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 Webster Famiiy Library of Veterinary Medicine 
 Cummings School of Veterinary Mediciae at 
 Tufts University 
 200 Wastboro Road 
 Nortli Grafton. MA 01 536 
 
sf i^f^^^n^ 
 
ROARING IN HORSES 
 
Roaring in Horses 
 
 ITS 
 
 PATHOLOGY AND TREATMENT. 
 
 P. J. CADIOT, 
 
 PROFESSOR AT THE VETERINARY SCHOOL, ALPORT. 
 
 TRANSLATED FROM THE ORIGINAL BY 
 
 THOMAS J. WATT DOLLAR, 
 
 M.R.C.V.S.G.B., Lie. VET. MED. AND SURG. H.A.S.S. 
 
 iUttstratel) bs (Etshtecn JtgttU5. 
 
 NEW YORK : ^l^^^}^^] R- JENKINS. 
 
 SWAN SONNENSCHEIN & CO 
 PATERNOSTER SQUARE. 
 1S92. 
 
I- 
 
 Printed by Hazell, Watson, & Viney, Ld., London and Aylesbury, 
 
PREFACE 
 
 'TPHE great Interest that was manifested 
 by the Veterinary Profession and the 
 public generally some two or three years ago 
 on the announcement of a cure for roaring 
 has induced me to translate the following 
 pages. 
 
 My acquaintance with the Author enables 
 me to testify to the thoroughly scientific 
 manner in which he has carried on his 
 investigations, and to assure the profession 
 that the present work represents the latest 
 development in operative methods for the 
 alleviation of roaring. 
 
PREFACE. 
 
 At the same time I wish to express 
 my thanks to Professor P. J. Cadiot, to 
 Monsieur Trasbot, Director of the Veterinary 
 School of Alfort, to Professor Nocard, and 
 the other professors of that institution, as 
 well as to many of the dleves, who have 
 rendered me very valuable aid whilst I was 
 among them. 
 
 I also desire to thank Messrs. Asselin 
 
 and Houzeau, publishers, Paris, for the 
 
 assistance they have afforded me in respect 
 
 of the plates, etc., for the illustration of 
 
 this edition. 
 
 THOS. J. WATT DOLLAR. 
 
SURGICAL TREATMENT 
 
 OF 
 
 CHRONIC ROARING. 
 
 I. 
 
 ROARING PRODUCED BY PARALYSIS OF 
 THE LARYNX. 
 
 The term ^'roaring" was given by ancient 
 veterinary writers and practitioners to a 
 symptomatic affection very commonly met 
 with in the horse, and characterised by 
 an unnatural sound— ^* rattling, snoring, or 
 whistling "—in respiration, which noise is 
 more noticeable or only to be distinguished 
 
ROARING IN HORSES. 
 
 during inspiration. The various alterations 
 which tend to create an obstacle to the 
 free circulation of air in the upper (superior) 
 respiratory passages are accompanied by 
 roaring. This is either acute or chronic, 
 according to whether it accompanies a recent 
 illness, when it may be transient ; or, on 
 the other hand, if it is the result of a 
 previous illness or injury, it is said to be 
 positive or chronic. 
 
 Among the morbid conditions which give 
 rise to chronic roaring, there is one — 
 paralysis of the muscles of the larynx— the 
 extreme frequence of which has been re- 
 vealed during this century by anatomical 
 and pathological research. These inquiries 
 have established that 95 per cent, of the 
 cases of incurable roaring were due to 
 paralysis of the larynx. Total paralysis is 
 
ROARING IN HORSES. 
 
 seldom seen ; it is nearly always unilateral, 
 and generally affects the left side. When it 
 follows irritation of the bronchial tubes or 
 lungs, the laryngeal hemiplegia is the result 
 of inflammation of the inferior laryngeal 
 nerve of the same side or pressure on it 
 by the hypertrophied bronchial glands ; the 
 diversity of relations of the recurrents as 
 they leave the pneumogastrics fully accounts 
 for the localisation of the laryngeal altera- 
 tions. When it appears without having 
 been preceded by a bronchial or pulmonary 
 affection, it is due either to hereditary 
 cause or to an accidental injury to the 
 recurrent or pneumogastric nerves. 
 
 It is simply necessary to give a glance 
 at the upper part of a larynx affected with 
 hemiplegia to judge of the deformity which 
 that organ has undergone. The orifice, 
 
10 ROARING IN HORSES. 
 
 circumscribed by the epiglottis, the aryteno- 
 epiglottic folds, and the arytenoid cartilages, 
 is shrunk up and rendered manifestly 
 unsymmetrical by the abnormal position 
 occupied by the left arytenoid being lower 
 and nearer the middle line than its fellow. 
 The falling of this cartilage necessarily 
 causes a change of position of the vocal 
 cord attached to its lower edge ; it is 
 turned slightly backwards and inwards and 
 therefore towards the opposite vocal cord, 
 producing a very noticeable shortening of 
 the lower part of the glottis (fig. i). These 
 anatomical alterations, more or less marked 
 according to the duration of the affection, 
 are generally in proportion to the respiratory 
 sound noticed during life. Immediately they 
 exist the action of the larynx becomes 
 very imperfect. The posterior and lateral 
 
Fig. I.— Superior orifice of the larynx and glottis of a horse affected 
 with chronic roaring. 
 
