LIBRARY NEW YORK STATE VETERINARY COLLEGE ITHACA, N. Y. This Volume is the Gift of New York Academy of Medicine Cornell University Library SF 911.Z94 V.I , Notes on surgery / 3 1924 000 924 492 ,..,. V. Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924000924492 NOTES on r\ \ V "^) S X Prom the Lectures of T/ I L I A M L . Z U I L L M e D , , D , V . S . Prof, of Veterinary Sargory & Obstetrics, VETSRIKARY DEPART? lEHT , imiVERSITY OP PET-titsYLVANIA. 18 9 1-92 o Compiled and revised for the Undergraduates of the VETE-RINARY DEPART MEHT by J . W . A D A M S , A B I I I li.7 !;Y V.Of f I ( 1 I: A r:r^ Printed by Miraoographic Process, at 802 Walnut St. Philadelphia. J INTRODUCTION TO MINOR SURGERY. VETERINARY SURGERY:- comprises the study and. treatment of all maladies affecting the exterior of animals; the repair of all injuries to which they may be exposed, and the remedying of all malformations and deformities-whether congenital or acquired. SURGICAL PATHOLOGY:- inquires into the cause, nature, seat, etc,, of those diseases for which surgical intervention is necessary, OPERATIVE surgery:- relates to the suppression or removal of such dis- eases. Surgery is thus a Science , In so far as it deals with the nature, causes, course iand termination of disease; an A rt , when a removal of the disease is effected by operation. The basis of operative surgery is Descriptive Anatomy «■ Veterinary surgery is often called upon to produce, by operation, certain functional changes in healthy animals, which render them more agreeable, suitable, or useful to man, either as companions, 'servants, or food» Dissection of the dead animal does not fully qualify the surgeon to perform all operations on the living crea- ture, because tissues, and often organs, of the dead animal differ so much in appearance, volume, color, consistence, elasticity, text» ure, and often situation, from the conditions found in life, that they can scarcely be recognized during an operation. He must be as familiar with the alterations produced by disease and by death, as with the conditions present during life. Pathology is therefore a guide to anatomy. The following Definitions of Technical Terms will help ili? student to a better understanding of the lectures, OPERATIONS are in character ;- Simple ,- as a puncture, or incision; or Complicated ;- Lithotomy, neurotomy. Bloodless ,- In which there is no hemorrhage; or Sanguinary,- " " " " considerable hemorrhage; of Urgency ,- That admit of little, or no delay; or of Convenience , or Fashion ,- Castration, "nicking," DISEASE:- (Fro des - negative, and aise - ease.) Any departure from the state of health. Disease is FUNCTIONAL;- When the phenomena are independent of any structural lesion, ORGAUIC:- When associated with an organic change in the affected part. PATHOLOGY;- (Pathos - suffering, and Logos - treatise) is a study of disease, whether organic or functional, NOIIENCLATURE:- (Naming of disease) is valuable because the names chosen express both the morbid condition, and its location, ITIS- The suffix- i-t-i-s- denotes an inflammation, as Periton-itis an inflammation of the peritoneum. Bronchitis , inflammation of the mucous tissue of the bronchi, -RHOEA:- as a suffix denotes such a catai^rhal condition as is indicated hj the terras Dia rrhoea and Enterorhoea, where, after transudation, a" liquid escapes ut)on a mucous surface « -RHAGIA:- as a suffix d'enotes a flo^ of blood from a raucous surface, as Enterorhag[ia, a hemorrhage from the intestines. -ALGIaT- as a suffix denotes ^ain unaccompanied by inflammation; as, Neuralgia , Gastralgia „ . , , -, ^ -AELtUaT^Ts a suffix denotes a morbid condition of the blood;- Anaemia denotes impoverishment of the blood; Uraemiar. excess of urea m the blood; Septicaemia- putrid infection of the blood; Pyaemia , purulent infection of the blood. •URIA:- as a suffix denotes a morbid condition of the urine; as,- Albu- minuria, albumen in the urine~{ Synonym, Azotuyia ) ; Haematuria, blood in the urine; Oxal uria , oxalates in the urine » HYDRO:- added to a word denotes a dropsical, or watery aff ection-as: Hvdro-p eriton ei-im^ a dropsical effusion into the peritoneum. H ydr o -cel e, etc„ -PlIEUl^lO,- added to a word denote:i air in an unnatural part- as; Tn&imQr ■pericardium , air inside the peri-cardlal sac« PERI,- means around, or investing, HYPER-or Super- means above; HYPO- means uiider , or below; EPI- , upon; PARA- , within, or by; the .sidg. of , EXALiPLES;- Peri-nephritis .- an inflammation of the investing membrane of the kidney. Hype r-ae mia, congestion. Hypo-c hondr ium , - the space below the cartilages of the false ribs, Epi-derrais , upon the derm^ or true skino -OKA- terminating a v;ord signifies a tumor;- as, Sarc-oma . Caroin-oma. PATHY,- as a suffix denotes a morbid condition of the part,- Encephal- opathy ■> or brain disease, LESIONS,- are appreciable anatomical changes. ETIOLOGY,- treats of the causes of disease. Causes of disease may be divided into;- I« INTERNAL,- having their origin in the mind, as, intense emotional excitement: or due to the accumulation in the blood of such products as Urea , Uric, or Lactic acid. II, EXTERNAL,- such as infectious miasms, viruses, poisons, traxjmatisms, I. ORDINARY,- to which all are exposed,- atmospheric changes. II, SPECIFIC,- those producing a specific disease,- such as the special cause of Tetanus, Mange. A contagious disease is due to a special cause, v/hose causative agent is a specific poison, that introduced into the body of another v/ill give rise to the same disease. An infectious disease is also due to a special cause, that under certain conditions is capable of unlimited increase or multiplication. Infectious diseases may or may not be con- tagious. I, PRIMARY,- any external traumatic cause. fTrauraatisra", means a wound.) II, SECONDARY,- well seen in the secondary Perl-carditis resulting from an accumulation of urea in the blooc, the retention of the urea In the blood being due to a diseased kidney, I. PREDISPOSING,- cause of disease is a special liability, or suscepti- bility, to its occurrence, and may be either inherited or ac- quired <, Inherited or constitutional predisposition to certain dis- eases is also termed Diathesis :- thus, the offspring of tuber- culous cattle may be said to be of a tuberculous, or phthisi- cal diathesis. s EXCITIKG,- causes give rise to morbid conditions in those already pre- disposed to certain diseases^ but lacking the action which deter- oiines their occurrence; thus* £©ar has operated to produce choreaj anger to produce jaundice. Animals predisposed to acute rheumatism on exposure to certain atmospheric changes, have an attacks SYMPTOLIS and SIGHS are such alterations of structure, or of function, as indicate a diseased condition^ They may be Objective , when ap- parent to the senses of the observer; Subjective,, when felt by the patient. Redness and swelling are objective; pain or numbness are subjective. ACUTE diseases develope rapidly, are severe, but tend to pass away, SUB-ACUTE diseases are less sudden and less intense. CHROHIC diseases are slow of development, duration and intensity, and tend to remain^ PATHOGHOMONIC,-- is applied to such symptoms as are characteristic of a particular disease;- as, the rusty discharge from the nostrils of a dog suffering with Pneumonia. DIAGNOSIS is the discrimination of disease, and implies an exact and comprehensive knowledge of the case, as regards the origin, seati extent, and nature of all its morbid conditions. Diagnoses are. Z- DIRECT,- when the actual condition is shown by a combination of clin- ical phenomena, or by pathognomonic signs. I Ir DIFFERENTIAL,- when the diseases resembling each other are called to mind and eliminated from each other. lit BY EXCLUSION,- when you can prove the absence of all the diseases which might give rise to the symptoms observed, except one , the presence of which may not be actually indicated by any positive symptoms. PROGNOSIS-'Of a disease is the ability or knowledge to foretell the most probable result of the conditions present- in short, progno- sis means prospect . Treatment- may prevent, cure, or relieve, PROPHYLACTIC " prevents;- as vaccination prevents Small-pox, ABORTIVE •' breaks up a disease already begun, EXPECTANT " allows a disease to run its natural course, and clears away all obstacles to its successful issue. PALLIATIVE- treatment mitigates the suffering of incurable diseases. RESTORATIVE- treatment overcomes weakness and prostratione 4 PARTI. minor surgery, chapter i . surgical diagnosis. diagnosis: BY EXCLUSION,- or the provitig what and '.vhere a disease Is, by proving what and where it is not, is of a great value. Disease is often most obscure just before its fullest development. Diagnosis by "intuition "" unconscious reasoning- is not reliable. In making a diagnosis two lines of investigation should follow, the General . and the Special . GENERAL INVESTIGATION should include the owner, or groom, and the pa- tient *s environment. Obtain the fullest possible history of the case, yet never so far rely upon the "ipse dixit" of any one as to neglect to make with greatest care a Special Investigation . SPECIAL EXMUNATION. Notice first the attitude assumed. A. ATTITUDE,- can not be said to be pathognomonic, yet must not be overlooked. Is the animal standing or recxjmbent; bearing the weight equally upon the limbs, or does it "favor" one limb? Unnatural positions are assumed for a purpose « and often fur- nish a key to the solution, B. FACIAL EXPRESSION should be noted. This is valuable in diagnosing certain internal diseases, as Rupture of the Stomach . Facial. expression in Tetanus, and Osteoporosia is peculiar. Pecul- iar notched appearance of upper eyelids is noted in Periodic Ophthalmia : dilatation of pupil of eye often seen when brain disease is present, C. A PECULIAR MOVEMENT, of a limb known as the "isochronous" movement, (ISOS - equal, and Chronos - time) because it corresponds to the pulse, usually accompanies suppuration of that member. An apparent stiffness in the movement of the head and neck is one of the signs of fracture of the transverse processes of some of the cervical vertebract. In Laminitis the hind feet are brought forward well under the body in order to relieve the affected members. In Tetanus the head and neck may be extended, the eyes wide open and staring, the nostrils dila- ted, the hind legs apart, the tail elevated, or awry- MQvement, or want of movement is often pathognomonic. When all motion is suspended in a limb, and it is carried free of the ground, an inflamed joint, or a fracture is strong- ly indicated, men ribs are fractured the respiration is chiefly abdominal. If in walking, the hind limbs are carried forward through the arc of a circle-convexity outward, you should suspect Azaturia In Navicular disease you notice the peculiar gait known as. '^pegged shoulder"- from lack of motion in the shoulders. Rupture of Flgxor Metatarsi, strain, of Psoas muscles, Strings Mil and paralyses of different kinds are all more or IWdefi. initely indicated by peculiarities of movement. (DJ SURFACE EXPRESSIOII will often reveal an atrophjr of muscle* !Kils atrophy may be due to disease in a foot, or to a disease of bone, elseTiTheret, (El laElISURATION,- Useful in diagnosing fractures « Measurements are made between fixed points on the bones^ Luxations ( disloca** tions) often revealed by measurements, tho* rigidity of the joint is a more conclusive indication^ More useful to human practitioner, and much employed by him in comparing the tho** racic walls in such pulmonary affections as "Unilateral Pleu- risy'''" never seen in the horse « {fV color,*- is of little importance except in unpigmonted (white) skins c The color of the Schneiderian membrane {also called ♦^Pituitary" membrane) of the nose is often talcen as an index to certain febrile conditions, A rosy pink indicates health; a congested appearance indicates fever « In Glanders the mu- cous membrane is of a pale leaden , or ashen color, presenting palq ^punched out" ulcers having a ragged, pirJcish edge« Gonounctiva is bright scarlet in acute inflammation, A nrot- tled black appearance of a tissue indicates sloughing, Yel*- low , or greenish spots point to gangrene* Blue ,, or bli^l-sh " purple is indicative of malignant tumors, cancers, etc, (G) TRAIISPAREHCY, Sometimes employed in diagnosing a Hydro-^cele B A Hydro-cole, behind which, a lighted Ccindle has been placed will present a transparency similar to that produced by an ©gg when held between the eye and a csmdle, This effect is not invariable, but if the translucenee is absent you may con- clude that you have a hernia, or a haomatocele (blood tumoi') to deal witho (H) L0CAII01I,-oftcn assists in diagnosis,^ especially of tumors, 7/ind« gallso A swelling anterior and external to the crural vessels and nerves suggests a Crural, or a Psoas Abscess » (I) TOUCH, is the keystone in the areh of physical diagnosis, and mist be cultivated persistently. It recognizes 1, FORM, 2, OOW- SISTEIICY, 5o FLUCTUATION, 4o WEIGHT, and 5.- TEL-iPER/LTUREo 1, FORM, or shape &t a Lipoma (fatty tumor) is moTc or less lobalated^ while a Cold Abscess or Cyst is quite regular in shape, and more fluctuating . The shape of the hoof is ^f value in diag- nosing llaviciilar, and some other foot diseases, 2, COIISISTEIICY of tumors containing liquid, or pus, is yielding and fluctuating, A Transudate is an effusion of serum into a cav- ity, while an Infiltration is a deposition, from- the blood of a substance-not ni3cessarily liquid either between *5r within the cells of a tissue. Therefore, it results that a Transu- date exhibits considerable fluctuation, and usually is soft and yielding; while an Infiltration is by comparison less fluctuating-more hard and firm. Fibrous swellings are dense, firm and unyielding. Fatty tumors are elastic. Pus swellings are doughy, 5, PLUCTUATIOir, Wot only indicates the nature of a SN/elling, but ^Iso its depth and attachments. It will reveal a Crepitus (crack- ling sound, or sensation) when pressure is made upon cellular tissue containing air; or when the roughened ends af a frac^ tured bone are rubbed against each other. 6 A fractured limb is usually mobile, and always shorter than the others a dislocated member is usually ifixsd? and mays or may not be short ere 4. WEIGHT, is important « A dense » firm tumor* heavy for its size is probably a Fibroma or a Scirrhous (hard) Cancer; a Lipoma (fatty tumor) is lobulated, elastic, and lighter proportion- ally.. A tumor may often be diagnosed by testing its 'vjelght upon the hand« Bitches are predisposed to Fibromaso 5, TEMPERATURE, of external, or local inflammations, may often be rec- ognized even when mkkski unaccom.panied by visible swelling. Considerable practice is necessary to educatb this sense suf- ficiently to be of much value in diaguoslSo Don't allow the sun^s rays to mislead you; but, using one hand manipulate the healthy part or member as much as the diseased parte (K) SOUNDS are valuable as an aid in recognizing unseen changes In In^- ternai organs. A uscultation (Lato Auscultation •- to listen) is the act of listening to the sounds given out by particulaa- parts of the body when struck., or to sounds produced by func- tional movem.ents of the heart and lungs „ Wlien practiced di- rectly by the ear, unaided by an instruments the auscultation is '-Immediate o" If some form of Stethoscope is used, the auscultation is "Mediate*" Stethoscope has little value in veterinary practice by reason of the grating sounds produced by contact of the instrument with the haire The interposition of an Indian rubber ring is said to remove this objection. (L) AUSCULTATION-Useful in detectingi circulatar^ and respiratory dis- orders. In Aneurisms the sounds are like those produced by an insect "buzzing in a paper bag", and are termed the " Bruit " (Ft, Bruit - a murmur.) A " Fremitus " is a. sound or a tremor conducted from the jaws or throat, through the medium of a serous -accumulation in the chest cavity, to the eaj^ or fingers placed against the wall of the thorax. Such accumulations exaggerate all chest sounds. It is necessary to know the normal heart and respiratory sounds in order to appreciate the abnormal sounds. (Ml PERCUSSIOH- determines the extent of a disease by the sounds elic- ited. It also serves to locate collections in the sinuses of the head, and to show the presence of certain lung, or liver disorders. Normal and abnormal chest sounds should be familiar, (lO SHELL- By this sense we may recognize the discharges from a fis- tulous poll, or withers, or from diseased turbinated bones. When bone is undergoing decomposition the odor evolved is pungent and sickening. Gangrene of lung tissue is known by a "heavy", "earthx", "musty ha^:" odor, and must not be confoun- ded with that of Acute Bronchitis, nor with that produced by the decomposition of the larger bronchi in Pneumonia, Pyemia gives the odor of "new -mown hay", and affects the sense of smell, as does "sugar on the tongue" the taste; in short, the odor is "sweet". The odor of sloughing muscular tissue Is "earthy" , 7 SYMPTOMATOLOGY, or the study of symptoms, is considered under tyro heads, - 1st., ALTERATIONS of FUNCTION . 2nd., ALTERATIONS Of STRUCTURE. ALTERATION of FUIWTION, shows disease, and is of importance in the diag- nosis of diseases of internal organs, where alterations in struct- ure are not appreciable. Earliest symptoms of most diseases is loss of appctita, then a loss of vigor and ambition. Cold flanks, dull eyes, drooping head and ears, and general "malaise" are all indicative of diseases. The circulatory system demands careful attention, and should be in a healthy condition if anaesthetics are to be administered. Never excite a fatty heart, nor increase the blood pressure on the vralls of an aneurism, ' The weight of a tumor may sometimefs interfere v;ith the circulation. PULSE,- The character of the pulse -frequency , force and size- as an index to the circulation, is of the utmost value. In health the pulse of all animals is variable, that is, it may at one time be a few beats above, and at another time a few beats below a mean rate which is the standard for that particular animal. Again, what is normal for one animal is abnormal for another of the same breed. This variation is natural, and should not cause apprehen- sion. Pulse varies with age. Approach an animal gently, or you will excite it, and hasten the pulso many beats. Pulse of Hors^ is felt where glosso-facial artery crosses the angle of lower jaw^ Pulse of Cattle taken at brachial artery, but when recumbent it is more convenient to take it at posterior face of the fetlock. Pulse of Dog taken at femoral artery, but is of little diagnostic value, as dog's pulse is normally intermittent, PULSE — RATE PEE MI YEARLING , ADULT . 45 — 55 35 - 45 50 - 65 40 - 50 80 - 90 70 - 80 90 - 100 70 - 80 100 - 110 90 - 100 120 - 130 70 In health the relation of the pulse to the respiration, both in repose and during exercise is, in the horse, as 3 to 1, The rela- tion varies in disease, and is not to be depended on in any animal except the horse. In cattle the pulse may be 80, and the respira- tion 10, during rumination. Pulse of cow, as regards the number of beats, is not to be depended upon in the diagnosis of disease; for confinement, pregnancy, obesity, artificial food, activity of the lactiferous glands, and the act of rumination increase the heart's action, and is consistent with perfect health. Intermit- tent pulse in horse is not necessarily fatal, even in Pnetcnonia, for in this case the irregtilar action may be due to debility, and not to heart clot. If to weakness, give diffusive stimulants-Milk, Beef Tea, or a bolus of Eggs and Beef. CHARACTER OF THE PULSE- 1st.- As regards the number of pulsations within a given time, the pulse is said to be FREQUENT- pulsus freouena - • or INFREQUENT- pulsus rarus . .. , , ^„x^,. 2nd.- As regards the time occupied by the beat, the pulse is QUICK- pulsus celer- : or SLOW=^\iisus tardiis. N U T E • OLD. 52 - 40 40 - 45 50 - 60 50 - 60 60 - 80 75 8 Srd«-As regards the dilatability of the artery, the puis© is LARGE- pulsus magnus : or SMALL. -pulsus parvus . 4:th.-As regards the compress ibility of the artery, the pulse is HARD- pulsus durus ; or SOFT- pulsus mollis. 1st.- A frequent pulse denotes iTever; a very frequent pulse extreme pros- tration and debility, A pulse is small in proportion to its fre- quency. Bleeding increases the frequency of the pulse, The pulse of hemorrhage just before death is sharp and rapid. There may be no more strokes in the quick than in the slovr pulse, but in the former the heart contracts more quickly and the periods of rest are longer*. Therefore, "quickness" refers to the time occupied by each beat, whilst "frequency" refers to the succession of beats. The IIIFREQUEIIT PULSE (pulsus rarus ) is often met within disease? of the brain due to compression, and in disordefed conditions of the digestive apparatus. The latter often cause in cart horses an intennittent pulse, 2nd.- The SLOW PULSE is often called a "long" pulse. 3rd,- LARGENESS or FULLIIESS of the pulse may be associated with strength or with feebleness of pulsations. Do not confound a full, feeble, with a full, strong pulse. The feeble pulse, if soft, indicates general, or cardiac debility. The SMMjL pulse may result from Anaemia, Congestion of some vascu- lar organ, feeble heart, or from great tonicity of arterial coats. 4rth,- A HARD Small pulse is termed " corded ", " wiry ", or " thready ", and is present during earlier stages of inflammatory disease, especial- ly during rigor. Hard pulse is seldom large; the strong, full pulse of Laminitis is the nearest approach. In inflammations an- terior to the diaphragm the pulse is full, slow and round; but when the inflammation is posterior to the diaphragm it is small, hard and thready. The Dicrotic Pulse is a double pulse, A Venous pulse may accompany heart disease. Small pulse alv/ays indicates nervous depression, THERMOMETRY, -Use the thermometer by the rectum, or vagina. Make obser- vations both morning and evening. Evening temperature always high- est. When the temperature reaches 105°F. the danger is great. The highest recorded temperature - 112'f.- was in case of Tetanus shortly after death. Temperature in health varies but little-not more than one^ degree. Normal temperature of horse and ox ranges from 99^- 101 F. Age influences the temperature, for the degree of heat is in direct proportion to the amount of tissue change. RESPIRATION - includes the two acts- Inspiration and Expiratioti . Inspiration is effected by the diaphragm and intercostal muscles; Expiration by the abdominal muscles, and by the elasticity of the lung tissue itself, A study of respiration includes the I, fre- quency, II. duration and III, regiilarity of these two acts. Notice which respiratory act consumes the greater time, I, FREQUENCY of respiration is increased by anything which increases the circulation, and is to compensate increased tissue change. Respirations may increase from 10 or 12, to 60 or 70 per minute. Effusion into the pleural cavity, by crowding the lungs and pre- venting their full expansion, will accelerate the respirations. II. INSPIRATION MAY BE IlIPEDED by an obstruction in the trachea, or larger bronchi; or by a croupous exudate of the glottis. s In E mphysema the lung tissue loses its power of contracting, be- cause of the inflation of the interlobular cellular tissue, and the abdominal muscles are called upon to assist in expiration, by- forcing the abdominal organs forward, thus helping to obliterate the intra-thoracic cavity; thus a double expiratory act results. The increased action of the abdominal muscles produces the "heav- ing" flanlcs- which condition is pathognomonic of this disease. Ill, CERTAIII DISEASES of the larynx and pharynx interfere with respiTa- tion, as for instance. Paralysis of the Epiglottis, and thickening of the vocal cords, and, by narrowing the entrance to the trachea, give rise to unusual sounds- roaring and v/heezing. In Pleurisy the expiration usually ends abruptly v,'ith a grunt- the result of pain; and the respiration is irregular. Hero all motion of the chest walls is in abeyance, as if the animal were suffer irig from a broken rib, and the respiratory acts are performed by the abdom- inal muscles and diaphragnio In Pneumonia the respiration is shal- low, and simulates that of Pleurisy, except in not being termina- ted by a grunt o In Peritonitis the respiration is almost entirely thoraciCo Stertorous breathing (snoring) arises from a relaxed condition of the volum palati, and is a symptom of brain disease, V/hen respiratory powers are impaired, stertorous breathing indi- cates approaching death. SEHSATIOII,- An "aesthesumeter" is an instrument used to test reflex mus- cular, and cutaneous sensibility. An ordinary pin will suffice, PAin- is intensified sensibility. Chapter II, MODE OF SECURING AlIIMALSo SECURING AimiALS FOR OPERATIOII:- Kindness, tact, firmness, and despatch are necessary in all surgical operations* Kervous and excitable animals ^ould be handled gently and kindly. Apparatus should be such as to be quickly applied and removed. Do not obstruct the respiration. Three Modes of Securing are practiced:- !• Bo nign . 2. Painful or Derivative . 5, Mechanical , I, BEHIGN, or kind method is used in minor operations upon tractable animals and is best executed by the person accustomed to handle ' the animal. Benign method used in such operations as dressing teeth. Mask is borne well by some horses, II, PAINFUL or DERIVATIVE method illustrates a principle of counter- irritation, and serves to attract the patients attention from the operation to the twitch, gag or what-not that is used. Employed when the patient will not allow such a minor operation as the ex- amination of an injured member, or the cleansing .of a sore. Re- peated use of the twitch on the ear may cause paralysis of that organ, III, MECHAlIICAIj i/ETHOD employs apparatus, which differs with the differ- ent animals, in operations on the standing and on the recumbent animal. The kind of apparatus varies with the operation* The ani- mal is secured by ropes, straps, etc., to prevent him injuring 10 cither hi-nnolf, or the operator and his assistants « STAIIDIITG POSITION o If the St^ding. position is adopted, the ground should aiot be too hard or slippervc, and the patient should be against a vail, or vrith the hind quarters in a corners V/e may use tho t\Yitch5 K-a^., blind, c radle . si de-li ne « IThere are three !<:inds of gag:- (a) .^Qller-i-ag., (b) h<er-£c,]i and (c) Poli ah-gag.c There are two kinds of t',7itch8Sj the' short ( 18--20 Incheo) and the .long. (4-5 feet). Apply the tw-itch to tho upper lip or to the ear„ The iron t^'M'itch does not so readily out tho skin of the lip as does the cordo The assistant should stand at t ho head and at one sido to escape the fore-linbs.. Horse -may be secured to a i7all or othor resisting body by the neckstrapo Deprivation of sight renders some horses docile, others unmanageable^ MaSlt. should be axjpliod from above or behind. Cradle In used to prevent a horse from biting hiinsolf, by limiting the lateral nover.v-5nts of tho head„ The a ide-' lino allo\7s no lateral movenonte Mnibs. nay bo flexod and secured either by manual ,> or I. UAJFJAI. FLSXIOII of a forelirob performed as follo^Ts:- An assistant, stanuiiig eroct arid firn,. and facing tho horse's hind quatcrs, grasps the toe of the hoof, th^ tnui-nb at the toe of the shoe and tho fingers extending vrcll in front of the v/all, and keeps the f et- lock J oin t •.-/ell f lex ed v/ith tho foot close to and just external to the elbow. In flexing the left fore foot use the left arm, and vice versa, * II, liECHAillCAL FLSXIOII of a forelimb consists in securing the pastern to tho foroanvi by a rope, or v/hat ±r, bcttf;!*, a strap having a buck- le at one o::o., Pasri the strap co'ipletely around the pastern and then around the forearm close to tho shoulder, tho knee being well flexed, Intei-pose some soft material betv7oen the heels of th© shoe and tho elbow to provont contusion, A sideline may be employed as follows:- The loop or hobble strap at the end of the sideline is placed around tho pastern of tho limb to be raised, and the line is passed over tho horsf>^«3 shoulder to an assistant on the opposite Sid?, v;ho holds it when the leg is flexed; or, the line is passed in front of the chest, roxxnd again to the same pastern where it is flxe4 , the 57ither3 sustaining the voight of the limb. I. I'lAlIUAL FLEXIOi: of the hind limb :- The horse's leg (cannon) rests on the assistants' thigh, his limb corresponding to that of the horse, that is, right leg to right leg, and vice versa, his back - being toward the horse's head. If the horse's tail be long it may be made to bear the strain by giving it one or two turns around the pastern, II. MECHAUICAL FLEXION of a Hind Limb is by far the most satisfactory. Several methods, A, If the tail bo long it is made into a loop, and a piece of rope passed half around this loop and both ends through it. Tall and rope thus form a "square knot% Pull tight so as to close the loop. One end of the rope close to tho tail has a ring spliced Into it. The other or long end of the rope is passed completely round the pastern, or through the hobble ring, if one is xrorn, and is then fastened to or passed through the ring in the short end of the rope 11 and. is then held "by an assistant standing several feet to the rear. The tail thus supports the burden of the limb, B, if the tail be short, a aide line may be fastened by one end about the neck, carried back along the spine, a half-hitch taken about the root of the tail, and then passed through a hobble ring on the pastern to be flexed, and held by an assistant standing in the rear. C. The side-line may be used as in "B", except that it is not fastened to the tail, but carried direct from the neck to the pastern about ■which it is given several turns, and then carried back to the as- sistant. This method best combined v;ith the "Ifeinual " method. There are three method.s by irhich the hind feet may be carried for- •ffard and secured:- A, A side-line fastened at one end about the neck is passed once a- round the hind pastern and then once aroiund itself, so as to in- clude the pastern in a sort of loop, and the end held by an assis- tant « This is about the same method as "C" above mentioned, B, The noose at the web end of a side-line is put about the pastern to be brought forward, and the line passed from behind to before bet"STeen the fore limbs, across the chest, back behind the shoulder of the limb on the opposite side, over the back, and do-vm toward the elbo\7 on the same sido as the limb to be secured, vrhere it is wrapped once around the rope ^hare it passes beneath the chest, and is brought out again, and held by an assistant. Both pasterns may be included. C, ;g(>th hin d pasterns may be secured by using t^ro ropes, as follows:- One side-line is fastened by one end to a hind pastern, and is then carried forvfard T^ithin the forearm, passed under the chost, then outvrards and back under itself so as to include the forearm, and is then carried straight up oyer the back where it is tied in a bow. knot v/ith the line of the opposite side, similarly adjusted. BUTEL'S HIPPO-LASSO, and the hippo-lasso of Raabe and Lunel are used Vfith considerable success. The POST TRAVIS is often used "to secure vicious or unmanageable animals, RECUMBEIIT POSITION. If it is necessary to "cast" a horse, it should be done on soft ground, strav/, litter, manure, saw-dust, or similar material, and as quickly, securely and safely as possible. Clear away all stones nails, pieces of virood, ^ I. THROWING BY means of ROPES:- There are several methods :- A. THE CASTIHG ROPE is simple, easily adjusted, and suitable for operations on the abdomen, inguinal and scrotal hernia, or castra- tion; but requires from 5 to 8 assistants. B. ROHAED'S LrlETHOD:- good for vicious animals, or when hobbles are wanting, or when assistants are few. This method requires some practice, C. BOULEY'S IffiTHOD requires but ^m. to cast a horse, D. RAREY»S IffiTHOD much like Bouley's. E. Yatel's Method requires 4 or 5 men, F. RUSSIAN METHOD is simple and requires but two men. G. HUNGARIAN IffiTHOD is excellent, the' not the most professional. II, THROWING BY means of HOBBLES is preferred when circumstances per- mit, and is often absolutely necessary. 12 A hobble may be improvised from a piece of rope 3 or 4 feet long, and an iron ring« Tie the rope to the ring and then pass it sever- al times around the pastern, being careful to pass it through the ring each tirao^ otherv/iss thvo rope may abrade the skin„ Bandage the pasterns of a valuable horse before applying hobbles. Hobbles used' only for casting; securing done with side-lines. The "^i ^listf hobbles are much used. This apparatus consists of four hobbles, a side line for the forearm, and sometimes a bridle and twitch. There are several methods of casting with hobbles :- A« ElIGLISH LETHODo B, STUTTGART tIETPIODo G. DAITISH ^iETHOBo D, BERLIII lETKODo E. BELGIAN LSTHOD* Fo lIORliiAlJ LIETHOD, Ga MILES' I'lETKOD. (For various "methods" seo"Fleming*s Opo Surgi') Zulll prefers side line methods to all others.. Care must be used in taking off the casting apparatus, precautions:- AVOID - ISto CASTIHG TOO SOOlI after feeding or vratering, or during pregnanc y o An animal should fast 24 hours, for with an empty ali- mentary canal there is less danger of rupture, and the abdominal muscles have less leverage. A hypodermic injection of Morphia Sulph» grs, ij-X, v;ill render an animal sleepy, or Chloral-hydrate may bo given T;itr Ext» Lobelia Fl, for the seme purpose. Chloro- form produces much struggling. In operations on the dog secure the oav/s, and in large dogs the feet, V/e may use anaesthetics, never Chloroform on the dog, 2ndo IIISUFPICIEIIT SECURIIIG. 3rdo TOO IvIUGH FORCE used to limit movements. 4th. IlIJURY FROM SURROUIIDIIJG OBJECTS, apparatus falling, 5th, OBSTRUCTING RESPIRATION, Keep the head and neck well extended, . ACCIDENTS:- I, In the s tanding position , (a) Abrasions may be produced by the twitch, hobbles or side-line, or in falling, (b) Fractures from struggling, (c) Muscular lesions from struggling. To prevent these, the tv/itch must be used humanely; the floor must not be slippery; the pasterns and knees should be bandaged, and the body blariketed if possible, !!• In the , decumbent position , we m.ay have (a) luxations (disloca- tions); (b) temporary or permanent stiffness or paralysis of limb, or body; (c) Rupture of viscera; (d) Asphyxia; (e) Fractures; (f) Muscular lesions; (g) Abrasions, Luxations and fractures are se- rious, but often unavoidable. Fracture of the limbs and pelvis not infrequent, but is usually preventlble. Temporary stiffness or paralysis is due to pressure on nerves, blood vessels and mus- cles, by the restraint or the cramped position, during a long op- eration, and may continue for a longer or shorter period. Abscess may form where a muscle is bruised. Asphyxia is usually due to obstruction of the respiration by the twitch, litter, assistant, throat-strap, or pressure on chest or belly. 15 By far the most common fracture, indeed, the most conmon of all accidents, is fracture of vertebrae. The last two dorsal, or first three liombar vertebrae may be involved. The annular portion usual- ly remains intact, and the body or "centrum" is crushed. Never more than two bones involved. May occur in animals of every age» Occurs during violent efforts, and is accompanied by a character- istic dull, cracking or grating, which may, however, be confounded with the slipping of a tendon on the stifle. The fracture is ac- companied by tremors of the shoulder and flank muscles, and by sweating, tho* neither are pathognomonic. This accident, which is most frequently due to disease of the bones, such as, osteo-poro- sis, is directly caused by compression of the bodies of the verte- brae, and is usually a result of one or more muscular acts. Dr . Zuill, teaches that forcible exte ns ion of the spinal coluiiffl. by the interspinousii transverse spinous and ileo-spinalis muscles, when opposed by the abdominal and more particularly the muscles af the hind limbs, crushes the bodies of the vertebrae, Fleming rec- ognizes this factor, but inclines to the belief that lateral , cur- vature of the spine is the chief factor. The accident is always recognized when the animal attempts to rise. Broken back is near- ly always fatal. Paraplegia may result either from stretching of the cord or from pressure on the cord by a splinter of bono, or hemorrhage,' PRECAUTIONS : - Cast on plenty of bedding , and keep the body below the level of the feet. Prevent arching of the back; keep the head and neck well e xtended , and destroy the leverage of one hi:id limb upon tho pel- vis by securing the limb well forvxard and closo to tho trunk. Do not bring the hobbled feet too close together, OPERATING TABLE, (vide Zuill*s table) has advantages which may be sim- med up as follows:- 1, Avoids the dangers attending the ordinary system of casting, 2, Places the horse on his feet again, easily and without danger, 3, Gives absolute safety, ease and convenience for the operator. 4, , Dispenses with assistants, 5, Saves time, 6, Economizes space and litter, 7, Secures greater cleanliness, (For methods of securing other animals see Fleming's Op. Surg.) ANAESTHETICS . LOCAL anaesthesia:- May be produced by refrigerants as, a mixture of ice and salt , or ether spray from an atomizer. Carbolic acid pro- duces local anaesthesia. Shave the hair from the region to be op- erated upon, and paint the line of incision with Carbolic acid. Re-apply lightly in ten or fifteen minutes. The Carbolic acid sears and benumbs the skin. After the operation apply oil, Hypo-derniic injection of Cocaine Hydro -Chlorate producen immediate anaesthesia at the point of injection only. Is valuable in diag- nosing obscure lameness. Inject the Gocaine over the nerve, both inside and without the limb, using care not to inject directly into an artery or vein. 14 GEI^ERAL AIIAESTHESIA:- C hloroform (CHCL5) is the best for veterinary purposes, for it does not produce the choking, suffocating sensa- tion that ether does. Chloroform kills by arresting" the heart; Ether kills by arresting tho respiration, Chloroforn is a cardiac depressant, ether a cardiac stimulant. In administering ether ex- clude all air; but in giving Chloroforni admit at least SOji of air. Pure Ghloroforra will arrest the heart. It may be administered from a leather or canvas bag fourteen inches long and eight or nine in- ches in diameter, having a looso cloth bottom, and a draw-string at each end. Place the bag over the horse's upper jav/ and, dra-^f the string tight. On a piece of cloth or sponge pour a measured quantity, one-half oz., of Chloroform and place T^thin the bag and close the end. Renew as often as necessary by adding one-half oz., at a time, till the tongue relaxes. Consult the pulse, but never touch the eyes to determine loss of sensibility. Animal should ^f^ea^ a mask. For the dog , use ether . Before anaesthetizing the dog or the cat secure the jaws by bandage or muzzle. The limbs of large dogs should be secured, and cats should be rolled up in a cloth and only the head left exposed. Chapter III, I II CISIO II S~PU II CTURES — HAEMOSTATICS, INCISIOIIS:- arc made by suca cutting instruments as scalpels, bistou- ries, draT;ing knives or "searchers," and scissors. Scalpels and bistouries are composed of blade and handle. Blade may be immov- ably joined to the handle, or hinged so as to shut. Bistoury blade may be free, or concealed as in embryotomy knife. The cutting edge may be straight or curved; the point may be sharp or blunt, probe pointed. There are special iiistruments for herniotomy, neurotomy and tenotomy. Drawing knives and searchers are alike in shape, but the latter are smaller. Scissors are of various sizes and shapes. There are "trimming," "dressing" and"roT;elling" scissors. POSITIOIIS FOR HOLDIIIG A BISTOURY OR SCALPEL ARE FIVE III NUMBER :- 1st., As a table fork, V7ith the edge dovm and the index finger on the back. 2nd. The cutting edge up, and tho index finger on the shank back of the biade, 5rd, As you hold a pen, the cutting edge being dovmvmrd, 4th, The same, the edge being upward, 5th, Held in the whole hand, cutting edge downward, and the blade passing between the thumb and fore-finger. There are several other positions* DRAWING KNIVES or "searchers" are held in two pos itions :- 1st, Grasp the handle firmly in thi3 hand, the blade toward tho little finger, and the cutting edge toward tho vrrist. Cut with a vrlst movement « and if necessary the left thtamb may exert pressure on the back of the knife, 2nd. Grasp tho handle firnly, tho blade to\7ard the little finger, tho cutting edge turned av/ay from the wrist, and the palmer surface of the hand dovm\7ard. 15 SAGE KlUFE:- held with the thximb as a point of support resting on tho hoof 6 SCISSORS, are held betv/een the thumb and middle finger » FORCEPS s are usually held between the thumb and first finger. Use only common dissecting forceps. All ingtrui-nents should ha sharp, free from blood- spots v/hich may cause scpticaenia, and from rust, METHODS OF'^ttiAiailG INCISIOIIS. They may be made, 1st. Inward s or toward the operator. The knifo is held in the first or third posit ion» and the skin rendered tense by the left hand. 2nd. Incision outward ^ or from the operator. Hold the scalpel in the second or fourth position. May use a metallic grooved director or sound, 5rd, From within, outvrard , 4th, From the skin , imvard , 5th, From the deeper tissues , outward . In opening a fistula, insert the bistoury and withdra-v it at more or less of an acute angle. Sub -cutaneous incision, made by pass- ing the point of a bistoury obliquely beneath the skin, as in tenot. omy and caudal myotomy, should be practiced t^henever possible. It may be done with bistoury scissors, FORMS OF incisions vary v/ith the' part to be operated on, and with the nature of the disease. They may be curved, "V" shaped, or straight and are kiiorm as:- 1st, Simple or Straight , 2nd. Composite , iiyhich are, (a) Curved, (b) elliptical or crescen- tic, (c) circular, (d) crucial, (e) T shaped, (f) V shaped. Elliptical incisions used for tumbrn, P U II C T U R E S . May be made to roach both natural and artificial cavities, and may be made by trocar , bistoury , or lancet , fleam , aspirator-needle , s yr ing e-ne edl e , or c onical cautery , I, THE TROCAR is the most valuable instrument, and is used for punct- uring cavities and withdrav/ing fluids and gashes. It consists of a sharp-pointed "stylet" r^ithin a closely fitting "cannula". The trocar may be straight or slightly curved, lon;^ for puncturing the rumen of the ox; medium for the chest; or short for puncture of the intestine of the horse and the exploration of tumors, or cavities. Hold a trocar as a shoemaker holds an a'r/l when serf ing, and push it. through the tissues v/ith a rotary motion , till the resistance sud- denly ceases. This sudden cessation of resistance indicates that the stylet has entered the cavity. The introduction of a trocar may be facilitated by smearing it viith carbolized oil or glycer- ine, or by incising the skin and t>ius lessening the resistance. In "hoven" in cattle incise the skin, hit the trocar a smart blov/ with the open hand, but do not drive it through more than four in- ches deep. Improper use of trocar, by injuring th-^ serous nembrane of the intestines, raay produce a profound peritonitis, especially in the horse, Nov/, steady the cannula with the left hand and with- draw the stylet, V/ithdrav/ the cannula with the right hand, using the left to make pressure on the parts around it. Do not allow air to enter the thoracic or abdominal cavities after the cannula 16 is ffithdra^rn^ After puncturing, a horso should not work for a "vyeek because a slight peritonitis alv/ays follows, and the intestinal and abdominal Trails becoine agglutinated, II. ASPIRA.T0R-1IEEDLE AIID SXPLORIIIG-IIEEDLE are useful instruments, but are too fragile for gonoral uso. Aspirating ^ttle and needle is used to empty th > chest cavity, distended synovial bursao, cysts, hydroceles, icCo An injecting syringe is used to introduce raedicin- al agents beneath the skin, or to introduce irritaj.its within cysts, tijmorso Pq t as sixx-n permanganate, Carbolized oil, Iodine etc., are used for this purpose. Simple incision into a cyst usually creates enough irritation to produce the formation of embryonal tissue and the absorption of the indurated wall. III. ACTUAL CAUTERY is used to evacuate abscesses r/hero there is danger of excessive hemorrhage if the lancet be used. The cauterizing iron should be heated to a white heat , and pushed slo7;ly in with a rotary motion till the cavity is reached. The cautery arrests hem- orrhage; is less likely to cause accidents than the knife, should the animal struggle, and the wounds remain open longer, and allow subsequent collections to escapes The cautery for this purpose should bo conical and blunt-pointod. PRSVEIITIOII AIID AimEST OF HEIlOREIiAGE. (Haemostasia.) I. PREVENTIOII may be accomplished by, ( AJ Refrigerants. (B) Digital comprossion. ( C ) 3 andag e c oi- ipr o ■-. 3 i o' ^ , (D) Tourniquet comprossio;.*, { E ) Elas tic bandag e , { Esmar ch ' s ) . Cold v/ater, ice, or ether spray cause contraction of the arterioles and capillaries, and ropel the blood from the part to be incised. II. ARREST OF PIAELIORRHAGE : - ' Bleoding may occur from arteries, veins and capillaries. The hemorrhage from, arteries is isochronous vrith the heart-beats, and of a bright crimson hue, that from the veins flows in a steady, stream, and is of a dark or purplish-red color, that from the capillaries appears to exude from the fresh surface of a wound, and is intermediate in color. Hemorrhage may be arres- ted by ( 1 ) . Physical . ( 2 ) „ Chemical and ( 5 ) . Surgical means . Iv PHYSICAL mean^ includes, (A), Stimulants, (D). Absorbents. { C ) , Refrigerants , Hot v;ater ( llO"*- 125" F. ) is a good stimulant hemo.qtatic. and cold water a good re frigerant hemostatic in capillary bleeding from the mouth, rectum, or vagina. Absorbents useful only in capillary bleoding, a tampon or plug of fine to".7 is the best « 2.- CHEIIICAL HAEiOSTATICS are, ( A ) , Ast r ing ont s , (B). Caustics. (A). ASTRIIIGEIITS constringe or contract, and coagulate? t&e tissues and effused blood. Vi negar is excellent, and never does harm. A sponge soaked full of vinegar is one of the best hcmostattcfj to uso in cases of bleeding from the rectum, vagina, or uterus. 17 Lomon .luico ^7ill answer nearly as \/ell« " Mons ol ' , s Solut ion (Liquor Perri Sub-sulphatis) is effective and non- irritating"- Thomas, Dr, Zuill says Monsel's Sol,, »*Produoes an ugly slough that rotards tho hoaling process" » ,Sesgui~chloride of Iron (Liquor Ferri Chloridi) is good. Alun and Tannin- are mild styptics, II it r at g of silvsr is not nuch usod. Alcohol produces a slough, Sub-3ulphat«9 of Irpn is excellent for moist corns. Cut them out and apply the styptic heforo suppuration begins. Small doses of TTolCrgot are said to bo efficacious - gtts, XX~XXX every half hour, for internal blooding, (B). CAUSSICS, V;hi to-hot iron ( for rum candens) is simplest- and best. Iron at a rod or black heat will adhere to the tissues, and A7hen removed vill tear £,v/ay the eschar and aggravate the hemorrhage. Hot iron makes a disagreeable slough, 5,- SURGICAL H3I.I0STA'i:iCS comprise, (A), Torsiojx, ( B ) , Compression, (C), Ligatinre, (Acupressure and Uncipressure - Fleming), (A), TORSION by forceps is often a convenient method of occluding large or small arteries or veins, v/ith thn subsequent formation of a coagulum. Results are about tho same as \/ith a ligature, (B), COtiPRESSIOlI is DIRECT when applied direct to tho part from v/hich tho blood is flov/ing, by filling the wound with plugs of tow, cot- ton, &c,, and bringing the edges of the ^;ound together by sutures, A bandage may often servo as vfoll as the sutures. Compression is MEDIATE xrhoii applied directly to th-^ parts covering the v^ounded vcs'jrjl by means of pledget': of oakun or cotton firmly applied by moans of a bandage. Bandage must not be allowed to remain on more than two days. Plugging, or using tampon is essentially the same in principle. Compression is IlEIEDIATE when applied directly on t he vroi-uided vessel . May be effected by plugging, or by digital impression. (C)« LIGATUEII;, Ligation of a blood vessel consists in tying a thread or cord around It more or less firmly so as to occlude and obli- terate it. Arteries O'ly are ligatod, for this operation on veins is apt to produce phlebitis, A ligature may be applied in three ways:- (1). Immodiatol.v . directly to the isolated bleeding vessel. (2), Mediately « v;hen tho ligature includes parts surroimding the vessel, (3). In continuity . i,e, some distance from the v;oundo IlJSTRULiElITS required are:- ordinary dissecting forceps, dissecting scal- pel, artery forceps (with spring), artery clamps, tenaculum, aneu- rism-needle, steel director, retractors, and suture materials. Ligature may be of silk, catgut, or silver. Catgut is rendered antiseptic by steeping for 12 hours in Chromic Ac, (l.';6) and in sulphurous ac, for same length of time, and then dried. Plunge in- to dilute solution of Carbolic Ac, just before using, tOleura Jimi- peris is very good). Catgut is soon absorbed, Tho ligature should be round. Lead is recommended by Agnev/, but is too viealfc. Silver is next in value to catgut, and often superior, V/hen ligating in continuity, after making an incision through the skin and subjacent tissues, do not incise the sheath of the artery and draw the latter out, but with forcops or tenaculum tear away 18 the connective tissue from around tho vess->la The nourishment of the vossol cones from its sheath, and no more of it should he de- stroyed than noc.93sary, for tho vessel will slough v/hore the sheath has- ■be')n torn avray„ Ta-:o caro ::ot to includo the nerve or tho vein acconpanyii:g the artery in the ligature « A clot forms on hoth sides of a ligature ^ in both clots vascularization takes place, and in a toxr hours penetrates the vessel v/alls and re-establishes the circulation. One danger of ligating a vein is, that parts of the clot botweon tho ligature and tho heart are often v/ashed out into the general circulation by the incoining current of tho vein next above thD ligature » Those loosened clots become emboli, and if pus is present suppurative phlebitis {blood poisoning) may result* In ligating, pass a grooved director under tho artery, and a thread- ed aneurism needle along the director and under the artery, always passing it from the accompanying vein. Tie all ligatures by a "recf-'lcnot "-called by some a "square lai.ot", (D). ACUPESSSURE is temporary metallic conpresaion of an artery« (1)9 May be done by passing a long needle through the flesh, over the vessel , and again thro * the f lesh« In exactly the same v;ay a flovver is fastened to the lapel of a coatc The pin pas- ses thro' the cloth, over tho sten, and thro' the cloth again, (2)« Pass a needle under the vessel , and pass the loop of a wire over tho point and fasten to the eye of the needle. The ves- sel is thus compressed betveon the needle and wire, (E)» UIICIPRESSURE, ^^ore in a deop wound the arter;: cannot be directly seized, traction upon surrounding parts v;ith a tcnaculu:n ^;ill often occlude the vessel. Chapter IVo CLOSUES OF V/OTJIIDS— SUTURES—CAUTERIZATION „ TO CLOSE A WOUITD and obtain cicatrization as sooii as possible, 170 employ I,- Adhesive pla st ers « II. Sutures. Healing by " fir st intentio n" is most desirable, but most v/ounds heal tJy " s econd int ent ion " , i,e. granulation. Only vTounds involving but a sizagle tissue heal by first intention, and they do so by means of plastic lymph , and not by coagulation. Cicatrization is carried on by tho leucocytes » These die, act as foreign bodies, and give rise to puso I. ADHESIVE plasters:- when properly applied are valuable to preserve immobility in fractures; in the union of v/ounds vhare there is lit- tle traction or movement; in superficial wounds; and as an auxil- iary to sutures, v/here a \7ound is deep and the tension greats Mater ials , ordinary shoema ker ' 3 , wax warmed and applied to the cot- ton or linen handage makes a good' plaster. Carpenter's ^lue, pitch Vonat ian turpentine , and Canada balsam are used with good results."' Collodion is good for small superficial T/ounds, and is air and v;ater-proof „ The bandage of the shops may be used on hairless skinj as in treating orchitis „ APPLICATIOII : - Shave off tho hair in the neighborhood of the wound.. 