up nails, the bursa podotro- 
chlearis is either directly wounded or inflammation extends to it from 
the sensitive frog. Such acute conditions are described under Diseases 
of the Hoof. 

The conditions included under the title to this section are all chronic, 
and vary greatly in origin, intensity, and extent. As, however, there is 
no satisfactory method of clinically separating them, we are forced to 
regard them under the one head, which therefore includes all aseptic 
inflammations in this position, and especially those of a chronic 
character. 

Pathology and Causation. 

The following structures are affected :— 

(1) The navicular bone. 

(2) The perforans tendon. 

(3) The bursa podotrochlearis. 

Opinions are divided as to the point of origin of the disease. Turner 
places it in that portion of the bursa surrounding the tendon, Fambach 
considers the disease starts from rupture of fasciculi in the tendon. 
Schrader and others locate the primary disease in the gliding surface 
of the navicular bone. LBrauell, however, maintains that the point of 
origin is not constant, and that sometimes one, sometimes the other 
tissue first becomes affected. The fact that the perforans tendon is 
always found diseased does not prove that the first changes occur in it, 
for immediately the surface of the navicular bone becomes roughened 
the tendon is endangered. Tho gliding surface of the navicular bone 
seems to be the commonest point of origin. Both the course and 
character of the process support this view. Little spots no larger than 
a millet-seed are to be found here, generally about the centre of the 
middle elevated portion, over which the cartilage appears coloured. 
Smith views these as calcareous deposits, but microscopic examination 


554 NAVICULAR DISEASE. 


reveals the same conditions as in arthritis chronica deformans, 7.c., pro- 
liferation of cartilage cells, with fibrillation of the intercellular substance. 
The cartilage thus altered loses its consistence and becomes eroded 
(fig. 123). 

As soon as the substance of the bone is attacked, granulations form, 
causing destruction of neighbouring portions of cartilage and of bone. 
Rarefying ostitis sets in; the compact tissue, normally of a yellowish- 
white, takes on a reddish colour, and disappears more and more in con- 
sequence of increasing proliferation of the medullary tissue. The bone 
may thus be so much weakened as to readily fracture under pressure of 
the tendon (Smith). Smith states having seen, in certain cases, change 
in the compact tissue precede that in the cartilage: this is more 
frequent where both feet suffer. As a rule, these peculiar osteophytes, 
which resemble those of arthritis deformans, and appear as though 
poured out on the surface, can be found on the margins of the navicular 
bone, and especially on the upper margin, where the bursa extends from 
the tendon on to the bone. The ligaments of the navicular bone become 
thickened, and sometimes ossified (Giinther). The upper surface of the 


Gy 
[ 


NE 


ene | 


Fia, 123.—Navicular bone in chronic navicular disease-—(after Brauell). 


bone, which contributes to the formation of the coffin-joint, is never thus 
affected. 

When the condition is preceded by bursitis, which Williams considers 
common, the parts are more or less reddened and injected, and the bursa 
is thickened and its surface roughened. Such disease must, of course, 
affect the tendons and navicular bone. 

Finally, inflammation may extend from the flexor perforans to the 
navicular bone; Fambach, indeed, regards this as the rule. Isolated 
fasciculi of the tendon are ruptured by excessive strain, and the process 
commences. But the course of the disease, and especially its long 
period of development, contradict this view, though it is a fact that, 
with few exceptions, the tendons are always affected. Smith found 
disease of the tendon in 99 per cent. of cases. The portion of tendon 
in contact with the navicular bone at first shows brown-coloured spots, 
its surface loses its. glistening character, and soon shows abrasion. 


NAVICULAR DISEASE. 555 


Single fasciculi on the surface of the tendon become ruptured (fig. 124), 
partly torn away, and rolled upward. Microscopic examination shows 
them to have undergone fatty degeneration (Smith). In old cases the 
tendons may be extensively eroded, and finally rupture. Almost all 
such changes in the tendons are, however, secondary. Immediately the 
surface of the navicular bone becomes rough from loss of the cartilage, a 
rubbing action, similar to that between the articular surfaces in arthritis 
-deformans, occurs between the rough navicular surface and the tendon. 
The fact that the portion of tendon most frequently affected is that 
exactly over the navicular bone supports this view, though granulation 
on the navicular bone may not be the sole cause of change in the 
tendons: rupture of fasciculi may perhaps at times be a primary con- 
dition, and seems indicated where the disease appears suddenly with 
severe lameness. Under favour- 
able circumstances, and with long 
rest, union occurs between the 
perforans tendon and the navicular 
bone, being favoured by the granula- 
tions on the latter. The portions 
of tendon thus altered later become 
ossified. 

Causes.—The tendency to navi- 
cular disease probably depends 
largely on peculiarities of con- 
formation; hence the hereditary 
character of the disease, and its 
tendency to attack more than 
one foot at the same time. Smith 

: : Fira. 124.—Flexor pedis perforans tendon in 
seeks to explain the disease by chronic navicular disease—(after Brauell). 
referring it to faulty develop- 
ment of the bony tissue of the navicular bone. Theoretically 
nothing can be adduced against this view, but further investigations can 
alone determine to what extent such peculiarities act as causes of the 
<lisease. One argument against it is, that the disease almost invariably 
occurs in well-bred horses, especially in those with narrow, high feet. 
In coarsely-bred animals it is only seen exceptionally, and under very 
special circumstances. 

Only two cases are reported of the disease also affecting the hind- 
feet. In both cases the investigators (Wrainsford and Fambach) con- 
firmed their diagnosis by post-mortem examination, aud there is no 
doubt that chronic inflammation of the gliding surface of the navicular 
bone and of the perforans tendon had occurred, but no explanation of 
the cause is given. In Fambach’s case the horse was lame for nine 


f 
Tl 
syyantrcneer 


ORIEL ULL LLL 


556 NAVICULAR DISEASE. 


months; as much as possible it avoided placing weight on the hmb, and 
both during movement and at rest kept the limb flexed. 

The almost constant occurrence of navicular disease in the flexor 
apparatus of the fore-limb and in the bursa podotrochlearis is partly 
due to the greater weight borne by the front-feet and to the violent 
strains thrown on the flexor tendons during rapid movement on hard 
ground or under the weight of the rider. Under these circumstances 
the navicular bone is exposed to severe pressure on the one side from 
the coronet bone, on the other from the flexor tendon; and though 
disease of the joint is seldom caused by bruises from below when 
moving over uneven ground, yet such an accident is conceivable. It is 
still very doubtful how strains, &c., act in producing the disease. The 
variety of opinion on this point is to some extent due to confusing 
cause and effect. In no lameness are errors of diagnosis so common as. 
in navicular disease. 

English authors consider that a small, narrow condition of the hoof 
often causes this disease, the strongly arched sole pressing on the 
navicular bone. This view is due to confusing navicular disease with 
contracted sole (Sohlenzwanghuf), as Brauell has pointed out. Williams 
regards the upright position of the fetlock as a predisposing factor, a 
view which is pertinent, so far as the position of the fetlock is in some 
degree referable to that of the hoof. 

Peters and Fambach first explained the connection between this 
conformation and the disease. Excessive lowering of the heels causes 
the axis of the hoof to become more oblique than that of the pedal bone, 
and throws excessive strain on the flexor perforans at every movement. 
The pressure on the navicular bone thus produced is increased by the flexor 
tendon describing a sharper curve in its passage over the navicular bone. 

Leaving the toe too long may similarly cause the disease, or induce 
inflammation of the flexor tendons. The upright position of the pastern 
is not the sole factor, but acts in conjunction with faulty trimming of 
the hoof. Williams’ view, that the most important factor is the failure 
to neutralise shock, appears incorrect, because under these circumstances 
the tendons would escape injury. Finally, it must not be forgotten that 
uprightness of the pastern may not only be a cause but also a conse- 
quence of the disease. 

Peters explains the fact that horses which stand “ over” on the front- 
feet more often suffer from this disease, by drawing attention to the 
sharper angle made by the flexor pedis when passing over the navicular 
bone, and directs attention to the circumstance that when the limb is 
loaded, and the os pedis in consequence sinks, that tension in the 
tendons increases, and, consequently, that greater pressure is exercised 
on the os naviculare. 


NAVICULAR DISEASE. 5by 


The frequent occurrence of navicular disease in horses with long 
pasterns is explained by the greater stress thrown on the tendons, On 
the other hand, obliquity of the pastern is in some respects an advan- 
tage, because the flexor perforans takes a straighter course over the 
navicular bone. 

Giinther thinks that turned-in toes predispose to the disease. Hert- 
wig’s view, that high heels favour its production, is based on a miscon- 
ception, though raising the frog from the ground may throw increased 
strain on the flexor tendons, The same applies to contraction of the 
foot, often blamed as a cause of the disease: it occurs during the 
development of the condition. 

Excessive pressure on the navicular bone accompanying sudden partial 
rupture of the perforans tendon may give rise to the disease, and was 
regarded by Fambach as the rule. I incline, however, more to Peters’ 
opinion, viz., that navicular disease is due to slowly acting influences con- 
sequent on change in position between the bones of the hmb or between 
them and the hoof axis, an idea which receives support from the slow 
character of the change. In riding- and carriage-horses, initial injury 
may be occasioned by sudden reining in, jumping, continued sharp 
trotting, galloping, and occasionally even by slipping. 

English authors, among them Turner and Goodwin, think it may be 
caused by long rest, desiccation destroying the elasticity of the hoof and 
favouring the disease. I cannot agree with Smith in thinking that con- 
tinued standing on a particular foot causes the disease. I have often 
seen descent of the os pedis under such conditions, but never navicular 
disease. Some of the above views may be due to faulty diagnosis and 
mistaking “contracted sole” for navicular disease, especially considering 
the favourable course noted by the older English authors, who report 
90 per cent. of recoveries. Bruises of the sole and frog are only 
occasional causes of navicular disease. 

In rare cases the disease occurs metastatically after influenza, and 
then generally in badly-bred and flat-soled horses, a fact which perhaps 
explains Brauell’s statement that horses often suffer from the disease after 
having had diarrhoea. This was possibly due to secretory metastasis, 
disease of the bursa occurring in consequence of specific micro-organisms 
obtaining access to it. 

Symptoms and Course.—The more important symptoms are— 

(1) Lameness. On account of its slow development the beginning of 
the disease is generally overlooked, and attention only directed to the 
parts after pain and lameness have set in. Lameness begins gradually : 
the first few steps, particularly if taken on hard ground, are painful, but 
this often disappears completely with exercise. When both feet are 
affected diagnosis is still more difficult. There may only be a tendency 


558 NAVICULAR DISEASE. 


to stumble (Smith). The seat of disease explains why pain should be 
most marked when weight is placed on the limb. Even in the stable 
the diseased foot is rested. As pressure on the affected navicular bone 
is greatest when the limb is directed backwards, at which time, of course, 
the flexor perforans is under most tension, the animal endeavours, as far 
as possible, to shorten this phase of movement, and, to remove weight 
from the tendon, the foot is held in a position of volar flexion with the 
pastern bone upright, sometimes to such a degree that the heels scarcely 
touch the ground. The gait then becomes stiff and insecure, and the 
animals readily stumble. 

When both feet are diseased the animal tries to shorten those phases. 
of movement in which weight is borne exclusively by one foot, and the 
limb is therefore carried stiffly and rapidly forwards. Spooner says. 
the animal moves as though it had a wooden leg. Owing to the pain 
the horse moves slowly, sweats, and soon becomes exhausted. 

Sometimes the difficulty in movement disappears after a few steps ;. 
sometimes it is permanent, or may even increase with exercise, depend- 
ing on the position, nature, and extent of the disease. It is usually 
more marked after great exertion. It occasionally disappears com- 
pletely after a long rest—a fact which renders diagnosis difficult, and 
may give the impression of recovery. To sum up, the symptoms are as 
follows :—-Lameness when weight is placed on the lhmb, increased after 
considerable exertion, decreased by long rest; volar flexion of the 
phalanges and extension of the foot, particularly during the first few 
steps. 

(2) Changes in the hoof. The local inflammation may be detected 
by exercising pressure on the navicular bone. One jaw of the pincers. 
is applied over the centre of the frog, the other over the wall of the toe. 
Hertwig’s special pincers are unnecessary ; but if the sole and bars are: 
very thick, they should be thoroughly pared before using the pincers. 
Pain can sometimes be detected by pressing with the thumb in the 
hollow of the heel. In doubtful cases Brauell recommends the use of 
a bar-shoe, the heel of which covers the centre of the frog. This. 
increases the lameness in real cases of navicular disease. 

In some cases forcible dorsal flexion gives pain. The foot is lifted 
as in shoeing, and the toe pressed slowly and powerfully downwards, or 
the horse is so placed that its toe rests on an elevation, thus causing the 
heels to be abnormally low when weight is placed on the foot. The 
same thing often occurs accidentally when the horse is moved on uneven 
ground, and produces very marked lameness. As a rule, there is no 
increased warmth or pulsation. Brauell and Haubner have drawn 
attention to the erroneous view advanced by English authors (Turner), 
viz., that increased pulsation was a symptom of this disease; Hausmann, 


NAVICULAR DISEASE. 559 


indeed, views absence of pulsation as pathognomonic of the disease in 
question, As already stated, other diseases associated with increased 
pulsation, such as contracted sole (Sohlenzwanghuf, laminitis ?), are often 
mistaken for navicular disease ; but as there is no acute inflammation, the 
absence of increased warmth and marked pulsation are not surprising. 

During the further course of the disease the hoof contracts, and the 
heels become longer and narrower. These changes in size and form 
suggested to Sticker the invention of a podometer—an instrument, 
however, which is of no particular value for diagnosis, and can be easily 
replaced by the meter used for measuring the angle of the hoof. 

As the patient no longer places weight on the foot, local nutrition and 
horn production suffer, the hoof contracts, and the coronary band appears 
more prominent, and seems swollen, The uprightness of the pastern 
causes the hoof to take a more perpendicular position as time goes on, 
The frog is also relieved of pressure, and this, with the defective 
development of the hoof, leads to shrinking in of the heels and atrophy 
of the frog—ain short, to contraction of the foot, the horn sole then 
appearing abnormally concave. 

That all these changes are due to diminished pressure and movement 
of the hoof is shown by the fact already pointed out by Williams, that 
they gradually disappear after operations like neurotomy, which remove 
the lameness. 

Although contraction of the hoof is important in diagnosis, it should 
never alone be relied on, because, as Haubner pointed out, the left foot 
is often smaller than the right. 

The quality of the horn also suffers during the disease. The wall 
frequently appears uneven, rough, or covered with rings, and its horn 
brittle. 

In the later stages the muscular tissue of the limb disappears more 
or less, depending on the degree of lameness (atrophy from want of 
function). 

The first stages of the disease generally pass unnoticed, until the 
eradual increase of lameness draws attention to them. The lameness 
may disappear with long rest, but always returns after hard work. 
Weeks and months pass, until at last it becomes necessary either to get 
rid of the animal or to perform neurectomy. Recovery is rare, and sup- 
posed cures mostly result from faulty diagnosis or from mistaking 
remission for recovery, as shown by the above-reported opinions of the 
older English authors, who put the average of recoveries at 90 per cent. 
Bracy Clark, an able observer, assesses them, on the other hand, at 1 in 
i6. From the nature of the disease, recovery must be rare, and can 
only occur during the first stages, z.c., while the disease is confined to 
the bursa of the flexor tendon. Prognosis is most favourable when, on 


560 NAVICULAR DISEASE. 


account of the sudden onset of lameness, there is a probability that 
inflammation is confined to the tendon and bursa, and that the flexor 
surface of the navicular bone is still intact. But when atrophy of 
muscle or hoof has set in, improvement is not to be expected. Excep- 
tional cases are seen, however, where recovery, or at least cessation of 
lameness, is produced by adhesion of the perforans tendon to the 
navicular bone. Gerke confirmed this by a post-mortem two years 
after the disappearance of lameness. Peters had a similar case, and has 
most kindly placed at my disposal the anatomical preparations ; but 
such a termination is very exceptional. 

Neurectomy, often resorted to to remove sensation, is apt to be 
followed by rupture of the perforans tendon. The tendon becomes 
more and more abraded by the rough surface of the navicular bone, 
until, at last in a moment of excessive strain, it suddenly tears 
through, leaving the horse completely useless. Temporary improvement 
following long rest must not be mistaken for cure. 

In Germany the disease is not nearly so common as is believed, and 
is often confused with diseases of the hoof and other lamenesses. 
Errors are easy, unless plenty of time is given to the examination, and 
diagnosis sometimes proves difficult even to the most practised. 

Differential Diagnosis. 

The condition may be mistaken for— 

(1) Contracted foot (Sohlenzwanghuf). The form of the hoof, the 
strongly concave sole, the curving inwards of the heels, the blood-stains 
in the white line and at points in the sole, are, however, sufficiently 
distinctive, while in contracted foot pain is more marked after pressure 
on the sole than on the frog, and lameness generally appears after 
shoeing, and disappears with careful paring of the sole and appropriate 
shoeing. Horses with contracted sole not infrequently go more dis- 
tinctly lame on soft than on hard ground, but in navicular disease the 
reverse is the case. 

(2) Greater difficulty is sometimes offered by cases of “ wiring-in of 
the heels” (Trachtenzwanghuf), which also at times appears as a 
symptom of navicular disease. Usually, however, there is then 
increased pulsation and pain on pressure over the quarters, though 
“ wiring-in” of a secondary character may contribute to lameness. In 
such case the frog should be carefully tested with the pincers. 

(3) Sprain of the posterior ligaments of the coronet-joint. This 
lameness is usually more severe. The posterior surface of the coronet- 
joint is then the seat of pain, whilst pressure on the sole causes no 
flinching (compare p. 545). 

(4) Some caution is required where thrush is present. If sufficiently 
extensive to involve the greater part of the frog, pressure on the thrush 


NAVICULAR DISEASE. 561 


may produce symptoms simulating those of navicular disease. The 
operator should then try the effect of forced dorsal flexion, which is not 
painful in thrush. 

(5) The symptoms of sesamoid lameness present a certain similarity 
to those of navicular disease (p. 549); a careful local examination is 
therefore necessary. 

Treatment.—<As above stated, recovery is only possible when the 
local changes are capable of repair. Disease which starts 
as an acute bursitis or tenositis offers some chance of 
cure, though inflammation soon extends to the articular 
cartilage of the navicular bone, and the condition becomes 
as intractable as if it started at this point. In recent cases, 
long rest and antiphlogistic treatment sometimes check 
inflammation and assist repair. Soft bedding, like sawdust, 
tan-bark, or peat, should be provided, and the feet kept 
moist ; thoroughly paring the hoof, so as to assist the action 
of cold moist applications, is useful. The presumed effi- 
cacy of bleeding (recommended by Turner and Goodwin) 
and of frog-setons (Sewell) depends on errors in diagnosis. 
In recent cases, the rest rendered necessary by setoning 
assists repair, but Brauell rightly questions the resorbent 
action of setons: continued rest is known to temporarily 
alleviate the lameness, and is sometimes resorted to by 
horse-dealers preparatory to sale. Rest and the inflam- 
mation produced in the fibro-fatty frog may, however, 
assist adhesion between the navicular bone and flexor 
tendons. Frog-setons were first recommended by Sewell, 
who constructed a special sharply-curved needle with a 
handle and sharp point (fig. 125) for the purpose of 
inserting them. The seton is best passed in the standing 
position, the limb being fixed by means of a_ knee- 
hobble (comp. p. 425, General Surgery), otherwise the foot 
may be moved during operation, and the needle broken. 
The point of the frog is first pared away, and a 
twitch having been applied to the nose or ear, the Fic.125— 
needle, previously threaded, is thrust into the hollow gee ee 
of the heel, through the plantar cushion and sensitive 
frog, so as to emerge at the point of the frog. The handle is 
then removed, the needle drawn through the frog, and the ends of the 
tape knotted together at the heel. The seton is left in position twelve 
to fourteen days, being moved daily to allow free discharge of pus. 
Sometimes it is saturated with oil of turpentine. 

There is no particular danger in passing frog-setons, though some care 

2N 


562 NAVICULAR DISEASE. 


is required to avoid injuring the perforans tendon; the tape must not 
be left too long, as it may be caught by the other foot and torn out. 

Restive horses require to be thrown for operation ; it is convenient 
to fasten the foot by means of a side-stick. 

The seton needle must be regularly but not too sharply curved; I 
prefer a nearly straight needle, similar to that used in cellulitis of the 
fibro-fatty frog. 

If setoning fails, nothing remains but to perform neurectomy. My 
present experience leads me to doubt the utility of resection of the flexor 
tendon, as in my hands it leaves the horse either permanently lame, or 
necessitates so long a rest as to be of no practical service. 

A valuable carriage-horse, which had for a long time suffered from 
navicular disease, contracted acute inflammation of the navicular joint in 
consequence of bruised sole. Operation was at once resorted to, and the 
navicular bone and perforans tendon found to be chronically diseased. 
The case did well, and the horse returned to work, but for several months 
trotted slightly lame. 

Proper shoeing is of great importance, both in preventing and treating 
this disease. In general, it is well to shorten the toes and lengthen the 
heels, either by suitably paring the foot or by applying leathers or shoes 
with thick heels. 

In marked contraction of the foot, india-rubber or cork pads or long- 
heeled shoes may be employed. Defay’s shoes sometimes diminish 
lameness considerably ; their action is assisted by moderate exercise on 
soft ground and by foot-baths. 

Tenotomy, recommended by Smith to assist adhesion of the perforans 
tendon to the navicular bone, is, in my experience, unsuccessful. 


X.—GREASE. 


Lit.: Numan, Gurlt u. Hertwig. 5, p. 59. Cock, Her. Rep. 13, p. 360. 
Delprato, Her. Rep. 16, p. 275. Straub, Her. Rep. 14, p. 213, 
Leblanc, Gurlt u. Hertwig. 17, p. 238, u. 18, pp. 42 u. 214. Siedam- 
grotzky u, Born, Zeitschr. f. Thiermed. 1886, p. 180. Moller, 
Monatsschr. 1889, p. 389. Dieckerhoff, Spec. Path. u. Therapie. 
Straube, Zeitschr. f. Veterk. 1890, p. 1. Griinwald, Oest. Monatsschr. 
1892, p. 168. Malzef, Bakteriolog. Untersuch. tiber die Aetiol. der 
Mauke (russisch). Dalrymple, Amer. vet. rev. vol. xiv. Kropf], 
Oesterr. Monatsschr, 1892, Nr. 7. Bermbach, Zeitschr. f. Vet.-Kund. 
1891, p. 111. Berger, Oesterr. Monatsschr. 1892, p. 529. 


The term “ grease” has been used since olden times to designate a 
series of disease processes in the skin about the fetlock, particularly on 
its flexor surface, the nature and course of which are exceedingly varied. 


~ 


GREASE. 563 


Certain characters are, however, common to all forms of grease, viz., its 
point of origin in the heel, its inflammatory nature, and its spontaneous 
appearance. The disease may be divided into four varieties :— 

(1) An erythematous. 

(2) An exanthematous. 

(3) A gangrenous. 

(4) A verrucous form. 

The first three follow on acute inflammation of the skin, which, how- 
ever, may be attended with complications, and may later assume a 
chronic course. ‘The last form is usually chronic. 

(1) Dermatitis erythematosa. This is the mildest form of grease, and 
is commonest in horses with thin, fine skins; well-bred animals suffer 
more frequently than heavy working-horses. In many horses the skin 
of the pastern-joint seems exceedingly sensitive, so that even the pres- 
ence of sand in soft soils may cause irritation, and give rise to this form 
of grease. The skin, which is free of pigment, appears red and rather 
painful, but after a few days these symptoms disappear, and active 
desquamation sets in. The disease consists of hyperemia of the papil- 
lary layer of the skin, produces no permanent injury, and only occasion- 
ally requires special treatment. When, however, the condition is 
neglected, and the horse continues to work, this form of grease may give 
rise to the next in order. 

(2) Dermatitis eczematosa. Eczema, or inflammation of the skin, 
appears spontaneously, is ushered in with swelling and redness, usually 
soon leads to exudation from the surface, and in general takes a typical 
course, which, however, is less easily studied in this position than in 
others. The swelling and redness are often scarcely visible, though there 
is lameness, especially when the animals are first moved, whilst the 
surface of the skin becomes covered with a yellowish-red fluid, which 
soon dries to a brownish crust. The papular stage is not well marked, 
though the vesicular stage, 12. the formation of small bladders, may 
sometimes be noted. The weeping stage (stadium madidans) appears 
more distinctly, and is rapidly succeeded by the formation of crusts 
(stadium crustosum). The crusts soon loosen under proper treatment, and 
desquamation follows (squamous stage), revealing normal epidermis. In 
characteristic cases the process takes eight to fourteen days, and ends 
in complete recovery, but not infrequently complications occur, especi- 
ally if the animals are worked during the disease. The movement 
of the skin produced by walking, assisted by the presence of foreign 
material, interferes with regular healing, and leads to the formation of 
folds, cracks, and fissures. Chronic proliferation then sets in around 
these, and leads to the formation in the hollow of the fetlock of thick 
cicatrices, which can only be removed by operation. 


564 GREASE. 


During the inflammatory stage the animals go very lame, especially 
for the first few steps, but improve after a short time at exercise. 

Causes.—‘“ Well-feathered” horses often suffer from this form of 
grease when working on wet ground. The epidermis is continually 
moistened, becomes macerated, and inflammation is then readily pro- 
duced in presence of infectious substances. The absence of visible 
external cause, and the simultaneous appearance of disease in several 
feet, or in several animals in the same stable, gave rise to the idea that 
grease was a blood disorder, and should be regarded either as a 
metastasis or as erysipelas. The fact that the same causes were acting 
on a considerable number of animals at the same time was over- 
looked. 

Jenner declared equine grease to be identical with cow-pox. Since 
his time “ protective grease” has even been spoken of, though neither 
Jenner’s experiments nor those instituted later im any way support this 
view. Many years ago it was denied by Leblanc, Deprato, and 
by other observers, and at the present time no doubt exists that 
eczematous grease is dissimilar to variola. It is even a question 
whether horse-pox can be included in the same category with grease. 
In France medical practitioners have claimed to have inoculated men 
with grease, and thus proved its variolous nature. But Leblanc 
pointed out the untenability of this view. He showed that the 
case of erease from which inoculation was said to have occurred 
had been in existence for six months, and therefore could cer- 
tainly not have been variola. The description indicates the case to 
have been verrucous grease. Dieckerhoff has suggested that Bouley’s. 
“ protective grease ” was probably stomatitis pustulosa. Berger declares 
having seen grease produced in horses by inoculation with sheep-pox, 
but his observations do not appear very trustworthy. The attempts. 
made in France to inoculate horses with cox-pox and cows with grease 
altogether failed. In the light of recent knowledge, it is easy to under- 
stand that the secretions found in the latter stages of grease produce 
inflammatory processes in man, but this in no way demonstrates their 
specific character. 

Grease has been described by various writers, amongst others by 
Hertwig and Spinola, as an erysipelas. But this view is supported 
neither by the mode of origin nor by the course of the disease ; and even 
though Malzef lately found, in cultures prepared from cases of equine 
erease, a micro-organism which appeared identical with Fehleisen’s 
streptococcus erysipelatis, yet latter-day views of the relationship of 
the streptococcus to erysipelas and to suppuration in no way bear out 
the above suggestion. 

Eczematous grease is usually produced by external irritation either of 


GREASE. 56 


OU 


a mechanical, chemical, or specific character. The disease often occurs 
soon after shoeing with high heels, because the changed position of the 
foot favours the formation of the folds in the skin just above the heels, 
in which sand and dirt lodge, and produce excoriation. Animals 
working on stubble or freshly-laid roads or forest paths are apt to 
contract slight skin injuries, which sometimes form the point of origin 
of disease ; the wound discharges, macerating the epithelium, irritating 
the skin, and producing inflammation. Griinwald describes an enzootic 
grease which appeared during the hottest part of summer amongst 
horses stalled in the open air under sheds, and in which the lower 
portions of the limbs were continually exposed to the sun’s rays. 
Horses which were sheltered from the sun were not affected, a fact 
which led Griinwald to compare the condition. with erythema solare of 
man, 

Kropfl noticed the same thing in horses at grass. Only the unpig- 
mented portions of skin in the hind-limbs seemed to be diseased. 

Bermbach believed that grease was conveyed from horse to horse 
by using the same washing-pails, &c. More probably the same general 
external influences were at work. 

Amongst chemical irritants must be numbered chalk-dust. In the 
army its action is often troublesome, on account of horses becoming 
affected immediately they are brought into chalky regions. I have 
repeatedly seen this. Columella had even noticed it, for he writes— 
“equus, qui hieme laborat, eundo per lutum, in aestate per pulverem.” 
The action is chemical, as shown by the fact that disease is favoured by 
washing the feet, the best preventive being simply to cleanse the parts 
with a dry cloth. 

Observations made on men, dogs, and other animals seem, however, 
to favour the belief that eczematous disease may be associated with 
constitutional changes, which are at present very imperfectly under- 
stood. 

Course.—Early and appropriate treatment generally results in 
complete cure in eight to fourteen days. Where, however, the disease 
is neglected, recovery is impeded by the formation of fissures and of 
new connective tissue, which latter sometimes produces prominent thick 
swellings in the pastern-joint. Though simple cracks soon heal with rest 
and proper treatment, large masses of new tissue are very often difficult 
to deal with, especially if adherent to the subjacent flexor tendons and 
sheaths. Before giving an opinion, the parts should therefore be 
thoroughly examined. 

The treatment of eczematous grease requires in the first place rest, 
because movement keeps up inflammation and favours the formation of 
fissures and of excessive quantities of cicatricial tissue. The skin should 


566 GREASE. 


be carefully cleansed with warm water and soap, the swellings rinsed with 
creolin solution, dried, and dressed with iodoform and tannin (1-3). An 
ointment of red oxide of mercury one part, with paraffin base or lanolin 
five parts, is useful. It may be smeared on wadding, laid on the surface 
of the wound, and fixed in position by a bandage. The dressing keeps 
out the air, and may be left in position until wet through, when the 
diseased spot is again cleansed and the dressing renewed. 

Recovery generally follows in about eight days. Even deep fissures 
are soon cured by complete rest, and the use of the ointment and a 
dressing. 

To check excessive proliferation (“proud flesh”) and cicatrisation, 
astringents like alum or sugar may first be tried; and in the event of 
their proving unsuccessful, caustics, nitrate of silver and sulphate of copper, 
are often of service. Mineral acids must be applied with caution, to 
avoid excessive destruction of tissue and risk of opening tendon sheaths. 

Cicatrices which project above the skin, or which, from contraction, 
have become hard and sharply marginated, can only be dealt with by 
the knife, caustics being in most cases useless. The portions of growth 
overtopping the neighbouring skin are removed, with antiseptic pre- 
cautions. The parts should be washed with sublimate, creolin or 
carbolic solution, and a dressing moistened with one of these materials 
applied and left in position twenty-four to forty-eight hours. This 
sterilises the point of operation. In quiet animals, the parts may be 
removed whilst standing; if necessary, cocain can be locally injected. 
Restive horses should be cast. The foot is extended as far as possible 
—in the case of the hind foot,it may be bound to the front one. The 
incisions should be smooth and regular; bleeding is generally slight, 
and can be checked by a pressure dressing, which at the same time 
prevents excessive new growth. By resting the animal and keeping 
the stall dry, healing is generally complete in eight to fourteen days, 
provided the growth is not extensive, z.¢., not more than 1 to 2 inches 
in size, otherwise cicatrisation proves difficult, and the growth is 
inclined to recur. During the past few years I have repeatedly 
removed growths of this kind from the hind pastern, and have cured 
cases in which medical treatment had proved useless. 

(5) Dermatitis gangrenosa has a special surgical interest, because ié 
often forms the first of a series of diseases which call for the display of 
surgical skill. It consists in spontaneous gangrene of the skin of the 
phalanges, occurs in solipeds, particularly during winter, and is oftenest 
seen in large towns. 

Causes.—The fact that gangrenous dermatitis occurs almost always 
in winter, and especially in cold countries, has suggested the idea that 
it is due to freezing of the skin. The fact that the disease does not 


GREASE. 567 


occur so much during periods of excessive cold as during thaws was 
not held to altogether disprove that view ; for it seems natural that moist 
cold should be particularly injurious, on account of its neutralising the 
protection afforded by the hair, and enabling the cold to act directly on 
the skin. The theory, however, is not in keeping with the local 
character of the disease. Were cold the sole agent, symptoms of 
freezing in the first and second degree might fairly be looked for around 
the gangrenous spot. They are, however, generally absent. The 
experiments of Siedamgrotzky and Jelkmann showed that the lowering 
of temperature, consequent on the use of salt (which is particularly 
common in large towns), could not be held responsible for the produc- 
tion of the disease. And, finally, it should be noted that at times, 
when gangrenous dermatitis is common, all wounds show a tendency to 
gangrene. It, therefore, seems tolerably clear that local freezing is not 
the only cause, but that other factors, probably of an infectious character, 
are also at work. Slight injuries to the lower portions of the limb lead 
to septic infection, which may result in inflammation, and when assisted 
by cold, in gangrene. In addition, cold readily produces necrosis in 
wounds, thus providing septic substances with a soil favourable for 
development. Whatever view may finally prove correct, thus much is 
certain, that as a rule infection acts along with cold in giving the first 
impulse to the production of gangrenous dermatitis. That this form of 
grease does occur, in exceptional instances, even in the warm season, 
only shows that gangrene of the skin may be produced independently 
of cold. 

Symptoms and Course.—The disease appears suddenly, gener- 
ally over-night. There is severe lameness in one or other limb, with 
inflammatory swelling of its lower portions, sometimes also in the upper 
parts. Fever is also common. More careful examination detects at a 
given spot a portion of skin, from 1 to 2 inches in diameter, which 
is soft, yielding, and swollen: pressure over this spot causes severe 
pain, and produces discharge of a reddish. turbid fluid. The pastern is 
the most common seat of disease, at a point just over the bulb of the 
heel, or on the anterior surface near the coronet. The pain continues, 
the limb increases in size, and in two to three days the gangrenous 
portion of the skin is cast off as a soft, grey, slimy mass: the resulting 
wound then becomes covered with granulations, which gradually fill up 
the cavity. In favourable cases a cicatrix forms, and recovery is com- 
plete in one to two weeks. 

But the disease does not always take so favourable a course; some- 
times the gangrenous inflammation extends downwards to the lateral 
cartilage, or the coronet bone, or penetrates to the sheath of the flexor 
tendon. In the first case a quittor forms, in the second an exostosis, 


568 GREASE. 


which later becomes a ring-bone. And if in such cases suitable treat- 
ment often leads to recovery, uc., to removal of lameness, yet when the 
sheaths of the tendons are also attacked, death usually occurs in a short 
time from septicemia or pyemia. If the necrotic process extends to 
the coronary vessels, pyzemia is apt to result. In the neighbourhood of 
the coronet, gangrene may extend to the coronary band, and produce 
severe inflammation, followed by loss of the hoof. 

Prognosis depends on the extent, position, and character of the 
disease. The larger the gangrenous piece of skin, the greater the 
difficulty of treatment, and the danger to deeper-lying structures. 
Gangrene near the coronet threatens the pedal joint, in the pastern the 
sheaths of the flexor tendons. Implication of tendon sheaths at once 
renders prognosis unfavourable. The same is true of complications like 
septiceemia and pyzemia; in this case the swelling rapidly extends upwards, 
often tu the elbow or knee, becomes very painful, and is accompanied 
by high fever. The character of the process may at. times vary; in 
certain years gangrenous dermatitis seems particularly malignant, and 
inchned to be complicated. The continuance of great pain after the 
necrotic portion of skin has separated is an ominous symptom. 

Treatment.—As a preventive measure, the feet in winter, and 
especially during thaw, should be kept as dry as possible, and care 
taken to protect them from the street mud, which macerates the 
epithelium, and favours infection and gangrene. The hair on the fetlock, 
and especially in the pastern-joint, may be anointed with fat, so as to 
keep out mud and water. This precaution, which I have often 
employed in large studs, has always had good results. For a similar 
reason, the feet should be carefully cleansed after work, and if possible 
dried; an excellent plan being to rub them with dry sawdust, wood- 
wool, or peat-moss. If horses with injuries like cracks or fissures about 
the feet are kept at work, the wounds should be carefully cleansed and 
smeared with tar or creolin; and if the external temperature be below 
the freezing-point, a dressing may be applied. 

If gangrene has already set in, its further progress may be prevented 
or checked by placing the parts in a lukewarm bath of sublimate or 
creolin solution, with which the affected spot may be frequentiy washed. 
At night a bandage should be used, moistened with camphor, or 10 per 
cent. chloride of zine solution. Lately I have had excellent results from 
applying a 1 to 3 per cent. solution of pyoktanin to the diseased spot 
by means of a mass of tow, fixed in position by a bandage. 

It is of importance to hasten separation of the gangrenous piece of 
skin; and if the entire piece cannot immediately be removed, loose 
portions at least should be cut off with scissors. The granulations 
are generally very abundant, and, being irritated by movements of the 


GREASE. 569 


limb, are apt to become excessive and irregular, requiring the use of 
caustics, tannin, and an appropriate pressure dressing. As a rule, it is 
more necessary to restrain than to excite their formation. If the 
patient be moved too soon they become excessive, and fungous growths 
appear, which give much trouble. If the coronet become swollen, the 
horn below must be rasped away. 

A common sequel of gangrene is the formation of fistulee just above 
the heels, in consequence of a necrotic piece of tissue being retained in 
the depths, and keeping up chronic inflammation and pus formation. 
The passage of a sublimate seton, or the injection of liquor Villati, is 
sometimes sufficient to procure healing, but in obstinate cases it may be 
necessary to freely lay open the parts. 

(4) Dermatitis chronica verrucosa. This condition, which in the 
14th century was known in Germany as “ Wasser,” “ Raspi,’ or 
“Strupfen,” in England as “grease,” and in France as phymatosis or 
“oyappe,” 1s always chronic and progressive. 

Originating in a small spot in the fetlock-joint, the process gradually 
extends until it may involve the entire carpal or tarsal joint. It is due 
to active proliferation in the rete mucosum; the cells produced, how- 
ever, do not become horny, but break down and form a fatty, ill- 
smelling, grey mass on the surface of the diseased skin. In less rapidly 
progressive forms the cells form a grey, mealy mass. The more intense 
the process, the more active the proliferation, and the more abundant 
the exudation which bathes the surface of the skin. The papille at 
the same time increase in size, so that they appear like warts, and may 
generally be recognised by the naked eye; sometimes they become as 
large as a pea. The deeper layers of the cutis, and even of the sub- 
cutis, take part in the process, producing marked elephantiasis. The 
process extends to the hair follicles; the hairs are mostly shed, and 
the few which remain are erect. 

Leblanc in 1850 made microscopical examinations of the diseased 
skin, and regarded the condition as a simple hypertrophy. He found 
the hair follicles and sebaceous glands enlarged. In another section I 
have pointed out how closely this process resembles canker. I myself 
regarded the two as identical, a view which has not up to the present 
been opposed in literature. Either disease may extend to new struc- 
tures, giving rise to the other; thus grease may produce canker, and 
canker grease. 

The disease is more frequent in the hind-feet, particularly in “ well- 
feathered” horses like Clydesdales ; sometimes it seizes on several feet, 
one after the other. Whether a specific organism is the causative agent 
remains for the present undecided, though such an explanation appears 
probable. Sometimes the disease originates from the eczematous 


570 GREASE. 


form of grease; not infrequently it is due to slight grazes or 
scratches. 

I have recently seen many outbreaks of this form of grease in certain 
stables ; indeed, there seems to be some ground for referring them to 
direct infection. In large establishments animals in hospital were often 
attacked after being rested for some time, and in one case the horse- 
keeper suffered from an eczematous disease on the hands. The local 
appearances and gradual spread of the disease point to infection, though 
its immediate cause is yet unknown. The variations in its method of 
outbreak and course suggest that it may be due to more than one 
cause, 

Prognosis.—Spontaneous recovery is very rare. As with canker, 
careful and often prolonged treatment is required. The greater the 
extent of the disease, the more active the proliferation and conse- 
quent thickening, and the further the growth has penetrated the 
papillary layer of the skin the greater the difficulty in treatment. The 
dry form is most hopeful. When the papillz have attained a consider- 
able size, and folds exist in the skin, little can be done. 

Treatment.—The condition being unquestionably a local skin 
affection, internal treatment is of little value, and the chief indica- 
tions are to cleanse, and keep clean, the diseased spot, to rapidly 
remove decomposing secretions, or to prevent decomposition occurring. 
When the process is confined to one small spot, the parts may be 
cleansed, a white-hot firing-iron passed several times over the diseased 
surface, and a disinfectant applied. In more extensive attacks the 
limb may be bathed several days in succession with lukewarm chloride 
of lime solution (Hertwig), or with creolin or sublimate lotion, and the 
diseased spots repeatedly washed during the time the lmb is in the 
bath. 

A surgical dressing is afterwards applied, containmeg a mixture of 
creosote and spirit (1-6), chloride of zine (1-10), or creolin (5 per 
cent.). 

Lies of Brunswick claims to have had excellent results from the use 
of sulphuric acid. My experiments confirmed this. The parts are 
carefully cleansed, the diseased surface painted with a mixture of 
sulphuric acid and spirit (1-10, or 1-20), and a dressing, moistened 
with the same fluid, applied. A little exercise should be given every 
day ; rest favours the disease. 

Large warts are removed with scissors. The dressing must be applied 
with moderate pressure, and renewed daily. Ointments are to be 
avoided until the surface becomes dry, when it may be beneficial to 
apply a little red oxide of mercury and paraffin or lanolin ointment. 

Treatment should be continued until the last trace of secretion has 


GREASE, o7E 


disappeared ; the lower parts of the limb must then be kept as dry as 
possible, and any relapse treated in the above manner. 

Dalrymple recommends hot poultices of wheat-flour and linseed-meal, 
to which acetic acid is added as the poultice becomes firm. This is 
applied for twenty-four hours, the surface of the skin cleansed with a 
dry cloth, and afterwards rinsed with chloride of zine solution. He 
states having thus cured cases in fourteen days. 

Straube lately recommended camphor dissolved in ether, and mixed 
with three times its weight of vaseline; this ointment is rubbed into 
the diseased skin. To check evaporation, the diseased parts are covered 
with carbolic wadding, and surrounded with flannel bandages. At first 
the dressing is changed daily, later every two or three days. When there 
was much itching, Straube gave arsenic internally with success. My 
latest experiments with sulphuric acid lead me to prefer this material 
before all others. Its application is certainly painful, but its action is 
generally surprisingly good. 


XJ]. THE DISEASES OF THE HIND-LIMDB. 


A. Diseases of the Quarter. 


INJURIES TO THE SOFT STRUCTURES OF THE 
QUARTER. 


BrRvuIses and wounds are commonest in horses, especially in winter, 
and are caused by kicks and “ treads” by the sharp heels of: the shoe. 
They also result from thrusts with the carriage-pole, from falls on rough, 
hard ground, or from animals slipping in front of the carriage and being 
run over. Amongst tramway and ’bus horses extensive injury of the 
muscles of the quarter is often produced in this way. In army horses 
wounds and bruises result from lance thrusts, sabre cuts, or falling on 
the rider’s spur. 

Blows may rupture large blood-vessels and produce extensive 
hematomata, but I have never seen lymph extravasation in such cases 
as Hoffman describes. Sometimes the skin and muscular tissue are 
torn through. The biceps femoris is often the seat of such injury, and 
‘in collisions the semi-tendinosus and semi-membranosus muscles are 
liable to be extensively injured. In heavy horses, wounds from stable- 
forks are often followed by septic cellulitis, which extends and produces 
destruction of the intermuscular connective tissue of the buttock, some- 
times even necrosis of the tuber ischii. After the cellulitis has subsided, 
fistulae may remain and give great trouble. 

Prognosis and treatment follow general principles, but one fact 
should always be borne in mind, viz., that the extravasation which 
follows bruising, and sometimes violent over-extension of muscle, is 
seldom troublesome, if not too early incised. 

In fresh cases, continuous cold irrigations and complete rest are 
most useful. By putting the patients to work or moving them too 
early, fresh bleeding and increase of the hematoma are favoured. To 


INJURIES TO THE SOFT STRUCTURES OF THE QUARTER. Bia 


favour resorption, small extravasations may, after the third or fourth 
day, be treated by massage; in large ones, «.c., those containing a quart 
or more of fluid, such treatment is seldom beneficial, or takes longer 
than healing after successful puncture. Nevertheless, the knife should 
not be used before the fifth or sixth day after the appearance of 
swelling, partly because of the danger of after-bleeding, partly of infec- 
tion and cellulitis. In five to six days thrombus formation is so far 
completed that bleeding is no longer probable, and the walls of the 
hematoma are sufficiently infiltrated with plastic material as to check 
the penetration of decomposition products. For the same reason, 
the opening should be made at the lowest point, the cavity emptied of 
coagulated blood as far as possible, and washed out with a disinfectant. 
A drainage-tube may be necessary. By adopting these precautions rapid 
healing is secured, and sometimes the walls of the hematoma immedi- 
ately become united. Needless to say, careful disinfection is of the 
greatest consequence. 

Wounds confined to the skin of the buttock often heal by primary 
intention if immediately sutured with antiseptic precautions, and dressed 
with a disinfectant like iodoform-tannin. Union is assisted by 
covering the wound with a clean cloth, which is kept moistened with a 
disinfectant. Rest is absolutely necessary. 

Muscular wounds in this position heal most rapidly under a scab. 
If, as is not infrequently the case, the entire wound-surface is open to. 
the air, this will be found the best procedure. The wound is carefully 
cleansed, rinsed with a disinfectant, loose fragments removed, and, after 
bleeding vessels have been ligatured, powdered with iodoform-tannin. 
As a rule, this produces a dry scab, which is firmly adherent to the 
wound; nothing further is required. If the scab separates at certain 
points, it should be removed, the secretion wiped off with a little 
wadding, and the dressing renewed. Sometimes only the upper part of 
the wound heals under a scab; but though the lower portion is wet 
with discharge, granulation and healing are only delayed, not prevented. 
When the surfaces of the wound are in contact, or when pockets or 
deep injuries exist, it is difficult to maintain asepsis, and suppuration 
almost always occurs; in such cases, drainage must be assisted and 
burrowing of pus checked by a free use of the knife, by making counter- 
openings, and possibly by inserting setons and drains, the wound being 
meanwhile frequently cleansed. 

Even when healing by first intention seems out of the question, 
recovery may be shortened by inserting stitches, particularly if the skin 
be separated from subjacent structures to any great extent. By bring- 
ing the flaps of skin together with thick threads, or, better still, with 
tape, which is not likely to cut, retraction of the cicatricial tissue in 


574 , FRACTURE OF THE FEMUR. 


the edges of the wound is checked, and in large wounds healing 
assisted. 

Fistule extending to the tuber ischii must be laid open, and if 
possible the necrotic piece of bone removed. 


Il—FRACTURE OF THE FEMUR. 


Lit.: Drosse, Th. Mitth. 1867, p. 152. Schrader, Her. Rep. 9, p. 91 
Dieterichs, Gurlt u. Hertwig. 22, p. 402. Stockfleth, Chirurg. p. 
515. Hanzo, Th. Mitth. 1878, p.118. Wilhelm, Jahrb. 1889, p. 
122. Hess, Her. Rep. 38, p. 299. Schwerdtfeger, Dresd. Ber. 
1861, p: 120. .Lichte, Gurlt u. Heriwie. 17, p, 369.” “Wieeikten: 
hoff, Ad. Woch. 24, p. 95. Fiedler, Th, Mitth. 1879, p. 87. Heu- 
berger, Ad. Woch. 1891, Nr. 11. 


In spite of its protected position, the femur is not infrequently 
fractured in the different species of animals,—in the smaller kinds, like 
dogs, by treads, in horses by kicks, and in oxen by falls. Horses 
produce it by struggling violently when cast, especially if the foot be 
fixed too high (that is, if the hoof be drawn up over the elbow-joint), 
and over-extended whilst in this position, Gurlt thinks that tying the 
hind-limb to the cannon bone of the fore-limb may cause fracture 
of the femur; but though I often fix horses in this way, I have 
never seen fracture in consequence. On the other hand, I consider 
tying the limb to the fore-arm or fastening it to the ring of a surcingle 
is dangerous. Fracture is favoured by absolutely fixing the hind-limb 
in a position of flexion, on account of the great strength of the extensor 
muscles of the quarter. The less the resistance to their contraction, the 
less likely is fracture of the femur to occur. Lichte describes fracture 
of the femur in a horse affected with horizontal luxation of the 
patella. 

Fracture of the neck of the femur, though occasionally seen, is much 
rarer in animals than in men, because in them the neck is less well marked, 
Schrader reports a case; the articular head had again become adherent 
to the femur opposite the lower trochanter. Fracture of the articular 
head itself is commoner; Dieterichs even saw a horse with double- 
sided fracture of the head of the femur. Fractures of the trochanters 
are rare, though I once saw the lower trochanter fractured by a fall on 
rough ground, Fractures of the lower articular processes sometimes 
intra-capsular are also infrequent, though they have been seen both 
by Stockfleth and by myself. The diaphysis breaks oftenest in 
dogs, usually near the lower end. Comminuted fractures may occur. 


FRACTURE OF THE FEMUR. aye 


Greve (Hertwig) found a horse’s femur broken into eighty-five pieces. 
In a race-horse which I examined, the upper portion of the shaft of the 
femur was broken into many pieces. Hering and Drosse state having 
seen fissure of the femur in the horse produced by a kick; the post- 
mortem showed a transverse fracture of the femur, and it would, 
therefore, appear that the condition was really “green stick” fracture. 
Fiedler saw a foal with separation of the upper epiphysis from the 
diaphysis and luxation of the femur. 

The symptoms of fracture, either of the shaft-head or neck of the 
femur, are generally well marked, Pain is severe, the animal goes 
lame both when placing weight on the limb and when advancing it, 
the limb itself is easily moved, especially in an outward direction 
(abduction), and crepitation usually exists, though, if the fractured 
portion be much displaced, it may be wanting. As a rule, the 
“slouching” movement of the entire limb may be remarked, even from 
a distance, and the only ditficulty is to say whether the fracture is in 
the femur or in the tibia. The diagnosis of fracture of the upper end 
of the femur is sometimes difficult, because of the lower portion of the 
bone becoming inserted into the articular cup and thus supporting the 
weight of the body; in such cases, however, the limb is, as a rule, quite 
visibly shortened. 

Fracture of a trochanter is followed by swelling and marked lameness 
when the limb is carried, slowness in movement, shortening of the 
forward stride, and, usually, by abduction of the limb. Fracture of one 
of the lower condyles produces severe localised pain and marked flexion 
of the limb, similar to that of inflammation of the stifle-joint (gonitis) ; 
the other symptoms of stifle lameness develop during the next few days. 

In horses and cattle the course is generally unfavourable, parti- 
cularly if much lameness is shown when weight is placed on the leg. 
Fractures of the diaphysis may be followed by death from bleeding if 
the femoral artery be injured. Union never occurs in fracture of the 
head or neck of the femur. Hess and Schwerdtfeger kept cases of 
fracture of the articular head under observation respectively for one year 
and for six months; in neither was there any bony union between the 
head and shaft. Even where union occurs, the animal remains lame, 
owing to injury of the articular cup by the friction of splinters of bone ; 
I have several times found the articular cartilage completely rubbed 
away. Fractures of the lower condyle take a very unfavourable course. 
Fractures of the diaphysis in small animals are more promising if there is 
no great displacement or shortening of the limb, Unfortunately, in dogs 
these two symptoms are generally marked, the upper fragment being 
thrust backwards through the muscular tissue, the lower one forwards; 
the mass of muscle thus interposed renders callus formation difficult, or 


576 FRACTURE OF THE FEMUR. 


altogether impossible. The observations of Hanzo, Wilhelm, and others 
show, however, that even in large animals recovery is not entirely out 
of the question. Wilhelm, indeed, saw a fracture of the femur unite, 
though the horse was at the same time suffering from fracture of the os 
pubis of the other side. After ten weeks in slings the horse resumed ~ 
light farm-work, though the injured limb had become 3 inches shorter 
than its neighbour. Fracture of the diaphysis in dogs is sometimes 
followed by formation of a callus fibrosus and permanent lameness, 
sometimes by perfect bony union and soundness. ‘These fractures are 
least serious, and unite most quickly in swine and small ruminants, 
which are better able to rest the limb. Fractures of the trochanters are 
least dangerous, as they do not prevent the animal standing on the limb, 
and therefore are not likely to induce laminitis in the opposite foot; 
but even they sometimes give rise to permanent lameness, which restricts 
the animal to slow work. The prognosis must largely depend on the 
degree of lameness associated with the fracture. Heuberger, in a horse, 
saw complete union of a fracture of the upper trochanter. 

Treatment is confined to resting the animal, and if a horse to 
placing it in slings. The methods of reduction often described are 
usually inadmissible ; even in dogs the muscles of the quarter are com- 
paratively powerful, and oppose great resistance to manipulation. The 
extension and contra-extension recommended often result in thrusting 
the fragments further apart. In dogs it is best to approximately replace 
the parts, and then to apply a plaster bandage, starting from the meta- 
tarsus and extending as high up the limb as possible, fastening it in 
position by a so-called “saddle.” The bandage is passed over the 
back and around the limb of the opposite side, to prevent it slipping 
down. This method often succeeds in dogs, but also at times fails. 

In larger animals both reduction and retention are much more 
difficult, though the former is to some extent assisted by anesthesia. 
T have never been able to secure the bandages and dressings which are 
often described in such a way as to give a secure hold without setting 
up injurious pressure. Unfortunately, at the present day the cost of 
keeping horses generally renders treatment out of the question. 

Ruminants and swine require rest and a comfortable stall, with plenty 
of soft bedding like peat-moss, and, to prevent their being annoyed by 
others, pigs should be placed in separate stalls. 

To prevent fracture of the femur in horses when cast, I can, with 
Dieckerhoff, recommend the so-called “leg twitch.” A girth or strong 
cord is passed round the thigh, about 6 or 7 inches above the hock, a 
strong stick, 2 feet in length, pushed through it, and the cord twisted 
tight, so as to press the Achilles tendon against the tibia. Any attempt 
to extend the limb now gives considerable pain on account of the 


FRACTURE OF THE FEMUR. 577 


pressure of the twitch, and the animal soon ceases to make further 
efforts. In addition, the twitch directly checks the action of the 
extensor. 

it is also well to avoid rigidly fixing the hind-limb; sufficient play 
should be given to prevent the extensors having an absolute fixed point 
against which to act. I therefore pass the girth or rope for fixing the 
limb over the tibia, between or over both fore-limbs in a forward 
direction, under the neck and across the loins, and then back again to 
the limb. Then I pass it twice around the tibia immediately under 
the first turn, and lead the end of the rope away over the body, where 
it is held by two assistants. The rope must not be drawn so tight as 
to prevent all play of the hind-limb. 