ROARING IN HORSES. 13 
 
 crico-arytenoidean, the thyro-arytenoldean and 
 arytenoldean muscles degenerate, and are 
 incapable of accomplishing their physiological 
 work. The transverse dimensions of the 
 superior opening of the larynx are already 
 lessened and are incapable of being extended, 
 and the opening is more reduced during 
 inspiration, especially when the respiratory 
 movements are quickened. As long as 
 the respiration is calm, the air passes the 
 laryngeal passage in silence ; but as soon 
 as it is quickened by exercise the left 
 arytenoid, instead of being taken upwards 
 and outwards by the action of the corre- 
 sponding muscles, is displaced in an inverse 
 direction. Pressed by the air inspired — 
 being carried below and inwards towards the 
 glottis and against the opposite arytenoid 
 cartilage, taking with it the vocal cord, the 
 
14 ROARING IN HORSES. 
 
 opening of the larynx being thus very much 
 reduced, — the respiration becomes insufficient, 
 painful, and noisy. 
 
 Such is the mechanism of the production 
 of roaring as connected with paralysis of 
 the larynx. The unnatural sound is pro- 
 duced by the obstacle which opposes the 
 accomplishment of respiration ; the arytenoid 
 cartilage and the left vocal cord brought to 
 the middle line become powerless. 
 
 In exceptional cases of total paralysis the 
 two arytenoids are carried together in front 
 of the glottis during inspiration, and the 
 vocal cords execute the same movement, 
 thereby considerably reducing the calibre of 
 the upper part of the larynx, and the 
 roaring is heard at its maximum degree. 
 
ROARING IN HORSES. 15 
 
 II. 
 
 TREATMENT. 
 
 The knowledge of the causes of roaring 
 accompanying pulmonary affections has given 
 rise to a prophylactic treatment, to which 
 several authors have drawn attention. By 
 the administration of alteratives — notably of 
 iodide of potassium — it has been sought 
 to prevent the compressive and atrophying 
 action of the hypertrophied bronchial glands 
 on the left inferior laryngeal nerve, but the 
 efficacy of the medicine is most uncertain. 
 Perhaps in many cases where no action is 
 manifested, the paralysis of the recurrent is 
 due to the pressure exercised upon it by 
 the inflamed lung or of the extension of 
 the inflammatory process, which in the first 
 
i6 ROARING IN HORSES. 
 
 instance was localised in the lungs and 
 pleura, to its own substance. (Gunther, 
 Moller, Vaerst.) 
 
 As to the therapeutic means used as cures 
 for chronic (definitive) roaring, they have 
 seldom been successful. The preparations 
 of arsenic, iodine and its compounds, mer- 
 curials, strychnine, given in pills, injected 
 intravenously or hypodermically, electricity 
 and the actual cautery, have been tried by 
 a great number of veterinarians, and often 
 several of these agents have been succes- 
 sively applied. Whatever has been done 
 has been practically of no avail. If in 
 some cases a transitory amelioration has 
 been effected, and the onward march of 
 the disease retarded, a cure has been the 
 very rare exception, and then only in cases 
 of very short standing. 
 
ROARING IN HORSES. 17 
 
 It had begun to be considered that chronic 
 roaring was an incurable disease, and ought 
 to be classed among those affections where 
 a palliative treatment could alone be looked 
 for ; and that the only means in these cases 
 was to perform tracheotomy in order to be 
 able to utilise the animals affected by it. 
 Nevertheless, for a long time the insufficient 
 nature of the remedies in use, as well as 
 the serious inconveniences and the possible 
 accidents which result from tracheotomy, 
 gave rise to the idea of a direct surgical 
 intervention on the deformed part of the 
 larynx. It was sought to do away with 
 the obstacle which prevented free respiration 
 by lowering the arytenoid and changing the 
 position of the vocal cord by excising those 
 organs. 
 
 It is to Gimther, Professor of the Veterinary 
 
1 8 ROARING IN HORSES. 
 
 School of Hanover, that we owe the first 
 attempts to that end (1845). This veterin- 
 arian, in the first place, resected both vocal 
 cords in a certain number of roarers. No 
 amelioration followed in any of the cases 
 operated upon. He next successively per- 
 formed ablation of the vocal cord on the 
 paralysed side, partial excision of the 
 arytenoid, total extirpation of the same car- 
 tilage, ablation of the vocal cord and the 
 corresponding ventricle, and then fixed the 
 arytenoid to the thyroid. These various 
 operations were no more successful than the 
 hrst. Several animals - rapidly succumbed, 
 and the others roared just as much as 
 before the operation. 
 
 These experiments were repeated at Berlin 
 by Gerlach ; at Alfort by H. Bouley ; at 
 Copenhagen by Stockfleth ; and at Turin by 
 
ROARING IN HORSES. 19 
 
 Bassi. Then they were abandoned. Every- 
 where the results were unfortunate, nil, or 
 doubtful. Of late years the surgical treat- 
 ment of roaring was re-studied by Moller, 
 Professor of Surgery at the Berlin Veterinary 
 School, who also apparently had finally con- 
 demned it ; and by Fleming, Chief Veterinary 
 Surgeon of the English Army. These 
 authors have made known methods that 
 have given a certain number of successes. 
 Moller has published his own manner of 
 operating in a memorandum, translated by 
 Hendrickx.* Fleming has explained his in 
 a work where some interesting documents 
 on laryngeal paralysis are to be found. f 
 
 * Moller, Das Kehlkopfpfeifen der Pferde {He7niplegia 
 laryngis) iind seine operative Behandlung. Stuttgart, 1888. 
 Trad, in Annal de Med. Vet., 1888-9. 
 
 t Yleniing, Roaring in Horses. London, 1889. 
 
