eruption of " hemorrhagic pimples." During the warm season one may
observe in numerous regions, especially the withers, neck, back and loins,
pimples in various numbers and sizes, from that of a hazel-nut to a large
put. First wdematoug on their periphery, slightly ecchymotic in the
246 VETERINARY SURGICAL THERAPEUTICS.
center, they soon ulcerate and give escape to blood which sticks to the
hair ; these hemorrhages are produced by filaria, whose last habitat was
the subcutaneous connective tissue {^filaria multipapillosa or hcemorrha-
gica). Successive eruptions are observed during the warm season ; the
disease generally disappears with the cold weather, but it may return the
following year. Though Brunswig and Liautard have seen animals die
from anaemia following these hemorrhages, death is the exception. The
rapid cicatrization of the ulcerated pimple is the rule ; sometimes sup-
puration occurs (Lamy). That which renders the affection serious is the
impossibility of using the animals, some remaining unfit to work for months
notwithstanding all forms of treatment (Drouilly).
The therapeutics is simple. Sustain the patients on good food, and
do not use them when the presence of the pimples interferes with the
wearing of harness. Wash the wounds with antiseptic solutions. When
there is suppuration Lamy cauterizes with the hot iron. If the pimple
is observed at the moment of the spontaneous opening the filaria can be
extracted and its entrance in the cellular tissue prevented.
The larvse of Xh.e filaria irritans are often the cause of serious com-
plications of wounds. (See Summer Wounds.^
We may also mention as a parasitic disease of the skin " a cutaneous
affection which often attacks hens, turkeys, especially pigeons, and some-
times geese (Csokor), and to which the name has been given of cutaneous
psorospermosis, epithelioina co7itagiosu7n or moUuscum contagiosi/m.''' It
is characterized by the production of nodosities, warts on the head, which
can, however, in pigeons cover the whole body.
Cauterization or ablation of the tumors is the most efficacious treat-
ment. Disinfection and isolation are to be recommended.
The connective tissue sometimes lodges psorosperms {Imlbianeal gigaii-
tes). ]\Iet with in cattle, sheep, goats or swine, they do not seem to
produce any trouble and offer no interest from a surgical point of view.
Hydatic cysts give rise sometimes to external growths in the cellular
tissue. Raymond treated a horse which had a tumor on the costal region
which healed after seven years, having thrown out a large number of
echinococci. Villate, Cohn, Broquet and Megnin have reported similar
cases, always in horses. These hydatic cysts at times undergo purulent
transformation. In an abscess of the temporal fossa Kirkman found a
handful of hydatids. At the post-mortem examination of a horse killed
on account of its bad condition, Ranvier and Dehors found a large ab-
scess extending from the left kidney to the superior border of the ilium ;
the pus contained a hundred or more echinococci. Simple incision and
puncture followed by iodine injection are insufficient in the treatment
TUMORS. 247
of hydatic cysts. Total extirpation is tlie best way. When impracticable,
remove all that can be taken off, use the curette on the rest.
Rivolta, Bassi, Gotti, Perroncito, and Vigezzi have described, in the
case of horses, donkeys and dogs, fibrous tumors of the connective
tissue due to spiiopterus 7-eticulus. They are frequent on the anterior leg,
at times compress tendons or nerves and give rise to lameness. Tschu-
lowski has shown that among horses which are the carriers of the spiropieriis
reticulus the embryos are ordinarily found in lymphatic vessels, the peri-
vascular connective tissue and the articular and tendinous synovial mem-
branes of the extremities. (See Raillet, Traite de Zoologie inedicale ; and
Neumann, Treatise on Parasitic Affections of Domestic Animals.^
The extirpation of the tumors is the only proper treatment.
CHAPTER II.
SEROUS BURSiE.
I.
TRAUMATIC LESIONS.
Wounds of serous bursse do not essentially differ from those of the
cellular tissue, except by the flow of a fluid of synovial aspect, which might
make one fancy an articular lesion. The clinical characteristics combined
with the anatomical data allow one in all cases to recognize the nature
of the disease. The gravity of the trauma depends on its extent, its aseptic
or infectious character, and the properties of the pathogenous agents de-
posited in it.
The treatment must be antiseptic : clipping of the hair around it,
irrigation with a strong disinfecting solution, in some cases sutures and a
closing dressing. If inflammatory manifestations occur, free opening and
treatment of abscesses are required.
