Chapter XIV (3)

A =contusion=, in its mildest form, is simply a bruise. Injuries of this class, when of magnitude, are very deceptive; the surface is unstained by blood, and there is no flesh exposed. For these reasons the ignorant are apt to disregard such accidents, and to express surprise when they terminate otherwise than kindly. When a bruise happens, blood is effused in smaller or larger quantities according to the extent of the injury. A small quantity of effused blood, sufficient to discolor the human skin, may be absorbed; but when the amount is large, the powers of nature are defied. The blood thrown out, not being taken up again, congeals, and ultimately corrupts. Then an abscess or a slough is necessitated; both are attended with danger: the first may be deep seated or superficial; either form is attended by much weakness. That generates considerable irritation, and may even be the cause of fatal hemorrhage; or it may lead to sinuses, the direction, the number, or extent of which, when they do occur, is not to be predicated. A bruise is, consequently, not to be judged of hastily. The amount of pain which it provokes is even unworthy dependence, as the injury may have hurt the bone or the tendon; and then, though the accident is rendered very serious, in the first instance no sign of agony announces the extent of the evil.

With regard to treatment, when a =lacerated wound= occurs, the first attention should be paid to the system, which has always been much shaken. Give, therefore, the drink composed of one ounce each of laudanum and sulphuric ether, with half a pint of water; repeat it every quarter of an hour till the shivering natural to the horse on these occasions has disappeared, and the pulse has recovered its healthy tone.

Avoid all poultices of the ordinary kind; one composed of one-fourth yeast and three-fourths of any coarse grain, excepting bran, may be applied. So also may a lotion thus composed:--

_Lotion for Lacerated Wounds._

Tincture of cantharides One ounce.
Chloride of zinc Two drachms.
Water Three pints.
Mix. Keep a rag constantly wet over the part.

Either will stimulate the parts, and probably prevent any tendency to unhealthy action. The yeast poultice produces this effect by giving off carbonic acid; the lotion accomplishes this intention by both its active ingredients. Each is stimulating, also disinfectant, and will counteract any filthy odor which may attend the sloughing process; but the lotion is perhaps to be preferred, as it is more easily applied. When the slough has taken place, should hemorrhage ensue, dash upon the part jug after jug of the coldest water; or, should no very cold water be at hand, drive upon the mouths of the vessels a current of wind from the nozzle of the bellows. Continue to do this till the bleeding ceases, or until a surgeon can be obtained to take up the arteries.

The after-treatment is simple: apply frequently the solution of chloride of zinc, one grain to an ounce of water; that lotion will cleanse the wound and prevent unpleasant smells.

As respects feeding, this must be regulated by the character of the pulse. Should the beat of the artery be quick and feeble, no hay should be given; good, thick gruel should constitute the only drink excepting in extreme cases, when two pots of porter may be allowed each day. Good oats and old beans, both crushed and scalded, should then constitute the food, and the utmost gentleness should be exercised toward the animal.

Should the pulse be natural, allow three feeds of oats each day, as, in every kind of injury to the horse, more danger is to be apprehended from debility than from any excess of energy.

=Incised wounds.=--When these happen, always dash the part with plenty of cold water or blow upon them with the bellows. Place the horse in the nearest shed; motion promotes hemorrhage, therefore a walk is not to be hazarded. The bleeding being arrested--for, in severe accidents of this kind, there is no time to send for assistance--let the animal remain perfectly quiet until the exposed surface has become almost dry, but on being touched by the finger feels sticky. Then draw the edges together, and keep them in that position by means of sutures.

