back from its anterior opening. It was the seat of beats isochronous to
the arterial pulsations, and each of these was followed by a series of vibrat-

^ In the case of H. D. Hanson of a horse that had died during an attack of colics,
lie found at post mortem : " a large growth of the size of a cabbage head, of hard
consistency, situated in the lumbar regions towards the base of the caecum, which on
being removed proved to contain a large abscess in its center communicating with
the ileocaecal artery and involving the right fasciculus of the great mesentery."
— Amer. Vet. Review, vol. xix., page 706.



ARTERITIS AND THROMBOSIS. 357

ing thrills. The external pudic artery communicated with a large venous
•division of the sheath.

In subjects of the bovine species, Moreau has seen two arterio-venous
aneurisms of the face developed on the course of the facial artery and vein.
In one, there was also exophthalmy, due to the dilatation of the ophthalmic
Areins.

Where surgical interference is decided upon, bloody manipulation, with
strict antisepsy, forms the proper treatment. The double ligature of the
artery above and below the sac must be applied on the aneurismal varix.
In all the other cases, both ends of the artery and of the vein must be
ligated (Delbet). If the sac is large, ligature must be followed by extirpa-
tion (Trelat). In cattle, Gurlt, Prinz, Meyer, have treated by excision
the arterio-venous aneurism of the great testicular without any accident
iollowing.

IV.

ARTERITIS AND THROMBOSIS.

Any inflammation existing in the tissues surrounding an artery, may
■spread on it and give rise to serious lesions. Some arteritis are embolical
in their nature ; others start in the course of infectious diseases, progress
quietly and become manifest only much later on, by functional disturb-
ances due to secondary thrombosis.

Obliterations or arterial thrombosis deserve a special study on account
of their peculiar symptoms. Assisted by the diminution of the circulatory-
current (Virchow), the principal part in their formation is due to arteritis
and embolies. The clot may be parietal, incompletely close the caliber of
the vessel and diminish the circulation ; but it may also prevent it en-
tirely. At first very thin, this clot generally develops in the direction of
the circulatory current as far as the first collateral ; it gradually increases ia
size ; sometimes the vessel which contains it is bosselated. Its color is
yellowish or reddish, its consistency more or less firm ; it seems formed
by layers successively deposited upon a primary nucleus. The muscles
which receive blood from thrombosed vessels present no important altera-
tion ; yet Bouley Jr. has found them " pale, discolored, and less consistent
than in normal state."

Besides traumatic thrombosis, arterial obliterations are frequently found
in horses ; their pathogeny is yet uncertain. Thrombosis of the posterior
aorta is most common. Some authors, Goubaux among them, have ac_
cused the laceration of the walls of the aorta, produced at a moment whea
the animal made a bad slip. But it is probable that these thrombosis
originate most commonly from infectious causes.



358 VETERINARY SURGICAL THERAPEUTICS.

If their etiology is not well known, their pathology is, at least for those-
that affect the vessels of the extremities. Thrombosis being either incom-
plete or very slow in its development, the increased collateral circulation,
prevents all accident of gangrene. Besides this, the bloody supply is suf-
ficient through the muscles when at rest ; but if exercise is demanded of
the animal, the quantity of blood that they receive is unable to insure thier
normal functions and then occurs a true impotency of these ischemied
muscles. At the time when the conditions of apparition of the lameness
are realized, the region, poorly supplied, becomes the seat of an excessive
pain ; the aspect of the animal is anxious, the great functions are accelerated.
If the artery can be explored beyond the obstruction, it is found that the
pulsations have disappeared ; palpation of the collateral of the canon give
no longer the pulse. In the entire region where the diseased vessel is
distributed, the skin is dry and cold, while it is hot and at times covered
"with perspiration in the other parts of the body, when the exercise has been
too long. These symptoms, added to this peculiarity, that the lameness
occurs after a certain amount of exercise and disappears after rest, are suf-
ficient to establish the diagnosis of arterial tJiromhosis.

