the course of the nerves, they are readily perceived, rolling more or less
under the fingers."

It is surprising that such extensive alterations of the most sensitive tissue
of the organismishould remain absolutely silent. As Tillaux remarks, in man,
if pain was proportional to the number of the neoplasms, life would be un-
bearable with such etherism of the nervous system. But as much as
solitary neuromas are painful, as much those bead-rolls of tumors seem
compatible with the regular execution of all functions. If lameness or
manifest pains would occur and that interference would be desirable on
valuable animals, this would be guided by the results obtained in man.
Bromide of potassium has proved advantageous (Nicaise) ; aconite,
antipyrine, salicylate of sodae has given good results. Only the large
neuromas producing pain exceptionally may necessitate extirpation.



NEURALGIAS. 395

IV.
NEURALGIAS.

Pains situated along the course of ner\'es most commonly result from
â– congestion, compression or inflammation of these organs ; but sometimes
they show themselves without any apparent alteration having taken place in
the nerves. Neuralgias then represent a syndrome related to several pro-
cesses ; some well known, with manifest lesions of the painful nerve ; others
of nature yet unknown. Hence, the division into neiiritic-neuralgias and
ncjiroses-neuj-algias. In animals, more or less acute pains, due to nervous
lesion, are commonly observed. By analogy to what takes place in man,
animals are also subjects to jieuroses-neuralgias. ^\\q facial neuralgia would
produce a kind of " symptomatic ophthalmia with redness, tears flowing
and photophobia, a little nasal discharge and ptyalism. The horse has
the eyes staring and brilliant, he moves his ears, lays them back as a
vicious animal, bends his head towards his leg, and manifests his pains by
groans analogous to that seen in animals on which a twitch is applied,
and by kicks against his stall" (Renner). Sciatic or femoro-popliieal
neutalgia is accompained " by shakings and lameness of the affected leg ;
moving and exercise increase the pains, specially when the foot rests on

the ground Sometimes, as characteristic in animals, tremblings of

muscles have been observed, giving rise to access of pains ; also weakness

of the leg, which is half paralyzed "' (Zundel). Certnco-brachial

neuralgia is accompanied by a continued or intermittent lameness with pain-
ful spots on the course of the nerves. Descriptions have been given of a
cervico-occipital neuralgia, which may be mistaken with torticolis — a dorso-
intercostal neuralgia, with pains during respiration ; — a lumbo-abdominal
neuralgia, with pains in the loins. Zundel speaks also of neuralgias of
the mammae and of the testicles. Moller has several times observed the
hyperesthesia of some cutaneous regions, without material lesions or
marked alterations. He considers as neuralgic in nature the intermittent
hyperesthesia of the poll and of the withers, brought on by frictions of
the harness and which is increased by the slightest pressure. He says
he has observed frequently neuralgias in the surface of distribution of
the occipital nerve.

In some of the cases of femoro-popliteal or sciatic neuralgia related in
horses, cattle, goats, the nature of the affection is at least doubtful. The
same can be said of the brachial neuralgia of Cantoni and of most of the
observations of this kind.

It goes of itself that the diagnosis of " neuralgia " must be made ia



39^ VETERINARY SURGICAL THERAPEUTICS.

animals with a great deal of reserve and after repeated examinations, irt
dogs especially, where rheumatic pains are very common, and might be
taken for neuralgia.

Neuralgia is treated by local means and internal medication. Sooth-
ing compounds and antispasmodics, specially bromide of potassium, vale-
rian, asafetida, camphor, opium, belladonna, aconite, have been tried.
To-day morphine injections, antipyrine, cocaine, hold the lead in anti-
neuralgic medication.

Upon the course of the supposed diseased nerve, cataplasms, oils of
hyoscyamus, of belladonna, blisters, points of firing, subcutaneous local
injections of morphine and atropine, are useful. Some authors recom-
mend massage, acupuncture, electricity. Sometimes the general condi-
tion of the patient must be looked after. Anemic animals should receive
iron and quinine ; rheumatic patients, salicylate.of soda.

Against some rebel neuralgias, more active treatment is required. Two
methods are left to the surgeon's choice ; stretching of the nerz'e and
neiavtomy. The first diminishes the transmission of sensibility of the
nerve without changing the motility. On the contrary, neurotomy sup-
presses all nervous current, and if it is completed by neurectomy (removal
of a piece of it), the regeneration of the nerve is more or less postponed
and therefore also the reappearance of the sensibility. These two rival
modes are not judged yet by veterinarians. However, neurotomy is more
familiar to them, and it is used for many painful conditions that have
remained rebel to ordinary therapeutic agents.

