e Class _Jv^LlI Book_ Copyright )^°_ ;Afi COPYRIGHT DEPOSIT. CATECHISM OF THE Principles of Veterinary Surgery BY W. E. A. WYMAN, M.D.V., V.S. AtTTHOB, OP "The Clinical Dlignosis of Lameness in the Horse," " Tibio-Peroneal Neurectomy," Translator op De Bruin's "Bovine Obstetrics," etc. New York WILLIAM R. JENKINS VETERINARY PUBLISHER AND BOOKSELLER 851 AND 853 Sixth Avenue 1905 LIBRARY of JONGKtsS Two Copies rtucnvou JUL 8 lyUi) Coi^it;iii tniry SS 'CL XXc. Not 4"- Copyright, 1905, by Wiluam R. Jenkins J.ZZ rights reserved printed by the Press of "William R. Jenkins PREFACE. Nobody can diagnose, treat and prognose a surgical case intelligently unless thoroughly acquainted with the scientific principles involved in any particular case. The student is obliged to gain his knowledge of the various surgical *' ologies " by lectures, and after all by the perusal and study of works written for the human practitioner. The former is insufficient and the latter obviously wrong. The principles applicable to human surgery and those of veterinary surgery, while in a great many instances closely related, nevertheless differ materially. For instance, asepsis, a condition sine qua non to the human surgeon, as a rule exists in veterinary surgery only in theory, although lately some of the leading surgeons in human surgery lean strongly toward antisepsis. In human surgery, periostitis plays an unimportant role, while it is of vital importance to the equine practitioner. Notice the difference in the prognosis and treatment of fractures. How many human surgeons apply the firing iron and blisters ? This work is purely for the veterinarian. As a former teacher of veterinary students, I am fairly conversant with their needs. It has been my most earnest desire and effort to supply a work which, while scientific and modern, is free from matters of doubtful in- terest to the American student. IV PREFACE The student requires a work which explains ; it is for this reason that I wrote this work in questions and answers. Depending on the importance of the subject from a practical standpoint, a more or less exhaustive discussion has been indulged in, exemplified by every-day cases. Occasionally the therapeutic part of this work has become a little more extensive than probably permissible in a work on the Principles of Surgery. The only apology which I offer, if such is necessarj^, consists in the desire to supply the stu« dent with certain reliable facts which he cannot find in print elsewhere. In arranging and classifying the various subjects, I fol- lowed Prof. Dr. Eug. Frohner's masterly exhibition on General Surgery, which Prof. Frohner kindly permitted me to do and for which I herewith extend my best thanks. Illustrations are omitted, as the clinic, the histological, pathological and anatomical laboratories should supply the student with the real thing. W. E. A. Wyman. CONTENTS. PAGE General Surgery 1 Arrest of Hemorrhage 7 The Healing of Wounds 13 Abnormal Granulations and Cicatrization 17 Regeneration of the Various Tissues 19 Traumatic Infectious Diseases 21 Suppuration of Wounds 21 Cellulitis 23 Traumatic Fever 28 Septicemia 29 Pyemia 32 Specific Traumatic Infectious Diseases 34 Malignant CEdema 34 Tetanus 35 The Treatment op Wounds 39 The Treatment op Specific Wounds 43 Contusions 47 Subcutaneous Ruptures 52 Ruptures of Muscles 52 Ruptures of Tendons 53 Inflammation o 55 Causes 56 Varieties 57 Symptoms 59 Course and Termination 60 Treatment 62 Abscess 69 Tl CONTENiS PAGE TJlcer ... 7a Fistula 7T Gangrene 81 Tumors 86 Connective Tissue Tumors 90 Fatty Tumors 95 Mucous Tumors 96 Cartilaginous Tumors 98 Osseous Tumors 99 Muscular Tumors 99 Nerve Tumors lOO Vascular Tumors 102 Lymphatic Gland Tumors 103 Sarcoma 104 Carcinoma 108 Papilloma 115 Adenomata 117 Cysts 118 Actinomycoma 121 Botryomycoma 125 Tuberculosis 128 Concretions and Foreign Bodies 132 Hernia and Prolapsus „ 141 Diseases op Bones 151 Fractures o 151 Inflammation 178 Periostitis » . . . „ . o 179 Osteomyelitis 184 Necrosis 185 Atrophy 189 Hypertrophy 190 Rachitis (Rickets) 191 Osteomalacia 192 CONTENTS Vii PAGE Diseases of Articulations 195 Arthritis „ , 195 Luxation „ „ 205 Distortion 209 Contusion .„ „ 213 Anchylosis „ 213 Contracture 215 Loose Bodies in the Joint 217 Diseases of Tendons ,,o 219 Tendinitis 219 Rupture , 225 Necrosis 228 Diseases of Synovial Sheaths of Tendons . . . » , 230 Inflammation , 230 Galls 233 » Diseases of the Mucous Bursa 236 Bursitis , , 236 Dropsy „ 238 Myositis o . . » , 239 Rupture „. » « » o 246 Atrophy o , 248 Diseases of Aponeuroses , o , 51 Diseases of Nerves , 254 Diseases of Arteries , , = . . » « 263 Arteritis , 263 Aneurism 264 Rupture , 268 Diseases of Veins 270 Phlebitis o 270 Varix 273 Diseases of Lymph Vessels 273 Lymphangitis 373 Lymphangiectasia 276 Viii CONTENTS PAGE Diseases op Glands 276 Lymphadenitis 276 Mammitis — Mastitis 279 Diseases of the Skin 286 Dermatitis 286 Burns and Scalds 293 Diseases of Mucous Membranes 300 Diseases of the Subcutis 301 Edema 301 Emphysema 303 Congenital Malformations 305 PEINCIPLES OF Veterinary Surqery. GENERAL SURGERY. Define a wound. A breach of continuity of tlie skin and mucous mem- "brane by sudden mechanical force. What two headings may wounds he classed under ? 1. Open wounds, where the break in the surface is about equal in extent to the deeper injury. 2. Subcutaneous wounds, where the break in the skin is either wanting or very limited as compared with the deeper lesions. Depending on the cause, what kinds of open wounds are recognized 9 (1) Incised or clean cut ; (2) punctured or pierced ; (3) lacerated or torn ; (4) contused or bruised ; (5) gunshot or punctured-lacerated-contused. What qualitative classification of wounds may be made 9 Simple and complicated, flap wounds, clean, dirty (dust, shavings), infected, poisoned, deep, perforating and super- ficial, fresh and bleeding, old granulating and suppurating wounds. 1 2 PRINCIPLES OF VETERINARY SURGERY According to the seat of tissues involved, what ivounds are recognized ? Abdominal, thoracic, cervical, etc.; muscular, bony, corneal, intestinal, skin wounds, etc. Name the most important general symptoms of a fresh wound ? Hemorrhage, retraction of the edges (gaping), pain, disturbed function, systemic disturbance. To what is the pain in afresh ivound due ? The so-called primary wound pain, which must be differ- entiated from the secondary wound ]3ain setting in later on and due to inflammatory changes, depends on the cutting and tearing of sensitive nerve fibres, and the richer the injured part is endowed with nerves the greater the pain. Are the luounds of all tissues equally painful ? Injury of the cranial contents, bones, cartilage, tendons and connective tissue are less painful than wounds of the cornea, periosteum, skin, mucous membrane (especially marked when the cutting agent is dull and its action delayed). To what extent do the various animals react to pain ? There is a great difference, depending on the age, sex, breed, species and temperament. Dogs are more sensitive than horses, and these more so than the ox. The individual disposition also plays an important role. Thus some horses can be fired without reacting perceptibly while others plunge about violently. What hind of hemorrhages are met with in wounds ? 1. Arterial hemorrhage : the bright red blood appears in jets synchronously with the pulse beat. GENERAL SURGERY 3 2. Venous hemorrhage : dark-red blood in a continuous stream flows from the vessel. 3 . Parenchymatous hemorrhage : this is a mixed hemor- rhage, as arteries and veins of small calibre are cut, the blood drips from the wound about in the same manner as water would from a sponge, and is of dark-red color. 4. Capillary hemorrhage : the blood drips in small drops from light wounds of the skin and mucous membrane, the capillary blood-vessels being cut. What else besides blood may floiv from wounds ? In case a large lymph vessel is cut, lymph; injury to articulations and tendon sheaths, synovia; injury of salivary glands, stenos duct and oesophagus, saliva; injury to stomach, /oofZ ; injury to intestines, /feces y injury of udder, Tnilh; injury of bladder and urethra, urine. What is understood by gaping of the wou7id f Tissues possessing more or less elasticity, the edges of a wound retract. The amount of gaping depends on the nature of the cut tissues and the direction of the wound ; thus wounds cutting across the fibres of muscles or tendons, or where the skin is especially tense, gape most. What is understood by disturbed function ? The part wounded suffers more or less loss of function. Wounds of the hoof, tendons, articulations, muscles, cause lameness ; those of the cornea disturb sight ; those of the tongue interfere with feeding. To what extent do ivounds influence the general health 9 Very painful wounds depress the animal to such an extent that it refuses food, more noticeable in the horse and 4 PRINCIPLES OF VETERINARY SURGERY dog. True shock as seen in man (vasomotor jiaresis, the blood accumulating in the abdominal vessels ; shallow res- piration ; weak, compressible pulse ; clamy, profusely per- spiring skin ; absence of mental originating power) is rarely met with in animals ; while following serious loss of blood pale mucous membranes, weak pulse, depression, etc. (anaemia), are observed. Occasionally sudden death follows the aspiration of air from an injured jugular vein, death being explained by air embolism of the pulmonary capil- laries, filling of the cavities of the heart with air or air embolism of the capillary vessels of the brain. What two forms of traumatic fever Tnay produce systemic disturbances ? 1. Aseptic wound fever : here a slight rise of temperature without detectable systemic disturbance follows the absorp- tion of pyrogenous material from the wound. 2. Septic fever. High temperature and decided systemic disturbance due to the entrance of some specific infectious material into the wound and later into the general cir- culation. Hoiv ivould you describe any wound 9 (1) Region of the body (neck, thorax, leg, etc.) ; (2) length, width, depth, shape, direction ; (3) edges of the wound (sharp, lacerated, flap, swollen, inverted, etc.) ; (4) secretion : odor, quantity, consistency, color ; (5) by palpa- tion with finger or probe the presence of foreign bodies and depth are learned. Fresh and deep wounds of the articu- lations, abdominal, cranial and thoracic cavities, tendon sheaths, and those where deep and serious hemorrhage was arrested, should not be probed. GENERAL SURGERY 5 Describe incised wounds. Cause — Sharp cutting instrument, as surgeon's knife^ glass, pieces of tin, sabre. Characteristics — Straight, oblong shape, gape widely, as a rule bleed freely, clean cut edge ; according to depth, they are tendinous, muscular, bony or skin wounds. Prognosis— Favorable in skin wounds, otherwise the question of economy, the amount and kind of tissue des- troyed, must be decisive. Describe punctured luounds. Causes — Pointed instruments, as dung forks, nails, needles, harrow teeth, splinters, bayonet, trocar, hypodermic needle. Characteristics — Small roundish opening, leading into a canal of more or less depth, with limited hemorrhage unless a larger vessel has been pierced ; they may be perforating and communicate with a joint, tendon sheath, abdominal or thoracic cavity, etc. Prognosis — Surgically clean instrument, even when caus- ing a perforating wound, entitles to a favorable prognosis, while the introduction of septic material, as by manure forks, nails, etc., may lead to fatal complications. Punctured wounds of the hoof may be followed by tetanus, while this. form of injury of the softer tissues may in turn produce- septic cellulitis, septicaemia, pysemia, etc. Describe lacerated wounds. Causes — Tearing of tissues by nails, hooks, caulks, etc. Characteristics — Slight hemorrhage, moderate gaping ; edges may be smooth or lacerated ; frequently a flap wound and then usually an angular tear. 6 PRINCIPLES OP VETERINARY SURGERY Prognosis — Depends on tlie part involved and extent of the lesion. Since there is more or less tendency to necrosis, this fact must be borne in mind in making a prognosis. What part of the body is often involved 9 In the horse, the eyelids, croup, breast and hind legs and false nostril ; in the dog, the cornea when fighting with cats. Describe contused ivounds. Causes — The action of a blunt instrument, as kicks, falls, running against unyielding objects, coronary caulks, lying for some time on hard and rough ground ; rope burns. Characteristics — When of a superficial nature the upper layers of the skin only are removed : abrasion, excoriation. Deep contused wounds exhibit little or no bleeding, as the separation of the intima and media from the adventitia of the bleeding vessel closes the lumen of the vessel on the same principle that the emasculator or ecraseur prevents bleeding. The edges are irregular, discolored, feel cold ; the neigh- borhood is swollen ; the wound contains partially detached tissue and bloodclots. Prognosis — There is always sloughing, and the prognosis is based to a great extent upon the possibility of securing perfect drainage and thus preventing septic infection. To what class of wounds do those created by the teeth of animals belong ? The bites of dogs and cats are more common than those of the horse or ox. Such wounds are either punctured, contused or lacerated, or a combination of the above. Dog bites quite often cause complicated fractures. Describe gunshot wounds. Cause — Projectiles, as buck and bird shot, pistol and rifle balls. ARREST OF HEMORRHAGE 7 Characteristics — It is a contused, lacerated wound ; there is a wound of entrance and possibly a wound of exit. The wound of entrance is smaller than the ball, because the skin is stretched as the ball hits it ; should it be larger than the ball, a foreign body has been carried in with it. With the shot fired close to the animal, the hair is singed by the powder ; when . the ball grazes the surface a friction burn results. The wound of entrance has either smooth, frizzled or lacerated and depressed edges. Hemorrhage is wanting unless a larger vessel has been cut. The wound of exit is larger than the ball, irregular and everted. Prognosis — Unless septic material has been carried in by the missile, the probe or the surgeon's finger, or vital parts destroyed or injured so as to interfere with the future use- fulness of the animal, the prognosis is good. Which animals are most exposed to gunshot wounds 9 In times of war, the horse ; during hunting seasons, all domestic animals get their share ; otherwise, hunting-dogs and cats. Define poisoned wounds. Wounds in which a poison has been introduced, as by snake-bite, bee or wasp sting, or which have been infected by glanders, rabies, anthrax, tetanus. ARREST OF HEMORRHAGE. Hoiv is bleeding stoj)ped 9 (1) Spontaneously ; (2) artificially. How does spontaneous arrest of hemorrhage take place ? It is mostly seen in capillary, parenchymatous hemor- rhage and when small veins are cut ; a clot (thrombus) 8 TRINCIPLES OP YETERINAEY SURGERY forms, also retraction and contraction of the cut end of the vessel. When a large blood-vessel is cut, spontaneous arrest of hemorrhage is due to retraction and contraction and thrombus formation at the cut end plus enfeebled heart action and changed composition of the blood. Why does spontaneous arrest of hemorrhage in small vessels readily occur ? Because blood pressure is very limited in capillaries and small veins, thus favoring the formation of a clot (thrombus). Hoiu does the changed composition of the hlood following serious bleeding encourage clot formation ? The changed composition of the blood mainly consists in a decided increase of tho white blood cells, by which its coagulability is greatly increased. Hoiu much hlood may an animal lose before succumbing to fatal cardiac or cerebral syncope ? Not over one-third of the total amount of blood, Hoiu quickly does the blood regenerate after a hemorrhage f The quantity of the blood is quite speedily replaced by resorption of the lymph of the tissues and the liquids of the stomach and intestines ; the quality of the blood is at first very watery, regeneration of the red blood cells being a slow process. How is a thrombus formed ? There are two kinds, the white and the red thrombus. The former is met with in the healthy tinimal, the latter is seen in septic states. At the same time both may exist together, and the thrombus is then termed a mixed thrombus. ■ ARRE^^T OF HExMORUHAGE 9 The white thrombus is formed by the white blood cells and Bizzozero's blood plaques, and is, so to speak, a physiological product and not a coagulum. The red thrombus is a patho- logical product, consisting of a fibrin constituted coagulum plus red blood cells met with in the vessels of animals suffering with septic disease. What becomes of the white thrombus ? When aseptic, it organizes ; when infected, it softens and breaks up into emboli. What is understood by organization of a thromhus 9 Its replacement by connective tissue. The new con- nective tissue formed results from proliferation of the endo- thelial cells of the vessel ; the thrombus itself only j)lays a passive role. The endothelial cells of the intima of the vessel take on a spindle shaped and multiform character, advance, perforate and surround the thrombus, developing later into fibrillar connective tissue cells, thus replacing the- thrombus by connective tissue ; while this occurs new blood vessels are formed from the vasa vasorum. This is termed the vascularization of the thrombus. How much time is consurtied in the process of organization and vascularization ? About four weeks. What else may become of a thrombus ? It may calcify and form a phlebolit (vein stone). How is tlie circidation interrupted by the thrombus re- established ? A collateral circulation forms. The vasa vasorum be- come larger and the central and peripheral arterial branches of the thrombus meet. 10 PRINCIPLES OF VETERINARY SURGERY What is understood hy softening of the thrombus ? When bacteria invade a thrombus it becomes infected and breaks up into little particles (emboli), which on entering the general circulation cause a general infection of the body (pysemia). Define artificial arrest of hemorrhage. The application of means which encourage coagulation or close the bleeding vessel. Hoiu do you chech hemorrhage 9 (!) By ligation; (2) compression; (3) torsion; (4) cautery; (5) heat; (6) cold; (7) remedial agents; (8) constitutional treatment. Hoiv is hemorrhage arrested hy ligation 9 It is the only safe means when large arteries or veins are cut. If possible, grasp the bleeding vessel with the artery forceps, draw it out of the Avound, isolate it froin the surrounding tissue, and with a surgical knot tie both extremities of the vessel. When tying this knot, do not tie the second one too tight, as it loosens the first one. If the bleeding vessel cannot be caught, it may be necessary to cut down onto it, or the less desirable method of carrying a curved needle underneath the vessel and tying it and all the tissues enclosed by the ligature. Avoid tying in a nerve. At times for anatomical reasons the bleeding vessel ought not to be ligated at its cut end, but ligation in continuity is indicated, as, for instance, injury of the internal carotid requires ligation of the carotid artery, or injury to the inter- osseous artery demand.^ tying of the radial artery. What material is used to ligate bleeding vessels f Aseptic silk or catgut. ARREST OF HEMORRHAGE 11 JIoio do you clieck hemorrhage by compression 9 It is employed in capillary and parendiymatous bleeding and when small vessels are cut. An exception to this rule is made in very dangerous hemorrhages, when the course of the vessel is either compressed with the finger (digital compres- sion), or anything which is readily accessible is temporarily crowded into the wound to compress the vessel. In these cases, when possible, a string or rope, cloth, etc., is tightly wound around the parts to constrict the whole member until other means can be employed, as far as possible observing antisepsis. What material is used to compress the bleeding parts 9 Sterilized oakum, absorbent cotton, bandages. What is torsion and how does it act as a hemostatic 9 It consists in seizing the vessel with an artery forceps and twisting it six to eight times ; as a rule, it is used only in smaller vessels. By twisting the vessel around its own axis the intima and media become detached and curl up, while the adventitia becomes twisted; the lumen of the vessel thus becoming smaller or closed. How does the actual cautery act as a hemostatic 9 In smaller vessels the mere radiation of the dull-red cautery causes coagulation, while an eschar is formed when the cautery touches the bleeding end. It is mainly employed in parenchymatous bleeding and hemorrhage from smaller vessels. Why is the actual cautery not a safe hemostatic in case a larger artery is cut 9 Because the blood pressure against the eschar is greater than the adhesive qualities of the eschar. 12 PRINCIPLES OF VETERINARY SURGERY Why should the actual cautery he employed at a didl-red heat ? At a wliite lieat the escliar formed is completely car- l)onized and would not stick ; when a black heat is applied ta the parts the eschar formed will adhere to the cautery. Describe the use of cold and heat as a hemostatic. Either one produces contraction and coagulation, but is; of use only in hemorrhages from small vessels and oozing- from larger surfaces. What remedial agents — that is, styptics — are employed in the' arrest of hemorrhage, and hoiv do they act ? These chemicals when brought into immediate contact., with tlie bleeding part, produce coagulation and contraction of the vessel. They are either applied directly to the parts, or a tampon is saturated with them and held against the- bleeding surface by some comjDressing agent. Modern surgery objects to their use, as they form a repugnant clot,, favor infection, and act as an irritant. Those more fre- quently employed are : tannoform, tannic acid, alum, vinegar- a.nd tincture of iron. What constitutional treatment is indicated in hemorrhage f' Unless an exhaustive hemorrhage occurred, rest is all that is required. In serious bleeding, rest, the application of" heat to the body surface, and stimulants and the infusion of' a normal saline solution per rectum, or in very urgent cases, intravenously^. In cases of internal bleeding, where the- leaking vessel cannot be secured, the best agent is fld. extr.. hydrastis canadensis. Describe hemophilia. A congenital tendency to persistent hemorrhages frona. the slightest wound. THE HEALING OF WOUNDS 13 Jn wliat animal has hemophilia been seen ? It has only bei n observed in the horse. THE HEALING OF WOUNDS. Name the vainous modes of repair by which destroyed tissues are replaced. (1) Healing by first intention {per primam intent ionem) ; •(2) by second intention (per secundam intentionem) ; (3) by third intention {jjer tertiam intentionem); (4) healing under a scurf ; (5) abnormal granulation and cicatrization. Define healing 2)ef primam intentionem. A primary union by cementing of the wound edges without pus formation. Under whcd conditions is primary union most likely to occur ? When the hemorrhage is arrested, bloodclots and foreign T^odies removed (dirt, hair, splinters, tissue shreds), when the wound is aseptic or rendered so, when the edges are smooth •and straight and closely aj^proximated, and when the wound is protected by an antiseptic dressing against secondary infection. What kind of wounds may be readily healed by first intention in animals 9 Surgical wounds, provided an antiseptic protective dress- ing can be applied. Describe the macroscopic changes seen in healing by first intention. First, the edges of the wound are united by blood, to be "replaced by the so-called wound cement (a lymphoid plas- Tmatic liquid). About the second day the edges are red. 14 PRINCIPLES OF VETEPJNAEY SURGERY painful and somewhat swollen. In about one week per- manent union takes place, with a little cicatrix at the sit© of incision. Describe the microscopical changes in healing by first intention^ White blood cells emigrate from the neighboring vessels. and invade the edges and wound cement. This cellular infiltration is due to the traumatic irritation of the parts, and is not the result of the presence of bacteria, as is the case in healing by second intention. In healing by first intention it. is an expression of reaction by the injured tissues, while in healing by second intention it represents a purulent inflam- mation. The greatest number of leucocytes in the wound, edges are met with on the third day ; after that they either- return to the blood vessels or die. Describe the process of cicatrization. The fibroblast produces the scar tissue. These are- roundish cells which arise through proliferation of the- endothelial cells of the vessels and those connective tissue cells which are present. The fibroblasts increase in size, and epithelioid, spindle and club shaped cells form ; these again change into fibrillar connective tissue cells, which in turn form the scar tissue proper. Vascularization of the wound edges takes place at the same time, the new vessels being formed by a process of budding from the walls of the cut capillaries. The young tissue formed by the fibroblasts plus; the newly created blood vessels is termed granulation tissue, which shrinks as soon as the fibroblasts change into con- nective tissue cells, the capillaries close, at which moment, scar tissue proper is formed. The last step in healing by first intention consists in the skinning over of the scar tissue,, the cells springing from the epithelial cells upon the edges. THE HEALING OF WOUNDS 15 Define healing by secundam intentionem. The filling of a wound- gap by granulations with pus formation. What tvounds usually heal by second intention ? All those where the fundamental principles upon which the healing by first intention is based have been disregarded. Therefore, infected wounds, those with wanting close approxi- mation of the edges, contused wounds, etc. 'Describe the macroscojjical changes seen in healing per secundam. During the first forty-eight hours the various tissues can be recognized ; at this time the surrounding neighborhood begins to swell, is reddened, exhibits increased heat and pain. About the second day the wound surface looks gray, due to a thin layer of coagulated plasma coming from the cut lymph vessels. During the next few days swelling and pain increase some more, the wound surface having a jelly-like, grayish- red look . About the fourth day the discharge from the wound is yellowish and opaque ; at this time the coagulated plasma resting upon the wound surface breaks up and, together with necrotic tissue shreds, is carried away in the wound discharge; now little red points are seen everywhere provided the wound is first cleansed by irrigation. The fifth to sixth day these red points, which are granulations, have grown higher and are covered with thick grayish-yellow pus. Up to the eighth day these granulations become larger, so as to fill the gap between the wound edges pretty well. About the eighth day the wound surface decreases and the edges approximate. Whenever the granulations are even with the level of the skin the granulating surface becomes smooth and glistening and no further granulations are formed. Next, the periphery of 16 PKINCIPLES OF VETEEINARY SURGERY the wound shows a dry pinkish seam moving toward the centre of the granulating surface, being followed by a bluish dry seam upon the pigmented skin ; this process continues until the whole granulating surface is skinned over. Describe the microscopical cJianges in healing by second intention. On the whole there is but little difference in those observed in healing per primam and those per secundain intentioneni. The main point of difference lies in the fact that on account of the presence of pus-producing cocci decided Irritation of the tissues is produced, as a result of which large numbers of leucocytes emigrate. Otherwise the infiltration of the wound edges, the formation of fibroblasts, vasculariza- tion — that is, the budding of the capillary vessels — the chang- ing of the fibroblasts into fibrillar connective tissue, is in no wise different from healing by primary union. Define healing by third intention. It consists in the union of two suppurating granulating surfaces. What steps are necessary to secure healing per tertiam ■? Absolute disinfection of the granulating surface with perfect coaptation of the wound edges held in place by an exact suture. To 'what extent is healing per tertiam applicable ? It is a most valuable method and should always be attempted, to bring about rapid and permanent union. How long after the primary injury occurred, may healing per tertiam be possible ? To avoid ugly scars — for instance, about the head of valuable horses — a wound of a week's standing can be healed by third intention. ABNOKMAL GRANULATIONS 17 Define healing under a scurf. This is a form of healing by first intention, by exsciccat- ing the blood upon the wound by means of chemical agents, as the result of which a firm adhering scab representing an. aseptic dressing is produced. Hoiv does healing under a scab tal-e place ? The new epidermis is supplied by the epithelial cells along the edges of the wound, these young ex)ithelial cells being x^rotected by the artificial scurf. Why is healing under a scurf of importance ? At times neither suturing nor bandaging the wound is possible, the scab then taking the place of an aseptic dressing. What agents are mainly employed to produce a dry scab? By dusting the wound with tannoform, tannic acid, iodoform, aristol, europhen, xeroform. ABNORMAL GRANULATIONS AND CICATRIZATION. Under what circumstances is the normal process of granulation and cicatrization likely to become abnormal ? In wounds with decided loss of tissue, presence of foreign Ibodies, continuous irritation and infection of the parts under- going healing, certain systemic disturbances. Define caro luxurians. It represents excessive and rapidly growing granulations, commonly termed proud flesh. 18 PKINCIPLES OF VETERINAEY SURGERY What part of the body is mainly exposed to exuberant granulations ? All those where the healing process is interfered with by more or less continuous irritations, as wounds in the flexion surface of the hock, pastern ; here the continuous flexion and extension irritates the wound. Also in fistula of the withers and saddle pressures when necrotic tissue is located at the bottom of the wound, thus irritating the parts constantly ; also in muscular hernia, nicely seen in deep peroneal neurec- tomy when the muscles protrude from an incision made into its surrounding aponeurosis ; here the pinching of the parts by the slit in the fascia keeps up the irritation. Name some other forms of abnormal granulations. Torpid, irregular, weak, pale. What are erethistic granulations ? Those which bleed very easily, are dark-red and very irritable and painful. Explain coagulation necrosis of granidation tissue. Following obstruction of the capillary vessels by inflam- mation or their imperfect development, the wound is covered with a diphtheritic-like membrane representing death of the upper layers of the granulation. When is a cicatrization likely to become abnormal ? In wounds with great loss of substance cicatrization becomes incomplete and the result is an ulcer, or the scar shows an undue accumulation of cornified epidermic cells. What is a keloid 9 A hard fibrous growtli ari-iii;;" i i a scav. EEGENEKATION OF TISSUES 19^ Which is their favorite locality 9 In the liorse, tliey are usually seen in tlie flexion surface of the pasterns, following barb wire cuts or a brush burn (rope or halter burn), and around the coronary region following calking. How may excessive scar contraction ajfect a part ? The great contractile power of the cicatricial tissue in extensive scars by puckering up the tissues surrounding the original wound may produce decided deformities, as in larger injuries of the eye-lid it may become everted (ectropium). BEGENERATION OF THE VARIOUS TISSUES. How does the regeneration of the skin and mucous membrane take place 9 As described under "The Healing of Wounds." The epidermis and epithelium of mucous membranes are rapidly replaced. How do muscular wounds heal ? The power of regeneration of muscles is very limited, only taking place in slight injuries, the rule being a connec- tive tissue scar in a muscle wound. How do te7idon wounds heal ? Cells are thrown out from the tendon sheath and sur- rounding tissue ; the granulations tlius formed invade the blood-clot which at first was created between the two ends of the tendon. This clot is absorbed, the granulation tissue unites the ends of the tendon and is gradually changed into connective tissue until it is finally difficult to tell the difference between the new and the old tendon fibres. '20 PRINCIPLES OF VETERINARY SURGERY How do hone wounds heal ? Same as fractures, tlirongli an ossifying granulation tissue, involving tlie periosteum, bone, and marrow (see the ^' Healing of Fractures "). How do cartilage u^ounds heal ? By proliferation of the perichondrium. In the wound is first seen a fibrous deposit, which later changes into an ossify- ing callus. When proliferation of the perichondrium starts, new cartilaginous tissue is also formed by cartilage cells adjoining the wound, while those cartilage cells close to the cartilage wound undergo fatty degeneration. How do peripheral nerves heal 9 The powers of regeneration of peripheral nerve tissues are good. Provided the ends have been united artificially, new nerve fibres formed by the old nerve fibres of the central stump grow into the peripheral stump. A club-shaped swell- ing (fibroneuroma) forms at the end of the central stump, chiefly due to a growth of the neurilemma, when the ends of the cut nerve are separated by a distance of half to one inch '(often seen in neurectomy). HoiD do ivounds of the brain and spinal cord heal ? Here no regeneration of the nerve substance occurs, but ~a connective tissue scar forms. How do ivounds of non-vascular tissues, as the cornea and articidar cartilage, heal ? It resembles the healing of vascular tissues. Leucocytes -emmigrate from sclera and conjunctiva, followed by cell proliferation of the fixed cells, with formation of fibroblasts, ^nd then change into connective tissue, but vascularization springs from the adjoining sclera. In articular cartilage, the TRAUMATIC INFECTIOUS DISEASES 21 scar, wliicli at first is made up of connective tissue, may be-^ changed in time into liyaline cartilage. TRAUMATIC INFECTIOUS DISEASES. What are traumatic infectious diseases 9 They comprise a number of accidental wound diseases,, due to the entrance of bacteria or their products (toxines) into- the wound. Name the most imjjortant traumatic infectious diseases 9 (1) Traumatic fever, (3) septicaemia, (3) pyaemia, (4) sup- puration of the wound, (5) cellulitis. In a wider serise of the tuord, ivhat other diseases belong to the traumatic infectious disease 9 Tuberculosis, anthrax, glanders, malignant oedema,,, actinomycosis, botryomycosis, etc. SUPPURATION OF THE WOUND. Name the cause of wound suppuration 9 Suppuration is the result of an inflammation caused by the infection of the wound by pus cocci. Name the most important pus producing bacteria 9 The most common pus coccus is the staphylococcus, pyogenes aureus, most frequently met with in circumscribed localized processes. Experiments show that subcutaneous injections of this germ usually cause an abscess; intravenous injection produces pyaemia and ulcerating endocarditis; intra- peritoneal injections cause a fatal suppuration ; 2, the less. 22 TRINCIPLES OF VETERINARY SURGERY common staphylococcus pyogenes albus; 3, staphylococcus pyogenes citrius; 4, streptococcus pyogenes; this and the first one are the most important ones; it is especially concerned in the production of progressive phlegmonous suppurations. What is 2)us 9 The material which forms as the result of suppurative inflammation. Describe healthy and laudable pus ? It is represented by a yellowish-white odorless alkaline thick creamy liquid which does not coagulate. What is ichorous pus ? Pus which has undergone decomposition produced by the presence of micro-organisms of j)utrefaction. What is sanious pus ? It is pus undergoing decomposition plus blood. By what is the quantity and quality of pus influenced f It depends on the consistency and vascularity of the tis- sues, the size and age of the wound, the kind and number of pus cocci, the time of the year, temperature, climate and species of animal. Describe the constituents of pus. When pus is allowed to stand in a vessel, two layers cari be seen. The upper one is thin and slightly yellowish, and is termed pus serum (Liquor puris). It contains an albuminous substance called peptone and salts in about the same propor- tion as the blood. The second layer or sediment is composed of pyogenic cocci, possibly other bacteria, tissue shreds and pus cor- puscles, red blood cells, droplets of fat. CELLULITIS 23 WJiy does pus not coagulate 9 On account of the absence of fibrinogen, wliich. has been changed into an albuminous substance (peptone) by the pus cocci. WJiat taJces place when the suppurative process does not con- fine itself to the u-ound but spreads to the surrounding tissues ? A diffused form of suppuration of the connective tissue is termed a phlegmonous inflammation. When the lymph vessels undergo inflammation, it is called lymphangitis ; the "veins, phlebitis. When pus cocci and their toxines (poisonous alkaloidal substances developed by bacteria) enter the general circulation, surgical fever, pyaemia and septicaemia may set in. CELLULITIS. Define cellulitis ? It is an infectious, mostly suppurative inflammation of the cellular tissue, and may be subcutaneous, submucous, subfacial, intermuscular, periosteal, perichondreal, tendo- vaginal, etc. What other name is employed to designate cellulitis 9 Phlegmonous inflammation. Name the causes of infectious or suppurative cellulitis. Most frequently the staphylococcus pyogenes aureus and streptococcus pyogenes enter the wound. What kind of wounds predispose to cellulitis 9 Deep, punctured, contused, lacerated ; very often the wound is small or even closed when cellulitis sets in. 24 PEINCIPLES OF VETERINARY SURGERY What is metastatic cellulitis ? The pus cocci after entering the wound do not remain irk the wound, but are carried to other parts by the lymph current. What varieties of cellulitis are recognized ? It may be superficial or deep, circumscribed and diffused;: from an anatomical standpoint, it may be interglandular^ intermuscular, subcutaneous, etc. Which is tlie most malignant form of cellulitis ? Septic cellulitis. It represents a mixed infection by pus^ cocci and septic bacteria. What is gaseous cellulitis ? It is a mixed infection, gas being produced by gas forming bacteria (Bacillus phlegmonse emphysematosse, bacterium. coli). What is a specific cellulitis ? One produced not by pus cocci but by an individual defi- nite bacillus, as in malignant oedema. In wliat animals is cellulitis usually met with ? Most frequently in the horse, next in the dog, and then in the ox. What forms of infectious cellulitis are the inost common ones? The most frequent form is the subcutaneous one, while in the horse, at least, snbfacial, intermuscular, perichondreal and tendovaginal cellulitis is often seen. Which forms of infect io^is cellulitis are of practical interest f" 1. Subcutaneous cellulitis about the head and hind legs, of horses (lii)S, eyelids, intermaxillary space). CELLULITIS 25 2. Siibmucoiis cellulitis of the mouth and pharynx, as stomatitis, phlegmonous glossitis and pharyngitis. 3. Subfacial cellulitis, as in fistulous withers, poll evil and punctured wounds about the legs. 4. Intermuscular cellulitis, involving muscles of the neck, shoulder, legs, abdomen and croup. 5. Subcoronary cellulitis (coronary calking). G. Perichondreal cellulitis about the lateral cartilage, as in quittor. 7. Cellulitis of the plantar cushion from nailpricks. 8. Cellulitis of the tendon sheath of the flexor tendons (horse). Subcutaneous and intermuscular cellulitis of the tail — in horses, following myotomy; in cattle, from inocula- tions (anthrax, blackleg). 9. Cellulitis of the prepuce and scrotum in the horse after castration. 10. Cellulitis of the mammary gland in cattle. Describe circumscribed cellulitis ? Inspection reveals a swelling over a Timited skin area. This swelling may stop abruptly, same as seen in purpura hemorrhagica. Unless deeply pigmented, the skin over the swelling is red, apjDears stretched and glistens. Palpation shows heat, pain, the j^arts being hard, soft or doughy. The- skin over the swelling cannot be wrinkled. How does circumscribed infectious cellulitis terminate 9 It may terminate in (1) an abscess; here the skin looks greasy, bluish, red or blackish ; palpation shows fluctuation. There may be fever. The contents of the abscess may reach the external world spontaneously. A part of the skin over the abscess undergoes necrosis, allowing exit of the pus. Unless opened artificially, the pus may burrow, leading to (2) a diffused purulent cellulitis. 26 PRINCIPLES OF VETEEINAEY SUEGERY Name some of the sequels to suppurative circumscribed eel- hilUis. Phlebitis, lymphangitis, lymphadenitis, septicaemia and pyaemia. Describe diffused cellulitis. Besides extensive swelling of the skin and fever there is decided pain expressed by lameness when the locomotory apparatus is involved. Subfacial cellulitis expresses itself by more or less fever and great pain. Being deeply situated, the skin over the diseased parts either does not show anything abnormal or some slight cedematous doughy swelling. The above also applies to intermuscular cellulitis. What course does diffused s^qopurative cellulitis talie ? There is a decided tendency to necrosis of skin, fasciae, muscles, etc., or death from septicaemia or pyaemia. Describe septic cellulitis. It is very acute in its action and spreads like wildfire, with high septic fever. On stroking the diseased parts a peculiar crepitation is sometimes felt, due to formation of gases from decomposition (septic emphysema). Its course is rapid and usually fatal. How do the various forms of infectious celliditis terminate ? This depends on their extent and character and the animal species. It may terminate in : 1. Resolution, quite common in circumscribed cellulitis and in that form commonly known as lymphangitis (Monday morning disease, seen in the hind legs of horses). 