Bruises of serous bursse have a varied progress. A violent blow may
rupture their walls and bring on the escape of the fluid they contain
into the surrounding connective tissue. Sometimes extravasation of
blood takes place in the cavity of the bursse, or an acute hygroma is
formed.
These accidents should be treated first with cool applications and after-
wards with moist heat and pressure. Blisters, firing, puncture, free in-
cisions with asepsis are the means recommended for obstinate hema-
tomas. Suppuration demands an early opening.
II.
HYGROMAS— BURSITIS.
The ordinary causes of inflammation of serous bursae are violent or
repeated traumatisms, inflammation of surrounding parts (phlegmon,
lymphangitis, arthritis) and certain general morbid conditions (rheuma-
tism, strangles, purulent infection). In the great majority of cases hygro-
mas are due to mechanical causes : the action of the heel of the shoe
pressing on the elbow when the animal lies down, the pressure and the
rubbing of parts of the harness on the withers or the poll of the head.
248
HYGROMAS— iBURStTiS. 249
According to the intensity of the local phenomena hygromas are acute
or chrofiic. In acute hygromas the tumor is warm, painful, oedematous or
fluctuating. The contents vary with the acuteness of the inflammation :
although generally serous and mixed with fibrinous clots, it may be hemor-
rhagic or purulent.
The therapeutics consist in reducing the inflammatory symptoms and
preventing suppuration. If the tumor is recent it may disappear by
the simple removal of the cause. Refrigeration at the beginning and later
balneation or tepid antiseptic lotions are the best means to use. If
rheumatismal diathesis is suspected salicylate of soda is to be prescribed.
With such treatment suppuration is prevented and either resolution takes
place or the hygroma becomes chronic. When suppuration occurs, free or
counter-openings should be made to allow the escape of the pus. An-
tiseptic irrigations followed by the application of a dressing or of absorb-
ing powders complete the treatment. Sometimes there remains a fistula
of difficult cicatrization.
Chronic hygromas are commonly seen in horses and in cattle, with
which they are accidents of daily occurrence : the elbow, poll, withers and
point of the hock furnish frequent examples of them. Sometimes they
follow acute hygromas ; at others they gradually develop under the in-
fluence of slight but continued irritation. Their wall, first soft, becomes
indurated or even calcareous. Sometimes they have but one cavity, at
others they have several distinct or communicating chambers. Their
internal wall is smooth at the beginning ; later it sometimes has false
membranes or vegetations (proliferans hygroma). These membranes,
which are loose, form small foreign bodies called riziform ' grains. The
contents of chronic hygroma is a viscous, clear or hematic serosity, with,
perhaps,fibrinous clots or calcareous concretions.
The walls of the pouch may indurate [fibrous hygroma) and form almost
the entirety of the growth ; then there is scarcely a small cavity full of
fluid, in the center of the mass. In cattle, some hygromas reach enormous
proportions and are covered with large horny growths.
In the treatment of chronic hygromas, one must; before everything
else, remove the cause of the trouble : to remove the frictions and the
rubbings that keep up the irritation is an indispensable condition. Cura-
tive means vary with the age of the lesion. If the inflammatory symptoms
are quite severe, if there is lameness, rest is to be prescribed. At the
outset, astringent lotions, the traditional mixture of vinegar and commoii
chalk, may prove sufficient. Delwart has recommended the mixture of
clay, vinegar, and sulphate of iron. Weber advises the following mixture :
' Rice-formed.
250 VETERINARY SURGICAL THERAPEUTICS.
Grams.
Norway tar .... 450
Green-soap 450
Tannin powder 100
" Every day, after stirring the mixture, a simple painting with a brush
is made without friction. This application is renewed every day without
taking notice of what takes place or being frightened at the sloughing
of large epidermic patches, which come off after several days of treat-
ment, and which must take place without interruption until recovery. No
accident is to be feared, for no serious consequence and no scars have ever
followed."
Irritating frictions (turpentine, ammonia, spirits of lavender) or blisters
(charges) ordinarily fail. Straight-line or needle firing is more efficacious ;
some obstinate hygromas are relieved by cauterization, when the cause of
the trouble has also been removed.
The cri/shitjg of the pouch, which is possible when the walls are thin,
is not sufficient : the exudation returns.
