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SURGICAL DISEASES

AND

SURGERY OF THE DOG

WITH NINETY-ONE ILLUSTRATIONS

BY

CECIL FRENCH

Doctor of Veterinary Science (McGill University)

WASHINGTON, D. C., U.S. A.

WASHINGTON, D.C., U.S. A.
PUBLISHED BY CECIL FRENCH

GREAT BRITAIN
London: Henry Kimpton, 13 Furnival Street, Holborn, E. C.
Glasgow: Alexander Stenhouse, 40 and 42 University Avenue

1906

Entered according to Act of Congress, in the year 1906, by Cecil French, in the Office of the
Librarian of Congress, at Washington,

[All Rights Reserved. |

LIBRARY of CONGRESS
Two Copies Recelved
Nov § 1906

Copyright Entry
r 19 0k

crass A XXc., No.

4€-417 8

copy B.

GEO. E. HOWARD
PRINTER AND BINDEK
WASHINGTON, D. C.

Contents

CHAPTER I.

CUNWRAT SURGERY irre aieercn tes. 5 as ....Pages 1 to 35

Antisepsis. Asepsis. Antiseptics— Suturing and
Ligating Material Absorbents.— Sutures.— Appa-
ratus and Methods of Restraint Anesthetics.— Gen-
eral Anesthetics Local Anesthetics.— Narcotics.
Hypnotics.— Inflammation.— Contusion. Hematoma.—
Wounds.— Shock.— Abscess.— Ulcer— _ Fistula.
Sinus.— Burns. Scalds.— Frost-Bites—— Erysipelas.—
Toxemia. Septicemia. Pyemia.— Gangrene.

CHAPTER iT.

THE EEA DYANDY NECK. Suktegiti iss Otel aek Pages 36 to 71

Congenital Malformations—— Traumatic Lesions.—

Abscess of the Scalp.— Foreign Bodies.— Neoplasms.
THE EYEs.

Congenital Malformations.— Traumatic .Lesions.—
Parasites.— Conjunctivitis Superficial Keratitis. Ul-
ceration of the Cornea.— Interstitial Keratitis— Oph-

~~ __ ,thalmitis —Glaucoma.—Hydrophthalmia—Amblyopia.
Amaurosis.— Cataract— Luxation of the Lens.—
Strabismus.— Exophthalmia.— Neoplasms.

SURGERY OF THE EYE.
Paracentesis.— Enucleation of the Eyeball.— Dis-
cission of the Lens.— Extraction of the Lens.
THE EYELips.

Congenital Malformations.— Traumatic Lesions.—
Blepharitis— Ectropion.— Entropion.— Trichiasis.—
Neoplasms.— Lachrymal Fistula.

ili

iv Contents

THE Ears.

Examination.— Traumatic Lesions.— Ulceration of
the Concha.—Otitis. Otorrhea.— Sinus.— Neoplasms.
Amputation of the Concha.

CHAPTER III.

THE HEAD AND NECK (Continued)......... Pages 72 to 117

THE Lips, MoutH, ToNGuE, AND Jaws.

Examination.— Immobilization of the Jaws with the
Speculum.— Congenital Malformations.— Traumatic
Lesions.— Stomatitis. Gingivitis. | Glossitis.— Par-
tial Amputation of the Tongue.— Foreign Bodies.—
Neoplasms.

Tue TEETH.

Structure, Disposition, and Development.— Conge-
nital Malformations.— Traumatic Lesions.— Incrusta-
tions of Tartar.— Calcic Pericementitis— Alveolar
Abscess and Maxillary Fistula.— Caries.— Scaling.—
Extraction.

THE SALIVARY GLANDS.

Traumatic Lesions.— Fistula.— Inflammation.

THe PHARYNX.
Examination. Pharyngitis— Foreign Bodies.—
Neoplasms.
THE ESOPHAGUS.

Examination.— Congenital Malformations.— Trau-
matic Lesions.— Foreign Bodies.— Esophagotomy.—
Neoplasms,

Tue Tuyroip GLAND AND GLANDULES.

_ Struma. Goiter. Bronchocele.— Unilateral Thy-
roidectomy.—Simple Thyroidectomy.— Exophthalmic
Goiter.

Contents

Tue LympnHatic GLANDS.

Lymphadenitis.— Neoplasms.
THE Nose.

Epistaxis.— Foreign Bodies.— Neoplasms.
THE LaryNX AND TRACHEA.

Foreign Bodies.—— Neoplasms.— Fracture of the
Trachea.

SURGERY OF THE TRACHEA.

Tracheotomy.

CHAPTER IV.

EO Sed Bs UG 15s ©, CRG eR Ce gn Reece PL Pages 118 to 133

THE LuNcGs AND PLEURAE.

Examination.— Traumatic Lesions— Pleuritis.—
Hernia.

SURGERY OF THE LUNGS.
Thoracentesis.

THE HEART AND PERICARDIUM.

Traumatic Lesions.— Pericarditis Hydropericar-
dium.

SURGERY OF THE HEART.

Suture of the Heart.— Pericardicentesis.

@HAPTER:V:

PERE UE ONNIIIN 5 5 c's a2 ooo ies wie dimes whee al aiege Pages 134 to 153

ABDOMINAL SECTION. CELIOTOMY. LAPAROTOMY.

THE PERITONEUM, MESENTERY, AND OMENTUM.

Traumatic Lesions.— Peritonitis—— Ascites—— Para-
centesis.— Foreign Bodies.— Neoplasms.

v1 Contents

CHAPTER VI.

THE ABDOMEN (Continued)........... .....Pages 154 to 214
Tue SToMAcH.

Examination.— Traumatic Lesions.— Peptic Ul-
cer.— Torsion.— Foreign Bodies.— Neoplasms.

SURGERY OF THE STOMACH.

Gastrotomy.— Gastro-Enterostomy. Gastro-Enteral
Anastomosis.

THE INTESTINES.

Examination.— Traumatic Lesions.— Intestinal Ob-
struction.

SURGERY OF THE INTESTINES.

Enterorraphy.— Enterotomy.— Enterectomy and
Entero-Enteral Anastomosis or Entero-Enterostomy.—
Ventrofixation.— Rectal Irrigation. Enemeta.

THE ReEctuM AND ANUS.

Examination—Congenital Malformations.— _ For-
eign Bodies.— Pseudocoprostasis.—Suppuration of the
Anal Pouches.— Anal Fistula. Anal Sinus.— Hemor-
rhoids. Piles—— Prolapse of the Anus. Procidence of
the Rectum.— Neoplasms.

THE LIver.

Examination.—Traumatic Lesions.— Neoplasms.—
Cholelithiasis.

SURGERY OF THE LIVER.
THE PANCREAS.

SURGERY OF THE PANCREAS.
THE SPLEEN.

Examination.—Congenital Malformations.— Trau-
matic Lesions.— Neoplasms. .

SURGERY OF THE SPLEEN.

Complete Splenectomy.— Partial Splenectomy.

Contents Vil

CHAPTER VII.

ELE eo EN CC MMEMUET Yo. cas oieic ccse ote Pages 215 to 250

THE URINARY ORGANS.

Urolithiasis.

THE KIDNEYS.

Examination.— Calculi.— Neoplasms.— Parasites.

SURGERY OF THE KIDNEY.
Nephrotomy. Nephrolithotomy.— Nephrectomy.
THE URETERS.

Calculi— Surgical Wounds.

SURGERY OF THE URETERS.

Ureterolithotomy.— Uretero-Ureteral Anastomosis.
Uretero-Ureterostomy.— Uretero-Vesical Anastomosis.
Uretero-Cystostomy.

THE BLADDER.

Examination.— Traumatic Lesions.— Cystitis —
Calculi— Torsion. Retroflexion.— Neoplasms.

SURGERY OF THE BLADDER.

Passage of the Catheter and Sound.— Passage of
the Catheter in the Male.— Passage of the Catheter in
the Female.— Irrigation.— Puncture.—Cystorraphy.—
Prepubic Lithotomy. Cystotomy.— Litholapaxy.—
Resection.— Vesico-Rectal Anastomosis. Cysto-Enter-
ostomy.

THE URETHRA.

Examination.—Congenital | Malformations.—Trau-
matic Lesions.— Stricture—— Obstruction.— Urethro-
tomy. Urethrolithotomy.

Vili Contents

CHAPTER VIII.

THE ABDOMEN (Continued).............6. Pages 251 to 287
THE REPRODUCTIVE ORGANS OF THE MALE.

THE PENIS AND PREPUCE.

Examination.— Congenital Malformations.— Trau-
matic Lesions.— Orchitis.— Neoplasms.— Parasitic
Emasculation.— Orchectomy.— Castration.

Tue Prostate GLAND.

Examination.— Prostatitis —— Neoplasms.
THE REPRODUCTIVE ORGANS OF THE FEMALE.
THE OVARIES.

Examination.— Congenital Malformations.— Ooph-
oritis— Neoplasms.— Oophorectomy.

THE FALLOPIAN TUBES AND UTERUS.

Examination.— Salpingitis. | Pyosalpinx— Metri-
tis— Procidence.— Torsion of the Cornua.— Rup-
ture.— Neoplasms.

SURGERY OF THE UTERUS.

Hysterotomy.— Hysterectomy.— Ventrofixation of
the Cornua.

THE VAGINA.

Examination.— Congenital Malformations.— Vagi-
nitis. WVulvitis— Prolapse—— Rupture.— Neoplasms.

CHAPTER IX.

THE ABDOMEN (Continued)..............+- Pages 288 to 306
HERNIA.

Abdominal Hernia in General_— Abdominal Hernia
in Particular.

Contents

THE MAMMARY GLANDS.

Traumatic Lesions.— Congestion.— Mammitis. Ma-
stitis— Neoplasms.

CHAPTER X.

TEES Sy ch 21 a0 Fy 1 ee Pages 307 to

Tue Lecs AND FEET.

Congenital Malformations.— Traumatic Lesions.—
Inflammation.— Foreign Bodies.— Neoplasms.— Am-
putation— Amputation of the Dew-Claw Digit—
Disarticulation of the Phalanges.

THE TAIL.

Congenital Malformations.— Traumatic Lesions.—
Inflammatory Affections.— Neoplasms.— Amputation.

CHAPTER XI.

Mir QSShOUS. SY ao Lee. oe, esteaen sees Pages 323 to

Traumatic Lesions.— Fractures in General.—Frac-
tures in Particular— Pseudarthrosis.— Osteitis. Peri-
ostitis. | Osteo-Myelitis—— Rachitis—— Osteomalacia.—
Neoplasms.— Osteoplasty— Osteotomy.

CHAPTER XII.

mie ARTICULARIONSG 3s. .iagee sacgpibosrees + Pages 350 to
Traumatic Lesions.— Luxations in General.— Lux-

ations in Particular— Synovitis.— Arthritis.

CHAPTER XIII.

PUR ORMPESEES, so. ss scans e cere ae aa aes Pages 363 to

Hypertrophy and Hyperplasia. — Inflammatory Neo-
plasms.—Tumors Proper.— Cysts.— Treatment of
Tumors.

322

349

362

393

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List of Illustrations

PAGE.
Halsted’s Subcuticular suture............... 6
Phonias “Sutures! Ves. Sys. Seat wets Ss . 7
simple Muzzle of tapéior rope. i). Jc siatn. ss» 8
Dawson-French Portable Hopples........... 8
Hobday’s Hopples ..... ARTs IS. Sora ec 9
Extension: Grate... 2gtnk Deans in. kee oe eae 9
Youne’s Operation ‘Trotighs ices. Secs. 9
“Cherry” method of treating gaping wounds.. 26
Carcinoma of the Neck)o/.0/0iGU... Sigecsal: facing 39
Operation toe: Metropion fo... 5 Sse et ds ae 58
Operation for Entropion’’.,. Wis 00.5 cals Savile 59
Papilloma of the Eyelid. ...9:2:% (MBAR 03,4 facing 60
Hypertrophy of the Orbital gland............ 7 St @O
Fat Speci tink "yo. RAE Pah ie thaonia ok ‘=e 63
Papilloinata of the Sar 05792) 5 1 ene Pe Se aS
Operation for Hematoma of the Ear-flap...... 67
Agipatation of the Concha siiei.s Cav aget. ne 69
Amputation. of ‘the Concha... 22.0 8.4 she. 69
Adputation of the Concha.) Powel. Sek * 71
Improvised, Bourrel: Gag. S2yuIR te 72
Examination of the Buccal cavity............ facing 72
French’ Wows Speculmiqta non. ose. 73
faker Mouth *Spechlime <. ¢o264 A Sis eee 72
Papillomata of the Buccal mucosa........... facing 78
Retention-cyst appearing in the Buccal cavity, “ 79
Retention-cyst burrowing down the Neck...... 79
Epithelioma of the Lip with secondary lym-
phate cnlargetient’ 200 ae Ae wee rok eae
Osteo-sarcoma of the Superior Maxilla....... ate
Pedunculate Osteo-sarcoma of the periosteum
of the Inferior Maxilla ........ USS La) ee
Maxillary fistula ........ Pay at bole soe 89
Sealine Chisel! Spee 2 eh i vin v's wile olwtelare We eres gI

Xi

Xil List of Illustrations
NO. PAGE.
32. Thyroid Gland and Glandules ............... facing IOI
33; Goiter CIRO e eae ike - <ieh ee Ame» <i ERE Sp Tee
34. Acute Tyinphadeaiis: oc feos teen cate ee =) OS
35: Tuberculous Lymphadenitis. Fistulous tract. . 109
36. Tuberculous Lymphadenitis. Fistulous tract.. “ log
37. Extra-uterine gestation showing two pseudo-

uteri and. niumenousscysts i Sis sut. alesse: peer
38. Rectal. .Donchenrettets}so 7). cast we testh 166
39,a,b. Simple Interrupted intestinal suture.......... 182
Mo. a; b.. -Lembert intestinal-suture. Atal Giese ot 183
oh Halsted’s intestinal Mattress suture ......... 183
42.a Hair-pin Method of intestinal anastomosis... . 187
42. b Hair-pin Method of intestinal anastomosis,

Bitst stage’ i./J<. douse «tab eee 188
42.¢ Hair-pin Method of intestinal anastomosis,

Secoud, stare csc. hikefol adh ice gee aes 189
#9..a,.D. Anal Sinus Sos Wisi). its tac emeraa peas - 197
44. Procidence, of: the. Rectum”, -- vJetieune tens. 200
45. a. Amputation of Rectal Procidence. First Stage 202
45. b. Amputation of Rectal Procidence. Second stage 203
46. a, b, c., Uretero-eystastomy. tsfoi a4 saab teen « 228
47. Male. Catheter 3.5 < kiehet owet. taser slob sd bye eres ie 238
48. Female. Catheter .~ eclageokcclt. tans ee 238
49. Vaginal ; Speculum, ...ns3 diesels Haasmpeeret 239
50. Menereal -Granuleniata:). aAdcti eis cendqot« facing 255
SI. Malignant Neoplasm of the right Testis...... “ 259
§2. Diagram to show course pursued by the finger

to quickly reach/ the; corm... ..cjasiafs jens’ - 269
53- Diagram illustrating technic of excision of the

OVAGFL cit c. Tikasiniene raed degincet baaiees 270
54- Procidence of the Vagina, Os Uteri, Uterus,

and, both, Uterine Gornuandiis Jaitiees « «.'- facing 275
55- Ventrofixation of Abdominal Viscera........ 281
56. Fibro-lipoma of the Vaginal wall............. facing 284
57. Estrual Hypertrophy of the Vaginal mucosa... “ 285
58. FIEPDUNOMIE Soo es beg os oe es Rees weatswakes ———
59. Inguinal Hernia in the Female.............. facing 293
60. Inguinal Hernia in the Female .............. < 233

List of Illustrations Xili

PAGE.
Diagram illustrating normal position of parts.. 295
Diagram illustrating mechanism of Inguinal
Wea MMI A Bates wc ithe «Bie male digs aide Siete! olae aaahe 5 295
Ineomal) Ternia.in the Male... 0... 00.2.5. facing 298
Serotal..Hermia in: the Male. .....5.... ahaa 205
PRCA AU LEENA ee acco luta W Scow Ge oie ar mse 8 * BOG
Mammary Tumor simulating Hernia........ el g0R
Lipoma of the Mammary region............ e304
Illustration showing situation of primary Mam-
mary Growth and the palpable Metastases.. “ 305
True Carcinoma of the Mammary gland...... See 308
Chronic interstitial Fibrosis of the Teat...... rfp. 400
Position assumed by the leg after division of
hie (LENO CMe i yi... 5 ke oa a oa wank, eae as “308
Dei A Mig gie es aise aitioe!ehuc G heistcjare) aber « she ater 311
Elastic sband: on the’ Wer <.)s0 3.0. ck hc eke « facing 312
Fibro-adenoma of the Skin of the leg exhibit-
inp’ impending malignancy . 24. 26.6. +.%« fo 35a
Piaats Male MOTO i.\ 2 ayn 2 oat ae ons ows sea oss Pera
dnferdipatal, Serous: Cyst)’ ses 'oc02 dase cence ee ~ peers
Effect of too tight or too early bandaging.... “ 328
Diagram illustrative of Bone-suturing........ 336

Biome Gaye jad tat ya eee a eee yard vite 341

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CHAPTER I

General Surgery

ANTISEPSIS. ASEPSIS. ANTISEPTICS.

Since Lister first advocated the employment of chemical agents
to prevent bacterial development in wounds, the principle has been
generally adopted, though it has received modification in recent
years. The original plan of antisepsis comprehended the disinfection
of instruments, suturing material, operator’s hands, area of opera-
tion, and everything coming in contact with the wound, by means
of chemical germicides supplemented by post-operative treatment of
the wound with antiseptic agents to inhibit the growth of bacteria.
Antisepsis is still practised, but on this continent has given place
largely to the aseptic method in which the use of chemical agents is
limited solely to the disinfection of the operator’s hands and the
cutis of the area of operation, sterility of instruments and suturing
material being obtained by means of heat; no antiseptics are per-
mitted to come in contact with the wound, chemical agents being
regarded as irritants to the tissues. Whatever advantages either
method may have over the other in its application to human surgery
it is not within our province to consider and we need only concern
ourselves with the one best adapted to canine surgery. There can be
no question whatever that the necessity for the application of the
principle in the latter instance has been greatly over-rated and that,
with a few exceptions, equally as good results are obtainable when
nothing more than the ordinary rules of cleanliness are observed.
The danger of starting up pyogenic processes consists not so much
in introducing bacteria from without as it does in creating condi-
tions within under which such bacteria can thrive to the point of
producing a toxic effect. It is when putrescible matter exists in
spaces removed from direct contact with the phagocytic action of the
living tissues that the conditions are ripe for bacterial multiplication.
Putrescible matter is easily creatable by the ligating of portions of
tissue, such as the omentum and large vessels, so as to form stumps;

2

2 Surgical Diseases and Surgery of the Dog

it is also ready existent in the form of certain natural secretions,
especially those of serous cavities, such as joints and the pleural
sacs, where septic surgical interference is commonly followed by
pyogenic processes, particularly when abnormal accumulations of
fluid are present. The normal peritoneum must be excepted on ac-
count of the well-known comparative immunity it enjoys, probably
by reason of the numerous recesses existing between the coils of the
viscera where there is a chance for microbic activity to become local-
ized, the pleura and joints on the other hand offering an unbroken
extent of space for the accumulation of fluids. Hence, the object
should always be to avoid the creation of putrescible matter, but
inasmuch as this is a matter of impossibility in some parts of the
body, it is necessary to take precautions to prevent infection by the
practice of aseptic methods, or resort to the alternative of drainage.
Aseptic methods are indispensable in operations involving interfer-
ence with the thorax, the cerebro-spinal canal, joints, and deeply
situated organs such as the thyroid gland; they are not so necessary
when the peritoneum is concerned, excepting when ascites is present,
but are advisable as a precautionary measure; they are also expe-
dient in operations on the surface of the body but can be dispensed
with where local infection has already occurred, as in wounds and
abscesses.

The preliminary steps in an operation on the lines indicated
above consist of sterilization of instruments and material and dis-
infection of the hands of the operator and the cutis in the area of
operation.

Sterilization of Instruments. Instruments are best sterilized
by boiling for at least ten minutes, and if some powdered carbonate
of soda is added to the water to the amount of one drachm to the
pint, so much the better. Sodium carbonate dissolves the capsules
of the germs and the latter are destroyed in much shorter time, and
moreover, it inhibits rusting. Chemical disinfectants are unreliable
but should be used to receive the instruments during the course of
the operation to prevent fresh contamination. For the latter pur-
pose a solution of carbolic acid (5:100) is suitable.

Sterilization of Hands. The hands of the operator always re-
quire thorough cleansing. They should first be scrubbed in hot
water and soap, particular attention being bestowed on the nails.
They should then be immersed for a few minutes in a strong solu-

General Surgery 3

tion of permanganate of potash until stained dark brown. Decolor-
ization can be effected by soaking them in a warm saturated solution
of oxalic acid, and the effect of the latter can be neutralized with
lime water. If it is desired to conduct an operation under un-
doubted absolute asepsis the only alternative is to wear thin rubber
gloves.

Sterilization of Region of Operation. _It is practically impos-
sible to completely disinfect the skin. Only the microorganisms
in the superficial layers can be destroyed by chemical agents. Those
existing in the deeper layers can not be reached by any agent
short of a gas, but it is known that they possess but feeble pyogenic
capacity which the living, healthy tissues have the power to over-
come. Welch proved that the white staphylococcus occurs in
wounds where every possible antiseptic precaution has been taken,
but it seldom exerts interference with the process of healing. Of
course, what has been written concerning the hands of the operator
applies equally as well to the cutis of the area of operation, but in
addition the hair should always be removed by means of clippers or
razor.

Antiseptics. There being such a variety of antiseptic agents,
I shall only briefly refer to a few which are specially adapted to the
particular purpose in view. Permanganate of potash is most valu-
able possessing as it does both microbicidal and deodorant proper-
ties and being at the same tinie free from toxicity. It owes its
power to its capacity to rapidly give up oxygen in the presence of
moisture. It is effectual for both dermal and mucosal surfaces.
It is used in the strength of 1:100 to 10:100. Corrosive sublimate is
very useful as an inhibitory agent, particularly in exposed joints,
but it is poisonous and corrodes metal. It is prepared by manu-
facturing pharmacists in tablets of definite strength and is used in
solutions of 1:2000, I1:1000, and 1:500. Carbolic acid is effective
in the strength of 2:100 to 5:100, but must be used with great cau-
tion as dogs are peculiarly susceptible to its toxic effect. Creolin
is an effective agent widely used. It is only slightly toxic and does
not corrode instruments. It is used in strength of 1:100 to 5:100.
Boric acid is a mild antiseptic particularly useful for eye work in
saturated solution of 4:100. Peroxide of hydrogen is an unstable
oxidizing agent usually of uncertain strength, capable of setting free
ten or twenty times its volume of nascent hydrogen. Its sole use is

4 Surgical Diseases and Surgery of the Dog

for evacuation of pus cavities. Being without irritant effect, it may
be poured in full strength into a septic wound. It immediately lib-
erates its oxygen, effervesces and forms a frothy foam which brings
dead and moribund matter to the surface. Boiled salt water in the
strength of 5:1000 to I:100 is used for flushing the abdominal cavity
and the bladder.

Of the dry antiseptics the synthetic powder Tri-brom-phexol-
bismuth, commercially known as Xeroform, is without a peer. It
not only promotes active healing but exerts a pronounced anodyne
effect as well. Whether used on ulcers or freshly infected wounds
the beneficial results are quickly apparent. Other excellent prepa-
rations are Aristol, Iodol, and Bismuth Formic-Iodide.

SUTURING AND LIGATING MATERIAL.

The materials commonly used for suturing and ligating are silk,
silver wire, silkworm gut, catgut, linen thread and rubber bands.
Pure Chinese twisted silk forms an excellent suturing material for
general purposes. Either white or black is used, the latter being
more easily seen, which is a matter of some advantage in suturing
hollow viscera. When used in the skin, the texture should be mod-
erately stout (Nos. 6-12), but for hollow visceral organs it should
be as fine as is consistent with strength (No. 2). Asa buried suture
or ligature it is also very desirable as it readily becomes encap-
sulated in the tissues and remains inert. It is best rendered sterile
by boiling just before using. Silver wire is indispensable in bone
suturing. If rendered perfectly sterile when inserted and the wound
remains free of infection, it may generally be allowed to remain per-
manently in place without fear of its giving rise to irritation, though
the latter sometimes happens, which necessitates its removal after it
has served its purpose. Silkworm gut being non-absorbable and at
the same time having a perfectly smooth surface, is preferred by
some to silk. It is rendered sterile by boiling and the knots possess
little tendency to become undone or loosened. Catgut is theoreti-
cally a very valuable suturing material on account of its being ab-
sorbed and not requiring removal. But it is sterilized with diffi-
culty (it can not be boiled), it is apt to be absorbed too rapidly, and
it becomes untied too easily through swelling and softening by
absorption of moisture. Chromicized catgut is said to be capable of
resisting absorption from three to four weeks. Any one of the other

General Surgery 5

materials, if properly sterilized, is used to better advantage, because,
though they do not become absorbed in buried positions, they are
safely encapsulated by natural processes and rendered perfectly
harmless. It is only rarely that a buried non-absorbable suture
needs to be removed. Linen thread, as supplied for sewing ma-
chines (it is-specially spun so as to travel evenly through the eye
of the sewing machine needle) is strong, ties a good knot, is steri-
lized by boiling, is not irritative, and can be obtained anywhere
where sewing machines are sold, and is therefore a desirable
material for fine sutures or ligatures. Rubber bands form an excel-
lent material for use as ligatures where portions of vascular internal
organs are extirpated. They never slip from position, do not cut
through delicate tissues and offer no impediment to the healing pro-
cess. Gluck advocates their use in operations where portions of the
liver, lungs, or spleen are removed, and Senn has used them to ad-
vantage in surgery of the pancreas.

ABSORBENTS.

The best sort of absorbent to swab up blood and other fluids
during an operation is a pledget of sterilized gauze.

SUTURES.

Of the various sutures used in general veterinary practice, I
can commend but two for application to cuticular wounds. These
are the “simple interrupted” and Halsted’s “buried” or “subcuticu-
lar” suture.

The Subcuticular Suture is undoubtedly superior to any yet de-
vised for canine work. Halsted contrived it whilst making a series
of experimental extirpations of the thyroid gland owing to the diffi-
culty which he experienced in maintaining aseptic wounds with the
ordinary suturing which penetrates superficially. It is well-known
that the skin, particularly in its upper layers and in the hair follicles,
swarms with microbes, and while these in large proportion are
non-pathogenic and do not inhibit the healing process, any suture
which passes from without to the subcutaneous tissue of necessity
creates a highway for microbic migration. The result is subcuta-
neous infection and a wound which, perforce, must heal by sec-
ondary intention with suppuration, which is always a slow process

6 Surgical Diseases and Surgery of the Dog

and one subject to more or less cicatrisation. In non-infected surgi-
cal wounds this suture, applied under aseptic conditions, will secure
healing by first intention. In traumatic wounds, which are invaria-
bly more or less infected, such desirable result is not always obtain-
able, though, at times, the two cut cuticular edges will speedily
unite whilst the subcuticular wound heals by the slower process of
suppurative granulation. This suture is particularly adapted to
linear wounds.

The subcuticular suture is applied in the following manner: The
needle is introduced on the under surface of the skin, as near to the
upper commissure of the wound as possible, and including only the
deeper layers of the skin, is made to emerge at the cut edge. Cross-

Mf
— ~
B
4 A VY
H G Y
Y 4 4
4, 0 Y
) » YW
\) 0) ty
a
v)

NS

=

ie oe

No. 1. The Subcuticular suture (a) in course of application (b) completed.

ing over, the same process is repeated on the opposite side, and so
on alternately. Sebacious follicles and hair follicles should not be
perforated by the stitches. If the wound is believed to be aseptic
and free of spaces the suturing is extended as far as the inferior
commissure, but if it is known to be infected, the suturing should be
carried only to a point which will allow a proper orifice for drain-
age. When the entire row is completed both free ends are pulled on in
opposite directions which brings the edges of the wound into close ap-

General Surgery 7

position. Knots are unnecessary because the tissues hug the unin-
terrupted suture so closely that slipping does not occur. The ends
should be cut off quite close or the animal may seize them and drag
the suture out. When reunion of the parts is established, which is
usually the case at the end of ten or fourteen days, provided the
healing process has proceeded without check, the suture may be
easily withdrawn by seizing one end and applying traction on the
same.

The Simple Interrupted Suture needs but a passing reference.
In ragged, angular and uneven wounds, where the subcuticular su-
ture can not be employed, and in those cases where the latter does
not succeed, recourse must be had to it. This suture should be tied
in a reef knot, and the latter should be made to one side of the
wound. Each suture should be placed from one-third to one-half
inch from its neighbor.

For severed mucous membrane the best suture is that figured
in the accompanying illustration. It was devised by Thomas. It
is superior to the simple continuous suture because it brings the cut
edges of the mucosa tightly together and divides the wound into
independent segments. Each end of the suture is threaded on a
cambric needle. Commencing at the top end of the wound, one
needle is passed through, and the
silk or catgut follows until there is
half the length of the suture on
each side with its needle attached.
A reef knot is tied and the needle
which is on the right side is
brought over the left and passed
through lower down and_ back
again to the right, while the needle
which is on the left is taken over
to the right and passed through
back to the left immediately ad-
joining the previous one. A reef
knot is again made and so on ae epee eat re
throughout the extent of the
wound. The various sutures employed in surgery of hollow vis-
cera are fully described under ENTERORRHAPHY.

8 Surgical Diseases and Surgery of the Dog

APPARATUS AND METHODS OF RESTRAINT.

Muzzles. Mouth Speculums. The simplest method to pre-
vent the dog from biting is to select a piece of tape or soft rope,
make an overhand knot or a half hitch in the same, slip the loop
over the closed jaws with the knot or
hitch undermost, tighten the latter,
carry the free ends under the ears to
the back of the head and tie there in a
bow-knot. Fractious animals should be
held by their owners and prevented from
backing away or turning the head
while this is being done. All short-
faced animals (Bulldogs, Boston Ter-
riers, Pugs, Toy Spaniels), in which the
capacity of the nasal passages is small
must be secured in this manner with ex-
treme caution. Under even a moderate

No. 3. Simple ete Of tape or degree of excitement ‘their nasal pas-

ages are insufficient to accommodate
the increased respiration, and these animals are forced to breathe
by the mouth. If this avenue is closed suffocation results, and the
heart may be overstrained or rupture of the pulmonary vessels take
place, to be followed by death within a few hours. The jaws may
also be secured with the ordinary muzzles sold in the stores, but
very few of the latter are really effective for this purpose.

In some cases, . particu-
larly of fractious animals, mor-
phine is very useful as a means
of control, injected hypoder-
mically. It renders an animal
contented, more or less obliv-
ious to its surroundings and
unmindful of slightly painful
manipulations.

Hopples. There are sev-
eral patterns sold by the in-
strument makers, but of these
I can confidently recommend te
as the best the portable Daw- No. 4. Dawson-French Portable Hopples.

General Surgery 9

son-French model. Its main feature is its self-locking action. A
swinging cam is suspended in a frame through which the control
rope passes. The frame is supplied with a screw-clamp by means
of which it is attachable to and detachable from any part of any table
at will. One set of four large and one set of four small noose leg-
bands are provided. These will fit an animal of any size, and are
connected to the control ropes by steel snaps. Should the operator
wish to tighten the control rope he does so by merely pulling on it,
and the moment he lets it go it is firmly clinched by the cam. The
animal can be quickly released from the control position at any mo-
ment by simply holding back the handle bars, by which the cam is
prevented from clinching and allows free passage of the rope. A
simpler but less effectual instrument was invented by Hobday, in

eS ee

. =
ete et ——<$———
_—S ae

= — .

No. 5. Hobday’s Hopples.

England. Lacking any of these devices a very simple method of
hoppling is to take four pieces of soft rope of good length and con-
vert one extremity of each into a noose. This is slipped over the
foot and tightened while the other end is fastened to the leg of the
table.

Operating Table. An
ordinary kitchen table ans-
wers all purposes. Where
may be covered with zinc
practice warrants it, this
which should drain to the No. 6. Extension Grate.
center. Here a small pipe
should carry off fluids to a
bucket suspended beneath.
To prevent the coat of the
animal from becoming sat- =
urated with blood or other No. 7. Young’s Operating Trough.

10 Surgical Diseases and Surgery of the Dog

fluids the extension grate made of enameled iron or improvised out
of wood will be found very useful. Another simple device is known
as Young’s operating trough.

BIBLIOGRAPHY.

Gluck—Langenbeck’s Archiy. f. klin. Chirurg. 29, P. 143.
Halsted—Johns Hopkins Hospital Reports. 1, p. 398.
Schloffer—Langenbeck’s’ Archiy. f. klin. Chirurg. 1898, p. 334.
Thomas—Brit. Med. Journ. Nov., 1898.

Welch—tTrans. of the Congr. of Amer. Phys. & Surg. 1891, 2, p. 1.

ANESTHETICS.

General anesthetics should be administered prior to the com-
mencement of all operations involving severe or protracted pain.
Not only is their employment prompted by humane consideration
but without it the accurate conduct of delicate operations is ren-
dered a matter of great difficulty and often an impossibility, owing
to struggling on the part of the animal. Their employment is con-
traindicated when cardiac or pulmonary diseases exist.

Local anesthetics, hypnotics, or narcotics are employed to dull
the peripheral or central sensibilities in operations of a minor nature.
Narcotics are also useful for the control of refractory or vicious
animals when under examination. Both hypnotics and narcotics
are also used for the production of complete general anesthesia,
but in this case very large doses are necessary, from which the
animal is slow to recover and which are not free from danger. It
will be found convenient to resort to them when the services of an
assistant are unobtainable.

GENERAL ANESTHETICS.

Choloroform and Ether, either alone or combined and di-
luted with ethyl alcohol are the drugs most extensively used for
the production of general anesthesia.

The vapor of chloroform, if administered under proper condi-
tions allows of no comparison with other anesthetic agents. There
can be no doubt that any danger attending its use has been much
overrated, owing to neglect of the observance of fundamental rules
governing its successful administration. Nevertheless, I would
warn those unaccustomed to giving it, not to employ it for valuable
animals.

The principal advantage derived from chloroform administra-

General Surgery II

tion is: Production of profound narcosis unaccompanied by reflex
movements which is preceded by a mild preliminary period of
excitement and succeeded by a rapid recovery from its effects. It
is dangerous only when administred in concentrated form. It is
then liable to produce rapid fall of blood-pressure through paraly-
sis of the vaso-motor center, which is quickly followed by paralysis
of the respiratory center. At the same time the heart’s action
grows weak under the combined influence of vagus inhibition, vaso-
motor paralysis and dilation of its cavities from the direct action
of the drug, though it may continue to beat two to five minutes after
respiration has ceased. In a small percentage of cases the heart’s
action may be the first to fail.

Ether is safer than Chloroform on account of its stimulating
properties. But there are well-deserved objections to its use, the
stage of excitement being very great and prolonged, even if the
administration be pushed without admixture of air; it is usually
productive of reflex movements and tetanic contractions of the ex-
tremities ; and complete narcosis is only possible under continuous
administration. These objectionable features can, however, be over-
come in large measure by previous administration of narcotics.
Only the best quality of ether fortior should be used.

But ether is liable to produce undesirable after-effects in the
form of affections of the respiratory tract, whereas the danger
from chloroform ceases with its withdrawal. Under ether-anes-
thesia there is always great secretion of saliva and mucus, while
under chloroform the amount is infinitesimal. This matter was care-
fully studied by Hoelscher in a series of experiments on dogs. The
animals were subjected to anesthesia lasting one hour. They were
laid in various positions—in the horizontal, with head elevated, and
with the head depressed. The buccal secretions were also stained
by injections of gentian violet. In all the animals that lay in the
horizontal position, the colored secretions were found to have pene-
trated to the smallest bronchii, showing that the force of the in-
spired air current was sufficient to drive back the buccal contents
into the bronchii. Moreover, the secretion acted as an obstruction
to the passage of the air and the animal was forced to breathe
harder. When the animal lay on the left side it tended to reach
the left lung more, and only slightly the right. In animals whose
heads were greatly elevated, this was sufficient to cause death by oc-

12 Surgical Diseases and Surgery of the Dog

clusion of the respiratory tract. When the head was depressed
slightly there was rattling in the throat, but the secretions did not
penetrate any further. When the head was allowed to hang free,
the secretions escaped from the mouth and none were inspired, but
when with the head thus held the fluids were prevented from escap-
ing they were inspired. Hence, in the administration of ether the
position of the head is a matter of great importance and must be
such as to permit of drainage of the buccal secretions. Rattling in
the throat is significant of their inspiration, and is to be avoided.
Vomiting is also more apt to occur with ether, and this with labored
breathing is productive of inspiration-pneumonia.

For the safe administration of either of these drugs a certain
proportion of air is necessary. This is particularly true of chloro-
form to which a large admixture is essential for safety. The pro-
portions have been worked out by Bert. He found that when the
anesthetic vapors and air were mixed in certain definite proportions,
and continuously inspired, safe anesthesia was established. If the
proportion of the medicamentary substance was increased, death re-
sulted. The interval between the anesthetic and lethal dose he
designated the “maniable zone.” In carefully determining the
limits of this zone with various agents, he arrived at the singular
conclusion that in every instance the lethal dose is precisely double
the anesthetic.

To illustrate, the following table is useful:

ANESTHETIC DosE LETHAL DosE
Chloroform 9 19
Ether 37 “maniable zone” 74
Ethyl Bromide 22 45

The figures indicate the number of grams of the anesthetic
liquid mixed with roo liters of air, and then reduced to vapor.

If an animal is made to inspire a mixture corresponding to
about the middle of the maniable zone, it is rapidly anesthetized and
will remain so as long as the administration is continued. But the
maniable zone is singularly limited, a few extra drops converting
the active dose into a lethal one. This is particularly true of chloro-
form. Eight grams volatilized in one hundred grams of air did not

General Surgery 13

narcotize a dog, but twenty grams killed it. The range is twelve
grams.

Ether has the same power in proportion, but is infinitely less
dangerous, since between active and lethal dose there is a range of
nearly forty grams. According to Embley, the chief factor in the
causation of sudden death under chloroform is vagus inhibition.
Chloroform vapor not stronger than one and one-half per cent in
air after a period of mild excitation, slowly depresses vagus ex-
citability, and if administered in strength of over two per cent may
cause dangerous or persistent inhibition. This action is all the
more intense and fatal from being exercised upon an organ whose
spontaneous excitability is diminished by the paralytic effect of the
drug upon the heart muscle itself. The failure of respiration is due
to fall of blood-pressure, and takes place invariably long before the
heart stops. Hence respiration should be watched as an index to the
circulatory condition.

If atropine is administered prior to the chloroform the vagus
is never inhibited and cardiac arrest does not follow. Rudolf and
others have made similar observations. Hence, we have in atropine,
administered hypodermically previous to chloroformization a very
convenient antidote, one which reduces all risk of vagus inhibition
toa minimum. If a little morphine is combined with the atropine
the primary excitant period attending the chloroform administra-
tion is suppressed, but the atropine should be in amount somewhat
in excess of what would be given alone, to provide for the mutual
neutralization of the two alkaloids. A suitable mixture for this
purpose is made in the following proportions: Morphine sulphate
three-quarters of a grain, atropine sulphate one-twentieth of a
grain, distilled water one drachm. Of this, small dogs take five
to ten minims, medium sized dogs ten to twenty minims, and large
dogs twenty to thirty minims, hypodermically. Some twenty min-
utes later the chloroform should be administered. In this manner
very little of the latter drug suffices to induce a profound and safe
narcosis of considerable duration.

During administration the action of the iris should be closely
observed. It is an almost infallible guide in the estimation of
the blood-pressure. Insensibility of the conjunctiva is often re-
garded as an indication of insensibility of the higher centers; but as
a matter of fact, the former is established before the latter, comse-

14 Surgical Diseases and Surgery of the Dog

- quently it can not be regarded as a satisfactory test. The first effect
of chloroform on the pupil is dilation from excitement, varying in
degree and duration in different individuals. Coincident with the
approach of the stage of narcosis and fall of blood-pressure, the
pupil commences to contract and continues to do so slowly until
either the return of sensibility or the stage of asphyxia. The stage
of complete or operative narcosis is reached when the pupil no
longer dilates in response to otherwise painful stimuli. It is the
degree of contraction which must govern the administrator in the
exercise of his judgment as to the quantity of vapor permissible.
Should the pupil become strongly contracted and immobile the
danger point is reached and the vapor must be immediately with-
drawn and fresh air supplied. Otherwise, the pupil will be seen
to dilate suddenly and completely and almost at the same time the
breathing will cease, an indication of vaso-motor paralysis and as-
phyxia, a state from which it is difficult or impossible to resusci-
tate the animal. There is, therefore, no pronounced change
to give warning of impending danger, and as soon as the pupil is
strongly contracted the supply of vapor must be cut off and air sup-
plied until dilation again commences, when, if necessary, more vapor
may be supplied and withdrawn as before, and this procedure kept
up until the completion of the operation.

To resuscitate from the asphyxial condition free access of
air to the lungs must be secured. The inhaling mask is cast aside
and the tongue grasped and drawn forward. Artificial respiration
is then resorted to. The effect is twofold. It not only brings
fresh air to the alveoli, but acts as a mechanical heart-stimulant and
restorer of blood pressure. Hence to be effectual it should be mod-
erately vigorotis to the point of compressing the chest. A good plan
is to suspend the animal with the head downward. It is believed that
this causes a determination of blood to the brain to stimulate the
flagging centers, and the vapor of the drugs being heavier than air
tends to gravitate.

Some practitioners place much confidence in medicinal anti-
dotes, such as the vapor of ammonia, medicinal doses of official
dilute hydrocyanic acid, hypodermic injections of ether and strych-
nine, but it should be remembered that if the respiration and circu-
lation are nearly at a standstill, drugs have little chance of being car-
ried to the vital centers, and moreover, many valuable seconds may

General Surgery 15

be lost in administering them. Prudence suggests that the best
course to pursue is to quickly supply as much as possible of Na-
ture’s stimulant—pure air, by promptly resorting to artificial respi-
ration in the open air, and to place little if any dependence on medi-
cinal antidotes. Wood reported before the Berlin Congress in 1890
that he had repeatedly taken dogs in which both respiratory and
cardiac movements had been absolutely arrested by chloroform or
ether and had restored them to life by pumping air in and out of the
lungs. Artificial respiration should be persisted in for some min-
utes after all signs of vitality have disappeared. When recovery
follows the animal needs to be closely watched until the practitioner
is thoroughly satisfied that danger no longer threatens. If strych-
nine is used it should be injected hypodermically in minute doses.
Hobday recommends placing hydrocyanic acid on the back of the
tongue. He uses one-eighth of a minim of the four per cent strength
to each pound body-weight of the animal.

For the proper dilution of chloroform with air the employment
of some special apparatus is desirable, and it is also advantageous
in economizing the drug. In Britain two or three patterns are in
use, devised respectively by Hoare, Junker and Hobday, all being
worked by manual or pedal compression. But when an animal is pre-
viously atropinized a simple inhalation mask suffices. No such care is
necessary with ether and the mixtures, which are preferably admin-
istered by the simple inhalation mask. When the latter is not avail-
able a tumbler or flower-pot may be substituted.

Chloroform should not be administered in the presence of
gas or candle flame, as it is decomposed thereby and sometimes
causes a persistent and harassing cough in the operator.

On account of the depressant action of chloroform and the
excitant action of ether, it was believed that the narcosis could be in-
creased and the effect on the circulation better controlled if the two
drugs were mixed. The first mixture was tried by Weiger, a Vien-
nese dentist, in the year 1850. It was composed of nine parts of
ether to one of chloroform, and received the name of the Vienna
Mixture.

In Germany the Billroth Mixture, consisting of ten parts of
chloroform, three of ether and three of alcohol, has found much
favor. It is undoubtedly the best of the mixtures. It produces pro-
round insensibility after a very short period of excitement (one to

16 Surgical Diseases and Surgery of the Dog

three minutes) and one-half to one ounce suffices to maintain com-
plete anesthesia for thirty to sixty minutes. The English or A. C.
E. Mixture, consisting of ethyl alcohol one part, chloroform two
parts and ether three parts, is an excellent one, producing a nareosis
equally as deep as the Billroth but induces greater preliminary ex-
citement and salivation. One ounce is sufficient to produce a sleep
lasting twenty to thirty minutes. The Hyderabad Chloroform Com-
mission found that only by respiration of the concentrated vapor of
this mixture could death result with difficulty, and respiratory fail-
ure always appeared first.

The comparative rate of evaporation of the drugs composing
the mixtures was studied by Ellis. A definite quantity of ether
evaporates in ninety seconds in the usual room temperature of 65°F.
The same quantity of chloroform takes five minutes to evaporate
under the same conditions, and the same quantity of alcohol takes
twelve minutes. If equal parts of alcohol and ether are mixed
evaporation of the ether is retarded—instead of seventy-five seconds
it takes two minutes, and the remaining alcohol takes another nine
minutes. The A. C. E. Mixture evaporates as follows: In the first
sixty to seventy-five seconds all the ether with some chloroform is
evaporated, in the next three to four minutes chloroform and alco-
hol, the first preponderating, and in the following two minutes the
rest of the alcohol.

LOCAL ANESTHETICS.

Cocaine is the principal local anesthetic. Caution should be
exercised in the selection of the drug, as it often contains impurities
when it is necessarily disappointing in its action. The crystals
should be rather large, colorless and nearly odorless. Great cau-
tion must also be observed in its employment, since in overdose it
is rapidly toxic. Lethal effect is manifested by mental distress and
violent muscular spasm.

In text-books it is the custom to direct the employment of solu-
tions of varying degrees of strength rather than mention the maxi-
mum dose which can be safely borne by the dog, a system which is
vague and confusing and opens the door to disastrous consequences.
Accordingly, no mention is herein made of solutions, that being a
matter which must be left to the judgment of the operator, bearing

General Surgery P7

in mind that the greater the concentration the quicker to develop
and the more widespread the anesthesia. The maximum dose which
can be employed hypodermically without causing any constitutional
disturbance must not exceed one-sixteenth of a grain per pound
bodyweight. On mucous surfaces this amount may be slightly ex-
ceeded, particularly in parts possessing much density of mucosa,
such as the vagina where absorption does not readily occur.

The anesthetic effect develops in from two to eight minutes and
lasts from fifteen to sixty minutes and covers an area about an inch in
diameter. It may be intensified by dissolving the cocaine in a quarter
per cent c. p. sodium chloride or a five per cent phenol solution. It
may also be considerably prolonged by the addition of one-fifth the
amount of morphine. There is an additional advantage in combin-
ing the last named drug in that it possesses antidotal power over
cocaine. Cocaine is most conveniently carried in the form of
tablets of definite strength as prepared by the manufacturing phar-
macists.

Solutions are applied to the conjunctiva and other mucous
surfaces by means of the camel’s hair brush or medicine dropper.
In this manner some slight anesthetic effect may be obtained on the
skin itself in parts where the latter is thinnest.

To properly anesthetize the skin in the area of operation, the
point of the needle should not be immediately thrust through the
skin as in administering an ordinary hypodermic injection but must
_ first stop within the skin which should receive a few drops of the
fluid. When an extended area is to be operated on, a series of in-
jections should be made, the point of the needle being reinserted
within and near the periphery of the wheal produced by the pre-
vious injection. In the case of a tumor, a circle of injections can
be made to surround the area.

Eucaine is preferred to cocaine by some practitioners. Its
anesthetic effect is somewhat slower to develop but it lasts longer
and is just as complete and is also less toxic and may be safely ad-
ministered in doses of one-half grain per pound bodyweight.

Eudrenine is a combination of cocaine and adrenalin. It pos-
sesses an advantage over cocaine alone in that the adrenalin dimin-
ishes vascularity of the part and thereby hinders absorption of the
cocaine, besides tending to render minor operations bloodless.

3

18 Surgical Diseases and Surgery of the Dog

NARCOTICS. HYPNOTICS.

Morphine and Chloretone are very useful narcotic and hyp-
notic agents in canine practice. With full somnific doses of the
former, hypodermically injected, most dogs can be rendered indif-
ferent to minor operations, but with few exceptions it is rarely pos-
sible to obtain complete anesthesia with loss of reflexes. It is a
very valuable agent in controlling fractious animals either for exam-
ination or operation. It speedily produces a contented frame of
mind which enables a complete stranger to safely proceed with ex-
amination. Subcutaneous injection of somnific doses causes a slight
and sometimes irritant swelling at the point of injection which, how-
ever, quickly subsides. In from three to ten minutes weakness of the
hind quarters, restlessness and salivation develop. Nausea and vom-
iting frequently occur and less often evacuation of the bowels. On
this account the practitioner should never administer the drug in
rooms where carpets or rugs might be damaged. In some thirty
minutes a light slumber is induced from which the animal can be
awakened without much difficulty. The somnolence lasts five or six
hours and the after-effects persist ten to twenty-four hours. Ac-
cording to Guinard, who studied the action of this drug experimen-
tally, a safe hypodermic somnific dose for mature animals is one-
twelfth of a grain per pound bodyweight, while half a grain per
pound bodyweight is lethal. In other hands one-seventh of a grain
per pound bodyweight has proven lethal. Guinard found puppies
much more susceptible and that their death might be produced by
one-seventy-fifth to one-twentieth grain per pound bodyweight.

Chloretone may be given in dose sufficient to entirely abolish
nervous reflexes. For this the dose must be one and one-half grains
per pound bodyweight. Less than that amount will produce but
partial anesthesia, and is not sufficient to prevent the dog from howl-
ing. Two grains per pound bodyweight is dangerous and two and
one-quarter grains is generally fatal. The drug should be given in
large capsules, or better still, in konseals as the latter dissolve
quicker, or it may be dissolved in whiskey or sherry wine. It is only
sparingly soluble in water. An animal that has received a full
dose of this drug is slow to recover its senses and equilibrium.

Given as a general anesthetic, chloretone acts on the central
nervous system, but unless given in poisonous dose does not depress
the circulatory system. Besides its central action, it possesses local

General Surgery 19

anesthetic properties. It may be substituted for cocaine, but should.
not be injected hypodermically other than in warm aqueous solution.

BIBLIOGRAPHY.

Bert—Comptes rendus des Scéances. 93, 1881, p. 768.

Bllis—On the Safe Abolition of Pain in Labor and Surgical Operations by Anes-
thesia with Mixed Vapors. London, 1866.

Embly—British Medical Journal. April, 1902.

Guinard—Le Morphine et l’Apomorphine. Etude Expériment. de Pharmaco-dy-
namie comparée. Paris. 1898.

Hoelscher—Langenbeck’s Archiv. f. klin. Chirurg. 57, 1898, p. 175.

Rudolf—Uniy. of Toronto Studies. Physiologic Series. No. 3, 1901.

INFLAMMATION.

Inflammation is the reaction to injury. It is tersely defined by
Professor Adami as “an attempt of the organism to repair injury to
a part.’”’ It is to be regarded as a physiologic process following a
pathologic action, its one aim being to remove foreign matter from
the part and bring about normal restitution. The phenomena of in-
flammation are essentially the same in whatever part of the body
they occur, the characteristic gross changes being heat, redness,
pain and swelling, of various degrees; the minute consecutive
changes being temporary contraction of the capillaries followed by
their dilation, effusion of serum, thickening and slowing of the
blood stream, peripheral migration and diapedesis of leucocytes, and
in advanced stages extravasation of the red cells. The causes are
either mechanical injury (friction, heat or cold, acids or alkalies) or
pathogenic microorganisms. Most surgical inflammations are of a
septic nature. The inflammatory process may have one of the fol-
lowing several terminations: Resolution with preservation of the
integrity of the part, fibroid induration replacing the injured tissue,
abscess formation or ulceration with formation of cicatricial tissue,
gangrene with formation of cicatricial tissue, and in the extreme
degree generalized infection and intoxication and death of the
organism.

Treatment. It must be remembered that a normal grade of in-
flammation is healthy and physiologic, and that treatment is only
required to assist the organism when either (1) it is too weak to re-
sist adequately, or (2) where the infective agent is too strong, or
(3) when the reaction on the part of the tissues is excessive (exu-

20 Surgical Diseases and Surgery of the Dog

-berant granulations, etc.) We treat, in short, in order to aid the or-

ganism to an orderly reaction and, inasmuch as, in the vast number
of cases, the inflammation is of microbic origin, most often our
endeavor is to assist by removing the cause of irritation.

The treatment of inflammation comprises both local and consti-
tutional measures. The cause must first be sought and displaced or
rendered inert. Irritants must be removed and microbic activity re-
duced. The agents employed locally are cold, heat and moisture,
astringents, irritants and counter-irritants, and blood-letting.

Cold in the form of an ice-pack, a stream of water from a hose,
or a refrigerant lotion (potassium nitrate 5 parts, ammonium chlor-
ide 5 parts, water 16 parts) is valuable in the early stages as a pre-
ventive, to contract the arterioles and diminish the local blood-sup-
ply, but its action must be maintained without intermission, other-
wise it does more harm than good by inducing a reaction after each
application. Heat and moisture, in the form of hot water applica-
tions with a sponge, or poultices, are indicated to relieve tension and
cause dilation of the vessels with increased flow of blood, when the
inflammatory process is fully established and suppuration imminent.
Heat and moisture tend to confine the suppurative process and bring
it to the surface. Astringents are of service to constrict blood-
vessels and are employed more often to combat inflammations of
mucous membranes as the mucosa of the mouth and penis and the
conjunctiva. For this purpose one of the most useful preparations
is the supra-renal liquid which exerts an almost immediate effect.
Other remedies commonly employed are aqueous solutions of zinc
sulphate (2:1000—6:1000), crystalized alum (1 :100—1I :400), tannic
acid (1:100—1:200). Irritants and counter-irritants are useful in
some of the chronic forms, but only the milder kinds should be used,
such as tincture of iodine and non-blistering liniments. | Blood-
letting is seldom practiced, but light scarification is an effective
means to relieve tension in conditions of extreme congestion.

Constitutional treatment is exceedingly helpful in many cases.
It must always be instituted with regard to the physical condition of
the animal. In the asthenic type of inflammation saline purgatives
should be administered, and their action supplemented with diuretics.
Both these remedies relieve distended vessels and determine a flow
of blood to the excretory channels. The diet should also be restricted.
In the asthenic type, tonics and stimulating diet are indicated.

General Surgery se

CONTUSION. HEMATOMA.

A contusion is a traumatic lesion in which the subcutaneous
tissue elements are lacerated, but in which there is no manifest ex-
ternal solution of continuity. The amount of damage may be of
any grade from simple capillary extravasations of blood into the are-
olar tissue (ecchymosis) to rupture of large vessels with profuse
hemorrhage producing a sac of blood (hematoma), to pulpification
of a large mass of tissue with impairment or destruction of tissue
vitality. In a hematoma the blood accumulates in a distinct cavity
in the tissues. The blood soon coagulates excepting when it exists
in serous sacs. Cell proliferation takes place at the border and the
blood pigment is gradually absorbed until only a clear serum re-
mains. Suppuration may also occur. Besides the local disturb-
ances, it is a remarkable fact that deep-seated and grave lesions
often occur at remote points following violent shocks, notably dis-
turbances of the cerebro-spinal fluid and rupture of visceral organs.
Cadéac has recorded instances of death from rupture of the portal
vein, right auricle, anterior and posterior vena cavae, respectively,
and Goubaux and myself cases from rupture of the liver.

Symptoms and Diagnosis. Contusions give rise to tenderness
and swelling. There may or may not be discoloration of the skin.
Recent hematomata fluctuate, but old-standing ones have a firm
circumscribed border with a soft fluctuating center, owing to fibrous
tissue formation. They are distinguished from abscess by a his-
tory of occurrence of the swelling immediately after the trauma-
tism and by absence of inflammatory phenomena. In the region of
the abdomen they must be carefully differentiated from hernia, for
which they are liable to be mistaken.

Treatment. Simple contusions are best left to natural processes
of repair. Recent accumulations of blood should not be incised,
unless infection has taken place, but they should be aspirated. Ex-
ception to this rule must be noted in the case of hematoma of the
ear-flap, where experience has shown that the shortest road to repair
is by free incision, turning out of the fluid blood and clots, and
bringing the separated tissue into apposition with sutures passed
right through the thickness of the flap. Hematomata undergoing
organization are best removed by enucleation after exposure of the
sac by incision through the skin. In severe contusions hot antis-

22 Surgical Diseases and Surgery of the Dog

eptic applications are indicated, and later inunctions, as the inflam-
mation subsides.

WOUNDS.

A wound is a traumatic or surgical lesion involving a breach of
surface continuity. A wound is said to be simple when it has a clean
edge and contains no foreign body; it is said to be complicated when
it gives lodgment to a foreign body or has been exposed to infection.
The local phenomena of wounds are pain, hemorrhage and loss of
function, of degree depending upon the extent of injury. Division
of a large or important vessel may be followed quickly by death, and
severe hemorrhage may terminate in death some hours later by in-
ducing cerebral anemia and consequent depression of the vital nerve
centers. Division of a motor nerve results in limited paralysis,
while the severing of a tendon causes at least temporary functional
impotency. An ever possible constitutional phenomenon is reflex
shock, which, however, is rare. The result of infection may be
abscess, erysipelas, septicemia, or pyemia, but wounds that have com-
menced to granulate are proof against infection, the granulating
tissue forming a protective barrier. This has been demonstrated by
Billroth’s well-known experiment of binding up a wound in such
condition with a fetid bandage without any reaction following. The
occasional more remote effects are thrombosis and embolism, and
entry of air into the veins. Amussat made experimental wounds in
the veins of the breast in numerous dogs into which air entered
spontaneously, the animals dying in from one to twenty-seven min-
utes thereafter, while Erichsen found that the entry of a cubic inch
of air would not cause death.

Wounds are usually classified according to their character, viz,
incised, punctured, contused, bite, gun-shot, and poisoned.

Incised wounds are produced by sharp instruments and are
usually simple, free of complications, and heal kindly without leav-
ing much scar, though they may give rise to considerable hemorr-
hage and complete temporary functional impotency of a part when
tendons or nerves are severed. Punctured wounds are caused by
penetrating sharp bodies, hooks, etc. Such bodies may break off,
the extremity remaining within the wound. If aseptic, it becomes
encapsulated, but if septic gives rise to purulent inflammation. Asa

General Surgery 23

rule, there is little hemorrhage. In the absence of foreign bodies
puncture wounds heal kindly.

Contused wounds are caused by blunt bodies and are character-
ized by more or less mangling of the subcutaneous tissues and irreg-
ular laceration of the skin. They are very liable to be infected.

Bite wounds are usually caused by animals of the same species,
and constitute one of the commonest forms of injury the practitioner
is called upon to treat. They are often multiple and usually the
flesh is torn and lacerated. The bites of vicious dogs or wild ani-
mals are sometimes sufficient to produce eventration and dislocation
of the eyeball. Bite wounds are commonly followed by suppurative
processes, the pus burrowing beneath the skin and forming ab-
scesses. The possibility of the virus of rabies having been intro-
duced into the system must always be considered, and steps be taken
accordingly.

Gun-shot wounds occur principally in hunting dogs. Ordinary
shot, when not fired at long range, enters the tissues at isolated
points. Should it lodge in the skin it invariably sets up suppurative
foci, but when it passes through the dermis and lodges in the deeper
tissues it may become encapsulated without causing any trouble.
When discharged at close quarters it may cause mutilation of tissues.
In the case of missiles of greater caliber the possibility of remote
lesions must always be considered. Vessels and nerves may be
severed, bones fractured, and viscera punctured. Bullet wounds of
the abdominal organs are considered elsewhere.

Poisoned wounds comprise those in which vegetable alkaloids,
minerals, ptomaines, snake poison, the sting of wasps and hornets
are deposited. They vary in their effect upon the organism accord-
ing to their toxicity, some producing violent local inflammatory
phenomena, gangrene, etc., others systemic intoxication.

In general, it may be said that wounds in the dog heal well
when the animal is healthy, but the presence of chronic and infec-
tious diseases tends to hinder the process. That pyogenic bacteria
may be derived from the circulation has been shown experimentally
by Rinne, who injected sterilized putrid fluids, together with
staphylococci, into the peritoneal cavity and found that suppuration
of all open wounds followed, which otherwise healed kindly. Open
serous sacs also retard healing.

The healing of wounds, whether surgical or adventitious, has

24 Surgical Diseases and Surgery of the Dog

been variously classified, but for our purpose the following is the
best and simplest division: (1) By first or primary intention, and
(2) by secondary intention i. e., through formation of granulating
tissue either (a) without suppuration, or (b) with suppuration.
What is termed healing by direct union, as may apparently take place
between two wounded peritoneal surfaces during intra-abdominal
operations, has no existence in fact, but is in reality healing by first
intention, as a certain amount of serum is thrown out indistinguish-
able from the inflammatory condition, and it is the organization of
this serum through fibrin which binds together. Healing by first
intention is always aseptic, and theoretically, it should be the aim of
the practitioner to ensure its sequence to surgical operations, but
owing to the conditions under which our patients have their being,
it is rarely possible to attain this desirable result. Hence, in the
majority of cases, healing of surgical wounds in the dog takes place
by secondary intention either without or with suppuration, but most
often with suppuration. This, however, is a matter of little moment,
provided adequate drainage is afforded. Adventitious wounds in-
variably heal with suppuration.

Treatment. The treatment of wounds comprises arrest of
hemorrhage, removal of foreign bodies, drainage, and coaptation of
edges. Hemorrhage from the larger vessels is controlled by liga-
ture, preferably with silk, a tourniquet being employed in the mean-
time if deemed advisable; bleeding from capillaries is controlled by
hot water or compression. To secure the best possible conditions for
healing it is important that all oozing be completely checked. While
experiment shows that blood-clot contains a large amount of bacteri-
cidal substance it is known that the pyococcus aureus is very resistant
to the latter, and if present renders a clot putrescible and conducive
to suppuration. In case of considerable hemorrhage large quantities
of hot saline solution (5:1000—1:100) should be injected into the
bowel or hypodermically. Foreign bodies must be extracted with
forceps, and if necessary, their point of entrance enlarged. Usually,
it is best to clip away the hair from the immediate vicinity of a
wound. Antiseptic irrigation should be avoided, particularly in
recent wounds, as all antiseptics tend to irritate the tissues more or
less. A single exception is hydrogen dioxide, which may be used
for the purpose of breaking up and removing septic material. It is
better to cleanse with a stream of warm sterilized water directed

General Surgery 25

from a fountain syringe. Even in suppurating wounds antiseptics
may be dispensed with where good drainage is provided. Abscesses
must be opened and carefully inspected for presence of foreign
bodies and dependent drainage openings established. The edges
of fresh wounds should be adjusted with regard that no cavity be
left in the deeper parts in which serum and blood may collect.
Where this is not possible ample provision must be made for drain-
age, to prevent abscess formation. The part of a wound most diffi-
cult to treat is always the subcutis. Here the defensive power of the
organism is poor, and should there occur any intervening spaces
they form suitable pockets for the reception of blood and serum
which, for the first few hours, exude in considerable quantity from
the surrounding wounded capillaries and veinlets, and which, as
already stated, form putrescible material. Should there be the
slightest degree of infection present, the microorganisms, being re-
moved from contact with living tissue, are free to multiply beyond
the area of its phagocytic action, and thereby establish abundant
suppuration. It is very difficult to prevent the formation of spaces
in the subcutis, especially in fat animals. To ensure drainage the
most dependent extremity may be left gaping, but in some cases it
will be necessary to insert a strand of plain sterilized gauze, one end
being allowed to protrude slightly, and leave it in place three or
four days. This holds good, of course, where bandages can be ap-
plied or other means taken to prevent the animal from reaching the
parts with its teeth or feet. Where the entire surface of the wound
can be brought into apposition so that no cavity remains drainage
can be dispensed with, but all doubtful cases should be drained. The
edges of fresh wounds are best united with subcuticular sutures.
But wounds the edges of which indicate the development of cicatri-
zation, and from which an animal has once torn the sutures, are pre-
ferably to be permitted to fill up by granulation.“t is remarkable what
large-sized wounds will fill up completely by granulation and leave
hardly a semblance of a scar particularly in animals with abundant
hair.

Wide-open or gaping wounds very often do not permit of
approximation or if they do the tension is so great as to preclude any
possibility of sutures remaining in position. Such wounds are
treated by the “Cherry” process. This consists of making a longi-
tudinal incision on either side a short distance to the outside of and

26 Surgical Diseases and Surgery of the Dog

parallel to the edges of the wound to relieve the tension, these incis-
ions being allowed to fill in by granulation. But these supplementary

a
—scae newer we 2a fF 228 eaxo2e 22228272
wwewwswese 2 e2e@e SG 2 2 e@ © = ase eS @we 2 Beene &

No. 8a. ‘‘Cherry’’ method of
treating gaping wounds. (A)
Original wound. (B) Site of re-
lief-incisions.

a

a

et ee ee ee ee oe

No. &b. ‘‘Cherry’? method of treating
gaping wounds. (A) Original wound re-
duced by (B) relief-incisions and (OC) ste
of secondary relief-incisions,

incisions may in themselves present such gaping as to threaten a
very long drawn-out filling in by granulation. That being the case

No. 8c. ‘‘Cherry’’ method of treating
gaping wounds, showing (A) much-re-
duced original wound and (B) (C) pri-
mary and secondary relief-incisions.

secondary incisions are made to
the outside of them.

Where tendons are severed
splints are often required to main-
tain the part in rest.

Shot, unless giving rise to
irritation, should be left un-
touched.

The treatment of perforating
thoracic and abdominal wounds is
described elsewhere.

Poison wounds call for ad-
ministration of stimulants, which
in the case of _ snake-bite
should be coupled with local
cauterization.

General Surgery 27
SHOCK.

Shock is a profound reflex depression of the nerve centers re-
sulting in vaso-motor paresis. The arteries losing their tone, the
veins become distended, and less blood than normal reaching the
brain, the vital centers are insufficiently nourished. It is due to
afferent impulses set up by injury or operation. It may occur even
under anesthesia, for though the afferent impulse constituting pain
is abolished by general anesthesia, those affecting the vaso-motor,
respiratory, and cardiac mechanisms are not controlled thereby,
Happily, the condition is rare in the dog, but it sometimes occurs in
animals of high nervous excitability, particularly where the injury
concerns the genital apparatus. It has occurred during the removal
of large tumors. I have experienced it following ablation of cancer-
ous testicular tumor, and Goubaux and Cadiot and Almy have re-
corded instances following removal of mammary tumors. This form
of shock is to be distinguished from that following profuse hemorr-
hage, or removal of a quantity of fluid from the abdomen, though in
either instance, the effects are the same. Both the latter forms are
of the nature of mechanical syncope, in the one case owing to cerebral
anemia, in the other to sudden removal of pressure and consequent
rapid distension of intraabdominal veins.

Symptoms and Diagnosis. The temperature is subnormal, the
pulse is rapid, irregular, weak and compressible, the respiration
shallow and irregular. The pupils are dilated and react but slowly
to light. One peculiar symptom is a sort of stupid expressionless
indifference to the surroundings.

Treatment. The indications are to raise the blood pressure as
quickly as possible. This may be accomplished by injecting large
quantities of hot saline solution (5:1000 to 1:100) both hypodermi-
cally and by the bowel. Eichel has shown that absorption of salt solu-
tion will compensate for considerable loss of blood in a short while,
particularly when transfused intraperitoneally. Heat should be ap-
plied to the body, adrenalin chloride solution administered internally
and hypodermics of trinitrin, digitalin, and minute doses of strych-
nine given. It may be necessary to practice artificial respiration.

ABSCESS.

An abscess is an accumulation of pus in any tissue of the body,

28° Surgical Diseases and Surgery of the Dog

but usually in the connective tissue. It is the result of inflammation
caused by pyogenic bacteria and the toxins which the latter elabo-
rate. The bacteria generally find access to the tissues through a
lesion of the cutis or a mucous membrane, but may be carried to
their ultimate destination by way of the blood or lymph streams.
The course of abscess formation is as follows: The provocative fac-
tor having gained access to a certain area of tissue, there is first
multiplication of the same followed by concentration of leucocytes
and other tissue cells. Many of these dying, liquefaction takes place
in the center of the inflamed area, but at the outer zone of inflamma-
tion a sort of wall of granulation tissue forms, protecting the sur-
rounding healthy tissues from the infected area. It is this wall
which was formerly regarded as a secreting membrane of the pus
and erroneously known as the “pyogenic membrane.” When, how-
ever, the process is of an acute nature, the germs may multiply so
rapidly that the walling in is incomplete, and, carried to surround-
ing tissues, more pus may form which must perforce burrow along a
course of least resistance, principally through intermuscular spaces
and along subcutaneous connective tissue, avoiding in its path joint
capsules, bone and fasciae, until, upon reaching a dependent position,
it begins to point and finally breaks through the skin or it may invade
vital organs and produce grave results.

Two forms of abscess formation are recognized, viz, “acute”
and “cold,” according to the rapidity of their development. A cold
abscess is ordinarily caused by tubercular infection, and it is gen-~
erally well encapsulated owing to its chronicity.

The lesions leading to the production of acute abscesses are of
diverse nature. Probably bites by other dogs figure in the majority
of cases, while contusions and the lodgment in the tissues of infected
foreign bodies either of external traumatic origin or by way of the
alimentary tract are frequently responsible. Among some of the
rarer forms may be mentioned: lympho-sarcomatous abscess occur-
ing in the neck, abscess of the perineal region proceeding from sup-
purating prostate gland, abscess produced by passage of transmi-
gratory strongyles as witnessed by Mégnin in the mammary region,
and actinomycotic abcesses.

Symptoms and Diagnosis. The symptoms of abscess may be
local or both local and general. Superficial abscesses are character-
ized by extensive local heat and swelling and but little constitutional

General Surgery 29

disturbance. They commence as a tumefaction with edematous peri-
phery. Within some thirty-six hours the center of the swelling be-
comes soft and fluctuating and surrounded by a zone of indurated
granulation tissue. With deep abscesses the initial symptoms are
fever, refusal of food, pain upon motion of the afferted part, and
edema of more dependent parts.

Most abscesses cause more or less functional distirrbance. Those
of the legs interfere with locomotion and even suppo-t of the body,
those about the throat inhibit deglutition and respiration, while pelvic
abscesses lead to suppression of defecation.

The lesions with which abscesses are most liable to be con-
founded are cysts, soft tumors, and hernia (in abdominal and peri-
neal regions.) For differential diagnosis, the aspirating syringe
should be employed. When a cachectic, wasted condition of the sys-
tem is evident, the tuberculin test is indicated.

Treatment. All acute abscesses in process of formation should
be closely watched. Wherever feasible, their development should be
assisted by hot fomentations. Immediately the presence of pus is
detected, the latter must be promptly evacuated by an incision made
with a sharp curved bistoury at the most dependent point. The open-
ing should be free to permit of subsequent drainage. In those cases
where the initial lesion is superficial and the fundus of the abscess
so deeply situated that its actual location can not be determined, it
is better to pass a probe or trocar through the initial lesion down to
the depths of the sac and thence towards the skin. Where the point
of the instrument is felt through the skin, the latter is snipped with
scissors and the passage through the connective tissue enlarged.
Some deep-seated abscesses, as in the parotid region, can only be
safely reached with a trocar after a simple skin incision is made. The
exit of the pus is to be favored by compression of the part and also
by injection of peroxide of hydrogen. The next step is to remove
any foreign body and thep to irrigate the sac. Most authors recom-
mend irrigation with antiseptic solutions, but this is really a matter
of little moment, the object aimed at being to hasten repair by flush-
ing the cavity and washing away all trace of dead and moribund tis-
sue, and this can be accomplished equally as well with plain water as
with antiseptic solutions. A fountain syringe is well adapted for
this purpose. The drainage tract must be kept open for a few days.
The treatment of cold abscesses requires more energetic measures.

30 Surgical Diseases and Surgery of the Dog

They must be opened, irrigated, thoroughly curetted, irrigated
again, and packed with antiseptic gauze.

ULCER.

An ulcer is an open sore of a superficial structure. It is brought
about by ordinary pyogenic or specific bacteria acting the same as in
abscess, an ulcer being a molecular death of a part of a free surface,
an abscess the same thing within the tissues, pus being secreted in
either case. But before such pyogenic bacteria can exert any ill-
effect in a tissue, there must be some impairment of vitality of the
latter either through destruction of its integrity by local irritation,
mechanical violence, etc., or interference with its nutrition owing to
disturbance of the local circulation or malnutrition of the body in-
duced by disease. Ulceration may be regarded as an inflammatory
disturbance which has continued past the point where healing takes
place by granulation, or a sort of continued local dying of a part,
though it is quite possible for an ulcer to heal spontaneously. A
wound that does not heal by primary intention or scabbing becomes
an ulcer. The process of ulceration consists of an infiltration of the
inflamed area with leucocytes which destroy and replace the tissues.
The leucocytes dying they are thrown off with the fluid elements de-
rived from the blood as pus.

Common seats of simple ulceration are the edges of the ear-
flaps, the external auditory canal, the tail, and the digits. Of specific
origin are tubercular ulcers particularly of the neck and the ulcers
of stomatitis.

Symptoms and Diagnosis. As already stated, any sore or
wound which does not heal by granulation is to be regarded as an
ulcer. But the process of ulceration may be healthy, or it may be
indolent, or exuberant. In a healthy ulcer the edges are smooth,
the base level and covered with healthy granulations, the surround-
ing parts normal, and an inodorous pus is discharged. An indo-
lent ulcer is known by its sunken surface, its raised irregular edges.
The discharge may be thin and watery. An exuberant ulcer is
characterized by development of so-called “proud flesh,” gelatinous
granulations rising above the level of the surrounding parts. It is
dark red and bleeds freely and discharges pus.

Treatment. In the treatment of ulcer it is important to protect

General Surgery 31

the sore from any kind of irritation, whether it be by the animal’s
own teeth, or from accumulated discharges. Healthy ulcers require
soothing treatment by means of dessicant antiseptic powders. On
external parts they should always be protected with gauze and band-
ages, though this is often a difficult matter to accomplish, owing to
the persistence with which any kind of application and even muzzles
are torn off. Indolent ulcers require gentle stimulation with weak
distilled aqueous solutions of nitrate of silver (4:100) before the
powder is used. Exuberant ulcers should be cauterized with the
solid nitrate of silver stick or the actual cautery. Drainage must be
provided for discharges where there is a tendency to accumulation.
The general health should be attended to, laxatives and tonics being
administered when the nutrition of the body is at fault. The ulcera-
tion of malignant tumors can only be treated by eradication of the
growth.

FISTULA. SINUS.

A fistula or sinus is any abnormal tract in the tissues forming a
communication between a septic focus or secreting gland and any
other part of the body, either the surface or a natural cavity or canal.
The term fistula is applied when the tract is open at both ends and
the term sinus when it is open only at one end. The great majority
of sinuses arise from abscesses which do not close up by granulation,
and their failure to close is usually due to the presence of a foreign
body or dead bone, but may also be due to protracted discharge
bringing about induration of the tissues in the line of evacuation,
and in rare cases to tubercular disease and actinomycosis. Occasion-
ally fistulae originate as congenital defects. Where the tract com-
municates with a secreting gland, the secretion itself independent of
any septic process may be sufficient to inhibit the healing process.

Treatment. The first step is to seek the cause. If a foreign
body be present, steps must be taken to remove it. Dead bone must
also be displaced. Next, the wall should be curetted or stimulated
by injections of strong distilled aqueous solutions of nitrate of sil-
ver (§:100—10:100). Failing in this, the tract must be laid freely
open, the lining membrane cut away, and the wound packed with
antiseptic gauze so that healing may proceed from the bottom.
Where it is considered inadvisable to open up the tract by reason of

32 Surgical Diseases and Surgery of the Dog

the proximity of large vessels or other important structures, instead
a counter opening may be made by inserting a director and cutting
down on the same. It is hardly necessary to point out that provision
must be made for drainage to guard against the reconversion of the
sinus into an abscess. Special forms of fistula and their treatment
will receive notice under their respective headings.

BURNS. SCALDS.

This form of injury varies in degree, from mere scorching to
destruction of the cuticle and hair with production of blisters, to
charring of the whole thickness of the skin, including often the
deeper tissues, with consecutive gangrene. Deep and extensive
burns are very apt to terminate fatally either through shock or ab-
sorption of toxic products produced by tissue destruction. Burns
may be caused by superheated liquids or solids, or by caustic sub-
stances.

Treatment. In light burns very satisfactory results are obtained
with applications of picric acid in solution (saturated while hot and
decanted when cold). Soothing ointments are also efficacious. In
severe burns treatment must be directed to prevention of sepsis, by
dusting with analgesic antiseptic powders. Blisters should be
opened by pricking with a needle. In gangrene, antiseptic irrigations
and dressings are indicated. To quiet the nervous system and
give relief from pain morphine and atropine should be administered

hypodermically.

FROST-BITES.

The local effects of frost-bites resemble burns, and like the lat-
ter, may vary in degree from simple hyperemia and infiltration to
separation of the epidermis by serous exudation, to mortification of
the part. Frost-bites are usually confined to the extremities of the
members, but it is very rare to observe extreme cases.

Treatment. The object to be aimed at is to restore the circula-
tion as slowly as possible. For this purpose, the affected parts may
be immersed in cold water, the temperature of which should be grad-
ually raised, or they may be rubbed with snow. In severe cases
leading to gangrene, the ordinary antiseptic treatment of wounds
must be followed.

General Surgery 33
ERYSIPELAS. ;

This is an extremely rare disease, the dog being almost immune
to the pathogenic action of the pyogenic streptococcus. Froehner
has recorded witnessing only four cases in seventy thousand animals
treated at Berlin. The infection, when it occurs, is apt to be metas-
tatic and induce remote troubles, one of Froehner’s cases having
exhibited myocarditis, pericarditis, hepatitis and nephritis.

Symptoms and Diagnosis. The local symptoms are much less
evident than in the human being, owing to the skin being hidden by
the hair. The area of infection is swollen and intensely red or
bluish red and sensitive. The usual constitutional symptoms of fever
are also present.

Treatment. Locally, the inflamed area must receive a thorough
cleansing with antiseptic solutions. The hair should also be re-
moved with clippers. Following this, ichthyol or thiol should be ap-
plied in the form of ointment, the strength of the ointment being at
least half and half. This dressing is to be freely and repeatedly
applied. Internally, tincture of the chloride of iron should be ad-
ministered in large doses, four or five times daily. Excessive febrile
manifestations may be combatted with antipyretic drugs, or better
still, by application of ice-packs to the body.

TOXEMIA. SEPTICEMIA. PYEMIA.

No sharp distinction can be drawn between these three forms
of systemic poisoning, since, properly speaking, the difference is one
of degree rather than of kind. By Toxemia is meant the absorption
of and intoxication by the products of microbic activity (toxalbu-
mins) having their origin in some local infective process. The term
Septicemia is used when living pyogenic bacteria enter the circula-
tion, while by Pyemia is meant the condition where these bacteria
are deposited in distant tissues with resultant production of multiple
abscesses. In the two latter conditions, therefore, the localization
of the bacteria in vital organs is what is most to be feared. There
may then result a train of disorders (cardiac, pulmonary, hepatic,
renal, or cerebral), any one of which may be sufficient in itself to
bring about a fatal termination. The microorganism most com-
monly concerned is the staphylococcus aureus, the streptococcus
being but slightly virulent in the dog. Metastasis may be by the
blood or lymph channels.

4

34 Surgical Diseases and Surgery of the Dog

The commonest provocative factors are suppurative conditions
following traumatic or unclean surgical wounds, retention of fetal
tissues, intestinal lesions, and omphalo-phlebitis in young subjects.
In some cases the origin is obscure.

Symptoms and Diagnosis. Differential diagnosis is difficult.
The chief symptoms are high intermittent fever with rigor, complete
anorexia, diarrhea, albuminuria, feeble cardiac action, vomiting, and
great prostration. In pyemia, the secretion from the initial wound,
is, as a rule, scanty but greyish or bloody. Symptoms of metastatic
abscess formation are sometimes evident. Recovery from pyemia is
rare. In young subjects, where the disease follows omphalo-phleb-
itis, it is common for suppurative foci to develop in superficial parts
of the body, and these cases usually respond favorably to proper
treatment.

Treatment. Treatment must be prophylactic rather than cura-
tive, 7. e., any possible further contamination of the blood stream
must be prevented. Deep suppurative and gangrenous foci must be
thoroughly drained and cleansed, and if necessary, amputation re-
sorted to. Superficial metastatic abscesses must be freely opened.
Constitutional treatment should be directed toward supporting the
strength with stimulants, but drugs are of little avail. Antistrepto-
coccic serum is worthy of a trial.

GANGRENE.

By gangrene is meant the mortification of tissue in bulk as
distinguished from ulceration or molecular death of a part. Gan-
grene can occur with or without the presence of bacteria, the essen-
tial cause being the cutting off of the blood supply. Interference
with local nutrition may result from crushing, the action of chemi-
cals, burns, frost-bites, embolism, tight bandages, strangulated her-
nia, paraphimosis, and the products of specific microorganisms. A
few instances are on record of infection by the bacillus of malignant
edema which usually terminated fatally.

Symptoms and Diagnosis. Gangrenous tissue is recognized by
its coldness, change of color, loss of sensation, and inability of the
part to perform its function. Where the disease process has ceased
to spread, there develops a so-called line of demarcation, which is
a zone of inflammation and actively proliferating repair tissue.

General Surgery 35

Treatment. The cause must be removed, and spread of the con-
dition prevented by separation of the dead from the living part.

Where possible, return of the circulation may be encouraged by gen-
tle friction, above the gangrenous area.

BIBLIOGRAPHY.

Amussat—Recherches sur l’Introduction Accidentelle de l’Air dans les Veines.
Billroth—cited by Noetzel in Langenbeck’s Archiv. f. klin. Chir. 55, 1897, p. 544
Cadéac—Rec. de Méd. Vétér. Jan., 1902.

Eichel—Langenbeck’s Archiv. f. klin. Chir. 58, 1899, p. 105.

Erichsen—cited by Horsley in Brit. Med. Journ. 1885, p. 213.

Froehner—Berl. thieraerztl. Wochenschr. 1894, p. 368.

Goubaux—cited by Cadiot & Almy in Traité de Thér. Chir. d. Anim. Dom.

Mégnin—Comptes rendus de la Soc. de Biolog. 1889, p. 304.

Rinne—Ueber den Eiterungsprocess und seine Metastasen 1889, p. 61.

CHAPTER II.

The Head and Neck,

CONGENITAL MALFORMATIONS.

Leaving out of account the malformations of the eye, ear, etc.,
which are treated of elsewhere, there is little of any surgical signi-
ficance. Occasionally anencephalic monsters are born, and it is note-
worthy that the shape of the head of the Bulldog and Pug is an
inherited congenital malformation, brought to perfection, if I may
use the term, by artificial selection.

What is known as Cervical Rib has been observed in the dog.
Gruber recorded an instance in which the transverse process of the
seventh cervical vertebra possessed a joint surface with which a
supernumerary rib articulated and between which and the first
sternal rib was a supernumerary muscle. On the opposite side the
corresponding transverse process was somewhat lengthened. This
condition is important only in that it may give rise to errors in diag-
nosis.

Bournay has described a congenital arterial-venous Aneurism in
the neck resulting from abnormal termination of the two carotids
and jugulars. It presented a subcutaneous pulsating tumor, which
was augmented in volume when the head was lowered and dimin-
ished when the latter was raised.

TRAUMATIC LESIONS.

The commonest wounds about the head and neck are those re-
sulting from bites by other dogs. When they suppurate they are
very apt to terminate in abscess formation of considerable extent
owing to the burrowing tendency of the pus. Spiked collars em-
ployed to restrain bulldogs are also a source of mischief, and one in-
stance is recorded of an intractable sinus resulting from such a spike
becoming detached and driven into the tissues. Puppies sometimes
sustain parturition hematoma of the scalp during birth.

36

The Head and Neck 37

Treatment. All wounds about these parts should be closely
watched for signs of subcuticular suppuration. Gaping wounds
should be sutured with the buried suture with provision for drainage.
Smaller wounds are best left to heal by granulation. If an abscess
develops free exit must be given to the pus at its most dependent
part. Fistulous tracts must be searched for foreign bodies.

ABSCESS OF THE SCALP.

This trouble is seen more particularly in young nursing pup-
pies, but it also occurs in adult animals. In puppies it may be of
pyemic nature following omphalo-phlebitis, but may also result from
local traumatic influences as is the case in the adult.

Symptoms and Diagnosis. The condition is recognized as a
large swelling on the top of the head, which very closely resembles
that peculiar to hydrocephalus, in fact, the first sight of the trouble
in the puppy may give the practitioner the impression that the animal
is the subject of the latter condition. By palpation the subcutaneous
situation of the fluid can easily be determined.

Treatment. The purulent matter must be evacuated by lancing
at a dependent point, and reaccumulation prevented. Hydrogen
peroxide may be injected to cleanse the cavity but if free drainage i is
provided, unassisted recovery is quick to follow.

FOREIGN BODIES.

Foreign bodies in the form of rubber bands are sometimes mis-
chievously slipped over the head on to the neck or string may be tied
tightly round the neck by children. Such bands by constant pres-
sure soon cut through the skin and may dangerously constrict the
trachea.

Symptoms and Diagnosis. If a linear wound is observed en-
circling the neck, such a foreign body may be suspected. At the
outset, the animal makes repeated efforts to rid itself of the body.
Later, as ‘the constricting action encroaches on the trachea all the
signs of dyspnea are exhibited.

Treatment. The indications are to remove the constricting
agent by dividing it, and in order to do this it may be necessary to
cut into the neck.

38 Surgical Diseases and Surgery of the Dog

NEOPLASMS.

The growths affecting the eyes, ears, alimentary and respira-
tory tracts, thyroid and lymphatic glands, are treated of under their
respective headings and only the more common ones which occur
in the skin and subjacent tissues will be described here. These con-
sist of papilloma, fibroma, hematoma, cutaneous horns, sarcoma, and
carcinoma.

Papilloma. Warty growths occur about the head and neck,
principally in old animals, but not so plentifully as on the extremities.
Favorite seats are the vicinity of the eyelids and the nose.

Symptoms and Diagnosis. They are sharply defined and some-
times pedunculate. In consistence, they may be soft or hard with a
smooth or slightly puckered surface. They are distinguishable from |
malignant growths by their limited dimensions and slow rate of
growth.

Treatment. Simple excision with curved scissors is sufficient,
but it is best always to cauterize the base with the actual cautery or
lunar caustic.

Fibroma. These tumors are found about the ears and eyelids
and the cheeks.

Symptoms and Diagnosis. Fibromata are always well demarked
and hard. They have their seat in the skin itself and with it are
mobile from the subjacent tissues, or they are situated subcutaneously
when of connective tissue origin. Occasionally they are pedunculate.

Treatment. The same as for Papilloma.

Hematoma. Contusion cysts occasionally occur as the result
of traumatism, usually a blow from a club or stone. One case re-
corded by Siedamgrotzky resulted from a bite. Rupture of vessels
taking place, there follows a condensation of connective tissue
around the extravasation, and the blood is either quickly absorbed
or undergoes organization and is more slowly absorbed, or it may
suppurate. Some cases seem to arise spontaneously and to have
communication with the veins, for if they are opened they continue
to bleed persistently.

Symptoms and Diagnosis. Blood tumors are known by their
subcutaneous position and their painless, tense, or fluctuating char-
acter. In the upper part of the neck they require careful differentia-
tion from burrowing ranula and cystic goiter. Aspiration may be
resorted to in doubtful cases.

aoe
Pal es

Rs as
og a ts

The Head and Neck 39

Treatment. Hematomata should not be interfered with but
allowed to undergo absorption.

Cutaneous Horns. There are a few cases of this peculiar form
of growth on record. Favorite positions are the forehead and inner
surface of the ear. The manner of their formation from sebaceous
cysts and papillomata is described in the chapter on Neoplasms.

Symptoms and Diagnosis. As the name indicates, they are
circumscribed outgrowths much resembling a horn.

Treatment. Extirpation should be practised, but the cyst at the
base of the horn must be removed at the same time.

Sarcoma. Sarcoma of periosteal origin occasionally arises in
the forehead. Being of highly malignant character with a great
tendency to invasion of adjacent parts, the prognosis must always
be grave. Sarcoma of cuticular or subcuticular origin is occasion-
ally seen but it is not common. It has been observed to follow
scratches or wounds.

Symptoms and Diagnosis. Periosteal sarcoma occurs as a sub-
cutaneous enlargement or upheaval which exhibits a very rapid
growth and soon attains an enormous size. The consistence of the
growth is variable. Usually it is bone-hard at its base, but may fluc-
tuate in the center of its surface. If adjacent bones are involved
when the tumor has its seat in the forehead, there may be a hemorr-
hagic discharge from the nasal passages. Sarcoma of the skin ap-
pears as an irregular tuberculate growth and assumes a fungoid
character when it breaks through the dermis.

Treatment. An operation in the early stages offers some chance
' of effecting complete eradication of the growth. Not only the actual
tumor but the healthy tissues in the immediate neighborhood must
be freely removed.

Epithelioma. Carcinoma. These tumors, formed of prolifer-
ating atypical epithelial or glandular (sebaceous or sudoriferous)
cells show a predilection for the head, notably the forehead and
vicinity of the ears, but occur also in other parts.

Symptoms and Diagnosis. Cancerous tumors vary in size from
a pea to the infantile head. In consistence, they are moderately firm
or hard, they are intimately united with the skin, and mobile from
the underlying structures, have a rather circumscribed, irregular,
puckered surface, and exhibit a tendency to ulcerate and become
metastatic to the nearest lymphatic glands.

40 Surgical Diseases and Surgery of the Dog

Treatment. Early and free removal is indicated, before the
‘lymphatics become implicated. .
BIBLIOGRAPHY.

Bournay—Rey. Vétér. Oct., 1899.
Gruber—Arch. f. Anat. und Phys. 1867, p. 542.

The Eyes

CONGENITAL MALFORMATIONS.

Sequestration Dermoid is a not infrequent form of growth of
congenital origin consisting of a patch of skin usually bearing tufts
of hair, situated on the mucosa lining the surface of the eyeball.
The explanation of its occurrence will be found in the chapter on
Neoplasms. It may be unilateral or bilateral and while it is usually
confined to the conjunctiva covering the sclera at the outer canthus,
it may also involve the corneal surface.

Treatment. The growth is operable, indeed, if not removed, it
will sometimes slowly enlarge. The animal should be narcotized
and the cornea anesthetized with cocaine. The growth is then
seized with forceps and detached by cautious dissection. To prevent
blood from beclouding the area a stream of warm sterilized water
should be played over the eye during the operation. A white cicatrix
usually develops which, however, is scarcely noticeable. Should the
growth extend far over the cornea, it is best to leave that portion of
it untouched.

Congenital Opacity of the Cornea. This is occasionally seen
in the form of minute whitish spots which tend to clear up sponta-
neously.

Persistent Pupillary Membrane. As the term indicates, this is
a condition in which the delicate membrane covering the anterior
surface of the lens during the greater part of intrauterine life, fails
to undergo complete resolution and persists as fibers, either singly
or in strands, passing across the pupil, or as a vascular, slightly
opaque membrane, floating or adherent to the capsule of the lens.
The condition would seem to be hereditary in some cases, for Bar-
rier recorded an instance in an animal whose dam had the same affec-
tion and had given birth to another blind litter, and whose sire had
suffered from some visual defect the nature of which was not de-
termined.

The Head and Neck AI

Symptoms and Diagnosis. Where but a few fibers persist,
vision is not impaired and their presence is usually unnoticed until
some disorder prompts a close inspection of the eye, but where the
membrane persists as such the animal experiences difficulty in see-
ing, particularly in brilliant light, and walks with hesitancy.

Treatment. Strands and floating membrane are operable with
technic similar to that observed in cataract or iridectomy.

Congenital Cataract. This is a rare affection appearing as a
partial or complete opacity of the lens, which may be calcareous, and
is in all probability due to hereditary influences. It tends to remain
stationary.

Treatment. Treatment must be by discission or extraction of
the lens.

Congenital Dislocation of the Lens. This condition has been
recorded by Fromarget in bilateral form, the dislocated body being
intimately adherent to the cornea. It is probably of hereditary na-
ture, since in Fromarget’s case another animal in the same litter was
likewise affected and the sire was also blind.

Treatment. The indications are to extract the lens, exerting
traction when it is adherent to any part of the chamber.

TRAUMATIC LESIONS.

The eye is liable to all forms and degrees of injury, chief
among which are contusions and wounds either of which may be
slight or severe. Contusions are usually produced by blows from
blunt instruments and the resultant lesion may be anything from
mere superficial loss of epithelium by the cornea to intraocular
hemorrhage, luxation of the lens, or even disruption of the optic
nerve. Slight injury to the cornea may, however, lead to severe
ulceration by septic infection. On account of the incompleteness of
the orbital arch a forcible contusion sustained immediately over the
eye commonly results in luxation of the latter, particularly in breeds
possessing prominent eyes, notably Pugs and Toy Spaniels, and this
lesion may also occur when a body presses between the eye and the
wall of the orbital cavity, as for instance, the tooth of another dog.
In other words, one dog may actually bite out the eye of another.
Wounds are mostly caused by sharp-pointed instruments, the tooth
of another dog, the claw of the cat, or as is not uncommon, by minute

42 Surgical Diseases and Surgery of the Dog

particles of sand or splinters of steel. The latter are apt to find
lodgment in the substance of the cornea. Hunting dogs sometimes
receive gun-shot wounds.

Wounds are non-penetrating or penetrating. Non-penetrating
wounds are limited to the conjunctiva, the cornea, or sclerotic. When
free from virulent infection they heal kindly, but microbic activity
results in conjunctivitis or keratitis and its possible complications.
Penetrating wounds are always serious when they pass the anterior
chamber, owing to the liability to suppurative inflammation. Even
when only the aqueous humor escapes the possibility of hernia of
the iris is always imminent. Penetration of the lens by a foreign
body may result in cataract.

Symptoms and Diagnosis. Contusions give rise to acute in-
flammation, lachrymation, pain, and photophobia, according to their
severity, and edema of the lids. When intraocular hemorrhage oc-
curs, the chambers become greatly distended and the eye acquires a
volume two or three times the normal and bulges. The lids become
everted and the humors assume a livid color, giving a hideous aspect
to the animal. Relief is sought by rubbing the eye against hard sur-
faces. Wounds and foreign bodies are easily seen upon close exam-
ination, but the organ is sensitive to manipulation.

Treatment. In all contusions and wounds soothing antiseptic
applications are indicated, as described under conjunctivitis and
keratitis. Recent luxations are amenable to reposition, and if the
optic nerve is not lacerated the sight may be preserved. To replace
the globe, it is first cleansed and an assistant required to hold open
the lids as wide as possible. Steady, firm pressure is then exerted
over the globe outside the border of the cornea on both sides with
the balls of the thumbs, until the organ slips back, which it generally
does with a slight sound. It may be necessary to slit the external
commissure before reduction can be effected and reunite it with a
stitch later. Protective antiseptic bandages should be applied for a
few succeeding days and the organ closely watched for signs of in-
flammation. Luxation of some hours’ duration or accompanied with
irremediable injury calls for enucleation of the globe. Foreign
bodies must be promptly removed after five to ten minutes of local
cocaine anesthesia (2:100). They are best lifted with a fine sterilized
forceps or needle. When firmly embedded it may be necessary
to pass a broad needle into and through the cornea and behind it to

The Head and Neck 43

form a surface against which to work so that the body be not pressed
entirely into the anterior chamber. In human surgery the Haab
magnet is employed to remove steel splinters. It compels the splin-
ter to retrace the tract by,which it entered, even from the lens. When
a foreign body is within the anterior chamber it must be extracted by
means of fine forceps or curette through an incision made at the in-
ferior border, everything being done aseptically. In case of hernia
of the iris the latter may be replaced with a sterilized sound or
the protruding portion excised and the stump returned, instillations
of eserine being used afterwards to cause its withdrawal from the
wound. Intraocular hemorrhage is a serious condition, and it is
- seldom that any treatment short of enucleation is of use. Puncture
is useless.

PARASITES.

Filaria may occur as evidenced by an observation made by
Rossi. In this case there was kerato-conjunctivitis, which devel-
oped into ophthalmia. A fistula and staphyloma formed, and the
eye was extirpated. The anterior chamber contained a purulent
exudate in the center of which a female filaria was found.

At the Pisa College an instance of a tick attaching itself to the
lower border of the cornea has been noted. In this case there were
profuse secretion of tears and spasmodic closure of the lids.

Treatment. In the case of filaria, its exit must be prompted by
puncturing under cocaine anesthesia the cornea at its superior border
with a fine scalpel introduced flatwise and causing it to escape with
the flow of aqueous humor. Ticks may be detached, under local
cocaine anesthesia.

CONJUNCTIVITIS.

Inflammation of the conjunctiva is the commonest ocular trou-
ble with which we have to deal. It is induced by ordinary pyogenic
microorganisms or a mixed infection, and it is also probable that it
is due in some instances to a specific infection. The provocative fac-
tors are traumatic lesions, foreign bodies, primary infectious
diseases such as distemper and inflammations of the respiratory
tract, and any condition tending to expose or irritate the con-
junctiva, such as ectropion, entropion, sequestration dermoid, neo-

44 Surgical Diseases and Surgery of the Dog

plasm of the membrana nictitans, and trichiasis. It may be brought
about by dust in animals which habitually run under carriages.

Two principal forms are recognized—the catarrhal and the pur-
ulent—and either may run an acute or chronic course. The term
“follicular conjunctivitis” is applied to a ldtalization of the disease
on the membrana nictitans, generally on its inner surface. Catarrhal
conjunctivitis is a simple malady of mild type, usually of short dura-
tion, and characterized by vascularization and the secretion of a mu-
cous or muco-purulent discharge. Purulent conjunctivitis is of a
much more intense type, accompanied with considerable pain, a pro-
fuse distinctly purulent secretion, and commonly corneal lesions.

Symptoms and Diagnosis. In the catarrhal form the vessels be-
come injected and a watery secretion at first forms and tends to run
over the lids and excoriate the neighboring skin. The secretion soon
changes to a greyish muco-pus and collects in the canthi and at
night-time glues the lids together with a scab. The animal seeks
to free itself of the matter by rubbing its eyes with its paws, but
that there is little or no pain is evidenced by the lack of photophobia.
In the purulent form the disease first appears mild, but in a few
hours grows severe. The vessels become deeply injected, the lids
swollen, there is great pain, photophobia, and sensitiveness to ex-
ploration, and tears are secreted profusely and run down the face.
The inflammatory secretion at first is thick and ropey but later be-
comes distinctly purulent of a yellowish or greenish color. Keratitis
frequently develops and quickly leads to corneal ulceration, and
sometimes to panophthalmia. When the cornea becomes involved
the disease runs a lengthened course and the acute symptoms pass
to a more chronic state, in which the abnormal sensitiveness disap-
pears. In follicular conjunctivitis the mucosa, principally of the in-
ner surface of the third eye-lid, is studded with minute dark red
round elevations which, when numerous, resemble granulation tis-
sue. Under these conditions the membrana appears red and tume-
fied and projects more or less over the globe.

Treatment. The first step is to search for and remove any ap-
preciable active irritant, such as a foreign body, entropion, or neo-
plasm of the third lid, and where there is any photophobia, confine
the animal to a darkened room. In the catarrhal form any of the
following lotions are useful: Boracic acid (1:100), permanganate
of potash (1:2000), sulphate of zinc (1:250). In many cases, and

The Head and Neck 45

particularly where there is active congestion, it is possible to abort
the trouble with instillations, repeated every two or three hours, of
from one or two drops of adrenalin chloride solution (1:10,0o00o—
1:2,000), a remedy which is remarkably active in blanching con-
gested membrane. It has a slight smarting effect to which some dogs
strenuously object, but this can be averted by previous instillation
of cocaine solution. Purulent secretions may be gently wiped away
with a wad of absorbent cotton, and the conjunctival sac should then
be copiously irrigated with any of the above-mentioned antiseptic
solutions, and finally receive a few drops of nitrate of silver solu-
tion (1:200—2:100). When the condition assumes chronicity, the
yellow oxide of mercury ointment (1:60) is indicated. The best way
to treat the follicular form is to remove the membrana nictitans un-
der cocaine anesthesia. It is seized with forceps, drawn forward,
and quickly snipped off with fine curved scissors. The hemorrhage
is insignificant.

SUPERFICIAL KERATITIS. ULCERATION OF THE CORNEA.

This is an inflammatory affection of the cornea which results
from causes similar to those which are operative in producing
conjunctivitis. But, it would seem that keratitis may also arise
as an idiopathic manifestation to which the young of certain breeds,
such as the Boston Terrier, show a marked predisposition.
It is most often unilateral but is also frequently bilateral,
and it is commonly associated with conjunctivitis. The in-
flammation may run one of several courses. Resolution by
absorption may take place in the stage of infiltration. Should the
process progress past this point to cell necrosis, it is most com-
mon for the superficial corneal layers to disintegrate and develop an
open ulcer. In some cases the ulcer extends inwardly and destroys
all the layers and perforation follows. When this happens, partic-
uarly at a lower peripheral situation, the iris is apt to fall forward
and protrude through the opening and become united with the
cornea by formation of repair tissue, when the condition is known as
Anterior Synechia. Or, the ulcerative process may stop short at
the superficial layers and the intraocular pressure cause the remain-
ing layers to bulge forward (Kerectasia), or all the layers may be
destroyed except the posterior one when the latter protrudes through

46 Surgical Diseases and Surgery of the Dog

the opening in the form of a small pouch (Keratocele). Should the
superficial layers remain intact, the pus infiltrates the deeper layers
and an abscess results. Such an abscess may undergo resolution,
but it tends to burst on the surface, or as sometimes happens, it dis-
charges inwardly into the anterior chamber (Hypopyon) and there
may inaugurate an acute ophthalmia. In rare instances, through
failure of an ulcer to heal, a fistula develops. In some cases the
ulcer becomes exuberant as in other parts of the body. As a result
of corneal ulceration and the consequent formation of scar tissue
an opacity remains which may vary in degree, receiving the name
Nebula, Macula, or Leucoma according to its intensity. Sometimes
the scar tissue formed after perforation fails to withstand the in-
traocular tension, and that portion of the cornea is forced forward
to form a pouch-like protrusion. This is termed a Staphyloma.
Ordinarily, a Nebula or Macula decreases little by little and finally
disappears, but dense Leucomas are usually a permanency. Kera-
titis is generally accompanied with more or less pericorneal injection
or conjunctivitis, but an asthenic type without manifest inflammatory
reaction is sometimes seen during the course of exhaustive diseases.

Symptoms and Diagnosis. The earliest symptoms are photo-
phobia, manifested by spasmodic closing of the lids, and increased
sensitiveness and lachrymation. The cornea becomes infiltrated and
opaque. This condition can last some weeks and be accompanied
with suppuration and new vessel formation. The process continu-
ing to the ulcerative stage, a grey or greyish white depressed or
excavated area appears, of variable breadth and depth, surrounded
by a zone of hazy cornea and sometimes vascularization. Threat-
ened perforation is recognized by bulging of the floor of the ulcer,
Kerectasia by a bulging opaque elevation, and Keratocele by a
translucent, hernia-like pouch surrounded by a border of opaque
cornea. Staphyloma is at first reddish, but later becomes densely
opaque. Abscess formation, which may be of variable extent and
occur at any portion of the cornea, is characterized by great photo-
phobia, secretion of tears, and pericorneal injection, and by a spot
which is at first grey but speedily grows yellow, and which may be
sharply defined by normal cornea or surrounded by a zone of
opacity. As already has been stated, an abscess, unless previ-
ously opened, discharges, as a rule, externally. When it empties
into the anterior chamber, the pus appears as a yellow mass within.