V.

PARALYSIS.

Under this name or that of akinesia is understood the abolition or
diminution of the contractility of muscles through their normal
stimulant. The simple diminution of muscular contractility is some-
times designated under the name of paresy. The loss of sensibility to
pain or to touch {atialgesy and afiesthesy) often exist with akinesia and
furnishes important elements of diagnosis. We have spoken of myopa-
thic paralysis in studying the diseases of muscles ; we will here treat only
of the neuropathic paralysis.

They present themselves under very varying forms, among which are : ist,.
local or isolated paialysis, involving one or several muscles of the same group,
sometimes several muscular groups ; 2d, monoplegia or paralysis involving
a whole leg, and of cerebral or spinal origin ; 3d, hemiplegia or paralysis of
one lateral half of the trutik ; 4th, paraplegia or paralysis of the hind
quarters ; ^"Ca.^ associated paralysis ; 6 th, diaplegia or diffused paralysis^



PARALYSIS. 397

At times the paralyzed muscles are flabby and relaxed ; if it is in one leg,.
one can move it in all directions without the slightest resistance {^flaccid or
relaxed paralysis ) / at others, but less commonly, the muscles are stiff,
con trac ted ( spastic pa ralysis. )

Neuropathic paralysis are only symptoms common to various lesions of
the brain, of the cord or of the nerves. To treat them rationally, it is
necessary to determine the seat as well as the lesion of the existing
lesions. There are cases where the impossibility of standing (paraplegia),
the lameness (paralysis of the femoral), the mode of carrying the leg
(paralysis of the radial), the aspect of the region (paralysis of the facial)
immediately give information. But in others, the diagnosis is difficult.
The sensibility, the reflexes, the electric contractility may give valuable
assistance.

The sensibility may be increased, diminished or perverted. In animals,
general sensibility is tested by pricking or burning. Generally the dimi-
nution of sensibility is located on the same side as the paralysis ; yet
hemiplegia can exist on one side and hemianesthesia on the other. The
examination of special sensations (hearing, sight, smell) is also very impor-
tant. Difference in the pupils, myosis, mydriasis, absence of pupillar
changes by light, indicate lesions of the encephalon, cervical cord or
sympathetic.

Tendinous reflexes (patellar reflex, that of the tendo-achillis) are nor-
mal, exaggerated, diminished or suppressed. Their mechanism is known :
the mechanical irritation, carried to the gray substance of the cord by the
centripetal fibres and the posterior medullar roots, is propagated to the
motrice cells of the anterior horns of the cord, where it is transmitted to
the muscles by the peripheric motrice ways. The integrity of the
*' spinal reflex current " is the condition of the presence, in the normal state,
of tendinous reflexes. They are diminished or abolished with lesions in-
volving the centripetal or centrifugal nervous fibres, or the anterior or
posterior roots of the marrow, or again .the gray medullary substance.
And as there exists in the encephalon and the superior layers of the cord,
moderating:; centers of these reflexes, one may understand how the lesions,
which involve the brain and the anterior half of the cord and suppress the
influence of these centers upon the inferior regions of the spinal marrow,
may produce an exaggeration of these reflexes. That is what occurs in
many circumscribed medullary affections, which leave intact the reflex
spinal arch.

Electric exploratiofi (faradizatiofi or galvanization ) gives also useful
indications. The electric muscular contractility is preserved in paralysis
with cerebral origin and in some paralysis with spinal origin (when
the segment of the cord, which innerves the paralyzed muscles, is in-



398 VETERINARY SURGICAL THERAPEUTICS.

â–  demne); it is abolished in spinal paralysis with disorganization of the
medullary segment corresponding to the paralyzed muscles, and in trau-
matic peripheric paralysis, a frigore or toxic (reaction of degeneration.)
The lasting abolition of electric contractility of paralyzed muscles is an
indication for bad prognosis. It coincides with the loss of the reflexes
and is soon accompanied with the atrophy of the affected muscles.

Let us resume the principal characters of /ara/i'j-/^ ay/V// cerebral origin,
of those with medullary origin, and of those with peripheric nenwus
origin.

