latter are not serious ; whether they run through the sheath only or extend
to the middle coat, they seldom, in animals, expose them to the forma-
tion of aneurisms.

Penetrating wounds divide the vessel completely or incompletely. Large
arteries entirely divided by a transverse section give rise to such abundant

347



348 VETERINARY SURGICAL THERAPEUTICS.

hemorrhage that death occurs before any repairing work can be started.
In arteries of medium size, deeply situated and communicating externally
by only a narrow orifice, hemostasis may take place naturally. In such
cases, both extremities of the divided artery retract in their cavity as
would the ends of a stretched elastic tube, when divided ; the open
mouths of the vessel shrink, the blood infiltrates in the sheath and the
surrounding tissues ; an external clot is formed first, then coagulatioa
spreads to the interior of the arterial ends and gives rise to an hitej-nal clot,
more or less elongated, generally extending to the first collateral. To
insure complete hemostasis, this clot must organize. From the arterial
wall and the edges of the wound, true vegetating endarteritis is started,
whose granulations penetrate the structure of the clot and transform it
into a fibrous tissue which in time retracts : to such an extent that after a
certain time the divided extremities represent only fibrous cords, united
together by a tractus of similar nature. All danger of hemorrhage is re-
moved as soon as the clot is sufficiently organized ; but at the beginning^
when it is still fibrinous, an external violence, a strong rush of bloody
current, a somewhat active inflammation of the coats of the vessel, are
sufficient to bring on a new hemorrhage, whose serious nature will be
proportional to the importance of the vessel.

Spontaneous hemostasis takes place so much more rapidly that the
animal's blood is " more plastic." In relation to this, dogs occupy the
first place ; then come cattle, sheep, and, far behind, the horse. In
dogs, the transverse section of the carotid is not always fatal.
Surgical practice shows that " hemorrhages due to transverse sections of
large muscular arteries, as in those of the neck, of the withers, chest and
croup in horses, either stop spontaneously or are easily controlled by
hemostatic means of secondary powerful influence." (Bouley.)



Fig. 85. Fig. 86. Fig. 87.

Wounds of the Arteries.

Incomplete sections are transverse, oblique or longitudinal. In almost
all, spontaneous hemostasis is possible. If the wound, transverse or
cblique, is narrow, the phenomena are similar to those of punctures. Aa



WOUNDS. 349

hemostatic wedge, with base outwards, whose point is between the two edges
of the wound, stops the flow of blood. In a large wound, involving more
than half the circumference of the vessel, the edges gape apart by the
retraction of the elastic fibers ; the wound assumes an oblong form which
favors trie hemorrhage — the divided ends no longer able to retract in the
depth of the tissues, the constant push of the bloody current prevents the
formation of an obliterating clot. Lotigitiidinal wounds are the less
dangerous. There is no marked separation of the edges ; repair goes on
as in pricks or in punctures.

In contused woiaids, arteries may be divided cleanly, as in wounds with
sharp instruments. Sometimes the internal and middle coats rupture
first ; the external favor the hemostasis by its stretching. Projectiles
give rise to lateral wounds, perforations or complete divisions. In the
tearing of arteries, the coats of the vessel stretch, then the internal tears
first ; if the stretching continues, the middle coat then gives away and
then comes the external. When the artery is of small size, there is no
escape of blood : the inside and middle coats are covered by the external,
which has stretched much before giving away ; the tearing completed,
both ends of the artery retract, especially the middle coat, and the ex-
ternal membrane, less elastic, covering the two stumps of the vessels con-
stitute a kind of cork which arrests the blood ; an effect similar to that
produced in torsion or section with the ecraseur.

A widely open arterial wound is always characterized by a rutilant hem-
morrage whose force of current is so much more marked that the vessel is
nearer to the heart ; the beatings of this organ being manifested upon the
flow of blood by jerks isochronous to the ventricular contractions. When the
external wound is narrow and sinuous, the fluid runs out yet freely, but it
is not pushed out so far. With the exception of wounds by tearing,
arterial divisions are always accompanied by an hemorrhage csWed primitive.
When arrested spontaneously or by treatment applied against it, some-
times the flow of blood reappears after a few days, either through the
exploration of the wound or softening and disaggregation of the clot ; this
hemorrhage is called secondary.

