toxines, elaborated by the staphylococcus aureus, produce an active
cellular hyperplasia, the rapid death of the newly formed cells, a disso-
lution of the intercellular substance, and, by reflex action, a vaso-dila-
tation which accelerates the diapedesis. Then, in last consideration the
microbes of suppuration would stimulate it by the pyogenic substances
that they produce, and suppuration would be but the effect of a re-
action of the tissues against some irritating substance, whether produced
by living beings or others of a purely chemical nature.

But, interesting as those data of experimentation are, they are not to
be taken into consideration from a practical point of view. All sup-
purative inflammation that we meet with among our patients, is to be re-
garded as microbic ; all is to be considered as the result of an infec-
tious process.

In general, phlegmons are isolated occurrences, with a more or less
rapid development ; it is not, however, rare to observe several simul-
taneously on the same subject, either in the same, or in different re-
gions. We have seen on one leg of a horse or of a dog, numerous
cutaneous and sub-cutaneous abscesses, brought on by the two staphy-
lococci. Eberhart has described a kind of " phlegmonous diathesis,"
which, in one case of a horse, was manifested for seven months by
abscesses on the four extremities. Hiibner treated a horse upon which,
in the course of two months, 250 abcesses appeared ; some of these were
the size of a child's head.

Whether the development of the abscesses be quick or slow, whether
the local phlegmasic phenomena be slightly marked or acute and gener-
ally disturbing, the signs obtained by the explorating puncture of a
tumour rarely leave room for a doubtful diagnosis. In doubtful cases,
that of an abscess of the thoracic or of the abdominal walls, or of
•deep abscesses of the neck and extremities, the nature of the diagnosis
TTiust be at once established by a probing aseptically performed.

An antiseptic treatment of any traumatism is the surest way to avoid
â– abscesses. During winter and rainy seasons, wounds of the lower
parts of the extremities, soiled with mud, are often complicated by-
gangrenous phlegmons. These can be prevented by disinfecting the
"wounds and covering them afterward with a dressing, or with a coat of
â– oil of cade or of tar. (Moller.)

Let us flrst consider the indications of the therapeutics of warm

JiLBSCESSES.

We have seen the means by which acute inflammation, threatening



104 VETERINARY SURGICAL THERAPEUTICS.

suppuration, can be overcome. By tepid antiseptic compresses, warm
baths, emollient and analgesical preparations — if pain is great, scari-
fications made with care — sometimes the metamorphosis of the phleg-
mon into an abscess may be avoided ; but this is only in a limited num-
ber of cases. When the phlegmasia is of an infectious nature, the
abortive treatment almost always fails. When once the pyogenic
microbes have collected in a mass in the inflamed tissues, suppuration
is scarcely avoidable. In days past, the absorption of the pus of
recent abscesses of small dimensions was often attempted, by making,
upon the region where the purulent collections existed, repeated applica-
tions of camphorated ointment. This treatment was sometimes success-
ful in the case of man (Velpeau says he used it with advantage) ; but
the cases where it proved successful were exceptional. This method is
now abandoned.

In order to make the pyogeny active to reduce to a minimum the
duration of purulent infiltration, and to precipitate the formation of the
abscess, sometimes emollients, sometimes vesicating agents, are used.
In general, as soon as the inflamed tissue suppurates, the pain resulting
from the inflammation diminishes ; if it continues sharp, one may, ii-i
the case of irritable subjects, continue the measures prescribed for acute
inflammation. For a long time, the ointments of poplar, belladona,
camphor, and the camphorated and opiated oils were the most generally
used agents ; many veterinarians employ them still. Emollient and
analgesical preparations made with vaseline begin to be preferred now.
"When the region permits it, warm baths give the best results, especially
in the treatment of phlegmons of the extremities.

The systematic use of vesicating agents to accelerate tlie formation
of a pyogenic group is an essentially veterinary measure. These agents
excite the inflammation, accelerate the purulent degeneration of the
tissue ; and the time when the abscess is ready to be opened, as well
as that when the animal can be returned to work, is shortened.

