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Cae APNE shy Rae Sd eee, : : ‘ - : ‘ Rete RRS eR : TOLER RD LE tuleh tego Gry oe Pe a > Pies A 2 SR Ra a) ei ph Pac a ere Uae, RK Ms P. se Nai teh teaciadinach viata ee ee oe Oe Pee IT A; f CORNELL UNIVERSITY THE Flower Veterinary Library FOUNDED BY ROSWELL P. FLOWER for the use of the N. Y. STATE VETERINARY COLLEGE 1897 Cornell Universit eneral surgery, HAND-BOOK OF VETERINARY SURGERY AND OBSTETRICS WITH CO-OPERATION OF ProF. Dr. ALBRECHT (MuNICH), STAFF VETERINARIAN BARTKE (STETTIN), PRoF. DE BRUIN (UTRECHT), PRoF. CADIOT (ALFORT), ProF. Dr. EBERLEIN (BERLIN), PRoF. DR. GMELIN (STUTTGART), STAFF VETERINARIAN HELL (ALTONA:, PROF. HENDRICKX (BrRus- SELS), PROF. Dr. HESS (BERN), PRoF. Dr. HIRZEL (ZURICH), STAFF VETERINARIAN KONIG (KGONIGSBERG), PROF. LANZILLOTTI-BUON- SANTI (MiLan), Docent LUNGWITZ (DRESDEN), PROF. DR. OSTERTAG (BERLIN), PRoF. DR, PFEIFFER (GIESSEN), PROF. DR. SCHINDELKA (ViENNA), DR. SCHMIDT (Vienna), LATE PROF. Dr. SIEDAMGROTZKY (DRESDEN), PRoF. Dr. VENNERHOLM (STOCKHOLM), PROF. DR. ZSCHOKKE (Zitrich). EDITED BY PROFESSOR Dr. JOS. BAYER and ProFgEssor Dr. EUG. FROHNER VIENNA BERLIN VOL. II. GENERAL SURGERY Dr. EUGEN FROHNER THIRD EDITION 1905 GENERAL SURGERY BY DR. EUGEN FROHNER PROFESSOR IN THE ROYAL VETERINARY COLLEGE IN BERLIN Authorized Translation From THE THIRD REVISED EDITION BY Ne Es d D. HAMMOND UDALL, B.S. A., D. V.M. ‘ASSOCIATE PROFESSOR OF SURGERY AND OBSTETRICS COLLEGE OF VETERINARY MEDICINE . OHIO STATE UNIVERSITY Columbus. TAYLOR & CARPENTER ITHACA, N.Y. \ 1906 EB) GOR AE bel WWW RELLY PIB ARY — Orreerg- 7t/ No. 23st F ee. Copyright, 1906 BY TAYLOR & CARPENTER 4906 Registered at Stationers’ Hall LONDON, ENGLAND PREPACE TO THE FIRST EDITION, In the following hand-book of veterinary surgery and ob- stetrics the general surgery, as well as the operative surgery, forms a separate, independent work. In a sense they serve as an introduction to the following third and fourth volumes of special surgery of the different organs. Any text-book of general veterinary surgery must depend on the investigations and text-books of human medicine. While I have kept this point in view in the development of the following plan, I think I have clearly drawn the relations between the general surgery of man and animals. I also admit that in the writing of this book I have followed princi- pally the plans which Billroth, and recently Tillman, have used in their text-books of human and general surgery. The reader will readily note that the following work is nota mere compilation of the books mentioned on human medicine. In many particulars veterinary surgery, like pathology, phar- macology and therapy, has developed independent lines. Many chapters on human surgery have no connection with veterinary surgery ; other divisions that are very important in human surgery are of little or no importance in veterinary science. Tuberculosis of the bones and joints, for example, belongs to one of the most important divisions of human surgery ; in veterinary surgery it is practically never the occasion for surgical interference. Conversely, actinomycosis and botryomycosis is of great importance in veterinary surgery, the latter is almost unknown in man. In man osteomyelitis is the most important form of inflammation of the bones ; in the horse periostitis is the most important form. Erysipelas, so frequent in man, appears to be very rare in animals. It is obvious that resection of joints, as well as most amputations of limbs, cannot be employed on (V) VI PREFACE. domestic animals. The aseptic method, which is so important in human surgery, seems to be of little importance in veteri- nary science because of purely external causes. Even bone- fractures present an entirely different surgical problem in large animals than in men. Firing, and the application of blisters for chronic inflammations of bones, tendons, and joints, are special surgical methods of veterinarians. On the other hand, the following work is not a compen- diiim of other surgical text-books on veterinary surgery. On the basis of many years of surgical and clinical activity, I think I have had sufficient experience to elucidate the follow- ing subject from my own point of view. In many chapters, namely, those on fractures and tumors, I was in a position to insert my own investigations. I was also careful to arrange the material purely from a veterinary standpoint, and only for the object of veterinary practice. On this basis the reader will find, for example, many references in this book to forensic veterinary science (age of wounds, fractures, fissures, muscular atrophy; curability or non-curability of bone-fractures in horses and cattle; abnormal fragility of bones ; prophylaxis of bone-fractures, etc.). Foreign bodies, parasites, and con- genital new-formations, which are of great surgical import- ance, have been given special attention. General surgery has numerous and important relations to general pathology and pathological anatomy. Unfortunately we have no text-book of general pathology in our veterinary literature. On the other hand we have recently come into the possession of a very important hand-book of veterinary pathological anatomy. I am under great obligations to this excellent book of Kitt’s for valuable suggestions and informa- tion. General surgery is also closely related tu anatomy. I have found a deficiency in the descriptions of tendon-sheaths and fasciz in most veterinary text-books on anatomy ; these are very important from a surgical standpoint, the descriptions are usually incomplete and indistinct. With reference to the relation of general surgery to bacteriology, it must be acknowl- edged that the latter has contributed largely to the problem of suppuration and inflammation, as well as to the combating of PREFACE. VII these processes by means of antiseptics, from a standpoint of both scientific and practical surgery. On the other hand, one must not overestimate the importance of bacteriology to general surgery and overlook. everything else for bacteria. Many surgical inflammations have nothing to do with bacteria ; this is especially true of the purely traumatic, aseptic inflammations of bones, joints, tendons, tendon-sheaths, and muscles. At suitable places I have considered it my duty to repeatedly refer to this obligation. From a diagnostic standpoint also, bacteriology should not be given too great weight in surgery. Pus-cocci, in particular, are of little practical diagnostic impor- tance ; this is especially true where the candidate, unfortu- nately, is overenthusiastic concerning the significance of a bacteriological examination, to him the presence of pus-forming . bacteria in pus from bones may form the principal evidence for the presence of a bone-fistula. The bacteriological confusions that have occurred concerning wound-erysipelas receive atten- tion in the chapter on this subject. There is no claim of completeness for the bibliography at the end of each chapter. My principal object was to divide the literature on human medicine from that of veterinary sci- ence and, above all, also to indicate to students the funda- mental investigations that have been made in human medi- cine; only the most important and recent works have been mentioned. The book contains no illustrations. I am opposed to the usual custom in veterinary science of appropriating illus- trations from works on human medicine, either unchanged or specially modified. I maintain that it is not admissible. KISssINGEN, August, 1896. PREFACE TO THE THIRD EDITION. The new, third edition of general surgery is improved and enlarged in many respects. The individual changes are as follows: The chapter on the etiology of tumors has been re- written, and many additions have been made to the casuistry of this group; unfortunately the recent etiological works on tumors are largely speculations. The chapter on botryomy- cosis has been newly written to harmonize with the most re- _cent investigations on this subject; there is hardly a doubt that in this wound infection we have to deal, not with staphy- lococci, but with an infectious disease sui generis. Regardless of the objections of critics, the chapter on tuberculosis has been retained and even enlarged ; the motive for following this plan is explained in that chapter. I have supplemented the important chapter on chronic deforming arthritis with the re- sults of recent investigations made in my clinic upon ringbones chronic gonitis, and omarthritis. This is also true of primary infectious osteomyelitis the occurrence of which in the horse, according to our recent investigations, can be no longer doubted. Recent investigations on myositis, neuritis, healing of fractures, necrosis bacilli, pseudo-edema bacilli, and foal- lameness have also been considered. On the subject of asepsis against antisepsis it may be definitely stated that now, even in human therapeutics, all have returned to antisepsis. In the first edition of this book I recommended antisepsis for the vet- erinary surgeon. Even for the disinfection of fresh wounds the application of pure carbolic acid, as well as the hot iron, has been recently recommended in human surgeries. What a change within one decade ! Berlin, December, 1904. ProF. Dr. FROHNER. (VIII) TRANSLATOR’S PREFACE The translation of the third edition of Fréhners ‘‘ General Surgery ’’ has been undertaken to supply a-well classified pre- sentation of the fundamental principles of surgery. Itis hoped that it may assist the beginner in obtaining a clear perspective of the mass of surgical diseases with which he must come in contact. That portion of the text dealing with bibliography has been omitted in the translation as it is practically unavailable to most English readers. Otherwise the text has been closely followed, no additions or other changes having been made. The translator of this work is especially indebted to Pro- fessor David Stuart White who has rendered valuable assist- ance in reading the proof sheets. He is also indebted to Drs. A. D. Fitzgerald and James Mcl. Phillips for suggestions that have materially reduced the list of errors. The translator wishes to express his gratitude to the firm of Taylor & Carpenter who have procured the authorization of this translation from the German publishers, assumed all financial responsibility, and shown every possible courtesy and assistance in furthering the progress of the work. D. H. UDALL. Columbus, Ohio, July, 1906. (IX) CONTENTS PAGE Preface 922525 ea ape a inne opto Vv Contents: so 3a ne ae ra XI SW ound soo ee a sa ie Sas ee ee et nn FS, I I. Definition, Classification, and Symptoms_____________ .___ I II. Incised, Stab, Contused, Shot, Lacerated, and Poisoned Wit Spe ole ei eee i aoe 6 III. Control of Hemorrhage __________.___-_--- eee 12 IV. Anatomical Changes in Wound Healing _______.________ 17 V. Wound Infection Diseases... _____. __-_. eee 25 I. (SUpPura tens. eo he ON ee eee eee Sua aS 25 Dor JPME SIN OM peek 4 Sa SS Sh Das ahh chet AD Bah Cees 28 Bs: » (ADSCESS= 22s thst haa ere Oe te a eee 34 4. Wound Fever_____. ______-0- eee 37 Re Se pticemia: o2 2.3 in nee a ee 40 6. SPYtMids 2s 2cncs tee eeeeeekee kk Pa Ames 22s yh a arora ree 44 7. Other Wound Infection Diseases ______________--_ 46 VI. Treatment of Wounds. __..__---_-_-- vewieea eb aescernsae 55 Subcutaneous Injuries of Soft Parts, (Contusion, Rupture)-_______ 64 Ty (@ Ott WS1 Ow sas le al beet ols nets wre 64 PY. “RUPUIe: 225. 2255-2525 es sete seee cee e cece ssueeaeces 70 Inflanimation 2224.23 oe a es ES ee as Sei ae 72 I, (Naturéand Causes). < 2222.52 222. so 22sec aS eeu 73 Il. Kinds, Symptoms, and Course of Inflammation _________- 76 III. Treatment of Inflammation ._.___._..---__--_------------- 79 Uleer, Fistula, Gangrene ____---___----.--- .--------------------- 84 Ty Ule@ ress gets See ee Some ae sas soe eee ascents 84 pT, SSA StU hs tne fateh pase RIS Along yd 2 IDES Nee a 86 Ith: Gangrene. = 2.2226 oe ee eet ed sate aera A ean an gt SPumons) sso 2 Sa ant cet ari ess seco hte Soa eee eee ee US 98 In “Tumors it: Generals: .2255-22: Congelatio. 2.52 ocala cateemimmasccce dens II. Surgical Diseases of the Subcutaneous Tissue_____.______ Te HGO@ia, 22228 ssa se es ee Se ase Ah eee ee 2; (EMI pb yS@ina: ..-ohe cose aw eee eee een eee III. Surgical Diseases of the Mucous Membranes__._.________ IV. Surgical Diseases of the Pododerm_____._________ eaceee ts é I. GENERAL REMARKS CONCERNING THE NA- TURE, SYMPTOMS, AND CLASSIFICATION OF WOUNDS. DeFINITION.—A wound, in a restricted sense, indicates any injury accompanied by a breach in the continuity of the skin or mucous membrane. Wounds may also be defined as open, hemorfhagic injuries, in contrast to lacerations and fractures which occur in the subcutaneous tissues and are not characterized by a breach in the continuity of the outer cov- ering. The latter are closed to the presence of air, they are aseptic; that is, protected against the entrance of infectious irritants. Wounds, on the other hand, are open to the entrance of septic infection. The symptoms, course, prognosis, and treatment for both are, therefore, extremely variable. For this reason the open and subcutaneous injuries must be considered under separate headings. An ulcer is differentiated from a wound by its tardiness in healing ; it may be considered as a wound which will not heal. k GENERAL Symptoms oF Wounps. ‘The most important symptoms of fresh wounds are hemorrhage, pain, gaping, and disturbed function. 1. Hemorrhage varies according to the size and con- dition of the wounded vessels. One recognizes arterial, venous, - parenchymatous, and capiliary hemorrhage. Arterial hem- orrhage is that which results from injuries to individual arteries, it spurts from the wound andisbright-red incolor. In venous hemorrhage large veins are involved, dark red blood flows from the peripheral ends in a continual stream as from a spring. Parenchymatous hemorrhage includes both 2 WOUNDS arterial and venous (mixed hemorrhage) ; the incised vessels are small, the blood is medium-red in color and flows from all portions of the wound similar to being squeezed from a ‘sponge (tumors, swollen parts, muscle). Capillary hemor- thage follows slight injuries to the skin and mucous mem- brane, the blood flows in drops from the incised capillaries. As a rule, transverse wounds to vessels bleed more freely than those in a longitudinal direction because the gaping is greater (therefore an incision should be longitudinal when operating). In contused we wounds the hemorrhage is occasion- ally very slight, the adventia constricts, the intima and media are retracted inwards, this results in mechanical closure of the vessel similar to that which occurs in torsion (ecraseur, emasculator). Penetrating wounds of large vessels usually close spontaneously (penetrating injury of the jugular from intravenous injection, an occasional penetrating injury to the carotid during the same operation). In previous anastomosis formation vessels bleed from both ends (carotid, large veins, thyroid gland). -~~The following symptoms are observed after severe hem- orrhage : general anaemia which is especially characterized by paleness of the visible mucous membranes ; coolness of the skin ; as well as weak pulse and heart-beat which results from sinking of the blood pressure and weakness of the heart. _-~Death from hemorrhage is further preceded by general weak- ness, tottering, vertigo, loss of consciousness, dyspnoea, dili- tation of the pupils, disappearance of the corneal reflex action, involuntary urination and defecation, as well as convulsions. Death is more certain when the loss of bloodis more than a third of the total amount. The The total amount of blood in a horse is equal to about one fifteenth of the total body weight. A horse weighing 450 kg., ee ition: for example, (blood contents = 1/15 = 30 kg. or litres) dies after a loss of more than 10 kg. (litres) of blood. Loss ofa third of the blood is followed by pronounced heart weakness and sinking of blood pressure, it is possible, however, for regeneration of the blood to take place from the parenchyma- tous fluids. Loss of a fourth of the total amount of blood is WOUNDS 3 ‘only followed by decreased blood pressure (phlebotomy). Regeneration occurs through the absorption of water from the lymph of the tissues as well as from the fluid contents of the stomach and intestines (hydraemia); this is followed by an increase in the formation of the white blood corpuscles (leuco- ytosis); finally the red blood corpuscles gradually increase _ in number, Injuries to large lymph vessels, joints, and tendon sheaths result in a discharge from the wound of lymph, synovia, and tendon-sheath fluid respectively; saliva is dis- charged from wounds to the salivary glands, salivary ducts, and esophagus ; food or feces from perforating injuries to the ‘stomach or intestines; milk from wounds to the udder; urine from lesions to the bladder or urethra. Hemorrhage is absent in corneal wounds. 2. Pain is due to cutting, bruising, or tearing the sen- ‘sitive nerves. The so-called primary pain should be distin- guished from secondary wound pain due to inflammation (nailing !). The pain of wounds is in direct proportion to the nerve supply of the affected tissues. Wounds of the skin, pododerm, periosteum, mucous membranes, cornea, or peri- pheral nerve endings are more painful than those of bone, car- tilage and tendon, connective-tissue, or brain substance. The blunter the cutting instrument, and the slower the separation of the tissue, the greater the apparent pain (experience in opera- tions). The sensitiveness of different animals varies according to the individual, age and sex, as well as the race and species. Many horses are very sensitive to ‘neurectomy while others remain quiet during the operation. Many horses will stand without narcosis for trepanation and tra- -cheotomy, as well as similar operations which require restraint, while others must be cast and restrained for operations that are far less painful. In general horses are more sensitive than cattle ; dogsand cats more than horses. Horses that belong to the warm blooded races frequently show more sensitiveness ‘than those of the cold blooded race (e. g. castration). Mares and stallions are usually more sensitive than geldings. The 4 WOUNDS following appear least sensitive : old horses, phlegmatic horses, and those affected with blind staggers. In comparison to man, all domestic animals appear to be less sensitive to wounds. Many animals, after a severe in- jury, show a certain amount of resignation similar to man (trained dogs). Complete insensibility follows deep narcosis (chlo- roform, cocaine); is present in dead tissues; and occurs after neurectomy, so that nail puncture in the hoof, for example, does not cause pain. 3. Gaping of wounds depends on the character of the incised tissue, as well as upon the direction of the wound. Gaping is most pronounced in those places where the skin is widely separated as a result of transverse muscle and tendon wounds. 4. Disturbed function occurs after wounds of the hoof, tendons, joints, and muscles, where it is characterized by lameness ; wounds of the tongue result in deranged mastica- tion; blindness may follow corneal wounds; wounds to the motor or sensory nerves may produce paralysis or anesthesia. Very painful wounds in the horse result in a diminution or complete loss of appetite, this is frequently observed after horses have been operated under restraint. Genuine shock or wound shock (sudden paralysis of the vasomotor cen- ter with anemia of the mucous membranes, retardation and paralysis of the activity of the heart) is very rare in animals. Perforating abdominal wounds in the horse are frequently fol- lowed by colic (peritonitis). The following conditions fre- quently follow injuries to large nerve branches (neurectomy): stagnation edema, inflammatory conditions, ulcer formation and necrosis of the skin and pododerm, inflammation of the periosteum, bone, and joints, exungulation, atrophic changes, fractures, tendon ruptures, etc. (See chapter on diseases of the nerves.) Occasionally sudden death follows the introduction. of air into the jugular vein (operation on shoulder abscess, phlebotomy); this is partly due to paralysis of the lungs (air emboli in the pulmonary capillaries), partly to paralysis of ‘ the heart (air in the chambers of the heart, air emboli in the WOUNDS 5 coronary arteries), partly to paralysis of the brain (air em- boli in the capillaries of the brain). ‘The aspiration of air into the abdominal cavity (gurgling sound), sometimes ob- served in the castration of stallions, is usually harmless. Finally, any wound may be followed by wound fever. Two forms are recognized, aseptic and septic wound fever. Aseptic fever is due to the resorption of degenerated blood products without the presence of bacteria. It is characterized by a slight elevation of temperature without severe disturbances of the general system (see chapter on wound fever). Septic fever, on the other hand, depends on the presence of specific infectious material which gains entrance to the wound and finally enters the blood stream. It is characterized by a marked elevation of temperature and severe derangement of the general system (see chapter on septicaemia and pyaemia). CLASSIFICATION OF WouNpDs.—According to the causes wounds are classified as follows: incised, punctured, lacerated, contused,stab, shot wounds, and bites. In addition to wounds due to mechanical force one must con- sider injuries produced by chemical irritants (caustics), and thermic influences (burns, freezing), which are classified as caustic wounds, necrotic wounds, etc. According to the condition of the wound they are classified as simple or non-contused (incised, punc- tured), and complicated or contused wounds (con- tusions, shot wounds, bites), wounds with and without loss of substance, flap or skin wounds, clean, unclean, (hair, dirt, dust), infected and poisoned, superficial, deep, and perforating or penetrat- ing (abdominal cavity, thorax, joints), slight, severe, and fatal, fresh and old, hemorrhagic, suppura- tive, granulating and cicatrized wounds. According to the seat and tissues involved they are classified as wounds of the head, thorax, throat, ab- domen, skin, mucous membranes, muscles, bones, cartilage, joints, tendons, brain, cor- nea, stomach and intestines. 6 INCISED AND STAB WOUNDS SHocK IN ANIMALS.—Beck has observed one case of paralysis of the heart in acalf asa result of castration (Wochenschrift fiir Tier heilkunde. t1gor). The animal bellowed very loud after the remova- of the first testicle (pain, fear, terror), collapsed and died immediately. The results of a post mortem were negative. II. INCISED, PUNCTURED, CONTUSED, SHOT, LACERATED AND POISONED WOUNDS. INCISED AND STAB Wounps.—These are due to injur- ies from surgical and ordinary knives, hay knives, hoof knives, butcher knives, case knives, shears, glass, pieces of iron, scythes, sickles, sabers, hatchets, etc. The characteristics. of incised and thrust wounds consist in their straight dir- ection, longitudinal form, as wellas sharply de- fined, smooth, non-contused edges. Hemorrhage and retraction of edges are more pronounced than in the other forms. ‘They are most often seen in horses, dogs, and cattle on various parts of the body, especially the limbs. According to depth they may be termed wounds of the skin, muscle, tendon, bones, and perforating wounds. The prognosis is favourable when the skin only is involved (suture). From a forensic standpoint it should be observed that many lacerat- ed and contused wounds present edges similar to those of in- cised wounds (wire, sharp edge of the hoof). PUNCTURED Wounpbs.—Punctured wounds are caused by manure forks, hay forks, nails, needles, pointed knives, and shears, lances, bayonets, harrows, splinters of wood, etc. Penetrating wounds in horses are most often due to manure and hay forks, as well as treads on nails and nailing. In the German Army the lance is a frequent cause of wounds on ac- count of its wide use in the cavalry. During operations -.- punctured wounds are often produced by means of the injection needle and the trochar (subcutaneous, intravenous, intra- peritoneal, parenchymatous, intraocular, subconjunctival, sub- dural, intracranial, and even intracerebral injections, paracen- tesis thoracis, paracentesis, abdominis, harpooning the udder, BITES, LACERATED AND CONTUSED WOUNDS 7 lumbar puncture). Punctured wounds are usually small, round, slightly hemorrhagic, and frequently lead toa fistulous canal. Perforations into joints, tendon sheaths, abdomen, thorax, eyes, etc., are common. Experience with injections and puncture has demonstrated that perforating wounds with sharp, clean instruments are harmless when they penetrate body cavities, the rumen, intestines, or a large blood vessel (jugular, carotid). All unclean objects, however, especially manure forks, unclean injection needles, old nails and harrow teeth, are liable to result in suppurative and septic infection (phlegmon, abscess, fistula formation, septicaemia, malignant edema, tetanus). Punctured wounds of the hoof (treading on nails, nailing) are frequently followed by tetanus. CoNTUSED Wounps.—Contused wounds are injuries caus- ed by blunt objects, treads on the coronet, kicks, falls, col- lisions, running into objects, being run over, falling into holes, remaining in a recumbent position for a long time. Con- tused wounds are usually irregular in outline, possess jagged, unclean margins, areswollen, often havea loss of substance, anddhe contused tissue has a tend- ency to become necrosed. Occasionally hemorrhage is slight or fails entirely even in large contused wounds. One can differentiate superficial (excoriations, abrasions of the skin) and deep contusions, with and without loss of substance. (See chapter on contusions. ) LACERATED Wounpbs.—Lacerated wounds have some of the characteristics of incised wounds, they are also similar to coutused wounds. ‘They are caused by catching on or getting against hooks and nails, by sharp calks, running into wagons, machinery, etc. In horses they are most often seen on the head (false nostril, eyelid), on the thorax, buttocks, and pos- terior limbs. Special lacerated wounds are observed on the cornea in dogs (scratches from cats). Lacerated wounds are frequently in the form of flap wounds with angular forma- tions, the margins of the wound may be regular or torn. BirEs.—Injuries caused by bites from dogs, horses and other animals present various characteristics; they may be punctured, contused or lacerated. They most frequently 8 POISONED AND GUN SHOT WOUNDS occur in dogs and horses, seldom in cattle or other animals. Dog bites frequently result in severe phlegmon and com~- plicated bone fractures; bites from horses in extensive necrosis of the skin on the sides and top of the neck (bites from animals standing in the same stall at night.) PoIsonED Wounps.—Under this term are included injuries, especially to animals at pasture and hunting dogs, due to snake bites, bee and wasp stings, as well as infected wounds (rabies, anthrax, glanders, tetanus, septicaemia). With reference to the specific diseases thus produced one must consult text books on toxicology and infection (see chapter on wound infection diseases). SHoTt Wounps.— These belong to a special type of con- tused wounds and may be termed contused-lacerated wounds. They are characterized by an external opening with smooth, contused, angular or lacerated margins, a tubular shot canal, and an exit opening. When the latter fails it is termed a blind shot canal. When the shot is fired near the seat of in- jury the wound edges are burned. Superficial, long, gutter- shaped injuries of the skin are observed in furrowed gun- shot wounds, contusions of the subcutaneous tissues without injury to the skin in gunshot contusions. Shots which per- forate only beneath the skin are termed seton shots. In the bones there exists either a shot hole, that is, a round, somewhat tube-shaped shot wound without splintering of the bones, or comminuted fractures, that is, comminuted bone frac- tures with splintering and crushing of the bones ; gun-shot con- tusions may be characterized by subcutaneous (simple) frac- tures. Unfortunately the literature of the German veterinary surgeries concerning gun shot wounds of horses in the earlier campaigns is worthless. According to the statistics of Jewse- jenko collected in the Russo-Turkish War, from a total of 211 horses shot, 41 involved injuries of the bone (equal to 20 per cent). Healing frequently follows encapsulation, especially small shot, the latter seldom change position (wandering). When other bodies, however, enter with the bullet; namely, dirt, hair, portions of the covering, of the tugs, etc., there develops a suppurative or ichoric inflammation in the vicinity GUN SHOT WOUNDS 9 of the shot canal. Shot woundsin horses are of importance in war ; otherwise they are seldom observed (hunting dogs, cats). GUNS AND PROJECTILES.—Shot injuries are produced, either by hand weapons (muskets, revolvers, pistols, small rifles), or cannon (shells, schrapnel, solid shot). Injuries caused by small shot are rela- tively slight, experience has demonstrated that in dogs they may heal without reaction. Injuries caused by musket balls are of more impor- tance. While these balls were formerly manufactured from lead, were round, and tolerably large in diameter, the bullets of modern weapons of war, especially the eight millimeter gun, have a very small diameter (eight millimeters), a cylindrical, long form, as well as a very hard steel jacket over a core of lead. On account of the steel jacket and small diameter these bullets retain their form, while the earlier bullets were flattened or shattered when they came in contact with a bone, causing severe injuries, especially to the soft tissues. Modern pro- jectiles exert, however, on hard bodies, especially bone, more active splintering force, and in addition to this an enormous penetration. According to Kocher (Zur Lehre von den Schusswunden durch Kleincalibergeschosse. 1895) the force of modern projectiles is a blow in the direction of their flight (penetrating influence)on the oneside, and an explosive effect (lateral impaction) onthe other. Asaresult of the penetrating as well as the explosive effect the tissues involved are either lacerated or contused (explosive effect), or torn away (pene- . trating force). The slower the speed of the bullet, the lighter the explosive effect; penetration and explosive effect stand, therefore, in an inverse ratio to each other. If the pro- jection force is less than the cohesion strength of the involved parts they become stretched and contused ; when both are equal there exists a wedge-shaped perforation ; if the force of the shot is greater than the cohesion of the parts the tissues are ruptured. In the first case the involved tissues are stretched; in the second they are pushed forward or to one side; in the third, lacerated. The degree of rupture depends on the diameter of the shot and the character of the tissues. An increase in the diameter of the missile is constantly occurring, this increases the surface of contact (oblique exit, change in the form of the shot). There exists a ‘‘reciprocal” influence between the target and the shot, in which the increased resist- ance of the target increases the explosive effect of the bullet, the explosive effect is also intensified by increasing the speed of the bullet. With increased resistance and explosive force there is a parallel diminution in the speed of the bullet (heating, deformation). A decrease in calibre and increase in the strength of the jacket results in decreased explosive force for elastic bodies, muscle and epiphyses of bone. Small calibre shots Io GUN SHOT WOUNDS from a short distance produce the following effect on cortical bone - laceration and contusion, splintering, and a bullet-shaped enlargement of the exit wound ; large calibers produce very severe lacerations with enlargement of the entrance wound; with an increased velocity small bullets may produce the same results. Through international agreement a calibre of not more than six millimeters has been adopted, the bullets to be covered with a hard jacket, so that they do not become deformed by spreading, lacerations are prevented as much as possible and the prognosis from shot injuries very much improved. The effect of the German eight millimeter gun on men and animals. has been demonstrated by experimental investigations (Preussisches Kriegsministerium, v. Bruns, Kocher, Koéhler and others). According to the investigations of Ellenberger and Baum (Berliner Archiv. 1893) on the horse it has a very variable action on different parts of the body at a distance of 250 to 600 meters. 1. The skin had, as a rule, a smooth-margined entrance wound which was usually smaller than the diameter of the bullet. The exit wound in the skin was always larger than the entrance wound. It was especially large when the shot had penetrated bones. and the wound was torn by bone splinters. 2. Injuriesto muscle vary according to their thickness. Insmooth, stretched muscle the wounds are in the form of a slit, have smooth edges. and are smaller than the diameter of the bullet; those in thick muscles are larger and more lacerated. The track of the bullet gradu- ally enlarges, thereby increasing the laceration so that the exit wound is about double the size of the entrance wound and severely lacerated. Spent bullets (rebounding shots), as well as bullets which have passed through bone, produce severe tearing of the muscles. It is remarkable that in such cases. vessels and nerves sometimes remain intact. Wounds in the fascia and connective tissue are in the form of aslit, frequently they are recognized. with difficulty. Tendons are split with a slight retraction of the edges. 3. The epiphyses of the long bones frequently pre- sent a shot hole, extensive laceration is constant; the epiphysis is less frequently disunited. Shots in the diaphyses, on the other hand, are usually characterized by complete fracture, or at least accompanied by pronounced splin- tering; even with grazing shots the bones, asa rule, are completely comminuted. Grazing shots on the epiphyses lead to splintering. Shots. in the center of short bones(carpus, tarsus, vertebrae) usually result in comminution. Flat bones usually present a shot hole with « round, small entrance wound, and a larger wound of exit which produces fissures and slightsplintering. When the ribs are hit in the middle there exists a shot hole the size of the bullet’s diameter, with longitudinal laceration and slight splintering at the GUN SHOT WOUNDS Ir somewhat enlarged wound of exit. Grazing shots in the longitudinal direction of the body fracture the ribs. Transverse shots through the thorax penetrate the entire horse. When the bullet comes in contact with a rib at the entrance wound, one is also fractured at the wound of exit, it isa complete break in the continuity. On the bones of the skull there is produced a shot hole with splintering and sometimes crushing of the bones. The base of the skull is shattered. Gun shot wounds of the cartilage, on the other hand, are relatively small, they are often in the form of a smooth split. 4. The lungs are severely lacerated, the shot track usually contains. splinters of bone, near the wound of exit the track increases in diameter. Also in the heart, one finds lacerated, flap, gaping wounds; seldom small round openings. In the small intestines there usually exists a small shot hole; in the large intestines, on the other hand,the wound is usually broad, flap-like and lacerated. The French Weapons, according to Gabeau (Recueil vét. 1895) in experiments on the cadaver of the horse, result in severe injuries which are always of a complicated nature. At a distance of 100 to 200 meters all bullets penetrated the body of the horse. In the skin the entrance wounds are circular, as though penetrated with a punch; the skin itself is not changed. In soft parts the exit wound is oval in form; skin overlying bones on the other hand, is lacerated and notched. In muscles the wound canal is much larger than the diameter of the bullet; it contains fleshy, bloody masses and dilates in the direction of the exit wound. The muscle fibers appear to be torn in the direction of the rotation of the bullet. The aponeuroses and flat ligaments present linear wounds; tendon wounds are twice the width of the bullet, their fibersappearto betornand lacerated. Long bones are broken or split and present oblique frac- tures with extensive splintering ; short bones are crushed into splinters ; the ribs present transverse fractures. The joints are commin- uted, their bones are crushed to pulp; sometimes fragments of the bone are torn away and thrown sev- eral meters. The ‘exit wound of joint shots is very large, the skin istorn in shreds. The lungs have cylindrical shot canals. In the liver the entrance wound is much larger than the bullet, the wound canal is very wide, the tissue of the liver is ground to pulp fora distance of three or four centimeters. In the stomach and intestines the entrance and exit wound are seemingly equal in size. In the hoof the entrance wound is hardly one mm. in diameter, almost invisible ; the penetration of the hoof is complete. The explosive effects of the so-called dum dum bullets is extremely active. ‘These are small caliber bullets from which the steel point has been removed (expansive bullets). According to Walker (The Veter- I2 ARREST OF HEMORRHAGE inarian. 1899) the entrance and exit wounds are small; the shot expands in the tissues and lacerates the bones and soft tissues. III. ARREST OF HEMORRHAGE. SPONTANEOUS ARREST OF HEMORRHAGE.—This is a cessation of hemorrhage of itself in contrast to artificial arrest by means of therapeutic agents. The so-called ‘‘stopping’”’ of hemorrhage occurs in capillary and parenchymatous hem- orrhage, as well as from that due to injuries to small arteries and veins. The causes of spontaneous arrest of hemorrhage are, first of all, the small amount of blood, in addition one finds a retraction of the vascular walls with a narrow- ing of the lumina of the vessels. Coagulation of the exposed blood results in the formation of a thrombus which closes the opening and lies partly within the lumen of the blood vessel, Because of slight blood pressure in the capillaries and veins thrombi form in them in a very short time, thus arresting hemorrhage. In large vessels, on the other hand, especially in arteries, thrombus formation fails to occur, or exists only after the loss of a large amount of blood with resulting heart weakness and decrease of blood pressure, so that the blood coagulum is no longer forced away by the blood stream. After the loss of large quantities of blood it is made more coagulable by the addition of white blood corpuscles, thus aid- ing in the arrest of hemorrhage. ‘This explains, for example, a fact which has been demonstrated by experiment, that stal- lions castrated without any precautions finally recover after severe hemorrhage. In general, as already remarked, the loss of blood must not exceed a third of the total amount, oth- erwise, there occurs a fatal paralysis of the heart and brain. Quantitative regeneration of the blood seems to take place rapidly through resorption of lymph from the tissues, as well as fluids from the stomach and intestines. The newly formed blood is, however, at first, very rich in water, the red blood corpuscles, on the other hand, are deficient, they are formed only after a long time. ARREST OF HEMORRHAGE 13 The exact phenomena of thrombus formation are not fully understood. The principal factor in arrest of hem- orrhage is the formation of a so-called white thrombus, which is composed of white blood corpuscles and the blood plates discovered by Bizzozero. This must be differentiated from the fibrinous coagulum which is the ordinary pro- duct of coagulation within the cadaver or outside the body. In contrast to the white thrombi, which to a certain extent are the result of physiological processes in normal living bodies, the so-called red thrombi are formed asa pathological pro- cess. The latter are made up of red blood corpuscles and fibrin and are formed during life in the vessels of animals suffering from septic affections, as well as from a general marasmus (marasmatic thrombi). These red thrombi are formed by a process of coagulation and death, similar to the formation of blood coagula in cadavers, they possess, therefore, an essen- tially different composition and importance. When both white and red thrombi exist at the same time they are termed a mixed thrombi. The course of white thrombi varies according to the presence or absence of infectious material. When the throm- bus remains free from infection, so-called organization occurs ; that is, it develops into indurated, vascular, connective tissue, whereby the injured vessel contains a solid and perma- nent cicatricial obstruction. If infectious material gains en- trance to the thrombus, however, there occurs a suppurative and ichoric softening of the thrombus with subsequent emboli. 1. The so-called organization of the thrombus con- sists in a replacement of the same by connective tissue. The cells of the thrombus itself do not undergo active division, the thrombus plays more of a passive role in that it is gradually pushed away by the newly formed tissue. The new con- nective tissue is produced by proliferation of the vascular epithelium. The endothelial cells of the intima of the vessels proliferate and are transformed into spindle-shaped and polymorphous formative cells, which advance towards the center of the thrombus, they penetrate and surround the same and are transformed later into fibrillar 14 ARREST OF HEMORRHAGE connective-tissue cells; so that the thrombus, under the influ- ence of the firm connective tissue, is finally pressed away and replaced. Vascularization of the thrombus oc- curs at the same time by means of a budding process from the vasa vasorum. In about four weeks the thrombus, when formed in small vessels, is made up of a cicatricial mass of connective tissue penetrated by capil- laries ; subsequently this becomes harder as a result of atrophy and retraction of the capillaries. Calcification or cretefaction of the thrombus is rare (so-called vein-stone or phlebolith). The re-establishment of the circulation, which was broken by the thrombus, is made possible by the formation of a collateral circulation, in which the central and per- ipheral branches of the artery given off at the thrombus, as well as the vasa vasorum, are dilated. Occasionally the blood stream afterwards passes through the center of the thrombus, which becomes pervious; or it may pass through dilated cicatricial vessels. 2. Softening of the thrombus is due to the entrance of bacteria, which produce a suppurative liquefaction and ichoric disintegration of the thrombic mass and thereby the danger of embolic processes and general infection of the body (compare with the chapter on pyaemia and phlebitis). DETERMINATION OF THE AGE OF A THROMBUS.—This is of impor- tance to the veterinarian from a forensic standpoint (thrombus of the arteries of the limbs and pelvis in the horse). Unfortunately, exact experimental investigations on the horse are wanting. In general thrombus formation is more rapid in small vessels than in large; pro- ceeds more rapidly in young animals than in old. Thrombus formation in chronic endarteritis in the horse seems to take place especially slow. In dogsit has been demonstrated experimentally that the thrombus is vascularized in from seven to fourteen days after injuries to small ves- sels, it is also composed of soft tissues; after three to five weeksa complete vascular cicatrix is present. Occasionally organization of the thrombus requires a much longer time. In old age calcified thrombi are observed. In general the age is determined by the consistence and color of the thrombus, which finally becomes hard and clear, as well as by the changes in the vascular walls. ARTIFICIAL CONTROL OF HEMORRHAGE.—This consists of closure of the bleeding vessel either by means of pressure or ARREST OF HEMORRHAGE 15 coagulation. The following are the most important methods : 1. Ligation of the bleeding vessel. The ligature is the surest means of controlling hemorrhage from large arteries and veins. The bleeding vessel is grasped with a good pin- cette aud then ligated with silk. When the isolation is not complete the surrounding tissue is also included (ligature en masse) after having passed around the parts with a needle. If none of these methods are applicable on account of the depth of the bleeding vessel the spurting artery must be ligated at a centripetal point (ligation in the continuity), for example, ae is ligated after an injury to the internal carotid. ‘ 2 Compression of vessels by knots and band- ages is indicated in capillary and parenchymatous hemor- rhage. Occasionally strong pressure may be brought to bear on the bleeding vessel by means of a tampon in the wound. Momentary and provisional relief from hemorrhage may be at- tained through pressure with the finger or hand (digital compression), the application of an elastic bandage (Es- march’s bandage), or a rubber bandage (Martin’s bandage); pressure should be applied between the wound and the heart. A special method employed by the veterina- rian for the control of hemorrhage consists in the application of clamps for the castration of stallions, The formerly em- ployed tourniquets (pad in the form of a girth) as well as the so-called acupressure are very seldom used at the present time. 3. Torsion of the bleeding vessels results in loosening and rolling up of the intima and media, as well as retraction of the adventia, thus closing the lumen of the injured vessel. Torsion is either applied to the bleeding vessel alone, when it is grasped with the pincette and twisted on its axis for a long | time, or the surrounding soft tissues may be included (torsion of the spermatic cord). From many castrations of horses I am convinced that regular torsion of the spermatic cord is a surer means for the prevention of hemorrhage than either clamps or the ligature ; from a standpoint of simplicity or asepsis torsion and clamps, especially the latter, are not preferable. I ppinrtine 16 ARREST OF HEMORRHAGE 4. Heat in the form of a red hot iron or cautery is efh- cient in many forms of parenchymatous hemorrhage. It forms an eschar over the ends of the bleeding vessels which performs the function of an aseptic bandage (searing the tail after amputation). The application of cold (ice-cold water, spray of ether) is less effective. Its action is due to the contraction and narrowing of small vessels). Hot water is employed at a temperature of 45-50 C. asa styptic for parenchymatous hemorrhage of the uterus. Even steam at a temperature of 100-120° has been employed recently in the human family for persistent cases of uterine hemorrhage (vaporization of the uterus, so-called atmocausis and zestocausis). 5. Thefollowing therapeutic agents exertastyp- tic influence, active only in capillary and parenchymatous hemorrage: liquor ferri chloridi, concentrated or com- bined with collodion, with surgeons cotton or in aqueous solution. This causes coagulation of the blood with simul- taneous constriction of the blood vessels. Other agents are alum, tannin,-creolin, sugar of lead, nitrate of silver, oil of turpentine, gelatine (subcutaneous), ergot or hydrastis is employed to control hemorrhage that cannot be treated surgically. HEMOPHILIA.