influence of these conditions is attenuated or annihilated, one must, by
appropriate treatment, stop the processes which may bring on mortifica-
tion of the tissues. Among working animals, cutaneous gangrene of
the regions injured by the harness can be prevented, by seeing that
they are in good condition, and are supple and exactly adapted to the parts
with which they are to come in contact. In the case of disabled animals,
which, on account of pain, are obliged to keep a reclining position for a
number of days, the same object will be reached by providing them with
a thick bed, free from injurious foreign substances, or by obliging them
to rest first upon one side of the body, then on the other (by turning
them over). One should bear in mind that blisters and caustics, applied
in excess, have at times a violent action, which, extending beyond the
desired effect, bring on the mortification of the tegument and of the
first sub-cutaneous layers ; and also that the cautery, which we use so
frequently, easily produces similar results, if it is applied in violation
of the established rules, is put on too hot, or left too long in contact
with the skin. In cases where the extremities have been injured, where
the permanent application of a bandage or of a more or less compres-
sive apparatus is required, sphacel by arrest of the circulation may
be avoided either by using only methodical and moderate pressure
upon the iniured region, or by spreading the apparatus over the entire
extremity below the seat of the wound, beginning the application of the



112 VETERINARY SURGICAL THERAPEUTICS.

bandage at the digital region. In cases of very severe inflammation of
the skin and sub-cutaneous tissues, one should endeavor to keep up a
sufficient circulation, and the changes necessary for the physiological
functions of the cellular elements; and should also provide against deep
disorders and alterations incompatible with the presence of life, by
actively overcoming the phlegmasic phenomena, and above all by using
the means which antisepsis gives us. Deep scarifications, division of
the aponeuroses pressing upon the tumefied structures, often produce
remarkable results. In cases of violent contusions or of wounds from
extensive bruising, having a wide ischemic zone, damp compresses or
warm antiseptic baths are to be recommended : the innervation will
then return, the collateral circulation will become more active, the
anatomical elements, for a moment in danger, will by degrees recover
their original activity ; for the wounds of contusion, the extensive morti-
fication threatened will be reduced to its minimum, carrying only a few
mortified shreds from the edges of the traumatism. How to prevent
several gangrenes of toxic origin, especially that due to ergotism, has
been known since the day when facts established the intimate connec-
tion existing between the ingestion of food altered by toxic products and
the appearance of gangrenous disorders in animals which ate this food.
The only way is to stop its use immediately, change for some other food,
or make the stock pasture somewhere else. But economical reasons,
which dominate all questions relating to the keeping and preservation of
stock, would often have rendered the execution of these prophylactic
measures very difficult if gangrene by ergot had not become so rare in
most of the countries of Europe. As far as necrotic accidents are
concerned which may result from central or peripheral nervous centres,
— diabetes, thrombosis and embolism, — there is no efficacious prophy-
laxy against these.

Properly speaking, there is no curative treatment of gangrene. One
cannot, indeed, expect to return life to necrosed tissues. Several rules
ought to be observed, however, to hasten the slough of the dead parts
and assist the work of repair.

To limit the extension of the gangrene, assist the elimination of the
eschars, and hasten the picatrization of the wounds remaining ; such
are the principal rules of interference.

When death has taken place more or less extensively in the tissues,
the most important thing, if one wishes to confine the destruction, is to
arrest at once the action of the causes which have produced it. Gan-
grene of a cutaneous spot, brought on by compression, is prevented
from spreading, both in width and in depth, by putting a limit to the
compression. By an energetic interference in the case of gangrene from
severe phlegmasia one may avoid the formation of new sloughs within



GANGRENE. II3

the neighborhood of the centre of mortification. Though, let us re-
mark, that if infectious gangrenes are ordinarily rapid in their progress,
ordinary sphacels have but little tendency to radiate. The bistoury or
the cautery are used only to permit the discharge of eschars infiltrated
with liquids or the introduction of antiseptic preparations into the net-
work of the tissues in order to prevent putrefaction. In the great ma-
jority of cases, one uses either repeated carbolic or corrosive sublimate
lotions upon the dead tissues and the surrounding parts, or continual
bathing in those solutions. At this stage, the disorders produced by
gangrene can be determined. There are cases where the sphacel has
extended so much in width and in depth, and has made such ravages,
that recovery of the patient cannot be expected. Gangrenes due to the
obliteration of a vascular trunk demand the immediate killing of the
animal. Those which involve only superficial layers — skin and tissues
underneath — are sometimes serious in their consequences, when they
are in the neighborhood of joints or tendons ; they often are complicated
with synovitis, arthritis with or without necrotic accidents and after-
ward cicatricial retractions. One must foresee these complications,
avoid useless expense, and as quickly as possible come to a conclusion
as to the future recovery of the patient.

