the brachial plexus ; it twists around the shoulder joint, reaches the internal
of the humerus, its posterior face, then the anterior face of the elbows and
that of the radius ; it ramifies in the extensors of the fore-arm, those of the
metacarpus, the external flexor of the metacarpus and the two extensors
of the phalanges. This paralysis has been frequently observed in horses
sometimes in cattle (Harms) and dogs (Moller). We have seen numerous
cases in horses and one in dog.

Like the preceding, it is generally due to the securing of horses in



404



VETERINARY SURGICAL THERAPEUTICS.



decubital positions ; the nerve is squeezed between the thorax and the
leg, specially if this one is in crossed position. It may arise from other
causes (traumatisms, fractures, tumors). Goubaux accuses falls and con-
tusions ; Tondeur has recorded a case due to a kick. Sometimes it arises
from strong and repeated contractions of the muscles, which the nerve
ramifies (Werner), or from struggles made to relieve himself from hobbles
(Weber). Benjamin has treated a six year old horse, phlethoric, taken
with paresis while working : harnessed to a heavy load and obliged to
make violent efforts, the horse suddenly fell, could not rise except with.




Fig. 93. — Complete paralysis of the radial. (MoUer.)

difficulty, and presented symptoms of cerebral hyperemia, of inco-ordina-
tion of motions in the anterior extremities, and lastly in the right leg, and
the functional troubles resulting from incomplete paralysis of the radial.
Often this becomes manifest after a quick and long race. Brauer has
seen it after a long exposure to cold rains (rheumatismal paralysis). In
one horse at our clinics, it occurred at night, probably from defective atti-
tude or from a slip. Bowmann and Brauer have related cases of double
radial paralysis, occurring suddenly. Moller has seen that of the left
nerve to be complicated in a few days with that of the right. In a case



PARALYSIS. 405

observed by Fries, it became complicated after some time with paralysis
of the opposite hind leg.

The diagnosis is not difficult. la a certain number of cases, paralysis
is incomplete or partial : at rest, the standing is normal, sometimes there
are twitchings of the olecranon muscles ; in walking, the leg is carried
forward with the joints semi-flexed, the foot drags on the ground. In
very slight cases, the trouble is manifested only by slightly marked symp-
toms ; but in quick gait, the legs flex to excess and the animal may fall.
When paralysis is complete, the standing of the leg and the lameness are
characteristic : at rest, the shoulder is depressed, the scapulo-humeral angle
wide open ; the olecranon muscles are relaxed, their mass less prominent ;
the elbow and knee joints are flexed ; the extensors of the phalanges are
paralyzed ; the flexed fetlock is carried forward ; the toe of the foot is
sometimes on a level with that of the other leg, or again in front or back
of the plumb line. The standing takes place on the toe or the anterior
face of the foot and digital regions. Walking is very difficult ; the leg is
more dragged than carried forward ; in the slightest standing, all joints
are flexed. In a horse observed by Tondeur, the nerve having been
bruised very low, where it leaves the groove of torsion of the humerus, the
extensors of the forearm were not paralyzed, but the anterior extensor of the
metacarpus and those of the phalanges functioned poorly and when walk-
ing was hurried the fetlock struck the ground. Changes in the sensibility
are far from being proportional to the degree of the paralysis; even when
this is complete, sensibility may remain well marked.

The prognosis varies with the cause of the paralysis and the intensity of
the symptoms. In few cases, the affection is very serious. Goubaux
records the observation of a subject which had to be destroyed the eighth
day. We have seen a similar case : the paralysis was due to securing in
crossed position ; the animal was placed in slings, and kept there for a
week ; he had to be removed from them, when he dropped and died six
days after.

These are exceptional cases. With this akinesia, whose symptoms
are sometimes so alarming, rapid recovery is the rule. Twenty horses
treated by Moller all made a recovery. Often improvement is manifested
after one, two or three weeks ; sometimes the symptoms remain in the
same condition for several weeks and then disappear in a few days. Like
Lustig and Moller, we have seen radial paralysis which did not disappear
except after a long treatment. Moller mentions a case where recovery
did not occur for nine months. To give up treatment too soon, because
the symptoms persist at the same degree for several weeks, is a fault which
one will not commit if the habitual march of the disease is known. On
the horse shown in fig. 94 the paralytic troubles lasted for a month before



4o6



VETERINARY SURGICAL THERAPEUTICS.



noticeable attenuation showed itself. A week later, he walked better. lit
two weeks he resumed work.