—Hemophilia (blood disease) is a congenital tendency to hemorrhage (hemorrhagic diathesis) which presents the following characteristics in man: uncontrollable hemorrhage after very slight wounds, This disease also occurs in the horse (Kohne, Siedamgrotzky, Dreymann, Otto, Zschokke, and others). The following examples have been observed: after enlarging castration wounds, after the removal of setons, after splitting fistulous canals, after the extraction of teeth in dogs ; hemorrhage has continued for hours and days regard- less of all preventatives. Not all reported observations from veterinary sources are free from exception ; I have never seen a case of hemophilia in the dog or horse. The real cause is unknown (abnormal condition of the blood? failure to coagulate ? deranged nourishment of the vas- cular walls?). According to Schindelka many descendants of the thor- oughbred stallion ‘‘Gunnersbury”’ suffer from a hemorrhagic diatheses (epistaxis) (transmission as in man?). Ce S. bas tN i KINDS OF WOUND HEALING 17 IV. ANATOMICAL CHANGES IN WOUND HEALING. KInDs OF WounD HEaLinc.—The anatomical changes in the healing of wounds, which have been demonstrated by the exhaustive investigations of Thiersch, are extremely variable. They depend upon the following conditions : whether the wound is clean or infected, sutured or open, incised or contused, with or without loss of substance. The following forms of wound healing may be recognized : 1. Healing by firstintention. 2. Healing by second intention. 3. Healing by third intention. 4. Healing under scab. 5. Abnormal granulation and cicatrization HEALING BY PRIMARY INTENTION.—Healing by first intention consists of a direct union of the margins of the wound through immediate agglutina- tion without suppuration. Healing by primary . union depends on the following conditions : fresh, non-infected (aseptic) wounds, fresh incised wounds with even margins and, when possible, without loss of substance ; when infection has occurred careful disinfection must be employed (antiseptic treatment); the margins of the wound must be brought in close apposition by means of sutures ; all foreign bodies (hair, dirt, blood, etc.) must be removed ; application of an aseptic bandage. In the domestic animals these conditions are usually applicable only to operation wounds, and then only - when possible to afford protection by means of a bandage. Macroscopically healing by primary union first presents an agglutination of the edges of the wound with blood, afterwards a lymph-like plasmic fluid (so-called wound cement) exerts the same influence. The surface of the wound remains dry. About the second day the margins of the wound are slightly swollen, sensitive, andred. After about a week (four to eight days). definite union results with the formation of a small cicatrix. Microscopically one soon observes emi- gration of the white blood corpuscles from the neighboring blood vessels to the margins of the wound and to the wound 18 HEALING BY FIRST INTENTION cement. This cellular infiltration of the wound with wandering white blood corpus clesis considered a process of inflammation. Wandering of the white blood corpuscles is due to a traumatic irritant (traumatic, aseptic inflammation) and is to be consid- ered, therefore, as a reactive manifestation on the part of the injured tissue. According to recent investigations bacteria which gain entrance to a wound that heals by primary union are soon rendered harmless and partly resorbed ; this is prin- cipally due to the bactericidal properties of the blood serum (antitoxins, alexins) which is one of the constituents of wound secretions. The infiltration of the wandering cells (leuco- cytes) in the wound cement and margins of the wound reaches its height on the third day ; from that time they degenerate or return to the vessels. The wandering cells take no part in the formation of the ‘definitive cicatrix, a former erroneous supposition. The cicatricial tissue develops from the so-called fibroblasts; these are round cells which arise from the proliferation of the fixed (autoch- thonous) connective tissue cells and the endothelium of the vessels. The fibroblasts gradu- ally enlarge; large epithelioid, as well as long, spindle, and club-shaped cells are formed ; these are afterwards transformed into fibrillar, connective tissue cells when they form genuine cicatricial tissue. Simultaneously there occurs a budding process from the walls of the incised capillaries, new vessels are thus formed be- tween the margins of the wound. The fibroblasts in combination with the newly formed vessels form the so-called germinal tissue (granulation tissue); this is a cellular and vascular new formation. After the transformation of the fibroblasts into connective tissue cells the granulation tissue contracts so that the newly formed vessels atrophy again; thus the formation of the genuine cicatricial tissue is com- plete. Finally the cicatricial tissue is com- pletely covered by proliferations fromthe epidermal cells (rete Malpighi, epithelium HEALING BY SECOND INTENTION 19 of the dermal glands) at the margins of the wound. This completes the process of healing by primary union. HEALING BY SECOND INTENTION.—This mode of healing occurs with suppuration as a result of infection with ordinary pus cocci. It is characterized by the formation of an abun dance of granulationtissue. One finds this form of healing in old wounds, wounds that have become infected, those that have not received aseptic treatment, contused wounds, wounds with a loss of substance, or those which can- not be sutured. Macroscopically, within the first twenty- four hours the individual tissues and blood may be readily differentiated on the surface of the wound. A serous, lym- phatic, reddish-yellow secretion is formed after one or two days, giving the surface of the wound a gelatinous appear-. ance. From the second to the third day the sur- face of the wound presents a granular ap- pearance (granulations), pus begins to form. During the course of the suppuration the necrosed tissue is sloughed off, the wound is ‘‘self-cleansing.’’ Later, the gran- ulating wound surface is gradually covered with epidermis from the margins of the wound, the newly-formed epidermis surrounds the margins of the granulations in the form of a light colored fringe. The granulation tissue contracts and is completely covered, there finally remains a broad, firm, tendonous cicatrix. The microscopic changes are identical with those which occur during healing by first intention. The only points of dif- ference are that in healing by second intention infection takes place. The wound is irritated by bacteria and their products, which results in the forma- tion of large quantities of granulation tissue, this being the product of a suppurative inflammation it fur- nishes a purulent exudate. MHealing, therefore, re- quires a much longer time (two or more weeks). Cellular in- filtration of the edges, formation of the fibroblasts, budding of 20 HEALING BY THIRD INTENTION the capillaries, and transformation of the fibroblasts into con- nective tissue proceeds exactly as in healing by first intention. Further, suppuration does not form an abso- lutely necessary condition for healing by secondary union. The essential condition is the abund- ant formation of granulation tissue, which may occur without suppuration (aseptic granulations). - Granulation tissue formed during healing per secundam serves principally as a com- pensation for the loss of substance. In ad- dition it forms an important protection against the entrance of infectious irritants into the blood stream. The entrances to the lymph streams are mechanically closed by the granulation tissue, the pus also contains bactericidal properties (pus serum, like blood serum ; pus corpuscles, like white blood corpuscles). This. __explains the long known surgical fact, that with the formation of granulation tissue the danger from general infection is greatly diminished after the third day. Experimental inves- tigations upon sheep have also demonstrated that granulating wound surfaces are not permeable for anthrax bacilli or for the toxins of tetanus. The protective action of granulations is of great importance, therefore, in veterinary science, as healing by primary union is seldom attained. Above all, the granula- tions supply the loss of substance when healing by primary union is impossible. Many wounds cannot heal except through the formation of granulation tissue (wounds f the cartilage and cornea). HEALING BY THIRD INTENTION.—This consists in the artificial union of wound surfaces that are already granulating and suppurative. It sometimes follows careful disinfection and exact suturing of suppurative granulations. Healing by third intention should not be confused with scarification and suturing of granulating wounds (same as healing per prima). Healing by third in- tention is of considerable importance in veterinary surgery as certain forms of purulent lacerated wounds may be brought to rapid healing by this method. This is especially true of HEALING UNDER AN ESCHAR 21 those about the head (false nostril), permanent union result- ing in wounds a week or moreold. Healing by third inten- tion should always be given a trial, especially in the horse, when healing per prima cannot be expected from scarification of the wound surfaces. HEALING UNDER AN Escuar.—This is a form of pri- mary wound healing. The blood dries on the surface of the wound and leads to the formation of a protective coat. In small wounds cicatrization without suppuration takes place rapidly beneath the eschar, new epidermis is quickly replaced from the margins of the wound. In veterinary surgery this method of healing is of great importance as many wounds can be neither sutured nor bandaged, the dry scab taking the place of the latter. It may be applied artificially by means of a hot iron, production of a necrotic covering (wounds of the ear, tail, joints, extirpation of small tumors from the backs of dogs), or by the application of tannin, tanno- form, glutol, amyloform, argentum nitricum or other disinfecting agents that produce an eschar. ABNORMAL GRANULATION AND CICATRIZATION.— While the various forms of normal wound healing by the processes of granulation formation and cicatrization lead, asa rule, after more or less time, to the formation of a typical cicatrix, many wounds form an exception tothisrule. The granulation and cicatricial process appears abnormal. This is true when foreign_bodies or necrosed pieces of tissue remain in the wound, when there is great loss of substance, when continued infection or irritation occurs in fresh or healing wounds, when the injured animal is suffering from certain infectious dis- eases (see below). 1. Granulations are especially abnormal when the granulation tissue forms too rapidly and in large quantities ; exuberant proliferations, fungus-like granulations (granuloma, caro luxurians, proud flesh). Excessive granu- lations are observed in treads on the coronet ; fistulous withers or saddle galls when necrosed pieces of tissue are re- tained and act as a constant irritant to the part; in skin wounds on the flexor surfaces of the joints (carpus, tarsus) J 22 ABNORMAL WOUND HEALING when continually irritated by flexion and extension move- ments of the limbs; in muscle prolapse as a result of con- striction and continued irritation of the exposed part after injury to the fascia of the limbs, in intensive suppurative infec- tion. Other diseased forms are: erethistic granulations, that is, sensitive, dark-red, easily hemorrhagic, and very pain- ful granulation tissue; atonic (torpid, asthenic) weak or deficient, as wellas unequal granulation, and gangren- ous d eg eneration of the granulation tissue (diphtheria of the granulations). 2. Cicatrization may become abnormal in various. ways. Great loss of substance results in an incomplete cicatrix ; suppurative decomposition in the formation of an ulcerorfistula. In horses there is frequently observed on the cicatrix an abundant accumulation of horny epidermal cells (horny cicatrix). Occasionally one observes a tumor- like proliferation of the cicatricial tissue (cicatricial keloid, cicatricial hypertrophy). This is seen in horses in the flexor ~~. regions of the fetlock and coronet (compare with chapter on keloids, under tumors). So-called painful or sensitive cicatrices (neurectomy, throat, shoulder) are rare in the horse. A cicatricial contracture occasionally results from extensive destruction of the skin, that is, cicatricial con- traction of the neighboring skin leads to change in position of parts of the body (caput obstipum from contraction of the tissues of the neck ; stilt-foot in necrosis of the skin on the posterior surface of the carpus and metacarpus; ectropium from extensive wounds of the eyelids). The causes of atypical wound healing are both local and general. Under local causesare mechanical lesions of the tissues (contusions, constant irritation from foreign bodies, licking, rubbing, and movements); irritation of the wound through chemical irritants (antiseptics, decomposing secretions, necrosed particles of tissue); infec- tion of the wound through specific inflammatory irritants. (botryomyces fungi, glanders, necrosis bacillus), or by means of various other especially virulent, pus forming bacteria ; deranged circulation (anaemia, hyperaemia, throm- bosis). Neurectomy, asa local cause of deranged circula- WOUND HEALING IN DIFFERENT TISSUES 23 tion and nourishment, may influence normal wound healing (injuries to the hoof). General causes of disturbed wound healing are: febrile general diseases; chloroform (reduced activity of the white blood corpus- cles; weakening of the activity of the heart); old age; general weakness and conditions of exhaustion; weak constitution; faulty breed- ing, care and food; diseases of the kidneys; hydraemia; cancerous cachexia; diabetis. Also the race and species, as well as the condition of the stable, temperature, season, climate, etc., all have an influence on the healing of wounds. Finally, many animals have _ idiosyncrasies which interfere with normal wound healing and favour the entrance and multiplication of infectious ma- terial. On the other hand, many animals appear to have congenital immunity against wound infection diseases; wounds on native born Algerian horses, for example, heal without suppuration and without treatment. WouND HEALING AND REGENERATIVE ABILITY OF DIFFERENT TIssuEs.—1. Wound healinginthe skin, pododerm and mucous membrane takes place according to the previously described methods.| Regreneration is most rapid in the following tissues: epidermis, skin and pododerm (formation of horn), the epithelium of the mucous membranes, as well as the connective tissues.- / 2. Muscle wounds do not heal by regeneration of muscle fibers, \ but-by means of a fibrillar, connective-tissue cicatrix. The regen- | erative ability of muscle is very slight. Proliferation and i enlargement of the muscle cells occurs only in the vicinity of con- nective tissue cicatrices, as well as in small, superficial injuries to the muscle, even here the formation of new muscle fibers is limited. 3. Tendon wounds heal principally through proliferation of the cells of the tendon sheath, of the paratendineum, and the interfascicular connective tissue, the genuine tendon cells of the tendon stump also take part. The granulation tissue that results from this proliferation unites both ends of the tendon and gradually changes into genuine tendon tissue (compare with the chapter on rupture of tendons). 4. Wounds of the bone heal in the same manner as fractures, through ossification of the granulation tissue (callus); this is formed from the periosteum and bone marrow, as well as the bone itself (periostitis, osteomyelitis, and ostitis ossificans) (compare with chapter on healing of bone fractures). fu 24 WOUND HEALING IN DIFFERENT TISSUES 5. Cartilage wounds that are covered with perichondrium (lateral cartilage, trachea, muscles of the ear) heal, similar to bone wounds, through proliferation of the perichondrium with the * formation of a callus that is at first fibrous and afterwards ossified. The cartilage cells that fall directly into the cartilage wound undergo fatty degeneration. Synchronous with the prolifera- tion of the perichondrium there occurs a multiplication of the neigh- boring cartilage cells with a new formation of cartilage tissue. In non-vascular articular cartilage, however, the relation is very different. Aseptic, clean, cartilage wounds in the joint never heal, they remain as a permanent defect. Infected, articular- cartilage wounds, on the other hand, heal completely. Severe irritation of the non-vascular tissue of the wound leads to the formation of granulations and a connective-tissue cicatrix. Afterwards the connective-' tissue cicatrix may be even partly transformed to hyaline tissue. 6. The peripheral nerves, when injured, possess an ex- tremely active regenerative ability. Whenanerve suture is applied replacement takes place through new formation of nerve fibers from the old nerve fibers of the central stump; these new fibers grow into those of the per- ipheral stump. When the ends of the nerves, however, remain at least one centimeter apart (neurectomy) the peripheral portion of the incised nerve degenerates, while the central nerve stump anastomoses with neighboring nerves, in this manner the conductivity is again established. At the same time new nerve fibers sprout from the central stump, which fill in the defect between the ends, and extend along the course of the peripheral portion. In this manner the nerve is replaced, when degeneration was complete, or fusion may occur when the fibers are still intact (chemotatic influence of the products of degeneration of the old nerve fibers on the growing central nerve cylinder). Asa result of constant irritation (neuritis) the central nerve end undergoes a new formation of nerve fibers and con- nective tissue, this results in a club-shaped swelling (neuroma). 7. Inthe brain and spinal-marro w—in contrast to the per- ipheral nerves—regeneration of nerve substance does not occur; there is a formation of connective-tissue cicatrix similar to that which occurs in regeneration of muscle. 8. In the non-vascular cornea healing of wounds is similar to that in vascular tissues. One first finds migration of white blood cor- puscles from the neighboring conjunctiva and schlera, as well as a sub- sequent autochthonous cellular proliferation with the formation of fibroblasts and the successive transformation of these into fibrillar con- nective-tissue. The formation of new vessels in the cornea, however, does not take place in the corneal tissue, but proceeds from the margin of the sclera. WOUND INFECTION DISEASES 25 V. WOUND INFECTION DISEASES. DEFINITION.—The term wound infection dis- eases or accidental wound diseases embraces the general surgery of a long list of affections due to wounds which depend on the entrance of microorganisms or their products (toxins). The bacteria gain entrance to the wounds by contact or through the air. They maintain local disease processes in the wound or some form of general derangement. In a narrow sense the most important wound infection diseases are: 1. Suppuration, 2. Phlegmon, 3. Ab- scess, 4. Wound Fever, 5. Septicaemia, 6. Pyaemia. The following diseases may also result from the wound: inflam- mation of the lymph vessels (lymphangitis), inflammation of the veins (phlebitis), as well as erysipelas. In a broader sense wound infection includes tetanus, glanders, tabies, botryomycosis, actinomycosis, tuber- culosis, malignant edema, strangles, anthrax, black leg, and Wildseuche. The following in- cludes a description of the wound diseases in the narrow sense. 1. SUPPURATION OF WOUNDS. CausEs.—Suppuration which accompanies healing by second intention is a product of inflammation caused by infec- tion of the wound with pus cocci. The following have been found most often on bacteriological examination : staphylococcus and streptococcus (staphylomycosis, strepto- mycosis). The following are the most important pus forming bacteria : -a) Staphylococcus pyogenes aureus is the most frequent pus coccus in animals, especially the horse. They are in the form of small, round, non-motile cocci; ar- ranged as lobules, clusters, or as diplococci; on potatoes, agar, and gelatine they form orange-yellow cultures. Experi- ments have demonstrated the fact that their action is due to the production of toxins which act as an irritant and produce inflammation. Subcutaneous injection of a pure culture usually results in the formation of an abscess; intra-abdominal 26 PUS-FORMING BACTERIA injection in fatal suppuration ; injection into the blood, py ae- mia as well as ulcerative endocarditis. Repeated injections have resulted in the seemingly rapid formation of amyloid degenerations (liver, kidneys). Staphylococcus pyogenes aureus is especially common in circumscribed, localized suppuration, in pyaemia, and in the pyaemic form of foal lameness. b) Staphylococcus pyogenes albus is less common. It is distinguished from the preceding form by its less virulent pathogenic action, and white, varnish-like cul- tures. According to some, it is the cause of moon blind- ness (?). c) Staphylococcus pyogenes citreus is rare. It is characterized by the citron-yellow color of its cultures, otherwise it is identical with the preceding. d) Streptococcus pyogenes is next in importance to staphylococcus pyogenes aureus. It forms cocci arranged inthe form of a chain; it does not grow on potatoes, on gelatine it forms very small white colonies. Streptococcus pyogenes is a special cause of progressive phlegmon- ous suppuration with subsequent septicaemia. It is found, therefore, in the septic form of foal lameness. It also appears to be identical with the streptococcus of erysip- elas, strangles, contagious pleuro pneumonia, acute articular rheumatism, and petechial fever (?). e) Bacillus pyogenes appears to be the most im- portant cause of pus formation in cattle and swine; see page 36. f) Bacillus pyocyaneus—the bacillus of blue and green pus—forms small, slim, very motile bacilli. They frequently possess four to six flagella. Through the decom- position of albumen they produce a blue and yellowish-green coloring material (pyocyanin, pyoxanthin) similar to the bacilli of blue milk. Chemically this is closely related to anthracine, it also belongs to the benzol group, and colors the pus and bandage blue or greenish-yellow. While the coloring material is harmless, the bacilli and their toxins have a patho- genic action towards experimental animals, producing an PROPERTIES OF PUS 27 edematous and suppurative inflammation at the point of in- jection. Bacilli with red coloring material are also found in pus. Coton BaciiLus.—The colon bacillus (Bacillus coli communis, Bacterium coli commune) is found in various varieties in the normal intestinal canal. It is present in many species and races, and is usually a harmless organism because its very poisonous toxins are neutralized in healthy animals by the action of the gall. Under certain unknown con- ditions the colon bacillus in the intestinal canal becomes highly viru- lent (calf diarrhoea, calf septicaemia, enteritis, peritonitis, cystitis, pyelonephritis, hepatic abscesses, endometritis, septicaemia puerperalis, polyarthritis and omphalo-phlebitis in the calf, malignant head catarrh in ' cattle, croupous enteritis in cats, as well as various other ‘‘colon bacilli” infections). Inthe subcutaneous connective-tissue it causes suppura- tion with more or less serious phlegmons (septic and gas phlegmon). It is alleged to be identical with Bacterium phlegmasiae uberis, bacillus foetidus, neapolitanus and lactus aerogenes. The following microorganisms may also cause suppuration under certain conditions: actinomyces and botryomyces fungi; the bacillus of glanders ; the streptococcus of strangles; the cocci of contagious pleuro pneumonia; the micrococcus pyogenes tenuis and tetragenes ; the capsule coccus (diplococcus); the bacillus pyogenes foetidus; the staphylococcus cereus, albus, flavus; proteus vulgaris, and others. Finally, the courses of many infectious diseases; namely, suppurations of tuberculosis and actinomycosis are, frequently accompanied by mixed infections of ordinary pus bacteria. For further informa- tion on suppuration, in regard to pus bacteria found in individual do- mestic animals, as well as on the development of so-called aseptic inflammation (injections of oil of turpentine, sublimate, nitrate of silver) compare with the chapter on inflammation. PROPERTIES OF Pus.—Under ordinary conditions pus forms a thick, creamy, yellowish or greenish, non-odorous, non-coagulable fluid (pus bonum et laudible). Asa result of infection with bacteria which produce a colored secretion the pus may be green or blue, seldom yellow. Thin, mucous-like, frothy, odorous pus indicates the presence of decomposition as a result of colonization of septic bacteria in the wound. The condition and quantity of the pus varies with the size and age of the wound, the blood supply and consistence.of the wound, the species, quantity and virulence of the bacteria, tempera- ture and season, climate, breed, etc. Pus from the horse is usually yellowish and cream-like ; that of cattle and birds is often caseous ; that of swine tenacious and green. 28 PHLEGMON When pus remains for a long time in a vessel one observes two layers. The upper isa thin, apparently clear, and yel- lowish fluid ; it forms the so-called pus-serum. Theunder layer is thick and straw-yellow ; it contains the pus-corpus- cles. The pus-corpuscles are formed princi- pally from the white blood-corpuscles that migrate from the blood vessels (Cohnheim). Part of them, however, are descendants of the fixed connec- tive-tissue cells, as well as the degenerated connective-tissue substance of the tissue. Upon microscopic examination one finds, in addition to the pus corpuscles, various forms of pus cocci which are occasionally enclosed within the pus corpus- cles. There are also observed various other bacteria, red blood-corpuscles, tissue cells, drops of fat, crystals of fatty acids and cholesterin. The recognition of cartilage cells and giant cells in the pus are of special importance in the diagnosis of cartilage and bone fistulae. The peptone contents of the pus is due to the transformation of the fibrinogen through the activity of the pus forming microorganisms ; absence of fibri- nogen in the pus accounts for its non-coagulability. When the suppuration does not remain confined to the wound, but involves the neighboring tissues in a suppurative inflammation, it leads to the development of a diffuse suppu- rative inflammation of the subcutaneous and submucous cellu- lar tissue (suppurative phlegmon), a circumscribed accumulation of pus (abscess), a suppurative inflammation of the lymph vessels (lymphangitis), lymph glands (lymphadenitis), and veins (phlebitis), as well asthe entrance of pus cocci andtheir toxins into the blood (wound fever, septicaemia, pyaemia). Compare with the subsequent chapter. 2. THE PHLEGMONS. DEFINITION.—Phlegmon, phlegmonous inflam- mation, or inflammation of connective tissue are terms used to indicate an infectious, serous, or suppurative inflammation of the connective tissue and all its parts; namely, the subcutaneous, submucous, subfascial, intermuscular, peri- PHLEGMON 29 osteal, perichondral, tendo-vaginal, and interglandular connec- tive-tissue. One speaks, then, of a subfascial or intermuscu- lar phlegmon, of a phlegmon of the subcutis, the perichon- drium, the tendon-sheaths, the udder, etc. CAUSES AND Forms.—Phlegmonous inflammation is due to the same bacteria that are found in suppuration. The streptococcus pyogenes and staphylococcus pyogenes aureus are the most frequent causes of phleg- mons (phlegmone streptococcia or streptomycosis ; phlegmone staphylococcia or staphylomycosis). The pus cocci usually gain entrance to the connective tissue through wounds; punc- tured, contused, and lacerated wounds form the ordinary sources of phlegmons. Very often the previous wounds are very small or entirely healed so that they can no longer serve as a source of entrance to pus forming bacteria. Formerly, the erroneous term of so-called spontaneous phlegmon was given to this condition. Phlegmon may occur ata point more or less removed from the point where the pus cocci gain entrance ; they being carried to this point through the lymphatic circu- lation. It may also occur that the infection of the connective tissue proceeds, not from without, but from the blood stream (metastatic or symptomatic phlegmon of pyaemia, strangles, contagious pleuro pneumonia, glanders). Hemor- rhage and lacerations of connective tissue asa result of con- tusions predispose to phlegmons. Surgically there are various forms of phlegmon. Classified from an anatomical standpoint we have—subcu- taneous, submucous, subfascial, intermuscu- lar. Itisalso spoken of as superficial and deep(e.g. subfascial), or circumscribed anddiffuse phlegmon. The circumscribed form confines itself to a phlegmonous swel- ling in the vicinity of the wound and frequently leads to the formation of an abscess (phlegmonous abscess). Diffuse phlegmon consists of an inflammatory infiltration of large areas of connective tissue and frequently results in necrosis of the skin, subcutem, fascia, tendons, tendon sheaths (gangrenous phlegmons), whereby other bacteria may also play a part (necrosis bacillus). 30 PHLEGMON Septic phlegmon, in contrast to the ordinary form, is especially virulent. Itis also termed progressive phleg- mon, progressive inflammation of the cellular tissue, or gan- grenouserysipelas. It is due toa mixed infection of pus cocci and specific septic bacteria (streptococcus septicus, micrococ- cus tetragenes, colon bacillus, and others). It is character- ized by a rapid, extensive, ichoric suppuration of the cellular. tissue, with a severe, often fatal general infection. The so- called gas phlegmon is a mixed infection composed of gas- forming bacteria (bacillus phlegmonz emphysematose, colon bacillus). The ordinary suppurative phlegmon is termed simple incontrasttothe specific phlegmons. The latter are not due to pus cocci, but to certain other bacteria, espec- ially the’bacilli which cause malignant edema and ery- sipelas (compare with the chapter on these subjects). -- GENERAL SYMPTOMS OF PHLEGMON.-Circumscribed phlegmon is characterized by swelling, high temperature, and pain over a small area of the skin. At first the swelling has a well defined boundary ; on palpation it may be hard and firm, or soft and fluctuating. Asa result of the swelling and tension the skin cannot be raised. Circumscribed phlegmon- ous swellings frequently result in the formation of an abscess ; it is characterized by fluctuation, a reddish-blue or dark grey color of the skin, and fever. Spontaneous evacuation may occur after necrosis of a small portion of the overlying skin. Healing follows by the formation of granulation tissue, when not evacuated artificially it may result in burrowing of pus as well as in progressive phlegmon. Suppurative lym- phangitis, lymphadenitis, phlebitis, as well as pyaemia and septicaemia may also occur. Diffuse phlegmon is characterized by extensive swelling of the skin—especially on the limbs—fever, and pain (lameness). Subfascial phlegmon is accompanied by especially high fever and severe pain, when the deeper layers are affected the skin may remain unchanged, or presents a slight, edematous, doughy swelling. Intermuscular phlegmon issimilar in appearance. All diffuse phlegmons frequently lead to extensive necrosis of the skin, subcutem, PHLEGMON 31 fascia, muscle, etc. They often result in fatal septicaemia or pyaemia. Septic phlegmon is very acute, spreads rapidly, and usually terminates in death. It is characterized by a high septic fever, extensive gangrenous destruction of the subcutem and neighboring soft parts, namely, the muscles, which are transformed into a discolored, odorous, punk-like, fatty mass, or a thin, ichoric discharge. ‘The diseased parts may crepitate as a result of the formation of foul gases (gas phlegmon, septic emphysema). TERMINATION.—The course of phlegmons varies ac- cording to their character and extent, as well as with the genus of the animal. 1. Circumscribed and diffuse phlegmons are followed by healing through resorption. The latter, especially, frequently heal without necrosis or abscess formation. 2. Abscess formation may result from any kind of phlegmon. The prognosis is more favourable when the phleg- monous inflammation is situated near the surface. Subfascial and intermuscular abscesses are a source of danger, they may be in the form of numerous, small pus foci, or converge to form a large abscess, general infection is liable to occur. Occasionally subfascial abscesses rupture spontaneously on the surface. 3. Necrosis may result from any form of phlegmon. It most often results from septic, subfascial, intermuscular, peri- osteal, and perichondral phlegmons, especially when there occurs a simultaneous influence of the necrosis bacillus (fistu- lous withers, poll evil, quittor, phlegmon of the planter cushion). Necrosis often forms the source of septicaemia and pyaemia. 4. Encapsulation of abscesses is most often ob- served in intermuscular phlegmon (shoulder abscess). In dif- fuse, subcutaneous phlegmons on the posterior limbs of the horse the phlegmonous process is occasionally suspended for a long time, healing is only apparent ; sooner or later the phleg- mon returns. Possibly this recurrence explains a previous encapsulation-isolation of individual disease foci, with a sub- 32 PHLEGMON sequent spreading of the inflammatory process as a result of rupture, laceration, or liquefaction of the capsule. 5. Chronic induration or schlerosis oc- curs when a diffuse, suppurative phlegmon terminates in a chronic connective-tissue proliferation of subcutaneous, inter- muscular, subfascial, and perichondral tissue. Schlerosis oc- curs on the posterior limbs after phlegmons (elephant leg), grease, or on the head (glanders), and leads to pronounced thickening of the skin; it is termed elephantiasis, pachyderma, or schleroderma. Compare with the chapter on elephantiasis. ‘TREATMENT.— When there is no evidence of abscess for- mation and resorption is possible, treatment consists in the application of moist, hot fomentations (Prieznitz), or disinfecting bandages (spirits of camphor bandage); antiseptic lotions, warm baths or cataplasms; ointments of camphor, iodoform, tar, carbolic acid, creolin, grey mercury; as well as subcutaneous injections of disinfec- tants. In subacute, and in chronic phlegmons especially, resolution or accumulation of the pus in a circumscribed cavity may be attained by the application of a severe counter- irritant in the form of tincture of iodine or un- guentum hydrargyri cinereum. Arecolin is a very good internal resorbent. All abscesses, on the other hand, should be treated early by meansofa free incision. Experimental investigations as well as practical experience have demonstrated that early evacuation of the pus by means of open inci- sions is the most satisfactory treatment (disinfectant activity of the oxygen of the air). One may also irrigate the abscess. cavity with antiseptic fluids and provide drainage. All necrotic tissue must be removed (amputation of the tail and claws ; resection of the lateral cartilage and the flexor tendon at its point of attachment to the os pedis). The application of massage is contra-indicated, especially for acute phlegmons. OCCURRENCE. — Most phlegmons are _ subcutaneous. PHLEGMON 33 Phlegmonous inflammations of the subfascial, intermuscular, and perichondral connective tissues, as well as the tendon sheaths are common, especially in the horse. Septic phleg- mons are very common in horses and dogs. The following phlegmons are of special practical’ importance : ‘ 1, Subcutaneous phlegmon of the soft parts of the head (lips, eyelids, zygomatic region, pharynx); throat, and shoulder (subcutaneous injections); 2. Submucous phlegmon of the mucous membranes of the mouth and throat (stomatitis, glossitis, pharyngitis) ; 3. Subfascial phlegmon of the fasciae of the throat, shoulder, and back (poll-evil, fistulous withers); 4. Phlegmon of the muscles of the throat shoul- der, elbows, gluteal region, and abdomen in the horse (deep wounds); 5. Subcutaneous phlegmons of the posterior limbs of the horse in both forms: the ordinary simple and the rare, characterized by abscess formation; 6. Subcoronary and perichondral phlegmons at the coronet (treads on the coronet), and the lateral carti- lages (fistulae of the lateral cartilages), as well as phlegmon of the planter cushion in the horse (nail punctures) ; 7. So-called panaritium of the claws of cattle and dogs, corresponding to the subcoronary phlegmon of horses (see below); 7 8. Subfascial phlegmon of the fascia lata and the tibial fascia inthe horse (punctured injuries, wounds. from blows); g. Phlegmon of the tendon-sheaths of the flexor tendons in the horse (traumatic, suppurative, and metastatic); 10. Subcutaneous and intermuscular phlegmon of the tail in cattle (lung plague injections, so-called tail worm), dogs (contusion), and horses (amputation ); 11. Phlegmon of the sheath and scrotum.in the horse (wounds, castration, glanders) ; 12. Phlegmon of the udder in cattle (small wounds, erysipelas, and furunculosis); 34 PANARITIUM 13. Puerpural phlegmon in cattle (septic gas-phleg- mon, so-called puerpural blackleg) from small contused wounds of the vulva and vagina at birth. PANARITIUM.—This name (derived from paronchium—inflammation of the bed of the nail—matrix unguis—) indicates a circumscribed phlegmon of the phalanges. In man, it applies to a special circumscribed, suppurative inflammation of the subcutaneous connec- tive tissue on tue volar surface of the finger. The word is derived from human medicine, and in veterinary science the application is somewhat false. Inman the anatomical structure of the subcutis predisposes to the existence of panaritium. The subcutaneous tissue on the volar surface of the finger is very thick, and its connective-tissue fibers are not parallel with the finger, but run perpendicular to it. Upon the entrance of pus cocci there first occurs a circumscribed inflammatory focus surrounded by fixed connective-tissue fibers (panaritium). The phlegmonous process extends from here to the tendon-sheaths, the periosteum, the joint, and the bone, there exists a progressive phleg- mon (panaritium tendonosum, periostale, articulare, osseum) which may lead to necrosis of the bones, suppurative inflammation of the joints and ttendon-sheaths, to necrosis of the tendons, and death of the entire phalanges, even to fatal septicemia and pyemia. Very similar pro- -cesses occur on the hoof of the horse, the claws of cattle, sheep, and dogs. Allthe above forms of panaritium can be observed in the -sheep and dog especially. In cattle one can distinguish panaritium of the toes, panaritium between the claws and between the balls. The term phlegmon is more often employed. Subcoronary phlegmon of ‘the horse is analagous to panaritium when it is complicated with phlegmon of the planter cushion, of the perichondrium, of the bursa of the navicular bone, as well as with necrosis of the flexor perforans, with fistula of the cartilage of the hoof, and suppurative inflammation of the pedal joint. 3. ABSCESS. DEFINITION AND CaAusEs.—Abscess (abscessus, apos- JAtema) isan accumulation of pus which is usually the product of a suppurative inflammation; it may de- velop from suppurative phlegmons, suppurative wounds, puru- lent hematomata, or metastatically through the blood. Pus bacteria, are the most frequent causes of abscess formation “(staphylococcus and streptococcus pyogenes). Abscesses in horses are very often due tothe streptococcus of stran- gles and the botryomyces fungus. In other cases the abscesses contain diverse bacteria; occasionally the mi- ABSCESS 35 crococcus tenius, the bacillus pyogenes fetidis, the colon bacillus, and other bacteria are the causes of abscesses. Oc- casionally abscess formation is due toa mixed infection with various microorganisms (tubercular and actinomycotic abscesses). In addition to pyogenic bacteria gas-forming or- ganisms may gain entrance, for example, bacillus phlegmonae emphysematosae, thus the so-called gas abscesses exist. Pus BACTERIA IN DIFFERENT DomMESTIC ANIMALS.—In HorRsEs ‘staphylococci and streptococci, as wellas botryomyces, are the most fre- quent causes of suppuration. According to Hell there are no positive differential characteristics between the coccus of contagious pleuro- pneumonia and pus cocci; the former may result in pus formation. Foth found streptococci of strangles and staphylococcus aureus in a strangles-abscess in the horse ; he is of the opinion, that under certain conditions, suppuration occurs in horses not affected with strangles, asa result of the activity of a streptococcus that cannot be differentiated from that of strangles by means of our present bacteriological methods. Schuemacher and Willach found a diplococcus in pus taken from a wound on a horse ; they were unable to discover any differential char- acteristics between this and the cause of contagious pleuro pneumonia. They thought that many suppurative processes were related, therefore, to contagious pleuro pneumonia. For shoulder abscess in the horse Bossi named a special pus-organism (micrococcus myositidis equi aureus and albus). According to Baldoni the cocci of shoulder abscess in the horse are identical with the pus cocci of man, except that they are more virulent.’ According to Jensen botryomyces fungi are the principal organisms in shoulder abscess. Schmidt found strangles cocci in a shoulder abscess. I, myself, found botryonryces fungi in 25-50% of shoulder abscesses ; ordinary pus cocci in 50-75%; occasionally strep- tococci of strangles were found. Lucet and Nocard maintain that abscesses in CATTLE are caused by special pus-organisms that have not yet been described, that they have demonstrated them bacterio- logically and given them special names as follows: streptococcus, ‘staphylococcus, and bacillus pyogenes bovis ; bacillus liquefaciens pyo- genes bovis, and bacillus crasus pyogenes bovis. The bacillus pyogenes bovis is identical with bacillus pyelonephritidis. In Swinz, ac- cording to Grips, the bacillus pyogenes suis is a specific pus-forming bacterium that can be demonstrated in nearly all abscesses. Kunneman found a special bacillus in 90% of all processes in cattle, which he named bacillus pyogenes bovis; this is not identical with Lucet’s bacillus. Pure cultures of this organism produce subcutaneous abscesses in cattle, in the vagina they cause 4 suppurative vaginitis. According to Glage the bacillus pyogenes suis and bovis are identical; it forms the most frequent pus-organism in swine and cattle, and is apparently transmitted 36 ABSCESS to swine through the milk of cattle suffering from disease of the udder. Jensen found the colon bacillus in prostatic abscesses in the Doc, he also found the same organism in suppurative peritonitis, cystitis, and pyelo- nephritis in the same animal. Forms oF Apscxess.—The following forms of abscesses are recognized; hot or cold (caused by acute or chronic suppurative inflammation). Cold abscesses are usually of tubercular, actinomycotic, and botryomycotic origin. Other classifications are: superficial and deep, primary and secondary, symptomatic or metastatic (strangles, pyaemia, tuberculosis, glanders), simple and multiple, congestive or wandering (wandering abscesses either pass downward from their own weight, or upward in the hoof, passing in the direction of least resist- ance), subcutaneous, subfascial, intermuscu- lar, strangles, bone, or hoof abscess. One also speaks of a fecal or urinous abscess. OccURRENCE.— Abscesses occur in all domestic animals, especially in horses, dogs, and cattle. Avian abscesses have a peculiar, dry, caseous appearance. Abscesses are usually found in the subcutis, lymph glands, beneath fascia, in muscles, and in the mammae; bone-abscesses are rare. In the horse they are most often found in the following parts : pharynx (abscess of the lymph glands), at the coronet (coro- nary abscess), throat (subcutaneous injection), shoulder (shoulder abscess), saddle positions, gluteal region, the leg, the anterior surface of the carpus, and the inner surface of the metacarpus. In the dog their favorite seat is on the head and throat (bites). Abscesses in old cattle usually develop slowly (cold abscesses). Symptoms.—A subacute abscess has the appearance of a circumscribed, hot, painful swelling. It is fluctuating at the center and firm at the periphery. The skin is adherent over its surface. Inthe absence of pigment one observes a reddish-blue or grayish discoloration of the skin, it also has a glistening appearance. * Fever often exists at the same time. Deep, or subfascial abscesses are characterized by a diffuse swelling without fluctuation. WOUND FEVER 37 In differential diagnosis one must distinguish between hematomata, phlegmons, galls, and new formations. An abscess is diagnosed as follows: it develops gradu ally under inflammatory conditions, it fluctuates, the skin is moveable onthe surface, discoloration in white-skinned horses. Fever may also exist. To diagnose a deep or subfascial abscess it may be necessary to use an exploring needle. Sometimes deep abscesses are char- acterized by a high, septic, continuous fever, and by an intense, diffuse, very painful swelling. TREATMENT.—The treatment of abscesses is purely surgical. It consists in early and complete in- cision with subsequent antiseptic irrigation. The formerly used ‘‘expective’’ treatment—-waiting for spon- taneous discharge of pus—is no longer considered good surg- ery. The skin becomes necrotic, the process is prolonged, suppuration is more extensive, especially in subfascial abscesses, when the life of the patient is in danger. Very large abscesses, especially subfascial, should be drained. Caution is required when opening deep abscesses in the vicinity of the larynx; only the skin should be incised with a knife, then bore with the fingers or some blunt instrument (sound, blunt pointed scissors) to the depth of the abscess. The opened abscess should not be tamponed, but treated as an open wound and drained. Cold abscesses may be treated with extirpation of their capsule (shoulder abscess), sutured, and then drained. Subfascial abscesses with pronounced extention, and necrosis of the neighboring fascia and muscle (fascia of the withers in the horse asa result of fistulous withers) are occasionally incurable (septicaemia). 4. WounpD FEVER. NATURE AND CaAusES.