As soon as gangrene has ended its work the surrounding parts be-
come inflamed, and by their reaction of the mortified territory is settled
in its boundaries. This is a natural and constant phenomenon, which
is accomplished more or less rapidly according to the extent of the
slough and the vitality of the parts involved. If the separation is slow,
it can be hastened by exciting reactionary phlegmasia with irritants
(blisters, or any cantharidal preparations, etc.) ; if, on the contrary, the
elimination of the gangrenous masses is accompanied by an intense
inflammatory reaction, and the surrounding tissues are much swollen,
then warm lotions, often repeated, of antiseptic solutions, pure or mixed
with narcotic substances, according to the degree of the pain, should be
employed. If the pain is excessive, preparations of cocaine are useful.

As the boundary fissure increases, the pus increases ; if its escape
is prevented, or if it accumulates in the dividing trench, frequent disin-
fecting washes, or the use of absorbing or antiseptic powders is good,
as well as the making of counter openings and the placing of drains.
The eschars, macerated by the pus, infested with numerous micro-
organisms, putrefy rapidly, and spread over the wound liquids with re-
pulsive odor, favoring infections and poisons the organism. In such
cases, continued irrigation is beneficial. To it as well as to the antisep-
tics one must also have recourse when there are important organs deeper
down which may yet be healthy. Often the greater part of the slough is
•excised or removed by actual cauterization. This last mode is prefera-
able to the use of potential caustics, which used to be placed on the



114 VETERINARY SURGICAL THERAPEUTICS.

eschar, and which, uniting with it, rendered it imputrescible. If caustics
are deposited in small quantities over large and thick eschars, they are
harmless, but their action may spread and corrode healthy structures.
It has been wrongly said that they have an especial affinity for diseased
tissues, and that, if they are used with care, their destroying action re-
mains limited to gangrenous soft parts, as to suppurating or carious
bony tissues. As Reclus remarks, the legend of the " intelligent caus-
tics " is no longer current. When the sphacel is extensive, instead of
destroying the whole of the eschar, one may make with the red iron
scarifications close to one another, which having partly burnt, are after-
wards filled with disinfecting powders or liquids.

When the process of elimination is completed, the wound resulting
from the slough of the mortified tissues is at times simple and covered
with a layer of active, healthy granulations, and requires the same treat-
ment as solutions of continuity with loss of substance ; at other times it
is complicated with necrotic alterations (aj^oneurosis, tendon, liga-
ment, bone), or with lesions, involving large blood vessels,' and with in-
flammation of a synovial or of a splanchnic serous membrane.

The general treatment is important only in gangrenes of a dyscratic or
infectious origin. Narcotics should be used only in cases where the
pain is great. Antiseptics are always useful when the sphacels are
extensive and threaten infectious accidents. Local disinfection is
always far more important than any of the various internal medications
recommended.

There are special rules for the treatment of gangrene according to
the form it assumes.

Dry gangrene, which we meet most frequently in animals, v^'hether due
to the compressive action of the harness or to continued decubitus, are
generally accompanied by sharp pains while the process of sloughing^
goes on. According to their seat, they are treated sometimes with
emollient or narcotic preparations of vaseline, or most commonly with
vesicating agents which are better to quicken the slough of the eschars.
These, generally dried up and parchment like, putrefy only on their
borders, where they are macerated in pus; they do not, as in moist
gangrene, expose the pa^-ts to infectious accidents ; there is no objec-
tion to leaving them entire and intact until they drop. Partial excision,
however, is advisable for the extensive stickfasts of the withers and of
the neck, which have such an offensive odor. If the suppuration is
abundant, free disinfecting washings are to be insisted upon. In no
case are the scabs to be torn away, no more than other eschars
resulting from a dry mortification ; doing so might produce secondary
necrotic lesions in the cervical or dorsal regions or in the lower part of
the extremities ; and in the neighborhood of a joint, it might be followed



ULCERS. 115

by the opening of the synovial sac. In cases where the fissure of separa-
tion is very deep, the pus abundant, and its escape difficult, several
incisions may be made to relieve the difficulty.