19 Cleans© tho woiind and appose tho edges. The piaster in narrov? strips is applied at right angles to the line of inaision, v/hich crosses the niiddle of each strip. These strips overlap each other ahout one-hali:. Leave the dopendont part of the v;ound micovered if a discharge is oicpoctedo, Drainage maj be promoted by inserting a surgical tube, or strands of horse-hair previously rendered asep- tic, into this lov/ost part of the vmund, A vfound on the leg should be bandaged obliquely, that is, in a spinal form, so as not to ar- rest circulation should the limb s\7elle In this case the middle of the bandage should be on the opposite side of the limb from the wound, and tho ends of tho bandage brought across the wound^j II. SUTURES* are used chiefly to repair solution of continuity either by primary adZaesion - rare in the horse,, or cicatrization; to pre- vent air from entering a \7ound or natural cavity; to prevent dis- placement or protrusion of organs, or to arrest hemorrhage* Most beneficial in recent wounds, but may be used after suppuration is established. Are contra-indicatod when a wound is much inflamed, swollen, deep, much contused, or gangrenous* Never allov; the sut** ures to remain in till they cut through, for that v/ill only increase the cicatrix, IlIDICATIOIIS* Cleanse the wound thoroughly of blood clots and foreign matter, and trim off %7ith scissors all ragged tissue* DovJt en- close iodoform or any other insoluble substance ( Iodoform is sol- uble only in ether) in the %wand, as it ttIII only aggravate the suppuration. Externally there is nothing better than iodoform. After the iTound has been cleansed '^msh it out ^jith an antiseptic, clos-^ it, and apply an antiseptic dressing to purify the air that may pass through to the nov/ aseptic \TOLind. Altitude above the sea materially influences the healing process. Suppuration decreases as the altitude increases. Sutures should be so applied as to bring the lips of the v/ound in exact apposition. If they are too tight they may Interfere >7ith the circulation, or subsequent swell- ing may cause them to tear out. They should be perpendiciilar to the edges of the v/ound, and should always go at least half the depth of the wound. Avoid injuring tendons, and making pressure upon nerve trunks. Place sutures at equal distances, and close enough to prevent "gaping" of the vroimd. Leave the loiter part of the wound open for drainage. Place tho first suture where the coap, tat ion should be most exact. As a general rule, do not tighten a suture till all arc placed. I^ot to one side of the incision, at its least dependent side to avoid soiling by the discharges. Use a "reef knot, or a surgical knot„ MATEEIAL FOR SUTURES. Metallic suture material is usually the best for tho veterinarian. Silver wire is strding, fine, pliable, and so non- irritating that it may remain in the flesh ten days or two weeks without inducing suppuration, ?fire of other composition, as lead, silver-plated iron, soft iron, fine telegraph wire, may also be used. Don't draw the sutures tight, or subsequent svelliiig may cause them to cut through tho flesh and produce an ugly cicatrix. Zihs. of steel or l?rass are much used, especially if the wound be largo and deopo Ths^ad or fine cord made of silk or hemp may be used of such size as is requisite to afford the necessary strengtho 20 The thread should not tie too thin or it may cut the tissues; better use a rather large or flattened thread, or strand of threads^ Catgut rendered aseptic, kept pliable in oil of juniper, and trea- ted Tflth carbolic oil just before using is an excellent suture ma- terial for V70unds '^vhose location does not admit of the sutures be- ing removed by the surgeon; because in the course of a fev/ weeks it is absorbed by the surrounding t issues « GENERAL REMARKS:- Horse's flesh is prone to suppurate, because of the smallnsss of the connective tissue corpuscles vrhich are but one- half as large as those of man; therefore, vre see why it is that in the horse wounds seldom heal by "first intention", but nearly al- ways by granulation accompanying a suppurative process. When the lips of a v;ound granulate take out the sutures. In shoeboil oper- ations use the pin and "figure of eight" suture and twist, leaving the v/ound open below. Inject an antiseptic solution twice each day, and remove the sutures at the expiration of ten days. SUTURE IIISTRULIEHTS : - are suture needles of various kinds,- straight, or curved, round or triangular, long or short; needle-holder or pin- holder, suture forceps, etc, KINDS OF sutures:- are many and adapted to the varying necessities of the woundSo Some sutures are for superficial wounds; others for deep wounds; some hold the parts in close apposition, others move loosely; some take a short and firm hold, others are employed where the grasp must be deep and somewhat loose. Therefore, the surgeon must choose that foi^ of suture that best fulfils the conditions that he wishes to create. Chief of these are:- 1, INTERRUPTED OR SIIviPLS SUTURE:- Used in recent, and in large wounds, either to bring the lips in moderately close apposition, or to re- tain tampons or plugs. Is formed of separate threads passing at right angles to the solution of continuity. Each thread is tied separately, begirining at the middle one- in a "reef" or in a "bow" knot, except in case of wire which is usually twisted. Place all the sutures before tying any, 2. UNINTERRUPTED OR CONTIIIUOUS SUTURE:- Much like the former, except that the sutures are made by one thread. T/hen placed this suture is shaped like the letter "Z", the horizontal threads being buried in the tissues at right angles to the solution of continuity, and the diagonal thread lying on the surface. Much used in superfi- cial and shallow wounds, as of skin and intestines. Has ty/o dls advantag es:- (a) is apt, if improperly placed, to corrugate (puck- er) the edges of the 'ffound; (b) Entire suture gives v/ay when the thread is cut at any one point. 5. r«yiSTED SUTUP^:- Much used. Retains the entire surface of the lon- gest wounds in absolute contact. Insert pins (brass or steel) at right angles to lips of wound allowing the heads and points to pro- ject an equal distance. Pins should be placed at uniform inter- vals, and every pin should enter and leave the tiasues at least half an inch from the edge of the wound. Now, with a thread or taps begin at the first pin and make several "figure of eight" turns between the head and point, the point of crossing lying over the line of contact of the lips of the wound. Then pass the thread to the next pin, and so on to the end and back again^ 21 If, instead, of making a "figure of eight" twist, the thread be car- ried in a circle beneath the head and point of each pin, V7e have the "circular twist"„ Twisted Suture used in all abdominal oper- ations o 4, SINGLE PHI SUTURE:- Useful for closing a small incision, especial- ly in a vein in the operation of "bleeding**, "Figure of eight", or a special knot, or tha "circular twist" may be employed, 5, QUILLED SUTURE:-^ Resembles the interrupted suture, except in that the separate sutures, instead of being tied across the wound, are fastened on either side to a long quill or pencil placed parallel to the line of the wound. Much used to appose in steady contact the deep parts of a wound. Has a disadvantage in not holding the cutaneous edges in close contact; a few interrupted sutures will do thiso Double thread and two quills used in quilled suture. G, Dossiled Suture , Use two needles, 7. Z igza g Suture . 8. "X" Suture o 9. "T" Sutures (vide Fleming's Op, Surg). CAUTERIZATIOII . Tv?o kinds are recognized, depending upon the agents employed to produce ito 1, Actual Cauterization implies the application to the living tis- sues of a heated body- a hot iron or cautery , 2, Potential Cauterization i-mplies the destruction of living tis- sues by the chemical action of substances naiT\od Caustics . V/e shall speak only of the former. ACTUAL CAUTERY:- Its value in Vet, practice has been recognized from remote antiquity* Used most frequently in the horse, seldom in the ox. Age nts employed are of metal. Iron good and inexpensive; steel is better and oxidizes and "scales" less readily. Plat inum is the best, but is expensive - worth tv;ice as much as gold, v/eight for weight'. Are of forms varying according to the use. The principal diseases and malformations for the remedying of which actual cautery is employed are;- diseases of the tendons', knuck- ling over and breaking dovm; of articular synovial membranes; chron- ic arthritis; of bones, periostitis and exostosis; infiltration into connective tissue; cold abscesses; lacerated muscles; viru- lent diseases, etc. There are three kinds of cauterization based on the depth of the tissue destruction, !• Superficial or linear, 2, Median , 5, Deep or penetrant. 1, SUPERFICIAL cautery is applied in lines or points to the derm so as not to destroy its entire thickness. The designs that should be used v/ill depend upon the region cauterized, but should be as sim- ple as possible. The lines should run a little oblique to the di- rection of the hair, and should never be closer than one-half inch to one another. Use a cautery having a convex edge for such line firing, and hold the iron at the right angles to the surface of the skin. The heat radiates into the tissue, producing acute in- flammation which tends to recovery. 82 As a chronic inflairanatioii can not exist in the same place at the same time that an acute inflammation is going on, the rationale of this treatment for chronic inflammations is apparent « 2. MEDIM CAUTERIZATIOH includes the true islcin or corixim, (cutis, derm etc). This is done by passing the cautery from six to eight times lightly over the same 'surfaces 3, DEEP CAUTERIZATION is usually accomplished by the use of platinum, points made from No., six or eight wire« These points penetrate through the skin into the subjacent tissues, and should not be placed closer together than one-half inch, and should form straight rows in all directions. Point firing in cases of spavin produces complete inter-tarsal and tarso-metatarsal ankylosis. V/hen using iron remove all scales. The thermo-cautery is the most efficient and convenient form of apparatusc (vide Fleming's Op, Surg, for further inf ormat ion ) , Chapter V. -:-I N F L A M M A T I N-'J- INFLAiaLA-TION (L, f lamma - a flame) literally means excessive heat. It attends all operations and* injuries, from the slightest to the most serious o It is now the surgeon's best friend, and again his most deadly foco .Fully three-fourths of the whole number of deaths occurring in Philadelphia annually result from inflammatory pro- cesses. Dr, John Hunter was the first to study inflammation thoroughly and to publish a systematic arrangement of it« He devoted 50 yrs» to this vjorko Inflammation is not a single process, but a combination of process- es. It is a complex term used to expresjj a totality of several Phenomenao The definitions are numerous. Thus, it is, "Simpler an increased action of the vessels"- Hunter; "A perverted action of the capillary system, generally attended by heat, redness, pain, and sv^ellin^"- Syme; "A peculiar perversion of nutrition or of se- cretion"- Alison; "Perverted nutrition of a living part, the effect of irritation or injury"- V/illiams; "A form of hypernutrition"- ZUILL, The several varieties are distinguished by well marked chau- acteristicsc The tendency of an inflam, may be toward a healthy or an unhealthy termination« I. HEALTHY INFLAM„ passes rapidly through the several phases and leaves the tissues normal. The termination of an inflam. depends much on constitutional vigor , therefore, v;e find a healthy inflam, occurring in healthy and vigorous constitutions, from which fact it is often called Sthenic , II, UNHEALTHY or ASTHENIC INPLMl. pursues a slow, irregular course, is accompanied by discharge and leaves the tissues more or loss struct- urally altered. Occurs more often in weak and deranged constitu- tions^ 23 III. BLOOD PECULIARITIES form the basis for specific inflammatory diis- eases, such as, glanders, farcy, small-pox, syphilis. IV. TEXTURAL PECULIARITIES. Purely an anatomical classification, based on the supposition that every tissue has a strong susceptibility to its ovm particular kind of infla::i?nation; thus, connective tis- sue when inflamed tends to the formation of x-us, serous membrane to the formation of serum, mucous membrane to form mucus, and crou- pous exudate. V. COMLION CAUSES, as blows, irritants. VI. LATENT INFLAMLIATIONS, diffuse and circumscribed, (many other clas- sifications of inf lam. ) . Dr. Zuill divides inf lam. into txio classes :- ACUTE and CHRONIC 1st. ACUTE IIIFLALl. runs its course rapidly and with well marked phenom- ena, 2nd. CHROIIIC IKFLAil, runs a long course and the symptoms are obscure. Many forms between these extremes, CAUSES of Inf lam. are. External and Internal , both of which are divided into Predisposing and Exciting . PREDISPOSIIIG CAUSE, is any influence which renders any tissue or tis- sues susceptible to inf lam, on the application of an exciting cause that under other circumstances would not produce this inflammation, EXCITING CAUSE is anything which, acting cotemporaneously v/ith a pre- disposing cause, produces inflammatory phenomena. Predisposing causes are; I, TElVIPERALffiHT . Certain peculiarities of temperament predispose to certain inflaiTimatory conditionc; a^, many diseases of tlior- ough-breds are not likely to occur in lyiaphatic animals. II, HEREDITY. Horses may inherit an organization which predispo- ses to such grave diseases and defects as glanders, curbs, spavins, ring-bones. Under an exciting cause the offspring of tuberculous animals may develop tuberculosis. III. AGE, Its influence noted in the distemper of colts and young dogs; siippurative tonsillitis in young pigs; rheumatic and bronchial affections of middle life, and senile gangrene, and atheromatous and cardiac affections of old age, IV, SEX, Females present inflammatory phenomena at the periods of menstruation or rutting, and are subject to such diseases as iiammitis, vaginitis, cystitis, and ovarian troubles. Males have orchitis, V, FOOD is a coram.on and powerful factor. In inordinate quantity or of inferior quality may produce gastritis, enteritis, colic, etc. Absence of salt may produce erythema. Ergot in suffi- cient quantity taken- in food will produce "ergotism" Y;hich is a condition in which the terminal blood vessels of the extrem- ities become so contracted that nutrition ceases and dry gan- grene results. VI, TEMPEPJLTURE and LOCALITY. Extreme cold predisposes to diseases of mucous membranes (lungs &:c,); Extreme heat to hepatic and abdominal diseases, (liver, stomach, and intestinal troubles); marshy districts to malaria; Southern States to splenic fever; Mountainous districts to goitre. Cretinism; damp climates to rheumatism. 84 VII. BLOOD, Chemical changes in the blood may predispose to throm- bosis and embolism. Imperfect oxidation and Uric acid in the blood may produce a rheumatic diathesis. Obscure changes in blood laden with waste from the body predispose to azoturia. VIII. ATTACKS OF INFLAIvI, predispose either directly or indirectly to subsequent attaches , Iviuraps in man has a tendency to produce orchitis, in vroman mammitis. IX, OVER-FUIICTIONAL ACTIVITY. Perfect reciprocity exists between the various apparatuses of the body, by which each supplements the work of another; as, the kidneys the work of the skin, et vice versa. In azoturia the abolition of this reciprocity may be observed; muscular exertion produces urea and uric acid- under peculiar conditions in over abundance; the skin ceases to act, the kidneys become Jiyperaemic and over worked, and an acute nephritis supervenes, EXCITING CAUSES are. External and Internal , both of vrhich are Mechani- cal and Chemical . 1. EXTERIIAL ICilCIiANICAL EXCITIIIG causes are cuts, bruises, punctures, fractures, parasites, etc, 2. EXTERNAL CHEM. EXCITING causes are Caustics- acids- alka- lies, rubefacients, vesicants, heat, cold, etc, 3. INTERNAL I/IECHANICAL EXCITING causes are; Calculi either biliary, renal, or salivary; tubercular deposit in the lungs; necrosis of bone causing inflan. df surrounding tis- sues; embolism; thrombosis; blood extravasation; pressure from morbid growth. 4. IIITEP-NAI. CHEM. EXCITING causes are; escape of bile or urine into the peritoneal cavity; perverted lachrymal, salivary, or urinary secret iozis. Urine too long retained within the bladder produces cystitis, and may cause uraemic convul- sions. Abnonnal conditions of the blood, especially, blood surcharged v;ith tissue waste, or containing certain medi- cinal agents that are eliminated by the kidneys, may pro- duce nephritis. Mercury produces salivary, cutaneous, and raucous inflammations, Cantharides may produce nephritis. Inflammation may extend, 1st. BY SYiilPATHY as in articular rheumatism; secondary syphi- lis; ocular inflam. from eye to eye; mumps from the paro- tid and submaxillary glands to the mami-nae, or to the testes; skin diseases, 2nd. BY INFECTION. Glands of certain regions inflame because they are irritated by the products of an inflammatory process in the adjacent tissues. The irritant is arres- ted for a time by each lymphatic node (gland) and causes it to inflame. Thus, by inoculation, extend cow-pox, glanders, and tuberculosis. Buboes arise from gonorr- hoeal inflam. of the urethra; "kernals" inside the elbow from injury to the foot; lymphangitis from suppuration in the foot; pox n^arks on the arm fro^i inflammatory in- fection from vaccination, 5rd. BY THE BLOOD. Embolism and thrombosis; Pyaemia from pus carried by the blood from a point of suppuration, depos- ited, and the formation of internal abscesses. 25 4th« BY CONTINUITY OF STRUCTURE. Thus an urethritis may extend and become a cystitis; a pharyngitis become a laryngitis; an erysipelas a cellulitis; or a visceral pleurisy a costal pleu- risy. SYMPTOMS OF ACUTE INFLAi-I. are, A« Redness , Bo SwellJJig.5 G o Heat i D« Pai n, E. Loss of Function . A. COLOR, is of little value in practice by reason of the pigment and hair, tho' it is apparent in mucous membranes. It is due to en- gorgement of the tissues with blood, and in inflam. will be bright red if the tissues are very vascular ^rich in blood vessels). As seen in the mucous membranes the color varies with the activity of the circulation from a bluish cast in the centre to a dull rod to- ward the inflamed periphery. Redness is due to dilated capilla- ries which are so numerous as to impart to the tissues their in- tense red color. There is no greater n^jmber of blood vessels in a given part after an inflammation than before. Conjunctiva and Schneiderian membranes conveniently indicate the presence or ab- sence of inflam» B., SV/ELLING due to several causes :- 1st, To the increased amount of blood in the vessel's of the part, 2nd, To the transudation or extravasation of serum into the tissues. 5rd, To a multiplication of organic cells . If the inflam. be in a tissue that is hard, unyielding and inelas- tic, as bone, horn, tendon, etc., little swelling will bo produced; but if in soft tissues, the sv/olling is often great, as observed in inflammations of the eyelids or face in conjunctival, laryngeal,, or pharyngeal inflammations. An inflammatory oedema of the glot- tis sometimes so narrows the air passage as to threaten with suf- focation, Tho same condition in conjunctivitis (Chemosis) causes the mucous membrane to protrude between the eyelids, producing a hernial condition of that part. May hax?e like hernias of the rec- tum, vagina, or any other tissue sufficiently soft, vascular, and well supplied with connective tissue, Thore may be considerable effusion into a synovial cavity- particularly when articular, or into the pleural or peritoneal cavities and no swelling be noticed, because there is room for the parts to sv;ell, and the tumefaction is much diffused; also because the sv/elling is enclosed within re- sisting v;alls which prevent our seeing or feeling it. The Schnei- derian membrane may be much inflamed, and pour out a large quanti- ty of exudate, and yet present no visible sv;elling. This is prob- ably. due to the fact that this membrahe has but a scant basement membrane, for the soft terminal ends of the turbinated bones, which possess much erectile tissue and are covered by this membrane, will be found to bo much engorged and thickened. The CI-IARACTER OF THE SV/ELLING will depend on several conditions-; 1st, The c onsistency of the effused material, whether serum or mucus; whether the intercellular spaces are filled with lymph, or with fat. 26 Sndo Densitx of the, diffused product. If the svfelling be soft and easily manipulated with the fingers, or if it "pit" on pres- sure, then it is o edematous and consists entirely of unorga- nized fluid seriLTi; if hov/ever, the s-;slling be found firm, hard, dense, and unyielding, as are erysipelatous sv;ellings, then it contains much fibrin and has begun to organize. The swelling may be due to hypertrophy , from the development of corinective tissue from the organized ti-ansudate, in which ease it will be firm to the touch: or it may result from an extravasation of pus, blood, or serum, and will be more or less soft and yielding. A hard s\relling due to organization of a fibrinous transudate may become soft by a retrograde met- amorphosis-^ fatty degeneration, and formation of an abscess. Rapid removal of the sv/elling by a purge indicates that it was due to serums. A hydragogue purge acts upon an oedema, as does bleeding upon the am't of blood in the body* Thirst, by its demand for v/ater, vrill drain away an oedema into the blood channels tf C. HEATe Edward Montgomery proved by a thermo-electric battery that blood coming from is hotter than that going to an inflamed part. The cause is probably increased metabolism in the inflamed area. The degree of heat may be recognized by comparing the ixaflamed with the corresponding healthy part , D. PAIN. The degree of pain is, as a rule, in direct proportion to the degree of inf lam. , and is most aggravated v/hen the inf lam, is at its hjLght, It is due to irritation (pressxire) of tho nerves in the infl.ajned tissues. Inf lam, may exist without pain. The most extensive inflammatory processes may exist v;ithin the liver, kid- neys, lungs, or brain, and even form abscesses v/ithout giving the slightest pain, because the tissues are soft and the nerve fila- ments are not pressed upon. Swelling of the pleural sac, and tho ulceration of the intestines in typhoid fever, for a similar reason give little pain* The intensit y of the pain is more often a result of the resiotance of the tissues than of the degree of inflarn , A very slight lami- nitis causes more pain than an intense inflam. of the scapulo-hu- moral region, because of the rigid resistance offered to the in- flamed Iceratogenous and keraphyllcus membranes by the unyielding horny box. Caries of a tooth will often cause more pain than a fatal peritonitis. Felons are so painful because the forming pus is bound dovm and imprisoned beneath strong and inextensible fas- cia, and the included nerve endings arc under great pressure. Immediately the fascia is pierced and the pus released, tho preS*- sure falls and the pain disappears. MATURE OP THE PAIN. Each tissue has a peculiar pain; that of pleu- risy is sharp, and lancinating; of orchitis is sickening; of per- iostitis is "gnawing"; of muscular tissue is dull and heavy ache; of the skin is burning and itchijig; of peritoneal serous .^.emlirane is a"ooreness", of periosteum ai3d tissues of the foot is "throb- bing". Sudden cessation of acute pain, especially when intestinal, is a very grave symptom, as it is an indication of mortification of the part; with even greater certainty, when accompanied by a v/oak pulse and a cold, clar.imy skin. 27 Sudden cessation of acute pain in the skin or tissues of the foot indicates sloughing* E, ALTERED FUNCTIONS « Marked and manifold« 1st. SUPERSEHSITIVEHESS ; as of the eye to the action of light( pho- tophobia) even several days before an attack of opthalnia, or inflam* of the eyes. For several days before the manifesta- tion cf certain inflaircnations of the bladder that organ may, through excessive sensitiveness, refuse to act as a reservoir for the urine, and allov/ it to escape. Gastritis is preceded by vomiting in man, dog, pig, and cat; in the horse by colic- ky pains o Glandular inflam, may bo preceded by increase of saliva, if of a salivary gland, as when giving mercury con- tinuously » A coryza, or inflani, of the Schneider ian membrane, exhibits an excretion before the actual "cold" is felt. 2ndo DISORDERED SECRETIOIIS : - Bile secreted duriiig the existence of a hepatitis is irritating^ In cystitis the urine excoriates the skin, Inflam, of the lacrymal glands causes the secre- tion to inflame the eye and irritate the skin \?here it hap- pens to come into contact vfith it, 5rd. BffERFECT or SUSPENDED FUNCTIOIIS:- seen during the existence of coma of the brain, and during the existence of the paraly- sis accompanying certain diseases of the nervous system, COIISTITUTIOIIAL SYIIPTOMS of inflam, are usually slight. There may fol- low an operation a slight disturbance knovm as "traumatic" or "sur- gical fever" and indicated by both temperature and pulse. In sur- gical fever th-^ first constitutional symptom is a chill . Increase of temperature is present in all fevers even when the animax suf- fers from a chill, and may be considerably higher than the external surface indicates. The thermometer often indicates the approach of disease. Conges- tive colic is preceded by a high temperature and a hard, tense pulse. Traumatic fever appears to be due in part to inflection, the substance taken into the blood renders it unfit as nourishment for the tissues It may assume an intermittent, remittent, or continuous type. In strong animals the fever v/ill be acute, or sthenic; in weak and impoverished animals asthenic, of an inter- mittent, remittent or typhoid character, especially in unsanitary stables, LOCAL IRRITATIOIi:- denoted by an indolent, inactive condition of the injured part, due to dofective arterial circulation, STRUCTURAL PECULIARITIES:- Some tissues resist injuries better than others. They may be symptoms of a nervo-muscular character, as, yawning, and stretching of the legs are prodromic of Tetanus, and are produced by constitutional causes; or, they may usher in a slight fever, or a disease if a wound be present. There may be symptoms of a nervous and circulatory nature; as, sen- sations of a v/aaunth with chilliness. Pulse increase from 55-GO per ' min. There may be changes .in the secretions of glands- salivary and kid- neys. The tissues become dry, the skin hot and parched, and thirst is constant and excessive. Give an animal suffering with fexrer plenty of water; chlorides are also demanded. The hepatic secre- tion changes and colors the faeces. 28 WHAT IS INFLAMMATION? The term is generic and, like nutrition, comprises several distinct phenomena : -■ 1st, Disturbed Nerve Action, 2ndo Disorder of the Blood-vessels and their contents. 5rdo Passage of contents of blood-vessels through the vessel- walls o -itho Changes in the perivascular spaces of the inflamed tis- sues,, I. DISTURBED NERVE ACTION is shown when an irritant is brought in con- tact \7lth the body a An unpleasant sensation travels along sensory nerves to corebro-spinal nerve centers, and is there changed to a motor impulse traveling out to produce muscular movement , The vaso-raotor system governs the circulatory system, the cardiac move- ment, and glandular secret ion„ II. DISORDER OF VESSELS AND CONTENTS:- The circulation depends mich ' upon the physical characteristics of the arteries, veins and cap- illaries « The tv/o former have three coats each;- a lining endoth- elium and intima; a middle muscular coat of circular and often lon- gitudinal fibres; and an external fibrous advent it ia. These coats vary in relative strength and size wxth the size of the vessels. The capillaries have only the thin endothelial walls. PHYSICAL PROPERTIES OF ARTERIES are due to their elastic adventi- tia, while their vital properties are duo to their circular muscu- lar fibres. Every artery ia thus acted upon by tv/o distinct for- ces, muscular and elastic . The heart by its action opposes these tv;o forces, and tends to dilate the artery. The capillaries are simply protoplasmic tubes. The first effect of some irritants upon the capillary blood vessels is to cause them to dilate, as nitrate of emyl; others first cause them to contract (ergot) and then frequently to dilate. Diminution of the calibre of a vessel is due to elasticity of ad- vontitia, and contraction of circular muscular fibres stimulated by the vaso-raotor constrictor nerves. As there are no muscular fibres that could produce dilatation, it must bo produced by me- chanical force of the blood current impelled by the heart, perhaps, assisted by relaxation or paralysis of the constrictor muscles. With dilatation the amount of blood is increased, the circulation is quickened, and the corpuscles crowd into vessels that before were invisible, they are dilated and give the color to the inflam. No nev; vessels form; those present simply dilate, lengthen, and grov7 tortuous, sometimes quite varicose. The dilatation extends from the arteries to the veins. The quickening in the flow cannot be due to the dilatation, for that, the hearts* work remaining constant, would slow the current. For a distance on all sides the blood is flowing into the area of inflam. This is called the " determination " of blood, and is the first stag e of inflam* This condition soon changes; first noted by a slowin g of the circulation. The red blood corpuscles pack close- ly together in the centre of the vessel, and tend to adhere to one another, though they do so in normal tissue. We now have the sec- ond stage, or period of "congestion". The current now becomes" slower; the \7hite blood corpuscles creep in large numbers slovfly 29 along the vessol-walls uninfluenced by the sluggish axial current. ThG slowing increases till the vessels are distended* so that with- in a small area the circulation has ceased: this condition is known as "STASIS" (stagnation). At the seat of stasis the capillaries are donsoly packed with corpuscles* distended, and almost devoid of plasma (liquor sanguinis)* though it is abundant behind the obstructing niaj^s of corpuscles « WHAT CAUSES STASIS? Experiments of Lister, Bezmott, Ryneck and others have proved conclusively, "that the local changes which lead to the production of stasis must have their seat either in the vralls of the vessels, or in the tissues v/hlch immediately surround them",-. Williams 9 Dr. .Ao Ryneck removed the blood from the vessels by injecting a liquid (salt solution) which was non*- irritating. He then injected a chromic acid solution which destroyed the vitality of the capil- lary v^alls and converted them into passive channe^l^ and no stasis could then be produced . Ill, PASSAGE OF COHTEIJTS of vessels through their walls. Normal blood consists of a solid, and a liquid portion. The SOLIDS are red, elastic, but non-amoeboid corpuscles which usu- ally flow along the centre of the blood stream; and som^irhat lar- ger amoeboid white corpuscles (leucocytes) found in the inert lay- er of liquid next the walls of the vessels. The LIQUID portion- pla.sma, or liquor sanguinis- consists of water, salts in solution, and the constituents of th«T fibrin, and is the nutritive part of tho blood. In hiealth this liquid food is contin- uously passing through the protoplasmic endothelial cells of the capillary walls, by a process of osmosis aided by filtration , and being picked up by hungry tissues. The endothelial cells are joined at the edges by a cement substance and normally no openings exist in these membranes; hov;ever, their protoplasmic nature offers no obstruction to the outward passage of either plasma or the active protoplasmic leucocytes. This out- going of plasma is termed by Agnew "transudation", also termed "ef- fusion", "exudation". The outgoing of w.boC. is termed "migra- tion ". Those tv^o processes are entirely healthy. In inflam, these tv/o processes are simply greatly increased, and for this reason inflam. is often spoken of as "a form of hypernu- trition." "If capillaries are abnormally distended , as in inflam ,, or otherwise injured, the cement substance betv;een the endothelial plates is liable to give way in the shape of minute holes, or stig- mata, which may become larger holes, or stomata . The passage of red blood corpuscles( diapedesis) , and the migration of white cor- puscles In infla m, through the unbroken capillaries and small veins, occur through these stigmata and stomata" „-Klein. The transudation is increased by anything that tends to obstruct the vessels, as; the pressure of tumors, indurated glands, arrest of the circulation in anasarca of the logs and belly, "Stocking" is produced by stasis of blood in the extremities. Mechanical ob- structions increase transudation, but not diapedesis, nor migration, "Ryneck proved that stasis could be produced in a blood vessel fil-* led with milk, and that the milk globules( tho' as small in many cases as leucocytes) did not pass through the capillary walls". The conclusion would seem to bej 30 lst« That there were no stomatao 2ndo That want of amoeboid moveraont prevented the milk globules from penetrating the capillary vails. Red blood corpuscles are not amoeboid, though highly extensible and elastic, and so can not easily pass through the storaata. The area of a "stoma", as of any circle, increases as the square of -its diameter; that is, if by the dilation of a capillary the diam- eter of a given stoma is doubled, its area will be multiplied by 4; or if the diameter be multiplied by 3, the area will be multi- plied by 9, This explains why a slight dilatation of a capillary may enlarge the stomata sufficiently to allow the escape of red blood corpuscles. normally the r.b.c. are to the v;hite, as 700 to 1, but in inflam, there is relatively a great increase in the number of the latter, geveral theories to account for this increase , 1st, An arrest in the formation of r.b.c, from w.b.c. or from lymph cells, 2nd, Increase in formation of v;,b,c. There is observed so great a decrease in tho number of v;,b,c, com- ing from the spleen that it is considered by some to be tho mill in which r.b.c, are made from white ones, "Again, it is assumed that ordinary white blood corpuscles are transformed into red oneSs> but of this there is no conclusi''n? evi- dence. The white corpuscles appear to be derived from lymphatic organs, whence they are carried by the lymph into tho circulating blood ".-Klein, If healthy blood be withdrawn from a blood vessel it v/ill coagulate quickly, and both red and white corpuscles will be entangled in the coagulura. We may, however, have a clot containing no corpuscle s in one part of it. The corpuscles^^heavier, vol, for vol., than the plasma in v/hich they f loat ;- hence , when tho blood is drawn and left at rest they slowly sink; and if for any reason the clotting tales place more slowly or the corpuscles rsink more rapidly than usual, a colorless top stratum of plasma, v/ith no red corpuscles in it will be left before coagulation occurs and stops further sinking of the corpuscles. The light-colored upper portion of the clot formed under such conditions is termed the "buffy coat", and is especially apt to form on blood dra^^m from febrile patients, because such blood clots usually slow. This fact was once thought very important, when blood-letting \7as a panacea. Horse's blood has ordinarily a buffy coat, because of tho marked difference in the specific gravity of the corpuscles and of the plasma; also be- cause it coagulates more slov/ly than human blood. In normal blood one tenth is albumen, fibrinogen and f ibrinoplastin. Tho inter- action of these two in presence of a third substance (fibrin fer- ment) produces fibrin. Any injury to the endotheliTjra of a blood vessel may induce tho formation of fibrin. When blood coagulates in a vessel, a dipping or "cuppinti" of the centre of tho UTjper sur- face of the clot takes place for this reason; some of the fibrin threads forming in the clot attach themselves by one end to the bottom of the vessel and by tho other to portions of the clot near its upper surfacoc Contraction occurs in tho fibres, their upper end is drawn toward the fixed end, and "cupping" is produeod. 31 As, at first, only the upper surfsice of a clot is free froni the walls of the vessel in uhich it is forming, only that part is free to move J and only that part ^/ill '"cup". Again, the upper part of the clot is loss resisting than the lovrer parts, and the fibrin will contract more at the top than at the bottom, and "cupping" result „"*Zuill, The contraction progresses, the shortened fibrin fibres tear away from the vmlls of the vessel, squeeze out the serum and still hold- ing the corpuscles, float in that liquid,^ Inflam, increases the amount of fibrin 4-5 times » Exercise and starvation increase it, "Fibrin formation is a destructive process rather than a construc- tive onOf Brown -Sequarde In inflammatory blood the albuminoids, phosphates, carbonates, and chlorides are increased,. The sodium chloride disappears from urin-T in inflam. of the lungs, and these organs are surcharged v;ith this salt» These phenomena are not con- stants In some inflammations of the joints the transudate is poor in fibrin, and in others so rich as to predispose to ankylosis. The exuded lymph contains two elements, adhesive and corpuscular . The escape of the transudate is follov;od by infiltration of both elements v;hich often penetrate the minutest lymph spaces, press upon neighboring nerve and muscle fibres, occlude the lumen of blood vess.^ls and thus -produce stagnation of their contents, pro- duce pain, and sometimes cause enormous tissue destruction. Most swellings are diic to infiltration, CHAHGSS III THE PERIVASGULAK SPACT'I-"' OF THE IlIPL;daSD TISSUES. V/hen an i?iflCimmatory transudate occur=5 cell activity Is much in- creased, These cells originate either from a proliferation of the cells of the tissues, or else have migrated from other tissues. Both viev/s have their advocates, Ilon-vascular tissues are chosen to prove whether the transudation, so-called, is in reality a tran- sudation from the blood vessels, or a product of the tissues them- solves. Profs, Recklinghausen and Strieker made conclusive exper- iments. They produced a traumatic suppurative keratitis of the cornea as follov/s:- Excise cornea of frog and place it in a drop of aqueous humor with Decemet's membreme uppermost. Prevent loss of vrater from evapora- tion. The cornea, at first transparent, gradually reveals its epithelia, lymphoid elements proper to the tissue, and then the corneal corpuscles. This due to refract i'yr^- pov/er being altered by death of the tissues. The cornea similarly prepared, but irrita- ted a quarter of an hour before excision, will show changes "simi- lar to those v/hich occur in a structure when first removed from the influence of vitality, and to this extent it simulates the first post mortem changes ," These changes are;- appearance of w.b,c„; corneal corpuscles having nuclei, exmoeboid movement and radiating branches. Round bodies appear within the cells. The "branches" separate to form granular cells containing a brood of no'f cells (endogenous cell-for'matiou) , The unexcised cornea of a fi'og, under the influence of inflam, shows the following changes:- The corneal corpuscles undergo the same changes as j,n the excised cornea. Leucocytes rapidly burrov^ into the cornea from the surrounding tissues, and develope from corneal corpuscles. Some writers deny this origin of leucocytes. 52 In 24 hours the cornea is cloudod hy 'vY,b,Cot and hy corneal cor- puscles which have becpjne vitalized and undergone active prolifer- ation. Migration not the exclusive origin of pus corpuscles ( "pus" considered later'?, as can bo soon by observing cartilage ^7hich has been irritated« Experiment has shovni the relation of connective tissue Kstis to the pus corpuscle,, Gemmation of connective tissue colls believed to occur <> Bone under inflarao loses its lime salts, and then undergoes the same changes as other connective tissues, IJ^ Gl andular structures under inflam« the cells originate from glandular cells, comiective tissue cells, and the vr.b.c. from the bloodo In serous inflam^ there is great activity in the protoplasm of the epithelium cells; the formation of fibrinous material which finds its v/ay to the free surface of the serous membrane vrhere it under- goes a connective tissue change » entangling great numbers of migra- ting leucocytes, and producing adhesions to apposed organs or tis- sues. In Mucous inflam, there are also an immense number of leucocytes, and an abundant fibrinous exudate, which together form the so--call- ed "false membranes" of diphtheria, and croupo IN GEIIERAL inflam, is characterized by excessive cell activity both of the tissues in the inflamed area and of neighboring parts. The cause of the abundant transudate is due both to the excessive a- raount of blood sent to the inflamed area and to a x^srversion of function of the cells in the capillary \7alls, which makes it pos- sible for the plasma to pass through in abnormal quantity. In normal nutrition the demand for nourishment of a given tissue is made by that same tissue through the telegraphic medium of the vaso^motor nervous system, A moderate "demand" { call it hunger or irritation ) by a tissue for nourishment acting as a moderate vaso- motor stimulus is follov/ed by a moderate transudation from the cap- illaries of food materials in solution in the plasma, Ceireful stu- dy of inflam, forces upon us the conclusion that it is simply "hy- per-nutrition"; that it originates and progresses under the same conditions that regulate normal nutrition, except that these con- ditions are all intensified. The demand or irritation of the tis- sues is excessive; the food supply is excessive; the cell activi- ties are quickened, they live faster and die sooner. In normal nutrition the cells assimilate their food and have time to organize and repair; but in the hurry of hypernutrition, while they reproduce rapidly, assimilation is poor- the new colls are of lovfly formed material, and there seems to be no time for organiza- tion or repair of normal tissue structure. Pus cdlls may be for- med. In sub-acute inflam, there is a more moderate degree of hypernutri- tion aiid imperfect organization of tho excessive cell proliferation occurs, as indicated by hypertrophies, tumors, neoplasms, sclero- ses, etc, NERVE IKFLUEIICE, The phenomena of inflam. prove that the blood vessels are not passive channels, but act under nervous influence, for sim- ple elastic tubes could not fulfil the functions of these conduits. The muscular walls imply a nerve-supply, and make it probable that portions of the nervous system act in an inflam. 55 Stimulation of the sublingual nervo increases the flov/ of saliva. The result is the same vfhether that stimulation be mechanical, physiological or pathological; the stimulatiom by an inflam« will do the same thing, { Move;ne'at of the nasticatory muscles aids in the secretion of saliva). Therefore, nervo iiifluenco is an important factor in inflam, Kjper-nutrition is produced thereby, and hyper- nutrition is inflame, et vice versa* Chapter VI « T E R M I N A T I II S OF I II FLA M M A T I II „ I„ Resolution o II ; Death or Mortification , Between those extremes there is a different termination for every variety of inflam. I. RESOLUTION is that change vrhich takes place in inflamed tissues by virtue of which they return to their original condition. It may take place in a few days, or a fe^y hours. First indications are a fading of color » or a fall ing of the local temp . The masses of corpuscles move on more freely, the vessels regain their normal size, the blood moves freely, the swelling abates either by absorp- tion into the capillaries, or through thT lymphatics into the veins, probably both, and pain , is lessoned . The cells may undergo fatty degeneration, but there not being sufficient inflam. to form puru- lent foci, are taken up by the lymphatics, Tv/o treatments:- Cold and Hot . !• Cold used at the beginning to reduce temperature; to stimulate contraction of blood-vessel \;alls and thus lessen transudation; and to Unit suppuration by retarding the brealcing dovm of cells, 2, Heat used in the latter stages to help maintain the vitality of the cells, and to favor the absorption of the transudate, II, MORTIFICATION, or death of the tissues, implies a victory of the destructive over the constructive forces, and is the reverse of resolution. The chemical and vital composition of the part is overcome and new substances are formed. The possibility of metastasis should alv/ays be borne in mind. An inflam, to be metastatic must entirely disappear on the appearance of an inflam*. at another point. Often see true metastasis in rheu- matism, and sometimes v/hore an inflam, of the lungs is suddenly transferred to the feet. Kov;ever, metastasis can never remove an inflam. from the body. There are metastases \7r©ngly so-called. Pneumonia can never become laminitis, though the latter may be me- chanically produced by over-functional activity of the tissues vrithln the hoof, caused by the ani;n,v>.l standing continuously during an attack of vnQ\mo-.\la., It is not a motafjtasis, for the lungs re- main diseased as before. By injury to one foot the other may be- come inflamed, because of having to bear double vTeight, but this is not metastasis. Orchitis or maramitis in connection v/ith -mumps is only a complication. 