prophylaxis can protect man and animals. Let us mention, however,
the results said to have been obtained by Feletti in the treatment of
human cysticercosis with the ethereal extract of fern.'
Against hydatic cysts, medical agents or puncture followed by an injection
of iodine are now seldom used. Total extirpation, with curettage of the
culs de sac, is the best remedy.
Primitive or secondary tumors may be observed in muscles. Their
diagnosis is easy. The slow process of development of the neoplasm, its
painless condition, and the absence of fluctuation are sufficient to indicate
cystic collections and abscesses. The treatment consists in removal, unless
countermanded by generalization. Lipomas, myxomas, enchondromas,
sarcomas, and epitheliomas demand total extirpation.
Actinomycosic tumors should be treated with iodide of potassium, and
in some cases should be extirpated. Those due to botryomxcetcs resist
the iodine treatment or give way to it very slowly. (See Actinomycosis
and Bottyomycosis.) .
' Feletti : Mercredi Medical, 1894, p. 417.
2/6 VETERINARY SURGICAL THERAPEUTICS.
ADDENDA.
/. Spasjns — Contractures — Cramps.
Cramps, their etiology and pathogeny, are still much discussed in medi-
cine for the human species. It is generally admitted that they may result
from muscular, nervous or vascular lesions.
Although the most of the observations reported in veterinary medicine
under name of crafnps relate to the displacement of the patella (see
Pseudo-dislocation of the Patella), yet in all species, and especially horses,
spasmodic muscular contractions and contractures analogous to the cramps
of man are observed, which may occur and have no relation with the dis-
turbances that may accompany painful cutaneous affections, Hirsemann
treated a horse which, after a disease of the lungs, was affected with
spasmodic contractions of the muscles of the neck and of the anterior
leg on the same side aj; the affected lung ; these contractions occurred by
spells, and were brought on by the slightest touch on the affected regions ;
at the same time it lowered its head and flexed and carried forward the af-
fected leg. The trouble lasted three weeks, and was finally relieved by
subcutaneous injections of veratrin. Dycer has reported an observation
of cramp of the flexor muscles of the head, which with the neck were
flexed to such an extent that the nose touched the sternum ; the front
legs were carried forward and flexed ; the animal rested on his knees, and
his body was covered with perspiration. Attempts to raise the head were
followed by great pain. After several hours the head and neck suddenly
relaxed, the animal began to eat, and no further trouble was ever ob-
served.'
MoUer has seen a horse in which cramps would appear when slight ir-
ritations were applied to the auricular region. " The introduction of the
finger into the ear would immediately bring on a violent contracture of the
corresponding hind leg, which was then carried forward and for a few
minutes held in an almost horizontal position. The animal was unfit for
any work, as pressure of the bridle round the base of the ear would bring
on the contraction. The ears and the peri-auricular region presented no
visible alteration." Contractures of the olecranoid muscles have been
recorded. In a case rela*,ed by Moller, these muscles were tense, rigid
and insensible to pressure ; the animal was very lame ; when at rest the
elbow was carried outwards. In large animals, contractures of the posterior
legs are sometimes observed at various intervals and of various duration.
' Dr. Nesbit has recorded a case of spasmodic contractions of the diaphragm
(stumps) , which was also accompanied with spasms of the masseter muscles,
which had appeared after a comparatively short journe}'. He recovered rapidly
by rest. (Amer. Vet. Rev., vol. xv., p. 452.)
PARASITES— TU MORS.
277
They do not yield to treatment. Sciatic neurotomy tried with them has
been unsuccessful.
//, Springhalt
This is an affection of the hind extremities which is frequent in horses
and observed also in mules (Bassi), donkeys and cattle (Booth, Furlanetto).
An analogous anomaly has been observed in the fore legs (Rigot, Delabere-
Blaine, Goubaux, Hering, Siedamgrotzky, Moller, Jacoulet and Barrier).
In some cases the trouble is hardly noticeable, in others it is so marked
that the foot strikes forward against the abdominal wall (Fig. 63). Al-
though ordinarily it develops slowly, accentuating itself by degrees, there
Fig. 63. — Horse affected with Springhalt. (From photograph. )
are individual cases in which it appears suddenly and without any ap-
preciable cause.