In the thrombosis of the aorta and its division the clot occupies variable
positions : it is found in the lumbar portion of the vessel, at its bifurca-
tion or in one of its terminal branches. The symptoms vary according to
the location or the extent of the obliteration. When this is incomplete,
either the gait is regular at the beginning of the exercise, or stiffness of the
hind quarters, resembling that of sprains of the loins, is observed. More
severe symptoms appear after a few minutes of trotting exercise : sometimes
it is a more or less complete paraplegia, but as the lesions are always more
marked on one side, it is more commonly a marked lameness of the cor-
responding member. It is easy to recognize the nature of these accidents
and distinguish them from those due to sprains of the loins, to muscular
lacerations or diseases of the spinal cord. The increased severity of the
symptoms by exercise, the absence of arterial pulsation or the diminution of
their force below the thrombosis and the lowering of the temperature of the
extremity suffice to make the diagnosis.

Thrombosis of the brachial trunk is more rare than that of the aorta.
Bouley, Schramb, George, Guntherberger, Weinberg, Moller, have re-
corded cases of it. The patient of Bouley had regular movements at the
beginning of the exercise ; after five minutes, he was lame on the left-
foreleg; after fifteen minutes, it was impossible for him to rest his foot on
the ground ; at the same time his respiration became accelerated and
loud, the skin was covered with perspiration, except the lame leg. At
post-mortem there was found an obliteration of the brachial trunk and its
divisions (sus-scapular, great posterior muscular, epycondiloid, anterior



ARTERITIS AND THROMBOSIS. 359

-and posterior radial arteries). In the observation of George, after ten
ininutes of exercise the horse was lame on both forelegs ; " they were
semi-flexed, scraping the ground, and seemed dumb or paralyzed. At
that time, the respiration was very labored, the beatings of the heart bounc-
ing ; the animal was anxious, the face contracted, the skin of the whole
body covered with perspiration, except the two forelegs, whose hairs
were dry and the skin cool." After fifteen minutes of rest these symp-
toms disappeared. At the post-mortem, one found a thrombosis of both
brachial trunks ; " the muscular structure was not discolored and presented
nothing abnormal; it was the same with the nerves." In a seven year
old mare, Moller has observed a similar case to that of George. Examina-
tion of the chest revealed hypertrophy of the heart ; but at rest nothing
abnormal could be detected in the forelegs. Trotting exercise, after ten
minutes, brought out a general stiffness of the anterior quarters; the legs,
the left especially, moved with difficulty, held in abduction, scraping the
ground, the feet stumbling over the smallest obstacles in their way; the
animal fell down repeatedly, and when up, would carry her shaking
legs in abduction. The symptoms disappeared after five or ten minutes
of rest, to return again after a short exercise.'

Therapeutics is powerless against arterial thrombosis. Alcalines are of no
use. According to Goubaux, the daily administration of 20 grammes of
iodide of potassium has given to Pilton two recoveries in cases of intermit-
tent lameness due to obliteration of the crural artery. New facts are
necessary to confirm the efficacy of this treatment. We have tried it on
three occasions without results.

Massage of the aorta per rectum, recommended by Collin and Bayer, is
useless and dangerous ; useless, as the clot is not disturbed ; dangerous, on
account of the embolics its broken pieces might promote. Moller told
us that he tried massage in a horse, and that death occurred in twenty-
four hours. At post-mortem, with the old lesions a recent clot was found
which obliterated the posterior aorta.

In rare cases, recovery has occurred under the influence of exercise.

1 Numerous cases of thrombosis and obliterations of the terminal branches of the
posterior aorta have been recorded in America by A. Liautard, Peabody, Ambler,
Huelsen and others. The symptoms were those described by the author. The
lesions varied. In one case of Liautard the obliteration involved the posterior aorta,
circumflex iliac, external and internal iliac on both sides — on the left side the clot
was traced in the tibial arteries to the hock. In another the internal iliac only with
its ramification was involved. In Peabody's case both iliacs were blocked ; on the
external the clot extended to the femoral, popliteal and tibial arteries. In the case
of Ambler it was found that the posterior aorta near its quadrification was partly
closed by a large clot extending to the left iliac down to the femoro-popliteal. On the
light side a clot existed also, but smaller. — American Vet. Review, vols. 4, 5 and 11.



360 VETERINARY SURGICAL THERAPEUTICS.

To this effect it has been recommended to trot the patients until the ap-
pearance of the symptoms, to give them a certain rest, and another
exercise and so on ; by these repeated restings, when the current of the
blood is stronger and more rapid, the clot would be gradually destroyed
or removed in a collateral branch. But there is small hope of obtaining
such result. Progressive increase of the affection is the general rule.