Asepiic puncture with trocar or bistoury does not succeed better ; it
permits the escape of the contents of the tumor, but the wound cicatrizes
rapidly ; the internal unmodified membrane continues to secrete and the
fluid collection returns. The puncture must be completed by an irritating
injection. Solutions of iodine succeed well in the treatment of hygromas
with thin walls. The modus operandi is described in the chapter on
Tendinous Hygromas. No serious complicatio;is need be looked for.
Other agents than iodine may be used : carbolic acid, 3-5 percent. ; cor-
rosive sublimate, i in 1000 or 500 ; thymic acid and a mixture of ergotine
and muriate of morphine give similar results. It is good, if possible, to
add pressure after the injection by a wadded dressing, or better, an elastic
bandage. The last is advised for the knee and fetlock to insure and ac-
celerate recovery.
Drainage is sometimes used successfully against some hygromas. Or-
dinarily a seton, tape, or long tent of oakum is passed through the vertical
axis of the tumor. This means, which brings on recovery by the suppura-
tion of the pouch, is objectionable, since it leaves two cicatrices ; and if
the ends of the seton are tied up, it allows the possible tearing of the skin.
It is better to have recourse to a drainage-tube fixed by a stitch of suture
or a safety-pin. Dependent puncture, fixation of a short drain and ir-
ritating injections constitute a good treatment.
Subcutaneous discission is a delicate operation, too commonly followed
by a return of the trouble to be recommended. Ordinary incision is pre-
ferable. After disinfection of the surfaces the pouch is freely opened, the
fluid allowed to escape, the clots removed, the rice-formed masses extrac-
HYGROMAS — BURSITIS. 25I
ted if there are any, and the vegetations or more or less calcareous pseudo-
serous membranes are scraped off with the sharp curette. By using cor-
rosive sublimate or carbolic acid, the radical operation is without danger.
Curettage of the internal membrane is to be preferred to cauterization,
actual or potential. The operation is completed by a few stitches of suture,
an iodoform dressing if possible, or collodion and antiseptic powders.
Sometimes the walls, fibrous or calcareous, have considerable thick-
ness. In such a case extirpation may be attempted. If the tumor is
pedunculated, elastic ligature is the best ; if the base is wide, a sharp in-
strument is to be used : incise the skin, enucleate the mass without
opening it, or divide in two and remove each half separately. Well-ap-
plied hemostasis, sutures, and disinfection afterwards may permit the rapid
union of the edges without suppuration. This is the ordinary treatment
of old capped elbows rebel to injections and cauterization.
Before considering hygromas individually, we will mention, once for all,
the serous collections that may be found in the various species, particularly
cattle, on the projecting parts of the body, especially the trochanter, ex-
ternal angle of the ilium, point of the ischium and external face of the
thigh. Their treatment is that of recent hygromas, a similar one to that of
traumatic serous effusions. We especially recommend dependent punc-
ture, drainage and injections of strong antiseptic solutions.
SPECIAL HYGROMAS.
/. Hygroma of the Elbow — Capped Elbow.
The repeated pressure of the heels of the shoe upon the summit of the
cubitus, in horses that lie down cow-fashion, produce, on the skin and
subcutaneous tissues, lesions of various kinds which are classed under the
general name of capped elbow. If the lesion consists in a dropsical con-
dition of the serous bursa of the elbow, in a true hygroma it is produced
in some cases by an acute or chronic inflammation of the skin or of the
cellular tissue underneath. According to the nature of the alterations,
capped elbows are cedematoiis, cystic, phlegmonous and indurated. They
are also divided into old and recent, acute and chronic.
In the sterno-costal decubitus, the body is supported by the sternum,
the abdomen and a little of one side of the thorax, it being always slightly
inclined to the right or to the left. The canon and the phalanges, flexed
upon the knee, come to lie against the forearm, and as the length of these
two folded parts is apparently the same, the heels of the shoe can press
upon the elbow. On many animals this is harmless. If the animal lies
on its right side, for instance, the right foot comes and rests between the
chest and the elbow on the coresponding axilla ; the left is carried suf-
252
VETERINARY SURGICAL THERAPEUTICS.
ciently in abduction to have no connection with the olecranon. It seems
that a special conformation of the knee, reducing abduction, must be
necessary to bring on this contact with the elbow. Perhaps, also, as Bouley
says, the relative lengths of the forearm and canon have an influence upon
the relations of those parts. What is certain is, that most of the horses
lie cow-fashion, and that
capped elbow occurs only
on predisposed animals.
