septic solution (sublimate i p. 100, phenic or cresyled water 3 p. 100) ; and
the wound will be covered with powder of iodoform or tannin, phenicated
or iodoformed vaseline. Preparations of vaseline are preferable to lard
ointment, which becomes rancid, irritates and makes the skin itchy. In
phlebitis of the extremities, douches in spray, given several times a day, are
advantageous. Later, when the acute phenomena have disappeared,
blisters are useful as resolutives, as recommended by Renault, Bouley, Rey.

When phlebitis is suppurative, so that the clot is infiltrated with pus, the
inflamed vein is becoming fistulous, the swelling increases, abscesses are
formed in various parts of its extent ; more than in adhesive phlebitis, the
danger of portions of the clot becoming loose and purulent infection must
be feared. There is escape of abundant pus, thin, of bad aspect, grayish
or reddish and at times having a fetid odor. A probe introduced into
the wound may penetrate far into the vein. It is proper to enlarge the
fistula and make in the vein antiseptic injections (tincture of iodine,
solution of sublimate, of phenic acid) with an India rubber tube adapted
to the end of the syringe or with the bent canula (Nocard). This treat-
ment, simple of execution, is recommended at the beginning, when sup-



VARICES. 367

puration is limited to a small distance in the vein ; it is insufficient when
the phlebitis is old, when the vascular walls are infiltrated with pus, and
the abscesses are developed in the perivenous structures. The vein must
be drained in its suppurating portion. After making a counter opening
on a level with the intravenous fistula, a fenestrated rubber tube is in-
troduced in the tract to insure the escape of pus and allow the cleaning
of the vein. We will return to this, in the article on suppurative phlebitis
of the jugular.

Another treatment consists in cutting down in its whole length the
portion of the fistulous vein and treating the part exposed. Like Hoff-
man, it is better, after exposing the vein in all its suppurating portions, to
clean it by curetting ; to leave no diseased point in the neighborhood of
the clot, clean the operated surface with a strong antiseptic solution and
dress with iodoform. In the legs the curetting can be completed with
antiseptic baths ; for the other regions, sprays are indicated. Between
these the wound will be protected with compresses dipped in microbicide
solution, or with antiseptic vaseline.

Ligature and extirpation are means which to-day are little used. In
some serious cases where free incision is dangerous, cauterizations with
fine points or with needles, of the suppurating venous portion, has brought
on recovery.

Hemorrhagic phlebitis, complication of the adhesive and suppurative
forms, due to the loosening, crushing, purulent destruction of the obliter-
ating clot, is treated by plugging of the wound, suture of its borders or
ligature of the vein. This last operation must be done antiseptically on a
sound part of the vessel and beyond the induration. Layer by layer the
tissues covering the vein are excised, the vessel is isolated and surrounded
with an aseptic silk thread tied with a straight knot. The wound is
irrigated with boiled water, is dried, dusted with iodoform, the edges
brought together by two or three stitches, the whole covered with a col-
lodion dressing. As for the fistula and the suppurating portion of the
vessel, they demand the same care as indicated for adhesive phlebitis.

IV.

VARICES.

Generally speaking, permanent dilatations of veins, varices or phlebec-
tasis, are rare in all animal species.

They occur most commonly on the veins of extremities, or those of the
organs where the venous current has an ascending direction. In horses,
they have been observed on the radial, saphena, axillary and testicular ; ,,



368 VETERINARY SURGICAL THERAPEUTICS.

in cattle, on the testicular ; in cows, on the mammary ; in pigs and dogs,
on the scrotal veins. In a two-year-old filly, Debloc has observed a varice
of the mammary vein as big as the head of a child. The extreme rarity
of hemorrhoids in all animal species is explained by the direction of the
pudic veins, and by the less pressure of the current of the blood, in these
vessels, in animals than in man.

The varicous dilatation of the saphena at the fold of the hock must
not be mistaken for the synovial dropsies found in that region. Varices
of the mammary veins, in bovines, may become voluminous, but do not
give rise to serious complications. Deep venous ectasis are accompanied
with dumbness, stiffness of the extremities and more or less pain.

Varices are lesions of a slow, chronic development. In general they
remain permanently, stationary or increasing little by little. Spontaneous
recovery is possible by the formation of adhesive phlebitis, which obliter-
ates the vessel. Left to themselves, they may become complicated with
phlegmonous inflammation, ulceration and hemorrhage. In the case of
Gillibert, the rupture of a varice of the axilliary vein was followed by
death.

