{"1": {"fulltext": "", "height": "3604", "width": "2372", "jp2-path": "courseinsurgical00pfei_0001.jp2"}, "2": {"fulltext": "LIBRARY OF CONGRESS.\\n\u00e2\u0082\u00acliap.-^\u00e2\u0080\u0094 Copyright No,\\nShelf\\n,yE2\\nUNITED STATES OF AMERICA.\\nn", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0002.jp2"}, "3": {"fulltext": "", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0003.jp2"}, "4": {"fulltext": "", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0004.jp2"}, "5": {"fulltext": "", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0005.jp2"}, "6": {"fulltext": "", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0006.jp2"}, "7": {"fulltext": "A COURSE IN\\nSURGICAL OPERATIONS\\nFOR\\nVeterinary Students and Practitioners\\nBY\\nW. PFEIFFER,\\nAssistant in the Surgical Clinic of the Veterinary High School in Berlin,\\nAND\\nW. L. WILLIAMS, V.S.,\\nProfessor of Surgery in the New York State Veterinary College,\\nCornell University, Ithaca, N. Y.\\nWith an Introduction by PROF. DR. FROHNER.\\nWith 42 Original Illustrations.\\nW. R. Jenkins,\\nNew York.\\nBalliere, Tindall Cox,\\nLondon,\\n1900.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0007.jp2"}, "8": {"fulltext": "44067\\n(lib* 4\u00c2\u00bb\u00c2\u00ab y of Conyre\u00c2\u00ab\u00c2\u00ab{\\nSEP 19C0\\njDofyWsb! --try\\nSECeNO COPY* 1\\nOROtS DIVISION,\\nCopyright 1900, B^\\nW. L. Williams,\\n7457?\\nPress of Andrus Church,\\nIthaca, N. Y.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0008.jp2"}, "9": {"fulltext": "INTRODUCTION TO DR. PFEIFFER S OPERA-\\nTIONS-CURSUS.\\nThe publication of a brief introduction to operations has\\nbecome a pressing need in the operative exercises which\\nhav^e been conducted jointly by the author and the under-\\nsigned, during the winter semester in the (Berlin) Veterinary\\nHigh School.\\nThe submitted guide is intended primarily to serve as a\\ncatechism to the .student in the technique of operations and\\nto support the oral explanations in the course by text and\\nillustration. Consequently only the most difficult and com-\\nplicated, to an extent the instrumental operations, are de-\\nscribed as briefly as po.ssible and fundamentally from the\\nstandpoint of technique. Designedly also only one method\\nof operation is described, as a rule, namely, that one which\\nfrom the standpoint of personal clinical experience has\\nproven the best, as for instance, castration by the method\\nof torsion, the Bayer operation for quitter, our method of\\nresection of the tendon of the flexer of the os pedis, etc.\\nThe multiplication of methods confuses the beginner\\nreadily as an important lesson in operative instruction, the\\nstudent must become thoroughly acquainted, among other\\nthings, with 07ie method with which he becomes .so familiar\\nthat he can rely upon it with perfect trust in practice From\\nthis standpoint also the needs of the veterinary practitioner\\nare met, who find in the same, besides the most important\\noperations on the hor.se, also .some in cattle (amputation of\\nthe claws) and dogs (entropium operation).\\nIn order to confine the handbook within proper limits, the\\nminor operations (sutures, cautery, catheterization, etc.), the", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0009.jp2"}, "10": {"fulltext": "IV\\nIntrod2iction to Dr. Pfeiffer s Operatio7is-Cursus.\\ninstruction regarding instruments and bandaging, as well as\\nthe methods of restraint, have not been considered. In the\\nsame way the indications for performing the described\\noperations are relegated to the lecture and the text books\\nof operative surgery.\\nFinally, we beg to acknowledge the estimable manner in\\nwhich the illustrations have been made from the original by\\nMr. Max Fischer, student, Berlin.\\nPROF. DR. FROHNKR.\\nBerlin, September, i8gy.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0010.jp2"}, "11": {"fulltext": "PREFACE TO ENGLISH EDITION.\\nProfessor Frohner s foregoing introduction to Dr. PfeifFer s\\nmanual explains fully its object. Having found it essential\\nto effective instruction in surgical technique, that the student\\nshould have extensive laboratory experience in the more in-\\ntricate surgical operations (the proper performance of which\\nperforce, includes training in methods of confinement,\\nanaesthesia, antisepsis, hemostasis, suturing, bandaging,\\netc.,) we have conducted a course in operations upon\\nanaesthetized animals, which are destroyed while yet un-\\nconscious, b}^ which the student becomes familiar with the\\nvarious operations under the normal conditions in the living\\nanimal.\\nThe non-existence of a satisfactory manual in English\\ninduced us to ask Dr. Pfeiffer s permission to translate and\\nuse, so far as might suit our purposes, his Operations-Cursus,\\nto which he readily assented, and in which his publisher,\\nMr. Richard Schoetz, concurred. It is, therefore, largely\\ndue to their courtesy and liberality that we are enabled to\\npresent to English speaking veterinary students and prac-\\ntitioners this little manual, accompanied by the worth given\\nit by the valuable experience of Prof. Dr. Fiohner and Dr.\\nPfeiffer.\\nWith a view to enhancing the value of the work to British\\nand American students, we have added some of the more\\nrecent, largely distinctively American, operations which we\\ndeem of sufficient value to warrant insertion in such a work.\\nTo this end, we have added cunean tenotomy, digital neurec-\\ntomy, Bossi s neurectomy of the peroneal nerve, McKillip s\\noperation for exploring the pharynx, Eustachian tubes, etc.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0011.jp2"}, "12": {"fulltext": "vi Preface to English Edition.\\n(staphylotomy.) Merillat s operation for roaring\\n(arytenoidrraphy) and our own operations of trifacial\\nneurectomy (for involuntary shaking of the head), repulsion\\nof molars, irrigation of the trachea, caudal myotomy (for\\ncurved tail), caudal myectomy (for gripping of the reins),\\nand vaginal ovariectomy.\\nIn order to keep the volume of the work within bounds,\\nwe have omitted, not without regret, Dr. Pfeiffer s extirpa-\\ntion of the submaxillary lymph glands, subcutaneous caudal\\nmyotomy (nicking), and castration by torsion. The chap-\\nters and illustrations on trephining have been greatly modi-\\nfied, and we have occasionally introduced suggestions in\\nMost of the illustrations were supplied by Mr. Richard\\nSchoetz, Berlin, from Dr. Pfeiffer s Operations-Cursus, the in-\\nstrument figures were provided by John Reynders Co., the\\nremainder are from original drawings by Dr. E. Merillat, and\\nMr. C. F. Flocken, veterinary student the chapter on\\nStaphylotomy was contributed by Dr. M. H. McKillip, and\\nthat on Arytenoidrraphy by Dr. L. A. Merillat, to each of\\nwhom our indebtedness is iieartily acknowledged.\\nW. L. WILLIAMS.\\nCornell University, igoo.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0012.jp2"}, "13": {"fulltext": "CONTENTS.\\nOperations on the Head\\nExtraction of Teeth i\\nRepulsion of Teeth 4\\nTrephining of Frontal Sinuses 7\\nTrephining of the Maxillary Sinuses 9\\nTrephining of Nasal Passages 11\\nLigation of Parotid Duct 12\\nEntropium Operation 14\\nStaphylotomy 15\\nTrifacial Neurectomy 16\\nOperations on the Neck\\nOpening of the Guttural Pouches 18\\nTracheotomy 21\\nIntra-tracheal Irrigation 23\\nArytenoidrraphy 23\\nIntravenous Injection 27\\nPhlebotomy with Fleams 29\\nPhlebotomy with Lancet 31\\nPhlebotomy with Trocar 31\\nLigation of the Carotid 32\\nCEvsophagotomy 34\\nOperations on the Trunk and Genital Organs:\\nPuncture of the Chest 36\\nPuncture of the Intestine 37\\nSubcutaneous Myotomy for Curved Tail 39\\nCaudal Myectomy for Gripping of the Reins 41\\nAmputation of the Tail 42\\nUrethrotomy 44\\nAmputation of the Penis 47\\nVaginal Ovariectomy 48", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0013.jp2"}, "14": {"fulltext": "viii Contents.\\nOperations on the Extremities\\nTenotomy of the Flexor Tendons of the Foot 54\\nTenotomy of the Lateral Kxtensor of the Foot (Stringhalt\\nOperation) 1 56\\nTenotomy of the Cunean Branch of Flexor Metatarsus\\n(Spavin Operation) 58\\nPlantar Neurectomy 59\\nDigital Neurectomy 62\\n{Median Neurectomy 64\\nUlnar Neurectomy 67\\nSciatic Neurectomy 69\\nAnterior Tibial Neurectomy 71\\nResection of the Lateral Cartilages of the Os Pedis 73\\nResection of the Tendon of the Flexor of the Os Pedis 77\\nAmputation of the Claws of Ruminants 79\\nAppendix\\nBayer s Sutures 82", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0014.jp2"}, "15": {"fulltext": "OPERATIONS ON THE HEAD.\\nEXTRACTION OF TEETH.\\nt Fig. I and 2.\\nInstriirnents. Extracting forceps acting as a lever of the\\nsecond class for the Miiolars, extracting forceps acting as a\\nlever of the first class for the pre-molars (the forceps for the\\nsuperior pre-molars are bent), fulcra of various sizes, mouth\\nopener with abundant lateral working room, reflecting lamp,\\nexporteur forceps, toothpick, splinter forceps.\\nTechyiiqtie. With quiet horses extraction ma}^ be carried\\nout with the animal standing, the horse being backed into a\\ncorner. Resistant animals must be laid down. After the\\napplication of the mouth speculum the diseased teeth must\\nbe properly identified by manual exploration, it must be\\ndetermined whether tliey are alread}^ loose or if they have\\nan abnormal direction (for example, are misdirected toward\\nthe cheek), the condition of the neighboring teeth, etc.\\nThese investigations can be rendered easier in case of insuf-\\nficient daylight ))y illuminating the mouth cavity with the\\nreflecting lamp [or still better, by means of an incandescent\\nelectric lamp]. After the partially chewed food pellets have\\nbeen removed with the toothpick or the fingers, count the\\nteeth from before backward until the diseased tooth is\\nreached, by passing the fingers along their median or inner\\nsides. For the extraction of the molars, extracting forceps\\nacting on the principle of a lever of the second class with\\nfulcra are used, the latter having a plane and a convex\\nsurface.\\nThe pre molar forceps are on the principle of a lever of the\\nfirst class, those for the superior pre-molars are bent on the\\nflat, becau.se if they were .straight the forceps handles\\nwould strike against the superior incisors and hinder the\\ndeep fixation of the forceps.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0015.jp2"}, "16": {"fulltext": "Extraction of Teeth.\\nThe next point is, to fasten only the diseased tooth with the\\nforceps and to so appl} them that the jaws of the same reach\\nat least to the gums. For this purpose draw the tongue out\\nfrom the angle of the mouth as far as possible on the sound\\nside, introduce tlie hand into the mouth, and place the index\\nfinger on the posterior border of the diseased tooth, while\\nwith the other hand push the open forceps backward upon\\nthe tooth row until tliey reach the finger and grasp the\\ncrown of the affected tooth with the forceps jaws. The free\\nFig. I. Extraction of the first inferior molar, viewed from within\\nsagittal section through the walla of the oral cavity.\\nhand is now withdrawn from the moulh, the forceps handles\\nare grasped with both hands, and the tooth fang loo.sened in\\nits alveolus by maintaining a gentle lateral movement, until\\nthe tooth evidently yields. The fulcrum is then carried in\\nwith one hand while with the other the forceps are main-\\ntained in the original position, and placed as far in as possi-", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0016.jp2"}, "17": {"fulltext": "Extraction of Teeth. 