accomplished by several methods, such as compress bandages, torsion, hot
iron, and ligatures. The heat from a hot iron will cause the immediate
clotting of the blood in the vessels, and this clot is further supported
by the production of a scab, or crust, over the portion seared. The iron
should be at a red heat. If at a white heat, the tissue is charred,
which makes it brittle and the bleeding is liable to be renewed. If the
iron is at a black heat, the tissue will stick to the iron and will pull
away from the surface of the wound. Cold water and ice bags quickly stop
capillary bleeding, while hot water is preferable in more excessive
hemorrhages. Some drugs, called styptics, possess the power of
contracting the walls of blood vessels and also of clotting the blood. A
solution of the chlorid of iron placed on a wound alone or by means of
cotton drenched in the liquid produces a rapid and hard clot. Tannic
acid, alum, acetic acid, alcohol, and oil of turpentine are all more or
less active in this respect. To check bleeding from large vessels
compression may be adopted. When it is rapid and dangerous and from an
artery, the fingers may be used for pressing between the wound and the
heart (digital compression), but if from a vein, the pressure should be
exerted on the other side of the wound. Tourniquet may also be used by
passing a strap around the part and tightening after placing a pad over
the hemorrhage. The rubber ligature has now replaced the tourniquet and
is bound tightly around the limb to arrest the bleeding. Tampons, such
as cotton, tow, or oakum, may be packed tightly in the wound and then
sewed up. After remaining there for twenty-four or forty-eight hours
they are removed. Bleeding may sometimes be easily checked by passing a
pin under the vessel and by taking a horsehair and forming a figure 8 by
running it above and below the pin, thus causing pressure on the vessel.
Torsion is the twisting of the blood vessel until the walls come
together and form a barrier to the flow of blood. It may be accomplished
by the fingers, forceps, or by running a pin through the vessel, turning
it several times, and then running the point into the tissue to keep it
in a fixed position.
Ligation is the third method for stopping a hemorrhage. The blood vessel
should be seized with the artery forceps, a clean thread of silk passed
around it, and tied about one-half inch from its end. The silk should be
sterilized by placing it in an antiseptic solution so as not to impede
the healing process or cause blood poisoning or lockjaw, which often
follows the ligation of a vein with unsterilized material. Sometimes it
will be impossible to reach the bleeding vessel, so it is necessary to
pass the ligature around a mass of tissue which includes the blood
vessel. Ligation is the most useful method of arresting hemorrhage,
since it disturbs healing least and gives the greatest security against
secondary hemorrhage.
SUTURES.
After the bleeding has been controlled and all foreign bodies removed
from the wound, the gaping of the wound is noticeable. It is caused by
the contraction of the muscles and elastic fibers, and its degree
depends on the extent, direction, and nature of the cut. This gaping
will hinder the healing process so that it must be overcome by bringing
the edges together by some sort of sutures or pins or by a bandage
applied from below upward. As suture material, ordinary cotton thread is
good, if well sterilized, as are also horsehair, catgut, silk, and
various kinds of wire. If the suture is made too tight the subsequent
swelling may cause the stitch to tear out. In order to make a firm
suture the depth of the stitch should be the same as the distance the
stitch is from the edge of the wound. The deeper the suture the more
tissue is embraced and the fewer the number of stitches required. In
tying a suture the square or reef knot should be used. Closure of wounds
by means of adhesive plaster, collodion, and metal clamps is not
practiced to any great extent in veterinary practice.
PROCESS OF HEALING.
