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American Veterinary Medical Association.

Proceedings of the American Veterinary Medical Association, Volume 49 online

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sides to avoid any chances of subsequent roaring on the left side. There
is very little bleeding under these conditions as compared with the
recumbent position, and you will observe how little physical or nervous
strain this operation causes. The danger of casting is entirely obviated
and the horse has been hurt less than she would have been by being
cast and then having to be let up.
We injected cocain subcutaneously and in the larynx.

Case 6. — Bay stallion with double scrotal hernia. Operators,
W. A. Axby and J. W. Blattenberg.

History — very obscure, animal shipped in from northern Indiana for
operation. (Cannibis indica, fluid extract, two drachms is given intraven-



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600 The Clinic.

ously.) Animal securely confined on the floor of amphitheatre.

W. A. AxBY : The field is prepared in accordance with modem antisep-
tic precautions.

On examination the scrotal Region presented a decided indurated, condi-
tion of both the dartous and subcutaneous structures. An ample incision
is made extending down to the tunica vaginalis, which is firmly adher-
ent to the surrounding structure. The tunica is very thin, containingr a
loop of intestines of considerable length and freed by blunt dissection
from surrounding structures up to the internal abdominal ring where an
incision through it discloses an atrophied testicle. The hernia is reduced,
tunica containing testicle and cord twisted and covered operation is com-
pleted.

A ligature of catgut is used passing it through and several times around
these structures and then securely tied. Now the dependent parts are
removed two inches below the ligature with the emasculator and the
wound irrigated with sterile water, dried, packed with bichlorid gauze,
the whole retained by two cutaneous sutures.

After proceeding with the same technique on the opposite side the
animal is assisted to consciousness by applying to the nostrils aqua am-
moniae on a sponge and is helped to' his feet in good shape.

After care : Animal to be kq)t in clean surroundings, prophylactic dose
of three-thousand units of antitetanic serum administered. The gauze
to be removed ift thirty-six hours and thereafter the lips of the woimd to
be cleansed daily with sterile water. Gentle exercise after the third day
is recommended.

Prognosis : Favorable.

Case 7. — Bay gelding. Operation for quitter. Operator, Dr.
W. L. Williams, Ithaca, New York. ^

Dr. W. L. Williams: We have been asked to operate upon this horse
for quittor or necrosis of the lateral cartilage. The quittor operation is
performed in a great variety of ways, one essential feature being disin-
fection. As the lateral cartilage is a pure h3raline cartilage, when it once
becomes diseased it heals very stubbornly and consequently in cases which
have proven refractory to the ordinary methods of handling I prefer to
operate by what is known as the Bayer operation.

Fundamentally, of course, the foot needs to be cleaned, pared down
and an antiseptic pack placed upon it for twenty-four hours. I assume
that you are all familiar with the Bayer operation and also know that
there are several types of quittor operation. Each operator has his
own method and hence the Bayer's operation is performed with slight
differences by each individual.

(The operation was then performed and after its completion the animal
was released and walked to its stall without difficulty.)

Dr. W. L. Williams: In removing the horn over the lateral cartilage
in this animal the laminae were found very badly diseased and indeed,
absolutely destroyed over a large area. The coronary band was also so
badly diseased that it had to be cut away in order to get the parts clean
and the lateral cartilage was found to have nearly all disappeared on



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The Clinic. 601

account of necrosis; one piece, however, of a green color, was lying prac-
tically loose, while another piece was necrotic and attached to the con-
nective tissue adjacent to it

The case gives good promise of a fair recovery, but there will be con-
siderable blemish at the coronary band. The dressing has been applied
to prevent the wound from suffering physical injury during the healing
period; it is thoroughly covered, packed and on the outside is an im-
permeable, tarred bandage, so that the horse in stepping into any kind
of filth will suffer no harm through infection unless infected matter is
dropped down between the bandage and the leg from above. If the
horse is comfortable and free from pain the bandage is allowed to remain
on for ten or twelve days.

Case 8. — Resection of ligamentum nuchae for poll-evil. Opera-
tor, W. A. Axby, Harrison, OhioT

Horse confined on table and general anesthesia of chloroform adminis-
tered.

Dr. W. a. Axby: This is a chronic condition observed over fourteen
months ago, but no radical operation has thus far been performed.