The Head and Neck 47

Treatment. As in conjunctivitis, irritants must first be sought
for and removed, and the animal should then be confined to a
darkened room. During the stage of infiltration soothing appli-
cations are indicated and for this purpose a warm solution of boric
acid (2:100) should be instilled by means of a medicine-dropper.
If there is much congestion present atropine is to be added in the
same proportion. In the stage of resolution yellow oxide of mer-
cury Ointment (1:60) may be smeared under the lids. Cocaine
should not be employed as it hinders the healing of ulcers. The
best treatment for ulceration is frequent instillations of distilled
aqueous solution of nitrate of silver (1:100) or of permanganate of
potash (1:2000); sublimate solution (1:5000), or formaldehyde
(1:3000) are also excellent. In the torpid stage, after subsidence of
the acute symptoms, gentle stimulation is needed, ointments of
yellow oxide of mercury, iodol, or aristol, or insufflations of calomel,
producing the best results. Indolent ulcers, keratocele, fistula, and
kerectasia require touching with the solid nitrate of silver stick.
In threatened perforation the intraocular tension should be dimin-
ished by aseptic paracentesis of the cornea. When perforation has
taken place atropine (1:100) should be used to produce mydriasis
or dilation of the pupil when the opening is in the center of the
cornea, and eserine (1:1000) to produce myosis when it is at the
periphery of the cornea, the object in both instances being to cause
the iris to retire from the lesion and thereby lessen the liability to
adhesion. Recent staphyloma is treated with instillations of eserine,
Or paracentesis to allow escape of the aqueous humor. Failing
in this, the protruding portion should be ligated with fine silk
under cocaine anesthesia, the ligature being allowed to remain in
position for a day or two, when the occluded portion is excised, but
in the interim the animal should be kept under morphine or it may
otherwise damage the eye by scratching. Abscess should be opened,
puncture with a needle sufficing. For nebula and leucoma yellow
oxide of mercury ointment or insufflations of white sugar may be
employed, together with internal tonic medication.

INTERSTITIAL KERATITIS.

This is a diffuse form of the disease in which the inflammation
involves the several layers of the cornea. It is characterized by mul-
tiple opacities and profuse intracorneal vessel formation. Ulcera-

48 Surgical Diseases and Surgery of the Dog

tion rarely takes place. It is seen in poorly nourished animals and
also those with rheumatic tendencies.

Symptoms and Diagnosis. The disease commences as a hazi-
ness which is sometimes streaky, near the center of the cornea.
This gradually spreads over the whole cornea, at the same time
showing scattered spots of greater density. There is usually a
slight flow of tears and some photophobia. Soon new blood vessels
commence to grow out into the layers of the cornea from the
ciliary vessels towards the center, producing a dull-red or salmon
color. In the course of time, generally some months, the eye com-
mences to clear from the periphery and the vessel formation sub-
sides, although slight haziness and even minute vessels sometimes
persist.

Treatment. The indications are to allay the inflammation and
maintain mydriasis and for this purpose nothing is better than fre-
quent instillations of atropine solution (1:100). Internally, the sali-
cylates should be administered in rheumatic subjects and tonics
in asthenic animals. In the clearing stage, after irritation has sub-
sided, the yellow oxide of mercury ointment (1:60) may be ap-
plied with advantage.

OPHTHALMITIS.

This term is applied to acute inflammation of part or all of
the eye. It is generally of a suppurative type. As a rule, it results
from causes of external origin, such as traumatism, perforating ulcer
of the cornea, infected operations, burns, etc. One case is on record
as having followed washing of the animal with strong lye. Accord-
ing to some authorities, it may arise by endogenous infection.
When limited to the anterior chamber the disease remains unilateral,
but when the entire eye is affected, the fellow usually sooner or
later becomes involved.

Symptoms and Diagnosis. The eye is tumefied and projecting,
and very sensitive. The conjunctiva are red and swollen. The
cornea loses its transparency, or if a perforation has occurred, a
wound is seen with injected or granular edges through which
issues a purulent matter. There is some fever present and the
animal is depressed and refuses to eat. When there is absence of a
wound, an ophthalmoscopic examination is necessary to detect the
presence of inflammatory debris.

The Head and Neck 49

Treatment. When the disease is confined to the anterior
chamber, antiseptic irrigation is indicated, and when the entire or-
gan is implicated there is nothing to do but to practise early enu-
cleation.

GLAUCOMA.

Glaucoma is a disease in which there is an augmentation of
the intraocular fluids, and as a consequence, increased intraocular
tension. It may arise as a primary affection or secondarily as a
complication of some other pre-existing disease. Acute, subacute,
and chronic types are recognized. The disease is most often seen
in aged animals and is more common in females than in males.

Symptoms and Diagnosis. Attention is usually first drawn to
the condition by a haziness or opacity of the cornea which is more
pronounced in the center than at the periphery, and by injection ,
of the conjunctival veins. On palpating the ball with the finger-tips
a hard feeling is imparted and usually the cornea is devoid of
sensation owing to the edema. There is no reflex movement of the
lids though compression of the globe itself may be painful. The
pupil is dilated and moves sluggishly, and the iris is discolored.
The pressure of the increased fluid in the posterior portion of the
globe forces the lens and periphery of the iris forward so that the
depth of the anterior chamber is depreciated. Vision is partly or
wholly inhibited and the eye slowly atrophies.

Treatment. The results of treatment are rarely satisfactory
and a guarded prognosis should always be given. Myotics are in-
dicated, instillations of solutions of eserine (1: 300) or pilocarpine
(1:200) being employed every two or three hours. Eserine has
the additional advantage of diminishing abnormal intraocular ten-
sion. Brisk purgatives should also be administered. Should these
measures fail, the only alternative is to practice partial iridectomy
as is done in the human subject with variable success, about one-
fifth of the muscle being removed up to the ciliary border.

HYDROPHTHALMIA.

This condition—so-called dropsy of the eye—is one of ex-
cessive secretion of the aqueous humor. It differs from Glaucoma
in that the cornea and sclerotic become distended. It is most com-

5

50 Surgical Diseases and Surgery of the Dog

mon in animals possessing naturally prominent eyes, such as Pugs
and Toy Spaniels.

Symptoms and Diagnosis. In the early stages the only symptom
is that of prominent bulging. If the condition is allowed to persist,
the tension to which the cornea is subjected brings about its dis-
solution and permanent loss of sight results.

Treatment. To relieve the tension the cornea should be punc-
tured repeatedly if necessary and this followed up with instillations
of eserine solution (1 :200).

AMBLYOPIA. AMAUROSIS.

These terms are applied respectively in those cases where vision
is subnormal or is entirely abolished, but where there is no ophthal-
moscopic change. The disorder may be unilateral or bilateral. The
causes are manifold. Some cases are due to inflammatory changes
or deposits in the retina. Others result from traumatism, encephalic
disturbances, severe hemorrhages, and atrophy of the optic nerve
as may follow infectious disorders, notably Distemper.

Symptoms and Diagnosis. The eye has a staring look. The
pupil is immobile and widely dilated, though there is slight pupillary
action in the incomplete form. Ophthalmoscopic examination may
disclose a local lesion, particularly in atrophy of the optic nerve when
the vessels which are normally numerous and red in appearance, for
the most part disappear, the few remaining assuming a greyish
color. Excepting in those cases resulting from sudden transitory
disturbances the evolution is usually slow, though Distemper cases
may develop in two or three weeks. Slowly developing cases have
usually graver import than those of the opposite nature, where
the condition may disappear with the passing of the provocative
factor.

Treatment. By far the best remedy is strychnine. This should
be injected hypodermically every three days in the temporal region
as advocated by Froehner. Very minute doses must be employed,
I to 3 mg. sufficing. So effective is this treatment that improve-
ment has been noticed after the second injection, and if the ophthal-
moscope is again employed neoformation of vessels may be ob-
served. In cases due to retinal deposits, iodine is indicated in the
form of the iodides internally.

The Head and Neck 51

CATARACT.

This term is used to denote any opacity of the crystalline lens
or its capsule. It is a common trouble. It is sometimes congenital
in origin, and sometimes traumatic from contusions and wounds,
but most frequently occurs incident to senility. The nature of
its development is not properly understood but it is believed to be
due to some condition interfering with the nutrition of the lens,
and heredity is known to play a part. Cataracts are also seen in
cases of diabetes mellitus. A cataract may be partial or complete,
unilateral or bilateral, and according to the stage of its development
may be soft or hard and consist of isolated spots, striae, or peri-
pheral, central, or total opacities, of white, bluish, or amber color.
Congenital cataracts show little tendency to further development,
but those arising in young animals increase in density at a rapid
rate. Senile cataracts on the other hand run a protracted course.

A cataract sometimes undergoes displacement or complete lux-
ation.

Symptoms and Diagnosis. The first symptom is impairment of
visual acuity and this becomes more and more marked as the con-
dition increases in intensity until total blindness is established. The
eye being examined, the telltale opacities are discovered, though
these, when slight, may be imperceptible without an ophthalmo-
scopic examination. Pupillary action may remain normal.

Treatment. As has been observed by Cadiot and Breton, cat-
aract never retrocedes in the dog and its treatment is exclusively
surgical and an operation beneficial. Theoretically, removal of the
lens could leave the subject capable of but vague sensation of near-
by objects. But, in reality, as has been observed by Cocteau and
Leroy, Contejean, Randolph, Moeller, and others, recovery of
almost perfect vision is the rule. This takes place progressively in
one to three months. At first the animal runs into obstacles and
scents its food before partaking. Distant objects and particularly
persons calling, are seen perfectly, and the animal runs at once; but
in approaching, it can no longer see and hunts around guided by the
voice. As the improvement takes place, accommodation, which is
always within narrow limits under normal conditions, is re-
established. Contejean holds that the lens is not regenerated and
cites the absence of Purkinje’s images as evidence. But this he
regards as unnecessary suggesting that certain muscular fibers can

52 Surgical Diseases and Surgery of the Dog

contract and diminish the equator of the eye, and this organ being
filled with liquid or semi-liquid, the cornea and retina become
separated, thus enabling focussing to take place. This view is sup-
ported by Randolph who points out that the dog is not possessed of
human visual acuteness, so that few demands are made on the ac-
commodative apparatus and consequently loss of the lens is at-
tended with comparatively little or no inconvenience. On the other
hand, Cocteau and Leroy in a series of experiments found that the
lens fibers were reformed in a certain length of time after their re-
moval.

There are two methods of producing removal of a cataract in
the dog, viz., by Discission and by Extraction. The best results
attend discission, though this method is not adapted to cases of
senile or hard cataract. Discission comprehends the laceration of
the anterior capsule of the lens with a specially constructed needle,
so as to cause the aqueous humor to invade the spaces between
the lenticular fibers, which causes the latter to swell and gradually
soften and finally undergo absorption. The reparative process is
initiated by the surgeon, so to speak, and the rest is left to Nature. It
is followed by little or no irritation and an uneventful recovery is
the rule. Extraction or immediate removal is not always followed
by favorable results; it gives rise to considerable irritation during
the healing process and there is an ever-present menace that the
animal will irretrievably injure the eye in its efforts to allay this
irritation. Still, the operation has several times been performed
without untoward results.

LUXATION OF THE LENS.

This lesion occurs through traumatism or as a complication of
cataract. The congenital form has already been noted. It may be
complete or incomplete and take place into either the anterior or
posterior chamber. It necessarily causes partial or total abolition of
vision.

Treatment. In anterior luxation the lens may be completely
removed by operative measures similar to those for cataract.

STRABISMUS.
Commonly termed “squint” this is a condition where the visual

The Head and Neck 53

axis is deviated from the point of fixation. It is a very rare con-
dition but has been seen by Hobday in which case it was congenital,
there being a convergent squint in both eyes. It may also result
from paralysis of the ocular muscles, their unequal contraction, or
from neoplasms of the orbit.

Treatment. Under general anesthesia the abnormally con-
tracting or contracted muscle is divided in a manner similar to that
in enucleation with some slight modification of technic. The con-
junctiva at the canthus on the affected side only is incised, the
probe-pointed hook passed inward and under the muscle, and made
to raise the latter which is then severed. Subsequent treatment is
directed to maintaining the wound free of infection by antiseptic
irrigation. In Hobday’s case the condition of one eye only was
improved by the operation.

EXOPHTHALMIA.

Reference has already been made to prominent bulging of the
eyes seen in Hydrophthalmia and Intraocular Hemorrhage. But
these must be differentiated from the protrusion of Exophthalmic
Goiter.

Symptoms and Diagnosis. In the latter disease the protrusion’
is so great that the eyelids cannot close, and the exposure to which
the eye is subject results in drying of the corneal epithelium
and ulceration. The accompanying and characteristic symptoms,
viz., enlargement of the thyroid and palpitation of the heart,
serve to distinguish it from other eye lesions.

Treatment. This is described under The Thyroid Gland.

NEOPLASMS.

Growths of the eye are uncommon, but both innocent and ma-
lignant types have been observed. Of the former, Pinguecula is a
term applied to a small nodule which sometimes appears in the con-
junctiva, and Pterygium to a peculiar hypertrophy of conjunctival
connective tissue. Granuloma of the cornea sometimes results from
a wound of that membrane. Reference has already been made to
congenital sequestration dermoid. Sarcoma and Carcinoma repre-
sent the malignant types.

Symptoms and Diagnosis. Pinguecula occurs near the margin

54 Surgical Diseases and Surgery of the Dog

of the cornea, usually at the inner side ; it has the appearance of fatty
tissue. Pterygium has a similar situation but has a striking shape,
being fan-shaped and convergent towards the cornea, upon which
it tends to encroach. Granuloma presents a granulating flesh-like
appearance and a hard consistence and is painless to pressure.
When extensive it may project from the eye and cause separation of
the lids. The surface is covered with a slimy secretion. Sarcoma
appears first as a small flesh-like wart or polypoid outgrowth on
the surface of the globe and spreads over the cornea and posteriorly.
Carcinoma is accompanied with swelling of the neighboring lymph-
glands.

Treatment. Pinguecula should be excised with scissors under
cocaine anesthesia. Pterygium must be seized with forceps, raised
from the surface of the globe and carefully severed from its corneal
attachment with a knife. It is then dissected from its conjunctival
bed and the edges of the wound united with sutures. Minute
granuloma may be excised or cauterized with the solid nitrate of
silver, but extensive granulomata and the malignant growths re-
quire enucleation of the globe.

Surgery of the Eye

In any major operation on the globe complete anesthesia is
essential. As far as inhibiting pain is concerned the local use of
cocaine is quite sufficient, but there is always danger that an animal
in possession of consciousness may start suddenly and cause acci-
dents. It is extremely important that all instruments be rendered
sterile as it is very difficult to combat infective processes in the in-
terior of the eye. Where instruments are to be introduced within
the eye, the conjuctival sac must also be thoroughly disinfected
with a bichloride solution (1:5000). Subsequent to operative
measures, the animal should be kept in a small darkened en-
closure to prevent active movements and the irritative effect of
strong light.

PARACENTESIS.

Puncture can be made under local cocaine anesthesia, and near
the lower margin on the outer side with a sterilized broad needle,

The Head and Neck 55

the conjunctival sac being previously disinfected with any of the
antiseptic solutions indicated in Keratitis. The lids are widely
separated either with the finger and thumb or a stop-speculum, and
the needle inserted flatwise and manipulated so as to separate the
lips of the opening and allow the aqueous humor to escape. It
should be withdrawn cautiously to guard against prolapse of the
iris as may take place with a too sudden gush.

ENUCLEATION OF THE EYEBALL.

For this operation certain instruments are indispensable to its
proper performance, to wit: a stop-speculum, fixation forceps, a
probe-pointed hook, and a pair of scissors curved on the flat. The
stop-speculum is first introduced to hold the lids apart. Next, the
cornea being seized with fixation-forceps (the latter being employed
to steady the ball), the conjunctiva and adjacent fascia are divided
in a circle close to the margin of the cornea by snipping at them with
scissors. The hook is then passed successively under the tendon
of each ocular muscle and made to raise the latter prominently to
view, when they are divided close to their ocular attachment. To
sever the only remaining attachment, viz., the optic nerve, the blades
of the scissors are passed between the divided conjunctiva and the
eyeball until the optic nerve is reached, when they are expanded
and made to cut the nerve squarely off. The hemorrhage is insignfi-
cant and can be controlled by pressure or packing. No after-treat-
ment is necessary, nor should any kind of bandage be applied. An
artificial eye may be worn, selected to match the sound one, and
it should first be introduced about a week or ten days after the
operation, but only worn for a few hours at a time at the outset.

DISCISSION OF THE LENS.

For this operation only two instruments are essential, viz.,
discission needle and fixation forceps. In bilateral cataracts only
one eye should be operated upon at a time. The pupil being previously
dilated with atropine, the conjunctiva is grasped with the forceps to
steady the globe, and the needle is passed through the cornea at a
point in its lower and outer quadrant corresponding to the margin
of the dilated pupil. It is then directed upward to the upper margin
of the pupil, made to enter the capsule and drawn boldly through
the latter. A second crucial incision is made in like manner and

56 Surgical Diseases and Surgery of the Dog

the needle is withdrawn. It should be borne in mind that the larger
the opening is made in the capsule, the more freely will the aqueous
humor produce the desired effect. Following the operation, the iris
must be kept well dilated with atropine (1:100) dropped in the eye
three times daily, until absorption of the lens is complete. This
takes place in varying periods, according to the density of the
cataract, three weeks being about the shortest time, the more pro-
tracted cases running into months. The operation should be re-
peated if absorption is slow or incomplete.

EXTRACTION OF THE LENS.

This operation is really an elaboration of the preceding one.
Extra instruments are necessary, namely, a Graefe cataract knife
and a Daviel spoon. The pupil being previously dilated with atro-
pine, and the speculum inserted, the eyeball is steadied by seizing a
fold of conjunctiva below the inferior border of the cornea with
the fixation forceps, dnd drawing it downward. The next step is
corneal section and the flap should embrace the upper half of
the diameter of the cornea. The point of the Graefe knife with the
edge directed upward is made to enter the anterior chamber at the
corneo-scleral junction and to emerge at a point exactly opposite
and the section completed with a gentle sawing movement. This
causes escape of the aqueous humor. The discission needle is next
introduced and with it the capsule is incised crucially as in the pre-
ceding operation. The back of the spoon is then laid against the
inferior portion of the cornea and firm but gentle pressure exercised
with upward motion to coax out the cataract. During the operation
the iris sometimes prolapses, when it is to be carefully replaced, or
failing in this it may be snipped off with scissors close to the border
of the cornea. The after treatment is the same as for the preced-
ing operation, but in this case, to prevent injury to the eye by
scratching, it should be bandaged with a piece of lint soaked in bi-
chloride solution and changed twice daily.

BIBLIOGRAPHY.

Barrier—Bull. de la Soc. de Méd. Vétér. 1898, p. 476.
Cocteau & Leroy—Journ. de Phy. Exper. et Pathol. 7, 30-44.
Contejean—Comptes rendus de la Soc. de Biol. 1896. p. 1032.
Fromarget—Rec. de Méd. Vétér. 1898, p. 89.

Hobday—Journ. Comp. Path. & Ther. 8, p. 250.
Moeller—Zeitschr. f. vergleich. Augenheilk. 1885, p. 65.
Pisa—Schweiz. Archiv. 1897, p. 230.

Randolph—Johns Hopkins Hospital Bulletin. Feb., 1895.
Rossi—Tjdsch. voor Veeartsenijkunde. Jan., 1895.

The Head and Neck 57

The Eyelids

CONGENITAL MALFORMATIONS.

At birth the margins of the lids are united and they do not
separate for some ten days thereafter. When separation fails to take
place, the condition is known as Ankyloblepharon. It is also some-
times seen in after life occurring as a result of inflammation of the
lids.

Treatment. In the partial form a grooved director is inserted
in the opening remaining and made to pass to the opposite canthus
in a line with the ciliary border; the tissue is then divided with a
bistoury or scissors. In the complete form, a primary incision is
made in a fold of skin gathered up with forceps and the operation
completed in like manner. To prevent reunion of the severed edges,
they must be frequently stretched apart and oil dropped in.

TRAUMATIC LESIONS.

The lids sometimes sustain lacerations which, if not attended
to, may result in deformity, entropion, ectropion, etc. Edema of
the lids often follows a blow, and abscess formation is an occasional
termination.

Treatment. The edges of wounds must be carefully approxi-
mated with fine silk sutures.

BLEPHARITIS.

Inflammation of the lids occurs as an idiopathic trouble con-
fined to the free border, often as a manifestation of eczema or
follicular mange. It has been known to terminate in ankyloble-
pharon. Suppurative inflammation sometimes results from con-
tusions and wounds and leads to abscess formation which may dis-
charge spontaneously into the conjunctival cul-de-sac.

Treatment. In blepharitis confined to the free border remedies
must be used to combat the condition present, whether eczematous
or parasitic, always, however, with the precaution to avoid irritating
applications. In abscess formation, the pus should be evacuated by
an incision made just external and parallel to the free border.

58 Surgical Diseases and Surgery of the Dog

ECTROPION.

Eversion of the edges of the lids is a rare trouble, being not
nearly as common as Entropion. It results from cicatricial forma-
tion following inflammation or injuries to the periocular tissues, but
may also be produced by swelling of the conjunctiva. It is gen-
erally seen in the lower lid and may be bilateral.

Symptoms and Diagnosis. The condition is recognized by
turning outward of the lid coupled with undue prominence of the
conjunctiva. Through the constant exposure to which the latter
is subjected it is more or less inflamed. Mucus and tears are freely
secreted.

Treatment. When due to conjunctivitis, scarification of the con- |
junctiva will at time suffice, but if this fails, the operation for the
cicatricial form must be undertaken. This consists in excising
under cocaine anesthesia an elliptical piece of the conjunctiva in the
long axis of the lid, or if this fails, in removing a V-shaped seg-

No. 10. Operation for Ectropion.

ment of the lid including all the tissues and skin and bringing the
edges of the wound together with silk sutures.

ENTROPION.

Inversion ot part or the whole of the edges of the lids is not an
uncommon deformity and is frequently complicated with trichiasis.
It is most often seen in hunting dogs and dogs of the larger breeds.

The Head and Neck 59

As in Ectropion, it may be caused by the formation of cicatricial
tissue following wounds, by chronic blepharitis, eczema, follicular
mange, etc. Spasmodic inversion accompanying acute conjuncti-
vitis and keratitis must not be confounded with the true deformity.
This lesion occurs most often in the upper lid, but both lids may
be affected.

Symptoms and Diagnosis. The lid is turned inward and com-
ing in contact with the eye actively irritates the latter, sometimes
to the extent of starting up ulcerative keratitis. There is usually
convulsive closure of the lids and much secretion of mucus and tears.
The conjunctiva are injected.

Treatment. This trouble is remedied by excision of an elliptical
portion of skin covering the lid. With entropion forceps a fold
of skin is seized, parallel to the ciliary border, of sufficient size to
cause the inturned lid to assume
a normal position, care being
taken to avoid including the
conjunctiva. The strip of skin
in the grasp of the forceps is
then excised with scissors close
to the forceps so that at least a
quarter of an inch of skin exists
between the wound and ciliary
border. The margins of the
wound are brought together
with subcuticular silk sutures. No. 11. Operation for Entropion.

TRICHIASIS.

Turning in of the eye-lashes occurs as a complication of en-
tropion, but it also takes place independently of the latter trouble.
It may lead to serious results as the constant rubbing of the cilia
against the cornea causes ulceration.

Treatment. The offending lashes must be plucked out with for-
ceps as Often as is necessary. If this proves insufficient total ex-
cision of the hair follicle must be practised by making two parallel
incisions along the margins of the lids on either side of the row of
hairs, and of such depth as to ensure complete removal of the
roots.

60 Surgical Diseases and Surgery of the Dog

NEOPLASMS.

The commonest form of growth seen in the eye-lids is Papilloma
or Wart. It is innocent but in aged animals may become malignant
by assuming epitheliomatous character. Fibroma also occurs, as
does Sarcoma.

The Membrana Nictitans and the Orbital Gland with which it
is closely associated are frequently the seat of swelling from acute
inflammation, hypertrophy from chronic inflammation, or myxoma.

Treatment. Warts are seized with forceps and snipped off with
curved scissors. As a rule, no anesthetic is necessary but nervous
subjects should previously be narcotized to prevent accidental injury
to the eye through sudden movements. The hemorrhage amounts
to nothing and soon stops spontaneously. When the growth is ex-
tensive it is necessary to remove a wedge-shaped portion of the lid
with scissors under cocaine anesthesia and suture the cut edges.
In either case, the base should be cauterized with the solid lunar
caustic. .

Enlargements of the Membrana Nictitans and Orbital Gland
call for removal under deep cocaine anesthesia by seizing the mem-
brane with forceps, drawing it forward and snipping it off with fine
curved scissors ‘as close to its base as possible. The cocaine anes-
thesia must be thorough and no attempt should be made to remove
the membrane until the full effect of the drug is procured.

LACHRYMAL FISTULA. :

This is a very rare affection. It may occur as a sequel to
traumatism, through extension of inflammation of the nasal pas-
sage causing obstruction within the duct, or through lodgment of
foreign bodies. The obstruction occurs where the duct emerges
from its bony casing and continues as a membranous tube to the
nose. Chronic suppurative inflammation starts up, the pus burrows
and perforates the bone and discharges externally.

Symptoms and Diagnosis. Lachrymal fistula appears as a tiny
trumpet-shaped orifice with pouting granulations a little below the
inner angle of the eye. Tears, muco-pus, or pus exude and soil
the hair. The eye swims in tears. To differentiate from maxillary _
fistula a fine probe must be employed and it should be remembered
that in the latter condition the discharge is invariably purely
purulent.

No. 12. Papilloma of the Eyelid.

ee

No. 18. Hypertrophy of the Orbital gland.

The Head and Neck 61

Treatment. This is a delicate undertaking. An attempt should
be made to divert the flow to the nasal cavity by establishing a new
opening directly into the latter, and promote healing of the outer
wound by cauterizing it.

The Eats
EXAMINATION.

The external ear, when healthy, can be easily inspected in a
favorable light if the flap is held aside, but for examination of the
external canal and drum an expansible speculum and mirror are
necessary. When the parts are inflamed they are very sensitive and
the animal usually offers more or less objection to manipulation
and it is sometimes necessary to apply a muzzle and even the
hopples.

TRAUMATIC LESIONS.

The wounds most commonly met with are bites by other dogs.
Contusions caused by the animal shaking its ear-flaps are not un-
common and these are referred to under Hematoma. Bite-wounds
vary in extent and position and are often irregular. Division of the
anterior auricular artery can give rise to severe hemorrhage. As a
rule, wounds of the ear are tardy to heal through continual scratch-
ing and agitation on the part of the animal.

According to Cadiot and Almy, the base of the concha may suf-
fer fracture and as a result the auditory conduit be more or less
completely obstructed if reunion should take place with defective
position of the parts.

Treatment. The edges, if severed, must be nicely sutured and
every effort made to avoid resultant deformity through irregular
cicatrization. In some cases it may be advisable to amputate a por-
tion of the flap, when the opposite ear should be treated in like
manner. During healing a protective ear-cap and soothing applica-
tion may be necessary.

ULCERATION OF THE CONCHA.

This disease is most commonly observed in fine-haired sub-
jects possessing long, pendant ears. The lesion is always situated at

62 Surgical Diseases and Surgery of the Dog

or near the edge of the concha. In most cases it occurs as a compli-
cation of otitis resulting from the bruising caused by violent or
constant shaking of the flaps, and it is then usually bilateral. It
may also result from traumatism and may develop as a manifes-
tation of eczema.

Symptoms and Diagnosis, One or more raw or scab-covered
ulcers are observed, with sensitive edematous edges. When
raw, and the flaps are violently shaken, blood may be swished in
all directions. The disease is generally progressive owing to the
incessant irritation of the shaking.

Treatment. When uncomplicated with otitis this lesion is
very stubborn and unresponsive to treatment. The flap should first
be soaked in a moderately hot antiseptic solution, and the same
treatment pursued as advocated for otorrhea, viz., application of
distilled aqueous nitrate of silver or protargol solution (3:100—
5 :100), twice daily, supplemented with xeroform or other analgesic
antiseptic powder to which a little orthoform may be added to get
a more pronounced anodyne effect. At the same time the ears
should be securely bound to the head, as further shaking counter-
acts all good effect of treatment. Failing in this after perseverance
a reasonable length of time, a portion of the flap must be ampu-
tated in as artistic a manner as possible.

When developing as a complication of otitis, treatment is seldona
necessary, the inflammation usually subsiding as the primary
trouble disappears with treatment.

OTITIS. OTORRHEA.

Inflammation of the ear is a very common affection, particu-
larly in long-eared animals. It is usually unilateral but it may be
bilateral. It exhibits all the phenomena of inflammation and ter-
minates in ulceration. The disease has been attributed to a variety
of causes, such as excessive animal diet or lack of exercise, but these
conditions bear little relation to it. In the great majority of cases,
it is a purely local pyogenic infection engendered by irritation pro-
duced by accumulation of cerumen and dirt. Such accumulation is
particularly provocative of irritation in ears with pendant flaps,
in which ventilation cannot freely take place. It is for the latter
reason that the disease is less common in animals with erect or
cropped ears. There is also a parasitic form of the disease caused

The Head and Neck 63

by the presence of the Symbiotes auricularum, which, however, is
extremely rare. Should ulceration once disturb the integrity of the
parts a further and constant irritant exists in the presence of the
resultant tissue debris which has no chance to escape by drainage.
The condition then assumes chronicity, the integument of the audi-
tory canal becoming thickened, sometimes to such degree as to oc-
clude the passage. This thickening is to be distinguished from the
not uncommon papillomatous excrescences. While the inflamma-
tion may extend as far as the tympanic membrane, it is very rare
that the latter becomes involved. When the disease is allowed to
become chronic it sometimes gives rise to the neoplastic forma-
tion known as papilloma. Complications in the form of hema-
toma of the concha or ulceration of its borders frequently arise as a
result of the violent shaking and scratching.

Symptoms and Diagnosis. In the acute form the animal inces-
santly shakes its head, scratches its ears, or rubs them along the
ground. Examination of the ear reveals a hot, congested, and
tender internal integument, which in the inner recesses is generally
coated more or less with dirt and wax. A mirror and ear speculum
may be employed to facil-
itate inspection, and the
latter is indispensable to
permit of free view of the
ulcers. As the inflam-
mation progresses, stp-
puration takes place and
a fetid purulent liquid
is discharged. The presence of ulcers and pus may always be as-
certained by the characteristic suction sound given forth by manipu-
lation of the base of the ear. If the disease is unilateral the head is
inclined sideways towards the affected sac. Hearing is often im-
paired. In the parasitic form epileptiform seizures have been ob-
served to take place, usually when the animal was excited.

Treatment. Attention must first be directed towards removing
all dirt and wax and tissue debris and thoroughly cleansing the auri-
cula and external canal, particularly the innermost recesses of the
latter. This is best accomplished by irrigating the parts with moder-
ately hot water by means of a gentle stream from a fountain syringe.
Antiseptic solutions may be used for this purpose but their employ-

No. 14. Ear Speculum.

>

64 Surgical Diseases and Surgery of the Dog

ment carries no advantage with it. The animal usually objects the less
the further the nozzle is inserted within the passage. Another method,
which is, however, more painful, is to grasp a small wad of absor-
bent cotton with the beak of a hemostatic forceps, dip it in the
fluid, and swab out the ear. In either case the passage should be
finally freed from all moisture with dry absorbent cotton in this
manner. Hair in the vicinity of the passage should be removed with
scissors. In cases exhibiting advanced ulceration and which con-
sequently would give rise to much pain upon manipulation, mor-
phine should previously be administered hypodermically.

A great many remedies have been advocated and employed
in this affection, but two or three are pre-eminent in their curative
power, and with them alone the worst form of the disease may be
eradicated. It should be remembered that this disease is an in-
flammatory one due to the action of pyogenic microorganisms, and
differs in no wise from inflammatory disturbances of the same
origin and nature in other parts of the surface of the body and re-
quires similar methods of treatment. In the active hyperemic stage
irrigation ot local bathing with moderately hot water is beneficial
followed by soothing applications. As a soothing application a
remedy combining antiseptic, dessicant, and analgesic properties is
desired and nothing meets the requirement better than the synthetic
powder xeroform. The milder ulcers call for gentle stimulation
and for this purpose nitrate of silver in distilled aqueous solution
(3:100—5:100) cannot be excelled. The employment of such solu-
tion for stimulating purposes may be limited, usually to three or
four instillations. It should be instilled night and morning into the
external meatus and retained there for a few minutes, the animal
then being allowed to shake it out, or in the case of a light-coated
animal, absorbed with a piece of cotton or sponge to prevent it
staining the hair. Indolent and exuberant ulcers may be actively
cauterized with the solid stick or powerful solutions. As the action
of the caustic is very painful the parts must be well anesthetized
with an instillation of a strong solution of cocaine. Local anesthesia
being established, the canal is dilated with a speculum to expose the
ulcers, which are then freely cauterized. A few hours after the ap-
plication of the nitrate a more profuse discharge takes place, which,
however, soon subsides. Severe and long-standing chronic cases
treated in the manner thus outlined may be permanently cured in

re j a ve ea 4
ee yas .

i e ae ; f ag ; wo “* ee ” “ ’ oe

No. 15. Papillomata of the Ear.

The Head and Neck 65

from two to six weeks, but as the trouble is prone to recur the ears
should subsequently be periodically examined.
In the parasitic form, parasiticides are, of course, indicated.
To ensure local applications reaching all parts of the canal the
base of the ear must be manipulated between the thumb and finger.
If the shaking of the flaps is violent enough to threaten the
production of hematoma or ulceration of their borders the protective
ear-cap may be employed.

SINUS.

A very rare form of sinus which is caused by the presence of a
dermoid dentigerous cyst in the temporal region may have its orifice
of discharge within the auditory canal (See The Teeth). Suppura-
ting lymphatic glands will also sometimes break through and dis-
charge into the auditory canal, thereby simulating otorrhea.

NEOPLASMS.

Two forms of neoplasms are commonly met with in the ear.
They are both innocent. They occur as papillomata which develop
in the vestibule of the outer ear, and as contusion or extravasa-
tion cysts (hematomata) which form beneath the integument of the
concha. Sebaceous adenomata have also been observed.

Papillomata. These tumors occur as single or multiple, flat,
coin-shaped or cauliflower-like excrescences. When numerous they
may extend well within the vestibule and block the canal. From
their surface they usually discharge a fetid, greasy matter. They
occur as the result of chronic otitis.

Symptoms and Diagnosis. The symptoms are identical with
those of chronic otorrhea, and the presence of the growths is as-
certained only by close inspection of the auditory canal. The animal
is often deaf.

Treatment. By far the most effective method of treating this
disease is complete destruction of the tumor with the thermo-cautery.
Ablation by snipping at the base of the growth with curved scissors,
as advocated by some authors, I cannot recommend, as it is uncer-
tain in result and is usually followed by recurrence of the trouble.
Cauterization is effected with the animal in the lateral position under
complete anesthesia. The burning process must be thorough. The

6

66 Surgical Diseases and Surgery of the Dog

ear-speculum should always be inserted while the cautery is in
use, partly for the purpose of dilating the canal, but also to protect
adjacent parts. A day or two later a mass of resultant necrotic
tissue needs to be removed with forceps and irrigation. Subsequent
treatment consists in irrigation with antiseptic solutions, thorough
drying with absorbent cotton, and insufflation or packing with ab-
sorbent powders, such as xeroform, aristol, etc. Any sluggishness
in healing or tendency towards unnatural secretion should be treated
with injections of silver solution in the strength employed in
otorrhea.

Extensive cutting or burning of the canal involving re-
moval or destruction of all or most of the integument leads to oblit-
eration of the canal. It will be remembered that it is the epithelium
of the free surface of the body which prevents union of contiguous
parts. When a raw surface, denuded of all epithelium, is brought
in contact with another similar surface, union of the two takes place
by interformation of connective tissue. Even a deep sac-like
wound fills up with reparative tissue, because the latter grows more
quickly than does the epithelium from the neighboring surface. If
the epithelium were the quicker to grow, it would extend over the
wounded surface, prevent the filling-up process, and lead to the for-
mation of pits and depressions in all wounds deeper than the skin.
And it is exactly this process of connective-tissue reparation which
tends to develop as a consequence of radical surgical measures af-
fecting the external auditory canal. A free granulating surface is
left, which fills up and coalesces and completely obliterates the
canal. The indications in these cases are daily irrigation of the
parts and packing with gauze impregnated with dessicant powders,
until the epithelium has had time to spread inwards over the raw
surface to the depths of the canal. A case presenting complete
obliteration of both canals following excesssive ablation of the parts,
and which I endeavored to remedy by making an artificial opening
and canal, terminated in failure after a four months’ attempt at
keeping it open. Strangely enough the hearing of the animal seemed
very little impaired, which suggests that this result is not to be re-
garded as altogether undesirable since it certainly protects from
future troubles of a like nature.

Hematoma. This lesion is characterized by rupture of ves-
sels and an extravasation of blood or hemorrhagic exudate beneath

The Head and. Neck 67

the perichondrium of the conchal cartilage. It may occur on both
sides but it is more often confined to the internal one. Ordinarily
the fluid remains unchanged other than to clot but it may suppurate.
If it undergoes resorption, which it is very slow to do, the re-
sultant cicatrization usually causes considerable shriveling and de-
formity. A spontaneous cure is rare.

Its origin is always traumatic, in most cases resulting from
the shaking and scratching provoked by otitis or conchal ulceration,
but it may also be caused by bites, or bruises.

Symptoms and Dtagnosis. The affected ear-flap exhibits a
characteristic bulging generally confined to the inner side but some-
times involving both. When of recent origin, the swelling is hot,
tense, and sensitive, and the head is depressed towards the affected
side. When of long-standing, it is insensitive, devoid of inflamma-
tory phenomena, somewhat indurated at its borders, and fluctuates.

Treatment. The indications are to evacuate the fluid and as
speedily as possible promote reunion between the separated peri-
chondrium and its subjacent cartilage. The latter step is accom-
plished by mechanical or chemical means. Simple lancing and with-
drawal of the fluid is ineffectual, for the sac continues to refill
for a lengthened period as often as it is emptied, and the longer
the healing process is protracted the greater is the resultant deform-
ity of the parts.

The most satisfactory results are obtained by the following
procedure: Evacuate the fluid by incision at the most dependent
portion of the flap. Then, after the manner first suggested by Mc-
Queen, pass interrupted radiat-
ing sutures through all the tis-
sues of the flap at intervals of
about one-third of an_ inch,
throughout the cystic area, tying
the knots on the surface where
the flap is free from hair. On
each succeeding day examine the
flap and squeeze out any little
fluid which may have accumu-
lated, through the original in-
cision. Remove the sutures in oF
the course of a week. In some No. 16. ope for Hematoma of the male

68 Surgical Diseases and Surgery of the Dog

cases a protective cap will be found expedient but usually the shaking
ceases as soon as the irritation which provokes it is allayed, and no
further bruising occurs.

Another method for promoting reunion of the tissues is to
inject a strong solution of iodine (iodine 1 part, potassium iodide 2
parts, alcohol 16 parts) after the exudate has been evacuated, but
it is neither as certain nor as speedy as the preceding one.

AMPUTATION OF THE CONCHA.

Under the term “cropping” this operation is extensively per-
formed on this continent for cosmetic purposes, or in other words,
to improve the appearance of the animal. Fashion, led by the
fanciers, regards the Great Dane, the Bull Terrier, the Boston
Terrier, the Black-and-tan Terrier, and certain French toy breeds as
fit subjects for improvement, and while such an operation cannot be
regarded as strictly legitimate surgery, yet it is described here so that
the practitioner may become conversant with the technic in order
that he may fit himself for undertaking it if he so elects.

Amputation is also indicated when the flap has suffered irre-
mediable laceration and in intractable ulceration of the concha, in
which case both ears should of course be fashioned as artistically as
practicable.

Various designs of clamps have been invented to facilitate the
operation and they are useful to employ as “markers,” so that both
flaps may be evenly cut, but there is none wholly satisfactory, for
the reason that it is impossible to construct a clamp of such shape
as to include in its grasp at one time all the parts to be removed.
One of my own design is figured in the accompanying illustration.

The Great Dane “crop” is the simplest of all. It is what is
known as a “straight crop,” and the straight clamp is employed.
It is best done at the age of about three months. General anesthesia
may be employed, but as the operation is one which can be done
rapidly, morphine narcosis is sufficient.

The first step consists in juxtaposing the flaps above the head
and snipping them with scissors together at a spot which is to form
the superior extremity of the “crop.’’ This secures equal length to
either ear. The clamp is then adjusted on the concha or flap, the
outer edge of the upper end of the instrument corresponding to the
snip, the lower end being pressed close to the head so as to include

The Head and Neck . 69

as much of the burr or lobe as possible, and it is then screwed tight.
Quickly following, the blade of a scalpel is run along the outer
edge of the clamp, thereby severing
the projecting portion of the flap.
The clamp is then immediately re-
leased. A_ slight hemorrhage fol-
lows but this soon subsides. It is
usually necessary to trim slightly the
lower extremity of the cut border

{ MMS

No. 17. First step in amputation of the Concha. No. 18. Second step in amputation of the Concha.

\

with scissors. After the opposite ear has been similarly treated, the
operation is complete. During healing, however, the resultant scar
tissue forming at the wounded edge is very apt to cause the forma-
tion of kinks oftentimes sufficient to prevent proper erection of the
ears in after life. This must be guarded against by submitting the
ears to a “pulling” process, or in other words, tearing apart any too
freely contracting cicatrization. For this reason, no animal which has
undergone the operation should be dismissed by the practitioner until
complete regular healing has been established. It is generally a few
weeks, or until all soreness has departed, before the ears are held
fully erect.

70 Surgical Diseases and Surgery of the Dog

The correct “crop” for the Bull Terrier and Black-and-tan Ter-
rier differs considerably from that given to the Dane. It is a very
close “crop” the greater part of the lobe being removed, and the
flap being cut long and narrow. When properly done, this “crop”
gives to the animal a very alert and sharp appearance. It is best
done at the age of six to twelve months, 7. e., not until the flaps are
well developed.

Persons who are expert in cropping animals of these two
breeds rarely use clamps, depending rather upon their skill to pro-
duce an even result. As already stated, clamps cannot be applied
so as to render the completion of the operation possible at one step,
nevertheless it is wisest for the beginner to make use of them to
the extent that it is possible. A curved clamp is necessary in this
case, and general anesthesia should also be employed.

The flaps are first juxtaposed and snipped as in the preced-
ing case. |

The next step is to apply the curved clamp with its concave side
towards the portion to be excised, the outer edge of its upper end
corresponding to the snip, its lower including as much of the burr as
possible. The clamp being screwed tight, the projecting portion of
the flap is severed as already described, and the clamp is removed.
The burr must now be removed, and this is accomplished with scis-
sors by extending the section from the inferior extremity of the new
border. The other ear having received similar treatment the first
part of the operation is complete. The after-treatment is no less
important than the actual cutting process. A “crop” of this nature
can rarely be depended upon to heal as is desired, 7, e., with certainty
that it will stand properly erect, without some sort of support being
afforded during cicatrization, for the reason that kinks are apt to
form at the wounded border if the flap is allowed to hang over.
Hence, it is necessary to provide some sort of splint. The best
device to meet this exigency consists of a strip of stout paste-board
shaped somewhat larger than the modified flap. Two such pieces
being prepared, holes are bored in them near either end and short
lengths of twine or tape are passed through these and fastened by
tying. This splint should not be applied until a few days succeed-
ing the operation or until all hemorrhage has subsided. It is then
smeared on its side opposite to that from which the tapes project,
with ordinary carpenter’s glue, and fitted and pressed firmly against

The Head and Neck 71

the hairy or outer side of the flap until the glue hardens and firm
adhesion is obtained. The two modified flaps are then raised into

position by tying together
the opposite tapes of each
splint. The erect position.
is thereby secured and
should be so maintained
until healing of the border
has fully taken place, the
splints being renewed if
necessary. The splints can
then easily be removed by
“peeling” them from the
flap, as, in the meantime,
the hair in growing, has
forced the glue away from
the skin. Some animals
will not fully erect the ears
until a few weeks have
elapsed. The Boston Ter-
rier is given a “crop” very

No. 19. Amputation of the Concha. Splints in
position.

similar to that just described but the

flap is cut somewhat shorter and sharper.

CHAPTER III

The Head and Neck—Continued

The Lips, Mouth, Tongue and Jaws
EXAMINATION. |

In docile animals examination of the buccal cavity is easily ac-
complished. The best way to expose all parts of the mouth is to
assume position facing the animal, place the fingers of the left hand
over the upper jaw, and extending the thumb, direct its extremity
on to the palate through the interdental space immediately posterior
to the canine tooth. This causes the animal to open its jaws, and
the right hand is then employed to raise or depress the lips or
tongue, as desired.

By another method the upper lips are pressed in between the
molars and the lower jaw gently forced apart by pressure over the
lower incisors.

In vicious animals the procedure may be rendered safe by
previous hypodermic narcotization with morphine.

IMMOBILIZATION OF THE JAWS WITH THE SPECULUM.

For protracted examination and some operations it is necessary
to secure immobilization of the jaws by application of some form of
speculum.

The simplest of the various devices in use is the well-known im-
provised gag of Bourrel.
A stick of wood somewhat
longer than the width of
the jaws is selected and to
either end a tape or cord is
fastened. The stick is
placed transversely be-
tween the molars, close to
the commissures, and held
in position by tying the

No. 21. Examination of the Buccal cavity.

The Head and Neck 73

tape or cord back of the poll. An additional tape or cord is then tied
round the muzzle back of the stick to prevent the jaws opening any
further. Of the manufactured articles my own device meets all re-
quirements. It is constructed on the same principle as the Wingrave
mouthgag used in human surgery. It is very light and strong, can

No. 22. French Mouth Speculum. No. 23. Baker Mouth Speculum.

be adjusted to fit any sized mouth and is self-expanding. Another
good instrument is the Baker speculum. One invented by Hobday
consists of spreading horizontal bars supported by perpendicular
bars which are secured immediately behind the canine teeth, but
it necessarily obstructs lateral passage of instruments and fingers of
the operator, and is too clumsy for small animals.

CONGENITAL MALFORMATIONS.

The young of the shortnosed breeds are occasionally born with
fissure of the upper lip—the so-called hare-lip. This deformity may
be unilateral or bilateral and may exist independently but is gener-
ally complicated with cleft palate.. It exists by virtue of incomplete
fetal coalescence of the parts. It does not occur in the median line
5ut always to one side by reason of the central part of the upper

74 Surgical Diseases and Surgery of the Dog

lip being developed from a different center from that forming the
outer part of the upper lip. Cleft palate forms a communicating
channel with the nasal cavities so that portions of alimentary mat-
ter pass out by the nose. Affected animals in which this occurs
suffer emaciation and usually succumb within a few days after birth.
In animals that manage to imbibe nourishment there is opportunity
for the giving of surgical relief at a later stage.

Treatment. Hare-lip may be successfully remedied at any
age. - The position of the canine teeth must be noted and if by
reason of their prominence they offer any interference are to be ex-
tracted. Cocaine anesthesia is sufficient for the operation. The
edges of the deformity are “freshened” by cutting away a narrow
strip of tissue at their borders and the parts loosened from the sub-
jacent gum by appropriate dissection. The edges are then approx-
imated and secured by stout silk sutures. If the sutures are subse-
quently torn out by the animal they are to be replaced.

Cleft palate is relieved preferably under chloretone narcosis
along similar lines but the technic is a good deal more difficult.
Before the separated edges éan be approximated, the palate, which
Owing to its intimate connection with the bone is not extensible like
the lips, must be separated from the bone by blunt dissection a short
distance on each side of the edges, and incisions made parallel to
the latter on both sides at the outer extremity of the freed area. The
edges are then “freshened” and drawn together with interrupted
sutures, the gaping incisions being left to fill up by granulation.

TRAUMATIC LESIONS.

Wounds of every variety may occur in or about the mouth.
Bites by other dogs and penetration by foreign bodies are common
lesions.

Treatment. The ordinary methods of cleansing, suturing and
giving drainage are indicated.

STOMATITIS. GINGIVITIS. GLOSSITIS.

Inflammation of the buccal tissues may be diffuse or limited

to the gums (gingivitis), the tongue (glossitis), the palate, the
cheeks, etc.

Catarrhal and gangrenous forms are recognized, the latter be-

The Head and Neck 75

ing commonly designated “noma” or “canker.” The gangrenous
form may lead to fatal termination by production of septicemia.

The disease occurs as the result of local infection, probably
through invasion by ordinary pyogenic microorganisms which un-
der normal conditions inhabit the mouth in large numbers together
with other varieties which are entirely innocuous. But for these
microorganisms to produce pathologic lesions it is essential that
some favoring conditions should exist, and such conditions are
generally believed to be either a local or general reduction of vi-
tality and diminished resistance of the tissues of the organism, or
an increased virulence on the part of the microorganism.

Amongst the local conditions are irritation produced by the
prehension or administration of hot or caustic liquids, by trauma-
tism, by penetration of foreign bodies such as needles, bones, etc.,
by the constricting action of certain bodies such as threads, rub-
ber-bands, and annular objects mischievously placed on the tongue —
or accidentally prehended, by the presense of calcic incrustations on
the teeth, by carious teeth, and by neoplasms. Amongst the general
conditions are certain states of infection of the entire alimentary
tract such as gastro-enteritis, and toxemias such as distemper.

Symptoms and Diagnosis. Mandibular action is inhibited, the
mouth exhales an obnoxious odor, and saliva dribbles and hangs in
filaments. In the catarrhal form the mucosa exhibits all the char-
acteristic signs of inflammation and is often covered with greyish
sordes. In gingivitis the gums are dark red, swollen, bleeding and
separated from the teeth.

In glossitis the organ is considerably swollen and in ad-
vanced stages of constriction cases may be many times larger than
normal so that it protrudes from the mouth and impedes respiration.
In the gangrenous form of stomatitis, the gums, internal face of
the lips and cheeks, and sometimes the entire buccal mucosa and
even the cuticular border of the lips are studded with fetid, grey-
ish necrotic patches, or round or oval ulcers. In gangrenous glos-
sitis the lesion is partial, being distinctly demarked and confined to
the tip and edges, the diseased portion being cold and of brown-
ish black color.

Treatment. In inflammation due to local conditions the indi-
cations are to remove the provocative agent and disinfect the mouth,
preferably with permanganate of potash solution (2:100). Atten-

76 Surgical Diseases and Surgery of the Dog

tion must also be paid to alimentation when the animal refuses to
eat. When the tongue is much tumefied the swelling may be modi-
fied by light scarification of the organ. The incisions are made on
the inferior surface, the operator being careful not to incise
too deeply.

Gangrenous inflammation demands energetic treatment. The
sloughing tissue must be removed with forceps and scissors and
the entire diseased surface gently cauterized and subsequently treat-
ed with disinfectant solutions. Gangrene of the tongue is treated
by amputation of the diseased portion, but conservatism should
always be observed when surgical interference of this organ is
contemplated.

PARTIAL AMPUTATION OF THE TONGUE.

For this operation scissors and wire ecraseur are employed.
The animal being anesthetized and its jaws immobilized with a
speculum, proceed as follows: Depress the muzzle in order to avoid
entrance of blood into the air passages. Insert two ligatures in the
healthy tissue, one on each side of the median line, by which draw
the tongue forward. If necessary, separate the diseased part from
the floor of the mouth by dividing the frenum with scissors. Pass a
couple of straight needles or pins through the organ at the proposed
line of section and apply the loop of the ecraseur behind these. The
needles or pins will suffice to keep the loop in the desired position.
Then remove the affected part by tightening the wire. Should any
hemorrhage supervene, control it by seizing the stump with fixation
forceps and draw it far forward which stretches the lingual ar-
teries, or ligate the latter. Another method is to use only broad-
bladed scissors with a.dull edge.

It must not be forgotten that an animal which has been de-
prived of the greater part of its tongue will have difficulty in drink-
ing, and must thereafter be allowed to quench its thirst from a run-
ning spigot above the level of its head.

FOREIGN BODIES.

These consist principally of fragments of animal or fish bones,
pieces of wood, skewers, fish hooks, pins, needles, or other hard sub-
stances, which are usually accidentally prehended with the food.

The Head and Neck 77

They may become wedged in between the teeth or perforate the
soft tissues. Youngs treated a case in which he found a splinter
of wood lodged between the upper gums behind the incisors, and
observed also a small wound on the left side of the frenum. Later,
an abscess formed in the throat and burst, and this led to the dis-
covery of another piece of wood which had penetrated the tissues
from the mouth and had lodged in the subcutaneous tissue slightly to
the right of the trachea. Annular bodies, rubber bands, or threads
may encircle the tongue, the ends of threads extending into the
esophagus. Servais recorded a remarkable case of constriction of
the base of the tongue by an annular portion of the aorta of a cow,
which had slipped over the tongue while the animal was feeding and
had become worked back by muscular movements of the organ. In
districts where porcupines abound, it is not uncommon for dogs, in
attacking these creatures, to receive a mouthful of quills. The
latter make a very awkward foreign body as it is hopeless to ex-
tract them without causing extensive laceration. When they pene-
trate out of sight, they usually work their way through the skin in
course of time and cause considerable pain in so doing.

Symptoms and Diagnosis. The presence of foreign bodies in
the mouth may be recognized by the persistent attempts of the ani-
mal to rid itself of the offending object by pawing at the mouth
and shaking the head. The jaws are champed or held open and
immobile, and saliva dribbles from the mouth. The presence of pins
and needles does not always give rise to indicative symptoms. They
may penetrate the base of the tongue so deeply as to be invisible and
only discovered by digital exploration, or they may gradually work
their way through neighboring tissues and ultimately find exit at
some other part of the body.

In Servais’s case of constriction of the tongue the latter was
enormously swollen and gangrenous.

Treatment. Substances wedged in between the teeth are re-
moved without much difficulty with suitable forceps or they may
be displaced by drawing a piece of silk or catgut to and fro in the
interdental space. Needles and pins lodged in the tongue are ex-
tracted with forceps. The tongue should be firmly grasped and
drawn well forward to permit of more easy removal. If the point
of the needle has penetrated in an anterior direction, the visible por-
tion is seized with forceps and extracted by traction in the opposite
direction. Bodies lodged in the cheeks may be removed by exter-

78 Surgical Diseases and Surgery of the Dog

nal incision if considered advisable. Porcupine quills must be
pushed forward through the cheeks, or left to emerge.

NEOPLASMS.

Both innocent and malignant growths occur in the mucosa and
submucosa and in the subjacent tissues of the buccal cavity. The
former class comprises the wart-like papillomata, fibroma or so-
called benign epulis, the buccal and salivary retention-cysts or so-
called ranula, and osteoma of the jaw. The malignant growths con-
sist of epithelioma and sarcoma or so-called malignant epulis. The
term epulis literallly means “situated on the gums,” and as it
possesses no pathologic signification and is equally applicable to one
form. of growth as to another, should be excluded from nomen-
clature.

The Papillomata occur fairly commonly in young animals
and are undoubtedly contagious or infectious in character (see
Chapter on Neoplasms, Papillomata). .

Symptoms and Diagnosis. They are observed as small, isolat-
ed or confluent, pedunculate or sessile, whitish, dendritic, multiple
growths, springing from the mucosa and situated on the inner aspect
of the cheeks and lips, on the gums, and sometimes on the tongue
and hard palate.. When numerous they interfere with mastication
and induce a buccal secretion of foul odor.

Treatment. This disorder does not actually require any treat-
ment, as after remaining in evidence for a few weeks the growths
disappear as spontaneously as they arise. To hasten their removal,
the larger ones and confluent masses may be removed with curved
scissors. The mouth should be swabbed out daily with deoderant
solutions, a solution of permanganate of potash (2:100) answering
the purpose.

Fibroma. This form of tumor is a hyperplasia of connective
tissue elements which may be a pure fibrous growth or of mixed
character, containing cartilaginous matter and spiculae of bone. It
has its origin either in the submucous tissue or the periosteum of the
maxilla. It occurs as a single growth and is not very common.

Symptoms and Diagnosis. It grows at the edge of the gums
as a firm reddish enlargement varying in size from a pea to a hazel-
nut. Its usual position is the neighborhood of the incisors and it
may occupy the entire area between the two canines. Its evolution

No. 24. Papillomata of the Buccal Mucosa.

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The Head and Neck 79

is slow and it may remain quiescent for months. This feature serves
to distinguish it from the malignant sarcoma of the periosteum.

Treatment. ‘The tumor must be freely excised and the wound
cauterized with the thermo-cautery.

Ranula. Retention-Cyst. The term Ranula is generally ap-
plied to all cystoid formations appearing in the buccal cavity. The
designation is inappropriate and should not be employed in medical
or surgical nomenclature. The correct term to employ is RETEN-
TION-CysT and the particular organ or issue concerned should
at the same time be specified. Thus, there may be a retention-cyst
of Wharton’s duct, through cohesion of its margin, or the cyst
may be brought about by destruction and dilation of sublingual
buccal glands. The latter form is the more common. By augmen-
tation, such cysts may burrow into the neck and have for their
external limitation the dermis.

Symptoms and Diagnosis. When the cyst appears in the
buccal cavity, one or perhaps two or three swellings are observed
adherent to the floor of the mouth on either side of the frenum.
The tongue is seen to be raised somewhat and displaced to one side.
The swellings may vary in size and shape, being sometimes cylindri-
cal, at other times round or oval, and may attain the size of a hen
or goose egg. The surface is glairy and slippery and in some cases
so translucent as to render the greyish or reddish-yellow, more or
less viscid contents plainly visible.

When the cyst burrows down the neck the formation is charac-
terized by its subcutaneous position in the submaxillary region or
at the superior extremity of the neck, the mobility of the skin over
the cyst, the viscid fluctuating contents, seemingly hard capsule, and
entire absence of inflammation. These cysts grow slowly and de-
velop without apparent cause. They need not be mistaken for any
other condition, excepting perhaps hematomata, but the latter de-
velop quickly and have a history of traumatism, and the skin is
usually adherent to them. A positive diagnosis can always be made
with the aspirator, the thick viscid contents of the reténtion-cyst not
being extractable with a needle of ordinary caliber.

Treatment. Operative measures are followed with good results.
The operator must seek to accomplish the complete excision or des-
truction of the cyst wall, and not merely lance and evacuate the
contents. Unless the entire capsule is destroyed, secretion will con-

80 Surgical Diseases and S urgery of the Dog

tinue and the cyst be reformed or a fistula established. While the
latter condition is of little importance when the orifice of discharge
is situated within the buccal cavity, it is a different matter when
the tract opens externally after an external operation.

Small and medium-sized cysts are not difficult to extirpate and
the sooner they are attended to the better. They should be seized
with forceps, incised throughout their entire length, and the lining
membrane dissected out or destroyed with the thermo-cautery, the
jaws being immobilized with the mouth speculum. Quite large cysts
may in like manner be totally extirpated, but the operation is some-
times rendered very difficult owing to extensive burrowing which
may extend behind the esophagus and larynx. In these cases
Froehner recommends the establishment of a suppurative inflamma-
tion within the sac to accomplish the destruction of the secreting
membrane. This may be done by injections of strong solutions of
iodine, as follows: Insert an aspirating needle and withdraw the
mucoid contents. The needle need not be aseptic, as the en-
trance of pyogenic microorganisms is desired, and it should be of
large caliber to permit of passage of the tenacious contents. In
some cases the latter can only be extracted by lancing the sac. Then
inject an equal quantity of an alcoholic solution of iodine (2:100—
5:100) until the cyst resumes its original size. Local pain and fever
will soon be evident. In two or three days’ time again employ the
aspirator to ascertain the presence or absence of pus. Should sup-
puration have failed to develop, repeat the injection again and
again, if necessary at intervals of three or four days. As soon as the
desired effect is produced freely lance the abscess to evacuate the
pus, and introduce a tampon of antiseptic absorbent cotton to stim-
ulate healthy granulations. Recovery is generally complete in from
three to six weeks.

Osteoma. Exostoses or osseous tumors occasionally arise on
the jaw bone as a result of diffuse inflammation of the periosteum
caused by external violence.

Symptoms and Diagnosis. These growths are characterized by
excessive hardness and their attachment to the bone by a broad
base. They are differentiated from malignant tumors by their
local character.

Treatment. Removal is effected by exposing the growth by
neision through the skin and then using a chisel.

No. 27. (After Cadiot and Breton). Hpithelioma
of the Lip with secondary lymphatic enlargement.

The Head and Neck SI

Epitheliomata. This malignant form of neoplasm occurs only
in animals of advanced age, growing at the inner edge of the lip,
usually the lower one.

Symptoms and Diagnosis. The tumor is observed at the outset
as a small flat growth, which later progressively ulcerates. The
ulcer has a raw, granulating appearance, or it may be hidden by a
thin scab. In some cases it is mammillated. It gradually increases
in size and may invade the entire lip or extend to the maxilla.
Secondary enlargements of the cervical and submaxillary lymphatic
glands generally develop. Differentiation from labial ulcers is not
difficult.

Treatment. Total excision must be practised. When the tumor
is small it is removed by A-shaped section through the entire
thickness of the lip the base corresponding to the free border of the
lip. The edges of the wound are then brought together with
interrupted sutures carried completely through all the component
textures. When the growth is extensive, the autoplastic operation
of Syme should be undertaken. Syme’s operation consists in pro-
longing the A-shaped incisions to form an X and continuing them
in an oblique direction downwards. The two quadrilateral sections
of skin’thus formed are separated from the subjacent tissues by
dissection and made to pivot on their base, and are then united by
sutures, the margin of each portion becoming the free border of the
lip. The operation is completed by stitching the mucosa to the skin.
The two small triangular spaces gradually fill in by granulation.

When the lymphatics are only slightly involved they should also
be ablated, but when they are extensively involved operative meas-
ures are contraindicated.

Sarcoma. This is, properly speaking, a tumor of the maxilla,
as it originates either in the periosteum, the medulla, or the en-
dosteum, but as it encroaches on the buccal cavity, it will be con-
sidered here. It is observed more often in the upper jaw than in
the lower. It may attain great dimensions and tends to rapidly in-
vade neighboring parts, such as the nasal chambers, the orbits, and
even the cranium. It often recurs after ablation but is not very
metastatic to the neighboring lymphatic glands, though it some-
times undergoes generalization.

Symptoms and Diagnosis. This neoplasm is frequently over-
looked in the earlier stages particularly when situated on the inner

7

82 Surgical Diseases and Surgery of the Dog

aspect of the jaw. As a rule, it is first noticed when it has attained
the size of a nut or small apple and by the animal exhibiting diffi-
culty in the act of prehension. The growth is insensitive and of a
pinkish or reddish tint, the size varying according to the stage of
development and the breed of dog affected. Its surface is irregular,
knotty, or lobulated, and covered with intact mucous membrane.
It is generally sessile with broad base and immobile from the sur-
rounding textures, but may be pedunculate. Contrasted with other
sarcomata its consistence is firm. In most cases but one rapidly-
growing tumor is present; at other times several may be seen with
confluent base. It may develop to such extent as to cause separation
of the lips. The adjoining teeth are hidden or forced out of their
sockets by upheaval.

Treatment. The entire growth should be excised as soon as
possible by means of a strong pair of short-bladed scissors or bone
forceps and the wound thoroughly cauterized to assist in the elimina-
tion of the morbid cells as well as to arrest the attendant hemorrhage.
It may be found necessary to remove one or more teeth. It is better
to remove too much tissue than too little in dealing with sarcoma.
Very large tumors require the use of hammer and chisel, and sub-
sequently the curette to effect their removal from the bone. During
the operation, which must be done under anesthesia, the muzzle
should be depressed to guard against escape of blood into the
trachea.

-Rizzieri recorded having treated and completely cured a case
in which the growth had invaded the whole of the right face, ex-
tending from the inner angle of the orbit to the lips. Cadiot and
Almy claimed a definite cure after a second operation in which deep
excision, curettage of suspected points, and cauterization were

practiced.

. BIBLIOGRAPHY.

Cadiot & Almy—Traité de Therap. Chir. des Anim. Domest.
Mégnin—Rec. de Méd Vétér. 1873, p. 639.

Rizzieri—Clin. veter. May, 1891.

Servais—Ann. de. Méd. Vétér. 1893, p. 84.

Youngs—Vet. Record. 1900, p. 423.

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The Head and Neck 83
The Teeth

STRUCTURE, DISPOSITION, and DEVELOPMENT.

In the typical mouth there are twenty permanent teeth in the
upper jaw and twenty-two in the lower.

The structure of the incisors is noticeable for the arrangement
of three cusps of which the central is the largest. The four inner
incisors of both jaws have these well developed, but in the corner
incisors the middle cusp is very large and the lateral ones rudi-
mentary or absent. The base of the crown on the inner aspect is
marked by a ledge which is extended to each cusp as a ridge or
cingulum.

The canines are large and firmly and deeply embedded in the
maxillary bone immediately behind the maxillo-premaxillary suture.
Their pulp cavity is capacious and extends almost the entire length
of the tooth.

Posterior to the canines are four teeth which were designated
by Owen as premolars, owing to deciduous or milk teeth being dis-
placed by them. As a matter of fact, the first of this group, count-
ing from before backward, has more the character of a true molar,
it having only a germinal deciduous predecessor, which seldom be-
comes calcified and generally disappears before birth, after being
transitorily manifested in the papillary stage. It is the smallest of
the four and has a single root and well-defined neck. The second
and third premolars resemble one another closely, are considerably
larger than the first, and possess two roots, of which the posterior
is the larger. The three anterior premolars are not in as close con-
tact as the posterior teeth, being separated by slight intervals. The
fourth premolar is the largest and strongest of the premolar series.
It is known as the superior sectorial. It is implanted by three roots,
two external and one internal. The crown is composed of two main
lobes supported by the external roots and a small one supported by
the internal root. The premolars of the lower jaw are similarly
arranged with the exception of the fourth which corresponds in po-
sition, approximate size, and number of roots, to the third premolar
of the upper jaw.

The true molars of the upper jaw are two in number and
are situated behind the premolars. They are permanent from the
the outset and do not displace milk teeth. They possess three roots,

84 Surgical Diseases and Surgery of the Dog

two external and one internal, each supporting a tubercle. The first
true molar of the lower jaw is the sectorial of that series and is the
largest tooth in the entire mouth. It possesses two firmly implanted
roots. This tooth opposes the fourth premolar of the upper jaw ina
scissor-like manner. When the dog wishes to divide tough meat or
bones he passes them back to these teeth and makes a shearing
movement by several short quick strokes of the jaw. The remain-
ing two true molars are quite small. The second is two-rooted but
the last possesses only one root.

The period at which both deciduous and permanent teeth are
erupted varies in different races and the sexes. In the larger breeds
and in females they appear somewhat earlier than amongst the
smaller animals and males. At birth the gums are smooth. Towards
the end of the third week the deciduous canines make their appear-
ance, about the twenty-fifth day the corner incisors, about the
twenty-eighth day the middle incisors, and about the thirtieth day
the pincers, The superior temporary incisors are cut before the
inferior.

At two months the permanent inferior pincers are seen to
pierce the gum, and by the fifth month all the permanent incisors
are up and in wear. The permanent canines are cut between the fifth
and sixth months. At the end of the sixth or seventh week the
second, third, and fourth premolars are in place, and between
the fourth and sixth months they give way to their permanent
successors. The first molar is erupted at about the sixth month and
the second during the seventh month. The first premolar appears
between the fourth and fifth months. Between the sixth and
eighth months the dog has acquired a full set of permanent teeth.

During the first few years of life the age may be approximately
gauged by the appearance of the four inner incisors of both jaws,
the lateral cusps of which gradually disappear. These changes can-
not, however, be absolutely relied upon since the extent to which
they take place depends more or less on the wear occasioned by the
animal’s food, and the health of the organs themselves. After the
first year the middle cusps begin to wear even with the lateral from
the two central incisors of the lower jaw. The same change takes
place in the two adjoining teeth in the following year. After the
third year the cusps are lost in the two central incisors of the upper
jaw, and their two neighbors undergo the same change after the
fourth year.

The Head and Neck 85

As the animal ages the prominences of the molars are worn
away, only the largest tubercles remaining. The posterior face of the
lower canine impinges against and abrades the anterior face of the
upper, in front of which it closes. The anterior face of the lower
canine also comes in contact with the corner incisor and an abrasion
takes place at this point. The older the animal the more apparent
are these abrasions. The crowns of the incisors become much re-
duced in size in aged animals, mere stumps remaining after eight
or ten years, while they are completely worn away after ten or
twelve years, or the whole tooth may be shed, together with the
first premolar. Gradual discoloration takes place in late years.

CONGENITAL MALFORMATIONS.

Certain breeds possess defective atypical dentition. This pecu-
liarity was referred to by Darwin and Magitot. The breeds invari-
ably having imperfect dentition are the Chinese, Turkish, and Mex-
ican Hairless. The phenomenon is not to be wondered at when it
is remembered that the teeth and dermis have a common epiblastic
origin. Individual members of the Mexican breed examined by
Waugh were found to have the tricuspid arrangement of the in-
cisors wanting, absence of the canines, and slower and later develop-
ment of the molars than other breeds. Half-breeds had canines
in the upper or lower jaw but not in both jaws. In several members
of both sexes of this breed that I have had the opportunity to ex-
amine I have found the arrangement generally as follows: In the
upper jaw there is a reduced number of rudimentary or fairly well-
developed incisors, but without the cuspid arrangement. Well-de-
veloped canines are in evidence, and on either side well-developed
first premolars and first molars, the animals being thus minus the
superior sectorials. In the lower jaw the incisors are developed
in about the same degree as those of the upper, but the canines
are less constant and sometimes entirely absent. Premolars are also
inconstant but first and second molars are often present showing
the inferior sectorials to be intact. When the molars have no teeth
to oppose them they may cause the formation of indentations in the
opposite jaws. As is natural to expect, these animals do not care to
eat hard foods, but prefer slops and soft bread and cakes. Meat can
only be swallowed if cut fine, as they are without the ability to re-
duce the size of tough or hard articles of diet, which dogs with nor-

86 Surgical Diseases and Surgery of the Dog

mal mouths accomplish by the scissor-like movements of their
sectorials.

In all breeds the deciduous teeth sometimes persist, while su-
pernumerary teeth, usually molars, are not uncommon. As a rule,
the larger breeds have a full complement of teeth, while the smaller
ones often lack the third molar of the lower jaw.

The teeth may occupy anomalous positions. Distortion of the
bones of the skull may throw the opposing jaws out of their proper
relationship so that the teeth cannot meet. An instance of such
deformity was witnessed by Gurlt.

Dentigerous Cysts. Through inclusion of epiblastic tissue dur-
ing fetal development teeth may occupy obscure positions. These
sequestered teeth have been found in the ovaries but their occur-
rence is perhaps more common in the temporal region, where they
give rise to cystic formation. Instances have been observed by
Werwey and Cadiot and Almy. Such cysts ordinarily remain quies-
cent but if pyogenic microorganisms gain entrance into their interior
inflammation takes place and a fistula results having its orifice of
discharge within the auditory canal. Its presence is first made
known by the appearance during the early months of life, particularly
about the period of dentition, of a soft, insensitive, hemispherical
tumor, which may persist as such or become fistulous.

Treatment. The proper treatment is complete extirpation of
the cyst as it is liable to return if any portion of the wall is allowed
to remain. If a tooth is found present it should be extracted. In
Cadiot and Almy’s case simple extraction of the tooth was all that
was necessary and healing was complete within a month.

TRAUMATIC LESIONS.

Fracture with exposure of-the pulp sometimes occurs in a me-
chanical way, being generally sustained during a fight or from at-
tempted extraction by inexperienced hands. Darwin has remarked
that wild carnivora kept in cages frequently sustain fracture of the
teeth through their habit of seizing the bars, and so we find to be
the case in dogs under similar conditions. Dogs in jumping over
iron fences sometimes get caught in the railing or are impaled, and
in their attempts to break loose, tear at the iron with their teeth,
and thus sustain fracture. Some animals have naturally brittle teeth
which are fractured with very little force, while others suffer from

The Head and Neck 87

erosion of the enamel in an unaccountable manner, particularly dur-
ing a severe attack of Distemper.

Treatment. Fractured teeth where there is evident pain from
exposure of the pulp cavity, should be extracted or filled.

INCRUSTATIONS OF TARTAR.

Incrustations of tartar occur very commonly, especially in city
dogs. Chemically, tartar consists of calcium and magnesium car-
bonate, calcium phospate, and some organic substances, and is re-
garded as a precipitation of these salts from their soluble condition
in the saliva by the action of certain microorganisms. The latter
have been isolated by Galippe and cultivated by Vignal.

The effect of tartar on the neighboring tissues is purely an irri-
tative one. By constant accretion, the deposit gradually works its
way in between the neck of the tooth and the wall of the alveolar
cavity, so that the tooth becomes loosened and may eventually drop
out. Should these accretions continue to extend, the peridental mem
brane (alveolar periosteum) becomes involved, when a far more
severe condition exists, viz., Calcic Pericementitis.

A brief reference here to the popular notion that the gnawing
of bones serves to “keep the teeth clean” will not be out of place.
This is surely a misconception, since tartar collects round the roots
of the teeth where any rubbing process of bone on tooth can scarce-
ly take place. On the other hand, bone-eaters are notoriously prone
to suffer from worn teeth, not to speak of other internal disorders
engendered by splinters and fragments of bone. Hence, bone can
hardly be regarded as a suitable diet for the dog.

Symptoms and Diagnosis. In the early stages tartar is observed
on the teeth as a yellowish or greenish-brown deposit. The seat of
the deposit is usually the base of the external face, but the whole
crown may be encircled. When it has invaded the alveolar cavity
the gums assume a more or less livid color and evince tenderness to
the touch. At the same time a foul odor is emitted from the mouth.

Treatment. Calcic incrustations are removed by the operation
of Scaling.

CALCIC PERICEMENTITIS.
This term is applied to inflammation of the peridental mem-
brane dependent upon deposits of tartar, sometimes described as

88 Surgical Diseases and S urgery of the Dog

alveolar periostitis. It usually affects a number of teeth, old dogs
sometimes losing almost the entire set. The calcic deposit leads to
ulceration of the peridental membrane and exposure of the neck of
the tooth. The membrane is gradually detached from the root of
the tooth, the border of the alveolar wall is absorbed, and the
inflammatory process finally leads to separation of the tooth from its
socket. This condition is often accompanied with ulcerative stoma-
titis. Galippe regards it as an infectious disease.

Symptoms and Diagnosis. The gum recedes, becomes livid and
swollen, and bleeds easily to the touch. There is a purulent dis-
charge from the alveoli (Pyorrhea alveolaris) accompanied by a
foul, penetrating odor. Saliva flows freely, and the animal shows
no disposition to partake of food.

Treatment. Extraction of all affected teeth is indicatea with
ample daily disinfection of the parts, preferably with solution of
permanganate of potash (2:100).

ALVEOLAR ABSCESS AND MAXILLARY FISTULA.

Reference has been made to the suppurative process (Pyorrhea
alveolaris) occurring in connection with inflammation of the peri-
dental membrane owing to calcic incrustations, and which is mani-
fested by purulent discharge at the edge of the alveolar cavity. Sup-
puration of the alveolar tissues may also have its inception on the
side of the root of a tooth as the result of injury, complicated
wounds, or fractures, or it may originate in the apical space inde-
pendent of any disease of the external parts, the tooth remaining
perfectly sound. A sudden jar sustained by the tooth in crunching
bones and animal membranes may result in injury to the nerve at the
apical space, to be followed by suppuration and subsequent death
of the pulp. The fourth premolar, which is the sectorial or
masticatory organ in the dog, is the tooth usually affected.

The disease is characterized by burrowing of pus, which may
either follow the peridental membrane down the side of the root
and find discharge at the margin of the gum or it may set up an
inflammation by fistulous tract either through the gums into the
mouth or externally on the face to form a maxillary fistula. The
last named condition usually takes place in the upper jaw near
the lower eyelid, the exact position varying according to the con-
formation of the head. According to Reul, the condition may be

The Head and Neck 89

bilateral through sympathy and may give rise to a symptomatic ca-
tarrhal inflammation of the nasal passages through contiguity of
tissue. The sympathetic
hypothesis is very doubt-
ful.

Symptoms and Diag-
nosis. A fistula existing
in the position mentioned,
should be probed. The
affected tooth can gener-
ally be determined in this
manner. The tooth may
or may not be painful to No. 30. Maxillary fistula.
percussion. Maxillary fis-
tula must be carefully differentiated from Lachrymal fistula. An
animal suffering from the former disease masticates with difficulty
and prefers a semi-solid or liquid diet. In some cases the progress
of the disease is accompanied with much emaciation.

Treatment. The tooth belonging to the affected alveolus must
be removed, and the fistulous tract irrigated. Recovery is usually
quick to ensue.

CARIES.

True decay of the teeth with molecular disintegration of the
constituent dental tissues, from which mankind so conspicuously suf-
fers, is exceedingly rare in the dog. It has been observed by Baume
Moeller, and Hoffman. The disintegration always commences on
the surface of the tooth, generally in some pit or crevice in the
enamel or at the neck, where protection from the movements of the
tongue as well as from the friction produced by the gnawing of hard
foodstuffs, bones, etc., favors the lodgment of alimentary particles
The degenerative process having commenced (the spot may or may
not be marked by a dark color) it spreads towards the interior of the
tooth, and the dentine being more susceptible to its action than the
enamel, a cavity is formed whose interior is larger than its orifice.
This disease must not be confounded with pericementitis which is
very common.

The observations of Miller have established the fact that the
degenerative process is due to a direct chemical cause, food par-

ere) Surgical Diseases and Surgery of the Dog

ticles undergoing fermentation through the agency of felt-like masses
of microorganisms and resulting in the formation of lactic acid.
The formation of the acid is dependent on the splitting-up of sugar,
the organized or digestive ferment of these microorganisms acting
upon cane-sugar in a manner identical with that exhibited by the un-
organized ferment of the yeast plant, by converting it into levulose
and dextrose and producing the acid as a waste-product. The rela-
tive immunity of the dog to this disease may be attributed to the
well known inactivity of his parotid saliva and the feeble capacity of
the submaxillary. It will be remembered that in the human mouth
the ptyalin of the saliva is very active in the conversion of starch
into fermentable sugar, thus producing an ample supply of the
pabulum necessary to sustain the fermentative potentiality of the
microorganisms. But as these conditions do not exist in the dog’s
mouth the amount of fermentable sugars present is infinitesimal, and
in the absence of sugars the microorganism is powerless to effect a
decaying influence. Miller found that the particular microorganism
is capable of growing in bouillon free from the presence of sugar,
but without the production of acid. This experiment was confirmed
by Sewill, who found, while making certain experiments in the arti-
ficial production of caries, that sound teeth immersed in a mixture
of meat and saliva remained alkaline, and even if small quantities
of acid were added, rapidly returned to alkalinity. Albumen as
white of egg or other form, was acted upon in the same manner.

Caries does sometimes result from a bountiful diet of sweet-
meats.

Symptoms and Diagnosis. This disease gives rise to sharp pain
manifested by cries, depression of the head towards the affected
side, and indisposition to eat. The characteristic cavity should then
be sought for by careful examination of every tooth.

Treatment. Ordinarily, carious teeth are extracted, but there
is no reason why the disease process should not be arrested by the
methods in vogue in human dentistry, when the owner so desires.
In this event the services of a competent dentist should be secured,
the animal being controlled with anesthetics by the attending veter-
inarian during the operation.

SCALING.

Removal of tartar is effected with the spring-tempered scaling

The Head and N eck gI

chisel commonly used by dentists, the point of which should be
kept sharp. It should be used with a pushing motion preferably in a

No. 31. Scaling chisel.

direction away from the gum, but the opposite direction may be
necessary to reach out-of-the-way places hidden by the gum. The
removal process must be thorough, since any particle left remain-
ing, by acting as a nucleus, favors further accumulation. | What
cannot be removed with the instrument can be cleaned up with a
small piece of wood whittled to the shape of a chisel and dipped in
weak acid. The operation should be supplemented with free use of
some disinfectant solution, preferably permanganate of potash
(2:100). The latter is easily applied by saturating a small piece of
absorbent cotton, holding it by hemostatic forceps, and swabbing
the parts.

In most animals, if patience and tact are observed, the operation
can be completed without muzzling or other means of control. In-
tractable animals should be narcotized. Dogs of small size are best
held in the lap during the operation.

After removal of deposits, the importance of maintaining the
teeth clean should be impressed on the owner, otherwise the con-
dition will soon be again in evidence. Some animals seem to be pre-
disposed to the affection and require to undergo periodic cleaning
in order to maintain the teeth intact. In these cases the daily use
of the permanganate is advisable.

EXTRACTION.

Single incisors or small molars may be extracted in most ani-
mals without recourse to anesthesia, but where several of the
smaller teeth are to be withdrawn it is well to narcotize with
morphine.

Firmly embedded canines or molars, particularly in large ani-
mals, should be extracted only with the animal under general anes-
thesia. The employment of a mouth speculum is usually necessary.

In extracting a tooth, it must be remembered that the operation
does not merely consist in “pulling” it, excepting where it has been

92 Surgical Diseases and Surgery of the Dog

already loosened in its socket. The tooth is grasped with the beaks
of the forceps, the latter being forced as far up the root as possible.
Incisors and other single-fanged teeth are loosened by application
of rotary motion (a half turn each way). Compound molars are
loosened by pressure inwards and outwards. In spite of the exer-
cise of due care, the roots are occasionally broken. This accident
need not cause anxiety as they are usually gradually forced out of
the socket by thickening of the peridental membrane occasioned by
the inflammation the extraction sets up. Their immediate removal
may be accomplished by employment of root forceps.

Hobday and Mosley, the latter a dental surgeon, have demon-
strated that false teeth may be successfully affixed to the jaws of
the dog, thereby enabling him to tear animal tissues.

BIBLIOGRAPHY.

Baume—Odontologische Forshungen Leipzig. 1882.

Darwin—The Origin of Species.

Galippe—Comptes rendus d. Scéanc. d. l’Académ. d. Sefienc. 116.
Gurlt—Cited by Kitt in Lehrb. d. Path. Anat. Diagnost. 1.

Hobday—Journ. of Comp. Path. & Therap. 10, p. 362.

Magitot—Traité d. Anom. d. Systéme Dentaire chez 1’Homme et 1. Mammiféres. Paris, 1877.
Miller—Independent Practitioner. Feb., March, May, 1884. May, June, 1885.
Moeller & Hoffman—Cited by Mueller in Die Krankheiten des Hundes.
Owen—Odontography.

Reul—Ann. de. Méd. Vétér. 1885, p. 34.

Sewill—Brit. Journ. of Dental Science. 1891, p. 629.

Waugh—Journ. of Comp. Med. & Veter. Archives. 1890, p. 235.
Werwey—Cited by Cadiot & Almy in Traité de Ther. Chir. d. Anim Domest.

The Salivary Glands

TRAUMATIC LESIONS.

Division of Steno’s Duct. A clean division would seem to be
remarkably free of any untoward result. Harms divided Steno’s
duct about half an inch from its orifice for the purpose of experi-
menting with the saliva. For five days the saliva flowed freely. On
the sixth day the wound was covered with a scab which the dog
scratched off. On the seventh day the scab had reformed permitting
but little saliva to escape. In twelve days there was a dry scab under
which the wound quickly healed. The animal was killed on the
fifty-first day, and examination showed that the continuity of the
duct had become reéstablished.

FISTULA.

This condition is very rare. It may develop from the presence

The Head and Neck 93

of foreign bodies, such as needles, which have found lodgment in
the gland, and certain other conditions. Favresse treated by in-
unction a year-old female suffering from a fluctuating swelling of
the right parotid. In two days the abscess burst and emitted a great
quantity of purulent liquid. A second orifice of discharge appeared
lower down. Both assumed a fistulous character, and saliva flowed
freely when meat was offered to the animal. Treatment by injec-
tions of nitrate of silver and inunction of vesicants produced no
improvement. The actual cautery was then employed—three times
within eight days—and was likewise barren of result. Finally,
when the animal had become greatly weakened it was decided to
extirpate the gland. The operation being completed, a simple
dressing was applied. Two days later this was removed and to
the astonishment of the operator, a threaded needle was found lying
in the depths of the wound. The needle had evidently originated
the trouble and had been overlooked at the time of the operation.

A maxillary fistula, supposed to have been caused in some man-
ner by the buckle of the animal’s collar was treated by Brissot with
an injection of carbolic acid. The following day the orifice had
become closed by peripheral edema thus arresting the discharge of
saliva, and in three days was completely cured.

Siedamgrotzky saw a fistula in a seventeen-year-old animal
opening by two orifices at the lower angle of the jaw and which
it was supposed proceeded from the parotid gland. The animal
also suffered from otorrhea. The latter condition responded to
treatment but the fistula stubbornly refused to heal. Later the dog
died from another trouble, and at the necropsy it was found that a
mixed tumor, partly an osteo-chondroma and partly an adenoma of
a sweat gland, was filling the tympanic cavity and the outer ear
passage.

INFLAMMATION.

Specific inflammation of the salivary gland is a rare disease.
It is frequently confounded with the rather common inflammation
of the submaxillary and retropharyngeal lymphatic glands. Simple
inflammation through infection by ordinary pyogenic microorgan-
isms may take place as a result of external traumatism and the pas-
sage and lodgment of foreign bodies. An occasional termination
of the disease is cystic transformation.

94 Surgical Diseases and Surgery of the Dog

The specific variety has been described as occurring in epizootic
form by Schuessele, Whitaker, and Hertwig. Busquet and Bon-
deand investigated a couple of cases and concluded that the disease
was contagious among dogs, was associated with the presence of
a microorganism which assumed the character of a diplo-strep-
tococcus in the saliva, and a diplococcus in the blood, and was analo-
gous or identical with Mumps of the human race.

Symptoms and Diagnosis. After three or four days of incuba-
tion, symptoms of lassitude and sneezing appear. Then a cough
develops and coincidently painful swelling of the parotid and sub-
maxillary glands, and edema of the neighboring tissues and lym-
phatics. Steno’s duct is rendered very prominent by swelling and
the salivary flow is meager. The general condition is unaffected
and the disease runs its course in less than two weeks.

Treatment. Hot fomentations or poultices, preferably the for-
mer, should be applied externally. If the swelling fluctuates vent
should be given to the pus by lancing, and any further accumulation
prevented. If a cyst forms the sac and its contents should be care-
fully dissected and enucleated, or it may be partially excised, the
contents let out, and the wall cauterized or subjected to iodine in-
jections.

BIBLIOGRAPHY.
Bondeand—Comptes rendus d. 1. Soc. de Biol. July, 1900.
Brissot—Rec. de Méd. Vétér. 1887, p. 487.
Fayresse—Ann. de Méd. Vétér. 1853, p. 2.
Harms—Jahresber. d. koenigl. Thierarzneisch. z. Hannover. 1869, p. 118.
Hertwig—Cited by Cadéac in Pathol. d. Anim. Domest.
Schuessele—Veterinaer Chirurgie.
Siedamgrotzky—Ber ue. d. Veterinaerw. im Koenigr. Sachsen. 1871, p. 75.

The Pharynx

EXAMINATION.

The pharynx is exposed to view by opening the jaws and de-
pressing the tongue or drawing it forward.

PHARYNGITIS.

This disease partakes of the same nature and is caused by the
same conditions which produce inflammation of the mouth. It is
also seen in certain specific diseases, such as rabies and distemper.
It is sometimes complicated with abscess formation in the submucous

The Head and Neck 95

tissue or retropharyngeal lymphatic glands, the lymphatics being
the highway of migration of the pyogenic bacteria.

Symptoms and Diagnosis. The symptoms are dysphagia,
abundant salivation, cough, retching and fever. The throat is sen-
sitive to pressure. Inspection reveals an inflamed, tumefied mucosa.
Soon the retropharyngeal lymphatics swell, but it is not often that
they suppurate.

Treatment. Hot fomentations give relief, but unless applied
continuously and the throat muffled subsequently, should not be
employed. The application of hot salt-bags is preferable. A lini-
ment composed of equal parts of ammonia, turpentine, and olive
oil is beneficial. Internally vaseline may be administered with ad-
vantage. Foreign bodies must, of course, be removed.

FOREIGN BODIES.

Any of the bodies which may lodge in the buccal cavity are
equally liable to be arrested in their passage through the pharynx.
When a dog is excessively hungry, or two or more are fed from
the same dish, they sometimes attempt to swallow foodstuffs too
large for passage of the pharynx which become retained there
by muscular spasm and produce the condition known as choking,
which, as a rule, quickly terminates in death.

Symptoms and Diagnosis. The symptoms of pharyngeal ob-
struction are: coughing, dysphagia, dribbling of saliva, and attempts
to vomit. Choking is characterized by suffocation.

Treatment. Forceps may be used to remove bodies which are
not productive of acute symptoms but when boluses of foodstuffs are
lodged in the pharynx no time must be wasted in seeking instru-
ments but the finger must be employed in an endeavor to dislodge
the body, preferably by retracting it, or by forcing it onward into the
esophagus.

NEOPLASMS.

Myxoma. This form of tumor occasionally occurs as a poly-
poid outgrowth of the pharyngeal mucosa. Dierix saw one suspended
from the pharyngeal wall at the level of the supero-posterior as-
pect of the larynx. Moeller mentions the occurrence of one which
was two inches in length. During the act of deglutition or even
locomotion they are apt to become projected into the esophagus.

96 Surgical Diseases and Surgery of the Dog

Symptoms and Diagnosis. The chief symptom is sudden suf-
tocation with as sudden recovery. Fits of vomiting may be pro-
voked particularly when pressure is applied over the pharynx.

Treatment. Removal should be effected by means of the wire
ecraseur.

Epithelioma. Malignant tumor of the Pharynx, while very rare,
is occasionally observed in aged animals. It is apt to exist some time
before being discovered, long enough for metastasis to the cervical
glands to take place.

Symptoms and Diagnosis. The appetite is very indifferent, and
the animal has difficulty in swallowing, and a fetid salivation de-
velops. Examination of the buccal cavity reveals the presence of a
raw ulcer. This ulcer must not be mistaken for a fistula pro-
ceeding from some foreign body which has found lodgment in the
subjacent tissues. The animal progressively emaciates and finally
the cervical glands become involved.

Treatment. There is no treatment for this disease.

BIBLIOGRAPHY.

Dierix—Cited by Cadéac in Path. des. Anim. Domest.
Moeller—Lehrb. d. spec. Chir. f. Thieraerzt.

The Esophagus
EXAMINATION.
The esophagus is examined by palpation over its course on the

left side of the neck, by passage of the probang, and by means of
the Roentgen rays.

CONGENITAL MALFORMATIONS.
Ectasia has been observed by Cadéac, and Stricture by Smith.

TRAUMATIC LESIONS.

Rupture and Perforation. These lesions are ordinarily caused
by bones and foreign bodies owing to the extraordinary peristalsis
or violent fits of retching engendered by their presence. Abscess
formation invariably results. When the thoracic portion of the or-
gan is pierced, purulent pleuritis results with fatal issue. Siedam-
grotzky recorded an instance of this kind where the perforating body

The Head and Neck 97

was a piece of bacon rind. Morey witnessed a case where a sharp
piece of bone perforated both esophagus and trachea and induced
gangrenous pneumonia, and Cadéac saw one where a peach stone
perforated the aorta.

Symptoms and Diagnosis. The symptoms of these lesions in the
cervical portion are painful swelling of the neck and suppuration.
In the thoracic portion, there are early collapse, febrile symptoms
and prostration.

Treatment. When the lesion is in the cervical portion it is
treated by exposing the gullet as in Esophagotomy and subjecting it
to frequent antiseptic irrigation. Unless the rent is extensive it
need not be sutured. e

Stricture. Stricture sometimes results from cicatrices fol-
lowing wounds by foreign bodies, improper use of the probang,
esophagotomy, and fistula. Similar effects are produced by com-
pression of extrinsic neoplasms usually of the bronchial glands, ver-
tebral exostoses, tubercles, goiter, and verminous aneurism of the
aorta. "

Symptoms and Diagnosis. Characteristic are the efforts at
swallowing. Liquids pass more easily than solids, which accu-
mulate above the stricture and distend the esophagus so that the
trachea and neighboring vessels and nerves are compressed result-
ig in dyspnea, etc.

Treatment. Stricture is treated by progressive dilation by
daily passage of the probang, a series of graduated instruments be-
ing employed. The latter are passed every two or three days and
left in place from five to ten minutes, each size being used three or
four times.

Diverticula. A Diverticulum was observed by Schellenberg in
which a bite and subsequent abscess formation were the causative
factors.

Treatment. Diverticula are treated by excision of a fusiform
portion of the stretched wall.

FOREIGN BODIES.

In the esophagus, obstructions usually occur either at the proxi-
mal end immediately behind the pharynx, at the lower extremity of
the cervical portion, or at a short distance anterior to the cardiac
orifice where its caliber is smallest. Sharp bodies may lodge at any

8

98 Surgical Diseases and Surgery of the Dog

part of the tube. Obstructions usually consist of bones, gristle,
large pieces of fat, fragments of tendon, skewers, etc. Large bodies
remaining in position for any length of time are very liable to pro-
duce local pressure gangrene and perforation. Sharp bodies may
also perforate at the outset.

Symptoms and Diagnosis. The animal refuses food or mani-
fests pain in the act of swallowing. There are spells of gulping and
choking with vomiting, salivation, scratching at the neck, the head
held extended, difficult respiration, and frequent outcries of pain.
The seat of obstruction, when it exists in the cervical region, is evi-
dent from painful swelling of the neighboring parts and this be-
comes intensified the longer the object remains. Such swelling may
interfere with the natural gait of the fore-legs through the edema
involving the shoulder muscles. Sometimes the body may be recog-
nized by palpation. In the thoracic portion the symptoms may be
obscure, there being absence of swelling and at times merely refusal
of food with rapid emaciation.

Treatment. Obstructions are removed by production of emesis,
by extraction with throat forceps, by propulsion with the probang, or
by esophagotomy or gastrotomy, according as the conditions present
warrant the application of either method of relief. Vomiting will
often displace a foreign body. It is best brought about by hypo-
dermic administration of apomorphia in doses of 1-40 to I-10 of a
grain. If the object is situated in an accessible position an attempt
should be made to grasp and extract it with the curved throat for-
ceps, after the jaws have been immobilized with a speculum. Fail-
ing in this and in cases where the object is beyond reach with the
forceps, the probang must be resorted to in order to push the body
on into the stomach. To pass this instrument the tongue is de-
pressed with the fingers of the left hand and the instrument, pre-
viously oiled, is made to pass into the median line and follow the
posterior wall of the pharynx into the esophagus. The bristle pro-
bang is a very convenient instrument, as it may be used for push-
ing Obstructions into the stomach or equally as well for extracting
them by the mouth, when they do not entirely occlude the lumen. It
is closed and passed until the bristles are well beyond the point of
lodgment, when they by pressure upon the whalebone, are projected,
completely filling the tube, umbrella-like, and the probang is with-
drawn. In the absence of this or any other special make of pro-

The Head and Neck 99

bang a horse catheter may be substituted for propelling the body
into the stomach.

Round or smooth obstructions may be pushed onwards but
excessive force must on no account be employed. Sharp bodies
should always be extracted by the mouth, when possible.

Failing in this, if the foreign body is lodged in the cervical por-
tion it must be extracted by esophagotomy, but this operation should
not be undertaken till every attempt at removal with the probang has
failed, unless asphyxia from pressure on the trachea is threatened.
Cadiot and Breton say that the operator should temporize with the
probang for two or three days and that it is rare that the symptoms
become alarming enough to render the operation necessary before
the fourth day.

It is sometimes necessary to resort to Gastrotomy in order to
deliver foreign bodies from the lower third of the esophagus, when
such bodies are too large or peculiarly shaped to be voided by vomit-
ing, or when it is feared that violent attacks of retching may lead
to perforation of the wall. They are extracted with the aid of for-
ceps or pushed upward into the mouth.

ESOPHAGOTOMY.

Interference with the continuity of the esophagus is borne well
by the dog. Billroth has shown that the continuity may be re-
established after ablation of a short portion of the tube. Incision
of the tube is performed in the following manner: Secure the
animal with hopples in the right lateral position with the head
extended. Remove the hair with clippers or razor and administer a
general anesthetic. Make the skin incision over the obstructing body
and on the left side of the neck on account of the inclination of the
esophagus to that side. Cut cautiously in between the anterior border
of the sterno-cleido mastoideus muscle and the jugular vein until the
great vessels of the neck are exposed. The esophagus is asso-
ciated with these and is distinguished by its pinkish color and tu-
bular muscular appearance. Grasp the organ with one finger and
draw it through the wound at the same time pushing the trachea
to one side. Incise its wall on its postero-lateral aspect. The ves-
sels are disposed mostly longitudinally and are more abundant at
the upper than the lower part, and the mucosa is recognized by its
folds and whitish color. Vomiting may occur at this point. Extract

nr ¢
Va lw

100 = Surgical Diseases and Surgery of the Dog

the obstruction. Leave the wound in the esophageal wall open to
heal by granulation, but if it is extensive suture it with catgut.
In ordinary cases the wound is healed at the end of two or three
weeks, and seldom later than two months. If gangrene of the wall
is present, do not attempt to stitch the latter, but let it heal by granu-
lation, in the meantime subjecting the wound to frequent antiseptic
irrigation.

In one case of obstruction by a large bone in a puppy, the
body was pushed from the right side towards the left side until
it was plainly perceptible under the skin. A simple incision was
then made through the skin and subjacent fascia and the wall of the
esophagus down on to the bone which was extracted. Nothing
further was done to the wound and the animal made an uneventful
recovery. The whole procedure was exceedingly simple.

Vomiting sometimes occurs during the operation. No solid
food should be given for two weeks and none at all by the mouth
for the first few days.

NEOPLASMS.

Intrinsic tumors occur with great rarity. Myxomatous -polypi
are referred to by Cadiot and Almy and multiple cysts formed of
dilated mucous glands have been observed by Eichenberg. Fibroid
enlargements caused by Spiroptera sanguinolenta occasionally occur
on this continent and are common in the South of Europe, South
America, and Asia. According to Manson, who frequently observed
the condition in China, these enlargements may bring about more or
less complete occlusion, particularly when they are large or numer-
ous near the cardiac end.

BIBLIOGRAPHY.

Cadiot & Almy—Traité de Thér. Chir. des Anim. Domest.

Cadiot & Breton—Médécine Canine.

Eichenberg—Cited by Cadéac in Path. d. Anim. Domest.

Manson—China Customs Med. Reports. 1876-77.

Morey—Journ. de Méd. Vétér. et d. Zootech. July, 1900.
Schellenberg—Schweiz. Archiv. 1891.

Siedamgrotzky—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1871, p. 67.
Smith—Cited by Cadéac in Path. d. Anim. Domest.

The Thyroid Gland and Glandules

Before considering the diseases to which the Thyroid is subject
and the extent to which surgical interference may be employed, it

‘O[UpURLS [BUId} xo *19]10 “EE ‘ON
(q) pue onpuets [eulejur (y) SsurMogs (surg

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The Head and Neck IOI

will be in order to briefly review the relationship which the Gland
and the recently discovered Glandules bear to one another, for it
is now known that both Gland and Glandules have each a separate
and specific function to perform in the animal economy.

In the immediate neighborhood of the gland, lying in the fas-
cia, are numerous separate nodular bodies, consisting of lymphoid
or of true thyroid tissue and designated “accessory thyroids.” They
are usually enlarged and more easy to find in animals having
hypertrophied thyroids, while in perfectly normal animals they are
at times so small that they can hardly be seen. Besides these ac-
cessory thyroids there are constantly present on each side two
bodies—the Glandules, one external to the gland and the other within
the gland. The external show considerable variation of position,
but usually one of proximity to the thyroids, and union of the two
portions is quite exceptional. Gley examined their disposition
in thirty-three dogs, and found them situated about the superior
third of the external face of each lobe, nearer the anterior border
than the posterior, superficially inserted in the face of, but never-
theless perfectly distinct from, the thyroid lobes, in fourteen of the
animals. In seven of the remaining nineteen animals one glandule
was enclosed in the external face, and the other isolated at the su-
perior extremity of the corresponding lobe. The internal are sit-
uated toward the internal or tracheal surface of the lobe, and as a
rule are completely covered by thyroid tissue and regularly enter
into extensive combination with it. Structurally, neither of these
bodies corresponds at any time of its development to the thyroid.

Numerous experimenters, among whom may be mentioned
Halsted, Schiff, Gley, Moussu, and Vassale and Generali have
demonstrated that suppression of the function of the thyroid gland,
including its total extirpation, is not productive of lethal effect but
results only in myxedema and cretinism, while removal of all the
efandules rapidly leads to a fatal issue. The leaving intact of one
glandule is sufficient to sustain life, but it is safer to leave all the
glandules possible.

STRUMA. GOITER. BRONCHOCELE.

Enlargement of the thyroid is quite common in the dog. It
is sometimes congenital and may be of such dimensions as to hin-
der delivery. Halsted has seen puppies born with glands twelve

102 Surgical Diseases and Surgery of the Dog

times as large as normal. The lobes and isthmus in these cases were
so developed that they formed a single horseshoe-shaped body al-
most encircling the trachea. The swelling generally disappears later.
It is believed that heredity plays some part in its development, but
it is also witnessed in puppies whose parents possess thyroids show-
ing no deviation from the normal.

In point of development even the normal gland may show
considerable variation in the newly-born animal, the difference de-
pending essentially upon the degree of development of the colloid-
containing vesicles.

Very young dogs are often seen with enlargement of the gland.
It may commence soon after birth particularly in members of cer-
tain breeds, namely, Pomeranians, French Pointers, Dachshunde,
Spaniels, and lap-dogs. Greenhow saw it in India, and Bramley,
writing in 1833, found it to be quite common as a “lobulated bron-
chocele” among puppies one month old bred from English dogs
in the trans-Himalayan regions. It seldom becomes large when
arising in young dogs, but gradually becomes reduced in size,
though in some instances will recur periodically.

Enlargements commonly occur during the course of general
diseases. In the experience of Zschokke it is a rare thing to find
dogs free of thyroid enlargements in some of the cantons of Switzer-
land.

Several forms of Struma are recognized. The enlargement
may be the expression of extreme vascular engorgement (Hypere-
mic struma). This is of a transitory nature and with little if any
pathologic significance. Muehlibach pointed out that it occurs dur-
ing the estrual period, and Bardeleben saw it in pregnant females.
Pflug refers to a remarkable periodic recurrence in members of
certain breeds, particularly Blenheim Spaniels, the swelling appear-
ing coincident with even a slight cold, but disappearing within
two weeks.

The commonest form is that of diffuse parenchymatous hyper-
plasia (Hyperplastic, Follicular struma) with or without a certain
amount of proliferation of the stroma and increase of gelatinous
contents in individual vesicles.

When a hemorrhage occurs in one of the goitrous nodules,
the extravasate undergoes an absorptive change, and according to
its age there may be anything from true bloody contents

The Head and Neck 103

through dark yellowish to perfectly clear serous fluid. (Cystic
struma).

Blood may also be extravasated into and infiltrate the con-
nective tissue adjacent to the gland, or even of the entire length of
the neck (Hemorrhagic struma).

Sometimes thick septa of the interstitial connective tissue de-
velop with consequent atrophy of the vesicles (Fibrous struma).

A very rare form of osteochondroma (Osseous struma) has
been observed by both Siedamgrotzky and Kitt, and I have also wit-
nessed the same condition in an aged Collie female. There was unil-
ateral enlargement fully the size of the subject’s own cranium. The
gladular tissue had almost completely disappeared, a few minute
isolated cysts and cell clusters marking the areas of functional per-
sistence.

Malignant neoplasm (Malignant struma) not uncommonly
affects old animals. It is usually of carcinomatous character. Ac-
cording to Kitt, sarcoma has never been observed for a certainty,
but Cuillé and Sendrail have recorded an instance and referred to
another case witnessed by Liénaux. Wells, Loeb, and others have
recently published observations indicating that not infrequently a
curious mixed tumor may form, in parts sarcoma, and in parts car-
cinoma. Malignant struma tends to infiltrate neighboring structures
and to lead to formation of secondary growths in the veins and in
the lungs by way of the veins and lymphatics and also within the
bones.

Symptoms and Diagnosis. The effect on the organism of the
different forms of goiter varies according to the nature, size, and
position of the growth. Some of the largest simple goiters hardly
affect the animal other than to render him unsightly. On the other
hand, quite insignificant growths have been known to produce seri-
ous respiratory disturbances, with spasm of the glottis, owing to
compression of the vagus and sympathetic nerves. Very voluminous
goiters may induce suffocation by causing a narrowing of the
lumen of the trachea and larynx. This is true also of the hemorr-
hagic form. Siedamgrotzky saw the esophagus completely encircled.
Moeller has seen dogs with enormous goiters unable to lie down
on account of the pressure on the trachea induced by that act. Van
Gemmern and Mecke saw vomiting (probably reflex) induced in a
one-year-old Italian greyhound when the gland was enlarged, which

104 Surgical Diseases and Surgery of the Dog

however, ceased when the swelling subsided. Cadéac says laryngeal
hemiplegia may result from pressure on the recurrent laryngeal
nerve. Complete suppression of thyroid function is followed by
cretinism and myxedema, conditions characterized by physical de-
generacy and deformity and grave nerve disturbances. There
occur an inerease in the general connective tissue with a mucoid
conversion of the ground substance, and marked idiocy. Rougieux
has recorded cases of cretinism, and Raynard has seen the con-
genital form accompanied by imperfect development of the body and
legs, thickened head, shortened neck, and feeble mental power.
Experimental myxedema and cretinism have been produced by
Moussu by complete extirpation of the gland, leaving the glandules
intact.