With moist gangrene, as with the preceding, the work of defining and
eliminating the eschar must be trusted to nature. Interference here
should also be limited ; assist the work of demarcation and prevent
with disinfections the accidents likely to follow the putrefaction of dead
tissues. The wound should be frequently washed w'ith antiseptic solu-
tions (strong preparations of carbolic acid, creolin, chloride of zinc or
of lime, or of permanganate of potassium) ; thus, the odor from the
putrefying tissues will be much less marked. The powders of coal or
of coal tar, thrown upon the mortified parts and into the fissure of the
slough, will also diminish this odor very much and absorb the gas
escaping from the decomposing tissues. As soon as the eschar is loose,
its superficial layers can be cauterized, or excised with the bistoury or
the scissors, being careful not to touch the sound structure. If pain is
severe, the inflamed tissues should be covered with boricated or iodo-
formed vaseline to which cocaine has been added. The antiseptic
washes should be applied frequently until the wound is covered over its
entire surface with granulations. Incisions along the edges and counter
openings are more dangerous in this than in dry gangrene ; they would
better not be made unless they are urgent, and then they must be-
made with the actual cautery.

Diabetic gangrene (dog) receives the same local treatment as the moist
form. Besides this, an antidiabetic regimen should be instituted (meat,
milk, exercise), with the internal administration of antipyrine, alcalines,
and arsenic.



IV.
ULCERS.

In a general way, all suppurating wounds, without tendency to cica-
trization, deserve the name of ulcers. Glanders, tuberculosis, carcino-
sis, and scurvy give rise to symptomatic ulcers, simple accidents of the
infections to which they are related.

The group of idiopathic ulcers has been considerably reduced by the
progress of pathological anatomy. It only contains now ulcers from
" unknown causes," and seems condemned to disappear soon from the
nosological list. These ulcers are the consequence of arterial, venous
or nervous lesions, which reduce locally the resistance of the tissues
and seem to be under the influence of diathetic states, especially of
arthritism. They are less frequent in animals than in men.

From the surgical point of view, we will recognize : i. Inflamjnatory



Tl6 VETERINARY SURGICAL THERAPEUTICS.

ulcers, which are the seat of phlegmasic phenomena, more or less
severe ; 2. Ftnigous ulcers, characterized by exuberant granulations ;
3. Atomic nlce?'s, without vital reaction of the affected tissues ; 4. Callous
ulcers, with indurated borders, cartilage-like, due to a chronic inflam-
mation of long duration ; 5. Phagedenic ulcers, which spread rapidly
by a quick and continued mortification of the borders.

A great number of ulcers, especially those which result from a chronic
simple phlegmasia or from repeated irritations, get well rapidly ; for
these, all that is required is to place the diseased region under favor-
able conditions, protect it from the influences which have given rise to
it, and continue the same course. Others, notwithstanding the taking
of energetic measures, require a long time to heal. According to the
case, antiseptics, excitants, caustics, the bistoury or the red iron are to
be used.

Faiiiful, erethistic inflaimnatory ulcers must be treated with sprayings
or warm antiseptic baths, and cocained or iodoformed vaseline appli-
cations. Wadded dressings, covered with an elastic band to apply
moderate pressure, are often beneficial.

Against fungous ulcers, astringents may do good. But at times the
granulations must be destroyed with caustics (nitrate of silver, sulphate
of copper, chromic acid or permanganate of potassium), with the cautery,
or be excised with scissors, the bistoury or the curette. Antisepsis and
elastic compressions do the rest.

Atomic ulcers are treated with light and repeated cauterization of
nitrate of silver or the hot iron, then with antiseptic dressings.

To bring a more active vascularity to callous tilcers, and keep in them
the necessary hyperemia for granulating, one must use damp heat, alone
or combined with elastic pressure. There are cases where recovery is
obtained only by destruction of the edges of the wound, with the bis-
toury, caustics or the actual cautery.