In all the cases where the paralysis is complete, it is always well to use
slings, until the time when improvement is noticed, and even as long a
time as the patient will stand them. The principal agents of the local treat-
ment are revulsives, blistering agents and electricity. Goubaux resorted to
the following treatment in one case : " Two needles, 15 centimeters long,
were thrust half their length, one in the large extensor of the forearm,
back of the scapulo humeral joint, the other in the short extensor of the
forearm, near its insertion to the olecranon. Both needles were attached to




Fig. 94. — Paralysis of the radial on the road to recovery. (From photograph.)

the poles of an electric pile. Each time the current was closed, muscular,,
violent and jerky contractions would take place, moving the leg a little in
all directions." Several seatings of ten minutes of this electrization were
applied. The fifth day, the olecranon muscles, first flabby, had returned
to their size and consistency, the animal was no longer lame and returned
immediately to his work. Inductive instruments have considerably sim-
plified the treatment by electricity and still it is little used in our animals
(see Paralysis in General).

Blisters are used oftener. Goubaux has called attention to their
good effects. The charge of Lebas or blisters are generally used. We
prescribe a blistering application on the external face of the arm, and.



PARALYSIS. 407

.administer 10 or 20 grammes of iodide of potassium. As soon as im-
provement appears, short walks, morning and evening, gradually increased,
are beneficial. Subcutaneous injections of strychnine (o gr. 025-0 gr. 05)
or of veratine (o grs. 10), made in the affected region, are recommended
by Bormann and Moller. Those of salt water or spirits of turpentine may
also be useful.

The treatment of incomplete paralysis is the same. The animal should
be put in slings or left loose in a box-stall ; locally, revulsives and blisters
should be used.

IF, — Obtit7-aior Nen^e.

This is generally mentioned only as consecutive accident of dystokial
labors and fractures of the pelvis : it is produced by active pressures made
upon the nerve on some points of its course, most commonly at the
obturator foramen, either during the passage of the foetus or by effused
blood or again by a large callus. In all species, it may also be due to
neoplasm of the neighborhood of the nerve ; it has also been observed in
white horses affected with melanosis of the pelvis.

At rest, the leg is carried more or less in abduction, the joints are
flexed, the toe of the foot turned outwards. In walking, the extremity is
moved with difficulty and with a motion of abduction. Little by little
there is atrophy of the muscles where the nerve ramifies — adductors of
the thigh, pectineus, short adductor of the leg. This atrophy with the
conditions detected by rectal examination confirm the diagnosis.

Against paralysis due to tumors or a callus, there is nothing to do.
For those of dystokial origin, "irritating frictions on the croup and thigh"
have been recommended. Cold irrigations of the vagina and massage
through its walls should be more efficacious. At times improvement
■occurs rapidly, even when no treatment is carried out ; quite often the
lameness does not disappear for months, sometimes it remains permanent.

V. — Femoral Nen'e.

It is no doubt to " hemoglobinuria " or " congestion of the spinal cord "
that most cases of femoral paralysis are due. Goubaux, Bouley, Reynal
saw in it the consequence of rupture of the 'psoas, which is " of such
delicate texture that it tears with the greatest facility, during life as after
death " (Rigot). But paralysis of the triceps cruralis may appear at the
onset of the disease, and at the autopsies of all the horses which had it, no
lesions of the psoas could be found. In these cases it was either a myo-
pathic paralysis, or a femoral neuritis, due, as myositis are, to rheumatismal
or infectious process.



408 VETERINARY SURGICAL THERAPEUTICS.

Among the post-hemoglobinuric symptoms, the most frequent is atrophy
of the crural muscles, which is easily reproduced experimentally, as
Goubaux did, in performing the division of the nerve " at the internal face
of the thigh, on its superior portion, between the vastus internus and
the anterior straight, where it furnishes its terminal branches." ' This
amyotrophy, generally evenly accused to the three parts of the triceps, is
neuritic and not myopathic in origin.

