(<i(nTi}>lil.V' 
 
 iiH'>im>iir iicnjMT 
 
HAND-BOOK 
 
 OF 
 
 VETERINARY SURGERY 
 
 AND 
 
 OBSTETRICS 
 
 WITH CO-OPERATION 
 
 OF 
 
 Prof. Dr. ALBRECHT (Munich), Staff Veterinarian BARTKE 
 (Stettin), Prof. DE BRUIN (Utrecht), Prof. CADIOT (Alport). 
 Prof. Dr. EBERLEIN (Berlin), Prof. Dr. GMELIN (Stuttgart;, 
 Staff Veterinarian HELL (Altona), Prof. HENDRICKX (Brus- 
 sels), Prof. Dr. HESS (Bern), Prof. Dr. HIRZEL (Zurich), Staff 
 Veterinarian KONIG (Konigsberg), Prof. LANZILLOTTI-BUON- 
 SANTI (Milan), Docent LUNGWITZ (Dresden), Prof. Dr. 
 OSTERTAG (Berlin), Prof. Dr, PFEIFFER (Giessen), Prof. Dr. 
 SCHINDELKA (Vienna), Dr. SCHMIDT (Vienna), Late Prof. 
 Dr. SIEDAMGROTZKY (Dresden), Prof. Dr. VENNERHOLM 
 (Stockholm), Prof. Dr. ZSCHOKKE (Zurich). 
 
 EDITED BY 
 
 Professor Dr. JOS. BAYER and Professor Dr. EUG. FROHNER 
 Vienna Berlin 
 
 VOL. 11. 
 
 GENERAL SURGERY 
 
 BY 
 Dr. EUGEN FROHNER 
 
 THIRD EDITION 
 1905 
 
GENERAL SURGERY 
 
 BY 
 
 DR. EUGEN FROHNER 
 
 PROFESSOR IN THE ROYAL VETERINARY COLLEGE IN BERLIN 
 Authorized Translation From 
 
 THE THIRD REVISED EDITION 
 
 BY 
 
 D. HAMMOND UDALL, B. S. A., D. V. M. 
 
 ASSOCIATE PROFESSOR OF SURGERY AND OBSTETRICS 
 
 COLLEGE OF VETERINARY MEDICINE 
 
 OHIO STATE UNIVERSITY 
 
 Columbus. 
 
 TAYLOR & CARPENTER 
 
 ITHACA, N. Y. 
 
 1906 
 
AUG 23 >906 
 
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 hf. 
 
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 Copyrichi, 190A 
 BY TAYI.OK «i CARPHNTKR 
 
 RegUtrrrd at fti 
 l,t)SDON I 
 
PREFACE TO THE FIRST EDITION. 
 
 In the following hand-book of veterinary surgery and ob- 
 stetrics the general surger}', as well as the operative surgery, 
 forms a separate, independent work. In a sense they serve as 
 an introduction to the following third and fourth volumes of 
 special surgery of the different organs. 
 
 Any text-book of general veterinary surgery' must depend 
 on the investigations and text-books of human medicine. 
 While I have kept this point in view in the development of 
 the following plan, I think I have clearly drawn the relations 
 between the general surgery of man and animals. I also 
 admit that in the writing of this book I have followed princi- 
 pally the plans which Billroth, and recently Tillman, have 
 used in their text-books of human and general surgery. 
 
 The reader will readily note that the following work is not a 
 mere compilation of the books mentioned on human medicine. 
 In many particulars veterinary surgery, like pathology, phar- 
 macology and therapy, has developed independent lines. Many 
 chapter.s on human surgery have no connection with veterinary 
 surgery ; other divisions that are very important in human 
 surgery are of little or no importance in veterinary science. 
 Tuberculosis of the bones and joints, for example, belongs to 
 one of the most important divisions of human surgery ; in 
 veterinary surgery it is practically never the occasion for 
 surgical interference. 
 
 Conversely, actinomycosis and botryomycosis is of great 
 importance in veterinary surgery, the latter is almost unknown 
 in man. In man osteomyelitis is the most important form of 
 inflammation of the bones ; in the horse periostitis is the most 
 important form. Erysipelas, .so frequent in man, appears to 
 be very rare in animals. It is obvious that resection of joints, 
 as well as most amputations of limbs, cannot be employed on 
 
 (V) 
 
VI Preface. 
 
 domestic animals. The aseptic method, which is so important 
 in human surgerj', seems to be of little importance in veteri- 
 nar}- science because of pureh^ external causes. Even bone- 
 fractures present an entirely different surgical problem in large 
 animals than in men. Firing, and the application of blisters 
 for chronic inflammations of bones, tendons, and joints, are 
 special surgical methods of veterinarians. 
 
 On the other hand, the following work is not a compen- 
 dium of other surgical text-books on veterinary surgery. On 
 the basis of many years of surgical and clinical activity, I 
 think I have had sufiScient experience to elucidate the follow- 
 ing subject from my own point of view. In many chapters, 
 namely, those on fractures and tumors, I was in a position to 
 insert my own investigations. I was also careful to arrange 
 the material purely from a veterinary standpoint, and only for 
 the object of veterinary practice. On this basis the reader will 
 find, for example, many references in this book to forensic 
 veterinary science (age of wounds, fractures, fissures, muscular 
 atrophy ; curability or non-curability of bone-fractures in 
 horses and cattle ; abnormal fragility of bones ; prophylaxis 
 of bone-fractures, etc.). Foreign bodies, parasites, and con- 
 genital new- formations, which are of great surgical import- 
 ance, have been given special attention. 
 
 General surgery has numerous and important relations to 
 general pathology and pathological anatomy. Unfortunately 
 we have no text-book of general pathology in our veterinary 
 literature. On the other hand we have recently come into 
 the possession of a very important hand-book of veterinary 
 pathological anatomy. I am under great obligations to this 
 excellent book of Kitt's for valuable suggestions and informa- 
 tion. General surgery is also closely related to anatomy. I 
 have found a deficiency in the de.scriptions of tendon-sheaths 
 and fasciae in most veterinary text-books on anatomy ; these 
 are very important from a surgical standpoint, the descriptions 
 are usually incomplete and indistinct. With reference to the 
 relation of general surgery to bacteriology, it must be acknowl- 
 edged that the latter has contributed largely to the problem of 
 suppuration and inflammation, as well as to the combating of 
 
Preface. VII 
 
 these processes by means of antiseptics, from a standpoint of 
 both scientific and practical surgerj-. On the other hand, one 
 must not overestimate the importance of bacteriology to general 
 surgery and overlook everything else for bacteria. Many 
 surgical inflammations have nothing to do with bacteria ; this 
 is especially true of the purely traumatic, aseptic inflammations 
 of bones, joints, tendons, tendon-sheaths, and muscles. At 
 suitable places I have considered it my duty to repeatedly 
 refer to this obligation. From a diagnostic standpoint also, 
 bacteriology should not be given too great weight in surgery. 
 Pus-cocci, in particular, are of little practical diagnostic impor- 
 tance ; this is especially true where the candidate, unfortu- 
 nately, is overenthusiastic concerning the significance of a 
 bacteriological examination, to him the presence of pus-forming 
 bacteria in pus from bones may form the principal evidence for 
 the presence of a bone-fi.stula. The bacteriological confusions 
 that have occurred concerning wound-erysipelas receive atten- 
 tion in the chapter on this subject. 
 
 There is no claim of completeness for the bibliography at 
 the end of each chapter. My principal object was to divide 
 the literature on human medicine from that of veterinary- sci- 
 ence and, above all, also to indicate to students the funda- 
 mental investigations that li ave been made in human medi- 
 cine : only the most important and recent works have been 
 mentioned. 
 
 The book contains no illustrations. I am opposed to the 
 usual custom in veterinary science of appropriating illus- 
 trations from works on human medicine, either unchanged or 
 specially modified. I maintain that it is not admissible. 
 
 KiSvSiNGEN, August, 1896. 
 
PREFACE TO THE THIRD EDITION. 
 
 The new, third edition of general surgery is improved and 
 enlarged in many respects. The individual changes are as 
 follows : The chapter on the etiology of tumors has been re- 
 written, and many additions have been made to the casuistry 
 of this group ; unfortunately the recent etiological works on 
 tumors are largely speculations. The chapter on botryomy- 
 cosis has been newly written to harmonize with the most re- 
 cent investigations on this subject ; there is hardh' a doubt 
 that in this wound infection we have to deal, not with staphy- 
 lococci, but with an infectious disease sui generis. Regardless 
 of the objections of critics, the chapter on tuberculosis has 
 been retained and even enlarged ; the motive for following this 
 plan is explained in that chapter. I have supplemented the 
 important chapter on chronic deforming arthritis with the re- 
 sults of recent investigations made in my clinic upon ringbones 
 chronic gonitis, and omarthritis. This is also true of primary 
 infectious osteomyelitis the occurrence of which in the horse, 
 according to our recent investigations, can be no longer 
 doubted. Recent investigations on myositis, neuritis, healing 
 of fractures, necrosis bacilli, pseudo-edema bacilli, and foal- 
 lameness have also been considered. On the subject of asepsis 
 against antisepsis it may be definitely stated that now, even in 
 human therapeutics, all have returned to antisepsis. In the 
 first edition of this book I recommended antisepsis for the vet- 
 erinary surgeon. Even for the disinfection of fresh wounds 
 the application of pure carbolic acid, as well as the hot iron, 
 has been recently recommended in human surgeries. 
 
 What a change within one decade ! 
 
 Berlin, December. 1904. 
 
 Prof. Dr. Frohner. 
 
 (VIII) 
 
TRANSLATOR'S PREFACE 
 
 The translation of the third edition of Frohners " General 
 Surgery " has been undertaken to supply a well classified pre- 
 sentation of the fundamental principles of surgery. It is hoped 
 that it may assist the beginner in obtaining a clear perspective 
 of the mass of surgical diseases with which he must come in 
 contact. 
 
 That portion of the text dealing with bibliography has 
 been omitted in the translation as it is practically unavailable 
 to most English readers. Otherwise the text has been closely 
 followed, no additions or other changes having been made. 
 
 The translator of this work is especiall}^ indebted to Pro- 
 fessor David Stuart White who has rendered valuable assist- 
 ance in reading the proof sheets. He is also indebted to Drs. 
 A. D. Fitzgerald and James McI. Phillips for suggestions that 
 have materially reduced the list of errors. 
 
 The translator wishes to express his gratitude to the firm 
 of Taylor & Carpenter who have procured the authorization 
 of this translation from the German publishers, assumed all 
 financial responsibility, and shown every possible courtesy and 
 assistance in furthering the progress of the work. 
 
 D. H. UDALL. 
 Columbus, Ohio, July, 1906. 
 
 (IX) 
 
PREFACE TO THE THIRD EDITION. 
 
 The new, third edition of general surgery is improved and 
 enlarged in many respects. The individual changes are as 
 follows : The chapter on the etiology of tumors has been re- 
 written, and many additions have been made to the casuistry 
 of this group ; unfortunately the recent etiological works on 
 tumors are largeh^ speculations. The chapter on botryomy- 
 cosis has been newly written to harmonize with the most re- 
 cent investigations on this subject ; there is hardly a doubt 
 that in this wound infection we have to deal, not with staphy- 
 lococci, but with an infectious disease sui generis. Regardless 
 of the objections of critics, the chapter on tuberculosis has 
 been retained and even enlarged ; the motive for following this 
 plan is explained in that chapter. I have supplemented the 
 important chapter on chronic deforming arthritis with the re- 
 sults of recent investigations made in my clinic upon ringbones 
 chronic gonitis, and omarthritis. This is also true of primary 
 infectious osteomyelitis the occurrence of which in the horse, 
 according to our recent investigations, can be no longer 
 doubted. Recent investigations on myositis, neuritis, healing 
 of fractures, necrosis bacilli, pseudo-edema bacilli, and foal- 
 lameness have also been considered. On the subject of asepsis 
 against antisepsis it may be definitely stated that now, even in 
 human therapeutics, all have returned to antisepsis. In the 
 first edition of this book I recommended antisepsis for tlie vet- 
 erinary surgeon. Even for the disinfection of fresh wounds 
 the application of pure carbolic acid, as well as the hot iron, 
 has been recently recommended in human surgeries. 
 
 What a change within one decade ! 
 
 Berlin, December, 1904. 
 
 Prof. Dr. Frohner. 
 
 (VIII) 
 
TRANSLATOR'S PREFACE 
 
 The translation of the third edition of Frohners " General 
 Surgerj^ ' ' has been undertaken to supph^ a well classified pre- 
 sentation of the fundamental principles of surgery. It is hoped 
 that it may assist the beginner in obtaining a clear perspective 
 of the mass of surgical diseases with which he must come in 
 contact. 
 
 That portion of the text dealing with bibliography has 
 been omitted in the translation as it is practically unavailable 
 to most English readers. Otherwise the text has been closely 
 followed, no additions or other changes having been made. 
 
 The translator of this work is especially indebted to Pro- 
 fessor David Stuart White who has rendered valuable assist- 
 ance in reading the proof sheets. He is also indebted to Drs. 
 A. D. Fitzgerald and James McI. Phillips for suggestions that 
 have materially reduced the list of errors. 
 
 The translator wishes to express his gratitude to the firm 
 of Taylor & Carpenter who have procured the authorization 
 of this translation from the German publishers, assumed all 
 financial responsibility, and shown every possible courtesy and 
 assistance in furthering the progress of the work. 
 
 D. H. UDALL. 
 Columbus, Ohio, July, 1906. 
 
 (IX) 
 
CONTENTS 
 
 PAGE 
 
 Preface V 
 
 Contents XI 
 
 Wounds i 
 
 I. Definition, Classificatiou, atid Symptoms i 
 
 II. Incised, Stab, Contused, Shot, Lacerated, and Poisoned 
 
 Wounds 6 
 
 III. Control of Hemorrhage 12 
 
 IV. Anatomical Changes in Wound Healing 17 
 
 V. Wound Infection Diseases 25 
 
 1. Suppuration 25 
 
 2. Phlegmon 28 
 
 3. Abscess 34 
 
 4. Wound Fever 37 
 
 5. Septicemia 40 
 
 6. Pyemia 44 
 
 7. Other Wound Infection Diseases 46 
 
 VI. Treatment of Wounds 55 
 
 Subcutaneous Injuries of Soft Parts, (Contusion, Rupture) 64 
 
 I. Contusion 64 
 
 II. Rupture 70 
 
 Inflammation 72 
 
 I. Nature and Causes 72 
 
 II. Kinds, Symptoms, and Course of Inflammation 76 
 
 III. Treatment of Inflammation 79 
 
 Ulcer, Fistula, Gangrene ■. 84 
 
 I. Ulcer 84 
 
 II. Fistula , 86 
 
 III. Gangrene 91 
 
 Tumors 98 
 
 I. Tumors in General 98 
 
 II. Special Kinds of Tumors 107 
 
 (XI) 
 
Xli 
 
 CONTENTS 
 
 A. Connective-tissue New Formations 
 
 1. Fibroma 
 
 2. L/ipoma 
 
 3. Myxoma 
 
 4. Chondroma 
 
 5. Osteoma 
 
 6. Myoma 
 
 7. Neuroma 
 
 8. Angioma 
 
 9. Lymphoma 
 
 10. Sarcoma 
 
 B. Epithelial New Formations 
 
 1. Carcinoma 
 
 2. Papilloma 
 
 3. Adenoma 
 
 C. Cystic Tumors 
 
 D. Infections Tumors 
 
 1. Actinomycoma 
 
 2. Botryomycoma 
 
 3. Tuberculosis 
 
 Concrements and Foreign Bodies 
 
 I. Concrements 
 
 II. Foreign Bodies .. ^___ 
 
 Hernia and Prolapse 
 
 I. Hernia 
 
 II. Prolapse 
 
 Diseases of Bones 
 
 I. Fractures 
 
 II. Inflammation of Bone. Periostitis. Ostitis. Osteomyelitis 
 
 1. Inflammation of the Periosteum. Periostitis 
 
 2. Inflammation of the Bone Substance. Ostitis 
 
 3. Inflammation of the Bone Marrow. Osteomyelitis 
 
 III. Necrosis, Atrophy, and Hypertrophy of the Bones 
 
 1. Necrosis of the Bones 
 
 2. Atrophy of the Bones 
 
 3. Hypertrophy of the Bones 
 
 IV. Rachitis and Osteomalacia 
 
 107 
 iq7 
 
 113 
 116 
 117 
 119 
 120 
 121 
 122 
 124 
 125 
 133 
 
 133 
 144 
 
 147 
 
 149 
 
 152 
 
 152 
 161 
 166 
 
 174 
 
 174 
 
 178 
 
 185 
 
 185 
 188 
 
 190 
 190 
 216 
 217 
 220 
 221 
 226 
 226 
 228 
 229 
 229 
 
 Diseases of Joints 232 
 
 I. Inflammation of the Joints. Arthritis or Synovitis 233 
 
 1. Serous Inflammation. Arthritis Serosa 234 
 
 2. Suppurative Inflammation. Arthritis Purulenta 236 
 
 3. Deforming Inflammation. Arthritis Deformans 238 
 
CONTENTS XIII 
 
 4. Tubercular Inflammation. Arthritis Granulosa 243 
 
 II. Chans^es in Position of the Joints. Luxation, Distorsion, 
 
 Contusion 247 
 
 1. Luxation or Dislocation 247 
 
 2. Distorsion or Sprain 252 
 
 3. Contusion or Bruise of the Joint 253 
 
 III. Anchj-losis and Contracture 254 
 
 1. Anchylosis or Stiffness 254 
 
 2. Joint Contracture (Stilt-Foot) 256 
 
 IV. Joint Bodies. Corpora Libera 258 
 
 Diseases of the Tendons, Tendon-Sheaths, and Mucous Bursae 259 
 
 I. Diseases of the Tendons 264 
 
 1. Inflammation of the Tendons. Tendinitis 264 
 
 2. Tendon Rupture 267 
 
 3. Tendon Necrosis 270 
 
 II. Diseases of Tendon-Sheaths 272 
 
 1. Inflammation of Tendon-vSheaths. Tendo-Vaginitis__ 272 
 
 2. Distension of Tendon-Sheaths. Hydrops 275 
 
 III. Diseases of Mucous Bursae 278 
 
 1. Inflammation of Mucous Bursae. Bursitis 27S 
 
 2. Hygroma of Mucous Bursae 280 
 
 Diseases of the Muscles, Fasciae and Nerves 283 
 
 I. Diseases of the Muscles 283 
 
 1. Inflammation of Muscles. Myositis 286 
 
 2. Muscle Rupture 293 
 
 3. Muscle Atrophy 295 
 
 II Diseases of Fasciae..! 297 
 
 1. Necrosis of Fasciae 297 
 
 2. Rupture of the Fasciae 298 
 
 III. Diseases of Nerves 299 
 
 1. Paresis and Paralysis 299 
 
 2. Inflammation of Nerves. Neuritis 302 
 
 Diseases of Vessels 305 
 
 I. Diseases of Arteries 305 
 
 1. Inflammation of Arteries. Arteritis 305 
 
 2. Dilitation of Arteries. Aneurysm 306 
 
 3. Rupture of Large Arteries 311 
 
 II. Diseases of Veins 313 
 
 1. Inflammation of Veins. Phlebitis 313 
 
 2. Dilitation of Veins. Varix. Phlebectasis 314 
 
 III. Diseases of Lymph-Vessels 316 
 
XIV CONTENTS 
 
 1. Inflammation of Lymph-Vessels 316 
 
 2. Dilitation of Lymph-Vessels. Lymphangiectasis 317 
 
 Diseases of Glands 317 
 
 I. Inflammation of Lj'mph-Glands. Lymphadenitis 318 
 
 II. Inflammation of the Mammary Glands. Mastitis 320 
 
 Surgical Diseases of the Skin and Mucous Membranes 323 
 
 I. Surgical Ui.seases of the Skin 323 
 
 1. Inflammation of the Skin. Dermatitis 323 
 
 2. Burns Combustio 325 
 
 3. Freezing. Congelatio 328 
 
 II. Surgical Diseases of the Subcutaneous Tissue 330 
 
 1. Edema ^ 330 
 
 2. Emphysema 331 
 
 III. Surgical Diseases of the Mucous Membranes 332 
 
 IV. Surgical Diseases of the Pododerm 333 
 
 Appendix. Congenital Malformations of Surgical Importance 334 
 
 Index 339 
 
WOUNDS 
 
 I. GENERAL REMARKS CONCERNING THE NA- 
 TURE, SYMPTOMS, AND CLASSIFICATION 
 OF WOUNDS. 
 
 Definition. — A wound, in a restricted sense, indicates 
 any injury accompanied by a breach in the continuity of the 
 skin or mucous membrane. Wounds may also be defined as 
 open, hemorrhagic injuries, in contrast to lacerations and 
 fractures which occur in the subcutaneous tissues and are not 
 characterized by a breach in the continuity of the outer cov- 
 ering. The latter are closed to the presence of air, they are 
 aseptic ; that is, protected against the entrance of infectious 
 irritants. Wounds, on the other hand, are open to the entrance 
 of septic infection. The symptoms, course, prognosis, and 
 treatment for both are, therefore, extremely variable. For 
 this reason the open and subcutaneous injuries must be 
 considered under separate headings. 
 
 An ulcer is differentiated from a wound by its tardiness in 
 healing ; it may be considered as a wound which will not heal. 
 
 General Symptoms of Wounds. The most important 
 symptoms of fresh wounds are hemorrhage, pain, 
 gaping, and disturbed function. 
 
 I. Hemorrhage varies according to the size and con- 
 dition of the wounded vessels. One recognizes arterial, venous, 
 parenchymatous, and capillary hemorrhage. Arterial hem- 
 orrhage is that which results from injuries to individual 
 arteries, it spurts from the wound and is bright red in color. In 
 venous hemorrhage large veins are involved, dark red blood 
 flows from the peripheral ends in a continual stream as from 
 a spring. Parenchymatous hemorrhage includes both 
 
2 WOUNDS 
 
 arterial and venous (mixed hemorrhage) ; the incised vessels 
 are small, the blood is medium-red in color and ilows from 
 all portions of the wound similar to being squeezed from a 
 sponge (tumors, swollen parts, muscle) . Capillary hemor- 
 rhage follows slight injuries to the skin and mucous mem- 
 brane, the blood flows in drops from the incised capillaries. 
 As a rule, transverse wounds to vessels bleed more freely 
 than those in a longitudinal direction because the gaping is 
 greater (therefore an incision should be longitudinal when 
 operating). In contused wounds the hemorrhage is occasion- 
 ally very slight, the adventia constricts, the intima and 
 media are retracted inwards, this results in mechanical closure 
 of the vessel similar to that which occurs in torsion (ecraseur, 
 emasculator). Penetrating wounds of large vessels usually 
 close spontaneously (penetrating injury of the jugular from 
 intravenous injection, an occasional penetrating injury to the 
 carotid during the same operation). In previous anastomosis 
 formation vessels bleed from both ends (carotid, large veins, 
 thyroid gland). 
 
 The following symptoms are observed after severe hem- 
 orrhage : general anaemia which is especially characterized by 
 paleness of the visible mucous membranes ; coolness of the 
 skin ; as well as weak pulse and heart-beat which results from 
 sinking of the blood pressure and weakness of the heart. 
 Death from hemorrhage is further preceded b}^ general weak- 
 ness, tottering, vertigo, loss of consciousness, dyspnoea, dili- 
 tation of the pupils, disappearance of the corneal reflex action, 
 involuntary urination and defecation, as well as convulsions. 
 Death is more certain when the loss of blood is 
 more than a third of the total amount. The 
 The total amount of blood in a horse is equal to about one 
 fifteenth of the total body weight. A horse weighing 450 kg., 
 for example, (blood contents = 1/ 15 = 30 kg. or litres) dies 
 after a loss of more than 10 kg. (litres) of blood. Loss of a 
 third of the blood is followed by pronounced heart weakness 
 and sinking of blood pressure, it is possible, however, for 
 regeneration of the blood to take place from the parenchyma- 
 tous fluids. Loss of a fourth of the total amount of blood is 
 
WOUNDS -3 
 
 only followed by decreased blood pressure (phlebotomy). 
 Regeneration occurs through the absorption of water from the 
 lymph of the tissues as well as from the fluid contents of the 
 stomach and intestines (hydraemia); this is followed by an 
 increase in the formation of the white blood corpuscles (leuco- 
 cytosis); finally the red blood corpuscles gradually increase 
 in number. 
 
 Injuries to large lymph vessels, joints, and tendon sheaths 
 result in a discharge from the wound of lymph, synovia, 
 and tendon-sheath fluid respectively; saliva is dis- 
 charged from wounds to the salivary glands, salivary ducts, and 
 esophagus ; food or feces from perforating injuries to the 
 stomach or intestines ; m i 1 k from wounds to the udder ; 
 urine from lesions to the bladder or urethra. Hemorrhage 
 is absent in corneal wounds. 
 
 2. Pain is due to cutting, bruising, or tearing the sen- 
 sitive nerves. The so-called primary pain should be distin- 
 guished from secondary wound pain due to inflammation 
 (nailing !). The pain of wounds is in direct proportion to the 
 nerve supply of the afiected tissues. Wounds of the skin, 
 pododerm, periosteum, mucous membranes, cornea, or peri- 
 pheral nerve endings are more painful than those of bone, car- 
 tilage and tendon, connective-tissue, or brain substance. The 
 blunter the cutting instrument, and the slower the separation 
 of the tissue, the greater the apparent pain (experience in opera- 
 tions). The sensitiveness of different animals 
 varies according to the individual, age and sex, as well as 
 the race and species. Many horses are very sensitive to 
 neurectomy while others remain quiet during the operation. 
 Many horses will stand without narcosis for trepanation and tra- 
 cheotomy, as well as similar operations which require restraint, 
 while others must be cast and restrained for operations that 
 are far less painful. In general horses are more sensitive than 
 cattle; dogs and cats more than hor3es. Horses that belong to 
 the warm blooded races frequently show more sensitiveness 
 than those of the cold blooded race (e. g. castration). Mares 
 and stallions are usually more sensitive than geldings. The 
 
4 WOUNDS 
 
 following appear least sensitive : old horses, phlegmatic horses, 
 and those affected with blind staggers. 
 
 In comparison to man, all domestic animals appear to be 
 less sensitive to wounds. Many animals, after a severe in- 
 jury, show a certain amount of resignation similar to man 
 (trained dogs). 
 
 Complete insensibility follows deep narcosis (chlo- 
 roform, cocaine); is present in dead tissues; and occurs after 
 neurectomy, so that nail puncture in the hoof, for example, 
 does not cause pain. 
 
 3. Gaping of wounds depends on the character of the 
 incised tissue, as well as upon the direction of the wound. 
 Gaping is most pronounced in those places where the skin is 
 widely separated as a result of transverse muscle and tendon 
 wounds. 
 
 4. Disturbed function occurs after wounds of the 
 hoof, tendons, joints, and muscles, where it is characterized by 
 lameness ; wounds of the tongue result in deranged mastica- 
 tion ; blindness may follow corneal wounds ; wounds to the 
 motor or sensory nerves may produce paralysis or anesthesia. 
 
 Very painful wounds in the horse result in a diminution 
 or complete loss of appetite, this is frequently observed 
 after horses have been operated under restraint. Genuine 
 shock or wound shock (sudden paral3'sis of the vasomotor cen- 
 ter with anemia of the mucous membranes, retardation and 
 paralysis of the activity of the heart) is very rare in animals. 
 Perforating abdominal wounds in the horse are frequently fol- 
 lowed by colic (peritonitis). The following conditions fre- 
 quently follow injuries to large nerve branches (neurectomy): 
 stagnation edema, inflammatory conditions, ulcer formation 
 and necrosis of the skin and pododerm, inflammation of the 
 periosteum, bone, and joints, exungulation, atrophic changes, 
 fractures, tendon ruptures, etc. (See chapter on diseases of the 
 nerves.) Occasionally sudden death follows the introduction 
 of air into the jugular vein (operation on shoulder abscess, 
 phlebotomy); this is partly due to paralysis of the lungs (air 
 emboli in the pulmonary capillaries), partly to paralysis of 
 the heart (air in the chambers of the heart, air emboli in the 
 
WOUNDS 5 
 
 coronary arteries), partly to paralysis of the brain (air em- 
 boli in the capillaries of the brain). The aspiration of air 
 into the abdominal cavity (gurgling sound), sometimes ob- 
 served in the castration of stallions, is usually harmless. 
 Finally, any wound may be followed by wound fever. Two 
 forms are recognized, aseptic and septic wound fever. Aseptic 
 fever is due to the resorption of degenerated blood products 
 without the presence of bacteria. It is characterized by a 
 slight elevation of temperature without severe disturbances 
 of the general system (see chapter on wound fever). Septic 
 fever, on the other hand, depends on the presence of specific 
 infectious material which gains entrance to the wound and 
 finally enters the blood stream. It is characterized by a 
 marked elevation of temperature and severe derangement of 
 the general system (see chapter on septicaemia and pyaemia). 
 
 CivAssiFiCATioN OF WouNDS. — According to the causes 
 wounds are classified as follows: incised, punctured, 
 lacerated, contused, stab, shot wounds, and bites. 
 In addition to wounds due to mechanical force one must con- 
 sider injuries produced by chemical irritants (caustics), and 
 thermic influences (burns, freezing), which are classified as 
 caustic wounds, necrotic wounds, etc. 
 
 According to the condition of the wound they are 
 classified as simple or non-contused (incised, punc- 
 tured), and complicated or contused wounds (con- 
 tusions, shot wounds, bites), wounds with and without 
 loss of substance, flap or skin wounds, clean, 
 unclean, (hair, dirt, dust), infected and poisoned, 
 superficial, deep, and perforating or penetrat- 
 ing (abdominal cavity, thorax, joints), slight, severe, 
 and fatal, fresh and old, hemorrhagic, suppura- 
 tive, granulating and cicatrized wounds. 
 
 According to the seat and tissues involved they are 
 classified as wounds of the head, thorax, throat, ab- 
 domen, skin, mucous membranes, muscles, 
 bones, cartilage, joints, tendons, brain, cor- 
 nea, stomach and intestines. 
 
6 INCISED AND STAB WOUNDS 
 
 Shock in Animals. — Beck has observed one case of paralysis of 
 the heart in a calf as a result of castration (Wochenschrift fiir Tier 
 heilkunde. 1901). The animal bellowed very loud after the remova- 
 of the first testicle (pain, fear, terror), collapsed and died immediately. 
 The results of a post mortem were negative. 
 
 II. INCISED, PUNCTURED, CONTUSED, SHOT, 
 LACERATED AND POISONED WOUNDS. 
 
 Incised and Stab Wounds. — These are due to injur- 
 ies from surgical and ordinary knives, hay knives, hoof knives, 
 butcher knives, case knives, shears, glass, pieces of iron, 
 scythes, sickles, sabers, hatchets, etc. The characteristics 
 of incised and thrust wounds consist in their straight dir- 
 ection, longitudinal form, as well as sharply de- 
 fined, smooth, non-contused edges. Hemorrhage 
 and retraction of edges are more pronounced than in the other 
 forms. They are most often seen in horses, dogs, and cattle 
 on various parts of the body, especially the limbs. According 
 to depth they may be termed wounds of the skin, muscle, 
 tendon, bones, and perforating wounds. The prognosis is 
 favourable when the skin only is involved (suture). From a 
 forensic standpoint it should be observed that many lacerat- 
 ed and contused wounds present edges similar to those of in- 
 cised wounds (wire, sharp edge of the hoof). 
 
 Punctured Wounds. — Punctured wounds are caused by 
 manure forks, hay forks, nails, needles, pointed knives, and 
 shears, lances, bayonets, harrows, splinters of wood, etc. 
 Penetrating wounds in horses are most often due to manure 
 and hay forks, as well as treads on nails and nailing. In the 
 German Army the lance is a frequent cause of wounds on ac- 
 count of its wide use in the cavalry. During operations 
 punctured wounds are often produced by means of the injection 
 needle and the trochar (subcutaneous, intravenous, intra- 
 peritoneal, parenchymatous, intraocular, subconjunctival, sub- 
 dural, intracranial, and even intracerebral injections, paracen- 
 tesis thoracis, paracentesis, abdominis, harpooning the udder,. 
 
BITES, LACERATED AND CONTUSED WOUNDS 7 
 
 lumbar puncture). Punctured wounds are usually small, 
 round, slightly hemorrhagic, and frequently lead to a 
 fistulous canal. Perforations into joints, tendon sheaths, 
 abdomen, thorax, eyes, etc., are common. Experience with 
 injections and puncture has demonstrated that perforating 
 wounds with sharp, clean instruments are harmless when they 
 penetrate body cavities, the rumen, intestines, or a large 
 blood vessel (jugular, carotid). All unclean objects, however, 
 especially manure forks, unclean injection needles, old nails 
 and harrow teeth, are liable to result in suppurative and septic 
 infection (phlegmon, abscess, fistula formation, septicaemia, 
 malignant edema, tetanus). Punctured wounds of the hoof 
 (treading on nails, nailing) are frequently followed by tetanus. 
 
 Contused Wounds. — Contused wounds are injuries caus- 
 ed by blunt objects, treads on the coronet, kicks, falls, col- 
 lisions, running into objects, being run over, falling into holes, 
 remaining in a recumbent position for a long time. Con- 
 tused, wounds are usually irregular in outline, possess 
 jagged, unclean margins, are sw o 1 1 e n, often have a 
 loss of substance, and the contused tissue has a tend- 
 ency to become necrosed. Occasionally hemorrhage is 
 slight or fails entirely even in large contused wounds. One 
 can differentiate superficial (excoriations, abrasions of the 
 skin) and deep contusions, with and without loss of substance. 
 (See chapter on contusions.) 
 
 Lacerated Wounds. — Lacerated wounds have some of 
 the characteristics of incised wounds, they are also similar to 
 contused wounds. They are caused by catching on or getting 
 against hooks and nails, by sharp calks, running into wagons, 
 machinery, etc. In horses they are most often .seen on the 
 head (false nostril, eyelid), on the thorax, buttocks, and pos- 
 terior limbs. Special lacerated wounds are observed on the 
 cornea in dogs (scratches from cats). Lacerated wounds are 
 frequently in the form of flap wounds with angular forma- 
 tions, the margins of the wound may be regular or torn. 
 
 Bites. — Injuries caused by bites from dogs, horses and 
 other animals present various characteristics ; they may be 
 punctured, contused or lacerated. They most frequently 
 
8 POISONED AND GUN SHOT WOUNDS 
 
 occur in dogs and horses, seldom in cattle or other animals. 
 Dog bites frequently result in severe phlegmon and com- 
 plicated bone fractures ; bites from horses in extensive 
 necrosis of the skin on the sides and top of the neck (bites 
 from animals standing in the same stall at night.) 
 
 Poisoned Wounds. — Under this term are included 
 injuries, especially to animals at pasture and hunting dogs, 
 due to snake bites, bee and wasp stings, as well as infected 
 wounds (rabies, anthrax, glanders, tetanus, septicaemia). 
 With reference to the specific diseases thus produced one must 
 consult text books on toxicology and infection (see chapter on 
 wound infection diseases). 
 
 Shot Wounds. — These belong to a special type of con- 
 tused wounds and may be termed contused-lacerated wounds. 
 They are characterized by an external opening with smooth, 
 contused, angular or lacerated margins, a tubular shot canal, 
 and an exit opening. When the latter fails it is termed a 
 blind shot canal. When the shot is fired near the seat of in- 
 jury the wound edges are burned. Superficial, long, gutter- 
 shaped injuries of the skin are observed in furrowed gun- 
 shot wounds, contusions of the subcutaneous tissues without 
 injur}' to the skin in gunshot contusions. Shots which per- 
 forate only beneath the skin are termed seton shots. In the 
 bones there exists either a shot hole, that is, a round, somewhat 
 tube-shaped shot wound without splintering of the bones, or 
 comminuted fractures, that is, comminuted bone frac- 
 tures with splintering and crushing of the bones ; gun-shot con- 
 tusions may be characterized by subcutaneous (simple) frac- 
 tures. Unfortunately the literature of the German veterinar}^ 
 surgeries concerning gun shot wounds of horses in the earlier 
 campaigns is worthless. According to the statistics of Jewse- 
 jenko collected in the Russo-Turkish War, from a total of 211 
 horses shot, 41 involved injuries of the bone (equal to 20 per 
 cent). HeaHng frequently follows encapsulation, especially 
 small shot, the latter seldom change position (wandering). 
 When other bodies, however, enter with the bullet ; namely, 
 dirt, hair, portions of the covering, of the tugs, etc.. there 
 develops a suppurative or ichoric inflammation in the vicinity 
 
GUN SHOT WOUNDS 9 
 
 of the shot canal. Shot wounds in horses are of importance in 
 war ; otherwise they are seldom observed (hunting dogs, cats). 
 
 Guns and Projectiles. — Shot injuries are produced, either by 
 hand weapons (muskets, revolvers, pistols, small rifles), or cannon 
 (shells, schrapnel, solid shot). Injuries caused by small shot are rela- 
 tively slight, experience has demonstrated that in dogs they may heal 
 without reaction. Injuries caused by musket balls are of more impor- 
 tance. While these balls were formerly manufactured from lead, were 
 round, and tolerably large in diameter, the bullets of modem weapons 
 of war, especially the eight millimeter gun, have a very small diameter 
 (eight millimeters), a cylindrical, long form, as well as a very hard 
 steel jacket over a core of lead. On account of the steel jacket and 
 small diameter these bullets retain their form, while the earlier bullets 
 were flattened or shattered when they came in contact with a bone, 
 causing severe injuries, especially to the soft tissues. Modern pro- 
 jectiles exert, however, on hard bodies, especially 
 bone, more active splintering force, and in addition to 
 this an enormous penetration. 
 
 According to Kocher ( Zur L,ehre von den Schusswunden durch 
 Kleincalibergeschosse. 1895) the force of modern projectiles is a blow in 
 the direction of their flight (pe net rati ng influence) on the one side, 
 and an explosive effect (lateral i mpactio n) on the other. As a result 
 of the penetrating as well as the explosive effect the tissues involved 
 are either lacerated or contused (explosive effect), or torn away (pene- 
 trating force). The slower the speed of the bullet, the lighter the 
 explosive effect; penetration and explosive effect stand, 
 therefore, in an inverse ratio to each other. If the pro- 
 jection force is less than the cohesion strength of the involved parts 
 they become stretched and contused ; when both are equal there exists 
 a wedge-shaped perforation ; if the force of the shot is greater than the 
 cohesion of the parts the tissues are ruptured. In the first case the 
 involved tissues are stretched ; in the second they are pushed forward 
 or to one side; in the third, lacerated. The degree of rupture 
 depends on the diameter of the shot and the character of the tissues. 
 An increase in the diameter of the missile is constantly occurring, this 
 increases the surface of contact (oblique exit, change in the form of 
 the shot). There exists a "reciprocal" influence between 
 the target and the shot, in which the increased resist- 
 ance of the target increases the explosive effect of the 
 bullet, the explosive effect is also intensified b)- increasing the speed 
 of the bullet. With increased resistance and explosive force there is a 
 parallel diminution in the speed of the bullet (heating, deformation). A 
 decrease in calibre and increase in the strength of the 
 jacket results in decreased explosive force for elastic 
 bodies, muscle and epiphyses of bone. Small calibre shots 
 
lO GUN SHOT WOUNDS 
 
 from a short distance produce the following effect on cortical bone : 
 laceration and contusion, splintering, and a bullet-shaped enlargement 
 of the exit wound ; large calibers produce very severe lacerations with 
 enlargement of the entrance wound ; with an increased velocity small 
 bullets may produce the same results. Through international agreement 
 a calibre of not more than six millimeters has been adopted, the bullets 
 to be covered with a hard jacket, so that they do not become deformed 
 by spreading, lacerations are prevented as much as possible and the 
 prognosis from shot injuries very much improved. 
 
 The effect of the German eight millimeter gun on men and animals 
 has been demonstrated by experimental investigations (Preussisches 
 Kriegsministerium, v. Bruns, Kocher, Kohler and others). According 
 to the investigations of EHenberger and Baum (Berliner Archiv. 1893) 
 on the horse it has a very variable action on different parts of the body 
 at a distance of 250 to 600 meters. 
 
 1. The skin had, as a rule, a smooth-margined entrance wound 
 which was usually smaller than the diameter of the bullet. The exit 
 wound in the skin was always larger than the entrance 
 wound. It was especially large when the shot had penetrated bones 
 and the wound was torn by bone splinters. 
 
 2. Injuries to muscle vary according to their thickness. Insmooth, 
 stretched muscle the wounds are in the form of a slit, have smooth edges 
 and are smaller than the diameter of the bullet ; those in thick muscles 
 are larger and more lacerated. The track of the bullet gradu- 
 ally enlarges, thereby increasing the laceration so that 
 the exit wound is about double the size of the entrance 
 wound and severely lacerated. Spent bullets (rebounding 
 shots), as well as bullets which have passed through bone, produce 
 severe tearing of the muscles. It is remarkable that in such cases 
 vessels and nerves sometimes remain intact. Wounds in the fascia and 
 connective tissue are in the form of a slit, frequently they are recognized 
 with difficulty. Tendons are split with a slight retraction of the edges. 
 
 3. The epiphyses of the long bones frequently pre- 
 sent a shot hole, extensive laceration is constant; the 
 epiphysis is less frequently disunited. Shots in the diaphyses, on 
 the other hand, are usually characterized by complete 
 fracture, or at least accompanied by pronounced splin- 
 tering; even with grazing shots the bones, as a rule, are completely 
 comminuted. Grazingshotson the epiphyses lead to splintering. Shots 
 in the center of short bones (carpus, tarsus, vertebrae) usually 
 result in comminution. Flat bones usually present a 
 shot hole with a round, small entrance wound, and a larger wound 
 of exit which produces fissures and slight splintering. When the 
 ribs are hit in the middle there exists a shot hole the size of the bullet's 
 diameter, with longitudinal laceration and slight splintering at the 
 
GUN SHOT WOUNDS 11 
 
 somewhat enlarged wound of exit. Grazing shots in the longitudinal 
 direction of the body fracture the ribs. Transverse shots 
 through the thorax penetrate the entire horse. When 
 the bullet comes in contact with a rib at the entrance wound, one is also 
 fractured at the wound of exit, it is a complete break, in the continuity. 
 On the bones of the skull there is produced a shot hole 
 with splintering and sometimes crushing of the bones. 
 The base of the skull is shattered. Gun shot wounds of the cartilage, 
 on the other hand, are relatively small, they are often in the form of a 
 smooth split. 
 
 4. The lungs are severely lacerated, the shot track usually contains 
 splinters of bone, near the wound of exit the track increases in diameter. 
 Also in the heart, one finds lacerated, flap, gaping wounds ; seldom small 
 round openings. In the small intestines there usually exists a small 
 shot hole ; in the large intestines, on the other hand, the wound is 
 usually broad, flap-like and lacerated. 
 
 The French Weapons, according to Gabeau (Recueil vet. 1895) in 
 experiments on the cadaver of the horse, result in severe injuries which 
 are always of a complicated nature. At a distance of 100 to 200 
 meters all bullets penetrated the body of the horse. 
 In the skin the entrance wounds are circular, as though penetrated with 
 a punch ; the skin itself is not changed. In soft parts the exit wound 
 is oval in form ; skin overlying bones on the other hand, is lacerated 
 and notched. In muscles the wound canal is much larger 
 than the diameter of the bullet; it contains fleshy, bloody 
 masses and dilates in the direction of the exit wound. The muscle 
 fibers appear to be torn in the direction of the rotation of the bullet. 
 The aponeuroses and flat ligaments present linear wounds ; tendon 
 wounds are twice the width of the bullet, their fibers appear to be torn and 
 lacerated. Long bones are broken or split and present oblique frac- 
 tures with extensive splintering ; short bones are crushed into splinters ; 
 the ribs present transverse fractures. The joints are commin- 
 uted, their bones are crushed to pulp; sometimes 
 fragments of the bone are torn away and thrown sev- 
 eral meters. The exit wound of joint shots is very large, the skin 
 is torn in shreds. The lungs have cylindrical shot canals. In the 
 liver the entrance wound is much larger than the bullet, the wound 
 canal is very wide, the tissue of the liver is ground to pulp for a distance 
 of three or four centimeters. In the stomach and intestines 
 the entrance and exit wound are seemingly equal in size. In the 
 hoof the entrance wound is hardly one mm. in diameter, almost 
 invisible ; the penetration of the hoof is complete. 
 
 The explosive effects of the so-called dum dum bullets is extremely 
 active. These are small caliber bullets from which the steel point has 
 been removed (expansive bullets). According to Walker (The Veter- 
 
12 ARREST OF HEMORRHAGE 
 
 inarian. 1899) the entrance and exit wounds are small ; the shot expands 
 in the tissues and lacerates the bones and soft tissues. 
 
 III. ARREST OF HEMORRHAGE. 
 
 Spontaneous Arrest of Hemorrhage. — This is a 
 cessation of hemorrhage of itself in contrast to artificial arrest 
 by means of therapeutic agents. The so-called "stopping" 
 of hemorrhage occurs in capillary and parenchymatous hem- 
 orrhage, as well as from that due to injuries to small arteries 
 and veins. 
 
 The causes of spontaneous arrest of hemorrhage are, first 
 of all, the small amount of blood, in addition one finds 
 a retraction of the vascular walls with a narrow- 
 ing of the lumina of the vessels. Coagulation of the exposed 
 blood results in the formation of a thrombus which closes the 
 opening and lies partly within the lumen of the blood 
 vessel. Because of slight blood pressure in the capillaries and 
 veins thrombi form in them in a very short time, thus arresting 
 hemorrhage. In large vessels, on the other hand, especially 
 in arteries, thrombus formation fails to occur, or exists only 
 after the loss of a large amount of blood with resulting heart 
 weakness and decrease of blood pressure, so that the blood 
 coagulum is no longer forced away by the blood stream. 
 After the los.s of large quantities of blood it is made more 
 coagulable by the addition of white blood corpuscles, thus aid- 
 ing in the arrest of hemorrhage. This explains, for example, 
 a fact which has been demonstrated by experiment, that stal- 
 lions castrated without any precautions finally recover after 
 severe hemorrhage. In general, as already remarked, the 
 loss of blood must not exceed a third of the total amount, oth- 
 erwise, there occurs a fatal paralysis of the heart and brain. 
 Quantitative regeneration of the blood seems to take place 
 rapidly through resorption of lymph from the tissues, as well 
 as fluids from the stomach and intestines. The newly formed 
 blood is, however, at first, very rich in water, the red blood 
 corpuscles, on the other hand, are deficient, they are formed 
 only after a long time. 
 
ARREST OF HEMORRHAGE 1 3 
 
 The exact phenomena of thrombus formation are 
 not fully understood. The principal factor in arrest of hem- 
 orrhage is the formation of a so-called white thrombus, 
 which is composed of white blood corpuscles and the blood 
 plates discovered by Bizzozero. This must be differentiated 
 from the fibrinous coagulum which is the ordinary pro- 
 duct of coagulation within the cadaver or outside the body. 
 In contrast to the white thrombi, which to a certain extent are 
 the result of physiological processes in normal living bodies, 
 the so-called red thrombi are formed as a pathological pro- 
 cess. The latter are made up of red blood corpuscles and fibrin 
 and are formed during life in the vessels of animals suffering 
 from septic affections, as well as from a general marasmus 
 (marasmatic thrombi). These red thrombi are formed by a 
 process of coagulation and death, similar to the formation of 
 blood coagula in cadavers, they possess, therefore, an essen- 
 tially different composition and importance. When both white 
 and red thrombi exist at the same time they are termed a 
 mixed thrombi. 
 
 The course of white thrombi varies according to 
 the presence or absence of infectious material. When the throm- 
 bus remains free from infection, so-called organization 
 occurs ; that is, it develops into indurated, vascular, connective 
 tissue, whereby the injured vessel contains a solid and perma- 
 nent cicatricial obstruction. If infectious material gains en- 
 trance to the thrombus, however, there occurs a suppurative and 
 ichoric softening of the thrombus with subsequent emboli. 
 
 I . The so-called organization of the thrombus con- 
 sists in a replacement of the same by connective tissue. The 
 cells of the thrombus itself do not undergo active division, the 
 thrombus plays more of a passive role in that it is gradually 
 pushed away by the newly formed tissue. The new con- 
 nective tissue is produced by proliferation of 
 the vascular epithelium. The endothelial cells of the 
 intima of the vessels proliferate and are transformed into 
 spindle-shaped and polymorphous formative cells, which 
 advance towards the center of the thrombus, they penetrate 
 and surround the same and are transformed later into fibrillar 
 
14 ARREST OF HEMORRHAGE 
 
 connective-tissue cells ; so that the thrombus, under the influ- 
 ence of the firm connective tissue, is finally pressed away and 
 replaced. Vascularization of the thrombus oc- 
 curs at the same time by means of a budding 
 process from the vasa vasorura. In about four 
 weeks the thrombus, when formed in small vessels, is made up 
 of a cicatricial mass of connective tissue penetrated by capil- 
 laries ; subsequently this becomes harder as a result of atrophy 
 and retraction of the capillaries. Calcification or cretefaction 
 of the thrombus is rare (so-called vein-stone or phlebolith). 
 
 The re-establishment of the circulation, which was broken 
 by the thrombus, is made possible by the formation of a 
 collateral circulation, in which the central and per- 
 ipheral branches of the artery given off at the thrombus, as 
 well as the vasa vasorum, are dilated. Occasionally the blood 
 stream afterwards passes through the center of the thrombus, 
 which becomes pervious ; or it may pass through dilated 
 cicatricial vessels. .^ 
 
 2. Softening of the thrombus is due to the entrance of 
 bacteria, which produce a suppurative liquefaction and ichoric 
 disintegration of the thrombic mass and thereby the danger of 
 embolic processes and general infection of the body (compare 
 with the chapter on pyaemia and phlebitis). 
 
 Determination of the Age of a Thrombus. — This is of impor- 
 tance to the veterinarian from a forensic standpoint (thrombus of the 
 arteries of the limbs and pelvis in the horse). Unfortunately, exact 
 experimental investigations on the horse are wanting. In general 
 thrombus formation is more rapid in small vessels than in large ; pro- 
 ceeds more rapidly in young animals than in old. Thrombus formation 
 in chronic endarteritis in the horse seems to take place especially slow. 
 In dogs it has been demonstrated experimentally that the thrombus is 
 vascularized in from seven to fourteen days after injuries to small ves- 
 sels, it is also composed of soft tissues ; after three to five weeks a 
 complete vascular cicatrix is present. Occasionally organization of the 
 thrombus requires a much longer time. In old age calcified thrombi 
 are observed. In general the age is determined by the consistence and 
 color of the thrombus, which finally becomes hard and clear, as well as 
 by the changes in the vascular walls. 
 
 Artificial Control of Hemorrhage. — This consists 
 of closure of the bleeding vessel either by means of pressure or 
 
ARREST OF HEMORRHAGE 1 5 
 
 coagulation. The following are the most important methods : 
 
 1. Ligation of the bleeding vessel. The ligature is 
 the surest means of controlling hemorrhage from large arteries 
 and veins. The bleeding vessel is grasped with a good pin- 
 cette and then ligated with silk. When the isolation is not 
 complete the surrounding tissue is also included (ligature en 
 masse) after having passed around the parts with a needle. 
 If none of these methods are applicable on account of the 
 depth of the bleeding vessel the spurting artery must be ligated 
 at a centripetal point (ligation in the continuity), for example, 
 the carotid is ligated after an injury to the internal carotid. 
 
 2. Compression of vessels by knots and band- 
 ages is indicated in capillary and parenchymatous hemor- 
 rhage. Occasionally strong pressure may be brought to bear 
 on the bleeding vessel by means of a tampon in the wound. 
 Momentary and provisional relief from hemorrhage may be. at- 
 tained through pressure with the finger or hand (digital 
 compression), the application of an elastic bandage (Es- 
 m arch's bandage), or a rubber bandage (Martin's 
 bandage) ; pressure should be applied between the wound 
 and the heart. A special method employed by the veterina- 
 rian for the control of hemorrhage consists in the application 
 of clamps for the castration of stallions. The formerly em- 
 ployed tourniquets (pad in the form of a girth) as well 
 as the so-called acupressure are very seldom used at the 
 present time. 
 
 3. Torsion of the bleeding vessels results in loosening 
 and rolling up of the intima and media, as well as retraction 
 of the adventia, thus closing the lumen of the injured vessel. 
 Torsion is either applied to the bleeding vessel alone, when it 
 is grasped with the pincette and twisted on its axis for a long 
 time, or the surrounding soft tissues may be included (torsion 
 of the spermatic cord). From many castrations of horses I am 
 convinced that regular torsion of the spermatic cord is a surer 
 means for the prevention of hemorrhage than either clamps or 
 the ligature ; from a standpoint of simplicity or asepsis torsion 
 and clamps, especially the latter, are not preferable. 
 
l6 ARREST OF HEMORRHAGE 
 
 4. H e a t in the form of a red hot iron or cautery is efl5- 
 cient in many forms of parenchymatous hemorrhage. It forms 
 an eschar over the ends of the bleeding vessels which performs 
 the function of an aseptic bandage (searing the tail after 
 amputation). The application of cold (ice-cold water, spray 
 of ether) is less effective. Its action is due to the contraction 
 and narrowing of small vessels. Hot water is employed 
 at a temperature of 45-50 C. as a styptic for parenchymatous 
 hemorrhage of the uterus. Even steam at a temperature of 
 100-120° has been employed recently in the human family for 
 persistent cases of uterine hemorrhage (vaporization of the 
 uterus, so-called atmocausis and zestocausis). 
 
 5. The following th era pe u tic age n t s exert a styp- 
 tic influence, active only in capillary and parenchymatous 
 hemorrage : liquor ferri chloridi, concentrated or com- 
 bined with collodion, with surgeons cotton or in aqueous 
 solution. This causes coagulation of the blood wath simul- 
 taneous constriction of the blood vessels. Other agents are 
 alum, tannin, creolin, sugar of lead, nitrate of silver, oil of 
 turpentine, gelatine (subcutaneous), ergot or hydrastis 
 is employed to control hemorrhage that cannot be treated 
 surgically. 
 
 Hemophilia. — Hemophilia (blood disease ) is a congenital tendency 
 to hemorrhage (hemorrhagic diathesis) which presents the following 
 characteristics in man: uncontrollable hemorrhage after 
 very slight wounds. This disease also occurs in the horse ( Kohne , 
 Siedamgrotzky, Dreymann, Otto, Zschokke, and others). The following 
 examples have been observed : after enlarging castration wounds, after 
 the removal of setons, after splitting fistulous canals, after the extraction 
 of teeth in dogs ; hemorrhage has continued for hours and days regard- 
 less of all preventatives. Not all reported observations from veterinary 
 sources are free from exception ; I have never seen a case of hemophilia 
 in the dog or horse. The real cause is unknown (abnormal condition 
 of the blood? failure to coagulate? deranged nourishment of the vas- 
 cular walls ?). According to Schindelka many descendants of the thor- 
 oughbred stallion "Gunnersbury" suffer from a hemorrhagic diatheses 
 (epistaxis) (transmission as in man ?). 
 
KINDS OF WOUND HEALING 17 
 
 IV. ANATOMICAL CHANGES IN WOUND HEALING. 
 
 Kinds of Wound Healing. — The anatomical changes 
 in the healing of wounds, which have been demonstrated by 
 the exhaustive investigations of Thiersch, are extremely 
 variable. They depend upon the following conditions : whether 
 the wound is clean or infected, sutured or open, incised or 
 contused, with or without loss of substance. The following 
 forms of wound healing may be recognized : 
 
 1. Healing by first intention. 
 
 2. Healing by second intention. 
 
 3. Healing by third intention. 
 
 4. Healing under scab. 
 
 5. Abnorma 1 gr an ula t ion and c ic a t r i za t ion 
 Healing by Primary Intention. — Healing by first 
 
 intention consists of a direct union of the margins 
 of the wound through immediate agglutina- 
 tion without suppuration. Healing by primary 
 union depends on the following conditions : fresh, non-infected 
 (aseptic) wounds, fresh incised wounds with even margins 
 and, when possible, without loss of substance ; when infection 
 has occurred careful disinfection must be employed (antiseptic 
 treatment); the margins of the wound must be brought in 
 close apposition by means of sutures ; all foreign bodies (hair, 
 dirt, blood, etc.) must be removed ; application of an aseptic 
 bandage. In the domestic animals these conditions are 
 usually applicable only to operation wounds, and then only 
 when possible to afford protection b}' means of a bandage. 
 
 Macroscopically healing by primary union first 
 presents an agglutination of the edges of the wound with blood, 
 afterwards a lymph-like plasmic fluid (so-called wound cement) 
 exerts the same influence. The surface of the wound remains 
 dry. About the second day the margins of the wound are 
 slightly swollen, sensitive, and red. After about a week (four 
 to eight days) definite union results with the formation of a 
 small cicatrix. Microscopically one soon observes emi- 
 gration of the white blood corpuscles from the neighboring 
 blood vessels to the margins of the wound and to the wound 
 
1 8 HEALING BY FIRST INTENTION 
 
 cement. This cellular infiltration of the 
 wound with wandering white blood corpus- 
 clesis considered aprocess of inflammation. 
 Wandering of the white blood corpuscles is due to a traumatic 
 irritant (traumatic, aseptic inflammation) and is to be consid- 
 ered, therefore, as a reactive manifestation on the part of the 
 injured tissue. According to recent investigations bacteria 
 which gain entrance to a wound that heals by primary union 
 are soon rendered harmless and partly resorbed ; this is prin- 
 cipally due to the bactericidal properties of the blood serum 
 (antitoxins, alexins) which is one of the constituents of wound 
 secretions. The infiltration of the wandering cells (leuco- 
 cytes) in the wound cement and margins of the wound reaches 
 its height on the third day ; from that time they degenerate 
 or return to the vessels. 
 
 The wandering cells take no part in the formation of the 
 definitive cicatrix, a former erroneous supposition. The 
 cicatricial tissue develops from the so-called 
 fibroblasts; these are round cells which arise 
 from the proliferation of the fixed (autoch- 
 thonous) connective tissue cells and the 
 endothelium of the vessels. The fibroblasts gradu- 
 ally enlarge ; large epithelioid, as well as long, spindle, and 
 club-shaped cells are formed ; these are afterwards transformed 
 into fibrillar, connective tissue cells when they form genuine 
 cicatricial tissue. Simultaneously there occurs a 
 budding process from the walls of the incised 
 capillaries, new vessels are thus formed be- 
 tween the margins of the wound. The fibroblasts 
 in combination with the newly formed vessels form the so-called 
 germinal tissue (granulation tissue); this is a cellular and 
 vascular new formation. After the transformation of the 
 fibroblasts into connective tissue cells the granulation tissue 
 contracts so that the newly formed vessels atrophy again; thus 
 the formation of the genuine cicatricial tissue is com- 
 plete. Finally the cicatricial tissue is com- 
 pletely covered by proliferations from the 
 epidermal cells (rete Malpighi, epithelium 
 
HEALING BY SECOND INTENTION 1 9 
 
 of the dermal glands) at the margins of the 
 wound. This completes the process of healing by primary 
 union. 
 
 Healing by Second Intention. — This mode of 
 healing occurs with suppuration as a result 
 of infection with ordinary pus cocci. It is 
 characterized by the formation of an abun. 
 dance of granulation tissue. One finds this form of 
 healing in old wounds, wounds that have become infected, 
 those that have not received aseptic treatment, contused 
 wounds, wounds with a loss of substance, or those which can- 
 not be sutured. 
 
 Macroscopically, within the first twenty- 
 four hours the individual tissues and blood may be readily 
 differentiated on the surface of the wound. A serous, lym- 
 phatic, reddish-yellow secretion is formed after one or two 
 days, giving the surface of the wound a gelatinous appear- 
 ance. From the second to the third day the sur- 
 face of the wound presents a granular ap- 
 pearance (granulations), pus begins to form. 
 During the course of the suppuration the necrosed tissue is 
 sloughed off, the wound is "sel&cleansing. " Later, the gran- 
 ulating wound surface is gradually covered with epidermis 
 from the margins of the wound, the newly-formed epidermis 
 surrounds the margins of the granulations in the form of a 
 light colored fringe. The granulation tissue contracts and is 
 completely covered, there finally remains a broad, firm, 
 tendonous cicatrix. The microscopic changes 
 are identical with those which occur during 
 healing by first intention. The only points of dif- 
 ference are that in healing by second intention infection takes 
 place. The wound is irritated by bacteria and 
 their products, which results in the forma- 
 tion of large quantities of granulation tissue, 
 this being the product of a suppurative inflammation it fur- 
 nishes a purulent exudate. Healing, therefore, re- 
 quires a much longer time (two or more weeks). Cellular in- 
 filtration of the edges, formation of the fibroblasts, budding of 
 
20 HEALING BY THIRD INTENTION 
 
 the capillaries, and transformation of the fibroblasts into con- 
 nective tissue proceeds exactly as in healing by first intention. 
 Further, suppuration does not form an abso- 
 lutely necessary condition for healing by 
 secondary union. The essential condition is the abund- 
 ant formation of granulation tissue, which may occur without 
 suppuration (aseptic granulations). 
 
 Granulation tissue formed during healing 
 per secundam serves principally as a com- 
 pensation for the loss of substance. In ad- 
 dition it forms an important protection 
 against the entrance of infectious irritants 
 into the blood stream. The entrances to the lymph 
 streams are mechanically closed by the granulation tissue, the 
 pus also contains bactericidal properties (pus serum, like blood 
 serum ; pus corpuscles, like white blood corpuscles). This 
 explains the long known surgical fact, that with the formation 
 of granulation tissue the danger from general infection is 
 greatly diminished after the third day. Experimental inves- 
 tigations upon sheep have also demonstrated that granulating 
 wound surfaces are not permeable for anthrax bacilli or for the 
 toxins of tetanus. The protective action of granulations is of 
 great importance, therefore, in veterinary science, as healing 
 by primary union is seldom attained. Above all, the granula- 
 tions supply the loss of substance when healing 
 by primary union is impossible. Many wounds cannot heal 
 except through the formation of granulation tissue (wounds 
 of the cartilage and cornea). 
 
 Healing by Third Intention. — This consists in the 
 artificial union of wound surfaces that are 
 already granulating and suppurative. It 
 sometimes follows careful disinfection and exact suturing of 
 suppurative granulations. Healing by third intention should 
 not be confused with scarification and suturing of granulating 
 wounds (same as healing per prima). Healing by third in- 
 tention is of considerable importance in veterinary surgery as 
 certain forms of purulent lacerated wounds may be brought 
 to rapid healing by this method. This is especially true of 
 
HBALING UNDER AN ESCHAR 21 
 
 those about the head (false nostril), permanent union result- 
 ing in wounds a week or more old. Healing by third inten- 
 tion should always be given a trial, especially in the horse, 
 when healing per prima cannot be expected from scarification 
 of the wound surfaces. 
 
 Healing Under an Kschar. — This isaform of pri- 
 mary wound healing. The blood dries on the surface 
 of the wound and leads to the formation of a protective coat. 
 In small wounds cicatrization without suppuration takes place 
 rapidly beneath the eschar, new epidermis is quickly replaced 
 from the margins of the wound. In veterinary surgery this 
 method of healing is of great importance as many wounds can 
 be neither sutured nor bandaged, the dry scab taking the 
 place of the latter. It may be applied artificially by means of 
 a hot iron, production of a necrotic covering (wounds 
 of the ear, tail, joints, extirpation of small tumors from the 
 backs of dogs), or by the application of tannin, tanno- 
 form, glutol, amyloform, argentum nitricumor 
 other disinfecting agents that produce an eschar. 
 
 Abnormal Granulation and Cicatrization. — While 
 the various forms of normal wound healing by the processes 
 of granulation formation and cicatrization lead, as a rule, after 
 more or less time, to the formation of a typical cicatrix, 
 many wounds form an exception to this rule. The granulation 
 and cicatricial process appears abnormal. This is true when 
 foreign bodies or necrosed pieces of tissue remain in the 
 wound, when there is great loss of substance, when continued 
 infection or irritation occurs in fresh or healing wounds, when 
 the injured animal is suffering from certain infectious dis- 
 eases (see below). 
 
 I. Granulations are especially abnormal when the 
 granulation tissue forms too rapidly and in large quantities ; 
 exuberant proliferations, fungus-like granulations 
 (granuloma, caro luxurians, proud flesh). Excessive granu- 
 lations are observed in treads on the coronet ; fistulous 
 withers or saddle galls when necrosed pieces of tissue are re- 
 tained and act as a constant irritant to the part ; in skin 
 wounds on the flexor surfaces of the joints (carpus, tarsus) 
 
22 ABNORMAL WOUND HEALING 
 
 when continually irritated by flexion and extension move- 
 ments of the limbs ; in muscle prolapse as a result of con- 
 striction and continued irritation of the exposed part after 
 injury to the fascia of the limbs, in intensive suppurative infec- 
 tion. Other diseased forms are : erethistic granulations, 
 that is, sensitive, dark-red, easily hemorrhagic, and very pain- 
 ful granulation tissue ; atonic (torpid, asthenic) weak or 
 deficient, as well as unequal granulation, and gangren- 
 ous degeneration of the granulation tissue (diphtheria of 
 the granulations). 
 
 2. Cicatrization may become abnormal in various 
 ways. Great loss of substance results in an incomplete 
 cicatrix ; suppurative decomposition in the formation of an 
 u 1 cer or f i st ul a. In horses there is frequently observed 
 on the cicatrix an abundant accumulation of horn}- epidermal 
 cells (horny cicatrix). Occasionally one observes a tumor- 
 like proliferation of the cicatricial tissue (cicatricial keloid, 
 cicatricial hypertrophy). This is seen in horses in the flexor 
 regions of the fetlock and coronet (compare wnth chapter on 
 keloids, under tumors). So-called painful or sensitive 
 cicatrices (neurectomy, throat, shoulder) are rare in the 
 horse. A cicatricial contracture occasionally results 
 from extensive destruction of the skin, that is, cicatricial con- 
 traction of the neighboring skin leads to change in position of 
 parts of the body (caput obstipum from contraction of the 
 tissues of the neck ; stilt- foot in necrosis of the skin on the 
 posterior surface of the carpus and metacarpus ; ectropium 
 from extensive wounds of the eyelids). 
 
 The causes of atypical wound healing are 
 both local and general. Under local causes are mechanical 
 lesions of the tissues (contusions, constant irritation from 
 foreign bodies, licking, rubbing, and movements); irritation 
 of the wound through chemical irritants (antiseptics, 
 decomposing secretions, necrosed particles of tissue); infec- 
 tion of the wound through specific inflammatory irritants 
 (botryomyces fungi, glanders, necrosis bacilhxs), or by means 
 of various other especially virulent, pus forming bacteria ; 
 deranged circulation (anaemia, hyperaemia, throm- 
 bosis). Neurectomy, as a local cause of deranged circula- 
 
WOUND HEALING IN DIFFERENT TISSUES 23 
 
 tion and nourishment, may influence normal wound healing 
 (injuries to the hoof). General causes of disturbed wound 
 healing are : febrile general diseases; chloroform 
 (reduced activity of the white blood corpus- 
 cles; weakening of the activity of the heart); 
 old age; general weakness and conditions of 
 exhaustion; weak constitution; faulty breed- 
 ing, care and food; diseases of the kidneys; 
 h3^draemia; cancerous cachexia; diabetis. 
 Also the race and species, as well as the condition of the 
 stable, temperature, season, climate, etc., all have an influence 
 on the healing of wounds. Finally, many animals have 
 idiosyncrasies which interfere with normal wound healing 
 and favour the entrance and multiplication of infectious ma- 
 terial. On the other hand, many animals appear to have 
 congenital immunity against wound infection diseases; 
 wounds on native born Algerian horses, for example, heal 
 without suppuration and without treatment. 
 
 Wound Heading and Regenerative Ability of Different 
 Tissues. — i. Wound healing in the skin, pododerm and mucous 
 membrane takes place according to the previously described methods. 
 Regr e n e rat ion is most rapid in the following tissues: 
 epidermis, skin and pododerm (formation of horn), 
 the epithelium of the mucous membranes, as well as 
 the connective tissues. 
 
 2. Muscle wounds do not heal by regeneration of muscle fibers, 
 but by means of a fibrillar, connective-tissue cicatrix. The regen- 
 erative ability of muscle is very slight. Proliferation and 
 enlargement of the muscle cells occurs only in the vicinity of con- 
 nective tissue cicatrices, as well as in small, superficial injuries to the 
 muscle, even here the formation of new muscle fibers is limited. 
 
 3. Tendon wounds heal principally through proliferation of 
 the cells of the tendon sheath, of the paratendineum, 
 and the interfascicular connective tissue, the genuine 
 tendon cells of the tendon stump also take part. The granulation tissue 
 that results from this proliferation unites both ends of the tendon and 
 gradually changes into genuine tendon tissue (compare with the chapter 
 on rupture of tendons). 
 
 4. Wounds of the bone heal in the same manner as fractures, 
 through ossification of the granulation ti ssue (callus); this 
 is formed from the periosteum and bone marrow, as well as the bone 
 itself (periostitis, osteomyelitis, and ostitis ossificans) 
 (compare with chapter on healing of bone fractures). 
 
24 WOUND HEALING IN DIFFERENT TISSUES 
 
 5. Cartilage wounds that are covered with perichondrium ( late ral 
 cartilage, trachea, muscles of the ear) heal, similar to bone wounds, 
 through proliferation of the perichondrium with the 
 formation of a callus that is at first fibrous and afterwards 
 ossified. The cartilage cells that fall directly into the cartilage 
 wound undergo fatty degeneration. Synchronous with the prolifera- 
 tion of the perichondrium there occurs a multiplication of the neigh- 
 boring cartilage cells with a new formation of cartilage tissue. 
 In non-vascular articular cart ilage, however, the relation is very 
 different. Aseptic, clean, cartilage wounds in the joint 
 never heal, they remain as a permanent defect. Infected, articular- 
 cartilage wounds, on the other hand, heal completely. Severe irritation 
 of the non-vascular tissue of the wound leads to the formation of 
 granulations and a connective-tissue cicatrix. Afterwards the connective- 
 tissue cicatrix may be even partly transformed to hyaline tissue. 
 
 6. The peripheral nerves, when injured, possess an ex- 
 tremely active regenerative ability. When a nerve suture is 
 applied replacement takes place through new formation 
 of nerve fibers from the old nerve fibers of the central 
 stump; these new fibers grow into those of the per- 
 ipheral stump. When the ends of the nerves, however, remain 
 at least one centimeter apart (neurectomy ) t h e peripheral portion 
 of the incised nerve degenerates, while the central nerve 
 stump anastomoses with neighboring nerves, in this manner the 
 conductivity is again established. At the same time new nerve fibers 
 sprout from the central stump, which fill in the defect between the 
 ends, and extend along the course of the peripheral portion. In this 
 manner the nerve is replaced, when degeneration was comj^lete, or 
 fusion may occur when the fibers are still intact (chemotatic influence 
 of the products of degeneration of the old nerve fibers on the growing 
 central nerve cylinder). As a result of constant irritation (neuritis) the 
 central nerve end undergoes a new formation of nerve fibers and con- 
 nective tissue, this results in a club-shaped swelling (neuroma). 
 
 7. In the brain and spinal-marrow — in contrast to the per- 
 ipheral nerves — regeneration of nerve substance does not 
 occur; there is a formation of connective-tissue cicatrix similar to 
 that which occurs in regeneration of muscle. 
 
 8. In the non-vascular cornea healing of wounds is similar to 
 that in vascular tissues. One first finds migration of white blood cor- 
 puscles from the neighboring conjunctiva and schlera, as well as a sub- 
 sequent autochthonous cellular proliferation with the formation of 
 fibroblasts and the successive transformation of these into fibrillar con- 
 nective-tissue. The formation of new vessels in the cornea, 
 however, does not take place in the corneal tissue, but 
 proceeds from the margin of the sclera. 
 
WOUND INFECTION DISEASES 25 
 
 V. WOUND INFECTION DISEASES. 
 
 Definition. — The term wound infection dis- 
 eases or accidental wound diseases embraces the 
 general surgery of a long list of affections due to wounds 
 which depend on the entrance of microorganisms or 
 their products (toxins). The bacteria gain entrance to 
 the wounds by contact or through the air. They maintain 
 local disease processes in the wound or some form of general 
 derangement. In a narrow sense the most important wound 
 infection diseases are : i. Suppuration, 2. Phlegmon, 3. Ab- 
 scess, 4. Wound Fever, 5. Septicaemia, 6. Pyaemia. The 
 following diseases may also result from the wound : inflam- 
 mation of the lymph vessels (lymphangitis), inflammation of 
 the veins (phlebitis), as well as erysipelas. In a broader 
 sense wound infection includes tetanus, glanders, 
 rabies, botryoraycosis, actinomycosis, tuber- 
 culosis, malignant edema, strangles, anthrax, 
 black leg, and Wildseuche. The following in- 
 cludes a description of the wound diseases in the narrow sense. 
 
 I. Suppuration of Wounds. 
 
 Causes. — Suppuration which accompanies healing by 
 second intention is a product of inflammation caused by i n f e c- 
 tion of the wound with pus cocci. The following 
 have been found most often on bacteriological examination : 
 staphylococcus and streptococcus (staphylomycosis, strepto- 
 mycosis). The following are the most important pus forming 
 bacteria : 
 
 a) Staphylococcus pyogenes aureus is the 
 most frequent pus coccus in animals, especially the horse. 
 They are in the form of small, round, non-motile cocci ; ar- 
 ranged as lobules, clusters, or as diplococci ; on potatoes, 
 agar, and gelatine they form orange-yellow cultures. Experi- 
 ments have demonstrated the fact that their action is due to 
 the production of toxins which act as an irritant and produce 
 inflammation. Subcutaneous injection of a pure culture usually 
 results in the formation of an abscess; intra-abdominal 
 
26 PUS-FORMING BACTERIA 
 
 injection in fatal suppuration ; injection into the blood, py ae- 
 m i a as well as ulcerative endocarditis. Repeated injections 
 have resulted in the seemingly rapid formation of amyloid 
 degenerations (liver, kidneys). Staphylococcus pyogenes 
 aureus is especially common in circumscribed, localized 
 suppuration, in p3'aeniia, and in the pyaemic form of 
 foal lameness. 
 
 b) Staphylococcus pyogenes albus is less 
 common. It is distinguished from the preceding form by its 
 less virulent pathogenic action, and white, varnish-like cul- 
 tures. According to some, it is the cause of moon blind- 
 ness (?). 
 
 c) Staphylococcus pyogenes citreus is rare. 
 It is characterized by the citron-yellow color of its cultures, 
 otherwise it is identical with the preceding. 
 
 d) Streptococcus pyogenes is next in importance 
 to staphylococcus pyogenes aureus. It forms cocci arranged 
 in the form of a chain ; it does not grow on potatoes, on 
 gelatine it forms very small white colonies. Streptococcus 
 pyogenes is a special cause of progressive phlegmon- 
 ous suppuration with subsequent septicaemia. It 
 is found, therefore, in the septic form of foal lameness. 
 It also appears to be identical with the streptococcus of erysip- 
 elas, strangles, contagious pleuro pneumonia, acute articular 
 rheumatism, and petechial fever (?). 
 
 e) Bacillus pyogenes appears to be the most im- 
 portant cause of pus formation in cattle and swine ; see 
 page 36. 
 
 f) Bacillus pyocyaneu s — the bacillus of blue 
 and green pus — forms small, slim, very motile bacilli. They 
 frequently possess four to six flagella. Through the decom- 
 position of albumen they produce a blue and yellowish-green 
 coloring material (pyocyanin, pyoxanthin) similar to the 
 bacilli of blue milk. Chemically this is closely related to 
 anthracine, it also belongs to the benzol group, and colors the 
 pus and bandage blue or greenish-yellow. While the coloring 
 material is harmless, the bacilli and their toxins have a patho- 
 genic action towards experimental animals, producing an 
 
PROPERTIES OF PUS 27 
 
 edematous and suppurative inflammation at the point of in- 
 jection. Bacilli with red coloring material are also found in 
 
 pus. 
 
 Colon BacilIvUS. — The colon bacillus (Bacillus cell communis, 
 Bacterium coli commune) is found in various varieties in the normal 
 intestinal canal. It is present in many species and races, and is usually 
 a harmless organism because its very poisonous toxins are neutralized in 
 healthy animals by the action of the gall. Under certain unknown con- 
 ditions the colon bacillus in the intestinal canal becomes highly viru- 
 lent ( calf diarrhoea, calf septicaemia, enteritis, peritonitis, cystitis, 
 pyelonephritis, hepatic abscesses, endometritis, septicaemia puerperalis, 
 polyarthritis and omphalo-phlebitis in the calf, malignant head catarrh in 
 cattle, croupous enteritis in cats, as well as various other "colon bacilli" 
 infections). In the subcutaneous connective-tissue it causes suppura- 
 tion with more or less serious phlegmons (septic and gas phlegmon). 
 It is alleged to be identical with Bacterium phlegmasiae uberis, bacillus 
 foetidus, neapolitanus and lactus aerogenes. 
 
 The following microorganisms may also cause suppuration under 
 certain conditions : actinomyces and botryomyces fungi ; the bacillus 
 of glanders ; the streptococcus of strangles ; the cocci of contagious 
 pleuro pneumonia ; the micrococcus pyogenes tenuis and tetragenes ; 
 the capsule coccus (diplococcus) ; the bacillus pyogenes foetidus ; the 
 staphylococcus cereus, albus, flavus ; proteus vulgaris, and others. 
 Finally, the courses of many infectious diseases ; namely, suppurations 
 of tuberculosis and actinomycosis are, frequently accompanied by 
 mixed infections of ordinary pus bacteria. For further informa- 
 tion on suppuration, in regard to pus bacteria found in individual do- 
 mestic animals, as well as on the development of so-called aseptic 
 inflammation (injections of oil of turpentine, sublimate, nitrate of 
 silver) compare with the chapter on inflammation. 
 
 Properties of Pus. — Under ordinary conditions pus 
 forms a thick, creamy, yellowish or greenish, non-odorous, 
 non-coagulable fluid (pus bonum et laudible). As a result of 
 infection with bacteria which produce a colored secretion the 
 pus may be green or blue, seldom yellow. Thin, mucous-like, 
 frothy, odorous pus indicates the presence of decomposition as 
 a result of colonization of septic bacteria in the wound. The 
 condition and quantity of the pus varies with the size and age 
 of the wound, the blood supply and consistence of the wound, 
 the species, quantity and virulence of the bacteria, tempera- 
 ture and season, climate, breed, etc. Pus from the horse is 
 usually yellowish and cream-like ; that of cattle and birds is 
 often caseous ; that of swine tenacious and green. 
 
28 PHI^EGMON 
 
 When pus remains for a long time in a vessel one observes 
 two layers. The upper is a thin, apparently clear, and yel- 
 lowish fluid ; it forms the so-called pus-serum. The under 
 layer is thick and straw-yellow ; it contains the p u s-c o r p u s- 
 cles. The pus-corpuscles are formed princi- 
 pally from the white blood-corpuscles that 
 migrate from the blood vessels (Cohnheim). 
 Part of them, however, are descendants of the fixed connec- 
 tive-tissue cells, as well as the degenerated connective-tissue 
 substance of the tissue. Upon microscopic examination one 
 finds, in addition to the pus corpuscles, various forms of pus 
 cocci which are occasionally enclosed within the pus corpus- 
 cles. There are also observed various other bacteria, red 
 blood-corpuscles, tissue cells, drops of fat, crystals of fatty 
 acids and cholesterin. The recognition of cartilage cells and 
 giant cells in the pus are of special importance in the diagnosis 
 of cartilage and bone fistulae. The peptone contents of the 
 pus is due to the transformation of the fibrinogen through the 
 activity of the pus forming microorganisms ; absence of fibri- 
 nogen in the pus accounts for its non-coagulability. 
 
 When the suppuration does not remain confined to the 
 wound, but involves the neighboring tissues in a suppurative 
 inflammation, it leads to the development of a diffuse suppu- 
 rative inflammation of the subcutaneous and submucous cellu- 
 lar tissue (suppurative phlegmon), a circumscribed 
 accumulation of pus (abscess), a suppurative inflammation 
 of the lymph vessels (lymphangitis), lymph glands 
 (lymphadenitis), and veins (phlebitis), as well as the 
 entrance of pus cocci and their toxins into the blood 
 (wound fever, septicaemia, pyaemia). Compare 
 with the subsequent chapter. 
 
 2. The Phlegmons. 
 
 Definition. — P hlegmon, phlegmonous inflam- 
 mation, or inflammation of connective tissue 
 are terms used to indicate an infectious, serous, or suppurative 
 inflammation of the connective tissue and all its parts ; namely, 
 the subcutaneous, submucous, subfascial, intermuscular, peri- 
 
PHLEGMON 29 
 
 osteal, perichondral, tendo- vaginal, and interglandular connec- 
 tive-tissue. One speaks, then, of a subfascial or intermuscu- 
 lar phlegmon, of a phlegmon of the subcutis, the perichon- 
 drium, the tendon-sheaths, the udder, etc. 
 
 Causes and Forms. — Phlegmonous inflammation is due 
 to the same bacteria that are found in suppuration. The 
 streptococcus pyogenes and staphylococcus 
 pyogenes aureus are the most frequent causes of phleg- 
 mons (phlegmone streptococcia or streptomycosis ; phlegmone 
 staphylococcia or staphylomycosis). The pus cocci usually 
 gain entrance to the connective tissue through wounds ; punc- 
 tured, contused, and lacerated wounds form the ordinary 
 sources of phlegmons. Very often the previous wounds are 
 very small or entirely healed so that they can no longer serve 
 as a source of entrance to pus forming bacteria. Formerly, the 
 erroneous term of so-called spontaneous phlegmon was given 
 to this condition. Phlegmon may occur at a point more or 
 less removed from the point where the pus cocci gain entrance ; 
 they being carried to this point through the lymphatic circu- 
 lation. It may also occur that the infection of the connective 
 tissue proceeds, not from without, but from the blood stream 
 (m etastatic or symptomatic phlegmon of pyaemia, 
 strangles, contagious pleuro pneumonia, glanders). Hemor- 
 rhage and lacerations of connective tissue as a result of con- 
 tusions predispose to phlegmons. 
 
 Surgically there are various forms of phlegmon. 
 Classified from an anatomical standpoint we have — subcu- 
 taneous, submucous, subfascial, intermuscu- 
 lar. It is also spoken of as superficial and deep (e. g. 
 subfascial), or circ u msc ribed and diffuse phlegmon. 
 The circumscribed form confines itself to a phlegmonous swel- 
 ling in the vicinity of the wound and frequently leads to the 
 formation of an abscess (phlegmonous abscess). Difi"use 
 phlegmon consists of an inflammatory infiltration 
 of large areas of connective tissue and frequently results in 
 necrosis of the skin, subcutem, fascia, tendons, tendon sheaths 
 (gangrenous phlegmons), whereby other bacteria may 
 also play a part (necrosis bacillus). 
 
30 PHLEGMON 
 
 Septic phlegmon, in contrast to the ordinary form, is 
 especially virulent. It is also termed progressive phleg- 
 mon, progressive inflammation of the cellular tissue, or gan- 
 grenous erysipelas. It is due to a mixed infection of pus cocci 
 and specific septic bacteria (streptococcus septicus, micrococ- 
 cus tetragenes, colon bacillus, and others). It is character- 
 ized by a rapid, extensive, ichoric suppuration of the cellular 
 tissue, with a severe, often fatal general infection. The so- 
 called gas phlegmon is a mixed infection composed of gas- 
 forming bacteria (bacillus phlegmonse emphysematosse, colon 
 bacillus). The ordinary suppurative phlegmon is termed 
 simple in contrast to the specific phlegmons. The latter 
 are not due to pus cocci, but to certain other bacteria, espec- 
 ially the bacilli which cause malignant edema and ery- 
 sipelas (compare with the chapter on these subjects). 
 
 General Symptoms of Phlegmon. -C ircumscribed 
 phlegmon is characterized by swelling, high temperature, 
 and pain over a small area of the skin. At first the swelling 
 has a well defined boundary ; on palpation it may be hard and 
 firm, or soft and fluctuating. As a result of the swelling and 
 tension the skin cannot be raised. Circumscribed phlegmon- 
 ous swellings frequently result in the formation of an abscess ; 
 it is characterized by fluctuation, a reddish-blue or dark 
 grey color of the skin, and fever. Spontaneous evacuation 
 may occur after necrosis of a small portion of the overlying 
 skin. Healing follows by the formation of granulation tissue, 
 when not evacuated artificially it may result in burrowing of 
 pus as well as in progressive phlegmon. Suppurative lym- 
 phangitis, lymphadenitis, phlebitis, as well as pyaemia and 
 septicaemia may also occur. 
 
 Diffuse phlegmon is characterized by extensive 
 swelling of the skin — especially on the limbs — fever, and pain 
 (lameness) . Subfascial phlegmon is accompanied by 
 especially high fever and severe pain, when the deeper layers 
 are affected the skin may remain unchanged, or presents a 
 slight, edematous, doughy swelling. Intermuscular 
 phlegmon is similar in appearance. All diffuse phlegmons 
 frequently lead to extensive necrosis of the skin, subcutem, 
 
PHLEGMON 31 
 
 fascia, muscle, etc. They often result in fatal septicaemia or 
 pyaemia. 
 
 Septic phlegmon is very acute, spreads rapidly, and 
 usuall}^ terminates in death. It is characterized by a high 
 septic fever, extensive gangrenous destruction of the subcutem 
 and neighboring soft parts, namely, the muscles, which are 
 transformed into a discolored, odorous, punk-like, fatty mass, 
 or a thin, ichoric discharge. The diseased parts may crepitate 
 as a result of the formation of foul gases (gas phlegmon, septic 
 emphysema). 
 
 Termination. — The course of phlegmons varies ac- 
 cording to their character and extent, as well as with the genus 
 of the animal. 
 
 1. Circumscribed and diffuse phlegmons are followed by 
 healing through resorption. The latter, especially, frequently 
 heal without necrosis or abscess formation. 
 
 2. Abscess formation may result from any kind of 
 phlegmon. The prognosis is more favourable when the phleg- 
 monous inflammation is situated near the surface. Subfascial 
 and intermuscular abscesses are a source of danger, they may 
 be in the form of numerous, small pus foci, or converge to 
 form a large abscess, general infection is liable to occur. 
 Occasionally subfascial abscesses rupture spontaneously on 
 the surface. 
 
 3. Necrosis may result from any form of phlegmon. It 
 most often results from septic, subfascial, intermuscular, peri- 
 osteal, and perichondral phlegmons, especially when there 
 occurs a simultaneous influence of the necrosis bacillus (fistu- 
 lous withers, poll evil, quittor, phlegmon of the planter 
 cushion) . Necrosis often forms the source of septicaemia 
 and pyaemia. 
 
 4. Kncapsulation of abscesses is most often ob- 
 served in intermuscular phlegmon (shoulder abscess). In dif- 
 fuse, subcutaneous phlegmons on the posterior limbs of the 
 horse the phlegmonous process is occasionally suspended for a 
 long time, healing is only apparent ; sooner or later the phleg- 
 mon returns. Possibly this recurrence explains a previous 
 encapsulation-isolation of individual disease foci, with a sub- 
 
32 PHLEGMON 
 
 sequent spreading of the inflammatory process as a result of 
 rupture, laceration, or liquefaction of the capsule. 
 
 5. Chronic induration or s c h 1 e ro s i s oc- 
 curs when a diffuse, suppurative phlegmon terminates in a 
 chronic connective-tissue proliferation of subcutaneous, inter- 
 muscular, subfascial, and perichondral tissue. Schlerosis oc- 
 curs on the posterior limbs after phlegmons (elephant leg), 
 grease, or on the head (glanders), and leads to pronounced 
 thickening of the skin ; it is termed elephantiasis, 
 pachyderma, or schleroderma. Compare with 
 the chapter on elephantiasis. 
 
 Treatment. — When there is no evidence of abscess for- 
 mation and resorption is possible, treatment consists in the 
 application of moist, hot fomentations (Prieznitz), 
 or disinfecting bandages (spirits of camphor 
 bandage); antiseptic lotions, warm baths or 
 cat aplasms ; oi n t men ts of camphor, iodoform, 
 tar, carbolic acid, creolin, grey mercury; as 
 well as subcutaneous injections of disinfec- 
 tants. In subacute, and in chronic phlegmons especially, 
 resolution or accumulation of the pus in a circumscribed cavity 
 maj^ be attained by the application of a severe counter- 
 irritant in the form of tincture of iodine or un- 
 guentum hydrargyri cinereum. Arecolin is a 
 very good internal resorbent. 
 
 All abscesses, on the other hand, should be treated early 
 by means of a free incision. Experimental investigations 
 as well as practical experience have demonstrated that early 
 evacuation of the pus by means of open inci- 
 sions is the most satisfactory treatment (disinfectant activity 
 of the oxygen of the air). One may also irrigate the abscess 
 cavity with antiseptic fluids and provide drainage. 
 All necrotic tissue must be removed (amputation of the tail 
 and claws ; resection of the lateral cartilage and the flexor 
 tendon at its point of attachment to the os pedis). The 
 application of massage is con tr a - indicated, 
 especially for acute phlegmons. 
 
 Occurrence. — Most phlegmons are subcutaneous. 
 
PHLEGMON 33 
 
 Phlegmonous inflammations of the subfascial, intermuscular, 
 and perichondral connective tissues, as well as the tendon 
 sheaths are common, especially in the horse. Septic phleg- 
 mons are very common in horses and dogs. The following 
 phlegmons are of special practical importance : 
 
 1. Subcutaneous phlegmon of the soft parts of the 
 head (lips, eyelids, zygomatic region, phar^'nx); throat, 
 and shoulder (subcutaneous injections); 
 
 2. Submucous phlegmon of the mucous membranes 
 of the mouth and throat (stomatitis, glossitis, 
 pharyngitis) ; 
 
 3. Subfascial phlegmon of the fasciae of the throat, 
 shoulder, and back (poll-evil, fistulous withers); 
 
 4. Phlegmon of the muscles of the throat shoul- 
 der, elbows, gluteal region, and abdomen in the 
 horse (deep wounds); 
 
 5. Subcutaneous phlegmons of the posterior limbs 
 of the horse in both forms: the ordinary simple and 
 the rare, characterized by abscess formation; 
 
 6. Subcoronary and perichondral phlegmons at 
 the coronet (treads on the coronet) , and the lateral carti- 
 lages (fistulae of the lateral cartilages), as well as phlegmon 
 of the planter cushion in the horse (nail punctures); 
 
 7. So-called panaritium of the claws of cattle and 
 dogs, corresponding to the subcoronary phlegmon of horses 
 (see below); 
 
 8. Subfascial phlegmon of the fascia lata and the 
 tibial fascia in the horse (punctured injuries, wounds 
 from blows) ; 
 
 9. Phlegmon of the tendon-sheaths of the flexor 
 tendons in the horse (traumatic, suppurative, and metastatic); 
 
 10. Subcutaneous and intermuscular phlegmon of the 
 tail in cattle (lung plague injections, so-called tail worm), 
 dogs (contusion), and horses (amputation); 
 
 11. Phlegmon of the sheath and scrotum in the 
 horse (wounds, castration, glanders); 
 
 12. Phlegmon of the udder in cattle (small wounds, 
 erysipelas, and furunculosis) ; 
 
34 PANARITIUM 
 
 13. Puerpural phlegmon in cattle (septic gas-phleg- 
 mon, so-called puerpural blackleg) from small contused 
 wounds of the vulva and vagina at birth. 
 
 Panaritium. — This name (derived from paronchium — inflammation 
 of the bed of the nail — matrix unguis — ) indicates a circumscribed 
 phlegmon of the phalanges. In man, it applies to a special 
 circumscribed, suppurative inflammation of the subcutaneous connec- 
 tive tissue on ti^e volar surface of the finger. The word is derived from 
 human medicine, and in veterinary science the application is somevi^hat 
 false. In man the anatomical structure of the subcutis predisposes to 
 the existence of panaritium. The subcutaneous tissue on the volar 
 surface of the finger is very thick, and its connective-tissue fibers are 
 not parallel with the finger, but run perpendicular to it. Upon the 
 entrance of pus cocci there first occurs a circumscribed inflammatory 
 focus surrounded by fixed connective-tissue fibers (panaritium). The 
 phlegmonous process extends from here to the tendon-sheaths, the 
 periosteum, the joint, and the bone, there exists a progressive phleg- 
 mon (panaritium tendonosum, periostale, articulare, osseum") which may 
 lead to necrosis of the bones, suppurative inflammation of the joints and 
 tendon-sheaths, to necrosis of the tendons, and death of the entire 
 phalanges, even to fatal septicemia and pyemia. Very similar pro- 
 cesses occur on the hoof of the horse, the claws of cattle, sheep, 
 and dogs. All the above forms of panaritium can be observed in the 
 sheep and dog especially. In cattle one can distinguish panaritium of 
 the toes, panaritium between the claws and between the balls. The 
 term phlegmon is more often employed. Subcoronary phlegmon of 
 the horse is analagous to panaritium when it is complicated with 
 phlegmon of the planter cushion, of the perichondrium, of the bursa of 
 the navicular bone, as well as with necrosis of the flexor perforans, 
 with fistula of the cartilage of the hoof, and suppurative inflammation of 
 the pedal joint. 
 
 3. Abscess. 
 
 Definition and Causes. — Abscess (abscessus, apos- 
 tema) is an accu m ulatio n of p u s which is usually the 
 product of a s utf) purative inflammation; it may de- 
 velop from su,j^urative phlegmons, suppurative wounds, puru- 
 lent hematomata, or metastatically through the blood. Pus 
 bacteria, are the most frequent causes of abscess formation 
 (staphylococcus and streptococcus pyogenes). Abscesses in 
 horses are very often due to the streptococcus of stran- 
 gles and the botryomyces fungus. In other cases 
 the abscesses contain diverse bacteria ; occasionally the mi- 
 
ABSCESS 35 
 
 crococciis tenius, the bacillus pyogenes fetidis, the colon 
 bacillus, and other bacteria are the causes of abscesses. Oc- 
 casionally abscess formation is due to a mixed infection 
 with various microorganisms (tubercular and actinomycotic 
 abscesses). In addition to pyogenic bacteria gas-forming or- 
 ganisms may gain entrance, for example, bacillus phlegmonae 
 emphysematosae, thus the so-called gas abscesses exist. 
 
 Pus Bacteria in Different Domestic Animai.s. — In Horses 
 staphylococci and streptococci, as well as botryomyces, are the most fre- 
 quent causes of suppuration. According to Hell there are no positive 
 differential characteristics between the coccus of contagious pleuro- 
 pneumonia and pus cocci ; the former may result in pus formation. 
 Foth found streptococci of strangles and staphylococcus aureus in a 
 strangles-abscess in the horse ; he is of the opinion, that under certain 
 conditions, suppuration occurs in horses not affected with strangles, as a 
 result of the activity of a streptococcus that cannot be differentiated 
 from that of strangles by means of our present bacteriological methods. 
 Schuemacher and Willach found a diplococcus in pus taken from a 
 wound on a horse ; they were unable to discover any differential char- 
 acteristics between this and the cause of contagious pleuro pneumonia. 
 They thought that many suppurative processes were related, therefore, 
 to contagious pleuro pneumonia. For shoulder abscess in the horse 
 Bossi named a special pus-organism (micrococcus myositidis equi aureus 
 and albiis) . According to Baldoni the cocci of shoulder abscess in the 
 horse are identical with the jdus cocci of man, except that they are more 
 virulent. According to Jensen botryomyces fungi are the principal 
 organisms in shoulder abscess. Schmidt found strangles cocci in a 
 shoulder abscess. I, myself, found botryomyces fungi in 25-50% of 
 shoulder abscesses ; ordinary pus cocci in 50-75%; occasionally strep- 
 tococci of strangles were found. Lucet and Nocard maintain that 
 abscesses in Cattle are caused by special pus-organisms that have 
 not yet been described, that they have demonstrated them bacterio- 
 logically and given them special names as follows : streptococcus, 
 staph34ococcus, and bacillus pyogenes bovis ; bacillus liquefaciens pyo- 
 genes bovis, and bacillus crasus pyogenes bovis. The bacillus pyogenes 
 bovis is identical with bacillus pyelonephritidis. In Swine, ac- 
 cording to Grips, the bacillus pyogenes suis is a specific pus-forming 
 bacterium that can be demonstrated in nearly all abscesses. Kiinneman 
 found a special bacillus in go% of all processes in cattle, which he named 
 bacillus pyogenes bovis ; this is not identical with L,ucet's bacillus. 
 Pure cultures of this organism produce subcutaneous abscesses in cattle, 
 in the vagina they cause a suppurative vaginitis. According to Glage 
 the bacillus pyogenes suis and bovis are identical ; it forms the most 
 frequent pus-organism in swine and cattle, and is apparently transmitted 
 
36 ABSCESS 
 
 to swine through the milk of cattle suffering from disease of the udder. 
 Jensen found the colon bacillus in prostatic abscesses in the DoG, he also 
 found the same organism in suppurative peritonitis, cystitis, and pj-elo- 
 nephritis in the same animal. 
 
 Forms OF Abscess. — The following forms of abscesses 
 are recognized : hot or cold (caused by acute or chronic 
 suppurative inflammation). Cold abscesses are usually of 
 tubercular, actinomycotic, and botryomycotic origin. Other 
 classifications are: superficial and deep, primary 
 and secondary, symptomatic or metastatic 
 (strangles, pyaemia, tuberculosis, glanders), simple and 
 multiple, congestive or wandering (wandering 
 abscesses either pass downward from their own weight, or 
 upward in the hoof, passing in the direction of least resist- 
 ance), subcutaneous, subfascial, intermuscu- 
 lar, strangles, bone, or hoof abscess. One also 
 speaks of a fecal or urinous abscess. 
 
 Occurrence. — Abscesses occur in all domestic animals, 
 especially in horses, dogs, and cattle. Avian abscesses have 
 a peculiar, dry, caseous appearance. Abscesses are usually 
 found in the subcutis, lymph glands, beneath fascia, in 
 muscles, and in the mammae ; bone-abscesses are rare. In 
 the horse they are most often found in the following parts : 
 pharynx (abscess of the lymph glands), at the coronet (coro- 
 nary abscess), throat (subcutaneous injection), shoulder 
 (shoulder abscess), saddle positions, gluteal region, the leg, 
 the anterior surface of the carpus, and the inner surface of the 
 metacarpus. In the dog their favorite seat is on the head and 
 throat (bites). Abscesses in old cattle usually develop slowh^ 
 (cold abscesses). 
 
 Symptoms. — A subacute abscess has the appearance of a 
 circumscribed, hot, painful swelling. It is fluctuating 
 at the center and firm at the periphery. The skin is adherent 
 over its surface. In the absence of pigment one observes a 
 reddish-blue or grayish discoloration of the skin, it also has a 
 glistening appearance. Fever often exists at the same time. 
 Deep, or subfascial abscesses are characterized by a diffuse 
 swelling without fluctuation. 
 
WOUND FEVER 37 
 
 In differential diagnosis one must distinguish 
 between hematomata, phlegmons, galls, and new formations. 
 An abscess is diagnosed as follows : it develops gradu- 
 all}^ under inflammatory conditions, it fluctuates, the 
 skin is moveable on the surface, discoloration in 
 white-skinned horses. Fever may also exist. To diagnose 
 a deep or subfascial abscess it may be necessary to use an 
 exploring needle. Sometimes deep abscesses are char- 
 acterized by a high, septic, continuous fever, and by an 
 intense, diffuse, very painful swelling. 
 