Struma can be comparatively easily diagnosed. Generally the
enlargement is bilateral, but not necessarily of uniform development. .

This bilateral character is of assistance in making a differential
diagnosis from mucous cysts, abscesses, and hematomata. Further-
more, its mobility, sharp demarcation, and freedom from sensitive-
ness aid in the diagnosis. It can hardly be confounded with any
other lesion unless it be lymphosarcoma involving the neighboring
lymphatics, but in the latter disease other lymphatics are usually
found to be involved. The enlargement may be so deeply embedded
that its presence is hardly suspected, and in other cases may be so
extensive as to occupy the entire distance between the trachea and
sternum. Leisering saw such a growth, it being a carcinoma, with
secondary growths in the walls of the internal jugular.

Malignant struma is distinguished from other forms by its tu-
berculate character and by the cachexia which accompanies it.

The hemorrhagic form involving extravasation of blood into
the connective tissue of the neck is sometimes a little difficult to
diagnose. It is accompanied by diffuse swelling of the neck with
local pain and heat, which may or may not terminate in suppuration.

The accessory bodies may also become hypertrophied, when
they receive the name of “aberrant struma.” They are often seen
in animals possessed of congenital struma. Woelfler and Wagner
observed one instance of a veritable enlargement of a nodule of true
thyroid tissue in an animal whose lobes only slightly exceeded the
normal in size. The tumor was as large as a hazel-nut, and hung
from the aorta by a pedicle.

The Head and Neck 105

The pathology of the Glandules does not appear to have been
studied up to the present.

Treatment. Soft goiters generally respond to iodine medication
administered internally and by local inunction. Very large and con-
tinuous dosing is usually necessary. Exceedingly large growths
may be reduced by these means within a few days, but they tend
to recur.

Fibrous goiters should be treated by strictly aseptic intra-
glandular injections of a few drops of tincture of iodine. After
the needle has been inserted it should first be ascertained that the
point has not lodged within the lumen of some enlarged vein, other-
wise it must be partially withdrawn and then reinserted. The dan-
ger consists in the immediate entry of the iodine into the venous
circulation. Horsley experimentally injected 15 c. c. of tincture
of iodine into the external jugular vein and brought about instantan-
eous death from cardiac paralysis by plugging of the right heart with
a hard clot. The injections should be repeated at intervals of several
days as soon as the inflammatory reaction has subsided. In some cases
several injections, lasting over a period of some months, are needed
to effect a cure. Bizard succeeded in producing absorption of an en-
largement in a dog aged five months by injecting the iodine into
the neighboring connective tissue instead of into the gland itself.

Cystic struma is treated by free lancing of the sac and evacua-
tion of the contents, but it must be remembered that the secreting
membrane needs to be destroyed, which can be accomplished by
iodine injections directly into the sac; otherwise a fistula is likely to
be established. An antiseptic tampon is then introduced in order
to stimulate healthy granulations.

Malignant goiters being so extremely metastatic to important
internal organs, and being usually accompanied by profound
cachexia, scarcely warrant any attempt at giving relief even by sur-
gical means. Unilateral neoplasm in the early stages would justify
unilateral extirpation of the gland, provided the glandules were
healthy and left in situ.

In any case of surgical interference it is absolutely essential
that at least one external glandule together with its blood-supply be
Jeft intact and a successful outcome is more likely to take place if
both external glandules are allowed to remain undisturbed.

106 §=©. Surgical Diseases and Surgery of the Dog

It becomes then necessary, in considering operative measures on
the thyroid gland, to speak of unilateral and complete thyroidectomy,
and unilateral and complete external and internal parathyroidec-
tomy or extirpation of the thyroid glandules.

UNILATERAL THYROIDECTOMY.

Unilateral Thyroidectomy, without regard to conservation of the
glandules, is carried out as follows: Make the skin incision in the
median line. This enables the operator to get down easily between
and without severing the muscles, which is conveniently done by
tearing with the finger or with the aid of a blunt instrument. The
lobes are found one on each side under the sternothyroid muscles.
Their mobility and slipperiness make their removal somewhat diffi-
cult. Draw the lobe up out of the wound by means of a suture
passed through it, and secure the ramifications of the superior thyroid
artery with a ligature, including the tissue surrounding them, apply
another ligature around the anastomosing termination of the inferior
thyroid, and, lastly, divide all-the attachments on the distal side of
the ligatures, leaving as small a stump as possible. It is worthy of
note that the necessity of maintaining an aseptic wound in thyroid
operations was particularly emphasized by Munk in his experiments,
and latterly by Halsted, who found it expedient to devise his “sub-
cuticular suture.”

SIMPLE THYROIDECTOMY.

Simple Thyroidectomy, leaving the glandules intact, is thus de-
scribed by Gley (translation) : When the glandules are isolated at the
superior or inferior extremity of the gland the operation is not dif-
ficult. But this disposition is not the most frequent, consequently it is
often necessary to explore for and enucleate them from the thyroid
body. Secure the superior and inferior extremities of the lobes by
two separate sutures. One of these sutures may often be made to
include the thyroid artery, but it is particularly essential that the
minute vessel which detaches itself to furnish the glandule be left
free. By means of these two sutures have an assistant draw up the
lobe in such manner as to render the glandule visible. Separate the
latter little by little from the adjacent tissues with a blunt instru-
ment. Now pass a fine ligature behind it, but in such a manner as

The Head and Neck 107

not to include a veinlet which receives branches from the lobe at
this level. If necessary, a portion of the lobar tissue may be in-
cluded. Finally, remove the lobe. There is only a slight oozing of
blood during the operation.

Moussu found it very difficult to preserve the veinlets, which are
necessary for the proper performance of the parathyroid function.

Gley and Nicolas found that the glandules underwent hyper-
trophy after extirpation of the gland.

Breisacher noticed that dogs fed on raw meat suffered more
acutely from thyroidectomy than those fed on milk and boiled meat,
and Victor Horsley observed that a vegetarian diet was that which
led to the fewest symptoms after thyroidectomy. Moreover, gram-
nivorous species do not show acute symptoms after extirpation.

EXOPHTHALMIC GOITER.

This disease is extremely rare. It has been observed by Fried-
berger and Froehner, Albrecht, and Jewsejenko. It is believed to
be a toxic condition dependent upon hyperactivity or perversion of
thyroid function. It is characterized by three principal features,
viz., thyroid enlargement, extreme protrusion of the eyeballs with
immobility or retraction of the lids, and cardiac palpitation.

Symptoms and Diagnosis. The disease is ushered in by palpita-
tions which generally appear consequent upon some physical or
mental shock, such as prolonged exercise, violent emotions, or fright.
Its evolution is ordinarily slow and may be interrupted with epilep-
tiform paroxysms (Jewsejenko). In very young animals restless-
ness, whining, occasional spasms, arhythmical pulsations and general
unthriftiness are apparent. The glandular enlargement is soft and
elastic and uniform in both lobes or is more pronounced in one than
in the other. The bulging of the eyeballs is so acute that disloca-
tion appears imminent. The cornea is usually ulcerated. Besides
these symptoms others may make their appearance, viz., trembling of
the extremities, anorexia, emaciation, pruritis, and subcutaneous ab-
scesses.

Treatment. lodine medication internally and externally is indi-
cated, together with administration of digitalis to combat the cardiac
irregularity. A case which terminated in complete recovery was
treated by local disinfection of the eyes, and inunction of belladonna

108 Surgical Diseases and Surgery of the Dog

and iodine, supplemented by injections of iodine into the gland with
cold baths.

Moussu found that administration of thyroid glandules of the
horse (eight per diem) materially modified the course of the disease
in human beings, though other observers have got absolutely nega-
tive results, but it is worthy of note that this form of struma can be
cured in the human subject by partial removal of the gland (Whar-
ton and Curtis).

BIBLIOGRAPHY.

Bardeleben—Cited by Pflug in deutsch. Zeitschr. f. Thiermed. 1875, p. 340.

Bizard—Archiv. Vétér. 1878.

Bramley—tTrans. Med. & Phys. Soc. Calcutta. 1833, p. 195.

Breisacher—Archiy. f. Anat. u. Phys. 1890.

Cadéac Pathol. d. Anim. Dom.

Case—Journ. Comp. Med. & Surg. Oct., 1888.

Cuillé & Sendrall—Reyv. Vétér. Oct., 1898.

Froehner—Cited by Albrecht in Wochenschr. f. Thierheilk. 1895, p. 308.

Gley—Comptes rendus d. 1. Soc. d. Biol. 1893, pp. 217, 396. Archiv. d. Phys. Norm. et
Pathol. 1892, p. 81. 1893, p. 767.

Gley & Nicolas—Comptes rendus d. 1. Soc. d. Biol. 1895, p. 218.

Greenhow—Indian Annals of Med. Science. 12.

Halsted—Johns Hopkins Hospital Reports. 1. Johns Hopkins Hospital Bulletin. 1.

Horsley—Brit. Med. Journal. 1885, p. 213.

Jewsejenko—Cited by Kitt in Lehrb. d. Path. Anat. Diagnost. 2.

Kitt—Lehrb. d. Path, Anat. Diagnost. 2.

Leiserung—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1872, p. 59.

Moussu—Comptes rendus d. 1. Soc. d. Biol. 1893, p. 394. 1897, p. 82. 1898, p. 867. 1889,
p. 242.

Muehlibach—Der Kropf. 1822.

Mueller—Jenaische Zeitschr. f. Medizin u. Naturwissensch. 1871.

Pflug—Deutsch. Zeitschr. f. Thiermed. 1875, p. 340.

Raynard—Rec. de Méd. Vétér. 1836, p. 8.

Rougieux—Cited by Morel in Ann. Méd. Psych. 1874. Koeberle in Essai sur le Cretinism.

- Strassburg, 1862.

Schiff—Rev. Méd. d. 1. Suisse Romande. Feb., 1884.

Siedamgrotzky—Ber. ue d. Veterinaerw. im Koenigr. Sachsen. 1871, p. 58.

Vassale & Generali—Rivista di Patol. nerv. e ment. 1896. Archiv. Ital. de Biol. 1896.

Wharton & Curtis—Practice of Surgery.

Woelfier & Wagner—Wiener med. Wochenschr. 1879, p. 198.

Zschokke—Schweiz. Archiv. f. Thiermed. 1881, p. 52.

The Lymphatic Glands

LYMPHADENITIS.

The lymphatic glands in the region of the throat are not uncom-
monly the seat of acute suppurative conditions, which are entirely
different from, and not to be confounded with, inflammation of the
salivary glands, which is a comparatively rare disease. The glands
most commonly affected are those draining the mucosal areas of the
mouth, pharynx, and larynx, viz., the Submaxillary, consisting of a
bilateral group of three glands lying subcutaneously between the
posterior border of the masseter muscle and the submaxillary sali-
vary gland, and the Retropharyngeal. The disease always results

No. 34. Acute lymphadenitis.

No. 36. (After Cadiot and Breton). Tuberculous lympha-
denitis. Fistulous tract.

The Head and Neck 109

from migration of pyogenic or tubercular bacteria. It commonly
develops during the course of inflammations of adjacent mucosal
areas, notably during pharyngitis. There would also seem to be a
specific form, or the disease may at least be enzootic in certain local-
ities, for Dessart, a Belgian practitioner, wrote that it was common
as a phlegmonous angina in the vicinity of Genappe, Belgium.

Acute Lymphadenitis. This, the pyogenic form, always runs a
very rapid course and terminates in suppuration, the pus tending to
be discharged spontaneously.

Symptoms and Diagnosis. The trouble commences as a hot, pain-
ful, unilateral or bilateral tumefaction at the site of either or all the
glands, sometimes together with edema of the facial tissues. The
head is held stiffly and eating is generally suspended. In severe cases
there may be considerable dyspnea and some danger of asphyxia.
The inflammation quickly spreads beyond the capsule of the gland
to the surrounding connective tissue giving rise to a diffuse peria-
dentitis which then obscures the outline of the gland. Suppuration
taking place, individual suppurative foci become confluent and form
a large abscess, which fluctuates, and if not relieved by lancing,
points, bursts spontaneously and discharges a great quantity of pus.

Treatment. Hot fomentations should be employed externally and
as soon as fluctuation is per-
ceived, the pus should be evac-
uated by free lancing and further
accumulation prevented by keep-
ing the opening free during the
few succeeding days.

Chronic or Tuberculous
Lymphadenitis. Tuberculous
lymphadenitis occurs in the
glands of the neck, which be-
come infected by auto-inocula-
tion in the same manner
as in acute lymphadeni-
tis. It may develop as a
primary lesion through
absorption of bacilli ar-
rested in the upper pas-

No. 35. (After Cadiot and Breton). Tuberculous lym-
sages, but more com- phadenitis, Fistulous tract.

110)=—s Surgical Diseases and Surgery of the Dog

monly secondary to pulmonary tuberculosis through absorption
from the tuberculous matter coughed up into the pharynx. The
disease runs a course common to tuberculous inflammations with
caseation and eventual breaking down.

Symptoms and Diagnosis. At first but little change is noticeable
in the glands, and they appear solid, mobile and freely defined. As
the disease progresses the inflammation extends to the periglandular
tissue and implicates the skin, the swelling then becoming diffuse,
soft, and fluctuating. Discharge takes place and a fistulous tract is
formed leading to the trachea or larynx. The external lesion pre-
sents a circular, oval, or irregular cavity with a thin, jagged border
denuded of hair, and gives vent to a greyish or sanguineous bacilli-
bearing purulent matter.

Treatment. This lesion being in most cases secondary to pulmo-
nary tuberculosis, is rarely suitable for treatment and only when it
exists as a primary focus in superficial regions should curative meas-
ures be attempted, and then only if spread of infection can be guard-
ed against. If the case is presented in the early stages, before the
development of periadenitis, and there is undoubted evidence of
softening, the entire gland should be enucleated by blunt dissection,
without opening its capsule. If the disease process is found to have
extended and involved the surrounding tissues, the entire mass must
be carefully dissected out. And if discharge has already occurred,
the cavity should be thoroughly curetted, enlarged, and irrigated
daily with corrosive sublimate solution (1 :1000).

NEOPLASMS.

The primary growths affecting lymphatic glands are Lymphade-
noma and Lymphosarcoma. Both innocent and malignant types of
the former are seen but the latter is essentially malignant. Malig-
nant lymphadenoma occurs in two forms, both characterized by gen-
eral hyperplasia of the glands, but one of which is also associated
with increase of lymphocytes. Secondary growths in the lymphatics
are a feature of cancerous tumors, though they are less common in
sarcoma than in epithelioma and carcinoma.

Benign Lymphadenoma. Lymphoma. This is a purely local
affection occuring as a single nodule or a series of nodules but lim-
ited to one region of the body. Such growths occur usually second-
ary to catarrhal inflammations. The cause is unknown. They do

The Head and Neck III

not affect the health, except in the case of the bronchial glands where
they may give rise to impairment of cardiac and respiratory function
by compression of the intramediastinal vasculo-nervous structures.

Symptoms and Diagnosis. To the touch they are smooth, hemis-
pherical lumps, firm, elastic, and painless. They are freely mobile
one on another in external glands and do not become adherent to
surrounding parts.

Treatment.. Where these growths appear as a blemish, they may
be presented for treatment, when they will be found amenable to
arsenic administered internally.

Malignant Lymphadenoma. Hodgkin’s Disease. This is a
rare disease in which there is an extensive and progressive symmet-
rical enlargement of the glands throughout the system, including not
only external lymphoid tissue, but also that of the spleen, the kid-
neys, the liver, and the bone marrow. In the human subject it is
most common in the young adult male, and this would also seem to
be true of the dog, as I have observed it in males of the age of two
or three years. The cause is unknown.

Symptoms and Diagnosis. The enlargement develops progres-
sively in one gland after another until a whole cluster of glands is
implicated. Another group becomes likewise affected until all the
external glands are involved, and finally the internal lymphoid tissue.
The submaxillary glands are usually the first to show the change,
and at this stage are liable to be mistaken for goiter, then the cervi-
cal, then the axillary, and then the inguinal. The enlargements are
not painful and show no tendency to break down. They adhere
together forming lobulated masses, but do not form adhesions with
the surrounding tissues and remain freely mobile. This feature
serves to distinguish the condition from acute or chronic lympha-
denitis or lymphosarcoma. As the disease progresses the pulse be-
comes rapid and the appetite capricious. Lethargy develops, the ani-
mal showing disinclination to mount steps or to travel far. The ab-
domen becomes abnormally distended and by careful palpation the
internal enlargements can be distinguished, particularly of the
spleen.

.. Treatment. There is no treatment possible and the prognosis
must always be unfavorable, a fatal termination ensuing in the
course of one or two years,

Lymphatic Leukemia, Leukemic Lymphadenoma. This dis-

112 =Surgical Diseases and Surgery of the Dog

ease is also rare and is distinguished from the former by marked
changes in the blood, but there is the same widespread enlargement
of lymphoid tissue and increase especially in the lymphocytes. In-
stances have been recorded by Siedamgrotzky, Leblanc and Nocard,
and Bouchet. Cadéac says the disease may be mistaken for tubercu-
losis. The changes taking place in the blood are highly characteris-
tic, the red corpuscles steadily, continuously, and rapidly decreasing
in number and suffering a diminution of hemoglobin, while the leu-
cocytes are greatly increased in number. The arteries sustain a
diffuse sclerosis.

Symptoms and Diagnosts. Usually there is the same progressive
enlargement of the external lymphatic glands, but it is occasionally
absent. Conspicuous among the symptoms are: inappetence, inter-
mittent fever, conjunctival injection, anemia, progressive emacia-
tion, increased and throbbing cardiac action, tendency to hemorr-
hage, languor, and respiration normal at rest but accelerated during
movements. The proportion of white to red cells varies at different
stages of the disease. In Siedamgrotzky’s observations it was as one
to fifteen to twenty to thirty, and in those of Leblanc and Nocard as
one to eighty-five. The normal is as one to five or six hundred. In
Bouchet’s case there was abdominal pulsation which was thought to
be due to an aneurism of the aorta, but at the necropsy it was shown
to have proceeded from abnormal development of the splenic vessels.

Treatment. As in the preceding form, the prognosis is hopeless,
death being inevitable within a few months, and seldom later than
one year.

Lymphosarcoma. This type of growth differs from the pre-
ceding in that it infiltrates neighboring parts and involves the skin
and forms metastases. It has also an extremely rapid growth. The
most common seat of the disease is the lymphoid tissue of the neck
and groin, but it may also occur in the mesenteric glands (Semmer,
Hobday), the vagina (McFadyean) and the bronchial glands
(Johne). When arising in the neck it is most apt to be mistaken in
the early stages for goiter, and also for traumatic and tuberculous
abscesses, all of which are prone to form in these parts.

Symptoms and Diagnosis. In external parts the first symptom
to be observed is a rapidly growing nodule or tumor, which, though
at first firm, elastic and painless, later on becomes tender and pain-
ful. The tumor soon gives rise to secondary growths in neighboring

The Head and Neck 113

glands and extends to the skin. It then breaks down and becomes a
bleeding fungating mass and discharges an ichorous matter. There
is usually considerable collateral edema of the head and neck. In
internal parts these growths may give rise to ascites.

Treatment. The prognosis must always be unfavorable and no
treatment is practicable. Martin attempted the removal of one of
these tumors from the groin in a three-year old animal. A month
later several small nodular growths were observed near the edge of
the almost healed wound, and one larger one situated in the opposite
groin. These were not interfered with and the animal succumbed in
ten weeks’ time.

BIBLIOGRAPHY.
Bouchet—Bull. de la Soc. Cent. de Méd. Vétér. 1897, p. 184.
Hobday—Journ. of Comp. Path. & Therap. 10.
Johne—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1881, p. 70.
Leblanc & Nocard—Ann. de Méd. Vétér. 1878, p. 164.
Martin—Journ. of Comp. Path.& Therap. 1896, p. 226.
M’Fadyean—Journ. of Comp. Path. & Terap. 3. p. 337.
Semmer—Oesterr.Vierteljahresschr. f. Veterinaerk. 1873, p. 20.
Siedamgrotzky—Ber. ue. d. Veterinaerw. im Koenigr. Bucheen. 1871.

The Nose.

EPISTAXIS.

Bleeding from the nasal passages depends upon various causes
the chief of which are traumatic influences, local inflammatory and
ulcerative changes, or the presence of neoplasms or parasites in the
nasal cavities. It is sometimes brought on by violent coughing and
it may also take place in cachectic subjects suffering from leukemia
or the pernicious anemia induced by the presence of uncinaria in the
intestine. It is in every case the result of rupture of the vessels of
the mucosa, whether arterial, venous, or capillary.

As a rule the hemorrhage is insignificant but it may be copious
and recur at intervals and even lead to fatal termination.

Treatment. When the bleeding is excessive the measures to
be adopted are both medicinal and surgical. Medicinally adrenalin
chloride solution (1:1000) should be prescribed in ten to twenty
drop doses every hour. Surgical measures consist in directing a
stream of cold water from a hose over the roof of the nasal pas-
sages, or pressing a piece of ice against the same spot.

9

114. . Surgical Diseases and Surgery of the Dog

FOREIGN BODIES.

Foreign bodies and Pentastomes sometimes’ find lodgment in
the nares. Dieterichs recorded a case in which a long bristle of a
hog had penetrated the pituitary membrane.

Symptoms and Diagnosis. Respiration is impeded, and there
may be epistaxis and fits of sneezing, and later a muco-purulent dis-
charge.

Treatment. The removal of a foreign body is extremely diffi-
cult when it is situated at any distance from the orifice. Agents
which induce snéezing and warm antiseptic injections are recom-
mended, and if this treatment fails, the nasal chamber should be tre-
phined and the body extracted or pushed forward out of the orifice.

NEOPLASMS.

Nasal tumors are not very common. When present, they are
usually found to be of myxomatous nature and polypoid in form.
These tumors may exhibit a tendency towards sarcomatous transfor-
mation. Polypoid fibromata are also seen. Chondroma, osteosar-
coma, and carcinoma occasionally occur, but usually as secondary
manifestation of a primary growth which has had its origin in
either the buccal mucosa or the maxillary bones and has invaded the
nasal passages. These malignant growths are recognized by the
upheaval, and eventually, perforation of the superior maxilla which
they produce.

Symptoms and Diagnosis. Growths of any size interfere with
respiration. Malignant neoplasms give rise to purulent or hemorr-
hagic discharges, frequently of fetid character. They are painful
to manipulation. When of long standing, the facial bones become
distorted or nécrotic.

Treatment. Constitutional treatment of polypi has been suffi-
cient to cause their disappearance. Gohier verified this in an animal
he tried to poison with large doses of arsenious acid after having
given up an attempt at extirpation. When surgical measures are em-
ployed, the wire snare should be tried, but failing with this, it is
necessary, owing to the conformation of these parts, to make
an opening in the superior wall of the nasal passage with a trephine,
and extirpate the tumor through the same. It is usually futile to
attempt the removal of malignant growths.

The Head and Neck 115

The Larynx and Trachea.

FOREIGN BODIES.

Though common enough in the pharynx, lodgment of foreign
bodies in the larynx is an accident of great rarity. The extreme sen-
sitiveness of the larynx is responsible for this immunity, for if they
do not become firmly wedged they are expelled by reflex cough-
ing. Bournay treated a dog one week for sore throat, accom-
panied by symptoms of dysphagia, whistling and roaring, coughing,
and occasional vomiting. It succumbed to asphyxia. The necropsy
revealed the presence of a small pebble near the vocal cords which
completely obstructed the orifice. The tracheal mucosa was edem-
atous and covered with a fibrinous exudate in which the stone was
also embedded.

Foreign bodies may also fall into the trachea, and this accident
has happened where the tracheotomy tube has been employed.

As a rule, if an obstruction more or less completely blocks the
passage, death quickly follows, but insignificant bodies are often
tolerated.

Symptoms and Diagnosis. Where complete obstruction exists,
symptoms of sudden suffocation develop. Where incomplete ob-
struction occurs, the symptoms are those of a subacute type of laryn-
gitis, with dyspnea, coughing, vomiting, and expression of anxiety.
There may or may not be spasm of the glottis. Differentiation in
the latter case lies between displaced polypi and laryngeal edema
occurring as a complication of laryngitis.

Treatment. If asphyxia threatens, immediate tracheotomy is
indicated. The opening should be made close to the larynx. If the
body is located above immediate relief is obtained, but if the dyspnea
persists it is evidence that the body is lower down in the trachea.
In the latter case a second opening should be made as low down
as possible. The next step is to endeavor to dislodge the body.
If it is in the larynx an attempt should be made to extract it by
the mouth, but if this fails, to dislodge it by manipulating with the
finger through the opening in the trachea. If the object is lower
down, it may be necessary to employ forceps, when great care
should be exercised not to force it further into the lungs. When
bodies reach the latter position they are beyond surgical intervention.

116 = Surgical Diseases and Surgery of the Dog

NEOPLASMS.

The trachea and larynx are occasionally the seat of single or
multiple papillomata. Cadiot and Almy and Mouguet have seen
instances. Tubercles also occur as a manifestation of pulmonary or
generalized tuberculosis.

Symptoms and Diagnosis. According to the authorities just
noted, dyspnea and violent fits of coughing are prominent symptoms
of papilloma.

Treatment. When the growth is situated in the larynx removal
by means of a snare is indicated.

FRACTURE OF THE TRACHEA.

This lesion was seen and described by Walley. The trachea had
sustained a complete transverse fracture which was supposed to
have been caused by violent traction. There was a space of an inch
between the severed ends. The first symptom noticed was a slight
tumefaction of the tissues round the throat. This was followed by
emphysema of the neck, chest, and one side of the body, which
increased in the neck at each expiration. An attempt at relief was
made by incising and stitching the edges of the aperture to the
skin above and below, but-the animal died soon after from pulmon-
ary congestion and emphysema of the mediastinal connective tissue.

That it is possible to treat this lesion successfully if attended
to in time would seem to be the case in view of the experiments of
Mesnard and Gluck and Zeller which are quoted below.

Surgery of the Trachea.

Gluck and Zeller divided and reunited the trachea experimental-
ly with good results. The division was made between the third and
fourth rings. Both sections were at first sewn into the skin wound,
eight to ten stitches being sufficient for each. Some days later
the cut extremities of both sections were brought into apposition
and sutured and the animal recovered the use of its voice. These
experimenters also practiced extirpation of the larynx. Mesnard
also removed two, three, and five rings from different dogs and
sutured the cut ends with catgut. Reunion was complete in ten
days.

The Head and Neck 117

TRACHEOTOMY.

This operation is indicated whenever dangerous dyspnea is
induced by the following conditions : acute inflammatory and edema-
tous affections of the larynx and tongue, and the presence of impact-
ed foreign bodies in the larynx and pharynx. It is also resorted to
for the removal of foreign bodies from the larynx and trachea.
The technic is as follows: Place the animal in the dorsal position
and extend the head and neck fully. Divide the skin and sub-
jacent fascia with one firm incision. Quickly separate the fibers
of the sterno-hyoid and sterno-thyroid muscles by teasing until the
rings of the trachea are exposed. Pass a sharp hook into the lower
border of the cricoid cartilage and elevate this. With a sharp curved
bistoury cut through two or three rings of the trachea in the middle
line but not too deeply. The incision may be simple, the edges of
the severed rings being stitched to the cutaneous wound or a cir-
cular portion may be removed and a tracheotomy tube inserted, the
latter being held in position by tapes tied round the neck. The
inner tube must be removed every few hours for the purpose of re-
moving accumulations of mucus which if allowed to take place
quickly obliterate the passage. Stitching of the trachea should be
avoided if possible, as the stitches tend to cut through the cartilage,
and if renewed very often lead to necrosis of the parts. A dog
wearing a tracheotomy tube must be closely watched, as some ani-
mals make persistent efforts to rid themselves of the instrument.

BIBLIOGRAPHY.

Bournay—Rec. de Méd. Vétér. May, 1894.

Dieterichs—Cited by Cadiot & Almy in Traité de Thér. Chir. d. An. Dom.
Gluck & Zeller—Langenbeck’s Archiy. f. klin. Chirur. 26, p. 427.
Gohier—Cited by Cadéac in Pathol. des An. Dom.

Mesnard—Rey. Vétér. 1902.

Walley—Journ. Comp. Pathol. & Therap. 1893, p. 80.

CHAPTER IV
The Thorax

The Lungs and Pleurae

EXAMINATION.

Examination of the lungs and pleurae is conducted by
means of auscultation and percussion. With the naked ear ap-
plied to the chest wall, respiratory sounds can be heard with
sufficient distinctness, but the employment of a stethoscope or phon-
endoscope accentuates them. Percussion is best accomplished by
tapping with the second finger of one hand on the corresponding
finger of the other hand laid flat against the chest wall. When
using these means for disgnostic purposes the position of neigh-
boring and more solid organs must always be taken into account.

TRAUMATIC LESIONS.

Wounds of the lungs and pleurae occur for the most part as a
complication of penetrating wounds of the thoracic wall. Their
gravity depends upon the degree of resultant hemorrhage and
the entry of either atmospheric air or pyogenic bacteria within the
sacs. If air beyond a certain quantity enters a pleural sac, the
condition known as pneumothorax is established, and both lungs
collapse. The animal makes violent respiratory efforts which gradu-
ally become less frequent and finally cease, cyanosis meanwhile
developing. If, however, an open wound becomes quickly sealed,
either spontaneously or by surgical measures, the air is gradually
absorbed and the lung again takes on its function. This is also
true of hemorrhage exudates. Slight rents in the pleura are not
as a rule followed by entry of air. In rents or incisions of at
least a half to an inch in diameter the lung may be seen to glide
over the incision hole with each act of respiration, the cohesive
force of the two pleurae being sufficient to overcome the pressure
of the atmosphere through the incision. Delafond probed a wound

118

The Thorax 119

with his finger until he felt the heart, and the animal recovered.
Theoretically, when only one sac is opened, sufficient for air to gain
entry, and the opposite sac remains intact, the condition is not incom-
patible with life, because unilateral respiration would still be pos-
sible. But, though the dog has two separate and distinct pleural
sacs, they are separated only by a thin diaphanous mediastinum,
and as a matter of fact, as has been established by all those who
have experimentally opened the chest-wall, air apparently readily
passes through this membrane and causes the collapse of the ad-
joining lung. At any rate, it has been found impossible to open
either sac to any extent without making provision for the main-
tenance of respiration by artificial means, and this involves the
temporary introduction of a tube into the trachea and the employ-
ment of bellows.

The other great danger lies in septic infection, which is very
apt to take place. In this respect, the pleura offers a striking con-
trast to the peritoneum,’ which possesses a well-known relative
immunity to infective processes. Sherman believes that this may
be due to the fact that the pleura does ‘not, like the peritoneum,
offer pockets or recesses in which an infection may be confined,
and that constant motion incident to respiratory and cardiac ac-
tion tends to disseminate pathogenic microorganisms. Were it
possible to drain the pleura, sepsis might be combatted, but inas-
much as drainage of the pleura inevitably results in collapse of
both lungs, no steps in this direction can be taken.

Symptoms and Diagnosis. Wounds of these parts are difficult
of both diagnosis and prognosis. If hemoptysis ensues it is in-
dicative of wounding of the lung. When air is entering a pleural
sac in small quantities, the fact is easily recognized by the sound
at every act of respiration. In any case, respiration is usually
greatly accelerated, and this is particularly true when hemothorax
exists. Penetrating or deep wounds of the chest-wall should
never be probed for fear of bringing about pneumothorax and in-
troducing microorganisms. Prognosis must always be guarded.

Treatment. Penetrating wounds of the thorax should be
closed as quickly as possible by suturing and application of anti-
septic bandages. No attempt should be made to evacuate hem-
orrhagic exudate in the pleural sac because it soon coagulates, and
is gradually absorbed even if present in considerable quantity.

120 ©. Surgical Diseases and Surgery of the Dog

Thierry treated a dog whose chest had been ripped open by a wild
boar between the seventh and eighth left ribs. At each inspira-
tion a portion of the lung would protrude. He sutured the wound
with a rusty needle and dirty suture, and the animal completely re-
covered within three weeks. Delafond had a similar experience.

PLEURITIS.
(Largely translated from Cadiot and Breton.)

Two principal types of this disease are recognized, viz., the
sero-fibrinous and the purulent. Both are believed to be of infec-
tious origin. The sERO-FIBRINOUS form is now known to be
most commonly associated with tuberculosis, but it is also known
that the disease may follow a sudden chill, such as hunting dogs
sometimes sustain when following their quarry into water in mid-
winter, or which house dogs suffer after being washed and ex-
posed to the cold air before their coats are sufficiently dry. Cadéac
places the percentage of tuberculous pleurisies at ninety. Para-
sitic infestation may also be responsible. Magnié attended an
animal which died suddenly with symptoms of vomiting and as-
phyxia. In the left sac he found a plastic exudate and signs of
pleuritis, but without effusion. A strongylus gigas which was present
was supposed to have excited violent contraction of the diaphragm
and produced asphyxia.

The disease occurs in all ages, but most frequently about the
third year. Spring and Fall seem most propitious for its de-
velopment.

The lesions most commonly found at necropsies are ecchymoses
and multiple granulations of diverse form, covered with a fibrinous
exudate and macroscopically resembling sarcomatous nodules. On
this account this type of the disease was formerly regarded as can-
cerous pleurisy. The tubercle bacillus is often found swarming in
the nodules. In acute exudations of recent origin microorganisms
of suppuration, particularly staphylococci are usually also present.
The lesions are rarely confined to portions of one pleura, but usu-
ally invade the whole of the sac, or the opposite sac may be in-
volved. The lung of the affected side is generally more or less
atelectasic.

Contingent lesions are often present. There may be hydro-
thorax of the healthy side, pericarditis, ascites, and anasarca of the

The Thorax 12!

lower extremities. Mathis saw a complete torsion of the posterior
Jobe of one lung in an animal destroyed suffering from pleurisy,
which he attributed to the varied positions in which it had been
placed for examination.

Symptoms and Diagnosis. Pleurisy is ushered in by an in-
termittent chill lasting three or four days. This is followed by
fever and dyspnea, thirst, injected mucosae, accelerated pulsations,
and anorexia. ‘The urine is scant, and sometimes albuminous. The
dyspnea is very apparent, respiration being superficial and painful,
and characteristically abdominal. There may or may not be a
cough. When present it is short, dry, and painful. The thorax
is particularly immobile on the diseased side, primarily from pain,
but later from interference by the effusion. Auscultation prior
to the stage of effusion and during the course of resolution reveals
friction. After effusion has taken place percussion with the animal
in the standing posture shows dullness up to a certain level cor-
responding with that of the contained fluid. Above this there is
a tympanitic sound. If the position of the animal be changed, dis-
placement of the fluid occurs with corresponding shifting of the
dull area. The vesicular murmurs become inaudible, bronchial
breathing alone being apparent. In the later stages mucous rales
may be present owing to pulmonary edema engendered by stasis
of the circulation. If the ear is applied to the diseased side and
the chest struck sharply, a wave-sound is heard. On the healthy
side respiration is labored.

The course of the malady is variable and the prognosis must
be guarded. In some cases effusion takes place almost at the
outset, in others particularly of tubercular origin, friction sounds
are audible for several days. The liquid may fill the sac very
quickly, or it may take from fifteen to twenty days. The disease
may terminate in resolution, the liquid becoming totally absorbed,
or it may assume a chronic character, or death may supervene.
Resolution is indicated by progressive disappearance of the func-
tional derangements. It is always slow to take place when the fluid
is not removed by thoracentesis. Death may occur through colla-
teral congestion and edema, or through asphyxia when both sacs
are involved. Syncope may be suddenly produced by secondary
pericardial effusion, myocarditis, or metastatic tuberculosis, particu-
larly of the liver. Should friction sounds continue, it may be re-

122 Surgical Diseases and Surgery of the Dog

garded as an indication of the existence of tuberculous nodules, in
which case the animal becomes a menace to its kind, and possibly
to the human race. Tuberculin should always be injected to con-
firm the suspicion. Inoculation tests may also be made on rabbits
and cavies, but no reliance is to be placed upon them in case of a
negative result, for the reason that old effusions are sometimes
completely sterile, while the nodules may contain large numbers
of bacilli.

A not infrequent sequel to pleurisy is atelectasis or pulmonary
collapse, caused by peripheral compression of the lung proceeding
from pleural or pericardial effusion. The presence of the fluid
interferes with the inspiration of air, and the pressure gradually
forces out the residual air in the alveoli. It is usually confined
to part of a lung, but may involve the whole.

Treatment. At the outset of the disease counterirritation in
the form of mustard plasters should be applied, and the costal and
sternal regions protected by a flannel chest jacket. After effusion
has taken place medical measures are directed towards producing
purgation and diuresis and sustaining the heart. The fluid is
best removed by thoracentesis, and this operation should always be
resorted to when dyspnea is intense.

Purulent Pleuritis. This disease is always of pyogenic ori-
gin through accidental penetration of microorganisms (staphy-
lococci and streptococci) into the pleural sacs. Delafond regarded
traumatism as a frequent cause. A violent blow, such as by the
hoof of a horse or by the horn of an ox, resulting in fracture of
one or more ribs, may so enfeeble the resisting power of the tissues
as to permit of incursions by microorganisms. Another manner
in which the disease may originate is through perforation of the
esophagus by foreign bodies, such as animal or fish bones. In one
instance Siedamgrotzky found an ear of wheat in the left pleural
sac, the channel of entry of which could not be determined in
spite of careful search. In another, Weber found a spikelet of
rye which had perforated a bronchus. Leclerc saw a fatal purulent
pleurisy caused by the discharge of pus from an abscess in the
lung resulting from the presence of a briar thorn. Cancerous
tumors are also productive of purulent lesions.

Symptoms and Diagnosis. The symptoms are fever with a tem-
perature of about 105° F., profound prostration, arched back,a slight

The Thorax 123

thoracic distension and tension of the abdomen. A positive diag-
nosis of the presence of pus can be made by thoracentesis. The
disease is quickly fatal by toxemia or pyemia.

Hydrothorax. This term is applied to a secondary affection,
which consists of an effusion of the serous fluid into the pleural
sacs as a result of stasis of the circulation. It may be brought
about by neoplasms of the bronchial and mediastinal glands, chronic
diseases of the heart, pericardium and lungs.

Symptoms and Diagnosis. The symptoms are dyspnea, res-
piration with open mouth, fainting spells, and incapacity to ascend
stairs or move far. It may be distinguished from pleurisy by the
physical signs, and by the effusion being bilateral and symmetrical.
This affection being dependent on other lesions, thoracentesis can
effect but a temporary improvement.

HERNIA.

This is a lesion of rare occurrence. An observation has been
recorded by Peuch. The animal at each expiration, presented a
soft, quivering, spherical tumor about the size of a hen’s egg, at
the lower part of the left side of the thorax, between the sixth and
seventh rib. When the animal barked, the swelling attained the
size of the human fist. Palpation revealed a rent of the entire
thickness of the intercostal muscles, about two inches in length.
Peuch treated this case by maintaining a pledget of pitch and
resin over the seat of hernia by means of a bandage rolled round
the chest. In eleven days complete recovery had taken place.

Surgery of the Lungs

A good deal of major surgery has been done on the lungs
in an experimental way, showing that interference with these vital
organs is feasible.

Wm. Koch experimented to test the susceptibility of the lungs
to various surgical procedures. He performed acupuncture with
aspirating needles or pointed instruments on over twenty dogs.
Later on he injected iodide of potassium in solution of various
strengths. On examining the organs some weeks later scarcely any
scar could be found, and he came to the following conclusions: (1)

124 Surgical Diseases and Surgery of the Dog

the lung is insensible to wounds with little or no reaction, (2).
portions of lung may be destroyed by injections or by the galvano-
cautery without killing the animal.

Gluck went further than this. He extirpated the whole of one
Jung in six animals. The animals were chloroformed, and strict
antisepsis and careful arrest of hemorrhage observed. A bow-
shaped incision with the convexity towards the sternum was made
through the skin and pectoral muscles between the third and sixth
ribs, and the edges separated with a tenaculum. The broad in-
sertions of the serratus anticus major muscle were detached, and
portions, three to five inches in length, of the third, fourth, and
fifth ribs resected, external to the course of the internal mammary
artery. The intercostal muscles of the parts noted were also ex-
cised, and all bleeding carefully stopped. The intact pleura was
now seized with forceps and divided the entire length of the wound.
At the same moment the lung collapsed, and breathing became
accelerated. Then the entire left lung was ligated at the root
and removed en masse, or it was extirpated piecemeal. After
extirpation, the entire contents of the mediastinum were visible, in-
cluding trachea, esophagus, both vagi nerves, vena azygos, ductus
thoracicus and heart with great vessels. Most of the animals re-
covered, though this has not been the experience of experimenters
in this country.

Schmid also resected portions of one lung in eight dogs, and
of these three recovered and five died. Four of the latter suc-
cumbed to empyema, in Schmid’s opinion, owing to entrance of
septic matter from the divided bronchii.

THORACENTESIS.

This operation consists in removing pleural effusions by means
of trocar and canula, or preferably the aspirating syringe. In
cases of true pleurisy the necessity for its performance first occurs
from the tenth to the fifteenth day after the onset of the disease.

It is best performed with the animal in a sitting or standing
posture. Pfeiffer directs that the dog be laid on the table, but
Moeller has seen an animal die within a few minutes from being
placed on its side. The site of puncture should be disinfected and
the instrument rendered sterile.

A fine trocar and canula, or preferably an aspirating needle

The Thorax 125

may be employed. The latter is best, for the reason that entrance
of air into the thorax can be guarded against, and the flow of
liquid being more gradual is less liable to interfere with intra-
thoracic pressure and cardiac action.

The needle should be inserted in a somewhat forward direc-
tion at the anterior border of the sixth, seventh, or eighth rib,
after first pulling the skin slightly to one side. The intercostal
space can be widened by pushing one finger into it. Slight pain
is evinced on puncturing the skin. The cavity is reached as soon
as resistance to the passage of the needle has ceased. If a canula
is used the fluid at first gushes out in a continuous stream, then
rhythmically synchronous with respiration. During expiration
the flow ceases and air rushes in, which must be prevented by plac-
ing the finger over the end of the tube after each inspiration.
If the flow suddenly ceases it is through plugging by flakes of
fibrin, which can be forced back by reinsertion of the trocar. From
two to five ounces of fluid should be withdrawn, and the operation
repeated daily at a new site of puncture, until no liquid remains.
When the effusion shows no sign of abating, Cadiot and Breton
advise irrigation of the sac with normal sodium chloride solution,
at a temperature corresponding to that of the body. No other
or antiseptic solutions should ever be injected.

BIBLIOGRAPHY.

Cadiot & Breton—Médecine Canine.

Delafond—Journ. d. Méd. Vétér. Theo. et Pract. 1829, p. 445.
Leclere—Rec. de Méd. Vétér. 1886, p. 937.

Magnié—Rec. de Méd. Vétér. 1870, p. 861.

Peuch—Cited by Cadiot & Almy in Traité de Thér. Chir. d. An. Dom.
Pfeiffer—Operations Cursus.

Sherman—Awmerican Medicine. June, 1902.

Thierry—Cited by Cadiot & Almy in Traité de Thér. Chir. d. An. Dom.
Weber—Adam’s Wochenschrift. 1861, p. 64.

Wm. Koch—Langenbeck’s Archiv. f. klin. Chirurg. 15, p. 706.

The Heart and Pericardium

TRAUMATIC LESIONS.

Not very long ago it was generally believed that a wound of
the heart was necessarily if not immediately fatal, but thanks to
the experimental researches of Fischer, Kronecker and Schmey,
Elsberg, Ricketts, Sherman, and others, we now know that the
gravity of a heart wound depends on its ‘size, location, and certain

126 §=Surgical Diseases and Surgery of the Dog

other factors, and that even with fatal outcome death may be de-
layed to the extent of several hours. Between five and ten per
cent of all heart wounds terminate in recovery. It is known, how-
ever, that there is a spot in the septum, between the ventricles,
where simple puncture with a fine needle is followed by immediate
arrest of cardiac action. In other respects, when a heart wound
proves fatal it depends upon either of two factors, viz., acute
hemorrhage or intracardial pressure. In either case the same re-
sult ensues, viz., starvation of the organ. In the former case
the wound in the pericardium is sufficient to allow the escaping
blood to pass out through the external wound or into the pleural
sacs in such quantity that it no longer enters the organ in sufficient
volume to stimulate the muscle of the latter to contract. In the
latter case the rent in the pericardial sac becoming sealed from one
cause or another, the accumulating blood reacts on the organ by
compression. Cohnheim has shown this by injecting various quan-
tities of fluids into the pericardial sac, the pressure being mainly
sustained by the auricles and great vessels at the base of the heart.
The ventricles continue to contract, but the auricles and great ves-
sels being compressed the entry of blood gradually decreases until
the heart pumps itself dry, and finally the ventricles also cease.
Wounds may be penetrating or non-penetrating, but the hem-
orrhage from the former is usually more copious than from the latter,
though from the latter a hemorrhage may be as serious in its re-
sults as from the former. The hemorrhage usually takes place
during systole, but it may also occur during diastole when the
wound is very large. Wounds of the right ventricle bleed more
freely than do those of equal size in the left, the latter closing
by coagulation more rapidly than the former, owing to the greater
length of the wound canal and thickness of the wall. For the same
reason perpendicular penetrating wounds bleed more freely than
do oblique. Hemorrhage is more severe in wounds from sharp
instruments than from bullets. When a penetrating body plugs
the wound, so to speak, a fatal outcome may be averted, or at least
delayed, some hours. In Nocard’s clinic at Alfort a dog was re-
ceived whose heart was transpierced by an arrow. Its master had
endeavored to extract the missile, but the latter had broken off
short in the wound. The animal had then run for miles, and did
not succumb until the following day, Nocard remarked that had

The Thorax 127

the owner succeeded in extracting tne arrow the animal would
have died almost immediately from acute hemorrhage.

Symptoms and Diagnosis. Heart wounds are recognized by
the location of the external wound, the general evidence of hem-
orrhage, the acute anemia, the disturbance of cardiac function, and
the local signs of filling of the pericardium and pleura.

Treatment. For the class of wounds in which the hemorrhage
is confined to the pericardial sac the operation of pericardicentesis
is theoretically indicated, but it must be remembered that even if
the pressure is successfully removed the hemorrhage may begin
anew.

For the other class of wounds in which the blood escapes ex-
ternally or into the pleural sacs there is only one alternative, and
that is to open the thorax and suture. Modern surgery has shown
that suture of the heart is a perfectly feasible operation. But, there
are certain difficulties to be overcome in the case of the dog which
are likely to cause even the most skilful and progressive operator
to hesitate.

PERICARDITIS.

The term pericarditis comprehends any inflammation of the
external serosa of the heart and roots of the great vessels. Every
inflammation of this membrane is essentially of infectious origin,
the inflammatory products invariably disclosing the presence of
microorganisms. Idiopathic pericarditis is an unknown entity,
aseptic lesions always cicatrising without inflammation. The pro--
cess of infection is said to be primary when the pericardium is
the original seat of attack by microorganisms; it is said to be
secondary when the pericardium is invaded during the course of a
general infectious malady.

The disease may be acute or chronic, and two principal types
are recognized, viz., the sero-fibrinous and the purulent, depending
upon the properties of the causative microbe.

Sero-fibrinous inflammation of the pericardium, while being
rarer than that of pleura and peritoneum, is, nevertheless, by no
means uncommon. Its development is usually secondary, either
from pyemia, rheumatism, pneumonia, or distemper, but most often
from tuberculosis, when it may occur either singly or complicated

128 Surgical Diseases and Surgery of the Dog

with pleural and pulmonary lesions. Trasbot and Rousseau have
observed it to occur primarily as the result of a chill, such as an
animal may receive on entering water during the heat of the chase.
Such instances are probably due to the attack of microorganisms
already present in the blood, under a condition of lowered vitality
of the animal. The investigations of Porcher and Desoubry have
demonstrated that bacteria are constantly entering the circulation
by way of the alimentary canal under normal conditions.

In the acute form the sac is filled with a sero-fibrinous liquid,
which is often blood-stained. At times a profuse hemorrhage
takes place, causing extreme distension, which may lead to rupture.
Both parietal and visceral layers are beset with villosities and false
membranes, and the presence of tubercle bacilli may usually be
demonstrated.

The slowly developing chronic form is commoner, but it fre-
quently succeeds the acute. Most tuberculous dogs affected with
pleural lesions also suffer from chronic pericarditis. The effusion
is liquid, serous, more or less profuse, clear or yellowish, trans-
parent, and often free from microorganisms. The surface of the
visceral membrane is studded with bacilli-containing neoplasms,
varying in size from a grain of millet to a pea. In the vicinity
of the base of the heart, where there is least mobility, it is usually
consolidated with the parietal layer, and sometimes there is com-
plete fusion of the two membranes. When the latter condition is
present the heart sustains compression and atrophies, so that its
chambers can no longer contain the normal quantity of blood.
When there is considerable effusion present the lungs frequently
suffer from atelectasis owing to compression.

Pyemic pericarditis is characterized by miliary whitish foci of
suppuration. Both conditions usually lead to more or less myocar-
ditis, softening of the muscle, and dilation of the chambers, or
there may develop a diffuse fibrosis, particularly in narrow-chested
animals.

The chief secondary complications to which pericardial effusion
may give rise, are: venous stasis owing to partial collapse of the
veins entering the heart through pressure of the fluid in the peri-
cardium; impairment of cardiac action; mechanical valvular in-
sufficiency ; one or all of which may give rise to hydrothorax, ascites,
and anasarca, the latter sometimes limited to the posterior ex-

The Thorax | 129

tremities, and to the sheath in males. In two animals examined
post-mortem by Siedamgrotzky there were also hepatic cirrhosis
and interstitial nephritis.

Rupture of the sac may take place when there is much dis-
tension and softening of the wall during hemorrhage or tuberculous
pericarditis.

Symptoms and Diagnosis. The disease is rarely detected in
its incipiency. It may continue until the end of the animal’s natural
life without being suspected, its existence being only discovered
post-mortem. When effusion commences dyspnea is observed,
which becomes very marked as the amount of fluid increases. Later,
when it is present in profuse quantity the interference with the
heart’s action becomes a serious matter, the animal is prostrated,
its orbits project, its expression is anxious, it breathes with great
difficulty, cyanosis develops, and distension of the jugular takes
place at the slightest exertion. The pulse is frequent, small, and
feeble, or it may be slower than normal and irregular. There is
an active thirst, but infrequent micturition, and the animal pro-
gressively emaciates.

In making a diagnosis pericarditis must not be confounded
with pleuritis. Wiéith a phonendoscope or good stethoscope the heart
beat can be plainly heard when the effusion is exclusively pleural,
whereas it can scarcely be detected when the effusion is confined
to the pericardium. In the latter case a splashing sound isochron-
ous with the cardiac movements can generally be heard, and there
is an area of dullness corresponding to the distended cardiac sac.
It must be remembered that both pleuritis and pericarditis may co-
exist. Accordingly, in every instance where thoracentesis is prac-
ticed, auscultation and percussion over the region of the heart is
indicated after removal of the pleural effusion.

A test injection of Tuberculin should also be employed for
prognostic purposes.

Treatment. Medicinal treatment is directed towards sustain-
ing the heart, reducing the inflammatory process, and preventing
complications. Vesicating agents, such as mustard and blisters are
said to produce good results. Digitalis, caffein and diffusible
stimulants are administered to combat cardiac asthenia. The best
way to remove the effusion is by the operation of pericardicentesis,
but many practitioners place much faith in hypodermic injections of

10

130 ©>s Surgical Diseases and Surgery of the Dog

pilocarpin. When the symptoms are grave operative measures are
imperative. (See Pericardicentesis. )

HYDROPERICARDIUM.

By this term is meant any non-inflammatory, passive effusion
of serous fluid into the pericardial sac. Like any other hydropsy
this condition is always of a serious nature, developing through
local stasis of the circulation owing to valvular lesions, auricular
tumors, pulmonary affections and chronic pleurisy, whereby starva-
tion of the pericardial capillary cells and filtration of some of the
fluid constituents of the blood take place. It may also develop
through capillary poisoning incident to chronic nephritis and cancer-
ous and tuberculous cachexia, and more or less during the agonal
period. It is nearly always associated with hydrothorax, the origin
of which generally precedes it, and very frequently with ascites
and anasarca.

The exuded liquid is clear and yellowish, or slightly tinged by
admixture of hemoglobin or blood. It contains less albumin than
blood serum, and a certain quantity of fibrinogenous material, which
causes it to undergo coagulation when exposed to the air. The
walls of the sac are pale and lack inflammatory adhesions. Benja-
min saw a case of hydropericardium associated with thoracic adeno-
pathy, in which the parietal serosa was beset with slightly granular
patches.

Symptoms and Diagnosis. The same physical and functional
signs are present as in pericarditis proper, but without elevation of
temperature.

Treatment. The same treatment is indicated as for pericar-
ditis.

Surgery of the Heart ;

That the heart is capable of sustaining operative interference
with subsequent perfect recovery of the animal has been amply
proved experimentally. In 1895, Rosenthal, who up till that time
was the first to attempt treatment of a wound of the heart by
direct means, exhibited to the Medical Society of Berlin a dog,
which had survived and fully recovered from resection of the
sternum and an experimental cardiac wound. Shortly after, Del

The Thorax 131

Vecchio succeeded in saving a dog which had sustained two ex-
perimental perforating wounds of the left ventricle and subsequent
suturing of the same, and since then, Salomoni, Philippov, and the
other experimenters previously mentioned have determined the feasi-
bility and usefulness of suture of the heart and pericardium with vari-
ous results. More recently Tuffier and Hallion have made a very in-
teresting demonstration. They anesthetised a dog until respiration
and cardiac pulsation had ceased. After a minute’s waiting, with
no sign of return of life, they incised the sixth intercostal space
and forced the ribs apart. The heart was seen to be perfectly still.
It was then seized between the fingers in such a manner that the
apex lay in the palm of the hand, while the ventricles were encircled
by the fingers. The next step was massage of the organ by com-
pression. For a period of one minute it remained motionless;
then very feeble intermittent contractions were apparent. It pro-
pressively recovered its functions and respiratory efforts recom-
menced. The thorax was closed, and the animal eventually re-
covered.

As has been pointed out under Traumatic Lesions of the Lungs,
it is impossible to open the pleural cavity to any extent without re-
sorting to artificial respiration, and for the same reason provision
cannot be made for drainage, and since it is rare to accomplish
surgical interference with this part of the organism without the
introduction of pathogenic microorganisms, in spite of the utmost
care, the usuat termination is a lethal one from septic infection.
However, there have been several recoveries from experimental
wounding and opening of the pleura and pericardium, and a clinic
case has been recorded by Delafond in which the pericardium
having been perforated by a wild-boar, the wound in the thorax
was closed with sutures, and in eight days the animal recovered.

SUTURE OF THE HEART.

The technic of this extremely delicate operation is as follows:
Every aseptic precaution being observed and the animal being
secured and anesthetised, the first step is to perform tracheotomy,
insert a tube in the trachea and connect the same with bellows,
which must be entrusted to the hands of a capable assistant, whose
whole attention must be bestowed on this important part of the
operation. A free longitudinal incision is made on the left side

132 Surgical Diseases and Surgery of the Dog

through the skin and pectoral muscles along the border of the
sternum from the third to the sixth ribs. The broad origin of the
serratus anticus major muscle is dissected, and the third, fourth
and fifth ribs divided beyond the course of the internal mam-
mary artery, and the intercostal muscles carefully severed. The
edges of the wound must then be retracted, or about an inch of each
rib may be removed. The intact pleura is now observed. All
bleeding being absolutely stilled, the pleura is incised along the
course of the wound. At the same moment the lung collapses and
respiratory efforts become labored. At this point artificial respira-
tion must be started up. The pericardial sac is quickly grasped,
drawn up into the wound, sutured to the muscles round the edges
of the thoracic wound, and opened by longitudinal incision. There
is no bleeding from the pericardium. The heart is brought up into
the opening in the chest wall by means of two long traction sutures
inserted on either side of the wound, and carried deep into the
ventricular wall, such manipulation in no wise interfering with its
function. Bleeding from the wound can be immediately stopped
by crossing the sutures and holding them taut. The permanent
sutures of silk are next placed, and these should be continuous,
superficially inserted and tied during diastole, the knots being firmly
secured. The next step is to make a complete toilet of the sac.
The latter is then closed by continuous silk suture, the chest wall
is sutured, including the divided muscular tissues, and finally a
subcuticular suture is inserted in the skin. The bellows should be
forcibly blown up just as the chest is closed, in order to expel alli
the air possible. Natural respiration shortly recurs, the bellows are
withdrawn, and the tracheotomy wound closed.

PERICARDICENTESIS.

This operation is resorted to whenever extinction of life is
threatened through distension of the sac by effusion, or when
secondary hydropsies have developed. There is little or no danger
attending it, as Elsberg has shown in his experiments that needle
punctures are always small, and though there is slight hemorrhage,
which is more considerable in the auricles than in the ventricles, it
soon ceases, and is never enough to endanger life.

The operation should be performed with an aspirator provided
with a short needle of minute caliber thoroughly sterilized. Em-

The Thorax 133

ployment of such a needle reduces the danger of syncope from too
tapid or sudden withdrawal of fluid to a minimum. The instru-
ment is used in the following manner: Shut the cock and withdraw
the piston to form a vacuum within the barrel of the syringe. Select
a portion of skin inferior to the area of dullness and disinfect it
as thoroughly as possible. Introduce the point of the needle under
the skin at this spot, open the cock, and press the needle slowly
inward until resistance ceases and the liquid is seen to gush into
the syringe. Shut the cock and empty the syringe, and repeat the
same action until the fluid is nearly all removed. Perform the
operation again and again if the effusion recurs.

BIBLIOGRAPHY.

Delafond—Rec. de Méd. Vétér. 1829, p. 714.

Del Vecchio—Rif. med. 1895, p. 50.

Elsberg—Journ. of Exper. Medicine. Sep.-Nov., 1899.
Fischer—Langenbeck’s Archiv. f. klin. Chirurg. 1867, p. 571.
Nocard—Arch. Vétér. 1882, p. 401.

Phillippov—Russ. med. 1886, p. 187.

Porcher & Desoubry—Comptes rendus d. 1. Soc. de Biol. 1895, p. 844.
Ricketts—American Medicine. June, 1902.

Rosenthal—Deutsch. med. Wochenschr. 1895.

Salomoni—Centralb. f. Chirurg. 1896.

Sherman—American Medicine. June, 1902.

Siedamgrotzky—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1872, p. 50.
Tuffer & Hallion—Comptes rendus d. 1. Soc. de Biol. 1898, p. 988.

CHAPTER V
The Abdomen

Abdominal Section. Celiotomy. Laparotomy

The operation of opening the abdominal cavity of a healthy
animal is ordinarily remarkably free from any ill-effect. It is ex-
ceedingly rare that peritonitis supervenes, even when the precau-
tions amount merely to an observation of the ordinary rules of
cleanliness. In fact, it may be unreservedly asserted that the
necessity for antisepsis, so far as fear of infecting the peritoneum
is concerned, has been greatly overrated. Numerous experiments
and abundant clinical observation have demonstrated beyond any
doubt that the peritoneum of the dog possesses extraordinary re-
fractory power against the action of pyogenic microorganisms.
(See The Peritoneum). There is little risk of peritonitis resulting
from introduction of any limited infection from without, such as
may occur during the course of an operation when the peritoneum
comes in contact with even the unwashed hands. Neither is there
any greater risk after it has been sealed by suturing of the muscular
wall. This is due to the well-known fibrinoplastic property of the
peritoneum. Wounded peritoneum possesses a remarkable power
of adhesiveness when brought in contact with peritoneum. This
fact is beautifully demonstrated during suturing operations of the
peritoneum, when fibrinous adhesions may be observed to form
and firmly bind apposed surfaces within a period of some half-
dozen minutes. The chief danger arises from the presence of much
putrescible matter, such as large blood clots and portions of organs
isolated from their vascular supply by ligature, etc., and allowed to
remain. The slightest infection sustained by quantities of such
matter is very liable to lead to general peritonitis. Extravasations
from the alimentary tract following imperfect apposition or suturing
of surgical wounds of the intestinal walls are always highly danger-
ous. In the various visceral-suturing experiments that have been

134

The Abdomen 135

carried out on dogs these conditions have been chiefly the cause of
fatal termination. But even when infective processes have started
up the disposition of the membrane with its pockets and recesses
offers opportunity for localization.

While the above remarks are true with regard to the dog in
health, the conditions are changed when, for instance, the peri-
toneum has already been subjected to infection, as may occur in
cases of intestinal obstruction, and there is then some risk to be
considered. Infective processes are then more likely to arise, not
only by direct migration of bacteria, but through their deposit
from the circulation. When an intestinal obstruction has existed
for any length of time a state akin to septicemia is produced, namely,
copremia, or in other words, the blood is charged with the pro-
ducts of intestinal putrefaction, together with the bacteria causing
the same. Under these and like circumstances, the wound may
tend to heal unkindly, and may even lead to unfavorable termina-
tion, but even here the risk may be greatly reduced by adequate
provision for drainage.

Because of this remarkable tolerance of abdominal sec-
tion, the practitioner need never shrink from undertaking the
operation as an explorative measure. It is not always pos-
sible to corroborate a,diagnosis of internal lesion by external
appearances or palpation. Especially is this the case in plethoric
animals and where the lesion is situated in a position remote from
the surface of the body. For instance, an animal may exhibit all
the symptoms of acute impermeability of the intestinal canal—in-
tractable vomiting and suppression of defecation, with extreme pros-
tration—and yet the abdominal wall may be so tense as to preclude
the possibility of diagnosis by palpation. Again, it is very difficult
in gunshot cases to decide whether the intestine or any other organ
has been perforated or not. The appearance of the external wounds
has no diagnostic value, since there is no gaping of the parts owing
to contraction of the abdominal muscles, and it is often impossible,
and in most cases inadvisable, to use a probe. Sometimes the sexual
impulse is manifested after ablation of the ovaries. This is generally
due to the persistence im situ of a portion of the ovarial tissue, which
can be ascertained by an explorative operation. It is recognized that
the sudden accidental application of a violent compressive force to
the abdomen when the bladder is distended is very apt to cause rup-

136 =©. Surgical Diseases and Surgery of the Dog

ture of the latter or even of other organs and bloodvessels. In such
cases it is a wise procedure to open the cavity when there is evi-
dence of systemic collapse. Internal hemorrhage through rupture
of even lesser vascular branches is always dangerous. Divided ves-
sels of the abdominal cavity possess a remarkable tendency to bleed
persistently. If, however, air be admitted through abdominal sec-
tion the conditions are quickly altered, clots commencing to form.
Such vessels, however, should always be secured to guard against
a recurrence of the hemorrhage when the cavity is closed and it
thereby returns to its former condition.

The operation should invariably be performed with the subject
under the influence of an anesthetic. Not only do humane con-
siderations demand this, but the accurate conduct of a delicate
operation on a struggling animal is an impossibility. Before the
abdomen is opened every possible contingency must be fully con-
sidered, so that the necessary instruments, surgical aids and sutures
be prepared, rendered aseptic and laid handy.

If it be possible to arrange, the animal should receive no food
for twenty-four to forty-eight hours previously, and also receive
a purgative. A distended bowel is always a particular annoyance
to the operator by reason of its tendency to extrude itself.

With regard to the selection of a site for section, it may be said
there are two main positions—the lateral and the median. Each
has its advocates, and without doubt each certain advantages over
the other. But it must be borne in mind that no absolute rule
can be laid down in the matter. Neither position is peculiarly
suitable for reaching every organ, and the operator must be gov-
erned by the conditions present. Most of the organs can be
reached by the median line, and this position has much to com-
mend it. It can be performed almost bloodlessly, it can be easily
enlarged, it affords better access to all parts of the cavity for ex-
plorative purposes, and it permits of perfect drainage. Further, any
resultant scar is not observable when the animal is in the standing
position. The chief objection offered against it is said to be the
greater risk of the dissected parts failing to become united. I can-
not concur in this opinion, never having experienced the misfortune
of hernia. La Torre holds that such risk is reduced to a minimum
if the incision is made through the muscular tissue of the rectus
abdominis, slightly to one side, and not through the aponeurotic

The Abdomen 137

tissue of the linea alba. Union of muscular fiber, particularly by
first intention, is always stronger than union by granulating cicatri-
cial tissue. Human surgeons recognize that the commonest factor in
the development of hernia is an infection causing the wound to fill
in slowly with scar tissue. Median section has a disadvantage in
males, in that the wound may become soaked with urine. Even
if the incision be made posterior to the preputial orifice, and this
difficulty thereby avoided, there still remains a pronounced tendency
to the development of suppurative processes. The reason for this
is to be attributed to the proximity of the penial mucosa, which is so
often the seat of catarrhal discharges, and whence microorganisms
can so easily be transmitted to the wound during the course of an
operation, and later by the animal licking the parts.

In the lateral position the risk of hernia is almost mil, but
among the drawbacks are: the greater thickness of muscular tissue
which must be divided; the necessity of securing the epigastric
vessels ; and the tendency of pus to burrow between skin and wall,
and even into the peritoneal cavity in the event of the wound sup-
purating during healing. Should purulent peritonitis intervene,
either from such burrowing or incident to secondary operations on
internal organs, the chances of recovery are remote, in consequence
of absence of drainage.

Generally speaking, the organs are best reached as follows: the
stomach, spleen, pancreas, and liver, in the anterior third—1. e.,
immediately posterior to the thorax; the ovaries and intestines ex-
actly in the center of the distance between the ensiform process
and the symphysis pubis; the uterus, bladder, ureters, and rectum
immediately anterior to the pubis.

When the operation is undertaken as an explorative measure
the surgeon is, figuratively speaking, groping in the dark. In such
instances the middle third should be chosen.

Instances have been recorded where it has been found neces-
sary to close the first incision and make a second one before the
seat of lesion could be reached. Venneholm described an opera-
tion for fecal impaction, the mass of which was lying in front of
the pubic bone. The mass was mobile, and the operator expected
to reach it without any trouble. The first incision was made in
the linea alba, but the obstructed portion of the bowel could not
be extracted. It was then necessary to make a second incision to
the side of the prepuce.

138 «Surgical Diseases and Surgery of the Dog

Gluck, in his experimental extirpation of the liver, found the
organ could be reached most conveniently by incising from the
ensiform process to the costo-vertebral articulation of the eighth
rib, and resecting the eighth and ninth ribs. Griffiths, in his ex-
perimental surgery of the pelvic viscera, found he could expose
the latter to better advantage by dividing the symphysis pubis and
then separating both sacro-iliac synchondroses by forcibly turning
the iliac bones outward. The bones can be separated two inches
or more.

The animal being secured in the proper position with hopples,
the skin in the immediate vicinity of the contemplated incision is
clipped or shaved of its hair and scrubbed with warm water and
soap. The incision is made with a sharp scalpel, and should not
be less than two inches in the smallest animals, while in the larger
breeds it may be found necessary to make the wound large enough
to admit the whole hand. To reach the cecum and kidney always
requires a large incision, owing to their remote position. The skin,
subcutaneous connective tissue and muscles are successively divided,
the fibers of the latter being separated according to the direction
in which their course runs. Three muscular coats require to be
divided in the extreme lateral position—the obliquus externus, the
obliquus internus, and the transversalis. In the median line there
are the aponeuroses of these muscles and a single true muscular
coat—the rectus. In the male prepubic median section is made by
incising the skin immediately to one side of the penis and dislo-
cating the latter—4. e., by pushing it in the opposite direction. In
making this incision one must avoid wounding the posterior epi-
gastric vein—a prominent vessel which runs on either side a short
distance from the penis. There is always slight hemorrhage in
this region. Section of the muscular wall can then be made in
the median line as in females. Froehner believes he can guard
against contact with urine and secure better prospect of healing
per primam in males by making always a lateral incision about
one and one-half to two inches to one side of the linea alba, and
subsequently painting the surface of the wound with a solution
of iodiform in ether (20:100). Stoss opens the muscular wall by
thrusting a grooved director through at one commissure of the skin
incision, after making the latter, and passing it with the groove
uppermost in contact with the inner surface of the wall along a

The Abdomen 139

line corresponding to the contemplated incision. There is no danger
of piercing the bowel with a blunt director, and if any portion of
the former should be caught up it is perceptible through the wall
as a slight elevation. In that case the director is withdrawn far
enough to release the gut and again passed. With the director
as a guide, the incision in the muscle wall is made with a bistoury.

Any vessel being divided, it is grasped with hemostatic for-
ceps, which generally suffices to arrest the flow within a minute or
two. The epigastric vessels should always be ligated. All hem-
orrhage being under control, the peritoneal coat may be picked up
with the dissecting forceps and pierced with the scalpel, or it may
be gently incised in situ, and the opening enlarged with the finger.
Beneath is found the omentum major, excepting just in front of the
pubic border. It may be gently pulled away from the hypogastric
region and stowed away in the epigastric, or an opening may be
made in it by tearing at a point opposite the incision.

The viscera are now exposed to view, and the necessary sup-
plemental operations demanded by the exigencies of each par-
ticular case are immediately undertaken.

There is generally some tendency to protrusion of intestinal
coils. This must be guarded against as much as possible, though
it is rare that any evil effects follow prolonged exposure. It may
be prevented by temporarily inserting flat sponges or small cloths
(sterilized) just within the wound. The radiation of heat
incident to prolonged exposure tends to lower the vitality of the
peritoneum, whereby its eliminative or absorptive power is checked.
Vincent in his experiments found that there was more likelihood
of peritonitis developing after exposure of the bowel, and regarded
it as important not to let any escape. Should it be necessary to allow
of any considerable protrusion of viscera it is advisable to carefully
protect the exposed organs with sterile gauze wrung out in hot
water and repeatedly applied. It is a good plan, when an opera-
tion is likely to last a considerable time, to employ a “‘celiotomy
cloth.” This consists of a piece of cloth with a slit in it made to cor-
respond with the skin incision, and sterilized. It is laid over the
abdomen, and thus prevents contact of protruding organs with the
skin. A full bladder, which is often an interference, may be
emptied by direct pressure.

The pelvic cavity is opened by extending the skin incision to

140 Surgical Diseases and Surgery of the Dog

the hinder border of the symphysis pubis (passing to one side of
the penis in the male). The symphysis is cut by means of a strong
knife or small hand-saw. One must avoid injuring the dorsal
veins of the penis in the male and the plexus of the veins from
the clitoris in the female, as hemorrhage therefrom is somewhat
difficult to control. A small block of wood is placed under the
sacrum, and the iliac bones forcibly turned outward so as to pro-
duce a fracture-dislocation at the sacro-iliac synchondroses. Resti-
tution of continuity of these parts is accomplished by wiring the
bones at the symphysis according to the methods employed in
bone suturing.

When it is desired to close the abdominal wall a careful in-
spection must be made to ascertain whether any blood clots or
other putrescible material or sponges remain in the cavity. These
are to be removed, as their presence is conducive to peritonitis.

No antiseptic solution for cleansing purposes should ever be
allowed to come in contact with the delicate peritoneum. Sterilized
water is the only permissible liquid.

If the omentum has been misplaced it should be returned as
nearly as possible to its original position. Any rents in this organ
should be sutured, otherwise there is risk of a loop of bowel pass-
ing through the same, when the condition would be ripe for
strangulation. Though I have never known strangulation to re-
sult from such conditions, once, while performing a necropsy, I
found a coil of small intestine protruding through a rent I had
made some two weeks previously in the course of a resection ex-
periment.

In intestinal operations the omentum is sometimes soiled, in
which case it may be advisable to remove the contaminated por-
tion, but it is very important to securely ligate any bleeding vessels.
In one of Senn’s experimental cases it was deemed advisable to
remove a portion of the omentum. The animal died the next day
owing to hemorrhage of the omentum by slipping or loosening of a
catgut ligature. Senn advises against ligaturing of the omentum
or mesentery en masse, but each individual vessel should be searched
for and secured separately with aseptic silk. One reason for this
is that tissues often shrink after operation, whereby ligatures be-
come loosened, so that it is dangerous to include a large area in a
single ligature. Parks has also pointed out that the stumps of

The Abdomen I4I

ligated omentum tend to give rise to trouble through mortification
of the occluded end. But, unless the conditions actually demand
its removal, it 1s bad surgery to excise this organ. For the omen-
tum performs an important function in the healing of abdominal and
visceral wounds. It plays the part of an operculum, invariably be-
coming adherent to the internal face of the wound or to wounded
surfaces of organs. In certain cases of hernia where its reduction
would present considerable difficulty it may be removed with ad-
vantage.

Because of this protective capacity of the omentum, which is
in reality a fold of peritoneum, it is quite unnecessary to stitch the
parietal peritoneum.

In certain cases provision must be made for drainage. I have
reference to conditions threatening to give rise to peritonitis.
Wherever perforation of the bowel or infected uterus is on the verge
of taking place, or has taken place, or microbic invasion has al-
ready occurred, the necessity for drainage becomes imperative.
The method is simple, and requires only the insertion of a strip of
sterile gauze in the course of the wound, one extremity being placed
within the peritoneal cavity, the other being allowed to protrude
through the skin. This should be left in place some five or six
days.

In bringing the edges of the muscular wound into contiguity
some operators apply independent sets of sutures to each of the
divided coats. Others use but one set of sutures to include all the
coats. In the median position there is but one small muscular coat
to unite, though the aponeuroses of the others should be included.
Much of the strength of the abdominal wall lies in the fascia in
front of the recti muscles. When interrupted sutures are used no
stitch should be tied until all are inserted, the curved needle being
employed, and then tying is to be commenced at each commissure
and gradually completed toward the center. When the opening
has been made directly through the linea alba, La Torre advises
that the aponeurotic tissue be removed as far as the muscular sub-
stance of the recti muscles, owing to the yielding tendency dis-
played by cicatrices of the former class of tissue.

When the epigastric artery and veins have been tied, the liga-
tures are very apt to become displaced or slip while the sutures are
being applied to the wall. This accident may escape the operator’s

142 Surgical Diseases and Surgery of the Dog

notice, and a fatal hemorrhage result. Znamensky lost a case in
this manner. Wherefore, careful attention should be paid to this
matter.

I consider the best way to suture the muscular wall is to em-
ploy the continuous suture of silk and allow both ends to protrude
through either extremity of the wound in the skin, along with the
ends of the buried skin suture. At the end of seven or eight days
the stitches may be removed by pulling sharply on one of the pro-
truding ends with forceps. Permanent sutures, 7. e., sutures which
are desired to remain permanently in the tissues, are capable of
giving rise to further trouble, hence it is always advisable to em-
ploy temporary ones.

Divided muscle unites very readily by first intention, ¢. e., by
adhesion of the cut edges through organization of inflammatory
serum by fibrin, provided the edges are brought into accurate ap-
proximation by sutures, and no suppurative process takes place in
the subcutaneous connective tissue to hinder. If reunion of the
divided muscle takes place with a minimum formation of connec-
tive tissue, the strength of the wall is little impaired, and the chances
of a resultant hernia are remote.

The importance of securing accurate approximation of all di-
vided subcutaneous tissue cannot be overestimated. The formation
of spaces must be guarded against as much as possible, for, as has
already been pointed out, such spaces, if infected, form suitable
foci for suppuration. The reason why pus is so apt to form in
males is owing to the proximity of the penial mucosa, which is
so commonaly the seat of catarrhal disorder, and the ease with which
‘bacteria are carried thence by the tongue of the animal or by the
surgeon during the course of an operation. The wound made
when the penis is dislocated in order to reach the median line is
particularly prone to suppurate. The connective tissue in this
locality is deep, and when divided tends to form quite a cavity
under the sutured skin. Therefore, it is always a wise precaution
to draw the divided subcutis together with a few sutures whenever
any gaping is evident. For the skin by far the best suture is the
subcuticular, insuring, as it does, the utmost protection from in-
fection from without. Any of the non-absorbable material may
be used, as it is easily removed, but silk is to be preferred.

The wound should be examined closely for the succeeding day

The Abdomen 143

or two for signs of suppuration, and if such be discovered it must
be promptly opened and the matter evacuated. A subcutaneous
abscess without drainage is always dangerous. Indeed, fatal ter-
minations have been recorded where such seemed to have been the
sole cause of death either through septicemia or pyemia. _Peter-
son lost two cases in this manner, eight and thirteen days after
the operation, respectively. Froehner says they are productive
of septic endocarditis. Where there is no infectious disease of
the teeth, or no discharging wound or disease process present,
whereby infection of highly virulent microorganisms could be trans-
mitted by the tongue of the animal, anything in the nature of a
protective bandage is best dispensed with, particularly when the
subcuticular suture is employed. As a rule, a dog soon learns
to work its muzzle in under a bandage to lick the wound. But,
in the excepted instances noted, it is advisable to protect the wound
as much as possible with gauze and linen bandages and a plentiful
supply of antiseptic powder.

An animal that has been subjected to laparotomy should be
restrained from taking active exercise for a few days, so that no
risk be run of the sutures tearing out from some sudden movement.

Occasionally, if non-absorbable sutures have been inserted in
the muscular wall, they fail to become encapsulated, and a sinus
is established long after apparent healing of the skin has taken
place. In such cases a director must be passed into the extremity
of the tract, and by means of a curved bistoury sufficient of the
parts laid open again to permit of the offending thread being ex-
tracted.

As has already been stated, purulent peritonitis occurring as a
result of intestinal perforation owing to imperfect suturing in sec-
ondary operations, or from the presence of *putrescible material,
or other causes, is an occasional sequel. If from symptoms of
collapse or local manifestations such condition can be diagnosed,
no time must be lost in reopening the cavity to establish drainage,
either in the same position or a new one. Internal lesions must
be attended to and the cavity irrigated with moderately hot water.

Kummer related an instance of a dog tearing out the abdominal
sutures three weeks after operation, and succumbing as a result
thereof in thirty-six hours, and Moeller recorded a similar occur-
rence. Caution must be observed in the feeding of an animal

144 Surgical Diseases and Surgery of the Dog

subsequent to this operation. Hobday found that a hearty meal
of solids is apt to induce violent peristalsis after the bowel has
been at rest for a longer or shorter period, and may cause tearing
out of the sutures and protrusion of the intestines through the
abdominal wound. For similar reasons vomiting must be guarded
against.
BIBLIOGRAPHY.

Froehner—Monatsh. f. prakt. Thierheilk. 1893-94.

Gluck—Langenbeck’s Archiv. f. klin. Chir. 28, p. 3.

Grifiths—Journ. Anat. & Phys. 1894-95, 29, p. 62.

Hobday—Journ. Comp. Path. & Therap. Sep. 1899.

Kummer—Langenbeck’s Archiv. f. klin. Chir. Pos, p. 534.

La Torre—La Gynéc. April, 1897.

Moeller—Lehrb. d. spec. Chir. f. Thieraerzte.

Parkes—Gunshot Wounds of the Small Intestines, p. 27.

Peterson—Journ. Amer. Med. Assn. 1901, p. 808.

Senn—Intestinal Surgery. p. 181.

Stoss—Monatsh. f. prakt. Thierbeilk. 1896-97.

Venneholm—tThieraerztl. Centralb. June, 1898.

Vincent—Rev. de Chir. 1881, p. -
Znamensky—Langenbeck’s Archiv. . kip. Chir. 31, p. 149.

The Peritoneum, Mesentery, and Omentum

The Omentum and Mesentery being but duplicatures of the
Peritoneum will be considered together with the latter.

TRAUMATIC LESIONS.

Wounds of the peritoneum occur as a complication of pene-
trating wounds of the abdominal wall. So long as such lesions do
not bring about the presence of putrescible material they usualy
terminate favorably, repair by fibrinoplastic formation quickly fol-
lowing.

Treatment. In general, uncomplicated peritoneal wounds
should be left to themselves, the only indication for surgical inter-
ference being the presence of putrescible material, when removal
of the latter and irrigation should be practised. It would seem
as if Nature had destined the Omentum to play the part of a
reparative or protective operculum, for this organ invariably be-
comes adherent to the site of peritoneal wounds.

Mesenteric and Omental wounds should always be sutured as
they predispose to strangulation by passage of a loop of bowel
through them. But omentum and mesentery should never be li-
gated en masse, but each individual vessel should be searched for
and sutured separately, because tissues often shrink after operation

The Abdomen 145

whereby ligatures become loosened, and because the stumps tend
to give rise to trouble through mortification.

PERITONITIS.

It will be remembered that the peritoneum is a large lymph
sac normally possessed of a remarkable absorptive capacity. Pro-
vided this property remains unimpaired it is rendered but moder-
ately susceptible to the action of pathogenic microorganisms. The
experiments of Wegner and Grawitz have shown that considerable
numbers of the ordinary forms of pyogenic microbes may be in-
troduced into the peritoneal cavity without any particular effect on
the animal, provided the absorptive power of the peritoneum is not
impaired. Reichel found that peritonitis developed only when the
quantity of putrescible material exceeded that amount which could
be eliminated within a limited time. Waterhouse injected 6 cc.
of cultures of staphylococcus aureus, streptococcus, and intestinal
bacteria, respectively, and found the animals survived. He then
tried to produce the same conditions which sometimes exist after
operations by introducing 8 cc. of urine and small quantities of blood
with the cultures, and still the animals lived. But the presence of
considerable quantities of putrescible material, such as blood clots
3 cc. in size when the cultures were introduced, was followed by
death in twenty-four hours. Cats suffering from ascites quickly
died from peritonitis, owing to diminished absorptive activity of the
peritoneum and the presence of a favorable culture medium. Hal-
sted introduced pieces of sterile potato, and found they became en-
capsulated without producing any disturbance, but when infected
with pyogenic organisms invariably caused peritonitis. Welch
made similar observations, and found’ further that an infected
wound readily and uniformly suppurated when it contained masses
of tissue strangulated by ligature. He made a large number of ex-
periments by ligating portions of omentum and then injecting cul-
tures of staphylococcus aureus into the peritoneal cavity. In most
cases general peritonitis developed, in some cases localized peritoni-
tis and in others no peritonitis followed the inoculation.

The conditions which impair the refractory power of the peri-
toneum are: General systemic conditions producing a lowering of
vitality, and presence of putrescible material in quantity in excess

Et

146 Surgical Diseases and Surgery of the Dog

of a certain amount which can be eliminated within a limited period.
The actual cause of the disease is always a septic infection. It is
customary to speak of a plastic type of peritonitis but this is purely
a regenerative process produced by aseptic causes, such as trauma-
tism or the passage of an aseptic fetus from the uterus (Blanc).
It attends every healing of aseptic wounds. Certain cysticerci also
provoke inflammatory secretions, but this is very rare. Pathogenic
microbes gain access to the peritoneum through penetrating ab-
_ dominal wounds, including septic surgical wounds, perforation of
any part of the gastro-intestinal tract, the spontaneous opening of an
abscess into the cavity, the perforation of the uterine wall in cases
of pyometra, by migration from contiguous tissues in septic inflam-
mation of the latter or following a sudden lowering of vitality as
may take place when a chill is sustained, and even by localization of
circulating bacteria as occurs in tuberculosis.

The disease may be acute or chronic, circumscribed or diffuse.
Contrasted with the other great serous sac of the body, the pleura,
the peritoneum offers opportunity for localization of infection by
reason of the coils of viscera forming pockets and recesses wherein
it may be and often is confined. The prognosis of the acute diffuse
firm is always grave.

Symptoms and Diagnosis. In the acute form the disease is
ushered in by depression, coldness of the extremities, rapid pulse,
and tenderness of the abdomen to palpation. In the early stages the
temperature is elevated but later becomes subnormal. Soon retch-
ing or vomiting appear and death takes place by toxemia. In some
cases the symptoms closely resemble those of intestinal obstruction,
but the distinguishing feature of the latter diseases is the stercora-
ceous vomiting. The circumscribed form is often unrecognizable on
account of the absence of any indicative symptoms.

Treatment. As this disease is caused by pyogenic microbes the
early removal of pathogenic foci which threaten to rupture into the
cavity is indicated. If septic material is already present or the con-
ditions are such that accumulation of putrescible material is likely
to ensue the cavity must be opened, flushed with warm sterilized
water, and free drainage established by means of folds or strands of
aseptic gauze introduced well within the cavity and the dependent
extremity carried outside the skin wound. These should be left in
place some four or five days. At the same time efforts must be di-

The Abdomen 147

rected towards keeping up the heart’s action, and encouraging the
elimination of morbid matter through the excretory organs.

ASCITES.

This is a trouble of purely mechanical nature, the result of im-*
paired circulation. It must be remembered that there are two cir-
culatory systems in connection with the abdominal cavity—the sys-
temic and the portal, and that anything which arrests the circulation
in either of these is liable to lead to ascites. The most frequent cause
would seem to be cardiac lesions, producing altered relationship be-
tween arterial and venous blood pressure and blood flow. There
then follow venous stagnation, capillary starvation and distension,
and transudation of certain of the fluid constituents of the blood.
Cadiot witnessed thirty-seven cases in less than three years and based
thereon statistics of the relative frequency of occurrence of the
various causes of the disease. Of twenty-eight cases, ten of the ani-
mals were afflicted with cardiac disease (pericarditis-7, mitral
lesions-2, tricuspid lesions-1). |The next most frequent factor was
tuberculosis of the liver, omentum, or mesentery, eight of the ani-
mals being thus affected. Pleuritis was responsible for four of the
cases, malignant tumor of the liver and lungs two, hepatic
cirrhosis without cardiac lesion three, and carcinoma of the
liver one. Of the remainder of the animals, five suffered
primary ascites proceeding from chronic peritonitis, and in six which
were seen but once, the causative disease was not definitely diag-
nosed. Chronic renal diseases and compression or obliteration of
the portal vein by neoplasms may also cause ascites.

The amount of accumulated fluid in ascites may be very con-
siderable, sometimes amounting almost to the actual body-weight
of the animal. Hobday removed five and one-half gallons from a
Mastiff by canula. It may be clear or yellowish and opalescent,
and sometimes contains white and red cells and endothelium. It
rarely coagulates. It is often of a pinkish tint when malignant
neoplasm is the causative factor, owing to rupture of vessels on the
surface of the tumor. A remarkable condition known as chylous
ascites may result from traumatic rupture of a lymphatic trunk
whereby the cavity becomes filled with a thick opalescent or milky
fluid rich in proteids and fine fatty globules with a tendency to
coagulate.

148 Surgical Diseases and Surgery of the Dog

Symptoms and Diagnosis. Ascites is recognized by the gradual
enlargement of the abdomen together with a sinking in of the flank
and the acquirement of a pronounced concavity by the vertebral
column. A wave or fluctuation of the contained fluid may be per-
ceived by placing the hand on one side of the abdominal wall and
tapping the side opposite. Percussion gives rise to a tympanitic
sound superiorly where the intestines are floating, and a dull one in-
feriorly. In very chronic cases there may be edematous swellings
of the abdominal wall, prepuce, and extremities. It is important to
differentiate from hydro- and pyometra. In these latter conditions
the outlines of the bicornate uterus can generally be made out,
percussion always calls forth a dull sound and fluctuation is imper-
ceptible. Differential diagnosis from such condition as chyle-cyst
is extremely difficult, but this form occurs with suddenness. As-
cites is occasionally confounded with other conditions. It is dis-
tinguished from the enlargement of gestation by palpation, and from
obesity by palpation and negative results attending aspiration.

Differential diagnosis between the various causative factors is
comparatively easy in some cases, while in others it is almost an
impossibility. There is little difficulty in diagnosing pericarditis,
pleuritis, and valvular lesions, by auscultation, but when the condi-
tion is the result of primary inflammatory changes, or secondary to
lesions of the abdominal cavity, the fluid must be first drawn off
to make palpation of value. If much emaciation or cachexia is
present, malignant tumor or tuberculosis may be suspected. To
differentiate between the two latter diseases, tuberculin should be
employed.

The prognosis must be guided by the causative factors present.
Only when the condition is idiopathic of simple peritonitis or is de-
pendent on the simple forms of hydrothorax or hydropericardium,
or compression of the portal vein by benign neoplasms, may any per-
manent amelioration be expected by eradication of the primary cause.
With these few exceptions, treatment can give but temporary relief.

Treatment. Diuretics and saline purgatives are employed to
lessen the amount of fluid. A case is on record of apparent recov-
ery by the daily internal administration of pilocarpine hydrochlorate.
Cadiot and Breton favor the employment of this drug. Paracentesis
is a more certain and rapid method and is employed when the dis-
tension and dyspnea are very considerable, but with the exceptions

The Abdomen 149

noted above the cavity fills up again in three or four days’ time.
When the condition is secondary to pericarditis or pleuritis the peri-
cardium or thorax must also be tapped.

Numerous cases by Morrison and others are on record in which
ascites due to portal obstruction has been overcome by ligaturing
the omentum to the chest wall, whereby anastomoses between the
vessels are set up and the blood finds its way to the heart without
passing through the liver; but this does not succeed in every case.

PARACENTESIS.

For this operation a relatively large trocar and canula should
be employed. They should be previously sterilized and the skin over
the area of puncture disinfected. This is important because the in-

troduction of pyogenic microbes into the peritoneal cavity when its
absorptive capacity is inhibited may be followed by rapid infection,
the intra-abdominal fluid acting as a highly favorable culture
medium. The instrument is introduced at the most dependent part
of the abdomen, the animal being made to assume the standing po-
sition, and the trocar immediately withdrawn. There is no danger
of wounding the intestine as the latter is floating on the surface of
the fluid. Only part of the fluid should be removed and that grad-
ually as sudden and total removal has been followed by syncope. In-
terruption of the flow indicates obstruction of the canula by false
membranes or coagula and is corrected by again passing the trocar.
When the condition is secondary to pericarditis or pleuritis, the
pericardium or pleura must also be tapped. (See Pericarditis and
Pleuritis).

FOREIGN BODIES.

Three classes of foreign bodies may gain access to the peritoneal
cavity. They consist of inanimate objects, verminous parasites, and
fetuses.

Inanimate Objects. Comprised in this class are: missiles
which have perforated the abdominal wall, bodies which have
traversed part of the alimentary canal and finally perforated the
gastric or intestinal walls, and surgical requisites such as sponges,
which have been inadvertently left in the cavity after being intro-
dluced during the course of operations. Their presence is not neces-

150 ©. Surgical Diseases and Surgery of the Dog

sarily productive of ill-effect. There are many cases on record of
the passage of such bodies as needles and skewers from the stomach
and intestines to the surface of the body without inducing any un-
toward symptoms, and it is well known that aseptic absorbable
bodies are removed by phagocytic action within comparatively short
time. There is always risk, however, that their exit from infectious
centers may establish tracts by which pathogenic microbes may in-
vade the peritoneum. Moreover, they may provoke epileptiform
symptoms by reflex irritation of nerves. (See The Stomach and
the Intestines). .

Symptoms and Diagnosis. When the passage of foreign
bodies is attended with infectious processes the symptoms are those
of peritonitis. There is often a history of the previous swallowing
of a body. As already stated, epileptiform seizures may attend the
presence of non-absorbable bodies unaccompanied with infective
processes. An explorative celiotomy may be necessary to establish
a diagnosis. .

Treatment. Inanimate objects of all kinds should be removed
by celiotomy, as by remaining in the abdominal cavity they are al-
ways potent pathogenic factors. Tracts by which they have entered
must be sealed by suturing, and if peritonitis is present the cavity
must be irrigated and free drainage established. Cases have been
recorded which have been successfully treated by operative meas-
ures. (See The Stomach).

Verminous Parasites. The parasites which may enter the
peritoneal cavity by perforating tract are teniae, ascarides, and the
giant eustrongyle. Cysticerci and pentastomes have also been found
present but their mode of ingress is undetermined. Instances of
perforation of the intestinal wall by teniae and ascarides have been
recorded by Cadéac, Lahogue, Dell, Morey, and others. A case
was brought to my notice where a multitude of round-worms had
ascended the bile-ducts and emerged through the liver tissue. These
parasites generally produce sub-acute peritonitis or rabiform symp-
toms. The giant eustrongyle enters by perforating tract by way of
the kidney. It is also productive of rabiform symptoms (Lisi).

Symptoms and Diagnosis. The symptoms being those of peri-
tonitis or nervous seizures, are naturally obscure, and a pre-mortem
diagnosis could only be established by explorative celiotomy.

Treatment. The indications are to remove the parasites, close

No. 37. Extra-uterine gestation showing two pseudo-
uteri and numerous cysts.

The Abdomen I51

perforating tracts, irrigate the cavity, and establish drainage; in
fact, treat such a case exactly as if it were peritonitis.

Fetuses. Fetuses may find their way into the cavity through
a rent in the wall of the uterus at any stage of their development,
but most commonly at the parturition period through operative
bungling, or they may pass the whole period of their existence there
by reason of the fecundated ova escaping from the ovary at the
fimbriated extremity of the Fallopian tube. True ectopic gestation
due to implantation of the ovum in the oviduct, which is common
in the human female and which is frequently associated with rupture
of the tube when the embryo has grown to a certain stage would
seem to be an extremely rare condition if the absence of recorded
cases is to be taken as indicative.

When a fetus falls into the cavity during parturition it may or
may not carry pathogenic microbes with it, according to whether the
uterus is infected or not. If it is aseptic it macerates and is absorbed,
though the hard parts take considerably longer to disappear than
the soft. This process may have cachectic and even lethal effect by
autointoxication. Blanc recorded a case which proved fatal within
a month. A septic fetus produces peritonitis. .

In extra-uterine gestation a sac or pseudo-uterus develops around
the fetus by formation of fibrous tissue. Such sacs have been found
attached to various portions of the peritoneum such as the neigh-
borhood of the. ovaries, the omentum, and broad ligament. The
fetus may continue to develop to full term and then decompose and
develop into a suppurative focus, probably by becoming a Jocus
minore resistentiae to the action of microorganisms circulating in
the blood, but it usually macerates and is partially absorbed. The
internal surface of the sac sometimes undergoes a sort of calcifica-
tion. An animal may conceive in the uterus while having a mace-
rated skeleton of a fetus in the peritoneal cavity. Undoubted cases
_ have been recorded by Vernaux and myself.

Symptoms and Diagnosis. As in the case of perforating in-
animate objects, so with fetuses, when they are accompanied: by
pathogenic microorganisms in their passage from the uterus, the
symptoms are those of peritonitis. At the time of parturition the
lesion is sometimes discoverable by digital palpation. In Blanc’s
case referred to above, a fibrinoplastic peritonitis had been pro-
voked which had caused an enlarged fluctuating abdomen.

152. Surgical Diseases and Surgery of the Dog

In extrauterine gestation there may be entire absence of any
indicative symptoms, but on the other hand rabiform symptoms may
be induced by reflex nervous irritation. In these cases the fetus
can generally be palpated as a firm tumor-like body.

Treatment. In all cases of this nature the fetus together with
any adventitious tissues should be removed. When rupture of the
uterus has occurred the operation should be undertaken as speedily
as possible.

NEOPLASMS.

Neoplasms occasionally develop on the peritoneum as primary
growths but they are more often secondary. The primary manifes-
tations are both innocent and malignant types. Of the former,
fibroma of the gastro-colic omentum and chyle-cyst of the omentum
have been observed, and emphysematous cysts of the mesentery,
cysts containing pentastomes; and hydatids of plerocercoides and
echinococci have been recorded as rare occurrences. Of the latter,
tubercular growths are comparatively common. Sarcomata of the
omentum, mesentery, and of the peritoneum have also been de-
scribed, while a neoplasm growing on the mesentery, the histologic
identity of which was not determined and which was surrounded
by secondary growths with metastases in the liver was witnessed
by Born.

Secondary neoplasms are of the malignant type. Miliary car-
cinoma has been observed by Cadéac in an animal from which he
had previously removed a mammary tumor. Secondary chondroma
of the peritoneum occurring as a metastasis from a tumor of the
same nature in the mammary gland has been described by Boutelle.
Metastatic venereal granulomata occur occasionally, and the mesen-
teric glands are often involved in cases of lympho-sarcoma.

Symptoms and Diagnosis. Innocent primary tumors if of
sufficient dimensions produce abdominal enlargement. The par-
asitic hydatids usually provoke inflammatory secretion which may
cause an ascitic appearance. Growths of both innocent and malig-
nant types generally give rise to cachexia. The diagnosis of all
forms of tumor is aided by palpation.

Treatment. Innocent growths are eradicable by opening the
peritoneal cavity and removing them by appropriate surgical me-
thods. Malignant growths are best left alone.

The Abdomen 153

BIBLIOGRAPHY.

Blanc—Journ. de Méd. Vétér. et de Zoot. Jan., 1900.
Born—Jahresber. ue. d. Leist. Sachsen. 1894,

Boutelle—Journ. Comp. Med. & Veter. Archives. 1895, p. 222,
Oadéac—Rec. de Méd. Vétér. 1888, p. 466. Rev. Vétér. 1887, p. 501.
Cadiot—Bull. de la Soc. Cent. de Méd. Vétér, 1893, p. 168.
Cadiot & Breton—Médec. Canine.

Dell—Journ. Comp. Med. & Veter. Archives.

Grawitz—Char. Annal. Jahr. 1886, p. 9.

Halsted—Jobhns Hopkins Hospital Reports. 1891, p. 2.
Hobday—Journ. Comp. Path. & Therap. Sep., 1899.
Lahogue—Rec. de Méd. Vétér. 1888, p. 650.

Lisi—Clinic. veter. 1883,, p. 293.

Morey—Journ. de Méd. Vétér. et de Zoot. April, 1897.
Recorded Case—Berl. thieraerztl. Wochenschr. 1899.
Reichel—Deutsch. Zeitschrift f. Chirurg. 1889, p. 30.
Vernaux—Rec. de Méd. Vétér, 1889.

Waterhouse—Virchow’s Archiy. 1890, p. 342.
Wegner—Verhandl. d. deutsch. Gesell. f. Chir. Berlin. 1877.
Welch—Trans. Cong. Amer. Phys. & Surg. 2, 1891, p. 1.

CHAPTER VI

‘The Abdomen—Continued
The Stomach |
EXAMINATION.

No satisfactory examination of the stomach can be made by
palpation owing to the remote position of the cardiac and pyloric
extremities, though it is sometimes possible to distinguish neo-
plastic changes in emaciated animals. Pressure over the region
of the organ is productive of pain in some conditions. The char-
acter of the vomitus is of considerable assistance in the establish-
ment of diagnosis, and must always be taken into consideration,
while the Roentgen rays can always be employed for the detection
of the presence of foreign bodies.

TRAUMATIC LESIONS.

Wounds caused by the passage of projectiles and sharp or
pointed implements are of occasional occurrence. Perforation of
the wall is always dangerous owing to escape of infective matter
into the peritoneal cavity and resultant peritonitis. In general, it
may be said that injuries of the stomach are far more serious than
those of the intestine, bladder, or uterus.

Symptoms and Diagnosis. Hematemesis usually takes place,
and there may be escape of contents of the organ through the ex-
ternal wound if the latter is large enough. Any decided penetrat-
_ing wound of the abdominal wall should be explored by celiotomy.

Treatment. Inversion of the edges of the wound and gastror-
raphy are indicated. The peritoneum, if soiled, must also be
cleaned or irrigated with sterilized water.

PEPTIC ULCER.

Ulceration of the mucosa of the stomach in conjunction with

154

The Abdomen 155

that of the intestine is fairly common as a result of specific infec-
tions, the ingestion of foreign bodies and corrosive substances,
and the presence of spiroptera, but true peptic ulcer is a lesion of
great rarity. It is the latter which may be dealt with surgically.
Nothing is known with certainty as to its etiology, though # is
probable that some local defect such as an embolus may give rise
to an ulcer through the action of excessive hydrochloric acid secre-
tion. Mathes, by daily administration of hydrochloric acid, suc-
ceeded in producing a peptic ulcer in a dog in which an artificial
defect in the mucosa had previously been made. Other experi-
ments have shown that contusions through the abdominal wall
are possible factors. A peptic ulcer always has a sharp contour
as if it had been cut out with a knife or punch, because the dead
and necrosed part has been digested out by the gastric juice, which
has no effect upon the living mucosa. If an artery is involved
death may occur from hemorrhage (Johne). An always possible
termination is perforation into the peritoneal cavity, but this does
not necessarily take place, as the area involved may become ad-
herent to the neighboring viscera through formation of inflam-
matory lymph.

Symptoms and Diagnosis.. The most prominent symptom is
hematemesis, though the lesion may exist and terminate in per-
foration without producing any definite diagnostic symptom prior
to dissolution. Walley conducted a necropsy, at which the pre-
sence of a perforated ulcer of this nature was demonstrated.
Symptoms of sudden collapse succeeding a history of chronic hema-
temesis are suspicious of perforation. Explorative celiotomy is
then indicated. A gastric lesion which does not respond to medical
treatment after a reasonable length of time is also an indication for
explorative celiotomy. The location of an ulcer cannot always
be determined from the serous side of the organ, and it may be
necessary to make an initial explorative gastrotomy, but there is
usually some thickening of the wall and discoloration of the serosa
at the seat of lesion.

Treatment. This consists in resecting the diseased portion of
the wall (Partial Gastrectomy) and suturing the cut edges.

TORSION.
This lesion is observed exclusively in the dog, probably on

156 => Surgical Diseases and Surgery of the Dog

account of the great mobility of its stomach. It occurs when
the stomach is empty and is characterized by rotation from right to
left, the esophageal and duodenal orifices being completely occluded.
The vessels are compressed, stasis of the circulation takes place,
and internal hemorrhage follows. Kitt has witnessed two instances
of this lesion at the necropsy of one of which I had the good
fortune to be present, and Cadéac states that he has seen three cases.

Symptoms and Diagnosis. The organ becomes enormously
distended by accumulation of gas, and this causes asphyxia within
a few hours by compression of the diaphragm. This lesion need
not be confounded with any other internal trouble, excepting perhaps
hernia of the diaphragm, Caparini having seen such a case, accomp-
anied by enormous gaseous distension of the stomach, because ex-
treme meteorism is peculiar to either of these conditions, and also
because there is entire absence of vomiting.

Treatment. The asphyxia must be promptly relieved by para-
centesis, the gas being allowed to escape gradually so that no evil
result may follow from sudden release of the pressure. A right
celiotomy must then be quickly performed in order to return the
organ to its normal position and re-establish its circulation.

FOREIGN BODIES.

There is scarcely any limit, excepting size, to the shape, char-
acter, and consistence of articles which the dog will swallow. They
are mostly swallowed together with the food or by subjects with
abnormal appetites suffering from gastric disorders, or accidentally
in play. Among recorded articles may be mentioned: fragments
of bone, wooden and metallic skewers, stones, play-balls, cork-
stoppers, tops, coins, rope, needles, marbles, and fabrics. Hair
when swallowed is apt to form into balls. Bruckmueller observed
a prevalence of the latter condition in dogs kept in barber-shops.
This authority also observed that pigeons when swallowed whole
acted as foreign bodies, and might cause death.

Such bodies are often vomited, but may remain in the stomach
or pass on to the intestine. It is noteworthy that foreign bodies
may be retained in the stomach for considerable periods without
materially affecting the animal’s health. Cadiot and Ries saw a
dog which had swallowed two peg-tops. During the following
eleven months there was no manifestation of sickness. Finally,

The Abdomen 157

one of the tops reached the duodenum and caused the animal’s
death, the other top being found free in the stomach at the
necropsy. Nichoux recorded an instance of a dog swallowing two
coins, which remained in the stomach for twelve years. On one
occasion I gave an emetic to a dog suffering from chronic gastric
trouble and freed the animal of a large flint stone, which the owner
averred had been swallowed six months previously. Sometimes
the pylorus becomes blocked. Greaves, in conducting a necropsy,
found a mass of small angular bones completely biocking the pass-
age, and Hulme and Morrison found a large piece of liver in one
animal, and a large tightly rolled ball of brown paper in another,
obstructing it in a similar way.

Sharp bodies may perforate the wall. Most commonly needles
and skewers work their way into the abdominal cavity and lodge
in some other organ. Petit found a needle embedded in the liver,
and cites three other similar cases. He also found a needle em-
bedded in the spleen of another animal. Sometimes such bodies
ultimately reach the surface of the body, not, however, without
inducing the formation of an abscess or fistulous tract. Straub
incised an enlargement, occupying nearly the whole surface of the
left abdominal wall, and removed some gangrenous tissue in which
was lodged a small piece of wire. Viramond mentions the passage
of a skewer some seven inches in length, and its exit in the region
of the xiphoid cartilage. Labat found a skewer free in the peri-
toneal cavity, but without trace of perforation. Norrit treated a
dog which had swallowed a fork. The animal showed some slight
indisposition, but apparently recovered. Celiotomy was performed
and the pronged end was found free in the abdominal cavity and
the handle encapsulated at the origin of the mesocolon. Recovery
followed in three weeks. Hamoir incised an abscess in the right
costal region. A long hat pin was found present, the head of
which was buried within the peritoneal cavity, which rendered its
extraction impossible. Celiotomy was performed in the immediate
neighborhood, when the head was found to be within the stomach.
It was pulled out, and the wound in the stomach wall closed. Re-
covery ensued. Ligniéres held a necropsy, at which a fine piece of
wire one and one half inches in length was discovered embedded
in the omentum. For some time before death the animal had ex-
hibited epileptiform convulsions. Ligniéres thought the latter were

158 Surgical Diseases and Surgery of the Dog

provoked by indigestion of food and drink, which, distending the
stomach, caused pressure on the body and consequent irritation of
the ramifications of the pneumogastric and celiac plexus. Labat
opened the abdomen of a Dane twenty-four hours after it had
swallowed a kidney together with a skewer eleven inches long,
which was sticking in it. The skewer was found partly free in
the peritoneal cavity. Recovery ensued.

