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Copyright N°
COPYRIGHT DEPOSIT.
A MANUAL
OF
OPERATIVE
VETERINARY SURGERY
BY
Ae LEU RAR Dy NEI Neve
Dean and Professor of Anatomy, Surgery, Sanitary Medicine and Jurisprudence
in the New York American Veterinary College; Officier du Mérite
Agricole de France; Member of the Société Centrale de Medécine
Vétérinaire ( Paris) ; Honorary Fellow of the Royal College
of Veterinary Surgeons (London) ; Corresponding
Member of the Academy of Medécine of Brux-
elles; Honorary Member of ‘the Société
Vétérinaire a’ Alsace- Lorraine, etc.
Author of ‘‘Vade Mecum of Equine Anatomy,’ ‘‘How to Tell the Age of
Domestic Animats,” ‘‘Animal Castration,” ‘‘Lameness of Horses,’
Translator of ‘‘Bouley on Hydrophobia,” of ** Zundel on
Diseases of the Foot’’; Editor of the ‘‘Ameri-
can Veterinary Review,’ etc., etc.
WITH NEARLY 600 ILLUSTRATIONS
New York
WILLIAM R. JENKINS
VETERINARY PUBLISHER AND BOOKSELLER
851-853 SixrH AVENUE
1906
LIBRARY of CONGRESS
One Copy Received
JUL 24 1906
Qoryiignt entry
Copyright, 1891, 1906 by A. Liautard, M.D., V.M.
All Rights Reserved
PRINTED BY THE
PRESS OF WILLIAM R. JENKINS
NEW.YORK
DR. A. CHAUVEAU,
f
_ Member of the Institute (Paris), General Inspector of the Veterinary Schools
e ae vance), Professor to the Museum of Natural Hisy Bao) 7
i. “As a humble token of the high appreciation of his scientific labors _ hep
i ae in behalf of Veterinary and Comparative Medicine, this work is, with -
| 5 _ Kind permission, dedicated by : Me : ee
| | | | ‘THE AUTHOR. a
a ~-
A
Ba
eee ee itech ah
PREFACE.
If an apology should be deemed necessary for any apparent tardiness
in the execution of the special undertaking of which the present work is
the result, it will not be very far to seek, but may be readily found by a
reference to the various and unceasing vocations in which the author of
the Manuva or OPERATIVE VETERINARY SurGERY is habitually engaged.
The labor of its preparation has, in fact, been alternated and shared with
that of other literary engagements of an imperative and unremittent char-
acter, and the onerous and exhaustive duties pertaining to his collegiate
functions, to say nothing of the demands of an extensive practice.
Engaged for years in the work of teaching this special department of
veterinary medicine, and having abundant opportunities, which have not
been neglected, of realizing the difficulties which the student who earnestly
strives to perfect himself in his calling is obliged to encounter, I formed
the determination long since to do what lay in me to facilitate his acquisi-
tion of knowledge; and it was then that I projected the present volume,
and began the accumulation of material by the compilation of data and
arrangement of memoranda, with the recorded notes of my own experi-
ence, the fruit of a long and extended practice before referred to; and of
course a careful study of the various authorities who have illustrated and
organized our copious veterinary literature. Moreover, haste in the pub-
lication, and a thorough digestion of the subject and the systematic order-
ing of material, could not be very easily combined, and a little delay in
the issue will prove no detriment to the value of the book.
With his own kind permission, the work is dedicated to Professor
A. Chauveau, General Inspector of the Veterinary Schools of France, as a
token of my high appreciation of his services as a scientist, and in recog-
nition of his standing among the lights of our profession; and especially
of my estimation of his excellent book on anatomy, in which he so ably
lays the foundation of the knowledge which constitutes the indispensable
condition of all success in surgical practice.
V1 PREFACE.
_I have been liberal with European authors, not only in freely cred-
iting them with their discoveries and theories, and in many cases quoting
literally their opinions and arguments, but especially so in adopting their
illustrations and enriching the work with the artistic representations orig-
inating in their’s—an emphatic manifestation of my high estimate of their
value and the skill of their execution. And it is thus that the names and
accomplishments of Rigot, Bouley, Gourdon, Peuch, Toussaint, Cadiot
and Zundel, of France; of Brogniez and Degives, of Belgium; of Hert-
wig, Hering, Moller and Hoffman, of Germany; of Lanzillotti-Buonsanti,
of Italy; and of Williams and Fleming, of England, will become famil-
iarly known to our readers.
But while I have in great part been guided in my work by the char-
acter of that of our predecessors, I have not restricted myself to the
lines observed by them, or exclusively respected the authority or prece-
dents of European surgeons, but have sought to do justice to the progress
of American veterinarians by honoring the contributions they have made
to our surgical knowledge; and it is due to accident alone, and to no in-
vidious design, if any omission or oversight has been committed, by which
any to whom credit should be awarded have failed to receive it.
The chapters of the Manuva which treat respectively upon ‘‘ Frac-
tures’? and upon ‘‘ Operations on the Foot” are reprinted from my own
previous writings. Thus, in the first instance, the remarks upon frac-
tures, with the kind permission of the Hon. Jeremiah M. Rusk, Secretary
of the Department of Agriculture, are extracted from an article published
in ‘‘ The Special Report on Diseases of the Horse;” and in the second in-
stance, touching the subject of operations on the foot, I have not hesitatea
to utilize my own translation of Zundel, produced as long ago as the year
1881. In both cases improvement has been made upon the previous treat-
ment of these topics by the addition of numerous illustrative plates which
accompany the text.
In the chapter upon operations on the genito-urinary apparatus the
reader is referred to my special work on the subject of ‘‘ Castration,”
which is not included in the present volume.
In completing the task undertaken in the preparation of the Manvat,
however perfect or imperfect may be the manner of its execution, while
I have been influenced by a desire to effect something for the benefit of
all classes of practitioners, including those of recent graduation, my ob-
ject above all has been to facilitate the labors of the young student while
industriously and anxiously toiling for the knowledge which is to qualify
PREFACE. Vil
him for a successful career in a useful and honorable profession; and if
I shall have succeeded in this object, and the success shall be certified by
the verdict yet to be pronounced, I shall feel fully satisfied and more than
ever encouraged to persevere in my efforts to elevate the standard of vet-
erinary science in America.
No toil has been spared, no effort relaxed, in the prosecution of the
design and desire to compel the approval of the judicious, and even to
escape the strictures of the critical, and I have not failed to seek for aid
and counsel from competent coadjutors. The entire text has undergone
revision, with a view to the improvement of its idiomatic structure, by my
esteemed friend, H. D. Holt, M.D., of Jersey City, N. J., to whom I am
also indebted for the favor of supervising the proof and overlooking the ©
issue and arrangement of the various chapters; and my publisher has
exercised a true liberality in providing an external garment and garni-
ture for the contents of the book, in all respects correspondent with
their value and interest. To that gentleman, therefore, are due my
warmest acknowledgments for whatever of internal and external
attractiveness may characterize the MANUAL OF OPERATIVE VETERINARY
SURGERY, and they are cordially and freely tendered.
I have now only to express the hope that this contribution to the
cause of veterinary progress may be as kindly received and favorably
judged by my colleagues as it is honestly designed to effect its object by
me, and that any shortcomings in the execution of the work may be len-
iently regarded. And so it goes into the hands of the public, to share the
fate of all human ventures, for better or for worse, as its fate may be.
THE AUTHOR.
CONTENTS.
PAGE.
PMT EODUOTIONS osnc'6 oiss 4 occ le Tae wale Serie iarieistetereitarsiete See pactain ak
CHAPTER I.
VANS MOREY ES TEPAIN Dosis aps teioraisiersiers <tversie eve) acarsicvciciniaraiciolere’s cvelerstekeneleyerste seis 14
Means of Securing Solipeds......... ........ botienoehiocnac tesa 14
Derivative or Painful Method................. Suwa cStshamceee eae @ 14
Mechanical or Restraint Method...... mists Bets Soarcs Sea Pageants rater tee 17
SCSTPO TTS Bails Cite | Cane An ER On moner et ortpe er samcaeer anne 17
eCHIMDCHL SP OsIAOM ac. 5 scot talclsroralers ais ale laisictore's ole 0'o eieianct are ow ie's, 3 27
Want arity FLOOD DIER. 9. cio. -= ajo’ orotate eet ncatateie ee oie eteteias’atesarsi sha 30
Beauties Ge MIC DS covet achat ean ce anne feta omen inene 38
CaN UPR ERODES NC crareraya fete Gram tele Pala = wietelaleiete lets x olalstels eile sia 44
Casting on the Operating Tables. OE RAM RR ERT TENS Go Bits 47
Means of Securing other Domestic Animals...................55 54
IB OVANES a opecs hee ie a Sees Bae Gi nee eicunicten ie aie Sattiaberera cielo mare stsee 54
Chyinen ane | aNTiNeSaajc0 oe oe oh aise (hele us eo oles. cleo clemio meee niaiean 62
Shiite G23 sicdaabb a docs cotoneoacanooacouungoDeboounaccEts Ome 62
Mops and Caisse cicctoek oes sree ieee wicisiele ave mate ate miata ete ster 64
SURGIOAT: ANESTHESIA. - 222s -Gadieietle ote Cioe™ cles pn dhancle ae Sew soe eae 66
MOCHIwAMeSthectatn tm nese sate eiereiceererei oie cieyeraueitaegsiey asi iorrkonmenede ener oetans = 67
General-Anesthesiais 3c nc.co.s a ooteeie ok icine Ie oe materia Gusts rae 70
Accidents of General Anesthesian..4 215 ice e-iacis wstbeierale oisreiss 75
Accidents Incidental to the use of means of Restraint........... 76
ESTA CULIT ES oc sare Bact ooo oe en Sa TTT IEE ere eg ome comet 76
ryuries ofs Soft Diesues) 0.0. ane)! Pema mn ioe ire es eae pansies = 79
CHAPTER II.
SureioaL D1aqnosis.
PIR INE SS Wits fata cate stats toie radia ears wim leis = chai Nroio ns a nine cata alates a sale elem aye 81
PROUCIS aces ha tres. oie clare ca ain eieia ar eretateie ate a cea dle’ sist cke aleve niciolatetssize 86
LE GTI Tao Aa ee amines Sete cs Bias s bine IAM Gn cet oma es ohare 88
Sane Lee yee erste aie cle thar sav erectus cisiave (arousal ofall wh onsuevons oysters carers ehscavelere oe 88
x CONTENTS.
CHAPTER III.
Sur@ioaL THERAPEUTICS. PAGE.
JuJes 2/2) 1a GPeoers SBEOOOGe mistoiey a theca State inotete stele te eitetereiets okies let ctale 90
Retentive Dressing......... aye Stal WiniGs ote oreMe tats let niotate nies cieia Pas ocser: 98
Uniting AN Jon ial Sas ravetara fas overs Qoalapese store saselnis Mbetentinas pticteleiateleeaeashe tee 99
SSHSPOMSONY. ssa paicvasia vases este aiie she AGyy. sso ele alateyer anal teeta eiaa ete ia ees 99
Compressive Dressing: 1 5 .o ceils o)sis viele aleie vos ev els eo, nlapiala alas «eine 99
Dividing” Dressing gape. acre mia sony ascssh ed wiakeierel eyes atnlaeta sais toate leat 99
REP USuyG SEs oe 5 jan wi eavante oyayecsl emia yarohe ain tere ise eee aust ne Rett Nei aad ats 99
Antiseptic. ooo sa tics catsetcheso-ale oor ete cate teins e eusisa sweated eteetatets oh 100
EVO.) ea een Arnie or herot noma sacra 2) ao cio ha aoc 103
Varieties of. Bandages ii. 2). 2 210,510 ouliaaewicwe sscoisiein’=is!ejpyeialelerayet=letm etnies 105
CHAPTER IV.
ELEMENTARY OPERATIONS.
JOU ORE SOD ORCUTT OSU OE IOD COD ICU Ca odo os DaGun SOAC Oe 125
TNCISLON Birks 5 Seis prorelosvere cue See Siewinw pine needa eteake ante carerteorete 125
DISSE CHOMS fers eyo cecum atone aoue cle e\oiateielor oie teacte te meron toteterec etereroreters 137
PU Cure ss erase reisioce wens ssi o'e Saye ie wie te auele ered atehahealavevehaloteterae otarorehe 138
PROUNLOTE: 5.5 cw aE Sos Bias se GIC Re eitle mien alot nl ohereatelemeenieretale . 142
1220716506)? We A ene oer rar conn ibe nd oe attic tad b BOD oop on cS 144
LOsmrhneayee BENNO COCR C5 agence Hoon bed Sudo co Sn anDoanaOdosod6DSs 144
STEELE OSs 0o orlove, e/a cs ogc asics Siai'eta ny crete eileve. erate Sheena muohe omkenectonererciorere 146
CHAPTER V.
OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
OUTIL Ree AAD ROPE Aas ie AR terse! eum cR ADRS rity keen 158
Actual Cauterization or Wiring. <5 ess s 28 sete we cine ee pecker 158
Transcurrent or Firing in Lines................ceeeeeeseeee 160
Firing ‘onthe Surface or “ia la‘Gaulet oo rece ce coe alee 171
Hiring in Superticial [Pom ts vcr. e. ulster sielare aiegeee arate ere 172
Objective Wiring) 2 sactesre ometeels eo detiles er ee ots etter areas 174
Deep Cauterization.....: ben ce are Lessa Aoray nadie ta cote Se hte
Rapid) Deep: Cauterization..227 0 o.oo ota e ose ioe ER 175
Inherent Wirin yye rete y- c fick ce iekersiey toatl teletsistarelereyeteioke etekeietorerasiores 178
Subcutaneous: Cauterizationy-c.. se-tieiice-tamicielolecieisia etree 180
Cauterization with the Thermo-Cautery.............2+ssss0 182
Cauterization invother Animalsy yc. erro sieies cieleiisliaiicietereteree 183
Aecidents of ActualiCauterizations sos ea. eee cee cere cieeee 184
CONTENTS. xi
OPERATIONS ON THE SKIN AND CELLULAR TissuzE—Continued. PAGE.
eg TUATHA pote A BHO EOC D OOS TOE OR CS e DIOS HOLL OC AISOoe svete re Oe
ease Mera ote ee ate aan eke pede cael oer 188
AATEC M SELON Grete sas oroiioke ei cncleieietarei ste etekwin Pointe east haveleeieteie cteratot= 188
REIGNS LO APPly MOONS. c+ sclaiin-alem ies un sliaisiniaie a ele Slap} oe ess 193
EROWVGUAIEUOIE. 2 27- C oo ora a eg « Nachle oo Sip hime teiasue aly hiate dee eid sta ards wes a 197
RPO GIISCUSIE oaths s, sereteeteia tooo otorsisatece. sYcreicioras <sastererel garate ABBE 198
Mecidents or Sequeles OF BetOns. 1... ss cscs eco ol elwlaieiwte witha wlan 198
EE OLOLIGTE Oech AUIAONR ce fasta +. Ts riageteaaients’ Sf ainisyguapatabei Neha: aloteteseisiats oor 200
MERIOISTO MN | 8S aig tres cS win aie Giajio'e oie aV@ RTOS ugh aisinnels Creyste Belen sore 201
LPG UTE! cA. - scccssecuy are c's Si xia ’e tie ste, sin @ ceased nresnk fuse eter ae 205
Elastic Ligature....¢.....+'s Cie iatdis classic aleatorp lew llomtsteneent torte 210
Lefora ie 0940 ko ss) ee eer orate Merioren acco Morme sn 211
PUN CHUTE, Sse ste cex= so ope ste oes cubs eels aie” oo evela vacate eter vo acs ake 211
CHAPTER VI.
OPERATIONS ON BONES.
LOGEC Cor CA CNOEANTGEER) orn c's gin a iaca 070 61 haa a tiiats fo alse oc stalw tatu ibiaeates ele) 212
Fractures of Different Bones................ aiataiatalints om ticle sores eO
PH SLICUILOIER wa Saige 5 Ie wrens oe ates Seay int oak 7k itarras 262
SATA PUDTIOIENs cicisee Se aya ts eve ate ohn wd nfo swe hs Reo a ale ia eee RES 266
Amputation of Alembers 055 sie soe cea- «ote waleiaw ae ole eee mete 268
Ge SOPAELOTH Sty Saf 5 AA Sod coe heave pews tae te eit eee 274
ee BET GHG Tats 55; Sais cos s sitilie bie dareiane ears siere seararstocente 277
EV ODIETRIOG sce stais stale a. ci diane odie te Ailsa wie wre aise, wins «gd Ns oat es mana 283
PCT LORCOLOMNY isa aiarajelc aus) oles, aibuarelororeichela ole: ele ene Srhwis oe hans ae estat Se See 291
TEESELLO TS Of DRONES oa a acide 6 Sain a. 58ers o LES ote OS .e'a)s-nie ns aelaelawe HTL 293
CHAPTER VII.
OPERATIONS ON MUSOLES AND THEIR ANNEXES.
Ge AAUMN YO COWMY ste) cciat ica sks Sein wha oo ahs Wa ays daze al MIS opal ephatictere webs 296
Caudal Myotomy by Transverse Incisions .................. 299
me es $5 PEON ICICI A poo ed. ork acts crete easels aah 300
s¢ : ‘© Mixed SU TaNETs cic njesolereiateleratsieteraetere 301
¥e es SOD CULABEOUS 894 ook 5.5< cin wictamtam Gia ints 302
Accidents following Caudal Myotomy...................... 306
Crurat Myotase. - Criral My0tomy iio cole ocinns dies ees ceinds oo. 308
Complications of. Crural My otomy,,.. 0c s/s... 3x maye oni neieciels sso 311
OnerateOns UDOT TPDGOUS Tessuesy 6 on is abe cm Sega cto 01018 Bh os 312
xii CONTENTS.
OPERATIONS ON MUSCLES AND THEIR ANNEXES—Continued. . PAGE.
YUE DDT DU DB Reo ee CURIOS OST ODD Gad CODAOntO adv OOG Ue boanar 312
Plantar ‘Tenotomy.. 2% 0.4.s00 sb UCEE HO MOOR CEDOPCUbOETOG aL 312
ACcidents Pollo WIE). Gece aces we arene © bike sistnle vies eysiacs nieinieteits 320
Carpal Tenotomiy.. |i). ans ccaece.n os «vse elsiciccin's o'n s\n 0 6 wisix' sia 321
Anti-Brachial Tenotomiy: :.. jc..2 001 2202-1 sohndsqncncocsn= B25.
Tarsal Tenotomies. ...........0eeeeeee seseee Gina cic ietalo netic 82.
Cumean (Penotomy. = so Nean)a ccs aes etacing o Pee nae “EO re wu
Peroneo-Phalangeal Tenotomy ....0.. 05... .ncncacssensecceses 326
Tenotomy in Birds: 5". ).' SP ieeleseeie state ats a seih Wate aura ibata Miniupeincany 327
CHAPTER VIII.
OPERATIONS ON THE DIGESTIVE APPARATUS.
OF TRE TCT as Me 3 Stop oereate ateavahalb ate: sistevals late cee RealatetaG Gieteiat nip tr 323:
Operative Dental Surgerysi.'sc- cic ete owes serene ale som nnsivins 330.
Leveling’of the Teethie cacao on vice ov eehelae aleuraibcl sap nnitaratctniels 335
Fextractronmiof, "Teethis. ai, «1s !acemie sis ol o!elen ote icindevnieirlniatoteectelatatavetens 343.
Bling Meets cat. oc ciety ciniais sce aw eeyse tune ear te te eeaeaeeae 356
CaminG WMRAUIBLTY 6.5/5: isis cree /olcio oiiels pve dir slemtalslaisteinte lela tereieeiiaine 356.
Operations on thé Tongue. ......ccvccvecccsccarveccissverssiceses 38
SurtrPe orients ce cieeic sw cenit Oe acon clone minie erases toys eel tere 360:
Ampujations:. GlOssOtOmy.2 <q 2c nsmwiem aac isis ste ois sini 361
OPERATIONS ON SADLVARY. GLANDS 5004: 21's aie a leisiaieiate aye eteta Ses ielome narnele 361
TODO abo HOD UE 6350 058.44 DOG BAO DOL AOHIN OSS SoSdse Aa aaodses 361
Maxillary Adenotomyns<. <5. stp aioe oom oie Lt eee nese eee enee 363
Operations on the Cisophagus........cccccccccscccedvcssuccescees 364
@isophageal Catheterism.... 0.5.2 .<0 on ecsne vie cemapiniieele «= 366
Mer LaXIS ss cere acts Sereeciiaietereels See 370)
Crushins the Foreign: Bouy.s\. 5c. sa. sna sae de oom oon sate 372
CGsophagotomy «..... 2.62 ens cewcc ss sce sescecameeetsscememnss 75
Aceidents \Molowing see. iccc cons oto0 oe c.oremiactnem a winner iineieiniett 77
Gastrotomy. Rrumenotomy. ....ecccccccercccccerencesccessssces ri
Fncision of the RUMEN, Tose.e yess ee ene ee aoe ee 378
LP LARICIL BAEY OOOSIOOO DODD BOC 6 DBUOAN Oo do cRoMenoosUsbus soadnd- 380
J TET MES ORAS IO AOU OOD COU OO OS OO LH OOS S00 HOME COOS OH osuN.CO00 383:
TTR 2 eo citer iets Ware ators Sree a ernie toler aleve Siesta Eee ee 385
Inguinal Vernias iv sic ses bis vb. mielere ui o's, vie cole nie/ntetelalols minal inte 394
Recent Inguinal. Hernia’ sc siv.c cs x emisieice sete ees ote nieieianiaals 397
Aceidents EH ollowine. | 22s. omisie sa his aie oles! afaleie lie iiss pie elle 411
CONTENTS. xiii
OPERATIONS ON SALIVARY Gtanps—Continued. PAGE.
Old TiewinalHarnia? = ses 5.2 asa cs os atene en Sadia le ete eas ee
Ineuinal Hernia: in, Geldings: « «iijscus tienda cade ntins ae ..+» 418
SEER POTOIR: 5 sic aurea rails areca che ew oars ae wo RBs vive eaten
Werineale (es ea os theeieatnaets earns Bee stata aysiu cist coal slave sv¢ <cistayeed
WPANGTE AIO epics arctan ctelercierors cine erties Ee cinie Kaine ialher eee = 421
Pelvic or Internal: Hernia‘of | Oxen. 252% ra+s oda sees wee 421
(Win Wye ale Verma se Ne oe css cin nics ein reread tia telealeneceiavoralereretetete 425
Dra parwcmatic TGR of: ic exci decane nares mole Cae aw ke 439
CRIES ALP ET CEDIA ois, 5 ciate asco nyse Nacapev eel ae Re ee OO 443
TU LPDULRTTILE eee Hee EIR OCOD OGD BOD CO TOO End ne DOO Gar 447
PHETOPBUOTIY 8 a0 crate ata Sis 3 win x SGD a eae leans iste s Seine Mee em 449
CHAPTER IX.
OPERATIONS ON THE RESPIRATORY APPARATUS.
On the Guttural Pouches. Hyovertebrotomy..... 0.0... cee ereccees 452
Larynqocomy. AgYleneclomy - i... cioidis a sia Peat ee a oewis: eels ley w nes 462
lemming, Method ct a: <tarcctaes vans ak a adans seein eeibiate 4s 463
ORIGE NICLNOGS. cca cisco ee cite so anglaise aaa Sapietetallae oS alate 468
Y UROL OO tis Oc Om OS OUT Icd HAD MOD On bo Sp Uae DOOR DOr TBA a atae 477
Aceidents)-H olla witie oc. so <n 6.250 «od a d.ca meus ph aisjeleeaee ees 486
LOM UCCTULOSLB a toh aisha eartaoi IN olckc, shat rene plate syevwiaharoiakeieieereleai shes Seheies cates 488
CHAPTER X.
OPERATIONS ON THE CIRCULATORY SYSTEM.
AFLCCHEAY: — F WETEMCLTON 7. a oe oie wise eaiela a a idem Ioa are sles tea ee 492
IPLEDOLOTIUY ae per ek ee Faas Be TE Toe Ya ats tee Oh eer eroteneiehe 493
iPRlepotoniy ine SOlpedss «ie 73S2 bit. oe o's ata boa vee ere werner 496
ie He-CHG PUpUlars 225 civ ac 2 ste Sens deine wemen oe 497
a at theiCephalic.. F215 2avs Acta os hee eee eben 499
és on the Subcutaneous Thoraciq................. 501
. at the Internal Saphenass6 a2 23s Sh Rk. eens 501
“ on other Superficial Veins >. 0. .0:.52 2). ¢ axter eee 503
o im Larve, Fruminants.0 t.-6<3 2s sic-stog mbes ee nace= 503
ae OTHE MUMUIALSG eats eo AG « Maou an Babe ola 504
oc at the Subcutaneous Abdominal ............... 504
$8 ompiinll Animals. cia. crc eraraic eacyereie ys eiietale eee aa 505
Accidents Following Phlebotomy.........................- 506
X1V CONTENTS.
OPERATIONS ON THE CIROULATORY SysTEM.—Continued. PAGE.
SAPLOTLOLOTIY So Fe cielo alidlei st pei aoe eters Ne SARIS aero ie rahe ae vee LE 514
Arteriotomy at the Transversal of the Face................. 514
sd fS-E- SIP OStETION AUTICUIAT AS “eracie cetera eer stcioe 515
6 ac MS Median: Caudal 22's! s Petes acca ape vase neces 516
Capillary Bleeding Sox. eae ek ste ee Un AR ene ee 517
Bleediny atthe Palates Toc e essence 2 scien ere srorbieps ne <leele latest 520
ee oe eS NOOTOME Dak dey dels ict etisalat ae ME ee Nees 521
a Sats SHOOb Gri Sete occa te eae ieee eesti 522
PUI GUCGE TA CTMOBLESUL. 1... at Sata «ia cralsioictes ate as in rea mole tie eae emer ie 528
Memporary: Orxbreventivelsaaas. sake ee Oe ciel wei a hee 524
Permanent or Definites «ss oe<daccecte sacttere os acts ete cise leaner 526
Physico-Chemical Hemostatics...............4. ate Charaka hatcterere 526
Surgical Hemostatics...............00e05 sic aviow hisienententa sete 530
CHAPTER XI.
OPERATIONS ON THE NERVOUS APPARATUS.
DAC TTR M VI RLUGLLL) DEERE D SOPEEACC AT OOOO TO OABAES DD TIRO NETO 2 541
CHAPTER XII.
OPERATIONS ON THE GENITO-URINARY APPARATUS.
ODGGEErISIN OF. REO TECRG c.f xin o's oc ye yids Hae hg as ae hk STORE 558
OP ECRTOLOMN GY scikic cision Re ee Se aes oe ies EEE RE eee 558
Preputial Wrethrocomeyicer os cr ieista sinters cuore shots eeeteor totale tetera eres 561
Scrotal Ey ai) A nee eee bs Seni en ht ceioetoenas ¢hcieranereee 561
Ischial ee Me TN Ee Or Go EE oe i. 563
CYRLOCOUIY SacBee sors aie a ojunio see alert a a ace cigisttas eres oneal cee eee 565
TL Ath obpity eR 2 Ane eC RR uC akaseeueckionan yr 565
AMPUTATION OF Che PENS. cin cos Soeeiisteeieree min eevee oinste arerteecee 569
CHAPTER XIII.
OPERATIONS ON THE Foor.
A MOLOMY: Ho os. bir Bohra fels BEES canoe Hee Ne OTe oreo eset ean 576
Diseases and *Wetectwositiesecmcietest cle ces seine eeetetneieere 583
Vices-of Conformation: o.\o.. sce see ocee oe ts eee eeeee 583
Instruments: 25.08 i eae ee alee cn ae eae eerie 589
General “Operations ssc a-v.sit asteine eo eeteeee ete tenths eter ene et 590
Dressings ssn Had crouse veers or teen tein eee aaa ei een Irene 591
CONTENTS. XV
OPERATIONS ON THE Foot—Continued. PAGE.
Diseases. Canker of the foot............... RC Pe 591
CARH Pontatos eae, wales tas ae ae oinkale OO ae ne tng Vas bei mae 607
SSINOET CIES os ssn ais 'eye) wi ain agi O% 0 204 wine ea EAN ae Maa oe 616
PON os eas oases Wels Ue sarah oka shai ere nisl eles dete hake eiaeies binie es 627
Punctured Wounds of the Foot........ SC omaniole sae eet ae Sie © 629
Contracted Heels. Hoof Bound......... aalaoh Wik tisdees masha water ches 640
Diseases er the Mrog os 275s". ae ssi eiacte care aaaliew saa a bbs OGD
Meraphtiyiloceles 3 o7<5.6014<sccsenilas ts eeetntes ae Ge Leia ate 668
EMNVEIE TS Se 5.555 igs s ois aes ee Pie lala De ieee olan oh ee 669
Navicular iSCase <a, vara acter einencio: merits career io eerie 694
QEIELO 2 Sine ita a clove o maids ale! sfnle a Hae R cine clause hake ale tc ia 702
Cutaneous CUibtor 5 47...:'5 <%-calap an simieted teers Caeiel avs oeie i aie 703
Rendinous Canton 6 .n0 021s atone wae e idee beittasioah werden oe 706
Sup Horny (nition ssaccncce pean cee saieerah lrekuis.c anh es <tioe fir
Cartilaginous “Quittor:.. oc cccleds vicis0ces es site Bie Coudnnbene sacs 714
CHAPTER XIV.
OPERATIONS ON THE EYE AND Ear.
On the Hye.
Operations on the Accessory Ocular Organs.......ccccccecveevcees 739
TRADI ALIC HE CSIOHS® = 35 ci6-«,.o: Ye oe eee nee stat leva ee 740
HOMMBIONSZOL- OOMUMMIIILYS... ¢\cr..cs ale aetein, amee a aetcin ce atau eee 740
Defective Congenital Conformations: \0, .2s.0cc 28 cse ee som 741
Pathological Growth and Caries of the Membrana Nictitans. 742
Operations on the Lachrymal Apparatus. ...........c0ccccceeseees 743
Oni. the Carancilas i322 fest ccing oe Soe aO so oe oi wae erases 743
On the Lachrymal Dueteuss cor. cect se secs abs aden edanwtas 744
On the: bachry mal Camaleree ys a ccicactee socaeee ess ance cmon 745
Operations on the Essential Organs of Sight............ ccc cece eee 746
Extraction of Foreign Bodies on the Surface of the Globe... 748
Paracentesis' or the Comes. tence eG iees eve oes seas we 748
SIR PHY TONKA 8 cio. 5 atalcweicinp womele oelee eal os Meee eae aos nise eee 749
RC RUSERCE AS cai ctare ayctaiibiaia.a wlerlaie sists: commie ara ti osaisle ancl clare niches 749
Ammputavionot Che, Wye ior '<.560's o/s, seas eiic wic,omnoeeed orc scien aidis'e 754
Oeniax PTO Messe <. s wsicis as ote ae wines Paneer oe tees nase oe oe 755
On the Ear.
PASEIUES TAGE HOTL wes cache’ cori ni ais; a c/cdav aie erates statements wists ls: Ciatwieia’ ciaiosnse. bunts 756
Xvi CONTENTS.
CHAPTER XV.
PAGE
DISEASES OF THE WITHERS........... misieisiatelatoistciefviaia fav's ic 6 ice eee 759
XCOriations. 2.3% icc.00' Sate lee teaielolee ois craiaual svahel svajevatt s Gop serene 765
Wisin cCli oman cacti trek eerie ells plats onic viele vis o's \0.2 Ce 765
Hematoma....... eetate terete akoa sian lescissoreis av vis diel byw oh ivnaiee eI 766
Wore Or SUCKIABE Taine once oo nalelsieiotel Sos ee arb as beatae ere 766
ADSCOSS 8s sesisyctere cleretoe tiers Gretel tccrenee, ee aoe Fagsrateielove enone orale sere 769
QWV ORIG, 226 esis on Racctcte cae eC erie ERNE aS tus citation tate ae 770
DiseasediortistuloussWithersses seme seein shee caine once 771
Terminations of Diseased) Watherss-. ete esti eee ieee 774
IDISHASES OF THE POLLS: \ Se bce tie teen <amieccisc sislosme es ee aoe eee 779
Excoriations, idematous Swellings, Core, Bloody Tumors.. 781
Cysteine aac cee PaR stelle bs nncbst pug Teese Dap Rin pa ere eT 781
INDSCOBS! 55. Fis. - sioisoigcole ayeiare piel eis] orev clave te atu. a.ctaelelemereban cio ie stats ata eeetetns 782
OM MWe ihre etstovarclelstatain aseisl sioeiate wales steieieiels'= oaenneete Stieeie 784
TABLE OF ILLUSTRATIONS
174
18
19
194
20
21
22
23
24
25
26
27
23
29
30
31
PAGE
PIR ARAL a «).2.e1cke che ciereint ais ae sere’ aetaleln alpyne@ eaietmal neluslonlar cect oye 15
BS ILOT ag re Mg he cicisy ois ones ol susia vere vue) sve sieves uel oetonah e rere Te VReTaG misters ete: <therers 16
rome BALM ACIOS:. carers cece wast alonie'sis Misc cc os atelomiel eh aie mon ierdereeeie 16
pod en MBATMACIOSS:. /././/a.2/4 10) 2:5, cwysieretarsicyora eaves cua verse a eae ope ee 16
(Greene nrsta cytes ns avid oish bath & lo a tod Rocic slci ahs iepetonaie fe lsmee tauneebotcois ee meee tasters Li
BaiG@radles 2. \o2o) sus ecieiiciss. (eiescsaie voaiel sian Qampstae vette aaletaniereike 19
BMLGl OPES BTS 12 rep avahe dh cje God diet ns 3.0) 0's hans nie ciesnle os 2h cowpea hue: Bae est 19
Bbaited MONO isc chert doo). sic ele ts eclek 5 a) a oeGied Sat Aeweme nd amelie 21
Securing the Hind Foot with Rope and Hobble.................. 21
Securing One Hind Leg with Rope Only ................0ece0e 22
Twitch, Side Bar, Surcingle ; Securing Hind Foot; Fixing Rope
OM the sally «2 ./5 0c: on eteeie Ha sane erga elgale ile) 2 Chee ames 22
Amathor Means of Using the Ropes ci. 2 ...sac ass se eee oto elas 23
Securing and Holding a Hind Leg with Rope................... 24
Securing Both Hind Legs with Hobbles.... ............se00005% 24
secure. all the Lees with Rope. sue - <cdsiwint. oot mbideetsakianee - 26
EHUD O=1SSO siaza,«' ovale 5's 5:01.00, 2 duet ate eRtRNS oem vies RR ep on css tener 27
BS HOG Kea Riss hctatsia:t =, «: 6 'e s /e:ai6i ker MOV eeMetepems chal Soak ota ate aye ahora Ee aca 28
PSSOU SS LOCKG 6.2.4 sinie.t cs carateicte een nia, alee ca este hee ecegh ieee GEG 29
Hiring adorse: in. W insot’s| Stocke. os. .s sccass anew mone eee 29
Laying a Eorse Down in-Winsous Siok... j.c<5 ss «7-6 Sumews oom es 29
Bin ehisheblop bles s.\..4.. awe smei ater acts sseic ae uoenene eee ieee 31
pelt-locking Eobbles.\:< crc armenian tae ceive ener wet demon Aerts al
Spring and String-hooksetye saan \otscfoe tore tat yawates a eae s 32
Barnardot' & Butteli: Apparatis 2 a... <5 oh bc off arise Sue oe « 33
Horse About’ To Be Casto. eee ore, 0052 Secs ete enact ead eae 34
Horse Thrown and Secured with Buttel Apparatus........ ..... 36
improved: Hobbles ofsDnemhours. 5.5 .%0':5. p Aderaes Geides Hoel 37
Neurotomy—Ist Position sen. 0 3.2.0 sto.c). en snares Som aas seem « 39
ee 2d £6 ime USE) SLOP). ~ia; & Sree ne dsES Suto ok eekree 39
OG 2d Weed SE ec Er ca eb arate ca eke MepteaIc EDA Se 40
se 3d ‘* —Securing Upper Hind to Upper Fore
EC aL RAR ag RMD ALTA Sei dit senna 41
es 4th ‘ —Securing Under Fore on Upper Hind
Pegs ee Raids ieee eh adeno sa 42
dth ‘* —Securing Under Hind on Upper Fore
TL Ope Roots wiles ti an anna aoe tates 42
oe 6th
Xvili TABLE OF ILLUSTRATIONS
FIG. PAGE
De. Side Bar Pop blese s+. mis ssci vale helatese ciate Meerewthale oe scsiets eo kveda ao oeTeMe 44
doe LOSS OD DIES 7. notte wieg dievelbhice ma Ge mesic cvels ate an ees eee 44
34) Application of Rohard Method i010 th ce cic ouiele ates aaje<cic.ce ees ate 45
Son -Amim~al: Secured: by suoharde Mehhodsamescnececiecee ne oneicieniact 46
OB), PVG MBO eos ar. tte pe atcrets eather eed teretp tazeVece eet ae aaielelane aioe esse oe ereraas 48
of /Dayian'sLable—Hull Backs Vaewey cc .t'. oncom pane sabes reteset ee 49
38 6 CS: I BROMGY VIEW. Warcte otis se Since eet Re Pole Mfecvalee etna 50
39 f (5. =A A Ia IP OSULLOM =, 1. € tera ?a oy einer ine Gash te 51
AO lod gsoniS Palle: scisccteeteidslsve stephens leo ae Hak Ore OR ae ones 52
40M SamepnyObliqued2ositione a. ape eee on mere cenci eer nee 52
A0p 6" SS Hormontal Postion. .ety.jaee si. selader ae ae ean eee 52
Al,’ Securing Cattle s3 h22 U0 ae he hides outos eeiecd ve oe sete eae aie rere 54
42). To ;‘Prevent Cattle from: Kicking? 125. .0. t.nc eas acne eens 55
43° ‘Tialian ose Clamp a. sccicccexs Woanies ane Shee Oe ake ee ee 56
44) ‘English Nose Glam silo. cc ais lente comets sears atte eere eer eee 56
45° HinelishuNose Glampsin dvs. i same e ces Naar moe ate ee eae 56
46° Square Kings tor Cattle)... . ces sel aa «eee on eerie 57
47. ing of Rollamd /. cit. us via 2's: ayee © os cle eee isiols sai el ener at ee 57
AS Alsatiamy EU .e crlsistereleleler Sib sda a Ree ayec ms ee eva or eh ecaca ea ieione eee 58
AQ! Nimes WithyElyelets.'.(.:../..<5/ ee sees io Aucnmatel ae els Mecsina steter ertaete A ite:
HOPeeunctureiomuneisepoum awilbhe rocarsaeae ame eer ere teers 58
Hla VRingsi with Poms: |. '.' cele ninle «ne « haetemveransica teeter dre mmierer 58
HI eeren chy (RINGS sis vasioe go slescieve et se oevete ie hoelee eithe case tele See Raat 59
HS Pune OLN UCM S.siels hin kia aisrce sae wim olete re stale tea «ine etotrce crenata tae aeee 59
HAG MarlOus Culdin ee SbICKS Myles serrate ye ee reir ciee orsenetsehe ther eet 60
LST BMA beat? cif te W 0) OF 2 Fe a aE pei ee eee Re ad toate A Ian ind SS wi Sa 60
HOw Steer laced ames tOCkSte tri sa. avacveenncnercic vote tas cities aromas cert niet 61
if) Awateh fom S wer tego sacar scie Some euckercle et nec eene re terete ke Pistere ieee 63
DS Gay LOL SWINE ase ten aeaie cists 5, ene oer errie! ita caiete serra alcaps) alatereitaeaa 63
HO) Mowerevent Swine trom ie in oe ete ticle eles atin 63
59a AnothersMethodin sea vaccine ts seimecte ent acter leis tes cic ered terpenes 64
GOW orPreventyWorstirompbiling terrane sree ceis ae eeeee 64
61) ‘Mouth Speculamiftor Dogs yas imise acai ce ssl els)s tes «og eee 65
62. Keeping Mouthiof a Dog iOpen. i) aie. sos. ee se i ee 69
63 ‘Collar Nippersifor Worse. needs vaaccits oe seas = e012 ee 65
G4: wRichardsonpAtomizerse ere weir rystec acral cle cic cia oe eiereee eee 68
G5. ‘Syringe of Prange oes sacar elorejerass mic ats «ates e416 2 ols eee 69
66.) “AspparatusiOf Deiaysint.\awer. tte cele m ite see © a > s.cle'e\e eel aL
67" Cox's Ghloroform: Bags tne hica bee) oss ole osteo oe eee 71
68 Gresswell’s Chloroform Bag.............. ns.s be vee OS 72
69 Carlisle’s ef Miahialen ee oa. eas a oad cane eee eee 72
me t Simple Speculam/Orisi. 1. 65 iets piienieines\s > sale oeicbe os ee eee 82
72 \Broguies Speculum Origen cee ck sieves 6 )- e210 eine sisisceiele ee eee 82
73 Green’s sf SeaifalNaveiadaleteos Sihetsrs aie le\s wie acl Colceid le toe chest eaenamea 83
74 Grange’s SOE CMI B ain oon Cn ENC MEO MREEEETARSIA Doc cc.on noc 83
4D) (Reynal’s\ Moth (Remector ys cies pate se nleys da sie viele le: se ne Oe 34
83
$0
93
94
95
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
TABLE OF ILLUSTRATIONS xk
PAGE
OSG) SPST. cca ein ries p's alarm ns alee PR Ur array 84
TONS He CULMS seys .reteras ae cro eyerscas oust atayeiete ete rate stated tase «reel cise <fohees = 84
ROSAS Hse POS COTO fe Pe eho alent elnllsda ons sien shoves cin et ISIS Dw vem niece ae 85
Exammmaiiowm Of: Dog's Mar 5 si. 5i5 ints: sm 2 fara ieveisin iwtenels « Be ECUS naa 85
AGRE ITEM USO CIENONAN 5 55: sag: 2 aw neni ouscahee she's arabe wl alete Wie Wiicia ss & xhe sans! 86
Straight, Curved Directory—Silver Probe...................... 87
CIM ANDY: SA SPITAL OE. 1a sie so Aisievacats/akiocs ea Varieties cn eiereiare!a amet e coals
Single and Double Roller Bandage.......:...00. 000... ceeee cece o4
Manner of Rolling a bandage. so. 25 ))\6 cles fue ade san een 95
DAMAALE VOM OTE he, aes vctststee deals earn SW eed Oyen ue see 95
Howto cA ppl ya BanGage’s x. as.0 ete y oes cca Se rare ei eos 96
Sametiye, PMs. stra ase Sates om ty ey gee ee GA BY ee ree 100
ISHCE LIT MOREE Sein es Ce ales vive as eae eee wae Leen 101
all Dop Norges 6x tees hain cs ctee ene we eves ea aloe a lgerde oe 101
Straight Dressing Forceps............ sed atias i rptete tate las tlarstalae aie 101
Carvediipressinoy WOreeps « i) aia cd walt voc, caraalgtte et Aos ow te oe See 101
PSientakecety oie O's 1) eens Meee arene Been ew oul seae Gn ay euneg) te merle 101
sult: Opens riastoens Aare sel ee ae.> ae eee Pare te Faerie 102
Resi .fe Ola otitis aye tots mrcse sets nyc oretcce te dae eeeer cists MENS eee aye 102
DSOMAED WONMPLESS: atccafsuei itnls nin ase > ceclensee nile ercaste esther s = dettemeters choke 103
Nome NC OMMpLESS ese ace sverci eve seveiersl ay evs sie celeio be eke ate Gt opetctenctapelerc seeleoe heen yan 108
rian gular OMpresssans vache eae aCe ee eee eee 103
Neck=iirey Compress. \a:7s statakeerlcts eu tetova we eeatelen emetet ate cle re et ietoe 103
Maltese-CrossCompress\. seers = ae na ctiae ese ee ae ee 103
Malt Mal fese-Cross:Compress, 4, 35 520-7 $i5:c:2 5 12 Saiandatoee scone 103
WD GmOleHOOnNpPTeSs! ssc) sevioyet sts as deyetapelc aways eine ees ave eRe aI 103
AED LEC OMIPT ESS. hoi chevaiasecaterasry eater a weclaissobe eistouenctalntore oie ae Oa ae 103
Graduateds Compress... soa sceptics os esos es pee 104
Perforated Comprossis<) vac ak eae ate te ele as nek ee ee 104
PE lahessOMe SOS). pecs telson tra a oceect cee add shen dhe SE Raa 104
Berns] Moistened Pads iiss. 5. sa ssa)aerneel sia is ones ale ome ore 106
sunple Krontal Bandage (full view). 2.2... 0 cece sees ees canes 107
ee % hae ealsinbot< <cyyts b Bis rE Loma 107
Compound Frontal Bandage (full view) .. ,............... LON
ef sé of (Sida Poi ENE SRE tie A oe ae 107
Monocular Bandacen(inll wiewic 52. esos oe ede dtas cee 108
if < (SIMO) ha set cn tet ogs ee ee ee ae ge 108
Binocular a Gui ues Sa enue a ties Shee ee eal occ Hah We 109
Be as (SIO) EE) eee ca eurains ee pa tn ee ee 109
Ear “s Git dai a onto A oye eee Se em Sanu ted tek ee 109
ae “e SIC ep Veer iaks scree ee ic rg et ea 109
pandas forthe, Mars) (side-view) :22h S22k coches aeraemals antanen 110
- Fa eat 92 RERUN SyS rE), ia Brat apelin wie: Ver ecto ea tee 110
Bandages for Dog............ AES OI Ce ciC oc AMS Pnshie Peete 111
DMODIS YS G TRO Mier ® fe) 5) SPAN ted oe ete oA erie ates teraiay else 110
D.O.4 TABLE OF ILLUSTRATIONS
123° Bandage for Superior Border of Weeki. ss ..asiisies ws oes “ee cule 112
124 sé ‘* Anterior and Lateral Parts of the Neck............ 112
125 as C8 NV TUHOLS sles tee clos hiss Velen Haye Ep ela bia crete Rt amaretto te 113
126 ss G6) PB aeey sau bya wanrina 8s Serelaleniersttanaton ava tye valent nian aay? 1138
127 se ec Muoins sands Crops d entrances sees siele Sere elo ska 114
128 ss CS UEP. hess we tebenal ee Bie letena avs one ate eeammMiaterata cote wietetat stale are 115
129 GEES SOPALALE AA .c Matevens ces ars otic aus lelersstelelateketeiatete terriers 115
130 i «¢ Inguinal Region-and Perineum.................+: . 116
131 ag ee ss :s ns ¢° | Separates. de sieactcons 116
132 es $65 LAD OMEM A favbes/s/ciss¥eceneie, Hs, Hove @reteG orn Oban rete ereererete ala ly g
133 oe GF MOBO SE cate tisier Slate’ veils tral wleyid ve citereseipte te Rts eral miateteya elters Bh
134 + 86 SBLGCAStis co dyevarce evevars ehateial a ciate uh chal al sha atctiandio «tea etee eae 117
135 - ae) (0104 (6 (2) Pan ne ree CC ODT enti USC ecto Hino cue 118
136 ag “ce Shouldenmlsolateds avaanmsier cose meee ee eine 118
137 e «Shoulder, Joint Proper. anieasaeidicstoues eae 113
138 &s Gh SEI DOWEAcicawic sculdie poe ahacerelomatae eee che aa eRe eee 119
139 fs C601 8) ST SOT aGCL score cate letersalutie a, Siobatts eats ereiwne a aoeeh epee 120
140 ee CF MHIQT@AUII. 5.4 foe oldie ain ei OP Shcka <tedeporbhoteret Rete eee anon 120
141 2g COR IKTIOB ss. 15:8 ss ino la tole: isa Se Wintes tee ee le ETO RRO ER Palate een 121
142 nf OO SHULL G 5p vex yh 0) let Shae WIG AR ALE fehare iolbeere tote ec panera RPO 121
143 He SAME VAT O]TS sisi) eyert is watts aeetetei(e'e re heitats Co ere ort hereon auetecs 122
144 <f CPNPEE TM TSOVALG 5 1, ofa) cyaners\sisrci ejerereichs @ Aa Ronee eaters ee mea aa ee 122
145 gs «< “HockandCannon:Applied ...23'o. ne ne sete eee 123
146 es fe eee “ FFF win) SESOLAEEG i, \ona\ercieras tecciela ayers ete 123.
Lap paeStraight, Bistourypaeysc errs sttcyercichehslets clssenetey ws ctelersveletelsiatevetekayeetess 126
148 Convex Cw NI ANE ae RPDS TC eee rol eteve atone at aro ais Beal ata etetee eters telors 126
149 Concave EN UL Whatmeyereire intent le Shealawarss atts tors Yolo Ms ayeite dasealis te Ge tai cetanatetieke gereee 126
150 Blunt BEA se Ire, SAC tS RIN AE HS otal in SAS ASIC 126.
151 Bistoury Caché (Castrating Knife for Females)..... ph isteyccke eco 126
Po BiL Sage: MKinives: otc spielen rete romrenstet erste ele tele ars arstsye se cite tote ol terelens 127
WBS ESCISSONS 52: aierele love, cschetavateleeteke hate tetatee seks Vevesetetele ovarete Gel olels fore loialerennerenere 128
ioe Bistoury heldiasiapeemmnnerreweaerraveiteledsier cls eieielsicre sii tefel lapels stents 128
156
157 | Bistoury helditisia Boy OL aeysOuMes foe. 6 c.cis0-c10'o, wies'e,o owreleleiners 129
1574
ee Bistoury, heldvasta; Table Waiter cy. vel eic'+ 6\s,<,0.0 01 s'elalsiee eames 129
160. Sage Knife held withyOne Handy... .). ne. «is ais veise eialed i enee 1380
aGHy es es ef SENT WOM LenS Here are si s\cles0. 5: is ols ss eiehe ote toleteiekete 130
162. Using Finger asi Director rye see ea nes nije s.0j 0: oie) «et ie eee 134
163° Sharp's: Demsculumm eee ce ereccs see oleic) cielo: ~) vo eke oicicl etches) stoke ietetetetenees 135
164 “T-shape:lncisioncasemee ree cette) niacle leleloe ae sg sua daiererseheterstete 137
165),..V-shape.) (6) ac SHVOel reetielte reine sty se oie 's svels Systane eee eee 137
M66 % Crucial 0) 86 0 )c Speers eee. Ui. eiayala io ol cverelehett oben 137
16% (Semi-Tnar Incistome maa ccrasic cictolsheveic cicletes leis) clnleleisielettelekeeetetee 137
TABLE OF ILLUSTRATIONS xxi
FIG. PAGE
GG Ye SiO MEGISION's 3 5 das. 2 0,0. 4 0/0/e, 3 ec) pic eiale'e& ores ole braheiaia wes aisha duimialers 137
GD FAC SMO) OM CISIOEE ire tie io ibe /oce's new 5166 61s of arei wens eral orn mesh srerehotiaha, osi are elas 137
Ob EMU BIG SEMEISION 2 1.12 reyoisicavoreitine alas cle eraait asians o mete ¢ weiss eicioveyel Ae 137
fade PMD ISSGehin eS HOTCEDS: co siete" a/s) 14 sie ose /civre wieusle a eess sista gee era's e ave. aisiahe 138
Bio) Wl Wop MOrce psy... x1 ae dale ese a clas Dei sharcye(orakanteictsterarcrn ate acrate rears 138
iva) © ViarlOUs SHApES/OF Pianeetss <7...'..'s(cie/se eee hem saelna waine » eee Pe 139
mar Manner Of Holding a TMancet.<scieie s a.csieigis ayeieieleisey ave o1e,ebe sfolekert ve 139
Ape EOC AT BING CANTY stonte.vc) ceteris tere oteus oevere wieisisteranicie cheat Ae ela et oa 140
MYO VSEIGUS: FOTN OL UEOCATS «6 0a.n's a)a'sa/sia:4. ciel are yorels crehnvas ahoietoiens 141
Pade phrplonin eo NGAG Less «5 see ateip cia aes alata obersdeloe SUN ee al clare tareceues aleve 142
175) > bandapeton Transversal: W OUNG. << ca.,.1,eeie 2 ealsicieaiae > sede eee eos 145
179 iy S “lrongitudinal Wrounmdsy': <,< .a-csctersecicie sa eve cteeeiee 146
180) Warious Sukured: Needles. | oo. <<< cn siamo aloceveiee thace tem Crieiae me eae 149
131 GroovedNeediles for Metallic'Suturess.. +. 4402 ee ees calcio 150
BS ee OPO LUT ASH INGEUULE I a cs ates bin.cavare & avceusia ei ai ticke Direkt nerecatetar uO vn Ce Toe 150
Mi EMERGING UN CCUG oso. 5 c/s: esata ic« cas = ais sv stave ete vate Ml acne Mn a etelee es 150
BSA IMP SONS NCCUIG Ss ae acecinin cl nisieadl tale Scie «erent elses eames aaah suai as 150
uso) vecdie Holder: of Mathie. 024 53 setae cea can dete dae to nnenone 151
See SUES SUORCOOS cores s,ate/cotc Stuer cfonepsye Miskele hate otherhelatned beer omen 151
A Site ECOG) OFTEN FOIGOR>: 2/570. . scaSepee Aa spree a eee eee ter 151
ea eiilpleor Imiberrupped SuvUre. ..enemee cet meneienn sees ea ae 152
Bis aM TOO PIE (OUI GMUEC har a2,0,s ae isco ays) 6 nie Sena tetas etiam elie OER eae 152
Oe CLOVER SiS MGUEE ./.,<'s,2, a cacle «sel ee eee. Toe eek cree PE EES 153
EEO OSSUCH PTLD ULC 5 5c asc nie ea ae ME REPAIY Stee oh PGR a ree etnG Gee 153
ere UO SUILPITG) a: 5: «5's saa averae cy Ceemere RT at SIS VAS nay te Been ae A 153
9s; SuLuTeswitheAdhesive, ban dagenmemurna sce icisis ceil semen neuer 153
Le See LOM PIM UUM. <<. <<, laser ee mete oe aie alere eats Sele AU OO Oe 154
aac wasted Sutures... o/s ete eee tee cece eee e nee e cece eens 155
LIC fae 1 1 a POMPE DA Tn OR EMA a Cie Ca eV Ay 155
HOS y Suture of Che: Warrier a. trl sneeioees ais waiten any Saatene See nee 155
BRO EE SSM TUG cs 25's jn inc cae ee EOP eats he aie, Seta aiehe ot eens Marae ee me hs 156
200) XM SULIT... cs cece Uisrepenacsrabens ore ot acevshe ied Ov etaredsiche) tees Pe ER Te 156
Sal WarLOUs’ CAULOLIES ci cysc hte tet utero dial alo ra cate Be hore aye a 161
yor Old-fashioned Draywianesse ter ase sis ot aiclne sas dae eeeie ee eee 162
US MEIN fh le) TAN gear pated ears os Ak ave onteeiac chee Cao aE Ee 163
20f | Various Hormnsiot Drawang inl Birino, oc. isiylasitecs iden ae ee 163
20d shinies 1m Dots andak ommtsee ys ae keen iets ete vis ocpater eree 173
UGE eAIS | CAULCLY, a cle Mreane alia dle tel arvana bieteue acster Sere 175
ie ceo lame lt Camber yer. ace opiates tose eh ns aac) sce ae ies aig saver ey etc ha ah aot 76
SS vnoursher: Caubernye weecserte ae mete aie 04 a oceuartvathentrerae ait ia ave wet ae 177
cod Cantery with ChaugingrPoimts.* |. sijic 3 Nes ac Sainte easel eccaeene 178
mu) s pourenetsCamtenye a tinietc aie Alslalvs Sok je aca nwrcidee se tends & Bier satiate 179
ily Aut ouhenmic, Guibetye sa. oct ak Veet Sakae abner aici pee speeneie il
a ae Rberies! Of PM ANCION + cic lascia’sinoe tion nists Sec cin le Owain eo 181
SUS MMEUnnIoT a Lav NAmeLn wun. SMM s Sata ee we awe lace. Kae 181
214 Paquelin (GENT yA eee era ote Ps pan rad Me A OT RR RR 182
xxii TABLE OF ILLUSTRATIONS
FIG. PAGE
Bip Paquelinwand de: Place, Cautery acces ti, s0\cievh bots teotertetctels 183
DUG e Seto Enh xi s.h dickens as Ue EAE Rew oe cake MSE. 189
217)
218 |
PAGE SOOM NEOULOS sn. stsrcin aie sateuellelomielaniaferstetstein eis te sears cioie cclalus sie eats 189
220
221 |
228i roe Seton Need lew 25h. i) ssi Pretec ctapere ete werne ciate espe mete NA Pe re 190
225. ‘QuillSuture’ Needles 2. 40/0 So.sjsencs cals cere ay ae a's erredoteye aie erence 180
224 Rowell Seton owes tel a Rea s Seta ae ras oho er 197
22) Heraseuriok Chassalenacy..<ecmioeioieiis ie. jsre alors steel ere ee re ie 262
226 s ri Gl Charmin eS) val SSP on See Pee) ghee Ue eS 203
227 2 SON BG (sy RAE a LH tem eat Mine bee Ai Be ane aL 205
228 ss ESO Chinon WALOs sees eee Tole ee cle Gone cece ee eas 203
229 ce” oP Reyna avers See an Ge oe ee a 204
290)" Elansemian “OCraseur yal sci c cistern sd aa saci cies Cee eine tae eae 204
PaO" | Papestry Wieatere sy ws ioe <iciee © = bis anwatose aaye eset elt ahe ee meee 205
Pies Preble Wieatunes oat. fete lerny= mS as ie) Pee aie ote eee he er eee eo 206
O20) \Hemale Needless seek tics sesh eet ochre Ore en eae eee 206
QSSe oO Mia euNeedlentiaers Aziosys nn sles eect NSA. Re le mike reactant teas 206
234) ist Step of the ligature by Hour. 55247 stey recuse at eenieeeecens 207
Boor ned: <* ue as BEAMS yi CePA MD BINNS ck oe re ae 207
2386 3d‘ me ‘s La Lae TRA RM US rk EMS 8 oe 207
237 4th “‘ yo es BE {EES 1 oe hd Re INE he ae ce ae 207
PBS blared Cubantoy ek] On ateked Prva MoU VeMa SU EAE Moles Amsco ade e 5 208
2390 Whe tins aires SeCUIred 6) oi sw mits Ginter ch amie los a taet aves fone tete ete eee 208
240 Thread and Needle for Subcutaneous Ligatures.....-........... 208
OA TRASH ISLS PD stctarele ete ertatet chalets co ty eter cin lnts nye ele eat uate tenn nrt tee Sree nee 208
DAD IO iP WE ery Sales SEN igs ni atia ya) cvey Mencia vansechalsine, eiled te raceeieyoVel CARRERE ERO 209
PHOS CHiN CU aN LTD Ga nk, ASE Roca Ae See MON Rbe NR RegteetE cils Gi 219
DAA NAT Ok Deeg Nearer hot ieee eae ease ea ee SNe e elates ok a7 ol RU era 209
DATS Wu EEL RCNA reap eect rence Sle os svenar ans Uc stoke tee ant A aehees oath toks end) He Oe oS 209
246 |The ipatures MMP OStOM, cnc ne = ccm ss ieee «4 felis omctem een 209
B47) Mie wbneo wine eye GUIPEU aye tok ky at Ne sterets 2 eicic swisha =O AU he saa een mE 209
248. Ligature Carrier. 20.0.0... 2.-. POEM CACAO os aS 22 210
249 Complete Fracture.......... Bedale wis aS stens, Gi eltee Acie ne eee 212
PAU meal bakoop tah Ee Hey) go 8 A AM tes Ee ena ares AraC, coal Sc 093 212
OF SransverseuurachureommnemcuaGlius ec scisise)< «clas eae eis eteeeiierere 213
252 Oblique a Go A OXIUIR So! oe es oe oo sree oe 213
253 Fracture of the Common Bone, with Callus..................... 219
254 Apparatus for Fracture of the Nasal Bone...................... 230
255 Apparatus for Fracture of the Bones of the Face Applied........ 231
956) SHractunevolmhe ower Jaws cassettes ctelaeriete actos iencinlstetel 232
257 Splint for Fracture of the Lower Maxillary:....-....:/.0..2.... 233.
258 So GG eé fee SBTANCHES ses cise see eee etshate ster siete erste 234
259 ST we hG os FSeltMascill ary ann: eee epenticaietelaetooner tac tehey te 234
260 Fracture of the Body of a Dorsal Vertebre.... ..............- 235,
TABLE OF ILLUSTRATIONS Xxiii
FIG. PAGE
261 United Fracture of the Spinous Processes of Dorsal Vertebre....
2614 Comminuted Fracture of a Dorsal Vertebre at the Annular
262 Fracture of the Axis in an Animal Suffering with Osteo-Porosis. .
263 United Transversal and Longitudinal Fractures of the Ribs......
264. Hractures of'the)Ossa Immomimatayy.:)0...o0c.enenevencaecccles «
265° Transverse Fracture of the Scapula..... 6.6 s:0 seed evedes sees.
266 Bourgelat Apparatus for Fracture and Dislocation of the Shoul-
Mer OMe. ss-25 ees ted He nc Waterers Re eae es
Pt ERG SAMIe MWe LACE Ht ies 22a sada edhe od wladawnnsaueres ee Ok ees
268 Delwart’s Bandage for Fracture of the Scapula..................
269 Another Bandage with Iron Splints. .............00.00..s 0000s
210° Comminuted! Hracture of the Humerus... .o.2.-....2-22ee
271 Oblique Fracture of the Humerus with Displacement and Partial
(Usa 0) Cab cle Sate ana Ae Pe A ecg eae an Care Pe dad act TP Re
2714 Consolidated Fracture of the Body of the Humerus.............
Bie abeachures Of Gio: Waauis.rs.' 6 Wa2.0e ol. a Ribnioas mie odes deus ees
273 ad A eM a SE Sed oe LE Aas Soe dae as 5
274 Bourgelat’s Iron Splint for Fracture and Ligation of the Forearm.
Biorb rachurerot the Hemmepyc.:.2:.4%.0-0% ooesee sce tee wed ok re dee
276 Sfiv | With SUOLOMINE > os or v's Ate anoaletrae Cael oa os ae aes
277 BS DEOL CAG LAD Ve fcta at eile fis ea ieech Dar Meta e oie oo eA hog ie ea
278 Bourgelat’s Iron Splint for Fractured Tibia....................
279 Splint and Dressing for Fractured Cannon Bone................
280 oe sf 23 on Lower Partiol Worelem (9. )i)/s.0.6 i220 eas
281 Bourgelat’s Splint for Fracture of the Cannon and Phalanges....
282 Longitudinal Fractures of the Os Suffraginis...................
283 Comminuted Fracture of the Os Suffraginis.....................
284 Animal with Fracture Below the Knee with Splints and Support,
Resting in Simpseeewen.. . 25.26% .604 were gee Meer eae
Fracture of Os Sesamoids..........0..0... rite ahead a-eiw ad abd a tite iaiet
WW 0
DH ®
or
t Amputating KniveSteepiie. ss 62/6 o5« - Siojetoi ora sheila aia, <\ oie ay ater eda
@D
wo
Amputating’ Saw eecweas ise e 309 saeas sakes aera nes
Wooden Lee-attercAinputationac.... cee eee ee ene
Cnarlier’s Meee OF ee of Horns in a Calf, 1st Step..
se sé “ee ee ee od ee
Marl Cutters caresses oe ol cnte ee eee ee Gu eee daar e ee
WwW Ww WW Ww
Oood wo
Oo oO
wore
6é ee
© 09
Co
H= CD
6) a) 8) ¢ saa aime! oo wheyme) a) Om vie, ef =\6 jos si v6) oF ep a 0mm 0101610 @.— Nine of es s
)
£§
25) prin s Tail Cmtiename nse «joist morsels wrdldescls oriole hae
295
296
enemas CATH ONY.. eee terame s viele eocoreme, oop chtrre Ma ee soe eee SO RTI
2S) Old-fashioned, Prepbume: eyo 2. lis ise toes elles uate
Bon Micnaiza re phinedrs ues, sw 1s Gu eaatcseerse aioe cea lee
B00) (Sincle-Handed uirepiines wis. 27 acta. cis wacctoeieee es Ad oaece Meee ree
301 Operation of Trephining. Modus Operandi.......... .........
236
236
237
249
250
251
251
254
254
255
256
256
257
257
280
281
xxiv TABLE OF ILLUSTRATIONS
FIG. PAGE
302 Bone Scrapers and Hlevators............0cseeeeeeeees si Share SPOS 287
on t Parts of the Head where Trephining is Performed............... 288
305 Common Points of Selection for Trephining.................0.- 289
BAD ORCISSONS aye lcsc cia lars mis chao okoie alePatounlos uapoPain Al aleee oacperlausysieeaie ie! Mistelasiets = 292
BON SMSUOULY,..is ohic-sicia oiciee ie biem mis pila ek menace meter tae Cae wages afore 292
SS! 5 FROYTOSUQMMBL. 52s ioioie vc cieis eve ieie'as SonD/aEs cel w/aiats eh olh a eles niel eye eteteferar eve alclnrenet 292
309 Seton Needlese ig.ca! < ly seliis clsiemverees SOS DUR bom Bae orarkc oe ol oie 292
SO MViaTious, HOLMS! OL) SAWS) vetelscrtare cicteysictletatel-lecislstete toe ete araarel= 293
Sel, HAIN SAW << since, ojeuaie crs) © s.a.cvetornia arateielsiete sie eee te eee oe EET 294
BlZs Bone: MOorceps..... sieictatsioie ciateteseeselenekevene cl verti esefeheterel she ehemseeasierreret re 294
Bilis ROUSE! vicreeis ele eieteleierete alc: cigs a ale atelSteleahoie = Ye mtateianeutetetcasaveiete Cmonertevs = 294
BLOM CHISE) s. 50 eia'e shinies = crate eSie Mstoeiars starch tales he REIS ttl te eee eee 294
SUSE Mallet caso alarotecciacsateles tue sietaistorels elem platalniqpstan! atl yelsoietes ate alert temne 294
314 Anatomy of the Perineal, Anal and Caudal Regions............. 298
31d . Bistoury for Caudal iM yotomiy si... cic scene etic tore reel 299
3154 How to Hold the Bistoury and Make the Incision............... 299
316 Transversal Incisions in Caudal Myotomy.... ................ 300
3164 Caudal Myotomy by Longitudinal Incisions.................... 300
317 Operation by Mixed Incisions (Vatel’s Method)................. 301
Sis: Caudal Dermatome \...,<si0 -.:.clsevcsyeccecksl anon eer onel ema «mts 302
SiO) aucal MiyotOmies ct. «1:1 s1sie voyeloveieis ierdoucietete Cue eieteetele Ue dereicune cc 302
a0) Brogniez’s Mode:of Operation y.jsai0. a2 cctnatenite cits Solicteee ecee 302
321 Simple Method to Keep the Tail Elevated..............-....... 304
322 Brogniez’s Apparatus to Elevate the Tail.............,.....-.-. 304
225 .. Hlevatme the Cail-with:Pulleys: .2cik2 (ogee. acemem staan lente 305
824 Bartlet’s Apparatus, Separate and in Position.................. 306
325 The Biceps Femoris in Cattle. Normal Position................ 309
326. ‘he same\over ithe Mnochanters.); {hs iii a's ations ee es isle stots oieene aes 309
S27: GOUze? S\Bistoullyis srereis xt olorerctvore ciciere orare) nvctevsvanaclels ravers seetaveneievcreie rece 311
328 Section of Carpus, Metacarpus, Suspensory Ligament........... 314
329). Straight; Renotoniy, Waite veya one, ele en = ate te reneial=oiern sssnce esha ee 316
350 7 Cunvedmlenoromy, shone ee ci prtersiein cies sisvenvee sroee oe) seein 316
$31. Shoe with. Prolonged Toe, for Club Poot) ..5...5: 0. s.secdsceeeeee 318
899) Movable Moc-Corkce’s <.ccles me cise ienectn muerte rela So's act a cise eee 318
SHS LONE EOCMSROON atic isntn yee eelanien eiselwciee olelste sie nicic, Flalete arene 318
334
335 Various Apparatus Recommended after Tenotomy.............. 319
336
337° Cunean‘Branch of the Flexor Metatarsi ... 0.0... 4s 0c0c. nee es 324
338 Tarsal Tenotomy. Cunean Tendon Exposed........-.........- 825
339) “LarsallMenotomyeuy Lhe Rendonbiarsedvnmras. cee cieacaee eieieeietts 325
340 Samples! of MooshsRasps nacre ater soccicransierai's oracrsie a oualelerenajatelageeters 336
S41 Brogmieziss Om ombribon ser ore cre ere mintera ete We <i etelomyer cle sao ohetens ater antares 339
B42 | Prange SiOd OMeriOrysaseyereyevovsieruenetors_ ol eycsreteinictatatataleteve tate ete lana tcioteenangre 309
843 - Brogniezis Tooth Chisels 5. onc wie os z.ceeiinie iets ors ne eiclotelewe paler 340
B44. ... Growalaig’s Chisel reycteraverer otal sschetees chore oteraierale eters etcterw tela ereinlenetercatiers 340
TABLE OF ILLUSTRATIONS xxv
FIG. PAGE
[ iggse s Molar Civtdor 01.2 sisi Sreyalole as clelvisideidstae aaistavee aemiiatneie )
Moller’s FTP ea dnerad vated cn acraNedeV cremate: cle cts ssstavetssereleratets 6) facia oi
SU UGV San MELE Cy ste OnE Ter ey aT eee beled oad
| Schefiler’s Extractor and Molar Ciubten sans Solicaticeteltal. Ae
Sa Alpimabiny py bolar (CATER sh cis sis ocx aia sie e's: setae wrtieln eieiate s(c:cl elelon spel 342
SAG: (Sales G1, Loably MarGe psi. 2isisicvedosoiw) ave, cowie misvalersisiaie hee Dae ersicts 343
SPA) WMPAT AMI DCOL 6 IGEN G i «ja <j5 chctases re ieyas Se 1 s/o. afal aVaheasehate Liat bias” Poesy alivida ete’ 344
eas ‘ecellier’s' Tooth Forceps for Molar .)....0..,...siasisiciaials 4s ceies dies sis 345
349 Garangeot’s Keys, Modified by Delamarre...................... 345
Ban 2Specuimm of dsecellieny, <<< 35 </aatalem ge smcaitaeewiolcmy fala varoeiselatere 346
Sollee lasse Molankixtractor (ullliview): scie-eeemerereccis eee cite bea. BAF
352 The same (side view)...........- sg lense id acGakebeyaqevdeNeiarae ol Magiots atest 317
Sao GNGCT DUES BOLCEDS. pias <5 sine tleve ele voveeldyere ohetermiaia niaayarciavelonak aes 34
See Ulli waxc Sa OL GETS yayele alanverc esa ot 7 cvsthen ola lor Aercyataten ane aledeiteua toke Cercle 349
STO me CO WANS; S MELON COP Siete cteveiciavchcl steve cies eke ares ayer islets tevetauarote met ley relates 349
306 ee Modified: by: Boule y.in!.vo. one Wenteies aan 350
Be OULEY S. POOU CYS) cfarciatels ver ieiere. 0,40) in ahs totes tmeimene oiat shelolalameinnes BoL
Filo! (Crone Vs Nokes On ean on SAn obs oon a aon HOA earn con bo oooa Ic 352
309 -Bourtel’s Method of Filing Dog's Teeth. 5.26 secece< tease dens B07
BGG COOL SCLAVCLS: \isnis ards es 0 - Ralnawiel a vale estat ola neetewlns em eveetelel= 307
SOLE MhODS Wey SUSPENSOLYs +.<.210.\+1+ operetta creractselerete sie ties aetetat rere eh ars 360
362 Anatomy of the Gisophagus and Jugular Vein of the Horse...... 365
Si SAME So LOMANC? . 5/..-\- <voirsnpeeieetseiateisis ele'e a /| </ahiehalald eiatatalele ee
aot Ordinary Whalebone Probamge cr. c)yisisie’ 6 «ts cla sic o oaiatee's sto ecctsls s 367
SODe MBKOSMTET/S {GAG 5 iaisiedstaenv Pea Go) Pol ars wrevel sicfe reese Ropers Petct eke ieTais 368
366 The (Esophagus Drawn Outward and Raised with the Scissors.... 375
Bie BILAL GONE LOCALS .\-.c)0:. 2's a ole eee Met ovel a) syoraie sate ct ial cis otintele vane Buyasiars 37
aus) pBrogniezs: Gastrotome sc meyacrtsia lnc ioscies =| o'se ala lanate tn oats a atotereteres wi 379
Bou) krocarsi for the Caecum yy mised sec .5 151% Zenrcs) aete uw wate a ere eile 381
BaO. ‘Brogniez's' Knterotomte sosens st. see ore cs a sree 2 <ieip nie atcinicie ele eels ole 381
oul ‘Holding the Trocar in Paracenthesis. 4./5 s.0s's -6.c22 sae ea seemes 384
372 Muscles of the Inferior Abdominal Region..................... 386
373
374 Mormations of Dlernmiasenmesies is ssi oec/-a cine esse mi aeisere fe ereaieslers 388
375
MG adeylinirical Hermniali Gace. 4.2.5. oak eee eae epee 389
377 Spheroidal Be eS ai6. cain c's, aie oi apeseroni ote cel escictake SNC eae 389
378 Conical oY S.A COS ERE RE ROO Aria Sea nehnen can Go eie 389
379 Pyriform Se ep aisy s2aics 5 Jaya syslousyar euch tanucuevcaateas aah rec RRO TS 389
580 Hernial'Sac in Clusters.) 2si<<\6 sce sizes Bra Se ietaie aicnre caked elec 389
apy p Multilobular Hammel Saos..- 2 222-.2-ev1e-a2---++ sare cee. 389
aos emanculated Inanmmal iernia... 3) w/<.0stactern'sin <ioemushcle mehareneie « 391
384 Anatomy of Inferior Inguinal Ring and Testicular Sac.......... 395
384a Herniotome......... MOORE Odd CHOOSE OSIaoIa Don Da do on aac nook c 406
Sop Hermiolomes OM COMA 37: sah. toie.s'a/louleFisigld 4s) te ote,a1s Steel aici aes 406
XXv1
FIG.
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412)
413
414
415 |
416 {
417
418
419 J
420
421
422
425
424
425
426
427
428
429
430
431
432
453
434
TABLE OF ILLUSTRATIONS
PAGE
Bistoury Sliding in Grooved) Direchoryy. ic. ./st isieiniw lame sisi ale stata leis 408
Holding Bistoury Upon Grooved Director.............ssse00s-- 409
Straight and Curved: Clamp. ty is, ier wacewnaniat have cess ete a eeretels 416
Sharp Hook for the Section of the Testicular Cord.............. 424
Clampiof Bordonmat. 5 ince lone ols ORAS nM CMAN 434
Nippers Of Benard sci. cites ce Gece en a Ware Oba Ce SQ hia erie 436
Platevand Nippersiof: Marlow... chi..s:<je den. omiieieiow nie wine elereciate ss 437
Vierbral Hernia soy. nvsiscvadeaier mrevsiebiera ie or terete hove, Bickete felerene eet crete ote ee 444
Anterior-Posterior Section of the Head............ spleen rose 453
Parotid Region—Superficial Layer. ........ REO ACCA OAC Tr 454
a Middle Layert (2 sts. pc batemen oe deter eee ee 455
Hyovertebrotomies st. cAe iis eicloar thats stele Sete tev ete ete rete dete Wie vere emare 457
Tracheal, "Tam pon) Cantal isonci.u ccs oatosiee eee © e alnlere teem eet 463
Mazor-shiaped: Mies o.5'5-2 a ies ee tote le ote tots be Mibcate Steer eeree oe me 463
Ben biHemite Ai, Saye Gs eae en coer gecteteiey ovate cle hate ie ete eeeeie la tedersttter eters 463
Hookjto Secure Cartilawers jaactiera aac. steve miele ceistene ofa etcvenvels atete 463
Special Horcepaa res lk Shak weee ek cre eg tee es Sorte i 464
Curved (SCissors: ole ss iV eet Nec Ue Wee ei pie le ete eke ore ere 464
FRG RRACLORE NS Six usb ie aialnisie wees we cttenel eee Men atch RTE EATe eter aan nO 464
Mlectriedlampii.i ss scthc so. < satel aidan dltehaian Selena TS ee phase 3 0S:
ett: Sectionsof Iharynm. 5...) vie + nae ace dcioe slo ee een Peete ele 466
Blunt. Bistowry si). ve): aise PLL chs he Ne, ee ae See etree 468
Gtnyed: Seissons.: iis ke Aaa Gu todas Ce ee I 468
Spine Tenaeulum; or Dilator.ossmis epee somes 1s eh le ahser 468
Hooked! Force psich i. .dakrc ose cuioues spe ete Sheek iO misl wees eetere 469
{ 470
| 471
472
IAT ViLEMECLODIY pH siortele erate pichode feiers veiclake ior een tevetstaleteisictaite eis oie J re
475
476
477
Anatomy of Prach eal (erromi saint ce ose educates eletaets epee 's &caiesere 478
Ordinary: Eracheotomiy: Mule. .\s aia: sips eee eyes eistmcetaniaraiaele ets 480
Tube of Disterich sy. . <p ..Avoes ve aches wea eats eee aieiat cate east cto 481
Gowing’s Tracheotomy Tube see 24 scien reer tate elelsialc elm avs eel eleisiele 481
Spooner’s ch FS Nepal anata a tei entrar etoile of = nti Mecenate neat 481
Vachette’s (Duloee rai: aici Savane teers aeistanahs siete orale fotiete ie folie ale o\ a etal telat eke 482
AMD gs yored EX KO CKIAIN aogier slo dade ado aooo pou ono DO OU UGhoden aos 482
Tube of Brogniez ...... Se SE rai SU RRO ON Bite BADER 482
Tubevot Leblanc ym ounted ase eee ane een ee enionie niet 483
Dubevot en auly sy, aye ewe sae thete creda lnlete eteksieteieiete ieee coveretetsisteleraie.e 483
MuberoL Pouches eau Gy vse Mts tone erate anos lerinleciceveleterslatalatatetelete 483
Mube oti Tmilint se Wicca ira eects ciel rel otetoretheret= 484
PubelofiPrashobe cance cutee ecko actestre ee eeteielesvere ele tel ciistoretehete star 484
Trachea, Open for: Introduction of Tubes... 0... eee heneeeees 484
Trocar Paracento-injecteur de Reul................. Sandddns Soc 489
TABLE OF ILLUSTRATIONS XXVIi
FIG, PAGE
435) ‘Ordinary Hleam), with Three Bladesi...:...\.2..0 deers ex) bs oe oe 493
436
el {German gud, Maglishvepring Bieams G2 6)i00 « dlere jou xcs «ik 'aie wees 494
4
ENE TAH 120 11009 oil By o'5 120115) a al RR i rea ae a RE Ne ra th 494
ee IN MER LC SELBIYSLESDECIL cn Wchat neve c\ceas im ae oie aoctertl chalstetoD a eee eeetal cir tneeNeM ate 494
ie Manner’ot Holding’ the Plewm: 2.42. ss sajslaw ss cee caccsewsscen ee 495
Peon SUUHES) LELET NIEEM INO: o1.!e'c) sizid cetera Selde wie sis sides Bae oes 4 ponvees 496
443 Anatomy of Jugular Vein and Cisophagus in the Horse......... 497
444 Anatomy of the Cephalic Vein................... ieee. Sao tier Oene
445 as *) -ntermalipaphenay¥ elit .2 +. c5ek2.04 2 ee eae 5N2
Bao ee nleboromy on theidusulare 2.75. 22 ieo6 dove es ee ses Saemotls Jee 504
443 “Position of the Facial Vein in Sheep. .2..¢.325.08+:.%...000 .o0 5U5
448 Anatomy of the Posterior Auricular Artery in Cattle............ 515
449 Anatomy of the Posterior Auricular Artery in Swine......... .. 517
Zoo) woireniation oF the Palite.itio7. sos. ck ob lene pees ees rene 5209
451) eancet-to Bleed at the Palate... 00200.) 2 esc bls selene DRL
452 Apparatus to Apply Pressure to Stop Bleeding at the Palate..... 521
455) wohoe tor Bleedime ati thevloes)~ 4-25. ee ee eee eee eae ee 2 Dee
BotvihenAdstrictor.of Brogmiez... (5. aagceeeee ieee kes «ete - 525
bese MC OUUETTGUE YS. 0 2% 6!a)c = t=) 210’ oc sco orn I eo Se eS
Ang. VA Naniepy ol Artery Worceps.:.:. nasceseele teens eecis aes aninee acne 534
An coopem Needles, or Tenaculam! +25 sseee eee eanae eee eet aee 534
Foe PA wolyinge the: Inigature: ;....: 2a pee epee cee sate sae le oie a
Om UR RIS NM MCT OL! ./6:). 6 ./s a <-s'and hoe Ree eee oe ack Sere eens
460; umproperly-made Knot: 2.2). >staeaeeetea es! nots ea ee ee 536
fate Artery Horceps for Torsion... 5:6 semeieeet! a ooo) ote eet eee
Ac? web lantar Nerves Digital Recioneesapepee sees ae sae. fe eee 548
463 Plantar Nerve on the Posterior Face of the Phalanges........... 549
AG4 Blunt Tenaculum, with Hlastie Band \22e.-:.-.2 2575252922282 2 pl
465 i ERE AD SAA ees c ryt ROO Sey ack ee Norte eam et STC E
266. hightiand lett Neurotomes.jsegmactocs. ses ss ase eo eee. 551
iret UAL CECI sca c or 5 \-) «co's + so 2 cetera cree ellen) et) ay eee ae TE
abon Hewale Catheter. 1 .\.) -/ teeter ee eae Dee Roe eet one a DON
469 Anatomy of the Perineal, Anal and Caudal Regions.......... .. 559
AVON wsecuretor ischial Urethrotomyameres cents asec eee ae eee 563
es t Forceps to Remove Foreign Bodies from the Bladder............ 564
Ai Sethe OL LTOCDEL . 5. ‘eRe eRe ee Tae ele ee ee os 465
AGA, Lithotrivor of Guillonsceaseese ew. oe Skiee) aod oe ern ele ... 466
ory crushing Horceps of Bomleyeuers 14220 santo <b a ee as 567
HIG» ESLVALVO, SpPCCULUM.:2/5< ener aterm oe viele ett es aration Batetel ie Stale, eee c o68
Avie, Dengan Normal Contiiimm a Nore Are cet echt nate cs 570
77a Amputated Penis, with the Urethra Protruding...... ......... 574
4778 Stump of Amputated Penis, with Stitches Uniting Urethra and
478
Longitudinal Section of the Digital Region. ................... 5
XXViil TABLE OF ILLUSTRATIONS
FIG. PAGE
79 Plantar Nerves in Digital Region ysis... moss ssideckh cs celeste etter 57
480) Arteries of thediotball Region aaaprelcere-itaelsielsleniaicies- slc+ o/s) )sieleuene . 579
481 Portion of the Keratogenous Apparatus. ..............0..--ce0s 580
ANSP) SEOMON Oe WN IEE 356 6a0gobdandocabo cb oandopeoCooadODODC wOC 580
483
484 sa TEHIVES Hse ha eislapatosic aces voli soarevete ai slataceiate lars arcane eieyehe ayers 589
485
486
487 | Drawing KML VES iss Risiysoree ey orsrnemeonel strane sia Ll Sea\ ts ofbicvsebevetert horace 590
488
ABO CIAS PB isn: acescto-9-5, siete aversia eh eiebsh Ab aieueirtoue tater e eaelate teem eo Pa acc ta Poh eaSereere 623
490 Woreepsiof Viachette oo a): ic:.\<,c/sis'e sis 0fejnlopotele epefebetnvaXey eles ei eeeeeretrnean 623
AOL) Cautery of Vachette, 3.0, -.js:neisrd stews sieve os HRI etens Oi orci eae Oe 623
492 Clasps Applied in the Thickness of the Wall.................... 623
493 Toe Crack. Secured: watliClaspsis cic iss lelerse slats on she eee 623
494 Quarter Crack Secured with Clasps. «2:4 au \<2 sin siejem opeyetelslsieienae oe) 623
495) .Operation byl hinnin sw Processs. eye) aelelaeeet lee isieei eka ie ie 626
496 Operation for Complicated Toe Crack. .........c00006 spenensss 626
497 Dressing for Complicated Toe Crack): 3:<fin.s< as enepicles mimi ae 626
498: Short-branched Shoe) ...:2. 4:0 desu aces Se eee eee ee ae ees
499. Foot: Prepared for Charlier Shoe... si, <= <\siere «cyte ee sh ieett eerie 653
HOO) boot ohod.s) Charlier’s Method acme site arse te ietacieieleietereane 653
POL. Mein ged Shoe ss. .1b.0 <<, cress. «e+ 50s, vee ee ere tS) aie eros terre nares 655
502) Articulated Shoe. . 2:2: cs, 0.1 eevee de ete etoetlevaetan aetolecteievenohorereaetede 655
Desa sno ol. Dela Broue..).\. in. omssiecer eee cece cs ce aya aya cues eee 656
HOA Viatrin's SHO. 65,08) sca.siale iso y crete oe eae Peele erstere cee eterna tea 656
DOO: (SHO! WIth AIS 0:65.05 os oie! «:<.btereroes tolerate lemeTayets ile.) ere tte ea 657
HOG) Jarrier’s Spreaders... .,<s..2- ss eerjcved ee siaeietee tele rote eer eer 657
O07 atosseDesencastelewr:) ./sLis% /yveciuylerseteleienronrae spel isiockeetteie aeons 658
508 "Spreading Shoes: <0. 5 +s. sss hele a ios ain bree ier ee teens 659
DOSA ASBeier Orin. 5.5 cis. 0:sie sie ote crane eye eelencleyey ote tronske tol siete ona ee eee 659
BOF Eatin SIS HOGS oj. 5: 45s o(e sie. dntm wreieiey otarateten ciara eel ints (ete fs eel oeets elena eae 659
DLO FMOUMMES SOMOS se 2) 3) s/o.5 ois! ie cie.0 wjeie 6! scutes aie | eves eatelsl hehe ae eee 660
511 () Detays) Contrary Vise. 2. 2. |. .'s..\< stu s we aes eiereley are eee 662
512 me Tammparo ved 1) $6). 0.3 2s amine, 0h ere onette onan ee aakte hes eee eee met 663
Sid) MericantiseDesencasteleurs..).(.\5 ati -sinieotts oe seer eee 665
514 Jovard ;Deseneasteleur... ....).:s <2:s\ aye. ss 'e.s via.c Sects stele pl err nemo eae 663
Slo Chrome ra TWA GIS 5.2), < sian sie ciciosntelals ete rs ieteicet etal ee he tees teen 677
516; (Chronte Maminitis; Toast: Siage |... i. .../s)s setts nolo a ete eleye 678
517 Foot) Adfected with Chronic Laminitis.. <<) ..).2 50%... ee 679
518. Chronic aminitis, with Keraphylocele: ci. 5 :ci+-ssisctsee ate teen 679
519 Changesoh Structure of the Os Pedis../)...2-/ssiaemieesteee ilies 684
§20° Local ColdDouche*Application,., .\.\.. 44) dc%. cossierceisttteieie melee 689
521 Apparatus of Mathew for Cold Water Application.... .......... 690
523 Cartilaginous Apparatus of the Horse’s Foot..............2..4-- 714
524
oe0 spr of Necrosis in Cartilaginous: Quittor.....,.:010. 0010000 «chee ee « 717
526
TABLE OF ILLUSTRATIONS XK
FIG. PAGE
527 Direction the Groove Should Take to Remove the Quarter in Oper-
ation. for Cartilaginons: QuittOr.....6 6. eesns eee ds oe ees 727
528 Truncated Shoe for Dressing in Cartilaginous Quittor or Compli-
CRTC AC ONIN savas stcrevere tin cre ison dn eiada wale hos hale oarkarleal Biaye Soars 733
oom Deplas hoe tor the Samo. 2s acces sice ced civees atenacs sl creas 734
530 igs Steps in the Application of the Dressing After Operation
531 ba os 5 ‘
532 FOPAC ALAS UIOUS, QUIELOL |: corel cis «ls: sc) ch meyalsiarate etm sielisiss<) aloes sce 739
Beep Oressing COMPleLed! oaie.ccc. asus a cisyeis arene ees wee dew Ol alee ieee 735
tem PIVeIIAS MiLGVAbODtaenin tion. cyst os inte o/s catcteleie see ov haimae ee eS 740
585 Bistoury for the Excision of the Encanthis..................... 744
eae MEET OID OL OWININTI S555: 51055 70,c0aciu<tefecayein cho: ste = ler sletioyctow acters me toes 749
Be STELG OL VVC DET cje's, adicin/sic oct. steayeuals'e as weiara ya tin aves o/n, Brave mui Gusev 745
Bas) meehiono£ the Elorse’s\ Hive 2.20 7h 4.2 tam spe 2 410 tole “ajo soloerteete enters erate 747
Poo MuneeOlated bISbOUNY,.j. cmc. ae oc curses 4 cleats ilo ais See Tae aT O an 748
Wee Ericispia SbyleniOl TueBlAMG.2.. cls a1. @ a2 os ciadais stevelneie oie cheers 750
Bete EOS MICZ, WTAOCALON . .s':\4's « sais crs tle aedtarntsi™s «Peotone sayeloe of 750
We me POLCE SiO: Wal Om er) Lud. (ee edema avs eat ete et wien tl tedealenetes 750
toe OCAEPES) NECUIES'. tile 5 .csa's cunw spe RR PR eee aaa AY arate 751
544 Operation of Cataract by Displacement of the Lens............. Tal
DEMO gS TES(0) 6a 67202) oy oe I oso RCM ind BF 752
546 Operation of Cataract by Flap Upwards... 0:22. 0-22) s.uaneee 753
By MIC VSEILOIIG 55002). wisn noo owls s,2's vee Ree eee ion tle coy eee linens 753
pao ekcrnita of Grante .. 5. 22h. dékcpi eee eee IHN ders a hots oe 753
Biome owiLo-erotect the. Eyes), sven eee Gin sits cie-aei estas aisiele 755
ne Artificial Eye—Side and Full View.........0..0ceeceeeeceecees 7155
oe Brogniez Apparatus for Amputation of the Ear................. 757
So. - Apparatus of Brogniez in Positiomeiy ce cc: =~. 2s occ. x ois spare levers 757
Ho le Nippersiof Garsault.\...¢.< screamin uke a1- lala wieie Agjow creer eale 757
556 ‘to Amputate Dogs) Mansmececcti.c© nis:s «150 s1ce.em ee eee 758
oby 760
558 : 761
bool Anatomy ofthe Withers 5.7 cp aches 4c) 2/25 Se 2 a lle cie a etes 762
560 } ,
561 J 763
562 Transverse Section of the Region of the Withers..............-% 764
563 Section of the Neck on a Level with the Poll..................- 780
INTRODUCTION,
Under the designation of operative surgery is understood that
department of medical science and practice which includes the
external and instrumental manipulations required in the treat-
ment of surgical diseases and accidental injuries or deformities ;
or perhaps it might be succinctly defined as surgical science me-
chanically applied.
The two branches—the science and the art—which constitute
the study of operative surgery cannot, of course, be dissociated
in a treatise on the general subject, and it will therefore be neces-
sary, as we proceed with the detail of our observations, to give
due consideration to the etiology, the symptomatology, the pathol-
ogy and other characteristic features of certain diseases, in their
relations to the indications of treatment and the manipulations
which they involve at the hands of the surgeon,
Viewed from the standpoint of comparative importance in re-
spect to the value of the results of human and veterinary surgery,
as relating to the vital status of the patients who become respect-
ively the subjects of both—the human being and the quadruped
races—veterinary surgery must of course consent to occupy the
subordinate place; a fact, however, by no means tending to dis-
parage the value or the just estimation of the calling of the scien-
tific veterinarian.
In human surgery the one paramount result held up to view
is the prolongation of the life of the patient. This is a consum-
mation to be achieved regardless of any considerations of cost or
trouble, while in veterinary surgery the prime motive is the res-
toration of the patient’s interrupted ability to fulfil his function
as an animated machine for supplying a certain amount of valu-
able force. For these reasons the scope of veterinary practice is
2 INTRODUCTION.
a circumscribed one, in comparison to that of human surgery, by
having the aim and being brought to the test of mere economic
utility. While the human life is prolonged at any cost, moreover,
the treatment of the animal is always supplemented and influ-
enced by the consideration that if curative efforts fail, the suffer-
ings of the patient may be terminated by the administration of
a prescription which will at once release him from pain and de-
prive him of life, with the full sanction both of self-interest and
benevolent feeling.
Another element which operates to define the sphere of the
veterinary surgeon is the natural disinclination of the owner of
a sick or disabled animal—perhaps a man of limited pecuniary
resources—in a tedious and unpromising case, to add to the ex-
pense of surgical attendance the cost of the unremunerated
“keep” of his disabled and unproductive servant.
It ought to be true, as a matter of course (perhaps it is so in
point of fact), that no man of intelligence and integrity will as-
sume the duties and responsibilities of surgical practice without
the due preparation and equipment, which is only to be acquired
by conscientious study and competent knowledge of medical
science at large. Especially and indispensably a surgeon must
be an accomplished anatomist. His knowledge must be thorough
and practical in the several divisions of anatomical science—he
must possess a familiar acquaintance with descriptive anatomy ;
he must be fully instructed in surgical anatomy or the anatomy
of regions ; he must have mastered the last chapter in pathologi-
cal anatomy ; and if there are any other kinds of anatomy, he
must master them all, and then he will have become an anatomist
in fact, and qualified to practice surgery. Yes; a surgeon must
be an AnaTomist.
And it ought to go without saying, that only a surgeon should
practice surgery, whether his patient be biped or quadruped. No
untrained layman should-presume to wield the knife and the
cautery with their associated arsenal of weapons and other appli-
ances for the subjugation of the enemy whose assaults it is the
special province of the surgeon to repel. An ignorant operator
may easily become, himself, a more dangerous “lesion” than some
of those which he presumes to treat. The man who can cut into
the living, and usually hypersensitive, flesh of a suffering animal,
without knowing what tissue or organ he is attacking, what artery
INTRODUCTION. 3
he is likely to sever, what nerve to wound, what organ to lacerate,
what function to paralyze; who would essay the operation of neu-
rotomy without knowing where to look for the plantar nerve; who
would undertake a case of vaginal spaying in ignorance of the
location of the flying ovaries; or who would operate for strangu-
lated hernia unaware of the mode of avoiding the infliction of
injury upon the posterior abdominal artery—such a man, if to be
found, should simply be subjected to an odium which should
ostracise him from honorable and equal association with others
of his species, besides being held criminally amenable to the law
providing penalties for the perpetrators of cruelty to animals.
These reflections may be unnecessary, but it is all too true
that our domestic animals too often become the victims of worse
than brutal masters, who take advantage of their helplessness and
inferiority to inflict upon them cruelties so gross and aggravated
that right-feeling men are often compelled to blush to call them
fellows. It is no excuse for this that it is done through the
agency of a pseudo-surgeon: such a plea merely doubles the
number of the wrong-doers.
In offering these suggestions, and in formulating the informa-
tion which follows, derived from the experiences of many studious
and observant men, and which in their aggregate and connected
form constitute the substance of this volume, it is assumed that
it is only from competent and qualified minds that the apprecia-
tion which it hopes to merit and to receive must come, and we
trust that to the extent of its justice and truth it will not be
withheld.
With the skill of the expert anatomist must be associated, of
course, the necessary mastery of therapeutics and a familiar knowl-
edge of special and general pathology, and all should be supple-
mented by a knowledge of the theory and practice of the farrier.
The science and the application of the laws of hygiene, so
generally, indeed almost wholly, ignored by our fathers, and so
largely a discovery of the present time, will never be overlooked or
depreciated by the genuine surgeon ; and while possibly the effects
of meteorological influences may have become of less importance
than they were considered to be in times gone by, a careful ob-
servance of their phenomena will never be a useless item of acqui-
sition. The fullest attention to the theories and application of
what may be denominated the science of antisepsis, and the adap-
4 INTRODUCTION.
tation of antiseptic measures, now so universally and unintermit-
ting an adjunct to all medical and surgical practice, and so utterly
indispensable in the departments of dressing and nursing, and so
often an available and valuable aid in the very act of operating,
must be considered now to have become an incorporated and con-
stituent department of the domain of surgery, and medicine as
well, and the cultured veterinarian will of course so regard it in
his practice. .
Without being necessarily a practical worker at the anvil, the
surgeon, as we haye intimated, must acquire a familiar acquaint-
ance with the theories and the art of the farrier. No one can
place too high an estimate upon the importance of the position
occupied by the foot among the anatomical regions where lesions
may be expected to occur, and whereas the shoe becomes practi-
cally identified with the living member, and is, in use, a portion of
the hoof itself, by the act of nailing the shoe and the hoof together
the inference becomes palpable. An occasion may easily arise
when a serious blunder in treatment may be traced to a previous
blunder in diagnosis, which ‘again may be referred to an earlier
blunder still, which has consisted in neglecting to examine the
foot, and the shoe which has injured it. What is the status, in
respect to his market value, of a horse with poor feet, or whose
good feet have been ruined by bad shoeing? So the veterinary
surgeon, though not required to be able to make a set of shoes,
should be expected to know how they ought to be made and fast-
ened. And when a special shoe is required for the correction of
a deformity, or as indicated in some diseased condition of the foot,
it will of course become the exclusive province of the surgeon to
dictate the whole process of forging and fastening, and to see that
his instructions are not ignored.
Besides the special scientific attainments to which we have
referred, there are many other qualifications which must enter
into the character of the good and skillful surgeon, in order to
round it into true symmetry and proportion. Bouley remarks
that ‘‘he must not only be a man of science, but a man of art,”
meaning, we suppose, that he should not only possess knowledge,
but know how to make it available. First, he must possess the
faculty of knowing how to gauge the necessity of his interference,
with its manner and its duration; or, on the other hand, whether
any interference is necessary, and whether the true indication is
INTRODUCTION. 5
not to refrain entirely from active measures. The result of his
decision will afford a good test and gauge of the extent to which
he has profited by his clinical and theoretical study. He is a
sound philosopher who can wisely determine when to det alone, in
opposition to the temptation to do something.
The acquisition of manual dexterity is an accomplishment of
prime importance and should be acquired, and can only be earned
by diligent practice upon the cadaver, or, what perhaps is more
effectual, besides being in itself real work, by utilizing every op-
portunity of performing minor operations, under suitable instruc-
tion, upon actual patients. Of course, expertness without practice
is impossible. It is not fully correct, perhaps, to speak of manual
dexterity in the singular number. The dexterity required should
be bi-manual or ambi-dexterity, and any surgeon who has not
mastered the art of using both hands indifferently, though he may
have learned all else pertaining to his profession, lacks yet one
thing. Cases will continually arise in which the inability to change
hands may interrupt the progress of an operation and involve the
practitioner in great inconvenience, if not embarrassment, and
possibly prejudice the case itself.
Courage and coolness, with patience, are essential qualities of
temper in an operating surgeon. To become alarmed and lose his
balance on the occurrence of some untoward incident, or the ap-
pearance of some unlooked-for abnormal development or compli-
cation, or to give way to a spirit of impatience because of unex-
pected delays, or, especially, to resent the fractious movements of
the suffering animal, writhing under the knife or the glowing
cautery, is both unprofessional and unmanly. The terms cour-
age, coolness, patience and kindness should describe his state of
mind while operating.
The whole axiom of Asclepiades, cito, tuto and jucunde, re-
veals the entire scheme of conduct proper for the surgeon under
all circumstances. Every movement of the surgeon should be
prompt and precise. Indeed, by operating rapidly he shortens
the duration, and consequently the sum of the inevitable pain,
and thus diminishes the anguish of a long and torturing infliction
on behalf of the patient. The maintenance of his own self-possession
will make him master of the situation, and assure a neat and ar-
tistic finish to his task, with no unnecessary divisions of tissues,
no mistaking of localities, and generally with no betrayals of
6 INTRODUCTION.
doubt and hesitation or awkward and aimless manipulations, such
as mark the attempts of the tyro and the novice. The confidence
and facility with which each movement is accomplished will not
fail to impress favorably those who are spectators of the opera-
tion, and to react favorably and profitably for the operators.
Although, of course, the qualities of accuracy, neatness and
rapidity must favorably impress the spectator, as well as benefit
the patient, it must not be forgotten that the true success of the
surgeon must find its evidence in the favorable result which
finally crowns his work. If that is assured, it is but a small
matter whether it is or is not applauded while in progress—the
applause will follow, in any case.
We quote from Bouley, in the Dictionnaire de Medecine et de
Chirurgie Vétérinaire, where he remarks, on another important
practical point: ‘The operative function of veterinary surgery
requires, on the part of the man who practices it, a certain cor-
poreal vigor, associated with sufficient agility to be able effectually
to overcome the resistance of animals under torture, and counter-
act the efforts and avoid the injuries they are always so prompt
and often so dexterous to inflict upon those who are causing them
pain. The veterinary surgeon must be cool-blooded and patient,
never losing his presence of mind while directing the manipula-
tions, often so difficult and so dangerous, which are necessitated
at his hands, especially when the large domestic animals are under
treatment. He must then—always, in fact—be prepared. for all
difficulties and eventualities that may arise, whether before, during
or after an operation, and he must inspire confidence in his assist-
ants by using full precautions for their safety and for his own, in
his defensive dispositions against the dangers to which they are
exposed.”
A surgical operation, as elsewhere described, is a mechanical
action, practiced with more or less rapidity upon the living body,
according to certain rules, either with the hand alone, or assisted
by instruments, with a therapeutical or a prophylactic object in
view, whether primarily necessary or facultative, of a prophylactic
nature.
It is especially as therapeutic measures that operations are
necessitated in the treatment of diseases and injuries; as, for ex-
ample, in the case of the removal or extirpation of diseased or
altered parts, whose morbid action injuriously affects the general
INTRODUCTION. i (
health or prevents recovery from a pre-existing disease. This
class of operations includes the opening of abscesses, the extirpa-
tion of gangrenous parts, or of necrosed or carious bone; or again,
for the modification of the nature of a traumatic lesion, in order to
stimulate cicatrization, as in the opening of a fistulous tract, or
the resection of an ulcerated surface; or when the economy is to
be relieved from the presence of a foreign body, or the abnormal
product of a natural function, as in cases of cesophagotomy, or
of calculi of the bladder, or of the salivary ducts. Operations have
also their prophylactic uses, especially in the various forms of in-
oculation and vaccination as anticipatory and preventive of infec-
tious diseases. They find their further obvious indications, again,
in remedying physical lesions when applied to fractures, dislo-
cations, deformities, and the endless list of accidental injuries,
wounds and hurts of every kind and degree. And, finally, they
have their justifiable use in mutilating the larger domestic animals,
designed for purposes of labor as beasts of burden or draught, in
improving their adaptability by castration or spaying, or as prop-
erly termed, “altering.” ’
Thus the general purpose of an operation is to palliate, cure
or assist in the recovery of surgical diseases; to prevent diseases,
and especially such as are known to be contagious; and so to
modify the condition of the domesticated animals as to enhance
their usefulness and value to their human owners.
In medical nomenclature, operations are variously designated
according to the methods and characteristic manipulations attend-
ing their performance, and the objects which they are designed
to accomplish. Thus:
(a) It is a light operation when superficial tissues or those of
secondary importance are involved, like that of venesection, or the
simple puncture of avein. On the other hand, it becomes serious
when it is performed upon important organs, or involves extensive
and complicated structures, as that for the reduction of strangu-
lated hernia; the removal of the lateral cartilage of the foot in a
case of quittor; the operation for chronic champignon, etc., etc.
(6) Operations are also dry or bloodless when accompanied by
little or no hemorrhage; and sanguinary or bloody when, on the
contrary, much hemorrhage attends any of their various steps.
(c) Again, they are simple or complicated according to the
extent and multiplicity of the tissues or regions forming their
8 INTRODUCTION.
seat; simple if performed by a single manipulation, complicated
when requiring several distinct or separate stages for their exe-
cution.
(d) Operations are called regular or determinate when per-
formed according to rules in relation to the disposition of the
parts, and, in general, upon sound structures; and they become
irregular or casual when the manipulations are extemporized to
meet the emergencies of the case, the necessity of the situation
and the unanticipated complications which may arise while opera-
ting, as particularly in cases of the removal of tumors.
(e) They have also received various designations indicative of
the time chosen by the surgeon for their performance; or made
imperative by the circumstances of the case; or according to the
object specifically in view: thus they are urgent or of necessity
when a fatal event would be the alternative of delay, and imme-
diate treatment becomes imperative, as the condition of the
patient’s survival, as in operation for the reduction of strangu-
lated hernia, or that of tracheotomy in a case of threatening suf-
focation ; and in cases beyond hope of complete recovery, they may
become necessary, indispensable, useful or palliative, according
to the degree in which they may be made available as a means of
relief, and may tend to the temporary respite of the sufferer, and
in some degree improve his value by measurably enhancing his
ability to continue to labor with some degree of comfort before
he is overtaken by a final and total disability.
There is another class of operations which justly deserves to
be totally discountenanced and ignored, and in fact are fit objects
for penal prohibition. They are known as operations of fantasy
or fashion. They are without real utility; are abortive attempts
to improve upon the symmetry of nature; are devised simply to
satisfy a mere whim of affectation; are in wretchedly poor taste ;
and probably subject their victims to a more aggravated and pro-
tracted species of torture than any other form of wound known to
veterinary surgery. There are sometimes conditions, however, in
which they may lose their alleged esthetic pretext and their ar-
tistic character, and the object of their performance may be
regarded as properly within the legitimate and beneficial sphere
of professional work.
The settlement of the point of the time, in connection with
any piece of surgical work, is not always one of mere secondary
INTRODUCTION. 9
importance in deciding the matters pertaining to the details of
an operation. When there is any option in the case it pertains
wholly to the surgeon to determine the question. And when the
period of abeyance has terminated by his decision in fixing the
day and hour when the contemplated treatment is to be applied,
the optional time becomes changed to the selected time. Of course
it is not always left to the option of the practitioner to select the
moment for the accomplishment of his task. He must be gov-
erned by the nature of the case, and may be left without the
opportunity of exercising any discretion in the matter. The
urgency of the occasion may be extreme, with no interval allow-
able for deliberation or choice, and the only available time, the’
peremptory present, must be accepted as that of necessity.
The operation being now obligatory, and the case understood,
the surgeon’s next thought is the choice of the locality of the
operation, and that being finally decided, the point of selection
has been reached. The case may easily present such features that
this point becomes too obvious for hesitation by becoming that of
selection as well as that of necessity, as indicated by the seat of
the lesion or diseased process. With traumatic cases, there is,
of course, but a single point of interest—it is the point of injury /
In surgical phraseology the terms method and procedure are
often used convertibly. There is between them, however, a dis-
tinction which, for the sake of precision, must not be lost sight of.
By method should be understood the principal and primordial
mode by which the operation is performed, while by procedure is
meant the special modifications and successive stages by which
the manipulations of the operation itself are regulated. For ex-
ample, in the removal of a vesical calculus there is one method by
lithotrity and another by extraction, and with both are involved
the insertion of instruments into the urethral canal, one being the
procedure with the catheter, and the other the procedure by the
injection of tepid water. Castration with clamps is a method,
when compared to double subcutaneous twisting (bistowrnage) or
to torsion; and it is performed by two procedures, that by covered
and that by uncovered testicles.
There are several important points which demand special at-
tention at the hands of the surgeon before beginning an operation.
Having finally reviewed the situation, and especially having men-
tally rehearsed the anatomical disposition of the region and the
10 INTRODUCTION.
pathological character of the lesion, with the necessary details of
the work before him, not forgetting to anticipate possible acci-
dents and complications; and being assured that his arsenal of
instruments, dressings, etc., is ample and in good and available
order, with a liberal provision of sponges, antiseptics, etc., and
duplicates of such of the instruments as are liable to be broken
or otherwise disabled, the condition of the patient should then be
ascertained. It will, of course, have been thoroughly understood
by the surgeon previously, but it is always among possibilities
that even at the appointed moment for operating, some changes
may be discovered or some new circumstances developed which
may modify or contraindicate the entire proceeding.
Some final preparation of the patient is always necessary. One
item of this consists in clipping the hair from the skin over the
seat of the operation, and thoroughly cleansing the part. In
some cases it is necessary to soften the tissues by means of poul-
tices, baths or wet bandages. There is also a constitutional and
general preparation which must not be neglected, with a view to
so modify the organism as to improve the ability of the animal to
withstand the shock of the operation. If weak and debilitated,
his strength and condition must be improved; if of an irritable
and nervous disposition, precautions must be taken to control it.
A comparatively low diet is almost always a salutary measure,
and sometimes even complete diet an essential preliminary to an
operation, and the surgeon must assure himself that they have
been properly taken into consideration.
In many cases the surgeon needs the co-operation of assistants,
either professional men or laymen. The aid rendered by a profes-
sional brother or by a student of medicine will of course be such
as will be assigned to him by the responsible surgeon, and cannot
be specified here—it will vary with every case. The facility and
success of an operation will be greatly promoted by their intelli-
gent and sympathetic aid, which will be quite of an indispensable
character. In enlisting laymen as assistants, it will of course
devolve on the surgeon to instruct them as fully as possible in
the nature of the services expected from them ; and in making his
selection of individuals it will be an important point gained if he
can obtain those who are accustomed to the management of ani-
mals, and who are expert in handling and successful in controlling
them.
ELS i,
nk Lt ee
INTRODUCTION. 11
There is still another party to be considered while referring to
the study of “preparation.” It is neither the animal, the surgeon,
the assistants, the instrument case, nor the lint and bandages. It
is the owner of the ailing animal, And to “prepare” Aim for the
event is oftentimes a performance requiring a larger amount of
judgment, tact, knowledge of human nature and patience than
the average man possesses. On the one hand there are those of
the optimist class who have quite an unwarranted opinion of the
power of surgery, and who, in despite of the most unfavorable
prognosis, insist upon a resort to the knife, even upon inadequate
occasions. And on the other hand are those who interpret any
suggestion which involves a solution of continuity professionally
proposed, however artistically consummated, as only a mild form
of sentence of death to the patient. But however antipodean
may be their views in other respects, they are in common quite
assured that for an operation which fails to restore the dilapidated
patient to a condition a little better than new, whatsoever may
have been the accident or lesion which he may have encountered,
and whatsoever may have been the skill and intelligence exhibited
in the treatment of his wounds or ailments, the only legitimate
and orderly conclusion is a suit at law for malpractice. It is the
function of the doctor to cure disease; if he treats disease without
curing it, he is an incompetent; this is the irrefragable logic!
Though the living animal had failed to return any remuneration
for his subsistence, and for the care lavished (?) on him during
the period of his disability, yet when reduced to the state of a
cadaver he should be compelled, if possible, in an indirect way to
net his bereaved owner a sum likely to prove largely anodyne to
the poignancy of the grief which the loss of so much property
had excited.
But aside from this, the owner of the living property, the value
of which is about to be jeopardized, is entitled to a full and candid
statement of the nature of the case, with its possibilities and its
dangers, and it is in the interest of the surgeon himself to observe
perfect frankness with his employer—not, however, to the extent
of compromising his position as doctus in the case, or foregoing
his self-respect by making concessions upon points of scientific
acquisition to a layman, however generally intelligent or specially
interested. The surgeon must assert himself as the representa-
tive and exponent of an honorable and learned profession, able
12 INTRODUCTION.
and prepared to acquit himself of his just responsibilities; and,
indeed, it is in this assumption by him, with the conceded assent
of the owner, that the virtue of the contract lies, which binds the
two parties with equal force, moral and legal.
This point, being understood and settled, should be looked
upon as furnishing the best preparation which the owner can ac-
quire, and he will need no other when he is thus made to under-
stand that he must have full confidence in the skill which he has
called into requisition, and must be guided by its implied guar-
antee that every possible precaution will be taken to carry the
patient through his trouble; and that if accidents of any nature
should occur, when not incurred through carelessness or error,
the risk is the owner’s, and he alone must assume it. Such an
understanding on the part of the owner will impose upon the
honorable surgeon an imperative sense of the conscientious care
with which his task should be performed, while at the same time
it will relieve his mind from the pressure of a possibly embarrass-
ing anxiety while engaged in his work, and it cannot fail to be of
advantage in various ways to all the parties concerned.
Minor matters, such as the condition of the weather, the
time of day, the selection of a place, the position which the oper-
ator must assume for himself, with that which he assigns to the
patient—these are points which are also to be carefully taken into
consideration. They have, one and all, more or less influence on
the facilities of execution of an operation, and perhaps also on the
results that may follow it.
CHAPTER I.
MEANS OF RESTRAINT.
The final preliminary before operating upon animals, is to place
the patient in such a condition of restraint as will assure the entire
safety of the surgeon and his assistants from injury likely to result
from the violent struggles of the terrified and suffering creature.
The severity or the duration of the operation furnishes no accurate
measure of the necessity of the restraint, or of its continuance or
degree. Any unusual or violent aggressive treatment will excite
his fears, and consequently his opposition, and whether the occa-
sion be a painful and protracted dissection, or the simple applica-
tion of a dressing, the surgeon may usually rely on the strenuous
resistance of the patient. It is of little account that there are
differences of dispositions in horses, as in men. With any un-
reasoning animal the case is the same, and with the excitement,
the anxiety, and no doubt, a vague terror of something unknown
impending, too often quite explainable by the treatment to which
he has been long accustomed at the hands of an unfeeling owner,
he is prompted by the mere instinct of self-preservation to defend
himself with such means as nature has taught him to use. The
necessity of enforcing a passive condition in the animal being thus
apparent, it ought not to be necessary to say that the means of
accomplishing it should be employed with reserve and moderation,
especially when they are painful in themselves, and that no man
claiming to be the possessor of humane instincts will permit
himself to increase the severity of their application by supplement-
ary ill treatment, in the infliction of “punishment,” upon the
alarmed and suffering brute, a course which is quite likely, more-
over, to be as ill judged as it is otherwise reprehensible, from the
fact that in most instances its effect is contrary to its intention, in
aggravating the evil it would remedy. It should never be forgotten
how easily the most fractious and timid animal may sometimes be
controlled by kindness and patience, and his agitation soothed by
14 MEANS OF RESTRAINT.
the sound of a familiar voice with which he has become accustomed
to associate acts of gentleness and friendliness. Under any cir-
cumstances, a habit on the part of the surgeon, of brutal treatment,
the exhibition of a bad temper, in the indulgence of fits of anger,
leading to acts of cruelty in the infliction of unnecessary pain on
his dumb and helpless victim, is not only in every way useless, as
being of no possible advantage in any direction, but tends to a
degree of moral harm in those who are thus culpable for which no
counterbalancing benefit can be imagined, and which certainly can
never facilitate the remedial effect—but quite the reverse—of the
pending operation.
A benignant method of controlling animals for the special
purpose for which treatment by the surgeon is invoked, is not,
however, alone sufficient, and it is thus that a resort to effective
means of physical restraint becomes unavoidable.
These are of two kinds: one consists in inflicting upon some
given part of the body, more or less remote from the seat of the
operation, a severe and continuous pain, which, by a process of
derivation, reduces that which is incident to the steps of the
operation, by distracting or diverting the consciousness from the
influence of the new suffering, against which he feels resistance
would be in vain, to that of which he is sensibly cognizant, and
thus the animal submits himself, with a comparatively voluntary
surrender.
The other kind consists of restraints proper, and are constituted
of mechanical devices for securing immobility by the process of
overcoming opposition by means of a dominating physical force.
Their use is not affected by the position of the subject, and they
are therefore applied in both the upright and decubital posture.
The first comprehends the derivative or painful method of Peuch
and Toussaint’s division; the second, the method by direct me-
chanical restraint.
MEANS OF SECURING SOLIPEDS.
A.— Derivative or Painful Method.
This method is in very common use, and usually proves to be
sufficiently effective to secure a degree of quiet and passivity in
the patient for the safe performance of many light operations.
Under some circumstances it is used in connection with the means
SECURING SOLIPEDS. 15
of direct restraint. The instruments mostly employed in the first
method consist of the twitch, the old fashioned barnacle, and
_ the gag.
Fig. 1.—The Twitch.
The twitch is the instrument most commonly used and, un-
fortunately, too commonly abused. In horses, it is sometimes
applied on one of the ears, and sometimes on one of the lips; and
is very severe in its action, wherever applied.
In applying it, the operator, passing his right hand through
the loop of cord of the instrument, grasps the tip of the upper or
the mass of the lower lip, leaving the loop to slip over his fingers
close to the skin which it then encloses, and with his left hand
turns the handle of the instrument until the cord is sufficiently
shortened to form a true ligation of the tissues which it cireum-
scribes. The pain caused by this constriction may be graduated
by the rotation of the handle of the instrument.. When in place
it is either held by an assistant or tied on the halter. If the
animal proves to be especially refractory under the infliction, the
assistant should be cautioned against aggravating the trouble by
forcibly dragging upon or jerking the instrument, violence of
that nature becoming in some instances the cause of severe injuries
to the muscular or nervous structures of the lips. We have
ourselves met with several cases of labial paralysis resulting from
such an improper and repeated application of the twitch. Some-
times the length of the wooden portion of the instrument is con-
siderably reduced, varying in its application in such a way that
when the open loop is placed on the lip the wooden part which
takes the place of the handle is placed on the lips through it, and
the cord is twisted by turning it.
The darnacles are formed of two articulating branches, made
of either wood or iron, with sundry notches at one end and a ring
at the other to fit into the notches. The degree of pressure re-
quired is regulated by shifting the ring until the proper notch is
16 MEANS OF RESTRAINT.
/
/
Fria. 2.—Short Twitch.
ascertained. The iron instrument is severe in its effects, probably
more so than the twitch, but is less easy of application. In apply-
ing the barnacles, the surgeon grasps the upper lip, and placing
Fic. 3.—Iron Barnacles.
each of the branches severally on opposite sides of the organ,
brings the ends together, immediately fixing them in place at the
desired point of pressure, and secures them by fitting the ring
into the proper notch.
Fic. 4.—Wooden Barnacles.
The wooden barnacles are made with circular sharp ridges cut
in both branches in order to intensify the pain, the ends, when
they are approximated, being secured by means of cords.
The gag is a means of derivation used principally in Central
Europe. It consists of a cord about one-quarter of an inch in
diameter, which is placed in the mouth, and passing upward on
each side of the face, is tied on the top of the head. This is twisted
to any degree of tightness by means of a small, round piece of
wood, which is passed between the cheek and the cord, the result
being excessive traction upon the commissure of the lips and great
SECURING SOLIPEDS. a Ure
Fig. 5.—The Gag.
pain to the animal. Lacerations of the commissure, or wounds of
the skin at the poll are to be anticipated if this manner of punish-
ment is not guardedly used.
There are besides these some milder appliances which must
not be overlooked. Among them is the repeated pricking of the
tip of the nose with a pin, and the introduction of foreign bodies,
such as musket balls in the ears. The origin of this last method
dates back to 1607, when little round stones were recommended
for the same object. When musket balls are used, holes should
be drilled through them for the insertion of a string, in order that
they may be withdrawn when necessary.
B.—Mechanical or Restraint Method.
The means employed in this method vary according to the po-
sition, whether upright or recumbent, in which it is desirable to
confine the animal during an operation.
STANDING POSITION.
The necessity of imposing restraint upon the patient while
under treatment in the standing position arises not alone from the
danger of injury to the operator and his assistants, from the biting
and kicking of the excited animal, but because he is so thoroughly
impartial in the distribution of his attentions that he even requires
protection from his own violence, and his own flesh must be guard-
ed from the contact of his own teeth.
They are usually resorted to in order to facilitate operations
of comparatively trifling importance, and which are not of a par-
ticularly painful nature, or are of easy and rapid execution, or
18. MEANS OF RESTRAINT.
under circumstances when the animal can be controlled by being
merely held by the head against a wall, or with the hind quarters.
in a corner, or perhaps tied to a wall, a post, or a tree. Certain
minor precautions are necessary on these occasions. For exam-
ple, the ground on which they stand must be smooth, though not
slippery ; of a good holding character, and neither too hard or too.
damp, in order to avoid falling, or slipping, or other possible ac-
cidents. Attention to these matters will be of great benefit to the
operator by leaving him a good foothold, with facilities for free-
dom of movement, and more at liberty to guard himself against
his patient, unexpected changes of attitude.
The means by which the movements of the head are kept under
control are the halter, the bridle, the bridoon and the cavesson—
instruments which need no description here. If the animal is left
unconfined, the assistant having passed the rope of the halter or
bridoon through his mouth, holds him close to his head, places
himself in front of him, or slightly on one side, and being atten-
tive to every movement the animal may attempt, anticipates it, by
pulling the head downwards if the animal is about to rear, or rais-
ing it upwards to prevent him from kicking with his posterior legs,
or inclining it to one side or the other, as the animal moves it in
one or the other direction.
An animal should never be tied with the halter-rope in his
mouth or over his nose. There is danger in both methods of se-
rious accidents, in case of a violent backing or jerking of the
head. In one case the result might be a section of the tongue,
and the other might involve a fracture of the maxillary. For simi-
lar reasons the bridle is also dangerous. The height at which the
head should be secured must vary with the movements attempted
by the horse. Thus, to prevent him from rearing or striking with
his fore legs, it should be placed low, but high when it becomes
necessary to guard against his elevating his posteriors in order to
kick with his hind legs.
To protect his head against possible self-inflicted blows result-
ing from his defensive struggles, and to prevent him from seeing
surrounding objects likely to alarm him, are precautionary items
of not a little importance, and the employment of the mask or cap
(Fig. 6C) is very effectual for that purpose. Fractious patients,
dangerous to handle and difficult to control, often become perfectly
quiet and thoroughly docile on finding themselves involved in dark-
SECURING SOLIPEDS. 19
Fie. 6.—C, the Cap. O, the Cradle.
ness, and submit to the necessary manipulations of the surgeon with-
out further resistance. When a proper cap is unobtainable a bridle
with blinders can be substituted, or a blanket placed over the head.
Biting the attendants may be prevented by applying a muzzle,
.)
(i
d
Fic. 7-—The Side Bar.
20 MEANS OF RESTRAINT.
and he may be protected from his own teeth by the use of the
cradle (Fig. 60) or beads, or the side bar (Fig. TAB). With the
cradle around his neck, the horse is prevented from carrying his
head on either side ; its use, however, must be carefully watched
lest the friction of the cord, which secures it in place upon the
superior border of the neck, should cause severe complications by
chafing or even cutting through the skin. Peuch and Toussaint
have reported one case of fatal tetanus from this cause, but no
such accident ought ever to occur, for the means by which it may
be avoided are easy and obvious, protecting the border of the
neck with pads. The side bar prevents the flexure of the neck
toward the side upon which it is placed, and when in use during
an operation is applied on the side occupied by the operator.
It is used both singly (on one side only), and doubly (on both
sides).
The danger of accidents arising from the unrestrained mobility
of the head of the animal being thus guarded against, those which
may be caused by striking and kicking with the feet are next to
be considered. In many instances it may be sufficient to simply
raise the foot from the ground, and to keep it thus suspended by
holding the leg in a position of flexure (Fig. 6).
No violent measures are necessary in order to obtain such con-
trol over the movements of the horse as are consequent upon com-
pelling him to support his weight on three legs only. The method
of raising the foot and keeping it off the ground is a matter too
familiar to every stable hand to need detailed instructions. But
a little art may be necessary, with a little compulsion added, to
induce him to continue to sustain the role of a tripod long enough
for the purpose of the operator. But this cannot always be de-
pended on, and therefore when he betrays an evident unwilling-
ness to submit quietly to such a confinement of the foot, the com-
pulsion of the ropes or straps must be resorted to. For the fore
lee the strap is attached below the fetlock and passed around the
forearm, and either buckled or held in place by an assistant.
When the rope is used it is passed around the coronet, the leg
flexed and the rope either passed round the forearm and secured
in the same manner as the strap, or thrown over the withers and
held by an assistant on the opposite side of the horse. For the
hind legs the rope, plaited rope or plate-longe, is necessary witl
the hobble. These are applied in different ways.
SECURING SOLIPEDS. 21
OA hte
oy
Fic. 7a.—Plaited Rope.
In the first method a hobble is placed on the coronet of the
foot to be raised, with the buckle outward, and the ring looking
backward; then a loop made at the flat end of the plate-longe is
Fic. 8.—_Securing the Hind Foot with Rope and Hobble.
passed around the neck; the rope is then carried along the back,
and with a single turn around the tail, is passed through the ring
of the hobble, from within outward. Pulling on the rope raises
the foot and carries it backward, where it is held by the assistant.
Second.—Sometimes the hobble is dispensed with, and the
rope is passed from the neck straight to the coronet, where a
double twist is made, and the foot controlled as before (Fig. 9).
Third.—In other cases, the plate-longe is secured to the tail,
instead of around the neck, conditioned of course upon whether
the tail is sufficiently long and furnished with hair of the strength
22 MEANS OF RESTRAINT.
Fig, 9.—Securing one Hind Leg with Rope only.
necessary. When matters are favorable in this respect, the
operator proceeds as follows: a loop being made at some distance
from one end of the rope, it is laid flat on the top of the tail, close
to its origin, and the short end being twisted around that extrem-
Fra. 10.—A, The Twitch. B, Side Bars. C, Surcingle. D, Securing Hind Foot.
E, Fixing the Rope on the TaiL
SECURING SOLIPEDS. 23
ity with from two to four turns, and the remaining portion passed
through the loop, and the other, or longer portion of the rope,
drawn taut, the knot is tied and the plate-longe thus firmly
secured. As in the two previous methods, by drawing upon the
longer end of the rope the foot can readily be raised and held in
position, either with or without the hobble.
There are occasions, when, although it may not be required
to have the leg and foot held up for the purposes of the opera-
tion, it still becomes necessary to do so in order to prevent the
animal from using his feet as weapons of combat, or to restrain
him from motion.
The plate-longe, and the single or double side-line, with one
or two hobbles, are then put in use, for the purpose of either
raising the leg from the ground and compelling the animal to
stand on three, or again to prevent motion in the posterior biped.
For example, in one case the flat part of the plate-longe is
Fig. 11.—Another Means of Using the Rope.
passed with a loop around the coronet of the leg to be kept steady,
the rope is then carried forward between the fore legs, then on
the side of the neck opposite to that of the leg to which the
plate-longe is fixed, over the withers, back to that side, and twisted
around itself behind the elbows, as it passes between the fore
legs (Fig. 11).
24 MEANS OF RESTRAINT.
Tn other cases a large loop of the plate-longe is thrown over
the neck, and the rope carried back to the coronet of the foot to
Se
; (€ "V2
Fi. 13.—Securing both Hind Legs with Hobbles.
SECURING SOLIPEDS. 25
be secured, and by one or two twists around itself, is brought
- backward, where it is held by an assistant. Sometimes a single
hobble is placed on the coronet, and the rope of this side-line
runs through its eye, which is turned forward (Fig. 12).
To prevent the animal from kicking with both hind legs, a
King hobble, carrying the chain, is put on one leg, and the chain
passed through the eye of another hobble placed on the other
hind leg, and the rope carried forward and secured as in the case
of raising one single foot, viz., between the fore legs, on either
side of the neck, over the withers and then after being twisted
around itself back of the elbow, held by an assistant (Fig. 19). In
some instances a double side-line is used, the loop being thrown
over the neck, and the ropes carried backward, one towards each hind
leg, and passed through the eyes of hobbles placed on them, and
returned forward, where they are secured with a slip-knot to the
loop of the side-line on each side of the neck.
For the same purpose, of securing the two legs of a biped,
whether anterior or posterior, LeGoff has invented a peculiar
apparatus, consisting of a Y-shaped rope, single at one end and
bifurcated at the other, each of the three ends having a running
noose or loop. If the two hind legs are to be secured the loops of
the bifurcated portion are placed on the coronets of these legs,
and the loop of the single portion secured on one of the fore
legs. If on the contrary, the fore legs are to be confined, the
arrangement is simply reversed.
Another excellent method of limiting the movements of the
animal to prevent him from kicking, and keep him quiet, is to take
a plate-longe, and beginning on one of his sides, at the girth, for
example, pass it forward across one forearm, a little below the
elbow, in front of him, on the other side across the other fore-
arm; then backward across the thigh, or a little below it, then
passing it back of the animal, to the first side across the other
thigh, to return to the starting point (Fig. 14). Passing the rope
through the eye of the flat extremity of the plate-longe, the legs can
be comparatively well kept together. To prevent the rope from
dropping too low, it is thrown over the back and secured on
itself on the other side by a knot. This part of the rope over the
back supports the two horizontal portions which run on each side
of the animal and keeps them in place.
This mode of restraint is but a simplification of the apparatus
26 MEANS OF RESTRAINT,
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* af Wi mm ek, — LL
vi
FIG. 14.—Securing all the Legs, with Rope all around the Animal.
invented by Raabe and Lunel—the hippo-lasso (Fig. 15). This
apparatus is called the straight jacket for horses, by the inventors,
and is composed of a strong breast-piece or Dutch collar, and a
breeching, placed over the withers and the croup. The breeching
carries on each side, firmly sewn on, a long strap, and at each
point, B, an iron eyelet. The breast-piece at B, carries also on
each side an iron eyelet, and on the front strap a strong buckle.
To place it in position, the Dutch collar is thrown over the neck
and the breeching laid over his rump. Both straps of this part of
the hippo-lasso are passed forward through the iron eyelet of the
breast-piece at B, back through that of the breeching at B, and
then forward again to be buckled. more or less tightly, at 6. The
length of the strap of the Dutch collar piece which passes over the
neck, and that of the creup, must be regulated in such a manner
that the horizontal position of the lasso is for the fore legs, but
a little below the forearm, and between the stifle and the hock
for the hind legs.
The hippo-lasso is an excellent means of restraint, and may
even be utilized for vicious animals upon which operations would
otherwise be impossible, except by throwing them. In shoeing
SECURING SOLIPEDS. a
Fd. 15.—Hippo-lasso of Raabe & Lunel.
vicious and clipping nervous horses it has given most excellent
results.
Among other varieties of apparatus used for controlling
animals in the standing position, are the various machines known
as stocks or travis. They are of many forms, and consist of heavy
wooden frames, firmly secured in the ground, with peculiar arrange-
ments for supporting the animal in slings, if necessary. They
are padded on the inside, for security against injuries and have on
one of their narrow sides a system of iron bars, against which to
secure the feet when the animal is raised from the ground. The
stock illustrated in Peuch and Toussaint’s work (Fig. 16), will
give a good general idea of one of the most approved forms of this
means of restraint. The stock of E. Winsot (Figs. 17, 17a and
18) is another form, which can be used for securing the animal in
either standing or laying position.
RECUMBENT POSITION.
Notwithstanding the many advantages attending the applica-
tion of the means already described, devised for securing the
immobility in the standing position of animals undergoing sur-
gical treatment, there are circumstances in which their efficiency
becomes wholly lacking. Sometimes it is because of the invincible
restiveness of the animal, but more often because of the serious
nature of the pending operation, which may require for its safe
28 MEANS OF RESTRAINT.
il
je
ii
a
Fic. 16.—The Stock.
performance a degree of deliberation and an amount of dissection
of the most painful character, with which only the most absolute
passivity, if not complete unconsciousness, is compatible. In this
class of cases the recumbent position in the patient becomes sim-
ply an indispensable requirement.
To throw or cast a horse signifies simply to apply the force
necessary to compel or induce him to lie down, and to continue
in that position during the pleasure of the surgeon. The forms —
of compulsion by which the desired result is to be effected are
next to be considered.
It would be improper to construe the word “throwing” as
LE:
SECURING SOLIPEDS.
Pyne
°F
— —_—— Fe
SSS
Fig. 18.—Laying a Horse Down with Winsot’s Stock,
30 MEANS OF RESTRAINT.
literally designating the act of violently casting down, as in a
wrestling match. On the contrary, it must be qualified as refer-
ring to a method of so manipulating the patient and directing his
movements as to bring about a change of posture with all the
appearances of a voluntary act on his part, which indeed it essen-
tially becomes.
The preparation of the ded upon which the animal is thrown,
and of its location, will require some judicious attention from the
surgeon. A convenient place, with sufficient space to allow per-
fect freedom of movement about the patient, such as a large yard,
a barn or an open field will fulfil the requirements. The ground
should be smooth, and, if possible, soft—a pasture lot or farm-
yard, or a manure heap often offering good facilities for the pur-
pose in country practice. In any case it should always be covered
with a layer of straw, sawdust or tan bark of sufficient thickness
to prevent a violent concussion when the patient falls, and ought
to be sufficiently wide to allow him to fall as nearly in its center
as possible. Its dimensions should be approximately from nine
to ten feet square.
An important point in its construction is that it should be free
from any hard foreign substances, such as stones, bones, pieces
of wood or iron, ete., for fear of contusions or other similar lesions
against any parts of the body of the patient.
Several methods are in use for throwing a horse, among which
are the peculiar apparatuses known as the hoddles. The ropes
and the operating tables are also used. The previous preparation
of the animal for. the operation ought not to be forgotten. This
usually consists in a fast of not less than twelve hours, and will
always be found to be a good measure.
A.— Casting with Hobbles.
These are of various kinds. Some are made of leather, others
of rope, but they are all constructed upon the same principle. The
English style, invented by Bracy Clark and afterwards improved,
which are in most general use, present so many advantages in their
facility both of application and removal from the legs after the op-
eration, that we shall limit our consideration to them alone (Fig. 19).
A set is composed of four hobbles, a chain and a spring hook.
Each hobble is formed of two straps of leather of unequal length,
the shortest (a) having attached on one end a strong buckle (7),
SECURING SOLIPEDS. 31
Jl
|
|
—=
=,
i a
Fic. 19.—English Hobbles. A, Hobble Unbuckled. B, King Hobble. C, Hobble in
Position, with Rope through the Eye.
and at the other an iron eyelet, narrow and somewhat elongated
(n), the eyelet of the longest (0) being somewhat square in form (e),
in order to allow the ring (7) to pass through it, and having in its
Fic. 19a,—Self-locking Hobbles of Prof. Barker.
32 MEANS OF RESTRAINT.
length a number of holes to allow it to be buckled with the short
strap. Three of each set are of this construction. The fourth,
which is the main, chief or king hobble, differs from the others
in the form of the iron eyelet of the shortest strap. In this hob-
ble it is made of a peculiar shape, and with a small slot,
through which the chain is passed and secured by a pin-screw
running through it. The chain belonging to this set measures
four or five feet in length, and has spliced at one end a casting
rope some fifteen feet long. At the other end the link of the
chain is flattened and made to slip easily through the slot of the
main hobble.
A
Fig. 20.—Spring and String-Hooks,
There are many forms of spring-hooks used. In our own
practice we use two strong spring padlocks, as being of easier
application and less liable to liberate the animal by becoming
loosened or breaking.
Besides the set of hobbles, a long plate-longe and a Bernardot
& Buttel apparatus are necessary. This consists of a wide and
strong surcingle, having on both sides two straps, joined together
in front, and a strong halter, which from the nose-band carries
another strap, which passes in front of the head, between the ears,
through an iron ring on the pole-band of the halter, and is to be
buckled to the single strap of the surcingle. By shortening this
strap, the head and neck are placed and kept in as much exten-
sion as may be desired.
Preliminaries being completed and instruments ascertained to
be in-efficient condition, the horse is placed at the side of the bed;
and we may here repeat that the manipulations which are next to
succeed are not designed to throw him off his feet with a violent
SECURING SOLIPEDS. - 30
Fic. 21.—Bernardot & Buttel Apparatus.
shock, but simply to place him in a posture of such discomfort,
and so to disturb the center of gravity that lying down becomes
an instinctive act, and is done voluntarily, in order to avoid the
act of falling ; it may be termed a voluntary compulsion.
When brought to the bed, a cap is placed over his head, and
all the hobbles are applied, simultaneously if possible, by four
assistants acting in concert. They should carefully observe that
the large buckle of each hobble is placed on the outside of the
leg, and that the eyes of the straps are turned toward the center
of gravity of the animal, those of the front hobbles looking back-
ward, and those of the hinder hobbles looking forward. The
chief hobble must be placed on the fore or hind leg of the side
opposite to that on which the animal is to lie.
The application of the hobbles on a timid and restive horse is
not always an easy matter. Remembering, perhaps, some similar
experience at some former period, he rebels, resists and kicks as
a natural consequence. If speaking soothingly and kindly, and
employing the usual tranquilizing and assuring processes, with
the raising of one of the fore feet, fails to quiet and control him,
a twitch is placed on his nose and left on until, at a preconcerted
moment, the hobbles are put in place; quickly, but as noiselessly
as possible, the chain is passed through the ring of the chief hob-
_ ble—on, say the fore leg for facility of description—then through
the ring of the other fore leg, back to the ring of the hind leg of
34° MEANS OF RESTRAINT.
the same side, through the ring of the other hind leg, and back
to the slot of the main hobble, where it is secured by the pin-
screw. The Bernardot & Buttel apparatus is then put in place
and buckled by an assistant, with the surcingle on the side of the
patient opposite to that on which he is to be made to lie. Previ-
ous to this, another assistant will have passed a long rope around
the body of the animal a little back of the withers, and with still
another holds it on what will be the wnder side when the patient
lies down. Still another assistant is placed at his head, to aid the
one who holds it, while yet another grasps the tail, and two others
seize the casting rope.
The second step of the operation is to reduce the animal's
base of support as much as possible, by bringing the four feet
together. To do this, the operator, standing in front of the as-
sistants who hold the casting rope, has each hind leg in succession
raised slightly from the ground and carried forward by the assist-
ant having it in charge, a gentle traction being made at the same
time upon the casting rope, in order to shorten the length of the
chain passing through the hobbles, the assistants at the head
meanwhile gently backing the animal still more to reduce his area
of support, until the equilibrium is so nearly lost that the animal
ie SM
Ae
| ay Dy
= SSA
SSS : Sf / WH
= = = = . a SF
aaa es Me y fh > =| ES
= =2 = S\N : , y yy 5 7 - SS
Fig. 22.—Horse about to be Cast.
SECURING SOLIPEDS. 35
instinctively abandons the effort to keep his feet, and assumes the
recumbent posture in order to avoid the shock of a heavy fall.
H. Bouley recommends that the first movement in this final
step should be an attempt to back the horse, in order to move the
fore legs first, and then to bring the hind legs forward, if the base
of support is still too broad. The twitch should now be removed ;
in fact, the most prudent plan would be to remove it the moment
the hobbles are in place
The final step of the act of literal throwing or casting beng
accomplished, the last indication remaining to be fulfilled is to
secure the patient in the most favorable position for the surgeon
to perform the important work of which all that has been under-
taken has been but preliminary. It is properly the permanent
(for the time being) adjustment of the body in such a manner as
to allow the surgeon the best possible access for all his manipula-
tions to the region which is to be the seat of his dissections
and other operative movements, without any unsteadiness or
opposition.
Bouley’s directions for this purpose are that the operator,
watching for the right moment, as the horse begins to totter,
gives orders to the assistants having charge of the ropes acting
on the body, the tail and the head, by a prompt and simultaneous
action, to pull in the direction of the side on which the animal is
to lie, and to those at the casting rope’to pull firmly but not
harshly in the opposite direction, while he himself pushes the
body of the animal towards the bed. By this arrangement of
opposing tractions the casting is easily effected; but unless the
assistants act in perfect concert, and especially if the casting rope
be drawn too rapidly and suddenly, the animal will be raised from
the ground with a sudden lift, to fall so heavily on the bed as to
possibly subject him to the risk of sustaining severe injuries.
Bouley remarks on this point: “An animal is properly cast
only when, bending his knees, he lies down softly and easily on
his side, bringing to the ground successively the shoulder, the
ribs and the hind quarters; or again when, the fall beginning
from behind, the order is exactly reversed.”
Once down, the forcible traction upon the chain brings the
four legs in close proximity, the spring hooks or padlock passing
through the link nearest to the ring of the hobble through which
the chain passes, coming out last. To provide against the possi-
C5 Mt ven eo
a fey dee
3 oie
36 MEANS OF RESTRAINT.
ble breaking of that portion of the chain which embraces the four
hobbles, Peuch & Toussaint advise the passing of the casting rope
and chain a second time through the rings of every hobble before
it is secured with the spring hooks. The animal being down, the |
straps of the Bernardot & Buttel apparatus are buckled, and the
head well extended on the neck. The use of this apparatus con-
siderably diminishes the difficulties involved in the contention of
the head. Before its introduction, two assistants were required
to keep it in extension and comparatively motionless; and even
then the results were not always easily reached nor accidents
avoided, whereas, with this halter and surcingle arrangement a
single strong assistant is sufficient to secure control of the head;
“
=
Pr
pt
(i
Fig. 23.—Horse Thrown and Secured by Bernardot & Buttel Apparatus,
SECURING SOLIPEDS. 37
and it has the advantage, besides, of “ preventing fractures of the
vertebral column, rupture of the diaphragm, and rupture of in-
ternal viscera.”
In some exceptional cases the surgeon will be obliged to im-
provise his hobbles. This may be done by fastening four ropes
of suitable length around the coronets, allowing sufficient room
- for the passage of the casting rope between the hobbles and the
skin, or again placing an iron ring through these loops of rope,
which are secured by a knot on the outside of the leg, as suggest-
ed by Mr. Dneubourg.
The removal of the hobbles and of the other apparatus em-
ployed in casting the animal, demands similar care and attention
to that which was required to put them on. While the Bernardot
& Buttel surcingle is unbuckled, the assistant loosening the
Fig. 24.—Improved Hobbles of Dneubourg.
straps of the cap, and ready to remove it at a moment’s notice,
the operator placing himself facing the soles of the feet, in order
to be out of danger, cautiously unscrews the screw-pin which
fastens the chain to the principal hobble, and removes it, when all
the hobbles becoming loose, are removed, and the animal being
freed from all restraint, is allowed to rise.
While the animal is rising it will be but prudent in the by-
standers to allow him all the scope he may choose. The action is
sudden and somewhat violent, and he may move his hind legs
38 MEANS OF RESTRAINT.
with a sudden jerk which may throw the hobbles off with force suf-
ficient to severely hurt some unguarded spectator upon whose per-
son they might infringe. We have been witness to such an oc-
currence, when they were thrown a distance of twenty feet, with
violence sufficient to inflict, possibly, dangerous injuries.
An animal thrown and secured as has been described is in a
suitable position for the majority of operations, such as those
about the head and neck, of the body, or of the upper part of the
legs. Butin many cases, it is necessary to fix a leg in a peculiar
position either to expose a given region of the body, or when
the limb itself becomes the seat of operation. The action of se-
curing the animal in the recumbent position is one of great im-_
portance, and none of its details ought to be overlooked. And
there are several points to which we have already referred in our
introduction, which may be again noticed with advantage. Bear-
ing in mind the accidents which may result from keeping the
horse in a state of painful passivity, and his instinctive struggles
to free himself, not to mention the painfulness of the constrained
posture itself, the inference is palpable that it is incumbent on the
surgeon to release the suffering patient from his trying constraint
at the earliest moment consistent with the proper completion of
the operation. Again, in securing the legs, care must also be
taken that, although a given position of a leg may facilitate the
movements of the operator, it is not justifiable if there is another
mode of securing the same object by means more comfortable
and less dangerous to the patient, as well as easier for the surgeon.
An experience of many years has taught us that six principal
modes of fixing an animal’s leg, fulfil all necessary requirements,
and that the special purposes and effects of these are such as to
forbid their modification.
In considering these six specific modes, it will promote facility
of description if the reader will follow our references to the dif-
ferent legs on a sort of mental diagram which by a mode of ab-
breviation by initials will designate—supposing the animal to be
thrown on the near side—the near anterior as N.A.; the off
anterior as O.A.; the near hind as N.H.; and the off hind as O.H.
First position—Exposing the inside of the N.A. leg.—A loop
of the plate-longe is secured on one of the fore legs, above the
knee, say the off leg, carried in front of the near leg, under it,
back and between the fore legs, always above the knee, to return
i
Te S 2,
SECURING SOLIPEDS. 39
Fic. 25.—1st Position. Neurotomy.
to the starting point, around the off leg again, back to and be-
tween the legs, thus forming a complete figure 8. This is re-
peated twice or three times, when a turn around all the crossings
of the rope between the legs ties up all the twists of the rope and
a double slip-knot is made on the forearm of the off fore leg.
Both legs thus secured, the near leg is released from the hobble,
and carried forward by an assistant pulling on it with a rope tied
around the foot.
For reasons already stated, we consider this position as the
only one justifiable for neurotomy on the inside of the off leg, or
for tenotomy. Firing on the inside of the coronet for ringbone,
or along the tendons, might also be performed in this position.
Second position—Securing the off fore on the off hind leg.—The
loop of the plate-longe is placed on the O.A. leg about the middle
i)
mth y
NTHEAHCHHLAAN
Yiyveree '
FIG. 26.—2d Position. 1st Step.
40 MEANS OF RESTRAINT.
of the cannon region, from there carried backwards over the O.H.
leg, above the hock, between both hind legs, and forward, be-
tween the fore legs and reflected back over the forearm, about
its middle, when it is given to an assistant stationed at the back
of the animal. An assistant is placed in front of the animal,
kneeling on the bed, and prevents the rope which passes in front
and over the forearm from slipping down too rapidly. The leg
being released from the hobble, the operator holding it carries it
backward, while the assistant at the back pulls slowly but
steadily on the rope, the action of this lever of the first kind,
with its fulcrum on the O.H. leg, the resisting power at the foot
of the animal and the moving power at the forearm of the off,
moves and draws the leg backward until it reaches the cannon
bone of the hind leg. At that moment, steadily holding every-
thing in place, the rope that is passing above the hock on the
near hind leg is allowed, cautiously, to slip below the hock, and
the near fore leg is then brought to the middle of the near hind
cannon bone, where it is secured with a double figure 8. Other sur-
geons secure the fore leg above the hock as in the plate we borrow
from Peuch and Toussaint (Fig. 27). The danger of injury to
the tendo-Achilles has caused us to change that position to the one
ey (|
SSS =
Ss : =
——— ———
SSS 2 = —S==
SSS === ———
— S —— De:
Fig. 27.2d Position. 2d Step.
SECURING SOLIPEDS. 41
above described. In this position the inside of the N.A. leg is ex-
posed, and it can be fired, either for disease of the knee or of the
tendons and burs. All operations upon the foot of the O.A. can
be performed except those required on the inside of that foot,
such as those for inside quarter-crack, complicated suppurating
corn or inside cartilaginous quittor.
Fig. 28.—3d Position. Securing Upper Hind to Upper Fore Leg. ,
Third position.—Securing the off hind upon the corresponding
fore leg.—In this the rope is first secured in the middle of the off
hind cannon region, carried forward and over the forearm, above
the knee, in front of the forearm, back between the fore legs,
between the hind legs and over the near hind leg, above the
hock, to the assistant stationed at the back of the animal. Re-
moving the leg from the hobble, and pulling on the rope the
near hind leg is brought, by the same method, to the middle of
the off fore cannon, where it is secured witha figure eight twist of
the rope. In this operation the inside of the near hind leg is ex-
posed from the hock down, and in that position, operations on the
inside of the hock can be performed, such as firing for spavin,
thorough-pins, curbs, and cunean tenotomy, as well as firmg on
the inside of the tendons, or even tenotomy. As far as the off
hind leg is concerned, only operations on the foot are justified,
with the exception of those on the inside of that part of the leg.
Fourth position—Securing the near fore on the off hind leg.—
The rope is secured by a loop on the middle of the cannon of the
near fore leg, which rests directly on the bed, carried backward
over the off hind leg above the hock, back between the hind legs,
42 MEANS OF RESTRAINT.
Fic. 29.—4th Position. Securing Under Fore on Upper Hind Leg.
forward wnder the forearm of the near fore leg, between the
fore legs and back to the assistant at the back of the animal. In
this action it again becomes a lever of the first kind, with the
fulerums above the hock, the resistance at the lower part of the
near fore leg and the moving power at the forearm. The leg is
drawn from its deep position to a superficial one, and secured
with a figure eight on the middle of the near hind cannon, and
not above the hock, for reasons already considered. This posi-
tion is only justifiable for operations on the inside of the near
fore foot, such as complicated quarter-crack, complicated suppu-
rative corns, inside cartilaginous quittor, and the like. The pe-
culiar awkwardness of this position, in which the leg is carried
in excessive adduction subjects the animal to the danger of severe
SECURING SOLIPEDS. 43
lesions in the axillary region, and it is justifiable only in the cases
specified.
Fifth position—Securing the near hind on the cannon of the
off fore leg.—The rope is first tied up by a loop on the middle of
the near hind cannon bone, forward over the forearm of the off
fore leg, between the fore legs, and back to under the near hind
leg, between the hind legs and to the back of the animal, where it is
held by an assistant. The legis again drawn from under hin, is
steadily brought to below the knee of the off forearm and secured
as in the other positions. In this position the only operations
to be performed are those on the inside of the digital region, or
rather of the foot of that leg.
FIG. 31.—6th Position.
Sixth position—Securing the off hind leg near the neck or
shoulder of that side of the body.—The rope is tied up by a loop
around the coronet of the off hind leg, that is below the fetlock,
carried forward toward the superior border of the neck, under
the neck and then toward the inferior border of that region, back
over the whole length of the animal to the front of the hind legs,
between these and over the tibial region of the off hind leg, where
an assistant holds it to the back. Other assistants, pulling on
the rope, and making it slide as it passes on the borders of the neck,
44 MEANS OF RESTRAINT.
the operator carries the leg forward until it reaches the outside sur-
face of the shoulder, or the lateral parts of the neck, where the rope
is secured by a double twist and knot around the coronet of the
near hind leg displaced. This awkward and painful position is
for operations in the inguinal region, including castration, in-
guinal hernia, removal of champignon, amputation of the penis,
or remoyal of tumors.
When the operations which have necessitated these various
positions have been completed, the leg which has been restrained
should be returned into its proper hobble, and this should be
done slowly and carefully, avoiding any unnecessary motions or
noises, and the animal relieved of his means of restraint as in all
other operations.
Fic. 32.—Side Bar Hobbles,
In a few instances, however, aside from these various
modes of securing individuals, the surgeon has recourse to
the side bar hobbles, which carries a hobble of its own at each
end, one hobble being fixed on a fore, the other on a hind leg.
Some of the English veterinarians are using the cross hobbles,
Fic. 33.—Cross Hobbles.
which has the advantage of being adapted for use upon legs
diametrically opposite, such as the near fore and the off hind legs,
and vice versa.
B.— Casting with ropes.
The hobbles are not the only kind of apparatus devised
for throwing horses, nor are they all made according to the
English pattern, although the same general principles pre-
vail in all. Ropes in the form of side lines, either single or
SECURING SOLIPEDS. 45
double, are often substituted for hobbles, and for many varieties of
these special claims are made by their inventors, or by those who give
them their preference, and use them in their practice. Without
entering into the consideration of the comparative merits of these
various methods, which vary, not only in nearly every country of
the world, but even in different sections of the same country,
there is a mode of their application, upon which we have a word
of comment to offer. This is the mode with a single, and that
with a double rope.
(Ist.) With a single rope.—This is the simpiest mode of
casting, but it is also the least safe. It is the oldest of the
methods in use, but has in our days been more or less modified
and improved. The method of Rohard seems to be as perfect as
any of them. In this, a rope from twenty to twenty-five feet in
length is necessary. The horse being placed near the bed where
he is to be thrown, is held in the ordinary manner. [If he is tolie
on the near side, the operator is placed on the right, near the
shoulder with the rope, in which is a knot about six feet from its
end, which Rohard calls the ring knot (a), and immediately below
it is another, called the stopping knot (b), through which the rope
will run. “In this way,” says Rohard, “there is a large loop
i; "WY
), Vi.
°
1
SS a=
:
a / = Ss
SS SS
eas = ae
Fle. 34.—Application of the Rohard Method.
46 MEANS OF RESTRAINT.
formed, which is thrown over the neck, while both knots made
lie a litile below the point of the shoulder.” Taking with the free
portion of the rope, a twist round both forearms, passing behind
them first, then forward across the near fore leg, in front of both
fore legs, and backward across the off fore leg, over the rope, it
is carried across the abdomen, to the near hind coronet, which it
surrounds from without inwards, to be brought back to the
posterior part of the withers on the near side, where the operator
takes hold of it. Then by degrees slowly pulling on the rope, 4
and making the animal raise his near hind leg by quietly urging 4
him, this leg is carried forward, with a uniform movement, until
at one moment, the animal attempting to resist or struggle, —
the assistant at the head carries it toward the bed, the operator
pressing with his body against that of the animal, until he slowly
settles down without injury on his side. To fix the leg definitely,
NG
Ce on \
ant “i ee \ y
, Z =
ee Bas EG —
fe SS aS
EP \ of
eer
Frag. 35.—Animal Secured by the Rohard Method.
one begins by the near hind leg. Making a double twist of the
rope around the coronet of that leg, this is carried towards the
loop which passes around the neck, and is there secured by a
double knot (a), and carried back to the off hind leg, which is then
carried far forward and secured to the same collar loop, with a
single knot (2). To release the animal, it is merely necessary to
untie the stopping knot, when the rope becomes loosened from
the legs.
SECURING SOLIPEDS. 47
(2d.) With double side lines, or two ropes.—Thisis dene by means
of a long rope, doubled in its middle, and having a knot made in
such away as to form a loop large enough to be drawn over the
head and neck of the animal; the two ends below the knot are
then passed in front of the chest and between the fore legs,
carried, one to each hind leg, around the coronet, turning it once
around the main rope, and passed on the collar loop from within
outwards, to strong assistants standing on each side of the
animal. By steady pulling both hind legs are carried forward,
until the animal loses his balance and settles on his haunches,
when a strong effort of the assistant at the head brings him down
on the bed. The hind legs are secured to the collar loop with
the ends of the rope, and the fore to the hind legs in the same
manner.
The various methods of casting which we have been consider-
ing, with hobbles and with ropes are, as we have before said, not
the only plans recommended. Almost every country «f Europe,
while also using the hobbles, has a fashion of its own in which the
ropes are utilized, and as to the fact of their widespread, if not
universal use, it would seem that not a few veterinarians of exten-
sive practice have originated and employed special methods of
their own devising, for which they claim more or less superiority.
Among those recommended in this country, we may mention the
apparatus of Mr. Miles, which he has used for years in his exten-
sive practice as castrator. Dr. Wm. Dougherty, of Baltimore, has
sent us a set of rope-hobbles and side-line, which upon personally
testing we are able to recommend as possessing important points
of excellence, especially in casting young colts for castration. For
further ight and broader information on this subject we must
refer our readers to the standard authors by whom it has been
discussed in the French, German, Danish and Russian tongues,
feeling at the same time quite confident that the general rules
which we have suggested and illustrated for the performance of
the operation of casting are sufficient to guide any intelligent
operator through all the steps of the proceedings.
C.—Casting on the Operating Table.
The necessity of employing such a number of assistants in
throwing a horse, with the difficulties often encountered in con-
ducting all the steps of the operation, and the accidents which
48 MEANS OF RESTRAINT.
too often accompany its execution, have led to the invention of
other means of accomplishing the object in which the objections
to the old method are sought to be obviated. It was with this view
that the operating-beds of Lafosse in France and Hart in Wurtem-
i
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Fic. 36.—Wall-bed of Fromage de Feugré
burg were contrived. The wall-bed of Fromage de Feugré pos-
sessed many advantages, but was abandoned on account of its
complicated structure. Of late years, however, several other
forms of operating tables have been devised, of which one espe-
cially is highly commended by European authors. It is that of Mr.
J. Daviau which consists of a broad and heavy table, furnished with
pads, surcingles, hobbles, ropes and other necessary appurten-
ances for securing the animal, and which is moved by a peculiar
crank arrangement which permits its adjustment in any required
position, from the horizontal to the vertical, and by which it may
be turned down flat upon an iron frame. The apparatus is placed
solidly on the ground, or can be made movable by a set of low
wheels attached to the heayy wooden frame upon which the table
and the crank are supported.
Mr. Daviau claims for his invention: 1st. That it obviates “all
the complications” accompanying the ordinary system of throw-
ing. 2d. It allows “the easy and comfortable rising of the horse”
after the operation, without danger. 3d. It gives entire security
to the operator, who can perform his task alone and without the
Fee,
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SECURING SOLIPEDS.
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49
Full Back View.
Fia. 37.—Daviau’s Table.
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SECURING SOLIPEDS,
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Back View; showing the working of pulley to
draw the table down.
MEANS OF RESTRAINT.
Fie. 40.—Hodgson & Magee’s Table.
52
SECURING SOLIPEDS. 53
need of assistant. 4th. No assistants are needed to be exposed
to danger, and the responsibility of the operator is diminished.
5th. Economy of time. 6th. Economy of material and space for
the performance of the ordinary operation of casting.
In this country several forms of tables are in use. Those of
Dr. Tiffany, Price and others, all of which are constructed somewhat
upon the same principles with respect to the action of an iron
crank to control the position of the table. Doctors Hodgson &
Magee, both veterinarians of New York, have invented a table which
for simplicity seems to surpass any one we have yet seen (Fig. 40).
Like the others, it has slings, ropes, hobbles, pads, etc., but dif-
fers from them in two important particulars. The first is the
manner in which the table is lowered and raised ; the second, the
manner in which the hobbles are secured and made immovable.
In the middle of the superior border of the table, and directly
below it on the posterior face, are two solid iron rings. In the
ceiling of the operating room, or on the cross-piece of the frame
in which it is enclosed, and directly opposite that in the border of
the table there is another. Another is fixed in the floor some dis-
tance back of the frame upon which the table rests when in a
horizontal position. To these rings two systems of pulleys are
attached, one connecting that in the ceiling with that in the bor-
der of the table ; the other connecting the ring on the posterior
face of the table with that in the floor. Besides this, under the
table are two strong iron eyelets through which chains are passed,
which at one end are secured to the hobbles by openings through
the table, and at the other are secured from slipping through the
ring by a wide T arrangement, secured on the last link. These
chains measure the distance which exists between the rings on the
floor and the table when in a horizontal position.
When the horse is brought alongside the table and tied up
with the slings, the halters and head-straps securing him, and the
hobbles being in place, the rope of the upper pulley is pulled by
an assistant, and the table moved slowly into the proper position.
The rope being then fastened to the ring in the floor, the table is
immovable. Upon the completion of the operation the rope is
gradually slackened, while an assistant pulls on the rope of the
base of the table which is thus restored to the vertical position.
54 MEANS OF RESTRAINT.
MEANS OF SECURING OTHER DOMESTIC ANIMALS.
(a) Bovines.—With these animals benignant measures are of
little avail. Kindness may in some possible cases—but they will
be rarely met with—succeed to a limited extent, but to trust to
the influence of the treatment so often effective with an intelligent
and docile equine, such as the petting caress, the soothing tone
of voice, or the kindly glance of a human eye, with even the placid
and mild-eyed milch kine, will be only an act of misplaced con-
fidence. To blind them, to induce dizziness by turning them
rapidly in a small circle, may at times produce good results, but
even then these measures will be more reliable if combined with
more palpable agents of restraint.
Cattle may be kept quiet in the standing position by raising
their heads, by passing the index finger and thumb of one hand
into the nostrils, with the arm over the face, and raising the tip
of the head upward, while the other hand, grasping one of the
horns, moyes the top of the head downward, the resistance of the
animal being overcome by pinching the nose with the hand which
grasps it with more or less force. By this means the head of the
animal is fixed, and the operator guarded against injury from the
horns, and the movements more or less limited. While maintain-
ing this position, the cavity of the mouth can be examined and
even short and simple operations rapidly performed. Another
device for preventing the animal from using his horns as a means
ri Waim L2Ay Wy
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SECURING OTHER DOMESTIC ANIMALS. 55
of contention is to tie along rope around their base, passing it
along the neck and the back with one loop around the ribs and
another further back around the flanks, and when reaching the
tail securing it there by a knot at the base of that member. The
head is thus kept elevated, and he is restrained from motion by
the pain experienced by the tail when the rope is tightened by his
attempt to flex it. This assures his passiveness (Fig. 42).
The practice of shielding the sharp points of the horns with
smooth, metallic balls is one which tends largely to diminish the
power of the animal for doing harm, by obviating to a great ex-
tent the danger from punctured wounds to which those who han-
dle them are exposed. The best mode, however, of securing cat-
tle while standing, is by tying the head up to a post or a tree, or
again by yoking an individual with his mate or another animal of
the same species. Kicks must also be guarded against. Those
by the fore legs are avoided by raising one foot and tying it on
the forearm, thus compelling the animal to stand on three legs.
But the hind legs of cattle are the most dangerous from their
ability to kick in so many directions, whether backward, forward
or outward.
Several methods are recommended by which to guard against
this form of danger. Among these may be mentioned the passing
of the tail forward between the hind legs and then outward, car-
rying it towards the stifle of the leg from which the kick may pro-
ceed, and holding it firmly with a backward pull; thus surround-
“ty *
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56 MEANS OF RESTRAINT.
ing or tying the leg with the tail. Again, to pass a twitch round the
leg above the hock, and to turn it until the tendo-Achilles pressed
upon, is brought in contact with the posterior face of theleg. A
loop of rope twisted upon a stick will answer the same purpose.
The use of hobbles, single or double, or of the side lines to secure
the hind legs, has also been recommended, as with solipeds, with
the difference that the horns furnish a strong means of support,
which is entirely lacking in the soliped. A method approved by
some of controlling the motion of the animal is to pass a rope on
one hind leg above the fetlock, and to carry this leg well forward,
or even to raise it from the ground and to tie it by the rope to the
forearm of the same side above the knee or around the horns. The
use of a long bar of wood held under the abdomen by two assist-
ants in front of the stifles ; keeping the animal pressed against a
wall by means of a wooden bar, with which an assistant pushes
firmly against the stifle of the side opposite to that upon which
the operator stands ; binding the animal against a wall with a rope
fixed to a ring in front of the chest and one behind the hind quar-
ters—all these are simple means employed to keep cattle quiet in
the standing position.
Some individuals, however, and especially bulls, are altogether
intractable, and require more severe and effectual modes of pun-
ishment. These are applied upon the muzzle of the animal in his
nasal septum by nippers or clamps, or with rings. Nippers are
of divers forms. One true, single clamp is commonly used in
Italy, and has been modified in England; another is in use in Hol-
Fic. 43.—Italian Fic. 44.—Modified Figs. 45 A and B.—Modified English
Nose Clamp, English Nose Clamp « Nose Clamps.
SECURING OTHER DOMESTIC ANIMALS. ow
land, which is a true screw-clamp ; another, which is preferred in
France—are a few among the varieties of this single instrument
for the application of pressure upon the septum nasi. They are
generally secured on the front of the face by ropes or straps.
They are effectual appliances, and by their aid the head can be
kept up and the animal controlled without difficulty. Among the
rings the simplest are most commonly in use. They are made in
two parts, articulated at one extremity, and united at the other
when in place by a rivet or screw. They vary much both in form
and size. Some (though still known as rings) are square; others
Fic. 46.—Square (?) Rings for Cattle,
are round and elliptical. The ring of Rolland, the Alsace ring, and
some of simpler construction carry an auxiliary ring at some part
of their circumference with which to secure them on the-face of the
animal by means of ropes or straps. These rings are applied after
the perforation of the nasal septum with a trocar or a punch-nip-
pers, making an opening of a size corresponding to that of the
ring. Sometimes the perforation is made with a hot iron, the
Fig. 47.—Ring of Rolland.
animal being properly secured and tied to a tree, or placed in a
yoke with the head elevated, the operator making a quick punc-
ture through the cartilage, and introducing the ring and riveting
it. The hemorrhage soon ceases spontaneously.
In order to dispense with the punch, trocar, and the puncture
with the hot iron, rings of a special construction have been in-
vented. These also consist of two parts, and are also articulated,
58
MEANS OF RESTRAINT.
\
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Fic. 51.—Rings with Points.
(aX
SECURING OTHER DOMESTIC ANIMALS. 59
one of the joints haying a sharp point with which the ring is
pushed through the cartilage. A simple form represented in
Figure 51 shows the point passing through an eye at the other
extremity of the ring to be bent over it in order to close the in-
strument. The ring used in some parts of France is contrived
Fie. 52.—French Rings,
somewhat on the same plan, but is more complicated. That of
Rueff is a kind of broken circle, which, when closed, forms a per-
fect ring in which the branches are kept together by a small screw.
Fic. 53.—Ring of Rueff.
The rope which is attached to the nasal ring is not always suffi-
cient to drive or control bulls, and conductor sticks armed at the
end with iron hooks of various shapes are recommended, The
apparatus of Vigan is a very simple one, but it fulfils all require-
ments and suffices for the restraint of the most vicious animals.
It consists of a wooden pole with an iron prolongation haying a
wide ring by which to hold it, and at a short distance from this a
hook to be inserted into the nose ring. Back of this is a strap to
secure around the horns the bar over the top of the head as it passes
between the horns. At the other extremity is an iron stifle through
which a surcingle is passed to be tied around the body of the
animal. Painful, and still easy to apply, this apparatus is not
only a powerful means of restraint, but is sufficient to prevent
any motion of the head.
60 MEANS OF RESTRAINT.
SECURING OTHER DOMESTIC ANIMALS, 61
Fic. 56.—Steer Placed in Stock.
The use of stocks for the control of bovines is often also re-
quired. These are used principally in shoeing oxen, but are
available for some operations which require greater passiveness
than can be obtained by the applications of the simpler means
above described. It is only in exceptional cases, and when an
operation is likely to be unusually painful and prolonged, that the
recumbent position is required with bovines.
The casting of cattle may be effected with or without hobbles,
but in either case special care is necessary to provide asufficiently
thick bed to protect the head, and guard against the possible
danger of fracturing the horns. A long board placed transversely
across the neck, with an assistant. seated on each end, affords an
excellent means of controlling his efforts and struggles. When
hobbles are used, they must be of smaller size than those used for
horses, and should be placed above the fetlocks.
To cast bovines without hobbies, either of two methods, one
invented by Rueff of Germany, and another described by Gwell
and Hertwig, will answer the purpose. In the first, the Rueff
method, a rope some thirty-six feet long isrequired, in the middle of
which a loop is made and fixed round the base of the horns. The
two free ends are then passed between the fore and the hind legs,
each being twisted from within outwards, around one of the
coronets, and brought back to the loop at the base of the horns,
through which they are passed to assistants, one on each side,
with directions to pull backwards. The feet are thus brought
close together, and the animal seats himself on his hind quarters,
62 MEANS OF RESTRAINT.
and finally stretches himself on the bed. If he struggles, the
traction on the ropes only expedites the fall. If he pushes for-
ward, or attempts to kick or even only moves his feet, the running
of the rope is so much more facilitated.
In the other mode, a rope about the same length and carrying
in one extremity a loop which is thrown over the horns, is passed
backwards along the superior border of the neck, as far as about
its middle, where a loose loop is made; then carried backwards
at the side of the vertebral column, where another loop is made, be-
hind the shoulders, and a third one around the abdomen, on a level
with the flank, where an assistant holds it backwards by the side
of the sacrum. If the animal is to bethrown on the left side, the
rope must pass on the right of the base of the tail, and vice versa.
Two assistants pull on the rope, while another holds the headand
tries to bring the animal down. The traction on the ropes tight-
ens the three loops, and under the effect of this force the animal
is made to lie down quietly. It facilitates the operation to lubri-
cate the rope with a litile grease or soap.
In order to avoid complications from lacing the ropes too
tightly about the body, itis always indicated to subject the pa-
tient to a moderate fast previous to casting by this mode.
(6) Ovines anp Caprines.—Although these animals are timid
and comparatively lacking in strength, they are at times capable
of struggling violently and becoming dangerous, and they can-
not be subjected to surgical treatment without being cast. Thisis
done by grasping both legs of one lateral biped, the right fore and
hind legs, for instance, and laying him over on the opposite side, the
left, and vice versa. If all the legs are to be secured, those of each
lateral biped are first tied, and with the two cords a straight knot
is made, binding all together. -
If the seat of operation is the head, the animal is held by an
assistant, who sits with the body of the animal between his legs,
with its back close to his own body, holding the fore legs with his
hands, and controlling the hind quarters between his legs. In
some cases when the operation is light, the operator holds the an-
imal himself without help.
(c) Swrne.—Securing a good hold of this animal is not always
an easy task, and it sometimes requires not a little skill and cun-
ning to do so. When seized, two assistants are necessary to cast
him, especially if he is of large size, and when down, either a muz-
SECURING OTHER DOMESTIC ANIMALS. 63
Fig. 57.—Twitch for Swine.
zle must be put on his snout to prevent his biting, or a peculiar
twitch placed between his jaws and twisted over the upper one.
If an examination or operation is to be made about the mouth,
a wooden gag placed between the jaws and held with cords, will
be found of great utility. Thevarious operations performed upon
TO)
Fig. 58.—Gag for Swine.
the noses of swine, to prevent themfrom digging the ground, may
be considered to some extent as means of restraint. The incision
of the snout, which consists in making several transverse cuts
through it; the nasal tenotomy, though not so successful; the
application of rings through the nose, by the same methods as
Fic. 59.—To Prevent Swine from Digging.
«
64 MEANS OF RESTRAINT.
Fic. 59a.—Another Mode.
those used in cattle, are simple means which only need mention, be-
ing more frequently performed in fact by raisers and breeders of
swine, and indeed rather belonging to their special domain than
to that of the professional veterinarian.
Fia. 60.—To Prevent Dogs from Biting.
(7) Does anp Cars.—Dogs can be prevented from biting by
muzzling them, or with a eord or band wrapped first around the
lower jaw, and then around both, and secured over the neck behind
the ears.
To examine the mouth in the absence of a speculum, as the
one represented in Figure 61, the mouth may be held open by
cords passed around each jaw behind their tusks, and pulling
them apart. If the animal is dangerous or ugly, the collar nippers
SECURING OTHER DOMESTIC ANIMALS, — 65
7 =
aa Till
tsar”
Fig. 62.—Keeping the Mouth of a Dog Open.
Fic. 63.—Collar Nippers for Dogs.
become very handy, in order to hold them by the neck and keep
them under control, whether for operation or for administration
of medicines.
Cats are most difficult to handle. They bite and they scratch,
and they are often unconquerable until they are fully subjected to
general anesthesia. In many instances, the co-operation of a good
assistant, accustomed to handling them, may be found necessary.
They may sometimes be madeamenable to treatment by grasping
them by the neck behind the ears, and close to the head with one
hand, and securing the fore paws with the other, while a second
assistant holds the hind legs, or it may become necessary to have
the four paws tied tightly together, and only the head held by the
assistant.
We have heard of the utilization of a man’s boot as a means of
feline restraint, particularly in the castration of the male, or
“Tom,” the head and body of the animal being thrust into the leg
66 MEANS OF RESTRAINT.
of the garment, leaving only the posterior portions exposed and
accessible to the operator. This may not be a scientific device,
but its effectiveness can hardly be doubted.
SURGICAL ANESTHESIA.
A resort to the various means of restraint, which we have been
considering, is sufficient in a majority of cases to bring under
perfect control such animals as require to be subjected to surgi-
cal treatment. But there is a class of cases in which they become
inadequate to meet the great requirements of inducing in the pa-
tient a condition in which a great diminution, or the entire
suspension, of sensibility and consciousness, with all power of
muscular reaction, is established throughout the organism. This
result is obtained through the characteristic action of the special
therapeutical compounds, known as anesthesia.
It is not merely as a more effectual means of securing control
over refractory patients that their administration is justified. Itis
also prompted by a proper humanitarian feeling in cases in which
severe and prolonged suffering accompany the operation.
In veterinary surgery, the indication for anesthesia, has not, to
the same extent as in human, the avoidance of pain in the patient
for its object, and though the duties of the veterinarian include
that of avoiding the infliction of wnnecessary pain as much as
possible, the administration of anesthetic compounds aims prin-
cipally to facilitate the performance of the operation for its own
sake, by depriving the patient of the power of obstructing, and
perhaps even frustrating its execution, to his own detriment, by
the violence of his struggles, and the persistency of his resist-
ance. ‘To prevent these, with their disastrous consequences, is the
prime motive in the induction of the anesthetic state. That it per-
fectly succeeds in fixing the patient in the attitude most favor-
able for the surgeon in the execution of the various parts of his
task, needs no affirmation, nor need we attempt to measure the
value of the discovery, which has proved itself to be such a price-
less benefaction to the world.
There are special cases where anesthesia is more particularly
necessary than in others, and where absolute immobility of the
patient is essential, and entire muscular relaxation indispensable.
Thus it is indicated in the reduction of fractures or dislocations in
SURGICAL ANESTHESIA. 67
the large domestic animals; in cases of delicate manipulation
and dissection with sharp instruments, as in the operation for
strangulated inguinal hernia; in the reduction of other hernial
tumors, in the performance of neurotomy; in operations upon
the eye, and in the removal of tumors of certain kinds. Itis also
indicated in certain operations upon the foot, which are always
accompanied with great pain, such as that for the extirpation of a
portion of the quarter of the foot, in the removal of the cartilage
affected with necrosis (quittor); or again, in deep punctured wounds
of the sole, where the resection of the plantar aponcurosis becomes
necessary, or the bones are scraped with the knife.
The anesthetic condition is also very favorable for the reduc-
tion of displaced organs, as of a prolapsed rectum, or uterus, or
bladder.
In operations upon the teeth, in some cases of parturition,
in castration, in firing, or even in the application of hobbles, the
induction of the anesthetic state has often been of great benefit
in quieting nervous animals, and subduing them to a condition of
passiveness, which relieved the movements of the surgeon from
all embarrassment and uncertainty.
As with human patients, anesthetics are contra-indicated in
animals subject to diseases of the heart or of the lungs. A full
stomach is also always a contra-indication of their administration,
especially in solipeds, which are lacking in the ability to relieve it
of its contents by vomiting.
Anesthesia may be either local or general, according to the
area of its effects. Local, when applied to the skin over a limited
surface, to which its effects are confined ; and general, when ad-
ministered by inhalation, and through the respiratory organs in-
fluencing the entire economy.
In local anesthesia the effects are obtained either by the pulveri-
zation of the proper substance upon the region where it is required
to take effect, or by the subcutaneous injection of special agents.
General anesthesia is usually produced by the inhalation of the
vapors of ether or of chloroform.
LOCAL ANESTHESIA.
The special indications for this are so numerous that they may
almost be considered as general, if not universal, and its applica-
tion is so simple and easy a process, and its effects usually so cer-
68 MEANS OF RESTRAINT.
tain, that it would become the practitioners of our day to utilize
it more frequently and extensively than they do. It is available
as well as useful in the simplest operations, and may be employed
in the opening of abscesses and cysts; in the puncture of cold
abscesses with the hot irons; in the puncture of the cornea; in neu-
rotomy ; in simple incisions of the skin; in the removal of small
tumors, etc., etc. We have used it with the best results in ureth-
rotomy, in caudal myotomy, in amputation of the tail, and the
removal of mammary tumors in dogs, ete. Bouley long ago rec-
ommended its application to surgical diagnosis, in cases of doubt-
ful lameness, an expedient which has recently been introduced into
this country by several veterinarians, for the differential diagnosis
of shoulder and foot lameness.
We have remarked that the anesthesia can be produced in
several ways, though two are principally in use. Among these
properly termed minor and secondary expedients, are the applica-
tion of cold water or ice, and cooling or freezing mixtures, and
pressure upon the blood-vessels and nerves, which have for years
been among the adjunct and agencies of surgical practice, but
have given place in recent times to methods more potent and
more certain in their effects. Notwithstanding this, however,
some mention of their nature and qualities, and the methods of
utilizing them will not be out of place, if only as a matter of gen-
eral reference, and a case might arise in practice when the infor-
mation might become practically valuable.
Ist. Pulverization of an Anesthetic Liquid.—The apparatus
employed for this process is the invention of Dr. Richardson, and
though the spraying tube has been from time to time more or
XQ
Fia. 64.—Richardson Atomizer.
LOCAL ANESTHESIA. 69
less modified, the mode of its employment continues unchanged ;
though any substance susceptible of easy pulverization may be
employed. Ether is the agent most frequently chosen. Rigolene
has given us great satisfaction in our own practice.
In impinging upon the skin ina state of excessive division,
the rapid evaporation of the liquid lowers the temperature of the
surface with which it comes in contact, and it is this process of
refrigeration which diminishes the local sensibility, and, as the
effect increases, overcomes it entirely for the time being, or so
long as the spray continues to be thrown upon the part.
Some slight objections, however, may be alleged against this ©
mode of producing insensibility, arising from the special proper-
ties of the fluid employed, and for this reason the mode by sub-
cutaneous injection is somewhat to be preferred.
2d. Subcutaneous Injections.—Both ether and chloroform
have been recommended, and extensively used, in this manner,
but without doubt the salts or compounds of cocaine possess ad-
Fic. 65.—Syringe of Prayvaz.
vantages over either of them. An epidermic syringe, or that of
Pravaz, is generally used for the purpose, with a solution of from
four to twenty per cent. strength, according to circumstances.