In 1875 I saw an old horse with fracture of the lower trochanter of 
the right femur. The forward stride was shortened about a quarter 
of its normal length. As the animal carefully avoided bending the 
joint, the toe grazed the ground. In advancing, the stifle described a 
circle outwards, though the upper part of the hmb was adducted. 
When weight was thrown on the diseased limb, or when the right fore- 
foot was lifted, the opposite quarter sank until the external angle of the 
left ihum was about 2 inches lower than the right. 

At the point where the lower trochanter should have appeared, a 
depression, about as wide as three fingers, was visible. Beginning at the 
anterior border of the biceps femoris, and running for about 2 inches in 
a horizontal direction, it rose in a slight curve and lost itself at the 
posterior border of the tensor fascize late. On careful examination the 
lower trochanter could be detected just in front of the biceps femoris; a 
weak crepitation sound was produced by moving it. As the horse was 
removed, its further progress could not be observed. 


HI1.—LUXATION OF THE FEMUR. 


Lit.: Lafosse, Her. Rep. 13, p. 247. Harms, Gurlt u. Hertwig. 37, 
p. 141. Derselbe, Han. Ber. 1876, u. 1879-80. Dieterichs, 
Chirurgie. p. 655. Derselbe, Gurlt u. Hertwig. 23, p. 200. Falke, 
ibid., 23, p. 64, u. 24, p. 378. Schirlitz, Th. Mitth. 70, p.88. Bossi, 
Her. Rep. 18, p. 167. EHilert, Gurlt u. Hertwig. 22, p. 253. Fiedler, 
Th. Mitth. 1879, p. 87. Bucher, Berl. Arch. 17, p. 376. 


In the horse, the depth of the articular cavity and strength of the 
ligamentum teres tend to prevent displacement of the femur. Rigot and 
others altogether deny that displacement occurs, though cases recorded 
by Schrader, Falke, and others clearly show that it may occasionally 

20 


578 LUXATION OF THE FEMUR. 


happen. It is certain that complete luxation cannot occur without 
rupture of the ligamentum teres, so that Dieterichs was unquestionably 
right in his dispute with Falke on this point. The pubio-femoral 
ligament derived from the prepubic tendon of the abdominal muscles 
sometimes remains intact after luxation, but the capsular ligament and 
surrounding muscular tissue are always ruptured. Incomplete luxation 
can scarcely occur in the horse, and the case in the cow reported by, 
Harms is open to doubt. 

In the horse the neck and articular head are more easily broken 
than displaced, but in oxen and other animals the conditions rather 
favour luxation, the articular cavity being flatter, and the hgamentum 
teres weaker. I have often seen luxation of the femur in dogs. Fiedler 
noted a case in a foal, where the epiphysis was also separated. 

In making post-mortem examinations of horses, Falke repeatedly found 
the hgamentum teres ruptured. In an old animal bought for dissection, 
which had shown no lameness prior to death, the ligamentum teres was 
absent. The points where the hgament is inserted into the head of 
the femur and acetabulum appeared deepened and smooth, but 
not a trace of the lgament was visible, and the pubio-femoral 
ligament, though normally developed, ended before entering the 
joint-cavity. The ligamentum transversum incisure acetabuli was 
normally developed; the posterior portions of the gluteus parvus 
were interspersed with cicatricial connective tissue. Probably luxation 
or violent distortion of the coxo-femoral joint had long before taken 
place, causing rupture of the ligamentum teres and of the muscle. 
Bucher’s observations show that rupture of the lgamentum teres is 
often followed by severe lameness. Two horses which he saw with 
this rupture were unable to support weight on the diseased limb. 
One rested the point, the other the side of the toe on the ground; 
the hock was excessively extended, and the phalanges fixed in a 
position of marked plantar flexion. It is not quite certain, however, 
whether these symptoms were exclusively dependent on rupture of 
the hgamentum teres. 

Amongst the causes are violent movement of the limb on the hip- 
joint, excessive flexion or extension in falling, and sometimes excessive 
lateral movement (ab- and ad-duction). The head of the joint, in 
quitting the acetabular cavity, does not always move in the same direc- 
tion, but may take a variety of positions, giving rise not only to pecu- 
liarities in the symptoms, but influencing prognosis and treatment. 

Symptoms.—tThe displaced limb is sometimes lengthened, some- 
times shortened, sometimes fixed in a position of adduction, sometimes 
in one of abduction. Its mobility in certain directions may be limited, 
whilst in certain others it may be abnormally increased. This resistance 


LUXATION OF THE FEMUR. 579 


to manipulation distinguishes luxation from fracture, a distinction which 
is strengthened by the absence of crepitation. In any case, freedom of 
movement is lost. Luxation is always accompanied by marked lameness 
when the limb is carried (swinging leg lameness), though there is also 
more or less inability to sustain weight. 

After a varying interval the hip-joint appears swollen, though the 
swelling is occasionally replaced by a depression, whilst the upper 
trochanter appears displaced, being sometimes more prominent, some- 
times sunk in the masses of soft tissue. The skin over and around the 
hip-joint is either very tense or abnormally loose. When the bone is dis- 
placed into the obturator foramen, its head may be felt from the rectum 
or sheath, and is especially distinct when the limb is moved. 

Prognosis is always doubtful, and in large animals generally un- 
favourable. Only during the first three days is reduction usually 
possible, and then with the greatest difficulty. If attempted early, it 
sometimes succeeds in smaller animals, but soft tissues and blood are 
hable to enter the joint-cavity and furnish great and frequently insur- 
mountable obstacles. After rupture of the lgamentum teres in large 
animals, relapses are very common; recovery is then exceptional, and 
the animal’s usefulness is seldom restored. In old-standing cases 
muscular contraction furnishes a further impediment to reduction. 

Treatment.—Large animals are cast on the sound side and anzsthe- 
tised ; and, as the operator’s strength is not sufficient to extend the limb, 
it becomes necessary to use mechanical aids. Extension once effected, 
it remains for the operator to effect reposition. This may sometimes be 
done by abduction, sometimes by adduction and rotation of the limb, 
though, as a rule, the latter is impossible of accomplishment. In 
smaller animals, like dogs, extension aud contra-extension may be left 
to an assistant, whilst the operator, having taken note of the abnormal 
position of the caput femoris, effects reposition. 

After successful replacement, the horse should be slung to prevent it 
lying down, which might cause a relapse. Prolonged rest is absolutely 
necessary in all animals. 

As the anatomical relations of the femur to the pelvis differ some- 
what in animals and men, the nomenclature and methods of reduction 
must vary correspondingly. The following classification seems to me 
the best :— 


580 


LUXATION OF THE FEMUR. 


Luxation of the Femur. 


Forwards— 
Luxatio iliaca, 


|The head of the 
femur lies on the 
ilium. 


Causes. — Forcible 
extension and rota- 
tion outwards (sup- 
ination). Most fre- 
quentincows, though 
it occurs in horses 
(Schrader). Pro- 
duced by suddenly 
turning in the stall. 


Symptoms. — Ab- 
duction and rotation 
outwards. When 
standing on the dis- 
eased side the hip 
is dropped, the tro- 
chanteris prominent, 
the skin covering it 
tense, lies in folds 
over the quarter and 


stifle. The limb ap- 
pears shortened, the 
stifle turned out- 
wards, the femur 


almost perpendicular. 
Stockfleth saw this 
dislocation in both 
limbs in a cow. 


Prognosis. — Un- 


Backwards— 
Luxatio ischiadica. 


Inwards— 
(a) Luxatio pubica. 
(6) Luxatio obtura- 
toria. 


Outwards— 
Luxatio supra 
cotyloidea. 


| 


The head of the femur 
lies below the ex- 
ternal branch of 
the ischium. 


Causes. — Forcible 
abduction and rota- 
tion inwards (prona- 
tion). Slipping out- 
wards of the joint. 
Commonest in cattle. 


Symptoms. — The 
animal generally lies 
on the belly. The 
limb is abducted and 
rotated inwards. 
When standing, a 
furrow is visible in 
front of the biceps 
muscle and a depres- 
sion in the region of 
the trochanter. The 
skin of the quarter is 
tensely stretched. 
Swelling and pain 
slight. A loud sound 
is produced in conse- 
quence of the head of 
the femur striking 
the ischium when the 
trochanter is struck 
or the extended limb 
suddenly thrust back. 


_Lameness, both when 


the limb is carried 
and when weight is 
placed on it. Trail- 


| ing of the limb, which 


is carried in a circle, 
the toe often rubbing 


the ground. 


favourable in horses | vourable. 


Prognosis  unfa- 
Stockfleth 


(a) Pubic luxation. 

The head of the fe- 
mur lies under the 
transverse branch 
of the os pubis. 


Causes.—In oxen 
and horses, excessive 
abduction (Bossi, La- 
fosse), passing the leg 
over hanging bales 
and becoming caught, 
slipping, &c. 


(6) Obturator 
tion. 
The head of the fe- 
mur lies in the ob- 
turator foramen. 


]uxa- 


Symptoms.—(a) In 
L. pubica, abduction 
and rotation  out- 
wards. Rolling, in- 
secure gait, trochan- 
ter indistinct, a 
depression over the 
hip-joint, passive mo- 
bility, abduction ab- 
normal, adduction 
limited. 


(6) L. obturatoria. 

Generally the same 
symptoms. The head 
of the bone can be 
detected (especially 
when the limb is 
moved) by examina- 
tion per anum or 
vaginam. 


Prognosis likewise 
unfavourable. Re- 


The head of the fe- 
mur lies above the 
cup of the joint. 


Causes. — Abnor- 
mal adduction move- 
ments. Blows, 
thrusts, falls. Com- 
monest in dogs. 


Symptoms.—Short- 
ening of the limb and 
adduction. Abduc- 
tion and movement 


limited. Swelling 
over the hip-joint. 
Trochanter —_ promi- 
nent. 


Prognosis. — Only 
favourable in dogs 


LUXATION OF THE FEMUR, 581 
Luxation of the Femur—continued. 
Inwards— Outwani 
Forwards— Backwards— (a) Luxatio pubica. L e ra ay 
Luxatio iliaca. Luxatio ischiadica. | (b) Luxatio obtura- chal pelle 
aca cotyloidea. 
and cattle. If re-| only saw recovery in | duction only possible | when seen early, 
placement is unsuc- | two out of nine cases. | in very recent cases. | Later, continuous 
cessful, partial restor- lameness. In large 
ation of movement animals, still less 
may follow the for- chance of permanent 


mation of a false 


recovery. 


joint, though lame- 
ness remains. Re- 
duction is readily | 
followed by relapse. | 


Treatment. — As 
usual in such cases. 


Treatment. — To 
attempt replacement, 
Extension and extension whilst the 
thrusting the head | limb is in a position 
of the joint back- | of abduction, followed 


Treatment.—Pow- 
erful extension whilst 
the limb is abducted, 
_after which reduction 
must be effected by 


Treatment. — Ex- | 
tension of the flexed | 
limb in the direction 
of abduction. Re- 
placement to be effect- 


wards. by rapid adduction | rotation and adduc- | ed by movements of 
‘and rotation out- tion. | adduction. 


| wards. | | 


IV.—INFLAMMATION OF THE HIP-JOINT (COXITIS). 


Lit.: Harms, Rindviehkrankheiten, p. 285 u. 288. Eberhardt, Guilt u. 


Hertwig. 22, p. 42. Noack, Dresd. Ber. 1889, p. 78. Falke, Gurlt u. 
Hertwig. 23, p. 64 u. 378. 
With the exception of the elbow-joint, the coxo-femoral articulation 


seems least inclined to disease processes, and in horses is seldom affected, 
though in them, and still more frequently in cattle, displacement accom- 
panied by partial or total rupture of the ligamentum teres and of the 
capsular ligament does occur.. In some of Harms’ collected cases (cattle) 
the head of the femur showed abraded spots. Eberhardt also reports 
cases in cattle where the post-mortem showed rupture of the ligamentum 
teres and of certain muscles around the hip-joint. 

Contusion of the hip-joint follows falls on rough, hard ground, though 
the bursa trochanterica is then more apt to become diseased. 

Spontaneous inflammation of the hip-joint is a rarity. In oxen double- 
sided purulent coxitis was seen by Noak, probably from embolism 
following traumatic pericarditis. In so-called paralysis (Lihme) in 
this region, purulent inflammation of the joint sometimes develops. In 


58? INFLAMMATION OF THE HIP-JOINT. 


cattle, as in men, some cases of suppuration in the hip-joint may be due 
to tuberculosis. 

The chronic inflammation termed malum cox senile, so common in 
men, is exceedingly rare in animals, though Falke’s observations show 
that it does occur. Schrader, who specially studied this form of disease 
in horses, also describes it as very rare. It is seldcm recognised, even 
post-mortem. 

_Symptoms.—Lameness is more or less severe, depending on the 
degree of inflammation. In cattle the diseased limb is extended with 
the toe turned outwards (Harms). The gait is of a rolling character, 
the limb being directed outwards and carried forward in a semicircle. 
It is apt to collapse under the animal, especially when turning on the 
diseased side. In the horse the symptoms are similar. As a rule, there 
is abduction of the Amb and lameness when it is carried (swinging leg 
lameness). Suppuration is notified by cellulitis in the region of the 
joint. 

Course.—The cases of hip-joint disease in cattle seen by Harms 
generally took an unfavourable course. A few improved, but none 
recovered completely. If lameness be marked, it is best to slaughter 
the animal. In horses, contusion of the hip-joint generally terminates 
in recovery in about fourteen days, but suppurative arthritis and 
arthritis chronica deformans are incurable. 

Treatment.—Rest is of the first importance. If necessary, the 
animal may be slung, otherwise it should be provided with abundant 
bedding. 

Recent contusions and displacements, if accompanied by severe pain, 
are treated with cold applications. If, after a walk, there is no marked 
improvement, a bichloride or biniodide of mercury blister may be 
resorted to. Setons and “issues” are also useful, though their efficacy 
chiefly depends on the rest which they enforce. 


V.—INFLAMMATION OF THE TENDON AND TENDON SHEATH 
OF THE GLUTEUS MEDIUS MUSCLE. BURSITIS 
GLUTAI MEDII. §. TROCHANTERICA. 


Lit.: Giinther, Myologie, p. 201. Renner, Gurlt u. Hertwig. 36, p. 470. 
Kettritz, The vet. journ. 22, p.158. Williams, Chirurgie. 6. Aufl. 
p. 292. 


Anatomy.—The M. gluteus medius, which forms an extension of the M. 
longissimus dorsi (Giinther), is provided in the horse with two tendons, one of 


INFLAMMATION OF TENDON, ETC., OF GLUTEUS MEDIUS MUSCLE. 083 


which becomes attached to the upper trochanter of the femur, the other passes 
over the ridge in front of the great trochanter, forming on its cartilaginous 
surface an extensive bursa, and becoming attached below to the surface of the 
femur. In horses, inflammation of the tendon and of its sheath on the middle 
trochanter produces a peculiar lameness, which was first described by K. 
Giinther, and afterwards by Renard and others. In England the disease is 
known as trochanteric lameness (Williams), or false hip-joint lameness. 


Causes.—This disease, which is only occasionally seen in horses, 
may be caused by bruising or violent strain of the tendon or its sheath. 
Bruises are produced by falls, by collisions with the carriage-pole, or by 
blows with some heavy body, strains by heavy draught-work, and by 
falling on the hind-limb, as often happens when the animal catches 
the heel of one of the hind shoes in the rack-chain. Sudden reining- 
up is also said to produce it. Horses with sloping quarters and slight 
muscular development seem predisposed to such injuries. 

Course.—The disease consists in a bursitis or tenositis, acute or 
chronic; the tendency always being towards a chronie condition, but 
the issue depending to some extent on the initial injury, and on the 
treatment adopted. Under appropriate treatment, lameness may dis- 
appear in four to six weeks; but if neglected, and especially if the 
primary injury be severe, the condition becomes chronic, and the animal’s 
usefulness is lost. 

The prognosis depends chiefly on the stage attained and the severity 
of the disease. When lameness is recent and slight, and the animal can 
be rested, there is good hope of recovery, but this is slighter in heavy 
draught-horses and in riding-horses than in such as are occupied in the 
lighter forms of draught. Marked wasting of muscle, the existence of 
swellings and severe or chronic lameness, render prognosis doubtful ; 
and where there is periostitis and exostosis, with abrasion of the 
cartilaginous covering of the trochanter, as described by Williams, 
there can be little chance of recovery. Kettritz’s suggestion that the 
bursa sometimes communicates with the hip-joint, and that, under 
certain circumstances, disease may extend to the latter, seems to me 
mistaken. 

Symptoms.—In recent acute imflammation there is increased 
warmth, swelling and pain on pressure over the great trochanter. 
When resting, the limb is usually flexed, though sometimes no change 
can be detected in the stable. When moving, the forward stride is 
shortened; less frequently, there is a tendency to lift the limb before the 
last phase of the stride is complete. The animal generally moves 
obliquely, as does the dog (Giinther), the sound side being thrust for- 
ward, and the limb kept in a position of pronation, @.¢., rotated inwardly. 
By placing the hand on the middle trochanter during movement distinct 


584 INFLAMMATION OF TENDON, ETC., OF GLUTEUS MEDIUS MUSCLE. 


crepitation may sometimes be detected (tendovaginitis crepitans); at a 
later stage the muscles of the quarter become atrophied. 

The slighter, and especially the chronic, forms of lameness are often 
only apparent when turning or when moving heavy loads, the horse then 
drawing with the sound leg, and endeavouring to shorten the period of 
loading of the diseased one. 

According to my experience, similar lameness is seen in other diseases, 
such as old cases of fractured pelvis ; the diagnosis must therefore be based 
principally on the local changes. I consider the crepitation sound most 
trustworthy, for both the swelling and pain may be caused by the upper 
trochanter. 

Treatment.— Recent cases, exhibiting acute inflammatory symptoms, 
are best treated by absolute rest, and cold applications, such as poultices 
or fomentations. Blisters may afterwards be used, and, if unsuccessful, 
can be followed by setons: the actual cautery has been employed with 
good results. Rest should be continued for some time after the dis- 
appearance of lameness; too early a return to work is liable to be 
followed by relapse. Some horses only recover sufficiently for light 
draught. 


VI—PARALYSIS OF THE HIND-LIMB. 


Lit.: Moller, Berl. Arch. 2, p. 300 u. ff, u. 6, p. 66. Pfister, Schweizer 
Arch, 1884, p. 18. Nocard, Peuch u. Toussaint, Chir. vét. 2. 
Aufl. p. 447. Beel, Deutsch. Zeitschr. fur Thiermed. 17, p. 41. Friis, 
Jahrb. 1888, p. 141. Giinther, Myologie. pp. 196, 235, u. 194. Fr. 
Giinther, Vix u. Nebel. 61, p. 389. Haubner, Dresd. Ber. 1858, p. 
55. Lees, Jahrb. 1888, p. 140. Hollmann, Gurlt u. Hertwig. 21, p. 
203. Delwart, Jahrb. 1862, p. 53. Schmidt, Th. Mitth. 1874, 
p- 140. Haubner, Dresd. Ber. 1858, p. 55. Meyer, Gurlt u. Hertwig. 
17; p. 76. Voigtlander, Dresd. Ber. 1860; p. 57, u. 1863, prior 
Dieckerhoff, Spec. Pathol. p. 678. Albert, Ad. Woch. 1877, 
p. 389. 


Anatomy.—The muscles of the hind-limb receive their nerve-supply from 
three sources ; the NN. ischiadicus cruralis and obturatorius. The ischiatic 
nerve, formed from the 6th lumbar, the first and second, and sometimes the 
third, sacral nerves, after giving off several muscular twigs, divides into the N. 
peroneus and the N. tibialis. The peroneus detaches a branch to the M. biceps 
femoris, and is then distributed to the flexors of the metacarpus and extensors 
of the foot, 7.¢., in the muscles lying on the anterior surface of the lower portion 
of the limb. 

The N. tibialis gives motor fibres, chiefly to the adductors, the flexors of the 
foot, the gastrocnemius, 7.e., to the muscles lying on the posterior surface of 
the lower portion of the limb. Finally, it is the nerve of sensation for the lower 
portions of the hind-limb. 


PARALYSIS OF THE HIND-LIMB. 585 


The N. eruralis is formed from the 3rd, 4th, and 5th lumbar nerves, passes 
out between the small and large psoas muscles, gives twigs to the ilio-psoas and 
external oblique abdominal muscles, and then divides into several branches which 
pass to the M. quadriceps femoris. Small twigs go to the sartorius and pectineus 
muscles, whilst the main stem forms the nerve of sensation for the skin and 
inner surface of the lower limb. 

The N. obturatorius, formed from the 5th and 6th lumbar nerves, passes out 
of the pelvis around the anterior border of the obturator foramen, to provide the 
obturator externus, the adductors, and the pectineus and gracilis muscles with 
motor twigs. 


A. Paralysis in the region served by the ischiatic nerve. 

(a) No accurate observations have yet been recorded of paralysis 
of the N. peroneus, nor have I myself seen cases. The muscles lying 
on the anterior surface of the lower thigh would in such cases be para- 
lysed ; in consequence the foot could not be bent, nor the phalanges 
extended, and therefore it would be impossible to abduct the leg, and 
the limb would assume a position of adduction. In walking, the quarter 
would be lifted abnormally high, as in tibialis paralysis, and the foot set 
down in an uncertain fashion. K. Giinther says that paralysis of the 
external popliteal nerve is followed by uprightness of the fetlock and 
severe knuckling, so that the horse walks on the lower end of the 
cannon bone. 

This observation is perhaps founded on experiments made by Fr. 
Giinther of cutting through the N. peroneus, after which paralysis of the 
extensors of the fetlock, coronet, and foot is said to have occurred. In 
man, atrophy of the gastrocnemius afterwards sets in; the muscles 
covering the anterior surface of the tibia, &c., appear relaxed when the 
limb is moved, and in time undergo wasting. 

(b) I have seen and described one case of paralysis of the tibial 
nerve. In this disease the muscles lying at the posterior surface of the 
tibia are affected; plantar flexion is impossible, that is to say, the hock 
cannot be extended nor the foot flexed (in the plantar sense). As, 
however, in the horse flexion of the hock brings both flexors of the foot, 
and especially the tendon of the flexor pedis perforans, into tension, the 
phalanges are necessarily fixed in this lameness in a position of plantar 
flexion. This is especially noticeable when the animal stands on the 
paralysed limb, because the hock is then excessively flexed. It is still 
possible, however, to place weight on the limb, because the Achilles 
tendon fixes the hock. 

The limb is advanced with all the joints excessively flexed, the foot 
being lifted very high, and set down with a hesitating (“ tapping ”) move- 
ment; the action as a whole bearing some resemblance to stringhalt. 
Trotting is impossible. 

The muscles at the posterior surface of the tibia, particularly the 


586 PARALYSIS OF THE HIND-LIMB. 


gastrocnemiil and flexor pedis perforans, are relaxed. and afterwards 
become atrophied. 

Nocard saw fractured pelvis in the horse produce symptoms closely 
simulating this lameness. Masses of callus had probably formed, which, 
by pressing on the N. tibialis, caused the peculiar lameness. 

As an experiment, I divided a horse’s tibial nerve just before its 
point of entry between the gastrocnemii. The animal at once assumed 
the position above described, the fetlock-joint showing plantar flexion, 
and the foot being excessively raised during the forward stride, 
though not quite in the same awkward way as in the other case, in 
5 which the immediate cause of the para- 
lysis was perhaps more centrally situated. 

(c) Paralysis of the ischiatic nerve is 
followed by more general lameness, the 
muscles involved including the semi-ten- 
dinosus, semi-membranosus, and biceps 
femoris, and the limb is no longer capable 
of free movement. Neither the hip, stifle, 
nor hock joint can be flexed, the limb 
hangs limply from the hip downwards, 
and can neither be lifted nor advanced. 
The skin of the limb loses its sensi- 
bility. On enforced movement the 
foot is dragged along the ground with 
the phalanges bent, and in dogs, &e., 
the dorsal surface of the toes is soon 
rubbed raw. When, however, by ex- 
ternal help, the limb is placed in its 
normal position, it is able to sustain 
weight in the usual way, because 
the extensors of the stifle fix that 

= - joint, and with it the other joints of the 

Fic. 106 paralysis of ibial ae limb (compare with my Diagnostik, 2nd 

edition, p. 181). 

I have seen three cases of ischiatic paralysis in dogs, one in a St 
Bernard, one in a bull-dog, and one in a working-dog.' In one case the 
dog had fallen from a window, and at first showed complete paraplegia, 
which, however, disappeared after a few days, leaving one limb affected 
with ischiatic lameness, which also disappeared soon afterwards. The 
second dog became affected during convalescence from distemper, and in 
the third the lameness had no apparent cause. 


' In Berlin, and throughout Germany, large numbers of dogs are employed for drawing 
light carts, sometimes singly, sometimes in pairs. They are of no determinate breed, and 
vary from the size of a collie up to that of a boar-hound.—[TRANSL.] 


PARALYSIS OF THE HIND-LIMB. 587 


In addition, I have repeatedly seen paraplegia in dogs, and others 
have seen it in horses; in the hind-limb the ischiatic nerve was affected, 
and in the opposite fore-limb the axillary plexus. This was clearly of 
cerebral origin. The condition described by Beel as paralysis of the hip 
nerves appears to have been paraplegia. Friis saw paralysis of the right 
fore and left hind-limbs, which was not improved after three months’ 
treatment. The absence of anesthesia and of muscular atrophy pointed 
to its cerebral nature. 

Up to the present little is known of the course of these paralyses. 
Though my case of tibial paralysis appeared incurable, the case of 
ischiatic paralysis in the dog produced by a fall improved so much in 
fourteen days as to warrant expectation of complete recovery. The two 
other cases were removed from observation, but appeared favourable, the 
disease not being of old standing. 

The causes are: disease of the brain or spinal cord, or lesions in 
the course of the nerves. Disease of the spinal cord usually produces 
double-sided paralysis (paraplegia). The above case of tibial paralysis 
appears to have been due to anatomical changes in the nerve during 
its course between the gastrocnemi. In dogs ischiatic paralysis is pro- 
duced both by wounds and by general disease like distemper. Albert 
found, on post-mortem examination of the horse which had been treated 
for three months without effect, the residuum of a blood extravasation 
surrounding the nerve at the point where it left the pelvic cavity. The 
tissues below this point were atrophied, and the muscles, especially the 
M. rectus femoris, had undergone extensive fatty degeneration. 

The prognosis must depend on general principles. In recent cases, 
where the only apparent cause is chill, and in those due to falls and 
sprains, the prognosis is more favourable than in old-standing cases with 
marked muscular atrophy. In incomplete paralysis the forecast is more 
favourable, but in complete ischiatic lameness the outlook is bad, espe- 
cially if there be local anesthesia. Recovery is still possible where 
sensibility and irritability to the Faradic electric current is preserved. 

B. Paralysis of the crural nerve and quadriceps femoris muscle. 
Rupture of the rectus femoris and vasti muscles, and of the straight 
ligaments of the patella. 

Though paralysis of the crural nerve is not common, yet in animals 
it occurs oftener than is generally believed. Sometimes it accompanies 
hemoglobinemia, sometimes it is produced by strain, by partial rupture 
following on falls, or by violently kicking backward. I have seen six 
eases in horses drawing heavy loads, and many more, as a sequel to 
hemoglobinemia. Its connection with this disease is explained by the 
fact that the crural nerve passes through the ilio-psoas muscle, which in 
hemoglobinzemia seems particularly involved. Although it is possible 


588 PARALYSIS OF THE HIND-LIMB. 


that myopathic lameness of the rectus and vasti muscles occurs in 
heemoglobinemia, yet the greater number of such cases are probably 
due to disease of the nerve indicated, because in nearly every 
instance the loss of function and excessive atrophy are common to 
all the muscles attached to the patella, and in a similar degree, a 
condition scarcely to be expected in a purely muscular disease. 
Other conditions, like psoas abscess, tumour formation, hemorrhage, &c., 
may also destroy the function of this nerve temporarily or permanently. 

Though post-mortem examination sometimes shows the rectus and 
vasti muscles in a marked state of fatty degeneration after this disease,. 
that fact in no way proves the condition to have been myopathic lame- 
ness, as has been suggested (compare with p. 204, General Surgery). 

Symptoms.—Weight cannot be placed on the limb, because it is. 
impossible to fix the stifle-joint, a necessary preliminary to walking. 
Attempts to sustain the body on the affected limb are followed by 
flexion of all the joints, including the phalanges. The stifle-joint is 
not completely extended on the ilium, and the skin on the inner 
surface of the thigh loses its sensibility. At a later stage the quad- 
riceps femoris muscle atrophies ; its loss of function is immediately seen 
when the animal moves, and may be detected by local examination. 
In incomplete crural paralysis the body sinks towards the affected 
side, whilst all the joints become somewhat flexed (fig. 127), the last 
period of the stride being consequently shortened. Animals suffering 
from this disease, however, in time learn to move better, the ab- and 
ad-ductors of the limb co-operating to fix the stifle-joint. This action 
is easily detected when the animal is walked very slowly past the 
observer: it is then seen that the upper end of the tibia is not only 
drawn backwards and upwards, but the patella is fixed on the condyles. 
of the femur. The last symptom to disappear in convalescence is the 
upright position of the os suffraginis, a consequence of incomplete 
action of the rectus and vasti. 

Paralysis of the crural nerve or of the above muscles may be mistaken 
both for muscular rupture and for lateral luxation of the patella 
(page 605). Ruptures in the various extensors of the patella have been 
seen by Delwart, Meyer, Haubner, Schmidt, and others. Delwart saw 
three cases of rupture of the rectus femoris in the horse, all caused by 
slipping or falling; two proved incurable. The symptoms resembled 
those of the above-described paralysis. Not infrequently a depression 
could be detected in the muscle. Post-mortem examination showed the 
muscles to be pale, as though boiled, their fasciculi shredded out and 
partly separated. 

Schmidt describes rupture of the vastus externus. A horse had 
trodden in a deep rut, and, the ground being frozen, was unable to with- 


PARALYSIS OF THE HIND-LIMB. 589 


draw its foot without assistance. Severe lameness was immediately 
apparent, the limb was relaxed, and collapsed at every attempt to sustain 
weight on it; the stifle and hock were markedly flexed. At first no 
change could be detected in the muscles, but after some days a depres- 
sion, about 4 inches deep, became visible on the outer side of the 
muscles attached to the patella. The horse was unable to rise tor 
fourteen days, but in three weeks’ time could again place weight on the 
limb, In two months it was put to light work, and in three months 
had entirely regained its usefulness. During its course this case also 
showed some resemblance to crural paralysis, and it is possible that it 
may have been of that character. 

Hollmann saw rupture of the rectus femoris muscle in a cow, followed 


Ose ening 


a a <) 


i 


Fic. 127.—Incomplete crural paralysis—-(from an instantaneous photograph). 


by permanent lameness; Haubner describes injuries to the extensors of 
the patella in a horse; Leesa double-sided temporary inflammation of 
the quadriceps femoris in a horse (hamoglobinemia ?). Meyer saw 
rupture of the rectus femoris, vastus externus and internus muscles in 
a cow; a distinct depression could be detected about 8 inches above the 
patella. The symptoms were similar to those of crural paralysis. 
Voigtlander confirmed his diagnosis of rupture of the straight 


590 PARALYSIS OF THE HIND-LIMB. 


patellar ligaments in an ox by post-mortem examination. The inability 
to stand, severe inflammation of the stifle-joint, marked flexion of the 
limb, and inability to extend or bear weight on it, and the relaxation 
of the affected ligaments, left little doubt of the character of the injury, 
even during life. Voigtliinder saw a cow with rupture of the inner and 
iniddle straight ligaments, and of the inner lateral ligament, and outward 
luxation of the patella. 

The prognosis depends principally on the severity of the symptoms. 
When pain is marked, and weight cannot be placed on the limb 
during the first few days, the prognosis, especially in the horse, is 
unfavourable. 

The treatment of rupture consists in absolute rest, the provision of 
plentiful bedding, and in turning the animal with sufficient frequency 
to prevent bed-sores. 

Course.—The number of recorded cases is at present too small to 
guide us in laying down the general course of crural lameness, in addi- 
tion to which each case varies according to its cause. Whilst the 
paralysis accompanying hemoglobinemia is generally obstinate, indeed 
often incurable, that produced by severe mechanical strain frequently 
disappears in a few days. I saw three cases of the latter kind recover 
in six, twenty, and forty-two days respectively, and two others after a 
short interval; one case appeared incurable. Early recovery may be 
expected in recent and incomplete paralysis. 

Treatment of crural paralysis must follow general principles. The 
use of the electric current, and especially of the Faradic current, is very 
difficult in the horse, and can seldom be advantageously resorted to. 
The position of the crural nerve also prevents its being directly arrived 
at, and treatment is therefore confined to, as far as possible, checking 
degenerative changes, and improving nutrition in the paralysed muscles. 
Massage, in the form of kneading and beating, is of great value for this 
purpose, and should, if possible, be performed daily. Exercise, in addi- 
tion to favouring regenerative changes in the affected nerve, assists 
circulation and nutrition in the muscles. In dogs the induced electric 
current may be employed. 

C. Paralysis of the obturator nerve. 

Paralysis of this nerve has not yet been seen, and must always be 
difficult to diagnose, because it would present none of the marked 
symptoms seen in the above-named conditions. In man there is ioss of 
function in the adductors, and inability to abduct the foot. It might be 
possible to directly detect paralysis of the adductor. 


THROMBOSIS OF POSTERIOR AORTA AND ITS BRANCHES. 591 


VII.—THROMBOSIS OF THE POSTERIOR AORTA AND 
OF ITS BRANCHES. 


Lit.: Raynal, Her. Rep. 14, p. 299. Jacob, ibid., 16, p. 148. Proeger, 
Dresd. Ber, 1875, p. 108, Heckmeyer, Gurlt u. Hertwig. 11, p, 434. 
Riihling, ibid, 33, p. 182. Terrillon, Fortschr. d. Med. 1887, p. 82. 
Bayeredahbrn -16s6) p. 88; Gassener, B.. T: W. 1892, p. 256, 
Schumm, ibid, 


Aneurism of the anterior mesenteric artery is common in horses, and 
loosened particles may be hurried with the blood-stream into the 
posterior aorta and its branches, which then becomes thrombosed. 
Proeger saw thrombosis in a cow in consequence of endocarditis. Stop- 
page of small vessels near the femoral or pelvic arteries by emboli of 
small diameter may produce no serious results, but where large vessels 
are plugged, the muscles served by them, no longer receiving the 
quantity of blood necessary for their functional activity, are incapable 
of sustaining severe exertion, lameness appears, the horse comes to a 
standstill, and finally myopathic paralysis of the affected muscles 
sets in. 

Whilst the animal is at rest circulation is maintained by collateral 
vessels, and it is only on movement that symptoms develop. The time 
of their appearance depends on the degree of obstruction in the vessels 
and the intensity of the muscular action. When the occluded vessels 
are small the animal may go several hundred yards, even at a fast pace, 
before lameness appears, and the symptoms vary in character according 
to the muscles involved, but thrombosis of large vessels is followed by 
symptoms of extensive muscular paralysis after even 3 to 5 minutes’ 
trot. A few minutes’ rest produces an apparently perfect recovery. 
The intermittent lameness thus produced is perfectly distinctive. 
Thrombi extending to the aorta sometimes prove fatal, as shown by 
cases described by Raynal, Jacob, Heckmeyer, and by myself. 

The disease generally develops insidiously, attention being first 
directed to it by the attacks of lameness, but when large vessels are 
blocked other well-marked symptoms are present, like dyspnoea, per- 
spiration, and cramp in the affected groups of muscles. The thrombosed 
vessel never again becomes clear, though collateral circulation is some- 
times established, and gradual improvement follows. In other cases the 
lameness increases, in consequence of the growth of the thrombus. 

Symptoms.—The intermittent lameness, which soon disappears 
with rest, but always returns on movement, is characteristic. Its 


592 THROMBOSIS OF POSTERIOR AORTA AND ITS BRANCHES. 


severity and extent depend on the position and size of the thrombus or 
thrombosed vessel. Blocking of the femoral artery is immediately 
followed by loss of function in the ilio-psoas and tensor fascie late, 
which it supplies with blood. Lameness is, consequently, most marked 
whilst the limb is being advanced. The forward stride is retarded and 
shortened, and the limb dragged, the reason being that these actions 
are normally performed by the muscles named. 

Thrombosis of the iliac artery, which supplies the glutei and quadri- 
ceps femoris, produces a “supporting leg lameness,” which closely 
simulates crural paralysis. The animal is unable to stand on the limb, 
because at every attempt the joints become flexed. Paralysis of the 
glutei is followed by loss of balancing power, and when double-sided by 
rolling of the hind-quarters to and fro. In obstruction of the caudal 
arteries the tail hanes limply downwards. Horses with double-sided 
iliac thrombosis rapidly lose control of both hind-quarters when galloped. 
The hind-limbs approach one another more and more closely, the hoofs 
are planted on the ground just alongside of one another, and finally the 
animal comes to the ground with the hind-quarters first. 

In bilateral thrombosis, or in thrombosis of the aorta, these symptoms 
are combined, and may become so severe that the animal is unable to 
support the hind-quarters, even when at rest. Such cases often show 
dyspnoea, tumultuous action of the heart, cramp in the muscles of the 
hind-quarters, and, if the animals be worked, epileptiform convulsions 
of the entire body. Though the rest of the body is bathed in perspira- 
tion, the affected region remains dry and cold. Sometimes even during 
rest the limb seems colder than that of its neighbour. 

Stallions are sometimes unable to copulate. I saw one in which 
erections occurred, but were not followed by ejaculation of semen. The 
post-mortem of such animals shows emphysema of the lung, with hyper- 
trophy and dilatation of the heart (Gassener). 

According to Terrillon’s observations on men suffering from this 
disease, the attack is accompanied by a feeling of painful stiffness and 
severe burning. In recent cases, animals show pain if the limb be lifted ; 
soon after, lameness becomes apparent. I once saw the primary attack 
due to embolism. The symptoms were severe dyspnoea, laboured action 
of the heart, frequent pulse, and cramp in the affected muscles. 

The prognosis depends on the degree of interference with movement, 
but the tendency is always towards aggravation of symptoms, not 
towards improvement, and only in slight cases can the development of 
an efficient coilateral supply and recovery be looked for. Of eleven 
army horses affected during the year 1891 with thrombosis of the aorta, 
of its branches, or of the radial artery, only one recovered. 

Treatment.—The solution or removal of the thrombus is impracti- 


DISPLACEMENT OF THE BICEPS FEMORIS MUSCLE. 593 


cable, and internal remedies, like the alkaline carbonates which were 
formerly recommended, are of no value. I regard massage (suggested by 
Bayer) as dangerous. Though the thrombus may be loosened by manipu- 
lating the vessel through the rectum, further coagulation readily occurs, 
and one of my cases thus treated died next night in consequence, the post- 
mortem showing complete thrombosis of the posterior aorta with fresh 
clots. The only treatment which I consider of value consists in exciting 
collateral circulation by regular work. As recommended by Bayer, the 
animal is exercised until the first symptoms of lameness appear, and then 
rested, or it may be put to continued light work. The increased blood 
circulation thus excited favours development of collateral circulation, 
but too much is not to be expected from this process. 


ViII.—DISPLACEMENT OF THE BICEPS FEMORIS MUSCLE. 


Lit.: Vatel, Handbuch iibersetzt von Pestel. vol. i. p. 348. Meyer, 
Gurlt u. Hertwig. 4, p. 76. Winkler, Ad. Woch. 1872, p. 193. 
Harms, Han. Ber. 1874, p. 83. Frohlich, Jahrb. 1883, p. 108. 
Eletti, Jahrb. 1858, p. 56. Strebel, Schweiz. Arch. 1891, p. 1. 
Rinquet-Desmarteaux, Her. Rep. 15, p. 332. Wilhelm, Dresd. 
Ber. 1881, p. 114. 


As a consequence of the differences in their respective anatomical for- 
mation, luxation of the biceps femoris is comparatively common in oxen, 
but very rare in horses. In oxen, the abductor of the hind-limb consists 
of two heads, and possesses, on the spot where it passes over the 
trochanters, a large mucous bursa; at this point it is only loosely 
connected with the underlying muscles. When, therefore, the fascia 
surrounding it is accidentally ruptured, the upper head of the muscle 
glides off the trochanter, is caught behind it, and lameness is at once 
developed. This condition is very seldom seen in horses, though cases 
are reported by Eletti, Strebel, and Moller. 

Causes.—The disease is almost entirely confined to mountain cattle, 
with sloping quarters and trochanters; it is especially common in thin 
animals; “ cow-hocks” are also said to predispose to its production. It 
is more immediately due to slipping, especially in a backward direction, 
as happens during work, and in coitus (Harms). 

Symptoms.—tThe lameness is usually confined to one leg (Harms. 
and Winkler). Immediately the muscle named becomes fixed behind 
the trochanter, flexion and extension of the limb are greatly interfered 
with. The limb is fixed in an extended position similar to that in 


upward luxation of the patella (Harms, Winkler), or is thrust outwards 
2P 


594 DISPLACEMENT OF THE BICEPS FEMORIS MUSCLE. 


and forwards with a kind of “mowing” movement, the claws scraping 
the ground. Winkler denies having seen the mowing movement in the 
twenty cases which came under his notice, but draws attention to the 
similarity between this lameness and luxation of the patella, from which 
it is only distinguished by the fact that the limb is not so firmly fixed 
when in the extended position. Sometimes the dislocation is only 
momentary, the muscle immediately returning to its normal position, 
so that the animal goes sound for a few steps, but soon after falls lame 
again. When the muscle becomes fixed in the abnormal position it 
appears tense, and its outline more distinct, whilst a depression appears 
in front of the trochanter. 

Course.—Spontaneous recovery is never permanent; and unless 
operation be resorted to, habitual luxation results, ae, the lameness 
continually recurs, or becomes lasting. 

Treatment.—Myotomy is the only means of cure. The operation 
is usually carried out with a free incision as follows :—By drawing the 
sound limb forward weight is thrown on its neighbour, and a nearly 
perpendicular incision, about 2 inches in length, is made through the 
skin 2 inches below and just in front of the trochanter, in the direction 
of the muscle. Beginning at its anterior border, the muscle is then 
divided from subjacent tissues by using the fingers or the handle of a 
scalpel. It is next lifted, a director thrust under it transversely, and it 
is divided with a scalpel from within outwards. With proper treatment 
the wound heals in sixteen to eighteen days. Hertwig has shown that 
the section might be made subcutaneously. Healing would doubtless 
be more rapid by observing antiseptic precautions, 

In the horse, the muscle does not pass over the upper trochanter, 
but backwards between it and the ischium, becomes attached by a 
tendon to the upper part of the ischial tuberosity, which it partly 
covers, and then blends with the middle and short abductor. The 
muscle, therefore, during its course, describes a curve, and one portion 
of it passes over the ischial tuberosity, to which it is attached by 
means of a tendon. 

In fractures of the ischium, the tuber ischii may be displaced by the 
pull of this muscle, resulting in deformity of the buttock; the 
symptoms are similar to those in the above-described disease of cattle. 
I have seen two cases of this kind in my own clinique. 

A ten-year-old grey gelding had fallen in front of the carriage and 
was lame, but showed nothing unusual in the stable. A careful examina- 
tion of the pelvis showed, however, that the left buttock was abnormally 
flat at the height of the tuber ischii. Seen from the side, the right 
buttock projected considerably further than the left, the flattening, 
which was about 1 to 2 inches in size, was most marked over the tuber 


DISPLACEMENT OF THE BICEPS FEMORIS MUSCLE. 595 


ischil, and lost itself above and below, as well as externally and 
internally. The right tuberosity could be distinctly felt, but the 
left was indistinguishable; a soft mass of muscle occupied its position, 
and the bone could only be felt in the depths. Around the trochanter 
the muscles of the quarter were slightly prominent, so that when seen 
from behind, the left quarter appeared broader than the right. In the 
lower region the middle line of the perineum was thrust about an inch 
to the left. 
At a walking pace there was moderate supporting leg lameness of 
the left limb, which was abducted both when loaded and freely 
swinging. By placing the hand on the quarter, close behind the upper 
trochanter, during movement, it was possible at the moment the 
limb was relieved of weight to detect a sensation as though a cord 
moved from behind forwards, and then immediately glided back again. 
Careful observation detected this jerking movement of the biceps 
femoris muscle, over a region extending from a point about 4 inches 
above and to the side of the upper trochanter, as far as the middle 
third of the femur. There was no pain, and the lameness was found to 
be due to distortion of the coronary joint, which was cured in fourteen 
‘days, the above-described changes continuing, but without occasioning 
lameness. 
The accident was probably due to old fracture of the tuber ischii, 
resulting in the point of insertion of the biceps femoris muscle being 
torn away and the muscle being displaced in a forward direction, thus 
‘differing from the condition usual in cattle where displacement is 
-backward. 
The lameness described by Elletti, as shown by Hertwig, was clearly 
-due to luxation of the patella. Iam doubtful whether Strebel’s case 
was really dislocation of the biceps femoris muscle, especially as 
recovery occurred in five days. 
_ Wilhelm saw acute atrophy of the abductor muscles in a horse. 
There was at first abnormal sensitiveness and severe prurigo, causing 
the animal to bite the parts, but this disappeared in a week, and was 
succeeded within fourteen days by well-marked atrophy; the muscles 
were relaxed, but there was no lameness. It is difficult to say whether 
this was a case of neuritis or of localised myositis. Possibly it was due 
to thrombosis of the vessels of the affected muscles. 


596 HIP LAMENESS. 


IX.—HIP LAMENESS. 


Lit.: Ginther, Myologie. p. 196. Vachetta, Jahrb. 1883, p. 110. 
Roloff, Thier. Mitth. 1874, p. 1388. Prietsch, Dresd. Ber. 1883, 
p. 83. Siedamgrotzky, ibid., 1874, p. 49. Eberhardt, Guilt u. 
Hertwig. 22, p.42. Noack, Dresd. Ber. 1889, p. 78, u. 1890, p. 76. 
Mayer, Gurlt u. Hertwig. 7, p. 111. Falke, ibid, 23, p,18. Falke, 
ibid., 23, p. 78. Bayer, Chirurgie. 2. Aufl. p. 427. Dressler, ibid., 
11, p. 301. Giovanoli-Soglir, Schw.. Arch, 1892, Kutzner, 
Zeitschr. f. Vet.-Kund. 1891, p. 64. 


The lamenesses described on previous pages may generally be diagnosed 
by careful examination, but not infrequently the symptoms are so ill de- 
fined that it: is impossible to detect the exact cause, in addition to which 
pathological changes occur in the quarter and upper parts of the hind- 
limb, especially around the hip-joint, the exact nature of which evades 
even the most careful examination. Owing to the thickness of the 
muscles, thorough palpation of deep-seated structures is impracticable, 
and inflammatory swellings and other anatomical changes often remain 
undetected, leaving the cause of disease obscure. Such cases are generally 
included under “hip lameness.’ The term comprises all forms of 
obscure lameness, in which, however, the symptoms point to the hip- 
region as the seat of injury; “hip lameness,” therefore, has the 
same position amongst lamenesses of the hind-limb as “shoulder lame- 
ness ” amongst those of the fore-lmb. 

To enumerate all the diseased conditions which might produce hip: 
lameness would .be almost impossible, the causes being too varied. I 
therefore confine myself to enumerating the most important. Hip. 
lameness may originate in the following structures :— 

(1) In the hip-joint. Mechanical injuries, bruises produced by falls,. 
collisions, or kicks, displacements in consequence of slipping, of the foot 
being caught in the ground, &c., are all liable to produce inflammation 
and lameness. Sometimes the skin and surface muscles are more affected 
than the joint proper, and then there is more or less pronounced inflam- 
mation over the hip-joint or external angle of the ilium. 

Partial or complete rupture of the ligamentum teres and extravasation 
of blood into the joint (Eberhardt) are not infrequently met with. Ina 
horse which had suffered from hip lameness for more than a year, some 
portions of which had undergone ossification, Siedamgrotzky found the hip- 
joint surrounded by fibrous connective tissue. The synovial membrane 
was about 2 inches in thickness, the articular cartilage had partly dis- 
appeared from the cotyloid cavity, and its edges were undergoing 
degenerative change. The case was therefore one of arthritis chronica 


HIP LAMENESS. 597 


sicca (coxitis chronica). Whilst making a post-mortem of a horse, the 
subject of hip lameness, Prietsch found fracture of the cotyloid cavity 
which had not been diagnosed during life. 

In cattle, luxation of the femur may remain unrecognised. Harms 
states having seen subluxations in these animals. Noack found double- 
sided purulent inflammation of the hip-joint in an eight-year-old cow. 
The joints when opened discharged about a cupful of very thick, gruel-like, 
greyish-brown, offensive pus. Noack described the disease as metastatic, 
and considered it a result of traumatic pericarditis which had simultane- 
ously existed. It is probable that in oxen purulent coxitis is sometimes 
of tuberculous origin. In the specific lameness’ (Lihme) of young 
animals, purulent disease of the hip-joint is sometimes met with (Mayer). 
Falke’s eontention that the arthritis chronica sicca, known in man as 
malum coxee senile, is common in horses, is obviously incorrect. Both 
clinical observation and the results of post-mortem examination are 
opposed to this view, though the disease does occasionally occur in animals, 
as shown by Siedamgrotzky’s cases. In dogs, it often causes chronic hip 
lameness, and I have seen it in foals suffering from so-called “ Kisballen.” 

(2) Another cause of hip lameness is disease of the bones, @.e., of the 
lumbar vertebre, pelvis, and femur. Old fractures of the pelvis some- 
times occasion obscure lameness. In one such case Bayer detected 
fracture of the os pubis. On superficial examination, fracture of the 
external angle of the ilium may be mistaken for hip lameness, as may 
fracture of the trochanter (p. 575). Under the title trochanteric lame- 
ness, Williams describes a disease of the upper trochanter in the horse, 
manifested by chronic inflammation and formation of exostoses. 

(3) The cause of hip lameness is more often to be sought in the 
muscles than in the hip-joint and the bones. In lameness following 
external injuries, bruises, sprains, and partial ruptures (in consequence 
of falls, kicks, collisions, or over-exertion), the seat of disease is often in 
the muscles, especially in those which are superficial. 

Particular attention should be directed to disease of the tendon and 
tendon bursa of the gluteus medius muscle, to thrombosis of the femoral 
or iliac arteries (p. 591), and in cattle to displacements of the biceps 
femoris. In exceptional cases, this also occurs in the horse. 

Kutzner noted gradually increasing atrophy in a horse of the biceps 
femoris muscle and of the upper portions of the semitendinosis. Lame- 
ness only appeared after three or four months, when the atrophy was 
far advanced; the foot was adducted just before the end of the stride, 
and set down too much under the body. The horse showed weakness 
in movement, and was unable to rise after lying on the diseased side. 
Kutzner referred the condition to thrombosis. Roloff noted paralysis 


1 Navel Ill, specific arthritis. —[TRANSL. ] 


598 HIP LAMENESS. 


of the gluteus maximus in a heavy draught-horse. When walking, the 
affected leg was advanced further than its neighbour, and was drawn 
towards the opposite side, causing the hind-quarters to roll towards the 
sound side at every step. The animal had great difficulty in moving 
backwards, dragged the foot along the ground, and could scarcely 
advance it beyond that of the opposite side. During movement, the 
thigh was strongly flexed, but only partially extended. The animal 
showed no pain whatever. The muscle gradually became atrophied, and 
its place was finally occupied by a trough-shaped depression. 

K. Giinther describes a similar case, which he refers to paralysis of 
the lumbar plexus. In this case the limb was so excessively extended 
during movement that the hoof even touched the chest or elbow. It 
was, however, still capable of sustaining weight. At a later stage the 
muscles of the quarter showed marked atrophy. 

Vachetta saw a peculiar lameness caused by disease of the psoas major 
muscle. 

Noack found rupture of the tensor fasciz latze muscle just below its 
insertion into the external angle of the ilium. The horse became sound 
in a month. 

(4) Until the typical peripheral nerve lamenesses were first recog- 
nised, they also were included under the description “hip lameness.” 
It is possible that certain cases described as hip lameness are due to 
functional disturbance of the sciatic, crural, and obturator nerves. As 
already stated, Giinther describes cases produced by paralysis of the 
lumbar nerves. 

The descriptions of neuralgia of the sciatic nerve in animals are 
unconvincing; certainly the occurrence of this condition has not yet 
been clearly proved. The same is true of inflammation of the sciatic 
nerve (Dressler). The lameness in calves and goats seen by Giovanoli- 
Soglir, and referred to inflammation of the sciatic nerve, was probably 
due to other causes. 

(5) Finally, disease processes near the hip-joint may produce lame- 
ness, the real cause of which either remains undiscovered, or is only 
revealed after very careful examination. Scirrhous cord, swelling of 
the inguinal glands, inguinal and femoral herni, all interfere with 
movement, and sometimes produce lameness, simulating that due to 
disease of the hip-joint, or of the bones or muscles. Inflammation of 
the subeutis over the hip-joint may also result in lameness. 

Symptoms.— Although the various forms of hip lameness, being 
due to different causes, exhibit important pecularities in their symptoms, 
yet, taken as a whole, they show certain features of general agreement. 
Thus in all there is difficulty in advancing the limb (swinging leg 
lameness), retardation of movement and shortening of the forward stride, 


HIP LAMENESS. 599 


and in many a tendency to stiffen the limb during movement, and to 
drag the toe. When the hip-joint itself is diseased, there is supporting 
leg lameness, and the animal tries to avoid throwing weight on the 
affected side,—symptoms which are usually absent in the purely mus- 
cular forms. Lameness is marked when turning and backing, and 
appears in an ageravated form after severe exertion. Sometimes it is 
most distinct when commencing work, and gradually decreases ; some- 
times the reverse. Though rheumatic lameness usually wears off with 
exercise, its continuance or aggravation by no means points to a 
traumatic origin. Mechanical injury is a much more frequent cause of 
lameness than rheumatism. 

Sometimes anatomical changes, such as muscular atrophy, swelling 
and increased warmth, can be detected, which assist diagnosis, and 
render it approximately exact. The more thorough and complete the 
examination, the less common will be the diagnosis “hip lameness,” 
which must always be regarded as a refuge for ignorance, and which 
we are only justified in delivermg when careful examination shows no 
visible cause for the lameness elsewhere. 

In other words, diagnosis must be arrived at by a process of exclu- 
sion. Cases occur, however, which even the most practised fail to 
exactly trace to their source. 

Course and Prognosis.—In forecasting the termination of a case, 
valuable indications are afforded by the character of the onset and 
course. Sometimes the disease appears suddenly, sometimes slowly ; 
sometimes it disappears in a short time, sometimes continues for months, 
or appears altogether incurable. These variations are always important 
in determining diagnosis and prognosis; indeed, the prognosis often 
depends entirely on the course taken. The following principles are in 
general true :— 

(1) Sudden lameness points to mechanical injury, and usually takes 
a more favourable course than that which develops slowly but pro- 
gressively. 