In those cases where perfect stoppage of bleeding, perfect coaptation of
the edges of the wound, and perfect cleanliness are obtained, healing
occurs within three days, without the formation of granulations, pus, or
proud flesh, by what is termed first intention. If wounds do not heal in
this manner they will gap somewhat and become warm and painful. Healing
then occurs by granulation or suppuration, which is termed healing by
second intention. The sides of the wound become covered with granulation
tissue which may fill the wound and sometimes overlap the lips, forming
a fungoid growth called proud flesh. Under favorable conditions the
edges of the wound appear to grow together by the end of the first week,
and the whole surface gradually becomes dry, and finally covered with
pigmented skin, when the wound is healed. The cause of pus formation in
wounds is usually the presence of germs. For this reason the utmost care
should be adopted to keep clean wounds aseptic, or free from germs, and
to make unclean wounds antiseptic by using antiseptic fluids to kill the
microbes present in the wound. The less the injurious action of this
fluid on the wound and the greater its power to kill germs, the more
valuable it becomes. All antiseptics are not equally destructive, and
some germs are more susceptible to one antiseptic than to another. The
most important are (1) bichlorid of mercury, which is to be preferred on
horses. It becomes weakened in its action if placed in a wooden pail or
on an oily or greasy surface. It is used in the strength of 1 part of
bichlorid to 1,000 to 5,000 parts of water, according to the delicacy of
the tissue to which it is applied. (2) Carbolic acid in from 2 to 5 per
cent solution is used on infected wounds and for cleaning instruments,
dressings, and sponges. It unites well with oil and is preferred to the
bichlorid on a greasy surface. A 5 per cent solution in oil is often
used under the name of carbolized oil. (3) Aluminum acetate is an
efficient and cheap antiseptic, and is composed of 1 part alum and 5
parts acetate of lead, mixed in 20 parts of water. (4) Boric acid is
good, in a 2 to 4 per cent solution, to cleanse wounds and wash eyes.
Compound cresol may be used in a 1 to 3 per cent solution in water.
Iodoform is one of the most used of the antiseptics, and it also acts as
an anodyne, stimulates granulation, and checks wound secretion. A very
efficacious and inexpensive powder is made by taking 5 parts of iodoform
and 95 parts of sugar, making what is called iodoform sugar. Tannic acid
is a useful drug in the treatment of wounds, as it arrests hemorrhage,
checks secretion, and favors the formation of a scab. A mixture of 1
part tannic acid and 3 parts iodoform is good in suppurating wounds.
Iodol, white sugar, ground and roasted coffee, and powdered charcoal are
all used as protectives and absorbents on suppurating surfaces. More
depends on the care and the method of application of the drug than on
the drug itself. On aseptic wounds use only those antiseptics that do
not irritate the tissue. If care is used in the application of the
antiseptic, corrosive sublimate or carbolic acid is to be recommended.
In order to keep air from the wound and to absorb all wound secretions
rapidly, a dressing should be applied. If the wound is aseptic, the
dressing should be likewise, such as cotton gauze, sterile cotton,
oakum, or tow. This dressing should be applied with uniform pressure at
all times and secured by a bandage. Allow it to remain for a week or ten
days if the wound is aseptic or if the dressing does not become loose or
misplaced or become drenched with secretions from the wound, or if pain,
fever, or loss of appetite does not develop. The dressing should then be
removed, the wound treated antiseptically, and a sterilized dressing
applied.
HEALING UNDER A SCAB.
This often occurs in small superficial wounds that have been kept
aseptic. In order that a scab may form, the wound must not gap, secrete
freely, or become infected with germs. The formation of scab is favored
by astringents and styptics, such as tannic acid, iodoform, and 5 per
cent solution of zinc chlorid. In case of fistulous withers, open
joints, or other large, hollow wounds that can not be dressed,
antisepsis may be obtained by warm-water irrigation with or without an
antiseptic fluid. It should continue day and night, and never be
interrupted for more than eight hours, for germs will then have gained
headway and will be difficult to remove. Four or five days of irrigation
will be sufficient, for granulations will then have formed and pus will
remain on the outside if it forms. For permanent irrigation the stream
should be very small, or drop by drop, but should play over the entire
surface of the wound. It is always better to heal an infected wound
under a scab, or treat it as an open wound, than it is to suture it,
thus favoring the growth of the inclosed germs and retarding ultimate
healing. In the latter case pus may develop in the wound, form pockets
by sinking into the tissues, and cause various complications. The
pockets should be well drained, either through incisions at the bottom
or by drainage tubes or setons. They should then be frequently syringed
out or continuously irrigated. In case proud flesh appears it should be
kept down either by pressure or by caustics, as powdered bluestone,
silver nitrate, chlorid of antimony, or by astringents, such as burnt
alum. If they prove resistant to this treatment they may be removed by
scissors, the knife, or by searing with the hot iron. The following
rules for the treatment of wounds should be followed: (1) See that the
wound is clean, removing all foreign bodies. (2) For this purpose use a
clean finger rather than a probe. (3) All hemorrhage should be arrested
before closing the wound. (4) Antiseptics should only be used if you
suspect the wound to be infected. (5) When pus is present treat without
closing the wound. (6) This may be accomplished by drainage tubes,
absorbent dressings, setons, or continuous irrigations. (7) Protect the
wound against infection while healing.