2. Abscess, met with in all forms of cellulitis ; when superficially located there is but little danger, while the sub- facial and intermuscular abscesses are often unfavorable. CELLULITIS 27 3. Necrosis, likely to be seen in all forms of cellulitis. Mortification of the diseased tissues is -mainly observed in septic, subfacial, intermuscular, perichondreal cellulitis, as poll evil, fistula of tlie withers, quittor. Septicaemia and pyaemia are often sequels. 4. Encapsulation of the abscess. The abscess becomes enclosed by a capsule, so to speak, and remains dormant ; most frequently seen in intermuscular cellulitis. A common example is the shoulder abscess in the mastoido humeralis of the horse. By and by the capsule gives way and another cel- lulitis attack takes place. This possibly explains the inter- mittent attacks of diffused subcutaneous cellulitis (lymphan- gitis, Monday morning disease, milk leg) so often seen in the hind legs of horses. 5. Chronic enduration. Sclerosis is often seen after repeated attacks of diffused septic cellulitis in hind legs of torses, representing a chronic connective tissue proliferation and leading to enormous thickening of the skin (elephantiasis). Such a chronic connective tissue proliferation involves also subfacial, intermuscular, perichondreal tissues. Qive the treatme7it of infectious cellulitis. As long as the presence of an abscess is not established, tot antiseptic sponging, irrigations and fomentations must be employed. As soon as possible the abscess should be opened, sloughs removed and the cavity irrigated with antiseptics and thorough drainage provided. The acute cellulitis of the torse's hind legs is combatted by purgatives. The best treatment of to-day consists in the hypodermic use of are- coline or intravenous use of collargolum with an external camphor treatment of the leg. 28 PKINCIPLES OF VETEKINARY SURGERY TRAUMATIC FEVER. Describe its nature and causes. It represents a constitutional disturbance accompanied "by various symptoms, as increased body temperature, increased pulse rate, changes in the composition of the blood, changes in the distribution of the blood, disturbances of the nervatory, digestive and respiratory apparatus. Fever following non- infected wounds is termed aseptic fever, explained by the absorption of broken down bits of tissue, blood clots, effused serum, which are known to have a pyrogenous action (fever- producing). Fever following infected wounds is termed septic or bacterial fever, also intoxication-infection fever, explained by the absorption of chemical poisons (toxines) of the wound secretion , the result of the action of pyogenic micro- organisms. How is the generation of traumatic fevers explained ? The exact origin of fevers is still somewhat dark. Never- theless it appears that the heat centre in the brain produces and regulates calorification. Experiments have shown that irritation of the heat centre causes a rise of temperature, while paralysis of the centre is followed by a sinking of the body temperature. Irritation of the heat centre may be produced by the action of chemicals, as mallein, tuberculin, argenti colloidalis, albumoses, toxines, etc., while a depres- sing influence is exterted upon the heat centre by such chemicals as antifebrin, anti]3yrin, etc. Traumatic fevers, therefore, in the light of modern science, probably depend on: the irritation of the heat centre by the absorption of poisonous chemical products contained in the wound secretion. SEPTICEMIA 29 Describe the symptoms of traumatic fever. (1) Rise of temperature. This may be slight when not exceeding 103 F.; moderate np to 104.9 F.; high up to 106 .7 F. Its course is usually atypical, continuoiis or remittent, and rarely intermittent. (3) Constitutional disturbance, only marked in high fevers expressed by psychical depression, disturbed heart a-ction, wanting appetite, irregular state of the bowels. Give the treatment of traumatic fevers. The essential feature is thorough disinfection of the wounds, absolute drainage, counteropenings to allow contin- uous evacuation of pus. Abscesses must be incised early and the infected granulations of the abscess wall removed by curetting or otherwise, followed by application of antiseptics. As a rule no internal treatment is necessary. Should internal antiseptics be indicated, camphor, quinine, alcohol, and in cattle also turpentine are the best known means. SEPTICAEMIA. Define septicceTnia. It is a traumatic infectious disease, due to the introduc- tion into the blood tissues of certain bacteria and their j)ro- ducts of metabolism without the presence of localized internal affections, but such generalized changes as swelling of the spleen, cloudy swelling of the kidneys, liver, heart, etc. What two main forms of septiccEmia are recognized ? (1) Bacterial septicaemia, due to the presence of bacteria and transferable to other animals by blood inoculation. (2) Septic intoxication, due to the presence of chemical poisons (toxines), not transferable to other animals by blood inoculation. 30 PRINCIPLES OP "VETERINARY SURGERY Name the most important microorganisms concerned in the production of hacterial septicoe,mia. Streptococcus septicus and pyogenes, staphylococcus aureus, micrococcus tetragenous, the bacilli of mouse and rabbit septicaemia, bacillus enteritidis, bacterium coli. How ivould you classify anthrax, blackleg, malignant oedema. and septiccemia hemorrhagica 9 Each of these diseases represents a " specific septicaemia/* Describe septic intoxication. A type of septicaemia due to the absorption of poisonous products of metabolism of bacteria. These products of meta- bolism are chemical poisons of an alkaloidal nature and are known as ptomaines, toxines, etc., entering the general cir- culation from some necrotic focus about the body (skin> intestines, lungs, etc.). What bacteria are of interest to the surgeon in septic intoxica- tion 9 Those enumerated under " Bacterial Septicaemia." What is saprc£mia 9 A type of septic intoxication depending on the absorption of products of metabolism of saprophytes, as proteus mira- bilis vulgaris and zenkeri . Define kryptogenetic septiccemia. A septicaemia the cause of which is not detectable. Describe the essential post-mortem changes of septiccemia. Blood thin and tarry ; all organs show great tendency to decompose. Subserous and submucous hemorrhages, espe- cially envolving endocardium and mesentery. The voluntary- muscles and heart muscle appear as if boiled, having a clay SEPTICEMIA 31 color ; spleen, kidneys and liver usually swollen. Sometimes there is parenchymatous and hemorrhagic nephritis, also catarrhal, hemorrhagic and diphtheritic enteritis ; also ulcer- ating endocarditis. The "wound may or may not be in an extremely septic state (diffused cellulitis spreading along the lymphatics) . The microscopical examination of the blood reveals num- erous microorganisms of some form or other with a decided breaking down of the blood corpuscles, the white ones espe- cially representing enormous aggregation of bacteria. Give the symptoms of septiccEmia 9 The wound may or may not show septic cellulitis. The constitutional symptoms are moderate or high fever up to 107 F. and more ; this high temperature is occasionally ushered in with a chill ; the pulse is very rapid and small, later imperceptible. The animal is drowsy and very weak ; trembling of the shoulder and gluteal muscles, even paralysis of the hindparts ; mucous membranes icteric, or dark red faeces, at first juicy, later mushy and finally diarrhceal, with colicky pains ; urine dark ; its chemical analysis shows albumen. Infected icounds of what parts are often folloived hy septi- ccemia in the horse ? Purulent inflammation of tendon sheaths and articula- tion, as also deep and extensive subfacial and intermuscular cellulitis, terminating in death in a few hours to several days; occasionally the disease drags along two to three weeks. How do you treat septiccBmia 9 Absolute disinfection of the whole wound surface; remove slonghs; provide drainage; deep recesses which cannot be 32 PRINCIPLES OF VETERINARY SURGERY drained should be irrigated with antiseptic solution. Make Jong and deep incisions where fluctuation is present ; in subfacial and intermuscular cellulitis, inject quantities of slightly warmed glycerine 10, iodoform 1 part. The in- ternal treatment is of little value ( excepting intravenous injections of soluble silver) ; nevertheless, stimulate with fearless doses of strychnine, digitalis ; give tonic doses of quinine, also camphor. PYiEMIA. Define pycBtnia. A traumatic infectious disease, due to the absorption of pyogenic microorganisms into the circulation with multiple or metastatic abscesses in different portions of the body. What bacteria are of interest in pycemia 9 Practically all those which are productive of septicaemia, especially the streptococcus pyogenes and the staphylococcus pyogenes aureus. How do these bacteria enter the general circulation ? There is first the infected wound ; the microorganisms multiply, may come in contact with a vein, the vein becomes inflamed as the result (phlebitis), and a thrombus is formed at this point ; this thrombus undergoes puriform softening, and a piece of it is swept away into the general circulation, this little piece of broken down thrombus now being termed embolus, and since it contains bacteria it represents an infected embolus ; this embolus is carried along by the blood until it reaches a bloodvessel having a smaller diameter than its own. Here the embolus stops ; the bacteria which it con- tains now multiply and an abscess follows. In this manner abscesses develop in the various portions of the body. PYEMIA 33 Wounds of which i^art of the hochj predispose to pycBmia ? In the liorse, wounds about tlie coronary region; in calves and colts, the umbilical region of the newly born; otherwise bone wounds. What do you understand by septicopyc2mia ? This disease is a combination of pysemia and septicaemia. Describe the essential post-niorteni changes of pycsniia. The essential features are purulent, inflammatory foci of internal organs, as liver, lungs, spleen, kidneys, joints, tendon sheaths, heart, muscles, etc. A purulent inflammation of the synovial membrane of the joints is of special importance in navel ill of the colt (polyarthritis pysemica). Purulent inflammation of the serous membranes is also seen (peri- toneum, pleura, meninges), also purulent inflammation of the eye (purulent choroiditis). Occasionally circumscribed hem- orrhages uj^on the serous membranes and those pathological changes peculiar to septicaemia, then septicopysemia. At the point of origin the veins are filled with a decomposing thrombus (purulent thrombo-phlebitis). Give the symptoms of pyc^mia. After the wound is undergoing the process of healing and suppuration established, a very irregular intermittent fever, sometimes ushered in with chills, is observed. Multiple sub- cutaneous abscesses may appear suddenly here and there or symptoms of a metastatic pneumonia or those peculiar to abscesses of the liver, kidneys, brain, or serious lameness due to pyaemic polyarthritis or tendovaginitis. What is the duration of pycE,mia 9 Longer than that of septicaemia, from several days to weeks, depending on the extent and location of the metastatic 34 PRINCIPLES OP VETERINARY SURGERY lesions. Occasionally the course is chronic, with great emacia- tion of the animal. Pyaemia is a very dangerous disease, but less fatal than septicaemia. The period of reconvalescence is very prolonged. How do you treat pycemia ? Stop the progress of the disease by disinfection, not only of the wound, but, if possible, of the interior of the vein, provide drainage, making long and deep incisions wherever indicated. The internal treatment is of little use, but quinine, camphor and strychnine are indicated. Of all agents, intra- venous injections of Crede's soluble silver salt are likely to give the best results. SPECIFIC TRAUMATIC INFECTIOUS DISEASES. Malignant CEdema. Define malignant oedema 9 A traumatic infectious disease, due to the entrance of the bacillus of malignant oedema and probably others into the subcutaneous or submucous connective tissue. What kind of u'ounds are favorable to the development of the adema bacillus 9 Punctured wounds permitting entrance of earth dust into the subcutaneous or submucous connective tissues. Here the oedema bacillus thrives, as the proper medium is present and above all an absence of oxygen. Injury to the tongue or oesophagus by foreign bodies, hypodermic injection impro- perly made, operations with dirty instruments ( empiric castrations). SPECIFIC TRAUMATIC INFECTIOUS DISEASES 35 Give the symptoms of malignant oedema. High fever ; a rapidly spreading oedema about tlie in- fected wound. The swelling when stroked with the hand or finger emits a fine crepitus, feels doughy and is very painful at the circumference, but cold and painless at the centre. The sloughing tissues are surrounded by a thin, putrid fluid; the discharge is sanious and foul smelling. Further, symp- toms of enteritis and pulmonary dyspnoea. The rapidly spreading gangrene with the presence of an emphysemic oedema are pathognomic. Name the salient post-mortem changes of malignant oedema. The subcutaneous tissue is infiltrated with a lemon- colored jelly, the surrounding muscles likewise, emitting also the foul odor of putrefactive gases. The fluid flowing from the parts is yellowish red, foams slightly and is of putre- factive odor. There is severe inflammation of the gastro- intestinal mucous membrane, also pulmonary oedema, but no swelling of spleen. Hotv does malignant oedema terminate 9 As a rule, by death in one to three days ; very rarely, by abscess formation and recovery. How do you treat malignant oedema ? Deep incisions, removal of all sloughs, antiseptic irriga- tions, drainage. Tetanus. A specific, traumatic, infectious disease, caused by the action upon the central nervous system of the strychnine-like toxin of the tetanus bacillus. 56 PRINCIPLES OF VETERINARY SURGERY What ivounds are favorable to tetanus infection ? "Wounds inflicted in dirty parts of the body, as tail, hoof, scrotum, vagina, umbilicus, etc. ; punctured wounds, espe- cially nail pricks, coronary caulks, amputation and myotomy of the tail, setoning, castration. What animals are subject to tetanus ? Mainly the horse ; next, lambs and pigs ; then, rarely, ■cattle and goats. The dog seems to be almost immune. Which are favorite places of the tetanus bacillus ? Rich garden earth, land manured with horse manure, street dust. What do inoculation experiments shoio ? The most common form of infection is through earth, while, of course, foreign objects, as nails, splinters, dirty instruments, etc., may convey the bacillus. It does not enter the blood current, but localizes in the wound and produces a strychnine-like toxin (Tetanotoxalbumin), which on being absorbed acts upon the central nervous system, giving rise to certain symptoms. Give the essential post-mortem changes of tetanuSi. Evident pathological changes are usually absent. Hoiv long is the period of incubation f Three to twenty days. Give the symytoms of tetanus ? These vary somewhat with the intensity of the intoxica- tion. There is a tonic spasm, especially of the extensors of the hind extremities, neck and masticatory muscles. Ears erect and stiff, eye partly covered by the nictitans, tail elevated and stiff ; saliva flows from the mouth ; lips some- SPECIFIC TRAUMATIC INFECTIOUS DISEASES 37 ■what retracted ; the whole body appears extended and th& points of both hocks are turned out ; the walk is stiff, the animal mainly supporting weight with the toe region of the hoof. By raising the head the eye is retracted and tha membrana nictitans falls forward over the eye. The mouth cannot be opened (trismus). Respiration is labored and from 20 to 50 or more per minute ; the pulse in unfavorable cases runs from 50 to 70. Temperature, as a rule, is but little elevated. The animal is easily excited. What is ortliotonos ? That type of tetanus where the vertebral column forms a straight horizontal line. What is opisthotonos ? That form of tetanus where the head is elevated and th& region of the back curved downwards. What is pleuTosthotonos ? That form of tetanus where the vertebral column is. curved to one side. What type of tetanus is practically the only one seen in the horse 9 Orthotonos. What is the termination of tetanus ? In the most acute form, death in one to three days ; in the acute form, death in four to ten days ; in the subacute and chronic form, death after several weeks or recovery in 20 per cent, of all cases. What does the prophylaxy of tetanus include ? Antiseptic treatment of all wounds and the injection of antitetanic serum, previous to or immediately following the injury. 38 PRINCIPLES OF VETERINARY SURGERY How do you treat tetanus 9 Keep the animal in a quiet and dark place. The applica- tion of slings is of doubtful value in the horse. Thorough disinfection of all wounds, even the slightest ones. Inter- ternally, chloral hydrate, bromide of potassium, fld. extr. gelsemium, fld. extr. calabar bean, atropia, injections of tetanus antitoxin. Internal medication in tetanus, to say the least, is unreliable. What is the rate of mortality in tetanus 9 Between 70 and 80 per cent. What other infectious diseases may follow traumatism 9 1. Wound diphtheria (Gangraena nosocomicalis) repre- sents a coagulation necrosis of the granulations of a wound, due to the action of a specific bacillus. In the croupous and diphtheritic form the granulations change into a yellowish, purulent necrotic mass; in the ulcerous form the granula- tions change into a grey, mushy necrotic mass ; in the pulpous form the granulations are changed into a stinking, decomposing, tarry, granular mass. 3. Glanders. Primary skin glanders very rare ; infection takes place about the head, extremities, along the belly, etc. The glanders ulcers develop out of the infected wound. 3. Rabies. 4. Symptomatique anthrax. 5. Anthrax. 6. Wild plague. 7. Tuberculosis. 8. Botryomycosis. 9. Actinomycosis. THE TREATMENT OF ^YOUNDS 3^ THE TREATMENT OF WOUNDS. What two forms of wound treatment are recognized ? The aseptic and antiseptic methods. What does the aseptic method consist of 7 It is of nse only in fresh aseptic germ-free wounds made by the snrgeon. Such a wound does not come in contact with any antiseptics at all. It is dried with sterilized tupfers, possibly irrigated with boiled water, and finally dressed with a sterilized dry dressing. To what extent is the aseptic method of wound treatment applicable in veterinary surgery ? In every-day practice it is not to be thought of. Most wounds are old and infected or fresh and infected. The sur- roundings are such that even should the desire exist to do aseptic work, it simply cannot be executed. Aseptic treat- ment of wounds can be best demonstrated at the colleges, but to the average practitioner it only exists in theory. Outline the antiseptic treatment of -wounds. This includes the production of a reasonably germ-free state of the resting-place of the patient, or at least field of operation of the wound, hands and arms of the operator, instruments and dressings, and preventing subsequent infec- tion by antiseptic dressings. 1. Resting-place of the animal. — The operation can be per- formed anywhere. Either have a straw bed or what is the best bed imaginable, one made up of a two to three inch thick layer of southern pine shavings. Just previous to the casting of the animal the bed is sprinkled with a 1 per cent, carbolic acid or permanganate of potash solution. Under- 40 PRINCIPLES OF VETERINARY SURGERY neatli the field of operation a clean rubber sheet is placed. This rubber sheet is of great practical interest, as it protects the field of operation against the invasion of bacteria from beneath, enabling the surgeon to operate almost anywhere. The hospital and college go one step further toward asepsis, by providing operating tables — practically, useless; theoreti- cally, ideal. The latest is Dollar's operating table. This mechanical contrivance upsets the mental equilibrium of any but the most decrepit old horse. The vast majority of horses cannot be gotten near it; those which you get into it almost invariably raise all sorts of disturbances before they are secured with the foot-chain, belly-strap, etc. In city practice it may be allowed to exist, but the country practitioner's experience with it on farmers' horses, which are but half broken anyway, would make quite a collection of broken bones of the head, fore and hind legs, to say nothing of the crushed fingers coming from the surgeon's anatomy. After an operation, to prevent secondary infection tho animal is prevented from lying down by tying him short. (Castration wounds in city practice; equally valuable in country practice, unless a dust and mud free pasture is given as a run.) 2. Field of opera^io?^,— Shave the parts; scrub with Park & Davis's mercury soap; rinse the parts with bichloride of mercury solution 1 : 500, and cover with a towel soaked in a bichloride of mercury solution 1 : 500 till the operation can be started. 3. Hands of the operator. — Remove dirt mechanically with brush, soap (P. & D. mercury soap) and warm water. Pay CO s e attention to the finger nails. After scrubbing both hands and arms with soap and water for some minutes, scrub them once more in a 1 : 1000 bichloride of mercury solution THE TREATMENT OF WOUNDS 41 and rinse tliem in water that has been boiled. (Now do not stick tliem into your pants pockets, readjust a rope or touch anything but the instruments or field of operation. ) Instruments. — Boil the instruments for ten minutes in a 1 per cent, carbonate of sodium solution, then place them in a shallow tray filled with a three per cent, carbolic acid solution. Dressings. — Sponges are hard to sterilize and should be replaced by gauze tupfers. At the same time they are hard to replace, as they soak up the discharging fluids so readily. They are best prepared as follows: After dusting them thoroughly, soak them for some hours in a permanganate of potasium solution (8 grains to 1 pint of water). ISText wash them repeatedly in boiled water. Then place one dozen sponges into one gallon of water containing dissolved one- half pound of hyposulphite of sodium and add four ounces of oxalic acid; leave them in this solution ten minutes; next pack them away permanently in a three per cent, solution of carbolic water. Gauze tupfers are simply boiled for half an hour and then placed in a three per cent, carbolized solution for future use. Bandages are best boiled and then kept soaked in a 1:1000 formalin solution. Ligatures. — Silk is boiled half an hour and then kept soaked in a one-half per cent, formalin solution. Sterile cat- gut is best bought, as its production is rather troublesome. A very convenient apparatus for the sterilization of knives, dressings, etc., is a formaldehyde sterilizer. What features should the antiseptic drug possess ? It must have sufficient power to promptly destroy strep- tococci and staphylococci. In this strength it must not irritate the tissues and interfere with the process of healing. 42 PRINCIPLES OF VETERINARY SURGERY It must not "be jjoisonous to the system wlien absorbed. It must be reasonable in price. Name the antiseptics of special importance to veterinarians. Heat, bicliloride of mercury, formalin, carbolic acid, creolin, protargol, iodoform, tannoform, zinc chloride, aristol. What wounds do you dress and bandage 9 All those which by the proper nse of antiseptics have become aseptic, in order to protect them against the further invasion of pyogenic or specific bacteria. When do you use a dry and when a moist dressing ? "Wounds which suppurate freely or secrete freely, other- wise those with cellulitis of the neighboring tissues, are given a moist antiseptic dressing. Parts yet to be operated and to be disinfected previous to the operation are also given a moist antiseptic dressing. (Hoof, in preparing for a quittor operation ; the metacarpal region previous to a neurectomy.) How often should a bandage be changed 9 It is not to be disturbed unless dislocated or unless the animal shows pain, fever or increasing swelling of the injured parts, when the bandage becomes soiled by pus or wound discharge. The odor arising from a bandage is not always a deciding feature for changing it. Under what circumstances is an open wound treatment indicated 9 Whenever the state of the wound or the part of the body prevents the application of a dressing. Under these circum- stances an attempt is made to replace the regular dressing by producing artificially a firmly adhering scab on the wound surface. THE TREATMENT OF SPECIFIC WOUNDS 43 Outline the treatment of luounds in general. 1. Stop the hemorrhage by compression, ligation or torsion (heat, actual cautery and styptics) . 2. Do not probe with instrument or finger unless you are sure that no septic material is carried into the wound by doing so. Remove all foreign bodies whenever possible ; pick them out with an artery forceps, wash them out with a stream of bichloride of mercury solution. In cases of lacera- tion or contusion look upon the torn tissues as beyond repair and remove them with the scissors. Clean the wound by scrubbing its neighborhood with P. & D. mercury soap, cut off all hair along its edges and if possible shave the edges. Wash out the wound with some antiseptic solution (bichloride of mercury 1:500), ridding it of all bloodclots, etc. 3. Drainage, closure and dressing. — All infected wounds must be drained, also large and deep ones. For that purpose Tise gauze strips or oakum strands. Deep, lacerated and con- tused wounds when infected ought not to be closed by sutures, but the "open wound treatment" is best instituted. Superficial wounds which can be asepticized and those which are aseptic should be sutured. In suturing a wound, avoid excessive tension, as the circulation of the parts is interfered "with by it, leading to sloughing. Wherever possible, apply an antiseptic dressing. THE TREATMENT OF SPECIFIC WOUNDS. Describe the treatment of a fresh incised wound. Arrest the hemorrhage, but do not use styptic agents if it can be avoided ; remove all foreign bodies ; clean the wound by antiseptic irrigations. When superficial, no drainage is necessary ; otherwise drain at the most dependent 44: PRINCIPLES OF VETERINARY SURGERY part. Suture in a waj to secure perfect apposition of the wound surfaces ; or, if tlie amount of skin permits, bring- the edges together, evert them, and run the sutures over the skin-ridge thus formed. Excessive tension upon the wound edges can often be materially lessened by dissecting the skin, from the subcutaneous tissue all around the wound for several inches. Whenever possible, apply a dry or moist antiseptic dressing. When no bandage is applicable, dust the wound with tannoform or tannic acid, or when sutured paint it with wound gelatin. Describe the treatment of a fresh punctured wound. Most wounds of this sort in animals are infected. The leading point in the treatment of perforating wounds is. drainage, if necessary, by counter openings, and thorough, disinfection. Get pent-up effusions out of the way. Remove foreign bodies (nails or splinters broken off in the wound). Hemorrhage, as a rule, is of little importance. Should a larger vessel be injured, try compression, and if that is. insufficient, enlarge the wound and ligate the artery or vein. In punctured wounds about the hoof the horn surrounding the puncture must be pared thin and the horn immediately around the opening removed ; then the nail tract is to be disinfected, followed by a warm antiseptic fomentation. Describe the treatment of lacerated and contused luounds. As a rule there is but limited hemorrhage. When larger vessels are injured they should be tied. To avoid secondary hemorrhage all shredded tissue must be removed Here primary disinfection is of vital importance, as the vitality of the wound is impaired. All wound recesses must be made accessible to drainage, if necessary by counter-openings. Coaptation of the wound surfaces by suturing is, as a rule> THE TREATMENT OP SPECIFIC WOUNDS 45 not indicated. Active local antiseptic treatment, to encourage separation of sloughs, to prevent septic complications, are essential. For tliis purpose, warm, moist antiseptic dressings frequently changed, and, above all, constant irrigation, are valuable. Describe the treatment of old and suppurating wounds. The rules laid down for " lacerated and contused wounds" ■are applicable. Suppurating wounds about the head as old as one week may be healed by third intention as follows : Dress the wound with sweet oil, scrub it clean with P. & D. mercury soap; remove all shreds; irrigate with 1:500 bi- chloride of mercury solution (use several quarts) ; freshen the edges; coaptate the wound surface absolutely with aseptic silk and cover with dry antiseptic dressing. Drescribe the treatment of gunshot wounds. When the hemorrhage is intense, ligate the proximal and distal ends of the vessel, if necessary enlarging the wound sufficiently to get to it. Do not probe with the finger or probe unless the entrance of the wound indicates that some septic material (piece of the harness, saddle, blanket, etc.) has been carried along; those wounds demanding exploration. l>ecause of extensive lacerations or destruction of vital parts can be probed, as the creature is usually doomed. It is not necessary to probe for the missile unless it interferes with the process of healing. Should the projectile become a source of irritation subsequently after healing is well established, it xnay then be removed with proper surgical precautions. Ordinarily, unless the wound is extensive, disinfect it and its surroundings and apply an antiseptic dressing. Extensive wounds and those manifestly septic are best given the open Tvound treatment. The wound tract should not be disturbed 46 PRINCIPLES OF VETERINAEY SURGERY unless evidences of inflammatory disturbances set in. Should they appear, then exploration, drainage, counter openings and disinfection become imperative. Describe the treatment of poisoned luounds. The stings of wasps, bees, hornets, yellow jackets are^ best treated with alkaline solution, as bicarbonate of sodium solution; internally, stimulants. Snake bites of the rattler^ viper, copperhead, highland and water moccasin are treated by ligating the whole part if possible, and when seen early incise the wound freely and inject with the hypodermic- syringe into the wound and surrounding tissues a 1 per cent^ aqueous solution of permanganate of potash ; internally,, give alcohol and digitalis freely. Describe the treatment of ivounds ivith abnormal granulations^ Excessive granulations are removed by the knife, scissors; or curette, and kept in check by astringents and pressure- bandage, provided its application is possible. Sulphate of copper, chloride of zinc, and a mixture of tannoform and alum (equal parts) and the actual cautery are reliable. Describe shin grafting. It consists in transplanting bits of the epidermal layer of the skin, with the strictest of aseptic precautions, to granu- lating wound surfaces which on account of their extent cannot skin over by the ordinary process of healing. Is shin gi'afting practical in animals ? It is not, — mainly on account of the great mobility of the parts and the limited blood supply of the skin. CONTUSIONS 47 CONTUSIONS. Define a contusion. An injury due to pressure by a blunt body, rending asunder subcutaneous tissue elements, but without a visible skin wound. Differentiate between a contused wound and a contusion. Ill a contused wound there is a primary visible infected cutaneous wound. In a contusion there is no primary visible infected wound. The distinction between them is one of degree and not of kind. Name causes of contusions 9 In the horse, saddle and harness pressure about the back, breast and head; in the hoof by shoes and crowding nails; blows, falls, etc. In cattle, blows from horns ; and in the dog, bites, blows. According to the extent and severity of the subcutaneous lesions, tuhat degrees of contusion are recognized 9 1. Contusion of the first degree. Limited hemorrhage, the bruised tissues are uniformly infiltrated by the extrava- sation (hemorrhagic infiltration), or the extravasation ac- cumulates in small circumscribed patches (ecchymosis, sug- gilation). 2. Contusion of the second degree. The effused blood collects in a subcutaneous cavity and forms a blood tumor (hematoma). When the blood effusion spreads over a diffused area it is termed a suffusion. 3. Contusion of the third degree. The bruised parts undergo necrosis, not as the direct result of the bruising, but due to (1) circulatory disturbances caused by the injury to the blood vessels, this process being termed primary anemic 48 PRINCIPLES OF VETERINARY SURGERY necrosis ; (2) secondary septic necrosis following the entrance of infectious agents. 4. Contusion of tlie fourth, degree. Complete pulpifica- tion of the contused parts. Describe the microscopical changes in bruised tissues. Slight contusions exhibit a tearing of the smallest blood vessels and their accompanying delicate loose connective tissue. In more serious bruises the intercellular substance is ruptured, pushing the cells apart. Destruction of the cells themselves, even in most serious contusions, is seldom observed. How does the microscopic study of contused tissues prove that the contusion per se cannot be looked upon as the direct cause of necrosis ? It shows that while the intercellular substance may be torn, the cells themselves remain intact, preserving their vitality, thus power of regeneration. How do contusions terminate 9 Termination differs according to their extent, location, degree, presence or absence of infection. They terminate by (1) resorption, (3) organization, (3) necrosis. Describe the process of resorption. Occurs in contusions of the first degree. The extrava- sation is taken up by the lymph vessels. First the coagulum squeezes out the serum which enters the lymph vessels; next, the coagulated fibrin becomes liquefied and is absorbed; then the white blood cells and finally the red ones disintegrate and enter the circulation. Describe the process of organization. Seen in more extensive extravasations, especially hema- CONTUSIONS 49 toma. As a result of the proliferation of the fixed tissue cells about the peripheral neighborhood of the hematoma, a cellu- lar infiltration with subsequent formation of fibrillar connec- tive tissue forms, eventually replacing the extravasation (this process is closely related to organization of a thrombus). Should the newly formed connective tissue not permeate the hematoma, but this chronic aseptic inflammatory process confine itself to the periphery, a connective tissue membrane encapsulating the extravasation is the result. This cyst formation is commonly seen in dogs. Describe the process of necrosis. Here the suppuration is due to the entrance of pathogenic bacteria into the blood extravasation. Diffused hemorrhagic infiltrations are likely to lead to septic cellulitis ; the hema- toma is changed into an abscess ; septicaemia and pyaemia may become sequels. Describe the symptoms of a contusion. There is always more or less sudden swelling except in deep subfacial or intermuscular bruises, where three to four days may pass before the soft fluctuating hematoma shows. Hemorrhagic infiltrations are somewhat hard to the touch. In the first few days there is no oedematous, doughy, hard, painful peripheral swelling ; in fact, this is usually peculiar to an abscess. Later on the contused area becomes harder, fluctuation disappearing as the serum is absorbed and re- placed by cellular elements. Excoriation of the skin over the area of contusion may be seen. Depending on the locality of the contusion, impaired or lost function is apparent : thus, lameness, difiQcult mastication, apprehension of food, par- alysis, contusion of nerves, spinal cord, insensibility from contusion of the brain. 50 PRINCIPLES OP VETERINARY SURGERY Give the constitutional symptoms following contusion. As a rule there are none. In case a large blood vessel is torn, the symptoms of acute anaemia present themselves. A rise of temperature is observed after extensive contusions (aseptic fever, due to the absorption of pyrogenous material). When contusions become complicated with suppurative pro- cesses the symptoms peculiar to them are present (necrosis, septicaemia, pysemia). Give tJie differential diagnosis of contusion swellings. Abscess. Hard and painful in the beginning, developing gradually, with late fluctuation ; peripheral area oedematous and doughy. Hematoma. Soft and early fluctuation ; sudden and complete development ; no peripheral oedema, at least not during the first few days. Abdominal hernia. Contents of tumor are compressible; the muscular rent can usually be located by palpation. In case any doubts exist, the contents of the swelling may be revealed by an aseptic puncture of the same. Describe the treatment of contusions. As a rule rest is important. In the slighter and super- ficial contusions, evaporating lotions, massage, or warm, moist antiseptic compresses, provided they can be applied, are useful ; otherwise, warm antiseptic bathing. Those contusions with considerable disorganization of tissues demand a treatment which will promote the activity of the local circulation, break up and diffuse the bloodclots and serous effusions and hasten absorption. Here warm moist antiseptic dressing or bathing, according to the region involved, are imperative. After four to five days the most dependent part should be freely opened, all recesses exposed to drainage, the cavity packed with antiseptic tampons, to CONTUtJlONS Oi "be removed at regular intervals to allow tliorough. irrigation of the parts. Those contusions with necrosis of the tissues and sup- purative cellulitis must be treated according to the rules already laid down, namely, removal of sloughs, absolute drainage and continuous disinfection as far as it is possible from a practical and economic standpoint. The treatment of blood cysts consists in excision. Which contusions are of practical interest ? 1. Those involving the withers, saddle region, point of the shoulder and sternum. 2. Hematoma of the croup and hind leg. 3. Contusions by the twist (lips); commissures of the lip by badly fitting headstall or from pulling ; interdental space from the bit in pullers. 4. Contusions about the external angle of the ilium and about the eyes, due to rolling and tossing about, as in painful colics. 5. Bruises over the atlo axoid regions. 6. In the dog, along the neck and back, internal ear surface, from pinching bites. 7. Bruises about the elbow (shoeboil). In the dog, over the ischiatic tuberosity. 8. Bruises over the anterior carpal region, as in horses that paw and hit the knee against the manger, or in cows that are kept on hard floors and kneel a great deal ; in horses, on the internal aspect of the knee and shin from interfering. 9. Bruises about the os calcis, as in horses which kick the stall partition. 10. Bruises of the sensitive parts of the hoof (podo- phyllous membrane), producing a hemorrhagic pododerma- titis, vulgarly termed corns. 52 rKINCIPLES OF VETERINARY SURGERY SUBCUTANEOUS RUPTURES. Ruptures of Muscles. Name the causes of muscle rupture. Follows violent muscular contractions, or by the action from without of blunt agents. Occurs mainly in young animals and racehorses. What muscles seem to he predisposed to lacerations ? Flexor metatarsi, the straight, oblique and transverse muscles of the abdomen, the crural triceps, gastrocnemius, gluteal muscles, biceps brachii, biceps femoris, triceps ex- tensor, mastoido humeralis, longissimus dorsi, psoas, postea spinatus, etc. What do you understand by spontaneous rupture of a muscle? The tearing of muscles which have undergone pathologi- cal changes, as in animals exposed to prolonged high fevers. Describe the symptoms of muscle rupture. The most important one is impaired or lost function, depending on the fact whether the rent is complete or partial. The torn muscle, being no longer antagonized by its antagonist, has full play, followed by symptoms peculiar to each case. In very recent cases it may be possible to feel the space between the retracted ends, which it must be remem- bered is soon filled by a blood clot and extravasations. Hoiu do muscle lacerations heal ? The blood clot is absorbed. The cells from the internal and external perymisium proliferate until the two ends are united by connective tissue. The ultimate damage, as a rule, is never great. SUBCUTANEOUS RUPTURES 63- Describe the treatment of muscle rupture ? Rest is essential ; stimulating liniments, even blisters. What do you understand hy hernia of a muscle 9 The protrusion of a muscle through a rent of its envelop- ing fascia. Rupture of Tendons. Name the causes of tendon rupture. The same as in rupture of a muscle. Sometimes it fol- lows spontaneously after prolonged rest, especially in animals which suffered with contagious pleuropneumonia or morbus maculosus. How may tendon ruptures be classified 9 Spontaneous (following prolonged rest, necrosis, inflam- mation); complete (involving the whole tendon); partial (where only some of the fibres of the tendon are torn). What tendons of the horse are most frequently involved in complete rupture 9 Flexor pedis perforans and perforatus, flexor metatarsi,, superior sesamoidal ligament, tendo achilles, extensor pedis. Which in the cow and dog 9 Flexor metatarsi and tendo achilles. Which is the most common tendon rupture of the horse 9 Flexor metatarsi, and flexor pedis perforans in the foreleg. Describe the process of healing of tendon rupture ? After the blood has been absorbed the connective tissue scar is formed by the interfascicular connective tissue, para- tendineum and tendon sheath. 