this must be divided subcutaneously and a sound ad-
herence prevented by passive movements applied
on the cicatricial plate. This operation is, however,
seldom successful.
Projecting cicatrices, old and fibrous — the cicat-
ncial cheloids — generally do not yield to the means for
recent wounds which we have spoken of. Formed by
dense connective fasciculi, elastic fibers, blood ves-
sels and an epidermic covering, they are at times some-
what regular, at others mammillated, multilobular, always fibrous, whitish,
glabrous, hard under the scalpel, or are covered with stratified epi-
dermic layers or horny growths. Among cattle, we have seen some of
those horny plates in various regions, and among horses, on the lower
parts of the legs. According to their dimensions and the length of time
they have existed, they are treated by cauterization or excision.
Recent sessile cheloids may disappear by long and continued methodic
pressure or by repeated scarifications and mercurial applications. When
these fail, ablation is the only treatment offering any chance of success.
This is also the best way to get rid of enormous projecting cheloids, more
or less pedonculated. Among animals, relapses are rare outside cases of
cicatrices resulting from the extirpation of tumors. Primitive neoplasms
of innodular plates are also exceptional.
Some very extensive wounds, and all those accompanied with loss of
Fig. 46. — Horny
Cheloid of the
Left Foreleg.
GRANULATIONS — CICATRICES. I97
substance, which occupy regions in the neighborhood of natural openings,
may be followed by deformities and accidents more or less serious.
The large cutaneous cicatrices of the lower segments of the extremities
bring sometimes, by their retraction, permanent deviations of the bony
levers ; those situated near articulations interfere with movements ; those
of the coronary band deform the hoof, give rise to quarter-cracks and
false quarters ; others, developed in natural canals or in proximity with
their openings, promote ectrojiion, contraction of the sesophagus, rectum,
anus or urethra.
Among the deformities and the accidents due to cicatrices, there are
some which can be prevented by more judicious selection of the therapeutic
means applied to the original lesion, and by a close watching of the
phenomena of cicatrization. The results obtained by Romary and Smith
show that it is possible to prevent some deformities in animals \)y cutaneous
grafting, which gives such happy results to man (Reverdin, Gosselin, Duplay,
Oilier, Thiersch).
Their curative treatment demands methods which vary according to
cases : section of cicatricial bands, forced dilatation of obstructed orifices
and canals, special operations, and the administration of iodide of potas-
sium — a medication preferred to overcome sclerous processes.
In certain regions where glabrous cicatrices are unsightly disfigure-
ments on a horse, they can be removed by excising a long elliptical
cutaneous flap, with the cicatrix in the center, and sewing, with silk or
silkworm-gut suture, the edges of the new wound which have been made
loose from the tissues underneath. To succeed in obtaining union by first
intention in such an operation it is necessary to take all the necessary pre-
cautions for perfect asepsis.
This treatment can be advantageously applied to valuable horses having
broken knees if their modes of standing are normal and their extremities
solid.
Treatment by operation upon broken knees goes back to 1829. Cherry^
made the attempt of removing a carpal cicatrix by excision of a vertical,
elliptical cutaneous flap, with the cicatrix in its center. In order to assist
the sliding of the skin, he also made on each edge of the wound, at some
distance from it, longitudinal incisions parallel to the borders of the wound.
This was an application, to the therapeutics of broken knees, of the old
method of autoplasty, or Ce/su's method, used for the treatment of various
affections of mankind. Cherry was partly successful with a donkey, but
was " disappointed " in operating on a horse. Other attempts made by
1 Cherry, on Broken Knees : The Farrier and Naturalist, 1S29, pages 38, 358,
372.
198
VETERINARY SURGICAL THERAPEUTICS.
VLirious parties were not much more fortunate. Before antisepsis was
known they could not succeed. In 18S9, W. Hunting and Duguid'
made new trials. Like Cherry, they removed, with the cicatrix, a long
elliptical cutaneous band, the long axis of which was parallel to the ex-
tremity ; a pin twisted suture brought the edges of the wound together.
They did not obtain a complete adhesive union ; still, on one subject, there
remained only a very slight cicatrix. Hunting advises operating only
upon old cicatrices, and insists upon the necessity of immobilizing the leg
if one would have com.plete success.
Fig. 47. — Autoplasty of the Broken Knee. (From Cherr}-, reproduced by \V.
Hunting.)
Delcambre and Vinsot " have reached this result by maintaining the
most careful asepsis, and by immobilizing the leg in a plaster dressing.