34: TREATIvIEITT is, lo Local and 2o Constitutionals I, LOCALo RemovB the cause, whether necrosed tissue, sequestra of bone or foreign tody, and favor resolution, ViThen the cause is removed, often little else may be done. In cystitis due to stone in the bladder, remove the stone and no further treatment may be necessa- ry. Surgical treatra't is usually directed to the cause. Opening of fistulas and giving good drainage will usually cure them, pus acts as an irritant, {'Nerving" in navicular disease only palliates, does not remove the disease. If we can't produce resolution, we should facilitate the removal of bad tissues without the injury of otherso Most important local treatment is rest , because it reduces func- tional activity. Work, on the contrary, increases structural change and quickens the circulation, and is thus contra- indicated, A blister is often applied to enforce rest of a joint, it stiffens the skin and causes pain on motion. In this way we nay often cure an acute spavin or a slight periostitis, by enforcing rest, A bandage can often be used to immobilize a limb by v/rapping it tightly about the part, in this way it acts as a splint, (A) COLD is a powerful agent in combatting inflara. Its effects are seen in tv/o kingdoms; in the vegetable -kingdom cold retards or even suspends growth, and the same in the Animal kingdom. Slight fall of temperature destroys the life of the chick in the egg. Cold climates retard physical and mental development of the Inhabitants, e,g, Laplanders, Fins, Low temperature diminishes sensibility, contracts the blood vessels, diminishes transudation and hence nutrition, ultimately slows the blood, and lowers the vitality of the tissue cells. All these conditions are antagonis- tic to inflammation. Water may be used alone or medicated. May use an antiseptic, as Carbolic Ac , Pot ass , Permang , , Acetic, Ac , , fee. Ways of using water v/ill vary according to circumstances. In laminitis stand the animal in a stream,, or in a tub of ice-water, not too cold. If you have no tub, make a clay-hole. The running water is better but should not come up higher than the fetlocks or pastern, never up to the knees or belly. In muscular inflam, cover with a cloth and drop the v/ater slowly on the part. On large suppurating sur- faces irrigation is best; it keeps dovm exuberant growths (cell proliferation, "proud flesh"), washes av/ay the inflammatory secre- tions, pus, etc., and thus reduces the danger of septic or pyaemic complications. Hot necessary to use large quantities; a few drops at a time is all that is required^ Interrupted irrigation from a hose is good, and should be applied as often a day as possible, and from 2-5 minutes at a time. Dry cold also very useful in first stages of inflam. , but not so good as wet cold in Vet, Practice, In human practice it is much used, and may be applied by coiling a hollow rubber tube closely about the inflamed part, securing it with plaster or bandages, and attaching this tube to a supply pipe. If the location of the inflam, renders this method inapplicable, rubber bags filled with cracked ice may be applied. Cold should be used with great care in total or partial paralysis. Why? 35 (B) HEAT is valuable in comtiatting the later stages of Inflam, , and' may- be used Dry or Moist, tho' dry is much to be prcferredo Applica- tion of heat as an antiphlogistic is not so easy as of eold« Heat rapidly dissipates, and if not kept up to about the point that can be borne without pain b£ the hand , no beneficial results will fol- low„ Therefore, if WATER be used, it MUST BE HOT and KEPT HOT. Agnew's "dry poultice" consists of a blanket or quilted coat whieh covers the chest, back and neck. It is useful in all inflammatory diseases of these regions. For an animal this poultice may be made as follows:- Stitch two or three thicknesses of cotton batting on the outside of the blanket, and over this stitch a piece of rubber cloth or strong paper^ Tightly secure the whole by a surcingle, and over this put tv;o or three blanket So Paper is impervious to air and enhance the value of the poulticoo This poultice will keep up a constant and gentle heat, -which will favor the flow of blood to superficial parts and thus relieve internal organs. Ex- cellent in lung troubles Dogs are treated in this v;ay, and it is especially useful in aciite bronchitis of children. Steaming . Vapor of hot water, medicated if desired, is valuable in combatting inf lam. , of lung tissue. It stimulates secretion, and arrests irritation of the air passages, "loosens" dry cough, etc. Animals appreciate the relief that steaming affords, and use sense in inhaling it. (For methods of steaming, see Finlay Dun's Mat, Med,, and Williams' Prac. Vet, Med,). ( C ) LOCAL BLOOD-LETTIIIG, in the first stage of local inf lam, is good treatment. It operates by unloading the over-distended blood ves~ sels. If the surface is a mucous membrane it may be scarified by using the thumb-nail j but if skin, then thi? will not answer. For the skin use a bistoury. Great benefit is obtained when done ear- ly in the progress of the inflam,, the lymph spaces and blood ves- sels are relieved of pressure and vent is given to the exudate vfhich has collected in the lymph spaces and areolae of connective tissue. Puncture relieves oedematous sv;-ellings by allowing the escape of serum. Very often follov/ing castration there is an oedematous sv/elling of the .sheath which is best relieved in this way. Scarification, Cups and Leeches tho' little used in Vet, Prae, are sometimes useful, especially in parts where it would be dangerous to use a lancet, or bistoury „ Leeches will remove about one oz. of blood eacho (D) LIGATION, Combatting inflam. by diminishing the supply of blood to the part is an American idea, and was used with good results during the late Civil V/ar by Kendall. Ligature of the superficial femoral artery relieved inflam. of the knee joint. Gangrene and secondary hemorrhage as a result of ligation will not occur in a healthy animal. Arterial pressure is increased in the body by li- gation and this is beneficial to the animal. This method of treat- ing acute traumatic lesions has never been tested in Vet, Med. Very useful in human elephantiasis. (E) COUNTER IRRITATION for treating internal inflammations may be used as an adjunct to other remedies. Counter-irritants act by estab- lishing a reservoir for the blood, and must always be applied at some distance from the inflamed area. They diminish both the force and quantity of the blood in the inflamed tissues by drawing it away to the tissues nearest themselves ^ 56 Do not push the action beyond the rubefacient stage. Valuable in the declining stages, when the inflam, tends to become chronic. Mustard is the best for this form of treatment. When a mustard plaster is applied it should be allowed to remain on till it dries, it can then bo brushed off v/ithout unnecessarily irritating the skin, "If removed at the end of twenty minutes or half an hour, it will be found so moist that it will be necessary to use water and wasli it off; this will be worse for the skin than to allow the mustard to dry and be brushed off "-(lectures of ISSBo) The mustard "should not remain on more than one-half or three-quarters of an hour, because otherwise vesicles will form and an ugly blemish re- sult; it will more readily produce a slough than anything else"- ^lectures 1890.) As a vesicant mustard is used merely to produce an oedema, A good rubefacient action is also produced by Oleyim Terebinthinae et Oleum Olivae, or by Camphora et Chlor of ormum , or by the lini- ments containing these. Chloroform blisters quickly if covered up; v;ill produce a blister of blood and serum in 5 minutes. Strong Ammonia when covered, or even uncovered, has the same actiono (F) VESICANTS differ from counter-irritants in the fact that they are also depletives and produce a large flo^7 of serum. Cantharides mixed v/ith Euphorbium may be used as a cerate, ointment, etc, Cantharides is the best blister we can use, but must be used with judgment. It always causes pain, and there may be an absorption of the cantharides causing an irritation of the bladder and kid- neys, and often a cystitis or nephritis. If the blister has been extensive this cystitis may be fatal. To remedy such a condition inject Tinctura Opii into tho bladder azid give mucilaginous drinks. Use with great care in very young, or in old or debilitated ani- mals, or it may cause serious constitutional disturbance, and sloughing, (G) BLISTERS, should never be used in the acute stage of an inflam,, no matter v;here situated, but only aftef the subsidence of acute inflam,, when it has a tendency to become chronic. Blisters eon- vert a chronic or sub-acute inflam,, into an acute inflam., because the two forma cannot exist together; now as the tendency of all acute inflammations is toward recovery, the efficacy of a blister applied directly to an inflamed tissue is apparent. If the inflam, be deep-seated and acute a blister is not indicated, tho' its ac- tion would produce a sort of artificial metastasis by causing a congestion of the skin and connective tissue, in this way depleting the original inflammatory lesion. Blisters e nforce rest and for this they arc more used in Vet. Med. than for counter-irritation. They act as a splint by making the skin stiff and painful to move, and they also compel the owner to let the animal rest. Rest for an inflamed tissue is often all that is needed, and gives best results in diseases of the joints and fibrous tissues. In pneumonia v/hen an animal is weal and depressed, cantharides from a blister is quitv .likely to be absorbed and produce constitutional disturbances, cystitis, nephritis, or the shock of a blister to the nervous system may prove fatal. An extensive blister which draws av/ay much serum from the blood always increases the fibrinous erasis of the blood. 57 Continued high fever also increases this fibrinous crasis, therefore when both of these sauses are acting, each one producing fibrin, we may have death from ante mortem heart-clot . Always treat pneu- monias xrith a viev; to prevent ante mortem clot by preventing the formation of fibrin; don^t use any depletives . Blisters are painful, burn and itch and the animal rubs itself. To prevent this apply a warm poultice to the part. This emollient soothes, allays pain, prevents the formation of scab and facili- tates the flow of senjm. For this purpose flax seed iriay be used. However, a poultice is at best a dirty thing to deal with. A bet* ter dressing is the following:- After blistering apply a thick pad of oakum; cover this with waxed or oiled paper or oiled silk, and over this wind firmly an ordinary bandage. Such a dressing will prevent the formation of dry scab, keep the skin moist and soft, encourage discharge of serum, allay pain and irritation, pre- serve the hair from falling out, eliminate the danger of sloughing, and allow the animal to go to work in two v/eeks with no evidence of having been blistered. Troublesome, hence is little used. Leave the dressing on 48 hours and vfhen taken off the entire epi- dermis (not the hair) can be peeled off. V'ash with warm vj^ater and soap, and dry gently. Apply eosmoline (vaselin, or petroleum jel- ly)- For the 2nd , , dressing use enough flannel to enclose the leg, and apply eosmoline on it. Wrap with paper or oiled silk, and bandage, and allow it to remain on the leg 5 days. Each day pour in at the top of the dressing a tablespoonful or more of carbolixed oil or molted eosmoline, Takis off in 5 days, because the flannel will be saturated with serum. Re-apply a similar dressing, let it remain for a week; then remove and wash the part. No further treatment is necessary. With this treatment the blister may be very severe, and yet there will be no swelling, pain nor irritation, no slough- ing, nor will the hair come out, VHien hair comes out it does so because of the hardening of the serura, and thin hardening is pre- vented by the oil-dressing, IODINE is one of the most useful agents in early stages of an in- flam. It is both a counter-irritant and alt erative.f Silver Nitrate "lunar caustic is said to have a similar action). In applying Tinc-^ tura lodi the hair should be shaved from the part, and the iodine painted on the skin with a soft brush as long as it continues to be absorbed. It should be applied at least 8 or 10 times daily; better every 15 minutes for half a day. If applied but once or twice a day little benefit will be derived. Apply in the sam.e manner at the end of a week or ten days. In thin-skinned and ner- vous animals Tr. lodi causes considerable pain; this may be redueed " to a minimum by using the following :- ^ Lugol's Sol, 15.C.C, Acaciae Pulv. l.c.c, Sacchari Pulv. l.c.c. Aquae (dest.) B.c.c. «^o o c « o • In this way we get all its good effects. Its alterative ac- tion can be secured by combining it with other drugs ^ Valuable in pharyngitis In doses of 8 to 10 grains to ounce of solution. oc Liigo 1 " s Sqlut ion is inuch used, and is coniposed of:- lodiim, grso 60 Potass„ lodo " ID. Aqua, ^ 85 „ loo, (H) COMPRESSION, by straps, flannel, rubber, or Derby bandages is a very good form of treatment. Equal pressure must be obtained, for unequal pressure of the edges of the bandage will cause ridges to form on the slcin, and if the bandage is too tight it may cut through the skin. In treatment of inf lam. , pressure acts in two . ways : 1st a By supporting the v;alls of the vessels, 2nd« By hastening absorption of lymph and thus facilitating a reduction of the swell ing« In treatment of old chronic ulcers it is the only form to be adop~ ted. Trim the ragged edges of the ulcer with the scissors, apply pads of oal-aira or adhesive straps, and over all a r o 1 1 er-bandage . This is an absolute necessity . Used also in acute cases. Bandage mustn't be too tight , and the pressure must be evenly distributed . In the treatment of old ulcers on hostler's shins, soak the leg in v/ater as hot as can be borne, and in which is some bran and a fev/ drops of Carbolic acid, for one-half hour at night. Dry and dress with lint, carbolized oil and a roller-bandage. Repeat for 5 or 4 nightso In a short time the edges will become healthy. After a- bout one V7eek of such treatment put on a compress of oeJoun, lint, or absorbent cotton, axid cover it with strips of adhesive plaster, and bandage fi-o'ii the foot upv;ard'3 till al)ove the ulcer. If exuber- ant granulations appear, uncover and scrape dovm to the healthy tissue, and apply a compress and bandage as before. Antiseptics also used to combat inf lam, , especially of wounds, II, CONSTITUTIONAL TKEATfclElIT, (A) BLOOD LETTING is powerful for good in early stages of inf lam, , but requires judgment. Never bleed a case that is likely to last a long time, nor in acute inflasnmatory diseases of the chest, as of lungs. Abstraction of blood acts in several v/ays:- as an antiph- logistic by removing a stimulating fluid, lowers the sensibility of the central nervous system- shown by the anaesthesia that fol- lows large hemorrhages. "In the first stage s of pneumonia blood- letting either aborts the inf lam, , or renders it susceptible to therapeutic agents". (Such treatment Dr. Zuill strongly condemns). In weaB: and debilitated constitutions bleeding is contra- indicated. The pulse should be our guide; not the amount of blood drawn. Bleeding is usually done on the jugular vein, using a fleam. Ele- vate the head and turn it to one side to make the vein more promi- nent. Get as much light as possible on the seat of the operation. The softening of the pulse is the indication as to the amount to be drawn. Phlebotomy and arteriotoray are best performed with a lancet. In cerebro-meningitis bleed from the temporal artery, and if closure of the wound does not stop the hemorrhage,* cither ligate the vessel or occlude it by pressure. We may destroy the vossel, but this is unimportant, as collateral branches will do ^the work. In the ox use a large instrument and make a large opening for a full stream. Close v/hen the pulse is noticeably influenced. Twen- ty ounces (1 pt«) in a large stream has more efficacy than forty ounces in a" trickling" one^ 39 The fleam must be placed over the centre of the vessel, or on the stroke the skin will roll, and an indifferent strea-n will result. (B) DEPRESSANTS as a class 'weaken cardiac action; depressing l^oth the force and frequency of the pulse, they diminish arterial pressure. Tinctura Aconiti in doses of from 50 to 60 drops may be given every 2 or 3 hours. Fleming's Tr. is four times stronger- dose for horse 12-15 drops. Two or three doses of either will produce marked influence on the pulse. Aconite is a paralizant to the peripheral endings of both motor and sensory nerves. The blood pressure falls through dila- tation of thG capillaries and v;eakening of heart muscle. Given almost entirely to slow the circulation, Veratrum Viride acts much as does Aconite. Dose of VoV.- Norv/ood's Tincture 12-15 drops; of U.S. P. tincture is SO-'GO drops. The U.S. P. tinctures are as good as the stronger ones. Care must be exer- cised in using either. Dilute- them so that the dose shall be about one-half a fluid ounce. The pulse may fall from 70 or 60 to 60 or 50, or even less, in a few hours. Only in tho congestive stage of an inflam. are depressants indica- ted, and these indications do not last beyond 24 hours, during which time we should visit the patient 2 or 5 times. In the con- gestive stage push the depressants up till the physiological effect 6s observed. In congestive stage of pneumonia one ounce of Aconite or Veratrum Viride is preferable to phlebotomy, for at the point where the latter would be useful the animal might die. Give '60^ of Aconite and Veratrur.i Vir, and Spiritus Llindorerus every half- hour till 6 doses have been given and thr; physiological effect ob- tained. These C£ui be used after bleeding to hold the circulation in check. IThen the heart is depressed hy these drugs, and bolov/ the normal, give alcoholic or any cardiac stimulants; but if the depressants are pushed too far no amount of stimulatioia will arouse the heart. Antimony has little effect on heart of horse or ox, but may be used for the dog- grs, 1-4 in tepid water. Opium is good drug; used to control pain and quiet the nervous sys- tem. It is indicated in acute inflaiumatory diseases, especially in enteritis or in peritonitis to stop peristaltic action, and al- low the inflam, to subside. Mercury much used in human practice; perhaps, too little used in Vet, Med. Especially useful in plastic iritis of both horse and man. Plastic iritis in man is a sequella of syphilis; in the horse indicates a glanderous diathesis. Mercurial treatmH removes the plastic material. In any inflam. of interior of the oye dozi't ne- glect to dilate the pupil to prevent adhesions forming between tho iris and lense. The following is good treatm't in plastic iritis:- ^ Hydrarg. Bichlor. (Corros.) gr, 1/4. Potass. lodidi gr, LX, M, fiat solutio cufn aqua, Sig;- One dose. In most inflammations of the eye vjre may use Donovans solution- gtts. XV-XX. (C) DIURETICS good in most inflammatory conditions and nearly always indicated. They with CATHARTICS deplete by removing products of textural change. Diuretics lower the temperature, and supplant the action of the skin. 40 They are thorefore, depletives , refrigerants , and derivatives ^ The principal ones are:- Liquor Airiraoniae Acetatis» Potass. Nitras, and Liq. Ammon* Citratis. (D) CATHAETIGS also indicated. They are also depletive, derivative, and refrigerant, l*he nucous monibrane of the intestines forms a very nia]*ked and extensive ofiiunctory. Cathartics act in two v/ays:- 1st. By ^clearing out the digestive tract and inviting the flow of blood to the intestines. 2nd. By diminishing the blood pressure the capacity of the blood vessels for absorption is increased. For horses use aloes alone, or equal parts of Castor and Linseed oils. For cattle use salines. For the dog use Castor oil, or jalap. Give in doses according to circumstances, or effects desired. In the horso the folloving will act quicker than the ordinary ball:- ^ Aloes Llass, .§"^^j- Calabar pulv, grs. XK, Saponis pulv. q.s. ad, fac. bolus llo, 1, This treatment is indicated in dropsical affections; in infla'n. of the brain and meninges. It assists the cure of inflarn, resulting from operations. Cathartics are contra- indicated in all inflamma- tions of the mucous membranes of the respiratory or alimentary tracts r when there is fever from diseases of these membranes, or v;hen the patient is \7eak from disease; in all inf la-nmat ions of the poritojieum, "Irion the patient is in the slings produce peristalsis by i-ettal injections, or by the use of Strychnia, llux Vomica, Gala- bar Bean, or Eserine, (E) TOIIICS:- should be given v/hen convalescence begins, i.e. when the acute inflan, is past, and the strength begins to fail. Among the best are Iron and .guinine, C inchona Sulph . is about as good as ouinine and much cheaper. As it is about one-third weaker than Quinine, give one-third larger dose. Of all iron preparations Sesqui-chloride is probably the best for the horse. Huidekoper likes Ferri et Potass, Tart. (F) STILIULAIITS : - Best are brandy, or pure whiskey, alcohol. Ammonium Carb. should be given in form of a bolus. Stimulants should never be given in the acute stages, nor in too large doses at any stage; small doses frequently repeated are much bettor, V^en in the early stages of inflam. vro find a thick urine, dry skin and torpid bowels administer cold v/ater with barley \rater; but when the febrile gymp-^ toms begin to disappear, the pulse is better and the skin moist, sustain the strength of the animal by nutritious food, (G) FOOD:- Four eggs made into a thick mass v;ith Bethlehem oatmeal to which has been added one or tv;o ounces of beef extract, and the whole made into boluses an.d given, half at morning and half at noon is excellent food, * Dr. Zuill thinks many cases of acute lung disease die of starva- tion. In acute fevers cold -.niter and lomon- juice or barley water quench t?iirst much better than vfater, (H) VEIJTILATIOII is all important. Don't treat an animal in a stable v;here there are foul odors, amraoniacal gas or other unsanitary con- ditions. Remove the animal, or refuse to treat the case^ 41 Chapter VII, C H R II I C I N P L A M M A T I JI . Acute inflan, may pass into the chronic, or the iiiflam. may origi- nate in the chronic forn« Chronic differs from the acute only in degreo. The active process is so subdued that much structural change may take place before it is recognized; or it may progress for months or years without disturbing the healthy action of the tissues, as seon in certain inflamnations of the joints, periosto- uir, liver, and pleura. SYl'iPTOliS differ from those of Acute inflam, only in degree. (A) COLOR soldom seen, but v/hen noticed is a dirty brownish, purple or bluish shade, by reason of the blood having lost its oxygen and assumed the character of venous blood in its slow movement through the capillaries. (B) HEAT usually somevvhat elevated, but not apparent to the hand. (G) PAIII if present, as a "soreness" rather than as a lancinating pain. Se?n in chronic arthritis. (D) St'ELLIlTG:- the result of effusion of either lymph or serum. Usual- ly forms glov;ly and extends into the tissues for some distance be- yond the seat of iiiflam. The sv;elling is hard and indurated, and som.etimes presses upon the veins, and by obstructing them causes an additional softer swolllug termed an "oedema". Chronic inflam. often unacco'ipanied by loss of function, COIISTIG."JTIO:IA.L sriiPTOIlS:- Seldom dr^tected, tbo' "/e may have in some cas- e.s fever-, thirst, diarrhoea, loss of appetite. Fever m.ay bo con- tinuous or intern it tent, with exacerbations, mostly in the evening, 1 or 2 degrees above the morning temp. Causes :- I, Local . II, General, I, LOCAL CAUSES are v/hatever overtax the vitality of a part, hence chronic inflam. often follorrs acute inflam , The vessels are stret- ched by the super- abundance of blood during the acute stage and caniaot assvcric their original size, but continue to overload the tissue with blood, and continuous engorgment results. Thus, a joint inflamed is liable to a recurring inflam. on the slightest cause, and the tendency to become chronic increases \r±th each at- tack, Prolon.qed functional activit.-y may induce chronic inflam; as when prolonged 3tim.ulatlon of the stomach produces gastritis, of the kidneys, nephritis, etc. All organs are thus liable. II, GEIIERAL causes:- Diathesis :- A glanderous diathesis is a general cause of glanders and farcy; a rheumatic diathesis of arthritis and osteoporosis. All diseases \^hich debilitate the system, as fevers, maladies affecting the kidneys, liver, or bone, predispose to chrorxr ic inflam. PATHOLOGY OF CHROIIIC IlIFLAl^:- An Unusual dilation of the blood vessels of a part, due to blood or lymph, red and white corpuscles, etc. In som.e places the exudate has formed connective tissue which has diminished the pliancy of the part and caused a true hypertrophy. The v/alls of the blood vessels become adherent to surrounding tis- sues, lose the pov7er, therefore, of normal dilatation and contrac- tion, and are unable to force the blood along by the usual muscu- lar and elastic movement of the vessel walls. The slowness of the circulation accounts for all the phenomena of chronic inflam. 42 The normal tissues undergo fatty degeneration, and becomo of a wliitinh homogeneous appearance. This condition is seen by cutting dovni into a necrosed part. In inflan, of a mucous ;-ie!nbrane Iherfj may be a profuse secrotion of mucous cells and an abundant desquamation of epithelium cells caus- ing false membranes to form rapidly^ as in croup and diphtheria^ In inflan, of a serous or synovial membrane \rhen the serum is in excess we have such a condition as is seen in pleurisy or hydro- thorax; if, hov/ever, the plastic or fibrous element predominate in the secretion, we v;ill have a connective tissue formation, fibrous bands passing from one serous membrane to another. In a joint this condition is termed "false ankylosis". Lungs may become adherent to the chest vmll in pneumonia and pleurisy. In chronic inflam, the formation of pus enclosed in a proper membrane constitutes a "cold abscess", TREATMEIIT:- I r Co nst itut ional , II. L ocal , I. COIISTITUTIOKAL:- Rest is the primary indication and the most im- portant, not absolute rest, but all voluntary movement stopped. The treat;ne:it is influenced and regulated by the case, especially so when the digestive organs are affected. Diet should be prescribed. ^.atha rtics are often indicated. Iodi ne in Lugol's Solution i.o usofi.il. Physiological actions of drugs best attained in small oft-r^^neated dosrs. In large doses a local irritant effect may be produced. Tonics may be indicated. IIux Vomica, Iron, Quinine, Cinchona, and Gentian preparations are valuable, II, LOCAL:- iiost importa-tt is removal of the cat.iso . If pus lies in a sinus, drain it a\;ay, if a foreign body bo present remove it; if stone in the bladder cause cystitis, remove the stone; in chronic inflai^, of joints, tendons and bones remove the causcc In ring" bone, splint and spavin it is rare that the bony tumor is the cause onl;>' indirectly. As in spavin, the pressure on the sac may cause a synovitis and lameness result; or by friction of a tendon over the bone tumor the tendon becomes inflamed; or the inflamed syno- vial membrane between the }>ony surfaces is the cause = Seldom that deposit- itself causes the lameness. Find in what way the tumor is causing the lameness and the animal can be cured. Local ble edings diminish transudation by unloadiiig surcharged ves- sels o Done in several v/ays:- By s carification incisions ^ or vene- sectipii nearest the part. Incisions not' only deplete the blood vessels, but drain off useless blood deposits and induce new for- med connective tissue to break dotmo This lowly vitalised tissue can thus be removed and the induration removed indirectly. Blister s are useful to excite a nev; action, and drain avTay lymph. May be applied directly to the parts, or in small patches at some distance and rene^7cd every ?,4 hours. Used with great benefit after extraction of blood. Counter-irri tation by stimulating liniments, mustard plasters, etc., to drav/ blood to the .surface, ALTERATIVES as Mercury, A rsenic , Iodine, and Si lver Hitras are ben- eficial, .Sciicri-s and Issues once in favor, but now little used. Popular opin- ion against then a.'5 against blooding, but they are often of valuog 45 and in near future may be more used. Often better than actual cau- tery „ Place at little distance from the inflamed tissue. May con- sist of one thread or a bunch of tape or of hair; the latter -when aseptic is best, and. easiest drawn through the wounds Rubber drain- age tube is useless because it will not be Kept open. Hair won't mat, and keeps up continuous drainag^e. S^he seton should not con- tain a dye, for, tho' insoluble in vrater, may dissolve in the li- quids of the body and act as a poison^ To introduce a seton ttse a seton needle, or a lancet, and prabe» Tact and knowledge are re- quired. When introduced treat for 24 hours with poultice, or warm water dressing to induce suppuration^ Then wash and cover with a pad of oakum to keep the part moist ^ and the pus soft. If -pas is allowed to harden the drainage will be interfered with. A week is long enough to allow a seton to remain; if left longer the forma- tion of new connective tissue may form a chronic fistulous tract. Ligation of principal blood supply has been done with success. Issues are similar and much used in hu-aan practice. Use caus-* tic potash to keep the part sloughing and scarring. Irrigation and pressure are valuable. Cold water constantly applied as a means of combatting chronic inflam. is not surpassed by any other means at our command. Pressure , especially when used with irrigation, is one of the very best means of treatment. Massage often good for thickened tendons, and tendinous sheaths. Give the groom a mixture of Neatsfoot or Cocoanut oil and cosmoline and tell him to apply morning and evening for two or three weeks, always rubbing till perfectly/ dry. Great improvement when this is done. PRODUCTS OP CHRONIC IlIFLALMA-TION :- are called transudates and exudates and consist of serum , blood and pus . The liquor sanguinis is blood minus the corpuscles, i«e» water, fibrin, albumen and salts. Outside of the vessels it loses some fibrin and corpuscles and be- comes serum, therefore, liquor sanguinis and serum differ but lit- tle and may be studied as one. But there are two varieties :- (A) serous and (B) fibrous depending on the quantity of fibrin present, (A) THE SEROUS may appear rapidly and in great abundance, or very slowly. Follows acute, but more usually chronic inflara. Different tissues yield differ, quantities. Connective tissues and imicous membranes yield an abxindance from their free surfaces, and it is mixed with leucocytes and varying amounts of glandular products, sometimes with r.b.c, changing the color from a straw-yellow to a red- dish tint. The presence of serum is not always an indication of in~ flam., as it is constantly transuding from vessels in normal process of nutrition. Mechanical venous obstruc- tion may produce marked accumulation of serum (as in ana- sarca), but when tho obstruction is removed the accumula- tion passes away. When serum collects in a serous or synovial cavity it is termed "dropsy". 44 (B) THE FIBROUS variety contains much fibrin and has a tendeni« cy to organise. Is not produced alike in all tissues. In the serous membranes, as pleura and peritoneum, it may be so slight in amount as merely to roughen their surfaces or it may form threads binding one organ to another, or ' it may solidly unite an organ to its containing cavity, as lungs to the parietal pleura, or to each other. Any number of degrees of intensity^ Very marked in pleurisy and pleuro-pneumonia, and in diphtheria o The intensity of the inflammation governs the ultimate form and permanency of the transudate, i.e. whether it shall be reabsorbed, organized, or break down into pus. The transudation of inflam, differs from, that of mechani- cal obstruction chiefly in being richer in fibrin. Cellu- litis of the extremities has a serous transudate, but yet differs from Tf/hat would result from an obstruction to the venous circulation, in that it contains more material for the building of tissue- llaCl, phosphorus, fibrin, etco These fibrinous transudates may do good or harm, Gpp,^., -»7hen they unite v^ounds, broken bones, or encyst foreign bodies; har m v;hen they obstruct or constrict mucous or serous canals (urethra, etc.), ankylose joints, destroy the transparency of the cornea, lense, A transudation of blood differs some"S5rhat from other transudates, and may vary in intensity from a slight discoloration to a true hem.orrhage. Chapter VIII. SUPPURATION., SUPPURATIOIJ is pus-formation, and is a result of inflam. It is a term used to convey the idea that pus comes into a tissue as a result of inflam,, in that tissue. Pus from an acute abscess of a healthy animal is a yellowish or greenish, homogeneous, viscid, sweetish, and almost odorless substance, of neutral reaction, and specific gravity 1,020 - 1,040. If heated it separates into two layers:- a liquid , clear and serous, and termed "liquor puris"; and a solid lovj-er layer of pus cells. The liquor purls holds in solution the same materials as does the liquor sanguinis, CHEiaCAL PECULIARITIES:- Pus contains myosin, tyrolin, etc. Pus cell is from one t\70-thousand -five hundreth to one three- thousandth of an inch in diameter and of various forms. There are also many much smaller bodies, supposed to be nuclei, in the liquor puris. A pus cell is granular and nucleated. Acetic Ac. clears up the cell, and discloses the nuclei. In an alkaline solution the cell disap- pears. Although of course, alive when formed, they are dead cells when taken from an abscess. "A pus cell is always a dead cell. » Reaction of pus taken from the body or exposed to air soon beccanes acid, "Laudab le pus (healthy) has no smell except that peculiar to the animal in v/hich it may exist".- Williams. 45 IclioTt^us pus "^contaijis shriveled colls, escaped and shriveled nuclei, molecular and fatty matter, blood corpuscles, fragments of fibrogeneous material; the liquor pur is is thin, liquid, or watery" and excoriates the skin. Such comer, from cancers and gangrexious tissue, Saneous pus is more or less bloody. Has a fatty odor ■vyhen from old sores, sinuses, or fistulous tracts. Curdy or Scrofulous pus is thin and contains cheesy flakes from, cold abscesses, lymphatic glands, and diseases of joints, L-luco-'Pus is a mixture of mucus and pus. Seen in inflam^ of bladder and noso<, Gummy or Ropyi P'-^ is found in syphilitic conditions, and is due to breaking dovrn of syphilitic gummata; seen in opening farcy abscesses, or the glands of a glandered horse, Alse seen in an abscess due to hypodermic injection. Such pus from an abscess, unless caused by a hypodermic injection, shculd make us suspicious of glanders » . Contagious pus contains the specific germ of some particular disease. Certain kinds of pus produce local infection. Purulent ophthalmia, glanders, fa.rcy, all varioloid diseases, distemper q£ dogs, gonorrhoea, etc., are not due to pus itself, but to the mi- crococcus in it, Liany substances may be accidentally mixed vrlth pus; as, epith- elial and pigment cells, tissue shreds. The blue color of blue pus is due to cyanuret of iron. Blue milk is due to a crystalline substance called pyrocyanin. Halted eye inspection T?Till usually diagnoso pus, but sometimes it is so mixed that it requires a chem- ical test. To the eje pus, mucus and w.b.c, look so much alike that Tve must resort to the microscope, tests:- Liquor Potassae added to pus coagulates it, but added to mucus causes no such coagulum. Better is DAY^S TEST:- A little water plus a fev; drops of a saturated oxidized alcoholic solution of gum guiacum, when added to pus vrlll produce a blue color. With gum guiacum make a saturated solution v/ith alcohol, Allov/ it to stand exposed to air till a fev; drops of it •;7ill give a ^reen color with Potass, Iod» , indicating that it is oxidized, ORIGIN OF PUSt, Originates in tv70 vmys:- 1st o from vessels, by the migration of leucocytes. 2nd, From the permanent connective tissue corpuscles. It is the inflammatory transudate that vivifies the connective tissue corpuscles and produces a leucoc- yte that is capable of movement. A pus cell can- not be distinguished from a w.b.c. Under inflamma- tory conditions abnormal quantities of the transu- date causes a vivifying of the connective tissue corpuscle, and a return to the embryonal state, A pus cell canH be told from a connective tissue cell in size, shape, or action. THEORIES as to the origin of pus arc many. In 172S it :7as first an- nounced that pus was formed in the blood and secretions and rem.ain- ed there, and that, therefore, bleeding and purging ^rere indica- ted. In 1763 Dr, John Morgan held this vievr, as did also Henle, and it was generally accepted in Europe, 46 German investigators attributed it to tissue destruction; Schwann to the existence of a "structureless, formative fluid;" Virchow to "the active proliferation of cells," "Pus is not derived from einy effusion, but is formed by vital changes in the germs of the tis- sue, and by a slight modification of the same process, new. connec- tive tissue is formed'.'- Williams, A foreign scientist introduced aiiilinc into the blood and found that the pus corpuscles in suppurative keratitis contained these grains. Some consider it to be a sncretion due to proliferation of connective tissue corpuscles, and others to leucocytes and mi- grated blood corpuscles. Pus is derived from two sources :- w.b.c . and connective tissue corpuscles ( c , t , c , ) , CAUSES OF SUPPURATIOIl:- differ in different animals, and in different tissues. Cellular connective tissue is most prone to suppurate and in greatest abundance, indeed, r/ithout this tissue there can be no suppuration* For this reason superficial ulcers, are more abundant than deep abscesses, liucous membranes suppurate quickly; serous membranes tend to form in a fevr hours an adhesive inflamma- tion, liiflairio of serous membranes of the nose may be follo-vTed by a profuse suppxiration; same thing occurs in inflam. of the vagina, uterus, urethra, etc, as seen in gonorrhoea, leucorrhoea, HOW IS PUS REMOVED? In one or more of three v'/ays :- 1st. By entrance of ma?.iy of the corpuscles into the blood vessels, and by the remainder organizing into connective tissue. If small it may disappear in this way, Reabsorption is kncOTi as "delitescence" , 2nd, By nev formation - neoplasm, 5rd. Liquor puris is absorbed, and the pus undergoes a fatty degen- eration and is then absorbed, or the pus may undergo a caseous (cheesy) degeneration, and later a calcareous change with a deposit of lime salts, VALUE OF SUPPURA-TION, It was once thought that all disease Y;as a direct result of pus, and that all pus formation was productive of great good by pxorifying the blood. In accordance with this belief setons and blisters were much used to establish a suppiiration, Setons are now used almost entirely for their counter-irritant value, SYl/IPTOMS PRECEDIIIG SUPP'ORA^TIOII. Those of ordinary inflam, (A) COLOR, Redness, in v/hite-iskinned horses, very intense at first, and gradually becoming darker till it is almost purple. Skin is smooth, glossy, and the- surrounding parts may be oedem.atous. The oedema will "pit" on digital pressure, and so will a deep-seated abscess. (B) PAIN, is usually dull and heavy from deep seated tissues, and lancinating from glandular structures. Disappears when suppuration is complete, (C) TEMPERATURE, at first elevated, will fall as soon as suppura- tion is established, (D) ALTERATION III FORil (swelling) depends on -the resistance of the tissues- the more connective tissue the greater the swell»> ing; and on the location of the pus- if deep-seated, then little or no apparent enlargement. 47 (E) "POIITTIHG" is a term used to express the fact that pus vrlll always seelc the surface even rrhen it is the direction of greatest resistance., Rindflcische^'3 theory is that the direction taken by tho pus is deterfiined by the disposi- tion of the connective tissue, hut this dont explain why hepatic or pulmonary abscesses invariably open upon the surface of those organs- unless a fall or a traumatism intervene, rathor tho,n into thoir internal cavities and chaimelSo (F) FLUCTUATIOII : - may shov; the presence of pus. It may be deter- mined by three methods of palpations Palpation means the act of ga.inir.g kno'ivledge through sensations imparted to the fingers o Isto Method o Place one hand on one side of the sv/elling and v/ith a finger of the other hand tap on the opposite side. If the contents are fluid an inpulse or thrill V7ill trav- el through the mass from the percussing finger to the op- posite hand. 2nd, Method :- Alternating palpation . Place hands on each side and alternate the pressure. This v;ill displace fluid when present. Bog-spavins, thorough-pins, etc, are ex- amined in this way„ 5rd, Method : - Place the fingers on one side of the tumor and the thumb on the other and transmit a wave from fingers to the thumb by tapping or pressing '.7ith the former. Used for examining small tu-aors* In cold abscesses or chronic abscesses fluctuation and other signs of inflam- mation may be feinting, because the process is slow, but the constitutional symptoms may bo grave , especially in an animal, dog, ox with a predisposition to these absces- ses „ In man cold abscess is infrequent. V/here the sup- puration is great it is accompanied Usually by rigors and chills alternating v/ith fever and profuse perspiration, 7/hen an abscess is deep, chills may occur in an intermit- tent forra» CONSTITUTIONAL SYMPTOMS s, usually %7oll marked:- dry tongue, incessant thirst, great restlessness, diminished secretions, all the evidence of a well marked fever, DIAGNOSIS OP SUPPURATION:- Often difficulty Characteristics of acute abscess are not peculiar to itself, but may be met in other dis- eases. An abscess"points", is more sv/ollen at one point than at others; the fluctuation, therefore, is hot iiniform in all places and in all directions. On the contrary, serous accumulations, cysts, hernias, adipose tumors, aneurisms, etc,, do , not point ; are equally swollen in all parts; and there is no yielding of thi* skin more in one place than in another,. i«e, fluctuation is the same everywhere. Cysts and aneurisms sho\7 no sjsmptoms of inflammation. Aneurism pulsates, and in come locations a cyst may also pulsate, tho^ to be more accurate it yibratos with the pulse v/ave rather than "pulsates". The History is of diagnostic value; an abscence of tenderness, slovf growth, and no chills v/ill differentiate cysts from abscess. 48 The walls of an aneurism expand C8ntrif\igally in every direction, "but an abscess never does. Auscultation will usually detect the "aneurismal bruit" 'which sounds like a "fly buzzing in a paper bagj| llo sound from an abscess. Pressure on the distal end of a blood vossol may cause an anourisra to enlarge, but does not iiifluence the size of an abscess. ErGssurc on tho proximal side of an aneu- risni causes its disappearance; not so \jltln an abscess, DonH con- found psoas abscess v/ith aneurism v/hich may occur at this point. The psoas abscess may disappear on pressure, or v/hen the horse is turned upon his back, because the pug socks deeper channels or pas- ses into the abdominal cavity, ^^Tien pressure is decreased or the horse assumes a natural position the pus slov/ly returns to its place and the abscess is again apparent. An aneurisn disappears only on pressure, and T,;hen pressure is decreased fills quic]k:ly « Abscess is distinguished fron adipose tumor by absence of inflanio, lobulation, and history of tho latter „ Abscess is not lobulatedo H ernias kkhs occur suddenly, and after severe exertion, traumatism or injur3'',. and not in parts affected by abscess. Psoas abscess occurs on the thigh external and anterior to the line of the blood vessels, \7hile hernia descends internal and posterior to the blood vessels. In doubtful cases explore vith the needle. This can even be used on tho heart itself. Rectal examination con- firms some hernias » Always aspirate before opening a tumor, even when \7o are sure it is an abscess. Cold abscess must be freely opened. Never open a cyst till there has formed a good wall of gr anulat ion t i a 5?ue ^ Suppurat ions ^nay be, !• Superficial , II B Diffusod o III, C ir cms cr ib ed » I. SUPERFICIAL SUPPURATIOII:- Inplics a discharge of pus from a free surface. Common on mucous membranes, as in gonorrhoea, glanders, catarrh, leucorrhoee.e II. DIFFUSED SUPPURATIOII; has no retaining vrall for tho pUs, but spreads in all directions, not in well defined fistulous tracts, Occxirs in both strong and in vfcai constitutionso Frequently follows ery- sipelatous diseases, compoiond fractures, severe contusions, etc. It is not always due to a lack of fibrin, but usually to a wide- spread inflam. of the connective tissues. Deficiency in amount of connective tissue is thought to favor this form of suppuration, SYMPTOidS. Chills, fever, loss of appetite, renal and other dis- orders. Absorption of pus by tho blood may cause typhoid symptoms, and even death, if allovred to continue, TREATIIEIIT, Frequent examination. Y/hen there is discharge of pAs» or pus accumulation, make free, deep incisions through the skin at the most dependent point, so that pug will escape by gravity. This v^ill also relievo engorged vessels and connective tissues. Always make incisions by aid of a director, and use great care. If the pus is not laudable i.e. if it is thin, watery, mixed with blood, of foetid odor, and excoriates the skin, then disinfect and deodorize the sinuses every t\7elvo hours with Potass, Perroang. grs, VI to f of vrater. Hydrogen Peroxide is very good for this purpose. We may use a pledget of oakira to keep tho wound open. 49 The skin below the incision should be greased to prevent excoria-* tion from ichorous pus, CONSTITUTIONAL TREATMENT. Combat pain and restlessness by using opiates. Give tonics, iron, quinine, etc., when necessary. Give good diet, ventilation and sunlight. Diffusive stimulants may be indicated. Ill, CIRCUMSCRIBED SUPPURATION. ( Phlegmon ^ or Abscess ). "Abscess" denotes any purulent collection in a natural ot artifi- cial cavity. When forming in the serous tissues of an articulation it is termed a suppurative "arthritis"; in the peritoneum it is a suppurative peritonitis; if in certain mucous cavities as in sinu- ses, it is termed "purulent collection of the sinuses". Purulent inflam, of mucous membranes is often called a "catarrh". May also have purulent collection of the pleura. Abscess with some writers is synonymous with "deposit", or a separation and collection of purulent matter from the blood. Other \Triters regard abscess as synonymous with "secretion", "fermentation of fluids", etc. Its true synonym is " Phlegmon " , or " Phlegmasia " and it includes all the phenomena of inflaramation* Abscesses are divided into:- I, Acute ( hot ). II. Chronic (cold). I. ACUTE ABSCESS T\xn.s the same general course as does an acute inflam,. Runs a rapid course and suppurates freely, II. CHRONIC ABSCESS riins a slower course; supptirates less freely and constitutes what is known as "cold abscess". Usually there is lit- tle pus and little inflammatory reaction; yet sometimes they attain enormous size. Acute Abscesses are, I, Essential or Idiopathic . II, Symptomatic or Consecutive , I. ESSENTIAL ACUTE ABSCESS, constitutes the entire disease , and re- sults from a blow or contusion, and not from any hereditary predis- position, (The "symptomatic" abscess is merely a symptom of some diseased condition which may exist elsev;here). Acute abscess in mucous or serous membranes is fomed in the basement connective tis- sue and in the connective tissue only. Abscess in a muscle con- tains pus which has been formed from the fibrous sheaths of the , muscle fibres ( sarcolemma, perimysium, endomysium), and not from muscle cells. The muscle cells when set free by the breaking down of the connective tissue, float in the pas, help fill the abscess and give rise to the myosin found in such abscesses. Blows, con- tusions, irritants, and atmospheric germs may provoke inflammation suppuration. How atmospheric germs produce suppuration is unknown. They may provoke pus on a clean wound. A v/ound protected from these germs will not suppurate. Wounds on mountain tops usually heal by first intention, for there few or no germs are present, and no piis is formed. Antiseptic dressings accomplish this either by killing the germs, or by filtering the air that reaches the wound, and so excluding themo Mercuric Chloride exerts little an- tiseptic influence in the tissues, because the albxjmen reacts on the mercury to produce an insoluble albiominate of mercury, v/hich is then inert and useless, Tait, Ashurst and many other surgeons use but little antisepsis, yet through scrupulous cleanliness at- tain the best of results. 