If used on a tumor a certain quantity of the solution, perhaps
twenty drops, is injected under the skin at two or three points
around its circumference, the desired effect following, and the
parts being ready for the operation within from eight to ten
minutes, more or less, according to the strength of the dose
administered. Hither of these modes of local anesthesia is harm-
less, and may be employed without risk or fear of complications.
70 MEANS OF RESTRAINT.
GENERAL ANESTHESIA.
The three principal agents which recommend themselves by
the efficiency and certainty of their action in producing general
anesthesia, are ether, chloroform and chloral hydrate. Their
adaptation varies, however, with the animals subjected to their
administration, Chloroform and chloral are chiefly used for the
larger animals, principally horses, while chloral and ether are re-
served for the smaller kinds, with which chloroform is so
generally dangerous, and even so often fatal, that its use with
them is almost entirely discarded.
Insensibility by Anesthetic Vapors.—The modes adopted for
the inhalation of the vapors of chloroform are numerous, but
among them all the merit of simplicity should probably be award-
ed to that which is recommended by Bouley. This consists in
the introduction into each nostril of a small sponge, or a ball of
oakum, saturated with the ether or chloroform, and held in
place by the hands of assistants. The inhalation of the vapors,
which are thus mixed with air, proceeds rapidly, the sponges
being recharged as soon as they become exhausted, and returned
to the nostril, until the object in view is accomplished. But
while this mode is a very convenient one, we conceive it to be
liable to certain objections.
First, unless the pouring of the liquid is very carefully per-
formed and in such quantity that the sponge is not over-saturated,
there is danger that a large portion of it may be wasted, by run-
ning off, either on the bed, or possibly, into the nostrils, causing,
in the latter case, great irritation of the mucous membrane.
And if the anesthesia is to be continued for a considerable length
of time, the effect produced upon the delicate membrane of the
nose may be sufficiently serious to end in the sloughing of the
parts. It must certainly have been with the view of avoiding
this complication that Defays invented the inhaler shown in
figure 66 with its wide range of application, from the dog to
the horse.
Many veterinarians have adopted an arrangement consisting
of a strong leather muzzle with large openings at its bottom and
sides for the free admission of the atmospheric air, the sponge
or oakum charged with the chloroform or ether being placed in the
bottom of the muzzle, which is fixed upon the animal’s head in the
GENERAL ANESTHESIA. (il
Fig. 66.—Apparatus of Defays.
ordinary way. This is a very convenient, though quite a simple
contrivance, but English veterinarians, and among them Mr. R.
Cox, recommend in preference a chloroform-bag, in the form
of an ordinary bag, made of strong canvas, both ends of which can
be closed by a running string, one being tied around the nose
7
Yi Y fp,
Wiffft
FIG. 67.—Cox’s Chloroform Bag in Position.
while the bag is secured by cords to the halter or to the straps
of the cap. The chloroform is introduced into the bag by means
of a thin piece of cloth saturated with the liquid.
The chloroform nose-cap recommended by Mr. Gresswell also
answers a very good purpose, and in fact, possesses advantages
which render it superior to the apparatus of Mr. Cox. It is not
so portable in its form, but is more durable in its construction.
In fact, it produces the features of the ordinary stable muzzle
which we have already mentioned.
The apparatus of Carlisle is also one of English invention, for
which great merit is claimed. We have used it, and the trial has
shown it to possess many features of marked superiority over the
others.
The quantity of liquid required to bring a large animal under
complete general anesthesia cannot be positively ascertained.
72 MEANS OF RESTRAINT.
n
i)
hy :
: sa
Fic. 68.—Gresswell’s Chloro-
Fic. 69.—Carlisle’s Chloroform Inhaler.
form Nose-Bag.
While it has often been induced by the inhalation of a single
ounce, there are cases in which two, three, or even more have
been necessary. An essential point to consider is that the
chloroform should be absolutely pure. Mixtures of two or more
drugs have also been employed, usually ether and chloroform,
with or without the addition of alcohol, but the result of all ex-
perimental tests has been, with us, to establish the conviction,
that as yet, chloroform used singly has proved itself to be the
most effective and the safest of all. The administration of
chloroform of course pre-supposes, besides all the other conditions
and preliminaries of an operation, such as previous fasting, the
preparation of the bed, and other incidental steps, the act of
throwing the patient. ;
When the effects of the inhalations begin to become manifest,
the first physiological change noticed is an extreme agitation,
accompanied with coughing. The animal struggles more or less
violently, the irritation and tickling of the throat produced by the
vapors upon the laryngeal mucous membrane, giving rise to a
spasmodic motion of the glottis, and whether the patient be a
oe
4
GENERAL ANESTHESIA. fo
large or a small animal, he exerts his strength to rid himself of
the apparatus and regain his freedom of motion.
These manifestations are, however, but of short duration, and
are soon followed by a state of passiveness, the respiration be-
coming easier, the cough disappearing and his energy subsiding ;
and in short, he is subdued. The eye then assumes its character-
istic expression, its brilliancy is lost, it is wide open, the pupils
slowly dilate, the gaze becomes fixed, the sensibility of the cornea
is lost, and the light ceases to effect it. The mouth becomes
more or less loaded with saliva; the pulse, which must be carefully
noted by an assistant, becomes slow and weak, the respiration
returns to its normal condition; the state of complete anesthesia
has been reached, and the patient, in happy unconsciousness, is
ready for the surgeon.
The time required to reach this condition varies with the sub-
ject, and especially with the quality of the drug administered. The
average period is from one to five minutes in small animals, and
from ten to fifteen in the large. In some few cases, however, half
an hour may elapse before complete insensibility is produced, and
again animals are encountered with peculiar idiosyncrasies, which
remain entirely refractory, and successfully resist every attempt
to reduce them to insensibility; a statement equally true when
applied to human patients.
The duration of the Anesthesia.—Some animals remaining
under the influence only for a few minutes, sometimes from fifteen
to thirty or forty, it becomes necessary to prolong the insensibil-
ity by renewing the inhalation, and they must, therefore, be con-
tinued until the completion of the operation. Recovery from the
anesthetic state does not always take place immediately and per-
fectly. As the effect begins to subside, the animal, having parti-
ally regained his senses, begins to move his eyes, raises his head,
perhaps allows it to fall back slowly on the bed, lying flat on his
broadside ; then his legs begin to move, and presently he attempts
to spring suddenly to his feet. He may succeed in doing so, but
again, his muscles may not have yet recuperated their power of
full action, and there may be danger of his experiencing a heavy
fall on the bed. His condition is one of drunkenness, and he re-
quires to be watched, and, if necessary, aided, in order to prevent
him from injuring himself by efforts beyond his strength while
in a state of weakness of which he is unaware.
74 MEANS OF RESTRAINT.
The symptoms of general anesthesia by chloroform, which we
have detailed, are those of ordinary cases. There are, however,
other symptoms which the vigilant operator will not fail to look
for, which are of great importance as indicative of the dangers,
and premonitory of some of the casualties incident to the situ-
ation. These we reserve for subsequent consideration.
Anesthesia by the Administration of Chloral.— While this
drug and its compounds, as sometimes used, produces in some
cases a condition of insensibility quite as complete as that ob-
tained by chloroform or ether, yet there are cases in which only a
less complete degree of success can be secured, though still suffi-
cient to be of great assistance to the surgeon as well as of relief
to the patient. That the intra-venous injection of chloral has been
shown to be the best of all modes of obtaining anesthesia, is an
admitted truth, but unfortunately it is a method of introducing it
into the system which will scarcely ever become sufficiently prac-
ticable to be available outside of the laboratory. Efforts to over-
come the difficulty referred to have not been wanting, however,
and Messrs. Cadeac and Mallet have experimented with chloral by
combining its action with that of muriate of morphine. By first
injecting subcutaneously a certain quantity of a solution of mor-
phine, and following it after a few minutes by a rectal injection
of a solution of chloral, they have obtained complete anesthesia
in a very short time. Fora horse they have used eighty centi-
grammes to one gramme of the morphine, and from eighty to one
hundred grammes of chloral; and, for a dog, ten centigrammes of
morphine and twenty grammes of chloral.
The administration of chloral in the form of balls, as commonly
practised by many veterinarians, in doses varying from one to one
and a half ounces, given on an empty stomach, and from one to two
hours before the operation, is undoubtedly good practice. We
have not personally had the opportunity of testing it m cases of
long and tedious dissections, but the benefit we have often de-
rived from it in short, though painful operations, justifies us in
recommending it, not only for this very object, but in any case,
where, from any possible cause, an animal is likely to receive severe
injuries during his struggles to liberate himself.
dle dnd 4
Pa
¥
ACCIDENTS OF GENERAL ANESTHESIA. 75
ACCIDENTS OF GENERAL ANESTHESIA.
Notwithstanding the caution observed in the use of ether or
chloroform, and however pure these articles may be, accidents must
be expected during their administration. They are not always of
a serious nature, but they may at times have fatal results.
Among those of minor importance is the cough which becomes
at times quite troublesome, but may be readily subdued by a tem-
porary arrest of the inhalation ; vomiting, which often occurs in
small animals, but which can be guarded against by causing the
patient to fast long enough to insure an empty stomach before
being etherized, and spasmodic contractions, of which the exis-
tence, when undoubtedly present, is often overlooked. Among
those of more serious nature are syncope, either cardiac or res-
piratory.
Cardiac syncope is a very serious accident, and in a majority
of cases proves fatal, especially in large animals. It is sudden in
its manifestation, and often unobserved until at too late a period
of the operation. Itis due to a gradual diminution, followed by
an arrest of the muscular contractions of the heart, and as far as
our observation extends is always associated with pre-existing
heart disease. The application of cold douches, of heart stimu-
lants, ammonia given by inhalation or internally, are the first in-
dications in these cases.
Respiratory syncope, which is far less dangerous, arises from
the influence of the laryngeal nerves upon the activity of the res-
piratory centers. Its access is sudden, being caused by the arrest
of the respiration. There is no convulsion, though the intoxica-
tion produced by the anesthetic vapors is sudden in its gs and
is generally detected only by careful watching.
The application of electricity, that of the electro-puncture, and
especially persevering efforts to effect artificial respiration, may
sometimes saye the animal, provided the trouble is not connected
with the complete arrest of the contractions of the heart.
In view of these possible incidental conditions, some general
rules suggest themselves tending to their avoidance. Great care
and exactness in gauging the doses of the anesthesia, with such
caution in their administration as to produce a slow and gradu-
ated effect, is one point. Free allowance for the introduction of
air with the vapors inhaled; close attention to the state of the
76 MEANS OF RESTRAINT.
circulatory and respiratory apparatuses, and the manner in which
their functions are executed, by ncticing the heart-beat and watch-
ing the pulse and the movements of respiration at the flanks, are
other points of importance.
Another point is the need of bearing in mind that an animal
submitted several days in succession to general anesthesia be-
comes more and more susceptible to its effects, and therefore
more exposed to the dangers they imply.
ACCIDENTS INCIDENTAL TO THE USE OF MEANS
OF RESTRAINT.
We have already considered some of the accidents which are
likely to interfere with the successful application of the means of
restraint, and especially with reference to the final act of the pre-
liminary series which occur at the moment of throwing the animal
and depositing him on his bed, particularly such as may follow
the neglect of properly protecting the head with the cap or
blinkers, or by an unnecessarily prolonged use of the twitch, or
from the sudden and violent movements of the animal himself.
These can usually be obviated by proper forethought and watch-
fulness. But the most careful attention cannot always assure
immunity from miscarriage and casualties. Thus, a common mis-
hap, and one which cannot be anticipated nor prevented, is the
sudden and heavy fall of the animal just as his equilibrium is lost.
The lesions which may follow this casualty may have their seat
either in the hard or soft structures, and are of the most serious
character, not only including, at times, fractures and dislocations,
and lacerations of the soft tissues, including the muscles, but may
affect the viscera, and even the blood vessels and the nerves—in
this last case involving the parts in all the evils of local paralysis
and its disabilities.
(a) Fractures.
This form of injury may have its seat in the vertebral column,
the ribs, and the bones of the extremities.
Ist. Mractures of the Vertebral Column.—In the list of frac-
tures, those of this region of the body are the most frequent.
The numerous reports of cases which are made public by veterin-
ary writers furnish sufficient evidence of the facility and frequency
of their occurrence, even when the most careful attention has been
ACCIDENTS DUE TO RESTRAINT. citi
bestowed on all the details of the work of casting. The very
peculiar circumstances under which these spinal fractures some-
times take place, baffling calculation, and occurring when least
expected or prepared for, illustrate the responsibility which the
veterinarian assumes, and the culpability with which he would
become chargeable by undertaking the work without due caution
and preparation, or without notifying the owner of the animal of
all the hazards and difficulties attending the case in all its steps
and stages. As will be seen when we come to the consideration
of this special lesion in the chapter on fractures, the symptoms
which accompany this accident are distinguished, as to one feat-
ure, by the suddenness of their appearance, which takes place at
the moment of the infliction of the injury or immediately after.
But the most important of the characteristics of the case is the
grave fact that the fracture is almost always of the comminuted
kind. This is held to be due to the excessively powerful mus-
cular contraction, resulting in the over-arching of the vertebral
column simultaneously with pressure from the abdominal organs,
caused by the sudden extension of the anterior and posterior
bipeds, bound together with hobbles, the violence of the siruggle
so powerfully pressing the vertebree together as to result in the
yielding of their spongy structure; and the crushing or grinding
of the bone is the consequence.
This theory of the production of fractures of this character
has been adopted by the majority of European veterinarians, es-
pecially by those of France, where it is understood as ‘“Bouley’s
Classical Theory.” In 1889, however, another theory was pro-
pounded and defended by Mr. Moussel, of Alfort, differing en-
tirely from that of Bouley, in which he claims that the kind of
fracture in question is not caused by an over flexion of the spine,
but, on the contrary, is the effect of an excessive extension / result-
ing from greater contraction of the ilio-spinalis muscle.
According to Dickerhoft, “three factors are active in the cau-
sation of these fractures. In the first place, the animal must have
some object as a point @ appui for one hind leg; that point must
be connected with either one of the other extremities or directly
with the trunk. * * * Secondly, the horse must make his vertebral
column tense by the contraction of the spinal extensor muscles.
* * * Thirdly, the horse must, simultaneously with the extension
of the hind leg and that of the vertebral column, draw its pelvis
78 MEANS OF RESTRAINT.
to one side. * * * But no one of these three elements, in itself,
will produce a fracture; they must all concur.”
Whatever may be the value of these theories, the fact that at
post-mortem examinations fractures have been discovered, in some
cases in the annular portion, and in others in the body, seems to
prove that any one of them is equally applicable with another.
To prevent these fractures, therefore, becomes the principal
object of the surgeon at the critical moment when the animal is
thrown. This involves a strict attention to the rules which we
have laid down for his guidance in the various steps of the act of
casting ; and, moreover, to have recourse, as often as possible and
as the indications suggest, to the aid of anesthetic agencies, and
by no means to ignore the value or neglect the use of the appa-
ratus of Bernardot & Buttel.
2d. Hractures of the Ribs.—These fractures are undoubtedly
frequent, as the result of heavy falls upon a badly-made bed—too
hard or too thin, or perhaps concealing hard substances, as stones
or the like.
3d. Fractures of the Pelvic Bones.—There are but few cases
on record of this kind of injury, but they are possible, as the re-
sult of carelessness in the preparation of the bed or improper
casting, or powerful muscular contraction.
4th. Fractures of the Bones of the Hxtremities.—Though prob-
ably less common than those last referred to, these lesions are not
unknown in veterinary practice. They occur principally in the
diaphyses of bones, or near to, or at the epiphysis, and are often in-
complete in their nature. Delafond describes a case of fracture
of the femur taking place during the application of the clamps
while undergoing the operation of castration ; and another case is
recorded of which the trochanter of the femur was the seat. Rey
has reported a case of fracture of the cubitus taking place as the
animal, when freed from the hobbles, made a violent effort to spring
from the bed upon which he had been thrown to be fired for a
chronic enlargement. These fractures of the extremities may be
avoided by careful attention, not only at the time of throwing the
patient, but in placing him in position and in properly securing
him, and giving him judicious assistance in regaining his feet.
5th. Dislocations. —These accidents are of very rare occur-
rence. One case, however, is recorded of a dislocation backwards
of the humerus, complicated with fracture of the cubitus.
INJURIES TO SOFT TISSUES. 19
(0) Insurtes to Sorr Tissvgs.
Ist. Lacerations of Muscles and their Annexes.—These are
the result of the distorted positions into which the extremities are
forced while undergoing operations. They may be discovered
immediately, or may be developed a few days after the operation.
Inflammation of the olecranean and pectoral muscles, of those of
the croup, and of the anterior part of the shoulder have been re-
ported. Bouley has seen a rupture of the aponeurosis of the great
and of the small oblique muscle of the abdomen, and one rupture
of the flexor metatarsi. A case of laceration of the diaphragm is
recorded by Bouley, Jr. In one of our own patients, laceration of
the olecranean muscles was followed by such severe complications,
that it became necessary to destroy the patient.
2d. Ruptures of the Viscera.—These are of rare occurrence,
being generally prevented by the precaution of refraining from.
throwing the animal, until assured of an empty digestive canal by
previous fasting. Accidents, however, have been witnessed by
Gohier, who has noticed their occurrence upon the rectum near
the anus. This horse had drunk freely of water before being
east. Bouley, Jr., has seen a case of rupture of the diaphragm.
Rey has known one of the heart, Schaak one of laceration of the
humeral artery, and eyen the giving way of the vena cava, in a case
of anervous animal upon which means of restraint were being
applied to dress a small wound. The patient suddenly fell, and,
struggling violently, died ; and at the post-mortem the abdomen
was found full of blood, and the vein torn back of the kidneys.
3d. Injuries to Nerves.—These are accompanied with loss of
power, usually temporary, but sometimes permanent. The posi-
tion in which it is sometimes necessary to fix an animal, as in the
diagonal, is that in which they are most likely to occur. The
symptoms of paralysis which are then manifested, betray them-
selves when the animal has just risen from the bed, when, upon
being called upon to move, the leg is discovered to be unable to
carry its weight, flexing upon its various bony levers, and render-
ing locomotion impossible. Sometimes these symptoms are of
but short continuance, and disappear under the influence of strong
stimulating frictions. The leg was, according to the popular
phrase, “asleep,” because of a temporary arrest and sluggishness
of the circulation. But in other cases, the condition is brought
80 MEANS OF RESTRAINT.
on by a true lesion of the nerves, the brachial, the lumbar plexus,
or some of their branches having undergone some traumatic hurt
which may prove more or less refractory to treatment.
4th. Asphyxia.—According to Peuch and Toussaint, this ac-
cident may result from the ignorance of assistants, who, in con-
trolling the animal and keeping him down on the bed, have com-
pressed the nostrils too tightly ; or again it may be caused by the
excessive pressure of the throat straps of the halter, or of the rope
which encircles the neck when a horse is placed in position for
castration. To explain the causes of this accident should be, with
an intelligent operator, sufficiently to hint the means of prevent-
ing its occurrence.
Conclusions.—A review of the matters we have been considering
in this chapter may not be out of place, nor unprofitable, even at
the risk of being, perhaps, a little repetitious. In view of the oc-
currence of these accidents, and appreciating the responsibility
assumed by the surgeon when about performing an operation
upon a more or less valuable animal, he cannot but be conscious
of the obligations which impose themselves upon him to take every
precaution to avoid them. He should therefore guard against
their eventual contingency, by closely inquiring concerning the
condition of his patient, and by satisfying himself that every part
of the apparatus of restraint is in good order; should avoid rough
treatment and employ anesthesia when possible, and never put an
animal in a constrained position for treatment when an operation
can be otherwise performed more advantageously and easily and
comfortably to his patient, and he should never allow him to re-
main in his restrained and compulsory recumbent position longer
than is strictly necessary. And above all, he should never under-
take an operation without having fully acquainted the owner of
the animal of the possibility of accidents. The fact of thus ex-
plaining matters to an owner, and of obtaining his intelligent con-
sent does not, of course, relieve the surgeon of his responsibility,
but rather, on the contrary, confirms and increases it by thus add-
ing a new, though an implied pledge to his employer to devote
his most conscientious endeayors and exercise his best skill in the
matter, in token of his appreciation of the confidence placed in his
skill and faithfulness.
da
-.
«“ oS ae
CHAPTER IZ.
SURGICAL) DIAGNOSIS.
The first query to be settled in examining a diseased animal is
whether the ailment with which he is attacked is merely a case of
disordered function, requiring only the administration of the
proper drugs to restore the usual order of things, or a case de-
manding the operative skill and expert ministrations of the sur-
geon, with bistoury and cautery and suture. The decision of this
query involves a thorough knowledge of anatomy, and is compara-
tively more difficult, as well as more important, than the mere
medical diagnosis of diseases pertaining to internal pathology.
Errors in surgical diagnosis are always both more dangerous and
more important than those of a mere medical character, inasmuch
as they are likely to be more readily exposed, and to involve a
greater amount of responsibility on the part of the surgeon.
To insure the certainty of his diagnosis, the surgeon must call
into exercise all his resources of knowledge and experience, and
employ all his faculties of observation and discrimination, with
such instrumental aid as may serve to facilitate and confirm his
conclusion, as to the nature of the cases before him. He must
especially employ all his organs of sense in the investigation. A
single sense is sometimes sufficient to diagnosticate the character
of some special lesions, but more commonly each sense is an
auxiliary of the others, and all are complementary to each. In
fact, the surgeon is not justified in reaching a conclusion as to the
detection of an affection, which is discovered by the sight,
or touch, or smell, or hearing, alone, but to escape the possibility
of error, he is bound to confirm his discovery by the corroboration
of another, or what is still better, of all the others, if possible.
In these cases, as in others, the eye is the most valuable and
comprehensible of the organs.
Ist. Sight.—Visible changes of contour, or color, or other
deviations from the usual appearance of tissues, or of regions, are
of course first made known through the sight of the eye. De-
formities, unless of very minute dimensions, with abnormal
82 SURGICAL DIAGNOSIS.
growths, prominent swellings and changes of direction in the
bony levers, belong to the same category, and if these are not suf-
ficiently distinct or conspicuous, and seem likely to escape the
visual observation of the surgeon, a careful measurement may de-
cide the point. The eye must also discern the changes occurring
in the various visible membranes, as for example, the heightened
redness of a congested membrane, and the paleness of an anemic
subject.
Again, if there is abnormal motion in a part, as in fractures
and dislocations, it is to the eye that the disclosure is first made.
This application and study of the use of his eye will be very
serviceable to the surgeon in the examination of the external sur-
face of the body, but when examinations within the organism, or
within its cavity, become necessary, however strong a light he
may have at his disposal, he will be compelled to have recourse
for assistance to the speculum, to hold the parts open.
There are many forms of this instrument.
The speculum oris, for the mouth, has very numerous shapes,
some of them very simple, as in Figures 70 and 71, and some com-
<a
(i)
j i
Fics. 70 & 71.—_Simple Speculum Oris. Fia. 72.—Brogniez Speculum Oris.
plicated, as in Fig. 72, the speculum of Brogniez. Green’s spec-
ulum is an American invention, simple, safe, comfortable to the
patient, and of easy manipulation (Fig. 73). Grange’s mouth
speculum is rather clumsy and heavy (Fig. 74). These instruments
are generally employed for solipeds. Placed between the jaws,
they open the mouth forcibly, and keep it so as long as they con-
tinue in place.
Sometimes, however, the mouths of these animals, as well as
those of ruminants, can be held open without them, by putting
SIGHT. 83
Fic. 74.—Grange’s Speculum.
the tongue out of one side of the mouth with one hand, while the
cheek is pulled out in the opposite direction with the other.
This same manipulation may answer for large ruminants, provid-
ing the head is kept elevated by an assistant. In swine, a gag
(See fig. 58) made of wood, is often used, and the speculum rep-
resented in figure 61 answers well for dogs. At other times,
however, with these animals, the mouth is kept open by separat-
ing the jaws with tapes passed around each, and pulled apart.
84 SURGICAL DIAGNOSIS.
Fic. 75.—Reynal’s Mouth Reflector.
Reynal is the author of an instrument which facilitates the
examination by the eye of some parts of the mouth. It is
polished on both surfaces, and acts as a reflector, and, when in-
troduced on the inside of the cheek, will help to detect diseased
spots on the teeth, which would otherwise escape discovery. The
Fic. 76.—Nose Speculum.
speculum to dilate the nostrils and examine the nasal cavities,
also acts as a reflector, but fails, we think, to fulfill the object,
for lack of sufficient dimensions. It is made somewhat on the
principal of the vaginal speculum used in human medicine, and
acts in the same manner.
Fic. 77,—Eye Speculums
SIGHT. ' 85
Fic. 78.—Ophthalmoscope.
The speculum to keep the eyelids apart will be found of great
assistance in the examination of that organ, so sensitive to the
light when in a state of disease, and so constantly kept closed on
that account. It is, in fact, this speculum which renders the use
of the ophthalmoscope practicable for the examination of the in-
ternal structures of the ocular globe.
Some of the various patterns of the speculum used in human
FIG. 79.—Examination of Dog’s Ear.
86 SURGICAL DIAGNOSIS.
surgery for the ear, will be found available in the examination of
the external auditory canal, especially in dogs. The dilatation of
the vagina and the anus is scarcely ever needed in veterinary
surgery, and instruments are there-
fore not required; nor is the endo-
scope, so useful in human sur-
Fia. 80.—Vaginal Speculum.
gery, of any value in veterinary practice from
the impossibility of using it upon animals.
To realize the value of these optical aids * kN
in the examination of cavities, a strong light Nea
is indispensable. Sometimes the ordinary
solar rays will be sufficient, but at others reflected and concen-
trated artificial light will be necessary, as in the use of the oph-
thalmoscope to examine the eye, or to detect the conditions of the
deep posterior parts of the nasal cavities.
(6.) Touch.—The taxis is the surgical sense par excellence,
and is probably the more valuable and reliable of all the means of
investigation possessed by the surgeon, the sight itself not ex-
cepted. Nothing else so accurately detects the changes in the
proportions, in the consistency, in the elasticity, or even in the
nature of tissues, and its discoveries may be made serviceable at
every stage of an operation of importance and delicacy. But to
attain a reliable certainty in the exercise of this tactical skill, the
finger ends must, equally with the eye, be thoroughly educated to
perform their functions with accuracy and discrimination. A
change in the aspect, form and contour of a region which
easily escapes detection by an ordinary observer, will become
instantly evident to the well-drilled digital extremities of the ex-
perienced operator. j
The object requiring examination is not always, however,
within reach of any portion of the hand, and resort must be had
to instrumental aid in the exploration of parts deeply situated, or
of fistulous tracts, and for this purpose the prove is brought into
requisition. It is usually of metallic material. generally silver, or
of lead, or may be made of gutta percha or whalebone, or other
:
]
TOUCH. 87
Fig. 81.—Straight, curved Directory—Silver Probe.
suitable, flexible substance, and either straight or curved as the S
probe. The director is also a probe, heavier than the ordinary
kind, and haying a small groove running its length on one side.
It is used as a kind of guide to prevent the deviation of the bis-
toury from its proper course, and to conduct it to the bottom of a
wound.
Exploring needles are used with advantage in the detection of
the nature of abnormal growths, the small and narrow wound
which they make being sufficient to ascertain the nature of the
liquid which may be present, without danger of complications.
The Dieulafoy aspirator affords another means of exploration
and discovery of deep-seated parts, inaccessible in the ordinary
way.
Fia. 82.—Dieulafoy’s Aspirator.
88 SURGICAL DIAGNOSIS.
(c) Hearing.—The indications obtained through the media
of the sight and the touch may be usefully supplemented, and are
often completed by those which address the sense of hearing.
The gurgling sound in liquid or gaseous tumors, the peculiar
bruit in aneurisms, caused by the current of the blood; the con-
tact of a stone in the bladder when touched by the exploring |
catheter ; the peculiar glow-glow of the entrance of air into a vein;
the characteristic crepitation of fractures, and the whistling of a |
roaring horse—these, and other signs, convey their information
with unmistakable distinctness to the auricular sense.
(d) Smell.—The exercise of the olfactory sense in the formation
of a surgical diagnosis is more limited than those just con-
sidered, and yet there are conditions in which it may be of great
importance.
The odor, sw generis, of gangrene and of necrosis are
promptly detected, and at once recognized, and the existence of
other pathological conditions, as of urinary or stercoral fistulous
tracts, and certain affections of the feet, are betrayed by the
pungent and aggressive appeal to the olfactory organs.
(e) Zaste—As free from anything like fastidiousness in
respect to offensive contacts and surroundings, as the surgeon
must unavoidably become, he draws a line; he insists upon a
strict monopoly of his gustatory sense for his own internal uses,
and only investigates the domestic animals in an alimentary way,
when entirely healthy individuals are reduced to a post-mortem
condition by the butcher, and served in the form of beef, mutton
and pork, properly cooked. But if the surgeon should desire
much valuable aid from the exercise of the physical senses in form-
ing his diagnosis, he will commit a serious error if he allows
himself to be entirely and exclusively guided by them. Strictly
speaking, a direct diagnosis may sometimes be arrived at by a care-
ful collation of the results of his researches, but he will often,
also, be obliged to modify or go beyond these conclusions, and
make an indirect diagnosis-besides.
There are two ways of making a positive surgical diagnosis:
one which may be called the direct, or diagnosis by confirmation ;
another known as indirect, or by exclusion. The former is by
ulterior investigations, confirming a previous diagnosis made upon
the basis of a single and prominent symptom; the latter by the
elimination of all diseases, which, though they may have some
TASTE. 89
resemblance to that which has been suspected, yet are excluded
by the presence of some specific and incompatible symptoms.
It is only by careful induction and cautious reasoning, that
the surgeon can settle the question of his diagnosis, and insure
such a true and tangible conclusion, as can only be reached when
there is a perfect correspondence between the suggestions derived
from the testimony of the physical organs, and the calm deduc-
tions of the logical faculty, aided by a disciplined and well fur-
nished memory.
CHAPTER III.
SURGICAL THERAPEUTICS.
This title refers to one of the most extensive and important
departments of surgical practice, upon which, indeed, as to its
proper administration, depends in a great measure the success of
the operative skill, of which it is the supplement and consummation.
It comprehends the bandaging and dressing of traumatic injuries.
DRESSINGS.
Gourdon says that “a dressing is a mode of local, periodically
repeated, treatment, producing a continued action, following or-
dinarily the performance of operations, and consisting in the
methodical application upon the surface of wounds of special
apparatuses, which complete the effect of the operation, and co-
operate in the recovery.”
The value of the skill and proficiency to be acquired by dili-
gent study and observation in this comprehensive and indispen-
sable art, need not be stated; that it is entitled to be so denomin-
ated no one acquainted with the niceties of its details and the
judgment and experience entering into their performance, need be
told. Norcan the dependence of the surgeon, for the good results
which he hopes to secure in Ais department of duty, upon the
faithfulness and intelligence of the nurse, who is to co-operate
with him in perfecting the healing process, be easily overrated.
An incompetent or unfaithful nurse, may spoil the best work of a
good surgeon. To protect a wound from immediate contact of
surrounding bodies, to shield it from injurious atmospheric effects,
malarious or otherwise; to keep aloof all putrid and virulent mat-
ters; to secure the absorption and neutralization of their morbid
products; to control the cicatrizing process in the ulcerated
parts; to apply topical treatment, according to indications, as
the curative processes develop; to produce a mechanical action,
such as dilatation or compression, according to the instructions
DRESSINGS. 91
of the surgeon, and the indications of the case. Such is a fair,
though brief synopsis of the duties of the nurse, upon whom it
devolves to give effect to the rules of surgical therapeutics.
A well-applied dressing may become the first step toward
assuring the success of an operation, those following it—even
when only methodically executed—being mere continuous degrees
of the one well-begun action. A well-applied dressing may sup-
ply the defects and amend the errors of an improperly performed
operation; and, on the other hand, a bad dressing may jeopardize
the success of a well-executed operation by interfering with the
process of cicatrization, and in other ways delay the recovery of
the patient, and even prevent it entirely, by causing unfavorable
complications.
The application of all dressings is subject to certain general
rules, from which no deviation is allowable. As in every action in
life, the first step should be that of preparing all the necessary
means and appliances for the work, and the last, before beginning
the actual manipulation, should be to ascertain that nothing more
remains to be provided, at the risk of a serious interruption and
delay, and loss of time in a search for some missing article of
necessity. On such a point the merest hint should be sufficient,
and, indeed, even a hint should be unnecessary with a practical
and thoughtful person; but, unfortunately, all persons are not
practical and thoughtful.
The next step for the surgeon is to secure for himself and his
patient a favorable arrangement in respect to light and room.
There must be nothing interposed before the eye, or that can limit
the free movement of the hand and the arm—a most obvious sug-
gestion.
Before applying a dressing, the wound should be thoroughly
cleansed and freed from blood, pus, the remains of previous
dressings, and, in a word, of any foreign or other substances
capable of becoming sources of irritation. This is best done
with water alone, but its effect is frequently greatly improved by
combining with it some of the compounds, such as carbolic acid,
sanitas, creoline, etc., which have proved their value as antiseptic
agents. It may be applied by carefully passing a fine sponge or
a ball of oakum over the surface of the wound, or it may be used
more freely in larger ablutions. Crusts or scabs, if any, may be
removed with the scissors or scraped away with the spatula, but
92 SURGICAL THERAPEUTICS.
the finger-nails must by no means be used for such a purpose;
for the twofold reason that it is both filthy and dangerous.
Handle the wound only as much as is necessary; all needless
taxis irritates—the inference is obvious. If the wound is deep,
injections can be combined with the lotions in cleansing it.
With the first dressing, there is probably only blood to wash
away, and that should be done thoroughly, not overlooking any
portion that may have dried in the hair and on the skin. The
essential condition of cleanliness applies not only to the wound,
but also to the material used for the dressing, and soiled cloths
or bandages, and dirty tow or oakum must be rigorously rejected.
And, while insisting on strict cleanliness in the instruments and
dressing material, it will hardly be decorous to the surgeon to
omit him from the category, and to remind him of the propriety
of looking to his own condition, and especially to that of his
hands.
In all his manipulations it should be a matter of conscience
with the surgeon to treat his patient kindly. Rough handling,
loud scolding, threatening or jerking, with a restless animal, to
punish him for an instinctive and natural attempt to move under
the infliction of pain, will not only be of no service, but, on the
contrary, will increase his fright and render him all the less docile
and willing to submit in quietness.
In applying the various parts of the dressings, unnecessary
pressure should be avoided, especially on soft tissues; and when
it is indicated, it should be applied by slow degrees, and as uni-
formly as possible, packing the wound upon its entire surface,
and completed only as the dressing is nearly ended. Assistants
should be enjoined to observe the same rules. The dressing
should be applied, not hastily, but rapidly; not with the idea of
saving time, simply with a view to lose none. The fact of avoid-
ing any waste of time, by working without needless pause, has,
moreover, the excellent effect of curtailing the sufferings of the
patient, and sparing him“much needless pain.
It is always important to watch the effect of the various arti-
cles of dressing as they are applied, in order to be certain that
they cause no pain either at the time, or at a later period by their
shape, the roughness of their surface, or their unskillful applica-
tion; and above all, that they cause no interference with any of
the essential functions of the economy, as the respiration or cir-
4 |
J
culation. This last especially may be impeded by excessive pres-
sure. To avoid this, bandages applied upon one of the extremities
of the body should be so placed as to direct the pressure from the
periphery toward the center. If applied in the opposite direction,
more or less strangulation might result, causing considerable
swelling below the bandage. In fact, all unnecessary or exag-
gerated pressure is liable to cause inflammatory swellings, erysip-
elous engorgements, or local gangrenes.
The maintenance of an equal and regular pressure will obviate
all danger of deformities of parts, and when methodically applied
upon irregular wounds, wherever needed, will serve to restore or
preserve them in the natural contour of the region. Neatness
and finish should be studied as much as possible, but not, of
course, at the expense of any of the special and essential objects
of the dressing.
Besides these general rules there are others relating to minute
points and touching the various elements, which, as a combined
whole, constitute the completed transaction, such as those relating
to the topical treatment, to the material used, to the rollers or
bands, and to the bandages proper. The medicinal compounds
used for topical treatment are either applied alone or through the
medium of other materials. They are of various natures and con-
sistencies, from that of the almost impalpable vapor used for
spraying, to the liquid forms in the numerous watery solutions,
alcoholic tinctures, and oils or liniments, to the hard and
other solid compounds in the various astringent, absorbing, stimul-
ating or caustic powders, or the soft pharmaceutical mixtures,
the cerates, the pomades, the ointments, the plasters, poul-
tices, ete.
The application of the material used should receive attention
from the surgeon. An invariable rule should be to avoid all ir-
regularity, roughness and unevenness, and to be careful that the
exterior application rests upon a regular and uniform surface.
For this reason it should be the order, in applying this material,
always to begin by using the smallest portions, increasing gradu-
ally to the largest, thus filling first the small infractuosities and
making an even surface, to be covered with larger ones and thin
pads, then with thicker ones, and finally with those of the widest
dimensions, which should bear a margin extending somewhat be-
yond the outlines of the wound. The entire dressing is to be
DRESSINGS. 93
94 SURGICAL THERAPEUTICS.
maintained in position by means of compresses, rollers or band-
ages, as the case may require.
Rollers are long bands of muslin, linen, or ticking, or broad
tapes, which are used principally in dressing wounds of the ex-
tremities, or of regions liable to much motion. Their length and
width vary, according to the requirements of the case. The sur-
geon will do well to assure himself of the dimensions of these,
and to ascertain that the rollers are of ample length, with some-
thing to spare, which excess in length can be cut off. Deficiency
in the length of a roller will interfere with a perfect completion
of its application. If too wide, it may prove difficult to apply it
neatly, while if too narrow it may have a tendency to act like a
ligature, and make even pressure difficult, besides being more
liable to slip and become loosened. Rollers are applied either dry
or moist. When moist, they become loose in drying, and their
action becomes insufficient. Dry rollers ought, therefore, to be
preferred.
Bands or rollers are prepared in two ways, either by being
rolled on one or on both of their extremities, and are therefore
called the single or the double roller. In applying it, the extrem-
.
Ss
Fia. 83.—Single and Double Roller Bandage.
ity is first folded tightly to make a small cylinder, which is held
by its extremities between the thumb and index finger of the left
hand, resting by its width between the same fingers of the right ;
and while the fingers of the left hand turn the small central cylin.
der, the band is rolled upon it toits end. Rolling on both ends
is done in the same manner. When half of it is rolled, a pin will
secure it and prevent it from becoming slack until the other half
is made ready to be used. In rolling the bands, slight traction
should be made at intervals by the thumb of the right hand, while
the fingers of the left keep the central cylinder steady—the object
of which is to have the roller firm, hard and solid.
In large establishments, or even in private practice where
great numbers may be required, the use of the small apparatus
represented in Figure 85 will be found very advantageous, the
DRESSINGS.
Fia. §4.—Manner of Roling a Bandage.
band being rolled upon the central rod with facility, and when
removed having the necessary qualities of a well-rolled bandage.
The general manner of applying a roller bandage is very simple.
Placing with one hand the end of a single roller, or the middle of
a double one, upon the part to be covered, and keeping it steadily
in position, the other hand holding the mass of the bandage with
recs
; wl)
Pky Nal ui 1G UU dn 1
Fic. 85.—Bandage Roller.
95
96 SURGICAL THERAPEUTICS.
the roll turned upwerd, gently draws on it away from the start-
ing point, unrolls it, and with it surrounds the entire region in
returning to the starting point. This process is continued until
the band is exhausted, when it is secured by pins or by strings.
Thus applied, it may be laid in a circular manner, when the turns
rest exactly upon each other, or in a spiral manner when they
overlap each other in part of their width, or in a crossed or figure
of eight manner, when the turns cross each other to meet always
at a given point. If they are applied upon cylindrical surfaces,
the folds generally lie smoothly and evenly upon each other as
they are successively formed, but if the region is of conical shape
or otherwise irregular in form, one of the borders will adapt itself
more readily to the parts than the others. Hence the formation
of bulging parts or pockets, which render the smooth and proper
application of the bandage very difficult, and may interfere with
its solidity. This is avoided by giving to the roller an oblique
half twist, which, while it changes the gaping border in its posi-
tion, prevents the slackening of the bandage and removes the
pocket. This is principally required in the bandaging of the lower
part of an extremity (Fig. 86).
The application of bands on double rolls is also subject to the
W
\*\\
\\\ \ \ \
N
FIG. 86.—How to Apply a Bandage.
DRESSINGS. 97
rules we have given. The completion of the process by the appli-
cation of the final dressings and proper finishing steps can scarce-
ly be subjected to rules which could not well be framed to meet the
varieties in the features and circumstances of the diversified cases
constantly occurring in practice. The only strictly general rule
that can be established, is, that when a bandage is placed on the
outside of a dressing, it must always, first of all, be fixed at the
points which are the most essential to secure it and maintain it in
its proper place.
The proper time for the removal or change of a dressing, is a
question which depends for an answer upon the consideration of
the nature of the wound, the season of the year, the age and con-
dition of the patient; in fact upon all the various circumstances
which in the judgment of the surgeon may influence the progress
of the cicatrization.
On general principles, the first dressing is not to be removed
until the suppurative process is thoroughly established, which is
towards the fourth or fifth day. But there are cases where special
circumstances indicate an earlier ora later removal. For example,
if the dressing has been applied to control the hemorrhage of a
divided blood vessel, from twenty-four to thirty-six hours are
generally sufficient to obtain the obliteration of the vessel.
Again, while it is justifiable to leave the dressing of a foot, which
has been subjected to an operation, for eight, fifteen, twenty, and
even twenty-five days without changing, and especially in these
days of antiseptics when so much is possible in the way of com-
bating the suppurative process, there are no doubt cases where
it must be looked after earlier, as where there is an exhibition of
increased pain, instead of the abatement which might be justifi-
ably looked for if the operation and the dressing had been
properly executed; the increase of pain indicating some compli-
cations which early exposure might easily have controlled. There
are, however, conditions where the removal of a dressing is in-
dicated in some more than in others, as, for instance, when sup-
puration is abundant. In these cases, to prevent the retention of
the pus in the wounds, and to diminish the danger of its pres-
ence, or of its absorption, or facilitate its escape, drainage tubes
must be used, or the dressing changed.
The removal of a first dressing usually involves an attention
to minute details not subsequently required, the various parts
98 SURGICAL THERAPEUTICS.
which compose it being often impregnated with blood and glued
together by concreted pus, causing, if removed carelessly, the
laceration of tissues, tearing of granulations, hemorrhages, etc.
It must especially be ascertained whether adhesions exist between
the material of the dressing, and if they are present they must
be thoroughly soaked by means of compresses wet with tepid
water, or a warm water bath, if the dressing is upon a region
which allows it, as, for instance, one of the extremities. When
this is done, the various constituents of the dressings may easily
be removed, one by one, but care and deliberation will still be
necessary. The smaller particles should be removed with the
forceps, not the fingers. If the location allows it we even prefer
to wash these away by irrigation, with a stream of luke-warm
water, or by soaking thoroughly in a foot bath. The wound is to
be cleaned out carefully, by soaking or sopping away the pus with
fine sponges, avoiding all rubbing upon the granulations or caus-
ing them to bleed. Then studying all the indications, to be dis-
covered in the condition of the wound, and avoiding all unneces-
sary manipulations, and attentively removing all causes likely to
interfere with the repairing processes, the dressing is to be re-
placed with all the original precautions. As little time as possi-
ble, consistent with thoroughness, should be occupied in this
process. The wound should be uncovered only as long as
necessity requires, the materials for the dressing being all easily
accessible without delay or hindrance, being prepared in advance
and carefully inspected.
The effects looked for in the application of dressings can be
divided into general and special, these varying in their nature,
according to the object which the surgeon has in view. The
first and principal object is to protect the wound from exposure
to the action of the atmosphere, and also against contact with
foreign bodies, thus to relieve the pain, diminish the inflammatory
irritation, and accelerate the cicatrization. It also prevents the
retention, by their absorption of the suppuration and serosity
which form on the surface. They also expedite recovery by
maintaining the natural warmth of the body in the region.
The special effects of dressing, vary according to the special
action produced by their application, and these may be considered
under several heads.
(a) Retentive dressing.—-This is designed to keep parts in their
RETENTIVE DRESSING. 99
normal condition and situation, and thus aid in their union or con-
solidation, without deformity. It is principally applied in cases of
fractures or dislocations, but finds also its main indication in
maintaining in their proper place the medicinal substances which
are the active agencies of cure.
(6) Uniting dressing.—That which is made with sutures or
adhesive plaster, to hold the parts in their proper position, and
maintain their perfect co-aptation.
(ec) The suspensory dressing, which is a variety of the reten-
tive dressing, and serves to support organs of soft texture in
some parts of the body, such as the testicles, or the mamma,
which by their position are exposed to traumatism by their sit-
uation, their weight, and by pulling and bruises. Suspensories,
is the name given to these special bandages; they are commonly
used in diseases of the testicles, and of the udder.
(d) Compressive dressings.—These are devised’ to produce
more or less active pressure upon a too active granulating sur-
face; to arrest hemorrhage, to change the vitality of some tissues
of a morbid nature, or to control the projection of abnormal bony
growths.
(e) The dividing dressing is the opposite to the uniting. It
is of common use in cases where too rapid closing of wounds is
to be prevented. It is applicable in infundibuliform surfaces, in
deep fistulous tracts, and in wounds which are the seat of foreign
elements, pathological or other. It operates by keeping the
superficial opening of the wound dilated, by means of tents,
sponges, ete.
(f) Hezpulsive dressing.—The object of this dressing is to
assist the exit of pus from the surface of wounds. A simple dress-
ing, by its absorbing properties, is somewhat of an expulsive na-
ture. The presence of a single tent of an absorbing quality, as
small balls, or padding of absorbent cotton; the application of
drainage tubes; all these facilitate not only the escape of the
secretions, but also the discharge of the morbid products. The
drainage is obtained by the introduction into the wound of India
rubber tubing, of various dimensions, perforated at intervals upon
their length, and kept in position by safety pins inserted through
them and the skin, at suitable points. These tubes, when extend-
ing through the depth of a wound, embracing its whole length, and
projecting through a counter opening, as well as through the
rt
i. Ur Uy
100 SURGICAL THERAPEUTICS.
Fig. 87.—Safety Pins,
natural ones of the wound, form an excellent means for contin-
uous irrigation, in the treatment of fistulous withers, complica-
ted poll evil and other diseases.
(g) Antiseptic dressing.—Is intended to prevent the entrance
of micro-organism into wounds, to neutralize their morbific ef-
fect, to check their development, and thus prevent their septic in-
fluences from taking effect. The application of the Lister dress-
ings, with the care required in the preparation and application
by the surgeon ; of the instruments and materials included in the
arsenal of pharmaceutical resources, comprising the antiseptic
sprays; the various acids, boracic, carbolic, and salycilic; the
alkaline sulphites and hyposulphites; permanganate of potash ;
solutions of bichloride of mercury and of creoline; antiseptic
gauze and absorbent cotton—all these, and more constitute dress-
ines essentially germicide, which cannot be too confidently
recommended to the attention and adoption of the veterinary
surgeon. .
The application of the wadding dressing, so highly recom-
mended by some, has given, in our hands very satisfactory
results, in many cases. Wadding well prepared and properly
applied, forms an almost invincible obstacle to the introduction
of micro-organisms, and according to Pasteur, by its direct action
upon the pus renders fermentation impossible.
The instruments necessary for the adjustment of dressings,
are generally speaking, numerous and varied. They consist of
forceps of all kinds, the ordinary dissecting, the bull-dog, the
' straight, and the curved dressing forceps; scissors, directors,
ANTISEPTIC DRESSING. 101
Fie. 89.—Bull-Dog Forceps.
SIU
aati SEL
FIG. 90.—Straight Dressing Forceps.
Fig. 92.—Syringe for Dressing. |
spatulas, the S. probe, and others; syringes, and sometimes
atomizers, and also razors, enter into the list of those generally
needed.
The materials used to form the base of the dressings vary:
charpie, wadding, wool, moss and sponges, are employed. Their
costliness as respects their commercial value, is probably the
reason why they are not more generally adopted in the
practice of veterinarians. Oakum is the material, par excellence,
102 SURGICAL THERAPEUTICS.
for the application of dressings in veterinary surgery, and is even
commonly used in human surgery. We are almost tempted to
claim for it the distinction of having been especially created for
the benefit of wounded horses, its various and valuable qualities
so obviously fitting it for the uses to which it is appropriated in the
equine clinic. It is excellent as a defense against the contact of
external bodies, and in preserving a uniform temperature in the
parts covered by it. From the sponginess of its consistency it
readily soaks and absorbs the fluids which form upon the surface
of a wound, while the tar with which it is more or less impregnated
confers upon it slight antiseptic properties, which assist in the
stimulation, and ave in themselves favorable to all the processes
of cicatrization. To be of good quality, it must be clean, soft to
the touch, and free from any foreign substance. Sometimes it is
cut into small portions for use, but more generally in strips, or
in such other special shapes as may be required. It is made into
balls by spreading out little masses of the fibres, which after being
separated from each other, are rolled between the hands, into the
required forms and sizes. They are exceedingly convenient in
Fie. 93.—Ball of Oakum.
constituting the first steps of this application of a dressing. It is
also made into pads or cushions, by stretching the fibres parallel,
into any given width and length, and folding them into the simil-
itude of a small mattress. This must be soft, and free from
lumps, or fragments of wood, and of an even thickness through-
—
~.
Se
Fic, 94.—Pad of Oakum.
out. These are made also of various dimensions, the widest and
thickest being used to cover the outside of the wound. It is also
shaped into dossils, rolls, and tents, or plugs, the adaptation of
which remains yet to be considered.
BANDAGES. 103
BANDAGES.
The catalogue of means and appliances for dressing is by no
means exhausted in those already mentioned. Among them are
the various forms of compresses, the rollers, the splints, the plates
and the means of drainage, with the various forms of rolled ban-
dages, wide bandages and mechanical bandages.
(a) Compresses.—These are pads made of linen, of various
sizes and shapes, and folded to any degree of thickness required,
which are sometimes applied immediately upon the wound, but
usually upon the oakum. They are not, however, of frequent use
in veterinary surgery, except under special indications. They
may be square, long, triangular, shaped like a neck-tie, or like a
Maltese cross, either complete or half, double or treble-tailed, and
generally patterned and graduated according to the form required
ee ae
F1G, 96.—Long Compress.
Fic, 97.—Triangular
Compress.
F1G. 100.—Half Maltese Cross Complete.
FG. 101.—Double Compress. Fic. 102.—Treble Compress.
104 SURGICAL THERAPEUTICS. -
B
_———ee Fig. 104.—Perforated Compress.
Fig. 103.—Graduated Compress:
by the case. They are commonly used in their entire thickness,
but are sometimes made with a hole in their center, and then
receive the name of perforated or fenestrated.
(6) Rollers have already occupied our attention.
(c) Splints.—These are long, flat, and more or less rigid strips
of wood, or other material, designed to be added to other dress-
ings, to give them some peculiar form or position, and to consoli-
date and strengthen them by increasing their rigidity. They are
usually applied upon the extremities or superior parts of the body,
and are composed not only of wood, but of hard leather, paste-
board, tin, gutta-percha, etc., ete., and maintained in position by
bands or adhesive mixtures. They must be carefully and accu-
rately applied in order to avoid chafing or excoriating the skin,
and are often padded, and their borders made especially smooth
and uniform.
(d) Plates.—These are small pieces of metal or wood, used
principally in the surgery of the foot, to keep in place dressings
of the plantar region, which require more or less pressure upon
Fic. 105.—Plates on Shoes.
BANDAGES. f 105
their surfaces. They consist of separate parts or sections, repre-
senting together the entire surface of the sole, one section sliding
on each side, between the foot and shoe, and are kept in place by
a third and narrower section, introduced transversely between them
and the shoe, towards the heel. It is important to ascertain, be-
fore applying them, that sufficient room exists between the sole
_ and the shoe, and also that the wall is not in such close. contact
with the shoe at the heels as to prevent the introduction of the
- eross pieces.
(e) Means of Drainage.—The conduit most commonly used is
a vulcanized india-rubber tube, which is introduced into wounds
to facilitate the escape of purulent and other discharges, and to
keep them in a cleanly state. They are of various dimensions, as
to the length and diameter, to accommodate those of the purulent
cavity, and are perforated at the side throughout their length, in
order to collect and receive all the impurities that may be present.
Instead of tubes, long tents of oakum are sometimes introduced
into a wound, for the purpose of absorbing the impurities, and to
serve as a means of drainage also.
(7) Moller Bandages.—These are the simplest of bandages.
They are applied with one or several rollers. We have already
mentioned their division into circular, spiral, figure 8, ete.
(g) Wide Bandages are made of broad, thin pieces of linen,
ticking or canvas in various forms, to adapt themselves to any
part of the body where they may be needed. They are sometimes
folded into pads or cushions, and employed as a means of applying
moisture. Those invented by Dr. Berns (Fig. 106) for this purpose
may be used with advantage. They are kept in place by tapes
or ribbons, which must be arranged and fastened about the body
according to the judgment and ingenuity of the surgeon.
The number of wide bandages is indefinite, and, according to
Bourgelat, twenty-seven species can be classified and enumerated.
He would prove himself, however, but an indifferent practitioner
who should find himself unable, upon occasion, to improve the
catalogue by adding new devices to meet new requirements.
In examining some of the principal varieties of the wide ban-
dage, we shall borrow from the excellent work of Peuch and
Toussaint. Our reference will be to
Ist. Simple Frontal.—This is a piece of cloth covering the
greater part of the forehead and the summit of the head or poll,
106 ; SURGICAL THERAPEUTICS.
FIG. 106.—Berns’ Mo'‘stened Pads.
with a fold superiorly to receive the forelock or toupet, and se-
cured by four bands. The lower two have either a small opening
or loop, which the upper two pass before extending down below
the throat, to cross each othér in the form of an X, and drawn
upwards in the lateral faces of the head to the poll, where they
are held (Figs. 107, 108).
2d. Compound Frontal.— This is shaped lke the former,
but extends further down on the face. It has six bands, the
middle ones having also loops at their free extremity, as in the
preceding, the upper ones being also secured in the same manner,
the lower ones crossing each other under the jaws, and also
carried upward to pass through the loops of the middle bands,
to be either tied on the poll, or drawn downwards and tied in the
maxillary space (Figs. 109, 110).
BANDAGES. 107
EZ
Fic. 107.—Simple Frontal (full view) Fie. 108.—Simple Frontal (side view).
Fie. 109.—Compound Frontal (full view). Fie, 110.—Compound Frontal (side view).
3d. Monocular or Simple Bandage for the Eye. This is an
oblong square, notched at the angles, corresponding to the ear of
the same side, and provided with two transversal folds, to adapt
itself to the convexity of the orbit. It is secured by five bands.
The upper three are attached to the throat-strap of the halter or
bridle, the lower two to the lower part of the same strap (Figs. 111,
112).
Ath. Binocular or Double Bandage for the Eye.—This is
formed of a large piece of cloth, notched on its two superior an-
gles to receive the ears, and secured with eight strings or straps.
A longitudinal fold in the upper, and another in the lower part
108 SURGICAL THERAPEUTICS.
1G ing it)\\\\
Nag ian \
Ri \ NA WY
Fie. 111.—Monocular Band (full view). Fria. 112.—Monocular Band (side view).
of the bandage, facilitate its adaptation to the surfaces it is to
cover (Figs. 113, 114).
5th. Bandage for the Maxillary Region.—This is of triangular
shape, and is formed either of sheepskin or of two layers of cloth,
between which a pad of oakum is sewed. It is furnished with
four straps. When applied, the base of the triangle is turned
backward, and the apex rests in the angle of the maxillary space.
The two upper straps, attached at each angle of the base of the
triangle, pass upward at the side of the parotids, and are tied on
the summit of the head, the two lower ones attached at the apex
of the triangle, passing over the nose to be tied at that point. We
have often obtained a better adaptation of this bandage by utiliz-
ing the cheek or the nose-piece of the halter
6th. Har Bandage (Figs. 115, 116).—This is made of two trian-
gular pieces of cloth, united at their base on the summit of the head,
each forming a kind of inverted pocket, with which the ears are
covered. Itis secured by six bands, the two superior having loops
through which the middle ones pass, these crossing each other
under the throat and extending upward to be tied on the poll.
The lower bands cross each other on the forehead and pass under
the head, to return on the lower part of the face where they are
secured, Another way to apply a dressing on the ear to enyel-
ope it properly is to use a thin bandage, which, after it has envel-
oped the ear, is passed around the head on each side, and secured
under the throat (igs. 117, 118). When supported by a tightly
BANDAGES. 109
Nr
S17.
hy,
Y} Wii .
YY) fe
ti
YY
Yj
Yy
28 115.—Rar Bandage (full view). Fic. 116.—Ear Bandage (side view).
fitting halter this bandage maintains its position in a manner quite
satisfactory. To this kind of bandage can be added the one used
for dogs under the name of cap, which is made of soft cloth or fine
cord net. The caps recommended by the Germans answer the
purpose also very well (Figs. 120, 121).
Tth. Bandage for the Parotids or Throat.—This bandage is
long and square, and is notched in the middle of the two borders
to secure the inferior border of the neck, and adapt itself to the
maxillary space. It covers the parotid, and is secured by four
110 SURGICAL THERAPEUTICS.
BSS fi 4 AVON
4 ‘M Mit
Uf]
f DE
om i. \ < ae
pe AG a ee ‘ SN
BN, NN ee \\S
ANS SO? VTS
ns MA YN \ vi \ NN
4 \)
ANI. \N Ss
\S VY i 1
aN ‘| } \\ tan)
I i D
AU ae
ih 'd
Fig. 118. Mas: for the Ears (full view), Fie. 122 —Parotids Band.
bands, two attached in front of the forehead, the others on the
poll. This bandage is often combined with that of the maxillary
region, and made in a single piece (Fig. 122).
8th. Bandage for the Superior Border of the Neck.— This
bandage is a long piece of cloth placed upon the dorsal border
and lateral faces of the neck, with a prolongation in front, passmg
BANDAGES, til
. SVEN
WES
Ww
Ww
Fig. 119.—Bandage for the Ears, A. Bandage for the Mamme, B.
Wi)
Wb lf
Fig, 12).—German Bandage for the Ears.
Fic. 121.—Another German Bandage for the Ears.
a SURGICAL THERAPEUTICS.
Ss
Fig. 123.—Bandage for Superior Border of the Neck.
between the ears and down to the forehead. Hight bands secure
it. The two inferior bands (0) have loops through which the
bands pass to cross each other under the maxillary bones, and
extend upward on each side of the head to be tied over the poll.
The bands (d@) are fixed on the breast-band of a Dutch collar, and
(7) is attached to the surcingle (Fig. 123).
9th. Bandage for the Anterior and Lateral Parts of the
Neck.—This bandage is octagonal, with a band at each angle.
The anterior are tied on the forehead or on the throat-strap of the
SS
FG. 124.—Bandage for the Anterior and Lateral Parts of the Neck.
BANDAGES. 113
halter, the middle ones over the dorsal border of the neck; the
posterior cross each other over the withers, and are secured to the
surcingle, as are also the two lower (Fig. 124).
10th. Bandage for the Withers.—This is square, truncated at
. its posterior angles, and having in the middle of its anterior and
4 posterior border a fold to adapt it to the height of the withers.
There are five bands. The anterior are secured forward, above
Fic. 125.—Bandage for the Withers.
the breast, the posterior are passed around the thorax and tied
together, the other sewed on the middle of the posterior border
extending along the spine and attached to the crupper.
FIG, 126.—Bandage for the Back.
114 SURGICAL THERAPEUTICS.
llth. Bandage for the Back.— This bandage is composed
of a long, square piece, truncated on its two posterior angles, and
has six bands, one at each angle. The two in front are tied to-
gether after passing around the chest, the middle ones after sur-
rounding the abdomen toward the umbilical region and the pos-
terior are united after forming a kind of crupper in passing under
the tail (Fig. 126).
12th. Bandage for the Loins and Croup.—This band-
age is of a form similar to the preceding, and of sufficient size to
cover the croup posteriorly. It is truncated on both posterior
angles, and each border, except the anterior, has folds to allow
the bands to adapt itself to the rotundity of the region. At each
Fic. 127.—Bandage for the Loins and Croup.
angle is a band, the posterior passing around the abdomen, and
carried backward and npward to be tied over the loins. The pos-
terior then turns from without inwards, over the round of the hip,
crossing obliquely the internal face of the thigh forward to the
stifle, and passing over the external face of the thigh to the mid-
dle bands on a level with the hip-joint, where they are tied. Two
extra bands may be attached to the front border and tied to the
surcingle, if thought necessary, to prevent the bandage from slip-
ping backwards.
13th. Bandage for the Hip (Figs. 128, 129).—This is formed of
a piece of cloth the length exceeding the breadth by one-half, or
in the proportion of three to two, and so, enveloping the hip and
part of the croup that the inner border runs along the peri-
num, and the outer on the external face of the thigh and leg.
BANDAGES. 115
FIG, 129.—The same separate.
This border (7, d) forms a fold about four inches wide at its base,
and the inferior (d, e, c) has two which, like the first, form an
exact adaptation to the parts. Hight bands belong to this band-
age—three upon the posterior border (a, a, @) at its superior part,
which are fixed to the crupper, the superior border having one
(6) long enough to reach to the surcingle, and the inferior border
having three (d, ¢, c). The bands d and e pass around the leg
and cross each other at g, the band d being fixed to the
crupper, while e extends to the surcingle forward. Band e crosses
obliquely to the inner face of the thigh, passes upward along the
116 SURGICAL THERAPEUTICS.
flank, and is tied to the surcingle. The band / is fixed upon e, as
seen in the illustration, Fig. 128 at h.
14th. Bandage for the Inguinal Region and Perineum.—
This is applied to the testicles or to the mamme. It is a long,
triangular bandage, with its base placed forward, and is provided
Fig. 130.—Bandage for the Inguinal Fic. 131.—The same separate.
Region and Perineum.
with four bands, one at each angle of the base. These are passed
around the flanks to be fixed on the loins, the two posterior on
the apex of the triangle to draw along the perineum, and passed
over, and on each side of the tail, crossing each other to join the
first one, to which they are tied.
15th. Bandage jor the Abdomen.—This should be oblong in
shape, its length double its breadth, and having folds on each of
its long sides to adapt it to the convexity of the body. The bands
are six in number, two of which are fixed on the loins, two on the
back, and two over the withers. A seventh is sometimes added,
which passes around the base of the neck and prevents the band-
age from slipping backwards (Fig. 182).
16th. Bandage for the Chest.—This is square, with a prolon-
gation in front to go between the fore legs, and which is notched
on the front to adapt itself to the chest behind the elbows. The
bands are six, one at each angle, and two on the prolongation in
front. These are fixed in pairs, over the back, the loms and the
withers (Fig. 133).
BANDAGES. 117
NY
FiG. 133.—Bandage for the Chest.
FIG. 134.—Bandage for the Breast,
118 SURGICAL THERAPEUTICS.
17th. Bandage for the Breast.—This resembles the preced-
ing, except that the narrow prolongation is attached under the
chest to the surcingle, or, surrounding the forearm, goes to the
withers. The others are tied over the withers and on the sides
of the chest to the surcingle (Fig. 134).
18th. Bandage for the Shoulder.—This is cut in the form of
a trapezium, to cover the shoulder and the arm. It is applied some-
what obliquely, and has on its front borders (Fig. 135) folds to
adapt it to the convexity of the anterior part of the arm. Of its
WAY
ES
A\y
FIG. 135.—Bandage for the Shoulder.
c f
\ yi! @
Fig. 136.—Same, isolated.
a
=
BANDAGES. 119
seven bands, ¢, ¢ are fixed on the withers at the origin of the neck,
ef, passing first around the forearm and joining ¢ ¢, as it passes
on the opposite side, and d, g, 2 are secured to the surcingle.
19th. Bandage jor the Shoulder Joint.—This bandage is
square and truncated on its superior angle, and is provided with
several folds to adapt it to the convexity of the shoulder. The
\\ Y SA
PER EERT RNR \ \\ y
QQ \\ \ WAY)
if
A wf
AQ WS — & If
i
Fig. 137.—Bandage for the Shoulder Joint Proper.
bands are six, three anterior and three posterior. The first two
are applied around the neck, the third on a ring at the surcingle ;
the other three also going to the surcingle, either directly or in
passing around the inside of the forearm.
20th. Bandage for the Elbow.—This bandage is of an ir-
regular shape, with folds on its lateral and lower borders, to adapt
FiG. 138.—Bandage for the Elbow.
120 SURGICAL THERAPEUTICS.
ra Z
Ss
SS ©
A oN
Fic. 139.—Same, isolated.
it accurately to the point of the elbow. Five bands serve to con-
fine it, 7 going directly to the withers where it is tied with 7, pre-
viously passed under and around the thorax on the opposite side,
g and f/ are secured to the breast-band of a Dutch collar, & passes
around the forearm on the inside, from behind forward, and
passes in front of the breast to be also secured to the Dutch collar.
21st. Bandage for the Forearm.—This is of an irregular tri-
angular sharp, with the apex truncated, and the base notched to
accommodate itself to the axilla and the fold of the elbow. When
applied, the apex of the triangular, which forms a short border,
is turned downward and the base upward in the axilla. Two
bands sewed to each angle of the base are fixed to the breast-band
Fic. 140.—Bandage for the Forearm.
BANDAGES. 121
of the Dutch collar, and the borders are secured by little tapes on
the outside of the forearm. Sometimes these borders are fastened
together by laces inserted obliquely.
22d. Bandage for the Knee.—This is square, notched on its
superior border and in the center, both of which are provided with
a small piece to form a gusset, in which the bony projections of
the knee are secured. A double, ordinary band, or, what is better,
an elastic strap attaches it to the breast-band, while smaller tapes
serve to tie it to the back of the knee.
4 ly
i
By)
wi oy } NS |
Fic. 141.—Bandage for the Knee. FIG. 142.—Bandage for the Stifle.
23d. Bandage for the Stifle-—This is of a triangular figure,
the base of which should be four times longer than its height. It
has three bands, one at each angle. That of the superior angle
passes along the flank, and is attached to the crupper strap at the
loins; that of the inferior angle twists forward and inward on the
thigh, and connects with the crupper at the base of the tail, while
the third band turns around the crupper, crosses the internal face
of the thigh from behind forward, passes in front of the stifle, and
terminates backward at the same point with the preceding band,
after twisting around that of the superior angle.
122 SURGICAL THDRAPEUTICS.
24th. Leg Bandage.—This is the complicated device repre-
sented in Figs. 143 and 144. It has four bands on its superior
border, (Fig. 144 a, 6, c, d) and the lateral borders have five or
six tapes. The bandage has three gussets, two of which, ¢
Fic. 148.—Bandage for the Leg Applied.
and d, are on the superior border, and one, 7, on the inferior, and
the two lateral borders have each one a fold. To put the bandage
in place, the band d is passed along the flank upward and tied to
the crupper strap, ¢, passing from within outward on the inside
Fic. 144.—The same, isolated.
BANDAGES. 123
. of the thigh, to be fixed on the round of the crupper. A and b
cross each other at the lower part of the leg, a little above the
tendo-Achilles, in order to allow @ to pass from the inside to the
outside of the leg so as to become attached to the surcingle,
while 4 is secured to the round of the crupper. The small tapes
are, of course, tied together in couples.
25th. Bandage for the Hock and Cannon.—This requires a
piece of cloth of sufficient dimensions to completely surround the
hock and cannon down to the fetlock. Its superior border is
Fig. 145.—Bandage for the Hock Fig. 146.—The same, isolated.
and Cannon, applied.
notched for the fold of the hock, and a gusset is made in its lower
extremity for the fetlock. Four straps proceed from its superior
border to be secured to the bandage of the leg, and the ends of
the small tapes of its lateral borders are tied together in pairs in
front of the leg.
(g) Mechanical Bandages.—This is the distinctive name of a
class of dressings which are not only a passive means of protec-
tion to the parts upon which they are applied, but from which
also proceeds a direct or positive action, by co-operating in the
recovery of lesions, if indeed it is not the true operating
cause which brings it about. Rollers and wide bandages some-
124 SURGICAL THERAPEUTICS.
times act as mechanical bandages. But the name is more par-
ticularly applicable to certain more or less complicated apparatus-
es, whose special mechanical action has the effect of producing
some defined therapeutical result. The metallic plate used in the
reduction of some forms of hernia; the metallic spring apparatus
used in applying pressure upon special regions, as, in orthopedic
surgery, or in the reduction of fractures or dislocations, like those
invented by Bourgelat, Brogniez, Defays, and others, are of this
class, inasmuch as all of these possess the constituent properties
which are understood to characterize the agencies belonging to
the category of mechanical bandages.
These will be subjects for our consideration when we treat of
the various conditions in which they are indicated.
CHAPTER IV.
BLEMENTARY OPERATIONS:
Under this term are understood those of a simple nature, as
perhaps an incision or puncture, or the insertion of sutures, and
other implicated manipulations, but which form the foundation
and belong to the operative generalities of the domain of major
surgery. They will be treated under the two principal heads of
division or dieresis, and reunion or synthesis.
DIVISION.
This is a very common surgical step, of which the object is
the separation of tissues from each other. Gourdon has recog-
nized six principal modes by which to divide tissues, viz.: by in-
cision, dissection, puncture, resection, ligature and cauterization.
Varying, somewhat, from this view, and considering resection as
an operation specially appropriate to bony structures, and liga-
ture as adapted to the cellular tissues, and classifying cauteriza-
tion as principally a means of puncture, we prefer, with Peuch
and Toussaint, to reduce the consideration of these modes of
division to three, viz.: incision, dissection and puncture.
A.—Incrstons.
Any methodic division of soft tissues made with a sharp
instrument is an incision. The basis of the majority of surgical
operations, their purpose is to allow the escape of the contained
fluid from a cavity, to enlarge the size of a wound, to make
counter openings, to extract foreign bodies, to remove pathologi-
cal growths, to destroy abnormal adhesions, to expose tissues to
be operated upon or tumors to be removed, to facilitate the re-
duction of displaced organs, etc., etc. The bistoury, the scalpel,
the sage knife and the scissors are the cutting instruments most
commonly used for making incisions. Sometimes, however, the
amputation knife, the tenotome, the herniotome, with lancets, or
126 ELEMENTARY OPERATIONS.
even drawing knives, take their place. Drawing knives, however,
are better adapted to excise the horny, or other similar hard struc-
tures, than to cut upon soft tissues.
Sl
Fig. 148.—Convex Bistoury.
Fic. 151.—Bistoury Caché (Castrating Knife for Females).
In form, the bistoury is either straight, convex or concave,
and usually is pointed, but the use of blunt or guarded instru-
ments is often indicated. The distoury caché is also employed in
some special operations. A bistoury is generally mounted with
a single blade, though sometimes several blades are mounted
together on one handle, and can be closed upon it in the
manner of an ordinary pocket knife. But when strict antiseptic
oe Sa = =
3 « ; 7
‘
INCISIONS. 127
rules are observed in the operations, the blade is held firmly on
the handle, and cannot be closed.
Sage knives, which are much used in operations upon the foot,
are but convex bistouries, single or double, curved upon their
length, and, according to the disposition of the cutting edge, are
called right, or left, or double. The blade is generally firmly
FIG. 152,—Right, Left and Double Sage Knives.
riveted in the handle, to render it more solid and better adapted
to the incision of the comparatively harder tissues. When made
to close as an ordinary pocket knife they are less solid, and more
difficult to keep in good condition.
The scissors vary also in shape, and are sometimes straight,
sometimes curved, and with either blunt or pointed ends. Be-
sides these cutting instruments, directors are often used as guides
to carry the knife in the desired direction, and obviate errors
and accidents in operating. The bistoury is held in different
128 ELEMENTARY OPERATIONS.
Fic. 153.—Various Shapes of Scissors.
positions, according to circumstances, as we shall proceed to point
out and classify.
Ist. Held as a writing pen.—That is, with the handle resting
on the back of the hand, the thumb, index and medius finger on
each side of the blade, the other two fingers resting on the skin.
ails XY
8 ii iN
Figs. 154 and 155.—Bistoury held as a Writing Pen.
In this position the edge of the blade may be turned either down-
ward or upward. The division mentioned by Gourdon, with the
fingers extended or flexed upon the blade is scarcely, and at best
but a variety.
2d. The instrument may be held as the bow of a violin, or
the thumb on one side of the articulation of the blade, with the
handle and all the fingers on the opposite side, the index on the
back of the blade, the medius on the articulation opposite the
thumb and the other two fingers on the side of the handle.
None of the fingers must be allowed to divert the instrument from
being carried horizontally upon the tissues. In this position the
edge of the blade may be turned either downward or upward.
INCISIONS. 129
Fics. 156, 157, 157a.—Bistoury held as a Bow of a Violin.
3d. The bistoury can be held as a table knife. The thumb
and the medius being placed on opposite sides, at the junction of
the blade and the handle, the index resting upon the back of the
FIGs. 158, 159.—Bistoury held as a Table Knife.
blade, the other fingers holding the handle in the hollow of the
hand. As in the preceding positions, the edges of the blade may
be either turned downward or upward.
Whatever position may be given to the instrument, it is to be
held firmly, and with a steady hand. Sage knives are generally
held by grasping the handle full in the hand, or, as when holding
a bistoury as a table knife, sometimes with one hand only, and at
others with both, according to the indications and the amount of
firmness and steadiness required. The manner of holding
scissors is already known. The only variation likely to be found
130 ELEMENTARY OPERATIONS.
Fic. 160.—Sage Knife held with One Hand,
Fic. 161.—Sage Knife held with Two Hands.
needful, is that in some cases it is handier to grasp them from
above and in others from below.
There are some general rules which are important to observe
in performing the simplest operation. These relate to the condi-
tion of the instrument, to the preparation of the parts, and to the
direction and dimensions of the incision.
The condition of the instrument must be such that the soft
tissues may be divided with but little pressure. It must cut and
not tear. Therefore, besides their state of thorough cleanliness,
they must be very sharp and their edge entirely smooth and free
of indentation, which would cause them to act as a saw and pro-
duce an irregular and ragged incision, more painful to the patient,
and more difficult to heal. It has been recommended to dip them
before using in oil or warm water, but these precautions can be
dispensed with.
The region upon which the incision is to be made must be
thoroughly cleaned, the hairs being clipped short, and sometimes
even shaved. In these days of antisepsy, it is proper to soak it
well, after it is washed, with some antiseptic solution. To makea
clean incision, the skin must be well stretched with the hands, the
instrument firmly held, and the division made by a steady move-
INCISIONS. 131
ment, to avoid the possibility of extending the incision beyond the
necessary limits.
The direction and size of incisions require careful consider-
ation. They must run as nearly parallel with the direction of the
muscular fibres and the large blood vessels and nerves of the
region as the condition of the part will permit.
- Their direction should also correspond to that of the long
axis of the part or tumor undergoing operation, and in such a
manner that the retraction of the skin will not tend to separate
the borders of the wound. Sometimes, according to the unavoid-
able natural motions occurring in a region, the normal folds of
the skin should be considered. A vertical incision is always pre-
ferable, as more readily allowing the escape of liquids, pus or
otherwise, which may have accumulated.
As much as possible, and generally, incisions should be made
with a single stroke, and of the full length and depth required by
the further steps of the operation. Besides diminishing the suf-
fering of the animal, such an incision will greatly facilitate all
the subsequent manipulations of the operator.
Incisions are made by four principal methods: first from
without inwards; second, from within outwards; third by sub-
cutaneous division; and fourth by the slicing, scraping or shaving
method. In the first two modes the instrument may be turned
in five directions.
(a) Towards the operator, by beginning at the farthest point
aud moving the instrument in the direction of his own person.
(6) From the operator, by reversing the former movement.
(c) From /eft to right and transversely, the instrument being
held with the right hand.
(d) From right to left, or in the opposite es with the
instrument in the left hand.
(e) From above downwards, in a vertical or slightly oblique
direction.
Incisions from left to right and from above downwards are the
most convenient, and for this reason the surgeon practices them
as much as possible.
Ist. Incisions from without inwards.—These incisions are
carried from the surface of the skin towards the deep structures
underneath. They may be made with any kind of bistoury, but
the convex is to be preferred.
a2 ELEMENTARY OPERATIONS.
The skin should be well stretched by various movements of
the hand, or of the operator, or his assistants, and held
tense and smooth, unless it is already sufficiently expanded
by the effect of the existing lesion underneath it. Then the
operator, holding the instrument in the first or third position,
carries the instrument, with the edges and the point turned down-
ward, to the spot on the surface to be divided, and penetrating
through the skin to the depth desired, completes the incision to
its proper length.
This mode of incising the skin answers for the majority of
cases, but there are others when the skin has to be divided care-
fully and by layers. Incisions are then made with the convex
bistoury, held in either position with its edge downward, carried
perpendicularly over the skin and often by repeated light strokes.
These two procedures answer when the part to be operated
upon offers a certain solidity. Otherwise the incision can be
made in a third manner, viz.: by taking hold of a fold of the skin,
held at one end by an assistant, at the other by the operator, and
completing it by a transverse section through the fold, made
from the apex to the base. The objection to this mode of dividing
is that the incision can never be thoroughly limited.
2d. Incisions from within outwards.—In contrast with those
already considered, these incisions are made from the deep parts
toward the superficial, and through the thickness of the skin.
The Straight Bistoury is here the preferable instrument, either
alone or assisted by a guide or conductor, which may be the grooved
probe, the director, or the finger of the surgeon. Hither with
or without, these incisions can be executed in various ways.
Without the Director.—With the bistoury held as a writing
pen, with the blade turned upward, first the poimt of the instru-
ment, and then the entire blade is thrust perpendicularly through
the tissues; then lowering the handle of the instrument until it
forms with the skin an angle of forty-five degrees, the instru-
ment is moved in an oblique direction in such a way as to stretch
and divide the skin, until at the end of the incision the bistoury is
brought back to a perpendicular direction to complete the incis-
ion ina neat manner. This incision can be made toward or from
the operator, according to the case. It will facilitate the action
of the instrument if the skin back of the hand that holds it is
stretched with the free hand of the operator.
INCISIONS. 133
Another manner of incision from within outward is to make a
fold of the skin, as already described, and by pushing the straight
_ bistoury through its base, and turning the edge, completing it by
a single stroke upward to the summit. When an incision already
existing must be enlarged, the bistoury, held in the second posi-
tion, is introduced flatwise under the skin as far as is necessary ;
then turned to bring the edge upward and pushing the point
through the skin by drawing the instrument outward, the flap of
skin between the two openings is divided at one stroke.
A fourth procedure is known as the incision with flaps. It is
principally used in amputations. With the left hand the surgeon
grasps a fold of skin, pushes the bistoury held in the first position,
but flatwise, through its base, and in drawing it out obliquely
by a sawing motion cuts out a semi-circular flap of the required
dimensions.
With the Director or Guide.—Incisions in this mode are made
to remove compressions caused by strictures, or to establish a free
exist to pus by a counter opening. Hither the finger or the
grooved probe or the director may be used as a guide to the in-
strument. In all cases there must already exist a natural or acci-
dental opening to allow the introduction of the director. Several
modes of procedure are employed according to conditions and ob-
jects in view. In one, the director being introduced into the tract
to be enlarged, as far as the point where the incision must end,
the bistoury, held in the first or second position, with the edge
turned upward, is made to slide into the groove of the director,
forming with it an acute angle, and pushed in its whole length,
dividing the tissues until it reaches the end of the groove, when
itis withdrawn in the perpendicular position. A second mode
is to carry the bistoury flatwise alongside the director, and when
reaching its end to turn the instrument with the edge upward,
first thrusting the point through the tissues and tegument, and
completing the incision by withdrawing the bistoury outward and
toward the operator. In a third procedure, which is that of mak-
ing counter openings, the probe or director is introduced into the
wound, and at its deep end, to push toward the skin until it raises
it from the inside or can be felt through it ; an incision from with-
out inward is then made at that point, and the director being ex-
posed, the bistoury is engaged in its groove and pushed alongside,
dividing the tissues at will in length and in depth, and establishing
134 ELEMENTARY OPERATIONS.
a broad communication between the original opening and the one
just formed. By using the sharp end of an S probe, passing it
alongside the director previously engaged, and pushing it through
the side, the making of the incision from without inward may be
avoided, as described above, and the groove of the S probe may be
used as that of an ordinary director.
‘Sometimes, however, when the original opening allows it, the
finger is introduced into it and used as a conductor. In this case,
a blunt bistoury is preferable, as less dangerous to the operator
than the straight instrument, or the curved form may be used.
This may be made to slide with the back of its blade, or again
flatwise, along the palmar face of the finger until the bottom of
the wound has been reached, and then turning the knife, the tis-
sues are divided by carrying the bistoury either toward or from
Fic. 162.—Using the Finger as a Director.
the operator. This procedure is more applicable when the fistu-
lous head is not deep, but it is preferable to the use of the ordin-
ary director as being a much better instrument of diagnosis, and
safer as a director of the bistoury.
3d. Subcutaneous Incisions.—The usefulness of this mode of
dividing tissues is best demonstrated by its application to cases
of tenotomy and myotomy, or the puncture preceding the injec-
tion of tincture of iodine according to some methods. It requires
special instruments, made with narrow blades or with fine trocars,
which, when introduced through the skin, leave a very small open-
ing, the division being made under the ligaments, with special care
to avoid its division beyond the point where the instrument has
been introduced. Suppuration seldom follows this operation if it
has been properly performed, and, accordingly, the cicatrization is
very rapid; the great advantage obtained by this mode of incision
cannot be overlooked.
INCISIONS. 135
4th. Incisions by Slices—Scraping or Shaving Incisions.—
These incisions are made by dividing the tissues in successive lay-
ers. Three varieties of operation are practiced, differing accord-
ing to the density of the tissues acted upon. In the first, which is
applicable to hard structures, the bistoury, or, preferably, the sage
knife is required. The instrument is held full in the hand, as a
table knife, or, again, as the bow of a violin, and is passed flatwise
over the surface of the tissues, and layers of various thicknesses
removed from it ; and sometimes the tissues are sufficiently hard
to require the strength of both hands for the management of the
instrument.
Fic. 163._Sharp Tenaculum.
In a second mode, applicable to soft tissues, a convex bistoury
and a pair of forceps or a sharp tenaculum are necessary. Rais-
ing with either of these a thin layer of the tissue to be divided,
the bistoury is carried slightly flatwise over the surface and a piece
of it is cut, scraped, or shaved off, the operation being repeated
until the desired depth has been reached.
A third mode is applied in cases of growths which are to be
cut off at their base. To do this, the growth is raised as much as
possible, by means of the forceps or tenaculum, and the amputation
is accomplished with a few sawing movements of the instrument.
The forms which incisions may receive are of two principal
kinds—the simple and the compound.
Simple incisions are those which are generally made with one
stroke of the bistoury, and generally from without inward,
and are either straight or curved. The straight, or simple, are
indicated for the exposure of regions, the opening of abscesses,
etc., etc. They are not as applicable to the removal of tumors,
especially of those which have large bases. The curved incisions
vary in their circular shape, and diifer also from the straight in |
the modus operandi, as they require a stretching of the skin to
be made in various directions, as that of the bistoury is changed
over the cutaneous surface.
Compound incisions are formed by the union of several simple
incisions, their number varying much, but they may be reduced
136 ELEMENTARY OPERATIONS.
to the following kinds: the T and V shaped, the crucial, the
elliptic, and the semi-lunar. The branches of these compound in-
cisions are made in the same manner as for the simple kind; when
two incisions are to meet at a given point, the second one must be
made, not to begin, but to terminate at that point; when two
incisions are to unite, one above the other, the lower one is to be
made first, to avoid the flow of blood from the upper, which would
cover and conceal it; and when two incisions are to meet at their
extremities, it is proper that the ends of the second incision should
start a short distance beyond the commencing point of the first,
and terminate with a similar space from the end of the first in-
cision. In other words, the junction of the extremities of the two
incisions must never be by a perfect acute angle. The angle must
always have a slight prolongation formed at one extremity, by the
extension of one, and at the other by that of the other incision.
These rules are not absolute, but may be changed as circumstances
may require.
In the 7-shaped incision, a straight cut is carried perpendicu-
larly upon the middle of another. In the V-shaped, there are
_two straight incisions meeting at an acute angle by one of their
extremities, this angle, as we have just said, having a small pro-
longation on one of its lines at their junction. The V-shaped in-
cision may open in every direction. Sometimes the two incisions
are made to meet at a right angle, to form the L-shaped incision.
In the crucial incision, two straight cuts are made to meet at
their middle, usually at a right, sometimes at an acute angle,
forming an _X-shaped incision. This is made in three steps, first,
a simple straight cut; second, the first part of the second incision
as in the T-shaped form, and third, the second part of the second
incision ending, not beginning,.at the point of junction of the in-
cision made in the first two steps, and in such a manner as to be
the continuation of the incision made on the second step. This
incision may also be made in two cuts, when the skin is hard and
adherent to the deeper tissues, by making the second incision
with one stroke of the knife, passing at the middle of the first.
The elliptic incision is made with two curved cuts, so united at
their extremities as to leave between them an elliptical space. The
semi lunar or crescentic incision is formed by two curved ones,
the circumferences of which are turned in the same direction,
leaving between them a form like that of the new moon.
INCISIONS. 137
Fic. 164.—T-shape Incision.
Fig. 165.—V-shape Incision.
Fig. 166.—Crucial Incision.
Fie. 167.—Semi-Lunar Incision.
Fie. 168.—L-shape Incision.
Fic. 169.—X-shape Incision.
Fic. 170.—Elliptic Incision.
OX DAFA
B.—DisskEcrions.
Dissection is the separation of the cellular tissue from the
various parts to which it is united. The scalpel, the bistoury
and the scissors are among the necessary instruments, sometimes
replaced or assisted by the fingers or a strong director. With the
scalpel, or the bistoury, the handle is also utilized, and frequently
the blunt extremity of the scissors, while again in some cases the
cellular connections are separated with the fingers or the blunt
end of a director. To these instruments are added forceps, either
the common dissecting, or the bull-dog form. Three procedures
are involved, viz.: the free dissection, the limited, and the dissec-
tion by slices or shavings.
138 ELEMENTARY OPERATIONS.
Fic. 172.—Bull-Dog Forceps.
(a) Free dissection is that of a flap of skin from the tissues
beneath, to which it is only slightly adherent. Holding the skin
with the fingers, or the forceps, with one hand, and having the
bistoury or scalpel in the other, the skin is raised as much as
possible and separated from the other tissues with a single stroke
of the bistoury, held as a pen or as a violin bow, the operator
drawing it towards him as much as possible. In the dissections
of flaps of skin, as those in the V, the T, the crucial, and the cres-
centic incisions, the strokes of the bistoury extend in length as
they approach the base, or the adherent portion of the cutaneous
flap. In the straight or elliptic incisions, on the contrary, the
strokes are longer at the beginning. When the cellular tissue is
very loose, its separation from the skin is made with the fingers
or the blunt end of the scissors. This mode, called enucleation,
is often employed for some special forms of tumors, as the
fibroid, or fatty.
(0) Limited Dissection.—The steps of this process are the same
as those of the preceding, excepting that the surgeon proceeds
by small strokes in order to avoid going too deeply into the
tissues, and leave the skin of a sufficient thickness.
(ce) Dissection by Slices or Shavings.—The skin being divided,
and the subcutaneous tissues raised with the forceps, the bistoury,
held flatwise, excises horizontally each layer of the structure by
a sawing movement.
C.—PuncrTuRE.
Properly speaking, this is a simple, special operation, designed
to penetrate into hollow parts, to explore the nature of tumors, to
DISSECTIONS. 139
examine the contents of natural cavities, or to provide for the escape
of gases or fluids. It is, therefore, a solution of continuity of
small dimensions, constituting often the first steps of an incision,
but which forms also an essential operation. It can be performed
with various instruments, as the lancet, the straight bistoury, the
trocar, the exploring needle and their adjuncts, the aspirator, and
the actual cautery.
Fic. 173.—Various Shapes of Lancets.
Puncture with the Lancet.—In form and shape the lancet
greatly varies, but in general it may be considered as a compound
bistoury, with a pointed and two-edged blade. The point may be
either quite wide, or very acute, and is sometimes curved, with one
edge convex and the other concave.
To use the lancet, the blade, open ata right angle with its
handle, is held between the thumb and index finger, while the
=
=
Fic. 174,—Manner of holding a Lancet.
140 ELEMENTARY OPERATIONS.
handle rests on the back of the hand, with the fingers slightly
flexed. The joint, brought close to the skin, and perpendicular to
it, is thrust by the extension of the fingers through the tegument
and tissues underneath and then drawn out perpendicularly, un-
less it is desirable to increase the size of the incision, when the
division is made by extending the incision from within outward.
Puncture with the Straight Bistoury.—The bistoury, for this
purpose, must be finely pointed and sharp. Held asa writing pen,
with its edge upward or downward, or as a table-knife, accord-
ing to the thickness of the tissues, and its action limited by having
the fingers at a given distance from the point, it is pushed per-
pendicularly and more or less rapidly at once to the necessary
depth. It is then drawn out, unless the incision is to be
enlarged, which is done by a motion from within outward
by the blade. Sometimes the instrument is pushed into the
tissues in an oblique, instead of a perpendicular direction, when it
is not desirable to have communication between the opening of
the skin and the one directly beneath it. This constitutes the first
step of the subcutaneous incision.
Fig. 175.—Trocar and Canula.
Puncture with the Trocar.—This instrument is composed
of two parts. A rod, secured to a firm handle at one extremity
and terminating at the other in a tri-faced point, is one; this rod
fits into a canula, blunt at one end and haying at the other a cup-
shaped flange, which is the other part. The canula is long enough
to receive the entire length of the rod, except the tri-faced point,
which projects beyond it. The two parts are fitted closely
together.
Trocars are of various size and form, being both straight and
curved. That which is used for hyovertebrotomy is the longest of
all; those used for rumenotomy are quite large in diameter; the
enterotome is, on the contrary, quite small.
DISSECTIONS. 141
Fic. 176.—Various Forms of Trocars.
To puncture with the trocar, the operator will assure himself
that it is in good condition, and that the rod can readily be with-
drawn from the canula when necessary. Holding the instrument
in such a manner that the handle, grasped by the three fingers,
rests in the palm of the hand, the thumb is applied on the canula
near its point of union with the handle, and the index extended on
the outside of it, to limit the play of the instrument; the trocar is
pushed through the tissues in a perpendicular direction, and until
a sensation of resistance is no longer felt. When introduced, the
eanula is held in place with one hand, while with the other the
rod is slowly drawn straight out, or by a slight rotary motion.
If the design of the operation has been the evacuation of the
liquid contents of a tumor, as the fluid escapes the growth dimin-
ishes, and it becomes necessary to insert the canula further in the
. cayity or turn it in different directions, to ensure the removal of the
entire contents. Yet it is necessary to be careful not to press the
orifice of the canula against the walls of the sac, a condition likely
to prevent the escape of the fluid.
To remove the canula, moderate pressure is applied with one
hand on the skin around the seat of the puncture, while the other
142 ELEMENTARY OPERATIONS.
withdraws the instrument by its pavillion, drawing it in a lne
parallel to the division in which it was introduced.
Exploring needles, or trocars, which are but small directors
with a lanceolate blade at one end, and asmall groove on one
side, are also used for making punctures, and their adaptation as
Fic. 177.—Exploring Needles.
very small trocars, with aspirators (principally that of Dieulafoy)
find frequent use in our surgery. These instruments have already
been considered in the chapter upon surgical diagnosis.
The Puncture with the Actual Cautery.—The conical cautery
is the one used in this mode of operation. It varies in diameter
and in length. The instrument is heated to a white heat, applied
perpendicularly upon the skin and pushed in until the sense of
resistance is no longer felt, when it is withdrawn. The condition
of white heat of the instrument is of great importance. Though
apparently an act of great severity, the operation finds numerous
applications in our surgical practice, principally for the puncture
of deep-seated cold abscesses. It has great advantages over the
puncture with the bistoury, inasmuch as there is no hemorrhage
to fear from its use; because the opening made by the cautery
remains unclosed a longer time, and because the inflammation is
modified in its nature, and the process of resolution thus assisted
by the caloric thrown in.
The use of local anesthesia, by the injections of cocaine, will
remove from this mode of puncture the rough side of its applica-
tion by rendering the operation entirely painless.
REUNION.
This term signifies the readjustment and consolidation of tis-
sues which had been disintegrated and divided—otherwise, simply
the reuniting of separated parts, and their restoration to a nor-
mal condition. This process is otherwise referred to as that of
cicatrization, a natural property of organic tissues, which, though
it may be aided and guided by the surgeon, can be controlled by
REUNION. 143
him only to the extent of preventing accidents and maintaining
natural conditions. The processes, the order, and the rapidity of
the formation of cicatrization are not the same with different tis-
sues, and certain distinctive terms have therefore been adopted
by which to denote the modified ways by which the purpose of
nature is effected. Thus we have immediate reunion or adhesive
inflammation or union by the first intention, by which separated
parts solidify upon simple contact, as varying from union by the
second intention, or by granulation and suppuration ; followed by
union by the third intention, when, together with the processes of
the second intention, there is added one of mortification and the
elimination of dead structure. This subdivision accords strictly
with the order of nature, as it may be constantly observed, the
phenomena of separation involving a regular gradation of de-
tail in the active forces employed in the recuperative effort, from
the simplest and most efficient in the wnion by first intention to
that which is, in fact, a struggle between the elements of growth
and preservation and the tendency to dissolution and death, as ex-
hibited in the third degree.
Before proceeding to the direct discussion of the means used
to assist the vis conservatrix in the reunion of divided parts, there
are some general considerations of which the surgeon must never
lose sight. They are not of the less importance because they are
matters of an obvious and secondary character, and refermainly to
what may be termed matters of minor detail. Where immediate
reunion is looked for, the wound must be fresh and clean, and
entirely free from clots of blood or foreign substances. The edges
must be smooth and even, and if there are any ragged portiops
they must be carefully excised. In addition to this, where there
is a granulating surface the granulations must be carefully inspect-
ed and their healthiness assured, and the surgeon must search care-
fully to ascertain that there are no fistulous tracts present. In any
case the hair must be clipped short around the edges, the skin thor-
oughly washed, and, what is a point of primary importance, the
exact coaptation of the opposite edges carefully ascertained and
secured.
The means employed to maintain the contact of the edges of a
wound, and assist in its closure are, according to Gourdon, of
four kinds—wposition, uniting bandages, adhesive plasters and
sutures.
144 ELEMENTARY OPERATIONS.
A.—Posttion.
This is more a preparatory step toward obtaining reunion than
a true means of securing it, and to have its full effect and assure
all its benefits, must be accompanied by the judicious application
of plasters or bandages. By position is understood such an atti-
tude of the patient as will tend to keep in coaptation the sides of
the wound, as opposed to a posture which would, if left unguard-
ed, disturb the immobility which is indispensable to the comple-
tion of a symmetrical union. The natural restlessness of the pa-
tient under the circumstances, even irrespective of the ordinary
liability to the slighter causes which divert his attention and ren-
der immobility impossible, forbid the idea of entire passivity. And
yet there are some cases where it is possible, or at least must
be attempted. This may be illustrated by the hypothetical case
of alacerated wound, forming a V shaped flap of skin, with its
base turned upward. By taking advantage of this condition, and
keeping the apex of the V downward, the position of the flap will
itself assist in closing the wound, the edges having a natural ten-
dency, from the contractive character of the fibres, to form, and to
maintain the desirable contact. But if, on the contrary, the flap
hasits base turned downward, the difficulty of keeping it in its
proper position will be greater, proportionately to the tendency of
the edges of the flap to drop away from those of the skin. Taking
advantage of the position of this peculiar wound, and assisting it
by the application of bandages or other means, will materially
facilitate the closure of the wound.
B.—Unitine Banpaces.
Though these are not so frequently required in veterinary as
in human surgery, they are very effective in bringing together and
retaining the edges of wounds, especially in the extremities, where
in both transverse and longitudinal wounds they fulfil their pur-
pose very satisfactorily, especially where only the skin is involved.
If the injury extends to the muscular substance, however, they
are both more difficult to apply, and less serviceable in their ef-
fects. In wounds of a transverse character, two bandages of a
length equal to that of the injured leg, and as wide as the great
axis of the wound, are required. One of these is divided into
UNITING BANDAGES. 145
FIG. 178.—Bandage for Transversal Wound.
three or four strips in one-half of its length, the other having in
its middle an equal number of longitudinal slits, smaller than
those of the first, these two being fixed parallel to the axis of the
leg, one above the other below the wound, by several turns of
rollers, and by passing the strips of one through the correspond-
ing slits of the other, the edges of the wound will, by opposite
traction upon the bandages, be necessarily brought together and
supported in that position (Fig. 178.)
The same method answers for longitudinal wounds, though
simpler in structure; this bandage, consisting of a single band of a
width equal to the length of the wound, and prepared with strips
and corresponding slits, as just described, at a distance of about
three-quarters of the circumference of the leg. Thus prepared, and
compressive pads placed on each side of the wound, the bandage
is manipulated as in the other cases, and when it is all properly
adjusted, is further secured by rolling it around the leg over the
strips (Fig. 179.)
C.—AnpHESIVE STICKING oR AGGLUTINATING PLASTERS.
These descriptive terms refer either to certain special mixtures
which are applied either directly, and alone upon the solutions of
continuity, or spread upon linen, in the form of the ordinary
146 ELEMENTARY OPERATIONS.
Fia. 179.—Bandage for Longitudinal Wounds,
surgeon’s plasters. They are better adapted for use, with the
smaller, than with the larger animals, answering all the require-
ments with the former class. They are composed of various in-
ingredients, differently combined, such as black pitch, with resin,
venice turpentine, etc., and oils, to improve their flexibility, and
aid their curative qualities.
Venice turpentine, alone, is sometimes spread over the bandages,
also a mixture of tar and Burgundy pitch. Pitch, alone, when
melted and mixed with cut oakum or tow, forms a good adhesive
mixture. The ordinary adhesive, or diachyton, or lead plaster,
used in human medicine, is of great value in the surgery of small
animals, and we have used it with great satisfaction with both
large and small patients, applying it in long strips, rolling them
around the affected region in two or three thicknesses. Collodion
has also been highly recommended. Hither alone, or applied with
thin linen, or what is better, with wadding, it forms over the sur-
face of a wound, not only an adhesive plaster, but also a protec-
tive dressing. Plasters are, in some cases, used alone as means of
reunion, and in the treatment of fractures, they form a powerful
adjunct in controlling the displacements of fragments of bone.
They are, however, also frequently used to reinforce other means
of reunion, and especially deep sutures.
D.—SvuTURES.
In all the category of surgical detail, there is nothing so effec-
tive, or indeed indispensable, as the suture, properly applied, for
SUTURES. 147
the retention of breaches of continuity, whether the sewing be
done by means of linen or silk thread, animal fibre, metallic wire,
needles, pins or other instruments. By no other means can the
parts be held in the necessary coaptation to insure a perfect
reunion. The suture is available for various purposes. Besides
contributing materially to the coaptation of the edges of a wound,
and thus aiding to secure a cicatrization by first intention, it pre-
vents the contact and introduction of air into a wound, arrests
and prevents hemorrhage, keeps in place lacerated fragments of
deep wounds which could not be controlled by bandages alone,
assists in the closure of artificial openings, such as may take place
in the walls of the abdominal cavity, and prevents the escape of
any portion of its contents, and assists in the closing of natural
openings. But, though principally useful in effecting the objects
enumerated, the essential indication of the suture appears in the re-
union of solutions of continuity, and, particularly, in regions where
the natural movements of the parts tend necessarily to prevent
the borders of the wound from remaining in undisturbed contact,
for a period sufficient to obviate the danger of serious blemishes
of cicatrization. But while the suture is of no less advantage in
fresh injuries, it is also indicated as well in suppurating wounds,
with the precaution of leaving room for the free escape of patho-
logical secretions.
Sutures are contra-indicated, when a wound becomes the seat
of extensive inflammation, or occupies a broad surface, or is ir-
regular, or accompanied by loss of tissue; or when the parts are
the seat of severe contusion, or contain foreign bodies or mortified
tissues in their depths. There are other cases also, where their
employment is contra-indicated, as when their object is likely to
be defeated by the uncontrollable movements of the patient.
Causes of failure may also sometimes be found in the writation
arising from the material of which the suture is formed, cutting
its way loose. By this accident, a wound which, if not interfered
with, would have left but little if any cicatrix, and would have
required but a short time to heal, becomes transformed into a
large, ugly, granulating surface, that is likely to leave a compara-
tively bad looking cicatrix in the end.
The application of these retentive stitches falls under the
general rules relating to the disposition of the edges of the wound,
and the special placing of sutures. In reference to the first point,
148 ELEMENTARY OPERATIONS.
the first consideration to be noted is, that the wound must, of
course, be thoroughly cleaned, and free from blood or foreign
bodies. Then the borders of the wound must be fresh, or, if old,
blackish, or beginning to granulate, must be slightly excised by
thin scraping, and the edges brought as closely in contact as
possible.
To apply the suture, the needle is to be held and used precisely
like an ordinary sewing needle. Ifthe skin is thick enough to require
it, a thimble can be used. Sometimes special needles with handles
are made, and sometimes forceps may be needed to grasp the
needle, and push or pull it through the integument. The needle
should pass through the skin as nearly perpendicularly as possible,
since, if introduced too obliquely, the tractions upon the skin may
be sufficiently uneven to involve the possibility of tearing out the
stitch. In placing the suture, nerves, tendons and blood vessels
must, of course, be avoided. The suture should embrace a good
hold of the skin to secure a greater traction and better approxi-
mation of the parts; the distance between the stitches must be
such that no gaping can take place; they must be disposed at
regular distances apart. When the needle is introduced from
without inward, the skin is raised with the fingers of the left
hand, or, better, with a forceps; if introduced from within out-
ward, pressure is to be made upon the skin with the fingers or
the blunt blade of a pair of scissors, near the point of exit of the
needle.
Generally, the suture is begun at the middle of the wound, in
which case the edges are made to meet more accurately and regu-
larly. This rule, however, will find numerous exceptions. All
the stitches should be placed before any are tied, and they must
be tied only sufficiently tight to keep the edges together; other-
wise they may cut through the skin. If not sufficiently tight the »
wound will be left gaping and cicatrization will be interfered with.
The knots ought to be placed as much as possible on one side of
the wound and towards the most dependent part, to avoid their
being soiled by the suppuration.
The material used for sutures varies much. Strong linen
thread, silk, metallic wires of silver, lead or tin, and in some cases
narrow and thin elastic cords or bands are used, according to the
circumstances. Metallic wires have the advantage of being less
irritating, and can remain in the thickness of tissues without giv-
oS
ag
SUTURES. 149
ing rise to excessive inflammation or ulceration if the swelling
should be extreme. Elastic cords or bands have an important
advantage in their property of yielding to the inflammatory swell-
ing, as it develops itself while avoiding dangerous or unnecessary
traction.
Fic. 180.—Various Sutured Needles.
Suture needles are made in countless forms and numbers,
straight and curved, and of different lengths and dimensions, but
having, all of them, flat poimts. When metallic sutures are used,
their extremity is grooved to receive the wire in such a manner
that its double thickness will not interfere with its passage
through the skin.
. 150 ELEMENTARY OPERATIONS,
tl
=
= 8
SS
——
=
—Ss
Fi@é. 182.—Trelat’s Needle.
Fig. 183.—Riverdin’s Needle.
Fia. 184.—Simpson’s Needle.
=
=
———
=
——
—
—
=——
SSS
FiG. 181,—Grooved Needles for Metallic Sutures.
——
—
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—
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——
————
——
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=—=
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——
Some needles are armed and protected with handles, as those
of Trelat, of Riverdin, and of Simpson. Sometimes their lanceo-
lated part has the eye pierced in its center; in others, the eye is
merely a notch, closed by a repulsor, moved by sliding through
the handle. Generally, the hand is sufficient to push the needle
through the skin, but at times, as has been mentioned, forceps or
needle-holders are necessary, such as the needle-holder of Mat-
thieu, an ordinary forceps or an ordinary pin-holder. The com-
mon wire dressing pin is also included among suture implements,
SIMPLE OR INTERRUPTED SUTURE, 151
Fia. 187.—Needle or Pin Holder.
but is not always efficient from lack of rigidity, when a stronger
and less flexible implement becomes necessary.
Sutures are of many kinds, some being superficial, others deep,
and otherwise classified, according to the requirements of their
application, into single, as when the thread or wire alone main-
tains the reunion, or compound, when it requires other and acces-
sory means, such as needles, pins, quills, etc., ete.
1. The simple or interrupted suture (Fig. 188) is formed of dis-
tinct stitches between the borders of the wound, each being tied
152 ELEMENTARY OPERATIONS.
Fig. 188.—Simple or Interrupted
Suture.
separately. It is made in two ways. By a first procedure, with a
needle holding a long thread, the surgeon holding both edges of
the wound, passes it through both at once, cutting the thread and
making each stitch entirely distinct, and tying then only when
they are all in place. He begins with the center stitch.
In the second procedure, a separate thread is prepared for
each stitch, having a needle at each end, which is passed through
the skin from within outward, and, as before, each stitch is tied
independently of the others. Often, only a single needle is used,
making the first half of the stitch from without inward, and the
second half from within outward.
This suture is used for recent wounds, and those in which
there is extensive laceration of the integument.
2. Looped Suture (Fig. 189).—This is an interrupted suture,
in which the threads, instead of being tied up separately over the
wound, are twisted together on each side, without being tied, in
order that each thread may be removed independently of the others,
if necessary. The cords are then twisted together, and sometimes
tied and sometimes not.
It was formerly recommended for intestinal wounds, and is but
little used at the present time.
3. Uninterrupted or Glover's Suture (Fig. 190).—This is a con-
tinuous suture, of which the stitches successively cross the wound
from both within and without. In making it, the thread is knot-
ted at the end, and the needle pushed through the skin at one ex-
tremity of one of the borders of the wound, from without inward,
and then directly opposite it through the other edge, brought to
DOSSILED SUTURE. 153
the first in crossing the wounds obliquely, and this is repeated
until the lower end of the edge, opposite to that at which the
suture was begun, is reached, when the thread is stopped by a
knot. Before securing the last stitch, care must be taken to re-
move any possible wrinkles between the stitches.
Fic. 190.—Glover’s Suture. Fic. 191.—Dossiled Suture.
4. Dossiled Suture (Fig. 191).—This is a variety of interrupted
suture, in which the thread is doubled, and at one end carries a
little ball or dossil of lint or oakum. Passed through one edge
of the wound from without inward, it is brought outside of the
wound, and cut the necessary length. Another similar thread is
passed through the other border in a similar way, and, when cut,
both threads are tied together in the center of the wound.
This suture is often used for the purpose of holding in place
the substances (wadding, oakum, etc.) that may be placed in the
wound, or to prevent the return of a hemorrhage. It is a strong
adjuvant of other hemostatic measures.
5. Quilled Suture (Fig. 192).—This is formed by a series of in-
terrupted stitches, supported on each side by a short piece of quill
or wood, or metallic pin, which must be longer than the great axis
YW
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OUUAGUOUTICLILUITTT
Av"
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YH Z
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nea Nanath
—
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Fic. 192—Quilled Suture. Fig. 193.—Suture with Adhesive Bandage.
154 ELEMENTARY OPERATIONS.
of the wound. To apply it, a double thread, with the ends knot-
ted, is passed through the edges of the wound, and several stitches
made in succession, as in the regular simple interrupted suture.
When these are in place, the support (quill, pencil or otherwise) is
passed through the lap of each double thread on one side of the
wound. Drawing this first quill close to the skin, the threads are
separated, and, between them, a second quill applied on the other
border of the wound, and secured in place by a knot. —
This suture is recommended for wounds of the abdomen. Peuch
and Toussaint recommend it after the removal of mammary tumors
in bitches. Sometimes elastic cords are used, in preference to or-
dinary threads, as being less putrescible, and yielding better to the
inflammatory swelling, etc.
Director Degive frequently employs the elastic suture with ad-
hesive bandages (Fig. 193).
Two adhesive bandages, of dimensions proportionate to that
of the wound, are glued on each side of it. These carry near the
border, in the neighborhood of the edges of the wound, small
holes, through which elastic rings are passed. These rings repre-
sent the threads used in the other mode of procedure, and through
these rings the quills or pins are placed, which will rest on the
outside of the bandages and keep them in place.
6. The single pin suture is a simple opera-
tion for small wounds, commonly used as the
last step of the operation of bleeding, and by
which both edges of the wound are brought
Fic. 194.—Single Pin together with a pin, and secured by a special
Sukunes double loop or hitch called the bleeding knot.
7. Twisted Suture (Figs. 195, 196).—This is frequently used
for wounds of the eyelids or of the nostrils. It consists in placing
through the borders of the wound as many pins as may be neces-
sary, and holding them by twists of thread. Ordinary pins are
generally used in veterinary surgery.
The pins are secured in different ways. In one case, the twists
are so made as to form a series of figure 8s, placing them two or
three times successively, first around the pin at one extremity of
the wound and repeating the movement with each pin. In an-
other way, instead of making a figure 8, the threads are turned
around the pins at each stitch, surrounding all with a circular
thread.
ZIGZAG SUTURE. . 155
Fic. 195.—T wisted Suture. Fig. 196.—Another.
Some veterinarians, in making this compound pin suture, prefer
the use of elastic rings to that of the circular or figure 8 threads.
We have personally used these rings with very satisfactory
results.
8. Zigzag Suture (Fig. 197).—This is a continued suture in
which the thread is made to cross and re-cross from one border of
the wound to the other. The procedure is as follows: a needle
carrying a long thread is passed through one edge of the wound
from without inward, and through the other in a straight direc-
tion from within outward. Starting with the same thread, a sec-
ond stitch is taken at some distance from the first, and on the
same side of the wound on which the first was ended, a second
stitch is made by passing the needle from without inward, and
back from within outward, to reach the side of the wound where
the first stitch was started at an equal distance from it. The re-
maining stitches are, of course, made in the same manner.
This suture has been recommended for the treatment of um-
bilical hernia in solipeds.
9. Suture of the Furrier.—This is performed with a needle and
a long thread, which is alternately passed through the edges of
the wound from without and from within. It is also a continuous
Fig. 197.—Zigzag Suture. Fig. 198.—Suture of the Furrier.
156 ELEMENTARY OPERATIONS.
Y
Y
Y
Y
e
N
N
N.
Ns
SS
\
Fig. 199.—T Suture,
suture, in which the coaptation of the borders of the wound is
regular and exact. It is principally applicable when the borders
of the wound have a tendency to overlap each other.
10. 7 Suture (Fig. 199).—This is the peculiar stitch used to
bring together the borders of a T or crucial incision. A thread is
used with a needle at each end, each of which is passed through
from without inward, in one of the angles of the T, and brought
from within outward beyond the transverse incision of the T when
being unthreaded and laid aside. The suture is completed by
tying the two ends of the thread together.
The same suture could be made with a single needle.
The same procedure is required for the crucial incisions.
11th. X Suture (Fig. 200).—This suture, which is recommend-
ed after spaying sows, is made by taking a stitch through both
edges at once, and carrying the thread obliquely across the wound,
starting the second stitch on the same border of the wound as the
first, and finishing in the same manner; the thread is then again
passed across the wound, and the ends tied together.
12th. Metallic Sutures.—These do not differ from the sutures
which we have considered, excepting that metals are used instead
of thread or silk. They are applied like the others, and secured in
the same manner, by knots or by twisting their ends together.
The period for the removal of sutures depends upon many
circumstances, and varies according to the nature of the tissues
involved, their thickness, and the species of the animals operated
on. In horses and in dogs, suppuration occurs more rapidly than
in ruminants or swine, and on that account the sutures cannot be
allowed to remain as long, without giving rise to the formation of
pus. Moreover, in regions where cellular tissues and blood vessels
are abundant, the pus is usually formed more rapidly than in those
REMOVAL OF SUTURES. 157
of the opposite formation, and consequently sutures must be re-
moyvedearlier. On general principles they should be taken out by
the fourth or fifth day, or even sooner, if indications of complica-
tion due to their presence are manifested.
In removing sutures, it is necessary to procced cautiously, in
order to avoid breaking any adhesions that may have been formed.
Asa general rule, but one should be detached at a time, be-
ginning at the least important point. The threads and needles
should be cut close to the side opposite to that on which they are
to be extracted; they must be carefully cleaned of crusts or dried
pus and any roughness whatever, and the skin should be carefully
held down as they are slowly drawn out. If the adhesion seems
at any points to be too light, the sutures must be left in a few
dayslonger. The application of adhesive mixtures, or of collodion,
will strengthen a weak cicatricial tissue.
When a suture has been applied, as well as when it has just
been removed, it is sometimes necessary, in order to prevent the
animal from biting or rubbing the cicatrix, to bring the cradle or
the side bar into requisition.
CHAPTER V.
OPERATIONS ON THE SKIN AND
CELLULAR TISSUE.
CAUTERIZATION.
The theory of the cautery is the irritation and disorganization
of living tissues, either by the immediate contact of heat or of
chemical substances, producing an analagous effect on the organ-
ism. Cauterization is thus of two kinds, the actwal and the poten-
tial, according to the agent employed in its production.
Potential cauterization, by reason of the nature of the agents
employed, as well as of the method of employing them, belongs
properly to the domain of therapeutics, and we shall therefore pass
the subject by with a simple mention, to give our attention to
what falls more particularly under the head of operative surgery,
the actual cautery.
ACTUAL CAUTERIZATION OR FIRING.
Firing is one of the most valuable of therapeutic agencies. It
is also one of the oldest and best known among methods of surgi-
cal treatment, in both human and veterinary medicine. It was
practiced and recommended as far back as the times of Columelle,
Absyrtus and Vegetius, when it was in high repute as a remedy
for articular diseases, sprains and weakness of the loins; but to-
wards the 15th century, its popularity waned somewhat, and it
seemed to have partially lost favor, until the days of Markam and
Gray in England, and Solleysel in France, where it regained by
degrees its former repute. It now holds an established place
among regular and methodical operations, and is one of the most
important among our surgical resources, applicable in many
pathological conditions, and efficacious in most. The following
long list of ailments and lesions in which it may be indicated is
given by Bouley.
oe o.
P
ACTUAL CAUTERIZATION OR FIRING. | 159
(a) Diseases of Joints.—Exostoses around the borders of
articular surfaces; sprains of ligaments; dilatations of synovial
bursze and indurations of their walls; dislocations; true or false
anchylosis; deformities of the extremities from excess of work;
congenital general weakness, etc.
(6) Diseases of Bones.—Exostoses; periostosis; callus of
complete or incomplete fractures; caries; necrosis.
(ce) Diseases of Tendons.—Partial lacerations; chronic swelling
after tenotomy.
(d) Diseases of Tendinous Sheaths.—Dilatation ; lacerations ;
changes in the structure of their walls.
(e) Diseases of Muscles.—Atrophy; induration; pathological
changes of structure.
(7) Diseases of the Cellular Tissuwes.—- Chronic cedematous
swellings; induration; abscesses; cysts.
(g) Diseases of the Nervous Apparatus.—Paralysis; occult
pains without visible lesions.
(h) Diseases of the Lymphatic System—Chronic lymphangitis ;
farcinous cords; pustules or tumors.
(7) Diseases of Weins.—Chronic phlebitis.
(7) Diseases of Arteries.—Hemorrhages.
(k) Special Diseases.—Carbuncular tumors; gangrene; ulcers ;
fistulas, ete.
To epitomise and simplify this long recapitulation, we may say
with Gourdon, that the use of the actual cautery is indicated when
its characteristic effect as an excitant and tonic is sought for in
atrophy, or in diseases of joints; or again, as a modifying factor
in chronic inflammation; as a derivative, and as a physical or a
preventive agent.
It is contraindicated in cases where there exists an excess of
vital irritation, or of inflammatory tendency, until the symptoms
which attend such a state of the system have more or less sub-
sided.
Actual cauterization is divided into the superficial and the
deep, the former being again subdivided into the mediate and the
immediate. In the immediate the iron is applied directly to the
skin, while in the mediate the action is supposed to be modified
by the interposition of some kind of medium.
The various modes of actual cauterization, according to Bouley,
are systematically exhibited in the following table:
160 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
[ Transcurrent, in lines.
| On surface, a la Gaulet.
; In points or dots.
Immediate Se jew e fee By ignited bodies.
By heated liquids.
| SUPERFICIAL. ... By radiation or objective.
|
l
Mediate......... lad skin or of a layer
By the interposition of
of lard.
l
{ Rapid.
| Inherent or disorganizing.
PENETRATING...
SUBCUTANEOUS.
Peuch and Toussaint have added the needle cauterization, and
firing with the thermo-cautery.
Overlooking several of these specifications, which are of little or
no utility, such as the firing with the inter-position of ignited bodies,
of heated liquids, kid skin, etc., we proceed to consider the
various prevalent and established modes in daily practice and of
general utility.
TRANSCURRENT, OR Firrmnc mn Lines.
The Cautery.—The instrument used in all these operations,
while formerly made of different metals, is now made exclusively of
iron, for which there are various reasons. It is not only because
of its cheapness and excellence and the general qualities which
give it universal precedence in the arts, but for some reasons pe-
culiar to the case. Thus, its changes of color when heated, render
it easy to gauge, proximately, the degree of heat, and it also
possesses the property of retaining heat longer than many other
substances.
The form of the cautery varies greatly. The style most com-
monly in use resembles a small hatchet, of triangular, prismatic
shape, thick at its base and with a thin border or edge, sometimes
convex, sometimes straight, and more or less sharp, according to
the indication. The handle is, of course, of wood or other non-
conducting material, and in respect to the weight, reference must
be had to facility of handling and power of retaining heat. The
THE CAUTERY. 161
my oy
Fig. 201.—Various Cauteries.
lighter ones are usually preferred, not only on account of this
facility, but as being less liable to produce too pronounced an
effect.
Heavy instruments, in consequence of the degree of heat they
radiate, and their contact with a broader surface of skin, are lable
to transform the firing into the condition of a mere burn.
The size of the cautery will necessarily be regulated by the ex-
tent of the region to be treated. The cautery must be perfectly
smooth, on its surface as well as on its thin edge, and to ascertain
that this is the case, before they are heated a file should be passed
over both surfaces, and before being applied to the skin they
should be again inspected by the surgeon or an assistant, to be
assured that the edge is clear and clean, and there is no roughness
to cause a ragged and uneven line on the skin.
In heating the cautery, a charcoal fire is much to be preferred
to that from the blacksmith’s forge. The latter soon soils and
blackens the instrument, while the former is smokeless and every
way cleaner, besides being portable and always convenient.
There is no uniform rule to govern the position in which the
animal must be secured. While there are occasions when he can
be treated while standing, and kept under control by the simple
means of restraint, in many, and indeed in a majority of cases,
162 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
it will be every way advantageous to have the patient thrown down
and secured, in order that the region to be fired may be exposed
as freely as possible—a point which has already been considered.
The parts upon which the firing is to be made must be thor-
oughly cleaned and especially free from scabs or greasy sub-
stances. The hair is to be clipped short whenever its length and
thickness are likely to interfere with the action of the instrument ;
yet the skin must not be shaved, inasmuch as a thin coat of hair
will always prove rather an assistance than otherwise, in drawing
the first lines, by preventing the instrument from slipping.
There was a period when animals were fired with a view to
their alleged ornamentation, without any pretext of necessity aris-
ing from disease, but simply in conformity to the behest of fash-
ion (and possibly as a means of the identification of property), but
this artistic firing for fashion’s sake is now altogether discarded,
and the burned-in shapes of fern leaves, stars, crosses, harps, etc.,
Fic. 202.—Old-fashioned Drawings.
etc., have made room for firings inflicted for better reasons and
with more beneficient and valuable results.
And while the results of these esthetic and artistic firings
made for purposes of embellishment were usually ugly, un-
sightly cicatrices, thickened and hairless, the operations of the
present time leave as their sequel but slight and superficial
marks, which are hardly entitled to rank as blemishes, though in
this connection must not be included, the Prangé firing (Fig. 203),
which, with its peculiarity, is applied as the ordinary line firing,
except that the lines are divided in small sections.
Firing in lines must be applied not only upon the diseased
part, but must extend somewhat beyond it, and the lines must be
made as nearly as possible parallel with the direction of the hair.
FIRING IN LINES. ’ 163
Fic. 204.—Various Forms of Drawing in Firing.*
*The firing on the loins we think ought to be parallel to the median line instead
of oblique.
164 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
This rule we consider a very important one, although it is known
that European veterinarians, when operating in some special re-
gions, entirely disregard it, firing in lines running at right angles
with the direction of the hair, though it is quite obvious that the
result must be an irregularity in the growth of the hair and a
wavy appearance, which can be entirely avoided by observing the
rule we have referred to.
A glance at Fig. 204 will give the reader an idea of the proper
form for making the drawings and the directions of the lines.
Not only should the lines run parallel with the direction of the
hair, but it is equally important that there should be no deviation
in the width of the intervals between the lines. It would be im-
possible to give exactly the distance which must separate them,
as this depends upon the thickness of the skin, the condition of
the patient and the effects to be produced.
In drawing the lines it must be remembered that they ought
to be of an even depth their entire length, but we do not think
that this can be easily accomplished with the instrument having
the convex edge, while there should be no considerable difficulty
in effecting it by a steady ahd uniform manipulation with the
straight edged iron, and by merely raising the hand at the begin-
ning of the line and depressing it slightly at the end.
The cautery must never be passed in one line against the
erowth of the hair, and by always drawing it toward himself the
operator will avoid injuring the bulbs, and escape the danger of
causing a subsequent abnormal growth of hair. Nor should the
cautery be passed twice in succession in the same line. If the in-
strument should slip out of its track before reaching half its
length, the line should be abandoned and the next one proceeded
with. To determine the lines correctly, and follow them accu-
rately by the eye alone, requires a natural aptitude which all do not
possess. It is an art, however, which, if possible, should be ac-
quired, and as well as when existing naturally, cultivated and im-
proved, by study and practice. But in the absence of the natural
faculty, which it is so desirable for the surgeon to possess, resort
must be had to the obviously reliable expedient of previous mark-
ing, by which a charcoal mark upon a light-haired, or a chalk mark
upon a dark animal will obviate all risk of lack of symmetry and
want of regularity.
The degree to which the cautery should be heated, as well as
a a
a
an
RULES FOR APPLYING THE CAUTERY.. 165
the manner in which it must be moved on the skin, is to be deter-
mined by the steps of the operation. In beginning the markings
of the firing or the initial drawing, the iron must be of a dark red
color, just hot enough to burn the thin coat of hair left on the
skin. By this method, any irregularity in the drawing can be re-
moyed and corrected by the passing of a second instrument.
When the entire surface has been covered with the initial draw-
ings, and everything is correct, the heat of the cautery can be
slightly an | progressively increased as the operation approaches
the end. The rapidity with which the instrument is moved over
a line should vary inversely to the degree to which it is heated, the
thickness of the skin, the consistency of the subcutaneous tissues,
and also the stage of the operation. Generally, the movement of
the cautery should be accelerated when the heat is greatest, when
the skin is thin, when the tissues underneath are hard, and when
the operation is nearly completed.
Another important rule is not to apply too heavy a pressure
upon the cautery when moving it over the skin. A slight pressure
with a slow movemeat is harmless and even advantageous at the
beginning of the operation, or when the skin is thick, but it be-
comes dangerous under the opposite conditions when the heat of
the cautery is extreme. In such a case a true incision of the skin
may be the result. Firing is essentially a bloodless operation
even when severely applied, but it is only by the careful observ-
ance of the above rules that hemorrhage during actual cauteriza-
tion can be avoided. Its appearance during the operation is, we
believe, the result of inattention, and caused by too hastily raising
the heat of the instrument, or more often by excessive pressure
upon it.
The observance or neglect of these rules will demonstrate the
difference between scientific and unscientific firing, and show that
while one is true scientific surgery, the other is simply burning
the skin. The first is applied by one who appreciates the value
of the results he hopes to realize, while the other merely places a
hot iron in contact with the skin, quite ignorant of the good or
evil results which may follow the act. As the operation progresses,
changes take place upon the lines, which give an indication of the
strength of the firing. These objective changes consist in a change
of color in the lines, and an accompanying exudation from the skin.
In the first degree, or light firing, the lines are not deep, and
166 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
are of a golden yellow tint, having only a few isolated drops of
serosity at their sides, the dermis not being extensible, and the
skin between the lines free from infiltration, the epidermis can-
not yet be scraped with the finger nail. In the second degree or
ordinary firing, the lines are of a lighter color, or bright yellow,
the drops of serosity are more abundant, the dermis is more ex-
tensible, the skin between the lines is thickened with infiltration,
and the epidermis is easily scraped off. In the third degree, or
strong jiring, the lines have a light yellow color, the dermis is so
thinned that the slightest traction of the portions between the
lines, which then become wider, stretches it, the serosity is abund-
ant and overruns the edges of the lines, and the skin between
them is infiltrated and possibly covered with small phlyctenases or
blisters. To proceed further will be to produce a deep burn,
which may be followed with serious complications, or at the least,
leave large, unsightly cicatrices.
The length of time required to produce these effects, and the
frequency of the applications upon a given region, are points by
no means easily determined. They are affected by many contin-
gencies, which cannot be anticipated. According to Fromage de
Feugré, a cautery heated to a cherry color must be used in each
line from ten to twelve times for a light firing, and from fifteen to
twenty for more serious cases; but Gourdon considers these fig-
ures too high, and says that from five to six strokes will be suffi-
cient for a firing of the first degree, from eight to nine for one of
the second, and from twelve to fifteen for the third, or strong fir-
ing. But these figures have no absolute value. The number of
strokes will depend upon many conditions, such as the heat of the
instrument, the state of the parts and the dexterity of the operator.
The effects resulting from actual transcurrent cauterization
may be divided into primitive and secondary.
(a) Primitive effects. —The inflammation which follows the
burning manifests itself by the appearance of a serous exudation,
the serosity being in the form of small drops, in greater or less
abundance, according to the degree of the cauterization. This
serosity collects between and at the bottom of the lines, and con-
tinues to flow for from twenty-four to forty hours, when it is re-
placed by the formation of crusts or scabs, dry, yellowish, and ir-
regular, and if the firing has been light, attached to the bottom or
the borders of the lines; but covering the entire cauterized sur-
PRIMITIVE EFFECTS. 167
face between the lines, as well as at the bottom, if the firing has
been stronger. These crusts of dry serosity remain adherent for
a few days only, and from the sixth day to the eighth they begin
to separate, but the dropping off of the cauterized portions of the
skin requires alonger time, varying according to the degree of the
firing. In the first degree they are eliminated by the formation
of a new layer of epidermis. It is a process of dry desquamation
by which they are exfoliated, and requires from two to three
weeks for its accomplishment. In the second degree, when the
thickness of the cauterized tissue is greater, the scabs proper are
more adherent, and it requires a process nearly allied to one of
suppurative expulsion, which may consume a month before the final
sloughing is accomplished. In the third degree, a regular process
of suppuration is necessary for the removal of the scabs, and
its completion will require a period of not less than five or six
weeks.
After light firing, the marks left are scarcely detectable; after
the second degree, the hair grows over the lines, but in an irregu-
lar way, giving a somewhat roughened appearance to the part,
while the strong firing leaves a thick and callous epidermis, and
therefore a serious cicatrix. Besides these first and direct effects
of the cautery, there are others which ought not to be overlooked.
About the parts where the firing has been applied, the skin and
the subcutaneous tissues become the seat of extensive inflamma-
tion, accompanied with pain and swelling, and in some animals
this may assume a severe aspect. The swelling may extend until
it involves the entire extremity, and this may seriously interfere
with the act of locomotion. It, however, subsides and disappears
as the process of the removal of the scabs advances, and when
this has been accomplished, the swelling and pain will also have
disappeared.
(0) Secondary effects. These are slow in their development,
and cannot be easily or well described, and they vary widely ac-
cording to the objects for which the firing has been applied. It
may be said, however, on general principles, that the development
of secondary effects cannot be expected except after a consider-
able lapse of time, allowing at least several months, and in any
case, only long after the objective effects have entirely disappeared.
The treatment following the operation, is of a very simple
character. For a few days, and until the secretion upon the
168 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
cauterized parts has dried and the scabs have begun to slough,
the animal must be restrained from lying down, and biting or
rubbing himself, nor must this vigilance be relaxed, until the
danger of breaking up the surface of the wound has ceased, with
the temptation which was kept up by the continuation of the irri-
tation, with the dropping off of the scabs and of the cicatrization.
There is no necessity for interference with the sloughing of the
scabs, or occasion for impatience to see them removed. After
a period of time, which varies according to the severity of the op-
eration, they will separate spontaneously, or with a little friction
of the parts, or washing with tepid water and soap.
A question of some importance in connection with this oper-
ation, is that which refers to the use of oily or greasy substances
in the treatment of the cauterized surface. In times past this was
accounted to be good practice, and soothing embrocations were
recommended and freely employed, but this treatment has become
nearly, if not wholly, obsolete. At the most, vesicating prepara-
tions are considered allowable, but even these only under special
conditions, as when the cauterization has not been sufficiently
strong. This practice is specially prevalent in the United States,
where the operations of firing and blistering are almost always as-
sociated. This combination has nothing objectionable, and in fact
is justified by the apprehensions and opposition existing among
Americans. Yet practitioners must always remember, that if
many cases where firing is indicated terminate unsatisfactorily,
after both firing and blistering, it is because the true and local
effects of the cauterization, by ordinary or strong firing, have not
been produced, when they were necessary to obtain good results.
The possibility of ugly cicatrices cannot be well avoided if proper
firing is to be depended upon. In view of the fact that the effects
of firing are not limited to those which visibly and immediately
appear on the surface of the skin, but that others of importance
are also to be anticipated, after a certain time, the question of the
duration of the rest necessary for the patient after the firing, be-
comes one of some importance.
All written authorities on the subject agree in saying, that
this rest must be a long one, reckoning it by months, though in
some instances light exercise, or even light work, may be allowed
sooner. Generally speaking, however, the surgeon will be guided
by the nature and history of his case, and especially by the extent
SECONDARY EFFECTS. 169
of the cauterization. The patient will of course require perma-
nent and absolute rest for a few days, or until the serosity and
the scabs have dried, but after that he may be allowed the liberty
of a box-stall, or of the pasture, without interfering with the
necessary oversight of his condition and progress. There are
cases where moderate walking exercise could not be otherwise
than beneficial in its effect upon the final result.
Though, as we have said, the application of greasy medica-
ments may not be recommended, yet, as a substitute or alterna-
tive, blistering ointments may be used to supplement too light a
firing. It is, in fact, not rare to find it necessary to follow the
firing with a severe blistering after the scabs of the first operation
* have fallen off. If this is done, however, it must not be until the
more active effects have diminished, and the inflammation has
subsided.
It may sometimes become necessary to solve the problem of
the duty of the veterinarian in cases where an animal requires the
treatment of the cautery on two places on one leg, or on two legs,
or perhaps on the entire four.
Humane feeling alone ought to furnish a sufficient guide in
this matter. When the operation is not only in itself so excep-
tionally painful during its performance, but is followed by further
suffering arising from the necessity of protecting the animal
against himself, it should be considered sufficient to inflict the
firings singly, and after the first infliction to repeat the torture
only after a respite of several days. On this point we differ from
the opinion expressed by some European writers, and cannot dis-
cover the alleged benefit to be derived from any extra dispatch,
in the absence of any urgent reason for considering it to be im-
perative. Our conviction is strong that one firing ought not to
follow another until the immediate effects of the first have sub-
sided, and the animal has had several days to recuperate from the
ereat strain he has been compelled to endure.
The application of transcurrent cauterization is very often in-
dicated in solipeds, and we borrow from Bouley a list of the ordin-
ary lesions for which it is most frequently employed.
A.—Raecions oF THE Extremities. Coronet.—Indicated against
ringbones, circular periostitis following phalangeal arthritis, or
deep penetrating wound of the foot; exostosis following fractures.
Applied in lines, parallel to the axis of the bone; not too near to-
170 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
gether, to avoid sloughing of the skin; never fire beyond the
second degree; avoid burning the coronary band. Results: gen-
erally efficacious, but necessary to repeat it.
Fretlock.—Articular or tendinous windgalls ; exostosis; perios-
titis after sprains or arthritis; induration of tendons; cold infil-
trations and induration of cellular tissue; knuckling. Applied
in parallel lines, vertical in front and slightly oblique behind. Re-
‘sults: not so satisfactory, though in many cases favorable.
Cannon.—Splints; callous and thick tendons; cold infiltra-
tion and induration of cellular tissue. Applied as in the fetlock.
Results: generally very satisfactory; second firing is often re-
quired.
Knee.—Articular and tendinous synovial dilatations at any —
part of the joint; hygroma; bony deposits. Applied in parallel
lines, vertical in front or oblique on the lateral faces. Very ad-
vantageous for synovial dilatations and hygroma; less so in exos-
tosis.
Forearm.—Bony growths of any kind; muscular weakness,
manifested by sprung knee. Lines parallel to the axis of the re-
gion. Beneficial for exostosis; doubtful in the other cases.
Elbow-joint.—Bony deposits; dilatation of articular synovial
sac. In parallel lines. Results very satisfactory.
Arm.—Weakness of olecranon muscles. In lines parallel to
the hairs. Results very doubtful.
Shoulder.—Muscular atrophy; paralysis; diseases of the artic-
ulation, dilatation of the coraco-radialis burs; lameness of un-
known nature, and located in that region, may involve the en-
tire region, or it may only cover the scapulo-humeral angle. In
the first case, applied in lines parallel to the direction of the
hair, extending from the upper to the lower end of the scapula,
the firing has an oval shape; in the second case, the firing is
circular, and forms parts of two parallel lines, slightly oblique to
each other. Generally advantageous in atrophy and occult lame-
ness, doubtful in paralysis, not so much in articular or tendinous
diseases.
Hock.—Articular or tendinous tumors, hygroma, dilatation of
the bursze of the extensors of the cannon and flexors of the foot,
bony growths, peripheric periostitis, cold infiltrations, and indura-
tions of cellular tissue. Drawings of the firing at the hock vary,
according as it may be desired to fire the entire joint or only part.
;
:
q
;
A
4
q
‘
—
REGIONS OF THE BODY. 171
In this latter case it is applied in vertical or oblique lines, form-
ing a drawing as regular as possible. In the former case two ways
are recommended ; in one the surface of the hock is divided into
halves by a line drawn parallel with the tendo-Achilles; all lines
back of this one are parallel with it, and all those in front of it
are parallel with the front of the hock, and therefore slightly
oblique to the others. In the other method, a line is drawn from
the point of origin of the tendo-Achilles vertically downward to
the cannon bone, and upon this, oblique, feather-shaped lines are
drawn on each side. Results, generally rather favorable in all
the diseases of the hock.
Leg.—Bony deposits, rupture of the cord of the flexor meta-
tarsi; chronic swelling applied in lines parallel to the region.
Results, very advantageous.
Stifle—Dilatation of femoro-patellar burs, exostosis of the
patella, luxation, pain remaining after bruises or wounds, liga-
mentous fistulas of old standing. Applied in several parallel ver-
tical lines in front, and on each side oblique to them. Results,
almost always successful.
Thigh and Coxo-femoral Joint.—For similar lesions to those
of the shoulder, atrophy, paralysis, occult lameness ; same appli-
cations. Results about the same.
B. —Recions or THE Bopy. Loins.—Weakness of vertebral
column due to paralysis; sprain of the vertebral column, vertebral
periostitis, occult pains. Applied in lines parallel or oblique to
the median line of the body. Results generally doubtful.
Withers.—Chronic cysts, indurations following fistulous
withers, old fistulas. A few lines parallel with the vertebral col-
umn, the others oblique. Results almost always beneficial.
Ribs.—Acute or chronic pleuresy and pneumonia. In lines
parallel with the long axis of the ribs; seldom used, the results
are difficult to appreciate. Principally used by Nicholson and
Maclean against contagious pleuro-pneumonia.
Fririnc ON THE SURFACE, OR A LA GAULET.
This is so named after its inventor. The mode of operation
is with cauteries which have their border, or the part which is
applied to the skin made to form a flat or slightly convex sur-
face (instead of being thin and sharp), in order to remedy one
of the principal objections to ordinary firing, that of leaving
172 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
permanent marks. It proposes to effect this by throwing upon
the surface of the skin an even radiation of heat. The descrip-
tion given by Mr. Gaulet is this: “The iron being heated to
nearly a cherry color, a straight line is made in the principal
direction of the region to be fired, and immediately alongside of
it another, and so successively until the entire surface is covered.
The first lines are then crossed, transversely or obliquely, by
others, which perhaps also touch each other, and at last, in order
to have the entire surface evenly cauterized, the parts which have —
not been touched in tracing the original lines are also touched
with the iron which then retains but one-half of the heat it pos-
sessed at first.”
* * * « After twenty-four hours, or perhaps less, an inflamma-
tory swelling takes place, and the skin is covered with small
blisters of serosity; three weeks after, the crusts which have fol-
lowed begin to drop off, and the hair is seen growing underneath
them.” .
According to Bouley, this method cannot be substituted for
the ordinary cauterization. If applied lightly, its effects are not
more severe than those of an ordinary blister; but if applied in a
severe form, it is liable to be followed by the sloughing of large
portions of skin, and to leave behind cicatrices of the very worst
description. It has, however, in the hands of Mr. Paul Bouley,
given satisfactory results in its application upon the stifle, the
point of the shoulder, and the cyst of the withers, and with Mr.
Naudin, in the treatment of chronic swellings of the extremities.
Firina in SuperFiciaL Pornts.
This form of cauterization is performed with instruments of
conical or olivar forms (see Fig. 201), having the point blunt and
rounded, in order torest on theskin without incising or penetrating
it. The point must not be so long as to cool off too rapidly, nor
so short as to be incapable of retaining a sufficient amount of heat.
In this mode of firing, the points or dots are arranged in quintu-
ples, a first series of points being marked in either a vertical,
oblique or horizontal line, equidistant from each other, and more
or less close according to the indications; a second series is
marked on a parallel line, at a distance equal to that which sepa-
rates the dots of the first series, and placing the first point on a
line with the middle of the space separating the dots of the first
FIRING IN SUPERFICIAL POINTS. , 173
series, thus alternating the application of the points in a third and
fourth series, until the whole surface is covered. This makes a
regular drawing, and leaves but little blemish afterward.
The rules pertaining to the application of firing in straight
lines are the same as in the cauterization in superficial points, and
they apply to this also, but we believe this is to be better indicated
in the firmg of small surfaces, for bony deposits, ringbones,
splints, spavins and side-bones, or generally in the treatment of
circumscribed diseases.
Fic. 205.—Firing in Dots and Points.
Firing in points is always more effectual than that in straight
lines, and being exempt from the danger of skin sloughs, it always
leaves fewer blemishes. Moreover, in a majority of cases, it can
be applied without casting the patient. These are points which
should count largely in its favor. The principal objection to be
urged against it is the greater length of time required to realize
the full measure of its effects.
Mr. Prangé has invented a mode of cauterization, which is very
similar to that in superficial points, but differing from it in the
fact that instead of points, the ordinary flat iron is used.
It is cauterization in lines, but instead of being long and made
with one stroke of the cautery, they are divided into short lines
(see Fig. 203), also arranged in quintuple, like the dots of the
point firing. This method has not found favor with those who
have experimented with it.
174 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
OBJECTIVE FIRING.
In this mode of cauterization, the heat is transmitted, not by
contact, but by radiation. It is a process rarely resorted to, and
when it is used it is more as an adjunct to transcurrent firing, or
as a simple mode of revulsion. It consists simply in bringing the
heated iron in close proximity with the surface to be cauterized.
Gaulet is reported to have obtained good results from it in
the treatment of ulcers, grease and ophthalmia; Leblanc in chronic
diseases of the eye, and Laux in the treatment of chronic lameness
of the thigh. According to Gourdon, it is indicated for the arrest
of some internal hemorrhage of mucous membranes; for the re-
duction of prolapsus of the rectum and of the uterus; in hernias;
to stimulate the cicatrization of ulcers, and against some chronic
inflammation of mucous membranes, of the conjunctiva, the pituit-
ary membrane, ete.
The cautery used by Mercier is square, oval or circular, with
the surface, which is to face the skin, unpolished, while the other
is smooth and polished, a disposition designed to graduate the
firing by facilitating the radiation of the heat with the first, and
diminishing it with the second.
The special aim in this plan is to avoid the formation of a slough,
and to attain it as perfectly as possible, the firmg ought to be so
managed, as to approximate the point of disorganization as nearly
as possible without reaching it.
In operating, the surgeon, after satisfymg himself of the con-
dition of the skin and its subjacent connections, moves the instru-
ment to and fro over the part, carefully avoiding contact with the
tegument. If the hair burns too quickly, it indicates an excess of
heat, or that the instrument is too near the surface. The heat
should be gradually increased from a brown to a cherry red color.
The duration of the operation depends on the condition of the
skin. When the epidermis can be easily scraped with the finger-
nail, or is raised by the formation of small blisters, and the fired
surface becomes moist, and shows little drops of serosity, and the
skin becomes thicker, denser, and more adherent to the subjacent
tissues, the evidence is present that the proper degree of firing has
been reached. 4
The serosity increases immediately after the operation, and
for some time continues to flow, until the surface is covered with
OBJECTIVE FIRING. 175
its dried pellicles or crusts. On the second or third day an in-
_ flammatory swelling is developed, and all the symptoms of ordin-
ary firmg are manifested, and after three or four weeks the reso-
lution is complete.
If the firmg has been too severe, the serous secretion becomes
very abundant, and the inflammatory swelling increases rapidly and
becomes warm and painful. Towards the fifth or sixth day the
skin becomes black, dries up, shrinks, is raised in large patches,
and sloughs off, leaving a broad surface, covered with large granu-
lations, very slow to cicatrize. One great advantage which objec-
tive cauterization can claim over ordinary firing is, that when prop-
erly performed, it leaves no blemish whatsoever.
Deep CavTERIZATION.
The cauterization which is carried beyond the thickness of the
skin and penetrates the subcutaneous structures, receives this
designation.
The manner in which the cautery is inserted into the tissues,
and the length of time it is allowed to remain in contact with them,
have justified the division of this kind of cauterization into rapid
deep, and inherent, or disorganizing cauterization.
Rarip Deep CaAvuTERIzATION.
This is the comparatively recent mode known as needle jiring,
inasmuch as it consists in the insertion of elongated sharp, needle
shaped cauteries, heated to alight red. Urbain Leblanc is credited
with the introduction of this species of instrument and is the
FIc. 206.—Abadie Cautery.
176 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
author of the first report of its results. The first cautery used
by Abadie resembled the one shown in Fig. 206. In using it,
the animal is generally secured in the standing position. It is
applied at a light red heat and made to penetrate through all the
tissues down to the subcutaneous cellular structure, and even
through the synovial sheaths. Leblanc’s advice is to make the
puncture by passing the iron three or four times in succession in
the same spot, but Abadie completes it atasingle stroke. This
firing is followed by severe inflammation of the parts, great pain,
swelling, abundant serous secretion, and the escape of synovial
fluid. It has, therefore, powerful revulsive effects, which, how-
ever, leave scarcely any marks, provided only the finest parts of
the cautery have penetrated the tissues. Otherwise extensive and
fatal suppurative arthritis may be looked for. This cauterization
is indicated in cases of exostosis, tendinous swellings, articular and
tendinous synovial dilatations, splints, ringbones, spavin, side-
bones, thick tendons, articular and tendinous windgalls, thorough
pins, blood spavins, ete.
In the true needle cauterization or ignipuncture, the form of
the cautery is changed, but in all other respects there is no
difference.
The forms of the needle instruments are numerous, and of
course each one claims some special merit. The cautery of
Bianchi and that of Foucher were first used, and these were fol-
lowed by the instruments in which the point or needle of platinum
could be changed. There were others of more complicated make,
as those of Bourguet, Salles, Lagarrigue, Vasselin and others, or
Fic. 207.—Bianchi Cautery,
RAPID DEEP CAUTERIZATION. 177
¥
:
Fig. 208.—Foucher Cautery.
of more recent invention the autothermic cautery of Mr. Ehret
(Fig. 211).
In using these instruments, whatever may be the position of
the animal, the perforation is made with a single stroke only, the
points being from three-fourths of an inch to an inchapart. When
operating on a synovial bursa, the needle is applied but once; but
if the skin is thick and indurated, two or even three times may be
necessary. The subsequent application of a stiff blister is recom-
mended by some, immediately after the operation, but by others
after an interval of a few days. This firing is always accompanied
by severe inflammation and its usual phenomena, but it generally
subsides after a few days.
178 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
<q
Fia. 209.—Cautery with Changing Points.
No severe accidents are likely to accompany needle firing.
Small hemorrhages may occur, but they usually cease spontane-
ously, though it must be admitted that fatal cases of arthritis
have been recorded, which, however, are avoidable by the use of
proper precautions. The attention required by the patient after
these operations do not vary from those required in ordinary cau-
terization, although the duration of the period of rest, always
necessary, may be less prolonged.
INHERENT F'rrRine.
This differs from other kinds, in being performed with the
cautery heated to a white heat, with a view to produce more or
less deep disorganization, according to the needs of the case.
Sometimes the application is made upon the surface only, but at
others at a required depth upon the deeper tissues.
179
INHERENT FIRING.
FIG. 211.—Autothermic Cautery.
Fig. 210.—Bourguet Cautery.
180 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
In the first instance, itis indicated in superficial cutaneous ulcers,
in wounds indisposed to cicatrize; in those following warts, in fun-
goid growths, in cancerous, melanotic or fibrous tumors, in gan-
grenous wounds and those following the opening of a cold abscess ;
in fistula due to caries or necrosis of bones, tendons or ligaments,
etc. The instruments used are of various shapes: round,
olivary, annular or cultellar. They are applied firmly upon the
tissues, and held in place for a few seconds, according to the density
of the parts If the surface is wider than the instruments, the
firing must be done by sections, applying the iron in detail upon
spots, until the entire surface has been touched. This is a better
method than that of rubbing the instrument over the surface, and
renders the effect more regular and uniform. In the second
degree, or the cauterization into the depth of the tissues, a conical
instrument is used and held in its place of insertion until it has
lost most of its heat, thus reaching whatever depth may be neces-
sary.
This cauterization is indicated against anthracoid, gangrenous,
farcinous and cancerous tumors; in wounds of a virulent or veno-
mous nature; in purulent infiltrations of the skin or of the
cellular tissue; in caries of bones, tendons, cartilages and liga-
ments, in dental caries, in indurated tumors, in fungoid growths,
polypoid granulations, ete. Renault has recommended them in
the treatment of the large sores so often occurring in granular
dermatitis.
SUBCUTANEOUS CAUTERIZATION,
Otherwise known as Neapolitan cauterization, or “a la Nan-
zio,” consists in the application of the cautery in points directly
upon the muscular structure, exposed by an incision made through
the skin. The method was known and had been mentioned by
Ruini, Solleysel, Bourgelat, Reynal and others in more or less
modified and varying terms, before Mr. de Nanzio called the at-
tention of the profession to the good results he had obtained by
it.
Its application is principally efficacious in the treatment of
chronic lameness of the shoulder or of the coxo-femoral joint.
The instruments required are two bistouries, one curved and one
straight, two flat tenaculums, a bull-dog forceps, scissors and an
ordinary olivary cautery. De Nanzio thus describes the opera-
SUBCUTANEOUS CAUTERIZATION. 181
FIG. 212.—Cauteries of Nancio.
tion: “My method consists in making an incision from above
downward to the skin covering the articulation, the location of
which has been first carefully determined. The skin is then dis-
sected from the cellular tissue, and the flaps enveloped with folds
of wet cloth. The flat tenaculum placed on each border of the
incision keeps it open, and with a blunt cautery, not too red, three
Fia, 213.—Firing 4 la Nanclo.
182 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
or four points are applied upon the seat of the articulation,
carefully ascertaining with the finger the point which the cau-
terization has reached, and carefully avoiding the opening of the
joint.”
The subsequent treatment is simple, and consists in cleanli-
ness, lotions of clear or slightly astringent water, and the protec-
tion of the wound by small threads of oakum. The suppuration
is abundant and the wound ugly, but these effects are soon modi-
fied, and healing is followed by only a simple linear cicatrix. Se-
vere complications have been recorded as sequelee of this operation,
but, on the other hand, several authors have spoken of it in very
favorable terms. Our own experience with it has not been suffi-
cient to warrant the expression of a confident opinion.
CAUTERIZATION WITH THE THERMO-CAUTERY.
This valuable instrument, the invention of Doctor Paquelin,
has only within a comparatively recent period been added defi-
nitely to the armament of the veterinarian. The original instru-
ment, as used in human surgery, has been modified by the inven-
tor, and as now sold by our instrument makers, is fully adapted
FIG. 214.—Paquelin Cautery.
CAUTERIZATION WITH THE THERMO CAUTERY. 183
i
i) =
3 Mths
~N
Y
(fem CS \i;
4 aK
i \ }
FIG, 215.—Paquelin and de Place Cautery.
to veterinary practice, and possesses points of superiority over
all the rest. It is used in the same manner and under the same
rules as other modes of firing already considered, but while its
application is followed by similar results, it possesses also many
other attendant advantages, which render it a valuable addition to
our operative means.
The veterinary cautery of Paquelin and de Place is a modifica-
tion which has recently been introduced, and which is considered
superior to the original instrument by those who have used it,
principally on account of the facility with which an even degree
of temperature is kept during the entire length of the operation.
The low price of the instrument is also an important item for vet-
erinary practice.
CAUTERIZATION IN OTHER ANIMALS.
Firing in Large Ruminants.—If firmg is not as commonly
used with these animals as with solipeds, it is not because its ne-
cessities are less frequent, but rather from economic considera-
184 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
tions, and because when they become seriously disabled, instead
of subjecting them to expensive surgical treatment, a wise pecu-
niary policy consigns them to the shambles where they may still
claim an unimpaired market value; while a dead horse is (in
popular estimation, at least) held to be of no particular worth in
theory, that is, whatever may be the unconscious practice of un-
inquiring eaters of ‘ beef.”
It has been applied, however, in very numerous instances, by
Cruzel, Roche, Lubin, Festal, and especially by Lafosse, who rec-
ommended its application in articular, muscular and tendinous
lameness ; for synovial dilatations, bony growths, anchylosis and
luxations, and also in nervous affections, epilepsy, paraplegia, va-
rious paralytic cases and amaurosis.
The modus operandi is the same as that already described
for solipeds, although allowance must be made for the thickness
of the skin, which requires a deeper application, and necessitates
the repetition of the firmg from twelve to fifteen times in the
same line, in order to obtain an ordinary effect. The scabs of the
firing generally separate in from fifteen to twenty days, and leave
pale rose wounds, followed by cicatrizations with a smooth sur-
face. The swelling of the parts, and the reactive fever following
the operation, is more severe, but subsides quite readily. The
animal must be prevented from rubbing or licking himself in
order to obviate the danger of secondary wounds with their trou-
blesome complications, as with solipeds.
In smaller animals cauterization is seldom resorted to. In
dogs, however, its application is sometimes indicated in lameness
of the elbow, the stifle, and even the hip jomts. Superficial firmg
by points has been advantageously applied, and is recommended
by Peuch and Toussaint.
Accrpents oF ACTUAL CAUTERIZATION.
To a great extent, the accidents and failures following the use
of the cautery result from the non-observance of the rules estab-
lished for the regulation of the operation, and subsequent care-
less and incompetent nursing. The remedy for these is too obvi-
ous to need mention.
(a) Section of the Skin.—This is a very common accident, usu-
ally chargeable to the carelessness or incompetence of the sur-
ACCIDENTS OF ACTUAL CAUTERIZATION. 185
geon, or it may be caused by the use of too heavy or too sharp an
instrument, or to an excess of heat or of pressure. It is recog-
nized by the separation of the edges of the wound, and the ap-
pearance at the bottom of the lines of a white nacreous stria,
shown by the subcutaneous tissue. There is no remedy for this
accident, and though it is not a very severe lesion, it is likely to
be followed by rough and irregular cicatrices.
(0) Hemorrhage.—We have said that firing is an essentially
bloodless operation if properly performed. The appearance, there-
fore, of drops, or perhaps of a small stream of blood, at the bot-
tom of the lines or points, and perhaps running over the surface
of the skin, though unattended with danger and not likely to be
injurious, is, at the least, evidence of some miscarriage of skill.
If it arises from the use of a rough or too sharp an instrument, it
can be readily suppressed by searing the part, or applying upon
bleeding vessels another cautery, heated a little in excess of the
first. Sometimes the burning of a small quantity of pulverized
resin, or of a small lock of hair in the bleeding cavity, will have
a sufficient hemostatic effect, and simple pressure will seldom, if
ever, fail.
(ce) Tearing off Scabs.—This is the result of careless and in-
secure dressing, and in omitting to provide effective safeguards
for preventing the patient from reaching the wound with his own
teeth, or rubbing it against some hard object. Suppurating
wounds of various dimensions are often the result of this inad-
vertency, requiring careful treatment, and sometimes leaving bad
blemishes to be regretted.
(d) Sloughing of the Skin and Subcutaneous Tissues.—This
accident is not uncommon, and like that just mentioned, is the
effect of the improper application of the cautery, though less the
effect of the firing than of burning the parts, and it is character-
ized by all the conditions of ordinary burn wounds. Among
specific causes, however, may be mentioned too strong a firing,
or firing with lines too near together, or touching each other at
some angle, or in crossing, or when too large an iron is used, or
one brought to a radiating heat, or too high a temperature; or
- when greasy substances have been applied in the lines, or the skin
submitted to long frictions. All these causes tend to the disorgan-
ization of the skin, with mortification and sloughing, and its separa-
tion in large patches, leaving after healing, broad, ugly blemishes.
186 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
(e) Bad cicatrices.—Though firing, however carefully applied,
will always be followed by legible marks, there are cases in which
bad, callous cicatrices form a positive and repulsive life-long dis-
figurement of the animal. In the mostaggravated forms of the ac-
cidents enumerated, there are circumstances which particularly
favor their occurrence. Among these may be regarded the thin-
ness and sensitiveness of the skin, the interference of the animal
himself, by rubbing and biting, and an excessive suppurative
action accompanying the falling off of the scabs. No treatment
is known that can be made effective against these lesions, but it
is satisfactory to know that they do not inhere in the operation,
and are preventable in the exercise of proper skill by the operator,
and attention by the nurse.
EXUTORIES.
An executory is any therapeutic agency or means the effect of
which is to promote the formation of purulent matter, and to
sustain the suppurative process after it has been established.
Some exutories have no special intrinsic qualities, and simply
take effect in the manner characteristic of foreign bodies when
lodged in any portion of the system; while, on the other hand,
some of them possess specific properties by which a special irrita-
tion is produced in the tissues with which they come in contact.
The various forms of seton are included in the first class;
the trochiscus, blisters, however composed, the moxa, and the
actual cautery belong to the second. But while the fact of
the utilization of the operation is as old as the practice of
medicine itself, the modes of application and the materials used
have varied considerably during various epochs. The use of the
root of black hellebore was recommended for diseases of the ears
in large ruminants, and also in the treatment of diseases of the
chest, or in cedematous swellings of the abdomen.
At a later period, the actual cautery found its advocates in
the treatment of tetanus. The introduction of feathers, or long
quills under the skin, in the treatment of old shoulder lameness,
followed, and in some parts of the world this practice has not yet
been wholly abandoned. Sometimes the feathcrs were used
alone, and in other cases air was blown into the cellular tissue
under the skin, in the parts where they were to be placed. The
s
Bi;
yer, a
EXUTORIES. 187
first description of the seton and its effects was given by Markam,
in 1556. But even after that date we read of the use of irri-
tating soft pencils, or candles composed of various ointments,
melted or mixed together, and introduced under the skin, incised
for the purpose, and more or less massed or bruised with some
hard substance. But the accidents which were apt to accompany
some of these energetic forms of treatment were of so serious
a nature that they gradually fell into disuse, and to-day this class
of principal exutories includes only the seton in its various forms,
the trochiscus and the vesicating preparations.
Exutories act as counter irritants, resolvents, and alteratives.
The irritation which follows their contact with the living tissues
excites the purulent secretions, and the activity in the process of
interstitial resorption, which they stimulate, render their adoption
and frequent use a source of much benefit and great satisfaction
to the veterinary practitioner. The list of ailments in which
their value is manifest and unquestioned is a long one, and com-
prehends affections of the chest, catarrhal inflammation of the
air passages, and affections of the abdominal organs, with those
of the eye, and in dogs of the ear. They stimulate the resolution
of local affections having a tendency to chronicity, for example,
cedematous swellings of the extremities, and they are frequently
indicated in diseases of the locomotory apparatus, in certain af-
fections of joints, and in rheumatic lameness, and also to excite
the resolution of soft tumors, especially those of the synovial
structures. The most eligible of the forms in which exutories
are prepared, especially when they are designed to act as a means
of drainage, or to prevent the accumulation of pus in anfractuous
cavities, is the seton. It is recommended in nervous affections
and in paralysis, and also for the relief of atrophied regions, and,
according to Bouley, it may often become a means of diagnosis,
as well as of prognosis.
In an acute disease having a tendency towards recovery, a
seton will have an irritating effect, and give rise to a phlegmous
swelling about its tract, while in the same disease, if the tendency
be toward a fatal termination, the artificial suppuration which it
causes will soon cease to flow, and the tract will remain compara-
tively dry.
There have been those who have made the seton a prophylac-
tic agent, or insurance institution, to be made use of at certain
188 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
special periods or seasons of the year, and have thus invented the
seton of prevention or of precaution, but without satisfactorily
demonstrating what is to be prevented, or what anticipated. The
theory, if any, in which such an assumption originates cannot be
certified, and honest veterinarians cannot themselves identify it
with such a practice or pretext.
If exutories are a frequent resort, and are highly appreciated
in veterinary surgery, and their general use is commonly unat-
tended with danger, yet they are not always so absolutely harm-
less that they may be trifled with, and prescribed without due
consideration of the peculiar conditions under which their use is
contra-indicated. It cannot be rationally supposed that the
potency to which they owe their beneficial effect when rightly
directed is to vanish when it is erroneously applied, and that it
can be made innocuous by misdirecting it. Animals debilitated by
heavy work or by disease; those affected with chronic organic
ailments; those threatened with eruptive diseases, or suffering
with septic complaints; none of these are fit subjects for the
application of exutories. :
SETONS.
A seton is a form of exutory which consists in the introduction
of a foreign substance under the skin, ordinarily a band of linen
tape, or a leather ring. The former is known as the tape seton,
while the second is more appropriately termed a rowel.
Tarr SEToN.
This is usually merely a piece of clean, white tape, of suitable
width and length as required by the case. In some circumstances,
however, cords or braids of lint or horse-hair are substituted.
The seton may either be introduced under the skin alone and
dry, or it may be saturated with some irritating fluid, or covered
with a stimulating ointment, to increase its effect and promote the
purulent secretion. The operator must not fail to allow a suffi-
cient length to securely tie the ends which pass out at the two
openings of the tract through which it is drawn. Yet they are
not always secured by an ordinary knot, but are quite generally
united by a species of twist upon their extremities, which can be
readily loosened when it becomes necessary. This knot must be
sufficiently wide and strong to prevent it from slipping through
SETON NEEDLES.
189
SSS
ts.
the incision. In some cases, instead of making a knot on the tape,
small wooden pins are secured at the extremities, and answer the
same purpose.
The essential instrument required to apply a seton is the
peculiar needle known as the seton needle. It is, of course, made
various lengths, some consisting of but a single piece (Fig. 218);
Fig. 217. Fig. 218. Fig. 219. Fig. 220.
SETON NEEDLES.
Fig. 221.
190 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
while others are in two or three sections, connected by screw joints
(Figs. 219, 220, 221), and in some few instances fitted to handles
(Fig. 217). But however they may otherwise vary, they are in
the general form of a stiff, iron rod, with one lanceolated extrem-
ity, both edges sharp, and a large eye at the blunt end to receive
the tape. The lanceolated portion is slightly curved on the flat
side. There are also other forms designed for special objects,
among which may be mentioned one which is used for passing a
seton through the frog of the foot, and is therefore known as the
frog seton-needle.
FIG. 222.—Frog Seton Needle.
For small animals, such as the dog, the smaller sized straight
needles are often suitable, and the one which is used for making
the quill-suture is very convenient.
Besides the seton needle proper, in its authorized and usual
patterns, occasions sometimes occur when to meet special require-
ments, a straight, pointed bistoury and a pair of scissors are re-
quired as adjuncts.
FIG. 223.—Quill Suture Needle.
The operation of setoning is comparatively a bloodless one,
and the division of the cellular tissues through which the needle
passes is very often made without any hemorrhage. Yet there
are regions where more or less blood may subsequently escape.
A region, therefore, where the cellular tissue is abundant and
loose, is that which is most favorable for the introduction of
setons.
The modus operandi is simple. The hair must be closely
clipped from about the points selected for the two preliminary
punctures, one for the entrance and one for the exit of the needle,
SETON NEEDLES. 191
and the patient must be properly secured. Certain nervous ani-
mals may oblige the surgeon to place them in the recumbent posi-
tion, but our experience has taught us that the cases in which this
is necessary are very exceptional, and that in the great majority
of operations, the simplest means of restraint, a twitch, with the
raising and securing of one or two of the extremities, is all that is
required.
The application of local anesthesia, so far as it may be practi-
cable, is also a measure which is in all respects judicious and com-
mendable. With the spraying apparatus, any part of the body
can be reached with great facility.
In introducing the needle, many veterinarians pass it directly
through the skin, which is raised ina fold, and drawn away as far
as possible from the deeper tissues. This maybe readily practica-
ble in regions where the cellular tissue is very loose and abundant,
as under the chest; but it is much less so, and more dangerous
where the skin is thick, and the subjacent connective tissue is de-
ficient or scant, and especially if the edges and point of the
needle are not perfectly sharp.
For this reason the method preferred by many is more judi-
cious, of making an incision with the straight bistoury through
the skin at each of the two extremities of the proposed tract
through which it is intended to pass the seton. The manipulation
is sufficiently easy and simple, the operator holding the skin in a
fold with one hand, while with the other he guides the needle
under the skin and parallel with it, through the cellular tissue,
entering through one of the punctures made with the bistoury,
and emerging through the other. The point most important to
observe here is that of so guiding the needle in its motion that it
shall neither plunge into the deeper tissues nor emerge outwardly
at the wrong place. At this point the scissors may be utilized by
laying blades flatwise over the place of exit, and pressing down
the surface. Directions are sometimes given, as the next step, to
insert the tape into the eye of the needle, but it would seem that
the safer plan would be to have the tape already in place when
the needle is introduced. After the tape has been drawn through,
and the needle disengaged, the next and final step is either to
unite the ends of the seton by a knot, or, without tying, to secure
them separately by the twisting or plaiting already described, and
leave them free.
192 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
The first effects following the application of a seton are those
met with in a majority of ordinary wounds ; more or less swelling
and inflammation, followed by an access of the suppurative pro-
cess. At the points of insertion and-exit of the needle, a certain
amount of hemorrhage takes place, generally of no importance,
and subsiding without interference, and this is succeeded by a
swelling along the braid of the seton, at first more or less diffusi-
ble, with a tendency to increase during the first forty-eight hours
but then becoming more defined. In the beginning, and for the
first two days, there is a flow of a thin serosity from the opening
of the seton, which gradually assumes the character of suppura-
tion of good quality in the shape of creamy, laudable pus. Up to
this period the seton needs no attention, and should be left with-
out interference, to exhibit the natural traumatic effect of its
presence. Although it is desirable to have the suppuration well
established and flowing freely, it must not be permitted to accumu-
late in the tract, and should be subjected once or twice a day to
gentle pressure along the entire length of the seton, to expel the
least portion of purulent matter present. At the same time, such a
pressure as would be likely to crush the granulations of the wound
and thus excite small hemorrhages, must be avoided.
_ The cleaning and washing of the openings of the seton, and of
the tape itself, must be carefully and strictly performed as often
as the abundance of the discharge requires it. It should be sys-
tematically attended to, not less than once or twice daily, at the
least. Precautions must be taken to prevent the animal from
biting and pulling off the seton, and yet this accident is very
possible, and it may frequently become necessary to replace it. In
that case the needle should be introduced by its blunt end, with
the new tape previously inserted in the eye. At times it becomes
necessary for other reasons to renew the seton. A feasible way
to effect this will be to attach the old tape to the new, and draw
out the former by means of the latter. The length of time a
seton ought to be allowed to remain in place varies according to
circumstances, extending to a period of from three to four weeks,
or even longer.
When the time has arrived for the discontinuance of a seton,
if more than one have accomplished their purpose and had the
desired effect, they ought not to be all removed at the same time,
but singly, and with an interval between them. Nor must the
APPLICATION OF TAPE SETONS. 193
wound be neglected because the seton has been removed, but it
must receive needed attention for several days. The openings of
the tract will still require cleaning, and the residue of the pus will
still require the aid of pressure to effect the final emptying of the
wound.
Tape setons are applied upon all parts of the body, but more
frequently, of course, in regions where their therapeutic effects are
most needed, for which reason they will be most commonly
found on the breast, the ribs, the shoulder, the hip, the thigh, the
stifle, the abdomen, the neck, the cheeks and the foot.
(a) The Breast.—This is a very common location for the setons.
In inserting it the animal is secured in the usual way, but to pre-
vent his striking the operator with his fore feet it will be necessary
to have one of his hind legs raised and firmly held. If there is
but one seton it must be introduced on the median line; if two,
one on each side of it.
The position assumed by the operator varies, according to the
ability he possesses, and the hand with which he operates. If
ambidexter, and but a single seton is to be introduced, he can
operate from either side of the animal, and if two are to be insert-
ed, he can change the needle from one hand to the other, to suit
his convenience, without change of position.
This seton is to extend from the anterior extremity. of the
sternum downward and backward, under the chest, or between
the fore legs, backward beyond the elbow. When the incision of
exit has been made, and the tape introduced into the eye of the
needle, the instrument must be drawn away in the direction op-
posite to that in which it was introduced, to avoid the possibility
of doing injury with the point or the edges.
(6) On the Ribs or the Chest.—Setons are used in these
regions for the treatment of diseases of the thoracic organs.
Sometimes as many as three are applied, either on one or both
sides of the chest. They should be placed in a slightly oblique
direction from before backward and from above downward,
beginning about the middle of the side of the thorax, and ex-
tending as far as the lower border of the chest, occupying, there-
fore, the lower half of the thoracic cavity. The manner of insert-
ing the seton in the tract made by an incision with a bistoury
through a fold of the skin has been already described, and a
repetition in minute detail becomes unnecessary.
194 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
Care must be taken while operating in this region to avoid
wounding the spur vein, which can be done by raising the skin
well from it when the point of the instrument has reached its
course, by which movement the needle passes outside of the
vein and can be brought outside on the inferior border of the
thorax. The tape is then placed in the eye of either the needle
or the blade as already frequently described. Our own practice
is to secure the tape through the eye of the blade, and draw the
tape into position by removing the needle from below upward,
considering this plan to be both more convenient and less dan-
gerous.
(c) At the Shoulder.—Setons are often applied in this region
against lameness of old standing; at times only one, at others
two, or even more, according to the extent and location of the dis-
eased region. When applying more than one, they are commonly
placed parallel with each other. Many practitioners place them
crossing each other, meeting in the middle of their length, with
their point of meeting on a level with the center of the scapulo-
humeral joint. In placing them, the compound, or three-jomted
needle, somewhat flexible (already described), will be necessary,
as being capable of adapting itself as much as possible to the
convexity of the joint. Some care is required in the selection of
a proper place for the puncture, and the animal must be kept in
the standing position as much under restraint as possible.
There is probably no special rule for the location and direction
in which setons should be applied, the discretion of the operator,
in many cases, furnishing the only guide. This is well wlustrated
in the application of the monstrous “seton a la Gaulet,” so called
from its inventor, and which consisted in surrounding the entire
scapular surface with one immense seton, beginning at the cervical
angle of the scapula, running along its anterior border to a point
below the shoulder, passing in front of the breast to the axilla,
through that region, horizontally back on a level with the elbow,
to return outward and then upward to the dorsal angle of the
scapula, where it ended. This form of exutory is no longer toler-
ated, the dangers attending it, from the severe and exhausting
drainage of the organism having brought it into discredit, with
the result of its dismissal from general practice.
A seton at the shoulder requires special protection from the
animal, by means of the cradle or the side bars, its location
APPLICATION OF TAPE SETONS. 195
making it too easily accessible to his teeth to be suffered to re-
main long in place without such a defence.
(d) Seton at the Hip-Joint.—Lameness of this region is fre-
quently treated by the tape seton, the conditions of their applica-
tion being nearly identical with those required when the shoulder
is the region involved. They are placed, whether single or dou-
ble, directly over the articulation, or crossing each other in the
X form, and also over the center of the joint; and care must be
taken that they are not inserted so obliquely as to interfere with
the free flow of the pus. A needle similar to that used with the
shoulder will be found convenient, and for a similar reason, the
thickness of the skin, and the closeness of its connection with the
sub-tissues, will render necessary the preliminary incisions with
the bistoury to facilitate the entrance of the needle ; and the con-
trol of the animal, as he is to be treated on his feet, should be
secured by supplementing the restraint of the twitch with that of
the side lines, and raising one of the hind legs.
(e) Setons at the Thigh.—'These are prescribed in chronic
swelling of the hind legs. The region they should cover extends
from a level with a point a little below the inside of the ischial
tuberosity to the superior third of the shank, and they should be
placed in a slightly oblique direction from without inward. It is
necessary while operating here, as in the hip-joint, to have the
animal well secured, and not only the twitch and the side-lines,
but sometimes the raising of one of the fore foot will be required ;
as of all setons, this is probably the most painful to insert, in con-
sequence of the division of branches of the sciatic nerves, which
lie in the course of the needle. The steps of the operation do
not in any way vary from those in other regions, and therefore do
not call for a redescription excepting perhaps to specify that in
placing the tape the convexity of the blade must be turned in-
wardly, and an assistant will be needed to hold the tail aside. The
tying of the tail to the surcingle on the opposite side of the body
will prevent its becoming soiled with the discharge of the seton,
and render the subsequent care of the patient easier.
(f) Setons at the Stifle-—This seton is recommended by Peuch
and Toussaint in lameness of that region which has resisted vesi-
cating liniments and blistering applications. They recommend
the recumbent position for the safety of the operator. A convex
bistoury and the ordinary seton-needle are required. The animal
196 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
while lying down has his hind leg extended by the traction made
upon it by assistants with a rope. An incision is made above
with the bistoury, and the needle introduced through it, it is
pushed downward in front of the joint, carefully raising the skin
as it progresses, to avoid injury of the femoro-patellar articulation.
(g) Seton on the Abdomen.—This seton is both difficult and
dangerous to apply in the standing position, and, therefore, unless
the animal is very carefully secured, and the operator unusually
dexterous, it is better to have the animal cast. The seton placed
on the median line, under the abdomen, extends from about the
xyphoid cartilage back to near the sheath or other mammez. In
applying it, care must be taken to avoid injury to the tunica abdom-
inalis and the abdominal muscles, or making a deep wound of
the abdomen. Caution must also be exercised against the possi-
bility of the animal kicking against the needle at the moment of
its passage through the skin at the opening of exit. The tape
when introduced in the eye of the instrument is to be drawn into
the tract by pulling the needle away from behind forward.
(h) Setons to the Neck.—These are recommended against im-
mobility and periodic ophthalmia. They are placed in an oblique
direction, one or two, on one or both sides of the neck. The hori-
zontal direction sometimes recommended is certainly quite un-
likely to facilitate the free escape of pus. In introducing the
needle it is better to direct it from below upward, starting at
about the level of the convexity of the mastoido-humeralis muscle.
(i) Setons on the Cheeks.—These have been more or less ad-
vised in the treatment of diseases of the eyes, and principally of
periodic ophthalmia. They are placed a little below the zygomat-
ic spine, below and in front of the temporo-maxillary articulation,
and extend downward some distance in front of the zygomatic
crest. The blood vessels of that region, and principally the large
nerves which cover the masseter muscles, must be carefully avoid-
ed, to guard against paralysis of the lip.
(j) Setons in the Foot.—The insertion of a seton in the foot,
or the frog-seton, as it is also called, has been principally recom-
mended in the treatment of navicular disease, though it is con-
sidered by many as of very doubtful utility. A special curved
needle (see Fig. 222) is used for the purpose. The horse is in
some instances kept in the standing position, while in some special
cases it is better to have him thrown.
ROWEL SETON. 197
The shoe being removed, and the sole and frog pared down
and made as thin as possible, either an incision may be made
in the hollow of the heels, or the needle inserted without it
through the skin, in such a direction as to have its point emerge
at about the front part of the middle commissure of the frog.
The tape is drawn into position by pulling the instrument straight
away through the opening of exit. The seton is to be secured by
tying ends together. When the operation is performed while the
animal is standing, a strong assistant must hold the foot, and the
needle pushed and passed through the frog rapidly, as by possible
struggles, severe injuries of the tissues of the posterior part of
the foot might result.
Rowe. SErTon.
This form of exutory is of earlier origin than the ordinary tape
seton, and consists in a round piece of leather, felt or pasteboard,
sometimes perforated in its center, which is deposited in a pouch
FIG. 224.—Rowel Seton.
made under the skin, either simple, or sometimes surrounded
with a band of tape to prolong its continuance. It is principally
used when the disposition of the parts renders the introduction of
a tape seton difficult, or when it is for any reason contra-indicated,
and especially when the exutory being indispensable to the well
being of the patient, it is at the same time imperatively required
that the animal shall be preserved free from any blemish or dis-
figurement. It is also to be preferred with animals which cannot
be prevented from tearing out the ordinary tape seton with their
teeth.
A pair of scissors and a straight bistoury are required for its
insertion. A simple incision is made with the bistoury, long enough
198 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
to allow the introduction of the rowel, rolled or doubled on itself ;
then, with the scissors passed flatwise under the skin, a pouch is
made, by dividing the cellular tissues, of sufficient dimensions to
secure the rowel, which is to be opened or unrolled and flattened
in the pouch in such a manner as to bring its central opening in
correspondence with the incision in the skin.
This form of seton can remain for a period of from fifteen to
twenty days, and there are cases where it has been kept in place
as long as six weeks. It can easily be removed with the forceps
or a pointed tenaculum.
TROCHISCUS.
This is an exutory formed of some mineral or vegetable sub-
stance, sometimes termed an issue pea, possessed of irritating or
even caustic properties, which are introduced under the skin in the
same manner as the rowel. They differ from the other exutories
by causing a greater amount of irritation, a higher degree of in-
flammation, and for that reason are left in place for a shorter
period, and are removed as soon as inflammatory symptoms are
well established. They are less frequently used in solipeds, but
are of more common employment in cattle. In the former, how-
ever, lameness of long standing in the upper segments of the legs
has been successfully relieved by them. In cattle they are often
inserted in the dewlap. They can be introduced directly under
the skin, either through an incision made alone, or attached to a
seton, which may continue longer in place after the removal of the
trochiscus.
AccIDENTS, SEQUELH OF SETONS.
The accidents which sometimes follow the application of setons
are: hemorrhage, gangrenous swellings, abscesses, excessive
granulations or fungosities, and indurations.
(a) Hemorrhage.—In ordinary circumstances, their introduc-
tion is accompanied by the escape-of only a few drops of blood,
but there are cases where abundant hemorrhages occur, either
resulting from an injury to some blood vessels, or because of a
special hemorrhagic predisposition in the animal, as when it is in
a debilitated or anzemic state.
When there is hemorrhage, it usually shows itself at the con-
clusion of the operation, the blood oozing in drops from the open-
ACCIDENTS, SEQUELZ OF SETONS. 199
ings of the seton, or causing a swelling, if it accumulates in the
tract. The ordinary means of hemostasis must be employed, as
cold douches, iced lotions, etc., and if these fail, the seton must
be removed, and the openings plugged with oakum, moistened
with hemostatic liquids, or with absorbent cotton; or it may even
be necessary to close the openings with sutures, or resort to the
the application of pressure. Bouley recommended the introduc-
tion of a thick tent of oakum through the entire length of the
tract.
(6) Gangrenous Swellings.—These are among the most common
and dangerous of accidents accompanying setons, and occur prin-
cipally during warm weather, in debilitated animals, or such as
are exposed to bad hygienic conditions or affected with some
special diseases.
The gangrene manifests itself by the appearance of a warm
and painful swelling, cedematous and diffused, spreading rapidly,
but in the central portion cold and painless, and a general reaction
soon becomes manifest. The animal becomes dull; the pulse is
accelerated and small, and the temperature heightened, the dis-
charge of the setons has changed its character to that of a thin,
sanious, and very feetid suppuration. All these symptoms become
rapidly exaggerated, and soon threaten the life of the patient,
unless heroic measures are at once resorted to.