—The term fever indicates a role of symptoms that are complex in character ; they are the re- sult of various derangements of the general system. The most important are: elevation of temperature, increased frequency of the pulse, derangement of the distribution of the 38 WOUND FEVER blood and blood pressure, as well as alteration in its composition. The digestive, respiratory, and nervous- system are also deranged. Elevation of temperature is not the only symptom of fever. The exact changes that take place during the existence of a fever are not yet fully understood. The most important changes, on the one side, seem to be increased assim- ilation, especially of albumen, asa result of changes in the blood ; on the other side, the heat center of the brain appears to play a part. This center regulates the distribution of the heat as well as the development of the heat in the body (caloric center). When the heat center is irritated, elevation of the temperature occurs ; when it is weakened or paralyzed, the body temperature becomes subnormal. Irritation of the heat center with a subsequent rise of temperature may be produced in various ways. Traumatic injuries from some instrument or asa result of other injuries (burns), or thermic through a high degree of heat (heatstroke, sunstroke), num- berless chemical agents (toxins, ferments, mallein, tuber- culin), reflex action asa result of pain (so-called nervous fever). Conversely, the heat center may become weakened or paralyzed with a subsequent fall of temperature. The factors which cause this condition may be traumatic (de- struction of the heat center), thermic (cold), chemical (antifebrin, antipyrin). In wound fever increased assimilation is combined with alterations in the blood, derangement of the heat regu- lators, and irritation of the heat centers. Apparently this is due to the resorption of dissolved bacterial toxins, as well as certain chemical agents found in the wound secretions. Wound fever may be termed a resorption fever. If the resorbed material is of bactericidal origin—bacteria or their toxins—it is termed a septic or bacterial fever (infection-fever, intoxication- fever, septicemia, pyemia). In a great many cases fever accompanies mild wounds, for example, after castration, or non-infected wounds, subcutaneous bone fractures, blood ex- travasations. The fever is apparently caused by the resorption WOUND FEVER 39 of ferment-like products produced by degeneration of the blood and tissues. Their action on the blood and nervous system is similar to that of the toxins of bacteria. Fever thus produced is called aseptic or ferment fever. The chemical agents thus generated are ferments of the blood and tissues (fibrin-ferment, histozyme), organic material from the degeneration of cellular tissue (nuclein from the nuclei of white blood corpuscles, free hemaglobin), and occasionally glandular secretions. One observes aseptic fever after the transfusion of blood, as well as in horses that have been restrained. Symproms—Elevation of temperature in wound fever varies according to its intensity and course. In the dog and horse it is classified as mild (39.5° C); medium (40.5° C); high (41.5° C). Wound fever is sometimes continuous (sep- ticemia), sometimes remittent, usually however, atypical. It is seldom intermittent (pyemia). Aseptic wound fever is not characterized by pronounced general symptoms, for example, that following castration in the horse. In septic wound fever, on the other hand, one observes: eleva- tion of temperature, derangement of the appe- tite, digestion, and activity of the heart; ema- ciation; psychic derangements, etc. Septic wound fever is often followed by septicemia and pyemia. (See chapter that treats these subjects). TREATMENT.—The main therapeutic problem consists in the local treatment of the wound. In aseptic wound fever it is usually sufficient to change the band- age, thoroughly remove the pus, and disinfect the wound. The drainage of wounds and incision of abscesses produces the same result. Septic wound fever, in addition to the above, should be treated internally with febrifuges. The most active surgical an ipyretics: (especially with synchronous weakness of the heart) are camphor and alcohol, they are best adminis- tered in the form of subcutaneous injections of spirits of camphor. \ 40 SEPTICEMIA 5. SEPTICEMIA. DEFINITION AND CausEs.—Septicemia (sepsis, blood poisoning, putrid fever) isa severe wound infec- tion disease characterized by the presence of bacteria and their products of degeneration in the blood. Unlike pyemia, it is not accompanied by internal or external local affections (metastasis), but by general changes in the structure of the internal organs. Thisis especially character- ized by swelling of the spleen,and parenchy- matousinflammation of the liver, the kidneys, the heart, and the other internal organs. It often occurs that septicemia and pyemiaare combined (sep- tico-pyemia, pyo-septicemia). From an etiological standpoint two principal forms of sep- ticemia are recognized: one due tothe action of bacteria, the other to that of chemical poisons (toxins). That due to bacteria is termed bacterial septicemia, bac- teriemia, or septic infection; that which results from toxinsistermed septic intoxication. The former may be transmitted through the blood to other animals, while the blood of the latter is not infectious. Between the two there are transitional forms and combinations (mixed in- fection). If no cause can be found for the existence of sep- ticemia, itis termed cryptogenic septicemia. 1, Septic infection is caused by several bacteria, they may be cocci or bacilli. One can differentiate, therefore, between a coccidial and a bacterial septicemia. Some of the cocci which may produce septicemia are the streptococcus septicus andthe micrococcus te- ‘tragenes; the cocci which produce pyemia, namely, strep- tococcus pyogenes and staphylococcus aureus are also able to cause septicemia. The experimental inves- tigations of Koch have demonstrated the pathogenic action of the following bacilli: the so-called bacillus of mouse septicemia, as well as the baciilus of rabbit speticemia, the group futher includes the colon bac- illus and the bacillus enteritidis. Specific SEPTICEMIA 4I Speticemias, in ‘contrast to the sim ple forms, may be caused by malignant edema, anthrax, blackleg, the organisin of erysipelas, and hog cholera, the septic form of so-called foal lameness, calf septicemia, septicemia hemorrhagica (wild- seuche), chicken cholera, and chicken plague. 2. Septic intoxication is due to the entrance of the poisonous products of bactericidal metabolism. These products aretermed toxins, ptomaines, putrid virus, cadaver or septic poisons, and meat poisons, their chemical structure is extremely variable (toxalbumen ; albumoses, organic bases namely, amine and nuclein bases, fatty acids, and aromatic products). Usually these toxins are absorbed from a purulent focus on the surface of the body, or they may be absorbed from the uterus, intestines, lungs, or liver. As a rule it is the above named pathogenic bacteria that colonize in ichoric wounds, in retained decomposing sec- undines (puerpural septicemia), or in ichoric foci in the in- testines and lungs, and whose products of metabolsim are re- sorbed. Other organisms, especially the bacteria of put- refaction, can gain entrance to wounds and pus foci in the body. They result in putrid decomposition of animal tissues, from which are formed strong chemical poisons, which are resorbed and cause general intoxication. That form of septicemia due to the products of metabolism of putrefactive bacteria (saprophytes) is termed sapremia. Proteus vulgaris andtheclosely allied bacillus celluleformans (flesh poisoning) are especially dangerious in this connection. Migration of the saprophytes, themselves, to the blood, was formerly supposed to be a cause of septicemia’; according to recent investigations this appears to occasionally take place. PATHOLOGY.—On post mortem examination of animals that have died from septicemia, the following conditions are noted: The blood is of a tar-like consistence and has the appearance of varnish. ‘The blood as well as the solid organs of the body manifesta tendency to putrefy. In septic infection a microscopic examination of the blood reveals the concerned bacteria, which have led to a decomposition of the white and red blood-corpuscles. The 42 SEPTICEMIA white blood-corpuscles, in particular, are transformed to form- less colonies of bacteria as a result of the numberless organisms. that have gained entrance. Asa result of parenchymatous disease of the vascular walls, there occurs a hemorrhage into the mucous membrane, beneath the serous membranes— especially beneath the endocardium—into the mesome- trium and omentum, kidneys, spleen, and liver. The spleen, liver and kidneys usually show par- enchymatous swelling, the heart-muscle, and occasionally the skeletal muscles, havea cooked ap- pearance. In many cases there also exists an ulcerative endocarditis; a catarrhal, hemorrhagic, and even diph- theretic enteritis; as well as a parenchymatous and hem- orrhagic nephritis. In very acute cases of septicemia these changes are not pronounced. ‘This is especially true of the toxic form, where, similar to poisoning, post mortem may give negative results. (Caution in the inspection of meat !). SympToms.—Septicemia is the most important and the most frequent general wound infection disease. It is found in the horse after traumatic, pyo-ichoric inflammations of the joints (pedal joint, tarsal joint) and the tendon-sheaths, as well as in severe septic, subfascial and intermuscular phleg- mons. In the cow and bitch septicemia frequently follows parturition (puerperal septicemia). Comparatively speak- ing, swine are very resistant to septicemia (castration). Ac- cording to the seat of origin, the local changes are extremely variable. 1. Septicemia in the horse is characterized by a septic phlegmon around the margin of the wound. Sometimes local wound changes are absent (peracute cases). The general symptoms usually begin with severe febrile indications. The temperature may go to 42 C., and over, occasionally it is accompanied by chills, the pulse is frequent, small, and finally imperceptible, heart weakness is pronounced. In many forms of septicemia, elevation of temperature may fail. One occasionally observes severe general symp- toms: complete loss of appetite (occasionally horses eat a quarter or half ration to within a short time of their death), —< SEPTICEMIA 43 pronounced emaciation and weakness, heaviness of the sensorium, trembling, sometimes paralysis of the posterior limbs, profuse and continued perspiration, dirty-red or icteric coloration, and echymosis of the mucous membranes, discolored, albumenous urine, and towards. the end, profuse diarrhea with symptoms of colic. The duration of the disease is extremely variable ; it may ter- minate fatally within twenty-four hours, it usually continues, however, several days, and may exist for several weeks (in- flammation of the pedal joint). 2. In cattle puerperal septicemia is the most frequent form (septic form of puerpural fever). Clinically, both forms of septicemia may be recognized; infection and intoxication. Puerperal infection is characterized, either by a puerperal phlegmon, a septic metritis (fever, straining, groaning, pain on pressure over the abdo- men, stinking, chocolate colored discharge from the uterus, diphtheretic changes on post mortem); or by an acute puerperal septicemia, which is differentiated from the preceding by general septic conditions (sudden loss of ap- petite and lacteal secretions, high fever, yellow mucous mem- branes, and weakness). As a rule it leads to death in from one to three days, and the post mortem changes are frequently slight or imperceptible. Puerperal intoxication ex- ists, either in the form of a parturient paresis (para- lytic calf fever, auto-intoxication), or slight symptoms of dis- ease (weakness, gastric derangement, normal temperature). Retention of the after-birth, especially, is a cause of a mild form of s apremia; sudden paralytic conditions with death after a few hours are rare (De Bruin). TREATMENT.—As in a wound-fever, so in septicemia, local antiseptic treatment of the wound is of greatest importance. Apply powerful disinfectants, carefully remove stagnated wound-secretions, give thorough drainage, incise early all fluctuating spots. A puerperal uterus should be thoroughly irrigated and any retained placentae removed. The internal administration of febrifuges is of secondary im- portance. Those agents which have been of greatest service 44 PYEMIA are: camphor, alcohol, and quinine. Argentum colloidale as wellas quicksilver in the form of small doses of calomel are employed internally. Antistrepto- coccic serum, on the other hand! has not proved satisfactory. { 6. PYEMIA. DEFINITION AND. CausEsS.—Pyemia is a general wound- infection disease ; in contrast to septicemia it is characterized by the formation of suppurative foci of disease in the body (metastases). The bacteria of pyemia are essentially those of septicemia. The most frequent causes of pyemia are pus-cocci, especially, staphylococcus pyogenes aureus,and strepto- coccus pyogenes. These are found in any abscess, and are the ones usually involved in metastasis (staphylomycosis niultiplex, staphylohemia, pyemia metastatica). They enter the blood from a primary pus-focus, colonize in .the various internal organs, where they multiply and cause suppuration. An acute or chronic pyemia depends on whether the pus cocci enter the blood stream suddenly, and in large numbers ; or gradually, and in small numbers. In general, pyemia is much less common than septicemia. In the horse it is usually the result of a septic, degenerating thrombo- phlebitis arising from wounds of the hoof, umbilicus, of the jugular vein, following injuries of the bone as well as from resorption of internal pus-foci (strangles). Pyemia of foals and calves which develops from a suppurative thrombo- phlebitis of the umbilical cord (pyemic form of the so-called foal lameness or calf lameness) is’ of practical importance ; these diseases possess no bacteriological individualities, in foal lameness, especially, staphylococci as well as streptococci have been demonstrated as a cause of the disease ; in calf lameness the colon bacillus has been recognized. In cattle, pyemia usually develops from the internal organs, especially from the uterus (pyemic form of puerperperal fever), when it originates from a suppurative thrombo-phlebitis of the uterine veins, it seldom results from traumatic gastritis. Stra ng les in the horse isa specific type of pyemia; the same istrue PYEMIA 45 of so-called dog distemper (suppurative folliculitis of the lips with secondary lymphangitis, lymphadenitis, and metastatic formations). Occasionally the origin of pyemia cannot be determined (cryptogenic pyemia). In many cases it is impossible to distinguish between sep- ticemia and pyemia, they both exist at the same time; one then speaks of a pyo-cepticemia. From a standpoint of practical surgery it is essential, however, to differentiate between cases of pure pyemia dnd septicemia. PATHOLOGY.—The anatomital characteristics of pyemia are a greater or lesser number of suppurative inflam- matory foci (metastati¢d processes) inthe internal and extérnal organs (lungs, liver, spleen, kidneys, brain, heart, skeletal muscle, joints, tendon-sheaths, etc.). In foal lame- ness, suppurative inflammation of the synovial tissues of the joints is the main characteristic (polyarthritis pyemica). One also observes, suppurative inflammation of other s¢rous membrane s, the peritoneum, the pleura, the meninges ; as well as suppurative inflammation of the eye (suppurative choroiditis and panophthalmia). Occasionally, one also observes, as in septicemia, an ulcerative endo- carditis and numerous circumscribed hemorrhages on the serous membranes, in the skin, in the eyes, and in the mus- cles. Anatomical changes characteristic of septicemia may also be present (septico-pyemia). Finally, the loc ‘al chan ges are sometimes very characteristic ; forexample, asa result of the colonization of numerous bacteria in the venous walls of the wound (umbilical wound), there occurs a suppurative inflam- mation of the vascular walls with suppurative degeneration of the organized thrombus (suppurative thrombo-phle- bitis). This forms a source of the suppurative embolic foci within the body, as well as a point of origin for many bacteria that are present in the blood and inner organs (micrococci). SymptToms.—Pyemic wound infection is ushered in with a varying, frequently intermittent, very ir- reg ular fever, and occasionally with chills. After this there develop symptoms of metastatic inflammation of the lungs, orsymptomsof abscess formation in & THE REMAINING WOUND INFECTION DISEASES he liver, kidneys, or brain, pyemic polyar- hritis, tendovaginitis, pleuritis, meningitis, tc. Occasionally, one further observes multiple, sub- ‘utaneous pus-foci, which often develop suddenly in arge numbers in the form of phlegmonous swellings in rarious parts of the body. Pyemia usually runs a longer ourse than septicemia; usually from a few days to a few veeks, depending on the seat and course of the metastasis. t may develop into a chronic pyemia with pronounced maciation of the animal. Recovery is more frequent than in epticemia, although it is uncommon, and convalesence oc- urs only after a long time. Puerperal pyemia (pyemic form of puerperal ever) is characterized by a febrile polyarthritis on the arpal and tarsal joints, mastitis, osteomyelitis, nd tendovaginitis of the flexor tendons, as well as hronic parametritis (multiple abscess in the pelvic ounnective tissue, chronic emaciation). It occurs in cattle, rat is rare in horses. Strangles-pyemia (so-called wandering strangles) evelops principally in the form of abscesses of the lymph ‘lands in various parts of the body (superior, middle, in- erior cervical glands, axillary glands, bronchial glands, omen- al glands, pubic glands, lumbar glands, popliteal glands) as vell as abscess formation in the brain, spinal marrow, ‘mentum, udder, kidneys, pancreas, orbit, etc. TREATMENT.—As in septicemia, the principal treatment onsists in careful local disinfection, drainage, and ncision. On account of its specific action as a febrifuge, uinine may be tried. 7. THE REMAINING WouUND INFECTION DISEASES ERYSIPELAS.—In man, this disease is a specific, infectious nflammation of the skin and subcutem ; it involves the 2te Malpighi and the papillary bodies. Through the medium of the ymph stream it rapidly spreads over large areas of the skin, and eads to severe general infection; the local changes, owever, are usually slight. A superficial wound is usually the point of rigin of the infection. The bacteriological investigations with THE REMAINING WOUND INFECTION DISEASES 47 reference to the bacteria which cause erysipelas are very contradictory. It was formerly thought to be entirely due to the streptococcus erysipelatis, aspecific organism discovered by Fehleisen. Ac- cording to recent investigations (Baumgarten, Fraenkel, and others), the specific action of the coccus of erysipelas, on the other hand, is very ‘doubtful ; this organism appears to be identical with streptococcus pyogenes. The theory has been advanced, therefore, that erysipelas is not a specific wound infection disease, buta localized form of. septicemia in the skin. According to its virulence, each strep- tococcus may cause suppuration, erysipelas, phlegmon, abscess forma. tion, pyemia, and septicemia (Marmorek). It is also claimed that erysipelas may be caused by staphylococci and typhus- bacilli. In man, therefore, according to the etiology, two forms of erysipelas are recognized: the primary, genuine type, due to strep- tococci ; and the secondary type, which occurs during the course of various infectious diseases. The symptoms of erysipelas in man consist in the appearance of a diffuse red swelling in the vicinity of the wound; the swelling spreads very rapidly, and frequently along the course of the lymph streams (migrant erysipelas, ambulant erysipélas.) In other cases new inflammatory foci arise in several distant places, they are manifestly metastatic (erysipelas multi nitiplex ). Corresponding to the extension of the erysipelas, there is ‘observed a rapidly developing, high grade fever. As the result of an active serous exudation, blisters are formed in many places on the surface of the skin (erysipelas bullosum). As a rule, the erysipelas heals with rapid sinking of the fever and desquama- tion of the skin. In typical cases the healing is as rapid as the develop- ment (simple, typical, non-complicated erysipelas). In other cases phlegmonous and gangrenous processes are present (erysipelas phleg- monosum and gangrenosum). Other complications are: erysipelatous pneumonia, pleuritis, endocarditis, pericarditis, myocarditis, diphtheria of the pharyngeal mucous membranes, enteritis, intestinal ulcers, nephritis, inflammation of the brain, neuritis, peripheral paralysis of the nerves, suppurative panophthalmia, otitis, parotitis, as well as septicae- mia, and pyaemia. In individual cases it has been observed that new formations (carcinoma, sarcoma, lymphoma, lupus) disappear after an accidental infection with erysipelas. Based on this experience, the un- safe experiment has been made of artificially producing erysipelas on the new formations mentioned by means of injections of erysipelatous cocci; the object being, to cause healing (erysipelas inoculation, cura- tive, artificial erysipelas). Treatment of erysipelas consists in epi- dermatic and endermatic (parenchymatous) applications of disinfectants (carbolic acid, creosote, creolin, lysol, tar, ichthyol, tincture of iodine, sublimate), incisions of the skin, with antiseptic irrigation, application of pressure to the healthy margins (collodion, strips of sticking-plaster), 48 THE REMAINING WOUND INFECTION DISEASES as wellascold. Recently the antistreptococcic serum has been applied. The fever is treated with camphor. Concerning the OccCURRENCE OF ERVSIPELAS IN ANIMALS def- inite knowledge is scarce. This is partly due to the fact, that the most characteristic symptom, the redness of the skin, is wanting in animals on account of the pigment formation and hair. On the other pand, genuine, typical erysipelas appears to be much less common in domestic animals than in man. For chis and other reasons, it is better not to use the word erysipelas in vet- 2rinary surgery, but in general, to speak of inflammatory edema. [In CATTLE, “erysipelas of the udder,” an erysipelatous, in- ‘ections inflammation of the skin, is seen in the udder before and after oarturition. The skin, on the posterior quarters of the udder in partic- alar, and occasionally on the inner surface of the tibia, is very red, yainful, and swollen. It is alleged that this affection is frequently complicated with phlegmons of the subcutem, and either leads to jesquamation and healing, or permanent schlerosis of the skin. A fatal ermination is never observed. In the Horsx, phlegmon of the poster- or limbs is considered erysipelas by many; Kitt, for example, lefines it asa dermatitis erysipelatosa, while Schindelka classifies t with the phlegmons. It is very questionable if the so-called erysip- :latous form of scratches is genuine erysipelas.s Malzew (Zur Aetio- ogie der Mauke. Inaugeral-Disseration. Dorpat, 1899) sustains the hheory, that with few exceptions, those inflammations of the fetlock ‘egion, known as scratches, are genuine erysipelas. In scratches of the iorse he claimed to have found regular streptococci, which were identi- cal with those of erysipelas. Also, according to his experiments, srysipelas could be successfully transmitted from man and dog to the kin on the fetlock region of the horse. Considered from the stand- oint ; that specific erysipelatous cocci do not exist (see above); that hese cocci are found much more often in non-erysipelatous, simple, uppurative inflammations of the skin ; that the disease is neither gen- ‘ral, nor has a tendency to spread ; the erysipelatous nature of scratches snot a well supported fact. On the other hand, perhaps the case lescribed by Se mmer (Oesterreichische Monatshefte. 1895, S289) was me of genuine erysipelas. Three horses showed swelling of the lips fter transportation in severe cold ; this spread rapidly to the region of he cheeks, the pharynx, the throat, and the anterior part of the thorax. \ll three horses died after a short time. Post mortem examinations evealed the following condition : an exudate in the swollen portions of he skin that was sero-fibrinous, partly fluid, and partly gelatinous in haracter; the pleura, pericardium, and peritoneum presented hemor- hagic inflammations ; in the thoracic and abdominal cavities, as well as n the pericardial cavity, there was an abundance of dirty-red fluid; on he omentum, and under the pleura of the lungs, there was anabundant MALIGNANT EDEMA 49 extravasate of blood; the spleen was enlarged. A pure culture of staphylococci were secured from the serous exudate of the swollen skin. Experimental cutaneous and subcutaneous injections of these in horses resulted in large, erysipelatous swellings at the point of injection (shoulder), which spread downwards to the carpus; fever and loss of appetite were also noted. In Docs, among 70,000 cases of disease, I have observed symptoms referable to erysipelas in only four cases; I have described one case in the Wochenschrift fiir Tierheilkunde (1894). Schindelka’s (Hautkrankheiten. 1903) experiences are identical with mine ; he has observed only three cases of erysipelas in the dog. Moller, also, (Lehrbuch der Chirurgie. 1893) has only occasionally observed typical erysipelas in the dog. In SwINE, on the other hand, erysipelas is much more common in the form of erysipelas of the head ; it may also be transmitted by inoculation to other swine (Fehlei- sen). Nothing definite is known concerning genuine erysipelas in sheep, cats, and birds. MALIGNANT EDEMA.—Malignant edema is a specific phleg- mon: it may be termeda sero-hemorrhagic infiltration of cellular tissue with gas formation. Apparently, the cause of the disease may be due to~severalbacteria. The most important is the malignant edema bacillus (bacillus edematis maligni) dis- covered by Koch. The bacilli of malignant edema form spores ; they are very motile; liquefy gelatine; take Gram’s stain ; they are anaerobic rods 3 to 5 micro-millimeters in length, and one mirco-millimeter broad; they are four times as long as broad and a trifle slimmer than the anthrax bacillus. Several rods become adherent to form threads 10-40 micro-millimeters in length. After the death of the animal the edema bacilli increase rap- idly in length, and form threads which are partly straight, partly curved, and partly twisted; they are arranged in such a manner as to give one the impression of bacilli arranged upon one another in rows. Spores are afterwards formed from these threads. In cadavers of asphyxiated individuals that have been kept for 24 hours at a temperature of 38°C, large numbers of malignant edema bacilli are found in the blood, especially in that of the portal vein (migration from the intestines). By the same method, the so- called cadaver-bacilli are constant in the blood of the liver and in the spleen after 12-24 hours, in the general circulation of our domestic animal cadavers soon after, as the result of death due to dyspnea, especially from colics, when they remain] un- opened for some time in a warm place (confusion with anthrax bacil- lus!). There are also various forms of pseudo-e dema bacilli (earth bacilli). The edema bacillusis extremely abundant in nature. It is especially numerous in the upper layers of the earth. If a small 50 MALIGNANT EDEMA mount of ordinary garden soil is brought beneath the skin of a rabbit, he animal dies from malignant edema in from 24-36 hours. The spores, of malignant edema are also found in horses that are entirely normal, in he saliva and in the feces, so that infection may readily occur in he oral cavity and in the vicinity of the anus. For this reason, infec- ions are very common in the vagina and in the puerperal iterus. The infection results from an unclean condi- ion of wounds of the skin or mucous membrane; and nay be conveyed by means of soil, feces, saliva, dust, :te., it depends, however, on the entrance of the edema yacillu) into the subcutaneous or submucous con- 1ective issue. The entrance of this organism into the circu- ating blood is comparatively harmless because the oxygen of the Mlood is fatal to anaerobic bacteria. Inoculation of the :utis also, produces go results (oxygen of the air). It is also lifcult for the bacilli to enter granulating wounds. Moreover, the ubcutaneous and submucous connective tissue must be previously’ veakened by means of previous contusions, the entrance of foreign vodies, ulceration, etc., before the edema bacilli gain entrance. This lepends, first, on the existence of a nourishing media for the bacilli ‘serum, lymph, blood). Then the infectious material must be as free is possible from the oxygenated blood, as the oxygen of the blood is atal to the bacilli. The greater the interruption of the circu- ation in the infected area, the more favorable are the conditions for he growth of the edema bacillus. According to recent investigation Besson), genuine spores of the edema bacillus cannot develop in the iealthy tissues of living animals (phagocytosis). Their development nuch more dependent on association with other bacteria microbes favorisants) especially with staphylococci. This condition »xplains, as in tetanus, that, regardless of the frequency of the occurrence of the edema bacillus (ubiquity), cases of sickness from malignant sdema are relatively uncommon in animals. Since Kitt has demonstrated that malignant edema could be ex- derimentally transmitted to domestic animals, numerous cases have been »bserved in cattle, horses, and sheep (Jenson and Sand, Reuter, Attinger, Elmenhoff, Nielson, Friis, Mesnard, Besson, Horne, de Bruin, Willach, Albrecht, Kitt, Gilruth, Reakes, personal observations). The rtauses are due to injuries, for example, subcutaneous injections of , 2serine, injuries of the tongue by means of food, foreign bodies, bites, ind perforating wounds; injuriesto the uterus, the vagina, and the vulva so-called puerperal blackleg which may also be caused by the pseudo- >dema bacillus and the genuine blackleg bacillus), operations with un- clean instruments, castration of sheep and goats, amputation of the tail. (n the Province of Brandenburg, in 1897, from 600 freshly shorn sheep, jo died from malignant edema (Lembcken); in New Zealand, in 1900, TETANUS, 51 among 4,000 shorn sheep, 300 died from malignant edema. In one case in a horse, I observed a twelve-hour period of incubation. Obviously, malignant edema has been known for a long time in veterinary science, but under other names (flying necrosis, black necrosis, fire, progressive cellular inflammation), and formerly as blackleg, sometimes as anthrax and erysipelas, as well as wildseuche and cattle plague. The symptoms of malignant edema consist of a swelling in the vicinity of the point of infection. This develops suddenly, is edematous, doughy,and very sensitive; it spreads rapidly to the neighboring tissues, and fre- quently crackles on palpation. The favorite seats of the edematous swellings are in the following places: the tongue, pharynx, laryngeal and parotid regions, the head, throat, and upper limbs, the lumbar and sacral regions. The center of the swelling is usually cool, relaxed and painless ; while the periphery is tense, hot, and sensitive. The subcutaneous and submucous connective and fatty tissue, as well as the neighboring muscular tissue, is filled with a gelatinous exudate, and a foul smelling gas. The yellowish-red edematous fluid contains many characteristic edema bacilli and threads, which are not present in the blood during life, and are only occasionally found in the blood after death. In many cases, however, the local symptoms are absent. One also notes high grade dyspnea (edema of the lungs), as well as severe ‘gastric derangements (inflammation of the mucous membrane). The disease usually runs its course in a short time (one _to three,days), terminating fatally with severe febrile symptoms. When the disease is confined to the head, recovery sometimes occurs. On post mortem the spleen, liver, and kidneys are usually intact ; splenic tumors, in particular, are occasionally absent. The treatment, as inphlegmons, consists in making free incis- ions—admit the air—the most active opponent of anaerobic bacilli; provide draifage and apply antiseptics. According to an observa. tion of Attinger, warm fomentations appear to be contra-indicated ; they favour the extension of the edema. With reference to the liter- ature on malignant edema Cf: Friedberger and Frohner, ‘‘Spec- ial Pathology and Therapeutics’. Sixth Edition, 1g04. Vol., II. Also Kitt: Monatshefte fiir praktische Tierheilkunde. Bd. VIII. TETANUS.—This was formerly considered a disease of the nerves characterized by trismus. As a result of the investigations of Nikolaier and Kitasato it was found to bea genuine wound- infection disease, caused by the bacillus of tetanus. It is most frequently observed in the horse after injuries to the hoof (nail pricks, nailing, treads on the coronet), the posterior limbs and the head, after castrations, after operations on the tail (amputation, setting up), subcutaneous injections, removal of setons, entrance of foreign bodies (kernels of grain) into the guttural pouches. It is also observed 2 TETANUS | cattle (tetanus puerperalis after injuries to the vagina and uterus, istration, umbilical wounds in calves), sheep and goats (castra- on, inoculation, seton, umbilical wounds). In dogs, however, tanus is extremely rare ; two cases have been observed by MOller. mong 70,000 diseased dogs, I have never seen a case of tetanus; the cperimental inoculations of garden soil into dogs by Nikolaier also ive negative results. Kitt, on the other hand, was able to produce tanus in dogs by injecting pure cultures. The tetanus bacillus (bacillus tetani) is in the form of a rod, \aped like a stick pin, music note, or cooking ladle ; the end contains spore. Itis found everywhere, especially in garden soil, as well as | earth that has been covered with horse manure, it is also und on the floors of horse stalls. As experimental inoculations ith ordinary garden soil have proved, infection usually re- alts from the entrance of:bacterial earth; other ob-° ‘cts may act as intermediate carriers of the tetanus bacillus (horse-shoe ails, splinters of wood, instruments, dust of hay, manure, kernels of rain, cob webs). Conditions for the infection are made more favora- le by the simultaneous existence of other microorganisms, especially 1e pus-forming bacteria (microbes favorisants). In contrast to the acteria of septicemia and pyemia, the tetanus bacilli do not enter the lood, but remain at the point of infection where they develop a trychnine-like toxin (tetanotox-albumen), which is resorbed y the blood. Inthe form of tetanospasmin it produces convulsions as result of its action on the spinal marrow. This toxin contains an un- recedented poisonous; a dose of 0.00025 grams, equal to 4 mg., equal » I-200 of a minum, produces death in the horse ; it is a thousand times tore poison than strychnine (lethal dose for the horse—o.25 grams). he toxin is absorbed by the substance of the axis cylinders of the peri- heral nerves and carried to the central nervous system. Tetanus, ierefore, is to be considered as an infectious disease, in which a general itoxication arises from the local point of infection. Occasionally one bserves a seemingly long period of incubation, several days r even weeks (the usual period is from 4-20 days), in which tetanus ccurs, for example, after careful disinfection and bandaging of the ‘round, even after healing and cicatrization are complete. I have ob- 2rved a period of incubation of even forty days in a horse (Monatshefte ir praktische Tierheilkunde. 1902). The symptoms of tetanus consist in locking of the jaws (tris- 1us) ; convulsive, stiff extension of the head, throat, and back (ortho- onus); dorsal or lateral curvature of the throat (opisthotonus and leurotonus) ; stilted, or sawbuck-like position of the limbs; stiff, xtended position of the tail and ears ; pronounced contraction of the ompressors of the abdomen ; dyspnoea (spasms of the inspiratory mus- les); increased reflex irritability ; timidity; and perspiration. In orses, the course is either very rapid (death after one to three ga WOUND DIPHTHERIA 53 days), or acute (death after four to ten days); in other cases, espec- ially in the non-frequent cases of recovery, a subacute and even a chronic course is observed (many weeks). One occasionally observes a contagious-like outbreak of tetanus (experience with military horses and in clinics), The mortality in horses is from 50-80%. The post mortem is apparently negative. Treatment is not very satisfactory (local disinfection ; removal of the foci of infection, ampu- tation of the tail, forexample; removal of external excitants; diate- tics), Administration of chloral hydrate, bromide of potash, morphine. The treatment of horses suffering from tetanus with tetanus antitoxin has not proved satisfactory. Antitoxin, on the other hand, has proven useful as prophylactic previous to operations (Nocard, Labat). With reference to'the literature on tetanus see: Friedberger and Frohner, ‘Special Pathology”. Sixth Ed. 1904, Vol. II. WounpD DIPHTHERIA.—The name wound diphtheria (hospital gan- grene, gangrena nosocomialis) indicates a wound infection disease which was formerly very common, but which has become infrequent under the influence of modern antiseptics. It consisted of a coa gu- lation necrosis of the granulations asa result of the action of specific bacteria (necrosis bacillus). The granulations are trans- formed into a yellowish-red, suppurative, ichorous pulp (croupous and diphtheritic form) ; or into a grey, pulpy, gangrenous mass (ulcerative form) ; or intoa stinking, putrid and soft mass similar to the pulp of a spleen (pulpy form). Treatment consists of burning early, or cauteri- zation of the wound with chloride of zinc. Bayer has described a case in the horse. The tissue in the region of the parotid glands was trans- formed into a greenish-brown, fetid mass; the process was accompa- nied with the formation of the gasses of degeneration, which had pro- duced an emphysematous condition of the neighboring tissues. I have observed similar cases in the horse. GLANDERS.—In rare cases, wounds in the horse become infected with the bacillus of glanders (primary glanders of the skin). This occurs, especially, on the extremities, abdomen, thorax, shoulders, and head. There then develops from the wound, a crater-like glanders ulcer; it is characterized by tenacious, discolored, frequently hemor- rhagicsecretions; from the ulcer, wreath-like swollen lymph vessels extend to lymph glands which are also swollen (glandular lymphangitis and lymphadenitis). Lameness exists according to the location of the glandular processes. Occasionally there also develops a chronic glandular phlegmon, whichmay finally leadto elephantiasis of the extremities and head (glandular pachyderma). I have described one case of this kind in the horse (Report 1883). Richter has described a case of glanders of the eye (glandular keratitis) (Zeit- schrift fiir Veterinaerkunde. 1896). For further information concerning glanders, especially with reference to differential diagnosis of the same, refer to text-books on special pathology. RABIES RaBIES.—Rabies is a genuine wound infection disease ; the cause the infection has not yet been discovered ; infection gains entrance m the saliva through the medium of wounds caused by bites, | then passes into the body. The bites, themselves, present no cial characteristics, as a rule they heal similar to the wounds of nus. The acquired virus is sufficient for the development of the zase, the appearance of the first visible symptoms may require 2ks, and even months (long period of incubation). According raragraph 35 of the government laws which refer to animal plagues, attempts can be made to cure animals affected, or supposed to be rected, with rabies; animals affected with rabies must be killed nediately (paragraph 37); those supposed to be affected must be ed or confined (paragraph|34). In man, treatment consists in cauter- ion, cutting out the wound, as well as in the application of strong fectants (sublimate, creolin, aqua chlorata, calcium permanganate, , carbolic acid is unefficient). BLACKLEG.—This is also a wound infection disease in which the ickleg bacillus gains entrance to the wound only through inju- ito the skin and mucous membranes (the subcutis and submucosa). ckleg, therefore, may be considered as a specific phlegmon cattle, similar to malignant edema, It is characterized by edema- s swellings of the skin which develop rapidly and crepitate, the cen- ; of these swellings undergo necrotic degeneration, they are ated on the upper parts of the limbs, the throat, the shoulders, the srior surface of the thorax, etc., the motions of the animal are also. anged ; there are swellings in the regional lymph glands; severe \eralsymptoms, and high fever are present. The course of the dis- 2is usually rapid, terminating fatally in from one to three days. atment of the area of infection is usually too l&te (incision, disinfec- 1 amputation, ligature). The so-called puerperal blackleg cattle is usually, not a case of genuine blackleg, but partly a gas. egmon, partly a malignant edema (Carl); sporadic cases of genuine rperal blackleg have been identified by Rievel, Olt, and tertag. For further information concerning blackleg see text- ks on special pathology, as well as Kitt, Monatshefte fiir praktische rhielkunde. VIII. ANTHRAX.—In contrast to man, anthrax is rarely a wound infection vase in animals. In addition to the ordinary infection through the ‘stines, one occasionally observes sporadic cases of entrance of thrax bacilli through wounds in the skin and mucous mem- nes, after previous operations (castration), bites, or punctures from :cts. There exists, first, a local inflammatory focus in the skin and cous membranes (anthrax carbuncle, anthrax edema) : is followed by a rapid general infection, which usually has. ital termination. Cases of anthrax of the skin and mucous mem- 1es were formerly described under the names, carbuncle disease, boil ” TREATMENT OF WOUNDS 55 fever, anthrax of the tongue, anthrax of the gums, and morbus carbuncularis. WILDSEUCHE.—The so-called exanthematic form of wildseuche exists apparently through the entrance of infectious material into small wounds of the skin or mucous membranes (injuries from the twitch, accidental injuries), and is, therefore, considered a wound infection disease. It is characterized by pronounced edematous swelling of the skin and mucous membrane, as well as the subcutis and submucosa of the head, the oral cavity, the submaxillary region, throat, etc., there also develop symptoms of septicemia hemorrhagica. Death usually occurs after 12-36 hours. Details concerning wildseuche may be found in text-books on special pathology. STRANGLES.—Strangles usually develops from the mucous mem- branes of the respiratory and digestive apparatus. Occasionally there occurs a strangles infection from wounds, whereby the regional lymph glands are involved first. A case of this type has been described by Litfas (Berliner tierarztliche Wochenschrift. 1895). I, myself, have observed two cases. With reference to other wound infection diseases (actinomy - cosis, botryomycosis, tuberculosis, lymphangitis, phlebitis, petechial fever) compare with the chapters on these subjects. Wounp INFECTION DISEASES OF THE VETERINARIAN.—The fol- lowing are the various wound infection diseases against which the vet- erinarian should be guarded: phlegmons, lymphangitis, and erysipelas, septicemia and pyemia, eczema on the hands and arms (obstetrics), anthrax, glanders, ra- bies, botryomycosis, tuberculosis. Among 365 officials in the Berlin Abbatoir and Stock Yards (veterinarians, butchers, etc.), 7 had inoculations with tuberculosis on the hands, 3 had questionable. nodules (Lassar). ar VI. TREATMENT OF WOUNDS. ANTISEPTIC AND ASEPTIC TREATMFNT OF WOUNDS.— Lister is the founder of the modern treatment of wounds. Working on the theory that wound infection might be pre- vented by the application of antiseptics, as well as careful bandaging, he employed, in 1867, carbolic acid with a band- age ; the latter being termed a Lister Bandage. This Lister bandage is applied as follows: irrigate the wound with a 2-5% solution of carbolic acid; spray the surrounding air 56 TREATMENT OF WOUNDS with the same solution; cover the wound with a piece of carbolized silk or surgeons cotton (silk or cotton protective) ; place over this a thick layer of carbolized gauze or other car- bolized dressing ; over this is placed an impermeable layer of surgeons cotton (mackintosh); the whole is retained by means of a moist, carbolized gauze bandage. Between the years 1872-1875 the Lister bandage was in general use in Germany. Later the use of the spray was dropped and the simple bandage applied. In 1880 the dry iodoform pack supplanted the use of the carbolic acid. Since then, other disinfectants have partially taken the place of iodoform (sublimate, creolin, lysol, tannoform, and other disinfectants). In recent times the use of antiseptics in human surgery has been restricted, in some cases even suspended. Schim- melbusch and others claim that when a wound has been infected for no longer than one minute there is no certainty of destroying the bacteria with disinfectants. There is no ob- ject, then, in disinfecting the wound, it is even harmful, because the tissues are irritated and the wound secretions are increased. Antiseptic treatment has, therefore, given way to the aseptic method, whichis carried out as follows: the wound is made as dry as possible with the use of a sterilized towel, and without the application of antiseptic fluids; it is irrigated*only with sterilized water, or sterilized physiological salt solution (0.6%), and then covered with a sterilized bandage. The material is sterilized in a specially prepared apparatus, it is exposed to steam of not less than 100° C., for a period of twenty to thirty minutes ; the instruments are sterilized in the same manner. Boiling for a long time in a one or two per cent soda solution is one of the surest methods of sterilization. Special care is taken with reference to disinfection of the hands of the operator. After the dirt has been thoroughly removed from the nails, the hands are brushed with soap and water, then washed in warm sublimate, carbolic, or creolin water, and finally rubbed in a fifty per cent alcoholic, or alcohol and soap solution. The following must also be rendered aseptic: the operating field, operating table, clothing of the patient, oper- ators, assistants and helpers, all utensils that are used, as well ANTISEPTICS 57 as the operating field in the vicinity of the wound. Even operating gloves, and masks for the mouth and nose are em- ployed as aseptic protectives. The aseptic treatment of wounds in human surgery has many advantages. Healing follows the natural self-pro- tection of the tissues (leucocytes, blood-serum), and there are only slight changes from external interference. Recently, many surgeons have changed from the purely aseptic method to the antiseptic; since Henle and others, contrary to the conclusions of Schimmelbusch, have demonstrated by means of statistics that local disinfection of the wound is possible within the first few hours, and that the results of the aseptic method are no more satisfactory than those of the antiseptic. Bruns even’ employed pure carbolic acid to disinfect the wounds, Kuster used the hot iron (Berlin Surgical Congress, 1gor). Antiseptic surgery involves the very difficult, or impossible, disinfection of the hands, which is not improved by the use of sterilized operating gloves (Berlin Surgical Congress, 1898). Up to the present time aseptic surgery in veterinary science has received a very lim- ited use. I have already mentioned this fact in the first edition of this book. The veterinarian deals mostly with old, infected wounds, in which, not asepsis, but thorough antisep- sis, is necessary. Even fresh operation wounds can seldom be given aseptic treatment, for example, in a clinic. Even in a well equipped veterinary hospital the aseptic surgical treatment of horses offers the greatest difficulties. Bandages can be applied only to a limited extent, in some cases it is almost impossible to prevent infection during the operation. When compared with human surgery, infection through the air plays a more important part (dust, hair), against which asepsis is of no use. For these reasons, the antiseptic method is to be preferred to the aseptic in veterinary science. ANTISEPTICS.