20 ROARING IN HORSES. 
 
 After having assured himself no cure could 
 be obtained by excision of the vocal cords, 
 Moller, convinced that the obstacle producing 
 roaring was situated at" the upper orifice of 
 the larynx, made a number of experiments 
 with the object of restraining the movements 
 of the arytenoid by ankylosing it to the 
 cricoid or by fixing it to the thyroid. 
 
 The first proceeding was to cut through 
 the cricoid and the first two rings of the 
 trachea in the middle line ; then, by means 
 of a pointed bistoury, to open the crico- 
 arytenoid articulation by incising the capsular 
 ligament of that joint, the patient being then 
 left alone for some weeks. It was hoped 
 that the arytenoid, ankylosed to the cricoid, 
 would not again fall down from the pressure 
 of inspired air. The greater number of the 
 horses thus operated upon were sensibly 
 
ROARING IN HORSES. 21 
 
 better afterwards, but the roaring never 
 completely ceased in any one case. 
 
 Moller then tried another operation which 
 allowed him to fix the arytenoid to the 
 thyroid by means of a ligature, without first 
 opening either the larynx or the trachea. 
 This operation was generally followed by an 
 increase of the roaring. He next tried 
 section of the paralysed posterior crico- 
 arytenoid, by opening the larynx by an 
 incision made at the lower border of the 
 parotid, between the jugular and the ex- 
 ternal maxillary veins. He thought the 
 resulting cicatrix would shorten the muscle, 
 support and perhaps raise the arytenoid ; 
 but the effects of the operation were most 
 uncertain. The roaring continued in nearly 
 every case subjected to the treatment. 
 
 These different experiments being very 
 
22 ROARING IN HORSES. 
 
 unfavourable, Moller decided on completely 
 excising the arytenoid cartilage (fig. 2), by 
 which operation he had In 1887-8 cured 
 
 Fig. 2. — Holler's operation. Vertical and antero-posterior section of 
 the larynx. — The dotted line represents the mucous membrane 
 covering the edges of the arytenoid cartilage. 
 
 twenty-two cases out of thirty ; that Is to say, 
 a proportion of 75 per cent, of successes. 
 
 The first of Fleming's experiments dates 
 from 1878. " The possibility of curing a 
 
ROARING IN HORSES. 23 
 
 case of roaring," says this Veterinarian, ''was 
 suggested to me by the examination of a 
 horse affected with fracture of the thyroid 
 cartilage. To remedy the accident the larynx 
 was opened up, and I was astonished at the 
 impunity with which the Interior could be 
 explored. The revelation which this fact 
 afforded determined me to attempt the cure 
 of roaring by a simple and sure operation. 
 The physiology of the horse's larynx and the 
 ease with which It adapts itself to surgical 
 treatment being little known, I had, like 
 those who preceded me In this line of 
 research, to make a variety of experiments." 
 
 Fleming successively tried excision of the 
 left vocal cord, the upper part of the arytenoid, 
 ablation of the cord and a very large portion 
 of the cartilage, but with little or no success. 
 He then removed the arytenoid entirely, and 
 
24 
 
 ROARING IN HORSES, 
 
 this was sometimes followed by a cure, whilst 
 in other cases it simply reduced the sound. 
 From examination of larynges of horses where 
 
 ,^^^x^. 
 
 Fig. 3. — Fleming's operation. Section of the larynx, — The dotted 
 lines show the incisions of the mucous membrane in ablation of 
 the arytenoid cartilage and the vocal cord. 
 
 the operation had been useless, or only partly 
 successful, he thought that the continued 
 roaring was due to the vocal cord ; he had 
 
ROARING IN HORSES. 25 
 
 there a practical demonstration of the part 
 that it took in producing the sound. Con- 
 sequently to insure a more certain cure he 
 found it necessary to excise the vocal cord 
 as well as the arytenoid cartilage (fig. 3), 
 and says this procedure gave the most satis- 
 factory results. 
 
 Therefore, whilst Moller advised excision of 
 the paralysed cartilage only, Fleming recom- 
 mends extirpation of the arytenoid, as well 
 as the vocal cord. But, although I have not 
 as yet had a long experience in these opera- 
 tions, I have made my choice, and do not in 
 the least hesitate to give my preference in 
 every case to the method established by 
 Moller ; it has the advantage of not inter- 
 fering with the laryngeal mucous membrane, 
 except in a very small degree, and in a 
 regular manner. On the other hand if the 
 
26 ROARING IN HORSES. 
 
 cure Is incomplete or not successful at all, 
 the vocal cord has nothing to do with the 
 persistency of the roaring ; the cicatricial 
 contraction cannot but hold it in its position 
 or draw it slightly outwards. 
 
ROARING IN HORSES. 
 
 ^1 
 
 III. 
 
 ARYTENOTOMY. 
 
 To excise the arytenoid cartilage with some 
 certainty of success it is necessary to act 
 
 Fig. 4.— Blunt-pointed bistoury. 
 
 methodically, and be prepared with certain 
 special instruments. 
 
 I. A razor knife or narrow-bladed, probe- 
 pointed bistoury (fig. 4). 
 
28 
 
 ROARING IN HORSES. 
 