3\\nble in such a manner that the plane side rests upon the\\ngrinding surface of the teeth. The fulcrum must be held\\nfirmh between the teeth and forceps in order that it shall\\nnot glide forward. The operator now lifts the tooth fang\\nout of the alveolus in such a way that in the inferior molars\\nthe forceps handles are pressed downwards, the superior\\nmolars upward. In this way, while the tooth fang gradually\\ncomes out the forceps glide over the convexity of the fulcrum\\nand favors the oossibilitv of tlie tooth drawino- out in the\\nFig. 2. Extraction of the second superior premolar, viewed from\\nwithin sagittal section through the walls of the oral cavity.\\ndirection of its fixation. In case of the last molars as a rule\\nthe forceps push against the oppo.site row of teeth of the\\nsame side before the tooth is completely withdrawn. In\\nthis case the tooth, which is now loose in the alveolus, is\\neither grasped more deeply by the forceps or is removed\\nwhen this is no longer possible with the exporter or with the", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0017.jp2"}, "18": {"fulltext": "4 Rf^mlswm Teetk.\\nhand. [In some young horses we* have found it necessary\\nto cut the tooth in two in its middle with tooth cutting for-\\nceps in f3fr^ss: to remove it]. With the pre-molar forceps the\\nfiilcram is placed beneath the extension in front of the jaws\\ntf the foiceps-\\nThis extensioa lests opcm the grinding surface behind the\\ndiseased tooth and acts in such a manner that the pre-molars\\ncan be withdrawn from before backward in their line of\\ndirection. For the extraction of the inferior pre-molars the\\nforceps handles must be pressed upward, in the superior\\ndownward. Satisfactory extratrtion can only occur after the\\ndisappearance of resistance is recognized, accompianied by a\\ncrefHtant sonnd due to the entrance of air into the aveolus.\\nCTrkv\\nx-ig. 5-\\nImsirmmumis. Razor, amvex scalpels (2^^, trephine, bone\\ngouge, bone gouging forceps, light bone chisel, heavy bone\\nchisel, mallet, compression forceps, curette, heavy tooth\\npunch coDca\\\\\u00c2\u00a3 at distal end, scissors, needles, thread, ab-\\nscHbmt cotton, antiseptic gauze, extracting forceps, heavy\\nsplinter forceps, dressing forceps, trachea tube, tenacula,\\nm^al probe, mouth speculum.\\nTeduaqme. Secure in lateral recumbent position, produce\\nanaesthesia, and if sinuses are involved in a way to make\\npossiUe the inhalation purulent matter, blood or other\\nliquid, prepare for tracheotomy which see) and perform it\\nin time to av ert any danger. Shave the region over the\\naffected tooth and trephine by the method described in the\\nfollowing chapter down upon the fang of the tooth, or in\\ncase odontomes, upon the tumor. In case of tooth fistula,\\nthe identity of the affected member is best ascertained by pass-", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0018.jp2"}, "19": {"fulltext": "R^misam if Teeth\\nr\\nF5G. 5.\u00e2\u0080\u0094 3L\u00c2\u00abi\\n^U.I.2XV(U. v/1^", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0019.jp2"}, "20": {"fulltext": "6 Repulsion of Teeth.\\ning a metallic probe through the fistula against the diseased\\nfang while one hand is inserted in the mouth and determines\\nthe location of the probe. In trephining be careful to avoid\\ninjuring adjoining teeth. Control homorrhage completely\\nafter removal of the osseous disc and then enlarge the open-\\ning with forceps, gouge or chisel, until the entire width of\\nthe tooth fang is laid bare. Insert a sharp scalpel at the\\noral side of the trephine opening between the periosteum\\nand superposed soft tissues and with the left hand in the\\nmouth to act as a guide, push the scalpel along the perios-\\nteum until it enters the mouth and extend this incision\\nbackward and forward until the .soft tissues are completely\\ndetached from the alveolar wall over the eijtire area of the\\naffected tooth. With a light, narrow bone chisel, cut away\\nthe entire external bony plate of the alveolus, the full width\\nof the tooth from the lower or oral- margin of the trephine\\nwound into the oral cavity. The chi.sel is to be so held that\\nthe outer edge is inclined from the tooth, otherwise the im-\\npact of the chisel may loo.sen the alveolar wall from the ad-\\njoining tooth. Drive the chisel for a short distance alter-\\nnately on each side and thus avoid the splitting off of large\\nsections of bone which might extend to the neighboring\\nalveoli. With the gouge and chisel remove all remnants of\\nbone covering the external or lateral side of the tooth. The\\nsoft tissues over the region are left undisturbed except the\\ndisc removed for trephining. When the tooth is bared the\\npunch may be placed against the end of the fang and the\\ntooth driven b}^ a few firm, quick blows into the mouth\\nwhere it is grasped by forceps or the hand and withdrawn.\\nIf this be impracticable or unsafe, comminute the tooth or\\ntumor to the desired degree with the heavy chisel and ham-\\nmer, and remove the pieces with gouge or forceps. Be\\ncareful to remove all fragments. Cleanse and disinfect the\\nalveolus and tamponade with iodoform gauze or cotton, and\\ndre.ss daily. In chronic fi.stula of an alveolus after removal\\nof a tooth by other means, remove the external bony plate\\nin the manner described, as if for removal of the tooth.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0020.jp2"}, "21": {"fulltext": "Trephining the Frontal Sinuses. 7\\nTREPHININCx THE FRONTAL SINUSES.\\nFig. 4.\\nInstriinieJits Razor, scissors, convex scalpels, compres-\\nsion forceps, tenacula, probe, trephine, bone scraper, curette,\\ngouge, bone gouging forceps, hammer, chisel, disinfection\\nmaterial, absorbent cotton, long curved uterine dressing\\nforceps, bone screw, lens shaped bone knife, probe pointed\\nscalpel.\\nTechniqjie. Shave or clip the hair from the region of the\\nfrontal bone at a level with the superior border of the orbital\\ncavit}^ and disinfect the area carefulh With a heav\\\\^\\nconvex scalpel make a circular incision, as large as the\\ndiameter of the trephine, the median border of which shall\\nbe I cm. from the median line of the face, directly through\\nthe skin, subcutem and periosteum, seize the isolated area\\nwith a tenaculum and with the scalpel or bone scraper\\ndetach the periosteum from the bone and remove in one\\npiece, the skin, subcutaneous tissue and periosteum. Con-\\ntrol hemorrhage. With the centerbit extended place the\\ntrephine accurately upon the denuded area, perpendicular to\\nthe surface of the bone, and by revolving it to and fro force\\nthe centerbit into tlie bone and continue until the trephine\\nhas cut well into the bone, when the centerbit should be\\nwithdrawn and the operation continued, being careful to\\nmaintain, the trephine perpendicular to the bone. The\\noperation is facilitated by grasping the trephine between\\nthe thumb and fingers of the left hand, constituting a con-\\nduit in which it can glide back and forth. The pressure\\nunder which the sawing is carried out must not be too great.\\nWhen the bony plate which has been sawed around begins\\nto loosen, the bone screw is screwed into the centerbit open-\\ning and the piece of bone is broken out, or it is pried out\\nwith the bone gouge or chisel. Uneven edges of bone\\nshould be smoothed with the lens-shaped knife. The ab-\\nnormal contents of the frontal sinus can now escape or be re-", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0021.jp2"}, "22": {"fulltext": "8\\nTrephiniiig the FroJital Sinuses.\\nmoved with curette, forceps and scissors, and the cavity irri-\\ngated with an antiseptic fluid. The frontal sinuses are in\\nFig. 4. Trephining facial sinuses. A, Trephining frontal sinus B,\\ntrephining nasal fossa C, trephining maxillary sinuses S, dia-\\ngrammatic outline of maxillary sinuses T, diagrammatic outline\\nof inner face of the maxillarv turbinated bone.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0022.jp2"}, "23": {"fulltext": "Trephining the Maxillary Sinuses, 9\\ninunicatioii with the superior maxillary sinuses and the\\nsuperior turbinated bone of the saine side so that indirectly\\nthe irrigating fluid can escape through the nasal opening by\\nway of the maxillary sinus or the injured superior tur-\\nbinated bone. In order to prevent aspiration of the fluid,\\nwhich is generally purulent, and to facilitate its escape, irri-\\ngation must be carried out with the head elevated and\\nflexed. An artificial connection between the frontal sinus\\nand the nasal passage can be made by passing the probe in\\na downward and inward direction, forcing it through the\\nthin bony plates and mucous membrane of the turbinated\\nbone and then by means of the probe pointed scalpel cut an\\nopening about 2 cm. in diameter. In order to prevent aspi-\\nration into the lungs, the animal must be allowed to get up\\nimmediately, or if under anaesthesia, a tampon trachea tube\\nshould be inserted in the trachea. In case of severe hemor-\\nrhage, the cavit}^ can be tamponed for twenty-four hours\\nwith a long strip of gauze one end of which hangs out of the\\nwound and the tampon fixed in position by two sutures\\npassed through the lips of the wound. The operation can\\nbe carried out in the standing position if the animal is quiet.\\nTREPHINING THE MAXILLARY SINUSES.\\nFig. 4.\\nTechnique. Shave the skin over the superior maxillary\\nbone on the median side of the zygomatic ridge. Make a\\ncircular incision as large as the diameter of the trephine\\nthrough the skin, subcutem and periosteum down to the\\nbone, the lateral or outer margin of the circle being about\\n15 mm. nasalwards from the zygomatic ridge toward the\\nlateral border of the levator labii superiorus muscle and\\nplace the trephine 7 cm. above the lower end of the zygo-\\nmatic ridge. The trephining is carried out as described\\nabove. It must be remembered that the superior maxillary", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0023.jp2"}, "24": {"fulltext": "lo Trephining the Maxillary Sinuses.\\nbone increases in thickness toward the zygoma, so that the\\ninstrument muit be held at an acute angle to the vertical\\nplane of the zygoma. At the point directed the trephine\\nopening lies partly on either side of the partition between\\nthe maxillary sinuses so that both cavities are simultane-\\nously opened. This partition between the two sinuses varies\\nin location with the age of the animal and in disease is fre-\\nquently partially or wholly destroyed, so that in practice\\nthe division is frequently ignored. Should the partition\\nnot break out with the trephined disc of bone it must be cut\\nawa}^ with the hammer and chisel or with bone gouging\\nforceps. The inferior smaller maxillary sinus communicates\\nthrough an elongated slit with the inferior turbinated bone,\\nthe superior larger maxillary sinus communicates directly\\nwith the nasal passage by means of the special naso-sinusal\\nopening, so that the irrigation fluid can here also escape\\nthrough the nasal passage. Care must be exercised to not\\ninjure the superior maxillary division of the tri-facial nerve\\nin its course through the maxillary sinuses, enclosed in\\nits bony sheath. This bony conduit is, in rare cases,\\nobliterated by pressure (odontomes) leaving the nerve\\nstretched across the cavity as a white, nacrous cord, in-\\ntensely sensitive. This neural conduit divides the maxillary\\nsinuses into inner or median and outer or lateral compart-\\nments in such a way that trephining alone affords incomplete\\nand unsatisfactory drainage. If a tooth has been repulsed\\nample drainage may be afforded into the mouth. Otherwise\\nlocate by digital exploration the lower border of the median\\nor inner compartment of the sinus and make a second tre-\\nphine opening over that point, insert the index finger of one\\nhand through the trephine opening and rest it against the\\ninner or median wall of the sinus formed by the maxillary\\nturbinated bone, while with the other hand introduce the\\nlong curved uterine dressing forceps through the nostril up\\nthe nassal passage until the end of the forceps is felt with the\\nfinger, break or cut through the intervening wall and push", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0024.jp2"}, "25": {"fulltext": "Trephining the Nasal Passage. ii\\nthe end of the forceps into the sinus. Introduce a tapering,\\nantiseptic piece of cheese cloth through the trephine wound,\\ngrasp it with the dressing forceps and draw it out until the\\nlower end appears at the nostril while the upper end hangs\\nfrom the trephine wound. The strip of cheese cloth may\\nalso be inserted by means of a probe, after the opening has\\nbeen made. Arm a long probe with a strong thread, insert\\nthe probe through the trephine opening and the wound in\\nthe turbinated bone and pass it out through the nostril,\\nattach the cheese cloth to the end of the thread and draw it\\ninto the wound by pulling upon the probe. Control hemor-\\nrhage during operation a. From skin, by compression or\\nligation, b. From intre-osseous vessels, by plugging with\\na conical piece of wood pushed into the vascular opening\\nor by absorbent cotton pushed into the channel with the\\npoint of a needle or tenaculum, c. From the sinuses or\\nwounded turbines by packing with cheese cloth or cotton.