This is their method :
The animal is thrown on the side opposite the leg to be operated upon ;
this is carried in extension and strongly fixed. The anterior face of the
knee is shaved, and this region and its surroundings, having been thoroughly
disinfected, are wrapped in a cloth made aseptic l)y immersion in boiling
water.
With scissors, an opening (fenestra), elongated in the direction of the
leg, is made through this wrapper, on a level with the cicatrix. Two slightly
curved incisions, meeting at a very acute angle at their extremities, define
' IV. Hiintmg, the Veterinary Journal, 1SS9, p. 474.
" Delcapibre and Vinsot, Bullet, de la Soc. Cent, de Med. Vet, 1894, p. 515.
GRANULATIONS— CICATRICES. I99
the piece of skin to be detached, which is to be left as narrow as possible.
It is dissected away from the hardened tissue underneath, the synovial
membranes being carefully avoided. Hemorrhage is arrested by force-
pressure, the wound is dried with aseptic plugs, and the edges are sutured
with silkworm gut, the stitches being one centimeter apart. If the loss of
substance is too great, before sewing, the edges of the wound are made
loose underneath for an extent sufficient to permit their perfect adaptation.
The suture and the shaved surface are all powdered with iodoform and
covered with iodoform gauze ; absorbing wadding is wrapped round the
knee, canon, and lower part of the forearm, and the whole secured by a
large band of muslin. To insure immobilization, a plaster dressing is placed
over the muslin, made of similar stuff.
On the tenth day the dressing is taken ofif. If the operation has been
performed aseptically, union by first intention has taken place. Another
similar dressing is applied, less the plaster, which has become unnecessary.
This is removed after eight days. The cicatrix is then sufficiently solid to
require no more protection or care. The animal can resume light wcrk.
A narrow line, subsequently covered by new hair, is the only mark left when
the operation is well performed.
CHAPTER V.
SECTION I.
MYCOSIS.
I,
ACTINOMYCOSIS.
Comparatively common in cattle, observed also in horses, swine, sheep,
dogs (Vachetta, Frohner), and elephants (Burke), actinomycosis is a para-
sitic disease, produced by a fungus — the actinoinyces of Harz. It exists
extensively in Germany, the south of Russia, Italy, Denmark, England, and
the United States, and has been observed in some parts of France. It is
exceptional in the suburbs of Paris. In ten years, we have seen but one
case among the cattle brought to the clinics of Alfort.
Actinomycosic tumors are primitive or secondary. The former exists
on the parts where the germs have penetrated : on the skin, the mucous
membranes, or the tissues that cover them. It has been observed in the
skin and the subcutaneous connective tissue of a number of regions.
Jensen has seen a pig which had, on the anterior face of the knees, two
actinomycomas, weighing, one, two, the other four kilos and a half. In
countries where the disease is enzootic, many traumas, the wounds of
castration principally, become actinomycosic centers. Often their seat is
on the head, where they invade the maxillaries. Such were those which,
in 1826, Leblanc described as " osfeosarco?na," and which others called
''spina vcntosay Such are those spoken of in the observations reported
by d'Arboval, Clare, Dick, Daws, Dupont, Warnell, Delwart, Williams,
and many others. While the tongue, the buccal and pharyngeal walls,
the retro-pharyngeal glands and the parotid are often affected, the intes-
tines seldom are. Rare also are the primitive lesions of the nasal cavities,
larynx, lungs, of the udder or bones of the legs. In horses, cases of ac-
tinomycosis have been observed in bones, the tongue, subglossal glands
and spermatic cord.
Primitive centers give rise to secondary lesions in their neighborhood
or at a distance from them, and when the disease becomes generalized
ACTIXOMVCOSIS.
201
Fig. 48. Actinom5'Cosis of the Lower Maxillary.
they may heal, as in tuberculosis, without leaving apparent marks. Ac-
tinomycites ordinarily spread slowly, little by little, through the blood ves-
sels, and apparently most
often through the veins.
All tissues and all organs
may be attacked, and if,
ordinarily, secondary tum-
ors develop in the lungs,
they are also observed in
the liver, kidneys, spleen,
serous membranes, lympha-
tic glands, and even the
encephalon.
Locally, the disease pro-
gresses both by continuity
and contiguity of tissues.
For instance, pulmonary
actinomycosis not only
generalizes often in both
lungs, but it extends from
the visceral layer to the
parietal layer of the pleura,
obliterates the pleural cavi-
ty, and reaches the thoracic
walls, where its clinical
signs can be easily recogn-
ized.