50 Prolonged pressure by collar or saddle tipon the skin may cause ab- scess, because the subcutaneous connective tissue is more delicate than the skin; it inflames and suppurates. Lower parts of the limbs are most subject, but we often see it in the fold of the pas- tern under the irritation of riud and -eret. The flinty grains irri- tate the skin and finally produce a cutaneous quittor with the sloughing off of skin. This is a common spring disease and is ter- med "mud feVer", or "erythema", II. SYMPTOi-SATIG ACUTE ABSCESS, is a result of a pre-existing disease. V/e frequen,tly see suppuration of IjTnphatic ganglia in the groin from suppuration of the foot; or abscess of the submaxillai'y gland from inflam, of the Schneider iaxa membrane. The lyi7\phatic ganglia nearest the seat of inflam, will tumefy and suppurate. This in colt distemper is but a sj/mptora and not the cause of the distemper. Seen also in suppurative tonsilitis of small pigs. When there is an inflam, of superficial tissues t.he lymphat- ics that drain the inflamed area are also inflamed. The lymphat- ics are the scavengers of the body, and when an inflammation is ^producing poisonous products they take up these products, become irritated and inflamed ("corded") and v/herever a ganglia retards the poisonous materials in its role as a filter, there suppuration may occur, Waen there is pre-existing cause of persistent suppu- ration in an elevated place, as the nape of the necls or the ^rith- ers, see that the pus can escape at the lowest point of the connec- tive tissue. In fistulous withers the pug may pass dovm and col- lect often in enormous quantity, either in front or behind the scapulo-humeral angle. This is called a "Congestive Abscess" and in the horse is usually accompanied by well marked sjrraptoms of in- flam, , but in cattle standing in the stable, pus may pass down from the nape of the neck and collect in large quantities at the elbow, or in front of the chest, or below it, vfithout the presence of inflammatory or other symptoms except, perhaps, some stiffiaess in fore-legs. Congestive abscess is always likely to complicate acute fistulous v/ithers» or the passing of a soton through the with^ ers for drainage. If deep, it may pass behind the scapula. Con- nective tissue of the horse, being smaller in size of its elements than in any other animal, is more prone to suppuration. In Dias- thetical diseases , as strangles and glanders abscesses may form vlAwk under the slightest inflam. In an animal v/ith rotten sloughs the smallest irritation may produce abscesses. Do r.ot operate on a horse, dog, or sheep having these diseases, but wait five or six months. Operation on a dog suffering from distemper is quite like- ly to cause pyaemia. An operation on a dog, usually causing but little pus formation, v;ill produce much pus if performed during or soon after distemper, llever castrate colts on a farm v/here there is strangles, as they are likely to die from abscess formation. The resulting suppuration may be due to a specific vibrio coming from the seat of the original inflam. PEEDISPOSIITG CAUSES are, I. Species , II. Age, III. Hygiene and Alimentation , I, SPECIES. In the horse inflam, usually ends in suppuration, seldom healing by first intention; tho' it is possible, and does happen 51 when atmospheric germs are excluded, by scientific antiseptic meth- ods, ¥/hy are tissues of the horse more prone to suppuration than are those of other animals? Because the tissue elements ( connec- tive) are smaller and denser than those of other animals. In 1 c,c, horse's blaod are 8,000»000. r<,b„c<, and in 1 CoC, human blood are 4,500,000c r.b.c. - i«e. as 16 is to 9 (ll«~6c Zuill), and this proportion is preserved throughout all the other tissues of the tvTO animals; i«e« , in an equal space the horse has almost twice as many muscular fibres as man, ll'-Go, or 16-3s PUS is dead, and therefore purulent; and is only purulent when dead, A WobcC, or a ct.c, (connects tiss, corpse,) must die be- fore it can be a pus cell. Histologically a pus cell may be a liv- ing cell, but surgically and p athologically it is deado Histolog- ically , as soon as there is any transudation there is suppuration (why?), but surgically and pathologically there is no pus till dead cells (pus cells) exist. Under the irritation of pus cells the surrounding ctoC increase in size by reverting through retrograde changes to an embryonal type, ■when they are then true w^b.c. The old saying that "pus begets pus" is not true, and this can be dem- , onstrated:~ A given quantity of pus placed betv;een two watch glas- ses and kept moist and at a temperature of 100 , Fah, , will not increase, but when placed in living tissues will exert upon the connective tissue those retrograde changes above mentioned, and will increase indefinitely. Dog com.es next to horse in order of pus formation, especially young dogs up to the time when they have fully recovered from dis- temper. Pus of the dog is always more or less mixed with blood, and assumes the color of light chocolate or the sediment of port wine, and closely resembles the pus from a glanderous tubercle or abscess of a horse. The coloring matter of the blood escapes very readily in inflammatory conditions. Abscess in the ox is much more rare than in the horse. Traumatisms tend to heal without suppura- tion, and lips of wounds to unite by first intention. An abscess in the ox is usually "cold" and very large. The more rustic and natural the life of an animal, the quicker the healing process; this is also true of coarse, raw-boned cattle. Sheep possess pyo- genetic power to a high degree (vide, "scab") though they seldom present abscess formation. In the pig the only disease likely to produce abscess is angina tonsillaris (tonsillitis). Then we may find abscesses in the intermaxillary space » • This is quite common, II, AGE. Earlx age of all animals predisposes to suppuration. The anat, omical elements, in the young, are small, well-nourished, of high vitality, reproduce rapidly, and therefore, all molecular changes are facilitatedo. Old age finds the tissues weakened and debilitated and as liable to suppuration as are yoiing tissues. In both cases the ten- dency is for an irritation to set up cell proliferation, but the new formed elements lack vitality necessary to produce cicatricial tissue, and rapidly break doi/ra and form pus. III. HYGIENE Aira ALIMEIITATIOIT : - In well nourished (not too fat) and well bred animals we sometimes get healing by first iiitentiono Thorough-breds and racers and all animals trained to speed and great muscular exertion are but slightly predisposed to suppurative inflam,, but lymphatic horses with thick skin, and long bri&tly 5S hair, bred in I077 lands eind fed on coarse food, are very prone to pus formation, PASHOLOCtICAL ANATOi'iy OF ABSCESS. The interior of a phlegmonous tumor (ahscess) presents char- acteristics v/hich vary with the tissues in which it is developed. In connective tissue v^e may find a mass v;hich is hard, dense and resisting at the centre, but softer at the peripheryo This is the first stage . On cross section it will present all the evidences of acute inflammation, the mass will be of a yellowish tint with more or less deep reddish-bro^n or black spots, ecchyniotic spots* all through ito These spots are simply blood clots due to the rup- ture at those points of the capillaries trhich have been very much inflamed, A yellot/ liquid fills up the areolar spaces of the con- nective tissue, and produces an appearance v/hich Hunter likens to "lemon-peel". A f ev7 days later the second staf^e can be seen^ The density of the central mass is yet more pronounced and is much harder un- der the fingers. Early v;riters thought tliis hardness and resis- tance "sras due to the coagulation of plastic lymph in the areolar spaces. They thought that lymph had plastic properties and could coagulate, but this is erroneous for in order to be absorbed such infiltrate must be rendered crystalloida All clots analogous to blood clots contribute feebly to cicatrization. Before cicatriza- tion can go on the clot must be either absorbed or transformed in- to absorbable m-aterials. Microscopically x-re see that a fibrous clot is the central point of cicatrization. The exudation sepa- rates into a liquid and a solid portion. The solid part is fibrin; the liquid is serum and contains the cellular elements. Of these elements the w.b.c. have great vitality, and under favorable con- ditions resist irxflaramatory influences that seek to destroy them, and participate in cicatrization. In abscess formation, however,' the \7.b,c, do not meet these -'favorable conditions". The ecchymotic spots (clots) of the hard central mass of the abscess soften, turn pale, become less resisting, and eventually become purulent foci having all the qualities of pus, but slightly colored by hemorrhage. This chocolate colored pus, due as has been said to the numerous clots (ecchymotic spots) in the hard central mass, is only found when the abscess is limited to a small space and is in the stage of breaking dovm„ This pus contains many cor- puscles. Each purulent focus irritates the surrounding tissues and causes them to break down and form pus. As there are often many foci, the swelling may now be enormous. The irritation and break- ing dovni of tissue to form pus continues around each focus, so that from a minute clot it gradually becomes larger and larger till its pus cav^-ty merges into that of an adjacent focus e Thus the tissue becomes honey-combed with small pus cavities, and eventually there Is but one large pus cavity or abscess. This is the v;ay in which pus forms in an acute abscess. If now the abscess is opened, the pus v^ill be found to be lau- dable. If blood in streaSs is seen in the pus, it has come from the incision; but if the bloody color is uniform throughout the purulent mass, then it has come from the abscess it self « 53 v/}ien the pua has been dravm off, we can examine the alDscess cavity. Usually it is an irregular sphere crossed in different directions by nerves and blood vessels, their number and size depending upon the region in which the abscess exists. In an abscess in the sub- maxillary region, due to strangles, the finger v;ili often detect a half dozen or more largo vessels and nerves, and much care must be exercised in exploring such a cavity. Their presence is accounted for in a siinjile vray:- The vasculo-nervous bundles are supplied by the blood v-hich traverses their sheaths vith' the material for sur- rounding themselves vrith a dense covering of connective tissue vrhich readily granulates and enables them to resist the macerating action of the pus. This gremulatioTi tissue has a soft velvety feeling to the fingers. The sides (walls) of the abscess cavity are covered with a v;hite, hard, dense, fibrous connective tissue; GO hard as to grate under the knife, and yet so thickly covered vith villous projections as to feel soft like velvet, PATHOGEIIESIS OF ABSCESS:- The hard resisting mass in the centre of an acute abscess in the first stage consists principally of embryonal cells (connective tissue corpuscles and white blood corpuscles), each having one large nucleus that stains deeply \7ith carmine. Around the nucleus is a semi-fluid matrix that stains but feebly, V/ith the appearance of purulent foci, these embryonal cells 'under- go a change. Their nuclei divide again and again till one cell may contain a great nuTiber, -i^rhich give to the coll a granular ap- pearance. If one of those multinuclear cells be treated with carm- nine the nuclei v/ill- stain less strongly than an embryonal cell Y,'ith a single nucleus. In fact, it will be found that the int en- sit 3/ of the carinine staining is directly proportional to the vital- ity of the coll, and inversely proportional to the number Of nucleit A pus cell, or granular cell, is a dead cell, and does not fix carmine at all. Therefore, as the nuinber of nuclei increases, so the vitality and pov;er of taking up carmine decreases. As the nu- cleus continues to sub-divide, oil globules appear and are recog- nized by their refractive po?/er on the rays of light passing through them; the cell nov; loses the pov;er of taking up carmine, has lost its vitality, is dead, and from a surgical and pathologi- cal standpoint is. a true pus cell, LAUDABLE PUS is thick, creamy and of an odor like the animal from which it is dravm. It contains but little intercellular sub- stance, YJhen the purulent globules are not numerous in the serous portion of the x>us it vrill be thin, v/atery and bad natured, and is termed " ichorous ". Chemically the serum of pus differs but little from blood se- rum. The serum of pus holds in solution certain albuminous and fibrinous materials, and from 5 to 10 times more of the soluble waste products of the body (creatine, creatinine, etc.) than does the serum of the blood. V/e may also find in serum of pus certain fatty bodies, refractory corpuscles, granular bodies from disinte- gration of r.b.c, and some r,b,c. either entire and round, or crcnate in outline. This crenation (or indentation) results from the action on the cell of certain ingredients of the pus- These ingredients are also present in the urine of azoturia, and there also the blood corpuscles are found to be crenate. 54 vraon an abscess has developed under a constitutional diathesis is specific- the gerin that has produced the disease may be found at the centre of the abscess. Purulent infection, charbon, glan- ders, etc. are produced by specific germs. The germ of Pyaemia is dumb-bell shaped; the germ of charbon is shorter and thicker, the bacillus of glanders is articulated and ha3f brillieoit points near its extreniitios. Those bright ];oints are spores, . WALLS OF All ABSCESS:- Section shov/s at the most internal part of the vmll an intricate netv/orlc of anastomosing blood vessels interlaced v/ith connective tissue, v/hich renders the v;all smooth and velvety^ It has been called the velvetv tissue, or " Pyogenic m embr ane''; the latter because it vfas once supposed to be the birtliplace of puse The formation of pus is not the ftinction of this membrane t>iough, the v;,b,c. do penetrate it froni T?;ithout<, The deeper layer of the abscess vrall is exclusively comiective tissue, dense, and analogous to fibrous tisfjue. The cells within the pus cavity vary \7ith thoir location. Those near the viralls are embryonal in struct- ure; contain one, or at most, but few nuclei, are vigorous, as in- dicated by their pov7Gr of taking up carmine; while those cells in the centre (farthest from the v;alls) contain many nuclei; are dead, because they have been pushed a-.7ay from their supt)ly of nourish- ment, and have starved. They \7on't take up carmine, and are true pus cells a TERLflllATIOlI OF ABSCESS , An abscess left to itself becomes a painful tu- mor with peripheral oedema. The external vail becomes tense and painful, is gradually macerated and-'raelted" av;ay by the pus till the skin is reached. Y/e arc now able to recognize fluctuation^ The peripheral oedema has become subcutaneous. The skin m.ay .yield to the pus in either of two v/ays:- 1st, The pus macerates the deeper layers of the skin till they drop piecemeal into the abscess contents. Only the epi- dei-mal layer is nov/ left; the hair stands on end, and the liquor puris (pus 5oru:n) exudes and moistens the skin^ In a fe-a hours this thin layer is broken through and the pus escapes, 2ndo By formation of dry gangrene, due to blood supply being cut off from the skin by the pressure of the abscesso This slough begins at the surface in little cracks which gradually extend in length till they merge into a circle about a central point of greatest pressure, and in depth till they pass through the opiderm, derm, underlying tie- sues down to the absciiss cavity, whether superficial or deep. This necrosed tissue then gives way before the pressure of the pus and the latter escapes. Usually these two processes are' combined, though the lancet should be used before they are ready to act« Surgical interference saves time, tissue, and pain^ FILLING OF ABSCESS CAVITY:- Within 24 hours after the pus escapes, the walls of the abscess lose their velvety character and become lumpy by the formation of granular tissue. This formation was prevented in the closed abscess, both toy pressure of the pus and by its chem- ical influence. The vascular loops grow tortuous, and almost fill the cavity if it is small. The whole cavity is thus filled vfith 55 new'-'formsd cicatricial tissue, of the same structiire no matter where formed. All tissues whether muscle, bone, or brain are unit-" ed by embryonal structure, which consists of embryonal cells, a multitude of capillary blood vessels of the first and second order, and a great number of cellular bodies designated by Robin, "embryoiJ. "cellulo~", or "f ibro-plastic'» tissue. The central layer is term- ed the "embryo-plastic" layer; the middle layer is termed the "cel~ lulo-'plastic" layer; and the external layer the'^'f ibro-plastic" lay^ er., CICATRIZATIOiro - At first, the cellular elements are protoplasmic and entirely spherical. As they age they increase in size and throw out prolongations. Thus the oldest cells, i.e. those in the exter- nal layer of the f ibro-plastic zone of Robin, are stretched out and tlien form the f ibro-plastic tissue of Robin* Later the body of the cell gradually thins do'iTn to the size of its two prolongations -and the whole forms are a connective tissue fibrillau This pro- cess is knovm as cicatrization . This tissue, like all connective tissue enjoys the power of contractility, to which the drawn ap~ pearanoe of old wounds is due. This contractility of cicatri- cial tissue is taken advantage of in the operation of "nicking" the tail, also in Entropia, in which the eyelash and eyelid are turned in towards the eyeball. This condition would soon destroy the sight if the lashes and lid were not everted by incising the skin above the edge of the lid, and producing cicatricial tissue which by its contraction turns the edge of the lid outward, ABSCESS BY COIJGESTIOII:- differs but little from acute abscess. There is no central induration, because the pus has -formed at a distance; and little inflammation excerit that due to the irritating presence of the pus. The pus collects, and produces inflammation and oede- ma by its presence in the tissues. The retaining walls are cover- ed by velvety tissue, but there is less connective tissue than in tlie walls of acute abscess, ABSCESS III A NATURAL CAVITY has other characteristics. 1 Abscess in a synovial cavity:- A sjmovial membrane is nor- mally grayish and opaline in color, because the capillaries are so small that the r.b.c, cannot pass through them euid redden the tis- sue. Under inflammation the capillaries dilate, the r.b.c, enter and streak, or color the entire synovial membrane a bright pink. The capillaries increase in size and number and form large vascu- lar loops; the epithelial cells peel off; and the synovial fringes denuded of epithelium become greatly hj'pertrophied, and assu-ne all the characters of acute abscess. The velvety wall is then produced, The contents consists of much liquid in which are many clots which contain epithelial cells from the synovial membrane, 2 Abscess in a mucous cavity:- There is first a plastic in- filtration between the derm and the epiderm of the mucous membranoo The exudate coagulates and pushes off the epiderm. Both then fall into the cavity. We can call the lymph in this case an "exudate", because raucous cavities are always open to the external air. Epidermal cells of serous and of mucous membranes are exfoliated in the same way. The inflammation progresses, and velvety tissue is formed as in other abscesses, but the contents of the cavity differs from the others. The exfoliated epiderm does not interfere with the secretion of the raucous cells which lie deep in the derm. 56 Their action is, stimulated, so that there is alvrays much mucus ■with the pus of such an abscess, DEGEHERA.TIOII_ OF PUS« Y/hen pus is unahle to escape from its cavity va- rious modifications are seeno The serous part of the puruJ.ent liquid is absorbed, leaving tho pus corpuscles. The latter become filled v;ith fatt;^ globules (fatty degeneration), sticlc together, becorae dry and caseous (cheesy degeneration). Next may follo'w an infiltration of lime salts into the pus corpuscles ( calcareous de~ generation); or they may disappear entirely and leave no trace behiiid. Virchow supposes that at a certain moment there is produ- ced lactic acid vrhich emulsifies fat, dissolves caseous pus, and acts upon lime salts to produce soluble calcium lactate. All these ere readily absorbed, and the abscess entirely disappears. SYIviPTOHS OF SUPERFICIAL ABSCESS are:- ( A ) Local or Obj_ective., and ( B ) G and '--'ill bo found at the .tiost dependent point. In case, hovrever, the suppura-tion is in the foot, the oedema -v/ill be above in those tissues v;hioh are iassst loosest, i.e. above the knee or hoclcj ex- tending often as high as the shoulder or patella, because the tis~ su.e3 about the fetlock and cannon bone are not capable of much dis-^ tension. The fluctuation usually escapes notice,. Search the regions bolov/ the seat of oedema. Oedema may be punctured 'with a trocar- carrying it slo-^/ly in v/ith a rotary motion, or a sharp-pointed grooved director may be used. The skin may first be incised to permit the trocar to penetrate the tissues more easily.. If pus is too thick to flov/ through the cannula, the point of the stylet 7/ ill b'o- seen to be' covered T/ith thick pus, and aspiration should be per- formed to bring it out. In using the trocar to relieve flatus never incise the skin, but plunge the instrument in by a single, quick., strong, and straight stroke, holding the point of the trocar in contact i.7ith the skin by the left hand, and using the palm of the right hand as a hammer « If the trocar don't penetrate the gu.t withdra'7 immediately and try again* In puncturing an abscess » you may puncture with a trocar 15 or 20 tiiries, if necessary to find the pus cavity > vrithout doing h8.rm. Explore vith a trocar everj day till pus is found, and then cut do^7n with a bistoury and. allo^ir the pus to escapee Perverted function of some organ may be the only symptom no- ticed. Hake it an invariable rule al-vrays to explore a. tximor first with a trocar •'.7hether ;/ou are sure of your diagnosis or not. Make a diagnosis as early as possible, DIFFEEEIITIAL DIAGIIOSIS. Cysts are round, \7ell-defined tumors, either deep or superficial, and sho-7 more uniform fluctuation than abscess^ They are never surrotmded by oedema, and are not painful. The most frequent form of cysts occurs on roadsters on the inner side of the caruion between the knee and fetlock, and are caused by their striking themselves, tho* not hard enough to produce a "speedy-cut '^ Never open these cysts; but bathe the parts for a few days '.7ith Dick's '/.Tiito Lotion, Lead-T/ater and Laudanum, or hot Vinegar and Alcohol till the inflamiT)atory symptoms have subsided and the sim- ple cyst remains. Through this from, above do^7n?7ards pass a seton of a single thread of silk, using a common suture needle, or a small sound. Over this apply a blister of 10 or 15?J ordiziary strength; put on an oakixm dressing, and bandage. A v;eek or ten days will usually effect a cure, A tumor at the top of the withers should be treated vith cir" cum-spectiono If it prove to be an abscess open it imjiiediately or it will produce serious trouble; but if it be a cyst, and be freely opened -.vithout having first produced granulation, by injecting an irritant into it, the skin m.ay slough away, and serious results follow. Blood tiiraors result from a rupture of blood vessels which lead into connective tissue. The hemorrhage ceases as soon as the pres- sure external to the blood vessel equals the blood pressure c The extravasatGd blood coagulates and serum infiltrates the neighboring 58 tii33ue3 and produces an oGdetna* This tiJinor is at first hot and in this respect £3iinulates acute abscess. Blood tumors do not fluc- tuate as do cysts and abscesses; but on manipulation there is con- veyac to the fingers a crackling sensation due to the forced break- ing dotru of the clot, Ilever open a blood tiaiior, for it vrill pro- vide a culture- bed for septic germs, and' septicaemia or pyaenia may results II ever open an aneurism, VPny? Escplore angiomas arid aneurisms with a capillary trocar. Soft cancers * hypertrophied t hyroid glands and aneurisms have all diagnostic symptoms. Synovi- tis must sometimes be discriminated; capillary puncture aids this diagnosiSo Articular sj'-novitis should never be opened, D if f er en t l3,l d iagnosis of hot or acute abscess from a ventra.1 hernia „ Pus may burrow into the abdominal cavity to form an abscess there. Hernia there results from a laceration of the abdominal v/allSo Both have inflairmatorj^ symptoms* Vermicular and peristaltic move-* ment is noticed in hernia both by auscultation and by manipulation. The movements and sounds vrill seem nearer to the hand and ear in a hernia than -p/hen they emanate from the abdominal cavity .^ "VThen in doubt, ha,VG recoiirse to the aspirating needle, or fine trocar-, PROOIIOSIS OB' ABSCESS varies^ Wo must consider its size, location, the resistance of the tissues, temperament of the animal, etc. Super- ficial abscess may not be serious, tho^ it may be quite so in re-- gions that arc abundantly supplied i^rith connective tissue, and of lo^ vascularity as, the withers, poll» It the abscess involve os- seous, tendinous or synovial atiTicturos, as it is especially like- ly to do v/hen of the vrithers or poll, it becomes much m.ore serious. Prognosis also serioiis 'jhen the abscess is in tissues lacking in coimectivo tissue. Abscess of the withers quite serious by reason of its often forming an abscess by congestion either anterior or posterior to the scapula, or passing dovm internal to that bone, A.bscesses in the jugular gutter nay empty into the thorax. Abscess in the abdominal cavity is very dangerpus. The cause must be con- sidered in making a prognosis; abscess of glanders is much more serious than abscess of strangles, TREATIIEIIT varies with the depth and stage of the abscess. In the first ( indurated) stage the treatment should favor pus formation and the reduction of inflammation. Antiphlogistic treatment : local bleeding ^7hen you think the abscess is about to develop, particularly in the extremities. This is done by puncturing the superficial tissues in several pla- ces ^/ith a lancet or bistoury, DonH injure deep tissues. Bleed- ing caLms, and allays pain by facilitating the formation and escape of pus, thereby softening the skin and allowing It to stretch and diminish the pressure upon the spelling tissues underneath. It should bo followed by hot baths and poultices to promote a, flow of serxm and further soften the skin, V/armth promotes the growth of embryonal cells, and so hastens pus formation. If this treatment ceases to do good, or the abscess is in a region difficult to poultice, v/e may use stimulating liniments, mercurial or cantharides ointment, or both combined, Opiira or Chloral hydrate and Camphor are useful local anaesthetics. When we fear that the condition is becoming chronic, blisters must be used. They may produce sloughing of the skin, but this is prefera- 59 ble to necrosis and gangrene of deeper tissues- the bone, for in- stance » In the ox and dog it is difficult to set up eruppuration^ therefore, it is here necessary to apply very severe blisters, ivlinoral acids, etc. In deep ab'^coss use a trocar, and should the pus he very thick use an aspirating needle or malco a counter open- inga Vfhen any doubt exists as to the diagnosis blisters are still indicated. After blood taiiors are converted into abscesses by blisters they may bo opened. Blisters act similarly v;hen applied to cysts o After aii abscess is opened it should be explored v/ith the finger, vhich can also bo used as a grooved director on ^hich to place the bade of the bistoury in enlarging the opening o Get good drainage oven if it bo necsssai-y to make a counter opening at the most dependent point of the abscess cavity. This may be don-e by introducing an "S" sound into the cavity and bringing its ex" tremity as n.car as possible to the surface at the point \7h0r0 the counter opening is to be made, cutting the skin over the point of the sound, and then cutting the tissues layer by layer over a groov- ed director. This latter precaution is necessary \fhen operating in proxi-Tiity to largo blood ve/^sels. The cavity should now bo cleansed by injections of antiseptic liquids, and a set on or drain- age tube introduced. In sone regions, as the sub-parot ideal ,; th e use of the bistoury is conti-a- indicated in opening an abscess. Here gather up a fold of the skin between the thumb and index fin- ger of the left hand, pass a bistoury through it and cut upv^ards. Through this incision dissect layer after layer of tissue by tear- ing and not by cutting till you reach the abscess. Do this tear- ing •'jith a grooved director or a soujid. Evacuate the abscess, ex- plore it with the finger and then cleanse it thoroughly. Opening an abscess, except so»ne few abscesses of the v/ithers, by the actual cautery is neither elegant nor surgical, and should be proscribed. It produces a v;omid that heals very slowly and has other disadvan- tages. Bad odor of pns indicates fornientation, and calls for the application of antiseptics. V'ash out all abscess cavities thor- oughly, and then apply an antiseptic dressing. COLD ABSCESS; Results from a chronic inf larnmat ion that has terminated in suppuration, Conraon in the sheep and particularly so in the ox. Divisions are:- 1. Superficial . 2 Deep » also (A) Pr in it lye or Idiopathic « ( B ) Local or S.Ymptoiiiatic . CAUSES do not differ essentially from those of Aoute abscess, tho' the inflamnatory process is slower and less raarked. In the horse the point of the shoulder where the collar rests, the angle of tho haunch, ribs and superior border of tho neck are favorite seats of abscess, llocrosis may also be complicated by cold abscess. Cold abscess is rather rare in the horse, but coninon aiiong ruminantSo Champignon and "scirrhous" cord are nraltiple cold abscess due to a suppurative phlebitis of tho cord. Suppurative lysTiphangitis must not be confounded with farcy buds- look for the oily pus of farcy. Cold abscesses are formed particularly in strangles. Cold abscess- es are of t-^o kinds :- { 1 ) Indurated . (^) Soft . 60 (1) In tlto limUTJiTSD tumor of COLD ABSCESS the connective tissue is not infiltrated v/ith soritn. The v;alls have a yellot? or a pink color, are fi'orous* and croalc under the knife <= In the centre of the tuvior nay T>8 found a small amount of pus, which may be cheesy if the tunor is old, and \f'ach alvrays contains much alhurrtano (2) In SOFT TUI-lOn the rctainins -jail is thin and the tissues red and "v3l('oty.,. The tiriior is fluctuating, She pus is a yellowish serous liquids runs easily, is sometimes purulent and may contain epithelial cells= In cattle they often gro'v* to enormous size^ DIAGIIOSIS OF GOLD A3SCF-SS, not altrays easy, Tlie indurated form is reg^i- lar, spherical, and never lohulatod as are some neoplasms ^ iEhere is no heat, sensitiveness, nor inflainmatory phenomena except s\/ell- ingo She seat of the tu"-nor is an important oleinont in diagnosis. 2he aspirating iieodlo is always used, iia!-:o punctures in all direc- tions till the cavity is reached, The soft form is more easily diagnosed. These soft tuj":\ors much rese^Tiblo sebaceous and serous cysts in consistency, and fatty tumors in appearance, especially vrhen on the ribs, but the trocar tells the talot, Ftitty turners are lobuJIatcda, The pus of farcy buds is oilyo TliG progress of cold abscess is extremely slov/n The pus may undergo fatty or caseous degeneration, or calcareous infiltrations and thus change or entirely disappearo Soft tumors may naintain their size 'or become larger vithout change in character, TREATliiElIT:'- Often removed under the impression that they are fibrous tunioTSe Give free sxit to the pus- this is the most rational treat* nent. We iT.ay often by a blister change a c}.ironic to an acute form, Yi'ith a long sharp bistoury cut doiTn to the pus cavity, T.Cay re- quire several punctures to find the abscess, and they should be made in different directions till pus is found. Evacuate the cav- ity and enlarge the openings using either a grooved director, or the finger, European v/r iters advise cauterizing the cavity with a white hot iron, but such treatment retards healing. The s inplor the treatment , the s ooner the cure . The tuiriors found at the scap- ulo-huinei-al angle are cold abscesses and not fibrous tumors. Pack the cavity tightly ',7ith oakuni ifhich has been soal-cod in some irri- tating substance, as Cantharides oint^ient or Tincture of Iodine, If the cavity is large and the T/alls thin, it is not necessary to incise the vfalls in all directions as in thick walls,, In the dog give constitutional treatment of Iron, Quinine and Oleusn Morrhuae, Chapter IX, ULCERA2I0II , ULCERATION Is a result of both Acute and Chronic inflammation, especial- ly the latter, Xt differs from raortif ication not so much in pro- cess, as in degree. Ulceration proceeds slowly- cell bj, coll ; i^iile mo rtifi ca tion proceeds more rapidly , and affects masses" of tissue at a time. Ulceration is Open , and Close « In excoriation only the epithelial layers of the skin are involved, \Vhen the pro- cess extends deeper it is termed ulceration. It is not necessary 61 for it to be en the surface; all tissues may ulcerate except horn, hair and nails, CAUSES :- i A ) Pr ed jgpo 5 ing , (E) Exciting . (A) PREDISPOSING CAUSES affect the nutrition. Certain changes in the blood cause ulceration of iroicoua membranes and skin, as seen in glanders and faroyo The rate of circulation and the quantity of blood sent to a part influence ulceration. Too much blood may pro- duce necrosis; too little may cause death of tissues from lack of nutriment.. Ulceration may be due to a disease of the heart or bleed vessels? too little force in the blood current; atheromatous change (fatty degeneration) of the blood vessel walls; or to the vreighc of a tumor pressing on a blood vessels Y/eight of the body alone, Yifien the nutrition of the body is at a low ebb, may cause '^bed sores='o Impoverished blood, and the obliteration of the blood chariaels by the v/eight of the body resting upon prominoirfc parts, and certain obscure trophic changes cause these "bed sores^. Certain structural peculiarities, as old cicatrices, may invite ulceration, Ilever blister a cicatrix; it may cause a dangerous slough „ (B) EXCITIITG CAUSES may be wounds, bruises, poisons, extremes of temperature. Specific ulceration is due to specific causes, and will reproduce itself. Ulceration shows all the phenomena of in- flammation. In excoriation or ulceration of the skin the cells are formed so rapidly that the cells of the epithelial layer do not have time to dry out and become flat, but appear more or less globular. Remember ! ulceretlon ai>d gangrene differ only in degyee. There is usually some Infiltration around an ulcer, and some thickening and induration. The discharge of most ulcers is quite irritating and is called "ichor". It can be seen flowing from cancers and old fistulas* and readily excoriates healthy tissues. Loss of tissue in "Close* or concealed ulcers takes place by ab- sorption, and this absorption of poisonous substances produces a blood poisoning, or an inflammatory fever. The extremities, being less favored by the circulation, are most liable to ulceration. Age, and nutritive conditions are powerful influences, Old^ or poorly fed animals are most liable, HEALING ;- When the slough is washed out by the ichor, there is a tran- sudation of fibrous lymph. The edges of the ulcer become tumefied (raised), and the entire surface Is covered by myriads of vascular loops each of which nourishes an individual colony of cells. These many colonies give a rough granular appearance and are called "granulations", A granulation Is, therefore, essentially a loop of a blood vessel, migrated leucocytes forming its walls- surroun- ded by plastic lymph. When healing, the edges lose their usual sharp definition, and the descent toward the centre of the ulcer is grr'adualo This apparent filling of the ulcer is not due to the growing up of granulations, but to a settling of the skin at the edges to a level with the ulcer after Inflammation has subsided. The ulcer contracts as it heals, because connective tissue forms and contracts. The granulations ate In size from a millet to a mustard seed. They are very delicate in structure, and will bleed and break down under very gentle manipulation. 62 They are very vascular and, therefore, have the po"S7er-of absorp- tion; "but they contain no lymphatics and no nerves, and are not sensitive o CICAIRI2ATI0H >' Ihe surface of the grajiulat ions becomes glased, glossy and less granular o The cavity contracts; pus disappears from the borders, epithelial cells creep over the edge from the skin. The red line of the border of the ulcer gradually gives place to a Tffhlte or bluish \7hite fringe of nev/ epithelium cells, and thus non- pigmented hairless skin is formed. Don*t allow a caustic to touch this new tissue or you will cause it to slough off ^ If necessary to use a caustic apply it to the centre of the ulcero Healing al- ways proceeds from the edge unless the skin has been left in isolated patches- islandSo' Skin grafting is successfulo True Ulcer is a granulating surface follovfing ulceration or gangrene* I9 Local Ulcers are all that are due to local causes© Us, Co nst itut ional Ulcers originate in a constitutional vicoo I. LOCAL ULCERS ARE, (A) Simple » (B) Com-plicated , (A) SILCPLS ulcers:- (1) Location- generally on the extremities » because these are more exposed to changes of temperatiire; to injuries? because there is little subcutaneous connective tissue to prevent contusion. Great distance from the heart is a factor in production of ulcer a Why? (2) Form depends on the cause, tendency is to assume the cir- cular forme (3) Borders, rotmd, smooth, no indentations, shelve off to- vrard the centre. Slight redness, induration not marked, no increasg in sensibility. (4) D epth « depends on the amount of tissue destroyed. (5) Granulations do not bleed on touch« ( 6 ) Discharge" bland , neutral „ The s ystemic symptoms a re usually apparent before the ulcer Is formed; they are loss of appetite, dullness, dry^ hard tongue, etCo, seen strikingly in "mud fever" ("cutaneous quitter" ) , TREATMENT :~ Simple Excoriation ^ Oxide of Zinc, Sub-nitrate of Bismuth and Boric acid is an excellent dressing. We may add a little lodo- form, A powder dressing is far preferable to a liquid oneo Char- coal may be used, Lycopodium makes your powder light; Calomel adds efficacy, but must be used with careo The rationale of the treat- ment- is to lessen the ,amount of blood in the part during the in- flammatory stage of the ulceration* Lead-water and Laudanum ap- plied to the ulcer in a cloth saturated with it is good, as is also local blood letting. Cold irrigation is th^ begt ^ Large quantity of water is not necessary; alloi-r it to merely drip, on the oakum dressings Too long irrigation lowers vitality'^and invites the disease; then vrarm v/ater is indicated. Purgatives and poultices are good„ Before poulticing, v/ash with Potass^, Permang, or Mercu- ric Chloride, or Tr, Iodine to render the part antiseptic„ The diet should be nutritlouso Don*t wash the surface with a sponge; allow the v/ater to drip. To Insure rest a splint Is sometimes nec- essaryo Prevent flexion of the fetlock by hard balls of oakum pack, ed tightly into the fold of the pastern. Ulcers on the posterior face of the knee-joint are treated with pads of oakum four or five inches thick applied from the elbow to the fetlock and held by ban- dages « 63 This prohibits flexion, and gives pressure '^hich aids healing « A sole-leather splint or an iron splint welded to the shoe v/ill also bring about this "enforced" rest, S|T3lint . 5 always on posterior side of limb o Ulcers are of t-wo kinds :- I. ULCERS WITH EXUBERAITO GEA2IULATI01IS. II. UL.CERS WITH DEFICIENT GRAITULATIOIIS . lo Edges of the ulcer are sv/ollen. Indurated^ irregular, and perpendicular to the skin. Edges of the skin may be everted two or even four inches, and the ulcer filled v/ith exuberant granula- tions« This condition is often se?>n 'vrhorc point firing has been praoticod, "Liush-room" grovrths, they are called. The discharge is profuse 5 thin and often bloody. This ulcer is called by many tvTi-- ters, the "irritable sore". The granulations are red or dark-pur- - pie 5 bleed easily, and the surface is covered by blood clots « These conditions are caused by an attack of acute inflammationo or hyperaemia in the ulcer itself, Aniinals out of condition, of poor appetite, "slab-sided", "scouring" if driven tvro or three miless are liable to this ulcer. The granulations axe soft and flabby » and their dark color is due to obstruction of the veins froTi exter- nal pressure, causing them to engorge. Fungus ulcer increases with great rapidity. Oedematous ulcer is pale, T7ith large flabby granulations bath- ed in a. serous discharge , Sloughir.K ulcer may folloi^ the oedematous ulcer. It is also called the "Phagedenic", or "GangrenoTis" ulcer,- See William's Sxirgery, Treatment of this ulcer "is a matter of great urgency and im- portance, but not alv/ays satisfactory", as complications may arise,, Ulcers are so called i?hen they occur above the knee or hock; when they occur bolo\T^ they are termed "quittors "^ TEEATJ/SniT:- First, absolute rest . Purge to regulate the digestive glands, A laxative that produces one or t-wo soft stools is indicated. never purge for 24 or 48 hours, A bolus of from G to 8 drams of aloes with a little calomel and calabar bean is good. The Calomel is more quickly absorbed when combined with soap. Give Opium, Sv^eet Spot's of Hitre or a few grains of Morphine if pain is present. LOCAL TPuEATIylElIT :- Local bleeding at a short distance from the sore.* Apply a wet cloth. Chapman's Method is good for beast also:- nar- row strips of lint cavered with oiled-ailk to prevent evaporation, for this is a wet dressing, and a roller bandage. Boric Acid dis- infects the discharges. Remove the dressing every 24 hours, VMer t reatment of ulcer Is almojst a specific , if it resists this, then add to the water Chloral, 12 grains to the ounce of wa- ter ^ A solution of nitrate of Silver painted around the ulcer is good, Cupric Sulph, and Nitrate of Silver are caustics that will remove exuberant granulations. A wash of Potass. Permang, is nice to remove pus., Dry, and add a layer of pulverized sugar, cover with strips of acJhesivo plaster, and over all wind a roller bandage REMOVAL OF E;CUBESAKT GRAHULATIOIIS By;- ( 1 ) Compression - and (2) Excision. Exclsign by hot iron and caustic potash has been practiced. 64 T3ut they are uncontrollable. Excision by the knife, curette, scis- sors, etc* is the simplest, tho* the bleeding is somewhat profuse. The after treatment is water dressing and compression . When the granulations lose their bright red color and become pale ashen and dead they form a- SLOUGHIIIG ULCEHl- TREATLSCIIT : - ( A ) Const itut ional . { B ) Local , Local consists of \7ashing the ulcer with dilute Hl-TOg-C 1-20 ) , applying a flax-seed poultice, covering vrith oilod silk, and secur-* ing with a roller-bandage. Renew every 12 hours for 5 or 4 days. When the slough has come a^ray, paint the parts about the ulcer with Lugol's Solution; then apply a compress dressing under oiled-silk, and secure v/ith a roller-bandage. II. ULCERATIOII WITH DEFICIEIICY:- (Indolent Ulcer.- Williams). Char act er ist ic s ; granulations small and pale, not sensitive; discharges thin, bloody and offensive. The walls about the ulcer are so thick and indurated that the blood cannot reach the small, pale, starved granulations, therefore, the cause of not healing is not a constitutional, but a local one. TKEATIIENT, Simple. Macerate the ulcer in warm vrater and bran for one or ttro hours each day. Then put on a water dressing, oiled silk and a roller-bandage; and repeat this each day for 4 or 5 days* Then place on a large piece of lint moistened with Alcohol, cover with oiled silk, and apply the roller-bandage V7ith equal pressure : this latter is most important. Do this each day for 4 or 5 days, and then put on a penianent dressing which may remain on for 5 or 6 days. Chapter X. MORTIFICATIOII . {Lat. mors- death, and facere- to make) may be defined as an absence of the phenomena associated with life. Old writers used the term "sphacelus" to denote complete death of a part; while by "gangrene" they meant dying tissue, or incipient mortification, often called "hot mortification". Gangrene is thus a condition preliminary to mortification.. Mortification of soft tissues we call a slough : of hard tissues, as bone or cartilage, we term a necrosis , and the detached piece of dead bone or cartilage is call- ed a "sequestnim". Only the heart is exempt from mortification, but it may undergo a fatty metamorphosis. The more vascular a tis- sue is, the more prone it is to mortify and the more rapid will be the invasion. Glandular tissue is not very susceptible to this process. Dermoid structures- skin, mucous membranes, etc., and muscles are most frequently affected, while bone, cartilage, tendon, nerve, and brain tissue, veins and arteries resist the process and die more slowly. causes:- Anything that renders the blood unhealthy, or Interferes with its free circulation- malnutrition. They arc numerous, but are 65 either:- I« EKt ern.al ( tra^.lInatie)^ or 11= AiltSiXJ-al'' II. INTERNAL CAUSES are those vThich act by' obstru.cting either veins or arteries, or both. They are further divided into (A) In- f lammatory c. (B) None inflammatory, (A) These are a fruitful source. Arterial obstruction will produce mortification if the collateral circulation is insufficient* Embolism or Thrombosis may reduce the blood supply to a part and cause mortif ieation; the same causes may bring on a congestive colic, and in a large arterial trurJc may prove immediately fatal. Any lesion of the intJL ma will cause the formation of fibrin, and thus predispose to production of clots. Arterial obstruction is favorGd_ hy a weak heart, endocarditis, anaemia, atheroma, purpura hemorrhagica, aneurisms, and exhausting diseases of a specific character* Venous obstruction only rarely causes mortification. Pressure on blood vessel 7falls reducing their calibre, agents in the blood which contract the muscular v/alls of the vessels- ergot, venom of serpents, poisons, and defective enervation, may produce mortifica- tion» Ulcerative keratitis may be caused by feeding a dog sugar. There are tv,^o va rieties of mortification, I« Acute (moist) and II „ Chronic (dry), and between these extremes occur every degree. All are inflam- matory in origin. I. ACUTE MORTIFICATION. S.vmptom.s are 1, Local and 2, Constitutional . 1» Local . Heat, redness, swelling, and pain. Color may be brown, purplish, yellow, or green. Red streaks are seen in unpigmented skins, along the course of superficial ves- sels. Then have a fall in temperature; diminished sensi- bility; an oedematous swelling that softens as it fills with a dark-colored serum. We may still be able to main- tain vitality in the part; but if these changes are allow- ed to proceed, and the circulation is cut off, vesicles form in the skin, cracks appear, it loosens and comes a- way leaving a smooth slippery surface, with an offensive odor^ The coldr becomes gray, then brown, and finally black „ The tissues become emphysematous- gas being gener- ated by the decomposition and fermentation going on in them, and give a crackling sensation to the fingers on pressure^ The foetid odor is due to the gas= If the skin does not yield, this gas will puff it up and make it res- onant o A decided difference in color is presented by different t issues „ Cellular tissue becomes gray and sodden; muscu- lar tissue dark and pulpy; tendons change but little, bone deprived of its periosteum, becomes brown or black, and dry. The medullary tissues retain their vitality long af- ter the death of the bone. The disorganised parts are starved by decomposition (due to oxidation) of the blood. Necessary factors in mortification are the living micro- organisms (aspergillum viridum, ete^ ) which eorae from without, penetrate all parts of the tissue and, according to Pasteur, act as ferments O o G6 2» Co nst itut I pna l symptoms are very marked and occur earlyo Pulse is full, strong and rapid, temperature 4 or 5 degrees above normal, hot, dry skin^ restlessness, thirst c As the disease advan-- ©es, the pulse loses fullness and becomes i/reak; the skin moist, cold and claTmy and temperature falls » The face wears an anxious expression; the urine is thick and cloudy; in short, there are v/ell-marked typhoid symptoms, due probably to decomposed fluids which have entered the circulation. After a variable time the slough separates from the living tissues. An inflammatory infiltration of lymph and leucocytes is going on in the tissues surrounding the dead t issue j and thus is formed a barrier which opposes entrance into the healthy tissues of septic material from the dead tissues^ At first a faint red line due to capillary congestion, and known as the "line of demarcation" shows Virhere separation will occur. This red line cracks at differ- ent points, and those cracks join to form one more or less cir-- cular crack ?;hich passes first through the skin and then through deeper tissues. The walls of the living tissue are never perpen~ dicular to the general surface, but slope obliquely down. and in . toward the centre. A fev; days are required for skin and muscle to separate; two or three weeks for tendons, three or four months for bones. Blood vessels do not slough till their canals are obliter~ ated. TREATIIENT:- 1. Constitutional . 2. Local . 1. Constitutional treatment . Rest, Anodynes for pain, refrig- erants, stimulants, tonics, quinine and iron, disinfectants, prop* er hygiene. 2. Local treatment seeks to remove the slough and to favor granulation. Blisters at a short distance from the slough; free scarification to remove serum, blood aiid pus, and thus relieve the circulation; poultices to promote separation- are good. Put char- coal or yeast in the poultice to destroy the odor. Renew every six hours, washing each time with Potass. Perraang., or other anti- septant. TiHien the slough has separated, v;e have a simple ulcer to treat. If tendons are involved, the separation takes place slowly. The treatment is- poultices changed frequently, and antiseptics. Enormous sloughs are frequent in cities where salt is put on the car tracks to melt ice. This form is called "raud fever". II, CHROHIC MORTIFICATIOII : - (Dry gangrehe) results from causes which interfere with the arterial circulation; Acute (moist gangrene) results from causes that interfere with the venous circulation, A feeble, fatty heart, or medicinal agents which act on the coats of the smaller blood vessels (ergot) can produce dry gangreneo Atheroma is also a fruitful cause. We must not interfere surgical- ly with a dry gangrene caused by atheromatous blood vesselSc SYMPTOMS, Constitutional disturbance, feeble, and often irregular pulse. There is a variety of dry gangrene caused by food contain- ing ergot, TREATMENT^ same as for Acute mortification. Chapter XI, 67 W U N D S . FOUIIDS III GENERAL are solutions of continuity of soft tissues. Solution of continuity of hard tissues, bone and cartilage, are designated fractures . Wounds are. Simple and Complex , (A) Sinple Tsrounds tend to heal by first intention, (B) Coraplex v^ou^icls have no such tendency. Wounds may be produced by any foreign body in motion, A wound in which the skin is not comproi:iisod is called "3Utacute»neous", Blunt bodies usually bruise and lacerate the tissues, but moving at a high rate of speed may produce a wound similar to an incised v/ound. Shoes, hoofs, horns, tooth, etc, are common instruments in production of wounds. All wounds, however, produced are accom- panied by some co.rmon characteristic phenomena. These phenomena are either immediate, or consecutive, I. Ba-EDIATS phsiiolieiia:- !• Pain of the wounded tissues- not to be confounded with the pain of irif lammat ion -which occurs hours later. Intensity of the pain varies v/ith the nature of the instrument and the sensibility of the region, A sharp clean cutting edge destroys but little tis- sue and produces but a momentary ti?;inge of pain at a definite point, A blunt instrument crushes and bruises much tissue, and the pain is intense, diffused and persistent. Mental action malces pain more , acute, i,e, if an animal is allovrod to contemplate the object that is to cause hxra pain he will suffer both mental and physical an- guish j therefore, Iceep instruments, as far as possible, out of sight. May blindfold the patient, A less pain may be attenuated by a greater. This principle of derivation is applied in the em- ployment of the "twitch" in minor operations, 2, Hemorrhage , caused by opening blood vessels. ■';7hen only skin and connective tissue are injured, the hemorrhage is capillary and the blood exudes in drops from all parts of the wound. When large arteries are compromised the blood is bright red, and spurts forth synchronously v,-ith the cardiac systole. Blood from venous trunks is dark colored and flov;s in a steady stream. Degree of the hemorrhage depends on the nature of the body; a sharp cutting edge produces a free hemorrhage; a blunt body usually so crush and close the vessels that there is but little bleeding. Some lacera- ted v,'ounds» as the tearing of an arm from its socket, compromise very large arterial trunks, and yet no bleeding results, because the endothelium of the vessels first, ruptures and its edges ciatI inward; next, the muscular coat parts and curls inward, and lastly the fibrous advent it ia parts after being drawn out to a point. The ecraseur acts upon this principle, 3, Separation of the Lips of the WuM:- Two causes :- (a) Penetration of the instrument, (b) Normal retraction of the tissues, Vrtiere the tissues arc lax the wound is either obliterated, or about the size of the instrument that produced it; but where the skin or other tissues are dra\m tense the wound "gaps" considerably. The direction of a wound influ- ences Its shape and size; e.g, a wound lengthwise with a imiscle gaps but little, but if transverse will be almost circular in shape. 68 II. CONSECUTIVE PHENOMENA:- The STjm total of these phenomena constitutes cicatrization ( healing) » It is better, hov/sver, to consider them separately o !