\\nRemove tampons after 24 hours and renew for a second\\nday if required. Leave all wounds open and irrigate with\\ntepid antiseptics.\\nTREPHINING THE NASAIv PASSAGE.\\nFig. 4.\\nTechnique. The trephining is carried out by the method\\ndescribed, in the region of the nasal bone, close by the me-\\ndian line of the face and according to indications either\\nabove or below a perpendicular line drawn from the lower\\nend of the zygoma to the nasal arch. The operation must\\nbe immediately against the median line since otherwise the\\nmaxillary sinuses are easily opened or the superior turbine\\nwounded at the point of insertion. Special care is also\\nnecessary in removing the disc of bone, because the superior\\nturbine lies directly beneath it and bleeds profusely when\\nwounded on its dorsal aspect. In all cases after trephining\\nabout the nose or face where inhalation of blood, septic", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0025.jp2"}, "26": {"fulltext": "12\\notomT\\n\u00e2\u0096\u00a0jfr rr cf tiu PmrwUd Daui,\\nliable to occur, perform trache-\\nT basic operatioii and retain the\\nr :s past.\\n.ATION OF THZ PARO:\\n.i^^ ^i ir.-i\\npointed scalpeL ten:\\nxieedle holder, needfcs, thread, probe, absorbent cotton,\\ncmette.\\nTfflnifni^ In case of salivary fisinla, divide the fistnkMis\\nFig\\nopeirmg in the ski:: --t 5v. ;z: rnt lissnes toward the\\npaiodd gland with a probe poiated scalpel and lay the\\nparotid duct finee for a distance erf* fixMn i to 2 cm. on the\\nproxim al side kA the fistula. If the fistula has its location\\non the side of the cheek, cast the horae and shave and dis-\\ninfect the vascular r^;ioa of the inferior maxilla. When\\nthe opeiator glides a finger over the vascular region from\\nbefere backward tnere is felt a resi^4ant cord, the external", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0026.jp2"}, "27": {"fulltext": "\u00c2\u00ab3\\ntiheoEsI backer \u00e2\u0082\u00acif tkt\\n4\\nkigfa and cattily tikro^^ tks ibU.\\nthre tissae wiCb a poor of fixceps 32a\u00e2\u0082\u00ac\\nF^.\\natehrb^knid tike ex:\\nboKdercftke\\nof saliTarr calciili wi _ _ ^_ _\\nBMMi^ mad CTStic dilatdoit of tihe p\u00c2\u00abo(ki dtzct. mace toe\\nzt Ae afibrte* tx tb\u00c2\u00ab pazocai\\naad after renoval oi calc^- ^e the wotnol\\nhy BKansof tmtfistmal siitefe kk sack a war dbcac t^ie extn^\\n\u00c2\u00abd sarftce? of the \u00c2\u00a3cp^ of tike v\u00c2\u00abM\u00c2\u00bbd[ tK tbe vati of tihe ^Kt\\nare bnMngltt in e^^ttsct er ligpaie tike ifiact on tike pnodenal\\nside of tike poiat ion. L%afemi is u t r\u00e2\u0080\u0094 yfi \\\\m if Tij\\na strott^ v.^ ..iread beknd tike ^^kkt^ pwl V^r\\nof a cnnred aeedte. carrrtng: tt xroaaiii tke", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0027.jp2"}, "28": {"fulltext": "1 4 En tropin m Opera Hon\\nduct and tying with a surgeon s knot. The parotid duct\\ncan also be previous!}^ split and an internal wound made at\\nthe point of ligation. Close the skin wound by means of a\\ncontinuous suture like an overcasted seam and cover the\\noperative surface with iodoform collodion.\\nENTROPIUM OPERATION.\\nFig. 7.\\nInstruments. Razor, scissors, mouse-toolh forceps and\\nligation forceps, needles, thread, 3 per cent, borax solution.\\nTechnique. Confine the animal in the lateral recumbent\\nposition [or in the horse operate standing] shave tlie skin\\nof the affected e3 elid and disinfect. Grasp the skin of the\\nej^elid midway between the inner and outer canthus either\\nFig. 7. Entropiiim operation on the superior and inferior eyelids\\nof the dog.\\nwith fingers or mouse-tooth forceps and elevate a fold of\\nthe skin parallel with the border of the eyelid to such a\\nheight that the inverted eyelid assumes its normal position.\\nPass one finger into the conjunctival sac to make sure that\\nthe conjunctiva is not drawn into the skin fold. The fold\\nis then clipped off with the scissors immediately below the\\nforceps. Between the border of the lid and the border of\\nthe wound the skin must be left intact for at least .5 cm.\\nBleeding vessels are ligated and the wound closed b\\\\^ means", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0028.jp2"}, "29": {"fulltext": "Staphylotoviy 1 5\\nof interrupted sutures. In the dog a funnel shaped hood\\ncan be applied after the operation, in horses a flap can be\\napplied made from sev^eral thicknesses of soft gauze [or\\ngenerally left uncovered with safet3\\\\]\\nSTAPHYLOTOMY\\n[McKillip s operation for making a manual exploration of the Eu-\\nstachian tubes, guttural pouches, pharynx and posterior nares, and for\\noperations upon those structures.]\\nInstruments. (a) A ratchet mouth speculum. (d) A\\nshort, curv^ed, probe pointed bistoury equipped with a fer-\\nrule to fit the middle finger.\\nRestraint. The patient is cast and secured in the laterstl\\n(costal) recumbent position and the head is turned upward.\\nTechnique. The mouth speculum is adjusted and opened\\nas far as is possible the tongue is protracted with the left\\nhand while the right containing the knife on the middle\\nfinger is passed carefully through the fauces until the knife\\nhooks over the posterior border of the soft palate. The\\nknife is then gently drawn forward so as to make an in-\\ncision along the median line of the soft palate from the pos-\\nterior border to its attachment on the palatine bone. The\\nhand is then retracted and the speculum removed for a few\\nminutes to permit the patient to rid its throat of the slight\\nhemorrhage and mucus that might have accumulated.\\nReadjusting the speculum as before the right hand is\\nagain passed through the fauces and now that the palate is\\ndivided a digital exploration will perfectly reveal the pres-\\nence of any abnormality in the region.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0029.jp2"}, "30": {"fulltext": "1 6 Trifacial Neurectomy\\nTRIFACIAL NEURECTOMY.\\n(For relief of involuntary shaking of the head.)\\nFig. 8.\\nInstruments. Razor, scissors, convex scalpel, tenacula,\\naneurism needle, compression arter}^ forceps, needles, thread,\\nabsorbent cotton, a stout piece of muslin 12 cm. square.\\n1^^^-\\nM\\n1\\n1\\n1\\n1\\n1\\n1\\nf\\n1\\n1\\nFig. 8. Trifacial neurectomy. M, Depressed levator muscle of the\\nupper lip A supermaxillary division of the trifacial nerve at\\nthe infra-orbital foramen.\\nTechniq2ie. Secure in lateral recumbency and produce\\nanaesthesia. Remove the halter, bridle or other head-\\ngear. Shave and disinfect an area 8 to 10 cm. square over", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0030.jp2"}, "31": {"fulltext": "Trifacial Neurectomy. 17\\nthe infra-orbital neural foramen. Locate by touch the in-\\nfra-orbital foramen below the levator labii superioris pro-\\nprius muscle and displace the latter downwards (toward the\\ninferior maxilla) until the foramen can be felt above the\\nmuscle. With the muscle displaced begin an incision,\\nabove the levator muscle in order to avoid the branches of\\nthe glosso-facial vessels below it, i cm. above the foramen\\nand carry it downward directly over the middle of the 5th\\nnerve a distance of 5 or 6 cm., cutting through skin, sub-\\ncutem and the levator labii superioris alaque nasi muscle,\\nlaying bare the nerve at its emergence from the foramen.\\nLet an assistant hold the lips of the wound apart and the le-\\nvator muscle downwards with two tenacula, dissect away\\nthe connective tissue surrounding the nerve until the latter\\nis clearly defined, pass the aneurism needle beneath the\\nnerve from above downwards being specially careful to in-\\nclude the uppermost or dorsal twigs, and passing a curved\\nprobe pointed scalpel or one blade of a pair of scissors\\nunderneath it, divide the nerve at the foramen, grasp the\\nfree end with compression or other forceps and excise a\\npiece at least 3 cm. long including all branches. Clean.se\\nthe wound, sprinkle with iodoform and close with continu-\\nous sutures. Place the square piece of muslin centrally\\nover the wound and fix it securely to the skin by means of\\na strong suture at each corner, in order to protect the wound\\nwhile the other nerve is being cut. Turn the animal to the\\nopposite side and repeat the operation on the other nerve\\nexcept the square piece of muslin which is here unneces-\\nsary. As soon as the animal stands, remove the protective\\npiece of muslin from the first wound, disinfect wounds and\\nleave undisturbed to heal by primary union. Avoid halter,\\nbri dle or other fixtures which might injure the wounds\\nafter operation.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0031.jp2"}, "32": {"fulltext": "OPERATIONS ON THE NECK.\\nOPENING OF THE GUTTURAL POUCHES.\\nFig. 9.\\nInstruments. Razor, scissors, convex pointed, and\\nstraight probe pointed scalpels, mouse-toothed and ligation\\nforceps, tenacula, probe, trocar, curette, drainage tubing,\\nneedles, thread, absorbent cotton.\\nTechuque. i. Viborg s method. The operation is pos-\\nsible on the standing animal. By extending the head and\\ncompressing the jugular vein there is brought out the tri-\\nangle immediately behind the posterior border of the in-\\nferior maxilla and beneath the parotid gland comprised be-\\ntween the posterior angle of the inferior maxilla the ter-\\nminal tendon of the sterno-maxillaris muscle and the ex-\\nternal maxillar}^ vein. In this so-called Viborg s triangle\\nafter the removal of the hair and the disinfection of the\\n.skin which is maintained stretched, make a 5 cm.\\nlong incision through the skin and .skin muscle im-\\nmediately beneath the aforementioned tendon and paral-\\nlel to it. It can also be done when tense swelling is not\\npresent by raising a fold of skin 2}^ cm. high. In case of\\npronounced swelling in Viborg s triangle the operator must\\ndetermine his location for operating by the position of the\\nsterno-maxillaris muscle. Then force a passage with the\\nfinger [or with blunt scissors or other blunt instrument]\\nthrough the loose connective tissue in the area which is free\\nfrom nerves and vessels on the inner or median side of the\\nparotid gland and of the stylo-maxillaris muscle to the gut-\\ntural pouch and force a passage through it at its lowest\\npoint with the finger or a trocar. In order to open the\\nempty guttural pouch it is desirable to grasp it by means of\\nforceps. Through the operative wound a drainage tube\\ncan be introduced into the pouch, which can be fixed in its", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0032.jp2"}, "33": {"fulltext": "Openi7ig of the Guttural Pouches.