Chapter 58

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 laminæ) 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° to 106° 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.

_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.