.obtained.

The severity of traumatic lesions of articulations is, in general, in pro-
portion to the functional importance of those organs. However, the
dimensions of the wound, its location on the anterior, posterior or
lateral face of the joint, the extent of the peri- and intra-articular lesions,
have much influence upon this severity.

The researches of Rigot and of Goubaux have shown that articular,
like tendinous, synovial sheaths are at times divided by partitions in
several lodges, a fact which explains the localization of the infectious
process to one part of the synovial, and the rapid recovery of some
articular wounds and some recent arthritis.

It has been said that articular lesions of the hind legs were ordinarily
more serious than those of the anterior ; but the real differences ob-
served on this point are more due to the anatomical complexity as well
as to the more or less active function of the joints. A deep wound
which involves a thick layer of peri-articular tissues is ordinarily more
serious than the simple wound of a cul-de-sac. A wounding body which
opens a joint, making in "the tissues that cover it a wound oblique
downwards and inwards, gives rise to a more compromising injury, more
exposed to intra-articular complications, than if it runs through the
tissues in an inverse direction. We cannot insist too much on this
point : what creates the danger, is the infection ; those are all the con-
ditions likely to produce it or favor it.

In the presence of an articulation which has just been opened, is it
proper, by probing, to explore the wound to precise the diagnosis or
recognize the exact condition of the alterations ? To-day, in human
surgery, says Ch. Nelaton, " the exploration with an aseptic probe, or,
better, with the finger, after enlarging the wound, is absolutely indi-
cated." For our' patients, on account of the circumstances in which we
are to realize asepsy, this practice would be dangerous. Although the
synovial flow is not characteristic of the opening of the articulation — as
it may result from a wound of the tendinous sheath — probing must be
excluded. Nothing is more dangerous than to enter joints with dirty or
suspicious probes, and explorations with an aseptic instrument which



526 VETERINARY SURGICAL THERAPEUTICS.

passes along the walls of a wound, made accidentally, is not always
harmless ; the instrument may become infected in passing through the
wound and inoculate the synovial. It is best to act as if the wound
was of the most serious nature. How many times the curiosity of the
practitioner has had for consequence the inflammation of a joint, which
could, otherwise, have remained closed.

The therapeutics of articular wounds and of traumatic arthritis has
varied much with all epochs. In pre-antiseptic times, the great severity
of those wounds has suggested against them the trial of the whole .
medico- chirurgical arsenal. Most varying preparations have in turn
been advocated and thrown aside.

Old farriers were already divided on the question of the treat-
ment of wounds of joints. Some, with Solleysel, used cauterization ;
others, with Garsault, recommended emollients.

In the years that followed the publication of the first veterinary
journals, the physiological doctrine was at its best. To prevent or
overcome inflammation, abundant bleedings were resorted to, and the
patient submitted to severe diets ; the diseased joints were covered
with decoctions of marshmallow, flax seed, or populeum ; simple poultices,
or those associated with narcotics, were used. The wounds them-
selves were dressed with tincture of aloes, diluted alcohol, camphor-
ated paste. The advocates of the antiphlogistic method published
their results, and Corroy, Auboyer, Pre'tot, made comments on the
" lucky series."

For Lecoq, the inflammatory symptoms ought to be treated first by
emollients, then the joint be immobilized and'the wound dressed with a
compressive bandage. He said : " I am inclined to consider the mech-
anism of the cicatrization of synovial membranes as analogous to that
which closes blood-vessels when their coats have been divided ; a por-
tion of the blood coagulates in the opening, adheres to its borders, and
in organizing, ends by becoming part of the divided coats. Com-
pression, assisting the formation and the sojourn of the clot, must neces-
sarily hasten the time of the cicatrization." ^ If antiphlogistic methods
succeeded sometimes, the failures were numerous, and soon were used as
objections to it (Renault, Tisserant) ; and again cases of spontaneous
recoveries were recorded, in which nature had done all the work. Still,
for a long time, poultices were kept in use. They reduce the pain, and
were supposed to " prevent inflammation." We know to-day that their
hot and moist atmosphere is, on the contrary, most favorable to py-
ogenous microbes and to infection.

As early as the beginning of this century, English veterinarians

' Lecoq: Rec. de Med. Vet., 1S33, p. 416.