\\n19\\nposition and prevented from slip])ing in or out by suturing\\nto the edges of tiie cutaneous wound, [In abscess of the\\nsub-parotid h-mph glands the operation is identical with\\nFig. 9. Head and neck of recumbent horse viewed from the side.\\nOpening of the guttural pouches (Hyovertebrotomy) according\\nto Viborg and Chabert. sm, Stylo-maxillaris muscle p, parotid\\ngland guttural pouch k^ larynx st^ sterno-maxillaris muscle\\nr, rectus capitus anticus major muscle c^ external carotid artery\\ne, external maxillary artery i, internal maxillary artery v, ex-\\nternal maxillary vein s, probe a, wing of atlas.\\nthe foregoing only that the abscess has pushed the lateral\\nwall of the pouch far inwards (medial) so that the pouch it-\\nself is not opened nor reached.]", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0033.jp2"}, "34": {"fulltext": "20 Opening of the Guttural Pouches.\\n2. Chaberfs method. Secure the horse in the lateral re-\\nCLiinbsnt position, remove the hair and disinfect the skin\\nbeneath the wing of the atlas. Make an incision about i\\ncm. in front of the lower half of the wing of the atlas and\\nparallel to it, about 6 cm. long extending through the skin\\nand skin muscle down to the parotid gland. The incision\\nis facilitated by rendering the skin tense with the left hand\\nand care is to be taken not to wound the auricular nerve\\nwhich passes directly along the atlas. Then draw back-\\nward the posterior border of the wound and separate with\\nblunt instruments the posterior border of the parotid gland\\nfrom the atlas to which it is bound l)y loose connective\\ntissue and draw the parotid gland forward with tenacula.\\nAt the bottom of the opening thus formed there is seen the\\nstylo-maxillaris (digastricus) muscle lying against the\\nmedian side of the parotid gland covered only by the\\naponeurosis of the mastoido-humeralis muscle. With the\\nhandle of the scalpel inclined toward the wing of the\\natlas penetrate in the direction of their fibers the aponeu-\\nrotic expansion of the mastoido-humeralis muscle and the\\nsterno maxillaris muscle. The puncture is thus located be-\\ntween the ninth and tenth nerves on one side and the in-\\nternal carotid on the other. Since the wall of the guttural\\npouch rests against the median side of the digastricus mus-\\ncle the pouch is opened by this incisior.. The operator in-\\nserts an index finger along the blade of the knife at first\\nand after withdrawal of the knife the other index finger\\nalso in the punctured wound and by forcibly parting these\\ndilates it. The abnormal contents are then removed by\\nmeans of forceps, curetting and irrigation. In order to pre-\\nvent adhesion of the firmly stretched stylo-maxillaris mus-\\ncle, introduce a strong drainage tube into the pouch and\\nfix it to the external borders of the wound by a suture.\\n3. Dieterich s method. This combines the operations under\\nI and 2, with the difference that the superior opening of the\\npouch is made immediatel) behind the stylo-maxillaris.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0034.jp2"}, "35": {"fulltext": "Tracheotoviy. 21\\n111 order to accomplish this the cutaneous wound over the\\nwingof the atlas must be prolonged below it. After detach-\\ning the posterior border of the parotid gland the operator\\nsearches in the loose areolar tissue with the index finger of\\nthe left hand for the vascular angle which is formed by the\\noccipital, internal carotid and external carotid arteries which\\nmay be detected by pulsation\u00e2\u0080\u0094 the same is located at a depth\\nof somewhere from 8 to 10 cm. Place the volar surface of\\nthe finger in the vascular angle and push a sharp scalpel\\nalong the dorsal surface of the finger to the pouch which\\nhere becomes opened on its posterior lateral surface.\\nThis method has the advantage over Chabert s that for\\nthe removal of hard contents (chondroid) the opening can\\nbe readily dilated, even to such an extent that the entire\\nhand can be passed into the air sac and the opening of the\\nEustachian tube be explored.\\nTRACHEOTOMY.\\nFig. 10.\\nhistnwieiits. Razor, scissors, convex scalpel, tenacula,\\ntenaculum and ligation forceps, trachea tube and suture\\nmaterial.\\nTechnique. In the superior third of the neck in the region\\nof the fourth to the sixth tracheal ring shave and disinfect\\nthe skin on the anterior surface of the neck to the extent of\\n10 cm. long b}^ 5 cm. wide. The operation can generally be\\nperformed upon the standing animal with the head extended.\\nIn lateral decubitus of the horse the operation is carried out\\nwith greater difficulty. The operator stands before the\\nright, an assistant before the left shoulder of the horse. On\\nthe shaved area the operator and his assistant takes up a\\nfold of skin 3 to 4 cm. high, transverse to the long axis of\\ntrachea, and divides the same by an incision. The 6 to 8\\ncm. long skin wound then lies in the median line of the\\nanterior face of the neck. After the skin muscle is cut", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0035.jp2"}, "36": {"fulltext": "22 Tracheotomy.\\nthrough, ill order to avoid hemorrhage separate the two\\nsterno-thyro-hyoideus muscles, by means of teiiacula, along\\nthe median line in the white strip of connective tissue.\\nThe trachea which is now laid bare is slit from below up-\\nward through thite or four tracheal rings if the operation is\\nto be performed without loss of substance. By the method\\nFig. io. Tracheotomy, s, Sterno-thyro-hyoidens muscle trachea\\nsch, mucous membrane of the posterior wall of the trachea\\ninterannular ligament.\\nwith loss of substance penetrate at the lower angle of the\\nwound, transversely, the lowest inter-annular ligament,\\nelongate the incision to the right and left, make a vertical\\nincision on each side upwards through one or two tracheal\\nrings, grasp the partially detached portion of trachea with\\nforceps and cut it out by means of an incision through the\\ninter-annular ligament, which now constitutes the only-\\nunion with the trachea. According to the size of the\\ntrachea tube and the width of the tracheal rings one or two\\ntracheal rings are removed. The outer canula of the tube is\\nnow introduced into the trachea directed upwards, the inner\\ninserted through the first and screwed fast to this with the\\nthumb screws. If the cutaneous incision is too long, occlu-\\nsive sutures should be inserted through the skin above and\\nbelow the trachea tube.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0036.jp2"}, "37": {"fulltext": "Arytenoidrraphy 23\\nINTRA-TRACHEAIv IRRIGATION.\\n[For dislodging septic or irritant substances from the trachea and\\nbronchi.]\\nlyistriunents. Same as for tracheotomy, and a gravity ir-\\nrigating apparatus fitted with 3 m. of rubber tubing about\\nI cm. diameter, 5 liters of .6 per cent, soda bicarbonate or\\nchloride .solution at a temperature of 37 39\u00c2\u00b0 C.\\nTechniqite. Operate on standing animal. Perform tra-\\ncheotomy. Elevate the gravity apparatus containing the\\nirrigating fluid i to 2 m. above the patient, have the ani-\\nmal s head slightly elevated, insert the free end of the rub-\\nber tubing in the trachea tube and let the fluid flow into the\\ntrachea in a moderate stream until it is filled and the animal\\nmakes explusive efforts, when the inflow is stopped and the\\nanimal permitted to lower his head and expel the fluid, then\\nraise the head again and repeat until the fluid is expelled\\nclear. Repeat the operation according to requirement. In\\ncases of suppurative bronchitis, peroxide of hydrogen should\\nbe added to the solution.\\nARYTENOIDRRAPHY.\\n[Merillat s operation for the cure of Roaring.\\nFig. II, 12, and 13.\\nInstruments. Scalpel, curved needle, strong suture of\\nbraided silk i m. long, retractors, long handled needle\\nholder, long tenaculum, angular or curved scissors, and\\nhaemostatic forceps.\\nTechnique. Cast the patient and anaesthetize, and place\\nand retain in the dorsal position with the head extended to\\nthe maximum on a straight line with the long axis of the\\nbody.\\nist. Make a longitudinal incision through the skin and\\nunderlying muscles from tlie base of the thyroid cartilage to\\nthe anterior margin of the first tracheal ring, dilate the", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0037.jp2"}, "38": {"fulltext": "24\\nA ryte7ioidrraphy\\nwound with retractors and control all hemorrhage before\\nproceeding further.\\nFig. II. Median longitudinal section of the larynx, showing location\\nof the ligature in arytenoidrraphy (diagrammatic), a, The left\\narytenoid cartilage b, left vocal cord c, cricoid cartilage c\\nbezePof cricoid cartilage d, d tracheal rings e, epiglottis f,\\nbase of the thyroid cartilage f\\\\ left ala of thyroid cartilage g,\\nsupraglottal sinus dotted lines representing vocal process.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0038.jp2"}, "39": {"fulltext": "A rytenoidrraphy\\n25\\n2iid. Laryngotomy. There is now exposed to view, from\\nbefore backward, the crico-thyroidean membrane, the con-\\nstricted portion of the cricoid cartilage, and the cnco-\\nFiG. 12. The third step of arytenoidrraphy (diagrammatic), a. Left\\narytenoid cartilage b, vocal cords r, the cricoid cartilage d^\\nthe first tracheal segment.\\ntracheal ligament. Pass a scalpel into the larynx through\\nthe crico-thyroidean membrane just behind the base of the\\nthyroid with cutting edge directed backward and cut\\n3", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0039.jp2"}, "40": {"fulltext": "26\\nA ryteJioidrraphy\\nthrough the above named structures. The bleeding is\\nagain controlled and especially a small vein related to the\\nanterior margin of the cricoid cartilage.\\n3rd. The incision is now gently dilated with the retractors\\nin order to inspect the laryngeal cavity. Forcible or even\\nmoderate traction with the retractors must be avoided so as\\nto prevent unnecessary injury to the cricoid cartilage. (It\\nis evident from recent observations that the injury done to\\nFig. 13. Knot used in ligating arytenoid cartilage in arytenoidrraphy.\\na, First tie b, knot completed.\\nthe cricoid cartilage by forcible dilatation of the opening is\\nfrequently the actual cause of its collapse.)\\nThe threaded needle is now passed through the space be-\\ntween the cricoid and thyroid cartilages, from without\\ninward to a point just behind the vocal process of the\\narytenoid (Fig. 11) and is directed back to the point of\\nentrance from a point just in front of the vocal process be-\\nneath the vocal cord. Th^ arytenoid cartilage is now\\npressed against the lateral wall of the larynx while an", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0040.jp2"}, "41": {"fulltext": "Intravenous Injection. 27\\nassistant draws the ligature tight and ties it by a knot con-\\nsisting of two hitches, each of which is a bow and which\\ncan be completely loosened by pulling the cut ends (Fig. 13).\\nIf the ligature is tied by any of the ordinary knots it will\\nbe necessary to again cast the patient at the time of its\\nremoval ten days later.\\n4tli. The parts around the ligature are now slightly\\nwounded so that the resulting cicatrix will hold the aryte-\\nnoid cartilage in place after the ligature is removed. This\\nwounding consists of an incision through the mucous mem-\\nbrane along the posterior border of the arytenoid and\\na resection of 2 cm. of the vocal cord beginning .5 cm.