The disease existing almost always upon a more or less large number of
animals, the most elementary prudence imposes the sequestration of the
patients. A ministerial order {YtbrxiZixy ii, 1887) prescribes the measures
to take with horses and mules of the army. In civil practice, besides
isolation, disinfection is recommended. During rainy weather, wounds
of all kinds should be treated antiseptically and protected with a dres-
3/6 VETERINARY SURGICAL THERAPEUTICS.
sing. These measures are generally sufficient to arrest the progress of the
disease.
The curative treatment is composed principally of external applications.
After Tixer and Delamotte, several veterinarians have tried without suc-
cess internal treatment with arsenious acid, kermes, iodide ofpotassimn,
mercurial compounds, nux vomica, tincture of iodine, hyposulphite of soda.
To this day, however, we do not know of therapeutic agents, which, given
internally, arrest the pullulation of the pathogenous element. To give
the patient a nourishing food is the important indication ; and tonics
and stimulants are useful.
Every author recommends to open the buttons with the red iron ; to
render the cauterization deeper, some dust the tract made by the iroa
with sulphur powder and bum it over. Decroix added to these points one
line of deep cauterization applied transversely in front of the lymphatic
swelling, which'never went beyond this barrier. Nocard has advised a free-
incision in the whole length of the cord and the destruction of its internal
wall by curetting or actual cauterization. Others have recommended the
extirpation of the cord with the thermo-cautery, taking with it some of
the healthy tissues. Peuch has seen this done with complete success.
Jacoulet has warmly recommended the free extirpation of the cord and of
its glands. The operation is simple when the cord is small and well de-
fined ; it becomes very difficult when the swelling is large, extending from
one end of the leg to the other, specially when the cord, the vessels and
nerves are involved in the same fibrous thickening. On this account,
extirpation remains limited to few special cases. Points firing with
free incision of the cord and curetting are specially applicable to extensive
lesions. To stimulate the cicatrization of wounds thus made, several
topics have been recommended ; blisters, tents soaked in camphorated
and phenicated alcohol (Wiarl), burnt alum, sulphate of copper, Rabel
solution, nitrate of silver, tincture of iodine, diluted nitric acid. Anti-
septic liquids (injections, baths, repeated sprays, with solution of cresyl
or phenic acid 3-4 p. 100, sublimate i. p. 1000) and dressing with iodo-
form, deserve preference over the others.
Actively treated, the affection ends ordinarily by recovery after a lapse
of time varying between several weeks and two months. In some cases,
cicatrization of the wounds has required five, six and seven months.
Besides the traumatic lymphangitis and the pseudo farcinous form,
other lymphatic inflammations are met with in animals which are due to
.special parasites or to specific processes.
The /arcy of oxen, very rare in France, common at the Guadaloupe, has
for principal manifestation a suppurative inflammation of the lymphatic
vessels and glands. The disease may invade the visceras (spleen, liver»
ADENITIS. 377
lungs), bring on excessive emaciation and end in death. It is not glanders,
nor tuberculosis, but a special microbian affection. In the post- mortem
pieces sent to Nocard by Couzin, he found a " fine and long bacillus,
assuming the form of little snakes entangled together ; the central part
resembling an opaque nucleus, from which radiated towards the periphery
delicate ramified threads; it gives the idea of the head of a cauliflower, a
bundle of thorns, or, better, a seed of burdock." It is inoculable to the
guinea-pig, cow and sheep. Horse, donkey, dog, rabbit, are refractory.
On these animals it only gives rise to a small abscess at the point of
inoculation.
Puncture of the abscess, made at an early date, free incision of the
cord, cauterization, curetting of their internal surface, constitute the local
treatment. Good food, tonics, stimulants, are also indicated. Recovery
occurs generally ; but one must count with the inflammation of the sur-
rounding lymphatic vessels and glands, and many subjects die in marasm.
Tuberculous lymphangitis have been studied but little in animals.