LACERATED AND CONTUSED WOUNDS.
Lacerated and contused wounds may be described together although there
is, of course, this difference, that in contused wounds there is no
break or laceration of the skin. Lacerated wounds, however, are, as a
rule, also contused--the surrounding tissues are bruised to a greater or
lesser extent. While at first sight such wounds may not appear to be as
serious as incised wounds, they are commonly very much more so.
Lacerations and contusions, when extensive, are always to be regarded as
dangerous. Many horses die from septic infection or mortification as a
result of these injuries. We find in severe contusions an infiltration
of blood into the surrounding tissues: disorganization and mortification
follow, and involve often the deeper seated structures. Abscesses,
single or multiple, may also result and call for special treatment.
In wounds that are lacerated the amount of hemorrhage is mostly
inconsiderable; even very large blood vessels may be torn apart without
inducing a fatal result. The edges of the wound are ragged and uneven.
These wounds are produced by barbed wire or some blunt object, as when a
horse runs against fences, board piles, the corners of buildings, or
when he is struck by the pole or shafts of another team, falling on
rough, irregular stones, etc.
Contused wounds are caused by blunt instruments moving with sufficient
velocity to bruise and crush the tissues, as kicks, running against
objects, or falling on large, hard masses.
_Treatment._--In lacerated wounds great care must at first be exercised
in examining or probing to the very bottom of the rent or tear, to see
whether any foreign body is present. Very often splinters of wood or
bits of stone or dirt are thus lodged, and unless removed prevent the
wound from healing; or if it should heal, the wound soon opens again,
discharging a thin, gluey matter that is characteristic of the presence
of some object in the part. After a thorough exploration these wounds
are to be carefully and patiently fomented with warm water, to which has
been added carbolic acid in the proportion of 1 part to 100 of water.
Rarely, if ever, are stitches to be inserted in lacerated wounds. The
surrounding tissues and skin are so weakened in vitality and structure
by the contusions that stitches will not hold; they only irritate the
parts. It is better to endeavor to obtain coaptation by means of
bandages, plasters, or collodion. One essential in the treatment of
lacerated wounds is to provide a free exit for the pus. If the orifice
of the wound is too high, or if pus is found to be burrowing in the
tissues beneath the opening, we must then make a counter opening as low
as possible. This will admit of the wound being thoroughly washed out,
at first with warm water, and afterwards injected with some mild
astringent and antiseptic wash, as chlorid of zinc, 1 dram to a pint of
water. A dependent opening must be maintained until the wound ceases to
discharge. Repeated hot fomentations over the region of lacerated wounds
afford much relief and should be persisted in.
BRUISES.
Bruises are nothing but contused wounds where the skin has not been
ruptured. There is often considerable solution of continuity of the
parts under the skin, subcutaneous hemorrhage, etc., which may result in
local death (mortification) and slough of the bruised parts. If the
bruise or contusion is not so severe, many cases are quickly cured by
constant fomentation with hot water for from two to four hours. The
water should be allowed about this time to become cool gradually and
then cold. Cold fomentation must then be kept up for another hour or
two. The parts should be thoroughly and quickly dried and bathed freely
with camphor 1 ounce, sweet oil 8 ounces, or with equal parts of lead
water and laudanum. A dry, light bandage should then be applied, the
horse allowed to rest, and if necessary the treatment may be repeated
each day for two or three days. If, however, the wound is so severe that
sloughing must ensue, we should encourage it by poultices made of
linseed meal, wheat bran, turnips, onions, bread and milk, or hops.