 Treatment. — The treatment of abscesses is purely 
 surgical. It consists in early and complete in- 
 cision with subsequent antiseptic irrigation. 
 The formerly used "expective" treatment — waiting for spon- 
 taneous discharge of pus — is no longer considered good surg- 
 ery. The skin becomes necrotic, the process is prolonged, 
 suppuration is more extensive, especially in subfascial 
 abscesses, when the life of the patient is in danger. Very 
 large abscesses, especially subfascial, should be drained. 
 Caution is required when opening deep abscesses in the vicinity 
 of the larynx ; only the skin should be incised with a knife, 
 then bore with the fingers or some blunt instrument (sound, 
 blunt pointed scissors) to the depth of the abscess. The 
 opened abscess should not be tamponed, but 
 treated as an open wound and drained. Cold 
 abscesses may be treated with extirpation of their capsule 
 (shoulder abscess), sutured, and then drained. Subfascial 
 abscesses with pronounced extention, and necrosis of the 
 neighboring fascia and muscle (fascia of the withers in the 
 horse as a result of fistulous withers) are occasionally incurable 
 (septicaemia). 
 
 4. Wound Fever. 
 
 Nature and Causes. — The term fever indicates a role 
 of symptoms that are complex in character ; they are the re- 
 sult of various derangements of the general system. The most 
 important are : elevation of temperature, increased 
 frequency of the pulse, derangement of the distribution of the 
 
38 WOUND FEVER 
 
 blood and blood pressure, as well as alteration in its 
 composition. The digestive, respiratory, and nervous- 
 system are also deranged. Elevation of temperature is not 
 the only symptom of fever. 
 
 The exact changes that take place during the existence of 
 a fever are not yet fully understood. The most important 
 changes, on the one side, seem to be increased assim- 
 ilation, especially of albumen, as a result of changes in the 
 blood ; on the other side, the heat center of the brain 
 appears to play a part. This center regulates the distribution 
 of the heat as well as the development of the heat in the body 
 (caloric center). When the heat center is irritated, elevation 
 of the temperature occurs ; when it is weakened or paralyzed, 
 the body temperature becomes subnormal. Irritation of 
 the heat center with a subsequent rise of temperature may be 
 produced in various ways. Traumatic injuries from some 
 instrument or as a result of other injuries (burns), or thermic 
 through a high degree of heat (heatstroke, sunstroke), num- 
 berless chemical agents (toxins, ferments, mallein, tuber- 
 culin), reflex action as a result of pain (so-called nervous 
 fever). Conversely, the heat center may become weakened 
 or paralyzed with a subsequent fall of temperature. The 
 factors which cause this condition may be traumatic (de- 
 struction of the heat center), thermic (cold), chem ical 
 (antifebrin, antipyrin). 
 
 In wound fever increased assimilation is combined 
 with alterations in the blood, derangement of the heat regu- 
 lators, and irritation of the heat centers. Apparently this 
 is due to the resorption of dissolved bacterial 
 toxins, as well as certain chemical agents 
 found in the wound secretions. Wound fever may 
 be termed a resorption fever. If the resorbed material 
 is of bactericidal origin — bacteria or their toxins — it is termed a 
 septic or bacterial fever (infection-fever, intoxication- 
 fever, septicemia, pyemia). In a great many cases fever 
 accompanies mild wounds, for example, after castration, or 
 non-infected wounds, subcutaneous bone fractures, blood ex- 
 travasations. The fever is apparently caused by the resorption 
 
WOUND FEVER 39 
 
 of ferment-like products produced by degeneration of the 
 blood and tissues. Their action on the blood and nervous 
 system is similar to that of the toxins of bacteria. Fever thus 
 produced is called aseptic or ferment fever. The 
 chemical agents thus generated are ferments of the blood and 
 tissues (fibrin-ferment, histozyrae), organic material from the 
 degeneration of cellular tissue (nuclein from the nuclei of 
 white blood corpuscles, free hemaglobin), and occasionally 
 glandular secretions. One observes aseptic fever after the 
 transfu.sion of blood, as well as in horses that have been 
 restrained. 
 
 Symptoms — E levation of temperature in wound 
 fever varies according to its intensity and course. In the dog 
 and horse it is classified as mild (39.5° C); medium (40.5° C); 
 high (41.5° C). Wound fever is sometimes continuous (sep- 
 ticatnia), sometimes remittent, usually however, atypical. 
 It is seldom intermittent (pyemia). Aseptic wound fever 
 is not characterized by pronounced general symptoms, for 
 example, that following castration in the horse. In septic 
 wound fever, on the other hand, one observes: eleva- 
 tion of temperature, derangement of the appe- 
 tite, digestion, and activity of the heart; ema- 
 ciation; psychic derangements, etc. Septic wound 
 fever is often followed by septicemia and pyemia. 
 (See chapter that treats these subjects). 
 
 Treatment. — The main therapeutic problem consists in 
 the local treatment of the wound. In aseptic 
 wound fever it is usually sufficient to change the band- 
 age, thoroughly remove the pus, and disinfect 
 the wound. The drainage of wounds and incision 
 of abscesses produces the same result. 
 
 Septic wound fever, in addition to the above, should be 
 treated internally with febrifuges. The most active surgical 
 antipyretics (especially with sj-nchronous weakness of the 
 heart) are camphor and alcohol, they are best adminis- 
 tered in the form of subcutaneous injections of spirits of 
 camphor. 
 
40 skpticemia 
 
 5. Septicemia. 
 
 Definition and Causes. — Septicemia (sepsis, 
 blood poisoning, putrid fever) is a severe wound infec- 
 tion disease characterized by the presence of bacteria and 
 their products of degeneration in the blood. Unlike pyemia, 
 it is not accompanied by internal or external local affections 
 (metastasis), but by general changes in the structure 
 of the internal organs. This is especially character- 
 ized by svi^elling of the spleen, and parenchy- 
 matous inflammation of the liver, the kidneys, 
 the heart, and the other internal organs. It 
 often occurs that septicemia and pyemia are combined (sep- 
 tico-pyemia, pyo-septicemia). 
 
 From an etiological standpoint two principal forms of sep- 
 ticemia are recognized: one due to the action of bac t er i a, 
 the other to that of ch em ical poisons (toxins). That 
 due to bacteria is teimed bacterial septicemia, bac- 
 teriemia, or septic infection; that which results 
 from toxins is termed septic intoxication. The former 
 may be transmitted through the blood to other animals, 
 while the blood of the latter is not infectious. Between the 
 two there are transitional forms and combinations (mixed in- 
 fection). If no cause can be found for the existence of sep- 
 ticemia, it is termed cryptogenic septicemia, 
 
 I. Septic infection is caused by several bacteria, 
 they may be cocci or bacilli. One can differentiate, therefore, 
 between a coccidial and a bacterial septicemia. 
 Some of the cocci which may produce septicemia are the 
 streptococcus septicus and the micrococcus te- 
 tragenes; the cocci which produce pyemia, namely, strep- 
 tococcus pyogenes and staphylococcus aureus 
 are also able to cause septicemia. The experimental inves- 
 tigations of Koch have demonstrated the pathogenic action 
 of the following bacilli : the so-called bacillus of mouse 
 septicemia, as well as the bacillus of rabbit 
 speticemia, the group futher includes the colon bac- 
 illus and the bacillus enteritidis. Specific 
 
SEPTICEMIA 41 
 
 speticemias, iu contrast to the simple forms, may be 
 caused by malignant edema, anthrax, blackleg, the organism 
 of erysipelas, and hog cholera, the septic form of so-called foal 
 lameness, calf septicemia, septicemia hemorrhagica (wild- 
 seuche), chicken cholera, and chicken plague. 
 
 2. Septic intoxication is due to the entrance of 
 the poisonous products of bactericidal metabolism. These 
 products are termed toxins, ptomaines, putrid virus, 
 cadaver or septic poisons, and meat poisons, 
 their chemical structure is extremely variable (toxalbumen ; 
 albumoses, organic bases namely, amine and nuclein bases, 
 fatty acids, and aromatic products). Usually these toxins are 
 absorbed from a purulent focus on the surface of the body, or 
 they may be absorbed from the uterus, intestines, lungs, or 
 liver. As a rule it is the above named pathogenic bacteria 
 that colonize in ichoric wounds, in retained decomposing sec- 
 undines (puerpural septicemia), or in ichoric foci in the in- 
 testines and lungs, and whose products of metabolsim are re- 
 sorbed. Other organisms, especially the bacteria of put- 
 refaction, can gain entrance to wounds and pus foci in the 
 body. They result in putrid decomposition of animal 
 tissues, from which are formed strong chemical poisons, which 
 are resorbed and cause general intoxication. That form of 
 septicemia due to the products of metabolism of putrefactive 
 bacteria (saprophytes) is termed sapremia. Proteus 
 vulgaris and the closely allied bacillus celluleformans 
 (flesh poisoning) are especially dangerious in this connection. 
 Migration of the saprophytes, themselves, to the blood, was 
 formerly supposed to be a cause of septicemia ; according to 
 recent investigations this appears to occasionally take place. 
 
 Pathology. — On post mortem examination of animals 
 that have died from septicemia, the following conditions are 
 noted: The blood is of a tar-like consistence and has the 
 appearance of varnish. The blood as well as the solid organs 
 of the body manifest a tendency to putrefy. In septic 
 infection a microscopic examination of the blood reveals the 
 concerned bacteria, which have led to a decomposition 
 of the white and red blood-corpuscles. The 
 
42 SEPTICEMIA 
 
 white blood-corpuscles, in particular, are transformed to form- 
 less colonies of bacteria as a result of the numberless organisms 
 that have gained entrance. As a result of parenchymatous 
 disease of the vascular walls, there occurs a hemorrhage 
 into the mucous membrane, beneath the serous membranes — 
 especially beneath the endocardium — into the mesome- 
 trium and omentum, kidne5'S, spleen, and liver. 
 
 The spleen, liver and kidneys usually show par- 
 enchymatous swelling, the heart-muscle, and 
 occasionally the skeletal muscl es, have a cooked ap- 
 pearance. In many cases there also exists an ulcerative 
 endocarditis; a catarrhal, hemorrhagic, and even diph- 
 theretic enteritis; as well as a parenchymatous and hem- 
 orrhagic nephritis. In very acute cases of septicemia 
 these changes are not pronounced. This is especially true of 
 the toxic form, where, similar to poisoning, post mortem may 
 give negative results. (Caution in the inspection of meat !). 
 
 Symptoms. — Septicemia is the most important and the 
 most frequent general wound infection disease. It is found in 
 the horse after traumatic, pyo-ichoric inflammations of the 
 joints (pedal joint, tarsal joint) and the tendon-sheaths, as 
 well as in severe septic, subfascial and intermuscular phleg- 
 mons. In the cow and bitch septicemia frequently follows 
 parturition (puerperal septicemia). Comparatively speak- 
 ing, swine are very resistant to septicemia (castration). Ac- 
 cording to the seat of origin, the local changes are extremely 
 variable. 
 
 I. Septicemia in the horse is characterized by a septic 
 phlegmon around the margin of the wound. Sometimes local 
 wound changes are absent (peracute cases). The general 
 symptoms usually begin with severe febrile indications. 
 The temperature may go to 42 C, and over, occasionally it is 
 accompanied b}^ chills, the pulse is frequent, small, and 
 finally imperceptible, heart weakness is pronounced. 
 In many forms of septicemia, elevation of temperature may 
 fail. One occasionally observes severe general symp- 
 toms: complete loss of appetite (occasionally horses eat a 
 quarter or half ration to within a short time of their death), 
 
SEPTICEMIA 43 
 
 pronounced emaciation and weakness, heaviness of the 
 sensorium, trembling, sometimes paralysis of the posterior 
 limbs, profuse and continued perspiration, dirty-red 
 or icteric coloration, and echymosis of the mucous 
 membranes, discolored, albumenous urine, and towards 
 the end, profuse diarrhea with symptoms of colic. 
 The duration of the disease is extremely variable ; it may ter- 
 minate fatally within twenty-four hours, it usually continues^ 
 however, several days, and may exist for several weeks (in- 
 flammation of the pedal joint). 
 
 2. In cattle puerperal septicemia is the most 
 frequent form (septic form of puerpural fever). Clinically, 
 both forms of septicemia may be recognized ; infection and 
 intoxication. Puerperal infection is characterized, 
 either by a puerperal phlegmon, a septic metritis 
 (fever, straining, groaning, pain on pressure over the abdo- 
 men, stinking, chocolate colored discharge from the uterus, 
 diphtheretic changes on post mortem) ; or by an acute 
 puerperal septicemia, which is differentiated from 
 the preceding by general septic conditions (sudden loss of ap- 
 petite and lacteal secretions, high fever, yellow mucous mem- 
 branes, and weakness). As a rule it leads to death in from 
 one to three days, and the post mortem changes are frequently 
 slight or imperceptible. Puerperal intoxication ex- 
 ists, either in the form of a parturient paresis (para- 
 lytic calf fever, auto-intoxication), or slight symptoms of dis- 
 ease (weakness, gastric derangement, normal temperature). 
 Retention of the after-birth, especially, is a cause 
 of a mild form of sapremia; sudden paralytic conditions 
 with death after a few hours are rare (De Bruin). 
 
 Treatment. — As in a wound- fever, so in septicemia, 
 local antiseptic treatment of the wound is of 
 greatest importance. Apply powerful disinfectants, carefully 
 remove stagnated wound-secretions, give thorough drainage, 
 incise early all fluctuating spots. A puerperal uterus should 
 be thoroughly irrigated and any retained placentae removed. 
 The internal administration of febrifuges is of secondary im- 
 portance. Those agents which have been of greatest service 
 
44 PYEMIA 
 
 are: camphor, alcohol, and quinine. Argentum 
 colloidale as well as quicksilver in the form of small 
 doses of calomel are employed internally. Antistrepto- 
 coccic serum, on the other hand, has not proved satisfactory. 
 
 6. Pyemia. 
 
 Definition and Causes. — Pyemia is a general wound- 
 infection disease ; in contrast to septicemia it is characterized 
 by the formation of suppurative foci of disease in 
 the body (metastases) . The bacteria of pyemia 
 are essentiallj^ those of septicemia. The most 
 frequent causes of pyemia are pus-cocci, especially, 
 staphylococcus pyogenes aureus, and strepto- 
 coccus pyogenes. These are found in any abscess, and 
 are the ones usually involved in metastasis (staphylomycosis 
 multiplex, staphylohemia, pyemia metastatica). They enter 
 the blood from a primary pus-focus, colonize in the various 
 internal organs, where they multiply and cause suppuration. 
 An acute or chronic pyemia depends on whether the pus 
 cocci enter the blood stream suddenly, and in large numbers ; 
 or gradually, and in small numbers. In general, pyemia is 
 much less common than septicemia. In the horse it is usually 
 the result of a septic, degenerating thrombo- 
 phlebitis arising from wounds of the hoof, umbilicus, of 
 the jugular vein, following injuries of the bone as well as from 
 resorption of internal pus-foci (strangles). Pyemia of foals 
 and calves which develops from a suppurative thrombo- 
 phlebitis of the umbilical cord (pyemic form of the so-called 
 foal lameness or calf lameness) is of practical importance ; 
 these diseases possess no bacteriological individualities, in foal 
 lameness, especially, staphylococci as well as streptococci have 
 been demonstrated as a cause of the disease ; in calf lameness 
 the colon bacillus has been recognized. In cattle, pyemia 
 usually develops from the internal organs, especially from the 
 uterus (pyemic form of puerperperal fever), when it originates 
 from a suppurative thrombo-phlebitis of the uterine veins, it 
 seldom results from traumatic gastritis. Strangles 
 in the horse is a specific type of pyemia ; the same is true 
 
PYEMIA 45 
 
 of so-called dog distemper (suppurative folliculitis of the lips 
 with secondary lymphangitis, lymphadenitis, and metastatic 
 formations). Occasionally the origin of pyemia cannot be 
 determined (cryptogenic pyemia). 
 
 In many cases it is impossible to distinguish between sep- 
 ticemia and pyemia, the}' both exist at the same time ; one 
 then speaks of a pyo-cepticemia. From a standpoint 
 of practical surgery it is essential, however, to differentiate 
 between cases of pure pj^emia and septicemia. 
 
 Pathology. — The anatomical characteristics of p3'emia 
 are a greater or lesser number of suppurative inflam- 
 matory foci( metastatic processes) in the internal and 
 external organs (lungs, liver, spleen, kidneys, brain, heart, 
 skeletal muscle, joints, tendon-sheaths, etc.). In foal lame- 
 ness, suppurative inflammation of the synovial tissues of 
 the joints is the main characteristic (polyarthritis pyemicaj. 
 One also observes, suppurative inflammation of 
 other serous membranes, the peritoneum, the pleura, the 
 meninges ; as well as suppurative inflammation of the eye 
 (suppurative choroiditis and panophthalmia). Occasionally, 
 one also observes, as in septicemia, an ulcerative endo- 
 carditis and numerous circumscribed hemorrhages on 
 the serous membranes, in the skin, in theej^es, and in the mus- 
 cles. Anatomical changes characteristic of septicemia may also 
 be present (septico-pyemia). Finally, the local changes 
 aresometimes very characteristic ; for example, as a result of the 
 colonization of numerous bacteria in the venous walls of the 
 wound (umbilical wound), there occurs a suppurative inflam- 
 mation of the vascular walls with suppurative degeneration of 
 the organized thrombus (suppurative thrombo-phle- 
 bitis). This forms a source of the suppurative embolic foci 
 within the body, as well as a point of origin for many bacteria 
 that are present in the blood and inner organs (micrococci). 
 
 Symptoms. — Pyemic wound infection is ushered in with 
 a varying, frequently intermittent, very ir- 
 regular fever, and occasionally with ch il Is. After this 
 there develop symptoms of metastatic inflammation 
 of the lungs, or symptoms of abscess formation in 
 
46 THE REMAINING WOUND INFECTION DISEASES 
 
 the liver, kidneys, or brain, pyemic polyar- 
 thritis, tendovaginitis, pleuritis, meningitis, 
 etc. Occasionally, one further observes multiple, sub- 
 cutaneous pus- foci, which often develop suddenly in 
 large numbers in the form of phlegmonous swellings in 
 various parts of the body. Pyemia usually runs a longer 
 course than septicemia ; usually from a few days to a few 
 weeks, depending on the seat and course of the metastasis. 
 It may develop into a chronic pyemia with pronounced 
 emaciation of the animal. Recovery is more frequent than in 
 septicemia, although it is uncommon, and convalesence oc- 
 curs only after a long time. 
 
 Puerperal pyemia (pyemic form of puerperal 
 fever) is characterized by a febrile polyarthritis on the 
 carpal and tarsa 1 joints, mastitis, osteomyelitis, 
 and tendovaginitis of the flexor tendons, as well as 
 chronic parametritis (multiple abscess in the pelvic 
 connnective tissue, chronic emaciation). It occurs in cattle, 
 but is rare in horses. 
 
 Strangles-pyemia (so-called wandering strangles) 
 develops principally in the form of abscesses of the lymph 
 glands in various parts of the body (superior, middle, in- 
 ferior cervical glands, axillary glands, bronchial glands, omen- 
 tal glands, pubic glands, lumbar glands, popliteal glands) as 
 well as abscess formation in the brain, spinal marrow, 
 omentum, udder, kidneys, pancreas, orbit, etc. 
 
 Treatment. — As in septicemia, the principal treatment 
 consists in careful local disinfection, drainage, and 
 incision. On account of its specific action as a febrifuge, 
 quinine may be tried. 
 
 7. The Remaining Wound Infection Diseases 
 
 Erysipei-as. — In man, this disease is a specific, infectious 
 inflammation of the skin and subcutem; it involves the 
 rete Malpighi and the papillary bodies. Through the medium of the 
 lymph stream it rapidly spreads over large areas of the skin, and 
 leads to severe general infection; the local changes, 
 however, are usually slight. A superficial wound is usually the point of , 
 origin of the infection. The bacteriological investigations with 
 
THE REMAINING WOUND INFECTION DISEASES 47 
 
 reference to the bacteria which cause erysipelas are very contradictory. 
 It was formerly thought to be entirely due to the streptococcus 
 erysipelatis, a specific organism discovered by Fehleisen. Ac- 
 cording to recent investigations (Baumgarten, Fraenkel, and others), 
 the specific action of the coccus of erysipelas, on the other hand, is very 
 doubtful ; this organism appears to be identical with streptococcus 
 pyogenes. The theory has been advanced, therefore, that erysipelas 
 is not a specific wound infection disease, but a localized form of 
 septicemia in the skin. According to its virulence, each strep- 
 tococcus may cause suppuration, er3'sipelas, phlegmon, abscess forma, 
 tion, pyemia, and septicemia (Marmorek). It is also claimed that 
 erysipelas may be caused by staphylococci and typhus- 
 bacilli. In man, therefore, according to the etiology, two forms of 
 erysipelas are recognized: the primary, genuine type, due to strep- 
 tococci ; and the secondary type, which occurs during the course of 
 various infectious diseases. 
 
 The symptoms of erysipelas in man consist in the appearance 
 of a diffuse red swelling in the vicinity of the wound ; the swelling 
 spreads very rapidly, and frequently along the course of the lymph 
 streams (migrant erysipelas, ambulant erysipelas.) In other cases new 
 inflammatory foci arise in several distant places, they are manifestly 
 metastatic (erysipelas multiplex). Corresponding to the extension of 
 the erysipelas, there is observed a rapidly developing, high grade 
 fever. As the result of an active serous exudation, blisters are formed 
 in many places on the surface of the skin (erysipelas bullosum). As a 
 rule, the erysipelas heals with rapid sinking of the fever and desquama- 
 tion of the skin. In typical cases the healing is as rapid as the develop- 
 ment (simple, typical, non-complicated erysipelas). In other cases 
 phlegmonous and gangrenous processes are present (erysipelas phleg- 
 monosum and gangrenosum). Other complications are : erysipelatous 
 pneumonia, pleuritis, endocarditis, pericarditis, myocarditis, diphtheria 
 of the pharyngeal mucous membranes, enteritis, intestinal ulcers, 
 nephritis, inflammation of the brain, neuritis, peripheral paralysis of the 
 nerves, suppurative panophthalmia, otitis, parotitis, as well as septicae- 
 mia, and pyaemia. In individual cases it has been observed that new 
 formations (carcinoma, sarcoma, lymphoma, lupus) disappear after an 
 accidental infection with erj^sipelas. Based on this experience, the un- 
 safe experiment has been made of artificially producing erysipelas on 
 the new formations mentioned by means of injections of erysipelatous 
 cocci ; the object being, to cause healing (erysipelas inoculation, cura- 
 tive, artificial erysipelas). Treatment of erysipelas consists in epi- 
 dermatic and endermatic (parenchymatous) applications of disinfectants 
 (carbolic acid, creosote, creolin, lysol, tar, ichthyol, tincture of iodine, 
 sublimate), incisions of the skin, with antiseptic irrigation, application 
 of pressure to the healthy margins (collodion, strips of sticking-plaster), 
 
48 THE REMAINING WOUND INFECTION DISEASES 
 
 as well as cold. Recently the antistreptococcic serum has been applied. 
 The fever is treated with camphor. 
 
 Concerning the Occurrence of Erysipelas in Animals def- 
 inite knowledge is scarce. This is partly due to the fact, that the 
 most characteristic symptom, the redness of the skin, is wanting in 
 animals on account of the pigment formation and hair. On the other 
 hand, genuine, typical erysipelas appears to be much 
 less common in domestic animals than in man. For 
 this and other reasons, it is better not to use the word erysipelas in vet- 
 erinary surgery, but in general, to speak ofinflammatory edema. 
 In Cattle, "erysipelas of the udder," an erysipelatous, in- 
 fections inflammation of the skin, is seen in the udder before and after 
 parturition. The skin, on the posterior quarters of the udder in partic- 
 ular, and occasionally on the inner surface of the tibia, is very red, 
 painful, and swollen. It is alleged that this affection is frequently 
 complicated with phlegmons of the subcutem, and either leads to 
 desquamation and healing, or permanent schlerosis of the skin. A fatal 
 termination is never observed. In the Horse, phlegmon of the poster- 
 ior limbs is considered erysipelas b)^ many; Kitt, for example, 
 defines it as a dermatitis erysipelatosa, while Schindelka classifies 
 it with the phlegmons. It is very questionable if the so-called erysip- 
 elatous form of scratches is genuine erysipelas. Maize w (Zur Aetio- 
 logie der Mauke. Inaugeral-Disseration. Dorpat, 1899) sustains the 
 theory, that with few exceptions, those inflammations of the fetlock 
 region, known as scratches, are genuine erysipelas. In scratches of the 
 horse he claimed to have found regular streptococci, which were identi- 
 cal with those of erysipelas. Also, according to his experiments, 
 erysipelas could be successfully transmitted from man and dog to the 
 skin on the fetlock region of the horse. Considered from the stand- 
 point ; that specific erysipelatous cocci do not exist (see above); that 
 these cocci are found much more often in non-erysipelatous, simple, 
 suppurative inflammations of the skin ; that the disease is neither gen- 
 eral, nor has a tendency to spread ; the erysipelatous nature of scratches 
 is not a well supported fact. On the other hand, perhaps the case 
 described by Semmer (Oesterreichische Monatshefte. 1895, S 289) was 
 one of genuine erysipelas. Three horses showed swelling of the lips 
 after transportation in severe cold ; this spread rapidly to the region of 
 the cheeks, the pharynx, the throat, and the anterior part of the thorax. 
 All three horses died after a short time. Post mortem examinations 
 revealed the following condition : an exudate in the swollen portions of 
 the skin that was sero-fibrinous, partly fluid, and partly gelatinous in 
 character ; the pleura, pericardium, and peritoneum presented hemor- 
 rhagic inflammations ; in the thoracic and abdominal cavities, as well as 
 in the pericardial cavity, there was an abundance of dirty-red fluid ; on 
 the omentum, and under the pleura of the lungs, there was an abundant 
 
MALIGNANT EDEMA 49 
 
 extravasate of blood ; the spleen was enlarged. A jmre culture of 
 staphylococci were secured from the serous exudate of the swollen skin. 
 Experimental cutaneous and subcutaneous injections of these in horses 
 resulted in large, erysipelatous swellings at the point of injection 
 (shoulder), which spread downwards to the carpus; fever and loss of 
 appetite were also noted. In DoGS, among 70,000 cases of disease, I 
 have observed symptoms referable to erysipelas in only four cases ; I 
 have described one case in the Wochenschrift fiir Tierheilkunde (1894). 
 Schindelka's (Hautkrankheiten. 1903) experiences are identical 
 with mine ; he has observed only three cases of erysipelas in the dog. 
 Mo Her, also, (Lehrbuch der Chirurgie. 1893) has only occasionally 
 observed typical erysipelas in the dog. In Swine, on the other hand, 
 erysipelas is much more common in the form of erysipelas of the head ; 
 it may also be transmitted by inoculation to other swine (Fehlei- 
 sen). Nothing definite is known concerning genuine erysipelas in 
 sheep, cats, and birds. 
 
 Malign .\NT Edema. — Malignant edema is a specific phleg- 
 mon: it may be termed a sero -hemorrhagic infiltration of 
 cellular tissue with gas formation. Apparently, the cause of the 
 disease may be due to several bacteria. The most important is the 
 malignant edema bacillus (bacillus edematis maligni) dis- 
 covered by Koch. The bacilli of malignant edema form spores ; 
 they are very motile; liquefy gelatine; take Gram's stain ; they 
 are anaerobic rods 3 to 5 micro-millimeters in length, and one 
 mirco-millimeter broad ; the}' are four times as long as broad and a 
 trifle slimmer than the anthrax bacillus. Several rods become adherent 
 to form threads 10-40 micro-millimeters in length. After the 
 death of the animal the edema bacilli increase rap- 
 idly in length, and form threads which are partly 
 straigiht, partly curved, and partly twisted; they are 
 arranged in such a manner as to give one the impression of bacilli 
 arranged upon one another in rows. Spores are afterwards formed from 
 these threads. In cadavers of asphyxiated individuals that have been 
 kept for 24 hours at a temperature of 38° C, large numbers of malignant 
 edema bacilli are found in the blood, especially in that of the portal 
 vein (migration from the intestines). By the same method, the so- 
 called cadaver-bacilli are constant in the blood of the liver and 
 in the spleen after 12-24 hours, in the general circulation of 
 our domestic animal cadavers soon after, as the result of 
 death due to dyspnea, especially from colics, when they remain) un- 
 opened for some time in a warm place (confusion with anthrax bacil- 
 lus!). There are also various forms of pseudo-edema bacilli 
 (earth bacilli). 
 
 The edema bacillus is extremely abundant in nature. It 
 is especially numerous in the upper layers of the earth. If a small 
 
50 MALIGNANT EDEMA 
 
 amount of ordinary garden soil is brought beneath the skin of a rabbit, 
 the animal dies from malignant edema in from 24-36 hours. The spores 
 of malignant edema are also found in horses that are entirely normal, in 
 the saliva and in the feces, so that infection may readily occur in 
 the oral cavity and in the vicinity of the anus. For this reason, infec- 
 tions are very common in the vagina and in the puerperal 
 uterus. The infection results from an unclean condi- 
 tion of wounds of the skin or mucous membrane; and 
 may be conveyed by means of soil, feces, saliva, dust, 
 etc., it depends, however, on the entrance of the edema 
 bacillu into the subcutaneous or submucous con- 
 nective issue. The entrance of this organism into the circu- 
 lating blood is comparatively harmless because the oxygen of the 
 blood is fatal to anaerobic bacteria. Inoculation of the 
 cutis also, produces no results (oxygen of the air). It is also 
 difficult for the bacilli to enter granulating wounds. Moreover, the 
 subcutaneous and submucous connective tissue must be previously 
 weakened by means of previous contusions, the entrance of foreign 
 bodies, ulceration, etc., before the edema bacilli gain entrance. This 
 depends, first, on the existence of a nourishing media for the bacilli 
 (serum, lymph, blood). Then the infectious material must be as free 
 as possible from the oxygenated blood, as the oxygen of the blood i= 
 fatal to the bacilli. The greater the interruption of the circu- 
 lation in the infected area, the more favorable are the conditions for 
 the growth of the edema bacillus. According to recent investigation 
 (B ess o n ), genuine spores of the edema bacillus cannot develop in the 
 healthy tissues of living animals (phagocytosis). Their development 
 much more dependent on association with other bacteria 
 (microbes favorisants) especially with staphylococci. This condition 
 explains, as in tetanus, that, regardless of the frequency of the occurrence 
 of the edema bacillus (ubiquity ), cases of sickness from malignant 
 edema are relatively uncommon in animals. 
 
 Since Kitt has demonstrated that malignant edema could be ex- 
 perimentally transmitted to domestic animals, numerous cases have been 
 observed in cattle, horses, and she e p (Jenson and Sand, Renter, 
 Attinger, Elmenhoff, Nielson, Friis, Mesnard, Besson, Home, de Bruin, 
 Willach, Albrecht, Kitt, Gilruth, Reakes, personal observations). The 
 causes are due to injuries, for example, subcutaneous injections of 
 eserine, injuries of the tongue by means of food, foreign bodies, bites, 
 and perforating wounds ; injuries to the uterus, the vagina, and the vulva 
 (so-called puerperal blackleg which may also be caused by the pseudo- 
 edema bacillus and the genuine blackleg bacillus), operations with un- 
 clean instruments, castration of sheep and goats, amputation of the tail. 
 In the Province of Brandenburg, in 1897, from 600 freshly shorn sheep, 
 50 died from malignant edema (Lembcken); in New Zealand, in 1900, 
 
TETANUS 51 
 
 among 4,000 shorn sheep, 300 died from malignant edema. In one case 
 in a horse, I observed a twelve-hour period of incubation. Obviously, 
 malignant edema has been known for a long time in veterinary science 
 but under other names (flying necrosis, black necrosis, fire, progressive 
 cellular inflammation), and formerly as blackleg, sometimes as anthrax 
 and erysipelas, as well as wildseuche and cattle plague. 
 
 The symptoms of malignant edema consist of a swelling in 
 the vicinity of the point of infection. This develops 
 suddenly, is .ed emat o u s, doughy, and very sensitive; it 
 spreads rapidly to the neighboring tissues, and fre- 
 quently crackles on palpation. The favorite seats of the 
 edematous swellings are in the following places : the tongue, pharynx, 
 laryngeal and parotid regions, the head, throat, and upper limbs, the 
 lumbar and sacral regions. The center of the swelling is usually cool, 
 relaxed and painless ; while the periphery is tense, hot, and sensitive. 
 The subcutaneous and submucous connective and 
 fatty tissue, as well as the neighboring muscular 
 tissue, is filled with a gelatinous exudate, and a foul 
 smelling gas. The yellowish-red edematous fluid contains 
 many characteristic edema bacilli and threads, which are not 
 present in the blood during life, and are only occasionally found 
 in the blocd after death. In many cases, however, the local symptoms 
 are absent. One also notes high grade dyspnea (edema of the lungs), 
 as well as severe gastric derangements (inflammation of the mucous 
 membrane). The disease usually runs its course in a short time (one 
 to three days ) , terminating fatally with severe febrile symptoms. 
 When the disease is confined to the head, recovery sometimes occurs. 
 On post mortem the spleen, liver, and kidneys are usually intact ; 
 splenic tumors, in particular, are occasionally absent. 
 
 The treatment, as in phlegmons, consists in making free incis- 
 ions — admit the air — the most active opponent of anaerobic bacilli ; 
 provide drainage and apply antiseptics. According to an observa. 
 tion of Attinger, warm fomentations appear to be contra-indicated ; 
 they favour the extension of the edema. With reference to the liter- 
 ature on malignant edema Cf : Friedberger and Frohner, "Spec- 
 ial Pathology and Therapeutics". Sixth Edition, 1904. Vol. ,11. Also 
 Kitt: Monatshefte fiir praktische Tierheilkunde. Bd. VIII. 
 
 Tetanus. — This was formerly considered a disease of the nerves 
 characterized by trismus. As a result of the investigations of 
 Nikolaier and Kitasato it was found to be a genuine wound- 
 infection disease, caused by the bacillus of tetanus. 
 It is most frequently observed in the horse after injuries to the hoof 
 (nail pricks, nailing, treads on the coronet) , the posterior limbs and the 
 head, after castrations, after operations on the tail (amputation, setting 
 up), subcutaneous injections, removal of setons, entrance of foreign 
 bodies (kernels of grain ) into the guttural pouches. It is also observed 
 
52 TETANUS 
 
 in cattle (tetanus puerperalis after injuries to the vagina and uterus, 
 castration, umbilical wounds in calves), sheep and goats (castra- 
 tion, inoculation, seton, umbilical wounds). In dogs, however, 
 tetanus is extremely rare ; two cases have been observed by M o 1 1 e r. 
 Among 70,000 diseased dogs, I have never seen a case of tetanus ; the 
 experimental inoculations of garden soil into dogs by Nikolaier also 
 gave negative results. K itt, on the other hand, was able to produce 
 tetanus in dogs by injecting pure cultures. 
 
 The tetanus bacillus (bacillus tetani) is in the form of a rod, 
 shaped like a stick pin, music note, or cooking ladle ; the end contains 
 a spore. It is found everywhere, especially in garden soil, as well as 
 in earth that has been covered with horse manure, it is also 
 found on the floors of horse stalls. As experimental inoculations 
 with ordinary garden soil have proved, infection usually re- 
 sults from the entrance of bacterial earth; other ob- 
 jects may act as intermediate carriers of the tetanus bacillus (horse-shoe 
 nails, splinters of wood, instruments, dust of hay, manure, kernels of 
 grain, cob webs). Conditions for the infection are made more favora- 
 ble by the simultaneous existence of other microorganisms, especially 
 the pus-forming bacteria (microbes favorisants) . In contrast to the 
 bacteria of septicemia and pyemia, the tetanus bacilli do not enter the 
 blood, but remain at the point of infection where they develop a 
 strychnine-like toxin (tetanotox-albumen), which is resorbed 
 by the blood. In the form of tetanospasmin it produces convulsions as 
 a result of its action on the spinal marrow. This toxin contains an un- 
 precedented poisonous ; a dose of 0.00025 grams, equal to % mg., equal 
 to 1-200 of a minum, produces death in the horse ; it is a thousand times 
 more poison than strychnine (lethal dose for the horse — 0.25 grams). 
 The toxin is absorbed by the substance of the axis cylinders of the peri- 
 pheral nerves and carried to the central nervous system. Tetanus, 
 therefore, is to be considered as an infectious disease, in which a general 
 intoxication arises from the local point of infection. Occasionally one 
 observes a seemingly long period of incubation, several days 
 or even weeks (the usual period is from 4-20 days), in which tetanus 
 occurs, for example, after careful disinfection and bandaging of the 
 wound, even after healing and cicatrization are complete. I have ob- 
 served a period of incubation of even forty days in a horse (Monatshefte 
 fiir praktische Tierheilkunde. 1902 1. 
 
 The symptoms of tetanus consist in locking of the jaws (tris- 
 mus) ; convulsive, stiff extension of the head, throat, and back (ortho- 
 tonus); dorsal or lateral curvature of the throat (opisthotonus and 
 pleurotonus) ; stilted, or sawbuck-like position of the limbs ; stiff, 
 extended position of the tail and ears ; pronounced contraction of the 
 compressors of the abdomen ; dyspnoea (spasms of the inspiratory mus- 
 cles) ; increased reflex irritability ; timidity ; and perspiration. In 
 horses, the course is either very rapid (death after one to three 
 
WOUND DIPHTHERIA 53 
 
 days), or acute (death after foiir to ten days) ; in other cases, espec- 
 ially in the non-frequent cases of recovery, a subacute and even a 
 chronic course is observed (many weeks). One occasionally observes a 
 contagious-like outbreak of tetanus (experience with military horses 
 and in clinics). The mortality in horses is from 50-80",,. The 
 post mortem is apparently negative. Treatment is not very 
 satisfactory (local disinfection ; removal of the foci of infection, ampu- 
 tation of the tail, for example ; removal of external excitants ; diate- 
 tics). Administration of chloral hydrate, bromide of potash, morphine. 
 The treatment of horses suffering from tetanus with tetanus antitoxin 
 has not proved satisfactory. Antitoxin, on the other hand, has proven 
 useful as prophylactic previous to operations (Nocard, Labat). With 
 reference to the literature on tetanus see: Friedberger and 
 Frohner, "Special Pathology''. Sixth Ed. 1904, Vol. II. 
 
 Wound Diphtheria. — The name wound diphtheria (hospital gan- 
 grene, gangrena nosocomialis) indicates a wound infection disease 
 which was formerly very common, but which has become infrequent 
 under the influence of modem antiseptics. It consisted of a coagu- 
 lation necrosis of the granulations as a result of the action 
 of specific bacteria (necrosis bacillus) . The granulations are trans- 
 formed into a yellowish- red, suppurative, ichorous pulp (croupous and 
 diphtheritic form) ; or into a grey, pulpy, gangrenous mass (ulcerative 
 form) ; or into a stinking, putrid and soft mass similar to the pulp of a 
 spleen (pulpy form). Treatment consists of burning early, or cauteri- 
 zation of the wound with chloride of zinc. Bayer has described a case 
 in the horse. The tissue in the region of the parotid glands was trans- 
 formed into a greenish-brown, fetid mass ; the process was accompa- 
 nied with the formation of the gasses of degeneration, which had pro- 
 duced an emphysematous condition of the neighboring tissues. I have 
 observed similar cases in the horse. 
 
 Glanders. — In rare cases, wounds in the horse become infected 
 with the bacillus of glanders (primary glanders of the skin). This 
 occurs, especially, on the extremities, abdomen, thorax, shoulders, and 
 head. There then develops from the wound, a crater-like glanders 
 ulcer ; it is characterized by tenacious, discolored, frequently hemor- 
 rhagic secretions; from the ulcer, wreath-like swollen lymph vessels 
 extend to lymph glands which are also swollen (glandular lymphangitis 
 and lymphadenitis). Lameness exists according to the location of the 
 glandular processes. Occasionally there also develops a chronic 
 glandular phlegmon, which may finally lead to elephantiasis 
 of the extremities and head (glandular pachyderma). I have described 
 one case of this kind in the horse ( Report 1883). Richter has 
 described a case of glanders of the e y e (glandular keratitis) (Zeit- 
 schrift fiir Veterinaerkunde. 1896). For further information concerning 
 glanders, especially with reference to differential diagnosis of the same, 
 refer to text-books on special pathology. 
 
54 RABIES 
 
 Rabies. — Rabies is a genuine wound infection disease ; the cause 
 of the infection has not yet been discovered ; infection gains entrance 
 from the saliva through the medium of wounds caused by bites, 
 and then passes into the body. The bites, themselves, present no 
 special characteristics, as a rule they heal similar to the wounds of 
 tetanus. The acquired virus is sufficient for the development of the 
 disease, the appearance of the first visible symptoms may require 
 weeks, and even months (long period of incubation). According 
 to paragraph 35 of the government laws which refer to animal plagues, 
 no attempts can be made to cure animals affected, or supposed to be 
 affected, with rabies ; animals affected with rabies must be killed 
 immediately (paragraph 37); those supposed to be affected must be 
 killed or confined ( paragraph I34). In man, treatment consists in cauter- 
 ization, cutting out the wound, as well as in the application of strong 
 disinfectants (sublimate, creolin, aqua chlorata, calcium permanganate, 
 etc., carbolic acid is unefficient). 
 
 Bi,ACKLEG. — This is also a wound infection disease in which the 
 blackleg bacillus gains entrance to the wound only through inju- 
 ries to the skin and mucous membranes (the subcutis and submucosa). 
 Blackleg, therefore, may be considered as a specific phlegmon 
 of cattle, similar to malignant edema. It is characterized by edema- 
 tous swellings of the skin which develop rapidly and crepitate, the cen- 
 ters of these swellings undergo necrotic degeneration, they are 
 located on the upper parts of the limbs, the throat, the shoulders, the 
 inferior surface of the thorax, etc., the motions of the animal are also 
 deranged ; there are swellings in the regional lymph glands ; severe 
 general symptoms, and high fever are present. The course of the dis- 
 ease is usually rapid, terminating fatally in from one to three days. 
 Treatment of the area of infection is usually too late (incision, disinfec- 
 tion amputation, ligature ). The so-called puerperal blackleg 
 of cattle is usually, not a case of genuine blackleg, but partly a gas 
 phlegmon, partly a malignant edema (Carl); sporadic cases of genuine 
 puerperal blackleg have been identified by Rievel, Olt, and 
 Ostertag. For further information concerning blackleg see text- 
 books on special pathology, as well as Kitt, Meaatphefte fiir praktische 
 Tierhielkunde. VIII. 
 
 Anthrax. — In contrast to man, anthrax is rarely a wound infection 
 disease in animals. In addition to the ordinary infection through the 
 intestines, one occasionally observes sporadic cases of entrance of 
 anthrax bacilli through wounds in the skin and mucous mem- 
 branes, after previous operations (castration), bites, or punctures from 
 insects. There exists, first, a local inflammatory focus in the skin and 
 mucous membranes (anthrax carbuncle, anthrax edema) 
 this is followed by a rapid general infection, which usually has 
 a fatal termination. Cases of anthrax of the skin and mucous mem- 
 branes were formerly described under the names, carbuncle disease, boil 
 
TREATMENT OF WOUNDS 55 
 
 fever, anthrax of the tongue, anthrax of the gums, and morbus 
 carbuncularis. 
 
 WiLDSEUCHE. — The so-called exanthematic form of wildseuche 
 exists apparently through the entrance of infectious material into small 
 wounds of the skin or mucous membranes (injuries from the twitch, 
 accidental injuries), and is, therefore, considered a wound infection 
 disease. It is characterized by pronounced edematous swelling of the 
 skin and mucous membrane, as well as the subcutis and submucosa of 
 the head, the oral cavity, the submaxillary region, throat, etc., there 
 also develop symptoms of septicemia hemorrhagica. Death usually 
 occurs after 12-36 hours. Details concerning wildseuche may be found 
 in text-books on special pathology. 
 
 vSXRANGtES. — Strangles usually develops from the mucous mem- 
 branes of the respiratory and digestive apparatus. Occasionally there 
 occurs a strangles infection from wounds, whereby the 
 regional lymph glands are involved first. A case of this type has been 
 described by L i t f a s (Berliner tierarztliche Wochenschrift. 1895). I, 
 myself, have observed two cases. 
 
 With reference to other wound infection diseases (actinomy- 
 cosis, bo t ry omycosi s , tuberculosis, lymphangitis, 
 phlebitis, petechial fever) compare with the chapters on these 
 subjects. 
 
 Wound Infection Diseases of the Veterinarian. — The fol- 
 lowing are the various wound infection diseases against which the vet- 
 erinarian should be guarded: phlegmons, lymphangitis, and 
 erysipelas, septicemia and pyemia, eczema on the 
 hands and arms (obstetrics), anthrax, glanders, ra- 
 bies, botryomycosis, tuberculosis. Among 365 officials 
 in the Berlin Abbatoir and Stock Yards (veterinarians, butchers, etc.), 7 
 had inoculations with tuberculosis on the hands, 3 had questionable 
 nodules (Lassar). 
 
 VI. TREATMENT OF WOUNDS. 
 
 Antiseptic and Aseptic Treatment of Wounds. — 
 Lister is the founder of the modern treatment of wounds. 
 Working on the theory that wound infection might be pre- 
 vented by the appHcation of antiseptics, as well as careful 
 bandaging, he employed, in 1867, carbolic acid with a band- 
 age ; the latter being termed a Lister Bandage. This Lister 
 bandage is applied as follows : irrigate the wound with a 
 2-5% solution of carbolic acid ; spray the surrounding air 
 
56 TREATMENT OF WOUNDS 
 
 with the same solution ; cover the wound with a piece of 
 carboHzed silk or surgeons cotton (silk or cotton protective); 
 place over this a thick layer of carbolized gauze or other car- 
 boHzed dressing ; over this is placed an impermeable layer of 
 surgeons cotton (mackintosh); the whole is retained by means 
 of a moist, carbolized gauze bandage. Between the years 
 1872-1875 the Lister bandage was in general use in Germany. 
 Later the use of the spray was dropped and the simple bandage 
 applied. In 1880 the drj^ iodoform pack supplanted the use 
 of the carbolic acid. Since then, other disinfectants have 
 partially taken the place of iodoform (sublimate, creolin, lysol, 
 tannoform, and other disinfectants). 
 
 In recent times the use of antiseptics in human surgery 
 has been restricted, in some cases even suspended. Schim- 
 melbusch and others claim that when a wound has been 
 infected for no longer than one minute there is no certainty of 
 destroying the bacteria with disinfectants. There is no ob- 
 ject, then, in disinfecting the wound, it is even harmful, 
 because the tissues are irritated and the wound secretions are 
 increased. Antiseptic treatment has, therefore, given way 
 to the aseptic method, which is carried out as follows : the 
 wound is made as drj^ as possible with the use of a sterilized 
 towel, and without the application of antiseptic fluids ; it is 
 irrigated only with sterilized water, or sterilized physiological 
 salt solution (0.6%), and then covered with a sterilized bandage. 
 The material is sterilized in a specially prepared apparatus, it is 
 exposed to steam of not less than 100° C, for a period of 
 twenty to thirty minutes ; the instruments are sterilized in the 
 same manner. Boiling for a long time in a one or two per 
 cent soda solution is one of the surest methods of sterilization. 
 Special care is taken with reference to disinfection of the hands 
 of the operator. After the dirt has been thoroughly removed 
 from the nails, the hands are brushed with soap and water, 
 then washed in warm sublimate, carbolic, or creolin water, and 
 finally rubbed in a fifty per cent alcoholic, or alcohol and soap 
 solution. The following must also be rendered aseptic : the 
 operating field, operating table, clothing of the patient, oper- 
 ators, assistants and helpers, all utensils that are used, as well 
 
ANTISEPTICS 57 
 
 as the operating field in the vicinity of the wound. Even 
 operating gloves, and masks for the mouth and nose are em- 
 ployed as aseptic protectives. 
 
 The aseptic treatment of wounds in human surgery 
 has many advantages. Healing follows the natural self-pro- 
 tection of the tissues (leucocytes, blood-serum), and there are 
 only slight changes from external interference. Recently, 
 many surgeons have changed from the purely aseptic method 
 to the antiseptic; since Henle and others, contrary to the 
 conclusions of Schimmelbusch, have demonstrated b)^ means of 
 statistics that local disinfection of the wound is possible within 
 the first few hours, and that the results of the aseptic method 
 are no more satisfactory than those of the antiseptic. B r u n s 
 even emplo^-ed pure carbolic acid to disinfect the wounds, 
 Kiister used the hot iron (Berlin Surgical Congress, 1901). 
 Antiseptic surger}- involves the very difficult, or impossible, 
 disinfection of the hands, which is not improved by the use of 
 sterilized operating gloves (Berlin Surgical Congress, 1898). 
 
 Up to the present time aseptic surgerj^ in 
 veterinary science has received a very lim- 
 ited use. I have already mentioned this fact in the first 
 edition of this book. The veterinarian deals mostly with old, 
 infected wounds, in which, not asepsis, but thorough antisep- 
 sis, is necessary. Even fresh operation wounds can seldom 
 be given aseptic treatment, for example, in a clinic. Even 
 in a well equipped veterinary hospital the aseptic surgical 
 treatment of horses offers the greatest difficulties. Bandages 
 can be applied only to a limited extent, in some cases it is 
 almost impossible to prevent infection during the operation. 
 When compared with human surgery, infection through the 
 air plays a more important part (dust, hair), against 
 which asepsis is of no use. For these reasons, the 
 antiseptic method is to be preferred to the 
 aseptic in veterinary science. 
 
 Antiseptics. — In selecting and deciding upon the various 
 therapeutic agents to be used in the treatment of wounds, a 
 general point of view comes into consideration. In the first 
 place, besides the disinfecting properties of the various ma- 
 
58 ANTISEPTICS 
 
 terials, we must consider the resistance of the organisms in the 
 wound. This resistance lies, as I have fully explained else- 
 where (Lehrbuch der,allegeraeinen Therapie), about midway 
 between the very resistant anthrax spores, and blackleg bacilli 
 at one extreme ; and the easily destroyed anthrax and swine 
 erysipelas bacilli at the other. The streptococci and 
 staphylococci, especially, should not be fought 
 with weak disinfectants; their destruction re- 
 quires stronger antiseptics (sublimate, creo- 
 lin, lysol, tannoform, carbolic acid, solution 
 of aluminum acetate, nitrate of silver). The 
 toxic action of the antiseptics must also be considered, their 
 irritating action on the wound, their decomposition by the 
 secretions of the wound, their strength and form, the price, 
 and the state of healing. In general the following rule should 
 be adopted : employ disinfectants which are ac- 
 tive, not too irritating, not easily decomposed, 
 non-poisonous, reasonably active in aqueous 
 solution, prompt in their action on the wound 
 (tannoform). Actual disinfection should be preceded by 
 careful irrigation. The following descriptions refer 
 to the more important disinfectants (detailed descriptions are 
 found in my Lehrbuch der Arzneimilellehre, 6. Aufl.). 
 
 Sublimate. — This is our most powerful and poisonous dis- 
 infectant. A i-iooo sublimate solution quickly destroys 
 all bacteria involved in wound infection. With the ex- 
 ception of ruminants it can be employed on all domestic animals. In 
 cattle sublimate acts as a specific poison, for this reason 
 one must be guarded in its use. When combined with albumenous 
 wound secretions it partly precipitates in the form of an albumenate of 
 mercury, partly decomposes (formation of oxychloride of mercury). 
 The decomposition has no material influence on its antiseptic action ; 
 decomposition may be prevented by the addition of sodium chloride 
 (pastil of sublimate). The advantages of sublimate are : its strong 
 antiseptic properties, non-odor, cost, convenience (sublimate tablets). 
 The disadvantages of sublimate are: pronounced toxicity, espe- 
 cially for cattle ; irritability, especially on the mucous membranes of 
 the eye (ophthalmology), and the uterus (obstetrics); it also rapidly 
 amalgamates the instruments. In France, in the place of sublimate, 
 hydrargyrum biniodidum rubrum is employed in a solution of 
 
ANTISEPTICS 59 
 
 I : 10,000 to I : 20,000 ; it is more active and less irritating. Many also 
 prefer hydrargyrun cyaiiatun to sublimate because it does not 
 amalgamate the instruments. 
 
 Creolin, Lysol, Bacilloi^, and other Crksol Combinations. — 
 The antiseptic action of the cresols is pronounced and rapid. A 3 % 
 solution destroys wound infection organisms. The dis- 
 infectant properties of cresol are apparently stronger than those of 
 carbolic acid. It further possesses deodorizing properties; it is 
 relatively non-poisonous, and inexpensive, its disadvantages are: 
 odor, irritating action of strong solutions on the mucous membranes, 
 gradual destructive action on rubber tubes, cloudiness of the solutions. 
 
 Carbolic Acid. — The action is relatively strong. Most bacteria 
 die after a long time in a 3% solution. The official carbolic 
 acid solution is mixed in a 4% solution. The action of carbolic acid 
 seems to be slight towards the infectious material of tetanus, rabies, the 
 tubercle bacillus, and the spores of anthrax. Castration clamps, for 
 example, transmitted tetanus after eighteen months, notwithstanding 
 the fact that they were placed in a 4% solution of carbolic acid for five 
 minutes (Nocard). Advantages: its strength is constant and it does 
 not decompose. Disadvantages : cost, odor, irritating and toxic action, 
 especially the latter, for cats. 
 
 Iodoform. — This is an excellent, mild stimulator of granulations ; 
 also used in etherial solutions 1:5-10). Disadvantages: odor, 
 cost, toxicity for dogs (licking), insolubility in water. The following 
 similar preparations from iodine are expensive ; for this reason they are 
 not much employed in veterinary surgery: lorentin, losophan, iodo- 
 phen, europhen, aristol, iodoformin, iodoformogen, iodol, iodtrichlorid 
 (easily decomposed) . In actinomycotic infections, iodine and iodide of 
 potash in aqueous solution (Lugol's solution) is a specific for 
 actinom3'cotic infection. 
 
 Tannoform.— At the present time this is our best aseptic cov- 
 ering and dry antiseptic. Applied early to cuts, it checks 
 suppuration (healing under an eschar). In horses it is preferable to 
 iodoform on account of being a more active and non-odorous antiseptic. 
 Other formaldehyde preparations are: glutol, amy lof orm, and 
 others ; they are more expensive and their action is less constant than 
 that of tannoform. Formaldehyde, itself, in a i to 2% solution is a 
 strong disinfectant, it irritates the wounds however ; it is very caustic 
 when concentrated (caution!). 
 
 Nitrate of Silver. — This is an excellent wound dress- 
 i ng. It is a strong disinfectant (a i : 100 solution is fatal to pus cocci). 
 It is a valuable regulator of abnormal granulations, and leaves a pro- 
 tective covering in the form of an eschar (eschar of silver). The same 
 is true of the more recent but very expensive preparations of silver 
 (argentum lacticum and citricum, actol, itrol, protargol, 
 ichthargan). 
 
6o ANTISEPTICS 
 
 Solution OF Aluminum Acetate. — This is an excellent non- 
 toxic antiseptic in a 2-8% aqueous solution (also contained in Bur- 
 row's solution); because of the expense it is preferable to the more 
 costly substitutes: alumnol, tannal, gallal, sozal, boral, salumin, 
 cutol, etc. 
 
 Bismuth Salts. — These are absorbing, astringent, dry 
 antiseptics; their action is similar to tannoform, they seem to be 
 more expensive, however. The following are most often employed : 
 bismuth subni tricum, subsalicylicum, gallicum (dermatol), 
 dithiosalicylicum (thioform), airol (iodid of dermatol). The latter in the 
 form of Airol Paste is an excellent aseptic protective covering foj 
 wounds; it is non-irritating, easily applied, dries rapidly, and is very 
 adherent. 
 
 Alcohol. — This is an important agent for disinfecting 
 the hands of the operator and the skin of the operating 
 field. It is best employed in the form of a soOjj aqueous solution or 
 aqueous solution of sublimate (absolute alcohol has only a weak anti- 
 septic action). Alcoholic soaps are also employed. Alcoholic 
 Tincture of Aloes stimulates granulations on old wounds and is an 
 active antiseptic. Tincture of Iodine is an excellent disinfectant 
 for infected wounds that have a tendency to necrosis. 
 
 Salicylic Acid. — A weak antise pti c, i t is non-poison- 
 ous however, odorless and non-irritating. It finds ap- 
 plication in ophthalmology, in irrigation of the internal organs of the 
 body, and in the treatment of cats. Thioform (^ bismuth dithiosali- 
 cylate) is a substitute for iodoform. It is especially employed because 
 of its non-odor and non-toxicity (very expensive !). 
 
 Boric Acid. — A mild, non-toxic, and odorless anti- 
 septic; its action is slight (ophthalmology, irrigation of the 
 uterus). The following, with other solutions of boric acid, possess a 
 similar action : borax and borate of magnesia, boral, an- 
 tipyonin, rotterin, antiseptin, borol. 
 
 Chloride of Zinc. — A caustic antiseptic (2-8% solu- 
 tion), its action as an antiseptic is relatively weak 
 (common agent for abnormal granulations) . 
 
 CvLCiUM Permanganate. — Weak antiseptic. Specific against 
 snake bites and the toxin of rabies. 
 
 C.\MPHOR. — A powerful antiseptic, especially for torpid gran- 
 ulations, phlegmons, and necrotic processes (spirits of 
 camphor bandage). Those agents which have a similar action are: 
 oil of turpentine, turpentine (old hoof remedies), thymol 
 oil of eucalyptus, balsam of Peru, and other etherial oils. 
 
 Tar. — An excellent antiseptic, especially for wounds of the hoofs 
 and claws. Wood tar is preferable to coal tar. 
 
 AouA Chlorata. — Strong antiseptic. Specific for rabies 
 and snake bites. Employed in ophthalmology. 
 
OPEN WOUND TREATMENT AND BANDAGING 6l 
 
 Pyoctanin. — Active antiseptic. Disadvantages: blue color. 
 
 Heat. — By means of high temperature pus bacteria die in 
 ten minutes at a temperature of 55-62°, the streptococcus of strangles 
 at 60°, the tetanus bacillus at 75°, the spores of tetanus at 100°. 
 
 Open Wound Treatment and Bandaging. — If a wound 
 is aseptically or antiseptically handled, and eventually sutured, 
 a bandage should be applied wherever possible. It protects 
 the wound from the entrance of infection (air, and contact 
 infection), as well as irritants. The bandage should be dry. 
 Such a bandage is termed a dry, aseptic wound band- 
 age. A moist antiseptic bandage is better for ex- 
 tensive wounds, pronounced suppuration, phlegmons, prepa- 
 ration of certain portions of the body for operating, etc. The 
 moist bandage combines protection with a continued antiseptic 
 action ; it neutralizes the action of the wound secretions ; the 
 moist warmth assists granulation and cicatricial formation. 
 Through maceration of the skin and horn it may occasionally 
 become injurious.. When a bandage is not changed for a long 
 time it is termed a permanent bandage. Other forms 
 of bandages are: simple, Lister, pressure, dry 
 dressings, ointment and tar bandages, iodo- 
 form bandages, antiseptic tamponade, etc. 
 "With referance to bandage materials and bandage technique 
 see : Bayer, Operationslehre. Onh^ the most important rules 
 for bandaging are given here. These are: i. Every 
 wound, when possible, should be bandaged. 2. The bandage 
 should, after aseptic operations, remain in position as long as 
 possible (following resection of the lateral cartilage, for ex- 
 ample, fourteen days). 3. The bandage must be changed, 
 however ; (a) when it becomes saturated with pus, wound se- 
 cretions, or filth ; (b) when improperly applied ; (c) when 
 there is pain or pronounced swelling in the vicinity of the 
 wound, or when fever exists. 
 
 In veterinary practice the open treatment of 
 wounds must often replace bandaging. This is especially 
 true of horses and cattle, in which the application of a bandage 
 in various parts of the body is impossible (gluteal region, up- 
 per limbs). In such wounds the oxygen of the air acts as a 
 
62 TREATMENT OF DIFFERENT KINDS OF WOUNDS 
 
 disinfectant ; it is of special value in malignant edema. For 
 this reason, the suturing of old or large 
 wounds is contra-indicated. The aseptic wound 
 bandage is most readily applied to dogs. When a bandage 
 cannot be applied healing under eschar may occur 
 (dry or moist blood-eschar ; necrosed eschar ; one formed by 
 tannoform, tannin, silver nitrate, dry dressings, etc.). Oint- 
 ments may take the place of a bandage (boric acid, silver 
 nitrate, decubital salve, etc.). Adhesive remedies per- 
 form the same function (airol paste, iodoform-colodion, zinc 
 paste, bismuth paste, adhesive plaster). In many cases, as in 
 human surgery, permanent irrigation is employed 
 with good results, that is, the wound is irrigated for a long 
 time with an antiseptic fluid. Immersion (water bath) has a 
 very limited field of application (hoof baths, baths for mange). 
 Antiseptic cataplasms are employed to encourage the 
 sloughing of necrotic tissues in hoof injuries, fistulous withers, 
 etc., (linseed meal bandage with creolin water). The appli- 
 cation of linseed meal to any wound is not considered good 
 surgery at the present time (Translator). 
 
 Treatment of the different kinds of wounds. — i. Fresh 
 incised, punctured and lacerated wounds or bites are 
 treated as follows : arrest the hemorrhage ; irrigate ; disinfect ; and 
 drain ; apply an aseptic tampon ; suture as much as possible ; and when 
 practical, apply a bandage. 
 
 2. Contused and old, especially suppurating wounds, are not 
 sutured; otherwise they are treated as fresh incised wounds. In 
 many cases of small, old, suppurating wounds, heal- 
 ing by third intention is possible; the modus ope- 
 randi is as follows: trim the margins, irrigate care- 
 fully for a long time, disinfect, remove all necrotic 
 portions, bring the margins of the wound in close 
 apposition by means of sutures (wounds of the head in the 
 horse). When removing foreign bodies or destroyed tissues from con- 
 tused wounds care should be taken not to remove the sound tissue also. 
 This is particularly true of flap wounds (treads on the coronet) , where 
 the retention of small flaps of skin is of greatest 
 importance. Contused wounds with pronounced suppuration and 
 tissue necrosis are best treated by means of moist bandages; as 
 open wounds; or with permanent irrigation. 
 
 3. Shot wounds are treated according to the same rules of asepsis 
 and antisepsis as those employed for the treatment of ordinary wounds- 
 
TRANSPLANTATION 63 
 
 As experience in men has proved that bullets are frequently encapsuled, 
 expective treatment should usually be followed, do 
 not favour extraction of the bullet (v. Bergman, Kocher). 
 Probing of the wound is also superfluous ; when the finger or probe are 
 not carefully disinfected it is even dangerous to life (keep the finger 
 and probe away). Shot wounds are best treated as follows : anti- 
 septic occlusion and tamponade; or drainage with- 
 out suture followed by a bandage. If for certain reasons it 
 seems necessary to extract the bullet (phlegmons, pain, high fever, 
 etc.), a simple incision is often all that is necessary ; employ foreign- 
 body forceps, curette, etc., in place of special bullet forceps. 
 
 4. Joint wounds, when fresh, should be carefully disin- 
 fected; sutured; and when possible, covered with an aseptic 
 occlusive bandage. It is not always possible to bandage perfo- 
 rating joint wounds in horses and cattle ; in those cases one ma)^ use 
 iodoform-collodion, airol paste, and other adhesive materials, the cau- 
 tery may be used to close the wound with a necrotic eschar, per- 
 manent irrigation is also employed. The earlier employed caustic ap- 
 plications in the vicinity of the joint (closure of the wound by swell- 
 ing) are of little value. Suppurating joint wounds in dogs may be 
 drained, irrigated, incised if necessary, and packed with an antiseptic 
 tampon. In horses and cattle they are frequently incurable. 
 
 5. Perforating abdominal wounds require careful 
 antisepsis; reposition of the intestines after thorough disinfection ; 
 ligation and removal of the prolapsed omentum, as well as a double 
 suture. 
 
 6. Poisoned wounds (snake poison, rabies, etc.) may be ex- 
 cised ; cauterized ; burned ; or treated with specific disinfectants ; po- 
 tassium permanganate, aqua chlorata, liquor ferri 
 chloridi, and calcium bichromate in the form of sub- 
 cutaneous injections. 
 
 7. Wounds that are granulating abnormally are 
 treated with the knife, curette, cautery, caustics (nitrate of silver and 
 chloride of zinc) , ointment bandages, tincture of aloes, etc. See treat- 
 ment of ulcers. 
 
 TranspIvANTaTion. — This was first employed by Reverdin, in 
 the year 1870. It was employed in human surgery to provide a rapid 
 covering for granulating wound surfaces. Thiersch also had a 
 broad experience in the transplantation of epidermis. Formerly, pieces 
 of skin, the entire thickness of the epidermis, were transplanted. At 
 the present time the modus operandi is as follows : the rules of asepsis 
 are very carefully observed ; very thin, superficial sections of the skin 
 are removed with a razor, they extend, however, to the papillary bodies ; 
 these sections are about the length and breadth of one's finger, they are 
 removed from the upper arm or limb, and are transferred from here to 
 the granulations. The granulations have been previously freshened 
 
64 SUBCUTANEOUS INJURIES OF THE SOFT PARTS 
 
 with a curette, the flaps of skin are applied without coming in contact 
 with any antiseptics (necrosis of the epidermis), they are carefully re- 
 tained in position by means of sterilized tin foil, a dry or moist band- 
 age (salt solution) is employed for protection. If the transplantation is 
 successful the pieces of skin heal to the granulations by first intention ; 
 about the third day they are vascularized by vessels from the granula- 
 tion tissue ; and the wound is covered through the formation of new 
 epidermis from these artificial islands of skin. A simpler method con- 
 sists in the removal of the epidermis only, from the healthy skin, this 
 being placed on the granulations. It is also possible to transplant mucous 
 membrane on mucous membrane, as well as pieces of bone with perios- 
 teum and marrow from living young animals to man. On the other 
 hand, the transplantation of nerves, muscles, and tendons, from animals 
 to man has not yet been successful. 
 
 The difficulties of transplantion consist in the prevention of death 
 of the removed piece of skin on the one hand, and the difficulty of 
 fixing it to the granulation tissue on the other. The latter is especially 
 difficnlt in animals. Mamadyschski has been successful in horses 
 and dogs with Krause's method of transplantation. Ouerruau 
 has successfully treated saddle pressure in the horse by means of trans- 
 plantation. Bayer, on the other hand, has repeatedly employed trans- 
 plantation in horses without results ; the great mobility of the skin of 
 the horse hinders exact fixation of the flaps, while the firmness and 
 non-vascularity of the same does not favour rapid growth. Bayer has 
 even retained the flaps by means of sutures and needles without re- 
 sults. Also, the hair on the skin of animals often retards growth. On 
 the other hand, the transplantation of skin and mucous membrane from 
 animals to man is successful ; the same is true of the transplantation of 
 spurs to the comb of a cock. 
 
 SUBCUTANEOUS INJURIES OF THE SOFT PARTS 
 (CONTUSION, LACERATION). 
 
 I. CONTUSION. 
 
 Definition and Causes. — In contrast to wounds of 
 the skin and mucous membrane, which are always accompa- 
 nied by a breach in their continuity, a contusion is an 
 injury to the soft parts without an external 
 wound. It is caused by pressure from a blunt instrument, 
 the skin, because of its elasticity, remaining uninjured, while 
 the underlying soft parts, especially those covering bone are 
 torn. Contused wounds and contusions are due to the same 
 
GRADE OF CONTUSION 65 
 
 causes. In every other way they are different, namely, symp- 
 toms, course, treatment, and prognosis. This is due to the 
 fact that contused wounds are open to infection, while in sub- 
 cutaneous injuries of the soft tissues the paths of infection are 
 closed. 
 
 The causes of contusions in the domestic animals are 
 various. In horses they are caused by pressure from the 
 harness, saddle, bit, shoe, faulty nailing of shoes (corns, 
 nailing), calks, kicks, blows, and falls, entering doors, self- 
 inflicted injuries from treads on the coronet, decubitis, etc 
 In cattle they are caused by horn-thrusts. Bites and chastise- 
 ments frequently produce contusions in dogs. 
 
 Grade of Contusion. — According to the severity and 
 extent of sabcutaaeous injuries, different grades of contusions 
 are recognized ; differentiation being based on the injuries to 
 blood-vessels. The simplest division is that which separates 
 a contusion with preservation of tissue from one that 
 results in necrosis. According to the extent of hemorr- 
 hage the first may be further subdivided into contusions with 
 slight or severe hemorrhage. In general, therefore, 
 three grades of contusion are recognized : 
 
 1. Contusions of the first g r a d e are character- 
 ized by a slight amount of hemorrhage. The extravasate may 
 be evenly distributed through the contused tissues (bloody 
 infiltration), or it may occupy small circumscribed foci 
 (ecchymosis, petechia). 
 
 2. Contusions of the second grade lead 
 either to large subcutaneous accumulations of blood ( h e m a- 
 tomata), there are also alleged to be circumscribed effu- 
 sions of large quantities of lymph (lymph-extrava- 
 sate), or to a superficial accumulation of a large amount of 
 blood (suffusion). 
 
 3. Contusions of the third grade result in 
 gangrenous death ot the involved tissues (necrosis, mortifica- 
 tion). The cause of death is due to the deranged circulation 
 brought about by extensive injuries to the blood-vessels (pri- 
 mary ansemic necrosis). Necrosis may also be due to en- 
 trance of infection from without or through the blood-stream 
 
66 SYMPTOMS 
 
 (secondary septic necrosis). Experimental investigations 
 have proved that the contusion of itself does not cause necrosis. 
 Complete crushing of the contused parts is sometimes 
 termed a contusion of the fourth grade. 
 
 Microscopic Changes in Contusions. — The following condi- 
 tions are found in contusions that are experimentally produced in ani- 
 mals : In contusions of the first grade only a laceration of the loose 
 connective tissue, that which is supplied by the smallest blood-vessels. 
 In contusions of a severe grade there is also laceration of the intercellu- 
 lar substance of the tissues, so that the cells are separated from one an- 
 other. In the severest crushing of the tissues, however, 
 the cells usually remain unimpaired. This explains the 
 fact that crushing, alone, does not result in necrosis (Gussenbauer). 
 
 Symptoms. — Swelling, due to hemorrhage, is the most 
 important symptom (contusion swelling). In contusions of 
 the first grade (bloody infiltration) the swelling is small and 
 diffuse. Large circumscribed swellings characterize second 
 grade contusions (hematomata). Hematomata on the hind 
 limbs of horses become especially large (larger than one's 
 head) ; I observed one case in the region of the udder in a 
 horse in which the hematoma contained 25 liters. Contusions 
 may occur in the following places : skin, mucous membrane, 
 subcutem, subfascia, intermuscular tissues, in the vicinity of 
 joints, within joints (hemarthrosis), in the tunica vaginalis 
 (hematocele, etc.). Superficial excoriations sometimes occur 
 on the skin over the contused area. As long as the contused 
 swelling contains nothing but extravasate, without any mate- 
 rial injury to the skin, and no infection from without, inflam- 
 matory symptoms are absent. This is true of hematomata and 
 is an accurate means of differentiating between a hematoma 
 and an abscess. The consistence of the swelling is usually 
 softer, fluctuation is pronounced, on palpation crepitation may 
 be noted (coagulum of blood). When the contused tissues 
 are rich in nerves, pain may accompany the swelling. This 
 causes lameness when the seat of injdry is in the following 
 regions or tissues : hoof, periosteum, muscles, and nerves. 
 Severe confusions of the nerves, spinal cord, and brain lead to 
 paralysis, insensibility, and unconsciousness. A reflex paraly- 
 sis of the central nervous system may result from severe peri- 
 
COURSE 67 
 
 pheral contusions (so-called shock). General symptoms are 
 usually absent. Symptoms of anaemia are observed only in 
 rupture of large blood-vessels. Resorption of extravasate from 
 severe contusions may be followed by febrille symptoms (asep- 
 tic resorption fever), and swelling of the lymph-glands. Fat 
 emboli of the lungs have occurred in man. Inflammation as a 
 result of contusion may result in suppuration and necrosis, it 
 may also assume the form of septicemia. 
 
 Course. — The termination of the blood-extravasate de- 
 pends upon its size, the degree of contusion, and the infection 
 or non-infection of the wound, it is, therefore, variable. The 
 blood may become resorbed, or encapsuled, orga- 
 nization, suppuration, or necrosis may also occur. 
 
 1. Resorption, that is, the absorption of the extra- 
 vasate through the lymph-vessels, usually follows subcutane- 
 ous contusions of the first grade ; small hematomata are occa- 
 sionally absorbed in the same manner. The component parts 
 are resorbed in the following order : the blood-serum, the dis- 
 solved fibrin, the degenerated white blood-corpuscles, and 
 finally the red blood-corpuscles ; the latter are resorbed partly 
 in toto, partly in a degenerated condition. The resorbed red 
 blood-corpuscles sometimes accumulate in the lymph-glands 
 to such an extent that the latter have an appearance of dark- 
 red swellings. Red blood-corpuscles which remain in the con- 
 tused areas undergo granular degeneration and give off their 
 coloring matter. The latter is diffused in the surrounding 
 tissues and is transformed into a crystalline hematoiden 
 or a soluble choleglobin out of which are developed color- 
 ing matters similar to those found in the gall ; green, red, blue, 
 and black (melanin) (lyatschenberger). These are visible 
 only in unpigmented skin where they appear in the form of so- 
 called black and blue spots. L,ater they are resorbed and dis- 
 appear. 
 
 2. Organization and encapsulation, so-called, 
 occur in relatively large hematomata. In the vicinity of the 
 hemorrhagic focus there exists, as a result of proliferation of 
 the autochthonous tissue cells, a cellular infiltration with the 
 formation of fibrous connective tissue. This gradually dis- 
 
68 DIFFERKNTIAI. DIAGNOSIS 
 
 places the extravasate and, similar to the so-called organiza- 
 tion of a thrombus, forms a connective-tissue indu- 
 ration as the product of an aseptic, interstitial inflamma- 
 tion (tumor fibrosus). When the connective-tissue 
 mass does not displace the extravasate, but the inflammatory- 
 process runs a chronic aseptic course around its periphery, as 
 around foreign bodies, the extravasate finally becomes encap- 
 suled by a connective-tissue membrane (blood-cyst, 
 hygroma). This process of cystic formation is frequently 
 observed in dogs. I have observed one case in which the 
 capsule developed in fourteen days. In the horse one occa- 
 sionally finds small, moveable blood-cysts located subcutane- 
 ously in the region of the withers, as well as subcutaneous 
 hygromata with free bodies (corpora libera) . Caseous in- 
 crustations, even cartilaginous and osseous 
 degenerations, may result from the organization of a 
 hematoma (othematoma in dogs, subperiosteal hematomata). 
 
 3. Suppuration and ichorous ulceration in 
 contused swellings is only the result of the entrance of infec- 
 tious material into the blood-extravasate. A hematoma then, 
 may terminate in an abscess, under certain conditions the 
 abscess may become encapsuled (shoulder abscess). Difi'use 
 bloody infiltrations terminate in phlegmons, necrosis 
 may develop during the course of the latter and, in case of 
 complications, pass into septicemia or pyemia. 
 
 Differential Diagnosis. — Contusions run an ex- 
 tremely variable course, the}^ may become complicated with 
 wound infection diseases, and they are often confused with 
 other surgical affections. One must consider tumors, 
 phlegmons, hernia, and fractures (crepitation). 
 It is of great practical importance to differentiate between 
 hematomata and abscesses. One must remember that hema- 
 tomata develop suddenly over their entire area ; abscesses de- 
 velop slowly. A genuine hematoma is not characterized by 
 inflammatory symptoms nor general febrile conditions. The 
 periphery of an abscess is hard, that of a hematoma is fluctu- 
 ating. In doubtful cases one may use the exploratory probe. 
 
TREATMENT 69 
 
 Treatment. — The treatment of contused swellings is 
 variable ; it depends on the degree of the contusion. 
 
 1. Slight, circumscribed blood- extrava- 
 sates may be treated with massage, moist heat, and com- 
 pression, as well as counter-irritants. The object being to 
 bring about resorption. 
 
 2. Large hematomata are best treated by means 
 of an incision, this should not be made too early. Extirpate 
 encapsuled blood-cysts ; 'aspiration, with a subsequent injec- 
 tion of tincture of iodine is sometimes effectual. Encapsuled 
 hematomata and hygromata may occasionally be ruptured 
 with force. 
 
 3. Necrosis, phlegmon and abscess forma- 
 tion should not be treated with massage. Suppurative and 
 necrotic inflammations are treated according to the rules of 
 antisepsis ; incise, remove the necrotic tissue, drain, and dis- 
 infect. 
 
 The most Important Contusions of Domestic Ani- 
 mals. — The following affections are of special practical im- 
 portance : 
 
 1. Contusion of the neck, withers, on the sad- 
 dle position, point of the shoulder, on the ster- 
 num, and in the vicinity of the shoulder in the horse (poll- 
 evil, fistulous withers, saddle galls, sternal 
 and shoulder abscess). 
 
 2. Contusions of the upper and under lips 
 (twitch), the skin at the angle of the mouth (bit), and 
 the mucous membrane of the interdental space of the infe- 
 rior maxilla in the horse. 
 
 3. Contusions of the external angle of the ilium, orbital, 
 process, zygomatic region, etc., especially in horses and cattle 
 (decubitis). 
 
 4. Hematomata in the gluteal region, especially in 
 the region of the buttocks, on the anterior surface of the 
 carpal joint, and on the inner surface of the metacar- 
 pus in the horse. 
 
 5. Bursitis intertubercularis and trochan- 
 t erica in horses. 
 
70 I^ACERATION (rUPTURE) 
 
 6. Contused swellings on the elbow in the horse and dog 
 (shoe -boil). In dogs they may occur on the neck, or at 
 the tuberosity of the ischium. 
 
 7- Contused swellings on the anterior surface of the car- 
 pal joint in horses and cattle, especially in working oxen 
 (knee tumor). 
 
 8. Contused swellings over the tuberosity of the os calcis 
 in horses (capped hock) ; the same on the posterior sur- 
 face of the OS calcis (curb). 
 
 9. Treads on the coronet, contusions of the 
 pododerm at the angle of the sole (corns), as well as 
 contusions of the balls of the hoof (sore heels). 
 
 10. Hematomata in the vicinity of the udder, anterior 
 and posterior in cattle (milk- vein, posterior abdominal vein). 
 
 11. Hematomata and blood-cysts on the throat and back 
 of dogs. 
 
 12. Hematomata on the inner surface of the ear muscles 
 in dogs (othematoma, hematoma auris) . 
 
 L,YMPH ExTRAVASATE. — This name applies to contused swellings 
 which are not filled with blood, but with lymph ; they are due to lacera- 
 tion of large lymph-vessels (lymphorrhea). According to Gussenbauer 
 they occur when, as the result of a contusion, the skin is raised from the 
 underlying parts (fascia) and slides over the firm subcutaneous struc- 
 tures. In contrast to hematomata, lymph-extravasates result in swellings 
 which develop slowly, so that growth is observed for weeks and even 
 months. The effusion of lymph does not coagulate as long as the skin 
 remains intact. On account of chronic development and inability of 
 thrombus formation, as well as resorption, the prognosis is unfavorable. 
 Hoffman has described two cases in the horse (buttocks) ; he also men- 
 tions having observed one case in the cow and dog (ear). Hoffman 
 further refers the so-called knee tumors in horses and cattle to extrava- 
 sations of lymph. Moller and Bayer contradict the occurrence of pure 
 lymph-extravasates on the posterior limbs of horses and on the ear 
 muscles of dogs ; they point out the possibility of a confusion with hem- 
 atomata. I, myself, have not yet observed a lymyh-extravasate in 
 either the dog or horse. 
 
 II. LACERATION (rUPTURE). 
 
 Musci^E Rupture. — This term indicates a subcutaneous 
 break in the continuity of individual muscles as a result of 
 
TENDON RUPTURE 7 I 
 
 severe Stretching and tension of the muscles, it is due to blunt 
 forces from without, or pronounced muscular contraction 
 (spontaneous rupture) : distinguish between this and open 
 muscular wounds. The rupture may be complete or incom- 
 plete. Diseased muscles are predisposed to rupture (idio- 
 pathic muscle-rupture). The symptoms are deranged mobil- 
 ity, the presence of a space or blood-extravasate at the point 
 of rupture, and a hernia (abdominal muscles). Healing fol- 
 lows through resorption of the blood-extravasate and the 
 formation of a connective-tissue cicatrix ; there frequently 
 remains a shortening of the muscles (muscle-contracture). 
 Ruptures of abdominal muscles in large animals are usually 
 incurable (ventral hernia). Treatment consists in the applica- 
 tion of a pressure bandage whenever possible. In dogs a skin 
 incision may be made and the muscles sutured. Muscle-rup- 
 tures are usually seen in horses and cattle. They most fre- 
 quently occur in the following places : the tibialis anti- 
 cus, the rectus, obliquus and transversus ab- 
 dominis; the quadriceps femoris (especially 
 the vastus lateralis); the gas t rochne m i us ; 
 gluteal; the biceps brachii and femoris; the 
 anconeus; the levator humeri; pectoralis 
 minor; longissimus dorsi; psoas; gracillis; 
 infraspinatus; and tensor fascia lata. 
 
 Tendon Rupture. — Tendon-ruptures also, should be dis- 
 tinguished from tendon-wounds, they are subcutaneous breaks 
 in the continuity. The causes are identical with those which 
 produce muscle-rupture. As a rule they are of external origin 
 (overextension). They may, however, be due to an inner 
 predisposition, such as diseased tendon following inflamma- 
 tion, deranged nutrition, or necrosis (^idiopathic ruptures 
 of tendons during the course of suppurative inflammations ot 
 tendon-sheaths, or contagious pleuropneumonia). Complete 
 and incomplete (partial, fibrillar) ruptures are recognized : 
 with reference to the latter, see chapter on inflammation, this 
 being the most frequent cause. Complete tendon-ruptures in 
 the horse most frequentl)' occur in the flexor pedis per- 
 forans, flexor pedis perforatus, flexors of the 
 
72 INFLAMMATION 
 
 metatarsi, and suspensory ligament; the ex- 
 tensor pedis and achilles tendon are seldom rup- 
 tured. In cat tl e and dogs the flexor metatarsi and 
 achilles tendon are most often ruptured. The S3'mptoms 
 of tendon-rupture consist in a peculiar lameness, as well as the 
 occurrence of a space between the ends of the ruptured tendon 
 (this is not present in rupture of the tibialis, and flexor pedis 
 tendon in the hoof). On anatomical examination one finds a 
 blood -extra vasate in the vicinity of the rupture, the ends of 
 the ruptured tendon are fibrous, and covered with blood. 
 Healing follows resorption of the blood, through the formation 
 of a connective-tissue cicatrix from the tendon-sheaths, the 
 paratendineum, and the interfasicular connective tissue ; this 
 afterwards takes on the character of tendon-tissue and may 
 finally lead to tendon-contracture. Treatment consists in the 
 application of a plaster-of- Paris bandage ; in dogs a tendon- 
 suture may be applied (compare with the chapter on diseases 
 of the tendons). 
 
 Rupture of Fascia. — Subcutaneous rupture of fascia 
 may lead to the formation of a so-called muscle hernia, 
 that is, to the protrusion of a portion of the muscle through 
 the rent in the fascia. I have observed many cases in horses 
 on the posterior limbs, on the neck, and on the shoulder (her- 
 nia of the semimembranosus and levator humeri). With ref- 
 erence to rupture of vessels, nerves, and articular 
 ligaments refer to the chapter on diseases of the vessels, 
 nerves, and joints. 
 
 INFLAMMATION. 
 
 I. NATURE AND CAUSES. 
 
 Nature. — Inflammation is a highly complicated reac- 
 tive process in irritated tissues. According to 
 the investigations of Cohnheim, v. Recklinghausen, 
 Pfeffer, Metchnikoff, and others, the principal changes 
 are as follows : 
 
 I. The irritation of peripheral centers of 
 circulation produces, reflexly, a vasodilitation 
 
THEORIES OF INFLAMMATION 73 
 
 (vasodilators) of the arteries, veins and capillaries of the in- 
 volved tissues ; this is the first change that occurs. 
 
 2. Acceleration of the blood-stream occurs with the vaso- 
 dilitation. This is soon followed by a diminished ve- 
 locity in the flow of the blood; finally the flow of 
 the blood is entirely suspended (stasis). 
 
 3. When retardation of the blood-stream occurs, the 
 white blood-corpuscles are arranged next to 
 the vessel walls, especially in the veins; while the 
 red blood-corpuscles occupy the center of the stream. At this 
 period the white blood-corpuscles pass through the walls of 
 the vessels (Migration) in the direction of the irritant (che- 
 motropismus, chemotaxis, phagocytosis), 
 whereby cellular infiltration of the inflamed tissue 
 occurs. 
 
 4. As a result of changes in the vessel walls 
 there occurs an active transudation of blood- 
 serum through the diseased walls of the vessels (i n f 1 a m- 
 matory transudate, exudate), occasionally there is 
 also a passage of red blood-corpuscles through 
 the capillary walls (d i a p edesi s). In this way the so- 
 called inflammatory swelling is produced. 
 
 5. Finally, in addition to the emigrated white blood-cor- 
 puscles, the fixed autochthonous connective- 
 tissue cells proliferate (division, proliferation) and 
 take part in the inflammatory process, especially in the cellular 
 infiltration. 
 
 Theories of InfIvAmmation.— According to recent theories on 
 inflammation the primary process is the irritation of the 
 local vasomotor nerves; the secondary process is the migration 
 of the white blood-corpuscles according to the law of chemotaxis, as 
 well as the changes which take place in the vassel walls (v. Reck- 
 linghausen). The importance of chemotaxis for the process of 
 emigration of the white blood-corpuscles has been clearly demonstrated 
 by P f e f f e r. Formerly the primary , essential processes were supposed 
 to be the changes in the walls of the vessels, the inflammatory exuda- 
 tion, and the migration of the white blood-corpuscles (emigration 
 theory of Cohnheim). Metchnikoff demonstrated the phago- 
 cytic theory whereby the white blood-corpuscles form a protection 
 against the entrance of inflammatory irritants by migrating and de- 
 
74 CAUSES OF INFLAMMATION 
 
 stroying them (devouring cells). According to Metchnikoff inflamma- 
 tion is merely a "phagocytic reaction" with certain attendant 
 symptoms. Among the old theories of inflammation, the humoral, 
 cellular and neural theories are of historical interest. Virchow es- 
 tablished the cellular theory of inflammation, according to which, the 
 inflammatory stimuli irritate the cells of the tissues, these hypertrophy 
 and proliferate thus drawing large quantities of fluid nourishment from 
 the blood (attraction theory, nutritive stimuli). The 
 humeral theory of inflammation accounts for the nature of inflammation 
 in changed conditions of the blood (dyscrasia) . According to the neural 
 theory the nervous system plays the principal part in inflammation 
 (paralytic and spasmodic theories of inflammation by Briicke, 
 Stilling and others). 
 
 Causes of Inflammation. — The inflammatory stimuli 
 that are operative on animal tissues are extremely variable in 
 their nature. Mechanical, chemical, thermic and 
 infectious causes may prepare the tissues for inflammation. 
 In general inflammation according to causes may be divided 
 into two, practical, very important groups. One group may 
 be termed an aseptic or non-bacterial (non-infec- 
 tious) inflammation ; it is caused, not through the action of 
 bacteria, but as a result of mechanical, thermic, and chemical 
 influences (traumatic inflammation, burning, acrids). The 
 other group includes the septic or bacterial (infec- 
 tious) inflammations ; they are due to the activity of micro- 
 organisms. The following are the most important causes of 
 inflammation : 
 
 1. Mechanical irritants (wounds, pressure, con- 
 tusions, strains, ruptures) produce the so-called trau matic 
 inflammations : wound healing by first intention, healing of 
 subcutaneous bone-fractures, muscle and tendon-ruptures, that 
 form of inflammation of the pododerm known as laminitis, 
 non- infectious inflammations of the joints (spavin, ringbone, 
 chronic deforming gonitis, omarthritis and coxitis, chronic 
 podotrochlitis), tendons, tendon-sheaths, mucous bursse, and 
 bones. A purely traumatic aseptic inflammation may combine 
 with one that is bacterial and infectious in character (healing 
 per secundam, healing of compound bone-fractures). 
 
 2. Thermic irritants in the form of heat and cold. 
 Purel}'^ aseptic inflammations of this kind are burns (red- 
 
CAUSES OF INFLAMMATION 75 
 
 ness, vesicles) and rheumatic inflammations, especially mus- 
 cular rheumatism (non-bacterial inflammation of mus- 
 cle due, simply, to irritation from cold). These thermic 
 aseptic inflammations may afterwards combine with one that 
 is infectious in character (suppurative infection of blisters). 
 
 3. Chemical irritants may produce various kinds and 
 grades of inflammation without the aid of bacteria, especially 
 suppurative inflammations. Experimental subcutaneous in- 
 jections of sterilized chemicals (oil of turpentine, creolin, 
 nitrate of silver, ammonia, and legumin) under aseptic precau- 
 tions, produce an acute suppurative inflammation in the ab- 
 sence of bacteria (Grawitz, De Bary and others). Inflamma- 
 tion due to chemical irritants is of practical importance in ther- 
 apeutics : through the application of irritants to the skin 
 various grades of inflammation are produced for the object of 
 healing (rubefacients, vesicants, pustulants, suppurants). 
 
 4. Infectious inflammations are caused by the en- 
 trance of microorganisms into the tissues. There are a great 
 many kinds of bacteria that may cause bacterial or septic in- 
 flammations ; namely, staphylococci, streptococci, edema 
 bacillus, tubercle bacillus, glanders bacillus, anthrax bacillus, 
 botryomyces and actinomyces. Examples of infectious in- 
 flammations are : suppuration of wounds, phlegmons, suppu- 
 rative arthritis, tendovaginitis and pododermatitis. None 
 of these organisms are mechanical irritants; 
 inflammation is due to their chemical pro- 
 ducts of metabolism (toxins). Leber was the 
 first to discover that infectious inflammation was due to chem- 
 ical irritants. From a culture of staphylococcus he isolated a 
 crystalline chemical substance (phlogosin) that has the pro- 
 perty of inducing inflammation. The so-called parasitic 
 inflammations (sarcosporidia) are of slight significance from a 
 surgical standpoint ; they also appear to be due to the action 
 of chemical bodies (sarcozystin). 
 
 Finally, certain factors of the disposition have an 
 influence in the production of inflammation (constitution, idio- 
 syncrasy, immunity). 
 
^6 KINDS OF INFIvAMMATION 
 
 II. KINDS, SYMPTOMS, AND COURSE OF INFLAMMATION. 
 
 Kinds of Inflammation. — According to the character 
 of the exudate various kinds of inflammation are recognized : 
 
 1. Serous inflammation is characterized by a 
 serous, watery, lymph-like exudate containing very few white 
 and red blood-corpuscles. It is the slightest grade of inflam- 
 mation ; the blood-vessels are only slightly changed. It occurs 
 in the skin and subcutum (inflammatory edema, blisters, 
 dermatitis bullosa); on the serous membranes of 
 the joints, tendon-sheaths, and mucous bursae 
 (serous arthritis, tendovaginitis and bursitis ; hydrops of the 
 
 joints, tendon-sheaths, and mucous bursae) ; as well as on the 
 mucous membranes (catarrhal inflammation) . 
 
 2. Fibrinous or c r o u p o u s inflammation is char- 
 acterized by the formation of an exudate that is v&xy rich in 
 fibrin and white blood-corpuscles. As a result of this, 
 croupous membranes (so-called fibrinous pseudo-membranes) 
 are deposited on the inflamed tissues ; leucocytes and fibrin 
 threads make up the essential composition of these mem- 
 branes. If a serous exudate is present at the same time it is 
 termed a sero-fibrinous inflammation. Fibrinous in- 
 flammations most frequently occur on the serosa of the joints, 
 tendon-sheaths, and mucous bursse (arthritis, tendovaginitis, 
 bursitis fibrinosa), on the mucous membranes (membranous 
 conjunctivitis, as well as on the iris (fibrinous iritis of moon- 
 blindness). 
 
 3. Suppurative inflammation is a special form 
 which is usually due to an infection with pus-forming bacteria 
 (streptococcus and staphylococcus pyogenes). The suppura- 
 tive exudate is composed partly of emigrated white blood-cor- 
 puscles, partly of proliferated fixed connective-tissue cells. 
 A circumscribed collection of pus in a tissue is termed an 
 abscess. A diffuse suppurative inflammation is termed a 
 suppurative infiltration; an accumulation of pus in 
 joints, or in the cavities of the head, is termed empyema ; 
 suppurative inflammation of the mucous membranes, suppu- 
 rative catarrh; of the mucuous membranes of the eye, 
 
SYMPTOMS OF INFLAMMATION 77 
 
 blennorrhea ; the skin of the external auditory canal, otorr- 
 hea; purulent vesicles on the skin are termed pustules. 
 
 4. Diptheritic inflammation consists of a coagula- 
 tion necrosis of the mucous membranes ; that is, in a deposit 
 of fibrin in the tissues with necrosis of the cells. It leads, 
 either to the formation of a so-called diptheritic pseudo- 
 membrane, or to a loss of substance (diptheritic 
 ulcers). 
 
 5. Hemorrhagic inflammation is characterized by 
 the presence of large numbers of red blood-corpuscles in the 
 exudate, which have left the vessels either per diapedesis of 
 per rhexin. This form of inflammation always involves severe 
 alterations in the walls of the blood-vessels. 
 
 6. Necrotic or gangrenous (ichorous, putrid) 
 inflammation is characterized by a discolored exudate under- 
 going putrid degeneration (mixed infections with septic bac- 
 teria and putrefactive fungi.) 
 
 7. Productive or proliferative (hyperplastic) 
 inflammation runs a chronic course, and results in new forma- 
 tions of tissue (thickenings, adhesions). According to the . 
 character of the new tissue it is termed indurated, 
 schlerotic, ossifying, deforming, adhesive, 
 pan no us, fungous, verrucose, etc. 
 
 8. Specific inflammations correspond to specific in- 
 fectious diseases (tuberculosis, glanders, actinomycosis, botry- 
 omycosis, strangles, anthrax). With reference to erysipela- 
 tous and phlegmonous inflammations see pages 28 and 46. 
 
 Symptoms of Inflammation. — The cardinal symptoms 
 of inflammation are: heat (calor), redness (rubor), 
 swelling (tumor), and pain (dolor) ; disturbed function 
 (f u nctio laesa) may be added as a fifth symptom. 
 
 1. Increased heat is most pronounced in acute inflam- 
 mations. In veterinary science it forms an important sign for 
 the determination of the existence of inflammation, as the in- 
 flammatory redness is frequently invisible. Heat is due to an 
 increased blood-flow, not to an increase in the production of 
 local warmth in the inflamed tissue. 
 
 2. Inflammatory redness, in most animals, is usually 
 
78 TERMINATION OF INFLAMMATION 
 
 invisible in the skin on account of the hair and pigment in that 
 tissue, on the mucous membranes, however, it is readily ob- 
 served. Redness is due to the dilitation and pronounced fullness 
 of the vessels (inflammatory hyperemia). One distinguishes 
 between injection redness, where only individual vessels ap- 
 pear to be strongly injected, and diffuse inflammatory redness. 
 
 3. Swelling is the result of an increased blood-supply 
 and an inflammatory transudate. According to the character 
 of the exudate and the kind of tissue in which the disease is 
 located, the consistence of the swelling on palpation is ex- 
 tremely variable : soft, firm, fluctuating, (abscess, hydrops of 
 the joints and tendon-sheaths), or crepitating (fibrinous arth- 
 ritis and tendovaginitis). Swelling is most pronounced in the 
 widely reticulated tissue of the subcutis, in inflammation of 
 the tendon-sheaths, joints, and glands. 
 
 4. Pain is due, partly to the pressure of the inflamma- 
 tory swelling on the nerves, partly to the involvement of the 
 nerves in the inflammatory process (neuritis). Acute inflam- 
 mations of organs that are provided with a rich nerve-supply 
 are extremely painful : skin, pododerm, periosteum, joints, 
 eyes ; chronic inflammations are usually less painful. Sudden 
 relaxation of pain in an acute inflammation indicates a bad 
 prognosis (necrosis of the pododerm). 
 
 5. Disturbed function is characterized by lame- 
 ness, suspension of the glandular secretions, opacity of the 
 cornea, etc. There is also a disturbance of the general condi- 
 tion ; this is partly due to the pain, partly to the absorption of 
 febrile producing irritants. 
 
 Course and Termination of Inflammation. — One 
 recognizes an acute (existing for a few days) , and a 
 chronic course (longer duration, at least four weeks), occa- 
 sionally a peracute (existing a few hours), and a suba- 
 cute (existing for one or two weeks). With reference to 
 the extent of inflammations, they are classified as superfi- 
 cial, and deep (parenchymatous, interstitial,) 
 local or circumscribed, and diffuse or progres- 
 sive. Finally we have inflammatory primary and 
 secondary foci (metastatic, embolic, general- 
 
THERAPEUTIC METHODS 79 
 
 ized, that is, an inflammation spread over the entire body- 
 through the medium of the blood-stream). The following are 
 the most important terminations of inflammation : 
 
 1. The inflammatory product gradually disappears (res- 
 olution) as a result of the resorption of the inflammatory 
 product through the lymph-stream under the influence of the 
 white blood- corpuscles (phagocytosis, hystolysis). 
 
 2. The retention of inflammatory new forma- 
 tions in the form of thickenings, indurations, and adhesions 
 (schlerosis, elephantiasis, tendon callus, exostosis, dermatitis 
 verrucosa, etc.)- 
 
 3. Gangrene may result from severe disturbances in 
 the circulation or complications with septic infection. 
 
 With reference to inflammations of individual organs see 
 chapters on inflammations of the bones, joints, muscles, ten- 
 dons, nerves, vessels, glands, skin, etc. 
 
 III. TREATMENT OF INFLAMMATION. 
 
 Therapeutic Methods. — Those processes which take 
 place in the tissues under the name of inflammation are con- 
 sidered necessary reactions of the body whereby external irri- 
 tants are expelled, and the body again assumes its normal 
 condition through the expulsion of these derangors of its func- 
 tion. Therefore, the inflammatory process, as 
 such, should not be combatted. The essential 
 problem of surgical therapeutics consists in the support of the 
 body in its endeavors towards self-protection and natural ad- 
 justment, rather than in derangement of natural healing by 
 means of improper treatment. Direct etiological methods of 
 treatment are possible only in cases of septic inflammation 
 (antiseptics). In all aseptic inflammations — those not due to 
 bacteria — indirect, symptomatic therapeutics are the only 
 ones to be considered. These consist in the application of 
 rest, heat and cold, massage and cutaneous 
 ir ritat i on. 
 
 Rest. — Rest for the affected part is the fundamental 
 treatment for nearly all painful inflammatory conditions. 
 