A functional anomaly symptomatic of various affections, it is character-
ized by a sudden, convulsive-like flexion of a leg as it moves. Gener-
ally it is more easily observed in walking, not so easily detected during
a trot or gallop. At times it shows itself only at the beginning of work,
and disappears when the animal is warm ; at others it is less noticeable
after a little exercise ; again, it may last as long as the exercise or work
is going on.
Widely different opinions have been expressed in regard to its nature.
Numerous authors think that it is the expression of articular lesiovs.
Carlo Ruini, Solleysel, Jean and Gaspard de Saulnier, La Gu^riniere,
2/3 VETERINARY SURGICAL THERAPEUTICS.
Abilgaard and Garsault have localized ii in the hock ; they had noticed
its appearance in spavined horses. In one case Natt^ found on the articu-
lar surfaces of the tibia and of the astragalus reddish erosions with irregu-
lar borders. Busteed asserted that the hock was always the seat of spring-
ghalt, and that it was due to ulcerations of the astragalus. Varnell and
Flemming upset that theory by saying that the American doctor had
mistaken for an ulcer the synovial fossa of the trochlea of the astragalus !
Rigot. Rey and Leblanc have observed true alterations of the tibio-tarsal
joint, changes in the synovia, lesions of the synovial membrane, articular
foreign bodies, wearing and fissures of the articular surfaces. In horses
that had springhalt in the fore legs Goubaux and Barrier have observed
fissures on the humero-radial articular surfaces, and in others that had
it on the hind legs they have seen similar lesions in the femoro-tibial,
femoro-patellar and tibio-tarsal joints. The influence of these lesions
seems small, however, when one considers that they may be found in
animals free from the trouble, or even may not be found at all in subjects
that are suffering from springhalt. The dryness of the articular and
tendinous synovial bursse of the hock, due to a disease of the spine, has
been considered by Comeny as connected with the manifestation of
springhalt. Barrier says that the too wide opening of the tibio-tarsal
angle is the cause of it. The hock is not the only joint which has
been supposed to be the seat of the disease. Villate, treating a lesion of
the stifle joint in an animal that had springhalt, fired it ; both diseases
were relieved at the same time. Pastureau, Bassi, and Chuchu accused
the stifle joint. Pastureau is of the opinion that springhalt and cramp
in solipeds are but varieties, or two degrees of the same affection located
in the femoro-patellar articulation, in which the {nter?ia/ femo7-o-patellar
ligament, hooked on the inner border of the trochlea, plays a more or less
important part. " If the hooking is incomplete, the flexor muscles en-
tering into action meet a resistance readily overcome, to which succeeds a
sudden flexion, convulsive like, carried to a greater extent than in normal
state ; hence the springhalt. If, on the contrary, the hooking is com-
plete, the animal finds itself unable to flex the leg and the cramp exists." '
Bassi and Chuchu have shown that it is not the internal femoro-patel-
ler ligament which is hooked, but the patella itself, on account of a special
disposition of the femoral trochlea. (See Pseudo Luxation of the Patella^
Many have attributed springhalt to muscular, tendinous or aponeurotic
lesions. For Lafosse and Bourgelat it is a lesion of the flexor muscles of
the tarsus or of the nerves distributed in it. Boccar and Brogniez think
that it is on account of the shortening of the muscles of the anterior tibial
regions, Brogniez is said to have produced it experimentally by placing
' Pastureau : Journ. des Veter. du Midi, 1849, P- 483.
PARASITES— TUMORS. 279
a wooden wedge between the metatarsus and the tendon of the lateral ex-
tensor of the phalanges so as to stretch it. L. Lafosse considers it only
a perversion of the muscular contraction. He says : " It is only a spas-
modic contraction of the flexor muscles of the metatarsus. We have re-
moved it several times by the section of one or several of these muscles,
which we have never found in that state of permanent retraction considered
by Belgian veterinarians as cause of springhalt." Hertwig locates the af-
ection in the excessive tension of the elevators of the thigh, and recom-
mends for it the section of the fascia lata. Gunther thought it to be clue
to an insufftciency of action in the muscles of the croup. Delafond be-
lieved it a diseased stretching of the tibial aponeurosis, an opinion recently
accepted by Dieckerhoff. After a minute study of the part played by
aponeurosis in locomotion the Berlin professor has pretended that spring-
halt is due to the shortening of the tibial aponeurosis, followed in time by
the atrophy of the ilexor muscles of the metatarsus. In an interesting
paper Wolf sustained the theory of Dieckerhoff. Orillard believes spring-
halt related to laceration of the muscles of the gluteal and posterior tibial
regions or to partial ruptures of the cord of the hock.