Phagedenic ulcers require a quick interference. They are treated
with the solutions of carbolic acid, creolin, or chloride of zinc, used in
lotions or in baths, or by iodoform dressing, changed often. Should
these be powerless to stop the invading march of the ulcer, the red
iron has to be used.

The therapeutics of Symptomatic ulcers is united with that of the
affection to which they belong. In some cases, a local treatment is
sufificient ; in others it is necessary to add to it an internal medication
-{tonics, alkalines, arsenic.)



FISTULA. 117

V.

FISTULA.

Modern classifications of fistulge are based upon the etiology, patho-
geny and anatomo-pathological characters of these lesions. We have
congenital and pathological fistnlie, also fistulce from want of cicatri-
zation and those from defective cicatrization. The most common con-
genital fistulaj are those of the umbilicus, the urethra, and those
which establish a communication between the rectum or the bladder
and the vagina. Pathological fiistuhz include numerous varieties. We
find the incomplete^ blind, or non-cotnmunicatiftg, and the complete or
communicating fistulge. Blind fistulae are called idiopathic when they
follow abscesses ; symptomatic when they result from other lesions ;
they are externally blind when they open on the skin ; internally blind
w'hen on the mucous tegument. Communicating fistulae include : i.
Serous fistulce, which open deep down in one of the large visceral
^cavities, in an articular or tendinous synovial sac, or in a natural or
accidental subcutaneous bursa; 2. Mucous ?^s\.\x\^, which open in a
reservoir or in a excretory canal. Generally, complete fistulas are
cutaneous and itiucous; one of their openings is on the skin, the other
on a mucous membrane ; they may be bi-mucous or bi-cutaneous when
they have two openings on those membranes.

The therapeutics of fistulae include numerous methods or means, which
have their special regulations. It is plain that lesions, so various as to
nature and origin, will require different kinds of treatment. Sympto-
matic fistulas do not demand the same care as idiopathic fistulae ; with
fistulas which opens in serous cavities, it would be dangerous to inter-
fere as it is ordinarily done with those which open on a mucous mem-
brane or in an excretory canal ; many of the latter require a special in-
terference.

Idiopathic purulent fstuhc, often kept up by the peculiar condition of
their walls, by the atony of their granulating layer, sometimes by the
sinuosity of their course, by the existence of subcutaneous or intra-
muscular undermining, or by the excessive mobility of the organic
layers of the region where they exist, do not resist a local energetic
treatment. One may recognize the nature of the persistence of the fis-
tulous tract by the more or less marked tumefaction of the region, the
quantity and the quality of the pus, and by exploring the tract. If it
be due to an undermining and kept up by frequent motions of the part,
one may, after thoroughly washing the cavity, attempt a cure by pres-
sure and immobilization of the region. But often the undermining: ex-



Il8 VETERINARY SURGICAL THERAPEUTICS.

tends far beyond the fistulous tract, or perhaps pressure cannot ba-
applied. In such cases, the rule is to make a counter-opening in the
most dependent part so as to allow and complete the escape of the
pus through a drain tube. Whether there is undermining or not, if the
fistulous tract is old, organized, and lined with an epithelial layer, cica-
trization cannot take place without destroying this superficial covering
and stimulating an active granulating process. Injections, the seton
and cauterization fulfil all these requirements. A great number of
therapeutic agents have been used in injections to stimulate the granu-
lation of fistulas ; among them metallic sulphates, tinctures and anti-
septics in concentrated solutions. The most desirable of these are the
Villate solution, the tincture of iodine, the alcoholic solution of corrosive
sublimate, the aqueous solution of chloride of zinc (S-io c;) and of car-
bolic acid (5ff). If cicatrization is slow, it is wise to change the injec-
tions. In cases where these fail, solid caustics may be introduced into
the fistulae : minium troches, pencils of nitrate of silver, paste of sub-
limate or of chloride of zinc. With obstinate bicutaneous fistula?, the
introduction into the tract of tents or small setons, impregnated with
irrigating caustic or vesicating preparations (Villate solution, tincture
of iodine, spirits of turpentine, blister ointment, basilicon, or iodide of
mercury ointment), is good practise ; when it is necessary to introduce
several tents, they should be made small, so as to not interfere with the
granulations. Cauterization of the tract of old fistulae with the hot
iron is an old, severe, but certain mode of treatment. It is done with
a blunt probe or a metallic wire of small dimensions; the narrow and
blunt point of the zoocautery is very good for short tracts. In some
cases, it is advantageous to have recourse to incision, and curetting
of the tract. Incision assists cicatrization of fistulae with several
tracts. The callosities existing on the walls of old fistulous canals gen-
erally require to be removed with the bistoury or with the curette.
.Some of these fistulae require special operations ; for instance, that
■which is present in cases of keraphyllocele, is relieved only by the ex-
tirpation of the horny growth.