8o HEAT 
 
 Mere rest is all that is required for recovery 
 from many inflammations. This is true of distor- 
 sions of the joints, aseptic inflammations of the hoof, and all 
 chronic deforming inflammations of the joints (spavin, ring- 
 bone, gonitis, omarthritis). In any case, rest supports the 
 action of other remedies. Motion is seldom indicated : chronic 
 inflammation, for example, chronic muscular rheumatism. 
 Rest, from a therapeutic standpoint, involves the removal 
 of the cause of inflammation — the inflammatory 
 i r r i t a n t — the shoe or nail in inflammation of the pododerm ; 
 the saddle, harness, and check-rein in inflammatory conditions 
 of the withers, saddle position, and jaw ; irritating foreign 
 bodies from beneath the lid in conjunctivitis ; removal of 
 loose pieces of necrosed cartilage and bone in chronic inflam- 
 matory processes (fistula of the lateral cartilage, bone-fistula). 
 Heat. — Heat is indicated in all aseptic forms of in- 
 flammation, but especially for the subacute and chronic 
 inflammations. Heat favors resorption of the inflammatory 
 exudate. This is due to stimulation of the circulation, diffu- 
 sion and migration of the phagocytes, as well as to softening 
 and breaking down of the inflammed tissue. Heat also re- 
 lieves pain by means of relaxation. Moist heat is especially 
 useful in the form of frequently renewed Prieznitz ban- 
 dages. The bandage is applied cold, this produces at first 
 an active contraction of the vessels which is soon followed by 
 pronounced dilitation . Frequent application of this bandage — 
 every three to six hours — regulates the deranged circulation 
 and has a favorable influence on the disturbed general condi- 
 tion (temperature, blood-pressure, activity of the heart, dis- 
 tribution of the blood, and nervous system). Warm poultices 
 (cataplasms) exert a similar action ; they are more difii- 
 cult to apply to animals (antiseptic cataplasms in inflammation 
 of the hoof). Recent methods of heat therapeutics in 
 man are the hot-air treatment, the hot-engorge- 
 ment (Bie r), andthe therapeutics of light (thermic 
 action of red rays, chemical, bactericidal action of blue rays). 
 A new heating apparatus with constant action has been in- 
 vented by U 1 1 m a n under the name hydro-thermo- 
 
COLD 8 I 
 
 regulator; Bayer has recommended its use for 
 the horse. The application of heat is con- 
 tra-indicated in all septic inflammations, 
 especially in septic phlegmons, as well as 
 malignant edemas; it favors the extension 
 of the process and the multiplication of the 
 infectious material. 
 
 Cold. — This is indicated only in septic, as well as in 
 the first stages of acute and very painful inflammations (tendon , 
 joint, and hoof inflammations). Its action consists principally 
 in a contraction of the dilated blood-vessels (anesthetic and 
 hemostatic action) ; it also has an antiseptic action on the 
 microorganisms that cause inflammation. Cold retards the 
 motility of white blood-corpuscles and even stops their migra- 
 tion. The application of cold according to a 
 set of fixed rules is more harmful than use- 
 ful in aseptic inflammations, because the nat- 
 ural healing process of phagocytic reaction 
 is destroyed. 
 
 According to experiments made by Bayer with employed 
 methods of application of cold, the most pronounced action 
 resulted from permanent irrigation of a shaved area 
 with cold flowing water (water tubes); at the end of one hour 
 the temperature had fallen 20°. A spray of ether 
 reduced the temperature fifteen degrees in ten minutes ; fifteen 
 minutes after the spray had been removed the temperature 
 had returned to normal. Seven to eight degrees was the 
 maximum reduction of temperature from the application of 
 ice bags and lyciter's tubes. The action of cold 
 baths and cold bandages is very weak ; when changed 
 every five minutes the temperature dropped 3 to 5 degrees in 
 favorable cases ; ordinarily the temperature drops only dur- 
 ing the first two or three minutes and then rises again. 
 Cold baths must be frequently renewed, or cold maybe 
 applied in the form of a stream. Applications of clay, 
 which were extensively used at one time are entirely insufii- 
 cient ; like cold baths the temperature is slightly reduced after 
 a few minutes, but soon returns nearly to normal. The fol- 
 
82 MASSAGE 
 
 lowing is an experimental case : the subcutaneous temperature 
 was 35.7° C, a clay pack of 12.5° C. was applied, the tem- 
 perature sank in five minutes to 32.5° C. In thirty minutes 
 it returned to 34.5° C, and after sixty minutes to 34.9° C. 
 
 Massage. — Massage is a very important form of treat- 
 ment in subcutaneous, and chronic aseptic inflammation of 
 tendons, joints, muscles, bone, and skin. It is 
 con t ra- i nd ica t ed in septic, infectious, suppu- 
 rative inflammations, especially phlegmons, 
 as it favors the spreading of the disease pro- 
 cess. It is also contra-indicated in painful acute inflamma- 
 tions. Four kinds of massage are recognized : 
 
 1. Stroking (effleurage). 
 
 2. Rubbing (friction). 
 
 3. Kneading or malaxation (petrissage). 
 
 4. Tapping (percussion). 
 
 Constant pressure (compression) may also be 
 considered a form of massage. The action of massage con- 
 sists in the removal of the exudate from the diseased and in- 
 flamed tissue ; it is mechanically forced into the lymph 
 channels and thus prepared for resorption. The distension 
 and swelling of the inflammatory enlargement are overcome, 
 thus reducing the pain. The circulation, nourishment, and 
 innervation are stimulated. 
 
 Cutaneous Irritants. — The so-called counter-irritant 
 method is of great importance in veterinary science in the 
 treatment of chronic inflammations. Blisters and 
 firing are the most important cutaneous irritants. These 
 are especially useful in chronic inflammations of the tendons 
 and joints, where the results are very satisfactory. Their ac- 
 tion is due to the transformation of a chronic to 
 an acute inflammation, which makes possible the 
 resorption of the inflammatory product. The cutaneous 
 irritants mentioned produce the following changes in tissues 
 affected with chronic inflammation : dilitation of the blood- 
 vessels ; inflammatory transudation of the blood-serum ; 
 migration of the white blood-corpuscles (phagocytosis) ; for- 
 mation of ferments (enzymes) out of the white blood-corpuscles, 
 
AGENTS THAT OPPOSE INFLAMMATION 83 
 
 by which the albumenous bodies in the chronically inflamed 
 tissue are digested in the form of albumenoses (propeptones), 
 and the solid products are softened, thus passing into solution 
 (histolysis). An actual cutaneous irritant exerts a deep influ- 
 ence on tendons, bones, and joints. This has been demon- 
 strated by microscopic examination of tissues following the 
 application of tincture of iodine to the skin. A few hours 
 after the application there occurs an extensive transudation, 
 and emigration of the white blood-corpuscles into the skin and 
 subcutem, as well as into the intermuscular tissue and perios- 
 teum of the underlying bones. These acute inflammations 
 may even reach to the bone-marrow and lead to loosening and 
 solution of the cartilage at the epiphyses (Volkman). 
 
 Agents that Oppose Inflammation. — As many in- 
 flammations are of an infectious nature they may be effectually 
 combated with antiseptics. In the treatment of deep 
 inflammations (phlegmon, strangles, tendinitis) antiseptics 
 which penetrate the skin must be employed (camphor, car- 
 bolic acid, tar, iodoform, mercury, etc.). Other drugs which 
 find use are the metallic and vegetable astringents; they 
 constrict the blood-vessels, form a protective dry covering, 
 and at the same time disinfect (silver nitrate, sugar of lead, 
 acetate of lead, alum, sulphate of zinc, lime water, tannin, 
 and tannoform). The so-called protective materials have a 
 purely mechanical action (oils, salves, collodion, plaster). 
 Potassium iodide is a specific for antinomycosis. 
 
 The serum treatment for inflammation and wound 
 infection diseases (antistreptococcic serum) has not proved 
 satisfactory. 
 
 Operative Treatment of Inflammation. — In many 
 forms of inflammation, especially the infectious (abscess, 
 phlegmon, ichorous inflammation), incision with subsequent 
 irrigation and drainage is preferable to any other treatment. 
 Against chronic hygromata (capped-hock) injections of pure 
 cultures of staphylococcus pyogenes have been employed ; this 
 results in the formation of an acute abscess which is treated as 
 such (?). In gangrenous inflammation the necrotic 
 portions must be removed, it may be necessary to 
 
84 ULCER, FISTULA, GANGRENE 
 
 amputate (tail, teeth, udder, ear, wings, limbs of dogs). 
 Other operations are scarification, that is, the local draw- 
 ing of blood by means of incisions or punctures ; phle- 
 botomy, at the present time this is employed surgically only 
 in that form of acute, aseptic inflammation of the pododerm 
 known as laminitis. Periosteotom}'- (artificial accelera- 
 tion of anchylosis formation by means of spavin operation) was 
 frequently employed at one time for spavin, and chronic 
 periostitis on the metacarpus. 
 
 ULCER, FISTULA, GANGRENE. 
 
 I. ULCER, ULCERATION. 
 
 Definition. — From a surgical standpoint an ulcer may 
 be defined as a wound that has no tendency to 
 heal (Billroth). It may also be termed a chronic, sup- 
 purative inflammation with a tendency to degeneration of the 
 tissues ; as a continual suppurative degeneration of the granu- 
 lations of the wound. Ulcerative degenerations also exist in 
 tumors as a result of suppurative infection of the new growths 
 (carcinoma). From a standpoint of pathological anatomy an 
 ulcer may be defined as a tissue defect due to necrosis or 
 suppuration. 
 
 Causes. — The causes of ulcers are partly local, partly 
 general. Two main groups of ulcers are recognized : 
 
 1. A primary and idiopathic ulcer is due to the 
 influence of a continuous inflammatory irritant on the wound. 
 It may be due to shaking the ears after injuries, constant lick- 
 ing of the wound at the point of the tail or on the limbs in 
 dogs. Other causes are irritation due to the presence of 
 foreign bodies in wounds, retained masses of pus, pieces of 
 necrosed bone, cartilage and teeth, continued irritating influ- 
 ence of carious teeth on the neighboring gums. 
 
 2. A secondary or symptomatic ulcer is the 
 result of a complication with a suppurative inflammation. To 
 this form belong cancerous ulcers; those of glanders, 
 tuberculosis and actinomycosis ; the corneal 
 
FORMS OF ULCERS 85 
 
 ulcers of dog distemper and diabetis mellitus ; and the 
 genital ulcers of dourine. 
 
 The so-called varicose ulcers of man, which occur on the 
 tibia, do not exist in the lower animals ; they are due to an 
 inflammatory vascular engorgement induced by 
 a dilitation of the veins of the skin, and are very common. 
 On the other hand, the so-called trophoneurotic ulcers, 
 which develop in man after severe neural disturbances, are 
 also seen in the lower animals (corneal ulcers following paralysis 
 of the trigeminus). 
 
 Forms of Ulcers. — According to the character of the 
 granulations ulcers are termed indolent (atonic, torpid, 
 painless), and irritable (erethistic, inflamma- 
 tory, painful). According to the character of the margins 
 ulcers are termed smooth and callus, that is, they have wall- 
 like, firm, cicatricial margins. With reference to the depth 
 they may be superficial, deep, or sinuous (sinuate, 
 undermined), or tube-shaped and fistulous (fistula). 
 Superficial ulcers on the mucous membranes are termed 
 catarrhal or erosion ulcers. According to the character 
 of the surface of the ulcer it is termed hemorrhagic, 
 ichorous, gangrenous, necrotic, diphtheritic, 
 fungoid, (hypertrophic, luxuriative), and phagadenic 
 (cancerous, increasing rapidly in diameter) . Serpiginous 
 ulcers (creeping) are those which move from place to place, 
 healing in one place and extending in another. The following 
 classification is made with reference to the size : miliary 
 (size of a millet seed), lenticular (size of the crystalline 
 lens), those the size of peppers, peas, dollars, etc. 
 With reference to the form, ulcers may be round, oval, or 
 irregular. 
 
 Treatment. — Many ulcers heal simply as a result of 
 rest, that is, after the removal of the irritating cause. 
 Ulcers at the ends of dogs ears, for example, heal after the 
 application of a bandage or ear-cap which prevents the shaking 
 of their ears. The same is true of ulcers at the point of the 
 tail, on the extremities, and on the eyes (cocaine). 
 
 Other methods of treatment are extirpation, cur- 
 
86 FISTULA 
 
 rettage, firing, or cauterization; they are thus 
 transformed into fresh wounds. The application of such 
 agents as the knife, curet, cautery, chloride of zinc, sublimate, 
 chromic acid, and other caustics is preferable to the use of 
 weaker antiseptics and irritants. 
 
 lodid of potash is an internal specific for actinomy- 
 cotic erosion ulcers of the oral mucous membranes ; necrotic 
 ulcers due to a general diseased condition may be treated with 
 arsenic. Ulcers of glanders are not treated. 
 
 The most Important Ulcers in Domestic Animates. — Ulcers 
 of surgical importance are far less common in animals than in man. 
 The following are of practical importance : 
 
 1. Ulcers at the point of the ear in dogs. 
 
 2. Ulcers at the point of the tail in dogs and cattle. 
 
 3. Corneal ulcers in dogs affected with distemper. 
 
 4. Hoof ulcers in horses (sole or wall). 
 
 5. Decubital ulcers as a result of lying. 
 
 6. Stomatitis ulcers in dogs. 
 
 7. Cancerous ulcers with carcinoma of the skin in horses 
 and dogs. 
 
 8. Ulcers of the tongue and lips in horses and cattle. 
 Also, many badly granulating wounds, as well as many treads 
 
 on the coronet, and pressure injuries in the region of the 
 saddle, on the withers and on the neck of the horse, may be considered 
 as ulcers. 
 
 II. FISTULA. 
 
 Definition. — In surgery many diseases are recognized 
 under the term fistula. One must differentiate between two 
 different processes. 
 
 I. Pus fistulae may be regarded as tube-like or 
 sinuous ulcers ; they result from inflammatory suppurative 
 foci that form in the depths of the skin, subcutem, muscles, 
 bone, cartilage, and glands, and which reach the surface by a 
 process of gradual ulceration (Billroth). They are, there- 
 fore, the product of a chronic, suppurative, destructive inflam- 
 mation in the depths of the tissues. The inflammation is 
 frequently sustained by the presence of fragments of necrosed 
 tissue (cartilage, bone), occasionally it is supported by the pres- 
 
I 
 
 PUS FISTULAS 87 
 
 ence of specific microorganisms (botryomyces); the suppurative 
 exudate being discharged through a tube-shaped canal. The 
 following are examples of fistulae ; fistula of the lateral 
 cartilage, fistula of the spermatic cord, 
 tooth fistula, fistulous withers, poll-evil, 
 phlebotomy fistula, fistula of the fetlock, 
 coronary fistula, gluteal fistula, sternal fis- 
 tula, pelvic fistula, costal fistula, and other 
 bone fistulae. 
 
 2. Secretion and excretion fistulae imply a 
 pathological relation of deeply seated secretory organs (glands) 
 and excretory organs (stomach, intestines, bladder) with the 
 external surface of the body. To this class belong salivary 
 fistulae, lachrymal fistulae, milk fistulae, 
 gastric fistulae, intestinal fistulae, ear fistu- 
 lae, and fistulae of the uterus. They are due, 
 either to traumata, and inflammations (acquired fistu- 
 lae), or they may have a congenital origin (ear fistula, 
 fistula of the intestines, urinary fistula). When the canal has 
 a free communication with the excretory organ and the exter- 
 nal surface it is termed a complete or communicating 
 fistula, when the canal ends in the tissues it is termed a 
 blind fistula. According to the form of the fistulous 
 tract it is termed a canal, funnel, or lip-shaped fistula. Other 
 forms are skin, mucous membrane, corneal, serous, and tendon- 
 sheath fistulae. 
 
 Pus Fistulae. — The symtoms of pus fistulae are 
 variable according to their location. The fistulous opening is 
 about the same in all forms ; it is usually small, constricted, 
 indurated, pus in various quantities is discharged from it. 
 The walls of the canal may be hard or smooth ; occasionally 
 it is filled with torpid granulations. At the bottom of the 
 canal one can usually feel a rough, hard mass of tissue 
 (necrosed piece of cartilage or bone). Fistulae are usually 
 painless, as they are the product of a chronic inflammation. 
 They may, however, become complicated with an acute in- 
 flammation — an acute phlegmon for example — under the influ- 
 ence of an injury or an improper operation. 
 
88 SECRETION AND EXCRETION FISTULAE 
 
 The treatment of pus fistulae is analagous to that of 
 ulcers. The suppurative ulcerative, and badly granulating 
 walls of the smooth, indurated and encapsuled fistulous tract 
 are transformed into clean wound surfaces. One should be 
 particular to remove the necrosed tissue at the fistulous canal. 
 An operation, therefore, is the best treatment for a pus 
 fistula ; open freely to the bottom, remove the necrosed tissues 
 (cartilage, bone, teeth), extirpate the indurated walls and 
 remove the granulations. For this purpose one may use the 
 scalpel, scissors, curet, bone- forceps, chisel, etc. To merely 
 split the fistula or cut around it, is usually 
 insufficient. After splitting, the essential treatment is 
 unperformed : this consists in the removal of the chronically 
 inflamed fistulous walls, and the ulcerative surfaces at the 
 bottom. When operating a pus fistula strict 
 antisepsis is necessary to prevent infection 
 of the fresh wound surface from the old sup- 
 purative foci. When these principles — upon which Bayer 
 placed special emphasis — are not observed, or when splitting 
 of the fistula is not followed by careful removal of the necrotic, 
 pus-infiltrated tissue ; the operation is easily followed by an 
 acute suppurative infection of the previously healthy tissue, an 
 extensive phlegmon is especially liable to occur. One should 
 observe the converse precaution : that, frequently, the 
 operative removal of a fistula appears to be 
 contra -indicated as long as there is an acute 
 phlegmonous inflammation in its vicinity. In 
 such cases the operation must be deferred until the phlegmon 
 has subsided. MoUer placed special emphasis on this surgical 
 principal in the operative treatment of fistula of the lateral 
 cartilage, it is necessary to coincide with his view on this 
 subject. 
 
 When a fistula cannot, or should not, receive operative 
 treatment it may be fired or cauterized, an operation 
 is more rapid and effectual. The mere application of 
 antiseptics is seldom effective. 
 
 Secretion and Excretion Fistulae. — These are 
 readily distinguished from pus fistulae by the fact that, instead 
 
PUS FISTULAS 89 
 
 of pus, various secretions and excretions are discharged from 
 the opening ; saliva, milk, urine, food, gastric contents, intes- 
 tinal contents and feces. Their healing is much more 
 d i f f i cult than that of pus fistula e. The conditions 
 which produce an unfavorable prognosis are : continual pres- 
 sure from the discharging glandular secretions, operations on 
 the stomach and intestines (gastric fistula, intestinal fistula) 
 lead to an opening of the abdominal cavity, when a fistulous 
 process exists this is doubly dangerous. Operations intended 
 to bring about removal of secretion and excretion fistulae are 
 of a plastic nature, they consist in an artificial scarification 
 and suturing of the fistulous openings. Firing and caustics 
 are seldom effective. In many cases radical treatment is the 
 only method of healing secretion fistulae, such as extir- 
 pation of the secretorj' gland (extirpation of the 
 parotid in the horse). 
 
 The Most Important Pus Fistulae in Domestic Animals. — 
 The following are of practical importance : 
 
 1. Fistula of the lateral cartilage in the horse. This is 
 a circumscribed necrosis of the cartilage which usually develops from a 
 parachondral phlegmon and induces a chronic ulcerative condition vdth 
 one or more fistulous canals leading to the coronet. Treatment : Extirpa- 
 tion of the lateral cartilage (Bayer's method) . 
 
 2. Fistula of the spermatic cord in the horse is due to 
 a chronic, suppurative, indurative inflammation of the spermatic cord 
 (funiculitis chronica) and the tunica vaginalis. It is caused partly by 
 the botryomyces fungus (botryomycesof the spermatic cord), partly by 
 ordinary pus cocci. Treatment : Extirpation of the degenerated sper- 
 matic cord (ligature, emasculator, ecraseur). 
 
 3. Tooth fistulae occur in horses, especially on the premo- 
 lars of the inferior maxillae ; in dogs they are more frequently seen on 
 the upper jaw. They are the result of a suppurative alveolar periostitis, 
 ostitis, and osteomyelitis. Treatment : Extract the tooth. 
 
 4. Bone fistulae develop from a suppurative, especially 
 necrotic, periostitis, ostitis, and osteomyelitis. According to their seat 
 they are classified as follows : sternal fistula, pelvic fistula, costal fistula, 
 inferior maxillary fistula (false tooth fistula), fistula of the tail, fistulae 
 of the round bones, etc. Treatment : Removal of the necrotic piece of 
 bone (sequester) by means of chiseling, trepanation, curettage, and 
 firing. Because of the deep seated position of the bone sternal fistulae 
 heal with great difficult}'. 
 
 5. Fistulous withers aud poll-evil exist in the horse as 
 
90 SECRETION AND EXCRETION FISTULAE 
 
 a result of contusions ; the contusions are followed by phlegmon and 
 necrosis of the skin, subcutem, bursae, fasciae, muscles, and bones, on 
 the withers, in the saddle position, and in the region of the neck. 
 Treatment : Operative removal of all necrotic portions, antiseptic drain- 
 age and irrigation. 
 
 6. Phlebotomy fistulae are supported by a suppurative thrombo- 
 plebititis of the jugular vein. Treatment : Double ligation and extirpa- 
 tion of the diseased vein. 
 
 The most Important Secretion and Excretion Fistulae. — 
 The following are of practical importance : 
 
 1. Milk fistulae in cows are due to injuries, followed by in- 
 flammation of the udder and abscess formation ; they usually occur 
 during lactation ; occasionally they are congenital. One distinguishes 
 between a fistula of the gland and one that leads to the milk duct. 
 Treatment : Scarification and suturing, firing, cauterization, application 
 of a milk catheter, healing is often possible only during the dry period. 
 
 2. A salivary f is tula is due, either to an injury from without 
 (wounds), or within (salivary calculi), it may be either a fistula of the 
 gland or duct. Treatment : L,igation, scarification and suturing, firing, 
 extirpation of the gland, injection of caustics. 
 
 3. Ear fistula (cervical fistula, cervico-branchial fistula) in the 
 horse is a congenital branchial-cleft teratoma at the base of the ear, 
 which contains a tooth (tooth-follicle cyst, erratic tooth). Compare 
 with the chapter on teratomata. Treatment : Extirpation. 
 
 4. Pharyngeal and esophageal fistulae are due to 
 external and internal injuries, as well as to perforating abscesses. 
 Treatment : Suture. 
 
 5. Gastric and intestinal fistulae are the result of ex- 
 ternal and internal penetrating wounds. According to the seat, and 
 species of animal they are classified as follows : Fistula of the 
 abomasum, rumen, reticulum, small intestine, large 
 intestine, and rectum. A very large intestinal fistula is termed 
 anus praeternaturalis — artificial anus — ; vagino-rectal fistula is 
 termed cloaca (anus vaginalis, recto-vaginal fistula) ; a fistula uniting 
 the bladder and rectum is called an anus vesicalis. Treatment: 
 Plastic operation. 
 
 6. Cystic and urethral fistulae are both termed uri- 
 nary fistulae. They are acquired (traumatic) or congenital. The 
 following are special forms : vesico-vaginal, vesico-rectal, 
 and vesico-intestinal. In a fistula of the urachus 
 (dropping of urine from the navel) the urine discharges continually 
 from the urachus because the fundus of the bladder is not closed. 
 
 Other forms of fistulae are lachrymal fistulae, corneal 
 fistulae, fistulae between the oral and nasal cavities. 
 
GANGRENE QI 
 
 III. GANGRENE. NECROSIS. 
 
 Definition and Kinds. — The term gangrene (necrosis, 
 mortification) indicates death of groups of tissues, as well as 
 local tissue death. In surgery various kinds of gan- 
 grene are recognized, in especial, dry gangrene (gan- 
 graena sicca) or mummification, and moist gangrene 
 (gangraena humida) or maceration (liquefactive degene- 
 ration). When accompanied by symptoms of inflammation it 
 is termed hot, otherwise, cold gangrene (sphacellus). 
 The colonization of putrefactive organisms (saprophytes) on 
 moist gangrene results in putrid gangrene (p u t r e s e n c e). 
 Ichorous or phagedenic (phagedena) gangrene is 
 termed putrid, progressive gangrene. Gas gangrene 
 (gangrenous emphysema) is caused by a mixed infection with 
 gas-producing bacteria (bacillus phlegmonae emphysema- 
 tosae, gas- generating varieties of bacterium coli). A circum- 
 scribed bone necrosis is termed a sequester; certain lique- 
 factive processes on the bones and teeth are termed caries. 
 Gangrene of the mucous membrane is termed diphtheria. 
 Superficial, drj', gangrenous areas are termed eschars. 
 So-called coagulation necrosis is a special anatomical 
 form of gangrene. 
 
 One further differentiates : gangrene of the skin', podo- 
 derm, subcutem, bone, muscles, tendons, mummification and 
 maceration of the fetus, a circumscribed and progressive, an 
 infectious and non-infectious (septic and aseptic) gangrene. 
 
 Causes of Gangrene. — i. Mechanical inter- 
 ruption of the circulation is one of the most fre- 
 quent causes of gangrene. Uninterrupted compression, or that 
 which is combined with destruction of the tissues (pressure, 
 contusions, strangulations, incarcerations) causes gangrenous 
 death as a result of anaemia, especially when combined with 
 injuries to blood-vessels (pressure necrosis, decubitis). The 
 statement has already been made under contusions, that 
 mechanical destruction, alone, does not result in cellular death. 
 Ligatures, thrombus formations, emboli, as well as diseases of 
 the walls of arterial vessels produce results similar to those of 
 
92 CAUSE OF GANGRENE 
 
 compression ; they cause an interruption in the exit of the 
 venous blood (anaemic necrosis). Death of the skin 
 and muscle occurs in from ten to twelve hours after the circu- 
 lation has been stopped ; anaemic necrosis of the intestines 
 follows complete interruption of one or two hours (incarcerated 
 hernia). Bone and cartilage are the least sensitive. Derange- 
 ment of the circulation due to hyaline thrombosis of the 
 branches of the peripheral arteries may result from gangrene 
 (mummification of the extremities) due to ergot-poisoning 
 (ergotism). 
 
 2. Chemical causes of necrosis include the caustics. 
 Their action is variable. The metallic caustics (sublimate, 
 chloride of zinc, chromic acid, sulphate of copper) destroy the 
 tissue cells through the formation of a precipitate of metallic 
 albumenates, and freeing of the acid compounds. The caustic 
 acids (nitric acid) produce an eschar formation through the 
 coagulation of albumen ; they also destroy cells by absorption 
 of water (sulphuric acid). The alkalies (caustic potash, lime, 
 ammonia) transform the albumen of the tissues into a slimey, 
 pulpy mass (alkali albumenate). Formaldehyde produces a 
 dry, horn-like, very deep necrosed area. Snake poisons, as 
 well as many infectious materials, may produce necrosis by 
 their chemical action. 
 
 3. The following thermic influences are classified 
 as causes of necrosis : high degree of heat (burning, com- 
 bustion), and cold (freezing, f r os t- gan gren e, 
 congelation). The so-called third grade of burning and 
 freezing is nothing but necrosis. There is a great difference 
 in the susceptibility of different tissues to thermal influences, 
 a loop of intestine, for example, dies in a few hours when ex- 
 posed to an increased temperature of 8° C. 
 
 4. Many infectious irritants cause so-called 
 gangrenous inflammations. Death of the tissues is 
 due partly to the chemical action of bacterial toxins, partly to 
 their derangement of the circulation. The ordinary pus- 
 forming bacteria — streptococci and staphylococci — 
 have the ability during the course of a suppurative inflamma- 
 tion, namely, phlegmon, to produce necrosis (necrosis of the 
 
NECROSIS BACILLUS 93 
 
 lateral cartilage during the course of a parachondral phlegmon). 
 The necrotic action of the following septic bacteria is especially 
 strong : necrosis bacillus, anthrax bacillus, 
 blackleg bacillus, edema bacillus, glanders 
 bacillus, the bacteria of hog cholera, swine 
 plague, and swine erysipelas (necrosis of the skin 
 in swine), malignant foot rot, gangrenous 
 eczema, gangrenous pox, the so-called gan- 
 grenous erysipelas of sheep and swine, infec- 
 tious diseases that are characterized by diptheria of the 
 mucous membranes, as well as manj^ cases of pete- 
 chial fever in the horse (necrosis of the skin, mucous 
 membranes, the nasal septum, the prepuce, and even the 
 articular cartilage.) 
 
 Also many fungi (necrosis fungi), especially tilletia 
 caries, ustilago carbo, ustilago maidis, and polydesmus exi- 
 tiosus, produce necrosis on the skin and mucous membranes of 
 cattle, horses, and sheep. The buds of buckwheat seem to 
 produce gangrene in a similar manner (fagopyrismus), the 
 same is true of lupinosis in horses, and clover- disease, as well 
 as the so-called gangrene of white spots. Necrosis of the skin 
 and mucous membranes has been observed in the horses ot 
 Batavia as a result of the colonization of a mould (hyphomycosis 
 destruens equi). 
 
 5 . Frequently several causes are operative 
 at the same time. Pressure necrosis in horses 
 and cattle may follow relatively slight mechanical insults when 
 a severe general disease exists at the same time. This is 
 especially true of diseases of the circulatory apparatus (fever, 
 septicemia, diseases of the blood, anaemia, cachexia, cardiac 
 diseases, general exhaustion). The following types of gan- 
 grene present similar conditions : gangrene of old age (gan- 
 graena senilis), the so-called sugar gangrene (gan- 
 graena diabetica), and that which follows diseases of 
 the spinal marrow, so-called symmetrical gangrene. 
 
 Necrosi.s Bacillus. — Under this name Bang described a bacillus 
 that had already been observed by L o f f 1 e r and Schmorl; it occurs 
 in a great number of disease processes, partly as a cause, partly as a 
 concurrent symptom (mixed infection). It is an ubiquitous bacterium, 
 
94 SYMPTOMS 
 
 especially in the intestinal contents, the feces, in dust and 
 dirt; in the tissues it causes coagulation necrosis, and diph- 
 theritic, ulcerative degenerations. It belongs to the 
 filiform bacteria { "streptothrix necrophora"), and develops, partly in 
 the form of rods, partly as a coccus, and partly in the form of long 
 filaments — as long as loo microns; on staining it presents clear, round 
 or cylindrical spaces. It is an anaerobe, uon-motile, and without 
 flagellae ( Ernst ) . With Loefflers solution of methyeline blue or carbol- 
 methyeline blue, recognition is easy ; it is decolorized by Gram's 
 method. It grows best in coagulated serum as well as in semi-solid 
 media at 39° C. House mice are specially sensitive to inoculation ; 
 after subcutaneous injection there develops an extensive necrosis 
 of the tissues, whjch results in death in the course of a week. The fol- 
 lowing conditions are caused by subcutaneous injections into the ear of 
 a rabbit; extensive necrosis with thrombus formation in the large 
 veins, embolic foci in the lungs, secondary pleuritis, occasionally 
 necrosis in the heart and other organs. Injections in cattle, sheep, and 
 swine result only in local swelling and abscess formation (Ernst). 
 Bang and Jensen have found the necrosis bacillus in the following 
 places : 
 
 1. In the HORSE as a cause of gangrenous dermatitis 
 (grease), fistulae of the lateral cartilage, coronary fis- 
 tulae, and in diptheria of the mucous membrane of the 
 colon. 
 
 2. In C.\TTLE as a cause of panaritium, gangrenous pox, 
 diphtheria of the uterus and vagina (also. demonstrated by 
 Ellinger), in necrotic inflammation of granulating 
 wounds, in calf diptheria, in necrosis nodosa multiplex of the 
 liver, abscesses of the liver, and embolic necrosis of the lungs and heart. 
 
 3. In SWINE in necrosis of the skin, diphtheria of the 
 nasal mucous membranes and oral mucous mem- 
 branes, as well as in necrotic foci of intestines and lungs in swine 
 plague. 
 
 4. In RABBITS Schmorl has observed a contagious, progressive, 
 necrotic inflammation caused by the necrosis bacillus. It was ushered 
 in veith pronounced swelling of the head (under lip) which extended to 
 the neck, thorax, and abdomen, and terminated fatally in from 12 to 16 
 days. 
 
 Symptoms. — Dry gangrene is characterized by dryness 
 of the dead tissues. The necrotic skin appears to be covered 
 with dried secretions, it is scabby, leathery, parchment-like, 
 sometimes as hard as horn, from brown to black in color, cool 
 and non-sensitive. Dry gangrene is most often seen in the 
 following places : on the back from saddle pressure, decubital 
 
SYMPTOMS 95 
 
 gangrene on the external angles of the ilium, zygomaticus, 
 etc., at the point of the tail in dogs, on the claws of cattle, on 
 the cornea, following cauterization with nitric acid and formal- 
 dehyde, after death and drying of the fetus in the uterus 
 (mummification ) . 
 
 Moist gangrene presents the following symptoms : the 
 n'ecrosed tissue has the appearance of a slimey, soft, slushy, 
 pulpy or ichorous, bloody mass ; in color it may be grayish- 
 yellow, grayish-brown, dark-yellow, dark-brown, brownish- 
 green, grayish-green, violet, or black. A necrotic lateral 
 cartilage is of a beautiful light-green color (bacteria which 
 form coloring matter). The necrotic masses of tissue are 
 usually cool and non-sensitive (cold gangrene). When inflam- 
 mation exists at the same time they have a warm sensation 
 (hot gangrene). Stinking, putrid gases occasionally develop 
 in the dead tissues (sulphide of hydrogen, hydrocarbons, 
 hydrogen, ammonia, carbonic acid), they cover the external 
 skin in the form of blisters, or produce a frothy condition of 
 the ichorous mass (gangrenous vesicles, gangren- 
 ous emphysema, emphysema septic um). 
 
 The gangrenous dead part is separated from the sound tis- 
 sue through a reactive, suppurative inflammation under the for- 
 mation of granulation tissue (demarking inflammation, 
 line of demarcation, zone of necrosis). When 
 the gangrenous process extends to the walls of the large ves- 
 sels it may result in a gangrenous erosion of the 
 vessel- wall and lead to severe arterial and venous hemor- 
 rhage. The general condition is also frequently afifected (septic 
 and pyemic affection). 
 
 Moist gangrene is most often found during the course of 
 septic phlegmons, on the pododerm, coronet, flexor surface of 
 the fetlock (gangrenous eczema), in the saddle, withers and 
 neck region, on the lower parts of the extremities, on the. 
 inferior margin of the lower jaw and tongue in the horse ; 
 on the udder of the cow, sheep and goat, on the scrotum and 
 tail of cattle and dogs, as well as on the fetal membranes 
 (putrid degeneration following retention), and in the fetus 
 (putrid emphysematous and macerated fetus). 
 
96 TREATMENT 
 
 Treatment. — Treatment of necrosis consists in oper- 
 ative removal of the necrosed part (knife, scissors, 
 curet, forceps, chisel, trephine, etc); occasionally amputa- 
 tion of an entire organ of the body is necessary (tail, end of 
 the tongue, penis, udder, claws, ears, limbs of dogs). Slough- 
 ing of the dry gangrenous masses may follow the application 
 of antiseptic cataplasms. Above all, thorough and con- 
 tinuous disinfection is necessar3^ To prevent decubitis 
 in horses and cattle use plent}- of soft bedding (tan-bark, sand). 
 
 Atrophy. — Atrophy is a reduction in the size of organs, as well 
 as individual cellular elements ; it is due to deranged nutrition and 
 pathological retrogression. (Aplasia is complete failure of organs, the 
 testicles, for example). From an etiological standpoint the following 
 kinds of atrophy are recognized in surgery : 
 
 1. Atrophy of inactivity is the result of inactivity of 
 organs, especially the muscles and glands. The cells, because of inac- 
 tivity, cease to assimilate (active atrophy). Compare with chronic 
 lameness in the horse that is usually accompanied by active muscular 
 atrophy, as well as atrophy of the penis in phimosis (high nrinator). 
 
 2. Pressure atrophy is the result of continued compression of 
 organs, for example, from new formations (passive atrophy). This is 
 seen on the os pedis as a result of keratoma. 
 
 3. Degenerative atrophy is due to deranged nutrition accom- 
 panying the course of an inflammatory process, for example, in the 
 udder and eye (atrophy and phthisis bulbi in moon blindness and sup- 
 purative panophthalmia) ; in muscular inflammation of the quadriceps, 
 anconeiTS, and longissimus dorsi (inflammatory atrophy); it 
 may also follow paralysis of the nerves, for example, the suprascapularis 
 (muscles on the external surface of the scapula), the trigeminus (mus- 
 cles of mastication), the spinal marrow (posterior limbs) (neurotic 
 atrophy). This is not usually a form of simple atrophy; degenera- 
 tive changes usually occur. Other forms are senile atrophy, the so- 
 called lipomatous atrophy of the muscles (obesity), and the udder 
 (fleshy udder). For further data concerning atrophy compare with the 
 chapter on diseases of the muscles and bones. 
 
 Atresia. Obliteration. — These terms indicate the closure or 
 growing together (adhesion) of body openings and canals. 
 
 1. Atresia is a congentital malformation. It occurs 
 in animals in the following places : rectum (atresia ani) , on the eye lids 
 (atresia palpebrarum), in the milk canal and milk cystern, as 
 well as in the lachrymal duct. 
 
 2. Obliteration is an acquired cicatricial adhe- 
 sion; it results from wounds and i n f lam m a t o ry processes 
 
STENOSIS 97 
 
 in the vagina, on the vulva on the sphincter of the teat, in the com- 
 missure of the lids, as well as in the vessels in thrombus formation, 
 which terminate in a form of cicatrization. In the female genital canal 
 there occasionally occur adhesions in the vulva and vagina after injur- 
 ies during coitus and parturition. Adhesions at the mouth of the teat 
 and in the milk cystern with the formation of folds in the walls are more 
 common ; they are caused by injuries, eczema, contagious aphtha, and 
 catarrhal mastitis. Treatment of atresia and cicatricial adhesions is 
 operative (perforation, teat probe, milking tube, bougies). 
 
 Stknosis. — Stenosis is a narrowing of the canals and cavities of the 
 body, especially the following : esophagus, trachea, urethra, vagina, in- 
 testines, milk ducts, salivary ducts, nasal cavities, maxillary sinuses, the 
 frontal sinuses, and intestines. According to the cause the following 
 forms of stenosis are recognized : 
 
 1. Compression stenosis. This is due to pressure of new 
 formations or abscesses from without on neighboring canals ; for ex- 
 ample, the trachea (goitre) ; on the esophagus (tuberculous new forma- 
 tions in its vicinity ) ; on the rectum (paraproctal abscesses and new 
 formations, tumors of the prostate). 
 
 2. Obturation stenosis consists of a narrowing or stenosis 
 of the canal from within through foreign bodies or new formations. 
 Examples of this are : obliteration of the esophagus from the retention 
 of food (pieces of turnips or potatoes) ; obstruction of the urethra by 
 calculi ; of the salivary duct by salivary calculi ; of the intestines by 
 intestinal calculi ; narrowing of the lumen of the trachea after fracture 
 of its cartilage (infraction) ; stenosis of the teat canal in cattle from 
 wart-like new formations, connective tissue, and epithelium, frequent 
 ring-like growths of the mucous membrane (so-called hard milkers) ; 
 stenosis of the lachrymal duct as a result of catarrhal swelling of the 
 mucous membrane ; stenosis of the nasal, frontal, and maxillary cavities 
 by new formations by which they are occasionally entirely filled ; 
 stenosis of the external auditory canal in dogs by papillomata. 
 
 3. Cicatricial stenosis or stricture is due to a cicatricial 
 retraction following a previous injury or inflammation. It is seen in 
 the trachea after tracheotomy, in the esophagus after esophagotomy, in 
 the urethra after urethrotomy, in the vagina following injuries due to 
 coitus and parturition, in the teat canal as a result of wounds and chronic 
 inflammation (chronic mastitis), in the false nostrils following injuries 
 with a severe loss of substance. 
 
 4. Congenital stenosis is seen, especially in cattle, in the 
 teat canal and at the passage from the milk cystern to the teat canal ; 
 occasionally all four teat canals are abnormally narrow (hard milkers). 
 In cows one also occasionally finds congenital stenosis of the vagina 
 (dystocia). A similar condition is observed in the lachrymal duct of 
 the horse. 
 
98 TUMORS 
 
 Spasmodic stenosis is very uncommon (spasmodic contraction 
 of the esophagus). 
 
 Ectasia. DilitaTion. — These terms indicate an enlargement of 
 canals and body-cavities ; the condition is exactly opposite to that pro- 
 duced by stenosis. According to the anatomical form the following 
 varieties are recognized : diffuse and circumscribed (diverticu- 
 lum), cylindrical, spindle-shaped, and sac-like. There 
 is also a genuine and a false ectasia. From an etiological stand- 
 point the following are recognized : 
 
 1. Pulsion-diverticulum formed by outward pressure from 
 an object within the canal : food above a stenosis of the esophagus 
 retained urine from a stenosis of the urethra. Here also belong dilita- 
 tions of the cavities of the head in hydrops. 
 
 2. Traction-diverticulum is due to a retracting cicatrix 
 from without. To this class belong macrostomia as a result of extensive 
 injuries to the angles of the mouth. 
 
 TUMORS. 
 
 I. GENERAL CONSIDERATIONS. 
 
 Definition. — From a surgical standpoint, in a restricted 
 sense, one usualh^ understands a tumor to be an atypi- 
 cal new formation not the result of inflamma- 
 tion; it has no assignable cause nor phj^sio- 
 logical termination; it has no anatomical 
 type, that is, it varies from the type of tissue 
 from which it develops (Cohnheim, Liicke). 
 This definition does not include the inflammatory new forma- 
 tions of tissue (hyperplasia), or the so-called infectious granu- 
 lation tumors (tuberculosis, actinomycosis, botryomycosis, 
 glanders) . A complete understanding of the nature of tumors 
 has not yet been acquired. 
 
 Classification. — From a clinical standpoint one first 
 differentiates between malignant and non- malignant 
 tumors. Carcinoma and sarcoma belong to the malignant 
 type. They are malignant for the following reasons : they 
 develop rapidly with a destruction of the neighboring tissues, 
 they have a tendency towards ulcerative degenerations, and 
 they are especially distinguished for the formation of metas- 
 tases in distant organs. The metastatic formations are pro- 
 
CONNECTIVE-TISSUE TUMORS 99 
 
 duced in the following manner : small portions of the tumor 
 (cancer cells) first enter the lymph-channels (local lymph 
 gland metastasis) and from there find their way into the 
 blood-stream (general metastasis of the lungs, liver, and other 
 internal organs). Occasionally the cancer cells enter directly 
 into the veins that are located in the tumor (jugular) and 
 thereby gain entrance to the blood-stream. Aside from meta- 
 stasis, malignant tumors may spread by continuity, contiguity, 
 and dissemination (proximity, contact, becoming detached 
 and forming new colonies). 
 
 The histological classification of tumors depends 
 upon their microscopic condition. Tumors are composed of 
 cells, connective tissue, and blood-vessels. Various groups 
 and varieties have been formed with reference to the cells 
 which go to make up the principal parts of the tumor. Fol- 
 lowing this classification according to Waldeyer they fall 
 into two large groups : 
 
 1. Connective-Tissue Tumors, (desmoid growths 
 of Waldeyer, histoid growths of Virchow). They 
 are composed principally of cells from the middle germ 
 layer. They may possess the structure of connective 
 tissue (fibroma, sarcoma), of fatty tissue (lipoma), mucous 
 tissue (myxoma), cartilage (enchondroma), bone (osteoma), 
 muscles (myoma), the vessels (angioma), or the nerves (neu- 
 roma). Frequently these tumors have no typical structure, 
 but are a mixture of various types, so-called mixed tumors. 
 
 2. Epithelial Tumors, (epithelial growths of 
 Waldeyer, organoid tumors according to Virchow). 
 They are composed principally of epithelial cells from the 
 inner or outer germ layer, Carcinomata and adeno- 
 mata are the principal representatives of this group. 
 
 HiSTOi^OGiCAL CLASSIFICATION OF TuMORS.— Vi r cho w divided 
 the tumors in general into extravasation or exudation tumors 
 (hematoma, hygroma), retention tumors (mucous cysts, athero- 
 mata) and proliferative tumors, or tumors in the narrow sense. 
 The tumors, in the narrow sense, regardless of whether they contained 
 one or several varieties of cells, were classified by him as follows : (a) 
 
 L©fC. 
 
lOO CAUSES 
 
 HISTOID tumors: fibroma, lipoma, enchondroma, osteoma, myxoma> 
 myoma, neuroma, angioma, sarcoma ; (b) ORGANOID tumors : carci- 
 noma ; (c) TERATOID tumors : dermoid cysts. 
 
 Cohnheim, with whom Tillman and others coincide, distin- 
 guished: (a) tumors formed according to the type of connective- 
 tissue substance (desmoid tumors according to Waldeyer): 
 fibroma, lipoma, myxoma, chondroma, osteoma, angioma, lymphan- 
 gioma, endothelioma, lymphoma, sarcoma, and mixed tumors of the 
 types named ; (b) tumors of the type of muscle tissue (myoma); 
 (c) tumors of the type of nerve tissue (neuroma, glioma); (d) 
 tumors of the type of epithelial tissue (epithelial growths ac- 
 cording to Wa Ide y e r) : carcinoma, adenoma, cystoma, epithelioma, 
 onychoma, teratoma. 
 
 Causes. — Nothing definite is known concerning the 
 origin of tumors. Among the numerous theories of 
 tumors the following are worthy of mention. 
 
 1. According to the EMBRYONIC THEORY of Cohn- 
 heim the existence of tumors, especially cancer, may be referred 
 to proliferation of embryonic tissues; there is an 
 excessive formation of this tissue during fetal development, or 
 an aberration of its physiological coherence whereby it is 
 changed into other tissue. These embryonic cells remain un- 
 developed in most individuals ; in others growth may be 
 stimulated as a result of injuries, mechanical or chemical irri- 
 tants, hypereiuia, or inflammation. The inheritance of many 
 tumors, as well as the existence of desmoid cysts in the inner 
 organs (misplaced epidermal cells in the ovaries), are best 
 explained by this theory. R i b b e r t has modified the theory 
 as follows : the cells or cell groups loose their cohesion, not 
 only before but also after birth, become isolated and finally 
 develop into tumors. 
 
 2. The IRRITATION THEORY depends upon a previ- 
 ous inflammation, as well as traumatic influences. The exter- 
 nal irritant causes a mechanical looseningof the cells and results 
 in an inflammatory proliferation of the connective tissue. The 
 detached cells (epithelial cells for example) may proliferate un- 
 restrained into the lymph-spaces. Chemical irritants and para- 
 sites also cause loosening of the cells through the production 
 of connective-tissue proliferations ; the cells become isolated 
 and proliferate. The development of papillomata after inflam- 
 
ETIOLGY OF TUMORS IN ANIMALvS lOI 
 
 mations of the 'skin, of sarcomata after bone fractures and of 
 cancers from a cicatrix, are cited as examples of this method of 
 tumor formation. 
 
 3. According to the INFECTION THEORY, either 
 microorganisms are the direct or essential causes of the tumor 
 (carcinoma, sarcoma, papilloma), or through certain influences 
 the sound tissue cells take on an infectious character. The infec- 
 tion theory is supported by the analagous infectious tumors : 
 experimental inoculation (sarcoma, carcinoma), as well as by 
 the process of metastatic formation. Unobjectionable 
 proof of the relations between microorganisms 
 and tumors has not yet been present ed; this is 
 especially true of sarcomata and carcinomata. 
 
 4. According to the AGE THEORY ofThiersch.age 
 has the following relation to the existence of tumors : In old 
 age the resistance of the connective-tissue 
 stroma is less than that of the proliferating 
 epithelial cells. Cancer is the result of a "shifting of 
 boundaries, and a boundary war of the epithelium against the 
 connective tissue" (Boll). The change of the cell char- 
 acter (anaplasia), due to a stimulus of the prolif- 
 erative force of the cells, results from the fact that in 
 old age the dependence of individual cells upon their sur- 
 roundings (altruism) is diminished ; they become similar to 
 the original, non-differentiated germinal cells (Hanse- 
 mann). For further information concerning the etiology of 
 cancer compare with the chapter on carcinoma. 
 
 Etioi^ogy oh Tumors in Animai^s.— Upon this subject little is 
 known. Many theories of medical science find place, with nothing 
 further to support their claims, in veterinary science. Thus Plicq ue 
 maintains that pressure from the bit causes carcinomata on the lips 
 of horses ; that they are caused in cats by the repeated bites of smaller 
 animals ( ! ! ). In Germany these observations have not yet been made. 
 Also the further theory, that subcutaneous fibromata are often the 
 result of pressure from the saddle does not seem to be proved, it is not 
 a genuine tumor, but a contused swelling (tumor fibrosus). Smith 
 and Washburn attempted to produce infection in eleven bitches by 
 means of coitus with a dog affected with sarcoma of the penis ; it is 
 alleged that the experiment resulted in sarcomatous nodules in the 
 vagina. They have also transmitted sarcoma to other animals by means 
 
I02 CLINICAL SYMPTOMS 
 
 of subcutaneous injections ( ? ). With reference to the professed 
 heredity of melanoma in horses, and cancer of the mammae in dogs, 
 nothing definite is known. On the other hand, on the basis of my own 
 experience, I am able to confirm the allegations of Plicque, that 
 young dogs seldom or never suffer from carcinomata, while old dogs are 
 frequent sufferers from this affection. In at least 262 carcinomata in 
 dogs I have never seen one in an animal less than two years of age. 
 Also the 49 cases of carcinomata claimed to have been demonstrated in 
 cattle (inner canthus of the ej'e) by Loeb and Job son were con- 
 fined exclusively to animals over six years of age. With reference to 
 the influence of nourishment it may be said that animals fed on a 
 meat diet are possibly predisposed to carcinoma. According to our 
 experience dogs suffer from cancer more often than swine or cattle. 
 Carcinomata are also common in horses. The claim of Trasbot, that 
 cancer can be experimentally produced by feeding nourishment rich in 
 albumen, is more than problemetical (compare with the chapter on car- 
 cinoma). 
 
 Clinical Symptoms.-— According to the character of the 
 tumor and the various stages of its development, these are 
 extremely variable. Cf: "Special Forms of Tumors. " The 
 development may be rapid or slow ; it may proceed from the 
 center of the growth (concentric development, growth by in- 
 tussusception) ; or from the periphery (eccentric growth, 
 growth by apposition). In the first case the tumors are cir- 
 cumscribed, in the latter the}' are diffuse or accompanied by 
 daughter tumors. Tumors are often observed undergoing 
 changes known as regressive metamorphosis; 
 namely, fatty degeneration, caseation, calcification, cornifica- 
 tion, chondrification, and ossification, mucous, colloid, and 
 cystic softenings, deposits of cholesterin, amyloid degenera- 
 tions, and pigment formation. When tumors become infected 
 they react as do other tissues, becoming inflamed, ulcerative,, 
 necrotic, and ichrous. The general condition is not affected in 
 non-malignant new formations (fibroma, lipoma, papilloma, 
 osteoma, etc.). Malignant tumors on the other hand, espec- 
 ialh' carcinomata, in addition to metastatic formation 
 result in a general derangement of the nutrition ; this is char- 
 acterized by emaciation, anaemia, hydraemia (cancerous 
 cachexia), in which important nourishment is removed 
 from the body on the one side, and toxic materials are taken 
 up by the blood on the other (auto-intoxication). As 
 
DIAGNOSIS 103 
 
 a result of ulceration of their surfaces many growths are 
 hemorrhagic: chronic epistaxis in ulcerative angioma, 
 adenofibronia, and carcinoma of the nasal septum of the horse ; 
 chronic hematuria in carcinoma of the bladder in dogs. 
 Finally tumors may cause secondary derangements of 
 neighboring organs b\' compression (melanoma of the parotid 
 region, of the rectum, on the tail; tumors in the air passages, 
 in the brain, in the spinal marrow, in the vicinity of large 
 vessels). 
 
 Diagnosis. — The diagnosis of a tumor as 
 such, that is, differentiation from other swollen conditions, 
 especially inflammatory, is not difficult. Tumors usually 
 develop slowly and without inflammatory 
 symptoms (pain, increased heat). Hema- 
 tomata are differentiated from new formations by their 
 rapid, sudden formation. In contrast to a phlegmon or 
 abscess, inflammatory symptoms usually fail in the devel- 
 opment of tumors, this is especially true of pain and in- 
 creased heat. Only chronic h^^perplastic inflammatory pro- 
 cesses are able, under certain conditions, to simulate tumor 
 formation to such a degree that diagnosis becomes extremely 
 difficult. Examples of this are seen in the wart-like forma- 
 tions which follow dermatitis chronica on the flexor surface of 
 the fetlock (dermatitis verrucosa), in the formation of exos- 
 toses after periostitis, as well as in keloids in a cicatrix. 
 
 Differential Diagnosis. — The differential diag- 
 nosis of individual tumors is more diflBcult. A 
 classification of tumors can seldom be made on their macro- 
 scopic appearance; a microscopic examination is more 
 valuable for making the special diagnosis. For making a 
 purely clinical macroscopic examination the following points 
 are of value : 
 
 I. The seat of the tumor with reference to the nature 
 of the tissue involved is often an index to its character. 
 According to experience, the penis, the testicles, and the 
 mammae are frequently seats for the development of carcino- 
 ma, sarcoma, and adenoma ; the periosteum for osteoma and 
 sarcoma ; the spermatic cord for botryomycoma ; the skin for 
 
I04 DIFFERENTIAL DIAGNOSIS 
 
 fibroma, carcinoma, and papilloma ; the subcutem for lipoma 
 and fibroma ; the nasal cavities for myxofibroma and adeno- 
 fibroma ; the maxillary and frontal sinuses for sarcoma and 
 carcinoma ; the nerves for neuroma. 
 
 2. Occasionally the size and development of the 
 tumor is an index for its diagnosis. The malignant tumors 
 are usually larger and develop more rapidly than the non- 
 malignant. Sarcoma and botryomycoma in the horse some- 
 times develop very rapidly and attain an immense size. In 
 the horse many sarcymata of the eye have a formidable devel- 
 opment. Soft fibromata are characterized by a relatively rapid 
 growth. Occasionally it is important to note whether the 
 tumor is single or developing in several places. Papilloma 
 and fibroma have a tendency to the production of multiple new 
 formations (papillomatosis, fibromatosis), this is also true of 
 botryomycoma. Sarcoma, carcinoma, and actinomycoma are 
 multiple when metastatic formation results in gen- 
 eralization (sarcomatosis, carcinomatosis). 
 
 3. The surface of the tumor is rough in papilloma, 
 botryomycoma, and carcinoma ; lobulatedin lipoma ; compara- 
 tively smooth in man\^ sarcomata and fibromata. 
 
 4. The consistency is softest in round-celled sar- 
 comata, soft fibromata, lipomata, and myxomala, as well as in 
 many cysts ; carcinomata and hard fibromata are more firm ; en- 
 chrondromata and osteomata are as hard as cartilage and bone. 
 
 5. The relation of the tumor to the skin 
 or to the neighboring tissues, is of great diagnostic 
 importance in malignant new formations (sarcoma, carcinoma) 
 as they have a strong tendency to include the surrounding 
 tissues in their processes of degeneration. They are, there- 
 fore, less sharply defined than the non-malignant tumors 
 (fibroma, lipoma, papilloma) ; carcinomata frequently present 
 superficial ulceration. Carcinomata and sarcomata frequently 
 attack deeper underlying tissues, even involving the bone. 
 
 6. Under certain conditions the race may be of im- 
 portance. In cattle actinomycotic and tubercular new forma- 
 tions are common ; in horses, botryomycomata ; in dogs, car- 
 
STATISTICS 105 
 
 cinomata. Grey horses are frequentlj'^ affected with 
 nielanosarcoma. 
 
 7. In doubtful cases age may be of importance in the 
 diagnosis of cancer ; young animals are seldom affected with 
 cancer, on the other hand, they are frequent sufferers from 
 sarcoma, lipoma, and papilloma. 
 
 8. Swelling of the neighboring lymph 
 glands is characteristic of malignant new formations, this 
 is especially true of cancer and sarcoma (metastasis). 
 
 Statistics. — With the assistance of the statistical publications of 
 J o h n e and myself , as well as the clinical annuals of the veterinary schools 
 at Berlin, Munich, and Dresden, Casper has arranged statistics on 
 tumors in the domestic animals from various points of view (Pathologie 
 der Geschwiilste bei Tieren. 1899). Among 86,000 diseased horses, 1131 
 (1.3 per cent) were affected with tumors ; among 85,000 dogs, 4029 (4.7 
 per cent) were similarly affected ; among 5,000 cattle, 102 (2 per cent) 
 were affected with new formations. In the years 1886-1894, I operated 
 on 643 new formations in dog?. Of these, 262 (40 per cent) were 
 carcinomata and adenomata; 97 (13 per cent) fibromata; 
 65 (10 per cent) papillomata; 44 (7 per cent) sarcomata; 39 (6 
 per cent) lipomata; 2 (0.3 percent) angiomata. In the years 
 1895-1902, I operated on 200 cases of new formations in the horse ; 25 
 per cent of these were sarcomata, 20 per cent botryomycomata 
 and fibromata, and 10 per cent were carcinomata. Therefore, 
 sarcoma, botryomycoma, fibroma, and carcinoma are 
 the most frequent tumors in the horse. These four kinds 
 of tumors form three-fourths of all new formations in the horse. They 
 are more frequent than cicatricial keloids, keratomata and 
 papillomata. The following are the least common: lipoma, 
 genuine osteoma, atheroma, adenofibroma and myxo- 
 ma of the nasal mucous membranes. The statistics of the 
 Pathological Institute (Casper, Johne), which include new forma- 
 tions of the internal organs that are not observed by the surgeon, 
 afforded facts in accordance with clinical observations : that carcinoma 
 is mvich more frequent in dogs than in horses or catttle ; and that in the 
 two latter species sarcoma is more frequent than carcinoma. Among 123 
 new formations in the horse, 60 were sarcomata (47 per cent), 28 car- 
 cinomata (22 per cent) ; among 93 new formations in the dog, 48 were 
 carcinomata (52 per cent) , 26 sarcomata (28 per cent) ; among 104 new 
 formations in cattle, 36 were sarcomata (35 per cent), 28 angiomata (27 
 percent), 8 carcinomata (8 per cent). With reference to the topo- 
 graphical distribution of tumors the following observations 
 were made : carcinomata were most often found in the kidneys. 
 
Io6 TREATMENT 
 
 the mammae, the maxillary sinuses, the thyroid glands, the skin, the 
 lymph glands, and the testicles ; sarcomata were miost often found 
 in the lungs, the liver, the lymph glands, the thyroid gland, the mammae 
 and the kidneys. Compare with statistics on carcinoma. 
 
 Treatment of Tumors. — In many cases, especially in non-malig- 
 nant forms, treatment is superfluous (blemish). When treatment is 
 indicated they should be operated at the earliest possible moment. 
 Operation consists in removal with the knife, scissors, or curet. Early 
 operation is especially indicated in sarcoma, carcinoma, and botrj'omy- 
 coma (fistula of the spermatic cord). When an operation is followed by 
 a recurrence of the tumor it indicates that small pieces of the tumor 
 remained. Pedunculated new formations, as well as tumors in the body 
 cavity (polypi of the nose, vagina, and rectum) may be removed by 
 tearing and twisting, by means of a ligature (ligation of the 
 neck of a tumor), or with the ecraseur. The galvanocautery loop, 
 employed in human surgery, is too complicated for veterinary use. In 
 many cases the firing iron is indicated, especially the thermo- 
 cautery, this acts as a hemostat during the operation, healing follows 
 under an eschar which takes the place of a bandage. The earlier ex- 
 tensively employed drugs should only be used in those cases where 
 an operation is impossible, or for econimic reasons is not practical (for- 
 maldehj'de in many cases of cancer of the hoof). The recent treatment 
 of certain tumors with iodid of potash is of some importance. It 
 is a specific for goitre, as well as actinomycosis of cattle (not, however, 
 against botryomycosis of horses). Iodid of potash may either be admin- 
 istered internally, or applied externally in the form of lyUgol's solution ; 
 tincture of iodine is active when applied externally or by means of in- 
 jections. The internal administration of arsenic has a similar influence 
 on papillomata. The parenchymatous injection of other remedies 
 (alcohol, acetic acid j is of doubtful efficacy, the same is true of treatment 
 with the aneline dyes ; the same may also be said of the artificial pro- 
 duction of erysipelas for the relief of carcinoma, a few examples of 
 which have been followed by success in human medicine. Concerning 
 the importance of the serum therapy compare with the chapter on 
 "carcinoma." Finally, the recently employed artificial inocculation of 
 malaria is of very questionable value. 
 
SPECIAL KINDS OF TUMORS I07 
 
 II. SPECIAL KINDS OF TUMORS. 
 
 A. Connective-Tissue New Formations. 
 
 I. fibroma. 
 
 Forms. — A fibroma or fibroid (connective-tissue 
 tumor) is a desmoid tumor composed largely of connective 
 tissue. Two forms are recognized: i. Hard fibroma 
 (fibroma durum, desmoid) is characterized by a hard, firm 
 consistency ; when cut it presents a white, tendinous, glistening 
 surface ; microscopic examination shows it to be composed 
 principally of straight, stratified, or crossed connective-tissue 
 fibers with a very few cells. 
 
 2. Soft fibroma (fibroma molluscum) is less common ; 
 it is soft in consistency ; when cut it presents a light-grey 
 transparent surface ; under the microscope it is seen to be 
 composed of loose moist connective tissue with very many 
 connective-tissue cells. Between the soft and the hard fibro- 
 mata there are many transitional forms. One also differentiates 
 circumscribed and diffuse, simple (solitary) and 
 multiple fibromata (fibromatosis). Pedunculated fibromata 
 on the mucous membranes are termed polypi (fibroma 
 pedunculum) ; similar fibrous new formations on the skin and 
 subcutem are termed cutis pendula (see below). Fibrous 
 proliferations in cicatricial tissue are termed keloids. My- 
 cofibroma is a special infectious form due to the activity of 
 the botryomyces fungus (botryomycoma). Finally, mixed 
 tumors with other new formations are very frequent, for 
 example, fibrosarcoma, fi br olipom a, fi brom y xo- 
 ma, fibroneuroma, fibroadenoma. 
 
 With reference to the causes of fibromata nothing 
 definite is known. Recently it has been attempted to associate 
 their development with traumatic and inflammatory influences. 
 Their relation to inflammatory cicatricial tissue, especially 
 the cicatricial keloids, as well as to the inflammatory connec- 
 tive-tissue hyperplasias (elephantiasis, tumor fibrous) has been 
 considered. At the most, repeated injuries or chronic inflam- 
 
I08 OCCURRENCE 
 
 mations are only occasionally the cause of fibroma formation. 
 The principal cause, for the want of better knowledge, seems 
 to lie in a fibromatous predisposition. This explains the cases 
 of congenital fibroma (congenital anlage of fibromata). The 
 multiplicity of cutaneous fibromata in dogs and horses also 
 speaks for the presence of an internal predisposing cause. 
 
 Occurrence. — Fibromata are benign, develop 
 slowly, are usually roundish, circumscribed, 
 nodular, smooth on the surface, firm, non- 
 hemorrhagic painless new formations of a uni- 
 form consistency. They are very common in the domestic 
 animals and may develop in any organ that contains connective 
 tissue. Their favorite seats, therefore, are in the sub- 
 cutem, the submucosa, the periosteum, and the subfascial and 
 intermuscular connective tissue; they are also common in the 
 uterus and in the nerves (so-called neuromata are nothing more 
 ihan fibromata of the nerves). The following forms are 
 of surgical importance in the domestic animals : 
 
 I . Fibromata of the skin and s u b c u t e m are most 
 frequently observed in horses and dogs. In the horse they 
 are especially frequent on the head, shoulder, and region of 
 the withers, as well as in the sheath. Ordinarily they are soli- 
 tary, sharply circumscribed, from the size of a pea to that of a 
 fist. Occasionally they are multiple, as many as one hundred 
 have been seen on a single horse (Siedamgrotzky) . 
 Subcutaneous fibromata average about the size of a goose-egg ; 
 sometimes they lie in a capsule from which they may be re- 
 moved after a skin incision has been made (M oiler). In 
 rare cases fibromata are found in the shoulder region in the 
 form of so-called shoulder abscesses (personal observations). 
 Bayer has observed fibromata on the scrotum of a horse that 
 were multiple, soft, and recurrent after removal. Many fibro- 
 mata of the horse are not genuine fibromata, but mycofibro- 
 mata (compare with the chapter on botryomycoma). Many 
 inflammator)^ connective-tissue hyperplasias are erroneously 
 termed fibromata ; to this class belong those found in harness 
 positions in horses and cattle (see below). According to my 
 own experience cutaneous fibromata are very common in dogs. 
 They are often multiple, especially on the thorax, on the ex- 
 
OCCURRENCE IO9 
 
 tremities, on the ears and eyes, on the back, on the tail, and 
 in the mammae. As in horses, hard fibromata are most com- 
 mon ; th^soft form are seldom found. Their size is variable ; 
 as a rule they are small, sharply circumscribed, hard, smooth, 
 and intact on the surface. Pendulous fibromata are occasion- 
 ally observed. In cattle myxomatous fibromata are occasion- 
 ally seen on the tail ( M a y r ) . Peter has described a fibroma 
 on the head of a cow ; the tumor weighed \i% kg., was pen- 
 dulant, and combined with cutaneous horn. On the other 
 hand, the subcutaneous, calcified, new formations of fibrous 
 tissue in the vicinity of dead larvae are not genuine fibromata 
 (hypodermoliths of Caparini). 
 
 2. Fibromata of the mucous membranes are either 
 flat, circumscribed proliferations with a broad base, or pedun- 
 culated tumors (polypi, polypoid fibroma); their 
 consistency is soft. Not all polypi of the mucous membranes 
 described in the literature are genuine fibromata. Many other 
 tumors of the mucous membrane have a pedunculated form ; 
 for example, lipoma, actinomycoma, and sarcoma. According 
 to the seat, one speaks of nasal, pharyngeal, laryngeal, vagi- 
 nal, cystic and rectal polypi. 
 
 In the nasal cavities the flat and polypoid fibromata 
 (myxofibroma) of the nasal mucous membranes are of 
 special importance in the horse ; this is due to the fact that so- 
 called nasal polypi produce a stenosis of the nasal pas- 
 sages, causing dyspnoea, chronic unilateral nasal catarrh, and 
 in ulcerative degeneration, an ichorous, fetid nasal discharge 
 with unilateral swelling of the glands (suspected glanders). 
 
 In the uterus and vagina of the horse, cow, dog, 
 and pig, pure fibromata and mixed tumors (fibromyoma, 
 fibromyxoma, fibrolipoma) occur in various forms. 
 
 Fibromata of the vagina are frequently pedunculated 
 (vaginal polypi). Typical fibromata from the size of a 
 cherry to that of a walnut are found in the vagina of the dog. 
 These vaginal polypi have a firm, hard consistence, occasion- 
 ally they are long and bottle-shaped ; they present no inflam- 
 matory symptoms. They are readily differentiated from those 
 chronic inflammatory swellings of the mucous membranes 
 which also develop in the form of pedunculated new forma- 
 
no TREATMENT 
 
 tions (so-called plicae polyposae). Fibromyomata in the uterus 
 of cattle and swine sometimes reach an enormous size (50 to 
 200 pounds) . In such cases the uterus extends into the abdomi- 
 nal cavity. Tumors which extend through the os uteri into 
 the vagina are smaller. Polypoid fibromata may also develop 
 in the pharynx or larynx (the so-called laryngeal polypi 
 in cattle are usually of an actinomycotic nature), in the gut- 
 tural pouches, in the bronchi (polypi which follow 
 tracheotomy in the horse are usually granulomata or botryo- 
 mycomata), in the rectum, bladder, urethra, and 
 teat canals. 
 
 3. According to Kitt, fibromata of the udder are 
 characterized by hard, nodular, sharply circumscribed swell- 
 ings ; in the dog they are from the size of a dove's egg to that 
 of a man's fist. They are composed of a mucoid and gelatin- 
 ous substance (myxofibroma). Occasionally, in addi- 
 tion to proliferation of the connective tissue, the glandular 
 tissue also proliferates (adenofibroma). Similar fibro- 
 mata are found in the testicles of dogs and horses. 
 
 4. In the internal organs fibromata are seldom ot 
 surgical importance. Kitt has observed a fibroma on the 
 tongue of a cow ; it was hard as a board, sausage-shaped, 
 16 centimeters long and 10 centimeters wide. Juredieu 
 has described a fibroma of the pelvis of a dog ; it was as 
 large as a hen's egg. It is not known whether fibromata 
 develop in the vertebral column of the domestic animals, thus 
 causing paralysis from pressure on the spine (lumbar 
 paralysis), similar to lipoma, sarcoma, and other new 
 formations. The}' are found, however, in the form of osteo- 
 fibromata in other osseous cavities, for example, the tym- 
 panic cavity of the horse (Fretjanow). 
 
 Treatment. — Treatment of fibroma consists in operative 
 removal by means of the knife, scissors, ligature, etc. Large 
 fibromata are extirpated with the scalpel and the wound 
 sutured ; small tumors may be removed in the same manner. 
 In the latter, healing may be produced under an eschar by 
 means of cauterization. Vety large, diffuse fibromata, which 
 cannot be entirely removed at one time may be operated on at 
 different times ; repeated partial operations until the enlarge- 
 
KELOID 1 1 I 
 
 ment is entirely removed. Operations upon polypoid 
 fibromata are verj^ difficult. When one can reach 
 them with the hand (vagina, rectum) they ma}- be ligated ; 
 ligation is more reliable when a double suture is passed through 
 the neck of the polypus and tied on both sides. Polypi that 
 cannot be so easily reached may be removed with the ecra- 
 seur , this applies especially to nasal polypi. In many cases 
 they must be torn or twisted away with the hand or forceps. 
 Keloid. — A keloid is a tumor-like, fibrous, hard proliferation of 
 the skin and subcutem ; it usually develoj^s from cicatricial tissue ( cica- 
 tricial keloid). In contrast to this, a spontaneous (genuine) 
 keloid has been differentiated. According to recent investigations the 
 existence of a "spontaneous" keloid is questionable ; this is due to the 
 fact that experience has demonstrated that keloids usually develop after 
 traumatic or inflammatory processes in the skin. The causes of keloid 
 formation are not yet fully understood. Some maintain that its develop- 
 ment depends on a specific infection of the wound, they claim 
 that this accounts for its recurrence following operations ; according to 
 others, the existence of keloids depends on an individual fibroma- 
 tous disposition of the body. In the domestic animals keloids 
 are most often met with in the horse. They follow injuries to the 
 coronet, the balls of the heel, the flexor surface of the 
 fetlock joint, the flexor surface of the tarsal joint, as 
 well as to the region of the tendons; occasionally they develop 
 after gangrenous dermatitis (grease), after firing, and after the applica- 
 tion of blisters. They form circumscribed, hard, fibroma-like new 
 formations that are usually extensive in size ; they are relatively rich in 
 blood-vessels ; in contrast to normal cicatricial tissue, they are covered 
 with a thick layer of epidermis. To a certain degree they are a highly 
 developed form of the so-called hypertrophic cicatrix (see page 22). 
 According to my own observations the continual movement and irrita- 
 tion of a wound that is often very insignificant appears to be one of the 
 principal factors on which keloid formation depends. I have never 
 observed recurrence following operations. According to Labat, 
 L, e b 1 anc , and others, on the other hand, many keloids are recurrent 
 after excision ; they caution, therefore, against the operation, and em- 
 ploy the elastic ligature (?) in combination with a disinfectant bandage 
 applied daily. J o h n e has described a cicatricial keloid of the flexor 
 tendons of a horse ; this was in the form of a hard, tendinous oval 
 tumor, 27 centimeters long and 18 centimeters wide, it was fungus-like, 
 proliferated from the tendon cicatrix, and adhered to the tendon-sheath 
 and skin. I have observed many similar forms of tendinous keloids on 
 the extenBor tendons of the coronet following treads on the coronet. 
 
1 1 2 ELEPHANTIASIS 
 
 ELEPHANTIASIS. — The name elephantiasis, .(schleroderma, 
 schlerosis, pachyderma) indicates a connective-tissue hyper, 
 plasia of the skin and subcutem, which results in a pro- 
 nounced thickeninj^ of those parts of the body involved. It is very rare 
 that elephantiasis is caused by a genuine fibroma; in such cases it 
 assumes the form of a diffuse fibromatosis. In the horse it is 
 usually the product of chronic inflammation of the skin or 
 subcutem (chronic indurative dermatitis and phlegmon following 
 scratches and phlegmon: so-called thick leg, elephant leg) ; or 
 specific, chronic inflammatory processes in the vicinity of the lymph- 
 vessels (glanders). Elephantiasis may also be caused by chronic 
 edema in the vicinity of the veins, as well congenital 
 dilitation of the lymph-vessels. In man the principal causes 
 of elephantiasis are leprosy and filaria sanguinis; according 
 to the condition of the skin the following forms are recognized : ele- 
 phantiasis glabra, verrucosa, ulcerosa, papillaris. Occasionally there 
 seems to be an individual predisposition to fibrous hyperplasias (ele- 
 phantiasis). La bat observed this in a horse on which a blister 
 (potassium bichromate) had been applied after firing; this was followed 
 by an extensive (60-70 centimeters large) fibrous new formation on the 
 limbs. Similar observations have been made by Rabe and L, us tig. 
 
 TvLOMA. — Tylomata are fibrous dermal prolifera- 
 tions (continual pressure from the saddle) that develop 
 from the subcutaneous tissue; they are the result of a 
 chronic, hyperplastic inflammation. They belong, similar 
 to elephantiasis, not to the genuine new formations, but are to be con- 
 sidered as chronic, inflammatory, connective-tissue hyperplasias. In 
 contrast to the circumscribed fibromata they are diffuse hard thicken- 
 ings of the skin and subcutem, they are found at the seat of the collar 
 in horses, on the carpus in cattle, on the elbow and ischial tuberosity in 
 dogs. They are sometimes so heavy as to cause a suspension of the 
 fibrous thickenings of the skin (cutis pendula). Occasionally they are 
 circumscribed, when it is very difficult to differentiate between them 
 and genuine fibromata. Callosities of the skin, in contrast to 
 tylomata, consist of a hypertrophy of the epidermis, there is always 
 present, however, a chronic, connective-tissue hyperplasia of the cutis. 
 
 RhinoschIvEroma. — According to Hebra (1870) rhinoschle- 
 r o m a in man is a specific tumor-like disease characterized by the forma- 
 tion of hard nodules in the skin and mucous membranes of 
 the nose, they afterwards extend to the lips, the superior 
 maxillae, the nasal cavities, the pharynx, etc. The course 
 is chronic and incurable, it occurs only in certain environments 
 and countries (Southern Russia, Eastern Provinces of Austria, Central 
 and vSouth America). The principal symptoms consist of cartilaginous, 
 painful thickenings of the nose which extend into the deeper tissues, 
 
LIPOMA 113 
 
 as well as on the surface ; ulcerative degeneration sets in, and they are 
 finally transformed into connective-tissue folds. This results in stenosis 
 and deformity of the nose, mouth, gums, and pharynx. 
 The rhinoschleroma bacilli have been discovered as the cause 
 of this peculiar affection ; they are found in the large, swollen, non- 
 nucleated cells of the diseased tissues. Transmission of this 
 bacillus to other animals has not been followed by 
 results. 
 
 In veterinary literature various affections of the horse have 
 been described under the name rhinoschleroma (Grawitz, Dieck- 
 erhoff,Rabe,vSchul/, and others); in many essential points 
 they are different from the disease described under that heading in 
 man. In the horse it is manifestly an entirely different affection. 
 M 6 1 1 e r and J o h n e also maintain that this is an incorrect term for 
 nasal tumors in the horse. According to Kitt the process is an 
 adenofibrous hyperplasia of the nasal mucous mem- 
 branes (adenofibroma). Under the microscope one finds 
 fibrous hyperplasia and amyloid induration of the connec- 
 tive tissue, pronounced proliferation of the mucous glands, as 
 well as new formatifjn, and dilitation of the vessels. Because of the 
 rich blood-supply it may be easily confused with angioma. The new- 
 formations consist of hard, nodular, lobulated, smooth, flat, lar- 
 d a c e o u s , transparent proliferations located close together ; ordinarily 
 they are found only in the lower third of the nasal cavity (pavement 
 epithelium); they are usually bilateral, and are hemorrhagic on the 
 surface (epistaxisj. Ulceration, dried blood, and cicatricial formation 
 may be present ( confusion with 'glanders). I have operated 
 several cases in the horse with good results. 
 
 II. LIPOMA. 
 
 Forms. — lyipomata or fatty tumors are conipo.sed 
 principally of fat-cells which lie in a framework of connective 
 tissue. In structure they are similar to normal fatty tissue, 
 they may occur in any part of the body where that tissue is 
 present, especially when it exists with connective tissue. They 
 are usually located, therefore, in the subcutaneous, submucous, 
 subserous, subsynovial, and intermuscular connective tissue. 
 If the fat-cells are in excess it is termed a soft lipoma; 
 when more connective tissue is present it has a firm consistence 
 (hard lipoma). Occasionally lipomata are pedunculated 
 (lipoma pendulans, lipoma polyposum). Lipoma 
 aborescens is a special form that develops in the vicinity 
 
114 LIPOMA 
 
 of joint-capsules, after rupture of the capsule the lipoma pro- 
 liferates in the form of a tree-like growth. Like fibromata, 
 mixed forms are common : lipo fibroma (lipoma fibroma- 
 tosum, steatoma), lipomyxoma (lipoma myxomatosum). 
 
 Occurrence. — Lipomata are not common. They form 
 circumscribed, roundish or oval tumors; occa- 
 sionally the}' are pedunculated and therefore 
 pendulant; some are small, others attain an 
 enormous size; they are nodular, lobulated, 
 and occasionally very soft; they crepitate in a 
 peculiar manner, apparently fluctuate on pal- 
 pation, and develop very rapidly. Other forms 
 are hard, develop slowl}^, are usually solitary, 
 but are sometimes multiple. They are non- 
 malignant tumors and never spread by metas- 
 tasis. It is a peculiar fact that they are not confined merely 
 to well-nourished animals, but often accompany anemic condi- 
 tions ; when the animal is affected with general emaciation 
 their size does not decrease. They may undergo caseous de- 
 generation. When injured, suppuration may occur ; occasion- 
 ally they are congenital . 
 
 Of those lipomata which occur in domestic animals the 
 following are of importance : 
 
 I. Subcutaneous lipomata are especially common in 
 horses and dogs. In the horse they occur on the sheath, tail, 
 and anus (Bayer), also on the walls of the thorax and 
 abdomen, and on the posterior limbs ; they are often multiple. 
 The vicinity of the biceps and knee-joint seems to be 
 a favorite seat for their congenital appearance in foals (per- 
 sonal observations) ; in this case they are circumscribed and 
 develop very rapidly. M oiler observed a lipoma in the 
 vicinit)' of the lower end of the biceps femoris that weighed 
 25.5 kilograms, Rhode observed one about the size of two 
 fists just above the patella on the external surface. In dogs, 
 where lipomata occur principally on the inner surfaces of the 
 limbs, on the thorax, and on the shoulder, I have observed 
 twelve cases. Their form is round or cylindrical, the size is 
 extremely variable, occasionally attaining that of a man's 
 
LIPOMA 115 
 
 head. They develop slowly, have a lardaceous consistency, 
 lobulated structure, and many times a pedunculated form 
 (pendulant). One also occasionally observes wandering lipo- 
 mata. 
 
 2. Pedunculated L,ipomata and lipofibromata are some- 
 times found on the mucous membranes of the horse in 
 the upper portions of the nasal cavities; they originate 
 from the nasal septum, the turbinated bones, or the ethmoid 
 bone ( G u r 1 1 ) . Occasionally they develop in the larynx; 
 F r i c k e r has described a case of lipoma on the anterior sur- 
 face of the epiglottis in a horse (laryngeal polypus), 
 the tumor was as large as a potato. Submucous lipomata in the 
 rectum cause obstruction and colic (Brose, Lessa). 
 Vaginal polypi are occasionally found in the mareon the vaginal 
 floor. Polypi are also found on the membrana nictatans 
 in dogs (personal observations). 
 
 3. Subperitoneal lipomata of the abdominal 
 cavity are relatively frequent in the horse ; they constrict 
 the small intestines or rectum and lead to fatal colic. The 
 new-formations have a long neck, are pendulant, and originate 
 from the omental attachment ; they possess no surgical im- 
 portance. Werner, in cattle, has diagnosed a lipoma per 
 rectum ; the tumor was the cause of colic, and removal 
 through the flank resulted in a satisfactory termination. On 
 rectal exploration of a horse suffering from colic Sommer 
 recognized the presence of a tumor anterior to the bladder ; 
 on post mortem this proved to be a lipoma. 
 
 4. lyipomata are seldom found in other organs. 
 Occasionally they develop from the dura; at other times 
 from the pia(Kiihnaeu). Pfister published the records 
 of a case where a lipoma was found to be the cause of lumbar 
 paralysis in a cow ; the tumor was located in the lumbar 
 region of the vertebral column. K b i n g e r has described a 
 similar case. According to Stockfleth they are occasion- 
 ally found in the udders of fat bitches. Esser removed a 
 lipoma that weighed four kilograms from the left half of the 
 udder of a mare. According to Montfallet lipomata in 
 the udder of the bitch are usually perimammary, seldom inter- 
 glandular. 
 
Il6 MYXOMA 
 
 Treatment of liporaata consists in extirpation with 
 the knife ; pendulant lipomata may be removed by means of a 
 ligature. 
 
 III. MYXOMA. 
 
 Definition and Occurrence. — M y x o m a t a (mucous 
 tumors) are composed of a gelatinous mucous tissue, with 
 stellate, branched, connective-tissue cells, an abundance of 
 mucous substance is also interposed . Their independent exist- 
 ence as tumors is disputed. Apparently they are 
 nothing more than edematous fibromata or 
 lipomata (Koster). The soft, edematous, gelatinous, 
 swollen lipotnata and fibromata are better termed myxofi- 
 broma t a and myxolipomata. Other mixed forms are : 
 myxomyomata, myxochondromata, fibrosarcomata, and other 
 muco-edematous forms. Myxomata, like fibromata and lipo- 
 mata, are non-malignant tumors ; they develop in thesubcutis, 
 submucosa, subserosa, on the periosteum as well as beneath the 
 fasciae. Occasionally they become sarcomatous. 
 
 Myxomata and myxofibroraata appear, relatively, to be most 
 frequent in the nasal cavities of the horse, where they 
 result in the formation of so-called nasal polypi (Hol- 
 ler, Hamburger, personal observations). Pedunculated 
 myxofibroraata are also observed on the floor of the rectum in 
 the horse, they are in the form of bean-shaped rectal polypi 
 the size of a child's head (personal observations. ) According 
 to K i 1 1 myxomata occur in cattle in the sinuses of the 
 head where they may become three times the size of a man's 
 fist ; they are smooth, nodular or lobulated, and are composed 
 of glassy, swollen, mucous vesicles containingmassesof connec- 
 tive tissue. Myxomata have also been seen in the sinuses of 
 the head in sheep (Cagny); and in the bladder in cattle 
 (lyciser ing). Myxomyomata, myxofibroraata, andfibromyx- 
 osarcomata have been observed in cattle in the uterus (K i 1 1 ); 
 in the mammae of mares and bitches (Kitt, M'Fadyean); 
 in the subcutisof thehorse (Ehlers); in the cutis of calves 
 in the form of soft tumors the size of hens' eggs on the inferior 
 
CHONDROMA II7 
 
 surface of the abdomen (M oiler); as well as beneath the dura 
 of the spinal marrow thus causing spinal paralysis ( Brats- 
 chikow, Holzmann). Finally, myxoma has been 
 observed in the placenta (De Bruin). 
 
 Treatment of myxomata of the nasal mucous membranes 
 consists in tearing out, and twisting off, as well as extirpation 
 after previous trepanation of the nasal cavities. 
 
 Mucous Degenerations of the Turbinated Bones. — Under 
 this heading Sand (Monatshefte fiir Tierheilkunde. 1893 ) has described 
 a tumor-like swelling of the facial bones of foals ; it was charac- 
 terized by dyspnea and nasal discharge, as well as raucous softening of 
 the turbinated bones, and the osseous walls of the superior maxillary 
 and frontal sinuses. The latter become dilated, and are affected with 
 hydrops and empyema. I have observed similar cases. 
 
 Myxedema. — The following symptoms have been observed follow- 
 ing disease or removal of the thyroid gland in man : edematous swell- 
 ings of the skin of the face and extremities (collections of mucin), 
 with pronounced general decrease in nourishment, strength, and psychic 
 activity (cachexia strumapriva following thyroid operations; related to 
 cretinism). Recently myxedema has been successfully treated in man 
 by the administration of thyroid-gland substance and thyroid-gland 
 preparations (iodothyrin). The existence of myxedema is explained as 
 follows : it is the function of the thyroid gland to prevent the formation 
 of mucin in the body ; in myxedema this function is destroyed (?). 
 
 IV. CHONDROMA. 
 
 Nature and Occurrence. — Chondroma (enchon- 
 droma, ecchondrosis, cartilaginous tumors) is a name applied 
 to tumors composed largely of cartilage ; this form of new- 
 formation is apparently rare. Hyaline cartilage is the principal 
 component (large or small cells). They are found in the fol- 
 lowing places : 
 
 a) in cartilage (ecchondrosis or hyperplastic chon- 
 droma) ; 
 
 b) in bones, on the ribs, in the pelvis, on the vertebral 
 column, on the first phalanx, on the ethmoid bone, and sphenoid 
 bone ; 
 
 c) in the udder, testicles, thyroid gland, in 
 the parotid, in the subcutem, and in other organs 
 that are normally free from cartilage (enchondroma in thenar- 
 
Il8 CHONDROMA 
 
 row sense ; heteroplastic chondroma). The occurrence of 
 chondromata in these organs is partly due to a metaplasia 
 (metamorphosis) of connective-tissue cells and endothelial cells 
 into cartilage cells, partly to aberration of germinal cartilage. 
 
 Chondromata are b e n i g n tumors, they areusually 
 solitary but occasionally multiple; they are 
 spherical in form (udder), and occasionally 
 very large. They are nodular, elastic, firm, 
 and painless. Chondromata are usually observed in com- 
 bination with other tumors (choudrofibroma, osteo- 
 chondroma, chondrosarcoma); they may undergo 
 softening, cystic degeneration, calcification and ossification. 
 An osteochondroma is composed of material similar to 
 non-calcareous (osteoid) bone tissue. 
 
 In the domestic animals chondromata are most often found 
 in the mammae of the bitch; they are from the size of a pea to 
 that of a man's fist, round, firm, painless, and sharply circum- 
 scribed from the normal glandular tissue ; they are nodular 
 and are not adherent to the skin. Cartilaginous, nodular, 
 sharply circumscribed chondromata are repeatedly found in the 
 testicles of the horse (Kitt). They are also fre- 
 quently found on the costal cartilages of the horse and 
 ox ; in this case they may possibh' have a traumatic origin 
 (Bruckraiiller, Kitt, Hahn, personal observations). 
 Chondromata are found in the vicinity of the thyroid 
 gland (Siedamgrotzky, Zahn). Seidamgro- 
 t z k y described a chondroma that was twice as large as a 
 man's fist, it was located on the first phalanx of a cow. They 
 have also been found on the maxillae and in the nasal 
 cavities of horses and dogs (Gurlt, Kitt); on the verte- 
 bral column of a dog with spinal paralysis (Smith); in 
 the vicinity of the ear in cattle ; at the base of the second and 
 third cervical vertebrae, hard tumors weighing 4^2 kilograms 
 and as large as a man's head (Morot); in the subcutis ot 
 cattle, horses, and dogs (Janson, Morot, Leisering, 
 Ostapenko); on the vocal cord of a horse (Lee); as 
 well as in the crystalline lens of a foal (Renner) . 
 
 Treatment consists in extirpation ; when large chon- 
 
OSTROMA 119 
 
 dromata are present in the udder it should be amputated. In 
 my experience many cases of chondroma of the udder in dogs 
 do not require treatment ; this is due to their stability and 
 non-malignant character. 
 
 V. OSTEOMA. 
 
 Nature and Occurrence. — An osteoma or bone 
 tumor is composed largel)' of osseous material. It is analo- 
 gous to chondroma. With reference to their occurrence they 
 may be arranged as follows : 
 
 a) Those occurring in bone (hyperplastic osteoma) ; 
 they develop partly from the periosteum, parti}' from the tela 
 ossea, and partly from the bone- marrow. They are known by 
 various terms : exostoses, osteophytes, hyperos- 
 toses, enostoses. To this class also belong new for- 
 mations of bone due to inflammation (exostoses). 
 
 b) Osteoma may also occur in the following organs, 
 although the}- contain no bone-cells : the m a m m a e, 
 parotid, brain, muscles, and other organs that nor- 
 mally contain no bone-cells (heteroplastic osteoma) ; they are 
 either due to metaplasia, or aberration of embryonic tissue. 
 
 According to the consistency one speaks of an osteoma 
 durum or eburneum (hard as ivory), spongiosum 
 (spongy), and medullar e (composed largelj^ of marrow). 
 According to the covering it is termed a cartilaginous 
 exostosis (covered with cartilage), or a bursal (located 
 beneath a mucous bursa). Mixed forms of osteomata are also 
 frequent: osteosarcoma, osteofibroma, and osteo- 
 chondroma . Osteomata with broken attachments .so that 
 they lie free in the cavities of the head are termed dead osteo- 
 mata. Unattached osteomata are located in tendons and 
 muscles away from the bone. 
 
 Osteomata form very hard, bone-like, painless, 
 benign tumors; they are more or less sharply 
 circumscribed, partly multiple, partly sol- 
 itary, and are usually located beneath the 
 skin . In the domestic animals they are more frequent than 
 
I20 MYOMA 
 
 chondromata. The following forms are of practical importance : 
 osteomata that frequentl}' occur on the inferior maxilla 
 and metacarpus, and are usualh* due to an ossifying 
 periostitis, occasionalh^ however, they are genuine tumors 
 (pedunculated fungoid and knob-like osteomata on the free 
 margin of the inferior maxilla) ; osteomata of the udder and 
 testicles in horses, cattle, and dogs ; of the crystalline lens 
 in the horse ; as well as those which occur in the cavities of 
 the head of both the horse and cow. The latter apparently 
 develop from rudimentary cartilaginous areas of the sphenoid 
 and ethmoid bones and occasionally form so-called total osteo- 
 mata (ossified brain). Odontomata and dental osteo- 
 mata of the teeth, on the maxillae, and on the petrous por- 
 tion of the temporal bone, are special forms. 
 
 Treatment consists of removal by means of the saw, 
 chisel, or trephine. 
 
 VI. MYOMA. 
 
 Nature and Occurrence. — A myoma or muscle- 
 tumor is composed of muscle-fibers. According to the 
 character of the fibers the)^ are classified as follows : 
 
 (a) lyciomyomata (myoma Isevicellulare), the more com- 
 mon form, are composed of non-striated muscle-fibers. They 
 are usually found in the stomach, intestines, uterus, in the 
 bladder, as well as metaplasticalh^ in tumors of the kidneys, 
 testicles, and ovaries ; occasionally the}- are combined with 
 other tumors (myofibroma). 
 
 (b) Rhabdomyoma (myoma striocellulare) is rare ; 
 it is composed of striated muscle-fibers, and is occasionally 
 found in mixed forms (myosarcoma). 
 
 Myomata are of slight surgical importance as they are 
 usually found only in the internal organs. K i 1 1 has de- 
 scribed a subcutaneous leiomyoma of the crural muscle, it 
 weighed 250 grams. Gratia has described a rhabdomj'oma 
 which had its seat on the vagus at about the middle of the 
 cervical portion in the horse Mo nod has operated an 
 encapsuled rhabdomjoma as large as a goose-egg in the 
 
NEUROMA 121 
 
 vicinity of the shoulder in the horse. Siedamgrotzky 
 has observed a leiomyoma of the testicles; Kolesnikow 
 observed a rhabdomyoma of the tail. lyeiomyomata of the 
 uterus are far more frequent (Kitt, Frank, Johne, 
 Eber, Gratia, Harms); the same is true of peduncu- 
 lated leiomyomata of the vagina that cause sterility (D e 
 Bruin ) ; leiomyomata that lead to stenosis of the intestines 
 (Schutz, Tetzner, Cadeac) and stomach (Rabe, 
 Lothes); as well as those of the bladder (van Tright, 
 Lienaux, Voirin, personal observations), and 
 kidneys (Johne). With reference to the treatment, myomata 
 of the uterus are experimentally treated, as in the human 
 family, with internal administration of ergot. 
 
 VII. NEUROMA. 
 
 Nature and Occurrence. — Two varieties of new for- 
 mations are described under the term neuroma, or n e r v o u s 
 tissue tumors. 
 
 (a) Genuine neuromata are a new formation composed 
 essentially of nerve-fibers ; they may be raedullated (neuroma 
 myelinicum), or non-medullated (neuroma amyeliuicum). 
 This form is very uncommon in man, and has not been ob- 
 served in the domestic animals. 
 
 b) False neuroma is a fibroma or myxoma of the 
 nerves (neurofibroma, neuromyxoma). It develops from the 
 connective tissue of the perineurium, and is composed princi- 
 pally of connective tissue or mucous tissue. These neurofibro- 
 mata in the horse occasionally develop as a result of neurec- 
 tomy when the operation is followed b\' a neuritis, the}' also 
 occur in saddle horses on the internal tibial nerve. Analogous 
 to the amputation-neuromata in man, they form spindle- 
 shaped or oval enlargements on the central end of 
 the nerve ; they are white in color, from a bean to a 
 dove's egg in size, and cause lameness. They 
 have been seen on the median nerve (M oiler, Trasbot 
 and others, personal observations) ; on the volar and planter 
 nerves ( H a rdy , Brauel, Rey and others, personal obser- 
 
122 ANGIOMA 
 
 vations) ; also on the peroneus (Bayer), and tibialis 
 (Becker). That form of false neuroma recognized in man 
 under the name helicine neuroma (plexiform neuroma) 
 has been repeatedly observed in cattle (Morot, Ostertag, 
 Tiemann, Matschke); it is multiple and develops in 
 the form of nodules and cords. Its favorite seat seems to 
 be in the brachial plexus, the cervical, thoracic, and abdomi- 
 nal ganglise of the sympathetic, as well as on the intercostal 
 nerves. In one case, multiple neurolSlbromata produced symp- 
 toms of paralysis in the ox (Matschke). Zietschm an n 
 described two other cases of multiple neuroma formation and 
 chronic interstitial neuritis of the brachial plexus in cattle, 
 there were no special symptoms of paralysis, the enormous 
 anatomo-pathological changes were remarkable when contrasted 
 with the clinical symptoms (slight motor weakness.) One case 
 of helicine neuroma has also been observed in the horse 
 ( Leisering) . 
 
 G 1 i o m a t a are a result of proliferation of the neuroglia 
 cells (supporting cells) of the brain and spinal marrow, they 
 are of no importance from a surgical standpoint. So-called 
 glioma of the retina is a sarcoma ( gliosarcoma) . 
 
 Treatment of neurofibromata consists of free exposure 
 and extirpation, recurrence is possible and the neurectomy 
 may have to be repeated. 
 
 VIII. ANGIOMA. 
 
 Forms. — A n g i o m a t a or v e s s e 1 - 1 u m o r s either 
 originate from blood-vessels (hemangioma, angioma 
 in the narrow sense), or from the lymph- vessels 
 (lymphangioma). Angioma is a collective term for 
 various tumors which are composed principally of dilated 
 hypertrophic, abnormally twisted, and newly-formed vessels. 
 The following forms are recognized : 
 
 a) Angioma simplex (teleangiectasis, naevus, naevus 
 vasculosis, birth-mark, fire-mark) is composed of dilated and 
 newly-formed capillaries of the skin. 
 
 b) Angioma cavernosum (tumor cavernosus) is 
 
ANGIOMA 123 
 
 a venous new-formation of the skin, mucous membranes 
 (nasal mucous membranes), bones, liver, etc. It is a cavern- 
 ous-like body containing large spaces that communicate with 
 one another. 
 
 c) Angioma racemosum (helicine angioma) is char- 
 acterized by its serpentine structure. 
 
 d) Angioma ly m p h at i c u m (lymphangioma, lymph- 
 angiectasis) is a rare form ; it is composed of dilated and 
 newly-formed lymph-vessels. It occurs in the skin (congeni- 
 tal elephantiasis), the tongue (macroglossia), and the lips 
 (raacrocheilia). It develops in the form of an angioma sim- 
 plex, cavernosum, and cysticum. 
 
 e) Fungus vasculosus (fungus hematoide.s) is not a 
 genuine angioma, it is a term that indicates various extremely 
 hemorrhagic new-formations. 
 
 Occurrence. — In the domestic animals angiomata are 
 observed in various parts of the body. The most important 
 are the superficial angiomata in the form of edematous areas on 
 the nasal mucous membranes of the horse, they 
 are usually cavernous, seldom simple, and lead to epistaxis, 
 ulcerative formations, dyspnea, and suspicion of glanders. 
 Deigendesch described a case of angioma which for ten 
 years caused periodic epistaxis. Liibke saw a case of cavernous 
 angioma of the mucous membranes of the nose and 
 eyes in a horse ; there was hemorrhage from these organs 
 that even extended to the lachrymal duct. S c h ii t z observed 
 angiomatous ulcers on the nasal mucous membranes as large 
 as a man's hand. Finally, angiomata of the nasal mucous 
 membranes are many times confused with other hemorrhagic 
 new-formations, especially the adenofibrous hyperplasias in the 
 same region (see page 113). 
 
 According to Zschokke osteoangiomata at the base 
 of the tail in cattle are not uncommon. They form tumors 
 twice the size of one's fist, which grow entirely through the 
 body of the vertebrae, are composed of numberless dilated 
 blood-vessels, and are made up of a reticulated, spongy, bone 
 substance. Rosenbaum observed a similar very hemorr- 
 hagic new-formation on the tail of an ox. Angiomata of the 
 
124 LYMPHOMA 
 
 skin and subcutem are less common in animals (Bon- 
 net, Leisering, Johne, M oiler, Siedamgrotsky, 
 personal observations). Grebe has observed a 
 cavernous angioma as large as a fist on the gums and lips of a 
 horse; the animal died during operation. Zschokke has 
 described an angioma at the base of the skull in a cow ; it 
 developed along the nerves which supply the external ocular 
 muscle, causing its paralysis and strabismus convergeus exter- 
 nus. Francesco has described an angioma on the penis of 
 a horse ; it was the cause of frequent and severe hemorrhage. 
 
 Leisering and Eggeling have seen angiomata of 
 the vaginal mucous membranes in cows. S t e n z e 1 has in- 
 vestigated four cases of angioma of the udder in cows. 
 Schindelka has described a lymphangioma of the mamma 
 in a cat. Angiomata of the liver, which occur frequently 
 in cattle and other animals, are of no surgical importance. 
 
 Treatment. — Healing of angiomata of the nasal cavities 
 in the horse cannot often be attained because of their deep 
 situation. Superficial angiomata of the skin are occasionally 
 very difficult to extirpate on account of their size and extent. 
 In human surgery the following methods of therapy are em- 
 ployed : Ligation of the blood-vessels which supply the part, 
 cauterization, firing, puncture with the thermocautery, appli- 
 cation of the galvanocautery, as well as the injection of liquor 
 ferri chloridi, alcohol, tincture of iodine, and extractum 
 secalis. 
 
 IX. LYMPHOMA. 
 
 Nature. — L y m p h o m a (tumor of a lymph-gland) is a 
 name used to indicate various disease processes of the lymph- 
 glands. 
 
 a) Leukemic lymphoma during the course of 
 leukemia. 
 
 b) Malign lymphoma during the course of pseudo- 
 leukemia. 
 
 c) Lymphosarcoma, lymphadenoraa, car- 
 cinoma and other genuine new formations in the lymph- 
 glands. 
 