The nervous etiology of springhalt has from the start counted many
advocates. We have already named Lafosse and Bourgelat. Youatt and
Spooner attribute it to the lesions of the great sciatic nerve, which " irritates
too violently " the flexor muscles. Perciwall attributed it to disordered
muscular contractions brought on by affection of the cord or the nerves
of the hind leg. At post-mortem examinations of animals thus affected
Renner has always found a chronic inflammation of the great sciatic
nerve, and for him the spasmodic contractions of the flexor muscles of
the tibia and hock must be due to this chronic neuritis. Vachetta, taking
the theory of Renner anew, gives the facts a different interpretation. For
him the paresis of the muscles supplied by the great sciatic nerve (biceps
femoris, semi-tendinosus) gives rise to a predominance of action in the
anterior muscles of the leg. Merle, Rousseau and Comeny think that
springhalt is due to medullary lesions.
Some authors attribute it \.o foot alterations. Watrin has advanced a
theory that Weber, Lavalard and Montagnac accept for certain cases'.
He says : " By the action of the tendons of the flexor of the digits the
flexion of the hock forcibly carries with itself that of the phalanges ; then
let us suppose that for any cause the flexion of the phalanges meets with
an obstacle, the animal will make an effort to overcome it ; if this dis-
appears suddenly by reason of the force used, the flexion will be exaggerated,
and in some cases springhalt will appear." Watrin especially suspects
the contraction of the external quarter of the foot and the rolling in
Qf the corresponding cartilage, which, hitting against the posterior face of
2So VETERINARY SURGICAL THERAPEUTICS.
the second phalange, constitutes an obstacle to the free movement of
the phalanges and produces the springhalt. Ch^nier thinks that spring-
halt is due to a lesion of the intra-horny tissues generally to pain or pres-
sure taking place at given moments of the walk. To back his opinion,
he says that horses that have cracks in the toe or the mammae of the foot,
or that have deformities of the hind feet, as in laminitis, do frequently
have springhalt. He remarks that the symptoms diminish by exercise,
as the tissues of the foot become accustomed to the painful irritations,
and that if the disease were seated in muscles, tendons or aponeurosis,
the irregularity of action would increase by work.
Like Gunther, many authors (Dieckerhoff, Bassi, Trasbot, Weber, Chu-
chu, and MoUer) admit to-day that springhalt is a symptom of a great
many different lesions. With Moller, springhalt can be divided into
idiopathic (without visible occasioning cause) and symptomatic, when due
to lesions of various nature and seat (bony diseases of the hock, scratches,
blows, seams, laminitis, quittor, keraphyllocele, canker).
In fact, springhalt is always a secondary symptomatic affection. The
spasmodic contractions which essentially characterize it are of a reflex
order and promoted by lesions very diversified in their nature and localiz-
ation, sometimes visible and at other times incapable of diagnosis, and
often incurable.
Let us see now the forms of treatment recommended for it. We will
speak only for memory's sake of the antispasmodics (belladonna, aconite,
stramonium) used by Renner to overcome " the spasm of the posterior
crural muscles." Vachetta has had some success with acupuncture and
irritating frictions on the biceps femoris and semitendinous muscles, which,
according to him, are in process of atrophy. But little can be expected
from blisters or firing of the hock.
Some authors who, like Percivall, Lafosse and Merle, admit a nervous
lesion, have tried the resection of the anterior tibial nerve, the principal
branch of the small femoro-popliteal nerve. The operation is easy : The
horse having been cast on the side opposite to the diseased leg, the opera-
tor, placed behind this leg, incises the skin parallel to the tibia on the
external side of the superior extremity of the bone, where the nerve,
easily found, runs in an oblique direction downwards and forwards. A
second stroke of the bistoury divides the tibial aponeurosis, and the nerve,
very near the surface there, is immediately exposed. The following
steps are those of all nervous resections. This neurotomy has never
given very satisfactory results.
T\i& section of the great sciatic ;/,?r7'^ (posterior tibial nerve) above the
hock, succeeds when the lesions are seated in the inferior parts of the leg.
(See Tendinitis.)^
PARASITES— TUMORS. 28 1
The section of the tendon of the lateral extensor of the phalanges was
recommended by Boccar as early as 1845. Having found that tendon
retracted and hard, he divided it at the point of its junction with that of
the anterior extensor of the phalanges, and obtained a complete recovery.
