Part 65

Treatment of these wounds is most difficult and unsatisfactory. We can do much to prevent this array of symptoms if the case is seen early—within the first 24 or 48 hours after the injury; but when inflammation of the joint is once fairly established the case becomes one of grave tendencies. Whenever a punctured wound of a joint is noticed, even though apparently of but small moment, we should apply without the least delay a strong cantharides blister over the entire joint, being even careful to fill the orifice of the wound with the blistering ointment. This treatment is almost always effectual. It operates to perform a cure in two ways—first, the swelling of the skin and tissues underneath it completely closes the wound and prevents the ingress of air; second, by the superficial inflammation established it acts to check and abate all deep-seated inflammation. In the great majority of instances, if pursued soon after the accident, this treatment performs a cure in about one week; but should the changes described as occurring later in the joint have already taken place, we must then treat by cooling lotions and the application to the wound of chlorid of zinc, 10 grains to the ounce of water, or a paste made of flour and alum. A bandage is to hold these applications in place, which is only to be removed when swelling of the leg or increasing febrile symptoms demand it. In the treatment of open joints our chief aim must be to close the orifice as soon as possible. For this reason repeated probing or even injections are contraindicated. The only probing of an open joint that is to be sanctioned is on our first visit, when we should carefully examine the wound for foreign bodies or dirt, and after removing them the probe must not again be used. The medicines used to coagulate the synovial discharge are best simply applied to the surface of the wound, on pledgets of tow, and held in place by bandages. Internal treatment is also indicated in those cases of open joints in which the suffering is great. At first we should administer a light physic and follow this up with sedatives and anodynes, as directed for contused wounds. Later, however, we should give quinin or salicylic acid in 1-dram doses two or three times a day.

WOUNDS OF THE TENDON SHEATHS.

Wounds of tendon sheaths are similar to open joints in that there is an escape of synovial fluid, "sinew water." Where the tendons are simply punctured by a thorn, nail, or fork, we must, after a thorough exploration of the wound for any remaining foreign substance, treat with the flour-and-alum paste, bandages, etc., as for open joint. Should the skin and tendons be divided the case is even more serious and is often incurable. There is always a large bed of granulations (proud flesh) at the seat of injury, and a thickening more or less pronounced remains. When the back tendons of the leg are severed we should apply at once a high-heel shoe (which is to be gradually lowered as healing advances) and bandage firmly with a compress moistened with a 10-grain chlorid of zinc solution. When proud flesh appears it is best kept under control by repeated applications of a red-hot iron. Mares that are valuable as brood animals and stock horses should always be treated for this injury, as, even though blemished, their value is not seriously impaired. If the subject is old and comparatively valueless, the length of time required and the expense of treatment will cause us to hesitate in attempting a cure.

GUNSHOT WOUNDS.

These wounds vary in size and character, depending on the size and quality of the projectile and also the tissue injured. They are so seldom met with in our animals that an extended reference to them seems unnecessary. If a wound has been made by a bullet a careful examination should be made to ascertain whether the ball has passed through or out of the body. If it has not we must then probe for it, and if it can be located it is to be cut out when practicable to do so. Oftentimes a ball may be so lodged that it can not be removed, and it then may become encysted and remain for years without giving rise to any inconvenience. It is often difficult to locate a bullet, as it is very readily deflected by resistances met with after entering the body.

The entering wound is the size of the projectile, the edges are inverted and often scorched. The wound produced in case of the bullet's exit is larger than the projectile, the edges are turned out and ragged. A bullet heated by the friction of the barrel or air often softens and becomes flattened on striking a bone or other tissue. Modern bullets that have an outer steel layer may pass through bone without splintering it. Lead bullets may split, producing two exit wounds. Spent bullets may only produce a bruise. Should bones be struck by a ball they are sometimes shattered and splintered to such an extent as to warrant us in having the animal destroyed. A gunshot wound, when irreparable injury has not been done, is to be treated the same as punctured wounds, i. e., stop the hemorrhage, remove the foreign body if possible, and apply hot fomentations or poultices to the wound until suppuration is fairly established. Anti-septic and disinfectant injections may then be used. Should pus accumulate in the tissues, openings must be made at the most depending parts for its escape. Wounds from shotguns fired close to the animals are serious. They are virtually lacerated and contused wounds. Remove all the shot possible from the wound and treat as directed for contusions. When small shot strike the horse from a distance they stick in the skin or only go through it. The shot grains must be picked out, but as a rule this "peppering" of the skin amounts to but little.