At any rate hemoglobinuria is not the only affection able to produce
the paralysis of the femoral nerve and its characteristic symptoms. It is
useless to repeat here the causes already mentioned in the chapter on
paralysis in general : abscesses, tumors, exostosis, intoxications. The
first observation of the report of Goubaux had his foot caught between
two stones of street pavement ; he made a violent effort, tore his shoes,
and became suddenly lame. Like the lameness resulting from section of
the femoral nerve, this did not give away to firing applied on the thigh.
At post-mortem, lesions of the great psoas and inflammation of the
femoral nerve were found. Schmidt related a case with similar etiology.
The patient of the second observation was affected with paralysis after a
violent effort, and that of Observation VI after a fall. The horse treated
by Trasbot had kicked in harness with both legs ; the right foot, held back,
was carried in forced abduction ; " the psoas torn at the moment of the
accident brought on a severe neuritis which demanded several months to
get well." Gunther had already mentioned kicking backwards as a cause
of femoral paralysis. i\Ioller has seen six cases due to powerful muscular
contractions.

Whatever may be the cause, the lameness of femoral paralysis is in all
cases very expressive : the sudden flexion of the stifle and hock joint, every
time the animal rests on the leg. The atrophy of the patellar muscles,
gradually manifested, is another unmistakable sign.

The treatment of femoral paralysis which occurs as prodome or symp-
tom of hemoglobinuria is connected with that of this last affection. To
treat post-hemoglobinuric paralysis and those of other origin, all vesicating
agents have been used. But cauterization is to be preferred. It is one
of the affections where lines firing is specially indicated. Goubaux has
tried electricity. A mare affected with this disease was cast; "two
needles were thrust into the fleshy tissues, one on the anterior part of the
croup pointing towards the lumbar region, the other at the lower extrem-
ity of the femur in the anterior femoral muscles. The needles were con-
nected with a galvanic pile, and the parts included between them
submitted to electric current for twenty minutes. Under this influence

1 Goubaux, Rec. de Med. Vet., 1844, p. 492.



PARALYSIS.



409



the leg executed numerous and violent contractions, which returned every
time the current was turned on." The seatings were not sufificiently repeated
to insure a noticeable result. While Goubaux doubted the possibility of
recovery, all the subjects treated by Lebel with blisters and exercise re-
covered in a few months.

In many cases, exercise and time are sufficient for a recovery (Bouley).
The patients should be left loose in a box ; they will be turned out. The
degenenation of the muscles will be prevented by daily massages, the ap-
plication on the external surface of the thigh of repeated stimulating or
blistering frictions or by firing. Subcutaneous injections of veratrine




^'£,



Fig. 95. — Paralysis of the femoral nerve. (From a photograph.)

(o gra. 10) have a decided advantageous action. Saturated solution of
salt is less efficacious and sometimes gives rise to rather extensive under-
mining of pus.

We prefer iodide of potassium (10 or 20 grammes a day) to nux
vomica. As soon as walking is possible without being too tiresome, the
patient should have light exercise. The atrophy of the patellar muscles
is sometimes well marked, but nevertheless, for it also, recovery is the
rule; after three to six months, the muscles have generally resumed their
normal contractility and size. Incurable cases are almost all hemoglo-
binuric in their origin.



410 VETERINARY SURGICAL THERAPEUTICS.

VJ. — Great Sciatic.

Well protected at its origin by the thick layers of the gluteal muscles,
the gt'eat sciatic is seldom affected, yet its paralysis has been observed in.
horses and in dogs. Ordinarily due to the forced extension of the hind
leg, in a slip or by a fall on the hind quarters, it is characterized by the
inertia of the totality of the muscles of the hind leg, except the triceps,
which is innerved by the femoral ; the paralyzed muscles become atrophied
with time. Rodet has related the observation of a horse affected with a
special lameness due to compression of the nerve. " The diseased leg was
moved as if being thrown forward by a sudden jerky movement. In this
action, so to speak automatic, the cannon and digital region were waver-
ing ; the cord of the bifemoro calcaneus being itself flabby and quivering."
Backing was almost impossible ; and often in walking, the anterior face ot
the fetlock rested on the ground. At the autopsy the great sciatic was
found pressed upon by a melanotic tumor. Moller has mentioned three
examples of this paralysis, observed in three large dogs.

It is not always present alone. In the horse it has been seen existing
with paralysis of the brachial plexus of the same side (Trasbot) or of the
opposite leg (Moller, Fries).

