traumatic center or realized gradually by a neoplasm developing ia
proximity of a nervous cord. On animals kept in decubital position for a
long time, specially when a leg is secured in crossed position, a more or
less complete impotency of the displaced leg is sometimes observed, due
as it is to the compression of the brachial plexus between the arm and the
trunk. After some dystokias, when powerful tractions have been made to
remove a foetus of abnormal size, out of proportion with the dimensions
of the canal through which it has to pass, one may frequently observe, in the
cow especially, a lameness due to compression of the obturator nerve (see
Paralysis). Accidents of similar order brought on by the compression
of the gluteal nerve or of the great femoro-poplitial, have been observed.

The application of cords and hooks may produce, in the foetus, various
paralysis yet little studied. Traumatic lesions, inflammatory exudates,
large cicatrices, tumors, exostosis are as many causes of compression of
nerves. At the post-mortem of a horse, affected with incurable lameness,
Rigot found, at the point of insertion of the tendon common to the great
dorsal and the long adductor of the arm, an irregular exostosis, which,
had injured some of the nerves of the brachial plexus ; " the neurilemna
and pujp of these nerves was of a dark-wine color." When the com-*



386 VETERINARY SURGICAL THERAPEUTICS.

pression is great or continued for a long time, the lesions consist irt
degeneration of the nervous cord and the paralysis of the region where it
is distributed.

Paralysis from casting will be avoided by not keeping the animal too
long down, specially when the anterior leg of the side on which he lies is
fixed in crossed position. In difficult accouchements, the foetus must be
displaced and put in good position to facilitate its exit and avoid all
nervous lesion of the pelvis.

The treatment of compressions of traumatic nature and of paralysis
resulting from it, is that of nervous contusions : rest and irritating frictions
on the affected muscles. If these atrophy, blisters, cauterization, exercise
are the most recommended agents.

Some paralysis due to the compression of a nerve by a bony callus demand
that it should be isolated from it. After the incision of the skin and tissues
underneath, the nerve is liberated by the aid of the gouge and mallet,
acting with a great deal of care. The nerve disengaged, the muscles re-
cuperate their functions and return by degrees to their physiological condi-
tion. The ablation of a large cicatrix or of a tumor may also remove
troubles produced by compression of the nerves in its neighborhood.

Contusions of neivcs result from external (blows, knocks, falls) or from
internal causes (luxations, fractures). They are observed generally on
nerves that are little protected. The facial, on account of its superficial
situation, is the most frequently affected. In the legs, nervous trunks,
situated rather deep in the greatest part of their course, are rarely injured
by traumatisms.

The lesions made vary according to the severity of the cause ; at times
there is only a slight bloody extravasation between the tubes and rupture
of some of them ; at others the bloody infiltration extends in the nervous
cord, far from the contused point ; in serious cases, there is crushing of
the nerve, rupture of its fibres, distension of the sheath by a reddish
pulp. Whatever may be the degree and extent of these lesions, the
neurilemma is intact or very little altered. The divided nervous tubes
undergo the wallerian degeneration in their peripherical end, and when the
nerve is entirely crushed, the recurrent fibres alone escape destruction.
These disorders are characterized by sharp pain at the injured spot,
which sometimes extends alongside the nervous trunk, and by a more or
less complete paralysis of the sensibility and motion.

Rest is the first indication common to all the cases. Besides, the
resorption of the exudate should be stimulated so as to relieve the nervous
element and prevent neuritis. Antiphlogistics, massage, then stimulating
and blistering applications are ordinarily used. The administration of
iodide of potassium internally is advantageous. The paralysis of all the



TRAUMATIC LESIONS. 387

•muscular groups where the contused nerve is distributed sometimes
remains.

After being considered for a long time as absolutely harmless, ligature
of nerves is accused of serious accidents. Now, it is known that it can-
not give rise to tetanus, but it produces acute pains, neuritis, paralysis ; on
that account isolation of nerves during operation is essential. If an artery
is to be ligated, the surrounding nerves must be respected. The close
relations of the pneumo-gastric, sympathetic and recurrent with the carotid
are known : it is useless to insist on the danger of constriction of these
important branches. In the rare amputations that we have made, the
nerves were always isolated and divided a little higher than the other tissues.