FIXED SUTURE NEEDLE: VERY USEFUL FOR INCISED WOUNDS OF NO GREAT
DEPTH.
]

The best means of inserting these sutures is with a curved needle fixed into a handle. The handle is wanted to obtain the necessary power, and the needle's point should be sharp to penetrate the hide of the horse, which in places is of considerable thickness. The needle is thrust through the integument about one inch and a half from one margin of the incision; it is brought out about the same distance within the divided soft parts. It enters the opposite side of the sundered flesh even with the place whence it came forth, and afterward it appears through the skin about equally distant from the opposite edge of the wound. There is a hole near the point of the needle; through this opening a piece of strong twine or narrow tape is threaded; when, the instrument being withdrawn, the twine or tape is pulled into the puncture which has been made. The needle is then released, the suture being left in.

A second person pushes the wound together, and, when the point of
the needle appears, threads it with a piece of zinc wire or soft
string. The needle is then retracted, and released from the wire or
string, whereby a suture is left in the wound.
]

So many sutures as may be necessary are thus inserted--in small wounds, these being about two inches asunder, but in larger injuries, three inches apart. All are duly placed before any are tied; the whole being ready, the wound is forced together by an assistant, while the strings are fastened--care being exercised not to bring any of them actually tight, lest the motion of the body or the swelling of the part should drag the sutures through the flesh and thereby tear them out.

A wound thus united may possibly heal by first intention, or the divided parts, when brought together, may join, and give no further trouble to the surgical attendant.

Union by first intention is, however, somewhat rare in the horse; and should not that take place, suppuration will be established. So soon as the pus flows freely forth, and the sutures appear to tighten or drag, cut them out by snipping the twine; but allow the strings to loosen before you attempt their withdrawal.

If this is not done, the sutures will speedily find an exit for themselves by causing the flesh against which the tension acts to be absorbed; thus the original injury will be rendered more complicated, and the ultimate blemish must be altogether greater.

All that is required after the establishment of suppuration is to bathe the part with the solution of chloride of zinc, one grain to the ounce of water. This lotion will suppress any fetor, and gently stimulate the healing process, as well as prevent the sprouting of fungoid granulations; it is necessary also to attend strictly to the directions laid down for feeding during the curing of wounds.

No. 1. The continuous suture, which is employed for sewing up
portions of bowel when the intestines are injured and exposed.

No. 2. The deep suture or the quill suture. In the horse pieces
of wood are substituted for quills. The wood is notched in the
center; and upon the indentations the sutures are fixed, to prevent
the movements of the animal from displacing them. It is sometimes
employed to bring the sides of deep and gaping wounds closer
together.
]

The treatment of an =abraded wound= chiefly consists in cleansing the surface with plenty of cold water, which should be allowed by its own weight to wash off any loose particles of dirt. No cloth or other aid should be employed to scrub the living flesh as though it were an insensitive board. The matter which cannot be removed by simply sluicing, had better remain to be expelled by the secretion of pus. The horse, especially when terrified, endures pain very badly; indeed, the animal is so timid and so delicately framed that it is always good surgery to spare all unnecessary suffering.

Support the body with laudanum and ether drinks, one ounce of each to the pint of water, as often as they may be needed. Let the food be generous, unless fever should arise, when the directions already given must be attended to.

=Punctured wounds= require only one kind of treatment, whether a nail be driven into the flesh of the foot, or the shaft of a cart be forced into the substance of the thigh. Here the knife must be employed; and, unless the animal shows evident symptoms of excessive weakness, it is better, perhaps, to operate while the parts are partially numbed by the shock, than to wait until a morbid sensibility is provoked. Always enlarge the opening; do this in the foot by cutting away the horn of the sole around the small puncture left by the nail. When the soft parts are penetrated, probe the wound first; then, if possible, insert a knife to the bottom of the puncture, and, with the edge downward, draw it forth. By this means a wound resembling a subverted =<= will be instituted. It will be narrowest toward the extremity, and widest at the mouth. A free opening affords a ready egress for all sloughs and pus. It materially aids the healing process, and effectually prevents the establishment of sinuses; while the clean incision left by the knife is of small import, when taken into consideration with the other consequences of a punctured wound.

Support the animal if necessary, or regulate the food by the symptoms.