\\nfrom the ligature. Return the patient to the lateral\\nrecumbent position to revive from the anaesthetic. No\\nform of intubation or tamponing that will forcibly dilate the\\nincision is admissible.\\nAfter-care. Apply antiseptics to the superficial parts of\\nthe wound. In ten days the ligature is untied and gently\\npulled out. Alarming dyspnoea may occasionally occur\\nfrom tumefaction of the laryngeal mucous membrane, at any\\ntime during the first four days following the operation.\\nUsually this condition can be met by simply dilating the\\ndermal incision by means of sutures passed through each\\nedge of the wound and tied at the poll, but when this fails\\ntracheotomy must be resorted to. It is never advisable to\\ninsert a tube through the original incision.\\nINTRAVENOUS INJECTION.\\nFig. 14.\\nhistritments. Scissors, hypodermic syringe.\\nTechnique. The operation is performed on the standing\\nhorse on the right jugular vein at the juncture of the upper\\nand middle thirds of the neck. At this place the subscapulo-\\nhyo ideus muscle lies between the jugular vein and the", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0041.jp2"}, "42": {"fulltext": "28\\nhi travenoiis Injection\\ncarotid artery. After clipping the hair, the skin should be\\ncarefully disinfected. The vein lies in the jugular groove\\nbetween the mastoido-humeralis and the sterno-maxillaris\\nmuscles covered onl}^ by the skin and cervical panniculus\\ncarnosus muscle. The operator stands by the right shoulder\\nof the horse and compresses the jugular with the thumb of\\nthe left hand (Fig. 14) or with second to fourth fingers of the\\nleft hand, in which case the ball of the thumb rests upon the\\nmastoido-humeralis muscle, in such a way that the vein\\nbecomes filled above the point of compression in the shorn\\nFig. 14. Intravenous injection.\\narea so that it stands out like a swollen cord. In ca.se of\\nfleshy necked hoises this compression is more readily\\nattained if the animal s head is somewhat extended and\\nelevated -b}^ an a.ssistant. If the vein cannot be made promi-\\nnent in this way the compression should be alternated\\nsuddenly and repeatedly the course of the vein then reveals\\nitself b}^ a wave-like movement which runs along the jugu-\\nlar groove from above to below. Just above the point of\\ncompression the vein is most fully distended and is here also", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0042.jp2"}, "43": {"fulltext": "Venesection. 29\\nmost firmly fixed. After testing the hypodermic needle to\\nsee that it is open, insert it just above the point of compres-\\nsion, through the skin, cutaneous muscle and jugular wall\\nin tlie direction of the vein from behind and below, forwards\\nand upwards i to 2 cm. deep, so that the point of the needle\\nenters the vein at its most distended part. In this way it is\\neasy to prevent injury to the median wall of the vein. The\\nneedle is held between the second and third fingers of the\\nright hand while the thumb covers its posterior opening.\\nIf the vein has been properly punctured blood will flow\\nfrom the needle upon the removal of the thumb. In this\\ncase the compression is removed, the left hand grasps the\\nneedle, the right connects the hypodermic .syringe, in which\\nno air is contained, and slowly discharges the contents of\\nthe syringe. In withdrawing the needle be careful to press\\nthe skin firmly against the underlying part. The omission\\nof this precaution frequentl}^ results in the formation of a\\nsubcutaneous extravasation of blood. If the vein is not\\nentered at the first attempt the needle should be partly with-\\ndrawn and then pushed in again in a slightly different\\ndirection.\\nFor venesection a hollow needle 5 mm. in diameter is used.\\nVENESECTION.\\nInstrumeyits. Razor or scissors, fleams, lancet, phle-\\nbotomy trocar, spring lancet, pin, thread or suture material.\\nTechnique. I. Phlebotomy with fleams is performed on\\nthe left jugular vein with the horse standing. The point of\\noperation is the boundary line between the upper and middle\\ncervical regions, because it is here that the subscapulo-\\nhyoideus muscle which separates the jugular vein from the\\ncarotid artery is most voluminous. At this point the skin\\nis shaved or clipped and disinfected. The extended blade\\nof the fleam is grasped at the joint with tlie thumb and\\nindex finger of the left hand, while the third and fourth", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0043.jp2"}, "44": {"fulltext": "30 VenesecHo7i.\\nfingers of the left hand compress the jugular vein at a point\\nfar enough below the shaved part that the fleam blade rests\\nupon it. In fleshy necked animals the course of the vein\\nmay be clearly made out by repeated distension and relaxa-\\ntion of the vein. It is well to be careful that the point of\\nthe fleam blade is not allowed to prick the skin prematurely\\nas it causes restlessness of the animal and that the fleam\\nblade is held perpendicular and parallel to the axis of the\\nvein. The most elevated point of the distended vein should\\nbe struck by the knife in such a way that the skin, subcu-\\ntaneous muscle and jugular wall are penetrated parallel to\\nthe axis of the vein. Drive the fleam blade into the vein by\\na short, sharp blow with the extended right hand or a light\\nwooden stick. The extension on the fleam blade prevents\\nits being driven too deeply. The size of the blade to be\\nused depends upon the thickness of the skin, etc. If the\\nvein is struck, dark red blood escapes from the wound in a\\nlarge stream. I^ay the instrument aside with the right\\nhand, while the fingers of the left hand continue the com-\\npression of the vein without interruption, in order to prevent\\naspiration of air into the vein, and also that the lips of the\\nskin and vein wounds shall not become overlapped by\\nwhich the escape of blood would be impeded. The escape\\nof blood may be favored by inducing masticatory movements\\nby the horse. The amount of blood to be withdrawn varies\\nbetween three and four liters, according to the size of the\\nanimal and the object to be attained. The closure of the\\nfleam wound is brought about either by an interrupted\\nsuture or a pin suture. For this purpose the compressing\\nfingers of the left hand are relieved by the thumb of the\\nright, the wound of the skin is grasped by the left index\\nfinger and thumb, the finger above, the thumb below, and\\nthe pin is stuck perpendicularly through the middle of the\\nskin wound, a few mm. from the borders of the wound.\\nNow that both hands are released a noose of silk thread pre-\\nviously prepared is applied over the pin and the loop closed", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0044.jp2"}, "45": {"fulltext": "Venesection. 31\\nand tied. In appl3nng the loop, care is to be taken to not\\nelevate the skin from the underlying parts. If the operation\\ndoes not succeed at the first effort, one should select an\\nundamaged portion of skin for a second attempt.\\nII. With the lancet the operation is performed on the\\nright side of the neck. In both operations the operator\\nstands near the horse s shoulder. The vein is compressed\\nas illustrated in Fig. 14. The lancet is held between the\\nthumb and index finger of the right hand with the blade at\\nright angles to the handle, the thumb and finger being so\\nplaced on the blade that the latter can barely penetrate the\\nvein, and the instrument is then pushed in just in front of\\nthe left thumb through the skin subcutem and venous wall\\nas deep as the fingers holding the lancet will permit. The\\nblade must be held perpendicular to the axis of the vein,\\nthe point must not be directed backward (dorsalwards).\\nThe wound in the vein is then slit upward somewhat\\n(toward the head) by dorsal flexion of the hand. In cattle\\nthe vein is compressed b}^ means of a cord tightly drawn\\naround the neck, and the operator takes a position for his\\nown safety and convenience beside the animal on the side\\nwhere the operation is to be performed, while an assistant\\nholds the animal by the horns, [or nose]. The closure of the\\nphlebotomy wound occurs in a similar manner as in I., only\\nwith the modification that the thumb and second finger of\\nthe right hand grasps the cutaneous wound from before and\\nthe needle is pushed through the lips of the wound by the\\nleft hand with the aid of the right index finger.\\nIII. With the trocar the operation is performed in the\\nsame manner, as has been described for intravenous injec-\\ntion. So long as the flow of blood continues the compres-\\nsion of the vein must not l^e intermitted.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0045.jp2"}, "46": {"fulltext": "32\\nLigation of the Carotid.\\nLIGATION OF THE CAROTID.\\nFigs. 15 and 16.\\nInstriwients. Scissors, scalpels, tenacula, moiise-toothed\\nforceps, ligation forceps, thread, suture material.\\n4 1\\nFig. 15. a, Ligation of the common carotid\\nartery d, oesophagotomy.\\nTech7iiqice. The\\noperation may be car-\\nried out with the ani-\\nmal standing or cast.\\nThe operation is\\nmade at the s a m e\\npoint as for phleboto-\\nmy and the same\\ncutaneous wound\\nmay be used for this\\npurpose. The incis-\\nion should be at least\\n10 cm. long extend-\\ning through the skin,\\nthe skin muscle and\\nfinally the subscap-\\nulo hyoideus muscle\\nand then a passage\\nforced with the fing-\\ners, with the cautious\\naid of the knife, to\\nthe trachea. At the\\njuncture of the upper\\nand middle thirds of\\nthe neck the carotid\\nartery passes along\\nthe border between\\nthe lateral and dorsal\\nsurfaces of the tra-\\nchea, accompanied\\ndorsally by the vagus", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0046.jp2"}, "47": {"fulltext": "Ligation of the Carotid.\\n33\\nand sympathetic nerves and ventral l}- by the recurrent nerve.\\nPass the index finger over and behind the carotid until it rests\\nupon the trachea encircling the inner and lower sides of the\\ncarotid, force a way through the surrounding tissue and\\nFig. i6. Ligation of the common carotid artery, c. Common carotid\\nartery 7, juglar vein v, vagus nerve r, recurrent nerve p,\\ncervical panniculous carnosus muscle sterno-maxillaris\\nmuscle st, levator humeri muscle.\\ndraw the carotid out through the operation wound. As a\\nrule the carotid is still surrounded by the lamellar fascia,\\nwhich comes from the deep fascia of the neck in which also\\nthe three above mentioned nerves are found. After these\\nhave been carefully separated the carotid is ligated twice\\non account of its collateral anastomoses and severed in", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0047.jp2"}, "48": {"fulltext": "34\\nCEsophagotomy.\\nevery case between the two ligatures. By this means we\\navoid rupture of the artery at the point of ligation where\\nthe nutrition has been cut off, through the stretching of the\\nundivided carotid in movements of the neck. Drain and\\nsuture the skin and muscle wounds.\\nCESOPHAGOTOMY.\\nFigs. 15 and 17.\\nInstriiments Razor, scissors, convex scalpel, .straight\\nprobe pointed scalpel, tenacula, artery and ligation forceps,\\nthread, absorbent cotton, suture material.\\nFig. 17. CEsophagotomy. r, Common carotid artery 7, jugular\\nvein o, o\\\\ oesophagus s, sympathetic nerve t, trachea st,\\nmastoido humeralis (lavator humeri) muscle.\\nTechnique. The operation can be carried out on the stand-\\ning or lying animal, on the left side of the neck, because the", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0048.jp2"}, "49": {"fulltext": "Qisophagotomy. 