54 PRINCIPLES OF VETERINARY SURGERY A very important point, especially from the practical standpoint of operative surgery (tenotomy), is that the round cells of the original granulation tissue change into spindle- shaped cells by the tension upon the tendon wound by the muscles and weight of the body. In other words, early and regular tension plays an important role in the process of healing of such injuries. Another point of practical interest lies in the fact that lacerations within a tendon sheath do not heal as quickly as those outside of it, for the reason that the more loose connective tissue is present (as is the case in injuries outside of a tendon sheath), the more rapid the process of healing, since the greatest part of the new tissue comes from the paratendineum. Aseptic injuries necessarily heal more kindly than infected ones. Because the pus opposes regeneration, the infected parts slough off, which in these tissues requires some time ; in between times free pro- liferation occurs by the paratendineum, and more or less severe thickening of the parts results. What are the common complications of tendon rupture ? In the aseptic form, some thickening of the parts and contraction ; in the septic form, decided thickening of the parts, contraction, and in case the tendon sheath becomes infected, cellulitis, septicsemia. Describe the treatment of tendon rupture. Attempt approximation of the parts and maintenance of the same by compression, plaster of paris cast, rest. In septic wounds, disinfect ; and should the tendon sheath be involved, drain. Prevent excessive granulation of the sur- rounding soft parts by astringent antiseptic compresses (tannoform) until sequestration of the necrotic masses has taken place. Any thickening may be treated subsequently INFLAMMATION 55 by the actual cautery and blisters. In dogs, one may try to suture the torn tendon. Give the symptoms of tendon rupture. Vary greatly with the tendon involved. There are always functional disturbances, as excessive volar or dorsal flexion. A gap may be felt and seen, increasing on exten- sion (flexor tendon) or on flexion (extensor tendon). INFLAMMATION. Define inflammation. Inflammation, not being a definite disease, cannot be defined. It represents the response of tissues irritated by an injury with a highly complicated reactive process. What are the phenomena of inflammation ? 1. A reflex vasomotor paresis producing a dilatation of the arteries, veins and capillaries of the inflamed tissues. 2. Followed at the same time by a great increase in the rapidity of the flow of blood (hypersemia), succeeded by a slowing and finally stopping of the blood current. 3. Concurrently with the slowing of the blood current the white blood corpuscles begin to line up and crowd along the vessel's wall (especially the veins), the red cells continuing to flow along the centre of the blood current. This condition is followed by the emigration of the white blood corpuscles into the surrounding tissues (diapedesis) from the interior of the veins through the walls of the vessel in the direction of the irritating element (chemiotaxis), which represents the condition commonly termed ''cellular infiltration of the inflamed tissue." 56 PEINCIPLES OF VETERINARY SURGERY 4. As the result of tlie altered condition of tlie walls of tlie blood vessels a more or less abundant transudation of liq. sanginis escapes from tbe dilated blood vessels, to wbicb is added the emigration of red blood cells from the capillaries, these two representing the main cause of the so-called "inflammatory swelling." 5. The proliferation of the fixed connective tissue cells together with the emigrated white blood corpuscles are actively concerned in the production of the so-called "cellu- lar infiltration of the inflamed tissue." Causes of Inflammation. Give a practical classification of the causes of inflammation. 1. Aseptic (mechanical, thermal, chemical). 2. Septic (due to the influence of pathogenic micro- organisms). Enumerate some of the most important causes of inflammation. 1. Mechanical irritations, as contusions, wounds, pres- sure, laceration, etc., produce a traumatic inflammatory process. It is aseptic in healing by first intention, subcu- taneous tendon and muscle ruptures, in that form of podo- dermatitis commonly termed founder ; finally, in all inflam- mations of a non-infectious nature of articulations, bones, bursae, tendons, etc. 2. Thermic irritations, as heat and cold. 3. Chemical irritants, as the application of vesicants, the action of acids or alkalies, the subcutaneous injection of certain agents, followed by a purulent inflammation without the presence of pus producing bacteria, in such pus as creolin, ammonia, turpentine. INFLAMMATION 57 What is the cause of an infectious inflammation ? The entrance of pathogenic micro-organisms into the tissues. What classes of bacteria are more coywtnonly concerned ? Staphylococci, streptococci, baciUus of tuberculosis, malignant oedema, anthrax, glanders, etc. Hoiv do these bacteria cause inflammations ? These micro-organisms do not irritate the tissues mecnani- cally, but become phlogogenous by their chemical uroducts of metabolism (toxines). What is phlogosin ? A cry stalliz able chemical of a phlogogenous nature, first obtained from staphylococci cultures by Leber. Varieties of Inflammation. According to the exudate, what varieties of inflammation are hnown ? Serous, fibrinous, purulent, hemorrhagic, gangrenous,, diphtheritic, productive, specific. ■ Describe serous inflammation. In this type of inflammation the walls of the blood vessels-- are but slightly altered, the exudate is watery, lymph-like,, and contains but few white and red blood cells. It is more^ common in the skin, upon the mucous membranes and serous membranes of articulations, tendon sheaths, etc. Describe fibrinous inflammation 9 Also known as croupous inflammation, the exudate- abounds in fibrin and white blood cells. When the exuda- tion cells and the newly formed cells of such an inflamed 58 PRINCIPLES OF VETERINARY SURGERY tissue are caught in a fine reticulum of fibrin, this membrane- like covering of the inflamed . tissue is termed a fibrinous pseudo-membrane. Fibrinous inflammation is most fre- quently met with upon the serous membranes of articulations, bursae, tendon sheaths and mucous membranes. Describe purulent inflammation. Usually the result of an infection with pus cocci. The accumulation of pus may be circumscribed or diffused. What is an abscess ? A newly formed cavity circumscribed by granulation tissue and containing pus. What is a purulent infiltration ? It is a diffused collection of pus in inflamed tissues. What is empyema ? An accumulation of pus in the sinuses of the head or articulations, etc. Describe hemorrhagic inflammatioii. In this form of inflammation the walls of the vessels in the affected tissues have undergone material alteration and the exudate contains a great many red blood corpuscles. Describe gangrenous inflammation . One of the most malignant types. The exudate is putrid, discolored and undergoing decomposition due to the presence of putrefactive bacteria. Explain diphtheritic inflammation. This represents a coagulation necrosis of the mucous membrane, followed either by the formation of a diphtheritic pseudo membrane upon the mucous membrane or loss of tissue in the necrotic parts. INFLAMMATION 59l Define coagmaiion necrosis. It means local death of cells clue to wanting nutrition, Tvith subsequent disintegration of these cells and their change into a substance resembling coagulated fibrin. JExplaiii lyroductive inflammation. A chronic process leading to and followed by tissue proliferation. Depending on the nature of the produced tissue, this type of inflammation may be fungous, endurating, granulous, verroucous, adhesive, etc. Explain sijecific inflammation. Inflammations due to the action of specific agents, as glanders, tuberculosis, actinomycosis, botryomycosis. Symptoms of Inflamm.ation. Name the cardinal symptoms of inflammation. Redness, heat, pain, swelling and impaired function. Sow is inflammatory redness (rubor) explained ? Pigmentation of the skin and the hairy coat of animals as a rule interferes with the ready demonstration of redness, while it is easily observed on the white skin and mucous membranes. Rubor is due to the dilated state and excessive accumulation of red blood cells in the blood vessels. How is the increased heat {color) of the parts explained ? There is no increase in the local production of heat within the inflamed tissues, this depending mainly upon the increased flow of blood to the parts. Sow is the swelling (tumor) of the parts explained ? By the dilatation of the vessels and inflltration of the tissues by the exudate. 60 PEINCIPLES OF VETERINABY SURGERY « Describe ihe quality of svcli a swellijig. This varies with the nature of the tissues involved. Ife. may be of doughy consistency, pitting on pressure, best seen in the loose subcutaneous tissue along the abdomen, due to the presence of serum in the tissue meshes, termed inflam- matory oedema. Swellings due to the accumulation of blood corpuscles or proliferating, fixed connective tissue cells are- harder and do not pit on pressure because these elements are- not as readily displaced by pressure from without. This. form of swelling is termed plastic or cellular infiltration. Explain the presence of pain in an inflamed part. Following the swelling there is an increase of pressuro- within the inflamed organ which in return means a bruising- of the sensitive nerves of that part. At the same time it is, probable that the nerves themselves undergo inflammatory changes. The greater the nerve supply, the greater the. swelling, and the less the inflamed part is capable of ex- panding, the greater the pain : for instance, in the skin». pododerm, eye, articulations. HoiD does impaired function express itself ? Lameness due to an inflamed muscle, which is rigid and contracted. The special senses may be impaired by the^ inflammatory process, and inflamed gland stops to produce- its natural secretion. Course and Termination of Inflammation. Classify inflammation according to the rapidity and intensiif^ of its course 9 1. (a) Peracute ; duration only a few hours, as malignanfe cedema, anthrax. (6) Acute ; here the process sets in with a. INFLAMMATION 61 limit itself in extent and intensity, etc., looking toward the removal of the exudate and healing of the diseased state of the walls of the vessels in the inflamed territory. Describe the means employed for the modification or arrest of inflammatory processes. (1) Cold, (2) heat, (3) compression, (4) drugs, (5) surgical interference . Sow does the action of cold influence the inflci,mmatorif processes 9 It contracts the dilated blood vessels, restricts tlie exuda- tive processes (emigration of the white blood cells, hemor- rhage), abstracts the increased heat of the inflamed part, depresses the functional activity of the sensitive nerves, thus easing pain. INFLAMMATION 63 Describe the application of cold for the relief of inflammatory processes, 1. By immersion. The diseased part is placed into a vessel with cold water, a fresh supply of cold water being added from time to time to get the action of continuous cold (the latter being done away with in case the parts are immersed in a flowing stream, as a brook, etc.) This method is practically confined to the treatment of inflammatory states of the hoof. 2. Cold fomentations. Consists of the application of some absorbent material, as cloths, bandages, etc., kept moist with cold water. This method is not very effective unless the dressing is moistened every five minutes. Experiments have shown that the temperature of the parts drops during the first two to three minutes, to rise to within the original temperature shortly ; at best the temperature can be kept down when cold is applied every five minutes, which lowers the temperature permanently some 5 to 9 degrees F. In these cases the addition of such agents as vinegar, alum, lead acetate, disinfectants (as carbolic acid, chloronaphtho- leum, formalin, etc.), is of twofold value : they influence acute inflammatory processes favorably, prevent infections and ease the mind of the owner, as the mere use of cold water may seem insufficient to him. 3. Continuous irrigation. This represents undoubtedly the most valuable means of applying cold. It consists in allowing a thin stream of cold water with or without the addition of medical agents to flow continuously over the diseased part. Experiments have shown that by this method the temperature of the irrigated part dropped about 36 deg. F. after one hour's irrigation. 64 TRINCIPLES OF VETERINARY SURGERY When is the application of cold contraindicated in the treat- ment of inflammation f It is only of use in the earlier stages of acute inflamma- tion. It should not be emiDloyed in infectious states, as it interferes with the process of healing by inhibiting the exudative process more or less, the latter being a vital factor in the process of repair. It should not be used in the treat- ment of serious bruises, as the vitality of the parts is already lowered by the contusion, and thus sloughing would be encouraged by the application of cold. In other words, there are few inflammatory processes which could be treated suc- cessfully by the application of cold after the inflammatoi-y processes once existed 36 to 48 hours. How does the action of heat influence the inflammatory p)rocess. Temperatures ranging from 78 to 122 deg. F. dilate the blood vessels, thus increasing the blood-flow and increasing nutrition of the parts. As a direct result of this, absorption of the exudation is encouraged. Heat softens and renders less tense tlie inflamed tissues ; consequently, pain is more or less relieved. Describe the application of heat in the treatment of inflam- mation. 1. By immersion. The part is immersed in warm water, a new supply being added from time to time to keep up the desired temperature. 2. Cataplasms. Linseed meal, bran, etc., is mixed with warm water containing some antiseptic agent, as one-half per cent, carbolic acid, etc.; or, better, cotton waste (such as is used to wipe machinery) is soaked with a warm antiseptic solution and applied to the inflamed part. These have to INFLAMMATION 65 he renewed every three to four hours to be of any A^alue. The best results are obtained by the so-called Priessnitz fomentation. Describe the Priessnitz fomentation. A cloth of an absorbent nature is dipped into cold water and wrung out. This cloth or bandage is applied to the diseased part. Over it are wra})ped several layers of woolen material. In cases which warrant the expense, a layer of oiled silk or some other impervious article is applied, before the last woolen bandages are placed. The whole thing is removed and reapplied every four to six hours. Describe the action of the Priessnitz fomentation. The application of the cold dressing produces a temporary -contraction of the underlying blood vessels, followed by a ■decided dilatation of them. The moist cloth or bandage soon becomes warmed by the parts with which it is in contact, and since the overlying woolen layers prevent the evaporation of heat, the temperature of the surface skin next to the moist dressing reaches body temperature. By changing the Priess- nitz every three to six hours the blood vessels are induced to contract and dilate, thus vitalizing the parts, materially encouraging the reparative processes— that is, the breaking down and absorption of the inflammatory exudates. During what stages of infiaTYi'mation is heat indicated ? In all subacute and chronic forms ; whenever the vitality of the parts is low ; where there is great tension ; where sup- puration is present ; when sloughs are to be separated. When is the application of heat contraindicated ? At the very outset of inflammation, in cases of septic cellulitis and malignant oedema, as these pathological pro- cesses are encouraged by the action of heat. 66 PKINCIPLES OF VETEEINAKY SURGERY How does compression influence the inflammatory process ? Compression is beneficial by promoting absorption and resolution, done by changing the rate of circulation suffi- ciently to bring about rapid absorption and normal nutrition.. By compression, inflammatory exudates are diffused, tissues loosened bound down by adhesions. What methods of compression are employed in the treatment of inflammation ? 1. Continuous compression, as by bandaging the part. 2. Intermittent compression, as by massaging the parts with the hand or fingers. To u'liat extent is massage of value in animals ? Massage is a very valuable means in the treatment of subacute and chronic aseptic inflammations. Its application is limited in animals, because it should be used from one to three times daily for five to fifteen minutes each time. The presence of the hairy covering renders it less effective in animals — in fact, interferes with the proper execution of it. The pressure to be exerted upon the painful parts renders the animal intractable. Therefore it is confined to the treat- ment of chronic inflammations in valuable horses and other pets. How do you massage a part ? By stroking, rubbing, kneading and tapping the part. Place a piece of stout paper which has been dressed with lard over the part to be massaged. This larded paper prevents the hair from becoming rubbed out. First stroke or rub gently the parts just beyond the inflamed area. After having thus emptied, so to speak, these tissues, massage the diseased parts in the direction of the emptied tissues, thus forcing the INFLAMMATION 67' exudate into the previously emptied tissues. In kneading the parts, rub the parts circularly with the pulps of the fingers, or, in the larger animals, with the closed fist. Massage by percussion is effected by tapping the surface over the diseased parts with the finger tips, the palm of the hand, or, in the larger animals, with a light wooden mallet. What class of drugs is employed in the treatment of chronic inflammation ? Those generally known as counter-irritants. Name the counter- irritants of special value generally employed. Such vesicants as cantharides and red iodide of mercury and the actual cautery. How do counier-irritants influence chronic inflammatory processes ? This question is by no means settled. Some claim that the irritant applied to the skin reflexly influences the blood vessels of the inflamed part, causing the blood to leave, so to speak, the deeper and affected parts and to accumulate in the artificially inflamed skin. The latest theory — and a rather improbable one — is that the chronic inflammation has been changed into an acute one. It is stated that the irritant causes the most deeply situated blood vessels of the chronic- ally inflamed area to dilate, followed by exudation of serum and emigration of the white blood cells. Out of these white blood cells certain ferments are formed which digest the albuminous constituents of the chronically inflamed part, with formation of an albumose liquefaction and subsequent absorption of the more solid inflammatory products. It seems to me that the action of vesicants and the actual cautery lies mainly in these facts : first, they cause decided pain, which induces the animal to rest the part exposed to the- 68 PRINCIPLES OF VETERINARY SURGERY counter-irritant ; next, as the result of the swelling of the skin and subcutaneous tissues, a more or less continuous compression of the diseased tissues is obtained, while pro- longed compression even is exerted by the scar formation following the application of the actual cautery, which, as previously shown, has a favorable influence upon chronic inflammatory processes. Other factors no doubt play an important role, as yet to be demonstrated. When do you employ antiseptics to co7nbat inflammation 9 Since a great many inflammations in animals are the direct result of a wound invasion by bacteria, antiseptic agents are required to inhibit their further development. What antiseptics are indicated to influence deeply located septic inflammation ? Those which penetrate the skin, as carbolic acid, iodo- form, camphor, etc. What operative measures may he empiloyed in the treatment of inflammation ? Venesection is to-day but little employed ; nevertheless, it is of value in an acute violent inflammation, especially indicated in that acute diffuse aseptic pododermatitis com- monly termed "founder." Scarification by punctures or incisions, while not often ■employed, frequently give relief in intense congestions, with the integuments thick and brawny, as in rapidly spreading inflammations, deep seated suppuration. The incision or puncture must go through the skin and cellular tissue to be effective. Such wounds, of course, are given subsequently a thorough antiseptic treatment. In gangrenous inflammations the prompt removal of tissue shreds or sloughs, either by ABSCESS 6^ excision or amputation, is called for (gangrene of the tail, udder, ear, etc.) ABSCESS. What is an abscess ? It is a newly formed cavity circumscribed by embryonic tissue and containing pus. Describe the formation of an abscess. First, pus producing bacteria invade a part. The small vessels of this part are distended with blood or even leuco- cytes, the connective tissue fibres are swollen, and the lympli spaces are filled with exudate containing enormous numbers of leucocytes ; the fixed cells of the tissue also undej-go changes, become nucleated, resembling leucocytes. In the meantime the cocci have multiplied and massed together, and by their peptonizing action upon the fibrin of the exudation and intercellular substance the centre of the inflamed tissue liquefies and the abscess is ready. The abscess cavity is walled in by a zone of granulation tissue, this embryonic tissue actiug as a protective layer between the infected parts and the adjacent healthy tissue territory, the abscess becom- ing larger by liquefaction of the granulation tissue from within to without. When the inflammation finally reaches the surface, an elevation due to fluid pressure from within forms, which from tension and liquefaction becomes thinner and thinner, breaks, and the contents of the abscess cavity evacuate spontaneously. What classes of bacteria are mainly concerned in abscess formation in the horse ? Streptococci and staphylococci. The latest researches. 70 PRINCIPLES OF VETERINARY SURGERY tend to show that the so-called botryomyces are no specific bacteria, but an aggregation of staphylococci. • What bacteria are mainhj responsible for the production of abscesses in cattle ? According to Lucet and Nocard, streptococcus pyogenes bovis, staphylococcus pyogenes bovis, bacillus pyogenes bovis, bacillus liquefaciens bovis, bacillus crassus pyogenes bovis. What forms of abscesses are recognized ? Acute, cold or chronic, circumscribed, diffused, gravita- tive, tympanitic, metastatic or pysemic, superficial, deep, intermuscular, subfacial, etc. What do you understand by an acute abscess 9 One following an acute purulent inflammation. What do you understand by a cold abscess 9 An abscess the result of a chronic purulent inflammation. What do you understand by a circumscribed, ivhat by a diffused abscess 9 A circumscribed one is limited by a wall of granulation tissue ; a diffused one is usually more extensive and not limited by a wall of embryonic tissue. What is a gravitative abscess 9 Abscesses point toward the point of least resistance ; therefore, depending on the nature of the tissues, the pus, trying to get out, wanders, appearing at some distant spot from its point of formation. What is a tympanitic abscess 9 One containing gases of putrefaction. ABSCESS 71 What is a metastatic abscess ? This is a secondary or symptomatic one. It is the embolic abscess of pyaemia. What is a superficial, deep, intermuscular, suhfacial abscess? It is termed superficial when occurring above the deep fascia ; deep when occurring below the deep fascia ; inter- muscular when occurring in a muscle ; subf acial when occur- ring below a fascia. Which animals exhibit abscesses most frequently ? Horse, dog, ox. In what region of the body are abscesses more generally found? Intermaxillary space, point of the shoulder, coronary region of the hoof, all parts exposed to harness pressure, as neck, back, etc.; fetlock, knee. From an anatomical ]}oint of vieiv, ivhere do abscesses more generally occur 9 In the subcutis, below the fascia, in muscles, in the mammary gland and lymph glands. Describe the symptoms of a subcutaneous abscess. There is more or less local swelling, which is hardest at its periphery. This swelling shows increased heat and more or less fluctuation on palpation, as soon as the progressive softening of the tissues takes place and the pus reaches the surface. The time consumed for the "ripening" of the abscess and the intensity of the symptoms are variable, depending on the density of the tissues lying between the abscess cavity and the surface. The skin over the abscess cavity is tense and cannot be displaced, and has a peculiar fatty, glistening aspect. At the point where the abscess is shortly to break, the hair stands erect and drops out. In 72 PRINCIPLES OP VETERINARY SURGERY non-pigmented parts the skin appears a lead color or bluish red. There may be fever. Describe the symptoms of a deep abscess. This is more difficult to diagnose, at least in its early formative stage. There appears soon local oedema, with a brawny feel, and other signs of suppuration, and, in case the leg is the seat of the deep abscess, great functional disturb- ance. Such symptoms may call for an explorative aspira- tion, puncture or incision made with proper precautions. How do you treat an abscess ? As long as the local swelling is hard, hasten the softening of the tissues by continuous hot antiseptic poultices. As soon as any fluctuation is apparent, at least in subcutaneous abscess, make a lengthy incision at the most dependent part ; irrigate the cavity with an antiseptic solution (bichloride of mercury 1:1000, formalin 1:1000, etc.) by means of a foun- tain syringe, several times daily; otherwise, institute the so- called open wound treatment. In deeply located abscess it would be faulty to wait for the abscess to point — that is, the detection of fluctuation by palpation — as the pus may gravitate, causing extensive necrosis and septic states. As soon as a deep abscess is sur- mised, make an incision through the skin, puncture the fascia carefully, and now, with the disinfected finger, by boring movements attempt to reach the abscess cavity. After thorough antiseptic irrigation of the deeply seated cavity and providing drainage, inject several ounces of iodoform and glycerine 1: 10, put in a drain, and after that treat same as a superficial abscess. Why are deep abscesses opened with the finger instead of ivith the thrust of a knife 9 To avoid injuring important blood-vessels and nerves. ULCER 73 Why do yoii, comhine iodoform ivith glycerine for the iinjection of deep and gravitating abscesses ? Glycerine, being heavy, enters every nook and corner of the diseased parts, drives out and brings to the surface float- ing products of septic inflammation. The glycerine subse- quently is absorbed, leaving behind a fine coating of iodo- form. This treatment has given me excellent results. Which are the characteristics of a chronic or cold abscess 9 The course of the chronic abscess is slow ; there is little tendency to point ; symptoms in general are slight. There is little development of inflammatory heat ; therefore it is called also cold abscess. The wall of granulations limiting it is thick and more or less organized into a connective tissue capsule. ULCER. Define an idcer from a surgical point of vieiv. It is a granulating surface of the skin or mucous mem- brane with limited tendency to heal. What two main classes of idcers are recognized 9 Primary or idiopathic, and secondary or symptomaticv ulcers. What two main classes of causes are concerned in the produce of ulcers ? Local and general causes. Enumerate the local causes of ulcers. Any agent keeping up an inflammatory process in a. wound, by continuously and locally irritating the wound, interferes with granulation and cicatrization, changing such 74 PBINCIPLES OF VETERINAET SURGEEY a wound into a primary or iJiopatliic ulcer : as pieces of necrotic tissue or foreign bodies at the bottom of a wound, continuous licking of a wound as by dogs, tlie persistent shaking of an injured ear (dog), etc. Enumerate the constitutional causes of ulcers. Certain specific local or constitutional diseases are fol- lowed by secondary or symptomatic ulcers, as the ulcer of farcy, actinomycosis and tuberculosis, corneal ulcers follow- ing dog distemper, etc. What circumstances encourage ulcer formation in tissues ? The more any agent directly or indirectly interferes with the circulation or nutrition of a tissue, the greater the ten- dency of such a tissue toward ulceration. This interference with the nutrition or circulation may be brought about, for instance, by the action of pus cocci, these producing cell necrosis ; or the circulation may be interfered with by pres- sure from an exudate upon the part, prolonged pressure, as seen in decubitus (bedsores). Finally, corneal ulcer from diminished innervation, as in paralysis of the trificial nerve (neuro-paralytic ulcer). According to the quality of the granulations, what forms of ulcers are recognized ? Sluggish and painless, irritable and painful ulcers. According to the edges of the idcer, what forms are recog- nized ? The healthy or simple ulcer, with a smooth, moderately indurated edge ; and the callous, indolent or chronic ulcer, with a wall-like, irregular, indurated edge. Depending on the depth of the ulcer, tchat forms are known ? Superficial, deep, sinuous, tubular, fistulous. ULCER 75 According to the quality of the surface granulations, what forms of ulcers are recognized f Fungous, or exuberant, phagedenic, gangrenous, diph- theritic. In describing an ulcer, ivhat main points are to he considered? Its granulations, edges, depth, surrounding skin, dis- charge, size, shape, seat. Describe a healthy idcer. Granulations small, cherry-red and regular ; discharges a limited quantity of laudable pus ; its edges slope and are "but little indurated ; its shape is regular, the surrounding skin flexible. Describe a fungous ulcer. Usually seen after injuries followed by undue contraction of the surrounding tissues, causing an obstruction of the venous circulation here. The granulations rise above the surrounding skin ; they may be large and flabby and bleed easily. Describe a phagedenic tdcer. It is due to infection by various micro-organisms ; its edges appear as if eaten out ; the surface of the ulcer is wanting in granulations, being covered with sloughing tissue. Outline the treatment of idcers. In some cases rest is sufiRcient ; for instance, dogs suffer- ing with ulceration of the tip of the ear are prevented from shaking the ears continuously by placing a hood over head and ears. In other instances, foreign bodies, bits of necrosed bone, cartilage, tendon, must be removed before healing can take place. Then, again, the granulations or the indurated edge may have to be removed by excision, curetting, cauter- 76 TRINCIPLES OF VETERINARY SURGERY ization, wliile actinomycotic ulcers are treated with iodide of of potassium internally and parenchymatous injections with, tr. iodine. Do ulcers play an important role in veterinary surgery ? They do not. Most of them yield readily to treatment, excepting, of course, some of the specific ones, as those follow- ing the breaking down of malignant growths (carcinoma), farcy (its treatment is illegal). Name the more important and more frequently met luith ulcers of the domesticated animals. In the dog, ulceration of the tip of the ear, cornea (dis- temj)er), tip of the tail, stomatitis ulcerosa (tooth disease), carcinomatous ulcer. In the horse, ulcers about the lower extremities, de- cubitus (bedsores), carcinomatous ulcers, ulcers in the regions exposed to harness pressure. Give the treatment of the healthy, indolent, fungous anci phagedenic ulcer. Healthy ulcer : Allow rest to the affected part. In case disintegration is evident, hasten the separation of the dead tissues by warm antiseptic poultices. As soon as healthy- granulations are obtained after removal of the slough most any kind of dressing will heal a simple ulcer, as dusting the parts with tannoform, tannic acid and iodoform (3: 1), etc. Indolent ulcer : Healing can only occur by the produc- tion of granulations, to be brought about by creating hy- pera3mia. Soak the indurated edges for forty-eight hours by a warm alkaline antiseptic poultice. Then incise the edges at a right angle and dress antiseptically. These incisions favor contraction and granulations will sprout in them. After two days curette the whole ulcer until the parts bleed and sound FISTULA 77 tissue is reached. Use warm antiseptic poultices for two more days. By this time all sloughs can be removed. Now treat the ulcer same as a simple or healthy one. Fungous ulcer : Remove the mushroom-like projections with the curette. Be sure to scrape its edges well. Follow "with astringent applications, as alum, tannic acid, tanhoform, sulphate of copper ; and wherever possible, hold them in place by a pressure bandage ; the dressings to be changed frequently. Phagedenic ulcer : Continuous warm antiseptic poultices to separate the sloughs. Should this be insufficient (shown "by the fact that the ulceration progresses rapidly), use the curette or knife or red hot iron to overcome the septic inva- sion ; after that, antiseptic stimulating applications are indicated. FISTULA. What is a fistula 9 A tubular wound surface which does not heal and from "which either pus, some secretion or excretion is discharged. JVhat two main classes of fistula are recognized 9 Purulent fistula and secretory and excretory fistulae. Naine the various varieties of fistula. The incomplete or blind fistula, the complete or com- municating fistula. What is a blind fistula ? One which leads to some necrosed tissue or foreign body, or empties into an abnormal cavity. 78 PRINCIPLES OF VETERINARY SURGERY What is a complete fistula 9 It represents an abnormal communication between two natural cavities or canals. What is a purulent fistula ? It represents the sequel of a chronic, destructive, deep, purulent inflammation, continued by necrosed tissues or specific micro-organisms, discharging its purulent exudate from a tubular tract. Name the more imijortant purulent fistulae . In the horse, quittor, funiculitis chronica (scirrhous cord), tooth fistula (lower premolar). In the dog, from upper maxilla, bony fistula, as from the sternum, ribs, pelvis ; inferior maxilla, coccygeal vertebrae. Fistula of the withers, neck and poll, and from suppurative phlebitis. What is a secretory and excretory fistula ? The first one is a pathological communication between a secretory organ and the body surface ; the second is an. abnormal canal between an excretory organ and the body- surface. Which secretory and excretory organs are more frequently Tnet with fistulous tracts ? In the cow, the udder or teat. In the horse, salivary glands, oesophagus, pharynx, stomach and intestines, urethra, between bladder and rectum or rectum and- vagina. Which congenital fistula is of practical importance ? The urinary fistula following wanting closure of the urachus in the newly born. Describe the symptoms common to purulent fistula ? Depending on the variety of fistula and locality involved. FISTULA 79 the sym'ptoms differ. But in all cases there is a discharge, either specific in nature, as milk, saliva, urine, faeces, etc., or pus coming from the external fistulous opening termed the mouth of the fistula. This external opening, as a rule, is funnel-shaped, and either covei-ed with rather large granu- lations or, as the result of the reaction of the scar tissue formed by the fistula wound, the mouth is puckered. In probing the fistulous canal, a tract of variable length straight or tortuous is detected. The walls of the fistulous canal are either covered with sluggish granulations or are smooth and tough. As a rule, pain is absent unless a recent inflamma- tion followed by acute cellulitis has set in. Outline the treatment of purulent fistula . The essential feature in the treatment is the removal of foreign bodies or necrotic tissues. By doing so, the destruc- tive purulent process is stopped, healthy granulating wound surfaces replace the sluggish granulations or indurated walls of the fistulous canal, provided thorough drainage and reasonable antisepsis are established — imperative, whatever method of treatment is employed. What two methods may he em,ployed in the treatment offistidaf (1) By escharotics, (2) operative measures. Which is the more effective one of the two methods ? In the vast majority of cases, direct surgical measures, as the knife, curette, scissors, bone forceps, etc. What does the treatment by escharotics consist of 9 It consists in the injection of caustics held in solution, in- jected with a view to slough out those agents which interfere with the process of healing, as corrosive sublimate, nitrate of silver, tr. iodine, villate solution, and the more lately intro- 80 PRINCIPLES OF VETEBINARY SURGERY duced agent— and one certainly of great value— protargol ; also the actual cautery. What are the essential points to be observed in operating a fistula ? Do not simply split the fistulous canal ; it is insufficient ; but remove all chronically inflamed parts and the ulcerating bottom of the fistula, and provide drainage if necessary by counter openings. Reasonable antisepsis is necessary to <_ avoid infection of the operation wounds by the previous purulent focci, or an acute purulent infection — that is, acute cellulitis — is likely to follow. Never operate a fistula as long as an acute cellulitis involves its neighborhood — well exem- plified in quittor operations ; treat this cellulitis, and then operate. Describe the symptoms^ common to secretory and excretory fistida. There is a fistulous opening and a fistulous canal, which in the secretory fistula communicates with a gland, as, for instance, in the salivary fistula in the horse, the parotid ; while in the excretory fistula the fistulous tract leads to some excretory organ, as the stomach, bladder, rectum, etc. These fistulae, therefore, may discharge milk, saliva, urine, faeces, food, etc. Do secretory and excretory fistula yield readily to treatment ? They do not ; because the irritating nature and the con- tinuous pressure of the discharge persistently interferes with the process of healing. Outline the treatment of secretory and excretory fistida. The actual cautery and other escharotics are of little value. Usually the best procedure consists in changing the GANGRENE 81 mouth of the fistula into a fresh wound and obliterating the opening by stitching it up. When this fails in secretory- fistula, removal or destruction of the gland becomes neces- sary. GANGRENE. Define gangrene. By gangrene, necrosis or mortification, is understood a local death of tissue. How is gangrene classified ? Into moist and dry gangrene, aseptic and septic gan- grene. What is dry gangrene ? A process of mummification. It represents a condition resulting from loss of water of the affected tissues. What is moist gangrene 9 That form of gangrene where the necrosed tissues under- go softening or pulpification, as evaporation of the watery constituents of the tissue cannot easily take place. What is putrid gangrene ? Necrosis plus bacteria of decomposition. What is ichorous or phagedenic gangrene 9 It is a putrid, rapidly spreading gangrene. What is emphysematous gangrene ? A gangrene due to a mixed infection with gas producing "bacteria. 