Ligature of nervous branches gives rise to active reactions. If it has
been done accidentally, the ligature must be cut immediately and the
nerve carefully isolated from the tissues which are to be ligated.

Though nerves enjoy a great elasticity, they are exposed to stretching,
tearing and pitUing. Luxations, fractures with displacement, callus,
tumors of large size, violent mechanical or traumatic actions may produce
in nerves lesions varying from the simple distension to complete tearing.
In the celebrated stallion Physician, affected with a fracture of the fore-
arm, the cubito-plantar and cubito-cutaneous nerves were found lacerated
by the fragments of bones and inflammed in two-thirds of the extent of
the forearm. Under the influence of mechanical or traumatic influences
of equal violence, arteries and veins give away before nervous cords
do. In these, the nervous tubes break up first, the neurilemma
stretches like the external coat of arteries. The pulling of sensitive
nerves gives rise to pain, to which succeeds anesthesia in the field of dis-
tribution of the involved nerve. With motor nerves, the same cause brings
on paralysis. The artificial pulling of nerves has been tried in man, to
overcome some painful affection. Trials of this kind, made on horses,
have given results inferior to those obtained by neurotomy.

Ordinarily in simple stretching, after having attended to the cause
(reduction of luxations, of fractures, removal of a tumor, partial resection,
of a callus) sensibility and motricity reappear. Revulsives may usefully
overcome the consecutive disturbances. Complete pulling generally goes
with such serious lesions that the killing of the patient imposes itself.
Amputation of the leg or suture of the nerve are the means to use in small
species.

Nerves may be the seat of pricks, cuts, contused or gunshot woiinds.
We are lacking clinical documents upon simple pricks of nerves in
animals. Notwithstanding the small size of the wounding body, a few fibers
are always divided : a " bloody sub-neurilematic or interfascicular suffu-
sion " takes place, producing only slight troubles.



388 VETERINARY SURGICAL THERAPEUTICS.

Complete accidental sections are met with wounds made on the course
of nerves. In contused or torn wounds, the nerve is flattened or
stretched, and as its resistance is greater than that of arteries and veins,
it generally gives away only after them. Projectiles may perforate, cut or
even tear off a piece of a nerve.

Nerves are retractile like arteries ; after their section, both ends separate ;
to favor the repair of the organ, it is indicated to apply suture of the nerve.
The atrophy of the peripherical end is unavoidable ; even with the most
perfect suture, a cicatricial septum is always formed. It is not doubtful
that sensibility and mobility may last or suddenly reappear a few days
even a few hours after suture ; but, as we have said, this must be explained
otherwise than by the immediate reunion of the cylindraxis. However,
clinical and experimental results justify the suture of nerves, and the opera-
tion must always be done early. Although it has been performed but
little in our animals, there are, however, indications for its use. In.
valuable animals, specially those of small species, it must be employed.
MoUer has with complete success sutured in the dog the tibial nerve
accidentally cut.

Here is the mode of doing it :

Assisted by his anatomical knowledge and armed with the necessary in-
struments (bulldog forceps, scissors, bistouris, catgut threads, fine needles),
the operator should expose both nervous ends. In recent wounds, he will
find them with their normal characters ; their ragged ends should be
smoothed over with the bistouri. In old wounds, the extremities are swollen,
adherent to the surrounding vessels and united by a more or less solid struc-
ture ; they must be slightly excised to bring in contact two fresh cuts. For
the reunion, several ways offer themselves. A direct suture may be made by
passing the thread in both stumps) ; the upper piece is first pierced
through from forward backwards, at one or one and one.half centimeters from
the cut, then the needle is made to pass through the other stump, this time,
from backward forwards. In the penneurotic indirect suture the
thread passes in the neurilematic envelop ; two stitches are sufficient
to insure the coaptation, but often the sheath slips, tears, and it is then
very imperfect. The parafieurotic suture does not involve the neurilemma ;
it only encloses the surrounding connective tissue. Some surgeons apply
four stitches, placed on the four sides of the nervous cords and including
the sheath and the superficial fibres of the nerve itself (Berger).

By using fine antiseptic thread (catgut or silk) and a needle of small
caliber, the nervous cords stand well the direct suture. The peripherical
end is held with the forceps, taking the neurilemma only ; it is run through
with the needle and then the other end is secured. A knot regularly tied
permits the perfect coaptation. The essential is to pass the threads near the



TRAUMATIC LESIONS. 389

■divided surfaces, so as to avoid the angular deviation of the united
extremities.