A =contused wound=, when slight, may be rubbed with the iodide of lead ointment, one drachm of the active agent to the ounce of lard; when all enlargement will sometimes subside, and the effused blood may be absorbed. However, the horse commonly receives injuries of magnitude. In the last case, take a sharp knife and draw it along the entire length of the swelling. Make a long gash, only through the integument, at every eighth inch, and be careful to carry the knife through the integument, or to the lowest portion of the detached skin. Any sac that may be left is certain to retain corruption, and may produce fearful after-consequences. The attendant measures consist in bathing the contusion with a lotion composed of chloride of zinc, one grain, water, one ounce, and diminishing the food or supporting the body as nature demands such treatment.

The after-treatment of all injuries consists in keeping any external orifices open till all sloughs and pus have disappeared. In surgery, a large and depending opening, by means of which the interior may drain, is always to be preserved, and the knife, to this end, may be employed so often as the healing process threatens to prematurely close the wound.

Formerly it was the practice to bleed after every injury; this was done to prevent fever. However, observation has shown that the vital powers are more often weakened than increased by the shock attendant on severe accidents. Whenever the contrary happens, it is far better to lower the pulse by repeated doses of aconite, than to abstract that which will subsequently be necessary to repair injury.

It was also once the custom to fill wounds with tents or lumps of tow, and to bandage every injured part. These habits only served to confine that which nature was striving to cast out. They consequently did much harm, and are now happily discarded.

A piece of loose rag, saturated in the oil or the solution of tar, should, during summer, be suspended over the mouth of every wound, to keep off the flies. The only tent which the author approves of is when an incised wound happens where assistance is far away, and difficult to procure. Then, to arrest the hemorrhage, let the horse rug, a man's coat, or anything else be violently thrust into the gash, and forcibly held there until proper assistance can be obtained.

Such is the present method of treating wounds; this to the reader may appear very cruel; but could he have walked through and have inhaled the atmosphere of the wards in hospitals appropriated to such injuries as they existed in former times, he would thoroughly understand that apparent want of feeling is, in reality, the height of charity.

To conclude this part, the author lays before his readers the following bandage, intended to meet an inconvenience hitherto experienced when a horse has the walls of the abdomen punctured. The constant motion of the part renders ordinary sutures of no avail, and for that reason bandages, unless so tight as to check circulation, are of little use. The annexed is made like a broad belt, and is buckled round the body. The bars are composed of vulcanized India-rubber; they will yield to the movements of the abdomen, and yet serve as sutures supporting any pendant flap, while at the same time they will allow the wound to be dressed without disturbing the bandage. They also offer the advantage of permitting the attendant to pull one support aside without removing the whole.

Every part in the horse subjected to much motion when wounded, should have an adhesive plaster placed over it, and retained there until the suppurative action is confirmed. By this means is excluded the atmosphere, which, when this precaution was neglected, has entered the wound, penetrated between the muscles, and by distending the body increased the suffering, as well as led to the worst of consequences.

Wounds in veterinary surgery rank among the most formidable cases with which the practitioner has to contend. They are not so because the flesh of the horse is slower to heal than that of the human being. Indeed, the scale in this respect inclines toward the animal; but they are rendered slow to heal and difficult to cure by two causes. The horse is always impatient of restraint; any effort to confine the creature is more likely to provoke dangerous resistance than to induce the slightest symptom of amendment. The quadruped naturally delights in motion. It was formed for activity. Even when in its stall the body is never absolutely still; the position is being changed; the legs are frequently stamped; the head, eyes, ears, and tail are never quiet. This innate quality retards the union of sundered flesh. It favors the gravitation of pus between the muscles, and thus generates sinuses. These are the torments of veterinary surgery. Could the sinus be anticipated, or in all cases eradicated, the principal difficulty would be removed; but intelligent as the horse is, it proves impossible to make the animal comprehend the necessity for quietude. Hence any trivial accident may lead to injuries of so extensive a character and so malignant a nature as will set the best endeavors or the most consummate skill at defiance.