82 PRINCIPLES OF VETERINAEY SURGERY Which form of gangrene is more frequently seen in animals ? Dry gangrene, as from harness pressure and decubitus (bed-sores). Which part of the body is quite often attacked by moist gangrene ? The flexion surface of the lower pasterns in gangrenous dermatitis (aggravated scratches). How is the gangrenous process usually limited ? At the junction of the healthy and necrosed tissues a wall of granulations is thrown out by the healthy tissues, by means of which the slough or necrosed tissues are separated from the living parts. This line of granulations, establishing the separation of the dead from the living tissues, is termed the line of demarcation. Causes of Gangrene. Name the causes of gangrene. (1) Mechanical, (3) thermic, (3) chemical, (4) infectious, (5) a combination of the above. Describe the mechanical causes of gangrene. Most frequent one, consisting of mechanical interference with the circulation of the part, such as contusions, con- tinuous pressure, incarceration, thrombosis, embolism. How soon after interruption of the circulation do shin and muscles undergo gangrene ? In ten to twelve hours. Hoiu soon after interruption of the circulation do the intes- tines, brain or kidney undergo necrosis ? In one to two hours. GANGRENE 83 Which parts resist gangrene considerably f Bones and cartilages. Describe the chemical causes of gangrene. To this class belong the escharotics. Caustic acids, as nitric acid, destroy the cells by coagulating the albumen and form a scurf, or kill the cells, as sulphuric acid, for instance, does by dehydration. Caustic alkalies change the tissue albumen into a smeary, soapy mass, while metallic caustics, as copper sulphate, chloride of zinc, corrosive sublimate, kills the tissue cells by precipitation of a metallic albuminate and the setting free of acids. Finally, snake poisons and certain toxines produce gangrene by chemical processes. Describe the thermic causes of gangrene. Here excessive heat (combustion) and cold are to be considered. Describe the infectious causes of gangrene. Certain streptococci and staphylococci, Bang's necrosis bacillus, the bacilus of malignant oedema, anthrax, acute glanders, etc., produce gangrene by their toxines, which pro- duce death of the affected tissues either chemically or by interfering with the circulation. Even certain fungi are also credited with such actions, as the ustilago carbo, tilletia caries, polydesmus exitosus. Describe the compound causation of gangrene. In all diseases where the circulatory apparatus of an animal is seriously taxed, as heart disease, general debility, fevers, cachexia, septicaemia, etc., extensive and serio\:s decubitus is seen to follow comparatively slight traumatisms^ explained by the limited vitality of the tissues due to the impaired nutrition of the body. 84 PRINCIPLES OF VETERINARY SURGERY Describe the symptoms of dry gangrene. Since in this form the supply of arterial blood is gradu- ally diminislied, while the outflow of the venous blood is not interfered with, the tissues, aided by evaporation, gradually lose their water and mummify — that is, become hard and dry. Thus the gangrenous skin appears black or brownish, is hard and leathery, and feels cold and is painless, but little decomposition occurring in this form. What regions of the body are mainly exposed to dry gangrene? The neck and back, from harness pressure ; in animals which are in the recumbent position a great deal, the skin over the external angle of the ilium, and about the eyes ; in the dog, the tip of the tail ; in cattle, the claws. Describe the symptoms of moist gangrene. When the arterial blood supply or the return flow of venous blood is suddenly stopped, the following symptoms — that is, those of moist gangrene — are likely to be noticed : Depending on the part involved and the extent of the lesion, there is intense inflammation, more or less impaired function, lameness, etc. The affected tissues feel soapy and soft at first and change finally into a pulpy, smeary mass, while the natural color of the tissues is changed into either a yel- lowish, greyish, blackish, brownish, or greenish hue. Thus, for instance, the color of the lateral cartilage becomes dis- tinctly green. The .necrotic tissues are cold and insensitive, an ichorous, foamy discharge being present, accompanied by a decided stench, due to the presence of putrefactive bacteria, especially noticed in gangrenous emphysema. What constitutional effects may gangrene have ? It may be followed by septic and pysemic infection. GANGRENE 85 What parts of the body are more frequently affected by moist gangrene 9 The flexion surface of the fetlock in gangrenous der- matitis, the lateral cartilage in quittors, the coronary region, the sensitive laminae, the region of the neck, poll and back, the subcutis, fasciae, and muscles, as in fistulous states ; the interdental space in pullers, the udder of goats, cows, and sheep, etc. Outline the treatment of gangrene. Prevent it by removing as far as possible its causes, and promote the circulation of the parts. When a serious inflam- matory process threatens to terminate in gangrene, free incision of the parts may relieve the tension, as, for in- stance, in strangulated hernia, incision of the constricting ring. When gangrene is unavoidable, prevent infection and decomposition by thorough disinfection, and establish drain- age to get rid of the fluids of decomposition retained beneath the gangrenous cover, followed by frequently changed anti- septic dressings. If gangrene localizes itself, hasten separa- tion by warm antiseptic poultices, and after the part has cleaned off, treat same as an ulceration. Should the necrotic process continue to spread, amputate the affected part, pro- vided economic reasons permit such a course, as in gangrene of the udder, tail, tip of the tongue, ears, claws, penis (after paraphimosis). What constitutional treatment is indicated in gangrene 9 In those cases of moist gangrene with tendency to spread and involving the deeper parts, absorption of ptomaines is likely to occur. These are forced into the lymphatic channels and connective tissue spaces along fasciae and tendon sheath (septic synovitis), or a thin walled vein may succumb to the 86 PRINCIPLES OF VETERINARY SURGERY attack of the toxines, and pysemia follows. These parts cannot be drained ; they are beyond reach, and are to-day best combated by intravenous injection of Crede's soluble silver. TUMORS. Define a tumor. Generally speaking, it is a new growth, neoplasm, with tendency to persist, without physiological function, of non- inflammatory origin, the anatomical arrangement of its component elements differing from the tissues from which it springs. Does this definition cover all vieius on tumors 9 It does not, as some of the authors also include new growths of inflammatory and infectious origin and cystic enlargements. Classify tumors from a clinical standpoint. (1) Benignant ; (2) malignant. Outline the characteristics of a benignant tumor. Its tissues usually are of the same nature as those from which it springs. It is mobile, usually encapsulated and cir- cumscribed ; it is painless and grows slowly because its blood supply is small ; it displaces but does not infiltrate the adjacent tissues. There is no enlargement of the regional lymph glands — that is, those between the tumor and the venous circulation. It does not affect distant metastasis, and when thoroughly removed does not recur. Outline the characteristics of a malignant tumor. Its tissues are radically different from its tissues of origin, TUMORS 87 being of an embryonic type ; they are usually painful and develop rapidly, are seldom encapsulated and invade the most resistant surrounding tissues ; therefore they are im- movable. The surrounding skin is likely to adhere, the regional lymph glands become infected and enlarged. Little bits of the tumor from here reach the general circulation, followed by secondary or metastatic deposits in internal organs. When removed, they tend to recur and may lead to constitutional disturbances. Give a histological classification of tumors. Microscopical study of tumors permits of two main classes : 1. Mesoblastic or connective tissue tumors. 2. Epiblastic and hypoblastic or epithelial tumors. What are connective tissue tumors ? Those which are composed mainly of mesoblastic cells, exhibiting fibrous tissue (fibroma), osseous tissue (osteoma), cartilaginous tissue (chondroma), mucous tissue (myxoma), muscular tissue (myoma), etc. What are epithelial tumors ? Those which are composed mainly of epiblastic and hypo- blastic cells — that is, epithelial cells ; for instance, the car- cinoma. Mevieiv the etiology of tumors. 1. They are due to the influence of bacteria or coccidia — a theory gaining in probability. 2. Cohnheim's inclusion theory, viz.: During foetal de- velopment more embryonic cells were produced than necessary for foetal requirements. These embryonic cells which are in 88 PRINCIPLES OF VETERINARY SURGERY excess and lying dormant, are stimulated hj some agent or other, leading to tlie growth of the tnmor. 3. Hereditary influence. 4. Irritation and injury. 5. Predisposition (melano sarcoma of the gray horse). 6. Age, sex, species, food. What observations tend to show that food and age are etiolO' gical factors in the development of tumors 9 The statistics of various veterinary colleges show that in carnivora (dog) carcinoma are more frequently seen than in herbivora (horse, ox); also, that carcinoma have never or but rarely been noticed in dogs below the age of two years. What does the clinical examination of a tumor consist of f By inspection, learn its seat and size, whether circum- scribed or diffused, the nature of its cutaneous covering and that of the adjacent skin. By palpation, study its fixedness or mobility, consistency and state of the regional lymph glands, whether painless or not. Learn the age of the patient, and, if possible, the history of the development as to its rapidity. Finally, to settle doubts as to the nature of the neoplasm, a microscopical examination of a bit of the tumor may, although rarely, be called for. A general examination of the patient for constitutional disturbances should always be made. What reasonable deductions can be made from the data ob- tained by the clinical examination of a tumor ? 1. The seat of a tumor or the nature of the tissues in which it originated suggests the following : Tumors in the testicles or mammary gland are likely to be carcinomata, botryomycoma in the testicular cord, fibromata, papillomata and carcinomata in the skin, in the subcutis lipomata and TUMORS 89 fibromata, osteomata in the bones, neuromata in the nerve tissue, myomata in muscles, etc. 2. Tbe age is of some importance, as young animals are rarely affected with cancer. Sarcomata and papillomata are more common in the young. 3. In regard to the size and development, it is to be remembered that, generally speaking, malignant tumors grow quicker and are of larger size than innocent ones. Soft fibromata and sarcomata develop very rapidly, while in the horse sarcomata and botryomycomata attain a large size. Of some importance, also, is the fact whether the tumor is solitary or whether several tumors are present (multiple). To multiple new growths the papilloma and fibroma is in- clined ; while the sarcoma and carcinoma, when becoming generalized, give rise to multiple metastatic tumors. 4. The surface of tumors permits of some deductions. Thus, the papilloma, fibroma, botryomycoma and carcinoma are nodular or bosselated (lobulated) in the fatty tumor, smooth in the sarcoma. 5. Consistency. Sarcomata are the softest ones. The lipoma, soft fibroma, myxoma and cysts are also soft. Some types of fibromata and carcinomata are hard, while enchon- dromata and osteomata are of bony hardness. 6. Relationship to the adjacent and overlying tissues. Benign tumors, as fibroma, lipoma, papilloma, are usually well defined and movable, no adhesions existing between the. tissues in which it originated and the adjacent skin. Sar- comata often invade the deeper tissues, while carcinomata are prone to ulceration. 7. Regional lymph glands invariably exhibit metastatic swelling in malignant tumors. 8. Animal species. Gray horses often show melano sar- 90 PBINCIPLES OF VETERINAEY SURGERY comata ; otherwise, "botryomycosis is quite frequent in the horse ; dogs, again, are more likely to be affected with car- cinoma, while actinomycosis is common in the ox. Connective Tissue Tumors. FIBROUS TUMOR OR FIBROMA (PLURAL, FIBROMATA). What is a fibroma 9 It is a benignant new-growth composed principally of fibrous tissue. What two forms of fibromata are recognized 9 The hard (fibroma durum) and the soft (fibroma molle). How do these occur 9 Either solitary or multiple. Describe the hard fibroma. It is elastic and hard, movable, and painless on section. It appears glistening, grayish-white ; firm ; blood-vessels scanty and small ; microscopically, it is made up of variously arranged fibrous tissue, a few yellow elastic fibres and very few connective tissue corpuscles. Describe the soft fibroma. It is more or less soft, depending on the amount of fibrous tissue present. It is composed of loose, succulent fibrous tissue. On section, it appears grayish-white, semi- transparent, juicy, glistening. Microscopically, it is com- posed of more or less loose connective tissue, numerous blood-vessels and connective tissue corpuscles. What secondary degenerative changes are fibromata subject to 9 Mucoid change, calcification and ulceration. TUMOBS 91 What type of fibroma is ijainful ? The fibroneuroma, seen to develop at the end of a cut nerve, especially in neurectomy wounds healing otherwise than by first intention. What is a polypus ? A pedunculated fibroma originating in the mucous membrane. What form of fibroma is most commonly seen in animals 9 The hard one. The soft fibroma is only occasionally met with in the skin of the dog. What is a mycofibroma 9 The mycofibroma or botryomycoma is a form of fibroma apparently due to the infection of the tissues by botryomyces, although V. A. Moore's (Cornell) researches, recently made, tend to show that it is not a specific infection, but most likely due to the invasion of the tissues by any one of several microorganisms, especially the micrococcus pyogenes aureus. What is a keloid 9 A proliferation of fibrous tissue originating in a pre- existing scar, most commonly seen in the flexion surface of a joint, as the fetlock, for instance. What is a compound fibroma 9 It is a tumor composed not only of fibrous tissue, but also of tissue peculiar to another tumor variety. Thus, when m.ade up of fibrous tissue and muscular tissue, it is termed a fibromyoma ; when mixed with nerve tissue, fibroneuroma ; when mixed with mucous tissue, fibromyxoma, etc. What are fibromata due to 9 Nothing definite is known. Traumatic and inflammatory 92 PRINCIPLES OF VETEEINARY SURGERY influences are believed in by some, while the main cause seems to lie in a fibromatous predisposition of the tissues or animal, the exact nature of which is unknown. Name the seats of predilectio7i of fibromata. 1. Skin and subcutis. In the horse, they occur mainly about the sheath, head, shoulder and withers ; are usually solitary and sharply defined ; occasionally multiple in size ; they range usually from pea to apple size. Those in the subcutaneous tissue are mostly encapsulated. In the dog, fibrous tumors, occasionally pedunculated, are common about the extremities, eyes, ears, along the back and in the mam- mary gland. 2. Mucous membranes. They are either pedunculated or have a broad basis. Other neoplasms exhibit the same symptoms : sarcoma, actinomycoma, lipoma. (a) Nasal cavity. Of special importance are the fibro- mata growing here, as they lead to stenosis and thus nasal dyspnoea, chronic nasal catarrh (with more or less stinking; discharge in case of ulceration). (b) Pharynx, larynx. Are quite rare in the horse ; in the ox, usually actinomycotic. (c) Vagina and uterus. More commonly met with in the cow, bitch and sow. (cZ) Milk ducts of the teat. Pedunculated fibromata are quite common in the cow. (e) In the udder. They are often seen in the bitch, are hard, nodular, circumscribed, of egg to fist size, and fre- quently are of a compound type, as adenofibroma, myxo- fibroma. (/) Testicles. Same as in the udder in both dogs and horses. TUMORS 93 Outline the treatment of fibromata. Early extirpation with the knife, scissors, etc., wherever" possible, gives the best results. More difficulty is met with ia the removal of the pedunculated fibromata, especially thoso pretty well up the nasal cavitj'-, pharynx, teat, taxing the ingenuity of the surgeon. For their removal, the ecraseur, ligature, forceps, or even the hand itself are indicated. Fibromata with a very wide base are also destroyed by the actual cautery or by applying caustics at intervals. CONNECTIVE TISSUE NEW-GROWTHS DUE TO CHRONIC HYPERPLASTIC INFLAMMATIONS. What is a keloid ? It is a connective tissue proliferation originating in pre- existing scar tissue. Name the causes of keloid. Some authors believe in a specific infection, others in a fibromatous predisposition, while continuous irritation of the parts seems to me the main factor. Where are keloids found ? Commonly seen in the horse in the flexion surface of a joint, or about such regions exposed to continuous motion as the heels, coronet, hock, fetlock. Describe a keloid. They are often seen to follow barb wire cuts. Such a keloid is hairless, usually circumscribed, smooth, round, oval, elongated, firm and elastic. What practical importance is attached to them 9 As a rule, they are of no consequence, representing simply an eyesore, but may, by reason of their position and 94 PBINCIPLES OF VETERINARY SURGERY extent, interfere with the function of a part, giving rise to lameness and psendo stringhalt. How do you treat keloids. They are best left alone, excision executed lege artis often "being followed by a larger keloid than the one which was extirpated. What is elephantiasis 9 A connective tissue hyperplasia of the subcutis and skin. In what animal is it most commonly seen 9 Hind legs of the horse. What are the causes of elephantiasis ? Chronic stasis of the venous circulation, and more fre- quently a chronic indurating inflammation of the skin and subcutis, such as follows lymphangitis, purulent cellulitis and the more serious forms of dermatitis about the lower extremities. How do you treat elephantiasis ? No successful therapeutic agent is known. What is a tyloma 9 It is a diffused callosity of the skin originating in the subcutis, representing a connective tissue hyperplasia. What are the causes of tylosis ? Continuous irritation, as from the collar, traces, har- ness, etc. Name the seats of predilection. In the horse, those parts irritated by the harness, as the neck, breast., etc. ; in the ox, the knee ; in the dog, the point of the elbow and ischial tuberosity. TUMOKS 95 Hoiv do you treat a tyloma ? By excision. FATTY TUMOR, OR LIPOMA. What is a lipoma ? It is a benign, tumor composed of cells filled with fat imbedded in a connective tissue stroma. What forms of lipoma occur f The hard and the soft one. What is the difference between these ? The hard lipoma is composed of an excess of fibrous tissue, while in the soft variety adipose tissue j)reponderates. How do lipomata occur 9 Solitary, occasionally mutiple, with a wide basis and pedunculated, as pure lipoma or mixed with other tissues (lipomyxoma, lipofibroma). Are lipomata common in animals ? They are not, but occur as often in a fat as in a lean animal. They seem to be met with most frequently in the dog, next in the horse, finally ox. As a rule, they are of limited clinical importance. Describe a lipoma. Depending on the amount of fatty tissue present, the consistency varies . As a rule, they are soft ; when tapped with the finger a peculiar tremor or pseudo fluctuation is felt. They are of variable size, circumscribed, round or oval ; as a rule painless, grow slowly and are mobile. What secondary degenerative changes are seen in lipomata 9 Calcification and ulceration (due to traumatism). 96 PKINCIPLES OF VETERINARY SURGERY What is the etiology of liiDomata f The same causes as enumerated under ''fibromata" are supposed to be active, although it seems that traumatic and infectious causes can hardly be concerned in their production. Name the seats of predilection of lipoTnata ? 1. Subcutis. In the horse, about the thorax and ab- domen, crural region, anus, tail and sheath. In the dog, about the inside of the thigh, shoulder and pectoral region. 2. Mucous membrane. In the horse they occupy the upper portion of the nasal cavity, originating in the mucous membrane of the septum or turbinated bones. They have also been observed in the larynx and on the epiglottis. Colic due to co-rectal obstruction from a submucous lipoma is on record. In the dog, li^Domata are occasionally met with on the membrana nictitans. So far, I have seen them only in Boston terriers. 3. Peritoneum. Fatal colics have been observed when long pedunculated lipomata of subperitoneal origin wind around the intestines in both cattle and horses. 4. Mammary gland. Occasionally seen in the fat bitch. Hoiv do you treat lipomata ? The circumscribed variety is best removed by incision with the knife. The pedunculated form may be ligated. The application of caustics and the actual cautery are not advised, as they produce nasty, badly-healing wounds. MUCOUS TUMOR — MYXOMA. What is a myxoma ? A benign tumor composed of mucous tissue. Describe mucous tissue. This tissue type is met with in the vitreous humor of the TUMOES 97 eye, and is also represented by the so-called Wliartonian jelly of the umbilical cord. Microscopically, it is composed of stellate connective tissue cells, the branching processes of which form a network in which the gelatinous basis sub- stance is lodged. Do all authors look upon the myxoma as an independe7it type of tumor 9 They do not. Some claim that the myxoma is simply an oedematous fibroma or lipoma ; in other words, a myxofi- broma or myxolipoma. Others state that they are simply connective tissue tumors which have undergone mucoid change. How does the myxoma occur ? Usually solitary and pedunculated. Describe the myxoma. It is quite rare ; as a rule, small, soft, elastic, vibratory and pedunculated ; grows slowly. On section, it is yellowish- grey, and a glairy mucin containing fluid exudes. How do you differentiate these from soft, fibrous, or fatty tumors, etc. By testing contents with hypodermic needle. To what secondary changes are these tumors liable f Inflammation, ulceration, fatty degeneration. What are the causes of myxomata 9 Not known. Name the seat of predilection of the myxoma. About the same as fibromata, as subcutis, submucosa, etc. ; therefore, in the horse it is most commonly met with in the upper portion of the nasal cavity, here called nasal polypus, 98 PRINCIPLES OF VETERINARY SURGERY having been found here also in the ox. Occasionally they are seen in the bovine bladder and uterus. Outline the treatment of myxomata. Early extirpation with the knife, scissors, ecraseur ; when necessary, trephining the nasal cavity to reach it. Cartilaginous Tumor — Chondroma. What is a chondroma ? Chondroma, or enchondroma, is a tumor composed prin- cipally of hyaline or fibrocartilage. How do they occur ? Usually as a mixed tumor ; quite often solitary, while in the dog multiple. Describe a chondroma. They grow slowly, are firm, elastic, painless, and of vari- able size ; are smooth or nodular. To what secondary changes are they liable 9 Ossification, calcification, cystic degeneration. Name the seats of predilection. While a comparatively rare tumor, it is most frequently seen in the mammary gland of the bitch ; further, in the tes- ticle and on the vocal cord of the horse, costal cartilages of the horse and ox, on the jaws of dogs and horses, and in the subcutis of cattle. Outline the treatment of chondromata. Extirpation by knife. On the whole, they can be safely left alone, as they are distinctly benign unless impairing function by reason of their size or position. (This also refers to the mammary enchondroma of the bitch.) TUMORS 99 Osseous Tumor — Osteoma. What is a7i osteoma ? An innocent new-growth composed either of compact or cancellous bone. How do they occur 9 Solitary or multiple, with wide basis or pedunculated, either as pure or mixed tumors. Describe an osteoma. It grows slowly, is hard or densely hard, painless, more or less circumscribed, connected with a bone or cartilage. According to their consistency, they are known as ivory oste- oma (osteoma eburneum); when capped with cartilage, as exostosis cartilaginea ; when overlaid by a bursa, exostosis bursata. What do you understand by an exostosis ? A bony new-growth, the result of an inflammation. Name the seats of predilection. In the horse, about the lower third of the lower maxilla and internal face of the metacarpus, in the cavities of the head of the horse and ox, and in the mammary gland of the bitch. What is a dental osteoma or odontoma ? It is a bony new-growth originating in the developing tooth or alveolar periosteum. Muscular Tumor — Myoma. What is a myoma ? An innocent tumor composed of muscle fibres. I. OF C. 100 PEINCIPLES OF VETERINARY SURGERY Wliat tivo varieties of myomafa are recognized 9 1. Composed of striated muscle elements — rhabdomyoma, •which is very rare. 2. Composed of non-striated m.uscle cells — leiomyoma. Name the seats of predilection. As a rule, the internal organs, bladder, stomach, uterus, intestines, testicles, ovaries, kidneys. Are they of practical interest ? Hardly, as they are exceedingly difificult to diagnose, and beyond reach as to treatment. What is the treatment of myomata ? The internal use of ergot may be tried. Nerve Tumors — Neuromata. What is a neuroma ? A new-growth composed of nerve fibres. What two forms of neuromata are recognized ? (1) True neuroma ; (2) false neuroma. What is a true neuroma ? It is a neoplasm made up of either myelinic or amyelinic nerve fibres, rarely if ever seen in animals. What are myelinic and luhat are amyelinic nerve fibres f The former have myeline within their sheath ; the latter have not. What is a false neuroma f It is a mixed tumor, being either a neurofibroma or myxo- fibroma developing from the nerve sheath. TUMORS 101 Describe a false neuroma. It is a pea to thumb size, somewliat movable, bard, pain- ful new-growth of comparatively slow development, usually met with at the proximal end of a divided nerve. What are the causes of false neuromata ? They follow almost invariably neurectomies, and are due to stretching the nerve before cutting it, or severing the nerve below the upper wound commissure, thus allowing its proximal end to project out of the upper wound commissure. This exposes the connective tissue of the nerve sheath to irri- tating influences, invariably seen in wounds healing by second intention — that is, those with pus formation, as a result of which connective tissue proliferation, expressed by a bulbous thickening of the proximal nerve end, takes place. Name the seats of predilection. After neurectomies they are found at the proximal end of the median, plantar and tibial nerves. Outline the treatment of neurofibromata. Dissect it loose from the surrounding tissue and am- putate. Are they likely to recur 9 The amputated tumor never recurs, but since a new neu- rectomy has to be performed to amputate the new-growth, a new fibroneuroma may start from the recent proximal nerve stump. Are neurofibromata of practical interest ? Decidedly so, as they cause lameness. They are very often met with, and will continue to be met with frequently, as long as the surgeon does not operate lege artis — that is, he must not stretch the nerve, dig around and mutilate the tis- 102 PRINCIPLES OF VETEEINAKY SURGERY sues, and operate aseptically, which is practicable by reason of the ease with which it can and should be executed in all neurectomies but deep peroneal. Vascular Tumor — Angeioma. What are angeiomata 9 Tumors composed of blood vessels. What forms of angeiomata are recognized ? (1) The simple angeioma (angeioma simplex); it is com- posed of anastomosing vessels, enlarged and tortuous capil- laries ; (2) the cavernous angeioma (angeioma cavernosum), which consists of thin-walled spaces or even vessels contain- ing blood ; their construction resembles the corpus caver- nosum of the penis, the blood flows into the space from arter- ies and is received by veins ; the lymphangeioma, composed of dilated lymph vessels. Describe the angeioma. They resemble a cyst, are of bluish or purple color, have a more or less wide base, are compressible and may pulsate. Which forms are seen in animals 9 In the erectile tissues of the nasal mucous membrane of the horse the simple, and especially the cavernous, angeioma, giving rise to dyspnoea, is met with. They have also been observed in the conjunctiva, lips and gums. In the mammary gland of a cat a lymphangeioma has been reported. On the whole, they are not often observed. To what secondary changes are angeiomata liable ? Ulceration leading to more or less hemorrhage, purulent nasal discharge, creating suspicion of glanders. TUMORS 103 Holu do you treat an angeioma f Their hidden position renders diagnosis and treatment difficult. When they can be reached, they may be punctured, fired, or liquid iron preparations injected into them, taking the precaution to compress the vessels which carry the blood out of the tumor long enough to insure coagulation, as other- wise an embolus might be swept away and lead to compli- cations. Lymphatic Gland Tumor — Lymphom.a. What is a lymphoma ? A tumor of lymphatic gland structure. Where do they develop ? They originate in pre-existing adenoid tissue. What forms oflymphomata are recognized ? 1. The metastatic swelling — that is, an inflammatory hyperplasia of the lymph glands as a result of chronic dis- ease of neighboring parts, such as tuberculosis, glanders, actinomycosis, equine distemper, catarrhal states. 2. Malignant lymphoma. Describe the malignant lymphoma. The lymph gland or glands undergo hyperplasia of their normal elements. It is peculiar to the disease known as pseudo-leukemia, or Hodgkin's disease. It is observed in horses, cattle and dogs. The tumors are multiple, painless; the enlargements variable, occasionally of great size ; groups of lymph glands or those of the whole body may be hyper- plastic ; they may be hard, firm or sof tish, have the shape of the gland, only materially enlarged. The lymph glands more frequently observable are the intermaxillary, cervical, inguinal, those below the knee, etc. 104 PRINCIPLES OF VETERINARY SURGERY Outline the treatment of lympliomata. Solitary lympliomata — that is, the swelling of regionary lymph glands — when due to specific infections, are not treated (glanders, tuberculosis, etc.); those due to simple chronic nasal catarrh take care of themselves as soon as the catarrhal state is relieved ; those of equine distemper undergo abscess formation and are treated as such. The treatment of multiple lymphomata of Hodgkin's dis- ease are not treated surgically, but iodide of potassium or arsenic, with proper dietetic regime, may be tried. Sarcoma. What is a sarcoma 9 A malignant tumor composed of immature connective tissue — that is, embryonic tissue. Describe the histological structure of this tumor. The number of cells are vastly in excess of the basis sub- stance. The cells are either round, spindle, giant cells or endothelial cells ; they have from one to more nuclei ; there is no distinct cell wall, and the stroma consists of an irregu- larly arranged intercellular cement ; in other words, there are no alveoli formed, as in carcinomata. The blood vessels, which are very thin walled or sometimes only represented by spaces, ramify among the cells, not running in the stroma as in carcinomata, because of the absence of any regular stroma. Hoiv do sarcomata groiu 9 Spasmodically ; now fast, now slow. To 'what degenerative changes are they subject ? Cystic formation, ulceration, hemorrhage, necrosis. TUMOKS 105 Do they alivays occur as pure sarcomata ? They do not, but also appear as mixed tumors, as fibre sarcoma, osteo sarcoma, etc. What varieties of sarcomata are recognized ? 1. The round-celled sarcoma. This is usually soft, vas- cular, fast growing, attains often large size, and gives rise to metastatic deposits in other organs. Its round cells vary in size and are imbedded in a homogeneous intercellular basis substance. On section they exhibit the vascularity and con- sistency of brain matter. Name the subvarieties of round-celled sarcomata. (a) The lympho sarcoma. Grows in lymphatic glands. (b) The alveolar sarcoma. So called as each cell is enclosed in a separate space or alveolus by the basis substance. (c) Melanotic sarcoma. Here the cells and the inter- cellular basis substance is pigmented, due, according to the latest researches, to specific embryonic cells capable of producing pigment. 2. Spindle-celled sarcoma. It is composed of oat-shaped cells or of very elongated bodies. A subvariety is the mela- notic sarcoma. 3. Giant-celled sarcoma. It is made up of round and spindle cells and large bone, marrow-like cells with many nuclei. Their consistency is from that of jelly to that of muscle. 4. Mixed-celled sarcoma. Composed of an admixture of round, spindle, star-shaped cells. 5. Endothelioma or angiosarcoma springs from the endo- thelial cells of lymph and blood vessels, which become en- larged and cylindrical. They are very malignant and subject to hemorrhage. 106 PMNCIPLES OF VETERINARY SURGERY 6. Melanotic sarcoma. Mainly seen in gray horses, but also in sorrels, blacks and bays. It is either a round or spindle celled sarcoma, developing quite rapidly, and subject to metastasis. As previously stated, it is pigmented, this pigmentation depending upon the so-called melanocytes. Which seats of predilection are of practical importance 9 1. Bones. In horses and cattle, in the nasal cavity and sinuses, leading to nasal dyspnoea and chronic catarrh. In the dog, they are usually seen on the upper jaw, the tumor having received the name of Epulis ; it is located on the gums, loosening and displacing the teeth, appearing as a firm or hard, painless, irregular-surfaced proliferation. Soli- tary and multiple osteosarcomata are seen also in the horse, cattle, swine and dog, in the scapula and humerus, femur and tibia, temporal bones, cervical and dorsal vertebrae, and according to the part involved may give rise to lameness or even paralysis. 2. Lymph glands. In the horse, they are met witli as soft, cystic or fluctuating neoplasm in the intermaxillary space at the point of the shoulder, on either side of the sheath or in the glands of the pubic region. In the dog, the pubic and neck region at times exhibit them. 3. Skin. In the skin and subcutis of the horse they are seen in the scapula and cervical region, often forming here large tumors, which may undergo gangrenous changes, and by their pressure upon the trachea may interfere with respira- tion. Other places involved are the sheath, lips, anus. In dogs, they are seen about the extremities ; while in bovines, about the vulva and vagina. 4. Eye. They occasionally develop in the orbital cavity of the horse, cat and dog, producing strabismus, etc. In such cases they may destroy the bones and enter the frontal TUMORS 107 maxillary sinuses, and even cranial cavity. In tlie eye proper they are found upon the choroid and retina. 5. Testicles. The gland continuously enlarges until even- tually it softens. The same may be said of sarcomata devel- oping in the thyroid, mammary and parotid glands, although in these the growth may also be circumscribed. 6. Sub-pleural or peritoneal sarcomata are quite common in the dog, horse and ox, but being beyond reach are of no surgical interest. 7. Melanotic sarcoma. Most commonly met with in the gray horse, but also occur in sheep, ass, dog and ox. They are either solitary, multiple or generalized. They may de- develop almost anywhere, even in bones and muscles, but usually are seen about the anus, vagina and vulva, penis, sheath or tail, about the cheeks, eyes, lips. The metastatic deposits are more frequently seen in the lungs, lymph glands, heart, liver, etc. What are the prognostic features of melanotic sarcomata ? Even when generalized they do not lead to constitutional disturbances except by reason of their position, as, for instance, one interfering with defecation would sooner or later lead to a fatal colic, etc. Describe the treatment of sarcomata. Early extirpation with the knife is essential. After m.etastatic changes have once established themselves no treatment is of any use. Isolated and hard fibro-melano sarcomata may be successfully removed, as this form of melano sarcoma is of a rather benign type. The treatment of sarcomata with caustic, as arsenic, etc., is nonsensical. All cancers supposed to have been cured with such and similar paste, usually received by some empiric under the promise of secrecy, were of a benign tumor type. 108 PRINCIPLES OF VETERINARY SURGERY Epithelial Neoformations — Epiblastic and Hypoblastic Tumors. CARCINOMA. What is a carcinoma 9 A malignant tumor growing from epithelial surfaces^ having its epithelial cells clustered in nests (alveoli) bounded by fibrous tissue. Are carcinomafa found in non-epithelial tissue 9 They are ; but in these cases they are secondary (meta- static). What do you understand by cancerous cachexia 9 This, also termed carcinomatosis, represents a nutritive disturbance, a generalized chronic sepsis, a sort of auto- intoxication, most likely due to the absorption and diffusion of secondary products originating from the carcinoma. What forms of carcinomata are recognized 9 1. The squamous-celled epithelioma. 2. The cylindrical or columnar celled epithelioma. 3. The acinous or spheroidal celled carcinoma. Subdivided into : (a) Hard or scirrhous cancer. (b) Soft or encephaloid cancer. Describe the squamous-celled epithelioma. It springs from the skin or mucous membranes ; in other words, from free epithelium-clad surfaces, especially at the junction of cutaneous and mucous surfaces. It is composed of flattened cells, surrounded by a fibrous stroma ; such a nest of cells is called epidermic pearls or cell nests. It begins usually as a wart -like growth or fissure, ulcerating early. On section^ TUMORS 109 tliey are not very juicy, white, rather dense and homogenous ; the consistency is greater than the surrounding tissue ; the regional lymph glands are invariably involved, especially seen in the epitheliomata originating from the skin or mucous membranes of the head (submaxillary lymph glands). Name the seats of predilection. Any mucous or cutaneous surface, as the skin, mucous membranes of the vagina, bladder, mouth, pharynx, penis, etc. Describe the cylindrical-celled epithelioma. This springs from the cylindrical surface epithelium of mucous membranes, and shows no ' ' cell nests. *' The walls of the diseased organs exhibit infiltrating indurated masses, which ulcerate early. It is composed of masses of ej^ithelial cells, and a fibrous tissue stroma in which columnar cell lined tubular glands rest. Name the seats of predilection. The mucous membranes of the intestines, uterus and stomach. Describe the acinous-celled carcinoma. Depending on the amount of fibrous tissue present, it may "be soft or hard. In the former, the so-called encephaloid cancer, the cellular element predominates; while in the latter, or scirrhous, the fibrous framework predominates. This also explains the rapidity of their growth, the soft one developing much more rapidly and ulcerating earlier than the scirrhous type. The acinous carcinoma originates only in the glandular epithelium. The hard cancer, as its name indicates, is a hard, tuberous growth at first movable with the gland ; later, by infiltration, the surrounding tissue becomes immovable, as it 110 PKINCIPLES OF VETERINAEY SURGERY adheres to the skin and adjacent tissues. In due time it usually implicates the regional lymph glands, and the finale is ulceration of the superjacent parts. Such a carcinomatous ulcer appears, with hard, everted edges, irregular outline and depth, rarely showing granulations, and is usually covered with sloughs. On section the knife creaks as it passes through, the cut surface having a cupped appearance. It is firm and white, very succulent, yielding the so-called cancer juice, a milky fluid mainly composed of epithelial cells. The soft variety on section appears somewhat like brain substance, both in consistency and looks, for which reason it is also called encephaloid. It is soft, and grows much more rapidly than the scirrhous form. They may form bosselated masses or globular bodies, or are composed of a number of rounded masses. They ulcerate readily, at times exhibiting a nasty, fungating, easily bleeding, mushroom-like mass termed " fungus hsema todes.^' What secondary clumges are carcinomata liable to 9 Ulceration, cystic degeneration, fatty and myxomatous changes. Name the seats of predilection. Testicles, mammary glands, parotis, thyroid, prostate gland, kidneys, liver, sudorific and sebaceous glands, etc. Hoiu is the behavior of carcinomata explained ? The blood vessels are normal and ramify in the stroma (in the sarcoma they are thin-walled and ramify among the cells). The individual cells of the carcinoma are always of the type of the parent cell ; for instance, those originating from the skin are squamous, those from glands are spheroidal, etc. Those carcinomata having little fibrous tissue grow fastest, as their blood supply is rich and evenly distributed. TDMOES 111 not enough fibrous tissue being present to obliterate the vascular supply by active contraction of this fibrous stroma. In the slowly developing tumors the blood supply is scanty from the beginning, on being confined mainly to the periphery of the growth, having been destroyed in the central portion by the rapidly forming and contracting fibrous tissue. These central portions, therefore, undergo fatty degeneration and break down, that is, ulcerate, provided they are located near a free surface, as the skin. Since the stroma in some forms of carcinomata is very limited, the blood vessels of such a tumor have but little support ; thus hemorrhage into the substance of the tumor or bleeding from the ulcerated surface is explained. The metastatic disposition of the cancerous tumors is explained by the fact that the cells proliferate in the connective tissue, lymphatic spaces reaching from here the nearest lymph gland (regional lymph gland). From here another lymph gland is attacked, until eventually the viscera are reached. Whenever this occurs the general health suffers, and the state carcinosis or cancerous cachexia sets in, leading to death from impaired nutrition, by the purulent and hemorrhagic discharges, involvement of important viscera, most likely also helped by the absorption and diffusion of septic products arising from the ulcerating carcinoma. Give the etiology of carcinomata. No positive data exist, and a great many theories applied to human carcinosis are of no value whatsoever in our animals. 1. Age. Since a great many animals for economic reasons are not permitted to reach an advanced age, little can be said as to influence of age in carcinomata. In the ox, therefore, very few cases, indeed, are on record. In the dog, it appears that they are unknown in those younger than two 112 PRINCIPLES OF VETERINARY SURGERY years old, the vast majority having been met with in the dog five years and okler. In the horse they are also more frequently seen in the older animal. 2. Food and hereditary tendency are claimed by some to be of etiological moment, it occurring especially in carnivora and rarely in herbivora. These two j)oints seem of very doubtful value. 3. Irritations. I do not believe that irritations either . traumatic or chemic are the direct causes ; they simply pre- dispose. Experiments made upon animals by exposing them to continuous irritation have failed to produce carcinomata. Furthermore, carcinomata are found in parts which are not exposed to irritations, as the thyroid gland, mucous mem- branes of the head, etc. Cancer of the lip and tongue, places certainly exposed to decided irritation, for instance, in the horse, according to this theory ought to be frequent, but, on the contrary, they are very rare indeed. 4. Parasitic infection. All the various bacteria and coccidia so far named as etiological factors, on further experimentation have proved to be saprophytes, and in the case of protozooa and coccidia proved to be no coccidia at all, but degenerative changes of the epithelial cell, their nuclei or nucleoli. In defense of this parasitic theory it is stated that cancer has been produced by artificial inoculation. But since most of tjie inoculation experiments turned out negative, this theory also needs further support. 