The principal means of treatment of superficial varices are : pressure,
cauterization, ligature, extirpation and coagulating injections.

Radical cure of veins is seldom undertaken in horses. If it is to be
attempted, a simple or double ligature should be applied above and below
the dilatation, with all required antiseptic precautions. In the case related
by Debloc, he made on the tumor two punctures with the fleam, closed
with pin suture and applied blisters. Notwithstanding the result, in this
case, ligature is better.

If surgical interference is not resorted to, douches, cold baths or
pressure with bandages are indicated.



CHAPTER IX.

LYMPHATICS.

I.

CONTUSIONS— WOUNDS— FISTULAS.

The slightest cutaneous or mucous wounds involve the lymphatic net-
-work, whose numerous canals drain the superficial layers of the dermis.
Limited to the capillaries, these lesions are without importance : a small
quantity of lymph mixes up with the blood, then the divided vessels
cicatrize. They offer a certain gravity when large vessels are open. In
animals, the superior face of the internal "face of the legs and round the
articulations are places where these wounds are most met. They give
flow to a serous liquid, which might be mistaken for synovia, when the
traumatism is near an articulation. The weak viscosity of the lymph, its
•whitish color, its coagulability, abundance of its white globules, the cessa-
tion or increase in the flow whether pressure is applied in the direction of
or against the current, all those establish the diagnosis. Often at the
moment the wound is made, there may be seen a true jerk of fluid, which
afterwards escapes in sheath, more or less abundant, increasing by exer-
cise, which may make the flow return by jerks.

A pinned suture is generally sufficient to arrest the hemorrhage. The
compression of the leg, from its extremity to above the lesion, made with
a flannel or a rubber roller, completed with an antiseptic dressing, slightly
compressive, also gives good results ; by this way, the exit of the lymph
contained in the open vessel is stimulated and the fluid mass carried during
the following days is reduced, thus facilitating cicatrization. Spontaneous
recovery is possible even in large lymphatic canals. Monro has seen, in a
pig, the thoracic duct, artificially wounded, cicatrize rapidly.

Having become fistulous, lymphatic wounds are tenacious. They are
treated by cauterization with nitrate of silver or sublimate or with the red
iron. Some practitioners prefer the injection of tincture of iodine.
Ligature applied on the peripheric end will be used if other means have
failed. It is sometimes difficult to apply it, and the operation is
frequently followed by an infiltration of some size of the extremity. Abso-
lute rest is indispensable, if quick recovery is expected. Infectious inflam—

369



370 VETERINARY SURGICAL THERAPEUTICS.

mation is possible. If it occurs, the treatment of suppurative lymphangitis
must be carried out.

Subcutaneous ruptures of lymphatics give rise to the affection de-
scribed under the name of traumatic effusion of serosity.

Bruises of lymphatic glands are nofgenerally followed with special com-
plications. Their treatment is that of bruises in general.

Wounds of glands are rare. They may, however, be accidentally injured
by wounding bodies and instruments of surgeons. The lyniphorragia, con-
cealed by the hemorrhage, stops with it. In the majority of cases, these
wounds demand only an antiseptic dressing and immobility. When the
flow of lymph continues, canalicular tract is established which must be
treated as the fistulas of lymphatic vessels. Extirpation of the glands is
sometimes necessary.

II.

LYMPHANGITIS.

Always secondary and produced by the entrance in the lymphatic vessels
of phlogogenous infectious elements, lymphangitis or angioleucitis present
numerous clinical varieties in all animal species. Generally those that are
observed are of traumatic nature and have for starting point a tegumentary
solution of continuity, — wound, prick, ulcer, abrasion. In cases where no
apparent solution of continuity exists in the region, whose lymph is col-
lected by the inflamed lymphatics, angioleucitis is the consequence of either
an interstitial auto-inoculation (glanders, distemper, tuberculosis) or of a
micro-trauma, rapidly wiped out, which still has lasted sufficiently to per-
mit the passage of infectious elements. Numerous facts have shown that
lymphangitis may appear after bruises without noticeable wound, re-
peated frictions, or cutaneous impregnation by septic or f)utrid fluids.
There are slow lymphangitis, " with incubation," which are manifested
only a long time after cicatrization of the wound through which the agents
of. infection have entered ; often then a shock or repeated frictions are the
cause of this " inflammatory return."