—In selecting and deciding upon the various therapeutic agents to be used in the treatment of wounds, a general point of view comes into consideration. In the first place, besides the disinfecting properties of the various ma- 58 ANTISEPTICS terials, we must consider the resistance of the organisms in the wound. ‘This resistance lies, as I have fully explained else- where (Lehrbuch der allegemeinen Therapie), about midway between the very resistant anthrax spores, and blackleg bacilli at one extreme ; and the easily destroyed anthrax and swine erysipelas bacilli at the other. The streptococci and staphylococci, especially,should not be fought with weak disinfectants; their destruction re- quires stronger antiseptics (sublimate, creo- lin, lysol, tannoform, carbolic acid, solution of aluminum acetate, nitrate of silver). The toxic action of the antiseptics must also be considered, their irritating action on the wound, their decomposition by the secretions of the wound, their strength and form, the price, and the state of healing. In general the following rule Font be adopted: employ disinfectants which are ac tive, not too irritating, not easily decomposed, non-poisonous, reasonably active in aqueous solution, prompt in their action on the wound (tannoform). Actual disinfection should be preceded by careful irrigation. The following descriptions refer to the more important disinfectants (detailed descriptions are found in my Lehrbuch der Arzneimitellehre, 6. Aufl.). SuBLIMATE.—This is our most powerful and poisonous dis- infectant. A I-lo0oo sublimate solution quickly destroys all bacteria involved in wound infection. With the ex- ception of ruminants it can be employed on all domestic animals. In cattle sublimate acts as a specific poison, for this reason one must be guarded in its use. When combined with albumenous wound secretions it partly precipitates in the form of an albumenate of mercury, partly decomposes (formation of oxychloride of mercury). The decomposition has no material influence on its antiseptic action ; decomposition may be prevented by the addition of sodium chloride (pastil of sublimate), The advantages of sublimate are: its strong antiseptic properties, non-odor, cost, convenience (sublimate tablets). The disadvantages of sublimate are: pronounced toxicity, espe- cially for cattle ; irritability, especially on the mucous membranes of the eye (ophthalmology), and the uterus (obstetrics); it also rapidly amalgamates the instruments. In France, in the place of sublimate, hydrargyrum biniodidum rubrum is employed ina solution of ANTISEPTICS 59 I: 10,000 to I: 20,000 ; it is more active and less irritating. Many also prefer hydrargyrun cyanatun to sublimate because it does not amalgamate the instruments. CREOLIN, LYSOL, BACILLOL, AND OTHER CRESOL COMBINATIONS.— The antiseptic action of the cresols is pronounced and rapid. A 3 solution destroys wound infection organisms. The dis- - infectant properties of cresol are apparently stronger than those of carbolic acid. It further possesses deodori zing properties; itis relatively non-poisonous, and inexpensive, its disadvantages are: odor, irritating action of strong solutions on the mucous membranes, gradual destructive action on rubber tubes, cloudiness of the solutions. CaRBOLIC AcID.—The action is relatively strong. Most bacteria die after a long time in a 3% solution. The official carbolic acid solution is mixed in a 4% soltitton. The action of carbolic acid seems to be slight towards the infectious material of tetanus, rabies, the tubercle bacillus, and the spores of anthrax. Castration-~clamps, for example, transmitted tetanus after eighteen months, notwithstanding the fact that they were placed in a 4% solution of carbolic acid for five minutes (Nocard). Advantages: its strength is constant and it does not decompose. Disadvantages: cost, odor, irritating and toxic action, especially the latter, for cats. IoDOFORM.—This is an excellent, mild stimulator of granulatiotis ; also used in etherial solutions 1:5-10). Disadvantages: odor, cost, toxicity for dogs (licking), insolubility in water. The following similar preparations from iodine are expensive ; for this reason they are not much employed in veterinary surgery: lorentin, losophan, iodo- phen, europhen, aristol, iodoformin, iodoformogen, iodol, iodtrichlorid (easily decomposed). In actinomycotic infections, iodine and iodide of potash in aqueous solution (Lugol’s solution) is a specific for actinomycotic infection. TANNOFORM.—At the present time this isour best aseptic cov- ering and dry antiseptic. Applied early to cuts, it checks suppuration (healing under an eschar). In horses it is preferable to iodoform on account of being a more active and non-odorous antiseptic. Other formaldehyde preparations are: glutol, amyloform, and others ; they are more expensive and their action is less constant than that of tannoform. Formaldehyde, itself, in a 1 to 2% solution is a strong disinfectant, it irritates the wounds however ; it is very caustic when concentrated (caution!). NITRATE OF SILVER.—This is an excellent wound dress- ing. Itisastrong disinfectant (a 1: 100 solution is fatal to pus cocci). It is a valuable regulator of abnormal granulations, and leaves a pro- tective covering in the form of an eschar (eschar of silver). The same is true of the more recent but very expensive preparations of silver (argentum lacticum and citricum, actol, itrol, protargol, ichthargan). 60 ANTISEPTICS SOLUTION OF ALUMINUM ACETATE.—This is an excellent non- toxic antiseptic ina 2-8% aqueous solution (also contained in Bur- tow’s solution); because of the expense it is preferable to the more costly substitutes: alumnol, tannal, gallal, sozal, boral, salumin, cutol, etc. : ‘ BismMUTH SaLts.—These are absorbing, astringent, dry antiseptics; their action is similar to tannoform, they seem to be more expensive, however. The following are most often employed : bismuth subnitricum, subsalicylicum, gallicum (dermatol), dithiosalicylicum (thioform), airol(iodid of dermatol). The latter in the form of AIROL PasTE is an excellent aseptic protective covering fo wounds ; it is non-irritating, easily applied, dries rapidly, and is very adherent. ALCOHOL.—This is an important agent for disinfecting the hands of the operator and the skin of the operating field. Itis best employed in the form of a 50% aqueous solution or aqueous solution of sublimate (absolute alcohol has only a weak anti- septic action). Alcoholic soaps are also employed. Alcoholic TINCTURE OF ALOES stimulates granulations on old wounds and is an active antiseptic. TINCTURE OF IODINE is an excellent disinfectant for infected wounds that have a tendency to necrosis. SALICYLIC AcID.—A weak antiseptic,it is non-poison- ous however, odorless and non-irritating. It findsap- plication in ophthalmology, in irrigation of the internal organs of the body, and in the treatment of cats. Thioform (bismuth dithiosali- cylate) isa substitute for iodoform. It is especially employed because of its non-odor and non-toxicity (very expensive !). Boric Acip.—A mild, non-toxic, and odorless anti- septic; its action is slight (ophthalmology, irrigation of the uterus). The following, with other solutions of boric acid, possess a similar action: borax and borate of magnesia, boral, an- tipyonin, rotterin, antiseptin, borol. CHLORIDE OF ZINC.—A caustic antiseptic (2-8% solu- tion), its action as an antiseptic is relatively weak (common agent for abnormal granulations). CaLuclum PERMANGANATE.—Weak antiseptic. Specific against snake bites and the toxin of rabies. CamPHoR.—A powerful antiseptic, especially for torpid gran- ulations, phlegmons, and necrotic processes (spirits of camphor bandage). Those agents which have a similar action are: oil of turpentine, turpentine (old hoof remedies), thymol oil of eucalyptus, balsam of Peru, and other etherial oils. Tar.—An excellent antiseptic, especially for wounds of the hoofs and claws. Wood tar is preferable to coal tar. Agua CHLORATA.—Strong antiseptic. Specific for rabies and snake bites. Employed in ophthalmology. Ll Kiet ae OPEN WOUND TREATMENT AND BANDAGING 61 PyocTaNIn.—Active antiseptic. Disadvantages: blue color. HeEat.—By means of high temperature pus bacteria die in ten minutes at a temperature of 55-62°, the streptococcus of strangles at 60°, the tetanus bacillus at 75°, the spores of tetanus at 100°. OPEN WOUND TREATMENT AND BANDAGING.-—If a wound is aseptically or antiseptically handled, and eventually sutured, \ a bandage should be applied wherever possible. It protects é wound from the entrance of infection (air, and contact infection), as well as itritants. The bandage should be dry. Such a bandage is termed a dry, aseptic wound band- age. A moist antiseptic bandage is better for ex- tensive wounds, pronounced suppuration, phlegmons, prepa- ration of certain portions of the body for operating, etc. The moist bandage combines protection with a continued.antiseptic ‘ action ; it neutralizes the action of the wound secretions; the moist warmth assists granulation and cicatricial formation. Through maceration of the skin and horn it may occasionally become injurious. When a bandage is not changed for a long time itis termed a permanent bandage. Other forms of bandages are>~Simple, Lister, pressure, dry dressings, ointment and tar bandages, iodo- form bandages, antiseptic tamponade, ete. With referance to bandage materials and bandage technique see: Bayer, Operationslehre. Only the most important rules for bandaging are given here. These are: 1. Every wound, when possible, should be bandaged. 2. The bandage should, after aseptic operations, remain in position as long as possible (following resection of the lateral cartilage, for ex- ample, fourteen days). 3. The bandage must be changed, however; (a) when it becomes saturated with pus, wound se- cretions, or filth; (b) when improperly applied; (c) when there ‘is pain or pronounced swelling in the vicinity of the wound, or when fever exists. = In veterinary practice the open treatment of wounds must often replace bandaging. This is especially true of horses and cattle, in which the application of a bandage in various parts of the body is impossible (gluteal region, up- per limbs). In such wounds the oxygen of the air acts as a ae, 62 TREATMENT OF DIFFERENT KINDS OF WOUNDS disinfectant ; itis of special value in malignant edema. For this reason, the suturing of old or large wounds is contra-indicated. The aseptic wound bandage is most readily applied to dogs. When a bandage cannot be applied healing under eschar may occur (dry or moist blood-eschar ; necrosed eschar ; one formed by tannoform, tannin, silver nitrate, dry dressings, etc. ). Oint- “ments may take the place of a bandage (boric acid, silver nitrate, decubital salve, etc.). Adhesive remedies per- form the same function (airol paste, iodoform-colodion, zinc paste, bismuth paste, adhesive plaster). In many cases, as in human surgery, permanent irrigation is employed with good results, that is, the wound is irrigated for a long time with an antiseptic fluid. Immersion (water bath) has a very limited field of application (hoof baths, baths for mange). Antiseptic cataplasms are employed to encourage the sloughing of necrotic tissues in hoof injuries, fistulous withers, etc., (linseed meal bandage with creolin water). The appli- cation of linseed meal to any wound is not considered good surgery at the present time (Translator). TREATMENT OF THE DIFFERENT KINDS OF WOUNDS.—I. Fresh incised, punctured and lacerated wounds or bites are treated as follows: arrest the hemorrhage; irrigate; disinfect; and drain ; apply an aseptic tampon; suture as muchas possible ; and when practical, apply a bandage. 2. Contused and old, especially suppurating wounds, are not sutured; otherwise they are treated as fresh incised wounds. In many cases of small, old, suppurating wounds, heal- ing by third intention is possible; the modus ope- randi is as follows: trim the margins, irrigate care- fully for a long time, disinfect, remove all necrotic portions, bring the margins of the wound in close apposition by means of sutures (wounds of the head in the horse). When removing foreign bodies or destroyed tissues from con- tused wounds care should be taken not to remove the sound tissue also. This is particularly true of flap wounds (treads on the coronet), where the retention of small flaps of skin is of greatest importance. Contused wounds with pronounced suppuration and tissue necrosis are best treated by means of moist bandages; as open wounds; or with permanent irrigation. 3. Shot wounds are treated according to the same rules of asepsis and antisepsis as those employed for the treatment of ordinary wounds. TRANSPLANTATION 63 As experience in men has proved that bullets are frequently encapsuled, expective treatment should usually be followed, do not favour extraction of the bullet (v. Bergman, Kocher). Probing of the wound is also superfluous ; when the finger or probe are not carefully disinfected it is even dangerous to life (keep the finger and probe away), Shot wounds are best treated as follows: anti- septic occlusion and tamponade; or drainage with- out suture followed by a bandage. If for certain reasons it seems necessary to extract the bullet (phlegmons, pain, high fever, etc.), a simple incision is often all that is necessary ; employ foreign- body forceps, curette, etc., in place of special bullet forceps. 4.' Joint woun iia when fresh, should be carefully disin- fected; sutured; and when possible, covered withan aseptic occlusive bandage. It is not always possible to bandage perfo- rating joint wounds in horses and cattle; in those cases one may use iodoform-collodion, airol paste, and other adhesive materials, the cau- tery may be used to close the wound witha necrotic eschar, per- manent irrigation is alsoemployed. The earlier employed caustic ap- plications in the vicinity of the joint (closure of the wound by swell- ing) are of little value. Suppurating joint wounds in dogs may be drained, irrigated, incised if necessary, and packed with an antiseptic tampon. In horses and cattle they are frequeutly incurable. §. Perforating abdominal wounds require careful antisepsis; reposition of the intestines after thorough disinfection ; ligation and removal of the prolapsed omentum, as well as a double suture. 6. Poisoned wounds (snake poison, rabies, etc.) may be ex- cised ; cauterized ; burned ; or treated with specific disinfectants ; po- tassium permanganate, aqua chlorata, liquor ferri chloridi, and calcium bichromate in the form of sub- cutaneous injections. 7. Wounds that are granulating abnormally are treated with the knife, curette, cautery, caustics (nitrate of silver and chloride of zinc), ointment bandages, tincture of aloes, etc. See treat- ment of ulcers. TRANSPLANTATION.—This was first employed by Reverdin, in the year 1870. It was employed in human surgery to provide a rapid covering for granulating wound surfaces. Thiersch also had a broad experience in the transplantation of epidermis. Formerly, pieces of skin, the entire thickness of the epidermis, were transplanted. At the present time the modus operandi is as follows: the rules of asepsis are very carefully observed ; very thin, superficial sections of the skin are removed with a razor, they extend, however, to the papillary bodies ; these sections are about the length and breadth of one’s finger, they are removed from the upper arm or limb, and are transferred from here to the granulations. The granulations have been previously freshened 64 SUBCUTANEOUS INJURIES OF THE SOFT PARTS with a curette, the flaps of skin are applied without coming in contact with any antiseptics (necrosis of the epidermis), they are carefully re- tained in position by means of sterilized tin foil, a dry or moist band- age (salt solution) is employed for protection. If the transplantation is successful the pieces of skin heal to the granulations by first intention ; about the third day they are vascularized by vessels from thé granula- tion tissue; and the wound is covered through the formation of new epidermis from these artificial islands of skin. A simpler method con- sists in the removal of the epidermis only, from the healthy skin, this being placed on the grantlations. It i also possible to transplant mucous membrane on mucous membrane, as well as pieces of bone with perios- teum and marrow from living young animals to Suan. On the other hand, the transplantation of nerves, muscles, and tendons, from animals to man has not yet been successful. ~~~ —- - The difficulties of transplantion consist in the prevention of death of the removed piece of skin on the one hand, and the difficulty of fixing it to the granulation tissue on the other. The latter is especially diffcnit in animals. Mamadyschski has been successful in horses and dogs with Krause’s method of transplantation. Querruau has successfully treated saddle pressure in the horse by means of trans- plantation. Bayer, on the other hand, has repeatedly employed trans- plantation in horses without results; the great mobility of the skin of the horse hinders exact fixation of the flaps, while the firmness and non-vascularity of the same does not favour rapid growth. Bayer has even retained the flaps by means of sutures and needles without re- sults. Also, the hair on the skin of animals often retards growth. On the other hand, the transplantation of skin and mucous membrane from animals to man is successful; the same is true of the transplantation of spurs to the comb of a cock. SUBCUTANEOUS INJURIES OF THE SOFT PARTS (CONTUSION, LACERATION). I. CONTUSION. DEFINITION AND CausEs.—In contrast to wounds of the skin and mucous membrane, which are always accompa- nied by a breach in their continuity, a contusion is an injury to the soft parts without an external wound. It is caused by pressure from a blunt instrument, the skin, because of its elasticity, remaining uninjured, while the underlying soft parts, especially those covering bone are torn. Contused wounds and contusions are due to the same GRADE OF CONTUSION 65 causes. In every other way they are different, namely, symp- toms, course, treatment, and prognosis. his is due to the fact that contused wounds are open to infection, while in sub- cutaneous injuries of the soft tissues the paths of infection are closed. The causes of contusions in the domestic animals are various. In horses they are caused by pressure from the harness, saddle, bit, shoe, faulty nailing of shoes (corns, inflicted fananies ne feast on the ange deoubitis, etc. In cattle they are caused by horn-thrusts. Bites and chastise- ments frequently produce contusions in dogs. GRADE oF ConTusion.—According to the severity and extent of subcutaneous injuries, different grades of contusions. are recognized ; differentiation being based on the injuries to blood-vessels. The simplest division is that which separates a contusion with preservation of tissue from one that results in necrosis. According to the extent of hemorr- hage the first may be further subdivided into contusions with slight or severe hemorrhage. In general, therefore, three grades of contusion are recognized : 1. Contusions of the first grade are character- ized by a slight amount of hemorrhage. The extravasate may be evenly distributed through the contused tissues (bloody infiltration), orit may occupy small circumscribed foci Cecchy mosis, petechia). 2. Contusions of the second grade lead either to large subcutaneous accumulations of blood (hema-— tomata ), there are also alleged to be dreumseribed et sions of large quantities of lymph (lymph-extrava- sate), orto a superficial accumulation of a large amount of blood '(suffusion). 3. Contusions of the third grade result in gangrenous death ot the involved tissues (necrosis, morttifica- tion). The cause of death is due to the deranged circulation brought about by extensive injuries to the blood-vessels (pri- mary anzemic necrosis). Necrosis may also be due to en- trance of infection from without or through the blood-stream 66 SYMPTOMS (secondary septic necrosis). Experimental investigations have proved that the contusion of itself does not cause necrosis. Complete crushing of the contused parts is sometimes ‘termed a contusion of the fourth grade. MICROSCOPIC CHANGES IN ContTUSsIoNS.—The following condi- tions are found in contusions that are experimentally produced in ani- mals: In contusions of the first grade only a laceration of the loose ‘connective tissue, that which is supplied by the smallest blood-vessels. In contusions of a severe grade there is also laceration of the intercellu- ‘lar substance of the tissues, so that the cells are separated from one an- other. In the severest crushing of the tissues, however, the cells usually remain unimpaired. This explains the fact that crushing, alone, does not result in necrosis (Gussenbauer). SympToms.—Swelling, due to hemorrhage, is the most important symptom (contusion swelling). In contusions of the first grade (bloody infiltration) the swelling is small and diffuse. Large circumscribed swellings characterize second grade contusions (hematomata). Hematomata on the hind limbs of horses become especially large : (larger than one’s head); I observed one case in the region of the udder in a horse in which the hematoma contained 25 liters. Contusions may occur in the following places: skin, mucous membrane, subcutem, subfascia, intermuscular tissues, in the vicinity of | joints, within joints (hemarthrosis), in the tunica vaginalis (hematocele, etc.). Superficial excoriations sometimes occur on the skin over the contused area. As long as the contused swelling contains nothing but extravasate, without any mate- tial injury to the skin, and no infection from without, inflam- matory symptoms are absent. This is true of hematomata and is an accurate means of differentiating between a hematoma’ and an abscess. The consistence of the swelling is usually softer, fluctuation is pronounced, on palpation crepitation may be noted (coagulum of blood). When the contused tissues are rich in nerves, pain may accompany the swelling. This causes lameness when the seat of injury is in the following regions or tissues: hoof, periosteum, muscles, and nerves. Severe contusions of the nerves, Spinal cord, and brain lead to paralysis, insensibility, and unconsciousness. A reflex paraly- sis of the central nervous system may result from severe peri- COURSE 67 pheral contusions (so-called shock). General symptoms are usually absent. Symptoms of anzemia are observed only in Tupture of large blood-vessels. Resorption of extravasate from severe contusions may be followed by febrille symptoms (asep- tic resorption fever), and swelling of the lymph-glands. Fat emboli of the lungs have occurred in man. Inflammation asa result of contusion may result in suppuration and necrosis, it may also assume the form of septicemia. CoursE.—The termination of the blood-extravasate de- pends upon its size, the degree of contusion, and the infection or non-infection of the wound, it is, therefore, variable. The blood may become resorbed, or encapsuled, orga- nization, suppuration, or necrosis may also occur. 1. Resorption, that is, the absorption of the extra- vasate through the lymph-vessels, usually follows subcutane- ‘ous contusions of the first grade; small hematomata are occa- sionally absorbed in the same manner. The component parts are resorbed in the following order : the blood-serum, the dis- solved fibrin, the degenerated white blood-corpuscles, and finally the red blood-corpuscles ; the latter are resorbed partly in toto, partly in a degenerated condition. The resorbed red blood-corpuscles sometimes accumulate in the lymph-glands to such an extent that the latter have an appearance of dark- red swellings. Red blood-corpuscles which remain in the con- tused areas undergo granular degeneration and give off their coloring matter. The latter is diffused in the surrounding tissues and is transformed into a crystalline hematoiden orasoluble choleglobin out of which are developed color- ing matters similar to those found in the gall; green, red, blue, and black (melanin) (Latschenberger). These are visible only in unpigmented skin where they appear in the form of so- called black and blue spots. Later they are resorbed and dis- appear. 2. Organization and encapsulation, so-called, occur in relatively large hematomata. In the vicinity of the hemorrhagic focus there exists, as a result of proliferation of the autochthonous tissue cells, a cellular infiltration with the formation of fibrous connective tissue. This gradually dis- 68 DIFFERENTIAL DIAGNOSIS places the extravasate and, similar to the so-called organiza- tion of a thrombus, forms a connective-tissue indu- ration as the product of an aseptic, interstitial inflamma- tion (tumor fibrosus). When the connective-tissue mass does not displace the extravasate, but the inflammatory process runs a chronic aseptic course around its periphery, as around foreign bodies, the extravasate finally becomes encap- suled by a connective-tissue membrane (blood-cyst, hygroma). This process of cystic formation is frequently observed in dogs. I have observed one case in which the capsule developed in fourteen days. In the horse one occa- sionally finds small, moveable blood-cysts located subcutane- ously in the region of the withers, as well as subcutaneous hygromata with free bodies (corpora libera). Caseous in- crustations, even cartilaginous and osseous degenerations, may result from the organization of a hematoma (othematoma in dogs, subperiosteal hematomata). 3. Suppuration and ichorous ulceration in contused swellings is only the result of the entrance of infec- tious material into the blood-extravasate. A hematoma then, may terminate in an abscess, under certain conditions the abscess may become encapsuled (shoulder abscess). Diffuse bloody infiltrations terminate in phlegmons, necrosis may develop during the course of the latter and, in case of complications, pass into septicemia or pyemia. DIFFERENTIAL D1IaAGNosis.—Contusions run an ex- tremely variable course, they may become complicated with wound infection diseases, and they are often confused with other surgical affections. One must consider tumors, phlegmons, hernia, and fractures (crepitation). It is of great practical importance to differentiate between hematomata and abscesses. One must remember that hema- tomata develop suddenly over their entire area ; abscesses de- velop slowly. A genuine hematoma is not characterized by inflammatory symptoms nor general febrile conditions. The periphery of an abscess is hard, that of a hematoma is fluctu- ating. In doubtful cases one may use the exploratory probe. TREATMENT 69 TREATMENT.—The treatment of contused swellings is variable ; it depends on the degree of the contusion. 1. Slight, circumscribed blood-extrava- sates may be treated with massage, moist heat, and com- pression, as well as counter-irritants. The object being to bring about resorption. 2. Large hematomata are best treated by means of an incision, this should not be made too early. Extirpate encapsuled blood-cysts ; faspiration, with a subsequent injec- tion of tincture of iodine is sometimes effectual. Encapsuled hematomata and hygromata may occasionally be ruptured with force. 3. Necrosis, phlegmon and abscess forma- tion should not be treated with massage. Suppurative and necrotic inflammations are treated according to the rules of antisepsis ; incise, remove the necrotic tissue, drain, and dis- infect. THE Most ImpoRTANT CONTUSIONS OF DomEstTic ANI- MALS.—The following affections are of special practical im- | portance : 1. Contusion of the neck, withers, on the sad- dle position, point of the shoulder, on the ster- num, and in the vicinity of the shoulder in the horse (poll- evil, fistulous withers, saddle galls, sternal and shoulder abscess). 2. Contusions of the upper and under lips (twitch), the skin at the angle of the mouth (bit), and~ ticous membrane of the interdental space of the infe- rior maxilla in the horse. 3. Contusions of the external angle of the ilium, orbital, process, zygomatic region, etc., especially in horses and cattle (decubitis). 4. Hematomata in the gluteal region, especially in the region of the buttocks, on the anterior surface of the carpal joint, and on the inner surface of the metacar- pus in the horse. 5. Bursitis intertubercularis and trochan- terica in horses. 70 LACERATION (RUPTURE) 6. Contused swellings on the elbow in the horse and dog (shoe-boil). In dogs they may occur on the neck, or at the tuberosity of the ischium. 7. Contused swellings on the anterior surface of the car- pal joint in horses and cattle, especially in working oxen (knee tumor). 8. Contused swellings over the tuberosity of the os calcis. in horses (capped hock); the same on the posterior sur- face of the os calcis (curb). g. Treads on the coronet, contusions of the pododerm at the angle of the sole (corns), as well as contusions of the balls of the hoof (sore heels). 10. Hematomata in the vicinity of the udder, anterior and posterior in cattle (milk-vein, posterior abdominal vein). 11. Hematomata and blood-cysts on the throat and back of dogs. 12. Hematomata on the inner surface of the ear muscles in dogs (othematoma, hematoma auris). LYMPH EXTRAVASATE.—This name applies to contused swellings which are not filled with blood, but with lymph ; they are due to lacera- tion of large lymph-vessels (lymphorrhea). According to Gussenbauer they occur when, as the result of a contusion, the skin is raised from the underlying parts (fascia) and slides over the firm subcutaneous struc- tures. In contrast to hematomata, lymph-extravasates result in swellings which develop slowly, so that growth is observed for weeks and even months. The effusion of lymph does not coagulate as long as the skin remains intact. On account of chronic development and inability of thrombus formation, as well as resorption, the prognosis is unfavorable. Hoffman has described two cases in the horse (buttocks) ; he also men- tions having observed one case in the cow and dog (ear). Hoffman further refers the so-called knee tumors in horses and cattle to extrava- sations of lymph. Moller and Bayer contradict the occurrence of pure lymph-extravasates on the posterior limbs of horses and on the ear muscles of dogs ; they point out the possibility of a confusion with hem- atomata. I, myself, have not yet observed a lymyh-extravasate in either the dog or horse, II. LACERATION (RUPTURE). Muscle Ruprurye.—This term indicates a subcutaneous break in the continuity of individual muscles as a result of ET ts pea rena TENDON RUPTURE 71 severe stretching and tension of the muscles, it is due to blunt forces from without, or pronounced muscular contraction (spontaneous rupture): distinguish between this and open muscular wounds. The rupture may be complete or incom- plete. Diseased muscles are predisposed to rupture (idio- pathic muscle-rupture). The symptoms are deranged mobil- ity, the presence of a space or blood-extravasaté at the potiit of rupture, and a hernia (abdominal muscles). Healing fol- lows through resorption of the blood-extravasate and the formation of a connective-tissue cicatrix; there frequently remains a shortening of the muscles (muscle-contracture). Ruptures of abdominal muscles in large animals are usually incurable (ventral hernia). Treatment consists in the applica- tion of a pressure bandage whenever possible. In dogsa skin incision may be made and thé muscles sutured. Muscle-rup- tures are usually seen in horses and cattle. ‘They most fre- quently occur in the following places: the tibialis anti- cus, the rectus, obliquus and transversus ab- dominis; the quadriceps femoris (especially the vastus lateralis); the gastrochnemius; gluteal; the biceps brachii and femoris; the anconeus; the levator humeri; pectoralis minor; longissimus dorsi; psoas; gracillis; infraspinatus; and tensor fascia lata. TENDON Ruprurge.—Tendon-ruptures also, should be dis- tinguished from tendon-wounds, they are subcutaneous breaks in the continuity. The causes are identical with those which produce muscle-rupture. Asa rule they areof external origin (overextension). They may, however, be due to an inner predisposition, such as diseased tendon following inflamma- tion, deranged nutrition, or necrosis (idiopathic ruptures of tendons during the course of suppurative inflammations ot tendon-sheaths, or contagious pleuropneumonia). Complete and incomplete (partial, fibrillar) ruptures are recognized : with reference to the latter, see chapter on inflammation, this being the most frequent cause. Complete tendon-ruptures in the horse most frequently occur in the flexor pedis per- forans, flexor pedis perforatus, flexors of the 72 INFLAMMATION metatarsi, and suspensory ligament; the ex- tensor pedis and achilles tendon are seldom rup- tured. In cattle anddogs the flexor metatarsi and achilles tendon aremost oftenruptured. Thesymptoms of tendon-rupture consist in a peculiar lameness, as well as the occurrence of a space between the ends of the ruptured tendon (this is not present in rupture of the tibialis, and flexor pedis tendon inthe hoof). On anatomical examination one finds a blood-extravasate in the vicinity of the rupture, the ends of the ruptured tendon are fibrous, and covered with blood. Healing follows resorption of the blood, through the formation of a connective-tissue cicatrix from the tendon-sheaths, the paratendineum, and the interfasicular connective tissue; this afterwards takes on the character of tendon-tissue and may finally lead to tendon-contracture. Treatment consists in the application of a plaster-of-Paris bandage; in dogs a tendon- suture may be applied (compare with the chapter on diseases of the tendons). RurTuRE oF Fascra.--Subcutaneous rupture of fascia may lead to the formation of a so-called muscle h ernia, that is, to the protrusion of a portion of the muscle through the rent in the fascia. I have observed many cases in horses on the posterior limbs, on the neck, and on the shoulder (her- nia of the semimembranosus and levator humeri). With ref- erence to rupture of vessels, nerves, and articular ligaments refer to the chapter on diseases of the vessels, nerves, and joints. Le pA “INFLAMMATION, I. NATURE AND CAUSES. NaturEe.—Inflammation is a highly complicated reac- tive process in irritated tissues. According to the investigations or Cohnheim, v. Recklinghausen, Pfeffer, Metchnikoff, and others, the principal changes are as follows : 1. The irritation of peripheral centers of circulation produces, reflexly, a vasodilitation THEORIES OF INFLAMMATION 73 (vasodilators) of the arteries, veins and capillaries of the in- volved tissues ; this is the first change that occurs. 2. Acceleration of the blood-stream occurs with the vaso- dilitation. This is soon followed by a diminished ve- locity in the flow of the blood; finally the flow of the blood is entirely suspended (stasis). 3. When retardation of the blood-stream occurs, the white blood-corpuscles are arranged next to the vessel walls, especially in the veins; while the red blood-corpuscles occupy the center of the stream. At this period the white blood-corpuscles pass through the walls of the vessels (Migration) in the direction of the irritant (che- motropismus, chemotaxis, phagocytosis), whereby cellular infiltration of the inflamed tissue occurs. 4. Asa result of changes in the vessel walls there occurs an active transudation of blood- serum through the diseased walls of the vessels (inflam- matory transudate, exudate), occasionally there is also a passage of red blood-corpuscles through the capillary walls (diapedesis). In this way the so- called inflammatory swelling is produced. 5. Finally, in addition to the emigrated white blood-cor- puscles, the fixed autochthonous connective- tissue cells proliferate (division, proliferation) and take part in the inflammatory process, especially in the cellular infiltration. THEORIES OF INFLAMMATION.—According to recent theories on inflammation the primary process is the irritation of the local vasomotor nerves; the secondary process is the migration of the white blood-corpuscles according to the law of chemotaxis, as wellas the changes which take place in the vassel walls (v. Reck- linghausen). The importance of chemotaxis for the process of emigration of the white blood-corpuscles has been clearly demonstrated by Pfeffer. Formerly the primary, essential processes were supposed to be the changes in the walls of the vessels, the inflammatory exuda- tion, and the migration of the white blood-corpuscles (emigration theory of Cohnheim). Metchnikoff demonstrated the phago- cytic theory whereby the white blood-corpuscles form a protection against the entrance of inflammatory irritants by migrating and de- 74 CAUSES OF INFLAMMATION stroying them (devouring cells). According to Metchnikoff inflamma- tion is merely a “phagocytic reaction” with certain attendant symptoms. Among the old theories of inflammation,.the humoral, cellular and neural theories are of historical interest. Virchow es- tablished the cellular theory of inflammation, according to which, the inflammatory stimuli irritate the cells of the tissues, these hypertrophy and proliferate thus drawing large quantities of fluid nourishment from the blood (attraction theory, nutritive stimuli). The humeral theory of inflammation accounts for the nature of inflammation in changed conditions of the blood (dyscrasia). According to the neural theory the nervous system plays the principal part in inflammation (paralytic and spasmodic theories of inflammation by Briicke, Stilling and others). ’ CausEs oF INFLAMMATION.—The inflammatory stimuli that are operative on animal tissues are extremely variable in their nature. Mechanical, chemical, thermic and infectious causes may prepare the tissues for inflammation. In general inflammation according to causes may be divided into two, practical, very important groups. One group may be termed an aseptic or non-bacterial (non-infec- tious) inflammation; it is caused, not through the action of bacteria, but as a result of mechanical, thermic, and chemical influences (traumatic inflammation, burning, acrids). The other group includes the septic or bacterial (infec- tious) inflammations; they are dué to the activity of micro- Organisms. The following are the most important causes of inflammation : 1. Mechanical irritants (wounds, pressure, con- tusions, strains, ruptures) produce the so-called traumatic inflammations: wound healing by first intention, healing of subcutaneous bone-fractures, muscle and tendon-ruptures, that form of inflammation of the pododerm known as laminitis, non-infectious inflammations of the joints (spavin, ringbone, chronic deforming gonitis, omarthritis and coxitis, chronic podotrochlitis), tendons, tendon-sheaths, mucous burs, and bones. A purely traumatic aseptic inflammation may combine with one that is bacterial and infectious in character (healing per secundam, healing of compound bone-fractures). 2. Thermic irritants in the form of heat and cold. Purely aseptic inflammations of this kind are burns (red- CAUSES OF INFLAMMATION 75 ness, vesicles) and rheumatic inflammations, especially mus- cular rheumatism (non-bacterial inflammation of mus- cle due, simply, to irritation from cold). These thermic aseptic inflammations may afterwards combine with one that is infectious in character (suppurative infection of blisters). 3. Chemical irritants may produce various kinds and grades of inflammation without the aid of bacteria, especially suppurative inflammations. Experimental subcutaneous in- jections of sterilized chemicals (oil of turpentine, creolin, nitrate of silver, ammonia, and legumin) under aseptic precau- - tions, produce an acute suppurative inflammation in the ab- sence of bacteria (Grawitz, De Bary and others). Inflamma- tion due to chemical irritants is of practical importance in ther- apeutics: through the application of irritants to the skin various grades of inflammation are produced for the object of healing (rubefacients, vesicants, pustulants, suppurants). 4. Infectious inflammations are caused by the en- trance of microorganisms into the tissues. There are a great many kinds of bacteria that may cause bacterial or septic in- flammations; namely, staphylococci, streptococci, edema bacillus, tubercle bacillus, glanders bacillus, anthrax bacillus, botryomyces and actinomyces. Examples of infectious in- flammatious are: suppuration of wounds, phlegmons, suppu- rative arthritis, tendovaginitis and pododermatitis.s None of these organisms are mechanical irritants; inflammation is due to their chemical pro- ducts of metabolism (toxins). Leber was the first to discover that infectious inflammation was due to chem- ical irritants. From a culture of staphylococcus he isolated a crystalline chemical substance (phlogosin) that has the pro- perty of inducing inflammation. The so-called parasitic inflammations (sarcosporidia) are of slight significance from a surgical standpoint ; they also appear to be due to the action of chemical bodies (sarcozystin). Finally, certain factors of the disposition have an influence in the production of inflammation (constitution, idio- syncrasy, immunity). 76 KINDS OF INFLAMMATION II. KINDS, SYMPTOMS, AND COURSE OF INFLAMMATION. Kinps oF InFLamMation.—According to the character of the exudate various kinds of inflammation are recognized : 1. Serous inflammation is characterized by a serous, watery, lymph-like exudate containing very few white and red blood-corpuscles. Itis the slightest grade of inflam- ‘ mation ; the blood-vesselsare only slightly changed. It occurs inthe skin and subcutum (inflammatory edema, blisters, dermatitis bullosa); on the serous membranes of the joints, tendon-sheaths, and mucous bursae (serous arthritis, tendovaginitis and bursitis; hydrops of the joints, tendon-sheaths, and mucous bursz) ; as well as on the mucous membranes (catarrhal inflammation). 2. Fibrinous or croupous inflammation is char- acterized by the formation of an exudate that is very rich in fibrin and white blood-corpuscles. As a result of this, .croupous membranes (so-called fibrinous pseudo-membranes) are deposited on the inflamed tissues; leucocytes and fibrin threads make up the essential composition of these mem- branes. If a serous exudate is present at the same time it is termed a sero-fibrinous inflammation. Fibrinous in- flammations most frequently occur on the serosa of the joints, tendon-sheaths, and mucous bursz (arthritis, tendovaginitis, bursitis fibrinosa), on the mucous membranes (membranous conjunctivitis, as well as on the iris (fibrinous iritis of moon- blindness). 3. Suppurative inflammation is a special form which is usually due to an infection with pus-forming bacteria (streptococcus and staphylococcus pyogenes). The suppura- tive exudate is composed partly of emigrated white blood-cor- puscles, partly of proliferated fixed connective-tissue cells. A circumscribed collection of pus in a tissue is termed an abscess. A diffuse suppurative inflammation is termed a suppurative infiltration; an accumulation of pus in joints, or in the cavities of the head, is termed empyema; suppurative inflammation of the mucous membranes, sup pu- trative catarrh; of the mucuous membranes of the eye, SYMPTOMS OF INFLAMMATION ay blennorrhea ; the skin of the external auditory canal, otorr- hea; purulent vesicles on the skin are termed pustules. 4. Diptheritic inflammation consists of a coagula- tion necrosis of the mucous membranes; that is, in a deposit of fibrin in the tissues with necrosis of the cells. It leads, either to the formation of a so-called diptheritic pseudo- membrane, or to a loss of substance (diptheritic ulcers). 5. Hemorrhagic inflammation is characterized by the presence of large numbers of red blood-corpuscles in the exudate, which have left the vessels either per diapedesis of per rhexin. This form of inflammation always involves severe alterations in the walls of the blood-vessels. 6. Necroticor gangrenous (ichorous, putrid) inflammation is characterized by a discolored exudate under- going putrid degeneration (mixed infections with septic bac- teria and putrefactive fungi.) 7. Productive or proliferative (hyperplastic) inflammation runs a chronic course, and results in new forma- tions of tissue (thickenings, adhesions). According to the character of the new tissue it is termed indurated, schlerotic, ossifying, deforming, adhesive, pannous, fungous, verrucose, etc. 8. Specific inflammations correspond to specific in- fectious diseases (tuberculosis, glanders, actinomycosis, botry- omycosis, strangles, anthrax). With reference to erysipela- tous and phlegmonous inflammations see pages 28 and 46. Symptoms oF INFLAMMATION.—The cardinal symptoms of inHenimation aré: heat (calor), redness (rubor), swelling (tumor), and pain (dolor) ; disturbed function (functio laesa) may be added asa fifth symptom. 1. Increased heat is most pronounced in acute inflam- mations. In veterinary science it forms an important sign for the determination of the existence of inflammation, as the in- flammatory redness is frequently invisible. Heat is due to an increased blood-flow, not to an increase in the production of local warmth in the inflamed tissue. 2. Inflammatory redness, in most animals, is usually 78 : TERMINATION OF INFLAMMATION invisible in the skin on account of the hairand pigment in that tissue, on the mucous membranes, however, it is readily ob- served. Redness is due to the dilitation and pronounced fullness of the vessels (inflammatory hyperemia). One distinguishes between injection redness, where only individual vessels ap- pear to be strongly injected, and diffuse inflammatory redness. 3. Swelling is the result of an increased blood-supply and an inflammatory transudate. According to the character of the exudate and the kind of tissue in which the disease is located, the consistence of the swelling on palpation is ex- tremely variable: soft, firm, fluctuating, (abscess, hydrops of the joints and tendon-sheaths), or crepitating (fibrinous arth- ritis and tendovaginitis). Swelling is most pronounced in the widely reticulated tissue of the subcutis, in inflammation of the tendon-sheaths, joints, and glands. 4. Pain is due, partly to the pressure of the inflamma- tory swelling on the nerves, partly to the involvement of the nerves in the inflammatory process (neuritis). Acute inflam- mations of organs that are provided with a rich nerve-supply are extremely painful: skin, pododerm, periosteum, joints, eyes ; chronic inflammations are usually less painful. Sudden relaxation of pain in an acute inflammation indicates a bad prognosis (necrosis of the pododerm). 5. Disturbed function is characterized by lame- ness, suspension of the glandular secretions, opacity of the cornea, etc. There is also a disturbance of the general condi- tion ; this is partly due to the pain, partly to the absorption of febrile producing irritants. CouRSE AND TERMINATION OF INFLAMMATION.—One Tecognizes an acute (existing for a few days), and a chronic course (longer duration, at least four weeks), occa- sionally a peracute (existing a few hours), and a suba- cute (existing for one or two weeks). With reference to the extent of inflammations, they are classified as superfi- cial, and deep (parenchymatous, interstitial,) local or circumscribed, and diffuse or progres- Sive. Finally we have inflammatory primary and secondary foci (metastatic, embolic, general- THERAPEUTIC METHODS 79 ized, that is, an inflammation spread over the entire body through the medium of the blood-stream). The following are the most important terminations of inflammation: 1. The inflammatory product gradually disappears (res- olution) asaresult of the resorption of the inflammatory product through the lymph-stream under the influence of the white blood-corpuscles (phagocytosis, hystolysis). 