After proper preparation of the field by shaving, scrubbing and the ap-
plication of tincture of iodin an incision ten inches in length is made
one-half inch from median line on the left side and extending from the
occipital crest backward over the cervical region; disclosing the bursae
filled with fiocculent pus and shreds of degenerating ligament. There is
a great amount of fibrous structure which will be removed together with
the diseased portion of the ligamentum nuchae by making an initial trans-
verse incision posteriorly and then dissecting it free from its anterior at-
tachment. Drainage will be afforded at the cut end of the ligament 6y
a perpendicular incision ; hemorrhage arrested by ligation, torsion or actual
cautery and the wound carefully packed with sterile gauze, retained by
deep sutures.

After treatment : Gauze to be removed in thirty-six hours and wound
daily irrigated with normal salt solution, dried thoroughly and* cavity filled
with acetanilid or boric acid. Should further necrosis of the ligament
appear such portions must be surgically removed and diligent care exer-
cised to insure drainage. The animal to be fed from the ground. Appro-
priate internal treatment is advised.

Prognosis : Favorable.

Case p. — Bay stallion. Operation for ridgeling. Operator, Dr.
J. H. Blattenberg, Lima, Ohio.

(The animal was cast on the floor of the amphitheatre and bound, the
operator making an incision into the abdominal cavity removing the testis
without making the hole through abdominal wall much larger than the
testis itself; this was accomplished by breaking through with two fingers
and getting hold of the epididymis.)

Dr. J. H. Blattenberg : I have never found the omentum because orig-
inally there is no canal fo^; the omentum to get down. I do not break



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602 Th£ Clinic,

through except with two fingers and do not allow anything to come out
except something relative to the testicle. Following the operation I have
the animal tied up for thirty-six hours. If the testicle is fair sized you
must necessarily make an opening into abdomen accordingly and have
a care not to allow the intestines to come out, often prompted by allow-
ing the animal to lie down. We use no anesthetic but it would be more
humane to do so. We consider, however, that the operation is no more
severe than ordinary castration.

Case 10. Black mare. Operation of supra-carpal tenotomy.
Operator, Dr. L. A. Merillat, Chicago, Illinois.

Dr. L. a. Merillat: The subject here is a five-year-old mare af-
flicted with "break knees," slightly jvorse on the off leg but affected on
both sides. The condition presented is a joint deformity, a disease be-,
longing to the group of deformities which are of articular origin; the
knee being the articulation affected. Yesterday you had the pleasure of
witnessing a similar operation by Dr. Adams on a deformation in the
plantar region on a very young colt, wherein the disease or pain resulted
in a contracture of the sessamoidean ligaments and of the flexor tendons.
Here is a similar condition affecting the carpal bones. The pain of
synovial or ligamentous inflammation causes the joint here to be held in
a state of flexion, and to accommodate the new position the tendinous
structure has become shortened.

The one thing to remember in regard to such a deformation is that
the tendon is not initially the seat of the disease. I think veterinarians
sometimes make mistakes through misinterpreting this condition. The
fact that a tendon is shortened is very often thought to be the cause
of the deformity, when in reality the tendon is perfectly normal ; its struc-
ture is absolutely normal; it is only defective in length, and the length
has been abbreviated to accommodate itself to the new angle at which the
joint was forced by the disease.

On examination of the knee we find here well pronounced carpitis.
It is not very difficult to decide that this carpus is affected with an
exostosis in the lower row. of carpal bones and that the exostosis is re-
sponsible for the condition.

The operation we are going to perform to correct this deformity is
known as carpal tenotomy. It consists of a division of the tendons,
attached to the trapezium; the external, the middle and a part of the
internal flexor of the carpus ; the muscles which occupy the posterior anti-
brachial region, which become tendinous about an inch above the trape-
zium bone and attach themselves to it. If the knee shortens or changes
position or flexes through disease, this tendon contracts and holds the
knee from falling back into its normal position.