35\\noesophagus lies on the left side of the trachea in the lower\\nhalf of the neck. When the oesophagus is empty the opera-\\ntion is performed in the lower third of the neck. An incision\\n10 cm. long through the skin and skin muscle is made be-\\ntween the anterior border of the mastoido-humeralis muscle\\nand jugular vein. With one finger each of the left and right\\nhand divide the loose connective tissue down to the oesopha-\\ngus, which lies between the left scalenus muscle, trachea and\\nthe jugular vein. Along the supero-external border of the\\ntrachea runs the carotid accompanied dorsall}- by the vagus\\nand sympathetic and ventrally by the recurrent nerves. The\\noesophagus feels like a round muscle within which one can\\nfeel a firmer cord (mucous membrane), and has a pale red\\ncolor. CEsophagus and trachea are surrounded by the deep\\nfascia of the neck. Pass one finger around the oesophagus\\nfrom behind, draw it away from the trachea, force through\\nthe deep fascia of the neck and draw the oesophagus out\\nthrough the external wound. After making an incision\\nthrough the muscle and mucous membrane introduce a\\nprobe pointed scalpel or a scissors blade into the lumen of\\nthe oesophagus and split its wall. The mucous membrane\\nis white and lies in thick longitudinal folds. When there is\\na foreign bod}^ in the oesophagus the operation is performed\\nat the point where it is lodged in the manner described and\\nthe oesophagus is opened barely enough to permit of the\\nremoval of the foreign body. In diverticuli of the oesopha-\\ngus an elliptical piece of the mucous membrane which has\\nbeen overstretched is cut out. The oesophageal wound is\\nclosed by a laminated suture, that is, the mucous membrane\\nis united by means of an intestinal suture and the muscular\\nwall sutured over this. The skin and nuLScular wound may\\neither be left open or closed with the Bayer .suture and band-\\naged, with a drainage tube in the lower angle of the wound.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0049.jp2"}, "50": {"fulltext": "OPERATIONS ON THE TRUNK AND GENITAL\\nORGANS.\\nPUNCTURE OF THE CHEST.\\nFig. i8.\\nInstrumeyits. Razor, scissors, chest trocar, vessel for re-\\nceiving the escaping fluid, dressing material.\\nTechnique. The operation is performed upon the stand-\\ning animal, which is held against a wall, the point of opera-\\ntion being the seventh intercostal space on the left side, and\\nthe sixth on the right. Dogs ma} be laid upon a table.\\nFig. 1 8, Puncture of the thorax puncture of the intestine.\\nThe ribs are enumerated from behind forward counting\\neighteen to the horse and tliirteen to the dog. Clip or\\nshave the hair and disinfect the skin immediately above the\\nthoracic vein. Hold the trocar with the handle in the\\nhollow of the right hand with the index finger on the instru-\\nment as in writing with a pen, sufficiently extended that", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0050.jp2"}, "51": {"fulltext": "Punchwe of the Intestines. 37\\nthe point of the trocar projects beyond it barely enough\\nto penetrate the thoracic walls (4 to 6 cm). After the\\nskin over the seat of operation has been drawn aside by the\\nleft hand place the trocar at the anterior border of the rib\\nslightly inclined forward and push it with a sharp thrust\\nthrough the skin, skin muscle, intercostal muscles, internal\\nthoracic fascia and pleura into the pleural sac. As soon as\\nthe resistance ceases, the thoracic cavity has been entered.\\nThe stilette is now withdrawn and the existing fluid which\\nmay be pus, blood, serum, etc., escapes. While this escape\\nis at first continuous, it later becomes rhythmic, synchro-\\nnous with expiration. The intermission of the outflow\\nduring inspiration permits, wuth the ordinary trocar the en-\\ntrance of air into the chest cavity. This occurrence may be\\navoided by closing the canula with the finger after each ex-\\npiration of the animal. The pneumothorax is best pre-\\nvented by using Billroth s trocar. [The same result may\\nbe attained with an ordinary trocar by passing a piece of\\nrubber tubing over the canula and dropping the free end in\\nthe vessel receiving the escaping liquid.] If the outflow\\nbecomes entirely interrupted introduce the stilette and re-\\nmove the occluding substance, usually fibrinous clots, from\\nthe canula. To remove the instrument, introduce the sti-\\nlette into the canula, press the skin against the chest wall\\nwith the left hand and draw the trocar out promptly. As\\nthe displaced skin resumes its normal position the puncture\\nis hermetically sealed. The outer opening may be covered\\nwith iodoform collodion.\\nPUNCTURE OF THE INTESTINES.\\nFig. 18 and i8a..\\nInstrtivients. Razor, scissors, lancet, intestine trocar,\\ndressing material.\\nTechnique. Puncture of the intestine is performed in the", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0051.jp2"}, "52": {"fulltext": "38\\nPuncture of the hitesti7ies.\\nright flank on the standing horse, lo cm. in front of the\\nexternal angle of the ilinm and the same distance below the\\ntranverse processes of the lumbar vetebrae, that is, at the\\nmost prominent part of the distension. After the skin at\\nthis place has been clipped or shaved, disinfected and dis-\\nplaced toward the external angle of the ilium, make a small\\npuncture through the skin with a lancet and then with the\\ntrocar held in the hollow of the right hand push it with a\\nstrong thrust through the skin, tendinous expansion of the\\nsubcutaneous muscle, the external and internal oblique and\\ntransverse abdominal muscles, subperitoneal fat and perito-\\nneum, in the direction of the elbow of the left side, enter-\\nFiG. i8\u00c2\u00ab. Intestine trocar with sheath,\\n3 mm., length of canula i6 cm.\\nOutside diam. of canula\\ning the base of the caecum and introducing the trocar to the\\nring on the canula. After the withdrawal of the stilette the\\nevacuation of the gas occurs at times intermittently owing\\nto collapse of the intestine. Occlusion of the canula is to be\\novercome by introducing the stilette.\\nWhen removing the trocar canula, in order to prevent the\\ndropping of food particles out of the canula into the perito-\\nneal cavity, replace the stilette, press the skin against the\\nabdominal wall with the left hand and remove the trocar\\nwith a spiral motion. The external opening may be closed\\nwith iodoform collodion. [We very much prefer a much\\nsmaller trocar than is generally sold by dealers for the pur-\\npose, the canula being 3 mm. outside diameter by 16 cm.\\nlong. The triangular point of the stilet is much elongated\\n(12 mm.) furnishing a cutting edge almost equal to a lancet,\\nthe incision with which latter is thus dispensed with, the", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0052.jp2"}, "53": {"fulltext": "Siibciitajieoiis Caudal Myotomy. 39\\nskin is not displaced, tlie trocar is held loosely by the canula\\nill the left hand and a smart blow strnck on the handle with\\nthe palm of the right hand driving the instrument through\\ninto the intestine. The wound being much smaller than\\nwith lancet, and closing at once, requires no after care.]\\nSUBCUTANEOUS CAUDAL MYOTOMY.\\n[Operation for Curved Tail.]\\nFig. 19.\\nInstruments. Sharp straight tenotome, bandage.\\nTechnique. The point or points of curvature and their\\nextent are to be carefully noted by having the animal|trotted\\naway from the operator. The curvature is generally due to\\nFig. 19. Transverse section of the tail. Caudal vertebra c, sacro-\\ncoccygeus lateralis muscle e, sacro-coccygeus superior de-\\npressor longus and brevis muscles (sacro-coccygeus inferior) i,\\nintertranversales muscles a, cocc3 geal artery s^ supero-lateral\\ncoccygeal artery infero-lateral coccygeal artery v, caudal\\nveins (dorsal, ventral, lateral) sch, caudal fascia h, skin.\\nunequal development of the two levator or extensor muscles\\n(Fig. 19^), though quite rarely the depressors (Fig. 19/)\\nmay be implicated. Confine the animal in stocks, or in", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0053.jp2"}, "54": {"fulltext": "40 Subcutaneous Caudal Myotomy.\\ndefault of these, control b}^ means of twitch and sideline.\\nCleanse and disinfect the tail and have it sharply bent by\\nan assistant in the opposite direction to the curvature.\\nLocate the longitudinal furrow between the levator and\\ndepressor muscles and at the lower margin of the levator\\njust above v, Fig. 19, insert the tenotome at the most promi-\\nnent part of curvation, the incision being parallel to the\\nmuscular fibers, and push the tenotome entirely through the\\nmuscle to the vertebra, then turning the cutting edge up-\\nwards, at the same time advancing the point of the tenotome\\ntoward the median line, sever the entire muscle. The\\nsuperior lateral caudal artery 5, Fig. 19, bleeds profusely if\\nsevered, and wounding of it may usually be avoided by with-\\ndrawing the tenotome a trifle in passing that point. Wound-\\ning the skin over the muscular incision is avoided by placing\\nthe thumb of the left hand over the line of incision so the\\nknife will be recognized as soon as the muscle and caudal\\nfascia are cut through. Remove the knife in the same man-\\nner as introduced. Release the horse and have him trotted\\nagain. If the operation is sufficient tiie tail should curve\\nin about the same degree as before, but in the opposite\\ndirection. If this has not been attained examine carefully\\nand sever any remaining bundles of muscle, and this not\\nsufficing repeat the operation as before at another point 5 or\\n6 cm. above or below the first, severing the muscle again.\\nOr if the depressor appears implicated, sever it in a similar\\nmanner. In extreme cases the entire lateral half of muscles,\\ntendons and aponeurosis may be severed. Apply an anti-\\nseptic pad to the wound and retain it by a moderately firm\\nbandage, which serves at once as an occlusive dressing and\\neffective hemostatic. Remove bandage in 24 hours.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0054.jp2"}, "55": {"fulltext": "Caudal Myectomy. 41\\nCAUDAL MYECTOMY.\\n[To prevent gripping of the reins].\\nFig. 20.\\nInstruments. Elastic ligature, straight bistoury, tenacula.\\nabsoFbent cotton, bandages, disinfecting material.\\nTecluiiqice. Confine the animal in lateral decubitis or in\\nstocks, cleanse and disinfect the tail, apply the elastic liga-\\nture as close as possible to the root of the tail and have an\\nassistant hold the tail extended upwards {i. e. dorsalwards)\\nand tightly stretched. Make an incision 15 to 20 cm. long,\\nFig. 20. Caudal myectomy. M, Depressor longus muscle.\\nover the middle of the inferior surface of one depressor\\nlongus muscle, beginning close against the elastic ligature\\nand extending toward the tail, severing at once the skin\\nand caudal fascia down to the muscle. Let an assistant\\n4", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0055.jp2"}, "56": {"fulltext": "42 Amputaiion of the Tail.\\ndilate the incision with tenacula while the operator dissects\\nthe depressor longus mnscle from the adjacent tissues at\\neither side when it is severed by a transverse incision close\\nagainst the ligature and the entire muscle dissected away\\ndown to the lower end of the wound and there excised.\\nThe small depressor brevis, lying on the median side of the\\nlongus, should not be removed, thus preserving a limited de-\\npressor power. Repeat the operation on the opposite de-\\npressor. Make two elongated tampons of absorbent cotton,\\nof the size and form of the muscles removed, saturate these\\nin i-iooo sublimate solution, insert neatly in the wounds\\nand apply a moderately firm bandage as closely as possible\\nto the elastic ligature. Remove the ligature, upon which\\nhemorrhage ensues, which is to be controlled by the appli-\\ncation of a second bandage extending higher up on the tail\\nover the previous location of the elastic ligature. Remove\\nbandage in 24 hrs. wash the parts and saturate the tampons\\nagain with i-iooo sublimate and apply a clean bandage,\\nallow it to remain for another 24 hrs. remove bandage and\\ntampons and treat as an open wound.