Symptoms and Diagnosis. In some cases there is complete
absence of any symptoms, but usually there is intense thirst, an-
orexia and persistent vomiting, together with hematemesis when
erosion of the mucosa exists. During movements sharp bodies
may prick the wall, causing sudden cries of pain. The animal
prostrates itself, or walks with arched back. On other occasions
there are fits of coughing, colic, restlessness, epileptiform, and even
rabiform symptoms. In this country I have found the practice of
feeding peanuts a fruitful source of violent seizure. Descodtes
witnessed rabiform symptoms in a case of impaction by raw carrots.
Pressure over the gastric region is usually productive of pain.
When any doubt exists, the Roentgen rays should be employed.

Treatment. Emetics, such as apomorphia, hypodermically ad-
ministered, should first be tried when the character of the body
is known for a certainty. Emesis i$ contraindicated when sharp or
pointed bodies are known to be the cause of the trouble. Delivery
should then be accomplished by the operation of gastrotomy.
Venneholm delivered the fibula of a horse from the stomach of a
large dog by this operation, and Porcher and Morey removed a
spoon, only the handle of which had reached the stomach, the
other extremity being still in the esophagus. At the Munich School
in 1877 a leaden ball measuring some two inches in diameter and
weighing some nine ounces was successfully removed.

NEOPLASMS.

Neoplasms of the stomach occur with great rarity. Carcinoma
of the pylorus has been recorded, as has multiple Sarcoma of the
organ. Kitt refers to verrucose Adenoma. Vogel has observed
fatal termination from hemorrhage. Non-malignant cicatricial
Stricture occasionally results from pyloric ulcer or by wounding
induced by some foreign body.

Symptoms and Diagnosis. Chronic vomiting, accompanied by

The Abdomen 159

progressive emaciation, are prominent symptoms. Pyloric neoplasms
may be palpated in the later stages when the animal is reduced to
mere skin and bones through inanition. The stomach is usually
much dilated. The symptoms are very similar to constriction-ob-
struction of the intestine, and explorative celiotomy may be neces-
sary to enable the practitioner to arrive at a correct diagnosis.

Treatment. Non-malignant strictures are amenable to treat-
ment, but malignant neoplasms are best left alone. The simplest
way to remedy occlusion by stricture and render the tract again
permeable is by the operation of gastro-enterostomy.

Surgery of the Stomach

It has been repeatedly demonstrated that it is possible to suc-
cessfully perform severe operations on the stomach, even to the
extent of removing the entire organ. In 1810 Merrem attempted
resection of the pylorus on three dogs which, however, died. In
1876 the operation was again attempted by Gussenbauer and Von
Winiwarter. Their experiments proved that the operation was not
necessarily dangerous, but they lost most of their animals from
peritonitis. Levy resected the pylorus, using the: Murphy button,
and experienced a mortality of fifty per cent. It was then found
that the operation of resection of the pylorus was more complicated
and took much longer than that of Gastroenterostomy, and that
subsequent perforation was more common owing to insufficiency
of the sutures.

Kaiser, Czerny, Carvallo and Pachon, Monari and Filipi, Fisher
and Frouin tried total ablation of the organ, but they all left
a portion of the cardia, as it was very difficult to effect reunion
of the esophagus and duodenum. A small sac usually developed
from the remnant and fulfilled gastric functions. In one of
Czerny’s cases the animal survived the operation five years. In
one of Monari’s the animal lost weight steadily. A great difficulty
lay in the fact that traction on the esophagus led to rupture of the
adhesions between esophagus and diaphragm, which gave rise to
pneumothorax.

On the other hand, physiologists and clinical operations have
shown that simple incision or Gastrotomy with Gastrorrhaphy is
by no means a very serious undertaking.

160 Surgical Diseases and Surgery of the Dog

GASTROTOMY.

This operation is performed for the delivery of foreign bodies
from the interior of the organ. It is also sometimes necessary in
order to extract bodies which have found lodgment in the lower
third or thoracic portion of the esophagus.

To reach the organ, open the abdomen in the median line
immediately posterior to the xiphoid appendage, and extend the in-
cision as far as the umbilicus. Grasp the organ and draw it out
as far as possible. When empty, it is separated from the abdominal
wall by parts of the liver and small intestine, and is covered with
omentum. When distended, it comes in contact with the abdominal
wall. Pack it securely with sponges and cloths round the part to
be incised to prevent escape of its contents into the peritoneal
cavity. If the animal has been fed a short time previously the
walls are seen to be intensely injected, but if it has fasted they are
pale. Before making the incision insert a couple of “securing”
stitches on either side of the contemplated opening, by which the
organ may be easily retained outside the cavity. These stitches
must not penetrate the mucosa. The walls are thick and vascular,
but the larger vessels can be avoided by making the opening mid-
way between the greater and lesser curvature, and at right angles
to the long axis. The organ may be opened with a sharp pointed
curved bistoury, or it may be punctured with this instrument first
and an enlargement made with scissors. When the muscular coat
is divided it contracts and becomes considerably inverted, and this
causes projection of the mucosa. The latter bleeds very easily
on slight irritation.

The delivery of sharp or hard bodies must be accomplished with
very careful manipulation. Hobday recorded a death from rupture
of the posterior aorta, occurring during removal of a hard piece of
gristle from the lower part of the esophagus by way of the stomach.

The margins of the opening are united by continuous suture,
of catgut or silk, throughout all the coats. The wound is then in-
verted by bringing the serous borders into apposition with a second
row of mattress or Lembert silk sutures, which must not penetrate
the mucosa. Lastly, the “securing” stitches and cloths are removed
and the organ allowed to slip back into the cavity.

Sutures and suturing of the wall of the alimentary canal will
be found more fully described under Enterorrhaphy. —

The Abdomen 161

GASTRO-ENTEROSTOMY.
GASTRO-ENTERAL AN ASTOMOSIS

These terms are applied to the operation, by which an anas-
tomotic opening is established between the stomach and intestines.
Such operation is indicated whenever the onflow of the gastric
contents is obstructed by structural changes of the pyloric or duod-
enal regions. The indications have their limitations, however, for
in canine practice the operation should only be attempted in the
presence of benign disease. The union should be effected between
the stomach and jejenum, and care must be exercised that in es-
tablishing the union the peristaltic movements are in the same
direction. Some sort of device is necessary to facilitate the opera-
tion, and either the Murphy button or my hair-pin method may
be employed in the same manner as described under Entero-enteral

Anastomosis.
BIBLIOGRAPHY.

Bruckmueller—Cited by Cadiot & Almy in Traité de Thér. Chir. d. Anim. Dom.

Cadéac—Path. des. Anim. Domest.

Caparini—I1 Bulletino vet. 1880, p. 129.

Cadiot & Ries—Cited by Cadiot & Almy in Traité de Therap. Chir. d. Anim. Dom.

Carvallo & Pachon—Tray. du Laborat. de Ch. Richet. 1895, p. 456.

Descottes—Rec. de Méd. Vétér. 1875, p. 946.

Fisher—Langenbeck’s Archiy. f. klin. Chir. 27, p. 736.

Frouin—Comptes Rendus de la Soc. de Biol. 1899, p. 397.

Greaves—Veterinarian. 1864, p. 761.

Gussenbauer & von Winiwarter—Langenbeck’s Archiv. f. klin. Chir. 19, p. 347.

Hamoir—Ann de Méd. Vétér. Dec., 1897.

Hobday—Journ. of Comp. Med. & Therap. Sep., 1899.

Johne—Cited by Kitt. in Lehrb. d. Path. Anat. Diagnost. 2.

Kitt—Monatsh. f. prakt. Thierheilk. 1894.

Labat—Rey. Vétér. 1895.

Levy—Langenbeck’s Archiy. f. klin. Chir. 1878.

Ligniéres—Cited by Cadéac in Pathol. d. Anim. Domest.

Mathes—Verh. d. Congress f. innere Med. 1893, p. 426.

Merrem—Animadversiones quaedam chirurg. experiment. in animalibus factis {fllustratae
Grissae. 1810.

Monari & Filipi—Arch. Ital. de Biol. 1894, p. 445.

Morrison—Amer. Veter. Review. 13, p. 175.

Nichoux—Reporter. d. Thierheilk. 1847, p. 101.

Norrit—Rec. de Méd. Vétér. 1834, p. 225.

Petit—Rec. de Méd. Vétér. 1900, p. 449.

Porcher & Morey—Bull. de la Soc. de Méd. Vétér. 1898, p. 707.

Straub—Cited by Cadéac in Pathol. d. Anim. Domest.

Venneholm—Thieraerztl. Centralb. June, 1898.

Viramond—Journ. d. Vétér. du Midi. 1830, p. 68.

Walley—Journ. of Comp. Pathol. & Therap. 3, p. 166.

The Intestines
EXAMINATION.

In the diagnosis of intestinal lesions palpation is of great aid.
The animal should be in the erect position, the practitioner stand-
ing behind and compressing the abdomen between the fingers of
both hands. In some cases it is necessary to make a direct ex-

I2

162 Surgical Diseases and Surgery of the Dog

amination by explorative celiotomy, while the Roentgen rays can
be employed with advantage in the detection of the presence of
foreign bodies.

TRAUMATIC LESIONS.

Wounds of the intestine occasionally occur from external
violence. There are several instances on record where a fall from
a great height, the kick of a horse, or a wheel passing over the
abdomen, have resulted in rupture of internal organs, generally the
liver or bladder, and while the bowel seldom suffers this lesion,
I have seen rupture of mesenteric vessels occur from a run-over.
Probably the commonest form of traumatic injury is wounding
by projectiles or implements. The effect of perforating bullet
wounds is always uncertain. Experimental research would seem
to indicate that they are usually followed by serious results, though
there can be no doubt that this must depend largely upon the
caliber of the missile. Parkes intentionally wounded thirty-seven
dogs by firing bullets of 22, 32, 38, and 44 caliber from Smith and
Wesson revolvers into the abdomen at short range. Three suc-
cumbed immediately afterwards from the effects of profuse hem-
orrhage from main vessels. ‘Twelve died inside of twenty-four hours
either from severe primary or recurring hemorrhage. In these
cases the bullet was of the size of 38 or 44 caliber. Two cases of
the series were subjected to the expectant treatment. Both died,
the first in one day, and the other in five days. Necropsies revealed
extensive extravasation of contents of the bowel and septic peri-
tonitis. Ten other cases died, living from three days to three weeks,
mostly from peritonitis, while only nine cases recovered. As a
result of these experiments Parkes reached the following conclu-
sions: Hemorrhage following shot-wounds of the abdomen and
intestines is often so severe that it cannot be safely controlled with-
out abdominal section; it is also sufficient in amount to endanger
life by secondary septic decomposition, which cannot be avoided
in any other way than by the same treatment, and extravasations
of contents of the bowel after shot injuries thereof are as certain
as the existence of the wound.

In another series of experiments conducted by Chaput forty-
six cases were treated by expectation, of which thirty-one died
(68 per cent) and fifteen survived (32 per cent). Of the thirty-

The Abdomen 163

one, three perished immediately from hemorrhage, and another died
very soon from perforation of the bladder. Of the twenty-seven,
eighteen succumbed in less than twenty hours. Of this number
four died from peritoneal infection after severe hemorrhage, and
the other fourteen from peritonitis without hemorrhage. Of the
remainder, six died on the second or third day and three on the
fourth. In most of the animals the perforations were numerous,
there being in none of them fewer than six, and in one twenty-six.
Chaput advocates immediate surgical intervention. When he
operated within three-quarters of an hour after receipt of the in-
juries he saved one hundred per cent. Seven cases operated upon
later than this terminated in four deaths and three recoveries.

McGraw shot four dogs through the abdomen with balls of
22 caliber and one drachm weight. All lived, and had apparently
recovered on the twelfth day after the shooting, when they were
killed. In one animal there was no trace whatever of the ball,
either in the abdominal cavity or the skin and muscles. In another
the ball had penetrated the spleen and cut four holes in the small
and one in the large intestines. The omentum, which was wounded
and injured, and intestines were bound together by adhesions. On
separating the coils of the intestines, the wounds were found to
have united, but a pouting projecting portion of the mucosa showed
where the ball had passed through. The third animal had suffered
perforation of the spleen and the small gut in several places. Many
of the places had healed, as in the second animal, but in one part
there remained two orifices lined by everted mucosa, which pre-
vented discharge of the contents by adhesion to neighboring coils
of intestine. In the fourth animal the spleen alone was injured.
In all the spleen wounds had healed without suppuration. These ex-
periments would indicate that bullet wounds of 22 caliber may
be left to natural processes of repair with safety.

With regard to wounds produced by implements, it may be
said that they are usually dangerous. Anything of the nature
of a bayonet stab is certainly so, but Stockfleth has recorded a case
of a dog being pierced transversely through the abdomen by a
hay-fork, the animal recovering fully without any sign of suppura-
tion having taken place.

Symptoms and Diagnosis. In perforating wounds of the
abdomen it is very difficult to decide whether the intestine or any

164 Surgical Diseases and Surgery of the Dog

other organ is involved or not. The appearance of the wounds has
no diagnostic value, since there is no gaping of parts, owing to
contractions of the abdominal muscles, and it is often impossible
and in most cases inadvisable to use a probe. Systemic collapse
from shock or hemorrhage is one of the principal symptoms of
perforation.

Treatment. In all perforating abdominal wounds the cavity
should be opened as soon as possible. There need be no hesitancy
on the part of the practitioner, because the dog is remarkably toler-
ant of abdominal operations. Divided vessels must be ligated,
rents in the bowel wall sutured, and blood and other putrescible
material carefully removed, and the cavity thoroughly irrigated
with warm sterilized water or the physiologic salt solution. The
search for rents and hemorrhagic foci must be systematic, every
inch of the bowel being passed through the operator’s hands and
closely examined. The remoter grandular organs must also be
inspected, and to accomplish this with facility it is necessary to
make a fairly extensive incision in the abdominal wall.

INTESTINAL OBSTRUCTION.

Under this term it is convenient to consider all cases in which
the onflow of the contents of the intestinal canal is obstructed.
The minor degrees of constipation which are amenable to medica-
tion do not properly form part of a surgical consideration, and
will not be discussed. Obstructions, using the term in a surgical
sense, occurred in Froehner’s clinic in about two per cent of all
cases treated.

All forms of obstruction may be classified into three principal
groups:

I. From ogstTAcLes, obliteration of the canal by obstruction
within its walls.

II. From compression, obliteration of the canal taking place
from pressure without. .

III. From constrRIcTIoNn, obstruction by causes developing in
connection with the wall itself.

I. OgpstacLes. This is the most common of the three forms
in canine practice, and may be subdivided into two groups: (a)
Fecal Accumulation (Coprostasis), and (b) Foreign Bodies.

The Abdomen : 165

(a) Obstruction by Fecal Accumulation. (Coprostasis).
This is of a chronic type, and occurs principally in the rectum
and colon, but may extend to the small intestine. This condition
is commonly observed in old dogs of sedentary habits that have
become subject to enfeebled contractility of the bowels and con-
sequent infrequent movements, and from which evacuations have
been regularly obtained by purgation. Dogs whose diet has con-
sisted largely of bone or meat are frequently sufferers. Frag-
ments of bone that have failed to become dissolved by the gastric
acid, and have escaped into the intestinal canal, pass to the colon
and rectum, where the velocity of the peristaltic waves is sluggish,
particularly in old age, and there become favorable nuclei for
further accretion (coprolith). In like manner, undigested frag-
ments of meat may accumulate. Such matter, gradually increas-
ing, stretches the wall past its power of contractility and paralysis
of the bowel follows. Coprostasis may also result from certain
affections of the nervous system, notably paraplegia, and from
proctitis.

Beyond a catarrhal disorder, set up by irritation of the mass,
there is rarely any inflammation present, the accumulation simply
piling itself up before the dam, though it may lead to chronic
troubles, such as proctitis, dilation, etc. The duration of this
trouble may be of weeks. Skerritt recorded a case of fecal im-
paction in which the dog had not evacuated the bowels for a
period of five months, and Zuill saw a dog in which suppression
of defecation had lasted three months.

Symptoms and Diagnosis.. The animal is dull and listless,
seeks seclusion, and assumes a reclining posture most of the time.
It rises with apparent effort, and moves with head and tail de-
pressed. It usually makes futile attempts at defecation, the while
giving vent to cries or groans. Perhaps some fluid matter is
passed, which generally misleads the owner into a belief that diarrhea
is present, an error which must not be shared by the practitioner.
In reality, this is but the catarrhal discharge initiated by the pre-
sence of the accumulation. Food is entirely refused, but water
is frequently swallowed. Emesis soon appears, and later becomes
stercoraceous. Abdominal palpation reveals the presence of a hard
cylindrical mass, of greater or less proportions. In one instance,
in which I relieved a St. Bernard by enterotomy, the fecal concre-

166 Surgical Diseases and Surgery of the Dog

ment had a diameter of very nearly five inches. Rectal obstruc-
tion is felt in the sacral region, that of the colon in the center, or
on the floor, of the abdomen. Digital pressure over the parts
sometimes calls forth expression of pain.

Treatment. It must be remembered that there are many de-
grees of constipation, which can be remedied medicinally. Vella
estimated by experiment the time taken by ingesta in traversing
the distance between the mouth and anus, and found it to be ap-
proximately forty-five hours. Hence, we may regard constipation
as existing when defecation has not taken place within the period
named. At this stage, withdrawal of constipating foodstuffs and
proper medication supplemented with enemeta, may abort a graver
issue. Failing in this, an examination of the rectum should be
made, by means of a metallic sound. The uterine sound used in
human surgery answers the purpose admirably. The instrument
can be inserted as far as the sigmoid flexure, and enables one to
tell whether the obstruction is within reach by the anus or not.
By sounding in this manner a pretty accurate idea of the location
and consistence of the feces may be obtained, and the unpleasant
digital process avoided. This procedure must be carried out with
due care, as it is usually vigorously objected to on the part of the
animal. The best way to avoid any accidental wounding of the
internal organs is to hopple the animal securely and prevent undue
movement of the hind parts by firmly grasping the root of the tail
with one hand. When the obstruction is found to be within reach
the rectal scoop is employed to disintegrate the mass piece by
piece. In some cases the rectal speculum facilitates the operation.
I use a scoop, the stem of which is hollowed to permit of a
steady flow of water on the point of the mass being attacked.
The extremity of the handle is shaped to receive the rubber tubing

No. 38. Rectal Douche-curette.

of a syringe, and the water escapes at the base of the bowl. The
stem is made in two sizes, either of which is screwed into the
handle.as desired. By means of this contrivance the double opera-
tion of scooping and irrigation can be carried out at the same

The Abdomen 167

time, and the mass may be more easily disintegrated and softened.
The water should be injected by means of a bulb syringe, as a
fountain syringe lacks the requisite force. It has been a matter
of observation that if a considerable volume of water can be
conducted beyond the obstructing mass the bowel will often be-
come sufficiently distended and stimulated to produce evacuation
without any further assistance. The instrument referred to being
of good length and fulfilling the part of an irrigator may
be employed to achieve this object. Rectal forceps are also useful.

In one instance where the impaction was in a Great Dane
and I was experiencing considerable difficulty in effecting its re-
moval with instruments, a small boy was employed to pass his
hand, well-oiled, within the rectum and seize and withdraw the
coproliths one at a time.

It is advisable to persevere with rectal clysters and purgatives
administered per orem until vomiting absolutely precludes their
employment, particularly when any progress at all of the impac-
tion towards the rectum is noticeable. It is well-known that foreign
bodies and coproliths may take weeks to travel but short distances.
By daily removing the mass collected in the rectum with the for-
ceps or scoop, the accumulation lying on the proximal side of the
same has a chance to gradually work its way onwards, and this it
generally does, although it may take severel days to do so.

When impactions are beyond reach per anum there is small
hope of affording relief without operative procedure of a major
nature. The advent of pronounced vomiting is the chief diag-
nostic symptom warranting surgical interference by celiotomy.
Thereafter purgatives should be strictly avoided, for further pro-
longation of temporising therapeutics is, as a rule, utterly useless.
Nothing is retained by the animal’s stomach, and its strength is
rapidly impaired. It is a mistake to await stercoraceous vomiting,
which is evidence that the impaction has alreadv been of some
duration, and that collapse is imminent.

After the abdominal cavity has been opened and the rectum
reached, an attempt should first be made to force the mass along by
determined but not too forcible manipulation, in order that it may be
extracted through the anal orifice. The latter part of the opera-
tion should always be conducted by an assistant, so that the opera-
tor’s hands may not become soiled. In this manner by persistent

168 Surgical Diseases and Surgery of the Dog

effort it is often possible to push obstructions which are situated
in the colon past flexures into the rectum. When the mass is too
hard or of such enormous dimensions that this method of delivery
is quite impracticable, nothing short of enterotomy offers any hope
of success.

Administration of eserine in the presence of considerable
tympanitis has led to rupture of the bowel.

(b) Obstruction by Foreign Bodies. This form of ob-
struction is generally of a sub-acute type and accompanied sooner
or later with inflammatory changes in the wall, leading to gangrene
and perforation. The duration of this trouble is never long. The
animal may last for one or two weeks, to die from toxemia through
absorption of the inflammatory products or of microorganisms
themselves. The manner in which this takes place will be discussed
under the next group.

It occurs mostly in the narrowest portion of the small intes-
tine—the ileum. Any foreign body that has remained in the
stomach for a longer or shorter period may ultimately find en-
trance into the bowel. The rapidity with which such objects may
travel depends upon a variety of factors, chief of which is probably
their character. Fibrous material would seem to be capable of
very rapid passage. Delperier treated a case where a dish-cloth,
which had been used to enwrap a hare, had been swallowed. On
the third day a portion of the cloth appeared at the anus. This
was seized, and the animal in pulling away, supplied the traction
necessary to effect its complete withdrawal. Smooth and hard
substances may remain for weeks, all the while slowly traveling in
response to the peristaltic waves, and without other reactive effect
than to induce some local ulceration. Senn introduced tubes of
glass and other material into the lumen, a few inches above the
ileo-cecal region, and found that it took thirty to forty days for
these objects to pass per anum.

Among the articles that have from time to time been re-
corded as forming obstructions may be mentioned: pebbles, but-
tons, portions of bones, rubber-balls, ‘coins, spinning tops, fruit-
kernels, nuts, marbles, tacks, cork, and cork stoppers, and even
infant’s shoes; in fact almost every conceivable article. Cork is
particularly dangerous, as what would otherwise pass safely through
will swell by absorption of moisture in the canal. Mathis, how-

The Abdomen 169

ever, saw a champagne cork passed. Compressed sponges are
sometimes given by malicious persons. In other instances masses
of leaves, straw, and grass have been found. Animals suffering
from eczema tear at and consume their hair, with the occasional re-
sult that impacted hair masses form. Bruckmueller has remarked
that dogs kept in barbers’ shops are very apt to suffer from im-
pacted hair masses. Siedamgrotzky removed a hair ball by entero-
tomy, and Gurlt found eighteen in another animal. Puppies some-
times swallow balls of yarn. These are apt to lodge in the pylorus or
upper bowel, and gradually become unraveled, the free portion
being carried the length of the bowel. When a threaded needle
is swallowed it may lodge at any part, while the thread is carried
along. :

Symptoms and Diagnosis. Foreign bodies are productive of
varied symptoms. A mobile body advancing by stages, is often
the cause of violent colicky pains. Sometimes it produces nervous
phenomena of a convulsive or rabiform nature. In some instances
primary vomiting has been observed, but it is probable that this
lasts only as long as the body remains in the stomach, or at the
most in the upper bowel. Vomiting of this nature is to be dis-
tinguished from that induced by an impacted body, which does
not occur for some hours later. All food is refused, and there may
be expression of considerable pain, with arching of the back.
Symptoms of icterus may also appear. }

Characteristic of complete occlusion by an arrested body are
the following symptoms:

The animal becomes dull and listless, seeks secluded and cool
spots, and reclines most of the time. There is no apparent pain.
Its appetite becomes capricious, and it finally refuses all food, and
rapidly emaciates. Vomiting appears, becomes more frequent
and violent, bile-stained, and lastly, stercoraceous. Hoare recorded
a case where the animal retained liquid nourishment forced upon
it. Thirst is apparent from the outset, but every draught of water
provokes a spell of vomiting. Defecation is suspended, and this,
together with stercoraceous vomiting, are the most typical symp-
toms of obstruction. Some writers speak of tympanitis, but I have
never seen this a very marked symptom. If one examines the in-
testinal tract of an animal dead of this form of obstruction, it
is true that the bowel for some distance above the seat of lesion

170 = Surgical Diseases and Surgery of the Dog

will be found to be much distended and often hypertrophic, but the
distension is not from gases, but from semi-fluid fecal matter.

Unless a dog be abnormally fat, all forms of intestinal obstruc-
tion can, as a rule, be diagnosed as such by patient and persistent
external palpation of the abdomen between the fingers of both hands.
Foreign bodies may be felt in any part of the cavity, but generally
in the center. Most of them may be rendered visible with the
Roentgen rays.

Treatment. This differs according as the obstruction is mobile
or fixed. Mobile obstructions are treated by therapeutic measures,
our object being to hasten their exit from the canal with the aid
of purgatives. But when their passage is arrested and they become
firmly lodged at any part of the canal, purgation is not only use-
less but decidedly harmful. In a few hours the wall at the site
of an obstriiction is in a state of inflammation. The muscular
layers become edematous, and their activity is impeded, if not
altogether arrested. Should even slight inflammatory process have
started, any further peristalsis is at once checked, and cannot be
awakened by the action of drugs, and if we remember that it is
only through the return of normal peristalsis that we can hope
for the natural removal of an obstruction the reasons for avoiding
purgation become self-evident. It may be laid down as a rule
that the administration of purgatives should be persisted in until
the advent of vomiting. As already stated, however, it is a mis-
take to wait for stercoraceous vomiting, which is evidence that the
obstruction has been of some duration, and that collapse is im-
minent. In Senn’s experiments vomiting occurred about five days
after artificial obstruction had been established.

At this stage a prompt and careful enterotomy offers the only
possible chance for recovery. With modern surgery no dog should
be allowed to die without an extreme attempt being made to render
the canal permeable. It is only after the inflammatory changes
at the seat of lesion have developed into gangrene that the per-
centage of recoveries is reduced to a minimum, but even then, life
may be saved by excision of the mortifying portion. Whether or
not resection of a portion of the bowel is necessary will depend
upon its viability. Congested bowel, even if dark red, may be
safely regarded as viable, but a greenish tint indicates the pre-
sence of gangrene. All doubtful cases should be treated as septic.

The Abdomen 171

A peculiar case was recorded by Morey. He operatea and
withdrew from the bowel over six yards of cord, but found it im-
possible to extract the entire length from the distal side of the
opening he had made, even with energetic traction. He closed the
wound, hoping the remainder would be voided, but the animal suc-
cumbed forty-eight hours later from peritonitis, occasioned by two
perforations in the lesser curvature, which he believed were caused
by the sawing action of the cord occasioned by the peristalsis.

II. Compression. This form of obstruction may arise by
(a) Direct compression of the gut, or (b) Indirectly by’ suspension
of peristalsis owing to arrest of the mesenteric circulation by com-
pression or torsion. Both these pathologic conditions may exist
together.

(a) Obstruction by Direct Compression may be due to ad-
hesions or slits in the mesentery or omentum, occurring as the result
of traumatic influences, or following visceral operations. | Wounds
of the bowel-wall, during the process of healing, invariably be-
come adherent to, and matted together, with neighboring coils,
omentum, and mesentery. This results in the formation of un-
natural flexures and curves, and even sharp angularities, and thus
are produced theoretically all conditions favorable to hindering and
obstructing the onflow of the contents. But, as a matter of fact,
such conditions rarely affect the bowel to such an extent as to
produce occlusion. The muscular coat of the dog’s bowel is de-
veloped to a high degree, and seems especially able to overcome
obstructions of this nature.

Reichel endeavored to produce occlusion experimentally by
sewing knuckles Of bowel in the form of an S, but could not suc-
ceed. Nevertheless, a single sharp flexure is capable of produc-
ing fatal obstruction. In one of my resection experiments where
successful reunion took place, adhesions formed between the line
of coalescence and one side of the wall immediately beyond, where-
by an acute flexure was developed. This, together with the stenosis
formed at the site of the operation, was sufficient to completely
occlude the lumen from the first, and death resulted in ten days’
time. I have also experienced a case of this kind where the in-
testine and uterine cornua became matted together in consequence
of peritonitis supervening on an oophorectomy operation. A great
amount of inflammatory fibrous tissue had developed, and this

172 Surgical Diseases and Surgery of the Dog

contracting compressed the gut and produced flexures. I have
found another case of obstruction recorded by Parkes, which re-
sulted through a fold of intestine becoming adherent to a stump
of ligated mesentery left free in the cavity. Acute flexure was
produced at the point against which the contents of the bowel
accumulated in large quantity. Jaffe referred to an instance of
partial obstruction through the small intestine becoming adherent
to the omentum after an experimental intestinal operation.

Compression resulting from passage of a loop of bowel through
a slit in the mesentery I have not found recorded as having occurred
clinically, with the exception of an instance mentioned under Tor-
sion, but the possibility of its taking place is fully demonstrated
by the results attending a series of experiments conducted by Baragz
in which knuckles of bowel were isolated but left in situ, the
margins of the cut extremities being inverted and sutured, and
the remaining upper and lower portions of the tract anastomosed.
It was found very difficult to so dispose of the mesentery that
rents did not remain, and in seventeen dogs five died as a result
of such rents by portions of bowel slipping through and becoming
twisted.

Hemorrhoidal nodules, suppuration of enlarged anal glands,
enlarged prostate, abdominal abscesses, neoplasms of the viscera
and retroperitoneal glands (Siedamgrotzky), and ascites, may
each and all bring about compression-coprostasis. These conditions
will be discussed under their respective headings elsewhere.

Symptoms and Diagnosis. The symptoms of obstruction by
direct compression resemble those of constriction-compression or
simple coprostasis, in greater or less degree. Explorative laparo-
tomy will alone enable the practitioner to arrive at a correct diag-
nosis of adhesion-obstruction, but before taking this step, all other
conditions named must be taken into consideration as being possible
factors in the production of the trouble.

Treatment. Intervisceral adhesions must be broken down by
gently tearing them apart, or with the aid of a suitable instrument.

(b) Obstruction by Suspension of Peristalsis Through Arrest
of the Mesenteric Circulation. Familiar examples of this form of
obstruction are Incarcerated and Strangulated Hernias, Torsion,
and Intussusception.

Incarcerated and Stranguilated Hernia. A hernia is said to

The Abdomen : 173

be incarcerated when the peristalsis of the herniated portion of
bowel is interrupted, generally through formation of adhesions,
and the passage of fecal matter is arrested, but without impairment
of circulation. The commonest exciting causes of this condition
are constipation and improper foodstuffs. A hernia is said to be
strangulated when in addition to incarceration there is interference
with circulation of the parts. Strangulated hernia may arise from
any cause which induces local venous congestion, such as incar-
ceration, elastic compression at the neck, inflammatory disturbance
in the wall of the retained loop, torsion of the latter, and greatly
increased peristalsis. In one fatal case which I saw, the animal
had partaken of a very heavy meal a few hours previously, which
led to accelerated peristalsis and congestion within the sac, though
the hernia had existed undisturbed for four years. Venous con-
gestion in a hernia leads to edematous thickening, serous exud-
ation, and reactive compression at or near the neck, and thus the cir-
culation becomes arrested. Once the nutrition of any portion of
the bowel is cut off, microorganisms quickly migrate from the
lumen through the wall, and local infectious peritonitis is estab-
lished. The fluid bacteria-laden exudate is rapidly absorbed, and
the animal dies within a few hours from toxemia.’ In the case
mentioned above death occurred at the expiration of thirty-six
hours. In many cases of artificial strangulation produced by
Tietze death took place in ten or twelve hours. Boenecken found
that bacteria commenced to migrate four hours after a loop of in-
testine was very tightly ligated. Ziegler made twenty-nine artificial
strangulations. In eight of these, bacteria were found within the
first ten hours. In three, which had lasted over fifteen hours,
bacteria were very plentiful, and consisted of colon bacilli and
ordinary pyogenic staphylococci and streptococci, the cocci being
the first to migrate. Tietze made _ seventeen artificial
strangulations, and nine of these showed migration in from six
to twenty-four hours. In this connection, it is interesting
to note that the dog exhibits a remarkable tolerance of simple
occlusion by single ligature. Jaffe found that when he ligated the
small intestine with a silk ligature the latter cut through little by
little until it reached the lumen, the bowel meanwhile becoming
reunited by linear cicatrisation without its permeability being at all
interfered with. Kirstein had the same experience with rubber

* 174 Surgical Diseases and Surgery of the Dog

ligatures. With the colon, Jaffe did not have similar results, for
in this part of the tract ligaturing was followed by local necrosis
and diffuse peritonitis. This is probably to be accounted for by
the fact that bacteria are believed to be present in greater numbers
in the large intestine than in the small.

Symptoms and Diagnosis. The symptoms of incarcerated
hernia are of a chronic type and very similar to those of fecal im-
paction, which have already been sufficiently discussed. Those of
strangulation are of an extremely acute character, appearing with-
in a very few hours. The breathing is accelerated, the temperature
somewhat elevated, and there is an anxious facial expression. The
cardiac impulse is scarcely perceptible, and the animal is soon in a
state of collapse. The collapse is believed to be due to the profound
impression sustained by the sympathetic system through the com-
pression. Food is entirely refused, but there is intense thirst.
Vomiting occurs very early, and becomes frequent and copious, and
finally feculent. The greater the degree of strangulation and the
higher the lesion occur in the tract, the more pronounced are the
symptoms. Such symptoms; coupled with the presence of hernia,
which is tense, hard, and painful, may be taken as indicative of
strangulation.

Treatment. Incarcerated hernia may generally be relieved
by taxis supplemented with purgative doses of castor oil and ene-
meta of olive oil. The application of ice-bags is also useful, to cause
contraction of the vessels. Where such measures fail of effect, re-
course must be had to enterotomy and further operative measures
to effect permanent reduction. Strangulated hernia is treated by
the operation of herniotomy, and if the viability of the bowel is no
longer apparent, by resection and anastomosis.

Strangulation being an extremely severe lesion, the chances
of recovery are always very slight. An early diagnosis and im-
mediate operative interference offer some hope.

Torsion. Volvulus. Ileus. These terms signify twisting of
the bowel about its mesentery or around its own axis. This lesion
occurs very rarely in the dog on account of its short mesentery.
Liénaux witnessed a case in a fox terrier which had been thrown
up and turned about a great deal by some children. The animal
suffered severe abdominal pain, and died fifteen hours later. The
necropsy revealed a torsion of the mesentery around an axis co-

The Abdomen 175

inciding with the origin of the superior mesenteric artery, and
which had involved the whole of the intestine extending from the
duodenum to the level of the transverse colon. Pécus observed a
case, but in this instance the torsion was preceded by a natural
or accidental rent in the mesentery, which permitted of the passage
of a knuckle of the bowel. Robinson tried many times to produce
it artificially, without success, except when it was sutured in posi-
tion, and even then the sutures were frequently torn out by the
forcible self-reduction of the volvulus. Tietze had similar ex-
perience. Kirstein and also Mall proved that the mesentery could
be twisted 180 degrees without the circulation of the same being
affected. This they did by resecting and reversing portions of
the bowel.

Symptoms and Diagnosis. The same pathologic changes
take place, and the same symptoms are in evidence, as occur when
the bowel becomes strangulated outside the abdominal wall in
strangulated hernia. The disturbance in the circulation is followed
by migration of microorganisms and lethal peritonitis. Arrest of
intestinal circulation, be it within or without the abdominal wall,
may always be differentiated from obstruction of the lumen if it
is remembered that the symptoms of the latter condition are slow
and gradual in appearance, that vomiting comes on in the later
stages or not at all, and that unless there be perforation by a
foreign body, there will rarely, if ever, be inflammatory effusion into
the peritoneal cavity ; whereas in the former, the prostration is great
and immediate, there is early and copious vomiting, intense thirst,
rapid pulse, and bloody effusion into the peritoneal cavity.

Intussusception. Little is known of the causes of this condi-
tion. It is generally attributed to irregular innervation of the
muscular coat. In Nothnagel’s experiments it was observed to
occur normally in some animals like the rabbit. He also found that
when an electric current was carried to a point in the bowel it not
only caused a contraction of that spot, but also a dilation below it.
The bowel below the point of contact gradually worked itself over
the contracted portion, and thus produced an_ intussusception.
Senn’s experiments render it conceivable that if this condition
occurs more often than is suspected spontaneous reduction may also
take place in a short time. In many artificial invaginations made
by him the intussusception disappeared of its own accord. In

176 =©§ Surgical Diseases and Surgery of the Dog

fact, so common was this self-reduction, that in order to maintain
the condition he desired he found it necessary to so suture the arti-
ficial invagination that disinvagination was made impossible. F.
B. Robinson classes it as one of the commonest sequelae to resec-
tion operations as performed by the end-to-end methods. Out of
two hundred and twenty-five dogs he used for such experiments,
he lost eight from intussusception. Hobday has recorded its oc-
currence after an enterotomy operation, and in another instance
after celiotomy, massage of the bowel, and removal of a fecal im-
paction with a scoop the contractions of the healthy portion having
brought about its invagination within the dilated and paralysed area
of previous obstruction. Kitt found much entangled masses of
packing thread in the invaginated portions, and refers to instances
of its occurrence in connection with tumor of the wall. Neumann
states that invagination may be provoked by the presence of as-
carides. Cadéac says it may be brought about by the ingestion of
cold water during the heat of the chase. Dudfield believed it might
be caused by supercatharsis induced by overdoses of sulphur.
Kowaleski found a piece of wood in the duodenum and three in-
vaginations in the ileum. It has been observed by many veterinar-
ians that a certain relationship exists between icterus and intussus-
ception. Some of the earlier writers regarded the latter as one of
the causes of the former. In forty dogs dead of icterus Reynal
found twenty-one with complication of intussusception. As late
as 1886 Rancilla, having conducted necropsies on the bodies of
sixty dogs dead of icterus concluded that intussusception was the
cause in four out of every five dogs affected. But Trasbot liga-
tured a portion of the bowel and could not produce icterus, and in
Senn’s description of all his artificial invaginations I find no refer-
ence to its development. A more plausible theory is that the in-
vagination occurs as a result of the long agonal period character- .
istic of icterus, possibly owing to loss by the bowel of some guid-
ing or restraining influence exerted by the bile, since physiologists
teach that one function of the latter is to maintain normal peris-
taltic action. Trasbot has suggested that it may be a consequence
of biliary intoxication whereby the sympathetic ganglia are vio-
lently excited and provoke spasmodic contraction of the muscular
layer.

Intussusception occurs mostly in young dogs, probably owing

The Abdomen 177’

to the greater fermentative changes occurring in their bowels, such
changes stimulating inordinate peristaltic movements. It is not un-
common to find multiple invaginations existing at one time. Var-
nell cited two instances observed by Leach, the subject being two
pointer puppies of the same litter which had died about the same
time, the intestine of each showing four separate invaginations.
The vessels of the most inferior ones only were strangulated sug-
gesting that the others might possibly have been of agonal or post-
mortem origin.

The duodenum may become invaginated within the stomach.
Peuch recorded an instance, the invagination forming a non-ad-
herent reddish cylindrical tumor some two and one-half to three
inches in length.

The small intestine may work its way into the colon and even
protrude from the anus. Such cases are apt to be mistaken for
simple procidence of the rectum unless carefully differentiated.
Dudfield saw a case of ileo-colic invagination. Petit found seven
instances of ileo-colic invagination of probable agonal origin at a
number of necropsies conducted by him in less than a year. Death
in these cases resulted either from pneumonia or icterus. Cases have
been recorded of the healthy bowel intruding itself into a dilated
portion following the removal of a fecal obstruction.

When an intussusception is established, the mesentery which
contains the blood-vessels is drawn into and included in the tumor.
There is necessarily pressure with consequent stasis of the circula-
tion in that part and gangrene of the entering and returning layers
may follow. Gangrene is less apt to affect the intussusceptum than
the intussuscipiens. The mucosa of the latter becomes extremely
red or blackish and congested, while the mucosa of the former may
be almost normal, though all the coats are usually somewhat
blanched. A clot of blood may exist between the two mucosal mem-
branes. The mesentery being attached to one side of the bowel it
draws on that side so that the tumor has a more or less curved ap-
pearance. The length of an intussusception generally varies between
five and ten inches. The lesion may be acute or chronic. The acute
form is accompanied with severe colic but the chronic condition may
exist without causing any apparent inconvenience to the animal. In
some of Senn’s artificial invaginations no symptoms of obstruction
were witnessed, and when the animal was killed weeks or months

13

178 Surgical Diseases and Surgery of the Dog

afterwards the lumen of the intussusception was not larger than an
ordinary lead pencil and yet the bowel on the proximal side was
not distended.

The greatest danger in the acute form arises from the con-
striction of the intussusceptum at the neck of the intussuscipiens.
Petit saw a case terminate in perforation. Spontaneous cure may
take place by the formation of adhesions between the neck and
sheath and the sloughing mass be voided per anum.

Symptoms and Diagnosis. There is no distinctive symptom
that will enable one to differentiate from acute obstruction from
other cause. An offensive sanguineous matter may be evacuated
per anum. Biot saw a case accompanied by marked and continuous
colic. Hill claims that a peculiar diagnostic symptom of this con-
dition is the action of the animal in lying on the top of its back
continuously for an hour together and seeming in that position per-
fectly at ease and free from pain. When the animal is not too fat
to permit of palpation the nature of the tumor may be surmised
from its curved and elongated shape, its sensitiveness, and free
mobility.

Treatment. The safest and most effective treatment consists
in opening the abdominal cavity and treating the lesion in a direct
manner. An attempt should first be made to retract the investing
layer. This is often impossible since adhesions will form between
the apposing serous surfaces within a very few hours. Sometimes
these may be broken down with a probe or fine straight bistoury.
Biot made a successful reduction in this manner. Should the con-
dition of the parts preclude the advisability of such a course, noth-
ing then remains but to perform resection and anastomosis.
Tremper cured four out of seven animals by forcing them each to
swallow three leaden balls supplemented with intervening doses of
castor oil. They were then made to run about when possible, or
were suspended by the fore-legs. The two following days they
were drenched with a decoction of linseed meal in water to the
amount of one quart.

Forcible rectal administration of fluids may also be given a
trial. Senn, in view of the unfavorable results attending his experi-
ments of this nature on cats, believes that it should only be resorted
to when the tumor can be positively located in the large gut. He
regards it as unsafe to attempt to force liquids beyond the ileo-

The Abdomen | 179

cecal valve, owing to the weight of the water exerting too strong
lateral pressure for the intestine safely to bear. While this may be
true as regards the cat it does not hold good for the dog. In the
latter animal the valve is nearly always patent and fluids can be
forced up as far as the stomach without any risk of damaging the
bowel wall.

In one of Senn’s cases of artificial invagination of the ileum
into the colon the abdomen was reopened on the third day and the
neck of the intussuscipiens exposed so as to observe the mechanism
of disinvagination by rectal injections of water. As soon as the
colon was well distended the adhesions at the neck of the intus-
suscipiens began to give way and complete reduction followed. The
animal recovered.

III. Consrriction. Under this heading are included all
obstructions arising by causes developing in connection with the wall
itself, namely, all forms of neoplasms, strictures, and cicatrices.

Tumors of the intestinal canal proper are rare. Adeno-carci-
noma and sarcoma have been observed. Organic strictures are of
somewhat more common occurrence and offer an admirable field
for surgery. Unlike cancerous tumors they are not productive of
cachexia and are lethal only to the extent that they lead to starva-
tion by occluding the tract, or to autointoxication. The duodenum
is a favorite seat for the development of stricture but it has also
been found in the colon. Cicatricial strictures may result from
healed ulcers and may follow coalescence of the resected bowel after
end-to-end anastomosis. The rectum occasionally becomes occluded
in puppies suffering from chronic diarrhea, the epithelial lining de-
generating and adhesion taking place between the submucosa layers.
According to Cadéac, lipomata may develop in the submucosa and
cause projection of the mucosa.

The mesenteric lymphatics are also occasionally affected with
growths, such as lymphadenomata, lympho-sarcomata, and_ tu-
bercles.

Obstruction is sometimes seen in puppies owing to congenital
occlusion of the canal, generally in the region of the anus. This
condition will be referred to under The Rectum and Anus.

Symptoms and Diagnosis. These vary according to the charac-
ter and position of the growth. Malignant tumors have a pro-
found effect on the entire organism, often of extreme and fatal

180 = =©§Surgical Diseases and Surgery of the Dog

marasmus. They may otherwise terminate life by metastasis to
other and vital organs. Non-malignant and circumscribed growths
and strictures generally give rise to symptoms of chronic obstruction.
For some time there is no disturbance in the general condition of
the animal, and it is possessed of its usual activity. The only differ-
ence noticed is a gradually failing appetite, but this is unaccompanied
by emaciation. As soon as complete occlusion takes place all food is
refused and there is still no appreciable falling off in flesh. Ina
few days’ time thirst and vomiting appear and it is then that
emaciation commences and rapidly pursues its course. Vomiting is
not a constant symptom, however. In the resection case referred
to under Compression Obstruction the animal died without having
shown any sign of vomiting. This was probably due to the fact that
the bowel above the seat of occlusion was distended for a distance
of only fourteen inches and from there onward to the stomach was
contracted. Kirstein mentioned having a similar experience in an
experiment where he completely severed the gut and closed the cut
ends separately by suture. The animal lived six weeks. At the
end of the third week its appetite failed, but in all this time it did
not vomit. After death it was found that but fifteen inches of the
gut above the lesion showed distension, the remainder being col-
lapsed. In my other clinical cases and in the experiments of Tietze
and Reichel, the distension was greater just above the seat of lesion
and gradually decreased towards the stomach, and all of these cases
were characterized by vomiting.

The advent of dissolution is usually somewhat slower than in
obstruction by foreign bodies. Much depends upon the position of
the stricture. The higher its position the more quickly is it fatal.
Death may occur by starvation in protracted cases, but it is probable
that it is more often directly due to absorption of microorganisms
by the dilated lymphatics and vessels in the hypertrophied portion of
the bowel immediately above the occluded area, such microorgan-
isms rapidly increasing in numbers in the blood.

Symptoms and Diagnosis. As a rule, explorative celiotomy can
alone enable the practitioner to arrive at a correct differential diag-
nosis.

Treatment. The only possible method of treatment is abla-
tion by enterectomy, and anastomosis.

The Abdomen 181

Surgerv of the Intestines

For all intestinal operations the animal should be secured in the
dorsal position with hopples and a general anesthetic administered,
the opening in the abdominal wall being made in the median line.

ENTERORRAPHY.

The coats of the dog’s bowel are composed of the following
layers: (1) Mucosa, consisting of the gland follicles and muscularis
mucosa, (2) Submucosa, which according to Clason is formed of
two relatively thin layers of inelastic connective tissue fibrils, which
cross at acute angles and run in a spiral manner around the intestine,
(3) Muscularis externa, a well-developed coat of thick inner cir-
cular fibers and of thinner outer longitudinal fibers, and (4) Serosa.

The mucosa can easily be scraped away with the aid of some
blunt instrument, and the serosa and muscularis externa can also be
removed with a little trouble. There then remains the white fibrous
submucosa, which is a very important layer and may be regarded
as the framework of the canal, the other tissues forming adjuncts
for the performance of its functions. This submucosa constitutes
the so-called “sausage-skin”, from which catgut is manufactured.
It is regarded by Halsted as most important in suture of the intes-
tine, because it affords a better hold for the stitches than does the
muscular coat.

In applying sutures it is highly important to guard against
sepsis from the interior of the bowel. While experience has taught
that simple celiotomy on the dog rarely terminates unsuccessfully
through infection, it is a different matter when the continuity of
of the bowel-wall is interferred with. No stitch which passes to the
outside of the serosa must penetrate the mucosa. The reason for
this is obvious. A communicating channel would thereby be formed
through which bacteria-laden intestinal contents would find egress
and rapidly infect the peritoneum. Septic peritonitis has often fol-
lowed experimental operations where such precautions have been
neglected.

A strong point made by Halsted is that each stitch should pass
through part of the fibrous submucosa, which is far stronger than
the combined thickness of the serosa and muscularis, but must on no

182 Surgical Diseases and Surgery of the Dog

account puncture the mucosa. With practice, Halsted believes that
one can soon learn to include the submucosa in stitching.

The entire row of stitches should unfailingly preserve a straight
line, and each stitch should be drawn only sufficiently to bring the
apposing surfaces fairly in contact. Tightly drawn sutures lead to
necrosis of the approximated edges.

Milliners’ needles Nos. 8 and 9, which are somewhat longer
than the ordinary cambric needles, should always be used on the
intestine. The best suturing material is the finest No. 2 black sew-
ing silk, sterilized, and it should be tied in the eye of the needle.
Nearly every surgeon of note who has experimented on dogs recom-
mends silk. Thick catgut remains unchanged not over seven days
as a rule, which cannot be considered a period of sufficient dura-
tion for certain coalescence to take place, and when tied the knots
interfere with accurate approximation. Fine catgut disappears in
less time, while aseptic silk threads can be tied with greater accu-
racy and the knots never become loosened, and its permanent pres-
ence in the parts never exerts any ill-effect. Where silk was un-
obtainable at short notice I have used ordinary sewing cotton (steri-
lized) with good results.

Of the various intestinal sutures it will only be necessary to con-
sider those figured in the accompanying illustrations. The first of
these, the simple interrupted suture, should never be employed be-

\

init

No. 39a. Simple interrupted suture. No. 39b. Simple interrupted suture.

cause all the coats are thereby pierced, which permits of possible
exudation of intestinal contents. The Lembert suture is very
commonly used. In this, the serous surfaces are brought into appo-

The Abdomen 183

No. 40b. Lembert suture.

sition and the cut edges of the mucosa
inverted. Halsted’s suture is other-
wise known as the “mattress stitch.”
Halsted claims that it is preferable to
Lembert’s because one row is suffi-
cient, it tears out less easily, and con-
stricts the tissues less. It is interest-
ing to note that several well-known
British surgeons have conceded this
claim, having observed that the Czerny-
Lembert suture generally gives rise to
the formation of a ridge in the interior
of the bowel which acts as a diaphragm
and contracts the lumen. The stitches
are inserted about one-third of an inch

CLS ae Pee ee heli ear aatl from the divided edges, and are

brought out just free of them.

ENTEROTOMY.

Incision of the intestinal wall is performed for the relief of
obstruction by fecal concrement or foreign bodies, provided any in-
flammatory process that the object has induced is not of such in-
tensity that gangrene is threatened, when enterectomy is the only
hope of a cure.

The abdominal cavity being opened and the omentum pushed
aside (see Celiotomy), distended loops of intestine usually appear
at the wound. These are always on the proximal side of the obstruc-
tion. For some distance above, the gut is dilated about one and
one-half times, or twice larger than below the seat of obstruction,

184 Surgical Diseases and Surgery of the Dog

the bowel on the distal side being usually collapsed. The obstructed
portion being found, it is drawn out of the cavity, retained well out-
side and away from the opening in the wall until the completion of
the operation. At the same time it should be protected and kept
warm with sterilized gauze wrung out in warm water. The condi-
tion of the tissues in the immediate neighborhood is to be carefully
noted and according as to whether the bowel is viable or not will
depend the necessity of simple incision or excision of a part. At
this stage some writers recommend application of bowel clamps a
few inches above and below the lesion in order to restrain the out-
flow of fecal matter through the opening. A simple clamp can be
improvised out of a piece of rubber tubing held in position by artery
forceps. But there is some danger of causing unnecessary injury
to delicate tissues and it is certainly useless on the distal side of the
obstruction where the bowel is invariably empty. Baragz lost a case
by compressing the bowel too tightly with a metal clamp. On the
proximal side a considerable quantity of feculent matter may be
found. I believe it is better to speedily evacuate the gut of this
putrefactive matter from as great a distance as possible beyond the
seat of an artificial opening, than it is to leave such dangerous filth
in close proximity to a wound we desire shall rapidly heal. An
incision is then made longitudinally at the greater curvature, and
immediately over the obstruction. No advantage is gained by try-
ing to force the latter back to another part of the bowel for delivery,
for if the tissues at the seat of obstruction are in such state of
mortification that they will not stand interference, enterectomy is the
only alternative. Where the obstruction is fecal and of such bulk
and extent as to occupy the greater part of the colon or rectum,
necessitating opening of a large tract, it is better to make a series
of interrupted incisions along the greater curvature. The obstruct-
ing body being removed, the operator gently compresses the bowel
between thumb and first finger for a good distance above and
towards the seat of lesion, so that all fecal matter may be expelled
from the neighborhood, care being taken that none of it enters the
peritoneal cavity. The parts are then thoroughly washed with
warm sterile water, sutured (see Enterorraphy), again washed, and
returned to the cavity, the omentum replaced as nearly as possible
in its normal position, and the wall closed (see Celiotomy).

It has been suggested that the insertion of the sutures may be

The Abdomen 185

simplified by placing withing the lumen of the bowel a piece of
bread moulded to the shape and circumference of the latter.

ENTERECTOMY and ENTERO-ENTERAL ANASTOMOSIS
or ENTERO-ENTEROSTOMY.

This operation becomes necessary when a portion of the in-
testine has lost its viability. Such condition arises most commonly
consequent upon acute intestinal obstruction or strangulation.

Removal of more than one-third the length of the small gut is
dangerous to life. Parkes found that recovery occurred most readily
when the portion of bowel resected did not much exceed six inches.
Experiments showed that extensive resection where the resected
portion exceeded one-half the length of the intestinal tract, and
where the animals survived the operation, was followed by maras-
mus as a constant result, though the animals consumed large quan-
tities of food. The operation is a difficult one and demands great
precision and attention to detail, but if undertaken in good time,
offers reasonable hope of success.

It is highly important to have a clear conception of the blood
supply of the bowel. It will be remembered that the intestine is
suspended by the mesentery which also supports the blood-vessels.
The latter divide some distance from the bowel into two branches
and these by union with neighboring branches form a chain of loops
running parallel with the bowel. From these loops are given off
terminal twigs to supply the bowel. Most of the twigs run in the
muscular coat. Some two inches of bowel include the area supplied
by one mesenteric branch.

There are two operations by which anastomosis may be effect-
ed, viz., the end-to-end and the lateral. The end-to-end operation
is more commonly performed than the other, but it is not feasible
if there is much difference in caliber between the two severed ends,
as might occur when a large tract of bowel is excised. There is
always risk of subsequent formation of stricture at the site of opera-
tion, for the continuity of the muscular wall is broken by a band of
inert cicatricial tissue. Myles has pointed out that the contents of
the bowel are necessarily forced past this point by mechanical
pressure from above and not by contraction. The expansile char-
acter of the gut is lost here, and with a sudden and pronounced
contraction just above this point the conditions are ripe for an

186 Surgical Diseases and Surgery of the Dog

intussusception. Frank examined specimens of anastomosed bowel
and observed that no true regeneration of the muscular coat had
taken place. There had been some proliferation of muscle cells
and an attempt to regenerate but fibrous connective tissue had
filled up the interspaces like a weed, crowding out the more delicate
structures. a

In the lateral operation each cut end is first closed by in-
vaginating its margins and suturing with continuous suture. By
incision, an opening is then made in the wall at the greater cur-
vature, about two inches from each closed end. Senn claims that the
lateral operation is particularly advantageous in that the point of
contact is always made on the convex surface, so that the means
employed to secure coaptation do not interfere with the blood supply
from the mesenteric vessels, and that it requires much less time
than end-to-end enterorraphy. The openings are brought into ap-
position by inter-suturing of their respective margins, or by employ-
ment of any of the devices used for the purpose, as in the end-to-
end operation, and are thus made to form the intercommunicating
channel between proximal and distal portions of the bowel. Pas-
sage of bowel contents is also by mechanical pressure from above,
but there is less liability to intussusception.

A great many devices have been contrived to facilitate anas-
tomosis. Some of them are merely intended to assist in holding
the cut ends in apposition while sutures are being applied, and take
no further part in affecting the reunion. Others allow the operator
to dispose with all or most of the suturing, but must necessarily
remain in position, holding the cut ends in apposition sufficiently
long for reunion to be established. Some of the latter, particularly
those which are unabsorbable, like the Murphy button, hold the
ends together by compression, thus producing more or less gangrene.
This feature of pressure-gangrene production constitutes a pro-
nounced defect, and all mechanical devices depending upon it for
the desired effect are necessarily active irritants and a menace to
the reparative capacity of the parts. In fact, the best method
must be that which dispenses altogether with the presence of any
foreign body, except it be to lend temporary support to the parts
during suturing.

But without the employment of some kind of supporting de-
vice, the operation is rendered vastly more difficult. When the in-

The Abdomen 187

testine of the dog is severed, the muscular coat immediately begins
to contract. The diameter of the tube is often diminished more than
one-half. The circular layer which is thickest causes the sudden
narrowing of the lumen, and the longitudinal layer then coming
into play brings about a pronounced eversion of the mucous mem-
brane. This action can be overcome to a considerable degree by
gently inserting the tip of the little finger within the lumen of the
severed ends, but even then it is a matter of extreme difficulty to
maintain the cut ends in apposition while the suturing is being
carried out.

For the veterinary practitioner a simple uncomplicated method
is needed, one which does not involve the employment of specially
manufactured devices, which excepting in large cities, are usually
unobtainable at short notice. The necessity for performing this
operation invariably arises as an emergency, hence it is indispensable
that the technic be as simple as is compatible with favorable re-
sults, and that any device necessary to facilitate the work be such
as may be fashioned out of material at hand and at short notice.
With this end in view I have contrived a method which I believe
to be peculiarly adapted to canine practice. The sole device of
which it is necessary to make use is a lady’s hair pin, bent as

———

No. 42a. Hair-pin method of anastomosis. Showing the manner in which the pin is bent.

figured in the accompanying illustration. Two of these are re-
quired, together with three or four pairs of hemostatic forceps to
act as clamps. Pieces of wire may be substituted, but not having
as much spring, they do not answer so well.

In order to follow each successive step in a complete enterec-
tomy and end-to-end anastomosis by this method let us suppose
that on exposing the viscera a tract of small intestine is found to
be in an advanced state of gangrene from the presence of some
obstruction, or owing to strangulation. The operator must first
carefully investigate the local blood-supply, bearing in mind that
no mesenteric vessel must be obliterated other than those supply-
ing the area of intestine it is intended to remove. This precau-
tion must be rigidly observed, because it is of the utmost import-

188 Surgical Diseases and Surgery of the Dog

ance that the circulation be preserved up to the very row of sutures.
All the circulation possible is needed to effect rapid coalescence
of the parts, and to ward off gangrene. The area of intended re-
section and the blood supply of the same being mapped out, the
mesenteric vessels are first secured by ligature, which is best done
by means of a curved needle and fine suture passed through the
mesentery and around them. The anastomosing loops running
near the mesenteric attachment are secured at a point level with the
proposed line of resection.

One prong of the hair-pin is passed through the mesentery
at the upper point of resection, and both are brought transversely

No. 42b. Hair-pin method of anastomosis. First stage.

across the gut. The other pin is affixed in the same manner at the
lower line of resection. No other bowel clamp is needed when the
pins are used, as the lumen is closed from the outset.

The intestine is severed with scalpel quite close to the clamped
prongs of the pin. The pin effectually inhibits all vermicular ac-
tion of the wall. The incision is extended to the mesentery, so as to
remove a wedge-shaped portion. The two pins are approximated
and tied tightly together, or they may be locked by means of addi-
tional hemostatic forceps. The sutures are now placed on one side,
starting at the mesenteric attachment. They are tied before pro-

The Abdomen 189

ceeding to the other side. The bowel is turned over and the
sutures are applied in the same manner on the other side. The
pins are then severed at
their bent ends with bone
forceps or stout scissors,
untied and _ unclamped,
and withdrawn, one prong
at a time. The remaining
Openings are closed with
one stitch each, particular
care being exercised that
the margin is properly
turned in at the mesen-
teric attachment. Finally,
the incision in the mesen-
tery is closed with contin-

No. 42c. MHair-pin method of anastomosis.
uous suture. Second stage. -

The bent pin method
is equally serviceable for lateral anastomosis, a portion of the
greater curvature being included between the two prongs in a direc-
tion approximately parallel with the long axis of the gut.

Of the mechanical devices employed in this operation it is only
necessary to refer to the metallic button of Murphy. Other absorbable
substitutes have been suggested and employed, but they are all made
on the same principle. They are somewhat difficult to use on ac-
count of the contraction and eversion which takes place immediately
the bowel is divided, and they involve a postoperative risk, because
they remain in place for a longer or shorter period, thereby becoming
foreign bodies, and because they effect reunion by pressure-necrosis.
The Murphy button is made in various sizes, only the smallest of
which is applicable to canine surgery. It consists of two interlock-
ing halves, either of which is inserted in each open end of the bowel.
The margin of the latter is then gathered around the stem of the
button by means of a purse-string suture, the two halves of the
button are locked by pressing them together, thus bringing serosa
into apposition with serosa, and the union is completed. A few
Lembert sutures may be applied additionally if it is desired to
reinforce the line of union. The button sloughs when a certain
degree of reunion has taken place and is voided at the anus in the
course of ten or fifteen days.

190 )=—s Surgical Diseases and Surgery of the Dog

The progress of reunion of anastomosed bowel has been studied
by Halsted and Mall. Before the completion of the operation a
primary union through sticking together of the serous coats by a
fibrinous substance took place. On the sixth day the serous walls
were firmly united by a semi-fibrous tissue, rich in spindle and
round cells. On the fourteenth day the union between the muscular
coats and the submucosa was very firm of fibrous tissue, and at
the end of two months all the coats were fully regenerated, and the
wall straightened out.

Senn found that if he resorted to additional mechanical irritation
of the apposed surfaces, by scarifying them with the point of an
aseptic needle, a curcumscribed plastic peritonitis ensued, which
caused adhesions and obliteration of the serous spaces to take place
very much sooner than when the latter were left intact.

Senn believes that the employment of omental grafts from
one to two inches in width and sufficiently long to completely en-
circle the bowel favor healing of visceral wounds, and afford an
additional protection against perforation. He observed that they
retained their vitality and became fairly adherent in from twelve
to eighteen hours, and were freely supplied with blood vessels in
from eighteen to forty-eight hours.

There is no doubt that it is a good plan to encircle the bowel
at the site of operation with omentum, because in any case there
is invariably matting together of the intestine with other parts,
and it is better that omentum should form the adherent tissue than
coils of intestine, which favor the formation of flexures and kinks.

Judicious after-treatment is no less important than the delicate
conduct of the operation itself. Extreme caution must be observed
in the matter of feeding for some time after apparent recovery,
both as regards the amount and nature of the food. Parkes had
one case that resulted in failure as late as three weeks from the
date of operation through neglect of caution in this matter.

Suppressed appetite and much emaciation are usually present
during the first four or five days following the operation, but as
recovery becomes certain the craving for food becomes inordinate.
A voracious appetite at this period must be sparingly gratified.
Liquid diet is best for the first two or three weeks.

It is interesting to note that such a severe operation may be
performed on the pregnant animal without necessarily inducing
premature birth. In Jordan’s experiments two females were preg-

The Abdomen IQI

nant at the time of operation, and later brought forth their young
at full term. Frank had a similar experience, operating on the
thirtieth day of May, and the puppies were born on the thirteenth
day of June following.

Jordan observed that the presence of tape-worms in the canal
had an unfavorable effect on the healing process.

VENTROFIXATION.

This operation consists in producing the formation of adhesions
between the wall of a portion of the intestine and the abdominal
wall by means of sutures. It has been undertaken by a few opera-
tors as a preventive measure against procidence. It must be re-
membered, however, that it involves the formation of a flexure at
the site of fixation, which at some subsequent period may become
the seat of fecal impaction. Liénaux and Gray have reported re-
coveries from procidence by this operation, but the reports having
been made within comparatively short periods after its perform-
ance (three months in Liénaux’s case) are valueless as to the
ultimate effect on the bowel. Hence, it is an operation which
is not to be counselled until all other means have failed. The
technic is as follows: The abdominal cavity being opened in the
lateral position, gently withdraw the everted portion, at the same
time having an assistant help by external manipulation. Next
insert the stitches which are to close the abdominal wall, but do
not tie them. Now pass two or three fine interrupted silk sutures,
threaded each to an ordinary milliner’s needle, into one side of the
wall of the bowel in a direction at right angles to the long axis
of the canal, by which they do not interfere with its vascularity,
taking care that the stitches do not penetrate beyond the submucosa.
Carry the sutures so as to include the peritoneum and part of the
muscular coat, a short distance from the margin of the incision.
Then tie these stitches, which brings the gut into the desired posi-
tion, cut the ends off short, and finally secure those in the muscular
wall, and close the external wound as in celiotomy.

RECTAL IRRIGATION. ENEMETA.

The injection of fluids into the bowel is a valuable surgical
and therapeutic measure. It is employed for three purposes, viz.,

192 Surgical Diseases and Surgery of the Dog

as a means of inducing evacuation of fecal accumulations or foreign
bodies retained in the lower bowel; for the purpose of applying
disinfectant and astringent medicaments directly to the mucosa
in diseased conditions; and for administering nutritive media
when food cannot be taken through, or retained in, the natural
channels.

As a defecatory aid it acts in two ways, viz., by softening and
disintegrating fecal matter and by distending the wall of the bowel
whereby the latter is stimulated to contract. For large and medium
sized breeds a bulb-syringe should be used to give the injections, the
“alpha” or “omega” makes being preferred, as they permit of a
continuous stream being thrown with varying degrees of force.
Fountain syringes unless elevated to a height lack the requisite
force. When it is desired to direct a stream beyond an obstruction,
the rectal scoop described under Coprostasis may be substituted for
the ordinary hard-rubber nozzle. For toy dogs and puppies the
rectal syringe for infants is to be preferred. Luke-warm soapy
water forms the best preparation where economy is necessary.
Equal parts of glycerine and water and olive oil are sometimes
employed with advantage. The quantity of fluid sufficient to dis-
tend the rectum and colon varies between one-quarter of a pint
in the smallest animals and one pint in the largest. If a larger
quantity is used it will pass the ileo-cecal valve and traverse the small
bowel, and if in sufficient amount will reach the stomach.

In most animals the ileo-cecal valve is patent, but where it is
not, it effectually prevents the passage of fluids, even if the latter
be forcibly injected. I have established by experiment that one-half
a gallon of water is sufficient to traverse the whole extent of the in-
testines and reach the stomach, in a fox terrier, and a little over a
gallon to have the same effect in a setter. It must, however, be
remembered that where a solid fecal obstruction is being attacked
a continuous stream should, of course, be kept up, as it escapes by
the anus as fast as it is thrown in.

Medicated injections employed for their local effect on in-
flammatory conditions of the intestinal mucosa may be advantage-
ously used in quantities somewhat larger than those used to merely
unload the bowel. Or, a preferable way is to carry out a veritable
irrigation of the bowel by means of an inlet and outlet tube, the
latter being attached to a fountain syringe in this case. The irri-

The Abdomen 193

gation should be continued until the returning fluid runs clear.
The medicaments mostly employed are protargol, nitrate of silver,
or tannic acid (1:100), or bichloride of mercury (1:5000). When
the latter is used, a pure water injection should follow it im-
mediately in order to guard against absorption of the drug into
the system.

Nutritive enemeta are employed to utilize the well-known ab-
sorptive power of the mucosa of the lower bowel. There are many
useful commercial predigested preparations which can be employed
in this manner with advantage. It would seem, however, that pre-
digestion is not altogether essential, for Voit and Bauer found that
egg-emulsion with the addition of a pinch of sodium chloride was
easily absorbed by the mucous membrane of the rectum and colon.
Eichhorst made similar observations. Other experimenters have
found that under certain conditions an antiperistalsis of the bowel
may take place (Nothnagel, Bernheim, Gruetzner, Swiezynski).
Nothnagel observed that salt solutions injected induced a retro-
grading current.

Nutritive enemeta should be heated to body temperature. Three

or four a day suffice.
BIBLIOGRAPHY.

Baracz—Langenbeck’s Archiv. f. klin. Chir. 1899, p. 131.
Bernheim—Journ. Amer. Med. Assn. Feb., 1901.

Biot—Rec. de Méd. Vétér. 1879, p. 357.

Boenecken—Virchow’s Archiv. 120, p. 7.

British Surgeons—British Med. Journ. May, 1897.
Bruckmueller—Cited by Cadiot & Almy in Traité de Thér. Chir. d. Anim. Dom.
Chaput—Archiy. Génér. de Médec. 1892, p. 261.

Clason—Upsal. Lakarefoerhandl. 7. Hofmann-Schwalbe. 1872, p. 182.
Delpérier—Cited by Cadéac in Path. d. Anim. Dom.
Dudfield—Veterinarian. 1864. p. 761.

Eichhorst—Pflueger’s Archiv. f. d. gesammt. Phys. d. Mensch. und d. Thiere. 1871, p. 570.
Frank—Med. Record. Oct., 1896. Sep., 1897.

Froehner—Monatsheft. f. prakt. Thierheilk.

Gray. Veter. Journal. 40, p. 401.

Gruetzner—Deutsch. med. Wochenschr. 1894, No. 48.

Gurlt—Cited by Moeller in Lehrb. d. spec. Chir. f. Thieraerzt.
Halsted—Johns Hopkins Hospital Bulletin. Feb., 1898.

Hill—Veter. Record. Jan., 1903.

Hoare—Veter. Record. Feb., 1903.

Hobday—Journ. Comp. Path. & Therap. 1899.

Jaffe—Virchow’s Archiv. 1877, p. 81.

Jordan—Lancet. 1897, p. 1106.

Kirstein—Deutsch. med. Wochenschr. 49, 1889.

Kitt—Lehbrb. d. Path. Anat. Diagnost. 2.

Kowaleski—Cited by Cadéac in Path. d. Anim. Domest.

Liénaux—Ann. de Méd. Vétér. Dec., 1897. Nov., 1898.

Mathis—Cited by Cadiot & Almy in Traité de Thérap. Chir. d. Anim. Domest,
Morey—Journ. de Méd. Vétér. 1896, p. 535.

Myles—Med. Press & Circular. April, 1897.

McGraw—Trans. Amer. Surg. Assn. 7, 1889, p. 123.
Neumann—tTraité des Malad. Parasit.

Nothnagel—Beit. z. Phys. u. Path. d. Darmes. Berlin, 1894.
Parkes—Gunshot Wounds of the Small Intestines.

Pécus—Cited by Cadéac in Pathol. d. Anim. Domest.

14

194 Surgical Diseases and Surgery of the Dog

Petit—Bull. de la Soc. Anat. de Paris. Nov., 1900.

Peuch—Cited by Cadéac in Pathol. d. Anim. Domest.
Rancilla—Rec. de Méd. Vétér. 1886, p. 409.

Reichel—Deutsch. Zeitshcr. f. Chirurg. 35, p. 495.

Reynal—Cited by Cadéac in Pathol. d. Anim. Domest.
Robinson—Journ. Anat. & Phys. April, 1896.

Robinson, F. B.—Med. Record. Aug., 1892.

Senn—Intestinal Surgery.

Siedamgrotzky—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1871, p. 78.
Skerrit—Amer. Veter. Review. Nov., 1899.

Swiezynski—Deutsch. med. Wochenschr. 1895, No. 32.
Tietze—Langenbeck’s Archiy. f. klin. Chirurg. 1894-95, p. 111.
Trasbot—Cited by Cadéac in Pathol. d. Anim. Domest.

Tremper— ditto ditto ditto.

Varnell—Veterinarian. 1864, p. 761.

Voit & Bauer—Zeitschr. f. Biologie. 1869.

Ziegler—Stud. ue. d. intestin. Form. d. Peritonitis. Muenchen. 1893.
Zuill—Translat. of Friedberger & Froehner.

The Rectum and Anus

EXAMINATION.

The anus is examined by direct inspection and palpation, the
rectum by dilating the anus with a speculum and reflecting light
rays within by means of a mirror. The rectum may also be
palpated in part through the abdominal wall.

CONGENITAL MALFORMATIONS.

Congenital occlusion of this portion of the alimentary tract is
of occasional occurrence. Its usual seat is in the region of the anus
where the integument remains imperforate or the rectum ends in
a blind pouch. It will be remembered that in fetal life the rectum
is formed from hypoblast and mesoblast while the anus is de-
veloped by invagination of epiblast, which as development proceeds
joins the hind-gut by absorption of the intervening septum. If
this process should fall short of completion the condition in ques-
tion is produced. It is a condition which is rarely discovered until
symptoms of rectal obstruction have developed. Assimilation of
its mother’s milk by the suckling is very complete in the alimentary
canal so that very little fecal waste takes place. Consequently, the
effect of an imperforate excretory office of a young animal may
not be pronounced for some days. Moeller saw one puppy which
had lived twenty-six days before its condition became manifest.

Symptoms and Diagnosis. The malformation may be suspected
by the exhibition of persistent yet ineffectual attempts at defecation,
a distended abdomen, and disinclination to nurse. When the anal
opening alone is wanting, the skin covering it is observed to be

The Abdomen 195

unnaturally prominent owing to distension by the underlying feces,
but where both rectum and anus are imperforate, this prominence
does not exist. Imperforate rectum alone is diagnosable only with
the aid of a probe.

Treatment. A trocar of proper size may be employed to effect
an opening by puncture, but the operator must avoid injuring the
sphincter. An improvised bougie should be passed two or three
times daily to prevent the formation of cicatricial adhesions, and the
parts may be touched with lunar caustic as found necessary.

FOREIGN BODIES.

Foreign bodies which have escaped arrest in their progress
along the intestinal canal sometimes find lodgment just within the
anus. This is particularly true of fragments of bone. These are
apt to partially penetrate. the wall and set up inflammatory dis-
turbances. Their presence is usually complicated with coprostasis
owing to the animal’s disinclination to defecate on account of the
pain accompanying that act.

Symptoms and Diagnosis. The symptoms are similar to those
of coprostasis. Palpation with the finger in the rectum will reveal
the presence of a foreign body.

Treatment. ‘The indications are to effect removal of the body,
if necessary with the aid of a rectal speculum and forceps.

PSEUDOCOPROSTASIS.

This is a condition which occasionally occurs in long-haired
dogs, the hair around the anus becoming glued with fecal matter,
which forms, so to speak, a firm plaster over the anal orifice, and
effectually inhibits the function of defecation.

Symptoms and Diagnosis. The symptoms are those of copros-
tasis. Examination of the anus will reveal the condition.

Treatment. The only treatment required is to clip away the
hair from the anal orifice, to disintegrate it by hot applications, and
follow this up with a brisk purgative.

SUPPURATION OF THE ANAL POUCHES.

This disease is common, particularly in males. Normally, the
glandular wall of the anal pouches secretes a greyish or brownish

196 =©. Surgical Diseases and Surgery of the Dog

viscous matter of nauseating odor and acid reaction which traverses
a short conduit to be discharged by a circular orifice on either side
of the margin of the anus. In animals of sedentary habits the
secreting surface often becomes inflamed and the character of the
secretion altered. The latter, more or less purulent, accumulates
and gives rise to a swelling or chronic discharge, which in house
dogs is particularly objectionable. When an accumulation occurs,
the animal by its own efforts sometimes succeeds in relieving itself,
but if the matter finds no outlet, it is apt to break through the skin
immediately outside the anus and discharge externally, forming a
fistula. If thorough discharge takes place, the fistulous tract may
close and spontaneous healing follow in the course of a few days.
Recurrence is not uncommon.

Symptoms and Diagnosis. The subject of this disease first
suffers from pruritis, from which relief is sought by constant Jick-
ing or biting at the anus or dragging it along the floor. In this
manner the matter may be expelled. Defecation, being painful,
may be suppressed, and may lead to coprostasis, but there is often
straining in the defecatory posture in an attempt to expel the matter
which must not be confounded with defecatory efforts. Digital
palpation of the parts reveals a tense or fluctuating enlargement,
which is hot and very sensitive to pressure. Sometimes the matter
finds almost continuous vent at the anus.

Treatment. Expulsion of the contained matter must be
brought about by local pressure exerted by the thumb and index
finger on either side of the anus. This procedure should be re-
peated for a week or two as often as the sac fills, and if the disease
then shows no sign of abating an injection of strong corrective
solution must be made within the pouches in the following manner:
Secure the animal firmly in the ventral position and dilate the
anus with a speculum, the two blades being inserted superiorly and
inferiorly respectively, so that the excretory orifice of the two sacs
will be in view on either side immediately within the anus. Armed
with an aspirating syringe containing some peroxide of hydrogen,
and to which a fine nozzle is attached, direct the latter in turn
within each excretory orifice to the depth of the pouches. Inject
the peroxide, withdraw the nozzle and squeeze out the frothing
matter by extranal pressure. Cleanse the parts with a wad of ab-
sorbent cotton in the grasp of hemostatic forceps. Then fill the

The Abdomen 197

syringe with a solution of nitrate of silver or protargol (3:100-
5:100), or a strong tincture of iodine, reinsert the nozzle and inject
the solution.

In a day or two a painful but regenerative local suppurative
inflammation follows, and the matter can be squeezed out at inter-
vals.

Failing by this procedure, the animal must be anesthetised, a
probe-pointed grooved director inserted, and the pouch opened up
and laid bare to the intestinal canal. The pouch is then irrigated
and its walls either cauterised or scraped with a sharp curette.

ANAL FISTULA. ANAL SINUS.

True anal fistula is rare. As has been pointed out elsewhere,
the term fistula comprehends any abnormal tract having two orifices
of discharge, while the term sinus is more properly applied when
there is but one orifice of discharge. An anal fistula to be true-
and complete must have two orifices, one situated in the rectal
mucosa, the other in the perianal cuticle. When it has but an ex-
ternal orifice and the other extremely in a cul-de-sac it is incom-
plete, or more properly
a sinus. The majority
of abnormal tracts about
the anus are tracts of
discharge leading from
suppurating anal
pouches, opening exter-
nally just without the
anus. At the same time
there exists the normal
excretory orifice within
the anus, but the fact of
the existence of the latter does not make the condition one of fis-
tula. It is rather one of sinus.

However, true fistula does sometimes occur as a result of
wounds caused by lodgment of foreign bodies, particularly sharp
fragments of bone, and other tracts arise from malignant neoplasms,
tuberculous abscesses, purulent prostatitis, disease or lesions of
neighboring bones, and external traumatism.

Symptoms and Diagnosis. As with inflammation of the anal

No. 43. Anal Sinus.

198 Surgical Diseases and Surgery of the Dog

pouches, pruritis manifested by licking or dragging the anus along
the floor, is a constant symptom. The usual form,—the external
incomplete fistula or rather sinus,—gives vent to a purulent dis-
charge. A true complete fistula may discharge fecal matter. The
probe should next be brought into use, to definitely determine the
exact course of the tract, but it must be remembered that should the
probe reach the lumen of the rectum, in the majority of cases it is
because it has passed through the normal excretory orifice, and
that this does not indicate the presence of a complete true fistula.
The probe and the speculum will always serve for making a differ-
ential diagnosis.

Treatment. In discharging anal pouches treatment must be
directed towards promoting a healthy secretory surface within the
gland, and for this purpose injections of solutions of nitrate of
silver or tincture of iodine as indicated under Suppuration of the
Anal Pouches should be employed through the abnormal tract until
the latter heals, which it usually does before long. In true fistula
the object is to destroy the wall of the tract. A grooved director
is passed through the fistula tract till its extremity projects within
the lumen of the gut, and it is manipulated so that its extremity is
pushed out through the anus. All the tissues intervening between
the director and the ano-rectal canal are then divided, and the wall
of the tract, including ramifications, curetted. Internal incomplete
fistula is treated in a similar manner, but it must first be converted
into the complete form, and to accomplish this the anus must be
dilated with a speculum.

Where the condition is dependent upon some other disease
or lesion, treatment must vary accordingly. Neoplasms must be
extirpated.

Following the operation the wound should be irrigated if
found necessary. If the sphincter has been necessarily divided,
incontinence is thereby created, but this only lasts for a certain
length of time until reunion of the fibers has taken place.

HEMORRHOIDS. PILES.

The typical hemorrdoidal condition is a very rare complaint.
It is often confounded with the very common condition of enlarged
and suppurating anal pouches. Old dogs of sedentary habits oc-
casionally suffer.

The Abdomen 199

Hemorrhoids are composed of varicose or dilated veins of the
hemorrhoidal plexus. When they have for their covering the skin
about the anus they are termed “external,” and when they are
limited by the mucosal membrane within the anus they are termed
“internal.” Both may co-exist, when they are described as “mixed.”
The external variety is usually seen as a cluster of small cutaneous
projections made up chiefly of hypertrophied perirectal connective
tissue, which may be secondary to inflammation of the anus or
rectum, and not truly hemorrhoidal. When the external veins
are involved, phlebitis may lead to thrombus, and they are then
apt to rupture, forming a soft tumor, which may suppurate, and
eventually become a fistula. The internal variety is composed of
numerous enlarged vessels, hypertrophied connective tissue, and
mucous membrane. This variety may exist in the form of a
tumor composed of a varicose vein, connective tissue, and a
few arterial twigs, which tends to protrude, especially during de-
fecation, or as a collection of sessile ulcerating excrescences which
are very prone to bleed when irritated by fecal masses.

The cause of hemorrhoids may be sought in anything which
may obstruct the portal circulation, such as coprostasis, hepatic
congestion and cirrhosis, enlarged prostate, proctitis and other
diseases of the rectum, and chronic cardiac disease. These con-
ditions lead to stasis in the hemorrhoidal veins, the more easily
on account of the freedom of the latter from the valves.

Symptoms and Diagnosis. The chief symptom in the early
stages is pruritis, manifested by the animal constantly dragging
the anus along the floor or licking the parts. Later there appear
the hemorrhoidal knots, and if the veins burst, considerable local
swelling. The pain may cause suspension of defecation. In the
internal variety there may be passage of blood. Rectal explora-
tion is painful.

Hemorrhoids may be confounded with polypi, which, however,
have a distinct pedicle, with prolapsus, and with suppuration of the
anal pouches, to differentiate from which a careful examination
is necessary, or with neoplasms, which are usually characterized
by induration.

Treatment. Simple pruritis and hemorrhoids of recent origin
or free from ulceration are amenable to medication and regulation
of diet. Treatment consists of administration of remedies which

200 Surgical Diseases and Surgery of the Dog

overcome constipation, cold enemeta, and appropriate inunction.
When chronic or ulcerated, protruding internal piles are best re-
moved with clamp and cautery under general anesthesia, as follows:
Hopple the animal and dilate the sphincter with a speculum. Seize
the tumor with forceps, draw it out, and clamp it at its base in a
direction parallel with the longitudinal axis of the gut. Cut it off
far enough from the clamp to leave sufficient stump for searing,
and apply the cautery. Instead of cauterising, a ligature may be
employed. The non-protruding form is best treated by punctate
cauterization, the point of the cautery being made to penetrate the
substance of the tumor.

When the external variety requires operative treatment it may
be seized with forceps, dissected from neighboring tissues, the pedicle
tightly ligated with silk, the tumor cut off on the occluded side, and
the wound sutured. Where blood has been extravasated the tumor
should be incised, the clot removed, and the skin sutured. An abs-
cess is treated in the usual manner.

PROLAPSE OF THE ANUS. PROCIDENCE OF THE RECTUM.

Distinction must be made between simple prolapse of the rectal
mucosa for a short distance, and true eversion or procidence of
all the rectal or intestinal tunics. The former condition probably
has its origin in a local hyperemia, while the latter is of the nature
of intussusception, and is due to any cause which may induce an
exaggeration of the normal ejaculatory functions of the rectum.
Simple prolapse of the mucosa may, by a constant and increasing
dragging effect cause the mus-
cular tunic to follow. Weak-
ness of the external sphincters
and of the supporting action of
the levator ani may at times aid
in producing the conditions.

_ Procidence of the rectum is
seen quite frequently in puppies
suffering from intestinal catarrh
and parasites. In older dogs,
anything which will cause the
animal to unduly strain, such as
No. 44. Procidence of the Rectum. chronic constipation, diarrhea

The Abdomen 201

with tenesmus, rectal polypi, hemorrhoids, urethral stricture, en-
larged prostate, labor pains, and the injection of superhot or irri-
tating clysters, may lead to eversion of several inches of the rectum.

In some instances portions of the colon or even the small in-
testine may form the protrusion. The importance of accurately
determining whether such is of local origin or not, is shown by the
experience of Walley. A three-months’ old St. Bernard was de-
stroyed after all the usual methods of effecting permanent reduction
had failed. At the necropsy it was established that some ten inches
of ileum had been forced through the ileo-cecal valve into the rectum
and the supposed rectal procidence was in reality an instance of
ileo-cecal invagination, which could only have been treated by
abdominal section.

Symptoms and Diagnosis. Simple prolapsed mucosa is easily
recognized as such. A typical protrusion presents the appearance
of a curved cylinder with the mucous membrane considerably
swollen. At the apex and in the center of the cylinder is the orifice
of the canal. In the early stages the protruding tissue is covered
with mucus and prone to bleed on coming in contact with any
rough surface. In the later stages the mass is more or less in-
durated with patches of ulceration and gangrene, particularly at
the dependent extremity. The passage of semi-solid feces is pos-
sible.

Treatment. Simple prolapsed mucosa is best treated by linear
cauterization as follows: Seize it in five or six places with as many
pairs of forceps, draw it out and make three or four radiating
stripes with the cautery through the mucosa only.

Procidence of the rectum is one of the most intractable mis-
haps in canine surgery. When the everted rectum has not become
congested it is not a very difficult matter to return it to its proper
position with the assistance of a little lubricant. By a digital
kneading process, commenced at the extremity of the protrusion,
the latter is gradually worked into the lumen. Replacement having
been effected, the next difficulty is to prevent further eversion. For,
recurrence of the trouble is very prone to take place, sometimes
shortly afterwards, at other times several hours later. Various
contrivances have been used as preventive means. The tobacco-
pouch stitch to constrict the anal opening, has been much used, but
very often it is efficient only as long as it is allowed to remain.
Degive recorded an instance of procidence, in which he made three

202 ~=Surgical Diseases and Surgery of the Dog

consecutive attempts at anal suturing, but with ultimate failure.
Finally, he performed celiotomy, and withdrew the bowel through
the pelvis. He did not attempt to stitch the bowel to the abdominal
wall, and there followed another eversion, and untimately the death
of the animal. Of late the Gersuny operation has met with some
success. This consists in injecting melted paraffin wax (specially
prepared for the purpose) into the submucosal tissue at the anal
margin to form pillars which act as barriers to further protrusion.

Failing replacement by the above simple measures, two opera-
tions only offer any reasonable chance of a successful issue. The
first and simpler of the two is amputation of the everted portion;
the other, celiotomy, withdrawal of the protruding portion, and
suspension of the same to the abdominal wall (ventrofixation) by
sutures. Amputation may always be recommended, but the other
method is contra-indicated where there is present much gangrene.
Unless the trouble is remedied by simple measures shortly after
its first occurrence and before congestion has taken place, it is
generally useless to temporise with simple reduction and anal
suturing. To the animal the return of the inflamed and swollen
parts must feel of the nature of a foreign body, and efforts are
immediately put forth to again bring about its evacuation. How-
ever, straining can be prevented for several days subsequently by
inducing chloretone narcosis.

The best method of amputation is as follows: The animal
being hoppled in the ventral position and given a general anes-
thetic, and the tail being held out of the way by an assistant, grasp
the protrusion with fixation forceps and extend it as far as possible
from the anus, and apply close to the latter a small rubber band
or ligature to act as tourniquet. Make a circumscribed incision
through the external intestinal tube parallel to the anal margin
and a short distance posterior to the ligature. The internal tube
must now be held steady, as but slight traction will pull it away
from the peritoneal cavity, which is not desired. Seize the anal
margin of the severed external tube, which by this time is much
retracted, with the hemostatic forceps and roll it outwards on itself,
thus exposing its serous membrane. Pass a fine silk suture threaded
to a fine milliner’s needle into the serosa and deeper layers of this
tube (but not past the submucosa) and out again, and then pick
up a similar piece of the inner tube. Tie this stitch and cut the ends
off close, thus bringing the two serous surfaces into apposition at

The Abdomen 203

S
SS

TUL TS

Meta
ae 3
TMU

No. 45a. Amputation of Rectal No. 45b. Amputation of Rectal
Procidence. First stage. Procidence. Second stage.
this point. Use the same kind of stitch on the opposite side, and
repeat it between these two until a complete circle of interrupted
stitches has been inserted and tied, from six to eight generally
sufficing for the entire circumference of the gut. The only vessels
which require particular attention are the median hemorrhoidal,
running on the lateral aspect of the internal tube, and these can be
included in one of the sutures. | While severing the external tube,
the venous branches returning on the serous surface of the
external tube, and which are more or less prone to bleed owing
to the congested condition of the area they supply, may require
to be seized with hemostatic forceps, and so held until the hemorr-
hoidal vessels are secured. As soon as the serosa-serosa suturing
is completed the occluded side of the intestinal tube, which is now
the only part connected with the procidence, is quickly severed close
to the line of sutures with either scalpel or scissors. To complete
the operation, approximate the two mucous surfaces with continuous
silk sutures, clean the stump and push it back within the anus.
The best anesthetic to use is chloretone, its prolonged narcotic
effect being desirable as tending to allay subsequent straining.
Hobday inserts a sound or clinical thermometer case within
the lumen of the inner layer. Four or five catgut interrupted sutures
are passed through the two layers down on to this and back
again, and tied close to the sphincter, in order to prevent retraction
of the inner layer, and the procidence is amputated.
Viborg and Stockfleth insert a hollow cone of wood (carrot
answers as well) on which there is a groove within the lumen, and
then ligate both layers on to this and amputate the occluded por-

204. Surgical Diseases and Surgery of the Dog

tion. This method produces pressure-gangrene and inflammatory
adhesion at the line of ligation.

Moeller passes two threaded needles crosswise through the
protrusion close to the anus. He then cuts through at a distance
of one-half to one inch posterior to the stitches and draws forth
both stitches from the lumen of the inner layer. After cutting
through the center of these, four sutures remain in position. If
necessary (in larger animals) two extra stitches may he passed
diagonally between these and treated in the same manner. All the
sutures are tied and the stump is pushed back into the cavity.

To all these latter methods one serious objection may be
offered—they do not take into account the possibility of the
protrusion being the sac of the hernia and containing a coil of
intestine, which would run the risk of being included in the liga-
tures or sutures.

NEOPLASMS.

The type of tumor met with in the anal region is epithelial
or glandular. When it originates in the skin immediately
outside the anus it is epithelioma, and when it grows within the
rectum just within the anus it is adenocarcinoma, though simple
adenomata of the peri-anal glands are sometimes found outside
the anus. Sutton regards the majority of anal tumors as innocent
sebaceous adenomata.

Symptoms and Diagnosis. The epitheliomatous tumor has a
characteristic shape, being wart-like or in the form of a cauliflower-
like excresence, and may be pedunculate. Froehner has pointed out
that this pedunculation is sometimes very suggestive of lipoma.
Its surface may be ulcerated with raised and hard edges, and give
vent to a turbid, evil-smelling secretion, which cauterizes the ad-
jacent skin. The tumor may be unilateral, bilateral, or situated
above or below the anal opening or it may be composed of numer-
otis knots completely encircling the same. In size, it may be as
large as a hen’s egg or an apple, and in consistence, usually soft
but sometimes hard. Its surface color is red or bluish-red. It
is easily distinguished from suppurating anal glands by absence
of fluctuation, but the knotty form needs careful examination to
differentiate from external hemorrhoids. A good rule is to regard
all rapidly-growing tumors of this region with suspicion.

Treatment. All tumors of the anal region should be totally

The Abdomen 205

ablated as soon as possible, the incisions being made well into the
healthy skin. A general anesthetic should be given. There is usually a
prominent nutritive vessel which must be securely ligated. The
general technic for removal of tumors is described in the chapter

on Neoplasms.
BIBLIOGRAPHY.

Degive—Ann. de Méd. Vétér. 1878.
Froehner—Monatsheft. f. prakt. Thierheilk. 6, 1896.
Hobday—Canine and Feline Surgery.
Liénaux—Ann. de. Méd. Vétér. March, 1903.
Moeller—Lehrb. d. spec. Chirurg. f. Thieraerzt.
Stockfleth—Handb. d. thieraerztl. Chirurg.
Sutton—Tumors, Innocent and Malignant.
Walley—Journ. Comp. Path. & Therap. 4, p. 160.

The Liver

EXAMINATION.

Very little of the normal liver can be palpated through the
abdominal wall. When, however, the organ is the seat of neo-
plastic or inflammatory changes, this method of examination is
very helpful in enabling the practitioner to arrive at a definite
diagnosis. But as with other visceral organs a confirmatory ex-
plorative celiotomy is usually necessary.

TRAUMATIC LESIONS.

These consist of wounds resulting from stabs or the passage of
missiles, and rupture through sudden application of force to the abdo-
men such as may occur at a run-over, without the superficial parts
exhibiting any trace of injury. Rupture is always very serious
because the blood-vessels are held open by the inelastic substance
in which they are embedded. I have seen the latter lesion take
place from the kick of a horse and be followed by death within
ten minutes from hemorrhage, and Goubaux records witnessing
an animal die from it within a few minutes after receiving a violent
blow in the abdomen.

Symptoms and Diagnosis. Diagnosis of internal hemorrhage
is always difficult and seldom in time for surgical interference.
It can only be by constitutional symptoms, viz., blanching of mucous
membranes, coldness of extremities and failing heart. There is
usually great tenderness immediately over the seat of lesion.

In all suspected cases explorative celiotomy should be under-

taken.

206 Surgical Diseases and Surgery of the Dog

Treatment. Bleeding from slight lacerations can be controlled
by direct pressure or thermo-cauterization after the abdominal
cavity has been opened. Severe wounds should be treated by
excision of the affected lobe.

NEOPLASMS.

Most neoplasms of the liver are malignant and secondary, the
latter consisting of carcinoma and sarcoma. Innocent growths
occur in the form of adenoma and cavernous angioma. Trasbot
has seen lipoma. Cysticerci have also been occasionally observed.

Symptoms and Diagnosis. A neoplasm that has grown to any
considerable dimensions causes a noticeable change in contour of
the abdomen, which in females may lead to a supposition of preg-
nancy. Palpation will reveal the presence of a freely mobile mass
within the cavity. Malignant growths are accompanied with
cachexia and emaciation. Intraabdominal tumors can only be
definitely located by explorative celiotomy.

Treatment. Only non-malignant neoplasms are _ eradicable,
and they are removed by partial hepatectomy or extirpation of the
whole of the affected lobe with ligation of all vessels. Hobday
attempted the removal of an adenoma, but the operation was un-
successful owing to hemorrhage.

CHOLELITHIASIS.

The formation of free concretions in the biliary passage is ex-
tremely rare. Froehner has observed and described a case in which
a calculus of the size of a cherry stone was found in the ductus chole-
dochus in an eight-year old Leonberger. In Paris and in Balti-
more gall stones had been experimentally produced in dogs by
the inoculation of weak cultures of the colon bacillus into the gall
bladder, thus indicating that such stones are indications of pre-
vious low inflammatory infection of the mucous membrane of the
gall bladder.

Symptoms and Diagnosis. The symptoms vary according to
the seat of lodgment of the obstruction. If it lodges in one of the
hepatic ducts or in the ductus cysticus, colic is induced without
icterus, whereas if it should completely block the exit of the bile
by lodging in the ductus choledochus, obstruction or hepatogenous
icterus develops. In Froehner’s case death took place within a few

The Abdomen 207

days with symptoms of profound icterus. Ante-mortem diagnosis
would be almost impossible without explorative celiotomy.

Treatment. The only effective treatment in cases of this
nature is to remove the obstruction by incising immediately over
it and afterwards suturing, as is performed quite commonly in
human surgery.

Surgery of the Liver

It is possible to remove a considerable portion of the liver
without endangering life or health. According to Ponfick, three-
fourths of the organ may be extirpated in the rabbit, and the
lost portion will become replaced within a few weeks by regenera-
tion of specific liver tissue. Gluck endeavored to extirpate the en-
tire organ in several animals. Of these, two were alive the morn-
ing of the seventh day and eating well, but the remainder died
of peritonitis or thrombophlebitis of the inferior vena cava soon
after the operation, though no necrosis of the ligated portion fol-
lowed when strict asepsis had been observed, nor was there any
secondary hemorrhage. It was found impossible tod completely
excise the organ because of the inferior vena cava being solidly
embedded in the Spigelian lobe.

The operation of Cholecysto-enterostomy, the establishment
of artificial connection between the gall-bladder and part of the
intestine, generally the duodenum, has been successfully performed
experimentally. L. R. Mueller records an instance of natural
union between a cholecystic gall-bladder and the intestinal tract
by development of an intercommunicating fistula. He divided the
bile-duct after having doubly ligated it. In spite of this the severed
ends reunited, the ligatures became partly encapsulated and the
canal regained slight permeability. Murphy has done the opera-
tion by means of his anastomosis-button. Previously, Colzi, De
Page, Harley, and others had experimented on dogs by suturing
the wall of the gall-bladder to that of the duodenum, and establish-
ing a fistula between the two through chemical destruction or in-
cision within the circle formed by the sutures. At the necropsies
which Murphy conducted after the animals had recovered and had
been destroyed it was found that a valve had invariably formed
on the intestinal side of the opening, thus preventing the contents
of the duodenum from finding ingress into the bladder.

208 Surgical Diseases and Surgery of the Dog

In practical surgery it is very rare that operative interference
of the liver is indicated. A few instances of removal of tumors
have been recorded. But most liver tumors are secondary, show-
ing the disease to be generalized and operative measures useless.

Partial Hepatectomy. To reach the organ most directly the
incision in the abdominal wall is made on the right side, extend-
ing from the ensiform process upwards close to the borders of the
ribs. A very large opening is usually necessary, particularly when
a very voluminous growth is present. An affected lobe should be
removed in its entirety, all vessels entering it being previously
secured.

Gluck has counseled the employment of rubber bands in lieu
of ligatures. All bile should be promptly wiped away, as it is apt
to contain pyogenic microorganisms.

BIBLIOGRAPHY.
Froehner—Monatsh. f. prakt. Thierheilk. 1893-94, p. 61.
Gluck—Langenbeck’s Archiv. f. klin. Chir. 1882-83, p. 606.
Goubaux—Cited by Cadiot & Almy in Traité de Ther. Chir. d. Anim. Dom. 2.
Hobday—Journ. Comp. Path. & Ther. Sep., 1898.
Mueller, L. R.—Beitr. z. path. Anat. und z. allg. Path. 19. Jena. 1896.
Murphy—Med. Record. Dec., 1892.
Ponfick—Cited by Von Bergman in Langenbeck’s Archiv. f. klin. Chir. 1893, p. 393.
Trasbot—Cited by Kitt in Lebrb. d. Path. Anat. Diagnost. 2.

The Pancreas

There are practically no diseases or lesions of the pancreas
which are remediable surgically. It is very rare that the organ
suffers injury either by direct or indirect violence, owing to its
remote location. Malignant neoplasms occasionally occur, but their
presence is seldom discovered until the disease process has ex-
tended and hopelessly involved other organs, notably the ductus
choledochus. Cysticercus cellulosae has occasionally been found
in the organ.

Surgery of the Pancreas

Berard and Colin have demonstrated that the pancreas has no
connection with the duodenum at one stage of its development.
It is originally composed of two distinct portions, the one lying
parallel to the duodenum, and the other perpendicular. Later

The Abdomen 209

these two sections effect a junction and become adherent to the
duodenum, the outcome of which is the common duct. This
fact has some bearing on the surgery of the organ, as will be pre-
sently seen.

Vaughan Harley describes the organ in the adult animal as
follows: It consists of two portions, the vertical and horizontal
or subgastric. One extremity of the vertical portion lies in the
mesentery away from the intestine, the other in close connection
with the duodenum, where it joins the horizontal portion to form
as it were the head of the gland, opposite the junction of the
stomach with the duodenum. The blood-supply is from the pancre-
atico-duodenal vessels. The horizontal portion is longer. It runs
from the point of union to the two parts below and somewhat
behind the stomach as far as the spleen, then turns downwards
and ends in a mesentery of its own on the level of about the middle
of the left kidney. In this portion the splenic vessels run, and in
extirpating it, it is necessary to separate them from the gland
substance.

In the light of considerable experimental surgery that has been
performed on the pancreas, physiologists concede that the gland
normally not only excretes into the alimentary canal but yields up
some substance to the blood, and that there is a constant breaking
down of sugar in the blood. If glucose be added to aseptic blood
it is used up in twenty-four hours.

As long ago as 1682 Brunner wrote that total ablation of the
gland was impracticable. More recently, the researches of von
Mering and Minkowski have shown that complete extirpation is
always followed by diabetes mellitus in severe form. Sugar was
found in the urine in some cases four hours after operation. Bern-
ard, Klebs and Munk, Finkler, Martinotti, Heyden, Vaughan
Harley, Senn, Hédon, and Mouret made some observations, finding
that complete suppression of the pancreatic function was incom-
patible with the animal’s existence.

Senn showed that complete division of the organ through
its middle portion leaving the excretory duct intact was not danger-
ous, provided hemorrhage, both arterial and venous, was controlled.
The detached portion never regained its physiologic importance,
and the parenchyma was removed by absorption without any ill-
effects being noticed in the animals. Removal of the entire organ

15

210 = Surgical Diseases and Surgery of the Dog

was invariably followed by fatal results. In six animals (cats and
dogs) operated upon, death occurred within a few hours to nine
days, either from shock, profuse hemorrhage, or gangrene of a
portion of the duodenum, owing to that part of the bowel being
deprived of its mesenteric vascular supply over an area correspond-
ing to the attachment of the pancreas.

Hédon and Mouret grafted portions of the pancreas sub-
cutaneously in a number of dogs in the following manner: Celio-
tomy was performed and the vertical portion separated from the
rest of the organ at the level of its junction with the head by means
of a ligature, without interfering with its vascular supply, it being
nourished by a special artery. This portion was then secured to
the subcutaneous tissue by sutures, its vascular pedicle passing
through the opening in the abdominal wall. In two or three days
after fixation a large retention-cyst formed through the persistent
secretion accumulating behind the ligature and distending the ducts.
A fistula resulted, but finally the secretion stopped and this por-
tion of the gland comported itself like a ductless gland. In three
weeks union was established with the subcutaneous tissue, and
newly-formed vessels sufficient for its nutrition had penetrated the
graft. The vascular pedicle was then suppressed and the graft
was complete, but the latter was found to undergo progressive
atrophy under the influence of connective tissue growth. In these
cases, if the abdominal portion of the gland remaining im situ
was extirpated, with a few exceptions no glycosuria developed
provided the grafted portion had not undergone advanced atrophy.
But if much atrophy was present there was considerable glycosuria.
The graft being extirpated, severe glycosuria appeared and termin-
ated the life of the animal.

Senn found that if he left the organ intact but occluded the
excretory duct, which rendered the animal physiologically in the
same condition as after complete extirpation as far as intestinal
secretion was concerned, the health remained perfect for three or
four weeks, but death resulted from marasmus in two to four
months. From this it will be seen that removal of the pancreas
must not comprehend resection of more than a portion of the organ,
and that the duct should be left intact.

Senn has shown that the operation is not dangerous provided
hemorrhage, arterial and venous, be controlled, though Vaughan

The Abdomen 211

Harley regards the mere effects of operation as very fatal, par-
ticularly from shock.

The mode of operation is as follows: Incise the abdominal
wall from the ensiform cartilage backwards for three to five inches
slightly to either side of the linea alba. Draw the duodenum for-
ward and separate the portion of the organ it is intended to remove
from its intestinal attachments. Doubly ligate all vessels. The
horizontal portion is reached by raising the spleen and great
omentum, or to simplify matters the latter can be completely re-
moved. Removal of the isolated portion can then be effected by
simple incision between the double ligatures. Senn advises the
employment of rubber-bands and prevents the knots made in them
from unfastening by transfixing them with a silk ligature. He
also advocates the severance of tissues by tearing rather than by
cutting, and states that it is not essential or necessary to remove
detached vascular portions of the gland as atrophy of the paren-
chyma ensues, but it is highly important to remove parts deprived
of their vascular supply.