Under the title oi paralysis of the tiiial nerve, some German authors,
Moller among them, describe the paralysis of the great sciatic, below the
lower third of the femur. At rest, in standing, the hock flexes, the leg
drops. During exercise, all the joints flex abnormally, the foot is carried
upwards as in springhalt ; trotting is impossible.

The treatment varies with the cause of the trouble. If the nerve is
compressed by a tumor, extirpation of the growth alone is indicated.
Against paralysis with unknown causes, bHsterings and iodide of potassium
should be tried first. Later, massage or faradization of the atrophied
muscles and exercise are indicated.

VII. — External Sciatic Popliteal.

The small fe7noro popliteal or external sciatic popliteal rises from the
sciatic on a level with the gemelli of the pelvis and runs from backwards
forwards, from upwards downwards, towards the external face of the
superior extremity of the tibia, where it terminates by two branches : the
miisculo-ciitaneoiis and the anterior tibial neji'c. The first ramifies in the
lateral extensor of the phalanges and the skin. The second, the most
important, goes to the anterior extensor of the phalanges and to the
flexor metatarsi. It is exposed to injuries principally at its passage on the
tibia.



PARALYSIS.



411



Paralysis of the external sciatic popliteal gives rise to symptoms, well
■described by Goubaux. At rest, either the digital regions are flexed and
the fetlock rests on the ground, or the foot stands firmly and nothing in
the attitude of the leg indicates a nervous lesion (fig. 96). In walking,
the execution of the movements is regular in the upper segments of the
leg and the extent of the step is normal, but the extension of the
phalanges being impossible, the toe drags on the ground and sometimes
seems deviated inwards. At the moment of putting the foot on the
ground, the standing takes place normally or the digital region is flexed
on the cannon, and its anterior face as well as the fetlock rests on the




Fig. 96. — Paralysis of the external popliteal sciatic nerve. (From a photograph.)

ground ; in this way the tibio-metatarsal angle is open to extreme, the leg
and cannon are in the same straight line. Flexion of the digital regions is
often frequent during backing. If the paralysis lasts, and the subject is
kept exercised, the wall is much worn at the toe.

In a horse affected with this akinesia, after a violent contusion,
Goubaux vainly tried blistering and cantherided pitch plasters on the course
of the nerve. The case of Bouley in his first observation recovered by re-
peated applications of charge of Lebas. We had only one case of this
nature to treat ; he got well in three weeks by a single blister on the
leg and exercise.



CHAPTER XI. >
BONES.

I.

CONTUSIONS.

Contusions of bones are quite frequent in horses. Depending on various
conditions (situation of the bone, thickness of the tissues which protect
it), its gravity varies principally in proportion to the violence of the shock.
At times the lesions are Hmited to the periosteum (undermining and sub-
periostic bloody extravasation) ; at others, the bony tissue is the seat of
numerous hemorrhagic centers and of crushing inwards if the trauma has
taken place on an epiphysis ; the marrow itself may be the seat of a true
bloody infiltration ; and again the contusion upon one face of the bone
may produce in some cases a chipping off or a fissure of the opposite
face. The traumatic center not communicating with the exterior, the
interested tissues are in favorable condition for cicatrization ; oftener,
exudates resorb regularly; after two or three weeks there remains noth-
ing of those alterations.

For slight contusions which have been received on an exposed or
badly protected bone, the animal should be left some time at rest.
Douches or slight revulsive frictions (camphorated alcohol, charge of
Lebas) favor the repair. With severe contusion, a severe lameness is mani-
fested immediately, or in the following few days ; an oedemaious swelling
appears, which may involve the bony structure ; there may occur high febrile
reaction. Often it is difficult to say if there is a simple contusion or a
split of the bone. Experience for many years has taught that these
traumas are frequently complicated with fractures ; and it is not ordinarily
in the first days that they occur, but only after several weeks, when
rarefying osteitis has diminished the resistance of the bone ; these fractures
then have for determining cause either muscular contraction while at work,
or some effort made by the animal, specially in getting up. Therefore, rest
is again the first indication of treatment for violent contusions of the various
Lony levers. It is prudent, in serious cases, to place the animal in slings,
to avoid his lying down and the efforts necessary to get up. The in-
flammatory phenomena may be treated with cold applications (douches^
412