\\nAMPUTATION OF THE TAIL.\\nFig. 19 and 21.\\nInstriime?its. Docking shears, ring cautery iron.\\nTechnique. The operation is carried out on the standing\\nanimal with the aid of the twitch and one fore foot held up\\nor side line applied to the hind feet. The point of amputa-\\ntion is determined by the location of the disease or the\\nwishes of the owner. At this point the hair is parted\\naround the tail, turned upwards and bandaged to the root\\nof the tail with a compression bandage (not a cord) which\\nat the same time serves to make the operation bloodless.\\nThen beneath the part clip the hair away for a space of 3 to\\n4 cm. around the tail, have an assistant hold the tail hori-", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0056.jp2"}, "57": {"fulltext": "Amputation of the Tail.\\n43\\nzontall3^ stand at the side behind the left leg and apply the\\ndocking shears in such a way that the clipped portion of the\\ndock rests in the semi-circular depression in the shears. By\\nquick and powerful closing of the handles of the docking\\nFig. 21. Amputation of the tail. Ivigature for binding the hair\\nof the tail upwards.\\nshears cut, if possible, between two caudal vertebrae at one\\n.stroke the skin, the fibrous fascia of the tail, the donsally\\nlocated levator, the ventrally located depressor, the curvator,\\nthe inter-transversales muscles with vessels and nerves, and\\nthe inter-articular cartilage. Grasp the .stump of the tail with\\nthe left hand and press the red-hot ring iron against the\\nparts between the skin and vertebrae for from ten to twenty\\nseconds in order to stop the hemorrhage so that a dry and\\nfirm necrotic scab covers the wound surface. In cattle and\\ndogs the tail is amputated in a similar manner between two", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0057.jp2"}, "58": {"fulltext": "44\\nU^ ethrotomy\\nvertebrae a straight knife will answer for operating instru-\\nment. Hemorrhage is likewise most promptly controlled b}^\\ncautery. Ligating the arteries and applying bandage is\\nmore aesthetic.\\nURETHROTOMY\\nFig. 22 and 23.\\nbistrmneJits. Catheter, convex scalpel, scissors, artery\\nand compression forceps, tenacula, lithotome, lithotomy\\nforceps, lithotrite, absorbent cotton, drainage tube, suture\\nmaterial.\\nTechnique. Urethrotomy may be performed on horses\\nin a standing position, the hind feet being secured with hob-\\nbles. If this is not practical)le, the animal is carefully cast,\\nafter;the urinary bladder has been empted, if possible, and\\nFig. 22.\u00e2\u0080\u0094 Urethrotomy at the ischial notch.\\nby preference the animal should be p aced in dorsal decu-\\nbitis. The point of operation will depend on the location of", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0058.jp2"}, "59": {"fulltext": "Urethrotomy.\\n45\\nthe calculus. If it is found in the pelvic portion of the\\nurethra or in the blad ler, the operation is made at the ischial\\nnotch. First the penis is drawn out from the prepuce and\\nthe catheter introduced into the urethra and pushed upward\\nuntil it has passed the ischial notch. After disinfection of\\nthe skin, render it tense and make a 5 cm. long in-\\ncisibn in the median line at the ischial arch through the\\nskin, bulbo-cavernosus muscle, spongy portion of the\\nFig. 23.\u00e2\u0080\u0094 Urethrotomy life size), h. Skin a, retractor penis muscle\\nb, bulbo-cavernous muscle c, spongy urethra urethra\\ncatheter.\\nurethra, and the urethral mucous membrane down to the\\ncatheter. In order to prevent infiltration of urine after the\\noperation, special care is to be taken to make the lower end\\nof the wound slanting in such a manner that the inner\\nwound is shorter than the outer. After the catheter has\\nbeen drawn back away from the ischial arch, introduce the\\nlithotomy forceps into the urethra or bladder, grasp the\\nstone and draw it outward its natural direction. The", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0059.jp2"}, "60": {"fulltext": "46 Ureth roto my\\ngrasping of the stone by the forceps is materiall}^ aided by\\nmeans of the left hand introduced in the rectum. One must\\navoid grasping, along with the stone, tiie mucous membrane\\nof the bladder. By careful rotary movement and pushing\\nthe forceps backward and forward the operator can deter-\\nmine before the extraction of the stone if the forceps can be\\nwithdrawn easily and without much resistance through the\\nneck of the bladder. If the stone is so large that it cannot\\npass the neck of the bladder, lithotripsy must be performed.\\nThis operation requires time and patience, since as a rule it\\nis not possible to encompass the entire calculus with the\\nforceps. That is, the narrowness of the neck of the bladder\\nprevents the sufficiently wide opening of the forceps. The\\nstone must consequentlj- be gradually broken off at its peri-\\nphery and the individual pieces of calculus removed. The\\ncharacter of the surface of the stone has an evident bearing\\nupon the practicability of lithotripsy. When this operation\\nis impossible, the operative dilation of the neck of the blad-\\nder with the lithotome can be undertaken as a last resort.\\nIntroduce the instrument closed into the bladder, it is then\\nopened and the neck of the bladder divided upward and\\nlaterally as the instrument is withdrawn. In order to pre-\\nvent injury to the rectum it should be emptied before the\\noperation is undertaken. After the removal of the stone,\\npush the catheter again over the ischial arch and luiite the\\nlips of the wound in the urethral mucous membrane by\\nmeans of intestinal sutures. Flush the bladder or urethra\\nby means of a warm 3 per cent, boric acid solution injected\\nthrough the catheter and then withdraw the latter. Finally,\\nsuture the skin wound and insert the drainage tube or iodo-\\nform gauze in the lower angle of the wound. [For student\\npractice on an anaesthetized horse, introduce a stone into\\nthe bladder through the urethral wound and practice\\ngrasping and removing it with the lithotomy forceps.]", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0060.jp2"}, "61": {"fulltext": "Amputation of the Penis. 47\\nAMPUTATION OF THE PENIS.\\nFig, 24.\\nInstruments. Elastic ligature, strong silk thread, convex\\nscalpel, artery and compression forceps.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0061.jp2"}, "62": {"fulltext": "48 Vaginal Ovariectomy.\\nTechnique. The operation is carried out on the recumbent\\nanimal, the upper hind foot being released from the hobbles\\nand drawn forward or otherwise so fixed as to not obstruct\\nthe field of operation. The point of operation is determined\\nby the character of the disease of the penis and the object to\\nbe attained by the operation. If possible amputate in front\\nof the preputial ring. After the penis is drawn out, and the\\npreputial region is carefully cleansed with brush and soap, an\\nassistant grasps the penis just behind the preputial opening\\nwith the hand and holds it firmly. A temporary elastic\\nligature is then applied in front of this hand around the\\npenis and the organ excised by circular incision about 5 cm.\\nin front of the elastic ligature or immediately in front of the\\npreputial ring. The dorsal blood vessels of the penis are\\nligated separately. The urethra lying on the ventral side\\nof the penis, and whicli is covered by the corpus cavernosum\\nof the urethra, is dissected out of the urethral groove for a\\ndistance of about 2 cm., its dorsal wall slit and the mucous\\nmembrane sutured, spread out fan-like to the surrounding\\ntissues. The urethra can also be slit dorsally and ventrally\\nand the one half sutured to the left and the other to the\\nright. A silk ligature is applied to the corpus cavernosum\\nof the penis and the elastic ligature then removed. After a\\nfew da3rs the silk ligature is also removed.\\nVAGINAL OVARIECTOMY.\\nFigs. 25, 25a, 25b, and 26.\\nhistrimients. Colin s scalpel, ecraseur 55 cm. long.\\nTechniqtie. Operate on the standing animal. Stocks are\\npar excelleyice the proper means of restraint and are essential\\nto the best results. In absence of stocks other means of\\nrestraint may be improvised. Secure the head elevated,\\nprevent arching of the back or rearing, by a rope over the\\nback, prevent lying down by two straps beneath the bod}^,", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0062.jp2"}, "63": {"fulltext": "Vaginal Ovariectomy.\\n49\\nand movements backward or forward h}^ ropes or straps\\nbehind and before the animal pinion all four feet and secure\\nthe tail tightly stretched upward to a beam.\\nFig. 25. Vaginal ovariectomy. Diagrammatic sagittal section\\nthrough dilated vagina of mare. A, Aorta R, rectum U,\\nuterus V, vagina vaginal incision.\\nWith soap, water and brush cleanse the tail, perineum and\\nvulva thoroughly, being especially careful to remove all\\ndetachable masses of sebum, 50 per cent, alcohol may be\\nused .sparingly to aid in removing the sebum. Too free a", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0063.jp2"}, "64": {"fulltext": "50\\nVagiyial Ovariectomy\\nuse of alcohol excoriates the delicate skin. Cleanse the\\nclitoris carefully. Follow the washing with a free application\\nof I looo aqueous sublimate solution to the external parts\\nand for a short distance cm.) inside the vulvar lips and to\\nthe clitoris. Do not introduce disinfectants into the health}^\\nFig. 26. Vaginal ovariectomy. Diagrammatic horizontal section of\\nuterus and dilated vagina. C, Clitoris 3f, urinary meatus V,\\nvagina O U^ os uteri U, uterus (9, ovary.\\nvagina nor deeply into the vulva as it will cause severe strain-\\ning during and subsequent to the operation and b}^ injuring\\nthe vulvo-vaginal mucosa favor subsequent infection of the\\nvaginal wound. Wash away the sublimate solution with a\\ntepid sterile .6 per cent, soda bicarbonate solution, and fill the\\nvulvo-vaginal canal with the same. After thorough disin-", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0064.jp2"}, "65": {"fulltext": "Vaginal Ovariectomy. 51\\nfectioii of the hands and arms remove the disinfectants by\\nwashing in sterile soda solution, which at the same time\\nrenders the hand unctuous and readily introduced through\\nthe vulva. Armed with the sterilized scalpel introduce the\\nright hand into the vagina promptly and when the vagina\\nis well ballooned unsheath the knife and placing it just\\nabove the os uteri (I. Fig. 25) parallel to the long axis of\\nthe uterus and a few mm. to the right or left of the median\\nline, the blade being held vertical, that is the cutting sur-\\nface parallel to the longitudinal muscular fibers of the\\nvagina, and guarding the possible extent of its introduction\\nwith the thumb and fingers, push it directly forward in a\\nstraight line with a quick thrust through vaginal mucosa,\\nthe muscular walls and the peritoneum until the disappear-\\nance of resistance indicates that the peritoneum has been\\npenetrated. This is the most critical step in the operation.