The abcess is formed ; evident fluctuation proves it. Must it be
opened immediately in all cases, or must one wait for its spontaneous
opening ? Superficial abscesses, it has been advised, should be left to
themselves, and in general, those whose pus may easily progress
towards the skin. But this waiting has its inconveniences ; it delays
recovery, carries with it a cutaneous necrosis more or less extensive, and
is not free from serious dangers. Abscesses formed in the neighborhood
of articulations or of tendinous sheaths may open in those cavities ; those
of prepectoral glands and of the thoracic walls, in the pleura ; those
of the abdominal walls, in the peritoneum. Our publications contain
numerous examples of fatal accidents thus produced. Therefore, at
present, the puncture of an abscess is the absolute rule.



ABSCESS. 105

But at what time must it be made ? Generally, one should wait until
the abscess is ripe. If the puncture is made when the pus is not vet
entirely gathered, secondary centers may form in the inflamed zone and
impose other interferences.

Numerous cases are observed, however, where the veterinarian is
obliged to make the premature opening of purulent collections. When
these are deeply situated, under aponeurotic fasciae or in the neighbor-
hood of a splanchnic cavity, of a synovial or tendinous sheath, or close
to a large blood vessel, a bone, a tendon, a ligamentous cord or the
fibro-cartilages of the foot, then they must be opened at once, if serious
complications are to be avoided. The attractive theory of the constant
tendency of pus to progress towards the tegumentary surfaces has seen
its days. Examples are not rare of inflammations of the great serous
membranes, of articulations, or of necrosis of organs with dull nutrition,
induced by abscesses, the lancing of which had been too long delaved
Thus, s-alivary, stercoral and urinary abscesses, where numerous bac-
teriae will unite to bring on gangrenous or septic accidents, should be
lanced at once. Also, purulent collections, in regions where they may
interfere with the execution of important functions, must be opened as
soon as they are recognized by sure signs. In this place, we may
mention especially the sub-parotid abscesses which interfere with
deglutition or respiration -, those developed in the pelvis, which com-
press the rectum ; those of the scrotal region, which may close up the
sheath, prevent erection and interfere with micturation. In case of
the horse, the same rule is to be observed for abcesses of the digital
region, and for purulent gatherings under the hoof : the former have at
times a rapid development ; under the cutaneous chorion, which is very
resisting, the pus spreads, gives rise to excessive pains, macerates the
tendons, fibro-cartilages, and the bones, and sometimes reaches one
of -the phalangeal joints ; the latter, unable to make their way through
the horny covering, rapidly separate it from its tegumentar)- membrane
underneath, and, before escaping at the coronet, produce in the tissues
of the foot most serious disorders. At this point, we may understand
that phlegmons vary as to gravity, and spread more or less rapidly,
according to the microbic species which has caused them. Ordinarily,
those originating from streptococci are more diffused and affect more
the lymphatics than those due to staphylococci.

Abscesses may be opened with the bistoury, froMr, or with the cautery.

The straight bistoury is most commonly used to lance abscesses.
The sharp edge of the instrument should be turned upwards or down-
wards, as the case may be ; the thumb and index, resting on the sides
of the blade, more or less close to the point, according to the depth of
the cavity to be opened, should limit the introduction of the blade. A
narrow incision is sufficient for superficial abscesses ; if they are large,



I06 VETERINARY SURGICAL THERAPEUTICS.

a free cut is required. For some deep abscesses, especially in the
regions where organs exist which must be respected, the tissues should
be divided layer by layer ; in some cases, it is wise, where once the skin
is cut, to lay the bistoury aside and divide the tissues underneath with,
he grooved director, the incision being afterwards enlarged with the
scissors or a blunt blade. In general, the incision is made parallel to
the muscles and to the vasculo nervous trunks of the region.

When one opens an abscess of the canon, fetlock or digital region
the sharp edge of the bistoury must always be directed towards the
shoulder. If it is directed towards the foot, and the animal, not suffi-
ciently under control, or irritated by the pain, should move his leg
suddenly, the tissues might be divided deeply and extensively ; and if
the abscess is on the sides of the fetlock, the digital blood vessels might
be opened, the ligaments or tendons cut, and the articulation opened.
We have seen in this way the division of the digital artery.