• S yncope (fainting) is due to cerebral ansjnia, caused in turn by a great loss of blood. Fainting occurs in the horse and dog when blood is lost in amount equal to one-fifteenth the weight of the animal, about ^t-oz. of blood to every pouhd of w't. To re- suscitate $ lower the head and allow the blood to gravitate mechani- cally to the anaemic brain. Slapping the face -^ith a wet towel, a cold douche, etc. will also invite the blood brainwarda 2. An aemi a, If at one bleeding sufficient blood be withdrawn to produce fainting, the animal may yet recover without apparent harm; but if the same amount of blood be drawn by several bleedings^ there is great danger of inducing a condition of progressive and persistent anaemia. Some butchers treat bulls and old calves in this way in order to remove the normal dark color of the meat, so that bull-beef will resemble steer, and old calf veal* 5. CICATRIZATION:- T^70 kinds, (A) By. First Intention , ( Non-suppurative, or adhesive cic- atrization). (S) By Second I ntention . (Suppurative, purulent 5 or plas- tic cicatrization). (A) First Intention , is ideal, and to be sought o The conditions essential to healing by first intention are:- (a) Close contact of the lips of the wound- at least, not more than 2 m. m, apart. This interval is soon filled by a plastic lymph. If the lips are too far apart a blood clot forms and acts as an irritating foreign body. Germs from the air set up a fermentation or putrefaction in the clot, and may cause septicaemia. Germs even on the healthy flesh are irritant and retard healing. (Proof:- if germs are kept from a v/ound by a cotton filter, healing by first intention takes place). Cleanliness is essential. (b) Remove all foreign bodies from the lips of the wound, (c) Leave no ragged edges on the wound. Trim smooth with the scissors or scalpel. Always arrest the hemorrhage before closing a wound. Wait till plastic lymph glazes the sur- face of the wound, then close, (d) Must remove the granulations of an old wound. These gran- ulations secrete pus, as a mucous surface Secretes mucus. Freshen the lips, stop the blood, and unite. (e) The nature of the tissue. The connective tissue elements of the horse are only one-half the size of those of man* and therefore* a wound on a horse will compromise doublfe the nvmiber of cells that the same wound on man would. Thus the horse is doubly susceptible to pus formation, i.e. healing by second intention, or granulation. The ox, dog> sheep, pig, and fowl best examples of healing by first intention. (f) Age . Both very young and very old animals are prone to suppurative processes and their wounds heal by second in- tention. (g) Diathesis , has great influence,- glanders and farcy. pre-< dispose to suppuration of wounds. Wounds made soon after, or during distemper of the dog, rot of sheep, angina ton- 69 siliaria of pigs 3 or straaglos ot the colt yrill not heal by first intentiort.. but riiay cause profuse suppuratioHo ■'^5 .g.l:iiiiate,o In moist climates the animals are lymphatic and second intention is the rule. In dry clijnates on nutri- tious food the animals are nerve- sanguinary- as the Ara- bian horse and Eng, thorough'-brcd and healing by first in- tention often occurs o Extreme heat or cold is unfavorable^ heat relaxes the blood vessels and congests the wound, while cold does the opposite, and both conditions inter- fere with healinge HISTOLOGICAL PHEKOMEIIA OF CIGATRIZATIOIIS- Cicatrization means healing, whether by first or second intention* Until quite recently it was thought that vrhen a wound healed by first intention, it was the exuded plastic lymph that first glued together the lips of the wound, and was later organized into connective (cicatricials or "scar") tissue, Dr* John Hunter said, ^Plastic lymph is exuded and becomes organized". This doctrine is only partly true, "Plastic lymph is exuded", does agglutinate the lips of a wound, but only indirectly forms cicatricial tissue, i«e, the plasma serves as food tiir the embryonal cells which are finally transformed into connect tive tissue cells. To study these changes in order and minutely, let us imagine that we have before us a clean incision through the skin and under- lying connective tissue, and are able to see, as through a micro- scope, every cell and to watch its movements from the time the wound is made till it has entirely healed. The wound is made, many cells are killed, capillary vessels are opened, the blood, escapes, lymph channels are opened and lymph pours forth. The stimulus of the traumatism and the comparative coolness of the air causes the walls of capillaries and the irregular boundaries of the lym- phatics to contract and diminish their lumen, and consequently ihe out-pour of their contentso The blood soon coagulates in the con- stricted mouths of the capillaries, and in the area occupied by the clot there Is no circulation, but by anastomoses a circulation is immediately established in deeper parts. Blood pressure is here slightly raised, plasma filters through the capillary walls into the perivascular spaces, and with some lymph escapes on the lips of the wound. If now, any external blood be removed and the lips of the wound brought in apposition we will see this plastic lymph fill the space between the lips of the wound, escape on the skin where it coagulates, and a fei? hours later dries and forms a scab. Very soon the capillary vessels show an inflammatory reaction* they become congested, dilate, the current is slowed, and there is transudation of plasma, and an outward migration of leucocytes into the area of clotted capillaries, and in 48 hours they may be found in immense numbers all through the plastic lymph between the lips of the woundo With this migration of corpuscular elements the con- nective tissue cells of the clot area begin to lose their fusiform or fibrillar form, and take on a spherical, embryonal type. These embryonal cells and their companions the leucocytes, are the prime factors in the formation of cicatricial tissue; for's if they find a sufficient amoimt of the plastic lymph to subsist upon, they con- tinue to live ( shoiild they die they form pus) till, at a certain stage of the healing process, each embryonal cell elongates and is gradually transformed into a fibre of cicatricial tissue. 70 Kiese cicatricial tissue fibres have not the definite arrangement of the fibres of a tendon for instance, but are curled, twisted and interminably interwoven. If the wound be in in usc le, the proper inasole substance of each niascle fiber undergoes a sort of fatty degeneration and is absor- btsdo ilie connective tissue cells of the sarcolenmia become ernbryo~ nal and act as described. If the wound be in nerve tjLssue., the proper nerve tissue (nerve cells, etc.) degenerates, but the con- nective tissue cells of the neurileirana, perineurium, etc, become embryonal. In a wound in bone , the lime salts are absorbed, the Haversian canals and Canaliculi enlarge, and the connective tissue ceU.s of the bone become embryonal, While the connective tissue cells of the clotted area are be^ coming embryonal, and the plastic lymph filling, the wound is be- comirjg gelatinous by the advent of myriads of leucocytes (white blood corpuscles), the blood from capillary vessels is being driv« en by many anastomosing channels through these embryonal cells, ^ese channels have no walls except the cells between which the blood is forced. From blood pressure these nearest cells gradually flatten and become endothelium lining a capillary vessel. The cells beyond them change to fibrous connective tissue envelop- ing the endothelium. Thus each loop of blood vessel is first boun- ded only by embryonal cells. These loops shoot forwards from all sides into the mass of embryonal cells, and where the wound is nar- rowest loops from opposite sides first unite. Those are the phe- nomena of healing by first intention. If a cicatrix be formed in muscular or nervous tissue, it will require several months for the proper muscle or nerve fibre to find its way through the scar, IN HEALING BY SECOND INTENTIOII ,* certain conditions are present which cause the migrated leucocytes and the new-foiroed embryonal cells to die and be thrown off as pus. These conditions are several :- The irritation of the raw surface of a wound by atmospheric germs, irritating liquids, foreign bodies, blood clot, sutures, iodoform, etc., or the presence of a great number of injured or destroyed cells may produce such an intense inflammation followed by such an excessive proliferation of embryonal cells, and aggregation of leu- cocytes, that many of the cells being unable to find food starve to death and become p\>s cells, !Kiese pus cells are pushed away from the granulating suirface as fast as they are formeda Each granule is composed of a capillary loop of blood vessel surrounded with embryonal cells. Those cells farthest from their source of nutrition- the blood- tend to weaken and die and form pus. Pus therefore, is always produced from a granulating surface. Never leave a blood clot in a wound. A very small clot may do no apparent harm. The leucocytes in the centre of a large clot will die and act as ferments. A transudate of plasma will form between the large clot and the walls of the wound » and in forty-i eight hours the clot will pass out and the edges of the wound will be covered by granulations. The skin shoots out over the granulations in a narrow ashy- white fringe. This new skin contains no pigment cells in the Mal- pighian layer, and has no sebaceous nor sudoriferous glands, nor hair follicles. All cicatricial tissue has a singular quality of contraatlon, by which large wounds are in time almost obliterated. 71 This quality of contraction of scar tissue often works harm by lim- iting the movement of an organ or memtoer; often hovrever, the sur- geon turns it to his advantage. In the conditions Ectropiura and Entropium, where the eyelashes are turned outTrard, or turned tnvyard against tho eyeball the surgeon by producing a cicatrix of the con- junctiva asid skin of the lid •ssxgxskSa^^ respectively can dra\7 the lashes to their proper place. Distended synovial bursae are sometimes cauterized on this principle to effect a reduction in their sizec TREATllEiJT OF SIl^CPLE WOUIIDS:- Remove all foreign bodies from the wound. Arrest the hemorrhage o If large vessels arc bleeding ligate with catgTit„ vSilk ligature may be placed in the depth of a wound of other animals, but in horse produces suppuration. Capillary hem- orrhage may be airrested by hot >7ater ( 100~115*Fo ) , ice water, al- coholized water (alcohol is astringent), or by u compress dressing, A sponge wet in dilute alcohol and bound tightly on the bleeding surface for one-half or three-quarters of an hour is very efficient* Put in the sutures, but don*t draw them close till the suture points have ceased to bleed j then wash out the clot with an anti- septic solution and close the wound. Sutures should close a woiind to the very bottom; they should go two-thirds the depth of the wound and should pass through the skin at an equal distance back from the edge of the wound, e.g., in a wound three inches deep, the sutures should pass through the skin two inches from the mar- gin of the wound, and should pass from one side of the woiond to the other at a depth of two inches. A too superficial suture will not close the deeper parts of a wound, but will leave a cavity which fills either with a blood-clot, or a large mass of plasma, and both are likely to ferment and cause trouble. Place the sut- ures an inch or inch and a half apart. The gaps between these SJiti^res are closed by superficial intermediate sutures., Therefore, for deep wounds two series of sutures are necessary. Use silver or iron wire, it causes less irritation than any other suture mater- ial, and leave the ends long- to allow for swelling. The following day the ends may be untwisted and the sutures loosened. V/hen silk is used, we may use a quilled or dossiled suturoo We may use an ordinary button to hold the suture on the skin, and may pass each strand of a double suture through an eye of the button and tie in a boW"-knot above the button. A piece of sheet-lead, or dossil of lint or oakum is also good. When the inflammatory process has nearly abated remove the sutures and apply strips of rubber adhesive plaster across the wound o A good adhesive plaster can be made by covering nraslin strips with shoemaker's wax. Clip the hair, warm the plaster, ap-* ply it, and it will stick very fast. Place above the plaster a light lint or oakum dressing. 72 IHCISED V/OUIIDS; are tKose cleanly cut "s^ith a sharp instrument. They are produced accidentally, in defense, or by the surgeon. The accora^ panying phenomena are:- I. IMiEDIATE:- 1, Pain . Momentary, and not intense because the nervo fila- ments are cleanly cut, not crushed or tpm, 2, Hemorrhage aliiTays abundant because the vessels' mouths are not closed by the instrument, and are usually cut trans- versely. May have syncope from hemorrhage. Arterial and venous blood easily distinguished. 3, Gaping of the Wound , which is always larger than the in- strument. Most gaping vrhen v/ound is transverse to a mus- cle; least gaping v/hen parallel to a inuscle. The wound is v/edge shaped from the skin inwards, and elliptical on the skin. II. SECONDARY PxiE!IOT:iEHA : - 1. Inflammation in immediate neighborhood of the v/ound, DIAGIIOSIS:- Easy if seen within fev/ hours, but after few days if OTach swelling exists, ^ve cannot deteiroino what kind of an instrument caused the wound. PROGIIOSIS:- Simple incised wounds not serious. Consider the extent and direction of the vround and the tissues involved- whether skin, mus- cle, vessel or nerve; and also consider the influence upon adjacent organs. treatlieiit:- (a) Remove foreign bodies. (b) Arrest hemorrhage, (c) Obtain apposition of lips of wound. (d) Render aseptic and apply antiseptic dressing. We may allay hemorrhage from large vessels by catgut ligatijre for horse, and silk ligature for other animals. From capillary vessels hemorrhage will suecvim.b to either hot ( lOO^-lSO^F. ) or cold water, a compress dressing, alcoholized water (alcohol is styptic), Tr, Lyrrh, Tr. Aloes or Tr. Capsicum. Cleanse the wound by a stream of water from syringe or hose, and remove all blood clots. Apply mild solutions of Corros. Sublimate (1-2,000), Potass. Permang, Carbolic or Boric Acids. Never antag- onize healing by "first intention" by inclosing withii a wound an Insoluble substance, as Iodoform. Clip hair close and disinfect for some distance on all sides, both before and after closing the wound. Close the wound by sutures which must go 2/3 the depth of woul^d. llay employ t^7o sets of sutures; a deep, and an intermediate super- ficial for the integument. We may use silver or iron wire. Leave ends long to provide for swelling. After 24-5G hours untwist and loosen, then make fast again, otherwise the wire v;ill cut thro' the tissues. If silk be used, a quilled or dossilled suture may be adopted. Piece of sheet lead, lint, or a bone button makes a good dossil. VJhen bleeding from suture points has ceased, close the wound, and not before, as a retained clot will act as a for- eign body. Steel pins and hcrse-hair also used. The antiseptic dressing may be of lint or bandage vrrung from a sol. of Corros. Subl, and held in place either by a roller bandage, or by adhesive plaster in strips applied to the shaved skin. The plas- ter may be used to hold in place a roller bandage. 75 PUNCTURED WOUIIDS:- Caused by pricking objects. Wound from needle is typical. They are:- I, Accidental. II. Intentional { si.irgical). Phenomena are:- Pain ; quite severe. The tissues are crowded apart and torn, rather than cleanly cut. Hemorrhage : - Nil, except \7hen large vessel compronised. Ves- sel usually rolls to one side. Not necessary for a punctured vround to "bleed freely to heal kindly. In most punctured wounds the ex- ternal orifice closes and great internal hemorrhage may ensue. These wounds if simple will always heal by first intention, A hjr- podermic needle upon which is dried blood or pus will make a wound that v;ill suppurate. Punctures with blunt instruments {cut nail) destroy tissi^ie and carry deep into the tissues foreign material (dirt, gravel &g.) whi-ch induces suppuration. A nail passing into a bone or tendon will usually produce a necrosis, or ga:agrenQ, Such wounds simulate "bruised wounds." TEEATliSKT:- If the wound bo large treat antiseptically. No sutixres nec- essary. May apply ointments the base of v;hich will not ferment as. Petrolatum or Lanolin, If nervous excitability Eind slight eleva- tion of temperature exist give a hypodermic injection of a solu- tion of 4-6 grs, Sulph, Horph, SUB-CUTAIIEOUS WOUNDS:- Like simple wounds. Healing always by first in- tention, due to exclusion of atmospheric germs. A kick from a heavy iron shoe may bruise off a muscle against a bone without breaking the skin. There may be inteiiss lameness and inability to use the member, but the lesion v;ill heal rapidly and by first in- tention. May have rupture of extensors of fore-arm ( olecranian muscles) in which case the leg will hang low down, the knee flexed and the foot resting on the toe. If we place the leg in position it will support the horse till he moves, when he may nearly fall to the ground. This rupture also heals kindly, TREATliENT:- Put animal in slings for 2-4 weeks. Application of this fact of absence of suppuration in sub-cutaneous wounds is made in tenotomy. , Pasteur .proved that certain atmospheric germH were necessary to suppuration and putrefaction, and in sub-cutaneous wounds these germs are excluded, PLEXOR TENOTOiiY:- Cast and secure so that the leg to be operated upon may be extended. Roll the skin on the cannon from before to behind on the inside of the fore-legs and on the outside of the hind-legs, so that when released the puncture may be left against the bone. V/ith sharp pointed straight bistoury make careful puncture between pcrforans and perforatus at a point midway between the middle and the line which separates the m.iddle and lov/er thirds o f the cannon. The puncture v/ill thus pass below the union of "check" tendon and pcrforans, and above the superior culs-dcsac of the great sesamoid sheath. Pass a short probe-pointed tenotoine thro' the prmcture, withdrav/ tlie bistoury, turn cutting edge against the perforans and rotate handle slowly backward. This tendon cut, then pass the blade (without withdrav/ing ) posterior to the perforatus, turn the blade and rotate the handle as before. Use care not to engage the vascular and nervous trimk that lies along the edge of the perforan 74 hetyjden the cutting edge and thumb. Such an accident •would be se- rious. As the bistoury is pressed against the tendons an assistant should strongly extend the digits and thus assist section of the tendon. Allow no air to pass thro* the incision in the skin, which should be as short as possible and of course in a direction paral- lel to the tendons, BRUISED WOUITDS:- are caused by blunt bodies traveling with sufficient velocity to rupture blood-vessels and break the skin; if only the capillaries be ruptured (skin un.corapromised) a Si mple Bruise results. If the impact of the moving body be only sufficient to drive the blood from the capillaries of the skin, without rupturing vessel- walls, the skin is mo-uentarily blanched (bloodless) and when the blood returns there may be a slight inflammatioii which recovers by delitescence: there is however, no rupture and therefore no brliise. But, if a small vessel rupture, a bruise results; blood passes into surrounding tissues, parts witVi its oxygen and turns purple. After 24-56 hours the centre is still purple while the periphery has become a greenish-yellow, and in a fe\-r days the entire region is of the latter color. A bruise is not serious. ETIOLOGY of bruised wounds. Any blunt body moving at sufficient speed to breaS-the skin, symptoms:- PHII'iAHY and COMSECUTIVS. I» Primary :- Pain is intense, most severe of all wounds for nerve- fibros are lacerated. Hemorrhage may be great, tho* usually scant because vessels are crushed and closed, liuch hemorrhage vfhere the instrument moves fast, less vrhen the instrument moves slov/ly. ' F orm of wound varies according to size, shape and speed of the instruiTient , and the retractility of the tissues. Such v;ounds are usually rough and ragged, because owing to a differ- ence in tensile strength and elasticity of different tissues, all tissues do not part simultaneously, Ecchymotic spots must be ante-mortem, II, C ons e cut i v e phenomena : - Inflammation comprising all tissues in vicinity of the womTxi, An inflammation transudate for several dayse Bruised v/ound never heals by "first intention", always by " granulation ". Portion of lips of Y,'ound alv/ays invaded by gangrene. Often after 5-6 days the entire surface will be cover ed by a dry scab (dry gangrene) from which the moisture was driven by the force of the blow. This "dry gangrene" in few days absorbs moisture from surrounding tissues and becomes moist. The primary "scab" has roots running into the tissues v/hich can only be got rid of by suppuration. After scab is gone wo find pus cavities. They must be drained or septicaemia, pyaemia &c. may result, DIAGIIOSIS:- Easy, Large anfractuous wound, and irre£?ular ecchymotic spots are pathognomonic, prognosis:- Grave. Ilever heals by "first intention". Complications vary according to animal'fe temperament, TREATilEWT:- Remove foreign bodies and cleanse; arrest hemorrhage (com- press or ligature). Convert into deep clean wound. Hasten healing by applying light, soft, aseptic dressings under pressure of a roll- er bandage over (not between) the lips of the v/omid so as to hold them in proximity till inflammation has subsided, and granulations formed. Lint, tow, oakum, cotton, or sponge may be used. If on a limb, a bandage or strips of adhesive plaster may be used. Let the bandage begin at the extremity of the limb and pass upv;ard to the wound. 75 GUNSHOT WOliHDS:- Size and shape depend on direction taken by the projec- tile. Large superficial opening when projectile passes tart^ent to the skin; »%Tiisll epening when projectile passes perpendiculai' to the skin. Bullet may rebound from bone or tendon and produce a double wound, or the point of entrazice and exit may be the same. Bullet against bone shatters latter. Entrance usually appears smaller that the projectile, and is depressed. Exit is large, rag- ged and elevated. Such foreign bodies as clothing, dirt, etc., may be carried into the v;ound» SYMPTOMS:- Hemorrhage usually slight. Wound appears as if cauterized. Cauterization: not due to friction of bullet, as determined by Perry *s experiments. Pain never violent; may be hot momentary twinge. Serious wounds often unnoticed till fainting results from loss of blood. Severe pain if large nerve trunk compromised. Inflammation in 2-3 days, lips tumefy; delirium may occur, COliPLICATIOlIS:- (a) Secondary Hemorrhage ; Primary hemorrhage not serious, but Sec- ondary hemorrhage (concealed) may be. Concealed hemorrhage of abdomen or thorax (or even of extremities) may occur ma2iy days- Cin one case 350^' after the wound was received. (b) F orm ation of Ab scess ;- from foreign bodies carried into v/ouiid, and causing irritation, (c) Tetanus:- often a sequella, diagnosis:- Simple, from appearance of wound, i.e depressed, and small, burned entrance; ragged, extruded, larger exit. PROGHOSIS:- Serious from possible complications. Bullet should come out. If left near a joint an arthritis, if near the peritoneum or pleura peritonitis or pleurisy may result. May have two openings and yet the bullet retained, sxA or one wound and no bullet in the tissue. Eovr? TREATliElIT : - Simple. Probe for bullet. Cleanse the v/ound v;oll, ligate vessels if necessary. Special probe for lead bullet consists of unglazed porcelain tip which retains mark of the lead and will yield to the chemical test for load. These wounds always slough and form fistulous tracts- slough in proportion to speed of bullet- the greater speed the greater slough. Entrance sloughs more than exit. These v7ounds apt to be the seat of septic infection. 'Jet perfect drainage, WRSIICHED WOUNDS:- Rare, but serious becauso they render animal unfit for work, and recovery occurs only after weeks or months, PROGHOSIS :- Important, Usually grave, TREATMENT:- Convert into clean, open surgical wound aind treat as other wound<5 , BITTEN wounds:- Etiology, Diagnosis and Prognosis simple, TREATliENT:- If on an extremity, an in^ediate tiftht ligature between v;ound and heart. Then facilitate bleeding by making free longitu- dinal and transverse incisions at point of injury. Knead inisc and m assage from the heart is good, but sucking the v^ound is better. No danger unless abrasions exist in the mouth. Spit out the blood. Cleanse wound thoroughly with running water. Cauterization by hot iron of some value; Agnog as a Tcaustic is of v.o value here. Snake poison disintegrates the blood corpuscley and capillary alls so 76 that haemoglobin permeates the tissues; and death occurs from want of oxygen, FISTULOUS wounds:- Those which resist cicatrization. AETIOLOGY:- Foreign bodies, as bullets; or bodies from within, as gan- grene, degenerating tumors in horses of carcinomatous diathesis, discharge from chronic (cold) abscess as of strangles (bastard strangles) or psoas abscess, or a seton or rowel may cause these woxindso The gliding of one muscle on another in a wound may cause embryonal (granulation) tissue to change into the pavement epithe- lium of a fistulous tract. Another type of fistula results from communication with a mi- cous or serous surface. The escaping liquid prevents cicatrization. Seen in perforation of intestines, oesophagus, Stenon's duct ( Sjali- vary fistula), in rectum, and between rumen and skin. In a few days the air ?/ill change a clear liquid discharge to a cloudy, clot- ted one, and soon pus appears. Pus soon abundant, thick, almost laudable. Pyogenic membrane forms. Discharge from fistula of a mucous surface is at first thick, later thin; the reverse when from other surfaces, SYMPTOMS : - !• Fo rm , single or multiple opening as in tendinous and cartilagi- nous quittor. More or less infundibuliform with the external opening masked by exuberant granulations, and showing no tenden- cy to cicatrize permanently. May cicatrize, but in a fevr days pus forms within and breaks out anew, generally nearer the pus cavity, II, Induration of wall of fistulous tract, to form a resisting fi- brous sheath vrhich may contain bony spiculae when bone is invol- ved. III. Quantit y of pus , is out of all proportion (greater) to the ex- ternal size of the wound, IV, Quality of pus, generally ichorous, of serous nature, irritating, greenish, containing necrotic shreds of tissue, may be foetid, or mixed with serum, mucus, &c,, according to location, V. Sen sitiveness , generally present. VI. The fistula itself; unless this present no diagnosis can be made. Examine V7ith finger when possible, or use probe. PATHOLOG, ANATOMY:- Acute inflammation : degree depending on the intensi- ty of the change of connective tissue about the fistulous tracts into embryonal tissue, which becomes indurated and in old cases forms a hard, bony wall, but is always covered by a layer of embry- onal tissue, diagnosis:- From syrapts. prognosis:- Grave, No tendency to heal. If on a synovial membrane a suppurative arthritis may result. On a mucous surface, constant mucous secretion also greatly retards healing, unless small in quantity. Urethrotomy usually followed by fistula which takes 5-6 weeks to heal. May close a fistula of Stenon^s canal by making counter opening thro* the mouth. Pass an iron wire thro* cheek into the mouth ( thro ' the fistulous opening ) and twist wire on the outside. Allow to remain till an internal fistula is established into the mouth, then remove the wire and close the external fistula by means of "pin and fig. 8". 77 TRSATlISlia::- Remove cause and get perfect drainage,. Cause may be neoiao- sed corjiective tissue, bone, cartilage, &c. Drainage facilitated by dependency of opening «, Anal fistula ( opening into thfe gut ) is treated by opening fis- tulous tract from end tb end and allo-aring wound to cicatrize. Recto-vaginal fistula cured by dissecting a\7ay raucous membrane to make wall for fistula, smaiER wouiiDs. Called also "granular" rounds because of the lime granules from size of a millet seed to that of a hazel-nut which are found in the connective tissue at their base. Always an intense itching present, and we cannot prevent the animal rubbing and biting the wound o ETIOLOGY?- Slight scratches, intei:fering wounds? harness galls, &c,, during the hot, dry days of summer. These wounds grow rapidly and are covered by exuberant mush-room granulations (due to constant irritation). The abundant secretion of pus dries on surface of wound to form little curled up scabs, above and about which the granulat ioias push their way. In chronic cases these imbedded gran- ules may undergo calcareous infiltration. The color of these exuberant granulations is red or yellow, and the whole mass is riushroo m in shape, and rests upon dense connective tissue membraneo Granular bodies are found everywhere above this membrane, and the itching caused by them is intolerant. In the West Indies asses and mules are most affected. There the llegroes cover such wounds with tar to prevent drying, and then cover with cloth to protect from flies. n '>•'"> X >< / / X X X X X ;'>::iz~:=<<^ >< >< >^ >< >^ ^ >',- J.- k c«zv'.rt-.'7. , C/'j'^y/? ra^ 79 CALLOUS WOUNDS. ETIOLOGY:- Burns from hobbles, ropes, manger; blisters in hollow of fetlock, knee or hock produce these grounds. A mass of granulations grows above the skin, covers over with horny scales and finally looks like a broad, low, dry wartc PROGNOSIS :~ Serious, because difficult to heal« treatment:- Place large pad of oalcuiii in the hollow of the limb and wrap tightly with roller bandage to prevent all motion by acting as a splint. Keep on till wound is entirely healed and skin is replaced* Constant motion produces irritation ^nd keeps wound open, Don*t cut T/ounds out; will take 5-6 months to heal* and owner will become discouragedo ULCEROUS OR CHAKCROUS WOUNDS. Show constant tendency to increase in size by molecular death of cells » Wound of itself not serious, but is symptomatic of se- rious constitutional disturbance. They do not tend to limit them- selves or grow smaller, TREATlffiNT:- Cauterize deeply to destroy virulent poison, then apply antiseptic treatments Healthy granulations will form underneath^ Then general treatment. 80 CHAPTER XII. FRACTURES . GENERAL CONSIDERATIONS. DEFINITION?" A fracture is a solution of continuity of hard parts-bone or cartilages Fractures iniportant in Veterinary practice rather from standpoint of diagnosis and prognosis . V/e treat to preserve usefulness; the physician to preserve life. Difficult to treat in the larger lower animals, because of their larger banes, greater muscular development and lack of intelligence, CLASSIFICATIONS:- Various. I. Incomplete. II. Corapletei(a) Simple. 1. ( b ) Comminut ed . I. An INCOIIPLETE fracture does not pass entirely through the parts, BXid they don't wholly separate. Appear usually as a longitudi-* nal slit or fissure. May be entirely tinder periosteum ( intra- periosteaDs as often happens in the tibia. Intra"»perio steal f ^actpxes may also be (a) Complete and (b) Incomplete, When incomplete and intra-perio steal the bone is at first apparently as strong as before, and no lameness; but later the gravity of the condition becomes manifest, II, A COMPLETE fracture is an entire solution of continuity, with separation of the parts. Fractures may also be;- A, SIMPLE, bone in two portions, B, COMMINUTED, when in more than two separate pieces. C, COMPOUND, when the external air reaches the solution of continr- uity. Common in radius and tibia and always oblique, D, COMPLICATED, when other tissues are involved. May be many ooror- binations of these, E, EPIPHYSEAL, seen in young animals before the cartilage which joins epiphysis and diaphysis has become thoroughly ossified; not serious as they repair rapidly. When the articulation is involved it is called an "inter-articular" fracture. In man may have "intra-capsular" fracture of head of femur, F, DIAPfflfSEAL, confined to shaft of bone, BY DIRECTION:- We have (a) Longitudinal, (b) Oblique, (c) Transverse, A Longitudinal fracture extends from end to end, and there may be or may not be displacement. Common in the phalanges; here they are always "articular", and without displacement. In an Oblique fracture one end may lodge in the medullary cav^ ity of the other and produce rigidity; in this case the bones form an angle with each other. Transvers e fractures of patella, bones of fetlock, ribs , or long bones often seen. Displacement of ends of bone caused by muscular contraction, and therefore limb usually shortened, but in fractures of patella, olecranon, external angle of Ilium &c., the bones are dnawn apart, and limb apparently lengthened. Compound fractures most serious from liability to suppuration and gangrene from entrance of atmospheric germs. 81 ETIOLOG-Y;- (a) Predisposins. causes are those peculiar to the species, age, ^ork, season* and disease « Cb) Exc iti ng causes are traumatisms. Draft horses, racers, young horses (bones soft), old horses (bones dry and brittle) arc especially liable. Fall and spring v/hen pavements slippery with mud, ice or sno^?; glanderous or cancerous diathesis by causing gum- niata in the medullary cavity v;ith softening of the bone; tiiiiors in bones of dogs; ossifragia of cattle and osteoporosis of horses all predis pose to fractures. Osteo-malacia (rickets) not the same as osteo-porosis: in rickets there is lack of deposit of lime salts in bones of the young; in osteomalacia there is deposit with subsequent absorption. In osteoporosis there is disease of the fibrous structure of the bono „ DETEPIillllllG causes:- Mechanical, traumatic. Animal may run against objects and fracture skull, neck» back. Heavy load on an incline may X'un over an animal. Muscular contraction cea\ only cause frac- ture \?hen a bone is diseased. Some difference of opinion, Zuill cites case v/here a horse leaped from one hind leg and broke the femur. In destructive mania, and in rabies, he says jaws have been broken by grasping objects too tightly. According to manner of production fractures are Direct or in- direct., A, DIRECT :- where bone brcalcs just at point of application of traumatian ( as by bullet ) , B, IIIDIRECT:- Where fracture occurs at a point distant from application of forces as when fracture of occipital bone of man results from brickbat falling on top of head: or as when horse falls, and femur strikes pavement y the head of this bone is driven into cotyloid cavity and either this part of the coxa or the sjrmphysis pubis is fracturedn symptoms:- Ic Deformity, 2, Crepitation, S, Abnormal Mobility, 4. Some- times lesion of soft tissues and skin. I, May be no deformity except sv/elling from hemorrhage &c. Swelling at first hot, pasty, obscure fluctuation, II, Later becomes hard and crackles on manipulation, also cr epitation of bones when ends rubbed together { crackling of a breaking blood- clot, and crepitation of bone differ.) Cannot hear it, but can feel it; tho' sensation seems to register itself on the ear, III„ Limb sw ing s freel y and is not under direct control of will, Rup- Lury of Flexor Metatarsi gives appearance of fracture, IV o Skin, and soft tissues may or m.ay not be broken, V« Pain always a constant rational symptom. Animal unable to put weight on limb^ Fracture of ribs causes local pleurisy, and respi- ration becomes abiioini.aal , REPAIR OF FRACTURES, Phenomena of healing of fractures resemble cicatrization of vjoundSu By experiments on animals we find:- Hemorrhage, is first phenomenon; clot envelops ends of bone^ On 2nd« day clot is surrounded by yellov/ish lymph (blastema) which pushes aside areolar and niu,scular tissue-, penetrates surrounding 82 1 issue, enters nedullary cavity. It thlclcens v/ith age, but remains yellowish. In 3 or 4 days have inflaiTimatory reaction with forma- tion of embryonal elements. About the 8th, day sone parts of the yellowish clot are whitish, more dense and resisting. These glis- tening, pearly foci are cartilaginous cells. These cells increase in size and nuraber, invade the entire mass about the fracture, and by the 12th « -14th. day have transformed the yelloMf clot into a "cartilaginous callus" or incomplete cicatrix. The cartilage cells are first formed next ths bone. By this time the blood clot has been absorbed. From 12thc-14th, day bone spiculae begin to form on surface of the bone and invade the cartilaginous clot thro' the spaces formed by the fusion of the cartilage capsules, 'i^ere the carti- lage cells come from v/e don't Icno'v^. They seem to spring from the clot itself* They undergo true ossification to form bone cells. The medullary plug ossifies first at its farthest extremity along the surface of the bone. 3y the 25th. day there is a bony tumefac- tion about the ends of the bono, but is not yet complete. When the callus has become true bone the medullary plug is absorbed, and much more rapidly than the external callus, which is called the "provisional callus," and which may be so small as to escape obser- vation. Dr. John Hunter thought the blood coagulum was the starting point for the reparative process. Hot so, and blood must be absor- bed or it acts as a foreign body. Dr. Hamil thought that the periosteum formed nev/ bone. Only the osteo-genotic layer (deep layer) is important. When the conr- nective tissue of the periostei.mi changes to embryonal tissue it liberates the bone corpuscles-osteophytes, which are formed and held in the osteogenctic layer and allov/s them to begin the \7ork of reparation. The embryonal cells march out into the jelly-lilce clot, and possibly change into cartilage cells, Fleurons proved that myeloplaxes and medulla cells are factors in bone formation. Don't have true pus unless air can reach the part, but do have granulation tissue not giving pus. Between the ends of the bones a layer of bone softens, and its connective tissue becomes embryo- nal. Into this embryonal mass loops of blood vessels shoot out from medulla, canaliculi and periosteum, Ilext comes the change of embryonal into fully formed connective tissue, the deposit of lime, salts, &c. Haversian canals form, and an absorption of bone from the provisional callus occurs. The reparative process of fractures is the same in rabbit and horse, but differs in other animals. In horse the "Provisional Callus" is converted into bone about the S5th. to 42nd. day, (Horse) PERIODS OF REPARATION OF FRACTURE. l~8th. day is called "period of fracture", 8-25th. " " " "period of cartilaginous callus." 25th, -4Snd, day is called "period of bone callus," Don't trust to strength of callus before S5th, day. 85 Surface of bone softens thro' action of Lactic Acid formed {Bilroth)» and bone fibrillae become embryonal and liberate bone corpuscles which begin bone formation. In man and dog the lymph does not change to cartilage, but directly to bone. In the child, rabbit and horse, JJl the fracture be compound- the lymph coagulum will change directly to bone, but if fracture be kept from air the lymph will become first cartila- ginous, then osseous. Thus, compound fracture of horse heals as does simple fracture of man. The flat bones of horse ossify direct ly« In the embryo the long bones are first gelatinous, next carti- laginous and finally bony; but the flat bones are first gelatinous then f ibrous t and finally bony. At birth bones of skull are dis- tinctly fibrous and ossification invades the bone from a central point-diroct ossification. After trephining horse's skull, the opening fills with connective tissue, which directly ossifies, prognosis:- Usually inadvisable to treat. May treat when fracture is simple, displacement slight, and location favors keepir*g bones in apposition; but not when suppuration present, tissues crushed, ar- ticulation involved, suppurative arthritis may arise and produce arJcylosis^ Fractures of phalanges generally involve articular sur- faces. Simple longitudinal fracture v/ithout displacement, with absolute rest and proper bandaging has fair chance of recovery, but can't depend on the diagnosis. Transverse fracture of long pastern can be cured. Fractures of humerus, radius, femur, tibia are oblique dnd large, strong muscles displace the bones even if the animal puts no v^eight on the limb-so don't treat. OrJLy when fracture of these bones is incomplete or intra-peri osteal do we treat. Then put in slings, the leg in splints, and maintain at absolute rest ( in slings ) for 6 Yfeeks at least. At 8- 10th. day the ends of the bones have softened in process of repair, and tho' no lameness be present, exercise may cause the bones to break apart* We do not treat displaced fractures of these bones. Join- ing these bones by means of screws is both impracticable and inad- visable. AjTiputation can be done, but in 6-8 months the other limb gives out and the animal must be destroyed. Fractures serious in proportion to the size of the animal; small animals better sustain their weight. Prognosis also serious when articulations, vessels, or nerves may be compromised by the callus that will form, GEIJERAL TREATMEIIT OF FRACTURES. Place animal where can be properly treated. To limit movement of bones while moving an animal^ fold horse-blanket, wrap tightly about fracture and fasten tightly with straps or rope. This called a "provisional dressing". An ambulance or low dray may be used as a transport. At the infirmary place animal in narrow stall (never in box-stall), in slings to support him and limit movement. Set bone by extension, counter-extension and manipulation. Zuill sug- gests fastening oblique fractures with gimlet-bits screwed thro* the ends, above which is placed the usual fracture dressing of splints ahd bandage, or plaster of Paris. May get local bone ne- crosis, but by 10-15 days the callus is firm and bits may be v/ith- drawn. 84 Force required to set a fracture incresisss greatly with age of the fracture:- fresh fracture of rabbit ''s leg requires tout 21bs. after 10 days SO lbs., after 10 days in horse 5,000 lbs« Cast large animal, fasten body to fixed object, attach block and pulley to limb and make extension. If animal unruly, tightly fasten to- gether the three sound limbs, put animal in slings. Chloroform him, lower to floor, set limb, raise again emd allow to recover from the anaestheslaa For equine species use Chloroform (requires too much ether) and leave one nostril open- at least 5Qfo of air should enter nostrils free from Chloroform, V/ith ether admit no air^ Ether may be used to continue anaesthesia produced by Chloroform. dressings:- Movable and Fixed . I, Movabl e a Large pads of oakum held in place by flannel roller, (beginning at extremity of the limb) over which are placed two padded splints wider than the diameter of limb. I^rhen in posi- tion on opposite sides, the dressing will be square and subse- quent swelling can be accommodated without disturbance to the dressing. Fasten these splints by separate x>^eces of muslin, or adhesive plaster, or by a continuous roller bandage. For compound fractures V7hera frequent dressing is necessary the ad- hesive plaster is preferablOo II. FIXED DRESSINGS:- Various stiffening materials in use. 1, Shoe m aker ^s \7ax h as a melting point of 70^-80^0. and is liable to burn the skin, so turpentine is added to lower the melting point* Apply oakum in a thick pad from tip of the limb to above the fracture and secure by muslin roller bandage. Over this smear hot wax, cover with another ban- dage, more v;ax, another bandage, fi:c., till of desired thick nesso V/here you wish to prevent a dry bandage slipping on hair, as above the hock, a little warm v;ax is good. 2. Gum Arabic in solution makes hard dressing difficult to remove, but is expensive, and takes Qr-8 hours to dry. 5. Starch or Dextrine also good, but too long to dry. 4, Alum and white of egg good, but dries slowly, 5. Plaster of Paris :- Cover limb with oakum and secure by thin roller bandage. For the plaster bandage use cheese cloth or '•gunny sacking." Impregnate the bandage with dry Plaster of Paris, roll and set on end in a shallow pan of water, V/hen moist quickly apply, and jf fresh , the plaster quickly "sets" very firm, 6, Silicate of Soda . Excellent, cheap, dries quickly. Apply oakum and secure v/ith a smooth firm bandage. With a brush apply the silicate just in advance of a second bandage. Repeat as desired. Use thin muslin; cheese-cloth better. Silicate best for open wounds as of joints and tendons, which must be treated as covered wound to exclude germs. In such case remove shoe, cleanse and thoroughly disinfect foot, skin and wound. Bandage from point of toe above wound and apply the silicate. If temperature remains nor- mal leave bandage on 2-3 weeks, but if temperature rises to 103 '^- 103 '/z." it indicates pus- then remove. 7. Gutta Percha :- In shops appears in lump (bulk), and in prepared sheets. One of best fracture dressings. To use the "lump" gutta percha, put a quantity into a pail of hot 86 water o When soft, work into ribbons long enough to pass around the limb. Make bracelets of these, harden in cold ■water and spring them about the limb over the oakum and bandage. \Vhen leg is covered, fuse the bands together by a hot iron* There is in market, gutta percha interlaid with linen for such purposes. Soften in hot water and mould to the limb. Cannot fuse this with hot iron, and must secure by bandage o III com pound f ractures with discharges P laster of Paris cannot be used, and gutta percha is best. May make opening by hot iron or knife for irrigationo Water does not damage this dressings Keep the hole closed by bandage o Always put animal in slings when such a dressing is on, to assist him in standing , Ordinary slings vrill slip backward as soon as the intestines empty themselves and allow animal to fall forward. They should have a yoke-breast- strap and a strong breeching hung 9 with the wide belly-band, from a central point above the backo For small animals a piece of netting or cloth may serve as a sling. At Alfort dogs with fractured legs are placed on the back, bandaged" down to a board, the legs fastened to upright corner posts and allowed to remain till wello Ho inconvenience to dog:> and re- sults good.. Fractures heal in horse in 6-8 weeks j. colts i'6 weeks, young dogs S"5 weekSo At end of this time remove dressing- if gutta per- cha, then warm first „ Small sloughs produced by over pressure at any points Pain warms the practitionero Movable dressing better for compound fracture, that wound may be dressed often. In comminuted fractures the splinters necrose, cause diffuse suppuration and acute osteo-rayelitis may follow; if the pus be not removed septicaemia or pyaemia may follow, When in compoxmd fractures a bone protrudes from a wound and camiot be withdrawn saw it off ( never pinch off) rather than en- large the wound-, COMPLICATIONS :- I, Fever always present, Combatted in plethoric animals by bleed- ing. Give laxatives (not purgatives) and diuretics'- Sodii Bi- carb,, grms. 10-20, II, Hemorrhage a Always present, but seldom serious in simple frac- tures, Ligate when necessary, even if you must cut down upon the vessel, III, I ncomplete union^ common in man and dogs in bones that continu- ally move (ribs). The provisional callus does not ossify, but forms a false joint. Ends of bone become polished and covered by layer of tissue resembling artic, cartilage. The fibrous callus unossified about ends of bone forms true capsular liga- ment- even funi cular ligaments. Cells resembling pavement epith- elium form on inner surface of capsular ligament and secrete a sort of synovia to lubricate the pscudo-arthrosis. May be cured by setting up an acute inflammation in the part, IV, Sequestration of bone, A splinter of bone detached from per- iosteum and detained in the '^provisional callus" will irritate and causs pus vmioh will work to the surface and produce a per- manent iistulous tract. 86 Treatment is tc cut ^loo^ fistulous tract to the bone, probe and xeinove the spliitter^. Curette ai?ay all necrosed tissue« I H C M P L S T E FRACTURES. Usually not recognized because of obgcury syinptoniSs SYIIPTOMS:- May see marks of external violence, swelling, extravasation of blood V lameness. Only after 4^5 weeks when a line of callus has formed; or the animal ovinces pain (from diffused periostitis) on pressure upon the periosteum can tto diagnose such a fracturoo Therefore^ v/hen ■we get a, history that after a fall, ^vrap or blow an animal goes lame; if nothing else 5.5 5nc3icated.; we should treat as incomplete fracture hj putting into slirigs and applying sha.t'p blister over the limb to prevent owner exercising him« For, after 8-10 days softening occurs at point of fracture, and if used the horse may entirely break dovmc. It is mal-practice to treat other- wise « Keep at absolute rest for S-G sleeks o SPECIAL P R A C T' U E E S « FRACTURE OF BOHSS OF HEAD:- Important only as to prognosis; usually kill qui-aklyo Caused by severe t r auras t ism.* Halter-pullers may break loose, topple bav-^kward and fracture skull,, SYMP'IOMSo- Vary -^fith location^ Fracture at base of slcull may disturb centres of sight or smell and also cause violent hemorrhage., Bleed- ing from ear when petrous portion temporal bone is fracturedo Fracture of dog's head common, usually quickly fatal, if not, immo- bility or paralysis remains „ DIAGNOSIS :- Easy, except at base of skull, in v/hiuch case it simulates concussiono If fracture of temporal bone exists, blood can be found at the tympanum of the ear by means of pledget of cotton on probe or forceps; and whenever found the bone is probably fractured, at any rate prognosis is grave. If the fracture is on the surface and depressed, trephine on sound bone introduce an elevator and, lift the depressed bone:- chances of success are few, FRACTURES OF FACE:- More frequents Traumatic., symptoms:- Profuse and diffuse swelling, much pain, especially on ma- nipulation,. Splinters of l>one may pierce McM. of nasal chambers cause severe hemorrhage, or cause emphysema of nose, head, neck,&c., by allowing air to enter areolar t issue „ In latter case skin crep- itates and is resonant on percussion^ prognosis:- Favorable- life not endangered^ TREATMENT:- Simple » To replace bones introduce a screw and pull out- ward, or trephine and use elevator as above. Will heal rapidly without treatments If bones of sinuses are fractured and not re- pl_aoed a large callus forms, irritates the mucus membrane and c.ause-s collection in sinuses o In frontal or superior maxillary sinus such callus may prove sufficient obstruction to cause roar- ing. If bones properly replaced, callus will be insignificant, FRACTURE OF PALATIITE ARCH:- Caused by blow on nose or premaxilla or by heavy ''curb" bit^ May recognize the fracture through no stril , when unable to do so through the mouth by reason of the thick. 87 dense tissue covering the boneo Piece of bone may cut the palato- labial artery and cause fatal hemorrhage „ Examine by fingers in- mouthy Ends of bone swing downward rather than upwardo TEEATMEHTS" Usually none needed. May use splints padded with oaJcum and held against palatine bone by roller bandage or straps over nosSc If nasal septum compromised by the fracture, there may be profuse foetid discharge, FRACTURE OF PRE-^IAXILLAi^ Usually due to a fall, and is longitudinal between pincers, or pincers and intermediates. diagnosis:- Easy. PROGWOSISS" Not ser^ouss Easily replaced ar*d maintained. If much com- plicated may have to remove some incisors. TBEATMEIMS" Replace bones and maintain by thread or wire about the fangse If fractures between the corners and dividers, use an ein- nealed brass wire, loop around canine teeth, between nippers and dividers, then around nipper and back around canine again and twist« May put a screw through end of bone; little irritation, left till callus sufficiently strong. For fractures near centre of the inci- sive arcade place pad of oakum behind incisors and bandage this in place with broad tape passing around the entire arcaifie. Give sloj)- py food~ mixture of wheat, bran and oatmeal. INFEKIOR maxilla:- Practically same as super-? differs only in cause, etc. Transverse fracture between corners and first molar is se- rious, and may be caused by falls, kicks, or by the violent con- traction of the masseters when in "exhibitions of temper" or in certain cerebral or meningeal diseases an object is seized between the incisors. SYMPTOMS :" Downv/ard displacement. Lower incisors and lip hang lax; animal cannot bring incisors together. If fracture be along symph- ysis, or involve but one ramus there will not be marked displace- ment, TRANSVERSE FRACTURE along course of molars is difficult to treat- se- rious-; if bad fracture do not treat. If on superior bifanch of the ramus is just as serious. The callus is large and gives trouble after healing. SYMPTOMS :- 1, Modification of shape. 