potassium ; their edges must be trimmed smooth, by cutting off all parts
too much bruised and even a little more, and they must be joined in
places by sutures closed or far apart, with or without drainage, as the
case may be. Little attention needs to be paid to the hemorrhage,
even when arterioles or veinlets are lacerated ; the crushing of the ex-
ternal coat and the retraction of the two others insure hemostasis.
When vessels of larger caliber are opened or divided, one must guard
against the possibility of a secondary hemorrhage and apply to then\
<;atgut ligatures. According to the region where the wound exists,
this must afterwards be covered with an antiseptic dressing or with a
â– coat of vaseline, also antiseptic. If the wound gapes widely on account
of the retraction of the tissues on the border, is without great loss of
substance and does not threaten sjangrene, sutures may also be useful ;
tliey bring the edges together, maintain them in proper position, make
the space to be tilled smaller, and cicatrix is limited, so that recov-
ery is more rapid. But when the loss of substance is considerable,
none of the previous means is to be applied — no sutures, no drainage;
other methods must be used. Wounds with gangrenous strips require
washings, baths, powders, — all of an antiseptic nature, — or continued
irrigation.
Very severe contused wounds, whose edges are bruised, crushed,
loose, or hollowed by anfractuosities, must be treated open, with or
without dressing, according to the region where they exist. After
proper cleaning by cutting, with bistoury or scissors, the disorganized
tissues, which are doomed to gangrene, should be disinfected with
antiseptic washings ; in some cases, free incisions and counter-openings
should be made, to prevent the stagnation of the pus in the irregular
and undermined structures. In some regions where the involved
muscles are covered with an aponeurosis, the tumefied muscular tissue
may protrude through the solution of continuity of the aponeurosis ; it
is then advantageous to incise the latter. Sub-aponeurosis phlegmons
should be punctured at once, drained and irrigated with antiseptic
liquids. Contused wounds with bony lesions (face, withers, hip)
require, ordinarily, a long time to cicatrize, and are often accompanied
with necrosis or other secondary affections. (See N'ecrosis.)
Of all traumatic lesions, these are the most dangerous, as regards
infectious complications. Therefore, it is emphatically commanded to
relieve them of whatever foreign substances they may contain, and to
purify them of all contamination they may have received. Irrigation
can never be too abundant, if the wound is irregular, anfractuous, un-
<lermined, or if the tissues have been soiled with hairs, manure, gravel,
earth or dust. When the wounded part allows it, when, for instance,
the injury is below the knee or the hock, it should be soaked for twenty
136 VETERINARY SURGICAL THERAPEUTICS.
minutes or half an hour in a warm antiseptic solution. For serious
traumatisms of the trunk and of the superior parts of the extremities,
we have sometimes resorted during the first few days to nebulizations
(atomizing) of corrosive sublimate or carbolic acid, made with the
atomizer of Lucas-Championniere. Balneation or nebulizations are
continued until the elimination of the sloughing tissues. In other
cases, after the 'wound has been well disinfected, it is sufficient to
irrigate several times a day with a solution of cresyl or common salt,
and to cover it, after each washing, with iodoformed vaseline or to dust
it with an antiseptic powder (iodoform, naphtaline, tannin, coaltar) in
sufficient quantity to cover it entirely. Continued irrigation is also
used with much success : it is generally employed for contused wounds
of the extremities on horses. It removes the secretions, diminishes the
sensibility and the pain, and attenuates the intensity of inflammatory
accidents. It is stopped when the wound is cleaned and free from ail
shreds of mortified tissues ; it has the inconvenience of retarding the
cicatrization by rendering the granulations soft or fungous. The facts
recorded by Trasbot have confirmed the remarkable efficacy of cold
irrigations in the treatment of traumatisms of horses ; it is important
that the water should not be too cold, since the continued action of cold
would be injurious, especially if parts of some dimension were already
under the influence of ischasmia.
Warm antiseptic baths, given twice or only once a day, with iodoform
dressings, constitute a treatment a little more complicated than cool
irrigations, but also more certain and more rapid. We obtain good
results with it. Recently, we have employed it with great success, for
a saddle horse severely injured by a tramway : the canon, fetlock
coronet and head on their anterior faces had a long contused wound, with
ragged edges ; the tendon of the anterior extensor of the phalanges
and the periosteum were bruised in several places ; the synovial bursa
of the fetlock was open. No complication took place ; after a month
the wound was entirely healed.