Such interferences are to be completed with an antiseptic dressing and
immobilization of the leg or its fixation in such a position that the stretch-
ing of the nerve shall be as slight as possible, — a condition which is some-
times difficult to obtain with animals.

If it has been necessary to cut off a small piece of the extremities of




Suture of Nerves.
Fig. 90. — Direct suture. Fig. 91. — Perineurotic suture.

the nerve, it is sometimes impossible to bring the nervous stumps in con-
tact. In such a case, the suture apart (at distance) with catgut threads
and under most rigorous antisepsy is the preferred mode of operation. The
leg placed in good position, peri and paraneurotic stitches will be applied
to reduce as much as possible the separation of the stumps ; some direct
points may also be made. It is rational to admit that the resortable
threads act as guides to the young afferent neuricles of the central end,
and prevent them from going astray (Forgue and Reclus).



390 VETERINARY SURGICAL THERAPEUTICS.

Regeneration of nerves is slow. In general, as we have said before, the-
sensibility and motricity do not return for several months.

In relation to the nerves that are incompletely divided, their complete
section is no longer demanded. Consolidate the union of the two ends
with a stitch, immobilize the part under an antiseptic dressing, is the indica-
tion to follow.

11.
NEURITIS.

In man, simple contusions, burns, frost-bites, bony or articular inflam-
mations, tumors, not infrequently give rise to neuritis. These are ititer-
stitial o\ parenchymatous, acute or chronic, descending ox ascending.

These last, in which are several groups, are yet badly known. In the
preceding chapter we have seen that the section of a nervous branch is fol-
lowed with degeneration of the peripheric end and that it has no noticeable
influence on the central stump. In ascending neuritis, there takes place
in the central end, either a process similar to the wallerian degeneration
(parenchymatous neuritis) or an inflammation of the perifascicular con-
nective tissue, the lamellar envelop or the interfascicular connective tissue ;
or again, the inflammation, both parenchymatous and interstitial, of
the nerve. Some troubles at a distance (paralysis, anesthesia, amyotrophy)
are explained by an ascending neuritis extending to the spinal marrow.

For animals, if neuritis may complicate traumatic lesions of nerves, it
is rare, and experimental studies have added nothing to the very incom-
plete data given by clinical observation.

" I have tied nerves in ligatures more or less firmly," says Vulpian. " I
have squeezed them between two hard bodies, cauterized with various
substances (cantharidine, liquid ammonia, acetic acid), pierced them with
needles, without ever, obtaining a true suppurative neuritis, beyond the
points submitted to the experimental violence." ' Charcot tells us also
that experimental lesions, even the most serious, of the peripheric nerves,
produce with difficulty, in most animals, a neuritis of some duration
and like that which is developed, on the contrary, so easily in man after
the slightest lesions.^

Whatever may be the special resistance of animals to the inflammatioa
of nerves, pricks with crushing of the tubes, contused wounds or those made
by foreign bodies, expose them more than clean sections. After the-
operation of neurotomy, when the wound has suppurated, sometimes a.

* Weir Mitchell. Des lesions des nerfs — Preface de Vulpian, p. XI.
^ Charcot. Lesions stir les maladies du systime nerveux, p. 13.



NEURITIS. 391

•defective cicatrization takes place with formation of a large cicatricial
tissue, painful, producing lameness : it is a plantar neuritis, which always
remains limited. This neuritis and a pseudo-neuritis may be observed oa
both ends of a neurotomized leg, even on both legs. It seems as if some
subjects are predisposed to them. As for other tumors of nerves, ablation
is followed by the removal of the lameness. Neurotomy performed above
the neuritic portion has therefore its indications.

In bovines, Gelle has described neuritis ( ?) of the branches which sup-
ply the external face of the shoulder. Due to pricks of the pointed instru-
ment which their driver uses as a whip, the sensibility would remain but
motricity disappear, and back of the acromion, at its lower portion, a sub-
cutaneous tumor, as big as a large pea, was observed. At the onset, Cruzel
recommends long affusions of cold water, soothing unctions of althea oint-
ment, camphorated or opiate populeum ; then, after a few days, frictions
of spirit of turpentine. Soon improvement becomes manifest; regular
exercise completes the recovery.