Godbille records an interesting observation of it. A steer in good con-
dition had on "the external face of the right anterior leg, a linear series of
bosselated, irregular tumors, of the size of the fist and moving under the
skin." The lower one was ulcerated, others showed fluctuation. On post-
mortem, all the internal organs were healthy, except some mesenteric
glands, infiltrated with granulations. Recognized early in some species,
tubercular lymphangitis may be treated either by incision and curetting,
or by excision ; in some cases, the extirpation of the collecting ganglion
completes the interference. (See Tuberculosis^ C^/zr^ris-z/i- lymphangitis,
common in dogs, are most always present in cases of serious epithelial
tumors. Very frequent in the mammce of sluts, they constitute thick
subcutaneous cords, nodular, and extending to the glands. Their total
extirpation, when the disease is comparatively recent and the patient
strong, is the only proper treatment. Old age, anemia, generalization of
the neoplasms, counter-indicate interference. (See Tumors.)
Lymphangitis of distemper are ordinarily not serious. In general, ab-
scesses punctured and freely opened recover by the simplest antiseptic
cares and the lymphatic induration diminishes little by little.
III.
ADENITIS.
True filters placed on the course of lymphatics, the glands arrest in-
fectious germs carried by the lymph. Their puUulation, the increasing
irritation that they produce on the glandular stricture, promote adenitis.
378 VETERINARY SURGICAL THERAPEUTICS.
For a long time, it was believed that adenitis were primitive, but it is ad-
mitted to-day that the glandular inflammation results, in all cases, from
an inoculation produced either directly through a wound of the gland, or
indirectly by a lesion some distance from it, existing on the course of the
afferent blood-vessels. Glands seem even more sensitive than the vessels ;
in clinics, lymphangitis without adenitis are exceptional ; adenitis with-
out lymphangitis are not.
If the most varied micro-organisms circulating in lymph may irritate the
glandular sifter, acute adenitis, like lymphangitis, are ordinarily produced
in animals by staphylococci and sometimes by streptococcus. The re-
searches of Schwarznecker and ours show that ordinary adenitis of horses
are generally due to the stapjiylococcus albus. The clinical varieties of
adenitis (tumefaction, induration, suppuration) are related to the varying
virulence of this staphylococcus. It is the streptococcus of Schiitz which
causes the suppurating adenitis of distemper. In bovines and other
animals, acute adenitis of various nature have also been observed, most of
them due to ordinary pyogenous microbes.
Ordinarily produced by inoculation from a wound at some distance from
it, adenitis demands first the use of antiseptics on the wound and the
afferent lymphatic blood-vessels, completed by a wadded dressing. The
primitive lesion, cutaneous or mucous, should be treated by antiseptic
irrigations, pulverizations or baths frequently repeated. Hot balneation
is to be preferred. Upon the inflamed gland, tincture of iodine may
be applied, a blister, or better, when possible, tepid antiseptic com-
presses. Intra-glandular injections of phenicated water 3 p. loo
(Hueter) have not been tried in animals. General and local bleeding are
abandoned.
The march of the inflammation depends on the degree of virulence of
the germs. A well made antisepsy will get the best of a microbe with
weak virulence ; little by little, the swelling diminishes, the pain subsides,
resolution takes place. Other germs, more active, produce pus. As soon as
it is formed, it must be allowed to escape and then antiseptic washes used.
The opening of some glandular centers- — subparotid or retro-pharyngeal
abscesses, those of the axilla or of the groin — demands some attention ; in
these regions, the bistouri must be handled with prudence, if large vessels
and nerves are to be avoided. The free incision of the maxillary glands is
without danger, and the puncture occupying dependent location, pus always
runs freely. At times, specially under the parotid, the pus has reached
the periadenic cellular tissue, there are great underminings and the
glandular origin of the abscess is difficult to locate. In such cases the
incision must be made large or a counter opening established ; drainage is
also obligatory. Ordinarily the wound closes rapidly. If healing goes oa
TUMORS. 379
too slow, the wall may be curetted, dressed with iodoform or injected
with tincture of iodine or iodoform ether.
Sometimes chroiiic adenitis follows the acute form ; at times it occurs
at once, either under the influence of specific diseases (glanders, tubercu-
losis, carcinosis), or as consequence of a sub-acute or chronic inflamma-
tion. The glands of a same group become hypertrophied and remain
independent (simple adenitis), or they gather and unite into a single
mass (adenitis and periadenitis).
In general, chronic adenitis are little painful. They have a great ten-
dency to last, and when the affection which has promoted them has dis-
appeared, it takes a long time for them to disappear, ' Slow resolution is
not their only termination ; sclerosis is frequent ; an acute return may bring
Suppuration.