2. The retention of inflammatory new forma- tions in the form of thickenings, indurations, and adhesions (schlerosis, elephantiasis, tendon callus, exostosis, dermatitis verrucosa, etc. ). 3. Gangrene may result from severe disturbances in the circulation or complications with septic infection. With reference to inflammations of individual organs see chapters on inflammations of the bones, joints, muscles, ten- dons, nerves, vessels, glands, skin, etc. III. TREATMENT OF INFLAMMATION. THERAPEUTIC METHODS.—Those processes which take place in the tissues under the name of inflammation are con- sidered necessary reactions of the body whereby external irri- tants are expelled, and the body again assumes its normal condition through the expulsion of these derangors of its func- tion. Therefore, the inflammatory process, as such, should not be combatted. The essential problem of surgical therapeutics consists in the support of the body in its endeavors towards self-protection and natural ad- justment, rather than in derangement of natural healing by means of improper treatment. Direct etiological methods of treatment are possible only in cases of septic inflammation (antiseptics). In all aseptic inflammations—those not due to bacteria—indirect, symptomatic therapeutics are the only ones to be considered. These consist in the application of rest, heat and cold, massage and cutaneous irritation. Rest.—Rest for the affected part is the fundamental treatment for nearly all painful inflammatory conditions. 5 | { 80 HEAT Mere rest is all that is required for recovery from many inflammations. This is true of distor- sions of the joints, aseptic inflammations of the hoof, and all chronic deforming inflammations of the joints (spavin, ring- bone, gonitis, omarthritis). In any case, rest supports the action of other remedies. Motion is seldom indicated : chronic inflammation, for example, chronic muscular rheumatism. Rest, from a therapeutic standpoint, involves the removal of the cause of inflammation—the inflammatory irritant—the shoe or nail in inflammation of the pododerm ; the saddle, harness, and check-rein in inflammatory conditions of the withers, saddle position, and jaw; irritating foreign bodies from beneath the lid in conjunctivitis; removal of loose pieces of necrosed cartilage and bone in chronic inflam- matory processes (fistula of the lateral cartilage, bone-fistula). Heat.—Heat is indicated in all aseptic forms of in- flammation, but especially for the subacute and chronic inflammations. Heat favors resorption of the inflammatory exudate. This is due to stimulation of the circulation, diffu- sion and migration of the phagocytes, as well as to softening and breaking down of the inflammed tissue. Heat also re- lieves pain by means of relaxation. Moist heat is especially useful in the form of frequently renewed Prieznitz ban- dages. The bandage is applied cold, this produces at first an active contraction of the vessels which is soon followed by pronounced dilitation. Frequent application of this bandage— every three to six hours—regulates the deranged circulation and has a favorable influence on the disturbed general condi- tion (temperature, blood-pressure, activity of the heart, dis- tribution of the blood, and nervous system). Warm poultices (cataplasms) exert a similar action ; they are more diffi- cult to apply to animals (antiseptic cataplasms in inflammation of the hoof). Recent methods of heat therapeutics in man are the hot-air treatment, the hot-engorge ment (Bier), andthe therapeuticsof light (thermic action of red rays, chemical, bactericidal action of blue rays). A new heating apparatus with constant action has been in- vented by Ullman under the name hydro-thermo- COLD 8r regulator; Bayer has recommended its use for the horse. The application of heat is con- tra-indicated in all septic inflammations, especially in septic phiegmons, aswell as malignant edemas; it favors the extension of the process and the multiplication of the infectious material. CoLp.—This is indicated only in septic, as well asin the first stages of acute and very painful inflammations (tendon, joint, and hoof inflammations). “Its action consists principally in a contraction of the dilated blood-vessels (anesthetic and hemostatic action); it also has an_antiseptic action on the microorganisms that cause inflammation. Cold retards the motility of white blood-corpuscles and even stops their migra- tion. The application of cold according to a set of fixed rules is more harmful than use- fulin aseptic inflammations, because the nat- ural healing process of phagocytic reaction is destroyed. According to experiments made by Bayer with employed methods of application of cold, the most pronounced action resulted from permanent irrigation of a shaved area with cold flowing water (water tubes); at the end of one hour the temperature had fallen 20°. A spray of ether reduced the temperature fifteen degrees in ten minutes ; fifteen minutes after the spray had been removed the temperature had returned to normal. Seven to eight degrees was the maximum reduction of temperature from the application of ice bags and Leiter’s tubes. The action of cold baths and cold bandages is very weak ; when changed every five minutes the temperature dropped 3 to 5 degrees in favorable cases; ordinarily the temperature drops only dur- ing the first two or three minutes and then rises again. Cold baths must be frequently renewed, or cold may be applied in the form ofa stream. Applications of clay, which were extensively used at one time are entirely insuff- cient ; like cold baths the temperature is slightly reduced after a few minutes, but soon returns nearly to normal. ‘The fol- ’ 82 MASSAGE lowing is an experimental case : the subcutaneous temperature was 35.7° C., aclay pack of 12.5° C. was applied, the tem- perature sank in five minutes to 32.5° C. In thirty minutes it returned to 34.5° C., and after sixty minutes to 34.9° C. MassaGE.—Massage is a very important form of treat- ment in subcutaneous, and chronic aseptic inflammation ot tendons, joints, muscles, bone, and skin. It is contra-indicated in septic, infectious, suppu- trative inflammations, espétiatty phlegmons, as it favors the spreading of the disease pro- cess. It is also contra-indicated in painful acute inflamma- tions. Four kinds of massage are recognized : 1. Stroking (effleurage). 2. Rubbing (friction). 3. Kneading or malaxation (petrissage). 4. Tapping (percussion). Constant pressure (compression) may also be considered a form of massage. The action of massage con- sists in the removal of the exudate from the diseased and in- flamed tissue; it is mechanically forced into the lymph channels and thus prepared for resorption. The distension and swelling of the inflammatory enlargement are overcome, thus reducing the pain. The circulation, nourishment, and innervation are stimulated. CUTANEOUS IRRITANTS. —The so-called counter-irritant method is of great importance in veterinary science in the treatment of chronic inflammations. Blisters and firing are the most important cutaneous irritants. These are especially useful in chronic inflammations of the tendons and joints, where the results are very satisfactory. Their ac- tion is due tothe transformation of a chronic to an acute inflammation, which makes possible the resorption of the inflammatory product. The cutaneous irritants mentioned produce the following changes in tissues affected with chronic inflammation: dilitation of the blood- vessels; inflammatory transudation of the blood-serum ; migration of the white blood-corpuscles (phagocytosis); for- Imation of ferments (enzymes) out of the white blood-corpuscles, AGENTS THAT OPPOSE INFLAMMATION 83 by which the albumenous bodies in the chronically inflamed tissue are digested in the form of albumenoses (propeptones), and the solid products are softened, thus passing into solution (histolysis). An actual cutaneous irritant exerts a deep influ- ence on tendons, bones, and joints. This has been demon- strated by microscopic examination of tissues following the application of tincture of iodine to the skin. A few hours after the application there occurs an extensive transudation, and emigration of the white blood-corpuscles into the skin and subcutem, as well as into the intermuscular tissue and perios- teum of the underlying bones. These acute inflammations may even reach to the bone-marrow and lead to loosening and solution of the cartilage at the epiphyses (Volkman). AGENTS THAT Oppose INFLAMMATION.—As many in- \ flammations are of an infectious nature they may be effectually combated with antiseptics. In the treatment of deep inflammations (phlegmon, strangles, tendinitis) antiseptics which penetrate the skin must be employed (camphor, car- bolic acid, tar, iodoform, mercury, etc.). Other drugs which find use are the metallic and vegetable astringents; they constrict the blood-vessels, form a protective dry covering, and at the same time disinfect (silver nitrate, sugar of lead, acetate of lead, alum, sulphate of zinc, lime water, tannin, and tannoform). ‘The so-called protective materials have a purely mechanical action (oils, salves, collodion, plaster). Potassium iodide is a specific for antinomycosis. 7 The serum treatment for inflammation and sora 1 infection diseases (antistreptococcic serum) has not proved satisfactory. OPERATIVE TREATMENT OF INFLAMMATION.—In many forms of inflammation, especially the infectious (abscess, phlegmon, ichorous inflammation), incision with subsequent irrigation and drainage is preferable to any other treatment. Against chronic hygromata (capped-hock) injections of pure cultures of staphylococcus pyogenes have been employed ; this results in the formation of an acute abscess which is treated as such (?), In gangrenous inflammation the necrot 1e portions must be removed, it may be necessary to 84 ULCER, FISTULA, GANGRENE amputate (tail, teeth, udder, ear, wings, limbs of dogs). Other operations are scarification, thatis, the local draw- ing of blood by means of incisions or punctures; phle- botomy, at the present time this is employed surgically only in that form of acute, aseptic inflammation of the pododerm known as laminitis. Periosteotomy (artificial accelera- tion of anchylosis formation by means of spavin operation ) was frequently employed at one time for spavin, and chronic periostitis on the metacarpus. ULCER, FISTULA, GANGRENE. I. ULCER, ULCERATION. DEFINITION.—From a surgical standpoint an ulcer may be defined as a wound that has no tendency to heal (Billroth). It may also be termed a chronic, sup- purative inflammation with a tendency to degeneration of the * tissues ; asa continual suppurative degeneration of the granu- lations of the wound. Ulcerative degenerations also exist in tumors as a result of suppurative infection of the new growths (carcinoma). From a standpoint of pathological anatomy an ulcer may be defined as a tissue defect due to necrosis or suppuration. CausEs.—The causes of ulcers are partly local, partly general. Two main groups of ulcers are recognized : 1. A primary and idiopathic ulcer is due to the influence of a continuous inflammatory irritant on the wound. It may be due to shaking the ears after injuries, constant lick- ing of the wound at the point of the tail or on the limbs in dogs. Other causes are irritation due to the presence of foreign bodies in wounds, retained masses of pus, pieces of necrosed bone, cartilage and teeth, continued irritating influ- ence of carious teeth on the neighboring gums. 2. A secondary or symptomatic ulcer is the result of a complication with a suppurative inflammation. To this form belong cancerous ulcers; thoseof glanders, tube reulosis and actinomycosis; the corneal eevrvrue FORMS OF ULCERS 85 ulcers of dog distemper and. diabetis mellitus ; and--the- Senital_ulcers-of-dourine. ae so-called varicose ulcers of man, which occur on the ibia, do not exist in the lower animals ; they are due to an inflammatory vascular engorgement induced by a dilitation of the vetns of the skin, and are very common. On the other hand, the so-called tro phoneurotic ulcers, which develop in man after severe neural disturbances, are also seen in the lower animals (corneal ulcers following paralysis of the trigeminus). Forms oF ULcERs.—According to the character of the granulations ulcers are termed indolent (atonic, torpid, painless), and irritable (erethistic, inflamma- tory, painful). According to the character of the margins ulcers are termed smooth and callus, that is, they have wall- like, firm, cicatricial margins. With reference to the depth they may be superficial, deep, or sinuous (sinuate, undermined), or tube-shaped and fistulous (fistula). Superficial ulcers on the mucous membranes are termed catarrhal or erosion ulcers. According to the character of the surface of the ulcer it is termed hemorrhagic, ichorous, gangrenous, necrotic, diphtheritic, fungoid, (hypertrophic, luxuriative), and phagadenic (cancerous, increasing rapidly indiameter). Serpiginous . ulcers (creeping) are those which move from place to place, healing in one place and extending in another. The following ’ classification is made with reference to the size: miliary (size of a millet seed), lenticular (size of the crystalline lens), those the size of peppers, peas, dollars, ete. With reference to the form, ulcers may be round, oval, or irregular. TREATMENT.—Many ulcers heal simply asa result of test, that is, after the removal of the irritating cause. Ulcers at the ends of dogs ears, for example, heal after the application of a bandage or ear-cap which prevents the shaking of their ears. ‘The same is true of ulcers at the point of the tail, on the extremities, and on the eyes (cocaine). Other methods of treatment are extirpation, cur- 86 FISTULA rettage, firing, or cauterization; they are thus transformed into fresh wounds. The application of such agents as the knife, curet, cautery, chloride of zinc, sublimate, chromic acid, and other caustics is preferable to the use of weaker antiseptics and irritants. Iodid of potash is aninternal specific for actinomy- cotic erosion ulcers of the oral mucous membranes ; necrotic ulcers due to a general diseased condition may be treated with arsenic. Ulcers of glanders are not treated. THE MOST IMPORTANT ULCERS IN DOMESTIC ANIMALS.—Ulcers of surgical importance are far less common in animals than in man. The following are of practical importance : Ulcers at the point of the ear in dogs. Ulcers at the point of the tail in dogs and cattle. Corneal ulcers in dogs affected with distemper. Hoof ulcers in horses (sole or wall). Decubital ulcers asa result of lying. Stomatitis ulcers in dogs. 7. Cancerous ulcers with carcinoma of the skin in horses. and dogs. 8 Ulcers ofthe tongue and lips in horses and cattle. Also, many badly granulating wounds, as well as many treads on the coronet, and pressure injuries inthe region of the saddle, on the withers and on the neck of the horse, may be considered as ulcers. Dy Shee OS) ie Il. FISTULA. DEFINITION.—In surgery many diseases are recognized under the term fistula. One must differentiate between two different processes. 1. Pus fistulae may be regarded as tube-like or sinuous ulcers; they result from inflammatory suppurative foci that form in the depths of the skin, subcutem, muscles, bone, cartilage, and glands, and which reach the surface by a process of gradual ulceration (Billroth). They are, there- fore, the product of a chronic, suppurative, destructive inflam- mation in the depths of the tissues. The inflammation is frequently sustained by the presence of fragments of necrosed tissue (cartilage, bone), occasionally it is supported by the pres- PUS FISTULAE 87 ence of specific microorganisms (botryomyces); the suppurative exudate being discharged through a tube-shaped canal. The following are examples of fistulae; fistula of the lateral cartilage, fistula of the spermatic cord, tooth fistula, fistulous withers, poll-evil, phlebotomy fistula, fistula of the fetlock, coronary fistula, gluteal fistula, sternal fis- tula, pelvic fistula, costal fistula, and other bone fistulae. 2. Secretion and excretion fistulae imply a pathological relation of deeply seated secretory organs (glands) and excretory organs (stomach, intestines, bladder) with the external surface of the body. Tothisclass belong salivary fistulae, lachrymal fistulae, milk fistulae, gastric fistulae, intestinal fistulae, ear fistu- lae, and fistulae of the uterus. They are due, either to traumata, and inflammations (acquired fistu- lae), orthey may havea congenital origin (ear fistula, fistula of the intestines, urinary fistula). When the canal has a free communication with the excretory organ and the exter- nal surface it istermed a complete or communicating fistula, when the canal ends in the tissues it is termed a blind fistula. According to the form of the fistulous tract it is termed a canal, funnel, or lip-shaped fistula. Other forms are skin, mucous membrane, corneal, serous, and tendon- sheath fistulae. Pus FistuLak.—The symtoms of pus fistulae are variable according to their location. The fistulous opening is about the same in all forms; it is usually small, constricted, indurated, pus in various quantities is discharged from it. The walls of the canal may be hard or smooth ; occasionally itis filled with torpid granulations. At the bottom of the canal one can usually feel a rough, hard mass of tissue (mecrosed piece of cartilage or bone). Fistulae are usually painless, as they are the product of a chronic inflammation. They may, however, become complicated with an acute in- flammation—an acute phlegmon for example—under the influ- ence of an injury or an improper operation. 88 SECRETION AND EXCRETION FISTULAE The treatment of pus fistulae is analagous to that of ulcers. The suppurative ulcerative, and badly granulating walls of the smooth, indurated and encapsuled fistulous tract are transformed into clean wound surfaces. One should be particular to remove the necrosed tissue at the fistulous canal. An operation, therefore, is the best treatment for a pus fistula ; open freely to the bottom, remove the necrosed tissues (cartilage, bone, teeth), extirpate the indurated walls and remove the granulations. For this purpose one may use the - scalpel, scissors, curet, bone-forceps, chisel, etc. Tro merely split the fistula or cut around it, is usually insufficient. After splitting, the essential treatment is unperformed : this consists in the removal of the chronically inflamed fistulous walls, and the ulcerative surfaces at the bottom. When operating a pus fistula strict antisepsis is mecessary to prevent infection of the fresh wound surface from the old sup- purative foci. When these principles—upon which Bayer placed special emphasis—are not observed, or when splitting of the fistula is not followed by careful removal of the necrotic, pus-infiltrated tissue; the operation is easily followed by an acute suppurative infection of the previously healthy tissue, an extensive phlegmon is especially liable to occur. One should observe the converse precaution: that, frequently, the operative removal of a fistula appears to be contra-indicated as long as there is an acute‘ phlegmonous inflammation inits vicinity. In such cases the operation must be deferred until the phlegmon has subsided. Moller placed special emphasis on this surgical principal in the operative treatment of fistula of the lateral cartilage, it is necessary to coincide with his view on this subject. When a fistula cannot, or should not, receive operative treatment it may be fired or cauterized, an operation is more rapid and effectual. The mere application of antiseptics is seldom effective. SECRETION AND EXCRETION FISTULAE.—These are readily distinguished from pus fistulae by the fact that, instead PUS FISTULAE 89 of pus, various secretions and excretions are discharged from the opening ; saliva, milk, urine, food, gastric contents, intes- tinal contents and feces. Their healing is much more difficult than that of pus fistulae. The conditions which produce an unfavorable prognosis are: continual pres- sure from the discharging glandular secretions, operations on the stomach and intestines (gastric fistula, intestinal fistula) lead to an opening of the abdominal cavity, when a fistulous process exists this is doubly dangerous. Operations intended to bring about removal of secretion and excretion fistulae are ofa plastic nature, they consist in an artificial scarification and suturing of the fistulous openings. Firing and caustics are seldom effective. In many cases radical treatment is the only method of healing secretion fistulae, such as extir- pation of the secretory gland (extirpation of the parotid in the horse). THE Most Imporrant Pus FISTULAE IN DoMESTIC ANIMALS.— / The following are of practical importance : I. Fistula of the lateral cartilage inthe horse. This is a circumscribed necrosis of the cartilage which usually develops from a parachondral phlegmon and induces a chronic ulcerative condition with one or more fistulous canals leading to the coronet. Treatment: Extirpa- tion of the lateral cartilage (Bayer’s method). 2. Fistula of the spermatic cord in the horse is due to a chronic, suppurative, indurative inflammation of the spermatic cord (funiculitis chronica) and the tunica vaginalis. It is caused partly by the botryomyces fungus (botryomyces of the spermatic cord), partly by ordinary pus cocci. Treatment: Extirpation of the degenerated sper- matic cord (ligature, emasculator, ecraseur). 3. Tooth fistulae occur in horses, especially on the premo- lars of the inferior maxillae; in dogs they are more frequently seen on the upper jaw. They are the result of a suppurative alveolar periostitis, ostitis, and osteomyelitis. Treatment: Extract the tooth. 4. Bone fistulae develop from a suppurative, especially necrotic, periostitis, ostitis, and osteomyelitis. According to their seat they are classified as follows: sternal fistula, pelvic fistula, costal fistula, inferior maxillary fistula (false tooth fistula), fistula of the tail, fistulae of the round bones, etc. Treatment: Removal of the necrotic piece of bone (sequester) by means of chiseling, trepanation, curettage, and firing. Because of the deep seated position of the bone sternal fistulae heal with great difficulty. 5. Fistulous withers and poll-evil exist in the horse as go SECRETION AND EXCRETION FISTULAE a result of contusions; the contusions are followed by phlegmon and necrosis of the skin, subcutem, bursae, fasciae, muscles, and bones, on the withers, in the saddle position, and in the region of the neck. Treatment: Operative removal of all necrotic portions, antiseptic drain- age and irrigation. * 6. Phlebotomy fistulae are supported by a suppurative thrombo- plebititis of the jugular vein. Treatment: Double ligation and extirpa- tion of the diseased vein. THE MOST IMPORTANT SECRETION AND EXCRETION FISTULAE.— The following are of practical importance: 1. Milk fistulae in cows are due to injuries, followed by in- flammation of the udder and abscess formation ; they usually occur during lactation; occasionally they are congenital. One distinguishes between a fistula of the gland and one that leads to the milk duct. Treatment: Scarification and suturing, firing, cauterization, application of a milk catheter, healing is often possible only during the dry period. 2. A salivary fistula is due, either to an injury from without (wounds), or within (salivary calculi), it may be either a fistula of the gland or duct. Treatment: Ligation, scarification and suturing, firing, extirpation of the gland, injection of caustics. 3. Ear fistula (cervical fistula, cervico-branchial fistula) in the horse is a congenital branchial-cleft teratoma at the base of the ear, which contains a tooth (tooth-follicle cyst, erratic tooth). Compare with the chapter on teratomata. Treatment: Extirpation. 4. Pharyngeal and esophageal fistulae are due to external and internal injuries, as well as to perforating abscesses. Treatment: Suture. 5. Gastric and intestinal fistulae are the result of ex- ternal and internal penetrating wounds. According to the seat, and species of animal they are classified as follows: Fistula of the abomasum, rumen, reticulum, small intestine, large intestine, and rectum. A very large intestinal fistula is termed anus praeternaturalis—artificial anus—; vagino-rectal fistula is termed cloaca (anus vaginalis, recto-vaginal fistula) ; a fistula uniting the bladder and rectum is called an anus vesicalis. Treatment: Plastic operation. 6 Cystic and urethral fistulae are both termed uri- nary fistulae. They are acquired (traumatic) or congenital. The following are special forms: vesico-vaginal, vesico-rectal, and vesico-intestinal. In a fistula of the urachus (dropping of urine from the navel) the urine discharges continually from the urachus because the fundus of the bladder is not closed. Other forms of fistulae are lachrymal fistulae, corneal fistulae, fistulae between the oral and nasal cavities. GANGRENE gr Ill. GANGRENE. NECROSIS. DEFINITION AND Kinps.—The term gangrene (necrosis, mortification) indicates death of groups of tissues, as well as local tissue death. In surgery various kinds of gan- grene are recognized, in especial, dry gangrene (gan- graena sicca) or mummification, and moist gangrene (gangraena humida) or maceration (liquefactive degene- ration). When accompanied by symptoms of inflammation it is termed hot, otherwise, cold gangrene (sphacellus). The colonization of putrefactive organisms (saprophytes) on moist gangrene resultsin putrid gangrene (putresence). Ichorous or phagedenic (phagedena) gangrene is termed putrid, progressive gangrene. Gas gangrene (gangrenous emphysema) is caused by a mixed infection with gas-producing bacteria (bacillus phlegmonae emphysema- tosae, gas-generating varieties of bacterium coli). A circum- scribed bone necrosis is termed a sequester; certain lique- factive processes on the bones and teeth are termed caries. Gangrene of the mucous membrane is termed diphtheria. Superficial, dry, gangrenous areas are termed eschars. So-called coagulation necrosis isa special anatomical form of gangrene. One further differentiates: gangrene of the skin, podo- derm, subcutem, bone, muscles, tendons, mummification and maceration of the fetus, a circumscribed and progressive, an infectious and non-infectious (septic and aseptic) gangrene. CAUSES OF GANGRENE.—1. Mechanical inter- ruption of the circulation is one of the most fre- quent causes of gangrene. Uninterrupted compression, or that which is combined with destruction of the tissues (pressure, contusions, strangulations, incarcerations) causes gangrenous death as a result of anaemia, especially when combined with injuries to blood-vessels (pressure necrosis, decubitis). The statement has already been made under contusions, that mechanical destruction, alone, does not result in cellular death. Ligatures, thrombus formations, emboli, as well as diseases of the walls of arterial vessels produce results similar to those of g2 CAUSE OF GANGRENE compression ; they cause an interruption in the exit of the venous blood (anaemic necrosis). Death of the skin and muscle occurs in from ten to twelve hours after the circu- lation has been stopped; anaemic necrosis of the intestines follows complete interruption of one or two hours (incarcerated hernia). Bone and cartilage are the least sensitive. Derange- ment of the circulation due to hyaline thrombosis of the branches of the peripheral arteries may result from gangrene (mummification of the extremities) due to ergot-poisoning (ergotism). 2. Chemical causes of necrosis include the caustics. Their action is variable. The metallic caustics (sublimate, chloride of zinc, chromic acid, sulphate of copper) destroy the tissue cells through the formation of a precipitate of metallic albumenates, and freeing of the acid compounds. The caustic acids (nitric acid) produce an eschar formation through the coagulation of albumen ; they also destroy cells by absorption of water (sulphuric acid). The alkalies (caustic potash, lime, ammonia) transform the albumen of the tissues into a slimey, pulpy mass (alkali albumenate). Formaldehyde produces a dry, horn-like, very deep necrosed area. Snake poisons, as well as many: infectious materials, may produce necrosis by their chemical action. 3. The following thermic influences are classified as causes of necrosis: high degree of heat (burning, com- bustion), and cold (freezing, frost- gangrene, congelation). The so-called third grade of burning and freezing is nothing but necrosis. There is a great difference in the susceptibility of different tissues to thermal influences, a loop of intestine, for example, dies in a few hours when ex- posed to an increased temperature of 8° C. 4. Many infectious irritants cause so-called gangrenous inflammations. Death of the tissues is due partly to the chemical action of bacterial toxins, partly to their derangement of the circulation. The ordinary pus- forming bacteria—streptococci and staphylococci— have the ability during the course of a suppurative inflamma- tion, namely, phlegmon, to produce necrosis (necrosis of the NECROSIS BACILLUS 93 lateral cartilage during the course of a parachondral phlegmon). The necrotic action of the following septic bacteria is especially strong: necrosis bacillus, anthrax bacillus, blackleg bacillus, edema bacillus, glanders bacillus, the bacteria of hog cholera, swine plague, and swine erysipelas (necrosis of the skin in swine), malignant foot rot, gangrenous eczema, gangrenous pox, the so-called gan- grenous erysipelas of sheep and swine, infec- tious diseases that are characterized by diptheria of the mucous membranes, as well, as many cases of pete- chial fever in the horse (necrosis of the skin, mucous membranes, the nasal septum, the prepuce, and even the articular cartilage. ) , Also many fungi (necrosis fungi), especially tilletia caries, ustilago carbo, ustilago maidis, and polydesmus exi- tiosus, produce necrosis on the skin and mucous membranes of cattle, horses, and sheep. The buds of buckwheat seem to produce gangrene in a similar manner (fagopyrismus), the same is true of lupinosis in horses, and clover-disease, as well as the so-called gangrene of white spots. Necrosis of the skin and mucous membranes has been observed in the horses ot Batavia as a result of the colonization of amould (hyphomycosis destruens equi). 5. Frequently several causes are operative at the same time. Pressure necrosis in horses and cattle may follow relatively slight mechanical insults when a severe general disease exists at the same time. This is especially true of diseases of the circulatory apparatus (fever, septicemia, diseases of the blood, anaemia, cachexia, cardiac diseases, general exhaustion). The following types of gan- grene present similar conditions: gangrene of old age (gan- graena senilis), the so-called sugar gangrene (gan- graena diabetica), and that which follows diseases of the spinal marrow, so-called symmetrical gangrene. NEcRosIS BACILLUS.—Under this name Bang described a bacillus that had already been observed by LOfflerand Schmorl; it occurs in a great number of disease processes, partly as a cause, partly as a concurrent symptom (mixed infection). It is an ubiquitous bacterium, 94 SYMPTOMS especially in the intestinal contents, the feces, in dust and dirt; in the tissues it causes coagulation necrosis, and diph- theritic, ulcerative degenerations. It belongs to the filiform bacteria (‘‘streptothrix necrophora’’), and develops, partly in the form of rods, partly as a coccus, and partly in the form of long filaments—as long as 100 microns; on staining it presents clear, round or cylindrical spaces. It is an anaerobe, non-motile, and without flagellae (Ernst). With Loefflers solution of methyeline blue or carbol- methyeline blue, recognition is easy; it is decolorized by Gram’s method. It grows best in coagulated serum as well as in semi-solid media at 39° C. House mice are specially sensitive to inoculation; after subcutaneous injection there develops an extensive necrosis of the tissues, which results in death in the course of a week. The fol- lowing conditions are caused by subcutaneous injections into the ear of a rabbit; extensive necrosis with thrombus formation in the large veins, embolic foci in the lungs, secondary pleuritis, occasionally necrosis in the heart and other organs. Injections in cattle, sheep, and swine result only in local swelling and abscess formation (Ernst). Bang and Jensen have found the necrosis bacillus in the following places: i. In the HORSE as a cause of gangrenous dermatitis (grease), fistulae of the lateral cartilage, coronary fis- tulae, and in diptheria of the mucous membrane of the colon. 2. In CATTLE asacause of panaritium, gangrenous pox, diphtheria of the uterus and vagina (also demonstrated by Ellinger), in mecrotic inflammation of granulating wounds,in calf diptheria, in necrosis nodosa multiplex of the liver, abscesses of the liver, and embolic necrosis of the lungs and heart. 3. InSwINE in necrosis of the skin, diphtheria of the nasal mucous membranes and oral mucous mem- branes, as well asin necrotic foci of intestines and lungs in swine plague. 4. In RABBITS Schmorl has observed a contagious, progressive, necrotic inflammation caused by the necrosis bacillus. It was ushered in with pronounced swelling of the head (under lip) which extended to the neck, thorax, and abdomen, and terminated fatally in from 12 to 16 days. Symptoms.—Dry gangrene is characterized by dryness of the dead tissues. The necrotic skin appears to be covered with dried secretions, it is‘scabby, leathery, parchment-like, sometimes as hard as horn, from brown to black in color, cool and non-sensitive. Dry gangrene is most often seen in the following places : on the back from saddle pressure, decubital SYMPTOMS 95 gangrene on the external angles of the ilium, zygomaticus, etc., at the point of the tail in dogs, on the claws of cattle, on the cornea, following cauterization with nitric acid and formal- dehyde, after death and drying of the fetus in the uterus (mummification). Moist gangrene presents the following symptoms: the necrosed tissue has the appearance of a slimey, soft, slushy, pulpy or ichorous, bloody mass; in color it may be grayish- yellow, grayish-brown, dark-yellow, dark-brown, brownish- green, grayish-green, violet, or black. A necrotic lateral cartilage is of a beautiful light-green color (bacteria which form coloring matter). The necrotic masses of ‘tissue are usually cool and non-sensitive (cold gangrene). When inflam- mation exists at the same time they have a warm sensation (hot gangrene). Stinking, putrid gases occasionally develop in the dead tissues (sulphide of hydrogen, hydrocarbons, hydrogen, ammonia, carbonic acid), they cover the external skin in the form of blisters, or produce a frothy condition of the ichorous mass (gangrenous vesicles, gangren- ousemphysema, emphysema septicum). The gangrenous dead part is separated from the sound tis- sue through a reactive, suppurative inflammation under the for- mation of granulation tissue (demarking inflammation, line of demarcation, zone of necrosis). When the gangrenous process extends to the walls of the large ves- sels it may result in a gangrenous erosion of the vessel-wall and lead to severe arterial and venous hemor- rhage. The general condition is also frequently affected (septic and pyemic affection). Moist gangrene is most often found during the course of septic phlegmons, on the pododerm, coronet, flexor surface of the fetlock (gangrenous eczema), in the saddle, withers and neck region, on the lower parts of the extremities, on the inferior margin of the lower jaw and tongue in the horse; on the udder of the cow, sheep and goat, on the scrotum and tail of cattle and dogs, as well as on the fetal membranes (putrid degeneration following retention), and in the fetus (putrid emphysematous and macerated fetus). 96 ' TREATMENT TREATMENT.—Treatment of necrosis consists in oper- ative removal of the necrosed part (knife, scissors, curet, forceps, chisel, trephine, etc); occasionally amputa- tion of an entire organ of the body is necessary (tail, end of the tongue, penis, udder, claws, ears, limbs of dogs). Slough- ing of the dry gangrenous masses may follow the application of antiseptic cataplasms. Above all, thorough and con- tinuous disinfection is necessary. To prevent decubitis in horses and cattle use plenty of soft bedding (tan-bark, sand). AtropHy.—Atrophy isa reduction in the size of organs, as well as individual cellular elements; it is due to deranged nutrition and pathological retrogression. (Aplasia is complete failure of organs, the testicles, forexample). From an etiological standpoint the following kinds of atrophy are recognized in surgery : 1. Atrophy of inactivity is the result of inactivity of organs, especially the muscles and glands. The cells, because of inac- tivity, cease to assimilate (active atrophy). Compare with chronic lameness in the horse that is usually accompanied by active muscular atrophy, as well as atrophy of the penis in phimosis (high urinator). 2. Pressure atrophy is the result of continued compression of organs, for example, from new formations (passive atrophy). This is seen on the os pedis as a result of keratoma. 3. Degenerative atrophy is due to deranged nutrition accom- panying the course of an inflammatory process, for example, in the udder and eye (atrophy and phthisis bulbi in moon blindness and sup- purative panophthalmia); in muscular inflammation of the quadriceps, anconeus, and longissimus dorsi (inflammatory atrophy); it may also follow paralysis of the nerves, for example, the suprascapularis (muscles on the external surface of the scapula), the trigeminus (mus- cles of mastication), the spinal marrow (posterior limbs) (neurotic atrophy). This is not usually a form of simple atrophy ; degenera- tive changes usually occur. Other forms are senile atrophy, the so- called lipomatous atrophy of the muscles (obesity), and the udder (fleshy udder). For further data concerning atrophy compare with the chapter on diseases of the muscles and bones. ATRESIA. OBLITERATION.—These terms indicate the closure or growing together (adhesion) of body openings and canals. 1. Atresia is a congentital malformation. It occurs in animals in the following places: rectum (atresia ani), on the eye lids (atresia palpebrarum), in the milk canal and milk cystern, as well as in the lachrymal duct. 2. Obliteration is an acquired cicatricial adhe- sion; it results from wounds andinflammatory processes STENOSIS 97 in the vagina,on the vulva on the sphincter of the teat, in the com- miissure of the lids, as well as in the vessels in thrombus formation, which terminate in a form of cicatrization. In the female genital canal there occasionally occur adhesions in the vulva and vagina after injur- ies during coitus and parturition. Adhesions at the mouth of the teat and in the milk cystern with the formation of folds in the walls are more common’; they are caused by injuries, eczema, contagious aphtha, and catarrhal mastitis. Treatment of atresia and cicatricial adhesions is operative (perforation, teat probe, milking tube, bougies). STENOSIS.—Stenosis is a narrowing of the canals and cavities of the body, especially the following: esophagus, trachea, urethra, vagina, in- testines, milk ducts, salivary ducts, nasal cavities, maxillary sinuses, the frontal sinuses, and intestines. According to the cause the following forms of stenosis are recognized : I. Compression stenosis. This is due to pressure of new formations or abscesses from without on neighboring canals; for ex- ample, the trachea (goitre) ; on the esophagus (tuberculous new forma- tions in its vicinity) ; on the rectum (paraproctal abscesses and new formations, tumors of the prostate). 2, Obturation stenosis consists of a narrowing or stenosis _of tke canal from within through foreign bodies or new formations. Examples of this are: obliteration of the esophagus from the retention of food (pieces of turnips or potatoes); obstruction of the urethra by calculi; of the salivary duct by salivary calculi; of the intestines by intestinal calculi; narrowing of the lumen of the trachea after fracture of its cartilage (infraction) ; stenosis of the teat canal in cattle from wart-like new formations, connective tissue, and epithelium, frequent ring-like growths of the mucous membrane (so-called hard milkers) ; stenosis of the lachrymal duct as a result of catarrhal swelling of the mucous membrane ; stenosis of the nasal, frontal, and maxillary cavities by new formations by which they are occasionally entirely filled ; stenosis of the external auditory canal in dogs by papillomata. 3. Cicatricial stenosis or stricture is due to a cicatricial retraction following a previous injury or inflammation. It is seen in the trachea after tracheotomy, in the esophagus after esophagotomy, in the urethra after urethrotomy, in the vagina following injuries due to coitus and parturition, in the teat canal as a result of wounds and chronic inflammation (chronic mastitis), in the false nostrils following injuries with a severe loss of substance. 4. Congenital stenosis is seen, especially in cattle, in the teat canal and at the passage from the milk cystern to the teat canal ; occasionally all four teat canals are abnormally narrow (hard milkers). In cows one also occasionally finds congenital stenosis of the vagina (dystocia). A similar condition is observed in the lachrymal duct of the horse. 98 TUMORS ’ Spasmodic stenosis is very uncommon (spasmodic contraction ‘of ‘the esophagus). “Eerasta. DILITATION.—These terms indicate an enlargement of canals and body-cavities ; the condition is exactly opposite to that pro- duced by stenosis. According to the anatomical form the following varietiesare recognized: diffuse and circumscribed (diverticu- jum), cylindrical, spindle-shaped, and sac-like. There isalso a genuine anda false ectasia. From an etiological stand- point the following are recognized : 1. Pulsion-diverticulum formed by outward pressure from an object within the canal: food above a stenosis of the esophagus retained urine from a stenosis of the urethra. Here also belong dilita- tions of the cavities of the head in hydrops. ‘2. Traction-diverticulum is due to a retracting cicatrix from without. To this class belong macrostomia as aresult of extensive injuries to the angles of the mouth. : i Vv a ‘ TUMORS. I. GENERAL CONSIDERATIONS. DEFINITION.—From a surgical standpoint, in a restricted sense, one usually understands a tumor to be an atypi- cal new formation not the result of inflamma- tion; it has no assignable cause nor physio- logical termination; it has no anatomical type, thatis,it varies from thetype of tissue from whichit develops (Cohnheim, Ltcke). This definition does not include the inflammatory new forma- tions of tissue (hyperplasia), or the so-called infectious granu- lation tumors (tuberculosis, actinomycosis, botryomycosis, glanders). A complete understanding of the nature of tumors has not yet been acquired. CLASSIFICATION.—From a clinical standpoint one first differentiates between malignant and non-malignant tumors. Carcinoma and sarcoma belong to the malignant type. They are malignant for the following reasons: they develop rapidly with a destruction of the neighboring tissues, they have a tendency towards ulcerative degenerations, and they are especially distinguished for the formation of metas- tases in distant organs. The metastatic formations are pro- CONNECTIVE-TISSUE TUMORS 99 duced in the following manner: small portions of the tumor {cancer cells) first enter the lymph-channels (locai lymph gland metastasis) and from there find their way into the blood-stream (general metastasis of the lungs, liver, and other internal organs). Occasionally the cancer cells enter directly into the veins that are located in the tumor (jugular) and thereby gain entrance to the blood-stream. Aside from meta- stasis, malignant tumors may spread by continuity, contiguity, and dissemination (proximity, contact, becoming detached and forming new colonies). The histological classification of tumors depends upon their microscopic condition. ‘Tumors are composed of cells, connective tissue, and blood-vessels. Various groups and varieties have been formed with reference to the cells which go to make up the principal parts of the tumor. Fol- lowing this classification according to Waldeyer they fall into two large groups: 1. CONNECTIVE-TissuE Tumors, (desmoid growths of Waldeyer, histoid growths of Virchow). They are composed principally of cells from the middle germ layer. They may possess the structure of connective tissue (fibroma, sarcoma), of fatty tissue (lipoma), mucous tissue (myxoma), cartilage (enchondroma), bone (osteoma), muscles (myoma), the vessels (angioma), or the nerves (neu- roma). Frequently these tumors have no typical structure, but are a mixture of various types, so-called mixed tumors. 2. Eprtuenia, ‘Tumors, (epithelial growths of Waldeyer, organoid tumors according to Virchow). They are composed principally of epithelial cells from the inner or outer germ layer. Carcinomata and adeno- mata are the principal representatives of this group. e HISTOLOGICAL CLASSIFICATION OF TuMORS.—Virchow divided the tumors in general into extravasation or exuda tion tumors (hematoma, hygroma), retention tumors (mucous cysts, athero- mata) and proliferative tumors, or tumors in the narrow sense. The tumors, in the narrow sense, regardless of whether they contained one or several varieties of cells, were classified by him as follows: (a) 100 CAUSES HISTOID tumors: fibroma, lipoma, enchondroma, osteoma, myxoma, myoma, neuroma, angioma, sarcoma; (b) ORGANOID tumors: carci- noma; (c) TERATOID tumors: dermoid cysts. Cohnheim, with whom Tillman and others coincide, distin- guished : (a) tumors formed according to the type of connective- tissue substance (desmoid tumors according to Waldeyer): fibroma, lipoma, myxoma, chondroma, osteoma, angioma, lymphan- gioma, endothelioma, lymphoma, sarcoma, and mixed tumors of the types named ; (b) tumors of the type of muscle tissue (myoma); (c) tumors of the type of nerve tissue (neuroma, glioma); (d) tumors of the type of epithelial tissue (epithelial growths ac- cording to Waldeyer): carcinoma, adenoma, cystoma, epithelioma, onychoma, teratoma. CausEs.—Nothing definite is known concerning the origin of tumors. Among the numerous theories of tumors the following are worthy of mention. 1. According tothe EMBRYONIC THEORY of Cohn- h ei m the existence of tumors, especially cancer,may be referred toproliferation of embryonic tissues; thereisan excessive formation of this tissue during fetal development, or an aberration of its physiological coherence whereby it is changed into other tissue. These embryonic cells remain un- developed in most individuals; in others growth may be stimulated as a result of injuries, mechanical or chemical irri- tants, hyperemia, or inflammation.The inheritance of many tumors, as well as the existence of desmoid cysts in the inner organs (misplaced epidermal cells in the ovaries), are best explained by this theory. Ribbert has modified the theory as follows: the cells or cell groups loose their cohesion, not only before but also after birth, become isolated and finally develop into tumors. 