There are regions where a puncture, as simple as it may appear,
gives rise to serious results when it is not methodically performed.
Before plunging the instrument into the abscess, one must take
into consideration the exact situation of the blood vessels, and bear i»n
mind that those may be displaced by the purulent collection. In push-
ing the bistoury deeply into such regions, an artery, a vein or a nerve
may be wounded, and as the result, a hemorrhage difificult to control, or
paralytic accidents may follow. Suppurative phlebitis has been more
than once the consequence of punctures made without sufficient care.

The opening of the abscess must be made in the most dependent
point, so as to allow the free exit of the pus. It is not necessary that
it should be large ; the discharge keeps it open until cicatrization is
complete. The custom of introducing the linger into the cavity to
break the band that may be found in it is not necessary, since i-n this
way tissues which may serve for cicatrizaiion are destroyed, or vascular
or nervous branches torn. An examination of the cavity ought not to
be made except for the sake of finding out the arrangement of its parts,
or of seeing whether it contains foreign bodies, has cul-de-sacs, or con-
tains pockets where the pus, collecting, may give rise to purulent infil-
trations. When the puncture is made at the lower point, and the pus
escapes as it is formed, recovery follows quickly. But if the purulent
cavity is large, it is advantageous, after it has been washed with an
antiseptic solution, to place in the opening a " rubber drain " with
thick walls, and sufficiently large to allow the running through it of the
albuminous masses, clots, or remains of necrosed tissues. 'J'his drain
is fixed to the cutaneous borders of the wound by a suture of a stitch or
two.

In regions where there are pockets, more or less deep, in which the
pus collects, and cannot be squeezed out except by pressure below the



ABSCESS. 107

incision, the inflammation continues and the granulating process is
delaj'ed. There are two ways of overcoming this stagnation of the pus,
namely, by a larger wound or a counter opening. If the pocket is small
and below the puncture, division of the tissues is not dangerous and the
wound may be enlarged without danger ; otherwise connkr openi-ngs
should be made. They are necessary in deep abscesses of the throat,
neck, poll, withers, abdominal walls, or extremities ; and if interference
has not been made early, wide undermining soon takes place, the bottom
of which is ordinarily far below the point of the original puncture.
Counter openings can be made by introducing through the incision of
the abscess a curved director, which, pushed towards the bottom of the
pocket, raise the walls of the abscess, which are then divided from out-
wards inwards. If the director is not used, the exact situation of the
bottom of the pocket is made oat with the finger, and at a correspond-
ing point the skin and subcutaneous tissues are punctured from out-
wards inwards. A fenestrated drain is then put through this second
opening and secured. Several counter openings may be required : they
are made in a similar way. For drainage, tents^made of oakum, disin-
fected horse-hair, or silk-worm gut are used, but the rubber tube is
better ; the escape of the pus is easier. Injections into the purulent
cavity, to wash it out, are also very advantageous.

To open the abscesses of mucous cavities a long trocar or a straight
"bistoury (protected by cotton or wadding wrapped round the blade within
two or three centimeters of the point) are used. Some abscesses of the
rectum can be opened with the index finger thrust suddenly through the
rectal mucous membrane, which is thin at the zone of fluctuation. For
others, are recommended a concealed bistoury, or one used for the punc-
ture of the vagina in ovariotomy.

Atone time the cautery was extensively used for opening abscesses.
This has the advantage of giving rise only to slight hemorrhage, and
does not have the danger of possible slippings of the instrument, and
therefore the cutting of nerves or large blood vessels, if the animal sud-
denly struggles. But it will escape the blood vessels or nervous bands
of the inflamed centre no better than the bistoury, if it be introduced
in their tracts. If the cautery be selected, one should take a long
pointed one, heated to white heat, place it upon the centre of the growth,
and by a double movement of pressure and semi-rotation push it in,
until a sensation of resistance overcome is perceived, which indicates
that the cavity is entered. The pus sometimes escapes immediately,
but sometimes not until the instrument is withdrawn.