The treatment must, first of all, look after the causal lesion. In pro-
portion as the wounds of the legs cicatrize, the glands of the axilla or of
the groin resolve. Similarly, the maxillary gland diminishes in size when
the purulent collection of the sinuses goes toward recovery. Local treat-
ment has little efficacy. Blisters have been recommended, napolitan
ointment, tincture of iodine, iodurated pomatum. If these are not suc-
cessful, superficial or deep cauterization deserves trial. Extirpation of
the indurated glands has been little performed in animals. We only use
it to establish the diagnosis in specific adenitis. In all cases, ioduie of
potassium internally will help.
Suppuration of chronic adenitis is treated like that of acute : incision
and antisepsy.'
IV.
TUMORS.
Primitive tumors of glands are extremely rare. Almost always secondary,
they generally accompany epithelioma and carcinoma, sometimes sarcoma
or enchondroma. In cancer, the glands, run through by the lymph of the
affected ground, are always suspicious. Generalization begins at the
nearest gland, that which collects the lymphatics of the primitive
focus ; hence it spreads little by little ; and frequently true neoplastic
^ Dr.'F. S. Allen'has recorded two cases of chronic adenitis successfully cured by
the removal of the enlarged gland. In one instance, microscopic examination
proved it to be a small spindle celled sarcoma. The whole tumor weighed eight
ounces. In the other, the growth weighed only four ounces. Microscopic e.xamin-
ation showed it to have been originally lobulated, with hollows at intervals and at
points containing small abscesses. It proved to be a lymphatic gland in a hypertro-
phical condition undergoing an irregular process of regeneration. — American Vet.
Jieview, vol. 8, pages 183 and 185.
380 VETERINARY SURGICAL THERAPEUTICS.
chains are observed. Staphylococci with attenuated virulence may pro-
mote glandular indurations resembling tumors ; but the fact is rare ; it is
observed, however, with the submaxillary glandsof horses ; fistulous indura-
tions can also be met in them, which suggests the presence of ulcerated
tumors.
Entire ablation is the only proper treatment. Easy for primitive tumor
and superficial glands, it may be impracticable for deep ones. The con-
dition of success is to operate early and stop only when healthy tissues are
reached. All surgical interference is contra-indicated when the disease
has gone beyond the glands that may be reached by the bistoury, specially
Avhen there are evidences of generalization.
V.
LYMPHANGIECTASIS.
Those are glandular, truncular, or reticular. In man, spontaneous
lymphangiectasis have been described, whose cause remains to be deter-
mined, and symptomatic lymphangiectasis, related to the inflammation or
compression of the white vessels. In diseases of the heart or of its en-
velopes, there exists sometimes a general dilatation of the whole lymphatic
system. At the autopsy of a horse suffering with valvular endocarditis
of both left openings, with extensive hypertrophy of the right heart,
Nocard found " such dilatation of the lymphatics that the thoracic dtict
had reached the size of the arm, and that upon the colic mesentery
the chilliferous vessels, filled with transparent lymph, measured one and
one-half to two centimeters in diameter." Such lesions are of no in-
terest in a surgical point of view, and lymphatic varices are extremely rare
in animals. Nocard has related two cases of them. In one, it was a soft
tumor, " puffy and fluctuating, of the sheath ; repeated capillary punctures
gave at each time a small quantity of limpid transparent fluid ; a serous,
multilocular cyst was suspected. Post-mortem revealed that it was a
gathering of large lymphatic vessels rolled upon themselves, entangled
intimately, whose walls, thick and very adherent at their points of contact,
had preserved in any other part of their length their characteristic thin
aspect and their transparency ; numerous valvular contractions could leave
no doubt as to the nature of the tumor.
" In the other case, the varices were on the lymphatics, satellites of the
saphena vein, not far from the groin, where they formed little soft tumors,
fluctuating, extremely irregular, enveloping the vein all round, upon a
length of about twelve centimeters, to such an extent that it was impossi-
ble to bleed at that vein ; and that it could not be opened except at the
lower part of the shank, below the inferior border of the short adductor.
LYMPHANGIECTASIS. 38 1
" In both cases, the dilatations were surrounded with a thick layer of
connective tissue, gorged with serosity and on the road to induration."