 2. A pair of curved scissors, the blades 
 of which should be very nearly perpendicular 
 with the handles (fig. 5). 
 
 3. A double branched hook, with a spring 
 
 h 
 
 Fig. 5. — Bent or curved scissors. 
 
 to keep the wound open during the operation 
 (fig. 6). 
 
 4. A pair of articulated artery forceps 
 (^^. 7), or a pair of long, strong, anatomical 
 forceps. 
 
 5. A tracheotomy tube of the form used 
 
ROARING IN HORSES. 29 
 
 by Trendelenburg for human surgery, and 
 intended to prevent the entrance of foreign 
 bodies into the trachea (fig. 8). It is a long 
 tracheotomy tube, the flattened surface or 
 
 Fig. 6. — Spring hooks. 
 
 pavilion of which is provided with a cap to 
 protect the outer orifice of the canula ; the 
 tube is surrounded on its external surface 
 with an india-rubber covering which fits very 
 tightly except in the middle, at which point, 
 when in position and in use, it forms a sort 
 
30 
 
 ROARING IN HORSES. 
 
 of balloon produced by inflating it, when 
 within the trachea, with air by means of a 
 small india-rubber tube provided with a 
 bellows, which is connected with it by an 
 
 Fig. 7. — Hooked or artery forceps. 
 
 opening in the wall of the canula from the 
 inside ; when distended the small india-rubber 
 tube is ligatured at a point outside the canula 
 and the india-rubber ball bellows removed 
 (fig. 9). In place of the above an ordinary 
 
ROARING IN HORSES. 31 
 
 tracheotomy tube may be used, but the canula 
 should be covered with aseptic gauze, fixed 
 by means of two Hgatures. 
 
 6. A bent needle with the eye close to 
 the point, and provided with a metal handle 
 
 (fig- 15). 
 
 Fig. 8.— Plug or stopper canula with ampullae or bellows attached. 
 
 Beyond these it is necessary to have a pair 
 of long, straight scissors, ordinary curved 
 scissors, anatomical and artery forceps, 
 sponges fixed to the teeth of bolted forceps, 
 needles, two sizes of catgut, and silk or 
 thread, wadding, carbolised gauze (Lister's), 
 
S2 ROARING IN HORSES. 
 
 or gauze rendered aseptic with iodoform, 
 and an antiseptic solution. 
 
 The animal being anesthetised * is placed 
 on its back and kept in that position by 
 means of a bar held by two or four assistants. 
 The head being well extended on the neck, 
 the region of the throat is shaved over a 
 surface limited in front by the hyoid, behind 
 by the fourth ring of the trachea, laterally by 
 the branches of the inferior maxillary and 
 the tendon of the sterno-maxillary muscles. 
 The shaved skin is washed with warm water 
 
 * As an anesthetic agent I at first persistently Hsed 
 chloral by intravenous injections (jugular) of one-third 
 or one-sixth strength, but this is subject to very serious 
 accidents. It is much better to use ether, chloral in 
 clysters associated with hypodermic injections of hydro- 
 chlorate of morphia, or chloroform, the recent researches 
 of Moller and Guinard having proved that chloroform 
 is not more dangerous to the horse than to man. 
 
ROARING IN HORSES. 33 
 
 and soap, and then with a one per thousand 
 solution of corrosive sublimate. 
 
 Method of Operating. — First Phase : 
 Incisioit of the Skin and Muscles which cover 
 the Larynx. — The incision of the tissues which 
 cover the lower surface of the larynx should 
 be made on the middle line, and extend 
 from the body of the thyroid to the second 
 or third ring of the trachea. These points 
 can be easily distinguished on examining the 
 region. That done, the skin is divided to 
 the full extent at one cut, the edges being 
 slightly turned back the intersection of the 
 sterno-hyoidean and omoplat-hyoidean muscles 
 is seen. The muscular coat can by that 
 means be cut through exactly in the middle 
 line. The division of the encircling laryn- 
 geal connective tissue completes the first part 
 of the operation. There is never much 
 
34 ROARING IN HORSES. 
 
 bleeding, and it is easily stopped by the cold 
 douche. When small arterial branches have 
 been cut in the muscular structure, or in the 
 deep layer of connective tissue (rendered 
 abnormally vascular in consequence of the 
 prior application of blisters or the cautery), 
 it is necessary to twist the injured vessels 
 or to apply bull-dog artery forceps. When 
 the bleeding has ceased the second part of 
 the operation is commenced. 
 
 Second Phase : Incision of the Larynx and 
 the two first Rings of the Trachea ; Intro- 
 diiction and fixing of the Camila. — This 
 incision may be made in one stroke, from 
 front to back, by plunging the bistoury into 
 the crico-thyroidean ligament behind the body 
 of the thyroid and in the middle line, divid- 
 ing successively this ligament, the cricoid 
 cartilage, the crico-tracheal ligament, and the 
 
ROARING IN HORSES. 35 
 
 first rings of the trachea.* But by doing 
 so, the operator is Hable to injure one of the 
 vocal cords, either during a movement of the 
 patient, incompletely anesthetised, or by intro- 
 ducing the instrument a little to one side of 
 the middle line, and thus taking an oblique 
 direction. To avoid this accident it is neces- 
 sary to act in the following way. The 
 bistoury held in a vertical position with the 
 cutting edge behind is passed into the crico- 
 thyroidean ligament immediately in front of 
 the cricoid cartilage, then this cartilage, the 
 crico-tracheal, and the two first rings of the 
 trachea are incised, then the lips of the 
 laryngo-tracheal incision are withdrawn from 
 one another by tenacula, or by spring hooks, 
 
 * The incision need only be extended to the first ring 
 of the trachea, provided the canula is not employed, or 
 only used at the moment of dressing the wound. 
 