(2) When improvement has once set in, complete recovery becomes 
probable in direct proportion to the rapidity with which the lameness 
has diminished. The gradual increase of lameness indicates patholog- 
ical changes, probably of an obstinate character. 

(3) The older the lameness, and the more marked the anatomical 
changes (muscular atrophy), the graver the prognosis. 

(4) Intermittency or remittency in the lameness is also an unfavour- 
able feature, particularly if the horse has been rested and properly treated. 

(5) The duty to be performed must also be considered: thus riding- 
and heavy draught-horses offer less probability of permanent recovery 
than those in lght work. 


600 HIP LAMENESS. 


(6) Disease of the joint is graver than muscular disease. 

Treatment.—In recent hip lameness, accompanied by inflammatory 
symptoms, rest and cold applications, in the form of poultices, con- 
tinuous cold-water irrigation, or ice bottles, are indicated. If the 
symptoms suggest rheumatic disease —that is, if lameness decrease with 
movement, if the course be intermittent, and if the disease appear with- 
out apparent cause——warm moist packs are better, and may be followed 
by infriction with mild irritants, like oil of turpentine, spirit of camphor, 
or ammonia liniment. The animal should be rested, and placed in a 
warm stall. In muscular disease, massage, in the form of rubbing, is 
valuable; but where paralysis is surmised, striking or beating the 
muscular tissue is better, and seems to check degenerative processes. 

If no marked improvement occurs in eight to fourteen days, a blister 
of cantharides, bichloride or biniodide of mercury (1-8) may be applied. 
Tt is best to mark out with chalk, or by clipping the hair, the position 
in which the ointment is to be applied to the hip-joint, because 
otherwise laymen always apply it over the external angle of the ilium. 

Should this treatment also fail, setons, subcutaneous injections of 
veratrin, or the application of the actual cautery may be resorted to. 
Amongst other injections, a concentrated solution of common salt has 
lately been recommended. I have not seen any good follow, though 
when the injection produces abscess formation, it certainly acts some- 
what like a seton. After recovery from long existent lameness, 
particularly from lameness produced mechanically, the horse should 
not immediately be put to work, and heavy work should especially be 
avoided. 


B. Diseases of the Stifle-Joint. 


Anatomy.—The two divisions of the stifle-joint formed by the condyles of 
the femur, and the interarticular cartilages crowning the head of the tibia, often 
communicate with one another, whilst the patella-joint consists of a roomy cavity 
above and in front of the condyles of the femur, which Franck says always com- 
municates with one, sometimes with both of the others. The tendon sheaths of 
the flexor metatarsi and extensor pedis also communicate with the external divi- 
sion of the stifle-joint. In the horse, a bursa known as the bursa prepatellaris, 
varying from the size of a bean to that of a walnut, is found on the anterior 
surface of the patella. 


LUXATION AND SPRAIN OF THE STIFLE-JOINT. 601 


I—LUXATION AND SPRAIN OF THE STIFLE-JOINT. 


Lit.: Stolze, Gurlt u. Hertwig. 14, p. 121. Meyer, ibid., 18, p. 313 (auch 
Liter.). Richter, ibid. p. 304. Violet, Jabrb. 1885, p.107. Santo, 
ibid., 1883, p. 109.. Guigas, ibid., 1888, p. 138. Waters, Jabrb. 
1854, p. 58. Stockfleth, Chirurg. p. 690. Meyner, B. T. W. 
1892, p. 75. Olivert, Gaz. vét. 1892, Ref. in B. T. W. 1892, p. 318, 
Sand, Deutsch. Zeitschr. f. Thiermed, 1893. 


The stifle-joint has broad articular surfaces, and a powerful liga- 
mentous apparatus. It is further surrounded on almost all sides by 
strong muscles and tendons, whilst the tibial spine projects upwards 
between the two condyles of the femur, and the relations of the two 
bones are so secured that in animals luxation of the joint is of exces- 
sively rare occurrence. Isolated cases have, however, been seen in cattle. 

Thus Stolze describes complete luxation of the tibia forwards. The cow 
was unable to advance the limb, which was rigid and somewhat shortened. 
It was still possible, however, to place weight on the leg, and the 
displacement of the bone could be detected by palpation of the stifle- 
joint. 

Reposition, though difficult, was finally effected, but the luxation 
soon recurred, in spite of the animal being slung. After replacing the 
parts five times—an operation which appeared easier on each occasion—a 
blister was applied ; the parts remained in position, and in three months 
the animal could move fairly well, and was able to return to grass. In 
the Jahresbericht for 1860 a similar case is described. 

Sprain of the stifle-joint may possibly occur from violent movements, 
but is certainly not common in large animals. Possibly the chronic 
inflammation of the stifle-joimt (gonitis chronica) seen in dogs is due 
to such injuries. In cows, Sand noted spontaneous dislocation of the 
tibia following partial destruction of the interarticular cartilages, in 
consequence of chronic gonitis. 


Il.—DISPLAGEMENT OF THE PATELLA. LUXATIO 
PATELLA. 


The patella is retained in position by a capsular ligament strengthened 
by two lateral ligaments, and by its straight ligaments, of which the horse 
and ox possess three; most other animals, however, only one. Finally, 
the pull of the triceps extensor cruris muscle sustains the patella above. 
Horses, oxen, and dogs are the commonest sufferers, and the luxation is 
either— 


602 LUXATION AND SPRAIN OF THE STIFLE-JOINT. 


(a) Upwards, over the internal lip of the trochlea of the femur; or 

(b) To the side, and always to the outer side. 

The two conditions, however, differ not only in their symptoms, but also 
in their prognosis and treatment, and therefore will receive separate 
consideration. 

(a) Luxation of the patella upwards, which occurs in oxen and horses, 
and has been seen by Olivert in a mule, is, strictly speaking, only a 
displacement of the patella within its articular capsule, the bone passing 
upwards over the external lip of the trochlea and failing to return. It is 
fixed in this position by its lower border lying against the upper margin 
of the inner lip of the trochlea. This luxation can, therefore, only occur 
after excessive extension of the stifle-joint. Violet has lately put forth 
the theory that the patella is retained on the trochlea of the femur 
by its lateral ligaments, and particularly by its internal lateral liga- 
ment. The surface of the internal lip of the trochlea describes the 
segment of a circle around the point of insertion of the internal 
lateral ligament into the femur. It can, therefore, easily be imagined 
that under certain circumstances the upper portions of the articular 
surface may lie nearer to the point of insertion of the ligament than 
the portions below. As a consequence the patella might easily be- 
come fixed in position on that surface of the inner trochlear lip, which 
Violet describes as being concave in the horse, and which in oxen is 
level, and require a very considerable exertion of strength to draw it 
down again. In consequence of this form of the articular surface of 
the internal lip of the trochlea, and of the tension in the lateral ligaments, 
the patella is sometimes arrested for a few moments, and, under certain 
circumstances, for a longer time at the highest point in its course, and 
the action of the limb thus interfered with. The condition might, 
therefore, be looked upon as fixation of the patella in a position of 
excessive extension. 

Causes and Symptoms.—lIt will be seen that dislocation may be 
due to one of two causes, viz. :— 

(1) Flattening of the articular surface of the internal lip of the trochlea 
in conjunction with abnormal tension in the lateral ligaments; or, 

(2) Fixation of the lower surface of the patella on the upper border 
of the inner trochlear lip. In the first case, it is natural that 
the lameness should often be remittent, but only last for a few moments 
on each occasion (habitual luxation). I therefore term this form, 
momentary upward luxation of the patella; and that produced by 
fixation of the under border of the patella on the upper border of the 
external lip of the trochlea, stationary upward luxation. Movement of all 
the joints of the limb, with the exception of the hip-joint, is dependent, 
however, on flexion of the stifle, on account of the insertion into or 


LUXATION AND SPRAIN OF THE STIFLE-JOINT. 603 


around it of the flexor metatarsi, gastrocnemii, extensor pedis and flexor 
pedis perforans, muscles ; and therefore when the stifle is fixed, the other 
joints are at once immobilised in an extended position, and flexion and 
free movement are lost. In fact, any interference with the movement 
of the patella produces lameness: in the case of momentary luxation 
there is a slight check, similar to that seen in stringhalt, just at the 
time the foot leaves the ground and should begin its striding movement. 
Bassi, indeed, regards stringhalt as due to momentary luxation. The 
peculiar check is often seen in the stable when the animal turns round, 
sometimes in one but not infrequently in both limbs. As a rule, it 
gradually disappears during work, sometimes only occurring during the 
first twenty to thirty steps. The sudden and excessive flexion of the 
limb which follows the check has produced the erroneous impression 
that it is due to cramp in the vasti and rectus muscle. 

The degree of lameness varies greatly. Sometimes it is necessary to 
look carefully in order to recognise it at all, but in other cases the 
patella is seen to remain fast for a moment and then suddenly descend. 

The symptoms are different when the patella remains continuously fixed 
above the internal lip of the trochlea, 7.¢., in stationary upward luxation. 
This condition only affects oxen and solipeds, because in other animals 
the internal lip is more rounded off, and fixation of the patella 
above it is impossible. In consequence of violent contraction of the 
vasti and rectus muscles occurring when rising or falling, kicking out- 
wards, or extending the limb, the patella passes too far upwards, 
and becomes fixed. Before this can occur, it is probably necessary 
for the straight ligaments of the patella to become elongated, as 
happens in pregnant animals by continual confinement to the stable 
(Violet), or to others after passing through severe attacks like influenza 
Not infrequently such elongation is congenital. Loose-jointed, weak foals 
suffer oftener than well developed horses. Fixation of the patella on 
the upper portion of the internal lip of the trochlea is at once followed 
by extension of all the joints of the limb and inability to flex them, even 
with external assistance. The limb is therefore stiff directed backwards, 
and cannot be advanced. If both limbs are affected at the same time, 
the animal stands as though rooted to the spot and cannot advance; 
where only one limb is affected, it can still hop forwards on the other 
leg. Luxation is, therefore, distinguished by lameness when the leg is 
carried and excessive extension of all joints. 

If, whilst the patella occupies this position, the rectus and vasti 
muscles be relaxed, the patella may rise from the lip of the trochlea of 
the femur and stand upright on its lower border, a condition which in man 
is known as vertical luxation of the patella. The symptoms are so charac- 
teristic that stationary luxation can be diagnosed from a distance, and is 


604 LUXATION AND SPRAIN OF THE STIFLE-JOINT. 


only likely to be mistaken for dislocation of the biceps femoris muscle 
in oxen, in which, however, the extended position is not so well marked, 
‘and the limb can always be flexed, if only to a slight extent, while the 
trochanter may be felt under the skin, and the patella at least moved 
sideways. In luxation, on the other hand, it is absolutely immovable, 
and les too high. 

The prognosis depends partly on the amount of interference with 
movement, and therefore with usefulness, partly on the character of the 
lameness, the age of the animal, and the length of time the disease has 
existed. In weakly foals, and in animals attacked during convalescence, 
both momentary and permanent luxation usually disappear as the general 
condition improves. The longer, however, lameness has existed, and 
the more frequent and marked the attacks, the slighter is the chance of 
recovery. 

Treatment. Young animals and convalescents should be well fed 
and kept from heavy work. With rest and the recumbent position, the 
straight ligaments of the patella return to their normal length. Every- 
thing likely to cause relapse must be avoided. In momentary luxation 
nothing further can usually be done, but stationary luxation calls for 
immediate reduction, which may be effected in one of several ways. 

(1) The patella often returns to its proper position after sudden 
backward or side movements. Energetic contraction in the patellar 
muscles, produced by an unexpected blow or by drenching the animal 
with cold water, also induce reduction at times. 

(2) Where the above means prove insufficient, an attempt should be 
made to free the lower edge of the patella by pressing on its upper and 
outer border, the pressure being directed backwards and inwards. 
Meyer grasps the patella with the whole hand and lifts it up whilst 
the animal is led forward. 

Reduction is assisted by passing a cord round the fetlock, lifting the 
toe from the ground and drawing it forward, thus extending the stifle- 
joint. The animal is then thrust forward, and at the same moment the 
patella pushed back (Richter). Where the animal is lying, the limb 
can be drawn forward and fastened as for castration, replacement being 
attempted in this position. 

After successful replacement, it is important to rest the animal for 
three to five weeks. The application of blisters, setons, &c., is only 
useful in keeping the limb at rest. If the patella again slips out when 
the animal lies down or rises, slinging may be resorted to. 

Violet, Santo, and Guigas lately recommended dividing the inner 
lateral ligament, and state having cured cases of momentary luxation 
which had been in existence for years (Guigas). The operation is, 
however, by no means easy, as I have found by experiment, because the 


LUXATION AND SPRAIN OF THE STIFLE-JOINT. 605. 


inner lateral ligament has no sharp border in herbivora, and is inti- 
mately connected with the capsule of the joint. 

(b) “ Lateral Luxation of the Patella.” 

In horses, oxen, and still more frequently in dogs, the patella is dis- 
placed laterally, and almost always towards the outer side. In dogs 
the disease is generally congenital and affects both limbs, being caused 
by arrest in the development of the condyles of the femur. Acquired 
luxations outwards are dependent on excessive strain or rupture of the 
inner lateral ligament. As the internal condyle of the femur is much 
the larger and projects further inward, luxation is very rare indeed in 
animals, though Stockfleth saw one case in a cow. Sometimes the 
patella still lies to some extent over the external condyle (incomplete 
luxation), though it is generally thrust on to its outer surface (complete 
luxation). Though in the horse the patella is certainly secured in posi- 
tion by a cartilaginous prolongation which curves over the inner lip of 
the trochlea, its displacement outwards is by no means impossible. 
Meyner saw luxation of this kind in two cows. 

Causes.—tThe predisposing causes of lateral luxation are uprightness. 
of the limb, obliquity of the quarters, and youth of the animal. The 
condition often appears in both limbs. Another factor may consist in 
relaxation and weakness of the ligaments. In dogs the inner lateral 
ligament is much slighter than the outer. 

Everything favouring rupture or strain of the internal lateral liga- 
ment may produce the condition. Meyer believed it was caused by 
rheumatic contraction in, or excessive action of, the abductors, but 
failed to effect a cure by dividing them. 

The prognosis is less favourable than in upward luxation. Pigs 
often suffer congenitally, and little can be done for them. As in other 
cases, the older the luxation the greater the difficulty in reduction and 
retention, and the less the chance of recovery. Incomplete outward luxa- 
tion is clearly more favourable than the complete kind. Meyner’s cases 
recovered sufficiently to allow the animals to be used for milking purposes. 

Symptoms.—tThe clinical symptoms of complete dislocation resemble 
those of crural paralysis and rupture of the extensors of the stifle-joint. 
They consist of lameness when weight is placed on the limb, with 
excessive flexion of all the joints. Where the patella is displaced out- 
wardly, the function of the rectus and vasti, and consequently the 
ability to bear weight, are lost, though the muscles named can still 
advance the limb, the stride being somewhat shortened. The capsular 
ligament appears distinctly below the stifle, whilst the patella can often 
be felt in its abnormal position. The symptoms are less marked in 
incomplete luxation, in which lameness is sometimes more pronounced 
when walking than when trotting, 


606 LUXATION AND SPRAIN OF THE STIFLE-JOINT. 


In dogs the patella is readily replaced, giving immediate relief from 
lameness, but soon slips out again (habitual luxation). In horses redue- 
tion is more difficult, and the limb is afterwards held stiffly, and only 
slowly advanced. 

Treatment.—A<As already stated, replacement proves easy in the 
carnivora, but in all kinds of animals retention is difficult. Hertwig 
states having kept the patella in position by hand for forty-eight hours. 
Relays of assistants were employed, and a blister afterwards applied. 
As bandages cannot be used to retain the parts, treatment is generally 
confined to rest and blistering, which compels the animal to keep the 
foot as still as possible. Large animals can be slung. 

I recently saw a peculiar displacement of the patella upwards and 
outwards. It was impossible to bend the ihmb, which was extended and 
directed forwards, but weight could very well be borne on it. When 
forced to move, the animal carried the leg forward, holding it stiffly, and 
not moving the hip-, stifle-, or hock-joints, and placed it far in advance. 
The progress of the body then brought the limb perpendicularly under 
the hip-joint, but the leg could not be placed behind this point, either 
actively or passively. Slight pressure against the outer edge of the 
patella sufficed to return it to its position, after which the horse could 
~ gometimes walk for several steps in the usual way ; suddenly, however, 
the patella again became displaced, and all the symptoms returned. 

The post-mortem showed the inner lateral and inner and middle 
straight ligaments to be diseased and elongated, allowing the lower 
border of the patella to ride up over the outer lip of the trochlea, and 
become fixed there. The upper border of the patella then inclined for- 
wards (vertical luxation), and the bone itself slipped outwards to an 
extent of nearly 1 inch over the external condyle of the femur. When 
the patella was replaced, the ligaments named were seen to be distinctly 
relaxed. The continual pressure exercised by the lower border of the 
patella had caused absorption of the articular cartilage of the femur, and 
the formation in it of a distinct depression, corresponding in shape to 
the lower surface of the patella. Attempts were made during life to fix 
the bone in its proper position by a dressing, and for a time proved suc- 
cessful, but had to be given up in consequence of their causing inflam- 
mation and necrosis. The most effective appliance was a broad strap 
fixed to the slings, and buckled round both stifle-joints. 

A splint was so applied to the tibia as to exercise pressure on the 
outer surface of the patella, but was only partially successful, though, 
after eight days of this treatment, the patella remained in position, and the 
animal could stand and even walk some steps without assistance. Previ- 
ously it had been unable tomake even a single step without the patella 
becoming displaced. Unfortunately it died from an intercurrent disease. 


RUPTURE OF THE STRAIGHT LIGAMENTS OF THE PATELLA. 607 


II.—RUPTURE OF THE STRAIGHT LIGAMENTS OF THE 
PATELLA. 


Lit.: Voigtlander, Dresd. Ber. 1860, p. 57. 


I have twice seen rupture of the outer straight ligament in horses, 
in one case caused by the impact of a carriage-pole, the second probably 
by suddenly springing up in the stable. Both animals showed marked 
supporting leg lameness. At first no weight at all was thrown on the 
affected limb, and later, only to a certain amount. The internal and 
middle straight ligaments could be felt below the patella, but the place 
of the lateral one was occupied by a depression. There was great pain 
on pressure below the patella, which, however, preserved its natural 
position. Treatment consisted in absolute rest: one patient was suffi- 
ciently improved in three weeks, the other in a month, to allow of its 
leaving hospital. 

Voigtlinder saw rupture of the straight ligaments in an ox. The 
symptoms were: inability to stand, severe inflammation around the 
stifle-joint, flexion of the limb, inability to extend the stifle, and relaxa- 
tion of the straight ligaments. The animal was slaughtered, and the 
rupture confirmed by post-mortem. 


IV.—FRACTURE OF THE PATELLA. 


Lit.: Renelt, Th. Mitth. 1860, p. 151. Steffen, Stockfleth’s Chirurgie. 
p. 519. Renault, Her. Rep. 17, p. 39. 


Fracture of the patella is rare, and up to the present has only been 
seen in horses. Kicks, collisions, and falls with the stifle-joint strongly 
flexed are the principal causes. Wollstein reports a case produced by 
struggling in hobbles, whilst Renault saw double-sided fracture in a 
horse in slings; the sling had worked backwards until the horse’s hind- 
feet were no longer in contact with the ground. Another animal is said 
to have broken both patelle by slipping. 

Fractures due to external violence are often comminuted, and associated 
with injury to the joint. Horizontal fractures are usually the result of 
violent muscular contraction. 

Symptoms and Course.—Fracture of the patella is characterised 
by severe lameness, inability to bear weight on the limb, violent pain on 


608 INJURIES AND ACUTE INFLAMMATION OF THE STIFLE-JOINT. 


movement and pressure, and swelling in the stifle region. Provided 
swelling is not too great, the pieces of bone can sometimes be felt, though 
there is rarely crepitation. The prognosis is in most cases unfavourable. 
In men, although much more can be done than in horses, ligamentous. 
union is the rule, because the fragments are considerably separated, 
and on account of its want of periosteum, the bone is little fitted for 
callus formation, while its lower portion is deprived of blood-supply, 
which for the most part is derived from the muscles. Transverse 
fractures and fractures into the joint are in large animals unfavour- 
able; the good results reported are clearly due to errors in diagnosis 
(Renelt). When, however, only a small piece, like the point of insertion 
of one of the. straight ligaments, is torn off, recovery may occur in a 
month. 

Treatment must follow general principles. Large animals require 
slinging, and in small ones a dressing should be applied, the limb being 
as much as possible extended. 


V.—INJURIES AND ACUTE INFLAMMATION OF THE 
STIFLE-JOINT. GONITIS. 


Lit.: Réhling, Gurlt u. Hertwig. 16, p. 135. Schrader, Gurlt u. Hert- 
wig. 26, p. 145. Schirrmann, Zeitschr. f. Vet.-Kund. 1892, 5. 


The larger domesticated animals, and horses in particular, often suffer 
injuries of the patella and stifle from treads, kicks, stabs with stable- 
forks, thrusts with lances, sabre cuts, &c., which give rise to suppura- 
tion in the joint. Inflammation may also extend to the joint from the 
tendon sheaths of the flexor metatarsi and extensor pedis; and as both 
portions of the femoro-tibial jot communicate, suppuration extends 
from one to the other, and eventually to the patellar joint. Acute 
aseptic inflammation of the stifle-joint is less frequent, but may follow 
violent bruises or dislocations, and lead to extravasation into the joint, 
or to gonitis acuta serosa (hydrops genu) (Rohling). 

The symptoms are: severe lameness; the animal carefully avoids 
placing weight on or moving the limb; all the joints of the limb are 
held stiffly in a position of flexion (fig. 128), there is diffuse swelling, 
and, when the joint is wounded, discharge of purulent synovia. The 
animal shows fever and loss of appetite, lies continuously, and, if not 
killed, dies from decubitus, and with symptoms of septicemia. The 
aseptic disease takes a longer course and exhibits less severe symptoms. 
Cases of moderate inflammation display a considerable likeness to gonitis 
chronica. 


CHRONIC INFLAMMATION OF THE STIFLE-JOINT. 609 


The prognosis of septic or purulent gonitis acuta is almost hopeless, 
and in most cases slaughter is to be advised. Fat oxen should at once 
be killed, to avoid the loss of condition which results when disease 
becomes general. The aseptic form may be treated, particularly in 
valuable animals. The prognosis should be reserved if severe pain 
exist, because the continuous weight thrown on the other foot may 
produce acute laminitis, or the animal, unable to stand, may die from 
decubitus. Sherman saw a horse die from division of the femoral 
artery produced by a lance-thrust in the flank. 

Treatment.—Recent wounds near the joint, or involving the above- 
named tendon sheaths, require antiseptic treatment; and as in large 
animals a proper dressing cannot be used, the wound must be disin- 
fected, and in the case of small injuries a blister of sublimate dissolved 
in 10 parts of spirit, or the actual cautery applied, in order to produce 
swelling, and close the wound in the joint as rapidly as possible. Large 
wounds may be carefully disinfected and sutured, or be kept aseptic 
by continuous irrigation. 


VI.—CHRONIC INFLAMMATION OF THE STIFLE-JOINT 
(GONITIS CHRONICA SICCA). 


Chronic inflammation of the stifle-joint principally occurs in heavy 
draught-horses and those which work continuously at a sharp trot. 
Omnibus, tramway, and cab horses often suffer from it, but I have also 
seen it in dogs, particularly in the larger coursing and working breeds, 
in which it is generally unilateral; in horses it often affects both sides. 
Post-mortem examination shows changes similar to those of arthritis 
chronica sicca vel deformans: thickening of the margins of the 
articular cartilage with ostitis, particularly on the tibia. Abrasion of 
the articular surface is most pronounced around the tibial spine, porcel- 
laneous deposits occur, and there is sometimes moderate dropsy of the joint. 
As a rule, the process is confined to the inner division of the femoro- 
tibial joint, the outer division and the patellar joint remaining intact. 

Symptoms and Course.—tThe disease sets in slowly and gradually, 
but generally proves so stubborn that the animal has to be destroyed. 
Sometimes it persists for months, or even years. At first the lameness 
is slight, and where the condition is bilateral may for a long time be 
overlooked. In the stable the diseased limb is kept flexed (fig. 128); 
when both are affected, they are rested alternately. In turning, the 
affected limb is often lifted spasmodically, as in spavin and stringhalt. 

2 Q 


610 CHRONIC INFLAMMATION OF THE STIFLE-JOINT. 


When commencing to walk, the animal shows swinging leg lameness 
and avoids extending the limb, so that the forward stride is shortened. 
The toe of the diseased foot is apt to catch on slight prominences; at a 
trot the lameness shows some resemblance to spavin lameness, but 
the limb is not moved spasmodically, much more often it is carried stiffly. 

Though pain cannot usually be detected, the capsule of the joint is 
often visibly distended below the patella, and in the later stages the 
internal condyle of the femur is distinctly increased in size. This 
examination is made standing behind the horse (of course taking proper 


Fic. 128. —Left-sided chronic inflammation Fig. 129.—Bilateral chronic inflammation 
of the stifle-joint (Gonitis chronica). of the stifle-joint (Gonitis chronica 
bilateralis)—(from a photograph). 


precautions) and grasping the stifle-jomts alternately with both hands, 
so as to compare one with the other. Dogs are examined in the same 
way. The animals sometimes show acute pain when the limb is 
abducted and rotated inwards (pronation). 

The disease is incurable, and neurotomy being out of the question, 
nothing can usually be done. Working-horses should be used as long as 
possible. If the owner insists on treatment, blisters, firing, or other re- 
sorptive measures can be tried. I have never seen good results, and con- 
sider the improvement of reported cases depends on mistakes in diagnosis. 


CHRONIC INFLAMMATION OF THE STIFLE-JOINT. 611 


A twelve-year-old gelding in heavy draught had for two years shown 
slight lameness in each hind-limb alternately. The limbs gradually 
became upright (fig. 129), the movement stiffer, and the quarters more 
markedly sloping. In both limbs the capsular ligament of the stifle- 
joint was prominent, being best defined below the patella (fig. 129). 
When resting, the hind-legs were lifted alternately and strongly flexed, 
at short intervals, and for a long time before the horse had not lain down. 
In work, the hind-limbs were carried stiffly and the stride shortened. 
The animal had become so useless that its owner had it slaughtered. 

The post-mortem examination showed marked proliferation of con- 
nective tissue in the muscles of the quarter and thigh, the new growth 
appearing in the perimysium externum in the form of broad white 
bands (myositis chronica fibrosa). There was chronic inflammation in 
the bursa glutzei radii, with great increase in the villi, which were 1 to 14 
inches in length and 4 to 4 of an inch thick. 

The patellar jot was full of a yellowish viscous fluid. The capsular 
ligament was distended, and the synovial membrane covered with long 
villous growths. In the true stifle-joint the articular cartilage had 
almost disappeared from the internal division, and scarcely a trace 
remained on the spine of the tibia, though numerous eburnated porcel- 
laneous deposits were visible. The margins of the internal division of 
the joint, particularly the tibial margin, were prominent and thickened. 
The patellar joint exhibited no particular change. 


VIIL—BURSITIS PRAPATELLARIS. 


The bursa prepatellaris, according to Hichbaum, occurs in fully half 
of all horses. It les on the anterior surface of the stifle-joint, and 
when injured is apt to become inflamed; the swelling, which is some- 
times fluctuating, sometimes moderately firm, attaining the size of two 
fists. It seldom produces pain or lameness, and only forms a blemish 
like “capped elbow.” 

The disease being caused by bruises or other injuries, is sometimes 
accompanied by inflammatory symptoms, but sometimes occurs without 
them. Lameness is absent in the latter case, a fact to be remembered 
in diagnosing other diseased conditions. Should treatment be considered 
necessary, fluctuating swellings (hygromata of the bursa) may repeatedly 
be punctured with the hollow needle, or with a slender trochar, and 
emptied of contents. Injection of iodine may also be tried. As in 
“capped elbow,” free incision leads to long-continued suppuration, and 
is therefore not advisable, unless the bursa can be destroyed by 


612 DISEASES OF THE LEG. 


cautery or caustic. Blisters and firing may produce gradual contraction, 
but require repeated application. Care must be taken not to incise a 
hydrops genu in mistake for enlargement of the prepatellar bursa. The 
hydrops swelling lies deeper, and cannot be so easily displaced under the 
skin as that now in question. 


C. Diseases of the lower Thigh or Leg. 


The thigh, especially in the horse, is surrounded by a tense, stretched 
skin, which on the external face is strong, but on the internal quite 
thin. Towards the front of the internal surface of the thigh, the skin 
and slightly-developed subcutis lie directly in contact with the tibia, 
which, therefore, at this point is particularly exposed to injury. About 
three-quarters of the bone, zc, the entire external and the posterior 
portion of the internal surfaces, are covered with muscles which are 
singly clothed with fasciz, and are again surrounded by the fascia lata. 
The latter arises from the muscles of the quarter and upper parts of the 
thigh, and is partly inserted into the crest of the tibia, partly extends 
below the hock, to become continuous with the tendon of the exten- 
sor pedis. In consequence of this formation, injuries to the leg present 
certain marked peculiarities. 


L—WOUNDS AND INJURIES. 


Injuries of the tibia are most common in horses, and are caused by 
kicks, and by the leg being passed over bales or over the carriage-pole. 
Sometimes the skin alone is inflamed, or extensively torn, but not 
infrequently the periosteum and even the bone are bruised. The 
bone is sometimes fissured by kicks, a condition which will later receive 
attention ; or diffuse periostitis is caused, though it also follows bruis- 
ing of the periosteum, without the bone itself being injured. 

Periostitis of the tibia produces well-marked swinging leg lameness 
and shortening of the forward stride, while the thigh is moved slowly 
and stiffly. It usually lasts three to four weeks, and is succeeded by 
thickening about the tibia. The local pain shown on palpation prevents 
any mistake in diagnosis. Injuries of the tibia itself can usually be 
detected by probing. 

The presence of strong fascia covering the muscles of this region, causes 
wounds which would otherwise heal without trouble, to be followed by very 


WOUNDS AND INJURIES. 613 


dangerous consequences. Injury to the fascia is troublesome, because 
the muscular tissue protrudes through the rent (muscular hernia), 
and being irritated by its edges, commences to proliferate actively ;— 
or suppuration may lead to necrosis of fascia, and, before the 
necrotic portions can be shed, excessive fungous granulations, the 
growth of which is favoured by the continuous movement of the 
muscle, arise and greatly impede healing. This condition is commonest 
on the lower portions of the biceps femoris muscle, but may occur in 
any region of the tibia. 

A second difficulty in the healing of such wounds is the development 
of subfascial cellulitis. It generally accompanies perforating wounds 
caused by stable forks. The symptoms are great pain when the animal 
stands on the limb or attempts to move it, moderate swelling, inflamma- 
tion of the neighbouring lymph vessels and glands, and fever. The skin 
is not excessively swollen, but at a later stage shows fungiform swell- 
ings, produced by deep-seated abscesses breaking through the fascia 
and becoming subcutaneous. As the cellulitis is frequently of a septic 
character, it may lead to extensive necrosis and fatal septicemia, a result 
favoured by the impossibility of discharges escaping through the unyield- 
ing fascia. 

The treatment must be directed by general principles. Cold appli- 
eations are useful in relieving the severe pain; the parts may be 
surrounded with straw, and kept continuously irrigated. Wounds, 
especially those reaching to the bone, are best treated by antiseptic 
measures. The periostitis may afterwards be dispersed by blisters. 
Sequestra must be removed as soon as they appear to have separated. 
If only the skin is bruised or excoriated, the parts should be cleansed, 
and smeared with lead or zine ointment. 

The exuberant granulations produced by muscular hernie are removed 
with scissors, the cautery, or caustics. To prevent their return, it is 
often necessary to still further divide the fascia; sometimes a piece of 
it may be excised, and further strangulation thus prevented. Though a 
pressure dressing is difficult to apply at this point, benefit sometimes 
follows the use of a few strips of adhesive plaster. A piece of leather 
or strong linen is smeared with resin plaster (composed of two-thirds 
resin and one-third wax), and applied so as to cover both the exuberant 
granulations and neighbouring parts. Absolute rest is indispensable. 
Subfascial cellulitis calls for early incision and disinfection, and, if neces- 
sary, drainage. Deep-seated abscesses are to be opened as soon as 
diagnosed. Immediately the mushroom-like swellings appear they 
should be divided, and the pus allowed to escape. 


614 DISEASES OF THE LEG. 


Il—FRACTURE OF THE TIBIA. 


Lit.: Albrecht, Gurlt u. Hertwig. 29, p. 238. Eickelbosch, ibid., 
p. 238. Kretschmar, Dresd. Ber. 1886, p. 69. Vitry, Jahrb. 1843. 
Gerlach, Gerichtliche Thierheilk. 1 Aufl. p. 398. Schmidt, Her. 
Rep. 17, p. 202. May, Gurlt u. Hertwig. 24, p. 318. Leisering, 
Dresd. Ber. 1872, p. 30. Walter, Gurlt u. Hertwig. 29, p. 337. Eber- 
hardt, ibid., 22, p. 42. Rivolta, Her. Rep. 18, p. 226. Behnke, 
Gurlt u. Hertwig. 12, p. 82. 


In the horse, fractures of the tibia rank next to those of the 
pelvis in point of frequency. Of 1082 fractures occurring during four 
years amongst army horses, 189 were in this bone. Such fracture is 
most often caused by kicks from horses in neighbouring stalls, the point 
struck being the anterior and internal face of the tibia, which les 
directly under the skin. In most cases the bone is at first only fissured, 
and the true fracture occurs later, during such acts as rising, lying 
down, or passing urine or feces. It is seldom postponed more than a 
week from the date of original injury, though cases exist where fracture 
has not occurred until four or five weeks afterwards (Kickelbosch, 
Kvetschmar). In a case of my own, fracture was delayed until a month 
after the injury, and in an army horse 127 days passed after the primary 
accident before the parts became separated. In such cases the fracture 
is probably incomplete (green-stick fracture), a view supported by the 
commonly-observed fact that the fragments show no callus formation 
(Schmidt). The primary injury probably produces local or green-stick 
fracture, which weakens the tibia, but only gives rise to complete frac- 
ture under severe strains, like those occurring when rising, lying down, 
&e. Abrasion of the edges of fragments either results after fracture is 
complete or is due to subperiosteal fracture, in which slight movement 
of the fractured portions is impossible. The absence of abrasion is not, 
however, evidence that green-stick fracture may not have existed for 
some considerable time, a fact of much forensic importance. A kick 
on the inner surface of the tibia, such as would be given by a horse 
standing on the opposite side, may at once produce complete fracture, 
which is then generally complicated. The bone is occasionally broken 
by the animal shpping (Eberhardt), falling, being struck with the 
carriage-pole during collisions, or by its struggling violently in hobbles, 
as, for example, during castration, though, in the latter case, the femur 
or vertebral column is more often fractured. 

With the exception of the horse, the commonest sufferers from 
fracture of the tibia are dogs, in which the accident is due to being 
kicked, run over, &c. Oxen and other animals are much less frequently 


FRACTURE OF THE TIBIA. 615 


affected ; nevertheless, cases are seen in them, and the practitioner is 
even occasionally called on to treat parrots and canaries. 

The symptoms vary according to the completeness of the fracture. 
Complete fracture renders it impossible to place weight on the limb, the 
unusual mobility of which can be detected even from a distance ; the foot, 
when lifted, remains dangling, and in the horse the condition shows some 
resemblance to rupture of the flexor metatarsi muscle. Fracture of 
the tibia, however, is at once differentiated by the impossibility of 
placing weight on the limb. 

In complete fracture, crepitation can always be detected. Not infre- 
quently the exact point of fracture is discoverable, especially if low in 
the leg. Perforation of the skin by splinters of bone removes the last 
doubts of fracture ; in such case traces of the external injury are generally 
apparent. 

Fissuring sometimes, though not invariably, produces well-marked 
lameness, both when weight is placed on the limb and when it is 
carried. Starting from the injured point on the tibia, the line of fissure 
may be mapped out by the existence of pain over it. Fissures in the 
subcutaneous regions of the tibia may be diagnosed with certainty, 
otherwise they can only be guessed at, for this linear distribution of pain, 
which is the sole reliable symptom, cannot be detected under the muscu- 
lar tissue. In the cases described in which there was no lameness, the 
fissure was probably subperiosteal. Green-stick fractures and_ local 
injuries are accompanied by lameness of greater or less severity, 
depending on the degree of periostitis; should the latter be slight, 
lameness is so little marked that animals, even with green-stick fracture, 
may be kept at work until complete fracture suddenly occurs. On the 
other hand, partial fracture and local injury to the bone may often be 
at once recognised, provided the soft parts are not greatly swollen. From 
the uncertainty which surrounds these cases, it is of the utmost im- 
portance, in every painful lameness resulting from mechanical injury to 
the inner surface of the tibia, to bear in mind the possibility of fissure 
or green-stick fracture. Their existence is the more probable if 
lameness be severe, and no marked periostitis or local pain can be 
discovered. 

Fractures of the malleoli of the lower end of the tibia, often seen in 
man, are rare in animals, though a case was detected by Leisering, on 
post-mortem examination, which had caused obstinate and incurable 
lameness. The external malleolus was separated for a length of 1:4 
inch, and to a height of ‘6 inch. The anterior portion of the middle 
protuberance was fractured. 

Course and Prognosis.—Although, in the horse, complete fracture 
of the tibia is almost always incurable, because the patient is unable to 


616 DISEASES OF THE LEG. 


continuously stand on the other leg until the fracture unites, and splints, 
&c., can only be applied to the lower portions, yet in oxen recovery has 
been repeatedly seen. Rivolta describes such a case in which a splint 
was applied by the local blacksmith. After six to seven weeks the 
animal walked sound. When the animal is valuable, and not of an 
excitable disposition, treatment may be attempted, especially if the seat 
of fracture be near the lower end of the tibia; in such cases recovery is 
possible. Foals and light-bred horses of quiet temperament are better 
able to endure the continuous lying than heavy animals, and therefore 
recover sooner. 

In sheep, goats, and carnivora, these fractures generally unite if not 
so high in the limb as to prevent a proper dressing being applied. 
In dogs, I have often seen fracture of the tibia completely cured in three 
to four weeks, even when complicated. 

In all animals, fissures and green-stick fractures unite in fourteen 
days to a month, provided the fracture remain incomplete. The animals 
require to be absolutely rested in slings for three or four weeks. The 
less the lameness, the better the chance of recovery. Fractures of the 
malleoli are unfavourable, especially in working-horses ; and as lameness 
is generally severe, the continuous weight thrown on the other foot may 
lead to laminitis. 

In instituting treatment, the above-mentioned possibility of fracture 
must always be kept in mind, and every injury of the inner surface of 
the tibia, whether extending to the bone, or causing severe lameness, 
should be followed by three to four weeks’ complete rest, the animal 
being placed in slings, or tied up short. Severe lameness consequent on 
periostitis is best treated with cold applications, followed by blisters. 
Further treatment must be expectant. 

Cases of complete fracture should be placed as soon as possible in 
slings, reposition attempted, and a plaster of Paris, tripolith, or adhesive 
plaster bandage applied. Adhesive plaster has the advantage of not 
slipping down so easily. Stolz recommends a mixture of 2 parts resin 
with 1 part wax; Frickers, 5 parts gutta percha, 2 parts lard, and 14 part 
wax. These mixtures are smeared on strong linen or leather, which is 
applied after the skin has been cleansed and dried. In oxen, with frac- 
ture of the lower part of the tibia, a plaster bandage may be used. 
These animals sometimes recover without treatment of any kind. 

The application of plaster or tripolith bandages is easier in small 
ruminants and carnivora, but to be efficacious the dressing should be 
carried below the hock, and as far upwards as possible; by including 
the stifle-joint the security of the dressing is greatly increased, and the 
use of the “saddle” rendered unnecessary, otherwise it can scarcely 
be dispensed with. It is formed by passing the bandage over the 


RUPTURE OF THE TIBIO-FIBULAR INTEROSSEOUS LIGAMENT. 617 


back, and around the opposite limb. (See treatment of fractured 
humerus. ) 

When applying the bandage particular attention should be given to 
the position of the limb, to prevent the fragments uniting in a faulty 
relation to one another. If union occurs with the parts rotated, move- 
ment is greatly interfered with. Before applying dressings to a compli- 
cated fracture, the wound should be carefully disinfected and covered 
with a layer of sterilised wadding. In case the parts cannot be rendered 
aseptic, a window may be left in the plaster bandage, to allow the 
wound to be inspected and kept relatively aseptic. 


II—RUPTURE OF THE TIBIO-FIBULAR INTEROSSEOUS 
LIGAMENT. 


Iam not aware that fractures of the fibula have been recorded in 
animals; they would certainly be difficult to detect during life. 
Behnke, however, in a mare, saw rupture of the interosseous ligament, 
with separation of the fibula from the tibia, from the animal shying 
whilst being ridden. Severe lameness at once followed, and though it 
gradually became less, recurred after lying down and rising. The limb 
was carried stiffly, and no weight was placed on it. Post-mortem 
examination showed the lower end of the fibula to have been torn away 
from the tibia; it lay amongst the muscles of the thigh, which it had 
severely injured. 


IV.—RUPTURE OF THE FLEXOR METATARSI MUSCLE. 


Lit.: Hertwig, Gurlt u. Hertwig. 13, p. 221. Meyer, ibid. 17, p. 77. 
Ruchte, Her. Rep..15, p. 291. Hollmann, Gurlt u. Hertwig. 21, 
p. 203. Spathe, St Cyr u. Rey, Jahrb. 1854, p. 59. Peters, Jahrb. 
1889, p. 128. Peter, Zeitschr. f. Veterinirk. 1889, p.25. Goubaux, 
Her. Rep. 15, p. 229. Albrecht, Gurlt u. Hertwig. 29, p. 243. 


In herbivora the tendinous portion of the flexor metatarsi muscle 
forms a diarthrodial ligament, which, in the horse, unites the stifle- 
and hock-joint in such a way that movement of one joint produces 
movement of the other, and permits the muscles of the quarter and 
thigh to assist in extension of the hock-joint. The tendon arises from 
the pit between the trochlea and the external condyle of the femur, in 
common with the extensor pedis, passes over the stifle-joint, lies in front 


618 DISEASES OF THE LEG. 


of the tibia, at the upper end of which it is surrounded by a mucous 
bursa, and is inserted by three slips into the hock and metatarsus. 
In ruminants the muscle is also provided with much tendinous tissue, 
but arises from the tibia. In carnivora it is replaced by a tendon 
which starts from the internal surface of the tibia and is inserted into 
the bones of the tarsus, serving to prevent excessive extension of the 
hock-joint. 

In the horse, rupture of this muscle is attended with such marked 
symptoms that attention was early directed to it. Solleysel described 
the disease, though he regarded the tendon as a nerve. At the end of 
last century the disease was described by Louchard as dislocation of the 
hock-joint. Bouley, in 1833, correctly explained the condition, and was 
followed by Rigaud, who made the experiment of dividing the muscle. 
Hertwig first thoroughly described the affection, and gave a full account 
of its origin. ‘ 

Causes.—Rupture of the tlexor metatarsi follows excessive extension 
of the hock-joint, produced either by the animal kicking violently or 
struggling in hobbles (Bouley, Hertwig), or from the limb being violently 
drawn backwards, as in shoeing in the travis, or drawn upwards by means 
of a cord passed through a ring. If, while the foot is thus fixed, the 
animal fall, rupture is very apt to occur. It may also be caused by 
efforts to withdraw the foot fixed in the travis, or caught in railway- 
points, or even in deep, soft ground, and sometimes forms a sequel to 
collisions, slips, or getting over bales. It seldom follows external 
violence, though Spathe saw a case where the muscle was divided by a 
sharp stone. Klemm recently recommended section of this tendon in 
the treatment of spavin. Rupture seldom affects both limbs, and is 
rare in animals other than the horse, though several cases are reported 
in cows (Ruchte, Hollmann). In dogs, I have seen the tendon which 
corresponds to this muscle divided by external injuries. 

Course.—The affection is naturally of sudden onset, and at once 
produces a peculiar lameness. As weight can still be placed on the leg, 
and the ends of the tendon retract comparatively little, union is seldom 
difficult. Judging by the many reported cases, union is almost always 
complete in four to eight weeks, even when both legs are affected, though 
Peters’ case in a riding-horse lasted for three months. In rare instances 
recovery does not occur, or is so Incomplete as to impair the movement 
of the hock. These depend on the position of the rupture and on the 
animal not being rested sufficiently long. Where the tendon is divided 
in the mucous bursa, or at its point of origin on the femur, recovery is 
less assured, because formation of new tissue remains incomplete, the 
paratendineum essential to union being absent from the tendon sheath 
and mucous bursa. On account of the peculiar nature of its insertion 


RUPTURE OF THE FLEXOR METATARSI. 619 


into the femur, the tendon rarely tears away, but when this occurs a 
fresh difficulty arises, because the new tissue consists of callus, which 
must grow both from the torn end of the tendon and from the femur. 
It is somewhat doubtful whether in Goubaux’s case the tendinous or the 
muscular portion of the flexor metatarsi was torn away; the point is of 
little importance. Probably it was the tendinous portion, because 
muscle is very rarely torn away from its insertion into bone. H. Bouley 
reports similar cases. As a rule even when the tendon is torn away from 
its insertion the case finally recovers, though it lasts as many months 
as the others weeks, and slaughter is often preferable to treatment. 


Fic. 130.—Rupture of flexor metatarsi muscle— (from a photograph). 


Partial recovery is one of the results of putting the horse to work 
before union is complete; the newly-formed cicatricial tissue gradually 
becomes strained and the tendon lengthened, necessarily causing 
permanent lameness (Rey). Excessive extension of the hock, which 
sometimes occurs during the early stages of union, disappears completely 
with time (Albrecht, Peters). A few cases have completely recovered in 
twenty-five days; probably the tendon was only partially ruptured. 

Symptoms.—This rupture is distinguished by lameness when the 
limb is carried, marked flexion of the stifle-joint, and excessive exten- 
sion of the hock. The symptoms are so marked that the condition can 


620 DISEASES OF THE LEG. 


be diagnosed with absolute certainty, even from a distance. That 
portion of the limb below the hock is not properly advanced, whilst the 
relaxation of the tendon favours excessive flexion of the stifle-joint. 
This want of harmony in the function of both joints produces an 
uncertain movement of the limb, which may give the impression of a 
broken bone, and was so interpreted by Bouley, Chansas, and others 
(Hertwig). The absence of fracture, however, is at once shown by the 
fact that the limb can still support weight. In rupture of the flexor 
metatarsi, the function of its tendon is in abeyance; while its. 
antagonist, 7.¢., the tendo Achillis, is unopposed, appears relaxed, and 
when the limb is relieved of weight and extended lies flaccid. This 
appearance is very characteristic, and only occurs in two other con- 
ditions, viz., rupture of the tendo Achillis and fracture of the tibia. It 
is most marked when the hock is excessively extended, as, for instance, 
by the farrier lifting the limb to remove the shoe. In recent cases the 
anterior surface of the tibia is sometimes slightly cedematous, in others. 
absolutely nothing abnormal can be seen. Severe swelling with pain 
on pressure over the course of the flexor metatarsi is quite exceptional, 
the muscles being clothed in a strong fascia. 

Treatment is confined to resting the imb. The animal should be 
kept perfectly quiet for four to six weeks, should be placed on a level 
surface, and not receive too much bedding. Work protracts recovery, 
though in isolated cases union occurs despite it ; it always takes a long 
time, however, and may remain incomplete, the ligament becoming 
elongated and the action permanently impaired. In horses of any value 
rest is indispensable. Blistering over the course of the affected muscle 
(recommended by Bouley and others) is unnecessary, and only serves to 
secure rest. Work can be resumed as soon as lameness disappears. 


V.—RUPTURE OF THE TENDO AGHILLIS AND 
GASTROCNEMII MUSCLES. 


Lit.: St Cyr, Her. Rep. 15, p. 243. Uhlich, Dresd. Ber. 1687,3paous 
Field, Posthumous Extracts from the Vet. Records, 1843, p. 34. 
Dieckerhoff, Spec. Path. u. Therap. p. 476. Siedamgrotzky, 
Dresd. Ber. 1882, p. 19. Martens, Berl. Arch. 12, p. 439. Schrader, 
Gurlt u. Hertwig. 15, p. 303. Tombs, ibid. 6, p. 350. Bormann, 
Berl. Arch. 1885, p. 304. Detroye, Rec. de Méd. vét, 1891, p. 
90, Hinwachtea, D. T. W. 1893, p. 123. Pirl, Berl. Arch deo 
Griiner, Berl. Arch. 1893, p. 320. 


Ruptures of the gastrocnemii muscles and of the Achilles tendon 
are much rarer in animals than rupture of the flexor metatarsi. They 


RUPTURE OF THE TENDO ACHILLIS, ETC. 621 


are oftenest seen in cows, sometimes in both limbs at once (Schrader 
and Bormann), though in horses both rupture and wounding of the tendon 
and muscles have been recorded. Rupture generally occurs at the lower 
point of insertion of the Achilles tendon, a portion of the os calcis being 
at the same time torn away In cows it has repeatedly been seen at 
the point where the muscle becomes continuous with the tendon 
(Bormann); but rupture of the muscle itself is known to occur both in 
horses and oxen. 

Einwiichter, in a horse, found not only the gastrocnemius but also 
the flexor pedis perforatus torn away from the femur. Til saw a cow 
with rupture of the Achilles tendon in both legs. Swelling resulted in 
the neighbourhood of the popliteal space, and gradually became larger and 
fluctuating, The cow could only shuffle about on the ground on her hocks. 

Causes.—Rupture follows violent contraction of the muscle, produced 
in cattle by leaping one another, in riding-horses by jumping, and 
in draught-horses by efforts to avoid slipping. The tendon may also 
be strained by falling from a height, or by the animal slipping with 
the legs extended under it. The injury may involve both muscles or 
the entire tendon, or may remain confined to certain portions; the latter 
is, however, the exception, complete rupture the rule. In small animals 
like dogs rupture may be produced by the animal being caught 
in a door. In the horse the Achilles tendon is sometimes cut through 
(Martins and Griiner). Traumatic inflammation of the os calcis or tendo 
Achillis, or suppuration in the tendon sheath, may also lead to rupture 
of the tendon. ‘St Cyr therefore distinguished primary and secondary 
rupture. Uhlich saw rupture soon after recovery from influenza. 

Symptoms.—When the muscles named or the Achilles tendon are 
completely torn away from their insertion, there is severe supporting leg 
lameness, inability to bear weight on the affected limb, and flexion of 
all joints. 

The Achilles tendon extends to the point of origin of the gastro- 
cnemii muscles, and when weight is placed on the limb serves the 
purpose of fixing the joints, especially the hock- and stifle-joints. It 
therefore fulfils an important part in supporting the body, and its rupture 
is followed by collapse of the limb,—the hock sometimes descending 
sufficiently far to touch the ground (fig. 131). The excessive flexion 
of the hock increases the distance between the points of origin and in- 
sertion of the flexor pedis, and the phalanges take up a position of 
excessive plantar flexion, ze, become “shot over.” The hock can also 
be flexed to an unusual degree by the exertion of a little force. As 
a rule, a depression may be noted in the course of the tendon or 
swelling in the gastrocnemii muscles; the tendon appears relaxed, even 
when the limb touches the ground. In incomplete rupture lameness is 


622 RUPTURE OF THE TENDO ACHILLIS, ETC. 


shown when weight is thrown on the limb and there is more or less 
pronounced flexion of the joints, particularly of the hock-joint. 

The prognosis depends almost entirely on whether the uninjured 
leg can sustain weight until union occurs. Small animals like dogs 
and eats almost always do well, but larger animals, as St Cyr pointed 
out, are less favourably circumstanced. They sometimes succumb 
to the continued standing or lying, for union takes from four to six 
weeks, and under some circumstances may be protracted for several 
months. Oxen do best lying, but as horses are obliged to stand, it 
becomes a question whether laminitis' may not supervene in the other 


Fra. 181.——Rupture of the tendo Achillis—(after Stockfleth). 


foot. The grounds for forming a prognosis are so slight that it is 
generally more prudent to withhold it, and watch closely for unfavourable 
symptoms. As a rule, in the horse the hind-feet are more liable to 
contract laminitis than the front, although they bear less weight,—a tact 
to be kept in mind when one limb is disabled. 

Union is more rapid when the tendon is ruptured than when it is 
torn away from the os calcis. Partial ruptures, in which some weight, 
however slight, can still be taken on the limb, are more hopeful. As 
a rule, the more marked the degree of flexion, the slighter the chance 
of recovery. 

Treatment.—In small animals the hock-joint should be as much 
as possible extended and a plaster bandage applied. Larger animals, 


1 The frequent reference to ‘‘ pressure laminitis’’ seems out of place to English practi- 
tioners ; the disease is, however, more common in Germany, perhapsas a result of the peculiar 
conformation of the foot in most German breeds of horses.—[TRANSL. ] 


FRACTURE OF THE BONES OF THE HOCK-JOINT. 623 


like horses, are slung, so as to keep the hock continuously extended, 
and the ends of the divided tendon or muscle as close as possible 
together. In quiet horses this may be assisted by bandaging and 
applying adhesive plaster. Such a dressing certainly allows of some 
movement, but for this very reason is better borne than the rigid plaster 
bandage or than splints. St Cyr stated that the latter are apt to 
produce excoriation, and that it is often better not to check movement. 
Martens saw the divided Achilles tendon unite in two months without 
the horse being slung, and Griiner in two and a half months. Light 
horses, when rising or lying down, are better able to protect the 
injured limb, may be left free in a box, though even then a dressing 
is useful, if the animal does not attempt to displace it by violently 
flexing the limb, In cows, Detroye applies a gutter-shaped splint to 
the back of the hock-joint, and fastens it by straps to the tibia and 
metatarsus. 

Wounds of the flexor tendons heal with still greater difficulty unless 
rendered aseptic, but that asepsis is quite possible is shown by Martin’s 
and Griiner’s cases. Particular precautions are necessary in injuries about 
the tuberosity of the os calcis. 


D. Diseases of the Hock-Joint. 
|.—FRACTURE OF THE BONES OF THE HOCK-JOINT. 


Lit.: Brauer, Dresd. Ber. 1871, p. 140. Rosenkranz, ibid., 1858, p. 
101. Detroye, Rec. de méd. vét. 1891, p. 20. Rey, Her. Rep. 18, p. 
207. Furlanetto, Le Progrés vét. 1891. Haase, Thieriirztl. Mitth. 
1869, p. 149. 