WOUNDS. 527

advocated cauterization of the external opening of the fistula, so as to
produce a scab, preventing the flow of synovia, and assisting the cica-
trization of the wound. This treatment was tried in France. Mercier
and Desmoulieres did not hesitate, when treating at the beginning of
the disease or in full period of inflammation, to thrust into the fistula
an iron heated white. The results seemed encouraging. The observa-
tions of Pauleau, Gerard, Pigeaire, Dubois, Faure, Eisele, had a tend-
ency to show that deep and repeated cauterization could bring on
recovery in cases where other treatments had failed. Renault called
this method " rash and irrational " ; he admitted it only in extreme
cases. The use of the red iron upon articular wounds gave rise to a
disinfecting action which, in some cases, might be beneficial ; but it was
rightly set aside for methods less incendiary.

Tisserant remarked that emollients and cauterization of the fistulas
gave only incomplete results. " There remain swellings of the diseased
joint, indurations of the skin or of soft parts, enlargements of the
articular extremities, often even exostosis. Against these, alteratives,
resolutives, actual cautery, etc., are used, and the treatment is pro-
longed beyond any expectation."^ The author recommended to abate
the" inflammation by emollients, then to use blisters in repeated frictions
round the joint. Instead of this last, pointed (Renault, Lecoq) or
line cauterization could be used. Sometimes ten or fifteen days after
the application of the blisters the animal could resume work. As de-
rivatives, numerous preparations and agents have been proposed, from
the most complicated topics to the simple sinapism. In a case of
articular wound of the hock, Saussol, after a twisted suture, applied all
over the joint " a coat of mustard diluted in vinegar ; twenty days
after the animal resumed his work." Some authors attached great im-
portance to internal treatment. Tartar emetic was much recommended ;
Reboul advocated it as late as 1845.

So as to obtain the closing of the synovial wound, every substance,
which, by virtue of its chemical properties, was able to coagulate albu-
men, was tried in turn. Burnt alum (Lecoq), alcohol and tincture of
aloes, Rabel solution (Mercier), tannin (Causse), salts of lead (Mazzino),
and sulphate of copper have been used with more or less success ; but
it is no doubt sublimate corrosive that has the largest number of advo-
cates. In a few years it supplanted all its rivals. Recommended by
St. Cyr, then Dubois, Ollivier, Pierre, Dyer, Delorme, Romant, Payan,
from the first days that it was used, it became acknowledged as one of
the most efficacious drugs in the treatment of articular wounds. In a

1 Tisserant: Journ. des Veter. du Midi, 1845, p. 145.



528 VETERINARY SURGICAL THERAPEUTICS.

superficial joint a pitched or turpentine pad was dusted over it, applied
on the wound, where it was kept by bandages or adhesive strips. Some-
times the synovial flow would stop, and when the dressing was taken off,
after eight days, " the bottom of the wound was covered with a firm scab
and recovery insured." If the obliteration was not complete a new plaster
was reapplied. With deep wounds the fistulous tract was generally
enlarged, as Schaack and Delorme did, and a lint, covered with the caus-
tic, introduced in the fistula. Several authors, in particular Rey, have
added blisters to that treatment. They were applied round the whole
surface of the joint, with application of the sublimate over the wound.

Barthe has tried to substitute nitrate of silver to sublimate. Bichloride
of mercury sometimes acts too strongly and gives rise to slough of a
large eschar, which increases the size of the wound, while nitrate of
silver, less active, easier to handle, gives rise to a scab, rapidly elim-
inated, without increase in the size of the external wound. Its use is
very simple. The pencil is introduced in the fistula, where it melts
slowly. It is good with large wounds to move it about to insure its
action upon every part of the penetrating wound. Its application can
be renewed several times, and at the same time the application of a blister
can be resorted to.

Collodion, simple or with sublimate, has been recommended, some
twenty years ago, to obtain the closing of the wound. Michotte, having
a deep wound of the stifle to treat, used first cool applications. The
second day four grammes of sublimate were dissolved in thirty of collo-
dion and applied in successive layers over the wound until formation of
a stiff scab. Nine days after this was removed ; the wound was closed.
Degive has also used the sublimated collodion with great success.