POISONED WOUNDS.

These injuries are the result of bites of snakes, rabid dogs, stings of bees, wasps, etc. A single sting is not dangerous, but an animal is often stung by a swarm of insects, when the chief danger occurs from the swelling produced. If stung about the head, the nostrils may be closed as a result of the swelling, causing labored breathing and possibly asphyxiation. Intoxication may be produced by the absorption of this poison and is manifested by staggering gait, spreading of the legs, paralysis of the muscles, difficult respiration, and a rise of temperature. Death may follow in five to ten hours.

Treatment.—Douse animal with cold water and apply any alkaline liquid, such as soapsuds, bicarbonate of soda, or weak solution of ammonia. Internally give alcohol, ether, or camphor to strengthen the heart. In case of bites by rattlesnakes, moccasin, or other poisonous snakes, a painful swelling occurs about the bitten part, which is followed by labored breathing, weakness, retching, fever, and death from collapse. The animal usually recovers if it can be kept alive over the third day. In treating the animal, a tight ligature should be passed about the part above the wound to keep the poison from entering the general circulation. Wash out the wound thoroughly with antiseptics and then apply a caustic, such as silver nitrate, or burn with a hot instrument. A subcutaneous injection of one-fourth dram of 1 per cent solution of chromic acid above the wound is also beneficial. Cold water may be applied to the wound to combat the inflammation. Bites of rabid dogs produce an infected wound, and the virus of rabies introduced in this manner should be removed or destroyed in the wound. Therefore produce considerable bleeding by incising the wound, wash out thoroughly with 10 per cent solution of zinc chlorid, and then apply caustics or the actual cautery.

HARNESS GALLS (SITFASTS).

Wounds or abrasions of the skin are frequently caused by ill-fitting harness or saddles. When a horse has been resting from steady work for some time, particularly after being idle in a stable on a scanty allowance of grain, as in winter, he is soft and tender and sweats easily when put to work again. In this condition he is liable to sweat and chafe under the harness, especially if it is hard and poorly fitted. This chafing is likely to cause abrasions of the skin, and thus pave the way for an abscess or for a chronic blemish, unless attended to very promptly. Besides causing the animal considerable pain, chafing, if long continued, leads to the formation of a callosity. This may be superficial, involving only the skin, or it may be deep-seated, involving the subcutaneous fibrous tissue and sometimes the muscle and even the bone. This causes a dry slough to form, which is both inconvenient and unsightly. Sloughs of this kind are commonly called "sitfasts" and, while they occur in other places, are most frequently found under the saddle. (See also p. 475.)

Treatment.—Abrasions are best prevented by bringing the animal gradually into working shape after it has had a prolonged rest, in order that the muscles may be hard and the skin tough. The harness should be well fitted, neither too large nor too small, and it should be cleaned and oiled to remove all dirt and to make it soft and pliable. Saddles should be properly fitted so as to prevent direct pressure on the spine, and the saddle blankets should be clean and dry. Parts of the horse where chafing is likely to occur, as on the back under the saddle, should be cleaned and brushed free of dirt.

The remedies for simple harness galls are numerous. Among them may be mentioned alcohol, 1 pint, in which are well shaken the whites of two eggs; a solution of nitrate of silver, 10 grains to the ounce of water; sugar of lead or sulphate of zinc, 20 grains to an ounce of water; carbolic acid, 1 part in 15 parts of glycerin, and so on almost without end. Any simple astringent wash or powder will effect a cure, provided the sores are not irritated by friction.

If a sitfast has developed, the dead hornlike slough must be carefully dissected out and the wound treated carefully with antiseptics. During treatment it is always best to allow the animal to rest, but if this is inconvenient care should be taken to prevent injury to the abraded or wounded surface by padding the harness so that chafing can not occur.

BURNS AND SCALDS.