The best way to prevent
it would be to tie up the
animal short enough to pre-
vent its lying down ; but
this could not be done
long. Sometimes by plac-
ing the animal in a box-stall
or tying it sufficiently long
so that it will not assume
the sterno-costal, but the
lateral decubitus, young
animals may be taught by
punishment not to assume
this position. Often the
capped elbow is produced
by a shoe which is too long ;
shortening the branches,
especially the internal, bev-
eling them, and indenting
them in the hoof may pre-
vent the trouble and cure
recent lesions. The cres-
cent shoe is advantage^
ous. (Fig. 57.)
A well-shod horse whose
hoof only rests on the olecranon may nevertheless become affected with
hygromas. The contact then must be relieved by applications on
the foot of pads, bags of bran or india-rubber air-cushions (Bouley).
A thick roll applied above the knee on the canon, the coronet or the
heels may do well : during the flexion of the leg it presses against
the thorax and forces abduction ; it also keeps the metatarsal and
the forearm apart. Zundel advises placing on the back of the knee
in the direction of the leg a stiff roll of straw secured above and
below on the lower part of the forearm and the superior portion of the
Fig. 57. — Shoe-Boil.
HYGROMAS — BURSITIS. 253
canon; this will prevent the flexion of the anterior affected leg. Placing
sharp points or using pads with sharp nails is a dangerous thing to do.
A good shoeing and simple soft pads are generally sufficient. A muzzle
is sometimes used to prevent the animal biting its elbow.
Local therapeutic means can be advantageous only when the region is
relieved of the bruising action of the shoe or of the heel of the foot.
The capped elbow when recent is soft and oedematous. Douches, slight
massage, astringent applications (white lotion, vinegar and chalk) and ex-
ercise are sufficient to obtain the absorption of the exudation from the
subcutaneous connective tissue. If the result is incomplete Lebas charges
or blisters can be used.
The cystic capped elbow, the true hygroma of the elbow, ordinarily does
not yield to these means of treatment. Repeated blistering applications
have been prescribed for it, especially the bi-iodide of mercury. The
preparation of Weber spoken of above applied daily will, after three or
four weeks, remove some voluminous hygromas of the elbow. Mr.
Weber says that this treatment "has never failed with him." Several
veterinarians have also obtained excellent results from its use. Puncture
is efficacious only when it is completed by the destruction of the cystic
membrane. The puncture should be made with the red-hot iron, the in-
ternal face of the wall should be scorched with it or touched with a
caustic substance (tincture of iodine, solutions of potash, chloride of zinc).
Sometimes after the opening a blister or a few points of firing are put on
the surface of the tumor. Some practitioners still use the vertical seton.
When the capped elbow is the seat of an active inflammation this can be
relieved by cold applications, emollients or camphorated ointment. Vesi-
cating agents to promote suppuration are also used. When the abscess is
formed a free opening is made, followed by frequent injections.
A more energetic treatment is necessary with indurated capped elbow.
Blisters and mercurial frictions have little effect : the Weber preparation
finds obstinate cases and cauterization does not always succeed. After
trying all these, if the tumor is quite circumscribed it must be ex-
tirpated. The ecraseur crushes the tissues and leaves a bruised zone
which sloughs off by suppuration and retards cicatrization. Elastic
ligature is always to be preferred when the tumor is somewhat peduncula-
ted. When it is wide and the application of the ligature somewhat
difficult, Moller recommends the use first of a very fine india-rubber
thread, which will not slip so easily. After a few days, when the tumor
has swollen by hyperaemia and exudation, this thread should be replaced
by another coarser. The elastic ligature can, however, be kept in posi-
tion with the aid of a metallic pin pushed through the mass (a kind of
pin suture). The section of the neoplasm will take from five to ten
254 VETERINARY SURGICAL TIIERAPF.UTICS.
days, according to its size. It is better to ha.ve the amputation per-
formed entirely by the hgature than to finish it with the bistoury : the
wound heals quickly and leaves but a little cicatrix.'
Excision is frequently made with the bistoury, but it is often more
difficult than at first thought, and often leaves a large wound. The ani-
mal having been thrown on the opposite side and the diseased leg carried
forward, the region is shaved and disinfected. Two curved incisions
meeting at their extremities are made on each side of the central axis
of the tumor, circumscribing a flap of skin, which is removed with the
mass. By careful dissection, avoiding injuries to the muscles, the anti-
brachial aponeurosis or the head of the olecranon, the fibrous neoplasm is
removed ; the edges of the wound are then brought together with silk or
silkworm-gut, and the whole is covered with a collodion plaster or a dress-
ing.