Cold water has been recommended early, and is yet to-day used in
large animals. Guilmot, Duvieusart,Sepulchre, Barreau, Sinoir, Causse,
Eloire and many others have published observations in relation to the
happy results they have obtained. For Trasbot (Archives 1877), " cold
irrigations constitute the treatment par excellence of articular wounds."
The flow in sheath is better than the strong current or the irrigation. As
much as possible, the water shall have a temperature of 12 to 15 degrees.
However, irrigation mu.^t not be left off, only when the temperature of
the water is in the neighborhood of zero. When irrigation was experi-
mented with at Alfort, students were made to apply it, changing every
hour, night and day, and constantly showering the diseased part with a
tube attached to a bucket placed full of water above the patient (Bouley).
In the case of Barreau " irrigation was done by six men, alternatively
pouring water over the wound with a syringe.'" Such methods had the

^Barreau : Journ. de Med. Vet. Milit.,1862, p. 18.



WOUNDS. 529>

inconvenience to require too many assistants to apply it. They were
not practicable.

Irrigating apparatus have simplified the method. A reservoir, placed
at 2.50m. from the ground, is fed with a watering pipe ; at its bottom a
metallic cork is adjusted, provided with a rubber tube, of various lengths,
and 7 to 8 millimeters in diameter. According to the cases, the free
end of this tube is introduced in the wound, or its terminal extremity,
perforated with holes made in its length, is twisted round the leg, above
the diseased joint. The metallic cork may have two beaks and carry
two tubes ; one to go round the joint, the other in the cavity. An ap-
paratus for irrigation can be arranged anywhere by using a tub, a barrel or
3.resQvvou ad hoc. As with many practitioners, continued irrigation has
given us remarkable results. We have seen an enormous articular wound
of the left hind fetlock, made by a ploughshare, healed in a month-
The wound and the synovial were irrigated with a tepid solution of
cresyl, 3 p. 100; for a few hours the articulation was enveloped with
antiseptic compresses, then submitted to a constant stream of cold
water. In five weeks recovery was perfect. A mare treated by Mauri
had a contused wound of the anterior face of the left fore fetlock, with
open joint ; after nine days the irrigation was stopped. " The synovial
flow had stopped, the articular fistula was closed, and the wound entirely
•covered with firm and healthy granulations."

About i860, ^gyptiacum ointment, recommended by Verrier,^ became
■" the favorite drug." In the treatment of articular wounds, this author
\ised first bleeding, diets, poultices, emollients, soothing lotions. The
pain reduced, he enlarged the fistula so as to be able to introduce his
finger into it, and with it several times a day he pushed in it a certain
•quantity of ointment, pure or diluted in oil. With this treatment, says
Verrier, pains subside rapidly, standing improves, fistula contracts, syn-
ovial flow becomes less abundant. Often after eight or ten days the
fistula is cicatrized and the joint has recovered the complete freedom
of its movements. Benjamin, Robert, Foelen, Royer, Salle, published
good results obtained with it, and notwithstanding the failures of Raulet,
Causse, Barreau, ^gyptiacum is classified amongst the best remedies.

Glycerine, used alone or with blisters, and continued irrigation has
been recommended by Aureggio. Injected in the fistula, " it shortens
the period of congestion and the articular inflammation ; " it has given
a number of successes "in desperate cases."'' But many practitioners
have failed to find in it a superiority over the preceding methods.

Camphor, quite in use some time ago in the treatment of articular

1 Verrier: Bullet, de la Soc. Cent, de Med. Vet., 1858, p. 1042.

2 Aureggio: Bullet, de la Soc. Cent, de Med. Vet., 1878. p. 290.



530 VETERINARY SURGICAL THERAPEUTICS.

wounds and then ignored, is yet employed in Belgium, in connection
with antisepsy.

Here is the therapeutic technic used by Hebrant, which gave him 95
p. 100 of recoveries :

Immediately after the accident, the injured region, after being well
cleansed, is soaked in bran water. It is then disinfected in the most
complete manner with phenicated water 5 p. 100, or Van Swieten solution,
and then covered with a coat of camphor ointment (camphor and lard
a. a.).