The treatment of symptomatic fistuhe depends on their causes, and
the conditions of their presence. Some are due to the presence of a
foreign body or a necrqsed, loose piece of bone ; they are recognized
by the pus which flows from them, not very abundant, or unpleasant
in nature. They heal rapidly after that which causes them is removed.
To do this, one has only to enlarge the size of the tract, take hold of
the irritating object and extract it. Most of these fistulee are the
expression of a necrotic lesion involving a bone, a cartilage, a tendon,
a ligament or an aponeurosis ; they secrete abundantly a grayish,
watery pus, often grumous and carrying small pieces of necrosed
structure. Generallv, the seat of the wound, the extent of the indura—



FISTUL.-E. 119

tion, and the probing allow one to detect the exact nature of the existing
lesion. The treatment varies according to cases. At times, simply a
larger incision, and escharotic injections are all that is required ; at
others, to stimulate the action of the caustics and permit the free escape
of the pus, one or several counter-openings have to be made, and
drainage tubes inserted ; at other times, if the necrotic lesion is super-
ficial, especially in cases of a bony alteration, it is better to dry off
immediately the source of the suppuration by removal of the mortified
part. Care should be taken that the pus be not in contact with tissues
with sluggish nutrition, since they offer an easy prey to pyogenic
tnicrobes. Cauterization of the diseased center, a method borrowed
from old hippiatria and brought down to our own times, is far inferior to
immediate extirpation ; it leaves an eschar, which sloughs off slowly ;
and in fibrous tissues a new focus of necrosis may be the result of the
extensive suppuration that follows. In horses and in cattle, sometimes,
the product of the secretion of fistulous walls dries and forms in the
tract a cylindrical, hollow, foreign body, which keeps up the suppura-
tion. We have just seen a remarkable case of this nature in an
animal suffering from an old fistula of the flank.

Of serous fistula, some get well quite rapidly by the division of the
tract and by simple antiseptic injections ; those of serous bursas and
small tendinous sheaths, belong to the same group. But fistulous
tracts which open into large tendinous or articular synovial membranes
are very serious in animals, on account of the difficulty of thoroughly
disinfecting those cavities : in former days, injections of CEgyptiacum,
a direct cauterization of the walls with a red iron or with nitrate of
silver, were recommended for these. To-day antiseptic treatment is
preferred. (See Articular Wounds and Arf/iritis.) Fistulae of the large
serous membranes are very rare ; they are observed only where the
traumatisms which precede them have given rise to a circumscribed
phlegmasia of these membranes and to the formation of adhesions which
bound the suppurating serous territory. Antiseptics are used for these
cases. Very recently, a strong carbolic acid solution has given us rapid
recover}' in a case of vagino-peritoneal fistula following an operation of
ovariotomy on a mare.

We shall be concise in speaking of the treatment of mucous fistula;,
and will return to it when we study these lesions in particular. Of these
fistula;, those which are kept up intentionally by a foreign body have a
well-marked tendency to cicatrization. 'I'lie muco-cutaneous fistulae of
the sinuses, following trephining, close in a few days by the removal of
the corks or drains which keep them open; those of the trachea heat
in the same way when the tube of tracheotomy is taken away. If those
that are due to dental caries or to suppurative alveolitis require a long
time to heal after the extraction of the diseased tooth, it is due to the



120 VETERINARY SURGICAL THERAPEUTICS.

slow process of the phenomena of the existing osteitis and to the accu-