(a) Fracture of the os calcis. Fractures of the bones of the hock- 
joint are, on the whole, rare, though cases have been seen, especially in the 
calcis and astragalus bones. Apart from those described below, in 
which the Achilles tendon is torn away from the tuberosity of the 
calcis, fractures of this bone are produced by external violence, by 
kicks (Haase), or blows with the hammer (Rosenkranz). Detroye saw 
three cases—one in a horse, one in a steer, and one in a calf, The 
horse had produced the fracture by slipping when rising in the stable. 
The bone was broken just above its articulation with the astragalus., 
In the steer, fracture was caused by mounting a cow, and in the calf, 
by falling into a ditch. The same causes which produced rupture of 
the Achilles tendon may of course lead to fracture of the os calcis. 

The symptoms and course closely resemble those of rupture of the 


624 DISEASES OF THE HOCK-JOINT. 


Achilles tendon, which in this fracture also loses its lower point of 
insertion, though fracture of the calcis is generally more painful than 
rupture of the tendon. The broken fragment is drawn upwards by the 
tendon, and the animal is totally unable to stand on the limb, which col- 
lapses. All the joints are excessively flexed, particularly the tarsus. In 
moving, the limb is lifted and the metatarsus and phalanges dragged, 
the tendo Achillis appearing relaxed. Crepitation is sometimes heard, 
whilst in compound fractures splinters of bone may possibly be detected 
in the wound. 

In horses and oxen treatment is rarely successful, but may be 
attempted in small animals, which offer some chance of recovery. Union 
is rendered difficult by the displacement of the fractured parts con- 
sequent on the pull of the Achilles tendon, by their defective nutrition, 
and by the inability of large animals to sustain themselves continuously 
on the other hind-leg, though Briiuer says he completely cured oxen in 
four weeks by applying a plaster bandage. Detroye reports a similar 
case in a steer: the lameness completely disappeared after a time. 
Haase likewise reports union in the horse, though the case lasted from 
twelve to fourteen weeks. 

The prognosis, therefore, depends, firstly, on the degree to which 
the fragments are displaced (sometimes dislocation is minimised by the 
insertion of the flexor pedis perforatus); and secondly, on the length 
of time during which the animal can stand on the other foot without 
laminitis setting in. Compound fractures may generally be looked on 
as incurable. 

Treatment is in general similar to that in rupture of the Achilles 
tendon. In these cases also it is important to fix the hock-joint in as 
complete extension as possible. Plaster bandages are useful for small 
animals. 

(b) Fracture of the astragalus is also rare; it follows forced rotary 
movement of the limb whilst the animal’s weight is upon it, or whilst 
it is fixed to the ground. A case which I saw in a heavy cart-horse 
had resulted from suddenly turning round. A case of Furlanetto’s in a 
cow was caused by falling into a ditch. 

The symptoms are: sudden and severe lameness, shortly followed by 
fluctuating painful swelling of the astragalo-tibial joint, similar to that in 
inflammation of the hock-joint. Crepitation can sometimes be detected 
by placing both hands around the joint and moving the lower part of 
the limb; but in other cases it is absent, and the condition may be 
mistaken for violent strain of the joint, which, however, is rare, or for 
severe subfascial cellulitis (p. 613); but as the latter is accompanied by 
swelling of the local lymph glands and by fever, it is sufficiently distinct 
from fracture of the astragalus. 


FRACTURE OF THE BONES OF THE HOCK-JOINT. 625 


Prognosis is absolutely hopeless, because the fracture always extends 
into the joint, recovery is extremely protracted, and no weight can be 
placed on the limb. It is therefore better to slaughter large animals 
without delay. An attempt at treatment may be made in cats and 
dogs by applying a plaster bandage, which should be put on whilst the 
leg is moderately extended, so as to limit as far as possible the lameness 
which will result from obliteration of the joint. The cases described by 
Furnaletto certainly recovered, but proved permanently lame. 

(c) Fractures of the other bones of the hock are less frequent than 
those above mentioned, and are either due to kicks, the animal being 
run over, or similar violent mechanical causes, or they appear in con- 
nection with sprains and luxations. Thus Rey found dislocation of the 
hock-joint between the scaphoid and cuneiform magnum in a horse 
which had caught its hoof between railway-metals and had fallen. The 
external small metatarsal was torn away from the large metatarsal, 
and the cuboid bone crushed. 

Diagnosis is seldom difficult, though the seat of fracture can only 
be determined by post-mortem examination. There is abnormal mobility 
of the hock-joint, especially for movements of ad- and ab-duction ; crepi- 
tation is often audible. 

The prognosis is generally bad, but depends on the degree of lame- 
ness, and is, of course, influenced by the other injuries and the nature 
of the animal’s work. 


Il.—LUXATION AND SPRAIN OF THE HGCK-JOINT. 


Lit.: Schrader, Busch’s Zeitschr. 3, p. 31. Townshand, Jahrb. 1883, 
p. 109. Stockfleth, Chirurgie. p. 624. Louchard, Peuch-Tloussaint, 
Chirurgie. 2, p. 235. Riffert, Th. Mitth. 1854, p.74. Haubner, 
Dresd. Ber. 1859, p. 54. 


I know of no reported cases of luxation in horses, for even Louchard’s 
case appears only to have been a severe strain, probably accompanied by 
fracture of the malleoh of the tibia or of the astragalus bone. Stock- 
fleth describes having discovered by post-mortem examination inward 
luxation of the astragalus in a sheep. He also saw displacement 
between the astragalus and upper row of smail hock bones in a cat 
which had fallen, hind-legs first, from a height; the metatarsus was 
thrust outwards. The displacement was immediately reduced, a rubber 
bandage applied, and the animal recovered. In a rabbit, which had 
also fallen from a height, Stockfleth found displacement of the astragalus. 
In a horse, which had passed its left hind-foot through a hole in a 

2R 


626 DISEASES OF THE HOCK-JOINT. 


wooden bridge, Haubner discovered rupture of the ligaments connecting 
the metatarsus and lower row of hock bones. ‘The limb was excessively 
movable, and showed, at the seat of curb, a depression. 

Schrader says that one of Havemann’s pupils cured a cow suffering 
from luxation of the metatarsus. Townshand reports a similar case: 
the metatarsus was displaced in a forward direction. The animal 
recovered, but always went lame. In Rey’s case, above cited, the union 
between the hock bones was divided, but there was no displacement. 
Stockfleth speaks of a similar case in which the astragalus and calcis 
were torn away from the cuboid and scaphoid bones; the horse was 
killed. Riiffert also saw a case in which the internal lateral lhgament 
and portions of the interosseous ligaments were ruptured. Union 
appeared to be strongest between the metatarsus and lower row of hock 
bones; Stockfleth only gives one case of dislocation at this point. It 
occurred in a dog; all the hgaments and flexor tendons were ruptured, 
and the lower part of the limb hung by the extensor tendons. Needless 
to say, in all these cases recovery is usually extremely protracted and 
difficult, for which reason it is usually best to advise slaughter. The 
strong ligamentous apparatus, together with the prominences on the 
articular surfaces of the tibia and of the astragalus, produce so firm and 
secure a union of the two bones that luxation of the astragalo-tibial 
joint is exceedingly rare. 


III.—WOUNDS AND ACUTE INFLAMMATION OF THE 
HOGK-JOINT. 


Lit.: Sanson, Her. Rep. 14, p. 301. Andrieux, Jahrb. 1887, p. 83. 
Lorenz, Zeitschr. fiir Veter. 1890, p. 21. Dieckerhoff, Der Spat. 
pe di 2: 


Wounds are by far the most frequent cause of acute inflammation 
of the hock-joint. They may be caused by thrusts with forks, 
lances, or sabres, by kicks, by the animal being trodden on, and in dogs 
by bites, or they may be due to operation for spavin or for enlarged 
burse. Point firmg sometimes causes suppuration in the hock-joint. 
Inflammation of the tendon sheath of the flexor pedis at the inner side 
of the hock or septic or purulent cellulitis near the joint may sometimes 
extend to it; or, again, the capsule of the joint may be perforated by 
gangrene consequent on lying long in one position. Acute inflammation 
of the tibio-tarsal joint also results from metastasis, and in horses is 
often seen after strangles (Sanson) and pyzmia. Inflammation of the 
hock-joint, probably of metastatic origin, has been observed in cows soon 


WOUNDS AND ACUTE INFLAMMATION OF THE HOCK-JOINT. 627 


after calving (Andrieux), sometimes in both limbs at once. Dieckerhoff 
describes several instances of spontaneous inflammation of the hock-joint, 
which proved on post-mortem examination to be of a purulent character. 
Whether the cases of rheumatic inflammation so often described are 
caused by catching cold is uncertain. 

(For injuries to the point of the os calcis, compare with p. 651.) 

Symptoms.—tThe local injury generally dispels any doubt as to the 
character of the disease, especially if synovia is being discharged. There 
is always more or less swelling, which extends round the joint, and both 
upwards and downwards ; though soft at first, it later becomes hard and 
resistant. The distension of the 
tibio-tarsal capsule is often masked 
by the periarticular swelling. 
Lameness is from the first severe, 
and is exhibited both when the 
hmb is being advanced and when 
weight is placed on it (mixed 
lameness). Fever is present in 
the purulent or septic variety of 
disease, and periarticular abscesses 
always form. 

The disease can only be mis- 
taken for severe subfascial cellu- 
itis “"(p. 613); but as this 
exhibits all the above-described 
symptoms, some little time may 
elapse before the diagnosis _be- 
comes assured. I have repeatedly 
seen such attacks in horses and 
dogs without being able to give a 
final opinion. If the condition im- 
proves after the abscesses break, Fig. 132.—Exuberant granulation in front 
and especiallyif lameness decreases, payee 
the joint may still prove intact, but 
improvement is sometimes only an apparent one, and due to laminitis, 
from the animal standing on the other foot. Increased pulsation in the 
metatarsal arteries points to the occurrence of laminitis and displacement 
of the os pedis. 

Fractures of the malleoli of the tibia and of the astragalus cause 
similar symptoms, and, unless accompanied by crepitation, are very 
difficult to diagnose. 

Injuries to the front of the hock are also ditficult of treatment, 
especially when large flaps of skin are destroyed. The unavoidable 


Y/ 
Oy 
y 


628 DISEASES OF THE HOCK-JOINT. 


movement of this joint in horses irritates the wound, causing active 
granulation, which is sometimes impossible to repress. Fig. 132 shows 
such a condition, photographed from nature. 

Course and Prognosis.—The course depends principally on whether 
the parts remain aseptic. If they do not, recovery is highly improbable, 
and oxen should be slaughtered before they have lost much condi- 
tion. The prognosis is therefore doubtful in all cases of inflammation 
caused by external injury or by metastasis, though inflammation is less 
dangerous in the lower, less mobile portions of the hock than in the 
tibio-tarsal joint, in which the destruction of the articular cartilage is 
always followed by severe and permanent lameness, causing the patients to 
he continuously, and generally proving fatal to the larger animals. In the 
case of smaller joints, inflammation may lead to obliteration of the joint 
and restoration of the animal’s usefulness. Provided the wound remain 
aseptic, there is less danger. Such cases are more particularly seen in 
cows soon after parturition. Slight cases, ze, those where inflammation 
is not marked, heal in fourteen days, but the more severe take four to six 
weeks, 

Treatment follows general principles. If the joint be injured, efforts 
must be made to preserve it. Small, and especially perforating, wounds 
must first be carefully cleansed and disinfected, and a blister of sub- 
limate, with lard or paraffin (1-10), then applied, or the firing-iron may 
be used. The swelling thus produced leads to rapid closure of the 
wound, and prevents infection of the joint. Large wounds, and _ par- 
ticularly those of an incised character, should be thoroughly disinfected 
and sutured. Quiet horses may be slung, and a surgical dressing 
appled; but when this cannot be used, and it is impossible to suture 
the wound on account of extensive bruising, permanent irrigation offers 
the best means of preventing infection of the joint. Lorenz cured a 
wound in a horse’s hock by irrigating with 1 in 5000 sublimate solution, 
and afterwards blistering. 

If purulent or septic inflammation has already attacked the tibio- 
tarsal joint, little can be done, though irrigation, with disinfectants, 
might be tried. Washing out the joint has not been successful in my 
hands, but it might be tried when the joint is opened. Syringing with 
disinfectants is useful in wounds in the lower portions of the joint. 

To prevent excessive granulation in the bend of the hock, the animal 
should be tied up short, and every precaution taken to limit movement 
of the hock-joint: the granulations themselves are treated on general 
principles. 


THOROUGHPIN. 629 


IV.—BOG-SPAVIN. 


Ger. Sprunggelenkgalle. 


Lit.: Zimmer u. Horn, Adams Woch. 1890, Nr. 44. 


Thoroughpin consists in excessive distension of the capsule of the true 
hock-joint. The capsular ligament and synovial membrane are attached 
above close to the articular surface of the tibia, below to that of the 
astragalus. Anteriorly and inwardly the sac presents a small dilatation, 
posteriorly and externally a larger one, which Franck says often com- 
-municates with the sheath of the flexor pedis perforans tendon at the 
inner side of the joint. Disease of this tendon sheath, however, seldom 
extends to the hock-joint, and vice versa. 

Distension of the capsule of the true hock-joint is commonest in young 
horses with upright hocks, but is also frequent in old stallions and 
pregnant animals (Giinther). It is generally due to chronic synovitis, 
brought on by severe exertion ; occasionally it follows acute synovitis. 
Chronic suppuration in this joint sometimes accompanies pyemic 
inflammation of the urachus in foals, and almost always results in 
death. 

The most noticeable symptom is the presence of a fluctuating swell- 
ing, which may be thrust back and forwards. 

There is seldom acute inflammation, and therefore lameness is rare. 
Distension of the capsule is only dangerous to life when due to acute 
synovitis or umbilical phlebitis. In well-developed cases the animal may 
show lameness after severe exertion. 

Treatment must follow general principles. Recent painful and 
inflamed swellings are treated by cold appiications, and later by blister- 
ing. As firing only diminishes the swelling, and always leaves visible scars, 
it merely substitutes one blemish for another ; nevertheless, Stockfleth 
recommends it. In young horses, with moderately developed thoroughpin, 
repeated painting with tincture of iodine or massage may diminish swell- 
ing, but seldom removes it completely. 

Caution is required in operating surgically. Removal of contents by 
Pravaz’s syringe or a slender trochar is seldom followed by permanent 
benefit, and injection of iodine is not more successful. In any ease, the 
operation must be repeated several times, at intervals of four to six 
weeks, to be of service. Evacuation by Pravaz’s syringe, washing out 
with 1 in 1000 sublimate solution, and the application of a blister, has 
lately been recommended by Zimmer. 


630 DISEASES OF THE HOCK-JOINT. 


Horn draws off the contents with a trochar, and applies, in place of a 
pressure bandage, a thick layer of glue, in which finely chopped tow is 
mixed to increase its strength. Incising the swelling is not unattended 
by danger, even where full antiseptic precautions are taken, because the 
an‘mal sometimes rubs off the dressing. Acupuncture has been recom- 
mended by Gloag and others. The swelling is perforated on either side 
to a depth of 2 of an inch by an apparatus composed of four needles 
thrust into a cork, when the fluid-contents escape. In five days the 
operation is repeated, iodine ointment rubbed in, an elastic bandage 
applied over all, and left in position for twenty-four hours. 


~V.—CHRONIC INFLAMMATION OF THE HOCK. SPAVIN. 
ARTHRITIS GHRONICA DEFORMANS TARSI. 


Ger. Spat. 


Lit.: Havemann, Anleitung zur Beurtheilung d. Pferdes. 2. Aufl. 1805, 
p. 186. Lafosse, Journ. des vét. du med. 1846, p.489. Dieckerhoff, 
Der Spat d. Pferde. Berlin, 1875. Schrader, Gurlt u. Hertwig. 3, p. 
257, u. 5, p. 95. Peters, Bericht des Vereins meck]. Thier. 1854, p. 11, 
u. 1857, p. 10. Moller, Berl. Arch. 6, p.182. Schitt, Gurlt u. Hert- 
wig. 19, p. 255. Kuobloch, Lehrbegriff der Pferdearznei. vol. 3, p. 229. 
Schubert, Dresd. Ber. 1866, p. 74. Hoffmann, Her, Rep. vol. 54. 
Kosters, Jahrb: 1891. Battazzi, xef. iB. T.,W. 1892) p. 95 (Siem 
Virch. Arch, 1869. 


It is not surprising that so common a disease as spavin should early 
have attracted attention. We find the disease described by Jordanus 
Ruffus and Marx Fugger, and treated of by almost every veterinary 
author. Owing to ignorance of pathological processes early observers 
attached undue importance to outward appearances and distinguished 
many kinds of spavin on the ground of their physical differences. 
This was the basis of the terms “ éparvin calleux ” and “éparvin sec,” 
invented by Solleysel, and still used in France to the present day, 
and of the English “ bog” and “ bone spavin.”’ In Germany Kersting 
distinguished five kinds of spavin. To the same cause was due the 
identification of spavin with stringhalt. 

For a long time the nature of the disease remained obscure, and it 
was sometimes thought to be a bone affection, sometimes an affection 
of the ligaments. Havemann first directed attention to the disease of 
the articular surfaces, and afterwards Schrader and Schiitz described 


' Prof. Moller here seems to be under a slight misapprehension. —[TRANSL. ] 


SPAVIN. 631 


the condition thoroughly. At the present day no doubt exists that 
Spavin is due to chronic inflammation of the joint, and the only question 
is in what structure the disease originates. 

Pathological Anatomy.—Anatomical examination reveals: 

(1) Changes in the articular cartilage of the scaphoid, and of the 
upper part of the metatarsus, sometimes of the cuneiform and other 
bones of the hock. Changes in the cartilage, abrasions, ulceration, 
and, at the borders of the articular surfaces, rugged uneven swellings, 
produced by thickening of the cartilage, which later becomes ossified, 
can all be detected by the naked eye. Microscopically, the intercellular 
substance is seen to be fibrillated, and the cartilage cells to be under- 
going multiplication, processes peculiar to arthritis chronica deformans. 

(2) The affected bones show deposits termed osteophytes, which 
sometimes start from the ossified cartilaginous growth, sometimes result 
from inflammation attacking the periosteum of the bones named. 

This local growth of bone is in fact the so-called spavin. It is 
usually only a secondary symptom due to inflammation extending from 
the articular surface to the periosteum. 

(3) Changes in the ligaments and synovial membrane. Both the 
villi and borders of the synovial membrane seem thickened and vascular. 
Sometimes the secretion of synovia is excessive. The ligaments of the 
joint, and the connective tissue surrounding it, are also thickened. 

(4) In advanced stages of the disease, the smaller joints may be 
obliterated, especially those between the scaphoid and cuneiform bones, 
and between the cuneiform and metatarsus. The ligaments are then 
often ossified, and so surrounded by new growths of bone that they can 
searcely be recognised. Sometimes the sheath of the flexor metatarsi 
muscle becomes diseased. 

In many cases pathological processes are confined to the lower and 
inner portions of the hock, though not infrequently they extend further, 
seize on the cuneiform bone and head of the inner small metatarsal, or 
even on the astragalus and external surface of the joint. The French, 
therefore, distinguish “¢éparvin tarso-métatarsien,” as opposed to the 
disease of the cuneiform bones and metatarsus, which is termed 
“éparvin métatarsien.” 

Pathology.—Though there is no longer any doubt that chronic 
arthritis is the essential factor in producing spavin, yet the views rela- 
tive to its development still differ considerably. In the first place, it is 
remarkable that the inflammation almost always starts on the inner 
surface of the joint, a fact which has given rise to various hypotheses. 
Whilst Rychner considers the disease starts in the ligaments, and 
afterwards extends to the joint, Lafosse holds that the process originates 
in strain of the inner tendon of the flexor metatarsi, for which reason 


632 DISEASES OF THE HOCK-JOINT. 


he recommends its being divided. Dieckerhoff believed that spavin 
started from disease of the sheath of this part of the tendon. Peters 
sought the explanation of disease occurring on the inner side of the 
joint in the anatomical formation of the parts. As the connection 
between the tibia and astragalus consists of a ginglymoid, or, more 
correctly speaking, a serew-like joint, in which the powerful lateral 
ligaments limit both abduction and adduction, and only allow of move- 
ment in the direction of the longitudinal axis of the body, one would 
expect that the axis of the joint would be perpendicular to that of the 
body. This is not the case, however; the (horizontal) axis of the joint 
lies obliquely to it, and, starting from the inner side, runs backwards and 
outwards. As a consequence, the two tibive are not perpendicular, but 
converge from above downwards, whilst the metatarsal bones of the 
two limbs are parallel with each other when the limbs are in their 
normal position. It therefore results that the power does not act per- 
pendicularly to the articular axis of the astragalus, and consequently, 
when weight is placed on the limb, the muscles do not simply extend 
the joint, but also tend to rotate it. This arrangement certainly assists 
the hind-limbs in earrying the weight of the body, and ensures stability ; 
but the consequent rotary movement of the limb necessarily involves 
displacement of the bones of the hock-joint, and thus favours strain of 
the ligaments and disease of the joints. The tibio-tarsal joint is pro- 
tected against injurious action of this kind by its strong lateral liga- 
ments, and by the prominences on the astragalus; whilst the inner 
portion of the lower joint, which can easily be shown by anatomical 
preparations to possess the least power of resistance to such rotary 
movements, has therefore to take the chief share in them, and accord- 
ingly is most exposed to strain of its lateral ligaments and _ fibrous 
capsule. Irritation and inflammation are thus caused in the neighbour- 
ing periosteum, and produce disease of the articular cartilage. Depend- 
ing on whether the cartilage and synovial membrane become affected 
early or late, lameness is either present from the first, or only occurs 
when new bony growths have formed outside the joint. This, again, 
depends principally on whether strain is severe from the first, or 
whether it is only gradually exerted. 

This theory seems to explain in a satisfactory way both the manner 
of origin and many of the symptoms of spavin. Anything which 
impedes this physiological rotation of the hock-joint, such as working 
in heavy ground or on rough pavements, must favour the production of 
disease. It seems to me that spavin cannot be referred to any single 
cause, but that the initial disease may start in one of several structures ; 
and therefore, while I consider the formation of the joint on which 
Peters thus lays stress to be without doubt one of the most important 


SPAVIN. 633 


factors, it would be unwise to deny the possibility of the process 
originating in disease of the bursa of the flexor metatarsi (Dieckerhoff), 
or even on the surface of the joint. I can only state that my investi- 
gations show the bursa to be frequently intact, even when disease of the 
joint is advanced. Nor does coexistent disease of the bursa necessarily 
prove the latter to have been the point of origin, for in many cases it 
becomes affected secondarily, by inflammation extending to it from the 
joint. 

Course.—The nature of the disease explains its chronic course. It 
is rarely caused by mechanical violence, but as a rule results from slight, 
continually repeated strain, and, therefore, develops slowly. The first 
symptom is usually slight semsitiveness, soon followed by lameness, 
though at this stage no anatomical change can be detected in the joint. 
Sometimes, however, disease occurs so gradually that lameness is entirely 
absent during the first stage, and before it develops, bony growth can 
be detected on the joint. In this respect spavin resembles a number of 
other diseases,——for example, contracted hoof. When it develops 
slowly, contraction may become well-marked, without causing lameness ; 
whereas in cases of rapid development, the walls of the hoof exert pain- 
ful pressure on the soft parts, and soon interfere with movement. 

As a rule, the appearance of the exostosis is preceded for two to four 
weeks by lameness, which gradually increases in severity in proportion 
as disease processes become more pronounced. In cases where at first 
it was only noticeable during the first few steps, it afterwards becomes 
continuous. Considering the nature of the pathological process, it is 
scarcely surprising that lameness appears periodically, is sometimes lost 
and then returns, or that in certain exceptional cases recovery takes place 
without treatment of any kind except complete and prolonged rest. 
From a purely theoretical standpoint there is no reason why the lesions 
in the jomt may not disappear and the parts recover in every respect 
the status quo ante, but, im point of fact, this termination is very rare. 
As a rule, recovery is only relative, and is followed by obliteration of 
the joint. When the articular surfaces have undergone change and the 
cartilage is destroyed, repair is absolutely impossible, and recovery can 
only result from adhesion of the opposing diseased articular surfaces. 
This takes from six to eight weeks, but may be indefinitely prolonged ; 
sometimes it never occurs, and the lameness is incurable. In actual 
practice it is never possible to foretell with certainty how the case will 
terminate, though a careful consideration of all the facts may give some 
indication. 

Causes.—In no other disease is the division of causes into causa 
externa and causa interna so well warranted and so practical as in 
spavin. The causa interna is a predisposition partly dependent on the 


634 DISEASES OF THE HOCK-JOINT. 


conformation of the hock, partly on that of other portions of the body. 
Whilst the complicated mechanism of the hock predisposes to disease, 
and especially to inflammation, this tendency is enormously increased 
by defective formation of the joint. It is scarcely needful to say that, 
under the powerful action of the muscles of the hind-limb, small 
cramped joints are more likely to suffer than those having well- 
developed, broad and ample articular surfaces. Defective development 
of the lower portions of the hock and of the upper end of the meta- 
tarsus, the condition described by horsemen as “tied-in hock,” is 
particularly disastrous, while a distinct curvature (sickle-shaped hock) 
is almost as bad. In this formation the action of the extensors pro- 
duces excessive movement of the hock-joint and great pressure on the 
articular surfaces, with danger of injury to the ligaments of the joint. 

But these visible peculiarities of formation are not the sole causes 
of spavin—the internal arrangement of the bones and ligaments may 
predispose to disease, as shown by the inheritance of spavin, and its 
occurrence in entire strains whose hock-joints appear perfectly formed. 
This view is further supported by the rare occurrence of disease in some 
races, ike the Danes and Holsteiners, whose hocks are by no means 
beyond reproach. In breeding, therefore, special attention should be 
paid to this disease. The exact nature of this predisposition at present. 
eludes us, though by many it is considered to result from incomplete 
development of the elements of the joints, especially of its bones and 
ligaments. 

In considering the question of predisposition, we have to remember 
that the formation of other portions of the limb, and even of the body, 
exercises a considerable influence on the development of the disease. 
Experience shows that uprightness of the fetlock- and stifle-joints is 
unfavourable, though this formation is often secondary, 1.e., a conse- 
quence, and not a cause, of the formation of spavin. Klemm considers 
that animals with cow-hocks, and those which stand with the hind-feet 
far back, are predisposed to the disease, and on this basis explains the 
curative action of shoes with high quarters and deep heels. 

Peters thinks that turned-out hocks are particularly prone to spavin, 
and there is no doubt that this formation interferes with hock action 
and increases the chance of disease. 

Experience also shows that very powerful horses with broad pelves 
and well-developed quarters are particularly liable, the reason being the 
great strain which this formation throws on the hock-joint. The more 
powerful the muscles of the hind-quarter and the freer the movement, 
the greater the strain on the hock. The same is true of overgrown and 
long-backed animals. To produce an equal output of energy, their 
muscles are forced to act more vigorously, and, therefore, greater strain 


SPAVIN. 635 


is thrown on the hock. For the same reason powerful, spirited horses 
more often suffer than quiet, phlegmatic animals. The fact that spavin 
is commoner in young horses is principally due to the incomplete 
development of their bones and muscles, and to the existing predisposi- 
tion being only brought into play when the young animal is put to 
work; horses, when once seasoned, not being likely to develop disease 
unless greater demands are made on their working powers, or the hock 
is accidentally injured. 

The causa externa is almost exclusively represented by mechanical 
injury. Severe, rapid work, especially under the saddle, or in front of 
heavy loads, often produces slight, frequently repeated strain. Peters 
thinks soft, moist ground and rough pavements particularly injurious, 
because the unavoidable rotary movement of the hoof on the ground is 
interfered with, and consequently takes place not at the extremity of 
the limb but in the joints, especially in the hock-joint. 

Single violent sprains, produced, for example, by wheeling round on 
the hind-quarters or suddenly throwing the horse on its haunches, may 
determine inflammation of the hock-joint, but this is far from common. 
Even less frequently is inflammation caused by external injuries, such as 
wounds or bruises. 

I am far from thinking that the above entirely explains the pathology of 
spavin; much further investigation is required to make it completely clear. 
The propagation of new theories, however, does just as little for science as 
the recommendation of new cures for practice. What is needed, above 
everything, is a clear insight into the physiology of movement. Such 
an investigation should not be confined to considering single sections of the 
limb, like the hock, but should take cognisance of the action of the limb 
as a whole. Though by no means a light task, it would well repay study, 
and we hope that in the near future some one will be found to undertake it. 

Consequences and Prognosis.—As stated, when speaking of its 
development, spavin generally takes a chronic course. The preliminary 
shght lameness is often overlooked, and before it becomes accentuated 
distinct changes have taken place in the hock, while in some cases the 
first stage of disease gives rise to so little pain that movement is not 
disturbed. In others, however, lameness exists before any change can 
be detected in the joint. Once started, the process generally continues 
without halt. In favourable cases it leads to union between the 
scaphoid, cuneiform, and metatarsal bones. The loss of movement in the 
hock-joint is only slight, and is so completely compensated for in other 
joints that lameness does not necessarily result. The time required 
varies greatly, sometimes being counted by weeks, sometimes by years. 

Though union principally depends on the animal being rested and 
placed under treatment, failing which the parts seldom unite, and 


636 DISEASES OF THE HOCK-JOINT. 


lameness persists, the converse is not equally true, for even the most 
energetic treatment is not always successful. Resolution, 7c, the 
disappearance of inflanimation and local change, is exceptionally rare. 

Errors in diagnosis have led to the belief that absorption often occurs, 
and that absorptive processes may be assisted by treatment. My 
experience is quite opposed to this view, which is due to confusing with 
spavin (7.e., arthritis chronica) many varied disease processes, the sole 
common feature of which is lameness. It is certainly difficult at times 
to confidently diagnose spavin on the first examination, especially if no 
reliable history is available. Nevertheless, an attempt at distinction 
should always be made, otherwise prognosis and treatment are mere 
gropings in the dark. 

Not infrequently lameness diminishes or disappears after a long rest, 
but the improvement is only temporary, and as soon as the horse returns 
to work, lameness recurs in an even severer form. It is clear that, with 
rest, the inflammation may diminish in intensity, but it seldom dis- 
appears completely. Though spavin may be viewed as a typical disease 
of the hock-joint, yet it shows many variations in course, partly on 
account of the conformation of the joint, partly of the degree and 
extent of disease processes, but especially of the variation in external 
influences, amongst the principal of which must be ranked the treat- 
ment employed in the particular case. 

In forming a prognosis it is necessary to bear in mind all the factors 
which favour relative recovery, @.¢., which contribute to removal of lame- 
ness, as well as those, on the other hand, which are likely to prevent it. 
Such factors comprise :— 

(1) The work required of the animal. The greater the exertion, and 
consequently the strain on the hock-joint, the less the chance of 
permanent recovery. Heavy cart-horses and hacks are therefore 
unfavourable subjects. 

(2) The degree of lameness and the time it has existed. If lameness, 
in spite of proper treatment, persists, it shows that the conditions are 
unfavourable to anchylosis, and the chance of recovery, therefore, is 
slight. For a similar reason, marked muscular atrophy is not a hopeful 
symptom. Severe lameness points to extensive change in the joint, and 
is also unfavourable, but slight lameness does not prevent the animal 
being used for certain purposes, even though it cannot be completely 
cured, 

(3) The animal’s conformation. The worse the conformation of the 
limb, and especially of the hock, the less the chance of recovery. In 
badly formed hocks even moderate work produces fresh strain and 
prevents the bones uniting. 

(4) The position of the disease. It has long been known that 


SPAVIN. 637 


exostoses on the flexor surface of the jomt are particularly troublesome, 
and that the chance of recovery is greater if the spavin le towards the 
back of the joint, and be confined to the cuneiform bones. This may 
partly be explained by the fact that new growths of bone in front of the 
joint are more likely to mechanically interfere with movement, even 
ater obliteration of the joint; while disease of the joint in this situation 
is less likely to be followed by anchylosis, because the amount of 
unavoidable movement is here greatest. As indicated by Havemann, 
the size of the exostosis is of less importance; horses with marked 
spavins may often be seen going sound, whilst those with a small growth 
may prove useless for every kind of work. 

(5) The animal’s age. 

The occurrence of spavin in young animals which have not done 
much work points to a strong hereditary predisposition, and naturally 
gives an unfavourable cast to the prognosis. In such animals the lame- 
ness may disappear for a time, but returns immediately work is 
resumed. 

Prognosis, though to some extent guided by the facts given, is always 
uncertain. It is never possible to say confidently that lameness 
will disappear, even when the diagnosis is beyond doubt. The vary- 
ing formation of the hock-joint and of the limb in the different 
breeds, the uses to which horses are put, and other factors (including 
errors in diagnosis), lead to the percentage of recoveries being very 
varyingly estimated by different experts. Taken altogether, they may 
number about 50 per cent. 

Symptoms.—Spavin lameness. The diagnosis of arthritis chronica 
in small, “clean” hocks offers no difficulty, provided disease processes 
have extended beyond the joint, and exostoses exist. Until they develop, 
however, diagnosis remains uncertain, for the lameness is not sufficiently 
characteristic to form the basis of a decided opinion. It is just on this 
account that errors so frequently occur, and that other lamenesses, even 
foot-lameness, are mistaken for spavin. But other injuries to the hock, 
such as sprain, &c., may lead even experts into error. Such mistakes 
often lead to doubts being cast on the treatment. 

The lameness accompanying spavin is scarcely ever sufticiently 
distinctive to alone determine the diagnosis, but must be considered 
along with the anatomical changes in the hock-joint. 

Even Knoblock, when speaking of it, says: “If one detects no swell- 
ing, how is one to know that a spavin will come?” I do not mean to 
say that the character of the lameness does not afford valuable informa- 
tion, but the kind of lameness is less important than the manner of its 
appearance and its after-course, and finally, than the absence of visible 
pathological changes, to which the lameness could otherwise be referred. 


638 DISEASES OF THE HOCK-JOINT. 


The onset and course of the lameness is, then, of greatest value; the 
style of movement, which varies greatly according to the position and 
extent of the inflammation and to other circumstances, much less so. 
In the greater number of cases the limb is incompletely extended. The 
last phase of the stride, while weight is still carried by the limb, is 
relatively shortened, apparently on account of the pain due to extension 
of the hock-joint. Immediately the hoof leaves the ground the limb is 
drawn rapidly forward. This sudden movement often resembles string- 
halt, and is best seen during the first few steps, or when turning in a 
small circle. 

A further consequence of the incomplete extension of the limb is an 
exaggerated hip-action, which is seldom absent. The shortening of the 
last part of the stride is compensated by extra movement of the 
quarter. Sometimes the limb is abducted, especially in double-sided 
spavin, in which the turning out of the limbs is often well marked. In 
other cases the fetlock becomes upright, in consequence of the incomplete 
extension of the hock causing the animal when moving over uneven 
ground to walk on the toe. 

As arule, lameness develops very gradually. At first it disappears 
after a few steps, and in many cases all that can be observed is a catch 
in the movement of the affected limb, resembling stringhalt when turn- 
ing round in the stall towards the sound side. ‘This usually disappears 
with work. The disappearance of lameness during movement, and its 
regular recurrence after rest, form one of the most important peculiari- 
ties of the disease. The fact that turning towards the sound side seems 
more painful than towards the diseased is explained by the pressure on 
the inner part of the hock being then greater. Occasionally, however, 
the lameness persists during movement, and may, indeed, become more 
severe, especially if it were previously well marked or of old standing. 
The increase in lameness when turning in small circles is clearly due 
to the rotary movement in the limb and the tendency to displacement 
of the bones in the affected section of the joint. 

The “spavin test” is sometimes useful in diagnosing spavin lameness: 
it consists in keeping the limb flexed for one minute and then trotting 
the horse. Lameness is very marked. 

This test, however, requires to be used with considerable care, 
especially in old horses, which may show similar difficulty in movement 
after the limb has been kept bent, even without having spavin. 

Various hypotheses have from time to time been advanced as to the 
immediate cause of lameness. Whilst the older practitioners considered 
the pain to be due to pressure of the exostosis on the periosteum, and 
supported their view by reference to the uneven surface of the macerated 
bones, we have known since Havemann’s time that the changes within 


CAUSES OF LAMENESS IN SPAVIN. 639 


the joint were not only the essence of the disease, but also the cause of 
the lameness. Though Hering opposed this, stating that spavin lame- 
ness 1s sometimes seen without disease of the joint, either his observa- 
tions were due to errors in diagnosis, or the process was only in a 
developmental stage, the articular surface not yet having suffered. As a 
rule, the onset and course of the lameness entirely agree with the 
observations made in men suffering from arthritis chronica, who at 
first only show lameness for a few steps. The lameness is probably 
due to changes partly in the articular surfaces, partly in the ligaments. 
Dieckerhoff adds disease of the bursa of the flexor metatarsi muscle. I 
doubt whether chronic inflammation of this bursa ever produces lame- 
ness. Under certain circumstances, exostoses may mechanically limit 
free movement of the joint. 

The exostosis may even precede the lameness in cases where the 
disease develops slowly: as a rule, the two appear simultaneously, but 
sometimes the bony swelling does not occur until two or three weeks 
afterwards. Its detection requires an accurate knowledge of the normal 
configuration of the hock-joint, and may be effected by viewing the joint 
either from the front or back. For this purpose the operator takes 
up a position either some steps in front of or behind the horse, and 
compares the inner surfaces of the hocks. In this way experts can 
detect the slightest differences, though it is by no means possible to 
determine by this examination alone whether or not spavin exists, 
especially in English thoroughbreds, whose hocks are seldom absolutely 
symmetrical. But even in other breeds a want of symmetry in the 
hocks cannot of itself be regarded as a certain sign of spavin. The terms 
“coarse,” &c., used in speaking of formation, are tacit acknowledgments 
of this fact, and are often only circumlocutions for spavin. The visible 
changes on its exterior usually show whether the joint is or has 
been diseased, but alone are not proof that the existent lameness is 
due to spavin, for very frequently the lameness disappears after anchy- 
losis of the joint, though other conditions may interfere with the move- 
ment of the limb. To refer such lameness to the changes in the 
hock-joit would be a serious error. The diagnosis “spavin lameness ” 
is only justified when— 

(1) The local changes are accompanied by lameness, the course and 
other peculiarities of which agree with the description above given. 

(2) Muscular atrophy or other condition points to old-standing 
lameness, probably connected with the anatomical changes. As already 
stated, exostoses are more likely to cause lameness the nearer they lie 
to the front of the joint. Sometimes traces of past treatment are 
visible, pointing to a chronic condition, and supporting the diagnosis 
“ spavin.” 


640 DISEASES OF THE HOCK-JOINT. 


Acute inflammatory symptoms, increased warmth, pain on pressure, 
&e., are seldom seen unless the condition has resulted from violence, 
but their presence is not Incompatible with spavin lameness. 

Differential Diagnosis.— By bearing in mind the above-mentioned 
principles, mistakes will usually be avoided, though the following 
conditions present many points of resemblance to the lameness now 
under consideration :— 

(1) Stringhalt, a disease which will be described in another place. 
Here I need only remark that the periodical appearance and gradual 
abatement of lameness during work point to spavin. 

(2) Hip lameness. In these cases lameness is only marked when 
the limb is carried (swinging leg lameness), whilst in spavin it exists 
both when the lhmb is carried and when weight is placed on it. The 
same applies to— 

(3) Gonitis chronica, in which also there is a marked tendency to 
stand with the limb flexed (p. 609). 

(4) Inflammation of the tendon sheath of the flexor pedis at the 
inner surface of the hock-joint. This, however, can scarcely be mistaken 
for spavin, on account of the marked swelling (p. 654). 

(5) Tendinitis and tendovaginitis of the flexor pedis lead, in the 
hind-limb, to pronounced lameness when weight is thrown on the hmb 
(supporting leg lameness), and can be detected by careful palpation. 

(6) Curb is less likely to be mistaken for spavin, because it seldom 
produces lameness, unless when accompanying the latter. 

(7) Spavin lameness is more difficult to differentiate from that due to 
ring-bone and sprain of the coronet-joint. It should be remembered, 
however, that in a hind-limb, ring-bone is comparatively seldom 
followed by lameness, whilst sprain is usually distinguished by the pain 
(due to rotation of the joint) which occurs when the animal is sharply 
turned round. 

(8) The absence of foot lameness is proved by a careful examination 
of the hoof. In laminitis there is marked pulsation of the metatarsal 
arteries. 

(9) Double-sided spavin is sometimes difficult to distinguish from 
mere stiffness. In “worn” horses, which, as a rule, show no real 
lameness, too much importance should not be attached to the results 
of the spavin test (p. 638), nor to the stiff movement. 

Treatment.—Spavin lameness is seldom followed by spontaneous 
recovery, and the first essential of treatment is sufficiently prolonged 
rest. Havemann, Strauss, and others consider all treatment useless, but 
this is certainly too extreme a view, for every busy practitioner must 
know of many horses which, after treatment, have perfectly recovered their 
usefulness. The nature of the pathological changes renders cure only 


ACTION OF TREATMENT FOR SPAVIN. 641 


relative, for the articular surface never recovers its normal condition, 
and well developed spavin lameness only disappears after anchylosis of 
the joint. But that it does so disappear is readily proved by post- 
mortem examination. Very often the lower joints of one or other, 
not infrequently of both, hocks are found completely united in animals 
which were perfectly sound before death. 

Such union requires, firstly, prolonged and perfect rest, a.¢., stoppage 
of all work, and, as far as possible, of movement. Whatever the nature 
of the other treatment, this rest 1s essential, and must be continued 
for four to eight weeks. 

Various auxiliary measures of treatment have been proposed and 
employed, but they all agree, on the one hand, in procuring rest of the 
joint, and, on the other, in evoking, in the neighbourhood of the diseased 
spot, an acute inflammation, which favours adhesion of the bones. The 
views as to their method of action, and the nature of the curative 
process, vary widely. Some consider that inflammation is diverted from 
the joint,—an idea which, however, is out of harmony with the views 
held of such processes at the present day. The same is true of the 
suggestion that the artificially induced acute inflammation may termi- 
nate the changes proceeding in the articular surfaces. This is only true 
in the sense that it may induce union between the bones; it cannot 
remove the chronic arthritis. In opposition to the above view, it has 
been pointed out that, in man, arthritis chronica deformans shows no 
tendency to the formation of stiff joints; but the objection leaves out of 
consideration the fact that, in man, the joints affected (hip-joint, &c.) 
are incapable of anchylosis; the same applies to the stifle-joimt of the 
horse (p. 609). In my opinion, recovery entirely depends on union 
between the articular surfaces of the cuneiform bones, or between these 
and the metatarsus. Union may be assisted by—— 

(1) Blisters. The action of blisters is usually too superficial. To 
exert much influence on adhesive processes, energetic, deep-seated 
inflammation must be excited, and concentrated sublimate solution, 
arsenic, euphorbium, croton oil (Schubert) are therefore more success- 
ful than cantharides blisters, and good results following the application 
of cantharides are usually due either to the rest given, or to the case 
not being spavin. The success obtained in the army by blisters may be 
similarly explained. To satisfy the owner I have often tried blisters, 
but seldom with good results. They may possibly be more active when 
subcutaneously employed, as recommended by Buch and Bassi. Bassi 
makes two or three converging incisions through the skin at the diseased 
spot, loosens the subcutis, and fills the pockets thus formed with blister. 

Setons, formerly much used, are now no longer employed. ‘They are 
easily rubbed out by the opposite foot, and leave ugly scars. 

28 


642 DISEASES OF THE HOCK-JOINT. 


(2) The actual cautery. On account of the more intense and 
penetrating inflammation produced, firing is more effective than blister- 
ing, and (ceteris paribus) in direct proportion to the intensity and 
extent of the periosteal irritation which it excites. It is of little 
importance whether the firing be in lines or points, the great thing is 
to set up artificial inflammation in the depths. Many practitioners, 
therefore, prefer to perforate the skin with a pear-shaped iron; in 
France a lone point is preferred (few perforant). In Germany, Gerlach 
tried the latter and other methods, but renounced them on account of 
the risk of producing fatal inflammation of the joint. Perforation of 
the skin and of the bursa of the flexor metatarsi with the pyriform iron 
is usually harmless, and is unquestionably amongst the most effective 
methods of dealing with spavin. On the other hand, the point, when 
incautiously used, may cause dangerous arthritis, especially if too thick 
and too long, or if any portion of the joint be opened. The point used 
in France is from 2 to 2 of an inch long, and therefore seldom pene- 
trates the joint, but when there is no marked exostosis, such an 
accident is quite possible. In presence of a large bony spavin, perfora- 
tion is scarcely ever followed by bad results. I have often used the 
pointed iron, in some cases with excellent result, but only where well- 
developed bony growths made it impossible to penetrate the joint. In 
this connection I need not say that the greatest caution must be 
observed in well-bred horses with thin skins. 

If the deposit be slight, the red-hot iron should be applied once to 
the highest point of the swelling, and passed through the skin into 
the bone by firm pressure. In dealing with large spavins, this may be 
done at two or even three points. As a rule, a blister of sublimate 
(1 to 6) may at once be applied. Sometimes the tendon sheath of the 
flexor metatarsi muscle becomes acutely inflamed, and severe lameness 
lasting several days results. This need cause no alarm, for the inflamma- 
tion will pass away of itself. When the exostosis is smaller, I regard 
the use of the point as somewhat dangerous. 

In Germany, Hoffmann recently advocated the pointed iron. He 
uses knitting-needles held in a pair of forceps, and introduced glowing 
hot. The animal is cast, the point of operation disinfected and rubbed 
with an antiseptic powder. The necessary number of knitting-needles 
(which can be broken in two) are placed in a basketful of burning 
charcoal, and, as required, are grasped with forceps and introduced into 
the bone. Froin fifteen to twenty perforations are made over a surface 
as large as a lemon. They enter the bone deeply enough to reach the 
marrow (Knochenmark). If want of resistance to the introduction of 
the needle shows that the joint has been entered, the needle must then 
at onee be withdrawn. 


METHODS OF FIRING AND OPERATING FOR SPAVIN. 643 


After firing, Hoffman applies a thick coating of iodoform, lays the 
hand flat on the parts, and moves the skin backward and forward so as 
to displace the openings in the skin from those in the deeper-seated 
structures. The surfaces are then once more strewed with iodoform. 
After some days a slight swelling occurs, an eschar forms, and in four- 
teen days all symptoms are stated to disappear. 

Batazzi recently recommended the treatment of spavin by subcu- 
taneous firing, formerly introduced by Nanzio. After making an 
incision 15 to 2 inches in length over the exostosis, the edges of the 
wound are drawn back and a few punctures made in the form of a 
triangle, with the base directed upwards. The same effect is more 
simply produced by firing through the skin, which has the advantage of 
producing smaller cicatrices. 

(3) Operation for spavin. Since the times of Abildgaard and Lafosse 
many operations have been proposed for the cure of spavin. Abildgaard 
first described section of the inner terminal tendon of the flexor meta- 
tarsi, afterwards extensively practised by Lafosse. Dieckerhoff, about 
the same time, suggested opening the bursa of this tendon. No doubt 
these operative measures may assist in removing lameness, but in my 
opinion their usefulness depends on the acute inflammation which 
tollows assisting union of the diseased surfaces, and not, as Abildgaard 
and Lafosse thought, on their producing relaxation of the tendon, and 
preventing it pressing on the diseased joint. Division of the tendon 
is, therefore, of much less importance than the production of acute 
inflammation of its bursa, which extends to neighbouring structures, 
and not only procures thorough local rest, but assists union by the 
periostitis which it gives rise to. Dieckerhoff’s method is very simple, 
and quiet horses may be operated on standing. Restive or dangerous 
animals are cast, with the affected limb lowermost. A twitch is applied, 
the horse placed against the wall with the sound lmb lifted as in shoe- 
ing, and the operator then passes a probe-pointed bistoury into the 
bursa of the diseased limb. After making sure that the bursa is 
really opened, the animal is placed in the stable. No after-treatment 
seems necessary, except to remove excessive granulations by suitable 
caustics. The wound generally cicatrises in three weeks, and after a 
further interval of a fortnight the horse can be put to work. 

In many cases this method is successful, but in others recovery does 
not occur, while in a certain, though small, proportion acute inflamma- 
tion of the hock-joint develops, and proves fatal. If in making the 
incision the operator cut too deeply, which is sometimes unavoidable, 
and alight on the boundary between the scaphoid and cuneiform bones, 
the joint is opened, and purulent or septic arthritis readily follows. It 
is, therefore, well not to make the incision too far back. Dieckerhoff 


644 DISEASES OF THE HOCK-JOINT. 


recommends the centre point between the anterior and posterior borders 
of the joint. 

No purpose is served by proceeding antiseptically, for success 
depends on the inflammation produced, and especially on the periostitis. 

The bursa can also be opened with a rather sharply-pointed pyriform 
cautery. It seems of no importance which method is adopted, though 
in using the firing-iron care must be taken not to open the jomt. The 
larger the exostosis, the less the danger. 

By bearing in mind that union depends chiefly on the exostoses 
around the joint, the articular surfaces themselves can only grow together 
after extensive destruction of the articular cartilage, the reason for 
seeking to produce extensive bony deposit in this region will be 
apparent. Periosteotomy is the surest method of effecting this, and has 
been widely recommended in the treatment of spavin (Sewel, Peters, 
Moulden, Hintermayer, and others). The operations recommended do 
not differ in any essential point. I have for some years practised Peters’ 
method, and always with the best results. 

It is as follows :-— 

The horse is cast on the diseased side, and by a cord passed 
round the corresponding front limb, the upper hind-leg is drawn far 
enough forward to clear the seat of operation. The hair is then cut 
away from the back of the hock-joint, midway between its anterior and 
posterior borders, to the extent of about one square inch, the surface 
washed with soap, rinsed with sublimate or carbolic solution, and the other 
antiseptic precautions, such as cleansing the hands, placing the instru- 
ments in carbolic solution, &c., complied with. By means of a probe- 
pointed bistoury or scalpel, an incision, at right angles to the left of the 
limb, and about half an inch long, is then made through the skin and 
fascia at the disinfected spot, a pair of curved scissors are introduced 
through the opening as far as the joint between the blades, and the 
skin divided from underlying tissues in the form of a “ V,” the imstru- 
ment being first thrust forward, then backward, severing the subcutis. 
The slightly curved knife (fig. 133) is next introduced into the front 
pocket of skin, the cutting edge directed backwards to avoid injuring 
the vena saphena. As soon as it has entered up to the handle, the 
cutting edge is directed towards the joint, and the back pressed with the 
fingers of the left hand, while, by gently rocking the instrument, it 1s 
made to penetrate the bones of the joint. The tendon of the flexor 
metatarsi muscle and the periosteum part with a loud “ crunching ” 
sound, The same process is repeated in the posterior pocket of skin, 
the sharp edge of the knife, however, being directed forwards. After 
wiping away the small amount of blood which escapes from the wound, 
the surface is rinsed with a disinfectant, and an antiseptic dressing 


PERIOSTEOTOMY IN SPAVIN. 645 


apphed. The bandage should be carried down as far as the fetlock, so 
as to obtain a firm hold. The horse is then allowed to rise, and is 
placed in the stable. If, during the next few days, the bandage become 
soaked through with blood, it should be renewed, otherwise it is left in 
position for six to eight days, when the skin wound will be found to 
have closed. 

By the exercise of moderate care in operating, pus formation can be 
avoided ; and should it even occur, it seldom entails grave consequences, 
for, on account of the flat position of the knife while 
making the incision, there is little danger of opening 
the joint, and thus producing dangerous arthritis. 

The horse must be rested for at least four to 
six weeks after operation, and during this time move- 
ment, as far as possible, avoided. Some operators 
even recommend fastening the animal up short to 
prevent it lying down. 

I have discovered by experiment that both the 
inner tendon of the flexor metatarsi and the peri- 
osteum of the cuneiform bones are divided in this 
operation; not infrequently the internal lateral ligament 
is also partly cut through. The above method produces 
active periostitis and thickening of the internal liga- 
ments of the joint, which favour periarticular exostosis 
and union of the smaller joints in a much higher degree 
than simple opening of the bursa and other operations. 

Though my experience is large, I have never seen 
bad results. For a short time exostoses are actively 
produced, but, to a great extent, disappear after 
a month or two, and may finally leave no trace of 
operation. 

It is not pretended that this procedure cures all 
cases of spavin, but the objections to it raised by Schiitt * pee eet ae 
and others in no way detract from its undoubted value. 

There need be no fear of using the knife, even when the exostosis is 
small. In such cases, to make sure of sufficiently dividing the perios- 
teum, knives of greater curvature may be used; these penetrate more 
deeply (fig. 1330). I have often broken the knife when pressing it 
into the bone, but never had any bad result. 

A clinique offers few chances of collecting reliable statistics of the 
results of such operations. When the patient is not returned, I consider 
the result to have been favourable, and on that basis have no hesitation 
in describing periosteotomy as thoroughly effective. Very few cases are 
sent back as uncured; and amongst those that I have been able to trace, 


a b 


646 DISEASES OF THE HOCK. 


many have remained for years free from lameness. Failing success by 
this method, the pointed cautery may sometimes be found of more 
service. Its use is without danger, the large exostoses preventing it 
entering the joint. 

Klemm’s method of dividing the flexor metatarsi muscle 5 or 4 
inches above the hock-joint is, in my experience, useless. If divided 
completely, lameness follows similar to that after rupture of the muscle 
(p. 619). By giving four to six weeks’ rest, the joint may become 
anchylosed, and lameness disappear, but this often fails to occur. Par- 
tial section sometimes disguises the stringhalt-like lameness, but cannot 
cure the disease of the joint, and the owner generally returns after an 
interval to submit the horse to further treatment. 

In the Prussian army the actual cautery has, during the last few 
years, been largely used in treating spavin, the successes numbering 
about 60 per cent. The method recommended consists in perforating 
the bursa with a pyriform iron, which is passed into the bone.  Peri- 
osteotomy proved of less value. It must, however, be remembered that 
in no other disease are diagnostic errors so frequent as here, for even the 
most careful examination often leads to no definite conclusion. Serious 
methods of treatment are only applied to serious conditions, 2.¢., to cases 
in which disease has made extensive progress, whilst the milder cases 
are blistered or fired; especially in the army, where firing and blistering 
are greatly relied on. 

As Hering pointed out, neurotomy is not of much use in spavin, 
Section of the tibial nerve above the hock, or of the cutaneous nerves, 
does not remove the pain or lameness. This is all the more unfortunate, 
as all the above-described methods of treatment are at times unsuccess- 
ful, and leave the horse permanently lame. 

The shoeing is of some importance. Klemm recommends raising the 
heels, and giving long quarters and a short toe, a suggestion I can fully 
support. Késter also recommended shortening the toe of the foot before 
treatment, and using long, wide shoes, with heels and toe-pieces. 


VI.—ENLARGEMENTS ON THE OUTER SURFACE OF 
THE HOCK.’ 


Ger. Rehbein. 