BIBLIOGRAPHY.
Berard & Colin—Canstatt’s Jahresbericht. 1857, 1-3, p. 64.
Bernard—Lecons de Phys. Exper. 2. Paris. 1856, p. 274.
Brunner—Experiments nova circa Pancreas. 1682. Miscellanea Mat. Curios. 1688.
Finkler—Verhandl. d. Congresses f. inn. Medicin. Wiesbaden. 1886, p. 172.
Hédon—Archiy. Méd. Exper. et d. l’Anat. Path. 3, 1891, p. 44.
Hédon & Mouret—Comptes rendus de la Soc. de Biol. 1895, p. 201.
Klebs & Munk—Tageb. d. 43 Versamml, deutsch. Naturforsch. u. Aerzt. in Innsbruck. 1869.
Martinotti—Giorn. del R. Accad. di Medicina dei Torino. 1888, p. 348.
von Mering & Minkowski—Archiy. f. exper. Path. & Pharmakol. 26, 1890, p. 371.
Senn—Trans. Amer. Surg. Assn. 4, 1886, p. 99.
Vaughan Harley—Journ. Anat. & Phys. 1891-92, p. 26.

The Spleen

EXAMINATION.

The spleen is easily felt in thin animals by abdominal palpation
with the fingers of both hands. In this manner neoplastic changes
can be detected without difficulty.

CONGENITAL MALFORMATIONS.

Accessory spleens sometimes occur. Spreull observed an in-
stance in which the organ was separated into two distinct por-
tions by a space of two inches.

212 Surgical Diseases and Surgery of the Dog
TRAUMATIC LESIONS.

This organ suffers similar lesions to the liver. Wounds are
always dangerous, as they lead to rapid and profuse hemorrhage.
They may occur as a result of perforations of the abdominal wall
from stabs and the passage of bullets. Accidental wounds inflicted
during the course of surgical operations are also serious. On one
occasion when I was performing oophorectomy, the organ extruded
itself during suturing of the abdominal wall and sustained an
accidental puncture by the needle, from which there was con-
siderable hemorrhage. The operation was not concluded until it
was believed the bleeding had been permanently arrested, but
secondary hemorrhage took place, with fatal termination.

Symptoms and Diagnosis. The same remarks on diagnosis of
wounds of the liver are applicable to wounds of the spleen. If a
wound is suspected, an explorative celiotomy should be promptly
undertaken.

Treatment. Pronounced wounds should be treated by splenec-
tomy. Parkes says that removal of the organ for acute wounds
nearly always results in recovery. Hemorrhage must not be ar-
rested by ligature, but direct pressure or thermo-cauterization suf-
fice where there is no extensive laceration.

NEOPLASMS.

Both innocent and malignant growths of the spleen occur.
Of the former the commonest are hematoma, hypertrophy, and cysts.
About three per cent of all necropsies disclose the presence of
single or multiple innocent splenic growth. A form of growth
known as leukemic adenoma occurs usually associated with similar _
enlargements in the other lymphatic glands, which are of a pro-
gressive and lethal nature. Malignant neoplasms are usually
secondary.

Symptoms and Diagnosis. Splenic neoplasms can only be
definitely demonstrated by explorative celiotomy though they may
be felt as a mobile mass on palpation. When they reach a consider-
able size they cause a change in the contour of the abdomen.

Treatment. Only cysts, hematomata, and non-leukemic hyper-
trophy are operable and these should only be interfered with when
of such dimensions as to interfere with the comfort or health of the

The Abdomen 213

animal. They are removed by partial or complete ablation of the
organ.

Surgery of the Spleen

It has long been known that the dog will survive complete re-
moval of this organ. Aristotle wrote: ‘The spleen is not an organ
which is indispensably necessary to the body.” Among the earlier
writers Pliny and Clarke mention that spleenless dogs not only
live after operation but even seem to improve in condition. Barde-
leben recorded the recovery of three dogs from which the organ had
been removed. Vulpian performed complete extirpation and the
subject lived six and one-half years without inconvenience, and
Crips saw two dogs alive five months after the operation. In recent
years Picard and Malassez, Bizzozero and Salvioli, Zesas, Vitzon,
Gibson, and Frouin have performed complete splenectomy experi-
mentally with recovery. Gibson found that total extirpation was
followed by a decrease in the number of red corpuscles in the blood
and a relative and absolute increase in the number of white corpus-
cles, and the animals gained weight. In one case, the subject was
killed six months later and the mesenteric lymphatic glands were
found to be distinctly enlarged. Gibson concluded that the spleen
has a blood-forming action which is perhaps a subordinate one.
Jordon had less favorable results with complete extirpation. Of six
dogs submitted to this operation, all suffered considerable shock and
three died. In cases where the organ was partially removed, the
animals appeared to suffer no inconvenience when the lower half
was excised, but suffered greatly when the upper half was removed.
Kuester ligated portions of the splenic omentum and vessels. The
corresponding part of the organ became greatly swollen and ulti-
mately atrophied. Jonnesco, and Carriére and Vanverts ligated the
whole of the gastro-splenic omentum, including the vessels, and
found that abscess formation might result in certain cases. Investi-
gating the matter, the latter observers discovered that in eleven
healthy animals, ten showed the presence of microorganisms in
the organ. The bacteria were more plentiful immediately after the
animals had eaten. They consisted of staphylococci, streptococci,
and colon bacilli, but their virulence was impaired. Hédon trans-
planted the spleen subcutaneously in the same manner that he trans-
planted the pancreas,

214 Surgical Diseases and Surgery of the Dog

Like other important glands, when the spleen is removed in
part, the remaining portion will undergo compensatory enlargement.
An instance is recorded by Landenbach in which the organ was
almost entirely extirpated and six months later was found to have
become completely regenerated.

COMPLETE SPLENECTOMY.

The animal being anesthetised and hoppled in the dorsal posi-
tion, make the abdominal incision slightly to the left of the linea
alba immediately anterior to the umbilicus. Insert the fingers in
the left hypochondrium and draw the organ forward through the
wound. Secure all vessels and their supporting tissues at the en-
trance to the hilus in three or four silk ligatures and make the
division on the occluded side.

PARTIAL SPLENECTOMY.

Secure the vascular branches supplying the portion of the organ
it is intended to remove with very strong double silk ligatures and
divide between the knots. Apply an elastic ligature around the organ
or ligate it in half-inch sections with continuous silk suture, and
remove the occluded mass with scissors.

BIBLIOGRAPHY.

Bardeleben—Dissertatio de gland, etc. Berlin. 1841.

Garriére & Vanverts—Comptes rendus de la Soc. de Biol. 1899, p. 244.
Clarke—Ephem. nat. cur. ann. 1676.

Crips—A Treatise on the Structure and Use of the Spleen. London. 1855.
Frouin—La Semaine Médicale. 1902, No. 17.

Gibson—Journ. Anat. & Phys. 1885-86, p. 324.

Hédon—Comptes rendus de la Soc. de Biol. 1899, p. 560.
Jonnesco—Congres de Chirurg. 1897.

Jordan—Lancet. 1898, p. 208.

Kuester—Cited by Adelmann in Langenbeck’s Arch. f. Elin. Chir. 36, p. 485.
Landenbach—Virchow’s Archiv. 41, p. 201.

Picard & Malassez—Gaz. Médicale. 1878, No. 15.

Pliny—Historia naturalis.

Salvioli—Moleschott’s Untersuchungen. 12.

Spreull—Veterinarian. 1868.

Vitzon—Rec. de Méd. Vétér. 1894.

Vulpian—Gaz. Médicale. 1855, No. 33.

Zesas—Langenbeck’s Archiv. f. klin. Chirur. 28.

CHAPTER VIL

The Abdomen—Continued
THE URINARY ORGANS.

Urolithiasis

The formation of free concretions in the urinary tract is of
fairly common occurrence. It is believed to depend upon two
factors, viz., a Systemic alteration or modification of metabolism,
and a Local alteration in the urinary tract. It is believed that
there must exist a primary organic nucleus around which the cal-
careous salts become deposited, or in other words, calcification is
secondary to, and dependent upon, local degenerative tissue
changes. Such lesion occurs in the healthy aseptic gland second-
ary to primary uric acid diathesis. Uric acid is a chemical poison,
and according to Ebstein, its excessive elimination originates an
inflammation which results in cellular necrosis. Such necrosed
cells or the albuminoid substance to which their destruction gives
rise, form the organic nucleus.

Antoine de Heyde, in 1686, was the first observer to note the
presence of the necessary nucleus, and more recently various ex-
periments have been carried out to ascertain the manner in which cal-
culous formation takes place. Tuffier conducted certain of these ex-
periments and observed that aseptic smooth foreign bodies were not
modified by a sojourn in healthy urinary passages, neither did the
organ enclosing them undergo any alteration by their presence.
These results impelled him to study the conditions under which
extractive matters of the urine are precipitated on the surface of
foreign bodies to form calculi. In order to do this he produced
varied chemical composition of the urine. Nitrogenous and phos-
phatic diet and ingestion of urates and oxalates produced no result
when sterile glass marbles were introduced in the kidney and
bladder. Nicolaier and Ebstein and Thomassen endeavored to
produce artificial lithiasis by incorporating derivatives of oxalic acid

ous

216 Surgical Diseases and Surgery of the Dog

with foodstuffs. The administration of oxamethane and oxaminic
acid produced no effect, but oxamide did. Oxamide is an odor-
less white powder, obtained by heating oxalate of ammonium. It
was given in doses of four to six grams for six weeks with as
little water as possible. Ebstein’s explanation of its effect was as
follows: the oxamide was dissolved in the digestive tract, absorbed,
and eliminated by the kidneys, where it induced organic altera-
tions, notably in the glandular epithelium. The latter underwent
necrosis and thus was produced the initial albuminoid nucleus in-
dispensable to the formation of all calculi. Tuffier repeated these
experiments and also examined for the presence of microorganisms
on the surface, and in the depths of the calculi with negative result.
This upset the bacterial theory of formation in favor of the physico-
chemical. The artificial calculi were extracted and the animals
subsequently restored to health.

It has been known for a long time that foreign bodies in the
bladder are very apt to become encrusted with urinary salts. In
the seventeenth century Anton Nuck introduced a piece of wood
within the bladder, and found it had become covered with in-
crustations at the end of several weeks. Tuffier in recent years
observed that while a foreign body with perfectly smooth surface
did not favor the formation of deposits, one with a rough surface
did, particularly if it were septic. On a piece of rough aseptic
silk he found deposits, but on smooth catgut there were none.
Moreover, catgut was absorbed in two weeks’ time. This fact
would seem to have an important bearing on the selection of sutures
for surgical purposes, but it must be mentioned that Maksimow
found that catgut used for cystorraphy experiments when it pene-
trated the mucosa, became the seat of deposit of urinary salts.
Znamensky found incrustations on carbolized silk sutures which had
penetrated the mucosa, sixteen days after performing a resection
experiment. On the other hand, Thomson failed to find
any seven weeks afterwards, in an instance where two sutures had
penetrated. In certain ureteral-suturing experiments conducted by
myself there were no signs of incrustation after periods ranging
from three to seven weeks.

Calculi of uric acid or urates (ammonium urate) are usually
small, hard, smooth, and yellow, brown, or reddish. They are
the most common to be met with, and originate as a result of uric

The Abdomen 217

acid diathesis. Calculi of oxalates (calcium and ammonium oxal-
ates) are believed to occur as a result of oxalic diathesis, and ox-
alic acid being a derivative of uric acid, the oxalic acid diathesis
is a secondary manifestation of the uric acid diathesis. They are
hard, variably shaped, but often mulberry-like, and brown or yel-
low. Calculi of cystin are also believed to be derivatives of
imperfect metabolism of nitrogenous substances. They are soft,
waxy, and brownish yellow. All these varieties are found pure or
mixed in aseptic acid urine, the local lesion necessary to their pro-
duction being inappreciable, but the principal réle being played by
the uric acid diathesis. The calculi of alkaline urine are mostly
secondary to them.

When the crystals form and persist as small gritty particles
the condition is termed “sand,” “gravel,” or sediment. If the
crystalline particles become agglutinated by renal or vesical mucus,
albumen, degenerated epithelium, or blood clots, the nucleus is
started, which grows by further accretion, until a “stone” or
calculus is formed.

The other varieties, 7. ¢., phosphates and carbonates (am-
monio-magnesium-phosphate, calcium phosphate, calcium carbonate)
occur in alkaline urine, and probably often secondary to the acid
deposits, a primary acid calculus becoming the seat of phosphatic
deposit through the development of alkaline urine as a result of
disease of the tract. It is probable that alkaline urine and the pre-
sence of products of local tissue degeneration may also result in
primary precipitation of phosphates and carbonates. Alkaline urine
results from fermentative changes incident to catarrhal inflamma-
tions. The latter condition is not uncommon in old dogs suffering
from hypertrophy of the prostate with consequent local debilitating
effect of stagnating urine. These calculi, with the exception of
those formed of triple phosphate, are hard, smooth, and white or
greyish, and attain considerable size. The triple phosphatic calculi
have rough jagged surfaces.

All these substances may assist in the formation of a single
calculus. A uric acid nucleus may be surrounded by phosphates
in the presence of altered reaction of the urine. A return of acid
reaction is followed by another layer of uric or urate deposit, and
so on.

The smaller breeds are more subject to urinary deposits than

218 Surgical Diseases and Surgery of the Dog

the larger. The condition having once developed is very liable
to recur. Thus, an animal may be said to suffer from a “uro-
lithic habit,” but this depends, of course, upon the persistence of
the lithemia, which plays the principal role in calculous formation.

The clinical importance of urinary calculi depends upon the
portion of the tract at which they find lodgment. The practitioner
is principally concerned with those found in the bladder and
urethra. These will be considered under their respective headings.

BIBLIOGRAPHY.
Antoine de Heyde—Cited by Legueu in Thése. Faculté de Méd. de Paris. 119, 1891.
Anton Nuck—Adenographia curiosa et uteri foeminei anatome nova. Edit. Judg. Batav. 1692.
Ebstien & Nicolaier—Ue. d. experim. Erzeugung von Harnsteinen. Wiesbaden. 1891.
Maksimow—Anwendungsversuche vy. Darmsaitenfaeden bei Blasenaht nach Epicystotomie. St.
Petersburg. 1876, p. 51.
Thomassen—Ann. de Méd. Vétér. 1893.
Thomson—Langenbeck’s Archiy. f. klin. Chirur. 41, p. 410.
Tuffer—Archiy. de Phys Norm. et Path. 1893.
Znamensky—Langenbeck’s Archiv. f. klin. Chirur. 31, p. 149.

The Kidneys
EXAMINATION.

Surgical diseases of the kidney are diagnosed by examination
of the urine, by abdominal palpation, and by direct inspection and
exploration. Examination of the urine discloses changes in its
physical and chemical properties. The excretion may be increased
or decreased in quantity or altogether suppressed, or it may con-
tain blood, hemoglobin, albumen, pus cells, and glandular cells.
When blood originates in the kidney it generally becomes inti-
mately mixed with the urine by the time it is discharged, the flow
of urine exhibiting its presence from the outset, while when it
comes from the bladder it is usually seen towards the end of
micturition.

Abdominal palpation with the fingers of both hands, the animal
being in the standing position, reveals alterations in the dimensions
and situation of the glands.

Direct intraabdominal inspection and exploration by acupunc-
ture or aspiration are necessary to discover the presence and char-
acter of abnormal secretions.

CALCULI. (See also Urolithiasis).

Urolithic deposits occurring in the kidney are of minor im-

The Abdomen 219

portance from a surgical standpoint because they may, and generally
do, exist without inducing symptoms which can be diagnosed.
They are often found at necropsies in animals which have suffered
from lithiasis exhibited clinically in other parts of the tract. They
are usually small, and probably have their origin in the urinifer-
ous tubules whence they pass to the pelvis of the organ. Should
septic processes take place and induce an alkaline reaction of the
urine, very large phosphatic calculi may be formed. The two
largest renal calculi recorded were found by Guillon, each occupying
one kidney and weighing ninety-six and ninety-seven grams re-
spectively. Mégnin observed others weighing six and seven grams.
Tuffier produced them artificially.

These bodies may cause irritation and abrasion of the walls
of the pelvis of the organ, which may lead to more or less hem-
orrhage, the blood being carried away with the urine and giving
rise to the symptom known as hematuria. If the calculi accumul-
ate in large numbers mechanical distension of the organ takes place.
But it very often happens that no appreciable symptoms whatever
are evident, and it is hardly to be doubted that many urolithic
animals go through life without the faintest suspicion of the fact
on the part of their owners. It is when the deposits enter the
narrower passages and obstruct the flow of urine that they form a
serious menace to the animal's existence. If a deposit becomes
lodged in any part of the ureteral canal a retention cyst of the kidney
or hydronephrosis results.

Symptoms and Diagnosis. This is very difficult when the
kidney is the seat of concretions of dangerous size, and is prac-
tically impossible without expulsion of sediment or the smaller
calculi. There is usually considerable hyperesthesia of the lumbar
region, arching of the back, in some cases strangury, pain at de-
fecation, and there may be painful attacks of colic induced by the
passage of calculi along the ureteral tract. Lauteur and Guillon
have both recorded witnessing attacks of colic. The alkaline or
phosphatic calculi are generally preceded by a history of catarrh
of the urinary passages. In some cases there is only stiffness in the
lumbar region, in others occasional lameness in one or both hind-
legs.

Hematuria may or may not be present, the blood appearing
with the last few drops of, or mixed with, the urine, but the amount

220 38=Surgical Diseases and Surgery of the Dog

of blood may be so slight as to be detected only with the aid of the
microscope. It is generally increased with exercise.

Micturition becomes frequent and the animal manifests a con-
stant tendency to lick the genitals, particularly at the end of mic-
turition.

Treatment. If there is reasonable suspicion of the existence of
deposits an explorative celiotomy is justified. If the latter has a
negative result, it is without serious consequences, while if it has
a positive one, a cure may be affected by further operative measures.
If on exploration the kidney is found to be healthy and showing no
signs of dilation or hydronephrosis, nephrolithotomy, or incision
of the organ and extraction of the calculus must be undertaken,
but if on the other hand it should prove to be atrophied or hydro-
nephrotic, or complete removal of contained calculi is obviously
impossible, nephrectomy or complete extirpation is indicated, pro-
vided the opposite gland is in functioning order.

The presence of caculi in the kidney may be detected in some
cases by palpation of the organ. Tuffier found it possible to detect
them by palpation over the hilus.- Failing in this, Lequeu recom-
mends acupuncture with a needle, the point of which coming in con-
tact with a deposit conveys sufficient sensation for purpose of diag-
nosis. Thomassen practised nephrolithotomy for the removal of
calculi artificially produced, with perfect results and with rapid
recovery of the animal.

In order to correct the lithemia or local conditions which give
rise to calculous formation and to prevent their recurrence a course
of medication and special dieting should be adopted. If the case
is one of acid lithiasis the administration of alkalies and diuretics
is indicated as well as withdrawal of meat. A diet of bread, milk,
and eggs is suitable. Alkaline or catarrhal lithiasis is also to be
treated with a milk diet supplemented with administration of mineral
acids and nux vomica. But in spite of medicinal treatment the so-
called urolithic habit will often persist and subject the animal to the
necessity of undergoing repeated operations, particularly in the
case of impacted urethral calculi.

NEOPLASMS.

The kidneys are rarely the seat of neoplastic formation. The
cystic conditions known as hydronephrosis and pyonephrosis oc-

The Abdomen 221

casionally occur, while instances of primary and secondary carcino-
mata and sarcomata have been recorded.

Hydronephrosis. This term is applied to the accumulation of
aseptic matter within the kidney. The lesion originates from ob-
struction of any part of the urinary tract, and may be partial or com-
plete, and according to the position of the obstruction, may be uni-
lateral or bilateral. The condition is described more fully in the
chapter on Neoplasms. It will suffice here to point out that when
the onflow of the urinary secretion is arrested, glandular secretion
continues for a time and the kidney, together with the portion of the
ureter above the obstruction becomes enormously distended. The
intraglandular pressure thus produced causes atrophy of the secret-
ing elements, and finally, if the condition continues long enough,
nothing remains of the erstwhile kidney but a large fibrous sac
with cystic contents.

Unilateral hydronephrosis is not necessarily dangerous, the
opposite kidney taking on the function of its degenerate fellow
(compensatory hypertrophy). Bilateral hydronephrosis is neces-
sarily fatal, the rapidity of the approach of dissolution depending
upon the degree of obstruction to the urinary flow. In one in-
stance experimentally produced by myself, but in which complete
occlusion of one of the canals had not taken place, the animal
lingered three weeks, all the while gradually becoming weaker and
narcosed from accumulation in the blood of non-eliminated poisons.

Symptoms and Diagnosis. In unilateral hydronephrosis, symp-
toms may be wanting and micturition still taking place. Life may
continue indefinitely, the healthy kidney taking on the function of
its fellow. In the bilateral form, micturition is gradually sup-
pressed, the animal at the same time exhibiting progressive emaci-
ation, anorexia, and pronounced lethargy. Abdominal palpation re-
veals the presence of an elastic tumor. Explorative celiotomy should
then be undertaken. The abdominal cavity being opened, the
tumor is seen intimately adherent to the sublumbar wall, and its
base traversed by well-developed blood vessels. The cyst fluctu-
ates.

Treatment. If the degenerative process has not involved the
entire kidney and the urinary tract can be made patent again, the
gland should be left undisturbed. But if the glandular tissue is
hopelessly involved, the only practicable alternative is to perform

222 Surgical Diseases and Surgery of the Dog

nephrectomy or complete removal of the organ. Tapping of the
cyst can only be palliative, and it soon fills up again. In a case re-
corded by Almy, where the cyst was believed to be tuberculous,
several successive tappings and iodine injections were employed
without avail.

Pyonephrosis. This term is applied to the accumulation of
purulent matter within the kidney. It is always the result of in-
fectious processes derived from the blood or by extension along
the urinary tract. It may also result from traumatism. | White
has recorded rupture of a pyonephrotic kidney.

Symptoms and Diagnosis. The symptoms are obscure. Pro-
minent are anorexia and emaciation. Examination of the urine
discloses the presence of albumen, pus cells, epithelial debris and
cylinders. In other respects the symptoms resemble those of hydro-
nephrosis, and the same means should be adopted to establish the
diagnosis.

Treatment. This is the same as for hydronephrosis.

PARASITES.

The giant Eustrongyle occurs in the kidney very commonly
in certain European countries. This parasite gradually destroys the
substance of the gland, and when nothing but the fibrous sac re-
mains tends to migrate, usually by the urinary tract. Previous
expulsion is exceptional.

Symptoms and Diagnosis. Hematuria is the principal symp-
tom. This, together with coincident manifestation of nervous or
rabiform symptoms should lead to suspicion of the presence of the
parasite. Explorative celiotomy is then in order.

Treatment. This must be by nephrotomy and extraction of
the parasite, or nephrectomy, according to the degree of destruction
which the renal tissue has sustained.

Surgery of the Kidney

The kidney is reached by extraperitoneal or transperitoneal
celiotomy. By the former method the abdominal cavity is opened
in the lumbar region, by the latter, through the linea alba.

In the extraperitoneal operation an oblique incision three to
five inches in length is made through the skin at the angular space

The Abdomen 223

formed by the posterior border of the last rib and the transverse
process of the first lumbar vertebra. The muscular tissue is then
divided by blunt dissection down on to the peritoneum. The index
finger being introduced within the wound is made to disengage the
peritoneum, but without puncturing it. Between it and the psoas
muscles lies the kidney. The latter is brought out through the
wound and grasped between the thumb and index finger of the left
hand, and is ready for the next operative step. This method is not
suitable when much enlargement of the gland exists, in which case
the transperitoneal method should be followed, the opening in the
wall being made anterior to the umbilicus.

For either operation the animal should be securely hoppled
in either the lateral or dorsal position and given a general anes-
thetic.

NEPHROTOMY. NEPHROLITHOTOMY.

Section of the kidney is undertaken for the extraction of cal-
culi and the parasitic Eustrongyle. The operation has been suc-
cessfully performed by Tuffier, Legueu, Thomassen, and Rubay for
the extraction of concretions. A longitudinal incision is made at
the convex border, where vascularity is at a minimum and hemorr-
hage, as a rule, insignificant. Superficial vessels of large caliber
traverse both faces of the gland, but do not anastomose at the
border. The incision is carried through to the pelvis. In case of
much bleeding (Tuffier experienced this on one occasion) it can
be arrested by a stream of water and compression of the renal
artery between thumb and finger. Every vestige of concretion is
then removed. Large alkaline concretions sometimes have branches
extending into the calyces, which increase the difficulty of their re-
moval. These are best freed by passing a blunt instrument around
them. In cases of acid concretions the ureter should be sought
and a probe passed down into its lumen into the bladder to make
sure that no stone is lodged in it.

The pelvis can also be opened by direct incision, but this posi-
tion is seldom selected, as a wound thus made is usually followed
by the formation of a serious fistula.

Tuffier and Thomassen closed the organ with three or four
catgut sutures. If sutures are used they must not be tied very
tight, so as to destroy any renal tissue and provoke the formation

224 Surgical Diseases and Surgery of the Dog

of cicatrical tissue. Healing under asepsis is per primam. Rubay
found it unnecessary to use any sutures at all, but merely returned
the wounded organ to its proper position. A minute scar forms
at the line of incision.

After-treatment consists in dieting exclusively with milk. In-
creased micturition usually follows for a few days.

NEPHRECTOMY.

This operation is indicated in advanced cases of hydroneph-
rosis, or whenever the renal tissue has hopelessly lost all power of
function, or has sustained severe wounding. The operation must
not be undertaken unless the opposite kidney is perfectly healthy.
It is difficult where the organ is much distended, and in case of
cystic formation it may be found advantageous to first open the
sac and evacuate the contents. The pedicle is clamped with blunt
forceps. The renal artery and vein are then ligated. It must not
be forgotten that these vessels often split up into three or four
branches soon after leaving the aorta. Ligation is best effected by
means of an aneurism needle, artery and vein receiving each a
separate ligature. It is always safest to apply double ligatures, as
the risk of hemorrhage from the pedicle is very great.

BIBLIOGRAPHY.
Almy—Ann. de Méd. Vétér. 1895, p. 415.
Guillon—Archiy. Vétér. 1876, p. 280.
Lautour—Rec. de Méd. Vétér. 1828, p. 315.
Lequeu—Thése Faculté de Méd. de Paris. 119, 1891.
Mégnin—Bull, de la Soc. Cent. de Méd. Vétér. 1881, pp. 156, 473.
Rubay—Ann. de Méd. Vétér. 1895, p. 415.
Thomassen—Ann. de Méd. Vétér. 1893, p. 659.
Tuffier—Archivy. de Phys. Norm. et Path. 1893.
White—Chicago Vet. College Quart. Bull. 1, 1902.

The Ureters

CALCULI. (See also Urolithiasis).

Urolithic deposits are seldom found in the ureters, but they
occasionally become lodged there in passage from the kidney to
the bladder, or they may form on the proximal side of the constric-
tion. Sutton described an instance in which a calculus was found
lodged in the vesical end of the left ureter, while there were two
large and two small ones in the bladder. Tuffier found calculi of

The Abdomen 225

oxalate of lime in the ureters in his experiments for the production
of concretions.

Symptoms and Diagnosis. This is as difficult as in the case of
renal calculi. A calculus impacted in the ureter obstructs the flow
of urine and results in the formation of hydronephrosis. If the
presence of the latter condition can be determined it remains to
make an explorative celiotomy to discover the cause of the obstruc-
tion.

Treatment. If the obstruction proves to be a calculus, ure-
terolithotomy or incision of the duct and extraction of the body
is indicated.

SURGICAL WOUNDS.

In operating on abdominal viscera it is possible to sever the
ureter by mistake or by a slip of the knife. The accident has hap-
pened in human surgery.

Treatment. Such a lesion can be remedied by the operation
of Anastomosis or Uretero-ureterostomy.

Surgery of the Ureters

The necessity for surgical interference with these important
ducts may only occur as a remote contingency, nevertheless every
veterinarian should know how to carry such an undertaking to a
successful conclusion. Hence, a brief review of the experimental
surgery that has been accomplished will not be superfluous.

The ureters are reached by exerting gentle traction on the
bladder, whereby they are made to stand out prominently beneath
the peritoneal fold under which they are loosely embedded. The
latter is opened by snipping with scissors, and the ureter can then
be drawn forward. It must not be confounded with the vas deferens
with which each ureter runs a short parallel course along the sides
of the bladder. The two ducts are very similar in size and out-
ward appearance, but the vas deferens is firmer, feeling like a piece
of whip cord.

The principal operations consist of Ureterolithotomy, Anas-
tomosis of the severed ureter, and Implantation of the ureter in
abnormal positions. The ureters have been experimentally im-

16

226 Surgical Diseases and Surgery of the Dog

planted in different parts of the bladder, in the vagina, in the skin,
and in the intestine. In one instance, Tizzoni and Poggi made an
artificial bladder out of a knuckle of small intestine in which they
implanted both ureters, the animal completely recovering.

Anastomosis or Uretero-ureterostomy was successfully accom-
plished in 1887 by Poggi, who invaginated the upper segment into
the lower and sutured it in position. Since then, van Hook, Bovée,
and Kelly have experimented in the same direction and the technic
of their several methods differs only in minor respects.

This operation is only available when the severed ends can
be easily approximated. The ureter of the dog runs in a com-
paratively straight line from the kidney to the bladder, and if more
than half to one inch of its continuity is destroyed, the tension
to which it is subjected by stretching is too great to permit of re-
union being maintained. But Bovée has shown that this difficulty
may be overcome by taking advantage of the mobility of the kidney
and displacing it posteriorly. The gland may be separated from its
. surrounding tissues and brought down to the level of the iliac crest
and there stitched to the abdominal wall. This procedure gives
considerable slack to the ureter.

Implantation in the bladder or Uretero-cystotomy may be
undertaken with good results, though there is always considerable
risk from cicatricial stenosis with resultant hydronephrosis.

Implantation in the bowel or Uretero-enterostomy is not a
practicable operation for the reason that intestinal bacteria invari-
ably ascend the ducts and give rise to pyelonephritis. It was at
first believed that if the trigonum vesicae were implanted together
with the ureteral orifices the ascending infection might not take
place, but the experiments in this direction all terminated fatally
through sloughing of the implanted part. The reason of this was
made apparent in the discovery that the blood-supply of the tri-
gonum came from the vesical arteries, and not from the ureteral,
so that in order to preserve the nutrition of the parts implanted
it would be necessary to include a large part of the bladder wall
which operation would practically resolve itself into Cysto-enteros-
tomy or Vesico-rectal anastomosis, which is described elsewhere.
Peters claims that if the ureters be so implanted that their free
ends project into the lumen of the bowel, a natural valve is there-
by produced, simulating the bile papilla, and that by this means

The Abdomen 227

the ascent of bacteria is, to some extent, prevented. Of late Barbat
has endeavored experimentally, with fair success, to use a portion
of small intestine to bridge over the gap left after resection of the
ureter. This he did by excising a small tract of ileum, without
disturbing its mesenteric attachment, closing the two ends of the
same, re-establishing the caliber of the remaining intestine with a
Murphy button, and implanting the upper end of the ureter and the
bladder in the isolated portion.

URETEROLITHOTOMY.

The obstructing calculus being located, the wall of the ureter
is incised and the body extracted. The opening is then closed with
a few interrupted black silk sutures placed so as not to include the
mucosa. The wall of the tube being considerably hypertrophied
at this point, is rendered quite prominent.

URETERO-URETERAL ANASTOMOSIS.
URETERO-URETEROSTOMY.

Kelly’s method is as follows: The open end of the lower frag-
ment of the ureter is closed with a fine silk ligature, and just be-
neath, a slit, about half an inch in length, is made in the ventral
wall. Two black silk sutures are passed through each lateral
wall of the lower extremity of the upper fragment, through the
slit in the lower fragment and out through its lateral wall. These
two sutures serve as tractors by which the upper fragment is drawn
into the lumen of the lower through the slit. These sutures are
then tied and the slit is entirely occluded. Two additional sutures
are passed through the lateral walls, avoiding the mucosa, where
the ends overlap. The ureter, thus anastomosed, is dropped back
into its normal position.

URETERO-VESICAL ANASTOMOSIS. 3
URETERO-CYSTOSTOMY.

The technic of this operation as experimentally performed by
myself, is as follows: The ureter (D) being exposed by raising
the bladder, a traction suture (A) is passed through it immediately
above the spot at which it is to be divided, and it is stripped of its

228 Surgical Diseases.and Surgery of the Dog

=: - \\ \, :
Vetta
‘| nN oO \\\\ SS

No. 46a. Uretero-cystostomy. First stage.

‘AANA sii WW
\N\ ih \\\
Neal

——a.

No. 46b. Uretero-cystostomy. Second stage.

ri vias "0 sh Ny

di w\
~ a o ¢ «¢ ot y \S
yy \\\ " / m >

No. 46c. Uretero-cystostomy. Third stage.

peritoneal covering for a short distance. It is then ligated near
its vesical insertion and severed just above the ligature. A spot on
the bladder is next selected as near to the original site of insertion
as possible. Here the peritoneum is incised a distance of about half
an inch and (C) deflected laterally. A small opening (E) is made

The Abdomen 229

through the muscular wall (B) and mucosa at the distal extremity
of the incision. Two sutures (F) of fine black silk threaded to a
fine straight cambric needle are passed through the muscular wall
of the bladder and continued through the muscular wall of the
ureter, avoiding the lumen as far as possible, at a point which will
permit the ducts to project into the bladder. By means of the trac-
tion sutures the ureter is approximated to the bladder, while the
sutures (F) are tied. Guided by a grooved director, the needle
holding the traction suture (A) is passed through the opening (E)
into the interior of the bladder and made to emerge through its wall
a little further on. In this manner the end of the ureter is
pulled through the opening. A third suture is then passed through
the bladder muscle and ureteral muscle at the edge of the opening.
Finally, the deflected peritoneum is united by the interrupted sutures
(G) and the traction suture pulled out after cutting one strand.
By intersuturing the bladder and ureter in the above-described man-
ner a broad surface of adhesion is obtained through which a maxi-
mum amount of tension is resisted.

BIBLIOGRAPHY.
Barbat—Journ. of Amer. Med. Assn. 1901.
Bovée—Ann. of Surgery. 1897, p. 66.
Kelly—Ann. of Surgery. 1894.
Sutton—Ill. Med. News. 1889, p. 121.
Tizzoni & Poggi—Ricostruzione della vesica orinaria. Bologna. 1891.
Tuffier—Arch. de Phys. Norm. et Path. 3.
Van Hook—Journ. of Amer. Med. Assn. 1893, p. 911.

The Bladder
EXAMINATION.

Affections of the bladder are diagnosed by functional symptoms
supplemented by abdominal, rectal, and vaginal palpation.

The functional symptoms consist of abnormal micturition and
changes in the physical and chemical properties of the urine. Blood
when it originates in the bladder is usually expelled at the end of
micturition.

A sample of the urine for examination may be obtained at the
time of its expulsion from the body by catching it in a receptacle or
causing the animal to urinate on a concreted surface; otherwise it
is drawn off by catheterization. By abdominal palpation the bladder
when empty can be distinguished only with difficulty. When it is

230 «©=©Surgical Diseases and Surgery of the Dog

distended, however, it may easily be felt as a pyriform body situated
immediately anterior to the pubic border. By rectal palpation it
can be felt under both conditions. The presence of uroliths and
neoplasms can generally be recognized by either method of pal-
pation, while inflammatory disturbances of the wall of the organ
are indicated by the evincement of pain on pressure.

TRAUMATIC LESIONS.

Injuries sustained by the bladder consist of traumatic or spon-
taneous rupture and wounds caused by penetration of foreign bodies.
Accidental wounds have also been inflicted during the course of
surgical operations.

Rupture. Rupture can occur under the influence of some sud-
den strain while the organ is distended. Harrison observed an in-
stance which occurred in a Mastiff while the latter was making
attempts to copulate.

The lesion can also result from the application of some violent
compressing force, as when a wheel passes over the abdomen.

It can also occur from gradual or sudden over-distension owing
to mechanical obstruction at the neck or in the urethra, such as is
caused by the lodgment of a calculus (Petit and Almy) or through
torsion of the organ (Siedamgrotzky).

It is less apt to follow the gradual formation of an obstruction,
as occurs from the presence of neoplasms, on account of the compen-
satory hypertrophy which takes place in the wall. But that it may
and does sometimes take place under such conditions is evidenced
by the following cases: Wehr described an instance resulting from
compression by a carcinoma of the retroperitoneal glands, De-
meurisse one from compression by a carcinoma of the neck of the
bladder, and Simonds another from compression: by an enlarged
prostate.

It may also occur as a result of suppression of micturition
through an animal’s instinct of cleanliness. In December, 1900,
the municipal court of New York was called upon to decide a suit
at law brought by the owner of a Japanese Spaniel against an express
company, which had contracted to deliver the animal at a certain
destination but which, through negligence on the part of its em-
ployees, it had failed to do. The animal, cooped for several hours,

The Abdomen 231

retained its urine until the wall of the bladder became paralysed,
and secretion continuing, rupture followed. The owner won the
suit.

Wounds. This class of wounds consists of stabs by pointed
weapons generally in the hands of vicious persons, gun-shot wounds,
and puncture by sharp extremities of bone in cases of fracture of
the pelvis. The researches of Vincent have shown that puncture
by instruments of small diameter, such as needles, are perfectly
harmless and heal spontaneously.

Surgical Wounds. Accidental incision during intraperitoneal
operations has occasionally taken place. Rodloff and Hobday both
relate that they have met with this accident, the former during an
operation for hernia and the latter while performing oophorectomy.
Siedamgrotzky, while operating for perineal hernia, which proved
to be of the bladder, incised the latter through the animal moving
suddenly. In each of these instances the lesion was sutured and
terminated in recovery.

Symptoms and Diagnosis. Systemic collapse with suppression
of micturition following a history of application of a compressing
force or of extreme distension of the bladder from obstructive causes
should lead to a suspicion of rupture. In thin animals abdominal
palpation will generally reveal the pyriform outlines of the distended
bladder, and if these can be made out rupture can of course be
excluded from consideration. Should such lesion have occurred,
. the introduction of a catheter is followed by escape of both urine
and blood. A definite quantity of aseptic liquid should then be
injected with moderate force. While this is being done, palpation
will reveal gradual distension of the organ, which is almost imme-
diately succeeded by collapse and the return of a diminished quantity
of the liquid. The aspirator may be employed to determine the
presence and character of any intraperitoneal fluid, but the latter
does not, as a rule, remain long in the cavity, being quickly absorbed.
In some of Znamensky’s experimental resections, where the stitches
in the bladder wall gave way, and the animals undoubtedly died of
uremic poisoning, there was not a sign of urine in the cavity, it
having been entirely absorbed.

Treatment. Rupture of the bladder calls for prompt operative
interference. Vincent made very complete experimental research in
bladder lesions in a number of dogs. He performed celiotomy,

232 Surgical Diseases and Surgery of the Dog

wounded the bladder in various ways (by instruments and bullets)
allowing urine and blood to escape into the peritoneal cavity, closed
the abdominal wall, reopened it several hours later, restored the
continuity of the parts, cleaned the cavity, and again closed the wall.
The following conclusions were reached: Solutions of continuity
of the bladder wall are capable of reunion by first intention if prop-
erly sutured, and even spontaneously in exceptional cases. Rupture
of the organ in half its extent heals very well. The chances of re-
covery are very good if suturing be practiced from six to twelve
hours after perforation with extravasation of blood and urine. They
diminish as the time increases and if suturing be undertaken twenty-
four hours later it is useless, the animal dying from the lethal effect
of the absorbed urine rather than from peritonitis. Nevertheless,
if the urinary intoxication is not pronounced the operation should
be proceeded with at any stage. A vigorous dog will survive forty-
eight hours. If drainage exists, as may take place through an ab-
dominal wound, life will be prolonged over this period, and it is
conceivable that spontaneous repair might thereby ensue.

Simple wounds are treated by celiotomy and simple cystor-
raphy. Severe wounds involving less of the tissue may be remedied
by resection.

CYSTITIS.

Inflammation of the bladder is an infective process caused by
the activity of bacteria which gain access to the organ by way of
the genito-urinary tract, the peritoneal cavity, or the blood stream.
Thus, it may be produced by septic catheterization, by extension of
inflammatory diseases of continuous or contiguous organs (nephri-
tis, urethritis, vaginitis, pyelitis, peritonitis), and by stagnation of
urine resulting from causes of a mechanical nature (prostatic en-
largements, urethral calculi). It has also been known to follow
prolonged retention of urine in instances where animals have been
kept in crates for lengthy periods. Other factors are the ingestion
of substances irritating to the mucosa of the urinary tract (can-
tharides and turpentine preparations) and causes of a traumatic
nature, such as wounds and the irritation of calculi. The disease
occurs in both acute and chronic forms. In most cases the former
develops as a complication of nephritis. |The mucosa becomes
swollen and highly injected and sometimes hemorrhagic. In severe

The Abdomen 233

cases there may be pseudo-membranous. formation and even gan-
grene, all the coats of the wall participating. In the chronic form
the mucosa is thickened and the muscular layers hypertrophied with
occasional formation of polypoid myxomatous growths.

Symptoms and Diagnosis. Acute cystitis is characterized by
impeded, frequent, and painful micturition with intermittent slight
attacks of colic. The urine flows drop by drop and may finally be-
come entirely withheld, the animal dying of uremia. The urine is
always greatly modified, becoming neutral or ammoniacal, and
containing epithelial debris, leucocytes, mucus, albumen, and crys-
tals of ammonio-magnesium phosphate, and sometimes blood. The
head is carried low, the movements of the hindquarters are un-
certain, constipation is present, the appetite is diminished or sup-
pressed, thirst is intense, the temperature elevated, the pulse hard
and frequent and respiration accelerated, and finally reflex vomiting
may occur. Palpation reveals a distended and extremely sensitive
bladder. The prognosis should always be guarded. In chronic
cystitis catarrhal symptoms form the prominent feature. The urine
is purulent and signs of distress follow the act of micturition. The
sound should always be passed to ascertain the presence or absence
of calculi.

Treatment. Disinfectant irrigation of the bladder is indicated,
a warm saturated boric acid solution containing a few drops of liquid
extract of belladonna being highly recommended.

On account of the limited capacity of a portion of the urethra
in males by which ample irrigation is rendered impossible, Camardi
has successfully practiced and recommends that the urethra be
opened in the perineal region, a drainage tube inserted, and irriga-
tion carried out thereby morning and evening.

If calculi are present they must be extracted. Internally, such
antiseptics as salol, urotropin and benzoate of soda which are elimi-
nated by the kidneys, may be given with beneficial effect. The diet
must be non-stimulating, all meats being withdrawn.

CALCULI. (See also Urolithiasis).

The urolithic deposits found in the bladder are of variable con-
formation, at times existing as small rounded concretions when they
are usually present in large numbers. Wesbitt counted one hundred
and ninety-four in one case, some of the stones being embedded in

234 Surgical Diseases and Surgery of the Dog

the mucosa. Sometimes they occur as calculi of smaller or larger
dimensions. The bladder may be completely filled by them so that
the urine must percolate through drop by drop (Kitt). At other
times, large single calculi are found, oval in form and closely con-
forming to the shape of the bladder. Johne saw one which meas-
ured 11 cm. in length, 7.5 cm. in width, and 6 cm. in thickness, and
which weighed 490 grams.

Symptoms and Diagnosis. Acid calculi in the bladder affect
the organ in no greater degree than they do the kidney. It is the
larger alkaline concretions with which we have principally to do in
this organ. As already stated, they usually occur concurrently
with, and probably as a result of, catarrhal cystitis. Hence pus is
generally present which makes the urine very turbid. The wall of
the bladder is greatly hypertrophied, and ulceration of the mucosa
with hemorrhage is common. Johne observed small polypoid
growths and it is not uncommon to find the smaller calculi em-
bedded in the mucosa.

The presence of the large cystic calculi can in most cases be
detected by abdominal palpation. They are felt on the floor of the
bladder. When calculi lodge in the neck of the bladder they induce
symptoms similar to those which are seen when the urethra is
obstructed.

Treatment. This can only be by operative interference. The
removal may be effected by either of three operations, viz., prepubic
lithotomy, lithotrity, or litholapaxy.

The preferable operation in all vesical cases, acon uae in the
female, is prepubic lithotomy or removal by celio-cystotomy, for
the reason that the prostatic portion of the urethra is often not
penetrable by instruments owing to enlarged prostate, and the ure-
thral method is not suitable for multiple or very hard calculi or for
encysted stones. The prepubic method affords better access to the
interior of the viscus and involves no more risk than does perineal
section, provided careful technic be observed. Moreover, it obviates
the necessity of the practitioner providing himself with a cumber-
some array of several sizes of lithotrites and an evacuating bulb.
In twelve cases of prepubic extraction reported by Malzew there
were only two fatal results.

In the female, the dilatability of the urethra more readily per-
mits of litholapaxy.

The Abdomen 235

The term lithotrity is used to designate the operation of crush-
ing the stone by means of a lithotrite, wielded through an opening
made in the urethra, and leaving the fragments to be washed out
by the subsequent flow of the urine, and the term litholapaxy the
crushing and removal of the fragments at one and the same opera-
tion. When the urethral method of removal is followed, litholapaxy
should be practiced, as good surgery aims to make certain the re-
moval of every vestige of concretion within the organ, so that
none may remain to form a nidus for further accretion or to become
an obstruction in its passage through the urethral canal. In fact,
it goes without saying, that lithotrity should never be practiced.
When the stone is lodged at or near the neck of the bladder in the
male the preferable way to effect its delivery is to force it back
within the bladder by means of the flexible metal sound or a bougie
and then remove it by prepubic lithotomy.

Whenever calculi are extracted from the bladder by direct oper-
ation, the ureters should also be explored to make certain that they
do not also contain such bodies. Sutton describes an instance where
he observed calculi lodged in both the bladder and ureter at the
same time.

The medicinal remedies employed in alkaline or catarrhal li-
thiasis are benzoic preparations and salol, together with the milk
diet.

Irrigation of the bladder with antiseptic solutions by means of
the catheter should also be resorted to, the object being to allay any
tendency to cystitis or to alleviate it if it has developed.

TORSION. RETROFLEXION.

Torsion of the bladder was witnessed twice by Siedamgrotzky.
In one instance it was caused by the presence of a subserous hema-
toma near the neck of the organ, in the other through an omental
sarcoma becoming adherent to the neck.

Retroflexion is a condition in which the viscus is bent abruptly
back into the cul-de-sac of Douglas under extreme expulsive efforts
in subjects suffering from prostatic enlargements of other form of
obstruction, and forms a subcutaneous swelling in the peri-anal
region (see Perineal Hernia).

Symptoms and Diagnosis. In torsion and in some cases of
retroflexion suppression of micturition takes place as a result of

236 Surgical Diseases and Surgery of the Dog

obliteration of the urethral lumen. Contrasted with suppression
resulting from prostatic enlargements and calcular obstruction it
is complete and sudden in its advent. The animal makes ineffectual
attempts to urinate and has colicky pains. Distension of the organ
is discoverable by abdominal palpation. To exclude calcular ob-
struction from consideration the catheter or sound should be passed.
Palpation with the index finger in the rectum or vagina permits of
differentiation from prostatic enlargements. Uncertainty as to the
condition present should be relieved by explorative celiotomy.

Treatment. As soon as the bladder is found to be overtaxed
it should be promptly evacuated by puncture. The condition must
then be relieved by direct adjustment through the open abdominal
cavity, according to the exigencies of the case.

‘NEOPLASMS.

Both innocent and malignant growths have been observed in
the bladder but their occurrence is extremely rare. Myxoma, myoma,
and primary and secondary sarcoma and carcinoma have been
recorded.

Tumors of the bladder offer but little scope for surgical inter-
ference.

Symptoms and Diagnosis. The dominant symptom is progres-
sive, painful, and frequent dysuria coupled in the case of malignant
tumors with cachexia and inappetence. The abdomen may or may
not show enlargement according to the size of the growth. Palpa-
tion of the abdomen or with the index finger in the vagina or rectum
discloses the presence of an uneven growth.

In cases of carcinoma, sarcoma; and myoma, seen respectively
by Demeurisse, Bournay, and Liénaux, there was no hematuria,
but Schulz observed in a case of primary carcinoma straining at
micturition for some time before a drop of urine was passed, the
latter flowing in a thin stream and being followed by a few drops
of blood. This was particularly noticeable after exercise.

Treatment. Celiotomy and extirpation of the growth or par-
tial resection of the viscus are indicated. If the terminal portions
of the ureters are involved they can be divided and implanted else-
where, while if the neck of the organ is diseased the only alternative
is extirpation of the growth and anastomosis of the remainder of
the organ with the rectum, as practiced experimentally by Frank,

The Abdomen 237

Gluck, and Zeller, and others. But it must be borne in mind that
a favorable termination to the latter operation could only be hoped
for in a young or middle-aged animal free from cachexia. Liénaux
attempted the removal of a myoma by blunt dissection, but experi-
enced excessive hemorrhage from which the animal succumbed two

days later.
Surgery of the Bladder

For all operations on the bladder the animal should be secured
with hopples in the dorsal position.

Simple operations, such as catheterization, irrigation and punc-
ture are performed without the aid of anesthetics, but all operations
involving celiotomy or perineal litholopaxy require general anes-
thesia. When the continuity of the wall of the organ is interfered
with Znamensky has advised the use of chloroform for the reason
that it is the only anesthetic which prevents muscular contractions,
the wound remaining its natural size, thus permitting of linear
suturing. Chloretone, since invented, produces the desired effect
equally as well. The opening in the abdominal wall should be made
immediately in front of the pubic border, in the median line, the
penis in the male being dislocated for this purpose. (See Celio-
tomy.)

The bladder is a prominent organ and easily reached. Some
authors advise the introduction of a catheter by way of the urethra
to facilitate its finding, but this is superfluous. When empty it is
easily pulled forward out of the abdominal wound, but when distend-
ed this becomes more difficult owing to hindrance offered by the most
prominent ligaments—the two lateral and the median unbilical en-
closing the obliterated urachus. On raising the organ and examin-
ing its superior aspect, two prominent vessels are seen which bi-
furcate and with others are distributed over the surface of the organ
in an arborescent manner. They become still more prominent when
the wall of the organ undergoes hypertrophy, as is commonly seen
in the presence of calculi, enlarged prostate, etc. Most of the
vessels lie just beneath the serosa and are therefore easily ligated.
When the organ is distended they are stretched but when it is con-
tracted they become very tortuous. The ureters find insertion im-
mediately to the outside of the two prominent vessels just before

238 Surgical Diseases and Surgery of the Dog

the bifurcation of the latter. They are embedded in more or less
connective tissue and fat and must be carefully sought for when
any extended operation is undertaken. The ureter crosses the vas
deferens on either side, and the latter must not be mistaken for the
former, an error which has befallen some experimenters.

PASSAGE OF THE CATHETER AND SOUND.

Catheters made of cotton web or soft rubber, preferably the
former material, are best adapted for use on the male. Their length
should be from fifteen to eighteen inches, and sizes three to twelve

No. 47. Male Catheter.

No. 48. Female Catheter.

‘(metric scale) meet all requirements. A wire stylet facilitates pas-
sage of the instrument, but it must be used with extreme caution
as it is very easily thrust through the wall of the instrument.
: Bougies for treatment of stricture are used in somewhat larger
sizes. For the female the catheter should be of the same material
as for the male, or, better still, of metal in the same sizes.

These instruments should always be rendered sterile and be
well lubricated before being used.

PASSAGE OF THE CATHETER IN THE MALE.

Secure the animal in the dorsal position and stand facing its
left side. Expose the penis by retracting the prepuce with the left
hand. Holding the catheter in the right hand insert it within the
urethral orifice and pass it gently along the canal. Some slight
impediment is generally met with at the level of the posterior ex-
tremity of the penial bone owing to a decrease in the caliber of the
urethra at that point, but it is easily overcome by a little increased
pressure. An obstruction at this point indicates a pathologic con-
dition. As soon as the ischial arch is reached, the wire stylet is

The Abdomen 239

gradually withdrawn to permit the instrument to pass the perineal

curve.
The bougie and metallic sound are passed in a similar manner.

PASSAGE OF THE CATHETER IN THE FEMALE.

Secure the animal in the
ventral position and dilate
the vagina with a specu-
lum. Introduce the cath-
eter into the vesti-
bule, direct it within
the urethral orifice,
and pass it forward
till it enters the
bladder. No. 49. Vaginal Speculum.

IRRIGATION.

This operation is productive of highly satisfactory results in
inflammatory conditions of the bladder, the object being to bring
disinfectant and other medicinal agents in direct contact with the
diseased tissue. It is also resorted to as an adjunct to urethrotomy
when the latter operation is performed for the removal of calculi,
in order to produce immediate evacuation of any calculi which may
still remain in the bladder. It is carried out by the siphonage sys-
tem. The animal being secured in the dorsal position, a catheter is
introduced within the bladder in the ordinary manner. The stylet
being withdrawn, the urine is permitted to escape. Connection is
then made with a small rubber tube and funnel and the latter are
elevated. The solution is poured in, and when the organ is well
distended is allowed to run out again by depressing the tube to a
lower level.

PUNCTURE.

This operation is indicated whenever urine is prevented from
escaping in the natural manner and there is risk of rupture of the
bladder from its accumulation. The operation is a minor one and
entirely devoid of any ill after-effects, owing to the remarkable
capacity of the organ to contract under the stimulus of an instru-

240 Surgical Diseases and Surgery of the Dog

ment however fine. Wounds of small size are thus promptly sealed.
Vincent punctured the bladder of a dog with twelve needles of
different caliber in an experimental way. There was no penetra-
tion of urine and no inflammatory reaction on the peritoneal side.
Znamensky had similar results. Rouville carried these investigations
a point farther and discovered that if the organ is distended by in-
jection, immediately after puncture, the fluid will escape at the ori-
fice of puncture in a jet and thus gain entrance into the peritoneal
cavity. On the other hand slow accumulation of urine after the
operation was not followed by filtration. Rouville was of the
opinion that in cases of unavoidable distension which necessitate
repeated puncture, this should be done at intervals sufficiently short
to prevent great accumulation. The best spot at which to make the
puncture is immediately in front of the pubis in the median line.
To reach the median line in the male, the penis can be pulled over
to one side. A very fine trocar and canula, or preferably an aspi-
rator should be used for the purpose. Puncture may be repeated
as often as is considered necessary.

CYSTORRAPHY.

All surgeons who have extensively practiced suturing of vis-
ceral organs advise the use of the ordinary milliner’s needle. The
surgical needle is very apt to wound vessels and induce local
hemorrhage. Znamensky experienced this trouble in his bladder-
resection experiments, the blood escaping into the interior of the
organ and forming a clot which prevented the free outflow of the
urine. Maksimow, Julliard, and Vincent had good results from the
experimental use of carbolized catgut, Nos. o and I, as a suturing
material, but occasionally the knots became loosened and it was too
quickly absorbed. Metallic suturing was always effective but some
difficulty was experienced in handling it. Vincent never had any
bad results from the employment of silk and considered it the best
material to use, an opinion in which I fully concur. It finally be-
comes encapsulated by an organized exudate. Maksimow tried
suturing throughout all the coats of the wall and the animals
succumbed. The mucosa tended to interpose itself between the ap-
proximated edges of the wound and hindered the reparative process,
the gut being absorbed before reunion was established, and there
was consequently extravasation of urine. Moreover, suturing mate-

The Abdomen 241

rial which penetrated, as is the rule with all foreign bodies, sooner
‘or later became the seat of deposit of urinary salts. Accordingly,
sutures must only be made to take up serous and muscular coats.
In other words, the proper method is that of sero-musculosa—sero-
musculosa, with inversions of the margin of the wound. This
method utilizes the well-known plastic activity of peritoneal surfaces,
which exceeds by far that of primary union of wounded muscular
tissue. It is important that sutures be applied not too far apart.
The extent to which the bladder will contract under the stimulus
of section is quite remarkable, being fully one-half the former capac-
ity, and sutures placed apparently at sufficient distance from each
other while the viscus is in this condition will be altogether too far
apart when it is distended with urine. Sutures placed at a distance
of 2 mm. from each other will be at 3 mm. after distension. A
single row of sutures suffices in simple cystotomy or after resection
of small portions of the wall, although this may be reinforced with
a second one at the discretion of the operator. Znamensky found
a double row imperative in cases where he resected the greater por-
tion of the organ. Vincent advises that the operation be supple-
mented by urethral injections of some colored fluid, such as milk,
with sufficient force to distend the organ. This affords means for
detection of permeability of the sutured surface, in which case a
second row of sutures must be inserted.

After suturing, the catheter should be used at least twice daily
until normal micturition is established, not on account of the opera-
tion interfering with the contractility of the organ, but because
blood-clots may clog the urethra. After operations on the bladder
the urine discharged for the first day or two is liable to be mixed
with more or less blood. In simple operations the animal usually
recovers its normal spirits within two days.

PREPUBIC LITHOTOMY. CYSTOTOMY.

The abdominal cavity being opened and the bladder drawn for-
ward and surrounded with packs, an incision is made where vas-
cularity is seen to be least. In the presence of calculi the organ is
usually much hypertrophied and its vascularity increased; hence
persistent bleeding is prone to occur at the site of incision. All
bleeding points should be ligated or twisted though they tend
to stop of their own accord through the subsequent contraction of

17

242 Surgical Diseases and Surgery of the Dog

_ the organ. The incision is made of sufficient length to effect de-
livery of the largest body present, and the edges of the wound
caught with hemostatic forceps. It is a good plan to apply the
sutures without, of course, tying them, before making the incision,
as it insures more accurate alignment being made than is afterwards
possible, owing to the tendency of the organ to contract under the
stimulus of the knife. Encysted calculi, i.e., calculi embedded in
the mucosa, are removed by scraping with the scoop. All calculi
being removed, the interior of the organ is flushed with a warm
antiseptic or saline solution and the wall closed as described under
cystorraphy.

LITHOLAPAXY.

The technic of this operation in the male is as follows:
Administer a general anesthetic and secure the animal in the dorsal
position with the hind legs drawn forward. Pass the catheter to
the bladder, draw off the urine and inject a quantity of antiseptic
or saline solution sufficient to distend the viscus. Open the urethra
as in urethrolithotomy, making the incision in the perineum at the
level of the ischial arch. Withdraw the catheter and introduce a
lithotrite of suitable size through the wound and cautiously pass it
through the prostatic urethra into the interior of the bladder. Turn
the shaft of the instrument so that the blades will point towards the
roof of the organ which is now undermost, and wait a few moments
until currents generated by the passage of the instrument have sub-
sided. Draw back the male blade and manipulate it until the stone
is caught. It may be necessary to turn the blades to either side.
Then lock the instrument and crush the body by screwing. Sudden
cessation of resistance indicates that either the stone has slipped
away from the grasp or it has been pulverized. Repeat the crushing
process until no stones of any size remain and then proceed to evacu-
ate. The latter part of the operation is accomplished with a bulb in-
strument, know as the evacuator, by which a suction effect is pro-
duced. In the absence of the instrument the next best means to em-
ploy is irrigation with the catheter. Leave the urethral wound open
to heal by cicatrization as in urethrolithotomy. In the female the
operation is more practicable provided the stones are of very
moderate size. It is conducted as follows: Anesthetise and secure
the animal in either position. Dilate the vagina with a speculum,

Phe Abdomen 243

and then the urethra, using for the latter purpose a conical blow-pipe
such as is provided in dissecting sets, or enlarge by incision as in
urethrolithotomy. Then introduce a lithotrite and extract or, if
necessary, reduce the stone or stones to fragments and evacuate
precisely as in the male.

RESECTION.

Extirpation of the bladder, whether partial or complete, is
borne well by the dog. Many experiments of this nature have term-
inated successfully. Tizzoni and Poggi who removed the greater
part of the original organ and connected the ureters with the neck,
found that the latter had undergone transformation into an entirely
new bladder-like viscus at the end of three years. Gluck and Zeller
extirpated the entire organ together with the prostate gland and
implanted the ureters in the skin in four dogs without losing an
animal. Fisher removed elliptical portions of the organ from eight
different dogs. Of these five recovered and one of the deaths was
apparently due to purulent accumulation in the abdominal wound.
In four of the cases no antiseptic precautions were observed. In
another series of experiments, carried out by Vincent, recovery was
complete in from three to four weeks, healing taking place by pri-
mary intention. Other successful experiments were made by Bren-
ner, Thomson, and Znamensky. The latter authority found that
one-third and even two-thirds of the wall could be resected and the
animal make a good recovery. When, however, more than two-
thirds were removed there was not sufficient of the detrusor muscle
remaining to accomplish ejection of the urine. The organ had lost
its power of contractility, the urine stagnated, dammed back, and a
hydronephrosis resulted. _Such a termination could be avoided in
the human being by employment of a permanent catheter, an expe-
dient which would hardly be practicable in the dog. It would be
better to divert the flow of urine into some other channel, the rectum,
for instance.

In partial resection due care must be observed that the ureters
be not destroyed. If it be found necessary to remove the part of the
bladder at their point of entry, they must be implanted elsewhere.
Vincent found scissors best for cutting all the coats at once. He
also found that the mucosa tended to protrude through the edges of
the muscular wound, owing to contraction of the latter. If this oc-

244 Surgical Diseases and Surgery of the Dog

curs, it must be trimmed, but Znamensky cautions against unneces-
sary cutting of it, because there is always more or less hemorrhage
therefrom, which finding its way into the interior of the viscus re-
tards healing, as pointed out under Cystorraphy. All vessels that
have been severed during the operation must be securely ligated.
The principal vessels are easily secured as they run under the serosa,
prominently in view. Two rows of sero-musculosa—sero-musculosa
sutures are advisable.

VESICO-RECTAL ANASTOMOSIS. CYSTO-ENTEROSTOMY.

It has been demonstrated by Frank that it is possible to under-
take this operation with favorable result. This does not seem very
remarkable when it is remembered that in early fetal life the renal
secretions empty into the primitive cloaca, that this dispositon is
normal throughout the life of birds, and that it may occur as a con-
genital malformation in the dog (Varaldi). For practical purposes,
however, the operation has little application, though, as has been
pointed out elsewhere, its employment as a remedial measure for
prostatic enlargements in stud dogs in which it is desired to con-
serve the testes, is deserving of trial. Frank found that the bladder
remained free from feces, that some cases were not followed by
ascending infection, and that the presence of urine with feces in
the rectum ‘did not produce pathologic irritation of the latter. The
feces were always passed in liquid form, being softened by the
urine.

To facilitate the operation Frank used the decalcified bone-
coupler devised by himself for anastomosis of all hollow viscera,
but the Murphy button would answer the purpose equally as well.
The bladder and rectum are emptied of their contents by gentle
squeezing and drawn forward into position. Two or three inter-
rupted Lembert sutures are applied about half an inch below the
lower ends of the incisions determined on in the bladder and rectum,
care being exercised in selecting them that the button or coupler,
when it is inserted, will not encroach on the ureteral openings in
the bladder. A longitudinal incision is then made in the bladder for
the coupler and the latter inserted and fixed in position with the
puckering string. The rectum is treated in like manner and the two
portions of the coupler united. Finally interrupted Lembert sutures
are placed around the borders to make the union more secure.

The Abdomen 245

BIBLIOGRAPHY. -

Bournay—Journ. de Méd. Vétér. 1892, p. 567.

Brenner—Langenbeck’s archiy. f. klin. Chir. 35.

Camardi—Giorn. di Anat. e Patol. degli animali. 1890, p. 327.

Demeurisse—Rec. de Méd. Vétér. 1892, p. 408.

Fisher—Langenbeck’s Archiv. f. klin. Chir. 27, p. 736.

Frank—Journ. of Amer. Med. Assn. 1900, p. 1174.

Gluck & Zeller—Langenbeck’s Archiy. f. klin. Chir. 26, p. 916.

Harrison—Amer. Veter. Review. 1881, p. 562.

Hobday—Journ. of Comp. Path. and Therap. 1899.

Johne—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1877-80, p. 35.

Juillard—Langenbeck’s Archiy. f. klin. Chir. 31, p. 148.

Kitt—Lehrb. d. Path. Anat. Diagnos. 2.

Liénaux—Ann. de Méd. Vétér. 1894, p. 662.

Maksimow—Anwendungsversuche von Darmsaitenfaeden bei Blasennaht nach Epicystotomlie.
St. Petersburg. 1876, p. 57.

Malzew—Arch. Vétér. de Petersburg. 1895, p. 238.

Petit & Almy—Bull. de la Soc. Anat. de Paris. 1900.

Rodloff—Gurlt & Hertwig. 18, p. 212.

Rouville—Comptes rendus de la Soc. de Biol. 1899, p. 646.

Schulz—Monatsh. f. prakt. Thierheilk. 1892-93, p. 506.

Siedamgrotzky—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1871, p. 73. 1897, p. 43.

Simonds—Proc. of Vet. Assn. 1840-41, p. 57.

Sutton—Ill. Med. News. 1889. p. 11.

Thompson—Langenbeck’s Archiv. f. klin. Chir. 41, p. 410.

Tizzoni & Poggi—Ricostruzione della vesica orinarta Bologna. 1891.

Varaldi—Mod. Zooj. 1893, p. 321.

Vincent—Reyv. de Chir. 1881, p. 556.

Wehr—Langenbeck’s Archiv. f. klin. Chir. 30, p. 226.

Wesbitt—Amer. Vet. Review. 1894.

Znamensky—Langenbeck’s Archiy, f, klin. Chir, 31, p. 148.

The Urethra
EXAMINATION.

The urethra is examined by palpation over its course and by
passage of the sound or catheter.

CONGENITAL MALFORMATIONS.

Congenital occlusion of the urethral canal is occasionally met
with both in males and females. Usually an orifice exists at some
part of the tract higher up and the animal suffers no inconvenience.
The term Epispadias is applied to the condition where the urethral
orifice is situated at the root of the penis, and the term Hypospadias
when it occupies a more distal and ventral position on the organ.
Both Kitt and Raynard mention having observed these abnormali-
ties.

Sometimes the primitive cloaca persists. Veraldi recorded a case
in which the urethra, one inch from the neck of the bladder, formed
a junction with the rectum an inch and a half above the anus. The
animal had never urinated by the natural channel.

Symptoms and Diagnosis. An animal born with occluded ure-
thral canal may go several days and even weeks before exhibiting

246 Surgical Diseases and Surgery of the Dog

any peculiar symptoms, urinary secretion simply slackening up in
response to the damming up that occurs, or if the obstructing mem-
brane be thin enough the urine may ooze through by pressure.
After a while the animal manifests uneasiness and the abdomen is
observed to be enlarged. Upon manipulation the distended bladder
can be made out.

Treatment. Simple puncture of the membrane suffices, the
subsequent flow of urine serving to keep the channel open.

TRAUMATIC LESIONS.

Wounds. Traumatic exposure of the urethral lumen sometimes
occurs as a complication of a wound of the neighboring tissues.
Mossé treated one inflicted by a knife in the hands of a miscreant.

Symptoms and Diagnosis. A break in the continuity of the
canal is recognized by a flow of urine through the wound.

Treatment. In extensive wounds the urethra should be su-
tured with fine catgut and the neighboring parts cleansed and freely
drained. Minor wounds may be allowed to heal by granulation.
Healing is usually uncomplicated and quick to follow.

STRICTURE.

Cicatricial contraction may follow wounds of the wall caused
by lodgment of calculi or surgical interference to remedy this con-_
dition. Siedamgrotzky attributed a case of stricture to extreme
torsion during coitus. A rather rare condition is the formation of
small exostoses on the penial bone, which, by encroaching on the
urethra, produce the effect of stricture.

Symptoms and Diagnosis. Difficult or suspended urination
accompanied by pain call for examination by passage of the sound,
when a differential diagnosis between this and obstruction by cal-
culi or prostatic enlargement can be arrived at. In using the sound
the normal decrease in caliber at the level of the posterior extremity
of the penial bone must be taken into account. :

Treatment. ‘This condition can be considerably relieved by
passing a sound or catheter every two or three days for a period
of some weeks and allowing the instrument to remain within the
canal for a few minutes.

The Abdomen 247

Exostoses of the penial bone are removed by exposing the bone
by cautious dissection without injuring the urethra, and removing
them with suitable forceps.

OBSTRUCTION.

This usually takes place from the lodgment of calculi, but may
also be occasioned by the parasitic giant Eustrongyle.

Calculi. (See also Urolithiasis.) It will be remembered
that in the male the Urethra is narrow in its prostatic portion, be-
comes widest in its membranous portion, and again narrow as it
passes into the cavernous portion, while it loses all power of ex-
pansibility as it traverses the gutter of the penial bone. Sediment
and the smaller stones very frequently pass into the urethra and
lodge at one of the narrower points and form an obstruction. This
takes place most frequently at the proximal extremity of the penial
bone, and also occasionally just anterior to the prostatic portion.
These stones may be present as an impacted mass of numerous
small calculi, cemented together by mucus, and extending some dis-
tance up the lumen of the canal. They often become embedded in
the wall. Siedamgrotzky described a case of a three months’ old
animal which died suddenly suffering from inflammatory edema of
the foreskin. He found a cylindrical calculus in the curved portion
of the urethra, the latter having been perforated by it, thereby
causing infiltration of urine. Tuffier found calculi in the prostatic
portion of the urethra.

_ Exostoses of the penial bone produce the effect of urethral cal-
culi and may be mistaken for the latter.

In the female also calculi sometimes lodge in the urethra, but
this seldom takes place owing to the larger caliber, shortness, and
dilatability of the canal.

Lodgment of calculi in the urethra causes damming back of
the urine in the bladder, which extends to both kidneys and results
in bilateral hydronephrosis and rapid dissolution. It is rare that
the bladder ruptures, owing to the compensatory hypertrophy which
it undergoes. Petit and Almy have recorded an instance. The ex-
tremity of the penis may also become gangrenous.

Symptoms and Diagnosis. The symptoms are very marked.
The animal is exceedingly uneasy, lowers its head, looks round at
the flanks, arches its back, assumes a straddling gait or posture like

248 Surgical Diseases and Surgery of the Dog

that of a female in the act of micturition, and makes frequent but
generally ineffectual attempts to urinate, though it is quite common
for a few drops of urine to be passed. Palpation reveals the ure-
thra above the penial bone distended. The bladder is also some-
what distended though not extremely so, but it is hard and painful.
On passing a catheter or probe, its passage is arrested at the seat
of lodgment of the body, and a sensation of something hard is con-
veyed to the touch. Unless relief is given the animal shows signs
of uremic poisoning in a very few hours. It becomes: indifferent
and stupid, lies on its side and moans if disturbed. Finally con-
vulsions take place prior to death.

Treatment. An animal received in this condition may be in
considerable danger either through rupture from over-distension of
the bladder or from hydronephrosis. Should the former lesion be
deemed imminent, no time must be lost in giving relief by puncture
of the bladder. The obstruction is next removed by the operation
of urethrolithotomy.

It must not be forgotten that the “urolithic habit” may subject
the animal to the necessity of undergoing supplementary and re-
peated operations in cases of impaction of the urethra. Siedam-
grotzky mentions relieving an animal by operative measures, which,
however, died later from the second impaction at the neck of the
bladder. Pécus treated a case, where, after operating on the first
occasion, a second impaction took place fifteen days later. After
that he allowed the urine to permanently find escape by fistulous
tract through the surgical wound. The successful outcome of this
expedient suggests the advisability of its adoption in all such re-
curring cases. Furthermore, the “urolithic habit” may be the cause
of calculous formation in the higher portions of the tract at no dis-
tant date, so that a guarded prognosis is always in order.

Parasitic Obstruction. The giant Eustrongyle in its passage
from the kidney has been known to enter the urethra. Here its
further progress is usually arrested by the penial bone, whereupon
it perforates the wall and lodges in the surrounding connective tissue
producing rapid formation of a swelling the size of a fist in the
perineal region immediately posterior to the testes. Leblanc saw
three cases of this nature. In one instance observed by Lacoste
the worm was expelled by the urethral tract, the host suffering
acute pain.

The Abdomen 249

URETHROTOMY. URETHROLITHOTOMY.

For this operation on the Male the animal should be secured
in the dorsal position with the hind legs brought forward, after
having been previously placed under the influence of a narcotic.
Local cocaine anesthesia should also be established. As a guide to
the sight of incision, expose the penis and pass the catheter in the
usual manner until its further progress is arrested. The point of
the catheter is easily distinguished beneath the tissues and it is im-
mediately over this spot that the incision is made in the median line.
The median line of the perineum is not crossed by vessels of any
size and like the linea alba is comparatively bloodless. Make the
incision from one-half to one inch in length, and carry it through -
the skin, subcutaneous fascia, and urethral muscles to the lumen of
the canal. The latter being exposed, remove the impaction with
probe, blunt forceps or curette. It is sometimes necessary to crush
before its removal can be effected. This being successfully accom-
plished, it must not be forgotten that a large number of calculi may
still remain on the proximal side of the obstruction. For this reason
the extraction of the impaction should always be supplemented by
irrigation of the bladder with a copious supply of warm sterilized
water injected with the aid of a catheter through the wound. ,It -
is best to leave the wound open. Though the urine finds vent for
a few days at the artificial opening thus established and there is
always a slight risk of its infiltration into the neighboring tissues,
in other respects it is an advantage, for the reason that additional
calculi may be passed from the kidney after the operation and are
thus more certain to escape, or may be dislodged should they be-
come fixed at the upper extremity of the wound as is sometimes the
case. The wound usually becomes entirely sealed up by granulation
in from eight to fifteen days and the urine is again voided by the
natural channel. If suturing is employed cicatrization may be com-
plete as early as four days.

In the Female. The animal may be sucured in either position
and anesthetized. Dilate the vagina with a speculum and first at-
tempt to extract the stone with forceps. Sometimes manipulation
with the finger in the vagina is sufficient to effect dislodgment.
Failing in this, it becomes necessary to enlarge the urethra by in-
cision. The walls of both urethra and vagina are intimately con-
nected, which allows of the former being freely opened up. Intro-

250 Surgical Diseases and Surgery of the Dog

duce a grooved director within the urethra until it comes upon the
stone, and then slit up the wall with a probe-pointed bistoury, and
employ forceps to complete the removal.

BIBLIOGRAPHY.

Kitt—Lehrb. d. Path. Anat. Diagnost. ile

Lacoste—Mem. de la Soc. Vétér. du Calvados et de la Manche. 1842-43, p. 228.
Leblanc—Bull. de l’Acad. de Méd. 1850, p. 640.

Mossé—Journ. de Méd. Vétér. et de Zootech. 1898.

Pécus—Journ. de Méd. Vétér. et de Zootech. 1896.

Petit & Almy—Bull. de la Soc. Anat. de Paris. 1900.

Raynard—Traité Complet de la Partur. des Anim. Domest.
Siedamgrotzky—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1872, p. 72.
Tuffier—Arch. de Phys, Norm. et Path. 1893.

Varaldi—Mod. Zooj. 1893, p. 321.

CHAPTER VIII

The Abdomen—Continued
THE REPRODUCTIVE ORGANS OF THE MALE

The Penis and Prepuce

EXAMINATION.

To expose the penis, hopple the animal in the dorsal position,
hold the prepuce lightly at its free extremity and retract it with
the fingers of one hand, grasp the penis through the prepuce at the
level of the posterior extremity of the penial bone with the fingers
of the other hand, and push it forward till it is prominently free of
the prepuce. Tie a piece of tape round the glans, and therewith
draw the organ gradually out till it is fully exposed.

CONGENITAL MALFORMATIONS.

Abnormalities of the penis are rarely met with. Taylor has
recorded a case of arrested development in which the organ, instead
of protruding in the ordinary manner from the prepuce made its
exit through an oval orifice in the skin in the raphe in front of the
scrotum. Congenital phimosis is sometimes seen. It is described
elsewhere. Hermaphroditism is also occasionally witnessed.

TRAUMATIC LESIONS.

Injuries to the penis most often result from the bites of other
dogs, but there is another class of injuries occasioned by the male-
volence of human beings which at times comes to the notice of the
practitioner. I refer to strangulation resulting from the appli-
cation of constricting material, and also to mutilation, by individ-
uals of brutal instinct while the animal is in the act of copulation.
Vatel witnessed a case of strangulation which resulted from the
presence of a ligature which probably had been applied to the parts
under these conditions. Bang found a ribbon twisted round the

251

252 Surgical Diseases and Surgery of the Dog

organ in another case. The following instance of mutilation came
to the notice of Moussu: A male being found accoupled with a fe-
male, the owner of the latter barbarously severed the connection
with a knife. The wounded animal was soon in a state of collapse, but
the hemorrhage being successfully arrested its strength was sus-
tained and it lived to an old age. The attendant practitioner being
unable to use a sound to prevent occlusion of the urethra by cica-
trization had to resort to urethrotomy. Moussu dissected the parts
after death and found the penis about an inch in length, regularly
rounded and presenting no trace of urethral orifice, though the
lumen of the canal was still patent almost to the extremity of
what remained of the organ. The opening made to give exit to the
urine had persisted as a small fistula, the orifice of which was
covered by the hair of the region.

Perforating wounds of the prepuce occasionally result from
bites. When they attain sufficient dimensions, the penis is apt
to slip through and out.

Symptoms and Diagnosis. Constricting agents produce great
tumefaction and symptoms similar to those of paraphimosis.

Treatment. The indications are to divide the constricting
body with scissors or scalpel. The operation is rendered difficult
by the local swelling. Subsequently the parts should be treated
as for paraphimosis. In cases of criminal amputation, the hem-
orrhage must be arrested as speedily as possible by ligating the
divided vessels, if necessary after opening up the prepuce, and
the urethra treated as in legitimate amputation. If cicatrical sten-
osis results, a permanent opening must be established in the urethra
beneath the ischial arch to give exit to the urine. Wounds from
bites are treated in the ordinary manner.

In one instance of stubborn healing of a preputial wound,
Hobday reported success after resorting to the “Cherry” process
of making longitudinal incision on either side of, and parallel to,
the original wound in order to lessen tension on the same.

BALANO-POSTHITIS. BALANORRHEA.

These terms are applied to the familiar catarrhal inflamma-
tion of the mucosa of the prepuce and free portion of the penis.
The urethra is rarely involved. In many cases this disease or-
iginates as a primary local infection. At other times it develops

The Abdomen 253

secondary to venous stasis, paraphimosis and phimosis, or it may
be traced to an initial lesion produced by traumatism or the pre-
sence of neoplasms or a foreign body. It is often seen during
the course of distemper or eczema. 7

Siedamgrotzky saw two cases of a fatal infectious disease
which had its inception as a virulent preputial catarrh with edema
of the scrotum, prepuce, inguinal and other external lymphatic
glands, together with leucocytosis.

Symptoms and Diagnosis. The prepuce is slightly injected and
swollen, and emits a yellowish, greenish purulent liquid, which
is generally licked away by the animal. The hairs surrounding
the preputial orifice are often agglutinated. As a rule, the neigh-
boring lymphatics are slightly enlarged, and in rare instances may
suppurate.

Treatment. This consists of injection of astringent solutions,
such as sulphate of zinc (5:1000), nitrate of silver (1:100), citrate
of silver (2:100), two or three times daily. Neoplasms, if pre-
sent, must be ablated.

PHIMOSIS.

This is a condition of morbid contraction of the free extremity
of the prepuce in front of the glans penis. It is not uncommonly
of congenital origin, when the orifice is often exceedingly minute.
It may also occur as a result of traumatism or of swelling induced
by local inflammatory disturbances.

Symptoms and Diagnosis. There is more or less obstruction
to the flow of urine, and in extreme cases the latter is passed by
drops. The animal is also unable to copulate.

Treatment. Under local anesthesia and with a bistoury and
grooved director, make a longitudinal incision in the middle of the
inferior aspect of the prepuce of sufficient length to permit of free
protrusion of the penis. A single incision is, however, usually in-
sufficient, for the reason that the resultant cicatrization leaves the
parts in the same or worse condition than before. Therefore, the
preputial ring should be circumcised and the mucosa stitched to
the outer skin. The stitches may be removed at the end of a
week. Care must be exercised to remove as little of the free ex-
tremity of the prepuce as possible or the penis will afterwards
protrude. Supplementary treatment consists of antiseptic irriga-
tion of the parts.

254 Surgical Diseases and Surgery of the Dog
PARAPHIMOSIS.

In this condition the prepuce, after becoming retracted behind
the glans penis, prevents the latter from returning to its normal
position.

It is most commonly observed after coitus. During erection
of the penis the hairs surrounding the preputial orifice sometimes
adhere to the organ, and as retraction of the latter takes place
the free border of the prepuce becomes inverted, thereby forming
a constriction. The glans then commences to swell, and if the
condition is not soon relieved it may terminate in gangrene.

Symptoms and Diagnosis. The animal walks with a straddling
gait, constantly licking the penis, and moves the hind quarters as
if in the act of copulation. Examination of the parts establishes
the diagnosis.

Treatment. With the.animal in the dorsal position, first en-
deavor to replace the glans by oiling and massaging, and at the
same time drawing the prepuce forward. Withdraw and cut off
any displaced hairs. Failing in this apply ice or direct a stream
of hot water on the organ and scarify it. If this does not succeed,
incise the prepuce as directed for phimosis. For a few succeeding
days allay any tendency to inflammation of the parts by injections
of warm antispetic or astringent solutions, as directed for balan-
itis. If gangrene is present amputation must be resorted to.
Haubner found it necessary to perform the latter operation.

NEOPLASMS.

Venereal Granulomata. A specific infective variety of neo-
plasm affects the mucosa of the penis and prepuce. The disease is
quite common on the European Continent and in Great Britain where
one of the kennel clubs has found it necessary to issue a circular
of warning against its perpetuation by breeding infected animals.
In this country it does not appear to have gained any foothold. In
twelve years I have only seen two cases, and both of these were
in male dogs which had recently been imported from England.
The area of invasion of the disease is not always limited to the
mucosa, for in some cases it infiltrates the adjacent tissues. It
may also exhibit metastatic tendencies to the inguinal glands. It
is an inoculable disorder, and is probably always communicated

No, 50. Venereal Granulomata.

The Abdomen 255

from an infected animal by the act of copulation. It may develop
on any part of the organ, but most commonly occurs at the base
and on the corresponding portion of the preputial mucosa. In
some cases it is confined to the glans, while in others it covers the
entire organ.

Symptoms and Diagnosis. Usually, attention is first drawn
to the condition by the emission of sanguineous non-purulent liquid
from the prepuce, and by the presence of circumscribed or diffuse
tumefaction of the latter. Palpation gives a subpreputial uneven-
ness. On exposure of the penis the growths are easily discern-
ible. In appearance, they vary according to the stage of their
development. At the period of discharge they appear as greyish-
reddish or pinkish vegetations, which are soft and friable, and bleed
easily on being touched, and are generally sessile, but may be
pedunculate. In the very early stages, 7. e., a few days after the
infection has been sustained, they have their inception as minute
vesiculate solid pimples. The rate of growth is not rapid, and
sometimes several weeks elapse before there is much increase in
size. Nevertheless, the disease is progressive and the erstwhile
papules gradually assume the vegetative character. A growth of
several months’ standing exists as a firm lobulated mass of purplish
color, and is generally accompanied with cachexia and emaciation.

Treatment. These growths, when of recent origin, may be
easily removed and without liability to recurrence, but when long-
standing and a considerable area of mucosa is involved they are
eradicable only with difficulty. To effect removal of circumscribed,
limited growths, expose the penis in the usual manner, anesthetise
locally with cocaine and snip them with curved scissors, including
with them a portion of the mucosa, to which they are attached.
Considerable hemorrhage may occur which may be arrested by
drawing the divided mucosa together with a few fine sutures. In
some cases it is necessary to slit and afterwards sew up the prepuce
in order to more effectually reach the tumors, and repeated opera-
tions at intervals of fifteen or twenty days may be required to effect
complete ablation. Thermo-cauterization should be tried when re- ‘
crudescence takes place. Curettage should not be employed, as it
involves risk of recurrence of the growth by fresh inoculation of
neighboring healthy mucasa.

In extensive invasion of the parts amputation of both penis
and prepuce is indicated.

256 Surgical Diseases and Surgery of the Dog

Infected animals should not be allowed to mate.

Papilloma of the Prepuce. Small growths, with or without
a pedicle containing melanotic deposits, the so-called pigmented
moles, are occasionally seen about the prepuce of black dogs.

Treatment. Simple ablation with scissors serves to eradicate
these little blemishes. .

Sarcoma and Carcinoma of the Prepuce. Malignant neo-
plasm is of rare occurrence, and when it does exist is inoperable.
Petit and others have recorded instances.

AMPUTATION.

This. operation is indicated when the organ is the seat of
malignant neoplasm or becomes gangrenous as a result of para-
phimosis or strangulation from other cause. The animal should
be anesthetised and hoppled in the dorsal position. The technic
is as follows: Draw the organ well out of the prepuce by means
of a tape tied round it, and apply a tourniquet above the proposed
line of section, which should be posterior to the os penis. Sever
the occluded portion of the organ with a scalpel. If section is
made through the bone a saw must be employed. Seize and ligate
all vessels with silk, expose the urethra and suture it to the free
extremity of the trunk with silk. Establish a prominent meatus
by incising the inferior wall of the extremity of the urethra for a
short distance in order to lessen the tendency towards subsequent
cicatrical stenosis. Remove the tourniquet and allow the stump to
slip back within the prepuce. For a few succeeding days irrigate
the parts with warm antiseptic solutions, and subsequently see that
the urethral orifice is maintained, by passage of the catheter if
necessary. Healing is usually complete in from ten to twenty days.
Should cicatricial stenosis of the urethra follow the best plan is to
establish a fistulous opening beneath the ischial arch by which the
animal may discharge its urine.

BIBLIOGRAPHY.

Bang—Stockfleth's Chirurgie. é

Haubner—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1868, p. 49.

Moussu—Rec de Méd. Vétér. 1887, p. 484.

Ridler & Hobday—The Veterinarian. 1905, p. 337.

Siedamgrotzky—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1879, p. 81. 1880, p. 18.
Taylor—The Veterinary Record. 1903.

Vatel—Rec. de Méd. Vétér. 1828, p. 590.

The Abdomen 257
The Testes and Scrotum

CONGENITAL MALFORMATIONS.

The condition known as Cryptorchism is not uncommon. Its
recognition by the veterinary practitioner is important from a
medico-legal aspect. Sometimes a whole litter of puppies is affec-
ted. One or both glands may be involved (monorchism, cryptor-
chism) and they are most frequently retained within the abdominal
cavity, generally at the level of the internal ring. Less frequently
they traverse the inguinal canal and reach the position normally
occupied by the scrotum (ectopia), the latter being absolutely want-
ing. Normal descent of the testicle occurs somewhat later, and is
more liable to deflection on the right side than on the left. Ina
true cryptorchid the development of the glands is always arrested,
the penis may be rudimentary, and sexual proclivity is lacking,
though some subjects exhibit a roving tendency. It is well known
that a retained testicle may grow to some extent at puberty, yet
neither then nor at any subsequent period does it reach its full
size and acquire its spermatozoa-producing powers, the tubules re-
maining atrophied. While incapable of producing spermatozoa,
the retained organ is capable of exerting that influence which the
normal testis exerts upon the development and growth of the body.
When one organ has fully descended and developed, the animal
is capable of procreation, but, on the other hand, when both have
failed to reach the scrotum it remains sterile, though it may yet
possess enough virility to copulate.

Griffiths experimented on several dogs, both young and full-
grown, by replacing the testicle and cord in the abdominal cavity,
with the following results: (1) When replaced in young animals
it undergoes little change, growing somewhat, but not so much as
the undisturbed organ until the approach of puberty. (2) The
testicle of a full-grown animal, when replaced, soon dwindles to
two-thirds or one-third its natural size, and after a short time
presents precisely the same structure as that which is found in
the replaced testicle of the young animal. There is no trace of sper-
matogenesis in the degenerated epithelial cells, and no spermatozoa
in the interior of the atrophied tubules.

Retained testes are prone to tumor formation. Leisering and
Sutton have seen tumors of retained testicles in monorchids. In

18

258 — Surgical Diseases and Surgery of the Dog

Sutton’s case the enlarged gland had undergone axial rotation.
Cadiot and Almy regard the condition as predisposing to tumor
formation.

Treatment. When it is considered advisable to remove the
glands in a true cryptorchid they are most easily reached by open-
ing the abdominal cavity in the vicinity of the inguinal region. They
are then sought for with the index finger, and when found drawn
outside the cavity, and excised after the cord has been securely
ligated with fine sterile silk.

In one instance I ablated the glands in a cryptorchid to cure
a mean disposition with successful result.

Ectopic testes are removed by cutting down directly over them,
the same technic being observed as for castration.

TRAUMATIC LESIONS.

The testicles occasionally sustain injury from the bites of other
dogs, and in countries where the dog is used to hunt the wild boar
he is often emasculated by the tusks of the latter animal.

Treatment. Hot antiseptic irrigation or sitz-bath is indicated,
and if gangrene is threatened the glands must be removed.

ORCHITIS.

Inflammation of the testicle is of rare occurrence. When it
takes place it is usually due to traumatism, such as the bite of an-
other dog or the kick of a miscreant, but it may also arise conse-
quent upon infection.

Symptoms and Diagnosis. The disease is characterized by
tumefaction of the gland and its coverings, more or less febrile
reaction, and acute pain when pressure is applied. It is to be dis-
tinguished from eczematous inflammation of the scrotum.

Treatment. Hot water applications are beneficial. This treat-
ment may conveniently be applied by causing the animal to take a
sitz-bath in any suitable receptacle containing a hot antiseptic solu-
tion.

NEOPLASMS.

Neoplasms of both the testicle and scrotum have been observed
a number of times. Some doubt exists among authorities as to

the right Testis.

No. pl. Malignant Neoplasm of

The Abdomen ; 259

the identity of the malignant type of growth (See Chapter on
Neoplasms). It is usually unilateral. Cadiot has seen tubercul-
osis. Enlargement of the gland may also exist as an indurated
fibroid condition, in which there is a great increase of connective
tissue with atrophy of the parenchyma, and sometimes presence of
retention cysts.

Symptoms and Diagnosis. The gland presents an indurated,
insensitive growth, sometimes five or six times greater than normal,
with uneven, knotty surface, and with or without fluctuating cystic
areas. The corresponding cord is usually tumefied.

Treatment. The only effective treatment is castration, and it
should be practiced early, the cord being ligated as far above the
thickening as possible. A very stout, double ligature should be
used. The operation is contraindicated when metastasis has taken
place. When the scrotum is involved, it may also be removed.

PARASITIC EMASCULATION.

Dogs on this continent are subject to attack by the emasculat-
ing bot-fly (Cuterebra emasculator). The first recorded instance
of this remarkable example of parasitism came to my notice in
Montreal in 1893. Since then Glass states that he has seen it on
two different occasions. Professor Fletcher, Dominion Entomolo-
gist at Ottawa, informs me that squirrels are commonly affected
to the extent of becoming emasculated either by the direct action
of the parasite or through their own endeavors to relieve themselves
of its presence with their teeth. Fitch also made this observation
in 1856, in the environs of Lakeville, N. Y. The fly deposits its
eggs by piercing the scrotum. In the instance which I observed
a small part of one extremity of the larva projected through an
orifice in the scrotum, the larger portion of it being buried and
encapsulated by a zone of inflammatory fibrous tissue. It was
seized with forceps and extracted without much difficulty. It is
probable, that if allowed to remain, the parasite would bring about
inflammatory changes in, or complete destruction of, the testicle,
in the same manner that it does in the squirrel.

ORCHECTOMY, CASTRATION.

This operation is primarily of importance as a remedial measure

260. Surgical Diseases and Surgery of the Dog

for local pathologic conditions, including prostatic enlargements.
It is also sometimes resorted to as a means of improving the temper
of vicious animals and to correct roving habits and also onanism.
The operation being very painful, the animal should be anesthetised
and hoppled in the dorsal position. Of the several methods by
which the organs may be removed, viz., clamping with cauterization,
torsion, emasculation, excision after ligation, the last-named is the
best, because there is less risk of subsequent secondary hemorrhage
than with the others. Owing to the dog’s habit of licking his
wounds bleeding may be started from vessels which have not been
ligated. In any case the best results are always obtained by
operating under strict asepsis and stilling all venous oozing, when
the scrotal wound may be immediately closed with a buried suture,
and healing is quick to follow. When blood clots are allowed to ~
accumulate or pockets to form, there generally follows a violent
inflammatory reaction and liability to peritonitis by extension.

The technic of ligation and excision is as follows: Render instru-
ments and suturing material sterile by boiling and thoroughly cleanse
the hands and scrotum. Grasp the testicle between thumb and fore-
finger of the left hand, thereby stretching the skin over the gland.
Expose the latter by one free incision down to the tunica propria.
Seize the gland and draw it out of the scrotal sac. The tunica
reflexa becomes retracted some distance up the cord anteriorly, but
remains adherent to the tail of the epidydimis posteriorly. Apply
a stout silk ligature to include both cord and tunica reflexa, and re-
move the gland with scissors, cutting the cord on the occluded side
close to the ligature.

The skin wound should be closed with a subcuticular suture.
If the parts do not suppurate healing will follow per primam, but
they should be kept under observation for a few succeeding days.
If pus forms it may be evacuated in the usual way and granulation
allowed to take its course.

Cagny has proposed a somewhat novel method. He ties a cord
temporarily round the scrotum above the testicles to keep these
organs in the bottom of the scrotal sacs. He then makes an incision
in the median line, draws both glands out and twists the two testi-
cular cords one upon the other after the manner in which two
strings are twisted upon each other. A catgut ligature is applied
to the twisted cords, they are severed below the point of ligation,
the stump is returned to the scrotum, and the integument sutured.

The Abdomen 261

BIBLIOGRAPHY.

Cagny—Reyv. Vétér. 1894.

Griffiths—Journ. of Anat. and Phys. 1892-93, p. 209.
Hobday—The Veterinary Record. 1899.

Leisering—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1864-70.
Sutton—Journ. of Anat. and Phys. 1884

The Postate Gland

EXAMINATION.

The prostate gland is examined by digital palpation, the index
finger, which may be incased in a rubber glove and well-oiled being
passed into the rectum. Enlargements are easily discernible in this
manner. Pronounced enlargements may be felt by abdominal pal-
pation in the pelvic region.

PROSTATITIS.

Acute inflammation of the prostate gland is uncommon. A
subacute or chronic type is more often seen. The disease is caused
by microbic invasion, usually by way of the urinary tract, and tends
towards abscess formation. A unilateral or symmetrical swelling
is formed which may attain the size of a hen’s egg or the human
fist. The pus may escape by the urethra, or it may break through
into the peritoneal cavity or into the rectum, or even discharge
by fistulous tract in the perineal region. The swelling, by com-
pression, occludes the urethral canal.

Symptoms and Diagnosis. The principal symptoms are sus-
pension of normal defecation and micturition, coupled with febrile
manifestations. The animal makes frequent and often painful at-
tempts to urinate. Urine may be voided freely or may pass by
drops, or there may be complete suppression of the flow. Con-
stipation may be present, the animal refraining from defecating on
account of the pain induced by the act. By abdominal palpation
the bladder is felt distended. Passage of the catheter calls forth
expression of great pain when the instrument reaches the prostatic
portion of the urethra. In some cases the compression is so great
that the instrument cannot pass. Finally, rectal exploration with the
index finger reveals the presence of a painful inflammatory enlarge-
ment, which fluctuates when it contains pus. If pressure is applied
the matter may be forced out by the urethra. In other cases the

262 Surgical Diseases and Surgery of the Dog

matter does not tend to accumulate, but is constantly discharged
by way of the urethra.

Treatment. This should be directed towards relieving pain
by administration of morphine or chloretone. Catheterization must
be kept up every ten or twelve hours so long as the flow of urine
is obstructed. If the catheter cannot penetrate, puncture of the
bladder must be resorted to. Brisk purgatives should also be ad-
ministered. A stream of cold water directed over the perineum
is useful to allay the inflammation. When pus is present an attempt
should be made to cause its evacuation by pressure over the gland
through the abdominal wall or with the finger in the rectum. Haub-
ner cured a case in this manner. Failing in this, the matter must
be removed by the aspirating syringe or a fine trocar and canula
introduced through the perineum, the finger in the rectum serving
to guide the instrument, or the rectum may be dilated with a
speculum and either instrument thrust through its wall into the
gland.

Prostatic abscesses discharging by way of the perineum are
treated by antiseptic irrigation.

NEOPLASMS. %

The growths which affect the prostate are the non-malignant
hypertrophic enlargements and malignant carcinoma.

Hypertrophy. Hypertrophic enlargement of the prostate is
a very common affection among old animals. It may occur also
in young animals. The condition is one of abnormal growth of
pre-existing gland-tubules but without the power of producing the
secretion as in the normal gland. After a variable time atrophy
of the tubules and muscle-fibers of the stroma takes place, and in
their place fibrous connective tissue develops. Small cysts are
formed through small areas of gland-tissue becoming separated by
trabeculae of fibrous or fibro-muscular tissue. It will be remembered
that the gland is voluminous under normal conditions and sur-
rounds the origin of the urethra and the neck of the bladder. Any
increase in volume tends, by compression, to occlude the urethral
canal so that micturition becomes a matter of difficulty and at times
an impossibility. Prostatic enlargements are very prone to pro-
lapse into the perineal region to constitute the contents of perineal
hernia.

Symptoms anl Diagnosis. The symptoms of hypertrophy are

The Abdomen 263

very similar to those of prostatitis, but devoid of febrile disturbance.
Dysuria is marked, the urine being passed frequently and in small
quantities. Each act of urination, particularly if strained, may or
may not be immediately followed by hematuria. When hemorrhage
takes place it is produced as a consequence of the hypertrophy,
the pressure from which, constantly exercised on the prostatic ven-
ous plexus causes stasis of the circulation. This plexus being situ-
ated superficially is easily ruptured by straining. The bladder be-
coming distended, the animal exhibits great distress and later acute
pain. As an immediate effect the bladder may rupture, but if the ©
distension is not great enough to result in this lesion, and the con-
dition goes unrelieved, more remote effects are apt to follow, the
stagnation of urine resulting in cystitis or hydronephrosis. Usu-
ally, constipation is also present, and may go on to complete copro-
stasis. This symptom is also the result of pressure by the enlarged
gland. When the latter is very voluminous it is sometimes possible
to feel it in thin subjects by abdominal palpation in the pelvic region,
but generally speaking, digital exploration by way of the rectum
is necessary to verify the diagnosis. Passage of the catheter is
met with obstruction in the pelvic region. As already stated, perin-
eal enlargements must always be considered as of possible prostatic
origin.

Treatment. The animal must first be relieved of retained urine
or feces. This is accomplished in the one case by catheterization,
or if necessary by aspiration or puncture of the bladder, and in the
other case by rectal injections and the use of the rectal scoop.

Medication has little effect on hypertrophic enlargements.
Mueller recommends injection into the gland by way of the rectum
of a solution of iodine composed of potassium iodide 2 parts, tinc-
ture of iodine 30 parts, water 60 parts. This preparation is in-
jected at intervals of eight to fourteen days by means of a hypo-
dermic syringe with a fine, long needle attached. Castration has
permanent remedial effect. This has been proven both experiment-
ally and clinically, first and most fully by White in America, and
by Griffiths almost simultaneously in England. Helferich cites
Guyon, Legueu, Pravone, Prezwalski, and Sackur to the effect that
this operation induces atrophy of the gland. It is probable that
changes in the vascularity of the gland play some part in its re-
duction after castration, as the process of atrophy which takes place

264 Surgical Diseases and Surgery of the Dog

is similar to that which occurs in the uterus subsequent to oophorec-
tomy. The operation should comprehend both testes to ensure
atrophy of both lobes, since when unilateral castration is practised,
only the lobe on the corresponding side is affected. The benefit
derived from the operation is apparent within a few days.

That the growth of the prostate is dependent upon the growth
of the testes is evident from the fact that it is not developed
until the time of puberty. It is a purely sexual gland, having noth-
ing to do with micturition, its function being to add certain con-
stituents to the seminal fluid at the time of its discharge. Griffiths
found that both the prostate and Cowperian glands remained small,
lost their glandular character, and became transformed into masses
of fibrous connective tissue, when the testes were removed before
the age of puberty (about ten or twelve months in the dog), and
that when the organs were removed after full development they
underwent a retrogressive metamorphosis to the extent of the glan-
dular epithelium becoming converted into the lower and function-
less type, and the stroma losing muscular tissue.

Kirby undertook castration experiments on dogs with the ob-
ject of discovering whether this operation could be of use as a
remedy for enlarged prostate in man. He found the average weight
of the prostate of thirty-five healthy dogs of certain size to be
17.347 grams. When the gland was removed from eleven similar
animals thirty to sixty days after castration, it weighed only one-
fourth the original weight.

In valuable stud animals, in which it is desired to leave the
testes intact, the alternative operation is Cysto-enterostomy, but it
entails considerable risk.

Carcinoma. Malignant adeno-carcinoma has been occasion-
ally observed, but it is not common. It occurs as a tuberous en-
largement, with a tendency towards retrogressive metamorphosis
and metastasis, particularly to the testicle.

Symptoms and Diagnosis. The symptoms are similar to those
of other forms of enlargement as regards the interference with
normal micturition and defecation. It may be differentiated by the
uneven, tuberous growth and the accompanying cachexia.

Treatment. There is no practicable treatment for malignant
neoplasm, excepting its extirpation and anastomosis of the stump
of the bladder with the rectum.

The Abdomen 265

BIBLIOGRAPHY.
Gluck & Zeller—Langenbeck’s Archiv. f. klin. Chirur. 26, p. 916.
Griffiths—Journ. of Anat. and Phys. 1889, p. 34. 1892-93, p. 209.
Haubner—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1863, p. 49.
Helferich—Langenbeck’s Archiv. f. klin. Chirur. 1897, p. 646.
Kirby—The Veterinary Magazine. 1894..
Mueller—Die Krankheiten des Hundes.

THE REPRODUCTIVE ORGANS OF THE FEMALE

The Ovaries —
EXAMINATION.

The ovaries are examined for diagnosis of pathologic conditions
by abdominal palpation or direct inspection. By palpation with the
fingers of both hands on either side of the abdominal wall, the
animal being in the standing position, it is possible, in thin subjects,
to recognize the presence of cystic neoplasms. In doubtful cases
explorative celiotomy should be resorted to.

CONGENITAL MALFORMATIONS.

The condition known as Dermoid Cyst, in which sequestered
portions of the epiblast occur, has been observed by Esser.

OOPHORITIS.

Inflammatory diseases of the ovary are almost unknown, though
the not uncommon cystic enlargements of this organ are looked
upon by some as having their origin in thickening of the follicular
wall caused by chronic inflammation. The organ is also occasion-
ally the seat of congestive changes. A remarkable instance of
purulent oophoritis was witnessed by Martin. The disease in this
case was attributed to a piece of rye chaff which was found lodged
in the ovary, and which had evidently worked its way thither from
the vagina, where it was supposed to have been deposited in an injec-
tion, as the entire tract it had traversed showed evidence of in-
flammatory changes.

Symptoms and Diagnosis. Congestion of the ovary is said
to be productive of epileptic seizures. Purulent disease produces
symptoms of toxemia. In both conditions there is extreme tender-
ness to pressure over the seat of the organs.

Treatment. ‘This consists in the ablation of the glands by celio-
oophorectomy.

266 Surgical Diseases and Surgery of the Dog

NEOPLASMS.

Practically the only growths we have to deal with in the ovary
are the cystic formations. Sutton has recorded an instance of
adenoma, where the tumor weighed fifteen pounds, and the occur-
rence of dermoid cysts has also been observed. Cysts sometimes
grow to a great size. They represent accumulations of unruptured
ripe Graafian follicles, and may be unilocular or multilocular. None
of these growths has any pronounced ill-effect on the animal.

Symptoms and Diagnosis. The abdominal cavity is distended
in proportion to the development of the growth, and the presence
of the latter may be ascertained by careful external palpation. The
cysts fluctuate on pressure. Differentiation lies between gestation,
hydrometra, and hydronephrosis. It is hardly to be confounded
with ascites.

Treatment. All ovarial growths should be extirpated by celio-
oophorectomy.

OOPHORECTOMY.

This operation, known in ordinary parlance as “spaying,” is
principally undertaken for the purpose of suppressing the sexual
function. In some cities where a high tax is imposed on the keep-
ing of females, and an altered female is placed in the same category
as a male, owners submit their animals to be unsexed from motives
of economy. This operation is also occasionally necessary as a
remedial measure for certain pathologic conditions, such as neo-
plasms, hyperemia, and purulent inflammation of the ovary.

In any instance where it is necessary to remove the uterus in
whole or part, the ovaries should also be ablated, otherwise their
presence gives rise to the formation of retention cysts.