5. Cohnheim's inclusion theory also fails to explain the development of most carcinomata, and is only applicable in those cases so rarely met with, primary carcinoma of bone or lymph glands. In luhich animals are carcinomata Tnainly seen 9 Horse, dog and cat. TUMORS 113 What anatomical structures most commonly exhibit carcinoma? In the horse : Mammary gland, kidneys, testicles, facial bones, ovaries, stomach, penis, retropharyngeal glands, spermatic cord, epiglottis. In the dog : Skin, mammary gland, anus, prostate, testicles, vagina, penis, thyroid. In this animal cancerous cachexia is not an infrequent occurrence. Hoiv rapidly do carcinomata develop ? The proliferation may persist for months or years ; the primary hard tumor develops slowly. How does the frequency of sarcomata compare with that of carcinomata 9 Carcinomata are not as often seen as sarcomata. Generally speaking, lohich parts exhibit carcinomata oftenest ? Sexual organs, mammary gland and thyroid. Describe the carcinoma of the skin. Most frequently seen in the dog on the ears, eyelids, prepuce, scrotum ; on the tail and back, anus and lower extremities. In the horse : the tail, prepuce, penis. The skin cancer may be circumscribed or diffused, infiltrates the surrounding tissues and leads to ulceration of the skin. It is usually hard, of irregular surface, has secondary nodules in the surrounding parts and secondary swelling of the regional lymph glands. Those about the penis are usually of large size and of ragged appearance. Describe the carcinomata of the mucous membrane. In the horse those in the superior maxillary sinus are firm, lobulated, vascular new-growths, containing a milky fluid, with a tendency to break into the frontal sinus or into the 114 PRINCIPLES OF VETERINAEY SURGERY buccal cavity, accompanied witli early swelling of the regional submaxillary glands. The same refers to those of the pharynx of the dog. They are also seen on the membrana nictitans of the horse and may fill the whole of the orbital cavity, eventually destroying the adjoining bones entering the sinuses. In the horse, dog and ox they are further seen upon the mucous membranes of the vagina, uterus and bladder. The only case of lingual carcinoma was observed in England on a twelve year old cat. Describe the acinous carcinoma. The mammary gland of the dog seems most frequently involved. They vary in consistency and size, and are mostly painless ; the surrounding parts exhibit cancerous nodules ; the skin may or may not be ulcerated ; the regional lymph glands are usually infiltrated. They may become very hard by calcification or ossification, but may also show fluctuation on account of cyst formations. Those of the testicles lead to a decided enlargement of the glands, thickening of the sper- matic cord, and swelling of the inguinal glands. Those of the thyroid gland are of interest. In the horse and dog they develop like a stroma, causing rapid emaciation and marasmus. They may attain a large size in the dog, exceeding in the horse the size of a man's head. The prostatic carcinoma in the dog, getting the size of a man's fist, is diagnosed by rectal palpation, it leading to con- stipation by obstructing the canal. Those in the dog about the anus are of mushroom or warty-like appearance, and quite common. The carcinomata involving internal organs are of little surgical interest, at least from a practical standpoint. Usually multiple and subject to metastasis, involving the pleura, peritoneum, mediastinal glands, etc. TUMORS 115 How do you treat carcinomata 9 Early extirpation with tlie knife. The best results give those about the anus, membrana nictitans, skin, penis, mam- mary gland and testicles. The operative treatment of those of the sinnses of the head is very unsatisfactory ; this refers also to the removal of the thyroid gland. In pet dogs with inoperable carcinomata, it would not be out of place to inform the owner of the possibility of an infection. The operating surgeon should take care of him- self, as it is a fact that a number of veterinarians belonging to our times have succumbed to carcinomatosis. Papilloma — Warty or Villous Tumors. What is papillortia ? An innocent mixed tumor, representing a proliferation of the papillary body and hyperplasia of the epithelium of the skin and mucous membranes. Do all authors agree luith this definition ? Almost all modern investigators do, although some still state that the papilloma should be counted among the fibro- mata, representing a connective tissue proliferation of the impillary body. What forms of papiUomata are recognized ? 1. TLe wart (verruca). 2. Condyloma. Describe the papilloma. Their structure shows one or more central blood vessels surrounded by a varying amount of connective tissue, the whole being covered by epithelial cells like those of the skin or mucous membranes. The warts may be solitary or multiple. 116 PRINCIPLES OF VETERINARY SURGERY usually circumscribed, more rarely represented by cauli- flower-like masses. They are hard, covered by horny epi- thelium, the vascular supply as a rule being small. Of the other type, the condyloma, but little is known in animals. It is a soft papilloma, quite vascular, moist, and not covered with horny epithelium, showing a granular, cauliflower-like surface. Give the etiology of the jpapilloTnata ? Continuous irritation seems to be actively concerned. Thus papilloma about the vulva seems to follow chronic dis- charges, the verrucous form of dermatitis following the infectious and subsequent chronic inflammation of the skin in the flexion surface of the fetlock. Horses and cattle grazing on stubble pasture get papil- lomata about the lips. Another factor is heredity ; puppies, colts and calves are born with them. In some instances it almost appears as though some infectious agent was concerned in the etiology of papillomata. I have seen every calf belong- ing to the South Carolina Experiment station within one month become covered with warts of variable size, the animals distinctly running down while affected with papillomatosis. Inoculation experiments proved negative ; also histological a,nd bacteriological studies failed to throw any light upon the subject. What animals show papillomata most frequently ? The horse, cattle and dog. Name the seats of predilection. In the colt, about the lips, nostrils, eyes, ears and prepuce ; in older horses I have seen them most frequently about the nose, on the belly and legs. In the dog, about the lips, eyelids, ears, cheeks, anus, prepuce, legs, and upon the TUMORS 117" mucous membrane of the mouth. It seems that water spaniels, are predisposed to them, as the vast majority of papillomata, upon the mucous membranes of the mouth was met with in this animal, hundreds of papillomata densely packed upon the mucous membrane lining the cheek having been seen in patients of mine. Those upon the mucous membrane were soft, yet not vascular, while those ordinarily encountered are of variable size and basis, covered with horny epithelium, the surface resembling a straw or mulberry. In cattle, the head, neck, along the spine, shoulders, teats and udder. They vary greatly in size ; those about the udder and teats, as a rule, thin and slender, or short, stubby and smooth ; in other places they are rough, bosselated and covered with a heavy coat of horny epithelium, with broad or small basis. Papillomata of the mucous membranes of the pharynx, oesophagus and bladder have also been observed. Give the treatment of papillomata. They can either be cut or twisted off. Caustics, while not as surgical and safe, are also employed. I managed to have very prompt results in the treatment of the South Carolina outbreak with large doses of potassium iodide and arsenic. Adenomata — Glandular Tumors. What are adenomata 9 They are innocent growths, composed of tissue closely resembling glandular tissue, originating from pre-existing;, glandular tissue. What forms of adenomata are recognized 9 1. The acinous type. 2. The tubular adenoma. 118 TRINCIPLES OF VETERINARY SURGERY Are adenomata absolutely innocent 9 They are not ; there seems to be a slight tendency to a conversion into carcinomata. Describe the adenoma. They originate from a secreting gland ; are of variable size ; are encapsulated ; single, but may be multiple ; are of slow growth and do not disseminate. Usually they are firm, to the touch unless cysts have developed in them ; appear usually as mixed tumors, being rare as pure adenomata. The acinous form is made up of acini, which communicate with each other by duct-like channels, the acini being lined with spheroidal epithelium. The tubular adenoma is composed of tubules lined with cylindrical epithelium. How common are they in animals 9 On the whole they are not often seen, excepting the adenoma of the thyroid gland of young dogs (stroma hyper- plastica simplex) ; more rarely in the horse. Oive the treatment of adenomata. In animals the hyperplastic stroma, especially in the dog, is about the only form of adenoma coming into consideration. In the horse removal of the thyroid is well borne, while in the dog removal of both lobules leads promptly to death in four to five days after the operation. The removal of one lobe (the largest one) is also well borne by the dog. In the dog, there- fore, internal medication with iodide of potassium with external iodine application, or injections of diluted tincture of iodine, is employed with fair results. Cysts. What is a cyst 9 It is a bag-like neoformation, containing either fluid or TUMORS 119 semi-fluid, hemmed in by a fibrous lining, covered either with endo or epithelium. What forms of cysts are recognized ? 1. Degeneration cysts. 2. Exudation cysts. 3. Extravasation cysts. 4. Retention cysts. 5. Cysts of congenital origin. 6. Genuine cysts. Describe degeneration cysts. These are cysts arising in pre-existing tumors, due to fatty, mucoid, etc., degenerations taking place in the tumor. These cysts contain mucoid or fatty, etc., fluids, and are usually observed in sarcomata and carcinomata, and then called cysto-sarcoma, cysto-fibroma, etc. Desfiribe the exudation and extravasation cysts. When a soft part is exposed to a contusion of sufiicient severity, a hematoma or lymph extravasation occurs. Asa result of the aseptic inflammation which follows, this fluid becomes encapsulated, and a hollow neoformation containing serum is the result, being in this instance an extravasation of blood cysts. The exudation cyst is the result of excessive secretion into a closed cavity, as a bursa, tendon, sheath, etc. , usually the result of a previous inflammation. Give examples of both. The extravasation cyst is seen about the neck and back of dogs after bites or on the haunch of the horse after blows. The exudation cyst is seen in the capped hock and capped elbow of the horse. 120 PRINCIPLES OF VETERINARY SURGERY Describe the retention cyst ? These are the result of the retention of the secretion of a gland. What forms of retention cysts are recognized f 1 . The sebaceous or atheromatous cyst, due to the dilata- tion of a sebaceous gland. Seen in the skin of the horse above the false nostril and internal canthus of the eye ; in the dog, in the skin of the back. 2. Mucous cysts are due to the dilatation of a mucous gland. They may occur wherever a mucous gland exists. In the horse, ox, nd dog the retention cyst of the sublingual gland below or on the side of the tongue is termed ranula ; retention cysts are further observed in the vagina of cows (Bartholinine's gland); also on the lips in the trachea nasal cavity. Retention cysts of large glands, due to the closure of a number of ducts or of the main duct, especially seen in the mammary gland of the cow, is termed a lacteal cyst. Describe the congenital, or dermoid, cyst. These are due to the inclusion of a bit of the epiblastic layer in the mesoblast ; the wall of such a cyst may show all the histological features of the skin. Dermoid cysts are met with at the base of the ear of horses and cattle. A little fistulous opening with a glairy discharge is seen ; the opening leads to a cystic cavity containing a tooth. Describe the genuine cyst. These, also termed cystomata, are epithelial neof ormations in glands with cyst formation. They have been observed in the parotid, mammary gland, thyroid gland and ovaries. TUMORS 121 Grive the treatment of cysts. The essential feature is the removal of the lining sac. If any part remains it will simply proliferate, and the trouble returns. This holds good especially with the sebaceou-s and mucous cysts. The operation for dermoid cysts consists in the removal of the tooth, if necessary with hammer and chisel, and a thorough curetting of the cyst walls. Infectious Neoformations. ACTINOMYCOMATA. What is an actinomycoma 9 It is an infectious new-growth, caused by the ray fungus or actinomyces. What organs are subject to actinomycotic infections 9 Any part of the body may become infected. In America the seats of predilection are the upper and lower jaws, the parotid gland and the region of the throat ; in England, the tongue ; in Denmark, the soft parts of the head ; and in Germany, the pharynx and bones of the jaw. Describe the diagnostic features of the actinomyces fungus. Imbedded in the soft part of the tumor or in the abscess, they appear as pale-yellow to sulphur-yellow minute grains macroscopically. With a magnification of 250 diameters, the grains are seen to consist of roundish masses of club-shaped bodies radiating from the centre. Describe the actinomycoma. Upon the part attacked depends the amount of connective tissue it possesses. The consistency of the tumor may be firm or soft. The growth of the tumor is slow. When arising in the soft parts of the head, a rather firm swelling 122 PRINCIPLES OF VETEEINARY SURGERY is seen, from wliicli one or more nut to egg sized tumors pro- ject. These tumors eventually break through the overlying skin and appear reddish, fungoid-like masses. Then, again, the original swelling becomes an abscess, bursts, discharging a creamy pus, the abscess cavity later filling with a fungus- like growth, eventually projecting beyond the opening through which the pus was emptied. The tumors seen in the pharynx are either pedunculated or have a broad basis, inter- fering with respiration and deglutition. When invading the bone, the latter enlarges decidedly. The actinomycotic growth may grow outward, break through muscle and skin, and appear as a mushroom-like mass, or the growth may take an inward course and appear in the mouth. What forms of actinomycosis are observed ? External, internal and generalized — the latter very rare. What animals are liable to actinomycosis f Primarily, cattle ; at times, horses, swine and sheep. Hotv are animals infected ? Usually through the ingestion of actinomyces-bearing food coming in contact with wounds of the mucous mem- brane of the mouth. Describe actinomycosis of the bones. Maxillary bones of cattle : The disease takes its start in the gums near a tooth, leading to an ossifying periostitis with formation of an exostosis. In those cases where the actino- mycoma spreads to the marrow, a rarefying osteitis results. In both the ossifying periostitis and rarefying osteitis, the superior and inferior maxillary bones become greatly en- larged. After having invaded the bone, the actinomycotic granulation tissue may appear in the mouth, loosening teeth, or may even extend into the maxillary or frontal sinuses. TUMORS 123 Of otlier bones, the following have been reported as actinomycotic : Sternum and ribs, vertebrae of the back and neck. Describe actinomycosis of the pharyngeal cavity. These soft tumors may resemble a polypus, being pedunculated, hanging from the mucous membrane ; are of pea to egg size, or they may have a broad base and be of fungoid shape. Similar neoformations are seen upon the mucous membrane of the larynx, trachea, vagina, intestines and nasal cavity. Discuss actinomycotic lymph glands. Those most frequently involved are the subparotid and submaxillary glands. Actinomycosis of lymph glands is never primary, but always of metastatic — that is, secondary — origin. The gland enlarges, is firm, oval or round, and painless, varying in size. Actinomycotic salivary glands are also seen occasionally. Actinomycotic submaxillary lymph glands have been seen in the horse. Discuss actinomycosis of the skin and suhcutis. More commonly seen about the head, udder, neck, abdomen, etc. They are both primary or secondary, the former arising from an infected skin wound, the latter from deeply seated actinomycotic processes which have broken through. They appear in the shape of nut to fist sized tumors, or as soft, reddish, fungoid masses. Fistulous open- ings may be present. Actinomycomata have been seen in castration wounds of pigs and in the spermatic cord of oxen and geldings. Discuss actinomycosis of the mammary gland. Those of the sow, where they are oftenest seen, appear as 124 PBINCIPLES OF VETEBINARY SUKGERY pea-sized nodules, containing pus and detritus, the nodule Toeing surrounded by a zone of firm connective tissue. Instead of the nodules, abscesses may be met with. In the cow one or more quarter of the udder is hard, duft to fibrous proliferations of the interstitial tissue, soft, pus« containing nodules being found here and there in the hyper- plastic quarter. Actinomycosis of the whole udder is com- paratively rare. Such an udder is hard and knobby, enlarged as a whole;. When cut into, the surface exhibits numerous little yellowish spots, each spot containing«a trifle pus. Discuss actinomycosis of the muscles. Statistics furnish one case where the elbow and shoulder muscles were actinomycotic. They are of metastatic origin, following skin actinomycosis. Discuss actinomycosis of the tongue. This form is quite rare in America, being quite prevalent in England and Germany. As a rule, the tumors are multiple, invading the whole organ. They produce marked induration, the result of severe connective tissue proliferation (Glossitis indurativa actinomycotica). Such a tongue is deformed, greatly enlarged and feels hard, for which reason it is termed "wooden tongue'^ in Germany. Somewhere upon, below or on the side of the tongue (usually the latter), one sees brownish spots, which are circumscribed, containing minute yellowish nodules. In between the muscle fibres and beneath the mucous membrane are firm, fibrous actinomycomata of pea to nut size, which, when cut into, are seen to be filled with a cheesy, yellowish material. As a rule, the regional lymph glands show metastatic changes. Actinomycosis of the internal face of the lips is character TUMORS 125 ized by brownisli actinomycomata. A very few cases of lingual infection in tlie liorse are on record. Describe the ireatment of actinomycosis. Those tumors wliich can be removed with, the knife should 1)6 attended to in that way, otherwise the excellent results obtained by the specific action of iodide of potassium demands its employ. BOTRYOMYCOMA yVTiat is a hotryomycoma ? An infections new-growth caused by the invasion of Ijotryomyces. Under what other names are the hotryomyces Tcnown ? Botryococcus, micrococcus bitryogenus, micrococcus ascoformans. Do all investigators agree upon the hotryomyces as the cause of hotryomycomata ? They do not. Some claim that the micrococcus ascofor- mans is not a specific germ, but simply a pus coccus. What is the nature of the hotryomycoma ? This neoplasm, also termed mycofibroma, represents a chronic inflammatory connective tissue proliferation produced by the hotryomyces. What animals are subject to botry oomycosis ? Primarily, the horse ; occasionally, the ox and swine. What mycofibromata are of interest to the surgeon ? Those in the skin and subcutis, muscles, mammary gland and spermatic cords. 126 PRINCIPLES OP VETERINARY SURGERY Describe the hotryomycoma of the skin 9 They are either solitary or multiple, from pea-sized nodules up to man's-head size, tlie largest ones being almost always met with, in the scapulo-humeral articulation and about the elbow. The tumor is of firm consistency, but may show soft iDortions here and there, with fistulous tracts extending into its interior. It cuts quite hard, the knife creaking as it passes through. The cut surface has a fibrous appearance, and shows here and there little cavities filled with, a yellowish mucoid fluid and pockets filled with pus . What cutaneous regions are principally involved 9 All parts exposed to harness pressure, elbow, point of shoulder, tail, lips and fetlock. Does the skin hotryomycoma confine itself to the skiri only f The larger tumors of this sort after developing in the skin invade the deeper organs. Describe the hotryomycoma of the spermatic cord. This condition is commonly termed scirrhous cord or champignon. At the time the animal is castrated, the castra- tion wound becomes infected with the botryomyces and a funiculitis botryomycotica is the consequence. It sets in by not healing of the castration wound, which continues to discharge pus. Now and then an acute cellulitis follows, alarming the owner, who usually at this stage seeks profes- sional advice. This cellulitis always sets in when the opening through which the i)us is discharged closes up, to disappear as soon as a new perforation is established allowing the pus to escape. This condition may persist for years without leading to serious consequences. The spermatic cord as a whole, or only its distal end, shows a rather painless, hard swelling. The vaginal process and the cord and surrounding TUMORS 127 tissues all form one solid mass, the skin at the most dependent part showing fistulous openings leading into tracts of various depths. On section, the surface is grayish white, showing here and there softened foci containing a muco-purulent semi- fluid holding the hotryomyces. Describe the hotryomycoma of the mammary gland. This is of rather malignant disposition, very likely to recur after excision, and has a decided tendency to invade the surrounding tissues. The part of the udder involved feels hard and nodular ; there may be fistulous openings and abscesses present, the affection occasionally spreading to the abdominal parieties and thigh. Describe the botryomycoma of muscles. These are quite often seen at a point where the mastoid© humeralis covers the point of the shoulder, representing a form of the so-called shoulder abscesses. They differ but little from those described under botryomycoma of the skin. Other muscles in which they are observed are those of the belly, intercostal muscles. Botryomycosis of bones seems to be very rare. One case is on record where the tumor developed from the maxillary sinus. This tumor, springing from the n^ucous lining, became as large as a child's head in two months, causing a bulging of the maxillary and frontal bones, unilateral nasal discharge and nasal dyspnoea. Gen- eralized botryomycosis has been described once ; it was a mare, the primary i)oint of infection being the uterus. Those botryomycomata found in internal organs have no practical surgical interest. How do you treat botryomycomata 9 They are best excised, carrying the knife well into the 128 PEINCIPLES OF VETERINARY SURGERY healthy tissues to prevent recurrence. In case the mammary gland is involved, it is best to amputate the whole gland. The same is done with the scirrhous cord. Those cases where a multiple botryomycosis is present, are operated from time to time, as it would be out of the question to remove all neoformations in one sitting. More recently medication with iodide of potassium and external applications or injections of tincture of iodine are reported to have given very satisfactory results. TUBERCULOSIS. What is tuberculosis 9 An infectious disease due to the presence of the bacillus of tuberculosis in the tissues of the body. Is tuherculosis of the domestic animals of much surgical interest 9 It is not, for various reasons. First, tuberculous disease of the external organs of animals is not of frequent occur- rence. Second, those operations of great value in man, as, for instance, resection of a tubercular joint, are not to be thought of in animals. Third, those animals where tuberculosis is more frequently encountered (ox, swine) are for slaughter, the tuberculous lesions exhibited by them being either of a localized, external description, and then of little practical moment, or the lesions are secondary and the result of generalized tuberculosis, in which case they are incurable. Which forms of tuberculosis are of practical surgical interest ? Tuberculosis of the mammary gland, lymph glands, skia and subcutis, mucous membranes, bones and joints, muscles, eye, testicles, brain and spinal cord. TUBERCULOSIS 129 Describe the tubercular mammary gland. The diseased process consists either of a localized tubercu- losis, tuberculous mastitis or diffused miliary tuberculosis. The bacillus rarely enters through the teat, thus creating a primary tuberculosis ; in most cases it is of embolic origin — that is, secondary. Such an udder, of which usually the posterior quarter is at first diseased, shows a diffused, hard swelling, which is little painful, with enlargement of the regional lymph gland and supra-mammary lymph glands. As the disease advances, hard nodules develop in the swollen quarter ; finally the whole udder may attain a large size and show the same symptoms just mentioned. In regard to the lacteal fluid, it must be said that in the earlier stages it under- goes no visible changes, only later it becomes watery and flocculent, containing the specific bacillus. Describe tuberculosis of the lymph glands. The affected lymph gland enlarges and becomes hard, explained by the process of calcification the tubercle under- goes and the proliferation of the interfollicular connective tissue of the gland. Infection of the lymph gland takes place both by the blood and lymph vessels. Name the lymph glands most commonly involved. Those in the intermaxillary space and those near the parotid gland, the retropharyngeal ; those of the cervical region, the prescapular, axillary, and those near the elbow, the inguinal, popliteal and precrural, the supra-mammary glands. Of the lymph glands of the internal organs, the bronchial ones alone are of interest, as, by becoming enlarged, they may compress the oesophagus and produce tympanitis. Describe tuberculosis of the skin and subcutis. This is but occasionally seen in cattle. They appear at 130 pr.iNCirLEs of veterinaky surgery first as swellings from nut to fist size, become soft and exhibit a cheesy material containing the tubercle bacillus. In the dog, nlcers on the neck involving the regional lymph gland have been observed. Skin tuberculosis has been frequently observed as a primary lesion about the head, and here especially about the eye and commissure of the beak of the parrot. They aro either soft tumors from pinhead to egg size, of globular shape, or skinhorn-like excrescences in the skin ; tubercular ulcers containing the bacillus are also observed. Describe tuberculosis of the mucous membranes. In the shape of ulcers or mushroom-like mass, it is observed in the larynx and trachea of cattle. Upon the nasal mucous membrane of cattle one sees occasionally an aggrega- tion of small, lardaceous looking nodules, which may become confluent and form an ulcer, there being also nasal dyspnoea and discharge. Uterine tuberculosis (endometritis caseosa tuberculosa) is not rare. In the parrot, tubercles and ulcers are seen upon the mucous membrane of the mouth and e3'e. Describe tuberculosis of the bones and joints. Tuberculosis of the bones is usually secondary, that is, it is caused by a tubercular embolism ; therefore, starting in the marrow, an osteomyelitis granulosa is the result. The bones more frequently involved are the tempoi-al bone, sternum, cervical, dorsal and lumbar vertebrae, and ribs. In tuberculosis of the middle ear (otitis media and interna tuberulosa) in swine, the infection takes its origin in the pharyngeal cavity and reaches the cavity of the middle ear via the Eustachian tube, creating here a tuberculos osteomyelitis, next periostitis and rarefying osteitis, necrosis of the bono now reaching the meninges, and finally brain. In goats. TUBERCULOSIS 131 sheep and horses, tuberculosis of vertebrse and ribs has also been reported. In fowls, tuberculosis of the bones is not a rare occurrence. Tuberculosis of articulations has been most frequently observed in fowls, that of the carpus and tarsus in swine ; while in cattle, tuberculosis of the hip, stifle and knee joints are less frequently seen. Describe tuberculosis of muscles. This form is of little surgical moment, being, as a rule, of an embolic nature, therefore the result of generalized tuberculosis. They appear as brownish nodules, of pinhead to bean size, usually circumscribed and arranged in rows, the muscles usually involved being the abdominal, thigh and pectoral muscles. Tuberculosis of the tongue is seen in parrots and at times in cattle. Describe tuberculosis of the eye. This is also an embolic form, and of rare occurrence in the ox, attacking the iris and choroid, eventually destroying the eye and changing it into a cheesy or granulating mass. Discuss tuberculosis of the testicles. This leads to enlargement of the glands. On section, pea to nut sized tubercles are seen. Tuberculosis of the spermatic cord, tunica vaginalis and prostate gland have also been observed. All these are comparatively rare ; those of the testicles are reported in the bull and boar, that of the prostate have been observed in the bull and dog. Tuberculosis of the ovaries seems to be quite frequent. Discuss tuberculosis of the brain and spinal cord. These are of interest from a standpoint of differential diagnosis, as they give rise to symptoms of paresis or 132 PKINCIPLES OF VETEEINAEY SURGERY paralysis, while tuberculosis of tlie spinal cord may produce locomotor ataxia or paraplegia. Describe the treatment of tuberculosis ? Generally speaking, such patients are not treated, for obvious reasons ; while in disease of the testicles or ovaries castration or spaying may be attempted. CONCRETIONS AND FOREIGN BODIES. What is a concretion ? A stone-like mass, a sediment of an earthy basis from retained secretions or excretions of the body. Enumerate the concretions of surgical interest. 1. Renal calculi. 2. Intestinal calculi. 3. Salivary cal- culi. 4. Lacteal calculi. 5. Preeputial calculi. 6. Rice kernel calculi. Where do you find renal calculi ? In the kidney, pelvis of the kidney, bladder and urethra. What is their compositio7i f Silicates, urates, triple phosphate, carbonate and oxalate of lime, etc. Hotu are they formed f 1. As a result of disease of the renal mucous membranes, colloids (mucus, epithelium, blood, pus) are present. These colloids form a nucleus around which the earthy salts of the urine are precipitated, eventually becoming calculi. 2. Through the agency of bacteria, which, by producing an ammoniacal fermentation, bring about precipitation of triple phosphate. CONCRETIONS AND FOREIGN BODIES 133 Describe the urinary calculi of the various animals. Horse : There are two kinds, those of the bladder and those in the urethra. Their composition is about the same, consisting of traces of iron, oxalate of lime and a greater amount of carbonate of lime. The vesical calculi are of nut to list size, are hard, either egg or disc shaped, with a smooth or mulberry-like surface and of yellowish color. One oi- several stones, as well as a finer sediment ("gravel "), may be found. The urethral calculi are usually found at the ischial curvature and are of pigeon egg to chestnut size. Cattle : These are composed of carbonate and oxalate of lime. As a rule, a number of round or disc-shaped pea-sized stones, glistening and yellowish, are found at the curve of the urethra. Dog : These are usually small, of pea size and present in. numbers. The surface may be rough or by continuous rub- bing may have become smooth. They are composed of oxalates, urates and triple phosphate, filling the whole urethra^ being wedged at the incur vated portion of the penial bone. Describe intestinal calculi. These are also known as enteroliths in the horse and are- of little surgical interest unless they can be reached from the- rectum. They are found in the caecum and colon, causing obstruction and colics. They are primarily composed of triple phosphate, formed by the precipitation of the phosphate of magnesia (coming from the food ; bran, for instance) by the ammonia found in any barn. The ammoniaco-magnesium phosphate and calcium phosphate — that is, the triple phos- phate — crystalizes around a kernel of oats or any other foreign, body, and the foundation to a calculus is laid. In cattle the so-called hair balls are quite often found in the rumen. These are also called bezoars and are made up of 134 PRINCIPLES OF VETERINARY SURGERY plant fibers or hairs. As a rule they cause no inconvenience, but may, when regurgitated, become lodged in the oesophagus and give rise to symptoms of choke. Describe salivary calculi. They are seen in horses and cattle, especially in Stenos duct. Single stones are of oval shape, while multiple ones are variously shaped as the surf aces which are in contact with each other are ground down. In the center there is usually some foreign body, as a bit of straw or an oat kernel, which forms the nucleus to the whole. They vary from pea to egg size and are composed mainly of carbonate of lime, some phosphate of lime and organic substances ; they have a white to pale yellow color. Describe lacteal calculi. These concretions, found in the teat or milk cistern of the udder, are made up principally of carbonate of lime with some fat and casein. They are of variable shape, may become as large as a hazel nut and range in color from pale yellow to gray. Clogging the channel through which the milk is emptied, it becomes of surgical interest. Describe iweputial calculi. These are observed in the urethral sinus of the penis and in the prepuce proper, the former being commonly termed ''beans," which when attaining a certain size may obstruct the flow of urine. They are smooth, oval concretions mainly consisting of inspissated smegma. Describe the rice Jcernel bodies. These peculiar formations, also known as corpora libra, chondroids, are of organic origin, representing coagulated or inspissated or calcified products of inflammation or bits of CONCKETIONS AND FOREIGN BODIES 135 neoformations, bone or cartilage. They are found in the guttural pouches, tendon sheaths, bursse and articulations. Hoiv do you treat the various calculi ? Urinary calculi are subject to operative measures — namely, by cystotomy and urethrotomy. Intestinal calculi in horses are, as a rule, beyond reach, if not beyond a positive diagnosis. Hair balls in cattle, when giving rise to choke, are treated as such. Salivary calculi are removed by opening the salivary duct and extracting the stone. The same refers to lacteal calculi. Preputial calculi can be easily removed by hand. The treatment of corpora libra is discussed under its respective head. Foreign Bodies. What are foreign bodies ? Any irritant entering the tissues of the body from with- out. In luhat parts of the body are foreign bodies of surgical interest 9 Buccal cavity, pharynx and oesophagus, stomach and intestines, respiratory apparatus, eye and ear, hoof, skin, sub- cutis, muscles, bones and internal organs. Where do you find foreign bodies in the mouth 9 In, beneath and around the tongue, between the teeth, mucous membranes of the cheeks, palate, openings of the ducts of salivary glands. What symptoms are they likely to produce 9 Ptyalism, chewing motions, quidding of food (difficult mastication), stomatitis and rabiform attacks (dogs). 136 PRINCIPLES OF VETERINERY SURGERY Enumerate some of the foreign bodies met ivith in the mouth. Splinters, needles, pieces of bone, fish, hooks, rubber bands, sprouting seeds (a regular lawn was seen upon the f aco of the tongue of a cow). In the ducts of glands, bits of straw, kernel of oats, barley. A dog is on record with a piece of metal in the Eustachian: tube and a horse with a piece of straw, having worked its way up the lachrymal duct. What animals are more commonly the subject of foreign, bodies in the mouth ? Dog, cat, cattle ; less frequently the borse. What symptoms do foreign bodies of the pharynx and oesoph- agus produce ? Difficult deglutition, pharyngitis and choke. What foreign bodies are usually met here ? In horses : Corn cobs, potatoes, turnips, apples, food boluses, pieces of a whip ; in the guttural pouches, accumula- tions of food. Cattle : The above and also hair balls, tin cans, pieces of metal, cloth, pieces of afterbirth, bacon rinds, beefsteaks (given empirically as an artificial cud). Dog : Bones, needles, fishbones, large pieces of meat ; in. playful dogs, spools, stones, etc. What serious sequels may these produce ? Perforation of the pharynx, rupture of the oesophagus and consequent internal hemorrhage from injury of the aorta, or pleurisy. What foreign bodies are seen in the stomach of cattle ? An endless variety ; all the way from horse rake teeth- down to needles, nails and stones. CONCRETIONS AND FOREIGN BODIES 137 What effect do they have upon cattle ? As a rule they do not cause any inconvenience, only wlien sharp and long enough they perforate the wall of the organ holding it ; thus they perforate the diaphragm, pericardium, and injure the heart, causing serious disease of the digestion and heart (traumatic gastritis and pericarditis). What foreign bodies are observed in the stomach and intes- tines of the dog ? Bullets, balls, coins, spools, etc. What symptoms do they give rise to 9 Sometimes none at all ; then again more or less anorexia, emesis, constipation, great restlessness, or great dejection ; in other words, symptoms suggestive of intestinal obstruction. What foreign bodies are seen in the rectum and urethra ? In the rectum of the dog any of the previously-mentioned foreign bodies may be seen ; in the horse, pepper, lumps of salt herring (introduced by empirics). In the urethra of the horse I found a piece of a catheter. W hat foreign bodies are found in the respiratory apparatus 9 Accumulations of food in the maxillary sinus ; in the nasal cavity, food, sponges, cotton, etc., placed there by jib- bers to hide nasal discharges of the horse. In the trachea,. pieces of cartilage aspirated during tracheotomy, pieces of the tracheotomy tube, oil, especially when drenched through the nose. What symptoms do they produce ? Purulent nasal discharge, usually unilateral when the sinus is affected, or violent fits of coughing at first, with subsequent symptoms of a foreign body pneumonia in case the foreign body entered the trachea. 138 PRINCIPLES OF VETERINARY SURGERY What symptoms do foreign bodies of the eye and ear give rise to 9 Eye : Depending on the nature of the irritant (bits of straw, hay seeds, etc.) and length of time they are present, the symptoms of a chronic purulent conjunctivitis are there, especially so in the horse when the foreign body is beneath the membrana nictitans. Ear : The oif ending agent is usually a parasite, as lice or mange parasites. What foreign bodies most commonly enter the hoof 9 Nails and glass. What portion of the hoof is more frequently involved f The commissures of the frog. What symptoms do they give rise to 9 Lameness, the result of pain due to pododermatitis. Describe the actions and results of foreign bodies in the shin and in underlying parts. Such foreign bodies may be bullets, shot splinters, etc. The most important feature lies in the fact whether they carry infection into the tissue which they enter or whether an aseptic wound is produced. Bullets, unless carrying bits of the harness or hair into the deeper parts, may become encap- sulated, creating no further sequels. Those causing infection of the parts give rise to pus production, as abscesses or more or less serious cellulitis. Foreign bodies of animal origin and introduced by the surgeon (catgut) become liquefied and are absorbed. Of what surgical interest is air as a foreign body 9 When animals are bled (phlebotomy), it is possible that CONCRETIONS AND FOREIGN BODIES 139 air may enter tlie vein and when of sufficient amount may produce death by arresting the heart. Outline the treatmeiit for foreign bodies . Those in the mouth are simply extracted with the fingers or forceps. Those in the pharynx of horses and cattle I have frequently removed by directing a stream of water from a handpump against the wedged masses (with proper care and judgment). In the dog, they are removed with a forceps or an emetic (apomorphine). In the horse, sialagogues, as areco- line and pilocarpine, may also be used. Those which are in the oesophagus are pushed into the stomach with the probang (an easy thing in the ox but much more difficult in the horse). At other times cesophagotomy or modifications of that opera- tion are indicated. Of course those cases where the pharynx or oesophagus are perforated are beyond remedy. Foreign bodies in the guttural pouches are best removed by Merillat's operation (opening the pouch through the soft palate). Those in the stomach — that is, the rumen — of the ox may at times "be removed by rumenotomy. Those in dogs, unless they come away with an emetic, or, if in the bowels, with a purge, may be removed by enterotomy, which when properly done is borne very well by the dog. Those in the respiratory appar- atus (the nasal cavity) can be removed with the fingers or forceps. Those in the sinuses by trephining them. Those in the trachea are usually beyond reach. Those in the eye may be washed out with a soft rubber syringe or picked up with a forceps. Those of the ear usually require an antiparasitic treatment. Those of the hoof are simply pulled out when present and good drainage and antisepsis are employed. Those in the skin and underlying parts are removed when m situ, unless it is reasonable to presume that an aseptic pro- cess of healing is possible, as in some gunshot wounds. 140 PRINCIPLES OP VETERINARY SURGERY Which foreign bodies of parasitic origin are of interest to the surgeon ? In the horse : 1. Filaria Papillosa. Found in the anterior chamber of the eye, giving rise to iritis and keratitis. Treat- ment consists of operative measures. This parasite has also- "been found in cryptorchids and hydrocele. 2. Filaria cincin^ nata. Occasionally causes a tendinitis in Russian horses. 3. Filaria medinensis. Seen in the subcutis of horses ia tropical countries, as East India, Africa, etc. It causes a form of elephantiasis (strongulus armatus). Has been found in the hypertrophied nasal mucous membrane. 4. Sarco^ sporidia. When present in great numbers give rise to aa interstitial myositis. In cattle : 1. Coe,nurus cerebralis. Produces symptoms of iDrain disease, as vertigo, wabbly gait, blindness, even para- plegia. Treatment by trephining. 2. Hypoderma hovis, Forms nut sized tumors, each tumor representing an abscess containing the larva. Treatment : Split the abscess and squeeze out the contents. In sheep : 1. Ccenurus cerebralis. Same as in cattle. 