When the tract assumes this gangrenous aspect the tape must
be immediately removed, and the tract thoroughly emptied and
cleansed, by injections of antiseptic liquids such as solutions of
phenic or salicylic acid, followed by cauterization with the red
iron in the tract, and through the cedematous swelling, accom-
panied by the free administration of tonics and antiseptics inter-
nally. No means should be neglected likely to overcome the
threatening septiczemia, which, if not controlled, will certainly have
a fatal termination.
(ce) Abscesses.—When the seton has been left in place too long,
or there has been neglect in respect to the care and cleanliness of
the tract, or when the tape has been removed, numerous abscesses
will sometimes be found along the course of the seton. They
have the character of phlegmonous swellings, and soon become
fluctuating.
While they remain superficial, no serious results need be appre-
hended, and all they require is to be opened to allow the escape
200 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
of the pus, and to be treated generally after the manner of similar
tumors in other parts of the body. But occasionally a filtration
of the pus takes place between the different layers of tissues, and
the abscesses become troublesome. To avoid their formation
there must be a complete and regular evacuation of the tract by
pressing out the contents once a day or oftener, according as
the discharge requires it. To avoid the possibility of the migra-
tion of the pus and the formation of a deep abscess, the operator
must be careful not to make a false tract with the needle during
its passage under the skin.
(d) Hexcessive Granulations or Fungosities—These often occur
at the openings of the tract, when the tape has been left in place
along time. They are not of a serious character, and can be re-
moved by excision or cauterization.
(e) Indurations.—These are also among the sequel of setons
left in position too long, or when, after the removal of the tape,
care has not been taken to press out and thoroughly empty the
tract of any remaining portion of the discharge. These indurations
appear in the form of long, hardened cords, extending more or
less in the original length of the setons. They often disappear
spontaneously, by a slow process of resorption, but in many cases
it becomes necessary to have recourse to friction with alterative
ointments composed of preparations of mercury or iodine. Deep
pointed cauterization, or their entire removal by dissection are also
recommended.
ABLATION OF TUMOBS.
Under this heading are included the various modes of the divi-
sion of tissues involved in the removal of tumors—a tumor being,
as technically defined, a non-inflammatory mass, constituted by
tissues of new formation, and haying a tendency to persistency
and possible growth.
The term ablation, of which the common definition is simply
taking away, is in surgery employed to denote the excision or re-
moval of tumors—a tumor being, in a surgical sense, any morbid,
circumscribed enlargement affecting any of the structures or organs
of the body, sometimes harmless, and sometimes malignant and
fatal in their character and termination.
The surgical means at the disposal of the veterinarian, by
which this operation is accomplished, are not so numerous as
ABLATION OF TUMORS. 201
those employed in human surgery, and can be comprehended in
the four principal processes of excision, ligature, tearing and
puncture. They are about equally employed, according to the
circumstances and nature of the case, and the discretion of the
operator.
1sv.— Excision.
This mode of ablation can be performed in four ways, with
the scissors, the bistoury, the ecraseur or the thermo-cautery.
(a) With the Scissors.—This is the simplest process, but is
applicable only to tumors of diminutive size, such as warts, con-
dyloma, and in general, to growths having a small and narrow
peduncle. Curved scissors are generally used. The tumor is
raised from the skin and secured with a pair of bull-dog forceps
before the scissors are applied. The hemorrhage which may
follow is not usually serious, and ordinarily requires no interfer-
ence, and when necessary, can be readily controlled by means of
cooling applications, pressure or cauterization.
(6) With the Bistoury.—When the tumor is coraparatively
small, with a narrow peduncle, its removal is effected in the same
manner as with the scissors, the only change being in the stroke
of the instrument. Usually a single stroke of the bistoury is suf-
ficient. But if the tumor is of large dimensions and covered by
the skin, the operation becomes more complicated and requires
more time and care. It isordinarily divided into three steps, viz. :
the incision of the skin, the dissection of the tumor, and its extir-
pation.
The form and size of the incision must of course correspond
to those of the tumor, which must be considered in reference
to its basis, connections, adhesions and surrounding tissues, as
well as the healthy or morbid condition of the teguments. The
straight incision is applicable to subcutaneous tumors, free from
adhesions or comparatively loose and susceptible of enucleation,
while that made through a fold of the skin is better adapted to
encysted growths, which it would be dangerous to open. The
elliptic incision is used when aportion of the skin is to be removed,
because of its being diseased or too thin, and its closing up would
be too difficult; or when the extent of the skin exceeds that of
the wound it covers. Crucial incisions, or those of the T or Y
shape, are indicated when a tumor of large size is to be exposed,
202 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
while it is necessary to preserve the skin which covers it. What-
ever form of incision may be used, it must always extend beyond
the base of the tumor toallow a free dissection and an easy removal
of all the diseased tissues. The convex bistoury is preferred in
this step of an operation and must be applied with light pressure,
and a very guarded motion, to avoid any subcutaneous blood ves-
sels that may run over the surface of the growth, and which may
be of large size.
The incision is followed by the dissection, which is done with
the scalpel or the bistoury, by separating the tumor from the teg-
uments, carefully avoiding surrounding structures, which should
be held aside with the forceps or tenaculum, in order to keep
the wound open and accessible. Instead of the scalpel or bis-
toury, the blunt end of the scissors sometimes becomes the in-
strument by which the adhesions of the cellular tissue covering
the tumor are most easily destroyed.
In the third step, or the extirpation of the tumor, either the
bistoury, the scalpel or the sage knife may be the most eligible in-
strument, according to the consistency of the tumor, whether hard,
cartilaginous or bony. If it is of sufficiently small size, by steady-
ing it with the forceps or tenaculum, it may be excised with a
single stroke of the instrument. If too large for this, it may be
controlled by passing a loop of ribbon or tape through it, by which
its position can be changed at pleasure, to facilitate its complete
dissection. The hemorrhage following may be arrested by any of
the usual hemostatic measures. When the tumor is of large di-
mensions this last step of the operation will require great care in
the execution, and the blood vessels which may run through its
base must be securely ligated before the tumor is entirely excised.
FiG. 225.—Ecraseur of Chassaignac.
ABLATION OF TUMORS. 203
(ce) With the Ecraseur.—The instrument used in this method
has received its name from the fact of its erushing action upon the
tissues upon which it is applied and for which it was invented by
Chassaignac. The original form of the instrument of Chassaig-
nac has been subjected to various modifications, some being made
to use with a chain alone, others to carry a wire, and others
again to carry a chain or a wire alternately. Others like that of
Reynal, of Miles, of Smith, and many others, vary also in shape orin
size, but without differing in their general principles, and whether
employed for the removal of tumors, or in special operations, as
ee
FIG, 226.—Ecraseur with Chain.
FIG. 228.—Ecraseur with Chain or Wire.
those of castrations in males,or spaying in females, the modus
operandi remains the same. This consists in enclosing the base
or peduncle of the tumor with the chain or wire of the instru- -
ment, and tightening it more or less rapidly at the discretion of
the operator, by means of the screw in the handle until it is com-
pressed, strangulated and crushed, and at last entirely separated.
The action should be more or less gradual, according to the size
of the parts and the consistency and vascularity of the tissues. A
204 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
Fia. 229a,—Haussman Ecraseur.
slow movement of the ecraseur is essential to avoid hemorrhage,
but although this rule is recommended by European authors, it
does not seem to be as important as it is reported to be, if we
may judge by the results obtained by American practitioners, in
view of the manner in which they use this instrument in the
operations of castration. Our experience, however, justifies a
slow and careful application of the crushing process, especially in
the removal of tumors where blood vessels of large size or in a
state of disease may be known to ramify, and particularly in the
ablations of the champignon of castration.
ABLATION OF TUMORS. 205
(d) With the Thermo-Cautery.—The ablation of tumors can
also be performed with the flat platinum cautery of Paquelin,
well heated, by following the same rules as with the bistoury,
both when either the growths are small, or the incision of the skin
and dissections of the tumor have been previously performed.
The advantages gained by the use of the red-heated cautery in
controlling the hemorrhage while the incision goes on, is too ob-
vious and important to be ignored or depreciated.
2p.—LIGATURE.
The ligature operates on the tumor in its own peculiar and
effective way, by circumscribing the base and depriving it of its
nutriment by occluding the circulation and leaving it to undergo
the process of gangrenous dissolution and sloughing, with the ad-
vantage of obviating any apprehended danger of subsequent hem-
orrhage. The kind of ligatures used for this purpose will vary
with the choice of the practitioner. In veterinary surgery, the
material is variously flax, hemp, silk, catgut, india rubber cords, or
metallic wire. Whipcord or fishing line is often used, when a
powerful constriction is to be applied, and their efficiency is in-
creased by being waxed or soaped. There are various ways of
applying a ligature, but they are all subject to the following rules:
the size of the ligature must be proportioned to that of the parts
to be ligated, and to their resistance ; it ought to be applied only
upon a limited portion of the tissues, and the skin ought never to
be included, except when the peduncle is very narrow, or the skin
already ulcerated.
First Method, Simple Ligature.—A cord or band is affixed
around the base of the tumor, and tightly tied by a single knot.
Sometimes the bleeding knot or double clove-hitch is preferred,
drawn tightly and secured by a simple knot.
The mortification of the growth may be accelerated, if thought
proper, by covering the ligature with some caustic preparation,
such as an ointment of sulphide of arsenic, or also by adding to
the effect of the ligature that of the actual cautery.
Second Method, Double Ligature.— This is
brought into requisition when the peduncle of the
tumor is too large to be easily embraced by a sin-
gleligature. It is made by piercing the base of the jyrg 299 Tapestry
growth through the centre, by means of a straight Ligature.
206 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
needle with a double thread or cord, thus dividing the growth
into separate halves, each having its own distinct ligature, tied
on opposite sides of the peduncle.
Third Method, Multiple Ligature.—At times, the tumor may
have a sufficiently wide base to require the addition of a third
ligature in order to secure a sufficient amount of constriction to
slough the entire mass, in which case special needles become
necessary. These are longer than the ordinary ones, though
more or less flexible, and with an eye in the centre, additional to
that at the extremity, according to indications.
When the tumor is to be divided into three portions two
needles are necessary, and a correspondingly long thread. The
needles being passed together through the base of the tumor, with
sufficient intervals between to divide it into three nearly equal
Fic. 231.—Treble Ligature.
parts, leave, when drawn through, three ligatures with which to
enclose separately the central and two lateral portions of the
peduncle.
If it becomes necessary to apply four ligatures, two different
needles are necessary, one (female) long, having an eye in the
A B
ee ee A —))
FIG. 232.—Female Needle. FIG. 233.—Male Needle.
centre, and another (male) of the ordinary form, with the eye at
its extremity, but of a size which will permit its passage with a
double thread through the central eye of the other. This male
needle is to carry a long, double thread. The manipulation is
very obvious. The first needle is inserted far enough to bring
the central eye half way through the growth, and the second
needle is passed through it, and out at the other side; then, draw-
ing out the first, two double ligatures are left, or one for each
quarter of the tumor. All that then remains is the tying of the
four knots.
To describe it more in detail, the female needle is inserted in
ae
My
io ry
ABLATION OF TUMORS. 207
FIG, 234.—1st Step of the Ligature FIG. 235.—2d Step of the Ligature
by Four. by Four.
the growth until the eye reaches the centre, when the male needle
is introduced at a right angle with it, and passed through the eye,
as in Fig. 234, to be drawn out on the opposite side of the tumor
carrying the ligatures with it (Fig. 235).
In the second step of the operation, the passage of the male
needle through the tumor with the double ligature is completed,
and by the separation of the needle from one of the threads, two
threads are left loose. The female needle is then pushed through
the tumor, when one of the threads is cut off (Fig. 236) ; the fourth
step being completed by haying the female needle drawn back
FIG. 236.—3d Step of the Ligature FIG. 237.—4th Step of the Ligature
by Four. by Four.
through its original tract with the last threads or loop (Fig. 237),
and when the needle is finally separated, it leaves the tumor divided
into four segments by four threads, whose extremities are drawn
and tightly secured by a single knot (Figs. 238, 239).
208 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
-
t
I
Wr
.
\
Re nn a
:
&
Fig. 239.—The Llga-
he \ tures Secured.
FIG. 238.—The Tumor divided
in Four.
Fourth Method, Subcutaneous Ligature.—This method is sel-
dom practiced, as there are always objections to leaving under
the skin the mortified structures divided by the constriction of the
cord. But as there may be circumstances under which the growth
cannot be immediately uncovered, its application becomes a ques-
tion of necessity.
Three needles are required: one, A, straight and sharp; the
second, B, straight and pointed; the third, C, curved and also
pointed. These are placed upon a single long thread.
a
Fic. 240.—Thread and Needles for Subcutaneous Ligatures. Fig. 241.—1st Step.
The growth A being subcutaneous, and spherical in shape, a
vertical cutaneous fold is raised above its superior third, through
the base of which the needle A is introduced. Leaving the fold
loose, and the skin resuming its position, a first portion of liga-
ture is found in place, under the teguments, surrounding one-
third of the circumference at C (Fig. 241). The curved needle, C,
is then passed through the tumor, entering at C, and coming out
at B, with the loop D, and at B the needle is removed (Fig. 242).
By these first steps of the operation, the superior third of the
growth is surrounded by the loop of thread B, C, D, both of whose
bo] ee
ibe ye PS
ABLATION OF TUMORS. 209
Fig. 242.—2d Step. FIG. 248.—3d Step.
extremities come out by the same opening (Fig. 243), while a sec-
ond thread, f f, is free between the superior and the two lower
thirds of the tumor (Fig. 244).
The manipulations for the superior third of the growth are
repeated for the lower third, with another thread, and the middle
third is then surrounded by two parallel threads A, B and C, D
(Fig. 245).
‘
\N
\\
y!
SSN SSS
CF
Fig. 245.—5th Step.
Both of these two threads are passed into the curved needle,
and it then becomes easy to carry under the skin the extremity of
the thread B to the opening D, and the thread A to the opening
C, where it will be tied to thread B. All the threads A, B, C, D
will thus form a loop embracing the middle third of the growth,
as the other threads will surround the upper and the lower thirds.
All the ligatures can be then tied to the required degree and the
operation is completed (Figs. 246, 247).
Fic. 216.—The Ligatures in Fic. 247.—The Ligature
Position. Secured.
When the ligature that is to apply the necessary constriction
upon the base of the tumor is in place, it must be tied more or
210 OPERATIONS ON THE SKIN AND CELLULAR TISSUE.
less suddenly and firmly, but never with sufficient force to pro-
duce an immediate section, an operation which could have been
more easily performed, and with less pain, with the bistoury. To
avoid this section, apply the constriction slowly, and in accordance
with the effects produced, and the resistance encountered by the
' ligature. If the tissues are soft and frangible, it would be unsafe
to complete the constriction at once, and it should be deferred
to a later period ; if, on the contrary, it is hard and resisting, the
ligature may be drawn tightly, and firmly tied at once. Ordinary
traction on the ligature may be made with the hands only, but
when extra strong and steady traction is required, wooden holders
will prove of great assistance. These means of securing the lga-
ture on the tumor are successful so long as it is comparatively
superficial, but if it is situated at a certain depth, special instru-
ments are required. Among these is one particularly adapted to
the removal of growths from the natural cavities, such as the
nasal, rectal, vaginal or inguinal regions. It consists of a wooden
or metallic tube, of variable length, through which the loop of a
double, strong, waxed ligature can be introduced into the cavity
Fi4é, 248.—Ligature Carrier,
and adjusted around the base of the tumor, and when in position,
tightened by traction on the thread at the mouth of the tube, and
so secured that the constriction can be maintained at any degree
of tightness, and increased or relaxed at pleasure.
3p.—Exastic LIGATURE.
This is but a variation from the ordinary ligature, in which
an india-rubber cord or tubing of suitable diameter is substi-
tuted for the other means of constriction. Itis applied like the
others at the base of the tumor, and secured in the same manner.
The peculiarity of its action arises, of course, from its elasticity,
the result of which is a constant unrelaxing, self-regulating con-
striction, which continues automatically until the ablation is
effected.
The growth upon which the elastic ligature is applied soon
begins to undergo changes, which may be at first unnoticeable.
ABLATION OF TUMORS. 211
But presently it becomes cooler, the skin becomes soft, flabby,
and of a dark brownish color; the mass becomes dry and con-
tracted, and in from fifteen to twenty days it drops off, leaving a
wound which heals in the usual manner.
The use of this ligature is, we believe, principally advantage-
ous for small growths, and we have obtained good results from it
in the castration of medium or small-sized animals, as well as in the
treatment of small and superficial tumors, as warts, and the like.
But in respect to large growths, such as the fibromas of the elbow
joint, from the enormous size of the wound which follows, and
the excessive length of time this requires to heal, we cannot feel
justified in recommending it in similar cases.
47H.—ReEMovAL BY TEARING.
This is a method of extirpating tumors by mere force, grasp-
ing them with one hand or with the forceps, and with the other
they are simply—with a twisting motion—torn from their connec-
tion. Of course it can only be practiced on small growths, but it
has the advantage of preventing hemorrhage, and can be performed
with the hands alone, or with the assistance of special forceps or
nippers. The principal objection is that it sometimes fails to
remove the fundamental element of the growth, and a renewal
of the trouble may be looked for.
57H.—PUNCTURE.
This subject has already been partially considered. It is per-
formed with either the bistoury, the lancet, or the trocar, but it
is principally applicable to soft tumors only, and as by its un-
aided action it is ordinarily insufficient to effect their complete
disappearance, it becomes necessary to resort to instrumental help,
in which cauterization with the pointed red iron, blistering applica-
tions, or the injection of irritating or modifying compounds, as
solution of tincture of iodine, become the efficient adjuncts, if not
in truth the actual curatives.
CHAPTER VI.
OPERATIONS ON BONES.
FRACTURES.
Tn technical language a fracture is a “solution of continuity in
the structure or substance of a bone,” and it ranks among the
most serious of the lesions to which the horse—or any animal—
It is asubject of special interest to veterinarians,
and to horse owners as well, in view of the variety of forms in
which it may occur, as well as of the loss of time to which it sub-
jects the patient, and the consequent suspension of his earning
capacity. Though of less serious consequence in the horse than
in man, it is always a matter of grave import. It
is always slow and tedious in healing, and is fre-
quently of doubtful and unsatisfactory result.
This solution of continuity may take place in
can be subject.
Fic. 249.—Complete
Fracture.
two principal ways.
In the most numerous in-
stances it includes the total thickness of the bone
and is a complete fracture.
In other cases it in-
volves a portion only of the thickness of the bone,
and for that reason is described as
incomplete (Fig. 250). If the bone
is divided into two separate portions,
and the soft’ parts have received no
injury, the fracture is a simple one;
or it becomes compound if the soft
parts have suffered laceration, and
comminuted if the bones have been
crushed or ground into fragments,
many or few. The direction of the
break also determines its further
classification. Broken at a right an-
gle, it is transverse (Fig. 251); at a
different angle it becomes oblique
PRAT
Sere
otek
<
a
Te
ETc
PAS Dea
Pe
rants 3
ea a see
FiaG. 250.
Incomplete
Fracture.
FRACTURES. Pele
(Fig. 252), and it may be longitudinal or lengthwise. In a com-
plete fracture, especially of the oblique kind, there is a condition
of great importance in respect to its effect upon the ultimate re-
sult of the treatment, in the fact that from various causes, such as
muscular contractions or excessive motion, the bony fragments do
not maintain their mutual coaptation, but become separated at the
ends, and this fact has made it necessary to add another descrip-
tive term in the words—with displacement. And this term again
suggests its negative, and introduces the fracture without displace-
Fig. 251.—Transverse Fig. 252.—Oblique Frac-
Fracture of the Radius. ture of the Femur,
214 OPERATIONS ON BONES. -
ment, when the facts justify this description. Again, a fracture
may be intra-articular or extra-articular, as it extends within a
joint or otherwise, and once more, éntra-periosteal, when the peri-
osteum remains intact. And, finally, there is no absolute limit to
the use of descriptive terminology in the case.
The condition of displacement is largely influential in deter-
mining the question of treatment, and as affecting the final result
of a case of fracture. This, however, is dependent npon its loca-
tion or whether its seat be in one or more of the axes of the bone,
in its length, its breadth, its thicknsss, or its circumference. An
incomplete fracture may also be either simple or comminuted, the
periosteum, in the latter case when it is intact, keeping the frag-
ments together, the fracture in that case belonging to the intra-
periosteal class. At times there is only a simple fissure or split
in the bone, making a condition of much difficulty of diagnosis.
Two varieties of originating cause may be recognized in cases
of fracture. They are the predisposing and the occasional. As
to the first, different species of animals differin the degree of their
liability. That of the dog is greater than that of the horse, and, in
horses, the various questions of age, the mode of labor, the season
of the year, the portion of the body most exposed, and the existence
of ailments, local and general, are all to be taken into account.
Among horses, those employed in heavy draught work or that
are driven over bad roads, are more exposed than light-draught
or saddle horses, and animals of different ages are not equally
liable. Dogs and young horses, with those which have become
sufficiently aged for their bones to have acquired an enhanced
degree of frangibility, are more liable than those which have not
exceeded the time of their adult prime. The season of the year
is undoubtedly, though in an incidental way, an important factor
in the problem of the etiology of these accidents, for though they
may be observed at all times, it is during the months when the
slippery condition of the icy roads renders it difficult for both
men and beasts to keep their feet, that they occur most frequently.
The long bones, those especially which belong to the extremities,
are most frequently the seat of fractures, from the circumstance of
their superficial position; their exposure to contact and collision,
and the violent muscular efforts involved both in their constant
rapid movement and their labor in the shafts or at the pole of
heayy and heavily laden carriages.
FRACTURES. 915
The relation between sundry idiosyncrasies and diatheses and
a liability to fractures is too constant and well established a path-
ological fact to need more than a passing reference. The history
of rachitis, of melanosis, and of osteo-porosis, as related to an
abnormal frangibility of the bones, is a part of our common medi-
cal knowledge. There are few persons who have not known of
cases among their friends of frequent and almost spontaneous
fractures, or at least of such as seem to be produced by the
slightest and most inadequate violence, and there is no tangible
reason for doubting an analogous condition in individuals of the
equine constitution. Among local predisposing affections, mention
must not be omitted of such bony diseases as caries, tuberculosis,
and others of the same class.
Occasional or “efficient” causes of fracture are in most
instances external traumatisms, as violent contacts, collisions,
falls, etc., or sudden muscular contractions. These external acci-
dents are various in their character, and are usually associated
with quick muscular exertion. A violent, ineffectual effort to
moye too heavy a load; semi-spasmodie bracing of the frame to
avoid a fall or resist a pressure; a quick jump to escape a blow;
stopping too suddenly after speeding; struggling to liberate a
foot from a rail—perhaps to be thrown in the effort—all these are
familiar and easy examples of accidents happening hourly, by
which our equine servants become sufferers. We may add to
these the fracture of the bones of the vertebree, occurring when
a patient is cast for the purpose of undergoing a surgical opera-
tion, quite as much the result of muscular contraction as of a pre-
existing diseased condition of the bones. A fracture occurring
under these circumstances may be called with propriety indirect,
while one which has resulted from a blow or a fall differently
caused is of the direct land.
The symptoms belonging to the existence of fracture vary ac-
cording to the site of the lesion. In case of its being on a bone
of the extremity there is irregularity in the performance of the
functions of the apparatus to which the fractured bone belongs,
and as a necessary consequence of the existing lesion, Jameness
more or less marked. If the broken bone belongs to one of the
extremities, the impossibility of the performance of its natural
function, in sustaining the weight of the body and contributing to
the act of locomotion, is usually complete, though the degree of
216 OPERATIONS ON BONES.
powerlessness will vary according to the kind of fracture and the
bone which is injured. For example, a fracture of the cannon
bone without displacement, or of one of the phalanges which are |
surrounded and sustained by a complex fibrous structure, is, in a
certain degree, not incompatible with some amount of resting of
the foot. But, on the contrary, if the shank bone, or that of the
forearm be the implicated member, it would be very difficult for —
the leg to exercise any agency whatever in the support of the ©
body. And in a fracture of the lower jaw, it would be obviously
futile to expect it to contribute materially to the mastication of
food.
A fracture seldom occurs’ which is not accompanied with a
degree of deformity, greater or less, of the region or the leg
affected. This is due to the exudation of the blood into the
meshes of the surrounding tissues and to the displacement which
occurs between the fragments of the bones, with subsequently
the swelling which follows the inflammation of the surrounding
tissues. The character of the deformity will mainly depend upon
the manner in which the displacement occurs.
In a normal state of things the legs perform their fiovantenne
with the joints as their only centres or bases of action, with no
participation of intermediate points, while with. a fracture the
flexibility and motion which will be observed at unnatural points
are among the most strongly characteristic signs of the lesion.
No one need be told that when the shaft of a limb is seen to bend
midway between the joints, with the lower portion swinging
freely, that the leg is broken. But there are still some conditions
where the excessive mobility is not easy to detect with certainty.
Such are the cases where the fracture exists in a short bone, near
a movable joint, or in a bone of a region where several short and
small bones are united in a group, or even in a long bone where
its situation is such that the muscular covering prevents the
visible manifestation of the symptom.
If the situation of a fracture precludes its discovery by means
of this abnormal flexibility, other detective methods remain. And
after all there is one decisive sign which, though it may not avail
in every case, as it does not, is in cases where its testimony can
be secured absolute and positive beyond question. This is crep-
itation, or the peculiar effect which is produced by the friction
of the fractured surfaces one against another. Though discerned
FRACTURES. BL
by the organ of hearing, it can scarcely be called a sound, for the
grating of the parts, as the rubbing takes place, is often more felt
than heard, but there is no mistaking its import in cases favorable
for the application of the test. The conditions in which it is not
available are those of incomplete fracture, in which the mobility
of the parts is lacking; and those in which the whole array of
phenomena are usually obscure. To obtain the benefit of this
pathognomonic sign requires deliberate, careful, and gentle man-
ipulation. Sometimes the slightest movements will be sufficient
for its development, after much rougher handling has failed to
discover it. Perhaps the failure in the latter case is due to a sort
of defensive spasmodic rigidity caused by the pain resulting from
the rude interference.
More or less reactive fever is a usual accompaniment of a frac-
ture, and an ecchymosis of the parts is but a natural occurrence,
more easily discovered in animals possessing a light-colored and
delicate skin than in those of the opposite character.
There are difficulties in the way of the diagnosis of an incom-
plete fracture, even sometimes when there is a degree of impair-
ment in the function of locomotion, with evidences of pain and
swelling at the seat of lesion. There should then be a careful
examination for the evidences of a blow or other violence sufficient
to account for the fracture, though very often a suspicion of its
existence can only be converted into a certainty by a minute his-
tory of the patient if it can be obtained up to the moment of the
occurrence of the injury. A diagnosis ought not to be hastily
pronounced, and where good ground for suspicion exists it ought
not to be rejected upon any evidence less than the best. Serious
and fatal complications are too often recorded of the results fol-
lowing careless conclusions in similar cases, among which we may
refer to one instance of a complete fracture manifesting itself in
an animal during the act of rising up in his stall after a decision
had been pronouuced that he had no fracture at all.
Fractures are of course liable to complications, those especial-
ly, from the nature of the case, which are of a traumatic
character, such as extensive lacerations, tearing of tissues, punc-
tures, contusions, etc. But unless these are in communication
with the fracture itself, the indication is to treat them simply
as independent lesions upon the other parts of the body. A
traumatic emphysema will at times cause trouble, and abscesses,
218 OPERATIONS ON BONES.
more or less deep and diffused, may follow. In some cases small
bony fragments from a comminuted fracture, becoming loose and
acting as foreign bodies, may give rise to troublesome fistulous
tracts. A frequent complication is hemorrhage, which often be-
comes of serious consequence. A fracture in close proximity to a
joint may be accompanied by dangerous inflammations of im-
portant organs, and may induce an attack of pneumonia, pleurisy,
arthritis, etc., as well as luxations or dislocations, and the more
so if situated near the chest. Gangrene, as a consequence of
contusions or of hemorrhage or of an impediment to the circula-
tion, caused by unskillfully applied apparatus, must not be over-
looked among the occasional incidents; nor must lockjaw, which
is not an uncommon occurrence. Even laminitis has been met
with as the result of forced and long-continued immobility of the
feet in the standing posture, as one of the involvements of una-
voidably protracted treatment.
When a simple fracture has beert properly treated, and the
broken ends of the bone have been securely held in coaptation, one
of two things will occur. Hither—and this is the more common
event—there will be a union of the two ends by a solid cicatrix,
the callus, or the ends will continue separated or become only
partially united by an intermediate fibrous structure. In the
first instance the fracture is consolidated, or wnited, in the second
there is a false articulation, or pseudo-arthrosis.
The time required for a firm union or true consolidation of a
fracture will vary with the character of the bone affected, the age
and constitution of the patient, and the general condition of the
case. The union will be perfected earlier in a young than in an
adult animal, and sooner in the latter than in the aged, and a
general healthy condition is of course, in every respect, an
advantage.
The mode of cicatrization, or method of repair in lesions of
the bones, has been a subject of much study among investigators
in pathology, and has elicited various expressions of opinion from
those high in authority. But the weight of evidence and pre-
ponderance of opinion are about settled in favor of the theory
that the law of reparation is the same for both the hard and the
soft tissues. In one case a simple exudation of material, with the
proper organization of newly formed tissue, will bring about a
union by the first intention, and in another the work will be ac-
FRACTURES. 219
companied by suppuration, or the union by the second intention,
a process so familiar in the repair of the soft structures by
granulation.
Considering the process in its simplest form, in a case in which
it advances without interruption or complication to a favorable
result, it may probably be correctly described in this wise :
On the occurrence of the injury an effusion of blood takes
place between the ends of the bone. The coagulation of the fluid soon
follows, and this, after a few days, undergoes absorption. There
is then an excess of inflammation in the surrounding structure, which
soon spreads to the bony tissue, when a true ostitis is established,
and the compact tissue of the bone becomes the seat of a new
yascular organization, and of a certain exudation of plastic lymph,
MM ee
LZ
FIG. 253.—Fracture of the Common Bone, with Callus.
220 OPERATIONS ON BONES.
appearing between the periosteum and the external surface of the
bone, as well as on the inner side of the medullary cavity. After
a few days the ends of the bone thus surrounded by this exudate
become involved in it, and the lymph, becoming vascular, is soon
transformed into cartilaginous, and in due time into bony tissue.
Thus the time required for the consolidation of the fractured
segments is divisible into two distinct periods. In the first they
are surrounded by an external bony ring, and the medullary cavity
is closed by a bony plug or stopper, constituting the period of the
provisional callus. This is followed by the period of permanent
callus, during which the process is going forward of converting
the cartilaginous into the osseous form.
The restorative process is sooner completed in the carnivorous
than in the herbivoroustribes. In the former the temporary callus
may attain sufficient firmness or consistency for the careful use
of the limb within four weeks, but with the latter a period of from
six weeks to two months is not too long to allow before removing
the supporting apparatus from the limb.
This in general terms represents the fact when the resources
of nature have not been thwarted by untoward accidents, such as
a want of vigor in the constitution of the patient or a lack of skill
on the part of the practitioner, and especially when, from any
cause, the bony fragments have not been kept in a state of perfect
immobility and the constant friction has prevented the osseous
union of the two portions. Failures and misfortunes are always
more than possible, and instead of a solid and practicable bony
union the sequel of the accident is sometimes a false joint, com-
posed of mere flexible cartilage, a poor psewdo-arthrosis. The ex-
planation of this appears to be that, first, the sharp edges of the
ends of the bone disappear by becoming rounded at their extrem-
ities, by friction and polishing against each other. Then follows
an exudation of a plastic nature, which becomes transformed into
a cartilaginous layer of a rough articular aspect. In this, bony
nuclei soon appear, and the lymph secreted between the segments
thus transformed, instead of becoming truly ossified, is changed
into a sort of fibro-cartilaginous pouch or capsular sac, in which
a somewhat albuminous secretion, or pseudo-synovia, permits the
movement to take place. Most commonly, however, in our
animals, the union of the bony fragments is obtained wholly
through the medium of a layer of fibrous tissue, and it is because
a
FRACTURES. Dak
the union has been accomplished by a ligamentous formation only,
that motion becomes practicable.
The prognosis in a case of fracture in an animal is one of the
gravest vital import to the patient, and therefore of serious pecu-
niary concern to his owner. The period has not long elapsed
when to have received such a hurt was quite equivalent to under-
going a sentence of death for the suffering animal, and perhaps
to-day a similar verdict is pronounced in many cases in which the
exercise of a little mechanical ingenuity, with a due amount of
careful nursing, might secure a contrary result and insure the re-
turn of the patient to his former condition of soundness and use-
fulness. Considered per se, a fracture in an animal is in fact no
less amenable to treatment than the same description of injury in
any other living being. But the question of the propriety and
expediency of treatment is dependent upon certain specific points
of collateral consideration.
First. The nature of the lesion itself is a point of paramount
importance. A simple fracture occurring in a bone where the
ends can be firmly secured in coaptation, presents the most favor-
able conditions for successful treatment. If it be that of a long
bone it will be the less serious if situated at or near the middle of
its length than if it were in close proximity to a joint, from the
fact that perfect immobility can rarely, in the latter case, be
secured without incurring the risk of subsequent rigidity of the
joint.
A simple is always less serious than a compouud fracture. A
comminuted is always more dangerous than a simple, and a trans-
verse break is easier to treat than one which is oblique. The
most serious are those which are situated on parts of the body in
which it is difficult to secure perfect immobility, and especially
those which are accompanied by severe contusions and lacerations
in the soft parts; the protrusion of fragments through the skin ;
the division of blood vessels by the broken ends of the bone; the
existence of an articulation near the point to which inflammation
is likely to extend ; the luxation of a fragment of the bone ; lacer-
ation of the periosteum ; the presence of a large number of bony
particles, the result of the crushing of the bone—all these are cir-
cumstances which discourage a favorable prognosis, and weigh
against the hope of saving the patient for future usefulness.
Fractures which may be accounted curable are those which are
222 OPERATIONS ON BONES.
not conspicuously visible, as those of the ribs, where displace-
ments are either very limited or do not occur, the parts being kept
in situ by the nature of their position, the shape of the bones, the
articulations they form with the vertebre, the sternum, or their
cartilages of prolongation ; those of transverse processes of the
lumbar vertebrze ; those of the bones of the face ; those of the ili-
um, and that of the coffin bones. To continue the category, they
are evidently curable when their position and the character of the
patient contribute to aid the treatment. Those of the cranium,
in the absence of cerebral lesions; those of the jaws, of the ribs,
with displacement, of the hip, and those of the bone of the leg in
movable regions, but where their vertical position admits of per-
fect coaptation.
On the contrary, a compound, complicated, or comminuted
fracture, in whatever region it may be situated, may be accounted
incurable.
In treating fractures, time is an important element and “ de-
lays are dangerous.” Those of recent occurrence unite more easi-
ly and more regularly than older ones. |
Second. As a general rule, fractures are less serious in animals
of the smaller species than in those of more bulky dimensions.
This injluence of species will be readily appreciated when we real-
ize that the difficulties involved in the treatment of the latter class
have hardly any existence in connection with the former. The
difference in weight and size, and consequent facility in handling,
and making the necessary applications of dressings and other ap-
pliances for the purpose of securing the indispensable immobility
of the parts, and usually a less degree of uneasiness in the de-
portment of the patients are considerations in this connection of
ereat weight.
Third. In respect to the eestor of the animal, the most
obvious point in estimating the gravity of the case in a fracture
accident is the certainty of the total loss of the services of the pa-
tient during treatment—certainly for a considerable period of
time, perhaps permanently. For example, the fracture of the jaw
of a steer just fattening for the shambles will involve a heavier
loss than a similar accident to a horse. Usually the fracture of
the bones of the extremities in a horse is a very serious casualty,
the more so proportionately as the higher region of the limb is
affected. In working animals it is exceedingly difficult to treat a
FRACTURES. 223
fracture in such a manner as to restore a limb to its original per-
fection of movement. A fracture of a single bone of an extremity
in a breeding stallion or mare will not necessarily impair their
value as breeders. Other specifications under this head, though
pertinent and more or less interesting, may be omitted.
Fourth. Age and temper are important factors of cure. A
young, growing, robust patient, whose vis vite is active, is amen-
able to treatment which one with a waning constitution and past
mature energies would be unable to endure, and a docile, quiet
disposition will act co-operatively with remedial measures which
would be neutralized by the fractious opposition of a peevish and
intractable sufferer.
The fulfillment of three indications is indispensable in all frac-
tures. The first is the reduction, or the replacement of the parts
as nearly as possible in their normal position. The second is their
retention in that position for a period sufficient for the formation
of the provisional callus, and the third, which in fact is but an in-
cident of the second, the careful avoidance of any accidents or
causes of miscarriage which might disturb the curative process.
In reference to the first consideration, it must be remembered
that the accident may befall the patient at a distance from his
home, and his removal becomes the first duty to be attended to.
Of course this must be done as carefully as possible. If he can
be treated on the spot so much the better, though this is seldom
practicable, and the method of removal becomes the question eall-
ing for settlement. But two ways present themselves—he must
either walk or be carried. If the first, it is needless to say that
every caution must be observed in order to obviate any additional
pain for the suffering animal, and to avoid any aggravation of the
injury. Led slowly, and with partial support if practicable, the
journey will not always involve untoward results. If he is carried
it must be by means of a wagon, a truck, or an ambulance ; the
latter being designed and adapted to the purpose, would, of
course, be the preferable vehicle. As a precaution which should
never be overlooked, a temporary dressing should first be applied.
This may be so done as for the time to answer all the purpose of
the permanent adjustment and bandaging. Without thus secur-
ing the patient, a fracture of an inferior degree may be trans-
formed to one of the severest kind, and, indeed, a curable changed
to an incurable injury. We recall a case in which a fast trotting
224 OPERATIONS ON BONES.
horse, after running away in a fright caused by the whistle of a
locomotive, was found on the road limping with excessive lame-
ness in the off fore leg, and walked with comparative ease some
two miles to a stable before being seen by a surgeon. His imme-
diate removal in an ambulance was advised, but before that vehi-
cle could be procured the horse laid down, and upon being made
to get upon his feet was found with a well-marked comminuted
fracture of the os suffraginis, with considerable displacement.
The patient, however, after long treatment, made a comparatively
good recovery, and though with a large bony deposit, a ringbone,
was able to trot among the forties.
The two obvious indications in cases of fracture are reduction,
or replacement and retention.
In an incomplete fracture, where there is no displacement, the
necessity of reduction does not exist. With the bone kept in
place by an intact periosteum, and the fragments ‘secured by the
uninjured fibrous and ligamentous structure which surrounds
them, there is no dislocation to correct. It is also at times ren-
dered impossible by the seat of the fracture itself, by its dimensions
alone, or by the resistance arising from the muscular contraction
excited by the surgical manipulation. This is illustrated even in
small animals, as in dogs, by the exceeding difficulty encountered
in bringing the ends of a broken femur or humerus together, the
muscular contraction being even in these animals sufficiently for-
cible to renew the displacement.
It is generally, therefore, only fractures of the long bones, and
then at points not in close proximity to the trunk, that may be con-
sidered to be amenable to reduction. It is true that some of the
more superficial bones, as those of the head, of the pelvis, and of
the thoracic walls may in some cases require special manipulations
and appliances for their retention in their normal positions, but
the treatment of these and of a fractured leg cannot be the same.
The methods of accomplishing reduction vary with the features
of each case, the manipulations being necessarily modified to meet
changing circumstances. If the displacement is in the thickness
of the bone, as in transverse fracture, the manipulation of reduc-
tion consists in applying a steady pressure upon one of the frag-
ments, while the other is kept steady in its place, the object of the
pressure being the re-establishment of the exact coincidence of the
two bony surfaces. If the displacement has taken place at an
FRACTURES. 225
angle it will be sufficient in order to effect the reduction to press
upon the summit or apex of the angle until its disappearance in-
dicates that the parts have been brought into coaptation. This
method is often practiced in the treatment of a fractured rib. In
a longitudinal fracture, or when the fragments are pressed together
by the contraction of the muscles to which they give insertion
until they so overlap as to correspond by certain points of their
circumference, the reduction is to be accomplished by effecting
the movements of extension, counter-extension, and coaptation.
Extension is accomplished by making traction upon the lower por-
tion of the limb. Counter-extension consists in firmly holding or
confining the upper or body portion in such a manner that it
shall not be affected by the traction applied to the lower; in sim-
pler language, holding it motionless against the force exercised in
the extension. In other words, the operator, grasping the limb
below the fracture, draws it down or away from the trunk, while
he seeks, not to draw away, but simply to hold still the upper por-
tion until the broken ends of bone are brought to their natural
relative positions when the coaptation, which is thus affected, has
only to be made permanent by the proper dressings to perfect the
reduction.
In treating fractures in small animals the strength of the hand
is usually sufficient for the required manipulations. In the fracture
of a forearm of a dog, for example, while the upper segment is
firmly held by one hand, the lower may be grasped by the other
and the bone itself made to serve the purpose of a lever to bring
_ about the desired coaptation. In such a case that is sufficient to
overcome the muscular contraction and correct the overlapping or
other malposition of the bones. If, however, the resistance can
not be overcome in this mode, the upper segment may be committed
to an assistant for the management of the counter extension,
leaving to the operator the free use of both hands for the further
manipulation of the case.
But if the reduction of fractures in small animals is an easy
task it is far from being so when a large animal is the patient,
whose muscular force is largely greater than that of several men
combined. In such a caseresort must be had not only to superior
numbers for the necessary force, but in many cases to mechanical
aids. A reference to the mode of proceeding in a case of fracture
with displacement of the forearm of a horse will illustrate the
226 OPERATIONS ON BONES.
matter. The patient is first to be carefully cast, on the uninjured
side, with ropes, or a broad leather strap about 18 feet long, passed
under and around his body and under the axilla of the fractured
limb and secured at a point opposite to the animal and toward his
back. This will form the mechanical means of counter extension.
Another rope will then be placed around the inferior part of the
leg below the point of fracture, with which to produce extension,
and this will sometimes be furnished with a block or pulleys, in
order to augment the power when necessary ; and there is, in fact,
always an advantage in their use, on the side of steadiness and
uniformity, as well as of increased power. It is secured around
the fetlock or the coronet, or, what is better, above the knee and
nearer the point of fracture, and is committed to assistants. The
traction on thisshould be firm, uniform, and slow, without relaxing
or jerking, while the operator carefully watches the process. If
the bone is superficially situated he is able to judge, by the eye, of
any changes that may occur in the form or length of the parts
under traction, and discovering at the moment of its happening
the restoration of symmetry in the disturbed region, he gently but
firmly manipulates the place until all appearance of severed con-
tinuity have vanished. Sometimes the fact and the instant of res-
toration are indicated by a peculiar sound, or “click,” as the ends
of the bone slip into contact, to await the next step of the restora-
tive procedure.
The process is the same when the bones are covered with thick
muscular masses, excepting that it is attended with greater diffi-
culties, from the fact that the finger must be substituted for the
eye, and the taxis must take the place of the sight, and the result
naturally becomes more uncertain.
It frequently happens that perfect coaptation is prevented by
the interposition between the bony surfaces of substances, such as
a small fragment of detached bone or a clot of blood, and some-
times the extreme obliquity of the fracture is the opposing cause,
by permitting the bones to slip out of place. These are difficulties
which can not always be overcome, even in small-sized animals,
end still it is only when they are mastered that a correct consoli-
dation can be looked for. Yet without it the continuity between
the fragments will be by a deformed callus, the union will leave a
shortened, crooked or angular limb, and a disabled animal.
If timely assistance can be obtained, and the reduction ac-
— ae
FRACTURES. 227
complished immediately after the occurrence of the accident, that
is the best time for it. But if it cannot be attended to until in-
flammation has become established and the parts have become
swollen and painful, time must be allowed for the subsidence of
these symptoms before attempting the operation. A spasmodic
muscular contraction, which sometimes interposes a difficulty, may
be easily overcome by subjecting the patient to general anesthesia,
and need not, therefore, cause any loss of time. A tendency to
this may also be overcome by the use of sedatives and anti-phlo-
gistic remedies.
The reduction of the fracture having been accomplished, the
problem which follows is that of retention. The parts which have
been restored to their natural position must be kept there, with-
out disturbance or agitation, until the perfect formation of a callus,
and it is here that ample latitude exists for the exercise of ingen-
uity and skill by the surgeon in the contrivance of the necessary
apparatus. One of the most important of the conditions which
are available by the surgeon in treating human patients is denied
the veterinarian in the management of those which belong to
the animal tribes. This is position. The intelligence of the
human patient co-operates with the instructions of the surgeon,
but with the animal sufferer there is a continual antagonism
between the parties, and the forced extension and fatiguing posi-
tion which must for a considerable period be maintained as a con-
dition of restoration require special and effective appliances to
insure successful results. To obtain complete immobility is
scarcely possible, and the surgeon must be content to reach a
point as near as possible to that which is unattainable. For this
reason, as will subsequently be seen, the use of slings and the re-
straint of patients in very narrow stalls is much to be preferred to
the practice sometimes recommended, of allowing entire freedom of
motion by turning them loose in box stalls. Temporary and mova-
ble apparatus are not usually of difficult use in veterinary practice,
but the restlessness of the patients and their unwillingness to
submit quietly to the changing of the dressings render it obliga-
tory to have recourse to permanent and immovable bandages,
which should be retained without disturbance until the process of
consolidation is complete.
The materials composing the retaining apparatus consist of
oakum, bandages and splints, with an agglutinating compound
228 OPERATIONS ON BONES.
which forms a species of cement by which the different constit-
uents are blended into a consistent mass to be spread upon the
surface covering the locality of the fracture. Its components are
black pitch, resin, and Venice turpentine, blended by heat. The
dressing may be applied directly to the skin, or a covering of thin
linen may be interposed. A putty made with powdered chalk
and the white of an egg is recommended for small animals, though
a mixture of sugar of lead and burnt alum with the albumen is
preferred by others. Another formula is spirits of camphor,
Goulard’s extract and albumen. Another recommendation is to
saturate the oakum and bandages with an adhesive solution formed
with gum arabic, dextrine, flour paste, or starch. This is advised
particularly for small animals. Dextrine mixed, while warm, with
burnt alum and alcohol cools and solidifies into a stony consistency,
and is preferable to plaster of Paris, which is less friable and has
less solidity, besides being heavier and requiring constant additions
as it becomes older. Starch and plaster of Paris form another
good compound,
In applying the dressing the leg is usually padded with a
cushion of oakum, thick and soft enough to equalize the irregu-
larities of the surface and to form a bedding for the protection of
the skin from chafing. Over this the splints are placed. The
material for these is, variously, pasteboard, thin wood, bark, laths,
gutta percha, strips of thin metal, as tin or perhaps sheet iron.
These should be of sufficient length not only to cover the region
of the fracture, but to extend sufficiently above and below to
render the immobility more complete than in the surrounding
joints. The splints again, are covered with cloth bandages, linen
preferably, soaked in a glutinous moisture. These bandages are
to be carefully applied, with a perfect condition of lightness.
They are usually made to embrace the entire length of the leg, in
order to avoid the possibility of interference with the circulation
of the extremity, as well as for the prevention of chafing. They
should be rolled from the lower part of the leg upward, and
carefully secured against loosening. Im some instances suspen-
sory bandages are recommended, but excepting for small animals
our experience does not justify a concurrence in the recommen-
dation.
These permanent dressings always need careful watching in
reference to their immediate effect upon the region they cover,
FRACTURES. 229
especially during the first days succeeding that of their applica-
tion. Any manifestation of pain, or any appearance of swelling
above or below, or any odor suggestive of suppuration should
excite suspicion, and a thorough investigation should follow with-
out delay. The removal of the dressing should be performed
with great care, and especially so if time enough has elapsed since
its application to allow of a probability of a commencement of the
healing process or the existence of any points of consolidation.
With the original dressing properly applied in its entirety in the
first instance, the entire extremity will have lost all chance of
mobility, and the repairing process may be permitted to proceed
without interference. There will be no necessity and there need
be no haste for removal or change except under such special con-
ditions as have just been mentioned, or when there is reason to
judge that solidification has become perfect, or for the comfort of
the animal, or for its readaptation in consequence of the atrophy
of the limb from want of use. Owners of animals are often
tempted to remove a splint or bandage prematurely at the risk of
producing a second fracture in consequence of the failure of the
callus properly to consolidate.
The method of applying the splints which we have described
refers to the simple variety only. In a compound case the same
rules must be observed, with the modification of leaving openings
through the thickness of the dressing, opposite the wound, in
order to permit the escape of pus and to secure access to the
points requiring the application of treatment.
FRACTURE OF DIFFERENT BonsEs.
Of the Cranial Bones.—Fractures of this variety in large
animals are comparatively rare, though the records are not desti-
tute of cases. When they occur, itis as the result of external
violence, the sufferers being usually runaways which have come in
collision with a wall or tree, or other obstruction; or it may occur
in those which in pulling upon the halter have broken it with a
jerk and been thrown backward, as might occur in rearing too
violently. Under these conditions we have witnessed fractures of
the parietal, of the frontal, and of the sphenoid bones. These
fractures may be of the complete or incomplete kind, which in-
deed is usually the case with those of the flat bones, and they are
liable to be complicated with lacerations of the skin, in conse-
230 OPERATIONS ON BONES.
quence of which they are easily brought under observation. But
when the fact is otherwise and the skin is intact, the diagnosis
becomes difficult. The incomplete variety may be unaccompanied
by any special symptoms, but in the complete kind one of the
bony plates may be so far detached as to press upon the cerebral
substance with sufficient force to produce serious nervous com-
plications. When the injury occurs at
the base of the cranium, hemorrhage may
be looked for, with paralytic symptoms,
and when these are present the usual ter-
mination is death. It may still happen,
however, that the symptoms of an appa-
rently very severe concussion may dis-
appear, with the result of an early and
complete recovery, and the surgeon will
do well to avoid undue precipitation in
venturing upon a prognosis. In frac-
tures of the orbital or the zygomatic
bones the danger is less pressing than
with injuries otherwise located about the
head. The treatment of cranial fractures
is simple, though involving the best skill
of the experienced surgeon. When in-
complete, hardly any interference is need-
ed; even plain bandaging may usually
be dispensed with. In the complete va-
riety the danger to be combated is com-
pression of the brain, and attention to
this indication must not be delayed. The
means to be employed are the trephining
of the skull over the seat of the fracture,
and the elevation of the depressed bone or the removal of the por-
tion which is causing the trouble. Fragments of bonein commin-
uted cases, exfoliations, collections of fluid, or even protruding
portions of the brain substance must be cleansed away, and a
simple bandage so applied as to facilitate the application of sub-
sequent dressings.
Fractures of the Bones of the Face.—In respect to their origin—
usually traumatic—these injuries rank with the preceding, and are
commonly of the incomplete variety. They may easily be over-
Fig. 254.—Apparatus for Frac-
ture of the Nasal Bone.
FRACTURES. 231
looked and may even sometimes escape recognition until the rep-
arative process has been well established and the discovery of the
wound becomes due to the prominence caused by the presence of
the provisional callus which marks its cure. When the fracture is
complete it will be marked by local deformity, mobility of the
fragments, and crepitation. Nasal hemorrhage, roaring, frequent
sneezing, loosening or loss of teeth, difficulty of mastication, and
inflammation of the cavities of the sinuses are varying complica-
tions of these accidents. The object of the treatment should be
the restoration of the depressed bones as nearly as possible to
their normal position, and their retention in place by protecting
splints, which should cover the entire facial region (Figs. 254, 255),
My
Fig, 255.—Apparatus for Fracture of the Bones of the Face Appli7d.
and special precautions should be observed to prevent the patient
from disturbing the dressing by rubbing his head against sur-
rounding objects, such as the stall, the manger, the rack, etc.
Clots of blood in the nasal passages must be washed out, collec-
tions of pus must be removed from the sinuses, and if the teeth
are loosened and likely to fall out, they should be removed. If
roaring is threatened, tracheotomy is indicated.
Fractures of the Pre-Maxillary Bone.—These are mentioned
by continental authors. They are usually encountered in connec-
tion with fractures of the nasal bone, and may take place either
in the width or length of the bone.
The deformity of the upper lip, which is drawn sideways in
_ 232 OPERATIONS ON BONES.
this lesion, renders it easy of diagnosis. The abnormal mobility
and the crepitation, with the pain manifested by the patient when
undergoing examination, are concurrent symptoms. Looseness
of the teeth, abundant salivation, and entire inability to grasp the
food complete the symptomatology of these accidents. In the
FIG. 256.—Fracture of the Lower Jaw.
treatment, splints of gutta percha or leather are sometimes used,
but they are of difficult application. Our own judgment and
practice are in favor of the union of the bones by means of metallic
sutures.
The Lower Jaw.—A fracture here is not an injury of infrequent
occurrence. It involves the body of the bone, at its symphysis, or
back of it, and includes one or both of its branches, either more
or less forward, or at the posterior part, near the temporo-max-
illary articulation, at the coronoid process.
Falls, blows, or other external violence, or powerful muscular
contractions during the use of the speculum, may be mentioned
among the causes of this lesion. The fracture of the neck and of
the branches in front of the cheeks cause the lower jaw, the true
dental arch, to drop without the ability to raise it again to the
upper, and the result is a peculiar and characteristic physiognomy
(Fig. 256.) The prehension and mastication of food become im-
possible; there is an abundant escape of fetid and sometimes
bloody saliva, especially if the gums have been wounded; there is
excessive mobility of the lower end of the jawbone; and there is
FRACTURES. 233
Fic. 257.—Splint for Fracture of the Lower Maxillary.
crepitation; and frequently paralysis of the under lip. But al-
though the aspect of an animal suffering with a complete and
often compound and comminuted fracture of the submaxilla pre-
sents at times a frightful spectacle, the prognosis of the case is
comparatively simple, and recovery usually only a question of
time. The severity of the lesion corresponds in degree with that
of the violence to which it is due, the degree of simplicity or the
amount of complication, and with the situation of the wound. It
is simple when at the symphysis, but becomes more serious when
it affects one of the branches, to be again aggravated when both
are involved. Fracture of the coronoid process becomes import-
ant principally as an evidence of the existence of a morbid diathe-
sis, such as osteoporosis, or the like.
The particular seat of the injury, with its special features, will
of course determine the treatment. Fora simple fracture without
displacement, provided there is no laceration of the periosteum,
an ordinary supporting bandage will usually be sufficient. But
when there is displacement the reduction of the fracture must first
be accomplished, and for this special splints are necessary. In a
fracture of the symphysis or of the branches the adjustment of the
fragments by securing them with metallic sutures is the first step
necessary, to be followed by the application of supports, consisting
of splints of leather or sheets of metal (Fig. 258 and 259), the entire
234 ; OPERATIONS ON BONES.
4 ve My 4
Ky Hi { sil uh
Fig. 258.—Splint, for Fracture of the Branches.
front of the head being then covered with bandages prepared with
adhesive mixtures. During the entire course of treatment a special
method of feeding becomes necessary. The inability of the patient
to appreciate the situation of course necessitates a resort to an
artificial mode of introducing the necessary food into his stom-
ach, and it is accomplished by forcing between the commissures
of the lips, in a liquid form, by means of a syringe, the milk or
Fig. 259.—Another Splint for Fracture of the Maxillary.
FRACTURES. 235
nutritive gruels selected for his sustenance, until the consolidation
is sufficiently advanced to permit the ingestion of food of a more
solid consistency. The callus will usually be sufficiently hardened
in two or three weeks to allow of a change of diet to mashes of
cut hay and scalded grain, until the removal of the dressing re-
stores him to his old habit of mastication.
Fractures of vertebre.—These are not very common, but when
they do occur the bones most frequently injured are those of the
back and loins. The ordinary causes of fracture are responsible
here as elsewhere, such as heavy blows on the spinal column, severe
falls while conveying heavy loads, and especially violent efforts in
resisting the process of casting. Although occurring more or less
frequently under the latter circumstances, the accident is not always
attributable to carelessness or error in the management. It may,
of course, sometimes result from such a cause as a badly prepared
bed, or the accidental presence of a hard body concealed in the
straw, or to a heavy fall when the movements of the patient have
not been sufficiently controlled by an effective apparatus and its
skillful adaptation, but it is quite as likely to be caused by the
violent resistance and the consequent powerful muscular contrac-
tion by the frightened patient. The sim-
ple fact of the overarching of the vertebral
column, with excessive pressure against
it from the intestinal mass, owing to the
spasmodic action of the abdominal mus-
cles, may account for it, and so also may
the struggles of the animal to escape from
the restraint of the hobbles while frantic
under the pain of an operation without
anesthesia. In these cases the fracture
usually occurs in the body or the annular
a part, or both, of the posterior dorsal or
F1G.260.—Fracture of the Body the anterior lumbar vertebra. When the
ph a Dersel Verte pre. tranverse processes of the last-named
bones are injured, it is probably in consequence of heavy concus-
sion incident to striking the ground when cast. Diagnosis of a
fracture of the body of a vertebra is not always easy, especially
when quite recent, and more especially when there is no accom-
panying displacement. There are certain peculiar signs accom-
panying the occurrence of the accident while an operation is in
236 OPERATIONS ON BONES.
Fia. 261a.—Comminuted Fracture of a Dor-
sal Vertebrea at the Annular Portion.
Fic. 261.—United Fracture of the Spi-
nous Processes of Dorsal Vertebre.
progress which should at once excite the suspicion of the surgeon.
In the midst of a violent struggle the patient becomes suddenly
quiet; the movement of a sharp instrument which at first excited
his resistance fails to give rise to any further evidence of sensation;
perhaps a general trembling, lasting for afew minutes, will follow,
succeeded by a cold, profuse perspiration, particularly between
the hind legs, and frequently there will be micturition and defe-
cation. Careful examination of the vertebral column may then
detect a slight depression or irregularity in the direction of the
spine, and there may be a diminution or loss of sensation in the
posterior part of the trunk while the anterior portion continues to
be as sensitive as before. In making an attempt to get upon his
feet, however, upon the removal of the hobbles, only the fore part
of the body will respond to the effort, a degree of paraplegia being
present, and while the head, neck, and fore part of the body will
be raised, the hind quarters and hind legs will remain inert. The
animal may perhaps succeed in rising and probably may be re-
FRACTURES. 237
FIG. 262.—Fracture of the Axis in an Animal Suffering with Osteo-Porosis.
moved to his stall, but the displacement of the bone will follow,
converting the fracture into one of the complete kind, either
through the exertion of walking or by a renewed attempt to rise
after another fall, before reaching his stall. By this time the
paralysis is complete, and the extension of the meningitis which
has become established is a consummation soon reached.
To say that the prognosis of fracture of the body of the vertebree
is always serious is to speak very mildly. It were better, perhaps,
to say that occasionally a case may recover. Fractures of the
transverse processes are less serious.
Instead of stating the indication in this class of cases, as if
assuming them to be medicable, the question naturally becomes
rather a query: “Can any treatment be recommended in a fracture
of the body of a vertebra?” The only indication in such a case,
in our opinion, is to reach the true diagnosis in the shortest pos-
sible time and to act accordingly. If there is displacement, and
the existence of serious lesions may be inferred from the nervous
symptoms, the destruction of the suffering animal appears to sug-
gest itself as the one conclusion in which considerations of policy,
humanity, and science at once unite.
If, however, it is fairly evident that no displacement exists;
that pressure upon the spinal cord is not yet present; that the
animal with a little assistance is able to rise upon his feet and to
walk a short distance, it may be well to experiment upon the case
to the extent of placing the patient in the most favorable cireum-
stances for recovery, and allow nature to operate without further
interference. This may be accomplished by securing immobility
238 OPERATIONS ON BONES.
of the whole body as much as possible, and especially of the sus-
pected region, by placing the patient in slings, in a stall sufficiently
narrow to preclude lateral motion, and covering the loins with a
thick coat of agglutinative mixture, and wait for developments.
Fracture of the Ribs.—The different regions of the chest are
not equally exposed to the violence to which fractures of the ribs
are due, and they are therefore either more common or more easily
discovered during life at some points than at others. The more
exposed regions are the middle and the posterior, while the front
is largely covered and defended by the shoulder. A single rib
may be the seat of fracture, or a number may be involved, and
there may be injuries on both sides of the chest at the same time.
It may take place lengthwise, in any part of the bone, though the
middle, being the most exposed, is the most frequently hurt. In-
complete fractures are usually lengthwise, involving a portion only
of the thickness, or one or other of the surfaces. The complete
land may be either transverse or oblique, and are most commonly
Fie. 263.—United Transversal and Longitudinal Fractures of the Ribs.
denticulated. The fracture may be comminuted, and a single
bone may show one of the complete and one of the incomplete
kind at different points. The extent of surface presented by the
thoracic region, with its complete exposure at all points, explains
the liability of the ribs to suffer from all forms of external vio-
lence.
In many instances fractures of these bones continue undiscoy-
ered, especially the incomplete variety, without displacement,
though the evidences of local pain, a certain amount of swelling
and a degree of disturbance of the respiration, if noticed during
the examination of a patient, may suggest a suspicion of their ex-
istence. Abnormal mobility and crepitation are difficult of de-
tection, even when present, and they are not always present.
FRACTURES. 239
When there is displacement the deformity which it occasions will
betray the fact, and when such an injury exists the surgeon will,
of course, become vigilant in view of possible and probable com-
plications of thoracic trouble, and prepare himself for an encoun-
ter with a case of traumatic pleuritis or pneumonia. Fatal injur-
ies of the heart are recorded. Subcutaneous emphysema is a
common accompaniment of broken ribs, and we recall the death
from this cause of a patient of our own, which had suffered a frac-
ture of two ribs in the region of the withers under the cartilages
of the shoulder, and of which the diagnosis was made only after
the fatal ending of the case.
These hurts are not often of a very serious character, though
the union is never as solid and complete as in other fractures, the
callus being usually imperfect and of a fibrous character, with an
amphiarthrosis formation. Still, complications occur which may
impart gravity to the prognosis.
Fractures with but a slight or no displacement need no reduc-
tion. All that is necessary is a simple application of a blistering
nature as a preventive of inflammation or for its subjugation when
present, and in order to excite an exudation which will tend to
aid in the support and immobilization of the parts. At times,
however, a better effect is obtained by the application of a band-
age placed firmly around the chest, although, while this limits the
motion of the ribs, it is apt to render the respiration more labored.
If there is displacement with much accompanying pain and
evident irritation of the lungs, the fracture must be reduced with-
out delay. The means of effecting this vary according to whether
the displacement is outward or inward. In the first case the
bone may be straightened by pressure from without, while in the
second the end of the bone must be raised by a lever, for the in-
troduction of which a small incision through the skin and inter-
costal spaces will be necessary. When coaptation has been af-
fected it must be retained by the external application of adhesive
mixture, with splints and bandages around the chest.
Fractures of the bones of the pelvis will be considered under
their separate denominations, as those of the sacrum and the os
innominata, or the hip, which includes the subdivision of the
ilium, the pubes, and the ischium.
The Sacrum.—Fractures of this bone are rarely met with
among solipeds. Among cattle, however, it is of common occur-
240 OPERATIONS ON BONES.
rence, being attributed not only to the usual varieties of violence,
as blows and other external hurts, but to the act of coition, and
to violent efforts in parturition. It is generally of the transverse
kind, and may be recognized by the deformity which it occasions.
This is due to the dropping of the bone, with a change in its di-
rection and a lower attachment of the tail, which also becomes
more or less paralyzed. The natural and spontaneous relief which
usually interposes in these cases has doubtless been observed by
the extensive cattle breeders of the West, and their practice and
example fully establishes the inutility of interference. Still, cases
may occur in which reduction may be indicated, and it then be-
comes a matter of no difficulty. It is effected by the introduction of
a round, smooth piece of wood into the rectum as far as the frag-
ment of the bone, and using it as a lever, resting it upon another
as a fulerum placed under it outside. The bone having been thus
returned may be kept in place by the ordinary external means in use.
The Os Innominata.—Fractures of the ium may be observed
either at the angle of the hip or at the neck of the bone ; those of
the pubes may take place at the symphysis, or in the body of the
bone; those of the ischium on the floor of the bone, or at its pos-
terior external angle. Or, again, the fracture may involve all
three of these constituent parts of the hip bone by having its situ-
ation in the articular cavity—the acetabulum by which it joins the
femur or thigh bone.
Some of these fractures are easily recognized, while others are
difficult to identify. The ordinary deformity which characterizes
a fracture of the external angle of the ilium, its dropping and the
diminution of that side of the hip in width, unite in indicating the
existence of the condition expressed by the term “hipped.” But
an incomplete fracture, or one that is complete without displace-
ment, or even one with displacement, often demands the closest
scrutiny for its discovery. The lameness may be well marked, and
an animal may show but little appearance of it while walking, but
upon being urged into a trot will manifest it more and more, until
presently he will cease to use the crippled limb altogether, and
perform his traveling entirely on three legs. The acute character
of the lameness will vary in degree as the seat of the lesion ap-
proximates the acetabulum. In walking, the motion at the hip is
very limited, and the leg is dragged, while at rest it is relieved
from bearing its share in sustaining the body. An intelligent
FRACTURES. 241
Fic. 264.—Fractures of the Ossa Innominata: 1, at the external angle; 2, at the
internal angle; 3, at the neck of the ilium; 4, at the body of the pubis; 4a, at the
antero-external angle of the ischium; 5, at the cotyloid cavity; 6, at the postero-exter-
nal angle of the ischium ; 7, at the symphysis pubis.
opinion and correct conclusion will depend largely upon a knowl-
edge of the history of the case, and while in some instances that
will be but a report of the common etiology of fractures, such as
blows, hurts, and other external violence, the simple fact of a fall
may furnish a satisfactory solution of the whole matter.
With the exception of the deformity of the illum in a fracture
of its external angle, and unless there has been a serious laceration
of tissues and infiltration of blood, or excessive displacement, there
are no very definite external symptoms in a case of a fracture of
the hip bone. There is one, however, which, in a majority of cases,
will not fail—it is crepitation. This evidence is attainable by both
external and internal examination—by manipulation of the gluteal
surface and by rectal taxis. Very often a lateral motion, or bal-
ancing of the hinder parts by pressing the body from one side to
the other, will be sufficient to render the crepitation more distinct
—a slight sensation of grating, which may be perceived even through
the thick coating of muscle which covers the bone—and the sensa-
tion may not only be felt, but to the ear of the expert may even
become audible. This external manifestation is, however, not
always sufficient in itself, and should always be associated with the
rectal taxis for corroboration. It is true that this may fail to add to
the evidence of fracture, but till then the simple testimony afforded
942 OPERATIONS ON BONES.
by the detection of crepitation from the surface, though a strong
confirmatory point, is scarcely sufficiently absolute to establish
more than a reasonable probability or strong suspicion in the case.
In addition to the fact that the rectal examination brings the
exploring hand of the surgeon into near proximity to the desired
point of search, and to an accurate knowledge of the situation of
parts, both pro and con as respects his own views, there is another
advantage attendant upon it which is well entitled to appreciation.
This is the facility with which he can avail himself of the co-opera-
tion of an assistant, who can aid him by manipulating the implicated
limb and placing it in various positions, so far as the patient will
permit, while the surgeon himself is making explorations and study-
ing the effect from within. By this method he can hardly fail to
ascertain the character of the fracture and the condition of the
bony ends. By the rectal taxis, as if with eyes in the finger ends,
he will “see” what is the extent of the fracture of the ilium or of
the neck of that bone; to what part of the central portion of the
bone (the acetabulum) it reaches; whether thisis free from disease
or not, and in what location on the floor of the pelvis the lesion is
situated. We have frequently, by this method, been able to detect
a fracture at the symphysis, which from its history and symptoms
and an external examination, could only have been guessed at.
Yet, with allits advantages, the rectal examination is not always
necessary, as, for example, when the fracture is at the posterior
and external angle of the ischium, when by friction of the bony
ends the surgeon may discern the crepitation without it.
Every variety of complication, including muscular lacerations
with the formation of deep abscesses and injuries to the organs
of the pelvic cavity, the bladder, the rectum, and the uterus, may
be associated with fractures of the hip bone.
The prognosis of these lesions will necessarily vary considerably.
A fracture of the most superficial part of the bone of the ilium or
of the ischium, especially where there is little displacement, will
unite rapidly, leaving a comparatively sound animal often quite
free from subsequent lameness. Butif there is much displacement,
only a ligamentous union will take place, with much deformity and
more or less irregularity in the gait. Other fractures may be fol-
lowed by complete disability of the patient, as, for example, when
the cotyloid cavity is involved, or when the reparatory process has
left bony deposits in the pelvic cavity at the seat of the union,
FRACTURES. 243
which may, with the female, interfere with the steps of parturition,
or induce some local paralysis by pressure upon the nerves which
govern the muscles of the hind legs. This is a condition not in-
frequently observed when the callus has been formed on the floor
of the pelvis near the obturator foramen, pressing upon the course
or involving the obturator nerve.
The treatment of all fractures of the hip bone should, in our
estimation, be of the simplest kind. Rendered comparatively im-
movable by the thickness of the muscles by which the region is
enveloped, one essential indication suggests itself, and that is, to
place the animal in a position which, as far as possible, will be fixed
and permanent. For the accomplishment of this purpose the best
measure, as we consider it, is to place him in a stall of just suffi-
cient width to admit him, and to apply a set of slings snugly, but
comfortably. This will fulfill the essential conditions of recovery,
rest, and immobility. Blistering applications would be injurious,
though the adhesive mixture might prove in some degree beneficial.
The minimum period allowable for solid union in a fractured
hip is, in our judgment, two months, and we have known cases
in which that was too short atime. _
As we have before said, there may be cases in which the
treatment for fracture at the floor of the pelvis has been followed
by symptoms of partial paralysis, the animal, when lying down,
being unable to regain his feet, but moving freely when placed in
an upright position. This condition is due to the interference of
the callus with the functions of the obturator nerve, which it
presses upon or surrounds. We feel warranted by our experience
in similar cases in cautioning owners of horses in this condition
to exercise due patience, and to avoid a premature sentence of
condemnation against their invalid servants; they are not all irre-
coverably paralytic. With alternations of moderate exercise, rest in
the slings, and the effect of time while the natural process of ab-
sorption is taking effect upon the callus, with other elements of
change that may be so operating, the horse may in due time be-
come able to once more earn his subsistence and serve his master.
fracture of the Scapula.—This bone is seldom fractured, its
comparative exemption being due to its free mobility and the pro-
tection it receives from the superimposed soft tissues. Only
direct and powerful causes are sufficient to effect the injury, and
when it occurs the large rather than the smaller animals are the
244 OPERATIONS ON BONES.
Fig. 265.—Transverse Fracture of the Scapula.
subjects. The causes are heavy blows or kicks, and violent
collisions with unyielding objects. Those which are occasioned
by falls are generally at the neck of the bone, and of the trans-
verse and comminuted varieties.
The diagnosis is not always easy. The symptoms are inability
to rest the leg on the ground and to carry weights, and they are
present in various degrees from slight to severe. The leg rests
upon the toe and seems shortened, locomotion is performed by
jumps. Moving the leg while examining it and raising the foot
for inspection seem to produce much pain and cause the animal
to rear. Crepitation is readily felt with the hand upon the
shoulder when the leg is moved. If the fracture occurs in the
upper part of the bone,-overlapping of the fragments and dis-
placement will be considerable.
The fracture of this bone is usually classed among the more
serious accidents, though cases may occur which are followed by
recovery without very serious ultimate results, especially when
the seat of the injury is at some of the upper angles of the bone,
or about the acromion crest. But if the neck and the joint are
FRACTURES.
“im
Ki i nuit Mth N
Fig. 267.—The same in place.
246 OPERATIONS ON BONES.
the parts involved, complications are apt to be present which are
likely to disable the animal for life.
If there is no displacement a simple adhesive dressing, to
strengthen and immobilize the parts, will be sufficient. A coat of
black pitch dissolved with wax and Venice turpentine, kept in place
over the region with oakum or linen bands, will be all the treat-
ment required, especially if the animal is kept quiet in the slings.
Displacement cannot be remedied, and reduction is next to
impossible. Sometimes an iron plate is applied over the parts
and retained by bandages, as in the dressing of Bourgelat (Figs. —
266, 267); and this may be advantageously replaced by a pad of
thick leather. In smaller animals, and also in larger ones, the
parts are retained by figure-8 bandages, embracing both the nor-
mal and the diseased shoulders, crossing each other in the axilla
and covered with a coating of adhesive mixture.
Li
q
FIG. 268.—Delwart’s Bandage for Fic. 269.—Another Bandage,
Fracture of the Scapula. with Iron Splints.
Fractures of the Humerus.—These are more common in small
than in large animals, and are always the result of external trau-
matism. They are generally very oblique, are often comminuted,
and though more usually involving the shaft of the bone will in
some cases extend to the upper end and into the articular head.
There is ordinarily considerable displacement in consequence of
FRACTURES. Pore
the overlapping of the broken ends of the bone, and this, of
course, causes more or less shortening of the limb. There will
also be swelling, with difficulty of locomotion, and crepitation will
be easy of detection. This fracture is always a serious damage
to the patient, leaving him with a permanently shortened limb
and a remediless, lifelong lameness.
If treatment is determined upon, it will consist in the reduction
of the fracture by means of extension and counter extension, and
in order to accomplish this the animal must be thrown. If suc-
cessful in the reduction, then follows the application and adjust-
Fic. 270.—Comminutd Frac- FIG. 271.—Oblique Fracture of the Humerus
ture of the Humerus. with Displacement and Partial Union.
ment of the apparatus of retention, which must needs be of the
most perfect and efficient kind. And finally, this, however skill-
fully contrived and carefully adapted, will often fail to effect any
good purpose whatever.
Fracture of the Forearm.—A fracture in this region may also
involve the radius or the cubitus, the first being broken at times
in its upper portion above the radio-cubital arch at the olecranon.
If the fracture. occurs at any part of the forearm from the radio-
248 OPERATIONS ON BONES.
cubital arch down to the knee, it may involve either the radius
alone or the radius and the cubitus, which there intimately unite.
Besides having the same etiology with most of the fractures,
those of the forearm are, nevertheless, more commonly due to
kicks from other animals, especially when crowded together in
large numbers in insufficient space. It is a matter of observation
that, under these circumstances, fractures of the incomplete kind
Fig. 271a.—Consolidated Frac- ; FIG. 272.
of the Body of the Humerus. Fractures of the Radius.
are those which occur on the inside of the leg, the bone being in
that region almost entirely subcutaneous, while those of the com-
plete class are either oblique or transverse. The least common
are the longitudinal, in the long axis of the bone.
This variety of fracture is easily recognized by the appearance
of the leg and the different changes it undergoes. There is
inability to use the limb; impossibility of locomotion; mobility
FRACTURES. 249
F1Gd. 273.—Practure of the Ulna.
below the injury; the ready detection of crepitation—in a word,
the assemblage of all the signs and symptoms which have been
already considered as associated with the history of broken bones.
The fracture of the cubitus alone, principally above the radio-
cubital arch, may be ascertained by the aggravated lameness, the
excessive soreness on pressure, and perhaps a certain increase of
motion, with a very slight crepitation if tested for in the usual
way. Displacement is not likely to take place except when it is
well up towards the olecranon or its tuberosity, the upper seg-
ment of the bone being in that case likely to be drawn upward.
For a simple fracture of this region there exists a fair chance of
recovery, but in a case of the compound and comminuted class
there is less ground for a favorable prognosis, especially if the
elbow joint has suffered injury. A fracture of the cubitus alone
is not of serious importance, except when the same conditions
prevail. A fracture of the olecranon is less amenable to treat-
ment, and promises little better than a ligamentous union.
Considering all the various conditions involving the nature and
extent of these lesions, the position and direction of the bones
of the forearm are such as to render the chances for recovery from
fracture as among the best. The reduction, by extension and
250 OPERATIONS ON BONE».
counter-extension; the maintenance of the coaptation of the seg-
ments; the adaptation of the dressing by splints, oakum, and
ageglutinative mixtures; in a word, all the details of treatment may
be here fulfilled with a degree of facility and precision not attain-
able in any other part of the organism. An important if not an
essential point, however, must be emphasized in regard to the
splints. Whether these are of metal, wood, or other material, they
should reach from the elbow joint to the ground, and should be
placed on the posterior face and on both sides of the leg. This is
then to be so confined in a properly construct-
ed box as to preclude all possibility of motion,
while yet it must sustain a certain portion of
the weight of the body. The iron splint rec-
ommended by Bourgelat is designed for frac-
tures of the forearm, of the knee, and of the
cannon bone, and will prove to be an appliance
of great value. For small animals our prefer-
ence is for an external covering of gutta per-
cha, embracing the entire leg. A sheet of this
substance of suitable thickness, according to
the size of the animal, softened in lukewarm
water, is, when sufliciently pliable, molded on
the outside of the leg, and when suddenly
hardened by the application of cold water
forms a complete casing sufficiently rigid to
resist all motion. Patients treated in this
manner have been able to use the limb freely,
5 Eng: ; 5 é Fic. 274. — Bourgelat’s
without pain, immediately after the application Iron Splint for Fracture
and Lugation of the
of the dressing. The removal of the splint is
Forearm,
easily effected by cutting it away, either wholly
or in sections, after softening it by immersing the leg in a warm
bath.
Fracture of the Knee.—This accident, happily, is of rare occur-
rence, but when it takes place is of a severe character, being of the
comminuted kind, and always accompanied by synovitis, with dis-
ease of the joint, requiring for treatment therefor, besides the in-
dication of perfect immobility of the joint, that of open joints,
synovitis, and arthritis.
Fracture of the Hemur.—The protection which this bone re-
ceives from the large mass of muscles in which it is enveloped does
FRACTURES. a9 b
not suffice to invest it with immunity in regard to fractures. It
contributes its share to the list of accidents of this description,
sometimes in consequence of external violence and sometimes as
the result of muscular contraction; sometimes it takes place at
the upper extremity of the bone; sometimes at the lower; some-
times at the head, when the condyles become implicated; but it is
principally found in the body or diaphysis. The fracture may be
of any of the ordinary forms, simple or compound, complete or in-
complete, transverse or oblique, ete. A case of the comminuted
variety is recorded in which eighty-five fragments of bone were
counted and removed.
The thickness of the muscular covering sometimes renders the
diagnosis difficult by interfering with the manipulation, but the
crepitation test is readily available even when the swelling is con-
siderable and which is likely to be the case as the result of the in-
FIG. 275.—Fracture of the Femur. FiG. 276.—Fracture, with Shortening.
252 OPERATIONS ON BONES. |
terstitial hemorrhage which naturally follows the laceration of the
blood vessels of the region involved. If the fracture is at the neck
of the bone the muscles of that region (the gluteal) are firmly con-
tracted and the leg seems to be shortened in consequence. Loco-
motion isimpossible. Crepitation may in some cases be discerned
by rectal examination, with one hand resting over the coxo femoral
articulation. Fractures of the tuberosities of the upper end of
the bone, the great trochanter, may be identified by the deform-
ity, the swelling, the impossibility of rotation, and the dragging
of the leg in walking. Fracture of the body is always accompanied
by displacement, and as a consequence a shortening of the leg,
which is carried forward. The lameness is excessive, the foot
being moved, both when raising it from the ground and when
setting it down, very timidly and cautiously. The manipulations
for the discovery of crepitation always cause much pain. Lesions
of the lower end of the bone are more difficult to diagnosticate
with certainty, though the manifestation of pain while making
heavy pressure upon the condyles will be so marked that only
crepitation will be needed to turn a suspicion into a certainty.
The question as to treatment in fractures of this description
resolves itself into the query whether any treatment can be sug-
gested that can avail anything practically as a curative measure,
whether, upon the hypothesis of reduction as an accomplished fact,
any permanent or efficient device as a means of retention is within
the scope of human ingenuity. If the reduction were successfully
performed would it be possible to-keep the parts in place by any
known means at our disposal? At the best the most favorable
result that could be anticipated would be a reunion of the fragments,
with a considerable shortening of the bone, and a helpless, limp-
ing, crippled animal to remind. us that for human achievement
there is a “thus far, and no farther.”
In small animals, however, attempts at treatment are justifiable,
and we are convinced that in many cases of difficulty in the appli-
cation of splints and bandages a patient may be placed in a con-
dition of undisturbed quiet and left to the processes of nature for
“treatment” as safely and with as good an assurance of a favorable
result as if he had been subjected to the most heroic secundum
artem doctoring known to science. As a case in point, we may
mention the case of a pregnant bitch which suffered a fracture of
the upper end of the femur by being run over by a light wagon.
FRACTURES. 253
Her ‘“‘treatment” consisted in being tied up in a large box and
let alone. In due time she was delivered of a family of puppies,
and in three weeks she was running in the streets, limping very
slightly, and nothing the worse for her accident.
Fracture of the Patella.—This, fortunately, is a rare accident
and can only result from direct violence, as a kick or other blow.
The lameness which follows it is accompanied with enormous
tumefaction of the joint and disease of the articulation. The prog-
nosis is unavoidably adverse, destruction being the only termi-
nation of an incurable and very painful injury.
Fractures of the Tibia are probably more frequently encoun-
tered than any others among the class of accidents we are consid-
ering. As with injuries of the forearm of alike character, they
may be complete or incomplete; the former when the bone is
broken in the middle or at the extremities, and transverse, oblique,
or longitudinal. The incomplete kind are more common in this
bone than in any other.
Complete fractures are easy to recognize, either with or without
displacement. The animal is very lame, and the leg is either
dragged or held up clear from the ground by flexion at the stifle,
while the lower part hangs down. Carrying weight or moving
backward is impossible. There is excessive mobility below the
fracture and well-marked crepitation. If there is much displace-
ment, as in an oblique fracture, there will be considerable short-
ening of the leg.
While incomplete fractures cannot be recognized in the tibia
with any greater degree of certainty than in any other bone, there
are some facts associated with them by which a diagnosis may be
justified. The hypothetical history of a case may serve as an
illustration :
An animal has received an injury by a blow or a kick on the
inside of the bone, perhaps without showing any mark. Becoming
very lame immediately afterwards, he is allowed a few days’ rest.
Being then taken out again, he seems to have recovered his sound-
ness, but within a day or two, or eyen in a shorter time, he be-
trays a little soreness, and this increasing he becomes very lame
again, to be furloughed once more, with the result of a temporary
improvement, and again a return to labor and again a relapse of
the lameness; and this alternation seems to be the rule. The leg
being now carefully examined, a local periostitis is readily discov-
254 OPERATIONS ON BONES.
SA
ey
Fia. 277. Fracture of the Fig. 278.—Bourgelat’s Iron Splint for
Tibia. Fractured Tibia.
ered at the point of the injury, the part being warm, swollen, and
painful. What further proof is necessary? Is it not evident that
a fracture has occurred, first superficial—a mere split in the bony
structure which, fortunately, has been discovered before some
extra exertion or a casual misstep had developed it into one of the
complete kind, possibly with complications? What other infer-
ence can such a series of symptoms thus repeated establish?
The prognosis of fracture of the tibia must, as a rule, be un-
favorable. The difficulty of obtaining a union without shortening
and consequently without lameness, is proof of the futility of or-
dinary attempts at treatment. But though this may be true in
respect to fractures of the eomplete kind, it is not necessarily so
with the incomplete variety, and with this class the simple treat-
ment of the slings is all that is necessary to secure consolidation.
A few weeks of this confinement will be sufficient.
With dogs and other small animals, there are cases which may
be successfully treated. If the necessary dressings can be success-
fully applied and retained, a recovery will follow.
FRACTURES. 255
Fractures of the Hock.—Injuries of the astragalus have been
recorded which had a fatal termination. Fractures of the os calcis
have also been observed, but never with a favorable prognosis, and
attempts to induce recovery have, as might have been anticipated,
proved futile.
Fractures of the Cannon Bones.—Whether these occur in the
fore or hind legs they appear either in the body or near their ex-
tremities. If in the body, as a rule the three metacarpal or meta-
tarsal are also affected, and the fracture is generally transverse
and oblique, and often compound, one of the segments protruding
sharply through the skin. Having only the skin for a covering the
diagnosis is easy. There is no displacement, but excessive mo-
IG. 279.—Splint and Dressing for Fractured Cannon Bone.
256 OPERATIONS ON BONES.
bility, crepitation, inability to sustain weight, and the leg is kept
off the ground by the flexion of the upper joint.
No region of the body affords better facilities for the application
of treatment, and the prognosis is, on this account, usually favor-
able. We recall a case, however, which proved fatal, though under
exceptional circumstances. The patient was a valuable stallion of
highly nervous organization, with a compound fracture of one of
the cannon bones, and his unconquerable resistance to treatment,
excited by the intense pain of the wound, precluded all chance of
recovery, and ultimately caused his death from nervous fever.
The general form of treatment for these lesions will not differ
from that which has been already indicated for other fractures.
Reduction, sometimes necessitating the casting of the patient;
coaptation, comparatively easy by reason of the subcutaneous sit-
uation of the bone; retention, by means of splints and bandages
—applied on both sides of the region, and reaching to the ground
as in fractures of the forearm—these are always indicated. We
have obtained excellent results by the use of a mold of thick gutta
percha, composed of two sections and made to surround the entire
lower part of the leg as in an inflexible case.
Fracture of the first Phalane.—The hinder extremity is more
liable than the fore to this injury. It is usually the result of a
Fla, 289.—Splint and Dressing Fig. 281.—Bourgelat'’s Splint for Frac-
on Lower Part of Fore Leg. ture of the Cannon and Phalanges.
FRACTURES. 257
FIG. 282 FIG. 283.
Longitudinal Fractures of Comminuted Fracture of the
the Os Suffraginis. Os Suffraginis.
violent effort, or of a sudden misstep or twisting of the leg, and
may be transverse, or, as has usually been the case in our experi-
ence, longitudinal (Fig. 282), extending from the upper articular
surface down to the centre of the bone and generally oblique and
often comminuted (Fig. 283). The symptoms are the swelling
and tenderness of the region, possibly crepitation; a certain ab-
normal mobility; an excessive degree of lameness, and in some
instances a dropping back of the fetlock, with perhaps a straight-
ened or upright condition of the pastern.
The difficulty of reduction and coaptation in this accident, and
the probability of bony deposits, as of ringbones, resulting in
lameness, are circumstances which tend to discourage a favorable
prognosis.
The treatment is that which has been recommended for all
fractures, as far as it can be applied. The iron splint of figure
281 gives excellent results in many instances, but if the fracture is
incomplete and without displacement a form of treatment less
energetic and severe should be attempted. One case is within
our knowledge in which the owner of an injured horse lost his
property by his refusal to subject the animal to treatment, the
post mortem revealing only a simple fracture with very slight dis-
placement.
2ES8 OFRRALTIONS ON ECNES.
Fractures of the Coronet.—Though these are generally of the
comminuted kind, there are often conditions associated with
them which justify the surgeon in attempting their treatment.
Though crepitation is not always easy to detect, the excessive
lameness, the soreness on pressure, the inability to carry weight,
the difficulty experienced in raising te foot, all these suggest, as
the solution of the question of diagnosis, the fracture of the
coronet, with the accompanying realization of the fact that there
is yet, by reason of the situation of the member, immobilized as it
is by its structure and its surroundings, room left for a not un-
favorable prognosis. Only a slight manipulation will be needed
in the treatment of this lesion. To render the immobility of the
FIG. 284.—Animal with Fracture below the knee with Spints and Support.
Resting in Slings.
FRACTURES. 259
region more fixed, to support the bones in their position by band-
aging, and to establish forced immobility of the entire body
with the slings is usually all that is required. Ringbone, being
a common sequela of the reparative process, must receive due at-
tention subsequently. One of the severest complications likely to
be encountered is anchylosis.
Fractures of the Os pedis.—Though these lesions are not of
very rare occurrence their recognition is not easy, and there is
more of speculation than of certainty pertaining to their diagnosis.
The animal is very lame, and, as much as possible, spares the in-
jured foot, sometimes resting it upon the toe alone and sometimes
not at all. The foot is very tender, and the exploring pincers of
the examining surgeon causes much pain. There is nothing to
encourage a favorable prognosis, and a not unusual termination
is an anchylosis with either the navicular bone or the coronet.
No method of treatment needs to be suggested here, the hoof
performing the office of retention unaided. Local treatment by
baths and fomentations will do the rest. It may be months
before there is any mitigation of the lameness.
Fracture of the Sesamoid Bones.—This lesion has been con-
sidered by veterinarians, erroneously, we think, one of rare oc
currence. We believe it to be more frequent than has been sup-
posed. Many observations and careful dissections have convinced
us that fractures of these little bones have often been mistaken
for specific lesions of the numerous ligaments that are implanted
upon their superior and inferior parts, and which have been de-
scribed as a “giving way” or “breaking down” of these liga-
ments. In our post mortem examinations we have always noted
the fact that when the attachments of the ligaments were torn
from their bony connections minute fragments of bony structure
were also separated, though we have failed to detect any diseased
process of the fibrous tissue composing the ligamentous substance.
From whatever cause this lesion may arise, it can hardly be
considered as of a traumatic nature, no external violence haying
any apparent agency in producing it, and it is our belief that it is
due to a peculiar degeneration or softening of the bones them-
selves, a theory which acquires plausibility from the consideration
of the spongy consistency of the sesamoids. The disease is a
neculiar one, and the suddenness with which different feet are
successively attacked, at short intervals and without any obvious
260 OPERATIONS ON BONES.
cause, seems to prove the existence of some latent morbid cause
which has been unsuspectedly incubating. It is not peculiar to
any particular class of horses, nor to any special season of the
year, haying fallen under our observation in each of the four
seasons. The general fact is reported in the history of a majority
of cases that it makes its appearance without premonition in
animals which, after enjoying a considerable period of rest, are
first exercised or put to work, though in point of fact it may
manifest itself while the horse is still idle in his stable. A
hypothetical case, in illustration, will explain our theory.
An animal which has been at rest in his stable is taken out to
work and it will be presently noticed that there is something un.
Fia. 285.—Fracture of Os Sesamoids.
usual in his movement. His gait is changed, and he travels with
short, mincing steps, without any of his accustomed ease and free-
dom. This may continue until his return to the stable, and then,
after being placed in his stall, he will be noticed shifting his
weight from side to side and from one leg to another, continuing
the movement until rupture of the bony structure takes place.
But it may happen that the lameness in one or more of the ex-
tremities, anterior or posterior, suddenly increases, and it be-
comes evident that the rupture has taken place in consequence of
a misstep or a stumble while the horse was at work. Then, upon
coming to a standstill, he will be found with one or more of his
FRACTURES. 261
toes turned up—he is unable to place the affected foot flat on the
ground. The fetlock has dropped and the leg rests upon this.
part, the skin of which may have remained intact or may have
been more or less extensively lacerated. It seldom happens that
more than one toe at a time will turn up, yet still the lesion in one
will be followed by its occurrence in another. Commonly two
feet of a biped, the anterior or posterior, are affected, and we re-
call one case in which the two fore and one of the hind legs were
included at the same time. The accident, however, is quite as
likely to happen while the horse is at rest in his stall, and he may
be found in the morning standing on his fetlocks. One of the
earliest of the cases occurring in our own experience had been
under our care for several weeks for suspected disease of the fet-
locks, the nature of which had not been made out, when, appar-
ently improved by the treatment which he had undergone, the
patient was taken out of the stable to be walked a short distance
into the country, but had little more than started when he was
called to a halt by the fracture of the sesamoids of both fore legs.
While there are no positive premonitory symptoms known of
these fractures we believe that there are signs and symptoms
which come but little short of being so, and the appearance of
which will always justify a strong suspicion of the truth of the
case. These have been indicated when referring to the soreness
in standing, the short “mincing” gait, and the tenderness be-
trayed when pressure is made over the sesamoids on the sides of
the fetlock, with others less tangible and definable.
These injuries can never be accounted less than serious, and
in our judgment will never be other than fatal. If our theory of
their pathology is the correct one, and the cause of the lesions is
truly the softening of the sesamoidal bony structure and inde-
pendent of any changes in the ligamentous fibers, the possibility
of a solid osseous union can hardly be considered admissible.
In respect to the treatment to be recommended and instituted
it can only be employed with any rational hope of benefit during
the incubation, and with the anticipatory purpose of prevention.
It must be suggested by a suspicion of the verities of the case,
and applied before any rupture has taken place. 'To prevent this
and to antagonize the causes which might precipitate the final
catastrophe—the elevation of the toes—resort must be had to the
slings and to the application of firm bandages or splints, perhaps
262 OPERATIONS ON BONES.
of plaster of Paris, with a high shoe, as about the only indications
which science and nature are able to offer. When the fracture is
an occurred event, and the toes, one or more, are turned up, any
further resort to treatment will be futile.
DISLOCATIONS.
Strength and solidity are so combined in the formation of the
joints of our large animals that dislocations or luxations are inju-
ries which are but rarely encountered. They are met with but
seldom in cattle and less so in horses, while dogs and smaller
animals are more often the sufferers.
The accident of a luxation or (its synonym) dislocation (dis-
placement) is less often encountered in the animal races than
inman. This is not because the former are less subject to oc-
casional violence involving powerful muscular contractions, or are
less often exposed to casualties similar to those which result in
luxations in the human skeleton, but because it requires the co-
operation of conditions, anatomical, physiological, and perhaps
mechanical, present in one of the races and lacking in the other,
but which can not in every case be clearly defined. Perhaps the
ereater relative length of the bony levers in the human formation
may constitute a cause of the difference.
Among the predisposing causes in animals, caries of articular
surfaces, articular abscesses, excessive dropsical conditions, de-
generative softening of the ligaments, and any excessive laxity of
the soft structures, may be enumerated.
The symptoms of fractures and of dislocations are not always
so variant as to preclude the possibility of error in determining a
case without a thorough examination, but the essential difference,
as it must always exist, must always be discoverable.
In a dislocation there is one very peculiar and characteristic
feature in the impossibility of motion associated with an excessive
liberty of movement—the impossibility of active or controlled
motion, and a facility of passive movement (or movableness) at
either the affected joint or at another of the same leg near to it.
In a dislocation of the scapulo-humeral (or shoulder) joint the
animal possesses no power of motion over the limb—no muscular
contraction can avail to cause it to perform its various functions
—pbut in the hands of the surgeon it may be made to describe a
DISLOCATIONS. 263
series of movements which would be simyp:y .npussible with the
joimt ina state of integrity. Both fractures and luxations are
marked by deformity, but while in a fracture with displacement
there will usually be a shortening of the leg, a dislocation may be
accompanied by either a shortening ov a lengthening. Swelling
of the parts is usually a well-defined feature of these injuries.
With all this similarity in the symptomatology of luxations
and fractures, there is one sign which either by its presence or its
absence will greatly assist in settling a case of differential diag-
nosis, and this is the existence or Jack of crepitation. It has no
place or cause in a mere dislocation; it belongs to a fracture, if it
isa complete one. If there is crepitation with a dislocation then
it proves that there is a fraccvre also.
The prognosis of a luxation is comparatively less serious than
that of a fracture, though at times the indications of treatment
may prove to be so difficult to apply that complications may arise
of a very severe character.
The treatment of luxations must of course be similar to that
of fractures. Reduction, naturally, will be the first indication in
both cases, and the retention of the replaced parts must follow.
The reduction involves the same steps of extension and counter-
extension performed in the same manner, with the patient subdued
by anesthetics.
The difference between the reduction of a dislocation and that
of a fracture consists in the fact that in the former the object is
simply to restore the bones to their true normal position, with
each articular surface in exact contact with its companion surface,
the apparatus necessary afterwards to keep them in situ being
similar to that which is employed in fracture cases, and which will
usually require to be retaineit for a period of from forty to fifty
days, if not longer, before the cuptured retaining ligaments are suffi-
ciently firm to betrusted to perform their office unassisted. A vari-
ety of manipulations are to be employed by the surgeon, consisting
in pushing, pulling, pressing, rotating, and indeed whatever move-
ment may be necessary, until the bones are forced into such rela-
tive positions that the muscular contraction, operating in just the
right directions, pulls the opposite matched ends together in true
coaptation, a head into a cavity, an articular eminence into a
trochlea, as the case may be. The “setting” is accompanied by a
264 OPERATIONS ON BONES.
peculiar snapping sound, audible and significant, as well as a
visible return of the surface to its normal symmetry.
Special Dislocations.—While all the articulations of the body
are liable to this form of injury, there are three in the large animals
which may claim a special consideration, viz:
The Shoulder Joint.—We mention this displacement without
intending to imply the practicability of any ordinary attempt at
treatment, which is usually unsuccessful, the animal whose mishap
it has been to become a victim to it being disabled for life. The
superior head of the arm bone, as it is received into the lower
cavity of the shoulder blade, is so situated as to be liable to be
forced out of place in four directions. It may escape from its
socket, according to the manner in which the violence affects
it, outward, inward, backward, or forward, and the deformity
which results and the effects which follow will correspondingly
differ. We have said that treatment is generally unsuccessful.
It may be added that the difficulties which interpose in the way
of reduction are nearly insurmountable, and that the application
of means for the retention of the parts after reduction would be
next to impossible. The prognosis is sufficiently grave from any
point of view for the luckless animal with a dislocated shoulder.
The Hip Joint.—This joint partakes very much of the char-
acteristics of the scapulo-humeral articulation, but is more strongly
built. The head of the thigh bone is more separated, or promi-
nent and rounder in form, and the cup-like cavity or socket into
which it fits is much deeper, forming together a deep, true ball-
and-socket joint, which is, moreover, re-enforced by two strong
cords of funicular ligaments, which unite them together. It will
be easily comprehended, from this hint of the anatomy of the re-
gion, that a luxation of the hip joint must be an accident of com-
paratively rare occurrence. And yet cases are recorded in which
the head of the bone has been affirmed to slip out of its cavity
and assume various positions, inward, outward, forward, and back-
ward.
The indications of treatment are those of all cases of dislocation.
When the reduction is accomplished the surgeon will be apprised
of the fact by the peculiar snapping sound usually heard on such
occasions.
Pseudo luxations of the Patella.—This is not a true disloca-
tion. The stifle bone is so peculiarly articulated with the thigh
DISLOCATIONS. 265
bone that the means of union are of sufficient strength to resist
the causes which usually give rise toluxations. Yet there is some-
times discovered a peculiar pathological state in the hind legs of
animals, the effect of which is closely to simulate the manifestation
of many of the general symptoms of dislocations. The peculiar
pathological condition originates in muscular cramps, the action
of which is seen in a certain change in the coaptation of the artic-
ular surfaces of the stifle and thigh bone, resulting in the exhibi-
tion of a sudden and alarming series of symptoms which have
suggested the phrase of “stifle out” as a descriptive term. The
animal so affected stands quietly and firmly in his stall, or per-
haps with one of his hind legs extended backward, and resists
every attempt to move him backward, and if urged to move for-
ward he will either refuse, or comply with a jump, with the toe
of the disabled leg dragging on the ground and brought forward
by a second effort. Thereis no flexion at the hock and no motion
at the stifle, while the circular motion of the hip is quite free. The
leg appears to be much longer than the other, owing to the straight-
ened position of the thigh bone, which forms almost a straight
line with the tibia from the hip jomt down. The stifle joint is
motionless, and the motions of all the joints below it are more or
less interfered with. External examination of the muscles of the
hip and thigh discovers a certain amount of rigidity, with perhaps
some soreness, and the stifle bone may be seen projecting more or
less on the outside and upper part of the joint.
This state of things may continue for some length of time and
until treatment is applied, or it may spontaneously and suddenly
terminate, leaving everything in its normal condition, but perhaps
to return again.
Pseudo-dislocation of the patella is likely to occur under many
of the conditions which cause actual dislocation, and yet 16 may
often occur in animals which have not been exposed to the or-
dinary causes, but which have remained at rest in their stables.
Sometimes these cases are referred to falls in a slippery stall, or
perhaps slipping when endeavoring to rise; sometimes to weakness
in convalescing patients ; sometimes to lack of tonicity of structure
and general debility; sometimes to relaxation of tissues from
want of exercise or use.
The reduction of these displacements of the patella is not
usually attended with difficulty. A sudden jerk or spasmodic
266 OPERATIONS ON BONES.
action will often be all that is required to spring the patella into
place, when the flexion of the leg at the hock ends the trouble for
the time. But this is not always sufficient, and a true reduction
may still be indicated. To effect this the leg must be drawn well
forward by a rope attached to the lower end, and the patella,
erasped with the hand, forcibly pushed forward and inward and
made to slip over the outside border of the trochlea of the femur.
The bone suddenly slips into position, the excessive rigor of the
lee ceases with a spasmodic jerk, and the animal may walk or trot
away without suspicion of lameness. But though this may end
the trouble for the time, and the restoration seem to be perfect
and permanent, a repetition of the entire transaction may subse-
quently take place, and perhaps from the loss of some portion of
tensile power which would naturally follow the original attack in
the muscles involved, the lesion might become a habitual weakness.
Warm fomentations and douches with cold water will often
promote permanent recovery, and liberty in a box-stall or in the
field will in many cases insure constant relief. The use of a high-
heeled shoe is recommended by European veterinarians. The use
of stimulating liniments, with frictions, charges or even severe
blisters, may be resorted to in order to prevent the repetition of
the difficulty by strengthening and toning up the parts.
AMPUTATIONS.
To amputate is simply to cut off In veterinary surgery it
comprehends the remoyal from the body of an animal of one or
more of its projecting parts, as a portion of a leg, or an entire ex-
tremity; the horns, the ears, the penis, the tail, etc. From the
nature of the case it involves a degree of deformity, greater or less,
with a loss of the function of the severed member.
The difference between amputation and extirpation has respect
only to the organs or members which become subject to the opera-
tion. The parts already referred to are amputated; the organs or
members liable to extirpation have their seat in the interior regions,
as the testicles, the ovaries, and even the uterus, in females, and
any other non-yital organs or morbid growths, including some of
the clandular structures, more particularly the lymphatic.
Amputations in domestic animals are of two classes: In one
case they are performed at the dictate of a capricious fashion, for
AMPUTATIONS. 267
*
the alleged purpose of improving the appearance of the animal,
and are performed upon parts of only secondary and accessory
functional importance, and which may be removed almost with im-
punity, as the ears, the tail or the horns.
In the second class, the subject is brought under the general
laws governing diseases and remedies, and they are practiced only
as it becomes necessary by the existence of diseased conditions in
important organs, such as the penis, the tongue and the locomotory
organs. In this class the serious nature of the operation must be
measured by the importance of the function fulfilled by the organ
implicated.
The instruments necessary for the operation are amputating
knives, similar to those used in human surgery, or more commonly
those belonging to our veterinary work, a strong, convex bistoury,
==
SAAR
Fic. 288.—Amputating Saw.
which is generally sufficient, an amputating saw, means of tem-
porary hemostasis, cord, an elastic band or ligature, needles,
sutures and artery and dissecting forceps.
For dressings, balls and pads of oakum of various sizes, com-
presses and antiseptic washes are needed.
In the present chapter we shall limit our consideration to the
amputation of the legs, the horns and the ears.
268 OPERATIONS ON BONES.
AmpuTATION OF MEMBERS oR Lips.
The amputation of the limbs of animals is a matter of much
less importance than a similar mutilation would be in human sur-
gery, and its occurrence is relatively much less frequent, being
necessarily limited by the exclusion of that large class of subjects
whose usefulness would necessarily be lost by the total impairment
of their organs of locomotion, thus rendered unfit for their work,
and even when it is indicated for animals designed for food con-
sumption, the question becoming pertinent whether it would not
be wiser and more profitable, in a large majority of cases, as it
would unquestionably be more humane, to deliver them at once to
the butcher, before subjecting them to a painful mutilation which
must necessarily more or less impair their condition, and therefore
materially diminish their market value.
As a matter of fact, it is principally upon dogs that, in ordinary
circumstances, the veterinarian is called to operate in this manner,
as even in his mutilated condition, he may continue to be able to
fulfil many of his duties as one of the domestic animals. But still
there are circumstances in respect to animals other than the dog,
under which the operation may be indicated and rationally prac-
ticed, as when the life of a valuable animal is to be saved on account
of his desirable qualities as a breeder, and which may not be dis-
abled from his special function by the lack of a limb. A valuable
ram or bull, a high-bred ewe or cow, or perhaps also a mare or a
stallion, may, for such a reason, become proper subjects for an
amputation.
But even under these conditions, other considerations of impor-
tance must not be overlooked, and whether it is a fore or a hind
leg which must be sacrificed, will be a point of great weight to be
considered in deciding for or against the operation. A female
with only three legs may yet carry a fetus to term, and be fat-
tened and put in good condition before being sold for meat, or
may possibly be covered by a male; but it would be impossible
for the stallion or the bull, deprived of one of his hind quarters, to
mount and keep the raised position a sufficient time to complete
the act of copulation.
Animals of small size and weight, being more supple and active
in their movements, suffer least from the loss of one of their limbs.
The distance from the mass of the body to the seat of the ampu-
AMPUTATIONS. 269
tation is also a consideration of moment. A reference to all the
reasons will necessarily prove that of all domesticated animals,
the horse is probably the one upon which the operation is least
justifiable. If ever tobe performed upon him, it can only be upon
the lower regions of the leg close to the ground, inasmuch as the
shortened leg can still be made useful as an apparatus of support,
either directly or indirectly, by artificial means.
The sum of the matter seems to be embodied in the following
_general considerations pertaining to the question of the amputa-
tion of the limbs of our domestic animals:
Ist. In Dogs it is indicated in diseases of both bones and soft
parts, as in comminuted fractures, complicated with contused
wounds of the skin or other soft strictures ; in old caries, com-
plicated with suppurative arthritis; in osteo-sarcoma; in the
crushing of muscular tissues around bones and their complete
separation ; in extensive gangrene, as that resulting from the ap-
plication of too tight a bandage ; in chronic suppurative articular
disease ; in sloughs of soft tissues surrounding the exposed bones ;
and in deep cancerous affections.
2d. Jn Ovines.—Indications are offered, as in dogs, in com-
minuted fractures, with lacerations of soft tissues, and more com-
monly in complicated phalangeal arthritis.
3d. In Bovines.—The same conditions exist as in the smaller
ruminants.
4th. In Hquines.—Amputation is indicated as a means of
saving an animal for breeding purposes ; in complicated fractures
of the cannon bone, or of the phalanges ; in gangrene of the digital
organs; extensive abscesses of the same region, with softening of
tendons, and in suppurative arthritis. It is also sometimes per-
formed for the removal of a supplementary limb.
5th. In Birds.—The amputation of a wing or even of a leg
can be performed, either to prevent flight, or to relieve a diseased
process of the limb.
But in all cases it should be performed upon healthy tissues,
above the seat of the disease, and at the greatest, possible distance
from the trunk.
The number of cases on record is not large, and they are prin-
cipally reported in European veterinary journals. In these we
find a case of amputation at the hock in a ewe, by Chabert; in a
cow at the knee, by Chaumontel; in an ox of one of the toes, by
270 OPERATIONS ON BONES.
Durant ; in a dog at the arm, by Fromage de Feugre; in a sheep,
in a case of foot rot, by Lecoq; in a mare at the fetlock, by
Maurette; in a stallion, on the third phalanx, by Bouley; and in
English journals: in a cow in the metacarpal region, by Laing; a
cow on the hind cannon, by Shield; and on a mare in this country,
by Huidekoper. Others are reported, which were attended by vari-
ous degrees of success, many of them, however, terminating fatally.
The proper mode of performing the operation is to secure the
animal in the decubital position, and to place him under the influ-
ence of general anesthesia, securing temporary hemostasis, by the
application of the circular ligature, or a bandage tightly placed
above the point of amputation, or, preferably, by using the process.
of Esmarch, which secures a more perfect removal of the blood,
and enables the operator to perform a thoroughly bloodless opera-
tion. Digital pressure, sometimes recommended for the smaller
animals, will not, however, secure as good a result as that obtained
by the circular ligature.
The operation is made in two ways: first, in the continuity of
the bones, or by the division of the substance of the bone itself;
and second, in their contiguity, or at the nearest sound articula-
tion. This last is also called disarticulation.
All amputations consist of three steps: The division of the
soft tissues, that of the bones, and the arrest or prevention of
hemorrhage.
The First Step, the Division of the Soft Tissues, may be prac-
ticed several ways, among which the principal are the circular,
elliptic and the ovalar methods, and that by flaps ; all of which
have the common object in view, of leaving a flap of proper form
and sufficient dimensions to cover the stump of the bone, and
prevent its projection beyond the surface of the wound.
The circular method, which is the oldest, consists in incising
the skin in a circular manner, stretched over the surface of the
region with the left hand of the operator, or with that of an assist-
ant. This must be done with rapidity, made by one stroke of the
knife, applied as perpendicularly over the skin as possible.
If the amputation is to be made in the continuity of the bones,
the skin being divided while stretched by the assistant, is sepa-
rated from its adhesions underneath, and reversed upward; when
close to the line where it is yet adherent, the muscles are divided
circularly, by one stroke of the knife, drawn to the bone. These
AMPUTATIONS OTE
muscles spontaneously retreat, and the superior stump is drawn
upward beyond the cutaneous incision. This action may be facil-
itated by separating from the bone whatever attachments may
exist between them. The periosteum is thus divided, on a level
with the retracted muscles.
The amputation in the contiguity of the bones, differs from
that in the continuity only in the fact that when the section of the
muscles is made, there is no division of the periosteum necessary,
and the disarticulation is completed with either the bistoury or
amputating knife, or, in preference, with the sage Imife. The
method by flaps consists in making on one or both sides of the
bones, one or two flaps of skin which are afterwards united to
cover the stump, and form the new surface.
In amputation by the contiguity of the bone, the method to
be preferred, and which may be practiced both from within, oui-
ward and contrarywise, is this: In the first instance, the knife is
passed through the soft tissues at the point where the bone is to
be separated, and the entire mass divided by drawing the instru-
ment toward the operator in a somewhat oblique direction. In
the second way, or from without inward, the flap is first drawn
with the point of the knife, and then dissected from without, or,
otherwise, made at once in the same direction, by one stroke of
the instrument. The flaps must be rounded, not angular, at their
line of meeting, and in such a way that the amputated wound
will represent an elliptic infundibulum, whose center is occupied by
the stump of the bone, surrounded by whatever projecting fleshy
structures may be brought over it to form a protective cushion.
The second step of the operation is that of the section of the
bone, or of the articular attachments.
In sawing the bone in its continuity, the periosteum being
divided, and the soft tissues protected by compresses, some little
art is necessary. The saw applied perpendicularly to the axis of
the bone, should be worked slowly at first, until a track is formed,
after which the movement may be more rapid. Pressure upon
the instrument is unnecessary, if it has been properly set. Special
caution should be observed in finishing, in order to avoid leaving
rough edges to be cut off with the bone forceps. The saw must
be propelled wholly by the action of the arm of the surgeon, his
body remaining completely motionless.
When the amputation is made upon the segment of a leg
272 OPERATIONS ON BONES.
which has two bones, though they may be divided separately, it
will be preferable, if they can be held together with sufficient
firmness, to act upon them jointly, but finishing the smaller bone
first.
The actual disarticulation, or second step of the amputation,
is performed by dividing the ligaments or other structures which
surround the joint, from without inward. Beginning with the
strongest and most external ligament by giving a movement of
semi-flexion to the articulation, not necessarily cutting them in
their middle, the joint is penetrated by inserting the knife be-
tween the articular surfaces. The double sage knife, according to
Bouley, is the most convenient. In articulations composed of ir-
regular surfaces, united by inter-articular ligaments, care must be
taken to avoid injuring the bones, and to divide the fibrous cords
only, as most of the synovial capsules must be removed, in order
‘to avoid fistulous complications.
In some disarticulations, according to Bouley, it is necessary
to use the saw to remove diarthodial projections on the surface of
the amputated bone, which if left in place would prove a serious
obstruction to the cicatrization of the stump
The last step of the operation is the arrest, or, what is better,
the prevention of the hemorrhage. It consists simply in twisting
or ligating the arterial vessels which have been divided. If the
means used for the temporary hemostasis prevent the operator
from discovering its source, the ligatures can be slightly relaxed
until it is betrayed by the oozing of the blood. The various
methods of permanent hemostasis have already been considered,
and need no further description.
In the application of a dressing to the wound of amputation,
the requirements are few, but they are imperative, and they are
sufficient, assuring the best results by their simplicity and solid-
ity. The soft tissues and the skin must be brought together,
over the extremity of the bone, and kept together by the applica-
tion of a continued suture, leaving a place of drainage for the
suppuration and the sloughing of the ligatures which occlude the
blood vessels, and the extremities of these must be gathered to-
gether at the most dependent part of the wound. This is com-
pleted and protected by the application of an antiseptic dressing
consisting of pads of oakum, absorbent cotton, or threads of
tourbe, kept in place by rollers, and supported by an outside
AMPUTATIONS. Die
envelope of coarse cloth. The wound may cicatrize by first or by
second intention, according to the severity of the original injury,
as well as to the amount of attention bestowed upon the antisep-
tic applications which may have been employed.
iS tae —.
SSS:
FIG. 289.— Wooden Leg after Amputation.
Complications are not uncommon after amputations, though
they do not materially differ from those which are encountered in
other serious operations. Among those which may be mentioned
are: Ist. Secondary hemorrhage, as the result of carelessness in
the application of the ligatures, which can be overcome, however,
by immediate or lateral compression, or by the renewal of the lig-
ature. 2d. Adscesses, of various dimensions, resulting from the
presence of the ligatures into the wound, or possibly of necrosis
of the bone. These collections are to be treated in the usual way,
as are also undermining of the skin by suppurative collections,
phlebitis, purulent infection and gangrene, all of these being con-
ditions having the same indications as in other forms of traumatic
lesions.
There are, however, some complications which belong specially
to the sequele of this operation, such as may result from an im-
proper section of the bone, which might end in the formation of
a conical stump, a condition which, like that of strangulation of
the stump, can only be relieved by a new amputation, with a bet-
Nien lp Aer a? Steet eS
274 OPERATIONS ON BONES. |
ter section of the bone, and more careful attention to the subse-
quent dressing. Vecrosis of the amputated bone may also com-
plicate the process of cicatrization, accompanied by more or less
pain and diffused suppuration, which cannot be relieved until the
necrotic bone has sloughed away. ;
Amputations in the contiguity of the bones are, besides, likely
to be complicated with synovial fistulas, which may be of an ar-
ticular or tendinous nature. The ordinary forms of treatment in
similar cases will be sufficient for these. =
These general rules regulate amputations of every kind, though
the various steps of the operation may have somewhat varied, ac-
cording to circumstances. But whether it be in the continuity
or contiguity of a bone, or whatever may be the bone involved;
whether the scapulo-humeral joint, the fetlock or the digital re-
gion; or even to remove supplementary digits; they are of equal
applicability, and the general modus operandi remains the same.
Even in the operation of amputation of the wings we find but
little room for modification or change.
In operating upon the wings of birds, with the principal object
of destroying their power of flight, it may frequently be accom-
plished by simply cutting off the extremity of the wing, at the
carpal articulation, with the scissors, and cauterizing the wound
with perchloride of iron or nitrate of silver.
Another method is to pull out the feathers from the inner side
of the wing, as far as the elbow joint, the skin being then incised
with a bistoury somewhat below the joint, and dissected and
reversed upward, the bones being then divided with the bone
forceps. The wound should be carefully washed or sponged with
cold water, to check the bleeding, and the skin drawn over the
stump, secured by interrupted sutures. The.bird requires no
special attention, and the wound heals in a few days.
AmpuTATION oF Horns.
The amputation of horns is an operation the description of
which dates back to 1790. ‘ It is indicated in cases of fractures, or of
vicious growths which might embarrass the motions and prevent
the usefulness of the animal, and also to provide against the mu-
tual injuries which cattle are liable to inflict upon one another.
It is also indicated in cases of suppurative collections in the si-
nuses, and for the removal of parasites from those cavities. It has
AMPUTATIONS. 275
of late not only assumed a place among the operations of fashion,
but has found favor from its alleged tendency to improve the
quantity and quality of milk, and of the flesh yielded by animals
subjected to it. It is in relation to this hypothesis that Gourdon
considers it as “a great progress in the raising of horned cattle,
and which, on account of the benefits that may be derived from
it, is perfectly justifiable.” The operation is comparatively a sim-
ple one, but nevertheless involves special considerations, varying
according to the species of the animal.
Ist. Jn Bovines.—If only the free extremity of the organ is
to be cut off, it is done with the saw carried rapidly through the
horny structure, the animal, of course, being properly secured.
But occasionally, especially in cases of fracture, the section is to
be made near the base, or the middle of the horn, and soft and
sensitive tissues are also involved. The amputation must then be
made below the fracture with a sharp saw, applied perpendicularly
to the long axis of the horn, and completed as rapidly as possible.
The operation will be accompanied by some hemorrhage, but
not sufficient, usually, to require the application of severe hemo-
statics. The wound is dressed with pads of absorbent cotton,
or of carbolized or antiseptic oakum, retained by compresses or
the Maltese cross bandage. Possible collections of pus must be
watched for, and the sinuses should be carefully cleaned by injec-
tions.
The dressings are renewed as often as the indications require,
and continued until the granulations have closed the cavities of
the sinuses, and the suppuration has almost entirely subsided. —
The application of a permanent dressing in the form of a pitch
plaster is recommended by Gourdon. It need not be removed,
like the ordinary dressing, and under some circumstances is of
great advantage.
Among the probable accidents attendant upon this operation,
there are four which require mention:
(a) Hemorrhages, more or less serious, always occur after
the section of the horn, and of its bony support. Usually, it is
sufficiently arrested by the dressing alone, but there are times
when the application of the actual cautery becomes necessary to
subdue it.
i
(b) Inflammation of the mucous membrane of the sinuses may
also follow. In its ordinary manifestation it is not serious, and is
276 OPERATIONS ON BONES.
likely to terminate either by resolution or even suppuration, though
in a few cases it may be followed by gangrene.
(c) Gangrene, which generally manifests itself toward the
eighth or tenth day, ordinarily ends in death, and is often accom-
panied by an attack of ophthalmia more or less violent.
(d) Incomplete cicatrization of the stump, occurring principally
in cases in which the wound has been neglected, and suffered to
remain too long unprotected by a dressing, and when the mucous
membrane of the horn has become the seat of chronic inflamma-
tion. A central fistula usually results, accompanied by an abun-
dant suppuration, which is apt to prove exceedingly intractable to
treatment.
2d. In many young ruminants this operation is performed on
calves two or three months old, and consists in removing the rudi-
mentary horns. For this Charlier has invented a peculiar tre-
phine kind of circular gouge, which is used as follows: The ani-
Fig. 290.—Charlier’s Method of Amputation of Hornsin a Calf. 1st Step.
mal being thrown and held by two assistants, the hair is cut short
around the base of the horns, and the trephine applied over the
horns in such a manner as to divide the skin and subjacent tissues
down to the frontal bone where they are isolated by a circular in-
cision, Then by a downward and horizontal twist of the trephine
the divided structures are gouged out and the secreting matrix of
AMPUTATIONS. 277
Fig. 291.—Charlier’s Method of Amputation of Horns in a Calf. 2d Step.
the horn removed. The hemorrhage is controlled with a com-
pressive bandage or other hemostatic, and antiseptic dressing
applied. The wound generally heals rapidly and without compli-
cations.
AMPUTATION OF THE TaIL.
For some unexplainable reason the term “docking” has been
applied to this operation, which is simply the removal of some of
the vertebree composing the caudal appendix. It is one of the
most peculiar among the operations of fashion, although, of
course, under some special conditions incident to all animals, it is
also sometimes performed as an operation of genuine beneficent
surgery. This may be the case, for example, when the tailis abnor-
mally so long and heavy as to interfere with the usefulness and
comfort of the animal, or when it becomes the seat of disease and
becomes affected with caries or necrosis, or fistulous tracts, or af-
fections of the skin. In some instances, also, this curtailing oper-
ation does constitute a true surgico-therapeutical means of obtain-
ing a local bleeding.
Docking, which is of English origin, is now performed all over
the world, and has given rise to a great deal of controversy upon
the question of its propriety. Whether it is an act of inexcusable
cruelty or not, it is not at present our province to decide, but from a
surgical point of view we feel that it is due to truth to say that we
are satisfied that a great deal of what has been said in opposition
to the operation results, from the various and, too often, bungling
Bs aie
f
Ra A
278 OPERATIONS ON BONES.
and cruel methods which have characterized the details of the
amputation. We believe that some of these methods may be so
modified as to relieve the operation of its apparent character of
cruelty. We refer now especially to the means which haye been
and are employed for the arrest of the hemorrhage which is likely
to follow the section of the blood vessels of the region.
The tail has for its bony support a series of the caudal verte-
bree—from fifteen to eighteen—varying in number and diminish-
ing in size from the sacrum to the end of the organ, and united
by a thick inter-vertebral ligament, and attached to them are the
caudal muscles in pairs, three on each side, the superiors or ele-
vators, the inferiors or depressors, and the laterals or inelinators. |
Beside these, there 1s also the ¢schio-caudal muscle, which extends
from the ischiatic ligament upward and backward to terminate on
the sides of the first caudal vertebree. Between each of the lateral
and inferior caudal muscles runs the lateral caudal, and on the
median line between the inferior muscles the median caudal ar-
tery, all running to the end of the tail, and likely, when divided,
to cause a more or less troublesome hemorrhage. . All these or-
gans are surrounded by the caudal aponeurosis, from the deep
surface of which proceed bands which form a special sheath for
each muscle, and is ultimately united by its external face to the
thick skin which surrounds the region. This skin on the upper
* and on each lateral face of the tail is covered with long, thick,
coarse hair, while the inferior face is hairless, smooth and com-
paratively thin.
Fia. 292.—Tail Cutters.
AMPUTATIONS. 279
Docking properly includes three steps: 1st, the preparation
of the tail; 2d, the amputation ; and 3d, the arrest of the hemor-
rhage. (There is, however, a mode of operation in which the last
two steps can be merged into one.) The animal is kept in the
upright position, and well secured. ;
Ist Step. Preparation of the Tail.—This is first well washed
and combed, and ought to be cleaned with an antiseptic solution.
The place where the amputation is to be performed should be
marked by clipping the hair from it in a circle, and above this the
hair should be secured either by being braided, or simply tied
tightly in a mass with a string around the tail. Some practition-
ers apply a cord ligature or an elastic bandage above the place to
prevent the hemorrhage.
2d Step. The Amputation.—This is accomplished by several
methods. The oldest mode was by using a simple hatchet as the
instrument with which the tail, properly prepared and laid over a
wooden block, was severed by a heavy blow on the “instrument.”
(Fig. 292).
FIG. 293. Tail Cutters.
280 OPERATIONS ON BONES.
At a later period, special knives called tail cutters, were in-
troduced. These were peculiar large shears, differing more or less
in general form and in that of their cutting edges, but which were
used in the same manner, and are still in common use by many
practitioners. The manner of using themis very simple. The tail,
prepared as before mentioned, and held horizontally by an assist-
ant, is so placed in a hollow formed in the edge of the shears as to
insure a perpendicular stroke, and the division is made by closing
the blades with a single quick and forcible motion. Other instru-
ments were invented to work by springs.
Fia. 296.—Spring Tail Cutter.
Some practitioners, instead of dividing the entire thickness of
the organ, prefer to do so by disarticulating the vertebree with a
bistoury, first making flaps on each side of the skin in order to
find the joint.
3d Step.—To stop the Hemorrhage.—The moment the tail is
amputated three streams of blood spring from the stump, with
more or less force, according to the position of the member, unless
a ligature or an elastic bandage has been previously applied. In
AMPUTATIONS. 281
either case attempts may be made to ligate or to employ torsion
of the arteries, but the hemostatic generally employed is the actual
cautery. The tail-cautery, heated to nearly a white heat, is firmly
held upon the truncated tail for a few seconds until it has stopped
the hemorrhage. To assist this
process and obtain the formation
of a thicker scab, certain com-
bustible substances are some-
times placed upon the wound
before the cautery is applied, to
increase the heat by their igni-
tion. A ring of hair or a little pulverized resin may be employed
for this purpose. ‘
We have before noted that in this measure of hemostasia there
is much that is repulsive and coarse, and that it is not at all in har-
mony with the spirit of modern scientific surgery, and we have
long felt a conviction that a great improvement is possible in the
manipulation of sucha case. We have, therefore, made the matter
one of careful experimentation, and the conclusion we have reached
is that the following course of procedure will meet all the indica-
tions and fulfil all the purposes contemplated, and at the same time
avoid the complications likely to occur, and obviate the objections
of the sensitive and the timid, besides securing results entirely
satisfactory to all the parties concerned.
First, to render the operation painless, we inject cocaine at two
or three points in the circumference of the tail skin. Then, around
the tail, and above the ring made by clipping the hair, as before
mentioned, to mark the place of amputation, we place a narrow
elastic band at a tension merely sufficient to stop the hemorrhage.
Having waited for the full effect of the anesthetic, and accurately
identified the center of the articulation between two of the vertebree
through which we intend to amputate, with a strong and sharp
bistoury we make rapidly a circular incision of the skin entirely
around the tail, and, if possible, divide the muscle with a single
stroke through the intervertebral hgament. Witha little care and
practice the amputation may be completed in a few seconds, and
there remains at the end of the tail but a smooth, perfectly blood-
less stump. We cover the fresh surface with a dressing powder,
antiseptic, caustic or astringent as indicated, and leave the patient
eating his oatsas hehad been doing during the operation, unaware
SSMAOHOow»
SAAN
Fie. 297.—Tail Cautery.
282 OPERATIONS ON BONES.
of the mutilation to which he has been subjected. We leave the
elastic band m place for from twenty-four to thirty-six hours, pos-
sibly loosening it once during that time, or tightening it, if any
oozing of blood is discovered, and removing it entirely as soon as
it becomes safe to do so.
The stump generally needs no special care, except in cases of
possible complications which may follow the operation. The am-
putation of the tail by flaps is also performed by some veterinarians
with great success, this mode leaving a wound which generally heals
very rapidly and without the ordinary possibility of complication.
Among these are, first, hemorrhage. The occurrence of this
is an evidence that the hemostasia has been imperfect, proba-
bly the cauterization has not been sufficiently thorough; or the
torsion of the arteries has been insufficient; or the ligature has
been loosely tied. This accident requires a repetition of the man-
ipulation, and perhaps another cauterization or torsion or ligature.
With the application of our elastic band this can scarcely ever oc-
cur. If it does, another turn of the band will complete the work.
Bad aspect of the Stump.—The amputation of the tail by sec-
tion through the continuity of the bone, as commonly happens
when the tail-cutters have been used, leaves in the center of the
wound a projecting portion of a vertebra, which is usually burnt
by the cautery, when this has been used. As the result of this,
and surrounding the mortified bone, large granulations rapidly
appear, overlapping the circular edges of the wound, and char-
acterized by an abundant discharge. The necrotic bone must
then be amputated and the granulations heavily cauterized with
caustics of the potential kind; the saturated solution of chloride
of zine making an excellent prescription for the purpose required.
To obviate this complication the operator will do well, when any
portions of vertebrz have been left in the stump, to remove the
fragments with the bone forceps rather than to wait for their re-
moval by the natural process of necrosis. We have never encoun-
tered these complications when using the elastic band, being
careful to amputate at the articulation of the vertabre. The
powdered dressings we have used have always kept the granulations
under control.
Multiple Abscesses.—We have met these once, as the result
of the presence of a very thick scab, which prevented the escape
of the underlying suppuration.
TREPHINING. 283
Gangrene and Tetanus have also been recorded as sequele of
this operation.
The rules we have given apply without change to the amputa-
tion of the tail in smaller animals, as sheep, dogs and cats.
TREPHINING.
The operation of trephining or trepanning consists in boring
into or through a bony or other hard structure, in order to form
an aperture for surgical purposes. Although the cranium is
usually the seat of the opening, it may be made in any part of
the body where the indications demand it.
The application of the trephine or of terebration, as it is called
when it is performed at the base of the horns of cattle, dates back
to antiquity, having a record antedating the time of Hippocrates,
and yet it was not until toward the year 1749 that it in fact entered
the domain of veterinary surgery. About that time Lafosse, Sr.,
performed it to open the frontal and maxillary sinuses in the
treatment of glanders and other diseases mistaken for it. It was
afterwards recommended by Greave and Haubner as the proper
treatment for the relief of purulent collections in the sinuses of
the head, and it has been recommended by many others for
parasitic affections of the cranial cavity, as cases of ccenurus
cerebralis.
Trephining is undoubtedly indicated in many pathological
conditions, and in fact ought to be more frequently practiced
by the veterinarian of to-day. Much has been lost, no doubt, by
its neglect and disuse. Its value is most fully demonstrated in
cases where it becomes necessary to remedy the effects of mechan-
ical lesions taking the form of bloody or purulent gatherings
within the cranium, like those which may result from the pressure
of fragments of fractured bones upon the brain. Fractures of thé
cranial bones resulting in this manner are not common with our
domestic animals, but when they do occur they are always of a
serious nature, and too often are beyond remedy. Ina case of
remediable character the removal of the pressure upon the men-
inges by trephining and cleansing the wound from the matters
which produce and continue it, whether bony fragments or bloody
extravasations, is the treatment indicated before any other. Yet
as experience has many times proved that the brain is able to sus-
tain a very considerable amount of pressure without betraying
284 OPERATIONS ON BONES.
any signs of inconvenience, the indication of trephining only
becomes absolute when serious nervous manifestations are ex-
hibited. In simple contusions, or even with complete fracture of
the bone, trephining is not indicated unless brain lesions are
unmistakably present.
It is indicated in solipeds in cases of chronic discharges pro-
ceeding from suppurative collection in the sinuses, characterized
by a yellowish, grumous, and often offensive, running at the nose,
usually from but one side, and not uncommonly accompanied by
a deformity of the face, caused by a bulging of the bones, and
associated with it a dullness on percussion over their surface.
Jessen & Unterburger have also recommended it in cases of
suppuration in the cavities of the nasal turbinated bones. In the
treatment of chronic catarrhal inflammation of the horns or of the
portions of the frontal sinuses which extend into the appendix of
the head, in ruminants, it has given excellent results.
It is also indicated for the removal of foreign bodies, either of
a pathological nature or the product of wounds, entering the
cranium from the outside. It is available for the removal of
polypi or any kind of neoplasm, of migrating dental cysts, of
odontome, or as one of the first steps in the operation for the
removal of diseased teeth from their alveolar cavity; in all these
cases it isthe first indication. It is also of common application in
extracting parasites, the ccenurus especially, from the cranial cay-
ity of small ruminants, when their location has been first positively
ascertained. In some severe cases of diseased withers accom-
panied with abundant suppuration, which may filtrate under the
internal surface of the scapule, and accumulate between that bone
and the thorax, it has been claimed that, performed upon the
scapula, it would furnish an eligible means of reaching the bottom
of the collection, and providing suitable drainage and consequent
relief.
Trephining the wall of the foot in special cases of laminitis,
to assist the escape of the effused blood from between the
lamince has also been tried, but with what results we are not
informed. It has even been performed in the treatment of immo-
bility, but so far as we have learned, has never been followed by
satisfactory results. It is also referred to in connection with the
cranial inoculation of rabies, as performed by Pasteur.
The special instrument employed in the operation is the
Ce ore
TREPHINING. 285
trephine, or trepan, in various modified forms. There are also
others which may be considered as accessory, viz., scissors, bis-
touries, forceps, bone-scrapers and elevators.
The brace and bit trephine is the original instrument which
has been more or less modified, and which, while it is capable of
more rapid execution, is probably less controllable than the ordin-
iil
hl
i
FIG. 298.—Old-Fashioned Trephine. Fig. 300.—Single-Handed Trephine.
286 OPERATIONS ON BONES.
Fa. 301.—Operation of Trephining. Modus Operandi.
ary trephine (Fig. 300), and therefore not so safe. The single-
handed trephine is also to be preferred from the fact that the
former requires both hands to manage it, while the latter can be
manipulated with a single hand. They are both what might be
properly denominated true circular saws, if judged by the result
of their application, which is the removal of a circular portion of
the bony structure, and a corresponding round opening, through
which other surgical indications can be fulfilled.
A simple gimlet has often taken the place of the regular instru-
ment, but such an appliance can be considered as possessing little
more than the character of a mere exploring needle, from the
impossibility of making an opening with it of sufficient dimen-
sions to be available for any other practical use.
TREPHINING. 287
The bone-scrapers, or elevators, which are sometimes employed
as accessory, are used for preserving the periosteal covering of
the bones; for removing the rough edges of the opening; or in
FIG. 302.—Bone Scrapers and Elevators.
raising the bony fragments which have been crushed in, or may
be pressing against the cerebral substances.
An important step before entering upon the operation, is to
determine the points which are to be avoided. Generally speak-
ing, any part of the head or of the body can be operated upon, so
long as there is a bony surface that can be readily exposed without
danger of injuring other important organs. But, upon the head,
the angles of bones and the tracts of the cranial sutures ought to
be avoided. In the more common applications of the operation
upon the head (Figs. 303, 304), one of four principal points is gen-
erally selected, by which to effect an entrance into the cavities of
the sinuses. The points marked 6, near the lower borders of the
frontal bone, will open the frontal sinuses: the point c, upon the
surface of the nasal bones, communicate with the superior part of
the nasal cavities in the upper portion of the turbinated bone; the
points e, upon the zygomatic bone, will enter the superior, and f,
upon the great maxillary bone, will penetrate the lower maxillary
sinus. Besides these specific regions upon which to apply the
288 OPERATIONS ON BONES.
ay
Fig. 303. Fia. 304.
Parts of the Head where Trephining is Performed.
instrument, there are conditions where, the bone being less sub-
cutaneous, the operation is less easily performed. Such is the
ease as to the lateral faces of the parietal bone, where it will be
necessary to penetrate through where the crotaphite muscle is.
This, however, makes a complication of little importance. Again,
there are indications, such as in cases of chronic coryza, with sup-
puration of the sinuses, where a double trephining becomes neces-
sary, one to enter the frontal, and the other the superior maxillary
sinus. Figure 305, which is borrowed from Peuch & Toussaint,
shows the exact location where the trephining can be made.
A, entering into the frontal; B, the upper, and C, the lower max-
illary sinuses.
The modus operandi of this operation is very simple. Unless
the animal is very restless, and cannot be controlled by the ordi-
nary means of restraint, or by local anesthesia, and must there-
fore be cast, or unless the trephining is merely the first step of an
operation to remove foreign bodies or growths from the sinuses, or
to apply special action upon a displaced bone, as in a fracture, we
prefer to operate in the standing posture, and in such cases have
found the use of cocaine of great advantage.
In any case the skin is first divided by either a V, or a T, ora
aa
TREPHINING. 289
Fie. 305.—Common Points of Selection for Trephining.
semi-lunar incision. We prefer the first as being least liable to be
followed by a blemish. The periosteum is divided in the same
form, if its division has not already followed that of the skin.
The flap thus formed in two structures is then carefully raised
from the attachment to the external surface of the bone, and
held aside by an assistant, with either a blunt tenaculum or
forceps. “The instrument is then implanted upon the centre of
the exposed bony surface, and by the rotatory or semi-rotatory
motion imparted to it, gradually separates a circular disk of the
bone. The pressure necessary to make the instrument seize or
bite on the bone may at first be considerable, but as the trephine
penetrates, the force must be carefully relaxed in order to avoid
the hazard of injuring the parts beneath by the sudden yielding
of the bone and plunging of the instrument into the parts beneath,
accompanied by the bony disk, as it separates from its last attach-
ments, perhaps passing beyond reach, and costing no little touble
and danger before it can be discovered and removed.
It is not judicious to penetrate through the bone at once. As
the operator feels that he has nearly reached the last turn, the
290 OPERATIONS ON BONES.
safe plan will be to partly separate the disk with a partial, oblique
turn of the trephine, and to complete the separation with the
elevator. Sometimes this segment will be retained in the crown
of the instrument, or, again, it will be only partially loosened. In
that case, securing it with a pair of bull-dog forceps, its excision
can be made complete with the bistoury, by dividing the mucous
membrane of the sinus which may hold it. If the edges of the
opening in the bone are not perfectly smooth, their asperities
should be removed with the bone scrapers or bone knives.
The indications following the perforation of the bone vary
according to the case. If it is a fracture, with pushing in of the
bone, the fragments, or the bone debris, must be removed by
being raised with the bone elevator, cutting from within outward.
Tf a removal of a parasite of the cranial cavity is to be effected, its
membranous envelopes may be carefully twisted around the jaws
of the forceps, and thus removed in a single mass. In cleansing
out a purulent collection in the sinus, it must be injected and
washed with the proper medicated solution. If, on the contrary,
the removal of a foreign body is necessary, as a polypus, or an
odontoma, or the extraction of a molar tooth by gouging, it may
become necessary to enlarge the opening. This is done either by
chipping off the edges with the bone forceps, or by making another
opening with the trephine, adjoining the first, and merging them
together by properly trimming and shaping them.
The dressings required after trephining vary according to cir-
cumstances. If the trephining has been but a preliminary step
to a subsequent manipulation, such as the raising of a fragment
of fractured bone, or for the removal of foreign bodies, tlfe wound,
after being thoroughly and antiseptically washed, can be closed
by bringing the edges of the integument together by sutures, and
covering the surface with a pad of oakum, kept in place by a fig-
ure 8 roller, around the head, or by one of the frontal, single or
double, already described. If, however, the operation has been
performed in a locality where there would be difficulty in retain-
ing such a dressing, the application of agelutinating preparations
or plasters will effect the object.
When the frontal and maxillary sinuses have been opened, and
it becomes necessary to wash out their cavities by injections thrown
into them, the trephined opening must be prevented from closing
by the introduction of a tent of oakum and a kind of soft cork,
by hs
PERIOSTOTOMY. 291
which may be kept in place by securing it to the halter of the
patient, to prevent it from falling into the sinus.
The cicatrization of the wound made by the trephining in-
strument springs from the rapid development of granualations
which soon fill up the opening. These granulations soon undergo
the various changes which take place in the process of calcification
and ossification, and the loss of bony substance is soon completely
repaired.
In a few instances, however, the seat of the operation, after a
few days, assumes a most unfavorable aspect, becoming swollen
and offensive, and betraying the characteristic necrotic odor. In
many instances the seat of the necrosis is found to be the edge of
the opening, and is due to the imperfect application of the tre-
phine, and the destruction of the periosteum. Care must then be
taken to remove all the loose necrotic fragments. To allow them
to remain imbedded in the granulations and under the skin, will
be to incur the certain hazard of the development of abscesses
and the formation of fistulous tracts, which will refuse to heal
until the last particle of diseased bone has been exfoliated and
removed.
PERIOSTOTOMY.
Periostotomy is an operation which consists in the subcutaneous
division of the periosteum, on the surface of bony growths. It
may be for the purpose of stimulating their resolution, or it may
be to relieve the pain arising from the tension of the inelastic
membrane as it is pressed upon by a tumor of the bone growing
under it. The operation was originally performed by Professor
Sewell of the Royal Veterinary College in 1846, and was at first
considered to be one of the neatest and most scientific among the
methods practiced for the relief of the lameness due to exostoses.
It was considered by Sewell himself to be far superior to any
other means then in use, counter irritations, firing, and the rest.
But although earnestly supported by the authority of its inventor,
periostotomy has not sustained its claims by exhibiting all the
results which were promised for it, and experience has shown that
it is in many instances not only a useless, but even a dangerous
operation. Several special instruments are necessary in its per-
formance. These are a peculiar rowel scissors (Fig. 306) to incise
the skin, for which, however, a special distowry (Fig. 307) is
292 OPERATIONS ON BONES.
Tex
ae
SSS
Sos
<=
307.—Bistoury. 308.—Periostome. 309.—Seton Needles,
sometimes substituted; a periostome (Fig. 308), a kind of blunt
bistoury, narrow and curved; and two flat needles (Fig. 309),
short and curved flatwise, one of which is blunt, and used to di-
vide the connective tissue, the other being sharp and to be used
as a seton needle to pass a tape into the subcutaneous incision, if
it is judged necessary. These needles may either be inserted into
a handle, or used free.
The operation is a simple one to perform. The animal being
cast and properly secured, an incision is made with the rowell
scissors or the bistoury, at the most dependent parts of the bony
growth, large enough to allow the introduction of the blunt curved
needle. This being pushed slowly under the skin, separates it
from its attachments, and upon being gradually withdrawn, the
periostome is passed into the tract thus formed, directly over
the bony tumor. Turning the sharp edge of the periostome on
the exostosis, and pressing it over the periosteum, this is divided
by subcutaneous strokes down to the most superficial layer of the
exostosis, which may be incised by the instrument.
When the tumor is of long standing, a seton may be intro-
duced by pushing into the tract, from which the periostome has
been removed, the curyed needle which carries the tape, and it is
brought out by an opening made at the highest part of the tumor.
Sewell claims that after twenty-four hours the parts become
the seat of alarge swelling, and more or less inflammation may take
place, but after twelve days the animal is ready to resume his
work, the swelling haying gradually subsided, and the lameness
RESECTION OF BONES. 293
passing off, sometimes the enlargement having disappeared. Our
own observation, however, differs from that of Sewell and agrees
with that of Reynal, as we have seen cases where excessive inflam-
mation has followed the operation, accompanied by the persistent
development of large indurated swellings, intractable to any other
form of treatment, and giving rise to permanent lameness. This
operation, although highly recommended by English practitioners,
especially in the treatment of splints, is not, however, held in the
same estimation by Continental veterinarians,
RESECTION OF BONES.
The resection of a bone is the removal of a portion of its sub-
stance, for the connection of a deviation from its normal position,
or other deformity, or in cases of fracture, or necrosis, or other
incurable disease. It is to a bone what excision is to the soft
tissues. It has been known for a long time, but it is within only
a comparatively recent period that it has found admission into
veterinary surgery, and even now it is but seldon practiced. It
is practicable on all parts of the skeleton, but there are some
special conditions in which it is more evidently indicated than in
others, such as cases of necrosis in the vertebra, giving rise to
obstinate fistulous withers, and in the treatment of some exostoses ;
or again in that of the complicated wounds accompanying frac-
tures.
WANA
Fic. 310.—Various Forms of Saws.
294 OPERATIONS ON BONES.
\
my
zs oa
ne MS
Fia. 312.—Bone Forceps,
Fia. 313.—Gouge. FiG. 313a.—Chisel. FIG. 3136.—Mallet.
The instruments necessary are quite numerous. Saws of
different forms, including the chain saw, the bone forceps, or
shears, the gouge, the chisels, and the mallets are all brought
into requisition at times. Before making a resection the diseased
bone must be thoroughly exposed by a free and long incision,
giving ample room to the surgeon for the free use of the instru-
ments. If the bone is already exposed, great care should be taken
to protect the soft tissues, the muscles, the blood vessels and the
nerves, from being accidentally wounded, by covering them with
compresses, cloths, or other substances.
RESECTION OF BONES. 295
The manipulations will of course vary, according to the bone
which is to be incised. When one of the long bones is to be re-
sected in its long axis, either in part or in whole, the periosteum
must be kept as nearly intact as possible; as the principle regen-
erator of the osseous tissue, its removal would necessarily interfere
with the cicatrizing process. It must be very carefully separated
from the bone, and isolated, to the whole extent of the segment
to be removed. This done, the bone can be readily cut off, with
either the chain saw or the plain instrument. The resection of
bones in their articular extremities seldom occurs in our practice;
it sometimes becomes necessary in diseases of the vertebree, in fis-
tulous withers, and occasionally in caries of the ribs.
In the first case, that of the diseased vertebra, the excision is
commonly made with the bone forceps and chisels, or even with
the gouge. The principal point to observe in these instances is
to avoid injury of the ligamentum nuche as much as possible,
and to save all the periosteum that can be preserved.
The resection of ribs is accomplished with difficulty, on account
of the proximity of the pleura which lines their internal surface.
To avoid wounding this important organ the rib is exposed by a
longitudinal or crucial incision, and after isolating the intercostal
muscles from their attachments, the pleura can be pushed away
from the bone with the blunt end of a scalpel, and with the chain
saw introduced carefully between the bone and the pleura, the
resection can be accomplished by dividing the bone from within
outwards. The hemorrhage which arises from the intercostal
artery can be stopped by plugging. The wound is dressed by a
protective antiseptic bandage applied round the chest.
The general indications, after the resection of bones, are to care-
fully watch the progress of the wound and watch for the possibility
of the formation of fistulous tracts, which may result from the
extension of the necrosis, which may not have been entirely re-
moved, or may result from the removal of the periosteum. These,
however, may often be prevented by so regulating the process of
eranulation, as to prevent the accumulation of pus in the wounds,
and if necessary, by applying caustics or resorting to any other
of the means recommended to fulfil the existing indications.
CHAPTER VII.
OPERATIONS ON MUSCLES AND THEIR
ANNEXES.
CAUDAL MYOTOMY.
This operation, more commonly known under the name of
pricking, is exclusively performed on equines, and is designed to
diminish the power of contraction of certain of the muscles of the
tail. However it originated, it has been perpetuated by a class of
horse fanciers who have, to a certain extent, made it a dictum of
fashion, and by whom it has been supposed to improve the
symmetry of the animals upon which it is inflicted But it has
lost, in our day, much of the estimation in which it was once
held, and while at first, before its prestige had been weakened, all
kinds of horses, indifferently, became victims to the bad taste
and thoughtless cruelty of the custom, either the external form of
our horses and the mode of attachment of their tails have been
improved by more skillful methods of breeding, or they have in-
stinctively learned the regulation style of carrying their caudal
extremities. "Whatever may be the cause, the fact is beyond
dispute that the indications for the operation have considerably
diminished.
But though the effect of the division of the inferior caudal
muscles is in fact, with some animals, to cause them to carry
their tails in lines more graceful and more horizontal than before,
it is still necessary, in order to accomplish a successful result,
that the tail should be properly attached to the body as a con-
genital arrangement, or well set up on the sacrum. A horse
with an oblique sacrum, with the tail set low and close to the
ischial tuberosities, can never bea good subject for the operation,
or made to serve as a favorable example of the beautifying effect
of pricking.
But with all this, there is sometimes a condition which (look-
ing not to the welfare of the horse, but solely to the conveniences
a.
CAUDAL MYOTOMY. 297
of his master), renders caudal myotomy an operation of necessity.
This occurs with those animals which have contracted the annoy-
ing habit, when driven in harness, of switching their tails over the
reins and, in effect, grasping and holding them so tightly that it
is only with difficulty that they can be extricated—often placing
the driver in a position of imminent peril by making it impossible
to control their movements at a moment when perhaps a disas-
trous collision or other dangerous encounter may impend.
‘There is also another condition which relieves caudal myotomy
from the imputation of relying for its justification exclusively on
the plea of being in the fashion, though it involves only the
sordid argument of a money consideration. This condition is
found in the case of the animal which carries its tail sidewise or
with a lateral curvature—a deformity which may in many instances
considerably diminish his market value. In other words, if the
contra-indication of the operation is the fact of bad conformation
of the animal and a low insertion of the tail, the indications, leay-
ing aside the question of good appearance, no matter if the tail is
attached low or high, are when the horse has the habit of taking
hold of the reins by switching it over them, and again when the
tail is carried crookedly sideways. We proceed to consider the
operation under all the requirements.
Caudal Myotomy Proper, or Pricking, means the division of
the two inferior sacro-caudal muscles, for the purpose of dimin-
ishing their contractile power. It is performed in several ways,
most of which consist not only in the division of the muscles,
but in the removal of a portion of the muscular substance.
There is, however, one method of which we have failed to dis-
cover any mention by European authors, and which we have for
years practiced in the United States, where it has been in vogue
for a period of more than forty years. This mode of operation
we shall consider in another place as the “ American method.”
A glance at plate 314 will show the peculiar anatomical position
of the muscles, blood vessels, and nerves of the region to be oper-
ated upon. Peuch and Toussaint refer to six modes of operations,
but we think the matter can be judiciously simplified by reducing
the number by at least one-half. We shall therefore adopt a sim-
pler classification, and describe the operation as it is performed
by, jirst, the transversal incision; second, the longitudinal; and
third, the transversal and longitudinal in combination. .
298 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
ZA
Zi
CS
ISS
218
—
\
Fic. 314.—Anatomy of the Perineal, Anal and Caudal Regions.
11.—The skin. 2.—Portion of the aponeurotic sheath of the coccygeal muscles.
33.—Inferior sacro coccygeal muscles. 4 4.—Lateral sacro coccygeal muscles. 5 5.—Is-
chio coccygeal muscles. 6.—Suspensory ligament of the anus. 7 7.—Lateral caudal
arteries, 8.—Deep caudal vein, satellite of the median artery. 9.—Median caudal
artery. 1010.—Inferior caudal nerves. 11.—Lymphatic glands. 12 12.—Superficial
caudal veins. 12'—One of the superficial caudal veins. 13.—Portion of the perineal
aponeurosis. 14 14.—Semi-membranosus muscle. 15.—Sphincter ani. 16 16.—Ischio
cavernous muscle. 1717.—Bulbo cavernous muscle. 18 18.—Suspensory ligaments of
thepenis. 1919.—Bulbous or internal pudic arteries. 20.—Incision of the urethral
canal for urethrotomy,. 21.—Anus,
CAUDAL MYOTOMY. 299
The patient must be kept, as much as possible, in the standing
position, with a twitch on his nose, and his hind legs hobbled, or
secured with the hippo-lasso; or if he is of a very excitable and
restless disposition, the stocks should be brought into requisition.
The decubital position is, in our opinion, unnecessary, and un-
doubtedly a very inconvenient one for the surgeon, and not at all
contributive to the performance of a neat operation. We have
often used cocaine when pricking horses, and it has in many in-
stances produced all the excellent effects of general anesthesia;
and we prefer it, therefore, to the inhalations of chloroform which
some recommend.
Ist. Operation by Transverse Incisions.—The instruments
required in this mode are a distowri a serpette, an instrument re-
sembling that known as bistowri caché of our obstetric cases;
Oe pp
BSE ip fil
il
wy x
Sid
Fia. 315.—Bistoury for Caudal Myotomy.
a sharp convex bistoury, and a bull-dog forceps, or a pointed
tenaculum. The animal being secured in position, an assistant,
placed on one side of the croup of the patient and facing
the operator, raises the tail perpendicularly and well on the
middle of the back of the patient, in order to render the mus-
cles tense and cause them to project well under the fine, soft
skin which covers that region. The operator, directly facing
the posterior parts of the animal, then firmly grasps the tail with
his left hand and steadies it, while holding the blade of the
bistourt a@ serpette between the right thumb and index finger, close
to its sharp part, and plunges the instrument through the skin
and the entire thickness of the muscle, beginning on its inside
border. or slightly on one side of the median line, and carrying
Fic. 315a.—How to Hold the Bistoury and Make the Incision.
300 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
the incision outward, right across the entire width of the muscle.
The incision must run through the entire thickness of the organ
and ought to be made by a single stroke of the instrument. The
first incision is to be made about three fingers width from the base
of the tail; the second from one inch and a half to two inches
back of it, and the third, if not considered unnecessary, at the
same distance from the second. Owing to the tapering form of
the tail, the incisions should become shorter as they approach the
end of that member. When all the incisions are made on the
right side, the operator, if ambidexter, changes hands and re-
verses his mode of manipulation, proceeding otherwise in the
same manner as before, being careful that all the incisions are
made directly in line with one another, entirely across the
muscle. f
These first three incisions constitute the first step of the
operation. If the division of the muscle has been made through
its entire thickness, the portions of tissue be-
tween the incisions will slightly protrude, and
these are to be seized with the bull-dog forceps,
and drawn over to one side, while they are care-
fully dissected away with the convex bistoury,
placed flatwise, under the muscle,
with the sharp edge turned up-
ward, and separating entirely the
two portions of muscles included
FIG. 316.—Trans. between the incisions. The amount
versal Incisions in of muscular tissue thus removed
Candal Myotomy. will measure from three to four
inches in length.
The number of the incisions varies. At first
one was considered sufficient, but the number was
eradually increased to five, while at present com-
mon agreement has fixed the rule at three.
2. The Operation by Longitudinal Incisions.—
This is comparatively an old mode of operating,
which, having been once abandoned, was revived
by Delafond, in 1833, when it was again reinstated
in general practice. It requires for its perform. Fre. 316a.—Cau-
ance only a strong, convex bistoury. The animal 44! Myotomy by
- 7 Site ., Longitudinal In-
being secured in the usual position, and the tail cisions.
CAUDAL MYOTOMY. 301
kept as in the other methods, the operator makes on the middle
of one of the projecting muscles a longitudinal incision, three or
four inches long, dividing at one stroke the skin and the fascia
underneath. From the muscle thus exposed, a portion is dissect-
ed, and by passing the bistoury under it, close to the vertebre, it
is removed by cutting it transversely at both extremities of the
cutaneous incision. The removal of the muscle is made first on
one, then on the other side of the median line.
3d. Operations by Mixed Incisions.—This was devised by
Vatel, who made two transversal incisions on each side of the tail,
from three to four inches apart, and uniting those of the same
side by a longitudinal incision, made in the direction of each in-
ferior caudal muscle, and then dissecting a portion of each organ
with the aid of a bistoury, or a pair of scissors, securing a hold at
one end with a pair of forceps, or a pointed tenaculum.
The method patronized by Brog-
niez, and recommended by Belgian
veterinarians, requires two special in-
struments: the caudal dermatome,
which is used for the division of the
skin, and the caudal myotome for
that of the muscles. The operation
is minutely described by Director
Degives, and includes the following
steps:
Two or three incisions are made
on the prominent part of the muscle,
parallel to its long axis, the first
about two fingers’ width from the \ :
base of the tail, a space of about half pyg. e17. Operation by:Mixed! In:
an inch being left betwecn each in- Clone Aten S maeias)
cision. These incisions are made with the dermatome, pressed
perpendicularly over the tissues to be divided. The two lower
incisions are first made, then the two middle ones, and the two
upper ones last. By this process the skin and subcutaneous fascia
are divided. The myotome is then introduced under the muscle,
from within outward, and after twisting it around the organ, di-
vides it by turning the instrument so as to bring 1ts sharp edge
against the muscular tissue. Thus divided, the muscles protrude
through the incision, and are then excised in the usual way.
302 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
Fig. 318.—Caudal Der- Fia, 319.—Cau- Fia. 320.—Brogniez’s Mode of
matome. dal Myotome. Operation.
The American, or Subcutaneous Method.—This requires but a
single instrument, viz.: a strong, straight tenotomy knife. The
operator, having the animal in the usual position, with the tail
under proper control, and holding his knife flat full in the hand,
plunges it flatwise through the skin, with the sharp edge turned
downward, from without inward, measuring carefully to intro-
duce it at about the separation of the lateral and inferior caudal
muscles, and pushing it as nearly as possible between the mass of
the muscle and the vertebre. When the instrument has pene-
trated to near the median line, the sharp edge of the instrument
is, by a twist of the hand, turned perpendicularly in the direction
of the muscle, and by a careful sawing motion, the division of its
fibers is accomplished. This is easily detected by a peculiar crack-
ing sound, which ceases as. soon as the entire thickness of the
muscle is divided. The edgeof the instrument can then readily be
felt under the skin. The cutting must be carefully done in order
to avoid the division of the entire thickness of the skin. A second
and third division must follow, the number being equal on each
side.
There is also another subcutaneous mode, practiced by Ger-
ae
CAUDAL MYOTOMY. 303
man veterinarians, but which is claimed by Hering to be uncertain
as to its results. In this operation both a straight and a curved
myotome are used. With the straight knife a small incision is
made, parallel to the axis of the tail and close to the hair, and the
curved myotome is then introduced between the skin and the
muscle. A turn of the instrument brings its edge against the
muscle, and by the usual sawing motion, the organ is divided from
within outward, the blunt end of the myotome sliding upon the
vertebree.
Neither of these subcutaneous methods include the removal
of any portion of muscle.
When the operation is finished, the animal may be relieved and
the tail released without any apprehension of serious hemorrhage,
although by reason of the unavoidable division of the lateral caudal
arteries, a certain amount will necessarily take place. But this is
not of aserious nature, and, as a rule, needs no special attention ;
we have seen the blood which had flowed quite freely while the
tail was hanging pendant, cease almost immediately when the
animal was returned to his stall, and the tail placed in the position
to be described on another page. But in case of an unusually
abundant hemorrhage, a simple compressible bandage may be
applied, to be left on until the bleeding is controlled.
The treatment appropriate for wounds resulting from incision
and removal of portions of muscular substance, is that which is
common to all suppurating wounds, cleanliness being the most
important item. While such attentions are naturally re quired for
animals subjected to any of the various methods of operation, the
subcutaneous mode can claim an important advantage in the fact
that the, healing process is almost always by first intention, and
the tail demands no subsequent nursing.
Whatever may have been the method of operation which the
animal has undergone, it will be subsequently necessary to place
the tail in some given elevated position, and retain it in position
for.a term ranging from two to possibly four weeks, or until the
wounds are cicatrized. Various devices are in use for keeping the
tail in an elevated position, the simplest and probably the best of
which is that of the pulleys. The proof is simple ; either a single
pulley is placed in the middle of the ceiling, or two are used, one
on each side of the stall, and in either case about on a level with
the loins of the animal. The tail is kept in the perpendicular
t
ive
“<
ai. Mie
304 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
Fa. 321.—Simple Method to Keep the Tail Elevated.
position by a cord passing through the pulley, one end being se-
cured to the tail and the other to a weight sufficiently heavy to
effect the purpose (Fig. 323). A little art is necessary in attaching
the cord to the tail. The hair should be nicely braided and a loop
formed, and then a small wooden pin run through the braid will
effectually prevent the cord from becoming detached. This plan
Cia
Ws, |
FIG. 322.—Brogniez’s Apparatus to Elevate the Tail.
>
a ee
CAUDAL MYOTOMY. 305
FIG. 323.—Elevating the Tail with Pulleys.
also has the advantage of equalizing the strain on the hair. In
respect to the amount of weight to be employed in this process,
much caution must be exercised in order to avoid excess. An
error here might cause the loosening and loss of the hair, with
the troublesome consequences of greatly interfering with the final
result at the cost also of much suffering to the horse. The cord
should run freely through the pulley and be of sufficient strength
to allow the animal to lie down if disposed to do so. It will be a
prudent precaution to accustom the animal to the use of the pul-
leys by placing them on him for a few hours daily for a short pe-
riod in anticipation of the operation. It will be necessary—as we
before remarked—for the horse, after that, to remain in the pul-
leys not less than two, and possibly three or four weeks, although
after a short time he may be relieved for the purpose of taking
proper exercise. The Bartlet’s apparatus recommended by G.
Fieming may also give very good results (Fig. 324).
Caudal myotomy is an operation, which, though simple in it-
self, may be followed by numerous and, at times, severe compli-
cations. Out of one hundred and forty-one animals operated
upon by Hering, four died from either gangrene, severe petechial
fever or suppurative infection. Among the most common acci-
dents met with are the following :
aad rs wey Ler eae
ie
306 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
Fic, 824.—Bartlet’s Apparatus, Separate and in Position.
Ist. Hemorrhage, which is not generally serious, taking place
mostly ‘when the tail is loosened and allowed to hang down, and.
ceasing as soon as itis again placed in an elevated position. It
is but seldom that it becomes necessary to interfere for the pur-
pose of arresting it, which is easily effected by the ordinary
means, as pressure or the application of hemostatics.
2d. Gangrene is one of the most dangerous sequele of the
operation, whether resulting from excessive traction on the tail
by the heavy weights, a dressing too tightly applied, or excessive
inflammation, or, according to Hering, to the completed section
of all the arteries supplying the tail. When becoming gangren-
ous, the wounds assume a brown or blackish appearance, the sup-
puration becomes sanious, with a repulsive, swt generis odor, the
tail is swollen and flabby, and the oedema surrounding is cold and
puffy. The gangrenous process generally begins toward the end of
the tail and progresses rapidly, endangering in time the life of
the patient. It is often only by the most energetic measures that
it can be controlled, such as the free use of antiseptics, scarifica-
tion, cauterization, or even amputation.
3d. Wounds of the Vertebrve and of their Ligaments.—These
injuries, not so serious in their character, are usually produced
by the contact of the knife during the operation, causing a
scraping of the bone and wounding of the periosteum or the
ligaments which unite the vertebre. Another injury is a re-
sulting necrosis caused by the formation of a fistula, from which
a thin sanious pus is discharged, and which forms a wound which
refuses to cicatrize. Though Zundel affirms that this complica-
tion is most common after the subcutaneous operation, long
experience with this process fails to justify our agreement with
' CAUDAL MYOTOMY. 307
this assertion. When disease of the bones exists, the indication
is to promote the exfoliation of the necrosed parts by free open-
ings, antiseptic dressings, and, if necessary, caustic injections.
Anchylosis of the vertebree is a common sequel of this complica-
tion.
4th. Adbscesses.—These suppurative collections are not uncom-
mon, especially in animals having peculiar idiosyncrasies, as in
cases of strangles. They may extend to the root of the tail,
around the anus, or any part of the hind legs even to the rectal
region. They require treatment similar to that of all analgous
gatherings.
5th. Anal Fistule.—This accident occurs when the first in-
cision is made so near to the anus that it enables the pus, when
it forms, to filtrate between the skin and the rectum into the pel-
vic cavity, and is a condition which can be relieved only by giving
free exit to the collected suppuration.
6th. Zetanus.— This termination can, in many instances, be
avoided by antiseptic measures during and after the operation.
Tth. The introduction of air into the veins is also mentioned
by Loiset and Brogniez, but in our opinion there is no more reason
to expect its occurrence in this than in any other operation.
8th. Hxaggerated Elevation of the Tail._—This is one of the
most common of all the sequele met with. In this case the tail,
instead of being carried horizontally and hanging gracefully, is,
on the contrary, either elevated vertically, or even laid back on
the croup. This is not precisely due to improper manipulations
during the operation, but is rather the result of the application of
too heavy a weight and an excessive amount of traction while the
animal is in pulleys. The most effectual way of avoiding this un-
pleasant incident is to watch closely the progress of the cicatri-
zation by taking the patient out for exercise and watching the
manner in which he carries his tail, and then increasing or di-
minishing the weight on the pulley, and shortening or lengthen-
ing the period of its use.
Operation for Abnormal Deviation of the Tail—This is in-
dicated where there is a lateral curvature of the tail, and the
animal carries it sidewise, whether it be a congenital habit or
oceurs as one of the complications of pricking; and also when he
carries it in an excessively elevated position. In these cases
myotomy is performed, according to the requirements, either on
308 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
the lateral caudal muscle on the side to which the tail is carried,
or upon one or both of the superior sacro-caudal muscles, the
elevators of the tail. Asa rule, one incision only is necessary,
and it must be done subcutaneously, and in the subsequent treat-
ment, instead cf placing the animal in pulleys, the tail must be
tied up to the surcingle on the side opposite to that of the opera-
tion; or it may be allowed to hang down free. An experience on
our part of many years, has rendered us skeptical as to the success
of lateral caudal myotomy, a careful dissection of the tails of
animals affected with this deformity having proved the existence
of an abnormality in the formation and development of the
caudal vertebrze which has been either the cause or effect of the
trouble. Operations performed upon animals of this class have
not been usually followed by a satisfactory result.
CRURAL MYOTASE—CRURBAL MYOTOMY.
This affection is peculiar to bovines, and is a species of dis-
location, or displacement of the long vastus muscle—the
external ischio-tibial. It is a lesion which forms a very serious
impediment to the act of locomotion, by its disabling effect upon
the movements of the hind leg.
The nature of crural myotase will be understood by those who
are familiar with the anatomy of the region in cattle. With them,
the biceps femoris covers, in its normal position, the whole of the
coxo-femoral joint, in such a manner that its anterior border (a 6),
Fig. 325, is situated in front of the jomt. This border, from
the articulation to its lower end, forms a kind of tendon, (ce)
closely connected with the aponeurosis of the fascia lata, (f) whose
divided layers surround the muscle, adhering intimately to its two
faces, the deep and the superficial. Passing over the trochanter
of the femur, with the assistance of a large mucous bursa, the
biceps is quite thin, and is kept in position by an aponeurosis (c)
which partially covers the gluteus externus, and is united to the
fascia lata.
When this aponeurosis is lacerated at a point on a level with
the hip joint, while the leg is carried backward, in excessive ex-
tension, it is possible that the trochanter, thus carried forward,
may become engaged in the laceration, the biceps itself being
hooked, as it were, behind the trochanter, and prevented from re-
CRURAL MYOTOMY. 309
FG. 325.—The Biceps Femoris in Cattle. Fia@. 326.—The same over the
Normal Position. Trochanter.
turning in its normal direction. This accident has been noticed
and mentioned in the remotest ages. It may result from both
predisposing and occasional causes. Among the former may be
reckoned the conformation of the animal, as when, for example,
the croup is short, flat and narrow, the hip joint not prominent,
and the trochanter high. Among the predisposing causes may
also be included that of leanness, as when the animal is thin and
in poor condition, and the cellular tissue deficient. The combina-
tion of these causes renders it easy for the muscle to slip over the
trochanter, now relatively prominent, and it is thus that the dis-
location occurs.
Occasional causes also call for mention. These include all
mischances likely to bring about the excessive extension of the leg,
such as falls, missteps, slipping, jumping, kicking, blows, etce.,
any of which may thus affect the limb and produce the lesion
under consideration. And withal, it may take place without any
visible, direct and efficient agency beyond the circumstance of the
excessively lean condition of the animal, and even if the difficulty
is remedied, and the displacement is reduced, while the same
state of things continues, there is a constant liability to a return
of the difficulty.
310 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
The symptoms characteristic of this lesion are readily identi-
fied. Principally, there is great difficulty in flexing the hip joint.
The diseased leg is dragged on the ground,‘carried outward and
backward and the animal resting it on the ground by the point of
the hoof only. It very much resembles the position of a limb of
a horse suffering with a dislocated patella. The anterior border
of the muscle, hooked by the trochanter, forms a longitudinal
projection, resembling a stretched cord, which becomes more and
more marked when examined nearer the coxo-femoral joint. It
can be made more prominent by raising the opposite leg, when it
will be found extending obliquely downward from the joint to the
patella. As the trochanter is no longer covered by the muscle,
this bony eminence becomes directly subcutaneous, and may be
readily recognized, holding posteriorly the displaced muscle,
which forms a kind of tumor behind it.
These symptoms, being rarely associated with inflammatory
phenomena, are not always easy to detect. There are cases where
the lameness, and the carrying of the leg outward and backward,
are the only apparent symptoms. The lameness, however, is.
characteristic, and may be temporary or intermittent, being more
severe when the animal is traveling up-hill than when descending,
but remaining the same on both soft or hard ground; and it
sometimes happens that while the animal is in the act of descend-
ing, the muscle will suddenly return to its place with a clapping
sound, and the lameness subside, though only to return again as
soon as the slightest effort is required of the animal, and bis hind
leg is again carried backward more forcibly than usual. This
peculiar intermittent character is sometimes the cause of an error
of diagnosis which confounds this affection with the dislocation
of the patella, but the exploration of the stifle will always serve
to establish the differential diagnosis.
This accident is more or less serious in its consequences, and
is particularly detrimental to the usefulness of working animals.
It may sometimes, however, subside spontaneously or by simple
rest, and especially if the condition of the animal is improved by
good feeding with fat-producing fodder. Sometimes the displace-
ment is complicated by a laceration of the mucous bursa with the
formation of a hygroma of warm, painful, edematous swellings,
indicating the rupture of the aponeurosis or the inflammation of
the cellular tissue.
“Se
CRURAL MYOTOMY. 311
Generally the dislocation is unilateral, butin other cases it may
occur in both legs. This last condition is always of a serious
nature, and seldom responsive to treatment. The displacement of
the biceps femoris seldom recovers naturally, although where in-
complete and intermittent, it may be benefitted by long rest, or
when, as we have before remarked, it is due to the excessive lean-
ness of the patient, in which case a liberal fattening diet will prove
the best remedy, by removing the cause of its appearance. Local,
external topical treatment by blisters, plasters, setons, etc., are of
no avail. The section of the muscle or the operation of crural
myotomy, is the indication. The modus operandi is not uniform,
although the final object is the same in all.
Our opinion in respect to the best way of operating is in favor
of that by the subcutaneous section. Thisis performed below the
trochanter, and yet as near to it as possible, where the excessive
tension of the hooked muscle can readily be felt. This consists
simply in making a small incision through the skin, by which to
introduce a blunt bistoury, which is inserted under the muscle,
with a director or a finger for a guide, and whenat a proper depth
turned to bring the sharp edge towards the aponeurosis, and cutting
it from within outward, carefully avoiding the section of the skin.
Fic. 327.—Gouze’s Bistoury.
The bistoury invented by N. Gouze answers the purpose very well.
There is no after-treatment required beyond the ordinary care re-
quired for all wounds.
Simple as the operation of crural myotomy is, some complica-
tions may accompany it.
Hemorrhage is notuncommon, usually subsiding without inter-
ference, but sometimes requiring the application of hemostatics.
Inter-Muscular A bscesses.— Diffused Suppuration.—These are
the result of improper manipulations during the operation, such
as lacerations of the cellular tissue by introducing the fingers too
frequently into the wound, or dividing the muscle in several places.
Gangrene.—Though but rarely met with, this should be re-
membered among the possible contingencies. It may occur as the
312 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
result of the presence of clots of blood or other mortified tissues
in the wound, and is indicated by the bad appearance of the parts,
the peculiar cedematous swelling, first warm and painful, but sub-
sequently becoming cool and painless. This condition requires
prompt and efficient treatment, both external and internal.
In Solipeds.—We once had occasion to resort to crural myotomy
for the relief of a case of pseudo-dislocation of the patella of several
months’ standing. The division was made towards the lower por-
tion of the muscle, and was followed by satisfactory results, though
not immediately.
OPERATIONS UPON FIBROUS TISSUES.
TENOTOMY.
In the terminology of surgery, tenotomy means the section of
tendons—an operation which contemplates the correction of de-
formities, from whatever cause they may proceed; the relief of
pressure upon exostoses, and the prevention of the complete execu-
tion of a normal function, as that of flying in birds. Our atten-
tion will, accordingly, be directed to the study of the five varieties
of plantar, carpal, antibrachial and tarsal tenotomy, with that of
the wings of birds.
Pruantar TENOToMY.
This operation is the proper remedy for the deformity known
as knuckling, or the malposition which arises from the exaggerated
flexion of the fetlock joint, and consists in the subcutaneous section
of the tendons of the flexor of the phalanges.
In this affection of knuckling, which is mostly peculiar to
solipeds, there is lameness more or less marked, with a hard and
painful enlargement of the tendons, and a consequent interference
with the act of locomotion, caused by an incomplete flexion of the
articulations. The fetlock is carried forward, and contact with the
ground is effected with the toe alone.
Instances of spontaneous cure or abatement are exceedingly
rare. On the contrary, it has a tendency to aggravation, the swell-
ing increasing, and the deformity becoming by degrees more and
more developed, until at length the anterior face of the wall of the
foot rests on the ground, and the case assumes all the well estab-
OPERATIONS UPON FIBROUS TISSUES. oily
lished characters of a recognized club-foot. Ina majority of cases
the disease is localized in the tendon of the deep flexor of the
phalanges, but it often extends to the superficial tendon as well,
or may involve the tarsal or carpal band, or the suspensory ligament.
This deformity of knuckling may exist in three different degrees:
either the cannon bone and the phalanges meet in an almost ver-
tical line, as in the case of the animal straight or upright on his
pasterns, which is the first degree; or the bones meet to form an
angle opening backward, the phalanges being somewhat oblique
in that direction, instead of forward, asin the normal state, and the
animal still resting on the entire plantar surface of the foot, which
is the second degree; while in the third degree these conditions are
still more exaggerated, the animal traveling altogether on his toeand
exhibiting a case of the perfect talipes. This last conformation,
which exists principally in the hind legs, is specially due to the
retraction of the deep flexor, while in the other degrees it is the
superficial flexor which is diseased. Lesion of the suspensory
ligament may coexist in either case.
The condition of the tendons, from which this deformity arises,
is not the only question to take into consideration when the pro-
priety of the operation is to be determined. The causes which
have produced it must not be overlooked. For example, while in
the hind legs the accident has usually a traumatic cause, such as
a sprain, violent over-exertion, lacerations, or contusion of tendons;
when the fore legs are affected it is most commonly as the accom-
paniment of some lesion in other parts of the leg, as of the foot
or the digital region proper, such as bad feet, navicular disease,
contraction of the heels, corns, quarter and toe-cracks, quittors,
deep punctured wounds, and very commonly ringbones, gr other
exostoses.
Taking all these various causes into consideration, with their
specific natures, and the extent of the lesions which accompany
them, we are justified in believing with Gourdon, that plantar
tenotomy is indicated with fair chance of success, when the knuck-
ling results from traumatism, and the perforans tendon is alone
diseased; and even when both tendons are affected, good results
are still not improbable; but that it is contra-indicated whenever
complications exist which are likely to prevent the leg from re-
turning to its natural position, as when the disease is of long
standing; when there are alterations of the articular surfaces;
314 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
anchylosis of the fetlock; exostoses; adhesions between the ten-
dons and the bones; large engorgements of the tendinous struc-
ture; or chronic dilatation of the synovial bursz surrounding the
region of the fetlock. Remediable cases would seem, from this, to
constitute rather a small minority of the whole number.
The fibrous tissues acted upon in plantar tenotomy, are the
tendons of the flexors of the phalanges, in that part of their length
which is situated back of the cannon bone, between the carpal or
tarsal sheath and the fetlock. The superficial tendon reaching the
fetlock forms a ring through which the deep flexor passes, a cir-
cumstance from which has been devised the manner of perforatus
and perforans, by which they are known.
Fic. 328.—Median section at the infe-
rior row of the carpus—of the metacar-
pus and suspensory ligament.
1. Os magnum.
2. Posterior common ligament of the
carpus.
. Band to the perfcrans.
. Suspensory ligament.
. Its superficial layer.
. The deep.
. Principal metacarpal bone.
ao oo Ff oO
~
The superficial tendon is covered by the fibrous expansion of
the two carpal and metacarpo-phalangeal sheaths in the fore, and
by the tarsal and metatarso-phalangealin the hind leg. The deep
flexor toward the middle of the cannon receives a strong, fibrous
band coming from the posterior ligament of the carpus or tarsus.
Below and between the two’small metacarpal or metatarsal bones
is the suspensory ligament, a strong band, thin superiorly at its
origin, and bifid inferiorly. Between the suspensory ligament and
the cannon bone, there is an interosseous vein and the two inter-
osseous arteries; on the side of the tendons, the internal and ex-
ternal collateral veins, with, in the fore leg, the principal artery
«
OPERATIONS UPON FIBROUS TISSUES. 315
collateral of the cannon, and the internal plantar nerve as its
satellite on the inside, and the external plantar nerve on the out-
side of the leg; while on the posterior leg the principal artery of
the cannon, which is the collateral metatarsal, is situated on the
outside of the bone, and comes in relation with the tendons only
in the lower part of the metatarsus.
In the anterior legs, the carpal bursa, lined with its synovial
sac, extends downward on the flexor tendons as far as below the
superior third of the metacarpal region ; the synovial vaginal sac
of the sesamoid sheath runs upward along the tendons, as far as
the lower extremities of the small metacarpal bones. It is at about
the center of the middle third of the cannon that the operation
can be performed without fear of injuring either of these synovial
SACS.
In the hind legs the tarsal sheath extends as far as the upper
part of the middle third of the metatarsal region, and the sesamoid
sac being the same as in the anterior leg, a little larger space is
left for the operation.
Modus Operandi.—To perform plantar tenotomy, the animal
must be thrown. Some practitioners operate with the horse on
his feet, but this position is dangerous, although by the use of
cocaine, much of the risk attending it may be obviated. The
animal is thrown on either side, according to the leg upon which
the operation is to be performed. If on the fore leg, it must be
on the side of the leg to be operated on in order to expose the
inside of the limb; if on the hind leg, the animal should be thrown
in such a manner as to make the leg upon which the operation is
to take place the upper one. The arrangement, according to
Gourdon, makes the operation feasible both on the inside of the
fore, and the outside of the hind leg.
Several modes of proceeding have been practiced. The old
method is by alarge lateral incision, in which the tendon is ex-
posed, divided either with a bistoury, or by being raised from the
wound and then divided. But this style of procedure necessitates
the formation of large wounds, and is liable to severe and trouble-
some complications, which the modern or subcutaneous method
obviates.
In performing the subcutaneous division, two instruments are
necessary. These are the straight and curved tenotomes. The
blade of the former is narrow, straight, thin and pointed; that of
316
Fie. 330.—Curved Tenotomy Knife.
the latter narrow, curved and blunt, and sharp on its concave
edge.
The animal being prepared, a puncture of the skin is made over
the tendinous region (carefully avoiding the synovial sacs, as men-
tioned above), by introducing the straight tenotome perpendicu-
larly between the tendons, until the point of the instrument is felt
on the opposite side of the leg. A slight sawing motion of the
instrument then cuts through the connective tissue which unites
them, and permits the introduction of the curved tenotome into
the tract made by the straight instrument, and the latter is slowly
withdrawn. At this point the leg is carried into excessive exten-
sion by the assistants, by means of ropes secured respectively,
one about the knee, and one about the foot, and pulling that of the
knee backward and that of the foot forward. The fetlock being
thus stretched to its utmost, the operator, with the edge of the
curved tenotome turned toward the deep flexor, makes a slight
sawing motion with the instrument, and cuts through the fibrous
structure from behind and forward, a peculiar crackling sound in-
dicating when the sectionis accomplished. The retracted extrem-
ities of the tendons can now be felt with a wide interval between
them, and the straightening, more or less, of the fetlock gives fur-
ther proof that the operation is completed.