2. The IRRITATION THEORY depends upon a previ- ous inflammation, as well as traumatic influences. ‘The exter- nal irritant causes a mechanical loosening of the cells and results in an inflammatory proliferation of the connective tissue. The detached cells (epithelial cells for example) may proliferate un- restrained into the lymph-spaces. Chemical irritants and para- sites also cause loosening of the cells through the production: of connective-tissue proliferations ; the cells become isolated and proliferate. The development of papillomata after inflam- ETIOLGY OF TUMORS IN ANIMALS Io! mations of the skin, of sarcomata after bone fractures and of cancers from a cicatrix, are cited as examples of this method of tumor formation. G 3. According to the INFECTION THEORY, either microorganisms are the direct or essential causes of the tumor (carcinoma, sarcoma, papilloma), or through certain influences the sound tissue cells take on an infectious character. The infec- tion theory is supported by the analagous infectious tumors : experimental inoculation (sarcoma, carcinoma), as well as by the process of metastatic formation. Unobjectionable proofoftherelations between microdrganisms and tumors has not yet been presented; thisis especially true of sarcomata and carcinomata. 4. According to the AGE THEORY of Thiersch, age has the following relation to the existence of tumors: In old age the resistance of the connective-tissue stroma is less than that of the proliferating epithelial cells. Cancer is the result of a ‘‘shifting of boundaries, and a boundary war of the epithelium against the ‘connective tissue’? (Boll). The change of the cell char- acter (anaplasia), duetoa stimulus of the prolif- erative force of the cells, results from the fact that in ‘old age the dependence of individual cells upon their sur- roundings (altruism) is diminished; they become similar to the original, non-differentiated germinal cells (Hanse- mann). For further information concerning the etiology of ‘cancer compare with the chapter on carcinoma. ETIOLOGY OF TuMORS IN ANIMALS.—Upon this subject little is ‘known. Many theories of medical science find place, with nothing further to support their claims, in veterinary science. Thus Plicque maintains that pressure from the bit causes carcinomata on the lips -of horses; that they are caused in cats by the repeated bites of smaller. animals (!!). In Germany these observations have not yet been made. Also the further theory, that subcutaneous fibromata are often the result of pressure from the saddle does not seem to be proved, it is not a genuine tumor, but a contused swelling (tumor fibrosus). Smith and Washburn attempted to produce infection in eleven bitches by means of coitus with a dog affected with sarcoma of the penis; it is alleged that the experiment resulted in sarcomatous nodules in the vagina. They have also transmitted sarcoma to other animals by means 102 CLINICAL SYMPTOMS of subcutaneous injections (?). With reference to the professed heredity of melanoma in horses, and cancer of the mammae in dogs, nothing definite is known. On the other hand, on the basis of my own experience, I am able to confirm the allegations of Plicque, that. young dogs seldom or never suffer from carcinomata, while old dogs are frequent sufferers from this affection. In at least 262 carcinomata in dogs I have never seen one in an animal less than two years of age. Also the 49 cases of carcinomata claimed to have been demonstrated in cattle (inner canthus of the eye) by Loeb and Jobson were con- fined exclusively to animals over six years of age. With reference to. the igfluence of nourishment it may be said that animals fed on a meat diet"are possibly predisposed to carcinoma. According to our experience dogs suffer from cancer more often than swine or cattle. Carcinomata are also common in horses. The claim of Trasbot, that cancer can be experimentally produced by feeding nourishment rich in albumen, is more than problemetical (compare with the chapter on car- cinoma). CLINICAL Symptoms,.-—According to the character of the tumor and the various stages of its development, these are extremely variable. Cf: ‘‘Special Forms of Famors.’’ The development may be rapid or slow; it may proceed from the center of the growth (concentric development, growth by in- tussusception) ; or from the periphery (eccentric growth, growth by apposition). In the first case the tumors are cir- cumscribed, in the latter they are diffuse or accompanied by daughter tumors. Tumors are often observed undergoing changes known as regressive metamorphosis; namely, fatty degeneration, caseation, calcification, cornifica- tion, chondrification, and ossification, mucous, colloid, and cystic softenings, deposits of cholesterin, amyloid degenera- tions, and pigment formation, When tumors become infected they react as do other tissues, becoming inflamed, ulcerative, necrotic, and ichrous. The general-condition is not affected in non-malignant new formations (fibroma, Hpoma, papilloma, osteoma, etc.). Malignant tumors on the other hand, espec- ially carcinomata, in addition to metastatic formation result in a general derangement of the nutrition ; this is char- acterized by emaciation, anaemia, hydraemia (cancerous. cachexia), in which important nourishment is removed from the body on the one side, and toxic materials are taken up by the blood on the other (auto-intoxication). As. DIAGNOSIS 103 a result of ulceration of their surfaces many growths are hemorrhagic: chronic epistaxis in ulcerative angioma, adenofibroma, and carcinoma of the nasal septum of the horse ; chronic hematuria in carcinoma of the bladder in dogs. Finally tumors may cause secondary derangements of neighboring organs by compression (melanoma of the parotid region, of the rectum, on the tail; tumors in the air passages, in the brain, in the spinal marrow, in the vicinity of large vessels). -DiaGnosis.—The diagnosis of a tumor as such, that is, differentiation from other swollen conditions, especially inflammatory, is not dificult. Tumors usually develop slowly and without inflammatory symptoms (pain, increased heat). Hema- tomata are differentiated from new formations by their rapid, sudden formation. In contrast toa phlegmon or abscess, inflammatory symptoms usually fail in the devel- opment of tumors, this is especially true of pain and in- creased heat. Only chronic hyperplastic inflammatory pro- cesses ate able, under certain conditions, to simulate tumor formation to such a degree that diagnosis becomes extremely difficult. Examples of this are seen in the wart-like forma- tions which follow dermatitis chronica on the flexor surface ot the fetlock (dermatitis verrucosa), in the formation of exos- toses after periostitis, as well as in keloids in a cicatrix. DIFFERENTIAL DiaGnosis.—The differential diag- nosis of individual tumors is more difficult. A classification of tumors can seldom be made on their macro- scopic appearance; a microscopic examination is more valuable for making the special diagnosis. For making a purely clinical macroscopic examination the following points are of value: a 1. The seat of the tumor with reference to the nature of the tissue involved is often an index to its character. According to experience, fhe penis, the testicles, and the mammae are frequently seats for the development of carcino- ma, sarcoma, and adenoma; the periosteum for osteoma and sarcoma; the spermatic cord for botryomycoma ; the skin for 104 DIFFERENTIAL DIAGNOSIS fibroma, carcinoma, and papilloma; the subcutem for lipoma and fibroma; the nasal cavities for myxofibroma and adeno- fibroma; the maxillary and frontal sinuses for sarcoma and carcinoma; the nerves for neuroma. 2. Occasionally the size and development of the tumor is an index for its diagnosis. The malignant tumors are usually larger and develop more rapidly than the non- malignant. Sarcoma and botryomycoma in the horse some- ,times develop very rapidly and attain an immense size. In the horse many sarcymata of the eye have a formidable devel- opment. Soft fibromata are characterized by a relatively rapid growth. Occasionally it is important to note whether the tumor is single or developing in several places. Papilloma and fibroma have a tendency to the production of multiple new formations (papillomatosis, fibromatosis), this is also true of botryomycoma. Sarcoma, carcinoma, and actinomycoma are multiple when metastatic formation results in gen- eralization (sarcomatosis, carcinomatosis). 3. The surface of the tumor is rough in papilloma, botryomyconia, and carcinoma ; lobulated in lipoma ; compara- tively smooth in many sarcomata and fibromata. 4. The consistency is softest in round-celled sar- comata, soft fibromata, lipomata, and myxomata, as well as in many cysts ; carcinomata and hard fibromata are more firm ; en- chrondromata and osteomata are as hard as cartilage arfd bone. 5. The relation of the tumor to the skin ortothe neighboring tissues, is of great diagnostic importance in malignant new formations (sarcoma, carcinoma) as they have a strong tendency to include the surrounding tissues in their processes of degeneration. They are, there- fore, less sharply defined than the non-malignant tumors (fibroma, lipoma, papilloma) ; carcinomata frequently present superficial ulceration. Carcinomata and sarcomata frequently attack deeper underlying tissues, even involving the bone. 6. Under certain conditions the race may be of im- portance. In cattle actinomycotic and tubercular new forma- tions are common; in horses, botryomycomata ; in dogs, car- STATISTICS 105 cinomata. Grey horses are frequently affected with melanosarcoma. 7. In doubtful cases age may be of importance in the diagfiosis of cancer; young animals are seldom affected with cancer, on the other hand, they are frequent sufferers from sarcoma, lipoma, and papilloma. 8. Swelling of the neighboring lymph glands is characteristic of malignant new formations, this is especially true of cancer and sarcoma (metastasis). STATISTICS.—With the assistance of the statistical publications of J ohneand myself,as well as the clinical annuals of the veterinary schools at Berlin, Munich, and Dresden, Casper has arranged statistics on tumorsin the domestic animals from various points of view (Pathologie der Geschwiilste bei Tieren. 1899). Among 86,000 diseased horses, 1131 (1.3 per cent) were affected with tumors; among 85,000 dogs, 4029 (4.7 per cent) were similarly affected; among 5,000 cattle, 102 (2 per cent) were affected with new formations. In the years 1886-1894, I operated on 643 new formations in dogs. Of these, 262 (40 per cent) were carcinomata and adenomata; 97 (13 percent) fibromata; 65 (10 percent) papillomata; 44 (7 percent) sarcomata; 39 (6 per cent) lipomata; 2 (0.3 percent) angiomata. In the years 1895-1902, I operated on 200 cases of new formations in the horse; 25 percent’of these were sarcomata, 20percent botryomycomata and fibromata, andio percent were carcinomata. Therefore, sarcoma, botryomycoma, fibroma, and carcinoma are the most frequent tumorsin the horse. These four kinds of tumors form three-fourths of all new formations in the horse. They are more frequent than cicatricial keloids, keratomata and papillomata. The following are the least common: lipoma, genuine osteoma, atheroma, adenofibroma and myxo- maof the nasal mucous membranes. The statistics of the Pathological Institute (Casper, Johne), which include new forma- tions of the internal organs that are not observed by the surgeon, afforded facts in accordance with clinical observations: that carcinoma is much more frequent in dogs than in horses or catttle ; and that in the two latter species sarcoma is more frequent than carcinoma. Among 123 new formations in the horse, 60 were sarcomata (47 per cent), 28 car- cinomata (22 per cent); among 93 new formations in the dog, 48 were carcinomata (52 per cent), 26 sarcomata (28 per cent); among 104 new formations in cattle, 36 were sarcomata (35 per cent), 28 angiomata (27 per cent), 8 carcinomata (8 per cent). With reference to the topo- graphical distribution of tumors the following observations were made: carcinomata were most often found in the kidneys, 106 TREATMENT the mammae, the maxillary sinuses, the thyroid glands, the skin, the lymph glands, and the testicles; sarc6mata were most often found in the lungs, the liver, the lymph glands, the thyroid gland, the mammae and the kidneys. Compare with statistics on carcinoma. TREATMENT OF TuMOoRS.—In many cases, especially in non-malig- nant forms, treatmént is superfluous (blemish). When treatment is indicated they should be operated at the earliest possible moment, Operation consists in removal with the knife, scissors, or curet. Early operation is especially indicated in sarcoma, carcinoma, and botryomy- coma (fistula of the spermatic cord). When an operation is followed by a recurrence of the tumor it indicates that small pieces of the tumor remained. Pedunculated new formations, as well as tumors in the body cavity (polypi of the nose, vagina, and rectum) may be removed by tearing and twisting, by means of a ligature (ligation of the neck of atumor), or with the ecraseur. The galvanocautery loop, employed in human surgery, is too complicated for veterinary use. In many cases the firing iron is indicated, especially the thermo- cautery, this acts as a hemostat during the operation, healing follows under an eschar which takes the place of a bandage. The earlier ex- tensively employed drugs should only be used in those cases where an operation is impossible, or for econimic reasons is not practical (for- maldehyde in many cases of cancer of the hoof). The recent treatment of certain tumors with iodid of potash is of some importance. It is a specific for goitre, as well as actinomycosis of cattle (not, however, against botryomycosisof horses). Iodid of potash may either be admin- istered internally, or applied externally in the form of Lugol’ssolution ; tincture of iodine is active when applied externally or by means of in- jections. The internal administration of arsenic has a similar influence on papillomata. The parenchymatous injection of other remedies (alcohol, acetic acid ) is of doubtful efficacy, the same is true of treatment with the aneline dyes; the same may also be said of the artificial pro- duction of erysipelas for the relief of carcinoma, a few examples of which have been followed by success in human medicine. Concerning the importance of the serum therapy compare with the chapteron “carcinoma.’’ Finally, the recently employed artificial inocculation of malaria is of very questionable value. SPECIAL KINDS OF TUMORS 107 II. SPECIAL KINDS OF TUMORS. A. COoNNECTIVE-TissuE NEw Form ATIoNs. I, FIBROMA. Forms.—A fibroma or fibroid (connéctive-tissue tumor) is a desmoid tumor composed: largely of connective tissue. Two forms are recognized: 1. Hard fibroma (fibroma durum, desmoid) is characterized by a hard, firm consistency ; when cut it presents a white, tendinous, glistening surface ; microscopic examination shows it to be composed principally of straight, stratified, or crossed connective-tissue fibers with a very few cells. 2. Soft fibroma (fibroma molluscum) is less common ; it is soft in consistency ; when cut it presents a light-grey transparent surface’; under the microscope it is seen to be composed of loose moist connective tissue with very many connective-tissue cells. Between the soft and the hard fibro- mata there are many transitional forms. Onealso differentiates circumscribed and diffuse, simple (solitary) and multiple fibromata (fibromatosis). Pedunculated fibromata on the mucous membranes are termed polypi (fibroma pedunculum) ; similar fibrous new formations on the skin and subcutem are termed cutis pendula (see below). Fibrous proliferations in cicatricial tissue are termed keloids. My- cofibroma isa special infectious form due to the activity of the botryomyces fungus (botryomycoma). Finally, mixed tumors with other new formations are very frequent, for example, fibrosarcoma, fibrolipoma, fibromyxo- ma, fibroneuroma, fibroadenoma. With reference to the causes of fibromata ‘nothing definite is known. Recently it has been attempted to associate their development: with traumatic and inflammatory influences. Their relation to. inflammatory cicatricial tissue, especially the cicatricial keloids, as well as to the inflammatory connec- tive-tissue hyperplasias (elephantiasis, tumor fibrous) has been cousidered. At the most, repeated injuries or chronic inflam- 108 OCCURRENCE mations are only occasionally the cause of fibroma formation. The principal cause, for the want of better knowledge, seems to lie in a fibromatous predisposition. This explains the cases of congenital fibroma (congenital anlage of fibromata). The multiplicity of cutaneous fibromata in dogs and horses also speaks for the presence of an internal predisposing cause. OccURRENCE.—Fibromata are benign, develop slowly, are usually roundish, circumscribed, nodular, smooth on the surface, firm, non- hemorrhagic painlessnew formations of auni-. form consistency. They are very common in the domestic animals and may develop in any organ that contains connective tissue. Their favorite seats, therefore, are in the sub- cutem, the submucosa, the periosteum, and the subfascial and intermuscular connective tissue; they are alsocommon in the uterus and in the nerves (so-called neuromata are nothing more yhan fibromata of the nerves). The following forms are of surgical importance in the domestic animals : 1. Fibromata of the skin and subcutem are-most frequently observed in horses and dogs. In the horse they are especially frequent on the head, shoulder, and region of the withers, as well as inthe sheath. Ordinarily they are soli- tary, sharply circumscribed, from the size of a pea to that of a fist. Occasionally they are multiple, as many as one hundred have been seen on a single horse (Siedamgrotzky). Subcutaneous fibromata average about the size of a goose-egg ; sometimes they lie in a capsule from which they may be re- moved after a skin incision has been made (M6ller). In rare cases fibromata are found in the shoulder region in the form of so-called shoulder abscesses (personal observations). Bayer has observed fibromata on the scrotum of a horse that were multiple, soft, and recurrent after removal. Many fibro- mata of the horse are not genuine fibromata, but mycofibro- mata (compare with the chapter. on botryomycoma). Many inflammatory connective-tissue hyperplasias are erroneously termed fibromata ; to this class belong those found in harness positions in horses and cattle (see below). According to my own experience cutaneous fibromata are very common in dogs. They are offen multiple, especially on the thorax, on the ex- OCCURRENCE 109 tremities, on the ears and eyes, on the back, on the tail, and in the mammae. As in horses, hard fibromata are most com- mon ; the soft form are seldom found. Their size is variable ; as a rule they are small, sharply circumscribed, hard, smooth, and intact on the surface. Pendulous fibromata are occasion- ally observed. In cattle myxomatous fibromata are occasion- ally seen on the tail( Mayr). Peter has described a fibroma on the head of a cow; the tumor weighed 11% kg., was pen- dulant, and combined with cutaneous horn. On the other hand, the subcutaneous, calcified, new formations of fibrous tissue in the vicinity of dead larvae are not genuine fibromata (hypodermoliths of Caparini). 2. Fibromataofthe mucous membranes areeither flat, circumscribed proliferations with a broad base, or pedun- culated tumors (polypi, polypoid fibroma) ; their consistency is soft. Not all polypi of the mucous membranes described in the literature are genuine fibromata. Many other tumors of the mucous membrane have a pedunculated form ; for example, lipoma, actinomycoma, and sarcoma. According to the seat, one speaks of nasal, pharyngeal, laryngeal, vagi- nal, cystic and rectal polypi. In the nasal cavities the flat and polypoid fibromata (myxofibroma) of the nasal mucous membranes are of special importance in the horse ; this is due to the fact that so- called nasal poly pi produce a stenosis of the nasal pas- sages, causing dyspnoea, chronic unilateral nasal catarrh, and in ulcerative degeneration, an ichorous, fetid nasal discharge with unilateral swelling of the glands (suspected glanders). In the uterus and vagina of the horse, cow, dog, and pig, pure fibromata and mixed tumors (fibromyoma, fibromyxoma, fibrolipoma) occur in various forms. Fibromata of the vagina are frequently pedunculated (vaginal polypi). Typical fibromata from the size of a cherry to that of a walnut are found in the vagina of the dog. These vaginal polypi have a firm, hard consistence, occasion- ally they are long and bottle-shaped ; they present no inflam- matory symptoms. They are readily differentiated from those chronic inflammatory swellings of the mucous membranes which also develop in the form of pedunculated new forma- 110 TREATMENT tions (so-called plicae polyposae). Fibromyomata in the uterus of cattle and swine sometimes reach an enormous size (50 to 200 pounds). In such cases the uterus extends into the abdomi- nal cavity. Tumors which extend through the os uteri into the vagina are smaller. Polypoid fibromata may also develop inthe pharynx or larynx (the so-called laryngeal polypi in cattle are usually of an actinomycotic nature), in the gut- tural pouches, in the bronchi (polypi which follow tracheotomy in the horse are usually granulomata or botryo- mycomata), in the rectum, bladder, urethra, and teat canals. 3. According to Kitt, fibromata of the udder are characterized by hard, nodular, sharply circumscribed swell- ings; in the dog they are from the size of a dove’s egg to that of a man’s fist. They are composed of a mucoid and gelatin- ous substance (myxofibroma). Occasionally, in addi- tion to proliferation of the connective tissue, the glandular tissue also proliferates (adenofibroma). Similar fibro- mata are found in the testicles of dogs and horses. 4. Inthe internal organs fibromata are seldom of surgical importance. Kitt has observed a fibroma on the tongue of acow; it was hard asa board, sausage-shaped, 16 centimeters long and Io centimeters wide. Juredieu has described a fibroma of the pelvis of adog; it was as large as a hen’s egg. It is not known whether fibromata develop in the vertebral column of the domestic animals, thus causing paralysis from pressure on the spine (lumbar paralysis), similar to lipoma, sarcoma, and other new formations. ‘They are found, however, in the form of osteo- fibromata in other osseous cavities, forexample,the tym- panic cavity of the horse (Fretjanow). TREATMENT.—Treatment of fibroma consists in operative removal by means of the knife, scissors, ligature, etc. Large fibromata are extirpated with the scalpel and the wound sutured ; small tumors may be removed in the samé manner. In the latter, healing may be produced under an eschar by means of cauterization. Very large, diffuse fibromata, which cannot be entirely removed at one time may be operated on at different times ; repeated partial operations until the enlarge- KELOID III ment is entirely removed. Operations upon polypoid fibromata are very difficult. When one can reach them with the hand (vagina, rectum) they may be ligated ; ligation is more reliable when a double suture is passed through the neck of the polypus and tied on both sides. Polypi that cannot be so easily reached may be removed with the ecra- seur, this applies especially to nasal polypi. In many cases they nits betorn or twisted away with the handor forceps. pe ge KELOID.—A keloid is a tumor-like, fibrous, hard proliferation of the skinand subcutem ; it usually develops from cicatricial tissue ( cica - tricial keloid). Incontrast to this,a spontaneous (genuine) keloid has been differentiated. According to recent investigations the existence of a “‘spontaneous’”’ keloid is questionable ; this is due to the fact that experience has demonstrated that keloids usually develop after traumatic or inflammatory processes in the skin. The causes of keloid formation are not yet fully understood. Some maintain that itsdevelop- ment depends on a specific infection of the wound, they claim that this accounts for its recurrence following operations ; according to others, the existence of keloids depends on an individual fibroma- tous disposition of the body. In the domestic animals keloids are most often met with in the horse. They follow injuries to the coronet, the balls of the heel, the flexor surface of the fetlock joint, the flexor surface of the tarsal joint, as wellas to the region of the tendons; occasionally they develop after gangrenous dermatitis (grease), after firing, and after the applica- tion of blisters. They form circumscribed, hard, fibroma-like new formations that are usually extensive in size ; they are relatively richin blood-vessels ; in contrast to normal cicatricial tissue, they are covered with a thick layer of epidermis. To a certain degree they are a highly developed form of the so-called hypertrophic cicatrix (see page 22). According to my own observations the continual movement and irrita- tion of a wound that is often very insignificant appears to be one of the principal factors on which keloid formation depends. I have never observed recurrence following operations. According to Labat, Leblanc, and others, on the other hand, many keloids are recurrent after excision; they caution, therefore, against the operation, and em- ploy the elastic ligature (?) in combination with a disinfectant bandage applied daily. Johne hasdescribed a cicatricial keloid of the flexor tendons-of ahorse; this was in the form of a hard, tendinous oval tumor, 27 centimeters long and 18 centimeters wide, it was fungus-like, proliferated from the tendon cicatrix, and adhered to the tendon-sheath and skin. I have observed many similar forms of tendinous keloids on the extensor tendons of the coronet following treads on the coronet. 112 ELEPHANTIASIS ELEPHANTIASIS.—The name elephantiasis, (schleroderma, schlerosis, pachyderma) indicates a connective-tissue hyper. plasia of the skin and subcutem, which results in a pro- nounced thickening of those parts of the body involved. It is very rare that elephantiasis is caused by a genuine fibroma; in such cases it assumes the form of a diffuse fibromatosis. In the horse it is usually the product of chronic inflammation of the skin or subcutem (chronic indurative dermatitis and phlegmon following scratches and phlegmon: so-called thick leg, elephant leg); or specific, chronic inflammatory processes in the vicinity of the lymph- vessels (glanders). Elephantiasis may also be caused by chronic edema in the vicinity of the veins, as well congenital dilitation of the lymph-vessels. In man the principal causes of elephantiasis are leprosy and filaria sanguinis; according to the condition of the skin the following forms are recognized: ele- phantiasis glabra, verrucosa, ulcerosa, papillaris. Occasionally there seems to be an individual predisposition to fibrous hyperplasias (ele- phantiasis). Labat observed this in a horse on which a blister (potassium bichromate) had been applied after firing; this was followed by an extensive (60-70 centimeters large) fibrous new formation on the limbs. Similar observations have been made by Rabe and Lustig. TyvLoma.—Tylomata are fibrous dermal prolifera- tions (continual pressure fromthe saddle) that develop from the subcutaneous tissue; they are the result ofa chronic, hyperplastic inflammation. They belong, similar to elephantiasis, not to the genuine new formations, but are to be con- sidered as chronic, inflammatory, connective-tissue hyperplasias. In contrast to the circumscribed fibromata they are diffuse hard thicken- ings of the skin and subcutem, they are found at the seat of the collar in horses, on the carpus in cattle, on the elbow and ischial tuberosity in dogs. They are sometimes so heavy as to cause a suspension of the fibrous thickenings of the skin (cutis pendula). Occasionally they are circumscribed, when it is very difficult to differentiate between them and genuine fibromata. Callosities of the skin, in contrast to tylomata, consist of a hypertrophy of the epidermis, there is always present, however, a chronic, connective-tissue hyperplasia of the cutis. RHINOSCHLEROMA.—According to Hebra (1870) rhinoschle- roma in man is a specifictumor-like disease characterized by the forma- tion of hard nodules in the skin and mucous membranes of the nose, they afterwards extend to the lips, the superior maxillae, the nasal cavities, the pharynx, etc. Thecourse is chronic and incurable, it occurs only in certain environments and countries (Southern Russia, Eastern Provinces of Austria, Central and South America). The principal symptoms consist of cartilaginous, painful thickenings of the nose which extend into the deeper tissues, LIPOMA 113 as well as on the surface; ulcerative degeneration sets in, and they are finally transformed into connective-tissue folds. This resultsin stenosis and deformity of the nose, mouth, gums, and pharynx. The rhinoschleroma bacilli have been discovered as the cause of this peculiar affection; they are found in the large, swollen, non- nucleated cells of the diseased tissues. Transmission of this bacillus to other animals has not been followed by results. In veterinary literature various affections of the horse have been described under the name rhinoschleroma (Grawitz, Dieck- erhoff, Rabe, Schulz and others); in many essential points they are different from the disease described under that heading in man. In the horse it is manifestly an entirely different affection. Moller and Johne also maintain that this is an incorrect term for nasal tumors in the horse. According to Kitt the process is an adenofibrous hyperplasia of the nasal mucous mem- branes (adenofibroma). Under the microscope one finds fibrous hyperplasia and amyloid induration of the connec- tive tissue, pronounced proliferation of the mucous glands, as well as new formation, and dilitation of the vessels. Because of the rich blood-supply it may be easily confused with angioma. The new- formations consist of hard, nodular, lobulated, smooth, flat, lar- daceous, transparent proliferations located close together ; ordinarily they arefoundonly inthe lower third of the nasalcavity (pavement epithelium) ; they are usually bilateral, andare hemorrhagic on the surface (epistaxis). Ulceration, dried blood, and cicatricial formation may be present (confusion with glanders). I have operated several cases in the horse with good results. II. LIPOMA. Forms.—Lipomata or fatty tumors are composed principally of fat-cells which lie in a framework of connective tissue. In structure they are similar to normal fatty tissue, they may occur in any part of the body where that tissue is present, especially when it exists with connective tissue. They are usually located, therefore, in the subcutaneous, submucous, subserous, subsynovial, and intermuscular connective tissue. If the fat-cells are in excess it is termed a soft lipoma; when more connective tissue is present it has a firm consistence (hard lipoma). Occasionally lipomata are pedunculated (lipoma pendulans, lipoma polyposum). Lipoma aborescens isa special form that develops in the vicinity II4 LIPOMA of joint-capsules, after rupture of the capsule the lipoma pro- liferates in the form of a tree-like growth. Like fibromata, mixed forms are common: lipofibroma (lipoma fibroma- tosum, steatoma), lipomyxoma (lipoma myxomatosum). OccURRENCE.—Lipomata are not common. They form circumscribed, roundish or oval tumors; occa- sionally they are pedunculated and therefore pendulant; some are small, others attainan enormous size; they are nodular, lobulated, and occasionally very soft; they crepitate ina peculiar manner, apparently fluctuate on pal- pation, and develop very rapidly. Other forms are hard, develop slowly, are usually solitary, but are sometimes multiple. They are non- malignant tumors and never spread by metas- tasis. Itisa peculiar fact that they are not confined merely to well-nourished animals, but often accompany anemic condi- tions; when the animal is affected with general emaciation their size does not decrease. They may undergo caseous de- generation. When injured, suppuration may occur ; occasion- ally they are congenital. Of those lipomata which occur in domestic animals the following are of importance : rt. Subcutaneous lipomata are especially common in horses and dogs. In the horse they occur on the sheath, tail, and anus (Bayer), also on the walls of the thorax and abdomen, and on the posterior limbs ; they are often multiple. The vicinity of the biceps and knee-joint seems to be a favorite seat for their congenital appearance in foals (per- sonal observations) ; in this case they are circumscribed and develop very rapidJy. Moller observed a lipoma in the vicinity of the lower end of the biceps femoris that weighed 25.5 kilograms, Rhode observed one about the size of two fists just above the patella on the external surface. In dogs, where liponiata occur principally on the inner surfaces of the limbs, on the thorax, and on the shoulder, I have observed twelve cases. Their form is round or cylindrical, the size is extremely variable, occasionally attaining that of a man’s LIPOMA 115 head. They develop slowly, have a lardaceous consistency, lobulated structure, and many times a pedunculated form (pendulant). One also occasionally observes wandering lipo- mata. 2. Pedunculated Lipomata and lipofibromata are some- times found on the mucous membranes of the horse in the upper portions of the nasal cavities; they originate from the nasal septum, the turbinated bones, or the ethmoid bone (Gurlt). Occasionally they develop inthe larynx; Fricker has described a case of lipoma on the anterior sur- face of the epiglottis in a horse (laryngeal polypus), the tumor was as large asa potato. Submucouslipomata in the rectum cause obstruction and colic (Brose, Lessa). Vaginal polypi are occasionally found in the mareon the vaginal floor. Poiypiare also found onthe membrana nictatans in dogs (personal observations). 3. Subperitoneal lipomata of the abdominal cavity are relatively frequent in the horse; they constrict the small intestines or rectum and lead to fatal colic. The new-formations have a long neck, are pendulant, and originate from the omental attachment; they possess no surgical im- portance. Werner, in cattle, has diagnosed a lipoma per rectum; the tumor was the cause of colic, and removal through the flank resulted in a satisfactory termination. On rectal exploration of a horse suffering from colic Sommer recognized the presence of a tumor anterior to the bladder ; on post mortem this proved to be a lipoma. 4. Lipomata are seldom found in other organs. Occasionally they develop from the dura; at other times from the pia(Ktthnaeu). Pfister published the records of a case wherea lipoma was found to be the cause of lumbar paralysis inacow; the tumor was located in the lumbar region of the vertebral column. Ebinger has described a similar case. According to Stockfleth they are occasion- ~ ally found in the udders of fat bitches. Esser removed a lipoma that weighed four kilograms from the left half of the udder of a mare. According to Montfallet lipomata in the udder of the bitch are usually perimammary, seldom inter- glandular. 116 MYXOMA Treatment of lipomata consists in extirpation with the knife ; pendulant lipomata may be removed by means of a ligature. III. MYXOMA. DEFINITION AND OCCURRENCE.—M y xomata (mucous tumors) are composed of a gelatinous mucous tissue, with stellate, branched, connective-tissue cells, an abundance of mucous substance is also interposed. Their independent exist- ence as tumors is disputed. Apparently they are nothing more than edematous fibromata or lipomata (Késter). The soft, edematous, gelatinous, swollen lipomata and fibromata are better termed my xofi- bromata and myxolipomata. Other mixed formsare 2 myxomyomata, myxochondromata, fibrosarcomata, and other muco-edematous forms. Myxomata, like fibromata and lipo- mata, are non-malignant tumors; they develop in the subcutis, submucosa, subserosa, on the periosteum as well as beneath the fasciz. Occasionally they become sarcomatous. Myxomata and myxofibromata appear, relatively, to be most frequent in the nasal cavities of the horse, where they result in the formation of so-called nasal polypi (Mol- ler, Hamburger, personal observations). Pedunculated myxofibromata are also observed on the floor of the rectum in the horse, they areinthe form of bean-shaped rectal polypi the size of a child’s head (personal observations.) According to Kitt myxomata occur in cattle in the sinuses of the head where they may become three times the size of a man’s fist; they are smooth, nodular or lobulated, and are composed of glassy, swollen, mucous vesicles containing masses of connec- tive tissue. Myxomata have also been seen in the sinuses of the headin sheep (Cagny); and inthe bladderin cattle (Leisering). Myxomyomata, myxofibromata, and fibromyx- osarcomata have been observed in cattle in the uterus (Kitt); in the mamme of mares and bitches (Kitt, M’Fadyean); in the subcutisof the horse (Ehlers); inthe cutisof calves in the form of soft tumors the size of hens’ eggs on the inferior CHONDROMA 117 surface of theabdomen (M6ller) ; as well as beneath the dura of the spinal marrow thus causing spinal paralysis (Brats- echikow, Holzmann). Finally, myxoma has been observed in the placenta (De Bruin). Treatment of myxomata of the nasal mucous membranes consists in tearing out, and twisting off, as well as extirpation after previous trepanation of the nasal cavities. Mucous DEGENERATIONS OF THE TURBINATED BonEs.—Under thisheading Sand (Monatshefte fiir Tierheilkunde. 1893) has described @ tumor-like swelling of the facial bones of foals; it was charac- terized by dyspnea and nasal discharge, as well as mucous softening of the turbinated bones, and the osseous walls of the superior maxillary and frontal sinuses. The latter become dilated, and are affected with hydrops and empyema. I have observed similar cases. MvyxxpEMas.—The following symptoms have been observed follow- ing disease or removal of the thyroid gland in man: edematous swell- ings of the skin of the face and extremities (collections of mucin), with pronounced general decrease in nourishment, strength, and psychic activity (cachexia strumapriva following thyroid operations; related to cretinism). Recently myxedema has been successfully treated in man by the administration of thyroid-gland substance and thyroid-gland preparations (iodothyrin). The oe, myxedema is explained as follows: it is the function of the thyroid gland to prevent the formation of mucin in the body; in myxedema this function is destroyed (?). Iv. CHONDROMA. NATURE AND OCCURRENCE.—Chondroma (enchon- droma, ecchondrosis, cartilaginous tumors) is a name applied to tumors composed largely of cartilage; this form of new- formation is apparently rare. Hyaline cartilage is the principal component (large or small cells). They are found in the fol- lowing places: a) in cartilage (ecchondrosis or hyperplastic chon- droma) ; b) in bones, on the ribs, in the pelvis, on-the vertebral column, on the first phalanx, on the ethmoid bone, and sphenoid bone ; c) inthe udder, testicles, thyroid gland, in the parotid, in the subcutem, and in other organs that are normally free from cartilage (enchondroma in the nar- 118 CHONDROMA row sense; heteroplastic chondroma). The occurrence of chondromata in these organs is partly due to a metaplasia (metamorphosis) of connective-tissue cells and endothelial cells. into cartilage cells, partly to aberration of germinal cartilage. Chondromataare benign tumors, they areusually solitary but occasionally multiple; they are spherical in form (udder), and occasionally very large. They are nodular, elastic, firm, and painless. Chondromata are usually observed in com- bination with other tumors (chondrofibroma, osteo- chondroma, chondrosarcoma); they may undergo softening, cystic degeneration, calcification and ossification. An osteochondroma is composed of material similar to non-calcareous (osteoid) bone tissue. In the domestic animals chondromata are most often found in the mamme of the bitch; they are from the size of a pea to that of a man’s fist, round, firm, painless, and sharply circum- scribed from the normal glandular tissue; they are nodular and are not adherent to the skim. Cartilaginous, nodular, sharply circumscribed chondromata are repeatedly found in the testicles of the horse (Kitt). They are also fre- quently found on the costal cartilages of the horseand ox; in this case they may possibly have a traumatic origin (Bruckmiller, Kitt, Hahn, personal observations). Chondromata are found in the vicinity of the thyroid gland (Siedamgrotzky, Zahn). Seidamgro- tzky described a chondroma that was twice as large as a man’s fist, it was located on the first phalanx of acow. They have also been found on the maxillae and in the nasal cavities of horses and dogs (Gurlt, Kitt); on the verte- bral column of a dog with spinal paralysis (Smith); in the vicinity of the earincattle; at the base of the second and third cervical] vertebrz, hard tumors weighing 4% kilograms. and as large asa man’s head (Morot); in the subcutis ot cattle, horses, anddogs (Janson, Morot, Leisering, Ostapenko); on the vocal cord of ahorse (Lee); as well as in the crystalline lens of a foal (Renner). Treatment consists in extirpation ; when large chon- OSTROMA 119g dromata are present in the udder it should be amputated. In my experience many cases of chondroma of the udder in dogs do not require treatment; this is due to their stability and non-malignant character. pe V. OSTHOMA. NATURE AND OCCURRENCE.—An osteoma or bone tumor is composed largely of osseous material. It is analo- gous tochondroma. With reference to their occurrence they may be arranged as follows: a) Those occurring in bone (hyperplastic osteoma) ; they develop partly from the periosteum, partly from the tela ossea, and partly from the bone-marrow. They are known by various terms: exostoses, osteophytes, hyperos- toses, enostoses. To this class also belong new for- mations of bone due to inflammation (exostoses). b) Osteoma may also occur in the following organs, although they contain no bone-cells: the mammae, parotid, brain, muscles, and other organs that nor- mally contain no bone-cells (heteroplastic osteoma) ; they are either due to metaplasia, or aberration of embryonic tissue. According to the consistency one speaks of an osteoma durum or eburneum (hard as ivory), spongiosum (spongy), and medullare (composed largely of marrow). According to the covering it is termed a cartilaginous exostosis (covered with cartilage), ora bursal (located beneath a mucous bursa). Mixed forms of osteomata are also frequent: osteosarcoma, osteofibroma, and osteo- chondroma. Osteomata with broken attachments so that they lie free in the cavities of the head are termed dead osteo- mata. Unattached osteomata are located in tendons and muscles away from the bone. Osteomata form very hard, bone-like, painless, benign tumors; they are more or less sharply circumscribed, partly multiple, partly sol- itary, and are usually located beneath the skin. Inthe domestic animals they are more frequent than 120 MYOMA chondromata. The following forms are of practical importance : osteomata that frequently occur on the inferior maxilla and metacarpus, and are usually due to an ossifying periostitis, occasionally, however, they are genuine tumors (pedunculated fungoid and knob-like osteomata on the free margin of the inferior maxilla) ; osteomata of the udder and testicles in horses, cattle, and dogs; of thecrystalline lens inthe horse ; as wellas those which occurinthe cavities of the head of both the horse andcow. ‘The latter apparently — develop from rudimentary cartilaginous areas of the sphenoid and ethmoid bones and occasionally form so-called total osteo- mata (ossified brain). Odontomata and dental osteo- mata of the teeth, on the maxilla, and on the petrous por- tion of the temporal bone, are special forms. Treatment consists of removal by means of the saw, chisel, or trephine. VI. MYOMA. NATURE AND OCCURRENCE.—A myoma or muscle- tumor is composed of muscle-fibers. According to the character of the fibers they are classified as follows: (a) Leiomyomata (myomalevicellulare), the more com- mon form, are composed of non-striated muscle-fibers. They are usually found in the stomach, intestines, uterus, in the bladder, as well as metaplastically in tumors of the kidneys, testicles, and ovaries; occasionally they are combined with other tumors (myofibroma). (b) Rhabdomyoma (myoma striocellulare) is rare; it is composed of striated muscle-fibers, and is occasionally found in mixed forms (myosarcoma). Myomata are of slight surgical importance as they are usually found only in the internal organs. Kitt has de- scribed a subcutaneous leiomyoma of the crural muscle, it weighed 250 grams. Gratia has described a rhabdomyoma which had its seat on the vagus at dbout the middle of the cervical portion in the horse Monod has operated an encapsuled rhabdomyonia as large as a goose-egg in the NEUROMA 121 vicinity of the shoulder in the horse. Siedam grotzky has observed a leiomyoma of the testicles; Kolesnikow observed a rhabdomyoma of the tail. Leiomyomata of the uterus are far more frequent (Kitt, Frank, Johne, Eber, Gratia, Harms); the same is true of peduncu- lated leiomyomata of the vagina that cause sterility (De Bruin); leiomyomata that lead to stenosis of the intestines (Schutz, Tetzner, Cadeac) and stomach (Rabe, Lothes); as well as those of the bladder (van Tright, Lienaux, Voirin, personal observations), and kidneys (Johne). With reference to the treatment, myomata of the uterus are experimentally treated, as in the human family, with internal administration of ergot. VII. NEUROMA. NATURE AND OCCURRENCE.—Two varieties of new for- mations are described under the term neuroma, or nervous tissue tumors. (a) Genuine neuromata are a new formation composed essentially of nerve-fibers ; they may be medullated (neuroma myelinicum), or non-medullated (neuroma amyelinicum). This form is very uncommon in man, and has not been ob- served in the domestic animals. b) False neuroma is a fibroma or myxoma of the nerves (neurofibroma, neuromyxoma). It develops from the connective tissue of the perineurium, and is composed princi- pally of connective tissue or mucous tissue. These neurofibro- mata in the horse occasionally develop asa result of neurec- tomy when the operation is followed by a neuritis, they also occur in saddle horses on the internal tibial nerve. Analogous to the amputation-neuromata in man, they form spindle- shaped or oval enlargements on the central end of the nerve; they are white in color, froma bean to.a dove’s egg in size, and cause lameness. They have been seen on the median nerve (MGller, Trasbot and others, personal observations) ; on the volar and planter nerves (Hardy, Brauel, Rey and others, personal obser- 122 ANGIOMA vations); also on the peroneus (Bayer), and tibialis (Becker). That form of false neuroma recognized in man under the name helicine neuroma (plexiform neuroma) has been repeatedly observedin cattle (Morot, Ostertag, Tiemann, Matschke); it is multiple and develops in the form of nodules and cords. Its favorite seat seems to. be in the brachial plexus, the cervical, thoracic, and abdomi- nal ganglize of the sympathetic, as well as on the intercostal nerves. In one case, multiple neurofibromata produced symp- toms of paralysisintheox (Matschke). Zietschmann described two other cases of multiple neuroma formation and chronic interstitial neuritis of the brachial plexus in cattle, there were no special symptoms of paralysis, the enormous anatomo-pathological changes were remarkable when contrasted with the clinical symptoms (slight motor weakness.) One case of helicine neuroma has also been observed in the horse (Leisering) Gliomata area result of proliferation of the neuroglia cells (supporting cells) of the brain and spinal marrow, they are of no importance from a surgical standpoint. So-called glioma of the retina is a sarcoma (gliosarcoma). Treatment of neurofibromata consists of free exposure and extirpation, recurrence is possible and the neurectomy may have to be repeated. VII. ANGIOMA, Forms.