To arrest the flow of blood, such is the only indication of arterial
Avounds. For a long time old surgery depended on the use of astringents,
styptics, cooling preparations. Cold water and ice have never arrested a
serious arterial hemorrhage, and even the classic chloride of iron does not
deserve the reputation made for it in veterinary surgery : it promotes the
formation of a clot where infectious germs pullulate, and if, after its use,
the surgeon wants to secure the strings of the blood vessels, they are very
difficult to find. For hemorrhages in sheet, cautery is the best. If the
lesion is on a leg, a temporary hemostatsis may be made with digital



:35o



VETERINARY SURGICAL THERAPEUTICS.



pressure or the tourniquet. Permanent hemostasis is obtained by antiseptic
plugging, torsion, ligature or forcipressure.

Compression in the wound demands minute asepsy. In legs, the
wound, made bloodless by the use of the tourniquet or ligature en masse
of the region, should be plugged with iodoformed gauze or antiseptic
wadding. A wadding dressing will complete the operation. After five,
six or eight days, under the gauze, softened with tepid water and removed
with care, will be found a dry, granulating surface ; the after cares are
the simplest.

y^iX!^ forceps iox forcipressure, it is generally easy to secure the ends of
the divided vessel. If ligature appears difficult, if the instrument is well
aseptic, it can be left in the wound and enveloped in the dressing. It is
removed after forty-eight hours.

Torsion, defended of late by Tillaux, deserves to be used for small
arteries. With the forceps, the arterial stumps are twisted ; the internal
and middle coats shrink, the remaining external covers the extremities and
stops the blood. (Figs. 88 and 89.)

Ligature is the most certain of all means.
Large vessels must be tied at both ends. With
a complete section, the extremities are retracted
in the interior of the tissues ; one must not
hesitate in cutting those to expose them. As
ligature, catgut or silk is used ; the essential is
that it should be aseptic. Catgut is resorbed,
silk incysts, and the tissues tolerate it without
reaction. Ordinarily, the ligature of the central
end is not sufficient ; even when the peripheral
end seems to be bloodless, it must be looked
for and secured, as the small clot that obliterates
it would not resist collateral circulation ; sec-
ondary hemorrhage might occur.

The effects of ligature of arteries are known :

the internal and middle coats break and retract ;

the blood coagulates in variable extent in both

stumps ; after a few days the strangulated ex-

The endarteritis promotes an active cellular neo-




I?ig. 88. Fig. 89.

Torsion of the arteries,

(Tillaux.)

ternal coat gives way.



formation, filled with capillaries starting from the walls of the vessel ; the
organization of the clot brings a lasting hemostasis.

To supply the circulation of the ischemied surrounding, collateral blood
vessels develop and prevent gangrene of the tissues formerly irrigated by
^he now obliterated blood-vessel.

With simple arterial puncture, one may often dispense with the ligature ;



RUPTURES. 351;

pressure is sufficient. When a large bloody tumor is formed, pressure of
the vessel toward the central end has been recommended : it can be used
for some arteries. If, however, the enlargement continues so as to en_
danger the conservation of the tegument, it is better to cut freely and
ligate the two divided ends of the vessel. Puncture of the carotid in the
horse has for a long time been considered a serious accident. But the
observations related by Favre, Bareyre, Delafond, Rainard, Cabaroc, Rey,
Mangin, Dayot, Prang^, Roux, have shown that generally the hemorrhage
can be controlled by the application of one or two pins on the wound of
phlebotomy, in taking hold of a sufficient quantity of skin and making on the
surface of the tumor a permanent pressure, with the aid of pads of oakum
soaked in cold water and held in place by splints and bandages. The
blood filtrates more or less abundantly in the jugular groove ; a diffuse
aneurismal hematoma is formed, which disappears ordinarily in eight
days ; sometimes this is enormous, and then pressing upon the trachea
brings on death by asphyxia (Rainard, Loucou). In the observation of
Van Autgarden, the roaring was such that the author had to perform
tracheotomy. These are exceptional cases. Ordinarily the resolution of
the tumor goes on little by little, the arterial wound cicatrizes, the current
of blood is preserved ; a secondary aneurism seldom follows. Noquet has
observed a case of this kind in a cow where the saphena artery had been
pricked during bleeding at the vein ; hemorrhage had stopped after the
closing of the wound with two pins ; there was a thrombus as big as an
egg. A month later, the tumor had the same dimensions ; it was punc-
tured, an abundant quantity of blood escaped ; a new suture was applied,
the pins sloughed out, which was followed by a mortal hemorrhage.