In general, in cerebral paralysis, there is hemiplegia of ike opposite side
of the lesion, and the cranial symptoms allow us to differentiate the cerebral
from the spinal hemiplegia. Ordinarily the sensibility is preserved ; when
there is anesthesia, it is hemiplegic and is situated on the same side as the
motrice paralysis. Bilateral alterations of the brain and those of the
mesocephalon may produce paraplegia. Lesions of the cortical layer of the
brain give rise to various paralysis ; motrice fibres having their origin in
the gray substance of the cerebral cortical portion and the psychomotors
being independent, autonomous, if the cortical lesions are circumscribed
they only give rise to monoplegia or local paralysis. But, here again, the
encepnaiic symptoms often allow a positive diagnosis. Some paralysis of
encephalic origin are alternate ; the face is paralyzed on the side of the
lesion ; the legs on the opposite side — a peculiarity due to the bulbar de-
cussation of the pyramidal fasciculi, which transmit the will of the motrice
regions of the brain to the different sections of the spinal cord. An
encephalic morbid center which is, for cranian nejt'es, a peripheric lesion
and involves the pyramids above their decussation, promotes a crossed
paralysis or alternate hemiplegia. The typical paralysis of the annular
protuberance is the alternate hemiplegia ; that of the bulb, the labio-
glosso-pharyngeal paralysis.

Paralysis of ffiedullaty origin are almost always ordinary paraplegia,
limited to the posterior legs ; sometimes the anterior are also affected
(cervical paraplegia) . In the cord, the ways of conduction being very near
each other, lesions, even small, produce easily those bilateral paralysis ; but
very limited alterations may give rise to hemiplegia or monoplegia, then
the suppression of the motility is always direct. The troubles of sensibil-
ity are various ; in general, anesthesia is paraplegic ; if it is hemiplegic, it
is situated on the opposite side to the lesion : at times anesthesia is only
in spots. When the cord is destroyed in all its thickness, reflexes which
have their center below the region are exaggerated. Muscular atrophy is
frequent. Some characters permit also to recognize the localization of
the lesion upon the cords or upon the gray substance. The alterations of
this last give rise to paraplegia, all reflexes corresponding to the diseased



PARALYSIS. 399-

TCgion have disappeared, the atrophy of muscles is rapid, there is diminu-
tion of the electric excitability and reaction of degeneration partial or
complete in the paralyzed structures.

Paralysis of peripheric nervous origin — the ones that we have particularly
in view — are generally limited to a single nerve or to a group of nerves in
the neighborhood, and rarely do they involve a great number of muscles.
At the same time that the paralysis of motion, anesthesia and trophical
disturbances are observed, ordinarily precocious, which little by little be-
come more marked, reflex excitability is destroyed. Electric explora-
tion is not slow in giving the reaction of degeneration.^

To establish a rational treatment of akinesia, the nature of the lesion
and cause of it must be known. Ischemia and congestion, hemorrhage,
softening, acute or chronic inflammation, tumors, various infections or
intoxications, are as many morbid processes liable to act on the nervous
system and promote paralysis very variable in their seat and in their march.
Paralysis occurring i-apidly are due to mechanical, toxic or infectious
causes, according to the cases : nervous compression, cerebral or medul-
lary hemorrhage, intoxication by vegetal or mineral poisons, infection and
intoxications by microbian poisons. Paralysis progressing sloivly zwwowncQ.
a chronic inflammation or a neoplasm.

In the chapter Diseases of tlie Brain and Cord we will come back on
the paralysis of cerebral and those of spinal origin. Several local parahsis
will be studied with other affections of the regions where they are met.
We will here consider specially the akinesia of extremities.

From what has been said above it is seen that local paralysis are ordinarily
determined by various causes which abolish the functions of a nerve by
destroying its continuity or altering its structure : by section, com-
pression, distension, laceration of the nervous branches, neuritis and
neuromas. It is sometimes difficult to learn their precise nature. Some
are of infectious or toxic origin. Often paralysis of unknown origin are
attributed to rheinnatisnt, when most commonly they are the result of a
slip, a fall or perhaps of an infection or intoxication; we hold that
truly rheumatismal paralysis or afrigore are very rare in all animals. Some
are peculiar to some species ; we meet with diphteritic paralysis only in
aviary species.