SARCOMA 125 
 
 d) Inflammatory hyperplasia of the 
 lymph-glands following chronic inflammatory processses 
 of neighboring organs (catarrh, strangles, glanders, tuber- 
 culosis, actinomycosis). 
 
 The so-called malign lymphoma (progressive hyper- 
 plasia of the lymph-glands, lymphadenia, lymphomatosis ma- 
 ligna, Hodgkin's disease, pseudo-leukemia) which frequently 
 occurs in man, is also seen in cattle, horses, and dogs. Like 
 leukemia, without however, a marked increase in the number 
 of white blood- corpuscles in the blood, it is characterized by 
 the enlargement of groups of lymphatic glands, or enlargement 
 of the entire lymphatic system of the body. They are arranged 
 in the form of multiple, nodular or clump-like, 
 lardaceous, soft or hard, painless, often very 
 large tumors in the vicinity of the inter- 
 maxillary glands, the superior, middle, and in- 
 ferior cervical glands, the inguinal, knee, 
 and pelvic glands. On account of the generalization 
 of this disease surgical interference is of no use ; treatment 
 is confined to the internal administration of arsenic oriodid of 
 potash. Solitary lymphomata in the intermaxillary space in 
 the horse may be extirpated without difficulty. Operative re- 
 moval for diagnostic purposes may be indicated (suspected 
 glanders). 
 
 X. SARCOMA. 
 
 Nature. — A sarcoma is a desmoid tumor which may be 
 termed an atypical proliferation of the embryo- 
 nic connective tissue. It is a malignant con- 
 nective-tissue ne w - for m a t i on in which the 
 cells (round-cells, spindle-cells, giant-cells, 
 endothelial cells) are far in excess of the in- 
 tercellular substance. They often develop very 
 rapidly, when they are usually associated with metastatic for- 
 mation through the medium of the veins. Sarcomata develop 
 anywhere in the body where connective tissue is present. Their 
 
126 SARCOMA 
 
 favorite points of development are the periosteum, the bone- 
 marrow, the lymph-glands, the cutis, the subcutaneous, sub- 
 mucous, and subserous (subperitoneal, subpleural) tissues, the 
 eyes, the glandular tissues (testicles, mamma, thyroid), as well 
 as the vessel-walls. Sarcomatous cellular activity is often 
 followed by regressive conditions ; these are softenings, cystic 
 formations, hemorrhage, ulceration, and suppuration. As in 
 other tumors, mixed forms are common ; forexample, fibro- 
 sarcoma, chondrosarcoma, myxosarcoma, osteo- 
 sarcoma . With reference to the causes nothing definite is 
 known. Recent theories concerning bacterial and protozoan 
 irritants have not been sustained. 
 
 Forms. — Sarcomata are characterized by many different 
 forms. According to the structure and the forms of the con- 
 nective-tissue cells the following principal types are recognized : 
 
 a) Round-celled sarcomata are composed of 
 large or small round-cells (large and small round- 
 celled sarcomata). The small round-celled sarcomata 
 are especially malignant. They consist almost wholly of 
 small round-cells, similar to white blood-corpuscles ; occa- 
 sionally they are combined with ameboid connective-tissue 
 cells which multiply very rapidly. The consistency, there- 
 fore, is soft, marrow-like (m edullary sarcoma), and the 
 growth is very rapid. 
 
 b) Spindle-celled sarcoma is composed essen- 
 tially of spindle-cells ; it often develops from a fibroma 
 (f i brosarcoma). 
 
 c) Giant-celled sarcoma is ver)^ malignant; 
 it is usually found in the bone-marrow (myelogenous 
 sarcom a, myeloid). 
 
 d) Stellate or "Netzzellen" sarcomata 
 usually arise from myxomata (m yosarcoma). 
 
 I e) Sarcomata with polymorphous formation 
 are composed of various forms of connective-tissue cells : 
 round-cells, spindle-cells, giant-cells, retic- 
 ular cells; there are many combinations of these cells 
 (combined sarcoma). 
 
 f) Alveolar sarcoma is characterized by a gland- 
 
SARCOMA 127 
 
 and cancer-like alveolar structure ; under certain conditions it 
 is difficult to differentiate it from carcinoma. The alveolar, 
 small and large round-celled sarcomata are of special import- 
 ance ; lymphosarcomata are examples of the former. 
 In contrast to carcinomata of a similar alveolar structure, the 
 alveolar sarcomata show an intercellular substance among their 
 cells. 
 
 g) Angiosarcomata or endotheliomata 
 (endotheliosarcoma, endothelial cancer, plexiform angiosar- 
 coma, plexiform angioma, cylindroma, perithelioma) are 
 angiomata with a sarcomatous proliferation 
 of the cells of the vessel- walls. They develop 
 from the following sources : the endotheliaLcells of the intima 
 and perithelium (adventia) of the blood- and lymph-vessels, 
 the lymph-cells of the connective tissue, as well as the endo- 
 thelium of the pleura, the peritoneum, the dura, and the pia. 
 They have been recently differentiated , then , as h e m a n g i o- 
 sarcomata (angiosarcoma of the blood-vessels) and 
 lymphangiosarcomata (of the lymph-vessels). De- 
 pending on their origin on the inner or outer wall of the 
 vessel they are termed intravascular (endothelial), and 
 perivascular (perithelial). Angiosarcomata are very 
 malignant ; thej^ show a tendency to hemorrhage and h3'aline 
 degeneration. They are easily confused with carcinomata. 
 They are characterized by pronounced thickening of the 
 vessel-walls, of hyaline appearance, and are frequently of 
 cylindrical form. 
 
 The following belong to the angiosarcomata or endothe- 
 liomata : cholesteatoma or margaritoma on the 
 venous plexus of the brain of the horse (endothelioma with a 
 deposit of cholesterin crystals), psammomata or sand- 
 tumors of the brain (endothelial tumors with a deposit of car- 
 bonate of lime), and xanthomata or xanthelasma (fatty 
 endotheliomata, endothelioma lipomatosum ; according to others 
 a form of lipoma). 
 
 h) Melanosarcoma or melanoma (pigment sar- 
 coma) is a brown or black, pigmented tumor that is often very 
 malignant ; it develops rapidly and is frequently recurrent. It 
 
128 SARCOMA 
 
 Spreads by metastasis and is most often seen in grey horses, it 
 may, however, occur in dark horses (brown, chestnut, black), 
 as well as in cattle, sheep, and dogs. Histologically melano- 
 sarcoma is partly round-celled and alveolar (soft, malignant 
 new-formation) J partly spindle-celled or fibrosarcoma (firm, 
 relatively benign tumor). Formerly the pigment was sup- 
 posed to be the coloring matter of the blood. According to 
 recent investigations, however, the pigment (hippomelanin) 
 frequently contains no iron ; it arises from specific embryonal, 
 pigment- forming cells, the melanocytes (Berdez and 
 Nencki, lyieber). According to Ribbert pigment 
 tumors are formed from the chromatophores. Accord- 
 ing to Joss the pigment is developed from the albumenous 
 material of the blood through a specific, metabolic activity of 
 the sarcomatous cells (highper cent of sulphur). Melanosis 
 is differentiated from melanoma by pigment infiltration, with- 
 out tumor formation, in the subcutem, in sheaths of muscles, 
 and in internal organs (calves, cattle, horses). 
 
 Occurrence. — Sarcomata are very common in the domes- 
 tic animals ; they are especially common in cattle, horses, and 
 dogs. Among 54 sarcomata observed b}^ Semmer, 30 were of 
 the dog, 12 of the horse, 4 of cattle, and 2 of swine. Among 
 643 new formations that I have operated upon in the dog, 44 
 were sarcomata ; among 200 new formations operated upon in 
 the horse, 50 were sarcomata. From a surgical standpoint the 
 following sarcomata are of importance : 
 
 I . Sarcomata of the Bones. — These are partly periosteal, 
 partly central (myelogenous) sarcomata, partly osteosarcomata. 
 They are found in horses and cattle, especially in the nasal 
 cavities and maxillary sinuses, where they may 
 develop from the ethmoid bone, the turbinated bones, the nasal 
 bones, the zygoma, or the superior maxillary bones. They 
 give rise to stenosis, cause chronic catarrh, and may 
 extend into the frontal sinus, the oral cavity, the 
 orbit, the cavities formed by the sphenoid 
 bone, and to other bones of the head. In dogs 
 they are most often found in the oral cavity, and on the 
 superior maxilla, less frequently on the inferior maxilla. 
 
SARCOMA 129 
 
 They develop on the gums in the form of proliferations that 
 are nodular, circumscribed, compact, as hard as bone or carti- 
 lage, and painless ; the surface is rough, irregular, granular* 
 or lobulated ; they cause the teeth to become loosened, dis- 
 placed, raised, and crowded apart (epulis). Central osteo- 
 sarcomata also occur in horses, dogs, cattle, and swine ; they 
 may be solitary or multiple, at times generalized ; they occur 
 on the humerus, the scapula, on the femur, on 
 the t i bia (lameness), the frontal bone, the petrous 
 portion of the temporal bone (facial paralysis), 
 on the bones of the cranium, neck, and verte- 
 bral column. Kammerman saw a case of spindle- 
 celled sarcoma in the cow ; it passed through the intervertebral 
 foramen of the atlas to the cervical marrow. Dieckerhoff 
 and F r o h n e r have observed diffuse myelogenous sarcomata 
 in horses and dogs. A sarcoma of the guttural pouch caused 
 hemiplegia by penetrating the vertebral canal of a horse ; an- 
 other in the same place caused paralysis of the tongue ( H a 1 - 
 lander). Spinal paralysis is caused in horses, cattle, and 
 dogs by pressure on the spinal cord from hard sarcomata 
 (Dorrwachter, Dexler, and others) . In swine a 
 form of so-called snuffle-disease is caused by sarcoma 
 of the facial bones. 
 
 2. Lymphosarcoma. — This is most often found in 
 horses and dogs. In horses, according to my experience, they 
 are soft, sometimes fluctuating and cystic tumors. They vary 
 in size from a hen's egg to that of a man's head ; they are often 
 multiple, and are found in the intermaxillary region 
 (suspected glanders), in the region of the larynx 
 (goitre-like tumors), on the neck, in the region of the 
 shoulder (a form of shoulder abscess), on the anterior 
 portion of the thorax, in the pelvic glands, on both 
 sides of the sheath, etc. In one case in a horse that was suf- 
 fering from "intermittent lameness" I found a lymphosar- 
 coma that involved the left iliac and femoral arteries ; it was 
 as large as a man's fist. I have also found lymphosarcomata 
 in dogs, especially on the neck and in the region of the pubis ; 
 they are often multiple. In cattle lymphosarcomata as large 
 
130 SARCOMA 
 
 as one's fist are found in the thoracic region, in the flank, and 
 in the sacral glands (Poncet). Strieker succeeded in 
 transmitting lymphosarcoma of a dog to thirty-one other dogs 
 by means of subcutaneous and intraperitoneal injections. 
 
 3. Sarcomata of the Skin and Mucous Membranes. 
 — These form circumscribed and multiple, or diffu.se and ex- 
 tensive tumors of soft or hard consistence. They may appear 
 nodular, lobulated, fungus-like or villous. In cattle and 
 horses they are found in the cervical and shoulder regions ; 
 in these places they form extensive tumors which may lead to 
 passive edema or suppuration ; they may extend to the 
 thoracic cavity and cause asphyxia from pressure on the 
 trachea ; generalization with metastatic formation in the in- 
 ternal organs is common. They also occur in other parts of 
 the body ; namely, on the extremities of dogs ; on the lips, 
 tongue, rectum, sheath, and fleshy-frog of the horse; on the 
 vulva and vagina of cows (cause of dystocia). Eberlein 
 has described a pendulous sarcoma on the inferior maxilla of 
 a horse. G i r o 1 1 i observed a myxosarcoma on the umbilicus 
 of a calf. Gorig has described a multiple sarcoma on the 
 throat and thorax of a hen. 
 
 4. Sarcomata of the Eyes. — These are most often seen 
 in horses, dogs, and cats. They occur either in the form of a 
 round-celled sarcoma of the orbit where they cause strabis- 
 mus (squint) and exophthalmos, as well as degeneration of 
 the neighboring bones, and even press into the frontal sinuses, 
 the maxillary sinuses, and the cerebral cavity (Emmerich, 
 personal observations), or a round-celled sarcoma (gliosar- 
 coma) of the retina, or as a melanosarcoma of the choroid 
 (Bayer). 
 
 5. Sarcomata of the Testicles, Udder, Thyroid 
 AND Parotid Glands. — These result in a circumscribed en- 
 largement, or enlargement of the entire glands, occasionally 
 the enlargement is enormous. According to my experience 
 they are relatively most frequent in displaced testicles, and 
 in the mammae of bitches, as well as in the thyroid glands of 
 the horse. W a 11 e y found in a horse (cryptorchid) a round- 
 celled sarcoma of the testicles that weighed 35 kg. I have 
 
SARCOMA 131 
 
 likewise diagnosed and removed from two stallions, two small 
 round-celled sarcomata of the testicles as large as a child's 
 head. Schuemacher has observed a similar sarcoma of 
 the testicles in a stallion. Garino has described twelve 
 cases of fibrosarcoma of the testicles in breeding animals 
 (eleven were unilaterial, one was bilateral) ; the testicles were 
 enlarged three or four times their usual size, 2)^-3 kg., the 
 spermatic cord was thickened as far as the inguinal ring. 
 Sarcomata also occur in the ovaries and kidneys. Re sow 
 described a primary round-celled sarcoma of the udder of a cow. 
 
 6. Subperitoneal and Subpleural Sarcomata. — 
 These are apparently common in cattle, horses, and dogs ; this 
 is especially true of sarcoma of the abdominal cavity, the 
 pelvic cavity, and the intestines. As a rule they cannot be 
 operated and are of no surgical importance. It is a peculiar 
 fact that many times they cause no obvious external 
 symptoms. They are usually first discovered during a post 
 mortem. In other cases they are the cause of colic (stenosis 
 of the small intestines), and general emaciation, as well as 
 cachexia. Sarcoma of the pelvic cavity may result in an in- 
 curable obstruction to parturition ; this is due to adhesions, or 
 to compression of the uterus and vagina. Primary or metas- 
 tatic sarcomata of the lungs, liver, spleen, kid- 
 neys, brain, heart, bladder, inner lymph-glands, 
 etc., are of no surgical importance. 
 
 7. Melanosarcoma. — This is most often seen in horses ; 
 it also occurs in asses, oxen, sheep, dogs, and goats ; it may 
 be isolated, multiple, or generalized. It is most often seen in 
 old grey horses. They are usually found in the following 
 places : in the vicinity of the anus, the vulva , the 
 vagina, the tail, the sheath and the penis, the 
 shoulder region — especially at the point of attachment 
 of the serratus to the scapul a — the eyelids, the 
 lips, as well as the region of the cheeks, the masse- 
 ters, and the parotid. The}^ may arise in any organ or 
 in any part of the body. They have been found by others' in 
 muscles, bones, and lymph-glands. Mauri has 
 described a case of melanoma on the body of the third lumbar 
 
132 SARCOMA 
 
 vertebra, which led to pressure of the spinal marrow with a 
 subsequent spinal paralysis. V a c h e has observed a similar 
 case of pressure atrophy of the lumbar marrow in a seventeen- 
 year-old mare. In other cases compression of the brain, in- 
 dividual cranial nerves (facial), the ischiadicus, and the 
 femoral artery, leads to paralytic conditions. I observed a case 
 of fragilitas ossium (multiple fracture of the pelvis and ribs) 
 in a horse affected with general melanosarcomatosis. In several 
 others, melanosarcoma in the perirectal connective tissue was 
 the cause of chronic colic due to obstruction. Roder observed 
 a case of stenosis of the urethra in a horse caused by melano- 
 sarcoma of the pelvis. Many melanosarcomata have a tendency 
 to ulceration and suppuration, so that, for example, cancer-like 
 ulcers are present on the skin, hemorrhage occurs in the nasal 
 cavities (personal observations). Internal melanosarcomata 
 may rupture and terminate in fatal hemorrhages. Generaliza- 
 tion is very frequently observed. Metastases develop in the 
 lungs, liver, heart, in the lymph-glands, etc. 
 With reference to the prognosis it may be remarked that i n a 
 great number of cases, even in the general- 
 ized form, general derangements are not 
 observed . Melanosarcomata are usuall}^ of incidental im- 
 portance in slaughtered horses that are otherwise normal. In 
 St. Petersburg in the years 1892-93, from 7000 slaughtered 
 horses, 36 cases of melanosarcoma, of which 8 were general- 
 ized, were observed (Sawaitow). Budnowski found 
 12 per cent of the First Sovereign Hussar Regiment (only 
 grey horses ! ) affected with melanoma ; in 63 horses the 
 melanomata were from the size of a pea to that of a hazel 
 nut ; complications dangerous to life had occurred only four 
 times in the regiment (seat in the pelvic cavity, on the omen- 
 tum, beneath the vertebral column, in the parotid). In other 
 cases melanomata are very malignant, they undergo ichorous 
 degeneration and chronic hemorrhage ; the patient suffers from 
 anemia and general cachexia. The soft, pigmented, round- 
 celled sarcomata have a special tendency to result in the latter 
 course. 
 
 Treatment. — Sarcomata should be extirpated as early 
 as possible. Treatment is unavailable when metastatic 
 
CARCINOMA 133 
 
 formation has already commenced. In the latter case especially 
 the prognosis of raelanosarcoma is very unfavorable ; satisfac- 
 tory results are obtainable only in solitary, firm, benign melano- 
 mata. The various conflicting statements concerning the value 
 of operative treatment for melanomata are explained by the 
 great variations in character of these tumors : benign ; very 
 malignant degree of extension. When the removal of the 
 tumor is incomplete, remnants of the sarcoma remain and 
 furnish a source for recurrence. Melanosarcomata are operated 
 exactly like other sarcomata ; I have successfully extirpated 
 them in the horse. Delamotte, to prevent recurrence fol- 
 lowing extirpation with the knife cauterized the wound and 
 then covered it with arsenic ; this possesses an affinity for sar- 
 comatous cells ( ? ). 
 
 B. EPITHEI.IAL NEOPIvASMS. 
 
 I. CARCINOMA. 
 
 Nature. — Carcinoma or cancer is an atypical 
 epithelial neoplasm; it has the property of 
 unlimited growth. All carcinomata are formed essen- 
 tially of epithelial cells, which lie in a connective-tissue stroma 
 (cancer-stroma) in the form of cancer-plugs, cancer-nests, or 
 cancer-nodules. They proliferate into the neighboring tissues, 
 break down the lymph-vessels and blood-vessels thus leading 
 to metastatic formations. At first the metastasis is 
 confined to the neighboring lymph-glands, afterwards it de- 
 velops in the form of a generalized carcinomatosis of the in- 
 ternal organs of the body. General derangement of the 
 nutrition thus produced — so-called cancerous cachexia 
 — is due to a form of auto-intoxication, that is, a general 
 chronic poisoning derived from the cancerous new-formation. 
 All carcinomata are derived from epithelial 
 tissues (Thiersch, Waldeyer). Virchow thought 
 that connective-tissue cells were transformed into cancer-cells, 
 this theory has not yet been demonstrated. 
 
134 CARCINOMA 
 
 Forms. — According to the different varieties of epithelium 
 (squamous epithelium, cylindrical epithelium, glandular epi- 
 thelium) the following forms are recognized : 
 
 (a) Squamous-celled carcinomata or can- 
 croids are found on the skin, oral mucous membranes, 
 mucous membranes of the pharynx and esophagus, conjunctival 
 mucous membrane, mucous membranes of the vagina and blad- 
 der, of the sheath, and of the penis. 
 
 (b) Cylindrical-celled cancer is found on the 
 mucous membranes of the stomach, intestines, and uterus. 
 
 (c) Glandular-celled cancer develops in the 
 testicles, mammae, thyroid gland, thymus gland, parotid, 
 prostate, in the sudoriferous and sebaceous glands of the skin, 
 in the mucous glands of the mucous membranes, in the liver, 
 in the pancreas, in the kidneys, and the suprarenal glands. 
 
 According to the consistence and form they are classified 
 as follows : hard, firm carcinomata with an abundance of con- 
 nective tissue (schirrhus, fibrocarcinoma); soft, 
 carcinomata of the consistence of the brain or spinal marrow 
 (medullary cancer, medullary carcinoma); 
 mucous and gelatinous cancer (carcinoma myxomato- 
 sura and gelat i n os u m) ; pigmented cancer (melano- 
 carcinoma); villous cancer (carcinoma papilloma- 
 tosum or villosum) and others. 
 
 Etiology. — The origin of carcinomata is no better un- 
 derstood than that of other tumors. A series of etiological 
 factors has been advanced to explain their occurrence in man ; 
 the same factors, with nothing added, have found place in 
 veterinary science (see below). 
 
 I. Age, sex, n u t r i t i o n, and heredity are con- 
 sidered predisposing infl^uences for the development of cancer. 
 Experience among men has taught that carcinoma pre- 
 ponderates among those advanced in age. It 
 may develop in any period of life but is seldom seen in a 
 person under forty years old. It is most often seen in people 
 between the ages of forty-five and sixty-five (50 per cent of 
 all cases). In animals (dogs) on a basis of material composed 
 of 262 cases I have observed that old dogs were the only ones 
 
CARCINOMA 135 
 
 affected with carcinoma ; I have never seen a case of cancer in 
 a dog under two 3'ears of age. Of the dogs affected eighty- 
 seven per cent were over five years old, fifty-four per cent 
 were over seven years. Carcinoma forms a contrast to sar- 
 coma ; the latter frequently occurs in young puppies. Similar 
 conditions have been observed in American cattle by L, o e b 
 and J obson ; of the forty-nine cases published all were in 
 cows over six years old. For an explanation of the influence 
 of age on the existence of cancer (diminished resistance of the 
 connective-tissue stroma in contrast to the proliferating 
 epithelial cells) see page loi. 
 
 With reference to the influence of sex, it has been main- 
 tained that in the human family the increased functional 
 activity of the sexual organs, especially the uterus and 
 mammae in females, predisposes to carcinomatous disease of 
 these organs. The relation appears to be similar in the dog, 
 where carcinomata of the mammae are seemingly frequent. 
 This theory cannot be applied to cows, however, where for 
 economic reasons, glandular activity and milk production are 
 most highly developed. Carcinoma of the udder and uterus 
 of the cow has apparently been observed in only a very few 
 cases (up to 1898 I have counted only three cases in the litera- 
 ture ; Guillebeau has recently published records of seven- 
 teen cases) although these organs are carefully examined in 
 abbatoirs. 
 
 Nourishment exerts an influence on the develop- 
 ment of cancer, in that it develops more frequently in those 
 who eat meat than in vegetarians (observations in England). 
 The same comparison has been made in the lower animals ; in 
 the carnivorous animals (cats, dogs) carcinomata are very 
 common ; while in herbivora (cattle, horses) cancers are prac- 
 tically unseen. This theory is valid onlj^ in dogs, which, ac- 
 cording to my own experience, are the most frequent sufferers 
 from carcinoma. The majority of the neoplasms in the dog 
 belong to this class. On the other hand, the statement that 
 the horse, as a carniverous animal, practically never suffers 
 from cancer is incorrect ; in the years 1895- 1902 I operated on 
 twenty-five cases of cancer in the horse. Swine, on the other 
 
136 CARCINOMA 
 
 hand — omniverous animals that consume flesh — are seldom 
 affected with carcinoma ; this has been demonstrated b}' ex- 
 perience in the abbatoir. Therefore, for the want of a better 
 cause, it is not so much the nourishment, as the species of 
 the animal that has a predisposing influence on the develop- 
 ment of cancer. Concerning the importance of heredity 
 in animals, which by many is considered the principal etiological 
 factor in man (compare with Cohnheim's theory of the scat- 
 tered embryonic cells, page 100), nothing definite is known. 
 Notwithstanding the fact that carcinomata develop only in old 
 animals, the possibility of heredity among them should not be 
 forgotten. For this reason caution should be employed in the 
 use of breeding animals that suffer from cancer. 
 
 2. Traumatic and chemical irritation have 
 recently been placed in the foreground as etiological factors for 
 the production of cancer in man. This theorj' is supported by 
 the appearance of cancer in the following places : the so-called 
 cicatricial cancer which develops in a cicatrix under the in- 
 fluence of a chronic inflammation ; the frequency of cancer of 
 the gall-bladder when under the influence of mechanical irrita- 
 tion from gall-stones ; the appearance of cancer on the lips, 
 tongue, and larynx of tobacco-smokers ; as well as upon the 
 skin of chimney-sweeps, workers in tar, paraffine, etc. Accord- 
 ing to Brosch continual irritation of granulating cutaneous 
 wounds with xylol developed artificial proliferations of the 
 epithelium in guinea-pigs ; it was alleged that these could not 
 be differentiated from incipient carcinomata of the skin (?). 
 According to M'Fadyean cancer of the skin occurs in Austra- 
 lian cattle after branding (j? ). According to Eggeling cutane- 
 ous cancer of the inferior maxilla occurs in swine in an enzo- 
 otic form as a result of feeding from troughs (? ). 
 
 Cancer has not yet been experimentally produced by the 
 influence of continued mechanical or chemical irritants, for 
 example, applications of tar to dogs and rats (Hanau) . 
 Probably the irritants are only able to cause cancer when there 
 exists a primary local or general predisposition ; they are not 
 essential etiological factors, but exert an accessory influence. 
 The fact should also be noted that carcinomata frequently de- 
 
CARCINOMA 137 
 
 velop in organs that are protected against external irritation 
 (prostate and thyroid gland of the dog, cavities of the head, 
 thoracic cavity, abdominal cavity in the horse). The theory 
 that cancer of the lips and tongue of ani- 
 mals frequentl}^ develops from external iri- 
 tants is also wrong from a veterinary stand- 
 point. On the contrary, they are very seldom produced in 
 his manner. I have seen only one case, and have found only 
 two ca.ses mentioned in literature. 
 
 3. Parasitic infection has in recent years been 
 frequently considered a cause of cancer. The parasitic 
 nature of cancer has not yet been satisfac- 
 torily demonstrated; its existence is improb- 
 able. Bacteria have also been credited as the cause of 
 cancer (cancer-bacillus of S c h e u e r 1 e n) ; so far they have 
 all proved to be inocuous accidental saprophytes (proteus 
 mirabilis). The cancer-bacillus recently described by 
 Schuller has proved to be a contamination of the prepara- 
 tion with cork-cells. Also the protozoa or coccidia, 
 which, according toPfeiffer, Thoma, Adamkiewicz, 
 V. Ley den, and others, existed in a special form within 
 the cancer-cells, have proved to be degenerated forms 
 of epithelial cells, as well as degenerated 
 nuclei and nuclear bodies. The following condi- 
 tions when examined under the microscope may be confused 
 with coccidia : endogenous new-formations of cells ; incom- 
 plete cellular division ; invagination of individual cells into 
 each other ; the presence of red and white blood- corpuscles in 
 cells ; pathological nuclear division ; mucous, colloid, hyaline, 
 and vacuolar degenerations of the cell-protoplasm, pathological 
 cornification ; degenerations of the nucleus, the nuclear 
 bodies, and the nuclear membrane. 
 
 Metastasis, which is common in cancer, as well as an 
 occasional successful artificial transplantation of 
 the cancer in both men and animals (Hanau, Geiss- 
 ler, Hahn, v. Bergmann, Wehr, Cornil, Jensen) 
 are cited as examples of the parasitic nature of the cancerous 
 neoplasm. In contrast to the few successful cases mentioned 
 
138 CARCINOMA 
 
 are the unsuccessful attempts at transmission of many other 
 investigators (Klebs, Tillman, Israel, Shattock 
 and Ballance, Alberts, Piitz, Trasbot, Du- 
 play, Cazin, Cadiot, Gilbert, Gratia, I^ien- 
 aux, Ivnglish Cancer Commission, and others) , 
 the parasitic nature is in no way proved by the artificial trans- 
 mission of cancer. The successful results of inoculations are 
 in reality nothing more than transplantations, or artil'icial 
 metastatic formations ; the specific pathological epithelial cells 
 have been transplanted, not the parasite of carcinoma, the new 
 cancer-proliferation develops from these cells. It has also 
 occurred that, in inoculation experiments carried on in man, 
 self-infection has taken place in those already affected. In 
 these cases the principal factor, a predisposition, was present. 
 
 Cancer in Mice. Jensen (Experimentelle Untersuchungen 
 iiber Krebs bei Mausen. Zentralblatt fiir Bakteriologie, 1903, Bd. 
 XXXIV, S. 28 ) has recently transmitted a carcinomatous tvimor in a 
 mouse over nineteen generations of white and grey mice (not, however, 
 to other animals). The transmission was a simple transplantation. 
 Mere crushing of the cells of the tumor produced negative results. 
 Proof of the parasitic nature of the carcinoma could 
 not be found. On the other hand, therapeutic experiments with 
 blood-serum from vaccinated rabbits produced good results in 
 diseased mice. The preparation of a serum to produce immunity is very 
 difficult; the results are also uncertain. Jensen, at least, 
 thought that there was no basis for the introduction 
 of hope from the seriim-treatment of cancer in man- 
 
 PSHUDO-C\RCiNOMA. — Zschokke has observed two cases of a 
 cancer-like tumor on the upper lips and intermaxillary space in horses ; 
 it was caused by a fibrillar fungus (actinophytosis), and was as large as 
 one's fist (Schweizer Archiv. 1903). It consisted of a connective-tissue 
 stroma with compartment-like enclosures (carcinomatous structure) , 
 these contained foci of leucocytes, and peculiar fungiform 
 structures with filiform processes (degenerated filimentary fungi). 
 In all probability the infection occurred from without through wounds 
 and epithelial defects in the oral mucous membrane. The fungus re- 
 sembled the actinomyces fungus, it varied from it, however, in certain 
 respects. 
 
 OccurrEncp:. — Localization of cancer is different in ani- 
 mals than in men. Horses and dogs are the only animals 
 of essential importance ; in cattle, sheep, goats, swine and 
 
CARCINOMA 139 
 
 cats, carcinomata are only occasionally of surgical importance. 
 The following are the most important special forms : 
 
 1. Carcinoma of the Skin. — This is most often found 
 in dogs ; according to my experience it most frequently 
 occurs in the following places: on the head (ears and 
 eyelids), on the back, on the tail, on the prepuce, 
 scrotum, in the vicinity of the anus and on the limbs. 
 In the horse the favorite places for the development of 
 cancer appear to be on the g 1 a n s penis, the vulva and 
 clitoris, on the tail and sheath, as well as in the 
 region of the bulbs of the foot. Carcinomata 
 of the penis form tuft-like, villous, often suppurative 
 tumors ; they usually attack the prepuce and lead to metas- 
 tases in the inguinal glands (Lei serin g, Moller, per- 
 sonal observations). Macroscopic appearance of carcinoma 
 is extremely variable according to the age and location of 
 the tumor. Carcinomata of the skin usually present the fol- 
 lowing appearance : they are attached to the skin, 
 have a tendency to ulceration and infiltration 
 of the adjacent tissues, and are firm in con- 
 sistence; the surface is nodular and rough; 
 the margins of the ulcers are wall-like and 
 firm; nodular formation is present in the 
 vicinity; there is a secondary swelling of the 
 neighboring 1 y m p h - g 1 a n d s. The neoplasms may be 
 circumscribed or diffuse ; large areas of the skin may become 
 ulcerative, nodular, thick, lardaceous, ichorous, and trans- 
 formed into immense tumor-masses that are foul in appear- 
 ance and odor. On the penis, carcinomata form tumors that 
 are papillomatous, villous, fissured, and often very laige. 
 
 2. Carcinoma of the Mucous Membranes. — These 
 are often found in superior maxillary sinuses of 
 the horse. According to my observations they form firm, 
 lobulated, hemorrhagic, very rapidly developing tumors. The 
 neoplasms are permeated with hemorrhagic foci and contain a 
 fluid similar to that found in the medullary substance of the 
 brain ; they usually arise from the mucous membranes of the 
 oral and pharyngeal cavities (squamous-celled cancer 
 
140 CARCINOMA 
 
 of the hard gums) and lead to loosening of the teeth, 
 penetration to the nasal cavities, maxillar}' sinuses, and even 
 the frontal sinus, they also result in swelling of the intermax- 
 illary lymph-glands (metastatic formation). Similar tumors 
 have been observed in the nasal cavities of the horse ; 
 in this case the squamous-celled cancer originated from the 
 squamous epithelium of the lachrymal duct (M o n t f a 1 1 e 1 1). 
 Carcinomata are further found in the pharyngeal cavity of 
 the dog, as well as in the turbinated bones and 
 esophagus of the horse. In the latter place, under certain 
 conditions, thej^ may lead to perforation and fatal pleuritis ; a 
 case of this kind has been described by Lorenz. Carci- 
 nomata are further observed on the mucous membranes 
 of the eyes in horses ; they either involve simph^ the 
 membrana nictatans (personal observations), or the 
 conjunctival schlera (Bayer), or penetrate the 
 entire orbit destroying the neighboring bones, especially 
 the frontal bone, the superior maxillary bone, the zygoma, 
 and the lachrymal bone, even penetrating into the frontal and 
 superior maxillary sinuses (Leisering, Moller, Eichler, 
 personal observations). Among two and one half million 
 cattle slaughtered in Chicago in 1899 Loeb and Jobs on 
 claim to have found forty-eight cases of squamous-celled cancer 
 of the lachrymal caruncle (at first it is about the thickness of 
 one's finger and papillomatous ; it afterwards becomes exten- 
 sive, fissured, and covered with blood-coagulum. 
 
 Carcinomata are also frequently found in the vagina, 
 on the clitoris (Kberlein, Hennig, Naudin), 
 in the uterus (Guillebeau), in the bladder, as 
 well as on the skin and mucous membranes of the 
 prepuce of dogs, horses and cattle. Olt has described a 
 case of cancer of the rectum in the horse (squamous- 
 celled cancer, congenital wandering of squamous epithelium 
 to the mucous membrane of the rectum). Carcinomata 
 of the bladder are usually in the form of villiform can- 
 cers ; they present cauliflower-like, villous, tufted, fissured 
 proliferations of the consistence of mucus, and have a firm 
 base. They lead to hemorrhage and ichorous degenerations, 
 
CARCINOMA 141 
 
 as well as to nodular formations in their immediate vicinity 
 (hemorrhagic, ichorous, fetid, sedimentous urine) ; occasion- 
 ally they extend to the peritoneum and the abdominal viscera, 
 or result in a fatal perforating peritonitis (Siedamgro- 
 tzky, Kitt, Pflug, Esser, Bang, Demeurisse, 
 Bollinger, and others). A case of cancer of the tongue 
 has been observed in a twelve-year-old cat (M'Fadyean); 
 he found a cancerous ulcer on the ventral surface of the tongue, 
 from here plug-like carcinomatous proliferations penetrated 
 the entire tongue. Pflug and Leblanc have described 
 a case of cancer of the tongue in cattle, and cancer of 
 the lips in a dog. In the larynx (epiglottis) onlj^ one 
 carcinoma has been observed (Casper). Cancer of 
 the stomach is far less common in animals than in man ; 
 veterinary literature contains records of only a very few cases 
 in the horse and dog (Oltmann, Roloff, Kitt, 
 Eberlein, Diirbeck), 
 
 3. Carcinomata of GIvAnds. — These are most frequently 
 observed in the mammae of the bitch ; I have operated eighteen 
 cases. Their consistence and size are extremely variable ; 
 pain and heat are usually absent ; the skin is either intact, 
 or possesses ulcerative foci and undergoes cancerous infiltra- 
 tion; the adjacent lymph-glands are frequently swollen. Carci- 
 nomata of the mammae are sometimes soft, and may even fluctu- 
 ate as a result of cystic degeneration. Many cases have been 
 observed by Bang, Kitt, Rabe, Johne, M oiler, 
 Piitz, Pflug, Stenzel, and others. In cattle, horses, 
 a^nd swine, on the other hand, cancers of the mammae seldom 
 occur ( C a d i o t ) . 
 
 Carcinomata of the testicles are common in horses 
 and dogs ; they often result in a marked enlargement of the 
 testicles (one form of so-called sarcocele), infiltration of the 
 spermatic cord, swelling of the inguinal glands, carcinomatosis 
 of the peritoneum, as well as metastatic formation ; they are 
 occasionally observed in cryptorchids, and are not uncommon 
 in the laterally displaced testicles of the dog. Cases of cancer 
 of the testicles have been described by Leisering, Stock- 
 fleth, Roll, Guillebeau, Siedamgrotz k y , M61- 
 ler, Frohner, Trasbot, Cadiot, and others. 
 
142 CARCINOMA 
 
 Carcinoma of the thyroid gland occurs most fre- 
 quently in horses and dogs; it occurs in the form of 
 goitre (struma maligna, struma carcinomatosa). 
 It is characterized by rapid development, emaciation and 
 cachexia of the animal, as well as metastatic formations in the 
 lungs (breaking down of the jugular) and other internal 
 organs, followed by a fatal termination (Johne, Kitt, 
 Siedamgrotzky, Moller, Zschokke, Hutyra, 
 Cadiot, personal observations). In dogs thyroid-gland 
 cancers may reach the size of two fists ; in horses they may 
 attain twice the size of a man's head. They often embrace 
 the trachea and esophagus, and occasionally extend as far as 
 the thoracic cavity. 
 
 Cancer of the prostate in dogs is of special importance 
 as it can be diagnosed per rectum, it often forms a tumor as 
 large as one's fist, and is the cause of habitual constipation 
 (personal observations). Only one case of cancer of the pros- 
 tate in the horse has been described (Cadiot). Carcinomata 
 of the anus are very common in dogs ; they originate from the 
 anal glands (compared with these, carcinomata of the rectum 
 are very rare). They form uneven, nodular, warty, cauli- 
 flower or fungus-like neoplasms ; they are fissured and lobu- 
 lated ; occasionally they are also pedunculated, soft, and 
 painless, 
 
 Siedamgrotzky has described a cancerous neoplasm 
 that originated in the thymus gland of the horse ; it led 
 to metastatic formation in the inferior cervical glands, the 
 principal lymph-vessels, and the retro- pharyngeal and sub- 
 maxillary Ipmph-glands, as well as to extensive schlerosis of 
 the subcutaneous and intermuscular connective tissue. It 
 presented the clinical appearance of a high-grade edema of the 
 skin on the dependent portions of the head, neck, and thorax. 
 
 H i n r i c h s e n observed a multiple cancer of the 
 lymph-glands of the head (medullary carcinoma) in tw^o 
 horses, it was characterized by metastases in the internal 
 organs, in the glands in the vicinity of the shoulder and arm, 
 and the axillary glands ; pronounced edema was also present 
 in the same vicinit)^ Similar cases of primary cancers of the 
 
CARCINOMA 143 
 
 lymph-glands in horses and dogs have been described by 
 Leisering, Casper, Kitt, and Frohner. Petit 
 has observed one case of carcinoma of the parotid in the cat. 
 
 4. Carcinoma of the Internal Organs. — They often 
 occur in horses, dogs, and cattle, but are of trivial surgical 
 importance. They are often found on the pleura, on the 
 peritoneum, in the omentum, and in the mediastinal, 
 mesenteric, and lumbar ly mph - gla nds, where 
 they are often multiple, characterized by secondary metastases, 
 and more or less generalized. Enormous masses of tumors are 
 often formed, they involve the lungs and other adjacent vis- 
 cera, and even penetrate the walls of the thoracic and abdomi- 
 nal cavities. Carcinomata have also been observed in the 
 liver, in the kidneys, in the suprarenal glands, 
 in the ovaries (10 to 20 kg. in weight, occasionally fatal 
 through hemorrhage and peritonitis), in the rumen, stom- 
 ach, intestines, in the lungs, in the brain, and 
 spinal marrow (metastases). A cancerous metastasis in 
 the horse has led to pressure-paralysis of the spinal cord 
 (Alfort Clinic). 
 
 Treatment. — As in sarcomata, so in carcinomata, the 
 earliest possible extirpation forms the basis for 
 successful treatment. Caustics are rarely indicated. Opera- 
 tive removal of the following forms is relatively simple : car- 
 cinomata of the skin and anus, as well as carcinomata of the 
 membrana nictitans and eyelids. Carcinomata of the mammae, 
 penis, and testicles are removed by amputation, or cas- 
 tration. It ' is more difficult to treat proliferating carcino- 
 mata in the cavities of the head (trepanation). Extir- 
 pation of cancer of the thyroid gland is especially difl&cult 
 (severe hemorrhage, cachexia strumapriva). All internal 
 carcinomata are incurable (pleura, peritoneum, lungs, internal 
 lymph-glands, liver, kidneys, bladder, stomach, intestines, 
 etc.); the same is true of generalized carcinomatosis. Arsenic, 
 which was formerly administered as an internal specific, acts 
 only as a stimulant to metabolism and nourishment. Inocu- 
 lation of the cancer with erysipelas has occasionally been fol- 
 lowed by recovery in man, it is seldom employed at the pres- 
 
144 PAPILLOMA 
 
 ent time as it endangers the life of the patient. Serum- 
 theraphy (injection of blood-serum from animals affected 
 with cancer, or from animals into which masses of cancer 
 have been inoculated) has not proved a success (Cadiot, 
 and others). This serum seems to possess a specific action 
 for experimental animals (mice) (Jensen). Recently, 
 Rontgen rays and radium rays have been employed to cure 
 cancer ( this method results only in the destruction of the 
 cancer- cells). 
 
 Statistics of Cancer in Animai^s. — Sticker has collected re- 
 ports from veterinary literature on 1217 cases of cancer (332 horses, 766 
 dogs, 78 cattle, 21 cats, 12 swine, 8 sheep and goats). According to fre- 
 quency they were arranged as follows : 
 
 1. Horse: penis, nasal and adjacent cavities (52 cases), kidneys 
 (29), skin (22), vagina (18), eyes and urinary bladder (14), lungs and 
 testicles (13), gingivae (11), anus, stomach, thyroid gland, uterus (8), 
 larynx (7), etc. 
 
 2. Cattle: uterus (16), kidneys (10), bladder (9), ovaries and 
 stomach (6), liver (4), vagina and lungs (3), etc. 
 
 3. Dog: mammie (341), skin (166), anus (89), thyroid gland and 
 lungs (10). 
 
 4. Cat: skin (6). mammae (5), lungs (3), liver (2). 
 
 5. Swine: kidneys (7), skin (2). 
 
 II. PAPILLOMA. 
 
 Nature and Forms. — Papilloma was formerly considered 
 a connective-tissue proliferation of the papillary body, and 
 classified with the fibromata (papillary fibroma); 
 recently it has been placed with the epithelial neoplasms 
 (papillary epithelioma) and is considered a mixed 
 tumor (fibro-epithelial neoplasm). It consists of a 
 hyperplasia of the epithelium of the skin and 
 mucous membranes with a simultaneous pro- 
 liferation of the papillary body (connective-tissue 
 and vascular new-formation). Two forms of papillomata are 
 recognized : 
 
 a) Warts (verruca) are hard, dry, horny papillomata 
 derived from the epithelium of the skin. 
 
 b) Condyloma (fig- wart) is a soft non-cornified, vascular 
 
PAPILLOMA 145 
 
 proliferating papilloma of the skin and mucous membrane 
 (pointed, broad condyloma) ; it is moist on the surface (fig- 
 wart, moist wart), and has the appearance of cauliflower or 
 cockscomb. 
 
 Etiology. — Chronic inflammatory irritants play 
 an important part in the development of papillomata. The 
 so-called verrucose form of scratches in the horse is a multiple 
 warty formation on the skin of the fetlock ; it is the product 
 of a chronic dermatitis or infectious inflammation of the 
 skin. They have also been seen on the lips of horses and 
 cattle that have been pastured in fields of stubble ; such 
 cases are due to inflammatory processes on the skin and mucous 
 membranes. Chronic irritants (excretions) in the vicinity of 
 the vulva and anus may also be considered occasional causes 
 of papillomatous neoplasms. Some believe that papilloma- 
 tous tumors are contagious. M e g n i n described alleged in- 
 fectious papillomata on the lips of lambs in which he demon- 
 strated spherical pathological microorganisms. M ' Fadyean 
 and Hobday have successfully transmitted papillomata from 
 one dog to another. A u b e r t and others have observed 
 transmission from cows to men. The inoculation experiments 
 of Grat i a , on the other hand, were unsuccessful. 
 
 In addition to the irritation theory, the question of 
 heredity as an etiological factor in the production of papil- 
 lomata must be considered. It has been observed that in foals, 
 calves, and dogs, papillomata are congenital. Many believe 
 in hereditary transmission. In these cases inflammation is 
 excluded as an etiological factor ; the basis of the cause must 
 lie in an embryonic proliferation of the cells. 
 
 Occurrence. — Papillomata are most often found in 
 dogs, horses, and cattle. 
 
 I. In dogs, the favorite locations for develop- 
 ment are the lips, the mucous membranes of the mouth (lips, 
 gingivae, tongue), the eyelids, the ears, especially the external 
 auditory canal, the buccal region, prepuce, penis, the anus and 
 vagina, as well as the extremities. Papillomata are 
 characterized by their rough and lobulated surface; they 
 are similar in appearance to strawberries, rasp- 
 
146 PAPILLOMA 
 
 berries, blackberries, cauliflower, cockscomb, 
 etc. They usually have a sharply defined margin, occasionally 
 they are pedunculated ; they vary in size from a lentil-seed to 
 that of a pea or a walnut ; they may be dry or moist on the 
 surface. General papillomatosis is common. 
 
 2. In cattle papillomata are often multiple so that 
 the entire skin appears to be covered with warts. They are 
 especially numerous on the head, throat, on the slioulders, 
 udder, abdomen, on the penis, and on the limbs. They form 
 rough, granulation-like, lobulated, painless neoplasms ; they 
 are often fissured, and are broad or pedunculated ; they are 
 firm in consistence, and yellowish-white in color, they become 
 confluent and attain the size of a man's fist, sometimes even 
 that of a man's head. Papillomata are extremely variable in 
 form ; at times they lead to an extensive thickening of the .skin, 
 and they may attain a weight of fifty pounds. Thierfelder 
 observed a papillomatous tumor that extended from the withers 
 to the root of the tail in a three-year-old heifer ; it was from 
 30 to 40 centimeters broad and 15 to 20 centimeters thick ; 
 from a distance it had the appearance of the horny covering of 
 an immense tortoise ; nearby it was similar in appearance to 
 the quills of a porcupine. Wehrner has described a case 
 of papillomatosis with a mane-like covering of hair (hypertri- 
 chosis) on the neck. In many cases the udder is the seat of 
 numerous papillomata ; the dry form is especially common on 
 the teats, occasionally the teats are the seat of soft, villiform 
 warts. In addition to these cutaneous papillomata, others 
 are frequently observed on the mucous membrane of the 
 pharynx and esophagus, occasionally they are seen 
 in the omentum and bladder. In lambs, warts are 
 very often found on the lips. 
 
 3. In the horse, especially in foals, warty growths 
 are found in the region of the lips, the nose, on the eye-lids, 
 ears, on the sheath, etc. In older horses they are found on 
 the following places : in the region of the saddle and 
 harness, on the coronet (personal observations), as well 
 as subsequent to scratches on the fetlock (dermatitis 
 verrucosa so-called "Straubfuss" bristle-foot). They are 
 
ADKNOMA 147 
 
 very rare in the bladder where they form one variety of so- 
 called villiform cancer. Canker of the hoof (canker 
 o f t h e f r o g) is a papillomatous neoplasm ; it is characterized 
 by pronounced proliferation of the papillary body and rete 
 raucosum ; in this disease the growth of the horn is suspended 
 (infection ?). 
 
 Treatment. — Treatment of papillomata consists in sim- 
 ply cutting away with scis.sors, or twisting off with 
 the fingers. Caustics (concentrated nitric acid and other 
 acids) are not indicated, with the exception of papillomatosis 
 of the frog ; in any case they should be applied with great 
 caution in the vicinity of the eyes and mouth. Papillomata 
 on the lids, because of the possibility of transformation, must 
 be thoroughly treated, that is, extirpate the entire tumor by 
 removing a keel-shaped .section of the lid. In young animals, 
 the internal administration of arsenic has occasionally been 
 followed by good results. Papillomata often disappear with- 
 out treatment. Spontaneous healing of cancer of the frog has 
 occasionally been observed after recovery from contagious 
 pleuropneumonia. 
 
 III. ADENOMA. 
 
 Nature. — An adenoma is a non-cancerous, be- 
 nign, epithelial neoplasm of glandular type. 
 Adenomata are termed tubular, acinous, or alveolar, 
 according to the type of the gland from which they are de- 
 rived ; they are also classified according to the nature of the 
 gland, adenoma of the thyroid gland (struma), 
 mammary, hepatic, su do r i f ero us and sebaceous 
 adenomata. When an adenoma consists largely of con- 
 nective tissue it is termed a fibroadenoma; when the 
 converse is true it is termed an adenofibroma (so-called 
 fibroepithelial neoplasms). Adenomata, regardless 
 of their benignity as epithelial neoplasms, occasionally have a 
 tendency towards carcinomatous transformation (malignant 
 adenoma, adenoid). 
 
 Occurrence. — It is most frequently seen, especially in 
 
148 EPITHELIOMA 
 
 puppies, in the form of goitre (simple hyperplastic struma) — 
 adenoma of the thjToid glands — it is less common in th-e horse 
 (I^anzi llo 1 1 i, Markus, Pfeiffer, personal observa- 
 tions). Adenofibromata ofthe nasal mucous mem- 
 branes are relatively frequent in horses (firm, rough, mul- 
 tiple, readily hemorrhagic, usually bilateral neoplasms on the 
 lower third of the nasal mucous membranes ; formerly they 
 were erroneously termed rhinoschleroma). Adenomata are 
 not rare in the mammae of the bitch. Only a portion 
 of these neoplasms, however, are pure adenomata, they are fre- 
 quently fibroadenomata, adenofibromata and myxoadenomata 
 (L/cblanc). An adenoma of the mucous membranes ofthe 
 larynx has been observed in a cow by Johne; sebaceous 
 adenomata and sudoriferous adenomata have been observed in 
 the skin of dogs, especially in the vicinity of the anus (perineal 
 glands) (Kitt, Siedamgrotzky, M oiler, and others). 
 Adenomata of the Harderian glands ofthe membrana 
 nictatans have been observed in the dog by S c h i m m e 1 and 
 myself. Adenomata also occur in the rectal mucous 
 membranes (glands of lyieberkiihn) of horses in the form 
 of cysts and polypi (personal observations). Adenomata of the 
 liver, as well as of other inner organs, are of no surgical 
 importance. 
 
 EpiThei,ioma. — In Germany this term is applied to a benign, 
 circumscribed neoplasm of the epidermis on the skin 
 (in France, epithelioma indicates a carcinoma). It is partly duetto con- 
 tinual irritation of the skin by pressure (callosities, clavus, 
 tyloma), partly caused by parasitic infection (epithelioma gre- 
 garinosum or moll u scum, bird-pox). 
 
 CoRNU CuTANEUM. — This is an epithelial neoplasm similar to 
 epithelioma (cor nu cutaneum, keratosis, keratoma). It is 
 a circumscribed outgrowth of newly-formed, horny, epidermal cells. 
 They are often found in cattle on the neck, iu the intermaxillary space, 
 on the head, on the abdomen and udder ; occasionally they occur in the 
 form of horn-like structures one-fourth to one-half meter in length ; at 
 times they are of actinomycotic origin (Schreiber); they may also 
 occur in birds as a symptom of tuberculosis of the skin (Eberlein 
 has described a typical case in a parrot), they are found in horses (fet- 
 lock, ear), sheep, dogs, and goats. — KeratomaTa (tumor-like, usually, 
 however, inflammatory hyperplasias of the hoof-horn) are similar pro- 
 liferations ; the same is true of onychoma (hypertrophy of the 
 
CYSTIC TUMORS 1 49 
 
 tissue of the nail), ichthyosis (congenital or horn-like thickening 
 of the entire ©kin, especially in calves), as well as hystriciasis 
 (congenital bristle-like erection of the hair and thickening of the skin). 
 Cystomata. — These are epithelial neoplasms in glands, 
 with cystic formation. They maybe defined as cystic adeno- 
 mata. They are most often found in the ovaries (ovarian cysts) , in the 
 thyroid gland (cystic goitre), in the mammae, parotid, and in the supe- 
 rior maxilla of the horse. In contrast to ordinary cysts, cystomata are 
 genuine, proliferating cysts (see page 150). 
 
 C. CYSTIC TUMORS. 
 
 Definition. — A cyst is a sac-like, spherical, or bladder- 
 like tumor ; it contains fluid and is surrounded by a capsule. 
 The development of cysts is extremely variable. The following 
 forms are recognized. 
 
 1. Retention-cysts. 
 
 2. Dermoid pysts. 
 
 3. Gen u in e cysts (cystoma). 
 
 4. Extravasation- and e x u d a t i o n-cysts. 
 
 5. Cystic degeneration. 
 
 Retention-cyst. — A retention-cyst is formed by a re- 
 tention of the secretions of a gland. Various 
 types of retention-cysts are recognized. 
 
 a) So-called mucous cysts develop from the mucous 
 membranes as a result of retention of the secretions of the 
 mucous glands. They are especially common in the oral cav- 
 ities of dogs, cattle, and horses ; they are situated at the 
 lateral and ventral surfaces of the tongue in the form of so- 
 called ranulae (retention-cyst of the sub-lingual gland; 
 according to others a dermoid cyst); in the intermaxil- 
 lary region and region of the larynx in the form of 
 so-called meliceris; on the mucous membranes of 
 the lips, especially on the upper lip in the horse; 
 in the nasal cavities; at the base of the epiglottis; 
 and in the trachea of horses and cattle. They are found in 
 the vestibule of the vagina in cows (retention-cysts 
 of both glands of Bartholin, or of Gartner's duct), 
 
150 DERMOID CYSTS 
 
 as well as in the rectum in horses (glands of lyieberkiihn). 
 
 b) So-called atheromata (pultaceous cysts, encysted 
 tumors) occur in the skin, especially that of horses (base of 
 the false nostril, inner canthus of the eye, base of the auricu- 
 lar cartilage), swine (teats), and dogs (back) ; they are 
 usually solitar)^. Multiple atheromata are rare (Velmelage 
 has described a case in the dog). Formerly they were all con- 
 sidered retention-cysts of the sebaceous glands. Recent investi- 
 gations have demonstrated that they are partly due to aberra- 
 tion of epidermal cells, such, cases must be classified with 
 dermoid cysts. 
 
 c) Retention-cysts of large glands, especially the 
 udders of milch cows are due to an obliteration of an individual 
 milk-duct, or the common milk-canal. 
 
 Dermoid Cysts. — This name indicates neoplasms which 
 belong to the teratomata. They are due to an embry- 
 onic wandering of germ -cells of the skin 
 or mucous membranes; these may pass into the 
 inner organs (subcutis, ovaries, testicles, brain), so that, 
 under certain conditions, the walls of the cyst contain all the 
 different elements of the skin or mucous membrane, namely, 
 epidermis, papillary body, hair and feathers, sebaceous, sudo- 
 riferous, and mucous glands. To this class belong the so- 
 called tooth -follicle cysts; these occur in horses and 
 cattle in the vicinity of the parotid glands(so-called ear-fistula); 
 they are branchial-arch teratomata, that is, derivatives of a 
 primative tooth-fold of the epithelium of the oral cavity, they 
 are a result of the presence of the branchial arches. One 
 usually finds a small opening at the base of the ear, the sur- 
 rounding hairs are matted by a tenacious, slimy fluid ; on 
 passing a probe it enters a blind canal or cystic hollow space, 
 at the bottom of which a molar tooth is found. About one 
 hundred cases of branchial-arch teratomata in horses and cattle 
 have been recorded. Dermoid cysts also include the very rare 
 tooth-teratomata on the superior and inferior maxilla 
 of the horse ; these are large tumors which contain hundreds 
 of teeth in all stages of development (Ostertag, Lohoof). 
 By many, ranula is considered a dermoid cyst. Dermoid 
 cysts of the ovaries are very rare (hair, teeth, bones). 
 
EXTRAVASATION- AND EXUDATION-CYSTS I5I 
 
 Genuine Cysts. — Genuine cysts are also termed cy sto- 
 ma t a ; they are glandular, epithelial neoplasms 
 (cystoadenoma) (see page 148). They are most often found 
 in the ovaries and in the thyroid glands. They are 
 the ordinary cystic formation (single sac, or multiple hollow 
 spaces) in the ovaries of cattle, horses, and dogs ; occasionally 
 they become very large. Stockfleth has observed a 
 cystic ovary that weighed 125 pounds, in a cow; Albrecht 
 has observed one that weighed 80, and another that weighed 
 50 pounds in the horse. I observed a case in which a cystic 
 ovary as large as a child's head constricted the rectum and 
 caused fatal colic in a mare. Finally, genuine cysts occur in 
 the superior maxilla of the horse (detached epithelial 
 foci) ; occasionally they press through the superior maxillary 
 sinuses into the nasal cavity (pseudo-hydropsof the maxillary 
 sinus). 
 
 Extravasation- and Exudation- cysts. — Hematomata 
 due to contusions may become encapsuled as a result of aseptic 
 inflammatory processes in their vicinity ; they form swellings 
 having a cavity filled with serum, and are termed extrava- 
 sation-cysts or blood -cysts. They are frequently 
 observed on the anterior surface of the carpal-joint in cattle 
 (so-called knee-boils), and on the neck and back of the dog. 
 Their existence is analogous to capsule formation around for- 
 eign bodies and parasites (foreign-body cysts, parasitic cysts). 
 Blood- and lymph-cysts, the result of gradual dilitation of 
 blood- and lymph- vessels (dilitation-cysts), are less common. 
 Exudation -cysts are formed in a similar manner as a 
 result of inflammation of mucous membranes and tendon- 
 sheaths. To this class belong hygromata of the mucous bursae 
 over the point of the elbow (so called shoe-boil) and os calcis 
 (so-called capped-hock) in horses and dogs, as well as hygroma 
 proliferum on the carpus of the horse and ox (one form of 
 knee- boil). 
 
 Degenerated Cysts. — These are cystic degener- 
 ated neoplasms (cystoid degenerations) ; they most often 
 occur in sarcomata and in carcinomata (cystosarcoma, cysto- 
 carcinoma, cystofibroma) . 
 
152 ACTIONOMYCOMA 
 
 Treatment. — Treatment of cysts consists in extirpa- 
 tion of the sac. Simple puncture or incision is 
 usually insufficient ; this is especially true of mucous cysts 
 and atheromata. On the other hand, puncture with a subse- 
 quent injection of tincture of iodine is effectual in many 
 forms of extravasation- and exudation-cysts (hjgroma, shoe- 
 boil); it is necessary to incise and remove the necrotic sac. 
 When removing the sac care should be taken to remove all the 
 parts ; no portion of the proliferating tissue should remain 
 behind. Special difficulty is encountered in the total extirpa- 
 tion of ranula ; this is also true of many mucous cj'sts in the 
 throat of the dog. On the other hand, teratomata are usually 
 operated without difficulty. In tooth-follicle cysts the teeth 
 are removed from the temporal bone with hammer and chisel, 
 and the mucous membrane of the cystic sac is carefulh' curetted. 
 Cysts of the ovaries in cattle ma}^ be crushed per rectum with 
 the hand. 
 
 D. INFECTIOUS TUMORS. 
 
 I. ACTINOMYCOMA. 
 
 Etiology and Pathogenesis. — Actinomycoma is a 
 swelling caused by the r a 5^ -f u n g u s or actinomyces. This 
 fungus, which belongs to the schizomycetes (cladothrix), was 
 described by Perroncito, Rivolta, Hahn, and Bol- 
 linger in the years 1868-1877. Macroscopically it forms 
 sulphur-yellow, sand-like kernels. Under the microscope 
 they have the appearance of glands, with a branching, rosette- 
 like arrangement, composed of club-shaped, thick threads. 
 Entrance of the actinomyces fungus into the 
 body seems to occur in various ways. It usually gains en- 
 trance through the digestive tract (mouth cavity, 
 pharynx, stomach, intestines). Their primary seat is on the 
 fragments of plants ; they have been especially demonstrated 
 on beards of grain, in the tonsils of swine, and in the 
 tongues of cattle. It is thought that transmission occurs as 
 
ACTIONOMYCOMA 1 53 
 
 follows : at first the fungus gains entrance to small wounds of 
 the mucous membranes, or passes into the excretory ducts of 
 glands, possibly it colonizes in the alveoli of diseased teeth, or 
 those that are changing ; its further extension is from these 
 points. In cattle, especially, beards of grain 
 covered with fungi appear to penetrate be- 
 tween the teeth and gums, as well as into the 
 tongue. When they once gain entrance removal is diflBcult 
 because of the peculiar arrangement of the hairs on the beards ; 
 a similar phenomenon is observed with rye-beards, for example, 
 when they become attached to one's coat-sleeve. A favorite lo- 
 cation for actinomycosis of the tongue is on the dorsal 
 surface where it begins to form the point. Epithelial 
 d e f e c t s are present at this point in many cattle (9 per cent), 
 thus favoring the introduction of an actinomycotic infection 
 (Hentschel and Fa Ik). According to Breuer the 
 folds of the dorsal surface, especially in old cattle, where 
 they are well developed, predispose to the retention of 
 fungus-covered vegetable fibers. Bostrom thought that the 
 ray-fungus developed exclusively on grain, especially in barley, 
 and that actinomycosis could be caused, only bj'^ ingestion of 
 portions of these infected plants. Symmetrically arranged air- 
 spaces are found in drj'^ grain-beards, these communicate 
 freely with the surface ; within these spaces the fungus is 
 able to live in a dried condition for more than a year ; when 
 the beards gain entrance to animal tissue proliferation is again 
 active. Dry fodder, therefore, appears to be the principal 
 source of infection in cattle ; perhaps simultaneous shedding 
 of the teeth also has an influence (Immiger, Claus). 
 Entrance to the lungs may take place by aspiration of the 
 fungus from the air; wounds of the skin, especially 
 castration wounds and umbilical wounds 
 allow entrance ; it may also enter through the open- 
 ings in the teats. In swine, infection of the snout from 
 the straw seems to be frequent. In a large number of cattle 
 treated with setons a majority of the wounds showed actino- 
 mycotic infection (Gooch); General extension (general- 
 ization) over the entire body by means of the blood-stream 
 
154 ACTINOMYCOMA 
 
 also occurs, similar to tuberculosis, though far less frequently. 
 With reference to the rapidity of growth of actinomycoma, the 
 following observation has been made by Anderson: 
 twenty cows were turned to pasture on the first of July ; small 
 and large tumors had developed on seventeen by the first of 
 December (five months). 
 
 Actinomycosis is a specific inflammation; domes- 
 tic animals are affected with three grades of the disease : i. 
 A degenerative granulo- fibrous inflammation (tongue). 
 2. A progressive purulo- granular inflammation (cold 
 abscess). 3. Fungoid actinomycoma (pharynx, skin). In 
 the vicinity of glands in which the fungus is active, there first 
 develops a granulation-like growth, the result of a 
 reactive inflammatory process. This leads to the formation of 
 tubercle-like nodules, larger round or lobulated swellings, and 
 tumors, which are termed actinomycomata. Sometimes 
 they are very soft, of a sarcomatous consistence, and yellow- 
 ish-red in color ; others are apparently firm and solid, of the 
 consistence of a fibroma, and greyish-white in color ; occasion- 
 ally they are spongy. They consist of a connective-tissue 
 stroma permeated with many nodules the size of a millet-seed 
 to that of a pea ; on the surface of the swelling these nodules 
 present a shiny appearance. The nodules have the microscopic 
 structure of a granuloma (round-celled infiltration with the 
 formation of giant-cells), they contain the sulphur-yellow, 
 sand-like actinoniyces fungi, the}' may also become confluent 
 and form larger nodules. In purulent degeneration of actino- 
 omycoma (mixed infection with pus-bacteria) so-called cold 
 abscesses are formed, these may be small or large and are 
 surrounded by very soft granulation-tissue. 
 
 Bacteriology. — According to Bostrom, pure cultures of actin- 
 omyces are best obtained by pulverization of the gland, and cultivation 
 upon coagulated blood-serum. They present the following character- 
 istics : first there are developed thin, gelatinous membranes, they are 
 formed of fine, transparent threads, and through a deposit of small white 
 particles containing numberless cocci and fibrillse they assume an appear- 
 ance of having been dusted with chalk. After two weeks the 
 centers of the white particles become yellowish, red, or brick- 
 red, the particles themselves become confluent; the periphery grows 
 
ACTINOMYCOMA 155 
 
 in the form of a transparent greyish-white layer. Old cultures become 
 wrinkled and hard. The fungus grows in a similar manner on agar> 
 glycerin-agar, and gelatine ; on potatoes it forms grey, yellowish, and 
 finally white granules. It also grows in the absence of air (facultative 
 anaerobic fiangi). Inoculation of the cultures into animals is not usually 
 followed by results. Wolff, Israel, and Johne are the only ones 
 that have developed inoculation-actinomycosis from cultures. 
 
 According to recent investigations actinomycosis occurs in several 
 varieties in both men and animals. Gasperini was the first to demon- 
 strate that actinomycosis in cattle could be produced by various varie- 
 ties of the fungus (sulfurens, albus, luteo-roseus). According to L,ig- 
 nieres and Spitz in Argentina there occurs an actinobacillosis 
 in addition to genuine actinomycosis. The bacillus does not take 
 Gram's stain ; clinically it is characterized by disease of the 
 lymph-glands (which is seldom sfeen in the genuine form) , and a grayish- 
 white color of the glands {in contrast to the yellow). Jelenewski 
 has discovered a specific "Actinomyces labiatusbovis" in actinomycoma 
 of the lips. Levy, Bruns, and others have further claimed that 
 several varieties occur in man (terobic and anaerobic), and that actin- 
 omyces bo vis and hominis, especially, are not identical. 
 According to Wolff and Israel, however, the acceptance of various 
 ray-fungi is incorrect; they explain the difference in size, etc. , by 
 variations in age, and the duration of the disease. 
 
 Occurrence. — One most frequently finds actinomycoma 
 in cattle in the mucous membranes of the m o u t h 
 and pharynx, in the tongue, in the maxillary 
 bones, in the skin, in the parotid glands, and in 
 the udder. Occasionally actinomycosis appears in a gen- 
 eralized form. The disease is most frequent in cattle; 
 horses, swine, and sheep are occasionally affected ; it is less 
 frequent in cats and dogs. 
 
 Actinomycoma of the Tongue. — In the tongue acti- 
 nomycosis is usually multiple and disseminated ; connective- 
 tissue proliferation is abundant (indurative, and acti- 
 nomycotic glossitis, actinomycotic schlero- 
 sisormacroglossia, so-called wooden-tongue). 
 The tongue is very much enlarged and deformed, occasionally 
 it is shapelessly swollen, and of a very firm, hard consistence. 
 On the mucous membranes of the inferior and lateral surfaces 
 one observes sharply circumscribed, somewhat 
 prominent brownish spots, spherical in form; 
 
156 ACTINOMYCOMA 
 
 through these there shine very small yellow- 
 ish nodules. Actinomycotic nodules are also 
 present in great numbers within and beneath the 
 mucous membranes, as well as between the 
 muscular fibers, they are firm, fibrous, round- 
 ish nodules, and vary in size from a millet- 
 seed to that of a pea ; in the center they consist of a suppura- 
 tive, caseous, calcified, or mortar-like mass. When cut the in- 
 durated connective tissue of the tongue is found to be lardaceous, 
 hard, and even crepitating. The lymph-glands of the 
 tongue also contain the above described nodules, as well as 
 abscesses in the form of yellow, sand-like, antinomycotic foci 
 containing pus. Actinomycotic erosions are also occa- 
 sionally found on the dorsal surface of the tongue, they form 
 epithelial defects where the body of the tongue passes over 
 into the point. Brownish actinomycotic nodules occur on the 
 gingivae as well as on the inner surface of the lips 
 (K 1 e p z o w) . On the ventral surface of the oral cavity actin- 
 omycotic proliferations of the mucous membranes occasionally 
 present the appearance of a ranula (H oh en 1 e i t er). A 
 few cases of actinomycosis of the tongue have been observed 
 in the horse (Truelsen, Gruber, Zschokke, 
 Novotuy, Struve, and others). Schilling has de- 
 scribed one case in swine. 
 
 Actinomycosis of the Maxili^arv Bone:s. — Actin- 
 omycotic ostitis of the superior and inferior maxillae 
 was formerly known as "winddorn" "spina ventosa," 
 "bone- worm," "maxillary tumor." It arises from superficial 
 granulations on the gums and mucous membranes in the 
 vicinity of the teeth. At first there exists an actinomycotic 
 periostitis ossificans with the formation of osteo- 
 phytes. If the actinomycoma also involves the bone-marrow, 
 there develops &n actinomycotic granular osteomye- 
 litis and rarefying ostitis (myelogenic actinomycosis), 
 with atrophy of the osseous framework and the formation of 
 great hollow cavities. Both processes lead to severe swell- 
 ing of the superior and inferior maxillae. 
 Frequently the actinomycotic granulation-tissue a.ssumes the 
 
ACTINOMYCOMA 157 
 
 form of a sarcomatous proliferation ; it may then pass in the 
 direction of the gums, the molar teeth, the skin, as well as 
 into the maxillary and frontal sinuses. In the horse central 
 actinomycoma occurs in the inferior maxilla with loosening of 
 the teeth. The disease also occurs in the form of an epulis-like 
 extensive actinomycoma of the dental alveoli in the inferior 
 and superior maxilhc (Pilz, Geiger, .Schwarz, and 
 others). Central, myelogenous actinomycoma is also o?j- 
 served in other bones: in the sterum, in the dorsal 
 vertebrae, cervical vertebrae (spinal pressure- 
 paralysis in the cow), in the ribs, in the tibia, in the 
 metatarsus (lameness). 
 
 Actinomycoma ok titjc Pharyncjkal Cavity. — In this 
 place it ffjrms fungus- like, polypoid, soft tuber- 
 cles or nodules; they are attached by short 
 pedicles, and vary in size from a pea to that of 
 one's fist. They usually proliferate from the pharyngeal 
 mucous membranes on the superior wall beneath the sphenoid 
 bone (anterior pharyngeal actinomycoma), they may arise 
 from tlie posterior wall of the pharynx in the vicinity of the ep- 
 iglottis (post e ri o r pharyngeal actinomycoma). They may 
 lead to dyspnea or asphyxia. Formerly they were termed 
 "pharyngeal Imyphomata" or "esophageal fibromata." Simi- 
 lar nodules are found on the mucous membranes of the esoph- 
 agus, in the larynx, in the trachea, and on the mu- 
 cous membranes of the trachea, nose, and vagina, 
 as well as on the mucous membranes of the digestive appa- 
 ratus. In Russia actinomycoma of the lips is es- 
 pecially frequent (more than 40 to 80 per cent of all cases) 
 (Jelenewski). 
 
 Lymph-gIvAnd Actinomycoma. — This is a secondary, 
 meta.static process, a sequela of primary affection of the oral and' 
 pharyngeal cavities. The sub parotid and intermax- 
 illary lymph-glands are most often affected in the form 
 of round or oval, firm nodules ; they are painless and vary in 
 size from a walnut to that of one's fist. In horses these actin- 
 omycomata occur in the intermaxillary lymph-glands where 
 they attain the size of a hen's egg or goose-egg; when unilateral 
 
158 ACTINOMYCOMA 
 
 the5^ give rise to suspicion of glanders (Bar an ski, Pilz, 
 R a s m u s s e n , Schmidt, H a r 1 1 ) . In a case described 
 by S cli m i d t all the lymph-glands of the head and neck, as 
 well as the bronchial glands, were swollen as large as a fist 
 and permeated with actinomycotic foci. In a case of suspected 
 glanders in the horse H a r 1 1 found the entire intermaxillary 
 region filled with a firm, flat swelling, it even extended to the 
 cheeks ; a finger-thick lymph-vessel cord extended to the 
 angle of the mouth, hard nodules were present at intervals 
 along the cord, they were from the size of a nut to that of an 
 egg ; hard nodules the size of a bean were also found in the 
 upper lips and in the region of the parotid. Microscopic ex- 
 amination of the extirpated gland revealed masses of ray-fungi. 
 The salivary glands are also occasionally affected. 
 
 ACTINOMYCOMA OF THE SkIN AND SUBCUTEM. — These 
 
 are primary (infection through a skin-wound) and secondary 
 (outward penetration of deep foci), on the head, neck, ud- 
 der, scrotum, in the region of the elbow and shoulder, as well 
 as on the abdominal wall. They either form nodules from the 
 size of a hazel-nut to that of one's fist, or fungoid, fleshy- 
 red, soft granulation masses ; the latter are either covered with 
 pus, or with dry brownish crusts. Occasionally the adjacent 
 skin undergoes an extensive phlegmonous swelling and schler- 
 osis. Daughter-nodules frequently form in the vicinity of an 
 old focus. Keratogenous formations are less common fS c h r e i- 
 ber). Subcutaneous actinomycoma is accompanied bj^ the 
 presence of fistulous openings. In a case described by H a r 1 1 
 a horse suspected of having glanders presented the following 
 symptoms : subcutaneous swellings in the flank and on the 
 ventral surface of the abdomen ; these areas were covered 
 with ulcer formations, abscesses and sanguino-purulent secre- 
 tions ; numerous actinomyces fungi were found in the indurated 
 abdominal muscles. Meier observed actinomycotic cutaneous 
 nodules as large as a hazel-nut in the saddle region of a horse. 
 Occasionall}'^ actinomycotic proliferations are observed on the 
 anterior surface of the carpal-joint in cattle (one form of so- 
 called knee tumor in working oxen). Actinomycoma has also 
 been found in castration wounds of both male and 
 
ACTINOMYCOMA I59 
 
 female pigs, as well as in the spermatic cord of castrated 
 horses and cattle (Rasmussen, Ma/.zarella). Accord- 
 ing to Burke the so-called Madura foot of ele[)hants is an 
 actinomycosis of the skin. 
 
 AcTiNYOMCOSis OF THE Udder. — This form is most often 
 seen in swine, it is also observed in cows. In the udders 
 of swine one finds numerous nodules, they are imbedded in a 
 firm, fibrous tissue ; in size they vary fr(jm a pea to that of a 
 walnut ; they may contain pus, or form large abscesses which 
 occasionally break through the skin. In cattle one observes 
 soft purulent nodules with fibrous induration 
 of the surrounding tissue; they vary in size from a 
 pea to that of a goose-egg, they may be confined to one or 
 more quarters, and occasionally they break through the skin 
 forming ulcers and fistulous tracts. Disseminated actinomy- 
 cosis of the udder is less common, in this case the entire udder is 
 severely swollen, and becomes hard and rough ; the cut surface 
 reveals numberless soft yellow flecks which vary in size 
 from a millet to a hemp-seed, they contain small ])urulent foci 
 in reddish nodules (B a n g, J en se n, Rasmussen, Kitt). 
 
 Actinomycosis of the muscles is of secondary origin 
 from penetrating cutaneous actinomycoma ; R a s s m u s s e n 
 has described one case of actinomycotic di.sease of the muscles 
 of the elbow and shoulder. Gorig has observed a case of 
 actinomycosis of the testicles in a bull, which developed after 
 an injury to the scrotum. In dogs, local actinomycotic affec- 
 tions (tumors, abscesses, fistuke) often accompany j)leuritis 
 and peritonitis (BahrJ. Actinomycoma of the internal or- 
 gans n u n g s, liver, spleen, kidneys, brain, dia- 
 phragm, uterus, b 1 a d d e r) is of no surgical importance. 
 
 Treatment. — Where operation is possible, extirpa- 
 tion with the knife is the best treatment, the same as in 
 other tumors. Actinomycoma of the tongue, as well as 
 deeply situated actinomycoma of the pharynx responds to the 
 external or internal administration of iodine, which is con- 
 sidered a specific for the disease. The action of iodine seems 
 to be directed to the tissues which surround the growth, as 
 actinomyces fungi flourish on media containing iodine. Kx- 
 
l6o ACTINOMYCOMA 
 
 ternally, iodine is administered in the form of tincture of 
 iodine, or as lyUgol's solution. The former may be painted 
 on the surface of the tongue, while Lugol's solution may be 
 employed in the form of parenchymatous injections into the 
 tissues of the tongue ; many scarify the tongue and then paint 
 with iodine solutions. For tumors that cannot be operated 
 iodid of potash administered internally is also alleged 
 to be a specific remedy. 
 
 According to Thomassen who, in 1885, was the first 
 to recommend the internal treatment with iodine, the following 
 results were obtained : for fourteen days the cattle were given 
 daily doses of six grams of iodid of potash dissolved in one- 
 half liter of water ; with a beginning of improvement the dose 
 was reduced to four or five grams. When the disease was 
 confined to the tongue and surrounding soft tissues, healing 
 averaged to occur at the end of fourteen days, improve- 
 ment was visible at the end of eight days. Numerous 
 demonstrations of the specific action of iodid of potash 
 have been made. (Fiirthmeyer, Bass, de Jong, 
 Ostertag, Deslex, Reeks, Perinni, Havas, Sou- 
 cail, Hohenleitner, Krug, Nocard, Schwabel, 
 Walther, Ehrhardt, Salmon, Bang, Jensen, and 
 others). In many cases iodid of potash is ineffective 
 (Immiger, Frick, Bouchet, and others). Bouchet, 
 for example, treated a horse anentire year with iodid of potash 
 (1500 grams in all) without results. In addition to the internal 
 administration of iodid of potash, it may be employed exter- 
 nally in the form of tincture of iodine, or Lugol's solution, 
 either in the form of painting on the surface, or parenchyma- 
 tous injections. The fact should not be overlooked, that 
 spontaneous reduction of actinomycoma, without previous 
 treatment, has occasionally been observed. Under certain 
 conditions, mere incision of the actinomycoya appears to be 
 followed by healing. Bossi has observed complete healing 
 in two cases of actinomycosis of the tongue in cattle that were 
 treated as follows : simple deep incisions of the tongue re- 
 peated three times at intervals often days, 
 
BOTRYOMYCOMA l6l 
 
 II. BOTRYOMYCOMA. 
 
 Etiology. — The name botryomycoma or myco- 
 fibroma indicates a chronic inflammatory proliferation of 
 the connective tissue ; it is due to the botryomyces fun- 
 gus that was discovered in 1884 (botryococcus, micro- 
 coccus ascoformans, micrococcus botryogenus). It is a fungus 
 formed of roundish cocci arranged in black- 
 berry-like clumps; it has received special investigation 
 from Rivolta, Johne, Rabe, Bollinger, Jensen, 
 Kitt, Hell, dejong, Poncet and Dor, Parascan- 
 d o 1 o, and others. Botryomycoma is a neoplasm that very 
 frequently occurs in the horse. Because of its size and ma- 
 lignancy it possesses as great surgical importance as actinomy- 
 cosis in cattle. I have, for example, operated not less than 
 400 cases in the 3'ears 1895-1903 in a surgical clinic of 8000 
 diseased horses. These included 175 shoulder tumors, 150 
 fistulae of the spermatic cord, and 75 other forms of botryomy- 
 coma. Botryomycosis, similar to actinomycosis, may be con- 
 sidered a wound infection disease in which the botryomyces 
 fungus gains entrance through small wounds in the skin, es- 
 pecially operation wounds (castration). Generalization is far 
 less common than in actinomycosis. Botryomycomata that are 
 very important from a surgical standpoint are most often found 
 in the following places: botryomycoma of the skin and 
 subcutem, of the spermatic cord, of; the udder, 
 of the nasal mucous membranes, and in the mus- 
 cles, it is less common in b o n e s. In addition to occurrence 
 in horses, botryomycoma has occasionally been observed in 
 cattle and swine, as well as recently in man. 
 
 Bacteriology. — Formerly the botryomyces fungus was considered 
 identical with ordinary pus-cocci, staphyloccus pyogenus aureus (Hell, 
 dejong, Galli- Valeric, Kitt). According to recent investiga- 
 tions of Parascandolo, and Poncet and Dor, the specificity 
 of the botryomyces fungus seems to be demonstrated. The inoculation- 
 experiments in horses, as well as the various bacteriological, physio- 
 logical, biological, and sero-diagnostic relations of both organisms 
 supply evidence against their identity. The botryomyces organ- 
 ism can even possess pyogenic properties — ability to 
 
1 62 BOTRYOMYCOMA 
 
 produce mycofibromat a — t hat are never possessed by 
 the staphylococcus. The staphylococcus forms goldish-yellow 
 cultures in any temperature ; the botryomyces organism, however, 
 develops cultures only at a temperature of i8°. Bacteriologically they 
 are alike in form ; they take the same stain with aniline dyes ; and their 
 grape-like arrangement in clusters is the same. Their development on 
 gelatine is not the same, their properties of immunization are also very 
 different. The pyogenic — not, however, the botryogenic — properties 
 are identical. 
 
 BoTRYOMYCOMA OF THE Skin. — This occurs in the form 
 of tumors that are partly solitary', partly multiple, and occa- 
 sionally scattered over the entire skin. It most often develops 
 in the saddle and harness regions, on the el bows, 
 tail, fetlocks, lips, and eyelids, in the region ot 
 the parotid, at the tarsal -joitit and scrotum. Their 
 size is extremely variable ; very often they are onlj' the size of 
 a pea to that of one's fist, occasional!}^, however, they assume 
 an enormous extension becoming larger than any other 
 tumor. At the elbow, in the region of the shoulder, as well 
 as at the fetlock, tumors have been repeatedly found that were 
 as large and larger than a man's head. Occasionally many 
 small nodules are arranged around a primary large nodule. 
 Their consistence is usually firm, at other times they are soft, 
 and may even show circumscribed areas of fluctuation ; occa- 
 sionally fistulous tracts lead into the substance of the tumor. 
 On the cut surface one finds sand-like deposits of botryomyces 
 fungi, as well as areas of liquefaction containing torpid gran- 
 ulation-tissue and small pus-cavities ; the latter are enclosed in 
 a tendinous, firm, schlerotic connective-tissue proliferation. 
 Large tumors proliferate from the skin into the subcutem and 
 into the organs that are more deeply situated. I observed one 
 case of actinomycoma on the back in the form of a fistula 
 of the withers. 
 
 BOTRYOMYCOSIS OF THE SPERMATIC CORD. MoSt CaseS 
 
 of so-called fistula of the spermatic cord in the 
 horse are to be regarded as funiculitis botr3^omycotica, specifi- 
 cally, as botryomycoma of the spermatic cord. Infection of 
 the castration wound takes place through the dust. The 
 stump of the spermatic cord begins to proliferate ; the tunica 
 
BOTRYOMYCOMA I 63 
 
 vaginalis undergoes a chronic induration, and adhesion takes 
 place between the two. They form a hard tumor that 
 varies in size from a man's fist to that ofa 
 man's head; in form it is shaped like a walnut. 
 The tumor may extend to the inguinal canal ; occasionally it 
 presents fungoid proliferations between the margins of the 
 wound (so-called champignon); it frequently encloses 
 one or more fistulous tracts, the latter open below in one or more 
 funnel-like, constricted, fistulous openings. The 
 fistulous openings discharge a purulent mass containing botry- 
 omyces fungi. In many cases the botryomycoma extends 
 from the spermatic cord to the sheath, the adjacent skin of the 
 limbs, and the ventral surface of the abdomen, so that there is 
 formed an enormous tumor several times the size of a man's 
 head. Bilateral fistula of the spermatic cord is common. In 
 extirpated preparations one notes the fatty, firm, ten- 
 dinous, light-grey, cut surface ; on this surface are 
 y ello wi s h -br o w n , torpid, m uco -puru 1 en t 
 areas of liquefaction; these areas contain the yel- 
 lowish-white, sand-like botryomyces colo- 
 nies, they may be seen with the naked eye. 
 
 BoTRYOMYCOsis OF THE Udder. — This form is common 
 in the mare (M oiler, Sand, Vennerholm, personal 
 observations) ; The udder is swollen, hard, shows 
 nodular induration, and fistulous openings, 
 as well as circumscribed abscess formation. 
 Typical botryomyces colonies may be recognized in the pus of 
 the fistulous tracts. According to my experience botryoniy- 
 coma of the udder is a very malignant tumor. Operative re- 
 moval is liable to be followed by recurrence ; for this reason 
 total amputation of the udder is recommended when the dis- 
 ease is confined to one half of the udder. They also have a 
 strong tendency to extend to the abdominal wall and to the 
 inner surface of the limb, extension is apparently rapid. I 
 have observed one case of this kind in which one half of the 
 udder was amputated two years before and the affection appar- 
 ently healed. Unterhossel has described a botryomycotic 
 neoplasm that weighed 35 kilograms ; it was located on the 
 udder of the mare. 
 
l64 BOTRYOMYCOMA 
 
 BoTRYOMYCOMA OF MuscLK. — Botryomycotic myositis is 
 especially common in the levator humeri in the form of so- 
 called shoulder abscess; it is \ also observed in the 
 abdominal muscles, the intercostal muscles, 
 and the lumbar muscles. Botryomycosisof the bones, 
 on the other hand, is apparently rare. In the case described 
 by Kitt, an adjacent botryomycoma was the cause of a rib 
 being transformed into a fungoid , osteoporotic mass. S t o r c h 
 has described a botryomycoma that exterded frcm the max- 
 illary sinus of a horse ; the new- formation arose from the 
 mucous membrane, and in two months had reached the size of 
 a child's head ; it caused swelling and asymetry of the maxil- 
 lary sinuses and frontal region, as well as dyspnea and uni- 
 lateral nasal discharge. 
 
 Generalized Botryomycosis. — In comparison with 
 actinomycosis this is very rare. In a case of fistula of the 
 spermatic cord of the horse observed by me botryomycotic 
 proliferations similar to the nodules of pearl-disease were 
 present in the lungs. Temp el and Bedel have observed 
 similar cases of metastatic formation on the diaphragm and in 
 the lungs (a botryomycoma of the uterus was the point of 
 origin in the former case). M'Faydean describes three cases 
 of generalized botryomycosis in horses affected with fistulse of 
 the spermatic cord (lungs, spleen). Kitt has observed a very 
 interesting case of botryomycotic endocarditis. H i 1 b r a n d 
 observed a case of botryomycosis of the kidneys (large tumor 
 in the vicinity of the right kidney, it was adherent to the colon 
 and rectum and filled with abscesses the size of hens' eggs), 
 with numerous botryomycotic abscesses the size of the head of 
 a stick-pin in the liver of ahorse. Kofler saw a primary 
 botryomycosis of the spermatic cord followed by metastases in 
 the lungs, in the muscles of the shoulder, the maxillary 
 muscles, and the kidneys. Tiirnau, when inspecting the 
 flesh of a horse affected with fistula of the spermatic cord, 
 found metastases in the lungs and liver. 
 
 Primary or secondary (metastatic) botryomycomata in the 
 lungs and other inner organs are seldom of surgical impor- 
 tance. A transplantation of botryomycoma of the lungs to 
 
BOTRYOMYCOSES IN MEN 1 65 
 
 the parietal pleura, and from there to the ribs has occasion- 
 ally been observed in cattle ; it led to granular ostitis, with 
 rarefaction and formation of costal fastiilae. Babe has described 
 a botryomycoma of the pelvic cavity that weighed 15 kilo- 
 grams ; it was complicated with fistulse having external open- 
 ings, as well as openings in the direction of the bladder. 
 
 BoTRYOMYCOSiS IN MEN. — In the past few years several cases have 
 been observed in men. P o n c e t and Dor (Paris Surgical Congress. 
 1897) reported four cases ; they were in the form of tumors on the 
 fingers, the thorax, and the elbows, they presented the following char- 
 acteristics : from a pea to that of a nut in size, pedunculated, fungoid, and 
 infiltrated with blood. Ten Siethof (Ref. Miinch. medWoch. 1898, 
 No. 15) saw in a man, who had been caring for a horse 
 affected with fistula of the spermatic cord(!), a dis- 
 ease of the palpebral conjunctiva that had the appearance of actinomy- 
 cosis ; it was accompanied by swelling and nodular formation. Typical 
 colonies of botryomycocci were found in the pus of these nodules. 
 
 Other cases have been described by IvCgrain, Sabrazes, 
 Laubie, Delor, Galli, Valerio, and Lenormand. 
 
 Treatment. — When possible, botryomycoma receives 
 operative treatment, the same as actinomycoma, this should 
 be as early as possible, and in the form of extirpation. 
 To guard against recurrence the incision should be carried a 
 certain distance from the tumor in tissue that is known to be 
 normal. Occasionalh' a botryomycoma is so multiple or so 
 large that operative removal at one time is impossible. Such 
 cases may be operated at different times. Siedamgrotzky, 
 for example, removed a large multiple botryomycoma from 
 the skin of a horse during six operations which covered a 
 period of three months. I have employed similar partial op- 
 erations. There are also cases which, on account of enormous 
 size or generalization, cannot be operated. 
 
 lodid of potash has been employed as a specific for 
 botryomycosis, the same as actinomycosis. Thomassen 
 gave horses daily doses of 10 grams of iodid of potash, the 
 spermatic cord was treated locally with tincture of iodine, after 
 a month the tumors were markedly smaller. S i e g m u n d 
 gave doses of 12 to 15 grams of iodid of potash three times 
 per day, so that the horse had 800 grams in all, 1200 grams 
 were given to another ; he reported satisfactory results. 
 
1 66 TUBERCULOSIS 
 
 Ostertag, Malkmus, and others, report similar results 
 from the use of iodid of potash. According to my own 
 experience and experiments the beneficial 
 action of iodid of potash has not been sup- 
 ported. In a horse affected with botrj^omycosis of the sper- 
 matic cord, the skin, the abdominal muscles, and the lymph- 
 glands, neither the internal administration of 325 grams of 
 iodid of potash, nor the subsequent intratracheal injection of 
 210 grams of iodate of soda, produced visible improvement. 
 The disease process had rapidly extended regardless of the 
 iodine treatment. Another horse with botryomycosis of the 
 spermatic cord was given 750 grams of iodid of potash during 
 a period of five months without visible improvement ; on the 
 other hand, he soon developed symptoms of chronic iodism. 
 The horse was operated and soon healed, Vennerholm, 
 K o n i g , and Winter have recorded similar failures of 
 iodid of potash in the treatment of botryomycosis of the udder. 
 Topper has also spoken against the iodid of potash treat- 
 ment ; he maintains that a trial is only indicated when the 
 diseased tissue cannot all be removed by 
 means of an operation. In any case it is not 
 correct to advise the owner of a horse against 
 the employment of an operation for the re- 
 lief of botryomycosis of the spermatic cord> 
 in preference to the iodine treatment, a more 
 certain and rapid healing results from oper- 
 ating as early as possible. 
 
 III. TUBERCULOSIS 
 
 Surgical Importance. While in human surgery tuber- 
 culosis of the bones, joints, and other external organs is of 
 great practical therapeutic importance, the same form in 
 domestic animals is of less significance. This is explained by 
 the fact that tuberculosis of the external organs is far less 
 common in animals than in man. Many valuable surgical 
 operations employed upon man — resection of tubercular joints 
 for example — are not practical in the lower animals. Finally, 
 tuberculosis is found principally in slaughtered animals (cattle, 
 swine); localized external tuberculosis is of slight importance 
 
TUBERCULOSIS 1 6 7 
 
 to the animal ; that form of external tuberculosis which is 
 secondary to a generalized type is incurable. 
 
 If, regardless of previous statements, tuberculosis of cattle 
 from a surgical standpoint is somewhat exhaustively consid- 
 ered in the following pages, it is due to the fact that such a 
 classification has never found place in text-books on veterinary 
 surgery. Like so many other chapters of surgical publications, 
 the one under consideration has been sadly neglected. If 
 tuberculous animals are excluded from surgical treatment, as 
 has already been explained, the diagnosis of tuberculous 
 changes, in itself, is of greatest importance, because of the 
 close similarity of many tubercular affections to disease pro- 
 cesses that may receive successful surgical treatment. Only the 
 following are mentioned here: differential diagnosis 
 of mastitis and metritis, tubercular arthrites and ten- 
 dovaginites as causes of diflferent forms of lameness, as well 
 as spinal tuberculosis as a cause of paralysis. In all 
 these cases an early diagnosis of a surgical affec- 
 tion as tuberculous, and therefore, incurable, 
 is of interest for the rapid repression of contagion (Oster- 
 tag' s method of repression), as well as of economic interest 
 to the agriculturist. With reference to the etiology and 
 pathogenesis of tuberculosis (tubercle bacillus) see text-books 
 on special pathology. 
 
 Tuberculosis of the Udder. — In cattle this is usually 
 secondary, due to emboli ; it is seldom primary (entrance ot 
 bacilli through the teats). Anatomically it may be a dissemi- 
 nated miliary tuberculosis, a tubercular mastitis, or a localized 
 tuberculosis. It usually presents the following symptoms : a 
 diffuse, symmetrical, painless, seemingly firm 
 swelling of the posterior quarters, with 
 swelling and enlargement of the supramam- 
 mar}^ lymph-glands. Later the swollen parts contain 
 large or small firm nodules, on palpation these appear 
 to be very hard. Other parts of the swollen udder gradually 
 become as hard as a board or stone. Occasionally the udder 
 becomes extremely large, the disease may extend from the 
 posterior to the anterior quarters. Diminution in size of the 
 
1 68 TUBERCULOSIS 
 
 udder, as shown in other chronic forms of inflammation, is 
 never seen in tuberculosis of this gland (Rabe). In con- 
 trast to other inflammations of the udder, the milk is at first 
 normal ; later it becomes thin, watery, mixed with floculi, and 
 frequenth- contains bacilli (Bang). Diagnosis is confirmed 
 by harpooning the udder (Nocard, Ostertag). Tuber- 
 culosis of goa t s is far less frequent. As yet only one case 
 has been observed in the horse (Parascandolo and de 
 M e i s) . 
 
 Tuberculosis of the Lymph-Glands. — Infection of 
 the lymph-glands occurs partly through the lymph-stream, 
 partly from the blood. Swelling and induration of 
 the tubercular lymph-glands is due to the deposit of tubercular 
 nodules, which afterwards become calcified, as well as to pro- 
 liferation of the interfollicular connective tissue. The follow- 
 ing glands produce forms of external surgical tuberculosis : on 
 the head , the lymph-glands in the vicinity of 
 the parotid; on the neck, the superior (retropharyn- 
 geal), middle, and inferior cervical glands; on 
 the anterior extremities, the shoulder and axillary 
 glands (shoulder lameness); on the posterior limbs, the 
 inguinal and popliteal glands; on the udder, the 
 pubic glands (supramammary glands) ; on the hips, the 
 external iliac glands. Tuberculosis of the following 
 glands belongs to the realm of inner patholog}' : those in the 
 thoracic cavity, bronchial, and mediastinal, as 
 well as intercostal and sternal lymph-glands; 
 those in the abdominal cavity, omental glands, lumbar 
 and sacral glands, as well as the glands of the 
 liver, spleen, and kidneys. Extensive enlargement 
 of the bronchial and mediastinal glands may lead to symptoms 
 of surgical importance when they press upon the esophagus, 
 causing symptoms of esophageal stenosis (chronic 
 tympany). The other internal glands are of no surgical sig- 
 nificance. Briickmuller has observed a case of tubercu- 
 losis of the thyroid gland in cattle. 
 
 J o h n e and R o d e r have described a case of tuber- 
 culosis of the glands of the shoulder in a horse, 
 
TUBERCULOSIS 1 69 
 
 it was in the form of a shoulder abscess. Nocard has dem- 
 onstrated, through extirpation and bacteriological examina- 
 tion, one case of tubercular disease of the intermaxillary 
 gland in a horse that was suspected of having glanders. 
 Rabe observed a case of tuberculosis of the intermaxillary, 
 subparotid, and superior cervical glands, with compression of 
 the larynx and high-grade inspiratory dyspnea ; the tubercular 
 tumor weighed 3J/2 kilograms. 
 
 Tuberculosis of the Skin and Subcutem. — This form 
 is very frequent in parrots, as a rule it is primarj^, in fifty per- 
 cent of all cases only the skin is involved (Eberlein). 
 Tuberculoma is found in the angle of the lids, on the eyelids, 
 and on the top of the head. Upon and beneath the skin they 
 form soft tumors from the size of a stick-pin to that of a hen's 
 egg, in form they are oval or round, they may also form k e r a- 
 togenous structures in the skin that are easily broken. 
 Occasionally one also finds small and large tuberculous 
 ulcers on the skin, in which large numbers of tubercle bacilli 
 are demonstrated. Cadiot observed an interesting case of 
 nasal tuberculosis in a cat, it was accompanied with extensive 
 ulcerous destruction of the skin, of the mucous membranes, and 
 the nasal and turbinated bones (Cf. Vol. III. Pg. 209 of this 
 hand-book). Tuberculosis of the skin is not common in cattle. 
 A few cases have been observed in cattle ; they were character- 
 ized by the formation of caseated or calcified nodules on cir- 
 cumscribed areas, or by the appearance of swellings the size of a 
 hazel-nut to that of a walnut or a man's fist over the entire sur- 
 face of the body. Afterwards these swellings became soft and 
 caseous, their contents contained tubercle bacilli (H ii 1 1 n e r, 
 Ivangdon, Degive, Stubbe, lyacaze, Hanozat, 
 Mischkin, Winter, M a c k e 1, and others). Godbille 
 and Nocard observed the following case of tuberculosis of the 
 subcutem in an ox : tubercular lymphangitis, with irregular, 
 subcutaneous tumors arranged in rows ; they were about the 
 size of a man's fist, and became fluctuating and ruptured on 
 the external surface of the right anterior foot. In a dog 
 M o 1 1 e r found a tuberculous ulcer on the throat, it was accom- 
 panied by swelling of the lymph-glands. In a cat he observed 
 
1 70 TUBERCULOSIS 
 
 subcutaneous tubercular nodules with swelling of the axillary 
 glands. Tubercular castration-cicatrices have been repeatedly 
 observed in swine (infection from men?). 
 
 Tuberculosis of the Mucous Membranes. — This is 
 most often found in cattle in the larynx and in the 
 trachea in the form of tuberculous neoplasms, ulcers, and 
 nodular hyperplasias of the mucous membranes, or tubercular 
 infiltration and abscess formation of the submucosa, the para- 
 chondrium, and the adjacent musculature. Tuberculosis of 
 the mucous membrane is common in parrots, it affects the 
 oral mucous membranes and conjunctiva in the 
 form of tumors and ulcers. Occasionally one observes in cattle 
 an ulcerative, tuberculous stomatitis and glossitis 
 ( M o u s s u) , as well as tuberculosis of the nasal mucous 
 membranes in the form of numerous conglomerate fatty 
 nodules on the nasal septum ; they vary in size from the head 
 of a stick-pin to that of a pea, and are accompanied with nasal 
 discharge and dyspnea (Z i m m er man, Strerathy, Bol- 
 linger, Kitt, and others). Johne and Eber have de- 
 scribed a case of tuberculosis of the mucous membrane of 
 the prepuce of an ox. Montfallet described a case of 
 tuberculosis of the tongue in swine. Tuberculosis of the 
 mucous membrane of the uterus in cattle is very common, 
 that of the vagina is less frequently affected. Tuberculosis 
 of the uterus presents the following appearance : the mucous 
 membrane is covered with yellowish-white tubercles, ulcers, 
 caseous foci, and abscesses ; the uterus contains a cloudy, 
 greyish-red, ichorous fluid (identical with a bacilli-containing 
 vaginal discharge), the serosa is covered with villous prolifer- 
 ations ; occasionally the uterus is very much enlarged, the 
 walls of the horns in particular become very thick, hard, 
 nodular, and covered with ring-shaped constrictions ; the ovi- 
 ducts often become thickened to the size of one's finger. The 
 sacral glands are usually enlarged and indurated. Tuberculosis 
 of the vulva usually exists at the same time : on the inner 
 surface one finds numerous indurated nodules the size of a 
 stick-pin, as well as ulcers the size of beans (Hess). Tuber- 
 culosis of the uterus is usually the result of tubercular peri- 
 
TUBERCULOSIS 171 
 
 tonitis, it is rarely embolic ; and is seldom the result of infection 
 at the time of copulation (DeBruin). 
 