Ligature of the carotid has been recommended by Montier, Segretain
and others. Quite delicate, it is not without danger of complications.
One must not resort to it unless the hemorrhage is very abundant or if
the extravasation, voluminous, interferes seriously with respiration.'

11.

RUPTURES.

Ruptures or subcutaneous tearings of arteries have for ordinary causes
traumatisms, comminuted fractures, luxation, muscular efforts, vomiting,
the action of veratrine (Hering), and certain manipulations of the surgeon

1 J. E. Erown has related the case of a three months colt which was homed by a
Jersey bull and which had received a lacerated, contused wound with division of the
carotid artery, jugular vein and pneumogastric nerve. Ten inches of the artery was
left hanging to the wound, with ten or twelve inches of the nerve and five of the
vein. The artery was ligated, the protruding ends of the artery and nerve were cut off. .
Recovery was perfect. — American Vet. Review, vol. xv., page 279.



352 VETERINARY SURGICAL THERAPEUTICS.

to reduce fractures and dislocations. Embolics may also soften arteria^
coats and promote rupture (Cad^ac). In the great majority of cases,
alteration of the vascular walls (atheroma, aneurisms) has been ob_
served on a level with the rupture. Some cases, however, prove the possi-
bility of rupture of vessels whose walls present no lesion of degener-
ation. When it occurs in a superficial artery, a diffuse, warm tumor forms
at once, irregular and pulsating as aneurisms do, though not so powerfully ;
seldom can the bellow murmur be detected in them. This bloody effu-
sion, called diffused o?- false aneurism, is not an aneurism. The name of
diffuse ajieurismal hefuatofna, proposed by Michaux, is to be preferred.

The large arteries of the thorax and abdomen rupture more frequently
than superficial vessels. Sometimes it is the pulmonary artery (Hering,
Hartmann, Prietsch). At the post-mortem of a dog, that had died sud-
denly, we found a large distension of the pericardium by blood ex-
travasated through two little tears situated on the right face of the pulmonary
artery. In the zone where the tears were, the artery was very thin and
presented several small transparent spots. But, no doubt, it is the aorta
which is injured in the greater number of cases. Larcher has reported
twelve observations at the Societe Centrale de Medecuie Vcterinaire (1876).
In all, the tears had taken place at the base of the primitive aorta, at a point
where the vessel is still covered by the pericardium ; this contained a notice-
able quantity of blood, sometimes fluid, more generally coagulated. In five
cases the structure of the vessel was the seat of atheromatous degeneration ;
in two, no visible alteration could be detected ; in five others, no mention is
made of the condition. To these twelve observations of Larcher, we
might add those of Vatel, Maillet, Rigollat, Palat and others published ia
other countries or recorded by us at the Alfort clinics. In horses, rupture
of the aorta is not rare.

If, generally, the diagnosis is only positive at the time of post-mortem,
the accident can be suspected, taking into consideration the circumstances
in which it takes place and the symptoms it gives rise to. The symptoms
are those of large internal hemorrhages. " In one case, a high jumper,
after a prodigious jump, suddenly drops on his hind quarters, to rise no
more. In another, the horse, as he is cast on the bed to be submitted to
an operation, makes a powerful inspiration, his eyes roll in their orbits, the
respiration and beatings of the heart stop and immediately he is pulseless."
(Larcher). In two cases that we have seen, the rupture took place during
the struggling of the animal while lying on a bed for operation. The
aorta may give way at a point some distance from the heart. At the autopsy
of a twelve year old mare, that died suddenly in stocks, we have found a
rupture of the aorta on its superior face, on a level with a small exostosis
of the third lumbar vertebrse. The vessel had two ulcerations ; the



ANEURISMS. 353

smallest like the scratch of a nail, having sharp, ragged and sinuous
■edges ; it occupied the entire thickness of the wall ; its bottom seemed
formed by a fine transparent anhistous membrane. The other, situated
like the precedmg on the dorsal face of the vessel, presented the same
external characters ; the tear started from its bottom.

Rupture of the pulmonary artery, primitive aorta or one of its divisions,
ordinarily kills in a few minutes ; all attempt at interference is useless.
With those of secondary and superficial arterial trunks, treatment may-
be efficacious. Pressure on the vessel, on the cardiac end, may sometimes
arrest the hemorrhage, specially if with it cold effusions and astringents
are used. The application of a compressive bandage may also give good
results. If, notwithstanding these, the blood continues to accumulate
under the skin, the ends of the ruptured vessel must be looked for and
secured with ligature.