" The horse is kept by himself, in a narrow stall, and submitted to a
proper diet and nitrated drinks. The ointment is applied four or five
times a day. After the first three days the strength of the ointment is
reduced — i part of camphor for 2 of lard, i for 3, i for 4. The horse is
not taken out of the stable as long as the treatment lasts. The great quan-
tity of camphor spread over the whole region produces a continuous cool-
ness, which prevents the inflammation of the joint ; the second or third
day the region is swollen, the albumen of the synovia is coagulated, gran-
Talations are stimulated, the fistula is soon obliterated. Besides this, cam-
phor has antiseptic properties, that we re-enforce by the addition of phenic
acid in the proportion of 5 p. 100."

This, it seems to us, is an antiseptic method in which camphor does
not play the principal part. To clean and disinfect the region with
phenicated water at 5 p. 100, or with Van Swieten lotion, this is well ;
but iodoform in powder, or iodoformed vaseline, would give just as good
results, at least, as camphorated ointment.

Among the treatments recommended of late, let us mention the
envelopment of the region and the closing of the wound with a rubber
roller (Petzold), with "clay" (Hoffmann), and the injection in the wound
of an alcoholic tannic solution (Vigezzi).

By this examination of the history of the therapeutics of articular
wounds, it is seen that recoveries have been obtained with most varied
means. But if comparison could be made between the successes and
the numerous failures, the result would be of the darkest. Whatever
has been said, most of those treatments would be powerless against
penetrating traumas, if infected in their depth.

The notions given by the pathogeny of the complications to which
wounds are exposed impose the abandonment of the old methods for
antisepsy. This must dominate the treatment of articular wounds.

Pricks of articulations, in general, are less severe than large wounds,
or those with loss of substance. Made under given rules, they
are harmless. We will see that hydarthrosis can be punctured witk
trocar with most complete impunity ; but for that we used instruments^



WOUNDS. 531

of small size, clean and aseptic. It has been advised to enlarge the
-wound, to open the synovial freely, to asepticize the articular cavity ; such
interference seems to us harsh in animals, where the purification of the
joint is always very difficult. We are satisfied with the disinfection of
the trauma and its occlusion with a dressing or a collodion covering.
Let us mention the observation of Michotte, relating to a wound of the
stifle joint, which was in this manner covered with several coats of col-
lodion and healed in a few days. The application of a sublimated
plaster, after disinfection of the prick, and a peri-articular blistering
friction, form a treatment deserving keeping ; the bichloride of mercury,
deposited near the synovial wound, acts on it by its germicide action ;
the blister brings on immobilization. The success obtained by Rey ,
Dyer, Delorme, has shown the value of this process. The essential is
not to enclose infectious elements. Before being " barred," the wound
must be carefully disinfected. As remarked Tisserant already in 1845,
if obliteration is efficacious, " it is with the condition that the synovia
shall remain identical to itself ; it is that the fluid, prevented from
flowing by the clot, shall be, as the blood, normal and compatible
with the regularity of the function; it is, at last, that no cause, external
or internal, shall have modified the synovial secretion in its quality,
so that the wound can be repaired regularly." '

To prevent the infection of the synovial, or to purify it in its soiled
part and protect it afterwards from the germs: such is for large wounds ;
as for pricks, what must be realized ? A careful antisepsy of the trauma^
by a free irrigation, shall be made ; by collodion covering and several
bands of gauze, it will be protected, after being dusted with iodoform \
then the region shall be immobilized in wrapping it with a wadded
apparatus, with or without plastered rollers, or again by a blistering
friction (blister, bi-iodide of mercury ointment, alcoholic solution of
sublimate i to 10). When the region does not permit the application
of a dressing, blisters are used, specially with advantage for narrow
articular wounds. The " derivative " action attributed to them is falla-
cious, almost null in its " useful " effects ; but it can have a most bene-
ficial influence in producing immobilization and closing of the wound.

When the wound is very large, it can be reduced by a few stitches
made towards its superior angle ; for some joints, drain tubes must be
applied. With our wounded animals, total suture is dangerous ; if the
asepsy of the superficial layers is not thorough, infected fluids spread tr>
the synovial. It has succeeded, however, in many instances, Saussol
has obtained a success by the twisted suture.