Acute or chronic, superficial or deep, lymphangitis are truncular,
reticular or radicular, as they affect the lymphatic trunks, the cutaneous
network or the roots of the white vessels in the various tissues. Favored
by some constitutional or diathetic conditions, they are produced by very
various pathogenous agents : there are as many kinds of lymphangitis as
there are micro-organisms susceptible to irritate the white vessels.

In inflamed canals, one often finds the staphylococcus albus or
aureus, sometimes the streptococcus pyogenes, the bacillus coli or
some leptotrix. Histology and bacteriolgy have permitted the distinction



LYMPHANGITIS. 37I

of Other forms of lymphangitis which we will study further on. Glanders,
distemper, tuberculosis, carcinosis produce specific angioleucitis.

The prognosis of those affections depends specially on their nature and
the activity of the microbe that has caused it. When pathogeneous
agents have but little virulence, the process has a tendency to subside, the
morbid contents of the lymphatics is easily resorbed. Very active
microgerms may, on the contrary, bring on suppuration or gangrene. The
close relations between lymphatics and the serous system explain the com-
plications of hygroma, synovitis, arthritis, peritonitis, which are some-
times observed.

Traumatic lymphangitis, the most interesting to the practitioner, is
common in horses. We will give to it our special attention.

/ — Traumatic Lymphangitis.

This form may succeed all solutions of continuity of the skin. It is
often seen in the withers, the shoulder, the neck, which are so com-
monly the seat of traumas. A simple abrasion, the prick of a dirty lancet,
are sufficient for its development. It ordinarily begins by a reticular
angioleucitis, accompanied with great sensibility, bristling of the hair, oede-
matous swelling of the skin ; and soon the trunks and the collecting glands
are affected.

There is a form of lymphangitis, specially frequent in the hind ex-
tremities of horses, characterized principally by the suddenness of the
invasion and the intensity of the first symptoms. A horse in perfect
health in the evening is found the next morning dull, feverish, hanging his
head, with a more or less marked and very painful swelling of a hind leg.
The lameness is intense, the animal moves with difficulty and carries its leg
in abduction. By examination, an oedematous swelling, painful in pro-
portion to the severity of the attack, is detected on the internal face of the
extremity. Appetite is partly or entirely gone. The following days, the
swelling keeps on increasing until it assumes the form of a shapeless post.
This sudden appearance of the affection and the great sensibility of the
internal face of the hind leg are characteristic of the infectious inflamma-
tion of the lymphatics ; most ordinarily, they justify the diagnosis of this so
frequent variety of angioleucitis. Old writers, among them Solleysel and
Garsault, attributed it to the bite of. the "shrew mouse." Lafosse refuted
this error ; he thought it to be a variety of anthrax, against which he
recommended scarification and repeated emollient lotions. In a paper
addressed to the Societe Ccntrale (^1862), Mottet described the disease
under the name of " Tarsopathy and Metaiarsopathy, or the diffused in-
flammation of the tarsus and metatarsus." The discussion which followed



372 VETERINARY SURGICAL THERAPEUTICS.

the reading of the paper by Leblanc was most interesting and proved
that the nature of the affection was yet a matter of much controversy.
However, the theory of IMottet, who saw in it a tarsal inflammation, was not
accepted. Several advanced the idea that those symptoms, so rapid and so
accused, might be due to phlebitis of the saphena. Bouley claimed that the
cord of the inner face of the thigh was due to lymphatics and not to venous
blood vessels, that it was a lymphangitis and not a phlebitis. To-day, the
fact is no longer discussed. Everyone recognizes in it an inflammation
of the white blood vessels. This lymphangitis, so frequent on the hind
legs of heavy draught horses, sometimes recurs at more or less remote
periods. Some subjects seem to be predisposed to it. On examination
of the leg, one finds a cutaneous solution of continuity, at times cracks,
pricks, but quite frequently no door of entrance to the pathogenous
agents can be found. The conclusion is that it is a lymphangitis without
previous inoculation. If there is no visible solution of continuity, it is
cicatrized or is so small that it escapes attention. Auto-inoculation
(endogenous infection, latent microbism) is extremely rare.