By paying attention to antisepsis union by first intention may be
obtained, though it is not to be greatly expected in ordinary practice.
The patient should remain at rest from one to three weeks. In the
first days following the operation the animal should not be permitted to
lie down.
To resume, when the cause is removed recent capped elbows, oedematous
or cystic, should be treated with antiphlogistics, astringents, the Weber
preparation or blisters. Phlegmonous growths demand the same treatment
as abscesses. Being indurated neoplasms, they ordinarily require the use
of ligature or of the bistoury.
Once cured, the return of the trouble is prevented by following the
regulations given above.
Large-sized dogs which have the habit of lying in a sternal position,
with the elbows resting on the ground, are exposed to callosities of the
skin of that region and inflammation of the olecranal bursa. When
this enlarges it forms a rounded or ovoid tumor, fluctuating and some-
times accompanied with inflammatory manifestations. In some cases the
surrounding tissues become indurated.
Whatever has been the growth of the tumor, and whether its contents
be serous or sero-fibrinous, recovery is not easy to obtain. Puncture
is insufficient and ligatures ihold badly. The removal of the sac is the
preferable method, performed aseptically without exposing the bone and
then dressed with a wadded dressing.
' Our experience with the use of the elastic ligature for the removal of these
tumors justifies us in differing from the author in his conclusions. With us
and many American veterinarians the wound has always been very slow in re-
pairing and the cicatrix has been rather ugly. With Myers one case lasted
from January to May before entirely healed. (Amer. Vet. Review, vol. xi., p.
121.;
HYGROMAS— BURSITIS.
255
//. Hygroma of the Knee.
This hygroma that Percivall calls " capped knee," is not rare in horses.
It is observed principally in those that rise " cow- fashion," and on those
that have fallen on their knees without division of the skin. It is frequent
in cattle. Its frequency depends on the way in which animals lie down
and rise. Some remain a certain time on their knees ; the pressure and
rubbing on that region wear the hair, irritate the
skin, lacerate the connective tissue or give rise to
a serous exudation. Serres condemned the bad
condition of many barn-floors in southern France,
and also the habit of having no bedding except
for the hind quarters.
In horses, recent precarpal hygroma is generally
painless, diffuse, spread over the anterior face of the
knee (Fig. 58) and evenly fluctuating. Whatever
its size may be those characteristics are sufficient
to distinguish it clearly from the tumors formed by
the dropsy of the tendinous or articular synovial sacs
of that region. In time the walls thicken and be-
come indurated here and there ; in its cavity float-
ing bodies (" riziform ") can be detected; some-
times inflammation occurs and purulent transforma-
tion follows. In cattle, the growth may reach con-
siderable dimensions (Fig. 59). Sometimes the
skin is excoriated more or less deeply ; not un-
commonly is it indurated, partly ossified and covered
with a thick horny production (Fig. 60).
If the build of the barns is defective let it be
remedied. When the tumor is recent and small,
irritating frictions (turpentine and ammonia mixed, tincture of canthar-
ides, camphorated alcohol) or blisters are recommended. These some-
times succeed when the sero-bloody collection of the connective tissue is
small ; when it is abundant they fail. Puncture with the trocar is in-
sufficient; it must be completed with iodine injections. Moderate press-
ure with the dressing or the elastic band assists in the recovery.
Freely open the pouch on its dependent side, remove the fibrinous
clots and rice-formed bodies that may be there, place a drain, and twice
a day inject carbolic-acid water or weak tincture of iodine : such treat-
ment will give the best results.
The seton run vertically is used by many ; the cavity closes by granu-
lation. A tent of flax or an india-rubber drainage-tube in place, an-
Fic
. 5S. — Hygroma
of the Knee.
256
VETERINARY SURGICAL TIIERAPKUTICS.
tiseptic injections can be thrown into tlie cavity. This treatment is
followed by induration of the knee. Furlanetto, with the seton, applies
a blister or a compressive figure 8 bandage over the knee.
Fig- 59- — Hygroma of the Knee in a cow (from Stockfleth). The tumor
measured i m. 56 in. in circumference. It was of one year's standing. It inter-
fered with locomotion. When the foot rested on the ground it flattened
down on its inferior surface.
Needle cauterization has given good results in the case of horses.