To rupture of blood vessels can be added the perforation of their coats
by nemathelmintes which they may contain. This accident has been
observed in horses with the sclerostomus armatus (Durieux) and in the
dog by the sanguineous spiropterus (Morgagni, Degive, Megnin.)'

III.

ANEURISMS.

According to the form of the arterial dilatation, aneurisms are divided
into fusiform, when they occupy the whole diameter of the vessel, and
sacciform, when limited to a portion of the wall only. Their origin is
primitive or spontatieous. A bruise may divide the internal membranes
of an artery and create a locus mirioris resistensice, where the traumatic
aneurism takes place. Acute or chronic inflammation of blood vessels,
atheroma, promote the formation of spontaneous aneurisms. Endarte-
ritis is often due to parasites (strongyli, spiroptera). In the majority of
horses, the great mesenteric, and at times the small and the caeliac axis
are the seat of aneurismal lesions due to the strongylus armatus. Very
severe colics (intestinal congestion, thrombo-embolic colics) seem to be the
result of an infection starting from these points. Megnin has described in
the dog two cases of aneurisms of the aorta due to the sanguinoletita.
spiroptera.

1 A case of rupture of the internal iliac is reported by W. J. Martin occurring in a
mare during the manipulations made by the owner to relieve her in a case of distokia.
The mare had received a small dose of chl»i-oform to quiet her pains but died as her
colt was removed. At the postmortem the rupture of the artery was found just below
the junction where it leaves the posterior aorta. — American Vet. Review, vol. xxiii,
page 114.



354 VETERINARY SURGICAL THERAPEUTICS.

Aneurisms constitute a prominent danger. Wounded, they give rise to
an abundant hemorrhage ; their rupture is generally fatal. Internal-
aneurisms are beyond surgical interference; the external only are justifi-
able of an active treatment ; they are rare in animals. They have, how«
ever, been observed in horses on the palatine artery, the pharyngeal, ifiter-
nal tnaxillary, gluteal, on various arteries of the legs ; in cattle, on the
vertebral, ischiatic and the tibial. The observations of Blaise, Steinmeyer,
Walley, refer to horses that have died from rupture of aneurisms of the
pharyngeal, carotid and internal maxillary arteries.

When, upon the course of an artery, one observes a tumor evenly fluctu-
ating, depressible, reductile, pulsating, he must think of aneurisms. Some-
times they are mistaken with neoplasm developed on the tract of a
vessel. Moller has told us that he made an error of this kind and took
a carcinoma of the neck for an aneurism. A puncture improperly made
may be followed by the most serious sequelae ; as the case of King related
by Percivall in his Hippopathologv : An old horse had on the croup a
tumor of the size of a man's head ; it was fluctuating. King punctured it;
a flow of blood took place at once ; plugging was vainly tried, the animal
dying. Dissection revealed the presence of an aneurism, partly ossified,
of the gluteal artery.

In the case of the cow recorded by Collin, she had on the left side
of the neck a soft, elastic tumor, as big as the fist, well defined, not
adherent to the skin, without heat or pain. Mistaking it for a cyst, the
author tapped it with a pointed red iron, which was immediately followed
by a flow of rutilant blood, jerky, as big as the finger. A continued suture
arrested the hemorrhage ; but the blood escaping in the subcutaneous
cellular tissue, the tumor became treble in size, and the arterial beatings
were readily perceptible. The treatment consisted of cold lotions. The
size of the tumor diminished. All danger seemed avoided, when the animal
rubbed herself against a tree, and serious hemorrhage followed. The
animal was sold to the butcher and destroyed. She had an aneurism of
the cervical artery.

Spontaneous recovery of aneurisms is possible ; it takes place by
thrombosis ; a clot is formed in the sac and closes it. The artery may
keep its caliber or obliterate. Such termination is rare ; ordinarily aneur-
isms assume larger and larger dimensions, disturb the surrounding tissuest
and their possible rupture is a constant danger to the life of the patient.
Furlanetto thought best not to interfere in two cases of aneurisms, quite
large, of the tibial artery in steers. Both animals were able to continue
their work.