It is important in performing this operation to clean and carefully dis-
infect the part in order to positively forestall infection. This tenotomy
is not such a very easy one to perform because there is no very dis-
tinct line of division between the muscles to be cut and those to be
avoided, and the superior carpal blood vessels located in this regrion



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The Clinic. 603

sometimes, if there is carelessness in the division, causes a. profuse bleed-
ing; moreover, the knife might also be carelessly plunged into the supe-
rior sac of the carpal sheath and cause serious s3movitis. The sac lies
just under the area to be operated on. «

An operating table is a much better means of restraint, for any opera-
tion that requires pulling on the leg is always difficult on account of the
fact that the horse's body will revolve from the traction required to hold
the leg in position. A bichlorid pack was applied yesterday to the opera-
tive area and aseptic precautions are quite important for we know that
it is not possible to avoid interfering somewhat with the venous circula-
tion; that possibly a synovial sac might be wounded and that blood will
fill the space between the cut ends.

' We are using a weak solution of cocain with a little adrenalin as a
combined anesthetic and hemostatic but one cannot very efficaciously co-
cainize such a field because the incision is through very hard structures
and besides it would be impossible to deposit the solution at every point
the knife will touch; it is helpful, however, for the cutaneous incision.
As Dr. Adams said yesterday the tenotome most desirable in this work
has a slightly curved and very short cutting surface, to facilitate cutting
off the tendons little by little without enlarging the skin wound, such
an instrument I would prefer to this one. It is also very important in
this as well as in all tenotomy operations to produce effectual results to
have the patient pretty well anesthetized, for if the patient is perfectly
quiet there is no interference in the division of the tendon otherwise
occasioned by the constant jerking of the leg.

The seat of operation is about an inch above the trapezium. The ex-
ternal tendon attached to the trapezium is the external flexor of the
carpus, the large one is the middle flexor; the one on the inside is the
internal flexor ; they are, of course, closely related in- this region and
there is no distinct line of demarcation between them to be seen in the
living subject, although, of course, easily separable in the dissecting room.
The knife is j?uided straight forward for a short distance and then
direfcted to the internal face of the leg. When the knife is felt under the
skin at the inside of the leg it is turned against the tendon, which is
then divided subcutaneously.

If the leg is not yet straightened because we have not touched the
external tendon, both sides should be divided without removing the knife
unless the horse is not quiet enough to carry out that plan. One must
be careful, of course, not to cut deep enough to divide the perforatus.

If one fears the tendons are not entirely cut off, it is important to
press the fingers into the space to determine if the skin is compressible
all around the field.

(The operation was completed and the horse allowed to stand.)
The after-care of such operation consists largely of putting the leg in
some form of brace to keep it straight. In this case the incision in^ the
skin is larger than necessary and is caused by the long blade and the
lack of general anesthesia. When the horse first gets up his leg will be
straighter than it was before, but if you watch him half an hour after-
wards in the stall, you will find it in the old position again on account



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604 The Clinic.

of the fact that he finds the most comfort in the flexed position, so iir
order to complete the work it will be necessary to force the leg into a
straight position for a period of three or four weeks by the application
of a brace, or a cast. The horse should be given sufficient rest to enable
the initial lesion to cure. Blistering and rest in the country at pasture is
very desirable.

You will now. notice that the leg has taken a pretty normal position. It
it a better leg than the opposite one. There would be no harm in operat-
ing on two legs at the same operating period if one were sure there
would be no complications. If one should get an abscess after the opera-
tion on both legs the patient having no leg to support his weight would
be in a bad way. A unilateral complication would be less serious.

Case II. — Black mare. Shortened tendon. Operator. Dr. L.
A. Merillat, Chicago, Illinois.

Dr. Merillat explained that this condition was due to inflammation of
the carpal joint. The pain of synovial inflammation, or of ligamentous
inflammation, had caused the joint to be held in a state of flexion, and
to accommodate the new position, the tendinous structure had shortened.

Dr. L. a. Merillat : The operation we are going to perform to correct
this condition is known as carpal tenotomy. (Operation proceeded with.)
The position is better than tlie opposite leg, but you will notice half an
hour from now, in the stall, that the animal will find the same old posi-
tion, and the application of a brace will be necessary to effect a cure.

Case 12. — Bay gelding. Operation for roarer. Operator, Dr.
L. A. Merillat, Chicago, Illinois.

(The animal was thrown in the ring by English hobbles and chloro-
formed.)