2o Hemorrhage from inferior dental artery. 5. Displacement, not easily noticed when fracture is underneath masseter, but through mouth may notice change of level of mo- lars at point of fracture. 4e Pain. 5. Crepitation also marked. Mast icat ion 'almost impossible. This serious in ruminants- food masses ferment in rumen- tympanitis- death, not so serious in horses, they can be fed artificially, diagnosis:- Easy, Usually find blood tumor under buccal mucus membrane, PROGNOSIS :- In horse not very grave, TREATMENT:- If anterior to first molar maxillo-dental canal usually in- volved. In male animal wire the first molar to the canine and in- cisor teeth, V/hen between canine and dividers, wire canines or anterior molars to nippers and twist the wire tight. In young horses and females must use the 1st, molar- no canines. 88 GO'^SPLETE B-RACTITRS BOTH 3IUNCHES IIIFERIOR MAXILLAa TBEAIMENT^- Wire both sides. For oblique fracture in addition to wire use screw from skin surface through bone into mouth. Leave for 2 or 5 weeks. Some advise a muzzle on jaw- use upper javr as a splint^ tight muzzle around face. Objectionable because einiraal will try to open his mouth; pressure of straps causes sloughing of skin. Bet- ter to use a splint o For fracture superior branch of inferior max- illa may v/ire betv/een two screv/Sa, FRACTURE OF VERTEBRAL COLUMN „ Usually occurs on last dorsal or first lumbar o The centrum always found to be crushed, and usually occurs while the back jLg arche d o "Butel'a harness" v/as devised to prevent this "arching" by holding the head vTell back, but fractures occur even with this precaution, though fewer, CAUSE:- Contraction of abdominal muscles approximates sternum and pubis arches the back^ separates the superior spinous processes and com- presses the centra (bodies) of the vertebrae^ Contraction of su- perior dorso-lujnbar and intersplnous muscles oppose the abdominal muscles and augment the ccmpression. Now, if the hind limbs are drawn ifcll forward and upward their leverage on the pelvis is lcs« sened. The upper leg is the most dangerous; carry the sideline from fetlock between hocks, under loins* over back and fasten to same fetlock. Strain of spinous muscle may occur, followed by swelling, atrophy, but becomes normal in 2-5 monthSe Not probable that muscular contraction v/ill break a normal sound bono. "Every vertebra broken at the University Hospital has shown evidences of disease^'* Always advise the owner of the risk, V/hen fracture occurs, horse suddenly becomes quiet, muscular tremors of fleinks and shoulders and profuse sweat follow. Animal rises infront, cannot always behind. May hear the snapping of the bone. Horse may rise, walk with unsteady gait behind, or drag one hind toe, stand a few days or weeks, then develop a paralysis and fall- never to rise. FRA.CTURES OF RIBS, Causes- falls and blows. The displacement always nil , the fracture usually transverse and complete, Intercostals prevent displacement. Swelling and crepitation present. Complications ; rupture of intercostal arte- ries; tearing pleura and hemorrhage may cause pleuritis; lung may be wounded and traumatic pneumonia, or emphysema of entire body occur. Liver may be penetrated- rupture of Glisson's capsule is followed by hemorrhage usually fatal, symptoms:- and alterations clear. Prognosis , not serious unless there are serious complications, TREATMENT :- Immobilize the ribs by applying adhesive plaster in strips. If a depression appears you must look for another fracture above or below. Put in proper position by putting screw In end of de- pressed bone and wiring to a screw in the apposed bono. Treat com- plications as they arise. 89 li- R A C T U R E S OF PELVIS. External angle of ilium frequently fractured by falls running against side of door, etc» Seen in horses with wide bony hips„ Colts liable to this from non-union of epiphysis'- even muscular contraction may pull epiphysis away, symptoms:- Evident o The small Oblique and Fascia Lata tend to sepa<=- rate the broken parts. When standing behind animal ilium appears buried in muscles of croup, while on opposite side the bony proces- ses are prominent. No crepitation. Pain intense on motion, and lameness marked from irritation of muscles by bony spiculaeo TREATMEIIT:- None, Let alone, will get well, but a deformity V7ill re- main. No callus forms- broken part merely smoothes over^ Do not interfere with work or breeding a Rest for 2 weeks in slings» then - can V7orko FRACTURE OF HECK OF ILIUli:- One of most serious fractures. Caused by falls, kicks, etc* Group drops down and appears only about 1/2 normal width* Weight -on acetabulum carries fractured bone upwards and inwards, thus croup drops* No way of reducing this fracture- muscles too voluminous* Fracture is always oblique; usually downward ^ backv^ard and outward, so that movable end df bone is external. Requires 6-^8 vieeks to hesl« Small horses have recovered so as to be serviceable, but deformity remains and is objectionable- Animal travels sidewise* croup only about 1/2 normal size, great irregularity of gait; cal- lus interferes with muscular movoinents. For breeding purposes such a callus will destroy the value of any mare; cannot deliver the foal through the narrowed pelvis. Does not hurt stallion for stud service^ prognosis:- Serious from complications of vessels and nerves crossing neck of ilium within and infront; bone carried inward in walking and may rupture large vessels and cause fatal hemorrhage. The cal- lus and new-formed connective tissue may contract upon and close ureters or pelvic vessels. Noticed on exercise; absorption of urea causing ureiiDic convulsions, and occlusion of blood vessel sudden lameness, FRACTURES OF COTYLOID CAVITY, noticed after a fall upon the hip { "indi- rect fracture"). May also fracture floor of pelvis. Blow upon great trochanter of femur is transmitted to cotyloid cavity, and the resulting fracture is always comminu ted. SYICPTOMS:- Leg shortened, mobile, will sustain no weight, held in pe- culiar position- arthritis. Do not attempt to treat any, but verj valuable stallion . FRACTURE OF FLOOR OF PELVIS:- Common through symphysis, especially In old horses. Causes: same as of other pelvic frac. Usually throUgh symphysis of ischia into one foramen ovale and forward through pubis. May occur secondarily as a complication o f fractures 6t neck of ilium. Frequently result of falls; of slipping when startl- ing a heavy load, etc., foot slips outward and backward, adductors of leg are forcibly extended and one coxa pulled violently from the other. Fractures from muscular exertion are usually on floor of pelvis, are simple, will get ?/ell if uncomplicated, and are worth treating^ 90 Thi oallu.'. <; in a mare may impedcj parturition, or may press upon o]r.t.'i>,;'.'3 tor \''essels and uerve and cause l ameneos o n .exercise.^, or a chronlo n3uritis with continuous pain and lamenesSo BIAGKOSIS:- Sactal examination, best and only sure yray^ If articula"- tici'i Involved advise destruction of animal. If animal walks and can stand well in slings, with little displacement may treat* If simple fracture of neclc with little displacement, advise omier of possible complications, and treat. Displacement may occur 10 days after injury received » \Vhy? For simple fracture of floor of pel- vis rest and slings all that is necessary. Symphysis heals readi- ly* usually^ Articulation ma;^ heal- usually not satisfactorily- false joint may be formed, FRACTURES OF EXTREMITIES. scapula:- Rare- usually at neck. Causes various, •SsaBto^BS.- apparent. Marked displacement and deformity, animal un- able to stand on limb, great extravasation of blood and serums pain crepitation. Usually outward bulging of ends of bone., Diagnosis, easy. Pr og nosis:- Always grave. Never treat any but brood mares and jestallions* Bones cannot be kept in apposition. Tre atmen t:- jlil. If pain does not soon kill, animal recovers with deformity as bones heal at an aurigle, Shoulder-truss of Bourgelat, and other appliances n<,g. HUMERUS:- Causes are traumatic. Marked displacement by the mariy and powerful muscles, and much swelling. Symptoms , swelling, crepitation, pain, mobility, and inability to sustain any weight and deformity, PROGIIOSIS, grave. Do not unite solidly except with much deformity. Difficult to keep bones in apposition. Animal usually dies in a few days from pain. No, treatment , FRACTURES OF FEMUR, also serious. More difficult to diagnose fracture of neck than of diaphysis. Make rectal examination. May mistake for fracture of cotyloid cavity, however find no extravasation into pelvic cavity, nor much internal swelling in epiphyseal fracture. Find no mobility or crepitation of pelvic bones. May mistalce it for dislocation of head of feraur, but ±n dislocations the limb is rigid and there is less suffering. Treatment only attempted in small animals. FRACTURE OF RADIUS:- Grave , because always oblique and easily displaced* DIAGNOSIS, easy because bone is near the skin. These fractures are usually compound and complicated. TREATMENT:- Bandage and splints, as temporary dressing till swell- ing subsides. After 5C-48 hours apply Plaster Paris dressing; when it becomes loose apply a lighter one, FRACTURE OF CUBITUS (Olecranon), Always serious. Caused by traumata; sometimes by muscular contraction in which case the fracture is on level with articular head of radius. The extensors of fore-arm draw broken part away from remainder of bone- no crepitation, but great deformity. Large blood clot between ends of bone. Animal knuckles over en anterior face of wall of hoof, and when moving drags toe along the groimd. Can stand on leg when it is placed under him. 91 Coixrollcations not serious as in fracture of radius. Articulation may not be involved in callus. Di agnosis simple. Progn osig usual- ly favorable. treatment:- Put in slings and keep limb as well under body as poa^ sible. If extensors are torn from their olecranonal attachment the contracting cicatricial tissue will draw them back, and animal may become useful. FRACTURE OF TIBIA:- Serious. Always oblique, often compound and com- minuted, and easily displaced. Causes are traumata, treatment:- Hone if comminuted. If simple fracture try Zuill's suggestion of fastening bones with gimlets. Intra~periosteal frac-' ture without displacement cannot be absolutely diagnosed till cal- lus is formed* Put in slings for 6-8 weeks and blister a limb to , enforc e ab solute rest . FRACTURE OP CAIOIOK AlID PHALANGES:- Serious. Not often displaced. Fracture of cannon usually transverse, not much deformity; easier kept in place than other bones- deep fascia assists fixation. Pl aster o^f Paris, dressings should be usede FRACTURE isT« PHALANXj usually longitudinal, seldom displaced, may in-^ volve both articulations, FRACTURE 2iJD. FBL^lLAILX:- also longitudinal, and more serious for h^th artioulatj.ons are involved; no d isplacement . May get crepitation; do not mistake normal sound of articulation for crepitation. Large ring-bone and ankylosis will follow. Sympt oms ^ intense, sudden lameness, followed soon by swelling and oedema. If seen when swelling is considerable may not be able to diagnose till 15*-20 days when ring-bone appears, FRACTURE 3RD„ PHALANX:- Often due to weakening of the bone by a kerato- or keraphyllo-cele. Sometimes caused by sudden throv/ing of body- weight upon this bone, CEREBRAL CONCUSSION. Of littljB importance to veterinarian. May have death and no lesions* Human surgeons divide into 5 groups :- I. MILD CONCUSSION:- Dizziness, ringing in ears; contraction of peripheral blood vessels causing extreme pallor of face; lower- ing of temperature; face cold; respiration slow. Slight stupor lasts for 15-50 minutes, when recovery takes place, and nothing but a feeling of "heaviness" remains. In domestic animals we may note slowing of pulse, low temperature, stupefaction, and paina II „ THUNDERING CONCUSSION:- Coma, Temperature falls, tetanic con- traction of muscles, arrest of heart and respiration, involun- tary voiding of faeces and urine- death, III, GROUP conYprises all intermediate staggs bfthv/F>ar< i, and II. Cold skin; respiration and circulation hardly perceptible, pulse slow may be emptying of bowel and bladder; stupor, pupils dilated and do not contract when exposed to light. Patient usually reco- vers in a few days, but may not regain normal intelligence for months^ 91 tfhen death doss not occur in 1-2 hoars, recovery usually f©llov/s, PATHOLOGICAL CHAIviGES:- Arrest of circulation and loss of senses due to mechanical stimulation of these centres in brain. Con- cussion tends to decrease capacity of cranium. Volume of brain almost fills cranium, and is incompressible. The cephalo- ra- chidian fluid normally oscillates to and from the cranial cav- ity isochronous v/ith the rise and fall of pulse wave in cere- bral arteries. This cui-rent is from Olfactory lobe ints Later- al Ventricles, thence by Foramina of Munro into Third Ventri- cle, thence by posterior foramen and Aqueductus Sylvii into Fourth Ventricle, thence underneath Cerebellar lobes to sub- arachnoid space of neural canal. The imprisoned fluid cannot escape from ventricles through the small exit in time to pre- vent pressure on brain and medvillary centres- "when concussion decreases capacity of cranial cavity. The floor of fovtrth ven- tricle (Calamus Scriptorius) and "valve of Vieusseus" are torn and centres of respiration, circulationi and some special senS' es are injured. The concu-ssion drives blood from cranial arter- ies producing anaemia; disturbance of centres of circulation, lowers heart ' s action, increasing the anaemia and Dallor, TREATMENT:-* Keep patient recumbent. Give plenty of cool, fresh air and keep the head low. Bathe face and head, fan or produce slight flagellation of face with wet towel. If we do not find a dead patient, will usually recover. 93 GliAPTER XIII. DISEASES OF BONE. GEIIERAL GOHSIDERATIONS:- OSTITIS:- is an inflammation of compact tissue of bone, OSTEO-I.TYELITIS:- is an imflammation of marrow of bono. PERIOSTITIS:- is an inflammation of the periosteum. ENDOSTEUM:- is the medullary membrane. The periosteum covers all bones, long or short, except where articular cartilage is present. It is very strong and vascular, and generates bone from its deep or ostecgonetic layer. The large multinuclear "myeloplaxes" of Robin and the spheroidal osteoblasts (marrow, or medulla cells) are cheifly concerned in bone form.ation. They receive their nourishjnent from the blood circulating in the periosteum, "In origin and structui-e the tissue of the osteogenetic layer of the periosteum and the marrow are identical". "In the embryo, the marro-sr is derived from an ingroi^th of the Gsteo-genetic layer" --Kleins MarroTi? of tv/o kinds;- (a) Yello w marrow -v-rhen many cells have ■undergone a fatty change, and (b) Red marrow, •vrheTi few have undergone this change, "Marro-!? consists of a very small amount of fibrous tissue as a matrix, and in it nvmserou*^ hlood "/esscjls and cells" c "The cells are of same size, aspect and shape as osteo- blasts of the osteo-genetic tissue, and are called marro?/ (medulla) cells". -Klein. "As no blood vessels exist i." the marrow, the cells are maintained by inbibition alone. If the marrov; cells die for want of fsod, they present purulent foci, just as d® connecti-»e tissue cells in abcess formation. Entire medullary cavity may be converted into pus". -Zuill, As a result of these three morbid processes (osteo-mye- litis, osteitis and periostaitis) '-re have localized bone dis- eases- exostoses, osteophytes, occ , Exostoses are of various names according to location, REPETITION:- Periosteum dips into line the cancelleted bone structure and to line marrow cavity where it is knoi,im as "end- osteuni". Thickness of bone due to periosteum, Claude Bernard, by feeding young animals on madder, which colors bone red, 7)roved that bone is deposited just beneath the periosteum; he put a slip of gold-leaf just under the periosteum and found later layers of red bone deposited on the outside of the gold. Periosteum transplanted to any tissue will form bone by moans of the transplanted medulla cells and myeloplaxes. Why does bone die vrhen its periosteum is removed? Because *by rupture of blood vessels in the periostoum nutrition of bone is des- troyed. Under influence of ijiflammation marY'Ovr cells rapidly give up their fat, the nuclei regain their central position in the cells, the protoplasm changes from a yellowish to a reddish color (loss of fat) and takes a stain readily. Myeloplaxes are nothing more than overgrovm, multinucleated 94 marrow cells. Under inflammation they burst and liberate their many embryonal cells. Blood vessels under inflanimation enlarge to several times normal size at expense ©f inter-haversian bone layers (this, in fracture, is knovv-n as softening; ) and the connective tissue exposed becomes rapidly embryonal. As the inflammation sub- sides, the cells become again normal to bone. Myeloplaxes most numerous in cancellated tissue, CONDENSING OSTEITIS:- Bone formed after an inflammation is less abundantly supplied with blood vessels than normally; the can~ cellated tissue is thicker and Haversian canals smaller. This condition is knov;n as "condensirig ostitis". Indeed, in extreme cases, nutrition may be so much diminished that dry gangrene and the formation of a sequestrum may occur. I^AKEIIYING OSTEITIS:- is the condition in vmich, after inflammation, the bone • svrells and the Haversian canals greatly enlarge, Osteo'-myelitis implies a local inflammation of marrov/ and can- cellated bone- abscess may result. If the osteo-myelitis runs through the entire medullary cavity ^q then have a diffuse osteo-myelitis;- due usually to a blovr, abscess. Fever and soreness may reveal the osteo-myelitis, for this produces an osteitis, and this a periosteitis. Unable to detect osteo-my- elitis for months, obscure lameness. In glanders and farcy may have osteo-m.yelitis. rinct + bone and SIDE-BONS. PRSLIMIKARY:- The terms "Ring-bone" and "Side-bone* are meaning- less. Old English Veterinarians studied them as " exostoses " and" endo s t o s e s " (also called p^riostoses) . There is 1st , an increase of size of the bone; 2ndly , its sur- face becomes covered by numerous salient bone tubercles. Periostitis (?) is a bone tumor less salient than ring-bone, Tha spongy bone contains anfractuous sinuses. The lameness and pain decrease with age of the lesion. Much of the enlargement of ring-bone is due to connective tissue formation. If lame- ness persists it is due more to ankylosis than to the bone tumor itself. These tumors resist all -forms ©f treatment. BOlffi TTOAORS OTP DIGITAL REGION:- Tv;o form.s:- The Cartilaf^inous & the Bony . I, The CARTILAGINOUS, called also "Side bone" is met in region of lateral cartilages, and generally in old horses, II. BONY FORM, called "ring bone", may occur on any face of the fetlock, and usually after excessive work, in young horses. ETIOL06Y OF RING B013E:- Drav/ing heavy load at a fast gait; false steps upon an uneven pavement, causing strain upon the later- al ligaments (the bone yields sooner than the tendon, and lo- cal periSiStitis followed by ring bone results); contusions on the fetlock causing an osteitis; ostitis from any cause; a fis 95 tulous tract so neav to periosteum as to produ.ce a lot^al peri- ostitis; chronic inflammation of any tissue of the foot or first phalanx; chronic suppuration of the foot; fracture with- out displacement, are all causes of ring bone. An o steitis is always follovred by periostitis, and p eriostitis causes rinf^ bone . Often periostitis disappears leaving peri- osteum permanently thickened. Straight, short-pasterned horses are liable to ostitis and periostitis from concussion. Why? Percivall says, "hereditary predisposition" plays an important role. Colts may be born with such faulty conformation (straight fetlocks) that ringbone is inevitable, Lovir-hoeled, flat-footed horses more prone to side-bones and ring-bones. SYMPTOMS:- Local and Rational . I. LOCAL. Tumefaction mora or less salient, rough, ir- regular, lobulated and easily seen when on first phal- anx. May exist on one or all sides, or complicate two phalanges. If the ring-bone is low enough to compro- mise the OS corona (second phalanx) the coronary band will be pushed outward and direction of growth of wall changed. Ankylosis often occurs. May have combination of ring-bone and side-bcne. EXAinNATION:- Profile is good; but fingers v/hen educated are better, and are "always on hand". Examine on all sides, and make comparative examination with the sound limb. May raeasixre by "calipers" or tape-line. Do not mistake, in an examination for soundness, the inferior lateral tuberosities of the first phalanx for ring- bone. They are ligamentous attachments and prominent in Vtrell-bred animals. II. RATIONAL, Valuable for prognosis. Lameness gets worse on exercise . WORSE I May disappear when ringbone well out. Often as rmich sa pain in the limb during rest as at work. Horse continually favors the foot, the frog atrophies and heels contract and add to the pain, Fetlock constantly flexed, and ten- dons contract through disuse;- knuckling results. Tenotomy does not remove the cause, and is therefore ineffectual. The first indication is to relieve pain so that feot vfill be placed on the ground. Therefore, perform neurotomy , and tenotomy will usually not be necessary. PATHOLOGICAL ALTERATIONS:- At first highly vascular membrane in which finally is deposited spongy bone whose anfrac- tuous porosities are filled with dense fibrous tissue which gives size to the ring-bone, DIAGNOSIS:- Easy. Difficult to diagnose diffused ring-bone, where almost no exost'sis, but rather a periosteal lameness. History irj^ortant in these cases. PROGNOSIS:- Serious. Almost impossible to cure in an adult, es- pecially in an animal 4 to 5 years old, for such animal has 96 defieient bone structure. More Bsrious if from faulty confor- malion, than if from fast ?/ork. Low ring-bone and. side-bone more serious than high ring-b'ons. Side-bone lamenoss permanent . Caused by plantar nerves being pinched betvre^n side-bones and phalanges when the foot is placed on the ground in extension. If the side-bsnes ttit^ ©Hl- '••^a^d. there may be no lameness, and the horse be sound . Ring- bones more serious in horses used for fast work, than for draft or farm animals. TREATMENT:- Many so-called "specifics". Blistering sometimes cures mild cases. Officinal Cantharides best„ To allay the irritation of the cantharides always com- bine v/ith Mercury, as:- y( Cantharid. Pulv, ) Hydrarg. Biniod. I aa Zij. Petrolati "q.s, ft . ung . or X Cantharid. Pulv, 1 part. Hydrarg, Bichlor. (corr) 1 part. Petrolati 5 parts, ft. ung. Clip hair, apply blister, put a fatty material on neighboring parts, and tie up horse's head. The blister inflames tissue, caiQ-ses incroasod capillary action and s\^'elling. The presstire upon the bone, and increased circulation absorbs some- of the exostosis. Yet siyellin g m.ay cause slough ©f a part severed from free blood supply by pressure. If blister did no good, may follow by actual cautery in points l/o inch apart over entire ring-bone. Paquelin's thermo-cau- tery better than soft iron points. ITocard stongly advises neurotomy as soon as a '.veil defin- ed ring-bone is recognized. Ne-t more than 3 to b% losses after neurotomy. In ring-bone we usually find contracted heels, and preparation for the operation is necessary. PREPARATION for neurotom.y. Thin the solos and soak the feet for 3 or 4 days, so as to get the heels to spread. In high, thick- Trailed feet a Defay's shoe will dilate the quarters after the operation. The frog if deficient may be reinforced by gutta percha, and a bar shoe applied to give frog pressure. Heui-'otomy may be done "high" above the division of the plantar nerves into the three digital branches,^ or " low " on the posterior digital branch in the fetlock. We can never be sure that the lov/ opera,tion will abolish all sensation, be~ cause the distribiitioii of these branches differs in different animals of the same species, "High" operation is surer, "Collateral artery of cannon" exists only on inner side of fore-leg. Prom before to behind the order of position is (1) vein, (2) artery, (3) nerve, (V. A. N.). The three run to- gether (nerve and artery in the same sheath) along border of perforan s tendon , the nerve usually being in the groove be- tv/een suspensory tendon and perforans. 97 OPERATION:- Cast, and fix leg to be operated upono Peel fer vas- cular bundle betif/eeii the tendons, clip the hair 'rith curved scissors from the spot of incision, and' with clean sponge or pad of oakom cleanse the part with antiseptic solution- (fol^ lev/ viith alcohol if very particular) . Locate nerve and incise with one stroke, l/i inches long, through skin. (Many strokes v/ill prevent healing by f irst intention) . With a pair o£ dis- secting forceps in each hand begin at lo'iTor end of incision and separate eonnective tissue along length of nerve. This ex- poses sheath containing artery and nerve. Carefully lift sheath and tear hole in it (not tearing nerve or artery) . The nerve v/ill roll out. Lift on grooved director and clear a?ray connective tissue. Pass thread under and tie dovm upon upper end of nerve. If it is nerve , horse struggles » Gvit nerve high up (above thread) so as to leave stump removed from atmosphe- ric irritation. May use retractor s to hold lips of incision apart (rubber band with flat hooks at ends) . laay put thread throughlips and hold open in this v^ay. Never /^rasp with for- ceps anything but connectiv e tissue . B ad results due to one of tv;o causes usually :- 1st, Pinching vein and causing thrombosis. 2nd. Exercise too soon after operation, causing neuro- mas by irritation of nerve stumps by chafin g . Do not nerve badly contracted feet, or old case of laminitis„ Animal should be at absolute rest for 4 weeks. Owner must ag"same all risk. Zuill thinks best to cast \Yhen you can get help; but if no help at hand give hypodermic injection of cocaine over nerve, and do the operation upon standing animal. Cleanse the wound antiseptically , allow hemorrhage to stop, and put in on® suture of silver wire, or v/ax-coated silk. Never dust Iodoform into the v/cand (foreign body), but over the v/ound after lips are brought together. Put on pad of oak^om vrith carbolized oil dressing and apply ^yes-si^sg bandage. Take out silk suture af- ter 48 hours. Untv/ist silver v/ire if necessary, and remove af- ter 72 hours. Loave this dressing on about 8 days. Sometimes cutaneous terminations of Ulnar or Radial nerves may still- supply sensation, and lameness persist. Cicatricial tissue miay form around end of nerve, contract and pinch nerve and cause permanent neuralgia; or a true^ neu- roma may form;- either must be removed. Often when the' vaso- motor and trophic nerve supply are cut off from a nerve tumor the latter will atrophy and disappear after a few months. Sensation retitrns to th^ foot after 3 to 5 months, but lameness does not result, because "a pathological impression has been transformed into a physiological one and pain is not register- ed". -Zuill, (Story from Ancient Hist, of a man's strange at^ tachment to a spiked mattress) . S P I, I IT T B , SPJJNTS are bone tujnors on cannon and rudimentai'v metacarpal bones. May involve one or both bones, and even the carpus itself. 98 kinds:- Io Simple, an exostosis on any part of cannon, II" "B eaded ," t\iro or more in line- one above another, III, "Pegged", appears on both sides of a rudimentary ineta-tarsal bone as if driven through from without. This most serious form, as it is most apt to interfere with the action of the tendons » AETIOLOGY:- I, Predig-posing causes . (a) Work out of proportion to strength. (b) Age- more often in young animals, because the interosseous lig- ament has not then ossified, and alone supports the rudimentary metacarpal, and this bone forms part of the carpal articulation and bears part of the weight of the animal. In the adult this ligament ossifies. In the colt, under violence, the bone being weaker than the ligament yields, periostitis and an exostosis (splint) follow. About 5/8 of weight supported by fore limbs. II« Occasional causes are blovTS, traumatisms. Hesults :- active only prior to maturity of the splint. When bone is inflamed lameness is present, but disappears if a "simple" or "beaded" splint when ankylosis is established. If splint enters groove and interferes with flexor tendons permanent lameness may result. symptoms:- I, LOCAL- Bone tumor , resisting, and located at union of principal and rudimentary bones. On coarse legged animals a fair sized splint may be overlooked, but in clean limbed horses a splint is easily recognized. We may have "splint lameness" without an apparent splint. II, KATIOKAL:- Lamen ess, may not be severe at first. Young horses when first put to work very apt to develop this "colt lameness^ In a colt an obscure lameness may be ascribed to splints. Splint lameness is almost pathognomonic; it is intermitten t- apparently cured by rest, but appears immediately when colt put to work. The same intermittency is noticed in an old hors^ with a splint v;hich interferes with flexor tendons. The exos- tosis frays the tendon and sets up inflammation which subsides on rest, but tends to become chronic. Question of soundness depends on animal's age, and the kind of splint. A simple splint is never an ul^soundness unless the animal is laine. If, in an examination for soundness, we find a splint we must make sure that it will not cause lameness by giving the animal a sharp 10 mile drive and examining after "cooling out," Therefore, a horse with splints is soim^ till proved lame, ANATOM. ALTERATIONS:- Splint forms under periosteum, puts it on the stretch and causes pain. Other alterations unimportant, except diminution of size of carpal groove and injury to tendons. DIAGHTOSIS:- Colt may be very lame with no external evidence to account for it. History of "splint lameness" in a green horse recently put at work justifies you in diagnosing splint, PEOGNOSIS:- Hot serious. Lameness usually disappears when exostosis of fair size. TREATMENT:- Troublesome. Counter irritants , as cautery, mercurial blis- ter, etc. V/hen lameness is due to stretching of periosteum, simple incision, or cautery points relieve, ^en splint strikes the ten- dons, little can bo donoo 99 OSSELETS . • Are centres of induration or ossification developed in the connective tissue about joints- particularly the carpus » CaM.^se4 by traumatisms, hence frequent in .stunjblers. These bony nuclei eufe small, surrounded by indurated connective tissue* and have no union with the skeletal bones. They cause permanent lameness, deformity, and may eventually produce ankylosis. Treatment is unsuccessful, S P A V I H . SPAVIH derived etymologically from French^ Eparvin^ a sparrow-hawk ~ { from a fancied resemblance of the motion of a spavined limb to the irregular flight of this bird.) Surgically, "a spavin is an exostosis on the internal or ex- ternal face of the hock, due to an osteitis or a periostitis," If the articular surfaces are compromised we have an "articular spavin. " Two kind s;" j Exostoses- dry, J. Inter articular- occult. This tumor grave. No lameness if spavin large, but if small , may be much« On posterior part of joint is less apt to interfere with function of joint and cause lameness. Another classification :- c Meta-tarsal- (entirely on Meta-tarsus). 1 Tarso-meta -tarsal- (partly on each). METATARSAL SPAVIN:- (low spavin) may be regarded as a high splint, es- pecially when it compromises head of rudimentary bone. Often hard to differentiate the two, prognosis:- Favorable, as spavin is low and posterior. More apt to cause lameness if spavin is on tarsus and anterior. Pain caused by ostitis, periostitis, arthritis (with peeling off of cartilage), synovitis- one or all. These conditions do not necessarily give an arikyloais. May be serious lesion and no external manifestation- hard to diagnose, CAUSES OF SPAVIN IN GENERA.L ARE:- I, PREDISPOSING; (A) Con genit al conf o . rmat ion . Narrow hocks have deficient artic- ular surface and this predisposes to spavin in two ways;- 1st. The animal's weight being carried upon too limited an articular surface, the pressure per square inch is too great; the tendency is to induce an ostitis which converts layer after layer of cartilage cells (from within outward) in- to bone, till finally only the outermost layers are left and bone can be seen through. This varnish — like layer of carti- lage cracks and scales off into the articulation, and an in- terarticular spavin is the result of this arthritis, 2ndly , the narrov/ hock has a greater tendency than the wide hock to open on the -sides, as the body sways from side to side, anc^ therefore must put a greater strain upon the lat- eral ligamerftso These ligaments keep the bones from separat- ing, and do so with less strain in the wide hock in which the 100 base of support is wide and less easily rocked from side to side, than in the narrov; hock ^rheve the base of support is narrow and the recking more easily produced. (B) Work, hunters, race horses, saddle horses are especially lia-* ble because they bear -weight of a rider at a fast gait, and often the v/eight of the two bodies is supported by a single limb. When a horse moves fast he throws his centre of gravity from side to side. He places the foot on the ground and fixes the leg and, as the centre of ^^avity svfays out"ward, the ten- dency is to open all Joints of the supporting limb on the in- side and close them on the outside. This tugs on and tears tendons ar«d ligaments or periosteum and tends to cause spavin. D(& not breed from horses with deficient hocks, as progeny v;ill irJierit the sane. Zuill cites case of colt born with spavins, due as he thinks to "maternal impression"- the mother having suffered from spavins during gestation, SYilPSOMS:- I, objective:- More or less -arell defined bony tumor on internal ot* anterior face of ooint. Make comparative examination. Have a fore foot raised, staiad directly behind animal, grasp tail in one hand and pass palmar surface of fingers of other hc4nd over the spavin. How grasp tail with this hand, and pass the other hand, over the sound hock. Do not manipulate one ioint oftener than the other. Notice all deviations of dis- eased joint from the sound one in form , size and temperature . Notice l ocation of spavin, whether high or low, etc, II, RATIOHAL;- Lameness almost pathognomonic. Greater in rapid gait; may be no lameness in a walk, V?hen trotting, the lame leg is carried through l/S its arc of flexion, and then it seems to halt for an instant, then to move faster through the second half of the arc as if to make up for time losto This hitching gait is usually quite noticeable on turning animal sharply, and never disappears entirely. The lameness of chron- ic spavi n is alwajys intermittent , diminishes on exercise , may entirely disappear {except the spasmodic jerk), but returns on cooling out. Always travels on the toe , and may raise the hip. Lameness is increased by flexion of the hock. This descrip- tion is of Tarsal and Tarso-metatarsal spavins, ACUTE spavin:- is a simple sprain and manifests itself by local heat, sometimes swelling at point of spavin, travelling on the toe, but animal does not warm put of his leuneness . METATARSAL SPAVIli is just like splint, I1ITER-ARTICUI.AR SPAVIK (treated under diseases of joints) is often call- ed "occult" spavin. The horse gets better on exercise, and returns to the stable less lame than when he came out, but he grows lamer from day to day; i.e. he comes out of stable this morning lamer than he did yesterday, BOG spavin:- considered under "hygromas," BLOOD SPAVIN considered under "diseases of veins", llany diseases of the hock may give rise to spavin lameness, though no spavin is pre- sent • diagnosis:- Easy, from above symptoms. 101 PEOGKOSISS- Serious, Lame a long time, and not fit to breed from, TKElAIMEtri:- Various. For Acute Spavin continuous Irrigation with very cold water is the best. Or bind "wet sponge-pack to hock, and horse fit for service in 10 days. Wiere lime-salt deposit has formed^ counter-irritants are need- ed. Blisters good only to act as a splint to keep limb quiet and compel owner to let animal rest. Incorporate some form of mercury with all blisters to bones. It soothes the itching of Cantharides and Euphorbiiam, and keeps horse from biting and rubbing the parto Firing advisable in ma.ny cases. Use points,- lines are too superficial. Points enter the bones, no danger of sloughing unless scales are left in articular bursae, A bent soft iron point may , maice so large an opening in a bursa as to leave the joint open. May fire 4-5 times and lameness persist. If ankylosis has occurred and lajneness persists, there must be some other cause, and firing will not cure. In most cases the lameness is due to the periosti- tis and pain caused by deposit of lime salts under periosteiom, and the pulling at periosteum by the principal and cunean branches of tendon of flexor metatarsi., Or it may be due to an arthritis or a synovitis of the cunean groove; or to inflammation of tendon itself produced by fraying of tendon on roughnesses deposited in its groove; or if a synovitis exists in the joint, motion mechanically pinches the inflamed membrane and causes lameness. Section of the cijnean branch in many cases cures. Dr. Zuill performs it for all classes and degrees of hock joint lameness, and claims about 80^ of cures. Firing cures about 40?^ of cases treated. GUKEAII TENOTOMY:- Line of incision is on a straight line from internal tuberosity of lower end of tibia to head of internal rudimentary metatarsal bone. Do not mistake tuberosity on cannon for the lat- ter. Divide this line into thirds and let the incision include the lower 1/2 of the median third, and the upper 1/2 of the lower third. The incision will thus cross the tendon, and bo far enough forward to escape the fascia which covers the tendon posteriorly. If a blister has been applied considerable hemorrhage may follov; (controlled by 50?2 solution Alcohol, hot water, or cold water). Cut down to tendon. If tendon in a deep groove, cut directly over the groove* and pretty well forward parallel to Saphena vein. Pass a grooved director or closed curved scissors under the tendon from below upwards . In cutting, hold director in left hand, bistoury in the right, and use the space between the scissors blades as a director for the knife. Cut tendon. May then seize ends of ten- don with rat-toothed forceps and cut a piece off on both sides of the incision. Should remove l/2-l inch of tendon. Then with probe- pointed tenotome pass forward beneath the skin and cut outwards along upper and lower borders of the tendon against the skin. Thus you will sever the strong band of fascia which binds the ten- don to the bone above and below, and which if uncut would soon be- come strong and render the operation useless. Cleanse and put in, 1 wire suture. CAUSES OF LAlffiHESS:- 1, Bone timor under the tendon causes synovitis, 2o Tension of tend on causes circumscribed periostitis. 5g Stretching of tendon may produce tendonitis . 102 Tarsal tenofioniy gives excellent results in these cases. If an acute spavin does not get well in a week* reduce the inflammation by cold water and operate. The operation can do no harm. The Ger- mans do a sub" cutaneous operation :- piincture the skin just poster- ior to Saphena vein, introduce a narrow probe-pointed tenotome and sever the tendon. This destroys function of tendon temporarily. It heals in 3-4 weeks, but by that time the lameness is cured. We may try the sub-cutaneous operation, and if it fails, do the regular operation* In the German operation there is danger of open- ing a synovial bursa. Make puncture from bellow UE5ISSSS'> Cunean tenotomy after firing » does no good; for firing sloughs out the • tendinous bursa and causes adhesions between tendon and bone^ Cut- ting tendon then does no goode TIBIAL SPAVIN AWD CURB, COUHBE (curved) is French word for tibial s,payin» "It is an exostosis on internal face of hock involving intex-nal tuberosity of tibia," This tuberosity well developed in thoroughbreds, SYUPTOMS;- The tuberosity enlarged, hot and painful, DIAGNOSIS:- Easy, Lameness from very first, due to ostitis and perios- titis, but lameness disappears as soon as inflammation dies out, PROGNOSIS:- Not grave, Sometijnes inflammation extends to articulation, and produces suppurative ulcerative arthritis, with permanent pain- ful lameness for which there is no cure. Cause is generally trau- matic, TREATI'IENT:- Rest, In early stage continuous irrigation, usually cures in 14 days. If it tends to become chronic^ blister; or better, put a few points directly into the periosteiom of the tumor. This per- forms periosteotomy, relieves pain, and turns a sub«acute inflam- mation to an acute which tends to recover, JARDE is French term for "curb". Curb is any tumor on the posterior and external face of the hock. Often it is simply a large mass of bony tissue involving head of splint bone, and may be called a high splint. Usually, most of the tumor is fibrous tissue, and when macerated, but little bone remains. This mass of fibrous tissue makes it difficult to differentiate curb from high splint, ETIOLOGY:- Conformation of joint as in spavin. "Cow-hock", The cannon should be perperidicular: in" cow-hock" it inclines downward, out- ward and forward; hence the angle between the tibia and cannon is too small, i,e, these two bones should more nearly form parts of one straight line. In "cow-hock" the gastrocnemii tendons pull at so neaily a right angle to the calcaneous that there is a greater tendency to open the hock joint between the calcaneous and cuboid, and between latter and metatarsal bones. Thus the ligaments are stretched unduly, and periostitis, lime-salt deposit, induration, etc, result. Breeding stallions, from frequent raring, and hunters and steeple«-chasers from jumping are frequently curbed. Narrow, thin hocks predisposed to both curb and spavin. In bad curbs where lameness persists, it is usually due to an arthritis (or interar- ticular curb), and will not disappear till ankylosis results. 105 "CoTir'-hock" produced generally by improper breediiig- thorough" breds v/ith work horses, S^QfflPTOMS:- Sumor on hock, seen on profile from one side, though curb may be on external and posterior face of hock. Horse vrith curb is unsound even if not lame. If a colt and never used, we can give a clear bill of health, but advise man not to buy; for though tech" - nically sound ^ he is serviceably unsound . The lameness is much like splint lameness, DIACaiOSIS:- Easy. Acute curb gets worse on exercise, though at first it may get a little better. Rests out of lameness^ Like splint lameness, PROGKOSIS;- Good» As a rule gets well after rest of 6-8 weeks, ar^ some counter- irr it at iony as fire or blister. Nearly all get well; some are permanfently lame from deposit of lime-salts in the tarsal sheath, vrhich interferes with tendons. This condition improves with rest; gets worse on exercise. The deposit rarely as large as spavin, treatment;- More successful than of spavin. Mild blister first, then more severe till good results attained; if none, then fire in points deep into diseased structures. Not so much tendency to slough as in line-firing* Platinum points best- less scar, OSTEO-MALACIA, An abnormal softening of bones of adult animals by removal of lime-salts, "Rickets '* occurs in young animals, and the softness of their bones is due to failure of the blood io deposit lime-salts^ Osteo-malacia is seen often in sheep and goats, and affects first the lower jav/ which bends out of shape in eating- limbs also bend. The bone appears as if macerated in dilute sulphuric or hydro-chlo- ric acid; it cuts like fibrous tissue containing much fat, and can- not be bleached. There is much new-formed connective tissue around Haversian canals, which are crowded with fat cells. Osteophytes scarce. OSTEO-FRAGIA AND OSTEO-POROSIS. Conditions just opposite. OSTEO-FRAGIA sesn in ^d animals . The bones are chalky and brittle from a lack of fibrous animal mat- ter (seen also in old people^) The bone resembles burnt boney and is seen frequently in rximinants, Osteppporpsis usually occurs in horses under 7 years old, though may not be noticed till 9-10 years. The diameter of the Haversian canals is greatly increased, (true rarefying ostitis). Embryonal cells fill these canals, fat is absent, bones will bleach, not enough fat in them to keep them from falling to pieces in a few months o The bones do not bend, but through loss of fibrous material the ligaments often tear av/ay from their bony attachments. This is often the first manifestation* aside from slight laneness. 104 CHAPTER XIV. DISEASES OF SYHOYIAL MEMBRANESo HISTOLOGY:- A single layer of pavement epitheliiain resting on a basement membrane, and under this connective tissue as;~ A synovial membrane chafed c:.^ ci;3> c:35 C O )-l r, n <:f, // J-'c X V V ^ X Tue or/7ia I) V Y V K !<■ ^ X !< X X X < ■/ X y y K X "■ >^ x- V '^;v/'^^^>*7.i5 iSy,'^::'Y/'aZ JHe^r6ra.77t and thickened sho^s absence of basement membrane; its place is taken by dense fibrous tissue as;- llormal membrane non-'vas- cular and insensitive, but under inflammation it be- comes in 24-36 hours highly vascular and very sensitive* The vessels are not new- ly formed; the pre-^existing vessels vrhich are normally too small to admit R.B.C, simply enlarge, admit blood and become reddened. Vessels are newly formed in inflamma- tion of tendons . Structures underneath or continuous with an in- flamed synovial membrane may be attacked. When articular cartilage is thus attacked it cracks, its superficial cells desquamate into the synovial fluid and ulcerations, or even bare bone may be left with often a consequent ankylosis. The synovia secreted by the epithelial cells of synovial membreine, particularly the synovial "fringes"- is normal- ly re-absorbed as fast as se- creted, so that the amount in the sac remains always about the same. Any alteration in the rate either of secretion or of absorption changes this quantity. Under inflammation secretion is hastened, and the sac fills, later however, se- cretion is slowed and absorp- tion hastened. The nature of the synovia also changes. The "synovial frin- ges"- Y/hore secretion is most active- hypertrophy and become anall pedunculated tumors floating in the synovia. They are crushed be- tween the articular surfaces; (causing great pain and lameness) the minute hemorrhages tinge the synovia a reddish color, and shreds of tissue are set free in the joint. An inflamed synovial membrane secretes a thickish fluid which cannot be absorbed, it remains, is colored by the hemorrhage, and may become of consisten- cy and color of molasses, coid refuse to pass through ah ordinary cannula. //^ ^ -^^ y! 'y/;/'^ y y ^/ir/j'c. Car/: r '/s /o/oay c-^ tri-'''^ J oa^jc 105 HYGROMA, DEFIHITIOH:- ''An excessive quantity of s3movial fluid v/ithin a synovial cavity" s Often called "wind-galls", and once thought to contain air„ Very con-non on old horsosc Kot serious, causes:- f I. Internal, due to rheumatic diathesis. (II, External , traumatic and traced directly to work„ Usually on the hind legs which do the most work, Fmscular ef- fort produces pressure and traction on these bursas; they inflaiie and secrete abnormal synovia,, Conformation and constitution af--^ feet liability to hygromas- long-legged horses more prone to hy- gromas o symptoms;- Io local, small tu>nef action* best seen when weight is on the foot. Appears at those anatomical interstices where tendons and fascia do not bind it down. May be tense and hard under pressures The location tells us whether or not it is a hygroma. Fluctuation when foot is raised; may be none when foot is on the ground. At first no lameness or pain, but l^ter the reverse. The walls finally greatly thicken; may enlarge to 10--15 times nor- mal size; may contract adhesions with the skin through nev; forma« tion of connective tissue outside of the endotheliTim of the bursa; or may undergo calcareous infiltration, and even fill up with a limey nodule. II, GEIJERA.L:- Lameness « at first a simple shortening of the step- no limping; later great tenderness and much lameness. If the tumor is large and soft., generally little lameness; but if small and hard, then lameness great. In young horses hygromas develop rapidly, and often produce intense la-neness, not so in old horses. The lameness is produced chiefly by the pressure and stretching put on the bursae by the tendons and ligaments. DIAGNOSIS:- Easy from location. PROGIIOSIS:- Fair, when the hygroma is simple. Grav e , v/hen the walls are infiltrated with lime-salts, for almost impossible then to get ab- sorption. AlIATOM, ALTERATIONS:- Not v/ell known. At first a h3rper3ecretion of nor- mal synovia, which under chronic inflammation becomes thick and dark-brown, (m.olasses). The older, the darker and thicker, Over-'filling of the sac ruptures one by one the fibres of the basement membrane; the walls thicken and harden; the epithelium proliferates and desquamates, and renders the synovia opaque and flocculent, Hypertrophied fringes may undergo calcification, and be liberated in the joint, and by scratching the articular carti" lage produce intense foreign-body— in- the-joint lamenessy difficult to differentiate from navic, disease » when in that region. The cha nges in character of the fluid important, the more li- quid, and lighter it is, the more readily will it yield to treat- ment, A cure ca,nnot occur until the fluid is clear and limpid. THEATMEKT:- I, PREPARATORY:- Aspirate the bursa. In a few days the fluid is replaced by normal synovia, which mixes with the dark sy- novia remaining in the bursa to produce a synovia intermediate in colore Remove daily till the liquid comes out clear and limpid. We may now. begin the Ho CURATIVE TRFJ^'j^vIElIT : - Variable, 106 A. Purgat ives ajid dJAiyetlcs supplemented by a "needle bath," or fine spray of cold v/ater throvm with force against the inflamed bursa may do good in earl;/, .stage o B« Bandaging.. Wet flannel roller f fl annel shrinks on drying; cotton loosens ) bandage gives good results^ Acetate of lead good to moisten the bandage. Elastic stocking, lyith lower edge resting on the hoof 9 is good for fetlock jointo Elastic roll- er also good- should begin on the hoof* Why? C« Blistering Agents xrhen disease has gone beyond Isi, stage. Ti nctu re of Io,d,ine painted over the skin» as long as the skin will absorb it is good, but slow. Blister contaizaing Hg I2 is both alterative and counter-irritant; use T/ith care in suTBiier, or •'Slimmer wounds" may be produced* Do E^J:SE.^ Good but dangerous. Fire in direction the hair points. Three degrees of firing:- 1« L light : - Pass over each line 4-5 times. 2. Medium^ " " « « 8-10 " 5* Dees.