It is claimed by some authorities that ablation of the ovaries
is not a certain preventive of the sexual impulse and the concomi-
tant uterine discharges. Leeney, a British practitioner, writing in
1890, asserted that regular periods of “estrum” might follow the
operation unless the animals were operated upon when pregnant,
and referred to a tradition existing in England that a female should
be allowed to copulate some ten days before being spayed, though
no explanation was offered. Hobday also believes that the effect
of the operation on the sexual impulse is by no means certain, and

The Abdomen 267

states that he has observed signs of “estruation” after the ovaries
had been removed, the animals even copulating with the male. Such
cases have occurred in my own practice, even where both ovaries
and uterus had been removed, but only in animals that had estru-
ated normally at least once, or had given birth to offspring. These
cases are to be explained on the theory of habit, the organism once
having experienced the sexual impulse continuing to exhibit it in
spite of the loss of the essential organs. There seems little doubt
that the operation performed before the advent of the first estrual
period is an absolute preventive. In some cases, at least, mani-
festations of this nature are due to the leaving behind of small
portions of ovarial tissue. Owing to the fact that the enveloping
sac of the ovary in adult animals is often the seat of considerable
fat, which completely hides the organs within, their recognition in
situ is a matter of impossibility, and it is then a very easy matter
to leave behind a minute portion of the gland. A peculiarity of
these cases of recurring “heat” is the appearance of the symptoms
at irregular intervals or almost continuously. Another phenom-
enon which occasionally occurs subsequent to the operation, is the
so-called “false heat” or attraction of the male without concurrence
on the part of the female, which seems to be dependent upon in-
creased or changed mucosal secretions. There are no physical signs
of estruation, but members of the opposite sex are persistent in
their attentions. The condition may last some months, but finally
ceases. It is due to the remnant of the reproductive tract under-
going certain changes after castration. At first, there occurs a
marked hyperemic injection of the mucosa, which becomes soft and
swollen. Secondly, the normal secretion is appreciably increased.
This condition lasts for a few months, when it is succeeded by
shrinkage and atrophy.

The ultimate effect of the operation. upon the organism varies
according to individual temperament. Some animals become fat
and inactive, while others are in no wise affected. There is little
doubt that metabolism is influenced. Curatulo and Tarulli believe
that the reproductive glands, besides developing ova, furnish a
secretion which modifies tissue change. They found that the phos-
phates in the urine were greatly and permanently reduced in quan-
tity after removal of the organs, which explained the utility of
Castration for the relief of osteo-malacia. Poehl believes this se-

268 Surgical Diseases and Surgery of the Dog

cretion to be an active oxidizing agent, which when eliminated from
the economy, diminishes oxidation of the organic phosphates con-
tained in the tissues, and these, combining with earthy bases, are
deposited in the bones in the form of calcium and magnesium phos-
phates. On the other hand, Mossé and Oulié claim that the quan-
tity of phosphoric acid is increased and not diminished.

The operation can safely be performed at any period of the
animal’s life, but the age to be preferred in virgin animals is be-
tween five months and the advent of puberty (about ten months),
selection of the time depending upon size of breed. It is not ad-
visable to operate while estruation is imminent or in progress owing
to risk of inflammation resulting from the congested condition of
the parts. Francis recorded an instance of fatal termination from
peritonitis after having operated under protest while the animal
was passing through the period, and in my own practice I have
experienced inflammation and chronic hemorrhage to follow, where
the operation was undertaken shortly before the period. The best
time to operate on matron females is a few weeks after.

The animal should be placed in the dorsal position and se-
curely hoppled and anesthetised, or a narcotic may be previ-
ously administered. Some operators prefer to narcotise and then
suspend the animal by the hind legs, this position having some ad-
vantage in lessening the tendency to protrusion of other viscera. The
abdomen may be opened by median or lateral section. The former is
to be preferred, and the incision should be made slightly to either side
of the linea alba, and immediately posterior to the umbilicus. If it
is made further back than this it is difficult to separate the organs
from their anterior attachments. When a flank incision is made,
but one is necessary, as both glands can be removed through the
same opening. With a little practice it is not a difficult matter
to acquire dexterity in finding the ovaries. Their position is be-
‘ neath the fourth lumbar vertebra immediately posterior to the
kidneys. One uterine cornu should first be sought. The peritoneal
cavity being exposed, the omentum is drawn forward and stowed
away anteriorly. The index finger is then introduced and directed
along the internal aspect of the wall on one side till it reaches the
sublumbar region. Here it is made to hook round the cornu, which
is immediately brought to the surface. By following this pro-
cedure the cornu can be almost immediately found, but to dive in

The Abdomen 269

among the coils
of intestine and
gropeabout forit
is time-consum-
ing and some-
times futile. This
cornu being
found it is fol-
lowed up till the
ovary is brought
to view. With
a little gentle
traction the lat-
ter is brought
well without the
abdominal wall.
The index finger
is then thrust
through the
broad ligament
and _ ligatures
are applied
above and below
the Ovary. It is No. 52. Diagram to show course pursued by the
finger to quickly reach the cornu.

always safest to

ligate and ligatures of silk are best. As has been pointed out
in another part of this work, divided bloodvessels of the abdominal
cavity possess a remarkable tendency to bleed when shut off from the
clotting influence of the air, and while there are some mechanical
devices (spaying scissors, spaying emasculators) on the market by
whose action the vessels are crushed, it is infinitely safer to ligate
and thereby reduce all risk of secondary hemorrhage to a minimum.
It is extremely important to apply ligatures so that all ovarial tissue
will be completely occluded. If any portion of the gland is left
behind, the object of the operation, when suppression of estruation
is aimed at, will be defeated. All tissue within the occluded area is
next excised with scissors, the division being made at the upper
extremity first. The one ovary being thus removed, the operator
follows the cornu back to its junction with its fellow, and follows

270 = Surgical Diseases and Surgery of the Dog

S
>"

MANA

No. 53. Diagram illustrating techic of excision of the Ovary.
(A) Rent in broad ligament made by finger. (B) Dotted line at site of excision.
(C) Ovary. (D) Ligatures. (E) Uterine cornu. (F) Uterine artery.

this one up to the other ovary, which is removed in like manner.
Both cornua are then replaced within the cavity, and finally the wall
is closed.

Some operators believe the uterus may be more easily dis-
tinguished by first introducing a probe, catheter, or sound into the
fundus of the organ by way of the vagina. This is an amateurish
method and hinders rather than expedites the operation.

According to Mueller, it is the practice among some German
veterinarians to secure sterility by applying two ligatures to the
uterus and then completely severing the organ between them. It
is hardly necessary to state that this sort of operation should never
be countenanced, for not only has it no effect whatever in prevent-
ing estruation and the desire for sexual intercourse, but it at once
establishes a pathologic condition, to wit, the formation of a re-
tention cyst, which if septic, develops into pyometra.

The Abdomen 271

Whenever an animal is observed to estruate subsequent to
undergoing oophorectomy, an explorative laparotomy should be un-
dertaken, the abdominal wall being opened in the vicinity of the
umbilicus. The first two fingers are then introduced and made to
search for the former seat of the extirpated organs, and for the
presence of cysts. These being discovered indicates the persistence
of ovarial tissue, which must be removed in the same manner as the
ovaries.

BIBLIOGRAPHY.
Curatulo & Tarulli—La Secrezione interna delle Ovaie. Rome. 1896.
Esser—Cited by Mueller in Die Krankheiten des Hundes.
Francis—The Americ. Veter. Review. 1894.
Hobday—Canine and Feline Surgery.
Leeny—The Veter. Journal. 1890, p. 11.
Martin—Cited by Kitt in Lehrb. d. Path. Anat. Diagnost. 2.
Mossé & Oulié—Comptes rendus de la Soc. de Biol. 1899, p. 447.
Poehl—Berlin. klin. Wochensch. 1893, p. 873.
Sutton—Journ. of Anat. and Phys. 1884.

The Fallopian Tubes and Uterus

EXAMINATION.

Examination of the Fallopian Tubes is carried out by ab-
dominal palpation in the same manner as for the Ovaries. Cystic
and purulent accumulations and solid tumors can be recognized.
In doubtful cases celiotomy is justified.

SALPINGITIS. PYOSALPINX.

Purulent inflammation of the Fallopian tubes occurs only as a
complication by extension of purulent inflammation of the uterus.
The symptoms and treatment are the same.

METRITIS.

Inflammation of the uterus occurs in three principal forms, viz.,
Catarrhal Endometritis, Puerperal Septic Metritis, and Proliferative
or Fibroid Endometritis.

Catarrhal Endometritis. Like any other catarrhal inflamma-
tion, this form of the disease is characterized by chronic secretion

272 Surgical Diseases and Surgery of the Dog

of purulent matter which finds vent at the vaginal outlet. Under
normal conditions pathogenic bacteria are constantly present
throughout the vaginal canal, but the uterine cavity remains free,
being protected by the mucus at the cervix. At times, howerer,
especially when vaginitis occurs, microorganisms gain entrance and
originate an inflammatory disturbance of the mucosa. It is rather
remarkable that it arises most commonly as a chronic process in
virgin females of advanced age. This I have found to be almost
invariably the case, and Froehner has made similar observations.
Should the cervical mucosa swell sufficiently to occlude the lumen, °
which it very often does, the matter is retained, gradually increases
in amount, and forms a septic retention cyst. This condition is
known as PYOMETRA. From pyometra secondary septic endo-
carditis is prone to result.

In chronic cases the wall of the uterus is extremely thickened,
the microorganisms present being very numerous and often located
deep in the tissues. In one instance the diseased organ when sub-
mitted to microscopic examination, exhibited a microorganism,
which in shape and size resembled the ordinary diplococcus lanceo-
latus of human pneumonia, which is found under normal conditions
in the mucous passages of the dog.

Symptoms and Diagnosis. When the cervical canal is patent,
the vagina presents an injected and swollen appearance, and the
discharge, which may be purulent, sanguineous or ichorous, takes
place more or less constantly, but more particularly after locomotion
or any expulsive effort of the abdominal muscles, such as accom-
panies defecation. The animal usually licks the vulva a great deal.
Abdominal palpation is painful. In the early stages of pyometra
there is little change in outward manifestations, and the disease
process may continue for some weeks, the abdomen all the while
enlarging, until finally the appetite becomes capricious, fails alto-
gether, and thirst and vomiting set in, accompanied by emaciation.
The symptom of vomiting is always indicative of grave toxemia.
By this time the abdomen is very much enlarged, and by careful
palpation the two distended cornua may be made out on either side
of the floor of the abdomen. The alteration in the contour of the
abdominal wall partakes somewhat of a bilateral uniformly cylin-
drical tense swelling, as contrasted with the pyriform outline of a
cross section of the trunk in dropsical effusion of the peritoneum.

The Abdomen 273

In addition to this, percussion fails to originate the wave character-
istic of ascites. It is easily differentiated from coprostasis, where
the mass is hard and unyielding and the outlines of the bowel can
be distinguished. It is hardly to be confounded with pregnancy or
obesity.

Puerperal Septic Metritis. This condition results from the re-
tention of septic matter (fetal membranes, etc.,) in the uterus in
connection with abnormal fetations or fetal deliveries. It com-
monly occurs in those cases where intrauterine death and non-de-
livery of fetuses takes place. Bacteria gain entrance from the
vagina and induce putrefactive changes. The latter are of ichorous
character. The inflammatory process extends and involves all the
coats of the organ and focal ulcerative degenerations occur and
lead to perforation. This results in general purulent peritonitis if
the animal has not already succumbed to toxemia.

There, are, however, rare instances recorded where retention
of fetuses has not led to extension of inflammation beyond the
uterus. Welch reported operating on an animal for the purpose of
removing the ovaries and finding a bony skeleton within the uterus,
the remainder of the fetal tissues having disappeared by decomposi-
tion. At the previous whelping period the animal had shown
symptoms of toxemia.

Symptoms and Diagnosis. There is a discharge of foul, green-
ish, or sanguineous, purulent matter. There is rarely any rise in
temperature, but the latter frequently falls below normal. The
animal ignores the offspring, and is listless, and total collapse rapidly
supervenes. The appearance of vomiting is to be regarded as
a grave symptom. As in intestinal obstruction, it marks the advent
of that phase in the struggle between bacteria and the organism
where the latter commences to succumb to septic infection.

Proliferative or Fibroid Endometritis. This condition is char-
acterized by chronic proliferative overgrowth of the submucosal
layer. This leads to great thickening of the mucosa, which acquires
a mammilliform appearance. Here and there may be seen minute
cysts. These represent generalised dilations of the mucosal
glands which have resulted from stricture of their mouths by the
fibroid growth. The entire organ may be much shrunken. As in
pyometra, estruation and the attendant uterine discharges no longer
occur. The disease is peculiar to aged animals, and produces little

19

274 Surgical Diseases and Surgery of the Dog

or no morbid effect on the organism, so that surgical interference
is superfluous.

Treatment. Catarrhal endometritis is difficult to treat short
of extirpation of the organ. In only the largest animals can any
attempt be made at irrigation, and even then it is practically impos-
sible to wash out the whole extent of the two cornua. Very good
results are obtainable by a course of administration of official em-
menagogue pills, which contain ergotin and other ecbolics. Should
the latter treatment fail after a thorough trial, celio-oophoro-hys-
terectomy is indicated.

When pyometra is established it is always best to remove the
uterus as soon as possible before the condition has become so ad-
vanced as to render a successful issue doubtful, owing to the great
tendency to formation of metastatic abscesses in the liver, spleen,
and kidneys. As in catarrhal endometritis proper, discharge of the
contained matter can be induced with emmenagogue pills, but the
disease is in no wise abated, the infective process having its seat
deep in the wall of the organ. These pills are very useful for ad-
ministering as a diagnostic agent in doubtful cases, as they invari-
ably cause the organ to expel its contents. Burke claimed to have
cured an animal suffering from a disease, which from his descrip-
tion was evidently pyometra, by administration of a mixture of er-
got, iodide of potash, and digitalis. But as he did not see the animal
again after the lapse of three weeks, the claim can hardly be credi-
ted, what took place having been in all probability expulsion of the
accumulated matter with temporary relief.

The puerperal form of the disease is to be treated by prompt
celio-oophoro-hysterectomy. Attempts at extraction of the fetal
remains and irrigation are not to be countenanced. The disease
is so rapid in its course that hesitancy on the part of the surgeon
may result in fatal termination. Moreover, the fact that all the
coats of the organ are involved in the inflammatory process renders
local disinfection an impossibility. Immediately after an operation
of such gravity, powerful stimulants, such as trinitrin, should be
hypodermically administered, and the physiologic salt solution in-
jected through the wound into the peritoneal cavity, or hypodermi-
cally for several minutes, as fast as absorption takes place. Provi-
sion should also be made for drainage as the peritoneum is ex-
tremely apt to have become infected.

No. 54. VProcidence of the Vagina, Os Uteri, Uterus, and both Uterine Cornua.

The Abdomen 275

PROCIDENCE.

Eversion of the uterus is rarely seen. It is sometimes con-
founded with estrual hypertrophy of the vaginal mucosa, polypus
and prolapse of the vagina. Its occasional occurrence is associated
with the whelping period. Recent writers describe the lesion as
being of a partial nature one of the cornua only taking part in the
protrusion. But that both cornua may participate I can assert from
a case in my own practice which is shown in the accompanying
illustration. The double lesion is also attested by the record of
Cros, a veterinarian at Milan, in the year 1832. This practitioner
was requested to treat a toy bull female, six years of age, which had
previously brought forth different litters of five and six puppies
without difficulty. On the occasion in question the uterus had be-
come completely everted and by pressure on the urethral orifice in-
terfered with urination. Three days after its first appearance the
organ was greatly tumefied and gangrenous. Recognizing the risk
involved in replacing tissues in such condition, Cros decided on
amputation. This was performed by application of a tight ligature
round the neck of the protrusion as far within the vagina as possible.
On the following day the ligature was further tightened to complete
the isolation and mortification. On the third day the protruding
portion was extirpated with bistoury with but slight hemorrhage.
The mass on examination was seen to include both right and left
cornua. The right horn which had carried the young of the last
litter was considerably longer than the left. The anterior extrem-
ities of both terminated obtusely from which Cros surmised that
they had been torn from their connections with the ovaries, the
latter organs remaining within the abdominal cavity. The opera-
tion was followed by complete recovery. Ridler and Hobday have
also witnessed and treated in like manner, but by immediate extir-
pation, a prolapse of both cornua.

In one case, recorded by Leech, the everted organ contained
the bladder and portion of the intestine.

Symptoms and Diagnosis. At first a tumor appears protruding
from the external genitals. It soon becomes swollen and inflamed
and later ulcerates. Patches of gangrene develop. The animal
strains as if at micturition. The tumor must be carefully differen-
tiated from the not uncommon condition of protrusion of the vaginal
mucosa which occurs at the estrual period.

276 = Surgical Diseases and Surgery of the Dog

Treatment. If the procidence is recent an attempt should be
made at reposition, after first cleansing the parts with some disin- —
fectant solution. To effect this it may be necessary to open the
abdominal wall and withdraw the cornua. They should then be
suspended to the abdominal wall with sutures (Ventrofixation).
If the parts are gangrenous or there is objection to celiotomy, the
protrusion should be ligated with stout silk as far within the vagina
as possible, the occluded portion being excised, not, however, until
the operator has satisfied himself that no other viscera are contained
within the mass. Following this operation the vagina should be
irrigated daily with antiseptic solutions.

In one case treated by Funk the everted cornu prevented the
delivery of the fetuses from the other so that Cesarean section be-
came necessary.

TORSION OF THE CORNUA.

This is a very rare condition. It has been described by Eichen-
berger, Guillebeau and Bonnet, and twice by Kitt. The uterus was
always gravid. In Eichenberger’s case the animal had previously
whelped without mishap, but on this occasion could not deliver.
Ergotin was administered and two dead fetuses appeared. Death
occurred ten days later from peritonitis. The left uterine cornu
and broad ligament were twisted and torn. The former contained
two fetuses. The posterior part of the canal was obliterated and
its wall atrophied, showing the condition to have been one of long
standing, probably a few weeks. In Guillebeau’s case the bitch was
delivered of one fetus. Labor continued but without any result
until death took place a week later from peritonitis. The left cornu
containing two dead fetuses and distended to a diameter of six
inches was twisted in its long axis at its junction with the body of
the organ. The broad ligaments of both cornua were lacerated.

Torsion may also occur independent of pregnancy as I have
had occasion to observe. A Yorkshire Terrier, aged seven years,
which had previously enjoyed good health, estruated sparsely. Two
weeks later it succumbed without any special symptoms other than
toxemia and a constant slight discharge of a bloody purulent matter.
On making a necropsy, the right cornu was found to be highly in-
flamed and to contain a purulent hemorrhage matter (evidently

The Abdomen 277

pent-up uterine secretions). A twist existed at its junction with
the body of the organ and this had prevented free discharge.

Treatment. The cases cited above emphasize the importance
of ascertaining whether any fetuses remain behind or not in all
difficult parturition cases. This can be done in almost any case by
digital palpation of the abdomen and genital passages. The pres-
ence of such being suspected, explorative celiotomy must be under-
taken. Relief is afforded either by reduction of the torsion, or if
necessary by complete extirpation of the organ.

RUPTURE.

This is a very rare accident and when it takes place it is usually
due to rough use of obstetrical instruments. It is said to occur also
spontaneously. If the organ contains fetuses the latter may pass
through the rent into the peritoneal cavity. The lesion is always
serious either from shock or infection of the peritoneum, and the
animal usually succumbs.

Symptoms and Diagnosis. When rupture occurs during par-
turition the contractions of the organ immediately cease and the
animal is prostrated. On the finger being introduced within the
uterus, the muscular wall is felt interposed between it and the fetus,
particularly when the latter is pushed up towards the pelvic region
by external abdominal manipulation. Suspicion of the condition
calls for prompt explorative celiotomy.

Treatment. The abdominal cavity being opened, fetuses and
membranes must be removed, the cavity flushed with moderately
hot sterilized water and drainage provided to carry off peritoneal
fluids. It is not necessary to suture the rent in the wall of the uterus.

NEOPLASMS.

The growths affecting the uterus are usually innocent in char-
acter. The commonest are fibromata, while myomata and lipomata
and cystic accumulations occur with less frequency. Malignant car-
cinomata have also been observed but they are rare.

Fibromata. These tumors spring from the muscular wall and
are often in part myomatous, in fact, Sutton believes that many
tumors described as fibroids are primarily leiomyomata and later
undergo fibrous degradation. They may grow either towards the ©

278 Surgical Diseases and Surgery of the Dog

lumen of the organ or in the direction of the peritoneal cavity. In
the former case, the larger growths may project through the os and
even past the vulva.

Symptoms and Diagnosis. Presence of these growths is recog-
nizable by external appearances supplemented by digital palpation.
In one instance reported by Romani the tumor seemed to provoke
reflex coughing. It prolapsed through the vagina and vulva during
a fit of coughing and the coughing recurred when it was pushed
back within the vagina, but again ceased on further prolapse.

It is important in diagnosing growths occupying the vaginal
passage to carefully ascertain whether they are of vaginal or uterine
origin.

Treatment. Extirpation is indicated. If it is not desired to
preserve the reproductive capacity it is better to remove the entire
uterus together with the ovaries. Tumors which project into the
vagina should be removed by way of abdominal section and not by
ligation within the vagina.

Hydrometra. This condition is characterized by accumulation
and retention of the products of normal glandular secretions within
the uterus. It may arise from any of the following causes: Occlu-
sion of any part of the canal (generally the cervical extremity)
through cicatrization occurring as a result of endocervicitis origi-
nating from injury received during parturition; Occlusion through
pressure by the ring in inguinal hernia; Occlusion by surgical means
in those instances where the organ is ligated and severed as a simple
but bungling method of preventing gestation. In any case, unless
pyogenic microorganisms gain entrance, or strangulation takes
place, the condition has no ill-effect on the animal.

Symptoms and Diagnosis. An animal affected in this manner
is generally regarded as being pregnant owing to the distension
of the abdominal cavity, but persistence of the enlargement and ab-
sence of lactation serve to correct this impression. Contrasted with
the condition known as Pyometra, there is no change in the ap-
pearance of the external genitals, no pain on palpation, anorexia, nor
emaciation; in fact the physical equilibrium is in no wise dis-
turbed. It may be more easily confounded with obesity. Operative
measures are unnecessary except in inguinal hernia where there is
danger of strangulation.

Treatment. This consists in total ablation of the organ to-
gether with the ovaries.

The Abdomen 279
Surgery of the Uterus

All operations on the uterus should be done under general
anesthesia, the animal being secured in the dorsal position for
median celiotomy and in the lateral position for lateral celiotomy.
The organ is best reached by opening the abdominal cavity in the
median line in the center of the distance between the ensiform pro-
cess and the pubic border.

HYSTEROTOMY.

This operation is resorted to in cases of fetal retention in which
decomposition has not occurred nor induced changes in the uterine
wall, when the fetus is too large to pass through the natural pas-
sages, and in inguinal hernia where the gravid uterus forms the
protrusion, and when it is considered dangerous to the dam to allow
completion of full term owing to the difference in size between her
and the sire. Under the latter conditions the chances of favorable
result are greater when the operation is undertaken any time up to
seven weeks of gestation. Fractures of the pelvis are apt to reduce
the caliber of the passage to such extent as to completely inhibit
parturition, when the operation becomes imperative. Brooks and
Whitworth and Menveux have recorded instances with successful
termination. Funk had to resort to the operation in an animal in
which one of the cornua had become inverted thus preventing the
expulsion of the fetuses in the other cornu.

Where the safety of the progeny is desired it is interesting to
know that the fetus may survive the death of the dam for some
minutes. Kehrers, in experimental observations, found that three
minutes after death the fetus began to show symptoms of asphyxia,
and in thirty-six minutes it was dead. Sauer extracted some fetuses
alive by this operation eight minutes after the death of the dam.

The technic of hysterotomy is as follows: The abdominal cavity
being opened with as little wounding of the mammae as possible,
draw out the organ in its entirety and protect it with cloths wrung
out in hot water. Some difficulty may be experienced in exposing
the organ, particularly if it contains several fetuses, but it must be
handled with gentleness and the opening in the abdominal wall
should be large enough to permit of free passage of the distended
organ. Make a single incision cautiously through the uterine wall

280 Surgical Diseases and Surgery of the Dog

opposite the insertion of the broad ligament, over one of the fetuses
nearest to the fundus of the organ, avoiding wounding the fetal
membranes. Extract the fetus and membranes intact and push
along the others to the same opening. The fetuses being removed,
a few Lembert or Halsted sutures should be applied to close the
incision. Some authorities regard this as not being absolutely ne-
cessary as the organ very quickly diminishes in volume, the wound
closing by its contraction and quickly cicatrizing.

In inguinal hernia of the gravid uterus, the operation is per-
formed in a similar manner after the hernial sac has been opened.
Pregnancy with normal delivery of fetuses may subsequently take
place.

HYSTERECTOMY.

This operation is indicated in hydrometra, pyometra, purulent
metritis, in cases of fetal retention and decomposition where the
wall of the uterus is involved, in torsion, and in inguinal hernia
where the gravid uterus forms the protrusion and it is not con-
sidered advisable to replace it in its proper position. It is also
sometimes undertaken in preference to hysterotomy and removal
of the fetuses in those cases where dystokia is feared as a result
of the animal having mated with a male of superior size.

The ovaries should always be removed at the same time.

The operation is performed in the following manner: Open
the abdominal cavity and draw out the organ as in hysterotomy.
Apply stout silk ligatures immediately anterior to the cervix and on
the further side of the ovaries, and to sections of the broad ligament,
excise the intervening parts with scissors, and return the stumps
to the cavity. In the case of the gravid uterus and in the larger
animals ligate the arteries separately as one ligature -at the cervix
is not sufficient for safety. There is liability of such ligatures slip-
ping from the stump with secondary hemorrhage a3 a result. It is
well-known that there is a remarkable persistency in the flow of
blood from severed vessels of the abdominal cavity even when only
small arteries are divided. Larkes had two such unfavorable re-
sults attending the removal of the gravid uterus. In cases of puer-
peral septic metritis drainage should always be provided for by
inserting a fold of sterile gauze within the cavity and carrying it

The Abdomen 281

through the wound to the outside. This is removed in the course
of five or six days.

Whenever the continuity of the uterus is destroyed, either in
one or both cornua, all portions of the organ lying above, as well as
the ovaries, should invariably be removed, otherwise there is every
probability of a retention-cyst developing from accumulation of
glandular secretions, and this may possibly be converted into a
pyometra.

The practice of severing the continuity of the organ as a sub-
stitute operation for oophorectomy in order to prevent gestation is
bad surgery and should never be undertaken. In like manner when
the operation becomes necessary in cases of inguinal hernia, and
only the middle portion of a cornu forms the protrusion, the upper
extremity should be pulled through the ring until the ovary is ex-
posed and the whole of the parts then be removed.

VENTROFIXATION OF THE CORNUA.

This operation consists in producing the formation of adhesions
to hold the uterus in position against the abdominal wall. This
object is attained by suturing the organ to the inner aspect of the
wall. The operation is performed as a remedial measure against
eversion of the uterine cornua. The technic is as follows: The ab-
dominal cavity being opened in the median line, the cornua are

wa
a

No. 55. Ventrofixation of Abdominal Viscera.

282 Surgical Diseases and Surgery of the Dog

sought, straightened out, and brought forward. The same sutures
which are made to close the opening in the muscular wall are passed
through the muscular tissue of the cornua in the manner figured
in the accompanying illustration, while separate sutures are used
in the skin wound.
BIBLIOGRAPHY.

Bonnet—Cited in Veterinary News. April, 1905.

Brooks & Whitworth—The Veterinarian. 39, p. 33.

Burke—The Veter Journal. 1890, p. 12.

Cros—Rec. de Méd. Vétér. 1832, p. 599.

Hichenberger—Schweiz. Archiy. 1883, p. 91.

Froehner—Monatsh. f. prakt. Thierheilk. 1892-93, p. 382.

Funk—Cited by Fleming in Veterin. Obstetrics.

Guillebeau—Schweiz. Archiv. 1890, p. 32.

Kehrers—Cited by Fleming in Veterin. Obstetrics.

Kitt—Lehrb. d. Path. Anat, Diagnost. 2.

Leech—The Veterinarian. 39, p. 790.

Menveux—Ree. de Méd. Vétér. 1894.

Ridler & Hobday—The Veterinarian. 1905, p. 334.

Romani—Cliniea Veterinaria. 1889, p. 203.

Sauer—Cited by Fleming in Veterin. Obstetrics.

Sutton—Journ. of Anat. and Phys. 1884.
Welch—Journ. of Comp. Med. and Veter. Archives. 1900, p. 761.

The Vagina
EXAMINATION.

The vagina is examined by direct inspection, the animal being
secured in the dorsal position with the hind legs brought forward.
By separating the labia of the vulva with the fingers it is possible
to see a short distance within, but to properly inspect the whole
extent of the canal an expansible speculum should be employed and
light reflected with the aid of a mirror.

CONGENITAL MALFORMATIONS.

According to Kitt, many typical instances of the condition
known as Anus-vulva-vaginalis have been recorded. This is a con-
genital malformation or imperfect development. It will be remem-
bered that during fetal life a depression forms at the site of the
anus, which joins the rectum and genito-urinary organs. It later
becomes separated from the latter, but if this process should not
continue to completion the above-named conditon results. Stenosis
of the vagina I have seen in a Collie, where copulation was im-
possible.

VAGINITIS. VULVITIS.

Inflammation of the vagina and vulva occurs in both acute and

The Abdomen 283

chronic forms. It most commonly arises as a result of dystokia
particularly in primiparous subjects. It may also be caused by the
presence of foreign bodies and neoplasms.

Symptoms and Diagnosis. Acute vaginitis is characterized by
the discharge of a mucous, purulent, or sanguineous matter. The
labia of the vulva are injected, swollen, and painful, as is also the
vagina. In the chronic form a whitish or greyish muco-purulent
matter is discharged which agglutinates the hairs at the inferior
commissure.

Treatment. In either form irrigate the vagina two or three
times daily with moderately hot antiseptic solutions and follow with
injections of astringent solutions such as nitrate of silver and sul-
phate of zinc (1:100). Citrate of silver solutions (2:100) are
highly recommended by Italian authorities.

PROLAPSE.

This lesion is of rare occurrence. Estrual hypertrophy of the
mucosa is commonly mistaken for it. It may occur as a contingency
of the act of copulation when the male exceeds the female much in
size and drags the latter about.

Symptoms and Diagnosis. A reddish congested mass appears
at the vulva. If not soon replaced it may ulcerate through contact
with the ground when the animal sits on its haunches.

Treatment. The everted part should be irrigated with warm
water and then replaced. If the protrusion shows a tendency to
recur, the vulva should be stitched, the stitches being withdrawn in
the course of three or four days.

RUPTURE.

This lesion has beén observed by Raynard, Pflug, and Kitt.
It is apt to be complicated by incarceration of the bladder through
the rent. It is usually occasioned by the careless use of instruments
in difficult parturition. Raynard regarded it as always a very
serious accident from which the animal never recovered, owing to
development of peritonitis.

Symptoms and Diagnosis. When the bladder is incarcerated
it projects from the vulva and is recognized as a fluctuating tumor

284 Surgical Diseases and Surgery of the Dog

appearing at the entrance of the vagina or between the lips of the
vulva. Micturition is suppressed or but a small quantity of urine
escapes at a time. An exact diagnosis can be made by puncture
with an aspirator.

Treatment. The abdominal cavity should be promptly opened
and displaced organs returned to their normal position. In view
of the great risk of peritonitis supervening it is advisable to secure
ample drainage with strands of gauze or tubes inserted in the wound.

NEOPLASMS.

The growths most commonly met with in the vagina are inno-
cent in character. They occur as fibromata either pure or mixed
with myxomatous, myomatous, or lipomatous elements, and as
hypertrophy of the mucosa. Adenomata have also been observed.
Malignant growths occur with comparative rarity. They have been
observed as transformed sarcomata and as contagious venereal
granulomata which have been variously described as carcinoma,
sarcoma, etc. (See Chapter on Neoplasms).

Fibromata. These occur in the form of polypi or as an en-
largement of the Cervix and in their gross appearance closely re-
semble the hypertrophic enlargement peculiar to the estrual period
and for which they are often mistaken. It is said of the myxo-
matous growths that they may remain quiescent for a long period,
but may finally assume a true sarcomatous character and at the same
time invade the deeper layers of the vaginal wall. The purer fibro-
mata are firm in consistence and insensitive, and have an intact
surface, though the latter may become ulcerated by contact with
the ground when the tumor is so large that it protrudes through the
vulva. These tumors are apt to interfere with free coition and fetal
delivery.

Treatment. Extirpation is indicated. Operative technic is the
same as for removal of the hypertrophic enlargement peculiar to
the estrual period. In the case figured in the accompanying illus-
tration which was operated on at the Johns Hopkins Laboratory the -
tumor was enucleated through a median external incision, which
was made to extend from near the tip of the vulva to the mid-hy-
pogastric region. Mueller treated a fibro-myoma by daily hypo-
dermic injections of ergotin. In one month the growth was con-

The Abdomen 285

siderably reduced and the animal subsequently made a good re-
covery.

Estrual Hypertrophy of the Mucosa. This condition is not
at all uncommon in young females. In my experience, members of
the St. Bernard breed are most apt to suffer. Pathologically, it
consists of an hypertrophied area of mucosa, a sort of elephantiasis,
the seat of which is usually the floor of the vagina anterior to the
urethral orifice, but the whole circumference may be involved. It
is very generally mistaken for and described as prolapse of the
vagina, but while the turgid mass of tissue protrudes more or less
through the vulva, with the exception of this feature it has nothing
in common with true eversion of the vagina. In its morphologic
and microscopic features the neoplasm resembles a myxoma and is
sometimes mistaken for such, but it is purely a temporary congestive
condition associated with the advent of sexual excitement. It gen-
erally makes its appearance towards the end of the estrual epoch
and subsides as the latter declines. It tends to recur periodically
and is then described as being habitual.

Symptoms and Diagnosis. A globular or pyriform tumor is
observed protruding through the vulva during the estrual period.
It is most prominent when the animal is in the sitting posture, be-
coming considerably retracted within the vagina when the standing
posture is assumed and if small may disappear altogether. Through
contact with the ground it may ulcerate in places and become gan-
grenous. There may or may not be a history of previous appearance
of the enlargements.

Treatment. The only effective way of dealing with this form
of enlargement and at the same time prevent recrudescence is to
extirpate it. Authorities in general advise that the protrusion be
reduced, a pessary or packing inserted within the vagina and the
vulva stitched, the stitches being left in position for several days.
All such measures are superfluous for the reason that the swelling
will usually subside of its own accord at expiration of the estrual
period. If treatment is undertaken it should be radical.

The most satisfactory method of removing the growth is as
follows: Draw the mass well out of the vagina by means of a stout
silk suture passed through its substance. Seek the urethral orifice
and insert a probe or catheter in the same, to serve as a guide, as
particular care must be exercised to avoid wounding it. If the mass

286 Surgical Diseases and Surgery of the Dog

has sufficient pedicle, remove it by means of the small-sized emas-
culator ; if it possesses a broad base, use a scalpel, making a fusi-
form incision. The mucosa must be sutured to prevent hemorrhage
which is otherwise copious owing to the turgescence of the parts.
Previous application of adrenalin chloride solution minimizes hem-
orrhage. The Thomas stitch should be employed (see Sutures).
Suturing the vagina is always difficult but this part of the operation
may be simplified by applying the sutures immediately beneath the
clamped emasculator before the latter is removed and while the area
of operation is within easy reach. Or if the mass is to be removed
by dissection apply the first stitch just beyond the upper angle of
incision, before using the knife. By means of this presection stitch
the field of operation can be kept in view while the suturing is being
completed. No after-treatment is necessary, but the urinary ap-
paratus must be closely watched for the first few succeeding days
for occlusion of the lumen of the urethra from swelling incident to
the wounded mucosa.

Other methods of removal are by clamp and cautery, by ecra-
seur or by ligature and subsequently allowing the mass to slough
off, but they are none of them so satisfactory as the method advo-
cated.

Venereal Granulomata. These tumor-like formations which
have already been described as occurring in the male similarly affect
the vaginal mucosa of the female. It is an inoculable disease and
is probably always conveyed by the act of copulation, hence sexual
intercourse should be prohibited. The growth appears as a soft or
firm, single or multiple, not particularly sensitive, wart-like nodular
protuberance. It is commonly situated on the floor of the vagina
between the vulva and the urethral orifice, though when long-
standing it may extend throughout the length of the vagina and
protrude from the vulva. It is a progressive neoplasm, grows
slowly at first but quite rapidly later and may reach its maximum
growth within a year. It then infiltrates the perivaginal tissues.
Occasionally metastasis takes place to the inguinal glands. In the
advanced stages it is accompanied by cachexia and emaciation.

Symptoms and Diagnosis. As in the male, it usually escapes
notice until it has advanced to the ulcerative stage when a non-
purulent evil-smelling, bloody discharge escapes from the vagina.
Palpation and examination with the aid of a speculum reveals the

The Abdomen 287

condition. Some males manifest an aversion to, and refuse to mate
with, a female affected with this disease.

Treatment. Surgical treatment is, as a rule, ineffectual, unless
the growth is limited, in which case a fusiform piece of mucosa, to
include the affected area, may be removed, and the edges of the
wound drawn together and sutured with catgut. If necessary to
reach the growths the perineum must be divided and afterwards
sewn up. Complete anesthesia should first be established.

Recurrence of the growths often takes place, when operative
measures should be repeated. Hobday says the growth may be re-
tarded by performing oophorectomy in addition to ablation. This is
comprehensible in view of the fact that uterine myomata in women
shrink and ultimately disappear after the menopause, and surgeons
take advantage of this by removing the ovaries and producing
artificial amenorrhoea.

BIBLIOGRAPHY.

Hobday—Canine and Feline Surgery.

Kitt—Lehbrb. d. Path. Anat. Diagnost. 1. 2.

Pflug—Cited by Kitt in Lehrb. d. Path. Anat. Diagnost.

Raynard—tTraité Comp. de la Partur. des Fem. des. Anim. Domest. Paris. 1845.

CHAPTER IX
The Abdomen—Continued

Hernia

ABDOMINAL HERNIA IN GENERAL.

The term Hernia is applied to any protrusion consisting of an
organ or part which has escaped from the abdominal cavity where it
normally belongs and protrudes through some natural or accidental
opening in the walls of the latter.

The contents of an abdominal hernia may consist of portions of
the bowel alone (enterocele), of the omentum alone (omentocele,
epiplocele), or of both these together (entero-epiplocele), of the
round ligament with more or less of the broad ligament (mesome-
trocele), and of one or both uterine cornua in addition to the latter
(metro-mesometrocele). The bladder, enlarged prostate gland,
spleen, and pancreas have been found present in a limited number of
cases. A peculiar instance of protrusion through the abdominal wall
has been recorded by Edgar, two fatty (?) tumors being found at-
tached to the uterus, one of which had grown through the abdominal
muscular wall.

The protruding organs are contained in a sac which consists
of an extension of the peritoneum. In some forms, such as the
scrotal and perineal, no true sac of neoformation exists, the pro-
truding organs passing into dilated cavities which are already lined
with prolongations of the peritoneum. The sac is covered by the
integument and subjecent connective tissue.

Hernia may be congenital or acquired. A familiar example of
the former is often seen in puppies soon after birth when the umbi-
licus remains patulous and a portion of the omentum passes through
to form a subcutaneous swelling. The inguinal ring is also occa-
sionally the seat of congenital hernia in females, in whom the round
ligament and part of the broad form the protrusion. Acquired
hernia is the result of either increased intraabdominal pressure,

288

The Abdomen 289

weakness of the abdominal parietes, traumatism, or the presence of
a predisposing factor in the form of a dilated inguinal canal and
congenital herniated broad ligament. It occasionally occurs subse-
quent to abdominal section, especially when the incision is made in
the aponeurotic tissue of the linea alba, through yielding of the cica-
tricial tissue of the wound. Hobday places the general percentage
of hernias resulting from celiotomy at four or five. In an extensive
experience, both clinical and experimental, I never have had the
misfortune to meet with it, which I attribute to the fact that I have
always avoided incising directly in the linea alba. La Torre experi-
mented on twenty-five dogs and determined that hernia after celio-
tomy was chiefly due to defective union of the muscular layer or
relaxation of the cicatrix, following incision through the linea alba.
This was not likely to occur when the incision was made through the
muscle. If made directly in the linea alba, before closing it, the
aponeurotic tissue should be removed as far as the muscular sub-
stance of the recti muscles.

There is always risk to be encountered from the presence of
a hernia, through incarceration or strangulation taking place or
through parturition being rendered impossible. In one fatal case
of inguinal hernia which I attended, the lesion had existed four
years, the portion of protruding bowel finally becoming strangulated.
A hernia is said to be incarcerated when the peristalsis of the re-
tained gut is arrested, generally through adhesions having formed,
and the lumen is obstructed by impacted feces. A hernia is said to
be strangulated when the return of the venous blood is impeded.
This is followed by stasis of the arterial flow, edema, and serous
exudation, which increases the distension of the sac. Finally, these
changes lead to migration of intestinal bacteria and gangrene. Both
these conditions are treated of fully under Intestinal Obstruction.

Symptoms and Diagnosis. Hernia is recognized as an elastic
fulness or swelling, by more or less disappearance of the same when
the animal is placed in the dorsal position, and by its reappearance
when placed in the erect, excepting in the case of the gravid uterus
and irreducible and strangulated forms. It may also be replaced by
taxis. It is often tympanitic, disappears with a gurgling sound, and
becomes tense if the subject is made to cough. It is never painful
unless inflamed. In a recent hernia the contents are, as a rule, easily
reducible and the sac retains its natural thin, translucent condition,

20

290 8=©§Surgical Diseases and Surgery of the Dog

but in a hernia of long standing it may become thickened and some-
times adherent to the contained organs or neighboring tissues. Dif-
ferential diagnosis lies between it and neoplasms and abscesses.

Treatment. It has already been remarked that a hernia con-
stitutes an ever-present menace to life. It naturally follows that
such a lesion should always be remedied at the earliest possible
opportunity. The owner must be informed of the possible termi-
nations and of the advisability of submitting the animal to treatment.
Treatment of hernia should be operative in all cases, there being no
more danger to the animal from opening the peritoneal cavity in
this manner than there is in any other abdominal section, provided
due care be exercised to avoid wounding blood-vessels and punctur-
ing viscera. The operation is termed Herniotomy. It is advisable
to deprive the animal of all food for two or three days prior to
operation and to administer an active purgative.

The fundamental principles governing operative measures for
either form are: reduction of the contents, dissection and complete
extirpation of the sac, and closure of the opening in the abdominal
wall, whether accidental or natural, by suture. The technic is as
follows: The animal being hoppled in the most convenient position
and anesthetised, an incision is made in the skin directly over the
protrusion. The subjacent fascia is next cautiously dissected until
the sac is reached, and the dissection continued until the latter is
completely enucleated. To distinguish the sac, when it is not ad-
herent to the surrounding connective tissue, it may be picked up
between the index finger and thumb when the intestine will slip
away, leaving the sac alone in the grasp. In a hernia of some du-
ration it is recognized by its whitish appearance, but if strangulated
it may be of dark-reddish color and not easily discernible. Some
writers, evidently borrowing from the principles of human surgery
where the possibility of infecting the peritoneal cavity always has to
be considered, advise that the contents be reduced without or before
opening the sac. I am a firm believer in opening the sac at the
outset, being no more fearful of any probability of inducing peri-
tonitis than I am when performing simple celiotomy. With an open
sac the operator can see what he has to handle, can see whether
adhesions have formed at the neck to interfere with reduction, and
can see whether any organs need to be extirpated. I have in mind a
few instances where the operation was needlessly prolonged for

The Abdomen 291

several minutes by vain attempts to return the organs without open-
ing the sac. When the latter alternative had finally to be adopted
it was found that adhesions had effectually prevented the efforts
from being crowned with success, and in one case the presence of a
diseased uterus was laid bare.

But it sometimes happens that the size of the ring prevents re-
duction of the contents. In this case it must be enlarged by means
of an instrument specially designed for the purpose, or if the latter

No. 58. Herniotome.

be not at hand a probe-pointed bistoury guided by a grooved director
will answer the purpose almost as well. The enlargement must be
made with due regard to the proximity of vessels.

The contents being returned, the sac is next removed. This
should be pulled well out, twisted, and excised after first applying
either a simple, multiple, or purse-string ligature to its neck as high
up as possible. The stump is then pushed within the abdominal
wall. The next step comprises closing the opening in the wall.
This is accomplished, as in celiotomy, by suturing the margins.
The skin wound is closed as in celiotomy. The subcutaneous ap-
plication of tampons with the object of giving additional support is
unnecessary, if not useless for the purpose for which it is intended.
Neither need supporting bandages be employed. The best suturing
material to use during the various stages is silk.

In strangulated hernia, treatment, to be effectual, must be
undertaken in the early stages, as the lesion is quickly fatal, usually
within twenty-four to twenty-eight hours. The sac is opened, the
ring enlarged by cutting, and the bowel slightly drawn out and the
entire mass carefully examined. Congested bowel, even if dark-red
in color, usually possesses sufficient viability for complete recovery
and may be safely returned, and the operation completed as already
described, but if any part is found to be gangrenous recourse must
be had to resection.

ABDOMINAL HERNIA IN PARTICULAR.
Umbilical Hernia. Umbilical hernia occurs either congenitally

292 ~=Surgical Diseases and Surgery of the Dog

or develops during the first few days after birth. The ring in this
case is formed by a patulous condition of the omphalo-mesenteric
duct and the sac by the sheath of the umbilical cord covered by the
integument. Under normal conditions the umbilical orifice becomes
obliterated by fibrous organization during the first few days suc-
ceeding birth. When this development proceeds tardily the em-
bryonic tissue in the neighborhood of the orifice gradually recedes
before the pressure of the viscera and a hernia is formed. The con-
tents consist usually of omentum alone, though sometimes large
intestine accompanies it. In acquired umbilical hernia of later life,
parietal peritoneum forms the sac.

Symptoms and Diagnosis. This form of hernia is easily recog-
nized as a soft or firm tumor at the umbilicus.

Treatment. The majority of cases of umbilical hernia among
newly-born puppies result in spontaneous cure, so that treatment of
this form is rarely necessary. Sometimes a small swelling persists
during life through adhesions forming between the ring, sac, and
omentum without complete return of the protrusion. It is a good
plan to apply adhesive bandages over the swelling to assist the tardy
closing process. Some practitioners claim to have good results
from the injection of a few drops of a ten per cent solution of
chloride of zinc. When it is necessary to treat by herniotomy the
best results are obtained by completely excising an elliptic portion
of the wall surrounding the umbilicus (omphalectomy).

Ventral Hernia. This term comprises all hernias which arise
through subcutaneous disruption of the abdominal muscles. It
originates either traumatically or by spontaneous rupture under
extreme intraabdominal pressure or it may result from surgical
wounds. The lesion is not very common. The symptoms and
treatment have already been outlined.

Inguinal Hernia in the Female. This form of hernia is most
common of all. It is characterized by passage of a fold of peri-
toneum and visceral organs through either or both inguinal canals.
The inguinal canal in the female is very short, and its diameter
varies according to the sex and conformation of the animal, being
more pronounced in the female than in the male. The internal ring
in the female is normally covered by parietal peritoneum, and con-
sequently sealed.

For some unknown reason the lesion occurs more frequently

No. 59. Inguinal Hernia in the Female.

No. 60. Inguinal Hernia in the Female.

The Abdomen 293

on the left side than on the right. In this connection it is worth
remembering that normal descent of the testes in the male is said
to be naturally later and more liable to deflection on the right side
than on the left, suggesting that the mechanism of descent is more
ample on the left. It is sometimes congenital in origin, and it may
not be detected until, the uterine cornua forming the contents and
becoming gravid, it commences to enlarge with the growth of the
contained fetuses. It may often be observed to occur in animals
after giving birth to litters sired by males very much their superiors
in size. In these’ cases the ring seems to dilate in sympathy with
the enormous distension of the abdominal cavity, its caliber being
increased with the stretching of the wall. As soon as delivery is
accomplished, a part of the collapsed uterus falls through, earrying
the peritoneum before it.

It is most common to find the round ligament together with the
peritoneal fold by which it is connected with the broad ligament,
and this is often the seat of deposit of a mass of fat. Some writers
in describing inguinal hernia refer to this ligamentous tissue as
omentum, evidently owing to the similarity between the two struc-
tures, but my investigations have shown me that it is a rare ex-
perience to discover omentum forming part of an inguinal hernia.

A condition of hypertrophy of the round ligament has been
designated pseudo-hernia. It is easily differentiated from the true
form.

Next in frequency we find one or both uterine cornua, in part
or whole, together with the broad and round ligaments, forming
the contents of the sac. As already remarked, should pregnancy
occur, a rapidly growing enlargement soon becomes apparent. The
increase in size may be first detected about one week after impreg-
nation has taken place. Delivery of the fetus per vias naturales is,
as a rule, impossible, the inguinal ring forming an impassable con-
striction. Unless removed by operation of hysterotomy it dies and
either macerates or decomposes and induces infective inflammation
and gangrene of the maternal parts. Instances have been recorded,
however, in which the young have been brought forth in a natural
manner. Prangé described a case of hernia of a portion of the
uterus which contained three fetuses, all of which were delivered
naturally a few hours after birth of six others. Roell had a similar
experience, In one instance which I relieved by operative measures

2904 Surgical Diseases and Surgery of the Dog

the entire uterus and one ovary together with the greater portion
of the small intestine formed the protrusion. In this case the
uterus was the seat of an enormous hydrometra formed from ac-
cumulated uterine secretions through occlusion of the cervical lumen
by compression at the ring.

Descent of other visceral organs may also occur. In cases
recorded by Hobday, Friedberger, Cadéac, Cadiot and Almy, the
sac has been found to contain portions of the small intestine, spleen,
pancreas, omentum, bladder, uterine cornua, cecum, and part of the
colon.

Adhesion of the pedicle of the protruding viscera to the bor-
ders of the ring is quite common, but it is rare that strangulation
takes place when the uterus alone is concerned. Prudhomme wrote
of seeing such a case, which terminated fatally. But when a knuckle
of bowel slips into the sac the risk of strangulation is greatly in-
creased.

In order to acquire a clear conception of the manner in which
congenital hernia of the round and broad ligaments and the uterine
cornua takes place, it will be necessary to review the prenatal de-
velopment of the sexual organs. In early fetal life there exists
an intra-abdominal glandular structure on either side of the lumbar
region—the Wolffian body—the structure which gives rise to the
reproductive gland of either sex. Connected with the Wolffian
body are two tubular structures leading to the uro-genital sinus, the
Wolffian and Muellerian ducts respectively, the former becoming
the vas deferens and epididymis in the male, and the latter the ovi-
duct, uterus, and vagina in the female. The Wolffian body is sus-
pended from the abdominal roof by a duplicature of peritoneum
from which a fold (the plica gubernatrix) is projected to and
through the inguinal region. This fold subsequently becomes the
gubernaculum testis in the male and the ligamentum teres in the
female. It is invested throughout with peritoneum which forms a
tubular sheath about it. Beneath this sheath are certain muscular
fibers having their origin in the abdominal muscles, and which are
known as the cremaster muscle in the male but are not specially
named in the female for the reason that in the latter sex they are
normally rudimentary.

We see that in the female there is an arrangement of struc-
tures almost identical with that which serves to bring about migra-

The Abdomen 295

tion of the testes in the male, and it would appear as if Nature had
almost intended the same phenomenon should occur in the female.
As a matter of fact, we often find evidence of an attempt on the
part of Nature to bring about migration of the female organs.
When the muscular fibers of the ligamentum teres are sufficiently
developed, the natural result is contraction, and there follows the

No. 61. Diagram illustrating normal position of the parts.

.
.
O)
.
.
.
»
»
.
.
.
’
'
U

No. 62. Diagram illustrating mechanism of Inguinal Hernia.

296 Surgical Diseases and Surgery of the Dog

formation of a pouch communicating directly with the peritoneal
cavity, and constituting a sort of diverticulum as in males. This
pouch forms the hernial sac in female inguinal hernia, and in pro-
portion to its development and the potential contractility of the
muscular fibers, predisposes the animal to this lesion.

Symptoms and Diagnosis. The swelling is situated behind or
beneath the inguinal mammae. It may be of such dimensions as to
reach the ground, when it is usually rendered sore by friction.
Contrasted with neoplastic formations, it lies deeply, is more or less
reducible, and decreases in size when the animal is placed in the
dorsal position, when there is absence of adhesions. Its consistence
varies according to the contents and the condition of the latter. A
slight hernia is moderately firm and resistant. The presence of fluid,
whether serous, mucous, or fetal, may cause fluctuation. The forms
as well as the movements of one or more fetuses may sometimes be
distinguished. By palpation a sort of pedicle can be recognized
leading to the inguinal canal, and the circumference of the latter
can often be plainly made out. If the bowel be involved, intestinal
murmurs may be heard with the aid of a phonendoscope. The fact
is worth remarking that nursing puppies, as a rule, refuse the teat
or teats under which the hernia lies.

A word of caution as to exploration of enlargements in the
inguinal region with instruments. Robb recorded having observed
an enlargement of the posterior mammary gland of the left side
which fluctuated, showing the presence of liquid. An unsuccessful
attempt was made to draw off the fluid with the aid of a canula.
Finally the tumor was opened and hysterotomy performed and a
fetus removed. The mother died of peritonitis, which evidently
had its origin at the site of the puncture. Raynard described a case
in which the pregnant uterus protruded until it had lodged in the
connective tissue immediately beneath the vulva. The owner suppos-
ing the enlargement to be an abscess opened it with a penknife, and
thereby established a fistula. Raynard explored the tumor and found
it to be the uterus containing a three-to-four-months’-old fetus. The
hernia was irreducible owing to adhesions having formed between
the uterus and connective tissue, and the animal died the following
day.

Treatment. Herniotomy in the following manner is indicated:
Incise the skin along the axis of the enlargement and enucleate the

The Abdomen 297

sac up to the inguinal ring by blunt dissection of the cellular tissue
connecting it with the skin. Some practitioners make a V-shaped
incision with its apex towards the anterior extremity of the sym-
phisis pubis, and the flap of skin supporting the inguinal mamma is
then turned over. There is no advantage to be gained by this pro-
ceedure as the canal can always be reached when the incision is made
beside the median line. In any event, there is usually a certain
amount of redundant skin to be removed. Next open the sac and
endeavor to reduce the contents. Sometimes this is easily accom-
plished, but at other times it is impossible. In the latter case the
ring must be enlarged by incision. The incision should be at the
extremity of the ring furthest from the median line, in order to
avoid wounding the external pudic vessels which make their exit
from the cavity towards the inner extremity. It should also be made
to avoid the peritoneum. If the bladder forms the contents and
is irreducible, it may be punctured to facilitate matters. When the
gravid uterus forms the protrusion, and is irreducible, removal of
the fetuses must be effected by Cesarean section or the entire pro-
truding portion may be excised, the stump being returned to the
cavity. In case the latter alternative is adopted the corresponding
ovary should be drawn out and also removed. Fetuses contained
in the opposite cornua are not necessarily disturbed by such extreme
measures, but may continue to develop till full term. Hobday has
recorded an instance, and Nauraux has experienced equally favor-
able results where the remainder of the uterus has been conserved.
The next step is ablation of the sac. The latter should be
twisted and ligated as near to the ring as possible, cut off on the
occluded side, and the stump returned to the cavity. The ring
should then be sutured, three or four sutures usually answering the
purpose. By using mattress sutures and at the same time slightly
inverting the edges, the ring can be permanently obliterated. Par-
ticular care must be exercised against wounding the pudic veins
which stand out very prominently. It may sometimes be found
advantageous to ligate them. Redundant skin should be removed.
Healing generally takes place by second intention, chiefly owing to
the large subcutaneous cavity which must of necessity be left in the
groin, and post-operative infection which it is difficult to prevent.
Inguinal and Scrotal Hernia in the Male. In the male the
inguinal form of hernia is relatively uncommon. It may occur, as

298 Surgical Diseases and Surgery of the Dog

in the female, owing to dilation of the inguinal canal. The intestine
then protrudes into the subcutaneous tissue carrying a fold of peri-
toneum before it. In scrotal hernia the sac is formed by the pro-
cessus vaginalis, and the contents, consisting usually of intestine,
rarely of omentum, protrude as far as, and rest in contact with,
the testicle. Under normal conditions the caliber of the processus
vaginalis formed by the descent of the testis becomes much re-
duced at its upper extremity after passage of the gland, but never
becomes entirely obliterated. If this contraction fails to take place
the neck of the pouch in the vicinity of the internal ring presents
an abnormal opening continuous with the peritoneal cavity thus
forming a ready avenue for escape of visceral organs.

Symptoms and Diagnosis. In the inguinal form the swelling
is formed between the penis and abdominal wall, while in the scrotal
form it exists as a very thick sausage-shaped tumor along the course
of the spermatic cord.

Treatment. Inguinal hernia is treated as in the female. Scro-
tal hernia necessitates some slight modification of technic. Opera-
tive measures consist in cutting down on the swelling in the groin
over the inguinal canal, opening the processus vaginalis, returning
the protruding organs, and suturing the dilated inguinal ring, as in
the female, at the same time allowing sufficient room for the
spermatic cord and vessels, which are left intact. Some writers
seem to regard it essential to remove the testes at the same time,
but there is no reason why they should not be retained, their pre-
servation being a matter of paramount importance in valuable stud
animals. Griffiths has demonstrated by experiments and obser-
vations on artificial and natural mono- and crypt-orchids that testis
may be manipulated without injury to itself or the structures of the
cord. In one instance he resected the cremasteric muscle and the
parts healed entirely. Barnard suggested an alternative method
by which the testis and cord are separated from the surrounding
structures and placed within the abdominal cavity outside the peri-
toneum. The tunica vaginalis is removed and the inguinal canal
completely closed by suture. Of course the object in preserving
the gland in this manner was the maintenance of the procreative
faculty. But Griffiths has proved that the full-grown testicle, when
so replaced, undergoes a degenerate change and loses its power of
spermatogenesis, so that no object would be obtained by this pro-
cedure.

No. 638. Inguinal Hernia in the Male.

No. 64. Serotaul Hernia.

No. 65. VTerineal Hernia.

The Abdomen 299

It has been suggested that in the scrotal and perineal forms
celiotomy should be performed, the herniated portion withdrawn
through the ring and then stitched to the abdominal wall to prevent
its return to the sac. This would surely be an error for the very
simple reason that the ring and sac would still persist, and there
would be no provision to prevent the escape of some other portion
of the bowel or other organ.

Perineal Hernia. The fold of peritoneum which in males is
reflected from the bladder to the rectum on either side, gives rise
in the center to a prolongation of the peritoneal cavity—the fossa
or cul-de-sac of Douglas, or excavatio recto-vesicalis. In females
two such prolongations are formed, one between the uterus and
rectum—the excavatio vesico-uterina. Perineal hernia constitutes
the passage into one of these cul-de-sacs of a portion of the bowel,
the omentum, the uterus, the bladder, or enlarged prostate. The
lesion is observed quite frequently in old males, and it is said, par-
ticularly in performing animals which are taught to walk on their
hind legs. It is otherwise usually produced as a result of expulsile
efforts necessitated by the presence of hypertrophied prostrate. It
can exist for a long time without interfering with the animal’s
health. It seldom becomes strangulated, though torsion of the
bladder is apt to take place, when that organ forms the contents,
or even a fistula may form. Liénaux has recorded witnessing a
displaced rectum caused by an enlarged prostate.

Symptoms and Diagnosis. This form of hernia appears in the
male as a subcutaneous swelling between the root of the tail and
the ischial tuberosity. In the female the swelling occurs in the
region of the vulva. Lucet saw a double perineal hernia, the swell-
ing on the right side being formed by the bladder, that on the
left by a portion of the omentum. In Liénaux’s case, above referred
to, the swelling appeared beneath the anus.

When the contents consist of the bladder the tumor has a soft
elastic consistence, resembling a cyst. In this case there is usually
dysuria. To determine the condition with accuracy the aspirator
should be employed. A large perineal hernia may interfere with
defecation and force the anus out of its natural position to one side.
It may be mistaken for enlarged anal pouches, from which it must
be carefully differentiated.

Treatment, If dysuria is present the bladder must be replaced

300 Surgical Diseases and Surgery of the Dog

in its natural position by the following method: Empty the rectum
with an enema, elevate the animal’s hind-quarters, insert the thumb
in the rectum and exert pressure with it through the rectal wall,
and at the same time manipulate the tumor from the outside.
Usually this maneuver is sufficient to cause the bladder to glide
back into place. When it fails herniotomy must be undertaken as
already described. It is best to insert a temporary tampon of
aseptic gauze in the wound to stimulate the formation of adhesions,
the skin being sutured over it. If the prostate is enlarged castra-
tion is also indicated. In one instance, where the prostate, much
enlarged, formed the protrusion, I removed the latter by a process.
of dissection and tearing away. In doing this the urethra was acci-
dentally ruptured. No attempt was made to suture it, and for a
week succeeding the operation urine flowed through the outer
wound, just as it is allowed to do after an operation for removal
of stone from the urethra. But the wound soon closed and urina-
tion by the natural channel was reestablished and the animal made
an uneventful recovery. Ina female in which the uterus formed the
contents, Benkert performed celiotomy in the inguinal region, in-
troduced his hand and replaced the organ in its natural position.
The animal produced young regularly thereafter. Liénaux treated
his case by opening the abdomen, straightening the bowel and sutur-
ing the latter to the abdominal wall.

Crural Hernia. This form is very rare. Kitt cites Lafosse
and Bruckmueller as authority for its occurrence, Hertwig refers
to it, and Girard has also seen it. Cadix recorded a case of bilateral
crural hernia in a female. It is characterized by protrusion of por-
tions of the viscera, usually the intestine enveloped by parietal peri-
toneum, through the crural ring in the course of the crural or
femoral vessels. Crural hernia emerges beneath Poupart’s liga-
ment, inguinal above it. The condition tends towards strangulation.

Symptoms and Diagnosis. The usual form of swelling is ob-
served but in addition there is lameness on the affected side.

Treatment. This is the same as already outlined, only the
technic involves particular caution in the avoidance of the vessels
which traverse this region.

Diaphragmatic Hernia. This lesion may be congenital or ac-
quired. It is characterized by protrusion of abdominal viscera into
the thoracic cavity with or without the peritoneal coat remaining

The Abdomen 301

intact. The acquired form may occur as a result of dilation of the
foramen sinistrum through relaxation of the cardiac, gastro-hepatic,
and gastro-colic ligaments when the empty stomach is primarily
the herniated portion. Fuenfstueck saw a case of this kind, the
stomach having become wedged in between the lungs and appeared
at the necropsy as a large distended bladder. It was supposed to
have resulted through a habit possessed by the animal of bounding
down a winding stairway. Caparini and Bernard have seen it re-
sult from violent expiratory and defecatory efforts. In these cases
there is rupture of either the tendinous or muscular portion of the
diaphragm. In Bernard’s case portions of the liver and intestine
formed the protrusion. In Caparini’s case there were two super-
imposed perforations, each giving passage to portions of the bowel.
The portion passing through the inferior aperture was strangulated,
while that passing through the upper rent had penetrated the in-
terior of the pericardium, distending it and displacing the heart
laterally.

Symptoms and Diagnosis. In the acquired form there is sud-
den restlessness, crying, anxious facial expression, dyspnea, and
meteorism, which are followed by death within a few hours. The
congenital form may exist for years without giving rise to any
symptoms.

Pancreatic Hernia. Under this name the earlier writers de-
scribed passage of the small intestine through the hiatus of Wins-
low, the foramen formed by the great omentum between the poste-
rior vena cava and portal vein, and bordered by the anterior ex-
tremity of the pancreas and the lesser curvature of the stomach.
No particular mention is made of its occurrence in the dog, the
only reference I have been able to find being a suggestion of such
a possibility in an article by Pécus.

BIBLIOGRAPHY.

Benkert—Cited by Cadiot & Almy in Traité de Thér. Chir. d. Anim. Dom.

Bernard—Reyv. Vétér. 1886. p. 452. Correspondenzbl. f. schweiz. Aerzte. Nov., 1897.
Cadix—Rec. de Méd. Vétér. 1898, p. 102. >
Caparini—Il Bulletino veter. 1880, p. 129.

Edgar—Veterinarian. 1894, p. 135.

Fuenfstueck—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1878, p. 106.
Girard—Rec. de Méd. Vétér. 1824, p. 114.

Goubaux—Rec. de Méd. Vétér. 1858, p. 984.

Griffths—Journ. Anat. & Phys. 1892-93, p. 209.

Hobday—Canine & Feline Surgery. Journ. Comp. Path. & Ther. 8, p. 153.
Kitt—Lehrb. d. Path. Anat. Diagnost.

La Torre—La Gynéc. April, 1897.

Liénaux—Ann de Méd. Vétér. March, 1903.

302 ~©Surgical Diseases and Surgery of the Dog

Lucet—Rec. de Méd. Vétér. 1892, p. 83.

Nauraux—Rec. de Méd. Vétér. 1888, p. 12.

Pécus—Journ. de. Méd. Vétér. et de Zootechn. 1894

Prangé—Rec. de Méd. Vétér. 1844, p. 619.

Prudhomme—Ree. de Méd. Vétér. 1844, p. 356.

Raynard—tTraité Compl. d. 1. Partur. d. Anim. Domest. 1, p. 443. 2, p. 302.
Robb—Journ. Comp. Path. & Ther. 6, p. 281.

Roell—cited by Fleming in Veter. Obstetrics.

The Mammary Glands

TRAUMATIC LESIONS.

The mammae sometimes suffer contusion, which according to
the degree of violence, may result in rupture of a few subcutaneous
vessels or intraglandular hemorrhage (hematoma) with destruction
of glandular tissue. Such injury may terminate in suppuration.

Treatment. Slight contusions require no treatment but are
best left to natural processes of repair. If suppuration takes place
vent must be given to the pus. In severe contusion ablation of the
gland may be advisable.

CONGESTION.

Towards the end of gestation and during lactation there de-
velops a normal turgescence of the parts. This turgescence and
also lactation is common in virgin and non-pregnant animals about
eight weeks after estruation—a sort of mistaken anticipation on the
part of Nature.

Symptoms and Diagnosis. The mammae are hot, tumefied and
slightly sensitive to pressure.

Treatment. Restricted diet, free purgation, and massage of
the parts are indicated.

MAMMITIS. MASTITIS.

This is an uncommon disease. It generally occurs during the
period of lactation shortly after parturition. It is caused by pyo-
genic bacteria which probably migrate through the galactophorus
ducts to the acini and thence spread through the perilobular lym-
phatics. Lucet and Leblanc have found a white staphylococcus
present, and Gaucher and Surmont have experimentally injected a
pure culture of a white coccus obtained from a case of chronic mam-
mitis in a human being and produced subacute inflammation of the
gland. One or more glands may be affected and usually the ante-

No. G6. Mammary Tuinor simulating Hernia.

The Abdomen 303

rior ones. As a rule, the inflammation terminates in multiple
abscess formation. Pyemia sometimes follows.

A rather remarkable case should be mentioned here in which
a swelling of the mammary region was observed by Mégnin, which
upon lancing was found to be due to the presence of a giant strong-
yle emerging from the body.

Chronic mammitis may succeed the acute form but it commonly
originates independently of the latter. It occurs as a sclerotic inter-
stitial fibrosis with gradual destruction of the glandular tissue.
This form will be referred to as Fibroma and it also is believed to
be due to irritative action of the white staphylococcus.

Neither form is to be confounded with simple congestion inci-
dent to sudden cessation of nursing by the offspring.

Symptoms and Diagnosis. In acute mammitis the glands are
hot, sensitive, greatly swollen, and edematous, and the milk is
replaced by a greyish or purulent matter. There is usually some
fever present and also suppression of appetite. The animal lies
down frequently and is indifferent to its surroundings. In a few
days multiple abscesses form and come to a head externally as dark-
red angry-looking foci. These, if not treated may persist as ulcers
and fistulae for some time after discharging, healing but slowly.

Treatment. The offspring must be removed and the remaining
healthy glands milked by hand. Hot fomentations must be applied
to the part and kept up as long as possible. The best way to carry
out this treatment is to stand the animal over a tub and apply the
hot liquid by means of a sponge. Purulent accumulations must, of
course, be opened up with a knife. The bowels should also be freely
evacuated with purgative doses of epsom salts.

NEOPLASMS.

The mammary gland is frequently the seat of neoplasia of both
innocent and malignant types. It is believed that in some cases
the innocent growths may undergo transition into malignancy. This
is particularly true of the adenomatous type of growth, and certain
it is that pure chondroma, which is ordinarily non-malignant, may
occur (Petit), while on the other hand chondromata are usually
associated with sarcomatous, myxomatous, and fibrous tissues, and
often osseous elements. The strictly innocent growths consist of
fibroma, myxoma, lipoma, adenoma, or very often mixtures of these,
and cysts. They are characterized by slow development, freedom from

304. Surgical Diseases and Surgery of the Dog

pain, and after attainment of a certain size, quiescence. The malig-
nant growths comprise sarcoma, carcinoma, and, as already stated,
mixed chondromata. They are distinguishable from the former
type by their more rapid growth, though they sometimes have
periods of quiescence, by extension to neighboring lymphatics, by
the pain and emaciation they induce, and by their tendency to ulce-
rate and undergo generalization. Either type must always be
carefully differentiated from inflammatory swellings and hernia,
particularly the inguinal variety (see Hernia). Hematoma resulting
from injury has been recorded by Rodet.

Fibroma. This is a common form of mammary tumor. For-
merly much confusion existed as to its proper classification and it
was not infrequently confounded with adeno-fibroma. But, inas-
much as the essential element in a fibroma is fibrous tissue and this
type of growth develops as a pericanalicular fibrosis or proliferation
and projection of connective tissue round the glandular acini, it is
now recognized as pure fibroma. By this process of fibrosis groups
of acini become ‘isolated, and these undergoing compression, lose
their glandular structure and appear as “islands” of cells. It was
these “‘islands’’ of cells which were once mistaken for true neoplastic
or adenomatous formations.

Fibroma sometimes undergoes transformation into a myxo-
matous condition.

Symptoms and Diagnosis. This growth develops as a hard,
knotty, mobile, and sharply-demarked swelling, varying in size from
a pigeon’s egg to the human fist, but may attain very large dimen-
sions. The myxo-fibroma is considerably softer.

Lipoma. The fat tumor occurs not uncommonly in plethoric
females.

Symptoms and Diagnosis. In consistence it is soft and larda-
ceous. It grows slowly and is sharply demarked from the neigh-
boring tissue.

Adenoma. True adenoma occasionally occurs in the gland and
is usually associated with more or less increased development of
fibrous tissue. Adeno-fibroma is the commonest type of growth met
with in this region. It may undergo progressive transition into
malignant carcinoma. Isolated or generalized cystic degeneration
is not at all uncommon.

Symptoms and Diagnosis. In macroscopic appearance adenoma
is very similar to fibroma, and is hard to differentiate, but is some-

No. 67. Lipoma of Mamuinary region,

Eat ax emer.

No. 68. (After Ortschild) Showing situation of primary Mammary Growth and the palpable
Metastases. Site of nipples indicated by solid black dots.

No. 69. True Carcinoma of the Mammary gland.

The Abdomen t 305

what softer, particularly when the cellular elements predominate
over the fibrous.

Sarcoma. Sarcoma occurs in pure form but more commonly
associated with osseous and cartilaginous structures. Pure sarcoma
is seen as a tuberculate growth, which may attain an enormous size.
The neighboring lymphatics and subcutis are usually infiltrated, and
the growth sometimes breaks through the skin. It is not common.

Symptoms and Diagnosis. The growth is reddish in color with
somewhat puckered surface and exceedingly soft and succulent and
contains a jelly-like substance. The skin covering it may be mobile.
It develops with great rapidity and is extremely metastatic.

Carcinoma. Carcinoma may arise from the glandular cells
proper or the epithelium of the ducts. The skin covering the glands
may also be primarily the seat of carcinoma which is not to be con-
founded with that of the glands, though in the latter case the skin
usually participates eventually. Myxoid transformation is not un-
common, and such tumors may also become cystic through retro-
gressive metamorphosis of the secretion of isolated normal acini.
Metastasis to internal and vital parts is the rule.

Carcinoma may originate as such per se, or as has already been
pointed out, may become progressively such by metamorphosis
from pre-existing adenoma. Primary carcinoma is infrequent.

Symptoms and Diagnosis. Carcinoma occurs most commonly
as a lobulated tumor, varying in size from a pea to a goose-egg,
which may remain quiescent for longer or shorter period, and finally
coalesce with the skin and degenerate. It usually occurs singly, but
secondary smaller growths are sometimes observed in the imme-
diate neighborhood of the main one. More than one gland, how-
ever, may be involved at the same time. Sudden increase in size
may take place, due to interstitial hemorrhage.

Symptoms and Diagnosis. Carcinoma is moderately hard and
usually knotty. When cystic degeneration has taken place, fluctu-
ating centers are perceived. Coalescence with the skin is recognized
by the bluish or reddish appearance of the latter, and usually by
eventual ulceration.

Chondroma. Cartilaginous growths are common but they in-
variably occur associated with other tissue elements, assisting in the
formation of a complex structure into the constitution of which
osseous, fibrous, and myxoid tissues enter. In some cases complete
ossification takes place. These tumors are to some extent metas-

21

306 = Surgical Diseases and Surgery of the Dog

tatic and therefore possessed of malignant character. The manner
in which this process takes place is described in the chapter on
Neoplasms.

Symptoms and Diagnosis. These tumors are easily recognized
by their hardness. They are usually encapsulated, often lobulated,
sharply demarked, free from the skin, and when removed surgically
can be shelled out. In size, they vary from a corn-kernel to the
human fist. More than one gland may be involved at one time.

Treatment. Treatment of mammary tumors should always be
operative, and no better rule can be observed than to practice early
and free removal. When tumors are encapsulated or limited to
definite areas the results are good, but when a primary growth
is surrounded by a zone of infiltration, or when metastasis has taken
place, or cachexia is present, the prognosis is unfavorable and re-
currence may be looked for.

The technic is very similar to that prescribed for neoplasms
in general, the principal difference being that mammary tumors are
usually very vascular and require greater precaution to guard
against hemorrhage.

Chronic Interstitial Fibrosis of the Teat. This condition can
occur without the mammary gland proper being involved, but it is
identical with chronic interstitial fibrosis or fibroma of the latter.
The accompanying picture illustrates the extent to which it may
develop. The cause is undetermined, but is probably microbic
in origin. Irritation incident to sucking by the offspring is cer-
tainly not necessary for its production, for it occurs in virgin
females. Hereditary tendencies would seem to play a part, for I
have seen it develop in identical teats in members of certain families.

Symptoms and Diagnosis. One or more teats are observed
to be considerably thickened and elongated. Taken in the hand
the teat does not impart a hard feeling, but one of decided aug-
mentation in volume. The gland to which the affected teat belongs
is still capable of functioning, and the milk can readily be drawn off,
but the teat itself is usually declined by the offspring.

Treatment. The condition being an unsightly blemish calls
for removal by surgical means, the technic of which differs in no
wise from that prescribed for ablation of dermal tumors.

BIBLIOGRAPHY.

Lucet—Rec. de Méd. Vétér. . June, 1896.
Mégnin—Comptes rendus de la Soc. de Biol. 1880, p. 30.
Rodet—Rec. de Méd. Vétér. 1827, p. 42.

CHAPTER X

The Extremities
The Legs and Feet

CONGENITAL MALFORMATIONS.

A congenital malformation of the anterior legs is not infre-
quently met with. The deformity is ordinarily confined to one
member but may exist in both, and consists of a contracted condition
of the flexor tendons, of variable degree, resulting in an unnatural
flexion of the metacarpals or even a true club-foot (carpipes). The
head of the radius may be dislocated.

Symptoms and Diagnosis. Where the deformity is of minor
degree, the foot can still be brought to the ground, but never in
straight line, and lameness is evident. In extreme cases where the
metacarpals are completely flexed on to the forearm, the carpus
forms the point of contact with the ground.

Treatment. In cases of minor deformity good results are
obtainable by sub-carpal tenotomy, but the reverse is the case in
true club-foot. Tenotomy is performed as follows: The animal
being narcotized with morphine and securely hoppled, the hair
shaved and skin cleansed, and cocaine injected locally, the skin is
incised longitudinally on one side of the tendon. The leg is next
flexed and the blade of a blunt-pointed tenotome inserted and di-
rected flatwise to the anterior border of the tendon. The cutting
edge of the blade is then turned towards the tendon, the leg is ex-
tended, and the tendon severed from before backwards. Any re-
sultant hemorrhage must be controlled by compression. Finally,
a light splint is applied to maintain the leg in extension while reunion
of the tendon is taking place. Nothing is done to the wound, which
heals in the course of a week, but provision should be made for
drainage in applying splints.

TRAUMATIC LESIONS.
Fractures. See The Osseous System.
397

308 Surgical Diseases and Surgery of the Dog

Rupture of the Tendo-Achilles. This contingency arises or-
dinarily through traumatism. A severe gash accidentally or malev-
olently sustained, a violent contusion, or crushing are the most
common causes. In one instance, witnessed by Simonds, the animal,
a Greyhound, had become impaled on an iron palisade, the point of
the latter penetrating between the tibia and tendon and lacerating
the tendon. Extreme muscular effort may also be responsible.
Bayer and Bruckmueller have both recorded instances of tearing
away of the tendon from its point of origin in the body of the muscle.
Thus, it will be seen that the skin may or may not be involved.
When complete division of the tendon has taken place the divided
ends immediately separate, but if the lesion be only partial,
separation may not occur for some days though it usually does so
eventually through muscular contraction.

Symptoms and Diagnosis. The behavior of the affected leg
is characteristic. Functional impotency of the metatarsus is com-
plete, the whole of the leg from the point of the hock to the toes
coming in contact with the ground, after the manner of the rabbit.
The animal is forced to walk on three legs. Examination of the
postero-inferior aspect of the leg reveals either a wound or a de-
pression corresponding to the separation of the divided ends.

Treatment. This lesion, if left to Nature, usually terminates
in spontaneous recovery, the continuity of the tendon becoming
reestablished in the course of a few months by fibrous cicatrization.
Collin recorded the history of four dogs whose master divided the
tendon of one leg each in order to prevent them going off to
hunt. In four months’ time the animals were at their old habits,

the lesion having completely recovered. The tendons in both legs
were then severed, but six months later the dogs again returned to
the hunt.

In the larger breeds, where the distance separating the divided
ends is more considerable, there is more risk of permanent im-
potency through failure of reunion. Therefore, treatment should
always be directed towards maintaining the leg immobilized in ex-
treme extension by means of splints and bandages applied so as
to extend from the patella to slightly beyond the digits, a drainage
window being provided where the skin is involved. It is not ne-
cessary to suture the divided ends, and the strain usually causes
the sutures to tear out. )

Cadiot and Breton.) Position assumed by
division of the Tendo-Achilles.

the leg

after

The Extremities 309

Traumatic Division of Tendons. This accident sometimes
takes place through the legs coming in contact with a mowing ma-
chine in the hayfield.

Treatment. The same treatment is indicated as is described
above.

Wounds. Various wounds are received in the feet, among
which may be mentioned cuts, pricks, crushing, burns, frost-bites,
etc. Sometimes the pads become worn to excess by traveling over
rough roads. The gravity of wounds depends upon their nature,
extent, and presence or absence of foreign bodies.

Symptoms and Diagnosis. In most lesions of the feet the pre-
vailing symptom is lameness with a tendency to rest the injured foot
by raising it, or, if both feet are affected, an assumption of the
recumbent position. This being observed, it only remains to make
a careful differential diagnosis. The practitioner must particularly
distinguish between traumatisms and interdigital eczema, a trouble
which is very common and which is usually mistaken for an injury
by the laity. Worn pads are recognized by the animal constantly
licking them. Fractured digital bones are often productive of fistula.

Treatment. The first step is to examine carefully for the
presence of foreign bodies, including fragments of digital bone, and
if such are found to promptly remove them. The foot should then
be thoroughly cleansed by irrigation with, or soaking well in,
moderately hot water. If the injury is confined to one foot, the
rest may be left to Nature, the healing process being closely watched,
but the animal should be confined on a clean wooden or concrete
floor. But if there should have been any considerable loss of tissue
on the plantar surface of both feet, thereby causing the animal great
pain during locomotion, protection should be afforded to the parts
in the following manner: Some antiseptic powder is freely sprinkled
over the plantar surface, a strip of gauze is placed over this, a pad
of absorbent cotton over the latter, and over all a boot constructed
of stout linen or thin leather. The dressing should be changed
twice daily. In all cases of this nature absolute rest is to be en-
forced. It requires about two weeks for the epithelium of worn
pads to become regenerated.

Fracture of the Nail. This is a quite common accident and
may be partial with the nail only slightly disturbed in its matrix,
or complete, when it is either suspended from its matrix or entirely

310 =©—- Surgical Diseases and Surgery of the Dog

torn away. It is accompanied with considerable pain and lameness.

Treatment. Slight fractures are capable of recovery if left to
Nature, but where there is much displacement of the nail it must
be extirpated by grasping it with forceps and jerking it quickly
_ away. When the phalanx is involved in the injury, it must also be
removed by disarticulation. After-treatment is usually unnecessary,
but the animal should be kept out of dirt as much as possible.

INFLAMMATION.

Inflammation of the Pads. This condition is observed prin-
cipally in animals which have traveled over hard, rough ground,
stubble, or asphalt during hot weather when the sun is strong. _

Symptoms and Diagnosis. The plantar surface of the feet is
hot, swollen, and extremely sensitive to pressure. The animal seeks
the recumbent position, shows great disinclination to rise, and walks
with evident pain, but trots with comparative freedom.

Treatment. The inflammation, when mild, responds quickly to
complete rest supplemented with hot fomentations. When intense,
the parts should be constantly fomented or covered with compresses
soaked in astringent solutions (alum 3 :100—5:100), to which some
laudanum may be added with advantage.

Inflammation of the Matrix of the Nail. Onychia. This is
an ailment affecting the bed of the nail and occurs usually as a com-
plication of traumatism or interdigital eczema. It may be acute
or chronic and may lead to ulceration and destruction of the nail.

Symptoms and Diagnosis. The animal walks with short, pain-
ful step, and prefers the recumbent position or holds up the affected
member. The matrix is hot, red, swollen and sensitive to pressure.
If suppuration takes place purulent matter oozes from the matrix.

Treatment. Acute cases are treated with fomentations. If the
presence of pus is detected vent must be given to it by lancing.
Ulcers are treated by touching them with the solid nitrate of silver
stick, or by application of tincture of iodine. Old-standing cases,
where the nail has suffered destruction, sometimes require complete
extirpation of the affected phalanx.

In-Growing Nail. This is a common trouble and affects the
supplementary digit or dew-claw, the nail of which, not coming to
the ground, escapes friction, and curves and grows to an abnormal

The Extremities 311

length. Its point may penetrate the pad and provoke suppuration
and lameness. For this reason dew-claws are frequently removed
as a preventive meas-
ure, otherwise it is
necessary to cut the
nails periodically
(about every six
months). Cutting is
best done with bone-
forceps or _ specially
constructed clippers, No, 72. Nail Clippers.

but care must be ob-

served to avoid cutting to the quick.

Interdigital Eczema. This is a disorder of rather frequent
occurrence and while it lasts is productive of considerable lameness.
Among the laity the pathologic lesions and lameness are usually
ascribed to traumatic influences. As the name indicates, the inflam-
matory disturbance is confined to the skin of the interdigital region,
but it is very apt to extend to and involve the matrix of the nail.

Symptoms and Diagnosis. The animal is observed to be con-
stantly licking or gnawing the parts and lameness is often very
pronounced. On examining the foot, the skin of one or more inter-
digital spaces is found to exhibit the characteristic appearance of
eczema of other regions, viz., redness, edema, suppuration and
ulceration.

Treatment. The foot should be daily soaked for a good while
in hot water or antiseptic solution. This is followed with a liberal
application of absorbent antiseptic powder to the inflamed area.
The foot should be protected with a bandage or boot, both to main-
tain it free of dirt and to prevent the animal licking. Ulcers should
be touched with the nitrate of silver stick.

FOREIGN BODIES.

Various substances may find lodgment in the foot, either acci-
dentally or through human malevolence or carelessness. Among
the recorded articles may be mentioned: shot, spikelets of grain, and
sharp bodies such as splinters, thorns, and short lengths of wire.
Elastic bands rolled on to the leg by children, ligatures applied by
malevolent persons, snares in which the animal may get caught

312 Surgical Diseases and Surgery of the Dog

while hunting, have each and all been known to result in serious in-
jury to the parts. Foreign bodies may produce immediate or remote
effects or they may be perfectly harmless. Aseptic bodies, and par-
ticularly shot, often become encapsulated and exert no ill-effect.
Infected bodies provoke inflammatory reaction and fistula. Any
kind of sharp body may work its way up through the tissues to a
distant area, leaving a fistulous tract behind it. A remarkable in-
stance is recorded by Ducourneau who, on exploring an abscess in
the digital region with a probe, found a fistulous tract extending
as far as the knee. On opening at the latter point he found a
spikelet of grass. The wound healed, but a new abscess developed
higher up some days later, which on being opened was found to
contain a second spikelet. Elastic bands impede the return circu-
lation and may induce gangrene of the extremity when their tension
is strong. When it is weak, they cut slowly into the tissues, causing
a circular section of the skin and subcutaneous tissues with edema
of the extremities. Non-elastic bands, such as thread, cause analo-
gous results but their constricting action is quick.

Treatment. The indications are to promptly extract foreign
bodies of any nature, if necessary by incising the skin, with the ex-
ception of aseptic ones which should be left alone unless they render
the animal lame. The wounds are then treated as already outlined.
If gangrene has set in the mortifying portion of the leg must be
amputated.

NEOPLASMS.

All varieties of tumor occur in the legs, but only the more
common growths affecting this part of the body will receive special
consideration. These are the innocent adenoma, fibroma, lipoma,
verruca, tyloma and hygroma of the elbow, hypertrophy of the stra-
tum corneum of the pads (corns), interdigital serous cysts, and
malignant carcinoma and sarcoma. Other forms, such as heman-
gioma and chondroma, observed by Gurlt on the digits, are so
extremely rare that they are to be regarded as pathologic curiosities
and merit but a passing reference.

Adenoma. These may be of sebaceous or sudoriparous origin.
They usually occur mixed with fibrous tissue and are liable to
undergo cystic degeneration. Common seats are the region of the
knee and hock. There is good reason to believe that they may

No. 73. (After Cadiot and Breton.)
Elastic band on the Leg.

No. 74. Fibro-adenoma of the Skin of the leg exhibiting im-
pending malignancy.

The Extremities 313

undergo transformation into malignancy. The accompanying pic-
ture illustrates a fibro-adenomatous growth which had arisen as
a result of chronic irritation, that part of the leg having suffered
constant friction from a chain. When removed and examined
microscopically it showed evidence of impending malignancy. This
case is referred to more fully in the chapter on Neoplasms.

Symptoms and Diagnosis. As adenoma arises from the glands
of the skin, it is intimately connected with the latter. It grows
very slowly. Sudden rapid increase in size is to be regarded with
suspicion as evidence of malignancy. It is usually rather firm but
may be soft in places owing to cystic degeneration. When of long
standing its weight may cause it to become pedunculate. Constant
licking on the part of the animal may render it sore. :

Treatment. Early and free removal should be practiced, par-
ticularly on account of the possible malignant termination.

Fibroma. This is a fairly common form of neoplasm about
the extremities, particularly in young animals. It usually springs
from the skin proper, but sometimes from the subcutis.

Symptoms and Diagnosis. A tumor of this nature is recog-
nized without much difficulty. It is sharply defined from the sur-
rounding parts, has a regularly firm or hard consistence, smooth
intact surface, is often pedunculate, and has a slow growth. Its
average size is that of a walnut.

Treatment. Ablation by the ordinary methods is indicated.

Lipoma, Fat tumors are usually seen in plethoric animals
advanced in years. Common seats are the shoulder and inner sur-
face of the thigh.

Symptoms and Diagnosis. Lipomata have a soft consistence,
with a dermal covering, and may be round or cylindrical in shape.
They are frequently pendulous, one observed by Huidekoper hang-
ing from the thigh, having very nearly touched the ground.

Treatment. These growths are removed in the ordinary way.

Verruca. This occurs in the form of the familiar wart, which
is fairly common in old animals, occurring at almost any part and
often multiple.

Symptoms and Diagnosis. Warts are recognized as smooth
hemispherical elevations, sharply defined from the neighboring parts
and sometimes pedunculate. Beyond forming a blemish they have
little significance.

314 Surgical Diseases and Surgery of the Dog

Treatment. Where it is desirable to remove them they are best
excised by a snip of the scissors and the base touched with lunar
caustic.

Tyloma. Capped Elbow. This term is applied to the un-
sightly callosities which develop in the skin principally in the region
of the elbow but also elsewhere about the legs, and which are fre-
quently complicated with hygroma, to be next described. They are
particularly common in members of the larger breeds, viz., Great
Danes, Mastiffs and Greyhounds, and develop as a result of constant
intermittent friction and pressure, through the habit these animals
have of lying in the sternal position and resting the elbow on the
ground. Pathologically, they are an epidermal hypertrophy and
hyperplasia, consisting of laminae of horny cells with but slight
fibrous development. They sometimes ulcerate.

Symptoms and Diagnosis. The condition exists as a callous
thickening with bare, greyish surface. When ulceration takes place
collateral edema may occur.

Treatment. No treatment is advisable for the reason that the
condition is merely a blemish and does not incommode the animal
and would soon recur because of the persistence of the causative
factor. Ulcers should be treated with nitrate of silver.

Hygroma. As distinguished from tyloma, the term hygroma is
applied to the fluctuating adventitious bursae which are frequently
associated with it. They are cysts of contusion or true neoforma-
tion, intermediate connective tissue becoming bruised and torn, and
spaces forming in which serous fluid and sometimes blood collect,
which may (rarely) suppurate and discharge by fistulous opening.
Organization by condensation of the adjacent connective tissue may
take place when the condition again resolves itself into uncompli-
cated tyloma.

Symptoms and Diagnosis. Hygroma exists as an indolent,
round or oval, uniformly fluctuating tumor, without peripheral in-
duration and ordinarily without inflammatory reaction. It does not
incommode the animal in any manner.

Treatment. A cure is difficult of attainment, for the same rea-
son as in tyloma. Simple puncture is valueless, for the cyst recurs
as soon as the outer wound has healed. “An attempt should first be
made to excite an imflammation within the sac. By means of an
aspirating syringe with large needle, the fluid is withdrawn from the

Multiple Verruea.

No. 76. Interdigital Serous Cyst.

The Extremities 315

sac and some weak tincture of iodine injected in its place. The
surface of the enlargement should also be painted daily with a
strong tincture. Suppuration may or may not result; if it does,
free exit should be given to the pus by lancing. Considerable
collateral edema may develop. This treatment should be repeated
a few times before being abandoned.

The only other alternative is ablation in the following manner:
The animal being narcotised and secured with hopples, the region
cleansed, and hypodermic injections of cocaine administered locally,
expose the sac by an incision in the skin in the direction of the long
axis of the leg and carefully enucleate it. It is usually adherent to
the olecranon. Finally, suture the skin with subcuticular silk
sutures and provide the animal with a soft bed.

Epithelial Hypertrophy of the Pads. Corns. This is an
infrequent form of growth, but troublesome when it exists. Patho-
logically, it is a circumscribed callosity which projects outwardly
and inwardly, and forms a depression in the corium.

Symptoms and Diagnosis. Corns are observed on the plantar
surface of the digits as circumscribed projecting callosities, with
regular or festooned contour, and possessed of a deep root. They
give rise to much lameness. .

Treatment. Radical treatment is the shortest road to a cure.
The callosity should be extirpated or eradicated by means of the
actual cautery, and the foot subsequently protected with antiseptic
powder, gauze, raw cotton, and a boot, until the parts are regener-
ated.

Interdigital Serous Cysts. These little enlargements are only
occasionally met with. They are rather troublesome to deal with.

Symptoms and Diagnosis. Attention is usually first drawn to
their presence by constant gnawing and licking on the part of the
animal at the interdigital region. There may be pronounced lame-
ness. The little bladder-like sacs are easily discerned.

Treatment. Radical measures are indicated. Complete re-
moval of the cyst-wall, either by dissection or cauterization with the
thermo-cautery or silver nitrate pencil is the only alternative to
effectually eradicate the trouble.

Carcinoma. As has already been stated, carcinoma may de-
velop from a pre-existing non-malignant growth, but it also occurs
as such per se. It is comparatively rare.

316 §=Surgical Diseases and Surgery of the Dog

Symptoms anl Diagnosis. Carcinoma is recognized by its
rapid growth, its hard consistence with occasional fluctuating or
ulcerating foci, its puckered surface of reddish blue color denuded
of hair, its intimate cohesion with the skin and its mobility from
underlying structures.

Treatment. Growths of this nature may be removed as soon
as possible, together with a considerable area of the surrounding
skin. When early and free removal is practiced, recidivation need
not be feared.

Sarcoma. Sarcoma arising either from the soft tissues or the
bones occurs about the legs. In the former case it may spring
from the skin proper or subcuticular tissues, and in the latter either
from the periosteum or the interior of the bone cavites (myelogenic
sarcoma). Myelogenic sarcoma usually develops in the cancellous
tissue near the joints and the usual seat is the forearm or shoulder
and lower extremity of the femur. The growth gradually causes
expansion and distortion of the osseous shell, which, however, is
continually being reformed from the greatly thickened periosteum,
so that there ultimately results a local deformity of enormous di-
mensions. Finally, it breaks down and discharges by fistulous
tract.

It may be remarked here that owing to the fact that myeloid
sarcoma (of the center of the bone) is of distinctly low malignancy
and very rarely forms secondary growths at a distance, the tendency
now is to speak of this as “Myeloma” and separate it from the
sarcomas proper.

Symptoms and Diagnosis. Sarcoma arising from the soft tis-
sues is characterized by very rapid growth, soft consistence and
tendency to ulcerate. It is either intimately blended with the skin,
when it is usually mobile from the subcutaneous structures, or lies
subcutaneously when it is sessile. Periosteal and Myelogenic sar-
coma is recognized by the local deformity and rapid increase in size
of the enlargement. All the deeper forms are generally accom-
panied with lameness.

Treatment. Only the more superficial forms are eradicable
by operative measures, though there are a few instances on record
of treatment of bone sarcomata of the lower extremities by ampu-
tation of the member above the seat of disease.

The Extremities 317

AMPUTATION.

Amputation of the leg is not very often practiced on the dog,
for the reason that few people care to see their animals going about
in a crippled condition, nevertheless occasions sometimes arise,
when, either on account of value for breeding purposes or because
of sentimental considerations, the practitioner is called upon to
undertake the operation. The dog seems to be but little incom-
moded by the loss of one leg, for he soon learns to run about
fairly well with the remaining three, and particularly is this true
when the lesion has occurred in the hind parts. Even when both
fore-legs are missing he manages to progress by hopping on the
hind-legs after the manner of the kangaroo. Furthermore, the
wearing of an artificial support is perfectly feasible, and several
cases of successful substitution have been recordel. A simple prop
can be fashioned out of some light wood, around the upper end
of which a strip of leather is attached to form a socket to snugly fit
the stump of the member. The contrivance is held in place by
means of a light leather harness reaching to the joint immediately
above. Or if something more elaborate is desired the skill and
experience of the artificial limb manufacturer may be sought.

The lesions for which amputation is indicated are severe frac-
tures, and malignant growths and gangrene of the extremities.

The best way to perform the operation is as follows: The
animal being hoppled and under general anesthesia and the parts
freed of hair and thoroughly cleansed, a tourniquet is first applied
above the area of the operation. A circular or wedge-shaped in-
cision is made through the skin around the leg, a little distance
below where the bone is to be divided. In order to provide
for a flap to cover the extremity of the bone, the skin must then
be retracted by gently drawing it towards the root of the member.
Some slight dissection of the subcutaneous connective tissue may
be necessary to properly free the skin. At the level of the retracted
skin the muscles, tendons, and vessels are next severed to the bone.
The latter is then divided with a saw. The amputated portion
being removed, the vessels are sought for, clamped with artery
forceps, and ligated with silk. All hemorrhage being stilled, the
parts are irrigated with hot sterilized water, and the skin is gathered
together with a subcuticular suture, the ends of the latter being

318 Surgical Diseases and Surgery of tha Dog

allowed to protrude from the wound, to be removed later on when
healing is complete. A dressing of antiseptic powder and gauze
should be applied and held in place with bandages and renewed
daily. A close watch must be kept for suppuration for a few
succeeding days, and if such takes place an opening be made
to give exit to the pus. Asa rule, healing is quick to follow.

AMPUTATION OF THE DEW-CLAW DIGIT.

Dew-claws are unsightly, and it is frequently desirable to re-
move them for this if for no other reason. But they may also
become the seat of painful in-growing nail and of injury from
extraneous causes.

When the digit exhibits no union with the main bone it is a
simple matter to snip it off with scissors, and if necessary, ligate
the nutrient vessel. In this case, no sutures are necessary, the
animal being allowed to attend to the wound itself. Where there
is true bony connection, the operation partakes of the nature of
true amputation, as described above. Suturing is generally advis-
able, but the lower extremity of the wound should be left open to
afford drainage. As in the preceding instance, the animal should
be allowed to lick the wound, though by so doing it may rid itself
of the stitches.

DISARTICULATION OF THE PHALANGES.

The various steps of this operation differ but little from those
proper to Amputation, except that the section is made at the joint
by division of the ligaments.

BIBLIOGRAPHY.
Bayer—Monatsh. f. prakt. Thierheilk. 1896-97) p. 18.
Bruckmueller—Cited by Kitt in Lehrb. d. Path. Anat. Diagn. 1.
Collin—Rec. de Méd. Vétér. 1824, p. 403.
Ducourneau—Rec. de Méd. Vétér. 1900, p. 188.
Huidekoper—Journ. Comp. Med. & Surg. 1888, p. 169.
Simonds—Proceedings of the Vet. Assn. 1840-41, p. 57.

The Tail
CONGENITAL MALFORMATIONS.

Anomalous formations are occasionally seen in newly-born
animals. Heredity would seem to play a part. In one instance
which came under my notice, in a family of Skye Terriers, some

The Extremities — 319

of the puppies of three consecutive generations were born with the
two terminal coccygeal vertebrae bent at right angles. Fox Terriers
and Poodles and other breeds which are ordinarily docked soon
after birth sometimes come into the world with bobtails. Whether
this variation can be regarded as a result of long-continued disuse
through the practice of docking from remote times, it is difficult
to say, though Darwin has pointed out, mutilations occasionally
produce an inherited effect. A good example of artificial selection
is seen in the Bob-tailed Sheep dog.

TRAUMATIC LESIONS.

The most common lesion to befall the tail is brushing or crush-
ing from its being caught in a closing door. Usually, in these
cases the wound is a compound one, but in some instances, as when
the organ is trodden upon, a simple fracture may result. A very
troublesome lesion is frequently seen in Great Danes. These ani-
mals are possessed of very long tails, which they wag with great
force. When confined in narrow quarters, constant pounding of
the organ against a hard surface soon renders the extremity bruised
and sore. Ulceration develops and the wound bleeds at the slightest
irritation, the blood being swished about in all directions, to the
disgust of everyone with whom the animal comes in contact. Fin-
ally, the bone becomes necrosed. Prevention in these cases is in-
finitely better than cure. If it is absolutely necessary that an animal
be confined in narrow quarters the conditions which are productive
of the trouble can be rendered nugatory by the adoption of a
simple device. Strips of wood three or four inches in width are
nailed to the wall lengthwise above the level of the animal’s head
on both sides and the back. From these some heavy draping made
of stout material is suspended and allowed to reach almost to the
floor. This acts as a buffer to the pounding tail, and the latter es-
capes injury.

Treatment. When the parts are badly crushed, amputation is
necessitated, but as long as the bone is intact and only the soft parts
injured, efforts should be directed towards saving the organ by the
usual soothing antiseptic measures employed in wounds of this
nature. Fractures, when simple, are treated as outlined in the chap-
ter on Fractures, but the bandages must be of the very lightest
character possible. Compound fractures generally necessitate am-

320 = Surgical Diseases and Surgery of the Dog

putation. Bruises of the extremity as observed in Great Danes,
when there exists chronic tumefaction and ulceration are usually
accompanied with necrosis of the terminal vertebra, when the latter -
must be disarticulated, by the flap method. Provision must then
be made to prevent a recurrence of the trouble until the wound is
healed. Besides the protective curtain advocated above, a sort of
flange should be applied to the tip of the tail, just above the wound.
This is best fashioned out of a long strip of felt about three quarters
of an inch in width, which is smeared on one side with ordinary
carpenter’s glue. The hair being clipped short, this is then wound
round the tail and on itself till a projection an inch or more in width
is thereby formed. Glue is the best adhesive material for the skin,
and when sufficiently thick, will hold any bandage in place, till the
hair in growing out forces it away from the skin, when it can be
peeled off with ease. When the tail is pounded against any surface,
the flange forms the point of contact and saves the tissues, and if
desired, bandages can be kept in place by tying above the flange.
The flange is left in place until complete healing has occurred, and
if it becomes displaced sooner must be reapplied.

INFLAMMATORY AFFECTIONS.

Circumscribed dermal inflammation may occur as a local mani-
festation of eczema. Further irritation on the part of the animal
itself by incessant scratching and biting soon sets up an ulcerating
sore.

Treatment. ‘Treatment is difficult, and at the best, tedious, for
most animals rebel at the application of bandage or muzzle.
Nevertheless, persistence in this as in every difficult undertaking is
usually crowned with success. The treatment most productive of
good results consists of cauterization of the ulcer with the solid
nitrate of silver, until a cicatricial inflammation is establisl.ed, and
subsequent liberal sprinkling of the inflamed area with some des-
sicant analgesic powder, preferably xeroform, to which a little ortho-
form may be added with advantage. The parts should be protected
from further irritation by antiseptic gauze and cotton bandages
whenever possible, every known device to keep the same in posi-
tion being tried in rebellious animals. At the same time, the
general health must be attended to, intestinal parasites eradicated,
the bowels freely opened, and a course of tonic treatment instituted.

The Extremities 321

Bad cases sometimes require weeks of persistent treatment.
Some authors advise amputation as a last resort, the site of opera-
tion being selected well away from the inflammatory area, but such
radical treatment is rarely called for.

NEOPLASMS.

Besides fibroma, which is of occasional occurrence on the tail,
malignant carcinoma is not uncommonly met with about the root
of the appendage. It exhibits all the characteristics of the typical
cancerous growth, developing rapidly, and having a hard con-
sistence with uneven, ulcerating surface, and tending to infiltrate
neighboring lymphatics. The method of treatment differs in no
wise from that applied to tumors of the skin in other regions, the
sole object being to cause total ablation.

AMPUTATION.

“Docking”’ of the tail is universally practiced as a fashionable
measure on certain breeds, among which may be mentioned: Fox,
Irish, Airedale, Welsh and Yorkshire Terriers; Field, Cocker, Sus-
sex and English Water Spaniels; Griffons, Schipperkes ; and French
Poodles. The puppies of the Bob-tailed Sheep dog sometimes re-
quire a slight reduction of their appendages to make them conform
to the standard. The length of stump allowed to remain in the
different breeds varies. The Yorkshire Terrier is allowed
a stump of medium length, about three inches (adult measure-
ment), French Poodles one of three to five inches, Airedale Terriers
of four to six inches, Sussex Spaniels of five to seven inches, and
English Water Spaniels of seven to ten inches. The Bob-tailed
Sheep dog is allowed only a maximum of two inches, and the re-
moval is effected three or four days after birth. In the other an-
imals, the operation is best performed a few days after birth, when
the undesired extremity of the appendage may be snipped off with
a pair of scissors, or removed with the tail gullotine, the skin being
pulled towards the root of the tail while the action is being made.
The bleeding rarely amounts to anything, and it can be easily con-
trolled by temporary application of an elastic ligature or strip of
tape.

In adult animals, when the operation is necessitated as a gen-

22

322 ~=©6© Surgical Diseases and Surgery of the Dog

uine surgical measure, more minute technic is required. It is
practically identical with that of amputation of the leg, but the
section is generally made at a joint so that it is in reality a dis-
articulation. The animal should be narcotized with morphine and
receive local injection of cocaine. The technic is as follows: The
hair being clipped or shaved off at the site of operation the latter
thoroughly cleansed, and the tourniquet applied above, the skin
and subjacent tissues are divided by circular incision at a line froma
half to one inch below the joint, and two opposite longitudinal in-
cisions extended up to the level of the joint. The soft tissues of
this area are next dissected from around the bone and the caudal
vessels ligated. The joint is then severed by division of the liga-
ments. The resulting flap should be secured with a single suture
only, in order that drainage may be unhindered. The tourniquet
is finally removed, and if any post-operative hemorrhage takes place
it can be controlled by an elastic ligature slipped over the stump
immediately above the wound. It is best to dispense with pro-
tective bandages and not restrain the animal from licking the wound.