Besides traumatic neuritis, toxic or infectious types are met in animals.
In horses, neuritis of the recurrent has been observed during lead in-
toxications. In cattle, after endometritis and peritonitis, Hamburger has
observed neuritis of the median and of the crural. In the course of
some infections, polyneuritis with muscular pains and sometimes subcuta-
neous ademas resembling polymyositis, may occur. Polyneuritis a frigore
seem rarer than polymyositis of the same nature ; but in hemoglobinuria,
it seems that besides polymyositis there are often polyneuritis, as the par-
alysis, anesthesia and rapid consecutive amyotrophy have a tendency to
prove. The differential diagnosis is specially based upon the normal or
painful state of the nervous cords of the affected surface. In polyneuritis,
compressions exercised upon the course of nerves give rise to acute pains ;
the same compressions are but little painful in polymyositis.

It is to this variety of neuritis that must be added the alterations, so
often observed in the femoral nerve, after " paraplegia." Goubaux has
described them wrongly under the name of "neuromas" of the femoral.
In reading the observations related by this author, it is seen that they affect
animals suffering first with '-paraplegia" or " hemoglobinuria" and which
remain lame on one hind leg. In all, he mentions the atrophy of the
triceps cruralis. In Observation I, it is said : " The anterior femoral
nerve was of a larger dimension than that of the opposite side ; it pre-
sented in the middle of its extent a swelling, as big as a hazel-nut, grayish
red in color ; in the middle of which the nervous fibres appear larger and
with the cellular tissue surrounding infiltrated with serosity." And in Ob-
servation II : " The anterior femoral nerve, at the place where it comes out
of the pelvic cavity to ramify in the muscles, presented an elongated



392 VETERINARY SURGICAL THERAPEUTICS.

swelling, hard, of a grayish red color." These are the lesions of the
post-hemoglobinuric femoral neuritis.

Trasbot has thus described the alterations of the nerve when the affection
is recent : " Its interfascicular connective tissue, extensively injected with
blood, has a dark red color. Little by little this same tissue, partaking of
the inflammation developed as consequence of the surrounding traumatism,
vascularizes and swells ; the nerve, upon a length of five or ten centime-
ters, presents then a fusiform swelling, whose transverse diameter may, in
ii-s middle part, be two or three times the primitive size, which is preserved
before and beyond the swelling. By simple dissection, it is observed that
the nervous cords are isolated from each other, individually enveloped
and compressed by the embryoplastic tissue now in process of formation."
The treatment of this affection shall be indicated in the chapter on
J^aralysis of the Femoral Neri'e.

The therapeutics of neuritis varies with its forms. Prevent the cause is
one of the first indications. For instance, by taking the precautions in-
suring immediate cicatrization, one will have great chances to prevent
neuritis of operation ; and if neurotomy is performed, by cutting the nerve
as high as possible, near the superior angle of the incision. With toxic
or infectious neuritis, the introduction in the organisms of nocive agents
should be guarded against, their elimination favored, or antitoxic agents,
resorted to to overcome their influence. When already neuritis is of some
duration, the restoration of the nerve by hydrotherapy, electrotherapy
(faradic or galvanic), massage and exercise will be indicated. Rheuma-
tismal neuritis should be treated by salicylate of soda. Overwork and cold
should be avoided.

III.

N EUROM AS— TU MORS.

Most of the authors that have treated of neuromas have placed under
that denomination all the tumors developed on the course of nerves.
But only the rare neoplasms formed by nervous tissue of new formation de-
serve this denomination ; the others are only fibromas, myxomas or lipomas
of nerves. The painful products found at the extremity of nerves in some
stumps of amputations are not neuromas ; neither are the pseudo-tumors
■which fill up the wounds of neurotomy, no more than the callus or the
cicatrixes of the tendons represent true neoplasms : they are the result of
the inflammation of the nerve and belong to neuritis. The same exists for
the post-hemoglobinuric " neuromas."

Let us remark that in the generality of the cases published in veterinary
medicine, histological examination has not been made. From the therap-
eutical point of view, the true nature of these tumors is indeed of secondary^



NEUROMAS — TUMORS. 393

importance, and whether it is for pseudo-neuromas, fibromas, myxomas, or,
on the contrary, true neuromas, the treatment is the same.