For man, elastic stockings, knee caps or cuffs form the whole treat-
ment. Analogous means might be tried in animals. Extirpation gives no
good results ; all surgical interference must be avoided. Sometimes
superficial dilatations ulcerate ; in these cases the therapeutics is the same
as that of lymphatic fistulas.
CHAPTER X.
NERVES.
I.
TRAUMATIC LESIONS.
Traumatic lesions of nerves are accompanied with complex troubles,
divided into immediate and consecutive. The former are known for
many years ; the others have brought about numerous discussions, and,
actually, the pathogeny of those is not yet entirely elucidated.
Whatever may be the nature of the wounding body, the phenomena
that take place in the ends of the bruised or divided nerves, are about the
same in all cases. For centuries, the Galenic assertion, " any nerve cut
cannot grow nor unite," has been admitted. But facts are related, showing
that the sensibility and mobility sometimes reappear in regions where they
were temporarily abolished by division, with or without loss of substance,
of the trunk which innerve them. It appeared, then, that divided
nerves could cicatrize and recover their functions temporarily absent. In
old observations, the return of innervation, to insensibilized or paralyzed
regions after a traumatic lesion, had been observed only after quite a long
time. This was explained by the admission of nervous regenerations ;
but no proofs were given to sustain this admission. In 1867, Richet,
watching a case of section of the median nerve, observed that sensibility
remained m the tissue animated by the divided nerve. A plausible explana-
tion of the fact was looked for, when Arloing and Tripier gave it the true
interpretation.
Veterinarians have for a long time noticed that plantar neurotomy
made above the fetlock, on one side only, did not result in the complete
anesthesia of the corresponding half of the foot. Moorcroft, who had
made this remark, explained it by iht/uiictiotial solidarity of Xht flan tar
nerves, by a kind of nervous assistance. Arloing and Tripier have shown
that after the section of a nervous branch, the sensibility remained
attenuated in the region animated by this branch, thanks to the recurrent
fibres that each nerve mutually exchanges with other nerves. At the point
of division, there are numerous anastomosis ; nervous threads belonging
to a given branch, return to one or more branches close by, where they
aningle, to go and terminate further on. After the section of a nerve,
382
TRAUMATIC LESIONS. 58^
â– while the direct fibres degenerate at the peripherical end, the recurrent
fibres remain intact and keep up a certain sensibility in a region which was
supposed entirely anesthetized. The theory of preserved sensibility took
the place temporarily of that of the returned sensibility and for a time nervous
regeneration was considered as the appanage of youth. It is scarcely
ten years since a most distinguished surgeon contested again the regenera-
tion of nerves, and affirmed that, even in making the suture of both ends,
the nervous current was unable to pass through the cicatrix. He said, if
sensibility is not entirely abolished, the fact is due to collateral roads, and
as motor nerves have none, motility is, in general, extinct without possibility
of return, by their division.
Some time later nervous regeneration was definitely established by
numerous Observations and experimental researches.
How does it take place?
When a nerve has been divided, the peripheric end loses its properties.
In each interannular segment, at the same time that tlie nucleus lying
against the sheath of Schwann swells and proliferates, the myeline breaks it
on its external face, on a level with each incision of Lantermann, and is thus
divided into balls. The cylindraxis, affected by the nuclear proliferation, is
in its turn indented and thousands of times cut alongside the degenera-
ting fibres ; soon it disappears, as well as the myeline, which is resorbed.
The sheath of Schwann is then filled with protoplasm and nuclei ; later,
these last elements atrophy, the protoplasm in its turn is resorbed and of
the nervous thread there remains but empty sheaths of Schwann, plicated,
lost in the middle of a fibro-fatty tissue. This change is general and
absolute — with exception for the recurrent fibres — and if regeneration
takes place, the cylindraxis must be rebuilt entirely.
Curious modifications occur in the central end, which do not extend
beyond the first annular contraction. In this short portion, the nuclei
proliferate, the myeline breaks up. There, a round or ovoid swelling
(central bulb of the neuroma of regeneration) is formed, grayish-white in
color, adherent to the surrounding tissues, encysted in a cicatricial mass
and united to the peripheric end by an intermediate tractus (cicatricial
segment) which serves as conductor to the regeneration. The cylindraxis,
instead of undergoing regressive changes, as in the peripheric end, be-
come the seat of a special constituting activity ; except those belonging
to recurrent fibres on the road to destruction, these cylindraxis granulate
at the point of the first contraction, from which start myeline tubes .
which ramify in the neuroma of generation. A single cylinder may give
twenty, thirty, forty of these tubes, which may be very irregularly arranged, ,
entangled, running through a thick conjunctive mass.