It is the exception that treatment of wounds, accompanied with
fracture of a bone of the extremities, or with articular lesions,, is under-
taken. For them the treatment of compound fractures or of open joints
is necessary.
To contused wounds of the lower regions of the extremities, produced
by the shoe, is often added a local, active, and diffused phlegmasia,
lymphangitis, and sometimes inflammation of the tendinous or articular
synovial sacs of the fetlock. For them especially, antiseptic baths and
wadded dressings must be used. In some cases (horses that inter-
fere) repetitions of the trouble must be prevented by proper shoeing or
protective apparatus.
WOUNDS 1-ROM 1-IRE-AKMS. I37
IV.
WOUNDS FROM FIRE-ARMS. (GUN-SHO^^ WOUNDS).
Particularly frequent among army horses and hunting dogs, these
•wounds vary indefinitely with the size and the penetrating force of tlie
agents which produce them. How different, as far as lesions and
severity, the contusion produced by a dead ball, the burn resulting from
the dertagration of the powder, the narrow perforations of small shot,
from the enormous mutilations made by big projectiles ! And how
numerous are the intermediate degrees between those extremes. The
wounding agent may be a regular projectile or a fragment of a small
bomb, a metallic substance with a sharp edge or a splinter of wood
torn by the projectile. If the latter penetrates the tissues, it may in-^
troduce into them a foreign body — a fragment of metal, a piece of
leather or of cloth.
Penetrating wounds involve injured bones in about a fifth of the
cases. Out of 211 wounds by fire-arms observed by Jewsejenko during
the Russo-Turkish war, 41 (igfO were complicated with bony lesions
(bones of the head, 12 cases ; vertebrae, ribs, pelvis, 14 ; anterior legs,
7 ; hind legs, 5 ; foot, 3). The most serious lesions were those made
by lead projectiles.
Wounds by fire-arms are generally characterized by their peculiar
aspect ; their borders, of leaden tint, brown, purple, or blackish, are
contused and ragged. Wounds made with modern arms differ much
from those made with ancient projectiles. The Lebel ball, conical,
with a very hard metallic envelope, has a considerable penetrating force ;
it runs through the tissues in a straight line and perforates and crushes
bones into splinters. The curious deviations observed from the spher-
ical balls of old guns, the " turning " shots, are exceptional with the
projectiles of modern warfare.
The therapeutics of these wounds has varied with the times. Old
surgery believed them '* poisoned " and recommended cauterization
with the red iron or boiling oil. Later, free incisions and immediate
extraction of the projectiles was the rule. To-day, they are treated as
contused wounds are treated, and when the wounding agent has remained
in the tissues, most commonly it is left there.
In animals, since the skin is protected by an abundant coat of hair,
it is rarely affected by burns from gunpowder ; and the incrustation in
the skin of some of it which had not burnt is without importance.
The eye may, however, be severely affected (Rey, Kopp). ITpon a
horse which, at Montebello, had remained some time near the mouth
of a piece of artillery which was firing, Kopp observed, the next day.
138 VETERINARY SURGICAL THERAPEUTICS.
a severe inflammation of the eye ; the entire exposed surface of the
ocular globe was filled with little wounds looking as if they had been
made with a punch. Subcutaneous lesions produced by dead projec-
tiles, which push into the skin without running through — lesions attrib-
uted in days gone to the " wind of the ball or the bullet," — must be treated
as contusions. If the skin and the superficial subcutaneous layers be-
come necrosed, the sloughing of the mortified tissues should be at-
tended to. (See Gangrene.) The examination of a contused wound of
the hoof by a ball (Kopp) disclosed the fact that the deep layers of the
hoof were infiltrated with blood, as in a corn, and that under the wall
there was a small hemorrhagic center.
A load of shot, if fired at short range, has the effect of a bullet, and
gives rise to all the disorders of the most contused wounds ; if the
shooting is made at long range, the shot penetrates the tissues sepa-
rately, and makes in them narrow and more or less deep tracts, at the
bottom of which it. is enclosed in a cyst. Only the shot that is super-
ficially situated, which is troublesome, or is arrested in delicate tissues,
such as the eyelids or the cornea, is removed at once (Peuch).