The ways by which the
actinomycites are intro-
duced are numerous.
Generally, they penetrate
through tegumentary so-
lutions of continuity,
wounds of the skin, or
mucous membranes, but
especially by the wounds
of the mouth and of the
pharyn.t ; at times they
enter through natural pass-
ages, glandular canals and ^'S- 49- Actinomycosis of the Tongue,
orifices of the teats ; it is the exception for the disease to start in the
intestines or the lungs. Pulmonary infection may take place from the
dust blowing out of forage that contains actinomycites,
202 VETERINARY SURGICAL THERAPEUTICS.
It is known that these germs have especially for habitat, plants, more
particularly the gramineous, and among them barley and wheat. They are
abundant in damp countries and during rainy seasons. As all fungi, they
like darkness, heat, and dampness. They have been found in the glumes
of wheat fixed in the tonsils, cheeks, and tongues of cattle (Johne, Plana).
It is by eating contaminated seeds or forage that herbivorous animals are
ordinarily inoculated. Thus it is also that the fungi may enter by way of a
cutaneous wound, when animals are lying on beds which contain them, or
rub themselves against soiled substances, trees or posts covered with them.
That they are caused by plants cannot be doubted, since the belief is
based upon numerous facts. This explains well the frequency of the
disease among herbivorous animals and its extreme rarity among other
species.
All forms of actinomycosis, and especially those of buccal localizations,
are observed less frequently at the time of the year when animals are kept
in the pasture, than in winter when they are fed on dry food which
wounds the buccal mucous membrane and makes a way for the entrance of
the actinomycites (Eckert, Claus, Klepzoff). At the abattoir of Moscow,
towards the end of 1893, the cases of buccal actinomycosis were twenty
times more numerous than during the summer and fall of the preceding
year (Klepzoff).
While offering noticeable differences, the statistics made by veterinarians
of the countries where the disease prevails, show that actinomycosic lesions
of the head, neck and skin are much the more common. Statistics of
Cbus give the following figures : Actinomycosis of the maxillaries (especi-
ally the lower ones), 5 i per cent. ; of the tongue, 29 per cent. ; of the
pharynx and peripharyngeal structures, 7 per cent. ; of the larynx and
trachea, 6 per cent. ; of the thoracic and abdominal organs and other regions,
7 per cent. In those of Imminger, while actinomycosis of the tongue is men-
tioned only at 4-8 per cent., the localizations in other parts of the head and
neck amount to 85-90 per cent. In 15 diseased cattle 14 had the
maxillaries affected. In 541 observations gathered by Mary are found :
271 lesions of the skin; 177 of the sub-maxillary glands ; 117 of the
bones of the head ; 5 i of the retro-pharyngeal glands ; 38 of the superior
cervical glands; 29 of the; lungs; 5 of the inferior cervical glands; 5 of
the tongue ; 4 of the pharynx ; 4 of the bronchial glands ; 4 of the dia-
phragm ; 7 of the other organs (Friedberger and Frohner). At the abattoir
of Petersburg, where Ignatjew counts actinomycosis on about 10 per cent,
of the cattle of Southern Russia, localizations on the lips and lower maxil-
lary are the most frequent.
Most external actinomycoses exhibit the following aspects : Hard tumors,
and an immediate inflammatory indurations and true neoplasms, hQllgwedl
ACTIXOMVCOSTS.
20'
with numerous fistulos from which escapes a pus more or less loaded vvith
very small retldish-yellow masses resembling small gravel. Some forms of
recent actinomycosis are neither ulcerated nor fistulous ; they resemble sar-
coma yery closely and their center is hollowed by one or more purulent
centers whose contents hold the actinomycetes in suspension. Others
already large and protruding exter-
nally, are open deep down on a
mucous membrane. In some cases
secondary tumors are found irreg-
ularly distributed round the primi-
tive tumor or arranged in chaplet
form. Under the microscope the
actinoniycetic mass appears made
of diverging, regular or undulous C^^^rz
filaments, sometimes ramified and
ending with pyramidal enlarge-
ments (conidia). This appear-
ance in " umbrella " shape is suf-
ficiently characteristic to permit the
diagnosis.
The treatment of actinomycosic
tumors includes the numerous means
Fig. 50 — Actinomycoses boris magnified
900.
used against chronic inflammatory productions and against true neoplasms.
Leblanc employed mercurial ointment and points cauterization ; Cruzel,
irritating frictions (spirits of turpentine and blistering liniments) ; Harms,
applications of an ointment of equal parts of arsenious acid and lard. To
dry the fistulse, injections of sulphate of copper, carbolic acid, 10 per cent.