Charcoal is to be sprinkled over the surface of the poultice when the
wound is bad smelling. After the slough has fallen off the wound is to
be dressed with warm washes of carbolic acid, chlorid of zinc,
permanganate of potash, or other antiseptic. If granulating (filling up)
too fast, use burnt alum or air-slaked lime. Besides this local
treatment, we find that the constitutional symptoms of fever and
inflammation call for measures to prevent or control them. This is best
done by placing the injured animal on soft or green feed. A physic of
Barbados aloes, 1 ounce, should be given as soon as possible after the
accident. Sedatives, such as tincture of aconite root, 15 drops, three
times a day, or ounce doses of saltpeter every four hours, may also be
administered. When the symptoms of fever are abated, and if the
discharges from the wound are abundant, the strength of the patient must
be supported by good feed and tonics. One of the best tonics is as
follows: Powdered sulphate of iron, powdered gentian, and powdered
ginger, of each 4 ounces. Mix thoroughly and give a heaping
tablespoonful twice a day, on the feed or as a drench.
PUNCTURED WOUNDS.
Punctured wounds are produced by the penetration of a sharp or
blunt-pointed substance, such as a thorn, fork, nail, etc., and the
orifice of these wounds is always small in proportion to their depth. In
veterinary practice punctured wounds are much more common than the
others. They involve the feet most frequently, next the legs, and often
the head and face from nails protruding through the stalls and trough.
They are not only the most frequent, but they are also the most serious,
owing to the difficulty of obtaining thorough disinfection. Another
circumstance rendering them so is the lack of attention that they at
first receive. The external wound is so small that but little or no
importance is attached to it, yet in a short time swelling, pain, and
acute inflammation, often of a serious character, are manifested.
Considering the most common of the punctured wounds, we must give
precedence to those of the feet. Horses worked in cities, about iron
works, around building places, etc., are most likely to receive "nails
in the feet." The animal treads upon nails, pieces of iron or screws,
forcing them into the soles of the feet. If the nail, or whatever it is
that has punctured the foot, is fast in some large or heavy body, and is
withdrawn as the horse lifts his foot, lameness may last for only a few
steps; but unless properly attended to at once he will be found in a
day or two to be very lame in the injured member. If the foreign body
remains in the foot, he gradually grows worse from the time of puncture
until the cause is discovered and removed. If, when shoeing, a nail is
driven into the "quick" (sensitive laminae) and allowed to remain, the
horse gradually evinces more pain from day to day; but if the nail has
at once been removed by the smith, lameness does not, as a rule, show
itself for some days; or, if the nail is simply driven "too close," not
actually pricking the horse, he may not show any lameness for a week or
even much longer. At this point it is due to the blacksmith to say that,
considering how thin the walls of some feet are, the uneasiness of many
horses while shoeing, the ease with which a nail is diverted from its
course by striking an old piece of nail left in the wall, or from the
nail itself splitting, the wonder is not that so many horses are pricked
or nails driven "too close," but rather that many more are not so
injured. It is not, by any means, always carelessness or ignorance on
the part of the smith that is to account for this accident. Bad and
careless shoers we do meet with, but let us be honest and say that the
rarity of these accidents points rather to the general care and
attention given by these much-abused mechanics.
From the construction of the horse's foot (being incased in an
impermeable, horny box), and from the elasticity of the horn closing the
orifice, punctured wounds of the feet are almost always productive of
lameness. Inflammation results, and as there is no relief afforded by
swelling and no escape for the product of inflammation, this matter must
and does burrow between the sole or wall and the sensitive parts within
it until it generally opens "between hair and hoof." We can thus see why
pain is so much more severe, why tetanus (lockjaw) more frequently
follows wounds of the feet, and why, from the extensive, or at times
complete, separation and "casting" of the hoof, these wounds must always
be regarded with grave apprehension.