According to their origin and the importance of the organs affected,

1 The reaction called degeneration is partial or complete. Specially accused in
traumatic paralysis consecutive to the section of a nerve, it has for principal characters :
diminution or loss of the excitability of the nervous trunk by faradic and galvanic cur-
rents; the persistency or even the exaltation of the galvanic contractility of muscles, in
contrast with the diminution or abolition of the faradic contractility ; the slowness of
the muscular jerking.



400 VETERINARY SURGICAL THERAPEUTICS.

local paralysis have a gravity which varies much. The altered, divided
nerve, more or less degenerated, may resume its role of conductor, but
often recovery is slow. When it is a question of the nerve of legs, and that
lameness prevents its utilization, there are cases where treatment cannot
be undertaken except for costly animals.

Rheumatismal paralysis are ordinarily benignant. Almost always they
disappear in a few weeks. Those due to slight traumatic lesions last
sometimes only a few days ; serious lesions of same nature bring on
paralysis of long duration, sometimes permanent. While the paralysis of
the radial nerve recovers almost always, that of the sus-scapuiar is per-
manent in most cases. The incurability of the paralysis of the recurrent
is explained by the constant compression on the nerve through the hyper-
trophied glands. The atrophy of the muscles is always a sign of bad
prognosis. The persistency of the faradic irritability is a favorable sign :
its exaggeration is a sign of early recovery. Incomplete paralysis, specially
those of traumatic origin, generally end favorably and in a short time.
It is known that most paresis of the radial nerve almost invariably get
well in two or three weeks. The older the paralysis is and the atrophy
marked, the more serious is the prognosis.

The means of treatment vary with the nature of the trouble. In case
of compression by a callus, a tumor, a cicatrix, the sharp instrument
must be resorted to. Paralysis that are produced by infiltration in recent
traumatic lesions have a natural tendency to diminish by degree and at
last disappear by the natural process of the cause. It is indicated to act
at the same time on the nerve and on the muscles. When possible,
recourse to electrotherapy is indicated, to shorten the duration of the
disease as well as to prevent the muscular atrophy. Electricity is a
powerful assistant, either by stimulating the nerve or exciting the mus-
cular contractility. The negative pole (cathode) should be placed on the
region corresponding to the nervous trunk or on a point where it is most
superiicial, and the positive pole (anode) upon the muscles where the
nerves ramify. The seatings of electrization will last four or five minutes,
and will be renewed every day, or from eight to ten minutes, and given
every second day. The current should be weak, and strong ones always
avoided, as being very painful. Often action is to be limited only on the
muscles. The atrophy will be prevented by exercise ; massage, blisters,
cauterization, subcutaneous injections of veratrin, strychnine, salt-water have
proved advantageous. In all cases existing for a short time, iodide of
potassium is indicated ; it promotes resorption in perineurotic effusions.
With rheumatismal paralysis, salicylate of soda will be prescribed.

One must not take for paralysis the muscular atony some\.\m.e% observed
in colts and in calves, in the first days following birth. Most often, the



PARALYSIS.



40 r



extensors of the metcarpus and of the phalanges are affected in the fore-
legs, and the flexor metatarsi in the hind. Recovery is ordinarily easily-
obtained by massotherapy, and simple dry frictions.

Local Paralysis of ExtreiMities.



Se



I.— Sus -Scapular Nerve.

The sus-scapular nerve, which ramifies in the antea and postea spinatus
muscles, can be injured in various circumstances : by bruises against the
shoulder, especially those which occur from forward backward when the
leg is raised to be car-
ried forward (M oiler)
or by a blow, at the
time of a fall, or by a
slip in abduction. In
army horses it has been
observed without be-
ing able to attribute
it to any other cause
than powerful muscu-
lar efforts or suddenly
executed movements.
We have observed it
after the securing in de-
cubital position. After
two months the atrophy
of the subspinatus spe-
cially was well marked.
(Fig. 92.) Under the
title of Laceration of
the Tendotis of the
Subspinatus, Bouley le-
lates two similar facts.
(See Tendinous Rupt-
ures.^ In some cases,
it is rheumatismal in
nature or related to hemoglobinuria. For Biot, it is muscular congestion
which, giving rise to ''hemorrhagic raptus," injures the sus-scapular; the
sweenied shoulder is but " the consequence of the compression and in-
filtration of the sus-scapular, by blood extravasated in nature round it and
in its structure."




Fig. 92. — Paralysis of the sus-scapular nerve (from a
photograph). E, projection formed by the scapular
spine ; Se, depression due to the atrophy of the postea-
spinatus muscle.