—Angiomata or vessel-tumors either originate from blood-vessels (hemangioma, angioma in the narrow sense), or from the lymph-vessels (lymphangioma). Angioma is a collective term for various tumors which are composed principally of dilated hypertrophic, abnormally twisted, and newly-formed vessels. The following forms are recognized : a) Angioma simplex (teleangiectasis, nevus, naevus vasculosis, birth-mark, fire-mark) is composed of dilated and newly-formed capillaries of the skin. b) Angioma cavernosum (tumor cavernosus) is ANGIOMA 123 a venous new-formation of the skin, mucous membranes (nasal mucous membranes), bones, liver, etc. It is a cavern- ous-like body containing large spaces that communicate with one another. c) Angioma racemosum (helicine angioma) is char- acterized by its serpentine structure. d) Angioma lymphaticum (lymphangioma, lymph- angiectasis) is a rare form; it is composed of dilated and newly-formed lymph-vessels. It occurs in the skin (congeni- tal elephantiasis), the tongue (macroglossia), and the lips (macrocheilia). It develops in the form of an angioma sim- plex, cavernosum, and cysticum. e) Fungus vasculosus (fungus hematoides) is not a genuine angioma, it isa term that indicates various extremely hemorrhagic new-formations. OccURRENCE.—In the domestic animals angiomata are observed in various parts of the bedy. ‘The most important are the superficial angiomata in the form of edematous areas on the nasal mucous membranes of the horse, they are usually cavernous, seldom simple, and lead to epistaxis, ulcerative formations, dyspnea, and suspicion of glanders. Deigendesch described a case of angioma which for ten years caused periodicepistaxis. Ltbkesawa case of cavernous angiomaof the mucous membranes of the nose and eyes ina horse; there was hemorrhage from these organs that even extended to the lachrymal duct. Schiitz observed angiomatous ulcers on the nasal mucous membranes as large asa man’s hand. Finally, angiomata of the nasal mucous membranes are many times confused with other hemorrhagic new-formations, especially the adenofibrous hyperplasias in the same region (see page 113). According to Zschokke osteoangiomata at the base of the tail incattleare not uncommon. They form tumors twice the size of one’s fist, which grow entirely through the body of the vertebrae, are composed of numberless dilated blood-vessels, and are made up of a reticulated, spongy, bone substance. Rosenbaum observed a similar very hemorr- hagic new-formation on the tail of anox. Angiomata of the 124 LYMPHOMA skin and subcutem arelesscommoninanimals (Bon- net, Leisering, Johne, Moller, Siedamgrotsky, personal observations). Grebe has observed a cavernous angioma as large as a fist on the gums and lips of a horse ; the animal died during operation. Zschokke has described an angioma at the base of the skull in acow; it developed along the nerves which supply the external ocular muscle, causing its paralysis and strabismus convergens exter- nus. Francesco has described an angioma on the penis of a horse ; it was the cause of frequent and severe hemorrhage. Leisering and Eggeling have seen angiomata of the vaginal mucous membranes in cows. Stenzel has in- vestigated four cases of angioma of the udder in cows. Schindelka has described a lymphangioma of the mamma inacat. Angiomataof the liver, which occur frequently in cattle and other animals, are of no surgical importance. TREATMENT.—Healing of angiomata of the nasal cavities in the horse cannot often be attained because of their deep situation. Superficial angiomata of the skin are occasionally very difficult to extirpate on account of their size and extent. In human surgery the following methods of therapy are em- ployed: Ligation of the blood-vessels which supply the part, cauterization, firing, puncture with the thermocautery, appli- cation of the galvanocautery, as well as the injection of liquor ferri chloridi, alcohol, tincture of iodine, and extractum secalis. IX. LYMPHOMA. NaturE.—Lymphoma (tumor of a lymph-gland) isa name used to indicate various disease processes of the lymph- glands. a) Leukemic lymphoma during the course of leukemia. : b) Malign lymphoma during the course of pseudo- leukemia. c) Lymphosarcoma, lymphadenoma, car- cinoma and other genuine new formations in the lymph- glands. SARCOMA 125 d) Inflammatory hyperplasia of the lymph-glands following chronic inflammatory processses of neighboring organs (catarrh, strangles, glanders, tuber- culosis, actinomycosis). The so-called malign lymphoma (progressive hyper- plasia of the lymph-glands, lymphadenia, lymphomatosis ma- ligna, Hodgkin’s disease, pseudo-leukemia) which frequently occurs in man, is also seen in cattle, horses, and dogs. Like leukemia, without however, a marked increase in the number of white blood-corpuscles in the blood, it is characterized by the enlargement of groupsof lymphatic glands, or enlargement of the entire lymphatic system of the body. They are arranged in the form of multiple, nodular or clump-like, lardaceous, soft or hard, painless, often very large tumors in the vicinity of the inter- maxillary glands, the superior, middle, and in- ferior cervical glands, the inguinal, knee, and pelvic glands. On account of the generalization of this disease surgical interference is of no use; treatment is confined to the internal administration of arsenic or iodid of potash. Solitary lymphomata in the intermaxillary space in the horse may be extirpated without difficulty. Operative re- moval for diagnostic purposes may be indicated (suspected glanders). KX. SARCOMA. NaTurRE.—A sarcoma is a desmoid tumor which may be termed an atypical proliferation of the embryo- nic connective tissue. It is a malignant con- nective-tissue new-formation in which the cells (round-cells, spindle-cells, giant-cells, endothelial cells) are far in excess of the in- tercellular substance. They often develop very rapidly, when they are usually associated with metastatic for- “mation through the medium of the veins. Sarcomata develop anywhere in the body where connective tissue is present. Their 126 SARCOMA favorite points of development are the periosteum, the bone- marrow, the lymph-glands, the cutis, the subcutaneous, sub- mucous, and subserous (subperitoneal, subpleural) tissues, the eyes, the glandular tissues (testicles, mamma, thyroid), as well as the vessel-walls. Sarcomatous cellular activity is often followed by regressive conditions ; these are softenings, cystic formations, hemorrhage, ulceration, and suppuration. Asin other tumors, mixed forms arecommon; forexample, fibro- sarcoma, chondrosarcoma, myxoSsarcoma, osteo- sarcoma. With reference to the causes nothing definite is known. Recent theories concerning bacterial and protozoan irritants have not been sustained. Forms.—Sarcomata are characterized by many different forms. According to the structure and the forms of the con- nective-tissue cells the following principal types are recognized : a) Round-celled sarcomata are composed of large or small round-cells (large and small round- celled sarcomata). The small round-celled sarcomata are especially malignant. They consist almost wholly of small round-cells, similar to white blood-corpuscles ; occa- sionally they are combined with ameboid connective-tissue cells which multiply very rapidly. The consistency, there- fore, is soft, marrow-like (medullary sarcoma), andthe growth is very rapid. b) Spindle-celled sarcoma is composed essen- tially of spindle-cells; it often develops from a fibroma (fibrosarcoma). c) Giant-celled sarcoma is very malignant; it is usually found in the bone-marrow (myelogenous sarcoma, myeloid). d) Stellate or ‘‘Netzzellen’”’ sarcomata usually arise from myxomata (myosarcoma). e) Sarcomata with polymorphous formation are composed of various forms of connective-tissue cells: round-cells, spindle-cells, giant-cells, retic- ular cells; there are many combinations of these cells (combined sarcoma), f) Alveolar sarcoma is characterized by a gland- SARCOMA 127 and cancer-like alveolar structure; under certain conditions it is dificult to differentiate it from carcinoma. The alveolar, small and large round-celled sarcomata are of special import- ance; lymphosarcomata are examples of the former. In contrast to carcinomata of a similar alveolar structure, the alveolar sarcomata show an intercellular substance among their cells. g) Angiosarcomata or endotheliomata (endotheliosarcoma, endothelial cancer, plexiform angiosar- coma, plexiform angioma, cylindroma, perithelioma) are angiomata with a sarcomatous proliferation of the’ cells of the vessel-walls. They develop from the following sources: the endothelial cells of the intima and perithelium (adventia) of the blood- and lymph-vessels, the lymph-cells of the connective tissue, as well as the endo- thelium of the pleura, the peritoneum, the dura, and the pia. They have been recently differentiated, then, as heman gio- sarcomata (angiosarcoma of the blood-vessels) and lymphangiosarcomata (of the lymph-vessels). De- pending on their origin on the inner or outer wall of the vessel they are termed intravascular (endothelial), and perivascular (perithelial). Angiosarcomata are very malignant; they show a tendency to hemorrhage and hyaline degeneration. They are easily confused with carcinomata. They are characterized by pronounced thickening of the vessel-walls, of hyaline appearance, and are frequently of cylindrical form. The following belong to the angiosarcomata or endothe- liomata: cholesteatoma or margaritoma on the venous plexus of the brain of the horse (endothelioma with a deposit of cholesterin crystals), psammomata or sand- tumors of the brain (endothelial tumors with a deposit of car- bonate of lime), and xanthomata or xanthelasma (fatty endotheliomata, endothelioma lipomatosum ; according to others a form of lipoma). h) Melanosarcoma or melanoma (pigment sar- coma) is a brown or black, pigmented tumor that is often very malignant ; it develops rapidly and is frequently recurrent. It — 128 SARCOMA spreads by metastasis and is most often seen in grey horses, it may, however, occur in dark horses (brown, chestnut, black), as well as in cattle, sheep, and dogs. Histologically melano- _ sarcoma is partly round-celled and alveolar (soft, malignant new-formation), partly spindle-celled or fibrosarcoma (firm, relatively benign tumor). Formerly the pigment was sup- posed to be the coloring matter of the blood. According to recent investigations, however, the pigment (hippomelanin) frequently contains no iron ; it arises from specific embryonal, pigment-forming cells, the melanocytes (Berdez and Nencki, Lieber). According to Ribbert pigment tumors are formed from the chromatophores. Accord- ing to Joss the pigment is developed from the albumenous material of the blood through a specific, metabolic activity of the sarcomatous cells (high per cent of sulphur). Melanosis is differentiated from melanoma by pigment infiltration, with- out tumor formation, in the subcutem, in sheaths of muscles, and in internal organs (calves, cattle, horses). OccURRENCE.—Sarcomata are very conimon in the domes- tic animals; they are especially common in cattle, horses, and dogs. Among 54 sarcomata observed by Semmer, 30 were of the dog, 12 of the horse, 4 of cattle, and 2 of swine. Among 643 new formations that I have operated upon in the dog, 44 were sarcomata ; among 200 new formations operated upon in the horse, 50 were sarcomata. From a surgical standpoint the following sarcomata are of importance : 1, SARCOMATA OF THE BONES. —These are partly periosteal, partly central (myelogenous) sarcomata, partly osteosarcomata. They are found in horses and cattle, especially in the nasal cavities and maxillary sinuses, where they may develop from the ethmoid bone, the turbinated bones, the nasal bones, the zygoma, or the superior maxillary bones. They give riseto stenosis, cause chronic catarrh, and may extendintothe frontal sinus, the oral cavity, the orbit, the cavities formed by the sphenoid bone, and to other bones of the head. In dogs they are most often found in the oral cavity, and onthe superior maxilla, less frequently on the inferior maxilla. SARCOMA 129 They develop on the gums in the form of proliferations that are nodular, circumscribed, compact, as hard as bone or carti- lage, and painless ; the surface is rough, irregular, granular, or lobulated; they cause the teeth to become loosened, dis- placed, raised, and crowded apart (epulis). Central osteo- sarcomata also occur in horses, dogs, cattle, and swine; they may be solitary or multiple, at times generalized ; they occur on the humerus, the scapula, on the femur, on the tibia (lameness), the frontal bone, the petrous portion of the temporal bone (facial paralysis), onthe bones of the cranium, neck, and verte- bral column. Kammerman saw a case of spindle- celled sarcoma in the cow; it passed through the intervertebral foramen of the atlas to the cervical marrow. Dieckerhoff and Frohner have observed diffuse myelogenous sarcomata in horses and dogs. A sarcoma of the guttural pouch caused hemiplegia by penetrating the vertebral canal of a horse; an- other in the same place caused paralysis of the tongue (Hal- lander). Spinal paralysis is caused in horses, cattle, and dogs by pressure on the spinal cord from hard sarcomata (Dorrwachter, Dexler, and others). In swine a form of so-called snuffle-disease is caused by sarcoma of the facial bones. : v 2. LyMpHOSARCOMA.—This is most often found in horses and dogs. In horses, according to my experience, they are soft, sometimes fluctuating and cystic tumors. They vary in size from a hen’s egg to that of a man’s head ; they are often multiple, and are found in the intermaxillary region (suspected glanders), in the region of the larynx (goitre-like tumors), onthe neck, inthe region of the shoulder (a form of shoulder abscess), on the anterior portion of the thorax, inthe pelvic glands, onboth sides of the sheath, etc. In one case in a horse that was suf- fering from ‘‘intermittent lameness’’ I found a lymphosar- coma that involved the left iliac and femoral arteries ; it was as large as a man’s fist. I have also found lymphosarcomata in dogs, especially on the neck and in the region of the pubis ; they are often multiple. In cattle lymphosarcomata as large 130 SARCOMA as one’s fist are found in the thoracic region, in the flank, and in the sacral glands (Poncet). Stricker succeeded in transmitting lymphosarcoma of a dog to thirty-one other dogs by means of subcutaneous and intraperitoneal injections. 3. SARCOMATA OF THE SKIN AND Mucous MEMBRANES. —These form circumscribed and multiple, or diffuse and ex- tensive tumors of soft or hard consistence. They may appear nodular, lobulated, fungus-like or villous. In cattle and horses they are found in the cervical and shoulder regions ; -in these places they form extensive tumors which may lead to passive edema or suppuration; they may extend to the thoracic cavity and cause asphyxia from pressure on the trachea; generalization with metastatic formation in the in- ternal organs is common. ‘They also occur in other parts of the body; namely, on the extremities of dogs; on the lips, tongue, rectum, sheath, and fleshy-frog of the horse; on the vulva and vagina of cows (cause of dystocia). Eberlein has described a pendulous sarcoma on the inferior maxilla of ahorse. Girotti observeda myxosarcoma on the umbilicus of a calf. Gorig has described a multiple sarcoma on the throat and thorax of a hen. 4. SARCOMATA OF THE EvES.—These are most often seen in horses, dogs, and cats. They occur either in the form ofa round-celled sarcoma of the orbit where they cause strabis- mus (squint) and exophthalmos, as well as degeneration of the neighboring bones, and even press into the frontal sinuses, the maxillary sinuses, and the cerebral cavity (Emmerich, personal observations), or a round-celled sarcoma (gliosar- coma) of the retina, or asa melanosarcoma of the choroid (Bayer). 5. SARCOMATA OF THE TESTICLES, UDDER, THYROID AND ParoTip GLanps.—These result in a circumscribed en- largement, or enlargement of the entire glands, occasionally the enlargement is enormous. According to my experience they are relatively most frequent in displaced testicles, and in the mammae of bitches, as well as in the thyroid glands of the horse. Walley found ina horse (cryptorchid) a round- celled sarcoma of the testicles that weighed 35 kg. I have SARCOMA 131 likewise diagnosed and removed from two stallions, two small round-celled sarcomata of the testicles as large as a child’s head. Schuemacher has observed a similar sarcoma of the testicles in a stallion. Garino has described twelve cases of fibrosarcoma of the testicles in breeding animals (eleven were unilaterial, one was bilateral) ; the testicles were enlarged three or four times their usual size, 214-3 kg., the spermatic cord was thickened as far as the inguinal ring. Sarcomata also occur in the ovaries and kidneys. Resow described a primary round-celled sarcoma of the udder of a cow. 6. SUBPERITONEAL AND SUBPLEURAL SARCOMATA.— These are apparently common in cattle, horses, and dogs; this is especially true of sarcoma of the abdominal cavity, the pelvic cavity, and the intestines. As a rule they cannot be operated and are of no surgical importance. It is a peculiar fact that many times they cause no obvious external symptoms. They are usually first discovered during a post mortem. In other cases they are the cause of colic (stenosis of the small intestines), and general emaciation, as well as cachexia. Sarcoma of the pelvic cavity may result in an in- curable obstruction to parturition ; this is due to adhesions, or to compression of the uterus and vagina. Primary or metas- tatic sarcomata of the lungs, liver, spleen, kid- mneys, brain, heart, bladder, inner lymph-glands, etc., are of no surgical importance. 7. MELANOSARCOMA.—This is most often seen in horses ; it also occurs in asses, oxen, sheep, dogs, and goats,; it may be isolated, multiple, or generalized. It is most often seen in old grey horses. They are usually found in the following places: in the vicinity of the anus, the vulva, the vagina, the tail, the sheath and the penis, the shoulder region—especially at the point of attachment of the serratus to the scapula—the eyelids, the lips, as well as the region of the cheeks, the masse- ters, andthe parotid. ‘They may arise in any organ or in any partof the body. They have been found by others in muscles, bones, and lymph-glands. Mauri has described a case of melanoma on the body of the third lumbar 132 SARCOMA vertebra, which led to pressure of the spinal marrow with a subsequent spinal paralysis. Vache has observed a similar case of pressure atrophy of the lumbar marrow in a seventeen- year-old mare. In other cases compression of the brain, in- dividual cranial nerves (facial), the ischiadicus, and the femoral artery, leads to paralytic conditions. JI observed a case of fragilitas ossium (multiple fracture of the pelvis and ribs) in a horse affected with general melanosarcomatosis. In several others, melanosarcoma in the perirectal connective tissue was the cause of chronic colic due to obstruction. Roder observed a case of stenosis of the urethra in a horse caused by melano- sarcoma of the pelvis. Many melanosarcomata have a tendency to ulceration and suppuration, so that, for example, cancer-like ulcers are present on the skin, hemorrhage occurs in the nasal cavities (personal observations). Internal melanosarcomata may rupture and terminate in fatal hemorrhages. Generaliza- tion is very frequently observed. Metastases develop in the lungs, liver, heart, in the lymph-glands, ete. With reference to the prognosis it may be remarked that in a great number of cases, even in the general- ized form, general derangements are not observed. Melanosarcomata are usually of incidental im- portance in slaughtered horses that are otherwise normal. In St. Petersburg in the years 1892-93, from 7000 slaughtered horses, 36 cases of melanosarcoma, of which 8 were general- ized, were observed (Sawaitow). Budnowski found 12 per cent of the First Sovereign Hussar Regiment (only grey horses!) affected with melanoma; in 63 horses the melanomata were from the size of a pea to that of a hazel nut ; complications dangerous to life had occurred only four times inthe regiment (seat in the pelvic cavity, on the omen- tum, beneath the vertebral column, in the parotid). In other cases melanomata are very malignant, they undergo ichorous degeneration and chronic hemorrhage ; the patient suffers from anemia and general cachexia. The soft, pigmented, round- celled sarcomata have a special tendency to result in the latter course. TREATMENT.—Sarcomata should be extirpated as early as possible. ‘Treatment is unavailable when metastatic __ ~ CARCINOMA 133 formation has already commenced. In the latter case especially the prognosis of melanosarcoma is very unfavorable ; satisfac- tory results are obtainable only in solitary, firm, benign melano- mata. The various conflicting statements concerning the value of operative treatment for melanomata are explained by the great variations in character of these tumors: benign; very malignant degree of extension. When the removal of the tumor is incomplete, remnants of the sarcoma remain and furnish a source for recurrence. Melanosarcomata are operated exactly like other sarcomata; I have successfully extirpated them in the horse. Delamotte, toprevent recurrence fol- lowing extirpation with the knife cauterized the wound and then covered it with arsenic ; this possesses an affinity for sar- comatous cells (?). B. EPITHELIAL NEOPLASMS. I. CARCINOMA. NATURE.—Carcinoma or cancer isan atypical epithelial neoplasm; it has the property of unlimited growth. All carcinomata are formed .essen- tially of epithelial cells, which lie in a connective-tissue stroma (cancer-stroma) in the form of cancer-plugs, cancer-nests, or cancer-nodules. ‘They proliferate into the neighboring tissues, break down the lymph-vessels and blood-vessels thus leading to metastatic formations. At first the metastasis is confined to the neighboring lymph-glands, afterwards it de- velops in the form of a generalized carcinomatosis of the in- ternal organs of the body. General derangement of the nutrition thus produced—so-called cancerous cachexia —is due to a form of auto-intoxication, that is, a general chronic poisoning derived from the cancerous new-formation. All carcinomata are derived from epithelial tissues (Thiersch, Waldeyer). Virchow thought that connective-tissue cells were transformed into cancer-cells, this theory has not yet been demonstrated. 134 CARCINOMA Forms.—According to the different varieties of epithelium (squamous epithelium, cylindrical epithelium, glandular epi- thelium) the following forms are recognized : (a) Squamous-celled carcinomata or can- croids are found on the skin, oral mucous membranes, mucous membranes of the pharynx and esophagus, conjunctival mucous membrane, mucous membranes of the vagina and blad- der, of the sheath, and of the penis. (b) Cylindrical-celled cancer is found on the mucous membranes of the stomach, intestines, and uterus. (c) Glandular-celled cancer develops in the testicles, mamme, thyroid gland, thymus gland, parotid, prostate, in the sudoriferous and sebaceous glands of the skin, in the mucous glands of the mucous membranes, in the liver, in the pancreas, in the kidneys, and the suprarenal glands. According to the consistence and form they are classified as follows: hard, firm carcinomata with an abundance of con- nective tissue (Sschirrhus, fibrocarcinoma); soft, carcinomata of the consistence of the brain or spinal marrow (medullary cancer, medullary carcinoma); mucous and gelatinous cancer (carcinoma myxomato- sum and gelatinosum); pigmented cancer (melano- carcinoma); villous cancer ncaneinonia Pendle tosum or villosum) and others. “ ae ie mes ErroLloGy.—The origin of carcinomata is no better un- derstood than that of other tumors. A series of etiological factors has been advanced to explain their occurrence in man ; the same factors, with nothing added, have found place in veterinary science (see below). 1. Age, sex, nutrition, and heredity are con- sidered predisposing influences for the development of cancer. Experience among men has taught that carcinoma pre- ponderates among those advanced in age. It may develop in any period of life but is seldom seen in a person under forty years old. It is most often seen in people between the ages of forty-five and sixty-five (50 per cent of allcases). In animals (dogs) ona basis of material composed of 262 cases I have observed that old dogs were the only ones CARCINOMA 135 affected with carcinoma ; I have never seen a case of cancer in a dog under two years of age. Of the dogs affected eighty- seven per cent were over five years old, fifty-four per cent were over seven years. Carcinoma forms a contrast to sar- coma ; the latter frequently occurs in young puppies. Similar conditions have been observed in American cattle by Loeb and Jobson; of the forty-nine cases published all were in cows over six years old. For an explanation of the influence of age on the existence of cancer (diminished resistance of the connective-tissue stroma in contrast to the proliferating epithelial cells) see page ror. With reference to the influence of sex, it has been main- tained that in the human family the increased functional activity of the sexual organs, especially the uterus and mammz in females, predisposes to carcinomatous disease of these organs. The relation appears to be similar in the dog, where carcinomata of the mamme are seemingly frequent. This theory cannot be applied to cows, however, where for economic reasons, glandular activity and milk production are most highly developed. Carcinoma of the udder and uterus of the cow has apparently been observed in only a very-few cases (up to 1898 I have counted only three cases in the litera- ture; Guillebeau has recently published records of seven- teen cases) although these organs are carefully examined in abbatoirs. Nourishment exerts an influence on the develop- ment of cancer, in that it develops more frequently in those who eat meat than in vegetarians (observations in England). The same comparison has been made in the lower animals; in the carnivorous animals (cats, dogs) carcinomata are very common ; while in herbivora (cattle, horses) cancers are prac- tically unseen. This theory is valid only in dogs, which, ac- cording to my own experience, are the most frequent sufferers from carcinoma. The majority of the neoplasms in the dog belong to this class. On the other hand, the statement that the horse, as a carniverous animal, practically never suffers from cancer is incorrect ; in the years 1895-1902 I operated on twenty-five cases of cancer in the horse. Swine, on the other 136 CARCINOMA i hand—omniverous animals that consume flesh—are seldom affected with carcinoma; this has been demonstrated by ex- perience in the abbatoir. Therefore, for the want of a better cause, it is not so much the nourishment, as the species of the animal that has a predisposing influence on the develop- ment of cancer. Concerning the importance of heredity in animals, which by many is considered the principal etiological factor in man (compare with Cohnheim’s theory of the scat- tered embryonic cells, page 100), nothing definite is known. Notwithstanding the fact that carcinomata develop only in old animals, the possibility of heredity among them should not be forgotten. For this reason caution should be employed in the use of breeding animals that suffer from cancer. 2. Traumatic and chemical irritation have recently been placed in the foreground as etiological factors for the production of cancer in man. ‘This theory is supported by the appearance of cancer in the following places : the so-called cicatricial cancer which develops in a cicatrix under the in- fluence of a chronic inflammation ; the frequency of cancer of the gall-bladder when under the influence of mechanical irrita- tion from gall-stones ; the appearance of cancer on the lips, tongue, and larynx of tobacco-smokers ; as well as upon the skin of chimney-sweeps, workers in tar, paraffine, etc. Accord- ing to Brosch continual irritation of granulating cutaneous wounds with xylol developed artificial proliferations of the epithelium in guinea-pigs ; it was alleged that these could not be differentiated from incipient carcinomata of the skin (?). According to M’Fadyean cancer of the skin occurs in Austra- lian cattle after branding (f? ). According to Eggeling cutane- ous cancer of the inferior maxilla occurs in swine in an enzo- otic form as a result of feeding trom troughs (?). Cancer has’ not yet been experimentally produced by the influence of continued mechanical or chemical irritants, for example, applications of tar to dogs and rats (Hanau). Probably the irritants are only able to cause cancer when there exists a primary local or general predisposition ; they are not essential etiological factors, but exert an accessory influence. The fact should also be noted that carcinomata frequently de- CARCINOMA 137 velop in organs that are protected against external irritation (prostate and thyroid gland of the dog, cavities of the head, thoracic cavity, abdominal cavity in the horse). Thetheory that cancer of the lips and tongue of ani- mals frequently develops from external iri- tants is also wrong from a veterinary stand- point. On the contrary, they are very seldom produced in his manner. I have seen only one case, and have found only two cases mentioned in literature. 3. Parasitic infection has in recent years been frequently considered a cause of cancer. The parasitic nature of cancer has not yet been satisfac- torily demonstrated; its existence is improb- able. Bacteria have also been credited as the cause of cancer (cancer-bacillus of Scheuerlen); so far they have all proved to be inocuous accidental saprophytes (proteus mirabilis). The cancer-bacillus recently described by Schuller has proved to be a contamination of the prepara- tion with cork-cells. Also the protozoa or coccidia, which, according to Pfeiffer, Thoma, Adamkiewicz, v. Leyden, and others, existed in a special form within the cancer-cells, have proved to be degenerated forms of epithelial cells, as well as degenerated nuclei and nuclear bodies. ‘The following condi- tions when examined under the microscope may be confused with coccidia: endogenous new-formations of cells; incom- plete cellular division ; invagination of individual cells into each other ; the presence of red and white blood-corpuscles in cells; pathological nuclear division ; mucous, colloid, hyaline, and vacuolar degenerations of the cell-protoplasm, pathological cornification; degenerations of the nucleus, the nuclear bodies, and the nuclear membrane. Metastasis, which is common in cancer, as well as an occasional successful artificial transplantation of the cancer in both men and animals (Hanau, Geiss- ler, Hahn, v.Bergmann, Wehr, Cornil, Jensen) are cited as examples of the parasitic nature of the cancerous neoplasm. In contrast to the few successful cases mentioned 138 CARCINOMA are the unsuccessful attempts at transmission of many other investigators (Klebs, Tillman, Israel, Shattock and Ballance, Alberts, Ptitz, Trasbot, Du- play, Cazin, Cadiot, Gilbert, Gratia, Lién- aux, English Cancer Commission, and others), the parasitic nature is in no way proved by the artificial trans- mission of cancer. The successful results of inoculations are in reality nothing more than transplantations, or artificial metastatic formations; the specific pathological epithelial cells have been transplanted, not the parasite of carcinoma, the new cancer-proliferation develops from these cells. It has also occurred that, in inoculation experiments carried on in man, self-infection has taken place in those already affected. In these cases the principal factor, a predisposition, was present. CANCER IN MICE.—Jensen (Experimentelle Untersuchungen iiber Krebs bei Mausen. Zentralblatt fiir Bakteriologie, 1903, Bd. XXXIV, S. 28) has recently transmitted a carcinomatous tumor in a mouse over nineteen generationsof white and grey mice (not, however, to otheranimals). The transmission wasa simple transplantation. Mere crushing of the cells of the tumor produced negative results. Proof of the parasitic nature of the carcinoma could not be found. On the other hand, therapeutic experiments with blood-serum from vaccinated rabbits produced good results in diseased mice. The preparation of a serum to produce immunity is very dificult; the results are also uncertain. Jensen, at least, thought that there was no basis for the introduction of hope from the serum-treatment of cancerin man: PsEUDO-CARCINOMA.—Zschokke has observed two cases of a cancer-like tumor on the upper lips and intermaxillary space in horses ; it was caused by a fibrillar fungus (actinophytosis), and was as large as one’s fist (Schweizer Archiv. 1903). It consisted of a connective-tissue stroma with compartment-like enclosures (carcinomatous structure), these contained foci of leucocytes, and peculiar fungiform structures with filiform processes (degenerated filimentary fungi). In all probability the infection occurred from without through wounds and epithelial defects in the oral mucous membrane. The fungus re- sembled the actinomyces fungus, it varied from it, however, in certain respects. OCCURRENCE.—Localization of cancer is different in ani- malsthaninmen. Horses and dogs are the only animals of essential importance; in cattle, sheep, goats, swine and CARCINOMA 139 cats, carcinomata are only occasionally of surgical importance. The following are the most important special forms: 1. CARCINOMA OF THE SKIN.—This is most often found in dogs; according to my experience it most frequently occurs in the following places: on the head (ears and eyelids), onthe back, onthe tail, onthe prepuce, scrotum, inthe vicinity ofthe anus and on the limbs. In the horse the favorite places for _the development of cancer appear to be on the glans penis, the vulva and clitoris, on the tail and sheath, as well as in the region of the bulbs of the foot. Carcinomata of the penis form tuft-like, villous, often suppurative tumors; they usually attack the prepuce and lead to metas- tases in the inguinal glands (Leisering, Méller, per- sonal observations). Macroscopic appearance of carcinoma is extremely variable according to the age and location of the tumor. Carcinomata of the skin usually present the fol- lowing appearance: they are attached tothe skin, haveatendency to ulceration andinfiltration of the adjacent tissues, and are firm in con- sistence; the surface is nodular and rough; the margins of the ulcers are wall-like and firm; nodular formation is present in the vicinity; there is a secondary swelling of the neighboring lymph-glands. The neoplasms may be circumscribed or diffuse ; large areas of the skin may become ulcerative, nodular, thick, lardaceous, ichorous, and trans- formed into immense tumor-masses that are foul in appear- anceand odor. Onthepenis, carcinomataform tumors that are papillomatous, villous, fissured, and often very large. 2. CARCINOMA OF THE Mucous MEmMBRANES.—These are often found in superior maxillary sinuses of the horse. According to my observations they form firm, lobulated, hemorrhagic, very rapidly developing tumors. The neoplasms are permeated with hemorrhagic foci and contain a fluid similar to that found in the medullary substance of the brain ; they usually arise from the mucous membranes of the oral and pharyngeal cavities (squ amous-celledcancer 140 CARCINOMA of the hard gums) andlead to loosening of the teeth, penetration to the nasal cavities, maxillary sinuses, and even the frontal sinus, they also result in swelling of the intermax- illary lymph-glands (metastatic formation). Similar tumors have been observed in the nasal cavities of the horse; in this case the squamous-celled cancer originated from the squamous epithelium of the lachrymal duct (Mont fallett). Carcinomata are further found in the pharyngeal cavity of the dog, as well as in the turbinated bones and esophagus ofthehorse. In the latter place, under certain conditions, they may lead to perforation and fatal pleuritis ; a case of this kind has been described by Lorenz. Carci- nomata are further observed on the mucous membranes ofthe eyes in horses; they either involve simply the membrana nictatans (personal observations), or the conjunctival schlera (Bayer), or penetrate the entire orbit destroying the neighboring bones, especially the frontal bone, the superior maxillary bone, the zygoma, aud the lachrymal bone, even penetrating into the frontal and superior maxillary sinuses(Leisering, Moller, Eichler, personal observations). Among two and one half million cattle slaughtered in Chicago in 1899 Loeb and Jobson claim to have found forty-eight cases of squamous-celled cancer of the lachrymal caruncle (at first it is about the thickness of one’s finger and papillomatous ; it afterwards becomes exten- sive, fissured, and covered with blood-coagulum. Carcinomata are also frequently found in the vagina, on the clitoris (Eberlein, Hennig, Naudin), inthe uterus (Guillebeau), in the bladder, as wellason the skin and mucous membranes of the prepuce of dogs, horses and cattle. Olt has described a ease of cancer of the rectum in the horse (squamous- celled cancer, congenital wandering of squamous epithelium to the mucous membrane of the rectum). Carcinomata of the bladder are usually in the form of villiform can- cers; they present cauliflower-like, villous, tufted, fissured proliferations of the consistence of mucus, and have a firm base. They lead to hemorrhage and ichorous degenerations, CARCINOMA 14! as well as to nodular formations in their immediate vicinity (hemorrhagic, ichorous, fetid, sedimentous urine) ; occasion- ally they extend to the peritoneum and the abdominal viscera, or result in a fatal perforating peritonitis (Siedamgro- tzky, Kitt, Pflug, Esser, Bang, Demeurisse, Bollinger, and others). A case of cancer of the tongue has been observed in a twelve-year-old cat (M’ Fadyean); he found a cancerous ulcer on the ventral surface of the tongue, from here plug-like carcinomatous proliferations penetrated the entire tongue. Pflug and Leblanc have described a case of cancer of the tongue in cattle, and cancer of the lips inadog. Inthe larynx (epiglottis) only one carcinoma has been observed (Casper). Cancer of the stomach is far less common in animals than in man; veterinary literature contains records of only a very few cases in the horse and dog (Oltmann, Roloff, Kitt, Eberlein, Dtirbeck). 3. CARCINOMATA OF GLANDS.—These are most frequently observed in the mamme of the bitch ; I have operated eighteen cases. Their consistence and size are extremely variable ; pain and heat are usually absent; the skin is either intact, or possesses ulcerative foci and undergoes cancerous infiltra- tion; the adjacent lymph-glands are frequently swollen. Carci- nomata of the mamme are sometimes soft, and may even fluctu- ate as a result of cystic degeneration. Many cases have been observed by Bang, Kitt, Rabe, Johne, Moller, Putz, Pflug, Stenzel, andothers. In cattle, horses, and swine, on the other hand, cancers of the mammez seldom occur (Cadiot). Carcinomata of the testicles are common in horses and dogs; they often result in a marked enlargement of the testicles (one form of so-called sarcocele), infiltration of the spermatic cord, swelling of the inguinal glands, carcinomatosis of the peritoneum, as well as metastatic formation; they are occasionally observed in cryptorchids, and are not uncommon in the laterally displaced testicles of thedog. Cases of cancer of the testicles have been described by Leisering, Stock- fleth, ROll, Guillebeau, Siedamgrotzky, Mol- ler, Fréhner, Trasbot, Cadiot, and others. 142 CARCINOMA Carcinoma of the thyroid gland occurs most fre- quently in horses and dogs; it occurs in the form of goitre (struma maligna, struma carcinomatosa). It is characterized by rapid development, emaciation and cachexia of the animal, as well as metastatic formations in the lungs (breaking down of the jugular) and other internal organs, followed by a fatal termination (Johne, Kitt, Siedamgrotzky, Moller, Zschokke, Hutyra, Cadiot, personal observations). In dogs thyroid-gland cancers may reach the size of two fists; in horses they may attain twice the size of a man’s head. ‘They often embrace the trachea and esophagus, and occasionally extend as far as the thoracic cavity. Cancer of the prostate in dogs is of special importance as it can be diagnosed per rectum, it often forms a tumor as large as one’s fist, and is the cause of habitual constipation (personal observations). Only one case of cancer of the pros- tatein the horse has been described (Cadiot). Carcinomata of the anus are very common in dogs ; they originate from the anal glands (compared with these, carcinomata of the rectum are very rare). They form uneven, nodular, warty, cauli- flower or fungus-like neoplasms; they are fissured and lobu- lated ; occasionally they are also pedunculated, soft, and painless.: Siedamgrotzky has described a cancerous neoplasm that originated in the thymus gland of the horse; it led to metastatic formation in the inferior cervical glands, the principal lymph-vessels, and the retro-pharyngeal and sub- maxillary lpmph-glands, as well as to extensive schlerosis of the subcutaneous and intermuscular connective tissue. It presented the clinical appearance of a high-grade edema of the skin on the dependent portions of the head, neck, and thorax. Hinrichsen observed a multiple cancer of the lymph-glands ofthe head (medullary carcinoma) in two horses, it was characterized by metastases in the internal organs, inthe glands inthe vicinity of the shoulder and arm, and the axillary glands; pronounced edema was also present in the same vicinity. Similar cases of primary cancers of the CARCINOMA 143 lymph-glands in horses and. dogs have been described by Leisering, Casper, Kitt, and Frohner. Petit has observed one case of carcinoma of the parotid in the cat. 4. CARCINOMA OF THE INTERNAL ORGANS.—They often occur in horses, dogs, and cattle, but are of trivial surgical importance. They areoften found on the pleura, on the peritoneum, in the omentum, and inthe mediastinal, mesenteric, and lumbar lymph-glands, where they are often multiple, characterized by secondary metastases, and more or less generalized. Enormous masses of tumors are often formed, they involve the lungs and other adjacent vis- cera, and even penetrate the walls of the thoracic and abdomi- nal cavities. Carcinomata have also been observed in the liver, inthe kidneys, in the suprarenal glands, inthe ovaries (roto 20 kg. in weight, occasionally fatal through hemorrhage and peritonitis), in the rumen, stom- ach, intestines, in the lungs, in the brain, and spinalmarrow (metastases). A cancerous metastasis in the horse has led to pressure-paralysis of the spinal cord (Alfort Clinic). TREATMENT.—As in sarcomata, so in carcinomata, the earliest possible extirpation forms the basis for successful treatment. Caustics are rarely indicated. Opera- tive removal of the following forms is relatively simple: car- cinomata of the skin and anus, as well as carcinomata of the membrana nictitansand eyelids. Carcinomata of the mamme, penis, and testicles are removed by amputation, or cas- tration. It is more difficult to treat proliferating carcino- mata in the cavities of the head (trepanation). Extir- pation of cancer of the thyroid gland is especially difficult (severe hemorrhage, cachexia strumapriva). All internal carcinomata are incurable (pleura, peritoneum, lungs, internal lymph-glands, liver, kidneys, bladder, stomach, intestines, etc.); the same is true of generalized carcinomatosis. Arsenic, which was formerly administered as an internal specific, acts only asa stimulant to metabolism and nourishment. Inocu- lation of the cancer with erysipelas has occasionally been fol- lowed by recovery in man, it is seldom employed at the pres- 144 PAPILLOMA ent time as it endangers the life of the patient. Serum- theraphy (injection of blood-serum from animals affected with cancer, or from animals into which masses of cancer have been inoculated) has not proved a success (Cadiot, and others). This serum seems to possess a specific action for experimental animals (mice) (Jensen). Recently, Rontgen rays and radium rays have been employed to cure cancer (this method results only in the destruction of the cancer-cells). STATISTICS OF CANCER IN ANIMALS.—Sticker has‘collected re- ports from veterinary literature on 1217 cases of cancer (332 horses, 766 dogs, 78 cattle, 21 cats, 12 swine, 8 sheepand goats). According to fre- quency they were arranged as follows: 1. Horse: penis, nasal and adjacent cavities (52 cases), kidneys (29), skin (22), vagina (18), eyes and urinary bladder (14), lungs and testicles (13), gingive (II), anus, stomach, thyroid gland, uterus (8), larynx (7), ete. 2. Cattle: uterus (16), kidneys (10), bladder (9), ovaries and stomach (6), liver (4), vagina and lungs (3), etc. 3. Dog: mamme (341), skin (166), anus (89), thyroid gland and lungs (10). 4. Cat: skin (6). mamme (5), lungs (3), liver (2). 5. Swine: kidneys (7), skin (2). g li, PAPILLOMA, NATURE AND Forms.—Papilloma was formerly considered a connective-tissue proliferation of the papillary body, and classified with the fibromata (papillary fibroma); recently it has been placed with the epithelial neoplasms (papillary epithelioma) and is considered a mixed tumor (fibro-epithelial neoplasm). It consists of a hyperplasia of the epithelium of the skin and mucous membranes with a simultaneous pro- liferation of the papillary body (connective-tissue and vascular new-formation). Two forms of papillomata are recognized : a) Warts (verruca) are hard, dry, horny papillomata derived from the epithelium of the skin. b) Condyloma (fig-wart) is a soft non-cornified, vascular PAPILLOMA 145 proliferating papilloma of the skin and mucous membrane (pointed, broad condyloma) ; it is moist on the surface (fig- wart, moist wart), and has the appearance of cauliflower or cockscomb. Er1oLocy.—Chronic inflammatory irritants play an important part in the development of papillomata. The so-called verrucose form of scratches in the horse is a multiple warty formation on the skin of the fetlock; it is the product of a chronic dermatitis or infectious inflammation of the skin. They have also been seen on the lips of horses and cattle that have been pastured in fields of stubble; such cases are due to inflammatory processes on the skin and mucous membranes. Chronic irritants (excretions) in the vicinity of the vulva and anus may also be considered occasional causes of papillomatous neoplasms. Some believe that papilloma- tous tumors are contagious. Mégnin described alleged in- fectious papillomata on the lips of lambs in which he demon- strated spherical pathological microorganisms. M’Fadyean and Hobday have successfully transmitted papillomata from one dog to another. Aubert and others have observed transmission from cowsto men. ‘The inoculation experiments of Gratia, on the other hand, were unsuccessful. In addition to the irritation theory, the question of heredity as an etiological factor in the production of papil- lomata must be considered. It has been observed that in foals, calves, and dogs, papillomata are congenital. Many believe in hereditary transmission. In these cases inflammation is excluded as an etiological factor; the basis of the cause must lie in an embryonic proliferation of the cells. OccURRENCE.—Papillomata are most often found in dogs, horses, and cattle. 