The above title includes all circumscribed thickenings on the outside 
of the hock-joint. They may be situated in the lgamentous apparatus, 
1 A literal translation of the German title wonld have no meaning to English ears, and yet 


no specific title exists in English. I can best explain Rehbein by describing it as spavin on 
the outer surface of the hock.—[TRANSL. ] 


ENLARGEMENTS ON THE OUTER SURFACE OF THE HOCK. 647 


particularly in the outer lateral ligament, or may arise from the cuboid, 
outer small metatarsal or other bone of the hock, but seldom or never 
from the joint. Chronic skin thickenings, and prominence of the external 
malleolus of the tibia, or of the small metatarsal, are often mistaken for 
the enlargements in question. Careful examination shows the nature of 
the condition, which usually results from kicks or other injuries of the 
outer surface of the hock. Sometimes it accompanies spavin, or forms a 
complication of that disease, in consequence of the chronic arthritis 
extending to the outer surface of the joint. 

In France also various theories are held as to the nature of the 
disease, which is termed “jarde” or “jardon” (comp. Rec. de méd. vét., 
1891, p. 323). 

Hertwig insists that horses often go lame from this condition, and 
show jerking movements of the limb similar to those seen in spavin. 
I have only seen lameness where the enlargement was accompanied by 
spavin. As a rule, it only produces lameness when caused by acute 
inflammation of the outer lateral ligament or of the periosteum. 

Diagnosis.—The examination for this enlargement is similar to that 
for spavin. The outer surfaces of the hocks should be compared. 
As a rule, it is easy to discover whether the skin alone is thickened, or 
whether the deeper-lying structures are involved. 

The prognosis is usually favourable. Only when spavin is also 
present is the prognosis doubtful. 

Treatment is usually unnecessary. If the ligaments and periosteum 
are acutely inflamed, they should be treated accordingly. In most 
cases rest and blistering remove the lameness, though thickening seldom 
disappears, and a slight blemish may always remain. 


VIIL—CURB. 


In horsemen’s parlance, this name includes all swellings on the 
posterior surface of the hock-joint. Seen from one side, the back of the 
hock-joint should appear as an absolutely straight line, stretching from 
the tuber caleanei to the fetlock. About 3—4 inches below the point of 
the calcis a swelling or convexity (hence the French word “ courbe,” 2.., 
curve) sometimes appears.’ 

In certain cases, especially in English thoroughbreds, it is due to 
excessive development of the external small metatarsal, sometimes to 

1 Jn France, since Bourgelat’s time, any excessive curvature of the internal surface of the 
joint, due either to over-development of the internal malleolus, or to thickening of the skin 


or internal lateral ligament, has been described as ‘‘courbe.” In Germany, ‘‘Courbe”’ or 
‘* Hasenhacke”’ has always been identical with our English word ‘‘ curb,” 


648 DISEASES OF THE HOCK. 


thickening of the skin, or of the flexor pedis perforans or perforatus 
tendons, sometimes to distension of the bursa tendinea of the flexor 
pedis perforans, which lies at this point, and is connected with the 
caleano-cuboid ligament. These conditions, which are usually easy of 
recognition, must, however, be distinguished from curb, resulting from 
thickening of the caleano-cuboid ligament (ligamentum tarsi plantare). 
The upper end of this ligament is attached to the posterior surface of 
the os calcis, whence it passes downwards to become attached to the 
cuboid, to the external small metatarsal, and to the scaphoid, as 
well as to the large metatarsal. In consequence of sprain, it often 
becomes inflamed, and afterwards chronically thickened, or the inflam- 
mation may possibly induce changes in the joint itself. Thickening 
of the flexor pedis perforans tendon, and especially of its reinforcing 
ligament, is usually easy to differentiate from curb, inasmuch as it 
extends further downward, 2.¢., can be traced along the tendon itself. 

Causes.—Horses with “tied-in” and “sickle-shaped” hocks are 
especially predisposed to curb, and, if incautiously worked when young, 
generally develop it. The reason appears to be that, as the calcano- 
cuboid ligament serves to unite the metatarsus to the os calcis, and as 
the caleis acts like a lever, to the end of which are attached the 
extensor tendons, especially the tendon of the gastrocnemius, the more 
nearly the bend of the hock approaches a right angle, the more power- 
fully does the gastrocnemius act, and, eoreeemeniins the more likely is 
this hgament to become strained. 

In “ tied-in” hocks the lower row of bones and the upper end of the 
metatarsus are too slight; the distance between the calcano-cuboid liga- 
ment and the anterior margin of the hock, which represents another lever, 
is too short. The less this distance, the more hable is the ligament to be 
strained and inflamed when the limb is forcibly extended during movement. 

The external causes consist in severe exertion, violent attempts at 
extension at moments when the limb is flexed and sustaining weight, as 
in jumping, or in heavy or uphill draught-work. Curb sometimes 
results from the horse being suddenly thrown on its haunches. The 
more powerful the muscles of the quarter and limb, the greater the 
strain on the calcano-cuboid ligament, a fact which explains the 
frequency of curb in very powerful horses. Curb sometimes occurs as 
a complication of spavin, in consequence of inflammation extending to 
the back of the joint and to the caleano-cuboid ligament. This is the 
cause of the so-called bony curb, which, however, might better be in- 
cluded under the term spavin. 

Symptoms.—(1) Change in the form of the joint. Curb appears 
as a swelling in the otherwise straight line of the hock when seen from 
the side (fig. 134). Careful examination and palpation differentiate 


CURB. 649 


strain of the caleano-cuboid ligament from disease of the tendons, tendon 
sheaths, or skin. It is more difficult to distinguish between bony curb 
and strain of the ligament, though in the former additional exostoses 
usually exist on the inner side of the joint. 

(2) Lameness is comparatively rare in curb, which in working-horses, 
therefore, forms little more than a blemish. Lameness, when occurring, 
is either due to the accompanying spavin, or is caused by inflammation, 
in the caleano-cuboid ligament. This explains why it so often resembles 
spavin lameness, and occurs only during the development of curb. 
Curb, when slowly developed, may not interfere with movement, but 
when caused by violent injury, and accompanied by sprain or rupture of 
the caleano-cuboid ligament, or of the reinforcing lgament of the 
flexor pedis perforans, is often accompanied by sudden and severe 
lameness. Pain is shown when weight is thrown 
on the limb whilst the fetlock-joint is held flexed. 
In such cases pain and increased warmth may be 
detected on pressure over the affected spot. These 
symptoms, like the lameness, generally disappear 
in two to four weeks, but the swelling persists. 
Young horses which work hard are liable to 
suffer from relapses. 

Prognosis.—The gravity of curb varies greatly. 
In general, and particularly in old working-horses, 
it is simply a blemish, but animals showing it 
should not be used for breeding, especially if the 
formation of the hock-joint be defective. In 
young animals, and in cases accompanied by 
chronic or intermittent lameness, prognosis de- 
pends partly on the extent to which the animal's 
usefulness is affected, partly on the formation 
of the hock-joint and the work to be done. 
Animals with weak “ tied-in” hock-joints, if put 
to severe work, often suffer repeatedly, and become 
perfectly useless. The above is true in a still 
higher measure of bony curb, appearing as a complication of spavin. 

The treatment varies with the nature of the condition. In acute 
inflammation, antiphlogistic measures, the use of cold poultices, &c., with 
resolvent ointments and massage, are indicated. Cantharides blisters or 
the actual cautery are useful later. But it must be borne in mind that 
such applications are only of use in lameness consequent on acute pro- 
cesses. They have little effect in removing well-marked swellings, and 
can never completely cure old curbs. The animals must be rested as 
long as they show lameness. Bony curb is treated like spavin. 


Fre. 134,—Curb. 


650 DISEASES OF THE HOCK. 


VIIl.—CAPPED HOCK. 


Like curb, the term “capped hock” is collective, and includes all 
swellings on the point of the os calcis, whatever their cause. Below 
the skin covering the tuber calcanei in the horse is usually to be found 
a subcutaneous bursa, lying on the upper or posterior surface of the 
tendon of the flexor pedis perforatus; under this, again, is a true bursa 
for the tendon, which glides over the cartilaginous cap of the tuber 
caleanei (fig. 135, e). The condition known as “ capped hock” may have 
its origin in any of these structures. It may, therefore, consist— 

(1) Of inflammation or chronic thickening in the cutis or subcutis ; 
inflammation in the lower portion of the thigh is sometimes followed by 
swelling, due to gravitation of extravasated fluid (false capped hock, 
Giinther). 

(2) Of hydrops of the bursa subecutanea ; this is one of the commonest 
causes of capped hock. 

(5) Of a swelling originating in the flexor pedis perforatus at the 
point where the latter covers the point of the hock, forming a cap, the 
“ egg-call” (Kiergalle) of Giinther. 

(4) Of hydrops of the bursa tendinea of this tendon; or, finally, 

(5) Of thickening of the point of the hock, due to disease of the tendon 
of the flexor pedis perforatus. 

Symptoms.—Though the swelling is recognised at a glance, especially 
if the hock be seen from the side, yet careful examination and palpation 
are required to determine the exact cause to which it is due. Cidema 
and inflammation of the skin are easily detected. Hygroma of the bursa 
subcutanea has an elastic character, and the swelling lies just under the 
skin, while hydrops of the tendon sheath is deeper seated, and is covered 
by the flexor pedis perforatus. Swelling of the tendon itself is charac- 
terised by greater hardness—a feature still more marked in exostoses on 
the tuber caleanei. 

In acute inflammation, increased warmth and pain can be detected. 
Purulent cellulitis and disease of the bursa subcutanea may lead to well- 
marked and widely-distributed swelling; the tumour on the point of 
the hock is then rounded in shape, and may attain the size of a child’s 
head. In aseptic inflammation, on the contrary, swelling is confined to 
the original spot. 

Lameness is rarely marked, and never occurs in simple injury of the 
skin or mucous bursa. Even when purulent inflammation sets in, it 
seldom produces lameness. On the other hand, inflammation of the 
flexor pedis perforatus, of its tendon sheath, or of the tuberosity of the 
os calcis, may produce great difficulty in movement; infectious conditions 


CAPPED HOCK. 651 


in these structures are generally accompanied by severe lameness ; but 
in all aseptic processes lameness is absent, or only occurs during 
development. 

Causes.—Capped hock results from external injuries produced by 
kicks or striking against hard objects. Confirmed kickers and irritable 
mares often have both hocks capped,—an indication which it is well to 
note when handling such animals. The horses often strike themselves 
against the side of the truck or vessel when travelling by rail or water, 
and produce capped hock. At one time it was thought that in mares 
the condition was produced by the urine. 

Prognosis.—True capped hock can seldom be cured, though the 
removal of cutaneous thickening is less difficult. Hygroma of the bursa 
subcutanea is usually obstinate, but can sometimes be improved, or even 
completely cured. Disease of the flexor pedis perforatus and of the 
bursa tendinea is more serious, and generally incurable, as is thickening 
of the os calcis, though recent cases sometimes improve under proper 
treatment. 

As these conditions seldom produce lameness, the working powers are 
not much interfered with. Even in draught-horses they are far less 
grave than curb, &c., and should not exclude the animal from the stud 
if the hocks be otherwise perfect. Infectious processes in the flexor 
pedis perforatus and in its tendon sheath are alone dangerous. 

Treatment.—Where acute inflammation exists, cold applications are 
indicated, as in curb. Wounds must be kept carefully disinfected. In 
disease of the skin and mucous bursa, resolvent applications and massage 
are most useful. 

Recent cases of hydrops in the subcutaneous bursa and bursa tendinea 
should be treated by blistering by the compound cantharides and 
euphorbium plaster, or by cantharidated collodion. The last two form 
a firm, unyielding covering on the surface of the skin, which exerts con- 
tinuous pressure on the inflamed swelling, and assists resorption of fluid 
from the bursa. Cantharidated collodion is even more convenient than 
the plaster, though it must be repeatedly apphed at short intervals, and 
the neighbourhood of the swelling covered so as to produce a sufficiently 
firm covering. 

Practitioners differ as to the advisability of surgical interference, 
mainly because the different conditions are not always differentiated. 

Puncture of hygromata with the hollow needle or slender trochar is 
seldom of service, the contents being soon replaced. It might perhaps 
be advantageously supplemented by the use of plaster or collodion, 
applied immediately after operation. 

In capped hock the knife has been employed with very varying success. 
Laying open the bursa subcutanea is seldom dangerous, and sometimes 


652 DISEASES OF THE HOCK. 


removes hygromata; but the result is not certain, and depends princi- 
pally on the degree of inflammation excited. Opening of the bursa 
tendinea, however, is very dangerous, and in incising the bursa sub- 
cutanea care must be taken not to injure the extensor pedis perforatus. 
The doubtful suecess which has attended operation for capped hock is 
principally to be referred to the tendon sheath having been opened. It 
is better to confine treatment to external applications. 

Corps-Rossartz Hell told me that he ruptures hygromata on the 
point of the hock by violence. For this purpose a bandage is passed 
round the hock whilst the animal stands on the limb, the other hind- 
foot being lifted up. If the foot be then released, the horse makes such 
violent attempts to flex the bandaged limb that the bursa may be 
ruptured and its contents discharged. The swelling dces not return. 
A case is reported in the Zeitschrift fiir Veterindérkunde (1890, 
p. 64) of this method being successfully employed. I have not been 
able to try it, but I regard it as by no means impracticable. In men, 
hygroma has for a long time been treated on the same principle. 

Wounds of the point of the hock may here receive consideration, as 
they are often of importance in the treatment of capped hock. As 
already stated, infectious processes in the skin and bursa almost always 
take a favourable course, and, though liable to be followed by some thicken- 
ing, do not cause further trouble, even when the swelling is of consider- 
able size. The same is true of wounds. It is quite otherwise in 
injuries of the bursa and tendon of the flexor pedis perforatus where it 
passes over the point of the hock, and suppuration or septic infection at 
this point is highly dangerous. Marked pain soon sets in, causing the 
leg to be continuously rested, and movement, as far as possible, avoided. 
The swelling extends over the joint towards the tibia, fever sets in, 
Jaminitis may attack the other foot, in consequence of the continued 
weight on it, and the animal prove unable to stand. It then lies con- 
tinuously, and, if not destroyed, soon dies from the effects (decubitus). 

The post-mortem examination shows the cartilaginous covering of the 
tuber calcanei to be partly or entirely destroyed, and the flexor pedis 
perforatus tendon more or less abraded. The severe pain and dangerous 
character of the disease are essentially due to movement of the tendon 
over the surface of the tuber calcanei, now denuded of cartilage. 

Any injury of the perforatus tendon, or even of its sheath, may 
provoke such results, and it is therefore scarcely needful to say that in 
recent wounds every effort must be made to prevent infection. 


LUXATION OF THE FLEXOR PEDIS PERFORATUS TENDON. 653 


IX.—LUXATION OF THE FLEXOR PEDIS PERFORATUS 
TENDON. 


Lit.: Hagen, Thier. Mitth. 1867, p. 151. Vogler, ibid., 1872, p. 160. 
Giinther, Exterieur u. Myologie. 


The flexor pedis perforatus tendon, at the spot where it plays over 
the point of the hock, is expanded into a kind of cap. <A short but 
powerful prolongation of the tendon is inserted into the os calcis on 
either side, just in front of the point of insertion of the tendo Achillis, 
which prevents the tendon slipping off the tuberosity of the calcis bone. 
Sometimes one of these ligaments is ruptured, allowing the tendon to 
glide off the calcis towards the opposite side, and to le on the lateral 
surface of the hock. Gjiinther describes a case of dislocation towards 
the inner side; others, amongst them Stockfleth, Bayer, Hagen, Vogler, 
and Moller, have seen it occur outwardly. The direction depends, of 
course, on which attachment is ruptured. As the tendon passes over 
the hock from within outwards, one would expect that the external 
attachment would most frequently suffer, and that dislocation would be 
towards the inner side. On the inner side the tendon either remains 
fixed about half way up the astragalus, or slips down as far as the 
articular prominence of that bone (Giinther). 

Such ruptures occur during heavy work, or follow external injuries 
like kicks, &e. 

Symptoms.—Displacement is rarely followed by severe lameness ; 
the gait is insecure, weak, and rolling (Giinther), and the animal 
appears to have lost full control of the limb. Standing behind the 
horse, the tendon is seen to glide off the tuber calcanei every time the 
hock is extended, and often to return to its normal position when the 
joint is flexed. When the tendon and neighbouring parts are inflamed 
from kicks, &e., the swelling and pain produce a more marked lameness, 
otherwise movement is only mechanically interfered with. While the 
horse stands on the limb, the lower joints show dorsal flexion, conse- 
quent on relaxation of the flexor pedis perforatus, but the hock-joint is 
extended. 

Prognosis.—Recovery is impossible, because the hock cannot be 
fixed for a sufficient length of time to allow the ends of the ruptured 
ligament to unite. Even though, by flexing the thigh, the tendon can 
be replaced, it again slips out of position the next time the thigh is ex- 
tended or weight placed on the limb. Asarule, little improvement can be 


654 DISEASES OF THE METATARSUS. 


expected, and only in cases where inflammation produces local pain does 
the lameness even diminish. 

As a rule, the animals can only do light walking-work, and are quite 
useless for riding or for heavy draught. 

Treatment is confined to checking the local inflammation sometimes 
seen in recent cases. 


E. Diseases of the Metatarsus. 


DISEASES OF THE TENDONS AND TENDON SHEATHS 
IN THE TARSAL AND METATARSAL REGIONS. 


In the horse, the tendon sheaths sometimes become distended both in 
the hock and metatarsal regions, preducing conditions of great practical . 
importance. Amongst the most important are— 

(a) Distension of the tendon sheath of the flexor pedis perforans 
(deep flexor of the digit) produces a swelling on the inner and posterior 
surface of the hock-joint. The sheath begins somewhat above the 
inner malleolus, passes downwards over the capsule of the joint, with 
which it sometimes communicates (Franck), then becomes somewhat 
flattened, and follows the course of the tendon, to appear at the 
posterior surface of the joint, about two inches below which it ends 
(fiy. 156, 0). 

Disease of this sheath is rather frequent in the horse, and sometimes 
produces a hemispherical swelling as large as a child’s head. Sometimes 
it attacks both legs simultaneously, without causing much lameness 
(fig. 137). It may in time decrease and even entirely disappear, especi- 
ally under proper treatment. In other cases, the portion of the sheath 
lying at the back of the hock-joint becomes enlarged, and may be mis- 
taken for curb, for which reason it has been called curb-gall or soft 
curb (Giinther). 

In other cases acute inflammation sets in. Bruises and injuries may 
cause septic tendo-vaginitis, accompanied by severe lameness and high 
fever, which sometimes proves fatal. The condition is even more 
dangerous if inflammation extend to the joint (p. 626), or, as in Johne’s 
case, produce necrosis of the flexor pedis perforans tendon, followed by 
rupture. Aseptic inflammation of this sheath is often caused by draw- 
ing heavy loads, and is therefore commonest in draught-horses. 

Prognosis.—Infectious inflammation of this tendon sheath forms no 
exception to the general rule, and prognosis is therefore unfavourable, 


DISEASES OF THE TENDONS AND TENDON SHEATHS. 655 


though I have seen cases recover. The higher the fever and the 
greater the pain, the less probable is recovery. In aseptic disease, the 
degree of lameness is a fairly safe guide. Occasionally the local 


Fie. 136. — Tendon sheaths and burse of 
the hock-joint seen from within (semi- 
diagrammatic)—(a) bursa of the flexor 
accessorius tendon; (4) bursa of the flexor 
pedis perforans tendon; (c) bursa of the 
internal division of the flexor metatarsi 
tendon ; (d) bursa calcanea ; (e) bursa of 
the flexor pedis perforatus on the point 
of the hock, 


Fig. 135.—Tendon sheaths and burs of the hind- 
limb of the horse, seen from without (semi- 
diagrammatic) —- (a) trochanteric bursa; (0) 
prepatellar, bursa ; (ce) bursa ot the extensor 
pedis ; (@) bursa calcanea ; (e) bursa of the 
flexor pedis perforatus tendon ; (/) bursa of 
the peroneus tendon. 


inflammation becomes so intense that the animal rests the leg con- 
tinuously, and throws so much weight on the other foot as to induce 
laminitis; but this is rare, and more frequently the animals are able to 


656 DISEASES OF. THE METATARSUS. 


work, despite considerable swelling. Complete absorption can scarcely 
be expected, though in exceptional cases it occurs in three to six 
months. 

Treatment depends on the nature of the injury. Wounds near 
the tendon sheaths, like wounds of the joint, require the strictest anti- 
septic precautions. In infectious inflammation, the tendon sheath may 
advantageously be washed out with disinfectants. 

Acute aseptic inflammation usually calls for nothing more than 
the ordinary soothing treatment; but in cases 
where this has proved insufficient, I have seen 
excellent results from freely firing in lines. 
Chronic dropsy of the bursa is also benefited by 
the cautery; and in these cases I have found 
repeated withdrawal of contents, by means of 
Pravaz’s syringe, sometimes very efficacious. The 
operation may be repeated every four to six 
weeks, though careful antisepsis is required to 
prevent infection of the tendon sheath. 

(b) Distension of the extensor tendon sheath 
in the hock region. The tendon of the peroneus 
muscle is provided, opposite the lower margin of 
the hock-joint and on its outer aspect, with a small 
sheath, which, when over-distended, forms an 
elastic swelling, varying from the size of a wal- 
nut to that of a man’s fist. The condition is 
oftenest seen in riding-horses, caused when the 
animal is thrown on its haunches. As lameness 
is not a prominent symptom, the swelling is 
Beis eae eA rarely treated, and only forms a blemish. 

burs of flexor tendons If necessary, the parts may be blistered and 

pies ee fired in lines. Operation is not dangerous, 

though, when suppuration occurs, considerable 
thickening always remains, and the remedy becomes worse than the 
disease, because everyone knows that the latter is of little importance. 

(c) Distension of the sheath of the flexor pedis perforatus. At the 
spot where the flexor pedis perforatus comes in contact with the 
posterior or upper surface of the tendo Achillis, and about four inches 
above the point of the hock, a tendon sheath begins, which extends 
downwards, and sometimes becomes the seat of extensive swelling. I 
have often seen it in coarse-bred horses, sometimes affecting both limbs, 
and forming above the tuber calcanei a longish swelling as large as a 
child’s head, divided into two parts by the tendo Achillis and the 
perforatus tendon. The position and size of the swelling are best 


DISEASES OF THE TENDONS AND TENDON SHEATHS. 657 


recognised by viewing the animal from behind. Sometimes the swell- 
ing is more marked on the inner, sometimes on the outer surface of the 
joint; the tendon can be distinctly felt in the depths. The swelling 
generally results from chronic bursitis, develops slowly, and seldom 
causes lameness. 

For this reason prognosis is favourable, though the condition itself 
may prove extremely obstinate. Success sometimes follows repeated 
evacuation of the contents every three or four weeks. The operation is 
not without danger, and I lost a horse from infectious imftlamma- 
tion of the tendon sheath. Line-firing may 
diminish, though it seldom completely removes 
the swelling. 

(d) The tendon sheaths in the metatarsal 
and phalangeal regions become distended in 
a similar way to those of the fore-limb, 
though the bursa of the extensor pedis, 
which hes in front of the metatarsus, at the 
fetlock-joint, is more often affected than in 
the fore-limb. It gives rise to a well-marked 
swelling, sometimes as large as a child’s head, 
which, though it does not cause lameness, 
greatly impairs the animal’s appearance, and 
sometimes leads to inflammation of the skin. 
I have often opened these swellings, and 
always found them to contain large quantities 
of fibrinous clot, which, however, cannot be 
detected by palpation. This explaims why 
neither blistering nor firing, nor even extrac- 
tion of the fluid contents, is successful, and 
why operation and removal of the organised 
contents are alone of use. Such operation Fic. 138,—Distension of sheath of 
- : . flexor pedis perforatus—(from a 
is quite safe, even when suppuration occurs. _ photograph). 

Recovery follows, after strict asepsis, 

though considerable thickening may be left. When the swelling 
is extensive, a portion of the distended bursa and skin covering 
it may be removed, and the edges of the wound brought carefully 
together. The operation is conducted as described on p. 497. 

(e) Distension of the sesamoid sheath is commoner in the hind- than 
in the front-limb. As a rule, it is caused by irritation, and appears 
slowly. Lameness, which is seldom troublesome, is rarely seen unless the 
flexor tendons are affected; but the swelling forms a blemish difficult to 
remove. Careful local examination shows which condition is present, 


and should always be resorted to, as the lameness often disappears after 
AES 


658 DISEASES OF THE METATARSUS. 


long rest. Provided the swelling has not long been in existence, the 
parts should be tightly bandaged after work; massage often removes 
swelling in young horses, but firing is surer. The swelling should never 
be incised, for the result is often fatal. Removal of contents by Pravaz’s 
syringe, or by trochar, is only of temporary benefit; nor does injection 
of iodine prevent resecretion, which may occur in a few minutes. The 
precautions to be observed in opening these swellings with the actual 
cautery are given on p. 497. 

In the hind-limbs such enlargements often become indurated, 2.c., the 


tendon sheath is chronically thickened, sometimes to the extent of $ or 


3 of aninch. Asa rule, the flexor tendons are diseased, and there is 
lameness, which may become severe after hard work. It is best seen 
when weight is placed on the lmb, and is accompanied by plantar 
flexion of the phalanges. The swellings are hard and immovable, the 
flexor tendons can scarcely be felt through them, and when the parts 
are firmly pressed the animal shows pain. 

Such enlargements are most troublesome in riding- and draught-horses, 
though, in other animals, they interfere with usefulness and sometimes 
render the horse unworkable ; they are little amenable to treatment. When 
recent, 7.¢., not more thana few weeks old, they may be diminished by the 
use of bandages, blisters, or firmg, but later the sole means of removing the 
lameness is section of the tibial nerve. I have often had good results 
from this operation, but occasionally the flexor tendons became elongated, 
producing flexion of the hock; in one case this was so marked as to 
prevent the animal being used. Hendricks has had similar results. 

I have often seen chronic suppuration in the tendon sheaths produced 
by external violence. Acute septic inflammation is here particularly 
dangerous, whether caused by mechanical injury of the tendon sheaths, 
or by extension to them of other inflammatory processes. Thus 
suppuration may be caused either by cellulitis, resulting from incised 
wounds, or by cutaneous inflammation accompanying gangrene. 

Diagnosis is sometimes difficult because of the swelling which 
always exists around the bursa. One symptom which always accompanies 
inflammation of the tendon sheath should, therefore, be particularly 
remembered, viz., lifting of the hmb, as in gonitis; in this case, however, 
the foot is advanced further in the direction of the front-foot of the 
same side (fig. 139). I have repeatedly seen this peculiar position, and 
consider it absolutely pathognomonic. Accurate diagnosis is very 
important, because treatment is scarcely advisable, except in valuable 
horses. The treatment, which consists in daily cleansing of the parts, 
washing out with disinfectants, and bandaging, is not often successful, 
laminitis generally occurring in the other foot, and carrying off the 
animal. In a few instances, however, I have seen recovery, though the 


DISEASES OF THE TENDONS AND TENDON SHEATHS. 659 


fetlock usually remains somewhat upright, and two cases, recently 
described by Wittlinger, show that perfect recovery is possible, even 
after acute suppurative inflammation of the tendon sheaths. 

Chronic septic inflammation of these sheaths is also seen in the 
horse. The clinical symptoms are not well marked; swelling is 
moderate, because the connective tissue surrounding the tendon sheath 
is not much affected. Pain is not so great as in the acute disease, but 
a turbid synovia, mixed with pus, is continually discharged. Very great 


Fic. 139.—Position of the limb, in infectious inflammation of the flexor pedis perforatus 
sheath in the fetlock region—(from a photograph). 


difficulty is found in closing the wound in the tendon sheath : healing is 
almost always prolonged, and often the horse is found one morning 
standing almost on its fetlock, and with the toe pointed upwards, the 
flexor pedis perforans tendon being ruptured. The condition is, in my 
judgment, incurable. The ends of the tendon, being necrotic, are 
incapable of regenerative processes; on section, the necrotic part is 
distinguished by its yellow, opaque appearance, from the glistening, 
satin-like, healthy portions. Not infrequently demarcation has com- 
menced, and can be detected by the vascular condition of the parts 


660 DISEASES OF THE METATARSUS. 


bordering on the necrotic portion. If the flexor pedis perforans is 
ruptured the animal should be slaughtered. 

Rupture of the flexor pedis perforatus is caused in a similar way, and 
also follows wounds of the metatarsus. The position of the phalanges 
is then less altered, though the fetlock is somewhat more oblique than 
usual. When the horse moves, the phalangeal joints are seen to be 
unusually Jax; they dangle from 
side to side each time the foot is 
advanced—an unmistakable symp- 
tom of this rupture. 

Uncomplicated rupture of the 
flexor pedis perforatus is less grave, 
the tendon often unites, and the 
usefulness of the limb may be fully 
restored. Treatment follows general 
principles (p. 505). 

A horse was stabbed in the heel 
of the right hind-foot with a manure 
fork, and severe lameness at once 
set in. Being called the same day, 
I thoroughly cleansed the wound, 
bathed the foot in creolin solution, 
and in the evening applied a large 
antiseptic dressing. The skin wound 
healed by primary intention, and 
pain diminished, though lameness 
continued. I therefore employed 
for the next few days, moist warm 
applications, but the case did 

Fie. 140.—Rupture of the flexor pedis per- not improve. The animal was 
forans tendon—(from a photograph). then regularly exercised, which 
ereatly diminished the lameness, 
until one day pain returned in an unusually severe form, and the sheath 
of the flexor tendon was found to be greatly distended just above the 
fetlock-joint, and very painful on pressure. The parts were again 
bathed, and hot poultices applied, but, as they gave no relief, blistering 
was resorted to. There was, however, little improvement, the swelling 
persisting. The sheath of the tendon was then opened under antiseptic 
precautions, allowing of the escape of purulent fluid, which could only 
be distinguished from ordinary pus microscopically, but which was then 
found to contain no micro-organisms. The examination was made by 
various persons, and every precaution was taken to avoid error. 
This seemed to show that purulent tendovaginitis had existed, 


STRINGHALT. 661 


doubtless as a result of the wound, and yet the pus contained no micro- 
parasites. Whether parasites had never been present, 7.¢., suppuration 
had been brought about without infection, or whether the pus cocei had 
perished, I am unable to say. One peculiarity of this case was, however, 
very remarkable, viz., that in spite of the great distension of the tendon 
sheath the connective tissue around it had never become the seat of 
cellulitis. In purulent tendovaginitis the tissues round the tendon 
sheath are almost always attacked with active cellulitis, and in conse- 
quence are more or less markedly swollen. 

The case also shows that pus may be produced without infection 
though it is, in my experience, unique in this respect. 


? 


Il.—STRINGHALT. 


Lit.: Sewell u. Spooner, Gurlt u. Hertwig. 5, p.295. Falke, Krankh. 
der Hausthiere. p. 272. Renner, Abhandlungen u. s. w. Jena, 1844. 
Bocear, Her. Rep. 8, p. 172. Foélen, ibid., 15, p..77. Goubawx, 
ibid, p. 268. Gitnther, Exterieur. p. 364. Schrader, Gurlt u. 
Hertwig. 7, p. 490. Dieckerhoff, Der Spat. p. 169. Bassi, Jahrb. 
1885, p. 103. Siedamgrotzky, Dresd. Ber. 1875, p. 50. Chel- 
chowsky, Hufschmied. 4, p. 74. Hales, Gurlt u. Hertwig. 7, p. 108. 
Ascheberg, ibid, 16, p. 414. Haubner, Dresd. Ber. 1858, p. 57. 
Palat, Her. Rep. 26, p. 254. Wittlinger, B. T. W. 1892, p. 172, 


The term “stringhalt” has been applied since olden times to that 
peculiar involuntary movement of one or both hind-limbs, in which the 
affected member is flexed with excessive suddenness, and lifted abnormally 
high, whilst it still continues able to support the animal, and otherwise 
allows of movement in the usual way. Sometimes the peculiar move- 
ment is seen while trotting, sometimes also while walking; as a rule, 
it persists in spite of work; sometimes it disappears for a time, but 
generally returns with rest; often it is only noticeable when the animal 
is turned in small circles. 

The immediate cause of this interference with movement has been 
sought for in different organs, but up to the present has not been clearly 
identified. Abildgaard considers the condition to be an “affection” of 
the muscles and nerves of the hind-limb. Villate thinks it is caused 
by abnormal development of the spine (Griite) of the tibia. Sewell and 
Spooner, when making the post-mortem of a horse affected with string- 
halt, found that the point of origin of the ischiatic nerve in the spinal 
cord was infiltrated with blood, and regarded this as the cause of the 
disease. Falke identified the condition with sciatica in man. Renner 


662 DISEASES OF THE HIND-LIMB. 


took it to be due to chronic inflammation of the ischiatic nerve, whilst 
Hochstetter attributed it to straightness of the hocks; Boccar sought the 
cause in contraction of the peroneus, after discovering that the condition 
disappeared on section of its tendon. Foelen and many others agreed 
with him, and reported favourable results from dividing the tendon. 
Goubaux, on the other hand, directed attention to the joints, especially 
to the hip-joint, which in his view became chronically inflamed in 
stringhalt. 

Up to this time investigators had viewed the condition as due to a 
single cause, but K. and F. Giinther divided it into the following 
Varieties :—— 

(1) Spavin-stringhalt, .¢., stringhalt caused by spavin. 

(2) False stringhalt, produced by pain in any region of the limb; 
and 

(3) True or involuntary stringhalt, due to irregularities in the 
functions of the antagonistic nerves of the lumbar and pelvic plexuses. 
Giinther states having frequently seen hyperemia of the ischiatic nerve 
without stringhalt, but says that stringhalt is sometimes accompanied 
by relaxation in the semitendinosus muscle. K. and F. Giinther first 
drew attention to the connection between stringhalt and certain surgical 
diseases—as, for instance, those of the foot. 

In a similar way, Dieckerhoff divided the disease into— 

(1) True idiopathic stringhalt, which he considered due to contraction 
in the fascize of the thigh. 

(2) Complicated stringhalt, accompanying spavin, curb, ring-bone, and 
other diseases. 

(3) Symptomatic stringhalt, consequent on inflammation in the pedal 
or other regions of the limb. 

Bassi differentiated two forms :— 

(1) True stringhalt, caused by interference with the movement of the 
patella ; and 

(2) False stringhalt, caused by a number of other diseases, such as 
spavin, &e., but principally by contraction in the tensor fascie late, in 
the fascia of the thigh, and in the extensor pedis tendon. 

I myself divide stringhalt into idiopathic and symptomatic forms, and 
include in the first. those cases due to no visible cause ; and in the second, 
those where a cause can be detected. 

Whatever be the cause, it is quite certain that the movement is 
involuntary. It must, therefore, be dependent on some mechanical 
action, ¢.g., contraction of the fascie, of the tendons, or of the ligaments, 
or on reflex action, originating either directly in the spinal cord, or 
through irritation of peripheral nerves, 7.¢., interference with innervation. 
I think both causes may at times be effective, though, as a rule, neither 


VARIETIES AND CAUSES OF STRINGHALT. 663 


can be clinically identified. Amongst mechanical causes—for we may 
also term the first variety mechanical—changes in the extensor pedis 
tendon, the fascia of the thigh, and the patella or its ligaments deserve 
special attention. Even though Siedamgrotzky’s attempt to produce 
contraction by exposing the peroneus tendon, and thrusting a piece of 
wood under it, gave negative results, yet numerous experiments, among 
which I may number my own, show that section of this tendon often 
removes stringhalt. But the fact that it sometimes fails shows that 
stringhalt is not due to a single cause. Amongst the others must be 
included contraction of the fascia of the thigh, referred to by Diecker- 
hoff, of the tensor fasciz latee, much spoken of by Hertwig, and of the 
lateral ligament of the patella, mentioned by Bassi. I have no practical 
experience of the last, though I have repeatedly seen stringhalt-lke 
movement in horses suffermg from habitual upward luxation of the 
patella (p. 602); and as in these cases the form of the upper surface 
of the trochlea of the femur possibly plays a certain part (p. 603), 
division of the inner Jateral ligament of the patella may prove of service. 
I have several times divided the fascia of the thigh when division of the 
peroneus tendon had proved insufficient, but have rarely seen real im- 
provement. When section of the tendon is unsuccessful, that of the 
fascia always fails. Sometimes the whole of these various structures 
may be divided without affording relief, in which case the condition is 
probably reflex, and either resembles chorea minor of man, or is due to 
disturbance in the co-ordination of movement, i.c., ataxia (p. 436). 
Symptomatic stringhalt following disease of the foot, such as pressure 
on the lateral cartilage, is most easily explained by regarding the reflex 
act as originating in these parts. 

The results of peripheral irritation chietly affect the flexor muscles, 
because the extensors act principally whilst weight is thrown on the 
limb, and their contraction is therefore more easily controlled. Possibly 
the central disturbance manifested by the affection of certain groups of 
muscles may sometimes be of a secondary character, the peripheral irri- 
tation in time causing changes in the central nervous matter. At any 
rate, temporary disease of parts removed from the centre sometimes pro- 
duces chronic stringhalt. Thus, after juries to the foot, such as pricks, 
treads, or laminitis, wounds of the hock, fractures of the external angle 
of the ilium (Haubner), or even after the application of a blister, one 
sometimes sees stringhalt, which continues despite removal of the original 
irritation. Ascheberg saw stringhalt result from tetanus. In such 
cases one might imagine that the peripheral irritation had produced per- 
manent interference with innervation, and that the oft-quoted dictum of 
Jordanus Ruffus, “ Cessante causa cessat effectus,’ no longer applied. The 
future alone can explain this condition. 


664 DISEASES OF THE HIND-LIMB. 


Temporary stringhalt accompanies various conditions, but especially 
injuries to the foot ; Wittlinger saw it after suppuration in the tendon 
sheaths of the fetlock region. 

The course of the disease varies greatly. The symptomatic form 
accompanying sprain develops slowly, and sometimes disappears at the 
same time as the spavin lameness. Stringhalt often develops rapidly 
after external injury ; some cases appear suddenly without visible cause, 
and are attributed (in my opinion erroneously) to catching cold. 

Prognosis is uncertain. The most favourable cases are those which 
have a visible cause, and which are of recent origin; such often cease as 
soon as the local mischief disappears. In symptomatic stringhalt, the 
prognosis chiefly depends on the nature of the primary disease, though 
it should not be forgotten that the interference with movement some- 
times becomes permanent. In the absence of all apparent cause, 
prognosis is very uncertain, because it is never possible to say whether 
the methods of treatment at present known may or may not be success- 
ful, and treatment, therefore, becomes experimental. 

Treatment.—The operation which has proved most generally suc- 
cessful in idiopathic stringhalt is tenotomy. It has one qualification, 
that, namely, of being easily performed. I operate in the standing 
position, and proceed as follows :— 

The hind-foot is lifted as in shoeing, and the hair having been 
shaved from a point close below the hock, on the outer surface of 
the metatarsus, where the tendon in question is almost subcutaneous, 
the skin is washed and rinsed with carbolic solution, A twitch 
is then applied, and an incision made with a pointed bistoury 
or scalpel, immediately over the tendon and parallel to it. To 
penetrate the fascia lying under the skin, the point of the knife is carried 
right into the tendon. A slender blunt-pointed tenotome is then passed 
under the tendon, 7.c., between it and the bone, and the cutting edge 
being directed upwards, the tendon is divided. Palpation of the parts 
will show whether section is complete. Bleeding being usually slight, 
the wound may be rinsed with a disinfectant and a dressing at once 
applied, under which healing will in four to five days be so far 
advanced as to allow of the wound being left open. If the instru- 
ments, the operator's hands, and the dressing be thoroughly sterile, 
healing happens by primary intention ; and even when suppuration occurs 
though the point of operation is left somewhat thickened, no further 
ill effect is incurred. Complete recovery may follow either at once, or 
be postponed for some days, or even weeks. 

I recommend resting the animal for eight to fourteen days after 
operation, and then turning it loose in a_ box, or moving it slowly on 
soft ground. 


OPERATIONS FOR STRINGHALT. 665 


I have several times divided the fascia of the thigh just in front 
of its union with the extensor pedis (Dieckerhoff's method) whilst the 
animal was standing, but restless horses should be cast for either opera- 
tion. After section of the peroneus, the tenotome is passed under the 
fascia, which is divided from within outwards, and a dressing applied 
reaching down as far as the fetlock-joint, to prevent slipping off. The 
after-treatment is as above stated. 

Hertwig recommended cutting through the tensor vagine femoris, 
about 3 or 4 inches below the external angle of the ium. This opera- 
tion is more difficult, and is often followed by burrowing of pus, asepsis 
being almost impossible. The result is doubtful; cases are said to 
have been cured, though in one, which was successful, the incision was 
only carried through the skin on account of bleeding. 

Bassi suggests dividing the internal lateral ligament of the patella. 
I have not yet tried this operation in stringhalt, but experiments show 
that it is not easy, on account of the hgament in question being so ill 
defined. The method is worth a trial in cases where the cause is 
thought to he in the stifle-joimt (p. 602). 

Starting from the hypothesis that in one case stringhalt was produced 
by inflammation of sensory nerves, I divided the tibial nerve, but 
without success. Failure also followed subcutaneous injections of 
morphine and veratrine, and section of the internal insertion of the 
flexor metatarsi muscle (Siedamegrotzky). 

A condition in some respects resembling stringhalt has been called 
“straw cramp.” The animals, while standing on straw, show peculiar 
symptoms, particularly when turning round. The affected hind-limb is 
lifted convulsively, sometimes so violently that the animal falls. 
Painful conditions like inflammation in the skin of the heel or in the 
bend of the hock produce similar symptoms, which are then, of course, 
easily explained. But in some horses, particularly in coarse-bred 
animals like Holsteiners, the attacks occur without any visible cause. 
The most careful examination fails to detect pain in the affected limb. 
In such cases tibial neurectomy produces no particular improvement. 
Similar symptoms are seen in luxation of the patella (p. 602). 

In another horse I had under observation, a similar effect was pro- 
duced by irritation of the ear. If the finger were introduced into either 
ear, the hind-limb of the same side was lifted and carried forward in 
an almost horizontal direction, the movement being convulsive. Though 
the condition only lasted a few seconds, the horse was quite useless, 
because the pressure of the bridle or halter on the ear immediately 
induced fresh attacks. Not the slightest anatomical change could be 
detected in the ears. 


666 DISEASES OF THE LIMBS. 


IIl.—INJURIES PRODUCED BY STRIKING (INTERFERING) 
AND THEIR COMPLICATIONS. 


Striking or interfermg is the term used to describe the injury 
inflicted by the horse’s foot on the opposite leg during work. It occurs 
oftenest in the hind-limbs, especially when the animal is trotted, the 
inner surface of the fetlock-joint is usually struck by the hoof of the 
opposite side; less frequently the coronet is the seat of injury. In the 
fore-limbs, striking sometimes affects the carpus and metacarpus, par- 
ticularly in badly-bred horses. 

Interfering is serious, because the horse can never be depended on; 
riding-horses may stumble in consequence of severely bruising the 
plantar nerve, which lies on the inside of the fetlock-joint, and is easily 
injured. But such injuries are also interesting to the surgeon, because 
they sometimes form the origin of disease processes of a grave character. 
The most frequent of these is cellulitis, which either extends in the 
subeutis, or may seize on the subfascial connective tissue, and, 
taking a chronic course, continually suppurate. In other cases, pus 
may break into the tendon sheaths of the flexor pedis pertorans, 
or into the cavity of the fetlock-joint, and produce incurable 
complications. Sometimes cutaneous gangrene and chronic inflamma- 
tion of the cutis result. Finally, wounds from striking may be followed 
by grease, &e., as stated on p. 569. 

Symptoms.—The cause of these injuries is indicated by their 
position on the fetlock-joint, coronet, metacarpus, or knee. Sometimes 
the hair is only roughened or rubbed off, sometimes the skin is 
excoriated, its surface being covered with blood or discharge, but more 
often there is a wound penetrating the cutis. Provided injury be 
confined to the surface of the skin, there is little or no pain, swelling, or 
lameness, and animals continue at work. 

But immediately inflammation extends to the subeutis, a circum- 
scribed swelling develops, which is followed by suppuration. The pain 
becomes severe, the animal goes very lame, and sometimes it is unable 
to bear weight on the limb. In extreme cases the entire body is wet 
with perspiration, and fever runs high. In such cases the plantar nerve 
may be inflamed, though more frequently the symptoms are due to 
cellulitis in the subfascial tissues. The condition then becomes very 
erave, on account of the possibility of pus breaking into the fetlock-joint 
or sheath of the flexor pedis perforans. When the tendon sheath is 
attacked, the limb is held as described on p. 658, the swelling extends 


e 


INJURIES PRODUCED BY STRIKING AND THEI COMPLICATIONS. 667 


upwards over the metatarsus or metacarpus, and any attempt to flex the 
lower joints of the limb produces great pain. There is almost always 
fever. 

The injury may be followed by diffuse subcutaneous cellulitis, in 
which case the swelling extends to the hock, or to the knee, invad- 
ing more particularly the inner surface of the limb. The lymph 
vessels are generally swollen, the lymph glands enlarged, and fever is 
present. This condition, which may also be caused by other injuries, is 
termed lymphangitis. The vena saphena may be involved, and throm- 
bosis result, but in my experience this complication is not so frequent as 
was formerly supposed; it seems probable that swelling of the lymph 
vessels was mistaken for thrombosis. The condition has been confused 
with erysipelas, from which it is distinguished by the fact that the sub- 
cutaneous connective tissue, and not the cutis, is the seat of disease. 

When accompanied by localised necrosis of skin, the affection becomes 
identical with gangrenous grease, dermatitis gangrenosa (p. 566). Finally, 
wounds caused by striking may produce a chronic dermatitis, already 
described as “ verrucous grease” (p. 569). Wounds due to brushing, 
when not infected, generally heal rapidly, unless the injury is 
repeated. 

Course.— Diffuse inflammation of the subcutis in horses is usually 
mild. The swelling appears suddenly, and increases for two to three days, 
during which pain is marked, and some fever exists; after the swelling, 
pain and fever then begin to diminish, and in about eight to ten days 
the animal is convalescent. Permanent blemishes are rare, but under 
some circumstances, especially if the cellulitis has been caused by infec- 
tion with a particularly virulent micro-organism, abscesses form in the 
upper parts of the limb, severe fever sets in, septicemia or pyemia 
develops, and soon leads to death. Luckily, such complications are not 
frequent. 

Subfascial cellulitis is graver, either when confined to the fetlock or 
coronet, or when appearing in a diffuse form. In the first case a 
circumscribed, very painful swelling develops around the fetlock-joint, 
and after eight to fourteen days, or sometimes longer, breaks and dis- 
charges a very offensive pus, mixed with fragments of necrotic tissue ; 
the pain then diminishes, and recovery occurs. Sometimes the abscess 
re-forms, and the disease may then last for a longer time. 

But if, instead of discharging outwardly, the abscess breaks into the 
fetlock-joint, purulent inflammation of the joint-cavity occurs, the pain 
and fever increase, no weight whatever can be borne on the limb, and 
even slight rotary movements of the foot produce severe suffering. The 
condition is then incurable. Injuries to the coronet may in a similar 
way be followed by purulent inflammation of the pedal or coronet joints, 


668 DISEASES OF THE LIMBS. 


and cellulitis extend to the sheaths of the flexor pedis perforans and 
perforatus tendons, with equally fatal results. 

The course which skin gangrene takes depends on the amount of 
surface implicated. Extension of necrosis inwards is especially dangerous, 
because the parts above mentioned may be attacked as in purulent 
cellulitis. (For complications resulting from the verrucous form of 
grease, compare with p. 569.) 

Sometimes fistulee form, the granulations which follow perforation of 
the abscess uniting again, whilst necrotic pieces of tissue are left in the 
depths. The subcutaneous fascia then plays a similar part to the lateral 
cartilage in ordinary quittor. Such fistule are often extremely 
troublesome. 

Causes.—Faulty conformation and large flat hoofs are the principal 
causes of striking. The animal may stand with the limbs too close 
together, or may turn the toes outwards. Both these peculiarities are 
accompanied by faulty action, which predisposes to the injury mentioned. 
Striking is also favoured by travelling on rough ground, and by exhaustion. 
Young horses often brush or strike while being broken in, or if, when 
driven, they are reined-up too short, especially before they become 
accustomed to work on paved streets. One of the most frequent causes 
of striking is, however, the mode of shoeing, the principal fault consisting 
in irregular paring of the hoof. If the inner wall be lowered and the 
outer left too long, the fetlock-joint is thrust towards the middle line of 
the body when weight is thrown on the limb, and may be injured by 
the opposite foot. Many farriers still favour the idea that striking is 
prevented by lowering the inner wall, and thus perpetuate one of the 
most frequent causes of striking. Bad fitting, allowing the inner edge 
of the shoe to project beyond the wall of the foot, or leaving the 
clenches too long, may also produce the same result; but, in compari- 
son with unskilful paring of the hoof, these only play a subordinate 
part. 

Treatment.—To prevent striking, special attention should be paid 
to the shoeing, and the application of a so-called “cutting shoe” will be 
found very useful, especially on the hind-feet. | After lowering the 
outer wall sufficiently to, at least, prevent it meeting the ground sooner 
than the inner, the edge of the latter is somewhat rounded off, and a 
short, heel-cutting shoe applied. Should the inner wall be too low, 
it must be raised by placing leather, &c., under the shoe. 

Injuries produced by striking must be treated according to their 
character. Complications are best prevented by carefully cleansing the 
wound, and smearing it with tar or other antiseptic. Such precautions 
are particularly necessary in winter, and when the roads are dirty 
(compare p. 566). Especial care is required if the skin be per- 


INJURIES PRODUCED BY STRIKING AND THEIR COMPLICATIONS. 669 


forated, as the entrance of infective material into the subcutis then is 
greatly favoured. 

When suppuration is already established, the first precaution must be 
to thoroughly cleanse and disinfect the wound, so as to prevent further 
extension. The after-treatment is based on general principles. Cold 
applications are contra-indicated, and should be replaced by moist warmth 
in the form of warm baths containing a disinfectant. If cellulitis extend 
further upwards, the limb should be enveloped in straw, kept saturated 
with disinfectants, or when little assistance is available, the leg may be 
smeared with grey ointment. Immediately pain diminishes and 
swelling commences to recede, slow exercise should be given to hasten 
resorption. 

Double precautions are required in subfascial inflammation. When 
located in the fetlock or near the tendon sheath, permanent lukewarm 
baths, containing disinfectants such as creolin, carbolic, &c., are indicated, 
and immediately fluctuation can be detected, the swelling should be 
opened, though due care must be exercised to avoid injuring large blood- 
vessels and nerves, or opening the capsule of the joint or sheath of the 
tendons. When the joint or the tendon sheath is implicated operation 
is better avoided, because in such cases no good ean result, and the 
owner is apt to conclude that the use of the knife was responsible for 
the death. 

Swelling in the soft tissues around the coronet is relieved by thinning 
the horn wall. Gangrene and the verrucous form of grease are treated 
on the lines indicated when speaking of these conditions. Rings and 
boots, often recommended against striking, are seldom of much value. 
Some horses are so apt to strike that not even the most careful shoe- 
ing 1s sufficient to prevent them injuring themselves, and in such eases 
boots may be tried. They require, however, to be so fashioned as not to 
be displaced if struck, nor cause injuries if tightly buckled. The best 
form of boot contains a metal spring exactly responding to the oval form 
of the fetlock, and softly lined. 

The straw and india-rubber rings often used in draught-horses force 
the animal to move with the feet further apart, but have no permanent 
effect on the action, and as soon as they are removed the animal strikes 


as before. 


F. Diseases of the Hoof. 


Though the horse’s hoof and the claws of dogs and oxen are physiologi- 
cially homologous, and in structure practically identical, yet the diseases 
to which they are subject vary in many points in consequence of the 


670 DISEASES OF THE HOOF. 


different influences to which they are exposed. The horse’s hoof being 
more liable to injury than the ruminant’s claws, becomes diseased not 
only more frequently, but also in different ways. The claws of 
carnivora again play quite a different part to the hoof and claws of 
herbivora. 

It may, therefore, be well to first turn our attention to the diseases 
of the hoof, especially as they have been more carefully studied. As I 
have already published a special work on diseases of the feet, I confine 
myself here to shortly considering such of the inflammatory processes in 
the hoof as have a direct bearing on veterinary practice. 


(a) Acute Inflammation of the Podophyllous Membrane. 
Pododermatitis Acuta. 


Acute inflammation of the podophyllous membrane is, with few 
exceptions, produced by infection with micro-organisms, and in many 
cases is accompanied by mechanical injuries. On account of the sensitive 
lamine and sole being bounded on one side by the unyielding horny box, 
and on the other by the os pedis, inflammatory swelling, especially when 
of a septic nature, must be painful, and tend to necrosis. The latter, 
though to some extent antagonised by the great vascularity of the 
parts, nevertheless is not infrequent. 

The surface of the podophyllous membrane possesses a well-developed 
stratum mucosum, formed of numerous layers of epithelium, which, how- 
ever, show no horny character. Not infrequently inflammation is 
entirely confined to this without extending to the corium, a condition 
termed pododermatitis superficialis, in contradistinction to inflammation 
of the deeper-lying structures corresponding to the corium and_ sub- 
cutaneous connective tissue, which is termed pododermatitis parenchy- 
matoso vel profunda. 

(1) Pododermatitis superficialis generally follows exposure of the 
tissue of the rete mucosum and entrance of infectious materal. Let us 
imagine that a nail has penetrated the hoof as far as this layer, 
but has soon been removed. Septic products, &e., penetrate by the 
nail tract as far as the rete mucosum, and may give rise to extended 
inflammation. In such cases we speak of a prick or stab. If, on the 
other hand, the point of entrance was an opening between the wall 
and sole, the condition is termed separation; while if it occur in the 
angle of the heel, we speak of a corn. 

Aseptic inflammation of this tissue, though rare, is seen during 
laminitis and formation of horn tumours, &e. In these cases the rete 


ACUTE INFLAMMATION OF THE PODOPHYLLOUS MEMBRANE. 671 


mucosum is sometimes thickened, as shown in laminitis, by increase in 
width of the white line. The horn produced during inflammation is some- 
times changed in character, stained yellow, or infiltrated with blood (corns). 
Infectious pododermatitis superficialis, on the other hand, is always 
accompanied by suppuration, if we are justified in describing the product 
as pus. Strictly speaking, the thick layers of rete break down under 
the action of the infective material, though exudation certainly 
eecurs in the neighbouring portions of the corium. This explains 
the tendency of the process to remain confined to the surface, and to 
extend along it towards the coronet, or, when the white line is the seat of 
attack, to extend along the thick layers of non-horny rete cells of which 
it consists. 

Though aseptic pododermatitis superficialis ends in resolution or 
chronic thickening, the infectious form is seldom followed by resolution, 
but the pus escapes outwardly, or into the cutis or subcutis, in which it 
produces inflammation. That the broken-down masses of rete do at 
times become absorbed is shown by the spaces occasionally found in the 
horn when cutting out a hoof. The same condition is often seen in 
the claws of herbivora. Sometimes several spaces are discovered one 
above the other, showing that the process has occurred repeatedly, and 
been interrupted by periods of normal horn formation. 