402 VETERINARY SURGICAL THERAPEUTICS.

This paralysis of the antea and postea spinatus is ordinarily indicated
by slight continued lameness, which, at the outset at least, is sometimes-
difficult to connect with its true cause. At rest, the leg is carried a Uttle
forward of the plumb line, the scapulo humeral prominence is carried
outward. In walking, the movement of the leg forward is stiff ; at the
time of putting the foot down, the shoulder angle is more prominent than
the other and is carried in abduction. Later, when the atrophy of the
sus and sub-spinatus muscles or of this one alone is well accused, the seat
of the disease is evident. Then the lameness becomes more manifest
after a certain length of work and the animal is unfit for fast work.
Goubaux has related an interesting case of paralysis of the sus and sub-
scapular nerves and of the axillary, observed in a horse, which, while
galloping, had run against the hub of a truck. The shock brought on an
immediate lameness which resisted several treatments. Two months
after the accident, the shoulder was thinned, atrophied, the elbow greatly
bent outwards with a deviation which increased during walking. At the
moment of rest, the weight of the body produced a certain amount of
dropping of the extremity. At post-mortem a marked atrophy of the
sus and sub-scapular muscles was found, also of the long and short abduc-
tors of the arm and of the sub-scapularis.

Recovery occurs in about half of the cases. Moller out of ten observa-
tions, obtained three recoveries, three improvements and four failures.
Traumatic paralys-is implies a more serious prognosis than those of rheu-
matoid nature. When the atrophy is already great, in general all treat-
ments fail. Revulsive frictions, firing, irritating subcutaneous frictions
form the base of the therepeutics. Electricity, used as we have said, may
render some service. Hansen says he obtained good results with hypo-
dermic injections of spirits of turpentine. We prefer the subcutaneous
injections of veratrine solutions (veratrine lO centig. ; water 5 grams.)
According to Goubaux, many have seen this paralysis resist to the firing
of the shoulder. But the lameness is slight, and allows the use of the animals
at slow work.

//. — Brachial Plexus.

This paralysis is sometimes of encephalic origin ; in this case, it is
preceded by other troubles, which may appear with it or after. In a
horse affected suddenly with paralysis of the right hind leg, and two days
later with a paralysis of the anterior corresponding leg, at the au-
topsy, hemorrhage of the cerebellum was found. Another horse which
presented symptoms somewhat similar recovered after three weeks.

Very generally this paralysis is due to local causes ; a sub-scapular
hemorrhage (Holniann), a deep abscess, a tumor of the internal face of^



PARALYSIS. 403

the shoulder. It often occurs as accident of casting. When one of the
anterior extremities remains for a long time in crossed position, the plexus
may be bruised or compressed between the shoulder and the trunk ; when
the animal is up, a more or less complete paralysis of the extremity is
observed. Almost always it is the leg upon which the animal is lying
which is affected ; the accident may occur even when the leg has not
been displaced. The horse of which Trasbot speaks lay on the right
side, and the left anterior leg secured above the corresponding hock ;
the right foreleg, left in the hobble, was the one which became para-
lyzed.

According to the degree of the lesions, one will observe a paresis of the leg
with tremblings of the olecranon muscles, but these will ordinarily disappear
rapidly ; at other times, when paralysis is complete, the inert extremity is
dragged upon the ground, carrying weight is impossible, the articulations
flex under it. The troubles of sensibility are less clear. When motility
is abolished, sensibility may yet persist normal or be only diminished.

The treatment must necessarily vary according to the producing cause.
Large callous tumors prevent interference. If an abscess develops under
the shoulder, in the depth of the axilla, pressing upon the plexus, it must
be opened early. A bloody effusion is less dangerous ; ordinarily it
resorbs by degrees and the leg recovers its motility.

We treat the paralysis of casting by immobilization, stimulating frictions
(camphorated alcohol, charge of Lebas, blisters) and by the daily admin-
istration of 10 or 20 grammes of iodide of potassium. Irritating sub-
cutaneous injections may be used with advantage. Trasbot's patient was
first left alone on a thick bed, but, on account of threatening bed sores, he
was placed in slings. The twelfth day, as the fore-leg was improving,
general troubles occurred, the right hind leg was paralyzed in its turn ;
complications due to "ascending neuritis, spread to the spinal cord.'*
Recovery took place, however, rapidly.

///. — Radial Nerz^e.

The radial, ox posterior humeral 7ierve, is the largest of the branches of