1. In dogs, the favorite locations for develop- ment are the lips, the mucous membranes of the mouth (lips, gingivee, tongue), the eyelids, the ears, especially the external auditory canal, the buccal region, prepuce, penis, the anus and vagina, as well as the extremities. Papillomata are characterized by their rough and lobulated surface; they are similar in appearance to strawberries, rasp- y Ss he Age 146 PAPILLOMA berries, blackberries, cauliflower, cockscomb, etc. They usually havea sharply defined margin, occasionally they are pedunculated; they vary in size from a lentil-seed to that ofa pea ora walnut; they may be dry or moist on the surface. General papillomatosis is common. 2. In cattle papillomata are often multiple so that the entire skin appears to be covered with warts. They are especially numerous on the head, throat, on the shoulders, udder, abdomen, on the penis, and on the limbs. They form rough, granulation-like, lobulated, painless neoplasms; they are often fissured, and are broad or pedunculated; they are firm in consistence, and yellowish-white in color, they become confluent and attain the size of a man’s fist, sometimes even that of a man’s head. Papillomata are extremely variable in form ; at times they lead to an extensive thickening of the skin, and they may attain a weight of fifty pounds. Thierfelder observed a papillomatous tumor that extended from the withers to the root of the tail in a three-year-old heifer; it was from 30 to 40 centimeters broad and 15 to 20 centimeters thick ; from a distance it had the appearance of the horny covering of an immense tortoise; nearby it was similar in appearance to the quills of a porcupine. Wehrner has described a case of papillomatosis with a mane-like covering of hair (hypertri- chosis) on the neck. In many cases the udder is the seat of numerous papillomata ; the dry form is especially common on the teats, occasionally the teats are the seat of soft, villiform warts. In addition to these cutaneous papillomata, others are frequently observed on the mucous membrane of the pharynx and esophagus, occasionally they are seen in the omentum and bladder. In lambs, warts are very often found on the lips. 3. In the horse, especially in foals, warty growths are found in the region of the lips, the nose, on the eye-lids, ears, on the sheath, etc. In older horses they are found on the following places: in the region of the saddle and harness, on the coronet (personal observations), as well as subsequent to scratches on the fetlock (dermatitis verrucosa so-called ‘‘Straubfuss’’ bristle-foot). They are ADENOMA 147 very rarein the bladder where they form one variety of so- called villiform cancer, Canker of the hoof (canker of the frog) isa papillomatous neoplasm ; it is characterized by pronounced proliferation of the papillary body and rete mucosum ; in thisdisease the growth of the horn is suspended (infection ?). TREATMENT.—Treatment of papillomata consists in sim- ply cutting away with scissors, or twisting off with the fingers. Caustics (concentrated nitric acid and other acids) are not indicated, with the exception of papillomatosis of the frog; in any case they should be applied with great caution in the vicinity of the eyes and mouth. Papillomata on the lids, because of the possibility of transformation, must be thoroughly treated, that is, extirpate the entire tumor by removing a keel-shaped section of the lid. In young animals, the internal administration of arsenic has occasionally been followed by good results. Papillomata often disappear with- out treatment. Spontaneous healing of cancer of the frog has occasionally been observed after recovery from contagious pleuropneumonia. III. ADENOMA. NaturE.—An adenoma is a non-cancerous, be- nign, epithelial neoplasm of glandular type. Adenomataaretermed tubular, acinous, or alveolar, according tothe type of the gland from which they are de- rived ; they are also classified according to the nature of the gland, adenoma of the thyroid gland (struma), mammary, hepatic, sudoriferousand sebaceous adenomata. When an adenoma consists largely of con- nective tissue it is termed a fibroadenoma; when the converse is true it is termed an adenofibroma (so-called fibroepithelial neoplasms), Adenomata, regardless of their benignity as epithelial neoplasms, occasionally have a tendency towards carcinomatous transformation (malignant adenoma, adenoid). OccuRRENCE.—It is most frequently seen, especially in 148 EPITHELIOMA puppies, in the form of goitre (simple hyperplastic struma)— adenoma of the thyroid glands—it is less common in the horse (Lanzillotti, Markus, Pfeiffer, personal observa- tions). Adenofibromataofthenasalmucous mem- branes are relatively frequent in horses (firm, rough, mul- tiple, readily hemorrhagic, usually bilateral neoplasms on the lower third of the nasal mucous membranes ; formerly they were erroneously termed rhinoschleroma). Adenomata are not rare in the mammae of the bitch. Only a portion of these neoplasms, however, ave pure adenomata, they are fre- quently fibroadenomata, adenofibromata and myxoadenomata (Leblanc). An adenoma of the mucous membranes of the larynx has been observed in a cow by Johne; sebaceous adenomata and sudoriferous adenomata have been observed in the skin of dogs, especially in the vicinity of the anus (perineal glands) (Kitt, Siedamgrotzky, Moller, and others). Adenomata of the Harderian glands of the membrana nictatans have been observed in the dog by Schimmel and myself. Adenomata also occur in the rectal mucous membranes (glands of Lieberkthn) of horses in the form of cysts and polypi (personal observations). Adenomata of the liver, as well as of other inner organs, are of no surgical importance. ' EPitHELIOMA.—In Germany this term is applied to a benign, circumscribed neoplasm of the epidermis on the skin (in France, epithelioma indicates a carcinoma). It is partly due to con- tinual irritation of the skin by pressure (callosities, clavus, tyloma), partly caused by parasitic infection (epithelioma gre- garinosum or molluscum, bird-pox). Cornu CuTANEUM.—This is an epithelial neoplasm similar to epithelioma (cornu cutaneum, keratosis, keratoma). It is a circumscribed outgrowth of newly-formed, horny, epidermal cells. They are often found in cattle on the neck, in the intermaxillary space, on the head, on the abdomen and udder; occasionally they occur in the form of horn-like structures one-fourth to one-half meter in length; at times they are of actinomycotic origin (Schreiber); they may also occur in birds asa symptom of tuberculosis of the skin (Eberlein has described a typical case in a parrot), they are found in horses (fet- lock, ear), sheep, dogs, and goats. -KERATOMATA (tumor-like, usually, however, inflammatory hyperplasias of the hoof-horn) are similar pro- liferations; the same is true of onychoma (hypertrophy of the CYSTIC TUMORS 149 tissue of the nail), ichthyosis (congenital or horn-like thickening of the entire skin, especially in calves), as well as hystriciasis (congenital bristle-like erection of the hair and thickening of the skin). Cystomata.—These are epithelial neoplasms in glands, with cystic formation. They may be defined as cystic adeno- mata. They are most often found in the ovaries (ovarian cysts), in the thyroid gland (cystic goitre), in the mamme, parotid, and in the supe- rior maxilla of the horse. In contrast to ordinary cysts, cystomata are genuine, proliferating cysts (see page 150). C. CYSTIC TUMORS. DEFINITION.—A cyst isasac-like, spherical, or bladder- like tumor ; it contains fluid and is surrounded by a capsule. The development of cysts is extremely variable. The following forms are recognized. 1. Retention-cysts. 2. Dermoid cysts. 3. Genuine cysts (cystoma). ‘4. Extravasation- andexudation-cysts. 5. Cystic degeneration. RETENTION-Cyst.—A retention-cyst is formed by a re- tention of the secretions of a gland. Various types of retention-cysts are recognized. a) So-called mucous cysts develop from the mucous membranes as a result of retention of the secretions of the mucous glands. They are especially common in the oral cav- ities of dogs, cattle, and horses; they are situated at the lateral and ventral surfaces of the tongue in the form of so- called ranulae (retention-cyst of the sub-lingual gland ; according to others a dermoid cyst); in the intermaxil- lary region and region of the larynx in the form of so-called meliceris; on the mucous membranes of the lips, especially on the upper lip in the horse; in the nasal cavities; at the base of the epiglottis; _ and inthe trachea of horses andcattle. They are found in the vestibule of the vagina in cows (retention-cysts of both glands of Bartholin, orof Gartner’s duct), 150 DERMOID CYSTS as wellas inthe rectum in horses (glands of Lieberktthn). b) So-called atheromata (pultaceouscysts, encysted tumors) occur in the skin, especially that of horses (base of the false nostril, inner canthus of the eye, base of the auricu- lar cartilage), swine (teats), and dogs (back); they are usually solitary. Multipleatheromata are rare (Velmelage has described a case in the dog). Formerly they were all con- sidered retention-cysts of the sebaceous glands. Recent investi- gations have demonstrated that they are partly due to aberra- tion of epidermal cells, such cases must be classified with dermoid cysts. c) Retention-cysts of large glands, especially the udders of milch cows are due to an obliteration of an individual milk-duct, or the common milk-canal. DeRmoip CystTs.—This name indicates neoplasms which belong to the teratomata. They are due to an embry- onic wandering of germ-cells of the skin or mucous membranes; these may pass into the inner organs (subcutis, ovaries, testicles, brain), so that, under certain conditions, the walls of the cyst contain all the different elements of the skin or mucous membrane, namely, epidermis, papillary body, hair and feathers, sebaceous, sudo- riferous, and mucous glands. To this class belong the so- called tooth-follicle cysts; these occur in horses and cattle in the vicinity of the parotid glands(so-called ear-fistula); they are branchial-arch teratomata, that is, derivatives of a primative tooth-fold of the epithelium of the oral cavity, they are a result of the presence of the branchial arches. One usually finds a small opening at the base of the ear, the sur- rounding hairs are matted by a tenacious, slimy fluid; on passing a probe it enters a blind canal or cystic hollow space, at the bottom of which a molar tooth is found. About one hundred cases of branchial-arch teratomata in horses and cattle have been recorded. Dermoid cysts also include the very rare tooth-teratomata onthe superior and inferior maxilla of the horse; these are large tumors which contain hundreds of teeth in all stages of development (Ostertag, Lohoof). By many, ranula is considered a dermoid cyst. Dermoid cysts of the ovaries are very rare (hair, teeth, bones). EXTRAVASATION- AND EXUDATION-CYSTS 151 GENUINE Cysts.—Genuine cysts are also termed cy st o- mata; they areglandular, epithelial neoplasms (cystoadenoma) (see page 148). They are most often found in the ovaries andinthe thyroid glands. They are the ordinary cystic formation (single sac, or multiple hollow spaces) in the ovaries of cattle, horses, and dogs ; occasionally they become very large. Stockfleth has observed a cystic ovary that weighed 125 pounds, inacow; Albrecht has observed one that weighed 80, and another that weighed 50 pounds in the horse. I observed a case in which a cystic ovary as large as a child’s head constricted the rectum and caused fatal colicin a mare. Finally, genuine cysts occur in the superior maxilla of the horse (detached epithelial. foci) ; occasionally they press through the superior maxillary sinuses into the nasal cavity (pseudo-hydrops of the maxillary sinus). EXTRAVASATION- AND EXUDATION-CysTs.—Hematomata due to contusions may become encapsuled as a result of aseptic inflammatory processes in their vicinity ; they form swellings having a cavity filled with serum, and are termed extrava- sation-cysts or blood-cysts. They are frequently observed on the anterior surface’of the carpal-joint in cattle (so-called knee-boils), and on the neck and back of the dog. Their existence is analogous to capsule formation around for- eign bodies and parasites (foreign-body cysts, parasitic cysts). Blood- and lymph-cysts, the result of gradual dilitation of blood- and lymph-vessels (dilitatjon-cysts), are less common. Exudation-cysts are formed in a similar manner asa result of inflammation of mucous membranes and tendon- sheaths. To this class belong hygromata of the mucous bursae over the point of the elbow (so called shoe-boil) and os calcis (so-called capped-hock) in horses and dogs, as well as hygroma proliferum on the carpus of the horse and ox (one form of knee-boil). DEGENERATED Cysts.—These are cystic degener- ated neop lasms (cystoid degenerations); they most often occur in sarcomata and in carcinomata (cystosarcoma, cysto- carcinoma, cystofibroma). / 152 actrdnomycoma TREATMENT.—Treatment of cysts consists in extirpa- tion of the sac. Simple puncture or incision is usually insufficient ; this is especially true of mucous cysts and atheromata. Onthe other hand, puncture with a subse- quent injection of tincture of iodine is effectual in many forms of extravasation- and exudation-cysts (hygroma, shoe- boil); it is necessary to incise and remove the necrotic sac. When removing the sac care should be taken to remove all the parts; no portion of the proliferating tissue should remain behind. Special difficulty is encountered in the total extirpa- tion of ranula ; this is also true of many mucous cysts in the throat of the dog. On the other hand, teratomata are usually operated without difficulty. In tooth-follicle cysts the teeth are removed from the temporal bone with hammer and chisel, and the mucous membrane of the cystic sac is carefully curetted. Cysts of the ovaries in cattle may be crushed per rectum with the hand. ue w . D. INFECTIOUS TUMORS. I, ACTINOMYCOMA. ETIOLOGY AND PaTHOGENESIS.—Actinomycoma is a swelling caused by the ray-fungus oractinomyces. This fungus, which belongs to the schizomycetes (cladothrix), was described by Perroncito, Rivolta, Hahn, and Bol- linger in the years 1868-1877. Macroscopically it forms sulphur-yellow, sand-like kernels. Under the microscope they have the appearance of glands, with a branching, rosette- like arrangement, composed of club-shaped, thick threads. Entrance of the actinomyces fungus into the body seems to occur in various ways. It usually gains en- trance through the digestive tract (mouth cavity, pharynx, stomach, intestines). Their primary seat is on the, fragments of plants; they have been especially demonstrated on beards of grain, in the tonsils of swine, and in the tongues of cattle. It is thought that transmission occurs as AcrigNoMycoma 153 follows: at first the fungus gains entrance to small wounds of the mucous membranes, or passes into the excretory ducts of glands, possibly it colonizes in the alveoli of diseased teeth, or those that are changing; its further extension is from these points. In cattle, especially, beards of grain covered with fungi appear to penetrate be- tween the teeth and gums, as wellasintothe tongue. When they once gain entrance removal is difficult because of the peculiar arrangement of the hairs on the beards ; a similar phenomenon is observed with rye-beards, for example, when they become attached to one’s coat-sleeve. sac, that is, the sac-shaped, protruded peritoneum covered with skin or mucous metnbrane; 3, the contents (intestine, omentum, bladder, stomach, liver, uterus). The margin of the mouth of the hernia is termed the hernial ring. The hernial sac consists of a mouth, neck, body, and fundus. According to the contents of the hernia one speaks of an enterocele (intestinal hernia), epiplocele (omental hernia), gastrocele (gastric hernia), entero-epiplo- cele, cystocele, hysterocele (hernia of the uterus), hepatocele, odpherocele. Inaddition to the essential contents hernias contain a serous fluid, hernial water. With reference to the mobility of the hernial contents, they are classified as reducible (moveable, free), that is, they may be pushed through the hernial mouth into the abdominal cavity ; and irreducible (immoveable), that is, a hernia that cannot be returned. The immobility is due, 186 SYMPTOMS either to adhesions between the hernial contents and the hernial sac, which is especially common in omental hernias (immobility of the omentum); or to incarceration (constriction, strangulation) of the prolapsed viscera, this is especially frequent in intestinal hernias. ‘ With reference to the causes of hernias, they may be congenital or acquired (traumatic). Symptoms.—1. A reducible herniais characterized by alarge or small hernial swelling which occupies a char- acteristic seat in the umbilical or inguinal region, ete. The swelling is painless, is not characterized by a rise of tempera- ture, and has a soft peculiar consistence ; the skin is moveable on the surface, occasionally ore: may easily palpate intestinal loops or pieces of omentum at its base. Percussion occasion- ally gives a tympanitic sound (air in the intestinal loops); on auscultation one can’ occasionally hear rumbling or gurgling peristaltic sounds. On pressure’ the swelling be- comes. smaller and finally entirely disappears inthe abdominal cavity. Palpation of the abdominal wall reveals the hernial mouth, it varies in size from a pea to that of one’s fist; in form it is round, oval or elongated, whenever a hernia has existed for a long time the free margin of ring becomes firm and tendinous. In rare cases the abdominal sac becomes ossified in cattle. 2. Incarcerated hernia, especially in horses, is first recognized by colic (strangulated inguinal hernia of stallions); in dogs and swine one further observes vomiting, and even stercoraceous vomiting;constipation is pres- ent in all animals. On local examination one finds an inflammatory swelling at the seat of the hernial sac; attempts to return the hernial contents are unsuccessful. TREATMENT.—One must differentiate between the treat- ment of a reducible and an irreducible hernia; the reducible form may receive either provisional (palliative). or definitive (radical) treatment. It should also be observed that many forms of hernia, especially those of the umbilical and ventral regionsin horses and cattle, heal spontaneously (cicatrization). On the other hand, many forms with a very TREATMENT 187° wide mouth (ventral hernia) are incurable, especially in horses’ and cattle. Finally, many forms of non-incarcerated hernias, especially those of the umbilicus, require no treat- ment as they do not usually result im diseased conditions. (colic, ete.). 1. The panies treatment of non-incarcerated hernia consists in the application of an abdominal band- age, this is especially useful for umbilical and ventral hernias. of dogs, foals and mares. The prolapsed viscera are pressed back into the abdominal cavity by the abdominal bandage, this is followed by a gradual diminution in size of the hernial mouth. Palliative treatment is further employed in the form of return of the hernial contents by means of pressure and reduc- tion of the hernial sac by means of artificially devel- oped inflammation and cicatricial formation in its vicinity. For this purpose the following agents have been employed: blisters (calcium dicromate 1-8 or 10), firing the skin of the hernial sac, applications of sulphuric acid, nitric acid, chromic acid, as well as subeu- taneous injections of alcohol, salt, and other irritating materials. The efficiency of this method is still questionable. At any rate it is not without danger. Gan- grenous necrosis of the skin with prolapse of the intestines has followed the application of acids; subcutaneous injections have been followed by severe phlegmons and fatal peritonitis. Other palliative remedies are ligation, clamping, and suturing of the hernial sac. 2. The radical operation consists in exposure of the hernial sac (herniotomy). The mouth of the hernia is. sutured with, or without, subsequent extirpation of the hernial sac (inverted into the abdominal cavity). Herniotomy is the surest method of treatment of a hernia because it not only removes the hernial sac but obliterates the mouth. Experience has taught that mere suturing, clamping, or binding the hernial sac is occasionally followed later by the passage of viscera through the remaining hernial mouth, this results in the gradual formation of a new sac. 188 PROLAPSE 3. Treatment of an incarcerated hernia consists first in the return of the strangulated viscera (taxis) through manual reposition, dorsal position, combined attempts from without and inside the rectum, placing the hind limbs in a special position to favor enlargement of the inguinal ring, as well as deep narcosis of the animal by means of chloroform, If reposition is not successful by this method, the constricted hernial moth (implication of the tunica vaginalis) must be enlarged by means ofa hernial incision (herniotomy), taxis may then be successfully employed. The return of the strangulated hernia must be preceded by careful disinfection, as well as resection of any necrotic portion (intestinal suture). In stallions, herniotomy of an incarcerated inguinal herniais usually followed by castra- tion with the use of clamps and the covered operation. II. PROCIDENTIA. PROLAPSUS. DEFINITION.—Prolapsus (prolapse) is a free passage of viscera through natural or arti- ficial body-openings without a covering of the skin or mucous membrane. Asa rule the causes are traumatic in nature. Thus, rupture of the abdominal wall results in pro- lapse of the intestines and other abdominal viscera; severe efforts at abdominal pressure, prolapse of the rectum ; stretch- ing and relaxation of the uterine ligaments, prolapse of the vagina and uterus; penetrating thoracic wounds, prolapse of the lungs ; severe wounds of the skull are followed by pro- lapse of the brain; bites of the eye, prolapse of the bulb; rupture of the vaginal wall, prolapse of the bladder ; paralysis of the penis and tongue, proplase of these organs. Prolapse should not be confused with eversion (in- version, inflexion) of a hollow organ (bladder, uterus), or with intussusception (invagination) of a sec- tion of the intestine or vagina into itself. Prolapsus vesice is a prolapse of the bladder through the ruptured vaginal floor into the vagina, or outwards through the vulva; inversio PROLAPSE 189 vesicze is an outward inversion of the bladder through the neck of the bladder and the urethra. In veterinary science the nature of prolapsus, inversion, and invagination is not always sharply distinguished. So-called prolapsus recti is often pro- lapse of the rectum with invagination; so-called prolapse of the uterus and vagina, an inversio uteri and vaginee with prolapse. Symptoms.—The symptoms of prolapse are extremely variable according to the organs affected. 1. Prolapse of the intestines consistsin the pro- trusion of portions of the small intestines, colon, and even cecum, through penetrating abdominal wounds, through the tnguinal canal after castration, or through a hernial ring after herniotomy. It is always a very dangerous accident. Reposi- tion must be accompanied by careful disinfection of the pro- lapsed intestines, taxis is followed by accurate suturing, cas- tration by the covered method may be necessary. 2. Prolapse of the omentum most often occurs after castration, or following perforating abdominal wounds. It is far less dangerous than prolapse of the intestines. Treat- ment consists in careful disinfection, ligation, incision of the stump, return of the stump, and careful suturing of the wound. Castration by the covered method may be employed. 3. Prolapse of the rectum is partly a prolapsus ani, partly a prolapsus recti, with or without invagination. It is a result of abdominal pressure from straining, chronic diarrhea, rough exploration, etc. It is most frequently ob- served in ,dogs, cats, and swine, less often in horses. The prognosis should be made with caution, reposition, regardless of sutures, is frequently of no permanent value, so that one must employ amputation of the prolapsed parts. 4. Prolapse of the vagina occurs in cattle as an inversion of a portion of the vagina (incomplete prolapse), less frequently in the form of an invagination of the entire vagina with a simultaneous prolapse (complete prolapse). It may follow traumatic influences as a result of parturition. A pos- terior dispiacement of the uterus when accompanied by atony of the uterine ligaments, so-called habitual prolapse, may occur in cows which occupy positions with the hind parts the lowest. 190 DISEASES OF BONES 5. Prolapse of the uterus is especially common ‘in cattle, it is caused by rough manipulations at the time of birth ; inversion with prolapse is also due to continued strain- ing. Reposition, and retention especially, is occasionally difficult, so that amputation is sometimes required. 6. Prolapse of the penis is observed in paralytic conditions, as well as in paraphimosis. Prolapse of the ‘tongue is either the result of rupture of the muscle, or paralysis (it should not be confused with the ordinary blemish in which the tongue is protruded). Prolapse of the bulb is most often observed in dogs (pugs) as a result of bites; treat- ment consists in reposition or amputation. Prolapse of the membrana nictitans is observed in tetanus. In ad- dition to these are inversion and prolapse of the bladder, prolapse the of pododerm, prolapse of the iris, prolapse of the posterior corneal membrane through a corneal ulcer (ke ra- tocele), forward protrusion of the cicatricial cornea (corneal staphyloma). The following internal changes in position of viscera are of surgical importance: torsion and anteversion of the uterus incattle, twisting of the left colonon its axis in horses. Twisting of the stomach on its axis is occasionally observed in dogs, as well as luxations and torsions of the spleen in swine. With reference to changes in position of the uterus, and abnormal positions of the fetus, see text-books on obstetrics. j DISEASES OF BONES. I. . BROKEN BONKS. FRACTURES. PRELIMINARY REMARKS ON ANATOMY AND PHYSIOLOGY.—Normal bone is composed of three principal constituents: the periosteum, the genuine bone-substance (tela ossea), and the bone-marrow. From a surgical standpoint the periosteum is of greatest importance in diseases of bone, this is especially true of fractures. The bone-marrow (endosteum), from a standpoint of veterinary surgery, stands next in importance. In diseases of the bone the tela ossea plays a less important part. x FRACTURES 19I For an understanding of the processes of healing, as well'as various pathological processes in the bone, it is necessary to have a knowledge ‘of the physiological development as it occurs im the normal growth of bone. Asa result of the embryological and histological investiga- tions of Kélliker, Gegenbauer, Waldeyer, and others, it has been demonstrated that bone may develop from periosteum, bone-marrow, or cartilage. One distinguishes, then, a peri- osteal, a myelogenic or endosteal, and an enchondral formation of bone. The organs mentioned supply, first of all, a soft germ-tissue, the marrow-tissue (osteoid tissue) in which the ostTroBLasts, that is, the specific bone-forming cells, then develop. The most important pro- cesses are as follows: I. Periosteal bone formation is similar to the perichondral form which occurs in the fetus, that is, it develops from the inner osteo- blastic cell- layer of the periosteum (so-called cambium or formative layer); the outer layer of the periosteum has few vessels or cells, it is rich in connective-tissue fibers, and plays no part in the development of bone. The formative layer of the periosteum contains marrow-spaces which have a rich cellular and vascular supply. A part of the former are transformed into osteoblasts; calcium salts are deposited around them and there is formed lamellar-like bone-tissue in which these cel- lular elements are confined in sac-like cavities and are tetained as so- called bone cells. 2. Myelogenic or endosteal bone formation follows ina ‘similar manner, the boundary between the marrow and the tela ossea is first supplied with osteoid tissue from the bone-marrow, this is followed _by the formation of osteoblasts and bone-tissue. 3. Enchondral bone formation is observed on the epiphyseal cartilage of fetal bones; it develops from the osteoblasts and marrow- cells of the marrow-cavities in the cartilage. If the epiphyseal symphisis is continually irritated (chronic inflammation, compound fractures, blows from sticks) developing bone becomes abnormally long (Berg- man, Tillman, and others). In contrast to the bone-forming activity of the osteoblasts, there stands the resorbing activity of the OsTEOCLASTS; this is constantly present in normal bone. The origin of these bone-solving, multinu- ‘clear, giant-cells has not yet been demonstrated by any method free from objection (descendants of the osteoblasts? the white blood-cor- puscles? the endothelial cells of the vessels? the adventitia or perithelial cells?), According to Tillman the activity of the osteoclasts is as follows: apparently they cause asolution of the calcium salts of the bone by the formation of free carbonic acid, thus resorbing the osseous matrix, in this manner small cavities or lacunae are formed in the bone (lacunar bone resorption, Howship’s lacunae), 192 FRACTURES Nature anp Causes.—Broken bone or fracture is a division of the continuity of the bone; in contrast toa bone-wound the external skin usually remains intact. The causes of fracture are either external or internal. Most fractures are due to external causes (kicks, blows, falls, contusions). One also differentiates between direct and indirect bone fractures. A direct fracture occurs at the seat of the trauma. An indirect fracture occurs at a distance from the seat of the traumatic injury. Contusion- and com- pression-fractures belong to the indirect form (fracture of the vertebrze from falling’on the hind parts); this is also true of fractures due to torsion and bending (straining of the first phalanx when caught in the rails, fracture of the vertebree when cast), and traction-orstrain-fracture (fracture of the calcaneum due to pulling of the achilles tendon when falling upon the strongly flexed hind limb). Frac- ture by contrecoup orcontra-fracture is classified among the indirect, forms, it occurs according to the principle of contra-fissure (fracture of the sphenoid bone by falling on the mouth, fracture of the internal angle of the ilium by falling on the tuberosity of the ischium). Fractures may occur in the absence of all external trau- mata, merely through internal causes, especially as a result of increased muscular contractions. So- called spontaneous bone-fracture is most frequently observed when casting horses ; it is due not merely to falling, but occurs as a result of pronounced muscular contraction while the animal is lying or balancing ; contraction of the longissimus dorsi results in a dorsal or lumbar fracture ; severe exertion of the retained hind limb, fracture of the femur, tibia, or meta- tarsus; severe struggling against retention of the anterior limbs may result ina fracture of the scapula or humerus. Spontaneous bone-fractures occur even in horses that are standing ; the lumbar vertebrze may be fractured by suddenly stopping or turning a horse (Ttasbot), violent kicking with both hind feet (Haubner), while galloping (Wittman), when rising (M oussu); the humerus when traveling rapidly, sudden turning of the horse by the rider, and heavy pulls \ ABNORMAL FRAGILITY 193. (Flook, Penberthy, Ernes, Lagrifoul); the pelvis and tarsus by supporting the body weight on one hind limb when slipping (personal observations); other bones of the hind limbs asa result of severe contraction of the extensors when kicking (Joly); the pisiform bone in heavy draft-horses (Moller); the lumbar vertebre, femur, and tibia dur- ing extraction of the teeth while the animal is standing (Eberlein). In many cases neither external nor internal influences can be demonstrated as causes of bone-fracture. The so-called idiopatic fractures must be explained by an abnormal fra- gility of the bones (fragilitas ossium, osteopsathyrosis). Idiopathic fractures are not uncommon in horses and cattle. The fragility is due either to certain pathological con- ditions of the bones, especially osteomalacia, rachitis, rarefying ostitis, bone caries, sarcoma (melanosarcoma), and tuberculosis; or to certain predisposing influences, old age (senile atrophy), standing in the stall for a long time when convalescent from some disease (atrophy of inac- tivity); extreme youth (juvenile bones, intra- uterine fractures); disease of the nervous system, es- pecially that form which occasionally follows neurotomy (trophoneurotic bone-atrophy); restricted mo- bility in the joints (anchylosis of the vertebral column in the horse sometimes results in fracture of the vertebrz). Occasionally no cause for the fracture can be found, regardless of a careful examination. These cases one must account for by individual variations in the solidity and elasticity of the bones of different animals: A heredi- tary fragility of the foals of certain mares has also been observed, it is characterized by numerous fractures. ABNORMAL FRAGILITY.—Without the acceptance of this condition many cases in veterinary practice are unexplainable. This is espec- ially true of those fractures of the spinal column in horses, which, re- gardless of the most careful precautions, frequently occur when the animal is being cast: they are more com- mon than is generally supposed or published. Experience has shown that old horses are especially predisposed to this form of fracture (cast- ing for operations on the teeth, extirpation of the lateral cartilage). If 194 FRACTURES these fractures are less frequently observed in many countries and clinics than in others, it is, according to my judgment, due not only to the various methods of casting but to the differences of race and conditions of nourishment. Further, this class includes those cases of multiple fracture in one and the same animal. Ina cow affected with osteoma- lacia the pelvis was fractured no less than fifteen times (Maris). Inu sound horse that suddenly became lame after a few jumps when gallop- ing, the sesamoid bones were fractured in all four limbs (Ruthe rfor d). A stallion fractured both femurs during a castration (Haselbach). One horse fractured all four of the second phalanges at the same time (Henon); another fractured three suffraginal bones (R6der); many others have fractured two of the first or second phalanges (Wend- worth, Mdller, personal observations). An abnormal fragility of the ribs and vertebre has also been repeatedly observed in horses (Degive, Thimmler, and others). The causes of abnormal fragility of bones in old horses are usually considered to be a senile atrophy of the bones, and in young horsesa rarefying ostitis. Recent investigations by French veter- inarians have resulted in an explanation of this problem. Joly and Vivien (Recueil. 1901) found the typical changes of rarefying ostitis in a first phalanx that was fractured while the animal was going at an ordinary trot. On macroscopic examination a rapid, artificial solution of the lime salts of the fractured bone was easily recognized when com- pared with the corresponding bone of the other foot. Microscopic examination of the fractured bones revealed numerous and extensive dilitations of the Haversion canals (rarefying osititis); the articular cartilage was secondarily involved (atrophy, penetration of the cartilage with vascular loops). Intwo cases of fracture of the lumbar vertebre . jn horses Jacoulet and Vivien found rarefying ostitis with vascular dilitation (redness), liquefaction of the fatty substance (float in water) and porosity. CLASSIFICATION.—From a practical standpoint the most important division is into simple (subcutaneous) and compound (open) fractures. Simple, subcutaneous frac- ture is a fracture of the bone without an injury to the skin. In contrast to’ this a compound fracture is accompanied by a skin-wound, so that the bone is exposed and entrance of infection is possible. : Further, a classification into com plete and incom- plete fractures is important. In the former the bone is broken across its entire diameter at the point of fracture, so that the ends are not attached to each other. The separation is only partial in incomplete fracture, there is only a cleft or FRACTURES 195 fissure, that is, a split in the bone (fissure, lon gitudinal fracture), or an infraction or bending (infraction, im- Pression, depression, subperiosteal fracture, green-stick fracture). Fissures most frequently occur on the first phalanx and on the tibia ; infractions, on the ribs; impressions, on the bones of the skull. Fissures are often transformed later into compound fractures. According to the direction of the broken line one distin- guishes transverse fractures (fractura transversa); oblique fractures (fractura obliqua); longitudinal fractures (fractura longitudinalis); spiral fractures with a wound-line that takes the form of a screw; fractures in the form of the mouth-piece of a clarionett (fracture en bec de flute); V-shaped fractures; and T-shaped fractures (on the first phalanx). According to the position of the broken fragments in ‘complete fractures various kinds of dislocation are recognized ; namely, dislocatio ad axin (angular fracture); ad latus (lateral or transverse displacement); ad periph- eram (rotation); ad longitudinam, either with impac- tion (Shortening), or separation (increase in length). Impaction is likewise a form of longitudinal dislocation with contraction ; diastasis is an opposite condition. i Further, in contrast to a simple fracture, in which the bone is broken only once, one speaks of a multiple fracture (fractura multiplex), double fracture, triple fracture, etc. They are observed especially on the first and second phalanges and on the epiphyseal ends. When the bone is broken into small fragments it is termed acomminuted or splinter- fracture (fractura comminuta); when a splinter- fracture is characterized by complete crushing of the bone it is termed a conquassion fracture (fractura conquassata). The latter occurs, for example, in vertebral fractures when casting horses. Partial bone fracture, which is not uncommon in vet- erinary practice, is of importance. Certain portions of the bone are broken, not the entire bone. These occur in the fol- lowing places: on the lateral tubercles and tuberosities of the 196 FISSURES humerus; on the trocanters of the femur; the spine of the scapula ; and the oblique and transverse processes of the ver- tebrze, especiailly the cervical and lumbar vertebreze. FissuRES.—These are of great practical importance, because in horses their occurrence is especially frequent, diagnosis is very diffi. cult, and many cases are finally transformed into complete fractures. In addition to the first phalanx and tibia, fissures are found in the vertebra, in the scapula, humerus, radius, metacarpus and metatarsus, femur, second phalanx, os pedis, in the ulna, etc. Fissures are fre- quent in the vicinity of gun-shot-fractures (penetrating shots). A peculiarity of fissures is that afteracertain time, often several days, they are transformed into complete fractures, this has been repeatedly observed in practice. Usually it is unexpected, and occurs during the night, when the animal is rising or lying down, on raising the hoof to be shod, etc., this is especially true of the tibia and first phalanx. Fractures due to kicks on the inner side of the tibia in the horse may be transformed into complete fractures after weeks or months (in two cases one went for seventy days, the other for one hundred twenty- eight days). Alsoin other bones, fractures occur which are transformed aftera time into the complete form. Especially remarkable are those cases of fissured vertebrae in the horse which occur after casting or falling, complete fracture taking place after several hours or a few days, even after weeks. They are characterized by sudden paralysis of the hind parts. Occasionally these occur in horses that have been used for saddle or driving purposes regardless of the fissure. According to the records of the veterinary litera- ture cases of this kind are not uncommon (Spinola, Dieckerhoff, Moller, Straube, Gutzlaff, Flatten, Wirgler, personal observations). I have, for example, observed that after the casting of a thorough-bred stallion complete fracture developed from a fissure after four weeks (twenty-nine days). During this time the animal was in perfect health and stood on all four limbs. In similar cases fissures in the horse have developed into fractures after a long time, even weeks; fractures of the metacarpus (Bauer), humerus (Philippi, personal observations), and radius (Freer, Giinther, Schmid). For refer- ence to old fissures from a forensic standpoint see page 210. FREQUENCY AND OCCURRENCE.—Fractures of bone most often occur in horses and dogs; they are not infrequent in cattle, birds and swine. In cats fractures are relatively uncommon ; because of their elasticity they may fall a considerable distance (several feet) without being injured. In the horse the ordinary causes are falls, running into objects, FRACTURES 197 collisions, kicks from horses, casting ; in dogs, kicks, bites, being run over, squeezed, falls, and stones. Bone-fractures in horses and dogs are most often seen-in large cities; in the former it is due to slipping and falling on hard smooth pavements, especially on asphalt when it is covered with sthooth wet ice; dogs are run over with street cars, hacks, and other vehicles. According to my experience in Berlin dogs suffer most often from fractures on Sundays (picnic parties), for that reason Monday’s clinic is supplied with an abundance of material; the same condition follows any inter- ruption in traffic. Fractures in war are usually caused by projectiles. The statistics of the Prussian Army afford valuable material relative to the frequency of fractures in horses. Among 30,000 horses, 400 fractures a year occur during times of peace. The total number of fractures, covering a period of five years (1891-1895) in the Prussian Army was 2000. The following regions are most often affected: pelvis, tibia, first phalanx, bones of the head, the radius, the metatarsus, and the vertebrae. Fractures of the tibia, pelvis, and the first phalanx cover about fifty per cent of all fractures in the horse. With reference to the frequency of fractures in the dog, my own published statistics covering a period of nine years (1886-1894) and 70,000 diseased dogs, show the following results : about 1700 (1693) suffered from fracture, this amounts to 2.3 per cent of the total number of diseased dogs. In Berlin, one in forty of all diseased dogs suf fers from fracture. Luxations,in contrast to fractures, are less frequent in dogs, vccurring about one fifth as often (I have seen only 344 cases in all, equal to .5 percent). _Accord- ing to my experience the most frequent fractures in the dog are of the femur (17 percent), the radius and ulna (15 per cent), the tibia and fibula (13 per cent), and the humerus (5percent), Inthe dog ninety ’per cent of all fractures involve the bones of the ex- tremities. The following bones are least often fractured : tee 198 STATISTICS sternum, bones of the cranium, the vertebral column, the . patella, the ribs, and the scapula. In cattle, fractures most often involve the head of the femur, pelvis, scapula, tibia, metatarsus, and bones of the tail. Recorded statistics are wanting. With reference to the frequency of fractures in swine, information is found in the work of Charpentier and Lafourcade. Fifteen per cent of all slaugh- tered swine show fractures of the ribs in vari- ous stages of healing. Transportation in narrow quarters explains this condition. Frequency of fractures in birds is furnished by the statis- tics of Larcher who has treated 250 cases. According to Cadiot the following bones are most often fractured : humerus, tibia and femur; the radius, ulna, scapula, and ribs are less frequently fractured. I, my- self, have treated 137 fractures in birds, 64 were in large birds. (hens, swans, parrots), and 73 in small (song and ornamental birds). Wings and limbs were most often fractured. STaTISTICcs.—1. Bartke has collected the following statistics on the horse from the records of the Prussian Army: in a period cover- ing ten years from 1886-1895, of 280,000 diseased animals, bone fracture occurred in 3473. Of 3000 recorded fractures, 1300—equal to 60 per cent—involved the limbs; 1ooo—equal to 30 per cent—involved the body and vertebral column; 200—equal to 10 per cent—involved the bones of the head. Individual fractures were as follows: Mibla ce 2oco6 Soo pe eases 557 times 18 per cent. Pelvis ase es fe ae 491 ‘ 16 se Furst Phalanx:2 cca ee 404 ‘‘ 13 a Radius 32s oe we ee 239“ 8 ee Cervical Vertebra _____________ gar 8 a Metacarpus __________-____.-_-- 210 ‘ 7 ~ Lumbar Vertebrz______._______ 87 “ 3 Dorsal Vertebree______.__._._.__. 75 “ 2.5 8 Humerus! 3. oo oo esas cosecs, (oe 2.5 EE UO rah 8 oo iets 3 8 BO 70 2.5 8 Ribsuscotsosciteteo Aaa see 68 «“ 2 es PGWMO? 22s ios Layee etecwecees 59 “ 2 ee Second Phalanx _______________ 53), 2 ee Third Phalanx_________________ ing te 2 ne Occipital Bone_.____._-----___- 52 2 eg STATISTICS 199 Sphenoid Bone ____--__________ 43 times 1.5 per cent. Scapula 225 een ee 35. I er Frontal Bone _________________. 33. I sf Superior Maxilla -____.________ go. ts I cs Inferior Maxilla ______.________ ars I a In the years 1895-1902 at the Surgical Clinic of the Berlin Veteri- nary School I treated 308 fractures from a total of 7000 diseased horses. Of these, 103 involved the pelvis, 43 the bones of the head, 38 the first phalanx, 21 the vertebree, 14 the scapula, 14 the humerus, 13 the tibia, 12 the second phalanx, 12 the femur, 9 the third phalanx, 6 the navicular bone, 5 the ulna, 4 the ribs, 4 the radius, 3 the metatarsus, 2 the sacrum, 1 the tarsus, 1 the carpus, 1 the patella, and 1 the sternum. According to Cadiot (clinic in Alfort) 159 fractures of the extremities of the horse were distributed as follows: tibia 32, pelvis 30, first phalanx 24, radius 17, metacarpus 15, humerus 13, femur and ulna 6, scapula 5, second phalanx 4, carpus 3, third phalanx 2, calcaneum and trochlea tr. Morkeberg at the Copenhagen Clinic has treated 69 frac- tures in the horse in the years 1896-1900. The fractures were distributed as follows: pelvis 31, first, second, and third phalanges 15, bones of the head 7, ribs 5 times. According to Verlinde 42 fractures occurred in twelve years in three Belgian Cavalry Regiments. They were dis- tributed as follows: femur 21, third phalanx 2, navicular, first phalanx, and second phalanx 1. 2. Ihave observed 1693 cases of fractures in dogs (548in the hospital clinic, 1145 in the polyclinic). 1145 fractures in the polyclinic were distributed as follows: head 22, trunk 60, anterior limbs 434, pos- terior limbs 537. Individual fractures compiled from 915 cases were distributed as follows: é per cent emt ya ssoseee else cecees 188 times 17.0 Radius and Ulna_______-______- 170“ 15.0 Tibia and Fibula__________-_____ 345“ 13.0 Humerus____--_- 2 58 « 5.0 Metatarsus ___. __-_----_------- ag. * 4.0 Metacarpis 22220222 se2sessaces 4o ‘ 3.5 Catpiis so2 oo es oe eee sees 38 < 3.0 Anterior Phalanges___-_------- 39“ 3.0 Posterior Phalanges______-____- BG st 3.0 Pelvis: j2s22 sa cesecss eee ees 30 * 2.5 FaPSUS = 2 oo cosas eee a7. 2.5 Coccygeal Vertebree____-__---- 26‘ 2.5 Scapula) -2. ee Ses ee eee i ey nee se e ne me be tomaeie Ok Chevesoae NC Rese SI e9e etabonatdes eaten hen Star at ata ea Sh Spee a aes Fe ieian acetone SG Fe tie on ee Sans thes 2 a eee Setar tie ate Crate, noon eI GPa See SESE Pato CAS fated Ay na Re Pay ate . 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