^ " 5* « « la-lS " English Veterinarians fire verx lightly and usually in "check- er board" fibres, as:- But in deep, firing lines should never cross one Ein- other for sloughs will occur at points of section. Some such figure as this may be made:- Firing in points^ Iron should be a cherry-red, as we wish the heat to radiate over about 1/4 square ' inch. Fire repeatedly in same places till you can see a white spot at bottom of each point. Cicatricial tissue closes the holes in time- if more contraction needed, put in more points, \7e may carry them into the synovial bursa, if we use "needle points," Always aspirate before fir- ing or blistering , and nev er in.iect an y irritating fluid into a. .jo int o Only acute v/ind -galls make an animal lame, and rest and cold irrigation for a week will usually cure. "C^^eCK^/^ BOt^/iO 1 ~$ FFAT^^^.'Z DILATATION OF SYIIOVIAL BURSA OF THE FOOT. This bursa can only dilate between the two lateral ligaments that unite the 2nd. and 3rd. phalanges. It is united to the inner face of the lateral cartilage? and only when very greatly disten- ded can it appear above the upper border of this cartilage, symptoms:- Obscure, unless bursa above cartilage. When weight is on the foot the bursa is hard, and, but for its smoothness might be mistaken for bone; when foot is raised the tumor is soft* DIAGNOSIS:- Easy when bursa can bo seen, but when not the diagnosis is difficult, TREATMENT:- Difficult, for we have the articulation to deal with, and cannot recognize at stage when treatment vfould do good. When seen cover tumor with Mercurial blister*, If fire is applied, do so in lines as severe as tissue will allow« Points contra- indicated, for they may open the joint. Lines produce cicatricial tissue which 107 contracts upon the bursa* Run the lines from above down to within 1/2 inch of the coronary band. After 3-4 days apply a Mercurial blister, if applied immediately the double action might cause slough, but after a fev; days a revascularization occurs vrithout danger. Synovial bursae of first and nocond phalanges so covered by fascia as Vj-erer to dilate. Fetlock is seat of many bursae ( called wind-galls when dis- tended), Bursae of the tendons distended more often than of the joint, bscause more exposed to traumata, necessary to make a dif- ferential diagnosis.:- bursa of joint appears always .abgve and be- tween cannon and suspensory ligament just below the buttons of ru- dimentary meta-carpals. Never descends below the joint . Rarely it may pass forvyard and unite with bursa of extensor tendons, in which case it may appear on each side of extensors (bilobed), and as far back as suspensory ligaments Shis bursa is very apt to be- come indurated, and even to undergo calcareous infiltration, BURSAS OF -T E N D N S o GREAT SESALIOID SHEATH:- Large, extends 1/3 way up cannon, and down to triangular ligament opposite middle of second phalanx. High-ac- tioned horses ("pounders") most prone. Weight falls on tendons and they pinch synovial membranes between themselves and the sesa- moid groove, with results before discussed. This tumor dilates above betv/een suspensory ligament and perforans, or between latter and perforatus. If much enlarged and neurotomy be done, it must be done hiigh up . TREATMEIIT:- In first stage allay inflammation by elastic stocking, or flar-nel bandage and shower bath. Later a Mercury and Cantharides blister, line firing, or ne edle^'Point firing, are advised. The lat- ter leaves no scar, ^31 chronic dilatation aspirate 4 or 5 tinies, then apply coun- ter-irritation. Injecting Carbolic Acid may remove wind-geills^ but 6 months later connective tissue would replace the synovia, movement would be interfered v/ith, and the case worse than ever. Flexion interfered with and stumbling produced. Dilatation of bursa of anterior extensor always cause tempo- rary lameness, with much oed^a and s^welling. This tumor bilobed. At first it pushes the tendon forward, but finally pressure makes it bilobed and very hard. DIAGJIOSIS:- Be sure this bursa does not unite with the joint. Can rec- ognize by making pressure on both sides of tendon to see If fluid appears at sides or behind the joint, TKEA^li-ffillT;- v/hen there is a coraiminication we must be guarded. Early, an elastic stocking long enough to come down and rest on hoof is good, this the best treatment; pressure causes absorption to cer- tain extent. Irrigation good. In CHROHIC stage blisters > line s or points ^ Usually treat- ment ineffectual. The distended bursa only a blemish, and does not cause lameness after 10 days. Do not treat urJless of large size. If the bursa is distinct may treat it surgically; incise the bursa 108 at a dependent point, wash out sac, and apply a blistering ointment {Eg I2) over the joint, Cantharides causes too much irritation, We wish to get a great induration to press upon and obliterate the bursa- may apply elastic stocking. May also inject salt solution around hygroma to produce an oedema to occlude the sac« DILATATION OF SYKOVtAi BURSAS OF KNEE AJID HOCKo Knee most serious o Dilatation may extend from lo^er third of fore arm to middle of cannon. Quick violent work predisposes- hun- ters, shaft'-hcrses, symptoms:- Tumor larger above than beloTf the knee, and more prominent on inside than without, Belo^ on anterior face the tendon may be knotty, rough and thickened, DIAGIJOSIS:- Easy. PROGNOSIS:- Grave, because it impairs animal's working value, shortens the step, even if it causes no lameness, TEEATliENTt- As for others; pressure, blisters, firing, etc. Rebel- lious callouses may remain. Firing in lines preferred to points. Iodine injections ma,y cure, but are dangerous. DILATATION OF ARTICULAR BURSA OF KNEE JOINT. Rare to find this unless osselets are presents The articular bursa can dilate only above the super-carpal bone, between the two radio-supercarpal ligaments, and may be in size from pigeon^ s to hen's egg, TRE;atME5IT:- The same except the elastic stocking, never use this upon the knee. DILATATION OF SYNOVIAL BURSAE OF HOCK. TARSAL SHEATH is most important. It extends from lower 1/4 of tibia to middle third of cannon* Common in work horses, because frequently strained, and may be quite large, symptoms:- Soft tumors above and below the hock, always posterior. Larger below than above. Is present in hollow of the hock between gastrocnemius tendon and perforans and perforatus muscles, and more voluminous on inside. TREATlffiNT:- Capillary puncture and aspiration followed by fire in fine points (lines not so good). Nocard advises Iodine injections- give fair results after a. fev/ y;eeksc DILATATION OF ARTICUIiAR BURSA OF HOCK. More grave, but never large. We must distinguish between the tendinous and the articular dilatation. The latter appears poster- iorly at two p6ints; (1) in hollow of hock, on inside, close down to the astragalus and well anterior, (2) on the outside just opposite. This is often called "Thor- ough piny because of the internal and external appearances and the fact that pressure at one point causes distention of the othsre 109 This bursa may also dilate on the anterior face and inner border of the hock. Vflien the dilatation is only at this point it may be termed a "bog spavin," and when it dilates at the two points (pra- viously mentioned) behind it constitutes thorough-pin. May have thorough~pin without bog-spavin, but never the reverse, treatment:" Ilone satisfactory. Best is to aspirate, then oast the ani- mal and put in fine points as close as you dare; even if you pene- trate the bursa serious results may not follow, OTHER SYNOVIAL DILATATIONS, I» 0£ flex or ten dons between caipal and tarsal sheaths and the great sesamoid sheaths* Point firing* Hot a thickened tendon, if the tiimefaction is soft when the foot is raised, II o Of c unean bursa makes spavin lameness, Ci:inean tenot-* omy. CAPPED HOCK. Not a_ syn ov ial dilatation," but posterior to the tendon and directly under the skin. Caused by traumatisms, shipping in cars, kicking, etco PEOGNOSIS:- Serious, Never apply counter- irritation by fi^-e or blister. treatment:- to promote absorption, frictions, continuous irrigation, judicious use of Iodine. May treat long and get no results. Best results in mild recent cases. If the cyst is opened prolonged sup- puration usually results. In old cases put a thread seton through from above to below, make the smallest possible incisions, SYNOVIAL dilatations OP STIFLE. May be tendinous or articular . Tendinous is of tendon of crural triceps and patella on femoral trochlea; articular is for articulation of femur and tibia, Leblanc was first to inject Io- dine into the tendinous bursa, and when this bursa was distinct from the articular burjsa his results were good. Often, however, these bursa commvmicate, and use of Iodine dangerous. symptoms:- I. Objective . Salient flattened tumor- hard or soft, as weight is on or off the foot. Number of soft tumors along border of patella, separated by depressions due to patel- la ligaments. Their walls may calcify, II, R ational , characteristic. When bursa is dilated, the Cru- ral triceps can scarcely perform their function. The con- dition looks like dislocation of patella. On a trot the lame leg is not advanced beyond the sound one, but placed on the ground beside it; the croup at same time thrown violently upward, the foot coming to the ground toe first. treatment:- usually effective. In early stages continuous irrigation; later severe blisters. If much distension, remove some fluid. May have intense lameness and slight distension. If blisters fail, use platinum point fire deep into the tissue, and quite close to- gether- will not slough. Do not injure the ligaments. Radiated heat from a large body brought near the skin does well, but requir- es e:qperience. 110 Dllat atlpn c^ s ynov ial bursa o,f h^ cannot be recognized- mus- cles too thick o RHEUMATIC SYNOVITIS, Develops under a rheumatic diathesis o Rare in animals. All serous membranes of body may be affected, and produce a fibrinous substitute like tow. Been long noticed that inflammation of se-- rous membranes follow long diseases. This not metastasis, but a complication of synovitis. Rheumatic synovitis is a sequence of improperly treated lung diseases; as neglect of diuretics, etc. symptoms:- May develop withiA a few hours during lung diseases. Fever high, and intense lameness* Large tendinous sheaths swollen and painful. At the next visit the inflammation may have disappeared from the first locality » and appeared in another synovial membrane, or a dropsical effusion may remain. ( Crepodine also liable to sud- den changes ) . DIAGNOSIS:- Easy, from rapidity of invasion, and intensity of symptoms, PROGNOSIS:- Useless while suffering, and tends to become sub-acute or chronic: if disappears, is apt to return^ Complications of endo- cardium or pericardium likely to follov/o AHATOM. ALTERATIONS:- Pronounced. Synovial tissue red and swollen, fringes hypertrophied and bursa filled with thickened albuminous synovia containing f ibro-albumi^ious shreds, and desquamated epithe- lial cells. Basement membrane becomes villose like a mucous mem-* brane. Surrounding tissues are infiltrated with this albuminous liquid and become friable. treatment:- Preventive to lessen tissue waste by Alcohol and Quinine, and to remove waste products from the system. If synovitis exists apply sponge poultices wet with hot water and covered with oiled silk; or warm fine spray; or astringents. Suppurative sy novitis may follow the rheumatic form. Counter-irritants indicated only when acute inflammation has subsided. Heroic doses of Salicylic Acid is good in early stage. Salicylate of Soda gvj-^o* Salicylic Acid is injurious to mucous membranes and needs watching. Good in all acute rheumatic conditions. SYNOVITIS. "Simple Acute Synovitis" seen frequently in running and trot- ting horsess hunters, shaft-horses; may arise from traction upon tendons in muscular exertion. SYMPTOMS:- Appear eapidly (not so marked as in rheumatic form). Lame- ness, tendons hot and swollen; pain not so acute as in rheumatic synovitis. TERMINATIONS:- R esolution or suppuration , or a dropsical condition (wind-galls). Vfhen su ppuratio n appears there is an Intense febrile condition; tendons hot and swollen, face drawn, hair on end, fae- ces dry and glazed. Skin over the synovitis becomes unctious, breaks and discharges. If the cannula be introduced the nature of the fluid drawn off will tell us what the indications are* Always aspirate in such a case- it may abort the inflammation. diagnosis:- Easy, and PROGNOSIS not serious^ Ill treatment:" In first stages antiphlogistic o Bleeding by pimctuxe or scarification good. Hot water, white lotion, lead-water and lau- danum, or zinc sulphate are good. If suppuration feared aspirate Txirsa with large hypodermXc syringe. Keep up continuous irrigation. If you cannot arrest suppuration open the bursa fredly, wash with antiseptics and put in a drainage tube. We have now a traumatic synovitis. TRAUMATIC SYNOVITIS. Usually complicates cutaneous or tendinous quitter by affect- ing the great sesamoid sheath. Under influence of atmospheric germs normal synovia changes from a light yellow oily fluid to a whitish opaque one, and is secreted in large quantities. The lameness is not; intense, and continues long after wound is nearly closed. Surrounding parts swell and indurate. The fistulous open- ing is surrounded by soft flabby granulations which bleed easily. The cavity finally fills with cicatricial tissue, and an enormous indurated joint remains, ALTERATIONS;- In a few hours after wound is made the synovia dries up, ar^d fibrinous false membranes form on surface of synovial membrane. Under inflammation the false membranes come away and leave a gran- ulated pus-secreting surface, DIAGNOSIS:- Easy, and PROGNOSIS serious. treatment:- Old treatment was to destroy the bursa,, Continuous irri- gation good. Put animal in slings, iinmobilize the part and apply a 10^ Biniodide of Mercury blister to produce swelling and oedema, and close the wound. May inject warai Biniodide of Mercury oint- ment into the depth of the wound. If the wound is patulous, close by one or two pin and figure 8 sutures. This treatment cannot be used on bursa from knee or hock down . For great sesamoid sheath remove the shoe, wash whole leg below knee or hock with soap and water, and antiseptics, followed by Alcohol bath. Allow to dry. Make wound aseptic and use plenty of Iodoform about it. Suture lips of wound with silver wire. Flex the leg; apply aseptic pads of oakum to whole foot and leg, and bandage from sole of foot up- ward. Cover whole with Silicate of Soda, This treatment aims to kill all septic germs on foot and leg, and to exclude all atmos- pheric germs. Carbolized oil, carbolized gauze, etc. may be used. Let this dressing remain as long as temperature does not rise, and if it should loosen at the top, put more dressing over it, ARTHRITIS . ARTHRITIS is an inflammation of a joint. Of two kinds :- Arthrit is ( Traumat ic . Serious because wound is open. \ Hon-tratmatlc , Less serious because sub-cutaneous. TRAUliATIO ARTHRITIS:- Caused by traumata. Non-traumatic may advance to a condition similar to that of the traumatic. Suppuration may follow. Traumatic Arthritis may follow quitter, suppurating corns^ "penetrating street nail," SYMPTOMS:- I, LOCAL. Discharge of synovia, at first slight and may la- ter be arrested, but after 24 hours an enormous flow of pure syno- via. If the opening closes, a hydrarthrosis may follow, and cica- 112 trlzation be prevented, t>ut retardation also results if wound left open. II „ RATIONAL. Pain little or none at first, but in 2-5 days when synovia flows freely pain is intense, and horse will not use the lega If traumatic arthritis is feared, resort to shower bath- ing, aiormous s'-velling at the culs~do-sac due to oedematous infil- tration into the tissues at this pointo Synovia becomes cloudy, and contains fibrinous clots. The induration _alway3 extends up the le^ . Buboes may form (suppuration of lymph glands), and the lymph channels become hard. Pus from buboes is thick, creamy and laudable; but pus from farcy buds is thin, oily, sticky, and tin- ged with blood { in color like abscess-pus from dog). Any corded lymphatic giving laudable pus is a result of an arthriti.-SsCJ) In chronic casses greenish-yellow shreds of cartilage are in the synovia. Pyaemia may arise. The swelling may harden by de- posit of lime-salts betvresn the ends of the bones and ankylosis take place. The articular surfaces are denuded of cartilage^ Progress of the disease is rapid. Three terminations; f 1„ ResCilut ion. "S 2. Ankylosis, \ 5« Death, AITATOM, ALTERATIOIIS:- Breaking of skin, zone of vascularization about the wound, synovial fringes hyper trophied. Synovial membrane shows desquama.tion of epithelium, and a fibrinous deposit, which loosens in 5-5 days, floats into the joint and is discharged as fibrinous flocculi, leaving the synovial membrane very vascular, and covered by granulations. Ends of bone now very vascular, cartilage cracks in every direction domi to true bone. Through these cracks granu- lations rise and overspread the edges of the cartilage plates. The latter exfoliate one by one into the joint, leaving the bone covered only by granulations. Two THEORIES to account for this exfoliation: - lo Bouley's , that the cartilage cracks by reason of ungr ciual expansion of bone and cartilage under inflamma- tion. 11. That cracking due to a segmentation of cartilage cells^ DIAGNOSIS:- Easy, from swelling, pain, ankylosis. prognosis:- Serious, Seldom a recovery. Heals by resolution if at all. Young small animals give best prognosis. If arthritis is sus- pected do not cjcplore with a probe, use finger. Keep germs out. treatment:- I. PREVENTIVE. Close wound as soon as possible to keep germs out, and do not probe it. Use continuous irrigation. May close a small wound by steel pins deep into the tissues, and figure 8 sutures about them. Apply mustard or biniodide blister. Shower or continuous bath over the blister goodo May put thick cloth over the surface, and keep wet with cold water « II, CURATIVE, Treat to produce ankylosis, may do arthro- rectomy (scrape cratilage from articular surface- n.g.), NON-TRAUMATIC ARTHRITIS:- Skin unbroken and germs excluded. Rare- hap- pens by violent stretching or fracture of the articulation. Scarce, ly any lameness. Articular fracture is the most frequent cause. Cartilage injured and inflammation follcv^s. 115 symptoms:- Decidedo St/ellins, hoat and pairio Ths sv^elling is ''pasty"* Great pain, and no weight put on the foot. Si^iulates founder, and may cause founder by thro'Jing the v/eight upon one limb for a long time. May become chronic, and a dropsical effusion into the joint remain. If the strain and strangles co-exist the joint will prob- ably suppurate. ¥/hen pus develops in the articulan, it soon comes to the surface and is discharged. If pus is suspected, drain the bursa by aspiration, and wash out with antiseptics, such as Boric Acid or Potass. Permang, Remove this solution entirely, and the in- flammation may be aborted. Or we must freely open the bursa and treat as travunatic arthritis. Progress is rapid at first, but tends to become chronic. May be, or not be lameness. diagnosis:- Easy, sv/elling, pain and lameness. Difficult v;hen an up- per articulation is involved, but may suspect from the constitu- tional trouble. prognosis:- Hot so grave. Will recover and leave a distended bursa, if it remains non-trai-imata'o. treatment:- a. general:- Allay inflammation. Do not bleed except from the jugulars, this good. Diuretics and Carthartics may do good. B. local:- Liniments, solutions of zinc, lead and opium, or continuous irrigation- frequent "noedlo baths." Do not bleed from toe or coronary plexUs, jugular good enough. Hot rr cold poultices of meal, bran, moss, cot- ton, or wool wet v;ith "white lotion," kept on continu- ously for 2-3 days. May afterv;ard apply Mercurial blis- ters; do not use in oarly stages, or suppuration will follow. If "wind-galls" form, treat them as such. If the liquid is cloudy and flocculent, drain the articu- lation and wash out as ir^icated. RHEUMATOID ARTHRITIS. Chiefly affects young calves, mules and colts which have been too rapidly fattened, and have- not been well purged of their meco- nium by colostrum. Is both an arthritis and sjmovitis, is common in breeding districts of Europe, rare in America, and not seen in animals over 6 months old. Colts from rhcimiatic mothers are pre- disposed. Two theories t Kopf 's theory- due to a rachitic taint. ■s French theory due to pyaemic arthritis following V castration. Pest mortem examinations do not bear out latter theory, Pye^ mic lesions are foijind in the joints, but in the Itimgs v/here the pus cells and clots are arrested before they can reach the joints. Both of these theories thrown aside. symptoms:- Sudden and intense lairtesiess of one leg; an intense constitu- tional febrile re-action, fever, thirst, loss of appetite, consti- pation, congested mucous membranes, tumefied painful hot joint. With these symptoms animal seldom liv3s beyond 3 or 4 days; dies of systemic poisoning of which the arthritis is merely a local man- ifestation. Or the swelling and lameness may disappear in 5-6 weeks J or pus may form, break out, open the joint» and suppuration and necrosis follow. Do not attempt to save the animal;^ its value will be nil It it lives. 114 prognosis:- Eighty per cent, of cases either die or are afterward val- ueless « MAT. ALTERATIONS:- Acute inflarnmatiori of synovial membranes; false membranes^^^sioften, suppurate and are discharged, treatment:- I, Preventive . Purge all colts that are not well purged by Colostrum (Sulphate of Sodiim or Mg« 40-100 grams )« II, Remedial : - astringents, anodynes, 'nvhite lotion", or "purpuleura ointment"- made from poplar buds, and having action sim- ilar to opium, may prove goodo Delafonde uses Cream of Tartar; he says Sulphate of Na, is too strong, as is also Aloes<» Destroy animal if suppuration has begun. CHAPTER XV < DISEASES OF TEITDONS AND L/IUSCLES. tendons:- Diseases few. Tendons chiefly affected are the flexors of phalanges. The following diagrams are intended to shov/ how the distribution of v/eight to foot and to tendons is modified by in- creasing or diminishing the angle between cEinnon and phalanges* Fore-leg of 1200 lb, horse. (JYbrrizaT. II 36oi.h. QO \\>k y^^ Z^O \bs. 'O^c r. D OVYTV 115 PHYSIOLOGY :- Phalanges about 45"^ with ground (Phalanges of fore^legs 60", and of hind-lega 65*'.- Harger.) and 155 with the cannon^ Weight is distributed at metacai-po-phalangeal joint in two direct tions:- Isto along axis of Phalanges to grounds 2ndo at a right angle to this axis and against the tendonso STRAIN OF CHECK^TEITDON. Caused by "over reaching^" vmen inflamed^ this tendon is intensely sensitive. CAUSESi'- lo Predisposing^ Long joints, and too small angle between cannon and phalanges. ( Check tendon of anterior limbs larger and stronger than of hind limbs,). Lesion of checlc tendon occurs at junction with perforans. Posterior check tendon (absent in mule) is strained by backing loads, JTomping, &Co When a lesion is pro- duced by pulling a v/eight up an incline, it is the flexor tendons, and is seen behind the carpus. Rupture of check tendon is called "breaking dovm.o" Does not come dovm immediately as when flexors rupture, but gradually during weeks » K II U C K L I N G , Is an abnormal increase of angle between cannon and phalanges, may even be greater than 180 **, T hre e stag es^ as shown below ; - ¥/hen 7/eight is taken from the tendon by straightening of bony rays, the tendon con** tracts. Contraction also produced by resting the limb when any disease of the foot as corns, contracted heels, etc., prevents animal from putting weight on the foot for considerable length of time. Vice versa, a strained tendon may lead to contracted heels. Knuckling is therefore, inerely a symptom. For contracted heels- pare the sole till blood oQzes through, leaving frog intact. Pack moist sponge into sole. In a few days frog flattens out, and heels spread; this better than a Iftifay's shoe. Plantar tenotomy is never indicated when the disease is in the foot, and can be relieved by neurotomy; is indicated only when the tendon is diseased. symptoms:- A<, Local . Lift the sound foot to ascertain the amount of contraction. Indurated swelling at union of check tendon and per- forans, usually sensitive. In chronic cases the tendons in this region are firmly united. B» Rational o Abnormal position, and consteoit back and for-^ ward movement of the foot- pawing. Travels low, is sore, stumbles constantly, "pegged shoulders," short step, and pain on movement as shoT/n by exaggerated dropping of head. Warms out of lameness, yet always lame. diagnosis:" Easy, but we should recognize the cause, whether in tendon or elsewhere o prognosis;- Grave, resists all treatment. Serious in saddle horses, less so in farm horses. Knueklers taken from paved streets to the country, may improve wonderfully in a few months. 116 AHASOMo ALTEEATIOlISi" Skin dense and thick, and adherent to the ten- dons. Sub-cutaneous connective tissue has disappeared and tendons united to each other. Marked vascularization of tendons and ecchy*^ moses frora rupture of capillaries with yelloi?ish deposit through whole tendon. May be true interstitial hemorrhage* TREATMEITT:- I, PREVENTIVE, V7ith normal tendons^ but a knuckling con- formation lower the heel s. Bandages, astringent lotions, irriga- tion are good. Blistering ointments if conditions are more marked* 11^ CURATIVE (Early stages). Blisters, or needle cautery carried deep into the inflamed tendon in a series of lines- no dan- ger. In a few days apply a blister over the points* Put a cradle on neck, and turn into a large box stall. To combat itching apply ointment containing vaseline and carbolic acid, or creolin* With marked knuckling and disease of the tendon, these treatments may do no good« Massage, morning and evening, rubbing in Neats-foot oll^ vaseline or cocoanut oil till dry, is goodo In late stages^ sub-* cutaneous flexor tenotomy is necessary^ Williams' Method is ob- ject ionablCo OPERATIONS- Cast so as to operate on i nsid e of fore-le g^ and outsid,e of hiS4e For fore~leg put "figure 8" on knees. Use t'R'o side lines; ^ne around leg above knoe and passing back between hind-legs to an assistant, the other about hoof and passing forward to an assistant, each to pull v/hen tendon is being cut. Use two bistouries, a straight narrow ono, and a probe poin- ted one with a very sharp cutting edge, V7ith the straight bis- toury make a puncture between perforans and perforatuss on a line vfith the tendons, at a point belovr the junction of check tendon and perforans and above suporior cul-de-sac of great sesamoid sheath. This space ii; the fore-leg exists between middle of cannon and un- ion of middle and lower thirds . First, cleanse the part thorough-* ly. If the skin is not indurated, just puncture through the skin. Assistants should hold hard so that the leg may not move and pro- duce too long an incision. Before withdrawing the bistoury intro- duce probe pointed bistoury, and push it down between the perfo- raiis and perforatus. Turn the cutting edge toward perforans, and slov/ly rotate handle backward 80-90^ assistants pulling hard. To cut the perforatus do not withdraw the bistoury, but pass the blade back of this tendon, turn cutting edge forward, and rotate as before. Skin should first be rotated from forwards backwards, so that incision may be left over the bone. To cut suspensory ligr ament , puncture on both sides just below button of rudimentary metacarpals V and cut forwards toward bone. DRESSING:- Cleanse the part, dust Iodoform into hair, apply 5-6 adhe- sive straps about leg above and below the puncture, and over this put oakum and a bandage. Take off in one week. If the cannon drops upon the ground, apply a posterior splint as for a fracture. Make the angle of the splint with the ground less than of the fetlock to allow for contraction of cicatricial tissue filling in space betvroen ends of tendon. Anterior splint may cause the bandages to separate the ends of the tendon too wide- ly, when weight is put on foot. Two to three v/eeks only needed to unite the tendons so that they will bear the weight of the animal, but he must not work. 117 Take off splint in 5 veeks and apply blister to keep horse from working. If he works he may break down, complications:- Synovitis, necrosis of tendons, section of nerves or blood vessels, suppuration, pyaemia, septicaemia, etc. INFLAMMATION OF MUSCLE. Often in dorsal muscles after casting, or severe exert ion. symptoms:- I. LOCAL. Swelling and muscular tremors* Bleeding gives dark, difficulty coagulable blood, due to products of disasslmila- tion in the blood, II. RATIONALo Horse dejected, appetite gonoj may have fever » congested mucous membranes o Not a serious disease, though blood that fills space between ruptured ends of muscle may cause suppu- ration, TBEAIMENT:- Draw a small quantity of blood, and give the swollen parts massage. They atrophy till almost nothing is left, then grow,, and in a few months ar© normal again» RUPTURE FLEXOR META-TARSI:- Quite common. Leg is thrown forcibly back- wards and outwards by action of posterior muscles (characteristic). May think it a fracture « Can stand just as well on that foot, TREATMENT, slings or blisters to keep from using, RUPTURE OF AI-ITEA SPINATUS, Postea-spinatus ^ Siceps., etc* Vfhen first is ruptured, horse cannot support his weight on that leg. SYMPTOMS:- deformity over the muscle (do not mistake for anterior Ituc- at ion of hianerus). Three or four weeks only needed to heal; then a rapid atrophy- "sweeny" follows. This is a common cause of "sweeny". May have ruptiire of most any of the shoulder muscles. Tendons of Gastrocnemii may rupture from kicking. Such an animal can walk, but hock is low. Destroy the animal. CHAPTER XYI. DISEASES OF VEINS AND LYMPHATICS. THROMBUS:- "A blood tumor between vein and skin ." Likely to follow a bleeding. Such a tumor is only serious when large. CAUSES are various;- Anything that alters the structure of the Intlma, In charbon and septicaemia difficult to close a bleeding, bacBUse of lack of haematoblasts (blood plaques). After a bleeding, work in the collar by arresting flow in the jugulars and raising blood pressure, favors formation of thrombus. Always secure a' horse after bleeding, so that he cannot catch the pin in the side of the stall and tear open the wound. Ointments may irritate, and cause rubbing and thrombus. Weight of blood in the extremities favors thrombus. May prevent a large thrombus by cold irrigation. Hot season, by relaxing the tissues, favors thrombus. SYMPTOMS:- Local . Flattened, then rounded tumor, at first soft, then pasty, finally hard. After 48 hours an oedraia surrounds tho tumor* which is now sensitive, and gives moist crepitation. X18 lEBMIliATIOHS:- I. Re^ab-sorptlon- fortimate. II o Adlieslve phlebitis , III. Suppurative p hlebitis if the fleam is dirty, and in- fects the woundo In this case the tumor softenc, fluctuates, and thin ichorous blood-stained pus appears around the pin. IVo Hemorrhagic phlebitis . DIAGNOSIS, Easy. PROGNOSIS uncertain, TREATMENT:- Of large thrombus is to remove pin, allow pus to escapes and disinfect the cavity. Dangerous to break up a clot in connec- tive tissue. Large thrombus may be absorbed under a mercurial blister (10 days after bleeding )» If a fistula forms, wash out with Alcoholic preparations, as;- Tro Aloes and Myrrho Preventive treatment the best, clean fleam, wash the sTcin, clip point from the pin, and secure the animal, PHLEBITIS o A frequent termination of thrombus. Clot external to vein and under the skin, assists in closing lumen of vein by pressure. Order of sequence» 1» Thrombus, "''~°~ 2o Adhesive, Phlebitis, 5o Suppurati1a?e Phlebitis, 4o Hemorrhagje Phlebitis, Vlhen a clot forms within the vein and acUieres to the walls, we have an adhesiv e phle bltis o Atmospheric germs or infection from the fleam may cause suppuration near the pin, the pus pene- trates the clot from without, enters the blood vessel, dissects clot away from the endothelium till it (pms) reaches living bloody Suppurative Phlebitis, The blood then oozes out through this fis- tulous track and reaches the air- hemorrhagic phlebitis. It soon coagulates, howwver, plugs up the vessel and stops the bleeding. In a few days the pus works in again, bleeding follows, etc, ADHESIVE phlebitis:- The true kind; the others are but complications, symptoms:- Swollen vein like hardened cord, and sensitive. An oedema in the jugular guttar for from 4-7 days, leaving indurated connec- tive tissue. General symptmns :- Reddened and thickened conjunctiva, and profuse perspiration on side of head on which phlebitis exists. Head extended as in tetanus. Symptoms pronounced in thorough- breds, but disease Itself less serious than in lycphatlc horses. Ho febrile disturbance if pus extends only as far as sub-cutaneous connective tissue. Open and wash antiseptically, and wait for cic- atrization. The vessel will become a fibrous cord and gradually dlsappBar, as often happens in ox, sheep and dog, in which collat- eral circulation is abundant, AllATOM, alterations:- Obstruction of vein, coagulation, followed after 56 hours by a whitish, concentric clot (deposited in concentric layers). The red coloring ipatter (haemoglobin) of the clot is dis- solved and absorbed from the periphery toward the centre, and by 10-15 days is a dirty whitish color. This white clot is the start- ing point for re-construction : it is food for proliferating endoth- elial cells. They become embryonal, and loops of blood vessels (from the vasa vasorum) extend into the clot, so that if the latter 119 be pulled away, the endothelium will adhere to it* The fihrin of the clot plays no part in re-construction; the emhryonal cells and leucocytes do, diagnosis:- Hard, resisting, hot, painful cord through which no blood circulates, prognosis:- Grave, vessels always close, and cerebral congestion may follow. If necessary to bleed again, only one jugular left to bleed from, TREATMENT:- Simple, Use no irritating applications. Natural tendency to resolution. Preventive , Rest; fix head by two side straps to keep jugular from any body. Low diet, laxatives. Food that re- quires no mastication, bran and Bethlehem oatmeal in broths or slops. Apply no fat that may turn rancid. Cosmoline or Lanolin good., Belladonna, Zinc, Lead, Opium, etc, good. In a few weeks may apply Red Iodide of Mercury to hasten absorption of remaining clot J but only in late stages when organization has occurred. Fire may be used. Usually terminates in SUPPURATIVE PHLEBITIS. SYMPTOMS:- From the fistulous opening escapes an amount of pus out of proportion to size of the wound. Septicaemia may invade the wound. Pus may eccuraulate and suddenly rupture into the general clrcula-, tion and cause general pyaemia; or may have multiple abscesses along the vein. Open them, they are not dangerous, and show that suppuration may arrest itself. The process may extend upward even into cranium with necrosis of skull bones. ANATOM, ALTERATIONS:- Inauration of skin and connective tissue, thick- ening of walls of vein. From skin to inside of vessel is one mass of connective tissue. Inside of vein covered by granulation tis- sue of a fistulous tract. The clot appears macerated and disinte* grated. Small points of suppuration are found along the vein, multilocular abscess, much as in scirrhous cord (champignon), TERMINATIONS:- By resolution rarely: more often in purulent infection. Septic invasion easy. When we notice disappearance of pus, dejec- tion, chills, high fever, loss of appetite, hepatic and renal symp- toms, we recognize septic invasion . There may be symptoms of pneumonia, pus in urine from multiple foci in kidneys, foci in the liver, symptoms of meningitis, or necrosis of bones of skull, DIAGNOSIS:- Clear, from symptoms. PROGNOSIS grave. If left to itself nearly always terminates in death, TREATMENT:- Varies with stage. First few days treat as for adhesive phlebitis. Open orifice and cleanse thoroughly. When abscesses form, open them to prevent pus from separating clot from wall. Use bistoury or cautery, and put in a rubber drainage tube. If no abscesses make a counter-opening at bottom of fistulous track, ex- ploring first with a soft rubber sound ( never use metal probe for such -purpose ), and draw a drainage tube through. Make antiseptic injections and treat on general principles. Remove tube as soon as suppuration is limited, it may then end by suppurative phlebitis. Or, ligate above and below clot, lay open vfhole vessel and treat as open wound, good . 120 ULCERATIVE PHLEBITIS:- Ulceration of endothelial lining of vein. Order of sequence is- thrombus, adhesive phlebitis, ulcerative phlebitis, symptoms:- As for the others, AHATOM. ALTERATIONS :- Vein enormously distended, hemorrhage every few hours or days, greatly weakening the animal, and death from exhaus- tion. Repeated small bleedings more exhausting than the same amount of blood drawn at one bleeding. TREATMENT:- Prevent movement of jaws by muzzle or strap. Secure so that horse cannot lie dovm. May be necessary to ligate the vessel, if so, ligate upon healthy vein above and below the clot, lay open whole extent of vessel between ligatures and cleanse thoroughly. This good treatment, DISEASES OF LYMPHATICS:- Traijmatisms of capillary vessels not manifes- ted; only when large. Lymphangitis usually traumatic. Bleeding from saphena vein may compromise the lymphatic trunk; get a clear opalescent fluid, coming in jets when animal walks, soon becoming slaverish. The lymph flow may be transitory when vessel is not large, or permanent when vessel is large. May pin up the wound end close with suture, then a lymph thrombus forms and acts as a blood thrombus, TREATMENT:- Pin to close wound, and put pressure over entire limb from foot as high up as possible. Use wet flannel or an elastic{ rubber) bandage. Keep absolutely at rest. Bandage prevents flow of lymph in the limb; cannot ligate because walls are friable. Limb may present varicose lymph glands on internal face of thigh and on sheath; these do no harm. LYl-iPHANGITIS or AMGIO-LEUCITIS is an inflammation of lymphatic vessels. Usually traumatic, or from carrying lymph from diseased parts. ETIOLOGY:- I. Internal- Hard to diagnose, II, Estfternal- most frequent, and divided into two groups :- \ 1st. Compromise the skin. Isnd, Compromise sub~cutaneous connective tissue and not the skin. Slightest prick may cause lymphangitis. Essential elements of a lymphangitis are virulent in nature. Inoculations cause it. Stings carry poison and produce a lymphangitis in some animals, which soon disappears from dilution. Lymphangitis arises only from recent wounds, though it may develop on healing of large wounds as, after serous cysts have healed, the contraction of cicatricial tis- sue may occlude lymph vessels and cause a Sympliati©, Irrupt ive dis- eases, as cow-pox may cause a Lymphat 16. Absorption of virus may cause breaking down of ganglia, compromise the skin and form ul- cers. Strangles, farcy, horse-pox, &c., cause this and are inocu- lable. Lymphatic horses are predisposed; anaemic animals, overworked horses even though In good flesh may develop the disease over night. A. wound out of contact with the air may give rise to lymph- if germs (septic) are present in the blood; so in "blstournage," SYMPTOMS:- Vary, Reticular lymphangitis- an inflammation of small ves- sels at seat of injury. Swelling of penis in gonorrhoea is reti- cular lymphangitis, but soon large trunks of groin are involved. Intense redness and a well limited swelling. Lymphatics are cord- ed and sinuous; rarely heal by resolution,. As a rule the cord en- larges, skin breaks, and pus flows from the point. 121 Character of pus depends on animal's diathesis, whether glan- derous or not. Cord may not break, but a peripheral infiltration occur called elephantiasis fibroma or "milk leg." Ganglia act as filters and arrest the disease till the ganglia themselves break down and allow the inflammation to travel on to the next ganglia. Preceded by RATIONAL s ymptoms :- depression of spirits* rise of tem- perature, increased pulse rate, local or general chills, thirst, etc., all 24-36 hours previous to the local symptoms. When septi- caemia appears, pulse becomes small and quick; may be insensible. Must give heroic treatment. Any lymphangitis under the skin is deep and may go unperceived till constitutional symptoms draw our notice. Deep abscess and lymphangitis difficult to differentiate in the early stage, especially in cannons of horse, ANATOM, ALTERATIONS:- Valves thickened. Cells accumulate and render vessel varicose. Later purulent foci in the vicinity; these may run together and cause diffused suppuration, or may break on the surface. diagnosis:- Easy. Determine whether specific or non-specific. If in doubt inoculate donkey, mule, guinea pig, rabbit, or dog and wait for results; negative results prove nothing, so use as many animals as possible. May confound a jugular phlebitis and a lymphangitis. See whether the blood flows through the vessel. In lymphangitis the whole region of the vessel is painful, in deep abscess only at one point. prognosis:- Varies. Grave if exposed to purulent or septic infection; more so if a bad constitutional diathesis. treatment:- Acute lymphangitis-antiphlogistic. Local bleeding when pain great, and a dense aponeurosis with pus underneath, or pus near an articulation. Emollients- V/arm antiseptic poultices, and hot antiseptic baths from the beginning. When pus appears treatr- ment changes; apply mercury and cantharides blister, open the parts freely and treat as suppurative erysipelas; several long in- cisions down to pus, ZUILL*S treatment:- As soon as lymphangitis is recognized apply 6 ozs. of a blistering ointment containing Cantharides pulv. 155^, Corros. Sublim. {or Hydrarg Binlodid.) 15?i, Petrolati 705^; all over the leg from hoof to above highest indication of the disease; then apply olive oil. Blebs are present next morning. Horse can work in 15- 20 days; some hair may come out. This is the only acute inflamma- tion that Dr. Zuill blisters, adenitis:- An inflammation of lymph glands. Acute Adenitis points to some lesion of the skin, as by cutting instruments, and is due to septic or raicrobic elements. We have tubercular-adenitis, rhino- adenitis, etc. Two divisions- I. Acute or I. External [Lymph glands II. Chronic nil. Internaljare more sensitive to irritation than lymph vessels. External adenitis of sub-parotid region, accompanied by dyspnoea, roaring, etc. is serious on ac- count of the location, and may be considered as a deep adenitis. ACUTE ADENITIS has well marked symptoms- a hard, round, smooth, sensi- tive and easily movable tumor. The surrounding coimective tissue is infiltrated; finally the gland is intimately adherent to the skin through the indurated connective tissue. 122 It is like an acute abscess, and may break, or become chronic. The pus is thick and creamy, and when it escapes, the temperature falls. Puncture as soon as pus is discovered; if only in the gland may not at first discover ito In the chronic state the gland re- mains hard. May confouiid internal adenitis with deep abscess. prognosis:- Not serious in superficial adenitis. PATHOLOGICAL AJIATOir/ : - Ganglia increased in size, hard, intensely con- gested, violet colored and often spotted with ecchymoses from cap*- illary hemorrhage* The gland contains R.B.G, and W.B.C. and large epithelial cells; the trabeculae becomes granular, and here suppu- ration begins, and converts the gland into a multiple abscess, v;hich soon becomes a single abscess. Suppuration may extend to surrounding connective tissue. The adenitis presents symptoms de- pendent upon the cause and the tissue invol^J-ed, TREATMEINT : - Same as for lymphangitis; local bleedings, emollients, blisters. Alwa,ys allow pus to escape . Is good surgery to make a puncture even if no pus exists; does the gland no hairm, and when pus does appear, it can escape. Prevents pus from extending to deeper glands. In colt distemper open indurated glands as early as possible, and pus may be forestalled. V7e may wait and get no fluctuation, yet deep structures be involved. If an incision 1/2 inch in depth does not reach pus, take a blunt instrument and tear down to pus, or to indurated glands and open them. Enormous enlargement on side of jaw indicates sub-parotid abscess, and is serious from compli- cations liable to occur. Even the eyes may suppurate. Forestall by heroic treatment. CHRONIC ADENITIS:- May arise without the acute stage and acute symp- toms. I.Iay be caused by prolonged suppuration of mucous membranes, as from collections in the sinuses, toe~crack, etc. symptoms:- Purely local. A well defined Itsnp (each ganglion increased in size, and proliferation of connective tissue) from size of nut to a fist, hard, insensitive, movable under the skin. Does not do harm, uraess near important organs; heals by resolution (slow), or by suppuration (infrequent). Chronic adenitis complicates many diseases, as "colt stran- gles"- known as "bastard strangles," In such a case the intermax- illary glands did not suppurate, other glands became chronically Eiffected, and after a few weeks or months suppurated. May occur in any tissue or organ in the body irrespective of lymphatic glands as in stomach, muscles, etc. Cannot diagnose it for a long time. Colt does not do well, back arched, coat rough, lack of spinal re- flex, and finally a soft tumor appears somev/here on body, and con- tains pus. The fistulous track may be very long and take months to heal. Cannot do much, will get well alone when pus escapes, DEEP adenitis:- treat as a tumor. Bronchial glands may enlarge and by pressure upon the recurrent laryngeal nerve (usually the left), cause roaring. Mercurials may sometimes cause re-absorpticin. 125 CHAPTER XVII « DISLOCATIOKS, SPRA.INS, DISEASES OF TEETH» DEFIHITIOIi:- Any change in relation of articular surfaces which inter- feres v;ith normal notion. Three classes :•- I. Congenital » where displacement occurred in utero. II • Spontaneous » gradual displacement. III. Traumatic , due to injury. The first tvro are not treated by Veterinarians. Spontaneous dislocations result from destruction of one or more articular elements as» ligaments, synovial membranes cartilage, etc. Rheumatoid arthritis* osteoporosis, etc., may bring this about. In the latter disease bones of hock or carpus may entirely separate through disease of ligaments. Animals usual- ly sacrificed before this stage reached, Traumat ic dislocation rare, but when it does occur the animal usually useless. Traumatic (a) Complete, "[Dislocation is often a'acompanied (b) Incomplete,) by a fracture, due to the tear- ing av/ay of bone bj;- ligamentous attachments. ETIOLOGY:- Violence „ In young animals the epiphysis may tear away by rupture of the cartilaginous, structure between epiphysis and dia- physis- a true epiphyseal fra.cture. EXTERHAL CAUSES are of two kinds:- I„ Muscular exertion (rare)^ II. Violence. May have forward dislocation of humerus at scapulo- -humeral articulation by horse falling upon his knees. Muscular contraction opposes displacement as do the ligaments. AllATOM. ALTERATIOITS : - Vary with date of injury. Synovial membranes, ligaments, and fragments of bone torn out; vessels, muscles or nerves compromised; cartilage scratched* In chronic conditions we may find a false joint. False joint may finally acquire a capsu- lar ligament, funicular ligaments, an articular secretion and a glazing of ends of bone that answers for artic, cartilage, DIAGNOSIS:- Important to recognize. symptoms:- Abnormal conformation, pain, heat, lengthening or shortening of the member, rapid respiration, usual;iy muscular rigidity of the limb, llo movement of the part on account of muscular contraction, TREATMENT:- I. Reduce, II. Prevent return. III. Prevent complications. I. REDUCE, by extension, counter-extension and coaptation. Great power necessary. Certain manipulations may effect a reduc- tion with less force than by direct extension: Ex.- When head of femur is in obturator foramen place animal on its backs abduct the femur to lift head from the foramen then rotate outward, forv^rd and downward. Most movable articulations way be reduced by rotation, II, PREVENTION OF RETURN:- Difficult in animals. Ill, PREVENTING COHPLICATIONS : - As in fractures. COMMON dislocations:- NECK:- (Not a true disli^cation) « If the extreme limits of normal movement are surpassed there occurs a strain of ligaments. 