When lymphangitis follows an operation — nevrotomy for instance — the
process is about the same. A few days after the operation, often after
twenty-four or forty-eight hours, the swelling of the leg is well marked, the
pain great, the resting of the foot on the ground suppressed, the appetite
diminished or gone. The wound contains little or no pus, its edges,
tumefied, are covered with a yellowish coating, diphteroid in appearance,
somewhat adherent. After several serious affections of the leg, synovial
inflammation principally, deep lymphangitis may occur, whose symptoms
and prognosis are often most severe.

Bacteriological researches made by us several years ago on suppur-
ations of horses and dogs, allow us to affirm that, in these species, trau-
matic lymphangitis are almost always the work of staphylococci and more
particularly the staphylococcus pyogenes albus.

The treatment must be specially preventive. Asepsy and antisepsy of
the operation guard against thfs complication. Accidental traumatisms,
specially wounds of the lower parts of the legs, should be carefully washed
and protected by a dressing. By a correct antisepsy, the retention of the
pus on suppurating surfaces and the infections of lymphatics will be pre-
vented.

As soon as lymphangitis exists, an active therapeutic must be started.
Up to later days, bleeding was recommended ; many practitioners per-
formed it on the jugular. Mottet preferred scarifications (eight or ten to
the hock, fifteen or twenty to the cannon) two or three centimeters long,
one or two deep ; he then soaked the leg in tepid water and thus obtained a
bleeding of two or three liters. According to Serres, three or four fric-



LYMPHANGITIS. 373

tions of ammoniacal liniments were sufficient to obtain a rapid resolution.
The same author had also obtained good results with embrocations of
mercurial ointment, repeated eight or ten times. D'Arboval and Ray
.advocated the use of blisters ; this, says Rey, " succeeds very well on the
iiternal face of the cannon ; one application is generally enough."
Several veterinarians resort to the charge of Lebas over the whole of the
inflamed region ; others use populeum ointment, or again others prefer
poultices.

All these means have only a mediocre efficacy. Lymphangitis being
the esultr of microbian injection, antisepsy must be the base of the treat-
ment. One must act at the same time on the inoculated lesion, and the
lymphatic inflammation, wounds, cracks, pricks, should be minutely dis-
infected with a sublimate solution (i p. looo), cresyl or phenic aid
(3 p. 100), and covered with a wadding dressing. Slight angioleucitis should
1)6 treated often by col'd baths or douches, massage and exercise when the
pain has subsided. General symptoms pass off first, but often the swell-
ing remains for two or three weeks.

When lymphangitis is severe, when it is a complication of a wound of
operation or of one accidental on the extremities, warm antiseptic baths are
indicated. They will be administered two or three times a day and last half
an hour each. It is advantageous to cover the inflamed surface with tepid
phenic or sublimated compresses. The absorbed fluid progresses in
lymphatics, where they bring their direct disinfecting action. Damp
moisture favors the resorption of exudates ; perhaps in some cases they
act in reducing the virulence of infectious elements. In other regions,
one may advantageously use antiseptic washing or spraying and protect
the wound with a dressing. To reach with more certainty the pathogen-
ous elements, some authors have advised injection of phenic water at

2 p. 100, here and there along the course of the inflamed lymphatics.
Repeated coatings of the leg with a solution of perchloride of iron at

3 p. 100, or diluted tincture of iodine, are worth trying with antiseptic
baths. With deep lymphangitis, antiseptic balneation is also a good
mode of treatment. By it, the inflammation and the pain rapidly disap-
pear, and complications are avoided.

Instead of ending by resolution, lymphangitis may pass to suppuration :
pus forms in the lymphatic vessels, in the perilymphatic cellular tissue and
sometimes in the thickness of the dermis. In some parts of the lymphatic
cord, , rounded fluctuating tumors are formed. And from them, either
after ulceration or if open by puncture, escapes a thick, whitish pus/

^ In the case related by W. C. Siegmund, the original cause of the lymphangitis
remained unknown. Several superficial abscesses had formed on the coronet, inside
cf the hock, alongside the thigh, some 40 in number. Tested with mallein, negative



374 VETERINARY SURGICAL THERAPEUTICS.

Antiseptic cleanings insure the cicatrization : it is rare for lymphorrhag3r
to last ; when it occurs on the extremities, it is always the most dependent
abscess which becomes fistulous. Diffuse suppuration and undermining;
demand counter-openings and drains. It is specially with deep lymphan-
gitis that sub-aponeurotic purulent collections and extensive gatherings
are to be looked for. Puncture of the fluctuating points is not always
sufficient ; the swelling must be carefully watched ; if the presence of a
purulent infiltration is suspected, explorating punctures must be made.