36 ROARING IN HORSES. 
 
 the incision of the crico-thyroidean membrane 
 is completed from behind forwards, and from 
 within to without by holding the bistoury in 
 the position of a bow reversed. The vocal 
 cords are distinctly seen to turn outwards at 
 the moment of inspiration ; and it is at this 
 time that the opportunity should be taken to 
 incise the crico-thyroidean membrane up to 
 the body of the thyroid without damaging 
 the cords. The canula is then introduced 
 into the trachea, and immediately it is in 
 position an assistant, with the aid of the 
 india-rubber ball bellows, moderately distends 
 the elastic balloon attached to the tube. The 
 operator should determine to what extent it 
 is to be filled by passing the index and 
 middle fingers of the left hand into the 
 upper part of the trachea, or by feeling 
 the air reservoir of the bellows. When the 
 
Fjg. 9. _Ai-y tenotomy. The second phase of the operation. The 
 crico-thyroid ligament, the cricoid cartilage, the crico-tracheal 
 ligament, and the two first rings of the trachea are cut through. 
 The canula and spring hooks are in position.— CC, cricoid; 
 1st A, first tracheal ring. 
 
ROARING IN HORSES. 39 
 
 balloon is sufficiently distended a ligature 
 should be applied to the india-rubber tube 
 near the cap of the pavilion of the canula, 
 and the remainder of the small tube with 
 the bellows removed (fig. 9). Even when 
 the balloon is filled to the desired extent, the 
 canula has a tendency to slip towards the 
 larynx ; it should therefore be kept in place 
 by a whipcord, a dossil, or a band placed 
 under the pavilion of the tube, and the two 
 ends carried backwards (fig. 9). 
 
 Third Phase : Ablation of the Arytenoid 
 Cartilage. — It is sufficiently easy to determine 
 which of the arytenoids is affected with 
 paralysis by a comparative examination of 
 their action, as well as to be able to judge 
 of its degree. In every operation which I 
 have made till now, the paralysis affected the 
 left side ; in three cases the two cartilages 
 
40 ROARING IN HORSES. 
 
 were the seat of the malady, but the left 
 always to a greater degree than the other. 
 
 Ablation of the arytenoid is divided into 
 the following parts: — {a) Incision of the 
 mucous membrane along the superior and 
 posterior edges of the cartilage ; {U) section 
 of the vocal cord, dissection of the cartilage 
 upon its inferior and anterior borders, and 
 its external face ; {c) section of the cartilage 
 near its articulation with the cricoid ; 
 (d^ dissection of the superior surface of the 
 cartilage. 
 
 (a) By means of the probe-pointed bistoury 
 and using a slight amount of pressure, the 
 mucous membrane bordering the superior and 
 posterior edges of the arytenoid is incised 
 (fig. lo). The instrument is carried to the 
 opening of the larynx, upon the middle line, 
 then directed from front to back as far as 
 
F,r 10 -Third Phase: (a) Incision of the mucous membrane of the 
 
 ""supeno?::! postenol Lges of the arytenoid. In order to render 
 
 Z demonstration more clear, the incision of the -con d part .s 
 
 continued in front to the middle portion of the ep.glotfs, and 
 
 backwards to the fourth tracheal ruig. 
 
ROARING IN HORSES. 43 
 
 the cricoid, then from within outwards and 
 from below upwards to the insertion of the 
 vocal cords. This incision can be made at 
 some distance from the edges of the car- 
 tilage, so as to affect the mucous membrane 
 as little as possible, which ought to be 
 entirely divided ; if incompletely so at the 
 first attempt, the bistoury must be used 
 anew. 
 
 (U) With long, well-ground scissors the 
 vocal cord is cut through at its insertion on 
 the arytenoid (fig. ii); then with great pre- 
 cision the cartilage is dissected, from behind 
 forwards, dividing the mucous membrane 
 along the lower edge and the muscular fibres 
 (crico - ary tenoidean and thy ro - ary tenoidean), 
 which are inserted on its external face 
 (fig. 12); then, holding the scissors vertically, 
 the mucous membrane which covers the 
 
44 ROARING IN HORSES. 
 
 anterior edge is detached from above to 
 below. 
 
 For the favourable execution of this third 
 part of the operation, the cartilage should 
 be tightly held by double tenacula or long 
 forceps with corrugated points, the lower 
 border and the external face is dissected on 
 turning it towards the middle line ; it should 
 be drawn backwards and upwards to divide 
 the mucous membrane from its anterior edge. 
 The only important rule is to hold the 
 points of the scissors always in contact with 
 the cartilage, to glide over it, to damage 
 the mucous membrane as little as possible. 
 The same may be said with respect to the 
 laryngeal ventricle, and the tissues detached 
 from the external face of the arytenoid. If 
 this is carried out there is not the least 
 danger in opening the ventricle. Towards 
 
Fig. 
 
 II— Third Phase : {b) Section of the vocal cord. 
 