As a rule, septic pododermatitis superficialis ends in perforation 
outwardly, though it often requires surgical assistance. The condition 
having been diagnosed and the horn cut away, a greasy, blackish fluid, 
termed horn pus, escapes, and the animal soon recovers if the parts be 
properly dressed and protected against fresh injury or infection. When, 
however, an artificial opening is not made the process extends, and the 
fluid forces its way along the lamin as far as the coronet, which it 
perforates by thrusting apart the coronary band and commencement of 
the horny wall, appearing, therefore, at the top of the coronet “ between 
hair and hoof.” Inflammation of the lower border of the lamine, or 
periphery of the sensitive sole, generally extends in the direction of the 
white line, and the pus, therefore, tends to escape at the heel. The 
discharge of fluid, grey or blackish material, termed “horn 
pus,” at the coronet or heels, and the absence of marked 
swelling, point to the superficial nature of the attack. 

(2) Pododermatitis parenchymatosa affects the corium or subcutis, 
and is generally associated with disease of the surface, from which it 
may originate, though it also results from deeper injuries, like pricks, 
&e. The podophyllous membrane, or its subcutis, forms the seat of 
acute inflammation, accompanied by exudation, &c.; suppuration almost 
always occurs, the pus being precisely similar in character to that 
formed in the other portions of the skin, and appearing thick, yellow, 


672 DISEASES OF THE HOOF. 


and creamy, while, if its formation is accompanied by necrosis, it may 
be offensive. 

The attack may terminate either in resolution, abscess 
formation, or gangrene. The first rarely happens. Much more 
frequently an abscess forms, similar to those in other positions, and 
leads to either——necrosis of the sensitive sole, purulent cellulitis, or 
septiczemia. 

Necrosis usually depends on inoculation with particularly virulent in- 
fectious substances, though it is favoured by the position of the sensitive 
laminze and sole between the unyielding horn on the one side and the os 
pedis on the other, which causes any considerable swelling to be followed 
by severe compression and interference with circulation. The enzootic 
occurrence of necrosis shows that infection plays an important part, 
though in winter the action of cold may also have a certain action. 
During outbreaks of gangrenous grease one often sees necrosis, the 
dangerous consequences of which are aggravated by the difficulty with 
which the dead tissue separates, and by the readiness with which putre- 
factive products are absorbed and diffused in neighbouring structures, 
leading to inflammation of the lamine or sole, and not infrequently to 
separation and loss of the hoof. Such a termination is preceded by 
excessive pain, fever, and extensive separation at the coronet. It the 
first point involved is one where the sensitive structure les closely in 
contact with the bone (as is the ease over the greater part of the sole 
and wall), necrosis almost always attacks the os pedis. 

Purulent cellulitis can, of course, only occur where inflammation 
seizes on sensitive structures possessing a subcutis like the posterior 
sections of the wall and sole of the coronet and frog. Inflammation 
attacks the connective tissue lying below the coronary band, producing 
a subcoronary inflammation which usually involves one-half of the hoof, 
occasionally the whole, and is recognised by the severe swelling and 
intense pain around the coronet. As pus may burrow into the pedal 
joint, the condition is grave. When occurring about the back of the 
coronet, this form of inflammation generally leads to fistule or quittors, 
which, however, are still more often the result of suppuration in the 
posterior sections of the sensitive sole or wall, where the subcutis is in 
direct contact with the parachondral connective tissue. 

Parenchymatous pododermatitis in the sensitive frog often causes 
purulent cellulitis of the fibro-fatty frog, which is particularly dangerous, 
on account of so often extending to the flexor pedis perforans tendon 
and producing necrosis. Purulent cellulitis of the fibro-fatty frog is 
distinguished by the violent pain shown, especially on dorsal flexion of 
the phalanges. When weight is thrown on the affected limb the parts 
are kept in a condition of excessive volar flexion, the weight is only 


ACUTE INFLAMMATION OF THE PODOPHYLLOUS MEMBRANE. 673 


borne for a moment, and the animal puts down the foot with the front 
of the wall quite upright, or directed downwards and backwards. Swell- 
ing appears in the hollow of the heel; after some time abscesses form 
and break, and not infrequently the flexor pedis perforans becomes 
ruptured. 

(3) Septiceemia oftenest results from necrosis of the sensitive lamin 
or sole, especially when the disease attacks the os pedis. As the pedal 
veins are incapable of collapsing, they offer little resistance to septic 
material penetrating their walls, and reaching the general circulation. 
Spinola drew attention to the frequent connection between necrosis of 
the pedal bone and attacks of septicemia or pyemia. The constant 
and severe pain also causes the patients to lie continually, and, further, 
predisposes to fatal blood-poisoning. 

Causes.—With the exception of laminitis, which will later receive 
attention, acute inflammation of the sensitive structures of the foot 
is due to external injurious influences. Mechanical injuries, like 
bruises, wounds by driven or picked-up nails, or separations of the 
wall allow of irritants reaching the sensitive parts directly ; in other 
eases the injury is thermal, but as the horny box forms so excellent 
a protection against ordinary changes in temperature, and burns from 
hot-fitting of shoes are nowadays rare, such cases are much _ less 
frequent. 

Cold is more frequently injurious, especially when the horn is split. 
Pricks in shoeing or excessive paring of corns may be followed by 
irritation during winter weather, especially if the roads are very dirty. 
Frostbite of the heels has been seen. Chemical substances, like acids, 
employed by farriers in treating disease of the feet, sometimes cause 
inflammation. But by far the most frequent cause of acute inflam- 
mation is infection with pus cocci and other micro-parasites. Normally, 
the soft parts are protected by the horny wall, but as soon as a fissure 
exists, in consequence either of pricks in shoeing, picked-up nails, the 
formation of sand-cracks, or separation of the wall, a way is opened for 
infection, which is especially liable to occur, as the hoof is continually 
covered with dirt containing septic substances. The course and con- 
sequences of the inflammation depend chiefly on the virulence of these 
organisms. 

Diagnosis.—The presence of acute inflammation of the sensitive 
wall or sole may often be detected by the peculiar action of the lame leg. 
As pressure within the hoof is increased when weight is thrown on the 
limb, lameness is most marked during movement, especially over stones, 
though in the stall the foot is often rested. 

The foot must be carefully examined to detect deformities or fissures 
in the horn. The manner of conducting this examination is described 

2U 


674 DISEASES OF THE FOOT. 


in my Diagnostik.  Palpation will detect increased warmth and 
pain. 

Amongst indirect symptoms, increased pulsation and oedema in the 
lower parts of the limb are particularly noteworthy. 

Prognosis.—The degree of danger depends chiefly on the position 
and character of the inflammation. Whilst pododermatitis superficialis 
only proves dangerous in the region of the bars, whence it may seize on 
the fibro-fatty frog, and in general yields readily to treatment, paren- 
chymatous inflammation often leads to severe complications. Any 
disease, affecting the posterior portions of the hoof, is apt to prove 
serious, because of the readiness with which diffuse cellulitis occurs in 
this region, and of the frequency with which it is succeeded by quittor 
formation, disease of the fibro-fatty frog, tendon sheath, or flexor pedis 
perforans tendon. 

As in many instances it is impossible to discover the extent or 
character of the process, the prognosis must be based on indirect indi- 
cations. The principal of these are the degree and duration of the pain. 
As a rule, the more stubborn and severe the lameness the graver the 
prognosis, especially when no direct cause is apparent, as, for example, 
when there is no protrusion of soft tissues. Necrosis and purulent 
cellulitis of the fibro-fatty frog or subcoronary connective tissue are 
exceedingly dangerous. The condition is also very grave when laminitis 
results from continuous standing on the other foot. (p. 557). 

Treatment.—Although treatment follows general principles, yet in 
acute inflammation of the sensitive structures of the foot, certain special 
precautions must be borne in mind. The advice to as far as possible 
remove the cause is eminently applicable here. Aseptic pododermatitis 
seldom calls for more than rest and cold applications in the form of 
poultices or continued irrigation. These soften the horn and permit it 
to yield under the pressure of the soft structures, while they directly 
diminish inflammation. As a precaution, however, after applying 
moisture for long periods, the hoof should be greased, to prevent it com- 
pletely drying again. When lameness disappears, special attention 
must be given to shoeing, 

Superficial inflammation, accompanied by suppuration, is best treated 
by thinning the horn, and allowing the pus to find early exit. An open- 
ing of a quarter to half an inch in circumference is sufficient to allow of 
the thin fluid pus escaping, after which the cavity is washed out, and 
injected with a disinfectant. Foot-baths are sometimes useful, though 
nothing but clean water should be used, unless the addition of a dis- 
infectant be thought advisable. The opening should be covered with 
a proper dressing to exclude sand, earth, or dirt, and plenty of clean, 
dry straw given as bedding. As a rule, with these precautions, recovery 


ACUTE INFLAMMATION OF THE PODOPHYLLOUS MEMBRANE. 675 


occurs in five to eight days. As already remarked, particular care is 
required when inflammation affects the bars. 

The treatment of parenchymatous pododermatitis, accompanied by 
suppuration, requires greater care. To prevent the occurrence of puru- 
lent cellulitis, pus must be allowed free exit. The diseased area should, 
therefore, be exposed as far as possible, and neighbouring parts thinned, 
though without removing more horn than is absolutely necessary. 
Thinning the horn relieves inflammatory swelling around the suppurat- 
ing centre. The next precaution is to remove all putrefying material 
from the inflamed cavity. For this purpose the parts are carefully 
washed with sublimate solution, or, if necessary, immersed in a dis- 
infectant foot-bath. They are next rinsed with sublimate, carbolic, or 
creolin solution, a tampon saturated with the same material applied to 
the exposed soft tissues, and a pressure dressing fastened over all. It 
is often necessary to inject the parts with the above, or with 10 per 
cent. chloride of zine solution. 

A pressure dressing answers the double purpose of protecting the 
inflamed spot from dirt, and the entrance of fresh infective material, 
and of preventing protrusion of soft parts, to which there is a consider- 
able tendency, partly from removal of support, but largely in consequence 
of inflammatory swelling. Being irritated by contact with the margins 
of the opening, the soft tissues swell and cause great pain, block the 
opening and prevent escape of pus, and facilitate the production of 
purulent cellulitis. To remedy this, nothing succeeds better than steady 
pressure, assisted, if necessary, by astringents like alum and tannin, or 
even by nitrate of silver. Dusting the granulations with iodoform or 
other disinfectant powder also helps to combat the inflammation. 
Very special care is called for when the pus is offensive. Foot-baths 
are useful on account of their cleansing the point attacked, but as 
they favour prolapse of soft tissues, a pressure dressing should be 
apphed. As soon as suppuration stops, the soft parts must be pro- 
tected by means of a dressing of tar and tow, until they again become 
covered with horn. This dressing should not be removed until the 
wound has thoroughly cicatrised, when a well-fitting shoe, protecting 
the diseased point until the new horn becomes sutficiently strong, is 
applied. 

In gangrene of the sensitive sole, the affected point must be com- 
pletely exposed, any dead tissue removed, and the freest possible exit 
given to gangrenous discharge. The gangrene may be recognised by 
the greyish yellow colour of the soft structures, and by the pain and 
bleeding which follow any interference with the spot. Necrotic portions 
of tissue are grasped with dressing-forceps and forcibly removed, after 
which the parts are treated as described. 


676 DISEASES OF THE FOOT. 


The treatment of cases complicated with purulent cellulitis of the 
fibro-fatty frog is described in the chapter on picked-up nails; that of 
the subcoronary connective tissue at p. 684. 


—PRICKS OR STABS IN SHOEING. 


The sensitive portions of the foot are often injured during shoeing by 
misdirected nails, with consequences of a very varying character. The 
chief factor appears to be the degree of injury, though infection plays 
no inconsiderable 7é/e in determining the result. When the nail only 
penetrates the neighbourhood of the rete mucosum, or injures this 
alone, a superficial inflammation results, with the above-described con- 
sequences. But if, instead, portions of the cuticular structures contain- 
ing connective tissue are affected, the usual, though not invariable, 
result is an attack of parenchymatous inflammation. The attack may 
often be avoided by immediately withdrawing the nail and closing its 
track by tar, wax, or by burning the horn, thus preventing infection of 
the wound; a proof that it is not the injury, but the infection it facili- 
tates, which causes inflammation. A second nail should not be driven 
at the same spot, as it would again open the path for infection. 

The os pedis is occasionally injured by driven. nails, though necrosis 
resulting from inflammation should not be mistaken for fracture pro- 
duced by a nail. 

The course of these injuries varies greatly. Superficial injuries some- 
times heal without proceeding to suppuration, in six to eight days under 
local cooling treatment and rest. Pododermatitis superficialis pro- 
duced by pricks generally causes suppuration, the pus, if not furnished 
with an artificial outlet, breaking through at the coronet at a point 
corresponding in position with the misdirected nail. Although in such 
cases spontaneous recovery is usual, 1t saves time, and the possibility of 
complheations, if an exit for pus be provided at some point in the white 
line. 

As pricks and stabs only occur in those portions of the sensitive 
structures which lie immediately in contact with the os pedis, and are 
unprovided with subcutis, purulent cellulitis is a comparatively rare 
compheation, necrosis of the lamin, and even of the os pedis, being 
more frequently seen (p. 672). As already remarked, the result 
depends more on the kind and degree of infection than on the extent 
of injury. Direct injuries of the bone lead, as a rule, to necrosis, which 
is apt to extend to the neighbouring sensitive structures. 

The diagnosis is based partly on the fact that the horse goes lame 
soon after shoeing and partly on examination of the hoof. For this 


PICKED-UP NAILS. 677 


purpose the shoe is removed, and the ground surface of the hoof, and 
especially of the white line, well cut out, so that the position of the nail 
holes can easily be detected. (For further directions, see p. 673.) If 
it is necessary to expose a nail tract, it should first be followed through 
the horn of the sole and white line, the wall being spared, so as to 
preserve a sufficient bearing surface for the next shoeing. 

Causes.—Want of care and skill on the part of the farrier is the 
usual cause of stabs or pricks, though they may be due to bad feet and 
to the animal’s restiveness, without any fault on the part of the farrier. 
Carelessness in shoeing is shown by the nail holes being misdirected, 
and by their occurring at points where there was not sufficient horn 
to warrant the driving of a nail. The usual causes of stabbing are 
coarsely punched nail holes and insufficient horn; stubs left in the 
feet rarely occasion pricks by causing the nail to deviate from its 
normal direction. 

The first step in treatment is to remove the nail and shoe.  Pro- 
vided suppuration has not set in, cold applications, in the form of foot- 
baths or poultices, may be tried. The parts must be cleansed, and 
infection prevented by giving the animal plenty of clean bedding, and, 
if necessary, applying a suitable dressing. Once suppuration occurs, 
treatment follows the above-described principles. 


Il.—PICKED-UP NAILS. PURULENT CELLULITIS OF THE 
FIBRO-FATTY FROG. RESECTION OF THE FLEXOR 
PEDIS PERFORANS. 


The above title will, for convenience, be regarded as including all 
injuries caused by the animal treading on foreign bodies which thus 
penetrate the soft structures of the foot. Such bodies include nails 
and wire, as well as pieces of iron or glass. As the horny sole usually 
offers sufficient protection, such foreign bodies almost invariably enter 
through the frog, and may injure the fleshy and fibro-fatty frogs,’ or, in 
exceptional cases, even the flexor pedis perforans tendon, os pedis, or os 
naviculare. Cases have been recorded of injury even to the os coronie. 
The foreign body usually glides off the bars and penetrates the side or 
furrow of the frog. 

Provided injury is confined to the surface of the fleshy frog, no bad 
results usually follow; but should the fibro-fatty frog be involved, dif- 
fuse purulent cellulitis may set in, suppuration may extend to the flexor 
pedis perforans tendon, and be followed by necrosis of the latter and 


10QOn account of their different behaviour when injured, Prof. Moller appears to distin- 
guish—(1) a horny frog; (2) a sensitive frog ; and (3) a fibro-fatty frog. The two latter are 
usually included under the term plantar cushion.—[TRANSL,. ] 


678 DISEASES OF THE FOOT. 


suppuration in the navicular bursa. The condition is then excessively 
dangerous, and animals generally die if treatment be delayed. The 
rapidity of the process is largely determined by the virulence of the 
infectious material. 

Prognosis depends, therefore, firstly on the position of the injury, 
and afterwards on its extent and the character of the infection. The 
depth of the wound may be determined by the length of the foreign 
body removed, and sometimes by probing; but as the probe may easily 
become the vehicle for introducing infectious materia] into the depths of 
the wound, it should be used with considerable care. 

The position of the injury is important, the most dangerous spot 
being the centre of the frog, immediately above which hes the navi- 
cular bone covered by the flexor pedis perforans tendon. Injuries at 
the point of the frog may extend to the lower surface of the os pedis, 
causing necrosis, which, however, is seldom so dangerous as disease of 
the tendon and tendon sheath, because necrosis usually remains confined 
to one spot, and healing occurs after exfoliation, even though the latter 
occupy a considerable time (three to four weeks). Severe lameness, and 
symptoms of diffuse purulent inflammation of the fibro-fatty frog, are 
always grave. On attempting to bear weight on the foot, the latter 
shows excessive volar flexion, swelling appears in the heel, and pain is 
exhibited on forcibly flexing the toe. 

Treatment.—The chief indications are to prevent infection, to disin- 
fect the wound, and to limit inflammation. After carefully removing 
the foreign body and taking precautions against any particles being left 
behind, the entire hoof must be pared as for shoeing, and any loose 
fragments of horn removed from the sole or frog. The track of the nail 
should then be cut out until the injured soft tissues are exposed. The 
funnel-shaped opening, and, if possible, the wound in the soft tissues, are 
then washed out with clean water, or, better still, with a disinfectant ; 
a syringe is useful, or the parts can be swabbed with a tampon saturated 
with 10 per cent. chloride of zine solution. As the chief object is to 
keep the wound disinfected, a dressing moistened with some disinfecting 
fluid is applied over all. 

Should pain increase during the next few days, the wound should be 
cautiously probed, and any imprisoned secretion allowed to escape, after 
which the foot is immersed twice a day, for one to two hours at a time, 
in a bath containing some disinfectant. Plenty of clean straw bedding 
must be given, and the dressing moistened five or six times a day. 

To sum up, the object of treatment is, to confine the inflammation to 
the point of injury, for which purpose it is necessary to keep the parts 
thoroughly clean, to avoid retention of pus or wound discharges, and 
to minimise the decomposition which is apt to occur in wounds. 


RESECTION OF FLEXOR PEDIS PERFORANS TENDON. 679 


When pain decreases, a dry dressing is sufficient; and as soon as 
inflammation or suppuration stops, a splint dressing can be applied to 
protect the soft parts, which are only covered with a very thin layer of 
horn. The sole is smeared with tar and covered with tow, which is 
retained by means of a pair of wooden splints placed one over the other 
in the form of a cross, with their ends thrust under the shoe. Provided 
the roads are dry, the horse can work with this protection, but in wet 
weather it is better to give a few days further rest in the stable. 

When suppuration is confined to a portion of the fibro-fatty frog, 
precautions should be taken against further infection and retention of 
pus, which would lead to diffuse cellulitis of the whole structure. 

In cases where the flexor pedis perforans tendon and its bursa are 
still intact, it is sometimes useful to scrape out the wound with a 
curette. This removes the infected masses of granulation tissue which 
form so freely, and constitute an obstacle to the escape of wound dis- 
charges and of necrotic material. After sponging out with chloride of 
zine solution, a tampon, moistened with the same fluid, is thrust into 
the wound, and a dressing applied. 

Disease of the flexor pedis perforans tendon can in general only be 
cured by resection. The procedure is as follows :—After very thoroughly 
thinning the sole, frog, and especially the bars, the horse is cast, the 
sensitive frog exposed, so as to allow any necrotic portions either 
of the frog or tendon to be removed. The affected foot is released, 
and a stout india-rubber tube applied, with some tension above the 
knee or hock to prevent bleeding. An incision is then carried through 
the whole thickness of each lateral furrow of the frog, the two 
meeting at the point of the frog. This frees the fleshy and a portion 
of the fibro-fatty frog, which are held back by means of a_ tape 
passed through the point of the frog. In making the incision, the 
course of any existing fistule must be noted, so as to expose their 
deepest points, and so discover the necrotic piece of tissue. If at this 
stage the fibro-fatty frog is found to be alone diseased, the necrotic parts 
are removed, the neighbourhood scraped with the curette, sponged with 
chloride of zine solution, and covered with a moist disinfectant dressing. 
As a rule, however, there is necrosis of the flexor pedis perforans tendon 
and purulent disease of the bursa podotrochlearis, and in such cases it 
is best to resect the entire terminal portion of the tendon. The operator 
first divides and reflects the tendon at its point of insertion into the os 
pedis, thus exposing the gliding surface of the navicular bone. As a 
rule, the cartilage covering the navicular bone is already macerated, or 
even necrotic. The tendon is then cut through at the upper border of 
the navicular bone by means of a knife shaped like a laurel leaf, the 
section being as smooth as possible ; a very sharp knife with a long 


680 DISEASES OF THE FOOT. 


handle is therefore necessary. The point of division must not be higher, 
otherwise the pedal joint will be opened. The stump of the tendon is. 
removed, the navicular bone scraped with the curette, and a granulating 
surface produced by removing the cartilage. The cavity is then sponged 
with a 10 per cent. solution of chloride of zinc, rinsed with carbolic 
solution, and several masses of tow, moistened with ¢arbolic or sublimate, 
pressed firmly into the cavity, after which the frog is returned to its. 
proper position, and a moist dressing applied over all. The space is 
filled with tow, partly to check the bleeding which follows removal 
of the tourniquet, partly to restore the fibro-fatty frog and sensitive 
frog to their normal position. The next day this dressing is removed, 
the wound rinsed out with disinfectants, and the dressing removed, but 
the cavity is only loosely filled with carbolic tow or jute. This second 
dressing remains in position eight to ten days, provided it is not wet 
through with discharge, and neither fever nor severe pain has set in. 
In the interval the walls of the space have everywhere become covered 
with granulations—in favourable cases without any trace of pus forma- 
tion. The dressing is then renewed every four or five days; and as the 
cavity fills with granulations, less material is used. Finally, healing 
becomes complete ; the frog may possibly appear rather shortened, but, 
as a rule, no other deformity remains. I have often had horses back at 
work in four to six weeks, but it is best to keep a protective dressing 
splinted on the sole for some time. 

The best results are seen in heavy draught-horses. In carriage- and 
trotting-horses shght lameness may persist for a considerable time, 
though it seldom proves permanent. 

From experience, I am unable to recommend partial resection of the 
flexor tendon, because the bursa podotrochlearis is generally implicated, 
and therefore, after removal of the necrotic portion, purulent bursitis 
continues, and leads to fresh necrosis of the tendon. Reports of success 
after partial resection of the flexor pedis perforans tendon are, there- 
fore, to be received with caution. The fact that recovery has been 
described as occurring in eight to fourteen days, or even earlier, shows, 
in my opinion, that the cases were not cases of necrosis of the flexor 
tendon, but only of the fibro-fatty frog, In these it is often sufficient 
to freely scarify the parts with the curette. 


Ill.—TREADS ON THE CORONET. PURULENT INFLAMMA- 
TION OF THE SUBCORONARY CONNECTIVE TISSUE. 


The above injury, as the name implies, is generally produced by the 
animal treading with the heel of one foot on the coronet of another. 
lither the coronary band, the upper portion of the wall, or the skin is 


TREADS ON THE CORONET. 681 


divided, and the injury often extends to subcutaneous structures, to the 
tendon of the extensor pedis, to the lateral cartilage, or even to the os 
pedis, and may even lay open the pedal joint. The danger is increased 
by the fact of the wound being bruised and infected from the beginning, 
for which reason treads never heal by primary intention, and gener- 
ally show a tendency to necrosis. The structure and position of 
the injured part favour this; the tendons, the os pedis, and the lateral 
cartilage are readily destroyed, whilst necrosis is favoured by the sur- 
roundings of the coronary band, in which acute inflammatory swellings: 
greatly interfere with nutrition, in consequence of the unyielding 
character of the horny wall. Finally, as treads most frequently occur 
during winter, the tissues are exposed to the action of cold and dirt, 
which are specially injurious. At this season of the year slight 
injuries to the coronet are readily followed by severe gangrenous 
processes, which show a strong tendency to extend to the sensitive 
lamine. Again, infection of the loose connective tissue lying under 
the coronary band often leads to diffuse cellulitis, which may 
extend to the pedal joint, and give rise to incurable purulent 
inflammation. 

Luckily, healing is usually very complete at this point, and one 
sometimes sees cases where large portions of the coronary band have 
been destroyed, yet no defect remains in the formation of horn. This 
is rendered possible by the papille of the coronary band and of the 
neighbouring skin replacing the lost parts. On this point compare with 
my Diseases of the Foot, 2nd ed., p. 59. 

Destruction of a section of the coronary band is followed by cessation 
in the secretion of horn at that particular point. Acute inflammation 
of the band also interrupts the formation of horn, and produces a 
cavity in the horny wall, the width and length of which depend on 
the size of the region affected and on the time during which inflamma- 
tion persists; the longer the time, the greater the perpendicular 
measurement of the cavity; the greater the extent of coronary band 
involved, the broader the resulting defect. When horn production is 
permanently checked, a depression forms in the wall, and gradu- 
ally grows downwards until it extends from the ecoronet to the ground 
surface of the foot. To discover whether the horny wall will again 
recover its normal shape, the horn below the coronary band must be 
inspected. 

A further obstacle to recovery consists in the papille of the coronary 
band becoming thrust out of place, and not returning to their normal 
position, During acute inflammation the papille of the coronary band 
are displaced relatively to one another, and must regain their former 
position before they can again produce a normal growth of horn. This 


682 DISEASES OF THE HOOF, 


is effected by the neighbouring papille, which have not suffered dis- 
placement. As the growth of horn starts from the periphery of the 
injury, the diseased and displaced papille are gradually brought into 
position by the growth of neighbouring horn tubules; and as repair 
proceeds, the normal state is restored. Sometimes the growth of 
horn is irregular, because it sets in before swelling has completely 
disappeared, and the papille are unable to take up their normal position ; 
or, again, horn production does not proceed regularly from the periphery 
towards the centre of the injury. The displaced papillze then become 
fixed in their abnormal position, and produce a horny tumour on the 
oronet, in consequence of certain of them not contributing to the 
formation of the wall, but producing disconnected masses of horn. The 
horny wall then shows a defect at the point in question, which detracts 
from its solidity. Sometimes the exterior of the wall is thickened, 
because horn formation goes on while the coronet is still swollen. In 
exceptional cases, this thickening may take place on the inner surface, 
producing a keratoma. 

In addition to such complications, more dangerous consequences may 
follow treads. If, for instance, in consequence of direct injury to the 
joint, its perforation by pus during an attack of purulent cellulitis in 
the subcoronary connective tissue, or of extension of necrosis towards 
the depths, purulent or septic inflammation attacks the pedal joint, the 
condition becomes incurable. 

Necrosis of the extensor pedis tendon produces severe lameness ; when 
the foot is extended, or attempts are made to bear weight on it, the 
lower part of the limb assumes a position of excessive volar flexion. 
‘The condition, however, involves no permanent injury, the defect in the 
tendon being replaced by connective tissue, which firmly unites the ends. 
Extension of necrosis to the sensitive laminz is dangerous, because of its 
tendency to involve Jarge areas, leading to diffuse inflammation of the 
sensitive structures, which may be followed by loss of the hoof. Necrosis 
of the lateral cartilage always produces quittor. 

Prognosis.—The consequences of treads may be exceedingly varied. 
‘The following points are of chief importance :— 

(1) The position and extent of injury. The more nearly the injury 
approaches the band, the graver it becomes. If the skin and upper part 
of the horny wall are alone injured, and the wound is not deep, healing 
soon follows; but treads on the coronary band not only offer great 
obstacles to treatment, but may involve the pedal joint, especially in 
the small, clean feet of well-bred horses. At the centre of the toe the 
pedal joint lies scarcely more than } of an inch below the coronary 
border of the horn, but as we pass back it recedes from the coronet, 
and is therefore less easily injured. For this reason, and also because 


TREADS ON THE CORONET. 683 


of the danger of injury to the extensor pedis tendon, injuries at the toe 
are always more dangerous than those at the side of the foot. 

(2) The size of the swelling and degree of lameness. As probing 
gives no reliable information as to the extent of the injury, and may 
produce perforation of the pedal joint, or introduce septic substances 
into the depths of the wound, the operator, in forming his prognosis, is 
forced to fall back on the amount of swelling and pain. Particular 
reticence should be observed when the parts are exceedingly painful but 
‘swelling is limited, especially if the pain is without visible cause. The 
general condition, appetite, temperature, &c., must, of course, not be 
neglected in forming a prognosis. 

Diagnosis is rarely difficult, though in horses with long hair about 
the feet some little care is required to discover the injury. When 
necrosis sets in it may be doubtful whether the original injury was a 
tread, or whether we have to deal with a case of spontaneous gangrene. 
Brushing, and similar injuries, produce wounds resembling those 
caused by treads both in course and consequences. 

Treatment.—tThe first and most important precaution is to clean 
and disinfect the wound. The hair which has been thrust into it by 
the heels of the other shoe, and the septic material which is always 
introduced in large quantities, should as far as possible be removed. 
The surrounding hair is clipped away, and any loose shreds of tissue 
-cut off with scissors. The entire hoof, particularly the coronet, is then 
washed and the wound soaked with carbolic solution, or, if time allow, 
the foot may be immersed in a bath of antiseptic solution. The wound 
may also be sponged out or injected with a 10 per cent. solution of 
chloride of zine. If the coronary band be much swollen, the horn 
should be rasped away over an area corresponding to the swelling before 
the final dressing is applied. I prefer moist carbolic or sublimate 
dressings, and having dusted the wound with iodoform, apply a 
mass of tow, moistened with a disinfectant, coverme the whole with 
several large tampons of oakum, which are held in, position by a 
bandage. Excessive pressure must be avoided. If the dressing be too 
tightly applied, it not only increases pain, but favours necrosis in the 
region of the coronet. Once the dressing is applied, it can be kept 
moist by pouring over it several times a day a disinfecting fluid. If 
pain diminishes and the dressing is not saturated with discharge, the 
latter may be left in position for two or three days, otherwise it 
‘should at once be renewed. Should suppuration occur, the moist dress- 
ing should be replaced by a dry one. 

Particular care is required during cicatrisation; horn formation 
at the coronet should be discouraged until all swelling has disappeared. 
Should it oceur, the parts may be moistened with a 5 per cent. caustic 


684 DISEASES OF THE HOOF. 


potash or soap solution, which will check the hardening of the new horn 
until inflammatory swellings disappear. Irregular cicatrisation must 
be treated in a similar way. 

Very little can be done to prevent abnormal growths of horn on the 
coronet. If such growths only affect a small area—if, for instance, the 
base is no bigger than a five-shilling piece—the newly-formed mass may 
be completely cut away, which will improve matters, and may possibly 
result in complete cure. This becomes necessary when the growth 
overhangs the wall, and, as is often the case, maintains chronic: 
suppuration around its base. The entire base is cut away and a dress— 
ing applied to check bleeding, which is sometimes severe, and may 
necessitate the use of the actual cautery. 


Inflammation of the Subcoronary Connective Tissue. 


The abundant connective tissue underlying the coronary band 
is in intimate connection with the subcutaneous connective tissue of the 
coronary region, and is related below to the parachondrium, and through 
this to the fibro-fatty frog. 

The subcoronary connective tissue is loose, and contains the great. 
venous plexus of the coronet. It extends as far as the capsular liga— 
ment of the pedal joint. 

Injuries to the coronet, like treads and brushing wounds, often lead to 
infection of, and diffuse inflammation in, this connective tissue (cellulitis 
of the subcoronary connective tissue). As a rule, the disease is confined 
to one side of the hoof, but sometimes extends to the other, so that the 
swelling involves the entire coronet. 

The condition is ushered in by inflammatory swelling, which appears 
more or less distinctly around the coronet, and is succeeded by violent 
pain, especially when weight is placed on the foot. The lameness is 
in direct proportion to the swelling, and is usually so severe as to 
prevent the animal ever standing firmly on the foot. The lymph vessels 
above the hoof are sometimes swollen, though this cannot always be 
detected with certainty. Rotation of the phalanges causes great pain. 

The disease shows a great resemblance to purulent inflammation of 
the pedal joint, and the diagnosis may for a time appear doubtful. 
Lameness, appearing simultaneously with swelling, points to primary 
subcoronary cellulitis; in secondary cellulitis, due to purulent inflam- 
mation of the joint, the swelling is preceded by severe lameness. And: 
further, while in primary cellulitis pain generally diminishes after dis- 
charge occurs, it persists in purulent disease of the pedal joint. 

Sometimes synovia is discharged, or the pedal joint may be felt by 


INFLAMMATION OF THE SUBCORONARY CONNECTIVE TISSUE. 685 


introducing the finger ; in such case no doubt can exist as to the nature 
of the condition. 

The course of subcoronary cellulitis is usually unfavourable. Some- 
times laminitis results from the animal continually standing on the 
other foot, and the patient dies from decubitus; sometimes the disease 
‘seizes on one or other of the lateral cartilages and produces quittor, but 
not infrequently septic inflammation occurs in the coronary band, 
destroys extensive tracts of tissue, and leads to fatal pyzmia or septi- 
eemia. The large vessels of the coronary venous plexus particularly 
favour the development of pyemia. Purulent inflammation of the 
pedal joint, produced by extension of the cellulitis, is a frequent com- 
plication. Its onset is characterised by increase of pain; and if 
inflammation had not previously extended beyond one-half of the hoof, 
by the swelling involving the entire coronet; fever is a constant 
symptom, though in some cases it may even precede this condition. 

Resolution is comparatively rare, and recovery, after perforation of 
the abscesses, still more so, though it has once or twice been seen. 

The inflammation scarcely ever affects the fibro-fatty frog, though it 
may attack the connective tissue above the coronet, producing necrosis 
of the fascize at this point, and leading to chronic suppuration and 
formation of fistulee. 

The prognosis is generally unfavourable, so that it is only advisable 
to treat animals of considerable value. On the other hand, recovery is 
not impossible, even when pain is severe, for sudden improvement 
sometimes occurs when the abscesses break. 

Treatment.—To prevent complications, all injuries of the coronet 
and its neighbourhood in which the skin is perforated, should if possible 
be treated antiseptically. Surface injuries are rarely dangerous. Treads 
on the coronet, especially when near the hoof, require particular care 
to avoid purulent inflammation. 

If cellulitis has already appeared, dispersal will be favoured by warm 
baths, to which it is well to add some antiseptic. The appearance of 
distinct fluctuation should be the sign for immediately opening the abscess, 
though considerable bleeding must be expected, and almost always occurs. 
After discharge of the pus, which is almost always blood-stained or 
decomposed, the cavity should be washed out with a disinfectant, and 
tampons inserted to check bleeding. The tampons can be kept in 
position for twenty-four hours by a bandage, the pressure of which will 
increase their styptic action, but care must be taken not to apply 
it so tightly as to produce necrosis. For the next few days the abscess 
cavity must be repeatedly and carefully syringed with disinfectants, 
and precautions taken against retention of pus; it may even be 
necessary to insert a drainage-tube. 


686 DISEASES OF THE HOOF. 


As the condition is painful, a good straw bed should be given, for 
there is less risk of laminitis occurring in the other foot, and hence 
less danger of a fatal termination from decubitus when the animal 
takes regular rest. 


IV.—CORNS. 


The term “cern” embraces a number of diseased conditions of 
the posterior portions of the foot, and especially cf the heels. The 
injury has its seat in the sensitive lamin of the quarters, in the 
sensitive bars, or in the sensitive sole. The condition has, therefore, 
been divided into three corresponding divisions. As a rule, it consists 
in bleeding at the surface of the horn, resulting from pressure or rupture. 
As long as the hemorrhagic spot remains uninfected, no inflammation 
results, but infection is followed by a pododermatitis, which may either 
be superficial or parenchymatous. In the latter case suppuration occurs, 
in consequence of which this form has been termed moist corn, in 
contradistinction to the dry form in which inflammation is absent. In 
the wall or sole, the bleeding is oftenest seen at the surface of the 
papilla. The blood in most cases is extravasated between these and 
the hoof-horn, the inner surface of which it saturates, and imparts 
to the newly-formed horn-cells a red colour. The red spots thus. 
formed sometimes appear as fine poimts if bleeding be confined to 
isolated papille, but generally as large red stains, which are only seen 
later when cutting out the foot,—that is, after the coloured layers of 
horn have grown down to the free surface of the hoof. 

If the extravasated blood becomes infected, inflammation follows, and 
often proves serious,—as, for instance, when pododermatitis parenchy- 
matosa extends from the bars to the fibro-fatty frog, in which it induces 
diffuse purulent inflammation. A troublesome condition may also be 
produced by infection of the parachondrium and formation of a quittor. 
These two complications are unfortunately rather frequent. 

Causes.—In consequence of the close union between the vascular 
laminz and the horn, it results that, as bleeding occurs so easily, 
inflammation is seldom seen without hemorrhage. Traces of it 
are, however, sometimes seen in the heels. The horn of the sole then 
appears shining, semi-transparent, and coloured yellow, changes which 
point to inflammation of the hoof matrix. 

The fact that the posterior parts of the hoof are oftenest the seat of 
mechanical lesions is partly due to their greater mobility ; the move- 
ment of the hoof is most apparent at this point, and rupture of soft 
structures, therefore, more liable to occur. Then, again, the heels carry 


? 


CORNS. 687 


a larger proportion of the weight, and the horn covering them is weakest. 
The more frequent occurrence of corns in the inner heel and in fore-feet 
must also be referred to the greater weight borne and the more marked 
impact during rapid movement. 

Corns are favoured by long, weak fetlocks, and by defects in forma- 
tion, especially in the front limbs. In animals which stand with the 
feet well apart, the inner heel is most generally affected ; in the opposite 
conformation, the outer. The weaker the horn of the heels, the more 
readily do such injuries occur: formation of rings on the surface of the 
heels points to corns. Abnormally narrow feet are generally the seat 
of corns, and in contracted heels they are almost always present. But 
wide hoofs are also liable to them; in such case the corn being an injury 
of the sole, whilst in narrow hoofs the wall is more often atfected. 

The principal external causes are faulty shoeing, especially improper 
paring, the use of too short or too narrow shoes, or allowing the shoes to 
remain on for too longa time. As corns are very rare in unshod feet, the 
idea obtained currency that they were always produced by the pressure 
of the shoe. For this reason farriers often endeavour to prevent the 
injury by rasping away the inner wall, so that it no longer touches the 
shoe. The result shows, however, that this idea is erroneous, for corns 
occur just the same, and, in addition, a sand-crack often forms at the 
coronet. It therefore seems clear that the heel should be supported by 
the shoe ; if not, it descends, and leads to rupture of the sensitive lamine. 
The attempt to remedy the evil thus leads to its propagation. 

Prognosis.— Although corns are so common that their absence in 
animals working in large towns is almost an exception, yet they give 
rise to much trouble. Severe consequences, however, only follow when 
the point of origin becomes infected; and as infection almost always 
takes place from without, it is of the greatest importance to protect the 
hemorrhagic spot against the entrance of foreign material. Sometimes, 
however, the horn is so defective that no precautions seem sufficient to 
prevent it, and then the animals suffer habitually, and little hope of 
cure can be given. Suppuration, when once established, may be followed 
by any of the above-described complications, especially in cases of podo- 
dermatitis parenchymatosa. Swelling of the coronet points to the later 
appearance of quittor, whilst severe lameness, pain on dorsal flexion of 
the toe, and swelling between the bulbs of the heel suggest purulent 
suppuration of the fibro-fatty frog, and affection of the flexor pedis per- 
forans tendon (p. 678). 

Bad conformation and work on stone-paved streets naturally lessen 
the chances of complete recovery. 

Treatment follows the principles above indicated (p. 674). The 
immediate cause must if possible be removed, and the shoeing receive 


088 DISEASES OF THE HOOF. 


attention. In “dry” corn nothing further is required. Paring 
out corns is undesirable, and even injurious, because, after removal of 
the reddened masses of horn, the soft tissues are often exposed, and 
entrance of infectious material facilitated. 

The inflammation produced by corns is treated as directed on page 
674. In parenchymatous disease, free exit must be provided for the 
pus; if necrosis have occurred, the dead tissue should be removed as 
early as possible, and the spread of infection checked, antisepties 
being employed either to destroy or hinder the development of specific 


organisms. 


V.—QUITTOR. 


Ger. Hufknorpelfistel. 


Lit.: Giesecke, Zeitschr. f. Vet.-Kund. 1890, p. 259. Koch, B. T7 W. 
1890, p. 307. Siedamgrotzky, Dresd. Ber. 1890, p. 21. Winkley 
Zeitschr. f. Thiermed. 1890, p. 297. Brauer, Dresd. Ber. 1889, p. 72. 


The term “ quittor” is applied to a chronic, purulent inflammation of 
the lateral cartilage and of surrounding structures, associated with 
necrosis and the formation of fistule. The cartilaginous prolongations 
of the wings of the os pedis are surrounded by a firm connective tissue, 
provided with many elastic fibres, termed the “ parachondrium,” which 
is in close relation with the subeoronary connective tissue and with the 
fibro-fatty frog. Suppuration in the parachondrium is always lable to 
be followed by necrosis of the cartilage; and, owing to the difficulty with 
which the dead portions separate, suppuration is obstinate, and the 
narrow canals or fistule through which the discharge escapes are ex- 
tremely difficult to heal. From time to time the inflammation becomes 
more intense, and leads to destruction of further portions of cartilage, so 
that, unless energetic treatment be resorted to, the condition usually con- 
tinues three to five months. 

A similar affection occurs in the subcoronary and subcutaneous con- 
nective tissue above the coronet, and has by Haubner been termed 
“coronary fistula.” In the same way, the French discriminate between 
“ Javart cutané” and “ Javart cartilagineux.” 

The process is caused by infection of the connective tissue with 
staphylococci. Sometimes the organisms enter through the skin, as in 
treads, in gangrenous grease, and similar diseases, but direct injury of 
the lateral cartilage is a rare cause of quittor formation if the wound be 
at once properly treated, and in by far the majority of cases the con- 


QUITTOR. 689 


dition has its origin in corns. The inflammation thus excited extends 
to the connective tissue lying above the sensitive sole, or a crack forms 
in the horn of the wall, in consequence of which the connective tissue 
lying under the sensitive lamine may become inflamed. 

On examining the parts, the parachondrium is found to be 
thickened and infiltrated with larger or smaller abscesses, while 
portions of the surface of the cartilage are necrotic, some being still 
adherent, others completely separated; they are generally of a greenish 
colour. 

The course of the disease is always chronic, whether it results from 
corns or from cracks in the horn. Recovery generally occurs, though 
sometimes only after complete destruction of the cartilage, a process 
which takes three to five months. As a rule, quittor remains confined 
to one side of the hoof, ze, to one lateral cartilage, the inner cartilage 
being most frequently affected, because primary disease is commoner at 
this point, For a similar reason the destruction of cartilage com- 
mences at the posterior end and extends forwards. 

Necrosis of the os pedis, suppuration in the pedal joint, and cellulitis 
of the subcoronary connective tissue or fibro-fatty frog sometimes occur 
as complications. The first only increases the duration of the process, 
but inflammation of the pedal joint generally proves fatal, whilst 
purulent inflammation of the fibro-fatty frog and of the subcoronary 
connective tissue are often the forerunners of other grave conditions 
(p67): 

Symptoms.—As purulent inflammation of the parachondrium is 
the starting-point of quittor the first symptom is a diffuse swelling of 
the coronet and of the bulb of the heel. This inflammation may in 
rare instances result in resolution, but generally an abscess forms, and 
discharges pus mixed with biood, after which the swelling partially 
disappears, leaving a fistula 1 to 2 ches in depth. After some time 
this closes up and a fresh swelling forms which takes the same course. 
The process is repeated at varying intervals. Often there are several 
fistulee which communicate with one another. 

Lameness is not often very severe, and may be so slight as to allow 
the animals to continue at slow work. With each recurrence of inflam- 
mation, however, the pain increases, and, if the pedal joint or fibro-fatty 
frog be implicated, it always becomes very marked, and then shows 
the peculiarities distinctive of disease in the regions named (pp. 678 
and 682). 

Prognosis.—It is very difficult to foretell the duration and probable 
results of quittor. As a rule, coronary fistule heal more rapidly than 
those of the lateral cartilage. In consequence of the process generally 


extending from the posterior towards the anterior border of the cartilage, 
2X 


690 DISEASES OF THE HOOF. 


the chance of early recovery is greater the nearer the fistula les to the 
anterior end of the cartilage ; absence of swelling in front of the fistula is 
a specially favourable symptom. Great swelling and severe lameness 
suggest a long continuance of the disease and troublesome complications. 
Quittor produced by cracks in the horn generally takes a _ very 
protracted course, being often due to necrosis of the os pedis. The 
probability of early recovery is in direct proportion to the recentness of 
the attack. In restive horses treatment is difficult, and recovery cor- 
respondinely protracted. Finally, the danger of purulent inflammation 
of the pedal joint is greater in horses with small weak feet than in 
heavy horses with large hoofs. In the latter, however, quittor is 
generally more obstinate than in the former, especially when it attacks 
hind feet. 

Treatment.—lIt is of primary importance to prevent infection of the 
parachondrium, and therefore especial attention must be given to the care- 
ful treatment of corns, cracks in the horn, and other diseases likely to 
produce parenchymatous inflammation of the sensitive structures in 
the posterior portions of the foot. ‘The freest exit must be given 
to inflammatory products, and the centre of disease kept as clean as 
possible. Injuries to the coronet are similarly treated, especially when 
the lateral cartilage is injured. Briiuer cured an injury of the cartilage, 
consequent on a tread, by carefully cleansing the wound with sublimate 
solution, and applying a dressing of iodoform and starch in the propor- 
tion of 1 to 5. Ihave repeatedly seen extensive injuries of the lateral 
cartilage heal by primary intention. 

If swelling of the parachondrium points to suppuration, the hoof 
must be kept soft, and a lukewarm foot-bath, contaiming a disinfectant, 
used to assist resolution. In case pus has already formed, it must be 
afforded free exit. Although abscess-formation always entails a 
quittor, suppuration may sometimes be prevented extending to the 
cartilage by sponging out the abscess cavity with 10 per cent. chloride of 
zine or other disinfectant. When this fails other methods of treatment 
ean be resorted to, all of which, however, depend on removing the 
necrotic piece of tissue as soon as possible, giving free exit to discharges, 
and checking the growth of pus cocci in the parachondrium. These 
comprise :—Injection with disinfectants. Liquor Villati has for many 
years enjoyed a wide reputation for this purpose. Williams recommends 
10 per cent. watery solution of corrosive sublimate to which a few 
drops of hydrochloric acid have been added to ensure complete solution. 
Carbohe acid has also been employed. In using these, the principal 
point is to bring them intimately into contact with the diseased mem- 
brane. For this reason it is best to first inject into the fistula, by 
means of a small lead syringe, some clean water or carbolic solution 


INJECTIONS AND SETONS IN TREATMENT OF QUITTOR. 691 


to, as far as possible, remove pus, a process which can be aided by 
gentle pressure. Then follows an injection with the active agent, 
which may be either liquor Villati, 5 per cent. carbolic acid, 10 per 
cent. chloride of zinc, or corrosive sublimate. To ensure the solution 
reaching the bottom of the fistula, the syringe should be provided with 
a long thin nozzle. 

The injections must be made daily, and continued until they 
cause considerable pain, when they are discontinued for a time 
and again resorted to until suppuration altogether ceases. Sometimes 
after a few days the swelling diminishes and pus ceases to be dis- 
charged, both favourable symptoms, as they point to commencing 
healing. 

Winkler recently recommended spirituous sublimate solutions, followed 
at a later stage by acetate of lead, also dissolved in spirit. He avoids 
using water. 

If the canal be too narrow to allow a syringe to enter, a thread soaked 
in sublimate may be passed to the bottom, a method of treatment which 
is especially useful in old fistulze with callous borders. After twenty- 
four hours the thread is removed, and exfoliation of the necrotic walls of 
the fistule assisted by warm foot-baths. Others employ the actual 
cautery for the same purpose, a farrier’s poker being made red-hot and 
introduced into the fistule. This is sometimes successful, but requires 
care in well-bred horses with small hoofs. The instrument must not 
be introduced too far, as the pedal joint might be opened, and special 
precautions are required in operating on the forward end of the cartilage. 
In enlarging the fistula, Williams employs a specially constructed 
bistouri caché closely resembling the herniotome (fig. 77). 

Koch recommends inserting setons. After placing the foot in a 
bath of 3 per cent. creolin solution, Koch endeavours to produce a 
counter-opening below the coronet by passing a Gerlach’s needle, and 
inserts a tape moistened with turpentine through the soft tissues. The 
parts are bathed once a day with creolin and injected with liquor 
Villati, and in sixteen to eighteen days the seton is removed. I 
have repeatedly tried this treatment, but have had no particular success, 
while I have often found the insertion of setons a difficult matter. To 
diminish the pressure of the horny wall on the swollen parts, Giesecke 
recommends applying linseed poultices containing creolin, and afterwards 
removing the softened horn. The fistulee above the coronet are scraped 
out with the curette, injected with 8 per cent. solution of chloride of 
zinc, and finally a small mass of tow covered with sulphate of copper is 
introduced. This procedure may require to be repeated ; after-treatment 
consists of injection with antiseptic fluids. 

I agree with Giesecke in regard to thinning the wall though I 


692 DISEASES OF THE HOOF. 


prefer, before using foot-baths, to remove the horn with the rasp over 
a space corresponding to the swelling. Free curetting seems very 
useful in some cases, but in others only increases pain and inflamima- 
tion ; I therefore prefer sublimate threads or “ pokering” to dilate the 
fistula. 

Although some cases are rapidly cured by one or other of the above 
described methods, yet in others no treatment seems effective. It is 
exceedingly difficult to exactly indicate the necessary conditions for 
healing, and therefore for some years I have more and more practised 
operation. Far from suggesting that every case of quittor should be 
operated on, I am yet forced to say that my experience shows operation to 
offer great general advantages, especially as regards shortening the course 
of the disease. If conditions are favourable to healing, operation should 
certainly be postponed, otherwise, and especially if careful after-treat- 
ment is possible, it should, on the contrary, at once be resorted to. When, 
for example, the quittor is of old standing, and has extended to the 
anterior portions of the cartilage, when pain is slight, and the animal 
able to work in spite of the discharge, it is better to try one or other of 
the above described methods of treatment. An opposite condition indi- 
cates the necessity for operation. In performing this, however, a time 
should be selected when inflammation is not acute, or pain severe, and 
when suppuration is slight, for under these conditions the chance of 
aseptic wound healing is far greater. I prefer total extirpation of the car- 
tilage to any partial measures, though, if the disease and swelling on the 
coronet be circumscribed, the latter may be tried. But even under these 
circumstances it very frequently fails to stop the disease, and complete 
extirpation afterwards becomes necessary. The method of total extirpa- 
tion has been fully described by Frick, and is divided into three stages 
—(1) Preparation of the field of operation ; (2) Resection of the cartilage ; 
and (3) After-treatment. The last requires at least as much care and 
precaution as the operative procedure, and if after-treatment cannot be 
properly carried out, operation is better avoided. 

After carefully cleaning and thinning the hoof, a portion of the horny 
wall, corresponding to the diseased cartilage, is rasped until thin enough 
to yield under the pressure of the thumb. This avoids the necessity of 
stripping the wall, which is very painful. The parts are then soaked in 
sublimate, and if operation should not immediately follow, the hoof may 
be surrounded with sublimate wood wool, and kept wet with sublimate 
solution for twenty-four hours. 

The horse is cast, and the diseased foot firmly tied to the 
cannon bone of the diagonal upper limb, 2c, in disease of the internal 
lateral cartilage of the left front-foot, that foot would be tied to 
the right hind-limb. An Esmarch’s bandage is then applied to 


EXCISION OF LATERAL CARTILAGE IN QUITTOR. 693 


the knee, the dressing removed, and the foot rinsed with sublimate 
solution. 

An incision is next made with a special curved knife, following the 
lower border of the coronary band, and corresponding to the size of the 
cartilage: any horn which has been left at this point is removed. The 
external surface of the cartilage is then divided from the coronary band 
and skin, towards which the convex surface of the knife is directed, the 
finger of the left hand following the movements of the knife to prevent 
the coronary band being cut through. Particular care must be taken not 
to divide the coronary band, especially near the bulb of the heel, iz., 
at the posterior end of the cartilage. 

The next step consists in separating the inner surface of the cartilage 
from its parachondrium, for which purpose the cartilage is cut through 
about its centre, and its posterior end separated. This completed, the 
toe of the foot is, by means of a cord passed round the fetlock and hoof, 
extended as far as possible to facilitate removal of the anterior half. By 
extending the foot, the capsular ligament of the pedal joint is drawn 
away from the cartilage, and the danger of injury diminished. The 
knife is then held horizontally, its convex surface downwards, and the 
rest of the cartilage separated from underlying structures, and removed 
with dissecting or dressing forceps. By thrusting the finger under the 
coronary band, it is easy to discover whether portions of the cartilage 
have been left. Any remaining should be removed with the curette, 
for on their complete removal depends much of the success of 
operation. 

The wound is washed out with sublimate solution, again examined, 
and any loose shreds or particles of cartilage excised with scissors and 
forceps. The surface of the wound is then rubbed with 10 per cent. 
solution of chloride of zine, the fistule scraped out with the curette, 
and dressed with chloride of zine. Sublimate solution is then injected 
once more, and a dressing applied. A couple of masses of tow saturated 
with 5 per cent. carbolic solution are thrust under the coronet to fill the 
cavity resulting from removal of the cartilage, and to check the bleeding 
which results after taking off the Esmarch’s bandage. The hoof is then 
enveloped in carbolic jute or sublimate wood wool, and a bandage applied 
to keep the dressing in place. A linen wrapper is placed over all, and 
supported by a straw rope passed round the fetlock. This ends the 
operation, which is, of course, carried out under antiseptic precautions, 
the hands being properly cleansed, and the instruments disinfected. 

The first dressing remains in position twenty-four to forty-eight hours. 
Soon after the animal has risen, it may appear saturated with blood, 
but the bleeding is of little consequence, especially if the animal is 
not upset. It is usually best to place it in a stall. High-couraged 


694 DISEASES OF THE HOOF. 


horses should be operated on under chloroform ; in others, anesthesia is 
unnecessary, as the operation is not very painful. 