CHAPTER VIII.
VEINS.
L

TRAUMATIC LESIONS.

Non-penetrating wo2C7ids of veins are, ordinarily, not serious. Punctures
and cuts cicatrize almost always rapidly. Bruises and denudations are
sometimes accompanied with thrombosis, phlebitis or escharrification of the
venous walls and then secondary hemorrhages.

Penetrating wounds are made by puncturing, cutting or bruising objects.
Pricks of veins, either by operations or accident, give rise to a more or
less abundant flow of blood, varying with the size of the perforation.
When the cutaneous opening is small, the blood becomes infiltrated in the
perivenous connective tissue and in the cellular sheath of the vessel ; an
hemostatic thrombus is formed. Wounds with sharp instrutnents are
complete or incomplete. Incomplete, they are longitudinal, oblique or
transverse ; it is with them that hemorrhage is persistent. Complete
sections are immediately followed by a double longitudinal and circular
retraction of the ends of the vessel, but nevertheless the hemorrhage is
always abundant. In some cases, the central end bleeds little ; in others
the hemorrhage is great, as when a collateral branch opens between the
wound and the first valve of the injured vessel. Transverse wounds of
veins may rapidly prove fatal, specially when the circular retraction of the
ends is prevented by adhesion of the vessels to the surrounding organs
(aponeurosis, bones) or by diseases of their own structure. Contused
wounds have their edges either clean or irregular and ragged. The
hemorrhage is light and of short duration. Consecutive phenomena are the
same as in the preceding wounds ; however, they are followed more fre-
quently with diffuse phlebitis, partial sloughing and secondary hemorrhage.

When there is subcutaneous wou7ids, the blood collects in the peri-
venous tissues, sometimes filtrates along the length of the vessel, in the
musculo-aponeurotic spaces, where it coagulates.

Wounds of veins whose walls have undergone no pathological alteration
have a tendency towards cicatrization. In incomplete solutions of con-
tinuity, temporary homostasis is made by a claviforra clot which spreads

361



362 VETERINARY SURGICAL THERAPEUTICS.

more or less in the perivenous cellular tissue, then obliterates the per-
foration of the vessels. If the trauma is protected from infection, cir-
culation goes on ; sometimes the cicatricial spot dilates and gives rise to
the enlargement that is commonly observed on the jugular of horses.
With complete sections, the mechanism of the temporary hemostasis is
the same ; effused blood coagulates outside the vessel, and then an in-
travenous clot of various length is formed.

The principal modes of treatment of venous wounds vary : siiti/re,
pressure and pluggitjg, cauterization and ligature of tlie vessel.

Punctures of veins are treated by pressure or suture. When the cutaneous
wound is small, simple compression is ordinarily sufficient ; it stops the
hemorrhage and pjrevents the entrance of air in the central end. Twisted
or pinned suture of phlebotomy is an excellent means. The use of styptic
substances and plugging have been recommended. Perchloride ot iron,
much used in old times, has the objection that it promotes the formation of
extensive clots and sometimes a severe phlebitis. Larger wounds must
be plugged with iodoformed gauze after careful disinfection. When press-
ure fails, forcipressure or ligating the vessel is indicated. If the wound
is deep, to avoid much cutting, the vein can be closed with one or two
hemostatic forceps, left in place for twenty-four to thirty-six hours. The
best treatment for complete section of the vein, is ligature. Upon both
ends, a silk or catgut thread is applied firmly, tied and stopped by a
straight knot.

The introduction of air in veins is an accident that may occur when a
vessel of some dimension, situated in the circle of the inspiration of the
thorax and of the heart, is open during an operation.

A peculiar noise, a gurgling, sucking or whistling is suddenly heard,
like that made by air entering by a small opening into the thorax of a
living animal. Sometimes a severe dyspnea appears, the mucous mem-
brane becomes pale, eyes are staring, pupils dilated, and death, generally
preceded by convulsive movements, takes place after a time varying
between a few minutes to several hours. Of the two cases recorded by
Barthelemy, one died after seven, the other in eight hours. Some cases
recover. Viardot had one case where lameness appeared suddenly after
the introduction of air into the vessel.

Yet, the introduction of air is not always followed by noticeable dis-
turbance, and already Dupuy, Liegeard, Rey, have insisted upon the great
quantity of air that it is at times necessary to introduce into the veins to
kill the horse.