To perform the operation, the animal is cast on the sound side ; the
affected leg is either left in the hobble or carried over the correspond-
ing fore leg ; the skin is shaved and disinfected ; the straight tenotome is
planted on the posterior border of the tendon, then under it to the middle
of its metatarsal region ; the curved tenotome is then substituted for it.
The instrument well in place, the tendon is divided by bringing it in con-
tact with its sharp edge. The wound, covered with a little iodoformed
collodion, cicatrizes rapidly by first intention. A removal of a small piece
of the tendon (Delwart) has been suggested, but this practice has no real
advantage except to retard the cicatrization. When the animal has got up,
it is not unusual to see that the phalanges do not extend sufficiently, the
fetlock flexes forward and strikes on the ground ; but after a few days
the regularity of the gait returns. There are cases in which, as in the
first case of Boccar, springhalt subsides immediately. More commonly,
the irregularity of the flexion motions disappears gradually, while cicatriza-
tion goes on, and the animal is given light exercise. It would be ad-
vantageous to have the animal walked during the time following the
operation.
Performed by Delwart, Brogniez, Foelen, Trinchera, Palat, Sergent, Guit-
tet, Ge'rard, Humbert, Adrian and Blaise, this tenotomy is said to have been
successful in numerous cases. Sergent has recorded fourteen observations
with the following results : Nine complete recoveries, four almost com-
plete, and one improvement. These are very encouraging. Out of six
horses tenotomy of the lateral extensor has given to Adrian and Schelameur
four successful cases, one half successful and one failure ; Blaise has had two
successful cases and one failure ; Moller has also been successful. We
have been less fortunate. Like Siedamgrotzky, we have failed in produc-
ing springhalt, operating as Brogniez did, and upon three affected animals
the section of the lateral extensor has failed.'
According to Dieckerhoff, it is preferable, in case of principally long-
standing springhalt, to cut both the tendon and the tibial aponeurosis.
The horse having been thrown on the sound side, the shank is tied up
above the hock with a cord or elastic ligature to cut off the circulation
and facilitate the reaching of the aponeurosis at the place of operation.
' Dr. W. H. Curtis has operated on a large horse and removed about half an
inch of the tendon, operating close to its union with the extensor pedes. The
case was one of two years' standing and very severe. Recovery was perfect.
(Amer, Vet. Rev., vol. xx,, p. 497.)
282 VETERINARY SURGICAL THERAPEUTICS.
The surgeon incises the skin below the hock on the terminal tendon of
the peroneo-phalangeal muscle ; in the incision he introduces the blunt
tenotome upon the aponeurosis, which he cuts transversely. Theti the
pointed tenotome is introduced under the tendon and divides it trans-
versely. The curved tenotome can also be used in this second step of
the operation. Wolff has obtained several successful results with this
method of Dieckerhoff.
Hertwig has recommended the section of the fascia lata. The animal
having been cast on the sound leg, a short inci'sion is made eight or ten
centimeters below the angle of the hip, into which a grooved director
is introduced under the fleshy portion of the muscle. The straight bis-
toury, guided by this director, divides the muscle from within outwards.
In this way Bassi has cured a mule.
The section of the cord of the flexor metatarsi has been suggested. The
animal is thrown on the lame leg, the upper leg being carried forward and
secured on the upper fore leg. Above the hock the cord is easily felt.
On a line between the lower and middle third of the tibia, with the
straight tenotome the skin and tibial aponeurosis are punctured and
pushed under the cord. The curved tenotome is then introduced in its
place and the tendon divided from backward to forward. A coat of
iodoformed collodion closes the wound and cicatrization takes place rapidly.
But ordinarily the trouble continues as before.
Pare the foot plumb, taking for guide the axis of the digital region,
and treat the contraction, if it exists, are the rules of Watrin's treatment.
The unshod foot is poulticed with clay for several days, and then a shoe
with ears is placed on it. Every ten or twelve days, the shoe is spread,
the feet widen, the cartilages, '" softened, do not longer hook against the
second phalanx." In some horses whose feet are much contracted the
springhalt subsides gradually and disappears with this treatment (Weber,
Montagnac).