Various methods oft reatment have been recommended against aneur-
isims. General depression by bleeding, low diet and purgatives (method



ANEURISMS. 355

cf Valsalva) is now left aside. Digital or elastic pressure (method of
Reid) is not practicable in veterinary surgery on account of the restless-
ness of our patients. Coagulating agents, so much in favor in days gone
by, are now ignored. Ligature and extirpation are now the only modes of
treatment resorted to by surgeons.

Ligature may be applied above or below the sac, or on both at once ;
the operation is simple. Aseptic catgut or silk is used. The ligature
above the sac (method of Anel-Hunter) has many advocates. As soon as
it is made, the tumor flags down, the murmur, pulsation, and expansive
movements cease ; the region becomes cold. The circulation through
the collaterals is generally sufficient to prevent the gangrene of the re-
gion where the ligated vessel carried the blood ; still there is a possibility
of this dangerous complication. A clot closes the sac. Under the in-
fluence of the collateral circulation, the blood reappears in the tissues, in
the sac itself, and the passive clot is transformed into an active clot. The
recovery thus requires : " (i) the temporary arrest of the circulation and the
formation of passive clots; (2) the graded return of the circulation, allow-,
ing the transformation of the passive fibrino-globular clots into active^
fibrinous." (Michaux.)

Double ligature, above or below the dilatation, is used as much as the
preceding. In the horse. La Motte has cured with it an aneurism as
big as a chicken's egg, situated on the poll, behind the ear, and developed
on the posterior cervical artery. In a similar case, Peters has also beea
successful with the same treatment.

Extirpation of the sac between two ligatures is considered by some
surgeons (Trelat, Delbet) as the choice mode of operation. It is more
complicated and requires more division of tissues than ligature, but it is
radical in its effects ; it removes the possibility of return and does not
expose to the suppuration of the sac.

One may be called to treat a hemorrhage due to the opening of an
aenurism. Reimers had a similar accident in a steer which had a tumor
on the croup ; the bleeding was stopped by plugging and perchloride of
iron. In some cases, interference must be applied as quick as possible.
Plugging, iodoformed gauze, double ligature or extirpation are indicated.

ARTERIO- VENOUS ANEURISMS.

In these, there is an accidental or spontaneous communication between
an artery and a vein. Traumatisms are generally the cause. It has
occurred in man quite often by bleeding with the lancet. The arterial
blood, with its pulsating force, enters into the vein and distends it. A soft
tumor is formed, whose characteristic symptom is the vibrating trem-



356 VETERINARY SURGICAL THERAPEUTICS.

bling, the thrill of English authors. " This peculiar trembling is observed
and also heard as well as it is felt by the touch ; it is composed of a sound
and a vibration. This sound and vibration are continued and are increased
in connection with the cardiac systole ; they are perceived especially at the
level of the tumor, where they are greatest, but they can be detected at
some distance from it. . . . The sound of this thrill has been compared
to the buzzing of a bee, the purring of a cat, the whizzing of a top, of a
mill, to the noise of the red iron dipped into water. . . . The vibration
is so characteristic that, felt once, its character and nature are never
forgotten." (Michaux.)

Cagny has described an arterio-venous mesenteric aneurism. The
cases of Chauveau, Collin, Nocard, Moreau, are interesting. In the
first, it was a tumor, as big as an egg, situated along the course of right
maxillo-muscular artery and vein, outside and a little back of the inferior
jaw. This tumor, easily reductile, would return as soon as pressure
ceased ; the hand felt in it a very strong pulsation, isochronous to the
systole of the heart; the vibrating thrill was readily perceived. At the
post mortem, the tumor was found to exist on the tract of the vein and
communicated with the artery ; it measured eight centimeters in length
and about four in width. Both vessels were dilated at the seat of the
aneurism.'

The case of Collin relates to a young steer, castrated ten months be-
fore by a gelder. Both cords had been twisted and then torn. The
animal presented in the scrotal region, a tumor, egg-like, indolent, very
soft and elastic. " In pressing it gently, one could feel the beatings cor-
responding to the cardiac systoles ; to which succeeded without interrup-
tion, well marked and characteristic vibrating thrills." When the subject
was killed, at three years old (thirty- two months after castration), the
tumor measured from fifteen to twenty centimeters in height and about
thirty in circumference. The dissection, made by Lesbre, showed that it
was produced by the great testicular vein and artery enormously dilated,
elongated and communicating together.

In a fifteen year old gelding, Nocard found a soft, elastic tumor, as
big as the fist, occupying the left side of the sheath, some centimeters