These wounds of domestic animals are fortunately of rare occurrence; however, when they do occur, if at all extensive, they prove to be quite troublesome and in many cases are fatal. According to the severity of the burn we distinguish three degrees: First degree, where there is a simple reddening of the skin; second degree, where there is a formation of vesicles, or blisters; third degree, where there is a complete destruction of vitality of the tissues, such as would occur in charring from direct contact with flames or from escaping steam. Besides the burns caused by flames and steam, there are other causative agents, such as chemicals (caustic alkalis and acids), lightning stroke, and occasionally the broken trolley wires of electric railways. When a large surface of the skin is burned or scalded, the animal (if it does not die at once from shock) will soon show signs of fever—shivering, coldness of the extremities, weakness, restlessness, quick and feeble pulse, and labored breathing. No matter which agent is a factor in the production of burns, the lesions are practically of the same nature. The extent and site of the burn should lead one in the determination and course of treatment. Burns of the shoulder and those about the region of the elbow or other parts where there is much movement of the tissues are grave, and, if at all extensive, treatment should not be attempted, but the immediate destruction of the animal is advised. A burn of the third degree, where there is a destruction of the vitality of large areas of tissue, even on parts not subject to much motion, is extremely tedious to treat; in fact, it is questionable whether the treatment and keep of the animal will ever be compensated for, even though recovery does take place; this, in any event, will require at least six or eight weeks. Burns caused by lightning stroke and trolley wires are liable to occur in irregular lines, and, unless death occurs at once, they generally are not serious.

Treatment.—Treatment should be prompt and effective. If the burns are extensive, the constitutional symptoms should be combated with whisky and milk and eggs, or ammonia carbonate, strychnin, caffein, or other stimulant to prevent shock. In the local treatment, to alleviate the pain, the application of cold water in some form and the hypodermic injection of morphine are to be recommended. In burns of the first degree, where there is only a superficial inflammation, lead carbonate (white lead) ointment is very good. Carron oil (limewater and linseed oil, equal parts) is a standard remedy, but a modification of it known as Stahl's liniment is perhaps better. This is composed of linseed oil and limewater each 200 parts, bicarbonate of soda 100 parts, and thymol 1 part. The scorched surface should be covered with this liniment and then with a layer of borated gauze or absorbent cotton, to protect from the air. The application should be frequently renewed. Carbolated vaseline may be used in place of the above. In case the burn is more extensive, the following solution may be used: Picric acid 2 parts, alcohol 40 parts, water 400 parts. The lesion should be thoroughly cleansed with this solution used on absorbent cotton. The vesicles, if any appear, should be opened with a clean needle, allowing the skin to remain. Strips of gauze or absorbent cotton saturated with the solution should now be applied and renewed only occasionally. In burns of the second and third degrees more satisfactory results may be obtained with nonpoisonous, dry dressing powder, such as is used in ordinary open wounds, as tannic acid 8 parts and iodoform 1 part, or a salve made of this powder and a sufficient quantity of vaseline. When sloughing of the tissues takes place the wounds should be cleansed with a warm 3 per cent solution of carbolic acid, all loose fragments of tissue removed, and either a dry, antiseptic dressing powder or carbolated vaseline ointment applied to exclude the air. Granulation tissue (proud flesh) should be controlled by the application of silver nitrate in the form of a caustic pencil.

Burns due to mineral acids may be first treated by flushing the parts with a copious quantity of cold water or by the application of whiting or chalk. Either use a large quantity of water at the start or use the chalk first, then wash with water. If the irritant has been a caustic alkali, such as potash, lye, ammonia, or soda, then vinegar should be the first application. Stahl's liniment is probably the best general application for all burns for the first week; then this should be followed by the ordinary antiseptic wound dressings.

GANGRENE.

Gangrene, or mortification, denotes the death of the affected part, and is mostly found attacking soft tissue near the surface of the body. Gangrenous areas may occur as a result of shutting off their blood supply. Constitutional diseases, such as ergotism, anthrax, and septicemia, predispose to gangrene. As external causes we have acids and alkalies, freezing and burning, contusions and continuous pressure that interrupt the circulation. There are two forms of gangrene—dry and moist. Dry gangrene is most often seen in horses from continuous lying down (decubitus) or from uneven pressure of some portion of the harness.

Symptoms.—There is a lack of sensation due to the death of nerves. In dry gangrene the skin is leathery and harsh, while in moist gangrene the tissues are soft, wrinkled, and friable; the hair is disturbed, and the skin is usually moist and soapy and sometimes covered with blebs. The tissue surrounding the moist gangrenous patch is usually inflamed, swollen, and hot, but this is less noticeable in the case of dry gangrene. Moist gangrene often spreads and involves deeper tissue, sheaths of tendons and joints producing septic synovitis or septic arthritis leading to pyemia and death. Dry gangrene is seldom dangerous, but the rapidity of its spread will indicate its virulence.