ROARING IN HORSES. 47 
 
 the finish of this stage of the third part of 
 the operation, when the fibres of the thyro- 
 arytenoid muscle are separated, the laryngeal 
 branch of the thyroid artery is cut (fig. i3' A). 
 The bleeding which results is not formidable, 
 and may be arrested by twisting the vessel, 
 or by applying a pair of articulated forceps 
 to its extremity, which should be held by an 
 assistant ; or the operation can be continued 
 without troubling about the matter, but then 
 the operator is constrained in his later 
 movements. 
 
 (c) The arytenoid, lifted and held up with 
 a pair of strong forceps or by hooked forceps, 
 is cut away from the outside inwards, near 
 its postero-superior or articular angle, by 
 means of the probe-pointed bistoury. This, 
 held vertically or in a slightly oblique 
 direction below and forwards, is applied to 
 
48 ROARING IN HORSES. 
 
 the external part of the arytenoid immediately 
 in front of the cricoid (^<g. 13) ; and a saw- 
 like movement Is made with a certain amount 
 of pressure, always taking care that It does 
 not slip. When the arytenoid Is partially 
 ossified (In nearly half the cases) It Is 
 necessary to use force. A sensation that the 
 resistance Is overcome and that there Is a 
 great deal of movement of the cartilage, 
 which is easily displaced in all directions, 
 indicates that the section Is complete. 
 
 Moller cuts the arytenoid from within 
 outwards, fixing It by applying the Index 
 finger of his left hand to Its external surface. 
 
 {d) The upper face of the arytenoid Is 
 dissected with the curved scissors, the car- 
 tilage Is lifted by forceps, and under the 
 posterior portion is passed the extremity of 
 the scissors, the handles of which are held 
 
illllli, ., 
 
 Fig. i2.-Third Phase: {h) Dissection of the arytenoid at its inferior 
 edge and exterior surface. 
 
ROARING IN HORSES. 51 
 
 nearly vertically (fig. 14), and by gliding over 
 the superior surface from behind forwards, 
 the fibres of the arytenoid muscle are de- 
 tached, the last adhesions of the point (bee) 
 with a little care are broken down without 
 interfering with the neighbouring parts. 
 Moller leaves the articular angle of the 
 arytenoid in the wound. It can be easily 
 removed by taking it between the teeth of 
 a pair of long forceps, and making the 
 dissection by means of the ordinary curved 
 scissors. 
 
 To perform the section of the arytenoid, 
 and destroy the adhesions of its upper surface 
 (<f, d\ the operator is sometimes troubled by 
 the blood and the pharyngeal mucus that are 
 thrown into the larynx by the movements 
 of deglutition ; the seat of the operation must 
 then be kept clean by soft napkins, plugs 
 
S2 ROARING IN HORSES. 
 
 of wadding, or small sponges fixed In the 
 teeth of bolted forceps. 
 
 When the different stages of the operation, 
 already described, have been properly accom- 
 plished, the edges of the wound are strictly 
 defined, and their dimensions are about equal 
 in point of length and breadth. 
 
 Advisedly I do not describe excision of 
 the vocal cord ; there is no advantage to be 
 gained in practising it, and I have already 
 stated my reasons. 
 
 Fotirth Phase : SiUttre. — The anterior and 
 posterior edges of the wound are united by 
 two or three threads of catgut passed by a 
 needle ad hoc, solidly attached to its handle. 
 The needle, v/ith a thread of about eighteen 
 inches long attached to it, is passed through 
 the anterior lip of the wound at about one-third 
 of an inch from the middle line ; there the 
 
FIG. li-ThirJ Phase: (.) Section o. the arytenoid close to its 
 articular angle. A, Laryngeal branch of the thyrotd artety. 
 
ROARING IN HORSES. 
 
 55 
 
 mucous membrane is penetrated from front 
 to back and from without to within ; then, 
 at a corresponding point, the posterior Hp is 
 traversed from front to back and. from within 
 to without (fig. 15). One of the ends of the 
 catgut thread is retained at the outside of 
 the posterior lip of the wound, and the other 
 is drawn back with the needle to the outside 
 of the anterior lip ; the ends of the thread 
 are then knotted together and drawn suffi- 
 ciently tight without injuring the mucous 
 tissue. To accomplish this rather delicate 
 part of the operation, the thumb or index 
 finger may be passed into the larynx, and 
 draw gently on each end of the thread ; the 
 extremities of the suture are then cut off 
 close to the knot. 
 
 The other two sutures are placed in the 
 same manner (fig. 16). When the laryngeal 
 
56 ROARING IN HORSES. 
 
 branch of the thyroid artery has been pressed 
 by an artery forceps, the bleeding is insignifi- 
 cant once the parts are sutured. 
 
 Dressing. — After having removed the blood 
 clots from the larynx it is filled up with 
 layers of wadding, or plugs of wadding and 
 gauze, rendered aseptic by iodoform, pro- 
 vided with strings to prevent them being 
 swallowed. It is advisable to put in some 
 long, flattened plugs at once ; the inferior 
 edges of which should be traversed by the 
 muscular sutures. The edges of the external 
 wound are joined together by two sutures 
 superposed at a distance of about one-third of 
 an inch from one another, the first made in 
 the muscular tissue, the other in the skin. 
 For both these silk thread or ordinary thread 
 is used. The skin suture placed in front of 
 the canula ought to be very strong, in order 
 
Fig. ^^,-Third Phase: {d) Excision of the cartilage by the curved 
 
 scissors. 
 