This is the method in simple tenotomy. Some operators have
suggested the introduction of the instrument between the sus-
pensory ligaments and the perforans in preference to the mode we
have described, in which case the section of the tendon must be
made from before backward. It is, however, a complicated pro-
cess, and one which is not without danger of injuring tissues
which ought to be left intact. The mode of operating known as
the Bernard method is based on this principle.
The double tenotomy, though considered at first as a severe
OPERATIONS UPON FIBROUS TISSUES. 317
operation, does not involve as many objections as at first thought,
but, on the contrary, has often been followed by very satisfactory
results. It is, therefore, a justifiable operation when the defor-
mity of the fetlock is quite extensive. In fact, it is unavoidable
when both tendons are united, or when the deviation in the di-
rection of the bony levers is caused equally by the common con-
traction of both. In performing this double tenotomy, the divis-
ion of the deep flexor being made by the manipulations already
described, the curved tenotome being still retained in the wound
between the tendons, the operator simply reverses its position in
order to bring the cutting edge in contact with the superficial
tendon, and completes the operation precisely as already described.
In this division of the tendon great caution must be observed, in
order to avoid making a complete transverse section of the skin.
Double tenotomy is also performed in some cases by introducing
the tenotome between the suspensory ligament and the tendons,
and dividing them by a section made at once through both from
before backward.
In some peculiar cases, besides the division of the two tendons,
that of the suspensory ligament has also been included, sometimes
in connection with the tenotomy, and sometimes independently.
In this case, the place selected differs from that which is indicated
for the simple or double operation. It is, indeed, toward the lower
extremity near the bifurcation, and toward the lower third of the
cannon, where it is more readily reached. The straight tenotome
is first introduced, flatwise on either the internal or external face
of the leg, between the ligament and the deep flexor of the pha-
langes, carefully avoiding the blood vessels and nerves, and the
curved instrument is inserted with its cutting edge toward the
ligament, the section being made by cutting from behind forward.
The instrument must not be introduced between the bone and
the ligament, nor must the section be made from before back-
ward ; such a course not only endangering the nerves and blood
vessels, but also involving the risk of breaking the blade of the
tenotome at the bottom of the wound.
Whatever mode may have been followed, and however many
tendons may have been divided, or whatever force may have been
applied to the rope by the assistants who made the traction, it is
an exceedingly rare result to obtain a perfect straightening of the
leg, most especially when the disease has been of long continu-
318 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
ance, and chronic adhesions may exist. A short walking exercise
following the operation may facilitate the straightening of the leg,
and in any event can have no injurious effect. But even with this,
it is sometimes several days before any well-marked improvement
can be discerned. There are cases, indeed, when ten or fifteen
days may pass without noticeable change, but if it fails to appear
after such a lapse of time, the case may be considered hopeless.
There are practitioners, however, among whom are Didot,
Delward and Hering, who object to this exercise, and hold that
the natural and spontaneous
straightening of the fetlock
can be greatly assisted by
proper shoeing, as, for exam- Fie. 332.—Mov-
ple, by wearing a shoe with a *”° To-Go".
Fic, 331.—Shoe with Pro- long toe, such as are used in cases of club-
longed Toe, for Club-Foot. foot, or again, by having peculiar movable
toe-corks by which the effect of the bearmg of the shoe is in-
creased. The ordinary long-toed shoe represented in Fig. 333
is often worn with advantage.
Fig. 333.—Long-Toe Shoe.
Complete rest after the operation will benefit the patient in the
most essential manner by diminishing the causes of pain and favor-
ing the cicatrization, and possibly preventing an exaggerated ex-
tension at the fetlock. Itis only after from twenty to twenty-five
days that moderate exercise may be allowed, and not less than six
OPERATIONS UPON FIBROUS TISSUES. 319
weeks should elapse before the ordinary labor of the patient can
be resumed. The resulting wound needs no special dressing, and
by being thoroughly sterilized by antiseptic manipulations, the
parts will heal without trouble. The suggestions of poultices,
fomentations, counter irritation, blisters and firing of old-time
surgery must be strictly ignored.
If, however, all the measures recommended for the straighten-
ing of the leg should fail, and, on the contrary, a tendency to an
Fie. 334. Fia. 335.
FIGS. 334, 335, 336.—Various Apparatus Recommended after Tenotomy.
excessive extension of the fetlock should be manifested, the appli-
cation of some of the various kinds of apparatus designed for the
correction of these defects may be experimentally tried, with a
320 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
possibility of good results. According to
their peculiar working arrangements, slowly
increased extension might be maintained,
or the leg might be steadily retained in a
given position, or with the power of regu-
lated motion, the result being an important
and permanent improvement in the value
and comfort of the animal.
The accidents, which may be apprehend-
ed in connection with plantar tenotomy are
hemorrhage and wounds of nerves, or of
the skin, or of the synovial sacs ; an exag-
geration of the extension, and a return of
the original deformity. To these Peuch
and Toussaint add gangrene.
(a) Hemorrhage, both arterial or vein-
oa ous. But this may be avoided by careful
attention to the rules laid down for the operation, and if it should
occur, hemostatis by pressure must be resorted to, and the band-
age can be safely removed, or at least the pressure diminished, in
from twelve to twenty-four hours.
(6) Wounds of Nerves.—These cannot very well be avoided,
and while they are manifested by severe struggles of the animal
at the moment of their occurrence, they involve no danger other
than those pertaining to similar injuries in other regions, viz.: the
temporary suspension of the sensorial functions.
(c) Wounds of the Skin.—These are among the comparatively
severe complications, and when they occur, they destroy all the
advantages which properly accompany the operation as a subcu-
taneous process. They are likely to complicate the operation with
fungoid growths upon the stumps of the tendons, abundant sup-
puration, ugly cicatrices, etc., and should therefore be specially
guarded against.
(d@) Wounds of the Tendinous Burse.—These may be attrib-
uted to an improper selection of the place where the puncture
should be made, and may be recognized by the flow of synovial
fluid from the wound. Suppurative synovitis may then complicate
the case with fatal effect. The treatment they require is that
directed for open synovial tumors. Local applications, rest, pres-
sure, counter irritation, blisters and firing are the indications.
.
=~
OPERATIONS UPON FIBROUS TISSUES. oe
(e) Hxaggeration of the Extension.—This may take place
when artificial means to produce sudden extension are too power-
ful, or when the violent efforts of the animal have caused a ten-
dency in the parts to give way suddenly. The apparatus before
referred to must be here brought into requisition.
(f) Return of the Original Deformity.—This results from
the retraction of the new tissue formed between the stumps of
the divided tendon. It occurs as a consequence of returning the
animal to his work at too early a date, and when the newly formed
tissue has not yet become sufficiently matured and solidified to
sustain the strain to which it had been subjected. Rest, cold
water bathing in a running stream, vesicating applications and
firing have been recommended as remedies, and even a second
section of the tendon may be suggested, though with but a doubt-
ful prospect of good results.
CarpaL TENOTOMY.
This defines the section of the tendons of the external and
oblique flexor muscles of the metacarpus. They are inserted on
the trapezium bone of the carpus, and their retraction occasions
the deformity known as sprung knees, a condition brought on by
excessive and exhaustive labor, though there is a class of pa-
tients in which the lesion may be ascribed to a congenital taint,
and it is principally for the benefit of this class of patients that
the operation is indicated and usually performed. It is principally
favored and utilized in Germany, where it was originated by
Dieterichs, though afterwards adopted and practiced by Prud-
homme, Lafosse, Miguel, Brogniez, Hering, Gourdon and others.
The operation can be performed on either tendon singly, or on
both ; but according to Hering, the division of the external mus-
cle is generally sufficient.
The anatomy of the region should be described before passing
to a detail of the steps by which the section of the tendon is ef-
fected. The external flexor is situated on the posterior external
part of the forearm, and terminates by the branches, one of which,
the funicular, is anterior, and passing in the groove of the external
face of the trapezium, becomes attached to the hand of the exter-
nal rudimentary metacarpal bone; while the other posterior, wide
and short, goes to the supero and posterior circumference of the
same bone, in connection with the middle flexor, to which it is
oan OPERATIONS ON MUSCLES AND THEIR ANNEXES.
united. The section must be made above the bifurcation of
the tendon, to avoid the artery which passes under it, though
it is quite deeply situated, and besides, there is no danger
of injuring the synovial sac of the carpal arch. The oblique
flexor is situated back and inside of this, and hasits tendon single,
terminated on the trapezium, with the posterior tendon of the
external flexor. The section must be made before the union of
the two tendons, in order to avoid injury to the carpal arch.
The animal is thrown, and the knee extended with two ropes,
one above and one below the knee, and drawn in opposite direc-
tions. The same instruments are used for carpal as for plantar
tenotomy.
The incision of the skin is made about two inches above the knee
with the straight tenotome, immediately in front of the tendon,
which is easily felt under the skin, and is raised with the fingers ;
the curved tenotome is inserted between the skin and the tendon,
from before backward, and the section made as in the plantar
operation. Gourdon suggests the introduction of the knives
under the tendon instead of between that and the skin. By this
mode the division is made from within outward, while in the
other way it is made from without inward.
The external flexor being thus divided, the section of the
middle flexor is made a little below; the puncture of the straight
tenotome is made between the two tendons, and the curved
tenotome inserted as before, between the skin and the tendon
from before backward, or preferably, from without inward, and
when its blunt end is felt on the posterior border of the muscle,
the section is made from without inward, with the usual motion of
the knife. Only a simple dressing is required, but the animal
must be kept at rest for at least.a month.
The modus operandi to which we give the preference over that
which we have just narrated, and which we have described in our
work on lameness, is very simple. The animal being thrown, on
the side opposite to that of the operation, and the knee extended
as usual, the operator, who is in front of the knee, feels for the
space between the two muscles, where they are about to unite,
and this being found, a straight tenotome is introduced through
the skin from before backward, about two inches above the super-
ior border of the trapezium, and under the thickness of the
middle flexor, and when the point of the instrument is felt on the
OPERATIONS UPON FIBROUS TISSUES. 323
other border of the muscle, in front, the curved tenotome is in-
serted and the straight one withdrawn, and the tendon divided
from within outward; the straight tenotome is then re-introduced
through the same opening, between the muscles, and carried from
behind forward on the posterior border of the external flexor,
under its thickness, until the point of the instrument is felt on
the anterior border, when the curved tenotome is again re-insert-
ed, and the division of the tendons performed as before. The
wound of this operation is simple, heals readily, and is liable to
no complications or accidents. Of course the operator must ex-
ercise due caution, when dividing the tendons from within out-
ward, to avoid making a complete section through the skin.
Anti-Bracut1aAL TENoToMY.
This operation has been recommended for the relief respec-
tively of sprung knees and knuckled fetlocks, but by reason of the
numerous and almost constant failures by which it was character-
ized, has been discredited, and banished from the domain of our
surgery. It consisted in the section of the tendinous band which
from the lower extremity of the coraco-radialis extends downward
to mingle with the fibres of the anti-brachial aponeurosis, in pass-
ing a little below and in front Of the elbow joint.
Brogniez, who recommended the operation, performed it by
making a longitudinal incision of the skin over the course of the
tendon, which is readily felt under the skin, and passing the point
of a convex bistoury over the aponeurosis and the band, dividing
it from without inward.
°
TarsaL TENOTOMIES.
Two modes of operation are practised upon some of the
tendons surrounding the hock joints, one upon the cunean branch
of the flexor metatarsi muscle, the other upon the tendons of the
lateral extensor of the phalanges. They are known distinctively
as the cunean and the peroneo-phalangeal tenotomy.
(a.) Cunean Tenotomy.—The flexor metatarsi, one of the
muscles of the anterior tibial region, is composed of two por-
tions, one muscular, the other tendinous. The tendinous portion
is situated between the muscular portion and the anterior extensor
of the phalanges, and is attached above to the inferior extremity
of the femur, between the external condyle and the external
324 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
border of the trochlea of that bone, and passes in the groove
situated between the anterior and external tuberosity of the
superior extremity of the tibia, downward to the hock, where it
rests on the anterior face of that joint and is attached by two
branches, one to the cuboid, on the outside of the hock, the other
to the superior extremity of the principal metatarsal bone. The
muscular portion, which rests on the external face of the tibia,
from the upper part of which it takes its origin, terminates in-
feriorly by a tendon which passes through a ring of the tendinous
portion, and becomes more superficial, and then divides into two |
branches, a large one, which goes to the superior part of the
principal metatarsal bone, in uniting with that of the tendinous
portion, and another, smaller, which bends inward, to terminate
at the small cuneiform bone. This branch is chosen as the seat
of operation. i
The operation recommended by Abildgaard and Viborg, was
indicated by Hertwig, and at a later period performed by Lafosse,
Hering, Mantel, Grad, Bugniet and Dieckerhoff. It is very com-
monly performed on this continent, and,
like many other operations at the time
of their first introduction, has been both
used and probably abused to such an ex-
tent that it has not yet received the credit
to which it is fairly entitled.
It is indicated for the relief of the pres-
sure which this branch makes upon the
distended periosteum of the enlarged tar-
sal exostoses known as spavins, and when
lesion in the hock, it will prove essen-
tially beneficial. But if, with the new
erowth of bony deposits, the joint itself
Fig. 397.—Cunean Branch of the should be involved, and some of the ar-
oxo: Seas ticular diseases should be present, the
result, so far as the removal of pain and lameness is concerned,
is not always certain. Although more or less satisfactory at times,
in many instances it entirely fails. The difficulty of positively
diagnosing the condition of the articular surfaces justifies the
surgeon in operating, when the tense condition of the tendon, its
pressure upon the exostosis, and the irritation of the synovial sac
the exostosis is, strictly speaking, the only .
OPERATIONS UPON FIBROUS TISSUES. 825
which aids its movements, which it produces, point with certainty
to the cause of the lameness.
The instruments necessary are scissors, a straight and a con-
vex bistoury, a dissecting forceps, a curved director, and perhaps
a curved tenotomy knife.
The animal is cast on the side of the leg to be operated upon,
the upper leg carried forward and secured on the upper forearm,
and the hair clipped over the tract of the tendon, which can be
readily identified by an oblique groove generally found running
on the upper portion of the bony enlargement. An incision
about two and a half inches long is made with the convex bis-
toury, either parallel to the tendon, or slightly oblique, and right
FIG. 338.—Tarsal Tenotomy. Cunean Fig. 339.—Tarsal Tenotomy. The
Tendon Exposed. Tendon Raised.
across its direction. This incision is generally accompanied by a
somewhat troublesome capillary hemorrhage, which ought to be
controlled before proceeding further. The tendon may then be
felt through its bursa, which is raised with the dissecting forceps
and opened, when the tendon is readily exposed. The curved
director is then inserted under the tendon, which is easily raised
from its tract, and by guiding the tenotome along its groove the
section is made by a single stroke.
Some practitioners complete the operation by amputating a
portion of the tendon. This is unnecessary, and complicates the
operation by subjecting the parts to the necessity of a repairing
326 OPERATIONS ON MUSCLES AND THEIR ANNEXES.
process, which is not needed for the result of the operation, and
exposes the animal to a complication of inflammation of the
synovial bursze which ought to be avoided. To obviate these
dangers, Dieckerhoff is of the opinion that the division of the
bursa is all that is required, and states that he has often secured
good results, from that alone, without the section of the tendon.
Besides this mode of operating, which may be called the open
incision, there is another procedure by subcutaneous division,
which is also recommended by some, but the difficulty of discover-
ing the tendon in its bony groove, and in reaching it properly, and
the possible complication of subsequent inflammation of the bursee,
will probably secure the preference for the method by open incis-
ion. The operation is completed by closing the wound with a
stitch of suture, and protecting it with antiseptic dressings. The
results of the operation are sometimes immediate. though in some
cases not apparent for a few days, but if after the lapse of two or
three weeks the lameness has not either disappeared or greatly
abated, it may be safely concluded that it is attributable to some
cause other than the pressure of the tendon.
(6.) Peroneo-Phalangeal Tenotomy.—Though the true
pathology of the peculiar affection of the hock joint known as
springhalt, and the cause that excites the spasmodic action
characterizing it, are far from being satisfactorily known, it has
been observed that in animals thus affected the tendons of the ex-
tensors of the foot in front of the hock have a tense or rigid
character, which renders them unusually prominent; and it is this
symptom which suggested to Brocar, a Belgian veterinarian, the
division of the tendon of the lateral extensor of the phalanges, or
peroneo-phalangeal muscle, as a means of cure. Brocar, Brogniez,
and Delwart performed it, and have recorded their success in
numerous cases.
The lateral extensor of the phalanges terminates inferiorly by a
round tendon, which passes into the groove situated on the out-
side of the lower extremity of the tibia, in a sheath formed at the
expense of the superficial external ligament of the tibio-tarsal
joint. In this sheath it bends forward and downward to join the
tendon of the anterior extensor toward the middle of the metatar-
sus, which it crosses downward, forward and inward.
The operation is of the simplest nature, and may be performed
with great facility. The animal being cast, and the section com-
OPERATIONS UPON FIBROUS TISSUES. a ya
pleted through a small incision made over the tendon, a little be-
low the hock, and near its junction with the principal extensor,
about one inch of the tendon is removed. Sometimes the action of
springhalt ceases at once, when the animal is allowed to rise to his
feet. Other cases require a few days for the completion of the
cure. The simple operation has proved satisfactory in our hands
in two cases.
TrnotTomy IN Brrps.
The operation is performed in this instance with the object of
preventing the animals from flying, and consists in the section of
the tendons of the extensor muscles of the carpus and phalanges.
The bird is held by an assistant, with its wing extended, and a
few feathers are pulled out from each side of the carpal joint, as
well as in front of the radius, to expose the skin, through which
the extensor tendons, two in number, are readily seen. A small
incision being made through the skin, the tendon is raised with
forceps, and a portion of it amputated, the operation being re-
peated on the other side of the wing upon the extensor tendons
of the digits, between the radius and the cubitus. The treatment
is applied to both wings; it is without hemorrhage, and the
wounds heal in two or three days.
CHAPTER VIII.
OPERATIONS ON THE DIGESTIVE
APE ARATUS,
ON THE TEETH.
The office fulfilled by the dental system in the preliminary
preparation of the ingesta, and the first step im the process of di-
gestion, is necessarily one of the utmost importance. Of course,
therefore, any diseased conditions which may interfere with its
efficient action, especially with the herbivorous animals, become
matters of deep interest to the veterinary practitioner. All facts
and circumstances concur to establish and substantiate the claims
of that branch of veterinary science which refers to the care
of the teeth as a very important specialty, and we shall, there-
fore, so estimate and so elucidate the subject of veterinary dentis-
try, so successfully studied and so largely developed in recent
years by American veterinarians.
The diseases of the teeth to which our domestic animals are
subject may be due to various pathological conditions. The den-
tal arches formed by their arrangement in the jaw may be the
seat of congenital deformity; the teeth may possess abnormal
qualities in respect to their number, their shape and their direc-
tion; or, again, in the condition of their grinding surfaces, and
there may also be special diseases of the siesta ss ee substances
of the tooth itself.*
The abnormality which exists in relation to the number of the
teeth is of not uncommon occurrence in horses, in which animal we
* sometimes discover the presence of supplementary molars, resulting
either from the persistence of a temporary tooth which has failed
to be shed at the proper time, or may be due to an excess of de-
velopment in the evolution of a dental follicle, as we may observe
in the formation of the wolf tooth.
In relation to the shape of the dental arches, there are cases
* We take pleasure in recommending, in connection with this subject, the excellent
little work on Horses’ Teeth, written by Mr. William H. Clarke.
OPERATIONS ON THE TEETH. 329
where, instead of presenting the regular and correct natural lines,
the upper and lower molar arches so far disagree as to render
their perfect coaptation impossible, and render the execution of
their function to a great extent impracticable. The direction or
implantation of the teeth is, at times, so far irregular and abnor-
mal as to change the frictional surfaces in such a manner as to
remove the wear and abrasion from the crown to the surface of
the organ. In relation to the disposition of their rubbing sur-
faces, it is well known that on account of the difference existing
in the consistency and power of resistance, two of their elements,
the enamel and the dentine, their frictional surfaces become rough,
irregular and sharp; and, as they sometimes assume excessive
dimensions, they may give rise to serious phenomena, especially
when they have their seat in a part of the dental arch where no
resistance can be offered to their development, as when the cor-
responding tooth of the opposite jaws becomes diseased or absent.
The special diseases of the elementary constituents of the teeth
exist in the depth of their substance, and consist in caries or ul-
ceration of the tooth, the affection involving the dental pulp itself,
with other diseases pertaining to the alveolo-dental membrane, all
of them being accompanied by a series of well understood symp-
toms, severely distinctive in their character, and which in the ma-
jority of cases call for the assistance of the veterinary dentist in
order to relieve the suffering animal from the distress in which
his human master knows but too well how to sympathize.
The symptoms pertaining to the various conditions above al-
luded to may be either common, or general, or special. Among
the general symptoms, the first to be observed is a change in the
style of performing the function of mastication, proportional to
the sensitiveness occasioned by the dental lesion. Thus it is ob-
served that although the animal seizes his food with the same
avidity as if his teeth were in good order, the motion of his jaws,
the chewing of the food, are slowly and carefully performed, the
lateral movements of the lower jaw occurring in a hesitating man-
ner, and often made on one side of the mouth only. In eating
hay, the mouthful of the food is never triturated as it ought to
be, and before the process of mastication is completed the animal
drops it out of its mouth in the shape of a flattened bolus, satu-
rated with saliva, to seize it again and make a new attempt at
mastication, perhaps twisting his jaw in different directions in his
330 OPERATIONS ON THE DIGESTIVE APPARATUS.
endeayor to accomplish the act without pain. The attempt seems,
however, to be vain; again the mouth is opened and the same
flattened bolus is dropped in the manger, and this continues until
the poor animal, suffering and hungry, is seen standing before a
rack full of hay for which he both longs and fears to touch. The
suffering horse will sometimes swallow his oats imperfectly mas-
ticated, but the partial chewing is performed slowly and with dif-
ficulty, his manner indicating the pain it costs him; dipping his
nose in the manger, chewing on the grain for along time, and
impregnating it with saliva before he swallows it. Soft food, bran
and mashes, cooked roots, scalded grains, and the like, are the
only aliments that can, without difficulty with this imperfect de-
gree of mastication, enter into the pharynx.
Animals suffering with diseases of the dental apparatus are
often affected with colics. At first they may be slight and inter-
mittent, but they soon become more severe and more frequent.
They may last for several days, and may be marked by the pecu-
liarity that during their continuance defecation may still continue,
though irregular as to time, and the movements scanty in amount,
the feces besides being in small and adherent lumps, and more
or less coated. In other cases they are soft, and the animal has a
tendency to be washy, and more or less to scour, but in either
case the droppings are more or less loaded with unmasticated
food. All these symptoms are manifestations resulting from an
imperfect digestion.
It is easy to understand that if this condition continues for
any length of time the entire economy will suffer from it. The
animal looses flesh; his coat becomes dull, dry and staring; his
force and ardor diminish; he sweats easily, and all his other func-
tions exhibit evidences of the weak condition of an organism de-
prived of the nutrition and strength which follow the ingestion of
food thoroughly masticated and well digested.
Having recognized these symptoms, which, if not seen by the
surgeon, should be brought to his attention through the history
of the patient; when intelligently stated, the diagnosis may be
considered established. But it becomes positive only after an
examination of the mouth, by which the special symptoms per-
taining to each alteration are elicited.
The inspection of the mouth, which may be kept open by the
use of the various speculums, or by merely pulling the tongue
ee! Shis
OPERATIONS ON THE TEETH. 331
sidewise out of the way, will, in a great majority of cases, easily
lead to the detection of the cause which interferes with masti-
cation.
First of all, when the mouth is opened, a peculiar symptom
will be observed, consisting in a change in the salivary secretion.
This will be increased more or less, and as the saliva will escape
freely, a peculiar acid odor will be noticed proceeding from it, and
on looking for the cause of this trouble, if it be one or other of
the irregularities already mentioned, such as the projection of one
of the teeth, the vicious inclination of their crowns, the sharp
edges, etc., critical inspection will soon reveal them. The teeth
will be found to be soiled with greenish food-detritus on the side
where the difficulty exists, and on that same side the animal will
be found to have stored the surplus food which he has accumu-
lated between his teeth and the cheek.
If, however, in consequence of being situated so far back in
the mouth that the eye fails to detect the condition of the part,
he can complete his examination with his hands. With due prac-
tice in this mode of investigation, one may become sufficiently
expert in the manipulation of the mouth to dispense entirely with
the aid of the speculum; though of course there will be cases
when in order to establish a thorough diagnosis of the exact and
positive condition of the part, this instrument cannot be dispensed
with. There are also conditions where the examination cannot
be carried out in the standing position, even with the assistance
of means of restraint, and the animal must be thrown down, and
even, says Bouley, “ placed under the effects of ether. In this condi-
tion, the jaws are readily kept open and immobile, the tongue is free
from contraction, and the hands and fingers can be carried over
the entire length of the dental arches without the slighest danger
to the operator.”
Manual exploration removes all doubt about the diagnosis,
since the surgeon may, by skillfully practicing the taxis, recognize
all the irregularities present, whether the vicious direction of the
dental surfaces, the uneven wearing of the teeth, the cavities
which may exist in their thickness, or the condition of their im-
plantation with that of the alveolar cavity, ete.
When the mucous membrane has been excoriated by the sharp
projections of the teeth, when the gums are highly inflamed, and
the jawbones have been bruised, and are necrosed and suppurating ;
don OPERATIONS ON THE DIGESTIVE APPARATUS.
when the saliva which flows from the mouth is abundant, gluey
and foetid in odor; when the mouth is hot, the mucous membrane
injected, and in the regions where this diffused inflammation has
started, lesions are apparent corresponding to the cause that pro-
duced them, such as deep cuts on the internal face of the cheeks,
which have been torn by the asperities of the teeth; when there is
swelling and redness of the gum at the point where itis inflamed ;
when there is enlargement of the bone, with a grayish hue at the
point where it is exposed and in process of sloughing; or again if
these fistulas penetrating the spongy tissues of the maxillary bone
—all this becomes evident under the careful and accurate manip-
ulation of the instructed fingers.
Besides the exhibition of the general symptoms belonging to
all discases of the dental apparatus, caries of these organs is
characterized by some special characters belonging to them ex-
clusively. Principal among these is the peculiar foetor of the in-
terior of the mouth and of the saliva flowing from it, which is
sui generis. There is also the escape from the mouth of this
saliva in excessive quantity and inlong, slobbering masses. Then
there is the existence on one of the faces of the carious tooth, and
principally on the crown, of a blackish spot, or of a hole, or of a
large excavation, penetrating the substance of the tooth at a vary-
ing depth, according to the extent of the disease and the duration
of its existence—the violent pain experienced by the animal when
the percussion is applied on the tooth, or its cavity explored with
the instrument—the swollen condition of the gum surrounding the
diseased tooth; its red color; its want of adherence in some places,
and the hemorrhage with the oozing of pus when pressure is ap-
plied directly over those same places; the soiled appearance of
the dental surfaces on the side of the diseased tooth, caused by
particles of food remaining adherent to their anfractuosities, and
filling up the cavity of the carious tooth, or forcing themselves
between the tooth and the gum, and spreading, diffusing the most
repulsive odor—these all belong to a carious condition of one or
more of the teeth. But if in addition to this the caries is of long
standing, and has advanced towards the root of the tooth, the or-
dinary complications pertaining to its development in the maxil-
lary bone at the alveola take place, and that point becomes the
seat of an inflammatory swelling, manifested externally by a pain-
ful enlargement, hot and cedematous, which gradually increases,
OPERATIONS ON THE TEETH. 333
though at a given time it may remain stationary, hard and resist-
ing. Again, as the progress of the disease continues, the hyper-
trophied dental root, by its continued pressure outward, may
destroy the external surface of the bone, and form a communica-
tion between the bottom of the diseased alveola and the external
plate of the maxillary. In these cases pus, saliva and putrefied
food collect or filtrate into the subcutaneous cellular tissue, and an
abscess is formed which soon ulcerates and empties itself on the
surface of the cheek. Once open, this abscess has no tendency
to heal, but, on the contrary, maintains its fistulous form, and dis-
charges through its opening a mixture of pus, saliva and food,
having the very repulsive and characteristic odor already men-
tioned. Exploration of this fistula with the probe will give different
results according as the fistulous tract is straight or irregular.
In the first instance, the probe will penetrate directly into the
mouth, opening on one of the faces of the diseased tooth, or even
passing into the center of its carious crown; while in the other
case it is arrested by the spongy substance of the ulcerated max-
illary; or it may strike against the root of the diseased molar.
At this point, changes will have taken place in the mouth,
upon the surface of the teeth, on the side of the jaw where the
disease exists. These changes vary, and consist either in a great
obliquity of the tables of the teeth, the crowns or rubbing sur-
faces being beveled in very oblique and opposite directions, or in
the well marked elevation or projection of the molars correspond-
ing to the diseased grinders, in the healthy jaw; a projection
which is in proportion to the diminished size of the opposite
carious tooth which stands much lower. The first condition is
observed when the pain caused by the caries has entirely prevent-
ed mastication on the diseased side, and the second, when, not-
withstanding the caries, the performance of mastication has still
continued.
The condition then presented by the carious tooth may also
vary. In some cases it may still be complete in its alveolar con-
nection, though otherwise partly destroyed, and yet firmly ad-
herent by its root. In others it may be broken, entirely or in
fragments, merely parts of the outer surface being present;
while again, some broken fragments, more or less detached, may
remain in the alveolar cavities.
Caries of the first and second superior molars may become
334 OPERATIONS ON THE DIGESTIVE APPARATUS.
complicated with lesions of the nasal cavities, when the ulcerating
process has been followed by a perforation between one or other
of these cavities and the mouth. This lesion is accompanied by a
discharge taking place on the side of the nose corresponding to
that of the diseased tooth. This discharge is of a muco-purulent
character, and mixed with saliva and food, which gives it the
usual fcetid odor as well’as a peculiar green appearance. It is
very different from that belonging to glanders, and is too charac-
teristic to justify by its presence an error in diagnosis in that
direction. If, however, the same complications take place in the
molars, whose roots rest on the sinuses of the head, the symp-
toms which are manifested are often so nearly similar in aspect
to those of chronic glanders, that the commission of an error
should not be considered wholly inexcusable. Careful examina-
tion will readily bring out the differential diagnosis between the
two diseases, though so different in their ensemble. When the
caries of one of these last molars exists to such an extent as to
transform the mucous membrane of the sinuses into a sup-
purative surface, and to cause the development of granulations
upon its surface; or to allow the collection of pus in the cavity of
the sinuses, a discharge becomes established through the nostril
of the side of the diseased tooth and affected sinus. This dis-
charge is white, grumous, very abundant, and keeps increasing,
and has also anextremely foetid odor, identical with that of dental
caries.
The lymphatic glands of the maxillary space then become
swollen, hard, though painless, and loose under the fingers. The
plates of the zygomatic, of the superior maxillary and of the
nasal become swollen, and give a dull sound on percussion.
Sometimes their surfaces are so thinned out that it flexes under
the pressure of the fingers, and they are then surrounded by an
cedematous infiltration of subcutaneous cellular tissue.
The long and minute consideration which we have thus given to
the diseases of the dental apparatus has been principally devoted
to the molar teeth of herbivorous animals, although many of the
conditions observed in the grinders may also be found belonging
to the incisors. Indeed, incisor arches may also offer abnormali-
ties in the number of teeth, in their position, and in the direction
or the length of these organs, and they may also become the seat
of accidental lesions, such as fractures, luxations, or the too
OPERATIONS ON THE TEETH. 335
rapid wearing of various parts of their surfaces, though it seldom
reaches the point of caries.
The different indications which the majority of these patho-
logical conditions may impose resemble so nearly those required
under similar circumstances for the grinders, that it becomes un-
necessary to appropriate a special chapter to their discussion, and
we therefore proceed to the consideration of the general opera-
tions performed upon the teeth, according to the indications .
which may be from time to time presented.
OPERATIVE DenvTaL SurGERY.
Two principal indications present themselves under this head-
ing. First, the leveling of the frictional dental surfaces, for the
removal of any existing asperities or sharp projections, in order
to establish a perfect coaptation, as well as the free movement
necessary for the execution of their function of attrition. Second,
the extraction of the teeth which have undergone such important
alterations in their structure, that their conservation becomes in-
compatible with the regular execution of mastication, or because
of the serious complications they may involve.
Leveling of the Dental Arches.—The original mode of operat-
ing to level the molar teeth consisted in making the animal chew
on the blacksmith’s rasp. It is a simple process, easy to perform,
without danger to the animal, and so well answering the purpose
that even to-day the process is still in extensive use. But this
modus operandi is not without its inconveniences, among other
objectionable points, requiring to be repeated for several days
until perhaps the teeth have become smooth by rubbing against
the rough surface of the rasp—a result not always as satisfactory
as it might be. More appropriate instruments have therefore
been invented, though, in point of fact, none of them are other
than more or less modified rasps or files, as they are truly called.
Their number and variety are to-day very great, and their quali-
ties vary very much, according to the taste, the ideas, and often
the dexterity of those who use them. Samples of these files are
represented in Fig. 340, and according to their general construc-
tion may be classified as rough and fine rasps, flat and angular,
guarded, double and single on one or other of their edges. Some
are simple, and formed of a single piece, while others are jointed
and compound, and may be screwed or unscrewed with facility
336 OPERATIONS ON THE DIGESTIVE APPARATUS.
FIG. 340.—Samples of Tooth Rasps.
for use and transportation; some have the rasp fixed to a solid
handle, and again, the handle in others is moveable, and may be
changed as indications may present themselves. Their number
in this country is about incomputable, and while many which we
find registered in the patent office are of real value, many others
have no reason for being beyond their maker’s whim. As we
have said, the advantages which any of them may possess depend
more on special conditions than on the result to be obtained, in
the removal of the small, sharp edges of the external surface of
the tooth, or its lateral faces, resulting from an excessive develop-
ment in the enamel.
Whatever may be the file which the veterinary dentist may see
fit to use, the manipulations required in its handling will be in all
cases the same. In referring to this, the first question which
; offers is, whether the use of the speculum is necessary to enable
‘the surgeon to file a horse’s teeth? There is no doubt that in
)mnany instances it will be difficult, and even perhaps impossible,
| to compel the patient to keep his mouth sufficiently open to per-
; mit the use of the rasp with the necessary delicacy and freedom, or
prevent him from constantly biting it, or keeping his jaws closed
during the operation. In every instance, the play of the instru-
ment will be sure to be interfered with by the excited patient.
We believe that American practitioners were the first to dis-
pense with the speculum in these cases; and that to Mr. House,
a celebrated veterinary dentist, who died not many years ago, is
due, in fact, the paternity of this specialty in veterinary surgery.
Whether the mouth of the animal is held open with a specu-
OPERATIONS ON THE TEETH. 337
lum, and the tongue drawn out and held on one side by an assist-
ant, or whether the operator himself controls the tongue with one
hand while working the instrument with the other, the manipula-
tions must be the same, viz.: the passage to and fro of the file over
the surfaces requiring to be corrected, wherever they are rough
and sharp; filing them just as the smith files the iron he is shap-
ing as he holds it in the vise. We believe, however, that the
rasping out ought to be done slowly, softly and without giving the
animal any cause for fright or excitement. The method sometimes
practiced of using the rasp with a succession of rapid movements
over the dental arches is certainly dangerous and liable to be ac-
companied with accident to the patient. An irritable, struggling
animal, by violent movements of the head, or in his attempts to
chew on the rasp, may easily receive injuries from the rough con-
tact of the instrument with the delicate structures of the mouth.
After such a passage of the rasp a number of times over the teeth,
the hand introduced in the mouth will at once detect the effect
upon the patient.
Although the use of the speculum may be advantageous in
many instances, there is certainly a risk attending its use, in the
possibility of bruises and lacerations which may occur at the bars
when the animal, annoyed by its application, chews upon it in his
endeavors to close his mouth.
The work of ji/ing when the teeth are sharp is of common in-
dication, and finds its direct application under the special condi-
tion that the edges or asperities which are treated should not be
too large or too prominent. If this should be the case, and the
inefficiency of the file or rasp, however, become evident in the trial,
other means remain for accomplishing the desired purpose. Such
a contingency was not lost sight of in former years, and chisels
and gouges were then employed to reduce the excessively devel-
oped projections of enamel.
With these instruments the patient was either thrown or treat-
ed on his feet, his mouth being opened with a speculum, with his
tongue drawn out and held on one side. The chisel was then laid
against the dental projection, and an assistant striking it with a
hammer, the excess of tooth was knocked off. Bouley considered
this mode of operation dangerous. “The chisel might, under the
impulse received by the hammer, slide in the mouth and severely
injure the tongue, the cheeks, and the soft or the hard palate; or
338 OPERATIONS ON THE DIGESTIVE APPARATUS.
in animals advanced in age, the tooth might be fractured or dis-
located; or again, the operator himself might be injured by the
instrument, when, suddenly displaced by a movement of the ani-
mal, the assistant knocks against it.”
It was to remedy this objection that Brogniez invented his
odontritor (Fig. 341), an instrument which carries on one end a
blade sharpened on both edges, and on the other is hollowed out,
in order to allow the play of a rod through one-half of the length
of the instrument. This rod is provided with a transversal handle,
which also acts as a hammer, by which the blow is carried against
the sharp edges of the tooth.
When the odontritor is used, it is not necessary to use a spec-
ulum to open the mouth, the holding of the tongue out of the
mouth being sufficient. The operator, holding the instrument
with the left hand, places the anterior sharp edge against the pro-
jecting portion of the tooth, and holding the rod by the handle
full in his right hand, moves it to and fro, striking at the proper
points as he moves it. This operation is repeated on both jaws
until all the sharper edges of the teeth have been cut off, and is
completed by passing the rasp over the dental plates, as is done
when the teeth are not too sharp.
Several modifications have been made in the conformation of
the odontritor, but that of Prangé is probably the best (Fig. 342)
It consists in having three blades, which may be changed at will
and which vary in the form and disposition of their cutting edges.
This instrument is considered superior to that of Brogniez, and
is thought to work to better advantage when the elevation of the
tooth is well marked.
The odontritor answers perfectly for leveling the molars when
the projections are not excessively developed, or do not offer too
ereat resistance to the action of the blade. But when an entire
tooth projects above the general level, the odontritor ceases to be
of any advantage, and it becomes necessary to perform the resec-
tion of the tooth, consisting in the removal of all that portion of
it which rises above the level of the general dental surface.
To Brogniez is due again the first instrument invented for the
performance of this operation in the chisel odontritor (Fig. 343).
This is composed of two rods, one of them having at one end, like
the ordinary odontritor, a frame of sufficient dimensions to allow
the entire molar to pass through it, and on the anterior border of
339
OPERATIONS ON THE TEETH.
eR AAU e}
Fig, 341.—Brogniez’s Odontritor.
Fig. 342.—Prangé’s Odontritor.
OPERATIONS ON THE DIGESTIVE APPARATUS.
| this frame a solid’ blade with a sharp con-
cave edge turned backward. The other
extremity of this rod carries a transverse
prolongation, which serves to change the
position of the blade when necessary, and
which has on its shorter portion a hole
through which the other rod is allowed
to slide. This second rod has on one end
a sharp blade which slides into suitable
grooves made in the frame of the first,
and is curved forward on its front edge.
On the other extremity it carries a metal-
lic mass which is used as a hammer.
In using this instrument, the tooth
being enclosed in the frame between the
two blades, the movable rod, with its sharp
edge, is pushed against the blade of the
frame, and a strong blow of the hammer
|| cuts off the tooth smoothly and evenly.
The chisel invented by Gowing (Fig.
344), works somewhat on the same princi-
ple as that of Brogniez.
Resection of the teeth has also been per-
| formed with the instruments used for the
same operation on bones. Saws of various
| form and design are also recommended, |
the chain saw, which we have often used,
being one of these. But there are serious fs ee
objections to this latter instrument, among :
which is its liability to become heated while in use,
when it becomes unable to “bite” upon the hard
i| |i) dental substance, and may, moreover, break or slide.
ai | The only method of overcoming these
ai objections, which, in fact, may occur
in using any kind of saw, is by hold-
ing a wet sponge against the tooth to:
which the instrument is applied—a
precaution which is not always of easy
adoption, and which can scarcely be
4 effected without more or less danger
hs) of wounding the hand which holds
Fig. 343.—Brogniez’s Tooth Chisel.
NAMEN a
OPERATIONS ON THE TEETH. 341
Fia. 345.
TT
TU
SAAS
SS
House’s Molar
Cutter.
Liautard’s
Cutter. Scheffler’s Extractor and Molar Cutter.
342 OPERATIONS ON THE DIGESTIVE APPARATUS.
Fic. 345a.—Hamlin’s Molar Cutter.
the sponge. But when none of these modes of operation can be
readily applied, the use of the tooth-chisel becomes the order.
Its application is simple, and with a well-made instrument in the
hands of an expert operator, quick and strong, the resection can
be readily performed.
The array of tooth-chisels or resectors is beyond compute in
variety and number, and especially in this country where the in-
stinct of mechanical invention is so universal, and the specialty of
‘veterinary dentistry is so extensively practiced, and many different
kinds can be inspected among the samples of workmanship which
decorate the show-cases of our instrument makers. Among the
principal forms, we may, however, mention those which recall the
names of Lafosse, Moller, Scheffers, Gowing in Europe, and of
Clarke, House, Liautard and Hamlin in this country (Figs. 345,
3452). Some of these instruments have their jaws closed, others
have them open. Some work by a peculiar thread-screw arrange-
ment, others by the manual power of the operators; and again,
the blades of some are straight and others curved, and still others
are sharp like a concave saw. In their application they all work
upon about the same principle, and are used in the same man-
ner. The mouth being opened, the tooth is seized between the
jaws of the forceps, and by the pressure of the screw with
which some of them are armed, or by the unaided strength of the
operator, the tooth is squeezed and cut off with a sudden snap,
followed by the dropping out of the mouth of the amputated
portion. As a rule, the surface left on the tooth shows but a
sli¢ht roughness, which can be smoothed off with the rasp.
OPERATIONS ON THE TEETH. 343
Extraction oF TEErTu.
The extraction or removal of teeth is indicated for the reduc-
tion of any excess in their number, which may interfere with mas-
tication ; or when these organs are abnormal in form or direction,
and obstruct the growth or usurp the place of a permanent tooth ;
or when they are diseased with caries, or affected with any of the
pathological conditions which we have before considered ; or when
they become the cause of a dental fistula.
To extract the incisors of any of our domestic animals, the
molars of dogs, or the caduc molars of large herbivorous animals,
some of the various forms of tooth forceps that are used in human
Fig. 346.—Samples of Tooth Forceps.
dentistry or the different shapes of the key of Garangeot or special
larger forceps, such as that of Lecellier (Fig. 348) or the enlarged
Garangeot’s key, as modified by Delamarre (Fig. 349), will be
necessary. The modus operandi is generally simple; the tooth,
still firmly attached to its alveola, or perhaps loose and more or
344 OPERATIONS ON THE DIGESTIVE APPARATUS.
Fic. 347.—Garangeot’s Keys.
less pushed out of its place by a succeeding growth, is seized be-
tween the jaws of the forceps, or of the Garangeot’s keys, and is
easily wrenched from its position by a strong pull or with a slight
twisting motion sufficient to lacerate its last adhesions.
The extraction of the permanent molars of a horse is a diffi-
cult and, under some circumstances, a serious operation. Their
mode of implantation and insertion in the alveolar cavities; the
great length of their roots as compared to the small dimensions
of their free portion; the narrow connections which exist be-
tween them, and withal, the solidity of the dental arch—all these
conditions are sufficient to explain the serious character of the
prognosis of this operation, and the difficulties which are often
encountered when the organ to be removed is the molar tooth of
a horse. These difficulties, however, vary considerably under pe-
culiar conditions, such, according to Peuch & Toussaint, as “the
age of the subject, the position of the tooth on one or the other
jaw, and the degree of alteration of the tooth to extract.”
For example, the operation is more difficult in young animals
than in adult, or older subjects, the latter requiring less effort,
the root of the tooth being shorter and the adhesion to the alveola
less solid. The upper are less firmly attached than the lower
OPERATIONS ON THE TEETH. 345
Hp
i
SSS SSS ss] ==
———
SSS SE
——* es:
Fiad. 348.—Lecellier’s Tooth Forceps Fia. 349.—Garangeot’s Ke
for Molar. fied by Delamarre.
molars, the presence of the cavities of the sinuses, and the
diminished thickness of the walls of their alveola rendering their
346 OPERATIONS ON THE DIGESTIVE APPARATUS.
insertion and implantation less tenacious than in the lower. The
extraction of the front is less difficult than that of the posterior
molars. “aie ae as when the teeth are partly destroyed by
; caries, a single effort will be suffi-
cient to extract them; but in other
cases, as when the seeds is dis-
eased, and the roots adhere more
intimately to the alveola, the extrac-
tion becomes very difficult. And
again, if the tooth having a hyper-
trophied root, resists the action of
the instruments through the op-
position of those immediately sur-
rounding it, which, though healthy,
are less firmly fixed in their alveola,
which are mechanically dilated by
the outward pressure made upon
the plates of the maxillary bone, is
easy to loosen and dislocate them;
and this is a circumstance’ which
must not be overlooked during the
manipulation required for the ex-
traction, in order to avoid serious
disturbances of the dental appa-
ratus.
Tn the extraction of a molar, the
patient must be thrown, and the
head well elevated, the mouth being
kept well open by means of a per-
fectly safe speculum, such as that of
Lecellier (Fig. 350), but we think
it rather clumsy to handle. Bouley
recommends the etherization of the
patient. The mouth is to be thor-
oughly cleansed. There are circum-
stances, however, in which the op-
eration of casting is unnecessary,
and, in fact, our own personal ex-
perience has raised doubts in our
mind as to the necessity at any
\)
N
N
nN
N
1 N
N
N
Fic. 350.—Speculum of Lecellier.
OPERATIONS ON
FIG. 351.—Plasse Molar Extractor (full view).
THE TEETH.
347
FIG. 352.—The same (side view).
348 OPERATIONS ON THE DIGESTIVE APPARATUS.
time of exposing the animal to the possible accidents which may
attend this mode of restraint. We hold strongly to the expedi-
ency of performing the operation in the standing position. There
will necessarily be cases in which to attempt to remove a tooth
with the animal standing would be simple folly and time lost, but
with many operators in this country, we have in several instances
succeeded in extracting a condemned molar without any other
means of restraint than a twitch on the patient’s lower lip or on
his ear. The removal of molars is effected in two ways—by pul-
ling, or by repulsion or gouging out.
The method by extraction or evulsion, is preferable whenever
it is practicable, having the advantage of causing less injury to
the surrounding structures, and is objectionable, principally for
the posterior teeth, which always oppose great difficulties to the
operation. The oldest instrument used in this operation is the
enlarged key of Garangeot, as modified by Delamarre. Its appli-
cation has always seemed to us difficult, if not dangerous, and we
think that it involves more or less risk of fracture of the plates of
the maxillary bone, on which account we prefer the large tooth
forceps, which may be found under many forms and designs, The
forceps of Plasse (Fig. 351), of Wendenburg (Fig. 353), of Pill-
wax (Fig. 354), of Gowing (Fig. 355), of the same inventor, as
modified by Bouley (Fig. 356), those of Gunther (Fig. 358), the
key-forceps of Bouley (Fig. 357), those of House, of Walters, and
many others will furnish the operator a large collection from which
to select. Many of these instruments are very complicated (as that
of Scheffer); some are clumsy and difficult to handle; have levers,
like those of Wendenburg and Pillwax; many work by merely
grasping the tooth and holding it by a peculiar arrangement of
spring, or of thread-screw, and thus to the end of the chapter.
We have for many years given the preference to the simple
forceps of Gowing, leaving off the little rod which is connected
with the cross-piece which carries the thread, and which is to be
screwed on the handles of the instrument to hold them firmly to-
gether. What we think most essential in the instrument is that
its arms should be firm and so solid as not to bend or yield when
the screw is applied on them, and that the jaws of the forceps
should not be too narrow nor too curved, and above all, that the
instrument should not be made unnecessarily heavy, a fault which
we have too often observed in some of the continental patterns.
OPERATIONS ON THE TEETH. 349
FIG 353.—Wendenburg Fic. 354.—Pillwax’s FIG. 355.—Gowing’s
Forceps. Forceps. Forceps.
Besides the forceps which we have named there are many
others, but whatever may be their plan or shape, the manner of
using them includes nearly the same manipulations for all. These,
in their various steps, are done about as follows: the animal be-
ing properly secured, with his mouth open, and his tongue drawn
350 OPERATIONS ON THR DIGESTIVE APPARATUS.
FIG. 356.—Gowing’s Forceps, Modified by Bouley.
out on one side, an assistant inserts the forceps into the mouth,
adjusting it to the tooth to be extracted, and notifies the op-
erator of the moment when he can close the jaws of the instru-
ment together, which is done in various ways according to the
kind of instrument in use. When the tooth is properly seized
and firmly held by the forceps, the operator, using all his force,
carefully and slowly oscillates the instrument from left to right,
and from right to left, in order to produce the gradual dislocation
of the organ, and when it is loosened from its attachments it is
drawn vertically out of its cavity by a final movement of evulsion.
There are instruments possessing a lever attachment close to the
OPERATIONS ON THE TEETH. 351
Soe
>
SS
LOD
Y
\
Ny
\
V
\
4
4
Fig. 357.—Bouley’s Tooth Keys.
jaws by which the extraction of the tooth is considerably facilitat-
ed. If the animal has not been put under general anesthesia the
dislocation of the tooth is very painful, and often accompanied by
ANA mE
352 OPERATIONS ON THE DIGESTIVE APPARATUS.
Fia. 358.—Gunther’s Forceps.
violent struggles, at the critical moment; and if the tooth is not
very strongly held by the forceps, it is possible that it may slip
out of the jaws of the instrument and drop into the mouth. To
avoid the possibility of its passing into the pharynx, we think it
would be but a prudential measure to have an assistant keep his
hand in the animal’s mouth ready to secure the tooth, if necessary,
before it passes beyond the soft palate.
OPERATIONS ON THE TEETH. 353
The second mode of extracting molars, or that by repulsion or
gouging, is the only one possible under all the circumstances,
when the prehension of a carious or diseased tooth cannot be
effected by the instrument used in the first method, as, for in-
stance, in cases of disease of the posterior molars when the carious
tooth is so far diseased or destroyed that not enough of its sub-
stance remains above the root to be reached by the forceps; or
again, when the exostosis of the root has reached such dimensions
that it will not allow its exit from the alveolar cavity, whatsoever
efforts may be made to overcome its resistance.
This operation was first recommended by H. d’Arboval, and
although it has been condemmed by some practitioners, is certainly
indicated for all operations upon the molars. All the superior
molars, together with the three anterior inferiors, are readily
reached by their roots, in trephining the external plate of the
bones in which they are implanted. The posterior inferiors are
the only ones that present any serious objections, and the trouble
is truly a tangible one, being nothing less than the necessity of
passing through the entire thickness of the masseter muscle.
The tooth demanding removal being surely identified, and the
impossibility of removing it by the mouth well established, the
animal is thrown on the side opposite to that which is occupied
by the diseased organ, and placed under complete anesthesia.
The location of the alveolar walls, upon which the operation is to
be made in order to reach the root of the tooth, must be first well
determined. If it is one of the last three upper molars, it will corres-
pond to the sinuses. But the operator must not allow himself to
be deceived by the presence of a fistulous opening, which, by ap-
pearing on the surface of the skin to indicate the point of attack,
may in fact mislead him by conducting him to a point consider-
ably remote from the diseased tooth. A positive and satisfactory
diagnosis being settled, and the hair being clipped, a large V or
cross-shaped incision is made over the spot selected for the tre-
phine, and carefully avoiding the infliction of any injury to the
muscles of the region, the sinuses are opened by removing two
or three circular portions, at a tangent to each other, to effect the
removal of a fair-sized piece of the bone. The edges or prolonga-
tions which remain are levelled off with the bone forceps, which
is certainly preferable to any other means; or if the opening made
in the bone is too small, it can also be enlarged by using the same
354 OPERATIONS ON THE DIGESTIVE APPARATUS.
bone forceps, by nipping off fragments from the edges and making
entrance into the sinuses of the proper dimensions. The wound
and the sinuses are then thoroughly cleaned out, and the blood
and the pultaceous purulent collection found in their bottom
thoroughly removed. This exposes the root of the tooth, in the
form of a hard, dry, greyish mass, analagous to a piece of necrosed
bone. The operator, then holding the blunt gouge, or repoussoir
in his left hand, applies it through the sinuses against the middle
of the dental root, and with a strong mallet held in his right,
strikes upon it with firm and steady blows. The mouth of the
animal being held open by the speculum, an assistant with his
hand upon the crown of the tooth studies the effect of each blow,
and notes as it yieldsto the percussion, and moves and loosens until
it becomes detached, and falls, liberated into his hand, secured
by his continuous grasp from any possible danger of being swal-
lowed. Asarule the tooth is pushed out of its cavity by the first
blows, either entire or in as many portions as it may have been
divided into by the carious process. But at times it becomes
necessary to repeat the percussion and to use considerable force
to compel it to leave the jaw.
The modus operandi is about the same for any of the molars,
though for the lower teeth greater force in the blows of the mal-
let is generally required, in consequence of the greater thickness
of the walls of the alveolar cavities in the lower maxillary bone.
If it is one of the posterior lower molars which is the subject of
the operation, the masseter muscle must be cut through, but the
general manipulations are otherwise the same, care being required,
however, to avoid injury to the glosso-facial artery, or the duct of
Steno.
Though apparently a severe operation, this is not a dangerous
one, the wounds which it involves healing rapidly, and the great
advantages which are realized by it, among which may be included
the cleansing of the sinuses, and the removal of their suppurative
collection, which could not be otherwise secured, amply compen-
sating for the severity of the process.
After the operation the wound is, of course, to be thoroughly
cleansed, fragments of bone to be remoyed, and acidulated gargles
used to wash the mouth and the cavity of the alveola of its blood.
The cicatrization of the external wound generally gives no
trouble to the surgeon, and requires no particular methods be-
OPERATIONS ON THE TEETH. 355
yond those of ordinary cleanliness and proper attention to the
granulating process. It is the cicatrization of the internal wound
which requires attention, and in some cases a great deal of it.
This isin order to guard against the collecting and the packing of
the food in the cavity of the alveola, and thus interfering with its
closing up by proper granulations. The diet of animals thus
operated on must, of course, consist almost entirely of liquid food,
as mashes of bran or of oatmeal; hay teas, flour water, milk, etc.,
or of cooked roots, scalded grains and the like. According to
some authors, fibrinous food is dangerous only during the early
days immediately following the operation, but our experience has
taught us that neither solid nor semi-solid food is to be allowed
to an animal which has lost a molar tooth, for a period of from
three to’ four weeks, and during that time the alveolar cavity ought
to be thoroughly cleansed out after every meal, until all possibility
of danger has subsided.
The vacuum left in the dental arch after the removal of a tooth
is never entirely filled up, but it gradually diminishes, in conse-
quence of the oblique direction which the teeth in front and behind
are disposed to assume, and which, though it brings them closer
to each other, never brings them into actual contact. It may hap-
pen that by reason of this vacant space the tooth on the opposite
side of the jaw may acquire a tendency to grow to excess, and from
want of wear, ultimately project above the level of the other teeth.
In reference to this it will be but prudent to watch the condition
of that particular tooth, and to be prepared to reduce it to its
proper level, if that should become necessary.
In reference to accidents that may occur during operations
upon the teeth, we have already mentioned the possibility of deg-
lutition of the tooth as it is drawn from its socket. In some cases
reported by Renault and Bouley fatal results have followed, caused
by violent colics thus induced. Strong cathartics have been rec-
ommended in these cases for the removal of the foreign body, but
the precaution which we have already mentioned will effectually
prevent the possibility of this accident. Bruises and excoriations
of the bars, with the speculum, and hemorrhage, are accidents
which also sometimes accompany these operations of extraction.
The first is not usually a matter of any importance, unless necro-
sis of the jaw should follow; and as for the hemorrhage, unless it
results from direct injury to the palatine artery, it is easily con-
356 OPERATIONS ON THE DIGESTIVE APPARATUS.
trolled by pressure and packing with oakum or compressed
sponges. Fractures of the alveola, or of the lower maxillary
bone, are of a more serious character than any of the preceding
injuries, the last, mentioned in a case recorded by Koerter, having
necessitated the destruction of the animal.
Firnine TEeeru.
This operation has not, we believe, as yet entered into the
general practice of veterinary surgery, and, with the exception of a
few veterinarians on this continent who have attempted it, we think
that in the presence of the many difficulties which exist in realiz-
ing a perfect result, similar to those obtained with the thorough
work of human dentistry, it will be some time before this branch
of veterinary dentistry can be practiced with any great prospect of
good and permanent results. Our experience in filing the teeth
of our domestic animals is very limited, and on that account we
will refrain from saying more about it, referrmg our readers to
the work of Dr. Hinebauch on “Veterinary Dental Surgery,”
where the subject is treated rather extensively.
CantnE DENTISTRY.
Operations on the teeth of the dog are sometimes indicated
under some peculiar and abnormal conditions, such as irregu-
larity in number or in direction, or in cases of traumatism, such
as fractures or dislocations. Their extraction is performed with
tooth forceps, as we have already had occasion to remark. Their
resection has been recommended by a French veterinarian, Mr.
Bourrel, as.a means of preventing rabid inoculation (Fig. 359).
The operation is a very simple one, and consists in smoothing
over the sharp points of the teeth with a file, though sometimes
sharp nippers are used in preference.
But an operation which is of daily necessity is that of clean-
ing the teeth by removal of the accumulation of cement or tartar,
which gathers on the external surface of the tooth, at its insertion
in the alveolar cavity, where it forms a thick crust, of greenish
gray color, composed of microscopic fungi. In neglected cases,
the gums become irritated and ulcerated, and the tooth, partially
denuded of its gum, exposes not only its free portion, but por-
tions of the root also, sometimes even becoming loose and drop-
ping out of the jaw. There is in these cases a free and abundant
OPERATIONS ON THE TEETH. 357
\\\
iar
FIG. 359.—Bourrel’s Mode of Filing Dog’s Teeth.
flow of saliva, of a characteristic and putrid smell; mastication
becomes impossible, and the animal becomes a regular martyr to
the lack of attention of his dental apparatus. The formation of
these concretions can be prevented in animals in the same way and
with the same care that is exercised in respect to the human when
teeth-washing, brushing, etc., with some of the properly com-
pounded tooth powders, will remove a slight coat of the offensive
deposit, but if the accumulation is quite large, it must be scraped
off with proper instruments (Fig. 360), carefully avoiding, if prac-
ticable, any injury to the gums, or the loosening of the teeth.
a
Fic. 360.—Tooth Scrapers.
358 OPERATIONS ON THE DIGESTIVE APPARATUS.
If several teeth are loose, and their loss is threatened, the bet-
ter course in regard to their extraction will be to remove them
singly, and not all at the same time, lest a serious hemorrhage
might supervene, which might eyen endanger the animal's life.
OPERATIONS ON THE TONGUE.
The pathological lesions to which this member of the digestive
apparatus is subject, and which may require surgical interference,
are principally wounds and tumors, the former demanding either
sutures or amputations of the organ, partial or complete. The
latter, however, present a greater variety of indications, according
to the nature of the neoplasm with which the organ may be af-
fected. Wounds of the tongue are quite frequent, but the most
common are probably those of the lacerated kind, though again,
they may be theresult of contusion, incision, or may even be caused
by burns.
Produced generally by self-inflicted bites, caused by falling,
or during epileptic seizures, they are usually made by the incisors.
A badly made bit, or a halter or rope tightly binding the mouth
and pressing down the tongue, may also produce a bruise, or even
a complete laceration of the organ. They are also not uncom-
monly seen as the result of bites inflicted by one animal upon an-
other, placed in an adjoining stall, when the separation between
them has been insufficient. In these cases, not only a portion of
~ the tongue, but often also the freenum may be more or less lacer-
ated—a condition which may also take place when the tongue
has been pulled out by an assistant, a groom or other person, and
the horse rebelling, pulls back violently and suddenly. Against
such opposite forces the soft structure of the frenum readily
gives away. The burnt wound, or scalding of the tongue, may
arise from the administration of a drench not sufficiently cooled, or
of too irritating a nature. The common way of steaming horses
with bran heated with boiling water, is also an occasional cause.
Injuries such as these are generally easily detected, present-
ing, as they do, a series of symptoms which may properly be
called general. Difficulty in eating, and a more or less abun-
dant flow of stringy saliva, which also may be mixed with blood,
is apt to be. among the signs. In relation to the special char-
acters, noticeably, there may be in one case a protrusion of the
OPERATIONS ON THE TONGUE. 359
tongue out of the mouth, with perhaps a drawing of the organ to
one side, or it may be pressed between the incisors and hanging
more or less outside of the buccal cavity. In opening this
cavity, the tongue may then be seen to be lacerated at its free
portion, the laceration being transversal or longitudinal, complete
or incomplete, and varying in dimensions, from a small portion of
the organ nipped from the main body, to nearly the entire portion
in front of the frenum. If the anterior portion is missing, the
freenum may be seen in its normal condition, or again may be exten-
sively torn, in which case the tongue is commonly hanging out of
the mouth. If the laceration is complete, the part in front of the
cut may have dropped outside and fallen into the bedding of the
animal, or of the one next to him, both stalls being more or less
spattered with blood from the hemorrhage which has accom-
panied the injury.
In cases of burns, the tongue presents all the symptoms of
glossitis, it is swollen, its epithelium readily peels off, the saliva-
tion is abundant, and the mouth heated and sore.
Considered from one point of view, the prognosis of lacerated
wounds of the tongue is not serious, there being but few forms of
that injury which are not more or less amenable to treatment. The
nature of the prognosis varies, of course, with the extent of the
wound, the depth of the tissue which it involves, and the amount
of substance already lost or requiring remoyal. A complete
section is always a serious matter, especially in herbivorous
animals, by which the tongue is so largely employed, and so ef-
ficient, as an instrument for the prehension of food, as well as for
aiding in its mastication, by keeping it in contact with the grind-
ers during the process of chewing.
In carnivorous animals, as in dogs, we have seen the complete
sloughing of the free portion attended with such difficulty in eat-
ing, that the destruction of the patient became necessary in
order to avert his death by starvation.
In almost all conditions of laceration of the free portion of the
tongue, there is an indication of an attempt to effect the union of
the divided parts, and our experience has led us to the conclusion
that no one is justified in refusing to treat a wound of the tongue
or abandoning such a case without at least an effort to save it,
even, as in some cases, where the divided parts are held together
by the smallest portion of substance.
360 OPERATIONS ON THE DIGESTIVE APPARATUS.
SUTURE.
It is only by suture that the attempt can be successfully
made. Peuch, Toussaint and Zundel advise the throwing of the
horse, but we prefer the standing position for the operation.
The instruments necessary are strong needles for metallic sutures,
and soft, pliable lead wire. We prefer this kind of suture as being
less liable to cut through the muscular structure of the organ
and haying less tendency to give way. Having carefully washed
the surfaces of the lingual wound, we apply an interrupted
suture, varying the number of stitches, according to the extent of
the laceration, and prefer the interrupted to the continued suture
for the reason that if one stitch fails to hold, it can be easily re-
placed by another. The important point is to secure a thorough
hold for each stitch, or in other words, to involve a good portion
of the tongue in the stitch on each edge of the wound.
Wounds of the freenum need no special treatment, but there is
an indication which by its application greatly facilitates, though
indirectly, the cicatrizing process of
q sll, i all the two parts. It consists in placing
All! iil | YA the tongue in a muslin suspensory,
ct ‘5
Nil |
[i
ORR el having the shape of the free portion
SOCONE Az of the tongue, and sewed together
ARN eer on a part of their circumference, leay-
ing an opening for the organ to enter.
This suspensory is kept in place by
two strings attached to the halter on
each side of the cheeks. The use of
this easily made appliance has given
us great satisfaction, not only in keeping the tongue in the mouth,
but also in limiting the movements of the organ, and preventing
the giving way of stitches. The suspensory is to be taken off
two or three times a day, and washed, or changed for another,
but must be kept in place as long as this condition of the patient
requires it. The mouth is to be kept clean by antiseptic astrin-
gents and cooling gargles, by means of a syringe or an irrigator.
The use of peroxide of hydrogen has given us excellent results in
these cases. Nocard recommends the application of a muzzle
upon the patient’s nose, to prevent the prehension of fibrous
food, keeping the mouth closed, and restricting the movements of
OPERATIONS ON THE TONGUE. 361
the jaws. During the treatment the animal is to be fed with
liquid or semi-liquid food, as mashes and gruels of all kinds, with
teas, milk, etc. It is only when the stitches are all united
that the animal can be brought by degrees to its ordinary diet.
After several days the sutures can be removed.
AMPUTATION, OR GLossoToMy.
When the sutures have failed, or when the peduncle which
holds the divided portions of the tongue together is too small to
permit the processes of circulation and nutrition to go on, the in-
dications are to amputate the part of the tongue below it. This
is done with the scissors; the hemorrhage that may follow is sel-
dom serious, and soon ceases spontaneously, or yields to the use
of hemostatics. Sometimes, instead of direct amputation, or in
order to avoid the hemorrhage, the removal of the divided portion
is effected with an elastic ligature—a mode of treatment also com-
monly used for the removal of lingual tumors. The ecraseur has
also been recommended, on account of the absence of hemorrhage
attending its use. The animal whose tongue has been amputated
eats slowly and with difficulty. His prehension of liquids is also
necessarily interfered with. It requires time and practice for
him to acquire facility in performing the old functions with
curtailed means.
ADENOTOMY.
This operation consists in the dissection and removal of such
of the glands as are accessible and amenable to that method of
treatment, including the lymphatic and salivary, and is described
as parotidian or maxillary, as one gland or the other becomes the
subject of operation. The extirpation of these organs is indica-
ted by pathological changes occurring in their structure, as in
cases of chronic infiltration following. a suppurative process, as
seen in the lymphatic glands of the inter-maxillary space after
strangles, and again when they become the seat of scirrous de-
generation, or of melanotic deposits, or in cases of salivary fistula
complicated with loss of substance of the excretory ducts.
Parotidian adenotomy is a very delicate operation, and has,
therefore, been but seldom attempted. To Leblanc, in 1822, is
due the record of its first performance, and of the advantages
attending it. A reference to Figures 396 and 397, which show
362 OPERATIONS ON THE DIGESTIVE APPARATUS.
both the superficial and the deep anatomical structures of that
region, will at once suggest the difficulties to be encountered in
the numerous and important blood vessels, which must be either
avoided or ligatured, and the important nerves which must be
saved According to Brogniez, the operation is fully justified by
its results, and possesses an undeniable claim to admission into
the domain of authorized veterinary surgery. After Leblanc, it
was performed by Brogniez, Vanhaelst, Delwart, Barlow and Per-
civall. ;
The Zraité de Chirurgie Vétérinaire furnishes the following
description of the manual execution of parotid adenotomy: “ The
animal, being well prepared, is thrown, with the parotid region
of the side on which he lies resting on a small bundle of straw, in
order to render the gland, which is to be operated upon, more
prominent, and the hair being clipped, a long incision is made in
the direction of the organ, viz., from the anterior part of the base
of the ear down to below the glosso-facial branch of the jugular vein.
This first incision, it may be remarked, must be’*made more to the
anterior border of the gland, which is strongly adherent to the
maxillary bone, as well as to the blood vessels and nerves passing
that point, and, if necessary, a second incision can be made be-
hind the first and perpendicular to its lower extremity. The skin
being dissected from the whole extent of the gland, the beginning
of the separation of the organ is made near the facial nerve, from
thence gradually working downward. The lower extremity of the
gland is isolated, and after it the posterior border, to terminate
by the superior extremity, which surrounds the concha—in other
words, without reference to the muscular layer that covers it, or
to some little glandular masses which are isolated from the prin-
cipal mass, nor even to its central portion situated under the fa-
cial branch of the jugular vein; the gland being thus separated
is removed in its whole circumference. After ligating the blood
vessels which may have been opened, the wound is dressed and
closed with quill sutures. Suppuration is soon established, the
eranulations rapidly develop themselves, and the cicatrization is
soon accomplished.”
The most serious complication usually met with is the section
of the facial and sub-zygomatic nerves, which is followed by par-
alysis of the face and lips on that side. Director Degives divides
the operation into three steps. Zhe first includes the tneision
OPERATIONS ON THE TONGUE. 363
and dissection of the skin. The incision is made lengthwise, from
the base of the ear down to the middle of the external face of the
gland, that is, as far as below the glosso-facial vein, and involving
the skin and the parotido-auricularis muscle, the dissection of the
skin being made a little beyond the borders and extremities of
the skin. The dissection of the gland forms the second step, and
must be as complete as possible. There are some parts where
the gland is difficult to isolate, especially at the base of the ear,
at its masseterine adhesions near the sub-zygomatic blood vessels
and nerves, but at these points some little glandular granulations
may be left. In this dissection the use of the fingers or of the
dull end of the handle of a dissecting scalpel is recommended in
order to avoid the blood vessels and nerves which are so intimately
connected with the organ.
Beginning with the ligation and section of the posterior auric-
ular vein, the anterior border of the gland is isolated from above
downward, carefully avoiding the sub-zygomatie blood vessels
and nerves, after which the jugular vein is isolated in the whole
extent of its parotid course, and the gland divided into two por-
tions, one above, the other below the vein. The dissection of the
upper portion is made from below upward, avoiding first, four ar-
terial divisions, including the external carotid, the temporal trunk,
the internal maxillary, and the posterior auricular; second, the
superficial temporal and the facial nerves; and third, the guttural
pouch, which is intimately adherent to the internal face of the
gland above. The smaller arterial branches that are divided are
ligated or twisted. The lower portion is then carefully dissected
from above downward. The dressing of the wound, which is the
third step, is performed according to the process of Brogniez.
Maxinttary ADENOTOMY.
We find but a single description of this operation, which is by
Director Degives in his Manwel de Medécine Opératoire Vétéri-
naire. Recommending it only as the last treatment in the re-
fractory fistula of Warthon’s duct, he first divides the skin and
the cutaneous muscle against the inferior border of the gland,
parallel to the glosso-facial vein, and makes an incision about four
inches long, which brings him to the loose and abundant cellular
tissue which surrounds the gland. The dissection is made with
364 OPERATIONS ON THE DIGESTIVE APPARATUS.
the fingers by tearing the connective tissue in the middle part
of the gland; when taking hold of it at that place it can be care-
fully pulled out, the division of the cellular tissue which holds it
being easily detached with the fingers or a blunt instrument. The
position of the wound is such that no special dressing is indicated,
suppuration having a free exit.
OPERATIONS ON THE. GSOPHAGUS.
The surgical affections which require interference with the
cesophagus and adjacent regions are classified as follows: Bruises,
wounds, lacerations, ruptures, tumors, jabot, obstruction by for-
eign bodies or alimentary masses, and strictures. The various
operations of direct application which are indicated in connection
with these casualties are: Catheterism of the cesophagus, the
taxis, the crushing of the foreign bodies, and cesophagotomy. This
classification, arranged by Peuch and Toussaint, meets with our
acceptance, including the operations enumerated, and in our con-
sideration of the subject we shall, for the present, refer our
readers for descriptions of the various forms of disease to the
standard authorities upon veterinary medicine, especially includ-
ing in the list the excellent work of Professor Williams.
Before entering upon a description of these operations, a re-
view of the surgical anatomy of that organ will be in place.
The cesophagus is a long musculo-mucous canal, which at the
third step of deglutition carries the food, both liquid and solid,
from the pharynx to the stomach. Stretched between these two or-
gans, it successively occupies the neck down its inferior region, the
entire length of the thorax, and a small portion of the abdomen.
At its origin (Fig. 362), situated on the median line, it communi-
cates with the pharynx by an opening above the glottis; from
thence it runs obliquely downward, from before backward, be-
hind the trachea, until about the middle of the neck, where it
begins to deviate to the left, resting from thence on that side of
the trachea. In this situation it enters the thorax, to resume its
former position on the trachea; passes above its bifurcation and
the base of the heart, running through the layers of the posterior
mediastinum, which covers it, reaches the right pillar of the dia-
phragm, and passes through it, and entering the abdomen, has its
termination on the left side of the small curvature of the stomach.
OPERATIONS ON THE CSOPHAGUS. 365
Fic. 862.—Anatomy of the @sophagus and Jugular Vein of the Horse. J J, jugular
vein; C, carotid artery; O H, sub-scapulo hyoideus muscle; D, esophagus; §, sterno-
maxillaris muscle; M, mastoido-humeralis muscle.
The relations of the esophagus must then be considered accord-
ing to its divisions of the cervical, thoracic and abdominal portion.
At its point of origin, at the pharynx, it is situated between the
larynx and the guttural pouches. In the upper half of the neck it
is in relation, in front, with the trachea; behind, with the long
muscle of the neck; and on the side with the car tid and its
satellite nerves. Below this point, and as it deviates to the left,
it is related to the left side of the trachea, upon which it rests,
and on its outside, with the scalenus muscle, the carotid artery and
the jugular vein. In a very few instances, instead of passing to
the left of the trachea, it deviates to the right, but otherwise holds
the same relations as when inits normal position. At its entrance
into the thorax, the cesophagus, still on the side of the trachea,
corresponds outwardly with the inferior cervical ganglion and its
branches, and to the vertebral, superior cervical and dorsal arteries
366 OPERATIONS ON THE DIGESTIVE APPARATUS.
and veins, which cross its course and further back, returning be-
tween the trachea and the longus colli, it passes over the left bron-
chia and to the right of the thoracie aorta. Beyond this, placed
between the folds of the posterior mediastinum, it is received
into the groove of the internal face of the lungs, with the cesoph-
ageal arteries and nerves. Passing through the opening of the
right pillar of the diaphragm, we find it in its abdominal portion
related on the right to a notch of the superior border of the liver,
and ending at the cardiac. The structure of the cesophagus is
formed of two coats; one of external and muscular, the other
of internal and mucous membrane. The external is composed
of muscular fibers, spiral, red and longitudinal, striated in
its anterior three quarters, and white in the posterior quarter.
Anteriorly, the crico-pharyngeus furnishes it with a sort of circu-
lar necktie. Towards its posterior portion, the muscular coat is
much thicker than in the other parts, and as it passes through the
pillars of the diaphragm, it is more or less pressed upon. These
three points must be remembered, inasmuch as they serve to ex-
plain the resistance which is encountered by instruments, such
as the catheter, or the probang, when introduced into its cavity.
The internal coat or mucous membrane is whitish, with longi-
tudinal folds, which are so developed at the cardia that they may
resist the passage of the probang into the stomach.
CEHsoPpHAGEAL CATHETERISM
is an opération consisting in the introduction of a special instru-
ment, solid or hollow, but always flexible, into the cavity of the
cesophagus, either to remove bodies that obstruct it, or to aid the
exit of gases which have accumulated in the stomach.
It is therefore indicated in three principal conditions, viz. :
first, tympanitis im ruminants; second, in cases of wsophageal
dilatation, or jabot ; and third, to dislodge foreign bodies arrested
in its canal.
In cases of tympanitis, it is of advantage if the trouble is not
too far developed, and danger of suffocation not too imminent.
In cases of wsophageal jabot, due to a more or less extensive
dilatation of the organ, in consequence of the lodgment and
packing of food, it is in many instances of but very little benefit.
When foreign bodies are lodged in the cesophagus, an accident
to which horses are liable, and which is very common in cattle
a
OPERATIONS ON THE SOPHAGUS. 367
and in dog's, it is often of great
advantage. The operation would
naturally depend very largely for
its success upon the size of the
foreign body, which of course is a
variable circumstance, and also on
the condition of its external sur-
face, whether rough or smooth, or
having projecting points; depend-
ing much likewise on the situation
in the length of the canal, and
whether it has become engaged in
the cervical or the thoracic portion
of the passage.
Probangs for the throat and a =
speculum for the mouth are instru- =
ments necessary for this operation. =
: Sule
There are various forms of pro- =
bangs, the designs of different in-
ventors. The first, which, accord-
ing to Brogniez, was invented by
Monro of Edinburgh, has been
more or less perfected. The pro-
bang of Baujin (Figure 363) is re-
yersible, and may be so adjusted
as to either push down or extract
the offending substance from its
place of lodgment. The instru-
ment in ordinary use is designed
essentially to push the obstruction
through the passage. It is found
in all our surgical instrument ma-
=
MI
[3
PING
¥
{
Helnall
i
ek
eS
Out
in
im
I
0)
L\
es
(J
EVIE, I,
ralian Kk
a
res
| \
7
Y qr} fi '
vl \\ ah it yh OW
\\ H a
at ull a:
Ay a
FIG. 363.—Baujin’s Probang.
kers’ shops, and is made of whalebone or of rubber, separable in
two parts, connected by a screw. One end (Fig. 364) has a bulb-
ous enlargement, the other a blunt mass or head, made concave
Fic. 364.—Ordinary Whalebone Probang.
368 OPERATIONS ON THE DIGESTIVE APPARATUS.
on its free end, the better to act without slipping against the ob-
ject with which it is to come in contact. The probang of the
stomach pump forms an excellent instrument for that purpose.
Dr. Peabody has constructed a simple implement of strong,
thick wire, twisted together and forming a rod of sufficient length,
protected by a tube of India rubber, and having one end formed
into a ring or loop, to serve as a handle, while at the other ex-
tremity a sponge of suitable size is secured and formed into a
bulb resembling that of the ordinary probang. Degives recom-
mends for use in cases of emergency an extemporized instrument,
formed of a whip handle or a branch of a tree, of sufficient
length, of the size of the little finger, with a bulb composed of a
ball of oakum covered with cloth. This bulb is attached to the
end with strong twine, of which a free end is left of equal length
with the instrument, in order to draw out the broken fragments
in case of fracture of the probang.
Whatever form of probang may be used, it is always neces-
sary to associate with it a speculum to keep the mouth sufficiently
open and immobile. Those which are recommended and em-
FIG. 365.—Brogniez’s Gag.
ployed in the exploration of the mouth are available for this pur-
pose. Butas these are not always obtainable, some ingenious and
simple apparatus can be made at a moment’s notice like that illus-
trated in Figure 365, which, or something equivalent, ought to be
within the scope of the inventive and constructive capacity of any
well equipped surgeon.
OPERATIONS ON THE (ESOPHAGUS. 369
In ruminants the operation is performed in the standing posi-
tion, with the head extended and elevated on the neck. In soli-
peds it cannot be performed except while the animal is down, and
when the head can be placed in the proper position of extension
to allow the instrument to pass beyond the elbow formed by the
pharynx and the esophagus. The animal being in position, and
the speculum adjusted, an assistant draws the tongue out of the
mouth, and the operator, placed in front of his patient, passes the
probang through the opening of the speculum, and rapidly pushes
it into the mouth, resting it upon the hard palate, in order to pre-
vent its being displaced laterally by the motion of the tongue. At
the bottom of the mouth the probang meets with some little re-
sistance at the soft-palate, but the instrument soon reaches the
fauces, in the pharynx, and penetrates the cesophagus. At this
moment possibly some resistance may be encountered, owing to
the contraction of the crico-pharyngeus muscle, but once engaged
in the cesophagus the instrument readily passes the proper dis-
tance downwards, according to the requirements of the case. If
the object in view is to relieve tympanitis, and a true catheter,
tube, or stomach pump or hollow probang has been used, the
gases will find a means of exit as soon as the instrument has
penetrated the stomach.
If the catheterism has been performed for the displacement of
foreign bodies, the resistance they offer to the pressure of the
probang must be overcome by a steady, and, at times, quite a
powerful pressure of the instrument, caution being always neces-
sary to avoid causing laceration of the wall of the passage. When
the obstruction is even but slightly loosened, its complete dis-
lodgment often follows from the mere unassisted contraction of
the cesophageal muscles. Caution and gentleness must not be
overlooked even in the mere withdrawal of the probang. It
should be practiced as a maxim, indeed, that whatever instrument
may be, for any purpose, made use of, not alonein the propulsion
of the intruding body in these cases, the operator must never re-
mit his caution and gentleness, nor lose sight of the fact of the
natural liability to accident always accompanying surgical in-
terference with the organs and tissues having their place in the
interior regions of the animal organism, and not cognizable by
the eye. Serious accidents have been recorded as resulting from
a lack of care and attention in the manner of withdrawing the in-
370 OPERATIONS ON THE DIGESTIVE APPARATUS.
strument. Lacerations of the esophageal walls, rupture of blood
vessels, perforation of the trachea, abscesses of the mediastines,
pleurisy and pericarditis belong to the list of recorded casualties
in this connection. To facilitate the working of the probang, in
these cases, certain practitioners have recommended the adminis-
tration of oil or mucilaginous drenches.
Tue Taxis.
The cesophageal catheterism which we have just considered is
principally applicable to cases where the obstruction is in the
thoracic portion of the passage. When it is in the cervical por-
tion, instead of propulsion or intrapulsion, it is by extrapulsion,
or by the course of the natural passages that the foreign body is
to be removed. In this case the taxis is made to take the place
of the ordinary artificial appliances, and the hands become the in-
struments with which the surgeon seeks, by making forcible and
methodical pressure, to move the impacted object back into the
mouth.
In 1820, Delafoy recommended a process which is to-day ad-
mitted to be one of the best modes of relieving cattle when suf-
fering with this difficulty, and many other methods have since
then been devised, but most of them are merely modified plans of
Delafoy’s method. We shall consider them as briefly as possible.
In order to raise the ¢mpact (as we shall for convenience call it)
back into the pharynx, Delafoy has the animal thrown, on the
right side, and administers a glass of sweet olive oil, and while
an assistant steadies the cesophagus, applies with his fingers upon
the impact, a retrograde motion which carries it upward, back
and to the pharynx. When it reaches that cavity, the head is
raised, the jaws are opened with a speculum, and the operator,
passing his hand through that instrument into the back of the
mouth, seizes the impact and brings it away. Lindenberg keeps
the patient on his feet instead of casting him, but otherwise ob-
serves the same modus operandi. Denenbourg operates with his
patient in a standing position. While an assistant holds the
head, well extended, and elevated on the neck, he places himself
on the right side of the animal, and with the fingers pressing be-
low the impact (like Delafoy), displaces it and gives it the as-
cending motion which transfers it to the pharynx, and keeps it
there by pressing hard below it. Then putting an assistant in his
OPERATIONS ON THE CSOPHAGUS. . ai
place he proceeds like the others to remove the impact with the
hand passed through the speculum.
Schaack operates also in the standing position, the hind legs
being hobbled above the hocks, the head is kept, as much as pos-
sible, in a horizontal position, and a speculum placed in the
mouth. The operator takes his place on the left side, in front of
the shoulder, the right hand on one side of the neck, the left on
the other. Ifthe impact is rather low down, or near the chest,
the extremities of the fingers are brought together and employed
to push it upward, with careful manipulations. If it is situated
higher up, near the cesophagus where it is less surrounded by
muscles, the pressure is made with the fingers closed. In either
case, however, when it has reached the throat, Schaack holds it
there, while an assistant with his hand boldly introduced into the
mouth, seizes it and draws it out of the pharynx.
According to Peuch and Toussaint, Mr. G. Tisserand, in cases
of jabot, operates as follows: Making a point of support on the
neck with the right hand, with the left he violently shakes the
part where the projection of the jabot is most prominent, and
then applies alternate movements, up and down, with a lateral
shaking of the enlargement until the patient voluntarily lowers
his head, and as he snuffles throws out through the nostrils and
the mouth, abundant mucosities, mixed with alimentary detritus.
If the first manipulations fail, Tisserand advises the occasional ad-
ministration of mucilaginous decoctions, or oil, or even plain water.
The method of Martin is one whichis also held in high esteem,
and at the hazard of needless repetition and unnecessary minutize
we give it in detail. Instead of extending the head, which has a
tendency to stretch the cesophagus and diminish its diameter, he
keeps the head of the patient low down, at about a foot from
the ground, and placing himself on the left side of the neck, he
passes his right arm over the neck, in such a manner that envelop-
ing the neck between both arms, his hands can join on the lower
border of the neck, and both thumbs pressed in the jugular
grooves, one on the right, the other on the left. It is by succes-
sive pressures from behind forward, that he succeeds in pushing
the impact in the pharynx. Then comes a peculiar step of the
operation: As by its presence the soft palate closes somewhat the
posterior opening of the mouth, the impact cannot re-enter this
cavity, and thus, while the mass is in the pharynx and resting on
Vey Re Wi FAG a Me
i Nee.)
372 OPERATIONS ON THE DIGESTIVE APPARATUS.
the posterior face of the velum palati, with both thumbs he pushes
it from above downward and from behind forward; the effect
of this is to depress the base of the tongue, and to enlarge the
isthmus of the throat sufficiently for the impact to pass through
it, back in the mouth, and drop it tothe ground. If, however, the
pressure required in this step of the operation could not, for one
reason or another, such as excessive thickness of the lower border
of the neck, for instance, be maintained, then the impact is ex-
tracted with the hand.
Courioux has advised the application of a cord around the
neck, below the impact to be moved upwards with it, as the dis-
placement is accomplished. The object of this is to retain what-
ever progress may be gained by preventing the mass from re-
ceding again. It forms a substitute for the fingers in holding it
in position.
The extraction by the mouth of many substances arrested
in the csophagus has also been effected with instruments.
Forceps long and curved, hooks and hollow sounds, having metal-
lic nippers or jaws, like that of Baujin, have been recommended.
That of Wegerer is probably entitled to the highest commenda-
tion of all. But with all their ingenuity and perfection their use
is not without danger of causing lacerations of the cesophageal
walls, and they are constantly liable to get out of order.
CRUSHING THE F'orEIGN Bopy.
At times the obstruction takes place in the cervical portion of
the cesophagus, and attempts to displace it, either toward the
mouth or the stomach, have failed. To meet this emergency
various means have been sought for, either to crush the impact, or
cut it in small pieces. One suggestion for the first object is to
break it with blows of a mallet, a piece of wood, or other object
held by an assistant, furnishing the point of resistance. But this
is obviously a dangerous process, nearly certain to produce
bruises and lacerations of the soft structures, with probably sub-
sequent gangrene. At best it can be available only when the im-
pact is in the form of a comparatively soft mass, such as ripe fruit
or the like.
Professor Lafosse had in 1846 suggested subcutaneous incis-
ion, and this was put in practice in 1855 by Chapard for the relief
of a cow choked by a piece of a beet. A simple puncture of the
OPERATIONS ON THE C&SOPHAGUS. 373
cesophagus was first made, with a straight tenotome, below the
obstruction, then a curved tenotome was introduced through the
wound, and by careful movements in the mass of impact, it was
sufficiently divided to enable it to resume its usual course down-
ward into the rumen. Though this mode of operation has not
- become established in general practice, the application of its prin-
ciple has not been overlooked, and has not been without its influ-
ence in simplifying the performance of the operation of cesopha-
gotomy.
CHSoPHAGOTOMY.
When the obstruction is in the cervical portion of the cesopha-
gus, and, either because of its nature or of its form, cannot be
displaced by any of the means we have discussed, the division of
the organ itself furnishes the only escape from the consequences
of the difficulty. The operation of cesophagotomy consists in the
exposure of the cesophagus and the incision of its walls. While
it is usually performed for the removal of obstructing bodies, it is
also indicated in some cases as a mode of facilitating the adminis-
tration of drugs, or, under special circumstances, of food and
drinks.
It is of French origin, and its adoption in veterinary surgery
seems to have occurred in 1782, when it was performed by Lom-
pagieu Lapole to remove an orange, arrested in the inferior region
of the neck. Since that epoch it has been performed on horses,
cattle, dogs, and even on swine. Damoiseau, Felix, Michel and
others have performed it on cattle; Thissine, H. Bouley, Reynal,
Rey, Marrel, Mauri on the horse; Peuch, Macgillivray, Williams,
on dogs, and Lagrange on pigs. H. Bouley performed it to re-
move a piece of corncob and a large molar tooth which, after ex-
traction, had slipped into the cesophagus; Baldwin extracted a
large piece of a root; Rey removed a cork; Peuch took away
pieces of bone from a dog. In fact, the operation has generally,
if not exclusively, as is but natural, been appropriated to the relief
of patients laboring under the difficulty we have been discussing.
A claim has been made in its behalf as a means of relief in lock-
jaw, by facilitating the artificial feeding of the sufferer. But such
a claim, as to any practical value which may be supposed to attach
to it, cannot in anywise possess any validity, nor be to any extent
sustained when we take into consideration the history and the
4
x
374 OPERATIONS ON THE DIGESTIVE APPARATUS.
nature of tetanus and its origin, with the complications and con-
sequences likely to accompany and to follow it. Marrel has rec-
ommended it in cases of fractures of the jaws; but such practice
would truly furnish an example of the proverbial case in which
the remedy is worse than the disease. It has also been recom-
mended for the relief of jabot, and has been, in some cases, fol-
lowed by favorable results. —
The instruments necessary for this operation are a convex and
a straight bistoury, a pair of dissecting forceps, a director, a needle
and strong thread; to these may be added a pair of scissors and
two blunt tenaculums, with also large forceps to grasp the impact
and extract it, close at hand. The animal must be kept in the
standing position, and held under thorough control by an assist-
ant, with a twitch on the lower lip or on the ear, and either fore
foot raised or both fore legs hobbled.
It must be taken into consideration that the cervical portion
of the cesophagus is situated immediately behind the trachea, con-
tinuing thence as far as the middle of the neck, when it deviates
to the left, where it occupies the lower third of the neck; and
again, that this cervical region is surrounded by an abundance of
loose connective tissue, having on each side the carotid and its
nerves. It will also be observed that the lower third of the neck
forms a triangular space, with above it the inferior border of the
sub-scapulo-hyoideus muscle, and on the sides the sterno-maxil-
laris, levator-humeri and scalenus. In this space it is in connec-
tion on the inside with the trachea, upon which it rests; and on
the outside with the scalenus, the carotid, the jugular and the
nerves of that region—organs which are all covered by the cuta-
neous colli and the skin.
The point of separation of the middle and lower third of the
neck, in the left jugular groove, is the place of election or of ne-
cessity for the operation, or where the incision of the skin must
begin, a little above and behind the jugular. If the obstruction
is considerably prominent, this incision must be made directly
over it.
Peuch and Toussaint, in their excellent work, divide the oper-
ation into three steps, which they thus describe :—
1st. Step. Incision of the skin and dissection of the subja-
cent tisswes.—Standing on the left side, the operator first deter-
mining the situation of the jugular vein, clips the hair from over
OPERATIONS ON THE GSOPHAGUS. 375
the tumor, stretches the skin with the left thumb and index
finger, and with the convex bistoury, extends the incision from
the initial point, about four fingers’ breadth down, parallel with
the blood vessels. The incision divides the skin, and the cuta-
neous muscle, and exposes the jugular and carotid and their nerves.
- The thumb of the left hand is then introduced into the incision
and depresses forward the blood vessels and nerves, while the
other fingers of the same hand are embracing the tracheal border
of the neck. The csophagus is thus exposed on thé lateral
border of the trachea, and the cellular tissue which covers the
organ is then divided. By raising the upper lip of the incision
with a blunt tenaculum the cesophagus may be still more exposed.
2d Step. Loosening or isolation of the cesophagus—Cutting
away part of the cellular tissue, the cesophagus is seized with
the thumb and index of the right hand and drawn outward. The
vasculo-nervous fasciculus are then let loose, the cesophagus is
Fic. 366.—The sophagus Drawn Outward and Raised with the Scissors.
376 OPERATIONS ON THE DIGESTIVE APPARATUS.
drawn out with the left hand, the right holding the curved scis-
sors, which being passed from above downward, and separating
the remaining portion of cellular tissue, holds the organ resting
upon its blades, in readiness for the third step (Fig. 366).
3d Step, or Incision of the wsophagus.—The operator then,
supporting the scissors with the esophagus resting upon them,
in the left hand, with a straight bistoury with the edge turned
upward, in the right, makes a large puncture in the cesophageal
walls, passing through their entire thickness, and afterwards en-
larging it with the aid of a director. At this point of the operation,
and at each deglutition, there is usually an escape of mucosities
mingled with food. When the impact forms a decided projection,
the incision should be made directly over the prominence.
Professor Nocard has modified the operation in cases where
the obstruction can be divided in small pieces, by making only a
correspondingly small incision. He uses both a straight and a
curved tenotome, and performs the first and second steps as in
the preceding methods, the third one being made as follows:
“The cesophagus being exposed, isolated and placed over the
scissors, the operator introduces the straight tenotome through
the cesophageal membranes, the blade running parallel with the
muscular fibers, into the thickness of the impact (apple, potatoe,
pieces of beet, etc.,) avoiding injury to the opposite surface of the
canal; then sliding the curved tenotome against the straight one,
and pushing it through the entire mass until it touches the op-
posite wall of the cesophagus, he withdraws the straight instru-
ment, and divides the impact by movements of the curved instru-
ment, analogous to those made in the division of the tendons in
the operation of plantar tenotomy. The blunt end of the curved
tenotome protects the cesophagus from any enlargement of the
original wound.”
Cagny, after exposing the cesophagus, as already described,
crushes the obstruction by repeated gentle blows of a small
mallet, as before described. He prefers this mode to that of in-
cision if the impact, though hard and flat, possesses but little force
of adhesion. When the objects of the esophagotomy have been
realized, there is no necessity for further interference, the appli-
cation of sutures being generally considered rather injurious than
otherwise, and though the resulting wound is of a somewhat com-
plicated nature, its perfect cicatrization in a comparatively short
GASTROTOMY. at:
time is the general rule. The principal indication is cleanliness in
the removal of the discharges, and of any mucosities or food that
may escape over its surfaces. H. Bouley has experimentally
proved that to obtain the cicatrization of cesophageal wounds it is
essential “to feed the animals with food of fibrous texture, and
nothing but pure water to drink.” By respecting this indication
all danger of complications is avoided.
The possible accidents and complications are: wounds of the
blood vessels during the first steps of the operation, but the
hemorrhage that follows may be stopped by pressure or ligature;
edematous swelling of the wound, suggesting the infiltration of
food or pus in the surrounding cellular tissue. Itmay terminatein
a. simple abscess, or it may be the precursor of a fatal gangrenous
complication: purulent infection, septicemia, tetanus, are also
possible sequele of cesophagotomy, but a faithful and judicious
application of antiseptic means in dressing and nursing the
patients will usually baffle the possible evil.
GASTROTOMY—RUMENOTOMY.
This title, in our opinion, ought to include the puncture or in-
cision of the rumen, when designed to liberate confined gases or
to remove the solid contents which may have accumulated in that
viscere. In the first case it is indicated when the tympanitic
condition of the first compartment of the stomach exhibits
alarming symptoms and resists all ordinary remedial indications ;
and in the second, when the gases of the rumen are mixed with
the alimentary mass contained in that organ and a larger opening
than that made by the trocar becomes necessary, for their re-
moval. In either case the left flank must be the seat of election
for the operation, the rumen occupying that side of the abdomen,
and situated at a point equally distant from the last rib, the
angle of the ilium and the transverse process of the lumbar
vertebre. Tabourin suggests the last intercostal space as the
proper place for the operation. The instruments necessary are a
large trocar (Fig. 367) with a straight and a curved bistoury. The
gastrotomes invented by Brogniez (Fig. 368) and Sajoux are too
complicated. The animal must be in the standing position.
Puncture of the rumen.—The operator, facing the left flank,
makes an incision through the skin, about an inch and a half long,
378 OPERATIONS ON THE DIGESTIVE APPARATUS.
Fic. 367.—Large Trocars,
with the bistoury, or with the blade of a lancet. Then placing
the trocar perpendicularly upon the flank and into the cutaneous
incision, presses it against the muscles, and with his right hand
strikes a heavy blow on the handle of the instrument and forces
it into the cavity of the rumen, provided the blow has been suffi-
ciently heavy. The blade of the trocar is then withdrawn, the
canula being left in place, and the gases allowed to escape, as
in the operation of enterotomy.
Incision of the rwmen.—The operator, using a convex bistoury,
makes an incision in the middle of the left flank, beginning a little
below the point selected for the puncture of the rumen, and
measuring a length of from three to four inches, cuts through
and divides the entire thickness of the skin, and the walls of the
rumen. The hand is then introduced and employed for the re-
moval of the food contained in the cavity. The further cleaning
out of the rumen may be done with a large spoon. Schaack
recommends the removal of only a limited portion of the ferment-
ing mass, and that the walls of the organ should not be scraped.
While the puncture of the rumen does not require to be fol-
lowed by any special subsequent treatment, the wound of the in-
cision needs to be closed immediately after the removal of the
contents of the organ. This must be attended with every anti-
septic precaution, and the closing be done by means of the inter-
rupted suture. The parts should be thoroughly cleansed. Adhe-
sion may be promoted by the application of a wide band of ad-
hesive plaster placed all round the animal, as recommended by
Professor Brush of the American Veterinary College. The wound .
of the puncture heals rapidly, while that of the incision requires
from a week to ten days, and if properly treated, unites by the
first intention, without suppuration. The accidents which are
:
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|
|
’
—
GASTROTOMY. 379
Fic. 368.—Brogniez’s Gastrotome,.
likely to follow these operations are subcutaneous emphysema,
abscess, or peritonitis. The first of these is not uncommon, or
dangerous; the abscesses are comparatively rarer; the peritonitis
generally proves fatal.
380 OPERATIONS ON THE DIGESTIVE APPARATUS.
ENTEROTOMY.
The division or puncture of the intestines, or enterotomy,
is an operation the object of which is to facilitate the exit of gases
contained in these organs, to prevent their excessive dilatation,
and to obviate certain too commonly fatal complications. It was
mentioned at an early day by Vegetius, especially in connection
with the treatment of wind colics, but not again spoken of until
1776, when Roem, Bomyinghausen, and at a later date, Barrier
and Herouard obtained good results from it. Bourgelat and
Chabert recommended it in the early stages of the disease, but,
notwithstanding the favorable dicta of all these authorities, the
operation was not fully admitted to a place in the domain of
veterinary surgery until Bernard, Dieterichs, Falke, Rey, Schaack,
Hayne, Eckel, Blendeiss, Charlier and others, had proved by nu-
merous facts that when performed under favorable circumstances
it is not only harmless, but is capable of insuring results of the
most beneficial character.
Intestinal puncture is indicated in cases of tympanitis or flat-
ulent colic, due to indigestion, or to an intestinal obstruction,
and must be performed whenever the accumulation of gases has
resisted ordinary forms of treatment. The indication, in our opin-
ion, is to operate early in the disease, as an almost positive means
of avoiding the complications, or rupture of the stomach or lacera-
tion of the intestines, which, if unchecked, may accompany the flatu-
lent accumulation. Enterotomy is also recommended in cases of
strangulated hernia, when the gases which are imprisoned in the
hernial intestines prevent its reduction. Imbert used it with ad-
vantage in reducing a strangulated ventral hernia. In former
days Chabert performed the operation through the rectum, and
Abadie, in 1875, reported a case in which he reached the intes-
tines through the vagina. But while it may be possible to ob-
tain access to the dilated intestines through these channels, it
is evident that it is a method which must oppose more difficul-
ties and involve more complications than the puncture through
the flank.
The point of selection for the operation is about the center of
the space formed forward by the border of the last rib, behind by
the external angle of the ilium, and above by the extremity of the
ENTEROTOMY. 3881
Reb
Fic, 369.—Trocars for the Ccoecum. FIG. 370.—Brogniez’s Enterotome.
transverse processes of the lumbar vertebre, on the right flank—
since it is there that the dilatation of the intestines is most prom-
inent. The puncture, if made at this stated point, penetrates the
second portion of the large colon; if it is made nearer the lumbar
vertebree, it enters the arch of the ccecum.
The only instrument necessary to perform enterotomy is a
trocar. The instrument used in cattle for puncture of the rumen
382 OPERATIONS ON THE DIGESTIVE APPARATUS.
was formerly employed, but it is quite unnecessary and of no ad-
vantage to use a canula of such dimensions merely to allow the ©
escape of the gases. A small, round trocar is now in general use,
and is in our estimation to be preferred to the ordinary flattened
form of instrument (Fig. 369). The enterotome of Brogniez (Fig.
370) is too large an instrument, and its use endangers the walls
of the intestines and the surrounding blood vessels.
Brogniez reports a case of injury to one of the ccecal arteries
by the point of this instrument. We have frequently had re-
course to the trocar of the epidermic syringe used for horses,
when no other instrument was conveniently at hand.
The animal suffering with flatulent colics is treated while on
its feet, and the pain it endures is usually of so intense a kind
that no means of restraint are necessary, and it remains per-
fectly indifferent to the insignificant and minor pang of the oper-
ation. The principal caution to be observed, is to be on guard
against the patient’s suddenly falling, but if this should occur it
need not interrupt the operation, which may be continued with-
out forcing it to rise.
The modus operandi is very simple. The spot being acurately
determined, the point of the instrument is pressed perpendicu-
larly upon the skin with one hand, and driven by a strong, quick
blow with the other upon the handle, through the skin and the in-
testinal coats into the visceral cavity. The withdrawal of the rod,
leaving the canula in place, completes the process, by giving vent
to the gases. These escape with more or less force, as announced
by a whistling sound as they pass out of the tube. The intestines
must then be entered from above downward, and not as recom-
mended by Hertwig, who punctures the most dependent part of
the abdomen, and thus exposes his patient to serious subcutaneous
infiltrations.
Peuch and Toussaint suggest the propriety of making a
small preparatory incision through the skin with a bistoury, pre-
vious to the main puncture with the trocar. The escape of the
gases continues for a varying time, according to the amount of
the accumulation. The instrument should continue in the
wound while the escape continues, and until the tympanitic con-
dition of the intestines disappears. If the escape of gas should
suddenly cease, it will be because the canula is filled with focal
or other matters, and the trocar must be re-inserted into its
*
———— a
lt a ee
PARACENTESIS. 383
canula until the renewed escape of the gas proves that the ob-
struction has been removed. If, however, they still fail to find an
exit through the canula, a second puncture must be made at a
short distance from the first. The wound of the puncture re-
quires no treatment.
According to Zundel, enterotomy is comparatively—in ordin-
ary cases—harmless; still, however, complications more or less
severe are possible, and have been observed. Hemorrhages,
though of no alarming nature, have been noticed, and several
cases of abscess have been recorded, either at the seat of the
operation, or at the wound of the flank, and even in the groim.
Peritonitis has also been encountered. Subcutaneous emphysema
has been mentioned by Bouley; but in an experience of many
years, we have never seenit. Laceration of the floating colon has
been reported by Schaack. As a means of prevention against
these accidents we would recommend great care in the introduc-
tion of the trocar through the abdominal walls, and especially a
condition of thorough cleanliness, with a careful disinfection, of
the instrument.
PARACENTESIS.
This term, with its synonyms of puncture and tapping, 1s at
the present time applied exclusively to the operation performed
upon the abdominal walls for the purpose of evacuating the seros-
ity collected in the peritoneal cavity, as the result of dropsical ef-
fusion. It consistsin puncturing the abdominal walls in the man-
ner practiced in enterotomy and gastrotomy. The operations are
similar, while the purpose varies materially in the several cases.
This operation had already been recommended by Vegetius—
afterward employed by Vitet, as a last resort in ascitis. Lafosse,
Jr., also speaks of it, and in more modern times we find it advo-
cated by St. Cyr, Lafosse, Forster and others. Though in the
majority of cases forming only a palliative treatment, it is never-
theless indicated in chronic dropsy of the abdomen, when all
other forms of treatment have failed to produce the resorption of
the fluid, especially when its accumulation interferes with the ab-
dominal and thoracic functions. In these cases of ascites it has
been performed upon horses, cattle and dogs. The injection of
tincture of iodine into the peritoneal cavity, after the removal of
ee
384 OPERATIONS ON THE DIGESTIVE APPARATUS.
the effusion, has been successfully added as a means of preventing
the return of the fluid.
In selecting the place where the operation is to be performed,
Brogniez, Degives, Peuch and Toussaint advised the middle of
the linea alba, at an equal distance from the xiphoid cartilage of
the sternum and the anterior border of the pubis; Zundel, on the
contrary, recommends “a puncture on the right side in ruminants,
on the left in horses, on a point at an equal distance between the
umbilicus and the external angle of the ilium, about on a line run-
ning from the stifle towards the cartilage of the last rib.” He
adds, however, “to select the point where the liquid is most de-
tectable and fluctuation better felt.”
A trocar of the size of a quill for large animals, and an aspirator
for the small, are the only instruments required. In operating on
large animals, they are kept standing, while small animals are laid
upon a table and placed slightly on their backs. Placing himself
on the left side of the animal, after having selected the place
where the puncture is to be made, the operator, holding the trocar
Fia. 371.—Holding the Trocar in Paracenthesis.
full in his hand and limiting its action by keeping his fingers a
short distance from the point of the instrument, pushes it by a
rapid and firm pressure through the thickness of the abdominal
walls, until he feels that he has overcome their resistance, and that
the instrument has passed into the cavity. The trocar is then
withdrawn from its canula and the fluid escapes through the tube.
Director Degives describes another modus operandi, which he
calls subcutaneous, in which the opening of the skin does not cor-
respond with the division of the deeper muscular layers, and by
which the opening becomes covered by the skin. To effect this
the skin is drawn a little aside, then punctured, or a large fold of
the tegument is taken hold of, and the puncture made at its base.
In either case, when the skin is loosened, its retraction completely
closes the abdominal opening.
HERNIA. 885
If the escape of the fluid should stop or diminish, a blunt
stylet can be introduced into the canula to clean it of any albu-
minous or epiploic mass which may obstruct it. The operation in
small animals is performed in the same manner.
As the removal of the entire accumulation of the fluid is dan-
gerous, though less so than in thoracentesis, it is better to permit
a portion of it toremain. The quantity is sometimes enormous,
ranging between thirty-five and ninety-six quarts. After the
quantity desired has been obtained, the canula of the trocar is
carefully withdrawn, and a bandage or roller of adhesive plaster
placed around the body of the animal.
Among accidents possible in this operation, wounds of blood-
vessels or of the intestines, and fatal peritonitis may be men-
tioned.
HERNIA.
GENERAL VIEW.
In a general sense, any tumor formed by the entire or partial
escape and protrusion of an organ, either wholly or in part, from
the restraining tension of the integuments, or from the cavity
which forms its normal location, is a hernia, or in popular phrase,
arupture. The more special application of the term is to the dis-
placement of the abdominal viscera, but it is also employed to
describe the encephalocele, or protrusion of the brain through the
cranium; the projection of the iris and the jadot, or protrusion of
the cesophagal mucous membrane, throughits muscular coverings.
And again the prominence of a synovial membrane beyond its
ordinary bounderies: that of a muscle through its aponeurotic
envelope; the prolapsus of the rectum; of the vagina; of the
uterus, etc., etc.,—these also receive the same designation and are
recognized members of the hernia family. We shall, in the pres-
ent chapter, mainly limit our consideration to the displacements of
the abdominal digestive organs.
The rationale of the formation of a hernia becomes a matter
of easy comprehension, when we take into consideration the gen-
eral anatomy of the abdomen, and especially the structure of its
inferior wall. The muscular layers which form the exterior wall
of this large splanchnic cavity are not of equal density through
their whole extent, and consequently do not offer in every part an
equal amount of resistance to the outward pressure of the interior
386 OPERATIONS ON TI) DIGESTIVE APPARATUS.
contents. In one place musculo-cartilaginous, or bony, it is in
another, musculo-aponeurotic. In some parts protected by only a
single layer of muscle, as in its anterior wall; in others the layers
of muscular aponeurotic structure, or of fibrous bandages, are re-
inforced by a powerful elastic band, as in the inferior portion, by
the tunica abdominalis. But besides this variety in the elements
2
FG. 372.—Muscles of the Inferior Abdominal Region.
1, aponeurosis of the great oblique; 2, fleshy portion ol the smali oblique; 3, straight of
the abdomen; 3’, transverse of the abdomen; 4, pre-pubic tendon; 5, inguinal ring; 6, its
anterior border; 7, the posterior; 8, external commissure; 9, internal commissure;
10, posterior border of the aponeurosis of the great oblique; 11, internal crural aponeu-
rosis; 12, flap of the aponeurosis of the great oblique, drawn downward to show the
origin of the reflex portion which forms the crural arch; 14, remains of the umbilicus,
forming the walls of the cavity, there is also to be taken into con-
sideration the fact that, at certain points in the walls, natural
openings exist, and that the abdominal cavity is therefore not
strictly a close cavity. These passages consist of the inguino-cru-
ral openings, the umbilicus and those found in the diaphragm for
HERNIA. 387
the egress of certain organs out of the abdomen, either during
foetal life or after birth.
The hernia, when not arising from a traumatic cause, is the
result of some violent muscular effort on the part of the animal,
in the course of which the viscera are made to exert a violent out-
ward pressure upon the walls of the abdomen. If the pressure
bears against any of the more solid portions of the wall, there will
be no yielding, and the parts will remain uninjured and intact.
But if the pressure becomes unduly violent, and the attack is di-
rected against some one of the weaker supports, there must be a
yielding, and the intestine or omentum, as the case may be, will
be forced through the opening which falls most nearly in line with
the direction of the violence. The resistance fails, the viscera
passes through the aperture, and there is a protrusion, a rup-
ture, a hernia.
Two elements must enter into the composition of all hernias,
with the exception of eventrations. They are the sac, and the
displaced organs which form its contents, and the mode of its
formation may be readily comprehended by a consideration of the
figures 373, 374, 375, which show the progressive displacement of
the peritoneum, as it is pushed through the opening of the ab-
dominal walls, by pressure of the intestines, which are also gradu-
ally passing through the same opening. The figures show in what
manner the hernial or peritoneal sac is formed.
The sac is thus shown to be the prolongation of the perito-
neum, which is displaced, moved and distended, or may have sus-
tained partial laceration of its fibres. It may even happen that
the rupture of that serous membrane is complete, and that it has
become lodged in the cellular tissue. In such a case the lacerated
peritoneum soon throws out a provisional reparatory sheath, which
becomes continuous with the natural serous membrane.
Whether formed by the peritoneum itself, or by a membrane of
secondary formation, the sac is always composed of a middle por-
tion, or body, and an opening, or ring, which constitutes a means
of communication with the abdominal cavity, with a neck or canal,
a narrowed portion, uniting together the body and the opening of
the tumor.
But little uniformity exists in the formation of the ring or
opening of a hernia. In some instances it is round or oblong, in
others it is a narrow slit, and again it exhibits a triangular outline.
388 OPERATIONS ON THE DIGESTIVE APPARATUS.
FIG. 373.
EXPLANATION.—In these three
figures an idea of the mode of
formation of hernias is given:
ad aa ad, represent a section of
the abdominal wall; o o o, the
aponeurotic opening through
which the peritoneum, pp pp pp,
is engaged to form the hernial
sac, s; the intestine, 7 i 7, is
shown entering the hernial sac
gradually.
FIG. 374.
FIG. 375.
In the ventral kind the aperture is wide and of varying dimen-
sions, and it may, moreover, be quite wanting, or again, it may
be long and cylindrical, as in inguinal rupture; while in the um.
bilical variety it is very short, and represented merely by the
thickness of the edges of the hernial ring. The dody or middle
portion of the intestines, or that which becomes lodged in the
cavity of the sac, also varies in size, direction and form, and may
be considered under the four principal heads of the cylindrical,
HERNIA. 389
Fig. 376,—Cylindrical Hernial Sac. Fig. 377.—Spheroidal Hernial Sac.
FIG. 378.—Conical Fig. 379.—Pyriform Fic. 880.—Hernial Sac
Hernial Sac. Hernial Sac. _ in Clusters, or having
three contractions—
SJ, a, b.
‘y 7
FIGs. 381, 382.—Multilobular Hernial Sacs.
390 OPERATIONS ON THE DIGESTIVE APPARATUS.
the spheroidal, the convex, the pyriform, to which Zundel adds
the clustered and the multilobular.
The relation as to dimensions between the body of the hernia
and the measurement of the ring is a point of importance in re-
lation to estimating the more or less serious nature of a case. It
will readily be inferred that with a narrow and contracted open-
ing, an obstruction may easily take place, and at an early date,
and that in due time the result will be manifested in the legitimate
form of a strangulation, an accident which will be accompanied
with various phenomena, according to the degree of pressure and
the duration of the period of formation, and all of them attended
with trouble and danger.
At first, as the capillary circulation becomes retarded and diffi-
cult, the intestines assume a red color, which passes successively
through many shades, from deep red to brown or a blue-black,
indicating the arrest of the blood, of which the dreaded sequel
may be looked for in the appearance, a little later, of signs of mor-
tification of the parts involved.
The blood then transudes through the walls of its vessels, and
filtrates into the sub-serous and sub-mucous cellular tissue, thus
increasing the bulk of the contents of the sac. At the same time
the external surface of the protruding intestines becomes the seat
of what is at first a yellowish exudation, but which becomes a
bloody deposit, ready for organization if the patient lives long
enough to survive the pains of the strangulation. By the eight-
eenth or towards the twenty-fourth hour, however, signs of total
gangrene make their appearance and the hernial portion becomes
flabby, cool, and insensible; the odor becomes very offensive, and
the tissues easily lacerated or torn. The fatal end is then near,
being rarely deferred beyond the twenty-fourth hour, unless im-
mediate relief has been interposed.
But, of course, every case does not observe this regular succes-
sion of symptoms, nor reach the same final termination, and in
the instances in which the interference with the circulation is less
pronounced and the degree of pressure upon the protruding
organ is lighter, probably not more than sufficient to interfere
moderately with the movement of the intestinal contents, we have
a modified evil to contend with in the obstruction or engorgement
of the hernia, with consequences in view less discouraging to con_
template The exudation upon the surface of the contents of the
Fig. 383.—Strangulated Inguinal Hernia.
A, intestinal circumvolution. B, herniated portion of the intestine. DD, neck of
the vaginal sac compressing the intestines. E, internal wall of the vaginal sac. T, tes-
ticle in the fundus of the vaginal sac.
sac has resulted in an adhesion with the internal surface, and the
hernia has taken its place in the class of the irreducible. Hernias
of long standing, which have, at intervals, shown indications of
obstructions, are, in the greater number of instances, in fact, ir-
reducible.
There are still, however, cases of simpler condition in which
the viscera continue to be movable in the sac, in which fact they
are due to the lubricating effect of a free serous exudation.
392 OPERATIONS ON THE DIGESTIVE APPARATUS.
Aside from other distinguishing characteristics, all hernias are
divisible into two classes—internal and external. Of the latter,
some, as the eventration, have no containing sac, while the others,
which have a serous covering, are in reality alone entitled to be
considered as the true hernias. These, usually occurring through
one of the natural openings, are called natural, in opposition to
the accidental, which, like the ventral hernias and the eyentration,
occur through accidental and artificial openings. Any of the ab-
dominal viscera, with the exception of the pancreas and the Iid-
neys, may enter into the formation ofa hernia, and as each is
known by the name of the displaced organ, we are given the
designations of enterocele for a hernia of the small intestines ; epi-
plocele, for that of the omentum, and entero-epiplocele of both the
intestines and omentum. The name of gastro-ventral 1s given to
the ventral hernia which involves with it the stomach; cystocele,
when it is the bladder which is affected, and hysterocele when the
uterus is concerned. Hernias can be, moreover, congenital or oc-
casional—that is, they may exist at birth or previous to it, and
also when making their appearance under special causes after
birth. They may be also considered as acute when recent, or
chronic, when of long standing.
Their originating causes are numerous, and may be said to
comprehend any which may predispose an animal to such a lesion
by contributing to an increase of the pressure which the organs
contained in the abdominal cavity bring to bear upon its walls, or
any weakness in the walls, which may diminish their power of re-
sistance to the pressure, as, for example, a condition of leanness
arising from a sudden or recent change from a state of obesity;
blows upon the abdomen; wounds and cicatrices of the abdomi-
nal walls; violent, jerking efforts, such as those required in com-
pulsory jumping or hauling, or in any other of the struggles to
which they are too often forced, and even when under the sur-
geon’s hands, when, as a patient, the animal is cast and secured
for an operation; the rapid relaxation after contraction of the
natural openings, repeated pressure, or excessive dilatation, as
with stallions used for covering mares, may be placed among the
predisposing causes. They have also been observed in mares,
after violent efforts during parturition; also during colics and
other tympanitis. To recapitulate and partly to repeat
The general symptoms characteristic of hernias, are compar-
a ae eee eee
‘4
=~
HERNIA. 393
atively easy to recognize, and can be reduced to two principal
points, to wit—the discovery of a tumor, and appearance of an
opening coexisting in the abdominal walls. These tumors and
openings offer many varieties of form and character. The tumor
located opposite to a natural opening, or under a breach or sepa-
ration in the structure of the abdominal walls, or under a cicatrix,
forms a mass, indolent, elastic, remittent, of varying size, but di-
minishing or increasing under peculiar conditions, such as rest or
pressure, and the standing, or the lateral or recumbent position,
etc., and having different forms, being located in various places.
It has also, in many instances, the quality of being reducible,
that is, it may be made to disappear by means of certain manipu-
lations and appropriate treatment, and arrangements of position,
to return to their previous status when these agencies are sus-
pended; or again, they will become permanently irreducible under
special pathological changes already alluded to. The presence of
borborygmus is also an important item among the means of form-
ing a physical diagnosis of these tumors. This is detected more
or less readily when the displaced organ is a portion of the in-
testines. They are, however, missing when the hernia is formed
by other organs, as, for instance, in case of epiplocele. Other
points connected with this subject remain to be mentioned.
Among these are the final symptoms, and more or less remote re-
sults, which may follow the presence and working of the lesion
upon the general economy and the physiological functions at
large, when the acute action has passed away.
The constitutional symptoms, or what may be so denominated,
will vary, in their nature and their intensity, correspondingly with
the condition of the hernia and the complications which may ac-
company each case. Among these complications, four principal
ones may be mentioned as taking precedence:
Ist. Zrreducibility.—This is more frequent in old cases than
in new, and is probably due to the increase in size of the dis-
placed organ to the degeneration of the tissues, or to old adhe-
sions between the organ and its covering, the sac. These cases,
which may be considered rather permanent than merely chronic,
maintain their status, either completely or partially, unchanged.
Yet they cannot, naturally or rationally, be held to be compatible
with a sound constitution or unimpaired stamina in the animals
so conditioned, and their liability to contract indispositions easily
394 OPERATIONS ON THE DIGESTIVE APPARATUS.
has frequently been remarked. Difficulty in the performance of
movements requiring effort has also been noticed, with conse-
quenily a liability to suffer traumatic injuries from external vio-
lence. To this must be added a fagility in contracting:
2d. Inflammation.— Generally this occurs as the result of
external injuries, but it may also occur without any apparent
cause. Its seat is the sac or its contents, and it affects the serous
structures alone, or assumes a phlegmonous aspect. The infiam-
mation of the serous tissue is often overlooked, while that of the
phlegmonous cannot pass unobserved. It may sometimes assume
a very serious character, and become even more dangerous than
the true strangulation.
3d. Obstructions or engorgements, common in intestinal her-
nias, are due to the accumulation of alimentary or stercoraceous
masses in the displaced intestines, or to gases which interfere
with the reduction of the hernia. This is often complicated with
strangulation, but is not in itself of a very dangerous nature.
4th. Strangulation.—This condition has been already consid-
ered. It is the result of excessive pressure upon the blood
vessels of the displaced organ, and while under its three periods
or degrees of congestion, inflammation, and gangrene, has usually
a fatal termination.
The general treatment of hernia has the two objects in view of
the destruction or obliteration of the sac, and the reduction or
closing of the ring. If the first is not always easy to accomplish
the reduction of the diameter of the ring often is so. Hach form
of hernia demands some special directions for the realization of
these two objects, and these will each receive its own share of
attention as they may in turn come under our notice in further
treating the various forms of hernia.
InaurnaL Hernia.
Inguinal hernia results from the passage or presence of a
portion of the intestines, or of the omentum, or of both together,
in the testicular or vaginal cavity whose opening of communica-
tion with the peritoneum or inguinal ring continues in its normal
condition, having never closed. A brief survey of the general
anatomy of the region involved will be a necessary preliminary to
our discussion of the subject, which is one of interest and im-
portance.
ee
bi
HERNIA. 395
L
D
E
Fic. 384.—Anatomical Disposition of the Inferior Inguinal Ring and Testicular Sac.
EXPLANATION OF Fic. 384.—A C, testicular sac, in which are shown—Ist, the neck
situated above the letter A, and concealed in the inguinal canal; 2d, a middle portion
extending from A to B; 3d, a fundus, B C, where the testicle is. DD, division of the
scrotal artery. IF G, inferior inguinal ring, whoso internal commissure is rounded
and formed of white fibres crossing each other and attached to the prepubic tendon.
H H, fleshy portion, from the small oblique, and forming the antcrior and internal lip
of the inguinal ring. K K, postero internal edgo of the inguinal ring, formed princi-
pally by an aponeurotic portion of the great oblique. L, scrotal artery. M, veins of
the scrotum and of the penis. N, part of the penis thrown backward. 000, tunica
abdominalis. P, muscles of the flat of the thigh, short adductor of the thigh.
The inguinal canal is an infundibuliform cavity, flattened
from one side to the other. It is situated in the groin, and
396 OPERATIONS ON THE DIGESTITE APPARATUS.
through it pass the testicular cord and the testicular blood ves-
sels, in the male, and the blood vessels of the mamme in the
female, as they emerge from the abdominal cavity. Situated on
one side of the prepubic region, it observes an oblique direction,
downward, backward, and from without inward, being formed
posteriorly by the crural arch, and anteriorly by the fleshy portion
of the small oblique muscle of the abdomen. Inferiorly it has
an opening called the inferior inguinal ring, which is made
through the aponeurosis of the great oblique, oval in shape, and
possessing two lips, edges or pillars, united together by two
commissures. The lips, divided into anterior and posterior, are
formed by the fibres of the aponeurosis of the great oblique
muscle of the abdomen, and a few of the muscular fibres of the
small oblique, reinforced by some bands of the tunica abdominalis.
The commissures, divided into external and internal, result from
the union of the extremities of the two pillars. The superior
opening of the inguinal canal is known also as the peritoneal
or superior inguinal ring, and is situated in front of and directly
opposite the crural ring. It represents a single slit, subject to
dilatation, placed also between the crural arch and the small
oblique of the abdomen, and allowing on its inner border the pas-
sage of the anterior pudic or posterior abdominal artery, it sur-
rounds the neck, and forms the entrance of the vaginal sheath. It
is open in horses, and often in bovines also, and it allows a direct
communication between the cavity of the vaginal sac and that of
the peritoneum—undoubtedly a predisposing condition to hernias,
not to be overlooked. The testicular sac offers to our attention,
from the point of view from which we now consider it, an
entrance, or true infundibulum, overlapping the internal opening
of the inguinal ring or canal; a neck situated just below that ring,
a continuation of the infundibulum or entrance, and which at a
short distance from its origin offers a well marked contraction in
its diameter—this being the point where strangulation takes
place—a middle part, containing the spermatic cord; and a
bottom, or true cul-de-sac, where the testicles and the epididymis
are lodged. ke
The special signification of the terms which have been else-
where and already employed to designate and classify the varie-
ties of form and manifestation characterizing different varieties of
hernia are of interest, and should not be lost sight of. They are
HERNIA. 397
divided principally into recent or acute, and old or chronic, and
we find them considered as enterocele, epiplocele, and entero-
epiplocele, according to their contents. The name of vaginal
hernia has been used to denote a case in which the intestine is
directly engaged in the inguinal canal; and hernia of the ring, or
hernia in the canal, describes that in which the viscera have en-
tered but a short distance into the sheath. Bubonocele signifies
that the intestine has entered but a very slight distance into the
inguinal sheath, in opposition to the oscheocele or scrotal hernia,
when. the intestine falls quite down into the sac, and with the
testicles themselves, occupies the bottom of the scrotum.
Inguinal hernias are generally accidental, but, as some authors
hold, are also sometimes congenital, having been found existing
. at birth; and in many instances they become permanent, the in-
testines occupying the vaginal sac without change, as a fixity.
Then, again, they may be intermittent, disappearing more or less
completely, under peculiar conditions, only to reappear under the
stress of new influential causes. Of course the classification of re-
ducible and irreducible, always holds. The classification of the
hernia of castration, which takes place during or after that opera-
tion, is considered by some to be properly one of the forms of
eventration.
A consideration of the anatomical disposition of the vaginal
canal, and especially of its upper ring, which presents an opening
communicating with the peritoneal cavity, will explain the reason
why inguinal hernias of the horse are more common in the stallion
than in the gelding. It is rare in’ bovines, but Lafosse has seen
it in sheep and in rams and although the anatomical disposition
of the canal in the dog render its occurrence difficult, Wolstein
has observed it in that animal. Cases are rare in females, but
Girard, Jr., has seen it in mares, Rychner in cows, and Hering,
Hertwig and Goubaux in bitches.
Recent Incurnat, Hernta.
When the hernia appears suddenly, in a subject not predis-
posed to it, the first symptoms are those of abdominal pain, ap-
pearing suddenly and without warning, and quite inconsistent
with the general perfect health of the animal. These symptoms
are at first vague in their significance, and definable merely as ex-
hibitions of simple pain in the abdomen.
398 OPERATIONS ON THE DIGESTIVE APPARATUS.
If in the stable, the animal becomes restless, paws with his
fore feet, gazes earnestly toward his flanks, and flexes his legs,
as if to lie down, and perhaps accomplishes that movement, but
only to resume the standing position. The skin is moist, the per-
spiration appearing on the face, around the ears, behind the
shoulders and in the groins. If he is in harness, his action is
changed, he shortens his steps, stops pulling, wants to stand still,
and becomes covered with abundant perspiration running over
him and dripping from his belly. These first symptoms excite
suspicion as to the real cause of the trouble, but they soon assume
a character which changes the suspicion into certainty. They rap-
idly assume greater severity, increasing in the ratio of the suffer-
ings of the animal, which then has no more rest or intermission,
and gives evidence of the most intense abdominal pain. He paws
and stamps upon the floor more and more violently, sometimes
kicking his abdomen; gazes anxiously toward his flanks; lies
carefully down and rolls to and fro on his. back, sometimes
keeping the dorsal position for a few moments, as if he could
only thus find relief; then suddenly rises to his feet and repeats
the movements, which give evidence of the torture he suffers, but
more forcibly and rapidly than before. The expression of his
face soon becomes characteristic. The lips are contracted, the
nostrils are retracted and dilated, and the widely opened eyes ap-
pear unnaturally large and prominent, rendering their agonized
expression more and more striking. The respiration becomes ac-
celerated and the pulse more rapid; the perspiration streams
more copiously from his body and the poor animal groans under
the weight of his trouble.
After a lapse of some hours, the time arrives for the occurrence
of strangulation, which may be pronounced the crisis or fatal
event of inguinal hernia. It is characterized by a peculiar mo-
tion of the head, which is thrown up and down repeatedly (and
which the French have designated by the word “encensé.”) This
motion, which is sometimes habitual with horses while in harness,
has a peculiar meaning when it becomes the expression of the
colic of hernia. It is then performed slowly, the head being ele-
vated gradually and extended upon the neck, to be suddenly
dropped again as if from weakness, to be again raised and
dropped during the few and brief intervals of remission of the
pains, while the animal possesses the ability to keep on his feet.
HERNIA. 399
In fact, when the hernia is completed, the colics are so violent that
the animal no longer lies down, but literally throws himself with
violence upon the ground, having become forgetful of the natural
instinct of conservation, and now rendered indifferent to all other
pain by the overpowering force of the hernial torture. With his
body covered with bruises, and bleeding from numerous superfi-
cial wounds, he now becomes a pitiable object. There are animals
of particularly sensitive temperament which will even, like those
in a rabid furor, bite themselves on their flanks and forearms in
their delirious desperation.
During these excessive sufferings there seem to be just two
positions in which the animal can experience a comparative de-
gree of comfort. They are, lying on his back, or maintaining the
dog-sitting posture, on his haunches. But these movements of
reprieve are of but short duration, and the pains may continue to
be manifested without cessation, by tumultuous, violent, unequal
struggles, which may continue twelve or fifteen hours, or even
more. At last, toward from the fifteenth to the twentieth hour,
all the signs of pain subside, and a great calm succeeds to the
previous violent agitation. This, however, is far from bemg a
good sign, or an indication of the termination of the disease. It
is, on the contrary, a sure token that a fatal termination is close
at hand, and if the patient has ceased to suffer, it is because the
anesthesia of death has fallen upon the organ in which his pains
originated. The parts which were so recently altogether too much
alive, have died. Gangrene has attacked the imprisoned intestine,
and with its appearance, loss of feeling has also come—and death
—for death is the loss of feeling. The animal is now in a con-
dition of extreme prostration. The temperature is diminished;
the perspiration is cold, the pulse is imperceptible, his face is
without expression, the poor brute can scarcely maintain a stand-
ing posture or move his legs when urged to, stir, and when the
last remnant of his strength is exhausted, after a few hours, he
drops upon the earth and dies without a struggle. Death rarely
delays beyond twenty-four hours following the strangulation.
This is the extreme limit, and in the greatest number of cases it
takes place within a shorter period.
These manifestations (the description of which we borrow from
H. Bouley), constitute the series of general symptoms of hernia,
but, at the same time, they do not belong exclusively to that kind
400 OPERATIONS ON THE DIGESTIVE APPARATUS.
of injury. They are those of any violent abdominal pain spring-
ing from any cause, and may be met with in invaginations, volvulus,
intestinal obstruction, etc. But ifnot possessing any positive and
intrinsic significance in themselves, they assume great value in the
diagnosis, when added to the series of local, or pathognomic symp-
toms which have their origin and limit in the inguinal region.
Two methods are available for the location of the seat of
the lesion, one being the external exploration of the inguino-
scrotal parts, the other consisting in the internal rectal examin-
ation of the pubic region. In a horse, and especially a stallion,
suffering from colics, the indication to a general and immediate
examination of the inguinal region, for abnormal appearances, is
always present, and it will not be safe to be too easily satisfied
with visual examination exclusively, to become certain that no
part of the intestines is engaged in the vaginal sac. The eye
may be deceived; it is the touch alone which will prevent all
possibility of error. The sensation imparted to the touch at the
beginning of a recent inguinal hernia is that of a thickened testi-
cular cord which has lost its usual suppleness, and whose con-
stituents can no longer be determined under the pressure of the
fingers. Thus thickened, the cord gives asensation of resistency,
increasing as the exploration is carried further up in the groin,
while toward the bottom of the sac, the scrotal mass feels fuller
than usual, the testicle becoming less movable, giving the sensa-
tion of aslightly puffy tumor. After several hours duration of the
disease, the characters become better marked, in consequence of
the increase in the size of the intestine, and the amount of exu-
dation, and there is also a formation of gases above the neck of
the sac, which also contributes to its increase in size.
The hernial tumor has thus. become changed from its original
appearance, by its enlarged size, and is easily detected by the great
general tension caused by the presence of the accumulating gases;
the cord is found to be tumefied in its whole length, while its
renitentcy increases as it extends upward into the canal. Direct
pressure with the fingers upon the tumor does not seem to cause
great pain, probably because this local sensation is dulled by the
extension of the excessive pains which radiate from the hernia
throughout the entire abdominal system. The external characters
of the inguinal tumor become more noticeable when both sides of
the testicular regions are compared, the difference between the
HERNIA. 401
healthy and the diseased regions being then easily ascertained.
Continued spasmodic movements of the healthy testicles have
been observed.
In the rectal examination of the horse, the hand may be easily
carried beyond the anterior border of the pubis, and the condition
of the superior opening of the inguinal canal, and the state of the
organs engaged in it thus ascertained.
In the normal condition, the anterior pillar of the superior
opening of the canal is easy of identification. It is in front and
on each side of the pubic region, and by reason of the extensi-
bility of its muscular structure, requires no greater force for its
separation from the posterior pillar than the introduction of two
fingers into the ring. When the intestine is in the vaginal canal,
after having passed through the superior opening, it can be felt
with the hand through the walis of the rectum, its situation being
generally on the inner side; and being thus recognized, it can be
raised, pulled upon, and sometimes even extracted from the open-
ing through which it had passed. But to be able to judge accu-
rately the nature of the object which has been felt, requires in
the surgeon an amount of experience in the taxis not always pos-
sessed, while its absence may at times betray the explorer into
serious error. Moreover, the sensations transmitted through the
rectum cannot in every case be truly interpreted, and it sometimes
becomes necessary to combine the two modes of examination em-
ployed simultaneously—the rectal investigation and the external,
manual, testicular exploration.
Thus, when with one hand in the rectum, pressing on the in-
ternal ring, and the other pushed well into the depths of the in-
guinal region, both are brought in contact, and it is discovered by
the actual touch that the inguinal canal is clear, the hypothesis
of strangulated hernia is at once negatived.
On the other hand, if there is hernia, and the imprisoned intes-
tine is encountered, the fingers of the two hands cannot possibly
come in contact, and the next question will be one of indication,
if not of prognosis.
As a rule, the prognosis of recent inguinal hernia is always seri-
ous. If developed without organic predisposition it is necessarily
a serious lesion by reason of its tendency to spontaneous strangu-
lation, which when unrelieved means death by torture, unless the
fatal event should be humanely anticipated and prevented by the
402 OPERATIONS ON THE DIGESTIVE APPARATUS.
fiat of a compassionate master. But a fatal prognosis need not
be unnecessarily volunteered. Timely and vigorous measures, es-
pecially emphasizing the “timely,” may still prevent the strangu-
lation and defer the sentence of mortality, and the sooner, there-
fore, the means of relief are applied, the more certain will be their
effect. Every minute’s delay increases the force of the disease and
lessens the chances of success. It is rarely the case that the lapse
of fifteen hours leaves any room for confidence, though it is not
yet time to abandon hope. Within that period there are many
chances for saying the patient, but after the earlier periods of the
attack a single hour’s neglect may be fatal—that hour may prove
to be the turning-point of the conflict.
The treatment of recent inguinal hernia assumes two forms,
consisting of the tas, and the operation of herniotomy, or the en-
largement of the neck of the vaginal sheath with a cutting instru-
ment. The first mode is indicated at once, or as soon as the her-
nia is recognized. The reduction must be accomplished in the
shortest time possible, the danger of strangulation becoming more
imminent and threatening with the lapse of every moment. The
taxis may give immediate relief, and may be materially assisted by
douches of cold water.
In this case the taxis consists in the manipulation of the part
with the hands, by pressure and otherwise, for the purpose of re-
placing the protruding intestine in its proper cavity; technically,
the reduction of the hernia. This manipulation is applied either
by simple pressure over the external surface of the diseased part,
or, if practicable and necessary, by supplementing it with a proper
traction applied upon the intestine from within through the rectal
walls. This manipulation may be applied by two processes, first
the subcutaneous, medial or indirect; and second, the direct taxis.
Ist. The Indirect Taxis.—In the first or indirect method, the
animal is placed in a standing position, with the hind legs secured.
Then the hand and arm of the operator, well oiled, are introduced .
into the rectum, using the right, if he is to operate on the left side,
and vice versa. When in the rectal cavity, the hand is carried to
the anterior border of the pubis, while with the other, passed in
front of the patella, pressure is applied upon the scrotal sac, and
the intestine pushed toward the superior opening. The hand in
the rectum then grasps the loops of the hernia, through the rectal
walls, and at the same time pulls them upward. Through these
HERNIA. 403
manipulations the surgeon may succeed in removing the difficulty,
if by that time the testicular sheath continues to be free from con-
gestion. But if this already exists, and the colics are increasing
in severity, the taxis in the standing position becomes impossible
and it will be necessary to throw the animal. This done, he must
be placed in the dorsal position, with his hind legs kept apart and
his haunches raised as much as possible by bunches of straw.
In this position, the operator must proceed to practice what
must be described as an exceedingly delicate massage or taxis
upon the scrotal sac, both hands being used, in such a manner as
to crowd or press the intestinal mass toward the superior opening
of the canal. The design of this is to stimulate the circulation
through the capillaries, and also to free the cavity of the intestine
from the semi-fluid and gaseous contents which may be present,
by this means diminishing its volume and facilitating its reduction.
That this must be done with the utmost caution and patience,
needs hardly to be urged. And it should be persevered in for at
least a period of thirty seconds before advancing to the other
step, which consists in gradually pushing the intestine toward
the opening. If the protruding loop is not too long, and the
massage has succeeded in its design, and the bulk of the tumor
has been sufficiently diminished, and, above all, if the hernia has
had but a short existence, it may be within the probabilities that
this external taxis alone will be sufficient to reduce it. But such a
result cannot be counted on with any degree of certainty, and it
is then the simple dictate of wisdom to make assurance sure, if
possible, by having recourse to double taxis, and attacking the
danger at both its internal and external accessible points.
For a single operator to undertake the performance of both
branches of this compound manipulation can hardly be advised.
Few men possess the necessary powers of endurance, and an acci-
dent might easily compromise the very life of both surgeon and
patient. At the least, it involves quite an unnecessary amount of
effort and fatigue. All the reasons are in favor of a division of
the work, by which a competent assistant will be put in charge
of the rectal taxis portion of the labor, while the practitioner in
chief will direct and execute all the other steps of the treatment.
The successful result of the operation will be known at once
by the diminution of the tumor, the disappearance of its puffy
and tense condition, by the sudden sensation of yielding, felt by
404 OPERATIONS ON THE DIGESTIVE APPARATUS.
the hand working in the rectum, and also by the facility with
which the fingers of that hand can be introduced into the now
liberated superior ring.
Anesthetics have been recommended as powerful adjuncts in
the application of the taxis, in this class of cases. Bouley
recommended their use, and Baggt, a Russian veterinarian,
agrees with Bouley, in advising their administration. His pro-
ceeding is thus described: The rectum being emptied, a solution
of two to four grammes of chloral and sixty or seventy centi-
grammes of acetate of morphia are thrown into it, while at the
same time compresses of chloroform are laid on the diseased side
of the inguinal region. In the course of ten minutes there is
such a relaxation of all the tissues that the reduction by rectal
taxis is quite easy. The spermatic cords are then surrounded by
rolls of bandages moderately tight, in order to prevent the return
of the hernia. These bandages are left on for eight or ten hours.
The danger of strangulation upon the testicular cords is an im-
portant objection to the adoption of this process. Severe appli-
cations of douches of cold water applied for one or two hours
previous to the taxis have been successfully employed by Steff
and Lacassin.
A process known as that of Patey, from its discoverer, con-
sists in the injection of oil of belladonna into the hernial sac, the
action of the oil, it is claimed, producing the dilation of the
pseudo-sphincter, which prevents the reduction. It causes a cer-
tain flaccidity of the parts, renders the taxis much easier, and con.
siderably facilitates the reduction.
2d. The Direct Taxis.—This procedure is of too dangerous a
character to maintain a place in the domain of veterinary surgery,
except under very exceptional conditions. It consists in apply-
ing the manipulations of the taxis directly upon the intestine,
previously exposed by the dissection of the testicular envelopes.
These manipulations, which are dangerous when the intestine is
distended by gases or fluids, may, however, be rendered easier by
relieving the intestinal loop, through the use of a fine needle-
trocar or aspirator, of the cause of its abnormal dilatation.
The method of Renault, mentioned by Zundel, is also a form
of direct taxis which, though it may be employed in cattle, involves
a subsequent fatal peritonitis in the horse. The operation con-
sists in the opening of the flank and the performance of the re-
HERNIA. 405
duction by direct traction with the hand thus introduced into the
abdomen.
The operation of herniotomy is that which consists in the
section of the neck of the vaginal cavity. Itis the proper opera-
tion for strangulated hernia. Bouley has said: ‘‘This operation
is not, as one may be inclined to think, a last resource, which is
not to be used except after the taxis, under its various forms, has
been applied and failed. Far from it. We believe, on the con-
trary, that in the horse, the taxis is a means of treatment which
is truly indicated only in the first five or six hours of the descent
of the intestine; that even, in this first period of time, one must
not use it too much nor too long, from fear of the complications
which might arise through the rectal manipulations, and that
after this limit of a few hours has elapsed, it is better to have re-
course immediately to the operation, without trusting to vain
hopes from the use of the taxis.” The operation is comparative-
ly a simple one, the dangers which were formerly apprehended
haying been greatly reduced by a better knowledge of the seat of
the strangulation, and of the parts to be divided, and the ratio of
mortality is now so small—forty-two recoveries out of fifty-two
operations—that hesitation is no longer justifiable.
The instruments required for this operation are straight and
curved bistouries, scissors, an ordinary director, a herniotome
(Figs. 384a, 385), or blunt, straight bistoury, and a pair of curved
clamps with strong cords to secure their branches. The hernio-
tome is a bistoury-caché, which, however, since the use of general
anesthesia, has been replaced by the blunt, straight bistoury, en-
ables the operator to divide the neck of the vaginal sheath in the
right place with more certainty than heretofore, and to regulate
more accurately the dimensions necessary to relieve the strangu-
lation. The director which is best adapted for use in herniotomy
is one which has a flat, lanceolated, grooved surface at one end,
and which, while it guides the blade of the bistoury, contributes
likewise to the protection of the intestine against the possibility
of injury by the sharp edges of the bistoury.
The patient to be operated on is laid upon a soft bed, anes-
thised as completely as possible, and placed upon his back. The
hind leg corresponding to the side where the hernia is located is
freed from the hobble, secured with a rope, and carried outward
in abduction, with the rope made fast to a fixed point near by—
406
Fig. 384a.
Herniotome.
OPERATIONS ON THE DIGESTIVE APPARATUS.
as a ring in the wall, a post, a tree, or
other immovable object. If the opera-
tion is to be performed at night, which
is too often necessarily the case, the
presence of additional assistants will
probably be required, in order to insure
an abundant amount and proper man.
agement of light, which is indispensable |
in so delicate a dissection.
In operating, the surgeon kneels be-
hind the patient and with a curved bis-
toury begins by making a long incision
upon the tumor, parallel with the long
axis of the testicle.
This incision is similar to that which
is made in castration with covered testi-
cles, and must involve only
the scrotum, the dartos,
and the first layers of the
lamellated cellular tissue
which unite this last to the
tunica erythroidea. The
remaining portion of this
lamelle is then carefully
incised, until the fibrous
coat is exposed, and the
tumor is entirely enuclea-
ted from its envelope of
cellular tissue. This done,
the fibres of the tunica
erythroidea are scraped
apart with the point of the
straight bistoury, until the
vaginal sac has been open-
ed, which the operator dis-
covers by the appearance
of a stream of liquid pass-
ing through. The canula-
ted director is then intro-
Wee duced into the opening and
Herniotomes of Colin.
HERNIA. 407
guides the bistoury, with which the hernial sac is now freely
opened, in front and behind. This free cutting allows the escape
of all the serous or sero-sanguineous fluid contained in the sac,
varying in quantity according to the duration of the hernia.
The contents of the hernial sac are now exposed. They consist
of the testicle, pushed outward, against the commissure of the
ring; the loop of the intestine, placed on the inner side of the
spermatic cord, rarely extending as far down as the testicle, but
_ usually reaching to the level of epididymis, and again, not un-
commonly remaining in the condition of a bubonoale. But what-
ever may be the dimensions of the protruding loop, the intestine
is always easily recognized by the roundness of its form, the smooth-
ness of its surface and its color, which may range from various
shades of red to bluish black. Itis also recognized by the changes
which have taken place in its consistency, resulting from the bloody
and serous infiltration which has taken place inits structure. The
intestine should now be carefully wiped off with a soft, fine sponge, .
or washed with lukewarm water, in order to free it from any de-
posits or adhesions of serous or bloody matter that may be present.
The opening of the hernial sac should be immediately followed
by the exploration of the neck with the index finger, with a view
to the determination of the exact point where the strangulation
exists, and to judge of its degree of tightness. This will not be
found upon the superior opening of the inguinal canal, as thought
by Girard, D’Arboval, Hertwig, Hering, Lafosse, Rey, Verrier and
others, but should be looked for two or three centimetres below that
opening, as demonstrated by Bouley; that is, where the neck of
the vaginal sac is situated. This point made out, if the hernia is
very recent, and the intestine has not yet become the seat of thick-
ening, a few tactical manipulations can be applied, the internal
face of the vaginal sac having first been lubricated with sweet oil,
or some mucilaginous substance, or even oil of belladonna; and
even cool irrigation has been of service. In the performance of
this taxis the first step is committed to the assistant, who stretches
both borders of the sheath in order to separate them in the form
of a funnel, the testicle being drawn outward, in order to stretch
the cord also. The operator then applies both hands upon the loop
of the intestine, and with moderate and gradual pressure endeavors
to push it through the neck of the vaginal sac. Rectal taxis applied
at the same moment may also be of great assistance. But these
408 OPERATIONS ON THE DIGESTIVE APPARATUS.
efforts must not be persevered in too long. If not successful al-
most immediately, it is better to have recourse at once to the in-
cision of the neck of the sac than to expose the intestine to the
subsequent effect of pressures or tractions of which the termina-
tion may be a fatal gangrene. The following steps are recom-
mended by Bouley in making this incision. Says this author: “One
assistant takes hold, with both hands, of the edges of the incision
made through the vaginal sac, stretching them into a funnel shape;
another draws the testicle outward and backward, to stretch the
cord. Then the operator having explored with his finger the con-
dition of the neck, introduces the blunt bistoury or the herniotome
(Fig. 386) as far as the neck of the sac, taking for his guide the
index finger of his right hand (Fig. 388), introduced
into the neck or canulated director, and holding the
instrument in such a manner that its
back rests against the pulp of the fin-
ger which supports it, and its sharp
edge turned outward, corresponds to
the stiffened band of the neck, to-
wards the internal face of the thigh.
This band will thus become stretched
over the knife in such a manner that
it divides itself upon the sharp edge
of the instrument, with the aid per-
haps of the slightest pressure made
by the finger which supports it. The
important point is to make a very lim-
ited incision, dividing only the thick-
ness of the vaginal sac and its fibrous
covering, and avoiding the wounding
of the cremaster, that being one of the
conditions of the closing of the sheath.
The division once made, the degree of
dilatation of the neck is readily made
out, and if the finger can be easily in-
troduced into it, the reduction of the
hernia becomes then an easy task.
The modus operandi by the use of
the herniotome differs but little from
the preceding. When this instrument
Fig. 386.—Narrow blunt Bistoury used as Herniotome.
Fig. 387.—The bistoury sliding flatwise on the Grooved Directory.
HERNIA. 409
Fig. 388.—Holding the Bistoury upon the Grooved Director.
is to be used, a careful measurement of the amount of opening to
be allowed to the blade must first be made. Then, guided by the
side of the index finger, and with its blade turned outward, the
instrument is introduced into the sac. When it has reached the
proper point where the division is to be made, the blade is brought
out by pressing upon the peculiarly-contrived handle of the instru-
ment, and the division of the band of the neck is completed.
After the division at the point of strangulation, the taxis is to
be used, both externally and by the rectum, carefully taking into
consideration the condition of the intestines in the application of
the various manipulations required.
Upon reduction of the hernia, obliteration of the sac is secured
by the application of a clamp, curved or straight, upon its parietal
layers, embracing between them the spermatic cord. In short,
the final steps of the operation will be precisely those by which
the operation of castration with covered testicles is completed.
This methed of closing the vaginal sac is the best, the simplest
and the most certain in its results. Itis true that the objection
that it implies castration is a weighty one, but the mutilation
which it involves is a condition of radical recovery which cannot
be obtained by any other means. The attempts which are made
to save the testicles, which are justifiable only in the case of very
valuable animals used for breeding purposes, are nearly always
followed by fatal results.
Among these may be mentioned the process by which, in-
stead of leaving the testicle to drop under the effect of the
pressure of the clamp, it is left inclosed in the vaginal sac, whose
divided edges are brought together by sutures.
Schmidt has attempted to push it back into the abdomen; but
such methods have been followed by fatal peritonitis. Bouley has
410 OPERATIONS ON THE DIGESTIVE APPARATUS.
also advised a subcutaneous herniotomy, which was put into prac-
tice afterwards by Siegen & Verrier, in which the careful puncture
of the sac was made at the origin, or, preferably, at the flabelli-
form insertion of the cremaster. After enlarging the opening, the
index finger is introduced into the neck, carrying with it the blunt
bistoury with which the structure is divided, and the reduction is
completed by the taxis, the wound being closed by several points
of suture. The use of antiseptics in our day obviates a large
portion of the danger arising from the complications which may
follow these modes of operation.
The operation for strangulated hernia in the gelding does not
differ much from that indicated for stallions, except in the man-
ner of closing the wounds, the clamp, in this class of patients,
being applied upon the hernial sac, involving the skin, as is done
in some cases of treatment for umbilical hernia.
The treatment of the patient subsequently to the operation is
generally a simple matter, the violent colics, with other manifesta-
tions of the hernia, having suddenly subsided, and the patient
being comparatively free from pain. He will probably give evi-
dence of some slight abdominal uneasiness, which will probably
be due to the pressure of the clamp upon the testicular cord, but
this will not be of long duration, probably requiring no other at-
tention than a moderate walking exercise.
The animal is then turned loose in a box stall and placed upon
a diet suited to his case, and watched for future developments.
The wound requires no special attention but cleanliness, and
towards the fifth or sixth day, when the suppuration is estab-
lished, the clamp can be removed.
It is about this time that complications may be looked for. A
fatal peritonitis, for example, may appear between the fifth and
tenth day, when everything has seemed to be progressing fayor-
ably, and bid defiance to treatment, especially if the intestines
were already in a gangrenous condition when the reduction was
made. After ten days there need be no more fear of complica-
tions, so far as the hernia is concerned, but it is not yet too late
for those of castration, which may still occur. The duration of
convalescence will average from twenty to twenty-five days, after
which the animal can resume his work. A return of the hernia,
recidive, is a rare and almost impossible event when the reduction
has been completed by castration.
HERNIA. 411
During the operation certain accidents may occur, including
eventration, an extra vaginal hernia and injuries to the intestines.
At the present time, eventrations are rare, by reason of the fact
that the division of the superior ring itself is no longer per-
formed. Yet they may occur through an accidental slip of the
knife, or a tearing of the walls of the vaginal sheath during ma-
nipulation for the reduction, and the accident is usually a fatal one.
Of extra vaginal hernia, Bouley says: ‘‘ While making the in-
cision of the neck, sometimes the cremaster muscle is divided in
the direction of its length; an accident possible, especially when
one uses the concealed herniotome, and when too much freedom
is allowed to its blade. It is then possible that the intestines may
become engaged through this incision, and appear outside of the
vaginal sac, above the inguinal ring. If at this moment, by mis-
applied taxis, the intestines should fail to re-enter the cavity of
the sac, eventration may take place. But if, on the contrary, the
intestine is first carefully returned into the vaginal cavity, and
then into the peritoneum, the edges of the peritoneal opening of
the canal being intact, the intestines will then be prevented from
making another exit.”
Wounds of the intestines may take place either through a
misdirection of the bistoury during the struggles of the animal,
or possibly from the nails of the operator or his assistants, and
the fact of their possibility suggests a sufficient hint touching the
obvious means of obviating their occurrence. The gravity of
these injuries will be measured by their extent.
Oxp InevrnaL Hernia.
Old, or chronic inguinal hernias, are those of which the charac-
teristic condition is that owing to the state of dilatation of the vag-
inal sheath, the intestine contained in it is enabled, without jeop-
ardy to the life of the patient, to continue its function in the same
manner as if it had remained in the open cavity of the abdomen.
The vaginal sac has in this case become a kind of large diverticu-
lum of such dimensions as to allow, without interference, the work
and motion of the intestinal tract, lodged within it, to go on in a
natural way. These hernias are divided into continued, or perma-
nent and intermittent—a division elsewhere alluded to—but they
may also be distinguished as simple and complicated.
412 OPERATIONS ON THE DIGESTIVE APPARATUS.
Among the varieties belonging to the latter category may be
named: the laceration of the superior opening of the testicular
sheath; the collection of serosity in the sac (hydrocele); the sar-
comatous transformation of the testicle where the hernia exists
(sarcocele); the adhesion of the intestines to the walls of the sac
(irreducible hernia); with obstruction and strangulation.
Although their causes belong to the list which we have already
considered, there is still a sort of latent difference observable in
the effects to which they severally give rise, as evidenced by the
slowness and tardiness of their maturity. They often appear, also,
as a sort of relapse or reactionary sequele (recidive of the French)
of acute hernia improperly reduced, or as a consequence of the ab-
normally dilated condition of the upper ring, while this constitutes
a predisposing cause. But this same condition of dilatation may
be congenital, and in animals with a predisposing conformation
chronic hernia of the intermittent kind is of easy occurrence.
Whatever may be their mode of formation, however, they are gen-
erally of long standing, and readily diagnosticated by their positive
and familiar characters.
Chronic hernias are generally of larger dimensions than the
acute, and when exclusively vaginal, filling the cavity of the scro-
tum and forming a true oscheocele. If the laceration of the supe-
rior opening of the canal has allowed the formation of a sac and of
an adjunct tumor, in front and outside of the cord, the hernial tu-
mor will then consist of two lobes, the smaller situated in the depth
of the groin, under the ventral walls, and the larger occupying the
scrotal sac.
These hernial tumors are usually formed by the small intestines
and the floating colon, in exceptional cases, by the pelvic curva-
ture of the colon as well. They vary also in volume as well as in
consistency, from an obyious cause; enlarging after meals, to con-
tract again when the abdomen is empty; and again, giving various
impressions under the hand, according as their contents are gas-
eous, liquid or solid. In the first condition, when the intestines
are empty and the animal is at rest, the tumor is soft, supple, elas-
tic and more or less reducible, but when the animal is in action it
increases in bulk, and becomes more tense and elastic, and less
easy of reduction. There is therefore a condition of intermittency
in their character, which is due to the peculiar conditions in which
the animal may be placed. The form of these tumors corresponds
HERNIA. 413
to that of the testicular sac in which they are contained, the in-
guinal oscheocele being pyriform, with its contracted portion
resting in the groin.
Vermicular movements of the intestines and borborygmus are
symptoms easily detected in large hernias. The tumor of a
chronic hernia is painless, or nearly so. Rectal examination
furnishes evident indications of the possibility, and of the
presence of the hernia by the degree of the dilatation of the ring
and the size of the organ engaged init. In such a case, the dila-
tation may be so great, even notwithstanding the presence of the
intestines, that the hands, placed respectively, one in the rectum
and the other in the inguinal region, can be brought in such near
proximity as to touch each other. All these symptoms, taken to-
gether, or even isolated, are sufficiently characteristic to establish
a positive diagnosis of simple chronic hernia,
The serous exudation which necessarily exists in chronic
hernia, may, when it is excessive, render the nature of a hernial
tumor more obscure, and give it the appearance of a case of true
hydrocele, the serous sac in these cases being so full as to render
it impossible to discover, either by sight or feeling, the presence
of the intestines contained in it, even the elastic resistance of its
walls being undetectable. But here a rectal exploration will help
to solve the question; and, again, by placing the animal in the
dorsal position, the gravitation of the liquid into the abdomen
will readily reveal the truth by leaving the intestine alone in the
sac.
Great caution is necessary in these doubtful cases, in which
a misdirected stroke of the bistoury, thoughtlessly or accidently
made, might prove certainly fatal, by incising the intestinal
knuckle, which it really is, instead of simply opening the mere
serous sac which it was supposed to be. The formation of a
sarcocele may also render the diagnosis difficult. In these cases
the testicle, considerably tumefied, rough on its surface, and hard
and painful, is felt at the bottom of the sac, and thus conceals the
character of the hernia. Still, with sarcocele hernia coexistent,
the scrotal tumor acquires an appearance and proportions differ-
ent from those of its uncomplicated state. In this last case, the
testicle constitutes the principal mass, and the elongated cord,
stretched by the weight of the organ, can be easily traced with the
fingers quite up into the groin. If, on the contrary, both hernia
414 OPERATIONS ON THE DIGESTIVE APPARATUS.
and sarcocele are present, the testicle is bosselated and hyper-
trophied, and the cord which supports it is surrounded by the
protruding intestines, which form on the outside an elongated
mass, of a consistency either puffy or perfectly elastic, according
to the period of digestion. Intelligent rectal exploration will
always reveal the presence of the intestine through the ring.
When chronic inguinal hernia becomes complicated with acute
inflammation of the displaced organ, the scrotal tumor becomes
warm, painful, evenly tense and remittent, and assumes nearly all
the characters of a phlegmonous tumor, that a strong tempta-
tion is offered to open it with the bistoury. But, if this is con-
templated, it should be preceded by a rectal examination, carefully
made, as the only means of avoiding a possible error of diagnosis
whose consequences would be fatal. If the inflammation con-
tinues to be localized, the intestine contracts adhesions with the
walls of the sac, and the hernia becomes irreducible; but if, on
the contrary, the phenomena of inflammation extend to the peri-
toneum, an acute peritonitis is established, and the patient suc-
cumbs in a few days.
The obstruction or engorgement, which is a possible complica-
tion of chronic inguinal hernias, consists in the distension of the
intestinal loop by the lodgment of alimentary masses of varying
bulk which accumulate, and for the time being, occlude the intes-
tinal tract. This complication may be recognized by the in-
creased volume of the tumor, its greater weight, and the sensa-
tion of a softish and puffy mass contained in it. Itis often, how-
ever, but a temporary trouble, the colics which attend it yielding
easily to appropriate treatment, and the removal of feces from
the rectum by back-raking being often sufficient in itself to afford
relief. But in exeeptional cases, treatment fails; the obstruction
becomes persistent; the feeces accumulate in the protruding in-
testines; the tumor is increased in bulk, and at length a period
arrives when such a disproportion between the volume of the dis-
tended intestine and the capacity of the opening through which
it has passed is established, that all the conditions necessary for
strangulation are fulfilled. This soon takes place and becomes
evident by the exhibition of symptoms akin to those pertaining
to its analogue of the recent or acute variety. There is, how-
ever, a difference between the two forms in respect to the impor-
tant matter of their comparative amenability to treatment, inas-
HERNIA. 415
much as while strangulation in the acute cases is only relieved
with great difficulty, without resorting to the operation of herni-
otomy, it is not uncommon in those of a chronic character, also
strangulated, to succeed by a careful exercise of the taxis, in dis-
placing the alimentary mass which causes the obstruction, and
thus forms one of the contributing conditions of the strangula-
tion. It is only in case of failure in this endeavor that herniot-
omy becomes admissible.
A chronic inguinal hernia is always a serious ailment, though
not necessarily incompatible with the life and health, and even
partial usefulness of the horse. It must, however, constitute a
blemish which cannot fail largely to depreciate his commercial
value, since it must always be liable to interfere with the efficient
performance of his accustomed labor, besides keeping him in a
state of greater or less exposure to complications and tendencies
which are a constant source and menace of danger to the valetu-
dinarian animal.
Operations for the relief of hernia are always attended with a
certain gravity, even when they are of the simplest character of
which they are capable, and if complications exist the danger
must necessarily be intensified and aggravated, even to the ex-
tent of jeopardizing the life of the patient. In the excellent
work of Peuch & Toussaint, speaking of the applications of treat-
ment, they remark: “In animals less than fifteen months of age
suffering with hernia, the expectant method is the proper indica-
tion, since the lesion may disappear as the animal gets older and
develops. Inguinal hernias of small size must be left alone, not
interfering, while in that condition, with the work of the animal.
The operation in chronic inguinal hernias, complicated with lacer-
ation of the superior opening of the inguinal canal, and conse-
quently with ventral hernia, is contra-indicated by the imminent
danger of the occurrence of eventration during the operation, or
when the clamp is removed. When, however, the hernial tumor
has assumed such enormous dimensions, that, like the udder of a
cow, it hangs down to the hocks, there is no more contra-indica-
tion, the animal being then useless - and yet some slight chances
of success still remain. Hernias complicated with hydrocele, sar-
cocele or obstruction, are cases calling for operation, and when
the point of strangulation has been reached, the indication of
immediate and urgent interference is imperative.”
416 OPERATIONS ON THE DIGESTIVE APPARATUS.
To this we may add, with Bouley, that the operation is also
indicated when the hernia is exclusively vaginal and of sufficient
proportion to interfere with the locomotion of the patient. It is
also indicated as a means of preventing its further development.
The operation for chronic inguinal hernia identifies itself with
that of castration with the use of the clamp, and by the process
known as covered testicles, as it is by this alone that the accom-
plishment of the ultimate purpose in the reduction of the hernia
and release of the strangulation can be obtained. The instru-
ments required are those needed in castration. The clamp, how-
ever, requires to be of increased length and dimensions, and
Fig. 389.—Straight and Curved Clamp.
curved, in order to adapt itself to the parts. A broad cloth, such
as a bed sheet, may prove useful to receive and protect the intes-
tines in case they should protrude too extensively.
The animal is placed in the decubital position on his back,
with the leg of the affected side maintained in abduction. Anes-
thetics are generally used, especially when there are fears of com-
plications, while, in fact, they ought never to be omitted. The
operator then, with the convex bistoury, makes carefully, on the
inferior border of the hernial sac, an antero-posterior incision,
parallel to the median raphe of the scrotal region, cutting through
the skin, the dartos and the first layer of the cellular tissue under-
neath. He then with his hands tears the adhesions which exist
between the dartos and the tunica erythroidea, in order to enucle-
ate the hernial tumor in its entirety. This step is easily effected
when the cellular tissue, which covers the fibrous coat, is not in-
durated, but if that should be the case when adhesions exist, the
s
HERNIA. 417
dissection should be carefully made with the knife until the ad-
hesions are completely divided and the fibrous coat fully exposed.
The reduction must then be attempted without opening the sac,
and in the absence of any adhesions this is effected without diffi-
culty, the inguinal opening being so large that, through the force
of mere gravitation, the dorsal position in which the animal is
placed is often sufficient in itself to cause the return of the intes-
tines into the abdominal cavity, even the testicle and the hernial
sac often following it in its inward movement.
If the reduction does not take place in this manner, or in con-
sequence of the position of the animal, the taxis, both scrotal
and rectal, is then indicated to be performed in the same manner
as for acute hernia. Difficulties in effecting this reduction may
arise from three causes—either, first, the bulk of the mass repre-
sented by the protruding intestines; or second, its obstruction ;
or third, the adhesions which it may have contracted with the
walls of the sac or with the spermatic cord.
To obyiate the first difficulty, while the manipulations of the
taxis, scrotal and rectal are simultaneously continued, it will
be well to relieve the position of the animal, and instead of keep-
ing him lying absolutely on his back, to allow him to turn
slightly, and to rest on the side opposite the hernia. In this
way the mass will not be so heavy to manipulate, and will be in a
better position to follow the dependent direction in which it
must be pushed by the scrotal taxis, while at the same time, by ~
the rectal manipulation, it can be more easily unfolded and drawn
from the cavity in which it wasimprisoned. But if, notwithstand-
ing all these precautions, this difficulty in the reduction cannot be
overcome, the indication of opening the sac still remains.
The incision of the sac is performed as in cases of recent
hernia, the bed-sheet already mentioned being held in readiness
to receive the intestinal mass as it will be exposed. Then the
animal being completely under the influence of ether, and in the
dorsal position, an assistant grasps the edges of the sac and
stretches them apart, funnel-wise, using both hands alternately,
gradually pushes the intestines towards the hernial opening, an
assistant at the same time slowly unfolding the mass and permit--»
ting it to slide into the abdominal cavity.
Rectal taxis may largely assist in this step of the operation.
If the reduction is rendered impossible by the interposition of
418 OPERATIONS ON THE DIGESTIVE APPARATUS,
obstructions, the first indication will be to evacuate the intestines
by a methodical pressure which will displace the alimentary mass
and return it toward the abdomen. The puncture made with the
aspirator has proved very beneficial in these complications.
The adhesions require the most careful dissection, especially
when they are short, and when both the visceral and parietal
layers of peritoneum are closely united. The separation must be
done by a succession of short, limited incisions, at the expense of
the thickness of the parietal layer.
When strangulation of chronic hernia occurs, it is due not to
want of room at the hernial ring, but to the enlarged bulk of the
protruding organ, which constitutes the obstruction. Conse-
quently the indication for herniotomy is not present. On the
contrary, as serious eventration is always to be feared, the only
indication is the removal of the obstruction as already indicated.
When the reduction has been completed, the occlusion of the
vaginal sac is to be obtained by the application of the clamp,
applied as high up as possible, as in cases of strangulated acute
hernia. ‘
In cases of inguinal, complicated with ventral hernia, attempts
at reduction may be made by placing a long clamp over the coy-
erings of the latter, involving with them the hernial sac and its
cutaneous envelope, as practiced in some cases of the umbilical
form.
We need but briefly to refer to certain different modes of treat-
ment of the various forms of hernia by the use of bandages, rec-
ommended by Petard, Grau, Klinger and Marlot, together with
the application of sutures upon the edges of the inguinal canal,
patronized by Hertwig and Dieterichs, to say that none of these,
any more than some others, borrowed from human surgery, can
give more satisfactory results, or be employed with greater safety,
and effect a radical cure better than the use of the clamp and the
castration by the process of the covered testicle.
InaurinaL Hernia IN GELDINGS.
Although inguinal hernia in the gelding is certainly less com-
mon than in the stallion, it is not, therefore, of impossible occur-
rence. But from the fact of its rare appearance it is far more
likely to be overlooked, and therefore neglected, with similar fatal
HERNIA. 419
results to those in the stallion, when it reaches the stage of
strangulation.
From the fact that, as the result of castration, the superior
opening of the testicular sheath is more or less closed, it becomes
a matter of rational inference, that hernia in a gelding is not of
posterior occurrence to castration, but that its existence is due to
a congenital disposition, and that by the operation of gelding they
have been reduced to their smallest proportions, in relation to the
dimensions of the intra-vaginal sac, to the dimensions, in fact,
of a bubonocele, which continues unobserved in consequence of the
smallness of its size, and the depth of its location.
These hernias are detected outwardly by a physical symptom,
to wit, the existence in the inguinal region, on either side of the
penis, and above the cicatrix of castration, of a tumor about the
size of an egg, soft, depressible, altogether painless, sometimes
elastic and at times puffy. It varies much in size, diminishing
with rest and quiet, and increasing with effort and active move-
ment. It may, in fact, under the first condition, entirely disap-
pear, to return as soon as the animal is put to work. In a word,
it has the true character of being intermittent. Aside from these
symptoms, rectal exploration furnishes positive data of its exist-
ence, by the abnormal dilatation of the ring, easily detected, and
by the pressure of the intestines lodged in it.
This hernia is also susceptible of strangulation, and is then ac-
companied by violent abdominal pains, which must not be ignored
as to their possible diagnosis and significance. The indication
for careful examination in that direction must, indeed, never be
overlooked in cases of violent colics in geldings. If these colics
are due to strangulated hernias, the presence of a round, tense,
resistant and painful tumor will be detected in either of the in-
guinal regions, and, according to Bouley, more commonly on the
left than on the right side. The strangulation in this class of
hernia is generally irreducible, and becomes rapidly fatal; if not
relieved immediately, it is not relieved at all.
The first indication of treatment is the reduction of the hernia
by simple, external taxis, or by combining with it the rectal taxis.
The reduction will be followed by the disappearance of all the
symptoms, and the animal will be apparently well, until a second
attack takes place. After the reduction, steps must be taken to
prevent its return, by an operation similar to one of those used in
420 OPERATIONS ON THE DIGESTIVE APPARATUS.
umbilical hernia, to obtain the reduction and retention of the in-
testine, by the application of a proper clamp upon the sac coy-
ered by the scrotal skin.
The treatment of the gelding for strangulated hernia does not
differ from that of the stallion. Ordinarily, the taxis is sufficient
to reduce such complicated hernia, but in case of failure in obtain-
ing rapid success one must be careful not to carry on the manipu-
lations so long as to encounter the risk of lacerating or tearing
the tissues. The wiser and safer plan will then be to have recourse
to the operation of herniotomy, an operation which should be
performed with the greatest care in separating and dividing the
existing cicatricial adhesions of castration. The clamp is after-
wards placed upon the hernial sac, with its cutaneous covering,
requiring a longer time to slough, and constituting a means of
retention most favorable to the success of the operation.
CruraL Hernia,
or merocele, is that form of rupture in which the abdominal
organs make their escape through the crural ring. It is a rare
affection among our domestic animals, but has been seen by La-
fosse,.Jr., in the horse, by Girard, Jr., in the dog, by Dandrieu in
cows, and by Hertwig in horses, donkeys and dogs. It is said to
be more frequent in males than females. It results from violent
muscular efforts, and especially from the slipping apart of the legs
when already separated or straddling in abduction. It is char-
acterized by a somewhat well defined tumor, of moderate size,
situated behind the inguinal ring, towards the middle of the flat
part of the thigh. When the rupture is recent, the animal is some-
what stiff in his gait, especially on the affected side, and carries
his leg in abduction. There isalsoa degree oflameness. Accord-
ing to Hertwig, the tumor is easily reduced, and not very painful.
In a few cases it may be complicated with strangulation. The
organs which have been found in the sac have been portions of
the small intestines ; the omentum, as reported by Hertwig, and the
bladder, in one cow, according to Dandrieu. The prognosis in
cases which receive early attention, is not serious.
The treatment consists in reducing the rupture, and afterwards
closing the passage through which it occurred. ‘This is effected
by making an incision through the skin over the tumor, and closing
HERNIA. 421
the ring with a few stitches upon Poupart’s ligament and the small
adductor of theleg. A good blister rubbed over the enlargement
completes the treatment. According to Zundel, three weeks of
subsequent rest are required to assure recovery.
PerineAL HERNIA.
Thisis a very rare lesion and, as Zundel describes it, is the pas-
sage of the peritoneum and viscera through the vasculo-aponeur-
otic floor of the bottom of the pelvis. Itis, however, reported to be
common in dogs, in which animal it is situated between the ischium,
the sacrum, the anus and the urethra, and is often mistaken for an
abscess. It is more frequently formed by the bladder than by the
intestines.
Pancreatic Hernia.
This hernia was first observed by Prinz, and afterwards noticed
by Husson, Roell, and others. It is caused by the strangulation
of the jejunum and the anterior part of the ileum through the
hiatus of Winslow, the orifice above the right angle of the pan-
creas, and of the vena cava, in front of the right kidney. It is
accompanied by symptoms of intestinal congestion, and cannot be
reached by any form of treatment, if indeed it can be accurately
diagnosed during life.
Petvic, ok IntErNaL Hernia oF OXEN.
This form of hernia is principally described by Zundel, from
whom we extract’the following: “It is the strangulation of a loop
of intestines, which has pushed through the ruptured peritoneum,
from before backward, between the testicular cord and the lateral
wall of the pelvis, the rupture of the peritoneum having resolved
during some of the manipulations of castration from excessive
stretching of the cord, as in the operation by tearing. It is, there-
fore, exclusively a lesion of the ox, and cannot affect the bull. It
is quite common in Germany, and has been met with in England,
Mecklenburg and Alsace. It was first described by Oesterten, in
1811, followed by Anker in 1824, and later by Zundel, Ostertag
and Tues. It is comparatively often seen, and in many cases over-
looked. The first intimation of the presence of the disease appears
in the onset of symptoms of a violent attack of colic. The animal
becomes anxious and restless, lies down hastily and rises again
422 OPERATIONS ON THE DIGESTIVE APPARATUS.
suddenly; turns about, moyes to and fro, lashes with his tail, and,
in a word, betrays all the usual signs of intense suffering, and it
becomes difficult, if not dangerous, to approach him in order to
make a proper examination. The temperature of the body is ele-
vated, there is some perspiration, the nose is hot, though still
moist; both respiration and circulation are accelerated. The ani-
mal refuses food or drink, rumination is suspended, and though
defecation has not ceased, the feces are hard, blackish and coated.
In from six to twelve hours, this state of febrile excitement
subsides, and the animal becomes dull and quiet, gazing towards
its flanks, the ears dropping, the hind leg corresponding to the
side of the hernia is extended backward, and at the same time the
lumbar region is relaxed downward. If the animal is lying down
he may remain quiet for a while, with his hind leg still extended,
but will presently spring to his feet with his back arched as before,
at the lumbar region, but which drops again and straightens im-
mediately. When he walks it is with a stiff action, principally
towards the diseased side; the extremities are cool, the pulse is
small and insensible, respiration is accelerated ; constipation at
length becomes complete with mucous and bloody passages, per-
haps accompanied with flatulence, but micturition is still easy.
Two or three days later there are other changes. The period
of calm terminates, and is succeeded by a season of alternating
agitation and repose—action and reaction of the fluctuating in-
flammatory process.
The animal now and then utters grunts of pain, his pulse be-
comes smaller, and is at length imperceptible, and all the un-
favorable manifestations are exaggerated. Hither gangrene has
supervened, or, as some would judge, enteritis, and all the symp-
toms point towards the more fatal termination,
It is only by rectal examination that the diagnosis can be posi-
tively established, and when this has been carefully and success-
fully made, he will have discovered what may be thus described :
a puffy mass, indefinite as to size, situated usually nearer the
sacrum than the pubis, onthe side of which, generally the right,
a portion of the intestines has slipped under the testicular cord—
this being the definition of a crural hernia. It may bea simple
protrusion of the intestine, and again, this maybe twisted around
the spermatic cord, a condition particularly likely to terminate in
strangulation.
HERNIA, 423
This lesion may continue as long as nine days, four to five
being the average duration, and it may terminate by spontaneous
reduction, but the trustful surgeon who too confidently and too
often expects to find that Nature has dispensed with his aid in
this kindly way, is doomed to encounter many disappointments.
Or it may end in gangrene or enteritis.
The fact that the disease, if not interfered with, may terminate
fatally in so brief a period as five days, of course renders the
prognosis quite a serious one, unless the nature of the ailment
has had an early identification and measures have been taken to
avert the danger. The gravity of the prospect is, of course, in-
creased when the complication with strangulation or enteritis, as
before mentioned, enters into the case.
The treatment, as in other cases, consists in the reduction of
the hernia. With a small proportion of patients this may be
effected by the simple act of causing the animal to walk down a
steep declivity—a sort of spontaneous, or semi-spontaneous cure,
from which, although founded on anatomical principles, too much
must not be confidently expected. We copy from Zundel his de-
scription of other and more scientific methods:
(a) Reduction by Simple Taxis.—The animal is placed on an
inclined plane, with his hind-quarters raised, and an assistant on
one side of him ready, at a given moment, to press on the loins.
The operator, with his hand in the rectum, searches for the in-
testinal loop, and when he has found it, holding it in the bottom
of his hand, he feels for the opening under the spermatic cord,
which he dilates with his fingers, and now, while the assistant
presses hard on the loins, as just mentioned, the intestine may
be readily felt moving downward and forward under the cord, to
resume its normal position. Although simple, and, in the ma-
jority of cases, successful, this mode has the defect of leaving the
animal exposed to a return of the hernia.
(6) Reduction by Laceration of the Cord through the Rectum.
—This method is recommended by Metzger, Hisele, Schenck,
Gierer and Ostertag. It consists in tearing away the adhesions
formed by the stump of the cord after castration, and loosening
it from the inguinal ring. It is, however, difficult to do, and not
without danger. The hand being introduced into the rectum,
and the opening found, the fingers are closed in the form of a
wedge, and with a slight movement of rotation pushed through
424 OPERATIONS ON THE DIGESTIVE APPARATUS.
the opening, and the cord thus separated from its adhesions.
After a while, the pressure, which was quite firm at first, dimin-
ishes, and the intestine gradually returns to its position. This
mode is slow in its steps, but it is successful in its results, even
in cases of obstruction and of strangulation. When it fails, it is
because of the strength of the adhesions between the cord and
the abdominal walls, or the inguinal canal.
(ec) Division of the Stricture through the Rectum.—To per-
form this operation, invented by Schmidt, a trocar about sixty-
five centimeters (some thirty-five inches) long is necessary. This
trocar has its point attached with a screw, in order to permit its
removal and the substitution of a blunt bistoury. With the left
hand in the rectum, a fold of that intestine is secured a little be-
hind the point of stricture, and the trocar pushed through it.
The stylet of the instrument being then withdrawn, leaving the
canula in place, the point of the trocar for the bistoury is then
inserted, while the hand, still in the rectum, leaves the rectal fold
loose, feels for the spermatic cord, raises it and guides the bis-
toury against it, which with comparative ease completes the di-
vision of the stricture.
(d) Division of the Stricture after Incision of the Flank.—
Through an incision made in the middle of the right flank, the
hand is introduced and grasps the spermatic cord, which is then
divided with a bistoury caché, or, which is better, with the inside
edge of a hook kept sharp, similar to the hook used in some cases
Fig. 390.—Sharp Hook for the Section of the Testicular Cord.
of distokia. The hernia being reduced, and the wound in the
flank brought together with sutures, a circular bandage is applied
around the abdomen. With the reduction of the hernia, what-
ever may have been the means of accomplishing it, the symptoms
subside, and the treatment is completed by the administration
of laxatives or sedatives, rectal injections, etc., as the indications
may require.