When the ends of the divided nerve are united or close to each other„ ,
384 VETERINARY SURGICAL THERAPEUTICS.
the young fibres run through the cicatricial bridge thrown between them,
reach the peripheric segment, penetrate into the sheath of Schwann or
mingle together, and many of them instill together as far as the limits of the
degenerated nerve, which is thus reconstituted. If these ends are separated
by a cicatricial structure of a certain length, regeneration still takes place,
providing, however, that the distance does not exceed 6 or 7 centimeters.
It is so much more easy and complete that the interfragmentary cicatrix
is more recent and shorter. It can not reach the periphery except by a
conductor, and of course it must be admitted that many new-formed
fibres are lost, degenerate, disappear ; others stop in their way ; those that
reach the periphery — the useful fibres — are but a small portion of the ele-
ments born from the central end. At any rate, regeneration is always
incomplete ; the new nerve is far from having inherited, in the same degree
as the old one, properties of sensitive and motive branches.
Some surgeons have recently mentioned cases in which sensibility re-
turned in some regions, immediately after bringing in contact the ends of
the divided nerve distributed in those regions (Tillaux, Nicaise, Polaillon,
Segond, Berger). This fact has been explained by recin-retice, assista^iccy
ar7'est of inhibition or dynamogeny ; but it is difficult to give of it a
satisfactory interpretation, with the actual data of physiology.'
It has been demonstrated that divided cylindraxis never unite again to
others ; there is always between them a fibrous cicatricial tissue, even in
cases where immediate reunion has been obtained ; the preparations of
Quenu prove it abundantly. The suture, performed early, cannot
prevent the degeneration of the peripheric end. A fortiori, when the
division is old, the most perfect suture will not permit the immediate
passage of the nervous current ; for this, the peripheric end, " true
cadaver," must be reanimated by regenerating from the centre to the
periphery. Like anatomical repair, the functional remains very imperfect.
The duration of the regeneration varies according to age, the height to
which the nerve is divided, and whether there has been simple division or
excision. It varies generally between five and six months.
These data are sufficient to understand, better than with all proposed
explanations, why the sensibility remains indefinitely reduced in the
regions placed under the influence of nervous branches which have been
divided or resected and why some lameness does not return, after
neurotomy, notwithstanding the regeneration of the divided nerve.
If the removal of the nervous influence does not seem to exercise a visible
immediate action upon the intimate phenomena of nutrition, it may-
bring on lesions with rapid or slow development, inflammatory or gangren-
* Berger, Laborde, Lifort, Btdletiu de VAcadhnie de Medecine, Paris, 1893, PP- -93»
313. 355. 450-
TRAUMATIC LESIONS. 385
ous in nature, hypertrophical or atrophica!, specially when other causes
occur ulteriorly, some of which are known — traumatisms, infections — and
others remain unknown. In the field of distribution of a divided
nerve, no organ or tissue is surely exempt from it. They have been
observed, specially in the skin, cellular tissues, tendons, bones and
articulations. Their mode of production is only imperfectly known, but
in animals, no more than in man, subsequent traumatisms do not seem
necessary to their production. On this point, clinical observation and ex-
perimentation agree. If, says Lancereaux, the production of lesions " is
assisted by a traumatism or any irritation of the tissues, it must be acknow-
ledged that this circumstance is not absolutely necessary and that some
times gangrene occurs entirely without any special occasional cause."
Quite recently, in a horse upon which, two years ago, we had divided the
external plantar nerve above the fetlock, we have seen appear, without
any traumatism, serious lesions which condemned him to be destroyed.
Brown-S^quard and other observers, who have studied the effects of the
section of the sciatic nerve, have not always seen the leg remaining indeinne,
as some pretend ; in several animals, they have seen numerous trophical
troubles, specially gangrene of the extremity and sloughing of the
phalanges.
The co7nptessio7i of nerves has causes whose action is either sudden or
slow. One understands that the evolution of the troubles will differ
Avhether the compression is produced severely at once in the middle of a