ROARING IN HORSES. 59 
 
 to prevent displacement ; to this should be 
 further attached linen bands or dossils, and 
 their extremities knotted above the upper part 
 of the neck."^ 
 
 Subsequent Attention. — The animal on 
 getting up is placed in a box without bedding, 
 and kept strictly without food for twenty- 
 four hours. Moller, who formulated these 
 Instructions, does not now rigorously apply 
 them. For some time past, he has given his 
 patients bedding and water to drink from the 
 first day. 
 
 The next day the dressing and the tube 
 
 * The principal changes that can be made in the 
 way of rendering this operation more simple are the 
 following: — (i) Make the incision only as far back as' 
 the first tracheal ring; (2) discard the use of the canula; 
 (3) apply no dressings. The future will determine the 
 efficacy of the means. 
 
6o ROARING IN HORSES. 
 
 are removed. The skin in the neighbour- 
 hood of the wound has the scales or crusts 
 cleaned off its surface, the sutures are cut 
 successively and the plugs removed. Then 
 the interior of the larynx is cleansed with a 
 sponge held in the teeth of a forceps, or by 
 the use of balls of wadding rolled round and 
 attached to sm.all sticks, the lips of the 
 wound being meanwhile kept apart by large 
 shouldered hooks (Ecarteurs de Faraboeuf). 
 Finally, having cut the small india-rubber 
 tube, and allowed the air in the balloon to 
 escape, the canula is removed. Very often 
 the distended rubber membrane has already 
 allowed the air to escape by an unseen issue, 
 and sometimes it is found torn. 
 
 The regular cicatrisation of the wound is 
 favoured by uniting the subcutaneous mus- 
 cular tissue to the skin by a few stitches. In 
 
Fig. 15. — Fourth Phase : Suture. — Mode of passing the thread. The 
 needle should pass the anterior and posterior lips at a point 
 equidistant from the middle line and close to their free edges. 
 In tracing the posterior lip of the wound, the needle should enter 
 at a point somewhat deeper than indicated in the figure, but so as 
 only to affect the mucous membrane. 
 
ROARING IN HORSES. d^, 
 
 order to permit the free action of respiration, 
 the threads of the middle suture of each lip, 
 kept long, are knotted moderately tight to 
 the upper border of the neck. They keep 
 the wound open and prevent the edges touch- 
 ing together during inspiration. The third 
 or fourth day these threads are cut, and the 
 sutures removed. 
 
 The further treatment consists In cleaning 
 the outside wound three times daily, with an 
 antiseptic solution (carbolic acid, corrosive 
 sublimate, or cresyl), without in the least 
 interfering with the intra-laryngeal wound, 
 the regular repair of which is the necessary 
 condition of success. Both cicatrise rapidly 
 enough. The first Is generally entirely closed 
 by the end of a month. 
 
 It has been recommended to give the 
 animal nothing but hay and water for the 
 
64 ROARING IN HORSES. 
 
 first three or four days, but It can be given 
 Its ordinary food Immediately ; the only 
 Indication of Importance being to place the 
 food and drinking water at a little distance 
 from the ground, In order to let out by the 
 wound any alimentary matter or liquid that 
 may penetrate into the larynx during the 
 first few days. 
 
 The febrile reaction produced by the opera- 
 tion is very little noticed, and persists 
 only during a few days. The temperature 
 seldom exceeds 39*5° Cent., or about 103° 
 Fahr. 
 
 The patient ought to be left completely at 
 rest for three or four weeks, and then walked 
 out morning and evening, or put to light 
 work. 
 
 The final effect of the operation cannot be 
 determined before the third month. With 
 
Fig. i6. — Termination of the suture. Position ot the three stitches. 
 When the sutures are well put in, the three threads should be 
 nearly parallel with themselves and with the middle line. The 
 first should not have the oblique position indicated in the 
 figure. 
 
ROARING IN HORSES. 67 
 
 the view of assisting the absorption of the 
 new elements which have not become organ- 
 ised, and to avoid as much as possible a 
 protruding cicatrix, I am in the habit of 
 giving, from the second to the fifth week, a 
 daily dose of a quarter to half an ounce of 
 iodide of potassium to my patients in their 
 drinking water. 
 
 Accidents and Complications. — i. Wounds 
 of the Mucous Mcvibrane and of the Arytenoid 
 ivhich has been left. — They result from slips 
 made in carrying out the movements that 
 form the third part of the operation, more 
 especially at the moment of cutting through 
 the cartilage at Its articular angle. The 
 mucous membrane may be more or less 
 seriously injured If the animal attempts to 
 lift its head and is not tightly held. In 
 putting in the sutures the remaining arytenoid 
 
68 ROARING IN HORSES. 
 
 may likewise be wounded by the needle. In 
 most cases where the cartilage becomes 
 inflamed, the mucous membrane becomes 
 tumified, hard, and of an enormous thickness, 
 and intense roaring continues. 
 
 2. Incomplete Deglutition of the Dressing, — 
 When the plugs or the gauze compresses 
 placed in the larynx are not closely fixed, 
 the animal, by its efforts at deglutition, may 
 cause them to pass into the eesophagus. 
 where they are taken hold of by a con- 
 traction of the muscular coat of that tube. 
 The next day, on removing the dressings, 
 the larynx is found empty. The plugs must 
 then be extracted by holding the head 
 extended on the neck, and carefully drawing 
 upon the threads attached to them in a ver- 
 tical or slightly oblique manner and forwards. 
 