After removing the first dressing, the hoof is washed with a dis- 
infectant, the wound freed from blood, again rinsed out, and another 
jute or tow tampon inserted. The dressing is similar to that employed 
after operation, and need not be renewed for eight to ten days, provided 
fever be not marked, or pain severe, and the covering show no signs of 
becoming saturated with discharge. ‘The after-dressings are similar, 
though, as the granulations increase, and occupy more space, the 
quantity of carbolic tow or jute placed under the coronet should be 
diminished. It is of particular importance that granulation should start 
from the base of the wound. Under no circumstances should the lower 
portions of the coronet be allowed to come into contact with the upper 
part of the hoof before the entire space above is filled up, otherwise a 
space is left at the base of the wound which, in case of suppuration 
occurring, would retain the discharge. For a similar reason, the newly 
formed horn should be regularly trimmed away from the coronet. 
Excessive granulations around the coronet are removed by astringents 
or caustics. 

This treatment is continued until the defect appears completely filled 
up, and the coronary band is adherent throughout its entire length with 
the underlying tissues, ze, until the space between the divided coronary 
band and its foundation is completely obliterated. A tar dressing is 
then applied, the wound surface being smeared with tar, and a bandage 
saturated with the same material wound round the hoof. If pain 
be slight, a bar-shoe can be put on, and the horse sent to slow 
work. The time occupied up to this point is from three to six weeks, 
so that, as a rule, operation considerably shortens the duration of the 
disease. Siedamegrotzky performed eight operations last year, and his 
cases, on an average, occupied thirty-one days in healing. 

The popular idea that the operation renders horses useless for work 
on hard roads appears to me, after a large number of observations, to be 
without foundation. Many carriage-horses on which I have operated 
have recovered so perfectly that not the shghtest trace of operation 
could be detected on examining the hoof; and the animals themselves 
have worked for years on the streets of Berlin. 

1 English veterinarians will scarcely agree with this. Judging from my own observations. 
in Germany, and also in France, there seems to be very considerable reluctance in giving 


chloroform, and a fear of serious consequences, which, in my opinion, are entirely unwarranted. 
—[TRANSL. ] 


LAMINITIS. 695 


VI—LAMINITIS. INFLAMMATION OF THE SENSITIVE 
LAMINA. 


Ger. Rehe, Verschlag. 


Lit.: Vergl. mein Handb. der Hufkrankheiten, IJ. Aufl. p. 92. Ferner: 
Pflug, Oesterr. Monatsschr. 1893, p. 3885. Imminger, Ad Woch., 1890. 


The term Jaminitis is used to describe a spontaneous diffuse derma- 
titis superficialis of the sensitive lamine. It sometimes results from 
chills, sometimes from errors in diet or other causes, usually affects 
both fore-feet, sometimes the hind-feet in addition, but seldom these 
alone. 

The affection starts as a severe hyperemia of the sensitive lamine. 
Exudation soon follows, and is associated with active proliferation in the 
well-developed layers of the rete. The immediate result is to loosen 
the connection between the hoof and its matrix, and as separation is 
favoured by the weight of the body, especially at the surface of the 
sensitive laminz, the most important of the pathological changes occur 
at this point. Within twenty-four hours after onset of the disease, the 
parts are much reddened and swollen, and proliferation of the young 
epithelium is taking place on the surface of the sensitive lamin, especi- 
ally in the region of the toe. Siedamgrotzky was perhaps the first to 
point out that the pressure of the body-weight, and the pull of the 
flexor pedis perforans tendon on the os pedis, not only thrust the bone 
downwards in toto, but that the pull of the flexor tendons, which are 
rendered tense in consequence of the weight on them, tends to rotate the 
os pedis around its transverse axis, and so to cause the toe to sink and 
the wings to rise. In proportion as the toe of the os pedis recedes 
from the wall, the surface of the sensitive laminze becomes thickened, 
until finally it may measure ten times its normal thickness. This 
thickening consists essentially in an increase in the white line, as can 
afterwards be distinctly seen on examining the under surface of the 
hoof. As the point of the os pedis moves downwards, the horn of the 
sole at the toe necessarily becomes flattened, and finally takes a convex 
form. This condition, in connection with certain changes in the horny 
wall, is termed “dropped sole.” It was formerly assumed that the in- 
flammatory growth pressed the os pedis downwards. Dominik insisted, 
on the other hand, that the horn of the toe was dislocated upwards, but 
that the os pedis remained in its normal position. Neither view harmo- 
nises with our present views, and to-day no doubt can exist that 
Siedamgrotzky’s explanation, given at length in my work on Diseases of 


696 DISEASES OF THE HOOF, 


the Foot, and to which I must refer the reader, is correct. I have also 
directed attention there to the fact that the continuance of this abnormal 
form of hoof is dependent on the pressure of the ground against the toe 
of the hoof whilst the animal is moving. Jn dropped soles the wall of 
the toe close below the coronet appears abnormally perpendicular, but 
near the bearing surface takes a more horizontal direction, whilst the 
bearing surface itself is not only longer but also more oblique. This 
abnormal formation of hoof is identified with chronic laminitis. 

The severe pain sometimes forces the animals to lie continuously, 
when death usually results. In other cases, the os pedis perforates the 
horny sole, purulent or septic inflammation of the sensitive structures of 
the foot sets in, pain increases enormously, the animal is unable to stand, 
and death occurs from pyeemia. 

Causes.—Laminitis is most common in badly-formed, flat, and 
pointed feet. Its onset is favoured by continuous mechanical irritation 
of the sensitive structures, resulting from severe work at high speed, 
from continuous standing, or unskilful shoeing, &c. Chill increases the 
tendency to the disease, which is therefore more frequent at the time of 
shedding the coat, after exposure to wet, or after long rest. The 
external causes comprise errors of diet and chill. Heavy foods, like rye, 
wheat, and barley, especially when given new, are particularly dangerous ; 
but new oats and new hay also produce laminitis. At present it is not 
quite clear how such foods act, but the fact that boiling and steaming 
seem to diminish the injurious effect, points to the presence of specific 
factors, and contradicts the view that the attack depends on the quantity 
of normally-digested material which enters the circulation at any one 
time. Such foods are particularly dangerous to animals which are 
unaccustomed to them, and which work little. Chills, either from 
sudden cooling of the body after perspiration, or from the consumption 
of large quantities of cold water, also produce the disease. Finally, 
laminitis oceurs as a complication of colic, during influenza, and soon 
after parturition. Imminger, who states that about 1 per cent. of 
mares become affected with “parturition laminitis,’ considers the 
disease due to toxic substances produced in the lochie. He says, 
however, that the feet seem to suffer less than the muscles. 

Symptoms and Course.—The disease appears suddenly, and is 
generally recognised on first taking the animal out of the stable by its 
attempts to avoid placing weight on the limbs, which are thrust forward. 
The fore-feet are moved rapidly, so as to avoid weight being thrown on 
them longer than is absolutely necessary, and the hind-feet are thrust 
forward in order to take a greater share of the load, and to relieve the 
front feet. 

When pain is less severe, the peculiar gait is seen most distinctly 


LAMINITIS. 697 


when turning; whilst, if the hind-feet also are affected, movement of 
any kind is exceedingly painful. The animals can scarcely be got out 
of the stable, and groan when forced to move. 

Pain is produced by pressing on the soles with the farriers’ pincers, 
especially around the toe, and the metacarpal arteries are found to be 
strongly pulsating. During acute attacks, fever is marked, thermometer 
readings sometimes rising to 39 or 40° C., whilst the surface temperature 
is unevenly distributed. 

In favourable cases these symptoms disappear in three to five days, 
but generally last longer. Displacement of the os pedis can be detected 
by the falling-in round the coronet and depression of the sole. Once this 
has occurred complete recovery is no longer possible; the soles “ drop,” 
and the animal ceases to be useful for work on stones or at a rapid 
pace. 

Horses with dropped soles exhibit a peculiar gait: the os pedis being 
partly rotated around its transverse axis causes relaxation of the flexor 
pedis perforans ; every time the animal extends the limb, therefore, the 
coronet-joint shows abnormal dorsal flexion, in consequence of which the 
heels come first to the ground. 

Laminitis is sometimes complicated with muscular rheumatism, 
pleurisy, pneumonia, or colic, the first two diseases being associated 
with rheumatism, the colic with dietetic errors. Laminitis may not 
become marked until the colic, pneumonia, or pleurisy has passed off. 

Differential Diagnosis.—The following are some of the conditions 
which most closely simulate laminitis :— 

(1) Bruising of the sole in unshod horses; this is detected by an 
examination of the foot. 

(2) Muscular rheumatism. In this case the animal sometimes moves 
as in laminitis; the step is short and cautious, but the front limbs are 
not extended, and while symptoms of inflammation of the hoof are 
wanting, the muscles of the limb seem in a state of abnormal tension, 
and are painful on pressure. 

Prognosis.—The consequences depend partly on the severity of the 
attack, partly on the stage at which treatment is resorted to, and partly 
on the formation of the hoof and the character of the complications. 
The intensity of the disease varies greatly ; it may be fairly estimated 
by the degree of pain. 

To ensure resolution, treatment must be adopted within the first 
twenty-four to forty-eight hours. In this case recovery is generally 
complete, though it should not be forgotten that for weeks after the 
disappearance of symptoms the tendency to fresh attacks continues, and 
therefore relapses are exceedingly common. 

The prognosis is less favourable when the hoofs are already deformed, 


698 DISEASES OF THE HOOF. 


and especially when the soles are dropped. Cases following errors in 
diet are less favourable than those of rheumatic origin; and when all 
four feet are attacked, there is less hope of recovery than when the 
front feet alone are implicated. Finally, heavy-bodied horses suffer more 
severely than lighter animals. 

Treatment.—From the earliest times laminitis has been treated by 
free bleeding, which I myself consider very useful if early resorted to. 
During the first three days bleeding from the jugular almost always 
produces rapid diminution of pain and inflammation. It is especially 
useful in cases following dietetic mischief, but is also of advantage even 
in rheumatic laminitis. Local bleeding, either from the coronet or sole, 
is less effectual ; and the production of a wound in the sole is dangerous, 
because it may become the starting-point of septic or purulent inflam- 
mation. If, therefore, bleeding from the toe be resolved on, the parts 
should be treated antiseptically. Bleeding from the coronary plexus is 
not so dangerous, and scarification of the coronet has often been recom- 
mended. 

The second means of treatment consists in cold applications. Cold 
poultices may be applied to the feet, or the animal may be placed in water. 
When pain is severe, poultices deserve preference. Foot-baths are 
only of use in slight lameness, and it should not be forgotten that con- 
tinued standing favours displacement of the os pedis, and, therefore, that 
it is preferable to allow the animals to le, and to apply cold applications 
to the feet. Plenty of straw bedding should be given, the animals being 
kept out of draughts, and made as comfortable as possible. It is also 
advantageous to remove the shoes and place the horse on a soft bed, so as 
to oppose descent of the os pedis by distributing pressure over the sole. 

In “ dietetic ” laminitis a dose of physic may be given, both to diminish 
local inflammation and remove, as quickly as possible, any injurious 
material from the bowels, thus preventing its absorption. In the 
rheumatic form the parts should be rubbed with spirituous solutions, 
and the body warmly clothed. 

Friis recently recommended pilocarpine in doses of 5 to 7 grains 
My experiments with this drug have given varying results; some cases 
showed improvement, others were unaffected. It may be tried, however, 
especially where the attack is obstinate, and the os pedis shows no signs 
of displacement ; but after displacement, of course, neither this nor any 
other drug can effect a cure. To diminish severe pain, subcutaneous 
injections of morphine are useful. 

tegulation of diet is especially necessary, and when the attack has 
followed excessive feeding, the animals are put on short rations. For 
the time being, corn should be completely withdrawn ; in summer, grass 
can be given; in winter, hay and bran-mashes. 


CHRONIC INFLAMMATION OF THE SENSITIVE LAMINE. 699 


It is now well recognised that, from the outset of the attack, exercise 
is useful, particularly in rheumatic laminitis. Sometimes the lameness 
oceurs whilst resting during a journey; and if the animal be started 
again, and pushed until it perspires freely, being afterwards carefully 
guarded against chill, it may completely recover. But, apart from the 
severe pain inseparable from this method of treatment, it may end in 
ageravation of the condition. The experiments made in the English 
army do not altogether recommend the treatment, though, under some 
circumstances, for example during field manceuvres, it may be useful. 

The treatment of dropped sole pertains to the province of shoeing, 
and I shall only remark here, that though the form of hoof may be 
improved, yet the animal’s usefulness is never completely restored. My 
experience supports Peter’s view, that, as soon as acute inflammatory 
symptoms have disappeared, it is best to apply shoes with thick heels, 
and to lengthen the heels of the hoof as much as possible. After 
shoeing in this way, I have seen marked improvement in horses 
which had for months been unsuccessfully treated by many varying 
methods. 


(b) Chronic Inflammation of the Sensitive Lamine. 
Pododermatitis Chronica. 


Chronic inflammation of the sensitive lamine follows slight but 
continually repeated mechanical irritation or other injury, the nature 
of which is at present imperfectly understood. The former class was 
studied and described by Lungwitz. Certain portions of the hoof grew 
with excessive rapidity and became thickened, sometimes causing horn 
tumours (keratomata) and chronic lameness; sometimes chronic inflam- 
mation occurs in the sensitive lamine, and interferes with horn produc- 
tion, producing “ seedy toe.” 

As a rule, these processes are all very obstinate. One section has 
little surgical interest, and, therefore, need not be considered here; it 
includes, for instance, ossification of the lateral cartilage, a condition 
of more importance in relation to shoeing. 


L—KERATOMA. 


Lit.: Frohner, Deutsch. Zeitschr. f. Th. 10, p. 576. Gutendcker, 
Monatshefte. 1890, p. 10. 


The horn forming the inner surface of the wall at the point where the 
wall is united to the sensitive laminz may become thickened, producing a 
new growth, which is variously known as keratophylocele, keraphyllocele 


700 DISEASES OF THE HOOF, 


or keratoma. Such growths sometimes start from the coronet, in conse- 
quence of treads or other injuries producing chronic inflammation in 
the lower papille of the coronary band and consequent hyperplasia. 
This pathological thickening gradually extends downwards towards the 
ground surface of the foot, and pressing on sensitive structures, gives 
rise to chronic lameness. 

In other cases the sensitive laminz form the points of origin of 
keratomata. In this case the irritation starts in the white line, being 
either set up by a misdirected nail, by separation of the wall, or by 
cracks in the horn. Keratomata so formed are confined to the lower 
portions of the wall, and though occasionally they extend upwards in 
the direction of the coronet, they seldom reach it. 

Such thickenings, of course, press on the sensitive lamine and os 
pedis, which, therefore, show a depression at the affected spot, corre- 
sponding in form to the keratoma. 

The diagnosis of keratoma during life can only be assured when the 
growth appears on the plantar surface. The white line then seems to 
be thrust towards the centre of the sole at the point affected, the inner 
border of the keratoma itself forming in fact the white lne. Where 
the growth is due to a split in the horn, the wall is divided from the 
new growth by a space. 

Keratomata, derived from the sensitive lamin, frequently produce 
chronic inflammation of the latter. In such cases a secretion, which 
is sometimes watery, sometimes purulent, discharges from the space 
between the horny and sensitive lamine. A probe may often be passed 
to the upper margin of the split, 72, as far as the upper end of the 
keratoma. 

Keratomata usually, but not always, produce lameness, which exhibits 
all the symptoms of foot lameness, except acute inflammation. In 
exceptional cases, even these (increased warmth and pulsation) may be 
detected. 

The prognosis depends principally on the presence or absence of 
lameness, and on the possibility of removing the diseased growth. 
It is, therefore, important to know whether the keratoma has originated 
in the coronary region, or from the lower sections of the sensitive 
laminee. In the first case, its removal not only offers great difficulty, 
but enforces a long rest as the hoof is divided to a considerable extent, 
and a large amount of horn removed. In the second case, the time 
required for recovery is In proportion to the distance the diseased growth 
extends upwards. Keratomata, growing from the coronet, generally 
produce deformity of the outer surface of the wall, which is therefore 
an unfavourable sign. 

Treatmeat.—The lameness can only be cured by excision of the 


CHRONIC INFLAMMATION OF THE SENSITIVE LAMINAE. 701 


keratoma. Mayer recommends thinning the affected spot with the 
rasp, and removing the keratoma by means of knife and forceps. 

Frohner and Gutenacker divide the wall around the keratoma with 
a special knife, remove the growth completely, and seek to_ assist 
healing of the operation wound by antiseptic precautions. 

The great difficulty of this method is to determine the extent 
of the keratoma by examining the outer surface of the wall. To 
obviate this, Gutenicker suggests boring into the wall and probing to 
discover how far the thickening extends. The growth may also be 
removed by starting from the bearing surface of the wall and working 
upwards until its upper margin is reached. 

The operation wound should be treated antiseptically. Like Bayer, 
however, I have grave doubts whether complete recovery always follows. 
The cavity in the os pedis may possibly be filled up again, but as the 
tendency to new growths exists in the sensitive lamine, and is not 
removed with removal of the keratoma, the disease not infrequently 
returns. 


Il.—CHRONIG INFLAMMATION OF THE SENSITIVE 
LAMINA. 


Lit.: Schleg, Der Hufschmied. vol. 4, p. 85. Lungwitz, Dresd. Ber. 
1873, p. 126. 


Considerable spaces sometimes form between the sensitive and horny 
lamine, whilst the surface of the sensitive laminz becomes covered with 
a thin, turbid, fluid secretion, At this point the sensitive laminz appear 
enlarged and displaced. Their surface, which in parts is completely 
exposed, is covered with a thin purulent secretion and not infrequently 
shows granulations. 

The process, described by Schleg as chronic “thrush ” (Hufgeschwiir) 
or thrush of the sensitive lamine, is usually confined to a spot the size 
of a shilling in the lower parts of the sensitive lamine. Sometimes, 
however, it extends upwards along the lamine, and may even reach the 
coronet, but there seems no tendency to penetrate more deeply. The 
chronic irritation around the diseased spot sometimes causes formation 
of keratomata (p. 700). 

The condition is due to chronic irritation, but it is as Inaccurate to 
describe it as ulceration as it would be to apply the same term to 
canker. The two processes, however, often show so great a resemblance 
as to be distinguished only with difficulty at the first glance. The prin- 
cipal difference consists in the benignant character and amenability to 


702 DISEASES OF THE HOOF. 


treatment of the disease now under consideration, as opposed to the 
very careful and prolonged treatment demanded by canker. ‘The 
rapidly curable cases of canker, sometimes described, are probably 
due to this disease. 

The condition generally develops after acute inflammation caused by 
pricks, separation, or fissuring of the wall. Schleg saw the disease 
result from separation. Should the inflammatory centre become 
infected, healing is delayed, and the disease may become chronic. ‘This 
is shown by the fact that, after removal of the infected portion of wall 
and careful cleansing of the surface of the sensitive lamine, healing 
generally follows in three to five weeks. 

Symptoms.—Attention is first attracted by the lameness or escape 
of discharge through the white line during shoeing. The extent of 
diseased tissue can be detected by probing. Lameness is not a constant 
feature, but appears immediately acute inflammation is set up by the 
entrance of foreign substances, 

The only difficulty in diagnosis consists in distinguishing this con- 
dition from canker, a point which often can only be settled by observing 
the course of the disease. Healing rapidly follows removal of the 
portion of wall covering the diseased Jamuine, whereas in canker the 
same treatment produces active swelling and vegetations from the sensi- 
tive lamine, which extend beyond the aperture thus made, and require 
great care to reduce. In this respect the two conditions present a very 
important difference. 

Treatment.—The first step is to at once remove the wall covering 
the diseased spot by means of the rasp and guarded knife without 
injuring the diseased sensitive lamine ; it is, therefore, necessary to note 
accurately the point of division between the horny and vascular parts. 
After cleansing, as far as possible, the diseased lamin, they are painted 
with liquor ferri sesquichlor., a mass of tow or jute, soaked with the same 
fluid, is applied to the diseased spot, and fastened by means of a bandage. 
If proliferation from the surface of the sensitive structures proves 
troublesome nitrate of lead may be employed; Schleg used the actual 
cautery. The above described dressing should then be applied and left 
in position for some days. When changing it, the parts are carefully 
examined, and if the wall has become further undermined the affected 
horn should at once be removed, but as a rule there is no marked 
tendency to extension. 


CANKER OF THE SOLE AND FROG. 703 


H1.—CANKER OF THE SOLE AND FROG (PODODERMATITIS 
CHRONICA VERRUCOSA VEL MIGRANS). 


Ger. Hufkrebs, Strahlkrebs. 


Since olden times a chrouic inflammatory disease of the horn secret- 
ing structures of the foot, which shows a strong tendency to extend and 
seize on fresh areas, has been recognised and generally described as 
canker. The disease consists essentially in chronic proliferation in the 
papille and tissue of the rete, the papillee becoming enlarged and the 
cellular elements of the rete undergoing active increase. True horn 
production is thus checked, the epithelium produced not forming horn, 
but breaking down and producing a greasy, stinking, grey fluid. As 
pointed out at p. 569, the disease is identical in character with so-called 
grease, 1.¢., 1t consists in a dermatitis verrucosa: it has also been stated 
that either condition may produce the other, 7.¢., that grease may cause 
canker, and canker grease. Both conditions are very obstinate. 

Symptoms and Course.—The commencement of the attack is 
generally overlooked. As a rule, a small prominence first forms on the 
frog and produces a grey, greasy, offensive material. On more careful 
examination the enlarged papille of the frog, which cause the swelling, 
ean be detected with the naked eye. Lameness is rare at first, a 
symptom of considerable diagnostic importance, for in acute inflam- 
matory diseases great pain and lameness are always present. In the 
sensitive laminz the process produces similar changes to the inflam- 
mation described on p. 701. Gradually, sometimes almost imper- 
ceptibly, the disease extends, attacking first the frog, then the sole and 
bars, passing from these to the wall, and sometimes reaching as high as 
the coronet ; always making its way between the sensitive and horny 
structures, which it finally separates. The sensitive lamine become 
enlarged and converted into fan-like structures, which produce exuberant 
vegetations immediately the wall covering them is removed. 

With the extension of the process to the bars and sole the hoof expands 
at the quarters, whilst the frog considerably enlarges. At this stage lame- 
ness is sometimes seen during movement over rough or even over soft 
ground. When the condition is neglected it continuously advances, until 
finally it affects the entire matrix, and may lead to loss of the hoof. 

Causes.—The causes of canker are at present little understood, and 
opinions as to the nature of the disease vary greatly. The name is a 
very old one, and originated at a time when it was customary to describe 
many different disease processes, distinguished by their malignant 
character, by the same term. It has long been recognised that canker 


704 DISEASES OF THE HOOF. 


has no real relationship with carcinoma or cancroid, and therefore, 
strictly speaking, the name is unjustifiable. Canker is probably due to 
specific infection, as seems indicated both by its course and the manner 
in which it reacts to treatment, but the infection does not appear to be 
due to a single organism but to several, which do not always agree in 
their method of action. The subject requires further investigation. I 
ceive this point more particular attention in my book on Diseases of the 
Foot. 

Prognosis.—<Although canker always takes a chronic course, yet it 
shows many variations which are of real importance in forming a 
prognosis. Under any circumstances the practitioner should be cautious 
in giving an opinion, though the greater number of cases recover. In 
forecasting the probable result the following points must be con- 
sidered :— 

(1) The nature of the growth. The more active the growth in the 
rete tissue and papille, and the softer the material produced, the 
graver the case. When the papillary growths retain their form, the 
case is more hopeful than when they are amorphous. 

(2) The area involved. The greater the tendency to extend, and the 
more widespread the disease, the less the chance of recovery. ‘Treat- 
ment is particularly difficult when the lamine are attacked, easier 
when the condition is confined to the frog and sole. Rapid extension 
is always an unfavourable sign. 

(3) The most difficult cases are those in which a predisposition to the 
disease exists, as shown by several feet being affected. 

(4) Treatment is, of course, nore difficult in restless and sensitive 
animals, and the prognosis correspondingly less favourable. The treat- 
ment in fact requires a great deal of patience, on the part not only of 
the veterinary surgeon, but also of the patient and owner. 

Treatment.—Perhaps in no other disease have so many drugs been 
tried as in canker. As indicated elsewhere, the selection of a proper 
material certainly plays a very important part in treatment, and only 
ranks second to the manner of applying it. Speaking generally, caustics, 
which destroy the new growths, together with astringents and disinfect- 
ants, appear most effective. Sublimate, chloride of zinc, carbolie acid, 
camphor, iodine, and many others have in turn found supporters, but, as 
Haubner very truly said, there is no specific against canker. With that 
I entirely agree, and may say that it requires long and close observation 
to discover the right material in any given case. 

In addition to local disinfection, it is necessary, firstly, to destroy 
the new growths on the papille ; and secondly, to check proliferation 
and secretion in the rete tissue. Success in the first case depends on 
the size of the new growths. Caustics, the actual cautery or the knife 


TREATMENT OF CANKER. 70d 


may be employed; but, whatever the means selected, care must be taken 
never to injure the deeper layers of the corium, but to confine treatment 
to the enlarged papille. The knife is less suitable than caustics, and 
has the disadvantage of causing bleeding. Amongst caustics, nitrate of 
lead, recommended by Piitz, perhaps stands first. When strewed over 
the diseased surface in the form of powder, it forms a dry scab, checks 
extension of the growth, exerts an intense drying action, and checks 
proliferation and secretion in the rete tissue. Sometimes the process 
starts again under the dry crust, which therefore requires to be carefully 
examined during the next few days. Inorganic acids, particularly fuming 
nitric acid, can also be used, but their application is more difficult, whilst 
their action is certainly not more satisfactory than that of nitrate of 
lead. The recent experiments with sulphuric acid in the treatment of 
grease (p. 571) suggest the advisability of trying it in canker; up to the 
present, however, I have not had a suitable case. When the growth is 
not severe, and the secretion is alone troublesome, liquor ferri sesqui- 
chlorid., 1 per cent. ; chloride of zine, 10 per cent. ; tincture of iodine, tar, 
&e., may be tried. Each has at some time been strongly recommended. 
Whichever be employed, a pressure dressing is always necessary. 

Portions of undermined horn must be removed. This is a sine qua non 
in treatment, and requires no slight dexterity and practice in handling 
the knife. 

As a rule, treatment is commenced by removing the horn, and, if the 
hoof be very dry and hard, by immersing the foot in a warm foot-bath. 
It is not always possible to remove every particle of loose horn at one 
operation, for as soon as bleeding occurs it is no longer safe to proceed, 
and is usually better to wait for a day. The foot is then soaked in a 
disinfectant, such as creolin, carbolic, chloride of zine, or sublimate 
solution. After one or two hours’ immersion, and after repeatedly 
washing the diseased part whilst the foot is in the bath, the material 
selected is applied, and a dressing put on. Next day this is renewed ; 
and if the process have extended further, the undermined horn is at 
once removed; otherwise, and if the surface remain dry, a fresh 
dressing is applied. 

At first, the dressing is renewed daily. To check excessive prolifera- 
tion, the parts are dressed with nitrate of lead, and a pressure dressing 
tightly applied. In disease of the frog, bars, and sole, a shoe provided 
with a removable iron covering, or a plaster cast, will be found exceed- 
ingly useful. To prepare the latter, the hoof is filled with freshly pre- 
pared plaster of Paris, mixed with chopped tow or hemp, to render it 
less friable, and the whole allowed to harden. When applying it, the 
sole should be covered with tow, so as to press as equally as possible on 


the growing tissues. A well-made shoe fulfils the same purpose. Even 
2 Ws 


706 DISEASES OF THE HOOF, 


at a later stage, it is important to renew the dressing every two or three 
days at least, and to examine the condition of the hoof. Particular 
attention should be directed to the margins of the diseased spot, and to 
the dry scab; if only the shehtest trace of grey, greasy material is pre- 
sent, if must at once be ascertaimed whether the process is not spreading 
in deeper-seated parts. 

The disease cannot be regarded as cured until every point is absolutely 
dry, and normal horn formation has again set in. In spite of all pre- 
cautions, relapses are very common, and therefore, for some months after 
recovery, the affected part should be kept under observation, so as im- 
mediately to check fresh onsets. Disease of the bars is exceedingly 
troublesome. The sensitive structures of the bar being in contact with 
those of the frog, the vegetations coalesce, and render it extremely difficult 
to completely expose the diseased spot. It is often necessary to excise 
a portion of the new growth, and insert tampons between the two, a very 
small tampon being first thrust into the depths, and followed by others 
of increasing size, so that the dressing extends into the space between 
the bar and frog in the form of a wedge. Many observers recommend 
placing the horse during the day on a thick clay bed, and, after thoroughly 
cleaning the hoof, to nse at night tan instead of straw. Although this 
method appears easy, its use is attended with many inconveniences. 
Apart from the necessity for daily cleansing and changing the bed, the 
clay becomes soiled by urine and feces, and requires frequent renewal. 
By working the horse on a brickfield, the same effect is produced more 
easily and thoroughly, whilst the daily exercise assists recovery. 

Such treatment is useful where the ground surface only of the hoof, 
i.e., the frog, sole, and bars, is affected, but is valueless in disease of the 
wall. The regular pressure on the new growths here plays the principal 
part; I have often seen recovery follow this treatment. 

A somewhat similar effect is produced by using the animal on soft 
ground, especially if shoes can be dispensed with. The process makes 
less rapid progress while the horse is at regular work than during rest, 
—a fact to be borne in mind. Should all other treatment fail, the 
animal should, if possible, be exercised. The effect is sometimes astonish- 
ingly good. 

Nocard some years ago recommended vigorous treatment with subli- 
mate solution. After completely exposing and carefully cleansing the 
diseased spot, it is sprayed for two hours and a half with 1 per cent. 
sublimate solution. The sole is then dried, and its surface sprayed for 
ten minutes with iodoform ether. Nocard gives Fowler’s solution in- 
wardly to the extent of 10 drachms in eight days. Later reports by this 
author and others show, however, that even this treatment sometimes 
fails. 


DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 707 


I need only repeat that more is due to care in carrying out operative 
treatment and skill in applying the dressings than to the selection of the 
material, though the latter plays a by no means unimportant rdle. 
Although the principles here set forth are sufficient to guide treatment, 
yet close persenal observation is necessary, and in many cases it may 
appear advisable to try certain of the other materials suggested. 


G. Diseases of the Claws in Cattle 
and Sheep. 


Lit.: Harms, Rindviehkrankheiten, p. 294. Hess, Fusskrankheiten d. 
Rindes. Siedamgrotzk y, Haubners Thierheilkunde, 10 Aufl. Schleg, 
Dresd. Ber. 1891, p. 99. Fambach, ibid. p,. 105. Vaeth-Moos 
bach, B. 2: W. 1891, p, 352. 


Although the claws of herbivora and swine are homologous with the horse’s 
hoof, yet they differ considerably from it in their outer form, and still more in 
their internal arrangements, Disease processes in the claws therefore show a 
general resemblance to diseases of the hoof, though they exhibit many special 
features dependent chiefly on the duplicate formation of the claws, and on their 
union by ligaments and soft tissues, partly on the absence of the frog and bars, 
and on other peculiarities of formation. 

The claw consists of a horny wall surmounted by a coronary band, and of a 
horny sole with bulbs similar to those of the horse’s heel. These perform the 
function of the frog, which, with the bars, is absent in ruminants. In medium- 


Fia. 141.—Vertical section of an ox’s claw. 


sized cattle the horny wall attains, on its outer part, a thickness of about 
3 of an inch, whilst the inner, which lies in contact with its fellow, is scarcely 
+ inch, and is considerably shorter than the outer on account of the sole sloping 
obliquely upwards to become continuous with it. 

The horny sole also has a thickness of about 3, of an inch, and reaches from 
the toe to the posterior third of the ground surface of the claw, where it becomes 
continuous with the wall. Above the wall, and between it and the tendon of 
the flexor pedis perforans, is a mass of firm connective tissue, to some extent 
corresponding to the fibro-fatty frog, and containing a large quantity of fat. 


The pedal joint (fig. 141) lies near the centre between the toe and ball of the 
foot, its middle point (/) being somewhat nearer to the toe than to the wall, and 


jn 


708 DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 


about # of an inch below the coronary border of the wall. A straight line 
drawn obliquely from the front of the interdigital space to the termination of the 
horny sole in the walls would nearly coincide with the lower border of the joint 
(figs. 141, 142). The posterior end of the os pedis lies between ¢ and d in 
figs. 141, 142, behind ¢ lies the navicular bone which completes the formation 
of the pedal joint. 

The coronet-joint is generally about # of an inch above the coronary border of 
the wall of the claw; the position of the fetlock can, or course, be determined 
by palpation. 

In each claw the tendon of the flexor pedis perforans forms with the navicular 
bone, close in front of the insertion into the os pedis, a bursa which corresponds 
to the bursa podotrochlearis of the horse. This lies over the posterior part of 
the horny sole, about the point where it becomes continuous with the bulb of 
the heel. 

The sensitive wall and sole differ little from the corresponding portions of the 
horse’s hoof, though the coronary band is broader, and reaches downwards almost 
to the middle of the horny wall. Between the claws the coronary band becomes 
continuous with the skin, which is hairless, and covered with a thick but slightly 
horny epidermis. Above this, 7.e., between the coronet bones, lies a large pad 
of fat, which is continued downwards under the inner horn wall, and assists the 
movement of the claws over one another. 

The bone of the claw (os pedis) is united to the coronet and fetlock bones by 
two internal and external ligaments, and through the former to the reinforcing 
band of the extensor pedis (ligamentum extensorum), whilst the cruciform or 
interdigital ligaments unite the two claws and prevent their being thrust too far 
asunder. The interdigital ligaments lying above the interdigital space unite the 
coronet bones, and pass through the fatty cushion of the bulbs of the heel to lose 
themselves in the sensitive sole. 


This peculiar structural arrangement renders cattle less suited for 
moving on hard ground, and, if they be forced to do so, predisposes the 
soft structures of the claws to injury. The distribution of weight in the 
claw is different to that in the hoof, Whilst in the hoof the wall sup- 
ports the principal weight and the sole is practically exempt, the sole of 
the claw carries by far the greater portion of weight. The same is true 
even when the claws are shod, and it explains the frequent occurrence 
of bruises of the sole. 

For a similar reason, the continued irritation of dirt and stable manure 
causes disease of the claw to exhibit special features. These consist in 
acute inflammation, which, under the action of infectious agents, lead to 
gangrene of soft parts and necrosis of bone, or purulent septic inflamma- 
tion of the claw or coronet-joint. 

The ox being less sensitive than the horse, Symptoms of inflamma- 
tion of the claws are less marked than those of laminitis, and examina- 
tion of the claws is more difficult than that of the hoof. Being generally 
macerated in stable manure, the claws of the hind-feet are less tender 
in this disease than the hoof in the like condition in the horse. It is 
also difficult in the ox to detect slight degrees of pain. When the pain 
is severe the animals lie a great deal and are difficult to raise, suggesting 


DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 709 


to non-professional observers that they are injured in the back. On 
forcing the animal to move, it endeavours, as much as possible, to avoid 
placing weight on the diseased foot, and in acute attacks weight is thrown 
on each only for a few seconds, or not at all. At the same time the foot 
is placed in peculiar positions ; when the pain affects the toe, most weight 
being placed on the bulbs of the heel, and vice versa: in the latter case, 
weight is only placed on the foot during a portion of the stride. 

In these animals a local examination, although absolutely necessary 
for diagnosing, is very difficult to make. When the animal is standing it 
is sometimes possible to lift the foot, as in the horse, and thus to examine 
it. In restless or obstinate animals, a cord may be passed round the 
front fetlock, carried over the withers to the opposite side, and the front- 
foot thus lifted. In the hind-foot the cord is passed round the leg just 
above the hock, or round the cannon bone, and a strong stick thrust 
through it. Two strong men then lift the foot; the hind-foot may also 
be drawn up to the shafts of a waggon and fastened. In any case, the 
animal must be firmly fixed by the head. 

When the animal is lying the foot is fixed by means of cords, though 
it is generally best to make the animal rise. Cattle often offer great 
resistance, which may sometimes be overcome by moistening the feet 
with turpentine, pouring water into the ear, or by bringing a dog into 
the stall. If all these methods fail, Johne’s method of lifting the animal 
may be tried: it consists in passing a girth, or strong rope, in front under 
the cariniform cartilage, behind under the ischium, so that it surrounds 
the animal’s body in a circle. This rope being properly fixed, a larger 
number of persons can assist, three or four standing at either side. Care 
must be taken, however, that a clear space of a yard or so is left in front 
of the animal, to allow it sufficient room to stretch out its head in 
rising. 

The foot being lifted, may be examined by pressing on and moving it. 
Any swelling, reddening of the neighbouring skin, wound about the claw, 
or discharge of pus should be noted. Both the coronet and skin of the 
interdigital space should be carefully examined, the foot being first 
cleansed. 

In cattle it is extremely difficult to use foot-baths, which, therefore, 
are of little practical value. 

Treatment is confined to carefully cleansing and keeping clean the 
parts by giving dry straw, and by the application of poultices and 
dressings. 


710 BRUISES OF THE FOOT IN OXEN. 


| —BRUISES OF THE SENSITIVE SOLE AND BULBS OF 
THE FOOT IN OXEN. 


In the smaller herbivora the claws are exceedingly strong in com- 
parison with the body-weight, and disease is correspondingly rarer than 
in oxen. In the latter, the claws of the hind feet are weaker than 
those of the fore, and therefore suffer most, while, of the two claws, the 
inner is the oftenest affected. Disease may be caused by long journeys 
over hard, rough ground, especially when the animals are fat, far 
advanced in pregnancy, or have been kept stalled for a long time, and 
are not shod. As, in oxen, the sole bears the greatest part of the 
weight, the reason of this will be apparent. The horny sole also 
becomes worn away in barefooted animals, and the bulbs of the foot 
suffer. 

Symptoms and Course.—The condition usually appears during a 
journey, the animals gradually becoming lame, the stride being shortened, 
with a tendency to lie, and to move the feet uneasily when resting. 
Once in their stalls they at once lie down, refuse food, and are 
difficult to raise. An examination of the claws shows that in one or 
more pain is produced by pressure over the sole and bulbs of the foot. 
The horn of the sole, later, appears reddened, and suppuration may occur, 
with discharge of pus at the bulb or coronet. When bruising is slight, 
and the animals are at once rested and placed on soft bedding, recovery 
follows in a few days, but in suppuration under the sole or bulbs there is 
danger of the animals dying from decubitus. The possibility of purulent 
inflammation and necrosis of the sensitive bulbs of the foot and under- 
lying connective tissue constitutes a further danger. Such cases may 
be followed by prrulent inflammation and necrosis of the perforans 
tendon, or be complicated with septic disease of the pedal joint. 

The prognosis must, therefore, be guided by the degree of pain and 
the existent changes. Necrosis of the tendon and purulent or septic 
inflammation of the joint is dangerous, but not absolutely hopeless, 
recovery sometimes following amputation of the claw; where several 
claws, and especially when several feet, are simultaneously attacked, 
however, there is little chance of the animal living. 

Treatment.— Unless suppuration has set in, it is often sufficient to 
give a few days rest, and plenty of soft bedding; severe pain may be 
combated by cold applications; but when pus has formed, a free exit 
must be provided, though with as little destruction of the wall and sole 
as possible. The superficial form of inflammation exhibits the same 
peculiarities as in the horse (p. 670), and a comparatively small opening 


WOUNDS OF THE SOFT TISSUES OF THE CLAW. mpd 


is sufficient to allow the thin fluid pus to escape. After carefully cleans- 
ing the claws and injecting undermined portions of horn, a dressing is 
applied, which by smearing with tar can be rendered waterproof, so as 
to guard against the diseased spot being soiled by manure, &c. Necrosis 
of the tendon or disease of the pedal joint necessitates amputation of the 
claw (p. 715). 


Il.—WOUNDS OF THE SOFT TISSUES OF THE CLAW. 


On account of the comparative thinness of the horny wall, the soft 
tissues of the claw are often wounded in shoeing. They may also be 
injured by picked-up nails or other foreign bodies penetrating the sole. 
Such wounds generally affect the posterior parts of the sole and the bulbs 
of the heel, and are therefore as dangerous in cattle as in horses, the per- 
forans tendon and pedal joint bemg readily injured in either; pricks in 
shoeing seldom injure more than the sensitive lamine. These facts 
should be borne in mind in forming the prognosis. 

Symptoms.—Lameness usually sets in suddenly. Sometimes it is 
only slight, sometimes severe. Before examination the claws must be 
thoroughly cleansed. When the flexor tendons are injured pain is acute, 
and little or no weight can be placed on the foot, while the animals 
show great pain on dorsal flexion of the claw. Implication of the joint 
is shown by excessive pain, especially on rotation of the claw, and by 
swelling of the coronet, most marked apove the toe. Not infrequently 
purulent synovia is discharged. 

Treatment requires the removal of any foreign body, cleansing of 
the injured spot, furnishing of a proper opening for discharge of pus 
(the above-mentioned precautions being borne in mind), and finally the 
observation of precautions against infection. Clean, dry straw should be 
provided, and, if necessary, a dressing applied. Injuries or secondary 
affections of the flexor tendons are treated on the lines laid down in 
speaking of panaritium. 


IIl.—WHITLOW OF THE CLAW, JOINT FELON, 
PANARITIUM. 


The term “ panaritium ” is used to distinguish an acute inflammation, 
rapidly leading to suppuration, and always attended with necrosis, which 
in man occurs under the nail, in oxen appears at different parts of the 
claws, and extends thence to more distant points. The use of the word 


ele DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 


is quite justifiable, for in cattle the condition attacks the part homo- 
logous with the nail, and the process develops in just the same way as 
in man. Panaritium is always due to wound infection, followed by 
cellulitis, which, partly in consequence of the action of the infecting 
agent, partly of the anatomical formation of the diseased parts, always 
tends to necrosis. In oxen the claws are exceedingly exposed to such 
infection. Being almost always surrounded by dirt, slight injuries of 
the skin, which are certainly not uncommon, at once open the way to 
infection, and this again often extends to deeper-seated structures. The 
process is, therefore, not confined to the skin, but extends to the sub- 
cutis, and not infrequently to the tendon sheaths, bones, and joints, 
producing conditions of the gravest character. 

According to its seat we distinguish panaritium of the toe and bulbs, 
and interdigital panaritium, all of which have been carefully described 
by Harms. JBeing essentially due to infection, this disease sometimes 
extends very widely, appears more frequently in certain establishments 
and even becomes enzootic, while outbreaks are favoured both by neglect 
of cleanliness in the stalls and by travelling on hard ground. Schleg 
noted inflammation of the interdigital skin, which often led to necrosis 
in cows at grass during the autumn. Of twenty-eight animals which 
stood together, eight were attacked, whilst those standing on the other 
side of the stable entirely escaped. 

(1) Panaritium of the toe develops at the anterior end of the inter- 
digital space. An inflammatory swelling appears, without any visible 
external injury, involves the coronet and skin of the interdigital space, 
and may extend beyond. Where pigment is absent, the skin appears 
reddened, swollen, and painful; and in walking, weight is only momen- 
tarily placed on the foot; the slightest pressure causes the animal to 
groan loudly. The attack is ushered in by fever and loss of appetite. 
After some days a separation occurs at the coronet, and soon afterwards 
a thick fluid pus is discharged. At this stage the symptoms usually 
moderate, granulation occurs, and is soon followed by complete recovery. 
Even when a piece of skin is destroyed, recovery occurs in two to three 
weeks. 

The condition consists of cellulitis of the cutis and subcutis, accom- 
panied by necrosis, and may therefore be described as panaritium 
subcutaneum. Harms views this as the first degree of panaritium. 

Inflammation often attacks the connective and adipose tissue lying 
above the interdigital space, and the tendons and ligaments of the pedal 
and coronet bones. The symptoms are then very severe; both swelling, 
redness, and pain are greater, scarcely any weight is placed on the foot, 
the swelling extends further backwards and downwards over the skin of 
the interdigital space, and fever, loss of appetite, stoppage of milk 


PANARITIUM, alte 


secretion, and general wasting ensue. The skin becomes gangrenous, or 
an aperture forms from which ichorous pus is discharged in large quan- 
tities. The symptoms then moderate, and recovery follows in about three 
weeks under appropriate treatment. This process might be described 
as panaritium profundum, 

But if such an attack be improperly treated, or the infectious mate- 
rial be particularly virulent, necrosis may extend to the coronet or pedal 
bone, or to one or other of the joints, and septic arthritis develop, «e., 
panaritium ossium vel articulare. The animal then shows intense pain. 
Immediately a joint is attacked, the swelling extends to the cannon 
bone, though in disease of the pedal joint, swelling is greatest around 
the interdigital space. The patient shows high fever, and the same 
symptoms as in panaritium profundum, but in an aggravated degree. 
Slight rotation of the claw produces great pain. It should, however, 
be remarked that in cattle the latter symptom is not so pathognomonic 
of arthritis as in the horse, because the swelling in and about the inter- 
digital space may render rotation very painful. But where no swelling 
exists, the symptom becomes particularly significant. Arthritis or necrosis 
of the coronet or pedal bone, as a rule, necessitates amputation (p. 
715). 

(2) Interdigital panaritium consists in infectious inflammation of the 
skin, and deeper structures connecting the two claws, especially of the 
fatty tissue, which is so abundant in this region. It occurs oftenest 
when the claws are excessively separated, and when the oxen are 
worked, both of which conditions favour injury and infection of the inter- 
digital skin. The skin between the two claws appears swollen, and pro- 
trudes somewhat in the form of a snail,—hence the origin of the French 
term “Limace.” Pain is marked, no weight can be borne on the foot, 
the animal lies continuously, and shows fever and loss of appetite. 
After a few days the skin between the claws breaks; sometimes the 
interdigital ligament is ruptured, and the swelling increasing in size, 
causes the claws to recede from each other. 

Appropriate and early treatment is generally followed by recovery, 
though in cases the process extends to the os corone or to the pedal 
joint. Asa rule, the latter danger is not so great as in panaritium of 
the toe, the pedal jot not being so likely to become implicated from 
this point. 

(3) Panaritium of the bulb of the foot generally attacks the inner 
bulb of one of the front feet ; sometimes both bulbs are attacked, very 
seldom the external alone (Harms). The cellular inflammation rarely 
confines itself to the sensitive parts of the bulb, and to the connective 
and fatty tissue lying above them, but, as a rule, seizes on the flexor 
tendons, and often on the pedal joint. Necrosis of the tendons sets in, 


7i4 DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 


with purulent or septic disease of their sheaths, at the point at which 
they pass over the navicular bone, for which reason this form might 
be described as panaritium tendineum. 

The symptoms consist of severe pain on attempts to place weight 
on the foot, and on pressure over the diseased bulbs. Necrosis of the 
flexor tendons, and disease of their burse, are shown by the claws being 
extended ; in arthritis, rotation of the claw is particularly painful. The 
excessive tenderness, and severe and more general swelling, distinguish 
this condition from simple bruising of the bulbs of the claws. 

The course depends on the character and extent of the disease. 
When the bulbs and the structures underlying them are alone impli- 
cated, recovery takes place in two to four weeks. In disease of the 
flexor tendons or pedal joint, amputation 1s the only resource. 

Treatment.—Preventive treatment consists in keeping injuries as 
clean as possible, and preventing further infection by dressings or 
smearing the parts with tar, and by giving plenty of dry, clean straw as 
bedding. When a panaritium is detected, the inflammation has usually 
passed the stage at which resolution is possible, and efforts must be 
made to provide the best possible exit for pus and necrotic tissues. The 
most useful agent is certainly the knife, though in many cases it cannot 
at once be used, and the abscess must be assisted to point by warm 
poultices of linseed, &c. Fambach recommends the long-continued 
application of warm alum solution. As soon as an abscess is discovered, 
and can be reached with the knife, it should be opened, the wound being 
antiseptically treated and washed out with 10 per cent. chloride of zine 
solution, or injected with 3 per cent. of creolin. Esser recommends 
using the curette, washing out the parts with 5 per cent. carbolic solu- 
tion, applying an iodoform dressing which is smeared with tar, and 
allowing it to remain in position for eight to ten days. To keep the 
horn soft, moist dressings are best. Gangrenous tissue should, as far as 
possible, be removed with the knife and scissors. 

The opening of abscesses is least dangerous in interdigital panaritium, 
and Harms recommends completely dividing the skin between the claws, 
if it has not previously been ruptured. In panaritium of the bulb the 
bulbs themselves should be spared as much as possible; they should 
never be completely divided in the longitudinal direction of the claw, as 
their further growth would be interfered with. In panaritium of the 
toe the skin is divided perpendicularly, the diseased point laid open, and 
free exit given to discharges. 

Dressing the parts calls for particular care. In panaritium of the toe 
and interdigital panaritium the interdigital space is filled with tow or 
jute, soaked in carbolic or creolin solution, to such an extent as to pre- 
vent the claws moving. Both claws are then covered with one dressing 


PANARITIUM. 715 


and surrounded by a bandage or cloth rendered waterproof by a free use 
of tar. 

As a rule, pain soon disappears after the abscess breaks or is punc- 
tured. The dressing may then be left in position for several days, but 
the above precautions should be taken when it is renewed. If granula- 
tion appears too free, astringents like solution of alum or sulphate of 
copper may be applied, or the parts can be dusted with charcoal. 

In oxen, the skin at the front of the interdigital space sometimes 
becomes inflamed, but the process remains confined to the cutis, and pain 
is less severe than in panaritium of the toe, though healing is difficult 
on account of the inevitable movement of the claws. The skin appears 
somewhat swollen and painful, and an inflammatory discharge flows 
from the surface, which, in drying, produces crusts, while the coronary 
edge of the horn becomes locally separated. The animals should be 
placed on dry straw, the diseased spot carefully cleansed, powdered with 
icdoform, and a triangular piece of wood corresponding to the width of 
the interdigital space placed between the claws and fixed in position by 
a strong cord or wire passed round the claws. This prevents movement 
of the claws, which interferes with healing. To ensure the cord or wire 
remaining in position, a couple of shallow grooves may be made with the 
knife or rasp around the lower part of the foot. 

Vaeth suggests the use of chloride of zine dissolved in water and 
made into a paste with an equal quantity of flour for treating inflamma- 
tory new growths and warts in the skin of the interdigital space. The 
material is smeared on the diseased spot and a dressing applied over 
it. Vaeth treats warts by laying them open and rubbing in chloride of 
zinc, after which they fall off in a few days. 


IV.—AMPUTATION OF THE CLAWS IN OXEN. 


When purulent or septic inflammation of the pedal joint occurs in 
consequence of any of the above-described forms of panaritium, or of 
injury from picked-up bodies, or when extensive necrosis attacks the 
phalanges, it is best to amputate the affected claw. Failing this, pain 
continues, and the animals die from decubitus, or from septiceemia. 
Even in the few cases which recover, the animal’s general condition 
suffers very greatly. 

The experience of Harms and others encourages the performance of 
this operation, very little disturbance being caused, and recovery being 
comparatively rapid and complete. 

Esser looks on amputation as the last resort in extensive necrosis of 


716 DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 


the phalanges. Provided the animal is still able to stand and has not 
suffered much in condition, he prefers conservative treatment. 

Amputation may be effected either by exarticulation of the joint of 
the claw, or by resection of the os suffraginis, Harms prefers the first 
method, and lays great stress on the necessity for preserving the bulbs 
in order to ensure regeneration. The navicular bone is not removed. 

The animal is cast, firmly fixed, and an Esmarch’s bandage applied 
round the knee or fore-arm to prevent bleeding. Harms then removes 
the horn in grooves at either side, and on the lower surface of the claw, 
by means of a farrier’s knife, the grooves thus made penetrating as far 
as the soft tissues and converging to one point. The coronary band is 
next separated, and the pedal bone removed along with the horn of the 
claw. 

Eggeling first thins the horn over the posterior half of the outer 
wall and of the bulb. With a curved knife he makes an incision, 
starting from the interdigital space, and keeping below the coronet, 
which exposes the pedal joint, and takes the direction a to 6b to ¢ (fig. 
142). The posterior end of the pedal bone (fig. 142, ¢) being reached 


? 


Fia. 142.—An ox’s claw, The letters a to d correspond to those in Fig. 141, and show the 
position of the pedal joint. 


the incision is continued downwards at a right angle (fig. 142, d) to 
prevent injuring the navicular bone. By pressing the toe downwards 
and backwards whilst making this incision, the pedal joint is opened, 


AMPUTATION OF THE CLAWS IN OXEN. tLe 


and the inner wall of the claw and interdigital ligaments may be cut 
through. 

I have repeatedly operated by this method during the last few 
years, and can recommend it. The greatest difficulty lies in so direct- 
ing the knife as to exactly find the jomt; but by bearing in mind the 
topographical relations given, and by using a very narrow though not 
too weak a knife, the difficulty is much diminished. 

After completely dividing the claw at the joint, loose or necrotic 
pieces of tissue are removed with scissors or knife. Any undermined 
parts and granulations are thoroughly disinfected, the articular cartilage 
scraped away from the coronet or suffraginis bone with a curette so as 
to produce a better granulating surface, the operation wound covered 
with a tampon soaked in tar, and a dressing extending above the 
fetlock-joint applied over all. The turns of the bandage are sewn 
together to keep the whole firm, and plenty of tar applied. This 
dressing is left in position for eight to ten days. On renewing it, 
good granulations are generally discovered without suppuration having 
occurred. Recovery takes four to six weeks, the stump being covered 
by horn, secreted partly by the remaining portions of the coronary band, 
but chiefly by the bulbs of the heel. This growth is so perfect that 
animals may even be again turned out to grass. 

After extensive necrosis of the os coronz, or purlent inflammation of 
the coronet-joint, it may be necessary to remove the coronet bone along 
with the lower end of the os suffraginis. The animal is fastened as 
above described, and an Esmarch’s bandage applied. The skin above 
the bulbs is then divided, either at the outer or anterior and posterior 
face of the phalanges, and separated from underlying structures, the os 
suffraginis being then sawn through in an oblique direction, from above 
downwards. After checking hemorrhage, the point of operation is 
cleansed, disinfected, and the flaps of skin cut to shape and sutured 
under the stump. The above-described dressing may be left in position 
for eight to ten days, and seldom requires to be renewed more than two 
or three times before healing becomes complete. 


V.—POOTROT IN SHEEP. 


Ger, Klauenspaltentziindung, Klauenentziindung, Moderhinke. 


Apart from foot-and-mouth disease, and from the virulent or 
malignant foot-rot of sheep, dealt with under works of special pathol- 
ogy, chronic inflammation of the claws occurs in sheep, and is accom- 


718 DISEASES OF THE CLAWS IN CATTLE AND SHEEP. 


panied by chronic suppuration in the coronet or interdigital space. The 
horn at the coronet is loosened, the claw undermined, the lower 
phalanges and their ligaments sometimes become necrotic, and the 
pedal and coronet joints may be attacked, though they suffer less 
frequently than in cattle. 

Causes.—As a rule, foot-rot is produced by the same causes as 
panaritium. Continued standing on wet pastures or manure softens 
the horn of the claws, produces maceration of the skin around the 
coronet, and while it favours inflammation of the surface, leads by 
infection to suppuration, which tends to extend to deeper-seated strue- 
tures. Once the upper edge of the horn becomes loose, or inflammation 
occurs in the interdigital space, recovery is impeded by the continuous 
movement of the parts and the entrance of fresh infective material; at 
the same time, the burrowing of pus is facilitated. 