It may be noted here that Dell attributed a case of pyemia
which he experienced, to an amputation undertaken to relieve a
crushed tail, the animal having been run over by a street car, but
it is not unlikely that the disease had its origin in the lesion which
necessitated the operation.

BIBLIOGRAPHY.

Darwin—The Descent of Man.
Dell—Journ. Comp. Med. & Vet. Archives 17, 1896, p. 100.

CHAPTER XI

The Osseous System
TRAUMATIC LESIONS.
Fractures

FRACTURES IN GENERAL.

Some interesting statistics of fractures have been tabulated by
Froehner based on seventy-four thousand eight hundred and
seventy-two cases of sickness and accidents treated by the staff of
the Berlin Institution between the years 1886 and 1894. In this
number one thousand six hundred and ninety-three were fractures,
making a percentage of 2.3, or in other words, in every forty dogs
treated, one had sustained a fracture.

Fractures of the extremities were most common, amounting
to ninety per cent of the whole, and one-half of all the fractures
were observed to have occurred in the larger of the long bones.

The prognosis of fractures in general must be regarded as
very good, eighty-five per cent of Froehner’s cases having com-
pletely recovered, the remaining fifteen per cent having comprised
the complicated, comminuted and pelvic fractures. In one-hundred
and fifteen cases recorded by Stockfleth ninety-two completely re-
covered. Froehner regards the prognosis of fractures in the dog
as four times more favorable than in the horse.

The causes of fractures are manifold, but result mostly from
traumatism, such as run-overs, blows from clubs or balls, kicks
from horses, falls from heights on to hard surfaces, bites of other
dogs, gun-shots, and even extreme muscular action on the part of
the animal itself, as occasionally occurs to the olecranon.

Various local or general conditions such as necrosis and old age
may exert a predisposing influence on the resisting power of the
bones.

Fractures may be partial or complete, compound or comminuted.

Partial fractures commonly occur as fissures, splinters, per-

se

324 Surgical Diseases and Surgery of the Dog

forations, or depressions, usually in flat bones, such as those of the
skull. To these must be added subperiosteal or the so-called green-
stick fractures in which the periosteum remains intact.

Complete fractures are observed in long bones and form the
majority of all fractures.

A fracture is said to be compound when a wound exposes it
to the atmosphere.

A fracture is said to be comminuted when it is shattered into
a number of fragments.

The immediate result of a fracture is hemorrhage from the
local vessels or those of adjacent parts which may be involved
in the injury. Inflammation is precipitated, giving rise to hypere-
mia and swelling of the contiguous tissue. In a few days these
subside, and finally there arise reparative processes associated with
callous formation. The process of solidification of the callus is
complete within fifteen to thirty days. Stockfleth observed com-
mencing ossification of the callus in a fracture of one of the lower
extremities, twelve days after receipt of the injury. It is more
rapid in the young and slower in the old. The ensheathing portion
becomes absorbed within thirty to sixty days, while the central
callus remains for a while, completely occluding the medullary canal,
but it also undergoes absorption at a later period.

Muscular action, particularly in cases of oblique fracture, may
cause considerable overriding of the broken extremities, the latter
being sometimes separated from one another such distance as to
make it no easy matter to replace them in correct apposition.

Separation of the epiphyses frequently occurs in very young
animals through slight traumatic influences or excessive motion.

Symptoms and Diagnosis. The chief symptoms are: Local
pain and swelling, more or less distortion of natural outlines, loss
of function, preternatural mobility in all directions, and crepitus.
Crepitus, however, is not invariably present, as when muscular fibers
or tendons become interposed between the fractured extremities or
when the hemorrhage is considerable.

Separated epiphyses are distinguished from luxations with diffi-
culty. Crepitus is less noticeable than in true fracture, being
“softer,” and it may be entirely absent.

Treatment. The object to be attained in treating a fracture
is reduction of any existing displacement of the broken ends and

The Osseous System 325

their retention in normal alignment. This is accomplished by rend-
ering the parts immobile by means of suitable splints and bandages.
As a rule, immobilization is indispensable, but exceptional cases
occur, as when a broken rib, which is in constant motion, becomes
reunited in a short while. The authorities in general teach that a
broken bone should be set and immobilized as soon after receipt
of the injury as possible. I have long ago discarded this method
of procedure, close observation of a great many cases having
taught me that it is far better surgery in the dog to await the dis-
appearance of all swelling incident to the injury before attempting
surgical interference.

Following almost every fracture there occurs more or less in-
flammation of the adjacent soft parts which is attended with con-
siderable tumefaction and pain. The application of non-resistant
bandages before the swelling is in evidence cannot be made to
diminish the interstitial effusion and tension to any extent with
safety, but rather serves to increase the latter, menacing free circu-
lation, involving risk of constriction and consequent gangrene, and
augmenting the discomfort of the animal. Moreover, it necessi-
tates frequent inspection at short intervals. If such bandages are
applied after the parts have become swollen they are soon rendered
so loose by subsidence of the swelling as to need renewal. Hence,
it is my practice to wait some three or four days for a reaction.
It may be argued that postponement involves risk of converting a
simple into a compound fracture. This is a matter which may be left
with absolute safety to the injured animal itself, provided the latter
is allowed to rest. I have never known such an accident to happen.

The advocates of immediate bandaging find it necessary to
advise that the foot be included in the bandage in order to prevent
dropsical swelling and stasis of circulation. By covering up the
foot we deprive ourselves of our best means of ascertaining whether
the bandage is too tightly applied or not, but on the other hand,
if we do not apply the bandage until the primary swelling has sub-
sided, the foot may be left free with perfect safety, as all danger
of pressure-necrosis from inflammatory swelling is past. Too firm
application must, however, still be guarded against.

Reduction and setting with dressings is effected in the follow-
ing manner: Correct overriding by grasping the lower segment and
submitting it to firm and steady traction. When the ends arrive

326 Surgical Diseases and Surgery of the Dog

in contact, correct the lateral displacement by direct pressure. Re-
duction may usually be effected by steady traction and manipulation,
but in some cases where overlapping is great and muscular rigidity
marked, general anesthesia should first be induced. Instead of
chloroform or ether, chloretone or chloral hydrate may be admin-
istered. The help of an assistant may also be required. The de-
gree of overriding present may be approximately ascertained by
measurement of both legs with a tape measure, the injured member
being found shorter than its fellow. The actual condition or posi-
tion of the fractured ends may be ascertained with the aid of a
skiagraph.

In some cases even if the overriding is successfully reduced,
the ends of the bones cannot be maintained in apposition owing to
the conformation of the parts preventing accurate bandaging. This
is particularly true of oblique fractures of the scapula, upper ex-
tremity of the humerus, and the femur. The only alternative is to
undertake suturing of the broken ends.

Normal apposition being secured, smear the leg freely with oil
or vaseline. A protective layer of any material is bulky and un-
necessary, the oil being sufficient to prevent friction, except at pro-
minences, which should be protected by padding about, but not on
them. If supporting splints are to be used, have them previously
moulded or shaped to conform to the contour of the leg, lay them in
place, and secure them with strips of adhesive plaster. For large
and medium sized animals splints are best made with strips of poro-
plastic felt, which can be moulded to the desired shape after moisten-
ing in hot water. A very light and inexpensive splint for the smaller
animals may be made out of the thin wooden platters on which
pastry-cooks serve pies, and dairymen butter, to their customers.
Rectangular splints may be made out of stout cardboard, cut, bent,
and glued together as desired. Supports should always be longer ”
than the broken bone.

Wind the bandage round the leg, commencing from the inferior
extremity and giving it a turn as found convenient, and taking care
to include the joints at either end of the broken bone. See that
the dressing is perfectly dry before the animal is allowed to move.

The permanent dressings which find most favor are made of
strips of gauze or cheesecloth thoroughly impregnated with dry
plaster of paris, sodium silicate, or starch, and rolled. A bandage

The Osseous System 327

so prepared is soaked in warm water until air-bubbles no. longer
rise from it to the surface, which indicates that all parts of the
roll have become saturated. It is then immediately applied. To
afford additional rigidity the ingredients may be smeared over the
bandage while it is being applied. Plaster of paris sets quickly,
but makes a very heavy dressing. A little salt added to the water
makes it harden still quicker, but so rapidly as to be of dis-
advantage. Pure silicate of soda bandages, while having the ad-
vantage of lightness, are impracticable, as a rule, as they take
several hours to become perfectly hardened. Mueller overcomes
this drawback by interposing small splints of wire gauze, or smear-
ing plaster of paris thinly in between the layers. Starch is also
slow to harden. Stockfleth advises the addition of a little mucilage
to assist the process. Another very useful immobile bandage, par-
ticularly for small animals, may be made by the addition of thick
mucilage or glue to strips of cotton.

I consider the best preparation to consist of a mixture of resin
and beeswax, two parts of the former to one part of the latter.
This is heated together until the ingredients are dissolved. It is
smeared over strips of bandaging material, and the latter applied
while it is still warm. This makes a very light, strong dressing,
and it is also quick to harden.

Where there are no pronounced prominences or angularities
to be included, shoemakers’ leather makes an excellent support with-
out any need of bandages. It is cut in one piece slightly smaller
than the circumference of the parts and moulded to the normal
shape of the leg in the same manner as felt, and allowed to dry.
Holes are punctured at short intervals near both margins, and it is
applied and kept in place by lacing.

Bandages can be removed by cutting with scissors, bone-for-
ceps, or any of the various makes of bandage shears. Plaster of
paris may be removed by pouring dilute acetic acid or vinegar along
the line to be cut, and then cutting the cloth with a knife, layer
after layer. Mucilaginous bandages may be immersed in hot water,
leg and all.

In general, fractured large bones need support by immobiliza-
tion for a period of at least four weeks, and the small bones some
two weeks.

It is sometimes found necessary to muzzle dogs under treat-

328 Surgical Diseases and Surgery of the Dog

ment for fracture to prevent them from tearing off the bandages
I have never found smearing the latter with bitter or noxious sub-
stances to answer the purpose, for an antagonistic dog will go to
almost any extreme to rid itself of what it regards as an imposition.

Too firm application of bandages becomes manifest by exhi-
bition on the part of the animal of pain, uneasiness, anorexia, fever,
and local swelling. Sometimes the edges of a bandage will abrade
the skin and originate local ulceration. In either case the bandage
must be removed in whole or part. Persistence of functional im-
potency after a reasonable course of treatment indicates pseudar-
‘throdic formation or anchylosis following intraarticular fracture.

In compound fractures it must first -be decided whether ampu-
tation is indicated or not. If it is believed that the leg can be re-
stored to usefulness, thorough antisepsis must first be employed.
The interior as well as the exterior of the wound is cleaned and
disinfected, detached portions of bone removed and counter-open-
ings made for drainage if necessary. The application of fixed band-
ages may be postponed until healing of the superficial wound has
taken place, though if it is considered advisable some support may
be given by the use of temporary splints. Or, the fracture may be
treated as a simple one, but a “window” must be arranged over
the wound to permit of free drainage.

FRACTURES IN PARTICULAR.

The Cranial Bones. Fractures of the cranial bones are uncom-
mon. In five hundred and forty-eight of Froehner’s cases there
were only four. The chances of recovery depend upon the pre-
sence or absence of intracranial complications, septic infection, and
the degree of injury sustained by the brain. Froehner says these
cases usually terminate fatally. Moeller states that he has witnessed
and successfully treated several cases in which both skull and brain
were injured.

There may be many degrees of injury from simple fissure in the
external lamellae to penetrating, depressed, or compound fractures
and those accompanied by intracranial hemorrhage. Martin in-
stanced a case of simple external fracture, in which he removed two
pieces of bone consisting of almost the entire covering of the frontal
sinus, from the depths of a fistula, which had been discharging
just above the left eye for more than a month. Whitlamsmith suc-

No. 77. (After Cadiot and Breton.)
The effect of too tight or too
early bandaging.

The Osseous System 329

cessfully treated a penetrating fracture of the frontal bone, half an
inch in length and one eighth of an inch in width caused by a
butcher’s knife which had been thrown at the animal. Part of the
brain substance, the size of a horse-bean, protruded through the
wound. The symptoms to which these injuries gave rise were:
partial paralysis of the right side but without loss of consciousness,
knuckling over of the knee whenever weight was put on that limb,
and aimless movements to the right in an irregular sort of circle.
The protruding portion of brain was removed, the skin shaved and
dressed antiseptically and the edges of the wound drawn tightly
together by silk sutures. Complete recovery ensued in a week.

The great danger of penetrating fractures which are not of
sufficient extent to immediately cause death is the liability to intra-
cranial suppuration. Depressed fractures are always dangerous
through their causing compression of the brain. The cranial cavity
is completely filled by the brain, its meninges, blood vessels and
fluids. Any decrease in its capacity necessarily results in com-
pression of the contained organs. While it is known that the cerebro-
spinal fluid under the influence of pressure is forced into the spinal
canal, thus permitting of a certain degree of accommodation to new
conditions, experiments have established the fact that compression
of the brain by one-sixth of its volume of any material is fatal, and
attended by very serious results under much less. Pagenstecher
studied the effects of brain-compression produced by injecting wax
between the dura mater and cranial vault. His researches showed
that the capacity of the skull could be diminished about one-thirtieth
without inducing cerebral phenomena.

Depressed fractures become evident through change of contour
and by examination with finger and eye. The symptoms appear
concurrently with the receipt of the injury. Owing to the increase
of intracranial pressure the blood flow is retarded and together
with the direct influence of the compressing body there ensue either
restlessness, stupor, or coma, with slow respiration and hemiplegia
or limited paralysis of certain groups of muscles. In one of Moel-
ler’s cases the animal remained deaf during the rest of its life, and
subsequently it was demonstrated at the necropsy that the temporal
bone had sustained marked injury.

Uebelen treated a Pointer which was in a comatose condition.
The kick of a horse had shattered the whole of the left side of the

330 © Surgical Diseases and Surgery of the Dog

cranial vault. Part of the muscular tissue covering the skull was
dissected and the splinters (sixteen in number) were removed, some
of them having to be loosened from the dura. Sharp projections
remaining were smoothed, the wound treated with carbolized oil
and the skin sewed up. Immediately after the operation the dog
recovered consciousness and evinced a desire to run about. In three
weeks the wound had healed but the parts remained soft underneath.
There was no permanent disturbance of mental function.

Fractures of the basal bones are invariably fatal either from
severe concussion or laceration of brain tissue, or rupture of intra-
cranial vessels with formation of blood-clots in consequence of which
compression of the vital centers takes place resulting in their para-
lysis. In these cases the onset of the symptoms may be gradual
though the animal may be at first rendered temporarily unconscious
from concussion.

In addition to well-defined examples of fracture the practitioner
may be confronted with obscure cases of injury in which there is
good reason to believe that the main lesion consists solely of con-
cussion and which completely recover in a very short while. Among
the symptoms are: total loss of consciousness, inability to coordinate
movements, weakened pulse, and occasional vomiting.

Treatment. ‘This is varied according to the presence or absence
of intracranial complications. Simple fractures require but local
treatment of any parenchymatous contusion and removal of bone
splinters, the rest being left to natural processes of repair. In pene-
trating wounds the chief danger consists in the liability to septic
inflammation. Accordingly, antisepsis must be maintained until
recovery. It may be found advisable to trephine for purposes of
ample disinfection, removing the portion of bone which has sus-
tained the perforation. Unless there be absence of any brain dis-
turbance depressed fractures should always be remedied by surgical
interference. If this cannot be accomplished in a simple manner
the skull must be trephined close to the depression, and in the hole
thus made a suitable instrument introduced to elevate the depressed
portion of bone. .

Compound cases are treated by antisepsis.

Comminuted cases with loss of substance may be treated on
the plan outlined by Uebelen, but unless the periosteum is preserved
no true ossific regeneration can take place, the open space becoming

The Osseous System 331

filled with dense connective tissue. Ossification can, however, be
promoted by the practice of Osteoplasty.

The Inferior Maxilla. Of all the head bones the inferior
maxilla is most commonly fractured. The lesion usually occurs
either at about the level of insertion of the second premolar imme-
diately posterior to the root of the canine tooth, or at the symphisis.
In the former position the fracture may exist simultaneously in both
halves or be confined to one side. This fracture is frequently com-
pound through laceration of the mucosa. It generally results from
direct violence, but in rare instances may be attributable to indirect
force exerted at a distant point. Such a case came under my notice.
A bullet shattered the bone posterior to the last molar and it was
concluded that the force of the missile exerted at this point had
tended to bend it downward or inward to the extent that it snapped
at its weakest spot, as a separate and distinct fracture also existed
just posterior to the root of the canine tooth and involved the second
premolar which was split into two distinct portions. This specimen
is in the Museum of the Army Medical Department.

Chronic mercurial poisoning has a peculiar effect on the lower
jaw bones. There is an interesting specimen in the Pathologic
Museum at the Copenhagen School. It consists of the skull of an
aged hunting dog which had suffered from chronic mercurial poison-
ing through excessive dosing of the drug for a cancerous growth
of the mammae. The lower jaw is carious, some molars are missing
and the left ramus is broken across the middle (Stockfleth).

Symptoms and Diagnosis. Characteristic are displacement of
the jaw so that the level of the teeth on one side is lower than on the
other, associated sometimes with lateral displacement, local tume-
faction and crepitation, salivation, difficult or suspended prehension
of food, and at times bleeding at the mouth.

Treatment. This is beset with difficulty. For fractured sym-
physis interdental splinting should first be tried. This is accom-
plished by passing and securely binding a piece of silver wire round
the canine and incisor teeth as near to their necks as possible but
free from the gums. It is sometimes necessary to file a slight groove
in the postero-lateral aspect of the canines to retain the wire in
position. Should this method prove unsuccessful the two separated
rami must be wired together with silver wire, the latter operation
being performed externally with the animal under general anesthesia

332 Surgical Diseases and Surgery of the Dog

as follows: Make a transverse incision through the skin over the
symphysis until the bone is exposed. Approximate the fragments
and drill a hole with a fine drill or bradawl transversely through both
halves midway between either extremity and near to the margin of
the symphisis, so as to avoid the roots of the canines. Then intro-
duce the wire, twist it, cut the ends off short and let them protrude
through the skin wound. With favorable progress, withdraw the
wire at the expiration of three or four weeks and promote healing
of the superficial wound.

Fractures through the body are best treated by application of
a permanent well-padded leather or wire muzzle, to remain on the
animal some three or four weeks. This muzzle must be firmly ap-
plied so that no mandibular motion is possible. The animal can
be fed on liquids administered by means of a funnel and tube, and
allowed to trickle through the teeth. Thirst must also be assuaged
in like manner. The mouth should be cleaned and disinfected daily.

Stockfleth successfully treated a case of unilateral fracture by
application of a splint of gutta percha. This was moulded to the
normal shape of the jaws and held in place with bandages to include
the muzzle and neck. In another instance he observed a comminuted
fracture heal by ligamentous union, but the animal experienced
considerable difficulty in gnawing bones, etc.

When reunion fails to take place by this method, the fractured
parts must be wired together as described above. Froehner com-
pletely removes the broken fragment, but this should not be done
until every other method has been tried and found unavailing.

The Hyoid Bone. Fracture of this bone generally occurs in
one of the greater cornua. It may follow violent seizure of an
animal by the throat, a method of apprehension in vogue among
members of the pound corps in some cities.

Symptoms and Diagnosis. The symptoms are local swelling,
dysphagia, and bleeding from the mouth when the mucosa is per-
forated by fragments.

Treatment. No treatment is possible.

The Vertebral Column. Fractures in this region are mostly
observed in the cervical, lumbar, and coccygeal portions. The prog-
nosis depends on the presence or absence of dislocation and the
amount of damage sustained by the cord. Unless the spinous pro-
cesses alone are concerned, when the cord is seldom injured, dis-
location is the rule.

The Osseous System 333

The coccygeal vertebrae become broken mostly through the tail
being run over or caught in doors.

Symptoms and Diagnosis. The principal symptoms are ten-
derness, crepitus, and motor and sensory paralysis. Crepitus and
tenderness alone must not be regarded as serious symptoms since
they may arise merely from fracture of a spinous process.

When the lesion is in the cervical region, death is usually im-
mediate, owing to paralysis of the phrenic nerve, that nerve having
its origin in the fifth, sixth, and seventh cervical pairs. If the frac-
ture occurs at or posterior to the seventh cervical vertebra, the
phrenic nerve still functions and supports respiration which becomes
then wholly diaphragmatic, the function of the intercostals being
destroyed. The neck is held stiffly and crepitus may be noticed if
the head is submitted to a twisting motion.

In the Jumbar and sacral regions the symptoms are: paraplegia,
and paralysis of the rectum and bladder. The intestines become
tympanitic from reduced innervation.

It is sometimes a matter of difficulty to make an early differ-
ential diagnosis between true dislocation, fracture of the vertebral
column and simple injury sustained by the cord from violent con-
cussion resulting from falls from great heights, which are far from
common. The cord may become ruptured or hemorrhage take place
into the canal. In these cases the symptoms usually disappear within
one or two weeks and recovery is often complete but will of course
depend upon the presence and extent of hemorrhage or degene-
ration.

Treatment. No treatment of fracture is possible. Concussion
cases must have rest, administration of water and liquid nourish-
ment and assistance in evacuation of the bowels with the aid of
enemata if necessary. The animal must be frequently turned to
prevent the formation of bedsores.

Simple fracture of coccygeal vertebrae is treated in the same
manner as a broken leg, but the bandage must be of the lightest
character possible, and made to include three or four vertebrae on
either side. When compound the prognosis is unfavorable and the
tail has eventually to be amputated above the seat of injury.

The Sternum. Fracture of this bone is a lesion of great rarity.
Koenig and Zundel have seen instances in which a run-over was
the productive factor.

334 Surgical Diseases and Surgery of the Dog

Symptoms and Diagnosis. Where no displacement exists there
are no significant symptoms. There may be crepitation during
respiratory movements.

Treatment. If the fragments are in apposition the animal
should be maintained at rest until consolidation is effected. If
displacement is evident it may usually be reduced by simple manipu-
lation.

The Ribs. These bones are more often fractured than those
of the vertebral column. One or more may be broken, but —
unless this takes place simultaneously there is not necessarily much,
if any, displacement. The prognosis is favorable provided pleuritis
or pneumonia do not supervene. Laceration of lung tissue may
occur when the violence is great.

Symptoms and Diagnosis. Displacement is recognized by ele-
vation or depression at the seat of fracture and local pain. Cellular
emphysema will be present, and may extend over a large area, when
the lung tissue is wounded. Crepitus is not always distinguished,
but its presence is best determined by auscultation immediately over
the area. The affected side of the thorax may be held rigid.

Treatment. This fracture is treated by securing immobiliza-
tion of the chest by means of broad bandages tightly applied. Re-
covery is the rule.

The Scapula. The scapula sustains fractures mostly in
the vicinity of the head and neck. As a rule, there is very little
displacement. Separation of epiphyses is not uncommon in puppies. —

Symptoms and Diagnosis. The entire leg hangs loosely with
the phalanges dragging on the ground, leading to considerable
abrasion of the latter.

Treatment. In my own practice I have often left these frac-
tures to Nature, in nearly every case with favorable result. Where
there is much overriding or tendency to pseudarthrodic formation
it is advisable to undertake internal splinting or wiring of the frac-
tured extremities. | German practitioners apply a saddle-bandage
which is well-padded and made to pass over the shoulder. English
veterinarians apply a plaster consisting of a mixture of resin one
part, venice turpentine three parts, and burgundy pitch five parts,
put on with a spatula while hot. The exterior is covered with some
material to prevent it sticking to other objects.

The Humerus. According to Froehner, this bone sustains

The Osseous System 3355,

fracture mostly in the lower extremity just above the trochleas where
the shaft is weakest. In fifty-four of Froehner’s cases eighty-three
per cent were in the lower third. Fracture may also take place in
one or both condyles in one or both legs. Moeller quotes Stock-
fleth to the effect that in twenty-six cases observed by him nineteen
were of fractured condyles and the remainder of fractured shaft.
The external condyle is more frequently fractured than the internal,
and usually the displacement is not great, the fractured portion of
bone being retained near its normal position by the external lateral
ligament.

Symptoms and Diagnosis. In fracture of the shaft or condyle
of one leg the animal moves about on three legs or sits on its
haunches without placing the injured member to the ground. When
‘the condyles of both legs are broken locomotion is peculiarly char-
acteristic, the animal either creeping or depending wholly on its
hind legs for propulsive power, kangaroo fashion. At rest, the
weight of the body is supported mainly by the haunches, the fore-
legs propped out in front. In severe bilateral fractures of leg-bones
a prone position is assumed.

Treatment. Fracture of the shaft, being high up, is rather
difficult to treat, and if little displacement is evident is perhaps best
left to natural processes. In cases of much overriding, the wiring
operation should be performed. The lower extremity of the shaft
is more amenable to bandaging, and there is a belief that the joint
should be flexed to avoid imperfect reunion. Fractured condyle
should be bandaged with the joint in full extension. Healing of the
latter class of cases is apt to be imperfect through ligamentous
union. Hertwig states that perfect reunion is the rule in young
dogs. In one of Stockfleth’s cases the animal regained complete
use of the leg, though the fractured portion became almost entirely
absorbed and the union was ligamentous. When ossific reunion
has taken place and the splints have been removed, there is usually
considerable stiffness, which, however, soon disappears with use
of the parts. ;

The Radius and Ulna. These bones form the seat of about
one-half of all the fractures of the fore-legs, and from one-half to
two-thirds of these occur in the lower third of these bones. Usually
both bones are broken together. When one bone alone is concerned
it is generally the ulna and in the olecranon, owing to the prominence

336 Surgical Diseases and Surgery of the Dog

of the latter. The olecranon has been known to become fractured
through great and sudden exertion of the triceps muscle. Fracture
of the radius alone may escape notice, through its consort sufficing
to support the weight of the body. The prognosis is most favorable
of all fractures, only three in one hundred and twenty-two of Froeh-
ner’s cases having failed to become reunited. In the early part of
the last century Sir Astley Cooper made some experimental obser-
vations on fracture of the olecranon. He found that in a transverse
fracture the action of the triceps muscle drew up the fractured
portion from one-half to two inches, the extent of separation de-
pending on the degree of laceration of the ligamentous fibers pro-
‘ceeding from the coronoid process to the olecranon. If the ole-
cranon was broken off within the insertion of the coronoid ligament,
and the fibers of the latter remained intact, the detached portion
moved laterally but separated little from the ulna, and bony reunion
easily took place. If, however, the break took place beyond the liga-
mentary insertion, and the detached portion was separated by the
action of the triceps muscle ligamentous union ensued from lack of
adaptation. A longitudinal fracture produced with but slight obli-
quity, so that the broken portions still remained in contact, readily
gave place to osseous reunion.

Treatment. Treatment of transverse fracture of the olecranon
with separation must therefore include adaptation to the detached
portion, which is best secured by suturing with silver wire, as fol-
lows: Under strict asepsis, expose the ulna by a longitudinal in-
cision, and clean away all blood-clots, etc. Drill corresponding holes
by means of a bradawl or small drill from the posterior surface of

No. 78. Diagram illustrative of Bone-suturing.

each portion of the bone through its thickness to the fractured sur-
face. Introduce the wire, approximate the parts, twist the wire and
leave the ends long to hang out of the wound to permit of their

The Osseous System 337

subsequent removal. The leg should be further secured with
splints, the joint being kept fully extended.

Treatment of other fractures of these bones is on the general
principles already described. In young dogs imperfect reunion of
separated epiphyses is occasionally seen. Such cases are treated
by refracture, which is usually easily accomplished manually.

The Carpus. The carpal bones are rarely fractured.

The Metacarpal Bones. These bones are quite commonly the
seat of fracture, especially in their upper or middle third, and one
or all the bones may be involved. Fracture of a single bone, not
being sufficient to cause a deviation of the parts from normal posi-
tion, the local swelling may at first sight suggest nothing worse than
simple contusion, consequently injuries in this region should always
be carefully examined before a diagnosis is given.

Treatment. The necessity of treatment will depend on the ex-
tent of the fracture.

The Digital Bones. These usually sustain compound fractures
from the foot being caught in doors, run over, or trodden on by
horses. The broken extremities can be seen and felt through the
external wound.

Treatment. In the treatment of these cases all splinters must
be removed, and it is sometimes necessary to resort to amputation.

The Pelvis. The pelvis may be fractured in any or all por-
tions. Fractures of this bone are often comminuted and compli-
cated with damage to the lumbar and sacral vertebrae, and have their
seat mostly in the external angle of the ilium, in the acetabulum,
or at the symphysis. They are often bilateral. An occasional com-
plication is rupture of the urethra. Rectal or vaginal palpation is
often of assistance in arriving at a correct conclusion. The prog-
nosis is doubtful, permanent lameness often remaining, though
simple fractures will sometimes make a good recovery provided the
animal is restrained in its movements. In brood-females this acci-
dent is particularly dangerous owing to resultant constriction of
the pelvic apertures which may necessitate delivery of the young
by Cesarean section. Hertwig believed that fracture was the most
common cause of pelvic deformity though rachitic conditions might
produce distortion in some instances. F. Mueller witnessed a case
in which the passage was so narrow that it would scarcely admit
of introduction of the finger.

23

338 Surgical Diseases and Surgery of the Dog

Treatment. There is no treatment possible except for frac-
ture of the symphysis, and reunion of these parts is assisted by
suturing with silver wire, as follows: Make the skin incision imme-
diately over the symphysis and to one side of the penis in the male.
Avoid injuring the dorsal vessels of the penis in the male and the
plexus of veins from the clitoris in the female, as hemorrhage there-
from is somewhat difficult to control. Separate the subjacent mus-
cular tissue until the fractured parts are exposed. Drill correspond-
ing holes in each half, close to the symphysis, introduce the wire,
approximate, twist the wire, and treat it and the wound in the way
already described. After this operation allow the animal perfect
‘rest and quiet until reunion is accomplished.

The Penial Bone. Ben-Danou has recorded an instance of
fracture of this bone in a Bulldog which was probably the result
of brutal handling by some person immediately after the animal had
copulated. Taylor has also recorded a case resulting from a fight.

Symptoms and Diagnosis. In the Ben-Danou case the penis
was tumefied and discolored. The animal made fruitless attempts
to urinate during which a few drops of blood escaped from the
meatus. Passage of the sound was arrested by an obstacle the na-
ture of which could not be determined. Anuria being complete the
bladder became much distended. The animal died three days later.
At the necropsy it was found that the bone was fractured at its
narrowest portion and the two broken extremities were overriding
and embedded in the penial tissues. The urethra was twisted out
of its natural position.

Treatment. Treatment in case of this nature would be by
slitting up the prepuce and amputating the organ at the seat of in-
jury, in the meantime withdrawing the urine by aspiration of the
bladder.

The Femur. Fractures of the femur occur mostly in the
middle third in adult animals and in the lower third in young ones.
Stockfleth saw one case in which both the neck and inferior third
were broken. They are usually accompanied by considerable over-
riding or displacement through muscular action, thereby causing
shortening of the leg. In fracture of the shaft the broken ends are
sometimes forced so far apart as to result in ligamentous union
with permanent lameness unless remedied surgically.

According to Sir Astley Cooper’s experimental observations,

The Osseous System 339

fractures through the cervix entirely within the capsular ligament
are incapable of ossific reunion. He ascribed this deficiency to the
feebleness of ossific action in the heads of long bones and to the
fact that the trochanter was much drawn up by muscular action so
that the head and cervix were not in apposition. Where the experi-
mental fracture continued compound the head of the bone became
absorbed or discharged by ulceration. By way of contrast he di-
vided the ‘bone external to the capsule in five dogs and all healed
by ossific union, as was also the case in longitudinal fracture.

Symptoms and Diagnosis. Dislocation of the hip-joint
has been mistaken for fracture through the neck. In both
accidents the leg is seen to be shorter than its fellow. In
fracture through the neck this is due to muscular action drawing
up the trochanter, and it is to be distinguished from dislocation by
greater mobility of the leg. In fracture of the lower third the stifle
is held fixed with the leg pointing backward, and with the foot
raised from the ground. Such accidents are apt to result per-
manently in more or less lameness owing to distorted reunion or
changes in the relationship of the fractures composing the stifle-
joint.

Treatment. The German and English methods of treatment
of shaft fractures are the same as for the upper bones of the fore-
leg, viz., by means of the saddle bandage and pitch plaster, respec-
tively. French veterinarians use strips of bandaging material which
are wound round the parts and coated with pitch.

Where there is much overriding and consequent risk of pseu-
darthrodic formation bone suturing should be undertaken, the in-
cision being made on the inner aspect of the leg with due regard
to the position of the femoral vessels. Felizet treated a dog suffer-
ing from a fracture of the neck of the femur by strapping the animal
to a board. In twelve days consolidation had taken place.

As a rule, fractures of the femur heal kindly, and some ap-
parently hopeless cases of fracture near the neck will entirely re-
cover without any treatment whatever.

The Patella. This bone being small in the dog is rarely frac-
tured. Sir Astley Cooper’s experiments on this bone show to what
extent recovery may be expected. He was unable to produce bony
reunion in transverse fractures, even when the rectus femoris was
divided just above. In longitudinal fractures there followed com-

340 Surgical Diseases and Surgery of the Dog

plete reunion provided the lesion did not extend into the tendon
above or the ligament below so that the parts remained in apposition.
Where both tendon and ligament participated there resulted separa-
tion of the broken portion and ligamentous union.

The Tibia and Fibula. Like the corresponding bones in the
anterior extremity, the tibia and fibula sustain fracture mostly in
the lower third. They require no modification of the general method
of treatment. Fractures of these bones heal very kindly.

PSEUDARTHROSIS.

When, through extensive overriding or defective immobili-
zation, approximation of the separated periosteum fails to take place,
the indispensable source of bone supply is wanting, and reunion
stops short at connective tissue formation without ossification, and
thus is produced a false-joint. This is particularly true in old ani-
mals in which the potency of the regenerative power is often im-
paired.

Symptoms and Diagnosis. The symptoms of false-joint consist
of persistence of functional impotency of the affected member, and
mobility of the distal extremity but without crepitus or pain.

Treatment. The best method of remedying the defect is by
resection operation, in which the false tissue is cut away, broken
down, or cauterized. With the animal under general anesthesia, the
part to be attacked is freely exposed by dissection. By means of
a gouge or curette the fibrous tissue is scraped away. The opera-
tion is completed by drilling the ends of the bone and suturing them
with silver wire, which will be found described more fully under
Fractures. (See also Osteoplasty).

OSTEITIS. PERIOSTITIS. OSTEO-MYELITIS.

Inflammation of bone will be better understood if it is remem-
bered that the essential element of osseous structures is connective
tissue, forming a framework which, in the bone proper, is impreg-
nated with earthy salts, in the central portion supports a vascular
nutritive medulla, and on the surface is modified by the presence
of an osteo-genetic or bone-constructive layer to form the perios-
teum, all parts freely intercommunicating by means of the Haver-
sian canal system. Because of this intimate connection, inflam-

The Osseous System 341

matory processes do not long remain confined to one part, but
quickly extend to another. Most inflammatory disturbances of
bone with which we have to deal in the dog are of a septic nature,
and involve the bone proper and medulla. They are acquired either
in cases of compound fracture or amputation, or as a result of acute
infection as may occur in the course of a severe infectious disease,
or in septic thrombosis. But in many cases the cause is wrapt in
obscurity. Contusions may favor the occurrence of infection by
production of a locus minoris resistentiae to the bacteria which may
have gained access to the adjacent soft parts or which may be cir-
culating in the blood. The course of the disturbance is similar to
that of any other purulent inflammation with migration of leuco-
cytes, occlusion of the Haversian canals, arrest of circulation, ne-
crosis, and establishment of purulent foci. The latter coalescing,
extend along the tract of the marrow and lead to its rapid dis-
integration. Pus breaks through the periosteum, burrows along
the lines of least resistance, and finally reaches the skin. If the de-
structive process is allowed to continue, the entire shaft may be
involved, and there is risk of septicemia and pyemia. The disease,
when of other than traumatic origin, most frequently attacks the
long bones.

Symptoms and Diagnosis. There is usually some lameness of
the affected member. If there is not already a superficial wound
when the animal is first seen by the practitioner, a swelling is ob-
served in the soft parts covering the affected area, as soon as the
pus penetrates the periosteum. The skin assumes a dark-red color
and looks “angry.” A fistula develops. The tract of the latter,
when probed, leads to bone, and this is the chief diagnostic symptom.

Treatment. This must be energetic and radical. It is useless
to treat this disease by means of antiseptic injections. The infected
focus must be removed and the only way to accomplish this is to lay
the fistula open, expose the medullary canal and scrape away the
inflamed marrow. The technic is as follows: The animal being
hoppled and given a general anesthetic, and a tourniquet applied
to the leg both above and below the wound, the diseased focus is
exposed by free incision and dissection down to the bone. Sufficient

TOL ——————

No. 79. Bone Gouge.

342 Surgical Diseases and Surgery of the Dog

of the outer compact tissue is next chiseled away with a gouge or
curette to permit of inspection and direct treatment of the whole
of the disease cavity. All adjacent granulating tissue as well as
that which is necrotic is removed, and the cavity flushed out with
a corrosive sublimate solution (1: 1000). Then the wound is either
packed with antiseptic gauze to stimulate the formation of granula-
tion tissue or the cavity is allowed to fill with blood by loosening
the tourniquet so that it may coagulate and become organized by
connective tissue. The latter is known as the Schede aseptic moist
clot method. It is described under Osteoplasty. In this case the
outer wound is immediately closed. This is the preferable way to
treat bone sinuses, but unless the parts are rendered perfectly asep-
tic, is apt to give trouble. When the packing method is followed, the
gauze is left in place a few days until granulation is well established,
the outer wound being in the meantime left open, but protected with
antiseptic bandages. This method makes regeneration more pro-
tracted than the other.

Osteitis Deformans. This is a rare diffuse form of osteo-
periostitis, affecting principally the bones of the skull and the long
bones of the extremities. It runs a very chronic course. The bones
become enlarged, soft, and spongy and covered by osseous vege-
tations. They are liable to become misshapen from bearing the
weight of the body in their weakened state.

Kitt has described a similar condition in a one-year old Great
Dane, which he regarded as of myositic origin, since the vegetations
were confined to the areas of muscular insertion, the region of the
joints remaining free. The vegetations were limited to the lower
jaw and the lower extremities.

Symptoms and Diagnosis. The disease is recognized by the
symmetrical uniform enlargement of the bones and by rheumatic
symptoms. In Kitt’s case, besides the deformity of the affected
parts, there was little abnormal in the animal’s ways, save an
unwieldy gait.

Treatment. There is no known method of arresting the pro-
gress of this disease.

RACHITIS.

This disease, popularly known as “rickets,” is characterized by
incomplete ossification of the skeletal structure in young animals

”?

The Osseous System 343

with more or less arrest of development of the whole body. The
ill-formed bone is produced principally in the epiphysial region of
long bones, and the sutures of the cranial bones, which in new-born
healthy dogs are well closed, are usually large in rachitic dogs.
The disease has been ascribed to malnutrition, particularly to food
lacking lime salts, to digestive disturbances, and also to hereditary
taint. It is highly probable that hereditary or congenital influences
play a part in its production, through insufficiency of the thymus
gland, in view of the symptoms following experimental ablation of
the gland practiced recently by Mendel. Dogs of the larger breeds
(Great Danes, St. Bernards) are most often affected, principally
between the ages of three and six months. It is important, how-
ever, not to confound with rickets a condition also seen in the young
of the larger breeds, where, owing to the weight of the body the
legs have to support before they are completely ossified, the latter
become bent and misshapen.

Symptoms and Diagnosis. A dog affected with rickets ex-
hibits a general disturbance of the system—indigestion, inappetence,
weakness and lethargy. In a little while the typical bone lesions
develop. In the long bones the epiphyses become greatly enlarged
and the shaft curved. In advanced cases the inferior extremities
give way, causing the knee and hock to come in contact with the
ground, the vertebral column becomes curved, the thorax sinks in,
and the tibs exhibit nodosities. The facial bones also show de-
formity. Sometimes the affected animal is unable to stand and
experiences considerable pain at the slightest movement. The dis-
tortion may involve the pelvic bones to such extent as to prevent
fetal delivery (Reichenbach).

Treatment. Practically nothing can be done in a surgical way
to remedy rickets, the treatment being altogether medicinal. The
diet must be stimulating and consist largely of meat, shaved green
bone, milk, etc. Of medicaments, cod liver oil, lime water, and the
official syrup of phosphate of lime are highly recommended. Treat-
ment on similar lines is indicated for simple crooked development,
but in the latter case the more the animal is confined and encouraged
to rest the better.

OSTEOMALACIA.

This disease, somewhat similar in its nature to rachitis, is char-
acterized by softening of the bones through resorption of their

344 Surgical Diseases and Surgery of the Dog

earthy salts. While rachitis only affects the immature animal,
osteomalacia is essentially a disease of adult life. It is very rare and
the cause is unknown but it is believed to follow disturbances of
nutrition. Any part of the skeleton may be attacked. Solby refers
to some hounds in which the disease progressively affected one bone
after another.

Symptoms and Diagnosis. The symptoms resemble those of
rickets but in addition to the deformity paraplegia may be present
and the bones easily fracture. The alveolar margins of the jaws
also absorb and the teeth fall out prematurely.

Treatment. There is no remedial treatment known, and pro-
phylactic measures must be depended upon when the disease is
recognized. Prophylaxis comprehends a stimulating diet of animal
food and administration of such preparations as are indicated for
rachitis.

NEOPLASMS.

Both innocent and malignant types of tumor occur in bone.
The innocent growths consist for the most part of osteoma, chon-
droma, and fibroma. The only primary malignant growth met with
is sarcoma, carcinoma, when it occurs, being always secondary.

Osteoma. True bony tumors may spring from any part of bone,
but most often from the periosteum. They are occasionally found
attached to the jaw bone, and Mueller refers to an instance observed
by himself of one attached to the transverse process of the fifth
cervical vertebra. They are also found in other parts of the body.

Symptoms and Diagnosis. They are recognized as regular,
round, hard, insensitive enlargements, sometimes attaining con-
siderable dimensions.

Treatment. Under general anesthesia, such growth is exposed
to its base by longitudinal incision and dissection of the skin. It
is then removed with the aid of a sharp chisel and mallet, the ex-
ternal wound being closed in the usual manner.

Chondroma. Cartilaginous tumors are found attached to bone.
They rarely ossify but may undergo calcification. Gurlt observed
them in both the superior and inferior maxillae and on the digits.

Symptoms and Diagnosis. Chondroma is always firm, round
or lobular and well demarked, and grows slowly.

Treatment. Removal is easily effected by ordinary methods.

The Osseous System 345

Fibroma. Fibrous tumors of bone-are of such rarity and in
clinical features resemble chondroma so closely that they need not
be considered here.

Sarcoma. This, the malignant type of growth occurring in bone,
will be found fully described in the chapter on Neoplasms, and
needs but a passing reference here.

Symptoms and Diagnosis. It is distinguished from the inno-
cent growths by its steady, progressive and rapid development,
and by other characteristics described elsewhere.

Treatment. Ablation of this form of growth is difficult to
attain. When practicable it must always be most thorough.

Carcinoma occurs only as a secondary manifestation. Puetz
has seen it in the epiphyses of the elbow joint.

OSTEOPLASTY

This term is applied to certain operations or processes by which
defects in the continuity of bones are remedied. The value of its
application to cases of severe comminuted fracture with absorption
or necrosis of the detached portions, in the treatment of osteomye-
litis, and the correction of pseudarthrodic formation following frac-
ture, has long been recognized. We find the earliest known in-
stance of its practice recorded by a Mongolian surgeon named Baber
who lived between the years 1483 and 1530 and wrote his life-doings
in the Turkish dialect. The reference concerns a man who broke
his leg in such a manner that part of the bone of the size of the
hand was completely shattered. He cut open the integuments, ex-
tracted the detached portions and inserted in their place a pulver-
ized preparation, which was said to have grown in place of the bone,
and resulted in its complete recovery.

A great many experiments in this direction have been carried
out on dogs by Ollier, Schede, Schmitt (37 experiments), Adam-
kiewicz, Rydygier and others in Europe, and by Senn and Mackie
and others in this country.

It was observed that cavities or serious breaks in the continuity
of bones were always followed by protracted regenerative processes.
Hence efforts were directed towards the finding of some substitute
which, when implanted in the defect, would take the place of the
missing bone and become intimately merged with the main body.
Many substances were employed to act as substitutes, among them

346 Surgical Diseases and Surgery of the Dog

ivory, cork, fresh bone procured from other animals, and decalcified
bone. But it was soon found that implantation of all these sub-
stances was followed, as a rule, by their more or less rapid and com-
plete absorption and the development in their stead of fibrous tissue
which became ossified according as there remained sufficient peri-
osteum, or not.

The practice of heteroplasty (7. ¢., where implanted portions of
fresh bone were taken from individuals of a different species) regu-
larly resulted in encapsulation and absorption and rather hindered
than hastened repair of the defect. Likewise portions of ivory and
decalcified bone played but a temporary role and were very apt to
induce pressure-atrophy or necrosis.

Recently, however, Morton has claimed to have successfully
supplied a deficiency of bone in a man by transplantation from a
dog, vascular attachment being maintained while the regenerative
process was going on, the animal being securely bound to the patient
for several days to secure this object.

Senn advises the packing of bone cavities with decalcified bone
cut in thin slices or chips. If the periosteum is carefully sewn over
the wound with catgut, repair is said to be much quicker than with-
out the implantation, the chips serving as a temporary nidus for
advancing granulations which permeate in all directions, until the
embryonic tissue becomes sufficiently organized.

In the skull discs of decalcified bone gave more favorable re-
sults in as far as they formed a mechanical protective covering which
became encapsulated. Senn says that the implantation of decalci-
fied bone in skull wounds prevents direct union between the pert-
cranium and the brain or its membranes, and that a cavity two inches
long and five-sixteenths of an inch wide will fill with new bone in
from seventy-five to ninety days. Repair is much more rapid in
young than in old animals. Darkschewitsch and Weidenhammer
have also observed normal bone development in place of implanted
decalcified bone plates, in skull wounds. Decalcified bone is obtained
by steeping fresh living bone in ten per cent nitric acid or dilute
muriatic acid. It is then immersed in a weak solution of caustic
potash to remove the acid and preserved in two-tenths of one per
cent alcoholic sublimate solution.

Homoplasty (i.e., the transplantation of living bone from
another individual of the same species) gave doubtful results. In

The Osseous System 347

a few instances true ossific union may take place, more especially
when the periosteum is carried over with it, but in most cases the
same results were obtained as in heteroplasty.

Schmitt removed a portion of the ulna one and one-half ccm.
in length and in its place transplanted a piece of bone from another
dog. Complete bony union took place on one side and fibrous union
on the other. No absorption was apparent and the vitality of the
implanted portion seemed to be maintained by thickening of its
periosteum.

Only when autoplasty (7.¢., where implanted portions were
taken from the same individual) was practiced, was there indication
of true union, and this was made more certain when the periosteum
remained adherent or flaps were left intact at the site of operation.
Even in this case there were signs of absorption.

All the above operations were done strictly aseptically. When
the parts were not rendered fully aseptic, they suppurated and ex-
truded the implanted portions. Thus it became evident that re-
generation of bone can only take place from periosteum, and where
the latter is entirely removed no true ossification can follow. A
displaced fragment, when replaced, must have connection with
periosteum which in turn is in vital condition either by connection
with neighboring periosteum or adjacent tissues. Hence the sur-
geon aims to conserve the periosteum to secure its bone-constructive
power.

The periosteum is capable of remarkable vitality, for it may live
and produce bone after its transplantation into an animal of a dif-
ferent species. Trueheart recorded a case of a man in which he
grafted pieces of periosteum to restore the middle third of a clavicle
which had been shot away. Fresh transplants were inserted three
times a month for two months when two and three-fourths inches
of bone had been produced. The periosteum was from newly-
killed dogs. A novel method was pursued by Rydygier. He tried
separating flaps from the periosteum just above a pseudarthrodic
defect, except at the border where it remained attached, turning
them over so that the inner side lay outwards and vice versa, and
laid them over the false tissue. Good results were achieved, but
Schmitt who repeated the experiments, failed, on account of the
movements of the animals, which could not wholly be restrained,
tearing out the flaps. Schmitt then resected a piece of a long bone

348 Surgical Diseases and Surgery of the Dog

one and one-half ccm. in length, and transplanted in its place a
piece of the same size and sewed both periosteums together. The
result was good.

All absorbable porous materials placed in bone cavities which
create favorable conditions for healing do so by virtue of compres-
sion, occlusion, and diminishing wound secretion. Instead of sup-
plying artificial means to this end, Schede advocated the natural
method of allowing the cavity to fill with an aseptic moist blood-
clot. The principle of this method is that coagula between sur-
faces of aseptic wounds do not undergo putrefactive or degenera-
tive changes, but become supplied with bloodvessels and are organ-
ized. The technic is as follows: Apply a tourniquet on the proximal
side, remove all diseased bone, disinfect the cavity thoroughly, su-
ture the soft parts, and remove the tourniquet. The cavity fills
with blood. Protect the wound with a layer of oiled silk, which
secures at the surface the formation of a moist blood clot. This is
an important point. Small cavities heal in from twelve to fourteen
days, while large cavities require from three to six weeks. The
cavity must be allowed to fill completely or the balance closes by the
usual tedious process of granulation. Neuber modifies this method
by filling the cavity with iodoform with which the blood mixes, and
thus lessens the chances of sepsis.

OSTEOTOMY.

This operation—the division of a bone—is sometimes necessary
to straighten a leg, one or more bones of which having sustained a
fracture have reunited in abnormal alignment. Complete anesthesia
is necessary and the parts should be rested on a sandbag to give
necessary support. A free incision is made down to the bone at the
site of the callus, on the outer side, and an osteotome (beveled on
both sides) introduced parallel to the long axis of the bone and then
turned across, or at a right angle to it. With repeated strokes with
a mallet it is made to penetrate the dense bone for two-thirds of
its thickness, but this must be done with due caution to check any
undue impetus on the part of the osteotome. The rest of the bone
can be “snapped” with a little manual force. But, if difficulty is
experienced in doing this, it means that the chisel must be used a
little more. The two extremities are then approximated so as to
bring them into alignment and a suitable splint applied, a window

The Osseous System 349

being arranged to permit of adequate drainage. It may be neces-
sary to expose and “trim” the cut extremities with bone forceps to
make them stay in alignment.

BIBLIOGRAPHY.

Adamkiewicz—Wien. med. Blaetter. 1889.

Astley Cooper—Treatise on Disloc. and Fract. of the Joints. 2nd. Amer. Ed. from 6th.
Lond. Ed. Boston. 1832.

Baber—Translation. Leyden & Erskine. London. 1826.

Ben-Danou—Rey. Vétér. July, 1898.

Darkschewitsch. & Weidenhammer—Rey. in Contralblatt f. Chirurg. 1892, p. 835.

Felizet—Bull. de la Soc. de Méd. Vétér. 1871, p. 193.

Froehner—Monatsh. f. prakt. Thierheilk.

Hertwig—Die Krankh. d. Hunde u. deren Heilung. 1853.

Koenig—Cited by Cadiot & Almy in Traité d. Thér. Chir. d. Anim. Dom.

Mackie—Med. News. Aug., 1890, p. 202.

Martin—Veterinarian. 1896, p. 458.

Mendel—Muench. med. Wochenschr. Jan., 1902.

Morton—Amer. Med. July, 1902, p. 55.

Mueller, F.—Oesterr. Vierteljahrsschr. f. Veterinaerk. 1878, p. 141.

Neuber—Virchow’s Archiv. 51. p. 683.

Ollier—De l’Ostéogénése Chirurg. Inter. Med. Cong. 1890. Traité Exper. et Clin. d. 1. R@
générat. d. Os et d. 1. Product. Artific. d. Tissu Osseux. Paris, 1867.

Pagenstecher—Cited by Almy & Cadiot in Traité de Thér. Chir. d. Anim. Dom.

Puetz—Berner Zeitschr. f. Thiermed. 1877, p. 335.

Reichenbach—Schweiz. Archiv. 1899, p. 217.

Rydygier—Deutsch. med. Wochenschr. 1878, Nos. 27 and 28.

Schede—15th. Congress d. Deutsch. Gesellsch. f. Chirurg. Arch. f. klin. Chir. 34, p. 245.

Schmitt—Langenbeck’s Archiv. f. klin. Chir. 1892-93, p. 401.

Senn—Amer. Journ. of the Med. Sciences. Sep., 1889.

Solby—Medico-Chir. Soc. Trans. 27.

Taylor—Veterinary Record. 16, p. 505.

Trueheart—Med. Press and Record. 1885, p. 382.

Uebelen—Repertor. d. Thierheilk. 1876-77, p. 297.

Zundel—Cited by Cadiot & Almy in Traité d. Thér. Chir. d. An. Dom.

CHAPTER XII

The Articulations

TRAUMATIC LESIONS.

Wounds of Joints. The joints of the extremities are most
subject to traumatic lesions. A joint may be merely punctured or
it may be laid freely open and complicated with injury of the neigh-
boring structures. A joint wound is dangerous only if infected,
simple non-infected puncture wounds often healing by primary
intention, but the larger the wound the greater is the liability to
infective inflammation and suppuration. Should the inflammatory
process pursue a pernicious course, it terminates by destruction of
the joint and local ankylosis, if in the meantime pyemia does not
intervene. But if the cartilages escape destruction the usefulness of
the joint may not yet be destroyed.

Symptoms and Diagnosis. A non-infected joint-wound gives
vent to a flow of synovia, which is recognized by its glairy appear-
ance. This fluid must not be confounded with that emanating from
an open tendon sheath with which it is very similar in appearance.
There is but little swelling or pain. When infection occurs, all
movements of the articulation are suppressed. The whole articula-
tion becomes tumefied and as the disease progresses, discharges a
grumous purulent matter. Collateral edema ensues, the function
of the member is totally suppressed, fever appears, the appetite fails
and the body emaciates.

Treatment. All wounds of joints or of periarticular tissues
should receive thorough antiseptic irrigation with a sublimate solu-
tion (1: 1000) the hair in the vicinity being removed. If infection
is not apparent, the lesion should be occluded with iodoformized
collodion and the region covered with an antiseptic bandage. When
infection has occurred, the joint must be laid freely open, irrigated
night and morning with the sublimate solution, protective bandages
being also applied.

Sprains of Joints. By this term is meant an imcomplete rup-

350

The Articulations 351

ture of the ligaments of a joint but unattended with displacement of
the articular surfaces. It is often accompanied with injury to the
neighboring parts. It is generally produced by external violence,
Such as a blow or fall, but may be caused by a sudden twist of the
joint during rapid progression. There results an increase of
synovial secretion and consequent distension of the sac, or hemorr-
hagic extravasation, according to the degree of injury sustained.
The condition may become chronic owing to incomplete absorption
of the inflammatory products, imperfect repair of the torn liga-
ments, or periarticular fibrous ankylosis. The round ligament of
the hip joint is a common seat of sprain.

Symptoms and Diagnosis. ‘The lesion is recognized by the fol-
lowing symptoms: local tumefaction and pain particularly on pres-
sure being applied, and pronounced limping or inability to bear
weight on the leg. Absence of crepitus or modification of the out-
lines and length of the member serve to distinguish a sprain from
a fracture or dislocation, though very often the swelling is so great
as to render it difficult or impossible to make a diagnosis until the
former has subsided.

Treatment. The indications are to enforce complete rest, and
where possible to secure immobilization of the joint by bandages.
A stream of cold water from a hose repeated several times daily
is beneficial. Resolution takes place usually in from one to two
weeks. Chronicity is recognized by persistent limping, in which
case external painting with tincture of iodine may be tried.

Luxations. Dislocations,

LUXATIONS IN GENERAL

These terms are employed when the articular ends of one or
both bones are displaced from their normal position. There are two
principal types—the Traumatic and the Congemtal. Tk first results
from direct or indirect violence while a dislocation is said to be
congenital when from errors or failure in development the normal
contiguity of articular surfaces cannot be maintained. A luxation
may also result from relaxation of ligaments owing to constitu-
tional debility, or from pathologic changes in ligaments or tissues
entering into the formation of a joint.

352 Surgical Diseases and Surgery of the Dog

A luxation may be partial or complete, according to the degree
of displacement present. Complete luxations are seen mostly in
enarthrodial joints such as the femoro-coccygeal, but they are also
very frequently partial in such joints. Partial luxations commonly
occur in the digits. This lesion generally carries with it more or less
bruising of the articular cartilages, rupture of ligaments, and con-
tusion of the neighboring parts.

Symptoms and Diagnosis. The symptoms are: pain, deformity,
either lengthening or shortening of the affected member, and immo-
bility. In general, a luxation may be differentiated from a fracture
by the absence of crepitus, but this is not invariably a guide since
the synovia may become inspissated and crackle under motion. The
chief distinguishing feature is the abnormal immobility, though
movements are sometimes possible in certain directions, while in
fracture there is abnormal mobility in all directions. The diagnosis
may be rendered difficult by the presence of tumefaction sufficient
to prevent the exact extent of the injury from being ascertained.

Treatment. The sooner a reduction is effected the greater are
the chances of repair and restoration of function in the joint. If 2
luxation is allowed to remain undisturbed for a longer period than
two or three weeks a change takes place in the relation of the parts.
The head of the displaced bone becomes enveloped in a new cap-
sular ligament formed from the surrounding cellular tissue, and
reduction is no longer possible. While the displaced bone gradually
adapts itself to its abnormal environment, so that a certain degree
of motion becomes possible, lameness invariably remains perma-
nently.

A case of luxation being presented, the first step is to secure
the animal, place it in a convenient position and proceed to examine
the seat of injury. If much swelling is present, the operation should
be postponed until it has subsided. Subsidence of the swelling may
be aided by playing a stream of cold water from a hose over the
parts, or by applying a refrigerant lotion. Recourse to general
anesthetics or preferably chloretone narcosis is of considerable as-
sistance and in some cases absolutely essential in order to overcome
muscular spasm. The parts are then manipulated with the aim to
restore the normal contiguity of the articular surfaces. Traction
is exerted on the member, sufficient to overcome muscular effort,
and then either extension, flexion, lateral pressure, or rotatory move-

The Articulations 353

ments of the joint, according to the direction of dislocation, the
movements being made in inverse direction to that in which the
lesion has taken place. Reduction being effected, the joint does not,
as a rule, tend towards reluxation, excepting in certain cases to be
noted hereafter. But the joint should be maintained immobile until
the local inflammatory changes have subsided and the parts assumed
their normal relationship. For this purpose bandages and splints
are utilized. At the expiration of fifteen days the latter may be re-
moved and the joint submitted to massage and passive exercise.

LUXATIONS IN PARTICULAR.

The Temporo-Maxillary Articulation. The most frequent
cause of this luxation is excessive opening of the jaws, as may oc-
cur at clinical examination, when dogs in worrying oxen attempt to
seize them or are kicked by them, when a greyhound seizes a hare
in the chase, or even when the animal yawns. The lesion may be
unilateral or bilateral and it takes place in a forward and upward
direction.

Symptoms and Diagnosis. In unilateral dislocation the symp-
toms are local paralysis with lateral displacement; in bilateral dis-
location there is forward displacement. The facial expression is
anxious, the animal salivates freely, howls with pain, and paws at
its head. The head is depressed when the lesion is bilateral and in-
clined to one side when it is unilateral. The interior of the mouth
is plainly visible, the back molars are seen to be separated, and in-
clined to one side in the unilateral form, and the tongue is discol-
ored and protruding. The eyeballs may also protrude owing to
pressure by the displaced coronoid processes. This condition has
many points of resemblance. to paralytic rabies, but anyone con-
versant with the symptoms of the latter disease need not confound
the two. In rabies the jaw can be closed; in dislocation it cannot.
The prognosis is good when there is no complication of fracture.

Treatment. Reduction is effected by depressing the angle of
the jaw, and entails the exercise of considerable force and patience.
An anesthetic is necessary and the animal should be secured on its
back with the face flat on the table. The jaw is used as a lever, a
fulcrum being formed of a stick from six to twelve inches in length
and from one-quarter to one-half an inch thick, with a wrapping of

24,

354 Surgical Diseases and Surgery of the Dog

protective material. This is inserted crosswise between the jaws as
far back as possible. An assistant must then bear down on the
anterior extremity of the lower jaw, and endeavor to approximate
incisors to incisors. The operator at the same time exerts traction
on the stick in a forward and upward direction till the condyles are
raised to a point where they slip back into the articular fossae. No
solid food must be given for several days.

The Vertebral Articulations. Reference has already been
‘made to this luxation in the chapter on Fractures. Complete luxa-
tion is rarely seen without being accompanied by fracture. It may
be recognized by the unnatural curvature of the neck, and the pres-
ence at the site of lesion of a depression on one side and an enlarge-
ment on the other. It is necessarily fatal. Partial luxation is occa-
sionally met with.

Symptoms and Diagnosis. When it occurs in the cervical
vertebrae the neck is curved with the head turned towards the side
from which the displacement has occurred, and the animal prome-
nades in a circle with a staggering gait. On the concave side of the
neck there is a depression, and on the convex side an enlargement.
If the head is straightened out and let go again it immediately re-
turns to the abnormal position unless by chance the luxation should
become reduced by this procedure. If there is any pronounced
pressure on the cord convulsions occur, and they are generally more
manifest in the muscles on the opposite side of the body.

‘Treatment. If after three or four days a gradual im-
provement is noticed in the distorted parts the prognosis may
be regarded as favorable, recovery taking place in the course
of a month, but should the animal become progressively weak and
emaciated, it should be destroyed.

The Scapulo-Humeral Articulation. The capsular ligament
enclosing this joint is remarkable for its looseness, where-
fore it possesses little power to oppose displacement. As a rule,
the head of the humerus is thrust to the anterior or external aspect
of the joint, internal or posterior luxation occurring when compli-
cated with fracture. Complete luxation is seldom seen, whereas the
partial form accompanied by little if any laceration of the ligament,
is not at all uncommon. It is brought about by extreme flexion of
the joint or traumatic influences.

Symptoms and Diagnosis. Lameness appears suddenly, the

The Articulations 355

leg seeming shorter than its fellow. The humerus can be extended
and flexed only with the greatest difficulty. The position assumed
by the head of the humerus is indicated by an enlargement, a hollow
existing at the site of the joint, and the parts are painful. Partial
luxations generally get well with treatment, but the prognosis of
complete luxation is less favorable. Hertwig had one complete
recovery.

Treatment. Reduction is effected by extension of the humerus
and pressure over its head in the direction of normal position.

The Humero-Radio-Ulnar Articulation. This luxation may
take place either inwardly or outwardly. It may be complete or
partial between the humerus on the one hand and the radius and
ulna on the other. The head of the radius may also be displaced
alone and, as a rule, to the outside. In these cases the annular liga-
ment uniting the heads of the radius and ulna is coincidently rup-
tured. Curiously enough, luxation of the head of the radius, and
sometimes of both radius and ulna, is often congenital in the Black-
and-tan Terrier breed, involving one or both elbows. When it
occurs under these circumstances the young are usually born in this
condition, but may also acquire it in the first few weeks of life.
I have also seen the congenital form in other breeds, and in one in-
stance there was an additional deformity in the shape of a club-foot.

According to Carougeau, humero-radio-ulnar luxation may
arise from various traumatic influences, from extreme flexion of the
forearm with external displacement and rupture of the
internal lateral ligament, or from twisting of the joint
with slipping of the coronoid process from the trochlea of the
humerus, in which case all the ligaments are ruptured. Luxation of
the head of the radius with rupture of the annular ligament con-
necting this bone with the ulna is chiefly caused by leaping or falling
from great heights.

Symptoms and Diagnosis. The symptoms of humero-radio-
ulnar luxation are depression on one side of the articulation and
enlargement on the opposite with infiltration of the neighboring
tissues and muscles. In addition to the change of contour may also
be noticed: turning of the foot in the opposite direction to that in
which the displacement has taken place, shorter appearance of the
leg than its fellow, a limping gait, and expression of pain when the
seat of luxation is handled.

356 Surgical Diseases and Surgery of the Dog

In dislocation of the head of the radius, there is a bulging
postero-externally, making the region of the articulation look
broader than natural. The forearm is flexed with the elbow held
immobile, the animal going on three legs. The displaced bone can be
plainly felt and if the elbow joint be forcibly extended and flexed a
slight resistance is encountered in the parts and the animal exhibits
considerable pain. The luxation is reducible and the joint moves
freely, but as soon as the animal uses the leg again, it recurs, be-
cause the annular ligament, which supports the two bones in place,
is ruptured. If the lesion is left to itself, the leg is permanently
incapacitated, and is always extremely flexed and carried free of
the ground. When both legs are affected, a standing posture is
impossible, the animal being forced to sit on its haunches. The
prognosis is unfavorable without operative measures, the lacerated
annular ligament showing little tendency to heal.

In the congenital form there is absence of inflammatory phe-
nomena and simply deformity which cannot be mistaken.

Treatment. The prognosis of acquired complete dislocation
of the joint is good in recent cases when uncomplicated with frac-
ture or extensive rupture of ligaments. It is reduced without much
difficulty by extension, flexion, and lateral pressure, but tends to
recur rather readily, so that it is imperative to keep the parts for some
days in a permanent bandage until repair of the ligaments has taken
place. Congenital luxation of the whole joint is seldom amenable
to treatment.

The only possible way to treat radial luxation, whether acquired
or of congenital origin is by wiring the bones together in the follow-
ing manner: The animal being hoppled and anesthetized, an incision

is made immediately over the annular ligament and the shafts of.

the two bones freely exposed by blunt dissection. Holes are bored
through the radius and ulna, as describel under Bone-Suturing,
silver wire is passed through the holes, the two bones are brought
into normal apposition, the wire twisted, the ends of the latter cut
off close, the wound closed, and suitable splints and bandages ap-
plied to immobilize the parts, provision being made for free
drainage. To prevent suppurative inflammation the operation must
be done strictly aseptically. The wire should be removed after five
or six weeks. The results of this operation often exceed the expec-
tations of the practitioner, the leg being used with freedom though
perfect use of the joint is not attained.

“e

The Articulations 357

The Radio-Ulnar-Carpal Articulation. Both the radius and
ulna may be displaced from their articulations with the upper row
of carpal bones, either singly or together. The capsular band unit-
ing the lower extremities of the two bones is ruptured in either case.

Symptoms and Diagnosis. Dislocation of either of these arti-
culations deprives the animal of the use of the leg, and is attended
with a change in contour of the parts, a bulging taking place in
either an anterior or posterior direction.

Treatment. This lesion is easily reducible but recurs if not
remedied by wiring the two bones together.

The Carpal Articulations. Any bone in this joint may become
separated from the remainder.

Symptoms and Diagnosis. The symptoms are local stiffness
and swelling with pronounced lameness and the joint may be bent
either inward or outward.

Treatment. The prognosis is good, recovery taking place in
about three or four weeks, when the bones are replaced in the or-
dinary manner and bandaged.

The Metacarpal Articulations. Luxations of these articula-
tions may occur at either their superior or inferior extremities. A
single bone may be displaced.

Symptoms and Diagnosis. In the case of a single bone the
symptoms are only slightly in evidence. In complete luxation of
the whole row the foot is raised from the ground and held ob-
liquely.

Treatment is the same as already outlined.

The Phalangeal Articulations, The digits are quite com-
monly put out of joint.

Symptoms and Diagnosis. The animal limps and manifests
pain at manipulation. The affected joint is found to be abnormally
mobile.

Treatment. Reduction is effected in the usual manner, atid the
parts immobilized for some days.

The Coxo-Femoral Articulation. Luxation of this joint oc-
curs not at all uncommonly. As a rule, the head of the femur is
displaced in a direction immediately above the acetabulum, but may
be forced into the foramen ovale. The displacement is more often
partial with slight damage to the capsular ligament than complete.
If complete, it is accompanied with rupture of both the capsular
ligament and the ligamentum teres.

358 Surgical Diseases and Surgery of the Dog

Symptoms and Diagnosis. At first the animal may walk on
three legs but later gains imperfect control of the injured member.
A swelling is observed over the joint, the trochanter has become
prominent, and the leg appears shorter than its fellow. In displace-
ment into the foramen ovale the leg appears longer than its fellow.
When the animal walks, the stifle is turned outward and a certain
swinging motion is evident. The prognosis is excellent provided re-
duction is effected soon after the accident. If the luxation is neg-
lected a false joint is formed through development of a new capsular
ligament from the surrounding cellular tissue, and the movements be-
come comparatively free, though the leg is dragged somewhat. The
longest period intervening between receipt of the injury and treat-
ment in my hands which turned out satisfactorily was two weeks.
Stockfleth found a false joint completely formed with a thick flask-
shaped capsule two months after the dislocation had occurred, and
Peuch failed to effect reduction in a dislocation of one month’s
standing.

Treatment. The leg must be forcibly extended by traction and
abducted, downward pressure being at the same time applied over
the trochanter.

The Patella. In the dog, the lateral patellar ligaments are
little more than rudimentary, while the middle one is well-developed.
Consequently the patella is very liable to become displaced either
to the inner or outer aspect of the joint, but as a rule to the inner.
The chief factor concerned in the occurrence of this luxation is
relaxation of the feebly-developed lateral ligaments, coupled with
a feebly developed internal ridge of the patellar groove of the femur,
and to complete the lesion it is only necessary for a violent or exces-
sive contraction of the tendon of the quadriceps femoris muscle to
take place, particularly in conjunction with inward or outward
turning motion of the lower part of the legs as, for instance, when
a dog jumps up and through a window. Toy breeds, such as the
Black-and-Tan Terrier and Japanese Spaniel suffer most, and it is in
these that we find the internal femoral ridge lacking in development.
The displaced bone is easily replaced when the whole leg is in an ex-
tended position forward but shows a great tendency to revert to the
abnormal position upon flexion.

Symptoms and Diagnosis. This luxation is characterized by
a peculiar carriage of the affected leg. The latter can no longer

The Articulations 359

help to support the weight of the body but is raised from the ground
and flexed with the stifle adducted, the hock turned outward, and
the foot carried inward and sometimes extending past the median
line. When both bones are simultaneously displaced, the tarsal
joint is extremely flexed and the hind parts assume a crouching
attitude, the mode of progression resembling that of a ferret. In
some cases locomotion is accomplished by a series of hops or the
animal walks altogether on the forelegs and elevates the hind ones.

Treatment. In treating this trouble the object to be aimed at
is to rest the entire leg for a period of several days, all the while
maintaining the leg in an extended condition in the anterior direc-
tion, for it is in this position that the bone falls into its proper
channel. The rest then gives the ligaments the opportunity to re-
cuperate and recover their normal tone. The entire leg from the
toes upward as far as possible above the stifle must be enclosed in
a stiff bandage, preferably of plaster of paris. To show how. all-
sufficient the rest treatment is may be mentioned the case of one of
Stockfleth’s patients, that of a restless female which was about to
whelp. It was impossible to keep her quiet and the bone in place,
but as soon as her offspring arrived she calmed down and lay
quietly with them a sufficient length of time for recovery to take
place. In another instance he bound the affected leg to the trunk
by means of bandages, so that the animal was forced to rest it.
Recovery followed in three weeks. In still another case of bilateral
luxation in a small animal splints of gutta percha were moulded to
both legs extending from above the stifle to the toes, so that the
animal which previously had crawled, walked as if on stilts. Some
two or three weeks of this support sufficed to effect a cure.

In the cases dependent upon congenital structural defect in the
femur the prognosis must always be doubtful for the tendency is
towards recurrence.

The Tibio-Tarsal Articulation. Stockfleth has recorded one
instance of this luxation. A hunting dog in chasing a cat had its
right foot caught in a vice attached to a joist, with the result that
the skin, ligaments and flexor tendens were severed, exposing the
tibia which was only suspended by the extensors. On account of
the hemorrhage the animal was destroyed.

The Caudal Articulations. Slight luxations sometimes occur
in animals possessed of slender tails, as for instance, in the Grey-
hound.

360 Surgical Diseases and Surgery of the Dog

Treatment. Reduction being effected, as light a bandage as
possible is to be applied, similar to that used when this extremity
suffers fracture.

SYNOVITIS.

By synovitis is meant inflammation of the synovial membrane
alone. When other structures of the joint are involved, the term
arthritis is employed. It may be acute or chronic. In the acute
form the synovial membrane becomes red, congested and swollen,
and at first stops secreting but later pours out an excess of turbid
fluid ; in the chronic it undergoes thickening. Either form is caused
by some slight injury such as a sprain, contusion twist, or overuse.
The articulations most commonly affected are the carpal, coxo-
femoral, femoro-tibial, and digital.

Symptoms and Diagnosis. In acute synovitis the leg is held
in any position giving the greatest ease, and any movement of the
joint gives rise to lameness. Examination shows the joint to be
hot and fluctuating and painful to pressure. In chronic synovitis
lamencss only becomes evident after use of the joint, but the sac
fluctuates.

Treatment. Treatment comprises rest, immobilization of the
joint with bandages, cold applications, and later painting with io-
dine. When the effusion is great, the sac should be aspirated with
antiseptic precautions.

ANTHRITIS.

This term is applied to general inflammation of all the struc-
tures composing and surrounding a joint. It may occur as a local
manifestation of rheumatism when it is of infectious origin though
unaccompanied by suppuration, it may develop as a simple inflam-
matory disturbance consequent upon local sprains, luxations, etc.,
or it may result from pyogenic processes, the germs entering either
by a wound, through extension of periarticular suppuration or
osteomyelitis, or in a pyemic embolus as may occur in cases of
omphalo-phlebitis of the newly-born.

Rheumatic arthritis may be acute or chronic. The former
runs a rapid course, the symptoms appearing within twenty-four to
forty-eight hours. The commonest seats of this form of the dis-

The Articulations 361

ease are the knee, stifle, feet, and hip joints. The affection is am-
bulatory in nature and tends readily to recur. Serous membranes
are frequently involved, notably the pleura, pericardium, endocar-
dium, and meninges. The chronic form commonly succeeds the
acute, though it frequently occurs as such from the start, the femo-
ro-tibial and carpal articulations being common seats. In this
form there is thickening of the capsule with formation of peri-
articular adhesions and sometimes osseous vegetations.

Purulent arthritis may also be acute or chronic. When acute,
pyogenic microorganisms figure as the causative factor, and when
chronic, tubercular bacilli. In the acute form, a free purulent se-
cretion is characteristic, and when of pyemic origin, several joints
may be affected. The disease pursues the same course as in the case
of infected wounds of joints, the joint tending to rapid disorganiza-
tion. The capsule gives way and discharges externally. Should the
inflammation subside, interarticular granulations spring up, and
these undergoing ossification, ankylosis results. In pyemic arthri-
tis of the new-born following omphalo-phlebitis, the foci ordinar-
ily develop in the shoulder, elbow, knee, hip, and stifle joints, and
often undergo spontaneous recovery. In the chronic tubercular
form, the internal face of the sac is covered with vegetations, the
synovia is slightly purulent and reddish in color, the bacilli are found
present, and there are invariably tubercular lesions elsewhere. This
form of the disease is very rare. A case has been recorded by
Cadiot.

Symptoms and Diagnosis. The symptoms of acute rheumatic
arthritis are intense pain on the least movement as manifested by
extreme lameness, marked local heat, constitutional disturbance,
affection of one ‘or more joints simultaneously, and very frequently,
shifting of the disease from one joint to another. In chronic rheu-
matic arthritis, the affected joints are stiff and painful, the symp-
toms are aggravated by cold and dampness, and several joints
may be involved. In simple arthritis of other than rheumatic ori-
gin, there is distension of the synovial sac, the movements of the
joint are suppressed, and the member may be unable to bear the
weight of the body. When chronic, there is little pain but hydrar-
throsis.

The symptoms of purulent arthritis are similar to those that
follow infected wounds of joints. There are fever and rapid pulse.

362 «§=©©Surgical Diseases and Surgery of the Dog

The joint is swollen, extremely sensitive, and fluctuates in places.
Finally, the pus discharges by one or several fistulous tracts.

Treatment. In acute rheumatic arthritis the internal admin-
istration of alkalies and salicylates is indicated. Pending recovery
absolute rest should be enjoined. The long-standing chronic form
of the disease is incurable, but the symptoms can be somewhat
mitigated by tonic treatment. Massage is also helpful. Excessive
synovial effusions which do not tend to be resorbed may be as-
pirated with antiseptic care. Purulent accumulations must be
promptly removed, the procedure comprising free incision in two
or more situations, antiseptic irrigation with corrosive sublimate
solution (I:1000) morning and evening, drainage, antiseptic dress-
ing and immobilization.

Osteo-Arthritis. Arthritis Deformans. Differing from chronic
rheumatic arthritis in extensive alteration in the joint structures,
osteo-arthritis is a disease more commonly observed in members
of the larger breeds particularly those which have been used for
draught purposes. The pathologic changes are disposed to be sym-
metric and consist in destruction of the articular cartilages and
increase in length and thickness of the periphery of the bone by
ossific deposit. In advanced cases the tendons about the joints
ossify. The cause is obscure but the disease is probably due to some
form of malnutrition of nervous origin. The articulations usually
affected are those of the knee, elbow, and stifle.

Symptoms and Diagnosis. Osteo-arthritis has a very slow evo-
lution. As the deformity of the joints develops, lameness, rigidity, —
and articular crepitus appear.

Treatment. The disease being incurable, no treatment is of
any avail, but the general health may be maintained by tonics.

BIBLIOGRAPHY.

Cadiot—Bull. de la Soc. Cent. de Méd. Vétér. 1895.
Carougeau—Rec. de Méd. Vétér. Nov., 1899.
Hertwig—Chirurgie f. Thieraerzte.
Stockfleth—Handbuch der thieraerztl. Chirurgie.

CHAPTER XIII

Neoplasms

This chapter is devoted to a description of the forms of Neo-
plasms that I have been able to find recorded as occurring in the
Dog. Certain forms, known to occur in other animals and in man,
are putposely omitted, because I have not succeeded in finding re-
liable data concerning their appearance in the Dog.

Surgical Neoplasms comprise about five per cent of all diseases
the practitioner is called upon to treat (Froehner). In other words,
in every twenty dogs treated, one is afflicted with some form of
growth.

We may conveniently divide conditions of Neoplasia into four
great groups:

(1) An increase in the
(a) Hypertrophy In which there is size of the individ-
excessive growth ual cells.

of a tissue in its
normal __ position,
the enlargement

(b) Hyperplasia being due to Pe ee

number of cells.
(2) Inflammatory Neoplasms:

(a) Simple Granulomata—Tumors formed of excessive
granulation tissue.

(b) Infective Granulomata—Tumors produced by in-
flammatory reaction in consequence of specific mi-
croorganisms.

(c) Strictures—In which there is diffuse overgrowth
of connective tissue producing structural changes
in the walls of canals.

(3) Tumors Proper:

(a) Simple Tumors—Tumors formed of tissues and
cells of the individual, the type of which predomin-
ates, and which have taken on a functionless and
excessive growth, and in which the power of growth
is indefinite.

363

364 Surgical Diseases and Surgery of the Dog

(4) Cysts—Abnormal encapsulated collections of fluid.
(b) Compound Tumors—Tumors formed of several
tissues.

(1) Hypertrophy and Hyperplasia

(a) Hypertrophy is commonly seen in organs which have
sustained an increase in functional activity. Thus, we see a
simple “accommodative” hypertrophy of the Uterus during preg-
nancy with increase of size in the individual cells. The Cervix
Uteri is also occasionally the seat of hypertrophy. Hypertrophy
of the muscularis of the Bladder is sometimes seen when that
organ contains calculi of large size. Johne saw an increase two
or three times above normal. A similar condition is seen in the
wall of the Intestine on the proximal side of a constriction or
chronic obstruction. When one of bilateral organs takes on the
function of its fellow, it enlarges, and the condition is spoken of
as “compensatory” hypertrophy. Thus, when one Kidney becomes
hydronephrotic or is extirpated, or the renal artery is ligated, the
opposite kidney enlarges. Gibson found the Mesenteric Glands
distinctly enlarged in an animal that had undergone splenectomy
six months previously. Hypertrophy of the Muscularis of the
Heart is seen in varying degrees according to age, breed, sex, etc.,
in certain diseases, and particularly the character of the ex-
ercise indulged in. Strictly speaking, that which is termed hyper-
trophy of the Heart is both hypertrophy and hyperplasia. The
hearts of hunting dogs are always relatively large. In old dogs a
general increase in the amount of all the component tissues leads to
hypertrophy of the Prostate Gland. The immediate cause of these
cases of enlarged prostate is not known. Some have suggested
increased vascular supply, but this is inadequate. Leisering de-
scribed hypertrophy of the Sebaceous Glands situated on the pos-
terior aspect of the fore-leg. According to Kitt, the Intestinal
Villi may become hypertrophied to a size four times above normal
through the irritation produced by the burrowing of tape-worms.

(0) Hyperplasia. As will be mentioned under Fibromata,
no sharp distinction can be made between this condition and
fibrosis. Irritation will lead to proliferation of connective tissue.
A familiar example is seen in the Skin at points exposed to friction or
pressure. Enlargements of the Thyroid Gland depending upon in-

Neoplasms 365

creased development of the parenchymatous tissue are commonly
associated with proliferation of the connective tissue stréma. Other
hyperplasias develop without adequate discoverable cause, particu-
larly in the Viscera, of which cirrhosis of the Liver is an example.
Hyperplasia of visceral canals will be referred to again under
Strictures.

(2) Inflammatory Neoplasms

(a) Simple Granulomata. A simple granuloma is a neoplasm
which does not advance beyond the stage of granulation tissue and
generally results from a wound. Wherever there is redundant
granulation tissue it is probable that the excessive growth arises
as a result of bacterial irritation. A granuloma involving the en-
tire Cornea was witnessed by Beierle.

(b) Infective Granulomata. Included under this heading are
the tumor-like formations produced by the agency of mi-
croorganisms. They are distinct from the simple granulomata in
that they are produced as a rule not merely upon the surface, but
throughout the various tissues. In some cases they are easily to
be confounded macroscopically with true tumors. This is particu-
larly the case with Visceral tubercular lesions which often assume
a carcinomatous or sarcomatous appearance. At one time Pleural
neoplasms were regarded as cancerous in nature, but the researches
of Cadiot have shown the commonest form of growth in this lo-
cality to be of tubercular origin. Among seven thousand dogs
examined at the Alfort School two hundred and fifty were found
to be tuberculous. In twenty-seven of these animals, twenty-one
showed the Lungs to be affected, fourteen the Pleura, fourteen the
Bronchial and Mediastinal Glands, three the Pericardium, one the
Heart, thirteen the Liver, twelve the Kidneys, six the Peritoneum
and Omentum, four the Spleen, and two the Intestinal Wall. Tu-
bercles were also found in the Testes, Bladder, and Ureter. The
mode of infection is believed to be by ingestion of sputum of
phthysical persons or inhalation of finely attenuated bacilli-bearing
sputum or dust. Of the twenty-seven dogs six belonged to res-
taurateurs, in whose establishments it is not a rare thing to find
infectious sputum, and where sweeping distributes the virulent dust
in the lower strata of the atmosphere. The above statistics agree
well with others recorded by Jenson who found the organs affected

366 Surgical Diseases and Surgery of the Dog

as follows in a total of twenty-eight animals: Lungs nineteen, Kid-
neys twelve, Spleen two, and Pericardium two. Cramer once saw
the Ovaries involved, and Mueller witnessed tubercular ulceration
of the Skin. Tubercles vary in size from a pin-head to a pea, and
when confluent may be of irregular dimensions. In color, they are
usually grey or white, and in consistence, rather solid on serous
membranes. They are productive of effusions.

Actinomycotic growths are occasionally witnessed in the dog.
Torrance destroyed a pointer suffering from ascites, and at the
necropsy found a large, solid, actinomycotic mass occupying the re-
gion between the heart and the diaphragm, and involving the pos-
terior part of the Right Lung, part of the Pericardial Sac, and the
Diaphragm. Gohn treated a case following a bite over the Tibia
with secondary infection of the Mouth. The disease is also re-
ferred to by Cadiot & Almy and Friedberger & Froehner, while
Murphy cites an instance in a woman whose dog had died with a
large swelling under the Jaw. Rabé observed a microorganism
resembling the actinomyces which he obtained from an animal suffer-
ing from multiple abscesses.

Under this heading I include conditionally the tumor-like for-
mations which occur in the Genital Mucosa of both sexes. There
is considerable diversity of opinion as to the histologic identity of
these growths. Smith & Washbourn, in England, who have ex-
perimented considerably with this disease, recognize it as sarcoma.
But it must be remembered that it is by no means an easy matter
to distinguish between granulomatous cells and those of true sar-
comatous nature. Both arise from connective tissue elements, the
process of development in either stopping short of cicatricial trans-
formation. It was Virchow who originally employed the term In-
fective Granuloma to emphasize the points of resemblance between
such cellular growths and true forms of tumor. The growths in
question have been variously described as papilloma by French
authorities, as condyloma by Bruckmueller, as carcinoma by Wehr,
Froehner, and other German authorities. Wehr inoculated minute
portions of these growths in the subcutaneous tissue of healthy
dogs with positive result in a number of cases. But with one ex-
ception, the growths after attaining the size of a hazel-nut became
absorbed completely. In the exceptional case, secondary nodules
developed in the internal lymphatics and spleen and caused the
death of the animal by inhibiting the urinary outflow which led to

Neoplasms 367

rupture of the bladder. In Smith & Washbourn’s investigations
one male was mated with twelve females, eleven of which became
affected. A second male contracted the disease from the females
and conveyed it to one of the two females with which it was mated.
In the vaginal wall the growth resembled a raspberry, and gradu-
ally increased in size and extent until the whole passage was in-
volved. It was situated most commonly in the neighborhood of
the urethral orifice, but in some cases projected from the vulva.
Sometimes the tumors were large enough to block up the vagina.
Older animals suffered more particularly, and very old ones were
severely affected. In the penis the growth was circumscribed, one
about a quarter of an inch in width. The mass was lobulated,
slightly constricted at the base, of a pinkish or purple color, and of
a consistence varying between soft and firm, but never hard. On
section, the surface was whitish and moderately firm. In one in-
stance there was a secondary growth in the inguinal glands. Smith
and Washbourn inoculated portions of the tumors into the sub-
cutaneous tissue of dogs. In four, the experiment was unsuccess-
ful, but tumors developed in the remaining thirteen. The follow-
ing conclusions were reached: These tumors can be transplanted
from the genitals, where they generally occur, to the subcutaneous
tissue of other dogs. They can be transplanted from subcutaneous
to subcutaneous tissue in other dogs. After reaching a maximum
of growth they may disappear spontaneously with or without ul-
ceration. They may continue to increase and cause death by
secondary deposits forming in the viscera. If the tumor disappears,
the animal is subsequently immune. Some animals are naturally
refractory.

(c) Organic Strictures. These are lesions of slow develop-
ment and may not become obstructive for a lengthened period.
Their origin in some cases is obscure, but they are generally re-
garded as resulting from a true inflammatory process having its seat
in the mucosa or submucosa. Stricture is occasionally seen in the
Intestinal Canal, particularly in the Duodenal Region, as a cir-
cumscribed hyperplasia. Generally, the walls are greatly thickened
at the point of lesion, the mucosa remaining intact. Hobday
has seen strictures in the Colon. The lesion has also been known
to follow the separation of a gangrenous intussusceptum and the
coalescence of the resected bowel after end-to-end anastomosis.
Stricture of the Urethra sometimes follows cicatrization of surgical

368 Surgical Diseases 2nd Surgery of the Dog

wounds or the irritation induced by the passage of calculi. Koch
refers to stricture of the Vagina, and Siedamgrotzky and Almy have
seen stricture of the Ureter.

(3) Tumors Proper

The effect of tumors on the organism is variable, but they
all have their being at its expense, performing no physiologic
function and contributing nothing to its support, and are therefore
truly parasitic.

Malignant growths have for their chief characteristics: inva-
sion of all the textures of the part in which they develop, rapidity
of growth, profound influence on the general health from the first,
tendency to recurrence after apparent extirpation, which means
a continued growth of left-over particles, and metastasis to other
and distant organs through the medium of the circulation or by the
lymphatic channels. They commonly ulcerate. On the other hand,
Innocent growths are generally well encapsulated, and do not in-
filtrate the surrounding structures, they grow slowly and with few
exceptions disturb the general health but little, they do not return
if completely removed, and do not produce secondary growths in
other parts of the body. While innocent tumors rarely undergo
a true process of ulceration, yet they are very frequently rendered
raw and sore by constant licking on the part of the animal, or by
abrasion through contact with the ground. They are sometimes
dangerous by reason of pressure they may exert on vital structures.
For instance, simple enlargements of the prostate gland are fre-
quently provocative of urinary troubles, and mediastinal neoplasms,
whether malignant or innocent, tend to give rise to nervous, cardiac,
respiratory, vascular, and digestive troubles. In the anterior me-
diastinum are found two groups of lymphatic glands—the bron-
chial, situated in the angle of bifurcation of the trachea, around
the origin of the bronchi, adjacent to which they extend for a
short distance into the pulmonary tissue,—and two trains of lo-
bules extend along the inferior face of the trachea from the base
of the heart to the first rib. Intimately related with these groups
are the anterior aorta and vena cava, cardiac, recurrent, and diaph-
ragmatic nerves, inferior cervical ganglia of the great sympathetic,
base of the heart, and vena azygos. Inflammatory tumors, such

Neoplasms 369

as tubercles, and tumors proper, and even simple adenitis following
Distemper, may encompass or compress the intramediastinal vas-
culo-nervous organs, the trachea, and the esophagus, giving rise
to manifestations of impairment of cardiac and respiratory func-
tions. It is not uncommon to observe a violently convulsive, dry
cough, without the usual concomitant symptoms of bronchitis or
pneumonia proceding from compression of the pneumogastric, a
condition to which the name of whooping-cough has been given.
Paralysis of the nerve finally develops and results in accelerated
cardiac action of such violence as to be perceptible at considerable
distance from the animal.

(1) SIMPLE TUMORS.

Connective Tissue Tumors
(a) Approximating to fully formed tissue:
Fibromata.
Chondromata.
Osteomata.
Lipomata.
Myomata.
Hemangiomata.
Neuromata.
(b) Formed of immature tissue:
Myxomata.
Sarcomata.
Epithelial and Glandular Tumors
(a) Approximating to fully formed tissue:
Adenomata.
Papillomata.
(b) Formed of immature tissue:
Carcinomata.

(2) COMPOUND TUMORS
Formed of several tissues:
Teratomata.
(1) SIMPLE TUMORS.

(a) Connective Tissue Tumors Approximating to Fully Form-
ed Tissue.

25

370 = Surgical Diseases and Surgery of the Dog

Fibromata. A fibroma is an innocent growth composed
of completely developed fibrous tissue grouped in irregularly
arranged bundles. With other tissue elements the fibromata com-
monly form mixed tumors, such as fibro-myoma, or fibro-lipoma.
They are closely related to the hyperplasias of connective tissue re-
sulting from chronic irritation, and in some cases can hardly be
differentiated. For instance, the diffuse form of chronic interstitial
mastitis characterized by the proliferation and projection of con-
nective tissue might be equally well classified as a hyperplasia.
Froehner regards the fibromata as standing second to the carcino- -
‘mata in frequency of occurrence, placing their percentage at thirteen.

They exist generally singly, but are often found in numbers.
They are commonly hard, but may be soft when situated in the
looser textures, and are of variable size and shape. In contrast
with the malignant tumors they are generally smaller, the average
size being that of a walnut; their growth is very slow, and they
remain quiescent for years. In further contrast with carcinomata
they are seen in quite young animals (from one to two years or
younger). Characteristic are their sharp demarcation from sur-
rounding textures, regularly firm consistence, intact surface, and
paucity of vascularity. They are sometimes rendered sore, how-
ever, by licking and gnawing. In shape they resemble a pea or
a nipple, and are occasionally pedunculate.

Fibromata occur most frequently in the Dermis and Subcuticu-
lar connective tissue and exhibit a predilection for the Breast,
Extremities, Eyelids, Back, Tail, the Mammae, and Submucous
Tissue particularly of the Vagina and Uterus (Petit, Leisering,
Watson, Penberthy, Leblanc, Romani). Rigal saw a large fibroma
attached to the Gastro-colic Omentum.

Chondromata. Cartilaginous growths may be innocent or
malignant. Innocent chondromata are frequently of mixed type,
such as osteochondroma. Very often the chondromata are asso-
ciated with sarcomatous elements when they are more or less
malignant. Chondromata may also be malignant to the extent of
forming metastases without the secondary nodules being histolo-
gically true sarcoma. The following recorded cases will serve as
examples: Virchow described a large ossifying chondroma of the
mamma, and a large tumor with a cystic interior in the omentum.
On the lungs there were numerous small nodules, most of which

Neoplasms 371

were on the pleura. Histologically, these nodules were found to
be composed of fibro-hyaline cartilage which had commenced to
calcify in the center. Ramifications extended from some of the
nodules into the lymphatics, and these had commenced to chondrify
in the center, but at the periphery there were collected groups of
cells without intercellular substance. “Nocard removed an osteo-
chondroma from the left inguinal mamma. A year later an anal-
ogous tumor had developed in the anterior left pectoral mamma,
which was also extirpated. In seven or eight months’ time an in-
cessant dry, harsh cough appeared without symptoms of bronchitis
but with violent and rapid cardiac action. The animal was de-
stroyed. At the necropsy were found: small osteo-chondromata
in the kidneys, and a multitude of similar tumors in the parenchyma
of the lungs. The right pneumogastric and cardiac nerves were
compressed and atrophied. Generali saw a mammary chondroma
form secondary growths in the lungs and kidneys, and one on the
pons Varolii. Cadéac saw an ossifying chondroma in the neck, the
size of a fist. It resembled abscess, which is often seen in this
region. It was blistered, but continued to enlarge until respira-
tion became impeded. Death followed in a few days. Post mortem
examination showed a voluminous tumor compressing the trachea
and esophagus. It was formed of a number of small nodules, some
of which were hard and some soft. On the mucosa of the larynx
were small miliary tumors, and on the mucosa of the trachea, and
in the lungs were other nodules. Boutelle worked out the pathology
of one of these tumors. An encapsulated, slightly lobulated calci-
fying chondroma of the mamma was removed surgically in Febru-
ary, 1892. In August, 1894, the subject was destroyed suffering
from abdominal tumor. The latter was found enclosed between
layers of peritoneum and attached to the stomach, omentum, and
spleen. A small portion of detached hepatic tissue was also ad-
herent to it. There were other secondary growths in the lungs,
pancreas, and axillary and mesenteric glands. The case also pre-
sented another interesting feature. At the site of operation in the
mamma a sinus had developed, and from this had arisen a
small growth which was histologically a carcinoma. Following
is the explanation of the process by which these tumors
develop. In the growth of chondromata’ the new cartil-

372 ~=©Surgical Diseases and Surgery of the Dog

age cells do not develop from pre-existing cartilage cells,
but from what may be termed “mother cells” of cartilage. At
the edge of a growing chondroma there are cells of an embryonic
type, looking like ordinary connective tissue cells, and it is these
cells which proliferate, and their “daughter cells’ develop a matrix
around them and become cartilage cells. So that such a chondroma
grows by the continuous accretion of new tissue at the peri-
phery. The cartilage cell as such is so surrounded by the matrix,
that manifestly it cannot form metastases, but these proliferative or
“mother cells’ can easily be carried by the blood stream to the
various parts of the body, and coming to rest in suitable relation-
ships will then proliferate and the resulting cells become true car-
tilage cells. It is in these primary cartilaginous tumors that there
occurs later on the osteoid or truly osseous change.

Mixed chondromata have been found in the Lungs (Cadéac),
the Thyroid (Siedamgrotzky, Kitt), the Tympanic Cavity (Siedam-
grotzky), the Cardiac Valves (Hamburger), in the Nasal Cavity
(Kitt), on the Digits, and they are very common in the Mammary
Gland. Of two hundred and fifty-six tumors of the mammae re-
moved at the Alfort School between October 1871 and December
1876, two hundred and eleven were osteo-chondromata.

Osteomata. These, the bony tumors, are not very common.
They are occasionally found on the Inferior Maxilla, the Penial
Bone, and on the Internal Face of the Cranium, particularly in dogs
suffering from ossifying pachymeningitis (Siedamgrotzky, Cadéac).
They have also been seen attached to the transverse process of a
Cervical Vertebra (Mueller), the Connective Tissue of the Neck
(Leisering), and on the Pulmonary Pleura (Vulpian).

Lipomata. Pure fat tumors are rare compared to other tu-
mors. They are more liable to show. other forms of connective
tissue, such as fibro-lipoma, lipo-myxoma. They occur most com-
monly as fibro-lipoma, and often attain enormous dimensions. They
are characterized by their subcutaneous situation, soft, lardaceous
texture, sharp demarcation, slow growth, and slight vascularity.
They are generally lobulated, due to septa of connective tissue.
In size, they may vary from a small nut to the human head. They
are the largest of all tumors. They are sometimes pendulous, and
not always round, but large and cylindrical. Froehner saw one
ten inches in length. Huidekoper saw one growing from the in-

Neoplasms 373

side of the thigh which nearly touched the ground. They are ob-
served mostly in well-nourished animals, and their favorite location
is on the Extremities, the inner surface of the Thigh, the Breast,
the Shoulder, the Belly, the Anal region, the Vagina (Oreste,
Falconio). They also occur in the Medulla of the Kidney (Bruck-
mueller), the Liver (Trasbot), the Trachea, Pleura, and Lungs
(Kitt, Semmer), and the Intestinal Submucosa. Two tumors at-
tached to the Uterus, one of which had grown through the muscular
wall of the abdomen, were seen and described by Edgar as lipo-
mata. It is doubtful if they could have been true lipomata, be-
cause a feature of lipomatous tumors is that they do not tend to
grow through surrounding tissues.

Myomata. A myoma is a tumor composed of unstriped
muscle fibers (leiomyoma) containing as a rule a considerable pro-
portion of fibrous tissue. It is of fleshy consistence, pinkish in
color, quite vascular, and may attain the size of the human fist. They
are seldom seen, but have occurred in the Heart (Jungers), in the
Bladder (Liénaux), within the Vagina (Mueller), and in the Pros-
tate. They are occasionally found in the Genital Tract of females,
but are extremely rare in the bicornate uterus. Fibromata
of the uterus are often in part myomatous, and Sutton has sug-
gested that many tumors described as fibroids are in the first in-
stance leiomyomata, but become degraded into fibrous tissue.

Hemangiomata. A hemangioma is a tumor composed largely
of blood vessels. Some authors include in the term localized dila-
tions of blood vessels, such as hemorrhoids and the scrotal vari-
cosities seen by Moeller, but these are not true angiomata of pro-
liferation. Virchow states that angiomata are comparatively rare
in animals. A lobulated angioma composed of groups of vessels
held together in a stroma of connective tissue and situated in the
Subcutis of the Right Groin was observed by Siedamgrotzky. The
term Cavernous angioma is used to indicate enlarged spaces lined
with endothelium, forming an erectile tissue, such as exists norm-
ally in the corpus spongiosum. They occur in the Liver, and while
quite common in the cat are not often met with in the dog. Sutton
has observed them as multiple enlargements, the size of walnuts,
occupying the liver substance and forming prominences on its
exterior. There is a very good specimen of this condition in the
Army Medical Museum at Washington. Lucet saw a cavernous

374 Surgical Diseases and Surgery of the Dog

angioma on the Left Shoulder. The term Plexiform angioma,
“Aneurism by Anastomosis,” is used to describe a condition where
vessels become dilated and convoluted and their walls thickened at
the spot. These by pressing on the intervening tissue cause it to
atrophy. This condition, properly speaking, is not one of neoplasia,
but a pathologic alteration of the vessels. It has been seen in the
Pectoral Mammae, in the Inferior Eyelids, and on the Prepuce
(Rigot). Crisp and Stibel also refer to this condition, the former
having possessed a good specimen.

Neuromata. This term is commonly applied to any tumor
arising from nerve tissue, such as overgrowths of the perineurium
and connective tissue of the nerve sheaths, but is properly only
employed in describing growths of nerve fibers with the complete
nerve cell undergoing proliferation. They are exceedingly rare,
but occasionally appear in the form of bulbs, composed of newly-
formed nerve fibers on the ends of severed nerves, and according
to Sutton, particularly when the proximal end is irritated by the
presence of a silk ligature.

(b) Connective Tissue Tumors Formed of Immature Tissue.

Myxomata. These tumors are composed of connective tissue
cells and an intercellular substance containing mucoid material, the
whole being traversed by thin-walled vessels and forming a spongy
structure. The more fully developed connective tissue tumors (fi-
bromata, lipomata, chondromata, etc.,) sometimes show areas of my-
xomatous growth. Myxomata are fairly common, and may at-
tain considerable size. One as large as the human head was seen
by Scoffié. A typical myxoma is soft and flabby, with a limiting
capsule, and either projects from a surface or hangs by a narrow
pedicle in the form of a polyp. Common situations are the sub-
mucous and Subcutaneous structures. They occur in the Pharynx
(Moeller), the Membrana Nictitans (Huidekoper), the Bladder
(Van Tright, Johne), the Penis (Koch), the Mammary Gland
(McFadyean), and the Vagina.

Sarcomata. By the term sarcoma is meant a tumor composed
of any variety of cell of connective tissue origin, which cells before
reaching maturity proliferate and divide, so that the whole growth
is composed of incompletely developed cells, like those of embryonal

Neoplasms 375

connective tissue. Ordinary healthy connective tissue is formed from
cells which have undergone a process of transition from cellular
to fibrous condition. In sarcomatous tissue, these cells show a
tendency to continuous proliferation instead of the formation of
fibrous trabeculae. Consequently, the consistence of sarcomata is
usually soft, but they may be mixed with more or less fibrous tissue,
when they are hard. They are often enclosed by a capsule, but fre-
quently infiltrate neighboring tissues. They are very prone to un-
dergo partial or complete mucoid changes. The partially de-
generate form is described as “sarcoma myxomatodes.” Instances
have been recorded by Creighton.

The Sarcomata occur with less frequency than the
carcinomata, Froehner placing their percentage at six or seven,
but they are equally variable in appearance. A mixed form is rather
common, such as fibro-,chondro-,osteo-,lympho-,myo-, and myxo-
sarcomata. In their gross appearance the sarcomata often manifest
a close resemblance to the carcinomata. They are remarkable for
their development in young as well as adult dogs, for their rapidity
of growth (some, however, grow slowly), their soft consistence
(some are also hard), their partiality for periosteal surfaces, their
inclination to metastasis, and their tendency to ulceration when
located in the skin and mucous membranes. Metastatic dissemina-
tion is mostly by the veins and particles becoming detached to be
carried along as emboli. By reason of this it is a common thing
to find secondary sarcoma in the lung or even right heart, and where
the portal vein is invaded, the liver. The tendency to ulceration
is probably dependent on the rege nL aS of nutrition with
rapidity of growth.

Primary Sarcoma exhibits a predilection for the Frontal Re-
gion, the Superior Maxilla, the Sternum, Bones of the Extremities,
the Skin, the Muscles, and the Mammary gland. Other organs
- sometimes invaded are the Nasal Bones (Kitt), the Testes (Siedam-
grotzky), the Vagina, the Uterus (Moeller), the Heart (Cadiot,
Bourney, Kitt, Johne), the Thyroids (Cadiot), the Lungs and Pleura
(Cadéac, Kitt, Leisering), the Stomach (Benoit, Mégnin), the In-
testine (Petit), the Omentum (Siedamgrotzky), and the Peritoneum
(Bournay). The cases of round-cell sarcoma of the Penis and
Vagina described by Smith & Washbourn are of very great interest,
but there is some doubt as to whether they were dealing with ex-

376 Surgical Diseases and Surgery of the Dog

cessive granulomatous formation or true sarcoma. This form of
growth is referred to under Infective Granulomata. True sarcoma
of the Vagina does, however, sometimes occur, for myxomatous
growths have been observed to undergo sarcomatous transforma-
tion.

The disease occasionally occurs as a general sarcomatous for-
mation (Mégnin, Froehner). A variety known as myelogenic sar-
coma is sometimes seen attacking the interior of Bone Cavities,
principally of the fore-arm and the shoulder. The distinguishing
feature between myelogenic sarcoma and periosteal sarcoma is that
the former is an excessive development of the bone marrow and
the letter of the periosteum, so that the cells forming the two are
of a different type.