Wounds in the shape of gutters, hollowed in the skin and superficial
subcutaneous layers by a ball which has reached them at right angles,
cicatrize by granulations and without severe inflammatory reaction.
It is sufficient to make simple washings and to cover them with an an-
tiseptic preparation. Immediate reunion might be obtained in some
cases if the contused condition of the borders did not prohibit.
Tubular subcutaneous wounds, like a seton tract, produced by balls
of all sizes, which pass through and through a region, generally close
quite rapidly and without suppuration, except at their openings. They
must not be probed or enlarged unless they conceal some foreign
body ; in other cases, they are aseptic, just as the tract of a trocar
heated to white heat, and the probing exposes them to infection or
destroys adhesions already made and interferes with cicatrization.
Clip the hair around the openings, wash these with a strong solution
of carbolic acid or corrosive sublimate mixtures, cover them with iodo-
form or iodoformed vaseline, and immobilize the region. These are
the only truly useful measures to take. If a fluctuating center appears
in the subcutaneous tract, it should be punctured, the cavity washed,
all foreign bodies that it may contain removed, and then it should be
dressed as the openings were. When the tracts of the wounds running
in the depth of a region pass through an aponeurosis, if the tissues
underneath become highly inflamed and suppurate, it is necessary ta
enlarge the tract and drain it. The hemorrhage which takes place in
some cases is also a condition which demands free incisions, but the
march and the gravity of the trouble depend, after all, upon the impor-
tance of the injured organs. It is evident that balls, which thus
WOUNDS FROM FIRE-ARMS. 1 39
run through some regions, may produce mortal accidents (perforation
of the intestines, of the lung, of the heart, or of the brain.) Let us
again say that a projectile that breaks up upon a bone may make three
openings on the skin; and that the existence of two openings is no
proof that the region has been run through, as the two openings may be
those of entrance of two balls which have not made their exit.
The projectile has penetrated the tissues in making a blind tract with
one opening only : it remains in the region : what is the treatment ?
Of yore, extraction, whenever possible, was recommended ; but numer-
ous facts have shown that the balls, which are almost always aseptic,
are tolerated in the great majority of cases. Then systematic absten-
tion is the rule of conduct adopted now by most surgeons. The wound
and its surroundings is carefully examined : sometimes palpation re-
veals a hard spot, a slight projection formed by the ball ; with a stroke
of the bistoury those are brought out that are arrested just under the
skin ; those that are lost in the depth of the tissues or have penetrated
the viscera are left alone. Wounds of the lung are relatively harmless
compared with those of the encephalon, spinal cord, or heart, which
are nearly always fatal. The penetration of a ball into abdominal or
thoracic cavities is not necessarily followed by complications ; and the
rule is, not to attempt the extraction. The question in human surgery
as to the course to take with abdominal wounds is yet undecided.
Reclus, who is a great admirer of abstention, admits interference
" not for the extraction of the projectile, but to repair the mischief it
has done by its passage : such as, the opening of an artery or a large
vein ; the section of a nerve or of a tendon ; laceration of a viscus,
the stomach, an intestine, or the bladder. " We do not interfere for like
occurrences among our large domestic animals. For the others, one
must be guided by rules laid down in human surgery. We will return
to this subject in the chapter on Traumatic Lesions of the Intes-
tines.
When the projectile is arrested in a musculo-aponeurotic region and
produces in it violent inflammatory phenomena, it must be looked for
by exploration of the tract of the wound. Sometimes the size of the
canal permits the introduction of the index finger, but ordinarily it has
to be enlarged by incision : an aseptic grooved director is intro-
duced into the tract, and a straight bistoury passed along the groove
carries the incision on to the necessary extent. When the projectile is
exposed, it is made loose with the extremity of the probe and extracted
with the denticulated jaws of long forceps. One should avoid violent
manipulations, which might result in injuring the tissues more or in
pushing the ball farther inwards : this recommendation is specially im-
portant for projectiles arrested in the neighborhood of serous mem-
branes. Bony lesions are always serious complications, with, however,
140 VETERINARY SURGICAL THERAPEUTICS.
many variations in their gravity. Ordinarily, balls which are incrusted.
in bones are left in ; if they are extracted, they must be made loose by
careful manipulations with the probe or a strong metallic rod ; some-
times the operation is quite difficult, and may demand the use of the
trephine, the yauge, and the mallet. The special instruments invented
in former times to extract projectiles are not employed now.