Symptoms and Course.—Attention being drawn to the disease by 
the accompanying lameness, the skin of the interdigital space is found 
to be red and swollen. Soon afterwards the surface becomes moist, a 
serous, and later a purulent, fluid being discharged. As a rule, inflam- 
mation is confined te the cutis, but the coronary edge of the horn and 
wall of the claw become loosened, the wall and the sole often under- 
mined, and the horny claw may even be lost, unless proper treatment 
be immediately undertaken. In exceptional cases panaritium sets in, 
producing necrosis of the ligaments, tendons, and bones. 

As swelling increases and the process extends, pain gradually becomes 
more acute. The animals lie continuously, or are absolutely unable to 
bear weight on the diseased foot, and suffer severely in condition. 
When the superficial attack receives no attention, the infection continues 
to extend, the disease becomes chronic, and may last for months. 

Prognosis depends on the extent of local changes and on the degree 
of pain. Particular caution is required when the animals show great 
pain, cease to feed, and fall off in condition. The more the claws are 
deformed, the slighter the chance of recovery. 

Treatment.—The animal should be removed to a dry place, all 
moistening of the parts avoided, and when the horn is loosened and 
undermined, provision should be made for the escape of discharges. For 
this purpose loose horn should as far as possible be removed, and the 
diseased spot carefully cleansed. When the disease is superficial, it 1s 
sufficient to smear the parts with tar, carbolic acid, or glycerin (5 to 10 
per cent.), or to powder the diseased surface with iodoform or similar 
disinfectant. Troublesome granulations are checked by astringents lke 
sulphate of copper, alum, sesquichloride of iron, &c., though the cause 
of such growths, which often consists in the presence of dead masses of 
tissue or projecting pieces of horn, must be removed. 


AMPUTATION OF THE CLAWS IN OXEN. 719 


In deeper-seated disease, the treatment is similar to that in panaritium. 
Fixing the claws by a dressing or piece of wood placed in the interdigital 
space, and fastened by string, will also be found of service. 

In sheep, the horn of the wall and sole sometimes grows irregularly, 
or becomes too long, leading to suppuration under the sole. The treat- 
ment consists in shortening the wall, thinning the sole, and giving a dry 
bed. Further treatment is guided by the same principles as in inflam- 
mation of the horse’s hoof. 

Finally, a grey fatty material sometimes accumulates in considerable 
quantity in the peculiar glands above the claws in sheep, and is dis- 
charged as a worm-shaped mass when the parts are pressed, or the 
claws foreed into contact. The condition, which has been described as 
claw-worm (Klauenwurm), is seldom of practical importance, but is some- 
times looked on by shepherds as the cause of other painful conditions. 
Under some circumstances, retention of this secretion may certainly lead 
to inflammation of the sac. A painful swelling then appears at the front 
of the interdigital space, and discharges more or less puriform fluid if 
compressed. To effecta cure, it is usually sufficient to repeatedly empty 
the sac by pressure. 


H. Diseases of the Claws in Carnivora. 


Lit.: Siedamgrotzky, Ueber die Struktur und das Wachsthum der Krallen 
der Fleischfresser. Dresden 1871. Schoénfeld’sche Buchhandlung. E1len- 
berger, Anatomie des Hundes. Berlin 1891, Parey. Kutzbach, Gurlt 
u. Hertwig. vol. 29, p. 243. 


The claws surround the last phalanx, which, in carnivora, is covered by the 
claw matrix, just as is the os pedis in other animals. The third phalanx of the 
dog lies almost at a right angle to the second, with which it articulates (Siedam- 
grotzky), and just in front of the jot shows a ring-shaped depression, to receive 
the base of the claw. The portion of cutis which serves as matrix to the claw 
shows circular thickening, the coronary band, which secretes the horn of the claw. 
The matrix covers the anterior portion of the third phalanx, and exhibits small 
furrows or laminee. The volar surface of the third phalanx is covered with a 
material homologous with the sensitive sole. The claw is formed by two horny 
plates, lying closely together, and enclosing a space. They are fixed by their base 
into the furrow in the bone, ‘Two elastic ligaments, which start from the upper 
end of the second phalanx, and run to the upper surface of the furrow, serve to 
lift the claw, and prevent it being excessively worn away. The claw does not 
touch the ground when weight is placed on the foot, and the weight of the body 
is therefore sustained by the pads of the sole and toes. These are rounded 
masses of connective tissue, containing elastic fibres and fatty tissue; they are 
provided with a strong epidermis, and are connected by ligaments with the 
phalanges. They are black in colour, contain neither hair follicles nor sebaceous 
glands, but are provided with numerous sudoriparous glands, 


720 DISEASES OF THE CLAWS IN CARNIVORA. 


—GROWING-IN OF THE CLAWS (INCARNATIO UNGUIS). 
DISLOCATION OF THE CLAWS. CHRONIC INFLAM- 
MATION OF THE CLAW MATRIX. LOSS OF THE 
CLAWS. 


In cats and dogs, the dew-claw, which does not touch the ground, and 
therefore is not worn away, sometimes becomes abnormally long, and 
assumes a curved form. Its point then enters its corresponding pad, 
produces great pain and lameness, and occasionally suppuration in and 
around the pad. Treatment consists in shortening the claw by means of 
forceps or strong scissors, care being taken not to remove too much, and 
thus injure the last joint of the toe. In judging of the amount to be 
removed, the claw of the other foot can be taken as a guide, provided it 
also is not overgrown. Inthe same way, the claws of cage-birds often grow 
to an excessive degree, and require to be shortened. 

In dogs, the claw and its matrix are sometimes violently torn off. 
Sometimes only a portion of the plate of horn is separated from the 
last joint of the toe; sometimes the greater part of it is gone, so that 
the claw only remains attached to the sensitive structures by a shred; 
sometimes it is completely lost. The accident is commonest in large 
dogs, in consequence of the claw being caught in a cord, net, or similar 
object, is painful, and always causes lameness. [Pain is especially 
severe if the claw remain hanging, because it then comes in contact 
with the ground at each step; its complete loss is less painful. Care- 
ful examination at once detects the character of the accident. If only 
a small part of the horny plate be lost, the parts may reunite, otherwise 
it is best to entirely remove the claw. It can simply be torn away ; if, 
however, the last joint of the toe be also injured or otherwise diseased, 
and if extensive change have taken place in the matrix, it is better to 
amputate the third phalanx by exarticulation at the last joint of the 
toe, which lies a little behind or above the upper edge of the nail. 
As a rule, strong scissors are sufficient, and by making one rapid 
cut the operation is rendered less painful. In the same way, a claw 
which is nearly separated from its matrix may be removed. No parti- 
cular after-treatment is required, the wound merely requiring to be kept 
clean; some dogs will bear a dressing, others will not. A dressing is 
most useful when the claw alone is removed, and the third joint of the 
toe left. If needful, the wound or claw matrix may be smeared with 
tar or creolin. 

Loss of the claw.—I have often seen chronic inflammation of the 
claw matrix in large dogs, which gradually leads to complete loss of the 


LOSS OF THE CLAW. TL 


claws. Kutzbach described it as panaritium. Where it originates in 
the coronary band, the horn of the claw is thickened and degenerated. 
Sometimes, however, the “sole” becomes diseased, and then nothing 
abnormal is seen on the claw, but the matrix, and particularly the lower 
surface of the claw, discharge a turbid fluid. Horn production is in 
abeyance, and, as a consequence, the claw is more or less loosened. The 
changes in the matrix are sometimes so slight that nothing whatever 
unusual can be detected with the naked eye; in others, chronic inflam- 
mation of the sensitive “sole” exists, leading to suppuration or ulcera- 
tion. The claw is thus loosened, and when the process extends to the 
other portions of the horn-secreting membrane, is completely lost. 

I have not been able to discover the exact cause of this disease, 
though it closely resembles onychia maligna in man. In some cases 
herpes or eczema of the neighbouring skin had extended to the matrix 
of the claw, but in others no cause whatever could be discovered. 
Kutzner has shown that the disease is not due to want of cleanliness. 
It often attacks several feet, generally affecting the dew-claws, so that 
it might be viewed as due to disturbance of nutrition. Large dogs in 
the prime of life are the commonest subjects. It is most frequently 
seen in autumn and winter in dogs which live near the seaside and often 
go into the water. 

The animal walks with a short, painful step, hes down a great deal, 
and has difficulty in standing. A local examination soon shows the 
character of the disease. 

As a rule, the process cannot be checked, but leads to complete loss of 
the claw, and therefore the prognosis principally depends on the number 
of diseased claws. Where confined to single claws, amputation at the last 
joint offers the most satisfactory results, otherwise the loose claw should 
be removed, the matrix cleansed and disinfected, smeared with tar or 
other disinfectant, and a bandage applied. Kutzner recommends liquor 
arsenicalis internally, and locally pencilling with nitrate of silver. 
Attempts to save the diseased claw always fail. In this respect 
the condition shows a great resemblance to canker and certain forms of 
chronic laminitis in horses. Unlike canker, however, it shows no ten- 
dency to produce vegetations from the matrix of the claw. 


Il.—BRUISES AND WOUNDS OF THE PADS OF THE 
SOLE AND TOE. 


The carpal-pads of carnivora do not touch the ground during move- 
ment, and the body-weight is sustained by those of the sole and toes. 


Continued exercise on rough, hard ground may wear these away, and 
22 


ioe. WOUNDS OF THE PAD IN DOGS. 


cause the animal to show pain when walking, a condition most commonly 
seen in sporting-dogs during the winter. In addition, the pads may be 
injured by treading on sharp objects, like pieces of glass, which produce 
more or less serious wounds. 

The naturally black colour of the pad is lost when its epidermis is 
excessively worn, and the surface then appears more or less red, painful 
on pressure, and abnormally warm. The animal rests a great deal, and 
when on rough ground, takes short steps, exhibits pain, and has a desire 
to lick the pads. Should the epidermis be completely worn away at 
any point, suppuration, or even necrosis of the pad, may occur. Severe 
lameness results, the appetite is lost, and fever sets in. Wounds of the 
pad generally suppurate, and may even become gangrenous. 

The prognosis is generally favourable when rest can be given and 
extensive necrosis has not occurred. In the latter case the phalangeal 
joints may become the seat of purulent or septic inflammation, though 
such a result is rare. 

Treatment.—When the pads are sore, the animal should be rested 
and placed on a dry, clean bed. In eight to fourteen days the epidermis 
will have grown again. If the parts be wounded or suppurating, the 
undermined epidermis is carefully removed with scissors, the wound 
cleansed, and any foreign body removed. Abscesses, when present, are 
freely laid open. Further treatment is scarcely desirable, both because 
the animal resists, and because it keeps the wound thoroughly clean by 
licking the surface. A surgical dressing is seldom needed unless granu- 
lation appears too active or cicatrisation is checked by the animal’s 
interference. A dressing may then be applied, or the diseased spot 
may be smeared with some bitter-tasting substance, like aloes, which repels 
the animal, and at the same time assists healing. Severe itching is 
sometimes removed by pencilling with cocain solution, but due precautions 
are required against absorption of the drug. 


INDEX. 


PAGE 
ABDOMEN, diseases of,. °  . . 213 
= puncture of, 224 
Abdominal hernia, 3 . 266 
a parietes, bruises of, 5 le: 
‘, wounds, . 5 Ps 

A 5 with inj uries to con- 
tained organs, 219 

A », With prolapse of in- 
ternal organs, . 218 
Abduction luxation of neck, . . 124 
Abscess of the shoulder, - Sy alge! 
», in sub-parotid lymph glands,. 71 
Actinomycosis tumours, : ahs 
sD of the jaw, c qh) 
a » pharynx, - 155 
», tongue, é 16 
‘Adhesive plaster, ‘‘ Fricker’ Si . 616 
Ale of the nostrils, wounds Se 5 ae! 
Alveolar periostitis, “ - 40, 42, 50 
Alveoli, neoplasms of, . : 5 OS 
Amputation of the bladder, . 339 
as eds’ : . 354 
i BISEE : . 3851 
Anal fistula, a 0 . 9809 
»» region, ue to, - . 293 
* tumours, ; 5 310 
Anorchiditis, . 5 ; 360 
Anus, dilatation of, . : . 3805 
3, diseases of, : ‘ . 290 
», preternaturalis, . : 2 221 
» prolapse of, . . > Pee 
», vaginalis, - : 5 PI 
vesicalis, ° 291 
Apomorphinei in impaction of cesophagus, 145 

Apparatus for prevention of vertebral 
fracture when casting, : . 414 
Arthritis chronica deformans tarsi, . 630 
Articulation of the jaw, inflammation of, 85 
Arytenoidectomy, 2 3 179 
Aspirator, Dieulafoy’s, 3 5 all 
Asthma nasale, : : 5 ie 
Atlas, fracture of, . . 5 al) 
Atresia anietrecti, . . 0 PAIL 

B 

BALANITIs in carnivora, - . 3847 
3 », horses, . : 343 
An SROXOD | 5 » 345 
», Swine, . - » 346 
Basedow’ s disease, ; ° 5 alghl 


Biceps femoris muscle, displacement of, 


muscle, rupture of, > : 
Bladder, amputation of, c : 

55 puncture of, . 

5 tumours in, : : 
Bleeding from the nose, 5 5 
Bog-spavin, . 
Bones, fracture of the cranial, . F 

», Of the face, fractures of, ‘ 
FF Pr hock-joint, fractures of, . 
», _ turbinated, necrosis of, ‘ 
Bougies in stricture of anus, . . 
Bouley’ s forceps, : . . 
Bowel fistula, ; : 
», injury of, ; ‘ 
», resection of, ; - . 
>, surgical diseases of, 2 0 
9) Sutures, Gely’s, . F 3 
es i Lembert’s, c . 
55 Wolfler’s, F : 
Brachial plexus, paralysis Oi, . 


Brain, concussion of, . 

Briuer’s trochar in distension of rumen, 

Breakdown in race-horses, . A 

Breast, tumours of, . 5 5 

Bruises of the abdominal parietes, 5 
45 Se toousnvoxen jm . 

fore-arm, i 5 

mammary gland, . 
a », pads of the sole and toe, 
», produced by the collar, > 

Bursa of the flexor pedis, inflammation 

of, 
Bursitis ‘gluteei medii vel trochanterica, 


2? 9 
32 2? 


2? 2 


5 sile ‘of the foot, 
Capped elbow in dogs, ° 


»,  intertubercularis, ; . 
»,  prepatellaris, . . . 
C 

Cazxcat fistula, 5 ; 5 
Calculi salivary, 5 . 
», urethral, c “ 

»» in ruminants, ‘ 

>, Urinary, . . ° 
Calculus forceps, ° . - 
Campylorhinus, ’ . : 
Canker of the ear, external, . ° 
5 = 29 internal, , 7 

fro . . 


Capped elbow in horses, 
treatment of, by elastic 
ligature, : 


92 99 


sp) tock. 
Oris of, 
Caput obstipum, 
Caries, dental, 


Carotid artery, injury of, : 
Castration of cryptorchids, 4 
Catarrh of the guttural pouches, c 
9 a 2? 5 ) a9 use of 
antiseptics in, c 
Catheter, Giinther’s, 
Catheterisation in dogs, 
nD horses, 
ae : - 
Catheterism, : : c 
Cervical muscles, cramp of, : 
ay , inflammation of, 
55 5 paralysis of, é 
», vertebra, dislocations of, 5 
an fractures of, 5 
ve Champignon” formation, . c 
Cheeks, diseases of, . : : 
», tumours of, é : 
Chest, tapping the, . : ° 
“* Choking” in cattle, . 


Chondroids, 
Chronic catarrh of the euttur al pouches, 
Circus movements after cervical injury, 
Cirsocele, : : 6 ° 
Claw, anatomy of, 

», chronic inflammation of matrix of, 

», whitlow of, : 

», wounds of soft tissue of, 

», amputation of, in oxen, 

», diseases of, in carnivora, 


95 Ae in cattle and sheep, 

,, dislocation of, . c 5 

>» growing in of, 5 . . 
loss Oly c 5 
Cloaca formation, : c 
Ccenurus cerebralis, diagnosis of 


position of,, 
difficulties in 


removing, . 

in sheep, °. 

Cold abscess in abdominal walls, : 

Collar bruises, . : 3 A 

», galls, . A : 

Colon, twist or rotation O 5 : 
Commotio cerebri, : : 

5 spinalis, : 

Comparative gravity of high and low 

ring-bones, . fs 

Compression. of the cesophagus, 0 


Concretions in the guttural pouch, 
Concussion of the brain, 
Congenital defects of the testicle, 
Contr acted tendons in foals, . 

** Corns,” : : 
Coronary- -joint, sprain of, 
Coronet, treads of, ; : 
Corpora oryzoidea, . 
Costal fistula, . 

Coxitis, 5 


INDEX. 
PAGE 
473 | Cranial bones, injuries of, 
», fractures, : 
476 | Cricotomy, : . ‘ ‘ 
650 | Crico-tracheotomy, . ¢ : 
650 | Crural canal, description of, 
121 5 hernia, : - 
37 | Crutch for use after tenotomy, = 
116 | Cryptorchids, castration of, ; 
361 , fertility of, ; 5 
98 | Curb, . : 
>» confor mation predisposing to, 
103 | Curvature of the spine, . 
100 | Cystitis, : . . 
333 | Cystoplegia, 
332 | Cystotomia, perinealis, : 
333 PA rectalis, . 5 . 
331 5c supra-pubica, : 
121 | Cystotomy, . . . 0 
122 
122 
120 D 
119 
349 | ‘*Drcusitus,” definition of, 
3 | Deformities of the trachea, : 
5 | Deglutition, mechanism of, . : 
209 Dental caries, . : 6 
140 ACV SUsimeate 5 5 : 
98 », fissures, a ; c 
98 a easter : 0 
125 ae forceps, 
369 5, instruments, Giinther s, 
707 Se cantare 
721 | Dermatophagus canis, in canker, 
711 Dermoid eyst, . ° 5 
711 | Diaphragmatic hernia, 
715 | Digestive tract, foreign bodies i in, 
719 | Dilatation of the rectum, ‘ : 
707 r urethra, : . 
720 Diplegia, laryngis, 0 : 
720 | Diseases of the abdomen, : 
(PAL 5 a3) USS 3 
291 AG ,, claws in carnivora, 
is » in cattle and 
112 sheep, . . 
29 9) ear, = 
114 . »,  fore-limb, 3 
111 .. pee OO lm 
214 96 gener; : : 
206 6 aa Lamnynixe 6 
198 ay » mammary gland, 
286 5 »,  Metacarpus, . 
107 an >»,  Mmetatarsus, : 
410 ap meck.= =. : 
_ », oesophagus, 
542 . », pelvis, , : 
152 5 », pharynx, : 6 
98 99 », prostate, 
108 op i aectums 
360 sf F scrotum, 
517 on », shoulder-joint, 
686 e » Spinal column, 
529 “ sie petal eee 
680 a _ tendons in the meta- 
133 tarsal regions, 
187 is », tendons in the tarsal 
581 regions, : . 


Diseases of the testicle, : . 
3 soe uhiohee. 
5 i. ehorax, - z 
», trachea, : 
Dislocation of the cervical vertebra, 
claws, : 


+P) 2? 
lower j jaw, . 


Displacement ‘of. the biceps femoris 


muscle, 
c san patella; 7s: . 
ae Leathe rir. . 
Distor tion of the neck, ‘ 3 


Knudsen’s iron 
splint for, . 
io 2 3 », results of, : 
>, varieties of, 
Diverticula of the cesophagus, . 


2? ” 2? 


‘* Dorsal flexion,” F : 
** Dropped Sole,” ; : 
E 


EAR, injury of the external, 

,», fistula of, . : 
Ectasiz of the cesophagus, 2 
Elbow, capped, in the dog, 
Elbow, capped, in the horse, . 

»,  jvint, inflammation of, 
» luxation of, : 
Electricity i in facial paralysis, . 5 
Empyema of the facial sinuses, 
as puncture for, 
Enlarged prostate, castration for, 
Enlargement of articular cavities in fore- 


° 


. 


limb, : 4 
5 ,, outer surface of the hock, 
Ef »» Synovial cavities in fore- 
limb, - 2 
i », tendinous synovial cavi- 
ties in fore-limb, . 
Enterotome, Brogneiz’s, , 0 
Epididymis, inflammation of, . : 
5 tumours of, . 
Epispadia, - 4 ° 5 
Epistaxis, 5 5 ° 5 
Epulis, - . 
Erythema solare, : 
Exomphalos, . 2 : 
Exophthalmic goitre, . : 
Exophthalmos, 
Extensor pedis tendon, necrosis Of) ts 
External canker of the Cate is : 
Extraction of teeth, . é 3 
Be be precautionsin, . 
F 
Face, fracture of the bones of, - 
Facial nerve, distribution of, - 
3, paralysis, : : 


», sinuses, empyema of, 

AS is trephining of, 
Femur, fracture of, , 

3). luxation of, - 
Fibro-fatty frog, purulent cellulitis of, 


INDEX. 725 
PAGE PAGE 
359 | Filaria cincinata in flexor ane tas 510 
612 | Fissure, dental, 38 
184 a6 of the male meatus urinarius, 312 
157 Fistula, anal, . : . 309 
120 7 costal, ;: 186 
720 Pedental. 51 
84 »,  recto-vaginal, 309 
», salivary, 73 
593 Se PScernals : 187 
601 ; of abomasum, . 222 
Di é of the bowel, 221 
121 ” ” ear, 97 
3, . rumen, 222 
126 Fistulous withers, 205 
125 | Flexion, dorsal, 528 
124 a, ollenee 528 
149 | Flexor metatarsi muscle, rupture of, 617 
528 », pedis perforans ‘tendon, resec- 
695 tion of, : 552, 679 
», pedis per foratus tendon, luxa- 
tion of. . 653 
,, tendons, ‘inflammation o of, 506 
92 35 Tupture of,  . - 502 
97 Flour ant’s trochar, ‘ 6 827 
149 Fluor albus in cows, . c . 379 
477 Footrot in sheep, . “alee 
473 Forcible dilatation in stricture ‘of anus, 308 
479 Fore-arm, br me ge ¢ . ; a 
On wounds of, 4 
“e Fore-limb, diseases of, . : - 443 
58 3; enlargement of articular 
912 cavities, j sated 
357 % enlargement of synovial 
cavities, b 490 
490 50 enlargement of tendinous 
646 synovial cavities, . 490 
Foreign bodies in the digestive tract, 271 
490 +e as », esophagus of se 
Carmivoray ss 
bs 3 ; cesophagus of 
oe ; Ene ars) 
366 9 Tuam od ae of aa 
po “ i) 
a A ais », esophagus of : 
65 swine, 145 
52 5 4 < Panee Be 
= trachea 16 
ae Fracture of the atlas, . 120 
131 3 - bones of the face, eel 
108 ” ” EF) oF) eae re 
’ ” 29 nee . 
ae % A caudal As tebre, ae 
43 a ‘5 cervica op 11 
55 »» cranial bones, 106 
48 > ;, dorsal vertebree, 410 
nA ay HoaaTUIES ¢ 574 
3 », frontal bone, . 110 
5 », horn core, : 109 
80 3 », humerus, 445 
6 Ag »,  hyoid bone, 20 
7 < », Jaw, splints for, 83 
58 A », knee-bones, . 481 
59 a »,  Jower jaw, : 82 
574 an ,, lumbar vertebre, 411 
577 ae », malleoli of the tibia, 615 
677 PA »,  Mmetacarpus, . - 498 


726 


Fracture of the navicular bone, : 
x », olecranon, : . 
*5 », os astragalus, . 
, og OS Guilons, 3 
3 », OS coroner, 
a »> OS pedis, 
3 » patella, c 
Pr 5 pelvis). 0 
a », phalanges, 


”? 99 Ot) 


after neurectory, 
premaxillary bone, . 


“3 Se tadius).. ° 
is ee ibs, s 
5 55 sacral vertebree, 
sis » scapula, 
Se 5, sesamoid bones, 
33 » sternum, . 
“ed Sa tullbiace ae : 
4 3, trachea, : 
ulna, . : 
F racture costar hoy G : : 


Fricker’s adhesive plaster, 


Friebel’s extension apparatus for con- 

tracted tendons, : ; : 
Frog setons,  . : : 5 
Funiculitis chronica, . : : 


G 
GALLS, collar, . 5 
;,  saddle,. 0 é 


3 in the carpal region, 
5 »,  fetlock regions, 
Gangrenous inflammation of the udder, 


Gastric fistula, . 6 
Gastrocnemii muscle, rupture of, : 
Gastrotome, Brognie7? s, : : 
** Gelber Galt,” 0 0 : 


Gid or stur dy i in sheep, 
Gland, sub-maxillary lymph, inflamma- 
tion of, . 

», sub-par otid lymph, abscess i in, 
,, thyroid, results of extirpation of, 
Glossoplegia, . 


Gluteus medius muscle, inflammation 
of the tendons of, 

Goitre, cystic, . 
»  exopthalmie, j ‘ 
», fibrous, : ; : 
meres 
>, varicose, 

Gonitis, : : 0 
»,  chronica sicca, . 3 ° 

Grease, . : 
Se cuesto exposure to sun’s 5 rays, . 
s,  inoculability of, 5 . 


Gums, neoplasms of, 

Giinther’s catheter for guttural pouch, 
“Gut tie,” : c : 
Guttural pouches, air in, 

chronic catarrh of, 
gas in, ° 
opening of the, . 
their purpose, 
tympanites of, : 


9 9? 


INDEX 
PAGE PAGE 
551 H 
470 
624 | HMATOCELE,. : : . 368 
623 | Hemothorax, . 191 
535 | Hemiplegia laryngis, : 162 
535 | Hernia abdominal, 0 5 266 
607 3,  cruralis, é 259 
420 »,  Giagnosis'of,  . d ~  22F 
533 »,  diaphragmatica, . . 268 
535 », essential constituents of, . 226 
21 », false inguinal, . 254 
471 »» incarcerated inguinal, 251 
185 », Inguinal, : 0 «. 242 
415 5 Ay in dogs, F a Hite) 
443 56 7B in horses, A 244 
546 5p ss in ruminants, . 208: 
188 rf Op in swine, . 256 
614 on non-strangulated, . 248 
164 A inguinalis inter stitialis, » 254 
469 », interna abdominalis, . 266 
185 >» muscular, : : ols 
616 », methods of cure, ; 231 
,,  nhon-strangulated, 230 
519 a5 pelvacs : : . 266 
561 ») perineal, 261 
370 »> peritoneal, . 267 
;,  scrotalis, é ‘ . 242 
»,  Sstrangulated, . 228 
», umbilical, . 235 
ventralis, . 262 
199 | Hernial trusses, 3 é 230, 237 
198 Herniotome, . fs c . 253 
491 Herniotomy, 0 . 233 
491 | Hind extremities, paraly sis of, . 431 
400 ,, limb, paralysis of, ; - 584 
222 | Hip-joint, inflammation Oi, 5 eel 
621 >) Lameness, 5 : 5 . 096 
282 | Hock, capped, . 650 
398 i enlargement of outer surface of, 646 
111 35 jou, ~ chronic inflammation of,. 630 
i ;, luxation of, : . 625 
91 is 5, Sprain of, ; 3 625 
71 ;, wounds of, A 626 
130 ge Holzzunge,” 5 F ; 16 
18 Hoof, diseases of, é : 669 
Horn cor e, fracture Of. . 109 
582 3 splint for, A lay’) 
128 | Horses’ ‘teeth, diagram of position 0) ee e!7 
131 | Humerus, fracture Oi 6 c . 446. 
128 | Hydrocele, 0 - 368 
128 | Hyoid bone, fracture of, 7 20 
128 | Hypospadia, . 0 3, OL2 
608 Hyovertebrotomy, - 100 
609 
562 
565 I 
564 
53 | Impaction of the crop in birds, » iy 
100 | Incarceration, definition of, . ey 
266 Incarnatio unguis, 720 
104 | Inflammation ‘of the articulation of the 
98 jaw, 85 
105 46 5, bursa of biceps 
101 muscle, 451 
104 Pe iB UTS EOn ’the liga- 
104 mentum nuchie, 132 


Inflammation of the bursa of the flexor 
pedis, . . 

external auditory 
meatus or Otor- 
rhea, 


39 2) 


ny », elbow-joint, c 
ve », epididymis, ; 
re », flexor tendons, . 
of », hip-joint, A 
35 », jugular vein, ; 


ligamentum nuche, 
podophyllousmem- 
brane, 
posterior ligaments 
of coronet-joint, 
prepatellar bursa, { 
prepuce in carni- 
vora, 
horse, 
oxen, 
a, swine, 
salivary glands, . 
sensitive ,lamine, 


9 99 2? 
39 9 2? 


695, 


spermatic cord, . 
stifle-joint, 
sub-maxillary 
lymph glands, 
sub-coronary con- 
nective-tissue,. 
tendons of Gluteus 
Medius muscle, 
testicle, . . 
udder, . 
urethra, ; 
urinary bladder, . 
wo  wullvage 5 
Inguinal hernia, 
Pe canal, description of, 
Injuries of the "knee in the horse, 
penis, . 4 
thigh, . 
i Aa vulva, 6 
5, produced by striking 
ference), . ; 
‘ to the anal region, 
salivary glands, 
‘r a, Gls : 
‘ ny SORE structures of the 
quarter, : : 
», of the carotid artery, . 
external ear, 
. >, jugular vein,*. 
3 >, recurrent nerve, 
sympathetic nerve, 
urethra, 
vagus nerve, 
cesophagus, 
pharynx, é 
rectum, . c 
Instruments for trephining, : 
Interdental space, injuries in, 
“Interfering,” injuries from striking or, 
Intestinal trochar, Friedberger’s, 
Intussusception, ; : 
Invagination of the bowel, 


29 ” 
99 9 


(inter- 


? bP) 


99 22 


INDEX. 727 
PAGE PAGE 
Inversio vesicee, - 336 
489 | Inversion of the urinary bladder, . 337 
Iodide of potassium in actinomy- 
cosis, on Ss 724 90 
95 | Iodine in actinomycosis, : 17 
472 | Irrigation of the pleural sac, . 212 
366 
506 
581 J 
“ Jarde, or Jardon,” 647 
Javart, cartilagineux, . 688 
670 » cutané, 688 
Jaw, actinomycosis of, 89 
544 »» paralysis of, 86 
611 », tumours of, 88 
Joint felon, 711 
347 | Jugular vein, inflammation of, 136 
244 ‘ »» injury of, ibily/ 
345 A 3) ustulayot: 135 
346 3 », thrombosis, 135 
68 
701 ys 
370 KERATOMA, . : 5 699 
609 Keratomata, excision of, 5 701 
Knee, fracture of the bones of, 481 
91 »» injuries to, in the horse, 482 
», tumours of, in cattle, . . 484 
684 », joint, chronic inflammation of, 487 
532 Knuckling over in foals, : = oly 
366 Kyphosis, : : aay, 
390 
329 L 
333 
377 | LACTATION, resemblance of, to inflam- 
242 tnation, é ; 391 
243 | Lameness, hip, : ‘ 596 
482 Pr sesamoid, . c 548 
349 si shoulder, . . 463 
612 ae Pe from rheumatism, 465 
377 a from thrombosis, 467 
Lamine, inflammation of sensitive, . 695 
666 Laminitis, . c - . 695 
293 Pe exercise in, . é . 699 
67 | Laparotomy, . 273 
111 | Laryngismus stridulus, 162 
Laryngitis, 157 
572 55 chronic, 159 
116 | Laryngo-fissure, 178 
92 5,  -Spasmus, 162 
116 | Laryngotomy, . 178 
117 | Larynx, diseases of, 158 
117 »,  eXamination of, 160 
329 », method of opening, 161 
aly »> neuroses of, . 162 
148 | Lateral cartilage, resection of, . 692 
148 | ‘* Leg twitch,” 576 
293 | Lips, bruises of, 2 
61 », diseases of, 3 
22 », tumours of, 5 
666 », wounds of, 2 
275 | Liquor Villati, - 187 
284 | Lordosis, 417 
284 | Lower jaw, dislocation ‘of, 84 


728 INDEX. 
PAGE 
Lower jaw, fracture of, 82 | Muscular hernia, A 
3. os ©6Splints' for, ‘fracture of, 83 | Myopathic paralysis of ‘the larynx, : 
Lumbo-dorsal fascia, necrosis of, . 441 | Myotomy of biceps femoris muscle, 
Luxatio patelle, > OO 
Luxation of the dorsal vertebra, . 412 
Bs we elbow-joint, . e 472 N 
ee me femur, ‘ 577 
io 3 », varieties of, 580 | NAvicuLAR bone, fracture of, . é 
Pe 5 flexor pedis perforatus 5 »,  Tesection ue 5 
tendon, ; 5 Obs = disease, . : 
3 a hock-joint, 625 a », in hind- feet, : 
ee ie lumbar vertebra, 412 ,, theories of, 8 
5 3 os astragalus, , 625 Neck, "complications of wounds i in, c 
Fe ‘5 os calcis, : 626 », diseases of, 6 5 ; 
An 5 patella, laterally, 605 ,,. distortion of, , 5 : 
5p - a upwards, 602 varieties of, cs 
55 5 phalanges, 528 | Necrosis of the extensor pedis tendon, 
5 4 sacro-iliac ar ticulation, 428 fy », externalear, . : 
re its shoulder-joint, . 448 Ae », lumbo-dorsal fascia, . 
a Ss stifle-joint, . 601 ,, turbinated bones, : 
55 » symphysis  ossium Neoplasms of the gums and alveoli, 
pubis, ; 430 | Neuroses of the lary nX, : : 
Lymphadenitis suppurativa, 195 | Nose, bleeding from, . . . 
Nostrils, foreign bodies in, . 
- tumoursin, . 5 5 
M 5 wounds of the ale of, : 
MAKROGLOSSIA, 16 
“ Maladie du cuit,” 433 O 
Malleoli of tibia, fracture of, 615 
Mammary duct, closure of, 403 | Oponrtorp process of dentata, fracture 
53 duct, stenosis of, 403 Ofsm as : : 
5 gland, bruises of, 389 | (£dema of glans penis, elastic bandages 
- 5, diseases of, 388 in, : 5 . 
3 > Structure of... 388 (Esophageal fistula, 
», Wounds of, . 389 BA foreeps, Delvos’ and Hert- 
Manéwe movements in disease of middle wig’s, . 3 ° 
ear, . 5 é 96 ss snare, Meiers’, j 5 
Mastitis acuta, 390 | Csophagocele, . . 6 c 
», catarrhalis, 396 | Césophagotomy, : 
»,  chronica, 405 | Csophagus, compression of, . 
»  gangrenosa, 400 es diseases of, F . 
»  lymphogenous, 392 as diverticula of, . : 
‘ parenchymatosa, . 396 sp ectasie of, 
cs 5 apostematosa,’ 898 so foreign bodies i in, in n cattle, 
»,  phlegmonosa, . : . 394 ee Me in horse, 
»,  traumatica, . 394 es s in swine, 
tuberculous, 406 a injury of, . 4 . 
Maxillary sinus, trepanation of, 62 3 paralysis of, 5 7 
Mechanical injuries, . 5 alg} " psorospermia in, . 5 
‘. pneumonia, 140, 168 5 rupture of, 
Metacarpus, diseases of, 7, 55 spiroptera sanguinolenta i in, 
Ap fractures of, 498 a stenosis of, ¢ : 
45 wounds of, 499 i structure of, in various 
Metatarsus, diseases of, . 654 aninals, . . 
Milk catheters, precautions in using, 404 5 tumours of, - 
Mouth, angular or sharp, 29 ma ventriculosus, 
», diseases of, : . 10 { Olecranon, fracture of, : 
», foreign bodies in, : 5 lll Omphalocele, ; 5 
gag for cattle, 142 | Opening the guttural pouches, : 
“ Mouth rot,’ 39 | Os astragalus, fracture of, : : 
Mouth, shear- like, 31 3 - luxation of, : s 
»,  Step-for med, 3 ,», calcis, fracture of, . 5 
Mucous degeneration of the turbinated ness) | LULXaONNOL me ; 6 
bones, . 64 ,, corone, fracture of, 
Muscles of the larynx, paralysis Oi 4 BY) ay joretaliish pf 2 


119 


351 
147 


143 
143 
149 
143 
152 
138 
149 
149 
141 
139 
145 
118 
153 
156 
149 
157 
152 


139 
155 
149 
470 
235 
101 
624 
625 
623 
626 
535 
535 


INDEX. 
PAGE 
Osteoporosis, : . 90 | Periproctitis, . . 
Othzematoma, . : 5 . 93 | Peritoneal hernia, 
Otitis externa, . : . 94 Pr scrotal hernia, 
>» interna, ‘ 3 . 94 | Phalanges, anatomy of, 
emmedia, : 5 296 3 fractures of, 5 
Otorrhea, P 95 +9 luxations of, . - 
Ovary, treatment of cysts ss 409 | Pharynx, diseases of, . . : 
xen, method of restraining, . 709 55 foreign bodies i in, : 
5p paralysis of, : 
a tumours in, é - 
IP Phimosis, ; . : 343, 
Phlebitis, 4 5 . 
Pap of the foot, wounds of, . 722 Phlegmonous mastitis, 5 . 
Panaritium, F 712 | Picked-up nails, : 
Paracentesis abdominis, - . 223 | Plaster for setting fractures, Stolz’ Shue 
3 thoracis, . 3 . 209 | Pleura, wounds of, ° . . 
Paresthesia, . 5 ; . 439 Pueumothorax, 3 c : 
Paralysis, facial, : 7 | Pododermatitis acuta, . = 5 
ne »,  lmasticatory, . 87 i chronica, 5 
Do trigeminal, . sid verrucosa vel migrans, 
OF of the brachial plexus, . 462 Podophyllous membrane, acute inflam- 
3 », crural nerve, . > 587 mation of, . 5 ° . 
35 », hind-extremities, 431 | Poll-evil, : 
oe ;, hind-limb, . 584 | Position of horses’ teeth, diagram of. 4 
. »,  ischiatic nerve, . 586 | Posterior aorta, thrombosis of, 5 
35 », Jaw (so-called), 5 eke Pr ligament of the coronet-joint, 
Hs », muscles of the larynx, 163 inflammation of, . 
35 », nervi radialis, 457 | Preisnitz’s poultices, . c 
36 », obturator nerve, 590 | Pre-maxillary bone, fracture of, 
a An cesophagus, ‘ . 153 | Prepuce, anatomy of, in horse, 
Ag So penis; . 9349 33 OG 6 
<3 »» peroneal nerve, 5 Beis inflammation of, in carnivor a, 
oh 5p ee TAwIS, Gg 153 a 5 horse, 
Ae », radial nerve,. 5 YRC ze - oxen, ; 
ae », rectum, 5 a UT swine, . 
56 »»  Supra-scapular nerve, 454 », _partial amputation of, 
of », tibial nerve, . 5, | tahet5) Pressure in treatment of tendinitis, : 
ap », tongue, 18 ** Pricks” in shoeing, . : : 
0 My es bladder, 331 | Probang for cattle, ; c 
Paraphimosis, . A . 848 | Processus vaginalis, dropsy of, 
Paraplegia, . - : . 4380 | Proctitis, : 
Paraproctitis apostematosa, . 5° SEN Prognathous jaw, : 
Parasites in the trachea, 167 | Prolapse of the anus, . ° 
Parenchymatous infiltration of rthe udder , 396 <5 ee keceum. 
a inflammation of the 3 », Of the urinar y bladder, 
udder, 396 4 », uterus, ° 
Parotitis, P 67 vagina, é 
Patella, displacement of, 4 601 Prolapsus vagine, é : 
» fracture of, > (aOY/ An vesice, 5 
“- luxation of, . : 602, 605 | Prostate, castration for enlarged, 
», rupture of the straight liga- $3 diseases of, . : 
ments of, . : . 607 | Pulmonary embolism, ° ° 
Pelvic hernia, . : d . 266 | Punetio intestini, : 5 
Pelvis, fracture of, . 420 >  Vesice, 5 ; 
Penetrating wounds of the abdomen, . 216 | Puncture for empyema, 
Penis, amputation of, : 5 BOE! 55 of the abdomen, 4 
»» injuries of, 5 : . 349 * 3 bladder, : 
»,  paralysisof, . 5 . 349 3 53 4 perineal, . 
,, tumours of, : S 5 Be) ee sh os rectal, A 
Pericarditis, septic, in cattle, . a mail s 3 + supra-pubic, 
Pericystitis, . 5 3 5 oe 5 53 bowel, : - 
as chronica, . 2, 83D 5 53 », through the ab- 
Perilaryngitis chronica fibr osa, . 158 dominal walls, 
Perineal hernia, ; fail or ae » through the 
Periosteotomy in splint lameness, ee 25) rectum, : 
Periostitis, alveolar, : 40, 50 | $5 7. rumen, : - 


730 ; INDEX, 


PAGE | 
Puncture of the thorax, . 210 Salivary glands, tumours of, é 
Purulent cellulitis of the fibro- fatty frog, 677 » woundsof, . 6 
| Sarcoptes cynotis in canker, . 
Scapula, fractures of, . : : 
Q Scirrhous cord, . ° : 
a bothryomyces in, = 
QUARTER, injuries to the soft structures A caused by ciecoueee 
Of is . E : - 572 equi, 
©*Quittor,” é : ; - 688 slephy locos in, 
Scrotal hernia, . . 
Scrotum, diseases Oly me 
BR Sectio alta, ; 5 : 
Sesamoid bones, fractures Oy : 
RADIAL nerve, paralysis of, . se 457 ‘si lameness, 
Radius, fracture of, . : . 471 | Sewell’s frog seton ‘needle, 
Ranula, . c : 19,68 | ‘‘ Sharp mouth,” 
Rectal tumours, : ‘ molt Shears, Pr ofessor Moller’ s tooth, 5 
Recto-vaginal fistula, . : | 309 | Shear-like mouth, ; . : 
Rectum, diseases of, . 9 . 290 | Sheep, ccenurus cerebralis ies ‘i 
9 dilatation of, . ‘ 5 wey | »,  footrot in, : : 
sy mules! tose : . 293 | Shoeing after tendinitis, ; 
a paralysis of, . C . 807 | Shoulder abscess, : 
», prolapse of, . : . 299 a joint, diseases of, ; 
e stenosis of, . A . 3806 ap 3) luxationioi, 7 ; 
wounds of, a c . 295 a lameness, . ; ; 
Recurrent nerve, injury of, . 5, lily 9 a from rheumatism, . 
Removal of ccenurus cerebralis, me ee3 a 3 ;, thrombosis, . 
Resection of the flexor pedis perforans, 677 Slip. . j 
an » lateral cartilage, a O92) |) Se Sit- fasts,” treatment of, : . 
5, navicular bone, - 552 | Skoliosis, ° . . 
Rhino- laryngoscope, Polansky and Skull, fracture of, C . 
Schindelka’s, : ; 5 (ley », wounds of, : 
Rhinoscleroma, : ; 0. taz/ “* Smooth mouth,” 4 
‘¢Ring-bone,” . . . 537 | Sole, bruises of the pads of, 
Ring- -bones, importance of shoeing in,. 5438 », dropped, : : : 
** Roaring,” 5 159, 162 », wounds of, ‘ , 
Pes chloral treatment in, . 163 | Spasm of the Rima Glottidis, : 
x morphine treatment in, . 163 | Spasmus Glottidis, : 
ps operation for, A 19 Spavan A 
Rotation luxation of the neck, sol24 55 «(LORS : 
a of the colon in horses, . 286 », conformation predisposing to,. 
“‘Ruminant’s mouth,” 4 3 eroo) ,, pathological anatomy of, 3 
Rumenotomy, .- ue 278 », test for, 4 ‘ F 
Rupture of the biceps muscle, . . 453 >, theory of production, . 
i ay tlexor tendons, 4 . 502 ,, treated by median neur otomy, 
be 5 », metatarsi muscle, 617 . ae opening bursa of 
53 5, gastrocnemii muscle, . 621 flexor metatarsi, 
fe » esophagus, . 5) se A periosteotomy, 0 
me »,  Sstraight,ligaments of the 5 5 section of flexor me- 
patella, ° - 607 tatarsi tendon, . 
a ,, tendo-Achillis muscle,. 621 | Spermatic cord, hydrocele of, . : 
sa »,  tibio-fibular interosse- », inflammation of, . 
ous ligament, 617 Spinal cord, inflammation of, . . 
¥ curvature, factors in producing, 
Spinaventosa, . : : - 
S Spine, curvature of, . : . 
Splints, : c - . 
SaAcRO-ILIAC articulation, luxation of, 428 », for fracture of lower jaw, 
Sacrum, fracture of, . é = 45 ,, theory of production of, - 
‘Saddle ” for fixing dressings in place, 576 | Split pastern, ‘ 
Saddle-bed, injuries in, Z - 199 | Sprain of the coronary joint, : 
Sp -galls, C 0 : 5 GS) ap »,  hock-joint, ‘ : 
Salivary calculi, é ‘ a 2 Me »,  Sstifle-joint, 
x fistulee, : . 73 | Stabs in shoeing, : 
ms clands, inflammation of, . 68 | Stenosis of the cesophagus, 
op 6 injuries to, . . 67 56 » rectum, 


Stenosis of the trachea, : : 
Step-formed mouth, . : : 
Sternal fistula, . : c ; 
Sternum, fracture of, - 


Stifle-joint, inflammation of, . 
injuries to, : “ 
5; Luxationvof, 5 : 
», sprain of, . 
Stockfleth’s wooden ring in prolapsus 


37 29 


ani, . . . 

Strangulation of the ton gue, . 5 

Striking or interfering, - . 
A boot for, 


Stringhalt, : 
attempts to produce arti- 


99 


ficially, . ° . 
ae forms of, . 
3 treated by section of thigh 
fascias) . 
Structure of ur ethra, : 
Struma, : 5 
Sturdy in cattle, : . : 
ee sheep, : 
Sub-coronary connective tissue, inflam- 
mation of, . C . 
Subcutaneous blistering, 
firing, 
Sub- maxillary iil glands, inflam- 
mation of, . : 


Sub-parotid ‘lymph glands, abscess in, 
Superior maxillary sinus, trephining g 

the, : . . ° . 
Supernumerary teeth, . 
Supporting leg lameness, definition of, 
Suprascapular nerve, paralysis of, 
Suspensory bandage, 

ligament, inflammation of, 


Suture, André’s tobacco pouch, ; 
‘5 Gély’s bowel, . . : 
Lembert’s bowel, . 


22 


3 Wolfler’s bowel, ‘ 
Swine, foreign bodies in “cesophagus of, 
Swinging leg lameness, definition of, 
Sympathetic nerve, injury of, . 
Symphysis ossium pubis, luxation of, « : 


4h 


THNIA CENURUS in sheep, . 
Tail, diseases of, : - 
Tapping the chest, 

Tartar, dental, . 

Teeth, diseases of, 
displacement of, 
extraction of, 


Le) 


2? © : 
pr ecautions ity gy 


3) 
irregular development, . 


29 


3 5 wear, . , ‘ 
supernumerary, 
Tender- mouthed horses, treatment of, . 
Tendinitis, : 


after influenza, 
Tendo Achillis, rupture of, 
Tendons contracted, . 
necrosis of 


INDEX, 
PAGE 
165 | Tendons, rupture of, after neurectomy, 
33 | Tendon sheaths, disease of, in tarsal 
187 and metatarsal re- 
188 gions, . 
608 i Py enlarged, opening by 
608 cautery, . 
601 55 r of fore-limb, schema of, 
601 | Tenotomy, 
5 importance of exercising 
304 after, . 5 . 
13 | Testicle, calcification of, 5 . 
666 3; carcinoma of,. - é 
669 » congenital defects of, . - 
661 », Giseasesof, . ; ; 
55 ectopia of, ¢ 
663 », inflammation of, 5 
662 i retention of, . . 
tumours of, . 
665 Testicles, supernumerary, : 
329 | Thigh, diseases of, : F : 
127 », injuries of, ; 7 c 
115 », wounds of, - 5 5 
111 | Thoracic cavity, wounds of, . . 
ee eIDyUTIEss : . 
685 | Thoracocentesis, : : 
641 | Thorax, diseases of, : 
643 »» puncture of, - 
Thrombosis of the jugular vein, : 
91 An 5, posterior aorta and 
71 branches, 
39 5, posterior aorta after 
63 endocarditis, . 
25 | Thyroid extract in myxcedema, ; 
422 », gland, consequences of re- 
454 moval, ; 7 3 
350 | Thyroidotomy, 5 : - 
502 | Tibia, fracture of, o 5 5 
303 3 49 malleoli of, 
Die », greenstick fracture of, . . 
273 | Tibio-fibular interosseous ligament, 
273 rupture of, , - : 
145 | Toe, bruises ‘of the pads of, 
422 », wounds AA 
117 | Tongue, actinomycosis of, 
430 4). diseasesiof 5 
», inflammation of, 
», paralysis of, . : 
Ser angulation of, : 
Tooth forceps, Frick and Hauptner’s, . 
111 5 7" Giinther’s, 5 : 
439 53) SCLEWs) ee : 
209 »» Shears, Metznik’ 8, : 
39 5 », Professor Moller’s, 
24 ;, substance, diseases of, 
27 | Torticollis, 
43 | Trachea, deformities of, 
48 5 diseases of, . 
26 + dilatation of, by tubes, 
28 30 parasites in, . 
25 fe stenosis of, . 
93 | Tracheal canula, Bar thélemy’s, 
506 ny a Leblanc’s, 
508 i fF Peuch’s, 
621 i) e double tube, : 
517 »,  trochar, Hayne’s, : 5 
504 Bs tumours, 2 - 


731 


PAGE 
503 


732 


Tracheotome, Martys’, j A 
33 Thompson’s, 5 
Trachéotomie sous cricoidienne, . 
Tracheotomy, . ° . . 
6 dangers of, 3 . 
:, ill etfects of, . 
ay tubes or canulee, . 
Traumatic inflammation of the udder, 
Treads of the coronet, . . ° 
Trephines, : . . 
Trephining instr uments, . . 
ne position for, . 
53 the facial sinuses, 
se », maxillary sinus, 
oe », Superior maxillary 
sinus, . c 
Trigeminal paralysis, . ° . 
Tumours, actinomyces, 5 6 
55 of the anus, . é é 
3 7 bladder, o . 
55 53 breast, . é 
5 45 epididymis, . 5 
oe) ” jaw, ° O 
- ae knee in cattle, 
is in lips, . 5 5 
me a nostrils, r : 
2? ” penis, e e 
AD =5 rectum, 
- a salivary glands, 
aa fs sheath, . 
e A testicle, 
va 93 trachea, 
- e udder, 
Me ‘ urethra, 
uterus, 


” 9 
vagina, 


Turbinated hones, necrosis of, : 
Twist of the colon, 


‘i is », method of detec: 
tion, 5 
ss Ff », Operation for, a 
Tylomata, c . 9 
Tympanites, acute, . 
5 composition of gas Ms 6 
i of the guttural pouch, ° 
U 
UDDER, actinomycosis of, ; 5 
» acute inflammation of, 
» amputation of, - 
>, . catarrh of, : 4 
>, chronic inflammation of, 
» gangrenous 5 
AC parenchymatous - 
», purulent a 
», traumatic 55 
tumours of, . 5 : 
Ulna, fracture of, ; : ; 
Umbilical hernia, . 


Degives’ treatment, . 
a” », Bordonnat’s clam for, 
s »,  Combe’s clam for, , 
25 pouch in swine, ; 5 


re) 99 


INDEX. 
PAGE 
173 | ‘* Unchoking” in cattle, : ; 
171 | Urinary bladder, inflammation of, . 
U7? ae 55 inversion of, é 
167 oe 55 5 in female 
Ua. animals, 
NG of H a paralysis of, . ; 
174 is At prolapse of, . . 
394 “a a 43 in female 
680 animals, 

60 °, cealeuli, i : - 

60 so x composition of, ‘ 

61 Ae 5 in the dog, . ‘ 

59 oF) oP) 9 horse, ° 

63 >, swine, 3 

Urine, incontinence of, . 

63 Urethra, anatomy of, in ox, 5 

87 5 inflammation of, 5 F 

76 is injuries of, . : 

311 = purulent catarrh of, . 0 
340 is structure of, . 6 9 
208 tumours of, . 0 ; 
367 Urethral calculi in the horse, . c 

88 >> in ruminants, 

484 Urethrotomy, complications of, in her- 
5 bivora, ; : 

55 oF in horses, : . 
353 3 in ruminants, . n 
311 | Uterine crutch, Giinther’s, . 

75 | Uterus, amputation of, : 
353 oes canceriot, : 6 . 
367 », prolapse of, . : : 
167 Bs a reduced by injection 
407 of water, 

341 nA tuberculosis of, : A 
387 ss tumours of, . 
386 

64 

286 
y 

286 
288 
208 | VAGINA, cysts of, 
279 5, occlusion of, 
278 », prolapse of, : ; 
105 ise) tumMmoursiof an. : c 

Vaginal ring, Sauberg’s, 

YT uuSses; 
Vaginitis, : 2 . 
“9 infectious, in cows, 

Vagus nerve, injury of, - 
406 | Varicocele, 0 ° c : 
390 | Venous pulse, . 
403 | Ventral hernia, 
396 | Veratrin in impaction of the ceso- 
405 phagus, . 
400 5p subcutaneous injection of, in 
396 95 paralysis of supraseapular 
398 nerve, ‘ ‘ C 
394 | Vertebree, fractures of, . 
407 50 injuries to, . 
469 Viborg’ s triangle, ; ¢ ; 
235 | Villat’s solution, : : 5 
239 | Vocal cords, resection of, 
240 | Volar flexion, ; : ; 
240 | Vulva, inflammation of, ; ; 
347 », injuries to, 


387 


386 
377 
380 
386 
381 
381 
379 
379 
117 
368 
271 
262 


145 


456 
412 
410 
101 
187 
161 
528 
377 
377 


_ §WHISTLING,” 


WwW 


Whitlow of the claw, 
Wound gelatine, 
Wounds of the abdomen, 


ale of the nostrils, . 

chest-wall, 

fore-arm, 

mammary gland, 

metacarpus, 

neck, 

pads of the sole and 
toe, ' 


Wounds of the pleura, 


39 


Wry neck, 


rectum, 

salivary ene 

skull, 

soft tissue of the 
claw, : 

thigh, 

thoracic cavity, 


Z 


ZEHDEN’S syringe and trochar for re- 
moyal of ccenurus cerebralis, 


113 


a 


o* 
2 ear 


Naa Bat Reins Sate Ag ithiget b en REL EN 
eer Ue U Bul ta” iy 


ce, eo " ett 
(ede 


I aa! j i S a 
‘ ‘ eS 
: ¥ 
UA ‘ rs 
Poon, at i = ‘ : 
4 x UJ 
7 ‘ t Mi 


- 


tt aa 


eas oar 


6 AG 


RARY 


OF CONGRESs 


InN)