Dr. L. a. Mkrillat: Here is a horse that probably will not be cured
by this operation. I believe that, judging from the symptoms he displays
in his struggles, he is rather more of a roarer from damage to the trachea
than from the larynx, and that he will continue to be a roarer. This is
more of a clinical case than a practical case. The horse being under
general anesthetic we may be able to give you a better exhibition than
otherwise.

There is an obstacle in the trachea detected by passing a rubber sound
from the laryngeal incision downward to the old scar of the previous
tracheotomy. An attempt to remove the obstruction would give one lots of
trouble. This horse's breath is fetid, probably from a pulmonary necrosis.

(The operation proceeded according to the Williams method and the
mucosa removed by Blattenberg's burr after which the horse was re-
leased, the operation being apparently successful.)

Case 13. — ^^Bay gelding. Operation for kick wound on the inner
aspect of the tibia. Operator, Dr. W. L. Williams, Ithaca, New
York.



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The Clinic. 605

Dr. W. L. WauAMs: This case, as far as wjc understand its history
is the result of a kick wound on the inner aspect of the tibil, and it has
been followed by necrosis with a sequestrum of bone imbedded in the
tibia. In introducing the probe we touch a diseased bone and, more-
over, I find that the fistula, which we saw. discharging pus runs over
behind the tibia, making it necessary to chisel away a part of the postero-
internal border of the bone in order to reach the seat of the trouble. We
have packed the wound with iodoform arid beyond daily disinfection it will
require no special treatment.

Case 14. — Resection of aponeurosis of flexor pedis perforans
tendon. Operator, W. A. Axby, Harrison, Ohio.

History and symptoms : Horse picked up a nail eight days previous, fol-
lowed with excessive lameness. The wound has received ordinary pallia-
tive treatment and the general condition of the animal is extremely bad.
Temperature 106 degfrees Fahrenheit; respiration accelerated with every
indication of general septic infection.

Animal is cast after receiving two drachms of the fluid extract of can-
nabis indica intravenously.

Dr. W. a. Axby: The field must necessarily be scrubbed and cleaned
as these important features have until now been overlooked After re-
moving all keratogenous tissue a transverse incision will be made through
the frog one inch anterior to the bulb of the heel. (Operation proceeded.)
Two incisions are made obliquely forwarded resecting a V shaped portion
of the frog and disclosing an advanced state of tissue necrosis of the plan-
tar bursae and aponeurosis. All possible necrotic tissue is removed, parts
curetted, irrigated and packed with iodoform with gauze. A dry dressing
applied externally consisting of gauze, cotton and oakum and the entire
region thoroughly sealed with application of pine tar. After treatment:
In anticipation of considerable slough, we deem it advisable to dress the
wound daily, as before described. Internal treatment in accordance with
symptoms of general infection.

Prognosis : Unfavorable.

Case 15. — Bay mare. Operation ovariotomy. Operator, Dr. H.
Fulstow, Norwalk, Ohio.

This was an operation for vaginal ovariotomy on a five-year-old marc
with colt, the mare being a nymphomaniac. The animal was high spirited
and difficult to control as there were no stocks and she cast herself two
or three times. She was eventually controlled and the operation per-
formed satisfactorily.

Case 16, — Bay mare. Operation ovariotomy. Operator, Dr. H.
Fulstow, Norwalk, Ohio.

This also was a case of vaginal ovariotomy, this animal being also diffi-
cult to control. One ovary was so covered with peritoneum as to make
it difficult to unravel. Two drachms of cannabis indica were administered
in the jugular vein. The ovaries upon being successfully removed were
found to be badly cystic.



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606 The Clinic.

Case I/. — Bay gelding. Operation for hydrocele. Operator,
George R. White, Nashville, Tennessee.

Dr. George R. Wni-m: This horse was sent here for operation for
scrotal hernia, but we find that it is nothing more nor less than an ordi-
nary "water sac." It is one of comparative infrequent results of castra-
tion of the .horse, but it is a very frequent sequel to castration in the
mule and on that account I want to say a few words about how to pre-
vent this difficulty in mule castration. The presence of a "water sac" in
a mule indicates either ignorance or carelessness on the part of the
operator and reflects as much on the veterinarian's ability as any opera-
tion he can do. It is absolutely essential that we educate qualified veteri-
nary surgeons to avoid leaving a "water bag" or sac and this is by
severing the proper part of the tunica vaginalis. If the mistake is made
of severing the cord in this location invariably will form a "water bag"
in the mule. Always sever the cord in mule castration an inch or an
inch and a half above the tunica vaginalis.