Septic or gangrenous forms of lymphangitis are rare. However, they
have been observed for many years (Vatel and Crepin) . A first important
indication consists in making, in the swelling, punctures with the red iron.
Frequently repeated antiseptic baths or sprays are to follow. In serious
cases (diffused suppuration, septic complications, gangrene) tonics, alcohol,
and antiseptics should be given internally.

Chronic lymphangitis develops in two ways : at times it appears at the
onset and by degrees reaches its definite characters ; or again, it follows
the acute form. In this last case, the swelling of the upper part of the
leg subsides, it remains more or less marked at the coronet, fetlock or
cannon, and there the induration gradually organizes itself. The oedema
spreads in the cellular tissue, irritates it, and also the deep surface of the
skin, the exuded fluid becomes fribrinous, the subcutaneous tissues
become indurated, the skin is thickened and sclerotic.

Against these cold swellings of the lower regions of the extremities,
therapeutics is rather poor. Blistering has given some success to Leblanc
and Mottet, but fails in most cases. The same can be said of the various
liniments and tonics recommended. According to Siegmund andZundel,
laurel and camphorated ointments, mixed with extract of belladonna, con-
stitute a true specific to remove the oedematous swelling — an opinion which
has not been approved by experimentation. Cauterization has been
frequently used ; if it has seemed successful with Lardit, Leblanc and
many others have seen it fail in their hands. Many cases might be men-
tioned where firing and blistering have aggravated the swelling. Seton at
the thigh, on the gluteal region, and scarifications have had and have yet
many advocates.

Is it proper to follow an internal treatment? Jacob, already in 1855,
advised iodine or iodide of potassium, after having obtained some results
ixoAi them. Here, as in numerous affections with sclerotic tendency^
iodide may be useful, specially in recent cases. Yet its action must not be
too much depended upon.

Sometimes chronic lymphangitis resists all treatments ; the coronet, fet-

Tesults were obtained. At the post-mortem a large abscess was found in the thick-
ness of the ischio tibial muscles. — American Veterinary Review, vol. 18, page 290.



LYMPHANGITIS. 375

lock and cannon swell more and more, and whether or not acute attacks
reappear, arrives the process comes to the elephantiasic fibroma. Moderate
exercise, thorough cleanliness of the extremity, hot water, massage,
moderate and intermittent compression with flannel or rubber bandages ;
such are the best indications to follow. Elastic pressure, as we have
said, demands some attention. A pad of oakum or wadding should always
be laid against the skin before the not too tight roller is applied and not
allowed to remain more than ten or twelve hours. Excessiveor continued
pressure promotes sloughing of the skin and of the tissues underneath. If
abscesses form, they should be opened at once. Chaps and cracks of the
skin should be treated by antiseptics and rest. By moderate pressure
also the oedemas occurring under the influence of standing in the stable or
-during rest at night will be prevented.

//. — Specific Lymphangitis.

Epizootic lymphangitis, also called farcy of Africa, farcy of Naples,
farcinosus lymphangitis, is a specific, contagious affection, produced by the
£ryptococc2is farcinosiis of Rivolta. It is proper to solipeds. Very com-
mon in Africa and at the Guadaloupe, it is rare in France.

In the infected localities, wounds of all kinds may be followed by it.
It is observed principally on the legs, the withers and the lateral parts of
the trunk. Its incubation varies from a few days to several months. The
•borders of the wound become indurated and very painful ; in its surround-
ings appear pimples (buttons) and then cords progressing along in the
•direction of the lymphatic current ; the collecting ganglion later on forms
a mamillated hard tumor. After a certain time, cords, buttons and
.glandular tumors become soft, ulcerate and allow the escape of a laud-
-able, creamy pus. These wounds, " cul de poule like," cicatrize very slowly ;
many become fistulous. The invaded region is always much engorged ;
the legs assume shapeless sizes. The observations of Blaise, Couzin,
Nocard, have shown that this affection, localized to the pituitary mem-
brane, may give rise to ulcerations resembling those of glanders.

At times difficult, the diagnosis can be established by microscopic
examination, the specific microbes being in abundance in the pus and
in the superficial layer of the wounds. Mallein gives also good indications.