Fractures of the bones of the face, which are not extensive, also
those of the spinous processes of the withers, of the point of the hi.p,
and of the ischial region are the least dangerous. On the contrary,
those of the bones of the extremities, which are often comminuted, as
well as the articular lesions, are cases of extreme gravity, and are, econ-
omically, incurable. Wounds of arteries and large veins — cases which
are rather rare — give rise to an immediate and abundant hemorrhage,
and ordinarily require the ligature of the injured blood-vessel.
If, in general, the tissues are tolerant of balls, they are not so of the
foreign bodies which the balls have carried with them. For those, ex-
traction is almost always necessary ; and this should be done with long
forceps.
Projectiles of large caliber (boulet. obus), almost always produce
enormous lesions. At times, they take off a leg or a part of the head ;
at others, they reach the neck or the trunk, thus causing, in nearly
every instance, irreparable disorders, if not death in a few minutes.
Even when the thoracic and abdominal walls appeared but little injured,
the viscera — lungs, heart, liver, and intestines — are contused, bruised
or torn. Some regions, however, maybe touched side-wise and injured
quite deeply, without complications of fracture, injury of large vessels
or important nerves, or opening of a natural cavity. These trauma-
tisms present all the characteristics of serious contused wounds, and
must be treated as such.
Though wounds by fire-arms are ordinarily free from infection, they
may be complicated with diffused phlegmons, gangrene, pyohaemia,
septicaemia or tetanus. The last two infections are generally the result
of an inoculation of the wound, after the injury by the earth, the dust,
or other matters containing the septic or tetanic germs.
In cases where treatment is undertaken hygienic measures should not
be neglected. If the wounded is suffering from the shock, and is weak
or depressed, stimulants and tonics should be administered.
Projectiles, left in the tissues, behave in different ways. There are
some which, having reached certain organic cavities (nasal, buccal
pharyngeal, stomachal or intestinal) or having been arrested in these
are eliminated through the natural passages. It is thus that balls which
have entered the intestines are rejected through the anus. Que'nu has
related to the Society of Surgery, a case particularly curious : a man
who had received a ball from a revolver threw it out three weeks later
WOUNDS BY TEARING. 14I
by the pharynx (^). In other cavities, if they remain, they may produce-
suppurative /inflammation. The biscaien that Rigot found in the gut-
tural pouch of a horse, which he dissected, had given rise to a sup-
purative collection in that sac. Many become fixed, or encysted,
and after the wound which tliey have made has cicatrized, nothing
remains to indicate their presence. The observation of Trasbot is an
example of it. At the autopsy of war-horses, balls were found enveloped
in a cellulo-fibrous case in various regions, even in the viscera. In man,
they have been found in the brain. But there are projectiles, which, while
remaining innocuous for years, travel along conjunctive layers, moving
by the laws of gravity or through the effects of muscular contractions.
In general, they move slowly, giving time for encysting to take place ;
then, under the influence of the continued pressure that they make upon
the dependent portion of their cystic envelope, the latter gives way, and.
the body thus progresses slowly through the tissues ; the walls of the
cyst close, unite, and form a fibrous tract, which may be found after-
wards (Ferrier). In a horse, which was wounded, in 1866, with a ball
that had entered the lumbar region and could not be extracted, MoUer
found, ten years afterwards, the projectile near the umbilicus ; it had
produced no trouble during all that time. Sometimes, in thus displac-
ing themselves, or even in remaining in one place, projectiles give rise,
on occasions, to various accidents — abscesses, neuritis, arthritis, or in-
flammation of the large serous membranes. The horse spoken of by
Garnet, kept for four months, in the lumbar region, a ball which, one
day, after a long journey, gave rise to an acute diffuse phlegmasia, and
an abundant suppuration, followed by death in a week. (See Foreig?i
Bodies.
V.
WOUNDS BY TEARING. (TORN WOUNDS.)
This kind of wound is observed in all animals ; but with the excep-
tion of the wrenching of the hoof, most of them, generally of little gravity,
have nothing compared with the great traumatisms, now so frequent
among men, because of the extensive part machinery takes in modern
industry.