The trocar has been recommended for opening deeply situated
abscesses or those of regions containing large vascular branches which
might be divided by the bistoury ; but, like the cautery, it does not
always escape those organs, and in the zones which are called " dan-



I08 VETERINARY SURGICAL THERAPEUTICS.

gcrous,'^ especially the parotid region, one should rather prefer to the
cautery or the trocar the following modus ofera/idi: with the point of a
straight bistoury, a simple cutaneous puncture is made in the centre of
the phlegmonous tumor, a grooved director is then thrust, by its dull
extremity, into the tissues until it has reached the centre of the cavity ;
by moving the director up and down, the tract it has made is enlarged.
Then draw it out and replace it with scissors having dull points. Then
when the director is removed, with their blades open and separated,
lacerate the tissues without danger of injuring important organs, and,
at the same time, leave a wide opening for the escape of the pus. A
counter-opening is made in the same manner. This technique is superior
to all others.

After the abscess is opened, and before the drain is placed, the parts
should be washed with an antiseptic solution — preferabl}' carbolic acid
(3-5 ^), corrosive sublimate (i in 1000), cresyl (3-5 fc), or tincture of
iodine. During the days following, until the cavity has all granulated,
two or three similar injections should be made through the drain tube.
Of course those should be made in various quantities, according to the
fetid odor of the pus and the seat of the abscess, which might suggest
the possibility of infectious complications. When the discharge has
a tendency to dry, the drainage tube should be taken off. Atomizations
of iodoform ether, used by some practitioners, are not any more ad-
vantageous than simple antiseptic injections.

When the suppuration lasts a longer time than abscesses ordinarily
require to be filled, the wound becomes fistulous, and various secondary
lesions may exist. Sometimes it is because of a foreign body that
must be extracted, or of an undermining where the walls have to be
modified, or it is on account of a necrotic lesion which, if it will not
yield to strong antiseptic solutions, must require another operation.

Septic or gangrenous phlegmons should be opened at once and treated
with strong disinfecting solutions. If there are portions of necrosed
tissues, they should be cut away. Continuous irrigation may also be
used with advantage.

After the pyogenic membrane has been cleaned, a slight pressure to
bring the walls of the sac more or less closely together, will accelerate
the cicatrization. Some authors, considering the lining membrane of a
warm abscess like the surfaces of a fresh wound, suggested bringing the
walls close together, after the careful and complete washing of the
cavity, in order to try to obtain union by first intention. This practice
generally failed, although it was of advantage in reducing the dimen-
sions of the cavity and in shortening the duration of the cicatrizations.
With antisepsis, the adhesive reunion of the walls of the abscess has
been attempted, after the walls have been cleaned with the curette and
disinfected with a strong carbolic solution. The results obtained, how-



ABSCESS. 109

ever, have not been encouraging. In the generality of cases, the sur-
faces, thus prepared and opposed to each other, continue to suppurate.
Sometimes the tissues, where the abscess has developed, remain tume-
fied for a long time and become indurated. The best treatment for
such consecutive indurations, is cauterization with penetrating points.

The " hemorrhagic phlegmon " of oxen is generally produced by pricks
of the goad with which they are driven ; sometimes it has been observed
after a violent blow, and also without any well known cause (Guittard)-
In some cases it is on the outside, in others it is deeply situated in mus-
cular interstices.

It is characterized at first by a large, diffused, renitent swelling, more
or less painful, which later becomes fluctuating. It is easily distin-
guished from serous collections and from the crepitating tumors of
symptomatic anthrax.

Cold abscesses differentiate from the preceding by a weak degree
of inflammatory reaction, or its absence altogether. The nature and
etiology of these are no less complex than of those of an acute charac-
ter. Tuberculous abscesses, so common in the human species, are excep-
tional in our domestic animals.

When multiple tumors develop rapidly and simultaneously in various
regions of the body, they are not always, as often supposed, cold puru-
lent collections. Sometimes they are true neoplasms ; sub-cutaneous
sarcomas may develop somewhat rapidly, and resemble cold abscesses.
We have observed a remarkable case of this kind among horses.