 3. Inflammation of the Lungs by Foreign 
 
Fig. 17. — Superior opening of the larynx and glottis of a roaring 
 horse that died of pneumonia eighteen days after the operation. 
 The lips of the wound resulting from ablation of the arytenoid 
 were not sutured. P, wound in the act of healing. 
 
ROARING IN HORSES. 71 
 
 Bodies. — It would seem as though this com- 
 plication ought often to arise considering the 
 opening made in the arytenoidean arch, the 
 incomplete closing of the upper orifice of 
 the larynx, and the possible entry into it 
 for some time of alimentary matter, saliva, 
 or drinking water. 
 
 In reality it is very rare, and in those 
 instances where it does occur it is un- 
 doubtedly the result of inattention and 
 negligence in taking care of the patient. 
 The great chance of avoiding it is in 
 placing the food and water at a little 
 distance from the ground, and allowing 
 nothing of an irritating nature to pass into 
 the trachea when the wound is being cleansed. 
 
 4. Exuberant Vegetation of the Cicatriciac 
 Tisstce. — It is very difficult to inspect the 
 reparative process of the intra - laryngea 
 
72 
 
 ROARING IN HORSES. 
 
 wound, and intervene during the develop- 
 ment of more or less prominent growths. 
 These, moreover, are not frequent, and 
 there is more harm done than advantage 
 obtained by interfering directly with the 
 reparative tissue. The causes of inflam- 
 mation of the mucous membrane are the 
 opening of the external wound and the 
 introduction of irritating foreign bodies into 
 the larynx. In consequence it is better to 
 consider these points before meddling. 
 
 5. Deformity of the Incised Cartilaginotts 
 Rings at the top of the Trachea. — This 
 consists in the lateral flattening of the 
 rings, and arises without doubt as a result 
 of the inflammation developed in their 
 substance. The transverse diameter of the 
 trachea may be reduced to the third of an 
 inch. The section of too many of the 
 
ROARING IN HORSES. 75 
 
 rings, the separation of their extremities by 
 retaining the canula too long in the trachea, 
 the pressure exercised on the upper part of 
 that conduit, and the extension of inflam- * 
 mation of the mucous membrane to the 
 perichondrium are the causes of this accident. 
 Partial ossification of the incised rings, of the 
 cricoid, and of the thyroid results in every 
 case ; but it remains limited to the parts 
 of the cartilages which surround the wound 
 and leads to no deformity of the larynx. 
 
 6. Shrinking of the Ti^achea at the Point 
 of Application of the Elastic Balloon. — This 
 follows partial gangrene of the tracheal 
 mucous membrane, and is the result of the 
 pressure exercised on that membrane by 
 the too great distension of the caoutchouc 
 balloon. The fibrous new growth or neo- . 
 plasm, which follows the casting off of the 
 
76 ROARING IN HORSES. 
 
 dead tissue, rapidly acquires great propor- 
 tions. The passage of the trachea may be 
 so reduced in six weeks that the finger 
 can only with difficulty be introduced. To 
 prevent this accident the india-rubber ampulla 
 should be but moderately filled, just suffi 
 ciently to close the trachea or use the tube 
 surrounded with gauze. 
 
 7,. Persistent Cough and Rejection of Ali- 
 mentary Matter and Drinking Water throicgli 
 the Nasal Cavities. — These phenomena appear 
 generally about the fourth week. The cough 
 which mostly appears at the beginning, is 
 occasioned by the abnormal irritability of 
 the cicatricial tissues. As for the rejection 
 of food stuffs through the nasal cavities, 
 it results from the irregular cicatrisation of 
 the anterior portion of the arytenoidean 
 wound, producing an interference with the 
 
ROARING IN HORSES. 'j^ 
 
 action of the pharynx at the origin of the 
 aesophagus. 
 
 Septicemia and tetanus are also two pos- 
 sible complications when sufficient, care is 
 not taken to avoid infection of the wound 
 during and after the operation (Instruments, 
 fingers of the operator or his assistants, the 
 articles necessary for dressing the wound, 
 removal of the dressings, and the cleansing 
 of the external wound). 
 
 Arytenotomy has been appreciated in 
 various ways by those veterinarians who 
 have practised it. At present I am not 
 entirely decided as to its value, and before 
 judging finally it is necessary to wait the 
 teaching of experience. But, I will say it 
 has given me a very encouraging proportion 
 of successes, and in successful cases the cure 
 of roaring is complete and lasting. 
 
78 ROARING IN HORSES. 
 
 At the Central Veterinary Medical Society 
 of France, sitting in Paris, Monsieur Cadiot, 
 on behalf of M. Labat, Professor of the 
 Toulouse Veterinary School, presented, on 
 May 1 2th, 1892, the first of a series of notes 
 and the results of six cases of chronic roaring 
 operated on by him under Moller's system. 
 
 Out of the six cases, two were radically 
 cured, one having the appearance of being 
 cured was prematurely put to work and 
 relapsed, two cases were much relieved, and 
 the sixth patient died three days after the 
 operation of a complication very much re- 
 sembling the disease described by Loiset 
 under the name of mechanical bronchitis 
 (bronchorrse asphyxiante) * 
 
 * Y'l^Q Rec7(eil de Medecine Vcterinaire d' Alfort, Series VIL, 
 Tome IX., No. 10, 30 Mai, 1892. 
 
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