_Symptoms and treatment._--A practice which, if never deviated
from--that of picking up each foot, cleaning the sole, and thoroughly
examining the foot each and every time the horse comes into the
stable--will enable us to reduce to the minimum the serious consequences
of punctured wounds of the feet. If the wound has resulted from
pricking, lameness follows soon after shoeing; if from the nails being
driven too close, it usually appears from four to five days or a week
afterwards. We should always inquire as to the time of shoeing, examine
the shoe carefully, and see whether it has been partially pulled and the
horse has stepped back upon some of the nails or the clip. The pain from
these wounds is lancinating; the horse is seen to raise and lower the
limb or hold it from the ground altogether; often he points the foot,
flexes the leg, and knuckles at the fetlock. Swelling of the fetlock
and back tendons is also frequently seen and is liable to mislead us.
The foot must be carefully examined, and this can not be properly done
without removing the shoe. The nails should be drawn separately and
carefully examined. If there is no escape of pus from the nail holes, or
if the nails themselves are not moist, we must continue our examination
of the foot by carefully pinching or tapping it at all parts. With a
little practice we can detect the spot where pain is the greatest or
discover the delicate line or scar left at the point of entrance of the
foreign body. The entire sole is then to be thinned, after which we are
carefully to cut down upon the point where pain is greatest upon
pressure, and, finally, through the sole at this spot. When the matter
has escaped, the sole, so far as it was undermined by pus, is to be
removed. The foot must now be poulticed for one or two days and
afterwards dressed with a compress of oakum saturated with carbolic-acid
solution or other antiseptic dressing.
If we discover a nail or other object in the foot, the principal
direction, after having removed the offending body, is to cut away the
sole, in a funnel shape, down to the sensitive parts beneath. This is
imperative, and if a good free opening has been made and is maintained
for a few days, and hot fomentations and antiseptic dressings applied,
the cure is mostly easy, simple, quick, and permanent. The horse should
be shod with a leather sole under the shoe, first of all applying tar
and oakum to prevent any dirt from entering the wound. In some instances
nails may puncture the flexor tendons, the coffin bone, or enter the
coffin joint. Such injuries are always serious, their recovery slow and
tedious, and the treatment so varied and difficult that the services of
a veterinarian will be necessary.
PUNCTURED WOUNDS OF JOINTS, OR OPEN JOINTS.
These wounds are more or less frequent. They are always serious, and
often result in anchylosis (stiffening) of the joint or the death of the
animal. The joints mostly punctured are the hock, fetlock, or knee,
though other joints may, of course, suffer this injury. As the symptoms
and treatment are much the same for all, only the accident as it occurs
in the hock joint will be described. Probably the most common mode of
injury is from the stab of a fork, but it may result from the kick of
another horse that is newly shod, or in many other ways. At first the
horse evinces but slight pain or lameness. The owner discovers a small
wound scarcely larger than a pea, and pays but little attention to it.
In a few days, however, the pain and lameness become excessive; the
horse can no longer bear any weight upon the injured leg; the joint is
very much swollen and painful upon pressure; there are well-marked
symptoms of constitutional disturbance--quick pulse, hurried breathing,
high temperature, 103 deg. to 106 deg. F., the appetite is lost, thirst is
present, the horse reeks with sweat, and his anxious countenance shows
the pain he suffers. He may lie down, though mostly he persists in
standing, and the opposite limb becomes greatly swollen from bearing the
entire weight and strain for so long a time. The wound, which at first
appeared so insignificant, is now constantly discharging a thin, whitish
or yellowish fluid--joint oil or water, which becomes coagulated about
the mouth of the wound and adheres to the part in clots like jelly, or
resembling somewhat the white of an egg. Not infrequently the joint
opens at different places, discharging at first a thin, bloody fluid
that soon assumes the character above described.