Hard cold abscesse^s, freq-uent among horses, in regions which support
the various parts of the harness (point and anterior border of the
shoulder, poll, superior part of the neck, withers, girth) do not get well
except by puncture. The central purulent collection in them is often of
small size ; and several probings maybe necessary to open it. These
probings are made with the straight, narrow-bladed bistoury, which is
thrust deep into the tumor. As soon as the centre of the abscess is
reached, if the pus exists in any quantity it escapes this way to the
surface. But the white {blanche) puncture, which fails to bring out pus,
does not necessarily mean that the abscess has no pus ; often the
bistoury does not reach the spot where it is, or passes alongside of it,
or the pus is so thick and caseous that it has no tendency to escape
through the way thus made. One need not hesitate to make new punc-
tures, and several tracts towards tlie centre of the indurated mass ; in
most cases the purulent cavity will be reached finally. But if the prob-
ing still remains fruitless, the inflammation which it causes is not with-
out a useful effect ; the pyogenic process is quickened, and the pus,
increasing in quantity, finally appears through one or another of the



I lO VETERINARY SURGICAL THERAPEUTICS.

openings made by the bistoury. The condition for the continuance
of the inflammatory tumor is removed, and the tumor then gradually
diminishes and soon disappears.

In numerous cases, it is necessary to enlarge the tract, from which the
pus flows. This is done with a bistoury, guided by a director, to make
a larger incision ; or by using a cautery heated to white heat, which is
thrust into the tract. A tent or a rubber drain is introduced and secured
in the wound when the enlargement of the incision has been made with
the bistoury. The drain, which insures the flow of the pus and allows
antiseptic or irritating injections, as the case may demand, into the
wound, is always preferable to a tent introduced into the tract of the
abscess.

Many practitioners use the cautery. It is not only dipped into the
indurated mass or introduced into the wound made by the puncture to
enlarge it, but it is also used to make a certain number of deep points,
to stimulate the resorption of the newly formed tissue. Often a vesicat-
ing preparation (blister, mercury ointment, or biodide of mercury oint-
ment) is applied all over the surface of the tumor to complete the oper-
ation and the action of the cauterization. The same means may be
used when the exploring punctures have failed to reach the abscesses.

When the cold abscess is in a region full of important organs (blood
vessels, nerves, and synovial membranes), the bistoury and the cautery
are not to be introduced deeply. The directions given in the chapter
on warm abscesses must be followed for these. Puncture with the
grooved director, after incision of the skin, is the best mode.

Soft cold abscesses should be opened in their most dependent part,
drained and irrigated afterwards with strong antiseptic solutions.

During distemper, voluminous cold abscesses may be seen appearing
in various regions ; they rapidly become fluctuating and ordinarily con-
tain a large quantity of pus. Their treatment does not differ from that
of ordinary abscesses : puncture, enlargement of the wound or counter
opening, drainage and frequent antiseptic injections.

Local secondary purulent collections, including congestive abscesses, re-
quire the same care, besides attending to the treatment suggested by their
various causes (necrosis, caries, phlebitis, inflammation of synovial
membranes, wounds of the oesophagus, of the rumen or of the urethra).
Multiple abscesses of the inferior regions of the extremities are some-
times accompanied by swelling of the leg, which may end in elephantiac
fibroma, when the rapid resolution of the phlegmasia is not obtained
by antiseptic balneation.

In cases of cold abscesses due to a diathesic condition (lymphatism,
rheumatism or anaemia) a general medication should be resorted to
(good hygiene, strengthening food, arsenical and iodous preparations).

The treatment of some dyscrasic abscesses (glanders) calls for no
attention. Animals which suffer from these should be killed.



GANGRENE. I I I

III.
GANGRENE.

Bacteriological discoveries have caused gangrene to be divided into
the aseptic on tlie one hand and the septic or infectious on the other.
We shall study the latter with the complications of the various trauma-
tisms. For the present we shall only consider microbian mortifications
and f/Vvv/wjT/'v'/v^/ sphacelus, in the genesis of which bacteria have played
a more or less active part.

On account of the multiplicity of the causes and of the complex
pathogeny of those gangrenes it can easily be understood that preventive
measures vary greatly according to circumstances. Let us observe,
however, that the git /ig/e/ies of ncn'ous origin (brought on by neuritis or
by lesions of the centres), those of a theromatous ?ind diabetic, as well as
those following thrombosis and embolism, are very rare in animals.

We shall first set forth the treatment of gangrenes, considered from
a general point of view ; afterwards we shall examine the therapeutics of
the two principal forms of sphacel of the soft tissues.

The prophylaxis of gangrene includes means deducted from the
numerous etiological conditions likely to produce it. When once the