=
HERNIA. 425
UmepinicaL Hernia.
Umbilical hernia is the protrusion through the non-obliter-
ated umbilical ring of either the omentum or the small intestine,
or both. Itis also known as an exomphalus or omphalocele. It
receives the name of enteromphalus or epiplomphalus when formed
by the displacement of the intestines, or that of the omentum
separately, and when both of those organs are implicated it be-
comes an entero-epiplomphalus. Umbilical hernia is quite com-
mon in horses and dogs, not less so in bovines, and has been no-
ticed in swine and sheep. It is most common in young animals,
especially soon after birth, is at times congenital, and may be long
continued, even to adult age, or for eight, ten or twelve years.
Umbilical hernias are either congenital or accidental. The
former are formed during fcetal life and continue at birth, al-
though, according to some authors, they are, strictly, not so
much congenital as accidental, and are, in fact, the result of the
pulling and stretching of the umbilical cord during the act of de-
livery. However this may be, they do usually, in fact, make their
appearance during the second and third months following birth,
when through the persistency of the opening, and the imperfec-
tion of the umbilical cicatrix, the intestines are enabled to pro-
trude through the ring, and subsequently to prevent its closing
by their presence. But again, while the cicatrix is weak, the ac-
tive exercise and forcible movements of the young animal while at
play may cause the rupture; and still, again, the protrusion may
be caused by intestinal derangements. Indeed, all traumatic
causes, such as contusions, blows, and any violent efforts taking
place during the period of consolidation of the closing cicatricial
tissue, may become an originating cause of this lesion. Animals
of low and lymphatic constitution are much predisposed to this
trouble, especially such as feeble colts, born of mares badly cared
for and insufficiently fed during gestation. Heredity fills a large
place among the predisposing causes in low-conditioned mares with
féeble organizations, and suffering with similar trouble when young,
dams of this class naturally bringing forth foals of defective stam-
ina, lable to perpetuate the same constitutional tendencies.
The symptoms of umbilical hernia are generally exclusively
local. It is characterized by a semi-globular or pyriform tumor
situated on the median line of the abdomen at the umbilical ring,
426 OPERATIONS ON THE DIGESTIVE APPARATUS.
and varying in dimensions from the size of a hen’s egg to that of
a child’s head—dimensions which may vary according to the con-
dition of vacuity or fullness of the intestine; the position of the
animal, whether standing or lying, or according to the length of
time it may have existed. The consistency of the tumor is very
variable. It may be soft, easily depressed by the finger ; elastic,
when distended with gases; or soft and puffy when containing
alimentary matter—these changes being accounted for by the na-
ture of the organ. An enteromphalus will give the sensation of
an elastic mass, while the epiplomphalus will form a puffy swell-
ing. This species of hernia is almost always painless, and exhib-
its as one of its peculiar and constant symptoms the character of
being reducible. In the generality of cases, it can be made to
disappear temporarily by the taxis and by forcing the protruding
portion back into the abdomen, but only to reappear at once as
soon as the pressure is withdrawn, especially if the animal is on
his feet. On being thus reduced, the opening of the ring can
readily be detected, and the fingers may be freely introduced
through its diameter and its form and dimensions ascertained,
shewing it to be sometimes elliptic, sometimes circular, and some-
times irregular, the originating cause of the hernia itself deter-
mining the difference.
Besides these more common symptoms of umbilical hernia,
there are others which can be detected by more careful examina-
tion. For instance, on applying the hand over the tumor, the ver-
micular motions of the intestines may be recognized, and by feel-
ing in the hernial sac, the presence of feecal masses may be discov-
ered; and it may be possible by auscultation even to detect the
presence of borborygmus through the displaced intestines, and
even to observe its true nature, by reason of the transparency of
the sac and its envelopes. These are the most ordinary symp-
toms of an exomphalus, although it is subject to complications,
and the symptomology will vary accordingly.
There are cases, but they are rare, in which the hernia be-
comes irreducible. The most serious of these are such as are
found to have become so in consequence of the formation of ad-
hesions between the protruding organ and the hernial sac—a very
infrequent occurrence. The most common cause will be the pres-
ence of undigested masses of food accumulated in the intestines,
such as hard balls of feeces or sand.
42
J =
HERNIA. 427
Inflammation of umbilical hernia may follow blows or bruises,
though such a result from these accidents is not a common one,
and its occurrence will naturally be accompanied with changes
in the appearance of the tumor, such as the usual phenomena
attending inflammatory action, as increase of temperature, ten-
derness or pain, cedema, etc., which may even at times so com-
bine their effects as to render the hernia irreducible. Engorge-
ments and strangulations, however, are very rare complications
of this form of hernia, a fact easily understood when it is con-
sidered that the neck of the hernial sac is formed by the umbilical
ring itself.
An exomphalus is usually an affection of little gravity, and
often disappears spontaneously, or if it persists after the period
of weaning, is easily radically cured when the animal grows and
develops. Yet even if undisturbed and unchanged, they persist
in remaining, their existence is not incompatible with perfect
health and full ability to labor, however they may reduce the com-
mercial value of the animal. They are less injurious to young
animals than to adults, and less dangerous when small than when
assuming large dimensions. When simple, they are easily amen-
able to treatment, but if complicated they become dangerous, es-
pecially so when the capacity of the ring is so disproportioned to
the dimensions of the protruding intestines that strangulation be-
comes an accident of easy occurrence. Reducible hernia is at-
tended with but little hazard, while the danger arising from the
possible formation of adhesions in cases which have passed into
the irreducible class becomes a matter of very serious import.
If it is an admitted fact that animals suffering with umbilical
hernia do often recover spontaneously, the recovery being a normal
incident of the natural development of the animal, due to changes
of position in the abdominal contents, not to specify other effi-
cient causes ; then the question of immediate or early interfer-
ence undoubtedly receives and justifies a negative answer. Our
own testimony is that we know of cases where patient waiting,
even for a period of twelve months, has been rewarded by the
' radical disappearance of the hernia. But the objections to such
long waiting are of a tangible and serious nature, and surgical
interference becomes imperative and indispensable. The persons
are few who are able or willing to nurse an idle horse for a year
for the sake of saving him from the pain of an operation.
428 OPERATIONS ON THE DIGESTIVE APPARATUS.
The object of all treatment is, of course, the reduction and re-
tention of the hernia, but the means of doing so are various.
They are mainly included under four heads. The first method is
by bandages ; the second, by external or topical applications ;
the third, by surgical operations for the constriction of the tumor;
and the fourth, such special treatment as may be required to meet
complications.
1st. Bandages.—The bandage of retention is essentially a belt
buckled around the body, by which a pad is kept over the open-
ing of the umbilicus to prevent the escape of the abdominal con-
tents, and temporarily perform their office in the subcutaneous
hernial sac. It is designed to aid in the mechanical closing of the
umbilical opening until that takes place by the process of physio-
logical change in the sac and its borders.
The forms of bandage in use are many and various, among which
Peuch and Toussaint name four principal kinds. A most import-
ant requisite in all of them is that while they possess the solidity
and fixity necessary to retain the reduced hernia in place, they
shall cause the minimum amount of discomfort to the patient.
The bandage of Marlot, according to Zundel, is the one which
best fulfills the three conditions of solidity, fixity and elasticity.
It consists of a kind of padded saddle, with straps at its four
corners, buckling on two belts, the anterior or pectoral, which sur-
rounds the chest like a girth, and the posterior or ventral, which
presses the retaining pad against the umbilicy. This pad isa
wide hair cushion of a moderate thickness, kept in place and pre-
vented from slipping back by a longitudinal girth connecting the
pectoral and the ventral belts.
The bandage of Massicra is much recommended in Italy. This
also is a small saddle with two wide girths passing under the
thorax, and pressing against the sternum and the epigastric re-
gion, with a steel band corresponding at its posterior extremity
with the umbilical ring, forming a plate padded with a hair cushion.
The apparatus of Strauss, used in Germany, is made somewhat
on the same principle, but is reinforced by a kind of breeches
which prevents it from slipping backward.
The length of time necessary for a patient to wear a bandage
will vary with the dimensions of the hernia—from one to three
months, according to Lafosse, being required to obtain a radical
eure. Marlot claims that an average of thirty-two days is all that
HERNIA. 429
isnecessary. The bandages must be applied only after the perfect
reduction of the hernia, and the most accurate adaptation of the
pad to the umbilical opening. These appliances are of difficult
adjustment and are unavoidably uncomfortable to the animal from
their liability to chafe and excoriate the skin. They, therefore,
constitute a mode of treatment which must necessarily be attended
with uncertainty, and, therefore, as justifying only a careful and
modified recommendation. Still, it has inthe hands of many prac-
titioners given very satisfactory results.
2d. Local Applications.—The treatment by irritating local med-
ication aims to produce in the tissues surrounding the hernial sac
an inflammation which will end in a serous infiltration which will
crowd away the protruding organ, prevent its return into the open-
ing, and subsequently facilitate the obliteration of both the-sac
and the ring. This result is obtained by the use of certain chem-
ical agents, which applied on the hernial tumor tend to produce
various degrees of inflammation, from simple rubefaction to com-
plete escharification of tissues. In former times sulphuric acid was
recommended, and as late as 1833, Hertwig employed it in appli-
cations made during two or three days. Blisters and their con-
geners have had their day. Astringents have also been recom-
mended, as also caustics, principally in the form of ointments, as
that of chromate of potash, in the proportion of one part in eight,
as recommended by Foelen—these also have had their advocates.
But of all these, nitric acid, applied externally, is the one which
has proved most satisfactory and least dangerous.
The treatment consists in applying acid upon the tumor of the
exomphalus, in sufficient quantity to produce an escharotic effect,
and afterwards promote the sloughing of the cutaneous sac. The
mode is thus described: After positive diagnosis of the nature
and character of the tumor, the animal being kept in the standing
posture, the hairs cut short, the acid is applied over the entire sur-
face of the sac, by rubbing it in with a brush, or a small ball of
oakum secured at the end of a stick, and dipped into the acid—
which should register 34° to 36° Baume—first passing it circularly
over the base of the examphalus to define the place where its action
is required, and then including the entire surface. A sufficient
quantity of the caustic must be applied, and with enough energy
to produce the disorganization of the skin in its entire thickness,
and positively produce its mortification. Experience has proved
430 OPERATIONS ON THE DIGESTIVE APPARATUS.
that the deeper the action of the caustic, the more successful the
operation is likely to be. It is said that nearly one ounce of the
acid is required for a tumor as large as a man’s fist, and that the
friction should be continued from three to five minutes. The
duration of the friction and the quantity of the acid to be used
must, however, be guaged by the dimensions of the tumor, and
also with careful consideration of the thickness of the skin. Dayot,
to whom is due the positive and practical introduction of this mode
of treatment, proposes to apply the acid in instalments, and recom-
mends that the application be repeated once or twice an hour,
according to the thickness of the skin, until the desired effect is
assured. The result of our own experience is a conviction that as
a rule only a single application is necessary. Nitric cauterization
produces a yellow eschar, which ordinarily remains for a long time,
soft, supple, and unctuous to the touch, but the epidermis of which
is easily lacerated. In some cases the formation of the eschar is
followed by a large swelling of the cauterized parts and the sur-
rounding tissues. Sometimes it makes its appearance immediately
following the operation, but more commonly it appears at a later
period, gradually increasing during the first hours following the
cautery, although again, in other cases, this swelling is altogether
absent. The cedema is the direct effect of the action of the caustic
upon the subcutaneous cellular tissue, which becomes infiltrated ;
and in this condition applies a uniform pressure in all directions
upon the peritoneal hernial sac, crowding back into the abdominal
cavity the displaced intestines and preventing their return by the
kind of retentive bandage which is formed by the engorgement
which takes place around the sac.
In the days following, after reaching the maximum develop-
ment, the cedema gradually diminishes by resorption, becoming
at the same time somewhat harder, the portions of cauterized skin
which is in its center meanwhile gradually drying, and becoming
transformed into a dry, hard plate.
In place of the hernia there now remains a fibrous mass of new
formation, which gradually diminishes and is soon more or less
resorbed. In the meantime, while these phenomena are taking
place, the process of the separation of the eschar has begun and
progressed, and on the eighth day, on the boundary between the
dead and the living structures, a fissure shows itself, and minute
granulations appear. The separation goes on slowly, from the
eae
HERNIA. 431
circumference to the center, leaving, when complete, a rose surface,
granulating evenly, small fibrous formations sometimes appearing
in its center. This wound heals rapidly, leaving a contracted
cicatrix, which assists in keeping the hernia in its place, while the
indurated skin, which for some time remains adherent to the still
fibrous, abdominal, subcutaneous tissue, contributes to the com-
plete obliteration of the ring. After a month the cure is radical,
and in place of the hernia, there remains only a hairless cicatrix,
often without pigment.
Though this treatment is simple, and has, by the results it has
shown, justified the credit it enjoys among those who have had
experience and knowledge of its working, it must not be at once
accepted as infallible, or unattended with danger. Cases are on
record which negative such a claim. For instance, too severe a
cauterization may be followed by the entire sloughing of some
portion of the abdominal walls, followed by a large eventration ;
and peritonitis, tetanus and intestinal fistulz are complications
which have sometimes disappointed hopes which seemed to be
well founded.
Animals to which this treatment has been applied must be
carefully watched for some time during the period following the
cauterization. They must be especially prevented from indulging
the tendency they often betray—to bite, or scratch with their
feet or legs, the irritated, cauterized surface. A cradle or aprons
hanging in front of their hind legs, or even bandages may prove
effectual to prevent this suicidal habit.
The topical remedies we have mentioned before, might in
strictness be considered as coming under the head of external
treatment, since they have all been applied to the surface of the
skin. There is, howevor another mode of application which is
subcutaneous, and which is represented by the method of Dr.
Luton, and employed in the treatment of the same ailment in
children. It consists in injecting subcutaneously, at each cardinal
points of the hernial sac, a few drops of a saturated solution of
chlorides of sodium (kitchen salt). We have had but one oppor-
tunity to try the value of this treatment, which we improved by
injecting ten drops of this solution at each point of a hernial
tumor. We produced an enormous swelling, followed after several
weeks by resorption and complete disappearance of the hernia.
According to Peuch and Toussaint, our friend M. Cagny has
432 OPERATIONS ON THE DIGESTIVE APPARATUS.
made the same experiment, but failed to obtain a successful
result.
3d. Surgical Operations for the Constriction of the Tumor.—
Modes of surgical treatment are numerous, usually haying in view
the destruction of the hernial sac, by the process of mortification,
so controlled and directed as to bring about the necessary work
of adhesion between the walls of the sac, above the line where the
mortification begins, with the formation of a secondary cicatriza-
tion between the edges of the skin, where the mortified sac has
dropped off.
Before casting the animal, without which the operation cannot
be performed, the surgeon must satisfy himself that the hernia is
reducible, and that there is no adhesion, and should carefully
measure the dimensions of the sac in order to know accurately
where the constriction must be applied. The animal must be
placed well on his back, with his hind quarters elevated—a posi-
tion which is sometimes sufficient alone to enable the hernia to
reduce itself. If that fails to occur, the sac can be evacuated by
the taxis. Itis then to be well stretched, and the application of
the means of constriction proceeded with.
These means are many, but may be considered under the three
heads of the ligature, the clamp and the sutwre—all of which are
occasionally combined in use, as the ligature with the suture, or
the suture with the clamp.
(a) The Ligature.—This old mode of operation consists in
the application—the hernia having been reduced—of a strong
cord, firmly tied at the base of the hernial pouch.
The modus operandi is very simple. The hernia being already
reduced, either by the taxis or by the power of gravitation, as
before mentioned, and the horse in the right position, on his back,
the sac is raised from the abdomen, and a strong ligature, firmly
tightened, is applied at its base, a strong fishing line forming the
best of ligature for this purpose. The degree of tightness of the
ligature must be such that the mortification of the sac will be a
gradual process, and that it does not slip from the walls of the
sac, on account of the progress of the inflammatory swelling.
Still this constriction must not be permitted to become so ex-
treme as to produce too rapid a sloughing of the skin, with the
possible result of a calamitous eventration.
In order to prevent the displacement of the ligature, some
HERNIA. 433
practitioners recommend the introduction of two small wooden
pins just under it, either parallel or crossing each other, through
the base of the sac.
If the hernia is very large, instead of employing this mode of
simple ligature, en masse, the operator may use two ligatures.
By pushing through the middle of the sac, close to the abdomen,
a dog seton-needle, carrying a doubled cord, and converting it
into two parts in cutting it from the needle, each length will serve
to embrace half of the tumor, in the manner practiced in the pro-
cess of removing large, hard tumors by ligature. Legoff has rec-
ommended the use of several ligatures dipped into ammonia, placed
one above the other upon the whole length of the sac, from its
bottom to its base, tightening them more and more as they ap-
proach the abdomen. By this process he combined constriction
with cauterization.
This mode of treating umbilical hernia is a simple and easy
one, but yet it is not very frequently practiced. The uncertainty
of its results, the possibility of the sloughing of the skin at too
early a period, with the danger of eventration, as well as that of
injuring the intestines with the wooden pins or the needle, have all
combined to impair its credit and discourage its use among care-
ful operators.
(6) Clamp.—In this process, which dispenses with the caustic,
after the reduction of the hernia, the skin is stretched and pressed
between the branches of a wooden clamp or of a specially adapted
forceps. The clamp is a simple implement, and may be made with
a curve, in which case its convexity is made to adapt itself to that
of the abdomen. When applied, it is pressed close to the abdom-
inal walls, and its branches brought together with nippers adhoc,
and secured with a strong cord, as in the process of castration.
The clamp is left on from nine to fifteen days. In many cases,
the displacement of the instrument is prevented by using the
wooden or metallic pins passed through the skin below it, the
ends of the latter being bent over to keep them in place. This
operation possesses some great advantages, but offers also some
special dangers, among which is the instinctive tendency of the
patient to get rid of the irritating appliance by tearing it off.
Another objection to the clamp is found in the danger of caus-
ing troublesome excoriations of the sheath by the friction which
it necessarily occasions. Benkert and Brogniez have advocated
434 OPERATIONS ON THE DIGESTIVE APPARATUS.
the use of metallic clamps, but an important objection is found in
their weight. Borhauer had the branches of the wooden clamp
perforated in several places for the introduction of the pins which
held it in place. Bordonnat has invented a special form of me-
tallic clamp or rather forceps, with sharp points on the inner bor-
der of one of its branches about one-half or three-quarters of an
inch apart, and in the other a corresponding number of holes into
which the points are designed to fit when the instrument is closed.
Each branch has a prolongation at each end, which on one carries
a vertical projection cut with a screw-thread, while in the other
there are holes corresponding with the projections, and there are
nuts to fit the screws. When the instrument is applied, and the
projections passed through the holes, the nuts not only hold it
in place, but are adapted to fix the pressure at any desired point,
or change it at pleasure. The umbilical forceps of Marlot is
made of two small wooden plates, slightly curved lengthwise, and
brought together by means of gooves in their dove-tailed extremi-
ties, through which screws are fastened. This instrument, like
the metallic clamps, is objectionable principally on account of
its weight, and is generally less practical than the ordinary clamp.
(ce) Sutures.—These are of various kinds, all agreeing, how-
ever, that the stitches upon which they rely shall be so close and
tight that the circulation will be so effectually cut off in every
part of the hernial sac that mortification cannot fail to follow.
The Quilled Suture.—This consists in placing the sac between
two small rods of hard wood or metal, and tying them before and
behind with strong cord twisted and rolled around their extremi-
ties, and also by passing here and there in their length sutures of
double the strength of those which are applied in cases of ordi-
nary quilled suture. Acting somewhat by pressure, this mode
much resembles the treatment by the clamp, but is little used at
present, notwithstanding some small advantages which it may be
thought to possess.
HERNIA. 435
Twisted Sutures.—This consists in applying upon the hernial
sac several stitches of strong cord in order to keep the reduced
hernia in statw quo. It is sometimes used in dogs, but is uncer-
tain and dangerous.
Suture of Delavigne.—This is another dangerous mode of
operation, no longer in practice because of the hazard of injury to
the intestines. It consists in applying a strong double suture at
the base of the sac in the following manner: With a small needle,
like that used by harness makers in sewing leather, a thread is
passed through and through on both sides of the flat, cutaneous
surface from right to left, or vice versa, then carried back the re-
verse way at a small distance from the first puncture, and the
sutures firmly tied. This is repeated until the entire sac is in-
cluded and the sutures have gone beyond the umbilicus. From
fifteen to twenty days are said to be sufficient to effect a radical
cure.
Method of Mangot.—To make a closing suture on the hernial
sac, without danger to the intestine, Mangot has recommended
the use of a perforated plate of lead, by which to aid in the reten-
tion of the intestines in place and accurately define the line upon
which the sutures are to be applied. The plate is made to cor-
respond in dimensions with the opening of the umbilical ring, but
somewhat longer and wider. Besides the longitudinal slit in its
center, it also has an eye at each corner for the attachment of
strings to secure it in place by tying them over the back. The
hernia being reduced, and the plate put in place by pushing the
skin of the sac through its longitudinal opening, the operator ap-
plies a continued suture over and on the outside of the plate to
keep it in position, with the flap of sewed skin hanging below it,
the entire apparatus being securely attached to the abdominal
walls by two pins running through the sac at the extremities of
the suture.
During the first days there is much inflammation. About the
third or fifth day the pins are removed and the skin below the su-
ture excised, leaving the plate to be retained only by the strings
which pass over the back. These are sufficient, however, to keep
it in place, and its removal will not be necessary until inflamma-
tion is well established all around them. A simple dressing, held
in place by a bandage, will help the cicatrization, which is said to
take place in from seven to eight days.
436 OPERATIONS ON THE DIGESTIVE APPARATUS.
Method of Hannon.—The modus
operandi here indicated does not vary
from that of Mangot, except in being
modified by the use of the quilled su-
ture, as before described, instead of
employing the transversal pins of Man-
got.
Method of Mignon.—This is a com-
plex mode, consisting of a combination
of the ligature, the clamp and the suture.
Like Mangot, he passes the skin through
aplate of lead, attaches perforated clamps
on the protruding sac below it, and pass-
es the stitches or sutures through the
perforations in the clamps.
Method of Benard.—This is strictly
speaking, the application of the crossed
suture, a stitch exactly resembling that
of harness and shoemakers in their re-
spective trades. In making it, a peculiar
forceps is used, which is applied like a
clamp, and serves not only to keep the
sac closed and secured, but also to pre-
vent the return of the intestines into its
cavity, and to assist in guiding the two
needles with which the suture is made.
Its branches are at one end articulated
together, and also at the other in order
to fit into handles. Itis twenty-two cen-
timeters in length, without including the
handles; two centimeters in height, and
one and a half in thickness. The branch-
es are brought together tightly by a spe-
cial screw arrangement near the handles,
and each has a number of holes, placed
recularly, one centimeter apart, and uni-
ted by a groove. Two strong straight
needles and strong waxed thread are re-
quired. In operating, the hernia being
first reduced, the skin is well stretched
Fic. 392.—Nippers of Benard.
eA
HERNIA. 437
between the branches of the forceps, then these are tightened by
the screw management of the handles, and next the instrument
is committed to the care of an assistant. The crossed suture is
then made by the simultaneous passage of the needles through
the holes in the branches of the instrument. The directions to
insert the needles simultaneously must not be overlooked. If
disregarded, the penalty liable to follow will be the tearing of the
waxed thread with the points of the instrument, and also a tang-
ling of the thread. This method gives a stronger ligature than
Mangot’s, but it lacks the support furnished by the metallic plate.
Method of Mariot.—The methods of Benard and Mangot are
here combined. A peculiar thin forceps is used having dotted
grooves on its outer surface to indicate where the stitches are to
Fic. 393.—Plate and Nippers of Marlow.
be placed. When the suture is finished and the forceps removed
a plate of zinc like that of Mangot is applied, as a means of reten-
tion, the zine plate being thought to be an improvement upon that
of lead, on account of its adapting itself better to the parts.
Method of Chedhomme.—The animal in this method is kept on
his feet, properly secured, and a plate of lead applied, as in the
process of Mangot. The hernial sac, folded in two on its longitu-
dinal axis is then passed through the opening of the plate, the
operator making the least possible traction until the remaining por-
tion of the umbilical cord, which is still quite large, is firmly held
between the thumb and the index finger of the right hand. Then
a stronger traction is made upon the sac, at the same time moving
it in various directions, while with the left hand the plate is
strongly pressed towards the abdominal walls. Then with the
intestines entirely replaced, the operator grasps the sac with the
438 OPERATIONS ON THE DIGESTIVE APPARATUS.
left hand, and with the right, introduces a strong needle which is
pushed through and through at each extremity of the sac, and
an elastic ligature passed three or four times around its base.
Towards the tenth day the slough is completed, and only a small
wound remains, which cicatrizes rapidly.
Direct Suture of the umbilical ring.—Director Degive recom-
mends for the treatment of umbilical hernia in young dogs, the
direct interrupted sutures of the ring, the number of stitches
varying with its dimensions. After bringing the threads together
the wound is left open until they have safely eliminated themselves.
We have employed this mode of operation for many years in the
hospital of the American Veterinary College, using antiseptic pre-
cautions, and with the best results. Making a longitudinal line
on the median line of the sac, and having carefully pushed back
the intestines, the edges of the ring are sewed together with two
or three stitches of cat gut ligature. The parts were then thor-
oughly washed with a solution of bichloride of mercury, and the
edges of the skin brought together with silk sutures and a com-
pressing bandage applied for the protection of the wound from the
patient's own teeth. Complete cicatrization follows in a few days.
Whatever may be the original mode of treatment the secondary
effects are about the same in each case. They consist of irritation
of the parts, more or less marked, and betrayed by the patients by
varying degrees of restlessness, and possibly, in some cases, by
abdominal pain or colics.
After a few hours the swelling of the part begins. A diffused
cedema takes place above the point of compression, and the hernial
sac is slightly swollen and warm and becomes covered with little
phlyctenoids, indicating a commencing necrosis. Perhaps a litile
fever is manifested and there is great thirst. By the third day
the swelling is quite large, and in males it may involve the sheath.
The sac then becomes cooler, the fever subsides, the appetite re-
turns, and the animal which has instinctively kept his feet, rests
himself by lying down. On the fourth or fifth day the skin of the
sac is insensible, cold and flabby, and the sloughing process between
the living and the dead skin has begun. Little by little this pro-
cess becomes more active, and the separation becomes more and
more marked, the secretion around its opening a purulent character,
and from the sixth to the tenth day the complete sloughing will
have taken place. The wound that remains is now granulating.
"ee ~ a
iw,
HERNIA. 439
Its length exceeds its width, and it is somewhat depressed in its
center It progresses rapidly towards cicatrization, only a small
scar remaining, and this is readily concealed by the growth of the
surrounding hair.
(d) Operation in Cases of Complications.—If the hernia is
irreducible and there is strangulation, the enlargement of the ring
must be carefully made with a curved, blunt bistoury, having a
short, guarded sharp edge. When the reduction is prevented by
adhesions, the operation necessary for their division will demand
the exercise of the utmost skill and caution to avoid injury of the
peritoneum, and there should especially be no neglect or parsi-
mony in respect to the employment of antiseptic precautions. In
fact, it would in many instances be wiser to leave the animal to
the resources of nature than to undertake an operation of so much
delicacy and importance, and which involves so many serious con-
sequences, without amply providing every resource of skill and
knowledge, and anticipating every contingency of accident or dan-
ger. In some cases, when the strangulation has been due to the
formation of gases in the protruding intestine, we have used the
aspirator for their removal, and then have met with no difficulty
in reducing them by the taxis. This is a means, however, which
is also recommended in the treatment of strangulated inguinal
hernia, and is discussed in the chapter appropriated to operations
in that region.
DIAPHRAGMATIC HERNIA.
A diaphragmatic hernia, or diaphragmatocele, istormed by the
displacement of one of the abdominal organs, and its intrusion
into the pleural cavities, through a laceration of the diaphragm. It
is necessarily an accidental opening, through which sucha dis-
placement takes place. One case is on record, and only one,
where the hernia passed through a normal opening, viz., the ceso-
phageal.
The causes which give rise to ruptures of this kind may be
classified under three heads: first, external violence; second, pow-
erful contraction of the expiratory muscles while making a violent
effort; and third, the exertion of force and pressure upon the dia-
phragm by the organs, situated on its posterior face.
(a) External Violence.—Yoremost in this category are blows
or contusions on the posterior costal region, such as may be made
440 OPERATIONS ON THE DIGESTIVE APPARATUS.
by the shafts of vehicles with either the blunt or broken ends.
The laceration of the diaphragm may occur either with or without
involving the fracture of the ribs. Several cases of this kind have
been seen and recorded by Professor Barrier.
(0) The Powerful Contractions of the Expiratory Muscles
during Violent Muscular Eifforts——It may result from the vio-
lent and concentrated action of the abdominal muscles, compress-
ing powerfully the intestinal mass, and crowding it against the
diaphragm, until it destroys its continuity at one or more points,
sufficiently to admit of the passage of the abdominal organ into
the thoracic cavity. Durand has seen it in a six-months-old colt;
Didry and Fabey have reported cases where the hernia took place
during violent efforts in hauling a load, and Franconi met with a
case of a similar character to the one referred to in which the rup-
ture opened into the cesophagus. Schild has seen it associated
with the efforts of parturition.
(ec) Violent Action and Pressure upon the Diaphragm by the
Organs Situated on its Posterior Face.—The obliquity, forward
and downward, of the inferior plane of the abdomen, is shared
forward upon the posterior face of the diaphragm by the organs
related to it, as the liver, the stomach and the anterior curvatures
of the large colon. These are bulky organs, and their united
weight being very considerable, the pressure it exerts upon the
diaphragm, under any extra impulse would tend directly and nat-
urally to the disruption of the weaker muscular fibres of the
midriff, and these yielding, the hernia would immediately become
developed, and thus we have the generation of this kind of hernia.
A sudden fall might easily bring this to pass, in a second or two
of time. Bouley has recorded a case in which this accident oc-
cured in an animal cast for a surgical operation. Pilton has seen
it take place in an animal falling down while butting against a
slope of ground.
Diaphragmatic hernias, like others, are either acute or chronic ;
or conyertibly, recent and free, or of old standing, with adhesions.
The distinctions of hepatocele, splenocele, stomachocele and entero-
cele are of but little importance, none of these differences being
discoverable in the living animal.
The symptoms of acute hernia of the diaphragm differ, accord-
ing to the extent of the laceration of the muscle, and the size of
the displaced abdominal mass. There are cases in which the in-
HERNIA. 441
jury is of so aggravated a character from the first, that a fatal
result immediately follows the formation of the hernia, the only
characteristic symptoms present being those of rapid asphyxia.
In other cases, though death must inevitably follow, the life of
the animal may be prolonged for several hours, or even several
days. And again, there are recent hernias which have been formed
under such conditions that they are still compatible with the sur-
vival of the animal. These assume the chronic character, and not
infrequently escape discovery.
The horse affected with diaphragmatic hernia becomes dull,
anxious and uneasy, avoiding his manger and avoiding his food.
He paws in the stall, giving evidence of suffering from abdominal
pains, but which betray no peculiar characteristics, and possess
no special or positive significance. Very often colics precede
the hernia, and its formation complicating the case, the colics be-
come more violent. During these colics the animal hesitatingly
and carefully lies down, rolls much, and assumes various attitudes
of no special significance, though the dog-sitting posture is some-
times held to be characteristic. During these colics, which are
more persistent than those due to intestinal indigestion, the pulse
remain strong and quite regular, and respiration is not only ac-
celerated, but difficult—the physiognomy is anxious, with an ex-
pression of apprehended suffocation, the nostrils are tetanically
dilated, inspiratory movements are performed with effort, and
expiration is of twice or three times its normal frequency. The
coexistence of this condition of the respiration-with the colics is
a sign of great importance as an element of the diagnosis. At
times auscultation furnishes valuable data. Borborygmus may be
detected in the thorax, where the respiratory murmur ought to
be heard, and dullness on percussion takes the place of the nor-
‘mal resonance, where the respiratory murmur has disappeared.
Bouley, though he recommends this means of diagnosticating,
considers it to be applicable only for hernias of large size, in which,
according to Lafosse, an increase in the size of the thorax, a well
marked projection of the cartilaginous circle of the ribs, and to-
gether with these, areduction in the size of the abdomen would be
noticed. When the hernia is small, the respiratory function is
unaltered.
Acute diaphragmatic hernias, not necessarily of fatal tendency,
are more difficult to detect. Probably from their rareness they
442 OPERATIONS ON THE DIGESTIVE APPARATUS.
often escape discovery, notwithstanding a somewhat positive exhi-
bition of abdominal and thoracic symptoms. And if this is so
with the acute form, it must necessarily more frequently occur with
chronic cases, which not only do not jeopardise life, but even fail
to interfere with the usefulness of the animal. The horse thus
affected not only has the double expiration of his emphysematous
lungs, but he continues to be subject to intermittent colics, and
especially if the hernia is formed by the intestines, and they con-
tinue to suffer from occasional obstructions. To this complication
of occasional actual obstruction must be added a perpetual liability
to become strangulated, with a certainty of speedy death following
that accident.
The lesions found at the post-mortem examinations of ani-
mals which have died with this description of hernia varies. The
accidental diaphragmatic openings may exist in different parts
of the central aponeurotic portion or in the peripherical muscular
zone, and may assume various forms, being at one time round, at
another eliptic or triangular, or indefinite and irregular, at times
very narrow, at others so extensive that the abdominal and thoracic
cayities are no longer distinct. Between these two extremes there
are many degrees and ample scope for the formation of chronic
hernias of a non-malignant character. When the hernia is recent
and has existed before death, the borders of the laceration whether
muscular or aponeurotic, are irregular, thready, infiltrated and
bloody, with small blackish clots adhering to the extremities of
the red muscular fibres. But when the rupture is of post-mortem
formation, resulting from excessive meteorism, there is no trace of
capillary hemorrhage upon the lacerated edges of the aperture.
With a chronic hernia these edges have various aspects; at
times thin, at others in thick cords; now torn in scallops, and
again with a regular edge, they are always smooth, hard, of fibrous
consistency, and even presenting a cartilaginous aspect. There is
never any formation of a special serous sac for these hernias, even
for those which take place through the normal openings. The
organs most commonly met in these diaphragmatoceles are the
omentum, the small intestines, the anterior curvature of the large
colon, and more rarely, the spleen and the stomach. If not con-
gested by pressure in passing through the opening, they continue
to perform their functions.
In these injuries the prognosis can never be confidently favor-
a
+ ee
(Vind
ie
HERNIA. 443
able. It is always serious. Some Ixll immediately, while with
others there may be a respite of several hours or days, and with
those which are chronic, there may be no apparent impairment of
life or health. But whatever may be the character or the aspect
of a given case, and however the prognosis may vary, it must
never be forgotten that diaphragmatic hernia has this invariable
character, thatits effect is always to interfere with the respiration ;
that the horse is at the best permanently affected with heaves, is
unable to perform any active or laborious service where strong
lungs are needed, and is always more or less liable to engorgement
and strangulation. Diaphragmatic hernias are incurable, their sit-
uation, in the deepest interior of the anatomy, rendering it impos-
sible to apply any means of direct therapeutic treatment. They
cannot be reduced, and even if that were practicable, they could
not be secured and retained in situ. Attempts have been recom-
mended by Bouley to reduce them by making an incision through
the flank and replacing the protruding organ in its proper posi-
tion by the taxis with the hand in the abdominal cavity. Whether
in our days of perfect antiseptics such an operation could be suc-
cessfully performed on the horse is a question not yet solved. The
experiment might be attempted with better chances of success in
cattle. In any case the operation will be justifiable only as a
last resource, and when the life of the suffering animal is abso-
lutely in jeopardy, in fact, as a final alternative, a dernier resort.
VENTRAL HERNIA.
This term includes all hernial tumors produced by the pro-
trusion of one or several of the abdominal organs through an ac-
cidental opening in the muscular and fibrous walls of the abdomen,
under the skin, which remains intact. The opening through which
this kind of rupture takes place is always accidental, unlike those
which pass through the natural channels, as the umbilical or in-
guinal, but still, in common with them, has a peritoneal lining.
Ventral hernias are of quite common occurrence, principally
however, in large animals, while in small quadrupeds they occur
less frequently, and they may take place in any part of the abdo-
men. They are known by distinctive names, corresponding with
those of the protruding organ, as gastrocele, hepatocele, enterocele
and epiploocele, ete.
They usually originate as direct causes in blows or contusion
444 OPERATIONS ON THE DIGESTIVE APPARATUS.
Fic. 394.—Ventral Hernia.
upon the abdominal walls, made by blunt bodies, which, lacking
force to pierce through the elastic skin, are yet sufficient to lace-
rate the interior abdominal walls. An example of this occurs in a
thrust from the shaft of a vehicle, or its broken end, in case of
a fall, or of kicks or horning among cattle in the field. In colts
they are more commonly found in the lower wall of the abdomen,
the animal frequently inflicting them upon itself by attempting too
high a jump over a picket fence, and failing to clear it properly.
Serres says that in cattle they may follow a severe distension of
the abdomen under the influence of tympanitis, abdominal dropsy,
or gestation.
The character of a case of ventral hernia will vary in respect
to its being acute and recent, or chronic and old. Indeed, the
lapse of but a few hours will materially change its character from
one to the other. If seen immediately after the infliction of the
a
HERNIA. 445
injury, it is in the form of a round, soft, elastic tumor, well-
defined in its outlines, and easily reducible. But if not examined
until after a season of delay, the definite configuration disappears,
and it is changed into an inflammatory swelling, edematous, warm
and painful to pressure—in fact having the aspect of a warm ab-
‘scess. In the recent cases, the edges of the torn abdominal walls
may be identified through the thickness of the skin, but the sur-
geon will vainly try to make out this condition if the inflamma-
tory process following the lesion has become established, and the
serosity and the blood have become sufficiently infiltrated into the
cellular tissue to make the change described. After a few days,
if the hernia is not situated too low in the abdomen, the swelling
moves downward toward a more dependent spot, and gradually
abating disappears in about two weeks. Upon reaching this
point, the hernial tumor is once more recognized, constituting, as
it does, the exclusive manifestation of the displacement of the in-
testinal mass, and its presence outside of its natural cavity. It is
recognized by its changing conditions—elastic when the intestine
isempty; soft and puffy during digestion ; by its state of tension,
increasing with effort, and by being painless, depressible and re-
ducible. When reduced, the edges of the opening are easily
made out, but it isnot uncommonly found, upon the subsidence
of the inflammatory process, that, during the continuance of that
state, adhesions of the protruding organ with the walls of the
sac have formed, and the hernia has become irreducible. In their
dimensions, ventral hernias vary considerably. They may measure
from the size of a large nut to that of a man’s head, or even exceed
that. Zundel reports a case where the rumen had penetrated into
the sac, which hung almost to the ground, and had produced a dis-
placement of the mamme, crowding them in a mass toward the
right side of the abdomen.
Although the diagnosis of ventral hernia is not difficult, it is
still not impossible to mistake a recent case for certain other affec-
tions of the abdominal walls, such as tumors of bacterian anthrax,
or those of a bloody nature, or with phlegmonous or cedematous
growths. The reducibility and elasticity of the tumor, the bor-
borygmus, and the presence of the opening through the abdomi-
nal walls, are intelligible signs by which to recognize the ventral
hernia. Aspiration of the tumor may sometimes be performed,
and rectal examination will also be of great assistance provided
446 OPERATIONS ON THE DIGESTIVE APPARATUS.
the injury is not beyond the reach of exploration with the hand.
Certain complications are not uncommon in ventral hernia.
Besides irreducibility already mentioned, excessive inflammation
has sometimes been followed by traumatic peritonitis. Lacera-
tions of the displaced organs have proved fatal. Internal hemor-
rhages, fistulas and consecutive eventration have also been record-
ed. Strangulation is not unknown, though it is comparatively
rare.
But with all these possibilities, it is not a rare circumstance to
meet with animals affected with ventral hernia, even of large di-
mensions, which have reached a good age with all the appearance
of perfect health. From data like these upon which to found a
judgment, it ought not to be difficult to deduce a prognosis which
should never be far wrong. But, although compatible with the
life, health and utilization of the animal, such a lesion must neces-
sarily detract more or less from its commercial value. Under
any circumstances, it is a blemish. The least dangerous of this
class of ruptures are those which are situated on an elevated point
of the abdomen. Recent and uncomplicated, they are amenable
to treatment more or less, according to their extent; if old or
chronic, the chances of success are reduced ; if strangulated, they
are generally fatal. Usually, a ventral hernia, to be curable,
must be treated when it is recent, and before sufficient time has
elapsed for the intestines to become, as it were, accommodated to
their new position, and especially before the cicatrization of the
borders of the lacerated openings has taken place. Recent and
free from complications, all that is required is their reduction
and retention in their proper place.
When reduced, whether by rectal taxis or by external pres-
sure, the parts are covered with a mixture of pitch and Venice
turpentine melted together, upon which is spread oakum cut in
small, short threads, which is to be covered with a second appli-
cation of the pitch, after which a sheet of pasteboard, itself also
impregnated with the pitch mixture, is placed over the opening.
The whole is then covered and held in place by a broad bandage
carefully rolled around the abdomen. Leather is sometimes used
in lieu of the pasteboard. This bandage, when applied upon male
bovines, requires to be carefully adapted in order to avoid any
possible interference with the penis, and its freedom of motion in
the act of micturition. The complications of swelling or bloody
tale
—s oe
HERNIA. 447
extravasations must not prevent the immediate application of the
bandage.
In eases of chronic hernia, compression is no longer sufficient.
Jannet recommends the use of clamps as in umbilical hernia, and
reports having relieved a case where the tumor was as large as a
child’s head. Leblanc advises the quilled suture, and Schwane-
feld cured by this mode a hernia twice as large as the head of a
man. Hertwig speaks favorably of the application of Delavigne’s
method in exomphalus. Going, Lafosse and Hertwig have ob-
tained success with nitric acid injections, and Krantz and Schutt
with blisters. Peyon, Dandrieu, Terrien and Obich have had
good results with the direct suture of the ventral walls in bovines,
and even solipeds. Bouley objects to the suture of the edges of
the opening, and also to injections into the evacuated sac of irri-
tating substances, to excite inflammation and produce the adhe-
sion of its walls. We have ourselves experimented several times
with the subcutaneous injections, but every attempt has resulted
in failure. According to Peuch & Toussaint, if old ventral her-
nias are to be treated, the best plan is to have recourse to bandag-
ing, as employed in the treatment of exomphalus.
EVENTRATIONS.
An eventration may be defined as a compound hernia, and it
constitutes an accident of the first degree of severity, consisting
in the formation of a hernia, of indefinite dimensions, taking place
through an opening involving the entire thickness of the abdomi-
nal walls, the skin included, in such a manner that some portion
of the abdominal viscera, but most commonly the intestines or the
omentum, become directly exposed. Ordinarily they are due to
some traumatic lesion, such asa thrust from or a fall upon a sharp
body, or they may be produced by stab wounds, or punctures with
a fork or a knife; or again, by kicks inflicted by other animals, or
horn-blows, when cattle are crowded into too contracted a space
and struggle for more room, or quarrel when herded in pastures.
And they quite commonly end the career of the wretched victims
of barbarity which are compelled to assist in the bloody and cruel
sport of the Spanish bull fight. They are also observed at times
following severe surgical manipulations, as in castration, during
the operation for strangulated inguinal hernia, after the efforts of
448 OPERATIONS ON THE DIGESTIVE APPARATUS.
distokia. They may also form one of the complications of some
of the forms of the treatment of umbilical hernia. In the
smaller animals, such as dogs, they may be produced by a severe
bite by a larger animal.
The pathognomonic symptom of an eventration may be con-
sidered the protrusion of a portion of the abdominal contents
through its lacerated walls. If the opening through which this
takes place is small, the viscera will appear as asmall round tumor,
which presently becomes transformed into a large mass of intes-
tinal circumvolution, which itself varies in dimensions, according
to the extent of the laceration. As the exposed intestines begin
to protrude, they for a period retain their physiological appear-
ance and normal color, but they undergo rapid changes, becoming
progressively darker, blueish and then black, and grow cool to the
touch. The viscera as they protrude from the abdomen may be
quite intact, but they often are injured, bruised or torn, the con-
ditions varying according to the peculiar circumstances attending
the accident. And not only is this so, but the sequel of the case
must be especially considered, since an eventration which possibly
might be susceptible of cure, if carefully tended from the first,
may become so aggravated and exaggerated as to preclude all
possibility of remedy, as when the wounded creature, frantic with
pain, from colics and otherwise, in rearing and struggling, forces
his entrails more and more out of their place, and tears and tram-
ples them upon the earth until they become a mere mass of crushed
and bruised viscera, ground into the earth. And yet, colics are
not always present in eventrations, even in horses whose irritable
temper, combined with the condition of the injured parts, would
naturally tend to render their occurrence quite inevitable.
The prognosis of their injuries varies according to the species
of the animal, and also under the special condition and circum-
stances of each case, as judged by itself. In horses, it is, in the
majority of cases, a fatal accident. The sensitiveness of the animal
to impressions upon the nerves, and the delicate susceptibility of
the peritoneum account for this. In ruminants they are less
serious, and certainly still less so in carnivorous animals, where
sometimes the whole intestinal mass may be seen hanging through
the laceration, and with extensive co-existing inflammation, with-
out the occurrence of a fatal termination.
Swine are also very sensitive to this kind of injury, though the
EVENTRATIONS. 449
prognosis may vary with them, according to the condition of the
lesion, being more or less favorable according as the bulk of the
protruding viscera is less or greater. The chances of recovery
will also vary in the ratio of the degree of the exposure of the vis-
ceral organs to the atmospheric air, or to the severity of any
traumatic accidents they may have encountered.
The indications of treatment suggested in these cases is obvious.
The first is always, when practicable, reduction. To return the
intestine to the situation designed by nature for its occupancy is
the first step to take. Ifit has not been seriously wounded, and
is in a state of cleanliness, and has escaped contact with the earth
and other soils and stains, simple washing may be attended to at
once. But if, on the contrary, it is bruised, soiled and inflamed,
it must be carefully cleansed with warm water, before being re-
turned to its position. This reduction must be carefully per-
formed by the taxis, and if the opening of the abdomen is too small
to allow this to be accomplished with facility, it will be good prac-
tice to enlarge the opening with the knife, rather than to hazard
the too free manipulation of the tender parts which will form the
dangerous alternative which may become the exciting causes of
consecutive inflammatory, and perhaps gangrenous sequele. If
instead of the intestines the eventration allows the exit of the
omentum, this also must be cleaned and washed, if necessary, and
returned, though in some instances it may be torn or cut off after
ligating its large blood vessels, or better yet, ligating the whole
mass with animal ligature. The second step of the operation con-
sists in applying means of restraint to retain the returned organ
and prevent a second exit. The quilled suture is at this jnncture
the means which always first suggests itself to the surgeon’s mind,
The clamps have their advocates, but Zundel prefers the metallic
interrupted sutures. The entire application is to be supported,
reenforced and protected by a wide bandage, similar to some of
those recommended in umbilical hernia.
LAPAROTOMY.
This operation, which consists in the opening of the abdominal
cavity through the loins or flanks, is one which, considering the
general indication for which it is performed in human surgery,
has found but little application and occupies but a small place in
450 OPERATIONS ON THE DIGESTIVE APPARATUS.
veterinary practice. According to Director Degives, who furnishes
the only description of the operation to which we have been able
to obtain access, the indication for laparotomy occurs in cases of
intestinal invagination, internal hernia and intestinal strangulation
and for the removal of foreign bodies from the abdominal cavity
or the intestinal tract.
Once a celebrated surgeon of New York had decided to prac-
tice it upon one of his valuable dogs, which was suffering with
impaction caused by the lodgement of a mass of hair in the intes-
tines, which we fortunately succeeded in softening and removing
by internal treatment. The indications for the operation are im-
perative as soon as a fatal result becomes imminent and certain.
The instruments necessary are a convex bistoury and suture needles.
Dr. Degives briefly describes the operation as follows: “ Posi-
tion and Restraint of the animal standing up, or in stocks, or
resting against a wall or its equivalent. If the animal is restless
let him be thrown down on the side opposite to that of the opera-
tion, which is divided into three steps.
First Step, opening of the jflank.—The abdominal opening
must be in the upper part of the flank, upon a line between the
hip and the last rib. This opening may be made in two ways:
Ist, or Simple Method.—It consists in making an incision
through the various anatomical layers, in the same direction, in
order to form a simple vertical wound, large enough to admit the
hand. The parts having been shaved, the division of the skin, the
abdominal muscles and the peritoneum is made successively with
the convex bistoury. The incision of the deep layers alone pre-
sents any difficulty, and this requires some attention, the hemor-
rhage being sometimes troublesome; but when the peritoneum is
exposed, the incision is increased, from without inward, with
either a blunt bistoury or the straight bistoury controlled by a
grooved director, an assistant protecting the intestines from the
contact of the instrument.
2d, or New Method, by. Complex Incision.—In this each mus-
cle is divided in the direction of its own proper fibres. Thus,
the first is a transverse, cutaneous incision; second, three muscu-
lar divisions, running in directions more or less opposed to each
other; the first, obliquely downward and backward; the second.
obliquely forward and downward, and the third transversal and
parallel to that of the skin. These incisions are very easily made,
LAPAROTOMY. 451
little more being necessary than a simple laceration of the intesti-
nal tissue with the fingers—there is little or no hemorrhage. The
opening thus made admits the hand into the abdomen, and when
it is removed the fibres of each muscle having a tendency to come
together spontaneously, the opening is more or less effectually
closed.
Second step.—This varies, to correspond with the object of the
operation; Ist, whether the extraction of a foreign body in the
abdomen or intestines, or 2d, the reduction of an invagination or
of an internal hernia (diaphragmatic, mesentoric, epiploic, or pan-
creatic), and, 3d, the displacement or removal of a tumor involving
the intestines.
In the reduction of an internal hernia, it may be necessary
either to pull or to push upon the displaced organ. In some cases
the hernial ring must be enlarged, and if that cannot be done with
the fingers, the bistoury must be used. The reduction of an intes-
tinal invagination is obtained by the combined action of a slight
traction on the invaginated part and a steady external pressure
upon the enlargement formed by it in the portion of the intestines
in which it is enfolded. When the swelling of the organs or the
presence of abnormal adhesions prevent the reduction, the traction
must be increased and in opposite directions—the invaginated por-
tion in one, the enfolded portion in the opposite.
Tf a stone, a calculus, or any foreign body is to be extracted,
the intestine is to be incised at some distance from the insertion
of the mesentery, on its lateral face, between the two curvatures.
On the removal of the body the intestinal suture is to be applied.
Third step, Closing the Parietal Wound.—When the complex
incision has been made, a strong cutaneous suture is all that is re-
quired. When the division has been a simple one, the edges of
the muscular wound are brought together by ordinary interrupted
sutures, and the skin is afterward sewed up. The drainage at
the lower part of the wound is always advantageous.”
As enteritis and peritonitis are common sequele of this opera-
tion much care and watchfulness devolve on the surgeon in direct-
ing the regimen and nursing of the patient in order to prevent the
possibility of their access from becoming a certainty.
CHAPTER IX.
OPERATIONS: “ON. THE] RESPIRATORY
APPARATUS,
ON THE GUTTURAL POUCHES—HYOVERTEBROTOMY.
This term fails to meet the approval of Zundel, who has pro-
posed that of Hyospondylotomy as a substitute, in order the better
to indicate the puncture of the sac of the guttural pouches which
it signifies. The former name, however, has been generally ac-
cepted, and while its etymology would point to the operation by
which the puncture referred to is made between the hyoid bone
and the atlas, it is still used to mean generally, the puncture of
the pouches, at whatever point it may be made.
These guttural pouches, which exist exclusively in the solipeds,
and are two in number, are situated between the cranium, the
pharynx and the atlas, resting upon each other on the median
line, each one, by an expansion of the mucous membrane of the
Eustachian tubes, forming a sac and filling the triangular space
situated posterior to the pharynx and extending to the larynx. The
mucous membrane which forms them is easily stretched, and the.
cavity may thus become greatly distended by the accumulation of
pus, and when this is the case, the pouch extends below the larynx
and the lower extremity of that organ. Thus situated in the parotid
region, these two sacs sustain important relations to other points,
varying according to the position, whether of extension or flexion,
of the head upon the neck, and are covered by seven separate
tissues, as represented in their order from without inward, by
1st, the skin; 2d, a layer of subcutaneous connective tissue, more
or less abundant; 3d, a thin expansion of cutaneous muscle with
the parotido-auricularis muscle; 4th, the parotid gland, whose
internal face is moulded upon the muscles and blood vessels un-
derneath; 5th, the following muscles in the order as named from
above downward, viz., the small oblique of the head—the stylo-
hyoideus, which fills the space left between the anterior border of
HYOVERTEBROTOMY: 453
Fig. 395.—Antero-Posterior Section of the Head, showing the Mouth, Fances,
and Nasal Cavities.
1, genio-glossus muscle; 2, genio-hyoideus muscle; 3, the velum palati; 4, pharyn-
geal cavity; 5, esophagus; 6, guttural pouches; 7, pharyngeal opening of the Eustach-
ian tube; 8, laryngeal cavity; 9, lateral ventricle of the iarynx; 10, trachea; 11, ethmoi-
dal turbinated; 12, maxillary turbinated; 13, ethmoidal volutes; 14, cerebral compart-
ment of the cranian cavity; 15, cerebellar compartment of the same; 16, falx cerebri;
17, tentorium cerebelli; 18, superior lip; 19, inferior lip.
the styloid process of the occipital bone and the superior border
of the long branch of the hyoid, through which the puncture is
made in order to enter the guttural pouches, and back of this the
stylo-hyoideus and the superior border of the digastricus ; then,
6th, on the deepest layer, the guttural pouches are found supe-
riorly, resting intimately on the internal face of the stylo-hyoideus
muscle, inferiorly closely cemented with the posterior face of the
pharynx and posteriorly with the superior extremity of the long
muscle of the neck; and 7th, the numerous and important blood
vessels and nerves belonging to the parotid region.
454 OPERATIONS ON THE RESPIRATORY APPARATUS,
AK
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\\\
RN
Hh a
Ui
Fia. 397.—Parotid Region—Superficial Layer.
PP, parotid gland; Mpa, parotido-auricular muscle; 3, transveral artery of the face;
4, maxillo-muscular vein; 7, jugular vein; 8, glosso-facial vein; 9, transversal vein of
the face; 10, maxillo-muscular vein; 12, posterior auricular vein; 13, facial nerve;
15, auricular branch of the 2d cervical pair.
The arteries are the three divisions of the primitive carotid ;
Ist, the occipital, which, by its mastoid branch, runs over the ex-
ternal surface of the styloid process of the occipital bone ; 2d, the
internal carotid, which runs upward through the thickness of the
fold of the mucous membrane which forms the guttural sacs; 3d,
the external carotid, with its parotid branches, the maxillo-mus-
cular, the posterior auricular, the superficial temporal trunk and
the internsi maxillary The veins, which are numerous, empty
HYOVERTEBROTOMY. 455
nny \ A KK li
Ait!
Fie. 397.—Parotid Region—Middle Layer.
P, parotid gland; D, digastricus muscle; Sh, occipito, or stylo-hyoideus, muscle;
Sm, sterno-maxillaris muscle; P, thyroid gland; H, posterior border of the great
branch of the hyoid bone; 1, primitive carotid artery; 2, external carotid artery;
8, transversal artery of the face; 4, maxillo-muscular artery; 5, posterior auricular
artery; 6, thyro-laryngeal artery; 7, jugular vein; 8, glosso-facial vein; 9, transversal
vein of the face; 10, maxillo-muscular vein; 11, anterior auricular vein; 12, posterior
auricular vein; 13, facial nerves; 14, anterior auricular nerve.
into the jugular or its different branches. The principal nerves
of the parotid region are the facial, the pneumogastric, the spinal,
the superior cervical ganglion of the sympathetic, the great hypo-
glossus and the glosso-pharyngeal. These nerves, with the exception
of the facial, are situated on the external face of the pouches below
the long branch of the hyoid bone and the stylo-hyoideus.
456 OPERATIONS ON THE RESPIRATORY APPARATUS.
This rapid summary of the anatomy of the parotid region will
sufficiently indicate the dangers which the surgeon is likely to
encounter at successive steps of the operation, and especially if
he duly considers the location of the occipito-hyoideus, which must
be reached before the puncture can be made, and again, the pecu-
liar course followed by the posterior auricular artery as it emerges
from the parotid to reach its destination.
Hyovertebrotomy is indicated in all cases of repletion of the
suttural pouches resulting from a purulent collection and main- —
tained by a process of chronic inflammation. It is principally
when horses have become liable to be attacked with strangles that
these purulent collections are formed. They are marked by an
increase of size in the pouches, gradually augmenting with the
continued formation of the pus, and interfering more and more
with deglutition and respiration, sometimes assuming such pro-
portions as even to threaten suffocation. Attacks of pharyngitis
or laryngitis, or catarrh of the anterior chambers of the respira-
tory apparatus and nasal cavities, or sinuses, are at times noticed
in connection with this affection.
To revert to the anatomical arrangement of the parts: The
guttural pouches, opening into the cavity of the pharynx by a
narrow slit, are situated on the lateral surface, and thus allow any
collection of pus they may contain to flow without interruption
into the pharynx,and hence into the other nasal cavities. We
have here an explanation of the fact that a discharge from the nose
in any one of a variety of affections, such as suppuration of the
guttural pouches, pharyngitis, laryngitis, catarrh, and also the dis-
charge of elanders, may all possess different characteristics, and
each exhibit a different aspect, and therefore demand a different
diagnosis and require different treatment.
The discharge from the guttur al pouches is whitish, glairy, more
or less mixed with mucosities, inodorous, non-adhesive to the wing
of the nose, and intermittent, being marked during mastication
or deglutition, and especially while swallowing liquids—in all form-
ing an assemblage of characteristics which should be sufficient to
distinguish the affection from all others. There is, besides this, a
negative point, in the absence of chancres, which with the distinct
nature and peculiarity of the discharge, and the characters so
typical of the maxillary lymphatic glands in that disease, will
largely aid in determining the difference between the two affections.
HYOVERTEBROTOMY. © 457
In respect to glanders, moreover, the bad odor, the thick, gru-
mous nasal discharge, and the soreness and dullness on percussion
of certain parts of the face, will in many cases serve to identify
and distinguish a pathological condition of the sinuses very dif-
ferent from that of the disease we are considering. Gohier and
Vatel also refer to guttural tympanitis, or dilatation of the pouches
by air, as a feature of their disordered condition. The amount of
pus collected in the pouches varies in different cases to such an
extent that from only a trifling degree of dilatation it may be suf-
ficiently extensive to produce a sensible projection of the sac below
the parotid. This dilation furnishes a guide for the determination
of the proper point at which to make the puncture, whether in the
upper, in the middle, or in the lower part of the pouches. The
upper operation is hyovertebrotomy proper. Besides these three
modes of operation, Gunther has proposed a fourth method which
consists in penetrating the pouches through the nasal cavities.
Upper operation—Hyovertebrotomy proper.—As described by
Chabert and Fromage de Feugré, this is one of the finest and most
delicate operations of veterinary surgery. Extremely so when per-
formed on horses whose pouches are healthy and normal in size,
it loses a great deal of its apparent difficulty when these are full of
pus with prominent and well developed walls. The nerves and
blood vessels which surround them are then easily pushed aside
from their position, and the lobules of the parotid are more or less
separated.
The instruments required for this operation are: a pair of
scissors, a convex and a straight bistoury, a dissecting forceps, am
Fic. 398.—Curvyed Trocar, or Hyovertebrotome.
S probe, or preferably, the curved trocar, the hyovertebrotome
(Fig. 398), and a piece of tape. Artery forceps and ligatures
ought to be always within reach. |
Bouley, Zundel and others recommend that the animal should
be kept in the standing position with simply a twitch on the lip,
458 OPERATIONS ON THE RESPIRATORY APPARATUS.
but our experience has taught us that the recumbent position is
the safest, especially if there are plenty of assistants at hand, with
instructions to keep the head of the animal steady, and in a mode-
rate state of extension on the neck.
The operation is divided into three steps; 1st, Zhe incision of
the skin and dissection of the parotid ; 2d, The puncture of the
pouch through the occipito-hyoideus muscle; and 3d, The estab-
lishment of the counter-opening.
Before considering these three steps, it will be well to answer
sundry important questions put by Lecoq in the first good de-
scription of the operation, made in 1841.
Where shall the puncture be made ?
The anatomical disposition, which we have already examined,
suggests as an answer to this query, that the occzpito-hyoideus
muscle is the proper place for the puncture. Its inner side is
lined with the mucous membrane of the pouches, and as has al-
ready been remarked, when this is distended by fluid and becomes
tense and resisting, it is in a much better condition for the pass-
age of the knife through its thickness than when flabby and soft,
and therefore movable and shifting, as if endeavoring to evade the
knife. At any other point the pouches are so surrounded by im-
portant blood vessels and nerves that the operation is precluded
by the danger which would be incurred by attempting it.
Where must the first incision be made to reach the occipito-
hyoideus muscle ?
It would be easy to reach the muscle by a division of the paro-
tid gland, but this would involve the formation of a fistula, and a
wound difficult to heal, to avoid which the gland must be raised
out of the way. This should be done by raising the posterior bor-
der, where it is loose and free from blood vessels or nerves of
importance, in preference to doing so by disturbing the anterior
border or superior extremity, where the posterior auricular artery,
the facial nerve and the sub-zygomatic artery are situated. The
superior extremity of the incision must begin near the inferior
border of the tendon common to the splenius and small com-
plexus muscles, a little in front of the transverse border of the
atlas, and extend downward for a space of two or three inches.
Upon what point of the muscle must the puncture be made?
The answer to this is—upon the central portion of the muscle.
The introduction of the bistoury into the superior part of the
* ; eg
ag
-
HYOVERTEBROTOMY. 459
muscle will involve possible danger to the posterior auricular ar-
tery, and the risk of the division of the facial nerve.
In what direction must the sharp edge of the bistoury be
turned ? .
The reply to this is the point of minimwm danger from irregu-
lar motions of the instrument, caused by the struggling of the
patient; and this result is most likely to be accomplished by carry-
ing the bistoury towards the tuberosity of the hyoid bone, and
consequently in the direction of the patient’s nose. With the
instrument turned towards the ear, there would be possible dan-
ger of dividing the posterior auricular artery, the facial nerve or,
perhaps, the internal carotid.
In carrying it toward the atlas, the internal carotid, and the
nerves surrounding it, would be the endangered parts, if any. If
directed downward, toward the larynx, a division of the great hy-
poglossus, and possibly of the external carotid, might be possible.
What must be the direction of the instrument?
If the bistoury is pushed through the occipito-hyoideus muscle,
and in a direction perpendicular to it, there will be great danger,
at a certain depth, of reaching and penetrating through the in-
ternal carotid artery; but if an oblique direction be given to the
instrument, not only is this danger avoided, but no accident be-
yond some slight muscular injury, of no importance, need be ap-
prehended.
Where is the counter-opening to be made?
The right place will be the most dependent part of the pouches,
and the instrument used must be either the S probe or the trocar,
as will be hereafter described.
These preliminary points being understood, we shall the more
intelligently follow the description of the three steps of the opera-
tion, which we now proceed to give.
1st. The Incision of the Skin and Dissection of the Posterior
Border of the Parotid.—This incision is made a little in front of
the transverse process of the atlas. It includes the skin and some
subcutaneous aponeurotic fibres, and extends to the posterior bor-
der of the parotid, which is at this point exposed. With the
straight bistoury and dissecting forceps, the parotid border is
dissected, and under it the aponeurosis of the levator-humeri is
divided. The finger is then pushed between the aponeurosis and
the small oblique muscle of the head, in order to reach the occipito-
460 OPERATIONS ON THE RESPIRATORY APPARATUS.
hyoideus, which is readily identified by feeling for the styloid pro-
cess of the occipital bone and the superior border of the long
branch of the hyoid. Some little hemorrhage and some strug-
gling of the patient may follow this incision, caused by the divis-
ion of the auricular vein and nerve, but the consequences will not
be serious.
2d. Puncture of the Pouch through the Muscle.—The central
point of the muscle being identified, the operator, with a straight
bistoury held in the manner of a writing-pen, introduces it under
the parotid, obliquely, from above downward, and from behind
forward, and thus divides the muscle through and through, and
penetrates the pouch. If the puncture proves to be sufficiently
large, the index finger is introduced into the opening for explora-
tion, and, if necessary, for its further dilatation.
If the collection of pus is not very abundant, and the mucous
membrane lining the sac not greatly distended, it will be important
to have a very sharp-pointed instrument, which will make its work
of incision sure, instead of merely pushing the membrane away
from the internal face of the muscle—an accident which might
lead to serious results.
But again, when the collection is abundant and the pouches
much distended, the use of the bistoury may prove unnecessary,
the puncture being then readily made by pushing the index finger
through both the muscle and the mucous membrane of the pouch.
3d. Making a Counter-Opening.—The S probe, or curved tro-
car (Fig. 398), is introduced through the opening made, and is
pushed down to the bottom of the pouch, where the mucous mem-
brane is easily torn; it is then carefully directed toward a point a
little below the glosso-facial branch of the jugular, back of the
thick border of the maxillary bone, and pushing against it with
sufficient force, the instrument forms a prominent point under
the skin. If the S probe is used, an incision is made with the
bistoury through the skin, and the instrument is exposed. If the
curved trocar, it is by a strong pushing movement passed through
the skin and brought outside. Whatever instrument may be used,
a piece of tape or kind of seton is introduced from the lower
through the upper opening, and the continued escape of pus thus
facilitated and ensured, The extremities of this piece of tape are
secured together by tying them with the knot used with the or-
dinary seton.
cy tlic mile iia
HYOVERTEBROTOMY. 461
The attention required by the patients after the operation 1s of
the simplest kind, consisting in keeping the wounded surface
thoroughly clean and keeping up the flow of the pus. This will
at first make its escape through the upper opening, but will soon
find its way through the lower one, and so long as it is discharg-
ing the opening must not be allowed to close, nor must the seton
be moved.
Puncture in the Middle and the Lower Regions of the
Parotid.—-These modes of operation are so nearly identical that,
with H. Bouley, we think they may with propriety be jointly con-
sidered.
In these cases but little attention to the anatomy of the part
is required. The growth of the purulent collection distends the
pouches, displaces the blood vessels and nerves, separates them
more or less from the parotid, and becomes more superficial, and,
in fact, may ulcerate through the skin and empty itself spontane-
ously. But this process is a very slow, tedious and painful one,
and subjects the patient to such a degree of suffering, that it be-
comes a duty imperative to interpose the resources of surgery for
its relief.
The puncture in this case should be made as early as possible,
and at the fluctuating point, as with an ordinary abscess. It is
made with the bistoury, or, what would be better, with the olivary
actual cautery, by which the prevention of hemorrhage will be as-
sured. The opening thus made and cauterized, will, moreover,
have less tendency to close too rapidly, besides which the modify-
ing effects of the cauterization will have a highly advantageous in-
fluence upon the healing process.
The opening of the pouch at its lower extremity has been
recommended when the purulent collection is small, or when con-
eretions of inspissated pus are supposed to exist in the cavities.
It is done by first dissecting the wide and thin lower portion of
the parotido-auricularis, then of the base of the parotid, under
which the distended pouch is seen and punctured.
We remember a case where the collection in both cavities was
such that we had no difficulty in opening them on each side of
the neck, about on a level with the thyroid glands, the lower
operation with emphasis !
Puncture Through the Eustachian Tubes.—Gunther has in-
vented a tube, rounded at one extremity, a sort of hollow bougie,
462 OPERATIONS ON THE RESPIRATORY APPARATUS.
which he introduces into the guttural pouches by passing it —
through the nasal cavities and the Eustachian tubes. Although
in performing this operation the animal is thrown down, it is very
difficult to accomplish, and requires to be preceded by the operation.
of tracheotomy. It also requires to be repeated several times, by
reason of the liability of the collection to return.
The mode of operation is a matter of no importance, since the
solutions of continuity resulting from it seldom assumes a form
more serious than that of an ordinary simple wound, and requir-
ing no special directions as to treatment. Even ordinary de-
tergent washes are scarcely necessary.
LARYNGOTOMY—ARYTENECTOMY. | x
The history of surgical interference at the larynx, to relieve the \
/ peculiar difficulty of respiration known as roaring, depending |
| upon paralysis of the laryngeal muscles, dates as far back as 1845, /
when Professor Gunther, of Hanover, attempted, in succession, the —
resection of the vocal cords, the removal of the vocal cord of the
paralyzed side of the larynx, the partial excision of the arytenoid
cartilage, the entire extirpation of that cartilage, the removal of
the vocal cord and of the corresponding laryngeal ventricule, and
finally the fixation of the arytenoid, by an anchylosis at its artic-
ulation with the thyroid cartilage. The results obtained by Gun-
ther were more or less successful.
These experiments were repeated by Gerlach, H. Bouley,
Stockfelth and Bassi, but subsequently repudiated and ignored.
But in later years Professor Moller, of Berlin, and George Flem-
ing, of London, have turned their attention to the subject, with the
suggestion of various new modes of operating, which have yielded
results more or less encouraging. The matter has been followed
up by other veterinarians in various parts of the world, and re-
cently especially by Professor Cadiot, and the successes which
have been recorded, though not always perfect, seem to justify the
prosecution of further inquiries and new trials for the relief of a
disease which has thus far baffled the skill of veterinarians, and
consigned many a valuable animal to the hands of the knacker.
The operation of Professor Moller, also recommended by Pro-
fessor Cadiot, as at present practiced, is the excision of the para-
lyzed cartilage. That of George Fleming is the removal of the
LARYNGOTOMY—ARYTENECTOMY. 463
cartilage and the vocal cord. / We shall describe the Fleming and
~ Gadiot modes as we find them recorded in their own works.
“Roaring in Horses,” by the former, and “The Surgical Treat-
ment of Chronic Roaring,” by the latter.
L “ The Fleming Method.—The special instruments necessary
a small ordinary forceps; scalpels; bull-dog forceps; tracheal
Fia. 399 —Tracheal Tampon Canula.
tampon; a canula, formed of along tracheotomy tube, with an
india rubber bag surrounding its middle. This bag is inflated
by means of an india-rubber air-pump, after the insertion of the
tube into the trachea, and is useful in preventing the flow of blood
into the bronchii during the horse’s getting up after the operation,
and for half an hour subsequently. Other instruments required
are a razor-shaped knife, with which to excise the cartilage; a bent
knife with which to remove the muscles from the outside of the
arytenoid cartilage; a hook to seize and raise the lower end of
Fic. 402.—Hook to Secure the Cartilage.
464 OPERATIONS ON THE RESPIRATORY APPARATUS.
Fic. 406.—Electric Lamp.
the cartilage; a special forceps with toothed ends, to seize the
body of the cartilage ; curved scissors to cut through the mucous
membrane; two retractors to keep the trachea opened during the
operation ; and an electric lamp to illuminate the interior of the
larynx.
Fleming describes the operation as follows: “The horse
should be well fed for a day or two preceding the operation, but
have little or no food or drink for some hours before its actual
performance. In the case of thoroughbred horses, a dose of four
ounces of tincture of opium in a pint of water, half an hour be-
fore operating, is advisable. The hair must be removed closely
from around the upper part of the trachea and larynx, before the
' LARYNGOTOMY—ARYTENECTOMY. 465
animal is cast, and he is thrown in the usual manner, on a good
bed of straw or moss or litter. The chloroform bag is put on, and
when the required state of narcosis is induced, the animal is placed
on his back, and maintained there by sacks filled with straw, placed
close under each side of the body. The neck and head are ex
tended in a line with the body, the head placed on the vertex and
kept steady by an assistant. The operator places himself in a
kneeling position, on the off, or right side of the body, if right
handed, beside the neck, with his back to the shoulder and face
toward the head.”
The operation is divided into three stages:
First Stage.—“ With a scalpel, an incision of from four to six
inches in length is made through the skin, the middle line of the
larynx and trachea, opposite the posterior border of the lower jaw,
extending from the body of the thyroid cartilage to the second or
third tracheal ring. This exposes the subscapulo-hyoid, sterno-
hyoid and sterno-thyroid muscles, which are incised to the same
extent, and as close as possible to their line of junction (raphe)
in the middle, the section being then carried through to the larynx
and trachea. There is a variable amount of hemorrhage now to
contend with, which, if only oozing, may be checked by sponging
it dry until the blood has ceased to flow; and if it comes from
twigs of arteries or veins, they may be seized, and twisted, or
ligated.”
Second Stage.—* The middle crico-thyroid ligament, cricoid car-
tilage, and one, two or three tracheal rings are cut through, in a
straight line, exposing the interior of the larynx and trachea. If
blood vessels are cut, they should be taken up. A retractor is
applied to the sides, and these being pulled gently apart by an
assistant, there is ample space in which to manipulate. The con-
vex lower border of the arytenoid on each side can now be seen,
and if the respiration is deep, that which is next the operator (the
right), will be observed to move actively from the side toward the
middle ; while if the roaring is due to paralysis of the left dilator
muscle, there is no movement in the opposite cartilage. When the
breathing is very tranquil, which is often the case, the right carti-
lage moves almost imperceptibly, and it becomes necessary to as-
certain whether the left one is really immovable. This can be
done by passing the finger, or a long probe, up toward the epi-
glottis, when the act of swallowing will be excited, during which
466 OPERATIONS ON THE RESPIRATORY APPARATUS.
the right arytenoid cartilage is energetically jerked into the mid-
dle of the cavity; but the left one is either motionless or only
feebly stirs, depending upon the degree of the wasting of the con-
strictor muscles on that side.
“Tf any blood lodges in the trachea, it can be removed by
large or small (handled) sponges, which may be passed to the
operator by an assistant who receives and washes them. As the
horse is now breathing through the wound, the chloroform bag
may be removed.
“Tt is always advisable to examine the interior of the larynx
carefully, in order to ascertain its exact condition, as there may be
something more in the case than an immovable cartilage. For this
purpose the electric lamp is invaluable.
Bs
if :
ye > a0 y
\ iil ss
at
pret Ms
SJ"
Fre. 407.—Left Side Section of Larynx, showing the Parts excised in the Operation
for Roaring.
“The left arytenoid cartilage may be excised by commencing
at the lower convex border, or at the upper part, where it meets
the right cartilage (Fig. 407). If the latter method is selected,
then a cut with a razor-shaped knife is made through the mucous
LARYNGOTOMY—ARYTENECTOMY. 467
membrane, into the arytenoid ligament and arytenoid muscle, as
close to the margin of the cartilage as possible, beginning between
the cartilage of Santorini, downward and then upward and the
vocal process at the insertion of the vocal cord (Fig. 407). The
hook is inserted in the vocal process, which is raised, and the
vocal cord is separated from the cartilage by the scissors; then
the muscles on the outside of the cartilage are cut with the bent
knife, or, what is better, pushed from its surface as close as possi- ,
ble. The hook is removed, and the body of the cartilage seized )
with the rachet forceps. The mucous membrane connecting the
cartilage with the vocal pouch is divided, with the curved scissors,
cutting as close to the cartilage as possible, to save the membrane.
“The arytenoid cartilage is now free, except at its articula-
tion with the cricoid, and it may either be disarticulated or cut
through with the scalpel at this point, care being taken to leave
no loose portionsor shreds. The cartilage being now only retained
by the soft parts at the upper portion (or base of the arytenoid
cartilage), these are cut through, close to it, with the scissors, when
it is altogether detached.
‘Care must be taken to avoid wounding the other cartilages,
or the pharyngeal mucous membrane, and to spare that membrane
in proximity to the arytenoid cartilage as much as possible, remov-
ing only that which covers its surface and the cartilage of
Santorini.
“The vocal cord is now removed close to its attachment to the
thyroid cartilage, in front and at its fixed border (Fig. 407). This
can be done with the scissors, a finger being passed to the bottom
of the ventricle to facilitate the excision; or the cord may be
drawn from the side by inserting a hook in it, to allow plenty of
room for the scissors.
“Tf the hemorrhage is troublesome, which it seldom is, the
blood can be mopped out of the trachea with the sponges. It
cannot pass down that tube, owing to the position of the neck.
If necessary, the electric lamp may be employed to ascertain how
the operation has been performed, or even during it performance ;
but after a little experience this is unnecessary.”
Third Stage.—‘*The trachea being completely freed from
blood, and the tampon canula introduced, the bag being inflated
after it has been properly placed into the trachea by means of the
air-pump, the canula is secured in position by a tape around the
468 OPERATIONS ON THE RESPIRATORY APPARATUS.
neck. Itis only required for about half an hour, until the hemor-
rhage has ceased, as it will prevent the entrance of blood into the
lungs while the horse is getting up, and for a short time after-
ward respiration being carried on through the tube. It ought
not to be left any longer, being liable to injure the interior of the
trachea. The blood being again removed from the larynx, one or
two syringe-fulls of the common salt or borax solution are inject-
ed into it and the pharynx. This washes out these cavities and
the sinuses of the head, a necessary precaution, as putrefying
blood in them sometimes gives rise to troublesome consequences.
Swallowing should be induced by touching the epiglottis, and
then the horse may be turned on his side, the lower margin of the
wound being depressed, to allow the remaining blood and water
to flow out. This completes the operation.
“The horse is nosy allowed to recover from the chloroform;
and when ready he may be assisted to get upon his feet, care
being taken that the canula is not displaced while doing so. The
wound is kept open with the finger for a short time, to allow any
remaining blood to escape, and itis afterward cleansed away from
around the wound, the face and nostrils sponged to refresh the
patient, and if the weather is cold, the body clothed and the legs
bandaged.”
Method of Cadiot.—The special instruments required are a
Fia. 409.—Curved Scissors. Fia. 410.—Spring Tenaculum, or Dilator.
blunt bistoury, curved scissors, whose blades are nearly perpen-
dicular to the branches, a spring tenaculum, a hooked or long
bull-dog forceps, a canula tampon, like that used by Fleming, a
LARYNGOTOMY—ARYTENECTOMY. 469.
Fig. 411.—Hooked Forceps.
peculiar curved needle, shown in Figure 418, straight, long and
ordinary curved scissors, bistouries, dissecting forceps, artery nip-
pers, loose and fixed sponges, thread, cotton, pheniated or iodo-
formed gauze, and antiseptic solutions.
The preparation of the animal is similar to that in Fleming’s
method.
First Stage.—Incision of the Skin and Muscles covering thé
Larynx.—The incision must be made on the median line, and ex-
tend from the body of the thyroid to the second or third tracheal
ring. This is done with the convex bistoury, first dividing the
skin in its whole length, when the edges separating show the
raphe of the sterno-hyoid and omoplat-hyoideus muscles. The
muscular layer can then be divided exactly upon the median line.
The division of the prelaryngeal connective tissue closes the first
stage. The hemorrhage is always light and easily controlled.
Second Stage.—Incision of the Larnyx and of the First Two
Rings of the Trachea, Introduction and Fixation of the Can-
ula.—The incision may be made by a single stroke of the knife,
dividing the crico-thyroid, and with it, successively, the cricoid
and the crico-tracheal ligaments, and the first rings of the
trachea. But by this mode of operation, the vocal cords may be
injured, and to avoid this, the bistoury held perfectly vertical,
with the edge turned backward, is inserted through the crico-thy-
roid ligament, immediately in front of the cricoid cartilage, and
this is divided with the crico-tracheal ligament, as well as the first
ring of the trachea. The edges of the laryngo-tracheal incision
are then opened with the spreaders, or the spring tenaculum, and
the division of the thyro-cricoid ligament is completed, from be-
hind forward, and from within outward. As by the act of inspi-
ration the vocal cords move more or less outward, this movement
should be carefully watched while making the incision of the
crico-thyroid membranes to save them from injury. The canula-
tampon is then introduced, and when in place, is moderately in-
flated by an assistant, the operator measuring the degree of dila-
470 OPERATIONS ON THE RESPIRATORY APPARATUS.
tation with his fingers in the superior part of the trachea. When
it is sufficiently expanded, a ligature is applied upon the India
rubber tube, and this is cut off. Though the tampon 1s inflated,
hie
"Wns
f if %
2:
ji
feria}
Fig. 412.—Arytenectomy. The second step is over. The crico-thyroid ligament, cri-
coid cartilage, crico-tracheal ligament and the two first tracheal rings are divided.
The canula and the tenaculum are in place—c ce, Cricoid Cartilage. 1, First Ring of
the Trachea. ;
the canula has a tendency to slip in the larynx, and for the pre-
vention of this accident should be secured by bands or strings tied
backward over the neck. _
Third Stage.— Ablation of the Arytenoid Cartilage. —The
ablation of the cartilage is effected by several steps:
(a) Incision of the Mucous Membrane along the Superior
and Posterior Borders of the Cartilage.—With a blunt bistoury
and a slight pressure, an incision is made in the mucous mem-
brane along the side of the superior and posterior borders of the
TARYNGOTOMY—ARYTENECTOMY. 471
arytenoid (see Fig. 413), the instrument being then carried into
the larynx on the median line, from before backward to the ceri-
coid, and thence from within outward and from below upward, as
far as the insertion of the vocal cord. To save the mucous mem-
Fia. 413.—3d Step. a, Incision of the Mucous Membrane along the Superior and Pos-
terior Borders of the Arytenoid.
brane, the incision may be made at some distance from the bor-
ders of the cartilage, but the division of the membrane must be
complete.
(6) Section of the Vocal Cord; Dissection of the Cartilage
on its Inferior and Anterior Borders and External Face.—With
long, sharp, straight scissors, the vocal cord is excised at its in-
sertion upon the arytenoid (see Fig. 414). The cartilage is then,
by small nips of the scissors, made from behind forward, dis-
sected in dividing the mucous membrane along its inferior bor-
der, and the muscular fibres of the crico-arytenoid and thyro-ary-
tenoid, inserted on its external face (Fig. 415); the mucous mem-
brane, which covers the anterior border, being divided from above
472 OPERATIONS ON THE RESPIRATORY APPARATUS.
Fig. 414.—3d Step. 0b, Section of the Vocal Cord.
downward with the scissors. To facilitate this part of the oper-
ation, the cartilage must be firmly held with either the hooked or
the bull-dog forceps, and carried toward the median line, when
the inferior border and the external face are dissected, and drawn
backward and upward when the dissection goes on, on the ante-
rior border. The only important or particular caution needed
here, is to hold the point of the scissors always in contact with
the cartilage, to keep close to it, to save the mucous membrane,
and to avoid the laryngeal ventricle as well as the tissues loosened
from the external face of the cartilage. Toward the end of this
third step, when the cartilage is separated from the fibres of the
thyro-arytenoid muscle, a hemorrhage takes place from the divid-
ed laryngeal branch of the thyroid artery (Fig. 416). This must
be controlled by torsion or artery nippers.
(c) Section of the Cartilage near its Articulation with the
LARYNGOTOMY—ARYTENECTOMY. 473
is
it
il :
i
a,
\
Fic. 415.—3d Step. b, Dissection of the Arytenoid at its Inferior Border and
its External Face.
Cricoid.—Raised and immobilized with a strong forceps, or the
hook forceps, held with the left hand, the arytenoid is separated
from without inward near its postero-superior angle, the articu-
lar, with the blunt bistoury. Held ina vertical direction, or some-
what obliquely downward and forward, the bistoury is moved to-
ward the external part of the arytenoid, immediately in front of
the cricoid, and the section is made by a limited and careful saw-
ing motion. When the arytenoid is partially ossified, which is a
condition encountered in nearly one half of the patients, some
force may be used. A feeling of cessation of resistance, and an
increased mobility of the cartilage, indicates the completion of the
section.
(d) Dissection of the Cartilage by its Superior Face (Fig. 417).
—This is done with the curved scissors. The cartilage being well
AT4 OPERATIONS ON THE RESPIRATORY APPARATUS.
Fie. 416.—3d Step. c, Section of the Arytenoid near its Articular Angle.
A, Laryngeal Branch of the Thyro-Laryngeal Artery.
raised with the forceps, the scissors are introduced under its poste-
rior portion, with the branches held almost vertically, and close to
the cartilage, from behind forward, and the fibres of the arytenoid
muscle are nipped off. With careful attention, the perfect dissec-
tion of the entire cartilage, including its beak, may be effected.
During this part of the operation, blood and pharyngeal mucosi-
ties may interfere with the manipulations, and must be removed
with pieces of soft cloth, wadding or sponges.
When these various manipulations have been well executed as
described, the surface left by the loss of substance presents a neat
and smooth appearance, not only on its borders, but over its en-
tire extent. Professor Cadiot, in this step of the operation, omits
the excision of the vocal cord, which he considers unnecessary.
Fourth Stage. Sutwre.—The borders of the wound are brought
LARYNGOTOMY—ARYTENECTOMY. 475
Fic. 417.—3d Step. d, Excision of the Cartilage with the Curved Scissors.
together with two or three interrupted catgut sutures, made with
a special needle (Fig. 418). Three of these are generally re-
quired (Fig. 419).
After cleansing the larynx of the blood, it is dressed with wad-
ding or iodoformed gauze. The edges of the external wound are
brought together by two interrupted sutures, one upon the mus-
cular coat, the other on the skin, the latter being so placed as to
prevent the displacement of the canula.
The care of the wound, aside from the matters of cleanliness
and the application of antiseptic measures, varies according to the
two modes of operation. But they agree in advising the: early
removal of the canula at a period not later than the day following
that of the operation.
Careful diet is indicated, but Fleming advises strict fasting
from both food and water for two or three days, while Cadiot per-
mits the animal to have his ordinary diet without interruption.
476 OPERATIONS ON THE RESPIRATORY APPARATUS.
Fia. 418.—4th Stevo. How to Apply the Sutures.
There is no serious febrile reaction, and after three or four weeks
the cicatrization is complete.
' The result of the operation cannot be fully ascertained until
about three months after the operation, when the animal can be
tested.
The application of the sutures constitutes an improvement, we
believe, on Fleming’s operations for assisting the cicatrization of
the laryngeal wound, which, however, can be more easily watched
if the external sutures recommended by Cadiot are dispensed
with. | Excessive granulations, when detected, must be cauterized
with chloride of zinc or nitrate of silver.
Among the accidents and complications that may follow ary-
tenectomy, and which are mentioned by Fleming and Cadiot, are
wounds of the mucous membrane and of the arytenoid left in the
larynx, incomplete deglution of the dressing, pneumonia from
TRACHEOTOMY. ATT
SS
SS
Fia. 419.—The Sutures are in Place; three are necessary.
foreign bodies, excessive granulations of the cicatrix, pyemia,
tetanus, besides those which result from the division of the carti-
laginous structure, such as deformity of the tracheal rings, and
the contraction of the tracheal diameter.
TRACHEOTOMY.
This term represents an operation consisting in making a
methodic opening of varying dimensions, in the cervical position
of the trachea, in order to provide a free channel for the atmos-
pheric air into therespiratory tract. Its ultimate object is either the
removal of foreign bodies, or of the abnormal growth from the
larynx, or to facilitate the passage of the air necessary to respira-
tion. Its subjects are principally the large domestic animals, more
especially the horse, and it has also been employed with advantage
on ruminants, and often successfully on dogs.
278 OPERATIONS ON THE RESPIRATORY APPARATUS.
The importance of the operation, with its utility, is readily
demonstrated by studying the effect of its performance, and esti-
mating the relief which immediately follows, in some special cases
of ailment or accidents, complicated with the danger of immi-
nently impending suffocation. It is performed in the middle of
the inferior border of the neck, in that portion where the trachea.
F1G. 520.—Tracheal Region. 7, Trachea; A A, Sterno-Hyoideus and Thyroideus Mus-
cles; S H, Sub-Scapulo-Hyoideus; S M, Sterno-Maxillaris; J, Jugular Vein.
being most subcutaneous, can be readily felt, in the lozenge
formed by the diverging branches of the sterno-maxillary muscles
below, and the two converging sub-scapulo-hyoideus above. The
trachea is here merely covered by the subcutaneous band of the
sterno-hyciaeus and sterno-thyroideus, and the whole is wrapped
TRACHEOTOMY. 479
by the thin expansion of the cutaneous colli. In this middle third
of the neck, the cartilaginous rings of the trachea, with the liga-
ments between which unite them, are readily identified.
The indications of tracheotomy, which are quite numerous,
are enumerated by Zundel, under five principal heads: 1st, when
an obstacle exists which interferes with the free access of air to
the lung, as in case of contraction or obstruction of any portion of
the air passages, including all the diseases of the upper part of the
respiratory tract, and acting directly, such as acute laryngitis,
cedema of the glottis, and polypi or paralysis of the larynx; or to-
gether with those which act indirectly, as strangles, purulent col-
lections in the guttural pouches, anasarca and purpura hemorrha-
gica; 2d, when foreign bodies have become lodged in the fauces or
the larynx, in order to facilitate their extraction, either directly, by
means of special forceps, or indirectly, by pushing them back into
the mouth to enable the surgeon to grasp them with his hand ; 3d,
to remove tumors, polypi, cysts or cancerous growths ; 4th, in cases
of fractures of the bones of the face, of the cartilages of the larynx,
or of the trachea; and 5th, again, when the trachea has become
the seat of any specific lesions, such as tracheocele; caries of the
tracheal cartilages, or of deformities, such as may result from frac-
tures, ossifications and contractions.
The operation is, however, contra-indicated when the cause or
object which impedes respiration occupies a point so low in the
passage as to be beyond reach by the tracheotomy tube ; or when
the difficulty in breathing and the danger of suffocation are due
to a diseased condition, either of the lungs or of the heart.
The instruments required for the operation are: a pair of
curved scissors, a convex and a pointed bistoury, a sharp-pointed
tenaculum, a bull-dog forceps, two blunt tenaculums and a trach
eotomy tube. Some special instruments for the division and am-
putation of the trachea have been invented, but the tracheotomes,
as they are called, do not generally serve as good a purpose as the
ordinary instruments already named.
Tracheotomy tubes are of various forms and devices. Some
are of very simple construction, and others are more or less com-
plicated. The ordinary tube consists of a bent and curved can-
ula, made of various diameters, more or less cylindrical, and
secured on a square plate, nearly flat, or with a curve in order
to adapt it to the convexity of the neck, and with an eyelet or
480 OPERATIONS ON THE RESPIRATORY APPARATUS.
Fig. 421.—Ordinary Tracheotomy Tube, front and back view.
slit at each corner, for the attachment of bands or straps. These
tubes are generally made of silver or nickel-plated metal, though
gutta percha is the material sometimes used, its lack of solidity,
however, rendering the instruments composed of it uncertain and
dangerous. Besides this ordinary tube, there is a long catalogue
of others, among which we have those invented by Dieterichs,
Gowing, Spooner, Vachette, Pradat, Brogniez, Leblanc, Renault,
Peuch, Inlin, Trasbot, and these do not exhaust the list. But
among all this host of instruments of this class there is probably
none which fulfils its purpose better than that of Director Degives,
somewhat modified by Professor Peuch (Fig. 430), which, by its
simplicity, and especially from the fact of its being a self-holder,
has proved itself to be the most convenient of all for general prac-
tice. When once inserted and adjusted, this tube may be left in
place without danger of removal or dropping of itself, while the or-
dinary tube, which requires to be secured by strings tied over the
neck, can never be as safe as the self-retaining instruments, which
hold themselves. ,
There are two methods of performing the operation, one of which
may be called the classical, and the other the immediate method.
In the former, two adjoining tracheal rings are divided, and re-
moved, in part or totally ; in the latter, a longitudinal incision is
made through the rings without loss of substance (Fig. 433). In
TRACHEOTOMY. 481
FIG, 422.—Tube of Dieterichs; Fig. 423.—Gowing’s Tracheotomy Tube.
posterior view.
FIG. 424.—Spooner’s Tracheotomy Tube.
either case the animal is, if possible, kept on his feet, with the head
elevated by a twitch applied on the lower lip. It may sometimes
be necessary to place him in stocks; to hobble his fore legs, or
perhaps only to raise one of the fore feet. In some instances the
patient is unable to stand, and, in fact, is already down when the
surgeon is called, and this is probably one of the only conditions
when the longitudinal incision is fully justified.
Classical Method.—This includes three steps, the object of
482 OPERATIONS ON THE RESPIRATORY APPARATUS.
Fia. 426.—Tube of Pradat.
Fig. 427.—Tube of Brogniez.
the first being the the exposure of the trachea; of the second, to
open it by removing a circular portion of the organ; and the
third by the introduction of the tube into the aperture prepared
for it.
A tee See
as \
+>,
-4
TRACHEOTOMY. 483
Fig. 430.—Tube of Peuch.
The operator stands facing the animal, slightly on the right.
Grasping the trachea (the hair having been closely clipped), he
fixes and stretches the skin with the left thumb and fore finger, at
about the middle of the tracheal region, and incises it with a sin-
gle stroke of the convex bistoury, cutting through the skin and
the cutaneous muscle. The incision is about three inches in
length, and exposes the sterno-hyoideus and thyroideus muscles.
These must be carefully isolated from the face of the trachea by
484 OPERATIONS ON THE RESPIRATORY APPARATUS.
TRACHEOTOMY. 485
the dissection of the cellular tissue which confines them, and drawn
apart by means of two blunt tenaculums, leaving a gaping wound
through which to reach the trachea, which is thus exposed, and
in readiness for the second step of the process.
Second Step.—In the second step portions of the two cartilages
which have been selected, are held by the pointed tenaculum, passed
through the connecting ligament, are excised, and a circular open-
ing established by the removal of a semilunar segment from each
ring. It is necessary at this point to be certain that the isolated
valve is securely held, to guard against the force of suction, by
which it may be liable to be drawn into the trachea as the new
breathing place is suddenly opened.
Third Step.—This consists in the insertion of the tube into
the aperture prepared for it, and is the simplest and easiest part
of the procedure. The only difficulty likely to occur is from the
neglect or error of the operator in measuring the dimensions of
the opening, and securing a perfect coaptation between that and
the tube. If the opening proves to be too narrow, it must, of
course, be enlarged, with the caution before mentioned against
losing any detached portions by the suction of the trachea. The
bull-dog forceps is of value here. If the tube is of the self-hold-
ing kind, its introduction completes the operation ; but if the or-
dinary tube before described is used, the tyimg over the neck of
the tapes attached to the flat plate becomes the final manipulation.
If no tube is at hand, the wound must be held apart with tapes
applied upon its edges, and tied over the neck.
Immediate Operation by Longitudinal Incision.—This is
done with the sharp straight bistoury, passing it at once through
all the tissues, penetrating the trachea between two cartilages,
and making a vertical incision of two or three rings. This mode,
as we have said, is principally justifiable in case of emergency
when suffocation is imminent, and no time can be lost in proeur-
ing the instruments necessary for the classical operation.
There is still another mode of operating, credited to Kris-
haber, which, from the location where it is performed, is better
known as sub-cricoidean tracheotomy, and which consists in mak-
ing the opening through the crico-tracheal ligament, which unites
the cricoid cartilage to the first tracheal ring. It includes three
steps, comprising the incision of the skin and dissection of the
underlying muscles, the incision of the ligament, and the inser
486 OPERATIONS ON THE RESPIRATORY APPARATUS.
tion of the tube. This mode of operating is simple and of easy
performance, especially in the absence of any swelling of the re-
gion. It prevents perichondritis, and is not followed by changes
in the diameter of the trachea. It has, besides, the advantage
of allowing the tube to be, to a great extent, concealed, and
thus removes one of the principal objections urged against the
operation in cases of chronic roaring, for which it might well be
recommended.
The subsequent measures vary somewhat, depending upon
whether the operation has been performed as only a temporary
expedient, or as a permanent means of relief for the difficulty in
breathing. In the first case, it is not necessary to remove the
tube before the acute symptoms, which have required its intro-
duction, have subsided, which is a condition which generally does.
not continue more than two or three days. If, however, during
that time the canula of the tube should become closed by the dis-
charge or other pathological secretions, it must be removed,
cleansed and replaced, to be left until its use becomes unneces-
sary, which will be readily discovered by the restored regularity
of the respiration when the tube is removed or its canula becomes
occluded.
If the tube is to be worn permanently, careful attention should
be paid to its proper fit and adjustment, and its daily removal
and thorough cleansing should never be overlooked. It should
be ascertained that the instrument fits properly, being held with
sufficient firmness in the opening, and making a safe and moder-
ate pressure on the soft tissues around. When the instrument
has been worn for a (variable) time, the opening of the trachea
has a tendency to contract, and becomes smaller by reason of the
development of the granulation of the edges of the wound. In
this case it may become necessary to enlarge the opening, by the
excision of the granulations, sufficiently to allow of the ready re-
introduction of the tube. When it becomes desirable to close the
wound, the removal of the tube, and the application of an ordi-
nary dressing, protecting it only by a pad of antiseptic oakum,
kept in place by a few turns of bandage around the neck, is all
that is necessary. Usually, after two or three weeks the cicatrix
is complete.
The operation of tracheotomy may be accompanied or followed
by various accidents :
ee]
TRACHEOTOMY. 487
Hemorrhage is rare, the small amount of bleeding which
occurs proceeding from the division of some of the arterioles,
branches of the carotid, passing between the cartilages over the
surface of the inter-cartilaginous ligament. It ceases spontane-
ously, and never requires any special attention. :
Emphysema of the neck may take place when the cellular tis-
sueis very loose and the edges of the skin overlap the tracheal in-
cision. It generally subsides without interference, or by moder-
ate, regulated pressure.
Tracheocele.—Renault so denominates certain growths which
appear on the tracheal mucous membrane, as the result of the ir-
ritation produced by the friction of the branches of the tube which
come in contact with it. He claims to have noticed their appear-
ance six weeks after the removal of the instrument. The nature
of the tumor varies much. They may be purulent, but they are
more commonly fibrous and of slow growth; and may sometimes
take the character of ossification of the cartilages. If these ob-
structions appear above the seat of the operation, the trouble is
easily remedied by the reintroduction of the tube, but if, how-
ever, they are found below that point, it is a more serious com-
plication, since it requires a second operation at a point below
that of the first.
The obstruction of the trachea by plastic exudation above and
below the seat of the operation, or its contraction, caused by the
overlapping of the divided ends of the rings which may have been
incised, may also be met with, and can only, as in the former case,
be overcome by a second operation. We personally remember a
case in which the formation of a post-tracheal abscess, which had
produced extensive contraction in the calibre of the trachea,
proved fatal through the impossibility of the introduction of a
tube after a second operation. The patient had been treated sey-
eral weeks previously for an attack of strangles, which had re-
quired an operation, and some six weeks after his recovery was
brought back suffering with a severe attack of roaring. As he
entered our hospital he fell to the ground, and the second opera-
tion was rapidly performed by a longitudinal incision, but the
tubes we had at hand were all too large, and in a few moments
the animal died. At the post-mortem a large abscess was found
behind the trachea, just opposite the seat of the first operation,
and the pus in collecting had so compressed and deformed the
488 OPERATIONS ON THE RESPIRATORY APPARATUS.
trachea that the index finger could scarcely be inserted into the
passage.
THORACENTESIS.
The usual intention of this operation is the removal from the
thoracic cavity of suppurative matter (empyema) or blood or se-
rous fluid, by puncturing the walls of the chest. It is indicated
in hydrothorax and in some traumatisms of the chest, and when-
ever there is a large collection of bloody or other fluid in the thorax;
in all cases, in fact, where the ordinary forms of treatment have
failed to relieve the patient thus affected. Although extensively
performed in human surgery, where the advantages and facilities
of operating are so many and so manifest, it has naturally proved
less beneficial to veterinary patients. And still, though probably
in the majority of the cases in which it has been employed the
relief which has followed it has been of only a temporary charac-
ter, and served only to prolong briefly the life of the animal sub-
jected to it, some few cases are on record in which it has given
very excellent results. The researches of St. Cyr have, moreover,
demonstrated that the operation is perfectly harmless, contrary to
the opinion formerly held, and that a large proportion of its fail-
ures to effect recovery are due to the fact that its application had
been too long postponed to justify a reasonable expectation of
success ; when, in fact, it had been deferred until the accumula-
tion of fluid had already become too abundant, and the pleural
membranes had already assumed the condition of a tendency to
pyogeny.
On this point, Peuch and Toussaint remark that if the punc-
ture is made when only the lower third of the cavity is full, and
if after the evacuation of the liquid a diluted solution of tincture
of iodine is injected into the pleural sac, as is done in human
surgery, perhaps more satisfactory results might be realized.
Our own view, however, is that the disposition of the pleura and
of the cavities, which they form, would scarcely justify the in-
jection. ;
The instruments required are a straight or convex bistoury,
and a small trocar, straight or slightly curved. Reul has invented
a paracento-injector trocar (Fig. 434), which is used for both the
puncture and the subsequent injection of the medical compounds.
The use of the aspirator (Dieulafoy) is also recommended.
THORACENTESIS. 489
Ey According to St. Cyr, the proper
place for the puncture is between the
seventh and eighth sternal ribs, a
little above the spur vein, this point
permitting the removal of a larger
quantity of fluid than any other, with
the advantage also of offering a wider
| space between the ribs, and a dimin-
fic ished thickness in the muscular sub-
; stance. Unless there are special rea-
sons to the contrary, the puncture is
made on the right side; if operating
on the left is indicated, care must
be taken to avoid injuring the heart.
For this reason the puncture is made
between the
eighth and ninth
ribs, with the
point of the in-
strument turned
backward. The puncture is made with the patient on his feet,
and he rarely needs any apparatus of restraint, though it will
always be judicious to apply a twitch on his lip.
St. Cyr describes the operation as follows: “The operator
makes an incision with the bistoury, about one inch long, near
the anterior border of the eighth rib or of the ninth, if he is on
the left side, dividing the skin and superficial muscular layers
until he reaches the internal intercostal muscle, which he leaves
intact. In piercing the cavity, he holds the trocar with the right
hand, guarding against its entering the chest too deeply by keep-
ing his fingers sufficiently near the point to gauge and control its
depth through the remaining undivided muscle. What remains
then is to withdraw the rod from the trocar, and keep the latter
in place while the fluid escapes. Any albumino-fibroid clots,
which may enter the canula and obstruct the flow of the liquid,
may be dislodged by introducing a blunt stylet into the tube.
When the canula is withdrawn after the escape of a sufficient
amount of fluid, the wound is closed with a single pin suture.
The trocar of Mr. Reul is inserted (Figure 434) in the usual
manner, with the nut E closed, and after removing the desired
Fig. 434.—Trocar paracento-injecteur de Reul.
490 OPERATIONS ON THE RESPIRATORY APPARATUS.
quantity of fluid, the nut F is closed and E is opened. In the
funnel D, the diluted tincture of iodine is poured and carried into
the chest as slowly as the operator thinks proper, where it mixes
with the remaining portion of the fluid. When the injection re-
turns in the instrument to a level with the little piece of glass C,
the nut Eis closed, and the instrument removed, thus guarding
entirely against the introduction of air into the chest.
In respect to the quantity of fluid that can be safely removed
at once, there are varying opinions. Some practitioners hold that
the cavity ought to be entirely emptied, or, at least, so far as the
location of the puncture allows, while others favor the method of
discharging the contents by installments.
According to St. Cyr, who has experimented very extensively
in this matter, the removal of a small quantity is followed by a
negative result, the fluid forming again in a very short time; while,
on the other hand, if the entire accumulation is taken away at one
time, amounting, perhaps, to forty or fifty quarts, it must be at
the hazard of encountering, as supervening disorders, syncope,
rupture of the pulmonary vesicles, congestions, or splenic or hep-
atic hemorrhages, with an ultimate fatal termination.
The question thus remains unsolved, and if recoveries have
been recorded by Lafosse, Jr., Strauss, Massot, Bar and others,
failures have followed the operation in the hands of Gohier,
Pilger, Bassi, Dieterichs, Prudhomme, St. Cyr, ete. Pellé and
Sewell have obtained recoveries when removing all the fluid at
once. Our own experience has been negative in the cases in which
we have observed both conditions—that of partial, and, as well,
that of the entire removal of the fluid.
Supplementing the operation with medicinal injections of
some sort has been recommended. Hertwig has used astringent
solutions ; Leblanc, Bouley and Prudhomme have favored the use
of tincture of iodine, and the following prescriptions, used in
human surgery, are recommended by Peuch and Toussaint :
Weak Solution—B—Tinct. of iodine, 10 parts; iodide of
potass., 1 part; distilled water, 100 parts.
This is first used, but, if it fails, the following is injected :
Strong Solution—&—Tinct. of iodine, 30 parts; iodide of
potass., 4 parts; distilled water, 100 parts.
The general treatment recommended for those forms of dis-
eases in which these liquid accumulations originate, must be per-
oe
THORACENTESIS. 491
severed in after the thoracentesis, including the counter-irrita-
tions, diuretics, tonics, stimulants, alteratives, ete.
The operation is performed on the dog also in the same man-
ner as on the horse, but either with smaller trocars, or, what is
better, with some one of the aspirators recently invented.
With this animal the results are more satisfactory on account
of the simplicity and unilateral development of the pleuritic
effusion.
CHAPTER X.
OPERATIONS ON THE CIRCULATORY
SYSTEM |
BLEEDING—VENESECTION.
The term bleeding, or venesection, signifies the opening of
certain veins for the escape of a portion of the blood, for a ther-
apeutical, or experimental purpose. If it is designed to reduce
the volume of the circulation, it is known as general, and is per-
formed upon some one of the larger blood vessels; if practiced
to remove blood only from a given region, it becomes Jocal, and
in that case the smaller vessels are divided. A better division is
that which is based on the nature of the vessel which is opened,
and thus it is phlebotomy, if a vein is opened; arteriotomy, if
an artery; and capillary, or arterio-phlebotomy, when the opera-
tion is practiced upon the capillary system.
There has been much discussion upon the question of the
utility of blood-letting, and strong advocates and earnest oppo-
nents, who have argued its benefits and denied its usefulness, and,
in fact, ascribed evil results to its practice, whether the depletion
affects the general circulation or a limited region. But upon this
we shall not enter. Those who maintain its practice consider it
to be indicated when it is desirable to reduce the activity of the
circulation, or, on the contrary, to stimulate it in parts where,
from different causes, it has been temporarily suspended, and to
stimulate absorption, or to relieve the organism of foreign ele-
ments.
It is, however, contra-indicated in all eruptive fevers, in anzemic
patients, and in those suffering with typhoid diseases.
The old fashion of “ taking blood” as a prophylactic measure,
or at a certain season of the year, is simply the result of an ignor-
ant delusion.
The quantity of blood that can be removed must vary, of
course, with the size, the nature and the condition of the animal.
PHLEBOTOMY. 493
Gourdon recommends the following scale as representing the aver-
age bleeding, proper, for the animals named :
The horse, between 4 and 5 pounds; large ruminants, 5 to 6
pounds; pig, 1 to 14 pounds; sheep, 6 to 9 ounces; dog, 3 to 6
ounces.
PHLEBOTOMY.
Phlebotomy, or the opening of veins, is the mode universally
adopted for general bleeding, and is generally performed upon
superficial veins.
The instruments necessary are fleams, lancets, scissors, bleed-
ing-sticks, pins, pin-holders, graduated jars or vases, and a piece
of silk, and, for small animals, bandages.
The fleam, made in various forms, resembles a small lancet,
and is secured on a steel support received into a metallic, horn or
gutta-percha handle. Ordinarily, two or three lancets of different
Fig. 485.—Ordinary Fleam, with three blades.
sizes have one common handle, upon which they are so mounted
as to be used singly with facility.
Some of them, of German make, or of English invention, or
of a Belgian pattern, act with a spring, like the phlebotome of
Brogniez.
The bleeding-stick is simply a stick of hard and heavy wood, a
foot or more in length, with which to drive the fleam into the
vein.
494 OPERATIONS ON THE CIRCULATORY SYSTEM.
Fia. 437.
FIa. 436.
FIGs. 486, 487, 438.—German and English Spring Fleams.
Fic. 440,—Bleeding Stick.
PHLEBOTOMY. 495
The graduated vase is to receive the blood, and at the same
time measure its flow. In ordinary practice a pail is substituted.
The pins must be long and strong. The pin-holder is used to
assist in the introduction of the pin when the suture is made and
the bleeding terminated.
Sponges and cold water should be accessible.
Mopus OPpERANDI.
Position of the Animal.—The standing position is the one
generally preserved. The animal is held well in hand by an as-
sistant, and if he appears to be excited and unwilling to stand
quietly, and soothing treatment has no effect, a twitch is placed
f on his nose, or a cap on his head.
The operation consists of three steps:
1st. Preparation of the Blood Vessel:
This consists in applying sufficient pres-
sure upon it to temporarily interrupt
the circulation and cause it to become
\
yy times with a ligature, when the loca-
\R tion of the vessel permits it. In some
/ | Vy) blooded and thin-skinned animals, a
oe \Yy little brisk exercise is sufficient to stim-
BASIN << \\
hi. ; y ulate the circulation and render the
A: \ \\\ S NX s 5 C
\ WN veins prominent.
\\ \ . 2d. Opening of the Vessel.—This
is done with the fleam, the lancet or
the bistoury. The fleam is more com-
UD, monly used for large animals. Held as
j in figure 441, it is brought opposite the
dh vessel, parallel to its course, and per-
fectly perpendicular to it, and at such
a distance from the skin as to approx-
imate very nearly, but without forming
an actual contact with it. When in
this position the fleam is made to pen-
etrate the vessel by a smart blow with
el ae ee the bleeding-stick on the back of the
Menin: blade; some practitioners, instead of
=
496 OPERATIONS ON THE CIRCULATORY SYSTEM.
striking with the stick, apply the blow with their hands, but
with cattle, the stick is indispensable. The moment the blow
has been applied properly, the stream of blood escapes freely;
when the blow has been too light, and the skin only divided, with
but a scanty or no escape of the blood, it is called a white bleed-
ing ; and slabbery when the opening is not large enough for the
escape of a full stream, or when the openings of the vein and of
the skin are not in apposition, which will be the case if the fleam,
instead of being held perfectly perpendicular to the skin, has
been held obliquely. The opening of the blood vessel with the
spring fleam is performed in the same manner, except that the
lancet receives its impulse from the spring instead of the stick.
The puncture with the lancet or bistoury should be made with a
single stroke of the instrument. In large and superficial veins,
the spring lancet is as easily and safely managed as the fleam.
3d. Closing the Blood Vessels and Stopping the Flow.—
When a sufficient quantity of blood has been drawn, and the pres-
sure upon the vein, which has been continued during the flow, is
gradually relaxed, the stream ceases, more or less completely. To
terminate it entirely, a simple stitch of pin suture is applied. It
is to be preferred to all other means, such as pressure, bandaging
or adhesive plasters. The suture is made by grasping the two
edges of the skin with the thumb and index finger of one hand,
and slightly raising them, then transfixing them with a long pin
through their middle, with either the hand or the pin-holder, in-
cluding a fair amount of skin, and completing it by a special knot,
made with silk or a loop of the long hair of the
mane or tail of the animal. In applying this
suture, the skin must not be pulled away from
the body too far, nor the knot tied excessively
; tight. To keep the wound clean and prevent
Fig. 442.—Suture after the animal from rubbing off the dressings is all
ana ae that is necessary, for a few hours, after the
operation. The wound heals by first intention, and the suture and
the pin can be safely removed after twenty-four hours.
PHLEBOTOMY IN SOLIPEDS..
Four of the principal superficial veins are selected for this
operation in solipeds; the jugular, the cephalic, the subcutaneous
thoracic and the internal saphena.
PHLEBOTOMY. 497
PHLEBOTOMY AT THE JUGULAR.
This vein is usually selected on account of its size, its situation,
and the facility with which it can be opened, and the wound of
the skin closed. It is, however, contra-indicated when the vessel
is in any degree diseased, or when the animal is sufferimg with
itching skin diseases.
Formed by the superficial temporal trunk and the internal
maxillary vein, the jugular descends through the parotid gland to-
ward its inferior extremity, receiving several collateral veins, and
reaches the groove of the lower part of the neck, which from its
presence is called the jugular groove, until it reaches the lower
extremity of the neck, when it enters the chest. In its course in
the groove it accompanies more or less closely the carotid artery;
a
Fia. 443.—Anatomy of the Jugular Vein and (@sophagus in the Horse. JJ, jugular
vein; C, carotid artery; O H, omo-hyoideus muscle; D, cesophagus; 8, sterno-maxillaris
muscle; M, mastoido-humeralis muscle.
498 OPERATIONS ON THE CIRCULATORY SYSTEM.
but in the middle third of its length becomes separated from it by
the fiat ribbon-like structure of the sub-scapulo or omo-hyoideus,
whose fibres pass obliquely between the two blood vessels, from
below upward. It is, therefore, in the middle third of the neck
that the bleeding at the jugular must be made, in order to avoid
wounding the carotid artery.
Besides the general rules already stated, this special bleeding
requires peculiar measures.
(a) Position of the Animal.He must be kept well in hand,
with the head somewhat elevated, and must be prevented from
seeing the various movements of the operator, by covering his
head with the cap or mask, or by having the eye, on the side of the
operator, covered with the hand of an assistant.
(6) The fleam is generally employed, the size of the blade vary-
ing according to the thickness of the skin and the condition of the
blood vessels. The left jugular is generally selected, unless contra-
indicated for some special reasons.
(c) Preparation of the Vein.—The application of artificial
pressure for the dilatation of the vein is not only unnecessary in
solipeds, but has in some cases proved dangerous. In this step of
the operation the hand is to be preferred as safer and more reli-
able than any ligature or bandage can possibly be.
The compression is made with the fingers of the hand which
holds the fleam, applying it in the jugular groove, below the point
where the incision is to be made. The projection of the vein may
be made more distinct by moistening the hair over the spot to
be punctured, with a wet sponge. The improper habit to which
some practitioners are addicted, of doing this with their saliva, by
spitting upon the neck is to be severely condemned. If the bleed-
ing takes place on the left side, the pressure must be made with
the left hand, the operator turning his back toward the hind parts
of the animal. [If it takes place on the right side, the pressure is
made with the fingers of the right hand.
(d) Opening of the Vein.—Placed as we have described, at
the side of the neck of the patient, his back turned toward his
hind parts, and pressing with the fingers of his left hand which
holds the fleam, as before stated, the operator grasps the bleeding-
stick, and striking upon the fleam, opens the vein, and the blood
escapes in a good, full stream. Maintaining the pressure on the
vein throughout the flowing of the blood, he lays aside the stick
PHLEBOTOMY. 499
and the fleam, and attends to the flow of the blood into the grad-
uated jar, or the pail provided to receive it.
(e) Keeping the Stream.—As we have said, the pressure upon
the blood vessel must be sustained from the beginning to the end
of the operation. Relieving it but for a moment is an error,
likely to be followed by the introduction of air through the wound
into the vein. Not only must it be kept up continuously, but it
must be steady. The habit which largely prevails of moving the
fingers or the vase up and down along the vein while the pressure
is applied, and with the idea of stimulating the flow of the blood, is
most dangerous. If the blood does not escape freely, though the
operation has been properly performed, an increased circulation
may be stimulated by making the animal move his jaws, or shak-
ing the bit in his mouth, or placing the bleeding-stick or a finger
of the assistant, into the mouth over the bars, and quietly moving
them.
(7) When the bleeding is to be stopped, the operator applies
one of his fingers over the wound of the skin and gradually re-
moves the pressure made below it. When this has been done, he
proceeds to the application of the suture, always introducing the
pin with the head turned upward, irrespective of the side on which
the operation has been performed.
(g) Subsequent Care.—This is the same as in other cases, but
we may add that an animal that has been bled at the jugular is
unfit to work for three days, in order to give time for the wound
to heal completely.
PHLEBOTOMY AT THE CEPHALIC VEIN.
The cephalic is one of the terminal branches of the median
subcutaneous vein, and runs upward and forward to pass toward
the lower extremity of the coraco-radialis, where it crosses the
tendinous band which this muscle sends to the anterior extensor
of the metacarpus, running in the space which separates the sterno-
humeralis muscle from the levator-humeri, and emptying into the
jugular, a little in front of the confluent of those two veins. In
this course, the most accessible portion is that which rests on the
inferior extremity of the levator-humeri. The fibrous band of the
coraco-radialis is the guide indicating its position, viz., a little in-
side the forearm, on a level with the anterior and oblique fold
which separates the arm from the forearm.
500 OPERATIONS ON THE CIRCULATORY SYSTEM.
nh
i
oe aes. =
i <7 me
2 = :
~ = = ——a
FEET
F, rs
ete
a ne
oe:
Sete
Fia. 444.—Anatomy of the Cephalic Vein. ™, Median subcutaneous vein; 6, basilic
vein; c, cephalic vein; d, inferior extremity of the coraco-radialis; t, aponeurotic band
extending from the coraco-radialis to the anterior extensor of the metacarpus; 8, ster-
no-humeralis; h, mastoido-humeralis; a, space between these two muscles; 7, humeral
vein.
On account of the presence of the other terminal branches of
the main vein, from which the cephalic rises, viz., the’ basilic, pres-
sure upon the cephalic does not allow of its dilatation. To obtain
this, the animal must be exercised for some time, and when
brought to stand still, to raise the opposite leg, or to carry the
leg to be bled forward.
As the vein is easily displaced from its position, it is hardly
PHLEBOTOMY. » 501
safe to attempt to open it with the lancet. The fleam is always
preferable. If the bleeding is from the left vein, the instrument
is held with the right hand, the operator is placed against the
shoulder, fleam haying its blade turned downward, the fingers
resting against the chest, and with a blow of the stick the vein is
opened. - This bleeding is often accompanied by the formation of
a hematoma over the course of the vessel, due to the fact that
very often the fleam has opened the vein through and through.
This, however, is not a matter of any serious consequence.
PHLEBOTOMY ON THE SuBcUTANEOUS THORACIC.
This vein runs on the side of the thorax, on a level with the
sterno-trochineus muscle, and is readily discovered toward the
sixth or seventh rib. To render it more conspicuous, a bandage
can be applied around the chest, as suggested by Chabert, or by
carrying the leg of the side to be bled forward, and by rubbing
hard the tract of the vein, or even by simple pressure with the
fingers.
The operation can be performed either by a simple puncture with
a lancet, or with a fleam, held parallel with the course of the ves-
sel, and between two ribs, to avoid breaking the instrument against
one of the bones. The bleeding is stopped in the usual way. It
is not unfrequently followed by the formation of a thrombus,
which generally disappears by pressure, or astringent local appli-
cations, and often by spontaneous absorption.
PHLEBOTOMY AT THE INTERNAL SAPHENA.
The comparatively large size of this vein, and its superficial
position, both explain and justify the fact that next to the jugular,
it is the one most commonly selected for the operation. For this
reason phlebotomy is indicated here, when it is contra-indicated
upon the vein of the neck.
The saphena is formed by two branches, and in its course
crosses slightly the direction of the tibia in running upward on -
the surface of the tibial aponeurosis, arriving at the flat of the
thigh, formed by the short adductor of the leg, and then dips in
the space left between this muscle and the long adductor, where
it empties into the femoral. In this course the vein is superficial,
covered only by a thin skin, from which it is separated by a thin
aponeurotic layer. It is at a point where the vein passes over the
502 ’ OPERATIONS ON THE CIRCULATORY SYSTEM.
anterior root; 7, its posterior root; 7, femoral vein; g, deep inguinal lymphatic glands;
c, short adductor of the leg; 7, long adductor of the leg; a, subcutaneous aponeurotic
layer; 7, fascia lata.
flat of the thigh that it must be opened. If the operation is per-
formed with the fleam, the higher the better; if with the lancet,
it can be done as the vein passes over the tibia, where it is more
accessible.
In operating, the leg opposite the one to be bled is held up
and backward by a strong assistant, in the posture of the black-
smith about putting on a shoe.
PHLEBOTOMY. 503
If the lancet is used, the operator, placing himself on that
side also, bends down, and, looking from under the abdomen of
the horse, brings the instrument close to the vein, opening it by a
rapid stroke, and enlarging the orifice by a slight incising motion
of the instrument.
If the fleam is used, the operator assumes the same position,
and applies it precisely as has been described in the cases already
considered.
Operating on the right side he holds the fleam with the right
hand and strikes with the bleeding-stick in the left, and vice versa.
This position of the operator is awkward, and not without
danger, exposing him to the chances of a blow with the stifle of
the leg which is held by the assistant. To avoid this, Peuch and
Toussaint suggest that the assistant, instead of holding the leg
backward, should carry it forward, and that the operator should
place himself behind the animal. It is also claimed that in that
position the vein is more easily exposed. The operation is per-
formed in the same way, except that the instrument is held with
the right hand if one operates on the left leg, and with the left
hand if the bleeding is done on the right leg.
The flow of the blood in this bleeding is generally slabbery,
and the introduction of the pin of the suture quite painful, and
means of restraint are, therefore, often necessary before the ani-
mal will submit to the application of the suture.
PxuEBoTOMY ON OTHER SUPERFICIAL VEINS.
Others, besides the veins which have been described, are also
subject to phlebotomy, but its performance is more with some
local object in view than that of a general bleeding.
All are performed with the lancet, the region (Fig. 446) where
they occur being at the transversal of the face,a; the angular of
the eye (b); the facial or glosso-facial, d; the superficial nasal,
(c); the posterior auricular (e); the deep lingual, the inferior
caudal, and the median subcutaneous of the forearm. Tf required
by their size and position a pinned suture is applied after the
bleeding, but in several instances pressure alone is sufficient.
PHLEBOTOMY IN LARGE RuMINANTS.
The operation is confined to two principal veins of the large
ruminants. These are the jugular and subcutaneous abdominal.
504 OPERATIONS ON THE CIRCULATORY SYSTEM.
Fig. 446.
PHLEBOTOMY ON THE JUGULAR.
It is performed in the same manner essentially as in the soli-
peds, and with the same instruments. But as cattle are less sub-
missive to the preparations which precede the operation, means
of restraint must be used with them, and they must be tied to a
tree or a post. The jugular of cattle has thicker walls than
that of solipeds, its diameter is much greater, and it is separated
from the carotid in its whole length by a thicker layer of muscle.
For these reasons a larger fleam becomes necessary. To dilate
the vein a strong ligature is applied tightly on the neck, the pres-
sure of the fingers never being sufficient to furnish the necessary
force. To open the vein the blow of the stick must be heavier,
and when properly given is followed, as in solipeds, by a strong
stream of blood, which rapidly ceases when the ligature is loosened
or removed. It is not always necessary to apply a pinned suture,
but it is always safer and more prudent to do so, though the in-
troduction of the pin is rendered difficult by the toughness and
thickness of the skin. The value of the pin-holder is demon-
strated in this case.
The thrombus which so often follows this operation is not
serious, and, in fact, its formation is stimulated by some practi-
tioners.
PHLEBOTOMY AT THE SuBcUTANEOUS ABDOMINAL.
This vein is of enormous volume, extending from the udder to
the xyphoid cartilage of the sternum, at the side of the abdomen,
PHLEBOTOMY. 505
to terminate in the internal thoracic vein. It is, therefore, easily
recognized, and particularly so in milch cows, and it is, therefore,
unnecessary to use the ligature or any other means to swell its
dimensions, the pressure of the fingers being more than sufficient.
A fleam of medium dimension is preferable to the lancet in this
case. The animal is firmly held by the head, and to prevent his
kicking, is pulled forward by its tail passed between its hind legs.
In opening the vein the operator places himself forward of the
shoulder, his back turned toward the head of the animal, holding
the fleam with the hand corresponding to the side of the animal
against which he is placed. The bleeding is stopped with a pin,
or, what is better, a bandage, to prevent the formation of a
thrombus. :
Puiepotomy oN SMALL ANIMALS.
Bleeding is seldom performed on sheep. When it is indicated
it is performed on the facial, the jugular, the cephalic, or the ex-
ternal saphena. 'The vessel is opened with the lancet, the wool,
a =
Fa. 447.—Position of the Facial Vein in Sheep.
if necessary, having been clipped off from the place of puncture,
and the wound is closed with a pin suture.
In swine two sets of veins are eligible for the operation, the
posterior auricular, as it runs at the internal face of the ears,
and the external saphena, where it passes along the tendo Achilles.
The lancet is used upon both. The first stops bleeding without
help; the second is closed with the pin suture.
In dogs, the jugular is sometimes opened. This vein, from its
position, requires the application of a string around the neck to
swell the vessel. The puncture is made with a small fleam or a
lancet, and the wound closed with a pin. The external saphena
506 OPERATIONS ON THE CIRCULATORY SYSTEM.
being quite large is chosen in preference to the internal, which is
very small. The place of selection is the superior part of the
ven, when it nearly reaches the posterior border of theleg. A
bandage is applied to stop the hemorrhage. The cephalic might
be opened as ib passes toward the interior third of the humerus,
the wound being closed by a stitch of twisted suture.
ACCIDENTS OF BLOOD-LETTING.
The operation of blood-letting may be followed by several
complications, some being of little importance, while others may
be sufficiently serious to compromise the life of the patient.
Among them may be named: The white and the slabbery bleed-
ing; wounds of surrounding non-yascular organs; the thrombus;
inflammation of the vein, or phlebitis; wound of the carotid, and
the introduction of air into the veins. Others, such as the lesions
of nerves, syncope, etc., are seldom, if ever, encountered in yeter-
inary practice.
lst—WHiITE AND SLABBERY BLEEDING.
It is a question whether these, properly speaking, should be
classed among the true sequel of blood-letting. We already
alluded to them when describing the various methods of perform-
ing phlebotomy. They are often the result of the disposition of
the parts, the vein being deficient in size, or more deeply situated
than natural, and thus imbedded in the loose surrounding cellular
tissue; or, perhaps, the cause is an unguarded movement of the
animal; and it is often known to be the imperfect manipulation
of the surgeon in striking the fieam too lightly, or not vertically,
and so failing to bring the openings of the skin and the vein into
exact coaptation.
These accidents are, however, of an unimportant character,
and are easily obviated by exercising more care and deliberation.
2d—Wovnpds of SurRRouNDING NoN-VASCULAR ORGANS.
(a) Wounds of the Trachea.—The improper action of the
surgeon is generally chargeable with this accident. He may have
erred in using too large an instrument, or the error may have con-
sisted in making excessive pressure when ligating the neck with
the cord used to effect the distension of the jugular. It is a rare
ACCIDENTS OF BLOOD-LETTING. 507
accident, but may be easily recognized by the flow of blood which
escapes through the nostrils, and possibly by the changes which
may affect the respiration by threatenings of strangling, suffoca-
tion, etc. In this serious case the ligation of the blood vessel is
the only means of stopping the hemorrhage.
(0) Wounds of the Caudal Muscles.—This is comparatively a
common accident with cattle, but is seldom attended with symp-
toms of a serious character. The principal danger consists in the
possibility of the formation of fistulous tracts, more or less re-
bellious to treatment, as besides the muscles, the tendons, and
even the bones may have been injured by the instrument.
3d—TxromsBvs.
This is understood to be a bloody tumor, or hematoma, which is
formed around the opening of the vein by the accumulation of the
blood in the surrounding cellular tissue. It appears when the
opening of the vein does not accurately correspond with that of
the skin, or when the incision of the tegument is too small to allow
a free flow of the blood through it. It often appears when the
animal is allowed to rub himself after the operation, or when the
opening of the vein has involved a section of one of the valves.
Some veins, as the saphena, the cubital, and the subcutaneous
thoracic, are more exposed to thrombus than others, even when
the operation has been well performed and completed. At these
veins, they are generally not serious, and are readily subdued by
simple treatment, if they do not spontaneously disappear.
But the thrombus, which is sometimes encountered at the jug-
ular, is of a more serious character, and is not unfrequently com-
plicated with phlebitis.
The symptoms of this lesion are essentially local, and the
symptoms and the disease are, in effect, one, consisting of a tumor
of uncertain dimensions, according to the quantity of blood col-
lected under the skin. In the beginning it is round, well cireum-
scribed, soft, and slightly elastic to the touch, but the swelling
soon becomes hard, perhaps oedematous, or somewhat diffused,
when it has been caused by rubbing on the part of the animal.
The simplest cases gradually disappear after two or three days.
But at other times they are not so tractable, and serious trouble
may ensue, the tumor becoming stationary, or perhaps increas-
ing in size, and then changing its character. It becomes warm
508 OPERATIONS ON THE CIRCULATORY SYSTEM.
and painful, assumes aspects of a phlegmonous nature, and per-
haps becomes complicated with hemorrhages. It is not yet too
late to look for resolution, but if it does not soon take place, and
if the symptoms increase, and the swelling extends, the vein is
changed into a hard, large cord, and a case of phlebitis is estab-
lished.
Absorption and resolution are now the two most favorable ter-
minations of thrombus, but they are of unusual occurrence, except
when the tumor is of small size, and promptly attended to.
Suppuration is the more common event, and if this continues
to be superficial, recovery may be looked for without obliteration
of the vein.
Philebitis, which commonly accompanies a deep suppurative
thrombus, is always a serious termination. Abscess of the throm-
bus, however, may assume various modifications, and may pass to
a chronic condition, or that of induration, or one of still more
serious nature, that of gangrene.
When it has become developed, the animal must be immedi-
ately secured to prevent him from rubbing the parts, and as early
as possible the treatment should be directed to the limitation of
its development and the promotion of its absorption. Local ap-
plications of cold water; astringent compresses, moistened with
vinegar or lead solutions; poultices of clay, of soot, or of chalk,
mixed with vinegar, will very often be sufficient to control or re-
move the growth. Sometimes, however, the absorption will be
more effectually stimulated by frictions with cantharidis oint-
ment, and in a week or ten days the thrombus will have entirely
disappeared. The Girard ointment, of Venice turpentine and
bichloride of mercury, is sometimes also very effective.
If the tumor assumes the nature of an abcess, and this re-
mains superficial, it may be opened with the bistoury, or the actual
cautery, and should hemorrhages occur they must be principally
controlled by pressure.
4th—PuteEBIirTIs.
The first effect of the inflammation of veins is the coagulation
of the blood and the formation of a clot in a given length of the
vascular canal, adherent more or less to the walls of the vessel, the
result being the partial or perhaps complete obliteration of the
vein, and hence a certain disarrangement of the circulation, which
ACCIDENTS OF BLOOD-LETTING. 509
may be supplemented by the anastomotic action of collateral ves-
sels above and below the occluded portion. Or, again, the circula-
tion may be entirely obstructed, and, as a consequence of the in-
flammatory changes, adhesions foliow, between the clot and the
venous wall, the clot being resorbed, and the obliterated vein
transformed into a fibrous cord. So long as the inflammation is
limited to the internal wall of the vessel, phlebitis is known as
adhesive; but if it extends to the external or even to the middle
structure, and becomes suppurative, itisso distinguished. Hither
of these forms of the disease may be changed by a third modifica-
tion to that of hemorrhagic phlebitis. These three forms or diver-
sities of the disease have been established by Peuch and Tous-
saint, whose views touching the treatment of the affection we also
reproduce, referring our readers for the pathological history of
the lesion to the various works relating to it.
Ist. Adhesive Philebitis.—At the beginning of the disease, the
animal must be placed under such conditions ‘as will tend most
favorably to influence the process of organization between the
clot and the venous walls, and to prevent the establishment of
suppuration. To effect this object, the enforcement of a state of
immobility in the patient is most essential. His head must be
firmly secured on both sides, and his mastication made as easy as
possible, by suitably regulating the consistency of his diet, in
order to diminish the force of the circulation, and so far obviate
the danger of the displacement of the clot and possible resulting
hemorrhage. The diseased parts should be treated by local ap-
plications, among which lotions of lead water, with continued cold
water irrigations, will give excellent results. But ointments of
any kind should be avoided, especially in warm weather, from their
liability to become rancid and irritant, and to stimulate the patient
to rub himself. The use of cooling applications must be perse-
vered in, in preference to the frictions with vesicatories, which,
especially in nervous animals with tender skin, might be liable to
encourage the suppurative process. In tougher-skinned animals,
and those of a lymphatic temperament, in which the inflammation
has a tendency to become chronic, resolvents, blistering, liquid
liniments, and alteratives are indicated, and of these, and first in
order, must be named cauterization with the red iron. The
conical cautery is applied on closed, fine points, and arranged
quintuply, every second point being deep, while the others are
510 OPERATIONS ON THE CIRCULATORY SYSTEM.
only superficial. By this peculiar mode of firing the absorption
becomes greatly stimulated, and the resorption of the tumor very
rapid. Cauterization, however, if beneficial in chronic, is not so in
acute cases, having in the latter a tendency to be followed by sup-
puration,
2d. Suppurative Phlebitis.—For this form of this serious af-
fection several modes of treatment are proposed.
(a) Hxpectant Treatment.—This is the plan by which the phy-
sician or surgeon, administering palliatives only, trusts to the vis
conservatriz for cure, watching meanwhile the development of the
disease, and waiting for and expecting the guidance of nature in
respect to his own interference.
(6) Simple Incision.—This is the simplest of surgical inter-
ferences, and means nothing more than the opening of the abscess,
the enlargement of the fistulous tract, and the formation of an
exit for the pus and coagulated blood which it contains. This is
done with an ordinary bistoury, guided by a probe or grooved
director.
(ce) Injections.—The fistulous tract which exists on the phle-
bitic tumor is washed with a detersive injection of solutions of
tincture of iodine, or perchloride of iron; or of corrosive subli-
mate, from 550 to isso. These are intended not only to remove
any remaining clots softened by the suppuration, but also to
stimulate the granulations and the cicatrization.
(d) Enlargement of the Fistula and Introduction of a Seton.
—AnS§ probe is introduced into the fistula, and when it has
reached the upper part of the swelling formed by the vein, close
to the obturating clot (which must not be disturbed), an incision
is made over its blunt end to enable it to pass out through the
skin. The fistulous tract is then enlarged with the straight bis-
toury from below upward to a small extent, and between the two
openings a small seton is passed by means of the probe, and se-
cured in place by knotting the ends. The movement of the seton
by drawing it to and fro, effects the removal of such portions of
the clot as may remain in the wound.
(e) Enlargement of the Intra Venous Fistula in its Whole
Length.—This consists in opening the tract from its commence-
ment to its superior cul de sac, as far as the adhesion between
the clot and the vein extends, the incision sometimes reaching
below the opening made by the fleam. Thus exposed, the tract
ACCIDENTS OF BLOOD-LETTING. 511
is washed out with the tincture of iodine or perchloride of iron
solution, or even destroyed with the actual cautery. The last two
forms of treatment, however, are dangerous, from their liability
to occasion consecutive hemorrhages.
3d Hemorrhagic Phlebitis—The most serious incident of
phlebitis, proceeding, as it does, from both the adhesive and the
suppurative forms, is the more or less abundant hemorrhage,
which, resulting from any of the various causes which have been
mentioned, may interfere with the cicatrization or obliteration of
the venous wound. Three modes of treatment are practiced for
their suppression. These are the twisted and the quilled suture,
and the ligation of the vein.
(a) The Twisted Suture.—This consists in the combination of
several (two or three) long pin sutures, placed upon the wound
made by the fleam, and including a larger portion of the skin at
the sides than the single pin suture of an ordinary bleeding.
Sometimes wooden pins are substituted for those formed of me-
tallic material, and when the sutures are completed, the wound is
strengthened by a coating of some strong, adhesive mixture.
Some practitioners, however, prefer to this the application of a
severe blistering friction, which, by the pressure of the swelling
which it produces upon the internal circumjacent parts, secures
practically all the effects to be obtained by a compressive bandage.
(b) Quilled Sutures.—These are applied on each side of the
wound, securing a good hold by placing them at some distance
from the edges, and embracing tightly between them a thick por-
tion of the skin. This point is important, for the reason that this
portion of skin is destined to be sacrificed by being left to slough
off, and this must not take place until the obliteration of the wound
is entirely completed.
(c) Ligature of the Vein.—The success of this operation, to be
assured, requires the selection of a healthy portion of the vein on
which to place the ligature, even if it become necessary to look
for it among the original roots of the jugular, viz., the facial and the
glosso-facial. In performing it, the animal must be secured in the
recumbent position. A single incision is made through the skin,
the whole extent of the obliterated vein, parallel to its axis, and
the vessel exposed and separated from the surrounding tissues.
The separation, which requires skillful and cautious manipulations,
can be effected by means of either a director or along probe. It
512 OPERATIONS ON THE CIRCULATORY SYSTEM.
will be no more than a wise precaution to apply a second ligature
below the clot, to prevent the possibility of the escape of suppura-
tive matter into the general circulation. The material of the
ligature may be either ordinary linen cord or silk. Our own pref-
erence is for sterilized catgut. The resulting wound is treated in
the manner proper for all similar wounds, and in from twenty to
twenty-five days complete recovery may generally be looked for.
4th. Wownd of the Carotid.—This complication of phlebotomy
at the jugular is not of common occurrence, but is easily possible.
It may become one of the consequences of using a fleam unneces-
sarily large, and out of proportion with the dimensions of the vein
and the thickness of this skin; or it may be caused by the exhibi-
tion of needless violence, in striking too heavy a blow with the
bleeding-stick. Nor are these the only causes to which wounds of
the carotid may be referred. An abnormal anatomical disposition
of the artery, either permanent or temporary, may cause it to re-
ceive the wound designed for its neighbor the jugular.
The symptoms pertaining to this accident are very character-
istic. The color and volume of the blood, and the rapidity of the
per saltum flow of the stream are sufficient evidences of the
arterial and non-yenous source of the hemorrhage. Concurrently
with this, a swelling takes place around the edges of the wound,
increasing with greater or less rapidity, and nearly resembling the
ordinary thrombus of venous extravasation, though differing from
it by the rapidity of its formation.
This false aneurism is now subcutaneous, and has a tendency
to extend itself downward toward the lower part of the neck, and
has, indeed, been found extending as far as the entrance to the
chest.
This accident is generally one of a serious nature, not alone
in itself, but often because of the specific manipulations which it
necessitates in order to overcome it. There are, however, several
fatal cases on record. The indications of treatment may be either
quite simple, or, at times, of serious import. If the puncture of
the artery is but a small one, and the flow not abundant, one or
two strong pin sutures may be sufficient to control it, especially if
associated with it steady and firm pressure is established directly
upon the course of the vessel, either by compressive bandages, or,
what is better, with the fingers firmly pressing in the jugular
groove. If, however, the wound is large, and accompanied by a
ACCIDENTS OF BLOOD-LETTING. 513
correspondingly profuse hemorrhage, it becomes necessary to have
recourse to the direct applications of a ligature. A description
of this operation will be made the subject of our chapter on
hemostasia.
5th. Introduction of Air into the Veins.—This is one of the
most remarkable of the accidents attending the operation of phle-
botomy. The phenomenon has been observed as early as the seven-
teenth century, but it was not until 1806 that it was observed and
recorded as belonging to the category of casualties connected with
the familiar act of blood-letting in an animal. The first author to
put the occurrence on record in this connection was Verrier, who
reported a case in 1806, and he was soon followed by others with
accounts of their experience with the same lesion and operation in
human practice.
There are two principal causes to which this accident can be
attributed. One of these may be an unnecessarily large aperture
in the vein, but more commonly it follows improper manipulations
on the part of the surgeon, particularly the irregular pressure
made upon the vein during the flow, by many practitioners, who
have formed the habit of rubbing the vessel along its length,
under the erroneous idea that by this movement they accelerate
the bleeding. Again, and perhaps principally, the casualty may
be the result of neglecting to close the wound of the skin with
the finger below the point from which the current proceeds, before
the pressure upon the vessel is stopped.
The occurrence is made known by a peculiar gurgling sound,
which is made more evident by auscultation of the heart. In the
meantime, the animal is attacked by shiverings; the respiration
becomes accelerated ; there is a rapid heaving of the flanks; the
body becomes covered with perspiration ; the action of the heart
is quickened; the countenance becomes anxious; the animal is
seized with convulsions; falls down and dies, unless by the con-
tinuance of the flow through the open vein the air may be carried
out throngh the same channel by which it entered, or unless the
quantity has been very minute. As the result of our own study,
tested by many experiments, we have become strongly inclined to
believe that the quantity of air necessary to produce death must
be very large, more, in fact, than a careful operator would allow
to enter without attempting to prevent it.
The possibility of the occurrence of this accident may easily
514 OPERATIONS ON THE CIRCULATORY SYSTEM.
be obviated, seeing that it merely requires careful attention to
the execution of the few details which constitute the act of vene-
section. But when it has taken place, the simplest and most ob-
vious thing to do is, if possible, to remove the air from the vessel
in which it has intruded. The means of effecting this consists in
reopening the closed vein, and permitting the blood to resume
its flow. The loss of three or four pounds of blood additional
is usually sufficient to insure the escape of all the air. Gourdon
recommends, in addition, showering with cold water, stimulating
frictions, and even, if the case seems to require it, artificial
respiration.
ARTERIOTOMY.
Bleeding from an artery is so termed to distinguish it from
phlebotomy. It is not commonly used in practice, being princi-
pally resorted to as a means of local depletion, and is performed
only on some of the most superficial of the vessels. In fact, there
are but three of these eligible by their position to the operation.
These are the transveral of the face, the posterior auricular, and
the middle caudal.
The modus operandi differs but little from that of phlebot-
omy, except that there is usually no need of the application of ar-
tificial means to sweil their bulk or increase their rotundity, their
position, and their distinct and characteristic pulsation, so readily
detected, sufficiently revealing their location and course. In open-
ing arteries the fleam is seldom used, the lancet or a pointed bis-
toury being a much more eligible instrument. The incision of the
vessel is made across its course instead of longitudinally, as in
phlebotomy, and the flow of blood must be arrested by means of
pressure with compresses or bandages.
(a) Bleeding at the Transversal of the Facé.—Though the
position of this artery is nearly correspondent in all animals, it is
principally with solipeds that it is chosen for blood-letting. It is
situated below the temporo-maxillary articulation, and crossing
the direction of the fibres of the masseter muscle, where it is coy-
ered only by a fine skin, it is opened at the same level with the
place where phlebotomy is usually performed. Some operators
prefer casting the animal, others the standing position.
The appearance of the vessel is that of a small, round pulsa-
ting cord, and, as before stated, it is incised, not as the veins and
ARTERIOTOMY. 515
opened, but in the direction of its axis. The stream differs from
that which flows from a vein, and instead of issuing with a regu-
lar flow, escapes per saltwm, or by alternating leaps, synchronous
with the action of the heart. It also differs from that of the veins
in color, being of a lighter and brighter red. As the application
of a pin suture will scarcely be sufficient to perfectly suppress the
flow, pressure must be resorted to, either by direct application
over the posterior border of the maxillary bone, or over the place
where the artery passes, or by covering the incision with a pad of
oakum, retained by means of a circular bandage passing by sev-
eral turns over the upper part of the head. The animal should
be tied up for several days after the penis, or until the closing
of the artery is fully assured.
(6) Bleeding at the Posterior Auricular.—Though the trans-
versal of the face can be opened in large ruminants, as well as in
horses, arteriotomy in those animals is more commonly performed
upon the posterior auricular, where it is attended by all the con- .
ditions of size and position required to serve the convenience of
the surgeon. In cattle, upon which it has been practiced for both
its general and local effects, it has been recommended in diseases
of the brain, and for affections of the eyes and other parts of the
head. The posterior auricular runs under the parotid gland from
the base of the concha upward on its external face, near its supe-
l 6 Le \
/ LM
Fia. 448. eae of the Posterior Auricular Artery in Cattle,
516 OPERATIONS ON THE CIRCULATORY SYSTEM.
rior border, where it loses itself. It is most superficial toward
the base of the cartilage as it issues from under the posterior cer-
vico-auricular muscle.
The operation is comparatively simple. The animal being firmly
held or tied to a post or a tree, hard friction is applied to the
ear to stimulate the circulation and render the artery more promi-
nent. The concha is held by the left hand, with the index finger
in front and the thumb behind the artery, the incision is made
by piercing the vessel with the lancet held perpendicularly to the
concha, the artery being cut directly across, and the incision en-
larged by a downward movement of the instrument. This is fol-
lowed by the appearance of a few drops of arterial blood, but
which soon stops unless the flow is assisted, which is done by the
operator, without releasing the ear, by striking light blows or taps
with a small stick along the course of the artery between the in-
cision and the animal’s head. This last step is indispensable to
obtain a good, free flow, per saltwm, of course. This whipping
process is continued until the stream becomes abundant, but may
be suspended when it reaches that point, to be renewed again,
however, if the hemorrhage diminishes. Artificial means to close
the incision are not usually required, the flow generally ceasing
spontaneously, but when that fails to occur a pin suture ora
bandage at the base of the concha, or finally the ligation of the
artery, if necessary, will effect the object. The animal must be
kept confined for some time, to prevent him from rubbing the
wound or shaking his head too violently.
In swine, this artery is so easily reached that it is often se-
lected in preference to other blood vessels which may be more or
less imbedded in the fat of the animal. The knowledge of its
position is very important, as it is very small and difficult to find.
Running vertically between the temporo-maxillary joint, it reaches
the base of the concha, and passes by the side of its convex sur-
face towards its point. It must be opened at the lower third of
the cartilage, where it presents its largest dimensions. The artery
must be cut transversely with the lancet. The bleeding ceases
spontaneously, or, if necessary, may be treated in the manner in-
dicated for cattle. (Fig. 449.)
(c) Bleeding at the Median Caudal.—tn cattle this artery is
quite large and very superficial. It runs along the inferior face of
the tail, being covered at the base of that organ by the inferior
CAPILLARY BLEEDING. 517
Fig. 449.—Anatomy of the Posterior Auricular Artery in Swine.
caudal muscles, then becoming superficial and readily accessible
to the end of the member. In opening it, it is pierced by the
lancet in the longitudinal axis of the vessel, the tail being kept
elevated. Ordinarily, however, not only is the artery cut directly
across, but the skin or surrounding muscular fibres are included.
The incision must be made on a level with the superior third of
the tail; higher up the operation may be complicated with abscess,
disease of the vertebree, sloughing of the tail, ete. If it becomes
necessary to stimulate the flow of blood the same “whipping”
process may be employed that was recommended in bleeding from
the posterior auricular. A bandage may be applied round the tail
to stop the hemorrhage, though it is not commonly needed.
A few practitioners prefer to operate with the fleam.
CAPILLARY BLEEDING.
The consideration of the operation which consists in the de-
pletion of the minute extreme vessels naturally and logically fol-
lows that which treats of a kindred procedure with the veins and
arteries. The intention of the treatment instituted for allis the
same, and their curative effects are adapted to similar ailments.
These are principally local, and may be divided into two classes,
to wit: those which have been in a great measure discarded from
general practice, and those which still retain their place in the
domain of veterinary surgery. The former includes bleeding at
the palate, the coronet, and the foot, and the latter comprehends
518 OPERATIONS ON THE CIRCULATORY SYSTEM.
the punctures, the scarifications, the ventouses, or cupping, and
the leeching, of regular current practice.
(a) Punctures ey Scarifications.—These are methods of
producing small superficial wounds through the skin and the sub-
cutaneous cellular tissue, to obtain the effect of a local bleeding,
or the escape of any other fluid contained in the subcutaneous
substance. They are indicated against local swellings and serious
effusions, or cedema of the’ cellular tissue. They can be applied
upon any part of the body, and though they take effect in the
escape of but small quantities of fluid, their action may be stimu-
lated by additional local applications, such as warm poultices,
warm water fomentations, or dry, stimulating frictions.
Punctures, however, are principally effective when employed
to overcome cedematous swellings of the extremities, and of the
genital organs, while scarifications are prescribed with better ad-
vantage to obtain the resolution of cold or chronic swellings, or
to control the inflammatory process in cases in which the tissues.
are largely swollen and threatened with gangrene.
Both the bistoury and the lancet, and, in rare instances, the
fleam, are used in fulfilling these indications.
In making punctures the skin and cellular tissue are pricked
or pierced to the depth required, with the bistoury or lancet, by
rapid thrusts distributed over the entire surface of the swelling,
and when the fleam is used it is manipulated precisely as when
used in bleeding, though, of course, with quick repetitions.
(6) Scarifications may be defined as rather small incisions, made
with a convex bistoury, with which the skin is cut from without
inward, in parallel series, but which, in some instances, when an
increased effect is desired, are doubled by a second series crossing
the first at an angle.
(c) Cupping.—This mode of obtaining capillary bleeding is
very seldom employed in veterinary practice. The cups are, how-
ever, indicated in subcutaneous inflammations, accompanied with
swellings, and resulting from blows, contusions, kicks, and other
and similar traumatic causes, and are often preferable to blisters.
They are recommended in arthritis, ostitis, and even in internal
phlegmasia. They render valuable aid in emptying some forms
of abscesses, and are credited with the possession of power to
arrest or prevent the absorption of virus introduced into wounds
or deposited on their surface.
CAPILLARY BLEEDING. 519
There are two modes of cupping, the dry and the scarified, or
wet. The dry cup consists in the simple application of the in-
strument upon the skin to produce a swelling, accompanied with
more or less injection of the capillary vessels, and a local irrita-
tion, which generally rapidly subsides.
The operation of scarified cupping consists, first, in applying
the instrument to produce the swelling, and when the tumefac-
tion is sufficient following it with the scarificator. In completing
the first step, which is the same as for the dry cuppings, several
means are used. The skin being prepared by clipping or shaving
off the hair, a small glass globe, filled with heated air, is placed
over the spot selected for the operation. A small ball of wadding
or oakum, either dry or moistened with an inflammable liquid, is
placed in the glass and lighted, and as it begins to burn the glass
is pressed upon the skin. To avoid burning the skin, pwmping,
or vacuum-cups, have been devised, some of which are provided
with scarificating blades. These are, however, too complicated
for our general practice. When the effect of the cupping is com-
pleted, the red and tumefied skin, which is exposed as the glass
is removed, is scarified with instruments ad hoc, as the lancet or
the bistoury, and the cup is immediately reapplied over the same
spot. The blood then escapes freely from the incisions, and con-
tinues to flow until the cup is filled and removed.
(d) Leeches are not as frequently used in veterinary surgery
as they might be with profit. They are well adapted to small
animals, such as dogs, whose fine and vascular skin yields readily
to their application. For applying them the skin is first smeared
with a little milk, sugar, or blood, and the leech, placed in a small
glass, or cup, or clean pill-box, is brought in contact with the skin
by reversing the cup or box upon the chosen place. Usually it
attaches itself at once, and remains until it becomes gorged with
blood, when it voluntarily releases its hold. Sometimes, however,
it is better to place them upon a thick compress, moistened with
tepid water, and to apply this over the skin. In applying them
on the leg it is a good plan to cover them with a cloth, secured
with a string tied about the leg above and below, forming a sort
of bag.
When the animal fails to drop off, after being thoroughly
gorged, a sprinkle of salt speedily causes him to release his hold.
The succeeding hemorrhage will ordinarily cease after a short
520 OPERATIONS ON THE CIRCULATORY SYSTEM.
time without aid, but if it is desirable to continue it, the parts may
be fomented with warm water, or covered with a warm poultice.
(e) Bleeding at the Palate-—Bleeding in this region of the
mouth is done by a division of the capillary network which rests
between the mucous membrane and the fibrous coat which lines
the bones forming the palate.
The bones represented by the inferior face of the palatine pro-
cess of the great maxillary bone, and the posterior face of the
short process of the anterior maxillary, are covered with a fibrous
coat, which extends over their whole surface and the cartilage
that fills up the incisive slit. On each side of the palate run the
palato-labial arteries, which, forward, form
an arch, and anastomose together, and give
rise to a single branch, which enters the in-
cisive canal formed by the internal face of
the two small maxillaries. The veins, which
are very numerous, form a large network
which fills the space left between these two
large arteries. The whole is covered by the
mucous membrane, which is white, rosy,
thick, adherent to the fibrous coat, and
showing a number of rugee, about twenty,
curved forward and diminishing posteriorly
in size and prominence. Anteriorly they are
Fig. 450.—Circulation very large, by reason of the presence of a
ee Sa sane certain amount of cellular tissue, which di-
s, grooves of thepalate; minishes by degrees, from before backward.
@ Palato-labial artery. ‘The anastomosis of the arteries takes place
about on a level with the third ruge of the palatine surface, and
it is, therefore, posterior to this that the bleeding must be per-
formed to avoid wounding the artery.
The instrument requiredis the simple bistoury, or the one rep-
resented in figure 451. The operator, facing the animal, and hold-
ing the tongue with the left hand, draws it out of the mouth on
the right side, and with the edge of the knife turned backward,
makes a small incision from before backward, in the middle of the
palate between the fourth and fifth rugee. There is no danger of
wounding the arteries if the incision is made at the proper place
and on the median line. When that is the case, the hemorrhage,
continuing for a variable length of time, subsides by degrees.
CAPILLARY BLEEDING. 521
Fia. 451.—Lancet to Bleed at the Palate.
If, on the contrary, an artery has been divided and the flow of
blood becomes sufficiently abundant and continuous to become
alarming, it becomes necessary to employ hemostatic means.
These may be a small sponge compressed or moistened with cold
water or an astringent solution ; or, if necessary, a pad of oakum
can be applied and secured with a bandage passed through the
mouth and around the maxillary bone, and tied on the face. It
can also be accomplished by means of a peculiar bit, represented
in Fig. 452. This bit has a small board in its middle, and on each
side of the bar two straps, one to
act as the check-piece of a bridle, i |
the other being passed over the @=—
nose where they are buckled to-
gether more or less tightly. The S
board of the bar is padded, and jye. 459 apparatus to Apply Pressure
is applied directly over the place to Stop the Bleeding at the Palate.
of the incision. The pressure should be continued for several
hours.
This operation was first recommended in cases of stomatitis,
in the peculiar form known by the unmeaning name of dampas,
but is resorted to for a much better purpose in apoplectic conges-
tion of the head.
(f) Bleeding at the Coronet.—In the “Dictionary of Veterin-
ary Medicine and Surgery,” Bouley says: “There exists on each
side of the coronet, a rich superficial venous plexus resting on the
cartilaginous plates of the foot, formed at this point by the union
of numerous veins of the digital region. These veins are united
by large communicating vessels, running on the anterior and
posterior faces of the second phalanx. Nothing is easier than
to open one of these vessels by plunging the point of a bistoury
through the skin; the puncture being followed by an abundant
flow of blood, and, if it is repeated, a large bleeding, quite as
abundant as that obtained by the opening of another large vein,
522 OPERATIONS ON THE CIRCULATORY SYSTEM.
can be gained. But it is not a matter of indifference whether the
puncture is made in front or behind, or upon the sides of the re-
gion. It must never be made on the sides, because of the danger ~
of injuring the cartilage, several cases of cartilaginous quittor
having been known which were attributable to no other cause than
bleeding on the side of the coronet. In front the operation is less
dangerous, although a wound of the tendon of the anterior exten-
sion of the phalanges is possible. It is safer to bleed on the pos-
terior part of the coronet, where no danger can be looked for.
This bleeding has been principally recommended as a local
operation in cases of acute laminitis.
(g) Bleeding on the Foot.—The toe is the part selected when
bleeding is performed on the foot. It is an operation which has
been known for many years, and under various forms, and with
different applications has been described by Virgilius, Columelle,
Absyrtus and Vegetius. It consists in the incision and removal
of a portion of the sole of the foot. It is indicated in all cases
where local bleeding is justified, and has, therefore, been recom-
mended in all congestions and inflammations of the foot, such as
bruises, burned soles and acute laminitis, though in this last case
its execution is rendered difficult by the unwillingness of the ani-
mal to support its weight on one leg during the operation. There
are several ways of bleeding at the toe.
Ist. The Chabert Method.—A special shoe must first be pre-
pared; it may be simply an ordinary shoe notched on its inner
border, which, without being removed, permits both the opera-
tion of bleeding and the subsequent application of a dressing.
In operating, the sole is pared out and a groove
made between the point of the frog and the toe of
the wall, with a drawing-knife, until the soft tis-
sues are reached. An incision is then made with
the curved bistoury at the bottom of the groove,
between the wall and the inferior border of the 08 yy, 453 gnoe for
pedis, and an incision made dividing all the ves- the Bleeding at the
sels that come in contact with the instrument. Cy eee
When the flow of blood has been sufficient, the
hemorrhage is suppressed by a compressing dressing of oakum
kept in place by bandages, or with plates, according to the condi-
tion of the foot, and whether it had been shod with the notched
shoe, or had remained entirely shoeless.
SURGICAL HEMOSTASIA. ae
2d. The Valet Method.—After the preparation of the foot, as
with the other method, a groove is made. It is posterior and
parallel to the line which marks the separation of the wall and the
sole, and the incision is made transversely, wlth a bistoury or a
sage-knife. It is usually followed by a good flow of blood. An
ordinary shoe is then placed on the foot, and a compressing dress-
ing of oakum put on and kept in place by plates.
3d. Crepin’s Method.—The difference between this and the
other processes consists in making the incision with a narrow draw-
ing-knife, which provides a larger opening for the escape of the
blood. A wide-webbed shoe, with a padding of oakum over the
wound, suffices to control the hemorrhage.
All of these methods have the same object in view, but many
veterinarians prefer to make the incision a little back of the line
separating the sole from the wall, and right at the toe, and they
sometimes remove a small portion of the sole with the sage-knife
or the bistoury.
The dressing which is required in these cases must be care-
fully applied, as protruding granulations may sometimes make
their appearance, and interfere with the cicatrizing process. If
the hemorrhage which accompanies the operation should be con-
sidered insufficient, it can be stimulated by placing the animal in
a foot-bath of blood-warm water.
SURGICAL HEMOSTASIA.
The extraneous hemorrhage, whether it be avoidable or un-
avoidable, which may occur during an operation, forms one of
the most embarrassing of the interferences to which the sur-
geon is liable, not only from the difficulties it interposes in the
way of the success of the operation, by disturbing his manipula-
tions, but as well, sometimes, by the effect of the loss of blood
upon the patient. It may happen, indeed, that instead of ceasing
spontaneously, or yielding to the effects of the ordinary dressings,
the hemorrhage becomes so obstinately persistent as in itself to
constitute a serious, and, if unsubdued, a fatal accident. It be-
comes necessary therefore for the operator, as one of the practical
elementary incidents of his calling, to be always prepared in an
emergent case to arrest the rebellious circulation by prompt and
efficient measures. Hemorrhage being an essential danger in all
524 OPERATIONS ON THE CIRCULATORY SYSTEM.
operations of considerable magnitude, the means of subduing it
should always, especially in cases of that class, be included among
the customary instruments and appliances of the working surgeon.
The flow may proceed from any of the blood vessels, the arteries,
however, from the nature of their functions and the force of their
action, requiring more frequently and more particularly the appli-
cation of precautionary and remedial measures.
TEMPORARY OR PREVENTIVE HEMOSTASIA.
This becomes necessary as an occasional expedient, when the
presence of the blood is likely to become an obstacle to the opera-
tion, and the preventive means may be applied either before or
during its performance. Included under this general head is the
circular compression, or ligation en masse, when the situation and
the form of the region render it practicable. The effect of this
being the flattening or collapse of the vessels, and the temporary
closure of their calibre, one of the necessary conditions of its suc-
cessful application, especially with the superficial vessels, is that
they should be situated near enough to some structure sufficiently
hard and solid to furnish an unyielding point appwi to the com-
pressing agent. If, from the position of the artery, no such point
of resistance can be made available among the surrounding parts,
resistance can be established by a double pressure made in op-
posite directions, in such a manner that the compressing powers
can furnish mutual support, each to the other. By this plan com-
pression can be effected in four different ways.
Ist. By Digital Pressure—When this can be applied and
proves sufficient, it is the simplest and the best mode. While it
serves to obstruct the circulation, its action is limited to the ves-
sel which alone needs it, andthe tissues are not contused by the
pressure; it can, moreover, be suspended or renewed at will, and
can be managed by an assistant who may be placed in a position in
which interference with the operator can be entirely obviated, and,
indeed, can sometimes be performed by the surgeon himself. It
is obtained by pressing the vessel with the tips of the fingers
placed either vertically upon the vessel itself, or along its course ;
and only such a moderate degree of force need be employed as will
prove sufficient to close the calibre of the vessel, without fatiguing
the hand by unnecessary pressure.
i.
SURGICAL HEMOSTASIA. 525
2d. Compression with the Circular Ligature.—EHither a band-
age or a circular string of sufficient strength may be employed in
this method. If needed upon the leg, it should be placed upon
the lower part of the limb, either dry and moderately tight, or
moistened with cold water. If kept in place for a certain length
of time previous to an operation, the effect will be to so reduce
the force of the circulation in that part as to render the perform-
ance comparatively a bloodless one. This proceeding is often
associated in veterinary practice with the operation of neurotomy.
In operations upon the foot, comparatively perfect hemostasia
may be obtained by circumscribing the coronet with a ligature
Fi4g. 454.—The Adstrictor of Brogniez.
formed of a strong circular string, tightly drawn, but as a substi-
tute for this, a special instrument has been invented by Brogniez,
which he calls the adstrictor, which secures the same results.
3d. Compression by the Tourniquet.—The adstrictor of Brog-
niez is but a peculiar form of tourniquet, which is composed of
two oval cushions or pads supported by metallic plates, and se-
cured on the inner face of a circular band adjustable as to its
Fig. 455.—Tourniquet.
length, and secured by a common buckle. This band is buckled
around the leg, and the pressure is made by the pads, which are
laid directly over the course of the vessel.
Ath. Compression by Esmarck’s Method.—Another mode of
compression, borrowed from human surgery, that of Professor Es-
marck, is designed to wholly prevent the loss of blood, and enable
the surgeon to perform a perfectly dry or bloodless operation. It
526 OPERATIONS ON THE CIRCULATORY SYSTEM.
consists of a roller of India rubber, to be so applied around the
seat of the operation as to cause the blood to recede toward the
center of the body, its return being prevented by firmly placing
a ligature just above the point of incision. The pressure pro-
duced by this band can be regulated by means of a tourniquet,
or a piece of elastic tubing, or an ordinary string that may be
twisted with a stick. This mode of compression is adapted to
cases of amputation of the limbs and of the tail, or the removal of
tumors.
PERMANENT, OR DerintrE HeEmostasia.
The arrest of hemorrhage may become necessary at any step
of an operation, but it is ordinarily when it has been completed
that the indication must be fulfilled. It is true that in many in-
stances, even after extensive lesions, the hemorrhage will cease
spontaneously, but it is equally true that at other times special
interference becomes a necessity. If the hemorrhage is capillary,
the surgeon may safely overlook it, and leave it to subside under
the influence of the retractility of the tissues; but if it is of ve-
nous origin, it cannot be safely left to spontaneous action. Still,
usually it is only when one of the larger veins is the seat of the
bleeding that danger becomes imminent, as with those situated
near the center of the circulatory system; but serious accidents
are seldom to be feared. If the vein is cut across, moderate pres-
sure upon the orifice will generally sure the formation of a clot
which will constitute a sufficient plug, or if the vein is opened
longitudinally by a lateral incision, pressure at the point of the
wound, though not strong enough wholly to stop the circulation
within the vessel, may still be sufficient to assure the rapid obliter-
ation of the wound. But when large veins or arteries are opened,
or even when the capillary hemorrhage is usually abundant, more
complicated means of hemostasia must be resorted to, and not
only applied carefully and securely, but also with cclerity. The
means of obtaining permanent hemostasia are of two kinds—one
taking effect through the physico-chemical action of special agents,
the other including those which are known as surgical means
proper.
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Puystco-CuemicaL Hemosratics.
Among these must be considered the refrigerants, absorbents,
astringents or styptics, and potential and actual cauterization.
the Fay '
™ .
SURGICAL HEMOSTASIA. 527
Ist. Refrigerants. — The agents included in this class act
almost exclusively by depriving the parts upon which they are
applied of their heat, and in producing a certain excitation upon
the vaso-motor nerves, followed by a toxic contraction of the mus-
cular fibres of the vessels, and the diminution, or sometimes the
complete arrest, of the bloody flow. Their action is principally
efficacious on vessels of small calibre, such as the capillaries.
Cold water, snow, cracked ice, and the very volatile liquids, as
ether, chloroform, and freezing mixtures, fill an important place in
this category. In veterinary surgery, cold water, being the sim-
plest, the most accessible and abundant, and the easiest to apply,
heads the list. Itis used in the form of douches, baths, lotions
and injections, or by means of compresses, pads, or cushions of
oakum laid upon the seat of hemorrhage. The saline mixtures,
and the snow or cracked ice, are placed in cloths, bags or blad-
ders, but their action must be watched in order to obviate the
possibility of congelation and mortification of the tissues, quite a
possible result of excessive refrigeration.
Refrigerants are generally considered as forming the least ef-
fective of hemostatics, but their facility of application has brought
them into common use. They are principally indicated against
external capillary bleeding, or that which escapes from a small
vessel, but would generally prove insufficient against a hemor-
rhage from a large vessel. They may, however, prove advanta-
geous against some internal hemorrhages, which, though they
may be controllable by other direct means, yet can be reached by
the water without difficulty or danger, and act directly or by con-
tinuity in producing the necessary contraction. In this manner,
injections into the nasal cavities, or the uterus, or rectum are
often efficacious in arresting a hemorrhagic flow suddenly occur-
ring. But in any case, refrigerants should be applied with care,
and their effect watched. If they are allowed to remain too long
in place, or the temperature be too low, they may induce an in-
flammatory reaction and local gangrene, or produce other dan-
gerous general effects upon the internal economy. On the other
hand, if imperfectly applied, and without a sufficient degree of
cold, their action, already weak, will become a mere useless nega-
tion, if not worse. Between these two extremes there is a middle
course, which the competent surgeon will be able to observe by
exercising his discretion, and an appeal to his own experience.
528 OPERATIONS ON THE CIRCULATORY SYSTEM.
2d. Absorbents. —Hemostatic absorbents proper are agents
which by their capillary action suck up or soak in the sanguineous
element from traumatic surfaces, and haying their structure
thickened and condensed by the presence of this contained liquid,
coagulated in their mass, oppose thereby an invincible obstacle to
the escape of the blood. Oakum, charpie, punk, spider-webs,
flour, fuller’s earth, sponge, and various vegetable powders be-—
long to this catalogue of medicaments. Oakum, which is the
substance which meets with general favor and is most commonly
_ used, is applied in the form of balls, dry, or soaked in cold water,
and packed over or into the depth of a wound, and kept in place
with bandages or compresses.
Compressed sponge has proved, in our hands, an excellent
hemostat, not only in capillary bleeding, but in that also of me-
dium-sized vessels. There is, however, an objection to its use in
the fact of its liability to become adherent to the tissues with
which it is in contact, and the consequent danger of renewing the
hemorrhage when removing it.
3d. Astringents, or Styptics.—These agents produce the co-
agulation of the blood, by a chemical action, resulting from the
combination of the astringent’s substance with the living tissues.
Their action differs essentially from that of the refrigerants in
the fact that they possess the special property of producing, by
their power of fibrillar astriction, the occlusion of the vessels
through the coagulation of the blood in their interior.
Astringents are used in both the solid and the liquid form.
Burnt alum in powder, and certain vegetable powders, belong to
the first class. The solution of sulphate of iron, sulphate of
copper, alum, acetate of lead, alcoholized water, solution of tannic
acid, ete., are included in the second. They must be judiciously
used, however, because of their liability sometimes to excite local
inflammations, more or less active. The action of the liquid as-
tringents is deeper, more energetic, more lasting, and more dur-
able than that of the solid, and they are for that reason sometimes
more reliable for the control of hemorrhages from large vessels.
Their consistency renders them, of course, alone available for
moistening compresses, balls, the tampon, or pads of any descrip-
tion. The most powerful of this class is the perchloride of iron,
which is remarkable for its power of coagulating the blood almost
instantaneously. When applied with oakum upon a bleeding sur-
SURGICAL HEMOSTASIA. 529
face it forms, with the blood, a blackish magma, and a resisting,
strongly-adherent clot in the cavity of the vessel.
4th. Potential Caustics.—The chemical astringents have gen-
erally the same mode of action. Upon being placed in contact
with the tissues they enter into combination with their elements
. and form a coagulum, and it is the presence of this clot which
produces the hemostatic effect. They are but little used, how-
ever, in veterinary practice. The nitrate of silver, some of the
mineral acids, as sulphuric, nitric, or arsenious, or bichloride of
mercury, are the potential caustics which are occasionally used,
though it should always be with great caution, in view of the
possible danger of producing an excessive effect.
5th. Actual Cauterization.—Cauterization with the hot iron
is the oldest and principal hemostatic in use in the surgical treat-
ment of the domestic animals, and in many instances may be made
to supersede all the chemical agents we have considered, more
especially in cases of capillary hemorrhage. It is applied with
the iron heated to a white heat, and laid upon the bleeding sur-
face, where it immediately creates a thick, impermeable eschar,
adherent to the wound, and offering an insurmountable barrier
to the escape of the blood.
To obtain all the effect desired the wound must be thoroughly
free from all extraneous substances, liquid or solid, that nothing
may interfere with the rapid formation of the eschar. The blood
should be well soaked out, a plug of oakum firmly pressed upon
the wound, and the iron pressed perpendicularly upon the tissues;
this rapidly forms the eschar. The application of the cautery
must be continued for a few seconds only, on account of its lia-
bility, while cooling off, to adhere to the tissues and to the eschar,
with the consequent risk of reopening the wound and renewing
the hemorrhage upon attempting its removal. It is better if the
eschar is not sufficiently thick, after a first application, to renew
it a second, or even a third time, always taking the same precau-
tions, and being careful to avoid contact with sound tissues.
In this operation it is essential that the temperature of the
cautery should be at its maximum. Half-heated, or cooled off by
the blood, not only is the application more painful, but the effects
are incomplete and the hemorrhage is likely to return. If the
blood escapes too freely, or coagulates too slowly, the eschar not
forming, it may sometimes become necessary to carbonize the
530 OPERATIONS ON THE CIRCULATORY SYSTEM.
bleeding surface by means of some combustible substance which
will furnish more solid materials for the protective scar. A loop
of hair, or some pulverized rosin, placed upon the wound, and
burnt with the cautery, often fulfills the requirements. For hem-
orrhage from parts below the surface, the edges of the wound
must be separated before the cautery is introduced, to prevent its
cooling before reaching the proper point of application. "When
the eschar is well formed and established it should be left without
interference to complete the process of sloughing.
The thermo-cautery, with which the required heat can be re-
tained at a uniform degree, is one of the best instruments for
the application of this mode of hemostasia, there being no need
of removing it until an eschar of sufficient thickness has been ob-
tained.
SurGcicaL Hemostatics.
Among the numerous surgical means of obtaining both per-
manent and definitive hemostasis, there are three which principally
merit our attention: compression, ligature and torsion.
(A) Compression.—We have already referred to this method
while considering the subject of temporary hemostasia. There
are cases in which it acts as an excellent mode of permanently
controlling hemorrhage, whether proceeding from arterial, venous
or capillary sources, and equally whether from a large surface or
from a deep cavity, where the origin of the hemorrhage cannot be
distinctly located. Still, for arterial hemorrhages it is only effica-
cious for vessels of small or medium size, or when the wounds are
of small dimensions. There are secondary circumstances which
determine the designations of certain variations of pressure. One
is the situation of the vessel, relatively to that of the bleeding
orifice, when the pressure, to be effective, must therefore be direct
or lateral, and with the latter, either mediate or immediate. Some-
times, again, it is applied at a distance from the bleeding point,
and in an indirect manner, and involves an alternative between
plugging and direct compression, Tt is applied to the wound
itself when the vessel has been cut directly across. It is usually
effected by covering or filling the wound with a dressing of
balls of oakum applied directly upon the bleeding orifice, and
covering these with pads, increasing in dimensions as they become
more superficial. The whole apparatus is submitted to pressure
SURGICAL HEMOSTASIA. 531
by approximating the edges of the wound, as much as possible,
by means of interrupted, pin, or a quill suture; or sometimes
a circular bandage of dry or compressed sponge, cut into small
pieces, may be used in the same manner as the oakum with ex-
cellent effect, especially when the hemorrhage is abundant, or
ligation become impracticable.
The objection to the mode of compression, generally speaking,
is its liability to become loosened in consequence of the softened
and yielding condition of the surrounding tissues. Yor this rea-
son the mode of applying the force directly is not often practiced,
or, at least, is adopted only when the hemorrhages are small and
controllable by slight pressure, or in case of the section of an in-
compressible artery, like that of a bone.
In order to increase the effect of direct pressure the surgeon
sometimes has recourse to the joint use of some of the physico-
chemical hemostatics before mentioned.
(a) Immediate Lateral Compression.— This is practiced
against hemorrhages due to lateral wounds of blood vessels, and
is applied directly upon the opening in the vessel. The method
of its application does not differ from that of direct compression,
and it is liable to the same objections in its irritating effect upon
the surface of the wound and consequent interference with cica-
trization, and the danger of a renewal of the bleeding. More-
over, if the vessel is without a solid resting-place, and there is no
sufficient resisting point, hemorrhage is not arrested. But again,
in a contrary condition, it may be followed by gangrene or the
obliteration of the vessel, and if the wound is of such a form that
this last accident cannot be avoided it is better to have immediate
recourse to the ligature. It remains, then, that this mode of hem-
ostasia is only advisable when the wound is small and the artery
small and superficial, or in such a position that it cannot be ligated.
Immediate lateral compression, however, can be made with
great benefit with the finger upon the wound, pressing with the
necessary force to prevent the escape of the blood, without clos-
ing the calibre of the vessel. The finger is kept in position for
one or two hours, with an occasional inspection to discover whether
the hemorrhage has ceased, and when it is removed there remains
but a simple wound, easy to dress.
This mode of compression has the advantage of obviating the
accidents that may occur from excessive external pressure main-
532 OPERATIONS ON THE CIRCULATORY SYSTEM.
tained by ligatures and dressings, such as the division of the skin
and the possibility of gangrene. The value of this measure of
digital compression may be estimated by the fact of its successful
application to a vessel of the dimensions of the carotid artery in
a case of a wound by pricking.
(6) Mediate Lateral Compression.—The compression here is
applied outside of the solution of continuity, in such a manner as
to leave a certain thickness of the tissues between the injured yes-
sel and the compressing apparatus. It may take effect either
directly upon the wound itself, or elsewhere along the course of
the vessel. It can be effectively made only upon superficial ves-
sels, principally arteries which, like those of the extremities, lie
upon or near enough to resisting surfaces to furnish a means of
support to the pressure. The manner in which temporary and
permanent hemostasia can be obtained is the same, excepting that
the cords, bandages and tourniquet are replaced by graded com-
presses, supported by rollers or appropriate bandages, which are
continued only during the existing necessity.
The objection to this hemostatic method, and which it shares
with all the other processes of compression, is, that when a large
vessel is to be compressed, and a certain amount of force becomes
necessary, Other tissues, with other vessels, veins and nerves alike,
must participate in the same pressure, and, as a consequence, dis-
turbances of varying degrees of severity will occur in parts situ-
ated beyond the compressed surface, proportioned to the duration
of their exposure to the acting cause. Hence the indication, in
applying the apparatus, to begin at the peripheric portion of the
region, to carry it toward the center, in passing over the wound
already protected and covered by the balls, pads or compresses,
which constitute the true means of compression.
The principal objections to this process of hemostasia can be
obyiated by leaving on the apparatus only for the minimum time
necessary to obtain the cicatrization of the wound of the vessel,
which will, of course, vary. according to circumstances, and will
be especially influenced by the consideration whether the calibre
of the vessel is to be preserved or obliterated.
If the vessel be a small one, the wound of small dimensions, and
the continuity of the channel is to be preserved, a few hours will
be sufficient ; or, if otherwise, it is to be obliterated, one or two
days will be required, or even at times one or two weeks.
SURGICAL HEMOSTASIA. 533
(ce) Plugging.—This mode of compression is chosen as a per-
‘manent hemostatic to arrest hemorrhages which occur upon the
surface of natural cavities, or upon wounds where the injured
vessel cannot be reached. This is done with balls, or pledgets of
oakum or sponge, carried with a forceps to the bottom of the
cavities, or with sachets, arranged in the manner of the tampon,
impregnated with an astringent solution or a cold mixture, the
whole being kept in place by the dressing which closes the cavity.
It is used in cases of epistaxis and hemorrhages from the uterus,
or those following castration. But with all its advantages it is an
uncertain mode, and opposes but a slight obstacle to the hemor-
rhage ; besides which it irritates, by the pressure of the plugging
material on the parts with which it is in contact, where it acts in
the manner of a foreign body, which in fact it is, giving rise to
some pain, and perhaps stimulating muscular contractions, and
thus exciting the hemorrhage anew. However, these objections
are not of sufficient weight to contra-indicate its employment
as a ready and efficacious means of hemostasia, or to prevent
it from being wisely appreciated and largely employed by the
surgeon.
(B)—Lieature.—The ligature is the typical and obvious means
of hemostasia—the hemostat par excellence—perfect in its sim-
plicity, though consisting simply in tying a circular thread or
cord around the wounded vessel with sufficient tension to close its
channel, suppress the circulation, and convert the tube into a
cord. It can be applied either on the cut extremity of an artery,
or upon its continuity. It is seldom applied upon veins, however,
from its liability to induce phlebitis, but still, it is resorted to in
wounds of large veins, or when the hemorrhage cannot be con-
trolled by other means.