The introduction of air into the veins should be avoided by applying
pressure beyond the point where the operation is performed and relieving
it only when the wound is closed or protected by the fingers. Frequently



THROMBUS. 363

this indication is neglected or imperfectly complied with, and yet no
accident follows. In fact, it is very rare.

When it occurs, phlebotomy is advised, pressures on the thorax, artifi-
cial respiration. When it happens during bleeding at the jugular, it is
lecommended to apply immediate pressure in the jugular groove, con-
tinue to draw blood and even open another, so as to open a double way
to escape with blood and the air it carries. (Bouley.)

In other cases, the vein is to be closed «t once on the central end, with
the finger or a forcipressure forceps, then have recourse to pressures on
the chest and artificial respiration. When the severe symptoms have
subsided, ligature is applied on the vessel.

II.

THROMBUS.

Thrombus is frequent in horses after bleeding. Often, even when the
operation is well performed, a small tumor develops at the point where
it has been open. The formation of an extra-venous clot is certain ; it is
the condition of the closing of the prick which has been made on the
vessel ; but when the bloody extravasation thus produced is small and
infectious elements are not introduced in the wound, its resorption is
rapid. The expression " thrombus " must mean bloody tumors of some
size, developed after a venous puncture, whose resorption takes place
only slowly or terminates by suppuration.

Rare in ruminants, it is common in horses. Bleeding on the veins of
the leg, specially the axilla and the subcutaneous thoracic, are ordinarily
accompanied with it.

The termination of thrombus depends on the presence or the absence
of pathogenous micro-organisms in the clot. When no infectious element
has been introduced in the wound by the flame, the resorption of the
bloody tumor takes place by degrees and most ordinarily it is completed
in a few days.

In contrary cases, it remains, inflames, becomes warm and painful ;
soon fluctuation is detected ; the thrombus is purulent. It is possible that
the infectious process reaches the vein, extends to the clot of the borders
of the puncture and promotes phlebitis. The inflammation may spread
more or less along the vein and give rise to a warm, painful swelling,
simulating a phlebitis, and yet the circulation remains in the vessel.

When the ligature appUed on the pin has been too tight, inflamma-
tion of the thrombus may end in the mortification of the cutaneous
squeezed spot ; this sloughed, the bloody tumor is widely exposed ; it



364 VETERINARY SURGICAL THERAPEUTICS.

suppurates and is at times complicated by inflammation of the venous
walls.

Thrombus are avoided on some veins by methodical performance of the
bleeding and taking all the necessary precaution it demands ; such as
an instrument whose length of blade is proportional to the caliber of the
vessel, application of the pin and of the ligature without pulling of the
skin, proper care after the operation.

Once the thrombus is formed, one must resort to an tiphlogi sties and
astringents : cooling applications, alum water, white lotions, douches in
spray. At the onset pressure and irritants are injurious. Their indication
is limited to cases where the bloody tumor remains ; then, the complica-
tions of suppuration and phlebitis are not to be feared.

If suppuration arises, the ligature must be removed, the wound enlarged
to allow the escape of pus and repeated antiseptic washes made. Deep
exploration of the suppurative center with the probe must be avoided,
as it may give rise to phlebitis.

In bovines, thrombus is observed on the jugular, saphena and abdom-
inal subcutaneous. On this last it is mostly found ; it is ordinarily
enormous and disappears more slowly than at the jugular. The treatment
is the same as that of solipeds.

III.

PHLEBITIS AND THROMBOSIS.

The relations which exist between phlebitis and thrombosis, between
inflammation of the veins and the coagulation of the blood, have given
rise to different opinions, and promoted numerous experimental researches.
The question as to which of these two processes was essential and primi-
tive has been the subject of many discussions.

During the first half of this century, the theory of primitive phlebitis,
as expressed by Hunter, was universally accepted. It was in 1856, that
Virchow advanced that of the primitive venous thrombosis. For him,
the coagulation of the blood in the vein is not a secondary alteration,
consecutive to the inflammation of the walls of the vessel ; this throm-
bosis is the essential and primitive phenomena of a process which ends in
phlebitis. Thrombosis is the starting point of adhesive phlebitis ; it is also
the first act of suppuration ; which " is a pathologic phenomena commenc-
ing by a coagulation and ending in softening of the thrombus ; the alter-
ations of the venous coats are secondary." Some anatomo-pathologists,
Cornil and Ranvier among them, have continued to teach the existence
of the primitive endophlebitis, but it must be said that the German opinion,
as that which prevails to-day.