Rigot has several times found in the metacarpal or metatarsal regions,
upon the course of plantar nerves, circumscribed nodosities, hard, varying
in size from that of a bean to that of a pigeon's egg. Small, they were
moveable under the skin ; large, they had contracted with it intimate ad-
hesions. Very painful to pressure, they gave rise to lameness. The
author describes them as follows : " They are composed of a very hard white
substance, by which the nervous threads are separated and pushed out-
wards, and spread round the tumor, flattened as little bands. In other
cases, this scirrhous substance entirely surrounds the nerve, compresses it
and forms with it an homogenous mass ; and again, in two of these
tumors, the largest I have ever seen, I have found in their center a cavity
containing a gelatiniform substance, mixed with a very small quantity of
blood." '

Rey, Delwart, Lafosse, have reported also examples of " neuromas " or
" tumors " developed upon nervous cords.

What is the proper interference to use against these alterations, called in
old times " ganglions of nerves?" Rigot and Lafosse have tried, in vain,
alteratives, compression and actual cauterization. Iodide of potassium
is without action. Excision is the only treatment that has been success-
ful. A horse lame for two months on the left foreleg was operated by
Rigot ; there was " on the course of the external plantar a tumor as big
as a large bean, very hard, moveable, painful to pressure of the thumb."
The animal was cast and the leg placed in proper position. The skin
incised, the tumor and the nerve were exposed upon a certain length.
The neoplasm was excised with the scissors. Immediately after the opera-
tion the lameness disappeared. The wound healed rapidly.

Lafosse found also on the inter plantar of one anterior leg a tumor,
whose characters resembled those of fibromas due to the spiropterus
reticulus : " The tumor had pushed forward the nerve, which was intact,
except on its posterior border. It was composed of a fibrous tissue
incrusted with small yellowish massed, hard, stone-like, similar to the
tuberculous deposits so common in cattle."

Interference varies in its details according to the more or less intimate
connection of the nerve with the neoplasm. When the diseased nerve is
small, it is excised ; but when it is an important trunk, it is possible to
preserve it if the tumor is pedunculated, hanging to the nerve and resting
on it, as in the case of Lafosse. When the tumor is central, sur-
rounded by flattened nervous filaments, one might, under anesthesia,
incise the nerve, and enucleate the neoplasm in preserving intact the con-
^ Rigot, Rec. de Med. Vet., 1S29, p. 462.



394 VETERINARY SURGICAL THERAPEUTICS.

tinuity of the organ. If the tumor envelops the nerve entirely, it is excised
on one of its faces and each half removed one after the other. At times
the nervous filaments and the neoplasm are intimately entangled ; the
separation is impossible ; the whole mass must be excised.

For painful cicatricial parts which succeed neurotomy, excision is the
most efficacious treatment. The central end of the nerve is isolated, and
separated on a healthy portion ; the neoformed fibrous product is then dis-
secl^ed. It is ordinarily found intimately adherent to the tissues under-
neath. Trasbot has thus removed a tumor in a horse, whose size
was about that of the small finger ; its tissue was white, slightly grayish,
very firm and hard like fibrous tissue ; the nervous threads run through it
separated, leaving between them quite thick layers of that tissue.

Neuromas of stumps of extremities are also treated by ablation.

The generalized neuromas, which transform the nerves in true bead-
roll of tumors, are seen only in cattle (Colin, Morot). The cow of Colin
had shown no ailment during life ; at the post-mortem, tumors were found
in the brachial plexus and in all the sympathetic system. At the lumbar
region, they formed a mass weighing five pounds. The pneumogastrics,
cervical and subcostal threads of the sympathetic, the inferior cervical
ganglions and several nerves of the head had isolated tumors of all sizes,
varying from that of a pin to that of a goose's egg. From the observations
of Morot, it seems certain that these neoplasms, are not rare in bovines.
During 1885, this author found them in eleven cows; two of them
had more than 120, one more than 100 and two more than 80. The
nerves of the dorsal, costal and sternal regions, as well as those of the
legs and of the posterior parts of the neck, were affected. The situation of
these tumors is most variable : " Some, situated directly under the neuri-
lemma, are visible by transparency. The others are difficult to be seen,
being imbedded among the central nervous threads. By exploration of