 Tuberculosis of the Bones and Joints. — Tubercu- 
 losis of the bones is usually an incidental symptom of general- 
 ized tuberculosis, and is, therefore, embolic. In most cases 
 the primary seat is in the bone-marrow (osteomyelitis 
 granulosa, caries centralis tuberculosa); it is 
 characterized by the formation of greyish-red granulating foci 
 and lacunar liquefaction (caries) of the osseous tissue, with 
 central cavernous formation and caseation. In cattle and 
 swine tuberculosis of the bones is often found in the following 
 places : the dorsal vertebrae, lumbar vertebrae, 
 cervical vertebrae (especially the first and second 
 cervical vertebrze as a result of tuberculosis of the adjacent 
 retropharyngeal lymph-glands), the petro u s portion of 
 the temporal bone, the sternum, and the ribs; 
 it has also been observed in the ethmoid bone, frontal 
 bone, occipital bone, humerus, pelvis, femur, 
 on the tibia, and in other bones. A peculiar form of tubercu- 
 losis of. the middle ear (tubercular otitis media and in- 
 terna) is observed in swine, it penetrates towards the brain, 
 and develops from an infection of the pharyngeal cavity 
 (Schiitz, S i e d am gr ot z k y). The tubercular inflamma- 
 tion extends through the Eustachian tube, and then over the 
 tympanic cavity ; it develops a tubercular periostitis, ostitis, 
 and osteomyelitis, with rarefaction and necrosis of the bones, 
 in this manner the process may extend to the cerebral men- 
 inges, the cerebellum, and the medulla oblongata. The tuber- 
 cular aifection maj^ extend to the external auditory canal, 
 which becomes filled with a tubercular tumor. A secondary 
 tuberculosis of the brain may develop in cattle in a similar 
 manner from primary tuberculosis of the frontal bone (Kiin- 
 n a u, M o u s s u ) . Tuberculosis of the petrous portion of the 
 temporal bone in a dog has resulted in unilateral facial paraly- 
 sis (M o n t fal let). Hess has described a case of kyphosis 
 in a steer caused by tuberculosis of the lumbar vertebrae. 
 R i e c k observed a case of paralysis of the hind parts in a bull 
 caused by tuberculosis of the sixth cervical vertebra, it resulted 
 
172 TUBERCULOSIS 
 
 in severe swelling and compression of the cervical marrow. 
 Knoll has observed two cases of sacral paralysis in swine 
 following tuberculosis of the lumbar vertebrae. Teetz has 
 observed a case of paralysis in swine as a result of tuberculosis 
 of the first cervical vertebra, H e y n e has observed a similar 
 casein a cow (seventh cervical vertebra, first dorsal vertebra). 
 Schmidt saw a cow collapse with sudden paralysis ; it was 
 necessary to kill the animal, post mortem revealed tuberculosis 
 of a lumbar vertebra and the adjacent spinal marrow. H a u g 
 has described a similar case. Tuberculosis of the bones is 
 common in birds. Cases of tuberculosis of the lumbar verte- 
 brae, ribs, etc.. have been observed in horses, sheep, and goats 
 (Walley, Rasmussen, Magin). 
 
 Tubercular arthritis is occasionally found in cattle 
 in the hip-, elbow-, knee-, and carpal-joints (arth- 
 ritis pannosa, granulosa, and caseosa), compare with the 
 chapter on arthritis. It is most often seen in birds, especially 
 in the joints of the feet and wings; it also occurs in 
 swine in the tarsal- and carpal-joints. By feeding tubercu- 
 lous milk Nocard produced tubercular arthritis experimen- 
 tally in a cat. C a d i o t observed tubercular gonitis in a dog. 
 With reference to tubercular tendovaginitis and bur- 
 sitis at the carpal-joint (extensor carpi radialis), and knee- 
 joint (extensor digitorum pedis longus) of cattle, compare with 
 the chapter on tendovaginitis and bursitis. 
 
 Tuberculosis of the Musculature. — ^This is mostly of 
 an embolic nature (generalized tuberculosis), it is not common 
 and has no surgical importance. In the abdominal, thor- 
 acic and appendicular muscles one finds round, 
 firm, sharply circumscribed greyish-brown nodules ; occasion- 
 ally they are arranged in rows ; they may be miliary in form, 
 or attain the size of a lentil or baan. Tuberculosis of the 
 tongue in parrots is more common, where it not infrequently 
 leads to active tumor formation in this organ. Tuberculosis 
 of the tongue in cattle is less frequent (Laquerriere, 
 Godbille, and others); according toOstertag only one 
 case was found during a period of ten years in the abbatoirs in 
 Berlin. 
 
TUBERCULOSIS 1 73 
 
 Tuberculosis of the Eyes. — While tuberculosis of the 
 lids and conjunctiva is common in parrots, in cattle tuberculo- 
 sis of the eye is relatively rare. It usually develops in the form 
 of an embolic tuberculosis of the iris and choroid, 
 and leads to d est ru ct io n of the bulb, and transforma- 
 tion of the same into a granular or caseous mass. 
 In a three-year-old cow that was affected with tuberculosis of 
 the lungs, Roder found tuberculosis of the right eye. Hess 
 observed the following condition in a cow that was affected 
 with tuberculosis of the lungs : symptoms of suppurative con- 
 junctivitis, blindness, and atrophy of the bulb, first the left 
 and then the right eye became affected. Post mortem revealed 
 numerous white points in the anterior chamber, as well as 
 fibrinous iritis, and white caseated nodules the size of a millet- 
 seed. In a slaughtered tuberculous cow Winter found the 
 entire inner eye filled with a caseous mass ; nodules from the 
 size of a lentil to that of a pea were found on the schlera and 
 cornea, where they were arranged in masses. 
 
 In another case lentil-sized, yellow nodules were found on 
 the anterior surface of the iris, it was also covered with yellow 
 foci the size of the head of a stick-pin, the latter were arranged 
 on the inferior margin of the iris, and were adherent to the 
 cornea. In a third case the retina was covered with numerous 
 tubercular nodules. Ed elm an has described a tuberculous 
 neoplasm that was located within the bulb of a tuberculous 
 ox, it pressed the lens out of position and caused atrophy of 
 the vitreous humor ; the neoplasm possessed the consistency 
 of a sarcoma, it was divided into cavernous spaces which were 
 filled with a muco-purulent mass. Similar cases have been 
 described by Moncet, Matthieu, Hess, Ripke, and 
 Schmidt. Amaurosis resulting •from pressure on the 
 optic nerve from tubercular new-formations is less common 
 (Fumagalli). 
 
 Tuberculosis of the Testicles. — Many cases of this 
 type have been demonstrated in cattle and swine in the 
 form of enlargement of the testicles, and deposits 
 of numerous tubercular nodules, the nodules vary in size from 
 a millet-seed to a walnut (Per r on ci to, Lydtin, Kitt, 
 
It 74 TUBERCULOSIS 
 
 Johne, Fambach, Goring, Arens, Schmidt, and 
 others). In one case in swine the right testicle weighed 3^ 
 kilograms, the left 10 kilograms. Jensen has described a 
 case in the cat. Hess has observed a tuberculous tumor as 
 large as a goose-egg upon the e p i d i d y m u s of an ox. 
 Meyer and others have described cases of tuberculosis of the 
 spermatic cord, vaginal tunic, and vesiculse 
 seminales. Cadiot and Frauenholz have reported 
 cases of tuberculosis of the prostate in cattle and dogs. 
 The numerous cases of tuberculosis of the oviducts belong 
 to the domain of inner pathology. 
 
 Tuberculosis of the Brain and Spinal Marrow. — 
 Tuberculosis of the brain is not rare in cattle ; it occasionally 
 develops with symptoms of paralysis and conditions 
 which are of surgical interest from a standpoint of differential 
 diagnosis (paralysis of the facial, oculomotor, 
 optic, trochlearis, hemiplegia, staggering 
 movements, torticollis). Symptoms of sacral 
 paralysis and ataxia have been observed in tuberculosis 
 of the spinal marrow, tubercular neoplasms in the lumbar 
 marrow have been demonstrated by Johne, S t e u d i n g, and 
 others. 
 
 With reference to the treatment of tuberculosis, experi- 
 mental extirpation of the diseased portion may be employed, 
 as in man, (castration, ovariotomy). One may also experi- 
 ment with aseptic injections of sterilized iodoform, emulsion 
 of iodoform gl3^cerin (10 per cent). These are injected into 
 the diseased organs, for example, into dogs. 
 
 CONCREMENTS AND FOREIGN BODIES. 
 
 I. CONCREMENTS. 
 
 General Considerations. — The name concrement is 
 used to designate hard, stony excretions composed of the saline 
 and organic constituents of the secretions and excretions of the 
 
URINARY CALCULI 1 75 
 
 animal body. Only a small number of these concrements are 
 of importance in veterinary surgery. The majority, namely, 
 intestinal stones of the horse, hair balls in the rumen and 
 reticulum of ruminants, gall-stones, renal stones, and pan- 
 creal stones are essentially conditions of inner pathology ; as a 
 rule they produce only symptoms of internal disease, and, 
 with few exceptions', are not amenable to surgical treatment. 
 The following will receive brief mention : 
 
 1. Urinary calculi. 
 
 2. Intestinal calculi. 
 
 3. Salivary calculi. 
 
 4. Milk calculi. 
 
 5. Preputial calculi. 
 
 6. Free bodies in joints and tendon-sheaths. 
 Urinary Calculi. — These either exist in the kidneys 
 
 and the pelvices of the kidneys (renal calculi), or in 
 the bladder (cystic calculi), they frequently become 
 lodged in the urethra (urethral calculi). 
 
 They are formed from the urinary salts, and are composed 
 of calcium carbonate (carbonates), calcium oxalate (o x- 
 alates), salts of silicic acid (silicates), uric acid and 
 uric-acid salts (urates), and phosphates of ammonia and 
 magnesia (triple phosphates). The formation of uri- 
 nary calculi is favored by the presence of foreign bodies on the 
 one hand, especially the organic albumenous products of 
 inflammation of the mucous membranes of the bladder and 
 pelvices of the kidneys, around which , as a nucleus, the urinary 
 salts are deposited, and bacteria on the other hand, these cause 
 degeneration of the urinary products to ammonia (ammoniacal 
 urinary fermentation), thereby making possible the formation 
 of triple phosphates. 
 
 In the horse urinary calculi are composed largely of 
 calcium carbonate with traces of calcium oxalate, and iron. 
 Cj'stic calculi form egg-shaped or flat, hard, yellowish stones, 
 the surface is smooth, mulberry-like, or has the appearance of a 
 gland ; in size they vary from that of a walnut to one's fist 
 or larger. Frequently a few, and even many small calculi 
 are present in the bladder. By constant wear they produce 
 
176 INTESTINAL CALCULI 
 
 facet-like surfaces on one another ; in addition to these one 
 also finds a gravel- or sand-like sediment (urinary gravel, uri- 
 nary sand). The weight of cystic calculi varies between 
 10 and 1000 grams. Urethral calculi are similar in character 
 but smaller, they vary in size from a hazelnut to that of a 
 chestnut, and average from 10 to 15 grams in weight. They 
 are usually situated in the vicinity of the posterior border of 
 the ischium. 
 
 Cystic calculi m cattle possess the following character- 
 istics : they are usually numerous, small in size, from a lentil 
 to a pea, pearl-like, of a metallic goldish-5'ellow or goldish- 
 brown lustre, and covered with facets. In oxen and steers 
 they are usually found lodged in the S- shaped curve of the 
 urethra. They are composed of the carbonates or oxalates of 
 lime, or of silicates. 
 
 In dogs the cystic and urethral calculi are usually small, 
 from the size of a grain of sand to a pea, and they often 
 exist in large numbers. Solitary cystic calculi, from the 
 size of a hazelnut to a chestnut, are less common. From lying 
 against one another their surfaces are frequently smooth and 
 covered with facets similar to the cuboid, one often finds, how- 
 ever, a rough, gland-like, warty surface. Urethral calculi in 
 dogs usually become lodged in the gutter of the bone of the 
 penis, so that the entire urethra as far as the bladder is filled. 
 Occasionally one finds a sand-like incrustration of urinary sed- 
 iment on the mucous membrane of the urethra. The urinary 
 calculi of the dog are composed largely of urates, triple phos- 
 phates, and oxalates. 
 
 The treatment of urinary calculi is purely operative ; 
 it consists in incision of the bladder (cystotomy), and the 
 urethra (urethrotomy). 
 
 Intestinal Calculi. — In the horse these are formed in 
 the large intestines, by getting lodged in the rectum, or at the 
 point where the colon terminates in the rectum, they become 
 the cause of so-called calculous colic. They consist essentially 
 of the triple phosphates which are derived from the 
 phosphates of magnesia in the food (bran) and the ammonia 
 in the air of the stall. The phosphates of ammonia and mag- 
 
SALIVARY CALCULI 177 
 
 nesia frequently cr3'stalize around an oat, a nail, a button, a 
 grain of sand, etc., which serves as a nucleus. Their size is 
 variable, the large ones reach the size of a large nine-pins ball 
 and weigh from 5 to 10 kilograms. Intestinal calculi are of 
 surgical importance when they can be ^reached per rectum. 
 Operative removal by means of laparotomy and intestinal in- 
 cision is as good as hopeless. Felizet successfully removed an 
 intestinal calculus by this method ; on the other hand those 
 cases in the horse terminated fatally that were operated on by 
 Dollar, Rickards, and Hall. 
 
 Hair-balls (bezoare, phytobezoare, aegagropila) in the 
 rumen and reticulum of ruminants are composed of matted 
 hairs and plant fibers. In cattle they reach the size of an apple 
 to that of one's fist. When regurgitated they occasionally ob- 
 struct the esophagus producing symptoms similar to those of 
 foreign bodies in the esophagus (tympany). In these cases 
 operative treatment is indicated (probang, esophagotomy). 
 
 Salivary Calculi. — In herbivora these are found in 
 Steno's duct (horse, cow, ass). They consist largely of the 
 salivary salts, namely, calcium car bon ate (80 to 90 per 
 cent), besides phosphate of lime and organic material ; they 
 have a chalk-white or yellowish-white color and occasionally 
 reach a considerable size, when they become as large as a 
 goose-egg and weigh 500 grams. Solitary calculi are oval or 
 sausage-shaped, they are covered with numerous facets. A 
 foreign body is usually found in the center of thfei|ffelculus (oat, 
 etc.). They are removed by means of an operative opening in 
 the salivary duct, or through the mouth. The so-called dental 
 calculi on the teeth of horses and cattle are composed of the 
 same materials as salivary calculi, calcium carbonate is the 
 main constituent. — Calcareous concrements in the tonsils are 
 very rare. 
 
 Free Bodies. — The name free body (corpora 
 libera, corpora orj-zoidea, rice-like bodies, 
 chondroids, joint- mice) indicates an organic structure 
 in joints, tendon-sheaths, mucous bursae, 
 subcutaneous hematomata, and the guttural 
 pouches of the horse; these structures are variable in 
 
1 78 FOREIGN BODIE.S 
 
 character. More than a hundred chondroids have frequently 
 been found in the guttural pouch. They are composed partly 
 of coagulated, inspissated, hardened, calcified products of 
 inflammation, parth' of constricted neoplasms or desquamated 
 bone or cartilage. See chapter on diseases of the joints. 
 
 Milk-CaIvCULI. — This is a name that indicates concrements in the 
 milk-cysterns or in the teats. They are variable in form, yellowish-white 
 or grey in color, and about the size of an oat or bean. They consist of 
 calcium carbonate (90 per cent ) , casein, and fat. W e i 1 1 e has 
 described a case in a heifer in which 22 milk-calculi were removed at an 
 operation, their collective weight was 72 grams. — The so-called pros- 
 tatic calculi are similar concrements which are formed from the 
 sedimental deposits from the secretions of the prostate. — Preputial 
 Calculi. Concrements known as preputial calculi, or calculi 
 of the glans penis, are found in the preputial sac of horses and 
 boars. They are oval or lenticular in form, smooth or sharp, rough, 
 and formless. They consist largely of inspissated smega, occasionally 
 they cause retention of the urine (urinary colic). 
 
 II. FOREIGN BODIES. 
 
 General Considerations. — Aside from foreign bodies 
 that are formed within the animal body itself (concrements) 
 many other foreign bodies from without gain entrance to 
 numerous portions of the body. In some waj's they are of 
 more importance to internal medicine than to surgery, namely, 
 foreign bodies in the anterior stomachs of the ruminant (trau- 
 matic inflammation of the stomach, diaphragm, and heart). 
 In many cases they produce conditions that necessitate surgical 
 interference. To this class belong foreign bodies of the 
 mouth-cavity, the pharynx, esophagus, stom- 
 ach, intestines, the nasal cavities, the con- 
 junctival sac, skin, subcutem, muscle, and hoof. 
 
 Foreign Bodies of the Mouth Cavity. — These are 
 most often observed in dogs, cats, and horses, where they 
 cause symptoms of salivation, stomatitis, and difiicult mastica- 
 tion ; in dogs, under certain conditions, they even produce 
 symptoms similar to those of rabies. When such symptoms 
 exist in these animals careful examination of the mouth cavity 
 should not be omitted. The following bodies are found 
 
FOREIGN BODIES I79 
 
 between the teeth, in and under the tongue, in the gums, 
 in the mucous membranes of the cheeks, at the openings 
 of the secretory ducts of the salivary glands, etc. : pieces of 
 bone-s pi i n te rs, gr a in, pieces of wood, needles, 
 particles of straw, and other sharp bodies. Sometimes 
 the tongues of cats and dogs, as well as birds, become ligated 
 with pieces of string or hair, they may also become con- 
 stricted with pieces of the trachea, transverse sec- 
 tions of the aorta, rubber tubes, and iron 
 rings. In cattle, even green stalks of sharp, pointed barley 
 with long roots have been observed upon the tongue. Oats, 
 rye, awns, and particles of straw have been found in the ex- 
 cretory ducts of the salivary glands. These foreign bodies 
 pass out of the mouth cavity and sometimes follow a peculiar 
 course. Needles and grain-awns have been found in the cra- 
 nial cavities of horses and swine ; a piece of metal was found 
 in the Eustachian tube of a dog ; blades of straw and kernels 
 of grain in the orbital cavity and temporal fossa of a horse. 
 
 Foreign Bodies in the Pharynx and Esophagus. — 
 These are especially frequent in horses and cattle, where they 
 cause symptoms of pharyngitis, difficult deglutition, stenosis of 
 the esophagus, and even perforation of the esophagus. The 
 most important foreign bodies are bones, pieces of meat, 
 fish-bones, bacon-rinds, masses of fat, pieces 
 of tendon, potatoes, beets, appl es, pear s, pieces 
 of linseed cake, balls of food, eggs, sauerkraut, 
 plum-stones, pieces of wood, needles, pills, 
 teeth, forks, knives, spoons, coins, pieces of 
 cloth, hair-balls, broken pieces of whip-han- 
 dles and probangs, balls of oakum, and remains 
 of the afterbirth. Their removal is often very difficult. 
 Treatment consists in the administration of emetics (apomor- 
 phine, veratrin), agents which stimulate the secretions of the 
 salivary glands (arecalin, pilocarpin), passitig the probang 
 and esophagotomy. Those cases in which the foreign body has 
 penetrated the thoracic portion of the esophagus are incurable 
 (pleuritis) ; occasionally a foreign body causes an injury to 
 the anterior or posterior aorta resulting in internal hemor- 
 
l8o FOREIGN BODIES 
 
 rhage, or an aneurysm of the aorta. — In the guttural 
 pouches of the horse, aside from the chondroids which 
 reach the size of a chestnut to a hen's egg, there may be found 
 necrotic portions of the bone (os hyoides), as well as pieces of 
 food which occasionally fill the entire sac. In one case a 
 musket-ball three centimeters thick was found in the guttural 
 pouch of an old military horse (Rigot). In another case 
 fungoid growths of aspergillus fumigatus were found in the 
 guttural pouches (Ries). 
 
 Foreign Bodies in the Stomach and Intestines. — 
 The greatest variety of blunt and pointed foreign bodies are 
 found in the anterior stomachs of the ruminant, especially 
 in the reticulum of the ox. Pointed foreign bodies 
 penetrate the gastric wall, the diaphragm, pericardium, and 
 heart, causing a characteristic disease marked by chronic indi- 
 gestion and severe cardiac symptoms (traumatic carditis and 
 gastritis). In their wanderings the foreign bodies often pass 
 outwards through the skin, their passage is characterized by 
 the formation of phlegmons, abscesses and fistulae of the 
 thoracic and abdominal regions. The most common sharp 
 foreign bodies are: nails, pins, darning-needles, hair- 
 pins, sewing-needles, cobbler's needles, pieces of wire, sharp 
 remnants of iron and metal plate, screws, knives, shears, forks, 
 pieces of glass, splinters of wood, pieces of stone, sharp angular 
 pebbles, sharp pieces of lead, pieces of thorns, branches of 
 vines, steel umbrella-ribs, and broken umbrella-sticks. The 
 most common blunt foreign bodies are : stones, pieces of brick, 
 gravel, sand, coal, pieces of wood, cork, cabbage-stumps, 
 apples, pears, hair-balls, bullets, spoons, pieces of coin, leather 
 straps, soles of shoes, pieces of cloth, pieces of clothing, neck- 
 ties, strings, laces, buttons, frogs, toads, striped snakes, adders, 
 and poisonous plants. Surgical treatment of these foreign 
 bodies consists in the much-employed laparotomy and gas- 
 trotomy (incision of the rumen). Foreign bodies in the stom- 
 ach and intestines of dogs (bullets, coins, stones, cork, hair- 
 balls, pieces of teeth) are occasionally removed by means of 
 emetics and purgatives. Otherwise, when sj^mptoms of death 
 appear, they must be removed by means of laparotomy. The 
 
FOREIGN BODIES l8l 
 
 prognosis of enterotomy in the dog is not unfavorable ; it has 
 been employed with good results by Siedamgrotzky, 
 Frohner, Degive, Plosz, Krause, and others. Occa- 
 sionally foreign bodies in dogs and horses pass away spon- 
 taneously (champagne-cork in a dog, curb-chain in a horse). 
 It sometimes occurs that foreign bodies, especially coins, 
 remain in the stomach of a dog for a long time, even years, 
 without causing trouble. A five- frank piece remained in the 
 stomach of a dog for twelve years without giving rise to in- 
 jury, a top for one year (N ich oux . Cadiot). In addition 
 to the above foreign bodies, one finds the following in the 
 rectum of the dog and cat : hard feces, fish-hooks, ker- 
 nels of grain, and other bodies which gain entrance trom 
 without. In the urethra, kernels of grain and broken pieces 
 of catheters have been observed ; artificial ligatures have 
 been observed around the penis in dogs (ribbons, etc.). 
 
 Foreign Bodies in the Respiratory Tract. — The 
 following have been observed in the nasal cavities and 
 superior maxillary sinuses of the horse : pieces of 
 food and bone, sponges, wisps of straw, oakum, tampons, ' 
 pieces of wood, blackberry twigs, hog's bristles, apples, pieces 
 of bandage, and moulds (mucor spinosus). In the larynx 
 and bronchi have been found pieces of cartilage, as well as 
 portions of a tracheotomy-tube, aspirated stones, and grain- 
 awns. Rhinoliths are rare ; this t3'pe is usuallj^ seen in the 
 guttural pouches in the form of corpora oryzoidea. 
 
 Foreign Bodies in the Eye and Ear. — Foreign bodies 
 in the conjunctival sac, especially beneath the mem- 
 brana nictitans (kernels of grain, awns, pieces of wood), are 
 the cause of a unilateral purulent conjunctivitis. When a 
 unilateral blennorrhea exists, careful examination of the entire 
 sac for the presence of foreign bodies should not be over- 
 looked. Treatment consists in removal under the influence of 
 cocain. Foreign bodies in the external auditory 
 canal are usually in the form of parasites ; occasionally they 
 gain entrance to the middle ear (-tympanic cavity), bird-mites, 
 in cattle, mange-mites in rabbits, larvae of fleas, and fleas 
 
I82 FOREIGN BODIES 
 
 (simulium) in animals at pasture. In addition to these, 
 masses of secretions from the ceruminous glands, water, sand, 
 splinters, beards of grass, and gravel stones have been found. 
 
 Foreign Bodies in the Hoof. — N ails and fragments 
 of glass are most frequently found. They usually enter at 
 the lateral or median cleft of the frog. Nails sometimes pene- 
 trate the soles of cats and dogs. 
 
 Foreign Bodies in the Skin, Subcutem, Muscles, 
 Bones AND Internal Organs. — Bullets, needles, 
 splinters of wood, and other foreign bodies enter the 
 body through the skin. By acting as carriers of filth, dirt, 
 and other unclean material rich in bacteria, they set up sup- 
 purative and septic inflammations (phlegmons, 
 abscesses); when the foreign bodies are aseptic healing occurs 
 without reaction, especially without suppuration. 
 The latter is especially true of shot and bullets, which may 
 become encapsuled and remain in the body without causing 
 injur3^ Foreign bodies that are soft and composed of animal 
 tissues are resorbed by means of phagocytosis and liquefaction 
 (catgut, pieces of lung, liver and kidneys that are experi- 
 metally transplanted into the abdominal cavity). 
 
 Other foreign bodies would include the entrance of air 
 into the veins and heart, as well as phlebotomy instruments 
 that gain entrance to the heart by passing through the wounds 
 in the vein (funnel, blades of a lancet). It is a peculiar fact 
 that heart-muscle is relatively non-sensitive to injuries from 
 foreign bodies ; this is demonstrated in those cases of traumatic 
 carditis in the ox, where the function of the heart is not sus- 
 pended for weeks and months, although severe chronic changes 
 are taking place. With reference to retention of the 
 afterbirth see text-books on obstetrics. 
 
 Parasites. The following parasites, which may be considered as 
 living foreign bodies, are of surgical importance : 
 
 I. Coenurus cerebralis (the worm which causes staggers) 
 develops in sheep and cattle, occasionally in horses, dogs, and goats. 
 In the brain they result in symptoms of paresis, and occasionally pro- 
 duce local symptoms (amaurosis); in the spinal marrow they may cause 
 symptoms of sacral paralysis. Treatment of the cerebral bladder-worm is 
 operative (trepanation, puncture). 
 
FOREIGN BODIEvS 1 83 
 
 2. Oestrus ovis f gad-fly ) in sheep causes symptoms of chronic 
 catarrh of the nasal cavities, and the frontal and maxillary sinuses 
 (disease caused by the oestrus larvae). 
 
 3. Gastrophilis larvae occasionally produce proctitis in the 
 rectum of the horse, they, seldom cause injury in the pharyngeal cavity. 
 Gastrophilis nasalis is very rare in horses (nasal discharge, sus- 
 pected glanders). 
 
 4. Pentastomum taenoides (lingulata ttenoides) is para- 
 sitic in the nasal cavities of the dog (rarely in horses). They cause 
 symptoms of severe, sanguino-purulent rhinitis. 
 
 5. Hypo derma bovis (oestrus humanis) lives in the larval 
 form in cattle, where it causes boil-like swellings as large as a walnut in 
 the skin(cestrus abscesses). These are subcutaneous abscesses, and 
 they communicate with the surface of the skin by a small opening, 
 through which the larvae finally pass out. CEstrus abscesses have also 
 been observed in military horses and English sale-horses in the follow- 
 ing places : in the saddle -region, on the withers, on the buttocks, on 
 the neck and abdomen (Hell and others). In a case described by 
 Ducasse he found a larva of hypoderma (bovis?) one and one half 
 centimeter in length in the medulla oblongata of a horse affected with 
 paralysis. Treatment consists in incision of the abscesses. Chronic 
 connective-tissue proliferations occasionally develop around the dead 
 larvte, their consistence is very hard and they finally become calcified 
 (hypodermoliths of Caparini). 
 
 6. Filaria papillosa lives parasitically in the horse in the 
 anterior chamber of the eye, where it causes a severe inflammation of 
 the iris and cornea. It may be removed through an incision in the 
 cornea (Vandevelde, Monatshefte fiir praktische Tierheilkunde. 1895). 
 The same parasite is found in the horse in hydrocele, ascites, and 
 cryptorchids. 
 
 7. Filaria lachr5'^malis is a harmless parasite found in the 
 excretory ducts of the lachrymal glands, occasionally it appears to cause 
 a conjunctivitis of the lids. 
 
 8. Filaria (Spiropt e ra) ci c nin nati (s. reticulata) is a 
 cause of tendinitis of the suspensory ligament, it causes an incurable 
 lameness (Mauri). Occasionally they cause a fibroma-like neoplasm 
 in the vicinity of the flexor tendons, which reaches the size of a hazelnut 
 to a dove's egg(Fr6hner, Bartels). They are also found in the 
 tendon-sheaths of the flexor tendons, in the walls of the tibial artery, 
 and in the ligameutum nuchse ( I once found them in the latter place 
 when operating fistula of the withers) . One case has also been observed 
 in the subcutem of the horse (Bassi). 
 
 9. Filaria hemorrhagica (filaria irritans) develops in horses 
 at pasture, especially in Russia and Hungary. It is found in various 
 parts of the body (withers, shoulder, neck), where it forms hemorrhagic 
 
184 FOREIGN BODIES 
 
 cutaneous nodules the size of a pea, so-called granular dermatitis. The 
 parasite lives in the subcutaneous tissue and can be demonstrated by 
 means of an incision. In general, treatment is superfluous. (For details 
 concerning this organism see "Special Pathology and Therapeutics," 
 Friedberger and Frohner. vSixth Ed., 1904, Vol. I). 
 
 10. Filaria medinensis occurs, as in men, in the subcuta- 
 neous connective tissue of horses and dogs (Africa, India, Brazil). 
 
 11. Cj'sticercus cellulosae (measles) is occasionally seen in 
 the eyes of swine. In one case they were found in a tumor on the knee 
 of a dog (Meyerstrasse) .^Ec hinococci in the frontal sinuses of 
 the horse cause symptoms of empyema (Preuss. Mil. Vet. Bericht. 1898). 
 
 12. Strongylusarmatus is found in the thickened nasal mucous 
 membrane of the horse (L,ammers). It also causes peritonitic pro- 
 liferations on the tunica vaginalis of the testicles (Hinrichse n), and 
 is not rare in cryptorchids (personal observations). Strongylus-like 
 nematodes have also been observed in the membrana nictatans of pup- 
 pies in France and America, where they were the cause of a contagious 
 inflammation of the eyes (E m m e r z, M e g n i n ). 
 
 13. Spiroptera sanguinolenta produces cysts in the walls 
 of the esophagus in the dogs of Java, this results in stenosis. 
 
 14. Distomum hepaticum is occasionally observed in the 
 scrotum of the horse as an incidental condition during castration 
 (Hiller). 
 
 15. Sarcosporidia (psorospermia, Miescher's tubules) cause 
 symptoms of myositis in the horse ; compare with the chapter on diseases 
 of the muscles. 
 
 16. Horse-leeches (hemopis vorax) are occasionally found in 
 horses and cattle in the mouth-cavity, pharynx and larynx (pharyngitis, 
 laryngitis, chronic marasmus). 
 
 17. Ixodes ricinus (mites) induce circumscribed inflammation 
 of the skin of dogs; one case of acarus of the conjunctival sac has 
 occurred in dogs (lower border of the cornea) , it caused severe conjunc- 
 tivitis (Tierarzneischule in Pisa; Clinica veterinaria. 1897). 
 
 18. Simuliiim maculata, and Simulium ornata and 
 reptans cause inflammation of the skin and mucous membranes of 
 the head with severe swelling (dyspnea, asphyxia, poisoning) in animals 
 at pasture. According to Bergmann the best protective is creolin 
 in oil or fish-oil (i to 20). 
 
HERNIAS 185 
 
 CHANGES IN POSITION OF VISCERA. 
 
 I. HERNIAS. VISCERAL HERNIAS. 
 
 Natitre. The term hernia indicates the passage of 
 viscera from body-cavities without an injury 
 to the skin or mucous membranes. Changes in 
 position of the viscera which are accompanied by a rupture of 
 the covering skin or mucous membrane so that they are exposed 
 to the air are termed prolapse. While in a broad sense 
 the term hernia applies not only to abdominal viscera, but also 
 to lungs, brain, and muscle ; in a narrow sense one under- 
 stands by the term hernia, a change in position of the abdominal 
 viscera. According to the seat they are named as follows : 
 umbilical hernia, inguinal hernia, scrotal 
 hernia, ventral hernia, hernia of the flank, 
 femoral hernia, perineal hernia, rectal hernia, 
 vaginal hernia, diaphragmatic hernia, and 
 other internal hernias. 
 
 In every hernia the following parts are recognized : r. 
 The mouth (hernial opening), that is, the opening in the 
 abdominal wall through which the viscera pass ; 2, the hernial 
 sac, that is, the sac-shaped, protruded peritoneum covered 
 with skin or mucous membrane ; 3, the contents (intestine, 
 omentum, bladder, stomach, liver, uterus). The margin of 
 the mouth of the hernia is termed the hernial ring. The 
 hernial sac consists of a mouth, neck, body, and fundus. 
 According to the contents of the hernia one speaks of an 
 enterocele (intestinal hernia), epiplocele (omental 
 hernia), g as t roc e le (gastric hernia), entero-epiplo- 
 cele, cystocele, hysterocele (hernia of the uterus), 
 hepatocele, oopherocele. In addition to the essential 
 contents hernias contain a serous fluid, hernial water. 
 
 With reference to the mobilit}^ of the hernial contents, 
 they are classified as reducible (moveable, free), that is, 
 they may be pushed through the hernial mouth into the 
 abdominal cavity ; and irreducible (immoveable) , that is, 
 a hernia that cannot be returned. The immobility is due, 
 
1 86 SYMPTOMS 
 
 either to adhesions between the hernial contents and the 
 hernial sac, which is especially common in omental hernias 
 (immobility of the omentum); or to incarceration 
 (constriction, strangulation) of the prolapsed viscera, this is 
 especially frequent in intestinal hernias. 
 
 With reference to the causes of hernias, they may be 
 congenital or acquired (traumatic). 
 
 Symptoms. — i. A reducible hernia is characterized by 
 a large or small hernial swelling which occupies a char- 
 acteristic seat in the umbilical or inguinal region, etc. The 
 swelling is painless, is not characterized by a rise of tempera- 
 ture, and has a soft peculiar consistence ; the skin is moveable 
 on the surface, occasionally one may easily palpate intestinal 
 loops or pieces of omentum at its base. Percussion occasion- 
 ally gives a tympanitic sound (air in the intestinal loops); on 
 auscultation one can occasionally hear rumbling or gurgling 
 peristaltic sounds. On pressure the swelling be- 
 comes smaller and finally entirely disappears 
 in the abdominal cavity. Palpation of the abdominal 
 wall reveals the hernial mouth, it varies in size from a pea to that 
 of one's fist; in form it is round, oval or elongated, whenever a 
 hernia has existed for a long time the free margin of ring 
 becomes firm and tendinous. In rare cases the abdominal 
 sac becomes ossified in cattle. 
 
 2. Incarcerated hernia, especially in horses, is 
 first recognized by colic (strangulated inguinal hernia of 
 stallions) ; in dogs and swine one further observes vomiting, 
 and even stercoraceous vomiting; constipation is pres- 
 ent in all animals. On local examination one finds an 
 inflammatory swelling at the seat of the hernial 
 sac; attempts to return the hernial contents are unsuccessful. 
 
 Treatment. — One must differentiate between the treat- 
 ment of a reducible and an irreducible hernia ; the 
 reducible form may receive either provisional (palliative) 
 or definitive (radical) treatment. It should also be observed 
 that many forms of hernia, especially those of the umbilical and 
 ventral regions in horses and cattle, heal spontaneously 
 (cicatrization). On the other hand, many forms with a very 
 
TREATMENT 1 87 
 
 wide mouth (ventral hernia) are incurable, especially in 
 horses and cattle. Finally, many forms of non- incarcerated 
 hernias, especially those of the umbilicus, require no treat- 
 ment as they do not usually result in diseased conditions 
 (colic, etc.). 
 
 1. The palliative treatment of non-incarcerated 
 hernia consists in the application of an abdominal band- 
 age, this is especially useful for umbilical and ventral hernias 
 of dogs, foals and mares. The prolapsed viscera are pressed 
 back into the abdominal cavity by the abdominal bandage, 
 this is followed by a gradual diminution in size of the hernial 
 mouth. 
 
 Palliative treatment is further employed in the form of 
 return of the hernial contents by means of pressure and reduc- 
 tion of the hernial sac by means of artificially devel- 
 oped inflammation and cicatricial formation 
 in its vicinity. For this purpose the following agents have 
 been employed: blisters (calcium dicromate 1-8 or 10), 
 firing the skin of the hernial sac, applications of sulphuric 
 acid, nitric acid, chromic acid, as well as subcu- 
 taneous injections of alcohol, salt, and other 
 irritating materials. The efficiency of this method is still 
 questionable. At any rate it is not without danger. Gan- 
 grenous necrosis of the skin with prolapse of the intestines has 
 followed the application of acids ; subcutaneous injections 
 have been followed by severe phlegmons and fatal peritonitis. 
 Other palliative remedies are ligation, clamping, and 
 suturing of the hernial sac. 
 
 2. The radical operation consists in exposure of the 
 hernial sac (her nio torn y). The mouth of the hernia is 
 sutured with, or without, subsequent extirpation of the hernial 
 sac (inverted into the abdominal cavity). Herniotomy is the 
 surest method of treatment of a hernia because it not only 
 removes the hernial sac but obliterates the mouth. Experience 
 has taught that mere suturing, clamping, or binding the 
 hernial sac is occasionally followed later by the passage of 
 viscera through the remaining hernial mouth, this results in 
 the gradual formation of a new sac. 
 
l88 . PROLAPSE 
 
 3. Treatment of an incarcerated hernia 
 consists first in the return of the strangulated viscera (taxis) 
 through manual reposition, dorsal position, combined attempts 
 from without and inside the rectum, placing the hind limbs in 
 a special position to favor enlargement of the inguinal ring, as 
 well as deep narcosis of the animal by means of chloroform. 
 If reposition is not successful by this method, the constricted 
 hernial moth (implication of the tunica vaginalis) must be 
 enlarged by means of a hernial incision (h e r n io to m y ) , 
 taxis may then be successfully employed. The return of the 
 strangulated hernia must be preceded by careful disinfection, 
 as well as resection of any necrotic portion (intestinal suture). 
 In stallions, herniotomy of an incarcerated 
 inguinal hernia is usually followed by castra- 
 tion with the use of clamps and thecovered 
 operation. 
 
 II. PROCIDENTIA. PROLAPSUS. 
 
 Definition. — Prolapsus (prolapse) is a free 
 passage of viscera through natural or arti- 
 ficial body-openings without a covering of the skin 
 or mucous membrane. As a rule the causes are traumatic in 
 nature. Thus, rupture of the abdominal wall results in pro- 
 lapse of the intestines and other abdominal viscera ; severe 
 efforts at abdominal pressure, prolapse of the rectum ; stretch- 
 ing and relaxation of the uterine ligaments, prolapse of the 
 vagina and uterus ; penetrating thoracic wounds, prolapse of 
 the lungs ; severe wounds of the skull are followed by pro- 
 lapse of the brain ; bites of the eye, prolapse of the bulb ; 
 rupture of the vaginal wall, prolapse of the bladder ; paralysis 
 of the penis and tongue, proplase of these organs. 
 
 Prolapse should not be confused with e v e r s i o n (in- 
 version, inflexion) of a hollow organ (bladder, uterus), 
 or with intussusception (invagination) of a sec- 
 tion of the intestine or vagina into itself. Prolapsus vesicae 
 is a prolapse of the bladder through the ruptured vaginal floor 
 into the vagina, or outwards through the vulva ; inversio 
 
PROLAPSE 189 
 
 vesicae is an outward inversion of the bladder through the neck 
 of the bladder and the urethra. In veterinary science the 
 nature of prolapsus, inversion, and invagination is not always 
 sharply distinguished. So-called prolapsus recti is often pro- 
 lapse of the rectum with invagination ; so-called prolapse of 
 the uterus and vagina, an inversio uteri and vaginae with 
 prolapse. 
 
 Symptoms. — The symptoms of prolapse are extremely 
 variable according to the organs affected. 
 
 1. Prolapse of the intestines consists in the pro- 
 trusion of portions of the small intestines, colon, and even 
 caecum, through penetrating abdominal wounds, through the 
 inguinal canal after castration, or through a hernial ring after 
 herniotomy. It is always a very dangerous accident. Reposi- 
 tion must be accompanied by careful disinfection of the pro- 
 lapsed intestines, taxis is followed by accurate suturing, cas- 
 tration by the covered method may be necessary. 
 
 2. Prolapse of the omentum most often occurs 
 after castration, or following perforating abdominal wounds. 
 It is far less dangerous than prolapse of the intestines. Treat- 
 ment consists in careful disinfection, ligation, incision of the 
 stump, return of the stump, and careful suturing of the wound. 
 Castration by the covered method may be employed. 
 
 3. Prolapse of the rectum is partly a prolapsus 
 ani, partly a prolapsus recti, with or without invagination. It 
 is a result of abdominal pressure from straining, chronic 
 diarrhea, rough exploration, etc. It is most frequently ob- 
 served in dogs, cats, and swine, less often in horses. The 
 prognosis should be made with caution, reposition, regardless 
 of sutures, is frequently of no permanent value, so that one 
 must employ amputation of the prolapsed parts. 
 
 4. Prolapse of the vagina occurs in cattle as an 
 inversion of a portion of the vagina (incomplete prolapse), less 
 frequently in the form of an invagination of the entire vagina 
 with a simultaneous prolapse (complete prolapse). It may 
 follow traumatic influences as a result of parturition. A pos- 
 terior displacement of the uterus when accompanied by atony 
 of the uterine ligaments, so-called habitual prolapse, may occur 
 in cows which occupy positions with the hind parts the lowest. 
 
I go DISEASES OF BONES 
 
 5. Prolapse of the uterus is especially common 
 in cattle, it is caused by rough manipulations at the time of 
 birth ; inversion with prolapse is also due to continued strain- 
 ing. Reposition, and retention especially, is occasionally 
 difficult, so that amputation is sometimes required. 
 
 6. Prolapse of the penis is observed in paralytic 
 conditions, as well as in paraphimosis. Prolapse of the 
 tongue is either the result of rupture of the muscle, or 
 paralysis (it should not be confused with the ordinary blemish 
 in which the tongue is protruded). Prolapse of the bulb is 
 most often observed in dogs (pugs) as a result of bites ; treat- 
 ment consists in reposition or amputation. Prolapse of the 
 membrana nictitans is observed in tetanus. In ad- 
 dition to these are inversion and prolapse of the bladder, 
 prolapse the of pododerm, prolapse of the iris, prolapse of 
 the posterior corneal membrane through a corneal ulcer (k e r a- 
 tocele), forward protrusion of the cicatricial cornea 
 (corneal staphyloma). 
 
 The following internal changes in position of viscera are 
 of surgical importance ; torsion and ante version of 
 the uterus in cattle, twisting of the left colon on 
 its axis in horses. Twisting of the stomach on its axis 
 is occasionally observed in dogs, as well as luxations and 
 torsions of the spleen in swine. With reference to changes 
 in position of the uterus, and abnormal positions of the 
 fetus, see text-books on obstetrics. 
 
 DISEASES OF BONES. 
 
 I. BROKEN BONES. FRACTURES. 
 
 Preliminary Remarks on Anatomy and Physiology. — Normal 
 bone is composed of three principal constituents : the periosteum, the 
 genuine bone-substance (tela ossea), and the bone-marrow. From a 
 surgical standpoint the periosteum is of greatest importance in diseases 
 of bone, this is especially true of fractures. The bone -marrow 
 (endosteum), from a standpoint of veterinary surgery, stands next in 
 importance. In diseases of the bone the tela ossea plays a less 
 important part. 
 
FRACTURES IQI 
 
 For au understanding of the processes of healing, as well as various 
 pathological processes in the bone, it is necessar)^ to have a knowledge 
 of the physiological development as it occurs in the normal growth 
 o f b o n e. As a result of the embryological and histological investiga- 
 tions of Kolliker, Gegenbauer, Waldeyer, and others, it has 
 been demonstrated that bone may develop from periosteum, 
 bone-marrow, or cartilage. One distinguishes, then, a pe ri- 
 osteal, a myelogenic or endosteal, and an enchondral formation 
 of bone. The organs mentioned supply, first of all, a soft germ-tissue, 
 the marrow-tissue (osteoid tissue ) in which the osteoblasts, that is, 
 the specific bone-forming cells, then develop. The most important pro- 
 cesses are as follows : 
 
 1. Periosteal bone formation is similar to the perichondral 
 form which occurs in the fetus, that is, it develops from the inner osteo- 
 blastic cell-layer of the periosteum (so-called cambium or formative 
 layer) ; the outer layer of the periosteum has few vessels or cells, it is 
 rich in connective-tissue fibers, and plays no part in the development of 
 bone. The formative layer of the periosteum contains marrow-spaces 
 which have a rich cellular and vascular supply. A part of the former 
 are transformed into osteoblasts; calcium salts are deposited around 
 them and there is formed lamellar-like bone-tissue in which these cel- 
 lular elements are confined in sac-like cavities and are retained as so- 
 called bone cells. 
 
 2. Myelogenic or endosteal bone formation follows in a 
 similar manner, the boundary between the marrow and the tela ossea is 
 first supplied with osteoid tissue from the bone-marrow, this is followed 
 by the formation of osteoblasts and bone-tissue. 
 
 3. Enchondral bone formation is observed on the epiphyseal 
 cartilage of fetal bones ; it develops from the osteoblasts and marrow- 
 cells of the marrow-cavities in the cartilage. If the epiphyseal symphisis 
 is continually irritated (chronic inflammation, compound fractures, 
 blows from sticks) developing bone becomes abnormally long ( B e r g - 
 man, Tillman, and others). 
 
 In contrast to the bone-forming activity of the osteoblasts, there 
 stands the resorbing activity of the osteoclasts ; this is constantly 
 present in normal bone. The origin of these bone-solving, multinu- 
 clear, giant-cells has not yet been demonstrated by any method free 
 from objection (descendants of the osteoblasts? the white blood-cor- 
 puscles ? the endothelial cells of the vessels ? the adventitia or perithelial 
 cells?). According to Tillman the activity of the osteoclasts is as 
 follows : apparently they cause a solution of the calcium salts of the 
 bone by the formation of free carbonic acid, thus resorbing the osseous 
 matrix, in this manner small cavities or lacunae are formed in the bone 
 (lacunar bone resorption, Howship's lacunae). 
 
192 FRACTURES 
 
 Nature and Causes. — Broken bone or fracture 
 is a division of the continuity of the bone ; in contrast to a 
 bone-wound the external skin usually remains intact. 
 
 The causes of fracture are either external or internal. 
 Most fractures are due to external causes (kicks, blows, 
 falls, contusions) . One also differentiates between direct and 
 indirect bone fractures. A direct fracture occurs at the seat of 
 the trauma. An indirect fracture occurs at a distance from 
 the seat of the traumatic injury. Contusion- and com- 
 pression-fractures belong to the indirect form (fracture of 
 the vertebrae from falling on the hind parts); this is also true 
 of fractures due to torsion and bending (straining of 
 the first phalanx when caught in the rails, fracture of the 
 vertebrae when cast) , and traction- or strain-fracture 
 (fracture of the calcaneum due to pulling of the achilles tendon 
 when falling upon the strongly flexed hind limb). Frac- 
 ture bycontrecoup or contra-fracture is classified among 
 the indirect forms, it occurs according to the principle of 
 contra-fissure (fracture of the sphenoid bone by falling on the 
 mouth, fracture of the internal angle of the ilium by falling on 
 the tuberosity of the ischium). 
 
 Fractures may occur in the absence of all external trau- 
 mata, merely through internal causes, especially as a 
 result of increased muscular contractions. So- 
 called spontaneous bone-fracture is most frequently observed 
 when casting horses ; it is due not merely to falling, but occurs 
 as a result of pronounced muscular contraction while the 
 animal is lying or balancing ; contraction of the longissimus 
 dorsi results in a dorsal or lumbar fracture ; severe exertion of 
 the retained hind limb, fracture of the femur, tibia, or meta- 
 tarsus ; severe struggling against retention of the anterior 
 limbs may result in a fracture of the scapula or humerus. 
 Spontaneous bone- fractures occur even in horses that are 
 standing ; the lumbar vertebrae may be fractured by suddenly 
 stopping or turning a horse (Trasbot), violent kicking with 
 both hind feet (H a u b n e r), while galloping (W i 1 1 m a n), 
 when rising ( M o u s s u) ; the humerus when traveling rapidly, 
 sudden turning of the horse by the rider, and heavy pulls 
 
ABNORMAL FRAGILITY I93 
 
 (Flook, Penberthy, Ernes, Lagrifoul); the pelvis 
 and tarsus by supporting the body weight on one hind limb 
 when slipping (personal observations); other bones of the 
 hind limbs as a result of severe contraction of the extensors 
 when kicking (J o 1 y ) ; the pisiform bone in heavy draft-horses 
 (M oiler); the lumbar vertebrae, femur, and tibia dur- 
 ing extraction of the teeth while the animal is standing 
 (Eber 1 ei n). 
 
 In many cases neither external nor internal influences can 
 be demonstrated as causes of bone-fracture. The so-called 
 i d i o p a t i c fractures must be explained by an abnormal fra- 
 gility of the bones (f r agil i t as ossi u m, osteopsathyrosis). 
 Idiopathic fractures are not uncommon in horses and cattle. 
 The fragility is due either to certain pathological con- 
 ditions of the bones, especially osteomalacia, rachitis, 
 rarefying ostitis, bone caries, sarcoma (nielanosarcoma), and 
 tuberculosis ; or to certain predisposing influences, old age 
 (senile atrophy), standing in the stall for a long time 
 when convalescent from some disease (atrophy of inac- 
 tivity); extreme youth (juvenile bones, intra- 
 uterine fractures); disease of the nervous system, es- 
 pecially that form which occasionally follows neurotomy 
 (trophoneurotic bone-atrophy); restricted mo- 
 bility in the joints (anchylosis of the vertebral 
 column in the horse sometimes results in fracture of the 
 vertebrae). Occasionally no cause for the fracture can be 
 found, regardless of a careful examination. These cases one 
 must account for by individual variations in the solidity 
 and elasticity of the bones of different animals. A heredi- 
 tary fragility of the foals of certain mares has also been 
 observed, it is characterized by numerous fractures. 
 
 Abnormal Fragility.— Without the acceptance of this condition 
 many cases in veterinary practice are unexplainable. This is espec- 
 ially true of those fractures of the spinal column in horses, which, r e- 
 gardless of the most careful precautions, frequently 
 occur when the animal is being cast: they are more com- 
 mon than is generally supposed or published. Experience has shown 
 that old horses are especially predisposed to this form of fracture (cast- 
 ing for operations on the teeth, extirpation of the lateral cartilage). If 
 
194 
 
 FRACTURES 
 
 these fractures are less frequently observed in many countries and 
 clinics than in others, it is, according to my judgment, due not only to 
 the various methods of casting but to the differences of race and conditions 
 of nourishment. Further, this class includes those cases of multiple 
 fracture in one and the same animal. In a cow affected with osteoma- 
 lacia the pelvis was fractured no less than fifteen times (Maris). In a 
 sound horse that suddenly became lame after a few jumps when gallop- 
 ing, the sesamoid bones were fractured in all four limbs iRu t he r f o rd). 
 A stallion fractured both femurs during a castration (Haselbach). 
 One horse fractured all four of the second phalanges at the same time 
 ( Henon ) ; another fractured three suffraginal bones ( R od e r ) ; many 
 others have fractured two of the first or second phalanges (Wend- 
 worth, MoUer, personal observations). An abnormal fragility of 
 the ribs and vertebrae has also been repeatedly observed in horses 
 (Degive, Thiimmler, and others). 
 
 The causes of abnormal fragility of bones in old horses are usually 
 considered to be a senile atrophy of the bones, atid in young 
 horses a rarefying ostitis. Recent investigations by French veter- 
 inarians have resulted in an explanation of this problem. J o 1 y and 
 Vivien (Recueil. 1901 ) found the typical changes of rarefying ostitis 
 in a first phalanx that was fractured while the animal was going at an 
 ordinary trot. On macroscopic examination a rapid, artificial solution 
 of the lime salts of the fractured bone was easily recognized when com- 
 pared with the corresponding bone of the other foot. Microscopic 
 examination of the fractured bones revealed numerous and extensive 
 dilitations of the Haversion canals (rarefying osititis); the articular 
 cartilage was secondarily involved (atrophy, penetration of the cartilage 
 with vascular loops). In two cases of fracture of the lumbar vertebrae 
 jn horses Jacoulet and Vivien found rarefying ostitis with vascular 
 dilitation (redness) , liquefaction of the fatty substance (float in water )^ 
 and porosity. 
 
 Classification. — From a practical standpoint the 
 most important division is into simple (subcutaneous) and 
 com p ou n d (open) fractures. Simple, subcutaneous frac- 
 ture is a fracture of the bone without an injury to the skin. 
 In contrast to this a compound fracture is accompanied by a 
 skin-wround, so that the bone is exposed and entrance of 
 infection is possible. 
 
 Further, a classification into complete and incom- 
 plete fractures is important. In the former the bone is 
 broken across its entire diameter at the point of fracture, so 
 that the ends are not attached to each other. The separation 
 is only partial in incomplete fracture, there is only a cleft or 
 
FRACTURES I95 
 
 Ifissure, that is, a split in the bone (fissure, longitudinal 
 fractu re), or an infraction or bending (in fr act io n, im- 
 pression, depression, subperiosteal fracture, 
 green-stick fracture). Fissures most frequently occur 
 on the first phalanx and on the tibia ; infractions, on the ribs; 
 impressions, on the bones of the skull. Fissures are often 
 transformed later into compound fractures. 
 
 According to the direction of the broken line one distin- 
 guishes transverse fractures (fractura transversa); 
 oblique fractures (fractura obliqua); longitudinal 
 fractures (fractura longitudinalis); spiral fractures 
 with a wound-line that takes the form of a screw ; fractures 
 in the form of the mouth-piece of a clarionett (fracture en 
 bee de flute) ; Y-shaped fractures; and T-shaped 
 fractures (on the first phalanx). 
 
 According to the position of the broken fragments in 
 complete fractures various kinds of dislocation are recognized ; 
 namely , dislocatio ad axin (angular fracture) ; a d 
 latus (lateral or transverse displacement); ad periph- 
 e r a m (rotation) ; ad longitudinam, either with i m p a c- 
 tion (shortening), or separation (increase in length) . 
 Impaction is likewise a form of longitudinal dislocation 
 with contraction ; diastasis is an opposite condition. 
 
 Further, in contrast to a simple fracture, in which the 
 bone is broken only once, one speaks of a multiple fracture 
 (fractura multiplex), double fracture, triple fracture, 
 etc. They are observed especially on the first and second 
 phalanges and on the epiphyseal ends. When the bone is 
 broken into small fragments it is termed acomminuted or 
 spli nte r- fracture (fractura comminuta); when a splinter- 
 fracture is characterized b}- complete crushing of the bone it is 
 termed a conquassion fracture (fractura conquassata). The 
 latter occurs, for example, in vertebral fractures when casting 
 horses. 
 
 Partial bone fracture, which is not uncommon in vet- 
 erinary practice, is of importance. Certain portions of the 
 bone are broken, not the entire bone. These occur in the fol- 
 lowing places : on the lateral tubercles and tuberosities of the 
 
196 FISSURES 
 
 humerus ; on the trocanters of the femur ; the spine of the 
 scapula ; and the oblique and transverse processes of the ver- 
 tebrcC. especiailly the cervical and lumbar vertebrae. 
 
 Fissures. — These are of great practical importance, because in 
 horses their occurrence is especially frequent, diagnosis is very diffi. 
 cult, and many cases are finally transformed into complete fractures. 
 In addition to the first phalanx and tibia, fissures are found in the 
 vertebrae, in the scapula, humerus, radius, metacarpus and metatarsus, 
 femur, second phalanx, os pedis, in the ulna, etc. Fissures are fre- 
 quent in the vicinity of gun-shot-fractures (penetrating shots). A 
 peculiarity of fissures is that after a certain time, often several days, 
 they are transformed into complete fractures, this has been repeatedly 
 observed in practice. Usually it is unexpected, and occurs during the 
 night, when the animal is rising or lying down, on raising the hoof to 
 be shod, etc., this is especially true of the tibia and first phalanx. 
 Fractures due to kicks on the inner side of the tibia in the horse may 
 be transformed into complete fractures after weeks or months ( in two 
 cases one went for seventy days, the other for one hundred twenty- 
 eight days). Also in other bones, fractures occur which are transformed 
 after a time into the complete form. Especially remarkable 
 are those cases of fissured vertebrae in the horse 
 which occur after casting or falling, complete fracture taking 
 place after several hours or a few days, even after weeks. They 
 are characterized by sudden paralysis of the hind 
 parts. Occasionally these occur in horses that have 
 been used for saddle or driving purposes regardless 
 of the fissure. According to the records of the veterinary litera- 
 ture cases of this kind are not uncommon (Spinola, Dieckerhoff, 
 Moller, Straube, Giitzlaff, Flatten, Wiirgler, personal 
 observations). I have, for example, observed that after the casting of a 
 thorough-bred stallion complete fracture developed from a fissure after 
 four weeks (twenty-nine days). During this time the animal was in 
 perfect health and stood on all four limbs. In similar cases fissures in 
 the horse have developed into fractures after a long time, even weeks ; 
 fractures of the metacarpus (B au e r), humerus (Philippi, personal 
 observations) , and radius (Fre e r, Giinther, Schmid). For refer- 
 ence to old fissures from a forensic standpoint see page 210. 
 
 Frequency and Occurrence. — Fractures of bone most 
 often occur in horses and dogs; they are not infrequent 
 in cattle, birds and swine. In cats fractures are 
 relatively uncommon ; because of their elasticity they may fall 
 a considerable distance (several feet) without being injured. 
 In the horse the ordinary causes are falls, running into objects, 
 
FRACTURES 197 
 
 collisions, kicks from horses, casting ; in dogs, kicks, bites, 
 being run over, squeezed, falls, and stones. Bone-fractures 
 in horses and dogs are most often seen in large cities; 
 in the former it is due to slipping and falling on hard smooth 
 pavements, especially on asphalt when it is covered with 
 smooth wet ice ; dogs are run over with street cars, hacks, 
 and other vehicles. According to my experience in Berlin 
 dogs suffer most often from fractures on Sundays (picnic 
 parties), for that reason Monday's clinic is supplied with an 
 abundance of material ; the same condition follows any inter- 
 ruption in trafl&c. Fractures in war are usually caused by 
 projectiles. 
 
 The statistics of the Prussian Army aflford valuable material 
 relative to the frequency of fractures in horses. 
 Among 30,000 horses, 400 fractures a year occur during times 
 of peace. The total number of fractures, covering a period of 
 five years (1891-1895) in the Prussian Arm}' was 2000. The 
 following regions are most often affected : pelvis, tibia, 
 first phalanx, bones of the head, the radius, 
 the metatarsus, and the vertebrae. Fractures 
 of the tibia, pelvis, and the first phalanx 
 cover about fifty per cent of all fractures in 
 the horse. 
 
 With reference to the frequency of fractures in the dog, 
 my own published statistics covering a period of nine years 
 (1886-1894) and 70,000 diseased dogs, show the following 
 results : about 1700 (1693) suffered from fracture, this amounts 
 to 2.3 per cent of the total number of diseased dogs. In 
 Berlin, one in forty of all diseased dogs suf- 
 fers from fracture. lyUxations, in contrast to fractures, 
 are less frequent in dogs, occurring about one fifth as often (I 
 have seen only 344 cases in all, equal to .5 per cent). Accord- 
 ing to my experience the most frequent fractures in the dog 
 are of the fem ur (17 per cent), the radius and ulna (15 
 per cent), the tibia and fibula (13 per cent), and the 
 humerus (5 per cent) . In the dog ninety per cent 
 of all fractures involve the bones of the ex- 
 tremities. The following bones are least often fractured : 
 
198 STATISTICS 
 
 sternum, bones of the cranium, the vertebral column, the 
 patella, the ribs, and the scapula. 
 
 In cattle, fractures most often involve the head of the 
 femur, pelvis, scapula, tibia, metatarsus, and 
 bones of the tail. Recorded statistics are wanting. 
 
 With reference to the frequency of fractures in 
 swine, information is found in the work of Charpentier 
 and Lafou r cade. Fifteen per cent of all slaugh- 
 tered swine show fractures of the ribs in vari- 
 ous stages of healing. Transportation in narrow 
 quarters explains this condition. 
 
 Frequency of fractures in birds is furnished by the statis- 
 tics of La re her who has treated 250 cases. According to 
 C a d i o t the following bones are most often fractured : 
 humerus, tibia and femur; the radius, ulna, 
 scapula, and ribs are less frequently fractured. I, my- 
 self, have treated 137 fractures in birds, 64 were in large birds 
 (hens, swans, parrots), and 73 in small (song and ornamental 
 birds). Wings and limbs were most often fractured. 
 
 Statistics.— I. Bartke has collected the following statistics on 
 the horse from the records of the Prussian Army : in a period cover- 
 ing ten years from 1886-1895, of 280,000 diseased animals, bone fracture 
 occurred in 3473. Of 3000 recorded fractures, 1800 — equal to 60 per 
 cent — involved the limbs ; 1000— equal to 30 per cent — involved the 
 body and vertebral column ; 200 — equal to 10 per cent — involved the 
 bones of the head. Individual fractures were as follows : 
 
 Tibia 557 times 18 per cent. 
 
 Pelvis 491 " 16 " 
 
 First Phalanx 404 " 13 " 
 
 Radius 239 " 8 " 
 
 Cervical Vertebrae 237 " 8 " 
 
 Metacarpus 210 " 7 " 
 
 Ivumbar Vertebrae 87 " 3 " 
 
 Dorsal Vertebrae 75 " 2.5 " 
 
 Humerus 72 " 2.5 " 
 
 Ulna 70 " 2.5 " 
 
 Ribs ^ 68 " 2 
 
 Femur 59 " 2 " 
 
 Second Phalanx 53 " 2 " 
 
 Third Phalanx 52 " 2 " 
 
 Occipital Bone 52 " 2 " 
 
STATISTICS 199 
 
 Sphenoid Bone 43 times 1.5 percent. 
 
 Scapula 35 " I " 
 
 Frontal Bone 33 " i " 
 
 Superior Maxilla 32 " i " 
 
 Inferior Maxilla 31 " i " 
 
 In the years 1895-1902 at the Surgical Clinic of the Berlin Veteri- 
 nary School I treated 308 fractures from a total of 7000 diseased horses. 
 Of these, 103 involved the pelvis, 43 the bones of the head, 38 fhe first 
 phalanx, 21 the vertebrae, 14 the scapula, 14 the humerus, 13 the tibia, 
 12 the second phalanx, 12 the femur, 9 the third phalanx, 6 the navicular 
 bone, 5 the ulna, 4 the ribs, 4 the radius, 3 the metatarsus, 2 the sacrum, 
 I the tarsus, i the carpus, i the patella, and i the sternum. 
 
 According to Cadiot (clinic in Alfort ) 159 fractures of the 
 extremities of the horse were distributed as follows : tibia 32, pelvis 30, 
 first phalanx 24, radius 17, metacarpus 15, humerus 13, femur and ulna 
 6, scapula 5, second phalanx 4, carpus 3, third phalanx 2, calcaneum and 
 trochlea i. Morkeberg at the Copenhagen Clinic has treated 69 frac- 
 tures in the horse in the years 1896-1900. The fractures were distributed 
 as follows: pelvis 31, first, second, and third phalanges 15, bones of the 
 head 7, ribs 5 times. According to Verlinde 42 fractures occurred 
 in twelve years in three Belgian Cavalry Regiments. They were dis- 
 tributed as follows: femur 21, third phalanx 2, navicular, first phalanx, 
 and second phalanx i. 
 
 2. I have observed 1693 cases of fractures in dogs (548 in the 
 hospital clinic, 1145 in the polyclinic). 1145 fractures in the polyclinic 
 were distributed as follows : head 22, trunk 60, anterior limbs 434, pos- 
 terior limbs 537. Individual fractures compiled from 915 cases were 
 distributed as follows : 
 
 per cent 
 
 Femur 188 times 17.0 
 
 Radius and Ulna 170 " 15.0 
 
 Tibia and Fibula 145 " 13.0 
 
 Humerus 58 " 5.0 
 
 Metatarsus 47 " 4.0 
 
 Metacarpus 40 " 3.5 
 
 Carpus 38 " 3.0 
 
 Anterior Phalanges 39 " 3.0 
 
 Posterior Phalanges 35 " 3.0 
 
 Pelvis 30 " 2.5 
 
 Tarsus 27 " 2.5 
 
 Coccygeal Vertebrae 26 " 2.5 
 
 Scapula 17 " 1.5 
 
 Ribs 16 " 1.5 
 
 Inferior Maxilla 16 " 1.5 
 
 Lumbar Vertebrse 11 " i.o 
 
 Dorsal Vertebrae 5 " 0.5 
 
 Patella 2 " 0.2 
 
200 SYMPTOMS AND DIAGNOSIS 
 
 With reference to the resistance ( resistance to pressure ) of bones in 
 different races and species, information has been supplied by the recent 
 investigations of Hoffman (Berl. tieraertl. Wochenschr. 1901). Of 
 the long bones of the extremities in the horse, the metatarsus was the 
 most resistant. A difference in breed was not observed ; age, on the 
 other hand, resulted in variations. The bones of cattle were far less 
 resistant than those of horses. 
 
 Symptoms and Diagnosis — The symptoms are ex- 
 tremely variable according to the nature of the fracture. Whrle 
 the complete fractures, especially the complicated, are easily 
 recognized, the diagnosis of fissures is often very difficult. In 
 general the following symptoms are characteristic of fractures 
 in the domestic animals. 
 
 1. Inability to support weight, as well as pain 
 when the animal is at rest or in motion, are the first visible 
 symptoms of fracture of the bones of the extremities. Any 
 sudden high-grade lameness in the horse, standing and trav- 
 eling on three limbs, should cause suspicion of fracture. 
 Horses and dogs stand and travel upon three limbs ; horses 
 either refuse to move or travel with great difficulty ; palpation 
 causes crying in dogs. Many fissures are characterized by a 
 line of pain along that of the fracture (p a i n - 1 i n e in fissures 
 of the first phalanx). Pain and disturbed function are often 
 absent in fractures of the pelvis and ribs, in many fractures of 
 the skull, as well as in fissures of the vertebrae. Total para- 
 plegia and anesthesia are observed in fractures of the vertebral 
 column. 
 
 2 . Abnormal mobility of the broken bones and 
 limbs at the point of fracture is the most characteristic symp- 
 tom. Abnormal mobility may be visible (pendulant position 
 of the limbs, abnormal positions and relations), it may also be 
 determined by palpation (fixation of the superior and inferior 
 fractured ends). Abnormal mobility is usually absent in all 
 incomplete fractures, as well as in fractures of the pelvis and 
 vertebral column ; in other cases the normal mobility of the 
 limb may be restricted or suspended (impaction). 
 
 3. Crepitation at the point of fracture, that is, a 
 rough rubbing sound on palpation and passive movements of 
 the fragments, is very characteristic ; this is often a direct 
 
FRACTURES 20I 
 
 pathognomonic sign of the existence of a fracture, especially a 
 splinter-fracture. (One should be careful not to confuse this 
 with arthritis and tendovaginitis crepitans). Crepitation fails 
 in all incomplete fractures of the vertebral column, and in 
 many fractures of the pelvis, as well as in marked dislocation 
 of the fragments. 
 
 4. Swelling in the vicinity of the broken ends is 
 characteristic of simple fractures, it is due to rupture and sub- 
 sequent hemorrhage in the adjacent soft tissues. Callus for- 
 mation results in swelling in old and complicated fractures, 
 especially when there is a phlegmonous inflammation of the 
 soft tissues. Swelling is often absent in incomplete fractures. 
 
 5. Injury to the skin, as well as a subsequent 
 suppuration and fistula formation occurs only in com- 
 pound fractures ; subcutaneous fractures seldom result in sup- 
 puration, it may occur through the blood by means of a pyemic 
 infection (strangles). 
 
 6. Derangement of the general condition 
 seldom occurs in simple fractures ; subcutaneous fractures 
 that are characterized by severe hemorrhage and injury to the 
 soft tissues may lead to a slight rise of temperature 
 without other general derangement. The rise of temperature, 
 which also occurs in animals, is termed an aseptic fever 
 (in man subcutaneous fractures are usually followed by a tem- 
 perature of 38.5-39.5). This is explained by the presence 
 of a ferment-like febrifacient formed from degenerated blood- 
 corpuscles at the seat of fracture, this material is resorbed 
 (v. Bergmann, v. Bruns, and others). Fever which 
 follows complicated fractures, on the other hand, is usually 
 septic because of the presence of pus cocci. Rupture of 
 large blood-vessels by fragments of bones is followed by symp- 
 toms of internal hemorrhage, this is especially true 
 of pelvic fractures ; severe crushing of the bone-marrow is 
 followed by fat-em boli in the lungs and brain. 
 In man, in addition to lipuria, albumenuria, and 
 cylindruria resulting from fracture, there have been ob- 
 served brown cylinders, increase in the urobilin contents of 
 the urine, and even hematogenous icterus as a result of the 
 absorption of coloring matter from degenerated blood. 
 
202 FRACTURES 
 
 7. For many fractures certain specific individual 
 symptoms are of diagnostic importance. Fracture of the 
 nasal bones produces visible impressions, epistaxis, 
 stenotic sounds, and even permanent stenosis with 
 dyspnea. Costal fractures lead to hemoptysis, 
 pneumonia, pleurisy, and injuries to the inter- 
 costal arteries. Fracture of the sphenoid bone, 
 under certain circumstances, results in amaurosis, and 
 dysphagia; fracture of the bones around the eye, phleg- 
 mon of the orbit; fracture of the hyoid bone and max- 
 illary bones, glossolysis, difficult mastication, 
 and dysphagia. Chronic catarrh of the guttural 
 pouches has been observed after fracture of the hyoid bone 
 (Siedamgrotzky, Rupprecht). Severe fractures of 
 the cranial bones are followed by insensibility, nys- 
 tagmus, hemorrhage from the ear (fracture of 
 the base of the skull and the temporal bone) , as well as fatal 
 paralysis of the brain; fracture of the cervical verte- 
 brae, by paralysis of the diaphragm; fracture of 
 the dorsal or lumbar vertebrae, by fatal paraplegia, this 
 is introduced by a sharply circumscribed motor and sensory 
 paralysis, later it gradually becomes generalized. Healed 
 fractures in the vertebral column produce deformities 
 through the formation of anchylosis and synarthrosis (torti- 
 collis, lordosis, kyphosis, scoliosis). Fractures of the last 
 rib in the horse have occasionally resulted in injuries to 
 the stomach and diaphragm (Grosswendt and 
 others). Paralysis of the larynx resulted from a fracture of 
 the first left rib in a dog (Frick). Laceration of the 
 obturator artery is common in fractures of the pelvis ; 
 it results in internal hemorrhage. Fractures in the vicinity of 
 the foramen ovale may result in permanent paralysis of 
 the obturator, which leads to paralysis and atrophy of 
 the adductors ; the nerve becomes involved in the callus 
 (Thommassen). Fracture of the external angle of the 
 ilium in a horse resulted in fatal laceration of the cir- 
 cumflex artery (Kemp). Fatal laceration of the in- 
 ternal thoracic artery in a horse has resulted from fracture of 
 
PROGNOSIS 20J 
 
 the sternum (Sand). In another horse with fracture of the 
 eighth and ninth dorsal vertebrae there was pronounced per- 
 spiration of the anterior regions which stopped in the 
 immediate vicinity of the fracture (Bourgoin). In other 
 horses with fractures of the vertebrae there are girth-shaped 
 areas of perspiration in the lumbar region (Roder ; personal 
 observations). A horse with fracture of the right external 
 angle of the ilium showed severe and permanent perspiration, 
 as well as non-sensitiveness of the skin beneath the right hip 
 ( Delacroix ). 
 
 RoNTGEN Rays. — The use of Rontgen Rays which 
 has recently become of diagnostic value in the illumin- 
 ation of fractures in man has been experimentally em- 
 ployed in veterinary science (B a 5' er, Eberlein, Pfeiffer, 
 Jensen, Hoffman, Troster, Kriiger, and others). 
 In the latter case it is not of general practical importance. The 
 application of rays in living animals is frequently associated 
 with great difficulties on account of the restlessnes of the 
 animal. In addition to this is the high price of the apparatus 
 (a Voltohm-apparatus for illumination of the horse costs 2500- 
 2800 marks), as well as the complexity of manipulation. On 
 the other hand, Rontgen rays may be employed in clinics, 
 especially upon small animals (foreign bodies), as well as for 
 the diagnosis of fissures and fractures of the bones of the 
 extremities (first, second, and third phalanges). (For details 
 concerning the application of Rontgen Rays in veterinary 
 science see my "Chirurgische Diagnostik der Krankheiten des 
 Pferdes. " 1902). 
 
 Prognosis. — When judging a fracture with reference to 
 its healing or non-healing propensities the following factors 
 are brought into consideration : 
 
 I. The species of the animal is of first importance in 
 giving a prognosis. In horses and cattle fractures 
 usually heal more slowly than in the smaller 
 animals. The cause is due, on the one side, to the fact that 
 it is either very difficult or impossible to apply a bandage on 
 a horse or a cow, the attempts at reposition and retention ot 
 the fragments are frustrated. On the other hand, as a result 
 
204 FRACTURES 
 
 of Standing for a long time upon three limbs, severe inflamma- 
 tion of the pododerm often develops in horses and cattle ; it 
 begins with increased arterial pulsation and severe pain, and 
 terminates with sinking of the os pedis and necrosis of the 
 pododerm with a subsequent septicemia (pressure laminitis). 
 Remaining for a long time in the recumbent position also pro- 
 duces contusions and decubital gangrene of the skin with 
 general sepsis because of the great body-weight of these 
 animals. According to the experience of the Prussian Army 
 onlj' 20 to 25 per cent of all bone-fractures in the horse are 
 curable ; of 3473 covering a period of ten years from 1886- 
 1895, 744 healed : equal to 22 per cent. On the other hand, 
 according to my experience among dogs, the total number of 
 healed fractures amounts to about 85 per cent. The prog- 
 nosis of fractures in the dog, therefore, is four 
 times as favorable as in the horse. The per- 
 centage of healing in birds is still higher. Also in swine, rib- 
 fractures especially, appear to heal very rapidly. The time 
 required for fractures to healin horses and 
 cattle averages from one to three months; in 
 the dog and sheep, three to four weeks; in 
 birds, fourteen days. 
 
 2. The bone itself, from a prognostic standpoint, is of 
 great importance ; one bone may heal very readily, another 
 with great difficulty, many seldom heal. In fully developed 
 horses and cattle the following fractures are usually incura- 
 ble: fractures of the cervical vertebrae, dorsal vertebrae, and 
 lumbar vertebras when the body or arch is involved and leads 
 to injury of the spinal marrow ; complicated (in most cases the 
 simple also) fractures of the femur, tibia, scapula, humerus, 
 and radius ; comminuted fractures of the first and second 
 phalanges, as well as many fractures of the pelvis. Fractures 
 of the metacarpus and metatarsus heal with great dif- 
 ficulty. The following, however, are relatively cure- 
 able: fissures, simple fractures of the ribs, fractures of the 
 external angle of the ilium, those in the vicinity of the eye, 
 simple fractures of the first and second phalanges, and caudal 
 vertebrae, as well as the vertebral processes. 
 
PROGNOSIS 205 
 
 3. The kind of. fracture is also of great importance 
 from a prognostic standpoint. In general the follow- 
 ing are unfavorable: comminuted fracture, 
 splinter and complicated fractures, as well as 
 those which involve a joint or occur in its 
 immediate vicinity (glenoid cavity). Simple 
 fractures, on the other hand, are relativel}' favorable. The 
 prognosis is also unfavorable in non-recent fractures which are 
 first brought for treatment some time after they occurred. 
 Fractures of the diaphyses heal more readily than those of the 
 epiphyses ; transverse fractures more readily than the oblique. 
 Healing is delayed when the patient suffers from internal 
 disease. Fractures in the vicinity of the joint occasionally lead 
 to anchylosis (fetlock-joint, coronary-joint, pedal-joint). The 
 prognosis of partial fractures is especially favorable, for exam- 
 ple, fracture of the lateral tuberosity of the humerus, or the 
 oblique processes of the cervical vertebrae. In general, fissures 
 are more favorable than complete fractures. , The prognosis 
 of many fissures, on the other hand, has been found to be 
 unfavorable. The process of healing seems to be very slow, 
 especially in fissures of the first phalanx of the horse (six to 
 twelve weeks and over). Fissures of the vertebral bodies are 
 mainly incurable. 
 
 4. The age of the animal has an influence on the prog- 
 nosis, experience has shown that the healing of bones 
 proceeds more slowl}^ in old animals than in 
 young. Young animals can remain standing or recumbent, 
 without danger, for a longer time than those advanced in 
 years. 
 
 Finally, in horses and cattle, in addition to the points 
 already discussed, one must decide whether the patient is worth 
 treatment from an economic standpoint, or whether it would 
 not be better to slaughter the animal. 
 
 Curability or Incurability of a Fracture. — The answer to 
 this question belongs to one of the most difficult problems with which 
 the practicing veterinarian has to deal. Because the question must fre- 
 quently receive an immediate answer ( on the race-track for instance ) a 
 careful consideration of the previously considered influences is neces- 
 sary. In particular, one must not forget to compare the value of the 
 
206 PROCESS OF HEALING 
 
 patient with the cost of treatment — that is, the resulting permanent 
 diminution in the usefulness of the animal. In doubtful cases, espec- 
 ially in cattle, one should advise slaughter. In certain cases, when the 
 patient is a valuable breeding-animal, treatment until birth of the 
 young may be advised. Cows advanced in pregnancy hiay be killed 
 when suffering from incurable fractures of the pelvis : perform lapa- 
 rotomy immediately after slaughter and extract the young through an 
 incision in the uterus (Cesarian section). 
 
 From a forensic standpoint also, it is often difficult to render 
 an opinion with reference to the curability of a fracture. In Prussia 
 many verdicts are rendered through the knackers privilege by 
 which the knacker has the right to reclaim for himself incurable 
 cattle. Occasionally these questions must be decided with careful ref- 
 erence to the existing conditions, especially to the seat and kind of 
 fracture. In general the previously explained conditions are sufficient. 
 One's verdict is controlled by the average statistics furnished by expe- 
 rience ("as a rule" curable or incurable). 
 
 It has been observed many times in horses and cattle, that, excep- 
 tionally, fractures with a very unfavorable prognosis may heal. Finally, 
 not all cases recorded in veterinary literature are free from exception : 
 PoBchl healed a complicated fracture of the inferior third of the 
 femur in a thorough-bred stallion in eight weeks (?). A complicated 
 fracture of the patella, which was broken in three pieces, healed in a 
 horse in two months with the formation of a bony callus ; lameness re- 
 mained which was severe when the animal trotted and slight during 
 walking movements (Andrieu). A pelvic fracture, which involved 
 fracture and displacement of the acetabulum healed in a cow (B e r d e z). 
 A separation of the pubic symphysis after difficult parturition in a cow 
 healed in four weeks, and twice afterwards the cow gave birth to calves 
 (Henninger). A bilateral complicated fracture of both inferior 
 maxillse at the interdental space healed in fifty days in a horse (Pas- 
 se r i n i ) . A fracture of the trocanter of the femur healed in a two- 
 year-old foal (Nenberger). I, myself, have observed healing in 
 two different cases of fracture of the lateral tuberosity of the humerus, 
 as well as in two fractures of the scapula, in fully developed horses. A 
 transverse fracture of the metacarpus of the horse healed in sixty-six 
 days ( P u j o s ) ; complete healing occurred in a similar manner in 
 fracture of the radius of a horse (Schafer, Salchow, and others). 
 In a four-year-old colt healing of a complicated fracture of the femur 
 took place in the slings in four months without the use of a bandage ; a 
 piece of the middle trocanter was discharged from an abscess (B r a u e r). 
 A fracture of the metatarsus in a colt four days old healed under a plas- 
 ter bandage in five weeks, similar healing occurred in a fracture of the 
 radius and ulna in a foal eight weeks old (Frank ). 
 
 Process of Healing in Simple Bone Fractures. — 
 
FRACTURES 207 
 
 Healing of simple subcutaneous bone-fractures occurs through 
 an aseptic inflammation very analogous to that of primary 
 healing of skin wounds. The uniting of the broken ends of 
 bone is due, partly to the regenerative activity of the peri- 
 osteum, partly to that of the bone-marrow. The 
 essential portions involved in callus formation are only the 
 connective-tissue, soft portions of the bone (periosteum, eud- 
 osteum); the tela ossea plays no part. Also the effused blood 
 at the point of fracture, as well as the neighboring soft tissues 
 are not involved in the process of healing. The union of the 
 fragments follows the formation of granulation-tissue, which 
 subsequently ossifies, the so-called callus, the granulation- 
 tissue is formed from the periosteum and bone-marrow. The 
 bone-callus is the product of an ossifying 
 periostitis and osteomyelitis. In this formation 
 one distinguishes various forms of callus : 
 
 I . The external callus or periosteal callus 
 is due to the activity of the osteoblasts situated tn the deep 
 layer of the periosteum. 
 
 2. The inner callus or marrow callus (endosteal 
 callus, myelogenous callus) is an analogous product of the 
 osteoblasts of the bone-marrow. 
 
 3. The middle or intermediate callus lies mid- 
 way between the external and inner callus, and is considered 
 as principally a continuation of the external callus, secondarily 
 a product of the vessels of the Haversian canals (endothelial 
 proliferation). 
 
 Finally, one distinguishes between a provisional and 
 definitive callus. The provisional callus forms a rela- 
 tively soft, spongy, extremely voluminous, newly-formed mass 
 of bone. The definitive callus is formed later from the provi- 
 sional callus as a hard, small, bony cicatrix. 
 
 Microscopic Changes of Callus Formation. Ac- 
 cording to histological and experimental investigations especi- 
 ally those of Virchow, Billroth, v. Volkmann, 
 P. B r u n s, Z i e g 1 e r, and others the following changes 
 occur : as in primary aseptic healing of wounds, there first 
 occurs a cellular infiltration at the seat of fracture, as well as 
 
2o8 FRACTURES 
 
 the formation of a cellular and highly vascular embryonic or 
 granulation-tissue (the callus), this proceeds from the perios- 
 teum as well as from the bone-marrow. During the process 
 two phases are recognized ; namely, the stage of ossifica- 
 tion of the callus, and the stage of retrogression 
 of the callus. 
 
 I. Ossifi cation of the callus, the result of the 
 ossifying periositis and osteomyelitis, proceeds, according to 
 recent investigations, as follows : a cartilaginous cal- 
 lus is first formed from the inner layer of 
 the periosteum, this is ossified as the result 
 of a direct transformation of the cartilage 
 into bone. (The osteoblasts play only a secondary role in 
 this process). Within three or four days after the 
 fracture small foci of osteoid tissue begin to form in the 
 embryonic tissue in the vicinity of the fracture, they form a net- 
 work of osseous trabeculae with inclosed marrow cavities. In 
 the second week the periosteal callus is a reticulated and 
 tolerably soft tissue. From the end of the third week it 
 develops into a firm, spongy callus-substance, rich in marrow, 
 the provisional callus. 
 
 2 Retrogression of the callus begins in the 
 fourth to the fifth week with obliteration of the 
 newly-formed vessels. The resorbing activity of the osteo- 
 clasts (CO2) liquefies the bone in the form of small spaces. 
 Small foci of necrosis occur in simple bone-fractures as a result 
 of derangements in the circulation at the line of fracture and 
 its immediate vicinity, this necrosis must also be removed by 
 lacunar resorption. At the same time the soft and uneven 
 provisional callus is reduced to a hard, smooth, bone-cicatrix — 
 the definitive callus — so that the previously thickened surface 
 of the bone is apparently smooth again at the point of fracture, 
 and the bone-cicatrix can hardly be seen, or recognized by 
 palpation. 
 
 Callus formation is assisted by the administration of small 
 doses of phosphorus (horse, centigram ; dog, milligram). These 
 small, continually administered doses of phosphor, 
 us produce a specific formative stimulus on the 
 bone-tissue which results in an acceleration of its 
 
ABNORMAL CALLU.S FORMATION 209 
 
 growth. The exact changes which occur have been experimentally 
 demonstrated by Wegener (Virchow's Archiv. 1872) through the 
 continual feeding for months of milligram doses iof phosphorus to 
 young rabbits, hens, cats, dogs, and calves, as well as to adxilt animals. 
 The following are the changes which occur : at areas where the cartilage 
 normally developed into reticulated spongy substance, with abundant 
 red marrow-tissue and rich blood-supply, there was formed compact, 
 firm and hard bone-tissue with rapid transformation of cartilage to bone- 
 cells ; this was especially true of the long bones, vertebrae, ribs, pelvis, 
 and the bones of the carpus and tarsus. The cause is due to a narrowing 
 (schlerosis) of the smallest bone-canals (canaliculi) ; the result is a 
 thick, firm, schlerotic bone-cortex. The development of the periosteum 
 is also accelerated, the product, likewise, of a firm schlerosis. The 
 intermediate epiphyseal cartilage undergoes more rapid ossification. 
 Finally, the marrow cavities become stenosed and eventually disappear. 
 Wegener's theory was investigated by Kissel (Virchow's Archiv. 
 1896) ; it was confirmed, however, by Stuben ranch (Berlin Surgical 
 Congress 1900). 
 
 Abnormal Callus Formation. — i. Retardation of 
 the previously described callus formation results from splinter- 
 ing of the bone, pronounced dislocation of the broken ends, 
 interposition of the soft tissues, continued movement of the 
 broken fragments (faulty bandage or lack of bandage), general 
 diseases (osteomalacia, rachitis, infectious diseases, constitu- 
 tional weakness), as well as infection of the broken areas 
 (compare with healing of compound fractures). Subcutaneous 
 splinter-fractures usually heal, small splinters may even be 
 completely resorbed, necrosis occurs only as a result of subse- 
 quent infection (formation of a sequester). 
 
 When callus formation fails to produce firm union between 
 the fragments, there exists a so-called false joint (pseudo- 
 arthrosis), that is, a permanent moveable union between 
 pieces of bone. This is especially observed on the head and 
 neck of the femur, on the first phalanx, and on the posterior 
 false ribs. 
 
 2. A callus which is abnormally large is termed 
 a hypertrophic callus or callus luxurians. 
 Hypertrophic cicatrix and callus luxurians correspond to ex- 
 cessive wound granulations ; the so-called callus tumors 
 have their analogues in the keloids and are usually osteomata 
 or enchondromata, seldom osteosarcomata. When two bones 
 
^lO FRACTURES 
 
 lying parallel to each other are firmly united by a callus forma- 
 tion, as is observed in the fracture of two ribs, there exists a 
 synostosis. The bony, immobile union of two bones in a 
 joint is termed anchylosis (anchylosis ossea). If the 
 callus is not composed of bone-tissue, but of connective tissue, 
 failure of ossification of the periosteal and myelogenous ger- 
 minal tissue, it is termed a callus fibrosus. This is 
 observed in the fracture of short, non-vascular bones, especially 
 the patella, navicular bone, sesamoids, the olecranon, calca- 
 tieum, pisiform bone, the body and coronoid process of the 
 inferior maxilla, and the false ribs. 
 
 Termination of Fissures and Fractures of Long Stand- 
 ing. — In the light of previous statements it is not difficult to imagine a 
 fresh fracture resulting from an old fissure. For a 
 forensic verdict it should be remembered that a fracture is preceded by 
 an old fissure or fracture only when granulation-tissue or callus forma- 
 tion is present at the margin of, or in the vicinity of the fracture. The 
 age is determined according to the condition of the callus (see above). 
 Fresh fissures and fractures present no callus formation but hemorrhage, 
 and the appearance of a fresh, aseptic inflammation. It is further ob- 
 served that a fissure, sometimes very early, at other times only after a 
 long period, may be transformed into a fracture. The smooth or uneven 
 condition of the broken surfaces is of slight importance for the determi- 
 nation of the age of a fracture. A smooth broken surface, without 
 other symptoms, does not indicate an old fracture ; experience has 
 shown that the surface, and edges of the broken surface may be worn 
 smooth within the first half hour after the occurrence of the fracture 
 (Giinther). Trasbot treated a case of fracture of the tibia in a 
 horse which first became apparent seven days after the occurrence of 
 the fissure ; a two or three mm. thick layer of young, very vascular, 
 spongy bone-tissue was present on the broken ends. The bone-marrow 
 was strongly injected, the compact bone-tissue could be easily cut. 
 On microscopic examination the Haversian canals were found dilated 
 and filled with round-cells. I investigated a case of fissure of the ver- 
 tebra in a horse in which only soft granulation-tissue had formed at the 
 seat of fracture after twenty-nine days, there was no callus formation. 
 
 Process of Healing in Complicated Bone Frac- 
 tures. — While the simple, subcutaneous bone-fractures heal 
 per prima through an aseptic ossifying periostitis and osteomye- 
 litis, complicated fractures lead to suppuration of the broken 
 ends with callus formation. The prognosis of a complicated 
 fracture depends upon the following conditions : duration of the 
 
TREATMENT 2 I I 
 
 active influence of the pus-bacteria, age of the fracture, the 
 extent of injury to the skin and surrounding soft tissues, as 
 well as the extent of bone-splintering. With slight injury to 
 the skin and soft tissues combined with careful disinfection of 
 the wound, healing proceeds nearly as fast as in simple bone- 
 fractures. With reference to the severity of a complicated 
 fracture, the splintering is of less importance than the degree 
 of injury to the soft tissues. A smooth fracture with- 
 out splintering of the bone, but with a large 
 skin-wound and extensive injury to the soft 
 tissues is far more severe than extensive splin- 
 tering with only slight injury to the soft 
 parts (Tillmanns). 
 
 The local changes in the broken area of a complicated 
 fracture, consist, in addition to the changes described under 
 callus formation, in inflammatory swelling, sup- 
 puration, burrowing of pus, phlegmon, phle- 
 bitis, lymphangitis, septic processes, ichor- 
 ous changes in the soft tissues, suppurative 
 periostitis and osteomyelitis, necrosis of the 
 bone (sequ est rat io n) and fistula formation; as 
 a result of general infection septicemia and p5'emia may follow. 
 
 Treatment of Simple Bone-Fractures. — The first 
 surgical problem consists in reposition (reduction) that is, 
 rearrangement and replacement of the dislocated ends in their 
 normal position by means of a pull (extension) and a 
 counter-pull (contra-exte nsion); the second consists in 
 retention, that is, fixation of the arranged fragments by means 
 of a bandage. Callus formation only follows accurate reposi- 
 tion and complete rest for the broken ends. In many of the 
 large animals, and in many fractures (ribs, pelvis, heads of 
 bones), it is impossible to fulfill both conditions ; certain frac- 
 tures, however, heal in the absence of reposition and retention 
 simply through natural healing, this is especially true of rib- 
 fractures and many fractures of the pelvis. In small animals, 
 on the other hand, especially in dogs, reposition and bandaging 
 is usually possible. 
 
 The application of the bandage in simple bone-fractures, 
 
212 FRACTURES 
 
 as well as the materials employed for this purpose have already 
 been described in a previous hand-book (Bayer, "Operations- 
 lehre"). I, myself, employ plaster-of-Paris bandages exclus- 
 ively in horses and dogs, and consider other forms of bandaging 
 material (tripolith, silicate-of-potash, gutta percha, lime, rub- 
 ber, starch, dextrin, pitch, paste-splints, wooden splints, 
 splints of iron and celluloid), as, at least, superfluous. Under 
 certain circumstances the}^ may be employed as an emergency 
 bandage. The plaster-of-Paris bandage is applied as follows : 
 after reposition is complete the broken ends of the limb are 
 firmly fixed above and below by one or two attendants ; thin 
 layers of padding are applied, especially at the seat of frac- 
 ture, so that the broken ends are well bolstered ; a cambric or 
 flannel bandage is applied over the whole. For horses the 
 application of padding may be omitted. Over this bandage 
 are then applied the turns of plaster bandage which have been 
 previously prepared from fresh plaster and soaked for a short 
 time in warm water. It must be applied in such a manner 
 that a uniform and extensive layer of plaster comes in contact 
 with the broken area and its vicinity. The bandage may be 
 strengthened by applying some of the prepared plaster in the 
 form of a paste. The following general rules must be 
 observed when applying a plaster bandage : 
 
 1. The bandage must not exert too great 
 pressure nor form cord -like constrictions. 
 One should also observe that the folds of the plaster bandage 
 are not too large or unequal. 
 
 2. The bandage should be inspected daily 
 with special reference to pressure and con- 
 striction. In dogs the paw of the involved limb should 
 receive special attention with reference to swelling, blue color- 
 ation, and necrosis. In these cases the bandage must be 
 loosened, or entirely removed. 
 
 3. The bandage, on the other hand, must 
 not be applied too loosely. The swelling which 
 occurs the first few days after fracture disappears as a result 
 of the resorption of the exudate ; the bandage, though properly 
 applied, becomes loosened, and must then be renewed. In 
 
FRACTURE.S 2 I 3 
 
 such cases a provisional bandage may be employed for the first 
 few days, until the swelling has diminished. 
 
 4. Special care is required in the applica- 
 tion of a padding over the seat of fracture in 
 dogs. In the following areas there is great danger from 
 pressure necrosis as a result of faulty padding : the skin over 
 the olecranon and os calcis, as well as upon the bony processes 
 of the carpus and tarsus. Necrosis is characterized by fetid 
 odor and fever, as well as general disturbances. In such cases 
 the bandage must be immediately removed and the contused 
 area treated with antiseptics. 
 
 5. The retention of bandages to the ex- 
 tremities of dogs is maintained by passing a 
 plaster-saddle over the back or thorax so that 
 it passes down on the opposite side. This 
 method prevents falling down and tearing of the bandage. 
 The plaster-saddle is especially useful in fractures of both 
 anterior and posterior limbs. 
 
 6. When possible, the neighboring joints 
 above and below the fracture are included in 
 the bandage. This favors immobility of the fractured 
 area. 
 
 7. After the application of the bandage 
 the animal is kept as quiet as possible until 
 time for removal. Horses are best retained in slings or 
 tied high, and given plenty of soft bedding ; dogs are locked 
 up. C agny healed many fractures in dogs by merely lock- 
 ing, without bandage, in a very narrow cage. The bandage 
 may be removed from dogs after three or four weeks ; upon 
 horses it should remain six to twelve weeks. 
 
 Application of bandages recently employed in a man by means of 
 which tlie patient may move about, and thus prevent severe muscular 
 atrophy and general derangements, are not applicable to the lower ani- 
 mals. Callus formation, on the other hand, may be promoted in the 
 lower animals by the internal administration of phosphorus. In the 
 horse the dose is one one-hundredth to five one-hundredths grams ; in 
 the dog, one half to two milligrams. Neurectomy as a last resort 
 may be employed where lameness remains as a result of fracture of the 
 first, second, or third phalanx. 
 
214 TREATMENT 
 
 Treatment of Compound Fractures. — Because of 
 the existence of an open wound, treatment is essentially dif- 
 ferent from that of a subcutaneous fracture. In contrast to 
 the pre-antiseptic times, with the introduction of aseptic and 
 antiseptic methods, and with the results of experience ob- 
 tained during the past ten years in the surgery of war 
 (v. Bergmann and others) the prognosis of compound 
 fractures, which were formerly treated almost exclusively by 
 amputation, has become far more favorable. In human sur- 
 gery, from a therapeutic standpoint, one distinguishes four 
 varieties of compound fracture : 
 
 1. When there exists only atrivial, fresh 
 perforation of the skin by a pointed fragment 
 of bone (penetrating fracture) a so-called asep- 
 tic, plaster-of-Paris occlusive bandage is 
 applied. Aseptic occlusion is produced as follows : careful dis- 
 infection of the skin, reduction of the perforating fragments of 
 the fractured bone, application of an evenly applied aseptic 
 bandage over the fractured area, the whole is then enveloped 
 in a plaster bandage which remains in position until healing is 
 complete. 
 
 2. Plaster-of-Paris bandages cannot be applied in the 
 following cases : recent compound fractures with 
 extensive injury to the skin or soft parts, 
 especially with splintering, or fractures 
 which produce an open joint. Such fractures are 
 treated as follows : carefully disinfect according to the rules of 
 antisepsis ; remove all lacerated tissue, blood clots, bone- 
 splinters, and foreign bodies, very sharp fragments may 
 be removed with the forceps ; ligate bleeding vessels ; enlarge 
 the skin-wounds until the broken ends are freely visible ; 
 carefully irrigate the cavity of the wound, 
 provide drainage, and insert a tampon of iodo- 
 form gauze; in certain cases the skin may be partially 
 sutured , an aseptic bandage is then applied, 
 this is changed according to the demands 
 of each case. A plaster bandage should be 
 applied only after complete healing of the 
 
FRACTURES 215 
 
 wound. A plaster bandage with a window is applicable 
 only to small injuries ; through the window in the cast the 
 wound is treated with aseptic bandages. 
 
 3. Old — more than one or two days — suppu- 
 rating, complicated fractures, especially those in 
 which there exists an ichorous wound secretion, gangrenous 
 decomposition of the tissues, as well as septic phlegmon in the 
 vicinity of the fracture, must be treated with energetic disin- 
 fection. When necessary open incisions may be made, 
 they are best treated with permanent antiseptic ir- 
 rigation. 
 
 4. With extensive crushing and bruising of the 
 entire fractured area, as well as with imminent septic general 
 infection from an extensive, suppurating and ichorous frac- 
 tured wound, when local treatment cannot be employed be- 
 cause of danger to the life of the patient, amputation of the 
 entire limb remains as a last resort. In general, amputation 
 is indicated in both the above named conditions. In veteri- 
 nary practice its use is restricted to dogs. 
 
 Fixation of the fragments with ivory nails or by means of 
 bone-sutures, employed largely in human surgery, are also 
 applicable to small animals, as well as to fractures of the 
 inferior maxilla in the horse. 
 
 Prophylaxis OF Bone Fractures. — In horses, prevention of 
 fractures while casting forms an important surgical 
 problem. Fractures of the vertebral column, femur, or pelvis may 
 occur. While the pathogenesis of these individual fractures is treated 
 in text-books of special surgery, the following remarks concerning their 
 prevention find place here : 
 
 I. Fractures of the vertebrae occur most often while cast- 
 ing old horses and thoroughbreds. In old horses the causes are due to a 
 senile atrophy of the bone, a rarefying ostitis, or an anchylosis of the 
 vertebral joints. While palliative methods are not applicable, one 
 should observe the following principles: when possible, operate 
 old horses standing (tooth operations), cast the animal 
 only when absolutely necessary. In thoroughbred animals 
 casting for castration, especially, affords an opportunity for the existence 
 of spontaneous fractures as a result of excessive contraction of the longis- 
 simus dorsi and ileo psoas, thereby producing excessive flexion of the 
 vertebral column. Prophylaxis consists in a previous weakening 
 
2l6 INFLAMMATION OF BONE 
 
 of the animal: light diet, exhaustion by high-tieing and over- 
 exercise, administration of laxatives (arecalin, eserine) , subcutaneous 
 injections of morphine, clysters of chloral hydrate (75-150 
 grams ) ; further, the application of a dorsal girth previous 
 to casting, vpith the greatest possible extension o f the neck and 
 head while in the recumbent position ; in prevention of lateral 
 movements by the application of a crupper and fixation of the head, 
 in the application of a twitch or the use of chloroform. 
 