As with compression, ligature may be immediate or mediate,
and may also be divided into temporary and permanent—tem-
porary, when its continuance depends upon some contingency—
permanent, when it is to remain until it is eliminated by suppura-
tion, or becomes organized and absorbed, as when the ligating
thread is composed of some special animal fibre—which is the
kind most commonly used.
The instruments required for this operation are: tenaculum,
aneurism needle, ligature materials, ordinary dissecting or bull-
dog forceps, scalpel or bistoury, and the grooved director.
584 OPERATIONS ON THE CIRCULATORY SYSTEM,
The kind of forceps used are known as artery forceps, and
are of numerous varieties.
Fic. 457.—Cooper Needles, or Tenaculum.
The tenaculum, or aneurism needle, is a kind of blunt tenacu-
lum with an eye at its end, and is used to seize or secure the
vessels.
The suture materials are linen thread, silk, animal ligatures,
such as catgut or tendinous fibrilla, and sometimes very fine me-
tallic wire. Ordinary linen thread and silk, well waxed, are most
commonly used in veterinary practice.
(a) Immediate Ligature.—This is the surest of hemostatic
means. It is applied principally upon large arteries surrounded
only by their cellular sheaths, and a difference is made in applying
= A
SURGICAL HEMOSTASIA. 535
it between vessels which are perfectly intact and those which
haye been partially cut through or otherwise injured.
The immediate ligating of an artery entirely divided includes
but two steps: the prehension of the artery and the adjustment
of the ligature.
When drawn out of its position with the proper forceps the
artery must be carefully examined for possible adhesions, and
especially any nervous threads which may be attached to its sur-
face—all of which must be dissected.
In placing the ligature many operators carry the thread, form-
ing a loop, with the forceps, and on seizing the artery and seeing
that it is clear from the surrounding tissues, they slip the loop
down over the instrument upon the vessel, to be tied by an assist-
ant. The apparent simplicity of this movement is deceptive ; too
often the loop of the ligature adheres to the wound, the ends roll
over themselves and one another, the ligature cannot be properly
-placed over the vessel, and the knot is tied over the forceps before
the thread has reached the artery. To avoid this it is better, when
the vessel has been well secured and isolated, to have the assistant
apply the ligature by its middle upon the jaws of the forceps, be-
hind the hand of the surgeon holding them, in order to be free in
his movements. Then making first a simple knot, without twist-
ing the thread, and tying it close to the forceps, he then, with the
Fia. 458.—Applying the Ligature.
thumbs, pushes the thread further along the artery, and ties it by
pressing the thumbs together with sufficient firmness to rupture
the internal membrane of the vessel. If the wound be deep, in-
stead of the thumbs both indexes are used to carry the thread
along the artery and tie it. The forceps is then removed and
536 OPERATIONS ON THE CIRCULATORY SYSTEM.
of
ip p} p ¥
Hl es J
oA
S77
Fa. 460.—Improperly-made Knot.
a second straight knot is made (Fig. 459). The knot represented
in Fig. 460 is improperly made and liable to become loosened.
The extremities of the thread are left of a sufficient length to
allow their being turned toward the most dependent part of the
wound. If they are cut too short they are liable to become loose
in the tissues, and be covered or concealed by the granulations and
become the center of a suppurative gathering. Ligatures intended
to remain in the tissues, must be made of animal material.
The wound of an artery always involves the application of a
ligature on both extremities of the course, the central and the
peripheric.
Where the artery cannot easily be raised or dissected from the
tissues into which it is retracted, the pointed tenaculum can be
used to draw it out of its position; this instrument is more suita-
ble for smali than large vessels, the coat of which it is liable to tear.
In the zmmediate ligating of an intact artery, and without a
solution of continuity, the vessel is exposed by means of an in-
cision, either parallel or sometimes oblique, and at others perpen-
dicular to the artery, according to its situation and the nature of
the subjacent tissues, carefully noting any projections of the
bones, muscles, or tendons which can be made available as points
de repere; observing, indeed, all the anatomical connections exist-
ing between the different structures. When the artery has been
nearly reached, in order to avoid injuring it, it should be separated
by dissection with the forceps and the bistoury from the tissues
covering it, or by introducing a blunt, grooved director under
them, as a guide, and dividing them with the knife. The sheath
of the vessel is also carefully divided and separated from the ves-
sel itself, which is then carefully isolated from its vein or surround-
ing adhesion, and the blunt-eyed tenaculum, or the aneurism
SURGICAL HEMOSTASIA. 537
needle passed under it. Sometimes this is easily done, but in
other cases the density of the connective tissue surrounding the
artery is too great to allow the needle to pass readily under it,
in which case the obstacle can be removed by scraping it away
with the finger-nail, which will obviate the application of extra trac-
tion upon the vessel. The ligature can then be adjusted around
the vessel by means of the tenaculum, and the operation completed
as usual.
(6) Mediate Ligature.—This operation comprises including
in the ligature of the vessel a certain portion of the surrounding
tissue—a portion which should be as small as possible.
It is done with a curved needle and a ligature of single or
double waxed thread or silk. The needle is introduced into the
thickness of the tissues, at a small distance from the artery, and
passed around it with the ligature, which should be firmly tied in
the usual way.
The ligature is quite painful in consequence of the pressure it
makes upon the nervous fibres which accompany the artery, and it
is less safe than the immediate operation, exposing the vessel dur-
ing its performance to the risk of wounds from the needle, and
requiring, besides, a stronger traction upon the ligature and the
knot, from the increased bulk of tissues involved; and there is,
again, great uncertainty as to securing a sufficient division of the
internal and middle coats of the artery. For these reasons it is
less adapted to large than to small arteries.
The effects produced by the application of a ligature are not
wholly mechanical. It is also followed by certain peculiar changes
in the condition of the vessel, and by specific inflammatory phe-
nomena which result in the permanent obliteration of the tubular
character of the artery.
When an artery is tied with the ligature the internal and mid-
dle coats of the vessel are also divided by the compressing thread,
and by their retraction above and below it they form a double
cone, the apices of which rest on the ligated spot, the external
coat resisting and arresting the flow of the blood. A clot is then
formed, and the irritation produced by the pressure of the ligature
stimulating the proliferation of the cellular elements of the walls
of the vessel, adhesions are soon established between them and
the coagulated blood, and the termination is the solidification of
the former tube.
538 OPERATIONS ON THE CIRCULATORY SYSTEM.
The presence of the ligature and its effect on the surroundings
of the blood vessel give rise to a process of elimination, by which,
after a certain time, the ligating thread is expelled, carrying with
it the vascular stump situated beyond the ligature. At the same
time, and while these phenomena are taking place outwardly, the
clot, adhering more and more to the vascular surfaces, soon be-
comes the seat of peculiar absorbent changes, and gradually dimin-
ishing in size, at length disappears.
As the resorption of the clot takes place the walls of the ves-
sel contract until at length the caliber of the artery becomes en-
tirely obliterated, and the former tubular canal is transformed into
a fibrous cord, extending from the point of the ligature to the
nearest collateral vessel.
This obliterating process of the arterial canal may, however,
be defeated by the interference of too active an inflammation, pro-
ducing the premature sloughing of the ligature, or by the exist-
ence in too close proximity to the point of ligation of a collateral
arterial branch. In both cases hemorrhages may follow; in the
first, because the adhesion of the clot is imperfect, and in the
second, because no clot has been formed.
(C) Torston.—This hemostatic process has been known from an
early date, but was not methodically described until about forty
or fifty years ago, by Amussat, who recommended it in preference
to the method of ligation. But daily experience has demonstrated
its inferiority, and proved it to be a less powerful hemostatic meas-
ure than that of the ligature, and, moreover, that it is only avail-
able for hemorrhages occurring in small vessels.
There are several ways of applying torsion. Among the
principal is that recognized by Amussat. It requires four forceps,
two ordinary azatomical, another whose branches are terminated
by smooth cylindrical jaws, and the fourth the artery-twisting
forceps. The artery is held with one of the ordinary forceps;
with the other the tissues surrounding it are separated from it;
then the twisting forceps grasp the artery at its extremity in
place of the one first used, keeping it out of the wound, and when
thus secured the instrument with the smooth transverse jaws is
applied above it, close to the tissues, and firmly pressed upon the
coats of the artery. In this position, the twisting forceps is given
a rotary motion upon its axis, as if the vessel were to be rolled
over its extremities, and is twisted upon itself by seven or eight
SURGICAL HEMOSTASIA. 539
Fic. 461.—Artery Forceps for Torsion.
turns. The smooth-jaw forceps is then removed, and the stump
_of the artery is released and pushed into the tissues, unless the
torsion has been sufficiently severe to produce the laceration and
retraction of the vessel. As the result of these manipulations the
two internal coats of the torn artery retract upon themselves and
the external coat is elongated and rolled upon itself—all in such
a manner that the clot is arrested by the retracted internal mem-
540 OPERATIONS ON THE CIRCULATORY SYSTEM.
branes, as well as by the support contributed by the pseudo-plug-
ging, which results from the twisting of the external coat.
This process is a complicated one, but it has been modified in
several ways. In one process only two ordinary artery forceps are
used ; one applied at some distance from the end of the artery,
transversely to its axis, and the other holding the vessel by its end
in continuity to its length. Keeping the first tight on the vessel,
the torsion is made by ten or twelve complete rotations of the
second.
Another still simpler mode consists in grasping the mouth of
the bleeding vessel, and giving it a number of rotations with a
strong artery forceps, the artery being thus twisted without tear-
ing or entirely dividing it. Nothwithstanding all these modifica-
tions, torsion is not applicable to large arteries, and cannot super-
sede the ligature. It is slower in performance; it is more painful ;
it requires a greater isolation of the vessel ; and the possibility of
untwisting, and with it, secondary hemorrhage, is always to be
feared.
CHAPTER XL
OPERAELONS ON THE NERVOUS
SYSTEM.
PLANTAR NEUROTOMY.
Although the word newrotomy, when correctly defined, means,
in a general sense, the dissection of nerves, it has in surgery an-
other signification, and is applied indifferently to describe the di-
vision, the resection or the amputation of a nerve, according to
the special manipulations of a given case. In veterinary surgery,
it is held to be strictly applicable to the operation which consists
in the dissection and removal of a portion of a nerve, and as the
present chapter proposes to treat principally of affections of the
foot, it is sumply correct to employ the term plantar as a prefix to
the title, as we have done. The design of the operation is the
destruction of the susceptibility of the region or organ implicated
in the treatment, and to subdue the pain, if not permanently, at
least for a period of time sufficient to restore a working animal to
his ability to labor, which, without such a relieving operation,
would have been lost to usefulness and comfort.
This curious and important operation has a comparatively
recent history. It is of English origin, two British surgeons
claiming priority in its performance. These rival contestants are
Moorcroft and Sewell, who put it in practice, the former in India,
and the latter in England, at about the same time. After its in-
troduction, it was frequently performed by English veterinarians,
among whose names occur those of Goodwyn, Coleman, Percivall,
Spooner and others.
Its introduction on the continent was in France, and is credi-
ted to Girard, Jr., who described it in 1824, and from that date it
continued to be a subject of experiment at the hands of many
veterinarians. We say experiment, because it was only after a
542 OPERATIONS ON THE NERVOUS SYSTEM.
long series of trials, and as the result of much discussion of its
merit and value, that it secured an affirmative verdict from the
magnates of veterinary practice, and became an established posi-
tion in our science. Yet the objections which it encountered in
Europe have not to this day been wholly eradicated, and on this
side of the Atlantic there are few practitioners who still decline
to give it their confidence and adopt it in their practice. The
opposition which it has encountered is founded principally upon
the failures, the accidents and the unfortunate sequele, which
were not rarely met with during the period immediately following
its original introduction. These objections we now proceed to
consider.
Stumbling has been mentioned as one of the first effects of
the loss of the tactile function of the foot, by the destruction of
its sensibility. The animal which has lost the solidity and the
certainty of his gait, will only after a long time become accus-
tomed to the proper use of the comparatively inert mass repre-
sented by so indispensable a part of his organization as his foot,
so complicated in its arrangements and adaptations, and so per-
fect a portion of his anatomical structure before the extirpation
of its nervous sense. And yet, while this condition of stumb-
ling must be fully appreciated by those whose anatomical knowl-
edge enables them to take into full and careful consideration
the physiology of the part, and who have verified the objection
from their own observation, there are also veterinarians of large
practice and long experience who have operated in numerous.
cases, even upon animals used for fast work, where the muscular.
effort is of a comparatively violent character, who have met with
the accident only in very rare and strictly exceptional cases. It
must rationally be inferred that an unskilled operation of such a
character would leave the patient in a condition of which an awk-
ward and stumbling gait would be but a natural and inevitable
sign. But it would also be in the course of a natural and healthy
reaction for a horse to educate himself rapidly to the situation,
and acquire a new certainty of movement and confidence in the
use of his feet, which would soon restore him to his former abil-
ity to labor.
The casting off of the hoof, as a complication or termination
of the operation in neurotomized horses, is one necessarily of a
fatal character. This fatality has, in some instances, followed the ~
PLANTAR NEUROTOMY. 543
operation within a period of from one to two months, but on the
other hand its occurrence has been deferred in other animals for
years. Evidently, these varying results must be considered as
the effect of different and quite disconnected causes. The truth
is, indeed, that in the first instance it is due to a gangrenous dis-
organization of the tissues within the foot, and in the second, in-
stead of being the result of insufficient vitality, or arising from
lack of nutrition of the parts, itis more probably the consequence
of the unregulated force of the concussion when the foot strikes
the earth—unregulated because of the loss of the discriminating
instinct formerly exercised, but now lost with the missing nerve-
consciousness which once controlled all the movements of the limb.
Tt could scarcely happen that such a condition of things should
fail, after years of continuance, to encounter some susceptible
temper in which to exhibit its baleful influence.
A reason which must not be overlooked in relation to the cast-
ing off of the hoof is the fact that in the neurotomized animal
the essential symptoms of the first development of any lesions
which might give rise to it, are missing. The first of these symp-
toms is the pain which is normally manifested by the lameness,
and for that reason it is that the care and attention required by
the foot of a neurotomized horse are at once so important and so
commonly overlooked and omitted. But without ignoring the
possibility of this accident, the question is presented, whether it
is of such common occurrence that its frequency constitutes a
cogent reason for abolishing the operation.
Our answer to this, founded on the showing of the record,
must be given in the negative. To quote but one among many
authorities—Professor Nocard says that out of more than one
thousand operations, he has never met with that accident. For
ourselves, in a practice of many years, with a number of neurot-
omy cases which we can count by the hundreds, we also have
never encountered it. In the only case we have seen, other causes
existed in the form of suppurative corns, which were overlooked,
and which were, moreover, complicated with gangrene of the vel-
vety and podophyllous tissues.
The Softening of the Perforans Tendon and its subsequent
rupture, is also a very severe sequel of neurotomy. This may
take place almost immediately after the operation, or it may be
postponed until after a few months, when the animal has resumed
544 OPERATIONS ON THE NERVOUS SYSTEM.
his work. It has, indeed, been charged to undue haste, in com-
pelling the animal to labor without allowing sufficient time for the
healing process to be completed, and it is also alleged that it is a
consequence of the performance of the operation on both sides of
the leg at once. Itis both a possible theory and a plausible argu-
ment that the failure of the tendon is the result of the shocks in-
flicted upon it while ina condition of disease and unconsciousness,
and this may explain the possibility of the accident without any
reference to the circumstance of putting the animal to work. But
this falls far short of proving that the neurotomy exercised any
potent agency in bringing on the softening and rupture. And as
to the effect of performing the double simultaneous operation, our
opinion will be readily inferred from the fact which we here state,
that out of the large number of neurotomy cases which have passed
through our hands, we have seen but a single case of softening
and rupture of the perforans tendon, and that was associated with
a fracture at theos pedis. The horse had been operated on upon
both feet, and on both sides at once, for navicular disease of old
standing, and on the third day following he was found in his box
standing on both fetlocks. He was destroyed and it was found
that the tendons of the perforans had given away in both feet, with
a fracture of the navicular bone and os pedis on one foot, and of
the os pedis alone at the semi-lunar crest on the other. It is our
constant habit to operate on both sides, and with this sole excep-
tion, we have never met with softening of the tendons.
Springhalt.—Beugnot and Renner report cases in which the
performance of the operation on the hind feet was followed by the
appearance of springhalt.
In addition to the points we have been discussing, other
alleged objections exist, which may claim superior force and value,
but there are none among them of sufficient weight, in view of
the many benefits realized from the operation, to justify its repu-
diation and abandonment.
Among these may be mentioned the theory that the foot de-
prived of its sensibility by neurotomy is more exposed to the se-
quele of pricks, contused wounds, corns, ete., from the cireum-
stance that there is no betrayal or visible manifestation of the
lameness which is usually indicative of lesions of that organ.
It is further objected that in many instances the lameness
shows, sooner or later, a tendency to relapse. But there is little
al ae
elas) ak a Je Wale tens
PLANTAR NEUROTOMY. _ 545
validity in this allegation, from the known fact that in a majority
of cases its early recurrence is mainly due to imperfect methods or
an unskillful performance of the operation, and cannot, for that
reason, be considered a proper incident of the case, but simply
an accident, which may be obviated by care and precaution, and
in judging the transaction, must be eliminated from the argu-
ment.
Probably the most important and most nearly valid objection
is that the suppression of the nervous influence has more or less
effect upon the nutrition of the digital region. Notwithstanding
the observations of Braael, the question of the direct influence of
the digital nerves upon the nutrition of that region is a pomt
which has not yet been thoroughly comprehended by our physiol-
ogists. For this region this objection, and the points involved in
it, call for further study, and it is nearly certain that when it has
received this the end will be the removal of the reproach brought
against neurotomy of interfering with the vegetative life of the
digital region.
Having thus examined the objections which have been urged
against neurotomy, a consideration of the advantages claimed for
it will come next in order of mention. Leaving out of view the
few failures to which the operation, in common with every human
act or endeavor, whether in great matters or small, is from the
constitution of things, liable, we proceed to the facts which demon-
strate the usefulness and value of the treatment, with a deserip-
tion of the various modes of procedure practiced by different sur-
geons. The facts of the direct and successful results which be-
yond question have been secured, are so numerous and so patent,
and they so far counter-balance all possible accidents, that no
conceivable array of abortive cases, if reported truly and with-
out prejudice, can impair their force and significance. It would
be impossible to reach even a proximate estimate of the value
saved and the loss prevented by the restoration of unnumbered’
useless and suffering animals to comfort and usefulness.
And these are what might be called the positive or direct ad-
vantages of neurotomy. But besides these, there are other advan-
tages in the secondary effects of the operation, of which the im-
portance cannot be ignored, especially when they are commended
to our attention by such authority as that of Professor Nocard, of
Alfort, when he says: “In several cases I have noticed a great
546 OPERATIONS ON THE NERVOUS SYSTEM.
diminution in the size of exostoses (ringbones), which we treated
by neurotomy;... ” and again, “‘ Neurotomy, by removing the
pain existing in the posterior parts of the foot, removes the cause
for knuckling, and prevents the retraction of ‘the tendons ;” and
further, “ It prevents also the serious accidents, so frequent after
firing of the coronet, sloughing of the skin, cartilaginous quittor,
necrosis of tendons or ligaments, opening of joints, etc., all being
accidents likely to follow the severe cauterization which, to be suc-
cessful, is required in the treatment of those exostoses.”
Speaking of these advantages, Zundel says: ‘“‘In rare cases,
besides the removal of the lameness, the recovery of the disease
which gave rise to it, may also be observed. Thus, after neuro-
tomy, contracted feet have, after a few months, regained their nor-
mal form, and exostoses have stopped their growth and even di-
minished in size.”
Having thus considered this matter, both pro and con, giving
on one side the objections urged against it, with the alleged facts
and inferences with which its opponents seek to maintain their ar-
gument, and on the other hand, shown the reasons which influence
the friends of the operation in advocating and putting it in prac-
tice, with their statement of its utility and the important bene-
fits it is capable of conferring, we are prepared to examine into
the conditions which indicate or counter-indicate this particular
method of surgical interference.
Bouley, speaking of its indications, said: ‘“‘When the digital
region is the seat of a chronic disease, manifested by pain and
continued lameness, provided the alterations of structure are not
of such a nature as to interfere mechanically with the execution
of the function of the region, neurotomy is indicated.” And
speaking of lameness, the seat of which is not located, Messrs.
Hardy and Hugues go farther, for with them “neurotomy can and
ought to be performed when a lameness from an unknown cause,
‘and whose nature is not recognized, has for a period of more
than three months resisted ordinary therapeutical and surgical
means.” ‘
Taking these as axiomatic rules, laid down by such authorities,
and substantiated by the results obtained by their observance, it
becomes evident that in all cases of lameness of the nature de-
scribed by these writers, or, to repeat, lameness and pain from an
unknown cause, neurotomy is the indication, and if it fails to cure
PLANTAR NEUROTOMY. 547
the undiscovered disease, it will, at least, relieve the lameness, if
not in all, yet still in a large majority of the cases.
In contraction of the heels, or in feet subject to chronic corns,
as result of their conformation, and in some cases of chronic
laminitis, where there is either no alteration of structure, or very
little, as well as in keraphylocele, here also neurotomy is bene-
ficial. But itis principally in navicular disease that its advan-
tages are best illustrated. And next to these, as best adapted to
prove and exemplify its benefits, must be classed ringbones and
sidebones, the characteristic exostoses of the digital region.
Excellent results have followed it when performed for the relief
of the lameness which often supervenes upon severe injuries, or
operations about the foot, such as fractures of the phalanges, crush-
ing of hoof, or any of the sometimes violent acts of surgical inter-
ference necessitated by the diseases of that region. The question
has even been discussed of the probability of obtaining beneficial
results in tetanus, following traumatic lesions of the foot ; especially
in punctured wounds.
A glance at the counter-indications of neurotomy will furnish
a plausible explanation of the objections alleged against it in its
earlier history. In the fact that the complications now recognized
as thus related to it were then unknown, and consequently un-
recognized, and the operation performed notwithstanding, we
at once discovered a sufficient reason for the failures and bad
results of the treatment, and the consequent odium into which it
naturally fell. It was not yet adequately comprehended—it was
misapplied—it was, perhaps, unskilfully performed—it failed. A
very logical formula; but it ought not to have been denounced.
Neurotomy is indicated in navicular disease, and for some in
the very incipiency of the attack, all other modes of treatment
being only palliative and temporary, and when it has advanced to
its chronic stage an operation will be of little advantage, or wholly
unsuccessful, if at this period the bone has become extensively
diseased, and the tendon reduced to the condition of a mere mem-
braneous pellicle. It is also contra-indicated in all forms of acute
inflammation of the foot; in badly formed feet, such as the flat or
pumiced of chronic laminitis ; and, again, when the lameness origi-
nates in a very large exostosis or other bony disease likely to be-
come a mechanical obstruction to the movements of the articula-
tion, or to the play of tendons, or to produce anchylosis. To
648 OPERATIONS ON THE NERVOUS SYSTEM.
resume, it may be said with Bouley, ‘one must not ask from neu-
rotomy more than it can grant, by applying it to cases where the
lameness must necessarily persist, even after the removal of pain
in the diseased parts.”
One important practical point in the performance of the opera-
tion is the determination of the place where it is to be performed.
A reference to the anatomical disposition of these plantar nerves
will aid us here. In the forelegs both the external and inter-
nal plantar nerves form branches about equal in size, running on
each side of the leg, with an identical disposition. Hach of these
nervous branches is situated along the tendon of the perforans
F1a. 462.—Plantar Nerves in Digital Region.
P, plantar nerve; A, original of the digital nerves; BBB, cartilaginous branch;
CCC, cutaneous branch; D, digital artery, with the nerve back of it; E E, ramifications
of the cartilaginous and cutaneous branch; FF, bulbous branches; G, Transverse
branches back of the fetlock joint: V, digital vein.
PLANTAR NEUROTOMY. 549
muscles, then, at a point a little above the fetlock, they ramify
and divide into three branches, or digital nerves proper; one prin-
cipal, posterior or continuation of the main trunk, running toward
FG. 463.—Plantar Nerve on the Posterior Face of the Phalanges.
P. plantar nerve; A, origin of the plantar nerve above the sesamoids; B, cartilagi-
nous branch; C, cutaneous branch; D, digital artery; H, branch to the cartilaginous
pbulbs—sometimes absent; I, branch of the plantar cushion; K, transversal coronary
branch; M, podophyllous ramification; O, pre-plantar nerve; Q, branch to the patilobe
eminence: R, arterial branches; V, vein which is sometimes found running back of the
plantar nerve.
the middle part of the lateral cartilage of the foot, under which
it passes; a second, anterior, smaller than the posterior, which is
divided toward the middle of the first phalanx, into several
branches, ramifying in the tendon and other parts of the anterior
region of the foot; and a third, or middle branch, which goes to
the coronary band and podophyllous tissue. The consideration
of the relation held by these plantar and digital branches to the
blood vessels constitutes an important practical point in the opera-
tion. Artery, vein and nerve descend on both sides of the fet-
lock, in such a manner that the vein is situated in front, the artery
550 OPERATIONS ON THE NERVOUS SYSTEM.
in the middle, and the nerve behind—the vein being on a plane
somewhat more superficial than the artery, which is a little deeper.
Consequently the operation may be performed at any one of four
points, and on either side of the leg.
These are, first, above the fetlock, on the plantar nerve proper;
second, below the fetlock, on the posterior branch; third, below
the fetlock, also on the anterior branch; and fourth, according to.
Nocard, above the fetlock, on the anterior branch. The first or
second of these locations is more often selected for the operation,
and forms either the high or low process.
For each of these operations there is a point of selection. In
the high process this is immediately above the fetlock, where the
nerve is most superficial and most easily exposed, on the outside
border, and a little in front of the perforans tendon. In the low
method it is below the fetlock, in the middle of that part of the
coronet region where a depression is felt between the tendon and
the first phalanx.
The question of preference between the high and low opera-
tions has been made the subject of much discussion, and it re-
mains still unsolved. With many the high operation is that which
yields the best results; others hold that the object especially con-
templated in any given case must determine the point as the oc-
casion presents itself. Itis only just to say, however, that the ma-
jority of practitioners prefer the high operation ; not only because
it is easier to perform, but also because it is more likely to be
successful.
Personally, we believe that the high operation, with some
few exceptional cases, is that which will prove almost generally
beneficial.
The instruments necessary are, a pair of scissors, a convex
bistoury or scalpel (we prefer the latter), a narrow, straight bis-
toury, two dissecting forceps, a pair of blunt tenaculums, with
an elastic band (Fig. 464), an aneurism tenaculum (Fig. 465),
needles, thread and sponges. Those who are familiar with the
operation highly commend_a new instrument, the neurotome (Fig.
466), which has been invented to take the place of the straight
bistoury.
Neurotomy is a simple operation, but a very painful one, and
it is necessary, therefore, to have the animal well secured from the
commencement of his struggles, which may endanger both himself
PLANTAR NEUROTOMY. Bis
Fic. 464.—Blunt Fig. 465.—Blunt
Tenaculum, with Tenaculum,
Elastic Band.
Fia. 466.—Right and Left Neurotomes.
and the surgeon and his attendants. We fully agree with the
admitted rule that animals undergoing surgical operations should
be thrown and properly secured. We, with other practitioners,
however, have succeeded so well in obtaining complete local an-
esthesia by the use of cocaine, that it has enabled us to perform
the operation in the standing position. We, nevertheless, can
scarcely see the necessity for general anesthesia when, as we be-
lieve, the intense pain which occurs the moment of the division
of the nerve can be mitigated by careful local anesthesia after the
nerve is exposed, should the operator think it necessary. A careful
consideration of the various methods recommended for securing
an animal, when cast for operation, has induced us to adopt the
following as the simplest, the safest and the easiest to apply and
control: The animal is thrown upon the side of the leg which is
to be operated upon, and, both legs being bound together above
the knee with a few twists of a flat rope in the form of a figure 8,
the leg to be treated is removed from the hobble and drawn
552 OPERATIONS ON THE NERVOUS SYSTEM.
forward with a rope attached to the foot. In this manner the
inside of the leg is first treated, after which the animal is turned
over and the process repeated on the outside. If the operation is
to be performed on both legs, the patient may be thrown on either
side indifferently, and his legs secured as before described. The
under leg is then first released and dealt with on the inside; then
rebound to the hobble and the upper leg liberated, and the process
repeated on the outside. The horse is then turned over, and the
inside of the second leg operated upon is neurotomized and
returned to its hobble; and finally, the upper leg, which was on
the under side at the beginning, is operated on upon the outside.
Our mode of operating may differ somewhat from those prac-
ticed by others, but the general plan is the same.
The patient, having always been prepared by local treatment
of his fetlocks, which have been soaked and firmly bandaged for
twenty-four hours, is cast and secured, as before stated, the hair
is closely clipped with the scissors, and the parts thoroughly
washed with an antiseptic solution (bichloride of mercury).
Having carefully felt for the location of the nerve, which, in many
cases, can be discovered by feeling the pulsations of the artery,
an incision is made through the skin with, if possible, one stroke
of the convex bistoury, measuring from an inch to an inch and a
half in length. It is an advantage to have the incision slightly
oblique to the direction of the nerve. Then, witha forceps in one
hand, and the handle of a bistoury or scalpel in the other, the
cellular tissue is lacerated from the edges of the incision, in order
to allow the application of the two blunt rubbered tenaculums,
which, when in position, hold open the wound; or sometimes
threads are used instead, being passed through the edges of the
wound and tied on the opposite side of the leg. If the incision
has been made in the proper place, after sponging away the trifling
hemorrhage which obscures the wound, the nerve may be seen at
the bottom, or it may be found surrounded with more or less
condensed cellular tissue, and the next move is its dissection.
With a dissecting forceps in each hand, we firmly grasp the con-
nective tissue with one, while with the other we tear it away
immediately over the nerve, removing it by two or three small
portions at a time until the nerve is exposed, lying more or less
closely to the artery. Then, with a gentle two-and-fro movement,
we isolate the nerve from its attachments with the cellular
*
q
1
Orne aa eee Oe ee
PLANTAR NEUROTOMY. 553
strueture, and when it is loosened, a fact easily recognized by
an apparent shrinking in its length, it is ready for the division.
At times we pass under it the blunt aneurism tenaculum, carry-
ing a thread with which to secure it, and when secured, passing
the pointed bistoury under it, we divide it with a single upward
stroke of the instrument. In other instances, instead of the ten-
aculum and thread, we use the neurotome, which, having a curved,
blunt end, enables us at once to isolate the nerve, and with a
simple motion of the sharp edge to divide it from below upward.
Upon making the section the lower end of the nerve is secured
with forceps, drawn out of the wound, separated from its adhe-
sions by scraping it with the bistoury, and when a portion about
an inch or an inch and a half in length has been dissected, and’
the resection is completed, either with the neurotomy knife or the
bistoury, the wound is to be cleansed with antiseptic washes.
The edges are in a very few instances secured by a stitch of
suture, but we often prefer a simple antiseptic dressing and a
bandage.
There is, of course, no doubt that animals will often struggle
during the operation, and especially at the moment when the liga-
ture is tightened upon the nerve, or when the nerve is divided,
but the pain in either case is so transient that while we appreciate
the value of anesthesia, we cannot recommend, in ordinary prac-
tice, general etherization or chloroformization. If it is necessary
to have recourse, as some do, to the tourniquet, or of any other
means, to control a possible hemorrhage, a large experience in the
practice of this operation has failed to show us a single case
where such practice would have been of advantage.
The various details of the operation are substantially the same,
both for the high and the low process. It must be borne in mind,
however, when operating below the fetlock, that the nerve is often
concealed by a little fibrous band, which a careless operator might
mistake for the nerve itself.
There is probably no special attention required as supple-
mental to the operation. The wound heals more or less rapidly
by first or second intention, and, as a rule, after two or three
weeks there are no signs of the occurrence excepting a simple
linear cicatrix remaining. Of the accidents which may be en-
countered during the operation, hemorrhage is the most import-
ant. Generally this is referrible to an error on the part of the
554 OPERATIONS ON THE NERVOUS SYSTEM.
operator in dividing the artery or the vein, and usually it is not
dangerous, though it may still prove very troublesome. If the
artery is divided the ligature must be applied on the truncated
ends; if the vein, pressure will be sufficient.
The last important point involved in a case of neurotomy is
the length of time required by a neurotomized animal to recuper-
ate before he can safely return to his work. It is undeniable that
to a too hasty return of the patient to his accustomed labor most
of the objections and alleged complications of the operation may
be traced, and for this reason the answer to the question how
long a rest shall follow the operation must be as long as circwm-
stances will permit.
Zundel, Gourdon, Fleming, and others, make a month the
minimum period within which no considerable exertion should be
undergone; we would sometimes be still more liberal in allotting
the length of the vacation.
CHAPTER XII.
OPERATIONS ON THE GENITO-URINARY
ge eee OS,
CATHETERISM OF THE URETHRA.
The object of this operation is the exploration of the interior
of the bladder, and consists in the introduction of a catheter,
species of canula, or through the urethral canal into that organ,
for the purpose of ascertaining and removing its contents. Al-
though the urethra of the male has great length, with an acute
curve at the ischial arch, the operation is not a difficult one. It
is described as the partial and the complete, according to the dis-
tance to which the instrument is inserted into the canal, being
partial when the catheter is pushed in the urethra only as far as
the pelvic portion of the passage, but complete when it is carried
completely into the bladder.
The operation is employed in animals of both sexes, and is
indicated in cases of retention of urine, due either to the pressure
of calculi, or to the spasmodic contractions of the bladder, which
accompany some cases of colic; or, again, when in attacks of
paraplegia the animal is unable to micturate naturally. It also
constitutes one of the first steps of the operation in urethrotomy,
in cystotomy, and in lithotrity.
We shall consider the operations separately as performed in
males and in females.
In Males.—The catheter used in veterinary practice for male
solipeds is composed of a tube of wire, twisted in close spirals,
and covered with a species of thin oil-cloth, making the outer sur-
face perfectly smooth, and forming a perfect canula. It is fur-
nished with a stylet made of flexible rush broom, or whalebone,
which can be readily withdrawn from the cavity of the instru-
ment.
Metallic catheters, invented first by Brogniez, and improved
on the plan of those used in human medicine, may also be ob-
556 OPERATIONS ON THE GENITO-URINARY APPARATUS.
Fic. 467.—Catheter.
tained, but they are not in as general use as the simpler and
cheaper kind above described. India-rubber instruments, more
or less pliable, constructed on the same general plan, are also
made.
Tn solipeds, urethral catheterism can be performed either when
the animal is standing or in the recumbent position. In the first
case he is kept quiet by the application of a twitch on one lip and
of the hobbles on his hind legs. This done, the first step is to
secure control of the penis by drawing it out of the sheath, which
must first have been thoroughly cleaned and washed to remove
all the sebaceous secretion which by its greasy consistency renders
this step of the operation quite a difficult one, many animals
resisting the attempt to accomplish this with all their force. But
by obtaining and retaining a firm hold of the penis above the
glans, and drawing upon it slowly, firmly and steadily, the resist-
ance of the animal may be at length overcome, and the organ
brought into full view. The operator then, guided by the little
protrusion of the urethral canal, in the middle and a little toward
the lower border of the glans, carefully introduces the instru-
ment, which should be freely lubricated with oil or vaseline,
pushes it slowly toward the ischial arch. When the instrument
CATHETERISM OF THE URETHRA. 557
reaches the ischial space the stylet must be withdrawn in order to
avoid the difficulty of bending the catheter over the curve formed
at that point in the urethra. At this moment a gentle but firm
and steady pressure upon the end of the instrument (easily felt
at the ischial arch), made by an assistant bending it forward, will,
with a little careful pushing, effect its entrance into the bladder.
This will, of course, become known at once by the cessation of
the resistance, and by the escape of the urine which may be con-
tained in the bladder.
The removal of the instrument is effected by simply drawing
it carefully from the passage.
Sometimes simple pressure over the ischial arch is insufficient,
and the bending of the instrument into the proper direction is to
be made through the rectum, and hence the indication of having
that organ well emptied before proceeding to the operation.
The indication of great caution in this operation is suggested
by a consideration of the fact that (if the canal should chance to
be of unusually narrow diameter or its walls softened by disease)
there is sometimes danger of forming false passages, by punctur-
ing the mucous membrane, and forcing the catheter into the
erectile tissue which surrounds the urethra. This is an incident
which, however, can be avoided by removing the stylet from the
canula before its introduction into the urethra, the canula itself
being terminated by a perforated oval bulb, perfectly smooth, and
thus incapable of inflicting injury.
In Catheterizing Females, a small catheter may be and is
sometimes used, but as a rule, the metallic instrument is prefer-
able, the conditions of the method, the shortness of the passage
Fie. 468.—Female Catheter.
and its comparatively large diameter, with the facility with which
it can be entered; rendering the metallic on all accounts more
eligible than the composition or the rubber tube.
The instrument, being lubricated with oil or vaseline, the oper-
ator, opening the vulva with the left hand, introduces his right,
holding the instrument, into the vagina, and carries it forward to
the meatus urinarius, which he can feel at about six or seven
558 OPERATIONS ON THE GENITO-URINARY APPARATUS.
inches in front of the vulva. While thus holding the instrument,
he feels, with the middle finger of his right hand, for the mucous
valyular fold which covers the meatus, pushes the finger under it,
and then, bringing the bulb end of the catheter to the opening of
the urethra, inserts it into the bladder.
The accidents that may arise from carelessness, or otherwise,
in the catheterism of males, are not met with when treating
females.
URETHROTOMY.
Incisions of the urethral canal are made for various purposes.
The removal of foreign bodies, usually calculi; the restoration of
the suspended power of micturition when is has been caused by
the closure of the passage; the establishment of an artificial
urethral opening ; and the penetration of the cavity of the bladder
when necessary for surgical purposes—these are among the
reasons for which this important canal is incised by the surgeon.
It is principally performed on males, the dimensions, aside from
its shortness, of the urethra in females being, as a rule, ample,
and the organ sufficiently dilatable for the removal of calculi,
or other objects, without involving the necessity of an operation.
Among the males, the ox is the animal which most frequently re-
quires it, by reason of the peculiar liability of this animal to suffer
from a constitutional tendency to the formation of calculi and
the fact that these accretions are often arrested in the urethra, in
consequence of a peculiar double curvature, or S formation, in the
penis.
With horses, it is in some districts quite a common operation.
In these animals, however, the calculi, though of rare formation,
are larger and are more generally retained, either in the bladder
or in the first portion of the urethra. In smaller animals, calculi
are also quite common and troublesome, especially in dogs, on
account of the presence of the bony formation in the structure of
the penis. ‘
In the horse, the principal operation is performed in the peri-
neal region, or the part extending on the median line from the
anus to the scrotum, bounded above and on each side by the
ischial tuberosities, and below by the flat of the thighs.
The skin of the perineum is very fine and thin, and is hairless
URETHROTOMY. 559
= . | 7. ii NBN f Ne : COG ed
RR Z 4 1% \\ GZAZAZ 10
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.
Fic. 469.—Anatomy of the Perineal, Anal and Caudal Regions.
11.—The skin. 2.—Portion of the aponeurotic sheath of the coccygeal muscles.
8 3.—Inferior sacro-coccygeal muscles. 4 4.—Lateral sacro-coccygeal muscles. 5 5.—Is-
chio-coccygeal muscles. 6.—Suspensory ligament of the anus. 77.—Lateral caudal
arteries. &.—Deep caudal vein, satellite of the median artery. 9.—Median caudal
artery. 1010.—Inferior caudal nerves. 11.—Lymphatic glands. 1212.—Superficial
caudal veins. 12’.—One of the superficial caudal veins. 13.—Portion of the perineal
aponeurosis. 1414.—Semi-membranosus muscle. 15.—Sphincter ani. 16 16.—Ischio
cavernous muscle. 1717.—Bulbo cavernous muscle. 18 18.—Suspensory ligaments of
the penis. 1919.—Bulbous or internal public arteries. 20.—Incision of the urethral
canal for urethrotomy. 21.—Anus.
RRs,
560 OPERATIONS ON THE GENITO-URINARY APPARATUS.
below the anus, but downward and on the sides, is is covered with
short hair. Below the skin are found the two principal layers of
aponeurotic covering, divided into the superficial and the deep.
The former, of fibro-elastic texture, is the continuation of the dar-
tos, and covers the perineal region, thinning down as it nears the
anus, to disappear at the sphincter ani. Its most superficial fibres
give attachment to a subcutaneous muscular fasiculus, which
from the splineter ani runs downward to lose itself about three
inches below. The latter plane, or deep aponeurosis is formed of
white inextensible fibrous tissues. Intimately adherent by its
external face to the superficial layer, it covers and unites with the
accelerator urine, and the ischio-cavernous muscles, as well as
with the suspensor and retractor ligaments of the penis. It then
passes between the ischio-cavernous and the semimembranosus,
to attach itself above on the ischial tuberosity and become lost
downward on the thighs. Some of its fibres directly surround
the fixed portion of penis, and join the aponeurosis common to
all the muscles of the flat of the thigh.
The suspensor and retractor of the penis form, in the upper
perineal region, that is, from the anus to the ischial arch, an ex-
pansion of sufficient width to form a true anatomical layer. Below
this they represent bands about half an inch wide, situated on the
median line, and covering the accelerator muscle. They are
formed of white muscular fibres. The blood-vessels and nerves
of this region, with the other parts pertaining to the anatomy of
the urethra, have already been considered.
The peculiarity that belongs to the penis of ruminants must
not be overlooked, when the question of urethrotomy in these
animals is under discussion. Their penis is very long and thin, and
is surrounded in the perineal region by a complete aponeurotic
sheath, and on a level with the pubis it has two curvatures, which
give to the organ the form of an S. Ona level with the second
curvature it gives attachment to the suspensory ligaments. The
free portion of the organ is elongated, strongly filiform, and
covered by a fine, rosy mucous membrane. The peculiarities
possessed by the penis of the horse do not exist in cattle.
The operation of urethrotomy is classified and designated with
reference to the part of the urethra, which is to be divided, and
this is of course determined by the location of the body to be re-
moved, making the designations principally regional; and it is
URETHROTOMY. 561
therefore said that the operation can be performed in three ways,
though three places would be the more accurate phrase.
Thus we have first, the incision at the point of the penis, or
preputial urethrotomy ; second, the division in the scrotal region,
or scrotal urethrotomy,; and third, the incision below the anus,
or ischial urethrotomy.
PreputiaL UREtTHROToMY.
In horses and dogs the urethra becomes more or less con-
tracted toward the full extremity of the penis, and calculi are
therefore apt to become arrested in that locality ; in other cases,
masses of sebaceous matter will collect in the navicular fossa. In
sheep, saline concretions are found, either in the prepuce or in the
urethra. All these conditions involve a contingency of surgical
interference. To remove them in the horse and in dogs, a trans-
verse incision is made with a bistoury over the spot where the
presence of the foreign body is detected, and it is readily disposed
of. If the erratic substanceis in the urethra, an incision is made
through its membranes and it is removed in entirety, or sometimes
after having been reduced to fragments by means of a probe or
of acurator. In sheep, the simple amputation is recommended
by some. The wound made in these cases heals without trouble.
ScrortaL URETHROTOMY.
Scrotal urethrotomy ean be performed either on the front or
behind the testicles. In cattle it is ordinarily posteriorly that the
calculus is lodged, more commonly in the second than in the first
curvature, and lence the indication for selecting this place for the
operation. Yet there are practitioners who prefer the anterior sec-
tion, because the penis being more superficial at that place, there
is less cellular and adipose tissue to be divided before exposing it.
In either case, the animal is thrown, with the hind leg carried
forward and secured as for castration. If the operation is to be
performed behind the testicular mass, an incision is made on the
median line, measuring about three inches in length, the cellular
tissue divided with the knife or the finger and the penis drawn
out through the incision. The calculus is extracted through a
longitudinal incision. The canal should then be examined with a
probe or bougie, to ascertain whether any more offending bodies
are present, and if so, they are of course also removed. The
562 OPERATIONS ON THE GENITO-URINARY APPARATUS.
wound may be either closed by sutures, or, preferably, left without
interference, to obviate the possible danger of the formation of
future scrotal abscesses.
In the pre-scrotal operation, the hair is first clipped short, and
an incision made through a transverse fold of the skin, to expose
the penis. The concluding steps are the same as those in the
former case.
It is, however, always advisable, when the animal is secured,
and before dividing the tissues, to insert the hand into the pre-
puce to draw out the organ. By thus straightening it and remoy-
ing the S curvature, it is possible, and sometimes occurs, that
calculi are displaced and extracted without the necessity of resort-
ing to the knife.
The urinary fistulas which are among the sequel of scrotal
urethrotomy, are of two or three weeks’ duration, seldom continu-
ing longer. Care must be taken to protect the skin from the
irritation produced by the dripping of the urine through the
wound.
Iscoian URrrTHRoTomy.
This is the most common of the three operations, and is appli-
cable to all males.
It is performed without casting, with the animal hobbled on
both hind legs and a twitch on his lip. (Fig. 470.) The decubi-
tal position is seldom required. The free use of cocaine has
enabled us to operate without any means of restraint, not only in
horses, but in camels, which are very awkward and uneasy animals
at the best, and especially when in the hands and under the knife
of the surgeon. The insertion of a catheter has been recom-
mended by many, to serve as a guide to the dissection of the
urethra, while others prefer the artificial dilatation of the canal
by the injection of water. In some cases, however, neither of
these expedients is necessary. The presence of the calculus and
the dilatation of the urethra above it, by the confined urine,
greatly assists in the location and puncture of the canal.
The incision must be made on the main line, on a level with
the ischiatic arch. The structures to be divided are first, the
skin, then the subcutaneous cellular tissue, the aponeurotic layers,
and the accelator urine; which being completed, a straight
puncture can be made in the urethra between the two suspen-
sory ligaments. The incision is then extended upward or down-
URETHROTOMY. 563
eS zs — z
a
————
Fie. 470.—Secure for Ischial Urethrotomy.
ward, as may be required, with the bistoury, guided by the
grooved director, a blunt bistoury being sometimes chosen from
the motive of prudence, in order to avoid possible injury to the
surrounding blood vessels.
In our experience we have secured very satisfactory results by
adopting the method recommended by Bouley, of making one
comprehensive puncture, which penetrates the canal without any
preliminary dissection of the incumbent parts, especially when a
catheter has been placed in the urethra for the guidance of the
knife. The hemorrhage, which generally accompanies this mode
of operation is of no great importance, often subsiding of itself,
and seldom requiring external hemostatic applications.
We believe it to be the better course, when the object in view
has been realized, to leave the wound to itself, without interfering
with the healing process by seeking to facilitate it by the applica-
tion of sutures. It gradually granulates and closes without any
special care beyond the observance of cleanliness and the neces-
sary measures to prevent irritation of the skin from the contact
of the urine as it “leaks” through the wound.
When the urethra has been opened, in whatever region of the
penis the offending foreign body may be lodged, it is readily
564 OPERATIONS ON THE GENITO-URINARY APPARATUS.
Straight. Curved.
Fas. 471, 472.—Forceps to remove Foreign Bodies from the Bladder.
extracted with straight or curve forceps. These can also be em-
ployed to secure those of comparatively small size that may be
found in the bladder, and answer very well likewise for those
masses of a sedimentary nature that are commonly seen in mares.
There may sometime be some peculiar pathological conditions
which render it necessary to prevent the closing of the wound in
cases of ischial urethrotomy, and when the formation of a perma-
nent artifical opening should, perhap, be attempted.
The entire closing of the urethra, in its anterior portion, re-
URETHROTOMY. 565
sulting from some special trauma-
tism would be such a case; or again,
when the formation of calculi has
become an established constitutional
habit, and the results of this perver-
sion of the nutritive and assimilative
function are always present and con-
tinually renewed. In view of this
unfortunate state of things, and to
prevent the closing of the wound,
Troeber recommends the use of a
peculiar tube, which, when intro-
duced into the urethra can be per-
manently retained in place for an
indefinite length of time (Fig. 473).
We have attempted the formation
of an artificial urethral opening, by ry4. 473.—Tube of Troeber, for Ischial
sewing together the mucous mem- Urethrotomy in Bovines.
brane of the canal and the skin, but the results of the experiment
were of the most transient character.
CYSTOTOMY.
Improperly known also as lithotomy, is an operation which
consists in the incision of the neck of the bladder to remove cal-
euli of dimensions too great for removal intact through the
urethra. This operation has no longer a place in our surgery, .
and, in fact, there is no existing reason for its performance. Ifa
calculus is of small or of medium size the neck of the bladder
can always be sufficiently dilated to permit its passage, and if it
should be of greater dimensions, and rendered impossible of ex-
traction by its size, the operation of lithotrity is always available,
and in experienced hands as nearly certain and safe as can reason-
ably be expected.
LITHOTRITY.
This term designates the operation of crushing, or piercing, —
or drilling stones in the bladder, in order to reduce them to frag-
ments, preparatory to their removal by means of forceps or cur-
ates, or by washing them out of the bladder with water. It
mostly corresponds with, or rather, includes the lithotomy of
566
OPERATIONS ON THE GENITO-URINARY APPARATUS.
Fig. 474.—Lithotritor of Guillon.
human surgery. It was per-
formed for the first time by
H. Bouley in 1858, with the
assistance of a practitioner
of human surgery, Dr. Guil-
lon.
Horses are more specially
the subjects of this opera-
tion in cases when the cal-
culi are too bulky and too
hard to be broken and re-
moved with the forceps
alone. In ruminants, on
the contrary, vesical calculi,
though more common, and
more numerous in single
animals, are generally of
sufficiently small size to
permit the relief of the pa-
tient by the simple opera-
tion of urethrotomy.
The instruments neces-
sary for this operation are
the lithotritor, or lithon-
triptor, with also the crush-
ing forceps. 'The lithotri-
tor of Guillon (Fig. 474),
or the crushing forceps of
Bouley (Fig. 475), are those
generally used. We are con-
vinced by our experience of
these instruments that the
. principal, and probably the
only objection that applies
to them lies against their
mechanical construction.
We consider them to be too
clumsy, too large and too
heavy; objections, however,
which are very easily obvi-
LITHOTRITY. 567
ated by any competent instru-
ment-maker.
While they must necessa- i
rily possess sufficient power to |
crush the calculi, we fail to see \
that a proper attention to the
features of symmetry, finish,
and convenience of manipula-
tion can involve any sacrifice
of efficiency. The instrument
can be made to possess ample
strength, while still more easy
to handle when introduced in-
to the bladder through the com-
paratively small opening of is-
chial urethrotomy.
A bivalve speculum (Fig.
476) to dilate the wound of the
urethra is sometimes of great
value. A large syringe, and
plenty of water, or what is
better, an irrigator for douches
to wash out the bladder, will
complete the series of neces-
sary instruments. The opera-
tion is performed with the ani-
mal in the standing position,
secured as for urethrotomy, or
cast if the operator so prefer
it, and placed under the influ-
ence of general anesthesia.
We borrow from H. Bou-
Fig. 475.—Crushing Forceps of Bouley.
ley, the father of the operation, his own description of the modus
operandi:
Access to the bladder having been obtained by the process
already described, the essential operation is divided into three
principal steps :
1st. The introduction of the lithotritor, and searching for and
grasping the stone; 2d, crushing of the calculus; 3d, removal of
the fragments.
568 OPERATIONS ON THE GENITO-URINARY APPARATUS.
Fia. 476.—Bivalve Speculum,
Ist. Introduction of the instrument for searching and grasp-
ing the stone.—This step varies with the instrument, as to whether
the lithotritor or the crushing forceps is used. If the first, the
instrument, well greased and kept closed, is inserted through the
urethral incision, with its concavity resting on the convexity of the
ischial arch, and is pushed obliquely forward and downward
through the pelvic portion of the urethra and the neck of the
bladder. When in this cavity the branches of the instrument are
opened, and by a slight and slow movement made to traverse the
cystic space until it comes in contact with the calculus, which then
drops into the hollow of the branch adopted by its shallow form
to receive it. The jaws of the instrument are then brought to-
gether and the stone firmly secured. |
The same description, in every particular, applies to the ma-
nipulation of the crushing forceps.
In some cases, however, it is necessary to disarticulate the in-
struments, and to introduce the branches separately, HE them
when both have been inserted.
It is important, in every case, to leave a small portion of urine
in the bladder to facilitate the movement of the stone-and aid in
its seizure without grasping and pinching the lining membrane of
the organ. If the bladder is empty a portion of water might be
injected.
2d. Crushing of the Stone. This is done by slowly approxi-
mating the jaws of the instrument. It is not necessary to reduce
the stone to very minute particles. It will be sufficient if their
dimensions are not too great to permit their free escape through
the urethral passage.
In remoying the instrument after accomplishing the crushing,
a great deal of the comminuted calculus is extracted between its
jaws.
3d. Removal of the Fragments.—Dilating the urethral wound
LITHOTRITY. 569
with the bivalve speculum, a stream of water is then thrown into
the bladder, either with the syringe or the tube of the irrigator.
The water ought to be tepid and antiseptic; and a hand intro-
duced into the rectum and manipulating the bladder, will facili-
tate the repulsion of the larger fragments, and the washing out of
the smaller. The general attention required in all cases of serious
operations will be necessary after the performance of lithotrity.
In respect to any special dressing, they are the same as those in-
dicated in simple urethrotomy.
Serious, however, as this operation is, it is comparatively free
from dangerous sequelee. Hemorrhages of easy control have been
met, urinary abscesses, with infiltration, have occurred, serious
wounds of the urethra, of the rectum and of the bladder may also
happen, but they are of rare occurrence, and can be avoided by
careful manipulation through all the steps of the operation.
AMPUTATION OF THE PENIS.
This operation is indicated in the horse when the penis becomes
the seat of warty growths; of epithelial, papillomatous, or can-
cerous degenerations; of fracture; of paraphymosis, or of paraly-
sis. Warty growths are usually found covering more or less the
free part of the penis; or its free extremity; or the glans penis;
and are also sometimes met with on the inside of the sheath, their
presence being accompanied with an offensive and very irritating
sebaceous discharge, becoming at times so painful as to interfere
with micturition. They resist the severest forms of treatment,
and it is not unusual for them to develop into forms of a more
alarming nature, notably those of chancroid degeneration, of
which, in fact, these epithilial growths are but the seminal origin.
In other cases the erectile tissue of the glans penis becomes the
seat of ulceration, extending in depth, spreading in such a manner
over the penis that the free portion of the organ becomes a mere
mass of bleeding surface, of irregular aspect, macerating in the
pus which abundantly forms, and which escapes with its peculiarity
of bloody saniousity, with the most repulsive odor and irritating
effect, rendering the act of micturition most painful and difficult.
In many instances the animal so dreads to bring his penis out of
the sheath that he urinates within the cavity formed by the folds
of the skin, adding another source of irritation to that already
570 OPERATIONS ON THE GENITO-URINARY APPARATUS.
existing. And if the penis is still allowed to pass out of the
sheath, the micturition is made with a crooked stream, which in-
stead of escaping forward is, on the contrary, discharged back-
ward. In such a case no treatment will relieve the difficulty but
the removal of the entire diseased structure.
In fractures of the penis ; in many conditions of paraphymosis ;
or in those of paralysis, the organ hangs suspended outside of the
sheath, and cannot be restored to its cavity. If pushed back it
soon returns to its abnormal condition, and even if retained by
artificial means, will continue in place only while the means are
continued to enforce it, becoming displaced again whenever the
restraining agency ceases to operate. This serves to render the
animal useless, in consequence of its appearance being so repul-
sive as to preclude his employment in public view. Of course the
only radical cure for such an ailment is the knife or its equivalent.
The operation usually consists in the removal of the free por-
tion of the penis, the necessity for going beyond this seldom
occurring, yet in order to reach the diseased part it is sometimes
necessary to divide the sheath along the median line.
The general anatomy of the organ, as far as it relates to the
operation, is very simple. The penis it formed by the corpus
Fig. 477.—Penis in Normal Condition.
cayernosum, a long, erectile structure, flattened from side to side,
and grooved on its inferior border for the reception of the corpus
spongiosum urethre, Terminated inferiorly by a blunt point,
this corpus cavernosum dips into the erectile tissue of the urethra.
After passing out of the pelvic cavity, by the ischial arch, the
spongious portion of this canal, is received into the groove of the
corpus cavernosum, at the anterior part, and also extends beyond
it. The mucous membrane is covered externally by the tissue
AMPUTATION OF THE PENIS. 2 SE
which gives to this part of the urethra its name, and this erectile
tissue terminates anteriorly in an enlargement, more or less
developed, forming the head of the penis, or the glans penis.
The urethra proper protrudes a little below the center of the
head of the penis, and shows in a cavity underneath, the urethral
fossa, more or less filled with a sebaceous secretion. The blood
vessels which ramify in these erectile structures are the two dor-
sal arteries of the penis, anterior and posterior, and the veins,
which form large branches, running also upon the dorsal border
of the organ.
Zundel very wisely insists upon two principal conditions (to
which we shall again refer) to realize in the operation, first to
manage to leave a free means of exit for the urine, by cutting
away less of the urethra than that of the cavernous body, and
second, to avoid the hemorrhage, which is especially liable to take
place in horses, on account of the abundant circulation in the
erectile tissues.
The animal if to be placed in the recumbent position, as in the
operation for castration, that is, on the left side; or it may prove
advantageous to place him on his back.
Five modes of operation are described by different writers on
the subject—Ist, the ligature; 2d, cauterization; 3d, excision ;
4th, by scraping; and 5th, by crushing.
As an adjunct to the various instruments which these different
operations may require, metallic catheters are also necessary.
The Ligature.—The catheter being introduced into the urethra,
beyond the point where the amputation is to be made, a strong
ligature is applied at that point and tightened sufficiently, if pos-
sible, to strangulate the portion of the penis which is te be
removed. After from twenty-four to forty-eight hours, the
external layers of the tissues will have become mortified, even to
a certain depth in the penis, and a new ligature is then applied,
and strongly tied like the first one. The deeper layers of the
penis are also, after a day or two longer, so mortified that they
continue attached to the tissues above the ligature only by a
small particle, which can be divided with the knife. The catheter
may then be removed or it may be allowed to remain in place a
few days longer. No special subsequent treatment is required.
If, after afew days, micturation seems to become difficult, the
urethral opening may be enlarged by the introduction of a bougie
572 OPERATIONS ON THE GENITO-URINARY APPARATUS.
or a catheter, or again enlarged by an incision with the bistoury.
Instead of the ordinary string, an elastic ligature may be sub-
stituted with the advantage of maintaining an uninterrupted pres-
sure upon the tissues up to the moment when mortification is
established in the part to be amputated.
Cauterization.—No catheter is required with this plan. Two
ligatures are applied, one anterior, by which the penis is kept out
of its sheath, and one posterior, acting as a hemostatic, placed
above the point where the division is to be made. The operator
then with a flat and sharp cautery, heated to white heat, makes a
complete section of the penis.
But, says Zundel, “as the urethra is especially delicate and
sensitive, it is better, in order to avoid its retraction, to separate
it from the cavernous body about half an inch in front of the place
where the section is made.” A hollow bougie of india rubber
inserted into the urethra will also prevent its contraction.
Professor Nocard has recommended the use of the galvano-
cautery, to obtain an easier division of the tissues, a more perfect
hemostatis and to shorten the duration of the operation.
Excision.—After introducing a metallic catheter, a rapid sec-
tion of the organ is made by a single stroke of the knife. Again,
says Zundel, ‘when the urethra is reached, it must be dissected
a little forward, toward the glans penis, and caused to protrude
about half an inch beyond the point cauterized.”
Scraping of the penis.—This method, which was put in prac-
tice in 1829 by Moiroud and Delafond, consists in scraping the
penis with a bistoury, in such a way that, the remaining portion of
the organ forms a cone, with its apex formed by the urethra. A
catheter may be introduced into the canal previous to the opera-
tion and left in place for awhile; or again, it may, if thought
proper, be entirely dispensed with. This mode precludes the
danger of hemorrhage.
Crushing.—By operating with the ecraseur, the amputation is
perfected without danger of hemorrhage. The chain of the
instrument is applied at the point of amputation, and by slow and
gradual action, cuts through the tissues until the diseased part
drops off. The danger attending this method is that the chain
may break during the process, in consequence of the resistance of
the cavernous tissue. This accident has certainly been encoun-
tered by many practitioners, and we haye ourselves witnessed it
I
4
a
4
1
q
=
AMPUTATION OF THE PENIS.. 573
in two instances. On one occasion it was found necessary to re-
place the chain twice, and to complete the amputation with the
knife.
Reynal has modified the crushing operation by making the
action of the ecraseur slower. He has invented a small instru-
ment (ecraseur) which is left in place for two or three days, being
tightened every day, or several times a day, until the mortification
is complete, and the diseased penis sloughs off. In this method,
a metallic catheter is placed in the urethra; in the other the
catheter is not required.
In reflecting upon the various modes of operation we have
thus described, and noting especially the two very important, and
indeed, essential requirements referred to by Zundel, in respect to
the matters of micturition and hemorrhage, we are struck with
the fact that in none of those methods are these obvious require-
ments complied with, or if they are, it is in a manner so faintly
implied, and so indefinite and unsatisfactory as to be scarcely
intelligible, and certainly to leave no distinct impression on the
mind, of the importance of the points referred to.
In every case the danger of possible subsequent interference with
micturition is threatened, whether the catheter is used during or
after the operation, or even, we fear, if left inthe passage “at least
two months,” as recommended by Peuch and Toussaint. We can
remember cases of our own which, with even a longer retention
of the catheter, were followed by failure. We have attempted the
formation of an artificial urethral opening below the ischial arch,
and with no better result.
We are tempted to believe that the hemorrhage is less danger-
ous than many think, and we believe it could be controlled by
ordinary pressure, or by plugging the sheath afterward, or by
still other means of hemostasia.
Taking all this into consideration, we cannot but think strange
of it, that the process used in human surgery, which we find
merely mentioned in some European works, but which we believe
has been performed by Gerlach, and which we ourselves adopted
more than fifteen years ago, should be practically ignored or
rejected by writers as well as practitioners. We have practiced it
during the period mentioned without having encountered the
slightest complication or troublesome sequel.
We refer to it as the only safe, and as, therefore, the best mode
574 OPERATIONS ON THE GENITO-URINARY APPARATUS.
of operation for the amputation of the penis. It differs from any
that have been previously recommended, and is as follows :
The animal being prepared for the operation in the ordinary
way, the penis is secured with a ligature at its end and drawn
out of the sheath, and another ligature tightly applied on the
upper part of the organ. An incision of the skin covering the
penis is made entirely around the organ and down to the cavern-
ous body, with the precaution of drawing the skin slightly back-
ward, so that when the amputation is completed, and the skin
allowed to return to its position, it will slightly overlap the stump
of the penis.
We divide the cavernous body, carefully avoiding injury to the
urethra, and when this organ is reached it is dissected from
its groove forward into the cavernous body (Figure 477q) for a
Fie. 477¢.—Amputated Penis, with the Urethra Protruding.
length extending between one and one-half to two inches, when
the division across the urethral canal completes the amputation.
The removal of the diseased tissue being thus made, we have before
us the stump of the cavernous body, almost dry, the hemorrhage
being prevented by the upper ligature, which moreover, secures a
good hold and good view of the mutilated organ. The urethra is
then slit on its inferior border on the median raphe and both flaps
turned upward and brought in contact by interrupted sutures with
the skin which has been so divided as to overlap the stump
(Fig. 477b). These sutures are made close to each other, of strong
silk or catgut. The result is that the stump of the penis carries
at its lower margin a slit of from one to one and one-half inches
in length, which, after allowing for all shrinkage of cicatricial
tissue, will always be sufficient to permit thorough micturition.
AMPUTATION OF THE PENIS. 575
Fig. 477b,—Stump of Amputated Penis, with Stitches uniting Urethra and Skin.
The sewing done and the upper ligature removed, the penis re-
tracts within the sheath, and the animal is.allowed to rise.
We have been performing this operation for fifteen years, and
have never yet met with the slightest complication or disappoint-
ment.
In dogs the amputation of the penis is indicated for about the
same diseased processes as in the horse. The amputation, however,
does not include only the soft tissues, but alsothe bone of the penis,
which is divided with nippers or a saw. The division of the cay-
ernous body is done with the ligature or the ecraseur. Strictures
of the urethra are of common occurrence after this operation, and
can be overcome only by the repeated introduction of the catheter,
or the enlargement of the urethral opening with the knife.
CHAPTER XIII.
OPERATIONS ON THE FOOT
ANATOMY.
In our domestic animals we call the foot the extremity of the
leg, and even only the extremity of the digit, for, considered in a
zodlogical point of view, the foot extends from the carpus or tar-
sus to the last phalanx, inclusive.
The foot of the horse forms an extremely important study on
account of the numerous diseases to which that member is sub-
ject, and also of the value of the motor powers required from the
horse ; the old horsemen expressed this importance by the aphor-
ism, ‘‘no foot, nohorse.” This truth finds daily its sad applications
in the premature ruin of large numbers of horses rendered useless
because of the defects in their feet. All the qualities of a horse
are, indeed, considerably diminished and can even be entirely
destroyed, by the bad conformation or accidental alterations of
these essential organs. The study of the foot of the horse has
been the object of many voluminous works, such as those of Gir-
ard, Bouley, Bracy, Clark, Anker, Leiserng & Hartman, Lafosse,
Gourdon, Reynal, Defays, and many others, to which we refer for
the more complete description of the organization of the foot.
The organ is composed of two orders of parts, some internal,
organized and sensitive; the other external, formed of a horny,
organic substance, the hoof, but entirely void of the property of
vital sensitiveness. The internal parts are bones, three in number,
the second and third phalanges, and the small sesamoid, which
form by their reunion the articulation of the foot; special liga-
ments, which maintain the connections of these bones; tendons,
which fill the triple office of agents of transmission of motion,
articular ligaments and organs of support of the weight of the
body; a fibro-cartilaginous apparatus, superadded to the third
phalanx, and which completes, so to speak, posteriorly, and
increases the surface by which it rests on the hoof and transmits
ANATOMY OF THE FOOT. 577
Fi4. 478..—Longitudinal Section of the Digital Region.
A.—Lower part of the plantar cushion. B.—Ligamentous bands of the fibrous
layers of the plantar cushion. C.—Fibrous membrane of the plantar cushion. D.—In-
sertion of the plantar cushion to the inferior face of the os pedis. E.—Spongy tissue of
oscoronz. F.—Articulation of first and second phalanx. H.—Perforatus tendon at-
tached to the os coronz. I.—Insertion of plantar aponeurosis to the semi-lunar crest.
K.—Spongy structure of os’suffraginis. L.—Section of perforatus tendon. M.—Yellow
fibrous band uniting the anterior face of the perforans tendon to the posterior face of
the oscorone. N.—Synovial sac of the sesamoido-pedal articular. O.—Tendinous sesa-
moid sheath. P.—Synovial capsula of the articulation of the foot. T.—Perforans ten-
don. Y.—Metacarpo-phalangeal joint.
to the ground the pressure which it receives. These are the lat-
eral cartilages and the plantar cushion ; arteries, veins, lymphatics
and nerves, remarkable for their number, development and dispo-
sition; and at last, a ligamentous, sub-horny membrane, or kera-
Fig. 479.—Plantar Nerves in Digital Region.
P.—Plantar nerve. A.—Origin of the digitalnerves. BB.—Cartilaginous branch.
CC.—Cutaneous branch. D —Digitalartery. G.—Transverse branches back of the fet-
lock joint. I.—Nerve of the plantar cushion. L.—Lateral band of the plantar cushion.
V.—Digital vein.
togenous apparatus, forming a continuation of the skin, which
surrounds the parts of the foot like a stocking, and upon which
the foot rests, as a shoe on the human foot. In this apparatus are
found: 1st, the coronary band, which forms a rounded projection
at the separation of the skin and hoof, and which serves as a
matrix to the periople and the wall; at its surface are seen numer-
ous villosities or papille ; 2d, the podophyllous or laminated tissue
which is spread upon the anterior face of the third phalanx, and
is remarkable by the sheet of parallel laminze which it presents at
its surface, separated by deep furrows in which are received the
analogous laminz of the internal face of the wall (Figure 481);
ANATOMY OF THE FOOT. 579
NY
\
4
5
\ A
RA es
AAS
N's
Suh
Fie. 480.—Arteries of the Digital Region.
AAA.—Digital artery. B.—Transversal branch in front of fetlock ioint C.—Pere
pendicular artery of Percival. D.—Its ascending branch. E.—The descending branch.
F.—Branch to form the superficial coronary circle. G.—Posterior transverse branches.
K.—Artery of the plantar cushion. P.—Circumflex artery. CC.—Ascending terminal
branches of the digital artery.
3d, the velvety tissue or villous tunic which covers the plantar
cushion at the interior face of the foot, and is the secreting organ
of the sole and frog, its surface covered with villosities similar to
those of the coronary band, and like them, of various sizes, are
lodged in the porosities of the internal face of the sole and frog.
The external parts of the foot are four in number: the wall,
580 OPERATIONS ON THE FOOT.
Fia. 481.—Portion of the Keratogenous Apparatus.
A.—The skin. BB.—Coronary band. R.—Its villosities. P.—Podophyllous tissue.
Fie. 482.—Section of the Hoof.
1.—Periople. 2.—Cutigeral cavity. 3.—Keraphillous tissue. 4.—Wall. 5.—Contin-
uation of the periople with the frog. 6.--The sole. 7—Union of the sole and wall.
8.—Frog stay.
the sole, the frog and the periople (Fig. 482). These form,
together, a horny box, the nail, or hoof, which is adapted exactly
by its internal cavity to the external contour of the sub-horny
membrane, contracting with-it an intimate union by a reciprocal
reception, and thus completing the structure of the foot, furnish-
ing to thesensitive parts an apparatus, thick, hard, resisting and at
the same time elastic, which makes one with them, and protects
them against violence from the substances with which the foot,
from the nature of its function, must necessarily come in contact.
Pee ee eee ee re ee
ANATOMY OF THE FOOT. 581
The horny substance which constitutes the hoof has a fibrous
aspect ; it is hollowed all over by cylindrical canals, whose superior
extremities, widened into a funnel shape, cover the papille of the
matrix of the hoof, either at the coronary band or velvety tissue,
while the inferior open in the wall upon the plantar border, in the
sole and frog, at the external or inferior face. These canals are
rectilinear, except those of the frog, which are flexuous; their
diameter varies from 0, 02 to 0, 2 or 04" These tubes are not
only hollowed in the horny substance ; they have also proper walls,
of very great thickness, formed of numerous concentrical layers,
received into each other. These are lamelle of pavimentous
epithelium, which constitute the horny tissue; in the walls of the
horny tubes, they are grouped flatwise around their inferior canals,
and stratified from within outward, so as toform successive and
concentrical layers; in the intertubular horn, these lamelle are
not stratified in a direction parallel to that of the tubes, but at
right angles with it. Around the tubes, the lamelle have an
oblique intermediate direction. A granular opaque substance fills
up the space lying between the horny tubes and the papille.
The hoof, which is a part of the epidermis, develops similarly,
that is, by the constant formation of cells in the layer which cor-
responds to the mucous malpighian body, at the expense of the
plasma thrown off by the numerous blood-vessels of the keratoge-
nous membrane. The velvety tissue is the starting point of the
elements of the sole and frog; the perioplic band is the organ
secreting the periople ; and the coronary band proper, the matrix
of the wall. Upon these different parts, the epithelial cells multi-
ply and flatten into lamellze, in the direction of the surface of the
keratogenous membrane, as they spread from it. The wall then
grows from its superior to the inferior border, and the other parts
of the wall from their internal to their external face. The villosi-
ties of the coronary band and of the velvety tissue are the organs
around which accumulate the epithelial cells; their presence
defines, consequently, the tubular structure of the horn.
The lamine, in the physiological state, do not co-operate in a
sensible manner with the formation of the wall; the keraphyllous
laminze form themselves at the coronary band, at the origin of the
podophyllous ; they descend with the wall, gliding at the surface
of the layer of cells which separates them from the laminated
tissue, a movement of descent which is facilitated, however, by the
582 OPERATIONS ON THE FOOT,
multiplication in the same direction of the said cells. When the
podophyllous tissue is inflamed, whether exposed or not, its latent
activity soon manifests itself. It gives rise to a great quantity of
hard horn, hollowed, as seen by Gourdon, with tubes, and oblique
in a direction backward. These tubes, more irregular than those
of the normal wall, are disposed in a parallel series; they are in
form round, villo-papillee, which have developed on the face border
of the laminz. In these cases of production of horn by the action
of the podophyllous tissue alone, one never sees, between the
sensitive lamine, distinctly formed horny lamin in the middle of
the other cells, as it is observed in the wall proceeding from the
coronary band. The horn which rises on the surface of the
podophyllous, immediately after the removal of the piece of the
wall, is not a permanent one; it must be replaced by the horn
of the coronary band. This change is complete, microscopical
examination proving that the wall which descends from the
coronary band, provided with keraphyllous lamine, engages itself
under the temporary wall, and slides by the action already
described over the surface of the soft cells of the laminated tissue.
As soon as this tissue, modified by inflammation, is covered over
by the permanent wall, its papillee become atrophied, and its action
returns to the limited boundaries of physiological condition.—
( Chauveau.)
The foot is anorgan of support and an apparatus of elasticity;
it is through it that the whole animal machine maintains its rela-
tions with the ground, and that it adapts itself in its various move-
ments, so to speak, to its roughness. It is this that, as a last
spring, distributes and modifies the force of all the movements of
the horny mass of the body, whose columns, the legs, may be
considered as the resultant. Intermediate with the body and the
. ground, the foot transmits all the actions of weight reaching it,
and also between the body and the sensorium, toward which all
sensations resulting from its contact with surrounding external
substance return, the foot then becoming at the same time an organ
of feeling. To adapt it to this triple formation, nature has given
to it three properties, in appearance incompatible with each other,
which has, however, harmonized, viz.: first, a very great external
hardness, due to its horny envelope; second, a certain amount of
flexibility, the combined result of the physical properties of its
cortical envelope and of its mechanical disposition of its different
ANATOMY OF THE FOOT. 583
parts, and thirdly, a highly developed sensibility resulting from
the high organization of its tegumentary membrane.—Gouley.
DISEASES AND DEFECTUOSITIES OF THE FOOT IN SOLIPEDS.
Of all the domestic quadrupeds, the horse is the most exposed
to diseases of the foot, which are more or less frequent in him
according to the work he is subjected to, the places he lives in,
and the nature of the ground upon which he travels. As rare as
are those accidents in farm horses, so common are they among
horses in cities, of heavy draught, and also army horses ; in all, in
fact which travel continually on hard, paved and stony roads, and
especially in large cities, where all those injuries can but be the
result of their constant work on stone pavements, always so rough
and slippery. If to these conditions are added the very numerous
accidents resulting from bad shoeing, so badly carried on, one will
be less surprised to see the foot becoming deformed and altered
in different ways, deteriorated, and preserving with difficulty, and
for a short time, its state of integrity, and becoming the seat of
numerous affections.
We shall distinguish the diseases proper and the vices of
conformation of the foot. The former are generally sufficiently
serious to merit special description. Among them some are su-
perficial, as the false quarters, uncomplicated cracks, or solution
of continuity, thrushes, canker; others of deeper interest, specially
those of the keratogenous apparatus, such as daminitis, with its
complications and sequele, keraphylocele, seedy toe, and separation
of the wall, which may extend as far as entire sloughing of the
hoof ; accidents then due to the suppuration accompanying several
diseases of the foot. Some maladies are specially the effects of
wounds, of contusions such as overreaching, quittor, bruised sole,
bruised heels, corns, punctured wounds, others are results of
shoeing, pricked, tight shoe, burned sole; others are deep alto-
gether, such as bionions, navicular disease, and, lastly, fracture of
the os pedis, or of the navicular bone.
VICES OF CONFORMATION.
Among the vices of conformation some are serious, as contrac-
tion of the heels, flat foot, pumiced foot, club foot, crooked foot,
rammy foot, and, lastly, the foot with bad horn.
584 OPERATIONS ON THE FOOT.
(a) Flat foot (Germ. Platfuss)—By this is understood the
foot in which the sole, instead of having the natural concavity, is,
on the contrary, flat, and by its whole surface about on a level
with the border of the wall and the base of the frog ; ordinarily
this is accompanied with low heels, more or less contraction, and
a well-marked oblique direction of the wall.
Flat foot is generally observed only on front feet, and is very
common in lymphatic animals or of low breed, raised in low and
damp soils; it may be congenital. Large feet, badly shod or used
up by very heavy work, are predisposed to it. It is claimed
that the weakening of the sole by too repeated and deep paring
of the sole will ultimately bring it on; it is said that abuse of
poultices may produce it; it follows excess of the hollowing of the
shoe by the upper surface, which, pushing the wall outward,
obliges the sole to drop lower than its normal level.
The horse with flat foot rests on all parts of the sole at once ;
there is no elasticity of the arch of the sole, and percussions take
place on it entirely. The actions of the animal are heavy, espe-
cially as it is commonly seen when the feet are large. When the
foot is somewhat tender, the animal lames easily, especially if the
shoeing is bad, or if the animal rests on the sole or is obliged to
trot on rough or stony roads, which render the percussion very
painful. There arises some irritation, which keeps on increasing,
and produces several accidents, such as bruised sole, corns,
pumiced feet.
The horse which has flat feet often has weak walls, and as the
nails of the shoe become loose, this is often cast.
By shoeing one may remedy this bad condition of the foot.
For this, the foot must be pared flatways, the sole spared, the wall
relieved only of what is broken off; the frog must be left alone,
the heels also; a shoe somewhat wide in the web, protecting,
therefore, the sole more than an ordinary shoe does. It will be
adjusted so as to rest on the border of the wall only, and not on
the sole ; still, care will be taken not to hollow it too much or to
excess. Sometimes a thick shoe only is necessary, without in-
creased width. Soles of gutta-percha or felt are also used, as
we will see when speaking of the pumiced foot.
(b) Pumiced foot (Germ. Vollfuss).—Thus is called the foot
whose sole projects beyond the level of the wall, and presents a
conyex surface, extending beyond the plantar border, upon which
}
i
y
d
ANATOMY OF THE FOOT. 585
the horse rests. It is the exaggeration of the flat foot. In the
pumiced foot the wall has a great obliquity, sometimes even
assuming a nearly horizontal direction.
The horse is never born with such feet ; this is amalformation,
accidental, or resulting from various causes. One of the most
common is lack of care of the foot, of necessary caution, for
instance, in paring, or shoeing in such a way as to bring the rest
of the foot on the circumference of the under part in such a way
that the sole does not touch the ground, and ceases to be pressed
by it. Too much concavity of the shoe may bring on this result,
by resting only on a too narrow part of the inferior border of the
foot ; and by opposition, not enough concavity will compress the
tissues, irritate them, and produce the same alteration. Feet
become pumiced by laminitis, but this is complicated with seedy
toe. Never, then, is the foot pumiced in its whole extent; its
deformity stops always at the limit of the inferior border of the
bars ; beyond them, behind, on each side are seen the excavations
of the lateral lacune of the frog, so much deeper that heels are
higher. The hoof does not preserve its circular shape. It atro-
phies on the side, and presents at the toe an excess of thickness
in the wall; the heels assume a greater development.
This deformity is very serious, and disables the horse easily;
rest takes place only upon the sole and frog ; after laminitis, upon
the sole and heels; it is always very painful. Work upon hard
ground and pavement is next to impossible. After laminitis, one
sees, during walking, that the foot rests upon the heels, and then
by a motion from backward to forward. An animal with pum-
iced feet has a tendency to forge and interfere; the slightest
bruise of the sole gives rise to serious complications. One often
observes wounds, suppurations, etc.
The indications are analogous to those of the flat foot; the
sole ought to be spared as well as the frog, the walls only ought
to be slightly trimmed; the shoe must be made so as to carry
the rest upon the border of the wall and protect the sole. When
the foot is not pumiced to excess, one must use a broad web shoe,
sufficiently concave to allow the sole to rest in it; but it must
not be too excessive, as then the base of the rest would not be
very firm. A sheet of gutta-percha, or felt, with tar and oakum,
may be placed between the shoe and the foot.
(ec) Club foot (Germ. Bockhuf).—This is the foot in which the
586 OPERATIONS ON THE FOOT,
wall is straightened more or less perpendicularly, or even obliquely
backward, so that the superior border of the wall is more forward
than the inferior. The superior levers participate always in this
vicious direction, which constantly brings back the rest of the
foot toward the anterior part of the wall, and, according to its
degree, makes the animal walk more or less on the toe, even some-
time obliging him to rest on the anterior face of the hoof; the
heels are raised from the ground, and the fetlock, instead of being
open forward, seems to be turned backward. This deformity,
which exists especially in the hind legs, is very common, and is
even natural in mules, and supposes, with its presence, high heels,
which throw the rest on the toe, which is always very thick. It
may also exist with low heels, especially when due to overwork or
other accidental cause. Horses which, like mules, are club-footed
only by a peculiar condition of the parts, walk with firmness, and
even pull better and work better in hilly countries. If they are
unfit for the saddle, it is because their reactions are hard, and that
they tire the rider. It is not so with those which are club-footed
from hard work ; they continually stumble, are subject to knuck-
ling, to interfering, or even to falling; and for these reasons do
they always require a mode of shoeing which would give them the
missing solidity, and render their walk more steady. This cir-
cumstance indicates the necessity of sparing the toe, and throwing
the weight back on the heels, which, however, must not be pared
off too much. The best shoe for such feet must be short, thin at
the heels, with a thick toe, shghtly raised upward, and prolonged
beyond the level of the border of the wall; small heels to the shoe
are often advantageous, as giving an opportunity for rest and
relief. The shoe with truncated branches of Lafosse (slipper),
which is a short shoe, not extending beyond the quarters, and
leaving the heels free, is sometimes used. This shoe is very thick
at the toe, and very thin at the heels. It is unnecessary to say
that club foot is often cured by tenotomy, or by treatment of the
tendinous retraction.
(d) Crooked foot.—We «all by this name the foot whose sides
are not of the same height; it may be crooked outward or inward.
This deformity may result from a vice of direction of the regions
above ; ordinarily, however, only from a deviation of the phalan-
geal one. Sometimes it is due to bad shoeing, to bad paring of
the feet; sometimes it follows unequal wearing of the foot, it being
ANATOMY OF THE FOOT. 587
without shoe. Colts which have never been shod, and are walking
for a long time on hard and rough ground, often present this con-
_ dition.
The horse with crooked feet inward, specially if the deviation
is much marked at the toe, is exposed to cut himself with the
internal heel of the shoe—to bruise himself ; the horse with crooked
feet outward cuts himself with the inner toe. Besides these,
lameness, from lacerations of articular ligaments, may often follow.
This is relieved, especially in young animals, by lowering the
side of the wail which is the highest, and sparing the other; the
proper shoe for this condition must be thicker in the branch cor-
responding to the lower side of the foot. The shoe ought to be
changed quite often, in proportion to the existing difference in
the height. If the foot is very crooked, it is difficult to straighten
it by having a greater thickness of the shoe; it would make this
too heavy. Sometimes it is better to use nails with large-sized
heads on the lower side of the hoof ; and in these cases one might
put on corks at the heels, external or internal, as required.
(e) Rammy foot.—This is a defectuosity of the foot, always
accidental, in which the surface of the wall offers more or less
numerous circles, above each other and running from one quarter
or heel to that of the other side. These roughnesses, arrranged
in rows, rise always from the coronary band, and form as many
elevations gradually descending and disappearing toward the in-
ferior border of the wall. They are so much more serious that
they are deep, and sometimes are accompanied with lameness,
especially when in great number, close to each other, and when
the foot is narrow and long. These circles are sometimes seque-
lee of laminitis, and accompany seedy toe; the rings are then in
the middle of the toe, which is more or less roughened, like an oyster
shell, and they disappear only when the primitive alteration is
removed. When they are small, not numerous, and grow down
without being replaced by new ones, this favorable disposition of
the wall must by stimulated by all the means which may stimulate
and keep up the suppleness, by light blisters over the coronet. A
light shoeing, often changed, is the best in those cases. Circles
which reappear continually are due to an intimate and continued
alteration, and are in company with other defectuosities, such as
contraction, pumiced foot, ete.
(f) Foot with bad hoof-—A hoof may be too soft or too dry.
588 OPERATIONS ON THE FOOT.
When too soft, too greasy, it contains too much dampness and is
lacking resistance. Horses which have this weak hoof, as said
Lafosse, have the foot tender and unfit for long walks on hard and
stony ground ; they are, besides, much exposed to lose their shoes,
because the hoof breaks up at the nail-holes. This fault is quite
common in large feet, frequently seen in Northern lymphatic ani-
mals, especially in those which come from marshy districts ; if, then,
those horses are submitted to stabulation, their hoof becomes dry
to excess, which gives rise to narrow and contracted feet. The
lower part of the foot must be pared with care, as it has but little
thickness ; the application of the warm shoe while fitting must be
as short as possible. An ordinary thin and light shoe must be
used; the nails will be as light and thin as possible, and ham-
mered in carefully.
Too dry hoof is liable to break, because it has lost its physio-
logical suppleness ; this brittleness is often met in animals whose
feet have been much in water and afterward are placed on dry
ground; it seems as if the water had dissolved the adhesion of the
horny cells. The same condition follows the excessive use of
poultices and also of strong grease in shape of ointments. It is
wise to grease, but previously the old crust must be removed.
Hoof ointments of wax, turpentine or tar are better. The foot is
called dérobé (broken) when by the use of a thick nail it is more
or less broken at the edges of the wall. These feet lose the shoe
easily; animals then go on bare feet, and then it becomes very
difficult to put other shoes on. It is necessary in these cases to
punch nail holes on the shoe corresponding with parts where the
hoof is sound. In paring, all the pieces of broken horn are
removed, or at least as much as can safely be done. Nails are
secured as high as possible; shoes must be changed as often as
possible, and the hoof is to be kept supple by unctuous applica-
tions. When the breaks of the horn are too large, softened gutta-
percha, or a mixture of gutta-percha three parts, with one of gum
ammoniac, melted together, can be used to fill the anfractuosities,
all grease having been first removed by a wash with ether; the
putty hardens, and the shoe can be tacked on solidly. Nails can
even be punched through the gutta-percha.
ANATOMY OF THE FOOT. 589
INSTRUMENTS.
The surgery of the foot requires special instruments for the
operations which influence action upon the hoof, as also for those
which are to be performed upon the tissues of the foot proper.
Besides those which are commonly required in ordinary sur-
gery, such as curved scissors, probes, bistouries and forceps,
others are needed of special forms and for special purposes ;
among those most commonly used are the different sage knives
and drawing knives.
Sage knives are lanceolated blades secured to handles, and
are either double or right or left. The blade, which is curved
upon its long axis, may be sharp on both edges, as in the double,
vl
til
FIa. 485. Fig. 484. Fie. 483.
SAGE KNIVES.
i
(Fig. 483) or on only one or other edge, when it is known as a
right (Fig. 484) or left (Fig. 485) sage knife, being thus adapted
to use by either the right or the left hand.
Drawing knives, which are made somewhat like those used by
blacksmiths in the ordinary method of paring the foot, yet differ
from those in being straighter in their attachment to the handle,
and also on being curved on their long axis, being also sharp on
both edges. The groove of the instrument is made to vary in
590 OPERATIONS ON THE FOOT.
width, and thus can be used as the different steps of the operation
may require (Fig. 486). Sometimes the drawing knife resembles
more that of the blacksmith, as being sharp on one edge only (Fig.
487), and in this case the groove of the blade is generally much
narrower than in the others. Some special operations require
peculiar forms of drawing knives; for instance, those which are
FIG. 487. FIGs. 486. Fig. 488.
DRAWING KNIVES.
made with a blade perfectly straight and narrow, very slightly
sharp on the edges, but having a very narrow groove at the ex-
tremity (Fig. 488). These are used principally in the scraping of
diseased bone-structure, in deep punctured wounds of the foot,
and in cartilaginous quittor, when small sections of cartilage are
to be removed from the lateral border of the os pedis, which could
not othewise be accomplished.
Other instruments are also required, the description of which
will be given as we refer to the different diseases where they find
their applications.
GENERAL OPERATIONS.
Removal of the sole (Germ. Absohlen).—This is an operation
by which the sole of the foot is removed by severing it from the
living tissues underneath. In times gone by this operation was
extensively performed, being considered indispensable as soon as
the slightest lesion under the sole existed. It was alleged that
ANATOMY OF THE FOOT. 591
unless this was done the suppuration would be likely to spread
underneath the horn. In our days it is rarely performed, as it is
considered that it presents but little advantage, so far, at least, as
it involves the removal of the entire organ. Sometimes, however,
portions of it have to be taken off, as in some special diseased con-
dition of the foot, such as in punctured wound, pricking by the
blacksmith, burnt sole, etc., the modus operandi of which will be
considered when treating of these diseases.
Removal of portion of the wall.—A few morbid conditions of
some parts of the foot require in their treatment the removal of a
portion of the wall, in order that the escape of pus, the removal
of diseased tissue, or the sloughing of necrossed cartiliginous or
bony structure, as in complicated cases of suppurative corns, of
quarter-crack or in cartilaginous quittor. A similar operation is
sometimes required in cases of toe-crack, complicated with disease
of the os pedis.
These will be further considered when treating of these special
subjects.
DReEssINes.
As nearly every operation of the foot requires a mode of dress-
ing peculiar to the manipulations which have been necessary, we
shall, when speaking of the different diseases, where parts of the
walls have been removed, include also a description of the peculiar
dressing they require.
There is one, however, which is thought much of in veterinary
surgery, and of which we will have to say more when speaking of
punctured wounds of the foot. This is the dressing with plates,
which serve to retain the plantar surface, the balls and pads of
oakum, which are placed to protect the wound. The application
of these plates is far superior to the leather sole, because of its
easy removal when the parts are being examined, and of their easy
replacement; thus allowing the surgeon to change the dressing
whenever he sees fit, without being obliged to remove the shoe.
DISEASES.
CANKER OF THE Foor.
(Germ., Strahlkrebs, Hufkrebs).—Under this somewhat un-
scientific,* though accepted name, is designated a peculiar disease
* Crapaud of the French.
592 OPERATIONS ON THE FOOT.
of the feet of solipeds, seated in the secreting tissues of the horny
box, always beginning at the frog, and characterized by alteration
of the horny secretion. Names of a more scientific meaning have
frequently been proposed, such as gnawing ulcer (Bourgelat),
schirrus or cancerous carcinoma of the frog, carcinoma of the
reticular tissue of the foot (Vatel), darter of the plantar cushion,
chronic podoparenchydermitis (Mercier), and epithelioma of the
Jrog (Fuchs). None of these has ever been accepted, and the old
hippiatric name has been retained.
History.—lt is conceded that the old veterinarians were ac-
quainted with canker, and Vegetius evidently speaks of it, but not
until the time of Solleysel do we find a description somewhat
complete of the disease and its treatment; Garsault, La Gueri-
niere, Weyrother and others spoke of it, and have expressed
various opinions as to its etiology, and especially as to its treat-
ment. Solittle progress was discernible in the writings of Bour-
gelat, Chabert, Huzard and Girard, on that very question, and so
many false ideas were admitted, that Chabert in despair has called
canker the opprobriwm of veterinary medicine.
It is but recently that serious research as to the nature of
the disease have thrown some light on the question, and estab-
lished the important fact that its seat is not in the disorganized
horn, but in the secreting organs, and that there is an alteration
in the products of this secretion ; that it is consequently to these
that remedies must be applied.
We might refer to the writings of Jeannie, Crepin, Hurtrel
d’Arboyal, Prevost, Mercier, Plasse, Percivall, Dietrichs, Eichbaum,
Wells, H. Bouley, Reynal, Haubner, Fuchs, Rey, Megnin, etc.,
each of whom has furnished his contingent, while still the inti-
mate nature of the disease remains but imperfectly known, and
there is but little certainty either in the treatment or its results.
Let us observe, however, that in our day canker has become
comparatively a rare disease, especially in cities, which, doubtless,
is because of the cleanliness of the streets. In the beginning of
this century, canker and grease—closely related diseases—were
frequent in Paris; then horses were obliged to travel through
deep gutters of mud, while to-day these affections are exceptional
occurrences (H. Bouley). The same thing has been observed by
Percival in England. When hygienic precautions were not as
well understood as they are to-day, in establishments employ-
;
DISEASES. 593
ing large numbers of horses, when the stables of mail and stage
coaches, and even those of military garrisons, were small, ill-venti-
lated and dirty, among horses standing in filth and soiled manure,
these affections were relatively common ; with hygienic improve-
ments, they have almost disappeared. In the army, canker was
the cause of considerable annual loss, almost as serious as those
from glanders; to-day it is rare and almost unknown.
Improvements in the different breeds of horses, either by bet-
ter choice of reproducers, or by changes in the mode of feeding,
resulting from the progress of agricultural processes, the suppres-
sion of common pastures, etc., have contributed to render the
disease less common.
Symptoms.—lt is seldom that the symptoms of canker can be
observed from the start; slow in its progress, and not surexciting
the sensibility of the parts, the disease may progress without
manifesting any ill effects, and consequently escape notice by the
owner or groom, nothing appearing to call his attention to the
affected foot. Thus, in a majority of cases canker is only dis-
covered after it has been in existence for a considerable period,
and when serious alterations have already taken place. It is
often at the shoeing shop, when the shoes are changed, that in
the laminze is observed a moisture more or less abundant, giving
rise to softening and raising of the hoof. The disease sometimes
attacks only one foot, often several feet at a time; at times when
one foot is cured, another becomes affected, and the disease thus
appears traveling alternately from one foot to another.
Usually the disease begins with the inflamation of the kerato-
genous membrane which covers the median lacune of the plantar
cushion; the hoof covering this is softened, raised by a serous
moisture, and once loose, is not renewed, the tissue producing it
having lost its function of secreting the horny substance, and now
secreting a serous element, which becomes the caseous matter of
which we shall speak hereafter.
Sometimes the disease begins by moisture in the hollow of the
coronet, by a kind of grease, a disease which we shall see to be of
the same nature as canker. Theis an cedematous swelling, warm,
somewhat painful, of the phalangeal region, first serous, then be-
coming opalescent, which seems to filtrate through the softened,
but not yet raised, epidermis. This inflammation, spreading little
by little toward the hoof, extends to the plantar keratogenous
594 OPERATIONS ON THE FOOT.
membrane, and gives rise to an exhalation of the same nature as
that of the skin which produces the separation of the hoof, and
the first marks of canker.
Sometimes one may observe at once, a fungoid growth of ficus,
formed by an hypertrophy of the tissues underneath ; this growth
is more or less moist and offensive, bleeding easily, having the
aspect of cauliflowers, and protruding through a break of the
softened hoof, and forming a thready detritus to be subsequently
studied. Commonly, the hoof is more or less loose, and under it
is a caseous matter, greasy, ordinarily of a foetid odor, easily re-
moved by scraping, being non-adherent to the tissue which
secretes it. Ifthe parts are well cleaned from this, the velvety
tissue of the pyramidal body of the frog, appears to be covered
with a smooth membrane of a slight whitish color; the external
layer then appears formed by a pellucid epidermic covering, show-
ing through its transparency the purplish color of the capillaries
underneath. The velvety tissue is diseased, but still retains its
functions, which, on the contrary, are increased but perverted,
and instead of secreting a horny substance which adheres to the
surface of the keratogenous membrane, produces the caseous mat-
ter already referred to. The break in the hoof frequently seems
small in size. Nevertheless, the alteration of the keratogenous
tissues, viz: the substitution for its normal, of a pathological se-
cretion, whose product is this loose caseous matter, is far ad-
vanced. There is then an extensive, though a concealed separa-
tion of the hoof. One then must not allow himself to be deceived
into supposing it to be a limited diseased process, by the apparent
external integrity of the horny box.
The characteristic of canker is its tendency to spread, like can-
cerous affections. Once manifested in any part of the sub-horny
tissues, the special changes which characterize the disease seldom
remain circumscribed; on the contrary, they generally extend
from that part asa centre, throughout the whole circumference,
and little by little, attack slowly but continuously the whole ex-
tent of the secreting apparatus, and thus loosen the entire horny
box—starting from the median lacune, or the glomes of the frog,
it extends to the branches and the body of the plantar cushion ;
then spreads at the side, in the lateral laminz, from there all round
on the velvety tissue, then by degrees reaches the inferior ex-
tremity of the podophyllous lamine and going upward, reaches
Sua
va
DISEASES. 595
the coronary band, the last point, where, in extreme cases, the
hoof preserves its adhesions with the tissues which form it. In
this condition the disease process progresses more slowly than be-
tween the sole and the velvety tissue, and then it seems to remain
stationary; otherwise the aropping of the hoof would be possible.
We have seen that often at the beginning, but especially as the
disease progresses, there are growths called fici, found principally
round the laminz, the frog and the sole.- These are of whitish
color, opal, varying in size and in shape; they constitute an
irregular mass, formed of those fici pressed together; some of
these growths have a wide basis, others are somewhat peduncu-
lated ; sometimes they are single, tubercular, slightly elevated ; at
other times elongated bodies, true fibrous bundles. The fici are
nothing more than the normal villosities of the keratogenous tissue
which have become tumefied and hypertrophied, and are found
principally where, in the normal state, the villosities of the velvety
tissue are themselves more numerous and more developed. Where
these vegetations are confluent, as upon the sharp edge of the
bone, they are separated from each other by a kind of deep sinu-
ous grooves, filled with the caseous matter secreted by the diseased
keratogenous structure. These growths bleed easily and grow
rapidly again when excised. Those most developed, and which
seemed to form a homogeneous mass, constitute, however, an
ageregate of smaller vegetations united in a certain part of their
extent, and continued at their bases.
Besides the vegetation of the living tissues, the plantar sur-
face of the foot presents, in old cankers, isolated fasciculi of solid
horny substance, of thready appearance, soft, analogous in their
form to coarse brushes whose hairs are glued together. These
isolated, still adherent, brushes are seen spreading toward the
sole; they correspond with parts of the velvety tissue which have
maintained their soundness in the midst of the diseased surface,
and there continue to secrete healthy hoof. These horny growths
are ordinarily multiple, and are of various shapes, often twisted,
and give to the plantar surface a peculiar aspect, so much so, that
their brushy masses sometimes retain the mud of the streets and
are filled at their bases with a black and fcetid substance of an
ugly appearance.
When canker has arrived at a very advanced period, it is char-
acterized by the deformity of the whole horny box, whose length
596 OPERATIONS ON THE FOOT.
and width is considerably increased. The last of these conditions
isa sure sign that the disease has spread under the wall of the
quarters and of the heels, and has produced the complete separa-
tion of the bars from above and below. When percussed, the
hoof at the heels givesa dull sound. The excessive length is only
an indirect consequence of the disease, and is due to the fact
that, so as to keep the animal at work, the walls are spared as
much as possible by the blacksmith, so as to avoid the contact of
the protruding parts with the ground.
Physiological signs are almost entirely absent in canker. It
is a curious fact that the sensibility which is generally highly in-
creased in all affections of the foot, even in chronic diseases, re-
mains always so obscure in canker that animals may be used for
a long time without lameness, though the sub-horny tissues have
become quite unprotected over a large surface.
Complications.—Very frequently, canker is complicated by a
disease of the skin, analogous to it, known as grease ; a disease
which, if not entirely of the same nature, as admitted by Plasse,
Megnin, etc., is closely related to it. It is often through this
that canker begins, and very often the two diseases exist together
in the same animal, one sometimes following the Maasai ay as
canker of one foot follows that of another. i
Among the complications of canker, as generally admitted, are
some injuries of the plantar cushion: inflammation and necrosis
of cartileges, ligaments or tendons, and even caries of the os pedis
and anchylosis, which are sometimes observed ; however, a close
examination of the facts allows us to say that these accidents do
not arise under the simple influence of the disease alone, but that
they are due to the improper use of sharp instruments, of the
actual cautery, and especially of potential caustics. As La Gueri-
niere said, the deep lesions of tendons and of the os pedis, which
are observed in severe cankers, have no other cause than the
action of too powerful dessicatives.
Duration, march, termination.—Canker is an essentially chronic
disease, and may be of long continuance, even lasting for years.
Still, under this heading there are. many variations, whose cause
it is difficult to find. There are horses whose disorganization of
the hoof is complete after two or three months. There are others
where the disease remains stationary for more than a year. We
have seen it remaining limited to one lacuna for months, and all
eS a eT.
it ail Mee lle
DISEASES. 597
‘at once assume a rapid evolution of disorganization. We have
noticed this principally after the use of sharp instruments.
Generally, animals affected with canker feed well, and for a
long time retain a good condition ; toward the end, however, they
lose flesh and exhibit symptoms of septicohemia, especially if
affected with grease. We do not admit that, as advanced by
some, canker can give rise to such virulent diseases as glanders
and farcy. ;
Diagnosis.—At the beginning, canker may be confounded
with thrushes, and many veterinarians have considered this as the
first stage of canker. There is, however, a great difference be-
tween the two: first, as to the anatomo-pathological point of
view, inasmuch as the pultaceous, foetid secretion is less abund-
ant; that the loosening of the hoof is less, and that there are no
fici; and again, especially in the point of view of the treatment,
where single cases of cleansing, with or without dessicatives,
easily control it, while canker remains rebellious to them.
Prognosis.—The prognosis varies. Where the animal is
young, well fed, and the disease is not too old, it is favorable.
Yet it remains uncertain, as often the most benign form may last
long and remain rebellious to all treatment. The severity and the
extent of the internal lesions cannot be estimated by the altera-
tions or deformities of the hoof, as these appearances are often
deceptive. Canker, though considered incurable for a long time,
is not absolutely so—far from it; with rational treatment, prop-
erly carried on, it is curable in the majority of cases. There are
cases, however, not very rare, where relapses and useless attempts
have discouraged the owner as well as the veterinarian, and where
it has been more advantageous to destroy the animal rather than
to submit him to a long, tiresome, and always expensive treat-
ment.
Pathological Anatomy and Nature of the Disease.—It has
always been considered that a morbid condition susceptible of
producing disorders so severe as those produced by canker, must
necessarily be a deep affection, essential and important to the
organic structure, and depending on a complete transformation in
its texture. And, indeed, it is the impression which predominated
from the time of Solleysel down to the foundation of veterinary
schools and which still exists with Girard, who considers canker
as a gnawing ulcer which changes and alters the tissues it invades,
598 : OPERATIONS ON THE FOOT.
and even with Vatel and Hurtrel d’Arboval, who looks upon canker
as the carcinoma of the reticular structure of the foot.
It is but recently that these ideas have been abandoned. Du-
puy, in 1827, considered canker as a hypertrophy of the fibres of
the hoof, admitting at the same time the disintegrations and
softening of those same fibres occasioned by an ammoniacal sap-
onization produced by an altered secretion.
In 1841, Mercier expressed the opinion that canker is nothing
more than a chronic inflammation of the reticular tissue of the
foot, characterized by diseased secretions of this apparatus.
It is now known that there is in canker no essential alterations
of the sub-horny tissues; no radical change of their substance,
and no deposit of heteromorphous molecules in their structure.
This last mentioned fact was well observed by Robin, who in his
microscopical remarks constantly observed the absence of the
characterizing elements of canker. Hertwig and Haubner, who
have made researches in the same direction, arrived at the same
result and have noticed the absence of any cancerous cells in
canker. This opinion is, however, doubted by Glisberg and Fuchs,
who look upon canker as an epithelioma, though they bring no
sufficient evidence to establish it.
Except vegetal parasitism, of which we will speak hereafter,
and which makes of canker a true dartre, an herpetic disease, as
demonstrated by Megnin, there is only in canker a chronic in-
flammatory condition of the sub-horny tissues which is mani-
fested by a perversion in their secretion, and is complicated by
a morbid hypertrophy of the villous processes by which their sur-
face is normally covered. Robin has seen in the fici, papillae made
thicker and more brittle by the plastic infiltration which moistens
them; he has observed besides, that at the points where the secre-
tion is good, it is so active, that instead of drying in sheaths, to
scale off afterward in transverse pieces, as normally occurs in the
frog and sole, the epithelial cells grow lengthwise, as those which
form the walls of the foot. Hence these long, horned, twisted
threads (epithelioma?) which are seen rising from the sole of long
affected cankerous feet.
It has sometimes been admitted that fici had deep roots in the
tissues, and even in the plantar aponeurosis, which is an error ;
injections and macerations having shown that there are no essen-
tial changes in the anatomical structures of these parts, and that
DISEASES. 599
what have been considered as the roots of fici were only cellular
tissues, which has become indurated under chronic inflammation
(Bouley). Fici are only fasciculi of villosities whose vascular net-
work is no longer retained by the thick horny box which encloses
them and which is infiltrated with plastic material.
Bouley has already admitted that canker could not be better
classified than among skin diseases, with and after dartroid affec-
tions, and thus gave reason to Huzard senior; Plass also found
that canker had the greatest analogy with grease, and that in it
the nutrition of the horn underwent the same alteration with nu-
trition of hairs in the second affection.
Megnin, in 1864, observed, in operating upon fresh pieces
taken from the living animal, and from one which had not received
any treatment, that in canker there is constantly a cryptogam, as
in favus, and that canker is a parasitic affection.
Examining the caseous product of the abnormal secretion which
characterizes canker, Megnin found in it a large quantity of very
animated vibrios, swimming in a liquid having in suspension nu-
merous epidermic cells more or less advanced in dissolution; he
found besides rounded corpuscles, which he recognized as the
spores of the cryptogam, and from which the vibrios escaped at
the maturity of the granulations there contained. In examining
the fici, he has recognized them to be an aggregate of hypertrophied
villosites, at the base of which were found in the mass obtained
by a slight scraping epidermic cells or parts of cells enclosed in a
net-work of inter-crossed, ramified threads, appearing to rise from
certain centers marked by an agglomeration of spores, forming in
their whole a yellow spot. In the water of the microscopic prep-
arations, one finds also several of these isolated threads, epithelial
cells, globules of lymph, of blood and finally spores; very rarely
vibrios ; oftener micrococci. These threads are nothing more than
the parasites, the mycelium product of the vegetation of the
spores ; those contained in the serosity, swell, break up, and the
granulations which escape from them become for some time the
vibrios, or as we prefer to call them, pseudo-vibrios ; as soon as
the brownian motion, which for some time animates the eranula-
tions, ceases, the cells which have proceeded from them (the micro-
cooci) gather together in chains and form the characteristic threads
of the mycelium.
This parasite of canker has been named by Megnin the kera-
600 OPERATIONS ON THE FOOT.
phyton or parasitic plant of the horn, by analogy with the tricho-
phyton, the parasite of the hair. We consider this name very
appropriate and prefer it to the name of odiwm batracosis, parasite
of the canker, which Mr. Megnin has also proposed.
Etiology.—The causes of canker are yet but little known;
there is one, however, which cannot be ignored, and which, if it
does not produce the disease, assists materially in its develop-
ment and is indispensable to its existence. We refer to the con-
dition of dampness. It is that influence of dampness which
explains why the disease is so very common in the marshy lands of
Poitou ; in the pastures of Holland, and in general in low grounds ;
and why it is more frequent in northern than in southern coun-
tries. Canker is incomparably more frequent in rainy seasons than
in those where dryness predominates. We have already seen in
the history of the disease that it is since the streets and the stables
of administration are kept more free from dampness that canker
has become less common.
Sometimes the action of direct irritating causes has been
admitted, and then the canker has been attributed to irritating
muds and the excrementitial liquids of stables ; their contact often
giving rise upon the skin, upon the glomes of the frog, to an ery-
thematous inflammation, soon followed by a serous flow, which ex-
tends to the sub-horny structures and gives rise to an exudation
in the lamine of the frog. This cause produces the rotten frog
(thrushes) but not canker. We believe that this cause has princi-
pally been admitted by veterinarians who look upon thrushes as
the first stages of canker, but this is not so, and for canker to
develop itself under similar conditions, others are necessary, which
are as yet unknown.
Canker has also been attributed to narrow and contracted feet,
so common in horses of meridional climates, and in which the sole
is very concave, with the frog and pyramidal body shrunk in.
Often in the lamine of these feet a sero-purulent moisture is dis-
covered, more or less offensive, which is a rotten frog, but not
canker, and but seldom followed by it.
To produce canker a simple irritation of the sub-horny struct-
ure is not sufficient. There must be a special cause, proper to
canker, stimulating alone the characteristic changes of the cause.
This cause we find in the eryptogam which characterizes canker, ,
propagates it, and which has no power of spontaneous existence.
oe i
DISEASES. 601
As with other parasitic diseases, canker is communicable by
contagion ; although the examples are quite rare they cannot be
doubted. MHutrel, d’Arboval, Plass, Blind and Megnin have ob-
served them, and in all the cases dampness has contributed to
the propogation of the cryptogam.
The lymphatic constitution in an animal is eminently propi-
tious to the development of canker, as it is observed to be, in fact,
for all parasitic diseases.
It is known by daily observation of facts that horses whose
skin is thick, with the hairy system well developed, the feet flat,
‘with thick frogs, are more often affected with canker than animals
of a nervous constitution. It is more particularly observed in
horses with much white at their extremities, with stockings and
white feet, and in those where there is a tendency to albinism.
An unknown diathesis has also been considered as causing a
predisposing constitutional organic condition, but this has not
been justified by observation. It may happen that canker cured
or dried on one foot, may attack another foot, perhaps a third,
and then a fourth, to re-appear in the first; this character of the
disease has often been mentioned as proof of this diathesic condi-
tion ; but it may also be explained by its contagious character.
The disease remains too much localized to be constitutional, as
generally in diathesic diseases we have critical ernpuons upon
different organs or different tissues. :
Treatment.—From the preceding remarks, it is evident that
in feet affected with canker, the keratogenous apparatus of the
foot has undergone no essential alteration in its structure, that its
thickness and density have only increased by consequence of the
infiltration and organization in its net-work of the plastic products
of inflammation. And, again, the secreting function of this appa-
ratus, far from being arrested, is on the contrary, more active; but
the products it gives instead of being concrescible, remain difflu-
ent; hence the impossibility for the hoof to be restored in the
regions where this alteration of secretion exists and remains.
These important facts, says M. Bouley, must take the lead in the
chapter of the therapeutics of canker, because they teach the
practitioner that the object to effect, in the treatment of this dis-
ease, is not to radically destroy the diseased tissues, as has been
too often done and recommended, but to return to them their
physical and physiological properties by the application on their
602 OPERATIONS ON THE FOOT.
surface, of modifying agents which influence the nutritive and
secreting functions of their tissues without interfering with their
structure. To reach this point, the most varied pharmaceutical
agents have been recommended, the most successful being those
which at the same time had parasiticide properties. We, however,
find it difficult to give the preference to any of them; and we have
now more faith in the modus faciendi, to the skill of the operator,
to the continued use of dressings properly applied, than to such
or such agent; all of those which have been recommended if
methodically applied, can cure canker, and it will be wise to em-
ploy them alternatively ; when one fails at first it is prudent to
try another; canker is a disease so often rebellious to treatment,
especially when confined to the lacune of the frog, that too many
remedies cannot be used.
The first indication is to remove the excess of the horn of
the wall, the length of which, we have said, is often very great;
then prepare a convenient shoe for the dressings. This shoe nec-
essarily varies, as canker is exclusively localized to the plantar
surface of the foot or extends to the podophyllous laminze. Gen-
erally an ordinary shoe is used, more or less covered (wide) and
so hollowed as to allow the free application of plates by which
the dressing is kept in place. When the condition of the disease
requires the removal of large pieces of horn, a truncated slipper
is used, proportioned in cutting to the extent of the parts of the
wall upon which it is to be applied. There are circumstances even
when shoes cannot be used, so much does the disease extend
under the wall. It is then necessary to use a shoe without nails, or
boots, secured to the coronet by means of straps. In all cases the
rule is to take care that the dressings remain fixed in the most
exact manner, and that through them a methodic, steady, but not
excessive pressure is constantly applied over the diseased parts.
The first step of the operation passed, the next consists in
the removal with proper instruments of all the loose portions of
the horn, either at the plantar surface, at the quarter, or at the
heels. One must avoid, in this operation, the excision of soft
parts; but the important indication is to follow the disease where-
ever it exists, and to leave no part of the horn which may haye
been detached by morbid exudations. Better cut the healthy
structures, and have them bleed, than to neglect to completely
expose a diseased part. This done, the horn is to be thinned as
‘ aa
DISEASES. 603
much as possible, upon the circumference of the diseased spots, in
order to give a suppleness which would ease the swelling of the
uncovered parts.
Upon the exposure of the disease where it exists, the fici exist-
ing on the surface and edges of the velvety tissues are to be
removed with the scissors or sharp sage knife; at the same time
the parts of horn which may have remained are to be cut off,
avoiding, however, the healthy tissue beneath, which still retains
its normal character.
When the canker is very extensive, so that the wall is loose on
each quarter, or on all its circumference, it is of advantage to pro-
ceed in the required operations at different times.
This done, the shoe can be put on; after which the diseased
surface and surrounding horn are to be covered with a thick layer
of the medicamentous preparation. If this isin form of a paste, as
is often the case, it is spread over with a spatula. If in powder,
it is thrown over it carefully. If liquid, balls of oakum are soaked
with it and placed on, the whole being then kept in place by pads
and plates. The important point is that the dressing should be
so applied as to be easily changed, that an exact, regular and
sufficiently strong pressure be kept on. No better means can be
used for this than the divided plates already referred to.
In canker the dressing must be renewed every day, and even
twice daily at the beginning of the treatment. This is an essential
condition of success, whatever may be the therapeutical agent
employed ; and this is not a simple difficulty in practice where the
patient is not always of easy access. Moreover, this dressing is
somewhat complicated, and can only be skillfully made by the vet-
erinarian himself.
It often occurs that upon the removal of the first dressing, (the
second day) one finds the tissues already covered by a layer of
hardened horn, adherent to the surfaces. One must then, with
the finger, a spatula, or a dry pad of oakum, rub it off where it is
found loose and movable and, if necessary, renew the application
of the dressing. The same must be done at the other dressings,
carefully watching if this new horn thus formed by the influence
of the medication, is not separable from the parts underneath by
the different morbid secretions of the disease. One must then
carefully scrape off all that is not adherent, and thin the edges,
and the projections of all the horn which retains its soundness ;
604 OPERATIONS ON THE FOOT.
the caseous substance being also removed; the same compressive
dressing to be put on again.
The modification in the horny secretion, and the formation of
a layer of hardened and adherent horn, are especially great in the
parts where podophyllous and velvety tissues exist; but are very
slow, and surrounded with difficulties in the median and lateral
lacunz of the frog. After ten days of treatment, one may have
brought about a normal secretion on the whole circumference of
the sole, on the inferior face of the os pedis, and on the prominent
parts of the pyramidal body. But in the lacunz the alteration
remains isolated, and resists treatment; and it often happens that,
if neglected, it may again spread and the disease reach its former
extent. It is then the case, when the disease is limited to the
lacunze, to add to the ingredient already in use and which is kept
applied upon the restored parts, another stronger and more active
agent, sometimes simply absorbent; here again it becomes diffi-
cult for us to advise the practitioner, the number of recommended
drugs being very large and the result depending less on their
nature than in the intelligent and persisting manner with which it
is applied. When caustics are used, it must be done with great
care, to limit their action only to the thickness of the keratogen-
ous tissue, and not to carry it to the destruction of the bone, or
still worse, of the plantar aponeurosis.
Let us glance at the drugs which have proved most successful
in the treatment of canker: First we have the different pyrogen-
ous preparations, especially wood tar, recommended by Bracy,
Clark, Reynaland Bouley, and which give astonishing results. Gas
tar, oil of cade, petroleum and soot have also been used, but with
less advantage ; creosote and phenic acid have often shown them-
selves very useful, by penetrating easier to the base of the villosities
where the parasite resides and thus acting more regularly ; phenic
acid proved very useful with Krause, Gerlach and Zundel.
After these the best recommended preparations are the salts of
iron. Hertwig seems to be well pleased with the powder of sul-
phate, and Arnold recommends the pyrolignite of the same metal ;
Megnin advises specially the perchloride, which, like phenic acid,
is rather a powerful astringent than a true caustic. The prepar-
ations of copper have also had their time, and especially the aceta-
tes, such as the egyptiacum ointment (Girard, Schaack, Rainard
and Rey); the baths of sulphate of copper were employed by
~
ee eee.
DISEASES. 605
Verrier, Jr., of Rouen; a solution of sulphate of copper and of
zine in water or vinegar were recommended by Delaval and Haub-
ner; Solleysel employed the preparations of copper, but added to
them arsenic andother drugs ; Eichbaum preferred the powder of
chloride of lime, and Rauch ordinary lime, while Aubry employed a
mixture of lime and caustic potash.
Caustics were well recommended by other practitioners, but
their prescriptions seem to be contrary to the rule we have laid
down in the beginning. However, one must not forget that the
tissues of the foot, especially when diseased, offer an extraordinary
resistance to the action of caustics ; they are, so to speak, impene-
trable, and the irritation they produce remains superficial, while
where those tissues are healthy such agents produce a deep cau-
terization. Again, this resisting force of the indurated tissues
against the actions of caustics is limited, and it is possible that
one, two or three applications may apparently remain inefficacious,
where a fourth or a fifth will give rise to extensive cauterization. The
result is explained by the repeated irritating influence of the caustic
agent, which, by gradually increasing the vascularity of the parts it
touches, increases also the means of their absorption and imbibition.
These facts must also be present to the practitioners mind, and
it is by them that he will be guided in their use, rendering them
at will, simply modifying, catheretic, or deep caustics.
Nitric acid was used by Percivall and Delorme, the latter con-
sidering it the best means in use. Sulphuric acid has also been
employed, seldom alone, but mixed with agents likely to reduce
its effects and render its applications more convenient. Collignon
and Renault recommend its reduction with alcohol; Mercier
mixed it with four parts of oil of turpentine; Prangé with equal
parts of tar, and Plass made a paste of it with burnt alum. This
last remedy, very simple in its formula, was applied without any
dressing ; it has proved most excellent in a great number of cases,
but may give rise to too deep cauterization (Bouley, Mendel).
Arsenious acid was much used by old horsemen, combined with
cegyptiacum, turpentine and otheringredients. Hoffmann prefers
the arsenite of soda in solution ; he sold his secret to the Austrian
government for a high price. Butter of antimony was recom-
mended by Huzard Sr., Prevost, and especially Huzard ; chloride
of zinc was preferred at the Lyons school.
The treatment of canker by actual cauterization was indicated
606 OPERATIONS ON THE FOOT.
by Solleysel, but soon abandoned by him. In applying the cau-
tery upon the uncovered tissues of the hoof, we encounter the
chance of producing a very severe inflammation, which spreads by
degrees and gives rise to extensive slough of the hoof, as a con-
sequence of the serious exudation which takes place; the action
of the cautery may then become either too mild or too vigorous.
Still, it has been recommended by Prevost, of Geneva. Hurtrel
d’Arboval, who also employed it, used it in the following manner:
the parts being covered with a mixture of gunpowder and sulphur,
a red-hot iron was applied to the spot, the powder burning sud-
denly and the sulphur slowly. If the combustion was too slow,
he increased it and kept it up by the same means. When the
operation is concluded the parts are transformed into a black scar,
which can be easily removed by scraping, and the application and
cauterization may be repeated, and so on until it appears that a
sufficient amount of heat has penetrated the tissues to destroy the
material by which canker may be regenerated. The cauterization
being once properly effected, then in order to sustain irritation,
the foot is covered with Burgundy pitch, or resin, melted and
warm, which is allowed to cool off on the foot, when a dressing of
oakum and the shoe are put on. The dressing is changed as soon
as suppuration shows itself and renewed with the same ingredients
in the same manner until the wound becomes healthy and granu-
lating.
It is only for the sake of the record that we refer to the ex-
clusively surgical treatment, based upon the erroneous idea that the
fici of canker are abnormal products, deeply implanted in the
tissues beneath, and where it was advised to look for the imagin-
ary roots of these fici at their extreme limits. In this treatment,
not only the diseased horn was removed, but the entire sole, the
plantar cushion and often the plantar aponeurosis was excised.
This practice, advised by Lafosse junior, was also recommended
in the veterinary schools by Chabert in France, and Dieterichs in
Germany. It prevailed for a long time, though experience showed
that the wound resulting from such an operation was of very slow
recovery, that the frog especially could not be regenerated, that
there remained a central ulcer, and that it gave rise to such a mal-
formation of the foot that the animal remained lame for a long
time, sometimes for life. Notwithstanding these objections, ob-
served by Jeaune, Girard and Eichbaum, this treatment is still
* ee
oad | , ill
ne
,?
7
DISEASES. 607
followed by a few who prefer it to the simple operations of Solley-
sel, which consists in the division of the loose pieces of horn and
the excision of the fungoid projections.
We have thus far only spoken of the local, without referring to
the internal or constitutional treatment of canker, recommended
by those who look upon the disease as constitutional. Without
believing that it can have any real curative effect, we, however,
admit its usefulness, when the disease is of old standing, and that
the animal has suffered much by it. Ferruginous preparations
are specially advisable, and we prefer the carbonates that are used
by Delwart to the sulphates recommended by Prevost, Delaval
and Hertwig, and it is well to unite them with bitters and tonic
powders. Arsenious acid is prescribed internally by Delaval,
Feuillette, Niederberger, Obich; and other alteratives, such as
mercury, which we would not advise. Nor can we understand
how any benefit is to be derived from diuretics and purgatives,
and especially from the use of external emunctories, such as
setons.
Corns.
Under this name is understood an alteration of the tissues
underneath the hoof; of the heels of the horse’s foot by lesions of
the living parts in the movements of expansion of the hoof; by
bruises, compressions or contusions. There is then a capillary
hemorrhage which extends in ecchymosis in the hoof. A corn,
then, is a bruise of the living horn at the extreme end of the
branches of the sole, and especially in the laminated tissue of the
folds of the bars. It is a very common disease, and one to which
all horses are exposed. Some have them constantly.
Corns are seen mostly on the fore feet, and on the inside
more commonly than on the external side. They are rare on the
hind feet, because in the various gaits the weight of the body is
carried more on the front legs and on the posterior part of the
foot, while in the hind legs it is the front part which principally
receives it.
I. Divisions.—Lafosse Sr., has distinguished them into natural
and accidental, while Girard considers them all as accidental. H.
Bouley designates as essential those which come from other than
external causes. We believe that it would be better to establish
the divisions on pathological and anatomical bases, and admit a
608 OPERATIONS ON THE FOOT.
corn of the wall, or laminated, that which has its seat in the
laminze which unites the wall to the tissues underneath, viz., in
the keraphyllous and podophyllous tissues of the heels and bars,
and a corn of the sole, or velvety, that which has its seat in the
velvety tissue which unites the sole to the fleshy parts. The
laminated corn corresponds exactly to the “natural” of Lafosse
and to the “essential” of Bouley. It is due to lacerations in the
movements of expansion of a badly-made foot. The other is due
to contusions. Whatever may be the adopted divisions, we, with
Girard, and as admitted in practice, recognize in each category,
the dry, the moist and the suppurated corn.
Il. Htiology.—All feet are exposed, but not all predisposed to
corns. They are more frequent in heavy feet, with those where
the heels are high or contracted in which there is a motion of re-
traction of the hoof which interferes with the displacement back-
ward of the third phalanx at the time of rest, and hence the lacera-
tions are easy; besides, there is a continual pressure upon the
living parts of the posterior region of the nail. Corns are fre-
quently observed in excessively long feet where the hoof does not
receive the moisture necessary to its elasticity ; it then losses its
suppleness and fails to assist the internal motions of the parts
contained within. It is seen whenever the hoof is too dry, the
posterior diameter of the feet being then diminished. Corns are
seen on weak feet, on which the hoof is too thin to resist the
dilating effect of the internal structure, and spreads excessively.
Wide and flat feet, with low heels, in which the interior surface of
the branches of the sole is on a level with the plantar border of the
quarters and bars, are very often affected with corns. The pres-
sure of the shoe or the roughness of the ground produce these
bruises through the sole. Here the conditions are unfavorable
to the normal dilatations of the hoof; the ungeal phalanx, being
unsupported by the convexity of the sole, has a tendency to drop
down lower, the tissues are easily lacerated and bruised in its dis-
placement at the time the foot rests on the ground.
The most serious causes of corns arise from the shoeing, which
not only sometimes gives to the hoof a shape predisposing to that
disease, but also very often is a determining cause itself of these
injuries. “As long,” says Hartmann, “as horses will have corns,
horse-shoeing cannot pass as an art, and their too frequent pres-
ence is an evident proof of our imperfect means of protection to
DISEASES. 609
the hoof.” Without shoeing there would be no corns, and it is in
its irrational methods that the true causes of these accidents
originate. It is by the greater or less frequency of corns that one
may judge of the state of that art in a country.
The faults are found, 1st, in the manner in which the foot is
pared, or in the shape which it receives ; 2d, in the fitting of the
shoe; 3d, in its application. In paring the foot, the sole is often
weakened and thinned too much; it does not resist the pressure,
and, at the time of resting the foot, all the weight of the body is
thrown upon the point of union of the sole with the wall. Ordi-
narily too much has been cut away from the frog, and this not
resting any more on the ground, no longer resists the pressure,
and the lowering of the branches of the sole is then extreme, as
proved by the experiments of Leisermg. The custom of cutting
the corns, and of cutting the hoof at the heels, acts in a similar
manner; the posterior half of the foot is weakened, and that is
the part which must carry the greatest part of the weight. One
needs only to compare a foot from which the shoer has removed
much horn at the sole, frog and bars, with one in which the hoof
has been left alone for a long time. In making a vertical and
tranverse section of the two in the middle of the frog, a little in
front of the angles of the sole, he will see at once how weak the
point of reunion of the sole with the wall has become, the means
of resistance to the pressure of the weight of the body through
the third phalanx being thus diminished, and consequently a pre-
disposition to bruises created.
The shape of the shoe also contributes to corns ; an excess of
concavity ; a shoe which from the last nail-hole is not flat to the
heels, whose branches are too much inclined, contributes to the
lateral contraction of the foot and givesrise tocorns. In this case
the shoe resists the play of the horny box, and by itself, through
the sole, exercises a great pressure upon the tissues underneath.
Too high caulks, in preventing the resting on the frog, cause an
excessive pressure on the inside of the foot, and compel it to rest
on the heels and the branches of the sole, which are too much
lowered. The opposite excess, when the shoe is thin at the heels,
as in the Coleman shoe—which is thick at the toe and thin at the
heels—produces a similar result, because in increasing the pres-
sure on the heels, it gives rise to bruises of the tissues through
the retrossal processes, which comes down too heavily. A very
610 OPERATIONS ON THE FOO".
wide shoe, too thin, may also contribute to the genesis of corns,
because, then, the shoe helping, with the intensity of the reactions
on the pavement or on too hard and stony roads, the shoe soon
gives under the foot, and compresses the sole and tissues beneath,
The manner in which the shoe is put on may also be a cause
of corns ; the shoe ought to rest exclusively on the inferior border
of the wall, and not touch the sole; when it is too narrow it may
be a cause of contusion or of contraction; if too wide it prevents
the natural expansion. It is upon horses long shod that the wrong
application of the shoe as a cause of corns is observed. As a con-
sequence of the growth of the hoof, the shoe no longer sufficiently
_ protects the plantar border of the foot, the heels of the shoe being
inward and pressing on the branches of the sole ; this is especially
the case when the shoe is thinned by wearing ; it yields, and easily
bruises the parts of the sole on which it rests; high caulks, on a
branch already too short, or too thin, act the more injuriously be-
cause, not being concentrated on the projection of the caulk, the
branch gives away sooner, and presses still more on the heels.
The shoe becomes an indirect cause of corns, when hard sub-
stances, as stones or dry earth, are found between its superior and
inferior face on the sole, or between the frog and the internal bor-
der of the branches of the shoe; this is a secondary cause, which
was formerly considered of great importance.
The work of horses has a great influence, corns being very fre-
quent in horses which work on pavements and stony and hard
roads. They are rare in country horses, but common in those of
great cities; a rapid gait contributes to their development on
account of the great pressure on the ground. The seasons have
also an influence, dry and warm weather depriving the hoof of its
moisture, and by preventing its elasticity of motion, increasing the
effect of pressure upon the tissues.
Emigration has been considered a cause of corns. Horses
coming from the north of Germany are mentioned as having been
rapidly affected by them after being in large cities. But if the
change too suddenly made from soft to dry bedding is an effective
cause, the mode of shoeing can also be considered as a stimulating
cause. The same is true with respect to the African horses, which
are generally free from the disease in their native country, but
frequently suffer with them when brought to France, and submitted
to a mode of shoeing so different from that of the Arabs.
DISEASES. 611
ITI. Symptoms.—The ordinary symptoms of corns are noticed
in the abnormal position of the leg at rest, in the lameness and the
sensibility of the region.
When lame with a corn the horse carries the leg forward of
the plumb line, and keeps it semi-fiexed at the fetlock; he tries
to relieve the painful region by resting ; sometimes he manifests
his pain by pawing and moving his feet from forward backward,
pushing his bed under him. The lameness is not characteristic ;
it varies greatly in intensity, from a slight soreness to lameness on
three legs. It is generally proportioned to the intensity of the
disease. However, there are horses so accustomed to their corns
that they do not go lame, while others are very much so for a
trifling injury. Sometimes it is intermittent, and diminishes when
the suppuration has made its way between hair and hoof. The
sensibility of the heel—seat of a corn—is discovered by an explo-
ration with the blacksmith’s nippers. Sometimes it is made known
by pressure of the fingers, the cases varying, of course, according
to the severity of the disease. There is often heat, especially at
the coronet, which may be tumified, particularly so when the corn
is of a complicated suppurative character. To obtain an accurate
view of the disease the foot should be well pared, and this opera-
tion may be greatly facilitated by the application of poultices for
twenty-four or forty-eight hours previously.
It is only by the objective examination and the pathological
anatomy, so to speak, of the corn that the moist or suppurative
variety can be distinguished from the dry, and we shall find either
a simple ecchymotic spot, or a complete disintegration of tissues.
IV. Pathological Anatomy.—The lesions vary according to
the severity of the disease. In dry corn, we find an infiltration
of blood in the horny structure. This is blood which has transu-
dated through the laminated or irritated velvety tissue from the
injured blood vessels. This blood gives to the hoof various tints,
more or less pronounced, not unfrequently yellowish, according to
the intensity and duration of the disease. The hoof sometimes
loses consistency and becomes brittle; at others, it is hard and
dry, and then resembles healthy hoof minus its coloration. If
the ecchymotic spot involves the whole thickness of the horn,
from its surface to its depth, it is an evidence of the continued
activity of the cause. A deep mark indicates a recent injury; a
superficial one is an evidence of an older corn, which disappears,
612 OPERATIONS ON THE FOOT.
and then it seldom produces lameness. Sometimes the marks are
arranged in layers, the healthy horn being alternated with others
which are infiltrated with blood. This is a proof of the intermit-
tent character of the acting cause which has originally produced
the corn. The ecchymosis, however, is not the actual seat of the
corn, which is more in the velvety and especially in the laminated
tissues, which are torn or bruised, the blood escaping through
the sole simply by the action of the laws of gravitation. It is
rarely that this lesion is looked for in the case of dry corn, and it
is usually ignored ; but in the confirmed corn, a true alteration of
the laminz of the keraphyllous tissue is observed. This is re-
placed by a horny tumor, a kind of keraphyllocele, analogous to
that of chronic laminitis, due to a union of the lamine under the
influence of the fibro-plastic exudation resulting from the inflam-
mation, which is of varying size, and presses more or less on the
sub-horny tissues. In some cases, this horn breaks up little by
little, and gives rise to quarter crack. The ecchymotic spots of
the dry corn may vary in size; they may range from the size of a
pea to that of a ten-cent coin. At other times they may occupy
the entire space between the bars and the walls of the foot.
In moist corn, there is not only hemorrhage, but also inflam-
mation proper, with serous exudation. The hoof is colored, as in
dry corn, of a brownish tint, due to the infiltration of blood which
occured at the start; on searching deeper, one will discover be-
tween the hoof and the living tissues beneath a separation of
varying dimensions, filled by citrine serosity. Most frequently
this separation takes place at the line of the sole with the wall,
and extends under both. The horny substance is then more or
less impregnated with this serosity, and then has a charcteristic
yellow appearance and a waxy consistency.
In suppurative corn, or more properly, suppurating, the in-
flammation ends in suppuration. The pus is secreted by the vel-
vety and laminated tissues. It makes room for itself by gradually
separating the hoof as its formation progresses. Before long it
passes between the podophyllous grooves of the bars and of the
quarters, the horny are lossened from the fleshy laminz, and in
its ascending progress the pus soon makes its appearance between
hairs and hoof at the quarter, at the heels, or at the glomes of the
frog. Itis not common for the pus to make its way through a
hoof of too thick or resisting a nature, unless it has first been
DISEASES. 613
sufficiently softened by poultices and thinned down with the knife.
This suppuration, in the generality of cases, brings on serious
complication, by the excessive pressure to which the sub-horny
tissues are then subjected. Gangrene of the velvety tissue near
the branches of the sole and of the podophyllous grooves which
have been lacerated in the suppuration, are very common compli-
cations. If the pus remains long in the hoof its gangrenous re-
sults may extend to the os pedis, the laternal cartilage, the plantar
cushion, and even to the plantar aponeurosis, and give rise to
necrosis or caries of the bones, or to quittor, to a more or less
variable extent. This sub-horny suppuration, which may some-
times be considerable, as well as the complications accompanying
it, are detected with the probe.
V. Termination and Prognosis.—Resolution is a common
termination of corns. But their relapse is common also, especially
in feet predisposed to them by bad conformation. A kind of
chronic condition of the disease, and one which is more liable to
become serious than the accidental. variety, is the ordinary ter-
mination in this case. The mere extent of the disease is of less
importance in the diagnosis than the predisposing conditions.
Generally the dry corn is less serious than the moist one, and
especially less than the suppurative. Complicated corns, princi-
pally in flat, wide feet, with low heels, by reason of uncertain,
protracted and expensive treatment, are in general fatal, and
necessitate the destruction of the patient.
VI. Treatment.—The largeness of the space we have consumed
in considering the etiology of corns will compel us to be brief in
our remarks upon the preventive treatment. Shoeing, which is so
often the cause of corns, may also be made a means of preventing
them, even upon predisposed feet, if performed with intelligence
and proper observation, based upon the anatomy and physiology
of the foot. Generally speaking, one must not proceed rashly by
changing too suddenly the mode of shoeing. We do not think
that any one specified system of shoeing will with certainty pre-
vent corns, but we do believe that each case demands its special
study and care. Usually, a flat shoe, and which has the heels
rather thin but resisting, and which rests on the wall proper, even
of the diseased one, if not too painful, is to be preferred. If the
shoe is for a low-heeled foot, the heels of the shoe should be
thicker in order to supply their insufficient height and to offer
614 OPERATIONS ON THE FOOT.
more resistance to the weight of the body. Sometimes the pro-
tecting effect of the shoe must be completed by the use of a plate
of gutta percha or leather between the foot and the shoe; india rub-
ber does not answer, as by its elasticity it interferes with the re-
sistance of the shoe. It is absolutely necessary to preserve the
hoof in a sufficiently supple condition, to effect which tar, hoof
ointments and other greasy substances are used. Flaxseed meal,
poultices of cow manure and salt water, a damp bedding, tallow
in the hollows of the heels, all are very good preventives and
even curative means, which a careful hostler will not neglect.
Paring the feet thin, as practiced by some, is very objectionable,
and is a serious obstacle to the extirpation of corns. The feet
should be pared as little as possible, especially at the heels or in
the lacune.
As for the curative treatment, there are, according to H. Bou-
ley, four indications to follow: First, remove the acting cause;
second, treat the injury it has produced; third, relieve the pres-
sure upon the diseased region, until it has returned to its healthy
condition; fourth, prevent the return of the injury.
The first indication is easy to fulfill with the accidental corn,
but often nearly impossible in that due to a bad conformation of
the feet. The second indication varies according to the extent of
the disease. Generally it is advised to thin down the hoof at the
bruised part and its surroundings, so as to relieve the pressure on
congested or inflammed parts. Still, we are not in favor of too
much thinning of the hoof, and except under peculiar conditions,
would practice it very slightly. Even in the moist corn, we be-
lieve in leaving to the hoof a certain protective thickness. The
pressure can be sensibly diminished by the application of chloro-
formed.oil, or of tincture of creosote; they very readily penetrate
the hoof, and act directly upon .the inflamed parts. We believe
that excessive paring, the “cutting out of the corns,” to use the
shoer’s expression, is injurious, and predisposes to new corns, by
weakening the region and promoting a more rapid desiccation and
contraction of the hoof. In all cases of dry and moist corn, one
must avoid making the parts bleed, the exposure of the soft tis-
sues, and all unnecessary cutting. Thinning is necessary in sup-
purative corn, and has to be done over the whole extent of the
separation of the horn, and a wide channel of exit made for the
pus on the side of the sole. Itis a wise plan not to remove the
i
4
:
:
DISEASES. 615
entire mass of the loosened hoof, as by this the dressing will be
much facilitated.
Cold baths are useful in all cases of corns; at other times
poultices of bran or other material are preferred. Sometimes
sulphate of iron or of copper are added to the bath, especially in
the moist corn. In the suppurative kind, when the suppuration
is irregular, and when complications are likely to follow, warm and
slightly aromatic baths are better, and after this, a dressing with
tincture of creosote, renewed the same day or the next. Later,
cold iron or copper baths may be used again; if the suppuration
has broken out between hairs and hoofs, injections of Villates’
solution, after free escape of the pus by the plantar surface, are
indicated.
In the complicated suppurative corn these means are iusuffi-
cient. We must cut deeper, and for this the animal must be
thrown. Then, when the diseased tissues are exposed by the
removal of the loosened hoof, the nature of the lesion must indi-
cate the requirements of the treatment. The velvety and podo-
phyllous tissues, if gangrenous, must be excised as far as their
diseased condition extends; carious bone is to be scraped, the
fibrous and fibro-cartilaginous structures, if necrosed, are to be
excised or cauterized, or sometimes left alone and watched, ac-
cording to the peculiar character and extent of their lesions and
the extent to which they exist. Once operated on, a dressing with
plates and bands is applied, and the animal allowed to rise.
It is by a peculiar shoeing that, for some time, the painful heel
must be relieved from supporting its part of the weight of the
body, and protected from outside pressure. This is the “bar
shoe.” By the transverse bar, which unites both branches, it pre-
sents a support to the frog and protects the heels. The resting
of the shoe takes place equally upon the wall of the toe and of
the quarters, especially the external, and it does not rest on the
diseased heels which may have been first cut away. Some veter-
inarians prefer the truncated, or the oblique bar shoe, or that with
a bar forming an acute re-entering angle. Hartmann recommends
the first; Mayer prefers the bar shoe in which the bar heels have
been thinned down, and even hollowed, to avoid as much as possi-
ble the pressure on the diseased part; this shoe has sometimes
given us good results in horses with a weak frog. In many cases
ordinary shoeing answers ; then the diseased hoof is pared down.
616 OPERATIONS ON THE FOOT.
The branch of the shoe in this case requires a greater thickness.
Whatever may be the mode of shoeing used much advantage can
be obtained by the application of a sole of leather or of gutta
percha.
SANDCRACKS.
Seime of the French; Hornspalt of the Germans; Fissura
of the Italians—are fissures or solutions of continuity observed
on the walls of the foot, ordinarily very narrow, which follow the
direction of the horn. Principally observed on the hoof of soli-
peds, it has been seen also in ruminants, but rarely, and of little
importance.
I. Division.—They may exist on every part of the wall. On
the median line of the nail they are called toe-crack, and then are
more frequent on the hind feet. They are rarely found on the
outside or inside toe (the mamelles of the French), but commonly
met with on the quarter (quarter-cracks), then situated on the
lateral parts of the wall, toward the heels, and more frequently on
the fore feet, especially on the inside. They are sometimes oblique,
relatively to the thickness of the wall. Cracks are superficial or
deep, according to the thickness of the wall involved. They are
complete when they extend from the coronary band down to the
plantar border ; incomplete when more limited. In this last case,
those which do not extend up to the skin are the more disposed
to recovery, and will grow down with the growth of the wall,
while those which extend to the coronary band are more serious,
being continually aggravated as the growth of the hoof progresses.
According to the date of their formation, they are called recent
and old. Simple cracks are those which only involve the wall;
they are complicated where there is more or less serious lesion of
the tissues beneath, such as inflammation of the laminz, hemor-
rhage, or caries of the bone. A serious complication is that of
keraphylocele.
II. Symptoms.—Often the solution of continuity is the only
one observed, and it is the special characteristic of the disease.
But the fissure may be masked, either accidentally or by design.
It may be concealed by the hairs, by the mud, or covered by hoof-
ointment, tar, wax, or even a putty of gutta-percha. Concealed
internal cracks have sometimes been discovered, such as fissures
involving the internal face of the wall, which, consequently, were
DISEASES. 617
not noticed from the outside, or showing but a slight depression
on the surface of the wall. These cracks are only discoverable
when the foot has been well pared down. As slight as the solu-
tion of continuity may be, it participates in the motion of dilata-
tion of the foot, and it is better detected when the foot is raised
than when it rests on the ground. Thisis the case when it is a toe-
crack, but on the contrary, the quarter-crack is more open when
the animal rests its weight on the leg, in which case, the sepa-
ration of the borders of the cracks may be from two to four milli-
metres, and may expose the bottom of the fissure. Ordinarily,
cracks appear first at the coronet, and there is then but a slight
opening, but as they become older, and grow down, they have a
tendency to become deeper and more complete. When of old
standing, their borders are rough and scaly, having between them
an ulcerated tissue and sometimes a fungus growth, from which
escapes a sanious fluid. In other cases, as of quarter-crack, the
edges have a tendency to cover each other.
Superficial cracks are not always attended with lameness; it is,
on the contrary, often very severe when they are deep. The pain
is generally in proportion to the depth and degree of opening of
the fissure, and also especially to any complications which may
exist in the tissues beneath. The lameness seems at times to be
due to the injury of the deep, soft tissues, and to be caused by the
motions of the horny box when they become pinched, irritated
and bruised. The affected animals are especially lame when the
foot rests on the ground, and the lameness is greater on a hard
than on a soft surface. If an animal suffering with toe-cracks is
moyed on descending ground, the lameness is greater than on
ascending a hill, the weight of the toe in the latter case producing
less opening of the edges of the solution of continuity. In quarter-
cracks, the severity of the lameness is always in proportion to the
rapidity of the gait; many horses which are but slightly lame on
a jog, become much more so when the gait is accelerated, the dila-
tion of the heels being greater, and the separation of the b_rders
of the crack increasing in proportion to the speed. When there
is lameness, there is naturally an increase of heat and sensibility
of the foot, especially at the seat of the crack. This is often dis-
covered by feeling with the hand; old cracks are generally accom-
panied bya thickening existing at a corresponding point of the
hoof. A deep, but recent crack, is apt to be accompanied with
618 OPERATIONS ON THE FOOT.
hemorrhage ; there is blood which sometimes exudes between the
borders of the crack, and flows in abundance when the movement
is rapid; and old crack, in similar circumstances, may show pus,
sometimes mixed with blood. A misstep, a sprain, may give rise
to hemorrhage in cracks which are ordinarily dry. In toe-crack,
_the solution generally involves the thickness of the wall, through
which it runs in a line almost parallel to the median plane of the
body, while in quarter-crack it is often oblique and irregular, not
exactly following the direction of the fibres, but following the
thickness of the wall obliquely in such a way that the external
solution of continuity is more posterior than the external. If the
crack is rather old, and the foot where it exists is contracted, itis
generally incurvated, one border covering the other, and some-
times they seem to be moulded on each other, so as to cover and
conceal the true crack.
III. Complications—Among these we may first mention the
inflammation of the recticular tissue, which is first pinched and
injured. This may be followed by suppuration and local gangrene.
Very often the disease is followed by necrosis of the os pedis, and
caries of varying depth. In toe-crack cases have been seen of
caries of the tendon of the anterior extensor of the phalanges, and
even arthritis, though rarely occuring, have been observed. In
quarter-crack, one may have cartilaginous quittor and suppurative
corns. As before stated, these lesions are indicated by the severity
of the lameness, the presence of the blood or pus through the crack,
and the extreme sensibility of the part. It is especially when, in
the course of treatment, a part of the hoof has been removed, that
the keratogenous apparatus has been exposed, that the abnorma-
coloration of the podophyllous tissue is seen, in its swollen condi-
tion and its sensibility to pressure, accompanied with the presence
of the pus or sanious discharge; and at times the necrosis of the
bone. Sometimes, also, foreign substances, as dirt or gravel, may
be found introduced in the cracks, and acting as causes of irrita-
tion to the sensitive tissues below.
A complication, not so frequent, however, according to some
authors, is that known as Aeraphylocele, and which consists in an
hypersecretion of horn, from the coronary band on the inside of
the crack. Sometimes the horny growth remains separate from
the borders of the crack, and is adherent to the wall only by its
base, towards the coronary band; this is especially the case when
DISEASES. 619
the wall has been thinned down or partly removed. In other
cases it is adherent to the two borders of the crack, and this forms
a natural cicatrix. This horny column, of varying length and
strength, according to its age, presses upon the tissues beneath,
and gives rise to severe lameness. With time there is correspond-
ing atrophy of the podophyllous tissue, or even of the os pedis.
This is often followed by a marked deformity of the hoof, and
especially a deep fissure, parallel to the direction of the crack.
The soft tissues under the keraphyllocele often in time become
harder, in consequence of the disappearance of the papille; the
hoof then is no longer adherent to the tissues beneath, and so
incurable cracks are the result. A double wall or false quittor
have often also been observed. Thus deformed, the footis always
subject to lameness, even if the crack is cured. Contraction or
atrophy of the frog have been observed with quarter-crack..
IV. Progress, duration, termination.—Ordinarily, cracks once
existing become worse. From being superficial and imperfect
they become deep and complete as a natural result of the ordinary
motions of the foot. If rest and some hygienic attention can be
given, they may recover spontaneously, and disappear by the nat-
ural downward growth of the hoof. This fortunate termination,
however, is principally obtained when the crack is due to acci-
dental causes, without deformity of the foot.
V. Prognosis.—Simple cracks, superficial and incomplete,
especially arising from the plantar border, almost always recover
under rational treatment, which has for its principal aim the pre-
vention of increase in the size of the fissure. Cracks starting from
the coronary band are always of a more serious nature, with a ten-
dency to increase easily. Still they are no longer to be consid-
ered incurable. Cracks in which the borders are much separated
by the motion of walking; those which are oblique ; those whose
edges are incurvated inward ; those where a portion of the wall
is loose ; those which bleed, and those where there is a continued
irritation of the sub-horny tissues, are the most serious; and so
much so, that they may require quite serious surgical interference,
and after all baffle the best skill of the operator.
VI. Etiology.—The causes of cracks vary greatly, and are
often multiple in a single case. Seldom the result of accident,
they are most commonly the combined effect of both a predispos-
ing and an extraneous cause. A frequent one among others is
620 OPERATIONS ON THE FOOT.
the relative dryness of the hoof, which then becomes excessively
brittle. We have seen the conditions in which the hoof loses its
natural flexibility, and shall here only state that alternate changes
from dampness to dryness have as much influence as the dryness
alone. Cracks are more frequent in animals working along damp
than in those pulling in dry and stony roads. They are common
in animals which after being kept in pastures are placed in good
paved stables, with dry bedding. It is principally in these condi-
tions we find the quarter-crack. During some seasons, while a
term of dryness follows continued wet weather, the conditions are
favorable to their formation, and they often assume an epizootic
form. Emigration to dry climates is a frequent cause, by produc-
ing the contraction of the ungueal structure. This last circum-
stance explains why cracks are more common in army horses,
which are called to go on long journeys during the warm days of
summer. Butif the European horse taken to Africa suffers less
from the disease, a similar result occurs to the African horse when
brought to our climate. The Arabian horse readily contracts
quarter-cracks in our stables, and with our shoeing. Animals with
small feet, or with hard and thick hoofs, have a natural predispo-
sition, which is also found in Hungarian, Russian or Tartar ani-
mals. Feet excessively large are also easily affected with the
disease, especially those which have canker or grease.
Unskilful shoeing may predispose to cracks, and this is princi-
pally the case if the wall is thinned or rasped down too much ;
the same result is obtained from shoes which are too wide or too
heavy, or which are kept on by too heavy nails.
Feet with toes turned outward are predisposed to it, as in
these the weight of the body rests more on the internal quarter,
which being thinner than the external, give way the easiest. Con-
tracted feet are subject to it.. Quittor, suppurative corns, and
some other diseases, are also predisposing causes. Among occa-
sional or accidental causes may be mentioned traumatism, contu-
sions of the foot and blows during work. The service of heavy
trucking for heavy horses exposes the hind feet to toe-crack,
especially if the pulling is done in going up hill or on slippery
pavements; mules’ feet are very subject to it, and heavy falls in
jumping and external blows are occasional causes.
TTeredity in cracks has been mentioned. We do not admit
this, except so far as it belongs among the predisposing causes
DISEASES. 621
which may be transmitted, and we should object to an animal for
breeding purposes though otherwise well-formed, if he were
affected with cracked feet.
Vil. Zreatment—Prophylaxy ought to be the principal treat-
ment of cracks. It is not always easy, however, to prevent them,
and it becomes important therefore, to treat them as soon as they
appear. One ought at least to try to prevent them from becoming
complete and deep. This form of treatment may be called the
hygienic, as it is not properly curative, and so long as the crack is
not yet completely formed, the animal may be kept at work as if
everything was normal. Curative treatment is that which is
applied to the deep or complete disease, more or less complicated,
and it most commonly consists in removing that portion of the
wall which bruises and irritates the tissues beneath, and in equal-
izing the wound. In general, there is no necessity for haste in
operating, the hygienic treatment being often sufficient to obviate
the need of serious operations. The distinction between the hygienic
and curative treatment is not, however, always definitely marked,
and quite often the two modes of treatment must be combined,
both the hygienic and the curative being necessary.
The prophylactic treatment consists specially in the applica-
tion of tonics, with the object of preventing the hoof from drying.
Its normal hyrogoscopic condition must be preserved, and it must
be prevented from taking up too much of the dampness of the
ground upon which it travels, as well as from losing that which
keeps up its flexibility. At times it must be rendered more moist
and, according to the requirements of the case, recourse must be
had to hoof ointments and other greasy substances, glycerine and
astringent poultices. At the same time the shoeing must be care-
fully attended to; the shoe must not be too heavy nor too wide,
and should be secured by nails of a proper size.
The hygienic treatment has for its first and principal indica-
tions to prevent the solution of continuity from increasing, from
extending through healthy structure, and especially to new hoof,
as this is secreted by the coronary band. The borders of the
cracks must be prevented from separating in the movements of
dilatation of the foot. The normal suture of the wall not being
produced by the natural process, or at least producing it only in
keraphyllocele, which is likely to be as injurious as the crack it-
self, the borders of the crack must be brought together artificially.
622 OPERATIONS ON THE FOOT.
It has been supposed that this could be done with the putty of
Defay’s, a mixture of gutta-percha (2 parts) and gum ammoniac
(1 part), introduced into the well-cleaned fissure, and pushed in as
deeply as possible by a warm iron plate or a spatula. This putty
is excellent for superficial cracks, but is insufficient to bring the
borders together when the fissure is somewhat deep, or especially
if it is irregular and sinuous.
A better way, at least for toe-crack, is that which consists in
suturing the edges of the solution of continuity by metallic clasps,
which immobilize the hoof. This mode is always preferable to
circular ligatures of wire or cord, which have the effect of interfer-
ing with the natural elasticity of the hoof. Clasps only fix the
hoof locally, and are an old means of treatment, having been used
by Solleysel and Garsault.
It was advised to perforate the horn through and through with
a small punch, and pass a wire, which was bent over the crack, or
twisted together at the ends. The same authority recommends
the driving of a nail through both edges, and securing it tightly,
as in the application of the nails of the shoe. This treatment was
recently recommended by Haupt, Lafosse and Rey. The first of
these professors takes an ordinary nail, with a small head, drives
it through one edge of the crack, so as to come through the other
at an equal distance from the point of entrance; the nail being
thus driven to the head the borders of the crack are then brought
together, and the nail secured in the ordinary way. Two or three
of these clasps are employed, according to the extent of the crack.
Lafosse makes a groove on each side of the fissure about one centi-
meter from the border, in a direction transverse to that of the
fibres of the wall, which limits the passage of the nail. The nail
is then introduced and secured as in the first instance. Rey
makes a track for the nail first, by drilling a hole through the
borders of the crack. The animal must be cast during these
operations.
The best kind of clasps or hooks are undoubtedly those of
Vachette, which require-special instruments for their application,
but give a real solidity to the means of fixing the position of the
parts. The clasps are all prepared, made of strong wire, bent at
both extremities, and slightly sharp inwardly (Fig. 489). These
are secured on the foot by a special nipper or forceps (Fig. 490)
in the notches made on the wall with a special cautery (Fig. 491) ;
DISEASES. 623
this cautery has its extremities flattened, the width of the clasp,
apart from each other. The forceps used to secure these is strong ;
its branches are flattened from side to side, and grooved inward,
and sufficiently apart from each other, while it is open, to receive
the clasps between its border; these branches, with the clasp,
are exactly fitted to the notches made in the wall with the cautery.
Fig. 489,—Clasps.
Fie. 491—Cautery
of Vachette.
UTE
FIG. 492.—Clasps applied in the
Thickness of the Wall.
Fig. 490.—Forceps of Vachette.
It is sufficient to press the branches of the forceps to close the
teeth or extremities of the clasps, and bring firmly together the
borders of the cracks. The number of clasps varies according to
the case under treatment.
A very simple mode of effecting reunion of the borders of the
if
ih
i
Fig. 4938.—Toe Crack secured Fig. 494.—Quarter Crack secured
with Clasps. with Clasps.
624 OPERATIONS ON THE FOOT.
crack is that of Hartmann. It consists in applying upon the wall
a sheet of iron, adapted to its outside, and secured on the foot by
two small screws.
Clasps are of a certain utility for toe cracks, but they often fail
in quarter cracks, on account of the thin condition of the wail,
which is particularly well marked in some feet. If the living tis-
sues are encroached upon, the clasp may give rise to complica-
tions, and still it is in that region that the effect of the motion of
the hoof must be prevented, and where immobility is essential, to
prevent the separation and spread of the edges of the crack.
Castandet has indicated a mode of treatment which has proved
very successful, and which may be applied to both toe and quarter
crack, where the fissure of the wall extends from the coronary band
to the lower border of the foot. It consists in making a groove
at about one centimeter on each side of the crack, which in depth
extends to its bottom, which, when reached, is white. If the
solution does not go to the lower border of the foot, these grooves
are made obliquely, and so as to meet together at their lower
termination, and form a V-shape. Thus the crack cannot increase,
and it grows down without injury to the soft tissues. Castandet,
after this operation, cauterizes the coronary band.
The transversal groove, recommended by Levrat, which cuts
the tissues in two and extends beyond the crack on each side about
three centimeters, which goes down to the soft tissues of the foot
and not beyond them, has for its object to diminish the effect of
percussion produced by the contact of the foot with the ground.
It, however, does not prevent the edges of the fissure from sepa-
rating, as the groove of Castandet does. It is chiefly useful when
there is a separation of the wall, or false quarter. At times a
transverse groove has been made to prevent an incomplete fissure,
starting from the plantar border, from spreading to the coronary
band. According to Hartmann, a single hole drilled through the
wall is, in most cases, sufficient.
Shoeing is of much assistance in the hygienic treatment of
cracks. In toe cracks, the toe should be spared as much as pos-
sible while the heels are lowered by paring, or by the application
of a shoe thicker at the toe, or by the removal of the calks at the
heels. While Defays holds that the shoe ought to lie close and
tight to the plantar regions of the crack, Hartmann, on the con-
trary, advises the paring of that surface at the toe, so that the shoe
oe. fy
ats ’
_
DISEASES. 625
cannot rest on the crack, and recommends the application of two
clips on each side of the toe.
In quarter cracks, it is recommended to lower the toe, to save
the bars and the frog ; and when the crack is incomplete, and not
accompanied with lameness, Defays recommends not to lower the
diseased quarter, and to have the heels resting well on that branch
of the shoe which shall be thick and straight. Schrebe advises a
calk on that side. If the crack is deep, with excessive lameness
and deep lesions, the quarters and heels must be pared down as
much as possible, and a bar to be then put on, resting on the
frog, if need be. An ordinary shoe, with a thick branch, may be
sometimes employed.
As part of the hygienic treatment, we may consider the means
recommended to increase the secretion of the coronary band. It
is known that a slight irritation at that part of the foot is accom-
panied with an increased secretion of hoof, which is sometimes
sufficient to give rise to a new growth of healthy horn. One of
the most common methods is to slightly cauterize the coronary
band with the iron. This was already known by old practitioners,
who employed an S cautery; but they committed the error of
burning the hoof too deeply instead of simply cauterizing the cor-
onary band. Solleysel speaks of the cauterization of the band.
Garsault mentions only the burning with three §S’s across the
crack. Such cauterization could have no useful effect, and the
deep application of the cautery might be followed by serious com-
plications. For these reasons Lafosse objected to them. In our
days it isabandoned, and the coronary band only is touched by the
cautery ; Castandet and Rey also employ it. Chemical cauteries
have also been recommended, nitric acid by Laguerriniere, and
more recently by Lafosse.
Putty of corrosive sublimate and ointment of oxide of mercury
are also in use, but have no marked advantages. Blisters prove
very beneficial, and also turpentine, as recommended by Lafosse
and Rey, and the oil of Cade by Maury. Defays advises the putty
of gutta percha, which is also used to conceal the clasps.
The curative treatment is necessary whenever any complication
attends the crack. If it is recent, antiphlogistics and rest should
be first tried; cold bathing, blisters combined with hygienic treat-
ment may then be sufficient. A single groove at the upper part
of the crack, near the coronary band, is often sufficient, or a re-
626 OPERATIONS ON THE FOOTY.
moval of a V-shaped portion of the hoof,
extending more or less deeply, accord-
ing to the condition of the crack, care
being observed to avoid the growth of
vascular granulations between the edges
of the crack. 'There are cases where it
is not necessary to remove the segments
of the hoof entirely down to the soft tis-
= sues, but only to thin them down and to
F1G. 495.—Operation of simple apply over it a dressing of oakum, se-
Too Crack by the process of thin- eyyred by several turns of roller band-
ning down the wall in V-shape.
ages. In all casesa bar shoe must be
applied to relieve the pressure on the quarter where the crack
exists, This is principally recommended by Prevost, Girard and
others.
If there are deep iesions of the sub-horny tissues, a piece of
the wall must be removed, and the operation for radical cure be
performed. It is an old operation, by which all diseased tissues
are exposed. As little of hoof as possible isremoved. In operating,
two grooves will be made alongside and at some distance from
the solution of continuity. The wall between is removed so as to
expose the podophyllous tissues from the coronary band down to
the sole, care being taken to avoid the tearing of the structure of
the coronary band, and the diseased tissues are thenremoved. If
the podophyllous tissue, it is excised with the sage knife; if the
bone is carious, it is scraped with the drawing knife. The whole
Fic. 496.—Operation for Com-
plicated Toe Crack B, by removal
of a piece of the toe of the wall.
A A.—Oblique grooves limiting
the size of the piece to remove. Fic. 497.—Dressing for Complicated Toe Crack.
DISEASES. 627
is then dressed up with a shoe having the toe thinned down, and
extending somewhat beyond the border of the foot.
The cicatrization does not take place from the coronary band
alone, but also from the horny secretions of the podophyllous tis-
sues. The repairis then quite rapid. The first dressing is re-
moved after eight or ten days, and if everything goes on well need
not be changed more than once a week.
The animal is not to be put to work until the hoof has obtained
a certain consistency.
The operation for quarter crack is similar, except that only one
groove is required in front of the crack, the tissues being exposed
as in the operation for the removal of the lateral cartilages of the
foot.
CaALK.
Synonyms.—Kronentritt (Ger.)—Atteinte (Fr.)—Thus is called
a contusion, with or without wound, that the animal receives on
the coronet, from the shoe of another foot, or from a foreign
body, or by another animal walking behind or alongside him.
The skin of that region is very thick, slightly extensible, not
easily yielding to the imflammatory swelling ; there is commonly
sloughing and mortification of tissues, accompanied with violent
pain. It is frequent in animals that forge, also in very young
horses or those which are weak in the lumbar region, and which
interfere and cut themselves in walking. This lesion is also very
common in the districts where horses are shod with high calked
shoes, when the wound resulting from it is made by the internal
branch of the shoe, which lacerates the skin of the coronet.
Horses shod to travel on ice are commonly affected with it; the
injury being more or less serious according to the size and sharp
condition of the ealk.
Horses ridden in ridding schools are often affected with it dur-
ing the various evolutions of the haute école.
It is called single when the wound is slight; concealed when
the pain is great and continued, as in the case where it takes place
on the tendon, near the heels or the quarters; horny when the
contusion has taken place on the wall or at the coronary band ;
complicated, when it is very serious and accompanied with other
more severe lesions. It is always a horizontal wound or a tumor
by contusion.
628 OPERATIONS ON THE FOOT.
I. Symptoms.—It is ordinarily recognized by the wound or
swelling which exists upon the parts. Often the horse is lame,
and the affected part warm and painful; sometimes the hairs are
cut, the skin scratched or torn. There may be a slight bleeding
at the seat of the wound. When the wall has received the con-
tusion, the vascular network underneath may become inflammed,
and then pus is formed between the teguments and the hoof,
which then become separated. Sometimes even the lateral fibro-
cartilage of the foot becomes irritated and swollen, and ulcerates,
especially when the contusion has taken place on that part where
the cartilage is; in this case the injury may be complicated with
cartilaginous quittor.
In severe cases, one may recognize a furuncular calk, charac-
terized by the mortification and sloughing of a portion of skin at
the place where the contusion took place; it is the cutaneous
quittor of old hippiatry, with formation of a core; this is always
very painful, and the inflammation generally spreads underneath
the wall. Bouley calls it gangrenous when there is unlimited
similar mortification of the tissues; in this case the slough in-
volves large portions of the skin. At times it may be called pAleg-
monous, When an abscess forms itself under the skin, then. the
coronet is warm, thick and inflamed, and the pain is extreme. —
Then if an incision be made through the dermis in its entire thick-
ness, an abundant bleeding takes place, generally followed by the
resolution of the disease ; if there is already suppuration, it is at
the same time immediately allowed to escape.
Il. Vreatment.—lf the injury is slight or recent, whether with
or without wound, very cold water and the removal of the cause
by taking off the shoe, are sufficient to bring on a cure. But if
the contusion has been great and deep, recovery is more diffleult
to obtain on account of the suppuration which will follow. Then
the application of poultices is indicated ; if there is formation of
a core, and mortification of tissues, poultices of honey are espec-
ially indicated ; in case of phlegmon, the poultice must be warm,
and then incisions and counter opening must be made for the
escape of pus; afterward dressings are made with oakum saturated
with tepid wine or tincture of aloes.
When the caulking is horny, the use of emollient topics is in-
sufficient ; an excellent way then is to obtain the required slough-
ing of the tissues by actual cauterization—the iron heated to white
DISEASES. 629
heat ; by thus destroying a portion of the hoof and the soft tissues
one will avoid the excessive pressure at the coronary band; this
may also be prevented by the thinning down of the wall with the
sage knife; but one must be careful not to remove too soon the
portions of horn which may be detached.
When the calking takes place at the heel, it is good—so as to
prevent other complications—to pare the foot down, especially at
the heel, to remove the divided hoof and transform the wound to
a simple one which can be dressed, as already stated, or with
digestive ointment secured by several turns of a roller.
When there are wounds of the teguments, it sometimes hap-
pens, if the immediate union has not been obtained, that the por-
tion of skin forming the inferior edge of the wound turns down
and that the granulations protrude, tending to form a kind of
fungoid growth. Chabert says that these must be cut off and
dressed with oakum soaked in alcohol.
Calking at the hind feet being the most severe, and those
which are followed by the most serious complications, on account
of the urine and droppings of the animal, which impregnate the
wound, one can never be too particular in keeping them clean and
dressing them well. When they end in cartilagious quittor, they
must be treated as that disease usually is.
As to the means of prevention, they consist in not placing the
horses too close to each other in stables, fairs, etc., in not forcing
them too much in their gait, in shoeing properly those which
forge or interfere, and in placing or riding them in such a way as
to avoid the possibility of their wounding each other.
PunctureD Wound or THE Foor.
Synonyms.—Naglebritt (German)—Nail in the foot (English)—
Clou de rue (French).—In veterinary science this designation has
been given to a punctured wound, often with laceration, some-
times with contusions, either at the sole or frog of the foot of the
monodactyles, and produced by sharp or cutting bodies, most
commonly nails, upon which the animal steps. The form of these
bodies, the direction they take, the force with which they pene-
trate, and the part of the sole they enter, give rise to various
lesions of varying gravity as they are older or as the injured part
enjoys a greater sensibility.
Etiology.—Nails, stumps of nails, are most often those which
630 - OPERATIONS ON THE FOOT.
are picked up in the streets; at other times it is a metallic sub-
stance elongated and sharpened; again, there are pieces of glass,
or other substances, such as bones or sharp stones, which are
picked up and produce the wound.
It is principally in-the streets of populous cities, in the yards
of builders, or on the grounds where buildings are pulled down,
that horses are liable to receive these injuries. In rural districts
they are rare, comparatively, to what they are in cities.
It is evident that horses with wide, flat, thin, softened hoofs
are more exposed than those which are of different structure.
I. Divisions.—Punctured wounds of the foot may be simple
or superficial, deep or penetrating.
One of these bodies piercing into the frog requires to go in
deep to be serious, as above the frog (which is itself quite thick,
though formed by a soft and flexible horn) is the plantar cushion,
a fibrous, soft and elastic mass, which offers a great resistance.
If, however, the injuring body is a very long nail, which runs per-
pendicularly in through the frog at the plantar cushion, it may
reach the terminal extremity of the perforans tendon, situated
immediately under the plantar cushion, and penetrate the sesa-
moid sheath. It is known that this sheath forms a sac of some
dimensions, that it extends above and below from the inferior
half of the coronary to the semi-lunar crest, and in its transverse
axis extends from one retrosal process to the other; the inferior
portion of this synovial bursa covers the plantar aponeurosis in
its whole extent. Sometimes, again, the puncturing body pene-
trates as far as the bone; sometimes the navicular; at others the
os pedis, and sometimes even penetrates into the articulation.
II. Symptoms.—They vary according to the seat of the lesion,
its depth, the mode of action of the penetrating body, length of
time it has remained in the wound, and the nature of the lesions
it has made ; all conditions which may change the character of
the disease from a first degree, when the animal shows no evi-
dence of pain, to the extreme point, where its life is in danger,
and evens ends in death, by the excessive local alterations and
the sufferings accompanying it.
Often the first point which assists in the diagnosis of the case
is the history. The driver has seen the horse become suddenly
lame, has examined the foot, and found a nail more or less deeply
imbedded; or it is the surgeon who finds the nail in its hiding-
eo
Wa
jie es PS Sa Ya se y NA TS a 1 MRP Teme eon ORAM ah hyp ca nT at beter ui ie
DISEASES. | 631
place. The exploration of the part shows with certainty the nature
of the lesion, the direction and depth of the wound, as well as the
physical condition of the body which has made it, and all cireum-
stances which allow a positive diagnosis to be made.
Quite often the nail is no longer in the foot; sometimes it has
left its mark—an opening which can be explored; often this is
not visible at first sight, though the wound may be even deep;
this is when the injury to the hoof has been very slight, and when
the hoof has retracted on itself by its elasticity or when the open-
ing is concealed by the dirt of the streets. It must be remem-
bered that sometimes the penetrating body remains broken in the
soft tissues after its entrance through the hoof. If the accident
is recent, only a little blood may be found—liquid or coagulated
—over the wound ; later, some serosity, more or less purulent, is
observed ; the pus is white or black, sometimes mixed with syno-
vial fluid ; sometimes there are granulations on the bodies of the
wound which protrude over the edges, commonly called proud
flesh. Such are the first objective symptoms obtained by the
exploration of the parts. Ordinarily they are insufficient, for it
is not always easy to probe the wound. It then becomes neces-
sary at the beginning to pare off the hoof all around the wound,
and sometimes to hollow it at the point of injury, without going
to the sensitive structure, however. In this way the exploration
and the probing of the wound are rendered much easier.
The pain, expressed by the lameness, is almost always mani-
fested ; it varies according to the seat of the lesion and its depth.
At first the intensity of the lameness does not give the exact
measure of the disease, and often one may be led into error by it;
but it gives an exact value of the lesion when a few days have
elapsed since the injury was received; if the pains are slight or
absent, they indicate that the reparative process is going on well ;
it is, on the contrary, interfered with by complications when, as
time goes on, the lameness increases instead of becoming dimin-
ished. Generally one can say that the injury will amount to
nothing when the lameness is slight, while, on the contrary, seri-
ous complications must be always looked for when it is great and
remains on long, even when the first lesion has been slight and
superficial. The wound, which has penetrated through the hoof
only, has no symptoms, no sequel ; the animal is not lame from
it, or if he be the lameness is very slight, the foot resting entirely
632 OPERATIONS ON THE FOOT.
on the inferior surface ; when the resting takes place only on the
toe, ordinarily the tendon is injured, possibly the synovial sheath ;
in cases where high inflammation exists the pain is very great, the
animal walking on three legs only.
The anatomical examination of the injured part teaches that
the most serious punctured wound of the foot is that of the cen-
tre of the foot, where the tendon, synovial sac, and where the
articulations may have been injured. Forward of this the wound
is less serious, even if it involves the bone. Posterior to it, it
can only injure the plantar cushion. Under this condition the
plantar region of the foot is divided into three zones ; one, ante-
rior, from the toe to the point of the frog; one, middle, extending
from the first to the median lacunze of the frog; and the third,
anterior, covering the space left back of this to the heels.
The most serious of the injuries to which the foot is liable are
those caused by foreign bodies which penetrate the middle zone,
that being the most complicated portion of the structure. The
symptoms will vary, according as the wound extends to the plan-
tar aponeurosis, or only as far as this membrane ; or lacerates the
soft surrounding tissues without touching it; or it goes beyond
this and injuries the small sesamoid sheath, or even going deeper,
severs the nayicular bone, or its ligamentous attachment to the os
pedis ; or reaches the last phalangeal articulation.
A wound of the plantar aponeurosis is always very painful,
especially when complicated with necrosis, in which case there is
no weight put on the diseased leg, and continual lancinating
pains and reacting fever are socn observed. The wound is then
fistulous in character, and the suppuration then flowing from it
meets with difficulties in its escape, which gives rise to a state of
general inflammation, and the foot becomes hot and very painful
If the necrosed scar becomes loose and sloughs off, being de-
tached by suppuration, improvement soon ensues, but as the ne-
crosis of the tendon has generally a tendency to spread, there is
an increase in the character of the symptoms. If the wound
extends to the sesamoid sheath from the start, the synovial fluid
is observed escaping, first pure, but soon becoming milky and
purulent in aspect, if the sheath has become inflamed, and easily
coagulated in yellowish clots. The pain is then very great, much
more so than when the aponeurosis alone is diseased. At times,
by rapid closing of the plantar wound or obstruction of the fis-
DISEASES. 633
tula, a warm swelling forms itself in the back of the coronet, which
raises the skin by degrees and becomes elevated, prominent at
one point, and giving a feeling of fluctuation. This swelling ends
in ulceration, and allows the escape sometimes of an abundant
synovial, purulent discharge.
The wound of the small sesamoid and of its ligament adds
nothing to these series of symptoms. The probing of the tract
will only determine it by the sensation of roughness which it will
give; but generally one must be careful in using the probe, es-
pecially when the flow of synovia is absent. If the foreign body
has pierced through the ligament, or has penetrated in the coffin
joint, phalangeal arthritis is the consequence. The same result is
likely to follow excessive inflammation of the foot and the macer-
ating effect of the suppuration, in which case the tendon may
soften down and give way. It may then also happen that this
tendon retracts by the contraction of the muscular fibres, and can
then be traced upward to the back of the coronet, or of the fet-
lock, according as the giving way has taken place higher or lower.
With arthritis there is a hot, painful swelling of the whole cor-
onet, with diffused oedema above the fetlock and the cannon, and
extending upward to the whole leg, complicating the lesion by lym-
phangitis, and painful swelling of the lymphatic glands. Then sub-
cutaneous abscesses are found round the coronet, with gangrene
of the tissues ; while, again there may be only an extensive fibro-
plastic exudation, which ends in calcarious organization and anchy-
losis.
In the anterior zone the only serious lesion met with is caries
of the os pedis, characterized by great pain, continual lancination,
loss of the use of the leg, and high reacting fever. There is
abundant bloody and fcetid suppuration, and the probe gives the
sensation of the soft resistance of the bone, of its rough condition,
and its partial fragility. The caries having most generally a pro-
gressive march, complications of separation of the hoof, to a vary-
ing extent, are often seen; the pus arrives at the surface between
hairs and hoof; and diffused gangrenes are also often seen, which
extend as well to the podophyllous as to the velvety tissues.
In the posterior zone, the only serious wounds are the lateral
ones, which may injure the fibro-cartilage and become complicated
with their caries or quittor and fistula down to the lacunz of the
frog, as we have seen in suppurating corn.
1B PAL he Orbos Ca Pe See eee ete
634 OPERATIONS ON THE FOO’.
Nails may penetrate the posterior zone through and through,
coming out behind the coronet, without danger. The sub-horny
suppuration may detach the frog and be the only serious compli-
cation to be met with.
As terminations of all these injuries we may see resolution, sup-
puration, gangrene, softening of the tendons and phalangeal arth-
ritis, and as sequelze, bony tumors of the coronet, and anchylosis.
The most serious complications are the dropping of the entire
hoof, the rupture of the tendons, tendinous and cartilaginous quit-
tors, for the injured hoof, and chronic laminitis for the opposite
one. :
IV. Prognosis.—This varies according to the seat of the
wound. Less serious in the posterior than in the anterior zone,
it is less in the last than in the middle, where the region is so
complicated and the nature of the tissues so different. The depth
of the wound has also some influence on the prognosis. Wounds
of the plantar aponeurosis are more dangerous than those of the
plantar cushion; those of the sesamoid sheath are more so than
those of the aponeurosis; they are still more serious if the bones
are affected ; the worst of allis that of the joint. The direction
of the foreign body and its simple or complicated action, will also
influence the prognosis.
This, we have already said, can be established by the severity
of the lameness. The nature of the foreign body must also be
taken into consideration; if blunt, which crushes the tissues, it is
more dangerons than if sharp and pointed. In a flat or convex
foot, punctured wounds are more serious than in a well-made foot.
They are less serious in heavy than in light draught horses, as the
former, though they may remain lame, are still useful. The
excitable condition of a patient will also alter the prognosis.
Wounds of the anterior feet are more serious than those of the
posterior.
V. Treatment.—tIn all cases, the first indication is to obtain a
natural cicatrization and natural repair, always more rapid and
perfect than that which is gained by surgical interference. This
is generally easily secured, and for this reason it is important to
avoid too severe manipulation upon the injured foot. One must
watch the progress of the disease, give the foot as much rest as
possible, remove the shoe, thin down in its whole extent the plan-
tar hoof, so as to avoid any pressure, and keep the foot in a cool-
ewe ee ee
pismiens. 635
ing bath—ordinary cold water, to which often is added acetate of
lead, sulphate of iron, or common salt, very beneficially. Poultices,
cold preferable to hot, give excellent results. By this treatment,
the progress of the inflammation is checked, and very often deep and.
serious wounds, even those where the tendinous sheath has been
injured, are easily cured. If the lameness gradually diminishes,
the case rapidly gets well; at any rate, by this treatment, the inflam-
matory process is diminished, and the painful pressure of the hard-
ened and thick hoof is avoided.
In the winter, when cold baths are of difficult application,
chloroformed or carbolized compresses may be applied round the
foot. The hoof is thus softened and the pain reduced. At other
times a blister is applied round the coronet.
If the lameness remains, or seems to increase, it is due to ten-
dinous necrosis or caries, and it becomes necessary to operate.
Must the surgeon then have recourse to an operation, and make a
simple wound with his sharp instrument? Or, is it still better to
merely depend on natural resources, and assist them ?
St is difficult to lay down any special rules. If the disease is
old, if the necrosis has progressed and is still increasing, a serious
operation becomes necessary. If the necrosis is recent, one must
be guided by external indications. Notwithstanding (Renault
remarks) one should not be too hasty, as the animal must neces-
sarily be laid up for several months afterward. It is often suffi-
cient, in a recently punctured wound, in order to avoid complica-
tions, to modify the conditions of the fibrous tissues in the whole
extent of the lesion, by applying substances simply antiseptic, or
still better, slightly caustic. Rey employs the cold bath, in which
he dissolves a pound of sulphate of copper for ten or fifteen
quarts of water; by this means he has secured the speedy recovery
of severe punctured wounds. For a long time, and with the same
object, we have been using a mixture of equal parts of sulphate
of copper and sulphate of iron, having first hollowed the foot
downward around the source of the puncture, and the sole being
. pared down as thin as could be borne.