WOUNDS. 415

■white lotion compresses, alum water) ; but generally a blistering preparation
is applied over the seat of the injury and extending some distance round it.
This has several advantages ; it hastens the steps of the bony inflammation,
and by the pains it gives rise to, it insures the immobility of the leg ;
besides deciding the owner to grant his horse a iiseful rest in seeing the
swelling and the effects produced by the blister. After ten or twelve days, if
lameness remains, the blister is renewed. Return to work ought not to
take place before five or six weeks after the accident, when, by the
repairing osteitis, the bone has recuperated part of its solidity. Often, at a
later epoch, a diffused exostosis develops at the point of the contusion ;
if it reaches large dimensions or produces lameness, alterative applica-
tions (red ointment, bichromate of potass ointment) or cauterization are
indicated.

II.

WOUNDS.

In pricks, generally the point lacerates the periosteum, slides over the
surface of the bone or breaks off ; the spongy tissue may be penetrated
quite deep. Sharp instruments injure bones in various thickness ; in
small animals, the section is sometimes complete, there is a true fracture.
Bruised wotmds (kicks, crushings) are the most frequent.

Made aseptic, bony wounds repair regularly ; even when the perios-
teum has been largely involved, the bone becomes covered with granu-
lations, there is not the slightest formation of necrosis. Minute dis-
infection is then essential. Sublimate ( i p. 1000), phenic acid or cresyl
(4-5 p. 100) used in irrigations, baths or sprays, clean the traumatic
center ; wadded dressing, phenicated or iodoformed vaseline, then pro-
tect the tissues against external germs.

If the wound suppurates, sometimes the pus collects between the
periosteum and the bone (sub-periostic abscess of Chassaignac), or the
periosteum is destroyed upon a wide surface. Free incisions, drainage,
washings, will prevent the retention of the jdus, its putrefying in the
bottom of wounds, and will protect against serious alterations. A superficial
and limited necrosis does not constitute a great complication : the work
of elimination goes ordinarily in a regular way and the wound, once
free of the foreign body, is soon filled by granulations. (See Necrosis.)
Suppurative traumatic osteo-myelitis gives rise to a large swelling of the
region and to high febrile reaction. It may rapidly extend to the totality
of the bone, and become complicated with septicemia or purulent
infection. (See Caries.)

In the treatment of contused wounds of bones, as in that of contusions.



414 VETERINARY SURGICAL THERAPEUTICS.

one must count with the rarefaction, the fragility of the injured organ.
Long rest and sometimes the use of sUngs are indispensable to prevent
consecutive fractures.

III.

FRACTURES.

Solutions of continuity of bones have extremely varying characters,
which have permitted numerous divisions of their lesions. From the thera-
peutic point of view, it is specially important to recognize : ist, incomplete
fractures, in which only a part of the thickness of the bone is involved,
and complete fractures, in which the dieresis is complete; 2d, close f 7-ac-
/z^r^j without solutions of continuity of the soft tissues surrounding the
traumatic center; and 3d, open fractures, with wound, exposing this center
to infectious complications.

A. — Incomplete Fractures.

Among incomplete fractures are counted : flexures, or bendings, partial,
fractures, fissures and interperios teal fractures. In (^^//^//Vz^j-, specially fre-
quent in yoimg animals, there is either no solution of continuity of the
bone, or it is injured m part of its continuity, " as happens in green
wood, which on being bent breaks only on the convexity of the bend-
ing, and remams continued in the concavity, where stretching of the
fibres has been less" (Bouley). Partial fractures or with splinters
are characterized by the separation, from the body of the bone, of a
piece more or less voluminous. To this are added the driving-in, the
furrows or perforation made by projectiles. Most generally incomplete
fractures are constituted by transversal, longitudinal or oblique fissures.
The tibia, radius, metacarpus are, on account of their being subcutaneous,
the most frequently injured. Whenever a violent traumatism has been
applied upon a subcutaneous bony surface, a split must always be feared
and treated as if it existed. The swelling of the region and the excessive
lameness imply always serious lesions, exposing to complete fracture. As
we have said, with rare exceptions, it is not in the first days that it takes
place ; the pain prevents the animal from resting on his leg or making
any efforts, and the bone has not yet undergone the changes resulting
from its inflammation. The fracture occurs most generally after several
weeks or in the course of the second month following the accident.
In a case related by Bouley, the tibia broke two months after the injury.