 2. Fracture of the femur is favored by struggling in the 
 hopples, firm fixation of the upper limb in an abdominal girth, as well 
 as permitting the limb to pass too far forward. Struggling against 
 fetlock straps is prevented by a twitch on the limb. When tieing the hind 
 limb it should be excessively flexed ( Dan i sh method), or allowed 
 a certain amount of mobility (Berlin method). Care should 
 be taken that the foot is never carried forward and 
 outward over the elbow-joint. F"urther, one applies a n asal 
 twitch, or chloroforms nervous horses. 
 
 3. Pelvic fractiires are caused, by throwing on hard ground. 
 They are easily prevented by providing a thick layer of straw. 
 
 From a forensic standpoint the facts mentioned are of great im- 
 portance. If an operator is able to maintain that previous to casting and 
 during the operation, the above named prophylactic methods were ac- 
 curately and thoroughly carried out, that he employed suitable casting- 
 apparatus, and gave accurate instruction to the attendants, he is in no way 
 responsible if fractures do occur. Such fractures occur re- 
 gardless of the most careful prophylaxis, and without 
 any fault or responsibility on the part of the operator. 
 My experience has demonstrated that special precautions by means of 
 a girth along the back, Bernadot and Butel's apparatus 
 do not always prevent fracture of the vertebrae. I must, therefore, 
 contrary to the statements of others, coincide with M 6 1 1 e r 's 
 opinion that casting horses is always associated with 
 a certain amount of danger. 
 
 II. INFLAMMATION OF BONE, PERIOSTITIS, OSTITIS, 
 OSTEOMYELITIS. 
 
 Classification.— Inflammation of bones, as well as in- 
 flammation of other organs, may be classified from various 
 standpoints. The following forms are differentiated : accord- 
 ing to the course, acute and chronic ; according to the 
 cause, traumatic, spontaneous, hematogenous, 
 
PERIOSTITIS 217 
 
 and specific (tubercular, actinomycotic, botryomycotic, 
 pyemic, glandular), primary and secondary (symp- 
 tomatic, metastatic) ; bacterial (septic), and n o n- bac- 
 terial (aseptic) ; finally, according to the character of the 
 inflammatory product — suppurative, ossifying, 
 fibrous, granular, and necrotic inflammation of 
 the bone. From a standpoint of practical surgery they are 
 classified from an anatomo-physiological standpoint ^Yith refer- 
 ence to inflammation of the periosteum, genuine bone-sub- 
 stance, and bone-marrow. While in man, hematogenous infec- 
 tion and inflammation of the bone-marrow is by far the most 
 important form of inflammation of the bone, in veterinary 
 science this is not true. In animals, inflammation 
 of the periosteum holds the most important 
 position. This is especially true of horses where the 
 periosteum, as an external covering of the bone, is exposed to 
 many traumatic insults. 
 
 In text-books of veterinary surgery osseous inflammations 
 are arranged as follows in the order of their importance : 
 
 1. Inflammation of the periosteum (peri- 
 ostitis). 
 
 2. Inflammation of the bone-substance 
 (ostitis ) . 
 
 3. Inflammation of the bone- marrow 
 (osteomyelitis) . 
 
 I. INFLAMMATION OF THE PERIOSTEUM, PERIOSTITIS. 
 
 Forms. — According to the causes, course, and inflamma- 
 tory products, and above all, with reference to the treatment, 
 the following forms of periostitis are recognized : 
 
 a) Acute non-suppurative periostitis, which 
 is also termed aseptic, traumatic inflammation of 
 bone. It is not due to the action of bacteria, but to mere 
 traumatic irritants (contusions, pressure, blows) acting subcu- 
 taneously . An acute, aseptic periostitis develops, for example, 
 as the immediate result of a subcutaneous bone-fracture. The 
 ordinary causes in horses are kicks, blows, treads on the 
 
2l8 PERIOSTITIS 
 
 coronet, pressure on the interdental space, and collisions ; the 
 inflammation, therefore, is usually circumscribed. As the 
 periosteum is a membrane having a very rich nerve-supply, 
 recent cases of inflammation are characterized by extreme 
 pain on palpation, lameness, a circumscribed semi-soft 
 swelling, and heat. Treatment consists in the appli- 
 cation of moist warmth, Priessnitz bandages, massage, 
 application of camphor, iodoform, and iodine ointment or 
 grey mercurial ointment. Ordinarily the acute form passes 
 into the following form ; into a chronic ossifying periostitis. 
 
 b) Chronic ossifying periostitis develops from 
 the preceding. It is located in the deeper layer of the perios- 
 teum, through the ossifying activity of this layer the inflam- 
 matory product is transformed to bone. Callus formation in 
 simple bone fracture is a typical example of ossifying perios- 
 titis (see page 206). In the same way there develop from 
 the circumscribed, acute, non-suppurative periostitis, chronic 
 inflammatory new formations of bone which are termed 
 osseous proliferations or exostoses (osteophytes, 
 hyperostoses, supraossa). In the horse this is the most im- 
 portant form of inflammation of the bone, and one of the most 
 frequent of bone diseases. It is especially frequent on the 
 inner surface of the metacarpus, in the region 
 of the coronary-joint (ringbone, pseudo-ringbone; 
 the exostoses correspond to the attachments of capsular and 
 lateral ligaments), in the region of the tarsal -joint 
 (spavin, lateral exostoses), as well as on the inferior 
 maxilla (pressure on the interdental space; pressure 
 from the manger on the inferior margin). In all 
 these cases the exostoses are due to chronic, frequent- 
 ly-repeated, traumatic irritation of the periosteum, as in 
 ringbone caused by a continual unilateral strain on the 
 ligaments due to an abnormal position of the hoof. The fre- 
 quent occurrence of exostoses on the inner surl'ace of the met- 
 acarpus is partially referable to a unilateral strain on the 
 periosteum between the metacarpus and splint bone. Of 784 
 exostoses, not less than 651 (83 per cent) were on the inner 
 surface (374 left, 277 right ; Preussische Militar-Veterinar- 
 
PERIOSTITIS 219. 
 
 Berichte 1886 to 1895). According to Zschokke seventy- 
 five per cent of all adult horses suffer from exostoses on the 
 metacarpus, ninety-three per cent are located on the inner 
 surface. In a similar manner Zschokke found that sixty 
 per cent of all adult horses are affected with exostoses at the 
 fetlock (pseudo-ringbone). One also finds exostoses on the 
 humerus in chronic bursitis intertubercularis, in the alveoli 
 of the teeth in chronic alveolar p e ri ost i t i s (adhe- 
 sion between the teeth and the alveolar wall, difficult tooth- 
 extraction), as well as on many bones in the form of so-called 
 multiple, symmetrical exostoses and hyper- 
 ostoses. A multiple exostosis formation in dogs has been 
 described by K i 1 1 ; many of the bones, especially the inferior 
 maxilla, the radiu.s, and the bones of the lower limbs presented 
 bony exostoses which clearly corresponded to muscular attach- 
 ments. He considered it a multiple hyperplasia of the bones 
 of myopathic origin, caused by muscular strain, and apparently 
 influenced by a pathogenic predisposition. Occasionally exos- 
 tosis formation leads to anchylosis — that is, osseous 
 adhesion between two joints (spavin, ringbone, vertebral col- 
 umn), as well as to s y no s t OS i s (bony adhesions between 
 the metacarpus and splint bones). Treatment of ossifying 
 periostitis coasists in the application of blisters, firing, perios- 
 teotomy, and neurotomy. Many exostoses gradually 
 diminish in size, occasionally they completely 
 disappear. 
 
 c) Acute suppurative periostitis is usually due 
 to an external injury (bone- wound, compound fracture) 
 whereby pus-forming bacteria gain entrance to the periosteum. 
 The cause of the infection rarely gains entrance through the 
 blood- stream (metastatic), or extends from a suppurative 
 inflammation of the bone-marrow ; in the latter case there exists 
 a so-called subperiosteal abscess. Treatment 
 consists in incision and antiseptic irrigation. 
 
 d) Chronic suppurative periostitis develops from 
 the preceding. It often leads to osteomyelitis, necrosis of the 
 bone, and fistula formation. It is most frequently observed as 
 a sequela of a complicated fracture (fistula of the rib, pelvic 
 
220 OSTITIS 
 
 fistula, sternal fistula), as a result of pressure on the inter- 
 dental space, as well as in alveolar periostitis (tooth-fistula, 
 empyema of the superior maxillary sinus) . Treatment is 
 operative (incision, curettage, trepanation, tooth-extraction). 
 
 The chronic fibrous periostitis is a chronic inflammation of 
 the external, connective-tissue layer of the bone, which, in contrast to 
 the deeper laj^er of the periosteum, contains no osteoblasts. It leads to 
 the formation of so-called periosteal callosities with a subse- 
 quent atrophy of the bone. It occurs in the horse on the bridge of the 
 nose as a result of pressure from the nose-band, it also results from 
 pressure on the interdental space. 
 
 2. INFLAMMATION OF THE BONK-SUBSTANCE. OSTITIS. 
 
 Forms. — Inflammation of the tela ossea occurs in the 
 marrow tissue and in the vessels of the Haversian canals, as 
 well as in the bone-substance lying directly over these areas ; 
 it may also occur in the marrow spaces of the spongy bone. 
 The ostitis is usually chronic and is due, either to external 
 irritants, especially pressure and contusion (spavin, articular 
 ringbone), as well as compound fractures ; or to specific 
 inflammatory irritants (actinomycosis, glanders). It may also 
 result from extension of inflammation from the periosteum or 
 bone-marrow ; it is seldom of hematogenous origin. The 
 following forms are recognized : 
 
 a) Rarefying ostitis, that is, an inflammation of the 
 bone characterized by atrophy of the bone-substance (oste- 
 oporosis) with the formation of hollow spaces (lacunae). 
 The atrophy of the bone is the result of a lacunar bone- 
 resorption. The initial stages of spavin and ringbone are 
 typical examples of rarefying ostitis in the horse, it is due to 
 severe, continued contusion of the bones of the tarsal-joint, 
 and the bones of the first and second phalanges as a result of 
 overexertion of the horse. Rarefying ostitis has been recently 
 demonstrated as a cause of idiopathic fractures of the first 
 phalanx, second phalanx, and other bones (fragilitas ossium) 
 of the horse (ostitis of fatigue). Actinomycosis of the interior 
 maxilla in cattle presents a combination of rarefying ostitis and 
 ossifying periostitis. The transformation from a provisional to a 
 
OSTEOMYELITIS 221 
 
 definitive callus in fractures is characterized by a rarefying 
 ostitis. Deniarking inflammation of the bone in sequestration 
 is a similar process. Finally, many consider osteomalacia a 
 chronic rarefying ostitis with a consecutive decalcification of 
 the bone. 
 
 b) Condensing ostitis is a process directly opposite 
 to the preceding. Instead of atrophy it leads to new forma- 
 tions, induration, and thickening of bone (osteoschlerosis, 
 schlerotic ostitis, eburnation). It is observed as 
 a form of cicatrization at the termination of callus formation, 
 in the latter stages of spavin, in the vicinity of bone-fistulae 
 and bone- sequesters (inferior maxilla), as well as after the 
 administration of small amounts of phosphorus. 
 
 c) Granular or fungoid ostitis is characteristic 
 of tuberculosis of the bones. It is of a hemato- 
 genous origin and in combination with a granular osteomye- 
 litis leads to the formation of tuberculous granulation-tissue 
 and to a suppurative liquefaction of the bone (caries). For 
 details concerning tuberculosis of the bones see page 171. 
 Many forms of arthritis and glanders of the bone lead 
 to similar processes. Zschokke has observed a case of 
 glandular ostitis of the sternum with chronic fistula formation 
 and perforation of the sternum (pleuritis). 
 
 Deforming ostitis is a chronic inflammation of the bone. In men 
 the following bones are most often diseased : long bones, the 
 cranium, the vertebrae, and the pelvis. The disease may be painful or 
 painless, it leads to hypertrophy, softening, and bending of the bones. 
 Spavin in the horse may be termed a deforming ostitis. 
 
 3. INFLAMMATION OF THE BONE-MARROW. OSTEOMYELITIS. 
 
 Forms. — One recognizes, as in periostitis, an ossifying 
 and a suppurative osteomyelitis. The first occurs 
 during the process of callus formation in simple fractures ; the 
 second in healing of compound fractures. In addition to 
 these, suppurative inflammation of the bone marrow may have 
 hematogenous origin through the entrance of pus-bacteria 
 from the blood (pyemia, foal-lameness, chronic swine-erysipe- 
 las, leukemia, intravenous injections of streptococci, cocci of 
 
22 2 OSTEOMYELITIS 
 
 contagious pleuropneumonia, bacteria of chicken-cholera, etc., 
 in serum horses) . Granularosteomj'elitisin tubercu- 
 losis of the bones is an example of this form. One further distin- 
 guishes a non-suppurative inflammation of the bone- 
 marrow (serosa, album enosa, or mucinoid 
 non-purulent osteomyelitis) with a non-suppu- 
 tive but sanguino-serous, muco-viscid, synovial-like exudate, 
 which may be due to various causes. In animals one most 
 frequently observes a suppurative inflammation of 
 the bone- n: arrow after compound fractures 
 of the long bones, as well as in connection with sup- 
 purative alveolar periostitis , it leads to the formation of 
 bone fistulae, bone-abscesses, and necrosis 
 of the bone. 
 
 Primary Osteomyelitis in Man. — In men, acute 
 primary infectious osteomyelitis is the most 
 important form of inflammation of bone. This is also termed 
 a spontaneous diffuse osteomyelitis or bone typhus. It is 
 found especially in young individuals and has been recently 
 considered a pyemic osseous affection of developing 
 bones, or as a phlegmon of the bone- marrow. 
 Bacteriological investigations have demonstrated that it is due 
 to no specific infectious disease, but that it may be caused by 
 any pus-forming organism, it may be caused, therefore, by 
 many bacteria, especially in the form of mixed infection. The 
 infectious irritant is most often found to be the staphylo- 
 coccus pyogenes aureus (staphylomycosis of the 
 bone-marrow). In other cases one of the following has been 
 demonstrated as the exciting cause : staphylococcus pyogenes 
 albus and citreus, streptococcus pyogenes, micrococci, colon- 
 bacterium, pneumococci, and even the typhus-bacilli. The 
 infectious material named has various paths of entrance to the 
 blood (intestines, tonsils, lungs, skin) and develops a 
 hematogenous osteomyelitis. This is usually primary, 
 that is, it runs an independent course ; it may, however, occur 
 as a secondary affection in connection with other infectious 
 diseases. Frequently onl}^ one bone, the femur, is affected ; 
 at other times several bones may be involved. On post mortem 
 
OSTEOMYELITIS 223 
 
 examination the following changes are found : multiple, 
 confluent pus- foci in the bone marrow, and 
 even total suppuration and ichorous ulceration 
 of this tissue; there also occurs a suppurative periostitis, 
 necrosis of the bones, bending and curvature of the bones, as 
 well as pyemia and septicemia. Severe types of the disease 
 present the following clinical symptoms: very high 
 fever, pronounced local swelling and pain, 
 as well as severe general disease which occasionally 
 leads to death in a few days (type of typhus). In 
 other cases the disease presents the symptoms of an acute 
 articular rheumatism. One also observes a chronic course ; 
 it often occurs that healing results from early operative treat- 
 ment (removal with a chisel, curettage, resection, amputation). 
 
 Primary Osteomyelitis in Animals. — Are domes- 
 tic animals also affected with an acute infec- 
 tious osteomj^elitis? Asa result of experience with 
 pyemia, foal-lameness, swine- erysipelas, and serum-inocula- 
 tions, its occurrence cannot be disputed. Osteomyelitis has 
 been experimentally produced in growing rabbits by intraven- 
 ous injections of staphylococcus pyogenes aureus (lycxer, 
 Rodet). Spontaneous cases, however, with the excep- 
 tion of two in the horse described by myself and Karnbach 
 (Monatshefte fiir praktische Tierheilkunde, 1903), have not 
 been recorded from reliable sources in veterinary literature. 
 In both these cases staph ylococci were demonstrated as 
 the cause ; the paths of entrance are through injuries in the 
 skin, especially those resulting from gangrenous dermatitis 
 (grease). At the same time a contusion occurred as a 
 predisposing cause of the disease. In both horses only short, 
 spongy bones were affected, especially the first and third 
 phalanges. 
 
 The clinical appearance of osteomyelitis consists 
 of the following symptoms, which are very important from a 
 diagnostic standpoint : the first symptom of osteo- 
 myelitis in horses consists of a suddenly 
 developing lameness in the diseased foot. 
 From the very first this may be so pronounced that the animal 
 
224 OSTEOMYELITIS 
 
 will be unable to bear weight on the limb ; the degree of 
 lameness may be very slight at first so that recovery is appar- 
 ent, this being followed in a few days by a sudden and pro- 
 nounced reappearance of the symptoms. If the seat of the 
 disease is in the phalanges the animal holds the limb in an 
 attitude of pronounced flexion. Every attempt to extend 
 the toe results in severe pain. Pronounced swelling 
 of the involved extremity soon follows the high-grade lame- 
 ness. The swelling is relatively painless, and it 
 is further characterized by the fact that it is present only 
 in the vicinity of the diseased bones. After the 
 disease has existed for a long time thickening of the 
 bone can be easily recognized. In osteomyelitis, especially, 
 the disease process soon involves the periosteum. The peri- 
 osteal osseous new-formation is either confined to 
 the affected area, or extends over the entire length of the bones. 
 This thickening, which is characterized by its hard con- 
 sistence, may be recognized by careful palpation combined 
 with pressure. Finally, after more or less time, pronounced 
 fluctuation with abscess and fistula forma- 
 tion appears on the surface of the swelling. Under certain 
 circumstances incision of the ab.scesses, as in man, leads to a 
 confirmation of the diagnosis, when the discharged pus con- 
 tains free drops of fat, when a probe comes in contact with 
 rough bone, or when a canal passes into the bone. The 
 diagnosis in the incipient stages of the disease 
 offers the greatest difficulities if no characteristic indications 
 are present. In this case, the differential diagnosis 
 of several diseases comes into consideration, they are easily 
 confused, this is especially true of the following : inflamma- 
 tions of joints, periostites, fissures and fractures, phlegmons, 
 botryomycosis, etc. 
 
 The prognosis of osteomyelitis in the horse is as 
 unfavorable as in man. If the osteomyelitis, itself, ter- 
 minates, the termination of the affection is relatively favorable 
 through encapsulation of the focus of disease. Such an 
 abscess of the bone, however, as experience has taught in 
 man, may be a constant source of further pain and lameness. 
 
OSTEOMYELITIS 225 
 
 As a result of concussions the process tnay become acute and 
 again assume the form of osteom5^elitis. Outward pene- 
 tration of the pus is another termination. It first forms 
 a subperiosteal phlegmon, after the periosteum has 
 been broken down by the pus there is formed a phlegmon 
 of the subcutem and muscles that surround the bone, 
 this eventually results in the formation of multiple fistulse. 
 When the abscess is situated in the vicinity of articular surfaces 
 (as occurred in the horses described), which is the rule in man 
 (embolic infarcts of the epiphyseal vessels of the articular ends 
 according to L,exe r), the contents may break into the joint- 
 cavity and lead to suppurative inflammation of 
 the joint. The prognosis of such a secondar}^ suppurative 
 arthritis is always bad in horses. Finally, pressure laminitis 
 may occur in the normal foot, general pyemia may also develop. 
 With reference to the treatment of osteomyelitis it should 
 be remarked that from an economic standpoint the animal 
 should be slaughtered as soon as the diagnosis is confirmed. 
 Operative opening of the diseased bone with the hammer and 
 chisel followed by curettage of the pus-foci should be experi- 
 mentally employed only in very valuable horses. 
 
 One case described by Haas as "Infectious Osteomyelitis in Cattle'' 
 may possibly have been a genuine case of primary infectious osteomye- 
 litis as recognized in human surgery. A Swiss cow, from a fine milk- 
 type, which had not been sick for the past three years suddenly became 
 ill, presenting the following symptoms : rise of temperature (40.1 C) ; a 
 hot, painful, hard SAvelling on the right fore-arm beneath the elbow- 
 joint on which no injury to the skin was visible. At first the case was 
 diagnosed as phlegmon. After ten days of fruitless treatment, during 
 which the swelling gradually enlarged, the diagnosis of phlegmon was 
 discarded for that of periostitis. A few days later a softening was de- 
 tected in the depths of the swelling, this was incised and a small amount 
 of pus escaped through the opening ; a fistulous canal leading towards 
 the radius was discovered. Improvement was rapid for a time, when 
 the condition suddenly became worse, the temperature was high and 
 the animal fell off rapidly in condition. There occurred burrowing of 
 pus, thickening of the periosteum, the surface of the bone became 
 rough, and small sloughed pieces of bone were found in the pus. A 
 few days later there appeared a fluctuating swelling as broad as two 
 hands at the left hip-joint, this was soon followed by a second (pyemic 
 metastasis). As healing was now impossible the cow was killed. On 
 
226 NECROSIS OF BONE 
 
 post mortem the following changes were noted : the bone-marrow 
 was very red and contained suppurative foci as large 
 as the head of a pin. The tela ossea, also, was affected with 
 suppuration and necrosis, the periosteum was swollen and loosened 
 as the result of a serous exudate, it could be easily raised. The pus 
 of the bone-marrow contained staphylococcus pyo- 
 genes aureus and albus. 
 
 lyucet has described an acute, infectious osteoarthritis in young 
 geese ; staphylococcus pyogenes aureus was found in the pus. Suppu- 
 ration of bone was produced experimentally in animals by injecting 
 cultures of the coccus. 
 
 The cases described by Frank, Osterman,Janson, Schick, 
 and others under this heading remain open to question. A classification 
 of the pathological changes in the bone-marrow in different diseases of 
 the horse has been arranged by Sticker. 
 
 III. NECROSIS, ATROPHY, AND HYPERTROPHY OF BONES. 
 I. NECROSIS OF BONES. 
 
 Causes. — Necrosis, that is, gangrenous death of par- 
 ticles of bone or entire bone, is usually the result of disturbed 
 circulation in the bones (anemic necrosis). Necrosis 
 may be due to traumatic influences, in which circum- 
 scribed portions of the bone are splintered by wounds or c o m- 
 plicated fractures and thus cut off from nourishment ; 
 if wound infection occurs at the same time the splinters become 
 necrotic, while small aseptic pieces of bone are resorbed. One 
 frequently ob.serves this form of bone necrosis in horses on the 
 inferior and superior maxillae (bone fistula), sternum (sternal 
 fistula) , on the ribs (costal fistula) , and on the pelvis (pelvic fis- 
 tula). In other cases the necrosis is of inflammatory 
 origin; especially as a result of suppurative perios- 
 titis and osteomyelitis, or it may develop in the 
 vicinity of strangles abscesses, as well as by exten- 
 sion of a neighboring inflammation to the bone-marrow (p u s- 
 bacteria, necrosis bacillus). In this manner 
 necrosis of the turbinated and ethmoid bones may result from 
 chronic inflammation of the nasal mucous membranes ; necrotic 
 pododermatitis may lead to necrosis of the os pedis ; necrosis 
 
NECROSIS OF BONE 227 
 
 of the tendon, to necrosis of the navicular bone ; phlegmon of 
 the neck, withers, or tail, to necrosis of the cervical vertebrae, 
 the dorsal spines, or the coccj^geal vertebrae. Necrosis of the 
 cartilage occurs in a similar manner (fistula of the lateral car- 
 tilage.) Bone-caries is a special form of necrosis of the 
 bones. It is usually the result of a granular, tubercular ostitis 
 and osteomyelitis, which leads to the death of portions of the 
 bone, and to lacunar liquefaction and progressive softening, 
 with partial resorption of the necrotic portions (Cf : Tubercu- 
 losis of the Bones, page 171). When pieces of bone are 
 sloughed off during the course of caries it is termed necrotic 
 caries. A similar form of caries affects the teeth, especially 
 the molar teeth of horses, so-called tooth-caries. This 
 consists in a progressive degeneration of the cement and the 
 dentine-substance caused by the decomposition of masses of 
 food, and the entrance of bacteria through spaces in the enamel 
 (rasping!) into the substance of the tooth. Embolic 
 necrosis is very rare in the domestic animals (primarj' embolic 
 necrosis of the first and third phalanges, see page 223 ; embolic 
 necrosis of the sphenoid bone in contagious pleuro- pneumonia). 
 Phosphorus necrosis of the maxillary bones as 
 seen in man, has been observed only in experimental ani- 
 mals (rabbits) after the inhalation of fumes from phosphorus. 
 
 Forms. — One recognizes a partial (circumscribed) 
 and total (diffuse), a simple and multiple, as well 
 as a superficial and deep necrosis. 
 
 The latter classification is of special practical importance. 
 
 a) Deep necrosis is usually circumscribed. The 
 necrosed piece of bone is termed a sequester, the pro- 
 cess of sloughing is termed sequestration. The 
 sequester is separated from the sound bone byademarking 
 ostitis, its surface becomes corroded and liquefied as a 
 result of lacunar bone resorption (osteoporosis, ero- 
 sion) at the same time there develops a wall of newly- 
 formed osseous tissue around the line of demarcation in the 
 form of a bone-capsule (bony case, dead covering). From 
 the bony covering a canal frequently leads to the surface 
 (bone-fistula), the sequester frequently passes through 
 
228 ATROPHY OF BONE 
 
 the canal and is cast oflf. Occasionally the entire bone is 
 thickened during the process of sequestration. Total necrosis 
 of a large bone is very rare — for example, the scapula of a 
 horse (necrosis formation extending from the periosteum). 
 
 b) vSuperficial bone-necrosis is frequently characterized 
 by e X fo 1 i at i o n. 
 
 Treatment. — As in treatment of other organs, treatment 
 of bone-necrosis is purely operative. It consists in removal of 
 the necrotic portion — the bone-sequester, which sustains the 
 bone fistula, by means of curettage, the bone-chisel, and 
 trephine, and the removal of the sequester with bone-forceps 
 (sequestrotomy, necrotomy). The injection of 
 caustics, as well as cauterization of the fistulous tract, seldom 
 results in healing. 
 
 2. ATROPHY OF BONE. 
 
 Forms. — One recognizes a concentric atrophy, that 
 is, one extending from without inwards, which is also termed 
 erosion atrophy of the bone; and an excentric, one which 
 proceeds from within outwards (osteoporosis). A classi- 
 fication according to causes is more important. According to 
 the latter classification the following forms are recognized : 
 
 a) Inflammatory atrophy or osteoporosis 
 occurs during the course of a rarefying ostitis (initial stages of 
 spavin, actinomycosis, osteomalacia, leukemia). 
 
 b) Pressure atrophy or erosion occurs on the os 
 pedis through pressure from the horny sole ; on the navicular 
 bone during podotrochlitis ; on the . vertebral column as the 
 result of an aortal aneurysm ; on the nasal bones through 
 tumors within or external to the nasal cavities ; on the maxil- 
 lary and frontal bones through new-formations in the maxil- 
 lary and frontal sinuses ; coenurus cerebralis may cause atrophy 
 of the bones of the skull. 
 
 c) Atrophy of inactivity occurs with muscular 
 atrophy in chronic forms of lameness (spavin, ringbone), 
 especially on the tarsus, metatarsus, and metacarpus. 
 
RACHITIS AND OSTEOMALACIA 229 
 
 d) Senile atrophy may lead to fracture of the vertebrae 
 during the act of casting old animals. 
 
 e) Neurotic atrophy during the course of diseases of 
 the nerves (neuroparalysis), and subsequent to incisions of 
 the nerves. 
 
 3. HYPERTROPHY OF BONE. 
 
 Forms. — One recognizes a circumscribed (exosto- 
 ses, osteophytes), and a diffuse hypertrophy of the bones 
 (hyperostosis). There is also a form of hypertrophy that 
 occurs within the bone itself, this is termed osteoschlero- 
 sis or eburnation. All these three forms are of inflam- 
 matory origin. In contrast to these there has been observed a 
 congenital hypertrophy of bone, which is especially seen 
 in horses and dogs on the bones of the skull and face (1 e o n - 
 tiasis ossea, big-head). Congenital hypertrophy of 
 different extremities, the toes for example, is termed mac- 
 rodactylia; congenital hypertrophy of bone, with a simul- 
 taneous hypertrophy of the soft parts, is termed acromega- 
 lia; acromicria is an opposite condition. 
 
 APPENDAGE. RACHITIS AND OSTEOMALACIA. 
 
 Definition. — The nature of rachitis and osteomalacia as well as 
 the relation of both to each other has not yet been determined in a 
 manner entirely satisfactory and consistent. Ordinarily rachitis is de- 
 fined as a bone-disease which affects y o u n g , still developing 
 bones; as a result of the disease they do not ossify, but continue in a 
 form of cartilaginous development. In contrast to this, osteomalacia 
 or bone-fragility, is a disease of old, developed bones which is 
 characterized by the loss of bone salts (halisteresis). The following 
 are classified among the causes of both diseases : specific infectious 
 inflammations of bone (epizootic development, inflammation 
 of bone similar to that caused by phosphorus poisoning) ; deficiency 
 of lime in the food (experimental development of rachitis in young 
 animals as a result of living on food deficient in lime salts, rachitis in 
 pigs and dogs kept on an exclusive diet of potatoes and bread, osteoma- 
 lacia in anemic milch cows whose diet is poor in lime). For further 
 information see Friedberger andFrohner: "Special Pathology 
 and Therapeutics." 1904, Sixth Ed. Vol. I. 
 
230 RACHITIS 
 
 Rachitis. — Rachitis (softening of the bone) most frequently occurs 
 in young pigs and puppies, as well as in birds. It is seldom seen in 
 foals and calves. According to Kassowitz rachitis is characterized 
 anatomically^ by a pathological vascularization of the 
 bone- forming tissue in the form of a chronic hyperemia and 
 inflammation at the seat of apposition (epiphyses, periosteum, and 
 bone marrow). This results in the following changes: 
 
 1. Proliferation of the cartilage at the epiphyses. 
 
 2. Lacunar liquefaction (halis tere si s) of the formed bone. 
 
 3. Irregular deposits of lime in the developing 
 bone. 
 
 In general the anatomical changes in the bone are as follows : the 
 periosteum is hyperemic and presents, on the inner side, a pro- 
 nounced proliferation and thickening of the bone-forming layers, 
 whereby the newly developed tissue is not ossified, but, for the 
 most part, remains soft. Ossification of this tissue occurs later, this 
 gives the bone a thick, plump appearance, a circumscribed enlargement 
 is recognized. The periosteal proliferations are most often seen at the 
 muscular attachments ; in swine at the femoral attachment of the psoas 
 magnus and internal iliacus, very often at the tuberosity of the calcan- 
 eum ; in certain cases the thickened periosteum may be torn away from 
 bones by muscular contraction, in swine from the scapula. The principal 
 changes in rachitic bones occur at the boundaries of the epiphyses and 
 consist in an abnormal proliferation of the epiphyseal 
 cartilage without sufficient calcification. Normally the cartilage 
 between the epiphyses and diaphyses is composed of two, thin, paral- 
 lel layers ; the proliferating and the ossifying layer. In rachitic bones 
 the proliferating layer is overdeveloped, while the ossifying layer is- 
 abnormally small ; instead of being parallel they are now irregular. 
 This abnormal proliferation of the epiphyseal cartilage leads to a thick- 
 ening and swelling of the epiphysis which ossifies only 
 when the disease has run a long course ; it leads to a curving and 
 bending of the long bones, and finally to a dislocation of the 
 epiphyses whereby the attachment between the epiphyses and 
 diapyses becomes loosened. 
 
 The most important symptoms of rachitis consist in a swelling 
 and enlargement of the epiphyses of the bones in the vicinity of the 
 joints (double-jointed); in a bending and curvature of the bones 
 of the extremities (shaped like the limbs of a badger 
 hound, or like a sabre); the vertebral column is curved down- 
 wards (lordosis), upwards ( ky phosi s), or laterally (scoliosis). 
 Swellings occur at the articulations of the ribs and costal cartilages 
 (rachitic beads); the pelvis becomes deformed (rachitic 
 pelvis); the coronary joint presents exostosis formation (rachitic 
 ringbone ) ; asymmetry occurs in the formation of the skull ; forma- 
 tion of a so-called chicken-breast, etc. 
 
OSTEOMAI.ACIA 23 1 
 
 Treatment of rachitis consists, in addition to the removal of the 
 cause (change of food), in the administration of phosphorus; for 
 the horse, one to five centigrams ; dog, one half to two milligrams. 
 They should receive a diet of bone-meal. 
 
 Osteomalacia. — Osteomalacia, or bone-fragility, is most often 
 seen in milch cows, especially during the period of lactation or preg- 
 nancy ; it is occasionally seen in horses (bran-disease, osteoporosis). 
 Opinions concerning the nature of the disease are extremely variable. 
 
 1. Virchow and others consider it a chronic, parenchy- 
 matous inflammation of the bone or a rachitis of 
 adults. As a result of accelerated vascular proliferations there results, 
 on the one side, a new-formation of soft, osteoid masses; on the other, 
 a lacunar resorption (halisteresis) . 
 
 2. Ziegler considers it a pure halisteresis — that is, a 
 simple decalcification of the bones without inflammatory new- 
 formation. 
 
 3. Peptrone has defined bone-fragility as an infectious 
 disease due to a specific bacterium ( nitrification) . 
 
 The anatomical changes in the bones, which are especially promi- 
 nent in those of the trunk and upper limbs, are as follows : in the early 
 stages of the disease and in light attacks, if one examines carefully, 
 an increased blood-supply is visible in the diseased bones. 
 There is a dilitation of the vessels and the canals through which they 
 pass. A section of the bone brings into sight small hemorrhagic points, 
 the marrow is infiltrated with many small extravasates, the bone tissue 
 in the vicinity of the dilated Haversian canals presents slight changes. 
 In a more severe type the hyperemia is pronounced ; the external 
 surface of the matrix, as well as a cut surface of the bone, present 
 highly colored points, the marrow is very hyperemic and filled 
 with hemorrhagic areas. The marrow cavities are dilated. 
 In the diploe and on the inner surface of the matrix one finds many 
 small pieces of bone that have become loosened from the surrounding 
 tissue. The bones are easier to saw or cut, their tone is 
 not so clear. Microscopically the homogeneous structure of the bone 
 substance is atrophied ; in certain areas it appears more transparent, the 
 bone-corpuscles are enlarged and transparent, in form they become 
 oval, round, and even polyhedral, their processes disappear. The 
 bone-cells gradually undergo fatt.y degeneration. 
 The entire process is a transformation of certain areas 
 of the bone-substance into osteoid, and final ly into 
 marrow tissue. In the most severe types of osteomalacia 
 the hyperemia of the bone and marrow is still more pronounced, the 
 osseous substance becomes spongy, more friable, 
 and softer; the matrix and diploe become smaller and smaller ; the 
 marrow gradually increases. The matrix is displaced from within 
 
232 DISEASES OF JOINTS 
 
 outwards, and is removed, even at the epiphyses; fractures of the 
 bone occur. When there exists a general derangement of the nutrition, 
 the marrow itself becomes softened, gelatinous, even watery, and pre- 
 sents a dirty -yellow color. The specific gravity of the bone 
 diminishes until more than half of the lime salts have disappeared ; 
 it contains, however, more water. 
 
 The s5'mptoms of osteomalacia in cattle are as follows : severe 
 derangement of the nourishment, emaciation, weak digestion, symptoms 
 of opsomania, hardening of the skin, cachexia, lameness, bone- 
 fractures, infractions, and distorsions. Fractures of the 
 pelvis and ribs are especially frequent, they often result from the slight- 
 est provocation (rising, lying, twisting, parturition), and are often 
 multiple. 
 
 Treatment consists in a change of food (food containing lime) , 
 administration of bone-meal or phosphates of lime, as well as, above all, 
 in the internal abministration of phosphorus (1-5 centigrams per 
 cow) in oil. Ovariotomy (castration) has been followed by good results 
 in man, it may be experimentally employed in cattle. 
 
 DISEASES OF JOINTS. 
 
 Anatomical Considerations. — From a surgical standpoint the 
 synovial structures (joint-capsule, synovial membrane ) are the 
 most important anatomical portions of the joint. In comparison with the 
 capsular ligament, the other ligaments of the joint, especially the lateral 
 ligaments, anterior and posterior ligaments, etc., are of secondary 
 importance from a surgical standpoint. By most authors the 
 synovial membrane is considered a serous structure 
 which has its analogue in the peritoneum and the pleura. Its inner 
 surface is covered with a simple endothelial layer which covers 
 the processes — the diverticuli and villi of the synovial membrane — but 
 does not cover the cartilage. Only in the fetus, as well as after a long 
 period of rest for the joint, does the synovial endothelium partially 
 cover the cartilage. The external la^'er of the synovial membrane, 
 which serves as its basis, is composed of a net-work of connective- 
 tissue and elastic fibers. (Others consider the synovialis, not a serous, 
 but a fibrous membrane). 
 
 The villi of the joint form fine, hair-like proliferations 
 directed from the synovial membrane towards the cavity of the joint, 
 occasionally daughter- villi are present. According to their histological 
 characteristics they are classified as follows: mucous villi, fat- 
 villi, cartilaginous villi, and fibrous villi, between these 
 there frequently occur transitional forms. According to Tillmanns 
 the synovia is formed principally from the mucous and fat-villi, 
 partly through secretions, partly through a solution of their cellular 
 
ARTHRITIS 233 
 
 elements. Schn e id e m ii h 1, on the other band, supports the theory 
 that Tillmauns' classification depends on a pathological condition, and 
 that the synovia is not formed by a continual disintegration of the 
 endothelial cells, but, as in other serous cavities from an independent 
 secretion. The secretory activity forms, therefore, the 
 principal function of the endothelium of the joint. 
 The villi of the synovial membrane and joint are extremely rich in 
 vessels especially in lymph-vessels, which apparently communi- 
 cate directly with the joint-cavity through open stomata; this explains 
 the great resorptive ability of the joint-capsule. The hyaline 
 cartilage, which covers both ends of the bones, is only apparently 
 homogeneous, normally it is composed of small fibers, this explains the 
 fibrillation found in various pathological conditions (Tillmanns). 
 
 I. INFLAMMATION OF JOINTS. ARTHRITIS OR SYNOVITIS. 
 
 Classification. — According to the causes, ana- 
 tomical characteristics, and course, inflammation of the 
 joints (sjmovitis) may receive various classifications. 
 
 From an etiological standpoint, one distinguishes, 
 above all, a no n -infectious (aseptic), and infec- 
 tious (septic) inflammation of the joint. Traumatic 
 arthritis is the most common, that is, an arthritis due to 
 injury, it may be aseptic or septic. There is also recognized 
 a primary and secondary inflammation of joints. The primary 
 develops direct, at the seat of action of the inflammatory irri- 
 tant. The secondary develops through extension from a 
 neighboring inflammatory process ; for example, inflammation 
 of the joint extending from the bone, or hematogenous 
 through the medium of the blood. Hematogenous arthritis 
 has been termed symptomatic or metastatic. It 
 occurs during the course of infectious diseases (acute articular 
 rheumatism, pyemia, septicemia, contagious pleuropneumonia, 
 infectious abortion, foal-lameness, petechial fever, malignant 
 head-catarrh in cattle, strangles, swine-erysipelas, swine- 
 plague, dog-distemper, glanders, tuberculosis, intravenous 
 injections of streptococci, etc., and in serum horses), it is 
 occasionally seen in cattle as the result of abortion, retention 
 of the fetal membranes, and metritis (puerperal pyemia), as 
 well as in lameness in calves (polyarthritis ) ; in goats during 
 
234 SEROUS ARTHRITIS 
 
 the course of an infectious agalactia ; finally, as the result of 
 certain constitutional diseases (gout). When several joints 
 are diseased at the same time it is termed polyarthritis 
 (rheumatic, septic, uric, pyemic), in contrast to traumatic 
 monarthritis. Symptomatic inflammations of the joints 
 include the specific forms of arthritis (tuberculosis, glan- 
 ders, actinomycosis). — In cattle, even certain physiological 
 forms of arthritis are observed, those occurring with change 
 of teeth and development of bone "dentition arthritis" (?). 
 According to the course, arthritis is classified as acute and 
 chronic. 
 
 According to the anatomical character of the in- 
 flammation, one distinguishes an exudative and a dry 
 inflammation of the joint (arthritis sicca). According to the 
 character of the exudate and the product of the inflammation 
 one further distinguishes the following forms: serous, sero- 
 fibrinous, fibrinous, suppurative, hemorr- 
 hagic, ichorous, deforming, caseous, catarr- 
 hal, pannous, fungoid, granular, erosive, 
 and ulcerative arthritis. 
 
 In the domestic animals the following are the most im- 
 portant and most frequent forms of arthritis, because of their 
 practical importance they are fully described : 
 
 1. Serous arthritis. 
 
 2. Suppurative arthritis. 
 
 3. Deforming arthritis. 
 
 4. T u berc ula r arthritis. 
 
 I. SEROUS INFIvAMMATION OF JOINTS. ARTHRITIS SEROSA. 
 
 Causes. — Serous arthritis is most frequentl}' observed 
 in dogs and horses as a traumatic, aseptic inflamma- 
 tion resulting from contusions and distorsions. It may occur, 
 however, as a symptomatic arthritis, especially in acute 
 articular rheumatism (polyarthritis serosa), less frequently in 
 pleuropneumonia, as well as metastatically in cattle as a 
 result of retention of the afterbirth ; it may also occur during 
 the course of mastitis (hip-joint, knee-joint, tarsal-joint). 
 
SEROUS ARTHRITIS 235 
 
 Symptoms. — Serous inflammation of the joints occurs in 
 two forms : acute and chronic. 
 
 a) Acute, serous arthritis is usually a traumatic 
 inflammation of the tarsal-joint, fetlock-joint, knee-joint, car- 
 pal-joint, or hip-joint, without injury to the joint-capsule. 
 It develops suddenly and presents the following symptoms : 
 a circumscribed and fluctuating swelling, 
 intense pain, lameness, and increased tem- 
 perature of the involved joint, there is not usually a 
 general rise of temperature. High fever is present 
 only in symptomatic arthritis. Acute serous arthritis termi- 
 nates in resorption of the fluid exudate followed by healing, 
 or, if resorption fails, it passes into the chronic form. In the 
 latter case the prognosis is unfavorable. 
 
 b) Chronic serous arthritis, also termed 
 chronic hydrops or joint-gall, develops from the 
 acute form, or it may be progressively chronic in nature. In 
 the latter case it is often supported by a hereditary predisposi- 
 tion in the form of an atony or slight vulnerability of the joint. 
 In contrast to acute arthritis, the swelling of a chronic hydrops 
 is painless and retains a normal temperature; inter- 
 ference with movement is absent or slight. Occasionall}^ this 
 form is intermittent in character. It is especially common in 
 horses and cattle in the form of so-called galls or the fetlock-, 
 tarsal-, or knee-joints. 
 
 Treatment.-— Acute serous arthritis in the early stages 
 is treated as follows : rest, moist heat, Priesnitz com- 
 press, compression, plaster-of- Paris bandage, and massage ; in 
 the latter stages, with irritating applications (tincture of iodine, 
 cantharides-collodion). The often incurable, chronic serous 
 arthritis may be treated with blisters and firing. The method 
 of treatment successfully employed in human surgery, where 
 the joint is punctured in an aseptic manner 
 and followed by antiseptic irrigation, is not indi- 
 cated in the treatment of the horse where a bandage can be 
 applied only with difficulty or not at all. In the treatment of 
 dogs this method may be experimentally employed. From a 
 prophylactic standpoint horses with joint-galls may be excluded 
 for breeding purposes. 
 
236 SUPPURATIVE ARTHRITIS 
 
 2. SUPPURATIVE INFLAMMATION OF JOINTS, ARTHRITIS 
 PURULENTA. 
 
 Causes. — Suppurative or pyo-ichorous arthritis is due to 
 the entrance of pus- forming bacteria into the joint. 
 As a rule they gain entrance through perforating joint- 
 wounds. In other cases a suppurative inflamma- 
 tion in the vicinitj^ extends to the joint (subcoronary 
 phlegmon, suppurative podotrochlitis and pododermatitis, 
 phlegmon of the fatty frog to the pedal-joint). Pus-bacteria 
 may also gain entrance to the joint through a hematogenic 
 course ; this is the most often seen during the course of a 
 pyemic polyarthritis in foals and calves. In horses, the 
 severe, acute suppurative arthritis which usually terminates 
 in septicemia is most often caused bj^ staphylococcus pyo- 
 genes aureus ; the subacute type, by streptococcus pyogenes 
 (Bo si). Staphylococcus pyogenes aureus (Sohnle) and 
 streptococcus pyogenes (Ostertag) have also been found 
 in suppurative and sero-purulent polyarthritis of foal-lameness. 
 In polyarthritis of calves, on the other hand, the colon bacillus 
 seems to play the principal part (Zschokke). 
 
 Pathological Condition. — In a suppurative and ichor- 
 ous arthritis one finds greyish-yellow or light-yellow, cream- 
 like, and viscid contents in the joint (suppitrative arthritis) ; 
 or an ichorous, discolored, brownish, chocolate-colored, grey- 
 ish-brown, or dirtj-green fluid, which is fetid and filled with 
 bubbles of gas (ichorous arthritis). The synovial membrane 
 is swollen, highly reddened, markedly thickened (as much as 
 one-half centimeter), and similar to an abscess- wall ; the inner 
 surface is covered with villiform, soft, reddish-grey granula- 
 tions. The slightest changes appear to be in the articular 
 cartilage. Marked erosions and ulcerous defects 
 are usually absent ; occasionally the cartilage is somewhat 
 rough and cloudy (glistening is absent), in many places it is 
 more or less thinned and softened. Abnormal color is the 
 most pronounced characteristic (light-grey, greyish-blue, 
 greyish-green, bluish-white). In the ends of the bones, 
 
SUPPURATIVE ARTHRITIS 237 
 
 when the process has existed for a long time, one finds osteo- 
 myelitic processes, inflammmatory osteoporosis and necrosis. 
 
 The general anatomical changes are usually of a 
 septicemic nature "(inflammatory swelling of the liver, 
 spleen, pancreas, heart, gastric glands, edema of the lungs 
 and glottis, hemorrhagic laryngitis and pharyngitis). Pyemic 
 changes are less frequent ; this is also true of genuine metas- 
 tases, especially in the lungs in the form of a multiple, 
 focus-like gangrenous pneumonia (necrosis 
 bacillus). 
 
 Symptoms. — Suppurative arthritis (empyema of the 
 joint), in contrast to serous inflammations of the joint, is char- 
 acterized by fever, symptoms of severe general 
 disturbance and severe lameness, as well as 
 a circumscribed, diffuse, circular, hot and 
 painful swelling of the joint (parasynovial phlegmon 
 and suppuration), occasionally periarticular abscesses are pres- 
 ent. If this condition is accompanied by a penetrating joint- 
 wound a suppurative discharge flows from the joint 
 into which one may pass a finger or probe. In the horse 
 the suppurative and pyo-ichorous forms of 
 arthrites of the large joints, seem, as a rule, 
 toruna rapidly fatalcourse as theresultof 
 septicemia or septicopyemia. In suppurative 
 inflammation of the small joints, especially the hoof-joint, the 
 fatal termination is somewhat delayed (one or two weeks). 
 Suppurative inflammation of the small joints in the horse is 
 occasionally followed by healing and anchylosis forma- 
 tion. This is especially true of the lower rows of the tarsal- 
 joints (intertarsal joints, tarso-metatarsal joints) when the 
 point cautery has been used for the treatment of spavin, of 
 the lower rows of the carpal-joints, of the fetlock-joint, and the 
 pedal-joint. It is a peculiar fact that the ass and mule, in 
 comparison with the horse, are less severely affected with sup- 
 purative arthritis (Bo si). One occasionally observes a 
 chronic form in cattle, this is especially true of the hip-joint. 
 
 Treatment. — The following forms are usually incur- 
 able in the horse : purulent and pyo-ichorous arthritis of 
 
238 DEFORMING ARTHRITIS 
 
 the hip-, knee-, tarsal-, shoulder-, elbow-, coronary-, and 
 pedal-joints. In all these cases, therefore, from an economic 
 standpoint, it is usually best to advise earl)' slaughter. Occa- 
 sionally they can be treated, as in* human surgery, with 
 puncture and incision, antiseptic cleansing, 
 drainage, and permanent irrigation ofthe sup- 
 purating joint. I have observed healing in the horse in four 
 cases of suppurative arthritis of the fetlock -joint, as well as in 
 many cases of suppurative arthritis of the pedal-joint (perfo- 
 rating nail punctures, resection of the perforans tendon). 
 Lutz has also described a case of healing. Treatment for 
 the dog, on the other hand, is more often indicated as bandag- 
 ing is more easily employed ; in certain cases, one may resort 
 to resection of the joint and amputation. In two 
 cases I have resected a suppurative maxillary-joint in the 
 horse with good results. 
 
 3. DEFORMING INLAMMATION OF JOINTS. ARTHRITIS 
 
 DEFORMANS. 
 
 Definition. — In human medicine ''deforming'' 
 inflammation of the joint indicates a chronic, aseptic, 
 senile arthritis (malum senile), which leads to per- 
 manent and severe changes in the entire 
 joint; it is not combined with suppuration. Its occurrence 
 may be spontaneous or traumatic ; it may be either mono- or 
 polyarticular ; its favorite seat is in the hip-, knee-, 
 shoulder-, and elbow-joints, and in the fingers and vertebral 
 column ; ordinarily it continues during life, is non-febrile, is 
 ushered in with stiffness, crepitation, and slight sensitiveness 
 in the involved joints ; finally, it leads to deformity of the 
 entire joint. Anatomically it is characterized by de- 
 generative as well as newly formed processes 
 in the ca r t i 1 age , bones, and joint-capsule, 
 
 a) In the articular cartilage one finds, on the 
 one side, changes which are t3'pical of a chronic, ulcera- 
 tive, dry arthritis; namely, fibrillation of the super- 
 ficial layers, foci of disruption and softening in the deeper lay- 
 
DEFORMING ARTHRITIS 239 
 
 ers, erosion and even complete atrophy of the cartilage with 
 the formation of smooth, polished surfaces ; on the other side, 
 there occur active proliferations of the cartilage in the form of 
 nodular swellings. 
 
 b) In the bones there exists a subchondral inflam- 
 matory osteoporosis with lacunar atrophy of the bone, 
 in addition to bony new-formations. 
 
 c) The joint-capsule shows proliferation, 
 thickening, and shriveling, one also occasionally 
 observes the formation of free j oint-bodies. 
 
 These combined changes result in pronounced deformities 
 in the involved joints, whereby their mobility is either re- 
 stricted or entirely suspended, or it maj' result in an excessive 
 mobility of the joints (luxations, loose joints). 
 
 Occurrence in Animals. — The following diseases may 
 be classified under chronic deforming inflammation of the joint : 
 spavin and articular ringbone in the horse; certain 
 forms of gonitis that are characterized by severe swelling 
 of the joint ; omarthritis (inflammation of the shoulder- 
 joint) ; and coxitis (inflammation of the hip-joint) in dogs, 
 horses, and cattle. Chronic, deforming inflammatory pro- 
 cesses are also frequent in the pedal-joint (so-called ringbone 
 of the pedal-joint), and in the carpal-joint (so called spavin of 
 the carpus) of the horse. So-called chronic lameness 
 of the pedal-joint (bursitis podotrochlearis) and sesa- 
 moid lameness in the horse, show a certain analogy to 
 arthritis. One also observes deforming arthritic changes in 
 chronic articular rheumatism. Sticker described 
 a case of polyarthritis deformans in the horse which showed 
 cauliflower-like, cartilaginous and osseous growths around the 
 margins of the joints, thickening and villous proliferations on 
 the synovial membrane, as well as an increase in the amount 
 of synovia. 
 
 The relation of spavin and ringbone, as well as 
 chronic gonitis and omarthritis in the horse, to de- 
 forming arthritis, is of special importance. 
 
 I . In the text-books on surgery spavin is usually defined 
 as a chronic deforming arthritis tarsi. In this 
 
240 DEFORMING ARTHRITIS 
 
 form the term is not entirely correct. According to the excel- 
 lent investigations of Gotti, whose accuracy has been 
 proved by Bayer, Eberlein, and myself, spavin, in 
 many cases, is not a primary disease of the cartilage ; the 
 bone forms the primary seat of the disease. Spavin is 
 primarily an ostitis of the cuneiform magnum 
 and medium, as well as the metatarsus; de- 
 forming inflammation of thetarsal-joint is a 
 secondary disease which develops from the 
 ostitis. "Osteoarthritfs chronica deformans", 
 therefore, is a more accurate term for spavin. According to 
 Gotti spavin is a slowly developing inflammatory process in 
 the bones, it is characterized by decalcification (inflamma- 
 tory osteoporosis, rarefying ostitis) whereby 
 numerous small or large spaces become visible in the bone ; in 
 these spaces one finds soft, reddish masses which resemble 
 granulation-tissue. This rarefying ostitis may be replaced by 
 a condensing ostitis (o s t eosc h le ros is). In 
 many cases, especially in the initial stages, these pathological 
 changes in the bone (rarefying and condensing ostitis) are 
 the only ones present in spavin, the cartilage and periosteum 
 are intact. Later in the course the ostitis may either extend 
 in a central direction towards the joint, involving the articu- 
 lar cartilage; or it may take a peripheral direction, that 
 is, extend to the periosteum (both processes frequently 
 occur at the same time). In the first case there exists a 
 secondary disease of the articular cartilage with degenera- 
 tion of the cartilage, active proliferation of the carti- 
 laginous cells, and the formation of an inner anchylosis. 
 If the inflammatory process extends fr5m the bone-substance 
 to the periosteum it leads to an ossifying periostitis 
 with the formation of osteophytes and an ex- 
 ternal anchylosis. The bones of the tarsal-joint have 
 then become partly osteoporotic, partly schlerotic masses 
 of osseous tissue. It is very rare that the inflammation 
 extends to the bursa of the tibialis anticus (compare with 
 Eberlein, "Der Spat der Pferde." Monatshefte fiir praktische 
 Tierheilkunde. 1898). 
 
DEFORMING ARTHRITIS 24I 
 
 2. Ringbone is a collective term for various chronic, 
 aseptic inflammatory processes at the coronarj^-joint. 
 One must differentiate, above all, between articular and 
 periarticular ringbone. In periarticular ringbone the 
 joint itself is not involved, it consists of a periarthritis, that 
 is, a chronic ossifjnng periostitis at the attachments of the 
 lateral ligaments or the capsular ligament (lateral, bilateral, 
 circular ringbone) . Articular ringbone, on the other 
 hand, similar to spavin, is an osteoarthritis chronica 
 deformans of the coronary-joint originating from 
 an inflammatory osteoporosis of the subchondral 
 bone of the first and second phalanges. There is an exten- 
 sion of the primary inflammatory process in the subchondral 
 portions of these bones, which leads to a secondar}' degen- 
 eration of the articular cartilage, to an ero- 
 sion of the cartilage, and finally to the formation of an an - 
 c h y 1 o s is. This process is accompanied by a regenerative 
 process in the bones (ostitis condensans). If the subchondral 
 osseous inflammation extends in a centrifugal direction — in the 
 direction of the periosteum — there further occurs an ossifying 
 periostitis with the formation of osteophytes in the vicinity of 
 the joint, that is, in addition to the articular, there is also a 
 periarticular ringbone. As a rule, old cases of ring- 
 bone are a complication of the articular with 
 the periarticular form. This also results in the de- 
 velopment of an external anchylosis. Microscopic- 
 ally the first changes in the diseased bone consist of a dilita- 
 tion of the Haversian canals, lacunar formation, the formation 
 of red granulation-tissue, as well as atrophy of the bone-cells. 
 (Cf: Udriski, "Die Krongelenkschale des Pferdes." 
 Monatshefte fiir Praktische Tierheilkunde. igoo). 
 
 The same changes are found in the fetlock-joint (ring- 
 bone of the fetlock-joint), and pedal-joint (ring- 
 bone of the peda 1 -j oi n t ) , (Cf: Karnbach, 
 "Die Hufgelenkschale des Pferdes. " Monatshefte fiir prak- 
 tische Tierheilkunde. 1900). 
 
 3. Chronic gonitis of the horse, likewise, is usually an 
 osteoarthritis, seldom a pure arthritis chronica 
 
242 DEFORMING ARTHRITIS 
 
 deformans. It usually attacks the medial portion of the 
 knee-joint, and in most cases has its origin in the bones 
 (tibia, femur) in the form of a primar}^ rarefying ostitis. 
 The inflammatory osteoporosis then extends in a central direc- 
 tion to the articular cartilage (erosion of the cartilage), 
 in a horizontal direction to the periosteum of the bones 
 on the sides of the tibia and the femur (formation of 
 osteophytes), and finalh' to the joint- capsule (prol i fer- 
 ation of the articular villi, hydrarthrosis, free 
 joint-bodies). Chronic gonitis in the horse less frequently 
 begins in the form of a primary chondritis (proliferation of the 
 cartilage-cells, fibrillation and degeneration of the intercellular 
 matrix), involving the bone in the form of a secondary pro- 
 cess. (Cf: Z ale vvsky, "Die Gonitis chronica deformans des 
 Pferdes." Monatschrift fiir praktische Tierheilkunde. 1901). 
 
 4. Chronic omarthritis in the horse is the most impor- 
 tant cause of so-called chronic shoulder lameness. Its seat of 
 origin is also usually found in the subchondral osseous tissue 
 (medial half of the joint, marginal portion of the scapula) in 
 the form of an inflammatory osteoporosis with a 
 subsequent osteoschlerosis. As a result of extension to 
 the articular cartilage there exists a chondritis with incur- 
 able ca rti lagi nous erosion ; nodular, warty, or crest-like 
 exostoses form at the margins of the joint, occasionally 
 these lead to a subsequent anchylosis formation; 
 inner anchylosis, similar to spavin and ringbone, does not 
 appear to occur. The j oi n t - c a p s u 1 e is thickened, the 
 articular villi are enlarged ; occasionally it also leads to the 
 formation of free joint-bodies. (Cf: Karubach, Die 
 Omarthritis chronica deformans des Pferdes. Monatshefte fiir 
 praktische Tierheilkunde. 1903). 
 
 The treatment of chronic deforming arthritis consists 
 in allowing the natural process of healing to run its course 
 (condensing ostitis), or in artificial adhesion (anchylosis) of 
 the joint by means of r est , firing, or blisters. Neu- 
 rotomy remains as a last resort. 
 
TUBERCULAR ARTHRITIS 243 
 
 4. TUBERCULAR INFLAMMATION OF JOINTS. ARTHRITIS 
 GRANULOSA. 
 
 Occurrence. — In cattle, swine, and birds, occasionally 
 in dogs, there occurs a tubercular arthritis, as in 
 man, during the course of tuberculosis. According to the 
 anatomical characteristics it is termed granular, fungoid, 
 spongy, and caseous arthritis, or car i es of the joint ; 
 (tumor albus and fungus Jaelong to older classifications). In 
 cattle it is found in the knee-joints, hip-, elbow-, and carpal- 
 joints ; in swine in the carpus and tarsus ; in birds in the joints 
 of the feet and wings ; one case has also been observed in the 
 knee-joint of the dog (C a d i o t). 
 
 Anatomical Changes. — Tubercular arthritis is charac- 
 terized by a granular inflammation with tubercular prolif- 
 erations on the synovial membranes, cartilage, and bone ; 
 when continued for a long time there occurs a tubercular soft- 
 ening and liquefaction of the ends of the joints (caries), as 
 well as caseation; occasionally the changes are typical of 
 a deforming arthritis. Tubercle-bacilli are present in the 
 proliferations and in the pathological synovia. 
 
 According to G u i 1 1 e b e a u two forms of tubercular 
 arthritis exist in cattle. Ordinarily the distended joint-capsule 
 contains fibrin, the synovial papillae are enlarged, sometimes 
 to the size of a hazelnut or plum ; man}' times they are flat, 
 several centimeters in length and breadth, and of the nature 
 of a pannous membrane. In the vicinity of the proliferations 
 the articular cartilage is destroyed (ulcer-like defects); the 
 articular epiphyseal ends of the bones are also eroded with the 
 tubercular granulation tissue. Edema exists in the vicinity 
 of the joint. Caseated tubercular nodules are less frequently 
 observed in the S3movial membranes and at the ends of the 
 bones. One occasionally observes processes of healing (de- 
 crease in the fibrinous exudate and the hyperplastic membrane, 
 formation of a cartilaginous cicatrix). 
 
 Symptoms. — According to Hess tubercular arthritis oc- 
 curs in cattle several weeks after parturition, as well as after 
 an abortion. Its favorite seat is in the knee-joint (communi- 
 
244 ARTICULAR RHEUMATISM 
 
 cation with the tendon-sheath of the lon^ extensor of the toe) 
 and in the elbow-joint. The disease frequently begins with a 
 severe lameness and in most cases runs a chronic course. As 
 a rule it is i n c u r a bl e and is associated with pronounced 
 muscular a t r o p h ^^ The diagnosis can be confirmed by 
 means of a tuberculin injection. 
 
 Arthritis Fibrinosa. — Fibrinous or croupous inflammation of the 
 joint is characterized by a serous exudate rich in fibrin, for this reason 
 it is also termed a sero-fibrinous arthritis. On palpation the 
 fibrin is recognized by a fine, crepitating sound (arthritis crepi- 
 tans). By many, fibrinous inflammation of the joint is termed catarr- 
 hal arthritis (increased desquamation of the mucous villi), and is con- 
 sidered a mild type of suppurative arthritis (Volkmann). It frequently 
 leads to anchylosis, occasionally to the formation of joint-bodies. It is 
 found in tubercular arthritis of cattle (see above). 
 
 Arthritis Pannosa. — Pannous inflammation of the joints 
 (arthritis chronica proliferans, or arthritis hyper- 
 plastica laevis) is a chronic arthritis characterized by the presence 
 of newly formed vascular granulation-tissue on the 
 surfaces of the articular cartilage. It is seen in chronic 
 hydrops, during the course of a chronic articular rheumatism, and in 
 tubercular arthritis of cattle (see above). Occasionally it leads to the 
 formation of free joint-bodies (corpora libera), as well as to a fibrous 
 anchylosis. 
 
 Arthritis Chronica Sicca. — Dry or ulcerative inflammation of 
 the joint (arthritis chronica ulcerosa) is observed in the horse 
 after a chronic lameness as the result of a long period of rest for the 
 joint ; it is seen after a severe distorsion, as well as in the early stages of 
 a deforming arthritis. It is characterized by fibrillation, disin- 
 tegration and erosion of the articular cartilage. Horses 
 and dogs are most frequently affected. 
 
 ArTicui<ar Rheumatism. — This is a febrile, infectious dis- 
 ease aclcompanied by a serous polyarthritis; it occurs 
 most frequently in cattle, less frequently in goats, swine, dogs, and 
 horses. Usually several joints are suddenly affected with a very pain- 
 ful serous arthritis ; its favorite location is in the carpal-, tarsal-, and 
 knee-joints ; it results in severe lameness. In cattle, especially, rheum- 
 atism of the joints is accompanied with inflammation of the tendon- 
 sheaths. As in man, the development of endocarditis (valvxilar disease) 
 forms an important complication. Though usually beginning as an 
 acute or peracute disease, it ordinarily runs a chronic course. The 
 anatomical changes in tihe joinits consist largely of a serous 
 or sero-fibrinous synovitis, as well as in inflammatory degen- 
 erative articular changes during a chronic course (arthritis pan- 
 
PYEMIC AND SEPTIC ARTHRITIS 245 
 
 n o s a and deformans); a suppurative synovitis is seldom observed. 
 As a rule the attack is simultaneous inseveral joints. 
 In the acute course one finds the synovial membrane highly reddened, 
 €ven hemorrhagic, turbid, swollen and thickened, the articular papillse 
 are vascular and enlarged. The amount of the synovial fluid is in- 
 creased, reddish in color, and often cloudy. In the early stages the 
 articular cartilages are very red ; later they become yellow and present 
 a rough, velvet-like surface. The tissues in the vicinity of the joint 
 also present an injected appearance, they are permeated with hemor- 
 rhages and infiltrated with serum (periarthritis); the connective tissue, 
 especiaUy, is affected with a gelatinous swelling, the adjacent muscles 
 are edematous and soft. The articular ends of the bone are hyperemic 
 and even infiltrated with hemorrhages ; the same is true of the bone- 
 marrow. In the chronic type the synovial membrane becomes markedly 
 thickened, and the inner surface of the joint is covered with a vascular 
 connective-tissue layer (arthritis pannosa); the articular cartilage un- 
 dergoes fatty degeneration, presents ulcerative losses of substance, and 
 becomes partly loosened. In other cases there develops, as in man, an 
 arthritis deformans. In dogs suffering from articular rheumatism there 
 have -been observed adhesions between the bones of the carpus and 
 metacarpus, as well as irregular osteophytic formations. General 
 changes occasionally occur in the body in the form of an endocarditis, 
 pleuritis and peritonitis. Treatment is internal. It consists in the 
 administration of large doses of natrium salicylicum( horses and 
 cattle 100 grams, dogs 2 to 8 grams, per day),salol, antifebrin, 
 antipyrin, salipyrin, etc. (see articular rheumatism: Fried- 
 berger and F r o h n e r, "Special Pathology of the Domestic Ani- 
 mals," 1904, 6 Ed., Vol. I). 
 
 Pyemic and Septic Arthritis of Young Animals. — Pyemic 
 and septic polyarthritis, formerly known as "foal-lameness", (foals, 
 calves, lambs, pigs, puppies) develops metastatically from a septic infec- 
 tion of the navel-wound ; it is the result of improper care of the navel. 
 Staphylococcus pyogenes aureus (Sohnle), and streptococcus pyo- 
 genes (Ostertag) have been demonstrated as the infectious irritant. 
 A few days or weeks after birth there develops an omphalitis with 
 suppurative thrombophlebitis and t hromboarteritis 
 which soon leads to a general infection of the body (septicemia, 
 pyemia). After previous febrile symptoms of a general disturbance 
 swellings develop rapidly and simultaneously on several joints, 
 especially the carpus, tarsus, knee, elbow, and hip; the swellings are 
 accompanied by lameness and finally lead to abscess formation. Most 
 animals die in the course of two or three weeks from septic diar- 
 rhea or internal pyemic metastases. On post mortem 
 one finds lesions of a suppurative, sero-purulent, or sero-fibrinous 
 polyarthritis, in addition to changes characteristic of pyemic processes 
 (pyemic form) ; in other cases the changes are more typical of s e pti- 
 
246 PERIARTHRITIS 
 
 c e m i a (septic form). When the navel-wound is not already healed 
 it shows traces of in f 1 amm a ti o n and suppuration, the umbili" 
 cal cord and the tissues surrounding the umbilicus are swollen, the 
 margins of the umbilical ring present ulcerative thickenings, abscess, 
 formation has taken place within the umbilical ring, drops of pus 
 may be pressed out of the umbilical opening. In addition to this 
 omphalitis, which may also heal, so that it presents no 
 external symptom of disease, there exists in the 
 deeper tissues a suppurative thrombophlebitis and 
 thromboarteritis iimbilicalis with thrombosis of the 
 portal vein and its hepatic branches. The synovial membranes of 
 the joints are injected, swollen, and thickened; the fluids of the 
 joints are cloudy, increased in amount, mixed with afloculent coagulum, 
 and are often purely suppurative in character (empyema of the joint); 
 the articular cartilages undergo ulcerative degen- 
 eratio n; at times the bone itself becomes necrotic; 
 occasionally the joint-capsules are perforated. Sup- 
 purative osteomyelitic foci are found in the bones. Abscesses form 
 between the muscles and tendons in the vicinity of the joint, the 
 muscles may even undergo suppurative liquefaction. The muscles 
 over the diseased joint are affected with fatty degeneration. The 
 most typical examples of this disease are seen in the knee-, tarsal-, 
 and occipito-atloid articulations. In addition, post mortem examina- 
 tion reveals metastatic foci in nearly all the organs, especially 
 in the liver, lungs, and brain, the kidneys, in the muscles, 
 and in the subcutaneous cellular tissues. In the liver these 
 foci are from the size of a millet-seed to that of a cherry and larger, in 
 the lungs from the size of a millet-seed to that of[a hen's egg ; in the early 
 stages they are dark-red, afterwards becoming yellow (so-called suppura- 
 tion of the lungs). The following diseases have also been observed : 
 pleuritis, endocarditis, pericarditis, bronchopneu- 
 monia, inflammation of the tendon-sheaths, peri- 
 tonitis, C3'stitis, suppurative iritis, panophthalmia, 
 leptomeningitis, etc. — T reatment is essentially prophylactic : 
 disinfection of the umbilicus and stall, ligation of the umbilicus. (For 
 further information see : Friedberger and Frohner, "Special 
 Pathology of the Domestic Animals". 1904, 6 Ed., Vol. I). 
 
 Arthritis Urica. — This is an arthritis due to the presence of 
 urates in the joints (go ut). It is a metabolic process the nature of 
 which is not yet fully understood ; it occurs in man and birds, and 
 occasionally in dogs. 
 
 PkriarThritis. — Periarthritis is an inflammation of the soft tissues 
 surrounding the joint, especially the periosteum; the points of 
 attachment of the capsular and lateral ligaments, the 
 posterior ligaments, and the suspensory ligaments, 
 the neighboring tendon-sheaths, and mucous bursae, as well as the 
 
LUXATION 247 
 
 parasynovial connective tissue. A form of periarthritis which is of 
 great practical importance in the horse is that type which frequently 
 attacks the insertions of the lateral ligaments and the capsular ligament at 
 the coronary joint, designated as so-called periarticular or false 
 ringbone (see page 241); the carpal tumors (false tumor albus), 
 described as a schlerotic inflammation of the periarticular connective 
 tissue, the tendon-sheaths, and the subcutis of the carpal-joints of cattle ; 
 as well as many alleged inflammations of the tarsal-, fetlock-, coronary-, 
 and pedal-joints in the horse. According to Siedamgrotzky 
 ninety per cent of all cases diagnosed as inflammation of the phalangeal 
 joints are periarthritis — that is inflammation of individual groups of liga- 
 ments without involving the synovial membranes or the articular sur- 
 faces. The following groups are frequently implicated : the internal and 
 external lateral ligaments of the pedal-joint, the external and internal 
 suspensory ligaments of the navicular bone and lateral cartilages, the 
 lateral navicular ligaments, the lateral ligaments of the second phalanx, 
 as well as the suspensory apparatus of the first phalanx. Karnbach has 
 demonstrated that genuine chronic deforming arthritis of the pedal-joint 
 (ringbone of the pedal-joint) is not uncommon. 
 
 II. CHANGES IN POSITION OF JOINTS. LUXATION, 
 DISTORSION, CONTUSION. 
 
 I. LUXATION OR DISLOCATION. 
 
 Definition. — Luxation or dislocation is a persistent 
 separation of both articular ends after over- 
 coming the restraining mechanism. If the dis- 
 location is only partial so that the articular surfaces are not 
 completely separated, it is termed a subluxation or in- 
 complete luxation. A simple dislocation, in contrast 
 to a complicated, is not accompanied by severe injuries, 
 especially fractures. One further recognizes a recent and 
 old, as well as recurrent or habitual luxation. Dias- 
 tasis is a term which designates a luxation of a false joint or 
 half-joint, for example, the sacro-iliac joint in cattle. For- 
 merly a change in position of the lens was termed luxatio lentis ; 
 that of the bulb, luxatio bulbis. 
 
 Causes. — One distinguishes traumatic, spontane- 
 ous or pathological, and congenital luxations. 
 
248 LUXATION 
 
 a) Traumatic dislocations are due to the influence 
 of external forces ; they may be indirect through abnormal 
 flexion, extension, or rotation of the articular ends by means 
 of a leverage ; or direct, as the result of kicks and blows. 
 Occasionally luxations in horses are due to muscular force, 
 for example, the patella may be dislocated upwards as a result 
 of severe contraction of the quadriceps femoris when the 
 animal is kicking. One most frequently observes traumatic 
 luxations of the hip-joint in dogs and cattle (less frequently 
 in horses); of the cervical vertebrae in horses and dogs ; of the 
 patella in horses ; of the inferior maxilla in carnivora, as well 
 as of the elbow-joint in puppies. Dislocation of the fetlock- 
 joint in race-horses is seemingh'- rare. 
 
 b) Spontaneous or pathological luxations are 
 due to disease or inflammation of the joint, atony or abnormal 
 stretching of the joint-capsule and articular ligaments, hydrops 
 of the joint, flattening of the articular condyles, as well as 
 deforming arthritis. Habitual luxation of the patella in the 
 horse is an example of this class. In human surgery various 
 forms of pathological dislocations are recognized: disten- 
 tion-luxation occurs in hydrops of the joint as a result 
 of stretching and atony of the joint-capsule and articular 
 ligaments ; destruction-luxation after suppurative 
 liquefaction of the articular ends (joint-caries) ; deforma- 
 tion-luxation as a result of deforming inflammation ot 
 the joint (loose- jointed). 
 
 c) Congenital luxations are usually due to arrested 
 development ; they seldom occur during birth as a result of 
 faulty manipulations. In many cases it is difficult to deter- 
 mine whether luxation of the patella in the horse is due to a 
 congenital or acquired flattening of the articular surface of the 
 internal condyle of the femur, or to congenital and acquired 
 overextension and atony (distorsion) of the joint-capsule 
 and articular ligaments, with enlargement of the articular 
 cavity. 
 
 Symptoms. — Luxation of the joints of the extremities is 
 characterized by lameness, as well as by restriction, 
 or abnormally free movement of the dislocated 
 
LUXATION 249 
 
 joint. In upward luxation of the patella, for example, the 
 knee-joint is abnormall}' extended and cannot be flexed ; ex- 
 ternal luxation, on the other hand, results in excessive flexion, 
 the limb is unable to support weight. Luxation of the inferior 
 maxilla in dogs is characterized by inability to close the mouth. 
 Upward luxation of the femur results in shortening of the 
 aflfected limb. In dogs the decrease in length maj^ be easily 
 determined as follows : with the animal in the standing posi- 
 tion extend the knee-joints equally and compare the positions 
 of the tarsi or the paws. Inspection and palpation 
 of the articular ends and comparison with the normal 
 joint of the opposite side are also important diagnostic meth- 
 ods. In upward luxation of the right femur of the dog, the 
 trocanters, especially the greater trocanter, are higher than 
 those of the opposite side ; this is readily determined by 
 inspection or by palpation with the thumbs. The other 
 changes in the form of the joint, as well as 
 the changed position of the dislocated bones, 
 and the changed position of the entire limb, may indicate the 
 presence of a dislocation. In general a dislocation may be 
 differentiated from a fracture by the absence of crepitation. 
 
 Complicated luxations maybe associated with frac- 
 ture of the dislocated bones, especially the glenoid margins 
 of the hip-joints, the cervical vertebrae, and the occipital bone ; 
 or with severe injuries to vital organs, especiall)' the spinal 
 cord in luxation of the vertebral column ; or finally, with 
 laceration of the skin and the soft tissues surrounding the 
 joint. In animals rupture of the skin seems to be uncommon. 
 Smith describes a case of luxation of the fetlock-joint in the 
 horse in which the metacarpus penetrated the skin and was 
 driven into the ground to a depth of four inches. 
 
 Diastases are observed in cattle at the sacro-iliac joint 
 and at the pubic symphysis, and in the vertebral column of 
 horses as a result of rupture of the intervertebral ligaments. 
 Complete diastasis of the sacro-iliac joint results in a detach- 
 ment of the tense, almost immoveable union between the sacrum 
 and the ilium, so that the sacrum sinks downwards and results 
 in stenosis of the pelvic canal. On rectal examinations the 
 
250 LUXATION 
 
 promontory is found to be directed downwards ; viewed from 
 without the vertebral column seems to have dropped while 
 the internal angles of the ilium are abnormally prominent. 
 Diastasis of the pubic symphysis may also be recognized from 
 the rectum. In horses rupture of the sacro-iliac ligaments 
 results in a form of so-called sacral weakness or sacral paralysis. 
 
 Anatomical Changes. — Luxations, with the exception 
 of the patella, usually result in laceration of the cap- 
 sule, and partial or complete rupture of the lateral and 
 accessory ligaments. Luxations of the hip joint are 
 characterized by rupture of the capsular ligament and 
 usually a rupture or tearing away of the round ligament. 
 Rupture of the joint-capsule leads to hemorrhage within 
 and around t h e j o i n t ; rupture and hemorrhage may 
 also occur in the neighboring soft tissues, muscles, connective 
 tissue, etc. Fractures are also observed, especially on the 
 acetabular margins of the hip-joint. Spontaneous luxations are 
 characterized by chronic inflammatory changes in the joint. 
 
 If reposition of the dislocated joint-surfaces is not pro- 
 duced a new joint is formed in the vicinity of the dislocated 
 ends (nearthrosis). In the vicinity of the hip-joint, 
 especially, the proximal extremity of the dislocated femur is 
 surrounded by an inflammatory tissue formation which is 
 very similar to a joint-capsule ; at the same time a new aceta- 
 bulum with a cartilaginous covering results from proliferation 
 of the periosteum of the pelvis. Nearthrosis formation is 
 most frequently observed after dislocation of the hip-joint in 
 dogs ; it is occasionally observed in horses. In a horse 
 affected with chronic hip-lameness K i 1 1 found the following 
 conditions: A loose, one half to two centimeters thick, con- 
 nective-tissue sac, which performed the function of a joint- 
 capsule in the region of the acetabulum ; enlargement of the 
 joint-cavity in the direction of the shaft of the ilium ; the 
 articular surface of the femur was worn smooth. 
 
 Treatment. — As in fractures, treatment of dislocations 
 consists on the one hand, in reposition ; on the other, in 
 retention of the dislocated ends. Healing depends on these 
 fundamental principles. Recent simple luxations heal rapidly 
 
LUXATION 251 
 
 when both conditions are fulfilled ; the ruptured capsule is 
 soon closed, the intra- and extracapsular hemorrhage is rapidly 
 resorbed. Unfortunately, with the exception of a dislocated 
 patella, reposition and retention is more difficult in animals 
 than in man. Reposition of the hip-joint, in particular, is 
 very difficult in well muscled horses and cattle, even with a 
 set of pulley-blocks it is not always possible to overcome the 
 mechanical resistance ; the application of a retention bandage 
 is also more difficult than for fractures. Retention of a reduced 
 hip-joint is not easy to accomplish even in dogs, as they will 
 not remain quiet. Relatively speaking the following luxations 
 are most easily reduced : the patella and first phalanx in the 
 horse, and the inferior maxilla in the dog. In all old luxations, 
 of which luxation of the hip-joint in the dog is a frequent 
 example, no experiments with reposition and retention are 
 made ; even apparently severe dislocations of the articular 
 head develop very rapidly into a nearthrosis, so that the limb 
 can be used again in a relatively short time. I have also 
 observed one case of spontaneous healing in luxation of the 
 hip in a horse. Arthrotomy and resection of the 
 joint, as employed in human surgery, is not usually applicable 
 for domestic animals (in the horse I have twice performed 
 resection of the maxillary-joint with good results). The suc- 
 cess and results of separation of the internal lateral ligament 
 of the patella, for upward dislocation of that bone, are yet to be 
 demonstrated. 
 
 Statistics OF Luxations. — i. In the horse the number of luxa- 
 tions is small when compared with other abnormal positions of the joints, 
 especially distorsions; the same is true when compared with other diseases 
 of the joints. There is an average of about one luxation to 
 fifty distorsions. In a thousand cases of diseases of 
 the joints, there is about one luxation. The following 
 statistics are compiled from the military records of the Prussian Army: In 
 ten years, 1886-1897, of 300,000 diseased horses in the service, over 36,000 
 cases included affections of the joints; of these, 15,000 were dis- 
 torsions, while only 320 were luxations. With reference to the 
 occurrence of luxations in different joints, statistics 
 indicate that the patella is by far the most frequent seat. The 
 fetlock-joint is second. Of 7,000 horses brought to the Berlin 
 Surgical Clinic, I have observed only five luxations of the femur, as 
 as well as two luxations of the patella and fetlock-joint. 
 
252 DISTORSION 
 
 2. Luxations are much more frequent in dogs than iu horses. Of 
 the 70,000 dogs treated by me in the Berlin Dog Hospital during a 
 period of nine years (1886-1895) there were 344 luxations (equal to 0.5 per 
 cent of all the cases) and 579 distorsions (equal to 0.8 per cent of all cases). 
 As a rule, in dogs the dislocation is at the hip-joint. 
 
 2. DISTORSION OR SPRAIN. 
 
 Nature and Symptoms. — A distorsion or spraiu is a 
 momentary separation of two articular surfaces in con- 
 trast to a permanent deviation of a luxation. As in luxations, 
 they are designated as simple and complicated, that 
 is, combined with severe injuries, especially fractures. 
 
 The causes of distorsion are the same as those of 
 dislocation, they vary onh^ in degree, less force is exerted. 
 The anatomical changes in the joint are essentially the 
 same as those accompanying dislocations. Simple distor- 
 sions lead to stretching and even laceration 
 of the joint-capsule and the ligaments of the 
 joint, as well as to hemorrhage within and out- 
 side the joint. These conditions often account for the 
 chronic course of man}- distorsions ; if a fracture also exists 
 the distorsion may be incurable as joint-fractures are not 
 amenable to treatment. 
 
 The symptoms consist in sudden lameness, as 
 the causes are usually due to an overstretching or forcible 
 rotation (oblique position, knuckling over, being caught in the 
 rails, etc.). Palpation of the joint by means of passive 
 movements, especially rotation, produces severe pain; in 
 addition, there is increased heat and swelling in 
 the joint (very frequently this is visible only after tw^enty- 
 four hours). Because of these symptoms, which are also 
 characteristic of inflammation of the joint, the case may be 
 diagnosed as arthritis instead of distorsion. Crepitation and 
 abnormal mobilit}', as well as permanent changes in position 
 are not present in simple distorsions ; on the other hand, 
 crepitation may accompany complicated distorsions. 
 
 The course varies according to the severity of the 
 anatomical changes. If there is only a slight overextension 
 
CONTUSION 253 
 
 ot the joint-capsule and articular liganaents, without a rupture 
 of the same, lameness may disappear in a few days. If, how- 
 ever, the joint-capsule is severely ruptured, the articular carti- 
 lage bruised, and extensive hemorrhage has taken place within 
 and outside the capsule, healing requires several weeks or 
 even months. There develops a chronic, partly ulcera- 
 tive, partly deforming arthritis (ringbone for 
 example), and even anchylosis of the joint so that 
 healing becomes impossible. As has been remarked, compli- 
 cated distorsions are often incurable. For these reasons 
 the prognosis of any distorsion should be 
 given with caution. 
 
 Treatment. — Recent distorsions are treated with rest, 
 moist heat in the form of Priesnitz compress, 
 massage, compression, and plaster-of- Paris 
 bandage. If the healing of distorsions is delayed, two or 
 three weeks for example — if the lameness still remains — 
 blisters and firing may be employed. Neurectomy 
 remains as a last resort for incurable cases. 
 
 Statistics ok Distorsions. — In horses, distorsions of the joint 
 form one of the most frequent of joint-diseases. About half of all 
 joint-diseases are distorsions. In the horse the fetlock- 
 joint and coronary-joint are most frequently sprained. Accord- 
 ing to the statistics of the Prussian Army, which are in harmony 
 with the estimates of Stockfleth and Bayer, distorsions of 
 the f e t lock- j oi n t are far more frequent than those 
 of the coronary-joint. According to the Prussian Military 
 Reports, in the years 1890-1897, there were 6000 distorsions of the fet- 
 lock-joint and only 2100 of the coronary-joint. In the year 1900, of 
 1900 cases of distorsion, iioo involved the fetlock-joint and 600 the 
 coronary-joint. In the year 1901 there were 940 distorsions of the 
 fetlock-joint and only 611 of the coronary -joint. In contrast to this, 
 M oiler and Frick maintain that distorsions of the coronary -joint 
 are more frequent. According to my own experience, distorsions of 
 the fetlock are more frequent than those of the coronary-joint ; of 120 
 distorsions examined (1895-1898), 70 were of the fetlock-joint, 50 of the 
 coronary-joint. Both joints are often involved at the same time. 
 
 3. CONTUSIONS OR BRUISES OF THE JOINT. 
 
 Nature and Symptoms. — A joint contusion is a bruising 
 of the joint ; it may occur directly by means of pressure, 
 
254 ANCHYLOSIS AND CONTRACTURE 
 
 blows, and kicks directly over the joint, or indirectly by 
 means of concussions and shocks which are operative at some 
 point below the joint and result in compression of the articular 
 surfaces. In the first case there exists a contusion and 
 inflammation of the capsular ligament and the periarticular 
 tissue ; in the latter, a contusion of articular cartilage, which 
 in severe cases may be associated with a fracture of the articular 
 ends. 
 
 The symptoms of joint contusion are similar, though 
 lesser in degree, to distorsions. The lameness in particular, 
 and the amount of pain shown on palpation, are less than 
 in luxation. On the other hand, contusions usually lead 
 to severe hemorrhage into the joint (h em ar t h rosi s), as 
 well as to a large fluctuating swelling in the vicinity of 
 the joint (contusion-swelling of the skin and subcutis). 
 
 The course is usually more favorable than that of dis- 
 torsions ; ordinarily resorption of the blood-extravasate in 
 the joint is rapid; function is entirely restored. At times a 
 hydrops of the joint may remain (joint-gall). The course is 
 unfavorable only when the contusion is complicated with a 
 fracture or joint-wound. 
 
 Treatment. — Earh- massage and compression 
 of the joint by means of a permanent or elastic bandage is the 
 most appropriate treatment for contusions of the joint. Re- 
 sorption maj^ be favored bj- moist heat, and later with 
 slight exercise. 
 
 III. ANCHYLOSIS AND CONTRACTURE. 
 I. ANCHYLOSIS OR STIFF JOINT. 
 
 Definition. — Anchylosis is an adhesion between two 
 articular surfaces ; it results in stiffness and immo- 
 bility of the joint. In contrast to contracture of the joint, 
 in which the mobility is only restricted, anch5^1osis implies a 
 complete suspension of the motion. According to the char- 
 acter of the connective substance at the point of adhesion, 
 anchylosis is designated as follows: osseous, cartilagi- 
 
ANCHYLOSIS 255 
 
 nous, and connective-tissue anchylosis (anchy- 
 losis ossea, cartilaginea, and fibrosa). Anchy- 
 losis ossea is sometimes erroneously termed synostosis. Ac- 
 cording to the location of the anchylosed masses within or out- 
 side the articular capsule, it is termed inner and outer 
 (intracapsular and extracapsular) anchylosis. 
 There is also a genuine and a false (apparent) anchylosis. 
 
 Causes. — Anch3'losis formation is either the product of a 
 chronic arthritis, especially the deforming, pannous 
 and granular types, or it is the result of a fracture involv- 
 ing the joint. It is most often seen during the course of a 
 deforming arthritis (spavin, ringbone); in ossifying periostitis 
 in the vicinity of joints ; as a result of periarthritis at the 
 carpal-joint ; following ossification of the intervertebral carti- 
 lages in old horses (causes of constrained movement in the sad- 
 dle-region and of fractures of the vertebrae); as a result of poll- 
 evil, which leads to adhesions between the cervical vertebrae 
 and permanent stiffness of the neck ; and in chronic inflam- 
 matory conditions of the inferior maxillary-joint. Occasion- 
 ally one finds the inferior surface of the vertebral column 
 of the horse covered wath osseous proliferations from the size 
 of a hazelnut to that of a hen's egg ; they are so closel)'^ bound 
 together that the vertebrae form a strong, immoveable column 
 (saddle constraint). Adhesion between the eyelids, which is 
 analogous to that between joints, is termed anchyloblepharon. 
 
 Treatment. — In the domestic animals anchylosis is 
 tisually incurable. When a joint is anchylosed the mo- 
 bility, pain, and lameness are suspended ; for this reason, in 
 veterinary medicine, certain chronic inflammations of the 
 joint, especiallj' spavin and ringbone, are treated with blisters 
 and the cautery in an attempt to produce artificial anchy- 
 losis of the joint. In man, anchylosis is treated in the 
 early stages with massage, passive movements and extension 
 of the joint under the influence of narcosis in an attempt to 
 prevent permanent stiffness. Complete anchylosis is treated 
 with resection of the joint, arthrotomy and osteotomy. 
 
256 JOINT CONTRACTURE 
 
 2.. JOINT CONTRACTURE (STILT-FOOT). 
 
 Definition. — The expression "contracture" designates 
 an abnormal position of the joint in which f r e e- 
 "dom of movement is permanently restricted 
 (knuckling of the joint, stilt-foot). This should not be con- 
 fused with contraction, that is, excessive muscular contraction. 
 
 Causes and Forms. — Restriction of the mobility of the 
 joint may be due to the following causes : diseases of the 
 joints, tendons, muscles, nerves, and skin, or it may be con- 
 genital. One designates, therefore, the following forms of 
 contracture : articular, tendinous, myogenic, 
 neurogenic, cicatricial, and congenital con- 
 tractures. 
 
 a) Articular contractures are due to pathological 
 conditions of the joint itself, there is a restriction of the free 
 mobility of the joint (articular stilt- foot). It may 
 result from any of the following conditions : exostosis forma- 
 tion and irregularities on the articular surfaces, inflammatory 
 new- formations in the joint itself, arthritis deformans, free 
 joint bodies, first stages of anchylosis. In the horse one most 
 frequently observes an articular contracture (articular stilt- 
 foot) during the course of an articular ringbone, the osteophy- 
 tic enlargements on the first and second phalanges, as well as 
 the first stages of anchylosis, mechanically restrict free move- 
 ment in the coronary-joint. The same condition is observed 
 in unilateral chronic arthritis of the maxillary-joint which 
 results in imperfect mastication on the side involved. 
 
 b) Tendinous contractures are due to contraction 
 and adhesion of the flexor tendons ; they follow a tendinitis 
 (tendinous stilt-foot). In adult horses tendinous 
 contractures are most often observed at the anterior fetlock- 
 joint (knuckling in a narrow sense) as a result of chronic 
 inflammation of the perforans tendon. 
 
 c) Myogenic contractures are due to cicatricial retrac- 
 tion of muscles as a result of previous ruptures and inflamma- 
 tions. Contracture of the internal and external flexors of the 
 carpus (flexor, and extensor carpi ulnaris) produces so-called 
 
JOINT CONTRACTURE 257 
 
 "knee sprung" in horses. Contracture of the mastoideo humer- 
 alis results in an oblique position of the neck (caput obstipum). 
 Unilateral contracture of the lateral coccygeal muscles causes 
 the tail to be held to one side. Apparently many cases of 
 acquired stilt-foot in colts are referable to a myogenic cause 
 (rheumatism, rachitis). 
 
 d) Neurogenic contractures result from derange- 
 ments of the muscular innervation, they are due, either to 
 paralysis and muscular weakness (paralytic neurogenic 
 contracture), or to cramps in certain groups of muscles 
 (spastic neurogenic contracture). Congenital stilt- foot in 
 foals (so-called knuckling) is due to a paralytic contracture 
 (congenital weakness of the extensor muscles). This hypoth- 
 esis explains the rapid recovery from stilt-foot in foals under 
 proper treatment. The relative ease with which it may be 
 cured does not sustain J o h n e ' s hypothesis. He maintains 
 that stilt-foot in foals is a tendinous contracture resulting from 
 a faulty position of the flexor tendons in utero. 
 
 e) Tissue or cicatricial contractures result from 
 tissue-contraction following a wound, burn, cauterization and 
 necrosis of the skin on the flexor surfaces of joints, as well as 
 on the neck (caput obstipum). Therapeutics of this affection 
 involves the same treatment as that employed in the operative 
 treatment of entropion in dogs : cutting out a piece of skin 
 (blepharoplasty ) . 
 
 f) Congenital contractures depend, either upon a 
 congenital muscular weakness (stilt-foot in foals), or upon a 
 deranged development of the joints of the fetus. The latter 
 conditions in domestic animals do not receive surgical treat- 
 ment because j'oung animals thus affected are not allowed to 
 live. The following congenital forms of club-foot are 
 recognized in man : (pes varus) an arthrogenous supination- 
 contracture of the foot ; flat-foot (pes valgus or planus), 
 an abnormal dorsal flexion of the foot; horse- foot (pes 
 equinus), an abnormal planter flexion of the foot. Genu 
 valgum (x-formed limb) also occurs. 
 
 Treatment. — Many cases of contracture are incurable ; 
 by means of an operation many are partially curable. This is 
 
•258 JOINT UODIKS 
 
 especially true of teudinous contractures (tendinous stilt-foot) 
 which may be benefited by tenotomy; and myogenic con- 
 tractures (knee-sprung, crooked tail) which are occasionally 
 improved by performing myotomy. The neurogenic con- 
 tractures also (stilt-foot of foals) sometimes recover when prop- 
 erly bandaged and massaged. Articular contractures (ring- 
 bone), on tlie other hand, are incurable, even neurectomy 
 is ineffective because restricted mo]:)i]ity is due to mechanical 
 causes, 
 
 Dkformitiks oi.' THE ViCKTKiu<AL COLUMN. — The follovvin^j types 
 of defonnilies of the vertebral column are sometimes congenital: 
 kyphosis (hnnip-back, carp-back); lordosis (hollow-back); 
 scoliosis (lateral curvature of the spine); occasionally a combined 
 form is seen (kyphoscoliosis). Bayer has described two cases 
 in the horse, one to the left, the other to the right. Other cases have a 
 rachitic origin (see page 230). In mares, lordosis may result 
 from repeated pregnancy, it may also result from pressure on the spinal 
 column. According to Johne the vertebral column of cattle may 
 occasionally rotate slightly on its long axis as a result of chronic 
 tympanitis of the rumen (tuberculosis of the mediastinal glands). 
 
 Deformities of the vertebral column may also be due to fractures, 
 chronic inflammatory processes in the intervertebral joints, 
 tuberculosis and new -formations. Hess has described a 
 case of kyphosis in a steer that was caused by tuberculosis of the lumbar 
 vertebr;t. An interesting case of dorso-lumbar curvature in the horse 
 has been described by Vatel. The curvature of the spine had dislo- 
 cated the kidneys, the posterior aorta was displaced downwards and 
 dilated to form an aneurj'sm. The lumbo-sacral joint was affected with 
 arthritis sicca and erosion of the cartilage, a bony tumor lay between 
 the seventeenth and eighteenth ribs, the articular surfaces of the 
 lumbar vertebriy were anchylosed. Goubeaux has furnished an 
 extensive work on "Deformitiiten der Wirbelsaule bei den Haustieren." 
 (Recueil. 1886-87). 
 
 IV. JOINT HODIE.S. CORrORA LIBERA. 
 
 Nature. — J o i n t -bodies (tree bodies, corpora libera, 
 joint-mice, mures articulorum, rice-like bodies, corpora ory- 
 zoidea) are free or pedtniculated smooth bodies situated in the 
 joint-cavity. They vary in size from a millet-seed to that of a 
 cucumber-seed, and are .seldom as large as a dove's egg, they 
 have a white glistening color, and are of the consistency of 
 cartilage or bone. Their origin ts extremely variable : 
 
DISEASES OF TENDONS AND TENDON-SHEATHS 259 
 
 1. Arthritis deformans and osteochondritis 
 <l ess i cans (coagulation necrosis) form the most frequent 
 -causes of joint-bodies ; circumscribed particles of the articu- 
 lar cartilage are sloughed off. 
 
 2. Others are the product of an inflammatory swelling 
 and a connective-tissue cartilaginous and osseous prolifera- 
 tion of the articular villi, especially the cartilaginous 
 villi, which are subsequently torn away or constricted. 
 
 3. Others occur from sloughing away of pieces of 
 cartilage or bone in complicated distorsions, luxations 
 and contusions of the joint. 
 
 4. Many are formed by coagulation and organization of 
 masses of fibrinous exudate (corpora oryzoidea). 
 
 5. In rare cases extracapsular new-formations 
 (exostoses, lipoma) grow into the joint-cavity and become 
 constricted. 
 
 Symptoms. — The occurrence of these foreign bodies is 
 very rare. When they are suddenly brought between the 
 articular surfaces the following symptoms may result : lame- 
 ness, which develops suddenly without any appa- 
 rent cause, and as suddenly disappears, remit- 
 tent lameness. Diagnosis during life is extremely diflScult. 
 Stockfleth found corpora libera in the knee- and tarsal- 
 joints of the horse ; Bruckmiiller in the shoulder- and 
 carpal- joints ; M o 1 1 e r found a bodj^ as large as a dove's egg 
 in the knee-joint of a horse. 
 
 Treatment in the horse is impossible. In dogs, as in 
 man, arthrotomy may be tried. 
 
 DISEASES OF THE TENDONS, TENDON-SHEATHS, 
 AND MUCOUS BURS^. 
 
 PREI^IMINARY REMARKS ON ANATOMY AND PHYSIOLOGY. 
 
 Tendons. — The tendons consist of fine tendon-fib rillae 
 which are bound by a cement-like substance into slender tendon- 
 fibers. Through the adhesion of numerous tendon-fibers tendon- 
 fasciculi (primary tendon-bundles) are formed. vSe veral 
 fasciculi are surrounded by e p i t e n d i n e u m to form secondary bun- 
 
26o DI.SKASI';S OV TKNDONS AND T1';nDON-SI1KATIIS 
 
 (lies ; epitt'iidineuni is a loose ooiinectivc-tissue layer containing a few 
 blood-vessels. The secondary htnuUes are combined in a similar man- 
 ner to form tertiary tendon-bundles out ot' which the tendon is 
 composed. The svirface ol' the tendon is covered with paratend- 
 i n e n ni , a loose connective-tissue layer. l<Vom a surj^ical standjioint 
 the following tendons are of jjreat practical inqH)rtance : the flexor 
 tendons of the jjlialan^jes ; namely, the en s ]> e n s o ry 1 i K-' '" e n ts 
 (superior sesamoid ligament), the flexor perforans and per- 
 foratns. The anatomy and physiology of the tendons under con- 
 sideralion, which may be regarded as supporting ligaments of the 
 |)luilan.i;eal joints, are of great importance for an understanding of the 
 pathogenesis, symptomatology, and tlunipy of diseased tendons. A 
 valn.ible contribution to this knowledge has recently been su]iplied by 
 Stoss (Anatouiie und L'hysiologie der riuilaiigenbaiider des Pferdes. 
 Monatshefte fiir praklische Tierheilknnde, I1S95). According to this 
 article the flexor of the first i)lialanx (so-called sviperior 
 sesamoid ligament) is primarily a volar interosseous muscle, flexor of 
 the first phalanx, and the most highly developed type of supporting 
 ligament, it prevents overextension of the fetlock-joint (so-called dorsal 
 llexion of the fetlock-joint). The (lexor of the first phalanx is attached 
 to the postero-snperior extremity of the metacarpus at one end and to 
 the sesamoid l)ones at the other. In the same manner the flexors of 
 the second and third phalanges form supporting ligaments 
 for the coronary- and pedal-joints. The so-called check ligaments 
 of the same prevent overstretching of the llexor muscles from the body 
 weight, and perform the same function for the coronary- and pedal- 
 joints as that performed by the eusi)ensory ligament for the fetlock- 
 joint. The check ligament of the llexor perforans arises from the 
 thickened posterior capsule of the carpal-joint; that of the flexor 
 perforatus from the radius above the carpal-joint. 
 