H. Bouley prefers the application of pulverized corrosive sub-
limate; after tracing the wound to its bottom, he fills it well with
the powder. This remedy was already recommended by Solleysel,
who used it in caries of the os pedis. Other practitioners prefer
phenic acid, and claim for it great advantages. By the action of
636 OPERATIONS ON THE FOOT.
the caustics upon the fibrous tissues exposed to necrosis, or
already in that condition, a double salutary result is obtained ;
first, the transformation of the part, which is the seat of a pro-
gressive gangrene, into a chemical eschar; and, again, promoting
the more active vascularization of the surrounding parts, and con-
sequently their increased power of healthy reaction ; conditions
twice favorable to the sloughing of the eschar, and the process of
repair following it.
When the wound has reached the os pedis, and this has become
carious, a portion of the sole is removed, so that the suppuration
can escape, the bone is scraped off, and a dressing of carbolized
alcohol applied, kept on by a thin shoe or slipper, with tin plates.
When there is a fistulous wound, through which synovia escapes,
yet not purulent, caustics are recommended. Solleysel preferred
these, but blacksmiths used them so carelessly that they soon
were discarded. Since, however, they have been employed again,
not in powder, but as trochiscus. Rey recommends the corrosive
sublimate in conic pencils, introduced to the bottom of the fis-
tula; by them he obtains an eschar, a solid clot, from the synoyia,
which closes up the wound and prevents the synovial flow, at the
same time stimulating the granulations which close up the fistula.
We have already said that these measures must be used only
when the synovia is not purulent, as then the escape of morbid
liquids may be prevented. It is not then uncommon to see
abscesses forming at the back of the coronet; generally not so
serious as is usually believed; not as much as those which take
place in front and which are due to suppuration of the articula-
tion. After the running out of those abscesses, sometimes the
wound of the foot assumes a better aspect, the symptoms im-
prove, and the animal recovers rapidly. Injections of a very weak
solution of tincture of iodine, as well as the baths of copper or
iron, are then very advantageous. Hertwig advises the introduc-
tion of a seton through the sesamoid sheath.
This treatment is not always sufficient, especially where the
lesions are deep. All the diseased structures must be then ex- .
posed, and they must be removed and the wound changed into a
simple one, which, well dressed, will heal without difficulty. The
operation is required in proportion to the extent and nature of
the lesion, and if this is recent and comparatively superficial, if a
piece of the foreign body yet remains in the wound, or if its re-
DISEASES. 637
moval has resulted in the sloughing of a small piece of dead tis-
sue, it may be sufficient, the foot being pared thin, as already ad-
vised, to simply make an infundibuliform opening, various in size,
so as to expose the bottom of the wound. For that purpose, the
drawing knife or the sage knife is used, a light shoe is put on, and
a dressing of digestive ointment, zegyptiacum, or simply alcoholic
mixtures, are kept on by plates. At times it is advantageous to
assist the process of sloughing by the use of caustics, sulphate of
copper, Villate’s solution, tincture of iodine, ete. If the wound is
near or at the heels, the branches of the shoe are shortened and
an appropriate dressing is put on. Subsequent dressings require
the same care. Cicatrization goes on and the hoof soon returns
to its normal condition. Sometimes the surgeon is called only
when the inflammation is far advanced and suppuration already
established. This peculiar condition is manifested by the swell-
ing and heat of the parts, the acute pains, and often the high fever.
The wound then must be at once enlarged and the pus allowed to
escape, and this is the true operation for deep punctured wounds.
The operation becomes more serious if there is separation,
partial or total, of the sole or frog, with a more or less advanced
disorganization of the tissues underneath. If there is escape of
purulent synovia, extensive cuttings are to be made.
In olden times, to perform the operation of the deep punc-
tured wound, the entire removal of the sole was performed, with-
out distinction or exception and notwithstanding the severe pain
following it. In our day, a portion of separated sole or frog
only is taken off. This is done by slices, and only so far as neces-
sary for the other steps of the operation.
This operation is indicated when there is great pain, continu-
ing without regard to what treatment has been followed. It is
also when the plantar aponeurosis has assumed a greenish tint,
diffused in its extent, without indication of a repairing process,
with the marks of sloughing of the dead structure. The instru-
ments needed are various: sage knives, single and double; draw-
ing knives of various sizes: a directory, bistoury and forceps.
The animal, properly secured, and placed under anesthetics,
if too irritable (Bouley), the horny structures are removed where-
ever the suppuration has separated them from the soft tissues be-
neath, or the sole is only pared down thin, as well as the horny
frog in its whole extent.
638 OPERATIONS ON THE FOOT.
This first step of the operation completed, the operator intro-
duces a director into the whole tract of the fistula, and with a
sharp sage knife a longitudinal incision is made, following the
canula of the directory as a guide, above and below the fistulous
opening, and in the direction of the antero-posterior axis of the
foot. This done, with the sage knife held in full hand, with one
cut the surgeon, by a deep incision, removes the greatest thick.
ness of the tissues all around the longitudinal cut he has just
made, transforming the fistulous tract into a conical infundibu-
lum, whose apex is at the bottom of the wound. If then the apo-
neurosis is not yet exposed, the operator removes with the for-
ceps and bistoury whatever tissues still cover it.
Then follows the excision of the aponeurosis. This is meas-
ured by the extent of the necrosis. As a rule, it must reach a
little beyond the diseased part, and by that operation the puru-
lent synovia finds a free chance to escape.
If the sesamoid is sound, it must be left alone, but if the
diathrodial surface is roughened, ulcerated and on the way to
desquammation, it must be scraped off with the narrow and long
drawing knife.
The complications of arthritis cannot be interfered with by the
surgeon. Itis by general antiphlogistic treatment, and by local
and external applications that they must be treated.
The operation ended, the dressing follows, and becomes one
of the most important parts of the means of recovery. As light a
shoe as possible is placed on the foot, a coat of hoof ointment,
Venice turpentine, or tar, is applied upon the thinned sole; pads
of oakum, wet with alcohol, carbolized or not, are then carefully
laid on the soft parts.
Some practitioners cover them with cegyptiacum (Mandel) ;
others simply with Venice turpentine (Lafosse).
The pads or balls of oakum must not be too thick or hard, as
no pressure is needed. The whole dressing is retained by plates,
and several circular straps of tape above the coronary band. Cold
water baths are always good afterward.
In the subsequent dressings one must bear in mind that the
work of repair, the granulating, is more rapid in the tissues of the
plantar cushion and fleshy sole than upon the bone and tendinous
tissue ; and that in this case itis longer than upon bone if this
has been scraped. The result of this is a wound which presents
DISEASES. 639
various aspects in its progress of cicatrization. It often has a
handsome granulating appearance over its entire surface, while at
the bottom there may be a clot of coagulated synovia covering the
surface of the sesamoid and the edges of the wound of the plantar
aponeurosis. A free escape of synovia must always be facilitated,
and often the development of the granulations has to be con-
trolled. If the cicatrization proceeds well and regularly, dress-
ings need be changed but seldom, being satisfied with the cold
bath, with copper solutions.
Dressings can be made with tincture of myrrh or aloes; some-
times in the centre with tincture of iodine. At times caustics are
again used, while at others, fragments of bone or of tendon have
to be excised.
The entire closing of such a wound may sometimes take place
in a month; but often, even without complications, two or three
are required. Complications may easily make their appearance and
interfere with the cicatrization. Sometimes pieces of necrosed tis-
sues which remain at the bottom of the wound give rise to fistulous
tracts, until they are entirely removed. In this case, twice as long
a time may be necessary to a cure. The pain and intensity of the
lameness after the operation do not accurately indicate the nature
of the disease; the general phlogosis, especially the synovial in-
flammation, always causes a special acute pain, which for from
three to six weeks may prevent the animal from resting his foot
on the ground. This pain is entirely independent of the process
of repair, and must not alarm the veterinarian. While the react-
ing fever is absent, and there is a good appetite and no swelling
in the region of the coronet, the progress may be considered sat-
isfactory.
After the cicatrization of the plantar wound made during the
operation, the parts may return to their physiological condition,
or nearly so; or, on the contrary, remain in an entirely abnormal
condition. Often, indeed, the sesamoid sheath may become oblit-
erated, the diarthrodial surface has lost its smoothness and there is
no more sliding upon it, the tendon having become united toit. The
animal then remains lame, and cannot be utilized except in walk-
ing; if coronary anchylosis, ringbones are detected, and the appli-
cation of firing is indicated. Sometimes neurotomy gives excellent
results.
640 OPERATIONS ON THE FOOT.
ContracteD Hrrxts—Hoor Bovunp.
Synonym: Zwanghuff, German; Fncasleture, French; Incas-
tellatura, Italian; H/ncatenadura, Spanish. :
This name has been given to a defect of the horse’s foot, by
which it becomes characterized by its general narrowness, more
marked, however, in the posterior than the anterior part. It is
especially marked by the diminution of the lateral diameter of the
horny box, the deformity consisting in a greater or less contrac-
tion of the heels and of the quarters.
It is principally observed in the fore feet, and it is there only
that it presents the characters we are about to describe. This is
due to the fact that in the fore legs there is need of a certain ex-
pansibility in the posterior part of the foot, which, especially during
the action of locomotion, receives the weight of the body; while
the contraction of the hind feet gives rise only to an ordinary form
of lameness. Sometimes one of the anterior legs only is affected;
sometimes both, and in this latter case the alteration is usually
greater in one foot than in the other.
Some horses are also seen whose feet are contracted ae on
one, usually the inner side, while the other preserves its normal
form and directions.
Sometimes “hoof-bound” is only a simple deformity, without
lameness and without serious result. But in most cases, it consti-
tutes a very serious affection, which renders many horses useless
and almost without value. It is of more common occurrence than
is generally admitted, and gives rise to many other affections of
the foot. Cases of lameness treated as located in the shoulder, or
as navicular disease, are very often nothing but the result of com-
mencing contraction of the heels. True navicular arthritis and
hoof-bound are closely related. Whether the disease of the sesa-
moid sheath, arising primitively, brings on the subsequent con-
traction; whether the contraction already existing gives rise to the
alteration of structure which constitutes the disease so named,
cannot always be determined. Hoof-bound was known in old
times, and the oldest hippiatrics have proposed means to cure it.
Riders especially have studied it, because the disease is most com-
mon in fine saddle horses, whose feet are small. It is frequent in
Turkish and Spanish horses, and animals from the Pyrenean dis-
tricts, but common horses are not exempt from it.
s = = ‘ " Ss «
ees ee SS fe
DISEASES. 641
H. Bouley describes two forms of the disease, the trwe and the
pretended or false contraction. In the first, the hoof is very nar-
row, sometimes even concave on its lateral face, to such an extent
that its antero-posterior considerably exceeds its tranverse diame-
ter; while at the same time its wall is more vertical, and the heels
considerably higher than normal, and the foot looks like that of a
mule, of which this is recognized as the normal appearance. In
the false contraction, there is merely a diminution of the transver-
sal diameter of the horny box in its posterior parts, the foot being
narrow and contracted at the heels only.
We prefer to recognize a total contraction where the whole foot
is contracted, and is smaller than its fellow, atrophied, so to speak,
consisting in a contraction of the quarter—when it is principally
narrow in those quarters, the condition extending back to the
heels—and a contraction of the heels when this is well marked
from the quarters to the heels only. <A coronary and a plantar
contraction have also been designated, depending upon whether it
occurs at the superior or inferior part of the foot, and there are
cases where the contraction is intermediate, that is, in the middle
of the foot only, while it has its normal size, both at the coronary
band and at the plantar border. Single and complicated contrac-
tions have also been named. It is admitted that it may be con-
genital, though rare; more often, however, it is developed by it-
self, as a result of special causes.
I. Symptoms.—The physiognominal aspect of the hoof-bound
foot is characteristic, and it is by this that we shall begin the symp-
tomatology of the disease. When the disease is total, the com-
plete general dimensions of the foot are observed to be smaller
than would be required by the size of the animal affected; most
frequently the hoof has an oval form, consequent upon the antero-
posterior diameter exceeding the lateral, which is generally dimin-
ished. In the contraction of the quarters, the narrow condition
of the foot is specially marked from the centre of the quarters
back to the heel. In contraction of the heels, the diminution is
very marked from the centre of the quarters to the end of the
heels, so that the two sides of the wall converge toward each other
posteriorly in following nearly a straight line, instead of the cir-
cular appearance of the normal state, and the heels have princi-
pally lost their round appearance, and are elongated, and even
pointed in appearance. The wall, in the regions where the con-
642 ‘ OPERATIONS ON THE FOOT.
traction is more marked, that is, behind, is either perpendicular
to the ground, or even oblique downward and inward, in such a
way that the coronary circumference is greater than the plantar,
and consequently it represents an inverted truncated cone.
The opposite form of contraction, that of the coronary, is seldom
seen, and we may ignore it. The wall is irregularly rough and
ramy, and without its shining appearance. The heels are gener-
ally high, nearly as high as the toe, though it is not so severely
altered in cases where the heels only are contracted. As a con-
sequence of the contraction of the plantar border of the wall, the
sole seems to become folded in the direction of its antero-posterior
axis, and it shows a much greater concavity on its internal face
than in the normal state. This cavity is then filled by the frog,
considerably reduced in size, thus presenting an idea of the sever-
ity of the contraction. Most frequently it is a thin, thready body,
flattened on its sides by the closing of the bars; its branches, thin
and narrow, resembling two bands so closely resting on each other
that the lacunze which separates them is no more than a narrow
fissure, which will scarcely admit the introduction of the thin
blade of a knife, and from the bottom of which escapes a sero-
purulent, gray or blackish liquid; the lateral lacune being also
transformed into two narrow and deep fissures, filled with the
same fluid. The bars, generally high, assume a direction perpen-
dicular to the ground, instead of being oblique, as in the normal
state, from the centre of the foot toward its circumference.
In all the regions of the foot, but especially at the wall, the
horn is so dry and hard that sharp instruments cannot cut its cor-
tical covering, while it is at the same time brittle, and hence nu-
merous superficial fissures appear at the quarters, and the outside
and inside toes, the frog itself being hollowed by fissures upon its
body and branches. Sometimes it happens that the bars show
deep fissures, running from above downward, to the extremity of
the lateral lacunze, which are thus continued by a crack of the
heel up to the skin of the coronary band. There is often a sepa-
ration of the wall and the’sole, the formation of what has been
called a double wall, or false quarter. Quarter cracks are com-
monly met with it. Corns are frequently seen in connection with it.
Whatever may be the form of the contraction, it is generally
accompanied by pain, manifested by change of position while at
rest and by lameness when in action.
DISEASES. 643
If only on one side, the affected leg is carried forward, and
thus relieved from the too painful pressure which would take
place if it remained im a vertical direction under the center of
gravity. When both feet are diseased, the horse is constantly
moving and balancing himself, pointing the legs alternately, and.
sometimes stretching both legs forward, as in laminitis, but always
moving, so as to push his bedding under him and away from his:
fore feet.
If the pain is slight, there is only a stiff gait, and the animal
hesitates and stumbles easily. But if the disease is advanced the
lameness is great and the animal is very groggy in his gait. He
fears to rest on his heels, which, without being a peculiar charac-
teristic, is a symptom which present, however, a particularly notice-
able condition. While there is hesitation in the action of resting,
there is difficulty in that of the shoulder. This is principally
observable when the disease affects both feet. The shoulders
then seem to be fixed to the trunk, and their motion forward is
very limited. The symptoms are mostly more marked when the
animal leaves the stable. It may then happen that the pain tem-
porarily losing somewhat of its intensity as the horse is moved,
the shoulders become more free, the liberty of action returns,
and once warmed up, the animal may offer a totally different ap-
pearance from that when first leaving the stable. But as soon as
they become rested, the pain returns as severely as before, if not
more so, and with it the same exhibitions of symptoms.
The examination of the unshod foot while it is warm, shows
the extreme sensiblity of the heels. The foot being pared, gen-
erally one may observe, in the region where the contraction is
most marked, yellowish or reddish discolorations, evidences of
the bruises in the living parts, as well as of the serous or bloody
exudations which have taken place on their surfaces. These indi-
cations are especially abundant on the level of the sole and wall.
If the contraction is old, there is at that point a purulent mass
which, when removed, leaves a cavity which sometimes extends
npward under the quarters. It is a separation of the wall, of two
or three centimeters in depth.
An important observation for hoof-bound, and which assists in
its recognition, is the increased wear upon the shoes at the toe,
which takes place not only when animals are working, but also
while idle in the stable, as the result of pointing and scraping the
644 OPERATIONS ON THE FOOT.
stable floor. The horse which has both feet diseased in constantly
in motion, to such an extent that his shoes are entirely worn in a
few days.
At times the pain is so great that it gives rise to general symp-
toms; the animal becomes anxious, loses his appetite, refuses his
food, lies down most of the time, and rises only with difficulty.
II. Complications.—We have already seen that quarter cracks ©
and dry corns are common affections of contracted feet. Exos-
tosis of the phalangeal region is also commonly met in such feet,
especially side-bones. Knuckling, and diseases of the tendons
and of their sheaths are also often caused by contractions of the
feet. The rest of the foot on its whole surface is thus perverted
and the tendons become retracted, painful and swollen.
Navyicular disease is so often met with in company with con-
tracted feet, that one disease is frequently mistaken for the other.
Laminitis has been said to be also one of the complications ; if
so, it is at least quite rare in its occurrence.
Tetanus has sometimes been observed among its associations,
and Hartmann attributes the development of- so-called idiopathic
cases of that disease to this condition of the feet.
The emaciation of the affected leg is a complication seen also,
with other forms of lameness.
Il. Pathological Anatomy.—We have indicated the external
changes of the hoof. The tissues that have been long enclosed in
the contracted foot become atrophied; molecular changes do not
take place as in the normal state ; they become changed in aspect,
composition and properties ; they become denser and more com-
pact, and are no more able to fulfill, to the same extent, their
physiological functions.
The plantar cushion is so completely pressed upon itself that
the stratified structure of its fibrous layers can scarcely be dis-
tinguished, and the presence in the interstices of the yellow fibrous
substance is with difficulty observed. It forms only a homogene-
ous mass, whitish in color, resisting in consistency, and lardac-
eous in aspect. The dilated bulbs which are above the cushion
are also considerably diminished in size, and present, when cut
through, a uniform white color, its composing substance being
reduced to a single inelastic mass.
The ungueal phalanx becomes deformed by degrees, loses its
circular shape and becomes of an elongated oval form. Its lateral
DISEASES. 645
faces assume a perpendicular direction; its structure is modified;
its substance becomes more compact, and the small vascular open-
ings are obliterated, while the largest are increased in size. The
work of obliteration is specially observable at the patilobe emi-
nences, which appear to be crushed. The lateral cartilages are
also much compressed, condensed and modified in their struc-
ture.
The nayicular bone is also compressed, the sheath and its sup-
port not allowing the easy play of the tendons, and it is in this
way that navicular disease may follow hoof-bound. But there
is a specially noticeable modification in the keratogenous appara-
tus, which, as a consequence of the arterial obliterations, fails to
receive freely and actively the necessary amount of blood. The
horny secretion proper to the podophyllous tissue, the white or
soft horn, is reduced; the podophyllous tissue itself is atro-
phied; its lamelle are less prominent and their separations are
diminished in depth; the adherence of the podophyllous or kera-
phyllous tissues still exists where the circulation of the blood is
not interrupted, but beyond, they are easily separated and often
present deep excavations toward the sole.
If hoof-bound advances slowly, the same atrophy of the sub-
horny tissues takes place. Then, however, it proceeds by degrees,
the tissues accommodating themselves in size to the gradually
diminishing dimensions of the cavity where they are contained,
and there is an equal proportion between the size of the hoof and
the volume of the tissues enclosed in it. These being less com-
pressed, there is less pain. In this manner an excessive contrac-
tion of the heels may sometimes exist without marked lameness.
IV. Prognosis.—This is the more serious as the disease is
more developed. Total hoof-bound if excessively tenacious, and
resists the best curative measures, though if there is only a slight
contraction at the heels, it is generally amenable to judicious
treatment. The duration of the disease is an important factor in
the question of the success of the treatment, as the condition of
the os corone, os pedis, navicular bone, sesamoid sheath, plantar
cushion and the atrophy of the keratogenous membranes have all
to be taken into consideration.
The age of the diseased animal and any existing complications
are, of course, circumstances which influence the prognosis in an
important degree.
646 OPERATIONS ON THE FOOT.
V. Etiology.—Hoof-bound, says H. Bouley, is not a simple
fact, produced by a unique cause acting always in the same man-
ner: it is, on the contrary, a very complex one, to the production
of which a great number of causes of various character and inten-
sity contribute with simultaneous or successive effects.
The hygrometic condition of the horny substance is a principal
feature in the etiology of the disease. It is when the hoof loses
by evaporation the moisture which it should contain that it con-
tracts as all organic substances do, and its flexibility returns when
by sufficiently long immersion in a liquid, the moisture it has lost
is recovered. Observation proves that this disease often finds the
conditions of its presence in circumstances which induce dryness
in the part. In such cases the foot has the property of retracting,
to an extreme degree, especially toward its posterior extremity,
where the frog is situated, constituted as it is of a softer and
more depressible substance than that of the wall. The same phe-
nomena takes place in the living structure that is observed upon
the hoofs of dead feet ; a phenomenon which cannot even be pre-
vented by filling their cavity with plaster. During life the hoof is
constantly permeated by a current of fluids which penetrate it
from its depth to the surface. It is the serous food that the hoof
is continually absorbing by the hygroscopic properties common in
living tissues, which counterbalance the tendency of the foot to
retract upon itself and keep it in the dimensions required for the
perfect reception of the parts it covers. So long as the equilib-
rium is preserved between the loss of this fluid by evaporation
and its renewal through the perspiration of the keratogenous
apparatus, the hoof preserves its physiological form; but if this
equilibrium is destroyed by an excess of the loss, then the condi-
tion occurs for the retraction of the hoof and the infliction upon
the parts underneath of an excessive and painful pressure.
This explains why, as proved by observation, lameness in
general and that of contracted heels especially, is more frequent
in warm than in moist seasons. Long standing in the stable is
also an efficient producing cause. The feet become dry upon a
constantly dry bedding, and here also the influence of inaction
must be taken into-account. The disease is commonly found in
stabulation, but seldom when the animal is in pasture; and when
it has existed it often disappears in the latter circumstances.
The alternation of dampness and dryness also influences per-
DISEASES. A GAT
haps more the genesis of the disease than dryness alone. A foot
too much impregnated with dampness, which is afterward left to
the air, becomes harder than a normal one placed in the same con-
ditions. It retracts easier, also. Itis probable that the water, in
softening the superficial layers of the wall, also renders the evap-
oration of the liquids of its deep parts more active. In the ordi-
nary condition of the foot, the evaporation is diminished by the
impermeability of the external hoof, which it owes to its density ;
but where this hoof is softened by maceration, its fibres, partly
disintegrated by the dissolution of the glutinous substance which
keeps them as a compact mass, allow the air to penetrate in their
interspaces ; air which dries them to a certain depth ; hence a
groportionate movement of retraction of the entire hoof upon
itself. This evil effect of an excess of moisture explains how it is
that poultices or other moist applications which horse attendants
abuse so frequently, may give rise to results entirely opposite to
the one in view, and why the hoof becomes dry and brittle, if not
contracted. These topical applications take off from the cortical
layer of the foot its protecting varnish, and expose it to lose its
water of growth.
Some of the practices in shoeing contribute also to the dessi-
cation of the hoof; such is principally that which consists in rasp-
ing the wall from the coronary band to the plantar border: as
also the too long continued contact of a hot shoe with the foot.
Shoeing itself promotes the same result, as, protected by a
shoe, the foot no longer wears normally and grows beyond nor-
mal limits. The mass of hoof which, in the process of growth,
has gone beyond the inferior limits of the podophyllous fissures, is
no longer in contact with the living parts beneath, and they cease
to be impregnated by the fluids which are thus constantly allowed
to evaporate. It then dries up by evaporation and become hard,
and retracts upon itself in such a manner that the circumference
of the foot in the lateral diameter diminishes more or less, espec-
ally posteriorly, and thus forces the incurvations of the sole and
of the bars (H. Bouley). If a horse remains shod for several
months without having his feet trimmed and pared by the black-
smith, these are seen contracting by degrees, as they increase in
length, and soon assume the aspect of hoof-bound.
But these are not the only effects of shoeing in the etiology of
contraction. On the contrary, this practice is the most common
648 OPERATIONS ON THE FOOT.
cause of this lesion of the hoof if not practiced with the intelli-
gence it requires. We have said, in speaking of corns, that they
were proofs of bad shoeing. The same might be said of the con-
traction. Moreover, corns generally indicate great errors in shoe-
ing, while hoof-bound demonstrates the ignorance of the physiology
of the hoof, which in action must enjoy the necessary elasticity to
relieve the contact with the weight of the body upon the ground.
No doubt the theory of Bracy Clark exaggerates the degree of
elasticity in admitting a great power of dilatation of the hoof, but
it is an opposite excess to deny it entirely. The dilatation of the
hoof, though limited, is evident at the heels; especially on feet
which have never been shod (Merche). There is especially in the
inside of the foot, in the soft and supple parts, a certain compres-
sibility of the hoof, which is often overlooked, and which is inter-
fered with by a too narrow or unmethodical shoeing.
The external dilatation of the hoof is comparatively limited,
but on the inside of the hoof there is, in the posterior part of the
foot (especially in the fore feet) a movement downward and out-
ward of the os pedis, for whether the normal elasticity of the hoof
is necessary, either by the physical and physiological constitution
or the arrangement of the constituent parts of the hoof. Quite
often, then, shoeing, especially if too tight, resists the internal
pressure. Even admitting that the dilatation of the heel is nor-
mal, shoeing which would prevent it, would always produce, at
the time of rest, a pressure upon the hoof which would limit the
compressibility of the deep, soft tissues. The frog, especially,
formed of a softer horn, and placed under the plantar cushion,
must receive this gradual pressure, which diminishes by degrees
as the hoof becomes harder, and is reduced considerably as it
reaches the external horny layers.
The errors committed in shoeing, and which predispose to
hoof-bound, vary. The first is in the manner in which the foot is
pared ; too often the heels are lowered to excess, while the toe is
allowed to remain too long; too often, again, the bars are hollowed
too deeply, thinned too mach, as well as the frog. The wall then
tends to retreat, as it is no longer protected behind. In reducing
the height of the heels, in opening them, the tendency to contrac-
tion is increased; the thinned hoof dries up, the lowered heels
lose their strength, and the bars are unable to perform their
functions.
DISEASES. 649
A vicious adjustment also contributes to contraction. "When the
shoe is so prepared that its upper face is concave, and its branches
form a plane inclined from without inward, and when this face
extends back to the heels, there is a circular pressure produced
upon the inferior border of the wall. This is a case in which the
foot has a tendency to drop, pressed in as it also is by the weight
of the body as the foot rests on the ground.
Another wrong practice is to place the nails too near the heels.
The fixing of the shoe on ie tends always to produce con-
traction, as Bracy Clark obser¥ed; it especially prevents the wide-
ening of the hoof, as remarked by Rodet and Coleman. But this
effect of the nails is well marked at the heels, where they prevent
the dilatation of that part of the foot.
These effects of shoeing are to be observed so much the more
rapidly and seriously when the hoof is thicker, denser, and of a
finer structure, as it is observed in small feet. In these feet, the
hoof grows more rapidly, and is on this account more ready to
contract. Let us now consider that this effect of shoeing is per-
manent, and that to the effect of a first shoeing comes to be added
that of a second, of a third, and so on, and we can readily under-
stand how truly the great number of contracted heels one may
meet with can be attributed to erroneous shoeing.
Inaction is also an important cause, as, says Turner, the horse
is by nature destined to be always in motion; it is a condition of
its health, and it is on account of this condition that in the state
of nature he is free from contracted heels. It is, on the contrary,
because the domesticated horse is confined within a stall for hours
and days, that his feet become contracted. We have seen colts
raised without exercise, whose feet were contracted before they
were shod.
Contraction of the heels is often the result of other diseases of
the hoof, and of other lameness. It is commonly associated with
corns, nayicular disease, punctured wounds of the plantar region,
accompanied with long sensitiveness of the posterior parts of the
foot, after-diseases of the frog, thrushes, side bones, phalangeal
articular diseases; in fact, after all affections of long standing,
even if they have their seat in the upper segment of the frog.
Finally, heredity has been named as one of the causes. This
cannot be denied as to some breeds, principally of meridional
climates, as a consequence of the organization of their feet, which
650 OPERATIONS ON THE FOOT.
are usually small. The proposition has, however, we believe,
been exaggerated. This is proved by the Arabian horse, which,
though accused of the vicious confirmation from heredity, has,
according to Vallon, Crompton, and others, the most admirable
comformation of his feet, when it has not been shod. It is broad,
with good heels, neither too high nor too low, well open, well
prominent, wide frog, the external wall being strong and well
developed. In the horses of Caramania, Anatolia, Syria, and those
of the Arabs, which are constantly in the desert, from Bagdad
and Bassaro to the Gulf of Persi the foot is handsomely made,
and free from all contractions when it has been exempted from
shoeing.
VI. Treatment.—Prophylaxy plays an important part in the
treatment of this disease. It is easier and especially more rational,
to prevent than to cure it when once established.
One of the first indications is to prevent the drying of the hoof,
to effect which baths and poultices have been commonly used—
the latter formed of cow manure, of clay, etc.—or by the applica-
tion of greasy substances, in order to diminish the evaporation of
the water of the hoof. Some practitioners are accustomed to use
tar and various hoof ointments. The number of preparations
brought into use is considerable, and in respect to some of these,
the secret of which has been kept by the inventors, the effects
have been entirely different, and the hoof, instead of preserving
its natural good condition, has been altered in its qualities. “It
is not with ointment,” says Hartman, “that the hoof injured by
the blacksmith can be repaired. - It is by good shoeing, and never
otherwise. The workman, to excuse himself, attributes to the
quality of the hoof the origin of the mischief he has done.” - Hoof
ointment never gives to the hoof its natural polish, but many oint-
ments, by becoming rancid, take off that which the blacksmith has
left. The irritating ingredients which compose them sometimes
produce the same results. This does not mean that a reasonable
application of ointment is not necessary ; but to act favorably it
is essential that one coat should be carefully removed before
the application of another. Otherwise, the new will fail of its
proper effect, and, on the contrary, the old coat, by its alteration, |
will give rise to a deterioration of the hoof, especially in affecting
the substance which unites the horny elements, and would reduce
it to fine powder. And, again, ordinarily it is only the wall which
DISEASES. 651
is greased, the hoof of the sole and of the frog being left without,
though they may be in equal need of it. The best hoof ointment
is made of lard, a small quantity of wax or turpentine, sometimes
mixed with tar. Glycerine is very useful, to give the hoof supple-
ness when it has become hard; it is applied by friction, after the
foot has been well washed and dried. In the majority of cases
poultices are preferable to mucilaginous baths.
Greasing is necessary for horses which are much exposed to
dampness, and is as good for the sole and frog, as for the wall.
It is applicable, also, to feet which have to stand on dry bedding. .
Feet, which, on account of diseased conditions, require to be fre-
quently soaked or poulticed, ought also to be greased. Bedding
of fine sand and of sawdust has been recommended. It is well,
also, to place horses upon marshy lands. All these measures may
be advantageous if the feet are properly shod.
Good shoeing is the essential prophylaxy of hoof-bound; we
must avoid all improper practices likely to promote desiccation
and contraction of the foot, such as abuse of the rasp; too long
application of the heated shoe when fitting it to the foot; the
lowering of the heels; the excessive paring of the frog or of the
bars; the bad fitting of the shoe; useless calks; too many nails
‘in the quarter or near the heels—all these errors must be carefully
avoided. The foot, moreover, must not be allowed to grow too
long. The shoeing should be renewed at least monthly, even if
the shoe is not worn. And lastly, the horse must not be allowed
too long periods of inactivity.
It has been proposed to abolish the custom of shoeing, but in
the present conditions and modes of using the horse this is im-
possible. The feet, deprived of their accustomed protection, would
soon become painful, and only by keeping the animal in the coun-
try could the feet be suffered to remain unshod.
Several modes of shoeing have been invented to prevent con-
tractions in feet which are predisposed to them. Some are un-
doubtedly beneficial, but they must be used as an ordinary shoe-
ing, and not reserved until the access of the disease. Good
ordinary shoeing is often all that is required, but no doubt better.
and quicker results will be obtained by the shoe with short branches,
with the flat shoe, or with the Charlier shoe.
The half shoe, the shoe with short branches (fer a croissant),
originally recommended by Cesar Fiaschi, then by Solleysel, La-
652 OPERATIONS ON THE FOOT.
fosse, Sr., and Crompton, is:
an ordinary shoe, made light,
with very short branches
(Figure 498), which when
put on protects the toe, the
mamme (outside or inside
toe), and the anterior parts
of the quarter in such a man-
ner that the parts posterior
to these remain uncovered,
and rest directly on the
ground. Thus shod, the
shoe is almost in its natural
condition; it rests on the
ground by its posterier part,
and the heels are made to
contribute to the movement
of expansion of the elastic
parts of the foot. This shoe, then, has real advantages, if the
posterior part of the foot is yet normal, but if the heels are low
and the frog atrophied, it ceases to be of service.
The flat shoe, or the shoe with base (fer a siege), first recom-
mended by Osmer, Morcroft, and more recently by Miles, Hin-
siedel and Hartmann, is the style generally adopted at the pre-
sent time in Saxony, and in various parts of Germany, as well as
in England. In France it has found its way through the benefits
observed by a few veterinarians. It is a shoe almost equal in
thickness to its width, square, so to speak, but as light as possi-
ble; the internal border of the foot surface being hollowed or
dished in order not to come in contact with the sole, while the
part which rests on the plantar border of the wall is perfectly flat
and horizontal. The heel portion is rounded, and covers mostly
the heels of the foot where the borders of the shoe become per-
fectly adapted to the borders of the wall, to the remotest part of
the heels, and preserves the same contour until it reaches the frog.
The shoe nowhere projects beyond the border of the wall; it is
only toward the toe that it is slightly raised and has a small clip.
The groove of the English shoe renders its application better
than the peculiar nail holes of the French. Five or six nails are
usually sufficient. This shoe allows the dilatation of the foot in
Fig. 498.—Short-branched Shoe.
DISEASES. 653
all its limits, and while protecting the heels, does not predispose
to their contraction. For its application, the plantar border only
needs paring. That of the sole, the frog and the bars must be
carefully avoided.
For the shoeing of Charlier, or peri-plantar (Figs. 499 and
500) the part of the hoof which is most exposed is protected. It
SS Wwe w=
i vont
Fig. 499.—Foot prepared for Charlier Shoe. F14. 500.—Foot Shod; Charlier’s Method.
preserves entirely all the other parts of the plantar surface in such
a way that, as in the conditions of nature, it is only by the fact of
the wearing of the shoe that the excess of hoof is gradually re-
moved. The foot shod by this process is provided at its inferior
border with a metallic bar, often greater in thickness than in
width, lodged in a groove made exclusively in the wall. This bar
adapts itself in its internal circumference to the contour of the
sole, which projects beyond the border of the groove, because all
its thickness has been preserved as well as that of the frog and of
the bars. In this way the rest of the foot receives its adjustment
from the shoe itself, and by the regions of the plantar surface
which it surrounds. This result does not, however, take place
immediately, or when the foot is recently shod; but by degrees,
and as the shoe wears out, the time arrives when the horse walks
both on his shoe and the sole of his foot. Owing to the general
equalization of the friction any partial wear is thus diminished,
654 OPERATIONS ON THE FOOT.
and the important result is secured of reducing the weight of the
shoe without the necessity of too frequent renewals, experience
having proved that for the fore-feet it is quite as durable as the
ordinary shoe of twice its weight, but which from the manner in |
which it is applied suffers, unaided, the effects of the pressure
and friction (H. Bouley). As in the action of paring the foot only
the projecting portions of the wall at the inferior border are re-
moved, the preserved parts of the plantar region resist the move-
ment of retraction, and thus prevent its occurrence in a transverse
direction. Again, as the thickness of the Charlier shoe is greater
than its width, it possesses a certain elasticity and adapts itself to.
the successive movements of the dilatation and contraction of the
horny box, however limited they may be.
We may now refer to some special modes of shoeing, recom-
mended as preventive of contracted heels, but which seem to us
to possess inferior advantage to the preceding. We first find the
unilateral shoe of Turner, which, according to that veterinarian,
relieves the foot from pressure upon the heels by placing the nail
holes on the toe and the external branch only. Turner recom-
mends also the conservation of the frog and that of the bars, and
it is probably to this that the success he has obtained by that
mode of shoeing is due.
Coleman recommended a shoe very thick at the toe and thin
at the heels, the toe being three times as thick as the heels. This
veterinarian thought that by this shoe the animal was obliged to
rest on his frog; at the same time the nails were driven in the
toe principally, so as to allow the dilatation of the heels. This
shoe has no real advantages, and predisposes to corns.
The dar shoe is of some utility when the frog is well developed,
by placing on that part the pressure of the foot, and leaving the
heels free. But it often fails in contracted heels, because in apply-
ing it these parts require to be pared down, in order to increase
the prominence of the frog, and a condition is thus produced
which does not exist in contracted feet. The same may be said of
the Charlier bar shoe.“ The objections stated and the reasons
suggested are true of all the various shoes designed to adjust the
frog pressure.
The hinge-shoe or articulated (Figs. 501 and 502) of Bracy
Clark and Vatel, and the half-shoe of Sempastous, of Peillard,
also possess but a doubtful utility. Practice has not confirmed
DISEASES. 655
Fic. 502.—Hinged Shoe. Fig. 502.—Articulated Shoe.
the hopes of their inventors. They are difficult to make, easily
injured, and of small solidity, and their advantages are wholly of
the problematic order.
Mayer has recommended a shoe whose internal border is
thicker than the external, in such a way that the plane of the
plantar surface of the shoe shall be inclined outward, and instead
of the concavity of the ordinary shoe, where the foot is pressed
- when in position of rest, there is a convexity which promotes and
even increases the dilatation of the foot. This mode of shoeing
has for its inconvenience the exposure of the sole to contusions.
It supposes an extensive expansion of the foot which is not natu-
ral; the horizontal plane is amply sufficient in ordinary circum-
stances. We have, however, used it advantageously in preventing
the pressure of the sole against the shoe by means of a sheet of
gutta-percha. We have used it in almost complete contraction,
and we think we have noticed, with Hartmann, that the dilatation
once started by a mechanical means, not too severely applied,
nature continues it, with the assistance of that style of shoe. In-
stead of giving that special shape of the shoe in its entire length,
it has been proposed to have it only at the branches; each heel
presenting at its internal border a thickness double, or even treble,
that of the external, by which the shoe is inclined outward by its
plantar and becomes horizontal by the ground face. It is flat at
the toe and the quarters, and is the shoe with slippers of de la
Broue (Fig. 503), of Solleysel, and that Vatrin has used in pro-
posing to have the internal half of the width of the shoe inclined
(Fig. 504). It thus resembles the shoe geneté or with ears, of
656 OPERATIONS ON THE FOOT.
\ If \
Fi@. 503.—Shoe of de la Broue. WW ipl
Fic. 504.—Vatrin’s Shoe.
which we shall speak hereafter. This shoe is only indicated when
the heels are already contracted ; they have no indication as pro-
puylastic shoeing.
The shoe with slippers is indeed a shoe which in some cases
may cure contraction. “If the results obtained have not been
very satisfactory,” says Defays, ‘“ this depends not upon the shoe,
but arises from the defective manner in which the foot was pared.
To be efficacious in that shoeing the heels must be left alone, and
the sole and the bars must be well thinned. It is true that in this
way the foot is im the most favorable condition for contraction,
but the circulation is rendered easier in the tissues underneath,
and the effects of the thinning of the hoof are diminished by the
resistance opposed to contraction by the inclined planes of the
branches of the slipper. The same may be said of the shoe of
de Belleville, also recommended by Solleysel, and for whose appli-
cations the foot has to be carefully pared. We feel assured of the
propriety of recommending the use of the inclined plane of the
branches of the shoe with the presence of a small clip on the
inner borders of the heels, such as proposed by Vatrin.
Attempts have been made to dilate the contracted foot and to
cause its return to its normal dimensions by mechanical means.
The shoe with ears (Fig. 505) has been devised for this purpose.
This is a shoe provided on the inner border of each heel with
& att oe
DISEASES. 657
an oblique, blunt, sometimes perpendicular clip, resting upon the
bars, which have been previously hollowed out for its reception,
the design of which is to resist the return of the hoof which has
been dilated, to its former contracted condition. Ruinien had
spoken of this shoe as early as 1618. It was put on, after the
dilatation of the hoof with the farrier’s nippers, applied on each
Fig. 505.—Shoe with Ears. Fia. 506.—Jarrier Spreader.
side of the quarter, the sole being entirely removed. In our days
this operation of removing the sole is considered useless, and in-
stead of the nippers of the farrier, dilators are used, under the
name of spreaders (desencasteleur). The oldest known form is
that of Jarrier (Fig. 506). This is composed of two curved
branches, 11 centimetres in length, articulated at one of their ex-
tremities like the ordinary compass, at which point there is a
screw of peculiar form by which the branches are closed or opened
at will, the other extremity having a strong claw projecting out-
ward. These claws are applied inside of the bars, toward the
heels, which are previously thinned out, and by manipulating the
screw the hoof is dilated to the extent desired. The shoe is then
used like an ordinary one, both heels being armed with a clip on
the internal border, the clips resting on the heels of the foot,
which have been first opened with the drawing knife. This mode
of treatment proved successful with Lafosse and others who ex-
perimented with it at the Saumur school. Under various experi-
ments, the desencasteleur has changed its form. Thus, Lafosse
has arranged the two branches to run separately upon a transversal
658 OPERATIONS ON THE FOOT.
Fic. 507.—Lafosse Desencasteleur.
rod like an ordinary vice, in which form the branches are shorter,
and more power is obtained (Fig. 507). There are many other
improvements which we cannot mention for lack of space.
Instead of applying the dilatation upon the hoof, and after-
ward using a shoe which is closely adapted to the dilatation thus
obtained, spreading shoes have been used. In the method of
Jarrier, the shoe has to maintain the hoof in the condition of
dilatation which has been accomplished by the instruments of ex-
pansion. It is a very delicate and difficult operation, so far as the
proper dilatation of the foot is concerned, requiring the closest
adaptation between the clips of the shoe and the parts of the wall
upon which they rest. An error of a few millimetres only is sufii-
cient to defeat the desired result; and the shoe, moreover, must
be taken off at each operation. To avoid this, special shoes, which
would act also as dilators, were invented. It was not, however, a
new idea; La Gueriniere had as early as 1733 prepared a shoe
composed of three pieces—one median, corresponding to the toe,
and two laterals, in connection with the quarters; these latter are
respectively articulated with the first, and have each three nail-
holes. When this shoe was fixed upon a foot, whether unsoled
or not, its branches were spread apart by a plate left in place, and
by increasing by degrees the length of the plate, a gradual and
increasing dilatation of the hoof was obtained. Gaspard Saunier
improved upon this shoe by placing on the internal border of the
branches, cranks, with a plate placed crosswise and resting upon
them (Figs. 508 and 508a). The objection to this shoe is that it
cannot remain on the foot except when the animal is at rest, as
when he is at work it soon becomes loosened; besides which it is
difficult to make properly.
.
j
DISEASES. 659 ©
(a
i
Fie. 508.—Spreading Shoe. Fic. 508a.—A Better Form.
Rolland has contrived an articulated shoe in three pieces, the
two lateral pieces being kept apart by double steel springs, which
press upon them from the toe on their internal border, and thus
effect the desired dilatation. Hatin has a simpler shoe (Fig. 509).
Tt is a light shoe, with nail-holes dis-
tant from the heels, and provided on
the internal border with a small clip,
upon which rests a V spring, fixed by
its. point upon the toe of the shoe.
The branches of the spring lodge in
the hollows of the sole and of the frog,
and press upon the shoe, and thus pro-
duce a slow dilatation. Steinhoff has
also invented a shoe with springs. It
has recently been proposed to obtain
the dilatation by means of a strong
sole of cautchouc, placed between the
shoe and the foot, leaving the frog full;
very thin where it rests upon the shoe and the foot, and becoming
thicker toward the inner border of the shoe, which it overlaps.
First it rests in the groove of the bars, and then portrudes upon
the flat of the shoe, and bears on the ground at the time of rest.
This elastic mass, compressed at the moment of contact, slightly
dilates the shoe, which is articulated, or, what is better, very nar-
row at the toe, and square; the heels, also, are thus slowly and
gradually dilated.
Fig 509.—Hatin’s Shoe.
660 OPERATIONS ON THE FOOT.
Goodwin also has invented a very ingenious, but too compli-
cated shoe, composed of three articulated pieces. From the center
of the median piece a prolongation of iron extends to the back of
the frog, and is of sufficient thickness to be perforated, the hole
having a thread through which a screw is introduced, running on
each side. The branches of the shoe have three nail-holes, and
from the inner border of the heel rises a clip so turned as to rest
on the origin of the bar. The mechanism of the shoe is easy to
understand, each branch being opened by the play of the screw
which passes through the prolongation of the median piece, one
extremity of which rests upon this prolongation, while the other
presses upon the, inner border of the movable branch.
\ The Goodwin shoe has been es-
sentially improved by Foures (Fig.
510). Itisa bar shoe, the bar being
thicker than the rest of the shoe,
and wider than the ordinary bar
shoe. The bar is notched on each
side, and through each notch runs
a thread or vise which holds a moy-
able clip, which is made to rest on
the inside of the bars, and which
are first properly thinned out. By
a motion of the clip through the
thread, the heels are slowly dilated
Fi. 510.—Foures’ Shoe. by degree. This shoe, however, is
very expensive, difficult to make, and easily put out of order.
In all these methods of dilatation the shoe has to be made of
several pieces, and in this condition is found a constant cause of
weakness and of rapid deterioration, for which reason they are
not very practicable. It is not so with the system used by De-
fays, Sr., by which the shoe, besides containing the essential ele-
ments of the desired mechanical dilatation, is left entire to fulfill
the functions of the ordinary shoe, as well. That which charac-
terizes Defays’ method, who had used it in 1829, but which was
made known only in later years, is that the shoe itself, which, by
its ductility in action, becomes the agent of the dilatation of the
hoof, becomes also, by its natural tenacity, the obstacle to the
return of the foot to its former contracted condition, when once
it has yielded to the outward motion which it has acquired. De-
_ ttt ill a at ae ——=—- - )
DISEASES. 661
fays uses an ordinary shoe, thick and narrow, and then further
narrowed at the toe, if it is to be used on a foot regularly con-
tracted. When it is thus affected, at five or six centimetres of the
heels if the contraction exists at the quarters, at the end of each
branch. This shoe carries on the inside border a strong, resisting
clip, made at right angles, to rest on the internal border of the
wall of the heels. The shoe is flat, grooved, like an English shoe,
with nail-holes slightly turned inward; the last nail-hole made as
far as possible from the heels. It is made of the best quality of
iron, in order to resist, when cold, the greatest amount of forced
spreading by the dilator; it is the expansive slipper of Defay’s
(pantoufle expansive).
The foot upon which this slipper is to be fixed must have both
heels pared evenly, the sole and the bars pared down to a spring,
and the hoof round the frog, on each side, thinned down as much
as can be borne. Then, the shoe, flattened and without curvature
on its faces—resting, therefore, on a strictly horizontal plane—is
put on the foot in such a manner that the clip of the heels rests
against the internal face of the quarters. This done, the space
between the two heels is measured with a compass, and then the
dilator is applied (Fig. 511). This instrument represents a true
vice, with jaws reversed, moving from, instead of approaching
each other. It is formed of two jaws which can be made to ap-
proach or separate by a transverse screw put in motion by a moy-
able lever. The degree of separation is regulated by a graduated
rule placed horizontally, which serves also to maintain the jaws at
the same point when separated. The two jaws being introduced
between the heels of the shoe, the vice being held perpendicularly
to the plantar face, the screw is slowly turned until the branches
are opened, say, eight or nine millimetres; then at the point or
points of the shoe which have yielded to the pressure of the in-
strument, one or more blows are struck with a hammer on the
outside of the branch of the shoe, to loosen the instrument, until
it drops down, without disturbing the screw, a record being made
of the degree of dilatation secured, upon the graduated register.
After three or four days the same operation is repeated, the spread-
ing being then not more than four or five millimetres. It must
be less than at the first, because at the beginning the less perfect
contact between the projection of the heels of the shoe and the
wall has allowed a considerable amount of dilatation without pro-
662 OPERATIONS ON THE FOOT,
Fig. 511.—Defays’ Contrary Vise.
ducing much result. These repeated dilatations once in four days
for a month, are assisted by the application of soft poultices in
horses which, on account of the pain and consequent lameness,
are kept in the stable. Others may be put to work, and receive
poultices only when at rest, or may be turned into damp fields.
The shoe rarely needs changing during the treatment, which lasts
about a month. This mode of opening the heels is especially
practicable and of easy application, and has the advantage of
allowing the use of the horse, whose foot is as well protected as
with the ordinary shoe. It becomes indispensable when the dis-
2a 7"
DISEASES. 663
ease has been of long continuance, and is accompanied with much
lameness. Itis liable to but one contra-indication, and that is
when the foot is not sufficiently strong to hold it, by reason of the
heels having been pared down excessively. It has been tested
for a long time, not only by the Defays, Senior and Junior, but
by many others. H. Bouley, in France, with Hartmann and Mayer
in Germany, recommend it as an excellent curative treatment.
These instruments have been modified and perfected, such as those
shown in Figs. 512 and 513.
Fig. 512.—Defays’ Improved Vise. Fig. 513.—Mericant’s Desencasteleur.
We must again mention the simple and light desencasteleur of
Jovard (Fig. 514), which is as powerful as that of Defays. It is
composed exclusively of a double vice, with opposite threads,
opening or closing two strong claws, which are applied upon the
Fig. 514.—Jovard Desencasteleur.
internal borders of the branches of the shoe; a rod of iron is in-
troduced in the holes of the head of the vice and puts the instru-
ment in motion.
It may be said that on general principles it is preferable to
treat hoof-bound by the use of dilating shoes than to resort to
the bloody operations recommended in earlier times. It is these
664 OPERATIONS ON THE FOOT.
that Brogniez recommended highly for the removal of one or two
quarters of the wall, with an appropriate dressing. H. Bouley,
howeyer, believes that it would be wrong to discard these opera-
tions entirely; he believes that there are conditions where they
become necessary, and where they furnish better and quicker
results than the others referred to.
We cannot overlook the treatment recommended by Barthelemy,
which consists in the thinning first with the rasp, then with the
drawing knife, of the bars, in their whole length, depth and thick-
ness; thinning them down to a spring under the pressure of the
finger. This done, a layer of blister is applied on the skin of the
cuti dura and upon it, in the parts corresponding where the hoof
has been thinned down; the application to be renewed several
times, until the lameness has subsided. This operation is followed
by an excess of the horny secretion and a marked enlargement of
the hoof, and gives good but slow results. Gross has often oper-
ated in the same manner, alternating the blister with poultices.
A modus operandi which has also been very satisfactory,
is the one that was recently made known by Weber, and which
consists in the division of the wall at several points, by grooves
extending down to the keraphyllous horn, in the direction of the
fibres of the hoof. Two or three are made, on each side, between
the quarters and the heels, the heels at the same time being pared
down, when a bar shoe is put on which rests on the frog, or if
that organ is atrophied, pressure upon it is simulated by the ad-
dition of pieces of leather. Frequently, instead of paring the
heels down excessively, and when the frog is atrophied, we prefer
a slipper after having pared the sole and bars to a spring. The
method of Weber is not new. It was previously known by La-
gueriniere, and is mentioned by Brogniez and Hurtrel d’Arboval.
With it we may slowly but surely achieve success, and there are
but few feet which are not relieved or cured; but the grooves
must be renewed from above at each shoeing. Solleysel made
lines of cauterization on each side of the heels, extending from
the hair to the shoe, which; running through the hoof, softens it
and renders it more tractable.
We cannot at present consider the complications likely to be
encountered, but must satisfy ourselves by remarking that in cases
of false quarters, to avoid the painful pinching of the soft parts
between the two walls, there is nothing better than to clean the
a eT
DISEASES. 665
place of separation thoroughly with the drawing knife, and to fill
the space with a putty of gutta percha.
DISEASES OF THE FROG.
This part of the horse’s foot is exposed to many pathological
lesions. Some are merely accidental, and result from the intro-
duction into its structure of nails, and other various foreign
bodies, more or less sharp, which the animal picks up in walking
or performing his work. We have already considered these forms
of lesion in the article upon punctured wounds. The frog is
often bruised, a lesion which may be followed by a complication
which we may be allowed to consider under the name of furuncle
of the frog. But besides this, some special diseases are also ob-
served, among them one already known to us under the name of
canker, and another which is more commonly known under that
of thrushes.
(A) Turusues.—This affection is often, but wrongly, considered
as the beginning of canker, being characterized by the presence
of a puriform secretion, blackened and very fcetid, which collects
and accumulates in the lacunze and excavations of the frog,
whether in its middle or upon its sides. There is often an in-
creased sensibility of the parts, which in some cases may give
rise to very serious lameness, preventing the animal from stand-
ing, and rendering the movement of walking very painful. The
horn of the frog often becomes soft and thready, when the frog is
called rotten, and the softness increases until it drops off by piece-
meal.
The causes of this affection are, first, excessive work on stony
roads; changes from excessive dryness to moisture ; the strong
muds of streets, and standing in damp and dirty places, especially
in urine and manure, as is often the case in badly kept stables.
But there are horses whose feet are also affected with thrushes
even when standing on a dry bedding; those whose feet are con-
tracted ; and again, well-bred horses with good frogs, and in which
there is a constitutional tendency to that condition of the horny
structures.
The treatment consists in avoiding all known causes likely to
give rise to this morbid condition of the frog. Sometimes the
foot must be pared, and all the parts where the puriform secretion
666 OPERATIONS ON THE FOOT
collects exposed and thoroughly cleansed. The lacune of the frog
are then to be dressed with Villate’s solution, Migyptiacum oint-
ment and sometimes only with simple drying powders, a mixture
of subacetate of copper, burnt alum and tannin. When the pain
is excessive, glycerine, with a little Goulard’s extract or per-chloride
of iron, is very beneficial. Dusting with calomel powder gives
also excellent results. In some cases again, excellent results are
obtained by poulticing. It is certain that proper shoeing must,
in many instances, be of great advantage.
(B) Furuncts oF tHE Froa.—Under this name is understood
the partial necrosis of that portion of the plantar cushion which
is situated above the frog proper, from a bruise of that part of the
hoof. lLoiset describes it under the name of plantar jfibro-chon-
dritis, connecting it with quittor, which he named, lateral jibro-
chondritis.
Symptoms.—There is nearly always, and especially at the out-
set, a severe lameness, the greater in degree as the mortification
is more extended and more deeply situated. While standing,
the affected leg is carried forward, resting on the toe; the heels
are raised, and the fetlock is half flexed. In action, the rest is
very slight, sometimes quite absent, and occurs on the toe only.
As the disease progresses, and the necrosed spot develops itself,
the animal rests his foot better, and the lameness diminishes.
Upon examination of the foot early in the history of the case,
a small opening may ordinarily be discovered, either on the body
of the frog, or in its branches, while at other times there is merely
a discharge of a yellowish serous pus of a strong odor, and more
abundant in quantity than would be expected from the size of the
wound, while surrounding it the hoof is loose and sometimes ready
to drop off. If the disease is several days old a mass of dead
tissues is ordinarily found partly loose, projecting through the
opening of the frog, which has the aspect of a whitish body,
slightly green, soft, loose and detached among the surrounding
tissues. When this core (bourbillon) is not visible it may some-
times be felt with the finger introduced through the wound in
the frog.
If there is no lesion of the frog the purulent fluid accumulates
under the hoof, raising and loosening it from the velvety tissues
to a varying extent.
Fluctuations may be sometimes even felt under the hoof. Some-
DISEASES. 667
time the pus oozes through the lacunz of the frog, while again it
may then appear at the heels, after making its way under the en-
tire sole.
Pathological Anatomy.—As we said at the beginning, the
characteristic lesion of the frog is the gangrene of a portion of
the fibrous structure of the plantar cushion, when it changes its
general appearance and becomes of livid yellow-greenish color,
while at the same time a process of elimination takes place in the
surrounding parts, and pus forms, separating the dead tissues
from the healthy structure surrounding. This process of elimina-
tion is more active on the surface than in the deeper parts of the
plantar cushion, to which very often this core remains attached.
In some serious cases the disease becomes complicated with ne-
crosis of the plantar aponeurosis, or of the os pedis, and some-
times of caries of the lateral cartilages, or cartilaginous quittor.
Causes.—Furuncle of the frog always proceeds from some vio-
lent injury through the horny envelope of the tissues it covers,
either when the hoof has been cut through and through by a
sharp instrument, or as the result of some simple bruise with-
out solution of continuity, contusion, or even crushing. Any for-
eign body likely to produce a punctured wound of the foot may
produce it. But in such cases as are accompanied by furuncle it
is necessary that the wound should be more of a contused or
bruised than of the punctured variety. Rough, angular stones
are the most common agents of injury, being often picked up be-
tween the shoe and the frog, and then, pressing more or less upon
the tissues underneath, they produce the same result when they
are located in laminz of the frog.
A thick, voluminous frog in a foot with low heels is very much
exposed to the class of injuries under discussion, equally with the
frog whose horny covering has been pared too closely.
Treatment.—The first indication, says H. Bouley, when one
has to treat a furuncle of the frog, is to thin down as much as
possible the horn of the plantar region, and especially that of the
frog, of the bars and the branches of the sole, in order to avoid
the painful pressure it would produce if its thickness should in-
terfere with the expansion of the parts. This done, if the frog is
already punctured, and there is an opening communicating with
the cavity where the core (or dowrbillon) exists, a free incision or
opening must be made through the hoof and the fibrous covering
668 OPERATIONS ON THE FOOT.
of the plantar cushion, and thus the escape of the pus facilitated.
If the horny frog has remained intact, a longitudinal incision must
also be made in order to allow the frog to discharge, and avoid
further burrowing or undermining of the hoof. It is bad practice
to attempt to pull the core out with a sharp instrument. It is
better to leave it undisturbed and wait for the natural process of
elimination, which may, however, be hastened by the application
of a poultice. The time required for the entire separation of the
necrosed spot varies, and as it approaches, the animal begins to
improve in the matter of resting his foot. When it becomes en-
tirely detached, the cavity which it occupied in the plantar cushion
is treated as a simple wound, with turpentine or tincture of aloes.
However, a dressing supported by the shoe with plates is always
advantageous, and must be frequently repeated. No great length
of time is usually required for the entire healing of the parts, and
the animal is soon returned to his work.
In a few cases, nevertheless, the furuncle becomes complicated
with necrosis of the plantar cushion, disease of the os pedis, or of
the lateral cartilages, the treatment of which must vary according
to the nature and severity of the lesions. In these instances
operations similar to those required in cases of deep punctured
wounds of the foot or in cartilaginous quittor are indicated.
KERAPHYLLOCELE.
This name was given by Vatel to a tumor which forms on the
internal surface of the wall of the horse’s foot, at the expense of
the keraphyllous tissue, which becomes hypertrophied. These
tumors are sometimes irregularly rounded, at other elongated,
but usually rounded and again flattened from side to side. They
vary in size from that of a goose quill to that of the finger, and
while in some cases they occupy the whole length of the wall from
the coronary band to the plantar border, in others they only begin
at one-third or one-half of the height of the wall. The difference
in size allows a division of keraphyllocele into complete and
incomplete. At different points the columns are roughened by
frequent enlargements. Sometimes full and formed by a very
compact and hard tissue, they are, however, sometimes of a fis-
tulous character and accompanied by a blackish discharge of an
offensive odor. The lamellz of the reticular tissue which are
nearest to them are generally wider and thicker than in the nor-
a
DISEASES. 669
mal state. As the tumor increases it compresses the lamellated
tissue and the corresponding surface of the os pedis, injuring the
soft parts, and resting in a groove they thus form for their
development.
The causes which give rise to their development are more
especially cracks of the walls; though they often follow laminitis
or supervene upon severe operations on the wall. Vatel claims
to have observed them after injuries on the hoof resulting from
the hammering of the foot while being shod.
The symptoms are very obscure. At first the animal is but
slightly sore in traveling, but the lameness increases as the tumor
enlarges in size. The region surrounding the tumor is always
warmer and more sensitive than is natural. In many horses the
coronet presents a swelling, well marked. In some cases the dis-
eased quarter is depressed, and the toe seems elongated. When
a toe or quarter crack is accompanied with severe lameness kera-
phyllocele may generally be suspected. But when none of these
external signs exists it is exceedingly difficult to make a positive
diagnosis of their presence, for though the swelling of the coro-
net, the heat and the pain of the hoof may be present, those
symptoms may belong also to other diseases of the foot. Then
the only means at our disposal is to pare the foot well down,
when, at the surface of the sole, the extremity of a portion of hoof
ordinarily harder than the normal consistency may be detected.
The treatment consists in removing the portion of the hoof
corresponding to the horny tumor, as in a case of toe cracks, and
treating the wound thus made in the same manner, according to
the indications presented.
LaminIvis.
Synonyms: Behe, Verschlag, Hufentzundung, German; Four-
bure, Fourbature, French; Rifondimento, Italian; Aguwadura,
Spanish.
By this name is understood the bloody congestions of the
keratogenous apparatus of ungulated animals. The increase of
the circulating fluid produces a swelling of the living tissues of
the foot; but these being enclosed in a box of so hard, resisting
a material, a painful pressure results, which becomes especially
common and serious in horses and other solipeds. It has also
been observed in bovines, though it is then less frequent and
\
670 OPERATIONS ON THE FOOT.
serious. It has also been seen in sheep, in goats and in swine.
It may, in fact, occur in all ungulated animals. Dogs, even, are
not exempt from its attacks.
The simple bloody congestion, more or less inflammatory, of
the keratogenous apparatus of the horse, is sometimes called acute
laminitis and acute founder. The disease may pass off by reso-
lution, leaving no traces of its occurrence, but more commonly
it becomes complicated with some lesion of more important and
serious a character, as hemorrhage, suppuration, inflammatory
exudation, and especially of a hypersecretion of the horny sub-
stances, in which case it becomes chronic laminitis or founder;
an affection which gives rise to alterations of a peculiar nature,
- and leads to certain changes in the form and character of the
hoof. We do not agree to the divisions admitted by several
authors, into traumatic laninitis, rheumatismal laminitis, and
metastatic laminitis.
I. Symptoms.—Laminitis, in most instances, is preceded by
certain general symptoms, such as are premonitory of the inva-
sions of ordinary inflammatory diseases, but of an uncertain sig-
nificance. There is dullness, general insensibility, muscular
tremblings, and stiffness of the loins. The respiration is accel-
erated, the pulse febrile, the mucous membranes injected, the
mouth dry, the foecal discharges dry and coated, the urine scanty;
and perhaps anorexia is present. Rodet, who held that laminitis 3
is more a secondary than primitive affection, and that it is simply |
an inflammatory angeiothenical fever which had localized itself,
was obliged to acknowledge that this fever has nothing character-
istic, and that it is always followed by laminitis. 4
It is certain, however, that but a short time elapses—from |
several hours to one or two days—after the originating cause has
become active, before the bloody congestion of the reticular
tissues and the peculiar phenomena belonging to the disease
become manifest. It is only when the capillary circulation of
the foot has considerably increased, and when the rigidity of the
structure prevents the swelling of the podophyllous tissue, that
laminitis truly exists.
Laminitis in the horse has the following principal symptoms:
Considerable heat of the entire foot, extreme sensibility with
intense pain, increasing rapidly, and obliging the animal to rest
upon the sound legs, in order to relieve the affected ones; diffi-
DISEASES. 671
culty and uncertainty in walking; and sometimes a peculiar trem-
bling of the muscles of the patellar face of the femur, and of
those of the extensors of the fore arm, which fill the triangular
space formed by the scapula and the humerus. The physiognomy
always indicates intense suffermg. The pulse is hard, the respi-
ration increased, and the skin hot, and in places moistened by a
copious perspiration. These symptoms vary with the legs which
are affected, whether the disease is located in the fore or hind
feet exclusively, or in all four together. As M. Bouley says, it is
a peculiarity of this affection that it may remain localized in the
feet of one patient, either forward or behind, or may at once
attack the four extremities, and that it seldom attacks the limbs
on one side only, to the exclusion of the feet of the opposite side,
i. €.,1t may be laterally biped, affecting either both the fore or
both the hind feet, but not often occurring otherwise. Some-
times, however, the disease is more marked in one leg than in the
other of one biped. It is generally only after some traumatic
lesion, or other local influence, that laminitis occurs in one foot
only. .
When laminitis affects the two anterior feet, the animal carries
its extremities forward, and the hind feet are brought well under
the centre of gravity. The standing of the animal is altered, the
walking difficult and painful, and the resting of the feet on the
ground is done with hesitation and fear. The feet are carried
forward, because the pressure takes place on the frog and on the
heels; if it should occur as in the healthy and normal condition,
upon the entire inferior circumference of the foot, there would be
pressure upon all the living tissues, which are gorged with blood, ©
tumefied and painful, and this pressure would greatly increase
the suffering of the patient. It is, then, to relieve himself, and
to avoid the intensity of the pain, that the animal instinctively
changes its mode of resting on the ground. In placing the heels
down, the weight is borne only upon a follicular, fatty tissue ;
from there it spreads along the side of the coronet to the fetlock,
and thus upon all the other portions of the leg, and in this way
the foot becomes greatly relieved during the action of resting.
If, however, the fore legs only were carried forward, the effect
would be equivalent to lengthening the body of the animal, and
he would be unable to carry on the action of walking. To allow
the fore feet to be moved, it is necessary that the body be carried
672 OPERATIONS ON THE FOOT.
forward by the hind legs and brought closer under the centre of
gravity, a position which contributes also to the relief of the
animal while at rest.
The more painful and diseased the feet become, the more the
animal fears the impingement of the ground. Thus, so to speak,
he sounds the ground before putting the foot down, and for this
reason the walking becomes slow, stiff and difficult, and the noise
of the contact of the foot louder than that of the healthy legs.
Sometimes the animal proceeds only by a series of jumps, or a
kind of rearing, while backing is especially difficult.
The hoofs of the foundered feet give to the hand, when feeling
them, a sensation of heat greater than that in the physiological
condition; a sensation which can be more readily detected by a
comparison of the fore and hind feet simultaneously examined. |
The pains in the diseased feet are rendered more manifest, also,
by percussion upon the hoof with the hammer, when each blow,
however light, is followed by a motion of the animal in suddenly
withdrawing his foot on account of the paim experienced. The
lateral arteries of the fetlock, in the foundered legs, beat stronger
than in health, and can be readily felt by the fingers. The feet
cannot be raised without great effort, and when raised, the animal
stands only with great difficulty, and makes struggling attempts
to relieve himself and resume its natural mode of standing on
four legs.
When laminitis affects only the fore feet, the animal will
sometimes remain standing for a length of time together; he may
retain this attitude for several days, without any displacement of
his body ; still he is observed moving suwrplace, from side to side,
especially on his fore legs, relieving one foot for a moment to give
the same comfort immediately afterward tothe other. But when,
exhausted by fatigue and pain, the foundered horse lies down, it ,
is very difficult to get him on his feetagain. He continues in the
decubital position, lying mostly flat upon his side, the fore legs in
constant motion, and soon complicates his diseased condition by
_ the addition of bed sores- upon the prominent parts of his body.
The attitude of the animal is very different when the hind feet
are affected; then both the anterior and posterior bipeds are
brought to each other, the feet of the hind legs being carried for-
ward under the abdomen, so that the rest may take place upon
the heels; and the anterior ones are carried backward, and nearer
DISEASES. 673
to the centre of gravity, to assist the function of the hinder ex-
tremities in sustaining the weight of the body. In this case, the
animal is constantly in side motion, on account of the pain he en-
dures. Walking is still more difficult, and seems to take place as
if the animal was treading on sharp needles, as, the more the an-
terior biped is engaged under the body, the more also those legs
are loaded with the animal’s weight, and the more difficult is their
movement. But the anterior legs, contrary to their ordinary func-
tion (not being adapted to the support of an overshare of the
body) sustaining now a great part of its mass, and moreover,
compelled to assist in the act of propulsion, necessarily and in-
evitably become easily fatigued, and too often in their turn be-
come likewise affected. Animals suffering with posterior laminitis
are found occupying the standing position less frequently than
those whose fore feet are affected. Their unsteady equilibrium,
consequent on their mode of standing, tires them more quickly,
and compels them to lie down, and once on the ground, it is again
more difficult to make them rise. They may do so readily with .
the fore legs, but the posterior extremities do not always respond
to the call.
The attitude of animals suffering with laminitis of all the four
feet, is the same as of those which are affected in the fore feet
only. All four feet are carried in advance of their plumb line, the
anterior forward, the posterior well under the centre of gravity.
Sometimes the horse has all his feet somewhat apart, in order to
carry the principal part of the weight on the inner side of the
foot. The standing posture being painful to either foot, the
animal lies down most of the time. Locomotion is very difficult
and staggering, and the animal can only be induced to move by
severe punishment, and even that cruel resort sometimes fails to
effect it. If the animal is made to walk, he does it with the great-
est difficulty, by reason of the increase of his sufferings, brought
on by the displacement. His legs, stiff and trembling, are raised .
‘in a convulsive manner, and brought back to the ground with the
greatest hesitation, and upon the heels; the constant motion of
the lips of the animal being well characteristic of his sufferings.
In the ox, laminitis is more frequent in the hind than in the
fore feet. It is, however, more serious in the latter, the inner
being more affected than the outer toe. The foundered ox walks
with hesitation, and takes advantage of every opportunity to lie
674 OPERATIONS ON THE FOOT.
down. When standing, his back is arched, the feet closed to-
gether, the hind feet resting on the heels, the fore legs on the
points of the toes. The fever is severe, sometimes attended with
loss of appetite and of rumination. If the disease continues long,
the cattle will die. The abdomen is stuck up and the animal
loses flesh very rapidly, indicating a serious condition, as the dis-
ease is principally found in fat animals, which are obliged to
make forced marches to be delivered at their markets.
IL— Termination and Complications.—Well treated, laminitis
is generally of short duration, and ends in three or four days by
resolution. Sometimes, however, this is not accomplished until a
later period, even toward the tenth day, though cases of this charac-
ter are rare; and even when resolution proceeds slowly, some lesions
in the foot may be looked for, and chronic laminitis will probably
result. Resolution in acute founder is marked by the gradual
disappearance of the local and general symptoms. In some sub-
jects, the improvement is quite rapid from day to day, and the
form of termination is known as delitescency. Laminitis ending
in resolution is not usually followed by alterations in the horny
box or the tissues which it covers.
When the congestion which constitutes the disease terminates
otherwise than by resolution, it is always followed by accidents of
varying character. Some of these may have a happy termination,
but, in the end, are more or less likely to be followed by a de-
formity of the horny box, to which the name of chronic laminitis
is given. Before entering upon this, however, let us examine the
various complications which may follow acute founder, and study
in succession: the hemorrhage, inflammation with exudation,
suppuration, gangrene, consecutive arthritis, metastasis, and,
lastly, chronic laminitis. Resolution is most commonly met with
in the ox. Sometimes the separation of the hoof by suppuration
occurs, and chronic founder is not observed in that animal. It is
seldom that seedy toe is observed.
a.—Hemorrhage, or apoplexy of the reticular tissue, is due to»
the rupture of the excessively distended capillaries, when the ex-
‘ travasated blood either infiltrates into the meshes of congested
tissue, or spreads around it, and penetrates between the podophyl-
lous and keraphyllous lamelle, filling up the spaces at the toe, the
mammz and the anterior parts of the quarters, the os pedis being
pushed back by the pressure of the incompressible fluid. The
_—
DISEASES. 675
pain is then very great; the blood, continuing to separate the tis-
sues, often oozes at the coronary band.
If this last sign is absent, a groove may be made with a draw-
ing-knife in the region of the toe, behind the commissure of the
sole and of the wall. If we meet with a cavity, resulting from
the extravasation of the blood in the podophyllous and keraphyl-
lous space, or if blood flows out from it, the true nature of the
complication becomes at once apparent. This mode of explora-
tion is generally difficult, as the animal in pain does not readily
allow his feet to be raised, and as the other foot cannot sustain
the entire weight of the body, the horse easily falls down. It is
sometimes necessary to throw the animal in order to make this
exploration, which very often becomes necessary if we would know
accurately the progress of the disease.
b.—Inflammation, with fibrinous exudation, or pseudo-mem-
branous formation on the surface of the podophyllous tissue.
The transudated fibrine mixes with the hoof, secreted by the podo-
phyllous tissue, and this matter separates that structure from
the keraphyllous laminz, especially at the anterior part of the
region. Again, in chronic laminitis we find this abnormal secre-
tion pushing the os pedis forcibly backward and separating the
toe of the bone from that of the hoof, and thus producing a pain
still greater and more violent than that produced by the laminitis
and the hemorrhage. These pains are often so intense that they
give rise to an access of furious vertigo. But pains, even when
of an exaggerated degree, indicate simply the presence of the
exudative form of laminitis. It is not a positive sign; the foot
must be explored at the toe, where, in the vacuum which exists
between the horny lamelle is found, more or less abundantly, a
. citrine serosity of a slightly reddish color. Sometimes this ser-
osity oozes between the hair and the hoof, in consequence of the
separation of the tissues at the coronary band, and appears in the
form of a thin, reddish foam, about the band itself.
e.—Suppuration between the wall and the podophyllous tis-
sue is a complication more rare than the others, but which, how-
ever, has been observed, especially when laminitis is traumatic.
We have seen it appear under the sole and separate it entirely
from the tissues underneath. In these cases, the pain is always
very great, and the living structures are pressed beyond measure.
Standing is impossible, and the animal continues lying down, or,
676 OPERATIONS ON THE FOOT.
under the influence of the pains, constantly moving from one leg
to another, balancing himself, so to speak. There is no relief for
him until the suppuration has shown itself between hair and hoof,
when it oozes cutward at the coronet. Relief, however, may also be
obtained by making an opening at the toe with the drawing-knife.
This complication often results in the entire separation and drop-
ping off of the hoof. Cases have been observed when this acci-
dent has taken place as early as the third day (Lafosse, Stanley).
Gillmeyer has seen a new foot grow out entirely, but this requires
a long time.
d.—Gangrene of the sub-horny tissues sometimes takes place,
though seldom, under the influence of the excessive pressure,
especially when there is sub-horny exudation. The violent pains
then cease suddenly; the resting becomes more solid; the move-
ments take place without difficulty. But at the same time, the
physiognomy of the patient becomes anxious and contracted; the
pulse becomes small and difficult to count; the temperature of the
body diminishes; the animal has a trembling gait; is indifferent
to any excitement; he is prostrated, and soon he ends by sep-
ticeemia. The hoof then often drops off, and the sub-horny tis-
sues are seen to be of a bluish-brown color, without consistency,
but with a very foetid odor.
Volpi thought that laminitis was the inflammation of the articu-
lation of the foot; but this arthritis, if it exists (a fact which is
rare), is not a consecutive phenomenon, but a complication. The
inflammation does not remain limited to the recticular tissue; it
extends also, and consecutively, to the contiguous structure,
spreads to the tendons and articular ligaments, even penetrates
to the synovial capsules of the articulation of the third with the
second phalanges, and may also react upon other parts of the
organism. The anchylosis of the articulation of the foot with
that of the coronary joint are complications somewhat frequent,
as well as that of the ossification of the cartilages of the foot.
e.— Metastasis has been often observed, and when accom-
panied by intense fever have been noticed as complicated with
serious diseases of the chest, especially of pleuro-pneumonia. At
other times, it has been the intestines to which the metastasis has
transferred the disease, in which case there is, in most instances,
constipation of the bowels. Enteritis, however, is seldom ob-
served, notwithstanding what has been said on the subject. This
DISEASES, 677
metastasis has also been seen toward the lumbar region, and this
is much more commonly believed from the fact that there is more
motion at the hip than at any other joint during locomotion, and
also because the back and the loins are more or less arched. In
fact, laminitis has been, by some, designated as an affection of the
loins; some have looked upon it as a rheumatism of that region.
All these errors have originated in the peculiar motion of the ani-
mal while walking, or of its peculiar mode of resting when stand-
ing still. We have also observed an attack af complete myelitis
as a complication of laminitis.
J-—The most common complication met with in chronic lam-
initis is an affection which we might have treated as a special sub-
ject had we not, upon principle, considered it as a sub-inflamma-
tory state of acute founder of the foot. An attack of laminitis
which has not ended by resolution in five, ten, or fifteen days at
most, takes a character of persistency which, in most cases, ends
in absolute incurability. To properly study chronic laminitis we
must observe it when the alterations which characterize it are ac-
complished. When we have completed the consideration of the
pathological changes, we will examine the intermediate period,
and discuss the mechanism by which these alterations take place
in relation to the pathological anatomy.
The first thing observed is the RANG
change of form in the hoof (Fig. als SS
515). The nail of a horse’s foot Ne :
easily recalls the form of a Chinese wf
shoe (Knollhuf, of Germany). The &
hoof seems to have also lost its “™
varnish and its suppleness in the
points corresponding to the dis-
eased parts. It is, besides, brittle, and seems to have lost part
of its connection with the remaining parts of the foot, and there
is a change in the direction of the wall, the fibres of which,
instead of being oblique to the ground, assume an almost hori-
zontal direction. The foot seems as if flattened from above down-
ward, and the lines which bound its surface form a well-marked
obtuse angle with that of the coronary region. The anterior wall
of the foot also forms a well-marked projection forward, from
which results a great exaggeration of the antero-posterior diame-
ter of the nail with the transverse diameter and the oval form of
678 OPERATIONS ON THE FOOT.
the horny box. The external surface of the wall, instead of be-
ing smooth, as in physiological conditions, presents, on the cou-
trary, a roughened appearance, which results from the presence
of circles of ridges and circular grooves, placed one above the
other and extending from one heel to the other. A remarkable
peculiarity is here observed in the fact that in the anterior part of
the nail the circles are quite near each other, while, on the con-
trary, upon the lateral parts they are separated by much wider
grooves. When, then, at the toe, the wall has some difficulty in
growing downward, on account, probably, of the internal adhes-
ions between the podophyllous and keraphyllous tissues; the
heels, on the contrary, grow without difficulty, and thus obtain a
relative height superior, and sometimes even equal, to that of the
toe. Often at the mamme and quarters of the foot contractions
are seen, and longitudinal grooves running from the coronary
band to the plantar surface, reminding one of the lesions usually
met with in encastelure.
Considered on the side of
the inferior face, the old found-
dered hoof offers four remark-
able lesions (Fig. 516). Besides
its oval form, a disposition al-
together different from that of
Fic. 516.—Chronic Laminitis, last stage. the normal state, the sole is
convex in all the anterior part
of the plantar region, especially at the point of the frog. There
exists at that point a transversal tumor or enlargement, projecting
sufficiently to‘exceed in height the inferior border of the wall. The
solar sheet has been pushed outward by the pressure against the
superior face from the contents of the horny box, and the foot is
convex. This convexity never equals the entire extent of the foot,
the deformity ending at the boundary of the inferior border of
the bars, beyond which and backward are found the cavities of the
lateral lacunze of the frog, so much more elevated as the heels are
also higher (Fig. 517). The center of this tumor or enlargement
of the sole is often flexible under the pressure of the finger, and
generally bleeds easily on the application of the sharp tools of the
blacksmith. It is not rare to see the sole perforated through and
through and showing the inferior border of the os pedis project-
ing through the border of the bone, which then soon becomes
hh ) GY) i
<e Ee BO
W085 SS
ea”. hl
DISEASES. 679
Fic. 517.—Foot affected with Chronic Laminitis.
a.—Anterior extensor of the phalanges. b.—Ordinary wall. ¢.—Coronary band.
d.—Podophyllous tissue modified. e.—Morbid horny wall #.—Seedytoe. g.—Displaced
and deformed os pedis. h.—VYelvety tissue. 7.—Perforans tendon. j.—Navicular bone.
k.—Perforatus tendon. /—Plantar cushion.
necrosed. This is the result of the excessive displacement of the
os pedis and of the strong pressure upon the velvety tissue against
the sole-tissue, which is atrophied or even destroyed (Fig. 518).
This is an ulcerating wound, somewhat semi-lunar, secreting a
Fig. 518.—Chronic Laminitis, with Keraphylocele
680 OPERATIONS ON THE FOOT.
very offensive pus, with granulation and proud flesh, or even REDE
ration of the sole.
Between the sole and wall the line of demarcation is no longer
so well defined as in the normal state. At the toe, the mammz
and the anterior part of the quarter, there is an excavation formed
of softer horn of bad nature, and less identified with the true
horn of the wall and of the sole. A complete vacuity is often
found, a cavity around the internal face of the wall at the toe and
at the mamme of varying depth and size, but always larger at the
inferior than at the superior end of the foot, where it gradually
diminishes, and often contains a dry, granular mass, resulting
from the drying of the blood, and the dried plastic lymph, mixed
with small, horny, pulverized masses. This cavity is formed in
front by the healthy wall and posteriorly by a new wall due to
the secreted hoof thrown upon the podophyllous tissue; this is
called seedy toe. This double wall is observed especially after
laminitis of the hind feet; it is more common in the donkey and
the mule; it is also noticed in horses with small feet, as in those
of Oriental breeds.
The deformities of the horny box due to chronic laminitis are
not in all cases identical in their character; there are degrees in
them, and consequently they vary in their features, which varia-
tions are due to the duration of the disease and its intensity, and
also, according to H. Bouley, to the primitive form of the diseased
foot. In a case of chronic founder of the fore feet, one may often
notice a difference between the deformity of the left and that of
the right foot. The deformities may take place at various times,
and one may find a well-marked case of seedy toe while as yet
the wall has preserved its normal oblique direction and shown
rudimentary ramy appearances. Again, the wall may have under-
gone changes in its direction only at the new hoof, which grows
from the coronary band; there is then formed between the old
wall and the coronet a circular groove, sometimes called the digi-
tal cavity, the deformities of the wall taking place only asit grows
down. At times, also, instead of the groove, there is a ridge of
horn at the coronary band, originating in the hyper-secretion of
the horn, which grows also downward. And, again, there are
cases where there is seedy toe and still no well-marked alteration
of the shape of the wall of the sole.
Chronic laminitis is always accompanied with more or less
DISEASES. 681
lameness. There are cases, however, where it is missing; for ex-
ample, in seedy toe. Ordinarily, the foot is raised from the ground
with a convulsive motion, as may be well observed in donkeys and
mules, which animals rest their feet on the heels. This soreness
' diminishes with time, as the foot, assuming its new form, offers a
‘wider space to the sub-ungulated tissues and presses less upon
them, these tissues having, at the same time, become somewhat
atrophied. In cases of hernia of the os pedis, the resting of the
foot on the ground is almost impossible, the animal being afraid
to bear his weight on the sole. The heat and the pain of the feet
are less marked. ‘The percussion is louder in case of seedy toe,
while it is duller when the space between the wall and the recticu-
lar structure is filled with hoof of new formation. This percus-
sion is very painful in case of keraphylocele. Unless there are
serious lesions, chronic laminitis is not accompanied with fever.
Ill. Pathological Anatomy.—At the initial period of lamini-
tis, when there is only simple congestion of the keratogenous ap-
paratus, and especially of the podophyllous tissue, the sub-horny
tissues are in a condition of sanguineous derangement, characterized
by objective signs. When the hoof covering them during life is
removed, they are found of a dark red color, in a kind of eythema.
When pressed between the fingers, their thickness is noted to be
increased, and they are found to be gorged with blood, an incision
made through them allowing the escape of a large quantity of
that fluid.
If the laminitis exists for several days, the podophyllous tissue
is found to be infiltrated with plastic exudations, and if there has
been hemorrhage or apoplexy, blood is found between both the
sensitive and insensitive laminze. In other cases there is pus, and
in case of gangrene, the tissues are found of a livid color.
The alterations are still more serious in cases of chronic
founder. When a foot, foundered for some time, is divided by
the saw in its antero-posterior axis by a section of all the parts,
the thing first noticed is a change in the connection of the os
pedis with the wall. These changes, however, exist principally at
the toe, and extend as far as the half of the quarters, on a level
with the lateral cartilages of the foot, while further backward they
are not to be observed. On the side, some laminz are always
found in their normal condition, as can be seen by a section of
the foot made transversely. Generally, a yellowish substance, of
682 OPERATIONS ON THE FOOT.
horny appearance, but softer, fills up the space situated between
the walls and the keratogenous structure. This is the product of
the exudation of the inflamed podophyllous laminz, mixed with
the horny substance which they secrete normally. These laminz
are themselves hypertrophied, being sometimes one and two cen-~
timeters in length and exceeding by four or five times their nor-
mal size. The keraphyllous laminz are also hypertrophied, a
condition which is evidently due, as respects the podophyllous
tissue, to the increase of vital activity, resulting from the inflam-
matory condition of the tissue and to the infiltration by fibro-
plastic exudation, resulting from the inflammation. As to the
keraphyllous laminz, they repeat on the internal face of the wall,
in an inverse manner, the disposition of the secreting lamine of
the hoof between which they are formed and lodged. These,
however, as they increase in extent, unite at their base in the
whole of that portion which does not co-operate to their union
with the podophyllous bands, and then forms a compact mass
uniting most frequently with the internal face of the wall. Some-
times this mass of yellowish hoof occupies the whole space be-
tween the os pedis and the wall, but, in some cases, it adheres
only to the wall, when it forms around the keratogenous tissue, a
new wall, also provided with keraphyllous lamine, and there is
formed between it and the normal wall that porous, brittle mass,
without homogeneity, which fills up the space, which constitutes
the seedy toe. The mass thrown between the wall and the os
pedis presses upon it; the anterior face of the bone assumes a
vertical direction, and the os pedis presses toward the solar arch
on its anterior border at a point situated posterior to that where,
in normal feet, this border rests. Notwithstanding its resting
power, the wall gives to the effort of the mass interposed in front,
the form of the foot changes, and then results the change to the
oval in the contour of the foot. Under the influence of the dis-
placement of the phalanx, not only the flattening and afterward
the convexity of the sole and even its perforation results, but the
plantar cushion is itself pressed down and crushed between the
bone and the frog, which is then generally atrophied. A hoof of
new formation is often developed between the sole and the infe-
rior face of the phalanx, in order to prevent it from necessarily
sinking. This increases the pressure upon the bone and contrib-
utes to its atrophy and sometimes to its complete disintegration.
DISEASES. 683
But, between the surface of the coronary band and the origin
of the roof, whose formation is anterior to the laminitis, there
may also be a new layer of hoof, more resisting than that which
occupies the space between the wall and the podophyllous tissue,
which is no more hoof mixed with the fibrinous exudation, but a
pseudo-hoof secreted by the coronary band. The fibres of this
hoof, however, instead of being rectilinear and growing down in
the direction of the old wall, with the fibres of which they are
continuous, are, on the contrary, sinuous and nodulated, and dis-
posed to take a somewhat horizontal direction. There is often,
besides the old wall, a deep horny tumor, a keraphyllocele which
grows inside, attempts to replace the soft horn secreted by the
podophyllous tissue, and adds to the pressure of the os pedis, by
forming a new wedge, more solid and resisting, which produces a
displacement of the phalanx, whose anterior face then often be-
comes more than vertical. This horny secretion from the coronary
band is made evident by a section of a foundered foot, when the
cutigeral cavity will be found much enlarged. Guyon, Jr., Hert-
wig, and Gourdon remark that the displacement of the os pedis is
counterbalanced by the more rapid development of the heels and
the projection of the foot forward; and that thus the phalanx
does not support the weight of the body except by its inferior
border only, but preserving nevertheless, its primitive position.
It is especially observed that when the foot is completely de-
formed, the projection of the wall does not prevent the os pedis
from remaining in its normal position.
The growth of the hoof from the podophyllous tissue and the
coronary band is not easily stopped. The horny masses which
are formed continue to increase, and even soon end in uniting.
There then remains a thick mass of deformed shape, four or five
times thicker than the normal wall, but where the keraphyllous
leaves are still noticed, corresponding to the podophyllous laminz,
largely.developed, and above all, running deeply into the wall of
the hoof. The space. between the wall and the anterior face of
the os pedis is filled with pus besides the secreted hoof ; the seedy
toe, if it existed, disappears. Though the hoof becomes thus
much more voluminous than before, the deep parts are not any
more in their normal condition, but are lodged in a smaller and
smaller space, and are thus in such a state of compression that
they become atrophied. The bone is altered in its texture, as
684 OPERATIONS ON THE FOOT.
XS
ye ae
Ss
ON 3
F1@. 519.—Changes of Structure of the Os Pedis in old cases of Chronic Laminitis.
well as in its form, and becomes denser and more brittle. (Fig.
519). One might suppose that as the disease progresses, the os
pedis would become pressed backward more and more toward the
sole, in consequence of its giving way under the pressure. This,
however, is not so. As the old normal walls disappear, the new
horn yields to the pressure from forward, the heels rise, the os
pedis resumes its horizontal direction, and the danger of hernia
of the bone diminishes, and a hypersecretion of the hoof is even
noticed toward the point where the hernia would have taken
place, in the middle of the pumiced sole.
We have, so far, supposed that chronic laminitis is always
manifested by the presence, between the internal face of the wall
and the podophyllous surface, of a mass of abnormal hoof. But
there are cases, after hemorrhage, and especially after serous
exudation, where, instead of it, a cavity is found—a seedy toe.
There is also an entire separation between the os pedis and the
wall. But the horny production, that of the podophyllous tissue
especially, is not sufficient in amount to fill up the whole space,
there being hoof only upon the podophyllous tissue. There is
then a sound wall formed, separated from the old one by a vac-
uum, which is often filled by a dry mass derived from the blood
and serosity, mixed with the horny cells. But more frequently
DISEASES. 685
the separation is limited to the height of the podophyllous tissue,
and the wall yet remains adherent to the coronary band, by its
cutigeral cavity. The band then continues to produce the ex-
ternal wall of the hoof, while the podophyllous produces the
abnormal wall, and the seedy toe remains between the two walls.
There are cases where the separation, produced by the con-
gestion of laminitis, takes place to such an extent, in circumfer-
ence or in height, that the hoof loses all its adhesion, except
toward the heels; and then one may see the curious fact of the
new generation of an entire new nail within the old one, the for-
mer being, so to speak, sequestered in the latter.
IV. Differential Diagnosis.—It is possible that, notwith-
standing its distinctly characterized physiognomy, laminitis, of
the hind feet especially, may be mistaken for a disease of the
spinal region. Often, when the founder is light, the hinder parts
wag, as in sprains of the loins, but the resting of the feet on the
heels, their heat and their sensibility, will soon point out the dis-
tinction. In more severe cases, the hinder founder may stimu-
late paralysis, especially if the animals cannot or will not raise
themselves. Here the history of the case is very useful, and the
explorations of the feet will assist in making the diagnosis. We
have seen cases of laminitis behind, where the raising of the foot
has been such that it might be taken for springhalt, or even for
locomotor ataxy. It may be also taken for tetanus when in mild
form, or yet incompletely characterized.
V. Prognosis.—Laminitis is so much more alarming and re-
bellious as to treatment, as it is more extensive, more serious, and
of longer existence. The most serious cases are those which are
due to a constitutional predisposition, and those which follow a
general alteration, or are complicated with other diseases.
Chronic laminitis is especially serious from the production
without separation, and in an excessive measure, of the horny
substance. Seedy toe is then less serious, and that which does
not extend to the coronary band is sometimes curable by the
gradual growth of the hoof; the tumor of the os pedis is the
most rebellious to treatment. The destruction of patients is often
necessary, from their inability to walk or to do any work, and
that notwithstanding all treatment they are entirely useless.
VI. Etiology.—ULaminitis has been attributed to many and
the most varied causes, and, among others, has now been ascribed
686 OPERATIONS ON THE FOOT.
to a traumatic origin, consisting of injuries of the foot; and again,
to internal lesions, resulting in the inflammatory process which is
characteristic of the affection.
The external traumatic injuries, which it is claimed are those
chiefly instrumental, are, on the contrary, of very rare occurrence -
as causes of the disease. Our observations agree with those of
H. Bouley, and if there is a traumatic causation for this disease,
or, at least, one identical with it in respect to symptoms and
primitive lesions, it is, nevertheless, certain that its progress is
very different; there is found with it an evident tendency to sup-
puration instead of exudation, and there is no such formation as
the chronic process which is found when laminitis is due to an
internal phlegmasia.
It has been said in reference to the action of the heated shoe
upon the hoof, the percussion of the blacksmith’s hammer and
the pressure of the shoe and of the nails upon the living tissues,
that all these causes together must, as their sure effect, make the
foot tender, and stimulate in its constituting structure, the con-
gestion which is the initial phenomenon of founder itself. But
this assumption may be successfully contested. But shoeing may
produce many forms of lameness; never laminitis. It has been
said that feet of defective conformation are more commonly af-
fected with founder that those which are well formed. This,
however, is not so; feet with contracted heels are no more predis-
posed to it than flat feet, as claimed by Girard. Traumatic acci-
dents, as blows, injuries and pressure, produced by stones, crush-
ing of the feet under heavy weights or under the wheels of a
truck, etc., may produce a violent congestion of the reticular tis-
sue of the foot, and consequently laminitis. But this founder
itself is of too active a character and more complex, perhaps with
a natural tendency to suppuration, as we have already said. It
must then be considered as varying from laminitis proper, or that
form in which the congestion is of a more passive character, or at
least internal and somewhat analagous to that which is sometimes
observed in the lungs or in the intestines. It might be better
described as an “‘astonishment” (¢tonnement) of the foot, as it is
sometimes called.
Laminitis proper is rarely due to a unique cause, but more
properly to a number of circumstances or to an assemblage of
various causes by which the horse is at first somewhat indisposed
DISEASES. 687
—sick in fact; and it is only after various general symptoms that
the disease localizes itself in the feet, or, as the old phraseology
has it, falls in the feet.
The most effective cause is too abundant and especially too
substantial feeding, which produces plethora by rich blood. It
is the use of other grains than oats, as wheat, barley or rye,
which especially predisposes to the disease. Latin authors called
it hordeatio (from hordeum, barley), and it is mentioned by Sol-
leysel, Garsault, Gaspard de Saunier, and various hippiatrics.
Rodet has observed its bad effects in Egypt and in Spain, where
animals were fed not only with those grains, but where they received
wheat in spike. Miltenberger had observed the same effects dur-
ing the war of 1812, in Poland, where the horses were fed with
rye. Even in our days laminitis is seen breaking out in the years
when feed is scarce and when oats have to be replaced by other
grains, as is proved by the observations of Bouley, Verrier, Rey,
etc. Artificial varieties of fodder also predispose to founder,
though less often; even oats, when given in excess, may produce
it (Solleysel, Blind), and especially if new oats (Hertwig).
The influence of seasons cannot be denied, and it is during
the summer months that laminitis is more frequent, while it is
rare in winter, as well as in the spring and fall. It is to the warm
climates of Spain and Egypt that Rodet attributed, in great part,
the frequency of the founder observed in the army horses en-
gaged in campaigning in those countries. It has been also attrib-
uted to the sudden checking of the perspiration, and cutaneous
chills when the animals are sweating; a cold bath or the drink-
ing of cold water at that moment having also often been consid-
ered as occasional causes.
The work of the horse greatly influences the development of
laminitis. It is more frequent in those which are driven at great
speed than in those which work while walking, and especially in
whose frame an excess of strength is required, and particularly
those which labor on rough and stony ground. It is almost in-
evitable if the animal is well fed, and if he is unaccustomed to
that kind of work and not trained for it, and most especially if it
is during warm weather. This explains why the disease was so
frequent among post, diligence and coach horses, especially dur-
ing the period preceding the establishment of railroads, when the
expenditure of strength exacted from these unfortunate animals
688 OPERATIONS ON THE FOOT.
reached the last limits of possibility. More recently, again, dur-
ing the war of 1870-71, when railroad traveling was more or less
impeded, laminitis became more common among horses from
which an excess of muscular effort was required. It is a frequent
and very serious accident among English race horses (Hering).
Laminitis in oxen is due almost exclusively to the fatigue of
long journeys and to repeated frictions of the unshod feet upon
the ground. It was very common before the era of railroads in
animals brought to market.
But prolonged rest and inaction also predispose to founder.
The disease is frequent in horses making sea voyages. It is not
rare to see horses become foundered when they are obliged to
stand up during several days in consequence of injuries to the ex-
tremities, or other pathological conditions, requiring them to be
kept in slings. In diseases of the feet which have required pain-
ful operations (toe or quarter cracks, punctured wounds of the
feet, quittor, etc.) it is quite common to see an animal persevere
in maintaining the standing position, and too often has the leg
corresponding to one first attacked become also affected, leaving
both of the anterior or both of the posterior ultimately affected in
a serious manner.
It is common for laminitis to follow intestinal congestions,
especially if these result from the administration of a drastic
purge, as aloes for example, and this is a very serious form of the
disease. Tisserand has seen laminitis of the anterior extremities
following parturition in mares, and particularly after abortion.
Gloag and Smith have observed similar facts. Hertwig says that
it sometimes follows rheumatismal affections, especially the acute
form.
A metastatic laminitis has been seen following diseases of the
chest. H. Bouley does not believe in these cases, and thinks the
laminitis is the effect of the quadrupedal standing position, or
also the feeding with farinaceous substances in too great quantity.
At times, founder accompanies malignant fevers, such as anthrax
and typhoid attacks, which are always accompanied with a certain
alteration of the blood.
VIL. Zreatment.—In acute laminitis all attempts must tend
to remove the congestion of the keratogenous apparatus, or at
least to abate its intensity, so as to prevent or diminish the seri-
ous sequels that may too often follow. To effect this, general or
DISEASES. i
o
local bleedings have been specially recommended, with antiphlo-
gistic applications upon the congested regions. General bleeding
at the jugular is especially indicated; a large bleeding of from
five to ten litres, repeated if the pulse or the condition of the dis-
ease indicates it. Local bleeding, often recommended, seems to
us, generally speaking, to be useless ; that of the toe is of difficult
performance in founder, as the feet are usually raised from the
ground with difficulty, and the operation is quite painful, and
may give rise to more or less serious complications. However, in
serious cases it can be done while the animal is thrown down, not
somuch on account of the blood depletion as to prevent the pos-
sibility of gangrene supervening. It is more useful in the ox,
according to Lafosse, who recommends to pare the foot down to
the quick and to put on the shoe again if the animal has to con-
tinue its journey.
The topical applications employed are varied and numerous:
the simplest and most practical is cold water, cold baths at half
the leg (Fig. 520); take in running water,
if it can be done, and if the animal stands
up; walking in the water is then recom-
mended, if practicable, walking increasing
the venous circulation of the part. Instead
of running water, ponds, marshy grounds,
pools of stagnant water, or even liquid
manure may serve the same purpose. In
establishments where horses are numerous,
there are special tubs where the water is
constantly changed. The animal may be -
placed in some of these, up to his fetlock,
in an astringent solution. Mathew has in- Z
vented an apparatus for continued irriga- Fis. 520.—Local Cold Douch
tion, consisting of a reservoir of water ele- Tea
vated above the body of the animal; around each coronet is placed,
in shape of a bracket, a tube of india rubber, perforated with holes
opening on the hoof; from the reservoir runs a tube which bifur-
cates and furnishes to each leg a descending division connected
with the bracket (Fig. 521). The water is then allowed to run
around the coronet and drip over the foot. Instead of simple
water, the use of snow or broken ice has been recommended,
wrapped in cloth round the hoof; pads of oakum dipped in solu-
\\
\\
\\
44)
690 OPERATIONS ON THE FOOT.
a
Fig. 521.—Apparatus of Mathew for Cold Water Application.
‘tion of salt, sulphate of iron, or alum; clay poultices mixed with
vinegar have also been used. As the heat of the foot has a ten-
‘dency to rise, the temperature of the liquid or of the topic used
must be often changed in order to keep up its antiphlogistic ef-
‘fect. Baths of sulphate of iron are especially indicated in cases
of traumatism.
Irritating frictions, used as derivatives, are also recommended,
but their efficacy in this case is at least problematical. Irritation,
when the congestion is somewhat passive, is not easy to produce.
However, frictions of the hock with oil of turpentine, by the pain
they produce stimulating the animal to move and not allowing
him to remain in a state of almost complete immobility, may be
advantageous. Blisters around the coronet are useful toward the
third or fourth day, when plastic exudation or hypersecretion of
the hoof are to be feared.
Frog seton is recommended by English practitioners ; Gabriel
says it is a sure means to prevent the separation of the nail. This
seems tous unwarranted. Internally, the administration of ni-
tre, cream of tartar, ammoniacal salts, sulphate of soda, are given;
drugs which are indicated by the febril state; alkaline remedies,
and principally of nitrate of potash in large doses, are administered
to render the blood more fluid and increase the venous circulation.
Aloes, recommended in England by Hertwig, are contra-indicated,
as increasing the disease and facilitating the dropping of the foot.
_ DISEASES. 691
It has been advised to take the shoes off. This is not only a
difficult operation, on account of the sufferings of the animal, ob-
liged to stand upon one leg, but it seems to us useless. Shoeing
has not the effect supposed of it in the etiology. If it is well
fitted it is not uncomfortable to the foot, while its removal from
the foot, hy the hammering it requires, is always painful, and had
better be avoided.
It has been recommended to pare the foot, to shorten it, to
thin the sole down; but this operation seems to us in many cases
superfluous. It is true that the topics will act more readily upon
the living tissues underneath, but the advantages thus obtained
do not compensate for the difficulty of the operation; at any rate,
it cannot be done except when the animal lies down.
We shall pass silently the effect, so to speak homeopathic,
that English veterinarians pretend to obtain with very warm
poultices around the foot, and which have their reasons only when
suppuration or gangrene is threatening. Neither shall we refer
to the compression of the foot, recommended by Nanzio—a treat-
ment which is much nicer in theory than in practice. In a great
number of cases, the patient is considerably relieved by resting
on a good bed, and this is especially necessary for severe laminitis
when locomotion is very painful. However, in less serious cases,
walking on soft ground, especially on grass, is an excellent treat-
ment. It stimulates the circulation in parts where the blood has
a tendency to accumulate, and controls the venous engorgement
of the keratogenous tissue. It has been sometimes recommended
to support the animal in slings to relieve him; but as with this
one would expose his patient to pulmonary complication, it is bet-
ter to cast him and keep him in that forced position, being careful
to turn him over from time to time.
A dietetic regime, light feeding, during the first days at least,
cooling drinks, rectal injections and comfortable blankets are all
indicated.
One must particularly watch what takes place in the foot, and
for this purpose grooves made at the surface of the foot have also
been recommended; but they cannot be made deep enough, as
the wall is always there resisting more or less to the eccentric
forces of the deep parts.
If toward the third or fourth day there is no marked improve-
ment, especially in traumatic founder, if even the patient becomes
692 OPERATIONS ON THE FOOT.
worse, if the pulsation at the digital arteries is stronger, harder
and more frequent, it becomes necessary at once to thin the sole
down, and make a puncture upon the line of demarcation of the —
sole and wall with the drawing knife. Often then a flow of pus
or blood, more or less altered, takes place, the nature of which in-
dicates the progress of the disease. If it is of a grey blackish
color, it is evidence that the horny tissue only is affected; while if
white, it indicates a greater change. Hertwig advises this opera-
tion always, when laminitis is of long duration. He thus pro-
duces an artificial seedy toe, which is considered the mildest form
of the disease. He recommends to make a deep groove upon this
white line so far as there is separation of the wall from the podo- _
phyllous tissue, and then combines the treatment with the use of
astringent baths of sulphate of copper. We have, on several oc-
casions, been pleased with this treatment, combining it with the
application of a blister around the coronet. It is preferable to
the longitudinal grooves, or to trephining, which is sometimes
recommended.
There are numerous cases, however, when, notwithstanding all
these rational means, the disease cannot be arrested, and when a
fatally chronic laminitis ensues. This must be considered incur-
able in the majority of cases. It is almost impossible to bring
the foot back to its physiological condition, and, above all, to pre-
vent the hypersecretion of the hoof which characterizes it.
However, in case of simple seedy toe, if it is the result of
hemorrhage, or even of suppuration, a cure may sometime be ob-
tained. Generally, by thinning it down, the entire portion of the
wall which, at the toe, the mamme and the anterior part of the
quarters is superposed, to the keraphyllous hoof, without adhering
to it, is removed. The keraphyllous hoof, also, is thinned down
in its whole extent; then a dressing of hoof ointment or tar is ap-
plied so as to protect it from drying and to keep it supple. In
these cases, the hoof coming down from the coronary band has
sometimes united with that flowing over the podophyllous laminz.
At other times the seedy toe is only cleaned of its contents, and
is filled with medicated oakum, if there is a wound of the podo-
phyllous tissue, or with hoof ointment and Venice turpentine, the
whole being kept in place by a wide web shoe. The last treat-
ment seems to us the best, only instead of hoof ointment we em-
ploy gutta percha, melted with gum ammoniac, as recommended
DISEASES. 693
by Defays. For this there must be no wound, and the cavity
must be well cleaned of all substances, or even washed with ether
to remove all greasy substances which would prevent the gutta
percha from adhesion with the hoof. This course has enabled us
to see deep seedy toes recover by the gradual growth of the foot.
Hence, the indication to try to obtain an artificial seedy toe as
early as possible, as recommended by Hertwig.
When there is thickening of the keraphyllous horn and adhes-
ion with the wall; when, also, the toe is formed entirely by a de-
formed horny mass, the case is more serious and the treatment
more uncertain. It has been recommended, wrongly, we believe,
to perform the operation which consists in cutting off all the pro-
truding hoof—to even cut off all the accidental production. To
do this the rasp and drawing-knife are used, the keraphyllous mass
being thrown down as much as possible. D’Arboval has also ad-
vised to make with the drawing-knife an artificial seedy toe be-
tween the internal face of the wall proper, which is preserved, and
the anterior face of the podophyllous apparatus, upon which a
thin layer is left. This treatment has an advantage over the other
of keeping the wall intact, to render easier and more solid the
application of the shoe which is to protect the foot and allow the
animal to resume his work. This operation, however, is only pal-
liative. It, however, gives great relief, especially in the first steps
of chronic laminitis.
Gross has been satisfied with thinning down with the rasp the
superior part of the wall, below the coronet, in a width of about
four centimeters, in such a way that from one heel to the other
there was only a very thin coat, which he protected with basilicon
ointment. The coronet was then stimulated with a little oil of
cantharides. Under this treatment, a new growth of hoof is
started, not so protruding, and by paring down by degrees the
hoof, a new foot was grown in a few months, less deformed and
more regular.
Meyer and Gunther.say that they have obtained good success
with this treatment, which nearly resembles that of Gohier and
Dehan, except that with those the entire wall was pared down to
a thin pellicle, flexible under the pressure of the finger. Silber-
man advised to place around the hoof, below the coronary band,
after paring it down thin, a band of steel, two fingers wide, which
could be tightened by a screw placed at the heels. In this way
694 OPERATIONS ON THE FOOT.
the secretion of the coronary band was kept under control, but
not that of the podophyllous tissue.
Generally in these cases the suppleness of the hoof must be
kept up by appropriate topics. It must be cut off when too thick,
and a shoe must be applied sufficiently wide in the web to protect
the anterior part of the sole as far as the point of the frog. This
shoe must be quite hollow on the foot surface, so as to avoid any
pressure upon the sole. It must be nailed on principally at the
heels, as nails at the toe would not hold sufficiently. Between the
shoe and the foot a piece of gutta percha, or felt or leather may
be put on. Thus shod, a horse will still do long service, even in
cities, and much more in the country.
When there is a wound at the sole, with separation of the part,
suppuration, caries of the os pedis, which protrudes through the
sole, it is advised to have recourse to a surgical operation. The
contents of the abscess under the sole must be evacuated, and the
sole thinned down in the entire plantar region. If the bone is
carious it is scraped, the necrosed parts are removed, and a proper
dressing, kept up by plates under the shoe, is put on. There are
a few cases where, by this treatment, horses have been enabled to
resume their work.
Often in chronic laminitis when, notwithstanding the opera-
tion and the shoeing, the horse is unable to resume his work, ac-
cording to H. Bouley, the operation of neurotomy will then be
beneficial. Grad is not of the same opinion. He claims that the
relief is then uncertain and only temporary. Jessen and Hering
say that this operation is followed very often by the sloughing of
the hoof, and the animals stumble very easily. According to
Braull this operation is followed by a greater growth of the hoof.
Tf the lameness is reduced after the operation the deformity of
the foot continues to increase.
Navicutar DIsEAse.
Synonyms.—Chronische Hufgenklahme, German; Maladie
Naviculaire, French. This disease, called by Loisel and H. Bou-
ley, podosesamoideal synovitis (synovite podosesamoidienne) ; by
Braull, chronic podotrochlitis, is an inflammation of the sesamoid
sheath of the horse, that Turner and some other English veterin-
arians were the first to describe, and which is mostly observed in
thoroughbreds.
DISEASES. 695
The disease is principally seen in the fore feet, and more com-
monly in one foot alone; sometimes, however, both legs are
affected, one first, and the other following. Navicular disease of
the hind feet is seldom observed.
It is accompanied with lameness and deformity of the foot,
and often proves rebellious to treatment. it is followed by con-
traction of the heels (encastelwre) which is itself often mistaken
for navicular disease. At any rate, the affections are nearly re-
lated, whether the disease of the sesamoid sheath, first occurring,
is followed by the contraction, or that the hoof, originally con-
tracted, gives rise to the subsequent alterations of structure
which constitute navicularthritis. At present we shall only con-
sider the deep inflammation of the podosesamoideal articulation,
occurring without primitive alteration in the form of the foot.
I. Symptoms.—These are at first obscure. The lesion is
deeply situated, and is, so to speak, concealed in the hoof, which
itself, is generally at first of very limited extent. The first symp-
tom which attracts attention is the lameness, which sometimes,
indeed, seems to be merely a certain weakness of the affected leg.
This lameness is at first intermittent and slight, but gradually in-
creases. When in the stable, the animal “ points,” that is, the dis-
eased foot is carried forward of a vertical line, and assumes a
state of general relaxation of the muscles, with the coronet
straightened and the foot mostly resting on the toe. This in-
complete rest of the leg, which is sometimes kept in motion for-
ward and backward, becomes especially apparent if the animal is
moved backward in his stall. He then sets down his foot with
much hesitation, and for a short time; the same thing also occurs
when, in order to relieve the opposite leg, the animal puts all his
weight on the diseased one. Still, a close examination of the foot
fails to reveal any marked lesion; no change of form appearing,
no wain at the coronary band; merely a little heat toward the
heels, or on the frog, where there can also be found a certain
amount of low and deep sensibility, made apparent only by per-
cussion of the hammer upon the foot, or by the pressure with the
blacksmith’s nippers, principally toward the heels and the frog.
According to Lafosse, the frog is often found indurated, atrophied
and thrushy. If exercised, the horse frequently stumbles, and
sometimes falls on his knees; he fears the pain of resting the
heels on the ground, and is limited in the movements of his knee
696 OPERATIONS ON THE FOOT.
and fetlock. If the heels are pared off, in such a manner that the
frog is well prominent, and the horse becomes much heated, the
lameness is increased, although at first it may have been very
slight. Blacksmiths may frequently obtain the same result by
placing under the foot a bar shoe, which, then resting on the frog,
and not the heels, greatly aggravates the lameness until it be-
comes excessive. This mode of diagnosis was originally indicated
by Brauell: When, after more or less exercise, the animal is left
to cool off, he at once points, straightens his fetlock, and slightly
flexes the knee; the leg has a trembling motion, and no rest is
taken upon the heels.
There are, however, according to Hertwig, cases where navicu-
lar disease suddenly reaches a period where, in the stable, the
animal avoids all resting on the heel; points constantly, and hes-
itates to put his foot on the ground when made to walk. It al-
ways seems that there must be some traumatic lesion in the foot,
as a punctured wound or a suppurating corn; and still there is
no increased heat in the hoof, and no extraordinary pulsation of
the arteries of the foot.
The disease has a tendency to increase, and the animal soon
becomes very lame upon being put to work, especially on a hard
road or rough ground. The heat of the foot is increased princi-
pally after work, though not in proportion to the lameness. The
sensibility of the foot is also more manifest under the exploring
pressure of the nippers. In the stable the pointing is well
marked, and the trembling of the leg gives signs of deep and per-
sistent pain. It is only after several months of this suffering that
the foot begins gradually to showa changeof shape. It then be-
comes visibly narrowed and elongated, in a manner which can
readily be detected both by sight and management. There is a
general atrophy of the hoof; the periople has disappeared, or
seales off; the foot becomes covered with ridges, more or less
marked, but better developed toward the heels; the frog has be-
become sunken and atrophied; the sole is ecchymosed, present-
ing evidences of corns; and the leg is atrophied, especially about
the muscles of the shoulder.
In cases where both fore feet are affected, the animal points
with either foot alternately, while seeking the desired relief for
each, but the rest on either is very short. The hind legs are
brought under the centre of gravity, the back is arched, and the
a
{
7
|
DISEASES. 697
decubitus prolonged. In stepping out of the stable, both fore
feet are held stiffly, and kept close to the ground, the animal
stumbles on his fetlocks, and often falls, and one might suspect
him of being weak. In walking, his shoulders seem to be rigidly
attached to his body, but as he warms up the legs move more
freely and his actions become less limited; but immediately on
cooling off, and especially the day following one of hard work, all
the symptoms reappear, with even aggravated intensity. The
disease increases steadily with the lapse of time. When one, or
what is more rarely the case, both hind feet are affected (Loiset
has seen it occur), the animal is stiff behind; he is Jame on oneor
both feet; he puts his foot on the toe only; knuckles at the fet-
lock; and presently an atrophy of the muscles of the superior
regions takes place.
Il. Progress, Duration, Termination.—The disease gener-
ally maintains a steady progress; nevertheless it very often un-
dergoes a remission, due to the hygienic conditions in which the
animal is placed; to the seasons; to the state of the atmosphere,
and to other causes. It may diminish in severity, and its symp-
toms disappear, while in its first period, if the animals are left at
rest—without shoes if possible—loose in a box, with damp bed-
ding, or in a marshy field; or in winter, during the rainy season,
while the atmosphere continues in a moist condition for a long
period. It is, under these circumstances, not uncommon to see
feet which had become contracted quite recover their natural di-
mensions. Aside from these exceptional cases of recovery, the
lesion keeps on slowly destroying the tissues where it exists; the
lameness remains constant, or becomes intermittent for years,
sometimes after the animals have become entirely unfit for work,
There are frequent complications involving the surrounding
parts; sometimes a true arthritis, and besides the complete atro-
phy of the muscles of the shoulder, the carpal ligament becomes
thickened, the tendon of the perforans undergoes the same alter-
ation, and ring-bones and side-bones may follow. Again, how-
ever, the animal may become knuckled to such a degree that he
can scarcely rest his foot on the ground at all.
Ill. Pathological Anatomy.—As we have said, the disease
has its seat in the synovial capsule, formed by the small sesamoid
sheath between the navicular bone and the perforans tendon, slid-
ing upon it. At first may be observed a certain injection of the
698 OPERATIONS ON THE FOOT.
synovia, and a darker hue in the coloration of the trochlear carti-
lage with the corresponding face of the tendon, the synovia be-
coming reddish and thick, the surrounding cellular tissue becom-
ing, also, inflamed and infiltrated. At a later period, when the
disease has somewhat progressed, there is a thickening of the
walls of the capsule, which is then filled with a clear citrine ser-
osity. There is then, a kind of hygroma, a chronic dropsical con-
dition of the sheath. In the interior of this are also to be found
fibrous bands, running from the tendon to the bone. If the dis-
ease is older, erosions are found upon the diarthrodial surface
of the navicular varying in number and in size, and the tendon
is roughened on its anterior face with longitudinal fissures. At
times, it becomes atrophied and thin, dry and brittle; and has
been found, it is said, ruptured transversely. In many cases, the
cartilage covering the bone has disappeared and the bone is ex-
posed, hollowed and affected with osteoporosis. The union of the
bone with the tendon has also been found among the varieties of
determination.
IV. Diagnosis.—This disease is at first easily mistaken. for
some form of rheumatic affection. Where pain is the main symp-
tom it is easily detected, but where there are no other signs of in-
flammation, it is just the lack of proportion between the intensity
of the lameness and the serious symptoms, such as the absence
of heat; of special sensibility; of pulsations in the digits, which
distinguishes navicular disease from other affections of the feet.
The error with contracted heels is easier, as here the change of
form of the foot being primitive, at once attracts the attention of
the practitioner; while this alteration in the foot is absent in
nayicularthritis at the outset of the disease.
V. Prognosis.— Generally, it is unfavorable, as most com-
monly the veterinarian is called only when the disease has already
made serious progress and passed into the chronic stage; and
again, because of the difficulty of reaching the disease by reason
of its peculiar location.
VI. Etiology.—To properly understand the etiology of this
disease, one must bear in mind the part played by the anterior
legs in the action of locomotion. Columns of support more than
of impulsion, it is their office to sustain the weight of the body
when it is thrown forward by the extension of the hind legs. The
reaction of the ground is first felt at the shoulders, through the
DISEASES. 699
muscular slings which attach them to the trunk, but it is partly
diminished in the scapulo-humeral joint, which closes, notwith-
standing the resistance of the muscles implanted on its apex. The
remaining force is transmitted to the vertical column, represented
by the union of the radius, the carpus and the metacarpus. Reach-
ing the digital region, this force is there decomposed. Part of it,
passing on the phalanx, loses itself and disappears in front of the
horny box of the foot, the other being thrown upon the flexor
tendons, and finally upon the perforans, which distributes it to
the posterior parts of the foot, and to the navicular bone. It must
be observed that in this complex action of decomposition of the
shock, the os sesamoid, though pushed from before backward by
the os corone is, however, supported by the resistance of the per-
forans tendon. Consequently, both the bone and the tendon are
pressing upon each other, when the feet are placed on the ground,
throwing the body forward by the impulse of the hinder parts,
and thus press powerfully against each other.
When this pressure takes place in an animal going full speed,
and a good and high stepper, it may commence by becoming
merely a slight confusion, but, if often repeated, the result may
be some lesion upon the corresponding surface of the bone and
of the tendon, or of the synovial which facilitates their move-
ments. But the energy of action in the animal cannot be con-
sidered the only producing cause of these lesions, as a vice of
conformation in the foot, a want of elasticity in its posterior parts
where the resisting power is diminished, may also produce it.
The disease, then, is observed in animals whose plantar cushion,
covered by a small, dry and atrophied frog, is itself badly deyel-
oped, from being compressed between the bars, which are more
vertical, or the heels, which are more contracted; all these be-
ing conditions which diminish the flexibility of the back of the
foot. ;
Two principal causes, then, co-operate in the genesis of navi-
cular disease, and are almost always present in animals thus
affected. On the one hand, it will appear among well-bred ani-
mals, especially those of English breeds, those from Hanover,
Mecklenburg and Normandy, which will be more affected. Loiset
and Lafosse, however, have seen it in common breeds, in animals
with flat feet and soft horns. Lafosse says he has seen it in mules.
But besides this influence of the breed, there is the effect of what
700 OPERATIONS ON THE FOOT.
we may denominate the hygiene of the foot; the too dry bedding,
certain wrong modes of shoeing and all the predisposing causes
of contracted heels. Let us add also, as a cause, the effect of
changing the animals from marshy fields, where they were walk-
ing on soft, damp ground, to stables with dry bedding—a cause
commonly present in horses transported from northern Germany
to the south. Hard work and excessive exercise are also causes
of this affection—for example, jumping fences with a heavy rider,
slipping in steeple-chases, racing, a sudden stop on the fore feet,
especially on stony, hard, frozen or rough ground. All these are
fruitful cases of navicular disease.
Traumatic causes, such as punctured wounds, involving the
sesamoideal sheath, are also productive causes which may origin-
ate navicular disease. We do not believe in internal causes, nor
admit, with Loiset, that visceral inflammation, sudden arrest of
perspiration, especially of the lower part of the legs, can produce
the disease. We should rather anticipate that these metastases
would affect more the more important serous structure. Neither
can we admit, with Lafosse, that this affection can also follow a
sudden arrest of the milky secretion.
VIL. Zreatment.—We have seen, in speaking of the termina-
tions of these lesion, that in certain peculiar circumstances which
may be accounted favorable to the return of the elasticity of the
foot, a spontaneous recovery is possible. This leads us to the
measure of the prophylactic means proper to be used; and it
seems evident that by a better hygiene of the feet, by rational
shoeing, sometimes educating young horses only gradually to fast
work, one may in many cases avoid navicular disease.
While it is in its first stages, one may, with care and patience, —
sometimes relieve the patient. In this case, absolute rest is coun-
ter-indicated, but on the contrary, moderate exercise, upon even
and not too hard ground; or, if the lameness is great, walking
exercise only, at a moderate gait. The absorption of the serosity
present is made easier by a little exercise than by absolute rest.
Bleeding from the toe, er the veins of the affected legs, is also,
at least, superfluous, the disease becoming chronic almost at the
outset. It is also a good practice to shoe the horse, and above
all, to remove the shoe frequently. The best shoeing is that
which allows for the natural expansion of the hoof. The Charlier
shoe has proved useful, while the bar shoe, which is heavier, and
DISEASES. | 701
presses upon the frog, is counter-indicated. It is important to en-
courage the suppleness of the hoof by proper ointment, especially
the application of glycerine, and to have under the feet a bed-
ding always slightly damp and soft. The bedding of moist saw-
dust is very convenient; we prefer it to poultices, and even to the
tepid alkaline baths mentioned by Hertwig. At times, at inter-
vals of about eight days, and then during two consecutive days,
a good friction with blister ointment above the coronet is advan-
tageous, as well as one with Lebas’ ointment. English practi-
tioners prefer salines; the better treatment would be to turn the
animal to grass. Brauell advises iodine internally, and says he
has found it work well. Others recommend diuretics. Setons in
the shoulder or chest seems to us inexpedient. We prefer the ad-
ministration of a purgative ball every eight days. Sewell and
Brauell advise a seton, running from the hollow of the coronet
through the plantar cushion, a little behind the tendon of the
perforans, and within a short distance, therefore, of the diseased
capsule, making its exit at the anterior third of the frog. This
drain is to be maintained for two, three, and even four weeks;
Sewell, Brauell, Hertwig, and several other veterinarians, English
especially, claiming much benefit from it. This seton is intro-
duced by means of a curved frog seton-needle; it has been used
but little in France. Bruner has recently proposed the puncture
of the sesamoideal capsule with a trochar, introduced into the
hollow of the coronet, an operation only practicable if the serous
collection can be felt outward. After the puncture, he recommends
an injection of iodine.
Lafosse proposes after the removal of the sole, the transversal
incision of the plantar cushion, with removal of a part of it, down
to the tendon, following the axis of the sesamoid; then the cau-
terization of the bone and its cartilage, in imitation of what is
sometimes done in punctured wounds of the foot. Brauell recom-
mended as a useful surgical operation, the section of the perforans
tendon in the metacarpal region, in order to prevent friction
against the sesamoid groove, and to allow an easier adhesion be-
tween the tendon and the bone. But it is to be feared that this
section, supposing that it proves successful, might so weaken the
tendon as to render the animal unfit for fast work.
If navicular disease should be accompanied with deviation of
the wall, and contraction, true or false, the treatment will be that
702 OPERATIONS ON THE FOOT.
of this affection in its simple form. An operation, often recom-
mended, has been that of neurotomy, upon the posterior branches
of the plantar nerves, repeated at intervals of at least fifteen days,
in order to remove the lameness wholly, without entirely depriv-
ing the foot of the sensibility of feeling. Berger, Brauell, Bou- ;
ley, Gross, Mandel, and others, have obtained real success by it;
but it is attended with serious dangers; at any rate the benefit is
not of long duration, or about one year. The animal then stumbles
more readily, and is more exposed to traumatic lesions, etc., and
it is probable from this cause that double neurotomy is seen to be
followed by softening of the deep parts of the foot, suppuration,
sloughing of the foot, while the animal has previously shown no
signs of pain. Consequently, neurotomy is an operation which
finds its application only in peculiar and exceptional cases, and
animals thus operated upon remain fit for ight work only.
QUITTOR.
Synonyus.— Fesselgeschwur, German; giarda, Italian ; gialarrs,
Spanish; javart, French.
A name of unknown etymology, by which old hippiatrics desig-
nate various affections of the inferior regions of the legs of the
horse, donkey and mule, and even of bovines. These possess the
common character of a degeneration of a portion of the tissues,
that is expelled by the efforts of nature under the form of a slough
(bourbillon). There is a softening of the mortified structures,
and an elimination by suppuration. In several old works, these
sloughs are called quittors (javars), and this name has been ex-
tended to the disease itself.
This name having been preserved by use, notwithstanding the
efforts of Vatel in opposition, we shall also employ it, and with
Girard, recognize: 1st. The simple or cutaneous quittor, which
is only the furuncle which occurs in the thickness of the dermoid
structure nearest to the coronary band. 2d. The tendinous quit-
tor, which greatly resembles the felon of man, where a portion of
the sub-cutaneous cellular tissue, and of a tendon sloughs out.
3d. The sub-horny quittor, the furuncle of the cutidura of the
coronary band itself, the slough involving the superior portion of
laminated tissue. 4th. The cartilaginous quittor, or the limited
caries of the lateral fibro-cartilage of the os pedis, and which old
writers compounded with the horny quittor. We might join to
DISEASES. 703
those the furuncle of the frog. We believe it useless, at present,
to enter upon a general consideration of quittor, and will pro-
ceed to examine the pathological phenomena presented by each
variety.
A. Curanzous Qurrror.—This is a simple furuncle of the
coronary region of the foot, in that part of the dermis nearest to
the coronary band, having, however, a special character on account
of the extraordinary thickness and inelasticity of the dermis of
the region it occupies, the result being a kind of strangulation of
the inflamed tissue beneath, and a very painful compression. It
is through error that some authors have designated by the same
name, the furuncle of the canon, of the fetlock, and of the co-
ronet.
The hind feet are more subject to it than the fore, and it is
more frequent at the heels, at the flexure of the fetlock, though it
is also observed on the sides and front of the coronet, in which
case it is much more painful. Cutaneous quittor has also been
observed in bovines, where, however, as we shall see as we pro-
ceed, it is generally complicated with the tendinous variety, and
becomes a true felon.
I. Symptoms.—Cutaneous quittor is characterized by an in-
flammatory tumor or swelling, warm, painful, and tense, of the
coronary region of the foot, the color of the skin being but little
changed, if it is dark, but if the skin is light then the redness
is well marked. This swelling is accompanied with a diffused
edema, extending to the fetlock, or even to the hock. We often
find angeioleucites, or rather what we call leucophlegmasiz. The
lameness is generally extreme, and the animal frequently can
scarcely rest on the diseasedleg. The pain is sometimes so great
as to induce general fever and loss of appetite, and the animal
becomes dull and depressed. After acquiring certain dimensions,
the tumor shows a tendency to soften at its summit, its base,
however, remaining hard for a considerable time. Rising more
and more, it soon ulcerates at a point from which flows a small
quantity of bloody pus, followed by the appearance of the slough,
(60urbillon). An abscess is now formed in the tumor, which, as
it opens, carries with it a portion of the skin, sometimes limited,
at others measuring from four to ten centimeters, and there is a
slough formed of the subcutaneous cellular tissue which separates
by the suppuration with the portion of dead skin. This comes
704 OPERATIONS ON THE FOOT.
out by degrees. It is still adherent by its base and cannot be
pulled out with the forceps unless by tearing and with acute pain,
and this is often followed by slight hemorrhage. A few days
later it will, however, become entirely loose, and in its place there
will remain a cylindroid open cavity extending through the tu-
mor, from its summit to its bottom, and from this a deep wound
results, followed by a sero-bloody secretion, mingled with pus.
As soon as the slough has taken place, or when it begins, the
lameness subsides, as well as all the other phenomena of the pain.
The wound heals up rapidly if there is no complication.
Cutaneous may easily be complicated with tendinous quittor if
the disease or process of sloughing of the mortified tissues ex-
tends to the tendons or ligaments of the region involved. This
complication is specially common in bovines, where cutaneous
quittor generally gives rise to more swelling and greater suffering
than in the horse.
The quittor has quite a rapid progress, and may last from
eight to fifteen days; very seldom longer. At times, it seems to
be asingle furuncle; at other times, there are several existing to-
gether. Often again, they come in succession, the first one treated
being soon followed by others. This is said to take place princi-
_ pally when the diseased part remains exposed to the action of ir-
ritating substances, and relapses are prevented by protecting the
part from the effects of these occasional causes.
Il. Pathological Anatomy.—It is an inflammation of the
very abundant sub-cutaneous cellular tissue of the region, spread-
ing from a starting point; the inflamed tissues are mortified and
becomes gangrenous, and by a process of suppuration, the econ-
omy attempts to eliminate them. The slough represents more
particularly the inflamed cellular tissue, which is thickened, and
which has become filamentous and hard and much impregnated
with purulent serosity.
Ill. Htiology.—Contusions of the region, bruises and punc-
tured wounds are quite frequent causes of cutaneous quittor, but
it may also take place without evidence of determining causes.
Mud, manure, urine, all filth in which animals have to walk or re-
main, are also considered as causes. For this reason the disease
is more common in the fall and winter, on account of the action
of cold at times, and frozen mud. It is also more frequent in cities
than in the country. Ray observes that the mud of cities is al-
eee
food
DISEASES. 105
ways more irritating and contains mineral substances, especially
lime, alkalines, and salts, and other substances. The gutters of
some industrial establishments have also a direct irritating action.
D’Arboval has observed that the mud of places where mineral
springs exist, is more irritating, as also are calcareous soils, where
cutaneous quittor is more frequent than in any other. Common,
large horses, notwithstanding their thick skins—or, rather on that
account and on account of the hair which covers it—are more
commonly affected than private horses. Towing horses are much
more exposed to the disease than those otherwise employed.
IV. Treatment.—As a first direction, during the course of
the treatment it is always a prudent rule not to work the animal
and to keep it in the stable, the feet being kept dry on a good
bedding. An internal treatment is seldom necessary to control
the general symptoms; if any is required, ordinary salines will
generally be sufficient. It is necessary to assist the process of
suppuration of the abscess by emolients, warm baths, poultices of
flaxseed or of marshmallows, with melted lard, applied quite
warm, or by the application of a mixture of honey and bran or
flour. We have applied a coating of blister ointment to the tu-
mor, covered with a warm poultice; the maturing effect is then
very rapid. It is often necessary to lance the tumor to reduce
the pain and prevent the mortification of ‘a large piece of skin.
This operation is reeommended by D’Arboval and H. Bouley, and
is specially indicated when the tumor is much developed. It is
then important to incise in the entire thickness of the dermis and
to a sufficient length, and if necessary to make severel parallel in-
cisions which will give rise to a copious flow of blood. In this
mode, the parts are relieved, the pressure of the tumefaction is
reduced and the gangrene diminished, if not entirely prevented.
It is necessary—and we insist on this point—to incise so deeply
that the tumefied skin is divided in its entire thickness. We have
seen blacksmiths thus operate by the introduction of points of
cauterization in the summit of the abscess; but this mode, though
facilitating the sloughing of the strangulated part and reducing
the compression, ought not to be preferred to the incision with a
sharp instrument—cauterization is more painful.
When gangrene exists and the abscess is open, the incision is
certainly less efficacious than at the outset, but it is not for that
reason useless, as it relieves the pain and prevents excessive com-
706 OPERATIONS ON THE FOOT.
pression. We do not by it attempt to loosen the slough, which
it is advantageous to have detaching loose itself when it holds
only by its base. If the abscess, once formed, is slow to ulcerate,
making a point of cauterization is a good way to stimulate the
escape of the matter of the slough. This mode of opening pro-
duces in the part an increase of vital action and forms a sore of
benign character, which falls off by the effect of the suppuration
formed underneath, and which is nearly always followed by a
comparatively speedy recovery. To obtain this radical cure, it
remains to continue the use of the ordinary means to facilitate
suppuration and bring on resolution. If the wound is pale and
covered at the bottom with large granulations, it must be dressed
first with basilicon ointment and afterward with alcoholic liquids,
as spirits of camphor, tincture of aloes, or simply an aromatic in-
fusion; at times, baths of sulphate of iron, with a little sulphate
of copper, are indicated; or, when the wound has become red, the
granulations vascular and of healthy character, a simple dressing
of egyptiacum ointment, diluted in vinegar, is enough. If proud
flesh develops itself, it must be cut off. It is important to have
the wound covered with a protecting dressing, which must be re-
newed daily if the suppuration is very abundant, or it may some-
times be left on for two days.
B. Tenprvous Quirror.—Synonym: Hornwurne (Germ.)—
It is the nervous quittor of hippiatres, and the analogue of the
felonof man. It is again a furuncle, different from the preceding,
only because instead of being limited to the skin and subcutane-
ous cellular tissue, there is caries of a portion of the tendons
(especially the flexors), or of the ligaments of the region, and also,
at times, necrosis of the bone with synovitis and arthritis. By
extension, though we think, improperly, the name has also been
given to the felon of the region of the cannon, while the applica-
tion ought to be confined to that of the digital region, situated in
the fold of the fetlock.
The quittor may be superficial or deep-seated when it affects
only the subcutaneous céllular tissue, uniting the skin to the ten-
dons, or where the inflammation extends to the phalangeal sheath,
and the pus accumulates into it. Differing from cutaneous quit-
tor, this form, generally less common, is more frequently seen in
the anterior than the posterior extremities. It may also be seen
m cattle.
DISEASES. 707
I. Symptoms.—The first symptom is an excessive lameness,
manifesting itself even where no visible change exists in the af-
fected leg. The animal evidently suffers great pain, while his
actions do not aid us in localizing it accurately, though the foot
is always examined as being the probable seat of it, the animal
raising it more rapidly than the other from the ground, and rest-
on it with much caution and hesitation. After from two to five
days, a phlegmonous tumor appears at the coronet, above the
heel. It is extremely warm, and much more painful than that in
cutaneous quittor, the hoof and the skin preventing the free de-
velopment of the inflammation by strangulating it. The foot
almost ceases to rest on the ground, but is flexed and raised from
it, feeling in the parts being very painful. The swelling of the
leg extends to the fetlock, or to the cannons, and even to the
knee. The animal has more or less fever, and when there is a
deep quittor, he loses all his appetite, and ordinarily lies down
and continues in the recumbent position.
Generally, much time is required for the phlegmon to assume
the character of an abscess, as the slough, being in this case no
longer formed by the cellular tissue, is slower to define itself.
This process of suppuration is not so well localized; there is, on
the contrary, a kind of deep abscess, which probably becomes
complicated by the resistance opposed to the ulcerative inflamma-
tion by the aponeurosis of the sheath and the thickness of the
skin. However this may be, it is always very difficult to recog-
nize the presence of one or several of these abscesses, even when
they form in the subcutaneous cellular tissue, and so much the
more if the purulent gathering is deeply seated.
After the opening of the abscess and exfoliation of the slough,
either with or without the dropping of a portion of the skin,
there does not remain the simple wound of the cutaneous quittor,
but on the contrary, a persistent fistula, running down a necrosed
point of the tendons or of the fibrous sheaths. At times, almost
from the outset, we may observe in the fold of the coronet numer-
ous little pimples, which terminate in as many deep fistule, from
which ooze a more or less thick humor, fcetid, puriform and
bloody. In frequent cases, the disease in unaccompanied with
suppuration, and there is a swelling, more or less hard, with a
gradual diminution of the pain and other inflammatory symptoms.
A more frequent complication is the suppurative inflammation of
708 OPERATIONS ON THE FOOT.
the tendinous sheaths, or even of the digital articulations. There
may also be a diffused gangrene with separation of the hoof and
purulent infiltration under the horny box—periostitis, and caries
of the cartilage. This is the deep tendinous quittor in the most
severe form. In this last case, especially if there is an accumula-
tion of pus in the tendinous sheath, the tumor is very painful, the
slightest touch giving rise to the manifestation of extremely acute
suffering, the hoof being constantly raised from the ground. The
fever is violent, there is a complete anorexia, and the exercise of
all functions is more or less disturbed. The compulsory resting
upon the healthy legs may give rise to swelling of the hocks, and
even to laminitis.
In cattle, tendinous quittor becomes more painful than in the
horse, and is always accompanied by a swelling which may extend
to the knee. Rumination stops, and the animal endures great an-
guish. The slough is followed by a wound of varying depth, which
often exposes the diseased articular surfaces of the phalanges. If
this remains too long, the pus may affect the interdigital ligament,
complicate the disease, and even make it incurable. Inthis case,
the amputation of one of the digits may sometimes be performed.
Il. Progress, Duration and Termination.—The duration is
generally protracted; the disease often gives rise to chronic lesions
difficult to remove. This will be easily understood, if we remem-
ber that the region affected is composed, between the skin and
the bones, of synovial capsules, ligaments, tendons and aponeu-
roses, more or less cellular tissue, and of very strong nervous
ramifications. If the disease is not very deeply seated or unilat-
eral, complete recovery may be looked for; but if there are
chronic lesions, if the articular surfaces become affected; espe-
cially if particles of bones are sloughing, if the animal recovers it
will be but imperfectly, and it will usually be accompanied by
anchylosis of the joint, and diffused gangrene is also a complica-
tion to be looked for.
III. Diagnosis.—We said at the beginning that tendinous
quittor is a very obscure disease; the lameness is very great, but
not characteristic; in proceeding, we referred to the acute local
pains at the side of the tendinous cord of the cannon, the inflam-
matory swelling, the increase of local pains, and the general reac-
tive fever.
IV. Prognosis.—It is a very serious disease, on account of
DISEASES. 709
the possible complications and sequele. The loss, or the deform-
ity of a phalanx, which are sometimes arrong the sequele of the
felon of man, are in him accidents which never give rise to serious
complications, or are quickly forgotten, while in the horse such
complications are equivalent to the death of the animal.
V. Htiology.—The causes are the same as those of a simple
quittor, which is complicated with the tendinous kind; this is also
observed after the subcutaneous abscesses, frequently resulting
from bruises, or even from punctered wounds. It is most com-
monly met with in low-bred horses, and Fisher says that it is
more frequent, and less malignant, in young than in adult ani-
mals; according to this writer, it is a common manifestation of
distemper. Irritating muds favor its development in the same
manner in active asinsimple quittor. It often appears without
appreciable causes.
VI. Zreatment.—When tendinous quittor is superficial, it re-
quires about the same treatment as the simple kind, except that,
in this case, the counter openings must be made early to prevent
the sloughs, migrations of the pus and the gangrene. The sur-
geon must not forget that the inflammation in this affection must
ordinarily terminate by suppuration, and he must bear in mind
that there is a possibility of the modification of the inflamed cell-
ular tissue, and that the mortified portion of that tissue must
slough out, as their presence, too long continued, may be very
dangerous. The general indication is to prevent, as much as pos-
sible, the accumulation of the pus, an indication which will be
best fulfilled by making openings for its escape, even before the
formation of the abscess. As the tissues which surround the pus
are very resisting, nature will not be able, or if so, only with great
difficulty, to effect the expulsion of these matters. It is for this
reason that it is necessary to assist her operations by making an
opening for the escape of the pus and of the slough. The opera-
tion is without danger; but if it is not performed in good time,
lesions will be likely to spread, the disease cease to remain a local
trouble, and the life of the animal become compromised.
It is also more necessary to make an opening when the puru-
lent secretion is established, for in this case it is important to
avoid delay and to facilitate its escape. A simple longitudinal in-
cision, four or five centimeters long, is sufficient, when the collec-
tion lies immediately under the cutaneous organ. This incision
710 OPERATIONS ON THE FOOT.
must involve the whole thickness of the skin, as far as the ten-
dons, and should be made in the middle of the coronet region, as
near the footas possible. It gives rise to an abundant hemor-
rhage, which relieves the part, and warm poultices and baths, to
accelerate the suppuration, are then indicated.
When the product of suppuration has passed in the tendinous
sheath, a longitudinal opening of this part towards the most de-
pendent points, is indicated. To do this, a canulated directory is
introduced to guide the bistoury; when the incision is made, the
pus flows freely, and by this mode the large blood vessels and the
various ligaments of the region are avoided in the operation.
Notwithstanding the incision, or if the suppuration had already
accumulated before it was made, the pus may also accumulate in
the pouch formed by the tendinous sheath behind the tendons. It
is then very difficult to prevent its collection in those deep parts,
and it may extend to the small sesamoid. It is because the pus
cannot run toward the skin that it filtrates along the tendon. It
is only by pressure and by injections that the indications presented
can be fulfilled. After making free incisions, one may try by pres-
sure to remove the pus accumulated between the tendons and their
sheaths, following it by cleansing injections, which must be re-
peated as often as possible.
The wounds which remain after the slough, in the superficial
tendinous quittor, and that which follows the opening of the
simple or multiple abscesses when it is deeper, are always charac-
terized by the presence of fistulas running down to some necrotic
spot of the tendons or of their sheaths. For these, an injection
is recommended of tincture of aloes, tincture of iodine, and some-
times of Villate’s solution; lately, dressings with petroleum or
phenic acid have been used. Phenicated baths, those of sulphate
of iron and lotions of permanganate of potash have also proved
useful. At times, when the fistulas are persistent, it is necessary,
after enlarging them, to have recourse to actual cauterization with
a pointed cautery introduced, while at a white heat, down to the
bottom of the tract. A general dressing of the wound follows,
with tincture of aloes, sometimes with egyptiacum. The dress-
ings should be more or less frequent, according to the quantity of
the pus discharged. We must dress it until the wound is entirely
healed, and it must, moreover, be carefully watched for fear of
another infiltration of pus, or the formation of other fistulas.
-———_—
— a ee
od
DISEASES. 711
Superficial cauterization is necessary in order to remove the
induration and swellings likely to follow, and to stimulate the
resolution. The action of the firing may be stimulated by blister-
ing, or by an alterative ointment of iodide of mercury, of sulphur,
ete.
C. Sus-Horny Quirror.—This is the inflammation of the su-
perior part of the keratogenous apparatus of the cutidura; or
even of the superior parts of the sensitive laminz. This quittor
is, therefore, located under the horny box, and is more like the
cartilaginous kind, which old hippiatrics, and especially Solleysel
and Garsault, describe with it. It generally takes place on the
quarter, and more seldom at the toe, or at the mammez. Some.
times it is observed at the heels, but it is then of small conse-
quence.
I. Symptoms.—The lameness is very great. The animal
walks on three legs, and there is strong reactive fever, due to the
excessive pain—this form of the disease being more painful than
the others, in consequence of the pressure of the horny structure
upon the inflamed tissues. At the origin of the nail a warm and
very painful tumor is found; the foot is hot and the hairs staring
on the site of the injury. If the disease has existed for some
time, there is a separation of the hoof at its origin, due to a sero-
purulent exudation, and under the hoof suppuration and mortifi-
cation of a more or less extensive portion of the coronary band,
or of the lamin will be found. The suppuration which there
exudes varies, being in rare instances blackish, as it is usually
found in traumatic injuries of the hoof; or, again, it is white and
unctuous, with the odor of decaying cheese; while more commonly
it consists of a bloody or greyish matter, mixed with pus.
If the mortified portion is not deeply seated, so that the slough
can take place readily, the quittor is quite simple, since as soon
as it has dropped off there is a well marked improvement. The
pain then ceases almost instantaneously, and the wound at once
progresses toward cicatrization. But it is not rare, even when
the mortification is somewhat superficial, to find the sub-ungueal
suppuration extending so that the matter runs under the hoof,
producing at times more or less serious fistula, or a separation of
the sensitive and insensitive lamine. Girard says it has been seen —
to extend downward to the sole, and to separate it from the vel-
yety tissue. The deep, sub-horny quittor may be complicated,
FLD, OPERATIONS ON THE FOOT.
forward, with necrosis of the tendon of the extensor muscle; with
the inflammation of the joint; with caries of the os pedis, and
even to assume the cartilaginous form of the disease by its exten-
sion to the cartilages of the foot.
After the recovery of the sub-horny quittor, if the coronary
band has been mortified in its entire depth, the foot may present
permanent longitudinal fissures, or seams, or transversal grooves,
presenting evidences of the existence of a cicatricial tissue when
the quittor was in progress.
Il. Prognosis.—The gravity of this quittor depends upon
the depth of the disease. When superficial and affecting only
the surface of the tissue, itis easy to cure, but if deeply seated
it is more serious, on account of the possibility of complications.
III. tiology.—Bruises and violent blows are the ordinary
causes of sub-horny quittor. It is commonly due to overreach-
ing, or to the wounds occurring when animals are wearing long
caulks, as in winter. The irritating effect of frozen mud has also
been admitted as a cause.
IV. Treatment.—The superficial quittor requires a simple
treatment. Kmollient baths and maturating poultices are then
indicated. It is a good plan to thin the wall with the rasp or the
sage knife over the whole extent of the furuncular tumor to a
height of about two fingers, A compress of chloroformed oil,
while it alleviates the pain, is also indicated to soften the wall.
It frequently becomes necessary to puncture the tumor, but we
prefer to cauterize it with a pointed iron, following the cauteriza-
tion with a poultice of honey with Venice turpentine or camphor.
Some authors recommend astringent baths, as oak bark, or of >
sulphate of iron. Itis often the case that after some interval fol-
lowing sloughing of the bowrbillon, the wound continues to dis-
charge a liquid secretion, which is an evidence that there is a ten-
dency to accumulation of matter toward the lateral cartilage, or
under the wall, in the laminz; or that there is some carious spot
existing. In the first, if probing horizontally, a cavity is de-
tected, it is convincing evidence that a cartilaginous quittor is in
course of development; in the second case, the pressure and col-.
lection of the matter increases the inflammation of the lamina,
separates the wall, and complicates the disease, necessitating the
operation of the sub-horny quittor.
The removal of the portion of the hoof which covers the lesion,
DISEASES. 713
must, however, include more than the purulent center, so tnat the
diseased tissues may be well exposed and the suppurative process
detach them readily. This removal, always proportioned to the
internal lesions, is made either lengthwise, following the direction
of the horny fibres, or crosswise. In that case, it will attack only
a portion of the wall toward its point of union with the skin,
This latter method, it is true, requires less cutting, but it has sev-
eral quite serious objections and often necessitates a second oper-
ation. Even in cases where the growth of the granulations can
be controlled, and where a good return of the horse is obtained,
the horse only recuperates its perfect integrity by the slow growth
downward of the wall. In some circumstances the operation is
completed by the removal of a portion, or even of the entire mass
of the sole, when it is separated from the velvety tissue.
The removal of a portion of the wall must be accomplished in
the manner which will be indicated for cartilaginous quittor, in
carefully avoiding the injury of the coronary band and of the
podophyllous tissue. The diseased tissue beg exposed, all that
is of bad appearance is removed, the carious portion being freely
taken off. An ordinary dressing of oakum with diluted alcohol,
or any other drug, kept in place with a light shoe or slipper, en-
tire or truncated, as the case requires, is then applied.
As for all wounds of the foot, the dressing needs only to be
changed when the pus accumulated under the oakum, or other
peculiar conditions indicate it. It is true that changing the dress-
ing is an effective means of cleansing the wound, but it has the
inconvenience of also irritating it, and especially at the begin-
ning may tend to interrupt the natural process of repair. It is of
advantage, after the first dressings, to change them as infrequently
as possible. In this way hemorrhages, which may always be
looked for, are avoided. This is a point of the first importance.
It has been proved that even in operations where a portion of the
wall has been removed, a dressing left on for from fifteen to
twenty days without removal, was followed by rapid recovery, the
new hoof growing under the oakum without suppuration. It is
useless to probe or wipe out the surface of the wound. On the
second dressing, that is, after a few days, the parts begin to be
covered with numerous white points, which are so many rudi-
ments of hoof. These, which at first are soft, white, and isolated,
gather together by degrees, and first unite into a thin layer, soft
714 OPERATIONS ON THE FOOT.
and yellowish, which becomes hard and thick; it is the hoof secret-
ed by the lamine, which, little by little, unites with that coming
from the coronary band. Excessive granulations or proud flesh
are removed in the ordinary way.
D. Carrizacinous Quirtor.—Hufknorpelfister (German)—
(improperly called sub-horny quittor, by Lafosse, Jr., coronary
quittor of Vitet; 7ibro chrondritis of the third phalanx, by Vatel;
sub-horny cartilaginous quittor of Girard; quittor proper of Del-
wart). This form of quittor is peculiar to solipeds, they being
the only animals which have fibro-cartilage on the os pedis.
Fic. 523.—Cartilaginous Apparatus of the Hrrse’s Foot.
a.—Lateral fibro cartilage. b.—The superior border. c.—Its posterior border. d.—
Anterior lateral ligament. e.—Flexor tendons. #.—Extensor tendon. g.—Os pedis.
h.—Retrorsal process.
These fibro-cartilages (Fig. 523) are two pieces, which, with
the plantar cushion, complete the os pedis and form the base of
the heels, each representing a piece flattened sidewise, a parallelo-
gram in shape, and extending posteriorly to the coffin bone.
Their external face is convex and pierced with foramina for the
passage of veins, and slightly overlies the surface of the bone of
the foot. It is separated from the skin by a very rich vascular
plexus. The internal face, concave, is hollowed by vascular
erooyves, and covers (forward) the articulation of the foot and the
cul-de-sac of the synovial sac which protrudes between the two
lateral ligaments of that joint. Downward and backward it is
united to the plantar cushion, either by continuity of tissue, as
|
Zz
DISEASES. (ole
-near the inferior border, or by fibrous bands running from one to
the other. The superior border, either convex or straight, is thin
and separated from the posterior by an obtuse angle in front of
which it presents a deep notch for the passage of the blood ves-
sels and nerves. The inferior border is attached, forward, to the
basilar and retrosal processes of the os pedis. Behind this it re-
flects inward, to continue to the inferior face of the plantar cush-
ion. The posterior border, oblique, backward and downward, is
slightly convex and unites with the preceding. The anterior
border, oblique in the same direction, is more intimately united to
the anterior lateral ligament of the articulation and can be sepa-
rated from it only by artificial dissection. It sends upon this
ligament and upon the anterior extensor of the phalanx, a fibrous
extension, which unites with that of the opposite side.
In their structure, the fibro-cartilages comprehend a mixture
of fibrous and cartilaginous tissue, a mixture which is far from
being homogeneous and even in the various parts. The more it
is examined forward and near the base, the more its substance is
seen to resemble that of cartilages proper, being white, flexible,
brittle, and homogeneous. Toward its posterior part it loses its
character of homogenity, becomes less brittle and presents in its
thickness a greater amount of fibrous texture. More posteriorly
again, the fibro-cartilaginous structure is more marked. By close
attention it seems to show cartilaginous nuclei, isolated, and sur-
rounded with an entirely fibrous substance; and again, at its pos-
terior extremity it becomes fibro-greasy with much cellular tissue
and unites with the plantar cushion. The vitality of the cartilage
is in inverse ratio with its density and consequently is greater in
its posterior part than toward the base and its anterior extremity.
This fibro-cartilage may easily and more or less completely be-
come ossified; old horses are those which most commonly present
this condition, and draught horses are more subject to it than
those used to the saddle. It assumes various forms. At times it
occupies the entire extent of the cartilage, and at others only at its
base; sometimes the external surface is ossified, while the internal
remains in its normal structure; then again, the ossification exists
only anteriorly while the posterior is cartilaginous, and it more
rarely happens that the process consists in bony lamellee, which,
starting from the base, spread toward various points of its cir-
cumference.
716 OPERATIONS ON THE FOOT.
These fibro-cartilages are generally more developed in the an-
terior than the posterior extremities. They also present, in one
foot, this slight difference, that the internal stands a little higher
than the external.
Cartilaginous quittor is a serious affection, characterized by
the partial caries of one of the fibro-cartilages; it is a partial gan-
grene whose character is to slowly spread into the cartilaginous
structure upon which it starts. To be treated with success, it re-
quires a very regular attendance, and often an operation, which
consists in the removal of the cartilage. Sometimes this opera-
tion is indispensable, and its study is interesting, especially be-
cause, though not as commonly performed as at the beginning of
this century, it is one which requires a high degree of surgical
skill for its success.
I. Symptoms.—A division has been made of an acute and
chronic form of this disease. Under the first name, is considered
the earlier period of the affection, that in which there is inflam-
mation of the cartilage and painful swelling of the part, and when
the caries or necrosis of the fibro-cartilage is not yet established;
or if there is a wound, when it does not yet granulate, and the
suppuration, if it exists, is very slight. Chronic javart would be
that in which the partial and progressive mortification of the
fibro-cartilage exists; for, as Renault has said, itis the ordinary
termination of fibro-chondritis.
When free from serious complication, the disease is generally
accompanied with but little lameness ; sometimes there is almost
none, and animals can be kept at work, especially at a slow gait;
but if made to trot, the horse will show lameness. It is especially
when the quittor exists in the posterior parts, that the inflamma-
tion and the pain are not excessive, because there is then an
abundance of soft, fatty tissue. But when the caries is more for-
ward, and is situated more deeply, in a point nearer the articular
surface, the lesion then affects the fibrous tissues and the pain is
greater. It is sometimes excessively acute.
Upon the lateral part of the coronet, toward the heels or the
quarters, more or less tumefaction appears, more or less painful,
according to the duration of the disease, and in this case more
or less indurated. In the centre there exists a granulating fistu-
lous wound. There are one or several fistule (Figs. 524, 525, 526)
whose openings show granulations, bleeding easily, their course
DISEASES. 717
Fies 524, 525, 526.—Cartilaginous Quittor. Various Spots of Necrosis.
718 OPERATIONS ON THE FOOT.
always forward, running at times in straight lines, at others ir-
regularly. The tracts frequently communicate and discharge a
granular, serous and thin pus, of pale greyish color, generally
odorless, or slightly sanious, containing greenish particles, which
are but pieces of diseased fibro-cartilage. The pus dries up on
the surface and adheres to the hoof and to the hair, and some-
times irritates the surface of the skin. If one of these fistula be-
come cicatrized, a fluctuating tumor soon appears, close to it,
which rapidly ulcerates, and then gives rise to another fistula. If
the disease is quite old, the hoof of the quarter corresponding to
the necrosed cartilage, loses its perioplic band, becoming rough,
ramy and cracked, and the wall is thickened, because the irritation
of the coronary band has stimulated its growth. This change in
the condition of the wall varies with the length of time the dis-
ease has existed, and consequently, it indicates its duration quite
accurately, when one remembers that the hoof grows downward
about one centimeter in each month.
When cartilaginous quittor is the sequelae or complication
of the suppurative corn, of a punctured wound by a nail of the
shoe, or any other affection of the foot, the symptoms proper to
these diseases are first observed, though the lameness is greater,
and the fistule of the quittor is evident. Often, however, this,
instead of being external and on the coronet, is situated at the in-
ferior part of the foot, at the internal face of the inferior border
of the wall, upon the sole, and sometimes connected with the
wound of some of those affections of the foot.
II. Pathological Anatomy.—When one examines the cartil-
age affected with the necrosis proper of quittor, he always finds
lesions in proportion to the intensity and the age of the disease.
It is seldom, however, that the portions of the cartilage which
have undergone the green degeneration, constituting the caries,
reaches more than one centimeter in extent; they have the form
of a small plate, of a green color, ordinarily elongated, and adhe-
rent to the healthy parts of the cartilage by one of its extremities,
that which is more forwardand the deepest. Others have com-
pared it to the green growth of a seed in germination. The
points of the fibro-cartilage which are in immediate contact with
the carious portion, have also a slightly pale greenish hue. These
are already diseased; there is already a beginning of necrosis; in
the remainder of its extent the exfoliation is separated from the
ye
it
»:
.
‘
:
:
es
DISEASES. 719
cartilage by a reddish, soft tissue, which also lines the inside of
the fistulous tract. This fistula, which extends from the necrosed
spot to the skin, is but the hollow tract left by the diseased proc-
ess upon the cartilage, while gradually destroying its substance.
Always lined with a pseudo-mucous membrane, by a true pyro-
. genic apparatus, the fistula is often narrow, sinuous, irregular in
its course and extent, especially if the disease is of some standing.
Renault, and after him Lafosse, have mentioned a special al-
teration of the fibro-cartilage which is sometimes met, and which
Lafosse looks upon as a step toward recovery. It is a softening
of the tissue, anatomically characterized by a loss of the consist-
ency of the cartilage, resembling the case of the cellular tissue
becoming indurated, or that of bones deprived of their earthly
salts after soaking in weak acids; its yellowish color is then char-
acteristic. It may be noticed during life, and is recognized by a
softening in the region of the cartilage, which then yields, giving
easily to the pressure of the finger; besides this, a probe intro-
duced into the fistulous tract readily penetrates into the softened
substance. But the true way to diagnosticate this change con-
sists in raising the coronary band or after thinning the wall; then
one will see and may feel the true nature of the transformation.
Lafosse adds that, in presence of this alteration, the removal of
the cartilage is no more necessary, for then the cicatrization is
readily obtained by stimulating the sloughing of the necrosed tis-
sue or by removing it.
With cartilaginous quittor there is always plastic infiltration
of the cellular tissue surrounding the cartilage. Very often the
wall of the synovial capsule of the articulation of the foot is some-
what thickened, and in that case there is less risk of injuring it
during the operation.—(Rey.)
Il. Progress, Duration and Termination.—Left to itself,
the caries of the fibro-cartilage may last for a long time, through
difficulty in determining its true nature. Spontaneous cure, how-
ever, is not impossible, as Renault proved it, and as many practi-
tioners have seen it, especially in young and healthy subjects,
when the disease is mild at its outset and effects parts of the or-
gans where the fibrous element predominates, as in the posterior
portion of the cartilage. This fortunate result follows the slough-
ing of the “bourbillon” which makes its appearance under the
shape of a greenish particle.
720 OPERATIONS ON THE FOOT.
But, ordinarily, the disease progresses slowly, destroying the
cartilage by degrees, and the diseased process ceases only when
the caries has reached the ligament of the joint, which it some-
times also attacks. The tissue of the fibro-cartilages has not
the force of reaction possessed by other inflamed structures, and
which is so well marked in cellular tissue. A process of suppura-
tion, such as rapidly eliminates the mortified structure, cannot
very readily take place in it, and when by natural forces the cari-
ous spot is eliminated and pushed outward, the surrounding tis-
sues are most commonly already affected. These undergo the
same alterations, and are eliminated in the same manner until
the entire cartilage is destroyed. This process of caries by repe-
tition may last a year.
In its progressive stage, the disease may spread to surround-
ing parts, such as the os pedis, the plantar aponeurosis, the liga-
ment of the joint, or the sesamoid sheath, all of which may be-
come the seat of inflammation. They are diagnosticated by the
greater pain and more marked lameness, symptoms which are
comparatively light in the simple necrosis of the cartilage.
Finally, as a possible complication of cartilaginous quittor, one
may observe an entire emaciation of the animal, an alteration of
the fluids due toa putrid or purulent infection; some authors
claim to have even seen glanders and farcy follow it; this is inad-
missible.
IV. Diagnosis. — Cartilaginous quittor is recognized only
when there is a wound from which escapes the product of the
suppuration and of the necrosis. This pus has nothing charac-
teristic, notwithstanding what has been said. If it is thinner
than that of a simple solution of continuity of the region, or that
of simple quittor; if itis less foetid than that of bony caries, it
has, however, of itself some special characters, varying according
to the subject and the degree of the disease, and especially resem-
bling much that of sub-horny quittor. If the escape of the pus is
slow, and it is desired to carefully examine it, a simple pad of
oakum, kept by a few turns of bandages on the fistulous opening,
will, when removed, give a sufficient opportunity to recognize its
nature.
The probing will often assist in distinguishing the cartilagin-
ous from the simple or sub-horny quittor. In these last, the fis-
tula is less profound, and does not reach the thickness of the
DISEASES. 721
cartilage; but, as in cartilaginous disease, the fistula is often sin-
uous, it is better to use a soft, flexible instrument, such as a fine
probe made of lead. The injection of liquid may take the place
of the probing; injected in a superficial tract, it returns outward
directly, while in deeper and irregular fistule, it will penetrate
more readily. The induration of the coronet, the rough and ramy
appearance of the hoof of the quarter corresponding to the fis-
tula, indicate generally a necrosis of the fibro-cartilage; these
characters are missing in the furuncle.
V. Prognosis.—In consequence of the tenacity of the disease,
this form of quittor is always serious; though this gravity has, in
our days, greatly diminished, on account of the means of treat-
ment now in use, which were unknown some thirty years ago.
Now, this affection, which was considered. by all hippiatrics as al-
most incurable and which more recently was treated by an opera-
tion which rendered the animal unfit for work for several months,
can in the majority of cases be cured in about fifteen days.
The prognosis, however, varies and depends on the complica-
tion. When there is caries of the ligaments, inflammation of the
articulation of the foot, or of the sesamoid sheath, the extirpation
of the cartilage itself, done with the greatest dexterity, is not
even a warranty of recovery. It remedies only the necrosis of
the cartilage, but leaves the other diseased processes to progress
in such a manner that the animal remains worthless if he has not
to succumb to them. The pain is, besides the other signs, one of
the most important points to consider: very acute, it is generally
a discouraging omen, and points to the existence of serious com-
plications.
VI. Etiology.—Heavy draught horses are more frequently af-
fected, on account of their peculiar work. The most common
cause is a bruise, a blow, a burn, a prick, any wound exposing the
cartilage; it is most common in horses drawing trucks loaded
with stones, which may drop on their feet and crush the fibro-
cartilage. The same cause exists for horses working in extensive
works of buildings, in the construction of railroads, and in the
shops of mechanic construction.
Owing to these conditions, it is also more common in large
cities than in the country, and more frequent in stony and tem-
porary roads than in those which are smooth and flat. Flat feet,
with low heels, are more exposed than others, as well as those
722 OPERATIONS ON THE FOOT.
whose hoofs are soft. Quittor is more frequent in the fore than
the hind feet, the fibro-cartilages of the fore feet being more de-
veloped and more flexible, and because their heels are generally
lower than in the hind legs. In some, it is more common on the
internal than the external quarters, while with us, it has been the
contrary.
It is often a complication of suppurative corn; of punctured
wounds of the foot, of canker, of simple and sub-horny quittor, of
grease, etc., which are then the determining causes of the disease.
VII. Zreatment.—When the disease is recent and the quittor
acute, and antiphlogistic treatment may be attempted and resolu-
tion looked for, baths and emollients are generally beneficial. A
good blister has sometimes proved advantageous, and when it is
used, limited suppuration, with the formation of a simple slough,
may take place.
Tf necrosis is well established, it is an indication of the neces-
sity of a recourse to more energetic treatment, in which case sey-
eral measures are recommended, including the actual and poten-
tial cautery and the removal of the cartilage.
In actual cauterization, the necrosed spot is destroyed by a
cautery brought to a white heat, applied directly upon it, after it
has been exposed by a freeincision. It is a simple treatment, and
one that has been successful in cases of posterior necrosis where
much fibrous tissue was diseased, and principally in young and
well-conditioned animals (Lafosse, Sr., Girard, Vatel, Mangin,
Renault). Still, this treatment not only often fails, but may even
become a means of irritation of the fibro-cartilage, and cause an
extension of the necrosis. (Hurtral, D’Arboval, Lafosse). In our
day, this treatment is almost entirely ignored by good practition-
ers, and the potential cautery more generally adopted.
This had already been employed by hippiatrics. Solleysel
principally recommended the use of corrosive sublimate mixed
with aloes; Girard, Barreyre and Bernard also mentioning it.
English veterinarians recommended their use very strongly.
(White, Blaine, Riding, etc.).. These practitioners all used the
solid caustic, either in the form of trochiscus or in powder, and if
they obtained good results, it required a much longer time than
that required in our day by the use of the liquid forms of caustics
which are at our command. With the solid form, the action was
of limited extent, and scarcely more effective than that obtained
4
aa
4
7
4
:
DISEASES. 723
by the actual cautery; moreover, they frequently injured the
healthy structures by irritating them and increasing the inflam-
mation, and thus resulting in serious complications.
As we haye said, liquid caustics are largely used to arrest the
spread of the caries; they modify the process of decomposition,
dry up the suppuration and stimulate the tissues without injuring
the healthy structures. This mode of treatment must be credited
to Mariage, who in 1847 established the unfailing efficacy of re-
peated injections of Villate’s solution; one of sulphate of copper
and sulphate of zinc, 64 grammes of each in 1 liter of vinegar,
and decomposed by 125 grammes of Goulard’s extract. It is
really simply a solution in vinegar of acetate of copper and zine,
holding sulphate of lead in suspension. Villate himself had al-
ready used his solution with success by injecting it in cartilagin-
ous quittor as early as 1829, since which time Burgniet, Verrier,
Sr., Collignon and others have recognized the benefit of liquid
escharotics in the treatment of the same disease. Villate’s solu-
tion is not a specific, and cartilaginous quittor has been cured by
the injection of tincture of sublimate with solution of nitrate of
silver (Bernard), with the perchloride of iron, chloride of copper,
sulphate of copper and zine, nitrate of lead, more or less concen-
trated mineral acids, and especially the Rabel water (Collignon).
It is difficult to say which is the more useful of these drugs
and which has been more successful. Success has also been ob-
tained with injections of tincture of iodine, phenic acid and even
petroleum. It is less the nature of the drug that insures the ef-
fect than the mode of using it. We ought also to say that, ad-
vantageous as this mode of treatment is, it is not infallible, though
Mariage and others so consider it. It is not to be preferred to
the extirpation of the cartilage, an operation which proves suc-
cessful when all other means have failed.
To obtain a cure by the use of liquid applications it is essen-
tial to make injections every day, and even several times daily.
These are made with a syringe, carefully adapted in respect to
size, with a small canula. The injection must be pushed well in,
but must be allowed to escape freely after coming in contact with
all the diseased surfaces which it is designed to modify. To effect
this, it becomes necessary, as the fistulee are sometimes very nar-
row, and even irregular, to enlarge them, or to make counter
openings. Mariage had originally insisted that these precautions
724 OPERATIONS ON THE FOOT.
were essential to the success of the treatment. H. Bouley and
Viseur also strongly insisted upon the same point, viz., that of en-
larging the fistula in order that the liquid should not be allowed
to remain at the bottom of the fistulous tracts, by which all possi-
bility of the extension of the disease from that cause might be
avoided. These enlargements of the fistula, or counter openings,
close, however, very rapidly; as a remedy to which, Hivernat has
suggested the introduction into the tracts of little wedges of wood
pointed like pencils, for the purpose of lacerating the walls of the
fistula, followed by the insertion in them of small setons, moist-
ened with Villate’s solution. Guerrapain introduced a fine meche
of oakum, a seton in the tract, by means of a curved needle. If
the fistula runs downward its bottom is under the wall, and he
thins this down and makes a counter opening through the hoof
thus thinned. This seton prevents the closing of the counter
opening, and enables the operator to push through the injection
regularly.
Other precautions are also necessary. One, especially, is rest.
The animal must not be put to work. Lafosse says that these
liquid caustics act with regularity and cure with certainty. A bar
shoe, not pressing on the diseased quarter, is also useful. Emol-
lient poultices are sometimes necessary after the injection, to
diminish the irritation. Mariage also recommends them. If the
fistula extends under the coronary band, or the podophyllous tis-
sue, it becomes necessary to thin, or to remove altogether, the
hoof of the diseased quarter.
After fifteen days of this treatment, the exfoliation often takes
place, and recovery follows. Often, however, twice this length of
time is necessary. After the first eight days the pus becomes
more abundant, white and laudable; the tumor softens and dimin-
ishes, as the pain subsides. Later, the injections penetrate with
greater difficulty, which is a good sign. The injections constantly
attack the germ of the disease and leave it without chance to re-
form or to spread; the gangrenous structure which develops in
the cartilage is changed into an inert substance; the pyogenic
membrane of the fistulous tract is stimulated; the process of
granulation becomes more rapid; the wound becomes more and
more healthy, and the diseased process ceases. If, however, it
continues, the wound changes its character, large granulations
develop themselves, and in their center the openings of the fistu-
~
ae
DISEASES. 725
lous tracts, which open on the cartilage, make their appearance.
At times the wound closes ; but, after a short interval, opens again,
or another forms at another point. There is then a repetition of
the same course of treatment by caustic applications—but gener-
ally this indicates a complication, and suggests the propriety of
an operation. The injections are generally successful, however,
and most certainly so if the caries occupies the posterior parts of
the cartilage. They may even succeed in the anterior parts, when
the animal is young and of good constitution. But if the cartil-
age has already become partly ossified, the caustic is irregular in
its action, and the result becomes doubtful. If the caries is deep
and extensive, and especially if the necrosis extends through and
through to a point corresponding to the synovial capsule of the
articulation of the last phalanx; or if the necrosis exists on the
internal face of the cartilage, where it covers that structure, then
the repeated injections of Villate’s, gr of any other caustic, may
be followed by serious complications. An old or complicated caries
will offer an increased resistance to the treatment by liquid caus-
tics, in proportion as there is more or less difficulty in bringing
them in direct contact with the necrotic points.
The third method of treatment is that of the removal of the
cartilage. This operation, first recommended by Lafosse, Sr., in
1754, was often performed by his son, and may be considered one
of the most valuable results of the application of anatomical
knowledge to the practice of veterinary surgery. This operation
was also performed by Bourgelat and his students, by Girard,
Hurtrel, D’Arboval, and was principally studied and described by
Renault. In Germany, notwithstanding the writings of Langen-
bacher, Dieterichs and Hertwig, it did not meet with approval,
and English veterinarians seldom, if ever, resorted to it. At pres-
ent, even in France, it is seldom performed, except in case of fail-
ure by the caustic injection treatment, and this is often the case
where the disease is situated in the anterior part of the fibro-
cartilage, where the cartilaginous tissue predominates, or where
the vitality is diminished, and above all, where ossification has
taken place. It is an operation of the greatest delicacy, and ac-
companied with great risks on account of the proximity of the
joint of the foot, and it requires an experienced operator and
thorough practitioner to justify a hope of successful results. It
consists in the excision, by layers, of the diseased cartilage, and
726 OPERATIONS ON THE FOOT.
in avoiding injury to the coronary band, and to the podophyllous.
tissue, which are essential elements of the organization of the
foot. It is also essential to avoid injury of the lateral ligament
of the foot joint, which is close to the cartilage, and above all, of
the synovial capsule of the joint, which is directly covered by the
cartilage. The partial or entire extirpation of the cartilage can
be performed. In the first case, only a portion of the necrosed
fibro-cartilage is removed. Vatel, Sanstas, Renault, Bell and La-
fosse have reported many cases of recovery by this mode of oper-
ation, but it is not likely to be thoroughly successful, unless in
circumstances as favorable as those accompanying the treatment
by liquid caustics. It is generally much better when the operation
is decided upon to perform it by excising the entire structure, and
removing all the carious elements. The partial removal is to-day
entirely abandoned, and entire extirpation accepted as the true
and only operative procedure. The best method of performing
it is that recommended by Renault and adopted in our colleges.
We shall make it the subject of description with all necessary
details, and with various modifications as performed by other
practitioners; we shall also offer some observations upon various
other modes of performing the operation in question.
The operation includes two principal steps: first the removal
of the part, or the whole of the wall corresponding to the diseased
cartilage ; and second, the extirpation of the cartilage itself. The
opinions of surgeons vary as to the amount of hoof which should
be removed, and the extent of horny tissue to be taken off. In
respect to the length of the superior border of the portion requir-
ing removal, it is generally agreed that it must extend from the
anterior extremity of the cartilage backward, that is, the two pos-
terior thirds of the space reaching from the toe to the heels, or
one-third of the circumference at the coronary band. But opinion
continues divided as to the lower border (Fig. 527). Lafosse, Sr.,
left it longer than the superior, and made the direction of the
division of the groove correspond to that of the fibres of the hoof.
Lafosse, Jr., accepting the idea of Solleysel and of Dieterichs, did
not reach the sole with its groove, and removed only a portion of
hoof parallel to the coronary band. Renault prefers crossing the
fibres of the hoof with the groove, and brings the lower end of it
to one-half the dimensions of the upper border, its groove running
backward. Rey considers this to be running too far back and
DISEASES. TAG
E
B Cc D
FIG. 527.—Direction the Groove should take to remove the Quarter in the Operation
for Cartilaginous Quittor. A B.—According to Lafosse. A C.—According to Rey. A D.
—According to Renault. A H.—According to Lafosse and Dietericths.
too near the heel, and recommends the groove to be so made that
the lower border will have the same length as the upper, and for
that reason advises that it be as nearly parallel as possible with
the line of the heels. Lafosse, Sr., removes too large a portion of
the hoof. Lafosse, Jr., leaves a portion of hoof which not only is
useless, but which interferes with certain steps of the operation,
when with the double sage knife, the skin is separated from the
external surface of the cartilage, and also, when this is removed;
and again, there is a separation between the severed portions of
the quarters much greater than occurs in the process of Renault,
which, like that of Rey, exposes the entire cartilage, and greatly
facilitates the operation.
It is to be understood that the foot has been prepared; that
the hair has been clipped over the skin covering the cartilage;
that the sole has been pared thin, down to the blood, as well as
the bar corresponding to the diseased cartilage, so that the quarter
has been allowed to project below the sole, to facilitate its ever-
sion. The foot has been, moreover, well prepared by two or three
days of poulticing, to render the hoof easier to be cut by the in-
strument, and the operation easier to perform, and therefore
shorter in its various steps, beside placing the patient in the best
condition for the endurance of so serious an operation.
After casting the animal upon a good bed, and fixing the feet,
placing a temporary hemostasis, by the use of a strong cord, simi-
lar to a tourniquet, around the coronet, a groove is made, using
various-sized drawing-knives, running from the anterior angle of
the lower border of the cartilage downward to the sole, following
728 OPERATIONS ON THE FOOT.
the direction recommended by Lafosse, Sr., Rey, or Renault. This
groove, made first with the widest, and finished with the narrow-
est of the drawing knives, must not touch the podophyllous tissue,
and still must run through the entire thickness of the wall, with-
out producing hemorrhage. In this step of the operation, as
Girard correctly observes, short cuts of the knife are always bet-
ter and quicker than those made by scraping or dragging with
the instrument. It is also important to come down to the soft
tissue at the coronary band first, and successively downward to
the inferior border of the wall, as otherwise, as the instrument is
moved from above downward, with a certain amount of force, it
might slip and cause a serious division or laceration of the podo-
phyllous tissue. The separation is then made of the wall from
the sole by another groove, extending from the end of the groove
already made, on the quarter, back to the heels. This is done
without difficulty, with a small drawing-knife, when the foot has
been properly prepared. There is, however, one point which
usually offers more or less resistance when the quarter is removed,
It is that where the wall is continued to the bars. This resistance
is sometimes so considerable that if much traction is made, the
wall will break more or less in front of the heels, where it is com-
paratively thin, and it may consequently become necessary to re_
move, by itself, the portion which has remained attached. This
little accident, however, can be avoided by ascertaining certainly
before the extraction of the wall is effected, that the continuity of
the wall and bars has been cut off. This being the case, the com-
plete separation of the wall from the sole is made by running the
sharp edges of the double sage knife through the structure of the
living tissue underneath. The resection of the quarter can then
be proceeded with.
For this purpose, a properly constructed lever is carefully in-
troduced into the groove before mentioned, at the wall and sole of
the foot. The inferior and anterior angle of the hoof at this point
being then carefully raised, an assistant grasps it with the nippers,
turns it back and tears it-slowly, while the surgeon, with such a
motion of the lever as may be necessary, assists in the tearing off
of the portion of the quarter requiring removal. If adhesions
remain, interfering with this manipulation, they are removed by
cutting with asharp instrument. As this separation of the wall
reaches about to the coronary band, the separation is very easy,
5 ne
“oe
DISEASES. 729
and no fear of lacerating the soft structures need be entertained.
Care is necessary at this step, however, to avoid injuring the cor-
onary band, and the podophyllous tissue; to prevent which it will
be prudent on the part of the assistant to press upon the band as
the separation takes place.
This being accomplished, the edges of the wound are carefully
examined; any projections remaining are removed, and the blood
is sponged off. The double sage knife is then carefully plunged,
with the convexity turned upward (that is, toward the skin), be-
tween the external surface of the cartilage and the internal face of
the skin, below the border of the coronary band, and then carried
forward and backward, or as required, until the separation of the
skin and the cartilage is completed and the external surface of the
cartilage is exposed. In moving the instrument backward, it is
necessary to be very cautious, especially while carrying the sharp
edges downward and inward, in order to avoid injury to the cor-
onary band and the skin, of which, however, there can be but little
danger, when the knife is carefully held and properly directed.