2. CEstrus ovis. Located in the nasal and maxillary sinuses^ giving rise to a chronic catarrh of the mucous membranes of those parts. Treatment consists in blowing some mild irri- tant into the nasal cavity, or for those in the sinus by" trephining, with subsequent irrigation of frontal sinus. In swine : The Cysticercus cellulosce has been found in the eye. In the dog : 1. Pentastomum tmnioides. In the nasal cavity and frontal sinus, causing a purulent rhinitis. Treat- ment : Trephine frontal sinus and inject benzine. 2. Filaria. medinensis. In the subcutis, producing a form of elephan- tiasis in dogs of tropical climes. 3. Spiroptera sanguino^ HEKNIA AND PROLAPSUS 1-11 Jenta. Seen in Java, producing cysts in tlie walls of the cesophagus. HERNIA AND PROLAPSUS. What is a hernia ? A protrusion of viscera through normal and abnormal ■openings in the walls of the cavity holding it without injury of the skin or mucous membrane covering it. Speaking of a hernia, what is ordinarily meant hy it ? A protrusion of the abdominal viscera through abnormal openings of the abdominal muscles. What other hinds of hernia are spoken of ? When a muscle protrudes through a rent of che fascia covering it, one speaks of a muscular hernia ; in the same way of hernia of the brain, lungs, etc. Jn regard to position, what varieties of hernia are known ? Umbilical, inguinal, ventral, scrotal, perineal, dia- phragmatic, femoral, vaginal, pelvic. Describe the make-up of a hernia. (1) The opening in the abdominal cavity, termed the ^' mouth ; " through this protrudes (2) the sac with its (3) oontents. Describe the sac. The sac is the pouch covering the bowel or omentum. That part external to the mouth of the hernia, or the main part of the sac, is termed the body, while the part constricted hj the mouth is known as the neck. 142 PRINCIPLES OF VETERINARY SURGERY Classify hernias according to ilie contents of the sac. Enterocele contains intestines only. Epilocele contains omentum only. Entero-epilocele contains both of the above. Cystocele contains the bladder. Gastrocele contains the stomach, etc . Name the clinical varieties of hernia. 1. Reducible. The contents of the sac can readily be returned into the abdominal cavity. 2. Irreducible. The contents cannot be returned, due to incarceration or inflammatory adhesions. 3. Incarcerated. The contents of the bowel form an obstruction to the return of the bowel into the abdomen. 4. Strangulated. An arrest of the circulation of the pro- truded bowel, due to severe constriction at its neck. Hoiv are hernias classified as to their origin ? (1) Congenital ; (2) acquired or traumatic. Give the symptoms of a reducihle hernia. In the so-called hernial region (region of the umbilicus^ inguinal canal) a swelling is found, which is soft, regular,, round and smooth. As a rule, there are no symptoms of inflammation, as heat, pain, swelling of the adjacent tissues. The integument over the tumor can be displaced. The con- tents of the sac either slip from under the palpating fingers or have a doughy, uneven feel. In the former it contains bowels only; in the latter, omentum. Of course both may bo present together. On placing the finger against the tumor and pushing it toward the wall of the cavity from which the tumor comes, the rent in the wall or the dilated state of the natural canal through which it came (inguinal canal) — that is, the mouth of the hernia — can be felt. This varies in HERNIA AND PROLAPSUS 143 size, may be round or show a split. The edge of this mouth, .in old hernias also termed the ring, has a firm, fibrous feel. In cattle this ring has been found ossified. The palpating fingers can reduce the hernia ; that is, can push back part or all of the contents of the sac into the abdominal cavity if the hernia be a ventral one. Percussion of the sac in case it contains bowels gives rise to a tympanitic sound. Give the symptoms of an incarcerated hernia. Ill the obstructed hernia most of the symptoms just men- tioned above are present, but there is this difference : in the sac, doughy feces, gases and liquids can be felt, the tumor is larger than ordinarily and cannot be reduced by taxis. There is abdominal pain. In dogs and swine, besides these symp- toms there may be slight vomiting. I have had two patients (geldings) for several years who invariably had nasty colics from incarcerated inguinal hernia whenever they were allowed to stand in the barn for a few days in succession. Both of these animals died subsequently, the post mortem examination revealing the fact that the incarcerated hernia had become strangulated, which diagnosis had been made at the time of their last illness. Oive the symptoms of strangulated hernia. More often seen in old hernias than recent ones. In the horse — usually the stallion of mature age — they are ushered in with colicky symptoms. The hernial sac is painful on pal- pation, and shows increased heat and cannot be reduced. The tumor feels tense, the animal stretches same as they do before stalling, or take a dog-sitting position or show other symptoms suggestive of intestinal obstruction ; the pulse is rapid and soon becomes wiry ; the facial expression is one of great anxiety, etc. 144 PRINCIPLES OF VETERINARY SURGERY Dogs and swiue show abdominal pain, vomit ; symptoms of collapse soon follow ; otherwise the hernial tumor exhibits the same conditions as in the horse. Hoiv do you treat a hernia ? There are two methods : 1, palliative ; 2, radical. Describe the palliative treatment. Only employed in reducible hernia. Here by means of a truss the protruded mass is retained in its cavity, as a result > of which sometimes the hernial mouth becomes so small that the gut no longer can protrude. This method is at times of value in young dogs, colts and brood mares. At the same time it must be remembered that in the young a hernia may disappear spontaneously, as the bowels quite rapidly enlarge and become too large to pass through the hernial mouth. Some practitioners advise the application of blisters and caustics, as sulphuric acid, the actual cautery. Others, again, advocate the hypodermic injection of a salt solution or alcohol — all with a view to produce artificially an inflamma- tion and scar formation around the rent in the wall of the cavity from which the contents protrude. These latter methods are of doubtful value and not without danger, as it is known that the integument covering the hernial sac sloughs off, thus causing a prolapsus ; while the hypodermic injections have as sequels peritonitis and septic cellulitis. Describe the radical treatment. Unless the mouth of the hernia is too large (say, exceeds five inches in length), the hernial sac may be obliterated by tying it off by means of an elastic ligature, as a rubber tube or even a common string (do not apply it too tight or the skin, will slough off too soon and a prolapsus may follow) ; or by stitching off the sac — that is, ligate it in sections. This latter HERNIA AND PROLAPSUS 145 form I prefer. Tlie above treatment lias the advantage that the peritoneal cavity remains closed and the dangers of a peritonitis are done away with, and on the whole it can be looked upon as a safe and reliable means. The most surgical treatment is herniotomy. Here of course asepsis and chloro- form narcosis are essentials, otherwise peritonitis is likely to follow. Herniotomy in the dog gives very nice results, while in the horse the nature of the tissues, as well as the difficulties accompanying asepsis, render it of doubtful value, at least in €very-day practice. That herniotomy can be executed suc- cessfully in the horse, especially in the colt, has been •demonstrated. Oive the treatment of incarcerated hernia. Attempt to reduce the hernia by hand (taxis). If neces- sary, put the animal into the dorsal recumbent position, assisting it by exerting traction upon the gut from within, that is, through the rectum. In cases of inguinal hernia in "the horse, since he most likely will have to be operated, put him upon the back and chloroform him ; abduct and bring well back the hind leg of the affected side. Should all this fail and the danger of strangulation become apparent or strangulation is already present, operate. Instead of widen- ing the hernial ring with the knife right away, puncture the loop of intestine presenting itself with a fine trocar and canula, such as is found in our hypodermic syringe cases, thus allowing the escape of a considerable amount of gas and liquid. In this manner I have succeeded frequently in re- ducing a strangulated hernia. When this fails, split the hernial ring, and re-position of the sac's contents becomes easy. In stallions, this is to be followed by castration by the covered method, while in geldings the tunica vaginalis is to be searched for and dissected from the bowels, which usually 146 PRINCIPLES OF VETERINARY SURGERY are connected with it by adhesions ; next the tunica is twisted once or twice around its axis and a small curved clamp applied over it as high as possible. What varieties of hernias are more commonly met with m our various animals ? Ventral hernia : Cattle and horses. Umbilical hernia : Dogs and horses. Inguinal hernia : Horses and swine. Describe the individual hernias. Ventral hernia : The causes are traumatic ones, such as kicks, falls upon blunt objects (tree stumps, etc.). The hernia may be located at any part of the abdominal parietes, usually about the flanks or along the linea alba. Their size -varies, but may be very large. My experience with these ruptures is, that when the mouth of the hernia exceeds eight inches they are incurable. From a standpoint of differential diagnosis, at least in recent hernias, one must remember abscesses and hematomata. In small animals herniotomy gives nice results, while in the larger ones the clamp or ligature is preferable. Pelvic hernia (gut tie) : Seen in the ox ; mainly due to a peculiar method of castration, consisting of tearing the spermatic cord through or tearing it out by sheer force. In consequence of this the parietal peritoneum is lacerated and a pouch results ; an intestinal loop may enter it and become strangulated. There are colicky symptoms. By rectal pal- pation under right or left transverse process of the sacrum the constricting cord and incarcerated intestine can be felt. Treatment consists of laparotomy or re-position of the in- carcerated loop by hand per rectum. Umbilical hernia : Seen especially in young animals. Heredity seems quite an etiological factor ; the animal is HERNIA AND PROLAPSUS 147 either born with the hernia or it appears soon afterwards. The contents of the sac are usually the colon or caecum. The mouth of the hernia is represented hy the umbilical ring. On the whole, small umbilical hernias are of little consequence, often disapxDearing voluntarily, the bowels becoming rapidly too large to pass through the abdominal opening. For this and other reasons this variety of hernia rarely incarcerates. The treatment in younger animals should be an expectant one unless the hernia is large. In older animals and in large hernias of the young animal, operative measures are indi- cated, as herniotomy (in the dog and colt, in the latter only when the ligature or clamp has failed); in older and larger animals the clamp or ligature are safest. Inguinal hernia : This may be looked upon as a danger- ous hernia, as, by reason of its location, incarceration of a descended intestinal loop quite frequently occurs. It is of most interest in the horse, and productive of the symptoms of au obstruction colic. The treatment consists in herniotomy. After return of the intestinal loop into the abdomen the animal is castrated by the covered method, the tunica vaginalis being twisted several times around its axis. Now a small and curved clamp is placed over the tunica vaginalis and cord and placed as near to the inguinal opening as possible. An important feature lies in leaving the clamp in position as long as possible, in order to obtain adhesions between the cord and tunica vaginalis, thus preventing the intestines from descending. Prolapsus. What is a prolapsus f A protrusion of viscera into the external air, through normal or abnormal openings of the body. 148 PRINCIPLES OF VETERINARY SURGERY What is the difference between a hernia and a prolapsus ? In the hernia, the integuments, as skin or mucous mem- branes, are not injured and the protruded viscera are not exposed to the external air, while in the prolapsus the integu- ments are injured and the viscera are in actual contact with the external air. What tivo terms are often confounded luith prolapsus 9 Inversion and invagination of a hollow organ. What does inversion and invagination respectively mean ? In inversion things are turned inside out ; for instance, in inversion of the bladder the organ is turned inside out, appearing externally through the urethra but not through a rent of the mucous membrane of the vaginal wall, as is the case in prolapse of the bladder. In invagination, one part of a hollow organ is drawn into another part ; in other words, the parts become telescoped. Name the causes of prolapsus. Traumatisms, as penetrating wounds extending into the abdomen or chest, resulting in prolapsus of the bowels or lungs ; lacerations of the vaginal walls, prolapse of the bladder, paralysis of the penis, prolapse of the penis, relaxa- tion of the broad uterine ligaments, prolapse of the vagina or uterus, constipation and consequent severe straining by the muscles concerned in defecation, prolapsus of the rectum, etc. Are all cases of prolapsus pure and simple those of a prolapse? They are not. In many instances it represents a com- "bination of prolapse with invagination ; in other instances it is a prolapse with inversion. Give an example of both. Prolapsus of the rectum is usually a prolapsus of the rec- HERNIA AND PROLAPSUS 14^ turn plus invagination of tlie rectum. Prolapsus of the- vagina is frequently not only a prolapsus of the vagina, but. at the same time an inversion of that organ. Describe the prolapsus 'more commonly encountered. Prolapsus of the Intestines. Follows penetrating wounds about the abdomen. The protruding bowels are usually the large, the small colon or the caecum. Another cause is the castration of ridglings (cryptorchids) through the inguinal canal, the bowels prolapsing either immediately or shortly after the animal rises. Finally, the bowels may protrude after herniotomy has been performed. In all these cases^ excepting perhaps the prolapse following herniotomy (pro- vided proper aseptic precautions have been taken previous to the operation and afterwards), the danger of septic complica- tions is great. The treatment consists in asepticizing the parts, thoroughly suturing the lacerated parts and applica- tion of a retention bandage wherever possible. Prolapsus of the Omentum. Follows penetrating wounds and ridgling castration. The treatment is the same as in prolapse of the bowels, but there is decidedly less danger. The protruding mass of omentum is ligated and cut off, the stump returned into the abdominal cavity. Since it is practi- cally impossible to stitch up the inguinal canal, I have had good results by firmly packing the cavity as high up the inguinal canal as possible with aseptic oakum and stitching the cutaneous wound. Prolapse of the Rectum. Follows empirical exploration of the rectum, prolonged diarrhoea, constipation — in fact, anything calling the muscles concerned in defecation into excessive play. Quite rare in the horse, it is seen in the cat, dog, and especially swine. As previously stated, it is often combined with invagination of the prolapsed parts. The 150 PRINCIPLES OF VETERINARY SURGERY treatment for prolapse of this sort is not always successful, as the parts will continue to appear externally, and amputation may become necessary. Prolapse of the Uterus. Most frequently seen in the cow. It follows almost invariably anything which induces the animal to strain persistently, such as rough empirical traction during labor, the weight of the partly detached foetal placenta hanging from the vulva, etc. Sometimes considerable trouble is experienced in retaining the parts after they have been returned : so much so, that amputation of the uterus may be required. Prolapse of the Vagina. Most frequently seen in the cow and bitch. As causes may be given relaxation of those organs which fix the vagina, as, at the latter stage of pregnancy, cows standing on floors sloping downward, difficult labor with traumatic lesions of the vaginal canal. The treatment consists in reposition of the parts and retaining them by a variety of trusses. Prolapse of the Penis. In cases of paraphimosis the penis cannot be retracted and therefore becomes prolapsed ; as also in paralysis of the penis. This form of prolapsus is most frequently seen in the horse and dog. The treatment consists in attempting reposition of the organ by hand, next by antiphlogistic measures, and when they fail, in amputating the prolapsed portion. Prolapse of the Tongue. Follows paralysis or lacera- tions of. the muscles. Treatment is unsatisfactory. Prolapse of the Bulb of the Eye. Seen in large-eyed dogs, as pugs, following bites, etc. Treatment lies in reposi- tion, or, in case the life of the tissues is destroyed, in amputation. DISEASES OP BONES 151 DISEASES OF BONES. Fractures. What is a fracture f A sudden forcible separation of the continuity of a bone. What are the causes of fracture ? 1. Exciting or immediate causes. 2. Predisposing causes. Describe the exciting causes. Fractures of this last class are subdivided into (a) frac- tures by external violence, (6) fractures by muscular action. In those due to external violence, as a blow, kick, etc., the fracture occurs at the point struck, or through transmission of the force by a bone or chain of bones at a distant point with more or less damage to the overlying soft parts. In those due to muscular action the bone is broken by sudden and violent contraction of muscles directly or indirectly attached to the bone. Again, those the result of external violence may be by direct violence or indirect violence ; the former occur at the point struck, the latter at a distance from the point of application of the force, the blow being trans- mitted through a bone or chain of bones. Exemplify the direct causes of fractures. Direct external violence : Fracture of the metatarsus from a kick. Indirect external violence : The animal falls and sits down like a dog, followed by fracture of some portion of the vertebral column. The animal's hoof is caught in a street 152 PKINCIPLES OP VETERINARY SURGERY rail ; in trying to free itself the animal twists tlie incarcerated hoof, resulting in fracture of the os corona, etc. Muscular action : Horses when cast in a narrow stall in their vain efforts to rise strain the muscles of the back to the utmost, executing at the same time all sorts of torsion moA^e- ments, resulting in fracture of the vertebral column. A very similar thing is occasionally seen in the operating room ; horses when thrown for an operation will struggle violently when lying on the bed, calling into most active play th& longissimus dorsi especially, as a result of which a fracture of the dorsal or lumbar vertebrae is observed. Fracture of the dorsal vertebrse has been seen to follow sudden rearing ; that of the lumbar vertebrae in animak turning quickly and short. Overtaxing the gastrocnemii or flexors of the knee has been followed by fracture of the calcaneous and pisiform bones respectively. Describe the 'predisposing causes. To this class belong the so-called idiopathic fractures. In these fractures the bones seem possessed of abnormal fragility ; a variety of fractures quite frequently seen in the horse and cow, especially in certain localities, osteoporosis, osteomalacia and tuberculosis apparently predisposing the animals to fractures. Old animals are predisposed by reason of senile atrophy, the very young by reason of their juvenile bones ; those that have been ill and in the barn for a consider- able length of time are predisposed by reason of inactivity atrophy. Anchylosis of the vertebral column is another predispos- ing factor. How are fractures classified ? 1. Simple : there is no open wound leading to the break. DISEASES OF BONES 1j3 2. Compound : here an oj)en wound leads to the broken "bone. Name the varieties of fractures. (1) Incomplete, (3) complete, (3) compound. Describe inconnplete fractures. This class is represented by fractures where the continuity of the bone is not entirely lost — that is, the break extends partially through the thickness of or partially across the bone. As incomplete fractures are recognized : (a) Fissure or fissured fractures. This consists of a crack or split in the bone. These are quite common in the horse and difficult of diagnosis ; met with usually in the os suffra- ginis and tibia. (5) Green stick fracture. This is a true incomplete frac- ture. It is called "green stick" because the appearance of the injured bone is about the same as when a green stick is held at either end by the hands and broken across the knee, lead- ing to a pulling apart of the fibres on the outside while the concave portion — that is, the one resting against the knee — is compressed. In the bone, therefore, a portion of its thick- ness is broken while the balance is bent. Only seen in tlie^ long bones and ribs of very young animals. (c) Depression fracture : In these a portion of the thick- ness of a bone is crushed. This must not be confounded with a depressed fracture, where the entire thickness of the bone is crushed in. Usually seen about the cranial and facial bones. (f?) Strain fracture : Consists of the breaking off of a piece of a bone, due to violent contraction of a muscle, as the tearing off of a piece of the-os calcis through strain upon, it by the gastrocnemii. 154 PKINCIPLES OF VETERINARY SURGERY Describe complete fractures. The fracture extends entirely across or tlirougli the thick- ness of the bone. How do you divide connplete fractures according to the direc- tion of the line of fracture ? Transverse : The break runs more or less at a right angle to the long axis of the bone. Generally caused by a direct force. Oblique : The line of fracture runs obliquely to the long axis of the bone. Generally due to indirect causes. Longitudinal : The line of fracture runs more or less parallel to the long axis of the bone. Dentated or toothed : Each broken end exhibits sharp points and depressions ; that is, it is serrated. V-shaped : Tlie upper fragment shows a triangular pro- jection, while the other one exhibits a notch into which the triangular or wedge shaped projection fits. T-shaped : Consists of an upper transverse or oblique line plus a vertical or longitudinal line of fracture. In the horse, most commonly seen in the os suffraginis. What is a midtiple fracture ? It is a complete fracture where either more than one bone is broken or where one bone is fractured more than once. What is a comminuted fracture ? It is a complete fracture with considerable splintering of the bone where the lines of fracture communicate with each other. Describe compouiid fractures. In this fracture the overlying soft parts either were injured from without by direct violence or from within by DISEASES OF BONES 155 pieces of bone forcing themselves tlirougli tlie tissues ; or, finally, the injury of the soft parts may be secondary, being the result of necrosis from the pressure of displaced bony fragments, rough handling, as an animal suddenly throwing excessive weight upon the broken limb on account of slings in which it rests or slipping, or the soft tissues injured during the accident, slough. This variety of fracture is always serious, mainly on account of the possibility of infectious complications, as tetanus, septicaemia, necrosis. Transverse displacement : There is a complete or partial dislocation of the fragments at a right angle to their former normal long axis ; that is, one fragment is either in front, T^ehind or back of the other one, but they do not overlap each other. Angular displacement : The fragments are dislocated at an oblique angle to their normal long axis ; that is, the frag- ments form an angle with each other. Rotary displacement : One or the other fragment is turned about its normal long axis. Over-riding displacement : The broken surfaces overlap each other, thus bringing the two extremities of the broken "bone more closely together. Impaction displacement : The bone is shortened as the fragments are forced into each other. Direct longitudinal sej^aration : The broken parts are drawn apart in a longitudinal direction. Which animals furnish the most fractures 9 In the large cities, with their ashphalt x^avement, street car rails, slippery roads in winter, fractures in the horse are common ; otherwise, kicks, running against solid objects, casting the animal, etc., are frequent causes. Next in fre- quency comes the dog ; here bites, blows, falls and being run 156 PRINCIPLES OP VETERINERY SURGERY over by wagons, etc., are tlie direct causes. Finally, birds and swine, and occasionally the cat, furnish clinical materiaL Which hones are viost frequently fractured in the horse 9 Fracture of the pelvic bones, tibia and os suffraginis represent about one-half of all fractures, the other half being: made up by the vertebrae, radius and metatarsus. Which bones are most frequently broken in the dog f The vast majority of fractures are those of the bones of the legs, only ten per cent, of all fractures being made up from fractures of such bones as the cranial, vertebral, ribs,, scapula, sternum. Which bones are most frequently broken in birds ? Mainly the femur, humerus and tibia. Which points do you take into consideration in the diagnosis^ of a fracture? 1. The history, that of a fall, kick, bite, runaway, etc. 2. Diminished or lost function and pain. When the bones of the extremities are broken the animal supports very- little or no weight at all and is moved with great difficulty. Loss of function, nevertheless, is not always marked, as, for instance, in certain fractures of the pelvic bones the animal can still suj^port weight with the affected leg ; in fractures of the ribs and in some fractures of the bones of the head there- is also an absence of loss of function. Pain, as a rule, is well marked, exhibited on palpation ; thus dogs cry out and the liorse will endeavor to get the affected limb out of reach of the one conducting the examination. Complete loss of function accompanies fracture of the vertebral column, characterized by paraplegia and complete anaesthesia, nor- mally enervated by that portion of the spinal column posterior^ to the point of fracture. DISEASES or BONES 157 3. Abnormal mobility, usually in all directions. By it is understood an independent mobility of a part of a bone which, aaormally is an unbroken structure. This is detected by inspection and palpation. While as a rule quite readily ob- served in complete fractures, it nevertheless is at times ap- parently wanting, as in fracture of the vertebrae or in those fractures where the fragments are driven into each other '(impaction fracture) and in incomplete fractures. 4. Crepitation. By it is understood the peculiar grating sensation heard or felt due to the rubbing together of the l)roken surfaces. This symptom is pathognomic of a fracture l)est detected by palpation and passive movements of the ends -of the bone supposed to be fractured. It is wanting when the T^roken fragments are very much displaced, in vertebral fractures and incomplete fractures. 5. Swelling. While quite often wanting in incomplete fractures, it soon follows other fractures, consisting of a swelling of the adjacent soft tissues, either due to the lacera- tion of the tissues at the time the accident occurred, subse- quent injury by the bony fragments, or septic inflammation. Swelling often greatly handicaps the diagnosis of a fracture, obscuring such symptoms as abnormal mobility and crepi- tation. 6. Injury of the skin may or may not be present, while in older fractures abscess formation fistulous tracts are seen. 7. Constitutional disturbance. Rise of temperature may l^e due to the absorption of ferment-like materials coming from the disintegration of the blood corpuscles at the point of fracture, being an aseptic fever and slight. In complicated fractures, as the result of the invasion of pus-producing bacteria and the consequent absorption of the septic material, a septic fever of variable intensity and seriousness results. 158 PRINCIPLES OF VETERINERY SURGERY Sometimes symptoms of internal liemorrliage are seen, the hemorrhage being the result of injury of a large blood vessel by the sharp bony fragments, occurring at times in pelvia fractures (obturator artery). 'What individual symptoms are of specific value in the diag- nosis of fractures f Epistaxis, nasal dyspnoea and depression of the nasal bones are i)eculiar to fracture of the nasal bones. Pneumonia^ pleurisy and hemoptysis may follow fracture of the ribs. Paralysis of the tongue, difficult deglutition and mastication as well as loosened teeth are met with in fracture of the hyoid bone, respectively maxillary bone. Fracture of the cervical vertebr£e may give rise to paralysis of the dia- phragm. Fracture of the cranial bones may be followed by paralysis of the brain. What points do you take into consideratioii in the diagnosis of incomplete fractures ? A positive diagnosis of these is not always possible, this referring especially to the so-called fissured fracture, quite commonly seen on the os suffraginis and tibia and less often, on the OS corona and vertebral column of the horse. The essential features upon which the diagnosis in these cases is based are: sudden intense supporting leg lameness (for detailed descriptions, see my " Clinical Diagnosis of Lameness in the Horse")? with a history of external violence. (This symptom does not hold good in cases of fissured ver- tebrae, where the horse sometimes works for days without showing any loss of function at all.) There is usually volar flexion of the phalanges, but no change in form or abnormal mobility of the parts. In one to two days after the accident there is more or less cedematous infiltration of the overlying^ DISEASES OP BONES 159 soft tissues. Tlie individual disposition toward pain varies greatly in animals ; in some it is impossible to palpate the limb, while others hardly react. Twisting of the fissured bone and pressure upon certain parts produce more or less pain. Theoretically, there ought to be distinct pain along the line of fracture ; in practice this may occasionally be detected, but on the whole such fractures can only be diag- nosed by the train of symptoms and the history of the case and by a systematic and thorough examination for all those conditions which have symptoms similar to those of a frac- ture ; in other words, the condition can be forcibly surmised by a diagnosis by exclusion. What points are of importance in the prognosis of fractures ? 1. Economic reasons. While a fracture may be curable, economic reasons may forbid the treatment. Therefore, in each case the first question is. Does it pay the owner to have this fracture treated? If not, the slaughter of the animal should be suggested. 2. The animal species. In the horse and cattle, treatment of fractures is tedious, because it is often very difficult and sometimes impossible to adjust dressings to the broken ends of the bone which hold the fragments in place. Continuously resting upon three legs or the recumbent position may be complicated by laminitis (comparatively rare) or by decubitus and subsequent sepsis. Fractures in cattle and horses heal in about one to three months ; in the dog, in three to four weeks ; in birds, about fourteen days. 3. The broken bone itself is of great importance. Thus, in the horse and cattle, fracture of the vertebrae with injury to the spinal cord, and, as a rule, both simple and complicated fractures of the femur, tibia, scapula, humerus and radius, certain pelvic fractures and comminuted fractures of the os 160 PRINCIPLES OF VETERINARY SURGERY corona and suffraginis, are incurable. Fractures of the metacarpus and metatarsus stand a slightly better show. Finally, treatment may be attempted in fractures of the processes of the vertebrae, simple fracture of the os pedis, OS corona, suffraginis, ribs, external angle of the ilium, facial bones. 4. The variety of fracture is equally important. Com- minuted and complicated fractures and those involving a joint or its neighborhood are, as a rule, not treated. Old fractures and those where marked displacement of the frag- ments is present are unfavorable, for this reason. Transverse fractures are more favorable than oblique ones. Simple fractures and fissures are more favorable than complete ones. Fractures near joints may lead to an anchylosis and therefore chronic lameness. 5. The age of the animal is important, for economic reasons and also because the process of healing is much slower in old than in young animals. The prognosis of fractures, especially to the beginner, offers many difficulties. The following examples may be of some service to him : 1. High-priced carriage horse (gelding), of good age, with fissure fracture of the os suffraginis. It will take from six to twelve weeks to heal the fracture. As the result of bony deposits along the fissure there are good chances for a chronic lameness, which may be relieved by neurectomy provided there are no articular complications. Inform the owner of these points and the approximate expense connected with the treatment of the animal. If you have yet to make a reputation, call on some brother practitioner of established reputation and business integrity to assist you ; then let the owner decide. DISEASES OF BONES 161 2. Running liorse (stallion), good age ; oblique fracture of the metatarsus. Prognosis favorable for a cure, but animal will be unfit for the race track ; useful for breeding purposes only. If the owner is satisfied to use him in the stud, go ahead with your treatment. 3. Trotting mare, due to foal in five days ; fracture of the shaft of the ilium. Perform Csesarean section and try to save the foal, because the mare is most likely doomed as a "breeder and may abort as the result of the accident. 4. Cow, in calf four months ; fracture of the floor of the pelvis. If this cow is a fine butter or milk cow, let her finish her period of gestation, and then remove the calf by performing embryotomy. In this way the owner will have the use of that cow for another year, when she ought to be sold for fat beef. If the cow is but a common scrub and in the above condition, advise immediate slaughter. 5. Pet dog ; comminuted fracture of the metatarsus. Owner wants the life of his favorite saved, no matter what the expense. Amputation below the tarsus most likely the only chance in this case. Try to impress the owner with the fact that a dog with three legs only is a burden to himself and all those about him. If he or she — it is usually a she — persists, operate. More than likely the animal will be at your office within a year or so to be chloroformed. 6. Gelding, 13 years old ; a little sore in front ; splendid worker. While going to the blacksmith fell on his left hind leg ; got up quite lame ; was put back into the barn and a veterinarian called at once, who diagnosed a fracture of the femur, and advised to kill the animal. This horse being the first one the owner ever bought, he thinks a great deal of him and orders the barn man to feed "old Jim" one more good square supper and that he will have him shot in the morning. 162 PBINCIPLES OF VETERINARY SURGERY lu tlie morning the barnman reports ''old Jim" eating well, very lame, and quite a swelling about the region of the hip, whereupon the owner concludes to call another veterinarian for an opinion and his choice falls upon you. The owner meets you, gives you the history of the case, most" likely omitting the diagnosis of your predecessor, and says : " If the leg of this horse is broken, I want to have him shot, as I don't want the old fellow to suffer any longer." Inspection simply shows a swelling in the region of the hip joint. This swelling is painful and hot. The leg is rested upon the toe, the horse drawing the leg up once in a while. Palpation from the stifle joint down is negative. Pulse, 48 ; respirations, 18. Mucous membranes slightly congested. Temperature, 101.2 deg. F. When backed out of his stall he hops on three legs. The history of a fall followed by sudden severe lameness causes you to suspect a fracture. Now you palpate the pelvic bones per rectum, at the same time having his leg twisted, brought forward, backward and abducted. You imagine you perceive a faint crepitus. After finishing your examination, what can you honestly say ? What facts has your systematic and careful examination revealed ? The owner wants a posi- tive answer one way or the other. This is a case where nobody can positively diagnose a fracture ; there are simply some indications to that effect. Tell the owner that since the decisive symptoms of a fracture are wanting and your examination is greatly handicapped by the large swelling, it preventing you from making a close examination of the underlying parts, you suggest an antiphlogistic treatment — (don't use the latter term, because he would most likely not understand the word " antiphlogistic ") — for four to five days, at the end of which time you will re-examine the horse. DISEASES OF BONES 163 HEALING OF FRACTURES. How do aseptic fractures heal 9 The process of repair is closely related to the healing of an aseptic skin wound. The blood which has been effused as result of the injury is presently absorbed and has nothing to do with the process of repair. The periosteum and bone marrow and soft parts undergo an aseptic inflammation, exudation occurs, and a mass of embryonic tissue — that is, granulation tissue — is the result. This granulation tissue, at first soft, subsequently ossified, glues the fragments together, so to speak, and is termed the callus, and the bone once more becomes a solid structure. What varieties of callus are concerned in the healing of fractures f 1. The external callus, developing from the bone-pro- ducing cells (osteoblasts) of the deeper layers of the periosteum. 3. The internal callus, developing from the bone-pro- ducing cells (osteoblasts) of the marrow. 3. The intermediate callus It lies between the fractured ends and is composed partly from the external, partly from the internal callus. What is a provisional callus ? The soft, spongy tissue at first forming around and be- tween the broken ends ; it is the result of the action of the osteoblasts. What is a permanent callus ? This is the provisional callus, having undergone ossifica- tion. In other words, it represents a bone scar formed mainly through the agency of the osteoclasts. 164 PKINCIPLES OP VETERINAEY SURGERY What is the difference between the provisional and permanent callus ? Both are the same product of a process of regeneration, only in different stages of development. What are osteoclasts 9 These are multinuclear giant cells supposed to have the power to form free carbon dioxide and thus dissolve the lime salts of the bones and absorb bony substance. What is a synosteosis 9 The permanent union of two single parallel bones by a callus ; for instance, in fracture of two adjoining ribs. What is an anchylosis 9 A stiff joint. Here the articulating extremities of two bones are rendered immovable by a callus. What is a fibrous callus 9 One which, instead of being composed of bone, is made lip of fibrous tissue. In other words, the callus never reached a higher development than the fibrous stage. Seen in frac- tures of bones with limited blood supply, insufiQcient immo- bilization of the fragments and in those where the fragments were drawn apart to considerable extent : false ribs, patella, pisiform bone, olecranon, etc. What two processes is the ossification of the callus the result of 9 It is the result of an ossifying periostitis and osteomye- litis. What is a pseudoarthrosis 9 It represents an ununited fracture ; that is, the broken €nds show mobility, being held together by fibrous union ; DISEASES OF BONES 165' there may be a fibrous capsule, wbicli after some time may secrete a serous fluid for lubrication of the broken ends of the bone, which may be smooth and eburnated and possibly covered by hyaline cartilage, in this instance forming a new joint. Describe the process of ossification of a callus. The ossification of the granulation is either a direct or indirect one. The former is the result of direct ossification by the osteoblasts of the periosteal and myeloginous granula- tion tissue (the embryonic tissue following inflammation of the periosteum and marrow). In the indirect process of ossification of the granulation tissue, this latter first becomes cartilage, which in turn becomes bony tissue. About the third or fourth day after the fracture occurs, little foci of osteoid tissue exhibit themselves at the point of fracture (due to the action of osteoblasts). In the second week the external callus is still soft ; by the end of the third week the periosteal callus consists of pretty firm, spongy bone. The internal callus undergoes the same changes. In four to five weeks the provisional callus begins to be converted into a permanent cicatrix (permanent callus), the superficial and deeper portions of the provisional callus become absorbed — mainly by the action of the osteoclasts ; finally, the medullary cavity of the bone is more or less restored and the surface of the bone shows but little of the large ovoid mass, the original callus. How is the regular callus formation interfered ivith 9 By constitutional diseases, as osteoporosis, osteomalacia, infectious diseases, by marked displacement of the bony frag- ments, infection of the tissues at the point of fracture, decided splintering of the bone ; by the lodging of soft tissues between 166 PRINCIPLES OF VETERINARY SURGERY the broken ends, continuous mobility of the broken ends (insufficient immobilization) . Hoiv do complicated fractures heal ? The seriousness of a complicated fracture lies in the amount of splintering of the bone, and especially the age and amount of injury to the skin and neighboring soft parts. Complicated fractures where the skin wound can be asep- ticised heal almost as rapidly as a subcutaneous — that is, aseptic — fracture. In the complicated fracture the callus formation is the same as in the subcutaneous fracture, but is greatly inter- fered with as the result of those conditions which are sequels of an infection, namely : purulent cellulitis, retention of pus, lymphangitis, necrosis of the soft parts and bones, purulent periostitis and myelitis, formation of fistulse and general sepsis, as septicsemia and pyaemia. How would you testify in Court in a case of this sort f A horse was sold by A to B and warranted by A as sound and true in all harness. In the morning after the pur- chase the horse is down and unable to get up. You are called and diagnose complete fracture of the tibia and order the horse killed. Post-mortem examination reveals a soft external spongy callus at the line of fracture. Your certifi- cate therefore will state that the animal was unsound at the time of purchase suffering with a fissured fracture of about two weeks' standing. Had the fracture occurred during the night at the new owner's stable, there would be no osteoid tissue present, that is, no callus, but simply an effusion of blood and symptoms of a fresh aseptic inflammation. Hoiv do you treat simple fracture ? 