For Bassi, the sectio?i of the internal anterior patellar is the operation
which offers the best chance of success. (See Pse into- Luxation of the
Patella:)
Upon an animal suffering with springhalt of both legs, we have suc-
cessively, and without noticeable result, performed the section of the an-
terior tibial nerve, of the lateral extensor of the phalanges, of the plantar
nerves below the fetlock, and of the cord of the flexor metatarsi. We in-
tended to divide the internal patellar ligament, but we lost sight of the
case. In another, where the springhalt was very severe (Fig. 63) we
divided the great sciatic nerve on the lower third of the leg ; four days
after the operation the function of the leg was normal \ a month later the
PARASITES — lUMORS. 283
hoof sloughed off, and the patient was destroyed. The irregularity of
the function had not returned.
It is seen that the therapeutics of springhalt is no less complicated than
the etiology. To treat it properly, the cause must first be known.
Correct the standing of the foot if it is defective, treat the painful lesions
which may exist, perform the operation of Boccar, patellar desmotomy
or sciatic neurotomy, according to the case ; such are the most frequent
directions. We are at present without means of treatment for the spring-
halt due to medullary lesions and muscular or nervous affections of the
superior regions of the leg.
For the springhalt of the fore legs, if proper shoeing does tiol relieve
it, plantar or median neurotomy might be tried.
CHAPTER IV.
TENDONS.
I.
CONTUSIONS.
All superficial tendons, but more particularly those of the extremities, are
exposed to contusions. The tendons of the flexors of the phalanges of
the anterior extremity, in animals that forge, overreach, or interfere, and
those of the hind legs in animals that kick backwards, are at times the
seat of an inflammatory, oedematous swelling, very painful, and due to
bruised traumas. As will be seen later on, however, true tendinitis {nerj
ferrure), in the etymologic acceptation of the word, is relatively rare.
The inflammatory lesions of those tendons are almost always the con-
sequence of sprains {efforts) or stretching produced during locomotion.
On account of the structure and weak vascularity of the tendinous
tissue, the ordinary characters of contusions are less marked than in
other tissues ; on the other hand, the progress of the inflammatory pro-
cesses is slow and the pain often very severe.
The treatment is that recommended in the chapter on Contusions in
general. Antiphlogistics first, massage and resolutives later, constitute the
principal agents. (See Tendinitis^
II.
. WOUNDS
Wounds and subcutaneous tendinous ruptures will be considered sepa-
rately. Although these lesions are manifested by functional signs about
alike for a given tendon, their prognoses differ considerably. In ruptures,
the traumatic center is protected from infectious agents, and cicatrization
takes place quickly and almost always without complications ; to avoid
the elongation of the divided cord is all that the surgeon has to guard
against. On the contrary, the wounds, like all exposed traumas, are sub-
ject to numerous complications, particularly to tendinous quittor or sup-
purative tenosynovitis.
In horses and cattle, pricks of tendons are particularly common on the
284
WOUNDS. 285
legs. The plantar aponeurosis is frequently affected by a puncture wound
of the foot ; the perforatus and perforans tendons are sometimes wounded
at the canon or the fetlock by forks or other sharp bodies. At all times
these lesions have been considered very serious ; yet their rapid cicatriza-
tion is possible. What makes them dangerous is the infectious condition
of the injuring body ; if this does not deposit in the wound phlogogenous
germs, there is only a temporary pain with production of a small fibrous
nodule ; which soon disappears. Like Furlanetto, we have sometimes seen
remaining at the point of the cicatrix a morbid sensibility, occasioning
lameness of long duration. On the contrary, wounds made with soiled
instruments have a serious prognosis ; too often they bring on acute sup-
purative tenositis, at times complicated with synovitis. (See Tendinous
Quittor.)
Sharp or bruising bodies may produce longitudinal, oblique or trans-
verse solutions of continuity of tendons. Transverse section is primi-
tively complete in some cases ; in others, the sound fibres break under
the weight of the body or of a powerful muscular contraction ; and again,
a bruised, contused tendon may become the seat of a necrotic inflammation
bringing on its complete rupture. Whether the division, however, is
primitive or secondary, the final result is the same ; peculiar functional
disturbances appear in each tendon as soon as it ceases to fulfil its special
part. The tendinous stumps are more or less apart ; the upper one, pulled
by the muscular contraction, draws up within its sheath ; the lower one
does not obey any more the articular motion likely to displace it ; and
often the space which separates them is filled with bloody exudation.
The treatment consists in disinfecting the wound, bringing the tendin-
ous ends together and immobilizing the traumatic region. If the frag-