Ordinarily the torn wounds that we have to treat in animals
are made by nails or hooks, and are very much like contused
wounds with a thin ischaemic zone. Very often their edges are as
nearly regular as those of incised wounds ; and when they are recent, if
their borders are brought together after having been minutely cleaned
of all soiling on their sutures, they may unite by first intention. This
{}) Quenu, Semaine Medicale, 1894, p. 328.
142 VETERINARY SURGICAL THERAPEUTICS.
result is often obtained for wounds of the lips, of the nostrils, eyelids,
and for those which, in all regions, involve only the skin and the super-
ficial subcutaneous layers.
Upon animals that work in railroad stations, mines, and iron found-
ries, more extensive and deeper lesions can be seen, — wounds with tear-
ing of the muscles, and the tendons, and with fractures. Rey has
related the case of a horse, which was thrown on the rails while draw-
ing cars, and was dragged thirty meters and found covered with
wounds, the lower jaw having been fractured as far as the neck, hooked
to a switch, tiie bone had been fractured and its lower part was held
only by a thin band of tissue. Violent contusions applied obliquely,
and bites also, give rise sometimes to lesions resembling torn wounds.
There are several cases of horses, an ear of which has been taken ofif
by a bite or by a kick.
Large tearings, when curable, must be treated as contused wounds.
They must be carefully disinfected with washes or warm antiseptic
taths, and their edges brought close together with sutures and covered
â– with an iodoform dressing. A simpler and more economical treatment
consists in washing them frequently and covering them with absorbent
or antiseptic powders.
When these injuries are situated on the legs, continued irrigation is
ordinarily employed. (See Wrenching of the Hoof.)
VI.
W^OUNDS FROM BITES.
These wounds have various characters, according to the animal that
has made them. They may have the aspect of cuts, punctures,
bruised, contused or torn wounds. Those made by horses are prin-
cipally contusions or contused wounds ; the tissues are bruised and
crushed ; two curved marks separated by an oval tumefied zone are
sometimes made on the skin by the incisives; when the skin is torn,
the wound is, ordinarily, irregular and ragged, even sometimes when the
edges are clean. Wounds made by large ruminants, rare and not se-
rious, look, also, like contusions and contused wounds. In the bites of'
dogs, the wounding dental arches make several punctures, with crushing,
cuts, and tearings of the tissues. With those of cats, one or several
punctures, generally somewhat deep, are found made by the canines.
Bites of large carnivorous animals are terrible ; often there are lacera-
tion of tissues and disorders rapidly fatal. Some birds with their
straight or crooked beaks may make bites by punctures or by tearing.
Large bites made by horses are rather often complicated with crushing
of bones; the muscular force that closes the jaws is considerable,-
roisoNEi) wouxDS. 143
sometimes the lower jaw breaks viiider the effort (See Fractures). Also
there are found the bites that dogs infiict upon each other during
fighting, fractures of the bones which form the basis of the wounded re-
gion (face, extremities). \\'e have just treated a hunting dog bitten
deeply on the shoulder by a bull-dog, in a short struggle, and in which
the neck of the scapula had been fractured by a bite of the teeth.
The therapeutical treatment that all these lesions require, allow them
to be arranged in two groups : i. Those where the contusion is more or
less severe ; 2. Those where the skin is perforated or torn.
Bites of the first variety heal, ordinarily, without complications. To
allay the pain, often great, tepid affusions or baths are used ; some-
times emollients and narcotics. If the bruised structures undergo
mortification, their sloughing can be stimulated and the wound treated
as ordinary contused wounds are.
Bites of the second variety — bites open or with wounds — must be
carefully disinfected with free antiseptic irrigation or immersion in a
tepid bath. The lesions, sometimes deep, that are inflicted with the
teeth do not exhibit all the gravity of the injury; there is also the pos-
sible infection with the saliva or other noxious substances which the
teeth may have carried into the wound. Not only does saliva contain
toxic leucomaines, but also numerous microbian species which can
bring on an intense local phlegmasia, suppuration, and phlegmons of
the wounded region. Tetanus, erysipelas, pyohaemia, are complications
to be feared with serious bites. Minute disinfection of the wound and
antiseptic dressings are the best preventive treatment of all such acci-
dents. In some cases continued irrigation will be preferred. As in
contused wounds, it may be necessary to make some excisions or to