 Ti';ni)on-vSiii-;atiis anh Mticous Huus.v;. — b'or surgery, the anat- 
 omy or tendon-sheuths and mucous bursiu is extremely iniportaut. In 
 most text-l)ooks on veterinary anatomy the arrangement is neither 
 detailed nor distinct. The following is a short description of the most 
 important relations in the horse according to Eichbuum (Berlin 
 Archiv. 1883). The physiological function of tendon-sheaths and 
 mucous bursie consists in facilitating the gliding movements of the 
 tendons, muscles, and skin, especially where they pass over projecting 
 areas. The physiological function has a common relation to the 
 anatomical and histological structure ; they vary only in external form. 
 They may fuse with one another, they have no constant structure, and 
 they may communicate with joints (for example, the tendon-sheath of 
 the extensor digitorum communis with the knee-joint ); further, mucous 
 burs;e uiay develop into tendon-sheaths. 
 
DISEASES or TENDONS AND THNDON-SHKATIIS 26l 
 
 The te n do n - Bh e a t h s (bursie vaj^inalis, vaj^inie tendineum) 
 form cylindrical sacs which isolate the tendons by means of sheatblike 
 coverin^^^s at points where they pass over extensor or flexor surfaces of 
 articulations. Occasionally several tendons are enclosed in one sheath, 
 namely, the tendons of the perforans and perforatus at the ])osterior 
 surface of the car])us and metacarpus. Similar to joint-capsules the ten- 
 don-sheaths are lined on their inner surfaces with synovial mem- 
 branes (serous sheath, mucous sheatli), which represent serous 
 membrane, in that they are lined with a single layer of endo- 
 thelium (by others, they are regarded as glandular, mucus 
 secreting organs). The external layer of the tenrlon-sheath has a 
 fibrous covering which is bound to the synovial membrane by means of 
 connective tissue. 
 
 The m u c o u s- b u r s a e (bursx' mucosae) form round sacs flat- 
 tened laterally ; they are situated beneath tendons, muscles, and skin ; 
 their inner walls are usually smooth, sometimes rough and net-like from 
 papilke and projecting tendon-fibers, or they have the appearance of a 
 fenestrated membrane. Two forms of nmcous bursa- are recognized. 
 J. Hursae mucosae subtendinae (burs;e subtendina- ), which, 
 because of their seemingly constant occurrence, are also termed "typi- 
 cal" mucous burste. They are situated at the points of origin and in- 
 sertion of muscles and tendons, beneath these organs and in close con- 
 tact with them. Like tendon sheaths, their inner surfaces are covered 
 with a layer of endothelium ; in old horses they frequently communi- 
 cate with tendon-slu-atlis and joints, in these cases they form a blind, 
 sac-like protrusion of the joint-capsule ( bursa- synovialis). The exist- 
 ence of this combination is of great importance in certain surgical 
 affections (galls). Bursa- subtendinu- are usually present in foals. The 
 following are of special surgical im])ortance : the bursa intertubercularis 
 of the biceps in front of the shoulder-joint, and the subtendinous bursa 
 of the flexor perforatus at the calcaneum. 2. Bursae mucosae 
 subcutanae (bursa- subcutana-) , because of their inconstant occur- 
 rence, are also termed "atypical" nmcous bursa- ; they develojj after 
 birth ("acquired" mucous bursa-) and increase in number with the age 
 of the animal. Apparently their origin is due to ruptures of the sub- 
 cutaneous connective tissue ; this is i>roduced by extension and (loxion 
 of the joint, especially through laceration of the subcutis over osseous 
 tuberosities ; laceration leads to encapsulation. The inner surfaces of 
 these acquired mucous bursae contain, therefore, in most cases, no 
 endothelial layer. They are found in all places where the skin is 
 moveable over osseous tuberosities, especially on the olecranon (shoe- 
 boil), calcaneum (capjjed-hock), and on the external angle of the ilium. 
 They are less frequently seen in the following places : on the jnitclla, 
 malleoli, withers, sacrum, and on the extensor surfaces of joints. 
 
 The following mucous bursae and t e n d o n - s h e a t h s 
 are of great surgical imjiortance: 
 
262 DISEASES OF TENDONS AND TENDON-SHEATHS 
 
 I. Head. — The subcutaneous bursae on the crest of 
 the occipital bone (neck-tumors in dogs). 
 
 II. Neck. — The bursa mucosa beneath the origin of 
 the ligament um nucha e, between the cervical ligament and 
 the superior surface of the atlas and its capsular ligament. It 
 varies in length from three to ten centimeters, is oval in- form, and 
 bounded laterally by the middle extensors of the head. A second 
 bursa mucosa is situated beneath the cordiform portion of 
 the ligamentum nucbae in the region of the second cervical 
 vertebra ; it is about the size of an apple, and lies between the cordi- 
 form portion of the cervical ligament and the points of attachment of 
 the lamellar portions of the cervical ligament to the crest of the second 
 cervical vertebra. It is bounded on both sides by the complexus 
 muscles (poll-evil in horses). 
 
 III. Trunk. — -A mucous bursa lies above and on both sides 
 of the withers (fifth to seventh dorsal vertebrie, fistulous withers). 
 There is a mucous bursa over the external angle of the 
 ilium — bursa iliac a lateralis — both upon the superior and the 
 inferior tuberosities of the same ; the superior is ten centimeters long, 
 and four to five centimeters wide. A third mucous bursa lies on 
 the tuberosity of the ischium — bursa tuberis ischii — 
 it is the size of a walnut (hygroma formation). 
 
 IV. Anterior Extremities. — A subtendinous bursa lies 
 under the insertion of the infraspinatus muscle ( bursitis inf ra- 
 spinati). A bursa m uc o s a lies between the tendinous origin of the 
 biceps brachii and the trochlea of thehumeru s — b u r s a 
 intertuberculari s — (bursitis intertubercularis). A very important 
 bursa mucosa lies on the posterior surface of the olecranon process 
 of the ulna, bursa olecrani; it is very common, from the size of a 
 walnut to that of an apple, it has vaginal walls and several compart- 
 ments ; occasionally it is situated more on the lateral side of the olecra- 
 non process of the ulna (shoe-boil). The following are important : the 
 tendon-sheath of the extensor pedis on the anterior surface 
 of the carpal-joint; the tendon-sheath of the extensor suf- 
 fraginis (at the same place); the tendon-sheath of the 
 middle extensor of the carpus; the t e n do n -sh e a t h 
 of the oblique extensor of the carpus; the tendon- 
 sheath of the external flexor of the carpus (M. exten- 
 sor carpi ulnaris); a subcutaneous bursa mucosa on 
 the anterior surface of the carpal-joint in cattle ("knee tumor"); the 
 tendon-sheath of the perforans and perforata s, this 
 is very large, situated largely in the carpal sheath, it begins about ten 
 centimeters above the carpal-joint and passes downwards as far as the 
 point of attachment of the check ligament to the perforans tendon (galls 
 of the flexors at the carpus), tenotomy should be performed below this 
 tendon-sheath ; the tendon-sheath of the flexor of the 
 
DISEASES OF TENDONS AND TENDON-SHEATHS 265 
 
 carpus (M. flexor carpi radialis) ; the bursa mucosa on the 
 anterior surface of the inferior extr em ity of the 
 metacarpus and metatarsus; the common tendon- 
 sheath of the flexor perforans and perforatus, it 
 begins ten centimeters above the fetlock-joint, passes over the posterior 
 surface of the superior sesamoid ligament, the sesamoid bones, the first 
 and second phalanges, and ends at about the middle of the second 
 phalanx (perform tenotomy above this tendon-sheath); the bursa 
 mucosa subtendinea on both lateral surfaces of the first phalanx. 
 
 Finally, the bursa podot ro chleari s is of great importance, 
 this is a mucous bursa beneath the insertion of the perforans 
 tendon; it begins at the posterior margin of the navicular bone and 
 reaches to the pedal attachment of the flexor perforans. It forms a closed 
 sac that does not communicate with the pedal-joint ; the anterior wall 
 covers the posterior surface of the navicular bone, while the posterior 
 wall is in contact with the flexor tendon (bursitis podotrochlearis) . 
 
 V. Posterior Extremities. — The bursa glutei medii (tro- 
 chanterica) is a mucous bursa beneath the end insertion of the 
 gluteus medius and maximus on the middle trocanter; it 
 forms a circumscribed sac on the outer smooth surface of the middle 
 trocanter (bursitis trocanterica). At the knee-joint is situated the 
 bursa mucosa subcutanea in front of the patella (bursa 
 prepatellaris), it is present in only fifty per cent of all horses, and 
 ■varies in size from that of a bean to that of a walnut. It is located on the 
 anterior surfaceof thepatella, usually on the projecting upper 
 half, and occasionally extends to the lateral border of the patella (bursitis 
 prepatellaris j. There is also a mucous bursa on the tibia beneath 
 the insertion of the middle straight ligament of the 
 patella, bursa sub p at ellaris (bursitissubpatellaris). The follow- 
 ing are of practical importance: the synovial bursa beneath the 
 origin of the flexor metatarsi and long extensor of the 
 toe, about fourteen centimeters long, large, it is located immediately 
 below the knee and communicates with the knee-joint; the bursa 
 mucosa subcutanea above the tuberosity of thecalcan- 
 eum — bursa calc an e i, this is very common, though not constant, 
 oval in form, four to five centimeters long, three to four centimeters 
 wide, and lies on the posterior surface of the upper end of the calcaneum 
 (capped-hock) ; the tendon-sheath of the lateral extensor 
 of the toe, this begins two to four centimeters above the lateral 
 maleolus and terminates on the upper surface of the metatarsus (string- 
 halt operation); the tendon-sheath of the long extensor 
 of the toe passes over the anterior surface of the tarsal-joint to the 
 point of attachment of the lateral extensor to the long extensor ; the 
 mucousbursa under the inner branch of the tibialis 
 anticus is roundish in form, the inner wall covers the medial surface 
 of the cuneiform bones and pyramidal bone, the outer wall surrounds 
 
264 DISEASEvS OF TENDONS 
 
 the branch of insertion (spavin-operation); the tendon -sheath of 
 the flexor perforaus begins about the width of three fingers 
 above the medial maleolus, passes down the posterior surface of the tibia 
 and the tarsal-joint, and ends just above the point of attachment of the 
 lateral flexor to the tendon of the flexor perforans (inflammations, 
 galls); the tendon-sheath of the lateral flexor arises 
 at the middle of the tibia on the medial side, it is from thirty to 
 thirty-five centimeters in length, passes down the medial surface of the 
 tarsal-joint to the pyramidal bone and terminates at the point where this 
 tendon is attached to the perforans ; the tendon-sheath beneath 
 the tendon of the per fo rat u s lies between the cap-like expan- 
 sion of the latter and the calcaneum, it terminates at the middle of the 
 calcaneum (curb). 
 
 I DISEASES OF TENDON 
 
 I. INFLAMMATION OF TENDONS. TENDINITIS. TENONITIS. 
 
 Causes. — Inflammations of tendons occur most frequentl}^ 
 in horses ; they are caused by strains, overexten- 
 sions, and partial ruptures of the tendons as a result 
 of overexertion in race-horses, trotters, and heavy draft-horses. 
 Direct contusions of tendons from blows are uncommon. In 
 most cases tendinitis is primarily traumatic in character ; 
 as it is not accompanied by an injury to the skin, it is not 
 under the influence of bacteria and is, therefore, aseptic. 
 It has its analogues in the similar traumatic and aseptic bone- 
 fissures, the processes of healing are similar. The following 
 conditions predispose to tendinitis: abnormal positions, 
 especially too long and too weak fetlocks ; low heels and long 
 toes ; imperfectly developed tendons ; deranged nourishment of 
 the tendons as a result of some previous disease, or standing 
 for a long time. 
 
 In other cases the inflammator}- process pro- 
 ceeds from neighboring tissues to the tendons. 
 Primary inflammation of the tendon-sheaths (contagious 
 pleuropneumonia) often results in a secondary tendinitis. 
 In a similar manner phlegmonous inflammations of the tendon- 
 sheaths from phlegmon of the fatty frog may lead to tendinitis, 
 it may also occur during the process of bursitis podotrochlearis 
 and sesamoid lameness (suppurative and necrotic ten- 
 
TENDINITIS 265 
 
 dinitis). Tendinitis resulting from inflammation of the tendon- 
 sheaths, when the latter is secondary to infectious diseases 
 (contagious pleuropneumonia), is erroneously termed metastatic 
 tendinitis. 
 
 Filaria cincinnata (spiroptera reticulata) 
 is rarely the cause of tendinitis. It is seen in the suspensory 
 ligaments of Russian and Italian horses, and occasionally 
 results in inflammation and lameness, as well as in fibroma- 
 like new-formations (see page 183), 
 
 Pathology. — In recent traumatic tendon-inflammations 
 one first finds a partial fascicular rupture of the ten- 
 don-fibers with a trivial extravasation of blood, or a 
 sanguino-serous infiltration of the interfascicular connective tis- 
 sue. The inflammatory reaction which soon follows is char- 
 acterized by hyperemia, bloody infiltration, and new-formation 
 of blood-vessels and connective tissue (tendinitis fi- 
 brosa). Granulation tissue is formed from the following 
 structures : the paratendineum, the adjacent tendon-sheaths, 
 the interfascicular connective tissue (epitendineum), in part, 
 also from the genuine tendon-cells of the ruptured tendon- 
 fibers. The voluminous, vascular, semi-solid granulation tissue 
 undergoes a partial atrophy of the tendon-fibers ; the soft 
 embryonic tissue is transformed into hard, crepitating, nodular 
 connective tissue, which is partly cartilaginous and osseous and 
 which forms a typical tendon-cicatrix (tendon-callus, 
 schlerosis tendinum). At the same time there may 
 occur a contraction, and adhesion of the tendon to the 
 adjacent structures. Necrosis may readily follow suppura- 
 tive inflammation of tendons. 
 
 Symptoms. — Tendinitis occurs principally in the -flexor 
 tendons (perforatus, perforans, and suspensory ligament); 
 it is much more frequent in the anterior limbs. In horses it is 
 characterized by lameness, which develops suddenlj^ or 
 gradually increases in severity, volar flexion is pro- 
 nounced. There is pain on palpation, increase of local 
 temperature, and in the early stages a semi -solid 
 swelling on that part of the tendon involved, the skin is 
 moveable on the surface. L,ater there is an increase in the 
 
266 TENDINITIS 
 
 consistency of the swollen tendon. If resolution does not take 
 place in the swelling, there remains, after the inflammatory 
 symptoms have disappeared, a firm, hard, tendon-nodule 
 or a diffuse thickening of the tendon. The lameness 
 gradually disappears, it may, however, become chronic. When 
 a tendon ha.s once been diseased it is predisposed to relapse; 
 this is especially true of race-horses, saddle-horses, and heavy 
 draft-horses. Severe inflammations finally lead to adhesion 
 between the tendon and the surrounding structures, as well as 
 to the formation of a tendon-contracture (tendon 
 stilt-foot). 
 
 Treatment. — In addition to complete rest, very recent 
 tendinitis characterized by severe pain and pronounced swelling 
 can be treated with a cold compress, cold baths, or per- 
 manent irrigation. In general it is better to immediately 
 employ moist heat in the form of a Priesnitz 
 compress. Massage, and pressure bandage 
 (silicate-of-potash bandage) are occasionally indicated. The 
 methods employed are for the following object : resorption of 
 the hemorrhagic extravasate and to support the natural pro- 
 cess of healing, that is, the reactive, aseptic, inflammatory 
 new-formation. It is also important to regulate the shoeing. 
 The toe-calk is removed and excessive length of toe is short- 
 ened, this removes strain from the flexor tendons and is of 
 special importance in inflammation of the flexor perforans, the 
 heels may be raised by adding heel-calks. 
 
 If the methods described are not followed by healing or 
 improvement after three or four weeks, especially when com- 
 bined with methodical massage, counter-irritants are 
 indicated. The variety and form of the remedy employed is 
 non-essential, the manner of application of the blistering oint- 
 ment or plaster is, however, of great importance. After having 
 thoroughly tested the following method of application, which 
 I learned in the Imperial Stables in Vienna, I can highly 
 recommend it : The hair is clipped previous to the application, 
 the skin is also thoroughly washed and disinfected, then apply 
 biuiodid of mercury ointment (1:4-5), this is rubbed in 
 thoroughly for fifteen minutes, covered with an ordi- 
 
TKNDON-RUPTURE 267 
 
 nary bandage over absorbent cotton, and allowed 
 to remain in position for two weeks. After twenty-four hours 
 the bandage becomes moistened with an extensive exudate 
 which soon dries ; the horse's head is tied up for the first few 
 days. 
 
 By employing the method described the application of the 
 cautery for chronic tendinitis becomes unnecessary, the 
 cautery may be employed in the form of line-firing. The 
 action of the cautery is like that of blisters ; it causes an arti- 
 ficial acute inflammation of the skin and the subcutaneous 
 parts ; the blood-vessels are dilated ; the white blood-corpus- 
 cles pass out of the blood-stream and become phagocytic ; the 
 solid masses of exudate are liquefied (peptonized) and resorbed 
 (histolysis), this is due to the formation of ferments from the 
 degenerating white blood-corpuscles. 
 
 If hard, painless, nodular thickenings remain in the ten- 
 don after the course of a chronic inflammation they cannot 
 be removed any more than other cicatricial formations. 
 Tenotomy may be successfully employed to counteract 
 retraction of the tendon. 
 
 The suppurative and necrotic forms of tendinitis must be 
 treated with incision, antiseptic irrigation, and 
 eventually with resection. 
 
 Statistics of Tendinitis. — Tendinitis is the most frequent form 
 of disease of the tendons, it is one of the most frequent surgical affec- 
 tions in the horse. In the years 18S6-1895, 36,230 horses were treated 
 in the Prussian Army for inflammation of the tendons and tendon- 
 sheaths. The affection most often involved both the perforans and 
 the perforatus of one limb (70 per cent); then followed the suspensory 
 ligament with 20 per cent. The right anterior limb was most often 
 affected (43 per cent), then followed the left anterior limb (36 percent) 
 (Bartke). — Inflammation of the tendons is far less common in dogs. 
 Among 70,000 diseased dogs ( 1886-1895) I have observed only twenty- 
 three cases of tendinitis ; the achilles tendon was most frequently 
 affected. 
 
 2. TENDON-RUPTURE. 
 
 Causes. — Incomplete tendon-rupture (partial, fibril- 
 lar, fascicular) was described under inflammation of tendons. 
 
268 tendon-rupturr 
 
 Complete (total) tendon-rnpture forms another, independ- 
 ent, affection. In contrast to open wounds and incisions of 
 tendons (tendon-wounds), ruptures are usually subcutaneous. 
 The causes are usually external and, like traumatic tendinitis, 
 are ordinarily due to overexertion and overstretching. They 
 are less fref|uently caused by contusions. As in tendinitis, i u- 
 ternal predisposing factors are common (so-called sp on- 
 tan cou s tendon-ruptures); these may be due to suppurative 
 inflannnation, necrosis, previous infectious diseases (contagious 
 pleurt)])neunK)nia, petechial fever), and other derangements in 
 the nourishment (osteomalacia, neurotomjO which cause a 
 loss of resistance. The following conditions especially predis- 
 pose to tendon-rupture :suppurative tendovaginitis at the 
 fetlock- and tarsal-joints, phlegmon of the fatty frog (nail 
 pricks), and bursitis podotrochlearis. It is especially liable 
 to occur as a result of prolonged standing on three limbs, the 
 well foot becomes affected with painful i)ressure laminitis. so 
 that the horse is obliged to again bear weight on the diseased 
 foot. In many cases it is not possible to determine the cause 
 of tendon-rupture (simultaneous rupture in several limbs). 
 
 OccuRRKNCE. — In horses the following tendons are most 
 often ruptured : flexor metatarsi, flexor p e r f o r a n s, 
 flexor ]^ e r f o r a t u s, and s u s p e n s o r \' 1 i g a m e n t , 
 in cattle and dogs the a c h i 1 1 e s tendon and flexor meta- 
 tarsi are most often involved. In general, total rupture of the 
 tendon is less common than other tendinous affections. For 
 exam])le, in the Prussian Army in the yeans 1 889-1895, thirty 
 thousand horses w^ere affected with inflammation of the tendons 
 and tendon-sheaths ; during the same time there were about 
 three hundred cases of tendon-rupture. One case of total 
 tendon-rui)ture occurs to a hundred of tendinitis and tendo- 
 vaginitis. As a rule only one tendon is ruptured ; in race- 
 horses and in spontaneous ruptures one finds, however, two or 
 three, and even all four limbs simultaneously involved. For 
 the process of healing see page 71. 
 
 Symptom.s. — The symptoms of tendon-rupture are vari- 
 able, they depend on the tendon aflected. 
 
 a) Rupture of the flexor metatarsi occurs in 
 
TENDON-RUPTURK 269 
 
 horses, occasionally in cattle, after over-stretchinfj of the ten- 
 don from excessive extension of the tarsal-joint Tkicks, slips). 
 It is characterized by a dandling movement of the 
 lower part of the hind limb which comes on sud- 
 denly, and a peculiar lameness in which the tarsal-joint 
 is abnormally extended. Loss (jf resistance in the 
 flexor metatarsi is easily recognized when the limb is raised in 
 a position for shoeing, carrying the limb backwards results in 
 tripping, at the same time the achilles tendon appears relaxed 
 and lies in folds. Apparently the prognosis is favorable, 
 healing without treatment usually takes place in one or two 
 months. 
 
 b) Rupture of the flexor perforans and sus- 
 pensory ligament is observed as follows : on the anterior 
 limbs of race-horses, as well as during the course of a chronic 
 inflammation of the pedal-joint, as a result of phlegmonous 
 processes in the tendon-sheaths and the fatty frog. It is 
 characterized by a lameness which develops rapidly with 
 abnormal dorsal flexion of the fetlock-joint; on 
 palpation one may locate a depression in the tendon at 
 the point of rupture. In rupture of the flexor perforans the 
 toe is raised. Ru[)tures of the flexor perforans and sus- 
 pen.sory ligament in the region of the nietacarjnis usually 
 require two or three months to heal ; ruptures which result 
 from necrosis are, however, nearly always incurable. Treat- 
 ment consists in the aijplication of a plaster-of-Paris bandage. 
 
 c) Rupture of the achilles tendon is frequently 
 observed in cattle. It is due to abnormal flexion of the tarsal- 
 joint and excessive stretching of the tendon by means of falls, 
 slips, and jumps, or to severe contraction of the gastrochnemius 
 during extension of the joint. It is characterized by a 
 severe lameness which develops suddenly, excessive 
 flexion of the lower part of the limb, knuck- 
 ling, and inability to support weight ; the achilles tendon is 
 thereby relaxed so that a space may be recognized at the 
 point of rupture. In dogs the prognosis is relatively good 
 (plaster-of-Paris bandage, tendon-sutures), in cattle and horses 
 it is unfavorable (slings j. Tho.se cases in which the tendon 
 
270 NECROSIS OF TENDONS 
 
 pulls awa}' the periosteum and particles of bone from the point 
 of the OS calcis are usually incurable. 
 
 Tendon-Luxation. This is occasionally observed in the horse at 
 the expansion of the perforatus where it passes over the os calcis. The 
 dislocation may be either to the external or the internal side. The 
 gliding movements of the dislocated tendon may be seen at the os calcis 
 with every extension. At the same time one observes local swelling 
 and an uncertain stumbling gait. The prognosis is grave, as a rule the 
 luxation is incurable. 
 
 3. NECROSIS OF TENDONS. 
 
 Causes. — Necrosis of tendons is due to a previous sup- 
 purative tendinitis, which usually results from extension of 
 phlegmonous processes from adjacent structures to the tendons. 
 As the genuine tendon-tissue is not a vascular structure 
 necrosis may easily occur and extend very rapidly. Necrosis 
 is most frequently observed in the perforans tendon at the 
 navicular bone, due to phlegmon of the fatty frog resulting 
 from nail-punctures. The suppurative process in the frog 
 extends to the bursa podotrochlearis, or, in perforating wounds, 
 it niaj'- originate in this bursa and develop into a suppurative 
 bursitis enveloping the perforans tendon in a sac of pus, which 
 results in its rapid necrosis. Necrosis of the sus- 
 pensory ligament of the bulbs and the navi- 
 cular bone, as well as the ligament which passes 
 from the lateral cartilage to the first phalanx 
 often results from a suppurative stone-bruise in the angle of 
 the sole. As these ligaments unite the perforans tendon to the 
 fatty frog, and the bulbs to the lateral cartilage, they fre- 
 quently convey the necrotic inflammation from one of these 
 structures to the other. (Com.: Pfeiffer, Monatshefte 
 fiir praktische Tierheilkunde. 1897). 
 
 Symptoms. — The necrosed particles of tendon present a 
 green, greenish- 3' ellow, or yellow appearance. 
 They appear to slough away rapidly from the sound tendon, 
 so that the smooth, soft, relaxed, greenish-colored membran- 
 ous structures may be removed from the cavity. Experience 
 has demonstrated that tendon-necrosis may seemingly develop 
 
NECROSIS OF TENDONS 27 1 
 
 very rapidly. I have seen diflFuse, green necrosis of the flexor 
 tendon develop within a week after the nail-puncture. The 
 other symptoms of necrosis of the flexor perforans are like 
 those of phlegmon of the fatty frog and suppurative bursitis ; 
 namely , severe supporting-leg lameness in which 
 the diseased foot bears either little or no weight, pronounced 
 volar flexion, marked swelling in the frog and 
 cleft between the balls, pronounced pain on 
 dorsal flexion of the hoof, as well as a general 
 febrile condition. 
 
 Treatment. — Treatment of tendon-necrosis is entirely 
 operative. It consists in a free exposure of the tendon and 
 removal of the necrotic particles. When a nail-puncture is 
 followed by the previously described symptoms an early opera- 
 tion renders the prognosis more favorable. The frequency 
 of incurable tendon-necrosis following nail- 
 punctures is largelj" referable to delay in the 
 operative treatment. The operation may be per- 
 formed in various ways. I employ the following technique : 
 removal of the frog and fatty frog as far as the tendon by 
 means of a three-cornered incision ; cut out that portion of the 
 perforans tendon which lies between the superior border of the 
 navicular bone and its pedal attachment ; carefully curette the 
 walls of the bursa, especially that which covers the navicular 
 bone, and remove all necrotic particles that maj' be attached to 
 it ; thoroughly irrigate the funnel-shaped operative wound, 
 and provide drainage by means of an incision in the vicinity of 
 the bulbs ; pack with a loose tampon of iodoform gauze, and 
 bandage the entire hoof. When this operation is employed 
 early and the entire terminal portion of the necrotic tendon re- 
 moved, healing usuall}^ occurs in one to two months if the 
 pedal-joint is not involved. 
 
272 INFLAMMATION OF TENDON-SHEATHS 
 
 II. DISEASES OF TENDON SHEATHS. 
 
 I. INFLAMMATION OF THE TENDON-SHEATHS. 
 TENDOVAGINITIS. 
 
 Forms. — Inflammation of the tendon- sheaths 
 (tendovaginitis, tendosynovitis, tendinous 
 bursitis, tenalgia) occurs, similar to inflammation of 
 the joints, in various forms. One distinguishes here, also, 
 traumatic (non-bacterial, non-infectious, aseptic), infec- 
 tious (septic, bacterial), and rheumatic inflammation 
 of the tendon-sheaths ; one further distinguishes a primary 
 and a secondary form (s )- m p t o m a t i c, metastatic), 
 acute and chronic, tubercular, etc. The various 
 anatomical characteristics of tendovaginitis are of importance. 
 The tendon-sheaths are covered on their inner surfaces with a 
 layer of endothelium which is identical in structure with that 
 lining the synovial membranes of joints, they are also covered 
 with a serous membrane analogous to the pleura and peri- 
 toneum. One distinguishes here, then, the following types of 
 tendovaginitis: serous, serofibrinous, fibrinous 
 (croupous, catarrhal, crepitating), suppurative, icho- 
 rous, and chronic fibrous. From a practical surgical 
 standpoint it is important to distinguish between the following : 
 acute serous and acute suppurative, as well as tuberculous. 
 
 Serous Tendovaginitis. — The causes are to be 
 found, either in external mechanical influences (overexer- 
 tions, contusions), or in internal infectious diseases (contagious 
 pleuropneumonia, septicemia, articular rheumatism, contagious 
 abortion), or cold (rheumatism of the tendon-sheaths). Pri- 
 mary, traumatic tendovaginitis usually affects only one tendon- 
 sheath ; the secondary, symptomatic or metastatic inflamma- 
 tions, usually attack several sheaths at the same time. 
 
 The symptoms consist in lameness, high temperature, 
 more or less pain, and a soft, either fluctuating (T. serosa) or 
 crepitating (T. serofibriuosa) swelling in the vicinity 
 of the diseased tendon-sheath. If the exudate is 
 not resorbed there develops, either a chronic hydrops 
 
INFLAMMATION OF TENDON-SHEATHS 273 
 
 (tendon-sheath orall), or a chronic connective-tissue 
 new-formation with pronounced thickening and schlerosis of 
 the walls (tendovaginitis chronica fibrosa, in- 
 durated tendon-sheath galls). In general the course of simple 
 traumatic forms of tendovaginitis is more favorable than the 
 symptomatic ; this is especially true of inflammations of sheaths 
 that occur during the course of contagious pleuropneumonia, 
 which are often chronic and remittent in character. Tendo- 
 vaginitis of the extensor tendons is more favorable than that of 
 the flexors. 
 
 The treatment of serous or serofibrinous tendovagi- 
 nitis consists in the application of moist warmth in the form of 
 Priesnitz compress, as well as massage, further, in the 
 application of a pressure bandage and absolute rest for the 
 aniinal. Cold, operative treatment, and firing 
 are contra-indicated. When the resorption is de- 
 layed and there is a tendency for the process to become 
 chronic, a stimulating application or iodine may be applied. 
 
 Suppurative Tendovaginitis. — This follows open- 
 i n j u r i e s to the tendon-sheaths ; it is the result of the en- 
 trance of pus-bacteria from without (punctured wounds at the 
 tarsal-joint) ; it may also be due to the extension of a 
 suppurative phlegmonous process from neigh- 
 boring structures to the tendon-sheaths (fatty frog) ; finally, 
 it may have a hematogenous origin in pyemia and 
 strangles. 
 
 It is characterized by the following symptoms: a 
 phlegmonous swelling which is very exten- 
 sive, spreads rapidly, is painful, and is occasionally 
 accompanied by abscess formation. The animal is very 
 lame and often has a high fever. It frequently leads to 
 necrosis and rupture of tendons ; to opening of neigh- 
 boring joints with a subsequent ichorous and suppurative 
 arthritis, especially in the knee-joint (the tendon-sheath of the 
 extensor pedis communicates with the joint-capsule), the 
 tarsal-joint, the fetlock-joint, and the pedal-joint; as well 
 as to septic and pyemic general infection. 
 Occasionally the course is very chronic, several months ; the 
 
:274 INFLAMMATION OF TENDON-SHEATHS 
 
 condition is alternately improved and aggravated for a period 
 of several weeks, relapses are common after the disease has 
 apparently been cured. 
 
 Treatment consists in the application of antisep- 
 tics . In the early stages one opposes the inflammatory pro- 
 cesses by means of antiseptic bandages, baths, and applications 
 (iodoform gauze, camphor ointment, spirits-of-camphor 
 "bandage, grey mercurial ointment). This method of 
 treatment, however, must not be continued 
 too long. When it is once demonstrated that there is pus 
 in the tendon-sheath or that the tendon is affected with 
 necrosis, an operation must be performed immediately. This 
 consists in incision, antiseptic irrigation, drain- 
 age, resection of the necrotic particles of tendon, and 
 the application of an antiseptic tampon covered with 
 an aseptic bandage. In such cases one does not 
 hesitate to open the sheaths of flexor ten- 
 dons of the horse. The only rational method of treat- 
 ment consists in an early free incision and a thorough disin- 
 fection of the suppurative tendon-sheath, with removal of the 
 pus and necrotic particles of tissue. 
 
 Tubercular Tendovaginitis. According to Hess 
 and G u i 1 1 e b e a u this is very common in cattle, it is partly 
 a primary affection, partly secondary to generalized tubercu- 
 losis. The tendon-sheath of the extensor metacarpi 
 (M. extensor carpi radialis) on the anterior surface of the 
 carpus is most frequently affected, it may be unilateral or 
 bilateral. Along the course of the named tendon-sheath, oc- 
 casionally along the entire length of the forearm, there exists 
 a diffuse, hot, firm, painful swelling ; it may be as large as a 
 man's arm, at times crepitation is present (tendovaginitis 
 fibrinosa). It is characterized by severe lameness, rapid mus- 
 cular atrophy at the shoulder, and general emaciation. The 
 animal is usually slaughtered as the condition is seldom cur- 
 able ; the tendon-sheath presents marked thickenings, is hyper- 
 emic and covered with fibrin, occasionally it contains numer- 
 ous corpora oryzoidea (hygroma proliferum). Inoculation of 
 guinea-pigs with the exudate produces tuberculosis. 
 
HYDROPS OF TENDON-SHEATHS 275 
 
 A similar tubercular tendovaginitis occurs in cattle in the 
 superior tendon sheath of the long extensor of the toe 
 (M. extensor digitorum pedis longus); occasionally the disease 
 is simultaneous with that of tuberculosis of the knee-joint 
 (communication ) . 
 
 2. TENDON-SHEA.TH GALLS. HYDROPS OR HYGROMA 
 OF THE TENDON-SHEATHS. 
 
 Causes. — A tendon-sheath gall is a condition 
 characterized by the accumulation of a serous 
 fluid in the t en d on - sh ea t hs , the walls of the 
 sheath are dilated and are usually thickened, 
 pain and other inflammatory symptoms are 
 absent, it is termed a chronic hydrops or hygroma 
 of the tendon-sheaths. It usually develops from a chronic, 
 repeated, serous tendovaginitis resulting from severe exertions, 
 it is, therefore, more common in old horses than in young. 
 The inflammatory irritant is found in the mechanical rubbing 
 of the tendon on the walls of the tendon-sheath ; the process 
 is aseptic; that is, it develops without the influence of 
 bacteria. Tendon-sheath galls as a result of contagious 
 pleuropneumonia are less frequent (among 1400 horses 
 affected with pleuropneumonia in the Prussian Army in 1895 
 only five cases were observed). 
 
 Occurrence. — Hygromata of the tendon-sheaths are 
 most often observed in horses and draft-oxen. The)^ are 
 usually classified as hj'gromata of the flexor ten- 
 don-sheaths and hygromata of the extensor ten- 
 don-sheaths; the former, because of their size, frequency, 
 and difficulty in healing, are more important than the latter. 
 
 a) The most important flexor tendon-sheath 
 hygromata in the horse are on the anterior limbs. The 
 flexor tendon-sheath hygromata at the pos- 
 terior surface of the carpus (the common tendon- 
 sheath of the flexor perforatus and perforans at the posterior 
 border of the carpal-joint, the hygroma originates about ten 
 centimeters above the joint and forms a long swelling which 
 
276 HYGROMATA OI" TKNDON-SHKATIIS 
 
 terminates at tlie second tliinl of tlie metacarpus). The 
 flexor t e n d o 11 - s h e a t li h y g r o m a t a at the pos- 
 terior surface of the fetlock, or windfalls (inferior 
 tendon-sheath of the perforatus and perforans, the hygroma 
 forms two long swellings placed at the sides of the tendon of 
 the llexor perforans, Ijchind the metacarpus and above the 
 fetlock-joint). On tlie posterior limbs, in addition to those 
 mentioned above, which are frequently indurated in the region 
 of the lellock ; there exist hygromata of the flexor 
 tendons in the region of the t a r s a 1 - j o i n t 
 (tendon-sheath of the llexor perforans on the ])ostero-internal 
 surface of the tarsal-joint, swelling as large as a child's head on 
 the inner surface, as large as a hen's egg on the posterior sur- 
 face — curb). Also at the sunnnit of the os calcis (tendon- 
 sheath of the llexor perforatus where it passes over the achilles 
 tendon, it originates twenty centimeters above the summit of 
 the OS calcis and forms two long swellings on the inner and 
 outer sides of the achilles tendon, it terminates just above the 
 summit of the os calcis). 
 
 b ) The most important extensor tendon h y g r o - 
 m a t a of the anterior lind)S are, first, those on the anterior 
 s u r fa c e of I h e c a r p a 1 - j o i n t , four so-called carpal 
 tendon-sheath galls. They are arranged as follows from the 
 lateral to the medial surface: i. Hygroma of the sheath of 
 the extensor suffraginis (M. extensor digiti minimi), 
 a swelling about the size of a goose-egg which begins at the 
 side and above the carpal-joint ; 2, distention of the tendon- 
 sheatli of the extensor pedis (M. extensor digitorum 
 communis), a swelling that extends from the lower end of the 
 radius over the anterior surface of the carpal-joint, to the 
 upper enil of tlie metacarpus ; 3, hygroma of the sheath of 
 the extensor m e t a c a r p i ( M. exten.sor carpi radialis) 
 in the middle of the anterior surface ; 4, distension of the 
 sheath of the oblique extensor of the carpus 
 (M. abductor poUicus U)ngus), a swelling which passes ob- 
 liquely di)wnwards and inwards from the supero-external 
 region of the carpus. On the anterior limbs there also occur 
 hygromata of the extensor tendons at the fetlock (mucous 
 
HYGROMATA OF TKNDON-SIIEATIIS 277 
 
 bursa, or tendon-sheath of the long extensor of the toe <jn the 
 anterior surface immediately over the fetlock-joint ; swelling 
 the size of a goose-egg). On the posterior limbs, in addition to 
 those already mentioned around the extensors of the fetlock, the 
 sheath of the peroneus tendon at the tarsus 
 may also become distended. It forms a hydro])s about the size 
 of a walnut on the infero-Iateral surface of the tarsal-joint. 
 Finally, although uncommon and seldom large, there occurs 
 an extensor t en d o n - sh e a t h hygroma on the 
 anteri(;r surface of the tarsal-joint, that is, a 
 tendon-sheath hygroma of the extensor pedis in the 
 middle of the anterior surface of the tarsal-joint. 
 
 The walls of these hygromata occasionally undergo pro- 
 nounced thickening, this is esjjecially true of those on the hind 
 limbs (tendovaginitis chronica fibrosa). Corpora oryzoidea 
 are occasionally observed within the distension (hygroma 
 proliferum). 
 
 Tkkatmknt. — Hygromata of the tendon-sheaths are 
 usually incurable. Ordinarily they are not accompanied 
 by lameness and are of little importance (blemishes;. In 
 cheap horses their removal should not be considered. Opera- 
 tive treatment, on the other hand, which is the only method 
 whereby results may be obtained, is not without danger Vje- 
 cau.se of the difficulty of applying an aseptic bandage. For 
 this reason treatment is not usually adopted. 
 
 When it is decided to employ operative treatment 
 for tendon-sheath hygromata, the only rational method is to 
 make free incisions, irrigate with antiseptics, 
 curette or extirpate the thick, fibrous wall, provide 
 drainage for the tendon-sheath and apply an aseptic 
 bandage. The object of the operation is to obliterate the 
 tendon-sheath by producing adhesions between the walls of 
 the sheath, and healing per prima of the incised w(jund. The 
 danger lies in the dilTiculty of ol^taining asepsis ; infection may 
 lead to suppurative and ichorous tendovaginitis with a conse- 
 cutive septicemia and pyemia. However, the operation has 
 been successfully performed several times. Puncture of 
 the hygroma with a sub.sequent injection of an aqueous 
 
278 DISEASES OF MUCOUS liURSAE 
 
 solution of iodicl of potash (i: 100-200) is a safer 
 operation, but the results are less certain. Regardless of a 
 few successful cases, puncture with the cautery 
 cannot be refjjarded as a safe operation. In chronic hygroniata 
 ordinary point and line-fning, as well as applications of blis- 
 tering ointments or plasters, produce no results. 
 
 III. DISKASKS OF MUCOUS BURvSAE. 
 
 I. INI'LAMMATION OF MUCOUS BURSAR. BURSITIS. 
 
 Forms. — Diseases of the mucous burstc may be classified 
 like those of the tendon-sheaths and joints, namely, serous, 
 'fibrinous, suppurative and hemorrhagic. They 
 may be further designated as t r a u m a t i c and i n f e c t i o u s, 
 a cute and chronic, as well as tuberculous and 
 bo t r y o m y CO t i c . According to the .seat of the mucous 
 bursa, one further speaks of a bursitis podotrochlearis, 
 intertubercularis, trocanterica, prepatel- 
 lar i s , o 1 e c r a n i , c a 1 c a u e i , and iufraspinati. 
 It is of special practical importance to distinguish between an 
 acute serous or sero-fibrinous, and an acute suppurative 
 bursitis. '' 
 
 vSkrous Bursitis. — The causes of acute serous in- 
 llanuuations (acute hygromata) of the mucous bursce are 
 usually traumatic. They consist in contusion of the 
 bursa by means of pressure, blows, or kicks, with a subsequent 
 extravasate of blood (bursal hematoma) and a circumscribed 
 inflammation. For example, bursitis olecrani in the horse is 
 due to pressure on the elbow from the heel-calks when the 
 animal lies with the limbs folded under the body (shoe-boil). 
 Bursitis calcanci is due to contusions of the bursa over the os 
 calcis, due to kicking. It has not yet been clearly demonstrated 
 whether metastatic bursitis occurs, as in inflammation of the 
 tendon- sheaths. It is claimed that bursitis podotrochlearis 
 may have a metastatic origin during the course of contagious. 
 pleuropneumonia, and that supra-atloid bursitis may result ia 
 the same way from strangles (so-called poll-evil). 
 
SUPPURATIVE BURSITIS 279 
 
 The symptoms of traumatic bursitis are as follows : 
 swelling which usually develops rapidly (over night), 
 local pain and heat ; the consistency of the swelling is variable 
 (semi-solid, fluctuating, crepitating). The contused skin may 
 be partially involved. If resorption does not occur during the 
 course of three or four weeks, there develops a chronic, 
 hyperplastic inflammatory process in the walls of the bursa 
 (chronic hygroma of the bursa). 
 
 Treat m e n t of acute serous bursitis consists in mas- 
 sage, Priesnitz compress, application of iodoform-collo- 
 dion, as well as thoroughly applied ointments of iodoform, 
 camphor, or mercury. Incision is con train dicated. 
 It leads to the danger of a suppurative bursitis as an occlusive 
 bandage is difficult to apply. 
 
 vSuppur.vtivp: Bursitis. — This is observed in contusions 
 that are accompanied by an injury to the skin and combined 
 with an opening into the bursa ; it also results from incisions 
 in serous bursitis. It is characterized by an extensive phleg- 
 monous swelling, as well as a purulent discharge. 
 It often responds very slowly to treatment which consists 
 in antiseptic irrigation, and drainage, as well as operative 
 extirpation of the infiltrated purulent bursa. 
 
 Tubercular Bursitis. — The subcutaneous bursa on the 
 anterior surface of the carpus in cattle is occasionally the 
 seat of a tuberculous inflammation (bursitis fibrinosa). The 
 mucous bursa is transformed into a sac as large as the head of 
 a child ; from this a form of carpal tumor, a tuberculous 
 hygroma, may develoi) (Hess, Ouillebeau). 
 
 Bursitis Podotrochlkaris. — This is a chronic i n f 1 auunation 
 of the tendon -sheath of the flexor perforans in the 
 vicinity of the navicular l)one, and just above the attach- 
 ment of the tendon to the os pediB. It is also known as podotroch- 
 litis,' inflammation of the pulley of the foot, chronic 
 lameness of the pedal-joint, or navicular disease. It 
 is especially common in narrow anterior feet of high-spirited horses. 
 The bursa just beneath the navicular bone is exposed to continual strain 
 and contusion from the descent of the bone ; this leads to a bursitis 
 
 'The term "podotrochlitis" employed by Bra 11 el I and extensively used since 
 that time is a false expression ; it should be called podotrochiliitis. "Podotrochlitis" 
 is a better sounding term (Cf. bursa podotrochlearis). 
 
28o HYGROMATA OF MUCOUS BURSAE 
 
 which develops very slowly with symptons of a chronic arthritis 
 deformans (ulceration and erosion of the cartilage of the inferior 
 surface of the navicular bone, with granular and rarefjdng ostitis and 
 even fracture of the navicular bone, thickening of the bursa, fibrillation 
 and laceration of the perforans tendon). The disease results in a 
 chronic, usually incurable lameness with contraction of the hoof. As a 
 rule neurectomy is the only method of overcoming the lameness. — 
 There is also an acute suppurative bursitis podotrochlearis due 
 to nail punctures. 
 
 2. HYGROMATA OF MUCOUS BURSAE ( CHRONIC HYDROPS). 
 
 Occurrence. — Hygromata of mucous bursse usually de- 
 velop from a chronic bursitis through the continual 
 influence of traumatic injuries; for example, the forma- 
 tion of so-called tumors of the elbow in the horse from lying 
 on a hard surface with the anterior limbs folded under the 
 body, or from contusions of the bursa olecrani when the animal 
 is rising, or the so-called carpal tumors in cattle (contusion of 
 the bursa precarpalis when the animal is rising or ij'ing down). 
 In cattle, a few hygromata are of tubercular origin, espe- 
 cially on the carpus. Tumor-like processes (cysts) appear to be 
 typical of many bursal hygromata. L,ike the fibrous hygromata 
 of the tendon-sheaths, chronic fibrous bursitis of the mucous 
 membrane may result in thickening and induration, even cal- 
 cification of the walls (capsule f o r m a t i o n) , as well as the 
 production of corpora oryzoidea on the inner surface (hy- 
 groma proliferum, ganglion crepitans). The 
 neighboring connective tissue also, is involved in the forma- 
 tion of the capsule in the form of a chronic peribursitis. The 
 following are the most important bursal hygromata : 
 
 a) Hygroma of the bursa olecrani, so-called shoe- 
 boil, forms a circumscribed, round or oval swelling at the 
 olecrailon process. In the horse it is the size of a fist to that 
 of one's head ; in dogs from that of a hen's egg to that of an 
 apple. In contrast to acute bursitis, it is painless, usually of a 
 firm, hard consistency, and the skin is more or less moveable 
 on the surface. It frequently occurs on both elbows in horses 
 and dogs without causing lameness. In well developed cases 
 it may be considered, not a bursitis, but a product of bursitis. 
 
HYGROMATA OF MUCOUS BURSAE 281 
 
 b) Hygroma of the bursa calcanei, so-called 
 capped-hock, forms a painless, circumscribed, roundish swell- 
 ing at the seat of the subcutaneous bursa over the tuberosity 
 of the OS calcis. It is about the size of an apple, elastic, and 
 is not usually accompanied b}'^ lameness. This should be dif- 
 ferentiated from other pathological changes in the same region 
 that are also included under the term capped-hock ; namely, 
 inflammation and hygroma of the tendon-sheath of the flexor 
 perforatus (cap-like expansion), contused swellings of the skin 
 and subcutem, as well as osteophytic formation on the 
 calcaneum. 
 
 c) Hygromata of the subcutaneous b u r s a e over the 
 tuberosities of the ischia, and over the occipital 
 bone are especially common in puppies in the form of pain- 
 less, circumscribed enlargements from the size of a dove's egg 
 to that of a goose-egg ; they are firm and smooth, and the skin 
 is moveable on the surface. In cattle, also, one frequentlj^ ob- 
 serves hygromata at the tuberosities of the ischia, occasionally 
 they become very large (size of a head). In horses, hygromata 
 of the same size are occasionally observed on both sides of the 
 withers. 
 
 d) In cattle there is frequentl}'- observed a subcutaneous 
 hygroma on the anterior surface of the carpus (bursa pre- 
 carpalis). It is in the form of a firm sac and may reach the 
 size of a man's head (carpal tumor), it is usually traumatic 
 (rising) seldom tuberculous in origin. This form is not 
 common in horses. 
 
 Treatment. — Treatment, like that of hygromata of the 
 tendon-sheaths, is seldom indicated in bursal h3^gromata 
 as they rarely cause lameness or other functional derange- 
 ments. Operative treatment of the so-called capped-hock is 
 not entirely free from danger, especially when it is in -the form 
 of a hygroma of the subtendinous bursa of the flexor perfo- 
 ratus. In all well-developed bursal hygromata 
 the application of blistering ointments and 
 plasters, as well as the use of the cautery 
 is of little influence. Mere puncture is rarely fol- 
 lowed with favorable results. Better results, especially in the 
 
282 HYDROCELE 
 
 treatment of shoe-boils, appear to have been attained by- 
 means of puncture, and injection of tincture of 
 iodine, with a subsequent incision in the skin and re- 
 moval of the necrotic sac (Kallmann); this method has 
 also been employed for carpal cysts in cattle ( Z e h 1 ). If the 
 hygroma is entirely detached, it only requires operative 
 removal, that is, complete extirpation of the cyst (not mere 
 incision) with the knife. The operation, especially in capped- 
 hocks and shoe-boils, usually requires a long period of after 
 treatment. Continual movement and inability to apply an 
 occlusive bandage prolong the process of wound healing. In 
 the treatment of capped-hock the rapidity of healing is in- 
 creased under the influence of a Bayer's tension- suture, in 
 certain cases it may heal by first intention. Operative treat- 
 ment is frequently followed by the return of the hygroma 
 as the cause is not removed. Small hygromata may be treated, 
 as in man, by subcutaneous rupture. The long- 
 employed ligature is applicable only to pedunculated hygro- 
 mata. The application of counter-irritants cannot be recom- 
 mended. Whether the recentl}' employed injection of pure 
 cultures of staphylococcus pyogenes aureus with subsequent 
 incision of the artificially developed abscess is of practical 
 importance, remains to be demonstrated. 
 
 HvDROCKLE. — This term indicates a chronic hydrops of the 
 vaginal sheath (processus vaginalis) in which the serous fluid 
 either lies free in the cavity of the fibrous portion of the tunica vaginalis 
 (hydrops ascites), or is found as a circumscribed swelling betwee-n the 
 duplicatures of the tunica propria (hydrocele of the spermatic cord). 
 The first form is common in stallions and is occasionally observed dur- 
 ing the castration of these animals; it is the product of a serous peri- 
 orchitis. The second form, on the other hand, while common in man, 
 is seldom seen in animals. Treatment, when one wishes to avoid castra- 
 tion, consists in the extirpation of the tunica propria. Disinfect, make 
 a free incision in the tunica vaginalis and expose the spermatic cord, 
 suture and apply an aseptic bandage. 
 
DISEASES OF MUSCLES 283. 
 
 DISEASES OF MUSCLES, FASCIAE AND NERVES. 
 I. DISEASES OF MUSCLES. 
 
 PRELIMINARY REMARKS ON ANATOMY. 
 
 Muscles. — Diseases of muscles, especially inflammations of these 
 tissues, are confined, partly to the m u s cle -f ib er s, partly to the 
 intra- and intermuscular connective tissue, the perimysium in- 
 ter n ti m and externum, as well as the fasciae and the subfascial 
 spaces. The fasciae play an important part in the surgery of 
 muscles. As the fasciae have not been given sufficient appreciation in 
 many anatomical text-books, the follovv-ing description according to 
 Eichbaum will be briefly considered: "(Die Faszien des Pferdes." 
 Berliner Archiv. 1S88 und 1889). 
 
 FASCite. — Fascia or muscle-ligament is considered a form 
 of aponeurosis. This firm connective tissue membrane is interwoven 
 with elastic fibers. Its function is to enclose or separate miiscles or 
 groups of muscles in a sheath-like manner. It consists largely of 
 connective-tissue fibers with a few blood-vessels and nerves, this ac- 
 counts for its tendency to necrosis. Interfascicular spaces are located 
 between the fasciie ; phlegmonous processes extend very easily and 
 rapidly within these spaces. The fascite support the muscles in their 
 activity by performing the functions of a physiological pump, they 
 favor the circulator}^ movements of the blood and lymph during con- 
 traction and relaxation of the muscles. Ruptures of fascite resi;lt in the 
 formation of muscle-hernias, and dislocation of muscles (biceps femoris 
 in cattle). On account of their firmness they are not often affected 
 with inflammation ; occasionally they form a wall against outward or 
 inward progression of an inflammation. On the other hand, they favor 
 the extension of subfascial phlegmons. The question of the relation of 
 contractures of the fascice to the development of stringhalt is still 
 open for accurate scientific demonstration. 
 
 1. Fasci.E of the Head and Neck. — i. The superficial 
 fascia of the neck (F. superficialis colli) is in combination with 
 the cutaneous muscle in the horse (aponeurotic portion of this muscle). 
 It forms two lamellae, and extends from the ventral margin of the neck 
 over the lateral surfaces, terminating on the dorsal margin ( cervical 
 ligament). A median septum passes downwards in the median line of 
 the inferior cervical border. 
 
 2. The deep fascia of the neck (F. profunda colli) 
 passes over the anterior and lateral surfaces of the trachea, and forms 
 the capsule of the thyroid glands above, as well as the external surface 
 of the guttural pouches. The jugular vein, surrounded by loose con- 
 nective tissue, lies between the superficial and the deep cervical fascia. 
 At the thoracic inlet this fascia covers the inferior tracheal glands. 
 
284 DISEASES- OF MUSCLES 
 
 3. The fascia propria of t he trac he a encloses the trachea 
 in the form of a sheath. 
 
 4. The nuchal Fascia (F. nuchte) borders posteriorly the 
 subcutaneous cervical fascia, and is to be considered as a lateral continu- 
 ation of the cordiform portion of the ligamentuui nuchse. It is located in 
 the region above the shoulder, and is covered with the superficial cervical 
 fascia. In the vicinitj' of the superior cervical border it is very thick 
 and contains the so-called fatty crest. 
 
 5. The fascia of the parotid and masseters (F. paro- 
 tideo-masseterica) lies between the auricular, parotid, intermaxillary, 
 facial and masse ter surfaces. The pharyngeal fascia extends 
 over the external surface of the pharyngeal muscles. 
 
 6. Tenon's fascia (Tenon's capsule ) originates on the corneal 
 margin of the orbit, passes over the anterior portion of the schlera, and 
 from there to the retractor bulbi, finall}^ enclosing the optic nerve. 
 
 II. Fasci.5 OF THE Trunk AND Pelvis. — i. The supe r f icial 
 fascia (F. superficialis s. subcutanea) lies below the thoracic and 
 abdominal panniculus carnosus, and becomes attached to the linea alba 
 in the median line. Posteriorly it forms the basis of the knee-fold, as 
 well as the superficial layer of the fascia of the prepuce, covers the 
 inguinal ring as well as the pudic glands, and encloses the testicles 
 in the form of the muscular dartos. 
 
 2. The dorsal fascia (dorso-lumbar fascia, F. lumbo-dorsalis) 
 is divided into a superior, superficial layer, which covers the longissimus 
 dorsi muscle, and an inferior, deep layer, which lies between the last 
 rib and the anterior margin of the ilium. Between the superficial fascia 
 ( I ) and the dorsal fascia there lies an interfascial space filled with loose 
 connective tissue (of surgical importance with reference to fistulous 
 withers and saddle -pressure ) ; similar spaces are located between the 
 layers of the dorsal fascia, as well as between the superficial laj^er of the 
 dorsal fascia and the longissimus. 
 
 3. The yellow abdominal tunic covers the external ob- 
 lique muscle. A continuation of this goes to form the fascia of the penis, 
 or the supporting ligament of the udder ; in combination with the 
 terminal aponeurosis (Poupart's ligament) of the external oblique 
 muscle it forms the inguinal fold and the crural membrane (lamina 
 femoralis). 
 
 4. The 1 u mbo-ili ac fascia (F. iliaca s. lumbo-iliaca) covers 
 the inferior surface of the iliopsoas in the lumbar region and becomes 
 continuous with the pelvic fascia. 
 
 5. The transverse abdominal fascia (F. transversa s. 
 transversalis abdominis) lies between the transverse abdominal muscle 
 and the jDeritoneum. The tunica vaginalis communis is a continuation 
 of this fascia. 
 
 6. The pelvic fascia (F. pelvis) covers over the inner surface 
 of the walls of the pelvic cavity. 
 
DISEASES OF MUSCLES 285 
 
 7. The perineal fascia (F. perinei) is divided into a super- 
 ficial layer (P. perinei superficialis), a continuation of the subcutaneous 
 fascia of the hips, and a deep layer (F. perinei propria), a continuation 
 of the fascia of the hip. 
 
 III. Fasci.^' OF THE Anterior Limbs, i. The superficial 
 fascia (F. superficialis) lies beneath the panniculus carnosus as far as 
 the elbow-joint, it is thin and transparent and extends as far as the 
 fetlock-joint. 
 
 2. The scapulo-humeral fascia (F. brachii) lies beneath 
 the preceding on the external surface of the scapulo-humeral region, 
 and consists of a superficial and a deep layer ; the first becomes con- 
 tinuous with the superficial layer of the sheath of the biceps brachii. 
 
 3. The true or deep fascia of the forearm (!{. anti- 
 brachii) passes, in the form of a firm band, over all the muscles of 
 the forearm as well as the median surface of the radius. At the carpus 
 it forms the deep carpal sheath (F. carpi profunda ), on the volar 
 surface of the carpus it forms the transverse ligament of the 
 carpus, it terminates at the middle of the flexor tendons in the form 
 of a semilunar margin. It forms several intermuscular ligaments 
 between the extensors and flexors of the forearm. 
 
 4. The fasciae of the foot (F. plantaris) form broad or 
 small ligaments which hold the tendons in position and strengthen the 
 articular ligaments. 
 
 IV. The Fasciae ok the Posterior Limbs. — The superficial 
 fascia (F. superficialis) is formed from a continuation of the aponeuro- 
 sis of the abdominal panniculus ; it covers the muscles of the hip, the 
 biceps and semitendinosus, as well as the sartorious, gracillis, and semi- 
 membranosus as far as the region of the knee ; it terminates at the 
 coronet. 
 
 2. The fascia of the hip (F. ghiteii ) lies beneath the pre- 
 ceding, and is a continuation of the dorsal fascia, it covers the muscles 
 of the hips and buttocks, and becomes continuous with the fascia lata 
 at the femur. Passing downwards it is transformed into a fascia which 
 encloses the muscles of the femur (tensor facia lata, biceps, semitendin- 
 osus); passes the tibia, and may be traced as far as the tarsal-joint. It 
 also forms numerous intermuscular septa between the muscles of the 
 hip and the femur. 
 
 3. The femoral ligament or broad crural ligament 
 (F. lata) is a continuation of the aponeurosis of the external oblique 
 muscle on the inner surface of the limb, it fuses with a projection of the 
 gluteal fascia on the anterior and posterior margins of the upper part of 
 the limb. It forms a ring for the entire musculature of the femur. 
 
 4. The tibial fascia (F. cruris) covers the muscles of the tibia 
 in the form of a very strong aponeurosis, and extends downwards over 
 the tarsal-joint and the metatarsus. It consists of a superficial (contin- 
 uation of the crural fascia), and a deep layer (formed from the tendon 
 
286 INFLAMMATION OF MUSCLES 
 
 of the biceps, semimembranosus, semitendinosus and gracillis), as well 
 as the common sheath of the tibial muscles. The last named muscle- 
 sheath encloses the muscles and is in immediate contact with them, it 
 is divided into three parts: i. The muscle-sheath for the flexor 
 metatarsi, anterior tibial muscle and long extensor of the toe ; 2. 
 The tendon-sheath for the flexor perforans and popliteal muscle; 
 3. The tendon-sheath for the lateral extensor of the toe. 
 
 I. INFLAMMATION OF MUSCLES. MYOSITIS. 
 
 Forms. — Accordiug to causes, the following forms are 
 recognized : traumatic ( contusions ), rheumatic 
 (cold, muscular rheumatism ), infectious (bacteria) , and 
 parasitic myositis (sarcosporidia, trachina). The follow- 
 ing specific infectious and parasitic types 
 of myositis are also recognized : actinomycotic, 
 botryomycotic, sarcosporidic, trichinous, 
 tubercular, and glandular myositis. According 
 to the course one distinguishes an acute and a chronic; 
 according to the character of the inflammation, a serous, 
 suppurative, interstitial or fibrous, paren- 
 chymatous, and ossifying myositis. Finall)', inflam- 
 mation of mu.scle may be classified as primary and secondary 
 (symptomatic, metastatic). The latter is observed during the 
 course of pyemia, strangles, tuberculosis, etc. The following 
 are of practical importance : 
 
 a) Traumatic myositis. 
 
 b) Muscular rheumatism. 
 
 c) Parenchj^matous myositis. 
 
 d) Suppurative myositis. 
 
 e) Interstitial myositis. 
 
 f) Ossifying myositis. 
 
 Traumatic Myositis. — This most often occurs in horses 
 as a result of contusions and exists in the form of an aseptic 
 inflammation, it msLj also result from overextension, strain, or 
 partial rupture of muscles. It is partly hemorrhagic, partly 
 serous (mj^ositis hemorrhagica and serosa). It 
 is especially observed in the region of the shoulder as a result 
 of blows and collisions. It is a cause of one form of so- 
 called shoulder lameness which is characterized by well 
 
INFLAMMATION OF MUSCLES 287 
 
 pronounced hanging-leg lameness and dragging of the limb ; 
 it is usually due to an inflammation of the lower end of the 
 mastoideo humeralis or the biceps muscle. lyocal examination 
 reveals a circumscribed area of pain, swelling, as well 
 as increased heat in the part on palpation. In contrast to 
 rheumatic myositis, the area of pain has a definite local bound- 
 -ary, and is not wandering ; ordinarily the anamnesis furnishes 
 evidence of the traumatic origin. Traumatic mj'^ositis is also 
 observed on transports as a result of improper treatment 
 and narrow stalls, especially in cattle and swine in the follow- 
 ing places : muscles of the shoulder, thorax, and gluteal 
 regions. When the animals are slaughtered the following 
 <:onditions are observed : serous and hemorrhagic, gelatinous 
 infiltration of the internal and external perimysium, softening, 
 discoloration, and degeneration of the muscular bundles, as 
 well as loss of transverse striations, and other degenerative 
 changes in the muscular fibers. Traumatic myositis usually 
 runs an acute course; this is especially observed in those 
 cases of shoulder lameness in the horse due to muscular con- 
 tusions. In many, resorption is rapid and recover}^ is complete 
 in a few days. In other cases there is a connective-tissue 
 development between the muscle-fibers at the seat of the con- 
 tusion as the result of a chronic aseptic inflammation (inter- 
 stitial myositis ; schlerosis of muscles) . Treatment consists 
 in rest and massage, as well as in the application of moist 
 warmth in the form of Priesnitz compress. 
 
 Muscular Rheumatism. — Rheumatic myositis due to 
 cold is most often observed in horses, dogs and cattle. The 
 anatomical changes are as follows: hyperemia, serous 
 and small-celled infiltration of the perimysium internum 
 (polymyositis serosa), softening, discoloration and de- 
 generation of the muscle-fibers (cloudy swelling, and fatty 
 degeneration) ; multiple hemorrhagic foci are less common 
 (polymyositis hemorrhagica). When the disease runs 
 a chronic course, rheumatic muscular cicatrices form as a re- 
 sult of new formations of connective tissue (interstitial 
 myositis) and atrophy of the genuine muscle substance. 
 The symptoms consist of lameness which develops 
 
288 INFLAMMATION OF MUSCLES 
 
 suddenl}^ after a previous cooling (rheumatic shoulder lameness, 
 rheumatism of the shoulder, omodynia, rheumatic sacral lame- 
 ness, lumbago), oblique position of the neck (torticolis), 
 occasionally dyspnea (pleurodynia). Shoulder lameness may 
 be caused by a myositis of the mastoideo humeralis, lameness 
 in the sacral region by myositis of the psoas muscles. These 
 muscles are painful on palpation, this is especially true of 
 the psoas muscles in lumbago of the dog. Hemoglobinuria 
 (lumbago, azoturia) of ^the horse is considered a rheumatic 
 myositis of the lumbar muscles, in contrast to traumatic myositis 
 the rheumatic form is often wandering and recurrent; 
 it often temporarily disappears entirely when the animal is 
 moved for some time. It also has a much greater tendency to 
 run a chronic course. Treatment consists in the external 
 application of moist warmth, massage and stimulating appli- 
 cations (spirits of camphor), as well as the internal adminis- 
 tration of salicylic preparations (horses loo grams, dogs 2 to 
 8 grams, of salicylate of soda per day), antifebrin or antipyrin. 
 In very obstinate cases of rheumatic shoulder lameness in the 
 horse one may also employ subcutaneous injections of veratrin 
 (0.05 grams veratrin in 5.0 grams spiritus). Very painful 
 omodynia in the horse, and lumbago in the dog, are often 
 rapidly improved by subcutaneous injections of morphine 
 (0.02-0.05 grams). The combined application of atropin and 
 morphine in shoulder lameness of the horse, on the other hand, 
 is not safe (fatal colic). 
 
 Parenchymatous Myositis. — As a result of excessive 
 muscular exertion, and pronounced exhaustion of the muscu- 
 lature of the body, especially from overheating as a result 
 of riding for a long distance, running on the 
 track ("race-track disease"), after standing for a longtime 
 in the cars ("shipping-disease" of cattle), after tying 
 horses high in the stall for a long time, after driving cattle 
 long distances, after casting, as well as a result of severe at- 
 tacks of hemoglobinemia (azoturia) , there develops in 
 horses, occasionally also in cattle, an acute, parenchy- 
 matous degeneration of muscles, with symptoms 
 of parenchymatous myositis. The following groups of muscles 
 
INFLAMMATION OF MUSCLES 289 
 
 are most often affected : the dorsal and gluteal muscles, those 
 of the psoas group, the quadriceps and the anconeus. On ex- 
 ternal examination of these muscles, especially the longissimus 
 dorsi and the glutei, one finds in the early stages, a hard 
 swelling and severe pain on palpation, the back is 
 carried stiffly; occasionally one also observes symptoms 
 of colic, hemoglobinuria, and high fever. 
 According to the degree of extension and localization of the 
 muscular degeneration one further observes, either a general 
 or sacral paralysis (sacral weakness), or a paralysis 
 confined to the extensors of the knee and elbow 
 (falsely so-called crural and radial paralysis) ; it may be uni- 
 lateral or bilateral. The macroscopic anatomical changes 
 are as follows : pale, light-grey color of the muscle, occasion- 
 ally it is colored like the flesh of fish, is abnormally friable, 
 and has a cooked appearance. Intramuscular hemorrhage and 
 rupture are sometimes observed. Microscopically, in addition 
 to the symptoms of secondary inflammation, various forms of 
 muscular degeneration are seen: cloudy swelling (al- 
 bumeuoidj, fatty, hyaline or amyloid degenera- 
 tion. The termination is variable. At times the 
 animal dies suddenly as a result of general paralysis. In 
 other cases degenerative atrophy of the involved 
 muscles may occur, it is partly chronic, partly acute and is 
 characterized by symptoms of paralysis and weakness. 
 Treatment consists in the use of slings, massage, and elec- 
 tricity, as well as subcutaneous injections of caffein and 
 camphor. 
 
 Since the year 1S96 when I first referred to the parenchyma- 
 tous form of myositis, which results from overheating, and 
 casting of horses, and called attention to the relation between 
 this and hemoglobinuria, many similar cases have been observed 
 in horses and cattle. A horse that was thrown for neurectomy 
 became very nneasy, on the following day there developed symptoms of 
 hemoglobinemia. The post mortem revealed parenchymatous poly- 
 myositis (Preuss. Stat. Militar-Veterinarbericht pro 1900). A horse 
 showed all the symptoms of hemoglobinuria after an operation that 
 lasted an hour and a quarter, during the operation the animal struggled 
 violently (Dages). A horse that was operated showed symptoms of 
 paralysis three days after being cast, hemoglobinuria became evident 
 
290 INFLAMMATION OF MUSCLES 
 
 on the fourth ; post mortem revealed myositis of the muscles of the limbs. 
 A two-and-oiie-half year old colt was led 90 kilometers [55 miles], after 
 which it stood a half day in the market. It showed general muscular 
 paralysis, acute degenerative bilateral muscular atrophy in the gluteal 
 and femoral regions, as well as hemoglobinuria ; it was two months be- 
 fore the animal was able to stand (Warn eke). Hemoglobinemia 
 occurred iu a cow as a result of overexertion during transportation ; 
 post mortem revealed paleness of the musculature and rupture of the 
 right extensor of the patella (Riiegg). Villagio considers "shipping 
 disease" in cattle as a primar)' parenchymatous myositis due to over- 
 exertion. 
 
 Suppurative Myositis. — This occurs in infected muscle- 
 wounds, either in the form of a phlegmonous myositis, 
 or muscular abscess; it leads to suppurative liquefac- 
 tion and necrosis of the muscle and its fascia, to fistula forma- 
 tion, burrowing of pus, septicemia, and pyemia. In other 
 cases interstitial myositis leads to encapsula- 
 tion of the suppurative foci. The latter form is 
 especially observed in the so-called shoulder abscess of 
 the horse. It is partly due to infection with streptococcus 
 and staphylococcus pyogenes albus, partly to that of the botryo- 
 myces organism ; it results in a circumscribed suppurative 
 myositis of the mastoideo humeralis, the infection gain- 
 ing entrance through superficial contused wounds in the skin 
 assisted by the lymphatic system. In one case observed by 
 J o h n e the tubercle-bacillus was the cause of a shoulder 
 abscess in the horse. Multiple abscess formation of the 
 muscle (myositis apostematosa multiplex) ma}- have a meta- 
 static origin as a result of the activity of pus-forming bacteria, 
 or it may be caused by the streptococcus of strangles, it is 
 observed during the course of pyemia and strangles. Treat- 
 ment of suppurative myositis consists in free incision, or 
 extirpation of the encapsuled abscess in shoulder tumors. The 
 treatment of shoulder abscesses by means of parenchymatous 
 injections of concentrated salt solution cannot be recommended 
 (Schmidt); according to Schilling ahorse treated by 
 this method died in four days as a result of gangrene and 
 sepsis ; E s s e r has employed it two different times with 
 unsatisfactory results. 
 
 Interstitial Myositis. — Interstitial fibrous myo- 
 
INFLAMMATION OF MUSCLES 29I 
 
 sitis (schlerosis of muscles) is a chronic inflammation of muscles 
 characterized by a new formation of connective tissue, it leads 
 to induration and contracture of the muscles, and may be 
 caused by various inflammatory stimuli. It is 
 ■observed during the course of chronic muscular rheumatism • 
 after traumatic, suppurative, actinomycotic (wooden-tongue), 
 tubercular, and botryomycotic myosites ; in muscular paralj^sis, 
 and muscular atrophy. In some cases the inflammatory irri- 
 tant is not recognized. In most cases, however, it originates 
 from the activity of bacteria or parasites. Many cases of 
 so-called rigidity of the os uteri in cattle may be designated as 
 chronic interstitial myositis of the cervix uteri. Pal at has 
 described a peculiar case of multiple interstitial 
 myositis in the horse. In an omnibus horse there occurred, 
 without visible cause (encysted muscle parasites?), hard swel- 
 lings on the throat, shoulder, thorax, and hips, as well as on 
 the buttocks ; this was soon followed by a slowly developing 
 general muscular weakness so that it was necessary to destroy 
 the animal. On post mortem examination he found con- 
 nective-tissue new-formations between the muscle-fibers of the 
 groups named ; nodules were scattered through these areas ; 
 in character they were fatty, calcified, and cartilaginous. 
 Fibrous myositis is incurable unless actinomycotic in character 
 (incision and iodin for wooden-tongue). 
 
 Ossifying Myositis. — Osseous formation during 
 the course of inflammation of muscle has been frequently ob- 
 served in horses, dogs and swine (Kitt, Cadiot, Con- 
 stant, Stephenson, and others) . The causes are extremely 
 variable. Part of the cases are due to multiple 
 exostosis formation at the seats of muscular 
 attachments, ossification of the muscles is a 
 secondary process. An interesting case of multiple 
 hyperostosis formation in the horse has been described by 
 Constant; it was identical with a form which is occasionally 
 seen in young people, where it is termed myositis ossifi- 
 cans multiplex progressiva. Because of chronic 
 incurable lameness the patient was destroyed. On post mortem 
 it presented the following characteristics : the attachment of 
 
292 INFLAMMATION OF MUSCLES 
 
 the middle gluteal muscle was ossified, in the belly of the 
 muscle there was located an osseous tumor the size of one's 
 fist, adhesions had taken place between the muscle and the 
 pelvis ; the pectineus and adductor lougus muscles were also 
 adherent to the pelvis and ossified. The internal obturator 
 muscle formed a bony tumor (osteoma) on the inner margin 
 of the obturator foramen ; finally, the ossified muscular attach- 
 ments projected from the trocanteric fossa in the form of bony 
 stalactites. — In other cases the ossifying myositis assumes the 
 form of a tumor-like process (osteoma; or it may_ origi- 
 nate from callus formation as a result of fractures. In man 
 ossifying inQammation of the muscles is occasionally observed 
 after continued traumatic influences (exercise of the biceps, 
 rider's bone in the gracillis). Similar changes have been 
 found in the biceps brachii of the horse as a result of bursitis 
 intertubercularis. 
 
 Myositis Sarcosporidica. — Innainmatioti of muscles due to the 
 wandering of ea rcos po r id ia ( pso r o sp e r m ia , M i e b c h e r ' s 
 tubules, gregarinae) ia especially lobserved in swine, cattle, 
 sheep, and horses (onmivora and herbivora). These are sicle-shaped 
 spores arranged in capsules, when the capsule ruptures they are trans- 
 formed into wandering cells which penetrate the adjacent musculature 
 in the form of an inflammatory infiltration. In the shoulder and dorsal 
 muscles of the horse they occasionally lead to the formation of sarco- 
 sporidia-swellings as large as one's fist, hard, and white or grey 
 in color. In sheej) they lead to the formation of encapsuled sarcospo- 
 ridia-cysts in the musculature of the esophagus, they reach the siz.e of a 
 pea. As a rule, however, the non-ruptured capsule is harmless, and it 
 is a frequent condition. It is most often found in the muscles in 
 the vicinity of the oral and pharyngeal cavities, as well as those of 
 the esophagus, in the tongue, in the masseter, buccinator, laryn- 
 geal, and pharyngeal muscles. Occasionally their presence in muscle 
 leads to interstitial myositis with atrophy and cellular infiltration of the 
 connective tissue of the adjacent muscular fibers. In other cases the 
 flesh of cattle is clear and has an appearance of the flesh of calves, this 
 is due to the presence of large numbers of sarcosporidia. In old 
 horses, as well as buffaloes, sarcosporidia appear to 
 be constantly present, in swine, also, they were found in a 
 fourth of those examined by Perroncito. Among a hundred cases 
 of cachectic sheep examined by Moule, sarcosporidia were found 
 in ninety-nine. Miescher's tubules are very common in the mus- 
 cles of herbivorous domestic animals, they seldom cause disease in the 
 
RUPTURE OF MUSCLES 293 
 
 host ; only in very rare cases have symptoms been observed which 
 were due to inflammatory changes in the muscle as a result of the pres- 
 ence of large numbers of sarcos])oridia. Hoflich has described an in- 
 teresting case of glossitis chronica sarcosporidica in a horse ; it was char- 
 acterized by pronounced thickening of the tongue, deranged prehension 
 of food, as well as emaciation. D a m ma n n and v. Niederhausen 
 observed dysi)nea in a sheep and a goat as a result of inflammation 
 of the pharyngeal and laryngeal muscles. Brouwier and T o k a- 
 renko observed difficulty in walking and standing, even complete 
 muscular paralysis in steers. Vi rchow saw paralysis of the posterior 
 extremities in swine. In two swine Brschosniowski observed 
 loss of appetite, continued recumbent position, pain on pressure in the 
 muscle, arched back, irregular movements of the hind parts, hoarse 
 voice and fever (suspected trichinosis) ; after slaughter the musculature 
 was found to be watery, cloudy, and permeated with numerous sarco- 
 sporidia. For further information concerning the literature and devel- 
 opment of sarcosporidia compare with symptoms of myositis trichinosa. 
 (Cf : Friedberger and Frohner, Special Pathology of the 
 Domestic Animals. 1904, 6 Ed., Vol. I. ). 
 
 2. RUPTURE OF MU.SCLES. 
 
 Causes. — Muscle- rupture occurs most often in horses and 
 cattle, partly as a result of contusion and rupture from with- 
 out, partly from overstraining and excessive muscular con- 
 traction. As in tendon-rupture, in addition to ordinary trau- 
 matic causes, so-called spontaneous ruptures may occur as a 
 result of diseased changes in the muscle. In general muscle- 
 ruptures are not cotnmon ; in the years 1888- 1896 about 1800 
 cases, 200 a year, were treated in the Pru.ssian Army for 
 contusion and rupture of muscles. As a rule the ruptures 
 involved the flexor metatarsi (20 ca.ses per year). In the 
 years 1886-1895 I found only twenty cases of muscle-rupture 
 among 70,000 diseased dogs. 
 
 Occurrence. — Muscle-ruptures are most frequently ob- 
 served in the following places : abdominal muscles 
 (blows and overstretching during the course of pregnancy in 
 cattle, less frequently from casting hor.ses); muscles of 
 the posterior limbs (overstretching from slipping, strug- 
 gling when fettered, abnormal contraction when kicking); as 
 well as in the cervical, shoulder, and thoracic muscles 
 
294 RUPTURE OF MUSCLES 
 
 (caused in the horse from running against wagon poles). The 
 individual muscles most frequently involved are the tibialis 
 anticus; rectus, obliquus, and transversalis 
 abdominis; the quadriceps femoris; the glutei 
 and gastrochnemii; the biceps femoris and 
 b r a c h i i ; the mastoideo humeralis, and pectoralis. 
 Symptoms. — According to the physiological activity ot 
 the ruptured muscles one observes various derangements in 
 function in the vicinity of the muscular apparatus, namely, 
 lameness, symptoms of paralysis, and prolapse. 
 At the seat of rupture one can frequently recognize a space 
 or cavity on the edges of which one may palpate the 
 ruptured and afterwards swollen muscle ; occasionally there 
 exists a fluctuating swelling at the seat of rupture due to the 
 formation of a hematoma following rupture of blood- 
 vessels. The most important muscle-ruptures present the 
 following symptoms : 
 
 a) Rupture of the tibia lis anticus muscle results 
 in abnormal extension of the tarsal-joint with severe hanging- 
 leg-lameness, dangling movements of the limb, and relaxation 
 (folds) of the achilles tendon. On account of the muscles 
 being covered with the fascia of the limb and the extensor 
 pedis, there is not usually visible, either depression, hematoma 
 formation, or swelling. The prognosis is not unfavorable ; 
 healing occurs in from one to two months. 
 
 b) Rupture of the gastrochnemius produces the 
 following symptoms : relaxation of the achilles tendon, and ina- 
 bility to support weight at the knee or tarsal joints, such 
 attempts being followed by excessive flexion. A space is usually 
 present in the course of the gastrochnemius muscle. The 
 prognosis is very unfavorable ; healing in horses and cattle is 
 rare. 
 
 c) Rupture of the quadriceps femoris is followed 
 by symptoms of paralysis of the quadriceps, namely, inability 
 to support weight at the stifle (sudden flexion). 
 
 d) Rupture of the abdominal muscles is occa- 
 sionally followed by an abdominal rupture (hernia abdomi- 
 nalis), this is especially true of cattle. 
 
ATROPHY OF MUSCLES 295 
 
 e) Rupture of the mastoideo-humeralis results in the 
 following symptoms : hanging-leg-lameness of the involved 
 anterior limb, hematoma formation, occasionally abscess for- 
 mation at the seat of rupture. 
 
 Treatment. — Reposition of the ruptured muscle ends 
 by means of the muscle suture is not practical in large domes- 
 tic animals. Treatment consists in providing rest (slings, 
 high tieing), in certain cases massage may be employed. 
 Healing of the ruptured area occurs through the formation of 
 a cicatrix as the result of an aseptic interstitial myositis ; oc- 
 casionally cicatrization leads to contracture of the muscles and 
 permanent shortening (torticollis after rupture of the mastoi- 
 deo-humeralis). 
 
 Luxation of Muscles.— This name signifies a change in position 
 (dislocation) of certain muscles. The biceps femoris in cattle is occa- 
 sionally involved as a result of slipping ; the upper insertion of this 
 muscle becomes detached from the trocanter and is displaced back- 
 wards ; it results in sudden lameness with extension of the entire limb 
 and inability to flex the joints. Treatment is operative (myotomy). It 
 is stated that luxation of the biceps femoris an(f brachii is occasionally 
 observed in the horse (Feger, Dominik). 
 
 3. ATROPHY OF MUSCLES. 
 
 Causes and Forms. — Muscular atrophy is a symptom 
 of various pathological conditions. The following forms are 
 recognized : 
 
 a) Simple muscular atrophy consists in diminution 
 in the size and number of muscle-fibers without degenerative 
 changes. It is observed in the form of so-called atrophy 
 of inactivity, it is a constant symptom of 
 chronic lameness, it is most often found in connection 
 with spavins and ringbones in the horse, and during the 
 healing of bone fractures. The forensic importance of mus- 
 cular atrophy for the determination of the duration of 
 lameness is usually overestimated. Regardless of the fact 
 that very often the relation between a lameness and an existing 
 muscular atrophy is not sufficiently demonstrated, experi- 
 ence has proved that a visible atrophy of the 
 muscles of the gluteal or shoulder regions 
 
296 ATROPHY OF MUSCLES 
 
 ma}' develop much more rapidl}' than is gen- 
 erally supposed. Atrophy develops more rapidly when 
 the animal is in good condition and very lame. The princi- 
 ples maintained by G e r 1 a c h in his standard veterinary 
 medicine (1872) are still in force. According to his work the 
 parenchjanatous fluids of the soft tissues ma}' become visibly 
 diminished in a very few days. In very painful cases of 
 lameness the fatty tissue is visibly diminished after eight 
 days; in very fat animals this may result in extensive atrophy 
 of the limbs within two to three weeks. In mus- 
 cular animals the flesh and cellular tissues 
 have undergone visible atrophy in three 
 weeks. Tendon becomes atrophic after a few months ; the 
 bones and hoof become visibly smaller after three to six 
 months. 
 
 b) Degenerative muscular atrophy consists in 
 cloudy swelling, fatty, wax-like or hyaline, and amyloid de- 
 generations, as well as disintegration of the muscle-fibers. It 
 develops after inflammation and paralysis of muscles. It is 
 most often observed in the horse as a result of parenchymatous 
 myositis of the longissimus dorsi, the gluteal, the quadriceps, 
 and anconeus muscles in azoturia ; it may also occur after 
 overheating and casting. In this manner a very rapid form of 
 atrophy may occur, so that high-grade muscular atrophy 
 may be visible on the back and hips in a few days (even 
 entirely unilateral). It is also observed after paraly- 
 sis of the suprascapular nerve (atrophy of the 
 spinati muscles), the radial nerve (atrophy of the anco- 
 neus), the trigem minus (atrophy of the masseters), as 
 well as the recurrent (atrophy of the left laryngeal mus- 
 cles ; roaring). It is also seen in muscular rheuma- 
 tism, in diseases of the dorsal marrow, as well 
 as in chronic lead poisoning (atrophy of the laryngeal 
 muscles; roaring). 
 
 c) Ivipomatous atrophy or pseudo-atrophy (lipo- 
 masia) of the muscles consists of an interstitial fat-cell pro- 
 liferation with displacement of the muscle-fibers. 
 
 Treatment. — Degenerative atrophy is usually an incur- 
 
NECROSIS OF FASCIA 297 
 
 able condition. From a prophylactic standpoint, to prevent 
 development, one may employ exercise, massage, vola- 
 tile applications, and electricity, as well as inter- 
 nal stimuli (strychnine, veratrin, caffein). 
 
 Hypertrophy of Muscle. — This term signifies a condition 
 opposite to that of muscular atrophy, it is usually the result of increased 
 activity (training). When horses are checked high there also develops 
 a hypertrophy of the steruo-maxillaris, and sterno- thyro-hyoideus 
 muscles as these are especially involved ; occasionally they present 
 symptoms of myositis. Sometimes one finds unilateral hj'pertrophy of 
 the mastoideo-humeralis in normal horses. 
 
 II. DISEASES OF FASCLE. 
 
 I. NECROSIS OF FASCI.^. 
 
 Causes. — Necrosis of the fascia is of special importance in 
 the horse ; either its presence is unrecognized or its importance 
 is underestimated. It results, either from a suppurative 
 muscle-vv^ound or from intermuscular and subfascial 
 phlegmons. In both cases the fascia easily becomes 
 necrosed because of its non- vascularity. On account of the 
 firm structure of fascia, and because of the deep position and 
 horizontal extension of many fasciae, spontaneous sloughing 
 and removal of the necrotic part is either very difficult or impos- 
 sible. Necrotic portions of the fascia? lead to chronic suppura- 
 tive processes and fistula formation which can only be removed 
 by operative means, that is, the necrosed tissue must be cut 
 out. 
 
 Symptoms. — That class of pus fistulae described in veteri- 
 nary surgery under the names fistulous withers, 
 shoulder fistula, fistula of the buttocks, 
 fistula of the fetlock, and coronary fistula 
 are often maintained in the following manner : as a result ot 
 suppurative and phlegmonous processes, necrosis of the fascia 
 is caused in the depths of the dorsal, shoulder, and gluteal 
 muscles, as well as in the fascia of the foot ; this necrosis 
 maintains a chronic suppurative condition. The necrosis is 
 usually circumscribed ; it may, however, become very exten- 
 
298 RUPTURE OF FASCI.^ 
 
 sive, for example, a diffuse subfascial phlegmon along the 
 course of the longissimus dorsi may cause septicemia and ter- 
 minate fatally. I have observed one example of this in a case 
 of fistulous withers in the horse. 
 
 Treatment. — When necrosis of the fascia is supposed to 
 form the foundation of a fistula, one should not hesitate to 
 expose the dead pieces of fascia by means of extensive, 
 deep, long, and broad incisions, through which all 
 the necrotic portions are removed by means of the 
 scalpel or scissors. In this manner fistulae of the 
 withers, shoulder, and gluteal regions that 
 have been in existence for months may be 
 healed in a few w e e k .s. One had better remove too 
 much than too little from the diseased muscle and fascia, 
 otherwise it will be necessary to repeat the operation. First 
 make long, deep incisions, through which, 
 under certain circumstances, pieces of flesh 
 as large as a pound may be removed, excise 
 the fascia regardless of its extent; by follow- 
 ing this method of treatment I have been able 
 to cure many cases of fistula in the horse. The 
 after-treatment consists in preventing stagnation of the wound 
 secretions in the depths of the fascia and muscles. This may 
 be accomplished, either by means of open-wound treatment or 
 drainage ; when practical it is best to employ permanent anti- 
 septic irrigation of the operation wound for several days. 
 
 2. RUPTURE OF FASCI.E. 
 
 Results. — When the superficial fascia, not the muscle 
 itself, becomes ruptured subcutaneously by means of blows or 
 kicks, the soft muscular structure sometimes projects through 
 the rent in the fascia. The involved area presents a visible, 
 circumscribed swelling. So-called muscle-hernia is 
 caused, especially in the horse, by kicks or pole-thrusts 
 and occurs on the muscles of the limbs or neck. In the 
 horse I have several times observed hernias of the semimem- 
 branosus, of the mastoideo-humeralis, and of the anconeus. On 
 palpating such a hernia one feels the sharp firm margin of 
 
PARALYSIS OF NERVES 299 
 
 the fascia, and a soft area in the center. It is best to allow 
 hernia of the muscle to recover without treatment ; when the 
 condition is aseptic and lameness is absent, incision of the 
 skin with subsequent suturing of the torn fasciae is superfluous. 
 
 Stringhalt. — The term stringhalt signifies a peculiar derangement 
 in the movements (ataxia) of the horse which is characterized by a 
 sudden, jerking, involuntary, excessive flexion of all the joints of the 
 hind limb. The causes have not been satisfactorily explained. An 
 idiopathic form of stringhalt is recognized ; by some it is considered 
 a contraction of the tibial fascia, a retraction of the tensor 
 fascia lata, or the tendon of the peroneus ; by others, a shortening of 
 the transverse ligaments of the patella ; while some refer it to a nervous 
 affection (disease of the spinal cord, peripheral neuritis, reflex neuro- 
 sis). The treatment, therefore, is extremely divergent (incision of the 
 fasciae, articular ligaments, tendons, nerves). Symptomatic string- 
 halt forms one of the symptoms of spavin, ringbone and scratches, as 
 well as various affections of the tarsal and pedal-joints (treads on the 
 coronet, nail-pricks, clefts in the horn J ; they produce reflex symptoms 
 which may be compared with the twitching movements observed in 
 people suffering from gout. 
 
 III. DISEASES OF NERVES. 
 
 I. PARALYSIS OF NERVES. PARESIS AND PARALYSIS. 
 
 Forms. Various forms of paralysis of the nerves are 
 recognized according to the grade, origin and extent. First, 
 one recognizes two grades of paralysis, namely, simple 
 weakness, paresis or incomplete paralysis ; and com- 
 plete paralysis. According to the origin the different 
 forms of paralysis are classified as cerebral, spinal, 
 and peripheral, with reference to the seat of the disease 
 in the brain, spinal column, or peripheral nerves. One also 
 differentiates motor and sensory, neurogenic and 
 myogenic paralysis. Finally, with reference to the extent 
 of the paralysis, it is termed monoplegia when only one 
 limb or group of muscles is involved, when one entire side of 
 the animal is affected it is termed hemiplegia ; when bilat- 
 eral, it is termed paraplegia. The division into atonic, 
 spastic, organic, and functional paralysis is of slight import- 
 ance in veterinary science. 
 
300 PARALYSIS OF NERVES 
 
 Causes. — The causes of paralysis of nerves are extremely 
 variable. Cerebral and spinal paralysis may be due to the 
 following causes : disease of the brain or spinal marrow, trau- 
 mata, infectious diseases, and poisons ; peripheral paralysis 
 results from rupture, laceration, compression and inflammation 
 of the peripheral nerves. 
 
 Differential Diagnosis. — It is easy to differentiate 
 between cerebral, spinal, and peripheral paralysis. Paralysis 
 due to an affection of the brain is usually characterized by 
 monoplegia and hemiplegia. Frequently one of the cranial 
 nerves is involved, and it is often accompanied by derangement 
 of the consciousness. There are several symptoms by which 
 spinal paralysis may be differentiated from cerebral. Ordi- 
 narily it results in paraplegia, while the cerebral produces 
 mono- or hemiplegia. This may be explained by the small 
 size of the spinal marrow in comparison with that of the brain ; 
 the pathological process usually affects the entire transverse 
 diameter of the organ. For this reason the paralysis is both 
 motor and sensory (anterior and posterior horns) . This results 
 in paralysis of all the muscles situated posterior to the diseased 
 area in the spinal cord. Psychic derangements are usually 
 absent in spinal paralysis, the cranial nerves usually remain 
 unaffected, in cerebral paralysis they are usually involved. 
 Simultaneous paralysis of the bladder and rectum indicates a 
 spinal affection. Spinal paralysis usually extends forward 
 from the primary seat, ascending. Finally, trophic derange- 
 ments in the paralyzed structures (muscular atrophy) are 
 especially characteristic of spinal paralysis. Peripheral 
 paralysis involves only individual muscles or groups of mus- 
 cles without cerebral or spinal complications. Occasionally it 
 is very difficult to differentiate between neurogenic and 
 myogenic paralysis. That form of parenchymatous myositis 
 of the anconeus and quadriceps group, which is especially fre- 
 quent in the horse, may possibly be falsely termed radial and 
 crural paralysis. 
 
 Symptoms of Peripheral Paralysis. — While cerebral 
 and spinal forms of paralysis produce symptoms of motor and 
 sensory depression of the brain and spinal marrow, disease of 
 
PARALYSIS OF NERVES 30I 
 
 the peripheral nerves results in symptoms which vary ac- 
 cording to the function of the nerve involved. In veterinary 
 medicine ,the most important forms of peripheral paralysis 
 result in the following symptoms : 
 
 a) Facial paralysis results in a unilateral par- 
 alysis of the muscles of the face. The upper lip 
 and the point of the nose are drawn in the 
 direction of the normal side, the under lip is dis- 
 torted in a similar manner or hangs downward. Food ac- 
 cumulates between the cheeks and the teeth. The n a s a 1 
 openings are constricted (peripheral paralysis). The ani- 
 mal is unable to close the e y e on the affected side, tears flow, 
 the upper eyelid also hangs downward (ptosis). The ear 
 may also be paralyzed (central paralysis). 
 
 b) Trigeminal paralj^sis, caused by paralysis of the 
 motor branches of the trigeminus, results in a paralysis of 
 the muscles of mastication. It causes difficult pre- 
 hension of food, salivation, dropping of the in- 
 ferior maxilla, and atrophy of the muscles 
 of mastication. 
 
 c) Paralysis of the supra scapularis is char- 
 acterized by a peculiar form of shoulder lameness in 
 which the shoulder springs outwards when weight is 
 placed on the foot of the involved side ; a space variable in 
 size is present between the thorax and the elbow. There after- 
 wards develops a pronounced atrophy of the spinati 
 muscles and the rotaters of the shoulder. 
 
 d) Paralysis of the radial nerve, which 
 innervates the exten.sor muscles of the forearm and limb, 
 especially the extensors of the elbow (anconeus), is only in 
 part a general paralysis of the nerves. In other cases it is 
 a myogenic paralysis of the anconeus (hemaglobinemia, 
 myositis after casting). It is characterized by in- 
 ability of the involved limb to support the 
 body weight. All of the joints of the foot are flexed, 
 they cannot be extended to support the weight of the body. 
 By pressing backwards on the carpus, the limb may be main- 
 tained in a position to support weight. The paralyzed muscles 
 feel relaxed, finally they undergo atrophy. 
 
302 INFLAMMATION OF NERVES 
 
 e) So-called paralysis of the crural nerve is 
 usually not due to paralysis of the nerve, but to that ot the ex- 
 tensors of the knee (quadriceps femoris) ; it may follow azoturia 
 or casting. It results, when supporting weight, in an abnor- 
 mal flexion of the knee-joint; as a result of par- 
 alysis of the extensor muscles extension of the knee- 
 joint is impossible. Chronic paralysis is followed by 
 high-grade atrophy of the muscles of the 
 knee. 
 
 f) Obturator paralysis results from pelvic frac- 
 tures in the vicinit}'- of the obturator foramen (inflammation 
 and compression of the nerve through callus masses). It is 
 characterized by abduction of the involved limb as result 
 of paralj^sis and atrophy of the adductors. 
 
 Treatment. — Therapy of nerve paralysis consists in the 
 application of massage, cutaneous irritants, elec- 
 tricity, methodical movements, as well as the sub- 
 cutaneous injections of strychnine and veratrin. 
 Among the peripheral forms of nerve-paralysis the following 
 have a relatively good prognosis : the facial and the radial, 
 paralysis of the suprascapularis and quadriceps is frequently 
 incurable. 
 
 2. INFLAMMATION OF NERVES. NEURITIS. 
 
 Causes. — Inflammation of nerves is of slight importance 
 in veterinary surgery, it is very rare on the one hand, and on 
 the other it is very difficult to recognize subjective symptoms 
 on the part of the animal. The causes, as in man, are of a 
 traumatic, infectious, rheumatic, and toxic 
 nature. Traumatic neuritis occasionally develops at the central 
 nerve-stump after resection of a nerve, this occurs as a result 
 of inflammatory processes in the immediate vicinity which 
 extend to the nerve. Inflammation of the planter nerves has 
 also been observed in the horse after interfering. T h o m- 
 m as sen has described a neuritis of the sacral plexus 
 apparently due to ruptureofthe nerves from jump- 
 ing. Hemiplegia laryngis (roaring in horses) is of special 
 importance with reference to its relation to contagious 
 
INFLAMMATION OF NERVES 303 
 
 pleuropneumonia. It occurs as a sequella of this dis- 
 ease, and by many is considered a neuritis of the recurrent 
 nerve which lies in the left pleural sac and is caused by an 
 extension of the inflammatory process from the pleura to the 
 nerve at the point where it passes around the posterior aorta ; 
 this leads to unilateral paralysis of the laryngeal muscles. 
 Also, paralysis of the laryngeal muscles which occurs in horses 
 during the course of chronic lead poisoning is con- 
 sidered by Thomassen as merel}' the result of a primary 
 chronic neuritis of the recurrent characterized bj'^ connective- 
 tissue new-formation and degeneration of the nerve. Accord- 
 ing to recent investigations of von Alarek, dourine in 
 the horse is not an affection of the spinal marrow, but an 
 infectious polyneuritis. He found round-celled infiltration 
 and connective-tissue new-formation, especially in the ischi- 
 adicus, tibialis, and crural nerves, to some extent, also, in the 
 median, infraorbital, tarsal, and intercostal nerves ; according 
 to him the symptoms of paralysis in dourine are of a peripheral 
 nature. An infectious, multiple, peripheral 
 neuritis occurs in animals and men in Dutch-India as a 
 result of eating clodded rice, it is known as beri-beri- 
 disease. According to some stringhalt in the horse is due 
 to a neuritis of the ischiadicus (?). In the domestic animals 
 one often observes inflammatory processes in the optic nerves 
 and the retina : neuritis retrobulbaris, papillitis, and retinitis. 
 Anatomical Changes. — As in inflammation of other 
 organs, the following forms of neuritis are also recognized : 
 suppurative and interstitial; the first is an acute, 
 the second a chronic form of neuritis. Macroscopically, 
 acute neuritis is characterized b}- redness, swelling, and a 
 serous or suppurative exudate between the fibrous bundles. 
 Microscopically one finds dilitation of the blood-vessels, small- 
 celled infiltration, nuclear proliferation of the sheath of 
 Schwan, as well as degeneration of the marrow, and axis- 
 cylinders. In chronic neuritis one finds connective-tissue 
 new-formations (induration, schlerosis) with a subsequent de- 
 generation and atroph}^ of the nerve-fibers. In the case of 
 neuritis interstitialis proliferans of the sacral plexus described 
 
304 INFLAMMATION OF NERVES 
 
 by Thomassen the plexus was four times as thick as normal 
 and presented high grade connective-tissue proliferation with 
 secondary atrophy of the nerve fibers. 
 
 Symptoms. — Neuritis of the sensory nerves is charac- 
 terized by severe pain in the involved area, and paralysis 
 and atrophy of the groups of muscles supplied by 
 the affected nerves. Interstitial neuritis of the sacral plexus 
 results in unilateral, severe muscular atrophy of one side of 
 the hip, and one limb (glutei, biceps femoris, semi-tendi- 
 nosus). In general, the clinical symptoms are very slight, 
 regardless of enormous pathological changes. Zietsch- 
 m a n n observed two cases of chronic interstitial neuritis of the 
 axillary plexus with neuroma formation in cattle, it resulted in 
 pronounced connective-tissue proliferation, no genuine paraly- 
 sis, but only slight muscular weakness of the affected limb. 
 Treatment consists in the application of nervines (morphia, 
 cocaine, str^'chnine, veratrin), as well as counter-irritants to 
 the skin, massage, and electricity. As a last resort for neuritis, 
 sensory nerves may be severed (neurotomy), or a section may 
 be cut out (neurectomy), or extracted (neurexairesis). 
 