The tincture of iodin is an ideal skin disinfectant for this as for
other operations and it should be used more often than it is. Some
surgeons in removing hydrocele make an eliptical incision but I find a
straight incision is about all that is usually necessary. More or less ad-
hesions are always present as they seem to be the natural consequence of
the hydrocele.

Case i8. — ^Light sorrel gelding. Operation for quittor. Op-
erator, Dr. R. C. Moore, of Kansas City, Missouri, assistant, Dr.
G. H. Roberts, of Indianapolis, Indiana.

This operation, an advanced case of quittor, was performed on an oper-
ating table in the smaller operating room of the college, the animal
having been given two drachms of cannabis indica in the jugular vein
shortly before the operation. It was found* that the hoof had grown up
under the coronary band and the bone ossified, requiring curettement.
Two* incisions for drainage were made and the operation performed suc-
cessfully. The animal afterwards was led to the stall in apparent com-
fort.

Case ip. — Bay gelding. Operation for roaring. Operator, Dr.
J. N. Frost, Ithaca, New York.

It was at first intended to operate on the horse standing in the stall
but the animal proved too excitable and was cast upon the floor of the
amphitheatre.

The William's method was followed and the operation did not differ
from previous operations for roaring performed during the clinic.

Case 20. — Bay mule. Operation arthritis. Operator, Dr. W.
J. McKinney, Brooklyn, New York.

This was a simple operation for arthritis in the shoulder joint per-
formed by puncturing to the condyle of the humerus. Drainage was
established and the enlargement successfully reduced.



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^The Clinic. 607

Case 2J. — Bay mule. Operation removal of fibroid tumor. Op-
erator, Dr. George R. White, Nashville, Tennessee.

This was an operation for removal of an immense fibroid tumor and
sac on the neck of an aged mule, situated above the anterior aspect of
the sternum.

The animal was placed on the operating table two and a half drachms
of cannabis indica injected into the jugular vein. Two lateral incisions
were made close to the base of the tumor, its adhesions were severed
and the tumor which weighed close to twenty pounds was successfully
removed, the wound packed, dressed and sutured, but the animal died
from surgical shock before regaining his feet, this being the only death
in the operating room during the entire course of the clinic of three or
four days.. The immense size and location of the tumor together with the
advanced age and physically weakened condition of the mule were con-
tributing factors to shock and death nn this case.

Case 22, — ^Heifer. Ovariotomy. Operator, Dr. John W. Jame-
son, of Paris, Kentucky.

This was a simple flank operation for ovariotomy in a heifer in calf
and called for no special comment.

Case 2^, — Heifer. Operation ovariotomy. Operator, Dr.
Manly, Dayton, Ohio.

This, also, was a simple case of ovariotomy performed on a heifer,
the only item of interest being the demonstration of the X-stitch by
Dr. J. W. Klotz.

Ca^e 24. — Bay gelding. Operation handling of float. Opera-
tor, Dr. C. C. Brown, Memphis, Tennessee.

This was a demonstration of the handling of the float in the mouth
of a horse tied in the stall.

A split molar tooth was discovered on the right side projecting out
into the mouth. A light pair of forceps w^re used to take out the piece
and the doctor suspicioned that the animal had been injured some time on
the inside of the face.

Dr. Brown rarely ever uses a speculum except where the animal has
a very bad tooth to extract and then it is indicated in order to keep from
injuring the gum when the forceps are set as sometimes happens.

Operation proceeded with and demonstration successful.

Case 25. — Dapple gray gelding. Roarer. Operator, Dr. John
W. Adams.

A tracheotomy tube had been inserted to this horse's trachea about
two weeks previously. Horse was cast and chloroform administered, and
the roaring operation performed.



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608 The Clinic.

Case 26. — Bay gelding. Operation median neurectomy. Op-
erator, Dr. J. W. Klotz, Noblesville, Indiana.

This was an operation consisting of removing a section of the median
nerve for lameness in the carpel joint, a simple operation, taking but a few
minutes and was performed successfully.

Case 27. — Bay gelding. Operation for fistula on the poll.



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