Lympho-Sarcoma is the term used to denote primary sar-
coma of lymphatic structures. The lympho-sarcomata are com-
posed of the same kind of cells, but have a stroma of reticulated
lymphadenoid tissue. They are not to be confounded with lymph-
adenoma nor with specific inflammatory enlargements involving
lymphatic structures. The dividing line between lympho-sarcoma
and lymph-adenoma is absolutely vague, as again between lymph-
adenoma (Hodgkin’s disease) and leukemic lymph-adenoma (lymph-
atic leukemia.) | Where the growth remains within the capsule
of the lymphatic glands then the term lymph-adenoma or “Hodg-
kin’s disease” may be applied. Where accompanying such glandular
overgrowth there is increase in the lymphocytes in the bloud, the
condition is one of leukemic lymph-adenoma or lymphatic leu-
kemia; where the excessive growth of the lymphatic tissue goes
on to infiltration and metastases, it is lympho-sarcoma. The lympho-
sarcomata are the most malignant of all the sarcomata, and are very
infiltrating. On account of their rapidity of growth and profound
effect on the general health it has been suggested that they are the
product of some very active species of microparasite. Their con-
sistence varies from soft to moderately firm with occasional calcar-
eous deposits, and the color on section is pinkish or reddish, and
they sometimes undergo cystic transformation, containing a red-
dish viscous, inodorous liquid. The lymphatics of the Neck and
Pubic region are most commonly affected, but any or all the glands
of the body may be involved. These growths are extremely metas-
tatic.

Neoplasms 337

Melano-Sarcomata or Melanomata are characterized by de-
position of a blackish pigment, both in the cells and intercellular
substance. While common in the horse, they are rare in the dog.
They arise especially from regions where there are already pigment-
containing cells, notably from pigmented moles. They are ex-
tremely malignant, and secondary deposits are often found at con-
siderable distances. They have been found in the Lips and Mouth,
whence they have traveled to the Lungs, appearing there in the
form of black interlacing lines (Lafosse, Bruckmueller). This
condition must not be confounded with the more common one of
coal-dust deposits (anthracosis pulmonum). Melanoma has also
been seen at the Base of the Brain in the form of little nodosities
(Bruckmueller). According to Leblanc, mixed melanotic growths
are not uncommon. There is a very good specimen of melanotic
sarcoma of the Pectoral Mammae in the Army Medical Museum
at Washington. Sutton refers to a variety of melanosarcoma which
seem to become mainly a source of pigment, which may enter the
circulation and be discharged in the urine as melanin. Such a
tumor was observed by Bunker. It was situated Subcutaneously
and discharged an offensive black matter through several openings.
Another tumor composed of fungoid growth mixed with melan-
otic matter was removed from the Breast by Crisp, and the animal
succumbed twelve months later to the same disease in the Lungs.

Glio-Sarcomata. A glio-sarcoma is a tumor containing neuro-
elia-cells mixed with sarcomatous elements, occurring in the central
mass of the brain or spinal cord. With regard to gliomata and glio-
sarcomata a difficulty presents itself in dividing tumors according
to their embryology. The ordinary sarcoma is derived from or-
dinary mesoblastic connective tissue. The glioma which closely re-
sembles it in structure is derived from the neuroglia, the connec-
tive tissue of the brain and retina, but this connective tissue, like
the nerves themselves, is of epiblastic origin. A tumor of this
nature, situated in the neighborhood of the Gasserian Ganglion was
observed by Gratia.

Endothelial Sarcoma or Cholesteatoma is a term applied to a
proliferation of endothelial cells aggregated into nodules of a pe-
culiar glistening pearl-like appearance. They originate from serous
membranes, lymphatics, blood vessels, and from the pleural and
cerebral membranes, and also occasionally in glandular organs.

378 Surgical Diseases and Surgery of the Dog

They are highly vascular, but run a slowly malignant course. They
are extremely rare. They have been seen the size of a pea occur-
ring on the Choroid Plexus and in the Lateral Ventricles (Cadéac,
Dexler), and the size of a nut occurring in the Parotid region
in two different animals (Liénaux).

(a) Epithelial and Glandular Tumors Approximating to Fully
Formed Tissue.

Adenomata. An adenoma is an innocent growth originating
from pre-existing glandular tissue and formed by proliferated
gland cells arranged in an orderly manner, and supported by a
fibrous stroma. But these cells differ from normal ones in that
they have no power of producing the normal secretion peculiar
to the gland tissue from which they grow. That is to say, if any
secretion at all is produced, it is a modified one, and the gland
has no means of discharging it externally by proper ducts. There
are adenomas of the liver which clearly show bile pigmentation,
and thyroid adenomas may lead sometimes to exophthalmic goiter
brought about by excessive production of excretion, which often
disappears upon removal of the tumors. Tumors of this class show
no tendency to infiltration of neighboring lymphatics, but under
certain conditions are capable of developing malignant characters.
(See Carcinomata).

The adenomata are often of mixed type, such as fibro-adeno-
mata, myxo-adenomata. Common seats are the Mammary Glands
(Sutton), the Peri-anal Glands, the Prostate Giand, and the Se-
baceous and Sudoriparous Glands of the Trunk and Extremities
(Liénaux, Leisering, Siedamgrotzky). Other organs in which this
form of tumor has been observed are: Harder’s Glands (Froeh-
ner), the Liver (Hobday), the Ovary (Sutton), the Vagina (Cam-
-ardi), the Lungs (Stockman), the Thyroid (Woelfler), and the
Cerebrum (Penberthy).

Lymphadenoma. This term is used to denote a form of neo-
plasm affecting lymphatic tissues and having the structure of lymph-
adenoid tissue. It occurs as a purely innocent local affection, a
common seat of which is the spleen, and also as a more or less
malignant disease. The difference between the latter and splenic
leukemia and lympho-sarcoma has already been pointed out under

Neoplasms 379

Sarcomata. The malignant form of growth may or may not be
associated with the condition known as splenic leukemia in which
there is also an augmentation of splenic pulp and an actual increase
in the number of leucocytes in the blood. There is no tendency
to extension of the disease process beyond the capsule of the glands,
the latter retaining their shape, so that the condition might be re-
ferred to as one of malignant hyperplasia. Single or several groups
of glands may be involved. The growths are soft or hard, accord-
ing to the amount of connective tissue present. They are danger-
ous in that they may exercise destructive compression of vital or-
gans, particularly intrathoracic ones, and the disease is eventually
fatal through production of cachexia and exhaustion.
Papillomata. A papilloma is a benign tumor arising from a
surface and having a framework of fibrous stroma and bloodvessels
with a covering of squamous epithelial projections or proliferations.
In common parlance it is termed a wart. According to Froehner,
the papillomata form ten per cent of all tumors. They occur chiefly
in young animals, and like other benign tumors, often in multiples,
and seem to arise in a spontaneous manner through causes which
are not understood. They also disappear with equal spontaniety.
Two forms are recognized, the hard growing on the Skin, and the
soft growing generally on Mucous Membranes. They are fre-
quently seen at the junction of mucous membrane with the skin.
The hard form exists as smooth hemispheric elevations, and the
soft as dendritic growths, i. ¢., arborescent masses growing from
a common base, or as cauliflower-like pedunculate growths. They
are always sharply defined from the neighboring parts. In general,
they are not very large, varying in size between a pea and a wal-
nut. In the skin they appear commonly on the Head, Back, and
Prepuce, and on the Extremities, particularly round the Pads of
the Feet, but may occur in any part of the body. Skin warts are
frequently the seat of melanotic deposits—the so-called pigmented
moles. In old animals there is good reason to believe that they
may become the starting point of true malignant epithelial in-
growths, and it is noteworthy that they grow in places commonly
the seat of epithelioma. Sometimes the epithelial layers decompose
and ulcerate, especially when irritated, by which they undergo dessi-
cation, and fresh material being continually added to the base,
a Wart-horn is produced. In the Vestibule of the Outer Ear papil-

380 Surgical Diseases and Surgery of the Dog

loma occurs as a peculiar flat, coin-shaped excrescence, which is
very troublesome, invariably giving rise to a noisome otorrhea. On
mucous membranes they occur at the edge of the Eyelids, on the
Membrana Nictitans, and on the Lips, Gums, Hard Palate, Tongue,
and Trachea (Mouguet). In the buccal cavity they are seen par-
ticularly among puppies and young dogs, and as they are often
observed to occur in several animals in the same kennel they are
regarded as contagious or infectious in character. Experiments
conducted by McFadyean and Hobday prove at least their inocula-
bility. These gentlemen succeeded in inoculating other dogs by
rubbing excised wart on a small area of scarified mucous membrane
on the lips. The growth developed in that locality in from six to eight
weeks, but failed to do so on the penis. Attempts to re-infect dogs
which had recovered gave negative results. These tumors always
disappear of their own accord, though successive crops of them will
develop at intervals of a week or two for a certain period. They
may be compared with the growth of warts on the hands of young
boys. Papilloma have been observed in the Pelvis of the Kidney
by Bruckmueller and Siedamgrotzky.

Endothelial Papilloma of the Pleura has been described by
Hutyra and Kitt. In the former’s case there were fine villous
clusters an inch in length, and those attached to the mediastinal
portion formed a tumor as large as the infantile head, displacing
the heart. The histologic structure was richly vascular with a
simple endothelial lining.

(b) Epithelial and Glandular Tumors Formed of Immature
Tissue.

Carcinomata. According to Froehner, these constitute by far
the commonest of all the neoplasms, averaging forty per cent of
the whole. Two main types are included in the term, viz., the
EPITHELIOMATA and the MALIGNANT ADENOMATA.

The Epitheliomata are derived from squamous epithelium, which
proliferate and form new growths. They arise most commonly
at the seat of junction of skin and mucous membrane, or where
two different kinds of epithelium merge.

The Malignant Adenomata are composed of proliferated glan-
dular cells, appearing as an overgrowth of follicles with a tendency
. to retrogressive metamorphosis of cells and infiltration of neighbor-

Neoplasms 381

ing textures. When such an overgrowth of follicles tends to retain
the glandular form it is termed Adenoma, but when the overgrowth
is characterized by infiltration and development of an embryonic
type of cells it is termed Carcinoma. If both types are present
in the same tumor it is termed Adeno-Carcinoma. The histo-
genesis of cancer remains a mooted point. There are some who
zealously advocate the parasitic theory, and others who as ardently
oppose it. Still other authorities are willing to concede the pos-
sibility of a parasitic origin in the first instance sufficient in itself
to initiate the atypical cell proliferation, or so to speak, to start the
cells running wild on a wrong track, but suggest that the habit once
having been acquired may continue independent of the initial
stimulus. At the present time the majority opinion is against the
parasitic origin of the disease. Heredity is generally recognized
as a potent predisposing factor in the dog as in man, but it must
be remembered that the lineal and clinical histories of our patients
are seldom traceable with accuracy. It is recognized that benignal
adenomatous tumors offer conditions favorable to the development
of carcinoma. As they contain both glandular cells and connective
tissue cells it is easy to comprehend this capacity of transition.
The phenomenon might be aptly described as “progressive carcino-
matosis,” and it is particularly prone to occur in consequence of
repeated injuries or prolonged continuous irritation. A typical
example is afforded by the following case which occurred in my
practice: A male hound, aged eight years, for some years had been
secured by a chain, one end of which was attached to a ring which
ran on a wire about forty feet long. In this manner the animal
was enabled to run to and fro within a limited area. On its right
side, as it left its sleeping quarters, was a high wall, while on the
other side, a short distance away, was its master’s residence. Hence,
on running to and fro the length of the wire, it would invariably
get on the side looking towards the house, and it so happened that
the chain tended always to get between its front legs and rub
continuously on a certain spot on the posterior and inner aspect
of the right leg. About two years previous to the time the case
was brought to my notice, an abrasion was noticed on this spot,
which gradually gave place to a sessile fibrous growth which en-
larged slowly for eighteen months. It then suddenly began to in-
crease at a much more rapid rate, its weight causing it to become

382. Surgical Diseases and Surgery of the Dog

pedunculate. Having removed the growth, I submitted it to Pro-
fessor Adami, who pronounced it a fibro-adenoma undergoing what
could not be regarded as otherwise than an early cancerous change.
In an instance recorded by McFadyean a carcinoma appeared
to have developed as a secondary growth from an anal adenoma.
But in no part of the body are such striking instances of progressive
malignancy afforded as in the mammary gland. While true malig-
nant adenoma of these glands is far from uncommon, the usual
type of growth met with in this region is fibro-adenoma exhibiting
a modified malignancy with proneness to recur after ablation but
with a tardy tendency towards general dissemination. This recur-
rence may take place in the area from which the initial tumor has
been removed by continued growth of left-over particles, or it may
take place in the neighboring mammae owing to a latent tendency
towards this form of tumor-formation existing in the mammary
glands as a whole, and which may break out in individual glands
at different times, the growths forming in the later years of the
animal’s life being more inclined to exhibit malignant character.
In an instance which I observed a firm mammary tumor appeared
in a Skye terrier female at the age of eight years. After reaching
a moderate size it remained quiescent for seven years, when it
suddenly commenced to enlarge at an alarming rate in addition
to giving birth to numerous secondary growths in the neighbor-
ing glands. It proved on examination to be carcinoma. In the
middle of the last century Leblanc observed this phenomenon and
referred to “simple hypertrophic enlargements” as being commonly
mistaken for cancer. He made some consecutive examinations of
recurring mammary tumors and noticed a gradual transition into
malignancy. The first growth removed was found to be simple
adenoma, but malignant characteristics become more and more ac-
centuated according as the recurrence increased in frequency.
Froehner believes that the majority of such tumors are malignant
in character, while McFadyean has expressed the view, after exam-
ining a series of these growths that the commonest form of en-
largement is of the nature of a fibrous induration, the groups of
cells scattered through the fibrous stroma being in reality the
compressed remains of the glandular acini, the compression re-
sulting from the formation of new connective tissue.

There is a specimen in the Army Medical Museum at Wash-

Neoplasms 383

ington showing primary adeno-carcinoma of the mamma with
secondary growth in the liver and spleen.

The carcinomata are notable on account of their rapid growth,

* but curiously enough, they may remain quiescent after attaining a
certain degree of development. Strong proof of carcinomatous
character is the progressive extension of a tumor to adjacent tissues.
Regional extension takes place through lymphatics with which they
are abundantly supplied, while general dissemination mostly takes
place through the venous system through perforation of a vein-
wall by carcinoma cells. Dissemination is less frequent in epithe-
lioma than in malignant adenoma.

Adult animals are the principal sufferers, and the average age
is in the neighborhood of eight years. Froehner based some
statistics on sixty-five cases he had treated by surgical procedure,
as follows:

Number of dogs affected. Aged.
Io 2—4 years.
18 5—6 years.
22 7—8 years.
12 g-I0 years.
4 12-13 years.

In a hundred observations on the part of Cadiot and Almy the
proportions were similar:

Number of dogs affected. Aged.
6 I—3 years.
18 3—5 years.
33 6—9 years.
26 Q-I2 years.
14 12-15 years.
3 15-20 years.

In microscopic appearance, carcinomata vary according to their
situation and period of existence. A typical carcinoma as occur-
ring in the skin is a more or less uneven, indurated, and sensitive
growth with a metastatic tendency to infiltrate neighboring tissues.
It has a circumscribed edge and a raw, ulcerating, crater-like center,
from which an offensive discharge is emitted. Ulceration is often
absent, and instead, the surface has an irregular scarred appearance.
The tumor is freely mobile from the surrounding tissues but inti-
mately adherent to its cuticular covering. Its dimensions may vary

384 Surgical Diseases and Surgery of the Dog

from the size of a pea to that of an apple or even the infantile head.

Carcinoma of the Skin manifests a predilection for the Ears and
Eyelids or their proximity, the Edges of the Lips, the Root of the
Tail, the Legs, the Paws, and the Scrotum. Carcinoma of the
Testes is not uncommon though there has been some difference of
opinion among veterinary pathologists as to the identity of these tu-
mors. Malignant growths of the testes are peculiarly difficult to
classify, as there may be every kind of deviation from the pure con-
nective tissue tumor through the mixed connective, adenomatous, or
cystic tumor, to the tumor of the almost purely glandular cancerous
type. The liability for tumors to show both proliferation of the tubes
and proliferation of the interstitial tissue, a peculiarity which is
also seen to some degree in the kidney is the explanation of the so-
called carcinoma-sarcomatodes. Kitt refers to the condition when
confined to the testicle as Hypertrophia adenosarcomatosa testis but
when it assumes a progressive character he names it Carcinoma testis
sarcomatodes. In cryptorchids the retained organ is often cancer-
ous. (Leisering, Sutton)

Primary Carcinoma of the Viscera is a comparatively rare dis-
ease. The organs in which either primary or secondary forms occur
are: the Bladder (Schulz, Demeurisse), the Prostate Gland, the
Kidneys and Supra-renals (Bruckmueller, M’Fadyean, Kitt, Bour-
ney), the Ureters (Siedamgrotzky), the Uterus (Leblanc, Bruck-
mueller, Camardi), the Thyroid (Siedamgrotzky), the Intestinal
Canal (Mueller, Cadéac, Laborde, Huidekoper, Eberlein), the Pan-
creas (Nocard, Cadéac), the Liver (Siedamgrotzky), the Spleen,
the Peritoneum (Cadéac), the Lungs (Kitt, Cadéac, Liénaux),
and the Heart (Cadiot).

(2) COMPOUND TUMORS.

Teratomata Comprising (a) Dermoid Tumors and Cysts and
(b) Parasitic Fetuses.

Dermoid Tumors and Cysts. These arise from sequestered por-
tions of the epiblast, occurring usually in unnatural positions. A
familiar example of Sequestration Dermoid is seen in the small
cutaneous nodules furnished with vibrissae which are constantly
present on the Cheeks in a line with the angle of the mouth. The
mucosa lining the surface of the Eye-ball is occasionally the seat of
congenital patches of skin, bearing tufts of hair, which have re-

Neoplasms 385

ceived the name of congenital moles. The explanation of their oc-
currence is based upon the development of the eye-lids. In early
fetal life the tissue covering the outer surface of the eye-ball which
ultimately becomes the conjunctiva is directly continuous with the
skin. Cutaneous folds arise and approach each other from the mar-
gin of the orbit to ultimately become the eye-lids, and their surfaces,
which are continuous with the covering of the eye-ball, become con-
verted into conjunctival mucous membrane. This conversion (into
mucous membrane) is dependent upon the complete occlusion of the
covering of the eye-ball, and if a portion or even all of the latter
remains uncovered, it persists as skin (Sutton).

Dermoid Cysts occur in the Ovaries. They may be composed
of skin or mucous membrane together with the appendages peculiar
to these structures such as hair and sebaceous glands, and contain a
mucoid fluid. Mueller quotes Esser as authority for their occurrence
in the dog. Dermoid Cysts containing rudimentary molar teeth
also occur in the Temporal Region (Werwey, Cadiot & Almy).
They usually undergo regressive metamorphosis, the cells consti-
tuting the lining of the cyst becoming detached to form part of the
cystic contents. Inflammation of the interior follows entrance. of
pyogenic microorganisms, and the matter gains exit by fistulous tract
in or near the auricular region.

Parasitic Fetuses are composed of cells of parts of individuals
parasitic upon another individual. They are not common. A very
interesting case was witnessed by Hodgkins where the parasite had
two fully developed feet and was attached to the tmbilicus of a
normal puppy.

(4) Cysts

A cyst is a tumor containing one or more cavities filled with
fluid or semi-fluid contents resulting from abnormal dilation of
pre-existing tubules or cavities. Strictly speaking, a cyst is not a
neoplasm, the whole style of a cyst being totally distinct from the
tumor proper, and so many widely differing factors may lead to cyst
formation that it is better to treat them as a totally distinct section.
Nevertheless, the purpose of the work will perhaps be best served by
including them in the same chapter.

Closely following Sutton’s classification, we recognize. in
the dog:

26

386 Surgical Diseases and Surgery of the Dog

(1) True Cysts.
(a) Retention and Gland Cysts....Hydronephrosis, Hydro-
é cholecyst, Ranula, Chy-
lecysts, Ovarial, Uterine,
Mammiary, Sebaceous,
and Mucous cysts.
C0). FAO SNES ©. Sass ire Geo Oe Cystic tumors associated
reg with remnants of the
Ducts of the Fetal Mes-

onephros.
(ey Eydrocele ssc chee aes Of the Tunica Vaginalis
Testis. ~

(2) Pseudo-Cysts.

CG) MISH roid at. Vie oth = Sat Deel atane, Ate eri Synovial, ete.
(b) Contusion and Extravasation Cysts ....Hematomata, etc.
(c) Neural Cysts . ‘Hydrocephalus and Piydrbtleld of Ventricles
(da): Parasite Cysts” oh ert. Ue ak Cea _...Hydatids
(e) Emphysematous CYStS oh eieg ates sacle ‘Of the Mesentery
(f) Degeneration CVEIS) nerigurnls Westies ah '.....Of solid Tumors

(1) True Cysts.

(a) Retention and Gland Cysts are formed by accumula-
tions of fluid which is hindered from escaping by some obstruction.
Should the condition persist, the glandular tissue undergoes pres-
ure-atrophy and finally the gland and its duct become converted into
a cyst, the contents of which are usually of a brownish-yellow color.
The condition known as Hydronephrosis is due to dilation of the
pelvis and infundibula of the kidney as a result of intra- or extra-
mural obstruction in some part of the urinary tract. If the obstruc-
tion occur in the Ureter from tumor, calculi, etc., or at its vesical
orifice, there is a unilateral accumulation, but if it occur at the Neck
of the Bladder or in the Urethra from enlarged prostate or impacted
calculus, the condition becomes bilateral. Unilateral hydronephrosis
does not necessarily exert a baneful effect on the health of the ani-
mal, the remaining kidney taking on the function of its defunct fel-
low, but bilateral hydronephrosis is speedily lethal through non-
elimination of urine. The condition has been observed by Roell,

Neoplasms 387

Siedamgrotzky, Almy, Cadéac, Sutton, Znamensky. Minute cysts
occur in the kidney as a result of interstitial nephritis. —

Hydrocholecysts result from obstruction in or about the Ductus
Choledochus, due to gall stones (Froehner), carcinoma of the head
of the pancreas (Nocard) or of the duodenum (Eberlein). This
condition is common to obstructive icterus. The term Ranula is
applied to all cysts occurring in the Floor of the Buccal Cavity,
whether of submaxillary, sublingual, or mucous origin. These cysts
arise through cohesion of the margins of the ducts.

Chy yle- cysts are formed of separated layers of Mesentery and
contain a chyle- -like fluid. Caparini saw an enormous perigastric
cyst extending from the stomach to the pelvic ‘inlet, which seemed
to have arisen under the peritoneal coat of the stomach at its greater
curvature and burrowed between the layers of the omentum.

Ovarial cysts represent accumulations of unruptured ripe
Graafian Follicles and probably owe their origin to thickening of
the follicular wall owing to chronic inflammation of the ovary. They
develop after incomplete oophorectomies, when sufficient glandular
tissue is left to function.

Uterine Cysts, under the name of Hydrometra, are character-
ised by accumulation and retention of the products of glandular se-
cretion. This condition is caused by cicatricial occlusion of the cer-
vical canal as a result of endocervicitis originating through injury
received during parturition, or it may arise ‘through pressure at the
cervix by the ring in inguinal hernia. The cavity of the uterus be-
comes much distended and coincidently the walls hypertrophy until
finally the organ attains a size simulating pregnancy. Should pyo-
genic microorganisms gain entrance, they develop rapidly in the
highly albuminous contents and produce the condition known as
Pyometra. Aine .

-- Sebaceous cysts have received the name of Atheroma. They are
usually small and contain a semi-fluid material. They are liable to
undergo secondary changes through irritation leading to inflamma-
tion and suppuration. According to Sutton, the contents may burst
through the capsule and becoming exposed to the atmosphere, dry,
and assume a brownish-black color and become very hard. The
mass is composed of epidermal scales which in consequence of the
exposure resembles horn in appearance and consistence. If the dried
mass is allowed to remain, growth continues at the base until at

388 Surgical Diseases and Surgery of the Dog

length a Cutaneous Horn is produced which may be many inches
in length. Lebert cites observers who have recorded the occurrence
of these horns.

Atheromata sometimes acquire a peculiar formation when they
are known as Proliferous Cysts. Through constant accumulation of
the contents the tumor is projected inwardly, the glandular epithe-
lium becoming pathologically inverted, and the whole surrounded
by proliferated connective tissue. Growth being unequal, the cav-
ities become distorted, branched in various directions, and filled with
polypoid excrescences. Werner has minutely described this condi-
tion, and Siedamgrotzky described a villous fibroid cystoma which
occurred near the Preputial Orifice.

Mucous Cysts are seen to occur as very general minute cystic
dilations of the uterine mucosal glands and their ducts in chronic
endometritis. They develop through stricture of the mouths of the
glands occurring in consequence of proliferative overgrowth of the
upper layers. These cystic dilations have also been seen in numbers
in the Esophagus by Eichenberg.

(b) Tubulo-Cysts. Tubulo-cysts are formed by dilation of
obsolete canals and ducts. It will be remembered that there is a
certain stage of indifference in the fetal development of the urogen-
ital system where neither sex is apparent. The Wolffian body or
mesonephros which ultimately becomes either testicle or ovary, gives
rise to certain tubules and two ducts—the Wolffian and Muellerian,
the former becoming the epididymis and vas deferens in the male,
and the latter the oviduct, uterus, and vagina in the female. In the
female dog the Wolffian duct remains rudimentary and partly dis-
appears. In the cow it persists as the duct of Gaertner, which
makes its way between the layers of the broad ligament and runs
downwards on the uterus to open into the vagina near the orifice
of the urethra. In the female dog the terminal segments sometimes
become the seat of small cysts, rarely exceeding a pea in size, though
I have seen them quite large, lobulated, and multilocular, which are
seen lining the uterine cornua at the margin of the broad ligament.
They have no pathologic significance.

(c) Hydrocele. The free communication between the general
peritoneal cavity and the funicular pouch permits intra-abdominal
accumulations of fluid to gravitate into the pouch but these dis-
appear when the animal is placed on its back. Inflammatory effu-

Neoplasms 389

sions and hemorrhagic extravasations (hematocele) may occur as
a result of injury, or secondary to orchitis.

(2) Pseudo-Cysts.

(a) Bursae. Synovial Cysts occur in the immediate neighbor-
hood of Joints or in the Bursae of Tendons, following acute or
chronic traumatic or rheumatic inflammations.

(b) Contusion and Extravasation Cysts. These include the
so-called adventitious bursae or cysts of true neoformation. They
are seen in situations where the skin lies in close contact with bony
prominences, as on the Elbow, and Digits, particularly in members
of large, sluggish breeds, and are due to unusual intermittent pres- .
sure from lying on hard surfaces. Another familiar form of this
cyst is that seen in the Earflap and known as Othematoma but in
this case the contusion is generally so severe as to produce a primary
extravasation of blood. Blood in serous sacs does not readily coagu-
late, but sometimes a clot forms when it is known as a thrombus.
Subcutaneous collections of extravasated blood rarely suppurate,
and if left to Nature sooner or later undergo absorption and organ-
ization by a process of reactive inflammation, but during the process
the resultant cicatrisation sometimes causes considerable shriveling
and deformity. Siedamgrotzky observed the occurrence of a cyst in
the subcutaneous tissue extending from the larynx to the left should-
er-blade, the development of which followed a bite received by the
animal in the neck a week previously. The same authority des-
cribed an extravasation hematoma occurring under the serosa of the
Bladder, near its neck, which brought about a triple torsion of that
organ. Recent, as well as old-standing organized, hematomata are
quite commonly found in the Spleen.

(c) Neural Cysts. These occur as Hydrocephalus and Hy-
drorrhacis, leading rapidly to paraplegia, psychic disturbances, coma,
or death. The dura is found distended by an accumulation of color-
less serous fluid.

(d) Parasitic Cysts. The varieties of these cysts are fairly nu-
merous. They have been found in the Liver, Mesentery, Omentum,
Muscular Tissue, etc.

(e) Emphysematous Cysts. These which are common enough
in the Mesentery of the hog, are sometimes seen in the same situa-
tion in the dog (Williams).

399 = Surgical Diseases and Surgery of the Dog

(f) Degeneration Cysts. Solid tumors often break down and
soften, their contents becoming fluid. The commoner examples are
tubercular Bronchial Glands, and malignant Mammary growths.

Treatment of Tumors

Only the general principles of tréatment as applied to Tumors
Proper and Cysts will receive consideration here, special methods
and the treatment of the several Hypertrophies, Hyperplasias, Gran-
ulomata, and Stricturés having pathologic significance being des-
cribed elsewhere under their respective headings.

While innocent growths with few exceptions seldom exert any
ill-effect on the organism, nevertheless, in superficial positions, they
are mostly unsightly blemishes, and for this reason alone their re-
moval is usually desired. Furthermore, as has already been pointed
out, some innocént growths are capable of assuming a malignant
activity, under certain conditions. Moreover, in many cases it is im-
possible to distinguish between the two types, so that it is safe to
adopt and observe the rule of early removal of all tumors growing in
accessible positions. In the case of growths of undoubted malig-
nancy the only hope lies in early and radical operative treatment with
Coincident removal of adjacent lymphatic glands when the latter
dre involved. The earlier the knife is used the greater is the pros-
pect for permanently eliminating the disease. Cancer is a local dis-
éase at the outset and in the early stages can be eradicated without
fear of recurrence. But in making ablation it is necessary to cut
wide of the diseased aréa without regard to subsequent deformity
and to avoid disseminating cells of the growth in fresh tissue. Oper-
ative measures are contraindicated and should never be attempted
when there is more or less generalization, feebleness, or cachexia
present.

There is only one method of ablation worthy of consideration
and that is by excision with the knife. It is true that in certain con-
ditions, such as inaccessible papilloma of the auditory canal, or tu-
mors growing from solid structures it is sometimes necessary to
rély on the thérmo-cautéry to completely eradicate all traces of dis-
eased tissue, but the employment of such means must be regarded as
stipplemental to the use of the knife rather than as substitutive. The
method of ligating and allowing the growth to slough off is only t6
be mentioned to be rigorously discountenanced as typical of the ertid-

Neoplasms 301

est of surgery, illustrative of which I need only mention the follow-
ing incident related to me by a practitioner. A silk ligature was ap-
plied late one night to a wart growing at the edge of the eye-lid. In
the morning the corresponding eye was found to be damaged to such
extent that the sight was destroyed. The animal had. practically
scratched its eye out during the night in its frantic efforts to rid
itself of the pain-giving ligature.

_. The, cleanest and best surgery calls for excision a the knife
and ligation of all severed bloodvessels. Where the main nutrient
vessels of a growth are not of large caliber and are comprised in a
distinct pedicle, the last step in the removal including hemostasis
may be effected by means of a good emasculator instead of ligatures,
but the operator must be sure of the adequacy of his instrument for
fear of secondary hemorrhage. Anesthesia, either local or, general,
should always be instituted. Growths which can be ablated without
much cutting can be removed painlessly by narcotizing the subject
with morphine hypodermically administered some thirty to sixty
minutes previous to operation and then employing hypodermic in-
jections of cocaine locally, but those involving extensive cutting re-
quire a general anesthetic. It is always best to securely hopple the
animal. Instruments. must be sterilized and the parts thoroughly
cleansed and freed of hair. When tumor and skin have coalesced,
an incision is carried through the latter on either side well into the
healthy texture. The subcutaneous tissue is divided all around the
diseased area by blunt, or if necessary, sharp dissection yntil.one. or
more pedicles supporting the nutrient vessels are exposed. The lat-
ter should then be ligated with silk and severed on the occluded side
with scissors, or they may be divided at their origin with an emas-
culator, which, however, should be allowed to remain clamped for
some little.time to guard against subsequent hemorrhage. Every
trace of diseased neighboring lymphatics must also be freely re-
moved by dissection, All bleeding points should then be seized. with
hemostatic forceps and. either twisted or ligated. The wound being
cleaned, preferably with a stream of sterilized water, the divided
skin is reunited with the subcuticular suture, redundant portions
being removed with scissors. A drainage tube or strand of sterile
gauze should be inserted and stitched in place in extensive wounds,
particularly where the formation of pockets in the subcutis cannot
be prevented, and where drainage is not employed the parts must be
daily inspected for accumulation of pus to which free exit must be

392 = Surgical Diseases and Ss urgery of the Dog

given. Circumscribed and encapsulated innocent subcutaneous neo-
plasms require simpler measures. A single skin incision is made im-
mediately over the growth and the latter being exposed is removed
by blunt dissection or enucleation. Healing, when uninterrupted,
takes place in from two to six weeks.

The treatment of retention and extravasation cysts comprises
two methods. It must be remembered that a cyst is but an accumu-
lation of fluid limited by a wall of concentrated connective tissue
lined in whole or in part with actively secreting cells, and that as
long as a portion of this wall remains in place secretion will continue
and reaccumulation of fluid take place. Hence, the surgeon always
seeks to remove or destroy every vestige of the lining membrane.
The preferable way to accomplish this is by blunt dissection of the
sac intact. Dissection must be performed with extreme care and
delicacy, because should the sac be inadvertently punctured, it im-
mediately collapses through escape of the fluid and its complete re-
moval is attended with difficulty and in some cases rendered impos-
sible. The other way is to destroy the secretory power of the lining
cells leaving the sac in position. This method is frequently re-
sorted to when the cyst lies in an inaccessible position or in prox-
imity to important blood-vessels, but it must only be employed with
due regard to the establishment of drainage as the object is to induce
an active suppuration. The contents of the sac must first be-evacu-
ated either by means of an aspirating syringe, or by puncture when
too tenacious to pass through a needle. Some irritating solution, such
as tincture of iodine or nitrate of silver solution, is then injected.
In a few hours this is followed by local inflammatory phenomena and
at the expiration of forty-eight hours the aspirator should again be
employed to ascertain the presence or absence of pus. If suppura-
tion has not taken place the injection is to be repeated every three
or four days until it does. Should pus be present it is evacuated by
lancing and the parts treated as an ordinary abscess.

Certain of the Pseudo-Cysts are treated by simple aseptic

aspiration.
BIBLIOGRAPHY.

Almy—Bull. de la Soc. Cent. de Méd. Vétér. 1897, p. 539.
Beierle—Monatsh. f. prakt. Thierheilk. 1892-93, p. 273.
Benoit—Rey. Vétér. Feb., 1896.

Bouchet—Bull. de la Soc. Cent. de Méd. Vétér. 1897, p. 184.
Bournay—Journ. de Méd. Vétér. de l’Fcole de Lyon. 1893, p. 282.
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Cadéac— Rey. Vétér. 1885, 1887.

Neoplasms 7 393

Cadiot—Comptes-rendus de la Soc. de Biol. 1893, p. 333. Bull. de la Soc. Cent. de Méd.
Vétér. 1893, p. 170. ;

Cadiot & Almy—tTraité de Thér. Chir. des Anim Domest.

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Caparini—Bull. veter. 1880, p. 330.

Cramer—Cited by Cadéac in Path. Intern. des Anim. Domest.

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Dexler—Monatsh. f. prakt. Thierheilk. 1895-96, p. 112.

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Edgar—The Veterinarian. 1894, p. 135.

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Huidekoper—Journ. of Comp. Med. & Surg. 1888, p. 169.

Hutyra—Berl. thieraerzl. Wochenschr. 1891, p. 87.

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Johne—Ber. ue. d. Veterinaerw. im Koenigr. Sachsen. 1869. 1881.

Jungers—Berl. thieraerztl. Wochenschr. 1894, p. 54.

Kitt—Lehrb. d. Path. Anat. Diagnost.

Koch—Encyklopaed. d. Thierk, und Thierz. 38, pp. 420, 602.

Laborde—Bull. de la Soc. Anat. 47, p. 503.

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521-552.

Leblane & Nocord—Ann. de Méd. Vétér. 1878, p. 164.

Leisering—Ber. ue. d. Veterinaerw. im. Koenigr. Sachsen. 1864. 1868. 1869. 1870. «

Liénaux—Ann. de Méd. Vétér. 1894, p. 662. 1895, p. 486. 1899. Rev. de Méd.
Vétér. 1888, p. 401.

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Murphy—Cited by Hyde in Diseases of the Skin.

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Geschwuelste.

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Watson—Cited by Fleming in Veterinary Obstetrics.

Wehr—Langenbeck’s Archiv. f. klin. Chirurg. 39, p. 226.

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Woolfler—Langenbeck’s Archiv. f. klin. Chirurg. 29, p. 70.

Znamonsky— ditto ditto ditto,

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» tA
= a 5 s
si * 26
+ ad
i
,
foainy
7 as
ons
Nes Beh
{. oe ; Hnh
ens}
r rr i
; >
;
yr? oe
Peet ;
{ eae a
a TR? YZ *o :
aes ey FY wrek se A Sate Low Speke
; PRE ot et Ae Miho

fen aan ae rs
t 3

INDEX

PAGE

Abdomen, The... 134, 154, 215,
Abdomen, Paracentesis of. the. .
Abdominal Hernia in. General..
Abdominal Hernia in Particular

Abdominal Section ............
WAISCOSS > afters Bars haetald es Shee a ees
Abscess, Alveolar ..............
Abscess of the Scalp...........
Absorbents' <<i<.2.355.2s5 06s.
Accumulation, lnsectiet Ob-
Struction by Fecal.......... ie
Actinomycosis. -........eccecccceces sees
Acute Lymphadenitis ........
Adeomata. %.... 61204 te 378,
Adenoma of the Legs and Feet..
Adenoma of _ the Mammary
Glands esas one estrsnicenes

Affections of the Tail, Inflam-

BINIAEORY |. creccle ccc cca sne 2
Alveolar Abscess
Amaurosis
Amblyopia
Amputation of the Concha.....
Amputation of the Dew-Claw

Digit

ee eer eee er eee eee

ee ee)

eee ere eee eee ee eee eee

a ee ee ee ee

Amputation of the Legs and Feet ;

Amputation of the Penis......
Amputation of the Tail..
Amputation of the Tongue, nice
tial
Anal Fistula, Anal Sinus. .
Anal Pouches, Suppuration ‘of the
Anastomosis, Entero-Enteral
Anastomosis, Gastro-Enteral. ...
Anastomosis, Uretero-Ureteral..
Anastomosis, Uretero-Vesical ..
Anastomosis, Vesico-Rectal ....
PARC ONIIES 8 i odo special hj adalS co lapet sia cata
Anesthetics, General
Anesthetics, Local

Aneurism
Ankyloblepharon

Antisepsis
PRATEISED ETCS Sy cies tron tig amie ees
Anus, Congenital Malformations
Air tetete i oho
Anus, Examination of the......
‘Anus, Foreign Bodies in the..
Anus, Neoplasms of the........
Anus, Prolapse:of thets.s ccc
Anus, The Rectum and ,.......

ee ee ee ee

eer eer eeee
ee
aterm eres eter eee sees ees eeene.

i ee eo)

ey

251
149
288

291

312

304

PAGE

Apparatus of Restraint..... ge Reiki 2
Avethsitis sess o> awsrege @ eh ee, cos 360
Arthritis Deformans arofhte skal tase 362
Atticulationss Whe?. 5; -..¢- seset. 350
Articulations, Luxation of the
Caspall,. dia -s+5 ith ihe aes 357
Articulations, Luxation of the
SECA A bis 25 a sherttateinde.= acid gai aes 359
Articulation, Luxation of the
Goxo-Femoral i42 curakicivsaie dics 357
Articulation, Luxa.ion of the
-Humero-Radio-Ulnar. ........ 355
Articulations, Luxation of the
eMetaearpall o/s «swe suckiunaes «5 357
Articulations, Luxation of the
Phalaggeal . gies eis ind jecote 357
Articulation, Luxation of the
Radio-Ulnar-Carpall ... .<ca52+, 357
Articulation, Luxation of the
, Scapulo-Humeral,,. ..¢.¢000+- 354
Articulation, Luxation of the
- Tempero-Maxillary .......8: 353
Articulation, Luxation of the .
Tibio- Tarsal SLanaee rach ciaveeis eiakate 359
Articulations, Luxation of the
Wertebraly sea cascs oeisce edicts s 354
Articulations, Traumatic Lesions
Ole eee ties eh ee ie pate: 350
PNSCIEES Se tress cmacitiantne crass ee acre 147
IASEPSISM ai Ua ncn ute charass wlslaisCclcievcia I
Balano=Posthitisv rors anciectte 251
Prlanorrbies § Se Fe hen fee sree etacn oye 251
Benign Lymphadenoma ........ be)
Blidden “Phe: +220) eacttereaoeieters 229
Bladder, Calculi in the ......... 233
Bladder, Examination. of the... 229
Bladder, Irrigation of the...... 230
Bladder, Neoplasms ‘of. the..... 230
Bladder, Puncture of the........ 239
Bladder, Resection of the...... 243
Bladder, Retroflexion of the.... 235
Bladder, Rupture of the........ 230
Bladder, Surgery of the:...:... 237
Bladder, Surgical Wounds of the 231
Bladder, Torsion of the........ 235
Bladder, Traumatic Lesions of
tHe taconite teep ee oPir ceiae 230
Bladder, Wounds of the........ 231
Blepharitis oil pa SE Cadi a Rigo ekce Gir 57

Bodies in the Esophagus, Foreign 97
305

396

PAGE
Bodies in the Feet, Foreign.... 311

Bodies in the Head and Neck,

I OGEIEM Fa ciate wneeee ee aia ane Vor
Bodies, Intestinal Obstruction

by Portign 22.2. ovo-s oes 6 168
Bodies in the Larynx, Foreign.. 115

Bodies in the Mouth, Foreign.. 77
Bodies in the Nose, Foreign...~
Bodies in the Peritoneal Cavity,
Foreign
Bodies in the Pharynx, Foreign 95
Bodies in the Rectum and Anus,

ey

Horeton : taser sc cee ees Js 195
Bodies in the Stomach, Foreign 156
Bodies in the Trachea, Foreign 115
Bone, Carcinoma of............ 345
Bone, Chondromasof-;.. .-2222.-- 344
Bone, Hibromar or soi gae esse 345

Bones, Fracture of the Cranial.. 328

Bones, Fracture of the Digital. 337
Bone, Fracture of the Hyoid.. 332
Bones, Fracture of the Metacar-

palitey... gcse Fash oAb Pe te 337
Bone, Fracture of the Penial... 338
Bone, Neoplasms of ............ 344
Bone, Osteoma offs 22ers. s - 344
Bone, “Sarconia! obese. occ eee 345
Bronchocele «... 8c Rote seeees IOI
Burns 3s. occa tond eet see eae a2
IBirsae {hess stciceaes ccs en leet 389
Calcic Pericementitis .......... 87
Caleuli in the Bladder.......... 233
Calculi in the Kidneys.......... 218
Calculi in the Ureters ....-.. 22, 224
Galeuli; inthe Urethra. s- a2... 247
Canker of the Mouth ..............00-- 75
Capped” Hlbow? > scGe2-seeeetekas 314
Carcinomata: > > a.5 0-3 sites eet Gee 380
Carcinoma, Of Bone® so. aets eng 345

Carcinoma of the Head and Neck es
Carcinoma of the Legs and Feet 315

Carcinoma of the Mammary
MG lands ies says coche nesses sake 305
Carcinoma of the Prepuce...... 256

Carcinoma of the Prostate Gland 264
Caries

Ce

fe athe okeke Pee Netcfercinagtiins meade 357
GATDINES - csc copies esate eid as ainiele afuie'els's'aia 307
Carpus, Fractiire of thes -......<.. 337
Gastrationty ses tore ere ear 259
Cataracks see vce eh eters eet terete 5I
Cataract) (Conveittal wa 544.- 41
Catarthal ~ Wettitis ...)-.6-60 es 271
Catheter in the Female, Passage

OERUNE,. 5c oheicee cise croakers siaieinere 238

Index

PAGE
Catheter in the Male, Passage of

thew ve lar ee ae oe eee 238
Caudal Articulations, Luxation of

GE acct eieiete ctl remiceee eee 359
Cavity, Fetuses in the Perito-
RGA See Pate ceteie eee Camere I51
Cavity, Foreign Bodies in the
Peritoneal: scsttantis. cea 159
Cavity, Verminous Parasites in
the /“Peritoneal ‘sevtakt yee 150
Celiotomy. ..2... Resse... eae 134
Gervicwh HAD oii westelccm st ac wiete a eae 36
Chloretotie: ':52.4. 2 GA Swab eens 18
Chloroform. ; .afa< 9s sb. do eee II
Cholelitinasis. .. 205 e003 ga 206
Cholesteatonidinagac. sree 377
Chondroma of Bone: 5.fo-cse8 44
Chondroma of the Mammary
Glands...) ... sHtieeietenmed: H 305
Chronic Interstitial Fibrosis of
the Peat fas-ays. 5 2th Janae 306
Chronic Lymphadenitis ........ 33
Clerta Palate (eit aarp iacat ce etal) stein eta 73
i ne, ERR EL ER EEE int. 307
Column, Fracture of the Verte-
Fal Ho. Siac eee eee 332
Compound) Tumors = oo ncne see 384
Compression, Intestinal Obstruc-
tion “hy. cok en tS ee 171
Concha, Amputation of the...... 68
Concha, Ulceration of the...... 61
Congenital’ "Cataract ‘2: 2/56 to 208 41
Congenital Dislocation of the
CGS 8 SS Pio a ee eee ge eee 4I
Congenital Malformation of the
‘Esoplagus®’s. s.te cece ee 96
Congenital iwalformations of the
Plyent 259 3 ee ee eee ee 40
Sondenieal Malformations of the
Byelids yee ect eee 57
Congenital Malformations of the
Head and! (Neck) s0che ene 36
Congenital Malformations of the
Legs: 'ant"Pecer es... fence ee 307
Congenital Malformations of the
Lipsy and) Mouths... ote 73
Congenital Malformations of the
Ovaries ee eee 265
Congenital Malformations of the
Penis’ yc ewe eee eee 251
Congenital Malformations of the
Prepuce: fond. mtaees ween 251
Congenital Malformations of the
Rectum sand Ants... eee 194
Congenital Malformations of the
Spleen’. - ec aces he eee 211
Congenital Malformations of the
Tail oa. he oe ae eee 318

Index

PAGE
Congenital Malformations of the
PREC GIy io ies, oes cere eve ere 85
Congenital Malformations of the
Meéestes and Scrotum’ 6.25. ... 257
Congenital Malformations of the
ele riiecinrs. «atin ce eateeine Sreciuehe 245
Congenital Malformations of the
Wee Lh iy faeeae la ih a ALL A i 282
Congenital Opacity of the Cornea 40
GOnanchyatiSeec: Posse he keen cee 43
Connective Tissue Tumors..... 369
Constriction, Intestinal Obstruc-
PROT ON oe cio aie cake aoe oe 197
SSUES TCT ae ed SE a oe cl 21
Goutuson Cysts: os. ccc cae 3890
OOEISEASIS” 98. wise ene teen oa 165
Cornea, Congenital Opacity of
[BOC eit ae hte el ahs Atle Lea 3 EO 40
Cornea, Ulceration of the...... 45
IETS ent tes | pera 2 315
Cornua, Torsion of the Uterine 276
Cornua, Ventrofixation of the
Uterine)". 2.5). Min fate wisi te 281
Coxo-Femoral Articulation, Lux-
ATU OV aRCON Gono eg aR EO beat Sante bs 59
Cranial Bones, Fracture of the.. 328
NOP DI PNM sia ticta,cielolate vial ofo/ais a aictales @avelele's 68
Crural, Terniav) 1) oslo h 4 eee 300
SPV BLONCHANIA tavere craisiaya-c sire /oiaieisl ae afevecoe ete 257
Cutaneous Horns on the Head
and Neck sj es aavaake aesvncet 36
Cuterebra emasculator ............... 259
MOBY SLITTS Se aval ais ahs igateretatalelererazeh ane 232
GVSEOLTAPIMY, | ease seat vieicaigesiees 240
pS tOR YE a's Ss 5: Wetec ibe tidialens 241
Cysto-Enterostomy .% 0s .sis<siscies 244
GUS ES Ha erat ts cfetets Ua ae ets @ siete’ 385
DivstsyiContusion:s i) os2s .6.ctsmei 3890
Cysts, Degeneration ...........+. 390
Gysts|, Dentigerous) s6iicis. asin: 86
Cysts; Denmoidhy 52. s42.be= cise 384
Cysts, Emphysematous ......... 380
Gysts. Hxtravasation .< .ssishies sie 389
evstsre Gland ent kcscicitsteeerk «,4c\6 386
Cysts, Interdigital Serous...... 315
Cyst of the Mouth, Retention.. 79
eysts, “Neural i. .5.30. She fencus' 380
Gy sts. Parasiticns<t/ecesetteletete 3890
leysts; Retention oi..'.).'sesanieee 386
Gy Sisse CIS cist secon toce hs hore atarene 386
Degeneration Cysts ............ 390
Dentigeraus Cysts. i.2 vines. ane 86
Dermoid: Cysts obiecad¢ccass cree 384
Dermoid, Sequestration ........ 40
Dermoid) Tumors...) fo ./ees eee 384
Development of the Teeth ...... 83
Dew-Olaws 310

Ce

0/

PAGE
Dew-Claw Digit, Amputation of
ENGy <3 aha cae apne tee cea aiaabis 318
-* Diaphragmatic: Meritia ee oss os: 300
Digital Bones, Fracture of the.. 337
Disarticulation of the Phalanges 318
Discission.. of the)Lens)~ jicces 55
Disease, Hodgkin's %<. 2 ames cc ste III
Dislocationsipi--.yandosme eet eer 351
Dislocation of the Lens, Con-
PENA «5 2 ielNeiaahaehos amma ncse 40
Disposition of the Teeth........ 83
Diverticula of the Esophagus... 97
Division of the Tendons, Trau-
IMABLCUs \s 5.5 Stach io lorek ap Acco ee 309
MIGCKINE Piera clavicle cian crntaein cele vishe einwieisietatels 321
Bars, > \Mhemccas eet aets Neoteiens 61
Ears, Examination of the ...... 61
Ear, Hematoma of the .......... 66
Ear, Neoplasms of the.......... 65
Ear, Papillomata of the........ 65
Bar. oinusnon the: st; 27445 ete. 65
Ears, Traumatic Lesions of the.. 61
Pictrapnany , soe Seas oss saa eer ee 58
Kezema; Interdigital )); .26.i2a ee 311
Elbow, Capped. ai).202H2 d4%;. vere 314
Emasculation, Parasitic ........ 259
Emphysematous Cysts ......... 3890
Endometritis, Proliferative or
Fibroid eyscisd} ina cnadsioeis 273
Endothelial Papilloma ......... 380
Endothelial. Sarcoma: .<sjsd.sieic siz 377
FUpleM CES iifig 5s Mek eto lee aa 191
Bnterectotiyss } baie 3c.sia/saereens 185
Bnterorraphy: 4 sens. vis canwhaaies 181
Bnterotoniys (f JActh <n. seiekn ees 183
Entero-Enteral Anastomosis 185
Entero-Enterostomy ............ 185
ntropion cai! sais. ar sete 58
Enucleation of the Eyeball...... 55
MEDISHAGIAS ) oie:5,craserate afatelaehe cs nicheliate tae kieets 245
TEDISEAKIS!: ». ..c.s5 chau baae a aanet 113
Epithelial Hypertrophy of the
Paden aca os. comer oon ee 315
Epithelial Tumors 2.2.02... 378, 380
ENPULHETLOW BUA) aracwayncet avavere ainisie so ereleis heals 380
Epithelioma of the Head and
NGG caine onus Biclrs Wala ee a 39
Epithelioma of the Lip ........ 81
Epithelioma of the Pharynx.... 96
MEDULLA waves elese¥e" shia ctaticheihiera’ niafors (aladotals terete 78
Breysineias Fac se scission 33
Esophagotomiy. ¢ 5 sijelo ielothidels 99
SOPMAPUS, ""TIGy utcc siete e daeane 06
Esophagus, Congenital Malfor-
MatiGnstar He tes i. ook eos & 096
Esophagus, Diverticula of the.. 97
Esophagus, Examination of the 96

398 Index
PAGE ‘ PAGE
Esophagus, Foreign Bodies in the 97 Eyelids, Traumatic Reem of -
Esophagus, Neoplasms of the.... 100 the ssssssscsasas viveanendvatte 57
Esophagus, Rupture and Perfor-
WHOMOL TAG eaves seine cieeie tes 96 Fallo
pian Tubes, The.......... 271
Esophagus, Stricture of the .... 97 Fecal Accumulation, Intestinal
Esophagus, Traumatic Lesions of Obstruction by .... 165
tite sho Sa ee 96 Feet, Adenoma of the Legs and 312
Estrual Hypertrophy of the Va- Feet, Amputation of the Legs
@inal + Mycoses. ee are 285 S
Estrum after Oophorectomy .........- 266 an See Gap Uk + Lk Oe Eke 317
Ether. 2... 0/826. 00 i See es eelee e's to F at 1 Carcinoma of the Legs ”
Eucaine .....2.. eee ee beeen eens 17 Hee Conecnel Malfocmations
Eudrenine PRO OUEE = 20d at AS si of die Tees aud: 307
Hustrongyle ..........ccesessacees , 248 — OF the Legs and......-- sees
Examination of the Bladder. .::. 229 3 eet, 4 ibroma Leas ee and 313
Examination of the Ears....... 61 eet, Foreign Bodies in the Legs
Examination of the Esophagus.. 96 and epstaymiand de «baile sisal ae mee 311
Examination of the Intestines.. 161 Feet, Inflammation of the ...... 310
Examination of the Kidneys.... 218 Feet, The Legs and ........... 307
Examination of the Lips, Mouth, Feet, Lipoma of the Legs and.. 313
Tongue and Jaws Visi vie... 72 Feet, Neoplasms of the Legs and 312
Examination of the Liver...... 205 Feet, Sarcoma of the Legs and 316
Examination of the Lungs and Feet, Be a Lesions of the
Plewbae <oss acts to oes ees 118 ria WAS Ee Aro se Heoie coe 307
Examination of the Ovaries.... 265 Feet, Wounds of the Legs and 309
Examination of the Penis ...... 251 Female, Reproductive Organs of
Examination of the Prepuce.... 251 5 a ht AR He oh oS AR 265
Examination of the Prostate Hemar, Hracture Of theirs pikes 338
Gland ovilvoottinn .. .<eiar .. 261 SHORES, . SAUBBNIE 2235309 8u> “Geet
Examination of the Rectum and B pe in ‘the Peritoneal Cav- 1st
ANUS’. nce. OR. MAIO FA) eee tet ace tet toe beet poke eee a a :
Examination of the Spleen ..... 211 eee eatus eee Prolifera- oui
Pcmination.oi- tle. Stemaeiniie ssa ee f
Examination. of. the Urethra’s.3 245 aoe: Ee taseioe ¥acoe Qos 370
Examination of the Uterus .... 271 Fibroma of he. Eeeudis : arate + eg
Examination of the Vagina.... 282 mi FOURA ;O1 “tae Hye = ae
Bxophthabaiaw sti. si hk 53 ibroma of the Legs and Feet 313
Exophthalmic Goiter ........... 107 eas 4 mer ies ary Glands pe
Extraction of. the. Lens ...0.i0%% 56 See Ot ile See ae Z
Extraction of the Teeth........ gI es ie A Veni ghee ee Me 277
auabierine Gestation locos. Ais Fibrosis of the Teat, Chronic ~
Extremities, hers cee 307 Interstitial s,< 2ecis 6a Ss eens ee
BREST » oissonpaacndarn. ee 4o Fibula, Fracture of the Tibia and 340
Eyes, Congenital Malformations aa rie the Bye ..lidinueiewees scot Ls
pi@te:: wai neh Fea “fa Aik ds ile ea aia a) Cal he
Bye, Pilaria-'in the! < 00... .8ciisseaes 48 Fistula, Anal ........++.+.ss0e8 197
Eye, Neoplasms of the......... 53 Fistula, Lachrymal .sijccsgs--5* 50
Eye, Paracentesis of the ...... 54 Fistula, Maxillary casi nerite ee 88
Bye, . Parasites in the 26.02.04. 43 Fistula of the Salivary Glands.. 92
we See: OP theses ott. oe 54 Povaen ree in Esophagus 97
ye, Traumatic Lesions of the.. 41 oreign Bodies in the Feet..... 31I
Eyeball, Enucleation of the..... s F oreien Bodies in the Head and ~
Eyeball, Luxation of the .............. 41 GOK. yids s:a.900)-5 © aghast ogeipiatens 37
Eyelids) :"The' soi 2k0 04. st CURE Foreign Bodies, Intestinal Ob- >
Eyelids, Congenital Malforma- struction, by ...asaews fs eobaye . 168
tioms: of theectins int. tele 57. Foreign Bodies in the Larynx.. 115
Eyelids, Neoplasms of the...... 59 © Foreign Bodies in the Mouth.... 77

Index

PAGE

Foreign Bodies in the Nose.... 114
Foreign Bodies in the Peritoneal
Cavity -

evewws COLYTECL. DETETER 149
Foreign Bodies in the Pharyax 95

Foreign Bodies ‘in the Rectum

andi Anusero. el Be ee 195
Foreign Bodies in the Stomach. 186
Foreign Bodies in the Trachea: 115
Frageares is, 20. 0 STA 323
Fractures in General. .......... 323
Fractures in Particular ........ 328
Fracture of the Carpus ........ 337
Fracture of the Cranial Bones.. 328
Fracture of the Digital Bones.. 337
Fracture of the Femur ......... 338
Fracture of the Humerus...... 334
Fracture of the Hyoid Bone .... 332

Fracture of the Inferior Maxilla 331

Fracture of the Metacarpal Bones 337
Fracture ‘of ‘the’ Naif“... 6.000.537. 309
Fracture of the Patella ........ *30
Fracture of the Pelvis......... 337
Fracture of the Penial Bone.... 338
Fracture of the Radius and Ulna 335
Fracture of the ‘Ribs:........). » 334
Fracture of the Scapula ........ 334
Fracture of the Sternum ...... 33
Fracture of the Tibia and Fibala 340
Fracture of the Trachea........ 116
Fracture of the Vertebral Col-
NITRA Lua. eh 332
Frost-Bites wc... ..cesbsvioeees 32
TE ATL-StONES phic (nip io 0,0 0:0 n'cjec ciialbblee'd o oskis 206
Gangrehe egi.ccasdutewe.. wecth 134
GPSEROLOBIY wis ofcu ss occu aes BEES 160
Gastro-Enteral Anastomosis 161
Gastro-Enterostomy’:...2....... 161
General Anesthetics .........5. 10
General Sureetry onde ca ete «= I
Gersuny’s Operation ................. 202
Gingivitis 2.4.5. Sie AO el
Gland, Carcinoma of the Pros-
HATCH cs ole ators OS PS. waa 264
Gland (Cysts (5 ik DMA Sw. eR 386
oe Examination of the Pros-
PEtw ee Cee Ste octets 261
Gland and Glandules, The Thy-
MOM es sore itiss Aenat ro OaN. ake ete 100
Gland, Hypertrophy of the Pros-
Gates Vy ebssesid« Rist Meets, 2 262
Gand Neoplasms of the Pros-
cee chet GE TOs CHER, « 262
Gland, The, Prostate: . ...:.%.3%. 261
Glands, Adenoma of the Mam-
GATS | sec -a4 cn Skis « ShiocR STS 304
Glands, Carcinoma of the Mam- —
MTIATY | cai viniscce ogre @eivicas We ee 305

399

PAGE

Glands, ‘Chondroma of the Mam-

MALY... cron wetlee Gar ce Gliese ats
Glands, Conecason of the Mam- te
(MALY. scremicnme Lebie tr A et 302
Gide Fibroma of the Mam- > <
WAHY, | vaiaiaiarnsdiccs weweeioues MEMO LME 304
FE Fistula’ of ‘the Salivary 92
Glands, Inflammation of the Sal-
PVE VI ts oeieacannitesaiese.c mc ame plo ee 93
Glands, Lipoma of the Mammary 304
Glands, The Lymphatic :.:...... 108
Glands, The swiammary ........ 302
Glands, Neoplasms of the Lym-
phatics asc. CHRae MIB hee IIo
Glands, Neoplasms of the Mam- ~~
SMM ATG SOREL. «is Ieee bree a Barats UQOS
Glands, The Salieaiy Renbaats (igen 92
Glands, Sarcoma of the Mam-
MALY... .2c dae Seek MER ERED 305
Glands, Traumatic Lesions of the »-
~Mammary~ SAI HES Sei A raee pear 302
Glands, Traumatic Lesions of the >>
Salivary oh. ealbeie?. cdonit 92
Glandular Tumors ........ 278, 380
Glaucoma, . too... POOL dee 49
Gino-Sarcomatay «carretera sce 377
GGRSSitiS, ic Sis as REREAD 74
Goiter ...... ial ratahs jeseveNte cjsae fein HORE Iol
Goitet, Exophthalmic .:.......%. 107
Granulomata, Infective ........ 365
Granulomata, Simple ........:. 365
Granulomata, Venereal 254s 286, 366
Halsted’s Mattress suture ..........5+ 183
Hands, Sterilization of the .... 2
Nee SU ORS Gains obtas MCS wae ae 73
Héad and Neck; The ........ 36, 72
Head ‘and Neck, Carcinoma of
UE ea ces te a eth crea oians steneree aes 39
Head and Neck, Congenital Mal- -°
MW TOLMALlONS OL Glee ome sce cla is 36
Head’ ‘and Neck, Cutaneous
TOES Of THES Te iscsi 39
Head and Neck, Epitholioma of
ETS DE ens Dine ia 0 cea s oesalalay eee le cae sole 39
Head and Neck, Fibroma of the 38
Head and Neck, Foreign Bodies —
Nghe dteCOva To MAIS Sq RAEN DOO 7
Head and Neck, Epithelioma (0)
ILE Aesesiche ona s ercicke duis ayes eteyoraiate 38
Head and Neck, Neoplasms of ~~
RO Ae phan clodin wore er Guat RES 38
Head and Neck, Papilloma of 3
HIG Gan kb ootnb en Bae eee 38
Head and Neck, Sarcoma of the 38
Head and Neck, Traumatic Le- 7
sions of othe 211i Jk wore ee 36
Heart and Pericardium, Phe? .4 125

400
PAGE
Heart and Pericardium, Trau-
matic Lesions of the.......... 125
Heart, Surgery of the ......... 130
Heart, Sutureiof the 3.220 css a. 20% 131
Hemanetomatay 92.) .sec1a0e <2 = eee 373
Vem aACOMAn ee puieic exetyare isle siete 2I
Hematoma of the Ear........... 66
Hematoma of the Head and
INCCK 5. tj.,nue 2 bicelles se ese 38
Flemornhoids .s:).4. Sr cfeiatcaiaies sie 198
Hlepatectomy: ais ieidtos =e le -tavesste 208
IBS on ras etcrh Ado Aa Seer eC 288
Henmas.Crumals S73eehi saan cies? 300
Hernia, Diaphragmatic ........ 300

Hernia in the Female, Inguinal 292
Hernia in General, Abdominal.. 288

Hernia, Incarcerated and Stran-
PUPA Ys. AeS Lhe c tntetee biete agate 172
Rerniaon the Wenge. <a es 123
Hernia in the Male, Inguinal.. 297
Hernia in the Male, Scrotal.... 297
Hernia: Pancreatic meas et: <cee 201
Hernia in Particular, Abdominal 291
tvenmiats Perineal <zccctw... cues 2909
FlerniasWimbilicall: 2 so-01<rsbiserte 291
PHernitas. Vienbhalisc.s. cinco cee 292
Hodgkin’s . Disease. .. 22.4... III
Elvapales Wen cscs dott ny ae Ree he
Horns on the Head and Neck,
Cutaneous! Vee wees 30
Humerus, Fracture of the ...... 334
Humero-Radio-Ulnar Articula-
tion, Jsuxation of thes. 33... - 355
Hydrocelewe. ae. tee er ee aes eee 388
Iydrometrat Modes oes es alae 278
Fly dtoneplrosis (tee coaie aie oisce ooo 221
TAVALOPEMICATAIUIN, 2.5... omjswacnaiees 130
Hydrophthaitiia Yi.h.cs. seeecen ¢ 49
iPydrothorax Paco kay ae cco case 123
Hivgroma aussie soe se aoa 314

Hyoid Bone, Fracture of the... 332

ELyperplasia secs seep gauss eas 364
EIVPEriLOphy, sc. ouaRaeoteew sm 364
Hypertrophy of the Pads, Epi-
ele lial ee ee onset sce ss 315
Hypertrophy of the Prostate
Me ReMTLGAS oN ciara case cons wane pads, noua ease 262
Hypertrophy of the Vaginal Mu-
COSds) TUSEGUAN retecisie cite ec oeieionre 285
PippmoticS (ce Gc cs cleat ere 18
TRV DOD VON ie cieles ereiah ale cleloreta eleierataatretarate 46
PAV POSPAGI AN! Fe ice1ciss'cio'a's lalla "a cyole te aiarniialnle 245
Hysterectomy (/)10.,c 4d Genk 280
PAVSHETOLOINY | 12 Sa2 ssa \ea acumen 279
\
Tews ie. LEMS S LuIae. sce oe 174
Immobilization of the Jaws with
the Speculwan! (2220050 ae ae 72

Index

PAGE

Inanimate Objects in the Peri-
toneal:; Cavityatt. st. aceon 149
Incarcerated. Hernia. .....,0ceeer 172
Incrustations off Lartanr | i.a eee 87
Infective Granulomata ........ 365

Inferior Maxilla, Fracture of the 331

Iinflanimation “<4s0c) Se Geek. gee 19
Inflammation of the Feet ...... 310
Inflammation of the Matrix of
the) Nardi 33 etucrs terol te cee eee 310
Inflammation of the Pads...... 310
Inflammation of the Salivary
Glandshitisctivkcn ch Sone dee eee 93
Inflammatory Affections of the
at ee. hpenieee mela eee eee 320
Inflammatory Neoplasms ....... 365
In-Growing Nails... ¢s)4. bee 310
Inguinal Hernia in the Female.. 292
Inguinal Hernia in the Male.. 297

Instruments, Sterlization of.... 2
Interdigital Eezema’ ..4:. 5... sak 311
Interdigital Serous Cysts ...... 315

Interstitial Fibrosis of the Teat,

Chronichs un sseeeiss - @atoctrece see 306
Interstitial: Keratitis. osscces ssi 47
Intestinal Obstruction .......... 164
Intestinal Obstruction by Com-

PYEGRID) Lou. cadet « galdc teeeeieee 171
Intestinal Obstruction by Con-

Strighont i4 [0300 4. .& cde due eee 179

Intestinal Obstruction by Fecal

Accumulation, (ssc .n see 165
Intestinal Obstruction by For-
eigen. Bodies, - iso :<suveen eee 168
Intestinal Obstruction by Ob-
SHACIES «+s caaj3 2's dene and mee 164
Intestines: Dhetsses 2k: teeta 161
Intestines, Examination of the.. 161
Intestines, Neoplasms of the.......... 179
Intestines, Stricture of the........... 179
Intestines, Surgery of the...... 181
Intestines, Traumatic Lesions of
the --)sihived i. Fos aes eee Mabe ae 162
Intestine, Torsion of the...... 174
Intestine, Ventrofixation of the 191
Intestines, Wounds of the...... 162
Imtissasception! “ooievo. ar ces one 175
Irrigation of the Bladder...... 239
Irrigation,’ Rectal ......-.c2..6ae IgI
Jaws, The Lips, Mouth, Tongue
BNO. chee c Bis: SUR toe 72
Jaw, Osteoma Of thes ssas<sceet 80
Jaw, Sarcoma; of Cheeit 5,204 508 81
Jaws with the Speculum, Im-
mobilization..ob - the. 1. s«seeer 72
JointseSprains of 08. sae. ee 350

Joints, Wounds of ....... ds eshte 50

Index

PAGE
Keratitis, Interstitial .......... RA
Keratitis, Superficial! ..)kitacteel 45
Keratocele © .csevcscccccccccceccccucces 46
Kerectasia ..c.ccccscccccccecccvccccce 45
Badneys, UHesetn nie. seeaia ce 218
Kidneys, Calculi in the ........ 218
Kidneys, Examination of the.. 218
Kidney, Neoplasms of the...... 220
Kidney, Parasites of the........ 222
Kidney, Surgery of the........ 222
Lachrymial Fistula i...2c0c20%-0 650
DGATOROMI Yo 5. s cinca oso Se elianelb 134
(aryn seine wees ees thee iaen 115
Larynx, Foreign Bodies in the.. 115
Larynx, Neoplasms of the...... 116
Beos and, Feet;i Thetico.ch. det. vas 307

Legs and Feet,
Legs and Feet,
the 317
Legs and Feet, Carcinoma of the 315
Legs and Feet, Congenital Mal-
formations of the 307
Legs and Feet, Fibroma of the 313
Legs and Feet, Lipoma of the.. 313
Legs and Feet, Neoplasms of the 312
Legs and Feet, Sarcoma of the.. 316

Adenoma of the 312
Amputation of

ee

Legs and Feet, Traumatic Le-
BIONS ENOL UNC. cicaseg tb sicie sis bie 307
Bembert Sutures 000). cates ca cjcieis sree 182

Lens, Congenital Dislocation of

EUTESae Sees Miyicee et ove sete tohale yor Saysnstat 4l
Lens. Discission of the ...... <<... 55
Lens, Extraction of the ........ 56
ens Isuxation Of the: nig. cm. « onie 52
Lesions of the Articulations,

Bie GAUUAANEICS ass cicivialscn,eo'« nanlaeite 350
Lesions of the Bladder, Trau-

ATI ALTOS calcd k makiachte afocyaisie oie hte 230

Lesions of Bone, Traumatic .... 323

Lesions of the Ears, Traumatic.. 61
Lesions of the Esophagus, Trau-
matic
Lesions of the Eye, Traumatic.. 41
Lesions of the Eyelids, Trau-

PLUTO H Ys. or od etetere haves ossicotenre bia 57
Lesions of the Head and Neck,
MUyeentIMAtic hte Shc bates o chopatsretaye 36

Lesions of the Heart and Peri-

cardium, Draumatic: )...:%.... 125
Lesions of the Intestines, Trau-

TOQUE alee i 9 aisle sre =o aa wie 162
Lesions of the Legs and Feet,

IP LAMTHALIC, cv arbehtsicisies cece eieisine 307
Lesions of the Liver, Trauma-

(2 Om SIROTA UHRIEEC 4 Saiifef ate eletete ul Oly

401
PAGE
Lesions of the Lungs and Pleu-
EAC)? L LAUMAMC) cicore csyucetere stores II

Lesions of the Mammary Glands,

Traumatic
Lesions of the Mouth, Trauma-

HICT ES os occa cote eee ioe ceete 85
Lesions of the Penis, Traumatic 251
Lesions of the Peritoneum, Me-

sentery and Omentum, Trau-

matic

saan See alan teralee weaned 144
Lesions of the Prepuce, Trau-

THANG, TAN ai. « sist ataglbees 251
Lesions of the Salivary Glands,

UD ratiintatichemete. sec.s colts aktelsta 92
Lesions of the Spleen, Trauma-

PCSOs Us haste caleba kde SRS 212
Lesions of the Stomach, Trau-

INARIGL GS PRS LOE ek at Oe 154
Lesions of the Tail, Traumatic. 319

Lesions of the Teeth, Traumatic 92
Lesions of the Testes, Traumatic 258

Lesions of the Urethra, Trau-
OTMAIE? = 35 Sioa stine sweaty « <lerattete 246
|) CCE) 0 be RCN ERO SU Cis ERELAIORI ONT CHIC RTOS OTERO A 46
Leukemia, Lymphatic ...,.).....: Ill
Leukemic Lymphadenoma ...... III
livatine Maternal tiers anes 4
Lip; Epithelioma of the: .:.....\. BI
Lips and Mouth, Congenital Mal-
formationsyore the .joseaee se 74
Lips, Mouth, Tongue and Jaws,
Meet Cae Fre Boat 72
Lips, Mouth, Tongue and Jaws,
Examination, Of th>scc.ss. 72
DAN GIMATAS joing s)<:.ge le see slantage ers 372
Lipoma of the Legs and Feet.... 313

Lipoma of the Mammary Glands 304

Pitnolapaxy 25 ssw alee toner 242
iithotomy,) Erepubic) eye. sles ae 241
Liver, Examination of the ...... 54
Liver, Neoplasms of the........ 206
Liver, «Surgery ;of the? ..5.)2qe<% 207

Liver, Traumatic Lesions of the 205

Local Anesthetics sic aieresitet g0t 16
Lune; Hernia. of; the...\.... -dee: = 123
Lungs and Pleurae, The... 2... 118
Lungs and Pleurae, Examina-
AOI OF othe wae -oic.o tie Gesees 118
Lungs and Pleurae, Traumatic
Lesionssof the <7; 272 sehen 118
Lungs, Surgery of the ........ 123
euxations ers votre cre siereecie 351
Luxation of the Carpal Articu-
WatIONS eiocs yiaiks fattes humetebneecls 357
Luxation of the Caudal Articu-
NATIONS) fccnc cccfars to ole olor dak atahotour 359

402
PAGE
Luxation of the Coxo-Femoral
Articqulation: ot. s.caiccelcestetnt 357
Luxation of the Hyeball ..-......---.+ 41
La@xations- in’ General’ . scicer6 351
Luxation of the Humero-Radio-
WinarccArticulation) a... a.s0c 355
Ltixation: of the =Lens «.:...-.:.. 52
Luxation of the Metacarpal . Ar-
tictilalOns 2). jonad oo deem Neoe 357
Luxations in. Particular ........ 353
Luxation of the Patella ........ 358
Luxation of the Phalangeal Ar-
tiCiwlatianisy. e.hevrie. as iate aint welt 357
Luxation of the Radio-Ulnar-
Carpal Articulations ......... 357
Luxation of the Scapulo-Hume-
ralazArticulationiass). sie: peaks 354
Luxation of the Tempero-Max-
illary Articulation ........... 353
Luxation of the Tibio-Tarsal
Artinulation. «i 93). 0s ded seas ais 359
Luxation of the Vertebral Attic-
AIVALIGHS es clea co hasan visccsain oa 354
Dey mphademitis.!— 5). scwc axa e nce cin 108
Lymphadenitis, Acute .......... 109
Lymphadenitis, Chronic or Tu-
DErEmlousienus ce 5 Some sstaeenign 109
Lymphadenatiiaié < 012.0 deo dew 378
Lymphadenoma Benign ........ IIo
Lymphadenoma, Leukemic .... III

Lymphadenoma, Malignant .... III

Lymphatie Glands, The......... 108
Lymphatic Glands, Neoplasms of
GE c AAS As Shs rom sro ee teen IIo
Lymphatic. Leukemia ........... III
Ligniphowid, 1.5 20)... Oo dnd sn 110
Lympho-sarcoma .......... 112, 376
REACUTG HA. ec e'd ciel calorstera ons slarbieie sie getters ele 46
Male, Reproductive ~Organs of
RON enie cot bat ce Cn aeeae tote 251
Malformations of the Esophagus,
(enertitads os w+ . Saw keen des 96
Malformations of the Eyes, Con-
Eo) Sn Bets bere 40
Malformations of the Eyelids,
Congenttal cia ovens. seers 57
Malformations of the Head and
Neck, Congenital ............ 36
Malformations of the Legs and
Feet; Con eed yo iaa h inieis 307
Malformations of the Lips and
Mouth, Congenital ........... 7A
Malformations of the Ovaries,
GOONER <0. atic ce tapite slo bie 265
Malformations of the ~ Penis,
251

Congenital @eeereeererevrereererer

Index

PAGE
Malformations of thé Prepuce,:
Congenital <0... sick pice oder 251
Malformations of the Rectum and ©
Anus, ‘Congenital ooo. aw: ace 194
Malformations of the Spleen,
Congenital. yo cc. n¢annatr sens 211
Malformations of the Tail, .Con-
Peital Sos hn wean gee 318
Malformations of the Teeth,
¢ COMREMIEALS ©, oue.cs fan earerotnee 85
Malformations of the Testes,
Conrenital™ \.2 set act meee 257
Malformation. of the Urethra,
Congenital: i .-6.cs00.9 < steels 245
Malformations of the Vagina,
Congeiiital 6000. sea 282
Malignant Lymphadenoma ...... III
Mammary Glands; The:........ 302
Mammary Glands, Adenoma of
thet, IAS care od reer 304
Mammary Glands, Carcinoma of
theses 2.2 eae chee ieee 305

Mammary Glands, Chondroma of
the
Seay. Glands, Congestion of
UNE OS Seaaetites wae are Shela
Mammary Glands,

305

re

302

theo: FOE Ree eee Lae. aoa 304
Mammary Glands, Lipoma_ of

WEG 6. lev aiate doa 55 6g 304
Mammary Glands, Neoplasms of

the. (cuss Pe swe ve eee 303
Mammary Glands, Sarcoma of

RHO T3453 atte Clee Tees Eee 305
Mammary Glands, Traumatic Le-

SiOiS “OF: ENG: ogee cates ee 302
Marnittttestie2es on ey sia 302
WMastitis.s<+ it, susunhstannee aeee 302

Material, Suturing and Ligating 4
Mattress suture, Halsted’s 1838
Matrix of the Nail, Inflamma-
ton WEEHES 2. ics Sunnte eeee 310
Maxilla, Fracture of the Inferior 331
Maxillary Fistula 88
Melano-Sarcomata, Melanomata 377
Membrana Nictitans, Neoplasms of the
Membrane, Persistent Pupil-
La VAD fac ttldens eee hictlee odes antes 40
Mesentery and Omentum, The
Peritoneum
Metacarpal. Articulations, Luxa-
tion of the

re cr

Ce ee

144

ee

Metacarpal.-Bones,. Fracture of

tehsil AE CS en ore hie cents 337
Methods of Restraint ........... 8
Metritisis2... .. . oovenk. deel oth elon 271

Metritis, Catarrhal fae ened eter pteiel cane

Index

PAGE
Metritis, Puerperal Septic ..... 273
Moles cs 4. icenes aie Missa ecpid Bij gied ©) ainieia isle 379
PROREUIILG } oo)5 0% oa oeb iarciarantia awe 18
Mouth, Canker of the ...............- 75
Mouth, Congenital Malforma-
tions of the Lips and ........ 74
Mouth, Fibroma of the ........ 78
Mouth, Foreign Bodies in the... 77
Mouth, Neoplasms of the ...... 78
Mouth, Papillomata of the...... 78

Mouth, Retention-Cyst of the ... 79
Mouth, Speculums 8
Mouth, Tongue and Jaws, The
27 open ii beat Eg Pay BE yn td ager 72
Mouth, Traumatic Lesions of the 74

Mucosa, Estrual Hypertrophy of
TE Va ee teat eee ee 285
WEINCS on oe oittete niepeecaice ake Gee 8
PUD IARIACA Pe Saw ain en chen 6 Cre fare 374
Myxoma of the Pharynx ....... 05
Nail; Fracture of the .........
l‘ail, Inflammation of the Ma-
ERIK MOLULNG. ares an saestenac st 310
Wat. Iu-GtOwine. 56+. .- 00 sa on 310
Narcotics Bide iepote cate: austen tote tageuah. ots 18
_ Nasal Neoplasms Dh fe eet Ce hin eae 114
PE MERE eiaelatets saierciers stoicinterl= antares eiateeis 46

Neck, Carcinoma: of the Head

ANIC on peri e e Nt LL +s Raed Sere 39
Neck, Congenital Malformations

of the Head and
Neck, Cutaneous Horns~ on- the

Head- and
oe ‘Epithelioma of the Head
Neck, Fibroma of the Head and 33
Neck, Foreign Bodies in-and on

ee eee eee ee eee

the: Head and..........0.5.. "27337
Neck, The Head and ........ 36, 72
Neck, Hematoma of the Head

ALINE GRAS tease ae SHE ees es 38
Neck, Neoplasms of the Head

MC ew eter dst tal ANA Ae ee 38
Neck, Papilloma of the Head

EIOVCES NRE eee cae Ee BRR o Sone 38
Neck, Sarcoma of the Head

ING Hy SEER URES ronasot caged Bie ae 39
Neck, Traumatic Lesions of the

head atid hoch hesise ao dete acres 36
INeoplasinstns aces cnadnnneree one 363
Neoplasms of the Bladder itd 236
Neoplasms of Bone ............ 344
Neoplasms of the Ears ........ 65
Neoplasms of the Esophagus 100
Neoplasms of the Eye ......... 53

Neoplasms of the Eyelids ...... 50

403
PAGE
Neoplasms of the Head and
INGClec pratt tel ecco einen 38
Neoplasms, Inflammatory ...... 5
Neoplasms of the Intestines.......... 179
Neoplasms of the Kidney ...... 220
Neoplasms of the Larynx ...... 116
Neoplasms of the Legs and Feet 312
Neoplasms of the Liver ....... 2
Neoplasms of the Lymphatic
RGTATIGS ssn re nara ase 110
Neoplasms of the Mammary
Ee aa ee fire SI NARS Ue 303
Neoplasms of the Membrana Nictitans 60
Neoplasms of the Mouth ......
Neoplasms, Wasal so. ic3 5.2... II4
Neoplasms of the Orbital Gland ...... 60
Neoplasms of the Ovaries ..... 266
Neoplasms-of the Penis ....... 254

Neoplasms of the Peritoneum ..
Neoplasms of the Pharynx .... 95
Neoplasms of the Prepuce 254
Neoplasms of the Prostate Gland 262

feeer

Neoplasms of the Rectum and
MS Reta iace ccnnedtlam » 58s 5 0t#204
Neoplasms of the Spleen > 212
Neoplasms of the Stomach 158
Neoplasms of the Tail ........ 321
Neoplasms of the Testes ...... 258
Neoplasms of the Trachea ..... 116
Neoplasms .of the Uterus ...... 277
Neoplasms of the Vagina ...... 284
Nephreetomy-- ss 00..0s0..cueevus 224
Nephrolithotomy ............04. 223
Nephrotomty =... 5 Se Ce ee 223
INetiFak «GyStS cnkcccconeks dere 389
IN CUFOMALA+ 54.065 olan dees 374
IPORG ye LAG» ssi lsinwnig ease peed ae 113

Nose, Foreign Bodies in 'the....

Objects in the Peritoneal Cavity,
Inanimate

Ce oS

y
Obstruction by Compression, In
testinal
Obstruction’ by Constriction, In-

ey

testinal ..i2.< coaswas 2 tae 179
Obstruction by. Fecal Accumula-
tion, . Intestigale.}!.4.,. scaaadees 165

Obstruction by Foreign Bodies,
Pntestinak) tic): aeiss 3a abla es
Obstruction, Intestinal .........
Obstruction by Obstacles, Intes-
tindhutiotidaei sad. 40. aimless
Obstruction by the Urethra ....
Obstruction by the Urethra,
Parasitic

404
; PAGE

Omentum, The Peritoneum, Me-

SEMCEIY 5) ALG is wren ojclesareisrsielehs sete 144
RenVCUIS oe re in ere ees wre ae 310
QophorectOmy suis. nso ss oe aa ace 266
GIG PHOFITS sx ce le talye Hla ae eins 265
Opacity of the Cornea, Congeni-

atl ee soccta aisara late ou -teas aasncloiemes oteus 40
Operating Lables, ten ceca 9
Operation, Sterilization of the ~

Re GIGiM OEE a salen ciestinioeeie tas 3
Opltaaaey, 2 hates «he oe ie aarti 48
oneal Gland, Neoplasms of the...... 60
ORCHECLO Mia eye sais <ieiere'e ckesens) oe 259
OCHiEIS 65). te chr. Aes eo eisiecetocs 258
Organic’ Strictures)-:. . a-stae annie 367
Organs of the Male, Reproduc-

PIV see Re «ha. Fei Noieterare axe 251
Oreans,, The (Urinary (3. 7o0. 2a 215
Osseous System, The ........... 323
Osseous System, Fractures of

RTO Tiered. ce csiera A see oles elererado ters 323
Osseous System, Traumatic Le-

SIONS VOL | thE): sce qorsisrarcinedtters 323
@StEiEISs soe Gee aS hl ocdtaheccteors 340
Ostettis /Deformans). 2). 3)- 5, 01)<!<% 342
Osteomat ce. bie tis Seto aye's tie sterotare 344
Osteoma of sthe? Jaw: encoqerres1- 80
O@steomalaciat jie = caer siersieaeicie ss 343
@steomata laine aloe dins ersermeer 372
Misteoplastyiridinds..kds Baten. tane 345
Gistentoniy * tide. esc aieeeass se 348
Osteo-Acthnitis! .....vetiosieratee eae 362
Osteo-Myelitis 3. . os. - eiceheere fe 340
Ov GiGIS. eos poss ae cele oie eee 62
@torriies” Messe kwon cece ostoenis 62
Owvariesi chery 2407 dew chee ee ace 265
Ovaries, Congenital Malforma-

HONS OL thes Geers eee 265
Ovaries, Examination of the.... 265
Ovaries, Neoplasms of the .... 266
Pads, Epithelial Hypertrophy of

Ha epee ree etary PAS ere ae Rintre et 315
Pads, Inflammation of the ..... 310
IPanereas, eabe © trefeureventrele eee 208
Pancreas, Surgery of the ...... 208
Pancreaties Elerniay y.jc)a0 ihe ttre 301
IRapillonsvatate rte tesie's cierto eel 379
Papillomata of the Ears ........ 65
Papilloma, Endothelial ........ 380
Papilloma of the Head and Neck 78
Papillomata of the Mouth...... 78
Papilloma of the Prepuce ...... 256
Paracentesis of the Abdomen... 149
Paracentesis of the Eye ........ 54
Paraplimosishiit sae ate ces eiee 253
Parasites in the Eye..... deters. 43

Index

PAGE
Parasites of the Kidney ........ 222
Parasites in the Peritoneal Cavi-
ty,” Verminons* >): fea 150
Parasitic: Cysts 25S elo. . eee 389
Parasitic Emasculation ........ 259
Parasitic Obstruction of the Ure-
tha 2.4... an kk one eee 2
Passage of the Catheter and
Sound seer sa.s seis eee ate ee 238
Patella, Fracture of the........ 339
Patella, Luxation of the....... 358
Pelvis, Fracture of the ........ 337
Penial Bone, Fracture of the.. a
Bents. Thee. 3.25. 2s ae ee 251
Penis, Amputation of the ...... 256
Penis, Congenital Malformations
Ofsthe | SS S0722ct Re eee 251
Penis, Examination of the ...... 251
Penis, Neoplasms of the........ 254
Penis, Traumatic Lesions of the 251
Peptic: Ulcert#/ 33 eeeaeee 154
Perforation of the Esophagus... 96
Pericasdicentesis)" 62-8252 132
Pericarditis: | 2 Aodci-i crepes oats 127
Pericardium, The Heart and.... 125
Pericardium, Traumatic Lesions
ofthe? Heartvand! 2208.0. ee 125
Pericementitis, ‘Calcic 2.2... 5008 87
Perineal: Hemnia-. . o.<4acheeer tee 301
Periostitis: cas cnc oceeemone oe 340
Peritoneal Cavity, Fetuses in the 151
Peritoneal Cavity, Foreign Bod-
16SHMin De) yc 8S. ca eee eis 149
Peritoneal Cavity, Verminous
Parasitesiinethe say ease 150
Peritoneum, Mesentery and Om-
enti ANS) 41. Brercncrsidoiooes 144
Peritoneum, Neoplasms of the.. 152
Peritonitis: tose 's ec. eee 145
Persistent Pupillary Membrane.. 40
Phalangeal Articulations, Luxa-
fion Lot the © 5) .-.c/ac sens ee 357
Phalanges, Disarticulation of the 318
Phatynx,..0 he. (55.5522) < 20. shee 04
Pharynx, Epithelioma of the ... 96
Pharynx, Examination of the.... 94
Pharynx, Foreign Bodies in the 95
Pharynx, Myxoma of the ....... 95
Phatyneitisn his $s cateahettage was 94
PhimoOsis, “475 sievate uses Get ater eas 253
Pilesi ts Soheeeiien cee cates 198
Pin gueculla. o.2clac < ove: cje'0ie vss caieivisiciw cies 53
Pleurae, The Lungs and ....... 118
Pleurae, Examination of the
EAanes) carne sors apporeroits haeeeteteee 118
Pleurae, Traumatic Lesions of the
Lutips: ane joe. asts's i's nae 118

Index

‘ PAGE
VRAIS ORE Seth agients «id 120
Pleuritss, PBurulent 52s. .0.2 te 122
ISGhY Dee sano eisivio tips = +o Sijalu Mareiweomieties = 114
Pouches, Suppuration of the

NTI patch, Sept ede wamomncts cicecbeies 195

Prepubic Lithotomy’ ........«.. 2+. 241
MEGED ICE. MGs ss dele be aireeeie ate eae 251
Prepuce, Carcinoma of the ..... 256
Prepuce, Congenital Malforma-

TONS MON thew Renae aaertch sete 251
Prepuce, Examination of the.... 251

Prepuce, Neoplasms of the...... 254
Prepuce, Papilloma of the ...... 250
Prepuce, Sarcoma of the ...... 256
Pleurae, Traumatic Lesions of the

WG ec de crsilh sia gS acd a esa eons 251

Procidence of the Rectum ...... 200
Procidence of the Uterus ...... 275
Prolapse’ of ithe JAnusigsé siseeyacescr- 260
Prolapse of the Vagina ......... 2090
Proliferative Endometritis ...... 273
Prostate, Gland) « Dhe! 4... sie. sas 261
Prostate Gland, Examination of

RDG Se laysis chasse 6 So wy shelnetherered 261

Prostate Gland, Hypertrophy of

PCR res erspepatacas shes otalaeevert aye. 262
Prostate Gland, Neoplasms of -
BNE aio cie ono erence amemtonuara aes 262

TACGSPAPIEIS Wie 8 2 chic. « hepa has « Sates 261
Seid anthnrOsisy)-slera-eics «cae 340
Pseudocoprostasis |< -cect scnmins 195
senda: CVstsik ejae ontiat ot akaseas 3890
PPCORV GRIME fy ohsrels niall slarei=ielsinie’ = siainisiapsalcl=) oi 53
Puerperal Septic Metritis ....... 273
Puncture of the Bladder......... 239

Pupillary Membrane, Persistent 40

Binilentwelemnitish ss sjei- «epee 122
Vemma asst ct yepateisraniscoreve.a%5 aye's Siete 33
Pyorrhea alveolaris .................. 88
JEAORa Tb ae Ae oSindeobide ona Semon 271
ROAEMTISS Fae ee vere etc tones 342
Radio-Ulnar-Carpal Articulation,
Mixation of thes. 3. aocsses = 357

Radius and Ulna, Fracture of the 335

Reantilaemesirerscts oslo tiasia ates tore 79
Rectal TPrripation® <5 2.5 08sset « IQI
Rectum and Anus, The......... 194
Rectum, Congenital Malforma-
HIG (OLR thes aac .sc te puaens ne 194
Rectum, Examination of the.... 194
Rectum, Foreign Bodies in the.. 195
Rectum, Neoplasms of the...... 204
Rectum, Procidence of the ...... 200
Region of Operation, Steriliza-
tir On TOG. cee core en eae
Reproductive Organs of the Fe-
TALE Shera ee ee sent2 Arne 265

405
PAGE

Reproductive Organs . of the
Malle ‘yi. stppteberd vgs isiormis ioue's esate 251
Resection of the Bladder....... 243

Restraint, Apparatus and Meth-
OdS) Obi asiscaossian idee eases 8
Retention=Gysts\ os.t76> sicse eee 386

Retention-Cysts of the Mouth.. 79

Retroflexion of the Bladder.... 235
Ribs; Fracture Of) the). .a.ch te - 334
BRICK EER ea varcinis aie) sya i-"n ie stole sfelatne nieteta ri otatara 342
Rupture of the Bladder ........ 230
Rupture of the Esophagus...... 96
Rupture of the Tendo-Achilles.. 308
Rupture of the Uterus ......... 277
Rupture of the Vagina ......... 283
Salivary Glandsiiihes iecasenes 92

Salivary Glands, Fistula of the 92
Salivary Glands, Inflammation of

EN SD ee rads Norn see careers 93
Salivary Glands, Traumatic Le-

SIONS OL theta facan sete nete 92
SIGUA GIEIS’ s A. «sehen Wa chet cies 271
Sarcomataaers so hence ee oe ne ikk 374
Sarcoma iol BONGs cuckoo re 345
Sarcoma of the Head and Neck 39
Sarcoma of the Jaw, aeescien cece I
Sarcoma of the Legs and Feet.. 316

Sarcoma of the Mammary Glands 305

Sarcoma of the Prepuce ....... 256
Scaldshs seers serene ewes 32
Scalding of the Teeth,......... go
Scalpx Abscess Onthewnamercas at B7
Scapula, Fracture of the ........ 334
Scapulo-Humeral Articulation,
Euxationsot thes teen caer 354
Scrotal Hernia in the Male.... 207
Scrotumye Whe sssteele ce ae coe ae 257
Section, Abdominal ............ 134
Septic Metritis, Puerperal ..... 273
Sepliceniia ’:,sccev recone reset ate 33
Sequestration Dermoid ......... 40
Serous Cyst, Interdigital........ 315
SIOCK: +0131 05 Uae deer ates tena 27
Simple Granulomata’---2 225. 365
Simple: Tumors > .sneeees : 360
SUMS, Lente occas 2 eee 31
Sinuss Anal’ ts cori oa e,ianesos 197
Sinus’ of the) Eags:...:.'7- daa ok 65
DAVIN ES oie c te tte aisies cists cleiores’s ctatta teeters 266

Speculum, Immobilization of the

Jaws withthe! see.ee sce eee 72
Speculums, Mouth! *.:.0i2....sc0s% 8
Spleen Ther 2 eae ae see 211
Spleen, Congenital Malformations

Of ‘thes sveasccc See 211
Spleen, Examination of the...... 211

Spleen, Neoplasms of the........ 212

406

Spleen, Surgery of ‘the 213
Spleen, Traumatic Lesions of the 212

Splenectomy .......+--eeeeeeee 214
Sprams-of*foints +s .002. 5.0 sess 350
DQEUMEY 6S: aicceest ciciciehe Rtclain wo wi ='al demiolneimisuslohee 52
Staphyloma 2... - ssc secs mesqensnemesines 46

Sterilization of the Hands .... 2
Sterilization of Instruments .... 2
Sterilization of the Region of

Operation sal Sane’ s.cuns'n ions le 3
Sternum, Fracture of the ...... 333
Stomiatitiss ner. enon dae oie ied 74
Stomach iPMe ye ek. eis «ae tals vias 154
Stomach, Examination of the .. 154
Stomach, Foreign Bodies in the. . 156
Stomach, Neoplasms of the ..... 158
Stomach, Surgery of the........ 159
Stomach, Torsion of the ........ 155
Stomach, Traumatic Lesions of

ERM be chai ao cya mn spine cei ie 154
Stomach, Wounds of the ....... 154
Strabismus yaa. ss sess te sceidetasle 52
Strangulated Hernia ........... 172
Stricture of the Esophagus...... 97
Stricture of the Intestines ........... 179
Strietupess ‘Organic (2340408 «sins 367
Stricture of the Urethra ........ 246
Structure of the Teeth ......... 83
Sergeant Sih. cairn ebalernds Fas wares IOI
Suppuration of the Anal Pouches 195
Superficial Keratitis ........... 45
Surgery of the Bladder ........ 237
Surgery of thé, Eye. ...-...0-.2: 54
Sareery, General... s.<j¢ceses elas I
Surgery. of the Heart oc. sss sxe 130
Surgery of the Intestines ...... 181
Surgery ,of-the Kidney ........ 222
Surgery of the Liver. .. 74: .4..%- 207
Surgery of the Lungs ......... 123
durgery of the Pancreas........ 208
Surgery of the Spleen ......... 213
Surgery of the Stomach ....... 159
Surgery of the Trachea ........ 116
Surgery of the Ureters ........ 225
Surgical Wounds of the Bladder 231
SHLUEES: ys MEK Zs oro eeilaet eaters 5
Suture, Halsted’s Mattress ........... 183
Sitare of the’ Hiedrt.../\mas aes 131
UENCE: TINO E saicte) sale sc cc’sw ainieiee less 182
Suturing Material ............. 4
Syme’s Operation «. 22.2.4. cccccsccene 81
SyHovitis 2s Mat TRE aioe wees 360
Synechia, Anterior .......ccccceceees 45
System, The Osseous ......... 323
Wable, Operating: ....2sacs.qenee 9
hail he wees vin: Matchen aioe ayaene 318

il, Amputation of the ....... 321

Index

PAGE
Tail, Congenital Malformations:
OL ARE, ,. tuinin oR NRE cect

‘Tail, Inflammatory Affections of

the alate ain Ate Oe Sea a tardde feo ey 320
Tail, Neoplasms of: the ........ 321
Tail, Traumatic: Lesions of the.. 319
Tartar, Incrustations of ........ 87

Teat, Chronic Interstitial Fibrosis

ofthe i. aa Sad. cee 306
Teeth, @he sie wsistereay Ren ok cee 83
Teeth, Congenital Malformations

of the «slick. Ree daa 85
Teeth, Extraction of the ........ QI
Teeth, Scaling of the ........... 90
Teeth, Structure, Disposition, and

Development of the 83
Teeth, Traumatic Lesions of the 8
Tempero- Maxillary Articulation,

Luxation of the 353
Tendons, Traumatic Division of 309
Tendo-Achilles, Rupture of the 308

eee eee we ew eee

'Restes,- Fhe: (a6. 3050 Je seein 257
Testes, Congenital Malformations

OF theres sos IAS Nokermaneelana we 257
Testes, Neoplasms of the ...... 258

Testes, Traumatic Lesions of the 258

Theracestesist 3 3.82 oe clas relents 124
‘horaxcel hey Acs ccenta oastenee 118
Thyroid Gland and Glandules,
Herein ead + esa ins Aesete alee 100
Thyroidectomy- ..6...6e.eeceeue 106

Tibia and Fibula, Fracture of the 340
T:bio-Tarsal Articulation, Luxa-

fiOwOF, thle? is sass o cee eee 359
Tongue and Jaws, The Lips, -
Mottin: \ 2.2 okt chicane o ac eee 72
Tongue, Partial Amputation of
CHG 3S ice EON ho ee 76
Warsionyot the Bladder 2.32: 235
Torsion of the Intestine ....... 174
Torsion of the Stomach ....... 155
Torsion of the Uterine Cornua.. 276
SRO KEHNA: * 5.2/5.4. octane cieta. ee 33
Trachea, Foreign Bodies in the.. 115
Trachea, Fracture of the ....... 116
Trachea, Neoplasms of the ...... 116
Trachea, Surgery of the ........ 116
Wracheahonw) » essen actos eens 117
Traumatic Division of Tendons.. 309
Traumatic Lesions of the Articu-
VaAtlOnS cs < cis » cat'era omc ek there 50
Traumatic Lesions of the Blad-
Or’... « aileSak sh amie kats aaantad 230
Traumatic Lesions of Bone .... 323

Traumatic Lesions of the Ears . 61
Traumatic Lesions of the Eso-
PhACUS © ais mel ate. ghasiems ae

Indéx

PAGE
Traumatic Lesions of the Eye . 41

Traumatic Lesions of the Eye-
WdSt rt ice OL tee 57
Traumatic Lesions of the Head
ANGE NCCKex. toe ee de ae seks 36
Traumatic Lesions of the Heart
and + Péricarditiin: cocece se. sces 125
Traumatic Lesions of the Intes-
HINES! Lci.cwER ee lo so eratie 162
Traumatic Lesions of the Legs
and Heeb carton <.oaes cote shaw 307
Traumatic Lesions of the Liver.. 205

Traumatic Lesions of the Lungs

Chatel ledkobhg: (ueemneneen Sint ai 118
Traumatic pe of the ‘Mam-
fiary Glands. Iv.". xt. Soe 302

Traumatic Lesions of the Mouth 74
Traumatic Lesions of the Penis
Traumatic Lesions of the Perito-

neum, Mesentery and Omentum 144

Traumatic Lesions of the Pre-
HCO. Sua kuine cioecyiees eae 251
Traumatic Lesions of the Sali-
ORLA -MerPAIMIAG) © S655 5: y's, o siwia en. « 92
Traumatic Lesions of the Spleen 212
Traumatic Lesions of the Stom-
ACHiee neyo dneiereda sacar sae ameare 154
Traumatic Lesions of the Tail .. 319
Traumatic Lesions of the Teeth 86

Traumatic Lesions of the Testes 258

Traumatic Lesions of the Ure-

PIGS ee leh wil Rae se oe eee 246
Treatment of Tumors ........ 390
Pinta IAGISabs sat eraversiorercisisves te fists. axe 32
AT ITSM GNSS sew citron torareteters siaiets 3
FETDCTCTHONIN, feicicisie.e c/o oc + wee ckeien lenis stele 365
Tuberculous Lymphadenitis ..... 109
dubes,. Lhe Pallopian...... 6.6 «: 271
PENDING SES: <cotie Jin sein os cists, eee 8 388
wumors, ‘Compound 6 4:J.6c6: 384
Tumors, Connective Tissue..... 369
pPiamors: Dermoids.c:: .cniacnin aslo 384
Tumors, Epithelial and Glandu-

Neate Sheer ans kek Die blac: ket’ 'd 378, 380
umes) PTORET saci.cis sc seniss ese ce 368
Samors, ~— Simple... acc ices ceeds 369
Tumors, Treatment of ......... 390
HylOMIA ciseccas Papeete MRR oF 314
Rlceeies teas ah eae 30
MRGGt POPC toe er bae vi Mean 154
Ulceration of the Concha....... 61
Ulceration of the Cornea......

45
Ulna, Fracture of the Radius and 335

Aasbilieal . Hernia asi iiss owes os 291
Urétéersy: Phe: 2o.40 tins. wale oe 215
Ureters, Culculi in the ......... 224

Ureters, Surgéry of the........ 225
Ureters, Surgical Wounds of the 225

U¥tterblithdtomy 2. ee ees 227
Uretero-Cystotomy ............ 227
Uretero-Ureteral Amnastomosis.. 227
Uretero-Ureterostomy ......... 227
Uretero-Vesical Anastomosis 227
Wrethtay Wneyes cas cacesetecost 245
Urethra, Calculi in the ......... 247
Urethra, Congenital Malforma-

HONS COL ERGs oss are cestode 245
Urethra, Examination of the.... 245
Urethra, Obstruction of the .... 247
Urethra, Parasitic Obstruction of

1) REWER SERA aL Ss 248
Urethra, Stricture of the ....... 246
Urethra, Traumatic Lesions of

thet (asc ciclo sie cassis cuseielvine ators 246
Urethra, Wounds of the ....... 246
Usethrolithotomiys one cnc o. eioreieis 249
Wrethrotomy, 4 cis. cease eee weirs 249
Usrinaty Organs, he 2s... ..%. - 215
Wirolitihtasisin ase acsaec ore cece 215

Uterine Cornua, Torsion of the 276

Uterine Cornua, Ventrofixation
Ol thelr sh titeseves cies o2.0-teee 281
Wipers; her eerste narcte siete cieteers 271
Uterus, Examination of the.... 271
Uterus, Fibromata of the ...... 277
Uterus, Neoplasms of the ...... 277
Uterus, Procidence of the ...... 275
Uterus, Rupture of the ........ 277
Uterus, Surgery of the ........ 279
Vagina, TRO i psiecnstas seiews.oc5% 282
Vagina, Congenital Malforma-
HONS) Of ThE? 05 cok we aeeeersiewats 282
Vagina, Examination of the .... 282
Vagina, Fibroma of the ........ 284
Vagina, Neoplasms of the ....... 284
Vagina, Prolapse of the ........ 283
Vagina, Rupture of the ......... 283
Vaginal Mucosa, Estrual Hyper-
trophy of the. .... 6 shure 285
WARIS: |< 5 six sna 'wio Sole ole ss 282
Venereal Granulomata.. 254, 286, 366
Mentral. Herma cenes..-ce cere 292
Ventrofixation of the Intestine.. I91
Ventrofixation of the Uterine
Comat ia ii tteneeen 281
Verminous Parasites in the Peri-
foneal Cavitvas dacdcss soccer 150
ViEEEUGA. co wicrrcds be a ck sxe nivel 313
Vertebral Articulations, Luxation
OfSER EY sc teicelins cate eee 354

Vertebral Column,
the

Fracture of

ee

Vesico-Rectal Anastomosis

Index

PAGE

ee 244

ZN. re hh ai Ake aeed 4 coh 174
eee IES AR tS Fh 282

j

See ee ee

PSAP eM ae 313

PAGE
Wounds of the Bladder, Surgical 225
Wounds of the Feet ........... 309
Wounds of the Intestine ....... 162
Wounds -of Joists 25s s- sean 350
Wounds of the Stomach ....... 154

Wounds of the Ureter, Surgical 225
Wounds of the Urethra ........ 246

aoe ;

— ah

Ri iaighe Me . ho
SDE ns LIE
Pry st PY oe a Eh.
SS ae abe ot a Pe