PHLEBITIS AND THROMBOSIS. 365

It has been tried to explain thrombosis in the various circumstances
■where they take place, either by an alteration of the blood or a change in
the structure of the venous wall. And again, successively were suspected the
excess of fibrin in the blood (hyperinosis), the exaggeration of its coagul-
ability (inopexia), the qualities of the serum, the excess of white globules,
the abundance and abnormal viscosity of the hematoblasts, — and at last
the simultaneous interference of several factors : such as a mechanical
disturbance in the venous circulation, in the diminution in the bloody
current, or in an alteration of this fluid. But none of these influences
has, from the point of view of the production of thrombosis, the impor-
tance that is offered by the condition of the venous endothelium. The
diminution or even the arrest of the circulation through a vein do not give
rise to thrombosis, if the endothelium, is perfect in its integrity. " Blood has
been kept in a venous segment, between two ligatures, during several hours,
even several days. On the contrary, as soon as the slightest alteration occurs
on the endothelial surface (for instance, in striking the external face of
the vein with a forceps), immediately clots are formed on the diseased
spot, as it takes place round a foreign body introduced in the vessel "
(Qu^nu). That which dominates in the formation of thrombosis, is the
alteration of the venous endothelium.

Bacteriological researches have shown this alteration in cases where the
naked eye examination would not permit it. Some thrombosis reputed
primitive have at last been recognized as secondary, of infectious nature,
promoted by micro-organisms. Spontaneous thrombosis, so called, is most
often but an attenuated form of phlebitis. " Between thrombosis called
spontaneous and suppurative phlebitis, there is only a difference of degree ;
the lesion is the same, the cause is identical."

In its turn, the theory of Virchow had to give its place to the micro-
bian. " This new doctrine considers some thrombosis (if not all) as of in-
fectious nature ; it rests on severe observations and the presence, on the
inside of thrombosed veins, of pathogenous micro-organisms ; it brings us
back to the conception of primitive phlebitis, anterior to the clot ; it adds
a pathogenous notion of great value, viz : that this phlebitis recognizes for
cause the action, upon the living endothelium, of a microbian agent "
(Qu6nu).

Phlebitis is specially common on veins where bleeding is performed, in
particular, in the jugular of horses, and the subcutaneous abdominal in
bovihes. Umbilical phlebitis, frequent and dangerous in young subjects of
all classes, shall be studied later on, in the chapter on Arthritis of Young
Animals.

There are several varieties of phlebitis. They are divided into super-
ficial and deep, inier?ial and external, traumatic and spontaneous, ifi/ec-



366 VETERINARY SURGICAL THERAPEUTICS.

tious, constitutional and toxic. We will only consider them, as in Hunter's
■ old division, as adhesive, suppurative and hemorrhagic. It is these which
apply best to veterinary practice.

Phlebitis and thrombosis being, in the very great majority of cases at
least, the result of a microbian pullulation, of an infection whose ordinary
agents are the staphylococci ; and again, adhesive, suppurative and
hemorrhagic forms of phlebitis being related to various degrees of viru-
lence of the causal condition, the treatment of the inflammation of veins
must specially consist in the use of antiseptics.

Phlebitis following operations performed upon veins shall be avoided by
the observation of the rules of asepsy. One will not neglect that all
venesection, to be harmless, involves the disinfection of the region and of
the instrument that opens the vessel. By the antisepsy of wounds con-
taining exposed veins, situated or involved in the traumatic center, the
infectious inflammation must be guarded against.

As soon as the diagnosis of adhesive pMebitis is justified, by the appear-
ance of an indurated cord, surrounded by an oedematous swelling, the
region must be immobilized and protected against all causes of irritation ;
not only thus limiting the venous phlegmasy but also guarding against the
breaking up of the clot and against embolics. (See Traumatic Thrombus
and Embolics). In most of traumatic phlebitis, there is, at the wounded
spot, a fistula which demands special care. The region wiU be clipped, and
disinfected, the escape of the pus will be facilitated by enlarging the
fistulous tract ; and this will be irrigated several times a day with an anti-