(Rosenbach), and cauterization are recommended. These means have
very generally failed. Extirpation of the tumor and the use of the curette
have given better results in the case of external lesions. Where these
" osteosarcomata " were treated early they gave way to surgical interference,
but when the maxillary was invaded in a great part of its thickness, a
secondary fracture was always to be feared. For this reason, in serious
cases, it was better to have the animal destroyed. Some success has been
attained in the case of man by the use of tubercuhn (Billroth) and by electro-
chemical treatment (Darier, Gautier).
Numerous clinical facts obtained during the last few years prove that
iodide of potassium is a true specific for the disease. Already in 1859
Dupont had reported several recoveries of " parotid indurations " by a com-
plicated treatment into which iodide of potassium entered. But it was
Thomassen (18S5) who demonstrated the remarkable therapeutic value
q£ this compound. Used first against "wooden, tongue," which, was
204 VETERINARY SURGICAL THERAPEUTICS.
cured in from two to four weeks, it was tried against osteosarcomata and
some other localizations of the disease. The results were favorable in
almost all cases, and healing often rapid (Furthmeyer, Bass, Nocard, God-
bille, Salmon, Engel Iterson, Soucail). Thomassen administered daijy one
dose of 6 grams of the iodide in half a bottle of water ; as soon as
signs of iodism — epidermic pellicles, flowing of tears, coryza, diarrhoea —
appeared, he lowered the dose to 4 or 5 grams.
At the onset of the disease, large doses of iodide (10 to 15 grams
daily) must be given. Often, as remarks Nocard, the advantageous effects
of the tieatment are not manifest until the signs of iodism are present.
Although local treatment is not indispensable, it is useful in the greater
number of cases of external actinomycosis. For " wooden tongue," Furth-
meyer advises painting the diseased organ with tincture of iodine;
others inject the same liquid into the fistulge of the osteosarcoma. In
parotid actinomycosis, the ointment of iodide of potassium has proved
advantageous.
In general, with the iodide and the local treatment, improvement is soon
manifest ; the swelling diminishes, fistulas dry up, and after a few week,
recovery is complete. There are some localizations, however, that remain
obstinate (Salmon). With man, Poncet failed in a case of pulmonary
actinomycosis. Several other surgeons have also reported failures.
II.
BOTRYOMYCOSIS.
Among the tumors of horses classed among fibromse, there aresome
that are of a parasitic nature, determined by a fungus that Rivolta has
named discomyces equi, that Rabe called micrococcus botriogetiics, and
Johne micrococcus ascoforvians. This parasite — the botryomycis or botryo-
t?iycete — is the agent of a portion of the _//^;//<:7^///(:'x, which give rise to com-
plications in the castration of solipeds ; but its field of action is not limited
to the spermatic cord : it has been seen in numerous indurations produced
by the harness, in many of the tumors of the skin and of the connective
tissue, in sub-maxillary adenitis and other lesions developed in many other
organs. Bollinger, Steiner, and Thomassen have found it in sclerotic
and purulent parts of the Itmgs ; Sand and Moller, in indurations of the
udder ; Jensen, in a tumor of the fetlock ; Kitt, in one of the tail and in
a bony lesion ; Rabe, in a tumor of the back. We have frequently seen it
in various regions, in chronic inflammatory neoformations of the skin and
subcutaneous tissues, sometimes also in old fistute, w-ithout strong indura-
tions of the surrounding tissues. It is extremely rare in cattle (Csokor) and
swine (Wilbrandt) and is not reported as found in other species,
I'.OTRVOMVCOSIS;.
?05
In general, botryomycosic tumors grow gradually, and little by little in-
vade the adjoining
tissues. Like ordi-
nary fibrom?e, they
leave intact the sur-
rounding lymphatic
vessels ; by excep-
tion they extend to
some distance by
continuity and by
contiguity of tissues ;
and thus they may
each serous cavities
and certain viscera,
especially the lungs.
In the horse, most
of the fibrous growths
hollowed by sup-
Fig- 5^^ — Botryomycosis of the shoulder and chest purating fistute are
(from a photograph). related to botry-
omycosis ; the pus that escaped from them contains very small granula-
tions, grayish in color and formed by
the botryomycetes. To insure the di-
agnosis, one can color with picro—
carmine a drop of the pus and ex-
amine it under a microscope of low
power, when the parasitic masses,
colored in yellow, will appear in vary-
ing number, ordinarily under the
form of " blackberries," masses or
clusters more or less voluminous, and
formed of micrococci associated in
zooglocia, sometimes in large disks
lightly granular.