124 ETIOLOGlf:- Accidental. Animal attempts to scratch head with hind toe, catches shoe in halter and falls either on concave or convex side of neck. Heck shows displacement of cervical vertebrae, perhaps sloughing of muscles of neck, but no paralysis. Easy to reduce, but head immediately returns to the side. Sometimes the head re- turns to its normal position after a time. There may be a double curvature . Pain great on movement, gait interfered with, and ani- mal nearly valueless. The articular surfaces are in contact and surrounded by their capsular ligament, though the cartilage may be ulcerated and bones crushed on the concave side. Aiikylosis occurs in a few weeks, after which the neck cannot be straightened. DIAGNOSI S : - S impl e . prognosis:- Grave, but may get well without treatment. TREATMENT:- Place animal on its side with convex side of its neck up- permost. Place knee on neck and reduce. To maintain in position run several small elastic rubber laces (tubing) from rings on the perpendicular strap of the halter to rings on the surcingle, as:- DISLOCATION OF PATELLA. Patella usually displaced outwards. Many say that the patella is not displaced, but that by extension of the limb the in- ternal condyle of the femur hooks beneath the patella between the internal and me- dian patello-tibial ligaments, possible in weak, loose- jointed colts. Prof. No- card says; this condition fr.equently oc- curs in animals convalescing from debili** tating diseases, in weak colts, and does sometimes occur in strong horses. When displaced, it is always outward . Congenital dislocation may be due to failure to develop of external condyle of femur. prognosis:- Favorable when animal regains vigor, and muscles their tone. TREATMENT:- Replace by striking animal with the whip to produce sudden muscular contraction; or with bit in mouth throw horse suddenly back on his haunches. If unsuccessful, cast and draw foot up to shoulder as for castration; or better, put a sideline on the cannori, and draw the leg f onward tov/ards the collar and fasten. Now make the horse struggle in order to cause the crural muscles to contract and replace the patella c Keep the leg constantly forward, attach- ed by sideline to the collar, for from 7-10 days, using slings to prevent the animal lying down. May fire or blister to create in- flammatory tissue, or to produce pain and assure more complete rest^ DISEASES OF TEETH. Consult Chauveau for the histology and macroscopic peculiari- ties of the teeth, anomalies:- a, supernumerary teeth « both incisive and molar. Not se- rious in the incisive arch, but on molar arcade may be a seventh molar- "wolf tooth"- which does harm only when not worn by the 125 first molar in the opposing jav;,, In such case it continues to lengthen till it may puncture and produce an ostitis of the oppo- site jav/» or may grow outv^ards and wound the cheolc, or inwards and lacerate the tongue^ Bad driving, and impei'fect mastication re~ sult« B, Un even vr earing of outside of upper and inside of lower mo- lars so that lateral motion is impeded or prohibited often occurs in horses that eat much soft food, or that bolt their food. As soon as the teeth begin to wound the gums and cause pain the move- ments are lessened and tho condition increased. The food accu:mi- lates in the cheeks » ferments and may cause an ostitis of the jaw. Ostitis of either jaw may result from an elongated tooth due to misplacements or absence, or excessive softness of the opposing tooth* The opposing tooth may have been extracted, or broken off, or misplaced. In "over-shot" (parrot) mouths the posterior molars of the under jaw are not completely opposed, and may from lack of wear gro\7 low and puncture the upper jav/. First molar of lower jaw may perforate roof of mouth (palatine process of supex'-raaxil- lary bone) and fill the nasal canal v/ith foodc This food ferments and becomes offensive* An odontoma, which is a piling up of cem.ent substance, may press on nerve53 at infra-orbital opening and cause continuous facial neuralgia,, DECAY OF TOOTH is progressive and slowp Begins usually on the free sur- face making a discoloration and finally a cavity which dips into the pulp, and fills with food vmich ferments. Causes are trauma'- tisms and fermentation^ SYl'IPTOMSS" Painful mastication., "quidding" food, emaciation, much food swallov/ed whole, dull colicky pains, dung not in balls, but in a mass till true diarrhoea appears and empties the bowels of irritat- ing, non-masticated food. Soon the animal recovers, tone of bowels only to repeat the process^ This periodic, diarrhoea ia indicative of bad teeth. DIAGNOSIS :~ Horse "eats badly," has no appetite; we find food on the dental arcades and recognize foctor of the breath. There may be a "collection of the sinus" in connection v/ith decay of a superior molar. Decay of the third upper molar is usually especially pain- ful on account of involving the superior dental nerve trunks. TREATMEIIT:- V/ash out mouth with hose, and pick out decayed food. Ex- tract, or cut off offending teeth* DRESSING TEETH:- Olden time farriers leveled dental arcades by allow- ing horse to champ upon a flat file. Later a chisel and wooden mallet were used to knock off sharp points. ( llovj- used at the Ber- lin school). This dangerous, and apt to wound the pillars of the tongue. Bourgelat invented the plane and chisel with loaded han- dle. This instrument will remove small points, but may dislodge a short projecting molar. Various instruments for cutting off teeth:- 1st, a chisel moved against a shoulder by a screw, this has been modified by striking the chisel when pressed against the tooth. Rasps are various:- flat and angular. Eiiropeari Veterinarians give a hypnotic before operating; they often cast to prevent chips of teeth from entering the trachea, A saw-chain nov; used to cut off teeth; keep the sav/ cool vrhen using. 126 TREATIIEITT OF DECAYS- Removal of tooth. Difficult to remove a large tooth from lower javr by drawing « and is dangerous to trephine and Tpunch out . When out we may have to make a counter- opening ( should do so) to allow food to pass out of alveolar cavity. To remove upper teeth trephine. Roots of third aiid fourth molars are in the inferior maxillary sinus. Roots of the third upper molar are very near the facial nerve. Wash out through the trephined skull from 18-'24 days, will then be healed. In lov/er jaw Me can trephine the first 5 molars; must cut through massetor for fourth and fifth, cannot reach the sixth* On the teeth of house dogs that get no bones, tartar collects and causes offensive odor, sore gams; may cause loose teeth, if so remove them, "Bones are a dog's tooth-brush, » Scrape the tartar away and apply Tr. Myrrh to harden gums, then give bones. Filing dov7n teeth of a vicious dog v/ill cure hLm of biting, SPRAINS . When a traumatisn is insufficient to produce a dislocation it produces a sprain. Common in the fetlock and loins, PETIjOCK;-' Anatomy ^ a perfect ginglymoid joint, but two movements pos- sible, flexion and extension. When lateral violence is exerted the lateral ligaments (external or internal) are wholly or partial- ly ruptured or periosteum at point of their attachment torn. Check tendon may be strained, ALTERATIONS : - Fibres ruptured, extravasation of blood- may be muscular rupture. In young animals the periosteum may be stripped away or ruptured, and splints, spavins and other bony tumors result, SYliPTOMS:- Sudden pain while moving. Lameness varies from a simple feint to great lameness. Hot, painful, oedematous swelling. May have complications of synovial membranes and suppurative synovitis. As a rule passes from acute to chronic condition. Oedema replaced by plastic lymph, v/ith thickening of tendons, and enlarged joints, an unsotindness even if no lameness, because it predisposes to inter- fering, emd partial turning of foot toward affected side, PROGHOSIS:- Serious, because in a mobile joint. If synovial membrane suppurates and ankylosis follows, the animal is useless. Osteo- phytes or exostoses also result and may predispose to interfering, stumbling, &c. treatment:- If called early, antiphlogistic- COIITINUOUS irrigation with cold water. Surround the limb v/ith perforated tubing and irrigate night and day . If we can diagnose rupture of tendinous fibres, place the foot in a fracture dressing that can be treated to con- tinuous irrigation as, guttaperch a. Best is the lump gutta percha^ Put the gutta percha in hot water to softeii, and mould bands of it^ to the leg v/hich has been covered with a tern layers of wet flannel bandage. To harden the bands pour cold water over thoo. We can novr allow water to run in betv/een gutta percha and the slcin. To remove the bands put the foot in warm water. When the sprain is old and stiff » may apply a blister or cautery (this the only treat- ment). Slight lameness of old sprains combatted by persistent use of hot water 2-5 times daily for 2-& weeks, for 5-10 minutes at a time, followed by ice-water for 10 minutes. 1S7 SPKAIIJ OF LOINS. SYMPTOMS:- Pathognomonic rigidity of spinal column- much like tetanus; anterior legs abducted, vertebral column arched (may be lateral curvature), tendency to assume and remain in any position; no mat- ter hovT awkv/arde If he drops from v;eakness, he rnmains do\7n till forced to rise. On attempting to rise he v/ill first extend the fore legs, then rest» finally sit on hi^ haunches like a dog and remaizi till molested. If urged he \7ill then ""throw himself from a sitting to a standiiig position v/ithout bending the back or flexing the legSo" Will get up sonowhat like a horse with azoturia, though in sprain a horse is stiff every\7here except in the shoulder and neck a Xp, walking the posterior extremity s'.^ings around, and the legs are strongly adducted ; tnay even cross so that the left foot may be on the right side, and right on the left side. "May be a space of 2ft« botvreen theso crossed feet." This incoorditnation is due to pressure on the spinal cord by inflammatory exudation, and is no- ticed v/hen the horse is backed; then the fore legs move back till they may even become posterior to the hind feet, yet the latter does not stir. Such a horse vTill never be able to carry v/eight up- on his back, but may pull a light load. causes:- Weight on back when animal too young; muscles tire and spinal column drops till articulations are strained or psoas muscles strained in attempts to arch the back against the load. Shaft" horse in stone T/agons may stumble and fall; the lower the shafts go the heavier the load upon the horse's back, and in this 7;ay this sprain often happens. "Broken backed" means sprained a not neces~ sarily a fracture of vertebrae, TREATIIEHT : - Hone other than rest in pasture for one year. 128 CHAPTER XVIII « DISEASES OF TESTICLES AlW ENVELOPES. 4//r^/f/o/^ DIAGRAM OF LEFT TESTICLE. 1, Superior ring. 2. Inferior ring, 5.5. External Commissure, 4.4. Internal Commissure. 5.5,5. Skin, 6,6,6. Dartos {Tunica Ery- throides). 7.7. Ventral Muscles. 8.8,8. Fibrous tunic (Fascia Transversalis). 9.9.9.9. Timica Vaginalis (Parietal Peritoneum). 10. Cavity of Scrotum. 11. Testicle (covered by Tunica Propsia and Tunica Albuginea), 12*13. Epidldyrnus. 12. Globus major, 15. Globus minor, 14.14. Yas deferens- 15,15, Testicular artsry, vftin an'i 129 nerve. 14*15. The "cord," 16, Floor of Pelvis, 17,17<, Cremaster ( only the upper part ) , SARCOCELE. Called also "Epididymitis," or more properly "Orchitis", is chronic, CAUSES : - Numerous » I« Idiop athic under a glanderous diathesis. Passes in- sensibly from acute to chronic state, II* T raum atic ( occasional )<> Ills Genital excitement under a constitutional diathesis. SYMPTOMS?- General depression, loss of appetite, abduction of hind legs, stiff movement; subdartoid tissue pasty, but the testicle hard, painful and enlarged. Oedema of skin and cord follows hardening of the testicle, and you may suspect hernia^ Later, the inflamma- tion subsidesjr but the hard testicle remainso A neoplasm is ex- cluded by the pain, swelling, heat, &c« TERMIIIATIONS : - Resolut:::on when due to traumatao Gangrene T7hen tissue crushed^ or inflammation is hyper-acute, suppuration follows and opens outffarda Atrophy of testicle and KetMEslXE adhesions i?iay fol- low chronic inflammation; the organ turns to connective tissue. ALTERATIONS s- Yellov/ serous infiltration of sub-dartoid connective tis- sue. The tunica albuginoa limits the exudate outwards <> Exfolia- tion of squamous cells of semeniferous tubules; thickening of ef- ferent duct and tubules, and both filled v/ith fluid. In glander- ous diathesis the iiif Icinmation starts from cells in semeniferous tubules. Humorous multiple abscesses may result, or gangrene from pressure of s\/ollen testicle outvmrd against the tough, inextensi- ble tunica albuginea. Atrophy, and usually a chronic or sub-acute inflammation follov^s, DIAGNOSIS:- Easy from symptoms. May in fev/ days confound sarcocele and hydrocele, for the two may be associated, though tru e hydrocele is non- inflammatory , comes on slowly and in large quantities. Hernia may accompany sarcocele; known by the intense colic produced, liake a rectal examination, PROGIIOSIS:- Always serious; resolution rare, especially if due to a constitutional diathesis. lIocaraL says, 9 out of 10 cases are due to glanderous diathesis, hence we must isolate animals, TREATMEl^T:- Laxatives « suspensory bandage (4 tailed) to support testi- cles. Do not put poultice of bran in the bandage, but a thick pad of cotton TTool? which gives both support and warmth. C ontinuous i rrigatio n by a fine spray is excellent in the early stages. If seen after a few days and cause uiik:no\7n, we may operate to deter- mine v;hether or not due to glanderous diathesis, Zuill advises ' less haste. There may exist a haematocele from traumatism*. In operating, certain possibilities should be borne in mind; the sper- matic vessels distended by formation of connective tissue may look like a huge bundle of vTorms, or from weight of the organ a hernia may exist. Cast as for castration or hernia. Incise scrotum and dartos to the fibrous tunic which is thickened by a lemon-yellow serum; do not cut through this, but dissect it and the vaginal sheath as 150 high up as possible and apply a curved clamp, high up, over sheath and containsd cord, and allow to slough off, this is a "covered op- erationo" If no h ernia exists , cut through and expose the testicle with its enormously enlarged (varicose) vessels^ Place chain of ecras- seur as high up on cord as possible, and talce 2-5 HOURS in cutting off. May improvise an ecrasseur to constrict, hut riot sever, the cord high up, by running a strong double cord through a piece of metal tubing and bringing the loop out on the side of the tube near one end, as:- r'Oi n >j TOURNJiQUifT 4o7- CORD Apply, and let cord slough off. B'ollowing castration is an oedema of scroti^, sheath and bellj^ ama exercise usually all that is needed to drain away the serum, pus, &c. If the oedema be hot and painful, deep scarification may be resorted to. A permsjient oedema affects also the cord, and is qalled "champignon" {Fr« mushroom) or "scirrhus." It is an indura- tion of the cord, vyith finally miliary abscesses in the dependent pockets of the testicular artery, vein and vas deferens. Extr a scrotal champignon is a mushroom-' like growth of granula- tions at the end of the cord in contact with the air. ETIOLOGY:- Liany, and often obscure causes. A .long, cord caught in the cicatrix may cause extra-scrotal champignon, French Veternarians always do the covered o peration , but this itself very often causes champignon. Castration by torsion most apt to cause champignon. Violent traction on cord during castration especially \?hen the clamp is closed by the forceps. Clamp too high on cord, is pushed ddwn by subsequent oedema, and cord torn, Olamp too low leaves cord too long; cord always relaxes in fi*om 5-5 minutes after an oj)- eration. Wait for relaxation before applying clamp. Extreme cold in Russia said to be a cause. Lymphatic horses more prone. Lack; of exercise : no better time to break a colt; if a stallion, then drive to harness. Unsanitary stables and hospitals . Castration of the standing animal and the steel clamp are fre- quent causes. The hand must grasp the cord very tightly, crushing and bruising it; and cannot relax .till the testicles are out, the ecrasseur applied and the cord severed. Thus also, the cord is often left too long, and" scirrhus," hernia, etc. may result. The standing operation, while it may "catch the eyes" of the laity, is never to be advised; it shows a lack of appreciation of the gravi- ty of the complications that may arise. EXTRA-SCROTAL:- SYMPTOilS (none constitutional). 1, Voltjminous, tumor-like mushroom. 2. Discharge of bad-naturcd pus. 5. Mi enlarging moss of exuberant granulations, INTRA-SCROTAL:- S.Yra2tOTis; (general symptoms marked). 1. Excessive, hot, painful oedema extending from belly to anus JFear champignon, 2. Back arched, and loins and legs stiff. 5. Marked lameness often. 4, Extreme debility. 131 Finally -when oedema is gone, animal may not regain condition. MakG rectal and inguinal examinations and find pus in inguinal re- gion„ Gait slow, dragging; may be marked unilateral lameness ■which soon disappears leaving a hard sensitive tumor. If the induration extends high up the cord make a r octal examination. I/Iay be old cicatrices or fistulous tracts on scrotum, skin adherent to ttunor, and much hard connective tissue. Fistulous tracts constantly ap-^ pearing and closing; may continue for years, and constantly ascends the cord, so that an extra- scrotal may finally become an intra- abdominal. Make rectal examination to determine how far the dis- ease has advanced; Mrhother the superior ring is patulous and will allov/ a loop of intestine to descend, otc» Do not operate if the disease is intra-abdominal » DIAGNOSIS :- Easy, from symptoms « AlIATOMo ALTERATIOIIS:- Merely inflammatory. 1st. A serous infiltration followed by inflasTimatory thickening of cord and scrotum. Cicatri- zation of stunip of cord, and rapid healing, vfhen drainage good, and conditions favorable ^ If bi-uised vessels are left phlebitis developes, which may end in resolution as adl'iesi'vc phlebitis, but usually runs into the sup- £ii51§i.i:ZG stage p Blood, pus and other liquids contained in the vessels of the cord gravitate to the most dependent parts of the tortuous ve3,sels, there remain and form foci of suppuration (multi- ple abscess) vvhich run together and discharge through one or seve- ral fistulous tracts. This condition ascends the cord, and may reach the abdominal cavity and set up a fatal peritonitis, or a general pyt.or:iia« treatment:- Follov/ing castration always drain away the oedema by exer- cise, scarification or hot iron. May make 100-SOO punctures, next drain away all pus, and v/ash cavity with antiseptics, Use needle spray of cold v;ater to put do-vm inflammat ion ^ Keep wound antiseptic. This is the extent of prophylaxis. If champignon de- velops , wait 2-S months before operating. Remove every portion of diseased cord or condition will soon return. If extra-scrotal, scissors and elastic ligature or ""ecrasseur only are necessary. If intra-scrotal it is more difficult; if intra-abdominal do not oper- at^e, OPERATION:- Hobble and cast on sound side. Take hind upper leg cut of hobble and secure with two sidelines; one carried from cannon for- ward parallel to body and secured to a post; the other at a right angle to the first sideline and simularly secured. One line holds the leg forward, the other keeps it strongly abducted. Make inci- sion as for castration by c overed operation : dissect up and put ecrasseur on s ound cord and take off. If diseased cord runs too high to admit of this, do uncovered operation and cut on sound cord high upo May ligate large vessels. May tear put an adherent tu- mor by fingers or curved scissors; not by a knifo for fear of hem- orrhage. When ready, place chain of ecrasseur about cord and re- move by twisting handle very slov/ly . for the vessels are very much distended v. (varicocele). An old champignon does not give so large a hemorrhagei,as a recent one, and may be removed quite as rapidly as a castration is done. After treatment as for castration. 1S2 HAEMATOCELE. DEFIlIITIOll:- An enlargement of the scrotum duo to extravasation of blood into ono or more of its tunics. CAUSES : - Tr auma t i c • symptoms:-" Exclusively local. Back arched, hind legs abducted, sudden appearance of immense tumor which fluctuates. The skin from dis-" tension is tense, smooth and shining. In a few hours the blood coagulates and the tumor crepitates when the clot is broken up with the hands. A few da.ys later clot and serum separate, and some fluctuation returns. Later inflainmatory oedema, and still later induration follow„ The characteristic s;pn-etdm j.s the cre-pitatio n. Always make rectal examination. Do not have hernia and colicky pains with hae-* matoceleo Always history of sudden development, due to traumatian. TERMINATIOIIS:" Resolution, or more often gangrene of testicle and en- velopes through pressure from clot, ALTERA-TIOHS.- Ecchymoses or contusions in skin and inflaTmation, The clot dark-brown., whitish if old» and always having a concentric structure and appearance denoting successive hemorrhages. Each bleeding flovjs till the external pressure equals blood pressure. A clot then forms, and in time serum separates, is partly absorbed, external pressure is lov;ered and another hemorrhage occurs o These layers of fibrin grow darker toward centre of the clot where no ab- sorption of haemoglobin can take place. Common seat for haematoma is in mesenteric folds. They tend to indefinite increase in size. diagnosis:- Haematocele developes suddenly; sarcocele requires months. H ydrocele also grows slov/ly, accompanied by no oedema, and gives no crepitation, but yields uniform fluctuation. Hernia gives col- ics always : haematocele never. Chronic inguinal hernia develops suddenly . Never fail to make rectal examination in testicular dis^ ease of stallions, prognosis;- serious because castration is necessary, and complications of pyaemia or septicaemia may result, treatment:- TVhen mild and slight treat by cold continuous irrigation, or cold and astringent poultices. Can hasten resolution and ab- sorption by a light Iodine blister. If these remidJe s fail per- form castration with a covered testi-cle. Incise scrotum carefully ^ layer by layer. May find bloody clots between skin and dartos, al- so between dartos and vaginal sheath. Bring vaginal sheath out through incision in skin and dartos, and dissect it well up into inguinal canal. Apply a clamp well up, and cut off testicle cord and their serous covering. Allow cleanp to slough off. The uncov- ered operation is contra-indicated because there is a vaginitis from traumatism, and if this sac is left the vaginitis may extend and cause a fatal suppurative peritonitis. HYDROCELE. Is a hypersecretion of serum from the vaginal shoath. There may be great distension. Two kinds : Essential and symptomatic, the former being rare. 155 ETIOLOGY of sjmptomatio fonrio Develops after some derangement of blood vessels. Ascites of abdomen may descend and cause hydrocele* Hernia may descend into vaginal sheath, obstruct venous circula- tion in tho cord, produce passive congestion of testicle and scro- tum v;ith consequent dropsy. Always more or less serum accompanying a chronic hernia; also a blood stained serum in sarcocelo. ' Liquid of hydrocele is stravz-colored and tfithout fibrin. The testicle Is. al\7ays high up on the posterior side of the tumor . Do not forget this! DIAGNOSIS:- When a lighted candle is held behind the scrotum the latter Tfrill appear translucent. This may fail. If the animal be placed on his back the hydrocele will pass into the abdominal aavity. Weight of the liquid may pull on anterior muscular wall of inguinal ring, cause it to dilate and a knuckle of bowel may descend into the scrotumoC oscheocele). We may be able to pass the hand through the upper ring in a rectal examination to determine the condition of this opening* TREATMEI^Ti- Not as for man by aspiration and injection of Iodine, be- cause of communication of vaginal and abdominal cavities^ T/hen upper ring is not large, but a hernia does exists we may reduce the hernia and castrate; but if upper ring is large the gut would de- scend, rest above and push the clamp off. In such case do the covered operation, dissecting the sac vrell up toward the upper ring. Before putting on a clamp always close the canal by twisting it and cord several times to narrovf the canal, then apply clamp, sjad gut will not descend. CHAPTER XIX, DISEASES OF WITHERS AND POLL, withers:- is that part of body between neck and back, and its base ex- tends from first to the eighth dorsal vertebra. The superior spiw nous processes of these vertebrae are the highest on the back. The tissues are in seven layers, I, Skin (thick and loose) and hair of mane, II, Sub-dermal cellular tissue; on median line yellow elastic fi- bres dense and loaded with fat and adhering to spinous proces- ses and to skin. III. Dorsal trapezius attaching to lower part of funicular ligament, IV. Cartilage of scapula. V. Rhomboideus muscle inserted beneath ligament and internal face ©f scapula. VI. An aponeurosis between rhomboideus and ilio-spinalis, VII. Ilio-splnalis, aiad on deep face the tJf^msVerse spinous covering vertebrae. Silmmits of spinous lirocesses spongy and ealarged. ARTERIES ard brfiirtchea of Dpysal and intercost als. Veins are branches from spinal and AoTSai pairs, ETIOLOGY:- Conformation bf wither s- low thick withers more exposed to pressure from harness and saddle. 154 Skin diseases, excessive lameness or fatness, and inequality of pressure of saddle are frequent causes. SIMPLE EXCORIATIOII : - by chafing of harness in warm v/eather. Hair %7ears off dovm. to follicles, and finally to rete mucosa. It becomes sen- sitive, exudes a yellov/, citrine liquid which dries on the surface, and in summer soon become "granular v/ounds," V/e must treat to pre- vent this condition. C0E2IS OF WITHERS:- A simple limited dry gangrene produced by the sad- dle pads through continued pressure , A single v/oiind cannot pro- duce them« There is first a sv/elling \7hich increases the rubbing, finally, the circulation is impeded and gaiigrene results. Most common location is betv/een folds of skin on back of necko symptoms:- Small swelling first seen an hour or so after collar is re- moved. This swelling is very sensitive and the animal resists all manipulation of it. Hext, a slight depression, and finally a fur- rough of separation with the depressed scab in the centre. Pus soon discharged from the farrough and continues till slough is elim- inated,, If animal continues to v/ork the slough extends to deep muscular layers and even to bone, and the discharge becomes ichor- ous. Fistulous withers may result. SITFASTS:- formed under saddle, arc caused by pressure, and are merely exaggerated corns, and may bo termed, "corns of the back." There may exist a very adherent slough of size of a hand and extending into the bone. Bad natured pus exudes. Do not tear av;ay the slough forcibly; allov; it to cone av/ay of itself. It is usually cone-shaped- its base being at the akin and apex inward. By tear- ing it from its fibrous attachment we open the lymph spaces at bot- tom of the v/ound, where pus collects and may cause a fistulous con- dition. This cannot happen v/hen the granulation tissue is intact; therefore, favor elimination naturally, ALTERATIONS:- Simple, Pressure has obliterated the blood vessels, starved the tissue, and gangrene (itself an irritant) is tho result. DIAGNOSIS:- Easy. PROGIIOSIS:- Hot serious, except v;hen on the median line where connec- tive tissue is dense and abuiidant, ACUTE OEDELiA OF V/ITHERS:- Frequent. Due to pressure and chafing in hot weather. symptoms:- a hot, painful , ill-defined oedema which pits on pressure. Differs from most oedemas by being hot and p ainful , though not so painfttl as corns and horns. Subsides in a few days when cause is removed* Cold abscesses of vvithers always begin by a hot oedema, due usually to a misfitting collar. Traces when attached too near bottom of collar may cause this condition at top of neck, A cure is effected by fitting the collar and giving rest, but gangrene will follow If not, HAEtiATOlIA:- or blood tumor of withers may result from bloXTS, bites, etc. This swelling forms immediately and fluctuates. Do not confound with an acute oodema, \yhich is hot and sensitive, while blood tu- mor is notp The latter grows hard in a few hours and crepitates on pressure. Some softening when scrum has exuded from the coagu-* lum. No pain, except what is duo to traumatism. 155 A fevr days later inflanmatlon arises, the swelling becomes hot and painful, but this is secondary to the blood tunorc The ordinary hot oedema from collar pressure is primary and occurs in a fev hours* ALTJSRATIOIIS : - Those of any sub- cutaneous blood tumor^ Cyst may result, CYsi OF withers:- Caused by chafing of harness without rupture of doop tissues. Serum escapes into connective tissue and forms a cavity filled with fluid. These cysts are sub-dermal, while blisters are betv;een derm and epiderm. Cysts may be on median liao of neck, or on sides; may be bilobed and as large as a child's head. No tendency to disappear, and no heat nor pain, TREATMEIIT : - Convert into an abscess e^nd open, ABSCESS OF withers:- Caused by collar, traumatisms, etc. SYMPTOMS:- The region is hot, painful and swollen, and there may bo an oedema between the fore-legs. Temperature may be 102 "-102, 5 F, Tumefaction diffused, always hard at first, finally fluctuates, and surrounding tissues become indurated. Points of softening ap- pear, the skin thins and breaks, and pus is discharged, Meem^rhile pus has macerated and caused necrosis of all sub-dermal tissues; even bono and cartilage, TKEATlflLlIT : - For erythema (abrasion) remove the cause {harness, saddle, etc). Apply a cold poultice in hot v/eather- may moisten with v/hite lotion. Moisture prevents irritation caused by drying, and the formation of "summer wounds," May apply an oil dressing, COBWS:- A corn is a dry gangrene, seldom more thaii s/10 of an inch in diameter, situated botv/eon tv/o folds of skin on the back of the nock and the beginning of the v/ithers. It is intensolj? painful, and the animal will fight against all attempts to handle it. Cast and rub a blisteriiig ointment deep into the folds of the neck. This blister in 24 hours removes the acute sensitiveness, produces swelling and janoothos out the skin, brings the corn to the surface and SC allov/s it to fall off, and the neck to heal. Warm poultices hasten elimination. The twitch or opium applications are not suf- ficient to take the place of the blister. If pus appears, give free drainage. Fistulous Avitliers may arise from extensive corns, cysts:- Use trocar or aspirating needle to find out contents of cyst. May open an abscess freely, but never a blood tumor or cyst, be- cause they are not protected by granulation tissue, and germs may take root there, grovr, cause septic invasion, extensive sloughing, or even a suppurative phlebitis, A1^7ays convert the cavity of a soft, fluctuating, non-painful and non-inflamraatory tumor into a pus cavity. Aspirate and apply a light blister to thicken the skin and produce granulation tissue OfR the wall. Aspirate again in a few days, and apply- anijther blis- ter. As soon as the serum Trithdravm is cloudy , inject I«^g1*s So- l«tion (1 part to 4 of distilled v;atcr) to set up some inf^^nmat ion. Do this till you know that plenty of pus exists and, that the lymph spaces are covered hy granulation tissue, then open as an abscess, drain and keep it clean. Thus treated they will heal kindly. 156 DISEASES OF KECK. SURGICAL ANATOlylY:- For osteology of this region consiilt Chauveau, OCCIPITO-ATLOID ASTICULATIOII presents in the occipital bone two condyles which fit into two anterior cavities of the atlas, A single cap- sular ligament surrounds this joint. It is strengthened above by the "cruciform" ligament, and on the sides by lateral bands/ and is enveloped by the cervical ligament, straight muscles of head, small oblique and great complexus. There are two, synovial mem» branes, one for each condyle « All movements are possible to this joint. ATLO-AXOID ARTICo An odontoid pivot and two diarthrodial facets on the axis opposed to a semi -cylindrical surface and two analagous facets on the posterior extremity of the Atlas. The ligaments are four in number J ~ 1, An odonto-atloid, 2, Superior atlo-axoido 3, Inferior atlo-axoid, 4, A capsulars There is one synovial membrane for centra of vertebrae*. All movements possible, LIGAMEIITUM NUCJUE:- Extends from occipital bone to second dorsal ver- tebra. Is in two parts, a f unicular and a lam ellar, both of \7hich consist of yellow elastic fibreso Above the funicular portion is much fibro-adipose tissue. The .tissues of the neck are in 8 layers^ 1. Skin and sub-cutaneous/tis.qiie'. •'='*> ^■''^'^*^''''* 5, Pearly aponeurosis of vertical fibres, splitting and em- bracing mastoido-humeralis. 3. Trapezius. 4» Angular is. 5, Splenius. 6, Great Complexus. 7, Small muscles interwoven about vertebrae. 8, Lamellar portion of rmchal ligament, ETIOLOGY:- Depends much on nature of \rork, and kind of harness. The collar by pressure on nuchal ligament may produce haematomas, phlegmones, bruises, excoriations, oedemas. Horse may fall and bruise neck against collar and cause a deep abscess. Weight of colla r predisposes to "mal de nuque," especially in old draft stal- lions, because crest of nock undergoes fatty degeneration, has lit- tle vitality, and hangs to one side. Mange of manes of horses, caused by an acaris, produces itching, rubbing, scabbing and sloughing. CORNS OF HECK:- A dry gangrene from collar pressure. Very sensitive while the dead tissue is attached to the living. When furrow of separation forms, pain largely disappears. Never tear out forcibly; treat to hasten natural elimination. If untreated this gangrene may extend into nuchal ligament, TREATMEI'IT:- Cast, and rub the neck 10-15 minutes with soft soap to re- move sebaceous collections from the skin; then thoroughly rub in a blister containing Mercury. Repeat in 48 hours™ Blister of no value, unless neck first well washed. 157 ABSCESS OP NECK:- may form between nuchal ligament and the deep niusclesi hence must be opened as soon as diagnosed. ■ Use trocar in examina- tion. This abscess is not sensitive, sub-acute, gives no fluctua- tion, may be confounded \yith other tumors. V/e usually find necro- sis of ligament, and often of bono. Opsn freely, and treat as an open vfound, SEROUS CYSTS on crest of neck are superficial and bilobed. CoTnmon in old stallions, and rre treated ar; other cysts, "UAL DU IIUQUE" is an inflammation of the nuchal ligament from any cause. The lamellar portion will always necrose forv/ard tov,rard occipital bone; the funicular portion necroses backward. If a deep abscess exists here, opened it becomes a fistulous tract, discharging shreds of tissue and ichorous pus of a "soapy" feeling. This slimy feeling is characteristic of necrosed tendon. If the fistula runs to necrosed bone there may be a sx^cissKSCEtRx calcareous infiltration of walls of the tract. Pain not great. DIAGNOSIS easy. PROGNOSIS grave, according to location. If funicular portion is attacked it is difficult to limit the slough, but it Js. easy to drain. If the lamellar portion is at- tacked the pus goes downv/ards and forwards, and may get so deep as to raalce it difficult to drain, DISEASES OF POLL, Are excoriations, bruises, cysts, abscess, necrosis, etc. T he tissues are in 2. Ig-.yers :- 1. Forelock, 2. Thick skin. 3. Thick layer of fatty tissue, 4. Ligamentum Huchac and termination of Splenius, 5. Tendon of Complexua; Great and Small Oblique, and between them the Great and Small Posterior Straight muscles of head. 6. Capsular liga^Tlent and synovial bursa. 7. Atlas, and atlo-axoid articulation in v/'hich is a small space where the cord is unprotected by bone ( "pithing" done here). ARTERIES are Occipito-muscular on surface of posterior straight, and Atloido-muscular parallel to ligamentum nuchae and a counterpart of the former; therefore, all incisions must be between these two €irteries and parallel with crest of the neck, ETIOLOGY:- Traunatissrs, disposition of this region, halter-pulling, etc. "Cysts of the poll probably not due to glanderous diathesis." Excoriations, haeraatomas caused by chafing of harness in hot weath- er, especially if straps are too heavy and too loose, CYSTS:- I, Superficial- due to harness. II, peep, ia dilatation of articular sjrnovial bursa and is bi- lobed, and non-sensitive unless irritated, and then may terminate in suppuration, T/Vhon pus forms the fluctuation is more obscuroo 138 SYMPTOMS-- Animal perfectly motionless with head extended. VThole body moves when head moves, as if animal had swallowed a fish pole^ Causo is pressure of pus on spinal cord. TERIIIHATIOIIS of atloidean hygroma are generally suppurative, DIAGIIOSIS:- Easy. Findhygroma and satisfy ourselves by puncture* that 1+ is hygroma and not abscess. treatment:- Capillary puncture, follov/ed by blister, actual cautery in points, or an injection of Lugol's Solution and treat as cyst of any other region. PHLEGMOli:- May appear spontaneously- follovring violence, and generally outside of the tendon. SYICPTOMS:- Animal irritable, and the part very sensitive, llay have to cast to diagnose betvj'een cyst and abscess. TREAT1.IE1IT:- If the cord is not affected, wo drain the abscess and keep the cavity clean; but if not done for several days the condition becomes very serious. We must operate early on account of the na- ture of the tissues. If v/e should open an arterial trunk it would bleed in a steady stream; pack with oakum and leave for 24 hourso This disease often terminates in "poll-evil," v/ith much bad natur" ed pus, and finally a cavity surrounded by necrosed tissues. POLL EVTL:- Very serious; may result in anchylosis of occipito-atlold articulation. PROGIIOSIS:- grave in proportion to proximity to cord. TREATIIEIIT : - Surgical, Opens put in drainage tube and keep clean. Vihen the fistulas persist and a perrTanent pyogenetic membrane forms V7e inject Iodine, Silver Nitrate, etc. In necrosis of liganentaj-m. nuchae v/e mv.y excise a portion of iho to:idon over the Atlas, scrape the bone, and prevent entrance of germs by a tight, close dressing. If the bono is not scraped ( not so good treatment ) we may treat as an open wound. Head will drop, but come up in a fev^r days. V/e can also make a sub-cutaneous section of the ligament pos- terior to the diseased part, and so limit the necrosis. The head will sink, the ends of the ligament bo drav/n apart, vasoular cica- tricial tissue v;ill form and necrosis v;ill stop when it reaches this point. CHAPTER XX. U II CLASSIFIED DISEASES. TUMORS;- are so thoroughly and completely studied in the course in Path- ology, that it is deemed inadvisable to discuss them here. I will only give pr^ Z uill's Classification of turaors_of_the. testicles. Group I. "Malignant;" Carcinoma, Sarcoma, " II, Cysts, Dermoid, etc. " III, Multiple tumors as, Enchondroma, For information consult Smith's or Stengel »s notes of Guiteras lectures; Greene's or Ziegler's pathology. 189 CRAPAUDINSa Also called '"^Smish of the Coro nary band" affects many hcrrsea Ox warmer clinies, and is seen sometimes in our own. causes:- For a long time traumatian i?as supposed to "bo a causoo ITocard found a myce lium to which he ascribed the disease « Both arc prob- ably factors, though the germ is probably more a ccidental than causative. symptoms:- Seen in coronary band; a dry, hard, fissured tumor extend- ing well up or down according to age of the disease. Horn is fis- sured usually transversely sutid not entirely through the derm. "When, through the derm the cracks fill v/ith a serous fluid of the foetid odor of thrush. The older the disease the wider and deeper the fissures, the more inf laiixmat ion and the greater lameness. Lameness like that of too-crack; when weight put on the foot cracks close upon soft tissues and cause much pain and some hemorrhage. In se-* vere cases gangrene may occur. PATHOLOGICAL ANATOMY:- Depends on location and age of the disease. Lumpy, nippled emberances surrounded by fissures, and surrounding tissues chronically inflamed. These excrescences are simply hyper- trophied papillae surrounded by a crack, as of thrush of velvety tissue, and instead of secreting normal epithelial cells, secrete horn cells v/hen inflamed. The excrescences often resemble "seed warts" seen on the human hand* DIAGNOSIS : - Easy « PROGNOSIS:- serious, as treatment is long and difficult; animal must have perfect rest and treatment for 3—4 months, TREATI^iEIIT : - Remove all diseased horn with sage or drawing knife, and apply for 3-4 days a poultice or dressing wet with an antiseptic. ?;hen removed the tissues will be soft. Now pare away horn to rete mucosa, and when all horn colls are removed, apply carefully Acetic Acid (do not let it act too severely). Dress with an emollient; a disinfectant hoof ointment, and leave on 4-5 days; then remove, pare down, and apply Acetic Acid, dress, etc., as before. Do this once a week for 3-4 months, till the tissues secrete normal epi- thelium. V/hen fissures close and normal cells are secreted, leave dressing on for 2-3 weeks, but it must be kept in place. Do not put to Tfork till parts are perfectly normal or they will crack again, Crapaudine is closely allied to thrush, and i& an eczema of the coronary band„ SUB-CUTANEOUS ELIPHYSEMA. Air below the skin, CAUSES:- Traumatic. Fractured rib pierces lung and admits air beneath skin, A tracheotomy poorly done; as where the skin about the in- cision has been loosened from underlying tissues," In such a case a horso may inflate himself. Such cases of emphysena are not dan- gerous unless the wound that caused the emphysema can of itself cause death. Fracture of tracheal rings may cause emphysema, and death may result from traumatic pneumonia, due to blood flowing down into the lungs from the broken rings, TREATMENT!- For the emphysema none is necessary; for the owner « however, we may bathe animal with Alcohols Witch-hazel, etc., and put on a bandage, this can do no harm. TABLE OF CONTENTS. ABSCESS- Acute 49 « Chronic 49 « Cold 59 " by Congestion 55 •• Deep 56 ." Essential Acute 49 " Filling of Cavity 54 " in Natural Cavity 55 " of Neck 157 •* Pathogenesis 53 « Pathological Anatomy 52 " .Predisposing Causes 50 " Superficial 56 " Symptomatic Acute 50 " Termination of an 54 * Walls of an 54 " of Withers 135 ACCIDENTS 12 ACTUAL CAUTERY 21 ACUPRESSUKE 18 ACUTE ADENITIS 121 ACUTE INFLAMMATIONS 23 ACUTE MORTIFICATION 65 » OEDEMA OF WITHERS 134 " SPAVIN 100 ANGIO-LEUCITIS 120 ADENITIS 121 •• Acute 121 « Chronic 122 " Deep 122 ADHESIVE PHLEBITIS 118 ALTERATION OF FUNCTION 7 AHAESTHETICS 15 AHGIO-LEUCITIS 120 AMATOMJf, Pathological- (Woiinds), 76 AIIIMALSf Mode of securing 9 AHTEA SPINATUS, Rupture of 117 ARREST OF HAEMOSTASIA 16 ARTHRITIS 111 " Non-traumat ic 112 H Rheumatoid 115 " Traumatic g^ 111 ARTICULAR BURSA OF KNEE^HOCK 108 « « « w JOINT 108 ATLO-AXOID ARTICULATION 156 ATTITUDE 4 AUSCULTATION, Diagnosis by 6 II, B BISTOURY, positions for holdi-rig 14 BITTEII WOUIIDS 75 BLISTERS S6 BLOOD-LETTIIIG, Local S5-58 BLOOD SPAVIII IQO BLOOD TdhiOR OF WITHERS 15^ BOG SPAVIN 100 BONE, BIIJG 94 BONE, SIDE 94 BONES, DISEASES of 93 BONES, Fractures of 86-90 BONE Tumors, Digital 94 BRUISED WOUNDS 74 BURSAS, Artie, of Hock 108 M It » 2nQ@ 108 » Synov. of Hoclc 108 " of Tendons 107 BUTEL^S Hippo Lasso 11 CALLOUS WOUIIDS 79 OAimOH, Fracture of 91 CAPPED HOCK 109 CASTRATION 150 CATHARTICS 40 CAUSES OF ABSCESS 50 " '* Inflffinmation 25 " " Suppuration 46 " •' Ulceration 61 CAUTERIZATION 21 CAUTERY 16 CAUTERY, ACTUAL 21 " DEEP 22 ■ MEDIAN 22 » SUPERFICIAL 21 CEREBRAL CONCUSSION 91 " " Intermediate 91 •» " Mild 91 •• * Thundering 91 CHANCROUS WOUNDS 79 CHANGES IN PERIVASCULAR SPACES 5I CHARACTER OF OPERATIONS 1 CHECK TEl^DON, Strain of II5 CHEMICAL PECULIARITIES OF SUPPURATION 44 CHRONIC ABSCESS 49 CHRONIC ADENITIS 112 & 122 " Inflammations 25 g. 4I » »' Pathology of 42 •• •• Products of 43 «• Mortification 66 CICATRIZATION 55 & 62 •» Hist, Phononi, of . 69 Ill CIECrOMSCKIBED SUPPURATIOIJ 49 CLASSIFIOATIOII OF FRACTURES 80 CLOSURE OF WOmiDS 18 COLD ABSCESS 59 COLOR, DIAGNOSIS By 5 COlvJPLETE FRACTURE ( Inf. Max. ) 88 CO'ttlPLICATIOHS, (Fractures), 85 " (Kiiu deling), 117 COI»IPLICATED ULCERS 6S COIvIPRESSIOlI 58 CONDEIISIIJG OSTEITIS 94 COHCtE-STION, ABSCESS by 55 COIIJUITGTIVITIS , GRAIIULAR 78 COIISECUTI^TE PHEIIOMEKA OP WOUUDS 68 COKSISTEKCYtDIAGUOSIS by 5 COilTEKTS, PASSAGE OF C. OF VESSELS &C. 29 CORIIS 155 « OF HECK 13S ^ •« WITHERS 154 COROIIARY BAIID, THRUSH OF 159 COTYLOID CAVITY. FRACTURES OF 89 COWHOCK 102 ORAPAUDIHE 139 CUBITUS, FRACTURE OF 90 CU1IEA2I TEKOTOm* 101 CURATIVE TREATLIENT OF V/OmiDS 77 CURB, JARDE 102 " TIBIAL SPAVIN AND 102 CYSTS 135-157 n SEROUS 157 " OF WITHERS 155 D DECAY OF TEETH 12G DEEP ABSCESS, SYMPTOLIS OF 56 •» ADENITIS 122 « CAUTERY 22 DEFICIENT GPJLNULATIOII 65 DEGENERATION OF PUS 56 DEPRESSANTS 59 DIAGNOSIS BY ATTITUDE 4 6 5 5 5 4 4 5 5 4 & 5 » tt AUSCULTATION II It COLOR n il CONSISTEJICY II { Dof in, ) . 1) BY EXCLUSION n 11 FACIAL EXPRESSION 1) It FLUCTUATION M It FORM M » GENERAL INVESTIGATION tf It LOCATION H u IffiNSURATION !t H PBROUSSIOII •• !! SIVJELL Jl 51 SOK^DS !i !1 SPECIAL EXAillllATIOlI i! !» SURFACE EXPRESSION ir SURGICAL « 1) TELIPEKATURE \\ »• TOUCH 19 M TRAHSPAEEIICY *» !• 'vVEIGHT DIFFUSED SUPPURATION DIKftiEATIOKS of Synov, Bursas of Hock, u " Artie. •• * Knee, 5! SYIIOVIAL S ii M n " Foot, U n w M •• Kocl£, a S A «| •» Knee and Hock, IV DIAGNOSIS BY PEGULI.AS MOVEMEHT 4 6 6 6 4 5 4 6 5 5 6 48 108 108 109 106 108 108 DISEASE, {Define) 1 DISLOCATIONS 123 DIURETICS 59 DEESSIIIGS OF FPvACTURES, 84 DRESSING for Kxiuckling, 116 " TEETH, 125 E EMPTRYSmiA,- SUBCUTAIIEOUS 139 EKDOSTEUM 93 EPIDIDYllITIS 129 ESSEl'ITIAL, ACUTE ABSCESS 49 ETIOLOGY,- Definition of 2 EXAiailATIOH, (Special) DIAGNOSIS by 4 EXCLUSION, DIAGIIOSIS by 4 EXCORIATION, Simple 134 EXPRESSION, -(Facial) DIAGNOSIS by 4 EXTRE^aTHS, Fracture of 90 EXUBERANT GRANULATIONS, 63 F FACE, Fractures of 86 FACIAL EXPRESSION, (Diagnosis) by 4 FEMUR, Fractures of 90 FILLING OF ABSCESS CAVITIES, 54 FIRST INTENTION, 68 FISTULOUS WOUNDS, 76 FLEXOR METATARSIS, Rupture of II7 « TENOTOMY, 75 FLOOR OF PELVIS, Fracture of 89 FLUOTUAIIOH, X-,V.-. i=y 5 FOOD, ^ 40 FORM '^ " 5 FRAOTUEES 80 •• BONES OF HEAD, 80 :i -a FRA.GTORES.B0KES OF FACR, 86 " OlimON MD PHALAHGES, 91 ^ Olavssification. of 80 » Gcmplete^ of Inf. Maxlll, 88 " Complications 85 » COTYLOID CAVITY, 89 » CUBITUS, 90 D3?essii3g of 84 EXTRmCCTlES, 90 FEMUH, 90 FLOOR OF PELVIS, 89 HCMSRUS, 90 INFc l^LAXILLA, 87 MECX OF ILIUM, 89 PALATINE ARCH, 86 PELVIS, 89 Periods of Reparation, 82 PEE -MAXILLA 87 RADIUS 90 RIBS 88 SCAPUI^A 90 Special 86 TIBIA 91 " Transverse along Molars 87 *• Treatment of 83 " VERTEBRAL COLUiaT 88 GENERAL IlTVESTIGATIOll , Diagnosis by 4 GUIJ-SHOT V;0U1IDS, 75 GRAilULAR CONJUMCTIVITIS, 78 » URETHRITIS, 78 GRANULATION 5 Deficient 65 " Exuberant 65 GREAT SESAMOID SHEATH, 107 H HAEMATOGELEs 132 HAJSMATOLiA, 154 HAEMOSTASIA, Prevention and Arrest of 16 HAEMOSTATICS, 14 HEALING (of Ulcers), 61 HERNIA, SCROTAL 150 HEPPD LASSO, BUTEL'S 11 HISTOLOGICAL PHENOMENA OF CICAIRI2ATI0H, 69 HOCK, Capped 109 " Dilat, of Artie. Bursa of 108 " * " Synov, " • 108 HUMERUS, Fracture of 90 ffiTDROCHEiS:, 152 HYGROMA, 105 VI ILimi, Fractur© of Heck of ^"^ nilCEDIASE PHSIOMEIIA OF WOUIIDS, ^"^ IIICISED ¥0U1IDS, "^2 incisions, ^^ IITFERIOR liAXILLA, Complete Fracture ^ » " Fracture of ^"^ IIIFLAiaiA-TIOlIS , ^^ »♦ Acute ^*5 p- Causes of ^^ « Chronic 25 & 41 « Mortification. 53 " of Muscles ^^"^ " Pathol, of Chronic 4:1 « Products of " 45 " Resolution 53 " Symptoms of 25 « S ern inat ions 33 ^' Treatment of 34 IIIS'XRO'MEtlTS, Puncturing 15 » (Suture), 18 & 20 IIITEIITIOIU First 63 »* second "70 IHTERAJffilOULAR, SPA^/IN 100 IiraEiaiEDIATE COilCUSSIOH, 91 IIISIiODUCTION, 1 JAPJ}E,~ CURB* 102 K KHEE, Dilattf of Artie. Bursa© of 108 « " " Synov. « • 108 KIIUCKLIITG, 115 " Complications 117 " Dressing for 116 « Operation " 116 LAlbiEIJESS , Causes of 101 LESIOMS, Defin. 2 LIGAiiElTTmi NUCHAS, 156 LIGATION, 55 LOCAL ULCERS, 62 LOCATIOn, Diag. by 5 LOUIS, Sprain of 127 LY12PHMIGITIS, 120 " Zuill's Treatment of 121 LYMPHATICS, Diseases of 117 &120 VII H MAIJtOIA.,,- OS'IEO- lOS MAL DU HUQPE, 137 MEDLAII CAUTERY » 22 MEMSURA.TIOK5 Diago by 5 METATARSAL SPAVIH, 9Q IttLD GEBSBJEL^ GOITCUSSIOII, 91 MODE of Securing Animals, 9 MOETIFIGATIOH, 55 & 64 " Acute 65 '- Chronic 66 MOVABLE DRESSINGS, (Practijre), 94 MUSCLES 5 Diseases of 114 " Inflammation of H''' MyEL.ITlSj- OSTEO- 95 H HATU'FAL CAVITY, Abscess in 55 HECK? Abscess of IS^ « Corns of 156 ♦• Disease of 136 IIERVE Influence, 32 KEUKOTOMl'", Operation for 9'"'' « Preparation for 96 HOH-TRAUMATIC ARTHRITIS, 112 IIUCHAS, LIGALffillTUM 136 JIUQUE, UAL. DU 137 OCCIPIO-ATLOID, Articulation 136 OPERATION for Knuckling, H^ OPEEATIOIIS, Character of 1 OPERATING Table, IS OPERATIVE, Surgery (Dofin.) 1 ORCHITIS, ^2® ORIGIN of Pus, *^ OSSELETS, ^® OSTEITITIS, Condensing ®4 " Rarefying ®* OSTEO-FRAGIA, ^°5 « -MALACIA, ^05 « -MYELITIS, ^5 •' -POROSIS, ^9? OSTITIS, 95 PAIN 9 PALATINE ARCH, Fracture of ^^ PASSAGE of Contents 6f Vessels, &c. 29 Till. p 55 PA2H0SEHESIS OF ABSCESS, 53 PATHOGIIOMOIIIC , ( Def in. ) 5 PATHOLOGICAL AIIATOM^ OF ABSCESS, 52 « " " WOUIIDS, "^^ PATHOLOGY, ( Def in. ) 1 " of Chronic Inflammation ^1 " (Surgical) 1 PECULIAR M0\Ti2iIElIT, Diag. by 4 PELVIS, ■frCvcV.vv^e oV 89 PERCUSSIOH , D\ &.e,-n.o 5. ^ S '^j 6 PERIODS of Reparation of Fractures, 82- PERIOSTITIS, 93 PERIVASCULAR SPACES, Changes in 31 PHALAIIGES, -froui^Vwye o> ®^ PHLEBITIS 5 113 « Adhesive 118 " Suppurative 119 " Ulcerative 120 PHLEGliOH, 158 POLL, Diseases of 155 & 157 « EVIL , 158 POST TRAVIS, 11 PRECAUTIOUS, 12 PREFIXES, (Hydro, Pncurao &c. ) 2 PRE-MAXILLA, Fracture of 87 PREPARATIONS for NEUROTOMY-, 96 PREVENTION OF HAEMOSTASIA, 16 PREVENTIVE TREATL-IEIIT OF WOUNDS, 77 PREDISPOSING CAUSES OF ABSCESS, 50 PRODUCTS OF CHRONIC INFLAMMATION, 45 PROGNOSIS, (Defin. ) 5 PULSE, 7 PUNCTURED V/OUNDS, 75 PUNCTURES, 14 PUNCTURING INSTRUMENTS, IS PUS, Degeneration of 56 « Origin of 45 * Theories 45 RADIUS, Fracture of 90 RAREFYI2TG OSTEITITIS 94 RECUMBENT Position, 11 REIiOVAL OF TEETH, 126 REPARATION of Fractures, 82 RESOLUTION, ( Inflammation) 55 RESPIRATION, 8 RHEUMATIC SYNOVITIS, 110 RHEUMATOID ARTHRITIS, 115 RIBS, Fracture of 88 ^NG-BONE, 94 RUPTURE OF JdlTEIi. SPEIATUS, tzC. 117 " '• FIEKOB METATARSI, 117 IX SPAVIII, u Acute tt Blood i» Bog K Causes of i« Int er ar t i colar H Metatarsal H Syinptoiiis of i9 Tibial and Curb SPECIE. FRACTURES, SPLIIITS ♦ SPEAIIIS 9 SA.RCOGELE, 129 SCAPULA » Fracture of 90 SCROTAL HERIIIA, 150 SEUSATIOII, 9 SEROUS CYSTS, 157 SECQIID Intent ion J 70 SESAMOID SHEA.TH, GREAT 107 SIDE BONE 94 STl-iPLE ULCERS., 6S ^ V/OLrjDS, Treatment of 71 SITFASTS, 154 SLOUGHIIIG ULCERS, 64 SMEI^Ls Diag- by 6 SOUIIDS, » " 6 99 100 100 100 99 100 99 100 102 86 97 126 SPRAIN OF LOINS, 127 STASIS, 29 STIFLE, Synov. Dil. of 109 STIMULANTS, 40 STRAIN OF CHECK TENDON, 115 SUBCUTANEOUS EtiPHYSELiA, 159 « WOUNDS, 75 SUFFIXES, such as it is, rhoea, &c* 1 SUMMER WOUNDS, 77 SOF'ERFICIAIx CAUTERY, 21 SUPPURATION, 44 & 48 •* Causes of 46 '» Cheraioal peculiarities of 44 & 48 •* Circumscribed 49 « Diffused 48 '^ Superficial 48 "* Tests of peculiarities of 45 « Value of 46 SUPPURATIVE PHLEBITIS, 119 SURFACE EXPRESSION, ( Diag. by) 5 SURGERY, OPERATIVE 1 '' VETERINARY 1 SURGICAL DIAGNOSIS, 4 « PATHOLOGY, 1 SUTURES, 18 & 20 SUTUBE Instruments, 20 SYMPTCMATIOj Acute Abscess 50 SYMPTOMA-TOLOGY, 7 SYMPTOMS, (Defxn„) 3 * of Superficial Abscess 56 SYIIOYIIL BURSA OF FOOT, Dilatation 106 •* " « KlIEE & HOCK, Dilatation 108 ^ Dilatations, 109 ^ " of STIFLE, 109 " ii/IEMBRA.HE, Disease of 104 SY1I07ITIS .;. RKEIBIAlTIC 110 3 THAUI'IATIC 111 TABLE. Operating IS TEETHn Decay of 126 " Diseases of 124 " Dressing of 125 »' House Dog 126 " Reirioval of 126 TS^-iPERATlHE, Dlag. by 6 TEndon^ Strain of Check ll5 TEIIDOHS. BURSAS of 107 " Disease of 114 TElIOTOMYs CUIISAII 101 « FLEXOE 75 TEEHOIATIOII of an Abscess, 54 TESTICLES AtlD FJTVELOPES, Diseases of 128 TESTS for Suppuration, 45 THEORIES as to Pus, 45 THERMOMETRY, 8 THROMBUS, 117 THROWING, 11 THRUSH OF COROIIARY BAUD, I39 THUIIDEEING COlICUSSIOlI , 91 TIBIA, Fracture of 01 TIBIAL SPAVIII AIID CURB, 102 TOIIICS, 40 TOUCH, Diago by 5 TRAIISPAREIICY, Diag, by 5 TRAIISVERSE FRACTURE along course of Molars, 87 TRAULiA.TIC ARTHRITIS, HI " SYNOVITIS, 111 TRAVIS, POST 11 TREATMEIIT, ( Def in. ) 3 TUMORS, {Bone} Digital 94 •' of Testicles, 138 TEEATMEIIT OF FRACTURES, 85 XT U ULCERATIOII., 60 " Causes ot 61 * Healing of 61 " v;ith deficiency, 64 ULCERATIVE PHLEBITIS, 120 ULCEROUS W0U1IDS» 79 ULCERS, (Complicated) 62 " (Local) 62 " (Simple) 62 " ( Sloughing ) 64 miciPREssuRii:, is UNCLASSIFIED DISEASES, 138 URETHRITIS, Granular 78 VALUE OF SUPPURATIOII, 46 VEINS, Diseases of 117 VEIITILATIOIK 40 VERTEBRAL COLUMII, Fracture of 88 VESICAIITSs 36 VETERIIIARY SURGERY, ( Def in. ) 1 W WALLS OP ABSCESS, 54 WIlID-GAIiLS, 105 WITHERS, Abscess of 135 « Acute Oedema of 154 •• Blood TuiTior of 134 « Corns of 154 « Cyst of 155 " Disease of 153 " Simple Excoriation of 134 WOUIIDS, Bitten 75 " Bruised 74 " Callous 79 " Consecutive Phenomena of 68 « Curative Treatment 77 « Fistulous 76 " Gun-shot 75 •♦ Immediate Phenomena of 67 *» in general, G7 « (Incised) Treatment of 72 « Pathol. Anat, of 76 " Preventive Treatment of 77 « Punctured 75 •• (Simple) Treatment of 71 « Sub-' cutaneous 75 " Summer 77 « Ulcerous or Chancrous 79 * Wrenched 75 Z ZUILL^S Treatment of LYliPHAITGITIS, i2l