1. By reducing the fracture. This means that the sur- DISEASES OP BONES 167 geoii restores the displaced fragments to their normal position or as close to it as possible 2. By retaining the fragments in position. Hoiu is a fracture reduced ? 1. By extension ; that is, the Surgeon exerts steady trac- tion upon the lower fragment. 2. By counter-extension. This means the fixing of the upper fragment. 3. By coaptation, by which is understood the adjustment of the fragments to their proper position. Why are these steps necessary ? Absolute rest to the broken bone and proper adjustment of the fragments are essential to the normal development of a callus. Can you reduce the fractures in all animals this way ? In the dog and other small animals, as a rule. The larger animals offer great difficulties. In such fractures as those of the pelvis and ribs, the reduction of a fracture by extension and counter-extension, etc., is out of the question; also when fragments of bone get between the ends when muscles are pinched in, when the broken bones can't be grasped or fixed. Why do you employ extension and counter-extension in reducing a fracture ? It is done to overcome the contraction of muscles and the elasticity of fascise, tendon, etc. How do you proceed for this purpose 9 The smaller animals may be given a dose of morphine and are then laid upon a table, where, with the help of one or two assistants, the upper fragment is firmly held, while 168 PRINCIPLES OF VETERINARY SURGERY anotlier person steadily pulls upon the lower fragment, as much as possible in the direction of the normal axis of the broken bone, while the surgeon adjusts the broken fragments to their proper j^osition. In the larger animals, chloroform is best. Given in the horse, morphine is contraindicated, as its after effects (the horse gets restless) are detrimental. Of course before the animal is laid down it will be necessary tO' temporarily dress the broken parts to avoid further injury as he is laid down. Sometimes extension, counter-extension and reduction can be effected simply with the aid of a nose-twist. In practicing extension in the horse it is at times necessary to make use of pulleys to overcome the resistance offered by the elasticity of muscles, tendons, etc. How can you tell that the limb is properly reduced ? Take into consideration the jjosition of the hoof or toes, as the case may be, and the length of the limb. Hoiu are the hrohen fragments retained in proper position ? In both horse and dog, I consider the plaster of paris bandage the best means. Hoiv do you apply the plaster of paris dressing ? Unless considerable swelling is present, a permanent dressing is applied as follows : Wrap around the affected part a thin layer of cotton ; place over it a flannel bandage and over this the plaster of paris dressing. In the horse it is not necessary to apply the first layer — that is, the cotton. How do you treat a recent simple fracture ivith considerable swelling of the adjacent soft parts ? Here a permanent dressing cannot be applied, therefore a temporary one should be used, consisting of padding the parts with cotton, placing over this a flannel bandage ; the DISEASES OF BONES 169 "broken parts being besides this braced by stays or splints of binder's board, wood, or in tlie horse, band iron, snch as is nsed in barrel hoops, held in place by the flannel bandage. Such a part is now kept moist with evaporating lotions until the oedematous state has disappeared, enabling one to apx)ly a permanent dressing at the end of the third to the fifth day of such treatment. What precautions do you tahe in applying a plaster of parts dressing 9 1. Apply the plaster bandage uniformly and not too tightly. 2. Watch the skin and parts at the lower end of the plaster dressing for any swelling ; when this shows — in other words, when oedema of the lower parts occurs — ease the dress- ing, in case of a temporary one, or remove it and apply a new one in case of a permanent dressing. 3. In dogs, it is essential to apply a cotton padding to all projecting parts to be covered with the plaster dressing, as the pressure continuously applied to the skin by the dressing would lead to gangrene and constitutional disturbances. Should necrosis of the skin really set in, treat the parts anti- septically. 4. Immobilization of the fractured bone being a requisite,, envelop the joints above and below the point of fracture with the dressing wherever possible. The shape of certain parts renders it very difficult to securely apply a plaster dressing, as, for instance, in the forearm or thigh, the dressing here having a tendency to slip down ; in these instances, run the plaster bandage over the back, forming a saddle, so to speak^ this latter holding the dressing in place, preventing it from slipping. 170 PEINCIPLES OP VETERINARY SURGERY What other precautions are necessary to secure healing of a fracture 9 Keep the animal quiet. Put the horse into a narrow stall and in slings, provided these do not irritate him. It is sometimes wonderful how a colt or horse, when turned into a box stall after his leg is properly set, will nurse it. The judgment of the surgeon is decisive here. Hoiv soon can you remove the permanent plaster of paris dressing 9 In the horse, in six to twelve weeks ; in the dog, in about four weeks ; and in birds, about fourteen days. Hou) can you encourage callus formation hy internal medica- tion 9 Give horses once daily one-quarter to one-half grain of phosphorus ; the dog, 1-200 to 1-100 grain. If you throw a horse for an operation and he hreaks a hone at the tim^e, what prophylactic steps must you take previous to throwing him and ivhile throiving him to escape a verdict of guilty in case the owner of such a horse sues you for damages 9 Three classes of horses demand our attention here : the highly -bred horse (runners, trotters, etc.), the highly-fed draft horse and the old horse. The first two are likely to fight and wriggle around viciously as soon as they are laid down, subjecting themselves to fractures and a struggling myositis ; the last one — that is, the old horse — is predisposed to fractures of the vertebrte by reason of ankylosis and senile atrophy of the vertebral bones. Whenever possible, operate the old horse in the standing posture and only lay him down when absolutely necessary. DISEASES OF BONES 171 The following plan, of course altered according to cir- cumstances, has given me splendid results : The horse which is to be laid down is given an aloetic purge, provding that his condition permits it. The day he enters or when at the home of the owner he is given a liberal water diet and fed a moderate amount of bran mash and no hay. The second day he is given an armful of hay in the morning and one bran mash in the evening ; as a rule, they do not care to eat very much anyway on account of the aloetic purge. On the third day he is operated, not getting any food but a little water when to be operated in the morn- ing, or a bran mash for breakfast and some water at dinner when to be operated in the afternoon or evening. Of course modifications must be made to meet the various conditions of the patient and of the surgeon's practice. The animal is to be thrown upon a soft bed and in a place affording sufficient space and light. The throwing harness should have a belly-band and a halter, by means of which the animal's head can be checked up sufficiently to prevent undue curving of the spine. In other words, the head and neck ought to be stretched out nicely when it is down. Undue lateral motions with the haunches and head are overcome by having someone hold the head properly and someone sitting upon the hip region. In case of all painful and prolonged operations the animals must be chloroformed, otherwise local anaesthesia is indicated. Will such precautions relieve the surgeon of all responsibility? Fractures will occur even under these circumstances, as experience teaches that the throwing of horses is not without danger to the animal. 172 PKINCIPLES OF VETEEINART SUEGERY How do you treat complicated fractures 9 Formerly compound fractures necessarily were looked upon as exceedingly dangerous accidents, but antiseptic surgery has taught us how to disinfect a wound and thus. reduce septic dangers to a minimum. The treatment of com- pound fractures differs radically from that of a simple or- subcutaneous fracture, by reason of the fact that the former- is complicated by a wound and therefore exposed to septia sequels. The sine qua non in the treatment of a compound fracture is exhaustive disinfection of the wound of the soft parts and drainage when necessary. 1. "When the wound of the integument is small and clean^ disinfect it ; set the fracture, apply an antiseptic dressing ta "wound and over it place the plaster of paris bandage. 2. When the fracture is complicated with decided lacera-^ tion of the soft parts, bony fragments perforating the skin or a joint open, disinfect every nook and corner of the wound, trim the sharp points of the bony fragments, ligate bleeding^ vessels, cut away contused tissues, remove foreign bodies, etc. ;. make counter-openings for drainage, arrange the bony frag- ments, suture the cutaneous wound as far as possible, pre-^ viously tamponing the wound cavity with iodoform gauze, and apply a temporary dressing, changing it at regular inter- vals. The plaster of paris bandage in these cases is to be applied as soon as the wound is healed. 3. Fractures with septic infection — that is, those older- than one or two days — are also " purified '* and best treated by continuous irrigation, applying such a temporary dressing- as will permit of limited disturbance of the bony fragments. 4. Fractures "where the parts are simply ground to pieces.. or those where the dangers of a general infection is marked. Thorough disinfection is to be tried, and when insufficient^ DISEASES OF BONES 173 as a last resource, amputation of the affected parts is neces- sary. When are the above principles applicable in veterinary surgery ? The veterinarian is occasionally called upon to extend such treatment to pet dogs, or larger animals which on account of their value as producers are worth the expense of such a treatment. Which fractures in the horse are of special interest to the practitioner ? 1. Fracture of the external angle of the ilium. Inspec- tion : Rounded appearance of that portion of the pelvis, swinging-leg lameness. Palpation : No crepitation, and absence of external angle of ilium, as the hony fragment is drawn down and inwards. Prognosis favorable. Time re- quired, four to six weeks. 2. Fracture of the shaft of the ilium. Inspection : Swinging-leg lameness, possibly swelling of that half of the pelvis. Palpation : Crepitation, usually by rectal examina- tion or by placing one hand over the region of the hip and the other one against the ischial tuberosity and causing the liorse to step over. Prognosis doubtful. 3. Fracture through the obturator foramen. Inspection : Supporting-leg lameness. Palpation : Crepitation on rectal examination. Prognosis doubtful. 4. Fracture of the pubis. Inspection : Supporting-leg lameness, possibly swelling under the belly (scrotum, udder). Palpation : Crepitation, not always detectable. Prognosis doubtful. 5. Fracture of external branch of the ischium. Inspec- tion : Little or no lameness, region of hip joint bulges out. 174 PEINCIPLES OP VETERINARY SURGERY Palpation : Crepitation, usually pronounced. Prognosis doubtful. 6. Fracture of the tuberosity of tlie ischium. Inspection: Swinging-leg lameness ; before swelling sets in, the affected region appears broader, later there is swelling, involving- rectum and vagina. Palpation : Crepitation more or less marked. Prognosis doubtful. 7. Fracture in the cotyloid cavity. Fractures through or close to the symphysis pubis almost invariably demand an unfavorable prognosis (for details, see my work on ''The Clinical Diagnosis of Lameness in the Horse '"). 8. Fracture of the os suffraginis. Due to jumping and missteps, sudden turning, slipping, etc., the fracture may be a comx^lete or, as is quite frequently the case, only a fissured one. Inspection: Supporting-leg lameness, possibly deform- ity and abnormal mobility. Fissured fractures, while caus- ing severe lameness, still permit the animal to support some weight. Palpation : More or less crepitation and abnormal mobility; artificial rotation produces great pain. In fissured fractures, palpation along the extensor pedis tendon may elicit a painful line, switching off to one side or the other (usually the outer one). Prognosis : In complete fractures, doubtful ; in fissured fractures, healing with a plaster of paris dressing may occur in six to eight weeks. 9. Fracture of the os corona ; fracture of the os pedis. The same rules, generally speaking, apply to those as given, under fracture of the os suffraginis. 10. Fracture of the femur. Due to falls, drawing the hind leg up as high as the elbow when tying the animal for operations. Lameness is severe. Crepitation usually well marked, also abnormal mobility. Prognosis is unfavorable^ DISEASES OF BONES 175 ■unless it be simply a fracture of the trochanter, when it is favorable. 11. Fracture of the tibia. Often the consequence of kicks upon the internal aspect of the limb ; it may follow also a fissured state of the bone, a complete fracture being the result of the lying down and rising or working of the animal. The symptoms of a complicated fracture are most common. Crepitation and abnormal mobility. Fissured fractures are difficult to diagnose ; when there is good reason to suspect one, treat as such. , 12. Fracture of the vertebral column. May follow a previous fissured state or occurs when down and unable to get up, as the result of excessive action of the ileo psoas and longissimus dorsi (excessive upward curving of the back) or from excessive bending of one side only. As a result of the injury to the spinal cord by the fractured bone, paralysis sets in, the animal is unable to rise and does not react to needle pricks. When happening during an operation, a peculiar crunching sound is heard ; otherwise I have never been able to detect crepitation or abnormal mobility. Prognosis is unfavorable. 13. Fracture of the ribs. Due to blows of some sort. Those following kicks are often complicated fractures. In- spection may reveal a depression or swelling. Palpation : Pain ; crepitation is rarely detected, but a crackling sensa- tion, due to subcutaneous emphysema, may be observed. Pleurisy, pneumonia, pneumothorax, etc., are likely to follow perforating fractures. Prognosis : In simple fractures, which are often only surmised, it is favorable, and four to six weeks' rest are sufficient ; in complicated fractures it is at times doubtful, and when not followed by death, fistula of the ribs may remain. 176 PKINCIPLES OP VETERINARY SURGERY 14. Fracture of tlie inferior maxilla. Of doubtful prog- nosis are transverse fractures of the brandies of the bone, mainly characterized by more or less crepitation, abnormal mobility, swelling, disturbed mastication. Fractures through, the union of the branches at their inferior extremity usually heal in one month. Describe the most important fractures in the dog. 1. Fracture of the scapula. Follows falls and being run over. Parts most frequently involved are the neck and coracoid process. Prognosis is favorable. 2. Fracture of the humerus. Usually involves lower third of bone. The prognosis of subcutaneous fractures is usually a favorable one. The plaster of paris bandage, in this as well as in fracture of the scapula, should be run around the chest and over the back like a saddle to prevent slipping and to immobilize the parts properly. 3. Fracture of the radius and ulna. In most cases both, bones fracture at the same time and mostly at the lower third. In solitary fractures of the ulna the olecranon is usually the part that breaks. Unless the fracture is badly complicated, the prognosis is favorable. While not abso- lutely necessary, I prefer to saddle the back with the plaster of paris bandage in these cases. 4. Fracture of the carpus is usually a simple one and has a favorable prognosis. 5. Fracture of the metacarpal bones occurs usually at the middle or lower third. Unless seriously complicated, they have a favorable prognosis. 6. Fracture of the phalanges. These are usually com- plicated, being mostly the result of the animal being run over. Prognosis even here is good, as the smashed toe is easily re- amputated, not interfering with the animal's usefulness. DISEASES OF BONES 177 6. Fracture of tlie pelvic bones. The most common cause consists in being run over, also kicks, falls, etc. The shaft of the ilium, its external angle and region of the coty- loid cavity are quite frequent, while of course the other pelvic bones are also, but less commonly, found fractured. There may be paralysis as well as the other symptoms peculiar to fractures. Prognosis is doubtful or unfavorable. 8. Fracture of the femur. This fracture heals less kindly, it being difficult to immobilize the parts, requiring at least four weeks. Most fractures occur at the lower third, next comes the upper third and finally the middle third of the bone. 9. Fracture of the tibia and fibula. This one has a more favorable prognosis than that of the femur. The part in- volved is usually the lower third of the bone. 10. Fracture of the tarsus, metacarpus and phalanges. The metatarsus usually breaks in the upper and middle third; the tarsus is less often fractured, while the i^halanges exhibit m.ostly a complicated fracture. In these, the same rules hold good as in the corresponding bones of the forelegs. 11. Fracture of the inferior maxilla. This one, as well as fractures of the bones of the head, is quite rare. The frac- tures of the inferior maxillary bones more commonly are found at the union of the inferior extremity of the branches (prognosis favorable); further, in the region of the canine tooth. Transverse fractures of this locality are often difficult to treat and may require excision of the bony fragment. 12. Fracture of the vertebral column. These are, on the whole, seldom encountered excepting those of the coccygeal vertebrse, the treatment of which consists in amputation of that part of the tail. Being almost invariably the result of "being run over, or getting pinched in between a door, the 178 PRINCIPLES OP VETERINARY SURGERY cervical and lumbar vertebrae are those most exposed to fractures, wbicli, leading to paralysis, leave no hope for a successful treatment. 13. Fracture of the ribs. Usually more than one rib is broken. A favorable prognosis can be offered unless such complications as pleurisy or pneumonia are present or to be expected. This fracture exceeds 'in frequency those of the vertebral column. 14. Fracture of the sternum. Seems to be exceedingly rare. Inflammation of Bone. From a practical standpoint, which are the most important structures involved in bony inflammations 9 The most important is the periosteum in animals ; next, the osseous tissue proper ; finally, the marrow. How do you term inflammation of the periosteum, bony sub- stance and marrow ? Periostitis, osteitis, osteomyelitis. Do inflammatory processes of bones differ materially from those of soft parts ? They do not, since the osseous tissue exhibits no material difference from the soft parts, practically speaking, being soft parts rendered firm by the addition of lime salts. For this reason injuries and diseases of bones are, on the whole, of like character and run about the same course as similar injuries and diseases of soft tissues. Depending on the course of the disease, lohat variety of inflam- mations are considered in bony inflammations f These inflammations run either an acute or chronic course. DISEASES OF BONES 179 Depending on the cause of the disease, luJiat variety of inflam- mations are considered in hony inflammations 9 The causes may be traumatic (due to external assaults), specific (as tuberculous, glanderous, etc.), hematogenous (originating in the blood), septic and aseptic, primary and secondary. Periostitis. What is periostitis ? Inflammation of the highly nervous and vascular fibrous membrane covering the bone, termed j)eriosteum. What forms of periostitis are of interest to the surgeon ? 1. Acute, aseptic or traumatic periostitis. 2. Chronic ossifying periostitis. 3. Acute purulent periostitis. ■4. Chronic purulent periostitis. 5. Chronic fibrous periostitis. Describe acute aseptic periostitis. This form of j)eriostitis is the result of contusions, blows, as kicks, interfering, pressure from the bit upon the inter- dental space, or is seen as a consequence of simple subcu- taneous fracture, and, as the name indicates, runs its course without the presence of pus producing bacteria in the affected tissues. What are the symptoms of acute aseptic periostitis ? The periosteum being highly endowed with nerves, pal- pation elicits decided pain and circumscribed doughy swell- ing. When affecting bones of the extremities, there is lameness, or when involving the interdental space of the lower jaw, the animal will not tolerate the bit, is more or less head shy, etc. 180 PRINCIPLES OF VETERINARY SURGERY How do you treat these cases ? Rest to the parts ; when possible, warm moist applica- tions, blisters. Describe chronic ossifying periostitis. In this form the products of inflammation become ossi- £ed, showing that the inflammatory process mainly involves the deeper layer of the periosteum — that is, the osteogenous layer inhabited by the osteoblasts ; the form is a sequel of acute asej)tic periostitis playing such an important role in the ■callus formation of a simple fracture. What are the causes of chronic ossifying periostitis ? Repeated traumatic irritation of the periosteum. What are the symptoms of this form of p)eriostitis ? In due time a bony growth appears, variously known as ■osteophyte, exostosis ; previous to the full development of this bony deposit there is pain on palj^ation, more or less doughy swelling, possibly lameness, etc. Which hones most commorily imdergo chronic ossifying periostitis ? The bone most commonly affected is the metacarpus of the horse ; here the exostosis is termed a splint and appears almost invariably between the small and large metacarpal bones on the internal face of the shin bone ; the exostosis about the tarsus is known as spavin. Animals with certain malpositions of the limbs are predisposed to a chronic ossify- ing periostitis, leading to a bony growth termed a " periar- ticular ringbone." In these cases the periosteum is con- tinuously irritated by being tugged upon by the ligaments of the joint, the result of the faulty position of the hoof. A similar explanation holds good in splint formations. In DISEASES OF BONES 18L chronic alveolar periostitis the tooth becomes united to the alveolar wall, rendering extraction at times very difficult. In horses suffering with chronic bursitis intertubercularis, bony deposits upon the humerus are found. How do you treat ossifying periostitis 9 By blisters and the actual cautery, and when they fail,, by neurectomy. Describe acute purident periostitis. In this form, pus-producing bacteria enter the periosteum from without — that is, through a wound of the overlying soft parts, as, for instance, in complicated fractures ; or the bacteria reach the periosteum from within, as in purulent myelitis ; or the infectious agent gets to the periosteum through the blood current, the periosteum in such a case representing a secondary or metastatic focus. How do you treat these cases ? By incision and antiseptic irrigations and dressings. What is a subperiosteal abscess 9 An abscess formed under the periosteum, the result of a j)urulent infection of the marrow (purulent osteomyelitis). Its treatment consists of incising the abscess and antiseptic injections. Describe chronic purulent periostitis. In complicated fractures this form of periostitis, a sequel to acute purulent periostitis, is quite frequently seen, there- fore, in complicated fractures of the ribs, pelvis, etc., as also in injuries to the interdental space by pressure from severe bits and curbing, in alveolar periostitis. Fistulous tracts are the consequence, because this form of periostitis leads to necrosis of bone and as the result of this to fistulous states, 182 PRINCIPLES OF VETERINARY SURGERY the dead piece of bone keeping up the irritation and thus furnishing active material for a purulent discharge. How do you treat chronic purulent periostitis ? This depends on the parts involved. Thus, in alveolar periostitis with empyema of the maxillary sinus, the sinus is trephined and the offending tooth removed. In other in- stances an incision is made down upon the diseased structures and the necrotic bit of bone removed by curetting, etc. Describe chronic fibrous periostitis. In this form a fibrous callus is formed, which by its pressure leads to atrophy of the underlying bone. In this instance the inflammation involves the upper layer of the periosteum, which, not being equipped with osteoblasts, can not ossify the products of inflammation, being a chronic connective tissue proliferation pure and simple. Its most common seat is right on top of the nasal bones, the result of pressure from the noseband of the bridle. Inflammation of the Osseous Tissue. Which histological structures does infiammation of the osseous tissue involve 9 The Haversian canals, spaces and canaliculi. What course does osteitis usually take 9 Almost invariably a chronic course. What are the causes of osteitis 9 The most frequent causes are pressure and contusions ; specific ones, as tuberculosis, actinomycosis, complicated fractures, the extension of inflammation from some other structure : for instance, from the marrow or periosteum. DISEASES OF BONES 183 What forms of osteitis are of interest to the surgeon 9 (1) Rarefying osteitis, (2) ossifying osteitis, (3) fungous osteitis, (4) deforming osteitis. Describe rarefying osteitis. This form of osseous inflammation is also known as osteoporosis. It is a degenerative osteitis, and usually the result of intensive or infectious processes ; it may exist alone or in combination with ossifying osteitis — that is, certain centers may exhibit a rarefying osteitis while the adjacent bony tissue undergoes an ossifying osteitis. Rarefying osteitis serves also to limit infectious processes, and further, to expel necrotic bone. Describe the changes taking place in the osseous tissue in rarefying osteitis. Following the inflammation there is an exudate. This exudate enters the Haversian canal, sj)aces and canaliculi; proliferation of the cellular elements takes place and thus embryonic tissue formation. As the result of the action of the osteoclasts, the bone undergoes rarefaction — that is, thinning ; granulation tissue becomes more and more abund- ant, gradually taking the place from which the bony sub- stance has been removed by the osteoclasts. The solution and removal of the bone does not occur uniformly, but irregularly here and there. Describe ossifying osteitis. This form of bony inflammation is also known as osteo- sclerosis. It is the opposite of rarefying osteitis, as it repre- sents a regenerative process and is usually the result of slighter and continuous — that is, chronic — irritations. Ossi- fying osteitis serves to render denser and stronger bony tissue 184 PRINCIPLES OF VETERINARY SURGERY wliich has been weakened by previous disease. Tlie inflam- matory process being ratlier sluggish, a process closely resembling physiological bone-growth is observed. It starts mainly from the Haversian canals, these becoming narrower and consequently the bone denser and stronger. Name examples of ossifying osteitis. It is seen in the development of the spavin, in the final changes of the callus of a fracture. Describe fu7igous osteitis. This accompanies specific diseases, such as tuberculosis, glanders. Tuberculosis of bones is of hematogenous origin. The infected granulations are exuberant, often being of a fungoid nature. Osteomyelitis and caries are always present. Describe deforming osteitis. This represents a chronic inflammatory process, leading to an unnatural form or shajDe of the bone involved, due to softening, hypertrophy, etc. Give an exam]Dle of deforming osteitis. The spavin. Osteomyelitis. What forms of osteomyelitis are to be considered ? Ossifying and purulent myelitis. Wliere is ossifying osteomyelitis seen ? In fractures. Wlien is purulent osteomyelitis seen ? In complicated fractures and infectious diseases, as in tuberculosis, for instance, or when pus-producing bacteria^ invade the bone marrow. In these two instances it is of DISEASES OP BONES 185 hematogenous origin ; that is, tlie infectious agents are hrouglit to the marrow by the blood current. Which form of osteomyelitis is the more common one ? Purulent osteomyelitis. Describe the changes taking place in osteomyelitis. At first the marrow appears dark red, due to hyperemia ; this is followed by absorption of the fat cells of the marrow, thus changing the yellow marrow into the juvenile or red marrow, which either organizes into bone tissue, filling the medullary canal as in callus formation of fractures, or when infected undergoes suppuration. In this case the adjoining bone tissue becomes involved and a rarefying osteitis is the result. As soon as the infectious material reaches the periosteum it is irritated by the infectious agent and an ossifying periostitis with subsequent exostosis follows, to be destroyed by the rarefying osteitis. As a result of this the ossifying periostitis becomes a purulent periostitis, the neighboring soft parts become infected, an infectious cellulitis ensues, and the pus thus eventually reaches the external world. Give exam^ples of purulent osteomyelitis. It is seen in the inderdental spaces of the horse as the result of pressure from severe bits in pullers ; also in connec- tion with alveolar periostitis in diseases of the teeth. Necrosis of Bones. What is necrosis of hones ? Death of the whole bone or part of the bone. 186 PRINCIPLES OF VETEEINAEY SURGERY Name the causes of hone necrosis. It is usually the result of a disturbed circulation of the "blood caused by (1) traumatism, (2) inflammation. Hoiu do traumatisms produce necrosis ? Suppose that an animal is kicked and a complicated frac- ture the result. Bony splinters in such a fracture are no longer supplied with nutriment, as their blood supply is inter- rupted. Being a complicated fracture — that is, one infected by pus-producing bacteria — these bony fragments become necrotic. In subcutaneous bone wounds, or, for that matter, bone wounds which are not infected — that is, in an aseptic state — small bone splinters will be absorbed. How does inflammation produce necrosis ? Most commonly necrosis follows infectious inflammatory processes which may either arise in the bone or invade it from adjoining tissues. The former, for instance, are repre- sented by purulent periostitis and osteomyelitis as seen in the inderdental sj^aces of horses bitted severely or inclined to pull, or in the latter it reaches the bone by continuity ; for instance, in severe inflammation of the pododerm the os pedis — that is, a portion of it — may undergo necrosis. In severe phlegmonous states of the muscles and fascise overlying the dorsal vertebrae, as is seen in fistulous withers, some parts of the vertebrae may undergo necrosis, etc. What do you understand hy caries ? The slow death of a part of a bone with softening, solution and partial absorption of the same, almost invariably due to specific infections, especially tubercular osteomyelitis and osteitis. It is a form of necrosis. DISEASES OF BONES 187 What do you understand by necrotic caries 9 The separation or expulsion of dead bony fragments of a carious bone. What is dental caries 9 Seen at times in the molar teeth of the horse, it represents a progressive destruction of the dentine and cement of such a tooth. Sow is dental caries produced 9 When the enamel of the tooth is injured, destructive agents (bacteria, decomposing food) enter and exert their per- nicious influence upon the dentine and cement substance. Is there any difference hetiveen dental caries and alveolar periostitis 9 Decidedly. They are two entirely different pathological processes, as dental caries may eventually lead to alveolar periostitis, but alveolar periostitis can never produce dental I caries, at least in the sense in which caries is here, according to modern views, employed. Dental caries usually starts at the crown of the tooth, working upward toward the root, "while alveolar periostitis begins at the periosteum of the alveolar cavity and root of the tooth. £>o all aidhors accept the above definitions of necrosis and caries 9 Most modern authors on pathology recognize the above definition as compatible with progressive medicine, while some authors yet understand by necrosis destruction of bone in mass, while by caries is understood by them molecular death of bone. 188 PKINCIPLES OF TETEEINARY SURGERY Why is the definition of caries, ^'Molecular death of honey** incorrect 9 According to recognized teachings of to-day the cell is tli& unit of life and not the molecule. Consequently, it is only a. cell or a group of cells which can die, and not the molecule. Of course by the misnomer " molecular death '^ those employ- ing this faulty combination mean to say that death of a small portion of an orgar) has taken place. Wliat forms of necrosis are of practical interest ? (1) Superficial, (2) deep. What is a sequestrum ? \ A piece of dead bone surrounded by living tissue. Describe the process of sequestration in deep necrosis. A necrotic piece of bone is a foreign body and thus acts as an irritant to the adjacent tissues, in this instance healthy osseous tissue surrounding it. Necrosis of bone and gangrene- of soft tissues are analogous; in a similar way as soft gangren- ; ous tissues are cast off soft healthy tissues by a line of granu- lations, the so-called line of demarcation, a line of granulation; springs up around and close to the necrosed bit of bone as the result of a granular osteitis. Now the salutory effect of a rarefying osteitis makes itself felt by dissolving and loosen- ing the dead piece of bone from the healthy bone, giving the. necrotic piece at the same time a worm-eaten appearance upon its surface ; while this is going on an ossifying periostitis and osteomyelitis develop around the site occupied by the dead piece of bone. Consequently new bone in the shape of an envelope forms, encasing the loosened piece of necrosed bone. This bony case containing the sequestrum and, of course, pus, is termed involucrum. This involucrum now is attacked by DISEASES OF BONES 189 tlie rarefying osteitis, which destroys it here and there, mak- ing openings into it through which the pus and sequestrum may be gotten rid of. The openings in the involucrum, the result of the rarefying osteitis, are termed cloacae. In time the soft tissues surrounding the sequestrum may undergo gangrenous changes and the pus and bony fragments reach. thb external world at the point of least resistance, at which, moment a fistula is established. What is an exfoliation ? A superficially located sequestrum, the result of a super- ficial necrosis. Sow do you treat hone necrosis 9 The essential feature consists in the removal of the necrotic fragment. For this purpose the chisel, the curette or the trephine may have to be employed. As a rule, caustic injections and even the actual cautery are less desirable. Atrophy of Bone. What is atrophy of bone f A decrease in size of the bone without change in its osseous structure. What forms of bone atrophy are recognized ? 1. Concentric : The thinning progresses from without to Tsrithin, as a result of which the diameter of the shaft becomes lessened. 2. Excentric : The thinning progresses from within to "without. Give examples of atrophy of bones. In sheep the cranial bones may become thin as paper as the result of the pressure upon the bone by the coenurus cere- 190 PRINCIPLES OP VETERINARY SURGERY "bralis; by pressure from keraphyllocele upon the os pedis the latter wastes. The pressure of an aneurism against the verte- bral column produces thinning of the latter, etc. In chronic lameness, such as from spavin or ringbone, not only wasting of certain muscles sets in, but also an inactivity atrophy of the metacarpus or metatarsus. Senile atrophy of bones leads to fractures of the vertebral column when aged horses are thrown for operations. In such diseases as actinomycosis and osteoporosis, osteo- malacia, etc., an inflammatory atrophy is seen as a sequel to a rarefying osteitis, the atrophic changes being the result of the action of the osteoclasts. Hypertrophy of Bone. What do you understand hy hypertrophy of hone ? An increase in size of the bone without change in the osseous structure. What forms of hone hypertrophy are recognized ? 1. Exostosis : It represents a circumscribed hypertrophy. This neoformation has no sharply defined boundaries, but gradually merges into the osseous tissue from which it springs. 2. Osteophyte : Also represents a circumscribed hyper- trophy, being just as much the product of an ossifying- periostitis as the exostosis, but its boundaries are sharply defined and the osteophyte makes the impression as if it could be readily separated from the bone from which it springs. 3. Hyperostosis : Represents a diffused hypertrophy ; in other words, a larger bone area is involved in the hypertrophic change. 4. Osteosclerosis : Represents a hypertrophy arising in the marrow of the bone, while those previously spoken of origi- nate in the periosteum. I, DISEASES OF BONES 191 What is Leontiasis ossea 9 This represents a congenital hypertropliy where the facial and cranial bones are hypertrophied. Seen in horses (so-called bull heads) and in dogs. Rachitis (Rickets). What is rachitis ? A constitutional disease, primarily characterized by soft- ening and distortion of the bones of young animals. What are the causes ? They are obscure. Some authors claim a specific infec- tion ; others heredity, unhygienic conditions, a deficiency of earthy salts in the food, etc. Describe the changes taking place in the rachitic hone. There is chronic hyperemia of all the bone-forming tis- sues. The periosteum thus exhibits thickening in the bone- forming layer, giving the bone a thick and heavy appearance. The tissue proliferation arises in the osteogenous layer of the periosteum, remains soft for a long time and is late to calcify. The insertion of muscles are the best places to observe these periosteal proliferations. An insufficient amount of lime salts in the excessively developed cartilage at the epiphyseal line, as well as the indiscriminate distribution among one another of medullary tissue bone and cartilage, is a peculiarity. These changes do not confine themselves to the epiphyseal line, but may render the shaft of the bone distorted and soft that it may be cut with a knife. What are the characteristics of a rachitic hone ? Abnormal development at the epiphysis near articulating surfaces, distortion of the long bones and vertebral column, 192 PRINCIPLES OP VETERINARY SURGERY bones of the head, a row of beaded enlargements at the union of ribs and costal cartilage, etc. What symptoms does the living rachitic anivoal exhibit 9 The animals more commonly exhibiting this disease are swine ; next dogs, birds, and more rarely the colt and calf. The creatures appear poorly nourished, they walk stiffly, may stagger and tire easily. The knee, hock, stifle, fetlock may be swollen and is tender on pressure. How do you treat rachitis 9 Establish hygienic conditions by changing food, stabling, etc. Prescribe a tonic treatment and phosphorus; horse, from -J to 2 grains ; dog, 1-20 to 1-120 grain. Osteomalacia. What is osteomalacia ? A constitutional disease of grown animals, characterized by softening and fragility of the bones. What animals are most exposed to it ? Mainly cows yielding a great deal of milk. What are the causes of osteo^malacia ? They are obscure. It is met with on high and low lands when fed the best of food or when succulent and watery on calcareous soils and those deficient in lime. The three theories as to its nature at this day are : 1. A process of decalcification of the bones pure and simple. 