Treatment.—The preventive treatment consists in avoiding all the influences that tend to disturb the nutrition of the tissues, such as excessive cold or heat or continuous pressure. Gangrene following decubitus may be prevented by using soft bedding and frequently turning the animal from one side to the other. In dry gangrene moist heat in the form of poultices or anointing the tissue with oils and fats will be found beneficial in hastening the dead tissue to slough off. When the outer skin begins to suppurate, it should be removed with a pair of pincers, and the patch treated as an open wound. In moist gangrene the tissue should be thoroughly disinfected with a 3 per cent solution of compound cresol, or particularly an alcoholic tincture of camphor. Continuous irritation with antiseptic fluids prevents the accumulation and absorption of poisonous liquids. Incisions into the dead tissue may be made, and when sloughing commences the tissue should be removed with forceps and the resulting wound treated as in dry gangrene.

ULCERATION.

An ulcer is a circumscribed area of necrosis occurring on the skin or mucous membrane and covered with granulation tissue. It is a process of destruction, and when this process is going on faster than regeneration can take place, we have a gnawing, or eating, ulcer. When such an ulcer increases rapidly in size it is termed a phagedenic ulcer. A fungoid ulcer is one in which the bottom of the ulcer projects beyond the edge of the skin. These ulcers secrete milky or bloody-white liquid called ichor. When the ulcer is of an ashen or leaden color, with the bottom and sides formed of dense, hard connective tissue, which gives but little discharge and is not sensitive, it is termed callous, torpid, or indolent ulcer.

Causes.—As in the case of gangrene, disturbances of circulation are among the most frequent causes. A wound to a tissue with slight recuperative power may be followed by ulceration, as in tumors. Certain germs may produce ulcers, as the glanders bacilli, which cause the ulcerations on the nasal septum in glanders.

Treatment.—This consists in removing the exciting cause at once. The secretions of the ulcer should be washed off with antiseptic solutions and the formation of granulation tissues stimulated by antiseptic salves, such as carbolated vaseline, lead ointment, or by dressings of camphor. Air should be kept from the ulcer by occlusive dressings. Where the ulcers are inflamed, warm lead water or lead water and laudanum will be found efficacious. Callous ulcers are best removed by a curette, knife, or hot iron and then treated like a common wound. Mechanical irritation should be avoided.

ABSCESSES.

These consist of accumulations of pus within circumscribed walls, at different parts of the body, and may be classed as acute and cold or chronic abscesses.

When an abscess occurs about a hair follicle it is called a boil or furuncle; when several hair follicles are involved, resulting in the formation of more than one exit for the inflammatory products, it is called a carbuncle.

ACUTE ABSCESSES.

Acute abscesses follow as the result of local inflammation in glands, muscular tissue, or even bones. They are very common in the two former. The abscesses most commonly met with in the horse (and the ones which will be here described) are those of the salivary glands, occurring during the existence of "strangles," or "colt distemper." The glands behind or under the jaw are seen to increase slowly in size, becoming firm, hard, hot, and painful. At first the swelling is uniformly hard and resisting over its entire surface, but in a little while becomes soft (fluctuating) at some portion, mostly in the center. From this time on the abscess is said to be "pointing," or "coming to a head," which is shown by a small elevated or projecting prominence, which at first is dry, but soon becomes moist with transuded serum. The hairs over this part loosen and fall off, and in a short time the abscess opens, the contents escape, and the cavity gradually fills up—heals by granulations.

Abscesses in muscular tissue are usually the result of bruises or injuries. In all cases in which abscesses are forming we should hurry the ripening process by frequent hot fomentations and poultices. When they are very tardy in their development a blister over their surface is advisable. It is a common rule with surgeons to open an abscess as soon as pus can be plainly felt, but this practice can scarcely be recommended indiscriminately to owners of stock, since this little operation frequently requires an exact knowledge of anatomy. It will usually be found the better plan to encourage the full ripening of an abscess and allow it to open of itself. This is imperative if the abscess is in the region of joints, etc. When open, we must not squeeze the walls of the abscess to any extent. They may be very gently pressed with the fingers at first to remove the clots—inspissated pus—but after this the orifice is simply to be kept open by the introduction of a clean probe, should it be disposed to heal too soon. If the opening is at too high a level another should be made into the lowest portion of the abscess so as to permit the most complete drainage. Hot fomentations or poultices are sometimes required for a day or two after an abscess has opened, and are particularly indicated when the base of the abscess is hard and indurated.