Until lately, the treatment of bot-
ryomycomas has been exclusively
surgical. First they enlarged the fistu-
lous tract, used antiseptic or escharotic
injections and actual cauterization.
As these processes generally failed,
it was necessary to have recourse to
ris.
52 — Botryomycosis of the tail
(from a photograph).
ablation of the tumor. When it is of small dimensions, the operation
206 VETERINARY SURGICAE TIIFRArEUTICS.
is easy, and is performed like that of benignant neoplasms ; if the
whole of the invaded tissues are removed, cicatrization takes place
regularly. Some months ago we removed from the shoulder an old
enormous mycofibroma, having many fistulce which poured out a quan-
tity of yellowish-white pus somewhat consistent and granular ; the
wound was closed in twenty days without any later interference be-
ing necessary. For the botryomycoma of the tail, the amputation
must be made above the growth. The removal of the " champignon "
,.^m^
-m
')
^^g- 53 — Discomyces equi. (Gr. i6o P.)
is an Operation of daily practice. (See Testicle and Cord.) But sometimes
in cases of long standing the tumor cannot be operated upon, since the
mycosic j^hlegmasia propagated along the testicular cord has reached, or
gone beyond, the superior inguinal canal.
Thomassen, in several serious cases, has used with success iodide of
potassium internally and tincture of iodine locally externally. The iodide
was given in lo or 15 gram doses a day, with two or three injections of
the tincture into the fistulous tracts. This treatment may be useful, but
it is slow in its action and not positive in its results. If it has given us
partly successful cases, wei have often used it for "champignon" and
cutaneous mycofibromce without the slightest benefit.'
We will resume the treatment of botryomycosis as follows : In all cases
where the tumor justifies surgical interference, remove it at once ; if the
operation is impracticable or dangerous, try, for a few weeks, iodide of
' We have had several occasions to use this treatment on horses brought to the
clinics of the American Veterinary College, and have generally obtained ex-
cellent results with it. ^Translator.)
iBACTERIAN ANTHRAX. 26/
potassium internally and the injections of iodine externally. After this
length of time, if no improvement is manifest, there is but little hope
of the efficacy of the iodine treatment.
SECTION 11.
VIRULENT DISEASES.
I.
BACTERIAN ANTHRAX.
Like septicsemla, fiarter/a// or sr/zi/fomafic anthrax is an infectious com-
plication of wounds. Cattle and sheep are the only animals affected.
It is of especially frequent occurrence among cattle, but animals less
than six months or more than four years old rarely have it.
The specific bacterium — bacterium Chairrai — invades the organism
through wounds of the skin and mucous membranes, and has to be intro-
duced deeply into the subcutaneous connective tissue. Intrad.ermic in-
oculations and superficial pricks remain almost always sterile.
The disease develops ordinarily through the wounds that animals receive
in infected pastures. Wounds of the lower regions of the extremities ex-
pose them to it particularly. The buccal and pharyngeal membranes
are also roads of entrance favorable for infectious elements : there are
frequent accidental wounds in them from the fodder, and the growth of
the adult teeth keeps up for a long time in the mouth lesions by which the
bacilli may enter.
After an incubative period of from one to fi\'e days — on the average forty-
eight hours — the characteristic phenomena of the infection appear, namely,
one or several subcutaneous, crepitating tumors and specific adenopathies
in their neighborhood. These tumors are ordinarily located on the chest,
axilla, shoulder, croup, thigh or groin. Although they are only more or
less painful and of small size at first, they spread very rapidly and may in a
few hours assume considerable dimensions ; by palpation they give the
sensation of crepitation ; by percussion, a tympanitic sound ; soon their
center becomes insensible and the skin is cold and gangrenous. Puncture
gives escape to a reddish fluid filled with gases. The prophylactic measures
are to protect the animals from the infection by avoiding exposure or by
rendering them unsusceptible through vaccination (Arloing, Cornevin
and Thomas).
The malignant nature of the disease and the rapidity of its progress
generally render all interference useless. " When recovery occurs, it
seems to take place spontaneously ; and when it is in connection with the
2o8 VETERINARY SURGTCAt. TIIERArEUTICS.
use of a more or less appropriate treatment, the part played b)^ this
treatment is very problematical and not well defined " (Galtier).
The local therapeutic means are the penetrating point, firing and the
injection of tincture of iodine and carbolic acid or corrosive sublimate