The succeeding step is to separate the skin from the cartilage; it
is to be carefully raised and separated from its attachments under-
neath, which is sometimes a process quite difficult to accomplish,
as the skin has always become more or less tumefied, and there-
fore has lost much of its natural flexibility and suppleness. Some
operators, in order to avoid these difficulties, and overlooking the
functions of the coronary band, cut it, and remove it, with those
portions of the skin which cover the cartilage. Others, more con-
servative (Herting, for example) cut it only through the middle,
until they reach the superior border of the cartilage, and then,
raising the two fiaps of the skin, accomplish the same result with
less cutting. ,
The destruction of the principal organ of the secretions of the
hoof having been involved in the first method, and having now
taken place, it can never be restored to a healthy condition, and
the animal continues to be exposed to the frequently serious com-
plications of ‘‘false quarter.” By the second method, the produc-
tion of a new wall is nearly always accompanied with the forma-
tion of a “quarter crack.” The recovery is slow in either case,
and more or less deformity is likely to follow. It is, then, the
better and wiser plan to separate the skin from below, and to
avoid the division of the coronary bands or of the teguments.
730 OPERATIONS ON THE FOOT,
The next step is the removal of the cartilage altogether. This
is done with the single sage knife, held firmly in the hand, either
the left or the right, always, however, that corresponding to the
side of the heel to be operated upon. Taking a point of rest with
the flat of the thumb upon the plantar surface of the foot, the in-
strument is pushed between the skin and the cartilage, and the
sharp edge turned backward, with a firm rotary motion, down-
ward and forward. The detached portion of cartilage is then
seized with a pair of bull-dog forceps, and brought outward, and
the sage knife is brought forward, downward and outward, from
under the cartilage. It is a good plan, in order to make more
room for working, to raise the skin and coronary band with a
blunt tenaculum. The operation should always be commenced
at the posterior part, in order to avoid the articular synovial cap-
sule, which might be opened if the removal of the cartilage was
begun forward. As the operator reaches the anterior part of the
cartilage, which is situated almost over this capsule, it is prudent
to hold the foot in excessive extension, and thus avoid injury to
the capsule. This is an important point to consider in the oper-
ation. The sharp instrument being carefully handled, every por-
tion of the cartilage is taken off, either at once, or better by layers.
successively, until the whole is removed. It is thus accomplished
in three or four pieces. In some instances the anterior portion is.
cut off by a longitudinal incision, made with a straight bistoury,.
following the direction of the posterior face of the coronet, the
object, in this case, being simply to render the operation easier.
The cartilage is thus removed, great care being taken to avoid
opening the capsular articular burs. It is essentially necessary
to remove the whole of the diseased tissues, in order to bring the
parts into the condition of a simple wound. Still, there need be
no alarm if some small portions remain, more fibrous than cartilag-
inous, which, deep as they are, may protect the synovial capsules
or the ligament; and moreover, they often slough off by them-
selves, with the abundant suppuration which follows.
To operate with the greater facility, it is well to have two forms
of sage knife, one right and one left-handed, and some of extra
streneth, with which toremove the larger particles of cartilage,
the others being small, thin and light, being adapted to the more
careful dissection necessary toward the lateral ligament, and
about the synovial bursz of the joint.
‘A pes eg ye Ms "5 ae
DISEASES. 731
Toward the end of the operation, the surgeon will, with the
finger, carefully explore the condition of the parts, to insure him-
self that the cartilage is entirely removed; that the articular syn-
ovial sac has been preserved intact; that the ligament of the joint
remains perfect, and that the parts are well washed, and ready for
the dressings. Although in the absence of possible complications,
the operation is now finished, it may yet be followed by some
serious sequelz, which we will next consider.
The operation may become complicated by a variety of atten-
dant and accessory circwmstances. Among these are, the opening
of the articular capsules; the wounding of the anterior lateral
ligament of the articulation; the ossification of the fibro-cartilage ;
caries of the os pedis; and the alteration of the coronary band
and of the reticular tissue.
The opening of the articular capsule, either during the oper-
ation, or by ulcerative process, is not so serious an accident as it
was originally thought to be. Still, however, it requires some at-
tention. It only becomes dangerous when the ulceration is ac-
companied by serious disorganization, and especially when it is
associated with purulent arthritis. (Renault, Hurtrel, D’Arboval,
Bernard). It is treated by simple pressure, camphorated paste, a
little corrosive sublimate mixed with starch, or better, with
Egyptiacum ointment.
The wound of the ligaments has also been considered a very
serious accident, which, according to Girard, cripples an animal
permanently. But Lafosse thinks this an exaggerated notion, and
claims to have witnessed the radical recovery of animals after the
necrosis and sloughing of the ligament.
If ossification of the cartilage is discovered during the opera-
' tion, the removal of all the unossified portion is first proceeded
with, in order to prevent a recurrence of the disease. The extir-
pation of the osteo-cartilaginous portion is then effected, either
with a small drawing-knife, or the gouge, or the bone forceps.
The removal is made as far as the ossification is found to be com-
plete, the operator making sure that every portion of cartilage is
thoroughly destroyed. If the ossification is but partial or irregu-
lar, the surgeon must be guided by the condition of the parts.
When the entire cartilage has undergone ossification, its suscepti-
bility to caries has ceased.
When caries of the os pedis exists, the part must be destroyed
732 OPERATIONS ON THE FOOT.
with the sage knife, the gouge, or the chisel, according to the
existing conditions. But in this case, portions of the reticular
structure require removal, of which, however, as little as possible
should be destroyed.
It may happen that the portion of the coronary band covering
the cartilage may be destroyed, either wholly or in part, either as
an effect of the disease, or by accident during the operation. In
the first case, if the entire band has been destroyed, there is noth-
ing to be done. But in the other case, if any portions of it re-
main, care must be taken to insure their preservation, as they
may supply the necessary elements for a new, healthy secretion of
hoof, and the quarter may grow again, more solid and less de-
formed. If the wound of the coronary band consists merely in a
simple division of limited extent, the wisest course will be to at-
tempt to obtain union by immediate adhesion, or first intention,
by bringing the edges of the incision together and maintaining
the contact by careful dressing. When the alteration of the re-
ticular tissue alone, is present, it is very essential to avoid the ex-
cision of the injured lamin. It is, in fact, the better course to
avoid wholly the use of sharp instruments, and to leave to the
natural process of suppuration the removal of the disorganized
parts. Renault having observed how their removal interfered
with the reparative process, has often left them undisturbed, even
when their dark color and softened condition indicated the small-
ness of their chance of conservation. The success of the opera-
tion after a first dressing, has shown the wisdom of the plan of
non-interference; they were found covered with a new layer of
yellowish hoof; and D’Arboval has on several occasions observed
the same result.
The dressing must be methodically and carefully applied.
Done well, a dressing greatly assists in the recovery, while many,
when badly performed, have been the cause of serious complica-
tions, which have greatly hindered the repairing process, and of-
ten, indeed, rendered a disease incurable, which need not have
been beyond remedy. in the application of the dressing, two
points are important to consider: first, we must dress the subcu-
taneous wound, resulting from the separation of the skin and the
extraction of the fibro-cartilage; the other, that of the sub-horny
wound, produced by the removal of the portion of the quarter.
Both are important, but the second requires the greater care, and
DISEASES. 733
is more difficult and more important than the former; any excess
in the sanguineous circulation must be prevented, and excessive
granulations must be kept under control. The dressing, then,
must be somewhat compressive, without being excessively rigid,
in order to obviate possible danger of excessive inflammation ; not
too loose or so soft as to allow hemorrhage, or the undue pro-
liferation of granulations. It must be both supple and firm, and
of an even and uniform pressure. The proper material is balls of
oakum for the subcutaneous wound, and pads of the same mate-
rial for the sub-horny, the first being moistened with alcohol,
while the others are made dry.
It is in question whether we should aim to obtain immediate
adhesive union of the wound resulting from the removal of the
cartilage, or in other words, whether it is good treatment to in-
troduce some material of dressing between the skin and the bot-
tom of the wound. Here opinions vary. Our belief is, that this
union is by no means easy to secure; and that the removal of the
cartilage, more or less altered, prevents it at various points. Still,
we must not raise the skin too much, and choosing a middle course
between, only a small, soft ball of oakum is now placed in the
deepest part of the wound, or a thin pad is placed between the
two parts, sufficient to represent about the natural form of the
part, being enough, however, to
prevent the immediate reunion
from taking place.
A light, thin shoe having been
prepared (Figure 528), adapted
to assist the application of the
dressing and its holding prop-
erly, it is put on with one of its
branches cut off short on the
side where the operation has been
performed, while the other branch
projects backward beyond the
heel, to support the rollers of the
bandage of the dressing. Des-
plas had thought to turn up that
long branch of the shoe (Fig. 529)
in the shape of a hook to assist in
Fia. 528.—Truncated Shoe for Dressing
: ; : in case of Cartilaginous Quiftor or Com-
holding the dressings. This is plicated Corn.
734 OPERATIONS ON THE FOOT.
Fic. 529.—Desplas’ Shoe for Dressing after Operation of Cartilaginous Quittor and
Complicated Corns.
useless. Some veterinarians leave the animal unshod, but the
bandage is more likely to slip off. The shoe must be put on while
the animal is down, and before the application of the dressing.
With some practitioners, that is the moment for the removal of
the tourniquet or cord, which had been applied at the beginning
of the operation in order to prevent the bleeding. This is an un-
necessary precaution, and only renders the application of the
dressing more difficult. First, balls of oakum are placed over the
coronary band, then, upon the points of union of the preserved
wall and of the podophyllous tissue, and then all over the wound.
We must endeavor, as Renault says, to give the dressing a cylin-
drical form, or rather, according to Rey, hemispherical, after which
the whole is covered with pads and rollers. These must be put
on in abundance, the rollers passing over the branch of the shoe
on the sound side, and running successively from above down-
ward, and generally from before backward (Figs. 530, 531, 532,
583). Flat feet require special care in dressing, and the fore feet
are generally more difficult to dress than the hinder. When all is
finished, the animal has to be watched for several days. Ordi-
narily, after the operation, there is abundant hemorrhage, occur-
ring within some fifteen minutes, and oozing through the dress-
ings. This requires no special attention, and generally ceases
spontaneously, or by the pressure of the dressing, or by the use
of the cold bath. If the dressing seems to be too tight, and the
animal shows signs of acute pain, with strong reactive fever, itis |
not therefore necessary to remove the dressing, but may be suffi-
cient simply to loosen the bandage. The animal should be placed
in a wide stall, or box, if possible, where he may move freely, and
DISEASES. 735
WARIOUS STEPS IN THE APPLICATION OF THE DRESSING AFTER OPERA-
TION FOR CARTILAGINOUS QUITTOR.
a
Fig. 531.—2d Step
- ted
Fig. 532.—3d Step. Fic. 533.—Dressing Completed.
lie down easily; and he must be prevented from tearing off the
dressing by the application of a neck cradle. A low diet is neces-
sary for several days, in some instances mashes being the only
food allowed. Still, a good appetite and lively condition are always
good signs.
The interval of time which should be allowed to elapse be-
tween the operation and the removal of the first dressing, should
be judged by the amount of pain which the animal seems to suf-
fer; by the temperature of the atmosphere; and by the amount of
liquid discharge found oozing from the wound and moistening
the dressing which covers and protects it. Generally, the dress-
ings should be disturbed as late and as seldom as possible. Cir-
cumstances will sometimes occur, however, which necessitate their
removal earlier, as for example, the extreme heat of the weather;
736 OPERATIONS ON THE FOOT.
the extremely offensive odor proceeding from the diseased parts ;
and a sudden and evident increase of pain in the wound, without
any known cause. Under these circumstances, which, however,
are of rather infrequent occurrence, it is sometimes necessary to
remove the dressing as early as the third day, although at this
time, as suppuration is not yet well established, the operation is
quite painful, and may be accompanied by free hemorrhage. But
if the weather is not excessive; or the dressing remains dry on
the outside, and matters seem to be generally in good condition,
the better course is to wait from eight to ten days, before the
dressing is renewed. Indeed, numerous cases are on record when
a still longer period has been allowed to elapse, and the re-dress-
ing has been deferred to the extent of three weeks, or longer. In
any event, great caution must be exercised in the removal of the
dressings, and the surgeon should be careful to have all his ap-
pliances ready in advance, in order that the wound may be ex-.
posed to the air for the shortest possible space of time. When
exposed, the wound should be of a red color, with commencing
granulations, and a temporary hoof, soft and whitish in appear-
ance, should be visible on the podophyllous tissue. A dressing is
then applied of tincture of aloes, or a weak solution of iodine.
At a later period the dressings are changed at intervals of about
eight days, and an application is made of pulverized sulphate of
copper, in order to facilitate the drying and hardening of the soft
hoof, Baths of sulphate of iron, with a small portion of sulphate
of copper are of service in promoting and hastening the cicatriza-
tion.
About the thirtieth or fortieth day after the extirpation of the
cartilage, the animal may be put to light work. But three or four
months, if not a longer period, must elapse, before it will be safe
to task him with heavy labor. . Toward the end of the assigned
term he should be fitted with a bar shoe, shortened on the side
where the quittor has existed. If the dressing is skillfully applied
and proper care is exercised, the diseased foot may be sufficiently
protected, and the animal made to resume his work with safety.
In time, the portion of hoof secreted by the coronary band
unites with that of the podophyllous tissue, and after a few
months, no remains of the operation are visible. But if the cor-
onary band has ulcerated; if the skin has been divided; if by
contact of the firing iron, or application of caustics, it has been
DISEASES. | 737
destroyed; the quarter then presents irregularities, and some-
times divisions, which may be of long continuance, and give rise to
a lameness which may, perhaps, become permanent. This danger
indicates the necessity of exercising the utmost skill and caution
in operating, in order to avoid possible injuries to the coronary
band.
Several modifications of the ordinary mode of operation have
been proposed. Some have had for their principal object, the
prevention of the extraction of the hoof, with a view of thus re-
turning the animals to their work at the earliest period practic-
able. It is thus that Hazard, Jr., proposed to make a crucial
incision upon the skin covering the fibro-cartilage; the four flaps
being so dissected as to expose it, and then removing it with the
sage knife. In this process, the extirpation of the entire cartilage
becomes extremely difficult without inflicting injury upon the lat-
eral ligaments and the synovial capsules.
Pagnier has proposed to merely thin down the quarter, to
make an incision in the skin along the superior border of the car-
tilage, and through this to remove the organ. But in this opera-
tion, however thin the hoof may be, it always interferes with the
entire extirpation of the cartilage.
Bernard, following the idea of Lafosse junior, who only re-
moved the superior border of the wall, proposed a mode of pro-
ceeding which is principally useful in cases of separation of the
hoof. Instead of removing the band of hoof parallel with the
coronary bourrelet, Bernard pared it down with the drawing-
knife, the sage-knife, or the rasp, in order to make it as thin as
possible, while avoiding the injury to the sensitive lamin. This
done, an incision is made along the coronary band, below it, de-
stroying its union with the laminz. At this step of the operation,
the indications are the same as in the ordinary modus operandi,
except that the coronary band being covered with a certain thick-
ness of hoof, is less flexible. This, however, is easily removed, as
soon as it becomes softened. The remaining steps of the opera-
tion are the same as in the ordinary, old way. That is to say, the
posterior part of the cartilage being well defined, the sage-knife
is used in the same manner. In this method, however, as the
sage-knife works more flat-wise, there is less danger of wounding
the ligaments or the synovial capsules. If any part of the car-
tilage remains near these organs, some care must be used in
738 OPERATIONS ON THE FOOT.
removing it, and it must be done by degrees, and in very small
portions.
The advantages of this process are: Ist, the avoidance of ex-
tensive wounds, and of the extreme pain produced by the extirpa.-
tion of the quarter. 2d, to keep the foot shod, and to allow the
animal to resume his work as soon as the first pain has subsided,
which may occur at quite a considerable interval in advance of
the perfect cicatrization of the wound. 3d, to avoid long and fre-
quently-repeated dressings.
In this method, however, the quarter left intact sometimes in-
terferes with the operation, and the excision of the cartilage is
more difficult, being only practicable, indeed, in cases where there
is a separation of the wall.
Maillet has modified the method of Bernard, so that, instead
of thinning down the band of hoof, he only applies the rasp upon
the quarter, and thins down with it all that portion which is ex-
tirpated in the process of Renault, and availing himself also, of
the drawing and sage-knives. The remaining details of the oper-
ation are like those of the ordinary processes. An objection to
this mode is that it can be put in practice only in cases where
there is already a separation of the wall. It is objectionable from
its tendency to weaken the foot too much, by interfering with the
firm and solid adjustment of the shoe, as well as retarding its
application to the hoof.
CHAPTER XIV.
OPERATIONS UPON THE EYE AND EAR.
ON THE EYE.
Ophthalmology, though it has made appreciable progress in vet-
erinary practice within a few years, has not yet reached a position
corresponding with that which it occupies in human surgery, and
probably will not for years to come, if ever. The difference in
value and importance between the functions of the organ of sight
in the man and in the horse is too measureless to induce or re-
quire an equal amount of interest and study in the optical path-
ology of the two animals, the human and the equine. It is in-
deed, a fact that many of the forms of disease which affect the
eye of the horse have not yet been recognized and investigated by
students of veterinary medicine.
For these reasons the contents of the present chapter will be
limited to those affections in which, strictly speaking, special sur-
gical interference has been so imperatively needed as to compel
the attention of scientific veterinarians, by considerations of both
duty and interest.
We shall consider the subject under two principal divisions,
or heads, viz., operations, performed on the accessory, and those
pertaining to the essential organs of the ocular apparatus.
1.—OperraTIons PERFORMED oN THE AccEssory OcuraR ORGANS.
On the EKyelids.—These constitute the two cutaneo or mu-
cous veils, which are situated in front of the organ, and are divided
into superior and inferior, uniting at their extremities to form the
angles or commissures of the eye. Besides these, there is a pecu-
liar apparatus situated on the internal or nasal angle, known as a
third eyelid, or menbrana nictitans. This is a small cartilage,
thinned out on its free border, continued on its posterior portion
with the adipose cushion of the eye, and covering it in front,
Wiping, as it were, its corneal surface, whenever the ocular globe
740 OPERATIONS UPON THE EYE AND EAR.
is drawn back into the orbital cavity. On the internal commis-
sure are found the caruncula lachrymalis, showing on the upper
and lower lids the lachrymal puncta, both of which empty into
the lachrymal sac, which is itself continuous with the lachrymal
canal, and through the lachrymal duct empties at the lower com-
missure of the nostril by the lachrymal opening.
Among the surgical diseases of the eyelids must be mentioned
traumatic lesions, pathological growths, defective congenital con-
formations, and specific diseases of their elements.
A.—Travumatic Lestons.
Bruises of the eyelids are specially common in horses after
kicks and blows in that region, and may also be the result of fric-
tion and chafing from the harness. If the cause has been severe,
cedema of the lid is the result, as well as more or less flow of
tears, and, possibly, irritation of the cornea. These accidents are
generally of no great severity so long as the globe of the eye re-
mains intact, but if this is injured serious complications ensue.
The indications of treatment are those of all similar injuries
of a local character, consisting of cooling astringents, with local
bleeding, which generally bring rapid relief.
B.—Souvutions oF ConrinuIty.
These are very common with all our animals. They are sel-
dom simple, but are more commonly complicated with lacerations
of the tissues, by nails, hooks, etc., or even the teeth of other
animals. Clean wounds by sharp instruments are rare, and are
easier to treat than those having torn and irregular edges. They
may be superficial, and may involve the thickness of the lid alone,
but they may also be deep and complicated with wounds of the
globe of the eye itself. The condition of the wound in this re-
spect is important to know, and should be ascertained as early as
possible. The raising of the eye with the elevator palpcebrum
(Fig. 534) greatly facilitates this examination, and the animal sel-
dom offers any serious resistance to it.
Fic. 534.—Eyelids Elevator.
SOLUTIONS OF CONTINUITY. 741
Simple lacerations of the lids commonly heal without any treat-
ment beyond mere cleanliness—a soft sponge and a little clean
water. But the application of the pin or twisted suture, in con-
nection with antiseptic measures will greatly promote cicatrization
by the first intention. Care must be taken to confine the animal’s
head in such a manner as to prevent him from rubbing the wound
until cicatrization is well established.
C.—DeErFeEctTIVE CoNGENITAL CONFORMATIONS.
Under this head we shall consider the deviation of the lids,
either outwardly or inwardly, from the convex lines of the cornea,
with which they should be parallel. A deviation in the growth
of the eyelashes, or ciliz, is another annoying irregularity of the
same region. The outward deviation of the eyelid is called ectro-
pion; the inward, entropion. The deviation of the eyelash is
known as trichiasis.
1. Hetropion.—The two principal causes of this abnormal
condition are an excess of mucous membrane or deficiency of
skin. Again, the ectropion depending upon paralysis of the orbic-
ularis palpcebrum, is of a different nature. Ectropion occurs more
frequently in the lower than in the upper lid When depending
on a want of skin, it is generally the result of a wound or a burn,
or possibly of an abscess, and is a cicatricial ectropion, in which
the retraction of the cicatricial tissue has carried the lid with it.
Paralytic ectropion is the result of age, and is more or less
peculiar to old animals. It may also result from a diseased condi-
tion of the conjunctiva, or of some of the organs of the orbital
cavity. A
The treatment of a case of this affection should be modified
by the nature of its cause. If it is due to excess in the mucous
membrane, the redundancy must be reduced. If caused by want
of cutaneous surface, the remedy must be applied to that surface.
If a hyphertrophied, mucous membrane is the trouble, astrin-
gents, caustics, and scarifications must be employed; or even the
removal of portions of the conjunctival mucous membrane, with
the scissors or the bistoury. If, on the contrary, the deformity
results from the condition of the skin, blepharoplasty or blepha-
rortapy must be resorted to. The simplest manner of operating
consists in amputating a V-shape portion of the eyelid and uniting
the edges with stitches.
742 OPERATIONS UPON THE EYE AND EAR.
2. Entropion.—This is a malformation in which the border of
the lid is turned inward. While in an ectropion the skin is in
excess, the reverse condition is discovered here, where it is defi-
cient. It is often the result of ophthalmic attacks, and it may
also follow a loss of substance in the conjunctiva, after ulceration,
or the removal of foreign growths. According to Leblanc and
D’Arboval it may follow some eruptive fevers, or parasitic dis-
eases. In entropion there is an increased flow of tears, abundant
muco-purulent secretion, keratitis, which may become ulcerative,
and loss of sight.
The treatment consists in the excision of all the inverted por-
tion of the deformed lid, which is accomplished by raising it from
the globe with a forceps, and separating it with a single cut of
the curved scissors, the protruding portion being then amputated.
The hemorrhage is stopped with cooling lotions.
Another mode of operating consists in cutting off only a por-
tion of the skin of the lid, and unfolding it by passing the finger
under the inverted border. Then a fold of skin is amputated near
the free border of the lid, and the edges brought together by
twisted pin suture.
3d. The deformity of trichiasis, or abnormal growth of the
lashes has been observed by Leblanc in sheep, but in our domestic
animals is a rare disease.
Amputation of a portion of the skin; pulling out the eyelashes,
followed by cauterization, and extirpation of the free border of
the lids, have all been recommended against this abnormality of
cutaneous secretion.
D.—ParHotoaicaL GrowrH AND CARIES OF THE MEMBRANA
NIcTITANS.
Acute inflammation of the third eyelid, either as a symptom
of ophthalmia, or resulting from direct traumatism, such as blows,
or the presence of foreign bodies, terminating in caries of the
constituent cartilage of this delicate organ, or the formation and
development of epithelioma of the mucous membrane, are condi-
tions often seen in our domestic animals, principally in horses and
dogs. We have often noticed this peculiar affection, so easily
recognized by the presence at the nasal angle of the eye, of granu-
lating masses of various sizes, protruding at their internal commis-
sure of the lids, and over the surface of the cornea, accompanied
\
ee ee ee
DISEASES OF THE MEMBRANA NICTITANS. 743
with more or less suppuration, lacrymation and ectropion of the
lower lid.
The epithelial growths, when small, will sometimes disappear
under the application of caustics, or can be removed with the
ligature, or by direct amputation with fine scissors. In some
cases they assume very large dimensions, the mucous membrane
becoming more or less ulcerated, and the cartilage itself diseased,
and amputation of the entire cartilage becoming necessary.
This operation is not of recent origin, having been per-
formed, within our knowledge, some years ago, though entirely
upon empirical grounds, in tetanic cases, from the fact that
the protrusion of the membrana nictitans over the inner side
of the external surface of the ocular globe, quite out of its nor-
mal position, had often been noticed among the symptoms of
lock-jaw. The removal of the “ hawck,” as the operation was then
called, has never, however, for the reasons which were them ac-
cepted, become legitimized among the therapeutics of the scien- °
tific veterinarian. The removal of part, or what is more effectual,
of the whole of the membrana nictitans requires three instru-
ments, a speculum oculi, a special forceps, like that of Snellen,
and a pair of curved blunt scigsors.
The animal must be thrown, and the eye being anestheticised
with cocaine, and the lids kept well apart with the speculum, the
organ, with the mucous membrane which covers it, is drawn out
with the Snellen forceps, and by degrees severed in its continuity.
When it is loosened sufficiently to be brought entirely out of the
orbital cavity, it is separated with the scissors from all its attach-
ments. The adipose mass which was then slightly protruding re-
turns to its position and the operation is concluded.
There is always a little hemorrhage accompanying the dissec-
tion, which, however, is readily subdued by means of a simple
compress of cold water. No special subsequent attention is neces-
sary.
II.—OPperraTIons ON THE LACHRYMAL APPARATUS.
A.—On the Caruncula Apparatus.
The caruncula lachrymalis is sometimes the seat of hypertro-
phy, as commonly seen in cattle, the vague designation of Hnean-
this being given to all such lesions of the caruncula lachrymalis,
whatever may be their origin or nature.
744 OPERATIONS UPON THE EYE AND EAR.
It is an affection which is quite frequent in dogs, as the result
of localized chronic conjunctivitis. It is characterized by a tume-
faction of the organ, more or less developed, pedunculated, pro-
truding in the inner commissure of the lids, and accompanied
by lachrymation, caused by the obstruction of the lachrymal
puncte. ;
While at the outset anodynes and astringent collyria may some-
times control its development, there are many cases in which its
removal by ligature or excision is indicated. Silk is recommended
by Leblanc as the best material for a ligature, but elastic thread
is in our judgement much to be preferred.
Excision is far preferable. The operation is a simple one, con-
sisting in merely severing the peduncle with a curved scissors or
Fa. 535.—Bistoury for the Excision of the Encanthis.
a bistoury (Fig. 535), ad hoc. The comparative abundant hemor-
rhage that follows is controlled by cold water applications. The
wound which remains is treated on general principles.
B.—On the Lachrymal Ducts.
The occlusion or obliteration of these little canals by foreign
bodies, or as the result of inflammation of their mucous membrane,
sometimes occurs in horses. Its characteristic symptom is an
abundant and continual lachrymation, and it is only by careful
examination of the condition of the orifices of the lachrymal punc-
tee, that a correct diagnosis can be assured; a thick, muco-puru-
lent discharge sometimes oozing from them. Though this diffi-
culty often subsides by resolution of the inflammation, or the use
of washes and collyria, there are cases where surgical interfer-
ence, of the nature of a true catheterism of the duct, with possi-
bly an enlargement of its canal with the bistoury, cannot be dis-
pensed with. The probe of Bowmann (Fig. 536), and the knife
of Weber (Fig. 537), answer the purpose very well.
The animal is placed in the decubital position, the grooved
probe introduced into the duct, and its wall divided with the knife,
guided by the groove of the probe.
ON THE LACHRYMAL APPARATUS. 745
SSS)
Fia. 536.—Probe of Bowmann.
Fig. 587.—Knife of Weber.
C.—On the Lachrymal Canal.
The obliteration of the lachrymal canal may become necessary
in consequence of changes in the structure of its walls, or the
pressure made upon it by the surrounding parts. In the first
case, it occurs as the result of traumatic lesions, or of inflamma-
tion of the mucous membrane, the exudates accompanying it, and
the accumulation of thick secretions in the channel of the canal.
In the second case, it is due to severe rhinitis, swelling of the in-
flamed mucous membrane of the nasal cavities, polypi, bony growth -
of any kind, or in cases of dental caries.
The symptoms are: Lachrymation, filling up of the canal, its
inflammation, and arrest of the flow of the tears through the
lachrymal opening at the nose.
According to Professor Leclainche, there are four modes of
treatment for the relief of this trouble.
1st. Opening of the natural tract and removing the cause of
the obstruction.—This is done by the catheterism of the canal by
means of fine probes, or by detersive injections forced through
the inferior opening in the nostrils; or, again, as practiced by
Director Trasbot, by insufflation.
2d. Making an Artificial Tract.—If the point of obliteration
is situated near the lower opening of the canal, an artificial open-
ing can be made above it. To do this, Leblanc recommends the in-
troduction of a whalebone probe through the superior lachrymal
opening into the canal until the place of obstructionisreached when
a counter opening is made with a fine bistoury through the walls
of the canal. Two or three silk threads are then introduced into
the new passage between the two openings and left in place for
about twenty days.
If the obliteration is in the bony portion of the canal, and
cannot be overcome with the silver probe, the perforation of the
lachrymal bone and an artificial fistula must be made.
746 OPERATIONS UPON THE EYE AND EAR.
Neither of these operations is often followed by successful re-
sults, although the perforation of the bone enables the tears still
to escape in the nasal cavities. The formation of a fistula fur-
nishes a channel for the flow of the tears over the lachrymal sur-
face of the face.
3d. Obliteration of the Natural Tract.—The intention of this
operation is to effect the entire obliteration of the duct from the
lachrymal puncta and the lachrymal duct down. It is obtained by
the cauterization of these parts, either alone or inclusive of the
obliteration of the lachrymal sac. Tincture of iodine often pro-
duces the same effect. As the result of this treatment, the flow
of the tears takes place over the face.
4th. Hatirpation of the Lachrymal Gland.—This is not re-
ferred to as a practicable measure, but only because it is some-
times mentioned in the way of theorizing. The situation of the
gland in our domestic animals renders the operation an impossi-
bility.
ITI.—Oprrrations oN THE EssentTIAL OrGANS OF SIGHT.
On the Globe.—The essential organ of vision, or ocular globe,
is a membranous ball, completely closed, and filled with transpar-
ent fluids of different densities, and popularly known as the humors
(or media) of the eye.
This ball, nearly spherical, flattened from backwards in front,
has its greater convexity in front, where it is closed by the cornea,
a transparent expansion, thick and resisting; the glass of the eye.
Posteriorly, it is composed of three capsular, concentrical sheaths,
proceeding from without inward. These are the fibrous sclerotic,
the choroid and the retina (Fig. 538).
In the cavity of the globe one of these membranes—the cho-
roid—throws out, perpendicularly to the great axis of the organ,
a septum, the éris, a kind of contractile diaphragm, perforated in
its center by the pupil.
The retina is a membrane of special nature, being an expan-
sion of the optic nerve, and performs the function of receiving
the impressions of light, and transmitting its impressions and
images to the brain.
The humors of the eye are three, considered from before back-
ward, the most anterior being the aqueous, the most posterior the
vitreous, with the crystalline lens in the intermediate position.
ON THE ESSENTIAL ORGANS OF SIGHT. 147
Fag. 538.—Theoretical Section of the Horse’s Eye.
a.—Optic nerve. b.—Sclerotic. ¢c.—Choroid.—d.—Retina. e—Cornea. f.—Iris,—
gh.—Ciliary circle (or ligament) and processes given off by the choroid, though repre-
sented as isolated from it, in order to indicate their limits more clearly. 7.—Insertior
of the ciliary processes on the crystalline lens. j.—Crystalline lens. &.—Crystalline
capsule. /.—Vitreous body. mn.—Anterior and posterior chambers. o.—Theoretical
indication of the membrane of the aqueous humor. pp.—Tarsi. qq.—Fibrous mem-
brane of the eyelids. +.—Elevator muscle of the upper eyelid. ss.—Orbicularis muscle
of the eyelids. ¢.—Skin of the eyelids. uw —Conjunctiva. v.—Epidermic layer of this
membrane covering the cornea. 2.—Posterior rectus muscle. y.—Superior rectus
muscle. 2.—Inferior rectus muscle, w—Fibrous sheath of the orbit (or orbital mem:
brane).
To this essential organ are added as accessories, first, a mus-
cular apparatus, constituted by seven muscles—a posterior straight
or retractor, four others, also straight, the superior, inferior, ex-
ternal and internal; and two oblique, or rotators, the great and
small, or external and internal oblique, second, an adipose pad;
third, an apparatus of lubrication, composed of the lachrymal
gland and its means of conducting the tears, the product of its
secretion, viz., the hygrophthalmic canals, the puncta lachrymalis,
the caruncula lachrymalis, the lachrymai ducts, the lachrymal
sac, and the lachrymal canal.
The whole mass of this apparatus is enclosed in a conical
fibrous sac, the ocular sheath, which forms a membranous lining,
as it were, to the orbital cavity, or bony box, which is anteriorly
open, except when closed by the eyelids.
Our design in the present chapter is to confine our considera-
tion entirely to such portions of surgical ophthalmology as are
likely to demand the careful and practical attention of the vet-
erinarian.
748 OPERATIONS UPON THE EYE AND EAR.
A.—Txe Exrraction oF Forrian Bopies oN THE SURFACE
OF THE GLOBE.
The presence of a foreign body between the lids and the globe
of the eye is just as painful to animals as to man, and may, if
allowed to remain, give rise to symptoms of irritation and inflam-
mation which, unless promptly relieved, may induce severe attacks
of diseases which may compromise the usefulness of the organ.
Dust, insects, and small seeds of various kinds may indeed
find a lodgment in the eye, and resist the efforts made for their
removal, notwithstanding the excited function of the membrana
nictitans, or the super-excited flood of tears stimulated by their
presence.
Immediate removal is the first iNaiencont This may some-
times be effected by bringing the lids together and keeping them
temporarily closed until the stimulated collection of tears washes
out the offending substance.
If this fails, cocaine must be applied upon the eye, and when
its full effect is obtained, careful examination must be made, if
necessary, with the assistance of a loup, by everting the lids, in
order to bring the entire surface of the cornea into view The
irritating body may be wiped out with the finger, a piece of cloth,
or a soft camel hair brush, or when the object is hard and angu-
lar, as a particle of metal or stone, which has become partly im-
bedded in the cornea, the forceps may be necessary.
B.—Puncturt, oR PARACENTESIS OF THE CORNEA.
The object of this operation is to empty the anterior chamber
of the eye of its aqueous humor, of a collection of pus, or to effect
a release of a living intruder from the cavity of the eye, as, for
example, the parasitic jilaria ocult.
The operation is simple, but the use of cocaine cannot be
omitted. The instruments necessary are a cataract knife, or a
lanceolated bistoury (Fig. 539). It is introduced obliquely through
the cornea, at a very short distance from the sclerotic, and its in-
Fic. 539 —Lanceolated Bistoury.
a ee Me SS eee ee
ON THE ESSENTIAL ORGANS OF SIGHT. 749
troduction of course causes the immediate evacuation of the fluid
contained in the anterior chamber, and the dropping or collapsing
of the cornea, which assumes a rough and shrunken appearance.
In a few hours, however, it resumes its normal condition, the
secretion of the humor having taken place, and the wound of the
cornea being closed.
Compresses of cold water, and the application of a weak solu-
tion of atropine will obviate severe symptoms.
C.—STAPHYLOMA.
This designation applies to a deformity or distension of the
cornea, consisting in its protrusion beyond its normal and sym-
metrical convexity. It varies in shape, and may be round or
pointed. It is very common in dogs, especially in young ones,
and if not discovered and attended to in its first stage becomes
very rebellious to treatment. If overlooked and neglected ulcera-
tion of the cornea and destruction of the eye is certain.
Cauterization, with nitrate of silver, the ligature, and complete
excision with the scissors are recommended, but the chances of
success depend on the length of time it has existed and the size
it has attained.
D.—CaTARACT.
The opacity of the crystalline lens, or that of its capsule, or
that of the humor of Morgagni, or of these three conjointly, pro-
duces loss of sight, and for its re-establishment the operation
called “of the cataract” is, in some exceptional cases, attempted
on horses and dogs.
The object in view is the extraction of the opaque lens; its
division into fragments that may be resorbed; or its dislocation
from its normal position. It is not often performed in veterinary
practice, but successful attempts have been credited to Vatei, La-
fosse and others, while still others, as Gohier, Brogniez, H. Le-
blanc, Haubner, Hertwig and Hering have reported their results
as sometimes successful and sometimes otherwise.
The animal is to be placed in the decubital position, and the
dilatation of the pupil is to be obtained by the application of a
solution of sulphate of atropia or extract of belladonna.
Among the difficulties connected with this operation is the
peculiar anatomy of the globe of the eye, which by the action of
750 OPERATIONS UPON THE EYE AND EAR.
the posterior rectus muscle is drawn back in the orbital cavity, a
displacement which not only renders the action of the instruments
more difficult, but also stimulates the motion forward, over the
cornea, of the membrana nictitans. The immobility of the eye is
one of the first points to be secured. There are two ways of
securing it, one fixing it from the front, the other from behind.
It can also be fixed from the front in two ways—that of Le-
blane and that of Brogniez. Leblanc uses a tricuspid stylet (Fig.
540), which has three branches, two of which are applied on the
Fic. 540.—Tricuspid Stylet of Leblanc.
sclerotic at the internal angle of the eye, the third, which is moy-
able, resting also on the same membrane at its inferior part. The
first two keeps the membrana nictitans from the cornea, and all
three, implanted into the sclerotic, keep the globe immovable.
Brogniez uses a special instrument, which he calls a “diapta-
tor” (Fig. 541), which is a metallic rod, having three or four
Fic. 341.—Brogniez Diaptator.
points, twisted like those of a cork-screw, which by a slight
pressure, combined with a little twist of the instrument, com-
pletely fixes the ocular globe.
To fix the globe from behind, Hayne, Dieterichs, Prinz and
Bleiweiss make an incision through the skin behind the orbital
arch, and an assistant, with one of his fingers passed through it,
keeps it in place by direct pressure.
General anesthesia is always indicated. Peuch and Toussaint
recommend the use of the Waldon forceps (Fig. 542) to immobil-
<a
Fia. 542.—Forceps of Waldon,
ON THE ESSENTIAL ORGANS OF SIGHT. 761
ize the eye. It operates by grasping the conjunctiva on the inner
angle of the organ, and keeping it motionless by a slight pres-
sure. The lids are kept widely separated by means of the specu-
lum oculi already mentioned. There are three principal modes of
operation besides these, which are used in human surgery, which
result in the union of these principal methods.
Ist. Method. Dislocation of the Lens.—It is intended to
displace the cataract en masse from the pupilar focus, and to fix
it in a dependent part of the chamber, behind the iris, where it
will no longer intercept the light.
It is generally performed in two ways—through a puncture of
the sclerotic (Scleroticonyxis), or by puncture through the cornea
(Keratonyxis). The instrument used is called Scarpa’s needle
(Fig. 543). This is either straight or curved. The eye being fixed,
Fic. 543.—Scarpa’s Needles.
and the pupil dilated, the needle is introduced through the scle-
rotic, on the outside, and lower part of the globe, a short distance
back of the cornea (Fig. 544), pushing it in a direction first slightly
obliquely upward, and then horizontally. The needle has thus
wee,
ce
\
Fia, 544.—Operation of Cataract by Displacement of the Lena
152 OPERATIONS UPON THE EYE AND EAR.
penetrated between the ciliary processes and the border of the
lens, and presently becomes visible to the operator, passing be-
yond the internal border of the pupil. By a slight motion up-
ward and downward, the capsule is then opened and the lens
depressed, first backward, then vertically, and pushed downward
into the lower part of the vitreous humor. A gentle rotation of
the instrument then releases it from the substance of the lens, and
it is returned to its horizontal position. The instrument is not
withdrawn until it is ascertained that the lens is established in its
new position.
When the puncture is made through the cornea the entrance
into the eye takes place near the center of this membrane, and
the access to the lens takes place through the opening of the
pupil.
In either case the wound of the globe is insignificant.
2d. Method. Hzxtraction.—There are two principal modes of
operation, one by extraction through a flap of the cornea upward,
and another by a linear incision on the side of the globe.
In the operation by the flap upward, the knife of Richter,
modified by Beer (Fig. 545), is introduced horizontally through
4!
ij
on
Fig. 545.— Knife of Beers.
the cornea, near the sclerotic border, a little above the horizontal
diameter of the globe, with the edge turned upward, and as soon
as the point of the instrument has entered the anterior chamber
of the eye, it is pushed in a straight, horizontal direction, passing
into the anterior chamber (Fig. 546), and when its point reaches
the opposite side of the cornea, it is pushed through it in such
a manner that its exit and its entrance occur at equal distances
from the sclerotic border.
The flap is completed by pushing the instrument directly out,
when the aqueous humor escapes, and the cornea collapses.
The anterior wall of the crystalline cover is then divided with
the kystitome (Fig. 547). The hook of which turns backward,
and is made to tear the envelope by moving it from above down-
ward and from within outward. ‘The upper lid being raised with
forceps, and a gentle pressure made with the finger at the lower
ON THE ESSENTIAL ORGANS OF SIGHT. 750
Fig. 547.—Kystitome.
border of the cornea, the lens presently falls out through the in-
cision. If it becomes engaged in the wound it can be removed
with the forceps or the curette of the kystitome.
Unless care is taken at this point to avoid making too great a
pressure upon the eye, there is danger of the escape of the vitreous
humor. The lids are then brought together and a light bandage
applied, and as in other cases, the animal must be prevented from
disturbing the wound by rubbing or otherwise.
The linear method consists in making a straight incision on
the outside border of the cornea with the knife of Graafe (Fig.
548). It is principally employed in cases of soft cataract.
Fig. 548.—Knife of Graafe.
754 OPERATIONS UPON THE EYE AND EAR.
E.—Amevrarion oR ExtrrPatioN OF THE EYE.
This operation is only indicated in cases of degeneration of
the globe, and after special traumatic lesions of the organ. It is
comparatively a simple one, and not as dangerous nor as painful
as it is generally supposed to be. It can easily be performed
with a simple or a blunt bistoury. Hertwig recommends a sage-
knife, and we have often performed it with only a pair of curved
scissors.
With the lids well separated, the eye, or what may remain of
it, is secured with a pointed tenaculum, or a pair of forceps, and
the conjunctiva divided in all its circumference with the knife.
Then passing the bistoury into the orbital cavity, close to its
walls, and cutting from the inside, and thence to the inferior part,
the entire mass is detached, with the exception only of being held
by the cord of the optic nerve.
This last attachment is then severed with the scissors. The
hemorrhage which always accompanies the operation is readily
subdued by pressure. Simple cleanliness is all that is required in
the subsequent treatment.
Doctor E. Rolland describes his modus operandi for the enu-
cleation of the eye as follows: The operation requires a specu-
lum oculi, a hook such as is used in the operation for strabismus,
curved blunt scissors, forceps to fix the eye, and a pair of scissors
curved on their flat for the section of the optic nerve.
The lids being held apart with the speculum the operator
grasps a fold of the conjunctiva, on the outside of the eye, and
slits it near the border of the cornea. Then, with the scissors,
the conjunctiva is entirely divided round its margin, near the
corneal border. The sub-conjunctival cellular tissue being after-
ward divided with the scissors, the muscles are brought out with
the strabismus hook and divided, beginning with the external
rectus. The speculum is then removed, and by pressing firmly on
both lids, the globe of the eye is pushed out of the orbital cavity.
The curved scissors are passed behind the globe, and the optic
nerve amputated at its point of entrance into the globe.
The operation ended, the orbital cavity is washed out with cold
sterilized water, and is then filled with pulverized and sifted bor-
acic acid. This dressing is removed daily for five or six days, and
the eye protected as in Fig. 549.
;
‘
i
¥
>
ON THE ESSENTIAL ORGANS OF SIGHT. 755
FIG. 549.—How to Protect the Eye.
OctLarR PrRoTHESIS.
The animal which has undergone the preceding operation is
considerably deformed, but the difficulty is easily remedied by the
insertion of an artificial eye.
Artificial eyes for horses were first introduced by Schmidt in
1850. They were originally made of glass, but many varieties of
material have since been used, and to-day all instrument-makers
probably keep them in stock, of hard rubber and gutta-percha,
etc. By the skillful use of pigments the artificial organ can now
be made to so closely match its living companion as to be undis-
tinguishable from that which the animal has always carried (Figs.
550 and 551).
But the artificial organ must not be introduced into the orbital
Fies. 550, 551.—Artificial Eye—side and full view.
756 OPERATIONS UPON THE EYE AND EAR.
cavity until all granulations, suppuration and inflammatory proc-
esses in and about the wound have ceased.
To put the artificial eye in place the upper li is raised and the ;
the border of the artificial organ placed underneath it; in the
meanwhile the lower lid is drawn downward and the correspond-
ing border of the eye pushed on its internal face. The eye is in
place, especially if after its introduction the animal makes a few
motions with his lids, all the folds of which are soon removed.
To remove the eye the lower lid is drawn downward, and it is dis-
lodged by passing a blunt probe under it toward its posterior face.
The artificial eye will not need removal oftener than once in eight
or ten days. If worn too long there might be danger, with cer-
tain materials, of softening. The advantage of having an alter-
nate eye will, upon reflection, become obvious. :
ON THE EAR.
AMPUTATION.
Usually, only horses and dogs are subjected to this opera-
tion. |
With the horse, the object is commonly either the correction
of a deformity, or the cure of disease or injury.
When performed upon the dog, it is principally as an opera-
tion of fashion—so-called—or in compliance with some prevalent
caprice relating to a supposed improvement in the appearance of
the animal. Yet with these it must at times, of course, become
necessary for the repair of anaccident. It should be understood
that the seat of the operation is in all cases the cartilage of the
concha.
Amputation in Horses.—The amputation may be either partial
or complete. One ear may exceed the other in size, and it may
become necessary to trim down the larger for the sake of estab-
lishing symmetry between the mismatched pair with the knife.
Or both may be similarly misshapen, and a partial amputation of
both may be, therefore, indicated, for the same esthetic reason as
that which influenced in the other case.
This operation is seldom, if ever, performed at the present
time. The complete amputation is indicated in cases where the
cartilage is affected with pathological degenerations, and especially
when these exist toward its base.
rr. or
AMPUTATION OF THE EAR. Tene
Partial amputation may be performed with the patient in
any posture, and may be considerably simplified by using Brog-
FIGs. 552, 553.—Brogniez Apparatus for Amputation Fic. 554.—Apparatus of Brog-
of the Ear. niez in Position.
niez’s apparatus. This consists of a wooden model of the inside
of the cartilage (Fig. 552), and of metallic en-
yelopes or patterns of the outside (Fig. 553) of
which there should be separate ones for each
ear. Both the wooden model and the metallic
pattern are held in place by a systematic screw
(or wood screw) like those usen by cabinet-ma-
kers in gluing wooden joints together. The ap-
paratus is adjusted as shown in Fig. 554, and
the excision of the protruding cartilage is made
with the bistoury.
Amputation with the nippers of Garsault
(Fig. 555), or that with the bistoury do not give
equally satisfactory results.
Complete amputation, according to Peuch
and Toussaint, is best performed with the ani-
mal under complete anesthesia. We have had
opportunities of operating without it, but it
cannot be questioned that it furnishes power-
ful assistance, when it becomes necessary to
ap : : FIG. 555.—Ni
keep the head in place, as in this case. ‘Ganecle a
758 OPERATIONS UPON THE EYE AND EAR.
We consider the operation to be comparatively a simple one,
though delicate handling is required.
A conyex bistoury or scalpel, dissecting and artery forceps and
needles and thread are the instruments required.
A circular incision is made always, if possible, by one stroke
of the knife, toward the base of the cartilage, beginning at about
the lower commissure of the external opening of the concha; then
carefully avoiding the division of the bifurcation of the parotid
gland, the insertion of the muscles attached upon the concha is
divided, the posterior and anterior auricular arteries are ligated,
the adhesions with the surrounding cellular tissue are lacerated
with the handle of the scalpel, and the ligament which unites the
concha to the annular cartilage is severed, the little prolongation
of the former can then be easily followed to its end, and the con-
cha be readily extirpated by lacerating its cellular attachments.
The wound is closed with sutures, and treated in the usual
way.
Amputation in Dogs.—Although, as we have remarked, this is
principally an operation of fashion, there are still conditions in
which it is rationally indicated. It is commonly performed with
scissors, curved or straight, with which the required portions of the
concha are amputated by a single cut of the instrument.
Instruments have been invented to insure a more certain suc-
cess in the operation, and a neater finish after the wounds have
Fig. 556.—Nippers to Amputate Dogg’ Ears.
healed. The limitation forceps, represented in Figure 556, pos-
sess some advantages in these respects.
In any mode of operation, the flap of skin first excised be-
comes the only true pattern by which to shape the second.
The operation is generally followed by some hemorrhage, but
this either subsides spontaneously, or by the application of local
hemostatics, and the cicatrization proceeds without help under
the scab, which after a day or two covers the edges of the wound.
CHAPTER XV.
DISEASE SHOP LIE Wit BERS:
The withers is the region of the body which, of all others, is
most exposed to lesion, the injuries to which it is subject being of
every form, nature and degree of severity. From its very loca-
tion it is especially liable to all kinds of external traumatisms, and
is peculiarly apt to suffer from blows, bruises, bites, contusions,
pressures and frictions by the harness, etc., and these give origin
to bloody or serous tumors; cold and warm cedemas, abscesses
superficial or deep, and various wounds of the surface, with or
without injuries of the subjacent tissues; and these again may be
followed by necrosis of the dorso-cervical ligament, and of the
apex of the dorsal vertebrze, accompanied with purulent filtrations,
in various localities, the formation of fistulous tracts, and possibly
the extenston of the diseased conditions to the ligamentum nuche, ©
ending with the disease of the neck, with all its unfortunate
sequel.
With the consideration of such a multiplicity of pathological
evils before us, an orderly and systematic arrangement of topics
is especially necessary, and we shall, therefore, in our treatment
of the diseases of the withers, adopt the classification of Bouley
aud Nocard. And this introduces us successively to the study
of excoriations, coedemas, hematoma, core or stickfasts, cysts,
abscesses, wounds, and the “diseased withers” proper, or what is
generally understood as ‘‘the persisting lesion, fistulous in its
character, and whose condition of formation and duration is
due to the mortification of the fibrous, yellow or cartilaginous
tissue of the apex of the spinous processes of the anterior dorsal
vertebree.”
Considered from an anatomical point of view, the withers form
a very complex region. Its skeleton is formed by the superior
spinous processes of the anterior dorsal vertebree, and it is sur-
rounded by muscles arranged in layers, intersected by fibrous
760 DISEASES OF THE WITHERS.
aponeurotic bands or sheaths. The vertebre give attachment
by the cartilaginous nucleus, which is at their apex, to the pos-
terior portion of the yellow, elastic cord, which is part of the
funicular portion of the ligamentum nuche, and are also united by
the interspinal ligament. The muscles which rest upon the ver-
tebree form six different planes, thus divided: 1st. The skin, lined
inside by cellular tissue, more condensed toward the median line
than on the sides, where itis loose; 2d. The trapezium muscle,
thin and aponeurotic inferiorly, but thicker in its upper portion,
ea
Fic. 557.—1st and 2d Layers of the Region of the Withers.
P.—Skin folded down. pf.—Funicular portion of the cervical ligament. tc.—Cer-
vical portion of the trapezium. td.—Dorsal portion of the same. ea.—Acromion spine
which is muscular (Fig. 557), and lying over the external surface
of the scapula and its cartilage of prolongation. 3d. The rhom-
boideus muscle, which is separated from the second plane on its
external surface by a layer of loose cellular tissue (Fig. 558), and
is lined in its internal face, by a yellow elastic band, inserted on
the inside face of the cartilage of prolongation of the scapula.
ee ea eS SS
DISEASES OF THE WITHERS.
761
Fic. 558.—3d Layer of the Region of the Withers.
cb.—Cartilage of the scapula. pf.—Funicular portion of the cervical ligament.
rh.—Rhomboideus muscle. a.—Angularis of the scapula. S.—Splenius,
Fig. 559.—4th Layer of the Withers.
sc.—Section of the scapula and surrounding muscles.
ap.—Its aponeurosis.
da.—Anterior small serratus.
gd.—Great serratus.
pf.—Funicular portion of the cervical lig-
ament. s.—Inferior attachment of the splenius. ad.—Ramifications of the dorsal
artery. gc.—Great complexus. pce.—Small complexus.
scapulez.
a,—Section of the angularis
762 DISEASES OF THE WITHERS.
This band is specially liable to attacks of necrosis. 4th. The su-
perior portion of the anterior small serratus muscle, which is
formed by a broad aponeurosis, attached to the superior extrem-
ity of the spinous processes of the vertebre (Fig. 559). 5th. The
SS
Fic. 560.—5th Layer of the Withers.
pl.—Lamellar portion of the cervical ligament. pf.—Funicular portion of the same.
ac.—Superior cervical artery. te.—Transversal spinous of the neck. bs.—Superior
branch of the spinalis. bi.—Inferior branch of the same muscle. ic.—Common inter-
costal. ad.—Dorsal artery. gd.—Great serratus. si.—Inferior scalenus. it.—Inter-
transversalis muscle.
anterior portion of the ¢/io-spinalis muscle (Fig. 560). The 6th
and the deepest of these planes, resting on the faces of the long
spinous processes of the vertebree, is formed by the transverse
spinal muscle of the back. (Fig. 561). To these are to be added
the posterior extremities of some of the muscles of the neck,
covered by the internal face of the scapula, the ramification of
the large blood vessels, branches of the anterior aorta, and the
dorsal and superior cervical artery with the spinal nerves which
are distributed in that portion of the body. If we map all this
distinctly in our minds, we shall have the material for forming an
idea of the structure of the withers, and the intricate and inter-
esting arrangement and disposition of its many parts, with their
relation to the ailments whichattack them. This will be facilitated
by an inspection of the illustration (Fig. 562), representing a
transverse section of the entire region involved. The drawing
exhibits the obliquity of the direction of the various muscular
layers, and demonstrates the tendency of the purulent gatherings,
by gravitating and collecting between them, to contribute to the
‘
4
.
DISEASES OF THE WITHERS. 763
Fié. 561.—6th Layer of the Withers.
pl.—Lamellar portion of the cervical ligament. pf.—Funicular portion. te.—Trans-
verse spinalis of the neck, ac.—Spinous processes of the dorsal vertebra. t.—Tuber=
osities of the same. te.—Transverse spinalis of the back. ie.—Common intercostal.
c.—Ribs. gd.—Great serratus. it.—Inter-transversalis. i.—Externai intercostal mus-
cle. 1.—Inter-spinalis ligament.
formation of the ailment recognized as a true “ diseased withers,”
with the habitual severity which is its characteristic.
The originating causes of the diseases of the withers may be
divided into the predisposing and the occasional. Among the
first are to be noted a defective anatomical conformation of the
region; the kind of work performed by the animal, and the degree
of care he receives. For example, when the withers are low, thick
and fleshy, as in heavy draught horses, the saddle of the harness
has a tendency to slip forward and cause chafing and excoriation,
an accident from which, however, animals with high, sharp withers
are by no means exempt; for though, for the reason stated, they
are less liable than those of the other conformation, the advantage
is offset by the fact that the skin is exposed to a more unequal
pressure, especially if that part of the harness is not properly
padded and fitted, and presses irregularly on the soft tissues,
upon which it rests.
764 DISEASES OF THE WITHERS.
ft N i
}
i
VN
==
SSS
SS SSeS?
QML
—=
SSS =
; —S=SS=
Fic. 562.—Transverse Section of the Region of the Withers.
p.—Skin. fe.—Fibre elastic tissue. t.—Dorsal trapezium. r.—Rhomboid muscle.
-cp.—Cartilage of the scapula. is.—Ilio spinalis. v.—5th dorsal vertebra. gd.—Great
serratus. ss.—Sub-scapularis. s.—Scapula. sSe.—Antea-spinatus. sh.—Scapulo-
humeral joint. pf.—Deep pectoral. pt.—Thoraciq walls.
Saddle horses are for the same reason peculiarly apt to become
sufferers from the lesion of which we are speaking. The self-
inflicted bites and the scratching and rubbing of animals suffering
from parasitic affections, in their efforts to relieve themselves, may
also result in placing them in the category of the predisposed.
To enumerate all the occasional causes would be to make a
catalogue of casualties, which would be best done by copying from
the accident columns of the daily press, and we shall merely refer
to a few of a kind which may possess some special characters and
notable features, not too obvious or common and familiar
Contusions of any kind, resulting from the causes stated, or
even little abrasions from the simple misfit of a blanket kept in
place by a surcingle too tightly buckled—anything, in fact. which
may give rise either by its immediate effect or by its continuance,
ee
DISEASES OF THE WITHERS. 765
to the slightest form of pathological change, may serve as a spark
which may kindle into the most serious case of fistulous, diseased
withers.
(a) EHxcoriation.—This is the simplest of the lesions of the skin
covering the withers, or any portion of the body. It is most com-
mon in summer, when it appears in the form of a red spot, becom-
ing rapidly covered with an abundant serous exudation, which
rapidly forms a yellow or brownish crust, adherent to the under-
lying tissues. This is always painful, especially in summer, when
it excites a violent pruritis, which may degenerate into a lesion
of a serious nature.
Excoriations, however simple, ought never to be neglected, and
precautions should always be taken against them. When they do
occur, local healing applications, usually simple ones, are sufficient,
and should be made without delay.
(6) Warm G?dema.—This is the result of the laceration of
the subcutaneous cellular tissue and its subsequent inflammation.
Saddle horses suffer from it, especially in summer and after long
journeys. At such times, the skin becoming more or less adher-
ent to the saddle, the motion of the animal, together with that
of the skin, is communicated with every step to the subjacent
cellular tissue (a sort of rubbing, to-and-fro motion); and this vio-
lence, though slight, produces by its long continuance the natural
effect of inducing an inflammatory state in the tissue. This
edema is characterized by a tumefaction of the parts, warm and
pitting under pressure, more or less painful, and having a tendency
to spread toward dependent structures. It disappears by resorp-
tion in two or three days, but leaves a slight thickening of the
cellular tissue, sometimes difficult to detect. This resorption
takes place if the originating cause has, within a moderate period,
ceased to operate; but if, on the contrary, it has been permitted
to keep up its irritating action, the cedema will increase, and in
due time the condition will be changed to that of suppuration—a
termination to be, if possible, by all means anticipated and pre-
vented.
The removal of the cause, sometimes accomplished by merely
giving the patient a season of rest, is the most important item in
the treatment. The resorption of the cedema can be accelerated
by means of massage, cold compresses, astringent lotions, weak
stimulating frictions of an alcoholic nature, or cold irrigations.
766 DISEASES OF THE WITHERS.
(ce) Hematoma, or Bloody Tumor.—This lesion is produeed
by a violent traumatism, such as a blow, a contusion, or a violent
bite by some other animal. It develops immediately upon the oc-
currence of the cause, resulting from the laceration of the super-
ficial blood vessels. It is characterized by a swelling, varying in
size according to the nature of the producing cause. It is at first
somewhat warm and fluctuating, then becoming puffy, and when
the blood has coagulated, hard, tense and crepitating. Ordinarily
it is not very warm or painful, but it becomes so after a few hours,
and then there is danger of its assuming a suppurative character.
Yet in other cases it may maintain that condition for two or three
weeks, undergoing the process of resolution, the resorption usually
becoming complete in that period. The correct diagnosis of this
condition, and of any occurrent changes, some of which it is im-
portant to know, can be more satisfactorily established by explor-
ation.
Left without interference and in the absence of irritating causes,
the hematoma will usually subside by spontaneous action. In their
treatment, cold applications are indicated during the first days of
its existence, but at a later period, when the tumefaction has be-
come of a denser consistency, absorbent and stimulating local
medication is indicated, such as blisters of cantharides, or of mer-
curial preparations, or of the iodine compounds. These applica-
tions, however, must not be too hastily resorted to, lest the exces-
sive or premature stimulation should end in the formation of
abscesses. Except when there is positive evidence of suppuration,
pressure by bandaging and the opening of the tumor with the
bistoury are always contra-indicated.
(d) Core, or Stickfast.—'This is caused by the immediate
mortification of a portion of the skin, and often of the deeper
tissues. It is a hairless scab of a blackish color, having the ap-
pearance of tanned leather. It is at times. superficial, and has a
tendency to extend to the subjacent structures. It is rigid and
inflexible, and its pressure upon the deeper tissues tends to in-
crease mortification. The tissues surrounding it are inflamed and
their sensibility increased, and at a later period a process of elim-
ination by suppuration takes place all around its edges. But this
pus does not very readily escape, and there is always a portion
remaining in the bottom of the sloughing surface which becomes
fistulated with the formation of collections. If the core should
DISEASES OF THE WITHERS. ~* 767
extend to the dorsal ligament or to the bones, the result will be
necrosis and caries, and a true diseased wither will be the conse-
quence. With these conditions, lymphangitis, leucophlegmasia,
and deep abscesses may be expected, and usually supervene.
The sloughing of the mortified structure is always slow, espe-
cially when the deeper tissues are involved, but the wound which
remains after the casting off of the core is not uniform in its sub-
sequent action. When it is superficial it heals quite rapidly, but
recovers only with great difficulty when it is deep-seated, and in-
volves fibrous, cartilaginous and bony structures.
The prognosis of this lesion of the withers varies according to
the thickness of the tissues which are involved; but it also varies
according to its location, those which are situated on the lateral
faces of the withers being less serious than those which occur on
the median line.
The treatment indicated is strictly local. The first indication
is to discontinue, or obviate, the irritating cause, by changing
the harness, by chambering it, or, what is better, by refraining
from working the animal until he has entirely recovered. The
second indication is to hasten the sloughing of the mortified tis-
sue, and allay the irritability which the animal betrays upon the
slightest touch of the hand, or other object, upon his back. Top-
ical remedies in the form of ointments, lotions or poultices, are in-
dicated for this purpose. As soon as the process of sloughing
begins it must be stimulated and encouraged. Warm compresses,
antiseptic lotions, glycerine, phenial mixtures are then beneficial.
The maintenance of simple moisture, by means of phenicated or
creolined mixtures has, in our own experience, been of great ad-
vantage. If during the process of the elimination of the core the
suppuration seems to be abundant with a tendency to accumulate
instead of escaping, care must be taken to facilitate its removal
by means of oakum, absorbing cotton, sponges or drainage
tubes. Sometimes the core is of unusual size, with roots reaching
deeply into the tissues beneath, but although this may be the
case, no attempt should ever be made to tear them forcibly away.
They must be permitted to drop away by spontaneous action. If
the edges are very wide they may be trimmed off with the scissors
or bistoury, but interference beyond this is never permissible.
When they have entirely sloughed away there remains but a simple
granulating wound, which ordinarily requires but mild forms of
768 DISEASES OF THE WITHERS.
treatment. The animal, however, ought not to be made to re-
sume work until it is entirely healed.
(e) Cyst, or Hygroma.—These terms designate a tumor which
usually forms on either the middle or the lateral face of the
withers, originating in the dropsical condition of a serous bursa.
On whatever part of the withers it may make its appearance, the
originating cause is the same, and it is the effect of friction, or of
the slight but long-continued irritation produced by an ill-fitting
harness, inflicted while the animal is suffering from parasitic dis-
eases. In these cases the connective areole of the bursa become
the seat of an amount of secretion in excess of that which is re-
moved by the act of resorption, and the accumulated hyper-
secreted fluid gathers into the cavity, to form the serous cyst.
When located in the median line, the hygroma constitutes a
soft tumor, of varying size, from that of a pigeon’s egg to that of
a child’s head—bilobulated, always soft, fluctuating, without heat,
and painless; even transparent, when the skin is pigmentless. It
always presents the differential characters of being well defined
in its outlines, and without inflammatory peripherical infiltra-
tion.
When the cyst is on the side of the withers it may present
some similar characters, but when it is deep, under the apone-
urosis of the trapezium, or even under the rhomboideus, an ex-
ploration becomes necessary to establish the differential diagnosis
from abscess, as upon the true nature of the tumor depends the
immediate indications of treatment.
Hygroma of the withers may retain their characteristics for a
long time, but many change in their nature under the influence
of external irritations, bruises, contusions, improper treatment,
etc. In that case the cyst is transformed into an abscess, or rather
a suppurating cyst.
In respect to the treatment of cystic withers, the first indica-
tion is to remove the cause, and with this not only will the accu-
mulation of the serosity cease, but the possibility of its trans-
formation into the abscess form will be removed.
When the cyst is small and of recent formation, resolvent
treatment is in order, as cantharides ointment, bichloride or
biniodide of mercury pomatums, ete. Actual cauterization, in lines
or in points, has given satisfactory results in chronic cases. In-
jections of tincture of iodine have also been recommended. Our
en eT
DISEASES OF THE WITHERS. 769
own experience warns us that it is not without danger, from its
liability to be followed by a severe form of diseased withers.
Bouley and Nocard, in relation to this mode of treatment, say “it
is better to empty the cyst with a capilliary trocar, or by the
aspirator, to wash its cavity with an antiseptic preparation, slightly
irritating (5 per cent. solution of phenic acid), to repeat this injec-
tion several times, until the liquid taken out of the cyst is per-
fectly limpid, and then apply over the entire surface of the skin a
thick coat of blister.”
The purulent cyst is treated as an abscess.
(f) Abscess.—A phlegmon of the withers may rise suddenly
under the influence of a severe traumatism, or become the sequel
of a hematoma, or of a cyst. It appears most commonly on the
superior part of the withers; sometimes on the sides, as a tumor
more or less warm and painful, first uniformly hard and tense,
and afterward soft, with a fluctuating center, and surrounded by
an cedematous infiltration, more or less developed. If the abscess
is superficial, ulceration of the skin soon takes place, followed by
the escape of thick, white and creamy pus.
If, on the contrary (and this is often the case), the abscess
is deep, developing itself under the the aponeurosis of the great
dorsal, or of the rhomboideus muscle, or even deeper, under the
cartilage of the scapula, or the thickness of the ilio-spinalis, the
symptoms then, however, being less defined. The tumefaction is
less characteristic, the heat less marked, the fluctuation not detect-
able, and the only sign which guides the surgeonis the excessive pain
manifested upon the slightest pressure on the tumor, and from
which the animal shrinks in fear. This sorenessis in fact so great
that in some animals it interferes with the action of the leg on the
side affected. The appearance of general febrile symptoms is not
uncommon at this period, with elevation of temperature, increase
in the circulation, anorexia, excessive thirst, etc. At this period,
also, it becomes important to be certain of the diagnosis, or at
least to be sure of the existence of the suppuration, and its loca-
tion must be accurately made out, in order to prevent the severe
disorders that may be caused by the presence of the pus; a prob-
lem which can be only solved by repeated capillary exploring
punctures, made at various points, and at given depths, according
to the dimensions of the phlegmonous enlargement.
The prognosis of abscess of the withers depends altogether on
770 DISEASES OF THE WITHERS.
the seat it occupies. If superficial, and on the lateral faces of the
region, it is not serious, If on the median line, it assumes a more
severe character. If deep, it is also of a dangerous nature, unless
it is simple or limited; but, on the contrary, if the quantity of the
pus has continued to increase, and infiltration has taken place into
the cellular tissue separating the muscular layers; or the sup-
puration has penetrated under the cartilage of the scapula; it
will have assumed the most complicated form of the disease, with
chances of recovery of a very doubtful character. When the pres-
ence of the pus has been detected, the immediate indication is to
assist its discharge by a free incision down to the bottom of the
cavity. The incision must be made on the most dependent part
of the tumor; in such manner as to prevent the collection from
settling in a cul-de-sac. A means of drainage must be provided,
and the tube is preferred to the tent of oakum, or even to the
seton, as more sure to reach all parts of the collection, and the
more thoroughly to wash out the cavity.
If, however, the suppuration has not been detected, the appli-
eation of local stimulation is indicated by means of warm com-
presses, hot poultices and the like ; a constant watchfulness being
maintained, meanwhile, in order to detect the presence of the pus
at the earliest moment of its formation ; when it must be immedi-
ately evacuated.
(g) Wounds.—Resulting from every variety of traumatic
agencies, these injuries will necessarily vary in their extent and
the nature of the tissues which are involved.
They therefore extend from the most trifling hurt of the skin
to the severest lacerations of the important ligamentous, cartila-
ginous and bony structures contained in the region under con-
sideration. With such a diversity in their form and nature there
must also be a corresponding range in the character of the prog-
nosis to be announced, from that of rapid spontaneous recovery,
without interference, to the gravest of terminations.
One of the principal indications in the treatment of wounds of
the withers is to prevent as much as possible the filtration and
deposit of pus through the various layers of the region, and facili-
tate the cicatrization, by placing them in a state of immobility,
and according to Bouley and Nocard, the best method of securing
this suspension of movement is to apply a broad blister all around
the wound, and to repeat the application after a few days. The
DISEASES OF THE WITHERS. TEL
pain caused by this compels the animal to abstain from all move-
ment, and besides this the inflammatory swelling resulting from
the blister promotes the cicatrizing process by stimulating the
proliferation of the cells of the repairing tissue. Aside from this
special direction, the treatment of wounds of the withers involves
no methods or indications different from those of similar hurts in
other parts of the body. In most cases the surgeon must trust
his experience and knowledge of general principles for guidance.
(h) ‘Diseased Withers” proper: Fistulous Withers.—As we
have before stated, this denomination belongs to “a persisting
lesion, fistulous in character, due to the mortification of the tis-
sues of the withers, fibrous, yellow, cartilaginous or bony.” It is
necrotic in its nature, and while it may attack but one, it may
also exist in all of these organs.
Whatever this condition may be, however, the necrosis is always
manifested externally by an indicator, in the form of a fistula giv-
ing exit to an abundant, thin pus, serous, sanious, grayish in color,
adhering to the hair, and irritating and excoriating the skin upon
which it flows. At first it is odorless, and nearly homogeneous,
but it soon becomes fcetid in odor and loaded with the detritus of
necrotic tissues, more or less abundant, varying in thickness and
in color, according to the nature of the tissue from which it is
formed. |
One or several of these fistulous openings may exist on one or
both sides of the withers leading from the same or from different
necrotic centers. Their number is not limited. Several of them
may be in existence at the same time, especially when the disease
has maintained its hold on the system for a period of three or
four months without being checked or cured; a state of things
not infrequently witnessed.
Their formation is explained by the constant accumulation of
the pus in the sinuosities of the original tract, which by degrees
overcomes the resistance of the surrounding structures, and es-
tablishes a channel for itself by the same process as that by
which the first outlet was formed. It may sometimes happen that
the opening of new canals becomes the cause of the closure, or
perhaps only the constriction, of the original channel, and a new
exploration becomes necessary to ascertain the new routes of the
fluid. In this case their direction will be best made out by the
injection of liquids through their open mouths.
772 DISEASES OF THE WITHERS.
The presence of one of these canals at the bottom of a wound
may sometimes be detected by the appearance of large, fleshy,
cone-shaped granulations, of a purplish color, from which an ooz-
ing of pus takes place upon the application of pressure.
But in another case, the orifice of the fistula may be directly
on the skin, surrounded with granulations, protruding, soft and
bleeding upon the slightest touch, with an escape of sanious pus
between them; these granulations at a later period, flattening, as
the wound contracts, until the thinned skin seems to be continu-
ous with the smooth, reddish membrane which lines the internal
face of the tract. It may even happen that a process of cicatriza-
tion taking place around the opening will transform its external
outlet into a narrow strait which opens in the bottom of a cavity
formed by the skin drawn inwardly by the cicatricial retraction of
the indurated peri-fistulous tissue.
The direct exploration of the fistula is the best mode of ascer-
taining its existence, direction, extent and depth, and also the
lesion which gives rise to it. This exploration ought to be made.
by the taxis, since it is obvious that no instrument can communi-
cate an impression such as can be obtained by the touch of the
finger. By the hand, therefore, must be ascertained the course
and sinuosities of the fistula, its diverticulum, the nature of the
necrosed tissue, and the extent of the mortification. But this
manual exploration is not always possible, either because of the
deficient caliber of the passage, or of its sinuosity, or its length.
Resort must be had to the various probes and directors in use.
When the necrosis occupies the apex of one or more of the
spinous processes, and the fistula is superficial, a slight incision
will expose the diseased spot to ocular inspection, and the condi-
tion of things may be at once fully realized. When the lesion is
limited to the cervical ligament, the eschar or slough will have
an olive-greenish color, and will be of soft, pultaceous consistency,
with a peculiar foetid odor, from its maceration in the pus. If
the necrosis has attacked the cartilages of the vertebra, the morti-
fied part assumes a yellow color, with a tint of pale green. In
all cases, however, it is more or less loosened at its borders, and
differs materially from that of the healthy tissue. And while at
the point of separation it is covered with a layer of granulations,
highly vascular, yet the continuity of the fibres between the
healthy and the diseased tissues still exists in the parts which are
See se ee ee
DISEASES OF THE WITHERS. ie
deeper and more central, where the connection is maintained by a
sort of peduncle of varying size, through which the necrosis con-
tinues to be propagated. If the disease is of sufficiently long
standing the necrosis may involve the entire thickness of the carti-
lage. In this case the spongy tissue of the vertebrze is exposed,
covered with the healthy granulations, which contribute to the cic-
atrization. This, however, is a rare termination, the bone, ordi-
narily, becoming necrosed or carious, the necrosis being indicated
by its brownish color, its dryness, its roughness and its sonority
on percussion, while the caries is recognized by its friability, its
red and yellowish color, the foetid suppuration which oozes from
its areola and the facility with which it yields to the edge of a
sharp cutting instrument.
This condition of mortification may affect but a single verte-
bra, but it is not uncommon to find several, or possibly all, the
spinous processes of the region affected.
While the fistula may be considered as the essential physical
symptom of this ailment there are other symptoms coexisting.
There is accompanying it an external swelling, sometimes diffuse,
sometimes compact, and more or less indurated, according to the
duration of its existence; very painful on pressure, and of which
the form, direction and extent so perfectly correspond with those
of the fistula, that it may be viewed as accurately representing
the extent and limits of the lesion itself.
This induration increases in consistency, and may with time
become infiltrated with calcareous deposits, or even bony growths,
attached to the spinous processes.
The diagnostic and prognostical importance of this induration
is very great. So long as there is no perceptible decrease in its
dimensions, no apparent improvement in the external wound or
modification in the nature and amount of the discharge can be of
any favorable signification, and the surgeon may feel thoroughly
assured that the disease continues unchanged in extent and char-
acter. As it diminishes it indicates that the necrosis is also con-
tracting its limits, and it becomes certain that the sloughing has
taken place and the wound is once again assuming its character
of original simplicity. And when the swelling disappears, and
the tissues have resumed their normal integrity, questions as to
the depth of the fistula, or the extent of its sinuosities, and abun-
dance of the discharge will cease to be of any significance.
774 DISEASES OF THE WITHERS.
In the beginning of the necrosis, while the parts are very
sensitive, the exaggerated sensibility is not at all in proportion to
the apparent extent of the disease. The animal shrinks from the
manipulations of the touch, and this is a symptom which should
be carefully considered in its relation to the progress of the dis-
ease, from the fact that in these manifestations it is passing
through the same phases as those which marked the progress
of the induration, running a sort of parallel with the duration
of the necrosis, and diminishing as the sloughing proceeds, the
interior situation being interpreted by the exterior phenomena,
with some exceptions. For there are cases in which it diminishes,
while the disease continues without change, to exhibit the same
severe symptoms. One effect of the abundant suppuration accom-
panying diseased withers, and the febrile symptoms which accom-
pany it, is a rapid loss of flesh by the suffering animal.
The disease is always of long duration, and even when treated
in the most rational manner. Its persistency will naturally cor-
respond with the slow process of the sloughs and repairs of the
tissues involved, themselves of comparatively low vitality and
slow of change. But as soon as the separation of the diseased
parts has taken place, however deep the wound may have been,
or whatever the number and depth of the fistule, the cicatriza-
tion proceeds rapidly, and is completed in a comparatively short
time. The terminations, which are to be looked for, are classified
by Bouley and Nocard under the following heads:
Ist. Resolution.— This is very rare if the disease has been
neglected, and only occurs when it has been of a circumscribed
extent and seated in a region favorably situated for the elimin-
ation of the mortified tissue, as when it escapes through large
openings, without lying long enough in the midst of the muscular
substance to produce the effects of the long confinement of the
pus in the deeply situated regions.
2d. Disease of the neck, when the necrosis has spread as far
forward as the cervical portion of the ligamentum nuche. This
forms the more common termination, and is as serious and fatal
as the original disease itself. It is too often met with, especially
in low-bred animals of lymphatic constitution.
3d. Death, too frequently.
4th. Putrid infection, due to purulent fermentation and the
absorption of septic principles.
—— a ee ne
DISEASES OF THE WITHERS. 775
5th. Purulent infection, zt. e., consecutive with the caries of the
vertebree and with the phlebitis of the veins of the region.
6th. Purulent pleurisy, resulting from the passage of the pus
into the thoracic cavity through the intercostal muscles.
Tth. Hxhaustion, in consequence of the uncompensated loss
of substance by the abundant continued suppuration, and its ac-
companying severe and persistent fever.
Fistulous withers is always a serious disease, not only because
of its progressive tendency, but also because, however intelligent
and proper may be the treatment it receives, it can never be relied
on to prevent the spreading of the necrosis, and assure a healthy
cicatrization. The degrees of severity nevertheless vary, accord-
ing to circumstances. It is less serious when the necrosis is on
the median line, and the prognosis is still more favorable when it
is on the posterior part of the region. When situated forward it
seems more tenacious, and the danger of its extending to the
neck is greater. But it is principally when its seat is in the an-
terior part of the withers that the prognosis becomes alarming, as
there the spinous processes are less prominent, the muscles thick-
er and more complicated in their arrangements, and the cartilage
of the scapula nearer, all these being conditions which render the
discharge of the pus more difficult and the purulent infiltrations
more likely to take place, and where also counter-openings are
made with more difficulty, and indeed become almost impossible
if the purulent accumulations are situated on the inside of the
scapula or its cartilage of prolongation.
It may be said, in fact, that the most important factor in the
prognosis of this disease is the distance which separates the apex
of the spinous processes of the vertebre from the superior border
of the cartilage of the scapula; the chances of recovery being in
the ratio of the distance between those two points. It is thus
that it becomes less grave in well-bred animals, with elevated pro-
jecting withers, than in low draught horses in which that region
is depressed and thick, and the projection of the dorsal processes
often replaced by a deep groove, bound on each side by the pro-
jection of the muscles and of the border of the scapular cartilage.
The disease is also of less gravity in young animals, except when
they are under the influence of distemper.
The treatment required in fistulous withers includes two prin-
cipal indications: Ist. To facilitate the escape of the pus and
776 DISEASES OF THE WITHERS.
obviate its action upon the tissues with which it comes in contact
and prevent its necrosing influence, and second to accelerate the
elimination of the necrosed parts.
The first indication is fulfilled in enlarging the fistulas to the
greatest extent possible. This is done with the straight bistoury
carried in the groove of the director or of the S probe, introduced
into the tract as far as possible. But when the fistula runs ob-
liquely downward and inward, and has become complicated with
diverticulums which run into the depths of the tissues, this en-
largement of the fistula is more difficult, inasmuch as it necessi-
tates too extensive a division of tissues for safety. This difficulty
is obviated by establishing counter-openings at points correspond-
ing with the bottom or cul-de-sac of the fistula.
The situation of these counter-openings must be carefully cal-
culated in order to make the drainage perfect. The instruments
most suitable are the dog seton needle, a curved trocar, or prefer-
ably the S probe, and a straight bistoury. The openings must
be liberal to assure the best results, and they must be prevented
from contracting or too rapidly closing, and so checking the pur-
ulent flow either by the introduction of a tent of oakum or other
permeable foreign substance, or, and it is much the better method,
by the use of a drainage tube similar to the India rubber irriga-
tion tube. This implement, besides fulfilling all the other indica-
tions desired, possesses the additional advantage of facilitating
the injection of fluid detergents or curatives into the fistulous
tract. When the drainage has become well established irrigations
must be made two or three times daily as long as may be neces-
sary. The fluids best adapted as being both detergent and cura-
tive in their nature are pure tepid water, phenicated water (five
per cent. solution), or permanganate of potash solution (one to
two per cent.), or again simple alcoholic water. The irrigation
can be made with an ordinary syringe. Peuch and Toussaint,
however, say “ that when the circumstances allow it cold water in
continued irrigation constitutes the best medication and that
which prevents most certainly all complications. On that account
they cannot recommend it too strongly.”
While this form of treatment is usually successful in cases of
lesser severity, there are many instances in which they become
powerless, and other means become necessary for the removal of
the necrosed part. In times gone by caustics, in both the solid
DISEASES OF THE WITHERS. 777
and liquid form, were held in high repute, even in the form of
actual cauterization, as recommended by Lafosse. In later times,
however, the serious effects which followed their application caused
them to be ignored. Preparations of lesser severity were then
recommended, among which were Villate’s solution; those of the
sulphates of copper or of zinc, in various degrees of strength;
of tincture of iodine, of spirits of turpentine, of nitrate of silver,
and even of tartar emetic, and their use was followed by good
results.
Cantharides ointment, applied externally over the swelling,
and by injections into the fistulous tract, after being diluted with
tincture of cantharides, is also reeommended.
When the pus has filtrated inside of the shoulder, Bouley and
Nocard suggest the propriety of ‘attempting to lacerate with a me-
tallic rod the cellular tissue of the internal face of the shoulder, so
as to produce an abscess by congestion, whose opening, which must
be made wide, would allow the escape of the pus, and the possible
frequent cleansing of the enormous fistula thus formed. By this
process one might avoid the serious accidents likely to result from
the sejourn of the pus, and its fermentation from the contact of
the tissues.”
For cases like these Lafosse recommended the trephining of
the scapula—a very serious operation. It is said to have been
successful with him, but it must be a difficult matter to perform
it properly in such a manner that the trephine is applied at a point
on the surface exactly corresponding to the bottom of the fis-
tula.
When all means of so stimulating the action of the parts as
to effect the arrest of the necrosis, and the sloughing of the morti-
fied structure have failed, there is but one alternative left, and
that is the direct amputation of the apex of the spinous process,
and the excision of the diseased portion of the ligament. But
this operation, indicated by Lafosse, is possible only when the
disease is limited to the apex of the most prominent spinous pro-
cesses. It is positively contra indicated in low and thick withers,
in which the wound left after the operation would be a hollow,
cup-shaped depression, from which the pus would naturally gravi-
tate and filtrate in all directions.
The instruments necessary for this operation are: A grooved
director, curved and straight bistouries, sage-knives, sharp draw-
778 DISEASES OF THE WITHERS.
ing knives, bull-dog forceps, and an amputating saw; and with
these the appliances usually needed in the way of hemostatics,
and the necessary dressings, artery forceps, oakum, sponges,
drainer-tubes, dog seton needles, etc. The various steps of the
operation are thus described by Peuch and Toussaint :
“Everything being ready, the operator enlarges the fistulous.
tract, simple or ramified as it may be, so as to expose the ne-
crosis. In making this special attention must be taken to give
the incision a direction favorable to the escape of the pus. This
first step of the operation is accompanied with abundant hemor-
rhage, which must first of all be arrested either by ligating the
divided blood vessels, or by plugging the wound with oakum
moistened with a solution of perchloride of iron. The hemor-
rhage stopped, and the necrosis exposed, the second step, and the
important one of the operation, is proceeded with. To effect this
the necrosed surface is limited by a double incision, made with a
sharp instrument, straight bistoury, or sage-knife. This incision
involves the entire thickness of the cervical ligament and the fibro-
cartilage covering the apex of the spinous process and passing
under this cartilage. In making this incision the operator must
be careful not to injure any of the other processes if they are not
diseased. This done, with the sage-knife the deepest layers of
the cartilage are excised, and then, with the drawing knife, the
bony tissue underneath is resected so as not to leave the smallest
particle of necrosed tissue. Here, as in some cases of foot opera-
tion, not only must all the diseased tissue be removed, but some
of the healthy structures. The resection of the apex of the ne-
crosed processes can be made with the saw instead. of the draw-
ing knife. But this instrument is preferable, as it is easier to
manipulate and it always leaves a smooth wound.”
The subsequent treatment is of the routine kind. The parts
are, of course, thoroughly cleansed; the hemorrhage is controlled
by pressure, a drain tube is secured at the lower angle of the
wound, and the edges are brought together by quilled sutures.
Repeated injections of phenicated water are passed through the
drainage tubes, and the patient is watched in order to prevent him
from injuring himself by rubbing. If the season and the cireum-
stances permit, continued irrigation is established.
Toward the fourth or fifth day the sutures are removed and
the dressing changed. The granulating process is carefully
DISEASES OF THE WITHERS. 779
watched, and its progress kept under control by mild caustic ap-
plications, or by pressure, to prevent an uneven and too rapid
cicatrization
During the treatment the animal must be kept quiet, and even
in some cases it will be prudent to hobble his fore legs in order to
limit his movements and prevent the filtration of the pus under
the shoulder. He is to be kept on light and nutritive diet, to
compensate for the losses resulting from the abundant suppura-
tion, and when the disease has disappeared, and there is only a
superficial wound remaining, and no more fear of returning com-
plications or relapses, the animal can be returned to his labors,
but must make his adieus to the bulky collar which has weighed
so heavily on his neck, and substitute for it the equally efficient
and far more sightly Dutch collar, which has never yet in any way
contributed to bring upon its wearer the calamity of diseased
withers. ;
DISEASES OF THE POLL.
This region of the neck is the seat of lesions, frequently occur-
ring, and of varying nature. They include excoriations, cedema-
tous swellings, cores, cysts, bloody tumors, abscesses, bruises,
wounds, etc., any of which may become complicated, and termi-
nate in poll evil, or the necrosis of one of the fibrous, elastic, or
bony elements which enter into the composition of that region.
In considering the anatomical structure of the portion of the
neck in question we find on the top a mass of hair, separated from
that of the superior border of the neck by a surface which has
become callous by the constant frictions of the head-strap of the
halter or of the bridle; the skin (Fig. 563), thick on the median
line, thinner on the sides, but always loosely connected with the
subjacent tissues; a thick layer of connective tissue, more or less
infiltrated with fat, and lardaceous in low-bred horses; the cord of
the ligamentum nuche, which is attached to the occipital bone,
and more or less covered by the cervico-auricularis muscles; on
each side, and on the same level, the terminal insertion of the
splenius muscles, and forming an elevation which is covered by
the aponeurosis common to that muscle and the small complexus,
which itself makes an apparatus of retention of great resistance
to the organs of the region; then another layer, composed of the
large tendon of the great complexus, the small oblique muscle of
780 DISEASES OF THE POLL.
Fa. 563.—Section of the Neck on a Level with the Poll.
p.—The skin. tc.—Lardaceous connective tissue on the top of cervical ligament.
gce.—Superior extremity of the great complexus and small oblique muscle of the head.
lc.—Ligament nuche. dp.—Posterior straight muscles of the head. 1lao.—Atloido-
occipital ligament. 1s.—Superior part of the atlas. sm.—Rachidian dura mater.
m.—Spinal marrow. ta.—Adipose tissue of the rachidian canal. a.—Atlas. ph.—
Pharynx. go.—Section of the great oblique muscle of the head. ao.—Section of odon-
toid process of the axis. p.—Parotid gland. sm.—Sub-maxillary gland. da.—Anterior
straight of the head, o.—(sophagus.
the head, the great oblique, and under them, the posterior straight
muscles of the head; a serous sac, assisting the gliding of the
cord of the ligamentum nuche over the atlas, which is very small
in young animals, assumes larges dimensions in old subjects; and,
finally, a skeleton of the region, the atlas, the axis and the occi-
pito-atloid and atloido-axoid articulations. Two large arteries are
distributed throughout the locality, the occipito-muscular and the
atloido-muscular.
The causes in which diseases of the poll originate are numer-
ous. Among them may be mentioned first, bruises, from blows
given with the handle of a whip, or of a fork; contusions and
continued frictions against hard substances, as the manger; the
pressure and rubbing of the parts of the harness (the bridle, etc.),
which pass over that region; the repeated rubbing which the ani-
mal inflicts upon himself when he is affected with parasitic cuta-
neous disease; the blows which he receives when in tossing his
head, he brings it in contact with the ceiling of his stable, when
this is too low, and he has formed the habit of pulling back on
the halter; the spreading of diseases of the neck by the extension
of the necrosis of the cord of the cervical ligament, all these are
a B
— oe
DISEASES OF THE POLL. 781
considered to be so many active agencies in the etiology of poll
evil.
In cattle it is most commonly chargeable to the pressure and
frictions of the yoke. Hertwig, with other German authors, con-
siders it, and particularly the sus-atloid hygroma, as the local mani-
festation of a diathesic condition, such as rheumatism and dis-
temper. They also admit that the true poll evil may develop itself
spontaneously, and independently of all other traumatic causes.
In considering the various forms which the disease may assume
in this locality we shall adopt the division sanctioned by Bouley,
who has thus arranged them. ~
A—Excoriations; B—Qiprematous SwELuinas; C—Core;
D—Buoopy Tumors.
Diseases of the poll, in horses, exhibit too close a resemblance
in their type and general history to escape notice, and the ther-
apeutic indications exhibited in them are the same. And it must
be borne in mind that however shght they may appear to be, and
whatever may be their nature, they always require immediate at-
tention and careful watching, and in all cases the use of the bridle
and the halter must be suspended.
E.—Cysr.
Cysts of the poll are divided into superficial and deep. The
former, which are of uncommon occurrence, have their seat in the
subcutaneous cellular tissue, and possess features in common with
those which appear at the withers. The latter is an abnormal
dilatation of the serous sac which facilitates the gliding of the
cervical cord upon the atlas; it is also known as the atloid hy-
groma. It generally begins suddenly, and is manifested by the
presence of a soft tumor, fluctuating, spherical, or bilobulated by
the median pressure of the cervical ligament. It is usually pain-
less, except when it is the result of acute violence, in which case
it may be accompanied with inflammatory symptoms, which may
extend to suppuration, but in such cases, which, however, are in-
frequent, there is also a degree of fever corresponding in intensity
with the other features of the case. The fluctuation is at first
uniform, and easily detected, but at a later period, as the secre-
tion becomes more abundant, and the tension of the pouch be-
a4
782 DISEASES OF THE POLL.
comes greater, and the thickening of the walls progresses, it be-
comes obscure.
In the stable the animal is very quiet, standing with the neck
extended and the head carried downward; he moves with difficulty,
without raising the head, and avoiding all movements of the
muscles of the neck, and especially of the extensors. At times
the distension of the walls of the cyst may be so extreme that
the capsular ligament of the occipito-atloid joint is pushed in-
ward in the rachidian canal, and when this occurs nervous symp-
toms appear, caused by the pressure of the rachidian bulbs.
If unremedied, it assumes a chronic condition, with progres-
sive distension, which may end in death by pressure upon the
bulb. Purulent transformation, and poll evil proper, are also the
possible terminations of the atloid hygrcma; indeed, it is only in
rare instances that it is known to subside by resolution or resorp-
tion. In cases of doubtful diagnosis as to the formation of cystic
or purulent collections, exploration will relieve the doubt, and at
once settle the question of treatment.
Blistering and absorbing applications, often repeated, and
combined with aspiration, have often relieved the atloid hygroma.
Cauterization in lines or points, both superficial and deep, are
also recommended. Injections of tincture of iodine have also
their supporters, but they are sometimes liable to give rise to vio-
lent irritation, ending in purulent collections, and perhaps necrosis
possibly of the cervical hgament.
F’.—Asscess.
This is the most frequent lesion of the poll, forming at once,
when the exciting cause is sufficiently active, or when originating
in the manner already described.
It consists at first, of a diffused, not well defined, swelling of
the abundant cellular tissue which separates the muscles of the
region, to coalesce at a later period, to form a single purulent
gathering, but not until it has macerated and destroyed all the
intermediate tissues into which it had become infiltrated, and this
destructive process advances so actively and persistently that when
it reaches the surface, instead of closing up, the abscess has be-
come transformed into a fistulous center, with a constant dis-
charge of mortified, fibrous, elastic, or bony structure.
DISEASES OF THE POLL. 783
The establishment of the suppurative process, even before
any local symptoms have been manifested, is betrayed by the
changed appearance of the animal. As described in the previous
pages, he becomes listless and dull, standing quietly with the
neck extended and the head resting on the manger; refusing to
move, or if doing so, never raising his head, and by grunts and
moans betraying the great pain he is suffering. If his head be
raised by force he rebels against it, struggles, goes backward,
strikes with his fore feet, and perhaps rears.
By bringing the animal under control and restraint, as by
throwing him, the abscess may be easily discovered, on one side
of the neck, as a diffused swelling, tense, warm, and so excessively
sensitive to the slightest contact, that it is with the greatest diffi-
culty that an obscure and deep fluctuation can be detected. The
positive nature of this tumor must then be made out as early as
possible, by repeated capillary explorations, since if discovered to
be unmistakably of a suppurative nature, a free exit to the pus
must be at once established, to avoid its necrotic tendency ; while
if it be a cyst, there is danger in opening it, arising from its lia-
bility to be followed by necrosis of the cervical ligament.
The prognosis of this abscess will vary according to the
length of time which may have elapsed between its inception and
its detection. The serious nature of this prognosis is explained
by the fact of the incompressibility of the pus and the inextensi-
bility of the aponeurosis of the splenius and complexus muscles,
which resist the swelling of the inflamed tissues, and by their
compression and strangulation, become the cause of gangrene. If
a diagnosis of abscess is made, and it is immediately opened, the
cavity may assume the character of an ordinary abscess, and close
entirely; but this is a rare termination. More ordinarily, the incar-
ceration of the infiltrated pus between the muscular layers is an
obstacle to its free and complete discharge, and it remains infil-
trated, gathering into cul-de-sacs, and migrating irregularly be-
tween the muscles. Hence the formation of so many fistulous
tracts, opening at diverse points on the skin, which are generally
the result of the necrosis of the ligamentum nuche, or of the
fibrous tissue of the tendons, or even of that of the atlas, or
possibly of the occipital bone.
All the dangers which are likely to follow the existence of an
abscess at the poll, demonstrate the necessity for prompt surgi-
784 DISEASES OF THE POLL.
cal interference. Whenever the presence of the pus is established
the abscess must be opened, and opened very freely. This must
be carefully done. The puncture must be made in the center of
the tumor, and after the evacuation of the pus it must be ex-
tended with the bistoury, introduced with the aid of a grooved
director, and making, of course, a counter-opening at the most
dependent point. This incision should be made parallel with the
cervical ligament, and must be carefully made, in order to avoid
wounding the capsular ligament of the joint, or the occipito-mus-
cular artery.
The hemorrhage which accompanies this operation is easily
controlled by pressure. Antiseptic dressings, with the use of a
drainage tube constitute the after-treatment, which must be similar
to that of the same diseases at the neck and at the withers, with
the difference, perhaps, that the dressings and cleanings must be
oftener renewed.
If no complications arise the wound will heal without diffi-
culty, and the animal may be able to resume work after two or
three weeks’ recuperation.
Pott Evu.
But if, on the contrary, the animal is suffering with the per-
sistent and tenacious lesion which consists in the necrosis of the
yellow or white fibrous tissue of the region, or a diseased condi-
tion of the surrounding bones, we are confronted with the very
serious affection commonly known as poll evil.
This disease originates, ordinarily, in one of those already con-
sidered, and yet it may appear spontaneously, if the instigating
traumatism from which it grew has been sufficiently severe or
violent. And, again, it may be a sequel or extension of a similar
diseased process in the neck.
Its characteristic appearance is that of a large induration, de-
veloped around one or several fistulous tracts, from which escapes
a thin, sanious pus, of foetid odor. Upon being explored these
fistulas are found to vary in their direction, in their depth, and in
the tissue on which they terminate. Exploring with the probe,
or, more certain, with the finger, a cavity is found more or less
filled with pus, with granulating walls, in the bottom of which
the cervical ligament is felt, isolated, roughened and more or less
escharrified, or, if this chord has remained intact, it will indicate
DISEASES OF THE POLL. 785
that the seat of the lesions is the tendon common of the splenius,
or of the complexus, or, perhaps, of the oblique or posterior
straight muscles. -
At an advanced period, when the progress of the mortification
has been for some time unchecked, and the bony insertions of the
ligament, or of the tendons, have become affected, the surfaces of
these bones also become affected and their roughened or possibly
necrotic character is readily recognized by the exploring finger.
It may also happen that the capsular ligament of the joint,
constantly macerated in the pus, softens and yields, and the pene-
tration of the discharge into the vertebral canal soon ends the
case by the rapid development of suppurative cerebro-spinal men-
ingitis.
Hertwig and Lafosse have reported instances where anchylosis
of the occipito-atloid joint had taken place.
There is in the museum of the American Veterinary College a
preparation of an anchylosis of the occipito-atloid articulation
which undoubtedly is the result of a case of chronic poll eyil.
The prognosis of this ailment is always serious. A slight
lesion may grow and develop into a case, with all its dangers.
For this reason a cautious expression of opinion on the part of
the surgeon is equally due to considerations of policy as to the
obligations of truth.
The treatment is essentially and exclusively surgical.
In the simplest cases free openings and ample drainage of the
wound, with plenty of washing and antiseptic attention will con-
trol the trouble.
In more severe cases, where the presence of the fistulous
tracts is stimulated by the induration of the parts, and the con-
stant movements of their walls, the external application of a
strong blister and the injection into the fistule of tincture of
iodine, or of cantharides, or of solutions, more or less concen-
trated, of tartar emetic, nitrate of silver, chloride of zine, etc.,
will contribute to immobilize the parts and stimulate the granu-
lating and healing process.
The section of the cord of the ligamentum nuchee is indicated
when the tension of the region becomes too rigid, and the pain inor-
dinate. This alleviating measure was first instituted by Langen-
bacher and Hertwig in Germany; then by Lafosse and Rey in
France, and it has always given excellent results. It relieves the
786 DISEASES OF THE POLL.
pressure and the pain, obviates the danger of gangrene, facilitates
the examination of the wound, and greatly aids the excision of
the soft, necrosed tissues, and the scraping of their bony attach-
ments.
The operation is simple. The patient is thrown, and a straight
bistoury, or in preference, a blunt curved tenotomy knife are the
instruments. With the latter, the division of the skin is avoided.
The ligamentous section is subcutaneous, the instrument being
introduced under the cord, and the division made from within
outward. When the section is made, the ends of the ligament
draw apart. If it is necrosed, the anterior stump is removed down
to its insertion in the occipital bone, which may also be scraped.
The same treatment is applied to the tendons of the muscles. In
fact, the opening is cleared from all mortified substances, and
treated as a simple wound.
After the operation, the animal carries his head low down and
vertical, but when the wound becomes cicatrized, and continuity
is re-established between the stump of the ligament and the ceryi-
cal tuberosity, the head becomes by degrees elevated, and is event-
ually restored to its normal position and natural liberty of motion.
INDEX
—_——
A
Abdomen, bandage for the, 116
seton on the, 196
Ablation of tumors, 200
Abnormal deviation of the tail, 307
Absorbents, 528
Abscesses, 199, 278, 382, 307, 709
782
Accidents after gouging teeth out,353
cesophagotomy, 377
of firing, 184
of general anesthesia, 75
of means of restraint, 76
of phlebotomy, 506
of plantar neurotomy, 541
of setons, 198
Actual cauterization, 158, 529
after-cares, 163
deep, 175
effects of, 166
immediate, 159
instruments for, 160
mediate, 159
penetrating, 160
primary effects, 166
secondary effects, 166
subcutaneous, 160, 180
superficial, 159
transcurrent, 160
various degrees of, 165
cautery, puncture with, 142
Acute hernia, 392
Adenotomy, 361
maxillary, 363
parotid, 362
Adhesive reunion, 143
plaster, 145
Administration of chloral, 74
After cares in amputation, 272
in caudal myotomy, 303
in tenotomy, 319
in trephining, 291
of actual cautery, 168
of setons, 192
treatment in hernia, 415
Air in veins, 513
Amputations, 266
in contiguity of bones, 270
after-cares in, 272
in continuity of bones, 270
of ear, 750
of horns, 274
of penis, 569
of tongue, 361
of tail, 277
modus operandi, 279
of wings, '758
of wings.of birds, 274
Anal fistula, 307
Anatomy, 2
of foot, 576
of guttural pouch, 452
of inguinal region, 396
of poll, 779
of withers, 760
pathological, in canker, 597
in corns, 611
of cartilaginous quittor, 718
of contracted heels, 644
of laminitis, 681
of navicular disease, 697
Anesthesia, 66
accidents of, 75
duration of, 73
general, 70
local, 67
surgical, 66
788
Anesthetic, pulverization of liquid,
68
Animal, preparation of the, 11
Anti-brachial tenotomy, 323
Antiseptic dressings, 100
Application, local, in hernia, 429
of dressings, 91
of sutures, 147
Arm, fracture of the, 246
Art in surgery, 1
Arteriotomy, 514
Arthrosis, pseudo, 218
Asphyxia, 80
Assistants in operation, 10
Astringents, 528
B
Bad aspect of the stump, 282
cicatrices, 186
Bandages, 103
binocular, 107
compound, 106
double, for the eye, 107
for abdomen, 116
back, 114
breast, 118
cannon, 123
chest, 116
croup, 114
ear, 108
elbow, 119
forearm, 120
hip, 114
hock, 123
inguinal region, 116
knee, 121
leg, 122
loins, 114
maxillary region, 108 ~
neck, 110, 112
parotid, 109
perineum, 116
shoulder, 118
joint, 119
stifle, 121
throat, 109
INDEX
Bandages for withers, 113
in umbilical hernia, 428
_mechanical, 123
monocular, 107
roller, 105
single, for the eye, 107
single frontal, 105
uniting, 144
Barnacles, 15
iron, 16
wood, 16
Bar hobbles, side, 44
side, 20 ‘
Beads, 20
Bed to cast, 30
Birds, tenotomy in, 327
Bistouries, 126
methods to hold, 128
puncture with, 140
Bleeding at coronet, 521
at foot, 522
at median caudal, 515
at palate, 520
at posterior auricular, 515
at transversal of the face, 514
capillary, 517
in swine, 516
white, 506
Bloodless operation, 7
Bloody operation, 7
tumors, 780
Bones of the extremities, fracture
of, 78
face, fracture of, 230
pelvis, fracture of, 239
resection of, 293
Bovines, securing of, 54
Breast, seton in the, 193
Bridoon, 18
Cc
Cadiot’s method, 468
Calk, 627
symptoms of, 628
treatment of, 628
varieties of, 627
Canine dentistry, 356
Canker of the foot, 591
complications of, 596
Cannon, bandage for, 123
Capillary bleeding, 517
Caprines, securing, 62
Cardiac syncope, 75
Caries of membrana nictitans, 742
Cartilaginous quittor, 714
Caruncular apparatus, 743
Cast, bed to, 30
- Casting bovines with hobbles, 61
ropes, 62
on operating table, 47
with double side lines, 47
hobbles, 30
ropes, 44
single rope, 45
Cataract, 749
Catheterism, cesophageal, 366
of urethra, 555
in females, 557
in males, 555
Caudal myotomy, 296
complications of, 306
Causes of diaphragm hernia, 440
dislocation, 262
furuncle of frog, 667
hernia, 392
inguinal hernia, 412
poll evil, 780
umbilical hernia, 425
Caustics, potential, 529
Caustic treatment of hernia, 429
Cauterization, 159
accidents of, 184
bad cicatrices after, 186
after-cares, 168
ala Gaulet, 171
deep actual, 159, 175
effects of, 166
immediate, 159
inherent, 178
in large animals, 188
in other animals, 183
in points, 171
mediate, 159
INDEX
789
Cauterization, objective, 174
penetrating, 160, 180
primary effects of, 166
secondary effects of, 167
subcutaneous, 160
superficial actual, 159
transcurrent, 160
various degrees of, 165
with thermo-cautery, 182
Cautery, actual, 158
Cavesson, 18
Cellular tissue, operation on, 758
Cephalic vein, bleeding at, 499
Chabert’s method, 522
Cheeks, seton on, 196
Chest bandage, 116
seton in, 793
Chloral, administration of, 74
Chloroform bag, 72
manifestation of, 72 —
Chronic hernia, 392
Cicatrix, bad, 186
Cicatrization, incomplete, 276
Circulatory system, operations on,
492
Cito, tuto et jucunde, 5
Clamps, 438
Classical modus operandi, 481
Club foot, 585
Comminuted fractures, 212
Common bone, fracture of, 255
Complicated operations, 7
Complications of amputations, 273,
275, 282
canker, 596
contracted heels, 644
fistulous withers, 773
fractures, 217
hernia, 893, 414
herniotomy, 410
laminitis, 674
plantar neurotomy, 320
sand cracks, 618
umbilical hernia, 431
ventral hernia, 446
Complete fractures, 212
Compound fractures, 212
790
Compound fracture bandage, 106
incisions, 135
Compresses, 103
Compression as hemostatic, 580
by circular ligature, 525
by tourniquet, 525
Esmarck’s method, 525
Compressive dressings, 99
Congenital defective conformation,
741
hernia, 393
Contiguity of bones, 270
Continuity of bones, 270
Contracted heels, 640
complications of, 644
division of, 641
etiology of, 646
pathological anatomy of, 644
prognosis of, 645
symptoms of, 641
synonym, 640
treatment of, 650
Contractions, spasmodic, 75
Contra-indication of sutures, 147
Core of poll evil, 780
of the withers, 766
Corns, 607
division of, 607
etiology of, 608
pathological anatomy of, 611
prognosis of, 613
symptoms of, 611
treatment of, 613
Coronet, bleeding at, 521
fracture of, 258
Cough, 75
Counter-indications of neurotomy,
547
Cox’s chloroform bag, 71
Cranial bones, fracture of, 229
Crooked foot, 586
Cross-hobbles, 44
Croup bandage, 114
Crucial incision, 136
Crural hernia, 420
Crural myotase, 308
myotomy, 308
INDEX
Crural myotomy, complications of,
311
Crushing of foreign bodies, 372
Cunean tenotomy, 823
Cupping, 518
Curative treatment of sand cracks.,
628
Curved incision, 735
Cyst of the poll, 781
of the withers, 768
Cystocele, 392
Cystotomy, 565
D
Daviau’s operating table, 48
Deep actual cauterization, 159, 175
Defections of the feet, 576
Defective congenital conformations,,
741
Definition of fracture, 212
of operations, 6
Dental surgery, 335
arches, leveling of, 335
Dentistry, canine, 356
Derivative method, 14
Determinate operations, 8
Diagnosis of cartilaginous quittor,
720
of fracture, 217
of quittor, 708
of ventral hernia, 445
surgical, 81
Diaphragmatic hernia, 439
causes of, 440
diagnosis of, 445
prognosis of, 442
symptoms of, 440
Dieresis, 125
Dieulafoy’s aspirator, 87
Differential diagnosis of laminitis,.
685
Digestive apparatus, operation on,
328
Direct taxis, 404
suture of the ring, 438
Disease, navicular, 694
INDEX
Disease, navicular, diagnosis of, 698
duration of, 697
Diseases of the frog, 665
of the feet, 576
of the teeth, 328
symptoms of, 329
of the poll, 779
of the withers, 759
Dislocations, 78, 262
causes of, 262
of the hip, 264
of the shoulder, 264
prognosis of, 263
special, 264
symptoms of, 262
treatment of, 263
Dissection, 137
by slices, 138
Division, 125, 425
of contracted heels. 641
of corns, 607
of laminitis, 670
of punctured wounds of foot, 630 |
of quittor, 702
of sand cracks, 616
Docking, 277
complications of, 282
instruments for, 278
modus operandi, 279
Dossiled suture, 153
Double bandage for the eye, 107
ligature, 205
roller, 94
side line, 23
tenotomy, 316
Drainage, 105
Dressings, 90, 591
antiseptic, 100
applications of, 91
compressive, 99
definition of, 90
dividing, 99
effects of, 90
expulsive, 99
in amputation, 27
in foot operations, 591
in fracture, 227
791
Dressings, instruments for, 100
in tenotomy, 318
in trephining, 290
material for, 93
removal of, 97
retentive, 98
suspensory, 99
uniting, 99
Dry operation, 7
Duration of anesthesia, 73
cartilaginous quittor, 719
canker of the foot, 596
quittor, 708
E
Ear, amputations of the, 756
bandage, 108
operation on the, 756
Effects of cauterization, 166
dressings, 90
primary cauterization, 166
secondary cauterization, 167
setons, 192
superficial points firing, 172
Elastic suture, 154
ligature, 210
Elbow, bandage for, 119
Elementary operations, 125
Elliptic incision, 136
Emphysema, 487
Enterocele, 392
Enteromphalus, 425
Enterotomy, 380
instruments for, 380
Epiplocele, 392
Epiplomphalus, 425
Esmarck’s method, 525
Etiology of canker, 600
eartilaginous quittor, 721
contracted heels, 646
corns, 608
cutaneous quittor, 703
diseases of poll, 780
withers, 763
fracture, 214
laminitis, 685
792
Etiology of navicular diseases, 698
punctured wound of foot, 629
sand cracks, 616
subhorny quittor, 712
tendinous quittor, 709
Eventration, 447
diagnosis of, 448
symptoms of, 447
treatment of, 449
Evulsion of teeth, 348
Exaggerated elevation of tail, 807
Exaggeration of extension, 321
Excision of tumors, 201
with bistouries, 201
ecraseur, 203
scissors, 201
thermo-cautery, 205
Excoriations of the withers, 765
on the poll, 781
Exomphalus, 425
Exploring needles, 87
Expulsive dressing, 99
Extirpation of the eye, 754
Extraction of foreign bodies, 748
Extraction of teeth, 348
Extremities, amputation of, 268
Exutories, 186
F
Facial bones, fracture of, 230
Fashion, operation of, 8
Femur, fractures of, 250
Fibrous tissue, operations on, 312
Filing teeth, 356
Finger used as director, 134
Fire, regions to, 167
Firing, 159
accidents of, 184
& la Gaulet, 171
A la Manzio, 184
effects of, 178 ‘
inherent, 178
indications, 159
in lines, 162
instruments, 160
needle, 175
objective, 174
INDEX
Firing on the surface, 171
superficial points, 172
First phalanx, fracture of, 256
Fistula, 274
anal, 307
Fistulous withers, 771
Fleming’s method, 464
Foot, bleeding at the, 522
canker of the, 591
club, 585
crooked, 586
diseases and defectuosities, 583
flat, 584
instruments to operate, 589
operations on, 576
pumiced, 584
punctured wound of the, 629
rammy, 587
seton in, 196
vices of conformation, 583
with hard hoof, 587
Forearm, bandage for, 120
fracture of, 247
Foreign bodies, crushing, 372
extraction of, 748
Fungosities, 200
Furrier, suture of the, 155
Furuncle of the frog, symptoms, 666
causes, 667
treatment, 667
Fracture of bones of extremities, 78
cannon bones, 255
coronet, 258
cranial bones, 229
facial bones, 280
femur, 250
first phalanx, 256
forearm, 247
hock, 255
humerus, 246
knee, 250
lower jaw, 232
os innominata, 240
os pedis, 259
patella, 2538
pelvic bones, 78, 289
pre-maxillary bone, 231
Fracture of ribs, 78, 238
sacrum, 239
scapula, 243
sesamoids, 259
tibia, 253
vertebrae 285
vertebral column, 76
Fractures, 76, 212
diagnosis, 217
comminuted, 212
complete, 212
complicated, 217
compound, 212
definition, 512
dressing in, 227
etiology, 214
incomplete, 212
longitudinal, 213
mode of repair, 218
oblique, 218
reduction in, 224
retention in, 227
simple, 212
special, 229
symptoms, 215
transverse, 212, 213
treatment of, 224
with displacement, 213
without displacement, 213
Free dissection, 138
Frontal single bandage, 105
Frog, diseases of, 665
furuncle of, 666
seton, 196
G
Gag, 16
Gangrene, 199, 276, 283, 306, 311
Gastrotomy, 377
Gaulet, firing 4 la, 171
Gelding, inguinal hernia of, 418
General anesthesia, 70
accidents of, 75
consideration on hernia, 386
operations on the foot, 590
Genito-urinary apparatus, 555
INDEX 793
Globe of the eye, operations, 746
Good surgeon, qualities of, 5
Gouging teeth out, 353
Granulations, union by, 148
Growths on membrana nictitans, 742
Glossotomy, 361
Glover’s suture, 152
Guttural pouches, operations on, 452
anatomy of, 452
H
Halter, 18
Hearing in surgical diagnosis, 88
Heels, contracted, 640
Hemorrhage, 185, 198, 273, 275, 282,
306, 311, 320, 487
Hematoma of the poll, 781
of the withers, 766
Hemostasia, compression in, 525, 530
by digital pressure, 524
Esmarck’s method, 525
immediate ligature, 534
ligature, 533
mediate ligature, 537
torsion, 538
tourniquet, 525
permanent, 526
physico-chemical, 523
surgical, 523, 530
temporary, 524
Hernia, 385
acute, 392
causes of, 392, 412
chronic, 392
complications, 393
complicated, 411
congenital, 392
crural, 420
diaphragmatic, 439
causes, 440
prognosis, 442
symptoms, 440
general consideration on, 386
inguinal, 394
of geldings, 418
symptoms, 419
794
Hernia, inguinal, treatment, 419
intermittent, 411
irreducible, 391-3893
old inguinal, 411
operatious, 415
pancreatic, 421
pelvic, of oxen, 421
perineal, 421
permanent, 411
recent inguinal, 397
reducible, 391-393
simple, 411
symptoms, 392
umbilical, 425
bandages in, 428
causes, 425
caustic treatment, 429
clamps in, 433
division, 425
ligature in, 4382
local application in, 429
INDEX
History of laryngotomy, 462
plantar neurotomy, 550
Hobbles, 30
casting bovines with, 61
cross, 44
side bar, 44
Hock, bandage for, 123
Hodgson’s operating table, 53
Holding a bistoury, 128
Horns, amputation of, 274
How to east, 29
Hygienic treatment for sand cracks,
621
Hyospondylotomy, 452
Hyovertebrotomy, 452
proper, 457
instruments for, 457
operation for, 458
I
subcutaneous injection, 431 | Immediate actual cautery, 159
surgical operation, 432
suture in, 434
symptoms, 425
treatment, 428
various forms of, 388
ventral, 448
causes, 444
complications, 446
diagnosis, 445
symptoms, 444
treatment, 446
Herniotomy, 405
after treatment, 410
complications of, 410
instruments for, 405
modus operandi, 405
High neurotomy, 550
instruments for, 551
modus operandi, 551
Hip, bandage for, 114
bone, fracture of, 240
joint, dislocation of, 264
seton on, 195
Hippo-lasso, 26
History of canker of the foot, 592
ligature, 534
reunion, 148
Incision of rumen, 378
Incisions, 125
by seraping, 135
by slices, 185
compound, 1385
erucial, 1386
curved, 135
definition, 125
from within outwards, 132
from without inwards, 131
how to make, 131
L-shaped, 136
semi-lunar, 136
simple, 1385
straight, 135
subcutaneous, 134
T-shaped, 136
V-shaped, 136
with director, 133
without director, 182
Incomplete fracture, 212
Indications for amputation of penis,
569
INDEX
Indications for crural myotomy, 308
cunean tenotomy, 323
enterotomy, 380
exutories, 187
firing, 159
cesophageal catheterism, 366
operations on tongue, 358
plantar neurotomy, 546
plantar tenotomy, 312
resection, 295
sutures, 147
thoracentesis, 488
tracheotomy, 479
treatments, 221
trephining, 283
urethrotomy, 558
Indurations, 200
Inguinal hernia, 294
of geldings, 418
old, 411
recent, 397
ring, bandage for, 116
Inherent firing, 178
Injections, subcutaneous, 431
Injuries to nerves, 79
to soft tissues, 79
Instruments for actual cauterization,
160
amputation, 267
applying torsion, 538
docking, 277
dressings, 100
extracting teeth, 343
general operations on foot, 589
herniotomy, 405
hyovertebrotomy, 457
laryngotomy, 464
leveling teeth, 3385
lithotrity, 565
needle firing, 175
cesophageal catheterism, 367
periostotomy, 291
phlebotomy, 492
points firing, 172
resection, 294
setons, 189, 197
sutures, 148
795
Instruments for thoracentesis, 488
tracheotomy, 479
trephining, 283
Intention, reunion by first, 143
Intermittent hernia, 411
Inter-muscular abscess, 311
Internal saphena vein, bleeding at,
501
Interrupted sutures, 151
Introduction, 1
Tron barnacle, 16
Irreducible hernia, 391, 393
Irregular operations, 8
Ischial urethrotomy, 562
J
Jacket, straight, 26
Jaw, fracture of lower, 232
Joint, dislocation of hip, 264
Jugular, phlebotomy at, 497
K
Keraphylocele, 668
symptoms of, 669
treatment of, 669
Knee, bandage for, 121
fracture of, 250
Knowledge required, 2
L
Laceration of muscles, 79
Lachrymal apparatus, operations on,
743
canal, operations on, 745
ducts, operations on, 744
Laminitis, 669
complications, 674
differential diagnosis, 685
division, 670
etiology, 685
pathological anatomy, 681
prognosis, 685
symptoms, 670
synonym, 669
796 INDEX
Laminitis, termination, 674 Means of restraint, 13
treatment, 685 Mechanical bandages, 123
Lancet, puncture with, 139 restraint, 17
Laparotomy, 449 Median canal, bleeding at, 515
modus operandi, 450 Mediate cauterization, 159
Large ruminants, cauterization in, ligature, 537
183 Membrana nictitans, operation in,
bleeding in, 503 742 °
Laryngotomy, 462 caries of, '742
Cadiot’s method, 468 Metallic suture, 156
Fleming’s method, 464 Method, Cadiot’s, 468
history, 462 derivative, 14
Leeches, 519 Fleming’s, 464
Leg, bandage for, 122 painful, 14
Leveling of dental arches, 335 subcutaneous, 302
Ligatures, 206, 482, 533 Methods for holding a knife, 128
double, 205 in making incisions, 131
elastic, 210 in operation, 9
immediate, 524 various, 485
mediate, 537 Modes of securing, 38
multiple, 206 Monocular bandage, 107
simple, 205 frontal bandage, 107
subcutaneous, 208 Modus operandi of amputation of
Light operations, 7 ear, 756
Limited dissection, 188 of extremities, 268
Lithotrity, 565 of horns, 274
instruments for, 566 of penis, 571
modus operandi, 568 arteriotomy, 514
Local anesthesia, 67 cataract, 751
applications, 429 Cadiot’s method, 468
Loins, bandage for, 114 erural myotomy, 811
Longitudinal fracture, 213 cunean tenotomy, 325
incisions, 300, 485 docking, 279
Looped suture, 152 enterotomy, 382
Lower jaw, fracture of, 232 excision of tumors, 201
Low neurotomy, 551 with ecraseur, 203
modus operandi, 551 extirpation of the eye, 754
L-shaped incision, 136 extracting teeth, 345
Luxations, 262 firing, 164
Fleming’s method, 465
M Z gouging teeth, 354
herniotomy, 405
Manifestation of chloroform, 72 hyovertebrotomy, 458
Material for dressings, 93 ischial urethrotomy, 562
Maxillary adenotomy, 363 laparotomy, 450
fracture of pre-, 231 leveling teeth, 337
Means of drainage, 105 ligature, 535
Modus operandi of lithotrity, 568
neurotomy, 550
cesophageal catheterism, 369
csophagotomy, 374
paracentesis, 384
periostotomy, 291
phlebotomy, 495
plantar tenotomy, 313
resection, 295
setons, 190, 198
sprung knees, 322
thoracentesis, 489
torsion, 538
trephining, 288
Muscles, laceration of, 79
Multiple ligatures, 206
Mode of repair of fracture, 218
of reduction of fracture, 224
Multiple abscesses, 282
Myotomy, caudal, 296
Mixed incisions, 301
Myostase, crural, 308
Myotomy, crural, 308
N
Nanzio, firing 4 la, 180
Navicular disease, 694
diagnosis, 698
duration, 697
etiology, 698
pathological anatomy, 697
prognosis, 698
symptoms, 695
synonym, 694
termination, 697
treatment, 700
Necessity, operations of, 8
Neck, bandage for, 110
setons at the, 196
Necrosis, 273
Needle-holder, 150
Needles, 149
exploring, 87
firing, 175
Riverdin’s, 150
Simpson’s, 150
INDEX
Nerves, wounds of, 320
é
97
Nervous system, operations on, 540
Neurotomy, 541
accidents, 542
contra-indications, 547
high, 550
history, 541
indications, 546
instruments for, 550
low, 550
modus operandi, 551
objections against, 542
plantar, 541
Nose rings, 56
cup, 71
Non-vascular organs, wounds of, 506
oO
Oakum, 102
Objections to neurotomy, 542
Objective firing, 174
Oblique fracture, 213
(Edematous swelling, 781
(isophagotomy, 373
Old inguinal hernia, 411
Omphalocele, 425
Operate, time to, 8
Operating tables, 30
casting on, 47
Operations, assistants in, 10
by longitud. incision, 300, 485
mixed incisions, 301
transverse incisions, 299
for hernia, 415
in complicated cases of hernia,
439
of fashion, 8
of necessity, 8
on accessory ocular organs, 739
bones, 212
caruncular apparatus, 743
cellular tissue, 158
circulatory system, 492
digestive tract, 328
ear, 756
essential organs of sight, 746
798 INDEX
Operations on eye and ear, 739
eyelids, 739
fibrous tissue, 312
foot, 576
genito-urinary apparatus, 555
globe of eye, 746
guttural pouches, 452
lachrymal apparatus, 743
ducts, 744
canal, 744
muscles, 296
nervous system, 540
cesophagus, 364
respiratory apparatus, 452
skin, 158
teeth, 328
tongue, 358
young ruminants, 276
preparations for, 10
Operative dental surgery, 335
Ophthalmoscope, 85
Optional time, 9
Os pedis, fracture of, 259
Ossa innominata, fracture of, 240
Other superficial veins, bleeding at,
503
Owner, preparation of, 11
Pp
Painful method of restraint, 14
Palliative operation, 8
treatment of sanderacks, 621
Pancreatic hernia, 421
Paracentesis, 388
of cornea, 748
Parotid, 3862
bandage for, 109
Patella, fracture of, 253
Pathological anatomy of canker, 597
cartilaginous quittor, 718
contused heels, 644
corns, 611
laminitis, 681
navicular disease, 697
growths on memb. nictitans, 742
Pelvic bones, fracture of, 78
Pelvic hernia of oxen, 421
Penetrating actual cautery, 160
Perineal hernia, 421
Perineum, bandage for, 116
Periostotomy, 291
instruments for, 291
modus operandi, 292
Permanent hemostasis, 526
hernia, 411
Peroneo-phalangeal tenotomy, 326
Phalanx, fracture of first, 256
Phlebitis, 408
symptoms, 509
treatment, 510
Phlebotomy, 493
accidents of, 506
at the cephalic vein, 499
at the internal saphena, 501
at the jugular, 497
at the subcutaneous thoracic, 501
in solipeds, 496
instruments, 493
modus operandi, 495
on large ruminants, 503
on other superficial veins, 503
on small animals, 505
Physico-chemical hemostaties, 526
Plantar neurotomy, 541
accidents, 542
contra indications, 547
high, 550
history, 541
indications, 546
low, 550
modus operandi, 551
objections, 542
tenotomy, 312
after cares, 819
complications, 320
dressing, 318
indications, 312
modus operandi, 315
Plaster, adhesive, 145
Plate ionge, 20
uses of, 21
Plates on shoe, 104
Points of selection, 9
INDEX
Poll evil, 784
symptoms of, 784
treatment of, 785
Position of wounds in reunion, 144
recumbent, 27
securing the legs in, 38
standing, 17
Potential caustics, 529
Preparation for operation, 11
of animal, 11
of owner, 11.
of patient, 10
Preputial urethrotomy, 561
Pricking, 297
Primary effects of cautery, 166
Procedure in operation, 9
Prognosis of canker, 597
cartilaginous quittor, 721
contracted heels, 645
corns, 613
dislocation, 2638
eventration, 448
fistulous withers, 773
fracture, 221
hernia, 401
laminitis, 685
navicular disease, 698
sand cracks, 619
subhorny quittor, 712
tendinous quittor, 708
Prothesis, ocular, 755
Pseudo arthrosis, 218
luxation of patella, 264
Pulverization of anesthetic liquid, 68
Pumiced foot, 584
Puncture, 138, 211
with actual cautery, 142
bistoury, 140
lancet, 188
trocar, 140
of the rumen, 377
Punctured wounds of the foot, 629
division, 630
etiology, 629
prognosis, 634
symptoms, 630
synonym, 629
treatment, 6384
Q
Qualities of a good surgeon, 5 «
Quilled sutures, 753
Quittor, 507
cartilaginous, 714
diagnosis, 720
duration, 719
etiology, 721
799
pathological anatomy, 718
prognosis, 721
symptoms, 716
termination, 719
treatment, 722
cutaneous, 703
etiology, 704
symptoms, 703
treatment, 705
division, 702
subhorny, 711
etiology, 712
prognosis, 711
symptoms, 711
treatment, 712
synonym, 702
tendinous, 706
diagnosis, 708
duration, 708
etiology, 709
prognosis, 709
symptoms, 707
termination, 708
treatment, 709
R
Rammy foot, 587
Recent inguinal hernia, 397
Recumbent position, 27
Reducible hernia, 391, 393
Refrigerants, 527
Regions to apply setons, 193
Regions to fire, 167
Regular operations, 8
Removal of dressings, 97
of sutures, 156
of tumors, 211
800
Removal of tumors by bistoury, 201
ecraseur, 203
excision, 201
ligature, 206
scissors, 201
thermo-cautery, 203
tearing, 211
Repulsion of teeth, 353
Resection of bones, 293
Respiratory apparatus, operations
on, 452
Respiratory syncope, 75
Restraint, means of, 13
mechanical, 17
Retention in fracture, 227
Retentive dressing, 98
Return of deformity, 321
Reunion, 125, 142
adhesive, 143
by first intention, 143
by granulations, 143
immediate, 143
position of wound in, 144
Ribs, fracture of, 238
seton on, 193
Riverdin suture needle, 150
Roller bandage, 105
Ropes, casting with, 44, 62
single, 45
Rowel seton, 197
Rumen, incision of, 378
puncture of, 377
Rumenotomy, 377
Rupture of viscera, 79
Ss
Sacrum, fracture of, 239
Sage knives, 127, 589
Sand eracks, 616
complications, 618
division, 716
etiology, 619
prognosis, 619
symptoms, 616
synonym, 616
termination, 619
treatment, 621
INDEX
Scabs, tearing of, 185
Scapula, fracture of, 243
Scarifications, 518
Science in surgery, 1
Scissors, 127
Scrotal urethrotomy, 561
Secondary effects of casting, 167
Section of skin, 185
Securing caprines, 62
dogs and cats, 64
in casting, 38
legs, 23
other animals, 54
ovines, 62
swine, 62
Selected time for operation, 9
Selection, points of, 9
Septicemia, 377
Sesamoid, fracture of, 259
Setons, 188
after cares of, 192
effects of, 192
instruments to apply, 189
modus operandi, 190
on abdomen, 196
brain, 193
cheeks, 196
chest, 193
frog, 196
hip, 195
ribs, 193
shoulder, 199
stifle, 195
thigh, 195
regions to apply, 193
rowel, 197
sequel of, 198
Shoulder, bandage for, 118
dislocation, 264
Side bar, 20
hobbles, 44
Side line, double, 23
Simple bandage for the eye, 108
fracture, 212
frontal bandage, 105
hernia, 411
ligature, 205
INDEX
Simple operations, 7
suture, 151
tenotomy, 316
Single roller, 94
rope, casting with, 45
side line, 28
Stifle, bandage for, 121
Simpson’s suture needle, 150
Skin, operations on, 158
Sloughing of the skin, 185
Solution of continuity of eyelids, 740
Spasmodie contraction, 75
Special dislocations, 264
Special fractures, 229
Splints, 104
Sprung knees, 321
Standing position, 17
securing the legs in, 23
Staphyloma, 749
Stocks, 27
Straight jacket, 26
Strangulated hernia, 394
Sub-cricoid tracheotomy, 485
Subcutaneous actual cauterization,
160, 180
incision, 134
injections, 69, 431
ligature, 205
method, 302
Superficial actual cauterization, 159
points firing, 172
Surface, firing on the, 171
Surgical anesthesia, 67
diagnosis, 81
hearing in, 88
sight in, 81
smell in, 88
speculum in, 82
taste in, 89
touch in, 86
hemostasis, 523, 580
therapeutics, 90
Suspensory dressing, 99
Sutures, 146, 151
dossiled, 153
elastic, 154
Glover, 152
801
Sutures, interrupted, 151
looped, 152
metallic, 156
of the furrier, 155
quilled, 153
removal of, 156
single, 151
single pin, 154
T, 156
uninterrupted, 152
X, 156
zigzag, 155
Symptoms of calks, 628
canker of foot, 593
cartilaginous quittor, 716
contracted heels, 641
corns, 614
cutaneous quittor, 703
diaphragmatic hernia, 440
diseased teeth, 329
dislocations, 262
eventration, 448
fractures, 125
furuncle of frog, 666
hernia, 392
inguinal hernia, 397
keraphylocele, 669
laminitis, 670
navicular disease, 695
phlebitis, 509
punctured wounds of foot, 630
sand eracks, 616
subhorny quittor, 711
tendinous quittor, 707
umbilical hernia, 425
ventral hernia, 444
Syncope, 75
cardiac, 75
respiratory, 75
Synthesis, 125
T
Tape setons, 188
Taste in surgical diagnosis, $9
Taxis, 370
direct, 404
802
Taxis, indirect, 402
Temporary hemostasis, 524
Tenotomy, 312
after cares, 319
complications, 320
cunean, 323
double, 318
in birds, 327
indications, 312
modus operandi, 315
peroneo-phalangeal, 326
plantar, 312
simple, 316
tarsal, 323
Termination of canker, 596
cartilaginous quittor, 719
fistulous withers, 774
laminitis, 674
navicular disease, 697
sand eracks, 619
tendinous quittor, 708
Tetanus, 283, 307. 877
Thigh, seton on, 195
Thoracentesis, 488
Thrombus, 507
Tibia, fracture of, 250
Tiffany’s operating table, 53
Time to operate, 8
optional, 8
selected, 9
Torsion, 538
modus operandi for, 588
Trachea, obstruction of, 487
Tracheotomy, 477
compheations, 486
indications, 479
instruments, 479
sub-ericoid, 489
Transcurrent cauterization, 160
Transverse fracture, 212
Traumatic lesions of the eyelids, 740
Treatment of calk, 628
canker, 601
contracted heels, 650
corns, 613
dislocations, 263
eventration, 449
INDEX
Treatment of fractures, 224
furuncle, 667
hernia, 402
inguinal hernia, 418
keraphylocele, 669
laminitis, 688
navicular disease, 700
phlebitis, 510
punctured wounds, 634
quittor, 705, 708, 709, 712, 719
sand cracks, 621
umbilical hernia, 425, 428
ventral hernia, 446
Trephining, 283
dressing, 290
indications, 283
instruments, 283
modus operandi, 288
Trochiscus, 198
T-shaped incision, 136
Twitch, 15
U
Umbilical hernia, 425
bandage in, 428
causes, 425
division, 425
subcutaneous injection in,
451
symptoms, 425
treatment, 428
Uninterrupted suture, 152
Uniting bandage, 144
dressing, 99
United fracture, 218
Urethra, catheterism of, 555
Urethrotomy, 558
indications, 558
preputial, 561
serotal, 561
ischial, 562
modus operandi, 563
Urgent operation, 8
Uses of plate longe, 21
of speculum, 82
INDEX 803
V Withers, excoriations on, 765
cedema of, 765
core of, 766
hematoma of, 766
cyst of, 768
abscess of, 769
wounds of, 770
fistulous, 771
Wooden barnacles, 16
Wound, punctured, of the foot, 629
Wounds of vertebrae, 306
nerves, 320
skin, 320
tendinous burse, 320
blood vessels, 377
non-vascular organs, 506
the carotid, 512
Varieties of sand cracks, 627
Various degrees of cauterization, 163
modes of taxis, 371
forms of hernial sacs, 388
sutures, 435
Veins, air in the, 513
Ventral hernia, 443
causes, 444
symptoms, 444 ~
diagnosis, 445
complications, 446
treatment, 446
Vertebre, fracture of, 235
wounds of, 306
Vices of conformation, 583
Vigan’s method, 59
Vomiting, 75
V-shaped incision, 136 x
X suture, 156
WwW
Z
Withers, anatomy of, 760
diseases of, 759 Zigzag suture, 155
bandage for, 113
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-
_ CATALOGUE OF
WILLIAM R. JENKINS’
Works Concerning
HORSES, CATTLE, SHEEP, SWINE, Etc.
1906
(*) Single asterisk designates New Books.
(**) Double asterisk designates Recent Publications
ANDERSON. ‘Vice in the Horse” and other papers
on Horses and Riding. By H. L. Anderson. Size,
Sexo cloth. Miustrateda cas seis oanieeeiee cer See LO
ARMSTEAD. “The Artistic Anatomy of the Horse.”
A brief description of the various Anatomical Struc-
tures which may be distinguished during Life through
the Skin, By Hugh W. Armstead, M.D., F.R.C.S.
With illustrations from drawings by the author.
ClothroblonaselO xa ere seein ieee se eines 3 75
BACH. ‘How to Judge a Horse.” A concise treatise
as to its Qualities and Soundness; Including Bits and
Bitting, Saddles and Saddling, Stable Drainage, Driy-
ing One Horse, a Pair, Four-in-hand, or Tandem, etc.
By Capt. F.W. Bach. Size, 5x73, clo., fully illus.1 00
(*)BANHAM, ‘Anatomical and Physiological Model of
the Cow.” Half life size. Composed of superposed
plates, colored to nature, showing internal organs,
muscles, skeleton, etc., mounted on strong boards,
with explanatory text. Size of Model opened,
1Oit. xa the, eloped tess TAI to opps ie ca canes 7 50
— ** Anatomical and Physiological Model of the Horse.’
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SIZEIOl Mode BB GAM ss crstetstets sores vieisielsivie/siewsiets 7 50
2 Veterinary Catalogue of William R. Jenkins
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F.R.C.V.S. New edition. Cloth, size 4 x 51-2, 192
BAUCHER. ‘‘Method of Horsemanship.” Including
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(*)BELL. ‘The Veterinarian’s Call Book (Perpetual).”
By Roscoe R. Bell, D.V.S., editor of the American
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and used until full, containing much useful informa-
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ration; Dentition; Temperature, etc., etc. Bound in
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CADIOT, “Exercises in Equine Surgery.” By P. J.
Cadiot. Translated by Prof. A. W. Bitting, D.V.M.
Edited by Prof. A. Liautard, M.D.V.M. Size,6x94%
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step is most clearly defined by excellent full-page
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Veterinary School, Alfort. Translated by Thos, J.
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(*)}—**A Treatise on Surgical Therapeutics of the Domestic
Animals.” By P. J. Cadiot and J. Almy. Translated
by Prof. A. Liautard, M,D.,V.M.
I. General Surgery.—Means of restraint of animals,
general anesthesia, local aneethesia, surgical anti-
sepsis and asepsis, hematosis, cauterization, firing,
II. Diseases Common to all Tissues.—Inflammation,
abscess, gangrene, ulcers, fistula, foreign bodies,
traumatic lesions, complications of traumatic les-
ions, granulations, cicatrices, mycosis, virulent
diseases, tumors. ;
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the Extremities.—Diseases of skin and cellular tis-
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tendinous synovial sacs, of aponeurosis, of arteries,
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Cloth, size 6 x 9, 580 pages, 118 illustrations..... 4 50
CHAPMAN. ‘Manual of the Pathological Treatment
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mechanical means. By George T. Chapman. Cloth,
size 6 x 9, 124 pages with portrait................ 2 00
CHAUVEAU. ‘The Comparative Anatomy of the
Domesticated Animals.” By A. Chauveau. Revised
by G. Fleming, F.R.C.V.S. 8vo, cloth, 585 illus..6 25
4 Veterinary Catalogue of William R. Jenkins
CLARKE. ‘Chart of the Feet and Teeth of Fossil
Horses.”? By W. H. Clarke. Card, size 91-2 x12.. 25
—** Horses’ Teeth.”? Fourth edition, re-revised, with second
appendix. Cloth, size 5 1-4 x7 1-2, 322 pp., illus..2 60
CLEAVELAND. ‘‘Pronouncing Medical Lexicon.”
Pocket edition. By C. H. Cleveland, M.D. Cloth,
size 3 1-4 x 41-2, 302 pages.......c.ceccssseedecess 75
CLEMENT. ‘Veterinary Post Mortem Examina-
tions.”’> By A. W. Clement, V.S. The absence in the
English language of any guide in making autopsies
upon the lower animals, induced Dr. Clement to
write this book, trusting that it would prove of prac-
tical value to the profession. Cloth, size 5 x 7 1-2, 64
pages, illustrated............... ays sta "sh oie oleae ee 75
(**)COURTENAY. ‘Manual of the Practice of Veterinary
Medicine.” By Edward Courtenay, V.S. Revised by
Frederick T. G. Hobday, F.R.C.V.8. Second edition.
Cloth, size 5 1-4 x 7 1-2, 573 pages .............. 2 75
COX. ‘“‘Horses: In Accident and Disease.” The
sketches introduced embrace various attitudes which
have been observed, such as in choking ; the disorders
and accidents occurring to the stomach and intestines ;
affection of the brain ; and some special forms of lame-
ness, etc. By J. Roalfe Cox, F.R.C.V.S. Cloth, size
6 x 9, 28 full page illustrations... ...............06 1 50
CURTIS. ‘Horses, Cattle, Sheep and Swine.’ By
Geo. W, Curtis, M.S.A. Cloth, size 7 1-4 x 10, 343
pages, 117 illustrations. ..-0-crci ne oe eee 2 50
(**)DALRYMPLE. “Veterinary Obstetrics.” A compen-
dium for the use of advanced students and Practi-
tioners. By W. H. Dalrymple, M.R,C. V.S.,
principal of the Department of Veterinary Science in
the Louisiana State University and A. & M. College;
Veterinarian to the Louisiana State Bureau of
Agriculture, and Agricultural Experiment Stations.
Cloth, size 6 x 9 1-4, 162 pages, 51 illustrations...2 50
851-853 Siath Avenue (cor. 48th St.), New York. 5
DALZIEL, ‘Breaking and Training Dogs.” Part I, by
Pathfinder. Part II, by Hugh Dalziel. Cloth,
BLS URS DOM aca st ead SS Hower biegte pits wmraaneens 2 50
— “The Collie.” By Hugh Dalziel. Paper, illustrated.... 40
— “The Diseases of Dogs.” Causes, symptoms and treatment.
By Hugh Dalziel. Cloth, illustrated............. 1 00
— ‘Diseases of Horses.” Paper ...........ccceeceeees eevee 40
— ‘*The Fox Terrier.” By,Hugh Dalziel. Paper, 40; clo.1 00
— “The Greyhound.” Cloth, illus..... ............ dewseadk, OO
— “The St. Bernard.” Cloth, illustrated.......... Bee ora 00
DANA. “Tables in Comparative Physiology.” By Prof.
Ost; Dana, MD. a Chartel i xollccdes ces ces cies ae
DANCE. “Veterinary Tablet.” By A. A. Dance. Chart,
17 x 24, mounted on linen, folded in a cloth case for
the pocket, size 3 3-4x 61-2. Shows ata glance the
synopsis of the diseases of horses, cattle and dogs;
with their cause, symptoms and cure.............. 75
(*)DE BRUIN. ‘Bovine Obstetrics.” By M. G. De Bruin
Instructor of Obstetrics at the State Veterinary
School in Utrecht. Translated by W. E. A. Wyman,
formerly Professor of Veterinary Science at Clemson
A. & M. College, and Veterinarian to the South
Carolina Experiment Station. Cloth, size 6 x 9, 382
PAPO Gf TN MGEERIAOMA base oe > 6s <alnjsace => W'alae’s ies 5 00
Synopsis of the Essential Features of the Work
1. Authorized translation.
2. The only obstetrical work which is up to date.
3. Written by Europe’s leading authority on the subject.
4, Written by a man who has practiced the art a lifetime.
5. Written by a man who, on account of his eminence as
bovine practitioner and teacher of obstetrics, was selected
by Prof. Dr. Frodhner and Prof. Dr. Bayer (Berlin and
Vienna), to discuss bovine obstetrics both practically and
scientifically. Ra : ee
6. The only work containing a thorough differential aiag-
nosis of arte and post partum diseases,
6 Veterinary Catalogue of William R. Jenkins
DE BRUIN, ‘ Bovine Obstetrics " (continued)
7. The only work doing justice to modern obstetrical
surgery and therapeutics.
8. Written by a man whose practical suggestions revolu-
tionized the teaching of veterinary obstetrics even in the
great schools of Europe. ;
9. The only work dealing fully with the now no longer
obscure contagious and infectious diseases of calves,
10. Absolutely original and no compilation.
1l. The only work dealing fully with the difficult problem
of teaching obstetrics in the colleges.
. The only work where the practical part is not over-
shadowed by theory.
. . . Aveterinarian, particularly if his location brings him in
contact with obstetrical practice, who makes any pretence toward
being scientific and in possession of modern knowledge upon this
subject, will not be without this excellent work, as it is really a very
waluaite treatise.—Prof. Roscoe R. Bell, in the American Veterinary
eview.
In translating into English Professor, De Bruin’s excellent text-
book on Bovine Obstetrics, Dr. Wyman has laid British and American
vetérinary surgeons and students under a debt of gratitude. The
works represents the happy medium between the booklets which are
adapted for cramming purposes by the student, and the ponderous
tomes which, although useful to the teacher, are not exactly suited to
the requirements of theeveryday practitioner . . . Wecanstrongly
recommend the work to veterinary students and practitioners.—-The
Journal of Comparative Pathology and Therapeutics.
()DOLLAR. ‘Diseases of Cattle, Sheep, Goats and
Swine.”’ By G. Moussu and Jno. A, W. Dollar,
M.R.C.V.S. Size6 x 9 1-2, 7385 pages, 329 illustrations
in the text and 4 full page plates.......... sieielevelem Ounen
(**)— ‘A Hand-book of Horse-Shoeing,” with introductory
chapters on the anatomy and physiology of the
horse’s foot. By Jno. A. W. Dollar, M.R.C.V.S.,
with the collaboration of Albert Wheatley, F.R.C.V.S.
Cloth, size 6 x 8 1-2, 433 pages, 406 illustrations ..4 75
— ** Operative Technique.’ Volume 1 of ‘‘ The Practice of
Veterinary Surgery.” Cloth, size 6 3-4 x 10, 264 pages,
272 illustrablonsery.crr. cs ecrkes setae eae ue eben sve aelane 3 75
— **General Surgery.”’? Volume 2 of ‘‘ The Practice of Veter
inary Surgery.” In preparation.
(*)—* Regional Veterinary Surgery.” Volume 3 of ‘The
Practice of Veterinary Surgery.” By Drs. Jno. A.
W. Dollar and H. Méller. Cloth, size 61-2 x 10 853
and xvi pages, 315 illustrations................. 6 26
851-853 Siath Avenue (cor. 48th St.), New York. 7
——
DOLLAR—(continued)
— **Cadiot’s Clinical Veterinary Medicine and Surgery.”
See ‘: Cadiot.”
— **Cadiot’s Roaring in Horses.”
See ‘** Cadiot.”
DUN. ‘Veterinary Medicines, their Actions and Uses.”
By Finlay Dun, V.S., late lecturer on Materia
Medica and Dietetics at the Edinburgh Veterinary
College, and Examiner in Chemistry to the Royal
College of Veterinary Surgeons. Edited by James
Macqueen, F.R.C.V.S. Tenth revised English edition.
ClOunSYSIZOWD PRI Ore 5, ds *acacie es Canoe ects es 3 75
DWYER..- *‘On Seats and Saddles.” Bits and Bitting,
Draught and Harness and the Prevention and Cure of
Restiveness in Horses. By Francis Dwyer. Cloth,
size 6 x 7, 304 pages, gilt, illustrated............. 1 50
FLEMING. ‘Animal Plagues.” Their History, Nature,
and Prevention, By Geo. Fleming, F.R.C.V.S8., ete.
First Series. Chronological History from B.C. 1490
to A.D. 1800. Cloth, size 6 x 9, 548 pages........ 6 00
Second Series. Chronological History from A.D.
1800 to 1844. Cloth, size 6 x 9, 539 pages........ 3 00
— **The Comparative Anatomy of the Domesticated Animals.”’
By A. Chauvyeau. Translated by Dr. Fleming.
See ‘* Chauveau.”
— ‘The Contagious Diseases of Animals.” Their influence on
the wealth and health of nations and how they are to
be combated. Paper, size 5 x 7 1-2, 30 pages..... 25
— ‘*Human and Animal Variole.” A Study in Comparative
Pathology. Paper, size 5 1-2 x 81-2, 61 pages... 25
— ‘*Parasites aud Parasitic Diseases of the Domesticated
Animals.” By L. G. Neumann. Translated by
Dr. Fleming.
See ‘‘ Neumann.”
8 Veterinary Catalogue of William R. Jenkins
FLEMING (continued)
— “Qperative Veterinary Surgery.”’ Vol. I, by Dr. Geo.
Fleming, M.R.O.V.S, This valuable work, one of the
most practical treatises yet issued on the subject in
the English language,is devoted to the common opera-
tions of Veterinary Surgery; and the concise descrip-
tions and directions of the text are illustrated with
numerous wood engravings. Cloth, size 6 x 9 1-4, 285
and xviii pages, 343 illustrations......,........-- 2 76
(*)Vol. II, edited and passed through the press by
W. Owen Williams, F.R.C.V.S. Cloth, size 6 x 9 1-4,
430 and xxxvii pages, 344 illustrations............ 3 25
— ‘Roaring in Horses.” By Dr. George Fleming,
F.R.C.V.S. Its history, nature, causes, prevention
and treatment. Cloth, size 5 1-2 x 8 3-4, 160 pages, 21
engravings, 1 colored plate...........scccsceenss 1 50
— ‘Tuberculosis. From a Sanitary and Pathological Point
of View. By Geo. Fleming, F.R.C.V.S. Paper, size
5-1-2 x 8 1-2, 39 pages........... ane ee eae eee 25
— ‘Veterinary Obstetrics.” Including the Accidents and Dis-
eases incident to Pregnancy, Parturition, and the Early
Age in Domesticated Animals. By Geo. Fleming,
F.R.C.V.S. Cloth, size 6 x 8 3-4, 758 pages, illus.6 25
()\GOTTHIEL. ‘A Manual of General Histology.”
By Wm. S. Gottheil, M.D., Professor of Pathology in
the American Veterinary College, New York; etc., etc.
Histology is the basis of the physician’s art, as
Anatomy is the foundation of the, surgeon’s science.
Only by knowing the processes of life can we under-
stand the changes of disease and the action of
remedies; as the architect must know his building
materials, so must the practitioner of medicine know
the intimate structure of the body. To present this
knowledge in an accessible and simple form has
been the author’s task. Second edition revised.
Cloth, size 5 1-2 x 8, 152 pages, 68 illustrations. ..1 00
851-853 Sixth Avenue (cor. 48th St.), New York. 9
GRESSWELCL. ‘ The Bovine Prescriber.” For the use
of Veterinarians and Veterinary Students. Second
edition revised and enlarged, by James B. and Albert
Gresswell, M.R.C.V.S. Cloth, size, 5 x 71-2, 102
— ‘The Equine Hospital Prescriber.” For the use of Veter-
inary Practitioners and Students. Third edition re-
vised and enlarged, by Drs. James B. and Albert
Gresswell, M.R.C.V.S. Cloth, size 5 x 71-2, 165
PPREL Accie6 Sopa coo cane OeemanonnO Soo DoD Asoc ard oor 75
— ‘*Diseases and Disorders of the Horse.” A Treatise on
Equine Medicine and Surgery, being a contribution to
the science of comparative pathology. By Albert,
Jas. B. and Geo. Gresswell. Cloth, size 5 3-4 x 8 3.4,
BAVMAeess Wlustravedsctcyssccoccr.cslcchia sw cie cit nets 1 75
— Manual of “The Theory and Practice of Equine Medicine.”
By James B. Gresswell, F.R.C.V.S., and Albert
Gresswell, M.R.C.V.S. Second edition revised.
Cloth, size 5 1-4 x 7 1-2, 539 pages................ 2 75
— “Veterinary Pharmacopexia and Manual of Comparative
Therapy.” By George and Charles Gresswell, with
descriptions and physiological actions of medicines,
by Albert Gresswell. Second edition revised and
enlarged. Cloth, 6 x 8 3-4, 457 pages............ 3 60
HASSLOCH. ‘A Compend of Veterinary Materia Medica
and Therapeutics.” By A. C. Hassloch, VS.,
Lecturer on Materia Medica and Therapeutics, and
Professor of Veterinary Dentistry at the New York
College of Veterinary Surgeons and School of Compa-
rative Medicine, N. Y. Cloth, size 51-4 x 71-2, 225
HEATLEY. ‘“ The Stock Owner’s Guide.’ A handy Medi-
cal Treatise for every man who owns an ox or cow,
By George S. Heatley, M.R.C.V.S. Cloth, size
Bidint th, We Nea iclaids a'eie que a a'ca'e vedic enais mea Sia 1 26
10 Veterinary Catalogue of William R. Jenkins
*\HILDE. **The Diseases of the Cat.”? By J. Woodroffe
Hill, F.R.C.V.S. Cloth, size 51-4 x 71-2, 123 pages,
illustrated <tc... 2h ee ae silveies a sie ae ec mondier eters 1 25
Written from the experience of many years’ prac-
tice and close pathological research into the maladies
to which our domesticated feline friends are liable—a
subject which it must be admitted has not found the
prominence in veterinary literature to which it is
undoubtedly entitled.
— “The Management and Diseases of the Dog.” By J.
Woodroffe Hill, F.R.C.V.S. Cloth, size 5 x 71-2, 3
extra fully illustrated. .c4.os. 6..9e- cae teeee 2 00 .
HINEBAUCH., ‘Veterinary Dental Surgery.” By T. D
Hinebauch, M,8.V.S. For the use of Students, Prac-
titioners and Stockmen. Cloth, size 51-4 x 8, 256
pages; illustrated: =. [.ca5 dace an sone iis re arena 2 00
“HOARE. “A Manual of Veterinary Therapeutics and
Pharmacology.” By E. Wallis Hoare, F.R.C.V.S.
Cloth, size 5 1-4 x 7 1-4, 560 pages..................2 00
(*)HOBDAY. ** Canine and Feline Surgery.” By Frederick
T. G. Hobday, F.R.C.V.S. Cloth, 5 3-4 x 8 3-4, 152
pages, (Gilluistrations.. <2. ss accecee omnes .2 00
(*)— “The Castration of Cryptorchid Horses’ and
the Ovariotomy of Troublesome Mares.” By
Frederick T. G. Hobday, F.R.C.V.S. Cloth, size
5 3-4 x 8 3-4, 106 pages, 34 illustrations,.......... 1 75
(**)/HUNTING. The Art of Horse-shoeing. A manual
for Horseshoers. By William Hunting, F.R.C.V.S.,
ex-President of the Royal College of Veterinary Sur-
geons. One of the most up-to-date, concise books of
its kind in the English language. Cloth, size 6x9 1-4.
126 paces; 96rllustrailons yscece. ancien 1 00
(**)JENKINS. ‘*Model of the Horse” and ** Model of the
Cow.”
See ** Banham,”
851-853 Sixth Avenue (cor. 48th St.), New York. 11
KEATING. ‘A New Unabridged Pronouncing Diction-
ary of Medicine.” By John M. Keating, M.D.,LL.D.,
Henry Hamilton and others. A voluminous and
exhaustive hand-book of Medical and _ scientific
terminology with Phonetic Pronunciation, Aecentu-
ation, Etymology, ete. With an appendix containing
important tables of Bacilli, Micrococci, Leucomaines,
Ptomaines; Drugs and Materials used in Antiseptic
Surgery; Poisons and their antidotes; Weights and
Measures; Themometer Scales; New Officinal and
Unofficinal Drugs, ete., etc. Cloth, 818 pages ...5 00
()KOBERT. ‘Practical Toxicology for Physicians and
Students,” By Professor Dr. Rudolph Kobert,
Medical Director of Dr. Brehmer’s Sanitarium for
Pulmonary Diseases at Goerbersderf in Silesia (Prus-
sia), late Director of the Pharmacological Institute,
Dorpat, Russia. Translated and edited by L. H.
Friedburg, Ph.D. Authorized Edition. Practical
knowledge by means of tables which occupy little
space, but show at a glance similarities and differ-
ences between poisons of the same group. Also rules
for the Spelling and Pronunciation of Chemical Terms,
as adopted by the American Association for the Ad-
vancement of Science. Cloth, 61-2x10, 201 pp..2 50
KOCH. ‘Etiology of Tuberculosis.”» By Dr. R.jKoch.
Translated by T. Saure. Cloth, size 6 x 91-4, 97
JOR) ie es ie ODO AN OMENS eS clas Ra ccelcomtsrae 100
LAMBERT. “The Germ Theory’ of Disease.”
Bearing upon the health and welfare of man and the
domesticated animals. By James Lambert, F.R.C.V.S.
Paper, size 5 1-4 x 8 1-4, 26 pages, illustrated..... 25
LAW. ‘*¥Farmers’ Veterinary Adviser.» A Guide to the
Prevention and Treatment of Disease in Domestic
Animals. By Prof. James Law. Cloth, size
Blaser I 2s UStrated..<. aos cence aeer eee anon GU
12 Veterinary Catalogue of William R. Jenkins
(**)LIAUTARD. ‘Animal Castration.”? A concise and
practical Treatise on the Castration of the Domestic
Animals. The only work on the subject in the
English language. By Alexander Liautard, M.D.,V.S.
Having a fine portrait of the author. Tenth edition
revised and enlarged. Cloth, size 6 1-4 x 7 1-2, 165
pages, 46 illustrations: *).). 2/01). cin. cese ee = cee eens 2 00
- The most complete and comprehensive work on the
subject in English veterinary literature.—American <Agri- ~
culturis
— **Cadiot’s Exercises in Equine Surgery.” Translated by
Prof. Bitting and edited by Dr. Liautard.
See ‘* Cadiot.”
— ‘A Treatise on Surgical Therapeutics of the Domestic
Animals.» By Prof. Dr. P. J. Cadiot and J. Almy.
Translated by Prof. Liautard.
See ‘* Cadiot.”
— **How to Tell the Age of the Domestic Animal.’”? By
Dr. A. Liautard, M.D., V.S. Standard work upon
this subject, concise, helpful and containing many
illustrations. Cloth, size 5 x 71-2, 35 pages, 42
illustrations..... aieisis obictaverdis eiaveisateu svete Salo atalevetareters 50
— “*TLameness of Horses and Diseases of the Locomotory
Apparatus.’ By A. Liautard, M.D.,V.S. This work
is the result of Dr. Liautard’s many years of experi-
ence. Cloth, size 5 1-4 x 7 1-2, 314 pages......... 2 50
— **Manual of Operative Veterinary Surgery.” By A.
Liautard, M.D., V.M. Engaged for years in the work
of teaching this special department of veterinary
medicine, and having abundant opportunities of
realizing the difficulties which the student who
earnestly strives to perfect himself in his calling is
obliged to encounter, the author formed the deter-
mination to facilitate his acquisition of knowledge,
and began the accumulation of material by the com-
pilation cf data and arrangement of memorandum,
with the recorded notes of his own experience, the
fruit of a long and extended practice and a careful
study of the various authorities who have illustrated
and organized veterinary literature. Cloth, size
6 1-4 x 9, 786 pages, 563 illustrations...........6. 5 00
851-853 Sixth Avenue (cor. 48th St.), New York. 13
LIAUTARD (continued).
— **Pellerin’s Median Neurotomy in the Treatment of
Chronic Tendinitis and Periostosis of the Fetlock.”
Translated by Dr. A. Liautard.
See ‘* Pellerin.”
— **Vade Mecum of Equine Anatomy.” By A. Liautard,
M.D.V.S. For the use of advanced students and
veterinary surgeons. Third edition, Cloth, size
5 x 7 1-2, 30 pages and 10 full page illustrations of
AMUSE DELCECMUe ic folsiet sins a'aus.s aime ata <tanlerceue celal See y 2 00
— Zundel’s ** The Horse’s Foot and Its Diseases.”
See ‘* Zundel.”
LONG. “Book of the Pig.” Its selection, Breeding,
Feeding and Management. Cloth................ 4 00
(LOWE. ‘Breeding Racehorses by the Figure
System.”? Compiled by the late C. Bruce Lowe.
Edited by William Allison, ‘‘ The Special Commis-
sioner,” London Sportsman, Hon. Secretary Sporting
League, and Manager of the International Horse
Agency and Exchange. With numerous fine illustra-
tions of celebrated horses. Cloth, size 8 x 10, 262
LUDLOW. ‘Science in the Stable”; or How a Horse
can be Kept in Perfect Health and be Used Without
Shoes, in Harness or under the Saddle. With the
Reason Why. Second Edition. By Jacob R. Ludlow,
M.D. Late Staff Surgeon, U. S. Army. Paper, size
Ale Axe Bnd 4 ol GOLA OG sikows/2\s)arececieiels w ereleterelele < creioiele 50
LUPTON. ‘*Horses: Sound and Unsound,” with
Law relating to Sales and Warranty. By J. Irvine
Lupton, F.R.C.V.S. Cloth, size 6 3-4 x 71-2, 217
PACES, AO uMMUStTAtiONS:: «021-2506 secs + were clieriass 1 25
MAGNER. ‘Standard Horse and Stock Book.” By
D. Magner. Comprising over 1,000 pages, illustrated
with 1756 engravings. Leather binding. ........ 6 (0
14 Veterinary Catalogue of William R. Jenkins
McBRIDE. ‘‘Anatomical Outlines of the Horse.” By
J. A. McBride, MRC.V.S. Second edition revised
and enlarged. Cloth, size 5 1-4 x 7 1-4, illus....2 50
()\M’FADYEAN. ‘** Anatomy of the Horse.” Second
edition completely revised. A Dissection Guide.
By John M’Fadyean, M.B., B.Sc., F.R.S.E. Cloth,
size 6 x 8 3-4, 388 pages, illustrated.............. 5 50
This book is intended for Veterinary students, and
offers to them in its 48 full-page colored plates,
54 illustrations and excellent text, a valuable and
practical aid in the study of Veterinary Anatomy,
especially in the dissecting room.
— ** Comparative Anatomy of the Domesticated Animals.”
By J. M’Fadyean, Profusely illustrated, and to be
issued in two parts.
Part I—Osteology, ready. Size 51-2 x 81-2, 166
pages, 132 illustrations. Paper, 2 50; cloth..... 2 75
(Part II in preparation.)
MILLS. ‘How to Keep a Dog in the City.”’ By
Wesley Mills, M.D., D.V.S. It tells how to choose,
manage, house, feed, educate the pup, how to keep him
clean and teach him cleanliness. Paper, size 5x 71-2,
ALO NP BESS wie ares wiccie enciaserele were w ctelettispe olelevate tamrete aaeteerere 25
(*)MOLLER — DOLLAR. *‘Regional Veterinary
Surgery.”’ See ‘‘ Dollar.”
MOHLER. “Handbook of Meat Inspection.”” By Robert
Ostertag, M.D. ‘Translated by Earley Vernon
Wilcox, A.M., Ph.D. With an introduction by
John R. Mohler, V.M.D., A.M. See ‘‘ Ostertag.”
MOSSELMAN-LIENAUX. ‘*Manual of Veterinary
Microbiology.”’ By Professors Mosselman and
Liénaux, Nat. Veterinary College, Cureghem, Belgium.
Translated and edited by R. R. Dinwiddie, Professor
of Veterinary Science, College of Agriculture, Arkansas
State University. Cloth, size 51-2 x 8, 342 pages,
ilustrateds sis .c5 Se yd ceiewrs ages wiettenletionterieters 2 00
851-853 Sixth Avenue (cor. 48th St.), New York. 15
()MOUSSU. ‘Diseases of Cattle, Sheep, Goats and
Swine.”
See ** Dollar.”
(*)NEUMANN. “A Treatise on Parasites and Parasitic
Diseases of the Domesticated Animals.” <A work
to which the students of human or veterinary medi-
cine, the sanitarian, agriculturist or breeder or rearer
of animals, may refer for full information regarding
the external and internal Parasites—vegetable and
animal—which attack various species of Domestic
Animals. A Treatise by L. G. Neumann, Professor
at the National Veterinary School of Toulouse,
Translated and edited by Geo. Fleming, C.B., LL.D.,
F.R.C.V.S. Second edition, revised and edited by
James Macqueen, F.R.C.V.S., Professor at the Royal
Veterinary College, London. Coth, size 6 3-4 x 10,
xvi + 698 pages, 365 illustrations ............... 6 76
NOCARD. ‘The Animal Tubereuloses, and their Relation
to Human Tuberculosis.” By Ed. Nocard, Prof. of the
Alfort Veterinary College. Translated by H. Scurfield,
M.D. Ed., Ph. Camb. Cloth, 5x 71-2, 143 pages..1 00
Perhaps the chief interest to doctors of human
medicine in Professor Nocard’s book lies in the
demonstration of the small part played by heredity,
and the great part played by contagion in the propa-
gation of bovine tuberculosis. It seems not unreason-
able to suppose that the same is the case for human
tuberculosis, and that, if the children of tuberculous
parents were protected from infection by cohabitation
or ingestion, the importance of heredity as a cause of
the disease, or even of the predisposition to it, would
dwindle away into insignificance.
(*)OSTERTAG. ‘Handbook of Meat Inspection.” By
Robert Ostertag, M.D. Authorized Translation by
Earley Vernon Wilcox, A.M., Ph.D. With an intro-
duction by John R. Mohler, V.M.D., A.M. The work
is exhaustive and authorative and has at once become
the standard authority upon the subject Second
edition, revised 1905. Cloth, size 6 3-4 x 9 3-4, 920
pages, 260 illustrations and 1 colored plate....... 7 60
16 Veterinary Catalogue of William R. Jenkins
(*)PALEIN, ‘A Treatise on Epizootic Lymphangitis.” By
Capt. W. A. Pallin, F.R,C.V.S. In this work the
author has endeavored to combine his own experience
with that of other writers and so attempts to give a
clear and complete account of a subject about which .
there is little at present in English veterinary litera-
ture. Cloth, size 5 3-4 x 81-2, 90 pages, with 17 fine
full page illustrations)... os -s.sedees esa camen eee 1 25
PEGLER. ‘The Book of the Goat.”? Third edition re-
written and enlarged. Cloth, 223 pages, illus....1 75
PELLERIN. ‘Median Neurotomy in the Treatment
of Chronic Tendinitis and Periostosis of the Fetlock.”
By C. Pellerin, late repetitor of Clinic and Surgery to
the Alfort Veterinary School. Translated, with Addi-
tional Facts Relating to It, by Prof. A. Liautard, M.D.,
V.M. Having rendered good results when performed
by himself, the author believes the operation, which
consists in dividing the cubito-plantar nerve and in
excising a portion of the peripherical end, the means
of improving the conditions, and consequently the
values of many apparently doomed animals. Agricul-
ture in particular will be benefited,
The work is divided into two parts. The first covers
the study of Median Neurotomy itself; the second,
the exact relations of the facts as observed by the
author. Boards, 6 x 9 1-2, 61 pages, illustrated. .1 00
PETERS. ‘A Tuberculous Herd—Test with Tuber-
culin.” By Austin Peters, M.R.C.V.S., Chief
Inspector of Cattle for the New York State Board of
Health during the winter of 1892-93. Pamphlet. ...25
REYNOLDS. “An Essay on the Breeding and Manage-
ment of Draught Horses.” By R. S. Reynolds,
M.R.C.V.S. Cloth, size 5 1-2 x 8 3-4, 104 pages..1 40
ROBERGE. ‘**The Foot of. the Horse,” or Lameness
and all Diseases of the Feet traced to an Unbalanced
Foot Bone, prevented or cured by balancing the foot.
By David Roberge. Cloth, size 6x 91-4, 308 pages,
Ulystratbed a cccciemem ne castes cieastolesets crete 5 00
851-853 Sixth Avenue (cor. 48th St.), New York. 17
(*)SESSIONS. ‘Cattle Tuberculosis,’’ a Practical Guide to
the Agriculturist and Inspector. By Harold Sessions,
F.R,C.V.S., ete. Secondedition. Size5x 71-4, vi +
MN OMM ALES totais sic ciel csi core. sie'n'e Avie ees. s go Sosa EOE 1 00
The object of the author has been to write the text
in such a manner that the subject can be understood
by those who have to deal particularly with it, yet
who, perhaps, have not had the necessary training to
appreciate technical phraseology.
SEWELL. ‘*The Examination of Horses as to Sound.
ness and Selection as to Purchase.” By Edward
Sewell, M.R.C.V.S. Paper, size 51-2 x 81-2, 86 pages,
illustrated with 8 plates in color............... 1 60
.... It is a great advantage to the business man to
know something of the elements of law, and nobody
ought either to buy or own a horse who does not know
something about the animal. That something this book
gives, and gives in a thoroughly excellent way....
—Our Anmmal Friends.
SMITH. ‘*A Manual of Veterinary Physiology.” By
Col. F. Smith, C.M.S., F.R.C.V.S., F.I.C., author of
‘©A Manual of Veterinary Hygiene.”
Throughout this manual the object has been to con-
dense the information as much as possible. The
broad facts of the sciences are stated so as to render
them of use to the student and practitioner. In this
second edition—rewritten—the whole of the Nervous
System has been revised, a new chapter dealing with
the Development of the Ovum has been added together
with many additional facts and illustrations. About
one hundred additional pages are given. Second
edition, revised and enlarged. Cloth, size 6 x 8 3-4,
673 pages, 102 illustrations......... 2.2. seeees 3 75
— (*)** Manual of Veterinary Hygiene.”’ Third edition revised.
Cloth, size 5 1-4 x 7 1-2, xx + 1036 pages, with 255
ASU OMS ver eterete elevates cialals! are le wa. eieie s oleis elpiole wielotnre 4 75
Recognizing the rapid advance and extended field
of the subject since the previous issue, the author
has entirely re-written the work and enlarged its
scope, whieh is brought thoroughly up to date. Con-
tains over 500 more pages than the second edition.
(“)STRANGEWAY. ‘Veterinary Anatomy.” Edited by
I. Vaughan, F.L.S., M.R.C.V.S. New edition revised.
Cloth, size 6 1-4 x 9 1-2, 625 pages, 224 illus...... 5 00
18 Veterinary Catalogue of William R. Jenkins
SUSSDORF. ‘Six Large Colored Wall Diagrams.” By
Prof. Sussdorf, M.D. (of Géttingen). Text translated
by Prof. W. Owen Williams, of the New Veterinary
College, Edinburgh. Size, 44 inches by 30 inches.
1.—Horse. 4.—Ox.
2.—Mare. 5.—Boar and Sow.
3.—Cow. . 6.—Dog and Bitch.
The above are printed in eight or nine colors.
Showing the position of the viscera in the large
cavities of the body.
Price; unmounted? 007 o. clce wces o toaeee 1 75 each
Ԣ mounted on linen, with roller... .... 350 *Ԥ
(*“)THOMPSON. ‘Elementary Lectures on Veterinary ;
Science.” For agricultural students, farmers and q
stock keepers. By Henry Thompson, M.R.C.V.S., .
lecturer on Veterinary Science at the Aspatria Agri-
cultural College, England. It is complete yet concise .
and an up-to-date book. Cloth, 397 pp., 51 illus..3 76
VAN MATER, “A Text Book of Veterinary Oph-
thalmology.””> By George G. Van Mater, M.D.,
D.V.S., Professor of Ophthaimology in the American
Veterinary College; Oculist and Aurist to St. Martha’s
Sanitarium and Dispensary; Consulting Eye and Ear
Surgeon to the Twenty-sixth Ward Dispensary; Eye
and Ear Surgeon, Brooklyn Eastern District Dispen-
sary, etc. Illustrated by one chromo lithograph plate
and 71 engravings. Cloth, 6 x 91-4, 151 pages...3 00
- . . We intend to adopt this valuable work as a text
book.—E. J. Creely, D.V.S., Dean of the San Francisco
Veterinary College.
VETERINARY DIAGRAMS in Tabular Form.
Size, 284 in. x 22inches. Price per set of five... 4 00
Mounted and folded in case..................3..% €0
No.1. ‘The External Form and Elementary Ana-
to.ny of the Horse.” Eight colored illustrations—
1. External regions ; 2. Skeleton ; 3. Muscles (Superior
Loyer); 4. Muscles (Deep Layer); 5. Respiratory Ap-
851-853 Sixth Avenue (cor. 48th St.), New York. 19
VETERINARY DIAGRAMS (continued).
paratus; 6. Digestive Apparatus; 7. Circulatory Ap-
paratus ; 8. Nerve Apparatus ; with letter-press descrip-
LET) aan Sey SS ee yo eS ee, Sea 1 25
No. 2. ‘*The Age of Domestic Animals.” Forty-two
figures illustrating the structure of the teeth, indicat-
ing the Age of the Horse, Ox, Sheep, and Dog, with
MUU eSe ni PulON 9.75 5 oss eso Sig cke cs eelee oe eee oe See 75
Mounted on roller and varnished..,.............. 2 C0
No. 3. ‘‘The Unsoundness and Defects of the Horse.’
Fifty figures illustrating—1. The Defects of Confor-
mation; 2. Defects of Position ; 3. Infirmities or Signs
of Disease; 4. Unsoundnesses; 5. Defects of the Foot;
WIL MU EOSCHIP hl ON cet .tey> aoe bt cas's See rsinaiow aie ees 75
Mounted on roller and varnished,................ 2 00
No.4. ‘The Shoeing of the Horse, Mule and Ox.”’
Fifty figures descriptive of the Anatomy and Physio-
logy of the Foot and of Horse-shoeing............. 75
Mounted on roller and varnished................ 2 00
No.5. ‘The Elementary Anatomy, Points, and But-
cher’s Joints of the Ox.” Ten colored illustrations
—1. Skeleton; 2. Nervous System; 3. Digestive
System (Right Side) ; 4. Respiratory System ; 5. Points
of a Fat Ox; 6. Muscular System ; 7. Vascular System;
8. Digestive System (Left Side); 9. Butcher’s Sections
of a Calf; 10. Butcher’s Sections of an Ox; with full
GCHOPIHaH Ee ante sok, taste gs Sielols o wa dete eas as Ws eed ab
Mounted on roller and varnished................ 2 25
WALLEY. ‘Four Bovine Scourges.” (Pleuro-Pneumonia,
Foot and Mouth Disease, Cattle Plague and
Tubercle), By Thomas Walley, M.R.C.V.S. With
an Appendix on the Inspection of Live Animals and
WL Gry bea CURL Os CLODH ee nta\0c'o 2's ce dels ove o-s.0\s 12 visiernie 6 40
20 Veterinary Catalogue of William R. Jenkins
WALLEY (continued),
(*)— ‘*‘A Practical Guide to Meat Inspection.” By
Thomas Walley, M.R.C.V.S., late principal of the
Edinburgh Royal (Dick) Veterinary College; Pro-
fessor of Veterinary Medicine and Surgery, ete,
Fourth Edition, thoroughly revised and enlarged
by Stewart Stockman, M.R.C.V.S., Professor of
Pathology, Lecturer on Hygiene and Meat Inspection
at Dick Veterinary College, Edinburgh. Cloth, size
5 1-2 x 8 1-4, with 45 colored illus., 295 pages..... 3 00
An experience of over 30 years in his profession
and a long official connection (some sixteen years)
with Edinburgh Abattoirs have enabled the author to
gather a large store of information on the subject,
which he has embodied in his book.
While Dr. Stockman is indeed indebted to the 3
old for much useful information, this up-to- ‘
date work will hardly be recognized as the old
‘¢ Walley’s Meat Inspection.” 1
WILCOX. ‘Handbook of Meat Inspection.” By Robert
Ostertag, M.D.
See ‘* Ostertag.”
WILLIAMS. “Principles and Practice of Veterinary
Medicine.” Author’s edition, entirely revised and
illustrated with numerous plain and colored plates.
By W. Williams, M.R.C.V.S. Cloth, size 5 3-4 x 8 3-4,
S68) PAGES’. s/o viales cusses oceie ois Coan Lolcbene ote reiohe teen eaten 7 50
— ** Principles and Practice of Veterinary Surgery.”
Author’s edition, entirely revised and illustrated
with numerous plain and colored plates, By W.
Williams, M.R.C.V.S. Cloth, size 61-2 x 91-4, 756
POLES Sees caccscsscesnouegescemaae ates winced Cae Cen
851-853 Sixth Avenue (cor. 48th St.), New York 21
THE MOST COMPLETE, PROGRESSIVE AND
SCIENTIFIC BOOK ON THE SUBJECT IN
THE ENGLISH LANGUAGE
(*)WINSLOW, ‘Veterinary Materia Medica and Therapeu-
tics..> By Kenelm Winslow, B.A.S., M.D.V., M.D.,
(Harv.); formerly Assistant Professor of Therapeutics
in the Veterinary School of Harvard University ;
Fellow of tiie Massachusetts Medical Society ; Surgeon
to the Newton Iospital, ete.
Third Edition, Revised 1905
Cloth, size 6 1-4 x 9 1-4, viii + 804 pages.......... 6 00
Your letter received and I am pleased to know that we are to
have an American Materia Medica.—J. H. Wattles, Sr., M.D., D.V.S.,
The Western Veterinary College, Kansas City, Mo.
. . Amdelighted with it. It is remarkably correct, complete
and up-to-date and is bound to supersede any other work on the same
subject heretofore before the profession.
No practitioner’s library is complete without it and it will be
indispensable for students, as it does away with the necessity of their
having a number of collateral books on the subject. _
It will be adopted as the text book in the Chicago Veterinary
College.—Dr. E. L. Quitman, Chicago Veterinary College.
The book is of admirable merit and full of valuable informa-
tion from beginning to end, very explicit, rich and interesting, and
should be in the hands of every student as well as practitioner of the
art of Veterinary Medicine.—Thurston Miller, M.D., Professor of
Materia Medica, Therapeutics and Chemistry, San Francisco Veteri-
nary College.
I consider it the only work on materia medica and therapeutics
suitable to the American veterinary practitioner. It deserves a wide
distribution among veterinarians. I have recommended it to my
students.—John J. Repp, V.M.D., Iowa State College, Ames, Iowa.
Cs)
©
Veterinary Catalogue of William R. Jenkins.
(*)VWYMAN. ‘Bovine Obstetrics.» By M. G. De Bruin.
Translated by W. E. A. Wyman, M.D.V.,V.S.
See also ‘‘ De Bruin.”
(*)— **Catechism of the Principles of Veterinary Surgery.”
By W. E. A. Wyman, M.D.V.,V.S. Cloth, size 6 x 9,
GLI PAGES se ccenictat seer a Wieisicteis ste pustateleeains 3 50
Concerning this new work attention is called to the
following points:
.—It discusses the subject upon the basis of veterinary investigations.
-—It does away with works on human pathology, histology, etc.
3.—It explains each question thoroughly both from a scientific as well
as a practical point of view. :
.—It is writen by one knowing the needs of the student.
.—It deals exhaustively with a chapter on tumors, heretofore utterly
neglected in veterinary pathology.
.—The only work in English specializing the subject.
.—The only work thoroughly taking into consideration American as
well as European investigations.
.—Offering practical hints which have not appeared in print, the
result of large city and country practice.
1
2
4
5
6
7
8
(**)— “The Clinical Diagnosis of Lameness in the Horse.”
By W. E. A. Wyman, D.V.S., formerly Professor of
Veterinary Science, Clemson A. & M. College, and
Veterinarian to the South Carolina Experiment
Station. Cloth, size 6 x 9 1-2, 182 pp., 32 illus....2 50
(*)— ‘* Tibio-peroneal Neurectomy for the Relief of Spavin
Lameness.”? By W. E. A. Wyman, M.D.V., V.S.
Boards, size 6 x 9, 30 pages, illustrated........... 50
Anyone wanting to perform this operation should procure
this little treatise; he will find it of considerable help.—The :
Veterinary Journal.
ZUNDEL. ‘The Horse’s Foot and Its Diseases.” By
A. Zundel, Principal Veterinarian of Alsace Lorraine.
Translated by Dr. A. Liautard, V.S. Cloth, size
5 x 7 3-4, 248 pages, illustrated.................. 2 00
ZUILL. ‘Typhoid Fever; or Contagious Influenza
in the Horse.” By Prof. W. L. Zuill, M.D:,D.V.S.
Pamphlet, size 6 x 9 1-4, 29 pages................. 25
Any book sent prepaid for the price
WILLIAM R. JENKINS,
851 and 853 Sixth Avenue, NEW YORK.
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