2. A chronic inflammation of the bone. 3. Infectious disease. DISEASES OF BONES 193 Describe the changes in an osteomalitic hone. The pelvic bones and those of the limbs are of special interest. In the beginning, there is simply hyperemia of the affected bone, small hemorrhagic foci being noticeable on. section of the bone. As the disease jifrogresses the hyperemia state becomes marked, the bone on section exhibiting bloody extravasation in the marrow and red punctation on the bone. When the disease advances yet more the bone becomes soft. The bone cells are replaced by fat cells. In short, the bone tissue degenerates until it becomes medullary tissue; the latter, increasing in bulk, becomes fatty, taking the place of bone tissue proper. Outline the symptoms of osteomalacia in the living animal. Perverted appetite, general depraved appearance. The creatures lie down a great deal, they are hide bound, the ani- mals walk stiffly. In well advanced cases, fractures, distor- tions of the bones of the pelvis and legs are common. Hoiv do you treat osteomalacia ? Change the diet to one rich in lime, give phosphorus with oil in doses of from 2 to 3 grains for cattle. In man the removal of the ovaries and testicles has given splendid results in the treatment of osteomalacia. Osteoporosis of the Horse. What is osteoporosis ? It is a rarefying osteitis, a form of osteomalacia peculiar i;o the young and adult horse. What are the causes ? They are obscure. A great many facts point toward a microbian origin, the pathogenic bacterium either acting as 19-i PKINCIPLE.S OF VETERINARY SURGERY the irritant by directly invading the system, or a toxic agent enters some way or other. I have seen hundreds of cases in the South, but do not believe in a direct contagion. I think that accessory causes, by interfering with bone nutrition, j)re- dispose the creature to succumb to an invasion by a pathogenic germ, or some other toxic agent; as such accessory causes may be mentioned unwholesome stables, as are frequently met with in cities, faulty food, etc. While this disease has been frequently observed in the large cities, I have seen but three cases of osteoporosis in the past live years in Milwaukee, and two of these horses came to the city suffering with the dis- ease, while the third, a pony, was in town about one year before my attention was called to its "big head." Describe the symptoms of osteoporosis. Its beginning is often insidious. As a rule, the animal soon becomes fatigued, sweats easily and has a poor and irregular appetite. Or the animal is brought to you on account of a lameness. The vast majority of cases seen by me were either shoulder, hip or stifle lame. Other animals are stiff, experience difficulty in lowering the head, walk stiffly, stumble easily, the long bones of the extremities may enlarge. Synovial distention about the various joints is an early symp- tom. A close study of the bones of the face usually shows in the earlier stages of the disease a rounded state — that is, a bulging of the nasal and superior maxillary bones; and when one hand is rested upon the nose and the other hand against the chin, now making lateral motion with the lower jaw — that is, grating the teeth upon each other — a dull, muffled sound is produced. Fractures and distortions are common. How do you treat osteoporosis 9 A change of climate gives the best result, even if it DISEASES OF ARTICULATIONS 195 1)6 no more tliaii placing the animal into another barn; good food, lots of sunshine, no undue exposure or excess of work, bone dust and small doses of phosphorus are valuable adjuncts. DISEASES OF ARTICULATIONS. Arthritis. W hat is arthritis 9 Inflammation of a joint. What structures of a joint may he affected in arthritis 9 The most important one is the synovial membrane. This is a serous membrane encapsulating the joint and analogous to the peritoneum or pleura. When inflamed it is termed synovitis. But the inflammation of arthritis does not only confine itself to the synovial membrane, but may involve the bone, cartilage, ligaments and tissues about the joint. Depending on the cause of arthritis, luhat forms are recog- nized 9 Traumatic, septic, infectious and aseptic arthritis. What other forms of arthritis occur 9 Arthritis the direct result of an assault is termed primary. When the sequel of a contagious inflammation, it is known as secondary. It is termed hematogenous or metastatic *vhen the irritant is carried there by the blood, as in infectious dis- eases; viz. : contagious pleuropneumonia, septicemia, etc. Acccording to the course of the disease, luhat forms of arthritis- are established 9 Acute and chronic arthritis. 196 PRINCIPLES OF VETERINARY SURGERY What is polyarthritis ? That state wliere several joints are inflamed at the same time, as in rheumatism, pyemia, etc. What is monarthritis ? That state where only one joint is inflamed. What is specific arthritis ? An arthritis the result of a specific infectious disease, as glanders, tuberculosis, etc. What is periarthritis ? Inflammation of the tissues surrounding a joint. How do you classify arthritis from a clinical standpoint f Serous arthritis (arthritis serosa). What is serous arthritis 9 Inflammation of a joint with a serous exudate into the joint cavity. W hat two main forms of serous arthritis are known ? Acute and chronic. What are the causes of serous arthritis ? Contusions and distortions, certain diseased states, as retention of the afterbirth, rheumatism. Describe acute serous arthritis ? Usually the result of a distortion or contusion of a joint leading to an aseptic inflammation, especially of the fetlock, hock and stifle ; followed by increased heat, decided pain and circumscribed fluctuation about the joint. In serous polyarthritis due to articular rheumatism there is in addition to the above symptoms also a decided elevatioa -of the temperature of the body. DISEASES OF ARTICULATIONS 197 What becomes of the exudate poured into the joint cavity a» the result of a serous arthritis ? It is either absorbed, or, when remaining, chronic serous arthritis is the consequence. Describe chronic serous arthritis. It is either found in joints predisposed to it by heredity (the joint is of a sluggish disposition and limited assaults affect it readily), or the sequel of an acute serous arthritis. This condi- tion, also termed galls, is common in the hock, stifle and fetlock joints of colts. As a rule, this condition does not interfere with locomotion ; the symptoms of an acute serous arthritis are present minus painful states and increased heat about the affected joint. How do you treat acute serous arthritis 9 Rest is essential. In the earlier stages cold applications, bandaging ; later, a warm moisture by Priessnitz fomenta- tions, iodine tincture or blisters are indicated. How do you treat chronic serous arthritis 9 Most any treatment is unsatisfactory, as blisters and even the actual cautery usually give negative results. From time to time favorable reports reach us in regard to the treatment of these conditions by incision of the joint with subsequent antiseptic irrigations. Such treatment, while possible and of great value in man, and which, under favorable circumstances, may be used in the smaller animals — as the dog — nevertheless is, to say the least, a rather hazardous undertaking in the horse by reason of the possibility of a secondary infection,, which is practically an equivalent to a death verdict. 198 PRINCIPLES OF VETERINARY SURGERY Purulent Arthritis (Arthritis Purulenta). Hoiu is purulent arthritis produced ? Pus producing bacteria may reach the joint via the blood current, as in pyemic polyarthritis of calves and colts, or a purulent inflammation of the soft tissues surrounding a joint may extend into the joint by contiguity, or, as is more com- monly the case, pus producing bacteria are carried into the joint through a wound perforating the joint. Describe purulent arthritis. There is high fever and great constitutional disturbance. Pain and heat and a diffused swelling about the joint are marked. In those cases where a penetrating wound was the cause of it, a purulent synovial discharge (opaque, straw color) is seen. Periarticular abscesses may be observed in any case of this sort. Is purulent arthritis a serious condition 9 Decidedly. In the horse these cases are soon complicated with septicemia or septicopyemia, rapidly causing death, especially when the larger joints, such as the stifle or hock, are infected. In case recovery should set in, ivhat cha^iges take place in a joint previously affected with purulent arthritis 9 Anchylosis of the joint will be the result. How do you treat purulent arthritis ? For economic reasons, at least in the larger animals, as the horse, no treatment is attempted. The indications are to puncture the joint, asepticize it, and keep it so by continuous irrigation. In the dog, resection of the joint or amputation can be practiced. DISEASES OF ARTICULATIONS 199' Deforming: Arthritis (Arthritis Deformans). What is arthritis deformans f It is a chrouic aseptic arthritis cliaracterized by a perma- nent and material change of the shape and structure of a joint. What are its causes 9 Usually a traumatism, as contusions or distortions. Her- edity — that is, a predisposition to it — plays an important role; chronic articular rjieumatism. Describe the changes talcing place in arthritis deformans. The disease usually starts in the articular cartilage. The cartilage cells proliferate, thus robbing the cartilage of its firmness. At the point where the articular surfaces come in contact — that is, rub each other — the cartilage is ground down more and more until eventually the epiphyses of the bones touch each other, the balance of the hyaline cartilage — that is, that portion not in actual contact with each other, but more or less free at the margin — also proliferates, forming excrescences. That portion of the periosteum covered by the synovial membrane where the latter is fixed to the margin of the joint also undergoes inflammatory changes by contiguity, as the result of which subsynovial exostoses are formed, read- ily seen or felt, and according to their location variously termed spavins or ringbones. The synovial membrane may in time become thickened as the result of the inflammatory process, this being especially the case at those points where it is fixed to the articular margins. Inflammatory changes, such as thickening of the connective tissue ligaments about the joint, as well as an ossifying periostitis, may become a natural consequence of the inflammatory process originally 200 PRINCIPLES OP VETERINARY SURGERY started in the hyaline cartilage of the articular cartilage^ gradually extending to these structures. What are the terminations of arthritis deformans 9 The pathological changes just described either advance to such an extent that the joint becomes useless or a more favor- able termination sets in by synosteosis. How does arthritis deformans terminate favorably by synoste- osis 9 To begin with, this only occurs in joints with limited motion, as in the tarsus and carpus. The favorable termina- tion lies in the fact that the articular surfaces, bared of their hyaline cartilage by the diseased process, become fused — that is, anchylosed. In such joints as the hip or stifle the free motion prohibits anchylosis ; such animals therefore remain- ing cripples. What articulations are mainly exposed to arthritis defor- mans ? In the horse, the hock joint, where the exostosis is known, as spavin ; the carpus, the stifle joint, the hip, the latter espe- cially in the dog, cattle and more rarely in the horse. Is the spavin aliuays the residt of a true arthritis chronica- deformans ? To be the result of a true chronic deforming arthritis, the pathological lesion must start in the articular cartilage of a joint. No doubt some spavins take their origin from this point. The classical histological studies by Gotti at the same time show that in many spavins the primary pathologi- cal lesions originate in the osseous tissue, and as the result of this primary osteitis a secondary chronic deforming arthritis sets in. This happens as follows : At first there is an osteitis. DISEASES OP ARTICULATIONS 201 of the cuneiform medium and magnum and metatarsus ; this osteitis by contiguity involves the articular cartilage in the inflammatory process, and a chondritis — that is, inflamma- tion of the cartilage — with subsequent proliferation of the cartilage cells, softening, etc., results, which now leads to a chronic deforming arthritis. Another way is this : There is at first an osteitis of the cuneiform medium and magnum, the overlying periosteum inflames and ossifying periostitis with its product, an exostosis — that is, the visible spavin with anchylosis of the articular surfaces — follows. The correctness of Gotti's claims have stood the tests of repeated investigations, also aided by the fact that in many spavins both the articular cartilage and periosteum are normal. The above applies equally well to ringbones. In periarticular ringbones no arthritis at all is present, but we have to do with an ossifying periostitis, the latter taking its origin at the point of insertion of the phalangeal ligaments. How do you treat arthritis deformans ? By rest, blisters and the actual cautery. Of less importance from a surgical standpoint are the fol- lowing forms of arthritis : Describe fibrinous arthritis {arthritis fibrinosa). The serous exudate in this form of arthritis contains an excess of fibrin, as a result of which a slight crepitation can be obtained by palpation. Anchylosis of the articular surfaces. is a frequent sequel. Describe panneous arthritis (arthritis pannosa). A chronic arthritis met with in chronic articular rheuma« tism and old galls, the articular cartilage being covered with vascular granulations which in time bring about fibrous adhe- sions, or, in other words, a fibrous anchylosis. 202 PRINCIPLES OP VETERINARY SURGERY Describe dry chronic arthritis (arthritis chronica sicca). Quite frequently seen in horses and dogs. It is charac- terized by a fibrillary degeneration of the intercellular sub- stance of the cartilage, followed by proliferation of the carti- lage cells, which, breaking down, its surface exhibits an eroded, worm-eaten appearance. As the result of the pressure and rubbing motion by the epiphyseal ends of the bones, the cartilage becomes thinner and thinner until eventually the bone, deprived of its articular hyaline cartilage, is exposed. This form of arthritis is observed in the articular cartilage of joints of animals kept for a long time in the stable on account of serious lameness. It is seen in the beginning of arthritis deformans, etc. Describe fungous arthritis. It is of little practical moment in animals. In birds, where it is more frequently met with, it attacks the joints of foot and wing ; in swine, the hock and knee ; in cattle, knee, stifle and hip joints. It consists of an inflammation of the synovial membrane with fungous -like deposits upon it, as well as necrosis and rarefaction of the bones and cartilage. W hat is articular rheumatism ? A serous polyarthritis due to a general infection. W hat joints are usually affected ? The stifle, hock and carpus. What complication is dangerous and common to it ? Endocarditis. Is it a chronic or acute disease ? While setting in acutely, its course is a chronic one. DISEASES OF ARTICULATIONS 203 Describe the changes in the joints. As a rule, a number of articulations are attacked at the same time (polyarthritis). At first there is a serous synovitis leading in some cases by its chronicity to an arthritis deformans. In the acute cases the synovial membrane is red- dish and swollen. The articular cartilage is also reddish, "becomes later yellowish and has a velvety appearance. The epiphyseal ends of the bones appear reddened and even hem- orrhagic, the marrow showing a similar state. The tissues surrounding the joint are hyperemic and cedematous. In advanced stages the synovial membrane is very much thick- ened, the cavity of the joint may show the changes of a pan- neous arthritis, the articular cartilage undergoes fatty degen- eration and ulceration. A true arthritis deformans is occa- sionally observed. Of other symptoms, those of endocarditis, pleurisy and peritonitis complicate the case. TF hat animals are most subject to articular rheumatism 9 Especially cattle ; more rarely horses, dogs, swine. Sow do you treat articular rheumatism 9 Main reliance is placed upon large doses of sodium salicylate. What is 'pyemic and septic arthritis of the young ? A purulent polyarthritis of metastatic origin, the result of an infection of the umbilical wound of the newly born. Outline the diseased process . Infection of the navel leads to the formation of a purulent thrombus in the bloodvessels of that region ; in other words, there is a purulent thrombophlebitis and thromboarthritis. Little bits of this purulent thrombus break off (embolus) "which, carried away by the circulation, produce a general 204: PRINCIPLES OP VETERINARY SURGERY systemic infection wliicli may be a pyemia or septicemia^ Soon after, a febrile reaction is shown by the animal, tbe^ joints, especially the bock, stifle, bip, knee, elbow, sboulder- joints swell, terminating by abscess formation in tbem. Such, animals live from two to three weeks, when they die with., symptoms of either pyemia or septicemia. Describe the most important changes in septic or pyemic- arthritis. The synovial membrane is red and swollen. The synovia, is increased in quantity and turbid or even replaced by pus. The articular cartilage and even at times the bones ar& necrotic. The tissues surrounding the j oints exhibit abscesses. The other post mortem changes are those peculiar to pyemia, or septicemia. Uoiu do you treat septic arthritis ? The treatment of the affected animal is practically hope- less ; the main feature is prophylaxis, as disinfection of tha- umbilicus and stable. Describe gouty arthritis {arthritis urica). Peculiar to birds, occasionally seen in the dog ; supposed to be the result of an excess of uric acid in the blood and tis- sues, impaired metabolism, etc. It is characterized by deposits of sodium biurate in and around joints. What is periarthritis ? It is an inflammation of the soft tissues surrounding a. joint. Name the soft tissues involved in the inflammatory process. The peritoneum, synovial sheath of tendons and synovial "bursse. DISEASES OF ARTICULATIONS 205 'Give a common example of periarthritis. Periarticular ringbone, taking its origin from the point of insertion of the lateral ligaments of the first interphalan- ,geal articulation. JExplain the nature of a periarticular ringbone. This form of ringbone is the result of a primary chronic ossifying periostitis produced by a tugging upon the lateral ligaments of the joint, such as follows faulty positions of the limb, for instance, in contrast to true articular ringbone, which starts either as a primary osteitis or occasionally as an •arthritis deformans, showing that there is a marked difference laetween articular and periarticular ringbone. Luxation of a Joint. ^fVhat is luxation 9 A permanent separation of two articular surfaces from each other with partial or complete laceration of its liga- ments. What is a subluxation ? A partial or incomplete dislocation ; that is, the articular ■ends are more or less in contact with each other, the liga- ments being rarely torn. What is a simple, what a complicated luxation ? In the former there is no serious damage done to the sur- Tounding soft parts or the bones, the articular ends are not ■exposed to the air ; while in the latter there is serious injury of soft parts or bones, as, for instance, a fracture, the articu- lar ends being in contact with the external air. What is a recent, what an old luxation ? The terms recent and old in this instance are not sug- gestive of the time passed since the accident, but indicate the 206 PEINCIPLES OF VETERINARY SURGERY changes in tlie parts involved. Therefore, in the former the displaced bone is not yet fastened by tissue changes in the place into which it was forced, while in an old dislocation the displaced bone is held firmly in its new location by tissue changes. What is relapsing or habitual luxation ? It is a dislocation recurring frequently and from slight cause. Depending on the cause, tvhat forms of dislocations are recog^ nized f 1. Traumatic dislocations : Due to sudden force. 2. Pathological or spontaneous luxations : Due to inflam- matory and other pathological processes. 3. Congenital dislocations : Due to a congenital malfor- mation of the joint. Hoiu does sudden force produce traumatic luxations ? The joint is either dislocated directly by a blow of some sort, the latter driving the articular ends apart, or external violence may act indirectly in this way : A bone struck at a» distant part transmits the force of this blow to its end, which drives it (the bone) out of the joint. Finally, sudden and severe muscular contraction may be an active cause of luxa- tion by pushing the head of the bone powerfully against the weakest part of the ligaments retaining the articular ends. Give some examples of traumatic dislocations. In the horse, the more common ones, although not as frequent as fractures, are upward dislocation of the patella by sudden powerful contraction of the triceps f emoris, as seen in kickers ; luxation of the cervical vertebrae (not a rare sight when a lot of bronchos undergo training) ; dislocation of the DISEASES OF ARTICULATIONS 207 metacarpo-plialangeal articulation, occasionally seen in run- ners. In the ox ; sacro-iliac articulation in cows dislocated dur- ing severe labor or by empiric assistance, and liip joint. In the dog, bip, elbow, cervical vertebrae, inferior maxilla. Name some 'pathological processes which produce spontaneous luxation ? In these dislocations one deals with a joint relaxed by previous disease and thus predisposed to luxations. Such may be a deforming arthritis or a chronic serous arthritis and edema of the retaining ligaments, as a result of which they easily yield to pressure, thus favoring dislocations. Describe congenital dislocations. In these cases the animal is born with a malformation of a joint, as a result of which the bone cannot retain its normal position. Those dislocations met with in the newly born and occurring during delivery as the result of rough handling do not belong here, but must be classified among traumatic dis- locations. The elbow joint of the dog is subject to congenital luxation. What are the symptoms offered by a dislocation ? Generally speaking, they are : Simple dislocation, abnor- mal rigidity in one direction and excessive mobility in another direction. In joints not covered with a heavy layer of muscles there is a visible change in the shape of the articulation. In case the luxation affects an articulation of \h.Q leg, the normal position of the bony columns is disturbed, the part may be abnormally extended or flexed, abducted or adducted. The leg appears longer in incomplete luxations, while it appears shorter than normal in complete luxations. In luxations of joints of the leg there is severe lameness and pain. 208 PEINCIPLES OF VETERINARY SURGERY In complicated luxations the symptoms peculiar to severe injury of the surrounding soft parts, as well as fracture of the dislocated bone, will be observed, such as external wounds, rupture of tendons, laceration of bloodvessels large and small, injury to more or less important nerves, open joint, etc. Describe the articular changes following a luxation. There is invariably a rupture of the capsular ligament ; the surrounding tissues — that is, the ligaments, nerves, blood- vessels, tendons and muscles — are either stretched or torn. An exception to this rule forms the dislocation of the patella, sacro iliac articulation and the symphysis pnbis. In the so-called spontaneous or pathological dislocations, as seen in. dislocation of the patella, chronic arthritic changes are fre- quently observed. As soon as luxation of a joint occurs and the capsular ligament is torn a hemorrhage into and surround- ing the joint, possibly including the adjacent connective tissue, muscles, etc., takes place. The old socket is filled with blood and the dislocated bone is imbedded in a bloody area. If an uncomplicated dislocation is reduced early, an almost normal condition is obtained in due time, unless some of the lesions undergo a faulty repair leading to subperiosteal formation of bone or periarticular thickening. In old luxations the pro- cess of repair is quite different. Let us suppose that the head of the femur has left the cotyloid cavity. I have seen and described in the current literature two such cases in mules observed in South Carolina. In horses it is very rare, but more common in dogs. The head of the femur in its new position is in contact with a bony surface, against which it presses. As a result of this pressure an osteitis and periostitis results which in turn leads to formation of bone around the head of the femur, and anew bony socket, even lined with DISEASES OF ARTICULATIONS 209 cartilage and endowed with a capsular ligament, may be formed. The lacerated and displaced connective tissue around the head of the femur, as well as the injured muscles, form adhesions holding the dislocated bone firmly in place. Outline the treatment of dislocations. Provided such is possible, reduction and retention of the •dislocated parts are primary essentials. In luxation not accompanied with serious lesions of the constituents of the joint or surrounding tissues, the rent in the capsular ligament soon heals, while the hemorrhage into the joint and surround- ing tissues is absorbed. In the larger animals, such as the iorse or cow, reduction is very difficult and retention often impossible ; in the smaller animals — as the dog, for instance — the dislocation can be reduced more readily, but the restless- ness of the patient renders retention of the reduced articular ends very difficult or impossible. In old luxations of the hip of the dog no attempts at reduction are made ; it is best to await the formation of a new socket by nature's efforts at repair. Dislocation of the inferior maxilla of the dog and luxation of the patella of the horse are easily reduced. For a «ure of habitual luxation of the patella, section of the internal patellar ligament has been advocated more recently. I have operated on three horses, but the time which has elapsed since the operation is too limited to permit of conscientious criti- cism. Distortion (Sprain). What is a distortion f A temporary displacement of two articular surfaces from each other, followed by an immediate return to place and by a partial or complete laceration of the retaining ligaments. 210 PRINCIPLES OF VETERINARY SURGERY Where does the main point of difference lie in a dislocation and distortion ? In the dislocation the separation of the articular ends is permanent and requires artificial aid for its reduction ; in dis- tortion the separation is momentary and the displaced articu- lar ends snap back into place by their own account. Depending on the severity of the sprain, ivhat two forms are recognized ? 1. Simple : No serious damage to the joint or adjacent tissues. 2. Complicated : More or less serious injury to the liga- ments, synovial membrane, bone, cartilage and soft tissues surrounding the injured articulation. W hat are the causes of distortions ? Anything causing a sudden wrench or twist of a joint, as slipping, getting caught in street rails, stumbling, faulty positions of limbs, faulty shoeing. How do faulty positions of J imhs produce distortions ? It is a well-known clinical fact that horses which toe out or toe in often furnish clinical material for'these cases. These animals have often an awkward gait — that is, they stumble quite readily — as a result of which sprains follow ; further- more, the retaining ligaments of their phalangeal articula- tions especially are in a somewhat relaxed state, the articular surface of their joints, by reason of the peculiar position which the bony column exhibits, is irregularly weighted ; that is, one side of the joint bears more of the body weight than •its partner, leading to a straining of the ligaments of the other side of such a joint. DISEASES OF ARTICULATIONS 211 How does improper paring of the lioof or shoeing produce distortion ? In a way similar to tlie one just explained. A hoof, one- quarter of which is left higher than its mate, will, at the moment it is placed upon the ground to receive the weight of the body, wabble more or less; in other words, the phalangeal articulations are at that moment twisted, which, as easily seen, leads to distortions. W hat articular changes take place in simple and complicated distortions f In simple sprains the capsular ligament is usually crushed, but may be torn ; the ligaments, not being elastic, cannot stretch, but elongate a little; as soon as their limit is reached a few of the fibres rupture or the whole ligament tears. In simple dislocation there is bleeding within and without of the articulation. In complicated distortions, the capsular membrane is likely to be torn, the ligaments lacerated more or less, the entire ligament may be detached from the bone, there may be a fracture or dislocation, extensive hemorrhage into the joint cavity and surrounding tissues. What symptoms does a distortion produce ? Sudden lameness ; quite often after a few steps this first or primary pain disappears, to reach a high degree as soon as the animal obtains some rest and is then started. This so- called secondary pain is the result of the setting in of an inflammatory reparative process. Now heat, swelling, at first doughy, later firm, pain on palpation, especially on rotation of the joint, are evident. How do distortions termiiiaie 9 In those cases where the capsular ligament and the other retaining ligaments are not torn, recovery takes place in a few :212 PKINCIPLES OF VETERINARY SURGERY days, but when tlie retaining ligamentous apparatus is lacer- ated a periarthritis develops in a few hours. These cases require four to six weeks for recovery. Whenever the liga- ment is actually torn the synovial membrane is seriously injured and possibly the bone, when there is a considerable hemorrhage into the joint cavity, the chances for a complete recovery are very slim, as a marked joeriarthritis may lead to the formation of a periarticular ringbone, or the seriously injured synovial membrane and joint become chronically dis- eased, exhibiting a chronic serous arthritis ; even an arthritis deformans may be the result. Septic complications are not •excluded, as the skin may have been injured at the time the animal fell or stumbled. The above shows that in all distor- tions accompanied with severe and persistent lameness the prognosis must be a guarded one. Outline the treatment of distortions. The first point is rest. When the season and conditions of the barn permit it, cold water applications with firm band- aging of the sprained joint is indicated the first day. From the second day on, moist heat and compression of the joint follow. Where this line of treatment is impossible, a blister Is applied or combined with the actual cautery. In some instances, where all these means fail, neurectomy may be practiced. Contusion of a Joint. What do you understand by a contusion of a joint ? It is a bruising, a subcutaneous injury of the tissues sur- Tounding and composing a joint. TV hat are the causes of such contusions ? Blows, pressure, etc., either act directly upon a joint or a DISEASES OF ARTICULATIONS 213" distant part is struck and the force of the blow transmitted to the epiphyseal ends of the bones. The latter represents an in- direct contusion. What articular changes take place in contusions of joints f In direct contusion the capsular ligament and periarticu- lar tissues are mainly injured, while in the indirect contusion the articulating bony ends, by striking against each other, compress and injure their hyaline cartilage, and even the bones themselves may fracture as the result of the blow. What are the symptoms of articular contusion ? As a rule, the hemorrhage into the joint cavity in contu- sion is considerable; as a result of which a fluctuating swelling about the joint appears; otherwise the symptoms are those of a distortion only ; the phenomena are all of a milder type. Hoiu do articular contusions terminate ? As a rule, favorably. Occasionally a chronic serous arthritis — that is, a gall — remains behind. Of course contu- sions complicated with fractures demand an unfavorable prognosis, at least in the larger animals. Outline the treatment of contused articulations. In the earliest stages cold and pressure to prevent further hemorrhage into the joint and surrounding tissues ; later,, moist heat and compression ; generally speaking, a blister is the most reliable and least troublesome treatment, y Anchylosis. What is articular anchylosis ? Destroyed joint mobility. 214 PRINCIPLES OF VETERINARY SURGERY What kind of tissues are found to he the cause of anchylosis of joints f Joints are rendered immovable by fibrous, cartilaginous and bony adhesions. What is an intracapsular, luhat an extracapsular anchylosis? In the former, also known as intra-articular anchylosis, the consolidating mass lies within the joint cavity, while in the latter it lies external to the capsular membrane. Give the etiology of articular anchylosis. In navicular hoof disease, in spavin and articular ring- bone, it is the result of a deforming arthritis. Anchylosis of the vertebral column, as in old horses, is due to ossification of the intervertebral fibrocartilages. It may be due to an ossify- ing periostitis such as arises in the course of a periarthritis. Generally speaking, it is the result of a chronic arthritis. W hen does the surgeon encourage the formation of an anchy- losis 9 As soon as a joint is anchylosed it becomes stiff, and not being able to move any more, it also becomes painless. This painless state is what the surgeon desires to obtain, as the absence of pain means equally well — in a great many cases at least — an absence of lameness. For this reason, for instance, a horse spavin-lame is fired and blistered with the hope to anchylose the parts and thus remove pain and lameness. How do you treat anchylosis ? In animals, at least, it is incurable. Such operations as osteotomy, resection of joints and arthrotomy, while invalu- able to man, are of little practical interest to the veterinary surgeon. DISEASES OF ARTICULATIONS 215 Articular Contracture. W hat do you understand by articular contracture 9 An incomplete anchylosis — that is, a permanent impair- ment of joint mobility — accompanied by fixation of the joint at an abnormal angle. What are the causes of articular contractures 9 They may be acquired and the result of diseases of ten- dons, muscles, nerves, skin or joints, or they are congenital, in •which case the creature is either born with them or predis- posed to them. Name the various forms of joint contractures. (1) Arthrogenous contractures, (2) tendogenous, (3) myo- genous, (4) neurogenous, (5) cicatricial, (6) congenital. What are arthrogenous contractures ? In these, pathologic lesions in or close to the joint hinder free mobility. Give examples of arthrogenous contracture. In the earlier stages of arthritis deformans, as in articular ringbone, exostoses about the joint, loose bodies in the joint. Which is the most common example of arthrogenous contrac- ture in the horse ? That due to articular arthritis. What is a tendogenous contracture ? In this form the mobility of a joint is limited by adhe- sions and shortening of flexor tendons. Give an example of tendogenous contracture. The one most commonly seen is met with in the foreleg of the horse, where the mobility of the phalangeal articulations 216 PRINCIPLES OF VETERINARY SURGERY "becomes limited as the result of chronic inflammation of the flexor pedis perforans and perforatus, the latter being fol- lowed by adhesions and shortening of these tendons. W hat is a myogenous contracture ? In these, free mobility of the joint is interfered with by a shortening of muscles. Give an example of myogenous contracture. In the crooked tail as the result of contracture of the lat- eral coccygeal muscles, in the so-called wry neck {caput ohstipum), there exists a contracture of the mastoido humer- alls. In the so-called sprung knee, where a contracture of the external and oblique flexor of the metacarpus is found. What are neurogenous contractures ? In these the free mobility of the joint is limited, as th& result of faulty enervation of certain muscles. Give an example of neurogenous contracture. This condition is quite often seen in the newly born ani- mal, especially colts, most likely due to a paralytic state of the extensor muscles of the legs, as the result of which the animal knuckles over. What is a cicatricial contracture ? In this form the mobility of the joint is handicapped by the formation of a large amount of scar tissue in close prox- imity to a joint, especially when involving the flexor surface of a joint ; such cicatrices may be due to burns, wounds, and are quite common in our country, especially where barbed wire fences are used, the flexor surface of the hock and fetlock being common sites of such cicatrical contractures. DISEASES OF ARTICULATIONS 217 What is congenital contracture f The only one of practical interest is the neurogenons con- tracture seen in the newly born colt, where, as the result of a jjaralytic state of the extensor muscles of the legs, the young creature knuckles over in the fetlock more or less. Outline the treatment of contractures. In arthrogenous and cicatrical contractures, at least always in the former, the case is hopeless. In tendogenous contracture tenotomy is to be tried and is sometimes success- ful. In myogenous contractures myotomy is indicated, giv- ing in the sprung knee fair results, and usually good, while not permanent, results in crooked tails; the congenital neuroge- nous contractures are treated by mechanical appliances, such as splints, bandages, etc. What is the difference between a contracture and a contrac- tion ? From a medical point of view the former represents a permanent rigidity of a part, while the latter represents a temporary rigidity. For instance, in lacerations of the exter- nal and oblique flexors of the metacarpus, scar tissue forms,, leading to a shortening (more or less), and therefore perma- nent rigidity of these muscles in this instance is a contracture^ while a temporary contraction of these or other muscles, for that matter, as the result of a clonic spasm, would lead to a. temporary rigidity of the muscle ; in other words, to a con- traction. Lioose Bodies in the Joint (Corpora Libra). What are corpora libra 9 These are smooth, white bodies of variable size, appearing single or multiple, in a joint cavity or synovial tendon sheath. 218 PRINCIPLE? or VETERINAEY SURGERY either floating free or attaclied by a pedicle to the synovial mem.'brane. What are the corpora libra composed of 9 Fibrous tissue, bony or cartilaginous, or a mixture of these. How large are they ? They vary in size from millet seed to pigeon Qgg size. How are copora libra developed ? 1. Usually due to a traumatism, as a piece of cartilage of bone may have been loosened by a complicated distortion, contusion of a joint, etc. 2. • From villous outgrowths of the synovial membrane. 3. From blood clots and fibrin poured out during an acute inflammation. 4. From detached pieces of cartilage, as in arthritis deformans. 5. From extra capsular neof ormations which have invaded the joint cavity. Are corpora libra often seen in animals ? They are rare, and only occasionally seen in the knee, hock and stifle joints. W hat symptoms do they give rise to ? By wedging the joint a sudden lameness of intermittent character which cannot be accounted for suggests loose bodies in the joint. Careful palpation may or may not detect them. How do you treat loose bodies in the joint ? The difficulties connected with executing an aseptic operation in the horse and applying the proper dressing to DISEASES OF TENDONS 219 teep the wound aseptic (a vital factor in a joint) would sug- gest tlie desirability not to operate the horse, while the dog offers better chances for a successful arthrotomy. DISEASES OF TENDONS. Inflamraation of Tendons (Tendinitis). What is tendinitis 9 An inflammation of a tendon. Name the causes of tendinitis. Predisposed to this trouble are animals with a sloping- fetlock, those with poorly developed — that is, weak — tendons, animals with low heels or long toes, the latter frequently seen. in our trotting horses, where the toes are allowed to remain excessively long by some trainers; nutritive disturbances, such as follow prolonged idleness in the stable; infectious dis- eases. Direct causes, usually of a traumatic nature, of pri- mary tendinitis are prolonged hard work, jumping, gallop- ing, hard pulling, as in runners, trotters and draught horses ; contusions, the result of kicks, etc., are occasionally the cause. Secondary tendinitis — that is, a tendinitis the result of an extension of an inflammatory process to the tendon from neighboring parts — are seen in cellulitis of the synovial sheath in consequence of aseptic cellulitis of the plantar cushion and in those inflammations of tendon sheaths, sequels to conta- gious pleuro-pneumonia, etc. In Italian and Russian horses, the presence of the filaria cincinnata and spiroptera reticulata is given as a cause of tendinitis. 220 PEINCIPLES OF VETERINARY SURGERY What anatomical lesions are found in tendinitis ? More or less laceration of tendon fibres, accompanied by a, sero-hemorrliagic exudate infiltrating the interfasicular con- nective tissue, is the first step. ISTow the inflammation extends to the peritendineum and paratendineum, causing a swelling- of tendon as the exudate pushes apart the bundles of tendoiL fibres. The sero-hemorrhagic exudate first alluded to is. replaced by an invasion of the parts by leucocytes; new blood- vessels and connective tissue are formed. The granulation tissue which is formed springs mainly from the paratendi- neum, the tendon sheath and a limited amount of it comes from the tendon cells of the ruptured tendon fibres. This soft granulation tissue gradually undergoes changes until eventually it becomes hard cicatrical tissue, which may not. only be simply connective tissue, but in its transformation, becomes cartilaginous or even bony. Three years ago, while studying double tibio peroneal neurectomy, I bought two horses with spavins. These ani- mals also suffered with chronic tendinitis. Microscopical examinations made of the diseased tendons showed patches of osseous tissue in the cheek ligament of the perforans, espe- cially abundant where the ligament blends with the flexor pedis perforans. What danger is connected -with the formation of scar tissue in, tendinitis ? It may lead to a tendogenous contracture and render tho^ animal a cripple. Hoiv is this brought about f All scar tissue has a tendency to retract. Consequently the scar tissue the result of a tendinitis shortens the tendon, thus altering materially the angularity of the various joints DISEASES OF TENDONS 221 "Controlled by that tendon. In serious inflammations, not only scar tissue forms between the ruptured fibres of the tendon, but adhesions with neighboring parts, as other tendons and tendon sheaths, occur. How do you explain the fad that in some cases of tendinitis the tendon does 7iot shorten, while it does in others 9 Retraction of the scar tissue can only take place when one end of the tendon is relaxed, so the scar tissue may take up the slack, so to speak.