 Neurotomy. — For certain incurable, painful forms of lameness in 
 the horse (lameness from ringbone, chronic navicular disease, con- 
 tracted hoof, chronic tendinitis, etc. ) severing the nerve is a valuable 
 palliative remedy. Animals that are otherwise useless are restored to 
 a certain amount of utility. For indications of this operation see 
 Bayer's article in Volume I. of this hand-book. The changes 
 that occur in a nerve that has been severed consist in 
 fatty and granular degeneration of the entire periphery from the severed 
 end of the cut section to its finest branches (descending degeneration). 
 At the same time, however, there begins a collateral anastomosis for- 
 mation with regeneration of the nerve-tissue from the central end, new 
 nerve-fibers sprout from this stump, extend over the defect, and grow into 
 the peripheral channels so that the function of the peripheral nerves is 
 restored again after a certain length of time. In suppurative infection 
 of the operative wound, as well as in continued traction on the central 
 end of the severed nerve, there develops a chronic interstitial inflamma- 
 tion of the central stump with the formation of a neuroma (see page 
 
 I2l). 
 
DISEASES OF VESSELS 305 
 
 DISEASES OF VESSELS. 
 I. DISEASES OF ARTERIES. 
 
 I. INFLAMMATION OF ARTERIES. ARTERITIS. 
 
 Forms. — One recognizes, first, an endarteritis, mes- 
 arteritis, and periarteritis according to the location of 
 the disease in the inner, middle or outer coat of the arterial 
 wall. According to the causes and course, one further 
 recognizes an aseptic, and septic or suppurative, 
 a traumatic and hematogenic, an acute and 
 chronic, as well as a deforming, ossifying, and 
 obliterating arteritis ; the latter is characterized by clos- 
 ure of the vessels. The acute suppurative and chronic deform- 
 ing forms of arteritis are of special practical importance. 
 
 a) Acute suppurative arteritis is the result 
 of an infection of the arterial wall with staphylococci or strep- 
 tococci. It either originates in the adventitia (periarteritis 
 purulenta), or it ma)^ extend from the injured intima (suppura- 
 tive thrombo-arteritis), or it may result from an embolism in 
 the blood (pyemic metastasis). Suppuration of the intima 
 results in a loss of the endothelium (suppurative necrotic 
 endarteritis). 
 
 b) Chronic deforming arteritis or arterio- 
 schlerosis (atheroma or atherosis of the vessel) is a mul- 
 tiple, focus-like, ulcerative endarteritis with connective-tissue 
 thickening of the intima ; the latter becomes necrosed and 
 defective (so-called artheromatous ulcers); it is followed by 
 fatty degeneration and calcification of the media. It leads 
 to induration, stenosis, and obliteration, or dilitation and 
 rupture of the diseased vessel-walls. While it is very frequent 
 in man (symptom of old age, alcoholism, etc.), it is rarely a 
 surgical defect in animals (iliac arteries, femoral arteries, 
 axillary arteries). Endarteritis and dilitation of the anterior 
 mesenteric artery as a result of strongylus armatus is of far 
 greater importance for internal pathology. Cattle appear to be 
 more predisposed to arterioschlerosis (endaortitis ossificans). 
 
3o6 DILITATION OF ARTERIES 
 
 Atheroma of the aorta with a subsequent meningeal embolism is 
 occasionally observed in horses. 
 
 2. DILITATION OF ARTERIES. ANEURYSM. 
 
 Forms. — Aneurysms are divided into diffuse and cir- 
 cumscribed. The circumscribed forms are either c 3' 1 i n- 
 d r ical (aneurysma cylindriforme), or spindle-shaped 
 (A. fusiforme) or s a c - 1 i k e (A. sacciforme). A diffuse aneu- 
 rysm is also termed angioma arteriale racemosum 
 (aneurysma racemosum, anastomoticum, cirsoideum); it is a 
 variety of new-formation, namely, angioma arteri^ plexiformse 
 (angioma racemosum) . Aneurysma arteriovenosum 
 (varix aneurysmaticus, varix arterialis, arteriophlebectasia) 
 is a special form due to the union of an artery and a vein 
 (phlebotomy, castration of cattle). Aneurysma dessi- 
 c a n s results from rupture of the intima and media, the 
 adventia is raised by the pressure of blood (so-called false 
 aneurysm). In rare cases the walls of the aneurysm are 
 formed in the liver, intestines and other organs. 
 
 Causes. — In the horse the most frequent cause is the stron- 
 gylusarmatus, it is most active in the anterior mesenteric artery, 
 where it produces a chronic deforming endarteri- 
 tis. A similar cause results in dilitation and thrombosis of 
 the femoral and iliac arteries as well as the axillary arteries. 
 In other cases the aneurysm may have a traumatic origin 
 (punctured wound), it may result from emboli, or from 
 degenerative conditions of the vessel-w-alls when 
 such conditions are exposed to the influence of concussions 
 (blows, kicks) or strong muscular exertion (increased 
 blood-pressure.) 
 
 Occurrence. — When compared with man, surgical forms 
 of aneurysm are very rare in the domestic animals (infre- 
 quency of arterioschlerosis). In the horse they have been 
 most frequently observed in the following places : the aorta, 
 the femoral and internal iliac arteries, in the 
 carotid, the b racial, the femoral is, the popliteus, 
 ischi adieus, facial, palatine, nasal, and internal 
 
DILITATION OF ARTERIES 307 
 
 maxillary arteries. Aneurysma arteriovenosum has been 
 observed in cattle in the vessels of the spermatic cord (sperm- 
 atic artery and vein), following phlebotomj^ in the horse 
 (jugular and carotid), as well as after injuries in the vicinity 
 of the masseters (masseteric artery and vein). 
 
 Symptoms. —Those that have a superficial location are 
 characterized by a pulsating swelling, on compression 
 of the artery by which it is supplied it either diminishes in 
 size or entirely disappears. On palpation and ausculta- 
 tion of the tumor friction sounds may occasionally be 
 recognized in the form of a buzz or hiss on the inner wall of 
 the aneurysm. Pressure on the neighboring nerves occasion- 
 ally results in continued and severe pain. One also observes 
 erosion of neighboring organs, even atrophy of the dorsal 
 and cervical vertebrae or the sternum. Aneurysms frequently 
 lead to rupture and hemorrhage, or to sudden 
 death from thrombosis and emboli. Spontaneous 
 healing by means of obliteration and calcification is seldom 
 observed. The most important forms of aneurysms in veteri- 
 nary science are characterized by the following symptoms : 
 
 a) Aortal Aneurysm results in a dilitation of the sinus 
 of Valsalva at the origin of the aorta. In a horse they become 
 larger than a man's head. Aneurysms in the abdominal cavity 
 may become adherent to the neighboring organs (stomach, 
 colon, small intestine); they also involve these organs and 
 may lead to an erosion of the vertebral column. In most cases 
 they produce no visible symptoms of disease for 
 a long time or during the life of the animal ; other cases 
 suddenly terminate in death as a result of in- 
 ternal hemorrhage, previous marked symptoms being 
 absent. Death from internal hemorrhage often follows con- 
 cussion (casting, fallsj, or it may suddenly follow severe^ exer- 
 tions ; the animal quivers, is very dyspneic, tumbles down 
 and dies in a very short time. Peculiar paroxysmal 
 symptoms without immediate death as a direct result have 
 also been observed. Lustig observed the following symptoms 
 in a horse after severe exertion : weakness in the hind parts, 
 sudden falling, pronounced dyspnea, as well as epilepti- 
 
308 DILITATION OF ARTERIES 
 
 form cramps in which the head and neck were curved 
 backwards and the feet extended, the animal rose again after 
 ten or fifteen minutes. Symptoms of vertigo were constant 
 in another horse that was affected with aneurysms in the pul- 
 monary arteries. Barrier observed the following symptoms 
 in a dog affected with aneurysm of the posterior aorta : emaci- 
 ation regardless of a good appetite, pronounced debility, 
 severe dyspnea on slight movement, and finally paralysis of 
 the hind parts (symptoms of heart weakness). In a horse 
 with an aneurysm the size of a man's head in the thoracic 
 aorta, Schmidt found a buzzing tone over the 
 vertebral column that was synchronous with the action 
 of the heart ; the animal was unable to take food, and traveled 
 with a straddling and stiff" gait in the hind limbs. Rupture 
 of the aneurysm into the stomach (Vogel), and into the 
 rectum (Labat, Cadeac, Duchene) has occasionally 
 been observed. Met tarn saw roaring (paralysis of the re- 
 current) in a mare as a result of an aortal aneurysm the size of 
 one's head. 
 
 b) Dilitation and thrombosis of the femoral and 
 internal iliac arteries (seldom axillary) in the horse may be due 
 to the following causes : diseases of the inner layer of the artery 
 (endarteritis) with the collection of a fibrinous coagulum on 
 the surface and stenosis of the lumen, or embolic obliter- 
 ation of the aortic branches from thrombi dislocated from 
 the heart or from aneurysms. One most frequently finds 
 thrombi in both external iliac arteries, or in the femoral arteries, 
 and in both internal iliac arteries. They are less frequently 
 found in the axillary or brachial arteries, and rarely in the 
 lumbar arteries. The terminations of the aorta and the origin 
 of the arterial branches are usually dilated; the walls are 
 thickened and affected with atheromatous degener- 
 ation; the intima is fatty, cloudy, calcified, and covered 
 with ulcers. Within the vessel there is located a strati- 
 fied and organized firm thrombus, clear in color, the lumen 
 is more or less stenosed, often there remains only a narrow canal. 
 Frequently the thrombus extends forward towards the aorta or 
 backward into the arterial branches, it may be confined to the 
 
DILITATION OF ARTERIES 309 
 
 aortic bifurcation. Occasionally the external or internal iliac 
 arteries of one side are completely filled with the thrombus. 
 In addition to the thrombus there frequently develops a second- 
 ary compensatory hypertrophy of the heart. As a result of 
 softening of the thrombus, emboli may pass into the peripheral 
 arteries of the extremities. The described thrombi usually 
 present no symptoms of disease while the animal is at rest. 
 The very peculiar, characteristic symptoms of this disease are 
 first observed after light or severe exercise in the wagon, 
 under the saddle, or on the training ground. 
 
 In thrombosis of the femoral and internal iliac 
 arteries which usually occurs in horses, seldom in cattle, 
 one first observes a progressive weakness in one or both poste- 
 rior limbs. The animal presents a characteristic paralysis 
 which develops very suddenl5\ It usuall}^ involves one side, 
 the animal has astaggering gait, strikes the affected 
 hind foot against that of the opposite side, either brings the 
 weight to bear only on the toe or drags the limb, trembles, 
 falls down and lies jerking the limbs for a few 
 minutes, and then lies back exhausted. At the same time the 
 frequency of the respiration is very rapidly 
 increased, the heart beat is bounding and ac- 
 celerated, the visible mucous membranes are strongly injected, 
 perspiration breaks out over the entire body. The temperature 
 of the paralyzed extremit}^ is usually subnormal, pulsation is 
 frequently absent in the tibial and planter arteries. After a 
 few minutes the animal rises again, the symptoms of paralysis 
 gradually disappear, after which recovery is soon complete. 
 From a diagnostic standpoint, the fact that the disease can be 
 produced experimentally by forced exercise is of great import- 
 ance. On rectal examination of the thrombosed 
 area one finds the following condition : the aorta and its 
 arterial branches are dilated, thickened, unyielding, filled with 
 a long firm substance and non-pulsating on the affected side. 
 In rare cases thrombus formation results in the production of 
 emboli in the peripheral arteries and results in gangrene 
 of the limbs. 
 
 Thrombosis of the axillary arteries, a less frequent condi- 
 
3IO DILITATION OF ARTERIES 
 
 tion, is introduced by simple lameness of the involved 
 side. The animal begins to stumble when moving, makes 
 false steps, trips, drags the toes, is unable to raise the limbs, 
 quivers on the affected side, and finally falls down. Deranged 
 respiration, accceleration of the heart beat, and congestive 
 conditions are not usually observed. After a short time the 
 function is again restored. 
 
 c) Aneurysma arterio-venosum of the sper- 
 matic cord occasionally follows castration of bulls. Along 
 the course of the spermatic cord there develops a prominent, 
 soft, cyiinder-like swelling, following ligation, twisting, or tear- 
 ing of the cord. It is due to fusion between the sper- 
 matic artery and vein, so that the blood passes from 
 the former into the latter (Gurlt, Collin, Kitt). 
 
 d) Aneurysm of the anterior mesenteric artery is of 
 no surgical importance ; see text-books on special pathology. 
 
 Treatment. — The radical treatment of aneurysms that 
 are accessible consists in extirpation of the dilated vascu- 
 lar portion after carefully ligating the afferent and efferent 
 vessels. Under certain conditions, however, the opera- 
 tion is very dangerous as it frequently results in anemic 
 necrosis of organs located peripherad to the ligature. They 
 have in man, therefore, been treated as follows : methodical 
 compression; injection of irritants (liquor ferri chloridi, 
 extract of ergot, alcohol) ; acupuncture and f i 1 i p u n c - 
 ture (application of a copper suture, silver suture, iron 
 suture, suturing with a horsehair); as well as galvano- 
 puncture or electropuncture (galvano-caustic 
 punctures with needles). 
 
 Casuistic. — Steinmeyer has described an aneurysm of the right 
 carotid at the heighth of the sixth cervical vertebra ; it occurred in 
 an eighteen-year-old horse that died very suddenly. There was a swell- 
 ing on the ventral surface of the throat as large as a man's head, he 
 found it to be a spindle-shaped aneurysm four and one-half centimeters 
 in length with a transverse rupture three centimeters long, the intima at 
 this spot was rough and covered with thrombi. M o u q u e t has observed 
 a similar aneurysm of the left carotid in the pectoral region (compres- 
 sible tumor with friction sound). — An aneurysm of the facial artery 
 and its branches in a Simenthal cow has been observed by Vogel. It 
 extended from the region where the artery winds around the face to the 
 
RUPTURE OF LARGE ARTERIES 3II 
 
 end of the angular artery of the eye ; it was sinuous in its course and 
 presented sac-like dilitations, pulsations were well marked, on ausculta- 
 tion buzzing and hissing sounds were recognized. An aneurysm of the 
 posterior tibial artery in an ox has been described by F u rla- 
 n e 1 1 o : it formed an elastic, painless, pulsating, conical swelling on the 
 inner surface of the tibia, it was fifteen centimeters in length and par- 
 allel to the saphenic vein. Blaise observed an aneurysm of the 
 pharyngeal artery in a horse, fatal rupture occurred resulting in 
 symptoms of angina. Nouquet has observed an aneurysm of the 
 artery that runs parallel to the saphenic vein : it was the result of phle- 
 botomy and terminated in fatal hemorrhage. An aneurysm of the an- 
 terior tibial artery with calcification of the walls has been extir- 
 pated by Straube. Many cases of aneurysmaracemosumon 
 the under surfuce of the tail in cattle have been recognized by Sand. 
 
 3. RUPTURE OF LARGE ARTERIES. VASCULAR RUPTURE. 
 
 Causes. — Rupture of large arterial branches is due to a 
 direct injury, or it may have an indirect origin by means 
 of concussion, falls, excessive muscular exertion — difficult 
 pulls, during severe exertion while the animal is cast, in the 
 act of vomiting, etc. In the last named cases of so-called 
 spontaneous rupture, predisposition to rupture is occa- 
 sionally present in the form of pathological changes 
 in the arterial walls. The following are among the 
 pathological conditions that may occur : aneurysms, arterio- 
 schlerosis, adipose degeneration of the vessel- wall, as well as 
 erosion of the latter through new-formations. In many cases 
 of spontaneous rupture of the aorta in the horse no visible 
 microscopic changes are present in the vessel-wall. 
 
 Occurrence. — Rupture of the large vessels is most often 
 observed in the aorta and its branches as well as in the p u 1- 
 monary arteries. The symptoms of i n t e r n a 1 hem- 
 orrhage are as follows : staggering, tumbling, sudden col- 
 lapse, paleness of the visible mucous membranes, cold ex- 
 tremities, as well as a weak and finally imperceptible pulse, 
 occasionally one also observes cerebral convulsions, and amau- 
 rosis (anemic adipose degeneration of the retina), as well as 
 vomiting. 
 
 Ruptures of the aorta usually occur at its origin 
 immediately behind the semilunar valves in the vicinity 
 
312 RUPTURE OF LARGE ARTERIES 
 
 of the sinus of Valsalva ; at this point the blood-pressure is 
 greatest, the walls are apparently thin and in most cases some- 
 what dilated; these regions form, therefore, an area of predilec- 
 tion for the formation of aortal aneurysms. Rupture of the 
 aorta occurs most frequently in horses ; it is observed after 
 casting, jumping, and falling. The blood flows into the peri- 
 cardium which is found distended with blood on post mortem. 
 Rupture of the anterior aorta is often caused by wagon poles 
 that penetrate the tissues. 
 
 Ruptures of the pulmonary arteries, likewise, are 
 observed in horses after casting. Severe hemoptysis (cough- 
 ing blood) as a result of the rupture of an aneurysm of the 
 pulmonary artery into a large bronchus was observed in one 
 case. Other ruptures that may be mentioned are : rupture of 
 the femoral arteries and obturator arteries in 
 fractures of the pelvis ; the internal iliac arteries in 
 fracture of the last lumbar vertebra ; the renal arteries 
 from concussions ; the colic arteries, when dilated with 
 aneurj'snis, from casting ; the cecal artery as a result of 
 a sarcoma ; the diaphragmatic artery from blows; 
 the carotid artery as a result of erosions from strangles 
 abscesses ; the posterior aorta through erosions from 
 sarcomata ; the axillary arter}' from a severe pull ; the 
 left cervical artery, etc., from fractures. — Treatment of these 
 ruptures is not usually possible. Ruptures of the palatine 
 artery, internal carotid artery, etc., must be treated by ligation 
 of the carotid artery. 
 
 Obliteration. — Adhesion and obliteration of the vessels as the 
 result of endarteritis obliterans is seldom observed in the domestic ani- 
 mals. Pirl has observed an obliteration of the posterior aorta 
 in the horse. The aorta formed a solid cord between two aneurysms, it 
 was about the thickness of one's finger ; anterior to the area of adhesion 
 there branched finger-thick, newly formed collateral vessels. Eligio 
 has described an obliteration of the iliac artery wdth symptoms of 
 paralysis. I have recently (1904) observed a case of stenosis of 
 the aorta in a horse ( apparently congenital) that resulted in clin- 
 ical symptoms of thrombosis of the internal iliacs. 
 
 Emboli. — These result from a solution of thrombic masses in 
 the heart, in the aneurysmatically dilated anterior mesenteric artery, 
 femoral artery, etc., especially in the horse. Emboli in the pododerm 
 
INFLAMMATION OP VEINS 313 
 
 lead to necrosis aud loss of the horn capsule ; emboli of the middle 
 rectal artery to paralysis of the rectum (Casper) ; emboli of the ophthal- 
 mic artery to sudden blindness (Arnold). 
 
 II. DISEASES OF VEINS. 
 
 I. INFLAMMATION OF VEINS. PHLEBITIS. 
 
 Forms. — As in arteritis, one also distinguishes in inflam- 
 mation of the veins, an endophlebitis, mesophleb- 
 i t i s , and periphlebitis; an acute and chronic; 
 an aseptic and septic (suppurative) phlebitis. 
 Suppurative necrotic phlebitis, or suppura- 
 tive thrombophlebitis is of special practical import- 
 ance. It either occurs during the course of a phlegmon or from 
 suppurative infection of venous thrombi through the entrance 
 of pus- forming bacteria from without, or in pyemia from 
 within, that is, from the blood (embolic, p3^emic, metastatic). 
 
 Symptoms. — Phlebitis is characterized by a cord-like, 
 nodular, firm thickening and induration along 
 the course of the veins ; passive edema also develops in 
 the vicinity of the diseased vein. The nodular formation is 
 due to localization of the inflammatory process at the valves 
 as a result of retardation and engorgement of the blood at 
 these points. Induration of the veins is the result of throm- 
 bus formation in the blood and thickening of the walls. 
 Through the release of infected portions of the thrombus 
 suppurative metastases of distant organs may result, 
 this i« especially true of the lungs ('pyemia). 
 
 With reference to the occurrence of phlebitis in the 
 domestic animals it may be remarked that formerly, especiall}- 
 in the horse, it was more frequently observed than now 
 (phlebitis of the jugular following phleb- 
 otomy, so-called phlebotomy fistula). Suppura- 
 tive omphalophlebitis of foals and calves (suppurative 
 thrombophlebitis of the spermatic vein with consecutive pyemia ; 
 so-called foal-lameness) is less common since the introduction 
 of umbilical antiseptics. On the other hand, the recent em- 
 ployment of intravenous injections of chloral hydrate 
 
314 DILITATION OF VEINS 
 
 in the horse has again introduced thrombosis of the veins and 
 phlebitis of the jugular. Phlebitis in the vicinity of wounds 
 and phlegmons is also of practical importance ; inflammation 
 of the saphenicvein in the course of phlegmons of the 
 posterior limb ("Einschuss") is not very common, the same 
 is true of the internal iliac and femoral veins, the 
 vena digitalis interna, radialis, brachialis 
 and cephalica, as well as thrombophlebitis of the nasal 
 mucous membrane which occasionally leads to suspision 
 of glanders in the horse. According to Zschokke the 
 latter is characterized by the following symptoms : the septum 
 nasi is dark- red in color ; it is covered with stratified, light- 
 yellow or reddish-grey wreath-like nodules, or cord-like eleva- 
 tions from one-half to two mm. in diameter ; they consist of 
 white venous thrombi that have their origin in a primary 
 phlebitis. Ulcer formation as well as a suppurative or caseous 
 exudate is wanting, this differentiates the condition from 
 glanders. 
 
 2. DILITATION OF VEINS. VARIX. PHLEBECTASIA. 
 
 Causes. — Similar to aneurysms, dilitations (varices, 
 phlebectasia) of the veins are found. Chronic inflammation 
 of the walls of the veins, especially the intima (chronic 
 endophlebitis) is the most frequent cause. In addition, 
 traumatic influences, as well as ulcerative and con- 
 genital dilitations of the veins must be considered. They 
 are favored by local and general vascular engorgement. 
 
 Symptoms. — Varices are present either in the form of 
 circumscribed nodular (spindle-shaped, sac-like, cyl- 
 indrical), or diffuse swellings along the course of the veins 
 of the skin and mucous membranes. They have a tendency 
 to become hemorrhagic and form ulcers (periphle- 
 bitis) , they also result in thrombus formation l^sup- 
 purative thrombophlebitis, pyemia), and in rare cases 
 in calcification and caseation (so-called vein stones, 
 phleboliths). In comparison with man varices in animals are 
 very rare. Varices of the mucous membrane of 
 
DILITATION OF VEINS 315, 
 
 the rectum, known as hemorrhoids, are \'ery 
 uncommon in animals. The same is true of 
 dilitations of the veins of the lower limbs 
 following repeated pregnancy (so-called vari- 
 cose veins). As a rule the diagnosis of such conditions 
 is erroneous, for example, in the dog that condition recog- 
 nized as hemorrhoids is usually a pathological condition of 
 the anal glands ; varix of the saphenic vein in the horse 
 (so-called blood-spavin) hardly ever exists. The cause of this 
 variation between man and animals is due to the fact that 
 chronic inflammatory conditions of the veins are far less com- 
 mon in animals than in man. In man many affections of the 
 heart and chronic pulmonary diseases, as well as the upright 
 position of the body, and pregnancy (pressure of the pregnant 
 uterus on the veins) induce venous congestions more readily 
 than in animals. Varices of the rectal mucous mem- 
 brane (genuine hemorrhoids) have only occasionally been 
 observed in horses, cattle, and dogs. Eckart found the 
 following conditions in a horse : numerous nodules and cysts 
 at the margin of the anus and termination of the rectum, they 
 varied in size from that of a pea to that of a cherry, were smooth 
 on the surface, slightly bluish in color, painful and hemorrhagic. 
 Varices also occur in the spermatic cord (so-called vari- 
 cocele), in the milk-veins of cows (hemorrhagic swellings 
 about the size of a hen's egg, Liebl); in the vicinity of the 
 anus and scrotal covering in dogs (characterized by 
 ulcer formation and hemorrhage ; Moller, personal observa- 
 tions); in the vesical mucous membranes of the dog (chronic 
 hemorrhage of the bladder, Frick);onthe anterior margin 
 of the masseter muscle in the form of a varix of the facial vein 
 in a remount horse (Preuss. Mil.-Ber. 1897); on the exter- 
 nal mammary vein of the horse (personal observation); 
 on the sa ph enic vein of the horse (Tep ly); as well as 
 congenital new-formations of the skin of foals 
 (W. Eber). Varix aneurysmaticus in the form of 
 an opening of the spermatic artery into the spermatic vein 
 after castration of bulls has been seen by several observers 
 (Gurlt, Prinz, Meyer, Wagenfeld, Collin, and 
 
3l6 INFLAMMATION OF VESSELS 
 
 Others) ; it produces a pulsating, buzzing swelling in the cord. 
 Treatment. — This consists in operative removal, or 
 ligation. In addition to these methods, those used in hu- 
 man surgery may be employed ; namely, removal with the 
 cautery, ignipuncture (perforation with the Paque- 
 lin), the injection of medical agents (ergot, alcohol, con- 
 centrated carbolic acid) , as well as methodical compression. 
 The latter methods may be experimentally employed. 
 
 Rupture of Large Veins. — The following ruptures with fatal in- 
 ternal hemorrhage have been observed, especially in the horse : rupture 
 of the portal vein, the pre- and post cava, and the mesen- 
 teric vein. Ruptures of the jugularis, axillary vein, vena 
 cephalica and s a p h e n a are not rare. 
 
 in. DISEASES OF LYMPH-VESSELS. 
 I. inflammation of lymph-vessels, lymphangitis. 
 
 Causes. — Inflammation of the lymph-vessels is usually 
 due to a wound infection disease induced by the 
 entrance of pus-forming bacteria into the open lymph-vessels. 
 It is most often found, therefore, in the following places : in 
 the vicinity of infected, suppurative wounds; in phleg- 
 mons; following too early incisions of hematomata in 
 the region of the buttocks and limbs ; as a result of f i s t u 1 a e 
 of the neck, fistulous withers, and inj uries from 
 saddle-galls. There also exist specific forms of lymphan- 
 gitis ; namely, in horses during the course of glanders and 
 strangles, as well as so-called pseudo-glanders 
 (lymphangitis ulcerosa sui generis, mallei- 
 forme lymphangitis); in cattle as a symptom of 
 tuberculosis of the skin ; in dogs during the course of 
 so-called dog-distemper. A plague-like infectious 
 lymphangitis with symptoms similar to glanders, but with a 
 benign course, is observed in horses and mules in the French 
 Army in Africa (Farcin d'Afrique, Lymph angite 
 farcinoide); the lymph- vessels of the skin swell into 
 cords and are covered with granulating ulcers, from the ulcers 
 there is a discharge of normal pus. This "African" glanders 
 
DISEASES OF GLANDS 317 
 
 is also frequently observed in Southern France, Italy, Egypt, 
 Russia, Japan, among American horses in the Philippines, 
 etc. It is caused by a fungus-like parasite, saccharomyces 
 (cryptococcus) farcinosus (lymphangitis saccharo- 
 mycotica, fungus-lymphangitis). So-called worm 
 in cattle is a similar disease (Farcin du boeuf). 
 
 Symptoms. — Lymphangitis is characterized by bead- 
 like swellings along the course of the lymph- vessels, that is, a 
 cord-like swelling interrupted by nodules. It is frequently the 
 result of inflammation of neighboring lymph-glands (lymph- 
 adenitis). Along the course of the bead-like swellings 
 there occasionally develops, especially at the seat of the valves, 
 numerous small abscesses (horse-distemper, dog-distemper). 
 Chronic lymphangitis leads to pronounced thickening of the 
 skin (elephantiasis in glanders of the skin).— 
 Treatment consists in incision of the abscesses, as well as 
 in the application of antiseptic fluids and ointments. 
 
 2, DICTATION OF LYMPH-VESSELS. LYMPHANGIECTASIS. 
 
 Causes. — Lymphangiectasis is usually congenital 
 and belongs in part to the chapter on tumors. It includes 
 the so-called congenital elephantiasis, macroglossia, and ma- 
 croscelia (see page 123). In contrast to this form there is, 
 however, an acquired dilitation of lymph-vessels ; it is espe- 
 cially observed after chronic recurrent inflammations of the skin 
 and subcutaneous tissue (inflammatory form of elephantiasis). 
 So-called lymph-cyst s — cystic dilitations of the lymph- 
 vessels — are a special form ; these must not be confused with 
 lymph-extravasates, that is, efiusions of lymph as a 
 result of subcutaneous rupture of lymph-vessels ; or lymph 
 fistulae, permanent ulcer-like openings in the lymph- 
 vessels following injuries. 
 
 DISEASES OF GEANDS. 
 
 General Remarks. — The general surgery of glandular 
 affections in veterinary science is of importance only as applied 
 
3lH INIT.AMMATION Ol" I.YMI'II-GLANDS 
 
 to certain j^lands, namely, the lympli-glands and the milk- 
 glands which present a group of important diseased conditions. 
 I''rom a surgical standpoint inflammation of the glands 
 most frc'(iuently demands treatment. Glandular inflammations 
 (lymphadenitis, mastitis) may be due to various causes and 
 present extremely variable forms. From an etiological .stand- 
 point the following forms are recognized: traumatic, in- 
 fectious, and 1 Ileum a tic inflammation of the glands. In 
 addition, tliere occurs a primary or independent form 
 in contrast to a secondary or symptomatic form the 
 latter is only a partial symptom of general disease (lympha- 
 denitis in strangles, glanders, tuberculosis ; mastitis in foot- 
 and-mouth disease). According to the path of infection 
 the following classification is observed: hematogenous, 
 lymphogenous, and galactogenous inflammations 
 ol' the milk-glands. According to thecour.se inflammation of 
 glands is cla.ssifled as acute and chronic. The classifi- 
 cation according to the anatomical character of the inflamma- 
 tion is of special importance. According to this classification 
 the following forms arc recognized: parenchymatous, 
 interstitial, suppurative, phlegmonous, catar- 
 rhal, and specific. Parenchymatous inflammation in- 
 volves the genuine secreting glandular substance ; the inter- 
 stitial form applies to the interglandular connective tissue ; the 
 catarrhal to the excretory ducts and the collecting mechanism 
 ( milk-cy.sterns) of the glands. 
 
 In the following will be described onlj^ inflammation of 
 the two most imjiortant types of glands from a surgical stand- 
 point, namely, the lymph-glands and the milk-glands. The 
 description is brief and from a general standpoint. 
 
 I. INI'LAIMIMATION Ol'" LVM PH-GLANDS. 
 LYMPHADENITIS. 
 
 Causks. — Inflammation of lymph-glands is usually in- 
 fectious in character. The infectious material enters 
 either through a lymphogenous path, from without to within 
 through the medium of the lymph-vessels (concentric lymph- 
 
INFLAMMATION OF LYMPH-GLANDS 3I9 
 
 angitis), or hematogenous, carried to the lyinph-glands by 
 the blood. Lymphadenitis is most frequently observed as a 
 result of the following conditions : infected wounds and 
 phlegmons, nasal catarrh, suppurative alveolar periostitis, 
 empyema of the sinuses of the head, pharyngitis, etc., it may 
 further develop in a specific form in strangles, glanders, 
 tuberculosis, actinomycosis, and b o t r y o m y - 
 cosis. From an anatomical standpoint one recognizes a 
 parenchymatous, interstitial, and suppurative lymphadenitis. 
 Pe r i 1 y m p h a d e n i t i s is not uncommon, that is, an in- 
 flammation of the connective tissue in the vicinity of the gland 
 that leads to adhesions between the latter and the surrounding 
 tissues (inferior maxilla). In the hor.se lymphadenites are 
 nio.st often observed in the intermaxillary lymph- 
 glands; in cattle in the lymph-glands of the neck and 
 udder. 
 
 Symptoms. — a) Parenchymatous lymphadenitis 
 is characterized fjy swelling of the gland, it is usually 
 acute in development and is accompanied by slight degree of 
 pain. Afterwards the swelling either becomes resorbed, or 
 the parenchymatous lymphadenitis changes into the suppura- 
 tive or chronic form. It is most often observed as a wound in- 
 fection disease following injuries, as well as subsequent to 
 catarrh of the mucous membranes. 
 
 b) Suppurative lymphadenitis is especially ob- 
 served during strangles in the horse. It is characterized by 
 severe swelling and pain as well as fe ve r ; it usually 
 terminates in fluctuation and abscess formation. If 
 the pus is not discharged outwards it becomes thickened 
 (caseation), or it is resorbed by the blood (pyemia, septice- 
 mia, petechial fever). 
 
 c) Chronic interstitial lymphadenitis is char- 
 acterized by the following symptoms : a painless, hard, 
 circumscribed swelling of the gland ; occasionally it be- 
 comes adherent to the underlyingtissues, and it 
 may contain hard nodules (glanders, tuberculosis, chronic 
 catarrh). 
 
 Treatment. — Chronic interstitial lymphadenitis is in- 
 
320 INFLAMMATION OF THE UDDER 
 
 curable, occasionalh^ it is necessary to extirpate the enlarged 
 gland for diagnostic purposes. Suppurative inflammations are 
 treated by means of incisions and antiseptic irrigation. 
 The parenchymatous form is treated with moist warmth, 
 parenchymatous injections, camphor oint- 
 ment, iodoform ointment, grey ointment and 
 other resorptives. 
 
 2. INFLAMMATION OF THE UDDER. MASTITIS. 
 
 CausEvS. — In cattle, infections are the most frequent 
 causes of mastitis, it is seldom of traumatic or rheumatic origin. 
 The infection may have a galactogenous, 
 lymphogenous, or hematogenous entrance. 
 As a result of bacteriological investigations in recent years, in 
 addition to tubercle-bacilli, actinomyces and botryomjxes 
 fungi, a number of specific organisms have been 
 found to cause mastitis. Ordinarily they gain entrance through 
 the duct of the teat (galactogenous infection) . The 
 following are the most important : 
 
 a) Bacterium phlegmasiae uberis, identi- 
 cal with the colon bacillus. 
 
 b) Streptococcus agalactiae contagiosae 
 and other streptococci. 
 
 c) Staphycococcus mastitidis. 
 
 d) Staphylococcus mastitidis gangrae- 
 nosae. 
 
 e) Galactococcus' versicolor, fulvus, etc. 
 
 f) Bacillus pyogenes. 
 
 g) Micrococcus tetragenes. 
 
 Forms. — I. Parenchymatous mastitis is partly 
 galactogenous through the entrance of bacteria of mastitis 
 from without, partly hematogenous, for example, during the 
 course of foot-and-mouth disease (symptomatic mastitis), it 
 affects the columnar epithelium of the alveoli and small milk- 
 ducts. It leads to a firm, painful, febrile swelling and pro- 
 nounced enlargement of the inflamed quarter of the udder. 
 Milk from the affected part contains a flocculent coagulum and 
 
INFLAMMATION OF THE UDDER $21 
 
 fibrin, SDiuetimes it is even yellowish and wheyish, or even^ 
 colored with blood, finally the milk-secretion is entirely sus- 
 pended. If resorption does not occur there develops, 
 either a permanent inflammatory hypertrophy of the 
 udder with marked enlargement and induration, or an atro- 
 phy with shrinking and permanent diminution in size of 
 the affected quarter. In other cases it passes into a s u p- 
 p u r a t i V e and even gangrenous form of mastitis. 
 
 2. Catarrhal inflammation of the udder (catarrh of 
 the udder) is localized especially on the mucous membranes of 
 the teat-canal (squamous epithelium), the milk-cysterns and 
 large milk-ducts (columnar epithelium). In the beginning the 
 gland itself is either slightlj- swollen or normal in size. It is 
 characterized by the watery, flocculent, wheyish condition of 
 the milk. Afterwards it leads to induration, stenosis 
 and obliteration of the teat-canal, as well as to the for- 
 mation of connective-tissue septa in the milk-cysterns which 
 lead to hard milking, drying up of the milk (agalactia), and 
 atrophy of the affected quarters. In other cases catarrhal 
 inflammation extends to the interstitial tissue and results in 
 chronic induration with permanent increase in size 
 (pseudo-hypertrophy) of the diseased quarters. Occasionally 
 it assumes a contagious form("gelber Gait," agalactia 
 catarrhalis contagiosa). 
 
 3. Phlegmonous mastitis (inflammatory 
 edema of the udder) is an infectious inflammation of 
 the skin and subcutem, as well as the interglandular connec- 
 tive tissue of the involved quarter. It is characterized by a 
 firm, painful, diffuse, hot, febrile swelling of the affected quarter 
 without qualitative changes in the milk in the earh- stages of 
 the disease. It is a result of infection from without (traumata), 
 or within (accompanying symptom of parenchymatous mas- 
 titis) and should not be confused with the non-painful and 
 non-febrile, physiological stagnation edema of cows advanced in 
 pregnancy. The chronic course results in chronic induration 
 and atrophy of the diseased quarter. 
 
 4. Chronic interstitial or indurative mas- 
 titis consists in an inflammatory new-formation of connec- 
 
322 INFLAMMATION OF THE UDDER 
 
 tive tissue with atrophy of the genuine parenchj^ma of the 
 udder. It may develop independently as a chronic inflamma- 
 tion during the period when the animal is not giving milk, 
 when it leads to a painless, hard, often very pro- 
 nounced enlargement of an entire quarter of 
 the udder; the milk is watery and flocculent. It often re- 
 sults from a previous acute, catarrhal, parenchymatous, or in- 
 terstitial, as well as a tubercular and actinomycotic mastitis ; 
 in the latter cases the nodular swellings are frequently 
 painful during the early stages of the disease. 
 
 5. S up purat i ve inflammation of theudder, abscess 
 of the udder (suppurative, apostematous, stereptococcal, 
 staphylococcal mastitis) is a circumscribed suppurative liquefac- 
 tion of the parenchyma of the udder during the course of pa- 
 renchymatous and catarrhal mastitis. It is characterized by 
 high fever, fluctuating areas on the udder, as well as a puru- 
 lent condition of the milk, it occasionally leads to the forma- 
 lent of milk-fistulae. 
 
 6. Necrotic inflammation of the udder is especially 
 common in sheep through the influence of specific microorgan- 
 isms (micrococcus mastitidis gangraenosse) ; it is less frequent 
 in cows where it occurs during the course of severe parenchy- 
 matous mastitis of a putrid character. During the course of a 
 suppurative mastitis necrotic portions of tis.sue may be 
 sloughed off (sequestration, mortification or mummification of 
 the udder). In these cases the milk is fetid and ichorous in 
 character ; the necrotic portions of the udder are discolored 
 and sloughed off. 
 
 With reference to tuberculosis, actinomycosis, 
 and bot r y om y cosis of the udder see pages 167, 159 and 
 
 163. 
 
 Treatment. — Treatment varies according to the form of 
 mastitis. In general the following methods are important : 
 frequent milking, the application of antiseptic agents 
 (ointments containing borates or salicylates), 
 early incision of abscesses, removal of necrotic por- 
 tions, amputation of single quarters, operative treatment 
 of stenoses and partitions in the teat-canals and milk cysterns. 
 
INFLAMMATION OF THE SKIN 323 
 
 Massage is contraindicated in all forms of infectious mastitis. 
 For further details compare with text-books on special surgery 
 and obstetrics. 
 
 SURGICAL DISEASES OF THE SKIN, SUBCUTEM 
 
 AND MUCOUS MEMBRANES. 
 
 I. SURGICAL DISEASES OF THE SKIN. 
 
 I. INFLAMMATION OF THE SKIN. DERMATITIS. 
 
 Causes. — The causes of inflammation of the skin are 
 traumatic, chemical, thermic, infectious, and specific in char- 
 acter (dermatitis traumatica, caustic a, combus- 
 tionis, erysipelatosa, suppurativa, malleosa). 
 According to the course and extent one recognizes a circum- 
 scribed and diffuse, superficial and deep, acute and chronic 
 dermatitis. 
 
 Forms. — From a practical standpoint it is important to 
 differentiate between the following anatomical forms of in- 
 flammation of the skin : 
 
 a) Erythematous dermatitis or erythema 
 of the skin consists of an inflammatory hyperemia of the 
 skin. According to the causes the following forms are recog- 
 nized : erythema traumatic um (pressure, rubbing) ; 
 toxic um or ab acribus (irritating chemicals, black 
 soap in dogs) ; c a 1 o r i c u m and s o 1 a r e (heat, burning of 
 first degree, action of the sun) ; as well as exanthemati- 
 cum (symptomatic erythema in swine-erysipelas). Small, 
 circumscribed erythema is termed macula; the multiple 
 form is termed exanthematous roseola. Inflammatory ac- 
 tive hyperemia must not be confused with passive hyperemia 
 or vascular engorgement (livid, cyanotic) ; the former is 
 characterized by a clear, arterial color of the reddened skin. 
 
 b) Serous dermatitis, when diffuse, is termed 
 inflammatory edema (serous infiltration of the cutis) ; 
 while the circumscribed form is termed vesicular eczema 
 (multiple vesicles), and bullous dermatitis (large 
 
324 INFLAMMATION OF THE SKIN 
 
 vesicles beneath the epidermis) ; urticaria or pom phus 
 indicates a circumscribed serous infiltration. 
 
 c) Suppurative dermatitis is the result of an 
 infection of the skin with pus-bacteria. It is either superficial 
 or diffuse (suppurative dermatitis), or assumes the 
 form of a circumscribed collection of pus beneath the epidermis 
 (pustular dermatitis, pustule, p us - vesic 1 e). 
 Acne and furuncle is a multiple, suppurative inflamma- 
 tion of the skin confined to the hair-follicles (suppurative 
 folliculitis). 
 
 d) H'e morrhagic dermatitis occurs symptomat- 
 ically in anthrax, either diffuse in the form of hemorrhagic 
 edema, or circumscribed in the form of carbuncles. 
 Hemorrhagic dermatitis may also have a traumatic origin 
 (contusion), or result from a complication of infection with sim- 
 ple hemorrhage (petechia, vibices, ecchymoses, hematoma, 
 suffusion). 
 
 e) Gangrenous dermatitis or necrotic der- 
 matitis (necrosis, gangrene) follows burning and freezing, 
 application of caustics, and contusions, as well as the action of 
 certain infectious materials (necrosis bacillus) ; compare with 
 the chapter on gangrene. Ulcerative dermatitis is a 
 similar form ; compare with the chapter on ulcers. 
 
 f) Chronic hyperplastic dermatitis occurs 
 partly as a chronic indurative dermatitis or schlerosis 
 (schleroderma, pachyderma, elephantiasis, tyloma), partly as 
 a verrucose dermatitis ("Straubfuss" bristle foot, 
 "Ingelfuss" hedgehog- foot), partly as a squamous in- 
 flammation (callosities, squamous eczema). 
 
 The treatment of dermatitis of the skin consists in 
 the application of antiseptics, astringents, protective agents, etc. 
 
 Acne and Furunculosis. — It is customary to employ these terms 
 to indicate that form of suppurative dermatitis which is confined to the 
 follicles of the skin (suppurative folliculitis). The smaller 
 nodules are termed acne ; the larger, pustule-like nodules which lead to 
 necrosis of the follicles are termed furuncles. They are most often 
 found in the region of the saddle and girth in the horse (so-called saddle- 
 mange, callosit}', nodxilar enlargement, lichen), as well as on the skin 
 over the bridge of the nose in dogs (muzzle, pustular form of acarus 
 
BURNS 325 
 
 mange); they have also been observed in cattle (udder) , and sheep 
 (abdomen). Treatment is purely surgical (incision, curettage, excision). — 
 In contrast to furuncle, carbuncle forms a specific, sanguino-gan- 
 grenous, circumscribed inflammation of the skin and mucous membranes 
 due to the anthrax bacillus. (In man, several furuncles arranged in a 
 group are also termed carbuncle) . 
 
 Eczema and Exanthema. — Eczema is a multiple dermatitis 
 caused by external irritants ; it runs a typical course and assumes 
 various forms; namely, aczema erythematosum, vesiculosum, papulo- 
 sum, pustulosum, madidans, crustosum, impetigenosum,and squamosum. 
 That form of dermatitis found on the volar surface of the fetlock, desig- 
 nated as scratches, is of special surgical importance. According to the 
 degree of inflammation it is termed eczema erythematosum, madidans, 
 crustosum, impetigenosum, squamosum, etc., and may be designated re- 
 spectively as dermatitis erythematosa, suppurativa, gangrenosa, etc. 
 Exanthema, likewise, is a multiple inflammation of the skin ; it is, 
 however, only a symptom of internal disease, and is not, therefore, of 
 surgical importance (vesicular exanthema in foot-and-mouth disease, 
 exanthema of small-pox, exanthema of swine-erysipelas, strangles, dog- 
 distemper, etc. ). Exanthema of the mucous membrane is termed e n- 
 anthema. (For further details concerning exanthema and eczema 
 see: Friedberger and F r 6 h n e r. Special Pathology. Sixth Ed., 
 Vol. I.). 
 
 2. BURNS. COMBUSTION. 
 
 Causes. — Inflammation of the skin as a result of burns 
 (dermatitis combustionis) is rarely observed in the 
 domestic animals, except when heat is used as a therapeutic 
 agent. In horses and cattle it is usually due to fires in the 
 stable, burning the pododerm with a hot iron, contact with 
 electric wires (street railway's), hot inhalations, and taking 
 hot food. Cats and dogs are burned with boiling water 
 or hot milk. In horses, in addition to burns of the skin and 
 pododerm, the mucous membranes of the respiratory apparatus 
 are burned by inhalations of hot air during conflagrations. 
 Extensive burning of the skin and mucous membranes is very 
 dangerous. 
 
 Degree. According to the duration and intensity of the 
 caloric influence, three degrees of burning are recognized : 
 
 a) The first degree is characterized by a mere red- 
 ness of the skin (dermatitis combustionis erythematosa), 
 
326 BURNS 
 
 which may be combined with a slight serous infiltration. 
 
 b) The second degree is characterized by the for- 
 mation of bl is ters (dermatitis combustionis bullosa) ; there 
 is a circumscribed collection of serous exudate between the 
 epidermis and rete Malpighi ; a croupous inflammation 
 exists on the mucous membranes. 
 
 c) The third degree consists in the formation of an 
 eschar (dermatitis combustionis escharotica), whereby the 
 burned portion becomes necrotic (dry gangrene) ; afterwards, 
 as the result of a suppurative, demarking inflammation it is 
 sloughed off. Necrosis of the pododerm in horses is especially 
 dangerous (exungulation). Complete charring of an 
 organ has been termed burning of the fourth degree. 
 
 In addition to local changes, extensive burning is also ac- 
 companied by severe general disease and fatal re- 
 sults. Experience in men has demonstrated that death is 
 certain when more than half of the surface of the body is in- 
 volved, even when in the form of the first degree. The result 
 is usually fatal when a third of the surface of the body is 
 burned. I have learned by personal observations on horses 
 that, under certain conditions, burning may be fatal when 
 onl}' a fifth or a tenth of the surface is affected ; the animal 
 suffers from an attack of hemoglobinuria. These results are 
 especially common when the mucous membranes of the respi- 
 ratory tract are simultaneously affected from inhalations of hot 
 air. Such cases present on post mortem, in addition to the 
 changes on the skin, fibrinous laryngitis, bronchitis, and 
 pharyngitis, glossitis and edema of the lungs, hemorrhagic 
 gastroenteritis, hemoglobinuria, infarcts of hemoglobin in the 
 kidneys, hemorrhages in the spleen and heart, as well as 
 parenchymatous hepatitis and myocarditis. 
 
 There are various explanations of the causesof death 
 in the severe, rapidly fatal cases of burning. It is considered 
 partly a poisoning, partly a derangement in the 
 circulation, partly a paralysis of the nerves as a 
 direct result of the burn. According to the toxic theory the 
 burning of the blood in the cutaneous capillaries results in a 
 decomposition of the blood and leads to hemoglo- 
 
BURNS 327 
 
 b i n e 111 i a , which determines the fatal course ; carbon dioxide 
 poisoning results from a diminution of the supply of oxygen 
 taken up by the red blood-corpuscles. In a short time 
 large quantities of hemoglobin circulate 
 freely in the blood; it causes hemoglobi- 
 nuria, infarcts of hemoglobin in the kid- 
 neys, as well as hemorrhages in the spleen 
 and gastric mucous membranes with sec- 
 ondary necrosis (diphtheria) of the latter, 
 in addition to free hemoglobin, the influence of a high degree 
 of heat on the blood apparently gives rise to other toxic bodies 
 (ammonia, pyriden bases, prussic acid, ptomaines). On the 
 other hand, materials formed by the decomposition of white 
 blood-corpuscles have been found. According to the nature of 
 fibrin ferment, these lead to coagulation in the capillaries 
 of the inner organs, followed by severe derangementsin 
 the circulation and necrosis, especially in the mu- 
 cous membranes of the intestines (Silberman, and Welti). 
 The earlier supposition, that death was due to cooling of 
 the body, cannot be maintained ; experience has shown that 
 death occurs in man when the burned are permanently placed 
 in warm baths. In many cases a reflex paralysis of the 
 nervous system as a result of excessive irritation of the 
 nervous system and overheating of the blood (44 C.) may 
 be accepted as a cause of sudden death from burning. When 
 the disease exists for some time, death results from a sub- 
 sequent affection: especially through a septic 
 infection of the blood as the result of resorption of septic, 
 putrid, and toxic materials from the gangrenous areas in 
 the skin, pododerm, and mucous membranes (septicemia). 
 Treatment. — The local treatment of burns is essentially 
 the same as for other wounds ; apply an aseptic bandage to 
 fresh wounds as soon as possible to prevent the entrance of 
 infectious material (pus-bacteria). If infection has already 
 taken place, antisepsis must replace asepsis. Nitrate 
 of silver is the best antiseptic for burns. This 
 possesses, in addition to strong disinfecting properties, a pro- 
 tective (eschar of silver) and anesthetic action, it is employed 
 
328 FREEZING 
 
 in the form of a 5-10 per cent aqueous solution, or ointment. 
 Other antiseptic protectives are bismuth salts, oxid of zinc, 
 iodoform in combination with talk or amylum as a dusting 
 powder, etc. Recently, sodium bicarbonate in the 
 form of a dusting powder, as well as picric acid (bandage) 
 has received special recommendation. Among the older reme- 
 edies may be mentioned so-called lime liniment (lini- 
 mentum contra combustiones), a mixture of equal portions of 
 lime water and linseed oil. Amputation is indicated in severe 
 burning of the extremities (tail, ears, toe-joint). Injuries 
 due to caustics are treated similar to burns. 
 
 3. FREEZING. CONGELATION. 
 
 Degree. — In freezing, also, one recognizes three degrees : 
 redness, vesicles (congelatio bullosa), and necrosis 
 (congelatio gangrenosa). In contrast to arterial hyperemia of 
 burning of the first degree, the redness of freezing is due to a 
 passive, venous hyperemia. The second degree is an inflam- 
 matory reaction of the bodj- in the course of which it leads to 
 the formation of thrombi and severe disturbances in the circu- 
 lation. The third degree of freezing leads to gangrene, which, 
 in contrast to the dry gangrene of burns, is moist. Death fol- 
 lows extensive freezing as a result of pronounced falling of the 
 body temperature, in other cases, as in burns, fatal septic 
 diseases develop afterwards. 
 
 Occurrence. — The domestic animals, especially the 
 horse, are very resistant to cold (winter coat). Usually the 
 injurious influence of cold in winter involves the pododerm, as 
 well as the skin of the coronet, the fetlock, and the pastern. 
 In the Russio-Turkish War (winter 1877-78) the Russian 
 army horses were repeatedly affected with a necrosis of the 
 pododerm similar to that which results from burns (J e w s e- 
 jenko). The African and Arabian horses seem to be very 
 resistant to cold. According to C a d i o t these horses in the 
 Franco-German War (1870-71) were more resistant than the 
 French horses. In the Crimean War (1854-56) the African 
 horses were also able to endure more than the English. Dur- 
 
FREEZING 329 
 
 ing the French Expedition against Algeria in the winter of 
 1845-46 the African horses remained well, while 25 per cent 
 of the army were frozen to death. Freezing of the scrotum is 
 common among the cattle of Denmark (Bang). Treat- 
 ment of frozen tissues is the same as that of burns. 
 
 Lightning-strokes. — L,arge animals are the most frequent suffer- 
 ers from this affection, this is especially true of cattle at pasture and 
 military horses. In stables, the standing and large animals are espe- 
 cially exposed ; for example, among nine horses in a stable only the five 
 that were standing were struck (Z i ege n be i n). The action of the 
 stroke is variable ; sometimes the skin is burned; the soft parts ma}- 
 undergo mechanical rupture; the nervous system may suffer from 
 electric concussion and pa raly si s ; at other times the action 
 is chemical in nature, the red blood-corpuscles are de- 
 composed (lightning-figures caused b}^ the solution and diffusion of 
 hemoglobin in the region). The burns of lightning are either superfi- 
 cial (singeing of the hair) , or deep enough to involve the muscle. In a 
 horse that was killed by a lightning-stroke, lines one half cm. broad 
 extended from the inferior surface of the thorax down the inner sides of 
 both anterior limbs as far as the hoofs, the hair on this strip was singed ; 
 the subcutem in the same region was strongly infiltrated with blood 
 (Sachs. Jaresbericht. 1894). A horny cicatrix remained in one horse 
 after healing had occurred (Miiller). In cows spotted with black the 
 stroke caused circumscribed areas of necrosis in the vicinitj- of white 
 hairs (Urbain). Experience has shown, that in light- 
 ning-paralysis the prognosis is relatively favorable. 
 
 Strong electric currents have an action similar to that of lightning. 
 According to Cadiot and Arloing a horse dies only after a long 
 time— several minutes — when exposed to a stream of 500-550 volts. 
 Horses only fall under the influence of 200-400 volts, 100 volts causes 
 slight trembling and collapse at the knees. 550-700 volts, when applied 
 for a short time, does not always result in death. The injuries in the 
 killed horses are partly in the form of circumscribed necrotic wounds, 
 partly the result of falling, rolling, and kicking. The horses that are 
 not killed often present nervous derangements (stupor, weakness), 
 these symptoms usually disappear, occasionally the paralysis is perma- 
 nent (effusion of blood in the brain). In a horse that came in contact 
 with the wire of an electric lamp the death was lightning-like in its 
 rapidity. Post mortem merely showed large quantities of blood in the 
 lungs and brain, as well as relaxation of the heart-muscle. Another 
 horse became rigid, the muscles quivered for several hours. (Wo h e r- 
 1 i n g). I observed a case in the horse in which there occurred burning 
 of the second degree. 
 
 Sun -stroke and he a t - s tro k e are of no surgical importance. 
 
330 CUTANEOUS EDEMA 
 
 Sun-stroke is a disease of the brain and medulla oblongata (hyperemia, 
 inflammation, apoplexy, paralysis) ; heat-stroke is a hyperthermia of the 
 body (overheating, dissolution of the blood, derangement of the heat 
 regulators). For further information see : Fried be rge r and Froh- 
 n e r, Special Pathology. 1904, Vol. II ). 
 
 II. SURGICAL DISEASES OF THE SUBCUTEM. 
 
 I. EDEMA. 
 
 Forms.' — The term edema indicates a serous infil- 
 tration of the subcutaneous connective tissue. According 
 to the causes the following forms of edema are recognized : 
 
 a) Inflammatory edema (acute edema of the 
 cellular tissue) is a serous inflammation of the subcutis and. 
 cutis ; it is, therefore, characterized by rise of tempera- 
 ture, pain, swelling that often develops rap- 
 idly, active hyperemia, and pronounced dis- 
 tension of the skin. It is most often found in the 
 horse in the form of so-called "E i n s c h u s s" [special form of 
 phlegmon of the hind limbs] . It also occurs as so-called c o 1 - 
 1 a t e r e a 1 edema in the vicinity of suppurative inflammatory 
 foci (abscesses). The following are specific forms of inflam- 
 matory edema: malignant edema, hemorrhagic 
 edema (anthrax), and blackleg. 
 
 b) Stagnation edema (edema of the cellular tissue) 
 occurs through h>dropic infiltration of the subcutis afttr stag- 
 nation of the venous blood or lymph. The edematous swell- 
 ing, therefore, is cool, painless, more or less so ft, 
 doughy, and occasionally it retains depres- 
 sions made withthefingers. In contrast to the clear 
 artrial redness of inflammatory edema, it presents a reddish-blue, 
 cyanotic or livid color. It is found as follows : in old and 
 atonic horses that remain standing for a long time ; in preg- 
 nant mares and cows, on the abdomen, udder, (edema of the 
 udder), and on the posterior limbs ; when the head is held 
 down for a long time ; following venous thrombi and phlebitis. 
 Hydremic edema (anasarca) is a special form of 
 stagnation edema due to chronic diseases of the heart, lungs, 
 
CUTANEOUS EMPHYSEMA 33 1 
 
 liver, kidneys, and diseases of the blood (hydremia) ; it is 
 found cougenitally in the form of so-called water-calves (water- 
 moles, lard or moon-calves). 
 
 Treatment. — The therapy of the different forms of edema 
 is extremely variable. Treatment of inflammatory edema 
 consists in antisepsis, hydrotherap)', in the application of an- 
 tiphlogistic remedies, incisions, and injections ; stagnation 
 edema is treated with massage, and compression, as well as 
 internally. 
 
 2. EMPHYSEMA. 
 
 Forms. — This is an accumulation of air in the 
 subcutaneous connective tissue (pneumatosis) ; two forms are 
 recognized: traumatic and septic emphysema. 
 
 a) Traumatic emphysema occurs, either after the 
 entrance of air through external injuries in the skin, espe- 
 cially in the vicinity of the thorax, throat, and orbital cavity ; 
 or after internal injuries to the thoracic walls and lungs 
 (coughs in cattle), after rupture of the esophagus, perforation 
 of the rectum and subcutaneous fractures of the tracheal 
 rings through which air pas.ses from within to without. Ac- 
 cording to the origin there is recognized an expiration- 
 emphysema (injuries to the trachea and the lungs), and 
 an inspiration- emphysema (aspiration through 
 pumping movements of the thorax, the abdominal walls and 
 the extremities). Under certain influences the accumulation of 
 air under the skin produces the following conditions : the en- 
 tire back is extensively swollen, the swelling is soft, 
 puffy, crackling, painless, and not accompa- 
 nied by local heat, it is characterized by a 
 tympanitic tone on percussion; the animal often 
 has a deformed appearance. In general the prognosis of trau- 
 matic emphysema is favorable, the air is gradually resorbed 
 through the blood- and lymph-vessels, and the general condi- 
 tion is not usually disturbed. It is a peculiar condition, that 
 inflammation of the subcutaneous connective tissue is usually 
 absent although infectious material must gain entrance with 
 
332 DISEASES OF THE MUCOUS MEMBRANES 
 
 the air. Treatment consists in massage and compression ; 
 frequently this is unnecessary. 
 
 b) Septic (gangrenous, spontaneous) emphysema is 
 due to the entrance of gas-forming bacteria into the subcutis, 
 namel)^ bacillus phlegmonse emphysematosse (gas-phlegmon), 
 a gas-forming variety of the bacterium coli, and other micro- 
 organisms. The gas beneath the skin is not composed of air, 
 as in traumatic emphj-sema, but of putrefactive gases 
 (carbureted hydrogen, sulphureted hydrogen, hydrogen, car- 
 bonic acid). In contrast to traumatic emphysema, one finds 
 symptoms of septic inflammation in the skin and subcutem, the 
 general conditions frequently undergo severe changes (septi- 
 cemia). Blackleg is a specific form of septic emph3-sema. 
 Following death of a fetus, there develops as a result of decom- 
 position, a subcutaneous, intermuscular, and subserous emphy- 
 sema (so-called emphysematous fetus or "dunst- 
 kalb" vapor-calf). 
 
 The treatment of .septic emphysema consists in mak- 
 ing extensive incisions, removal of the gas, thorough disinfec- 
 tion of the subcutis, as well as eventual amputation of the 
 diseased parts (tail). 
 
 Tympanitis. — The accumulation of air in bodj- cavities and hollow 
 organs ( tympanitis, meteorism ) is occasionally of surgical importance ; 
 it may follow injuries (pneumothorax following perforating tho- 
 racic wounds ) , and frequent.y receives operative treatment by means of 
 puncture (tympanitis of the rumen, meteorism of the 
 intestine). Tympanitis of the guttural pouch in foals 
 is a peculiar affection, it is due partly to the entrance of at- 
 mospheric air, partly to the development of putrefactive gases. Occa- 
 sionallj^ one also observes the entrance of air into the abdominal 
 cavity (castration) and into the veins (aspiration of air, see page 4). 
 
 III. SURGICAL DISEASES OF THE MUCOUS 
 MEMBRANES. 
 
 Inflammation. — Inflammation of the mucous membranes 
 presents the same causes and forms as inflammation of the 
 skin. The following are of special surgical importance : in- 
 flammation of the oral mucous membranes (stomatitis), 
 
DISEASES OF THE PODODERM 333 
 
 mucous membranes of the nose (rhinitis), eyes (conjunc- 
 tivitis), pharjmx (pharyngitis), vagina (vaginitis, 
 colpitis), uterus (endometritis), bladder (cystitis), 
 and rectum (proctitis). The following forms of inflam- 
 mation occur on the mucous membranes named : 
 
 1. Erythematous inflammation of the mucous 
 membranes. 
 
 2. Catarrhal inflammation of the mucous membranes. 
 
 3. Suppurative inflammation of the mucous mem- 
 branes. 
 
 4. Apthous (vesicular, phlyctenular) inflammation. 
 
 5. Pustulous inflammation of the mucous membranes. 
 
 6. Ulcerative inflammation of the mucous membranes. 
 
 7. Croupous (fibrinous, membranous) inflammation 
 of the mucous membranes. 
 
 8. Diphtheritic inflammation of the mucous mem- 
 branes. 
 
 9. Phlegmonous inflammation of the mucous mem- 
 branes. 
 
 10. Chronic hyperplastic (granular, verrucose, 
 polypous, cystic, fibrous, follicular, etc. ) inflammation of the 
 mucous membranes. 
 
 There are also specific inflammations of the mucous 
 membranes (actinomycosis, tuberculosis, glanders, etc.). 
 
 Treatment consists in the application of disinfectant, as- 
 tringent, and protective materials. 
 
 IV. SURGICAL DISEASES OF THE PODODERM. 
 
 Inflammaton. — Inflammation of the pododerm (pododerm- 
 atitis) presents the same general causes and forms as inflam- 
 mation of the skin. The following special construction, how- 
 ever, causes variations : the resistance of the protective horn- 
 capsule (hoof, claws) ; failure of the subcutis over the third 
 phalanx, the pododerm occupying the relation of the perios- 
 teum ; as well as the exaggerated development of the papillary 
 body and the rete mucosum. The following forms are recog- 
 nized : superficial and deep; acute and chronic; 
 
334 CONGENITAL MALFORMATIONS 
 
 serous, suppurative, hemorrhagic (corns), 
 and gangrenous or necrotic; infectious (nail- 
 pricks) and non-infectious or aseptic (laminitis) ; 
 chronic productive (keratocele, chronic laminitis) ; as 
 well as circumscribed and diffuse pododermatitis. 
 Because of failure of the subcutis over the third phalanx 
 phlegmonous inflammation occurs onh- at the coronet 
 (subcoronary phlegmon), in the vicinity of the lateral 
 cartilage (parachondral phlegmon), as well as in the 
 fatty frog (phlegmon of the fatty frog). 
 
 APPENDIX. 
 
 CONGENITAL MALFORMATIONS OF SURGICAL IMPORTANCE. 
 
 General Considerations.— Aside from mere patholog- 
 ical and anatomical considerations, congenital cases of malfor- 
 mations are of less interest in animals than in man ; the}^ are 
 seldom of practical surgical importance, as new-born animals 
 with extensive malformations are usually killed. Still there 
 are a considerable number of congenital malformations in vet- 
 erinary surgery that are amenable to plastic operations. These 
 are anomalies of the genital and digestive apparatus, ej^es, 
 udder, skin, and extremities. 
 
 Congenital Malformations of the Genital Appa- 
 ratus. — In male animals cryptorchidism, that is, re- 
 tention of one or both testicles in the abdominal cavity (ab- 
 dominal cr3'ptorchid), or in the inguinal canal (inguinal cryp- 
 torchid) is of greatest practical importance, it most frequently 
 occurs in stallions. With reference to treatment see : Opera- 
 tionslehre by Bayer (Bd. I), [or : "The Castration of Cryp- 
 torchid Horses and the Ovariotomy of Troublesome Mares" 
 Hobday^]. Failure of one (m o n o rch i d), or both testicles 
 (an orchid) is rare, aplasia of one or both testicles is of 
 great importance in the castration of cryptorchids (failure to 
 find the testicles). In exceptional cases, three testicles (t ri- 
 
 'Translator's reference. 
 
CONGENITAL MALFORMATIONS 335 
 
 orchid) have b^ea observed. An occasional forward dis- 
 location of the testicle, lateral to the penis, is peculiar to 
 dogs ; in these animals there also seems to be a predisposition 
 to the development of new formations in the testicles. Con- 
 genital fissures are also found in the urethra, the urethra does 
 not form a closed canal opening at the end of the penis, but 
 may have a dorsal opening (epispadia), or a ventral open- 
 into the sheath (hypospadia). It may even form a semi-canal 
 or fistula, opening at the scrotum and perineum. Congenital 
 stenosis of the prepuce (phimosis) sometimes occurs. 
 One frequently observes new-born foals in which there is an 
 opening in the urachus from which urine is constantly drop- 
 ping (fistula of the urachus); the following 
 have also been described : cystic urachus, ectopia 
 of the bladder as a result of exstrophj-, as well as 
 cystic diverticulum after obliteration of the urethra. 
 
 In female animals one frequently observes congenital 
 cystic ovaries, congenital closure of the vagina (atre- 
 sia vaginae), abnormall}' large development 
 of the hymen, failure or incomplete development of the 
 cervix and uterus, atresia and obliteration of the tubes. 
 There further occurs the formation of hermaphrodites, 
 and apparent hermaphrodites (pseudo-hermaphrodites) ; I 
 have operated two cases of penis-formation in the 
 vagina of mares. Finally, the fo r m a t ion of rudimen- 
 tary teats (after-teats) is not uncommon on the scrotum 
 or in its vicinity- in bulls, oxen, goats, and rams. 
 
 Congenital Malformations in the Digestive Appa- 
 ratus. — Fissures in the lips and intermaxillary bones (hare- 
 lip, labium leporinum), as well as the palate (cleft pal- 
 ate, wolf's jaw, palatoschisis) are especially observed in pup- 
 pies and foals as well as cattle. They are seemingly 
 uncommon ; in 70,000 cases of diseased dogs I have ob- 
 served only three cases of cleft palate, and only one case of 
 hair-lip. Congenital shortening of the frenum linguae has been 
 observed in calves. On the maxillae, especially in the horse, 
 it frequently occurs that the jaw is abnormally long and pro- 
 jecting (prognathism), or abnormally short and receding 
 
336 CONGENITAL MALFORMATIONS 
 
 (brachygna thisra). These are frequenth' the cause of so- 
 called pike- and carp-mouth (brachj-gnathia superior and in- 
 ferior.) Many anomaliesoftheteeth are also congenital, 
 especially the disposition to shear- mouth due to narrowness be- 
 tween the rows of teeth in the inferior maxilla ; the persist- 
 ence of the incisor milk-teeth ; the occurrence of supernumer- 
 ary teeth (polyodontia), and canine teeth in mares. The fol- 
 lowing may also be mentioned : congenital dilitation of the 
 guttural pouches in foals which results in catarrh of 
 the guttural pouches ; congenital diverticulum of the 
 esophagus in horses as a result of aberation at the second 
 branchial cleft; congenital hernias in horses, dogs, and 
 swine, which occur in the form of umbilical, inguinal, and 
 perineal hernias. Perineal hernia (hernia perinealis, vesicalis, 
 cystocele) in dogs is due to a protrusion of the recto-vesical 
 excavation ; in bitches to a protrusion of the vesico- vaginal 
 excavation. Congenital adhesions of the anus and rectum 
 (atresia ani, atresia recti) have been seen in dogs 
 and swine. The formation of a cloaca (common opening 
 for the rectum and vagina, or bladder and urethra) is fre- 
 quently congenital in animals. According to Mayr one 
 must differentiate between typical and atypical forms, as well 
 as between cloacas that have, and do not have, fissures in the 
 bladder. The following are the most important of the latter 
 forms : atresia ani simplex, atresia ani vesicalis, 
 (anus vesicalis), atresia urethralis (anus urethralis), 
 atresia ani vaginalis (anus vaginalis), atresia ani 
 with cloaca formation at the vestibule of the 
 vagina (anus vestibularis), as well as anus vulva lis, 
 perinealis, and scrota lis. 
 
 Congenital Malformations of the Eye. — D e r m o i d 
 of the cornea is a congenital anomaly that is relatively 
 frequent in dogs and calves, it is also seen in horses, sheep, 
 and swine. It consists of a spherical projection of the skin 
 over the cornea at the external angle of the lid; Schindelka 
 has collected statistics on twenty-nine personal and reported 
 cases, nine of these were in cattle, eight in dogs ; I have 
 observed and operated fourteen cases in dogs. The following 
 
CONGENITAI. MALFORMATIONS 337 
 
 also, are not rare in dogs and horses: coloboma, that is, 
 congenital fissure and defect of the iris and tapetum ; congen- 
 ital cataract (cataracta congenita) , and atrophy of the 
 retina (amaurosis); hyperthrophy of the uveal 
 bodies in the horse ; congenital closure of the lids in dogs 
 (atresia palpebrarum congenita) ; congenital atro- 
 phy of the entire eye in dogs and foals (microphthalmus); 
 retention of portions of the pupillary membrane (membrana 
 pupillaris perseverans), as well as the vitreous artery 
 (arteria hyaloidea persistans); finally, atresia of 
 the lachrymal duct at its nasal opening. 
 
 Congenital Malformations of the Uddkr. — A con- 
 genital smallness of one or more quarters of the udder in com- 
 parison with the others (m i c r o m a z i a) is common in cows. 
 Abnormally large development of the milk-glands (macro- 
 mazia) in male animals, especially in billy-goats, forms an: 
 opposite condition. Complete failure of an udder in female 
 animals (aplasia or hypoplasia of the udder) is 
 rare. Congenital closure (atresia) of the openings of the 
 teats, as well as congenital stenosis of the teat-canal (steno- 
 sis) is occasionally observed in cows. Cows frequently have 
 an excessive number of teats or after-teats (six instead of 
 four) , and dwarf-teats, as well as failure of the fourth teat 
 (c o n gen i t a 1 1 y t h r ee- 1 ea t ed). 
 
 Congenital Malformations of the Skin.— In addi- 
 tion to dermoid cysts in the skin and subcutem (occurring 
 in dogs partly in the form of multiple furunculosis), horses, 
 cattle, and goats are frequently affected with a congenital 
 baldness (atrichia, alopecia); the opposite of this 
 condition, excessive growth of hair (hypertrichosis), 
 occurs in horses on the mane and tail. An abnormality that 
 is frequent in fully developed dogs consists in an excessive 
 growth of the claws, especially the after-claws (hy peron y- 
 chia), with excessive bending (on y ch o g r y posi s) and 
 growing into the skin (paronychia) ; according to my ex- 
 perience one per cent of all diseased dogs (540 cases in 70,000) 
 are thus affected. So-called "hornsaule" keratocele of the 
 horn-capsule is an abnormality that is sometimes congenital in 
 the horse. 
 
338 congenital malformations 
 
 Congenital Malformations of the Skeleton and 
 Limbs. — Abnormal smallness of the entire skeleton, in part a 
 result of fetal rachitis, is termed dwarf formation (micro- 
 somia or acromicria); the opposite condition, excessive 
 development of the limbs, is termed macrosomia, acro- 
 megalia, leontiasis ossea, etc. According to 
 Zschokke, restricted growth of the bones that depends on 
 a derangement in the development of the cartilage (achondro- 
 plasia) is termed cretinism ; that which depends on a de- 
 ranged ossification is termed rachitis. A surplus number 
 of entire extremities (pol5^melia) in the domestic ani- 
 mals is less frequently observed than an excessive number of 
 toes and claws (polydactylia); the latter anomallj' on 
 the anterior feet of swine, as well as on the inner surface of the 
 metacarpus in the horse, has been frequenth'' described and 
 successfully operated. The same is true of adhesions between 
 the claws to form a single claw (sy n d act y 1 i a) in swine. 
 Double formations also occur, especially in calves ; I have 
 operated one such case of omopagus parasiticus. 
 Failure of entire extremities (a m e 1 i a) , or single toes (p e r- 
 odactylus) is observed in new-born animals. Finally, one 
 occasionally finds congenital fissure formation in the bones of 
 the skull (cranioschisis), and the vertebral column 
 (spina bifida), the former is occasionally combined with 
 protrusion of the brain (e n c e p h a 1 o c e 1 e) , as well as con- 
 genital curvature of the vertebral column of the horse and deer 
 (kyphoscoliosis). 
 
 Congenital Malformations of thf Respiratory 
 Tract. — An abnormal enlargement of the bones 
 occasionally causes dyspnea and chronic nasal catarrh in 
 foals. Congenital deformities also occur in the trachea 
 in the form of stenosis, dilitation, and sabre-scabbard-like 
 flattening, it may also roll on its axis or assume the form of a 
 spiral. Goitre is very often congenital in puppies. The 
 following congenital malformations are also of importance : 
 ear-fistula (see page 90) and congenital deafness; I 
 have observed the latter several times, especially in Dalmation 
 dogs, when it was without doubt a hereditary affection. 
 
INDEX. 
 
 Abnormal fragility 193. 
 Abnormal granulations 21. 
 Abscess 34. 
 Acarus 184. 
 
 Accidental wound infection] dis- 
 eases 25. 
 Acne 324. 
 Acromegalia 229. 
 Acromicria 229. 
 Actinobacillosis 155. 
 Actinomyces 153. 
 Actinomycoma 153. 
 Actinomycosis 153. 
 Actinophytosis 138. 
 Actol 59. 
 Acuepressure 15. 
 Adenofibroma 113. 
 Adenoid 147. 
 Adenoma 147. 
 /Egropila 177. 
 African glanders 316. 
 Airol paste 60. 
 Alcohol 60. 
 Aloes, tincture of 60. 
 Alopecia 337. 
 Aluminum acetate 60. 
 Alveolar sarcoma 127. 
 Amelia 338. 
 Anchylosis 254. 
 Aneurysm 306. 
 Angioma 122. 
 Angioma racemosum 123. 
 Angiosarcoma 127. 
 Anorchid 334. 
 Anthrax 54. 
 Antiphlogi sties 83. 
 
 Antiseptic treatment of wounds 55. 
 
 Anus vaginalis 336. 
 
 Anus vesicalis 336. 
 
 Aortal aneurysm 307. 
 
 Aortal stenosis 312. 
 
 AphthEE 333. 
 
 Aplasia of the udder 337. 
 
 Aplasia of the testicles 334. 
 
 Apostema 34. 
 
 Aqua chlorata 60. 
 
 Argentum nitricum 59. 
 
 Arrest of hemorrhage 12. 
 
 Arteries, 305. 
 
 inflammation of, 305. 
 
 dilitation of, 306. 
 Arterioschlerosis 305. 
 Arthritis 234. 
 
 deformans 238. 
 
 fibrinous 244. 
 
 granular 243. 
 
 pannous 244. 
 
 purulent 236. 
 . pyemic 245. 
 
 serous 234. 
 
 sicca 244. 
 
 ulcerative 244. 
 
 uric 244. 
 Aseptic treatment of wounds 55. 
 Athermoa 150. 
 
 of the vessels 305. 
 Atherosis 305. 
 Atmocausis 16. 
 Atresia 96. 
 Atrichia 337. 
 Atrophy 96. 
 
 B 
 
 Bacillol 59. 
 
340 
 
 INDEX 
 
 Bacillus cellulaeformans 41. 
 
 pyocj'aneus 26. 
 
 pyogenes 26. 
 
 tetatii 52. 
 Bacterium coli 27. * 
 
 Bacteremia 38. 
 Bacteria of pus 25. 
 Bandage 61. 
 Bezoare 177. 
 Birth-mark 122. 
 Bismuth salts 60. 
 Bites 7. 
 Blackleg 54. 
 Bleeding i. 
 Blood-disease 16. 
 Blood-extravasate 65. 
 Blood-cysts 151. 
 Bone, atrophy of 228. 
 
 diseases of 190. 
 
 formation of 191. 
 
 fractures of 190. 
 
 glanders of 221. 
 
 development of 191. 
 
 hypertrophy of 229. 
 
 inflammation of 220. 
 
 necrosis of 226. 
 
 tuberculosis of 171. 
 
 wounds of 23. 
 
 tumors of 119. 
 Bone-caries 227. 
 Bone-callus 207. 
 Bone-fistuku 87. 
 
 Bone-marrow, inflammation of 221 
 Boric acid 60. 
 Botryomyces 161. 
 Botryomycoma 161. 
 Brachygnathism 336. 
 Bullous dermatitis 323. 
 Burns 325. 
 
 Burrow's solution 60. 
 Burste 259. 
 Bursitis 278. 
 
 Calcium permanganate 60. 
 Calf-lameness 245. 
 
 Callosity 112. 
 
 Callus 207. 
 
 Callus tumors 209. 
 
 Camphor 60. 
 
 Camphor spirits, bandage of 32. 
 
 Cancer 133. 
 
 Cancroid 134. 
 
 Carbolic acid 59. 
 
 Carbuncle 324. 
 
 Caries 91. 
 
 Carcinoma 133. 
 
 Caro luxurians 21. 
 
 Cartilage-tumore 117. 
 
 Cartilage-wounds 24. 
 
 Cataplasm 80. 
 
 Caustics 92. 
 
 Cellular theory 74. 
 
 Chemotaxis 73. 
 
 Chloride of zinc 60. 
 
 CholeBteatoma 127. 
 
 Chondroids 118. 
 
 Chromatophores 128. 
 
 Cicatrix 119. 
 
 Cicatricial contracture 22. 
 
 hypertrophy 22. 
 
 keloid III. 
 
 stenosis 97. 
 Cicatrization 19. 
 Clavus 148. 
 Cleft-palate 335. 
 Cloaca 336. 
 Club-foot 257. 
 Coagulation necrosis 91. 
 C(enuru9 cerebralis 182. 
 Cold 81. 
 
 apparatus for application.of 81. 
 Coloboma 337. 
 Colon-bacillus 27. 
 Combustion 325. 
 Comminuted fracture 195. 
 Compound fracture 194. 
 Compression 15. 
 Compression stenosis 97. 
 Concrements 174. 
 Condyloma 145. 
 Congelation 328. 
 
INDEX 
 
 341 
 
 Congenital malformations 334. 
 Congenital stenosis 97. 
 Connective-tissue tumors 99. 
 Connective tissue, 
 
 inflammation of 28. 
 Contra-fracture 192. 
 Control of hemorrhage 12. 
 Conquassion fracture 195. 
 Contused wounds 7. 
 Contusion 64, 253. 
 Cooling apparatus 81. 
 Corpora libera 177, 258. 
 Corpora oryzoidea 177, 258. 
 Cranioschisis 338. 
 Creolin 58. 
 Crepitation 200. 
 Cresol 59. 
 
 Crural paralysis 302. 
 Cryptogenic septicemia 40. 
 Cryptorchidism 334. 
 Cutaneous irritants 83. 
 Cutaneous horn 148. 
 Cylindrical-celled cancer 134. 
 Cylindroma 127. 
 Cysticercus celluloste 184. 
 Cystic calculi 175. 
 Cystoma 151. 
 Cysts 149. 
 
 D 
 
 Deafness 338. 
 Deforming arthritis 238. 
 Degenerative atrophy 96. 
 Degenerative cysts 151. 
 Decubitis 91. 
 
 Decomposition, bacteria of 29. 
 Demarcation, line of 95. 
 Depression 195. 
 Dermatitis 323 
 Dermatol 60. 
 Dermofilaria 183. 
 Dermoid of the cornea 336. 
 Dermoid cysts 100 
 Desmoid growth 99. 
 Diapedesis 73. 
 Diastasis 249. 
 
 Digital compression 15. 
 Dilitation 98. 
 Diphtheria 93. 
 
 Dislocation of fragments 195. 
 Distomum hepaticum 184. 
 Distorsion 252. 
 Diverticulum 98. 
 Dumdum bullet 11. 
 
 Ear-fistula 90. 
 Eburnation 221, 229. 
 Ecchondroma 117. 
 Ecchymosis 65. 
 Ectasia 98. 
 
 Ectopia of the bladder 337. 
 Eczema 325. 
 Edema-bacillus 49. 
 Edema, inflammatory 330. 
 
 malignant 49. 
 Elephantiasis 112. 
 Electric influence 329. 
 Embryonic theory 100. 
 Emigration 73. 
 Emphysema 331. 
 Emphysematous fetus 332. 
 Enanthema 325. 
 Encephalocele 338. 
 Enchondroma 117. 
 Endarteritis 305. 
 Endosteum 191. 
 Endothelioma 127. 
 Endothelial cancer 127. 
 Enostoses 119. 
 Epispadia 335. 
 Epithelial growths 99. 
 Epithelioma 148. 
 Erosion 227. 
 Erysipelas 46. 
 Erythema 323 
 Eschar 92. 
 
 healing under 21. 
 Exanthema 325. 
 Exfoliation 228. 
 Excretion-fistula 87. 
 
342 
 
 INDEX 
 
 Exostosis 119. 
 
 Expiration-emphysema 331. 
 Exudate 86. 
 Extravasate 65. 
 Extravasation-cyst 151. 
 Exudation-cyst 151. 
 
 Facial paralysis 301. 
 False joint 209. 
 Farcin d'Afrique 316. 
 
 du boeuf 317. 
 Fascist 283. 
 
 necrosis of 297. 
 
 rupture of 298. 
 Fatty tnmor 1 13. 
 Ferment fever 39. 
 Fever 37. 
 Fibroblasts 18. 
 Fibro-epithelial new-formations 
 
 144. 
 Fibrocarcinoma 134. 
 Fibroma 107. 
 Fibroid 107. 
 Fig-wart 144. 
 Filaria cincinnata 183. 
 
 hemorrhagica 183. 
 
 irritans 183. 
 
 lachrymalis 183. 
 
 medinensis 184. 
 
 papillosa 183. 
 Fire-mark 122. 
 Fissure 196. 
 Fistula 86. 
 
 Fistula of lateral cartilage 88. 
 Flat-foot 257. 
 Foal-lameness 245. 
 Folliculitis 324. 
 Formalin 259. 
 P'ractures 190. 
 Fragilitas ossium 193. 
 Free bodies 177. 
 Freezing 328. 
 Foreign bodies 178. 
 Fungus heniatoides 123. 
 
 vasculosus 123. 
 Furunculosis 524. 
 
 Galactococcus 320. 
 
 Galls 275. 
 
 Gangrene 91, 95. 
 
 Gangrena nosocomialis 53. 
 
 Gangrenous emphysema 95. 
 
 Gas-gangrene 95. 
 
 Gas-phlegmon 31. 
 
 Gastric fistula 90. 
 
 Gastrophilus 183. 
 
 Genuine cysts 151. 
 
 Germ theory 100. 
 
 Giant-celled sarcoma 126 
 
 Glanders 53. 
 
 Glands, inflammation of 318. 
 
 Glandular-celled cancer 134. 
 
 Glioma 130. 
 
 Goitre 147. 
 
 Gonitis 241. 
 
 Gout 246. 
 
 Granulation 119. 
 
 Granuloma 21. 
 
 Gregarintu 292. 
 
 Gun-shot wounds 8. 
 
 H 
 
 Hair-balls 180. 
 Hair-lip 335. 
 Halisteresis. 
 Healing per primam 17. 
 
 per secuiidam 19. 
 
 per tertiam 20. 
 
 under an eschar 21. 
 Heat 80. 
 Heat-stroke 329. 
 Hemangioma 122. 
 Hemangiosarcoma 127. 
 Hematoma 65. 
 Hemiplegia 299. 
 
 Hemoglobinemia following burns 
 Hemophilia 16. [326. 
 
 Hemopis vorax 184. 
 Hemorrhage i. 
 
 arrest of 12. 
 Hemorrhoids 315. 
 Hermaphroditism 335. 
 
INDEX 
 
 343 
 
 Hernia 185. 
 
 Histoid tumors 100. 
 
 Heat-stroke 329. 
 
 Hodgkin's disease 125 
 
 Horn, cutaneous 14S. 
 
 Horny cicatrix 22. 
 
 Horse-leech 184. 
 
 Hospital-gangrene 53. 
 
 Hydrocele 282. 
 
 Hydrops of tendon-sheaths 285. 
 
 Hygromata of mucous bursfe 280. 
 
 of tendon-sheaths 275. 
 Hyperonychia 337. 
 Hyperostoses 119. 
 H\'poderma bovis 183. 
 Hypodermoliths 183. 
 Hypoplasia of the udder 337. 
 Hypospadia 335. 
 Hystriciasis 149. 
 
 I 
 
 Ichorous inflammation 77. 
 Ichthyosis 149. 
 Incised wounds 6. 
 Idiopathic fractures 193. 
 Impaction 195. 
 Impression 195. 
 Inactivity, atrophy of 96. 
 Incised wounds 6. 
 Infectious tumors 152. 
 Infection, septic 40. 
 Inflammation 72. 
 Inflexion 188. 
 Infraction 195. 
 Inspiration-emphysema 331. 
 Intestine, fistula of 87. 
 
 calculus of 176. 
 Intestinal hernia 185. 
 Intestinal prolapse 189. 
 Interstitial myositis 286. 
 Intoxication, septic 41. 
 Invagination 188. 
 Inversion 188. 
 Iodoform 59. 
 Irrigation, permanent 81. 
 Itrol 59. 
 Ixodes ricinus 184. 
 
 Joint-bodies 258. 
 Joint, caries of 243. 
 
 contracture of 156. 
 
 contusion of 253. 
 
 diseases of 232. 
 
 distorsion of 253. 
 
 empyema of 237. 
 
 galls of 235. 
 
 hydrops of 235. 
 
 inflammation of 233. 
 
 luxation of 247. 
 
 rheumatism of 244. 
 
 sprain of 252. 
 
 stiffness of 254. 
 
 villi of 232. 
 
 K 
 
 Keloid rii. 
 Keratocele 14J 
 Keratoma 148. 
 Keratosis 148. 
 Kyphosis 258. 
 
 Labium leporinum 335. 
 Laceration 70. 
 Lacerated wounds 7. 
 Laryngeal tuberculosis 170. 
 Lateral cartilage, fistula of 88. 
 Leiomyoma 120. 
 Leontiasis 229. 
 Ligature 15. 
 Lightning-stroke 329. 
 Lipoma 113. 
 Lipomasia 296. 
 
 Liquefactive degeneration 191. 
 Longitudinal fractures 195. 
 Lordosis 258. 
 Lugol's solution 59. 
 Luxation 247. 
 Lymphadenia 125. 
 Lymphangioma 123. 
 Lymphadenitis 318. 
 
344 
 
 INDEX 
 
 Lymphadeiioma 124. 
 Lymphangiosarcoma 127. 
 Lymphangitis 316. 
 
 Lymph-glands, inflammation 
 
 of 318. 
 Lymphoma 124. 
 Lymph-cysts 317. 
 Lysol 59. 
 
 M 
 
 Maceration 91. 
 
 Macrochelia 124. 
 
 Macrodactylia 229. 
 
 Macroglossia 124. 
 
 Macromazia 337. 
 
 Macrosomia 338. 
 
 Macula 323. 
 
 Malformations 334. 
 
 Malignant edema 49. 
 
 Malignant lymphoma 124. 
 
 Margaritoma 127. 
 
 Massage 82. 
 
 Mastitis 320. 
 
 Medullary cancer 134. 
 
 Melanocysts 128. 
 
 Melanosarcoma 127, 131. 
 
 Melanosis 127. 
 
 Meliceris 149. 
 
 Metnbrana pnpillaris perseverans 
 
 337- 
 Mesarteritis 305. 
 Metastasis 40. 
 Meteorism 332. 
 Micrococcus ascoformans 161. 
 Microphthalmus 337. 
 Miescher's tubules 184, 292. 
 Milk-calculi 178. 
 Milk-fistula 90 
 Micromazia 337. 
 Microphthalmus 337. 
 Microsomia 338. 
 Monoplegia 299. 
 Monorchidism 334. 
 Mortification 95. 
 Mucous bursse 260. 
 
 inflammation of 278. 
 Mucous degeneration of the tur- 
 binated bones 117. 
 
 Mucous tumors 116. 
 Mucous membrane, inflamma- 
 tion of 332. 
 Mucous cysts 149. 
 Mummification 95. 
 Mures arliculorum 258. 
 Muscles 283. 
 
 atrophy of 295. 
 
 diseases of 283. 
 
 hypertrophy of 297. 
 
 inflammation of 286. 
 
 luxation of 295. 
 
 rheumatism of 287. 
 
 ruptures of 293. 
 
 tumors of 120. 
 
 wounds of 23. 
 Myeloid 126. 
 Mycofibroma 161. 
 Myoma 120. 
 Myositis 286. 
 Myxedema 117. 
 Myxoma 116. 
 Myxoscarcoma 126. 
 
 N • 
 
 Nsevus 123. 
 Nasal polypi 109. 
 Nearthrosis 250. 
 Necrosis 91, 95. 
 Necrosis-bacillus 93. 
 Nerves, diseases of 290. 
 
 inflammation of 302. 
 
 paralysis of 299. 
 
 tumors of 121. 
 
 wounds of, 24. 
 Neuritis 302. 
 Neuroma 122. 
 Neurotomy 304. 
 
 o 
 
 Obliteration 96. 
 Obturation-stenosis 97. 
 Odontoma 150. 
 CEstrus ovis 183. 
 Omarthritis 242. 
 Omentum, prolapse of 189. 
 
345 
 
 Omapagus parasiticus 33S. 
 Omphalitis 245. 
 Onychogryposis 337. 
 Onychoma 148. 
 
 Open treatment of wounds 61. 
 Organization of hematomata 67. 
 Organization of thrombus 13. 
 Organoid tumors 100. 
 Ossifying myositis 291. 
 
 periostitis 217. 
 Osteoblists 191. 
 Osteoclasts 191. 
 Osteoma 119. 
 Osteomalacia 229. 
 Osteomyelitis 216. 
 Osteophytes 119. 
 Osteoporosis 228. 
 Osteopsathyrosis 193. 
 Osteosarcoma 128. 
 Osteoschlerosis 221, 229. 
 Ostitis 220. 
 
 P 
 Pachyderma 112. 
 Palatoschisis 335. 
 Panaritium 33. 
 Papilloma 144. 
 Paralysis 299. 
 Paraplegia 299. 
 Parasites 182. 
 Paresis 299. 
 Paronj'chia 337. 
 Pentastomum taenoides 183. 
 Percussion 82. 
 Periarthritis 246. 
 Periostitis 217. 
 Perithelioma 127. 
 Perodactylus 338. 
 Pes varus 257. 
 Petechia 65. 
 Phagedena 91. 
 Phagocytes 73. 
 Pharyngeal lymphomata 157. 
 Phimosis 335. 
 Phlebectasia 314. 
 Phlebitis 313. 
 Phleboliths 14. 
 
 Phlegmon 28. 
 Phytobezoare 177. 
 Pigmented sarcoma 127. 
 Plaster-of-Paris bandage 212. 
 Pneumatosis 331. 
 Pododermatitis 338. 
 Podotrochlitis 279. 
 Poisoned wounds 8. 
 Polyarthritis 234. 
 Polydactylia 338. 
 Polymelia 338. 
 Polyodonlia 336. 
 Polypi 109. 
 Pomphus 324. 
 Preputial calculi 178. 
 Pressure atrophy 96. 
 Pressure necrosis 91. 
 Priesnitz bandage 80. 
 Prognathism 335. 
 Prolapsus 18S. 
 Prostatic calculi 178. 
 Proteus 41. 
 Psammoma 127. 
 Pseudo-arthrosis 209. 
 Pseudo-carcinoma 138. 
 Pseudo-glanders 316. 
 Pseudo-hermaphrodite 335. 
 Pseudo-leukemia 125. 
 Psorospermia 184. 
 Ptomaines 41. 
 Puerperal blackleg 54. 
 Puerperal pyemia 44. 
 Puerperal septicemia 43. 
 Pulsion-diverticulum 98. 
 Pultaceous cysts 150. 
 Punctured wounds 6. 
 Pus 27. 
 
 l)acteria of 25. 
 Pus bonum 27. 
 Pus-cocci 25. 
 Pus-fistulae 87. 
 Pustule 324 
 Putresence 91. 
 Pyemia 44. 
 Pyemic arthritis 245. 
 Pyocyanin 26. 
 
346 
 
 INDEX 
 
 Pyoktanin 6i. 
 Pyoxanthin 26. 
 
 Quittor 88. 
 
 R 
 
 Rabies 54. 
 Rachitis 230. 
 Radial paralysis 301. 
 Ranula 149. 
 Ray-fungus 153. 
 Regeneration of tissue 23. 
 Renal calculi 175. 
 Reposition of bone-fractures 211. 
 Retention of bone-fractures 211. 
 Retention-cysts 149. 
 Rhabdomyoma 120. 
 Rhinoschleroma 112. 
 Ringbone 241. 
 Rontgen-rays 203. 
 Roseola 323. 
 
 Round-celled sarcoma 126. 
 Rupture 70. 
 
 Salicylic acid 60. 
 Salivary fistula 90. 
 Salivary calculi 177. 
 Sapremia 41. 
 Saprophytes 41. 
 Sarcoma 125. 
 Sarcosporidia 184. 
 Scab, healing under 21. 
 Schleroderma 112. 
 Schlerosis 112. 
 ScirrhuB 134. 
 Scoliosis 258. 
 Secretion-fistula 90. 
 Senile atrophy of bone 229. 
 Septicemia 40. 
 Septicopyemia 40. 
 Septic phlegmon 30. 
 Sequester 91. 
 Schleroderma 112, 324. 
 Schlerosis 112. 
 
 Shot-wounds 8. 
 
 Silver nitrate 59. 
 
 Skin, inflammation of 323 
 
 diseases of 323 
 Spavin 239. 
 
 Spermatic cord, fistula of 162. 
 Sphacellus 91. 
 Spina bifida 338. 
 Spina ventosa 156. 
 Spindle-celled sarcoma 126. 
 Spiritus 60. 
 
 bandage of 32. 
 Stab-wound 6. 
 Spontaneous bone-fracture 192. 
 
 luxation 248. 
 Spiroptera sanguinolenta 184. 
 Splinter-fracture 195. 
 Squamous-celled cancer 134. 
 Stagnation edema 330. 
 Staphylococcus 25. 
 Stasis 73. 
 Steatoma 1 14. 
 Stilt-foot 256. 
 Stenosis 97. 
 Strangles 55. 
 Streptococci 26. 
 Streptococcus septicus 40. 
 Stricture 97. 
 Stringhalt 299. 
 Strongylus armatus 184. 
 Struma 147. 
 Sublimate 58. 
 Suffusion 65. 
 Sun-stroke 329. 
 Suppuration 25. 
 Syndactylia 338. 
 Synostosis 210. 
 Synovitis 233. 
 
 Tapping 82. 
 
 Tannoform 59. 
 
 Tar 60. 
 
 Teeth, anomalies of 336 
 
 Teleangiectasis 122. 
 
 Tendinitis 264. 
 
INDEX 
 
 347 
 
 Tendons 259. 
 
 diseases of 264. 
 
 inflammation of 264. 
 
 luxation of 270. 
 
 necrosis of 270. 
 
 rupture of 267. 
 
 wounds of 23. 
 Tendon-sheath 260. 
 
 galls of 275. 
 
 inflammation of 272. 
 Tendinous stilt-foot 266. 
 Tendovaginitis 272. 
 Tenonitis 264. 
 Teratoid tumors 100. 
 Teratoma 100. 
 Tetanus 51. 
 
 bacillus of 52. 
 Thioform 60. 
 
 Thrombosis of femoral arteries 308- 
 Thrombus 13. 
 Ticks 184. 
 
 Tooth-follicle cyst 150. 
 Tooth-fistula 89. 
 Tooth-teratoma 150. 
 Torsion 15. 
 
 Traction-diverticulum 98. 
 Transplantation 63. 
 Trigeminus, paralysis of 301. 
 Triorchid 334. 
 Trismus 51. 
 Tuberculosis 166. 
 Tumor 98. 
 Tumor albus 243. 
 
 cavernosus 133. 
 
 fibrosus 68. 
 Tyloma 112. 
 Tympanitis 332. 
 
 u 
 
 Udder, actinomycosis of 159. 
 
 botryomycosis of 163. 
 
 tuberculosis of 167. 
 Ulcer 84. 
 
 Ulceration 84. 
 Urachus, cystic 335. 
 
 fistula of 335 
 Urinary fistula 90. 
 Urinary calculus 175. 
 Urticaria 324 
 Uterus, prolapse of 190. 
 tuberculosis of 170. 
 
 Vagina, prolapse of 189. 
 Vaporization of uterus 16. 
 Varix 314. 
 Veins, dilitation of 314. 
 
 inflammation of 313. 
 Venous calculi 14. 
 Verruca 144. 
 Vessel-tumors 122. 
 Villous cancer 134. 
 
 w 
 
 Warmth 80. 
 Warts 144. 
 Wildseuche 55. 
 Winddorn 156. 
 Withers, fistula of 89. 
 Wolf's jaw 335. 
 Wooden-tongue 155. 
 Wounds I. 
 
 bandaging of 61. 
 
 diphtheritic 53. 
 
 healing of 17. 
 
 treatment of 55. 
 Wound fever 37. 
 Wound infection diseases 25. 
 
 Xanthoma 127. 
 
 Zestocausis 16. 
 
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 warm praise. With its companion volumes, will form a valuable addi- 
 tion to the literature of veterinary medicine. — "Jour, of Comp. , Path, 
 and Therapeutics." 
 
 Published by the author. Sent, express prepaid, on 
 receipt of price. 
 
 General Surgery 
 
 BY DR. MED. EUGEN FROHNER— Professor in the 
 Royal Veterinary High School in Berlin. Authorized 
 Translation from The Third Revised Edition, by D. 
 HAMMOND UDALL, B.S.A.. D.V.M., Associate Professor 
 of Surgery and Obstetrics, Ohio State University, Columbus, O. 
 The translation of Frohner's General Surgery has been 
 undertaken to meet the need of an English text-book on the 
 subject. This text-book is Vol. II. of a hand-book of seven 
 volumes written by various authors and edited by the late 
 Prof. Joseph Bayer, of Vienna and Prof. Eugen Frohner of the 
 Berlin Veterinary School. One other volume of this hand- 
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 speaking veterinarians. 
 
 The reputation of Prof. Frohner as a writer of text-books 
 
 is too well known to require explanation. This translation is 
 
 from the 1905 edition ; the subject is presented in a scientific 
 
 manner ; is both concise and complete, and based on the 
 
 experience of many years of carefully prepared statistics from 
 
 the largest clinic of its kind in the world. $3.00 net. 
 
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 VETERINARY PUBLISHERS AND BOOKSELLERS 
 
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BY PIERRE A. FISH, D.Sc, D.V.M. Professor of 
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 Veterinary Doses and Prescription Writing 
 
 A full list of drugs with their doses for the different do- 
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 of medical terms applicable to Veterinary medicine. Pre- 
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 Elementary Exercises in Materia Medica and 
 
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 A laboratory manual treating of the more commonly used 
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 Second Edition. Revised and enlarged. $1.50 net. 
 
 There are features in this book which betoken a grateful advance 
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 Exercises in Physiology 
 
 A laboratory manual. Part I., Chemical Physiology. 
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 Second Edition. Revised and enlarged. $1.50 net. 
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