1 Tisserant: Loco citate, p. I14.



532 VETERINARY SURGICAL THERAPEUTICS.

One of us has related a case of rapid recovery by antisepsy, of a very-
serious wound of a hind fetlock. On the external face of this region,
there existed a straight solution of continuity, lo centimeters long; the
metacarpo-phalangeal synovial was widely open between the large
sesamoids and the inferior extremity of the principal metatarsal. In
separating the borders of the wound, we could see in front the metatar-
sal and phalangeal articular surface's, and behind the anterior one of the
great sesamoids. The peri-traumatic surface and the wound were
disinfected, irrigated with Van Swieten solution, and an iodoform wadded
dressing applied. This was removed seven days after ; under the gauze
was found only a little reddish serosity ; the synovial was closed and
the tissues covered with granulations. A new drjessing was applied. A
month after, the wound was all healed. Treated with minute antisepsy,
articular wounds would have no other march, if their purification could
always be made perfect.

Sometimes the wound is complicated with fracture of the articular
extremities. Small splinters would not necessarily produce the fatal
loss of a joint ; but there is always advantage to destroy the patient.
Resections and amputations are not admissible in our therapeutics. The
■cow with wooden leg which illustrates the cover of the Surgery of Hoff-
mann will not tempt practitioners, and still less owners of animals.
These operations shall be reserved for small animals. Conservative
surgery is always to be preferred. By well directed antisepsy, dressings
■well applied, septic accidents shall be conquered. Ankylosis is always
better than amputation, on account of the accidents this last is exposed
to, and the great difficulty presented by orthopedy in veterinary surgery.
The gazelle amputated by Laligant for a metatarso-phalangeal arthritis,
which died from the operation; would have lived with an ankylosed leg,
if frequent cleansing injections had only been used.

It remains for us to say a few words as to immobilization. Almost all
authors have considered rest of the joint as a very favorable condition
to the repair of the wound, and have advised it as much as it is possible.
In 1873 Degive expressed doubts upon its efficacy. It was known that
horses suffering with traumatic arthritis of the knee had perfectly
recovered, although they were obliged to travel some distance (Servoles).
In various cases, where immobilization had been neglected, recovery
had taken place as rapidly as when the leg had been kept at rest.
Degive asked himself, " if immobilization was really useful or prefer-
able to free motion, to moderate mobility of the articular levers." For
Maris, " immobilization is always useless in articular wounds, the animal
fulfilling this indication himself." Laho and Thiernesse, on the contrary,
continue to believe that this immobilization is one of the principal con-



TRAUMATIC ARTHRITIS. 533

ditions of success, and the great majority of authors are of the same
opinion.

To reduce inflammatory phenomena to their minimum, the patient
should be placed in slings, unless he is too irritable. For lower articu-
lations of the legs, wadded dressing gives a sufficient immobilization ;
for the others, blistering should be used.

Immobilization must not be kept too long ; one must take into con-
sideration the stiffness of the joint and the peri-articular amyotrophies.
As soon as the synovial wound is closed and pain is gone, massage and
moderate exercise are the therapeutics of convalescence.

As remarked by Tisserant, often recovery is not complete ; there
remain lesions which necessitate the application of firing. With an-
tisepsy, these consecutive alleviations are less frequent at present.

We have had particularly in view the treatment of articular wounds of
horses. For cattce and small animals, the indications are the same. In
dogs, tepid repeated antiseptic baths have given us the best results ia
cases of wounds of articulations of the extremities.

V.

TRAUMATIC ARTHRITIS.

With soiled articular wounds in general, already the third, fourth or
lifth day, the infection has spread into the joint : traumatic arthritis
exists.

The swollen, very painful, articulation is held in the position most
favorable to the relief of its structure. If it be on a leg, the standing
takes place on the toe ; there are frequent convulsive movements of the
leg indicating lancinating pains ; a warm, oedematous swelling in-
vades the surrounding regions or the whole leg ; there is an abundant
flow of synovia scarcely of suspicious aspect or already purulent.

As the infection process spreads, the symptoms are more marked :
the most limited motions of the joint give rise to acute pains, that the
animal avoids in remaining immobile, standing on its place or con-
stantly lying down. Soon the swelling has become enormous. Through
the fistula the escaping synovia is purulent, loaded with yellowish-white
clots, exhaling a foetid odor. Fever is high,- the temperature going up to
or above 40*'. The loss of flesh is more and more marked ; eschars,
due to the long decubitus, appear on the prominent parts of the body.
When the subjects resist, the articular cartilages are destroyed and the
joint ankyloses. But this termination is not fatal ; by an energetic