\\nThe vagina of the mare possesses the property of dilating\\nin a remarkable manner like a balloon filled with air, occu-\\npying at such times practically the entire pelvic cavity, the\\nrectum collapsed, and the roof of the vagina stretched firmly\\nagainst the sacrum and in immediate contact with the great\\npelvic vessels, A Fig. 25, while at the sides and below the\\nvaginal walls are generally in immediate contact with the\\nbony walls of the pelvis. The roof of the vagina, when at\\nrest, is in contact with the floor of the rectum and attached\\nthereto by connective tissue until within 6 to 8 cm. of the os\\nuteri where the two organs are separated b}^ a peritoneal\\nduplicature which constitutes the operative area. This\\noperative area, parallel to the rectum when the vagina is at\\nrest becomes perpendicular to it when ballooned so that\\nthe operator needs to make his incision directly forward\\nthrough a tense, thin, perpendicular wall like a drum head.\\nThere is in this state no operative area above whatever and\\nan upward incision wounds the rectum and perhaps the\\nposterior aorta or one of the iliac arteries.\\nIf the hand is introduced immediately after the injection\\nof the sterile saline solution the vagina will generally be", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0065.jp2"}, "66": {"fulltext": "52 Vaginal Ovariedorny\\nfound ballooned or will quickly become inflated under\\nmovements of the hand. If the solution is thrown out. the\\nvagina may collapse and closely invest the hand, in which\\ncase more soda sohition should be injected when it will again\\ndilate. If the hand is introduced without the knife, with-\\ndrawn and then introduced with the knife it will be frequently\\nfound that the vagina has collapsed and needs a second fill-\\ning with the fluid. Patience until dilation is accomplished\\nand promptness to act when attained are prime requisites\\nto success. The knife should be pushed through the vagina\\nquickly making a clean wound the width of the knife blade,\\nwhen the latter is to be withdrawn and laid aside. It should\\nbe remembered that in this ballooned state, the anterior\\nwall of the vagina is but 2 to 3 mm. thick and easily pene-\\ntrated, the completion of the wound being indicated by the\\nsudden disappearance of resistance. Introduce the hand\\nagain, insert one finger in the incision, then a second finger,\\nand holding the fingers in the form of a cone push the entire\\nhand into the peritoneal cavity. Immediately below the in-\\ncision and continuous with the tissues involved in the wound\\nlies the uterus with a transverse diameter of 4 to 6 cm.\\nWith the palmar surface of the hand downwards,, trace the\\nuterus forward a distance of 15 to 18 cm., where it ends\\nabruptly in two cornua of about the same size as the uterus,\\nwhich are given off horizontally at almost right angles.\\nTrace these to right and left for a distance of 14 or 15 cm.,\\nwhere they end obtusely, and 3 or 4 cm. beyond this in a\\ndirect line, resting upon the anterior border of the broad\\nligament is the dense oval ovary varying in size from 2.5 to\\n7 cm. in diameter. Withdrawing the hand, carry the\\necraseur enclosed within the hand through the vaginal\\nwound to the region of the ovary, release the ecraseur and\\nretrace the parts if necessary, and locating the ovary drop\\nthe chain over the ovary from above and either grasp the\\novary with the fingers through the chain loop from above\\nand draw it into the loop or passing one or two fingers\\naround beneath the ovary push it up through the loop to be", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0066.jp2"}, "67": {"fulltext": "Vaginal Ovariectomy\\n53\\ngrasped by the thumb and index finger above. The chain\\nloop should be of barely sufficient size to admit of the easy\\npassage of the ovary. Holding the ovary with the one hand\\ntighten the chain quickly with the other, examine to make\\nsure that a loop of intestine is not caught, draw the ovary\\nwell through and get a large portion of the oviduct, and cut\\noff promptly, holding to the ovary until carried out through\\nthe vulva. Remove the other ovary in the same way.\\nGenerally it is most convenient to remove the left ovary\\nwith right hand and vice versa, but both may be removed\\nwith either hand. Wash away any blood from external\\nparts, applv sublimate solution freely to vulva, perineum\\nand tail. Keep the patient quiet for five or six days, and\\nfeed lightly on laxative diet. If infection occur mop out\\nthe vagina with antiseptics. If abscesses form open them\\npromptly into the vagina or rectum by thrusting an index\\nfinger through their walls. If the infection causes difficult\\ndefecation by pressure on the rectum or swelling of its coats\\nthrough inflammator}^ implication keep the feces pultaceous\\nby means of enemas.\\nJOHN REIYNDERS CO. NEW YORK\\nFig. 25a. Special spa5 ing ecraseur 55 cm. long.\\nJ REYNDERSaCO.NEWYORK-\\nFlG. 25b. Colin s scalpel.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0067.jp2"}, "68": {"fulltext": "OPERATIONS ON THE EXTREMITIES.\\nTENOTOMY OF THE FLEXOR PEDIS TENDON.\\nFig. 27.\\nInstruments. Razor, scissors, sharp tenotome, bandage\\nmaterial.\\nTechiiiqiie. Tenotomy is generally performed on the ten-\\ndon of the deep flexor of the foot or perforans, seldom on\\nthe superficial flexor or flexor of the os coronse of the ante-\\nrior foot. The horse is -laid on that side upon which the\\naffected foot is located and the member to be operated upon\\nis bound upon a narrow board or extension splint of suffi-\\ncient strength to retain the foot in complete extension.\\nThe median side of the foot is upward, the extending splint\\nunderneath. [With the operating table the extension splint\\nis uncalled for.] On the median side at the middle of the\\nmetacarpus the skin is shaved and disinfected over the ten-\\ndon of the flexor pedis. The left hand grasps the meta-\\ncarpus from above and behind in such a manner that the\\nthumb rests upon the median or upper surface of the meta-\\ncarpus, the index and second fingers on the lateral or under\\nside of the flexor pedis tendon. While the left thumb\\npushes the skin toward the metacarpal bone, that is, for-\\nward, a sharp pointed tenotome held perpendicularly in the\\nright hand is introduced with the cutting edge toward the\\nhoof through the skin, subcutem and anti brachial fascia\\ndown to the flexor pedis tendon. Immediately on the ante-\\nrior border of the tendon insert the tenotome so far that the\\npoint of it can be felt on the lateral or outer side through\\nthe skin with the left hand. The cutting edge of\\nthe knife is then turned against the tendon of the flexor\\npedis, that is, it is directed backward, the fore foot is ex-\\ntended by an assistant by means of a rope bound around the", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0068.jp2"}, "69": {"fulltext": "Tenotomy of the Flexor Pedis Tendoii.\\n55\\npastern and looped around the hoof, and the. extensor pedis\\ntendon is cut through under light pressure, by the operator\\npressing downward on the liandle of the knife. A loud\\ncrackling as well as the disappearance of resistance by ex-\\ntension shows that the tendon is severed. In this way we\\ncan avoid injury to the common digital artery, the internal\\ncutaneous vein and the internal and external interosseus", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0069.jp2"}, "70": {"fulltext": "56 Strbighalt Operation.\\nveins which run between the flexor pedis and the suspen-\\nsory ligament. After the removal of the knife and after\\nseeing that there is a wide space between the ends of the\\ntendons, the foot is unbound from the splint and the band-\\nage applied to the metacarpus, which rests upon the fetlock\\njoint and remains in position for eight days. Healhig of the\\ncutaneous wound b}^ primary union.\\nSTRINGHALT OPERATION.\\n[Tenotomy of the lateral extensor of the pedis.]\\nFig. 28.\\nInstrjunents. Razor, scissors, sharp tenotome.\\nTechiiqiie. On the lateral side of the metatarsus there is\\nformed a triangle opening toward the tarsus formed by the\\ntendons of the extensor pedis longus muscle and the lateral\\nextensor of the foot which unite on the anterior surface in\\nthe middle of the metatarsus. The tendonous sheath of the\\nextensor pedis longus muscle reaches toward the toe to near\\nthe point of juncture of the two tendons the sheath of the\\nlateral extensor ends below 3 to 4 cm. above the point of\\nunion. In the middle of this space witiiout a sheath, which\\nis 3 to 4 cm. long, and below the annular ligament of the\\nhock the operation is carried out, after the skin has been\\nshaved and disinfected. The operation can be performed\\nupon the standing horse, a twitch being applied and the\\nhind foot being taken up as for shoeing. The tendon of\\nthe lateral extensor is easily felt under the skin as a hard\\ncord about the size of the little finger. Stretch the skin\\nand grasp the tendon with the thumb and index finger of\\nthe left hand, insert the sharp tenotome with the cutting\\nedge toward the foot perpendicularly upon the tendon\\nthrough the skin, subcutem and aponeurosis derived from\\nthe crural fascia push the knife from before backward\\nunder the tendon, direct the cutting edge of the teno-\\notome against it and with the hock extended sever the", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0070.jp2"}, "71": {"fulltext": "S// -1)10 11 a It ^pe a tio n\\n57\\ntendon as well as the fascia Ihrongh to the skin. If the\\ntendon has been completely severed its retracted ends may\\nFig. 28.\u00e2\u0080\u0094 Stringhalt operation (tenotomy of the lateral extensor).\\nRight hind foot seen from the external side. The skin covering\\nthe lateral extensor of the foot is laid back in the form of a flap,\\nthe crural fascia divided. Tendon of the lateral extensor of\\nthe foot (peroneus) crural fascia; tendon of the anterior\\nextensor pedis muscle d, the triangle formed by and e.\\nbe felt under the .skin i to 2 cm. above and below the\\nwound. After the operation an antiseptic bandage is ap-\\nplied resting upon the fetlock. The bandage should re-\\nmain eight days and the cutaneous wound heal by first in-\\ntention.\\n5", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0071.jp2"}, "72": {"fulltext": "58 Cunean Tenotomy.\\nCUNEAN TENOTOMY.\\nFig. 29.\\nhistruments. Razor, straight scalpel, tenotome.\\nFig. 29. Cunean tenotomy. Tendon of the cunean branch of flexor\\nmetatarsi muscle exposed.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0072.jp2"}, "73": {"fulltext": "Plantar Neiirectoviy. 59\\nTechnique. Most horses can be operated on standing,\\notherwise cast on the affected side and extend the tarsns.\\nShave and disinfect an area 5 to 6 cm. square on the inferior\\nmedian surface of the hock over the course of the cunean\\ntendon of the chief flexor of the metatarsus. Locate the\\ntendon b\\\\ palpation as it passes obHquely downward and\\nbackward and make a perpendicular incision at a point\\nmidway between the anterior and posterior borders of the\\nhock or slightly anterior thereto about i cm. long, begin-\\nning at the lower border of the tendon and extending down-\\nwards toward the foot. Insert the tenotome beneath the\\ninferior border of the tendon and depressing the handle cut\\nupwards and outwards through the tendon and fascia to the\\nskin, or inserting the tenotome flatwise between the skin\\nand tendon push it upwards to the superior border of the\\ntendon, then turn the cutting edge of the tenotome toward\\nthe tendon and elevating the handle, using the superior\\nborder of the wound as a fulcrum, cut the tendon through\\nfrom above downwards. By firm pressure upon the teno-\\ntome in the latter method periosteotomy is simultaneously\\naccomplished. The completion of the operation is evidenced\\nby the retraction of the cut tendon leaving a well marked\\ndepression at the point of operation. Disinfect the wound,\\napply an aseptic bandage and allow to remain undisturbed\\nfor 6 days. Healing by primar}^ union.\\nPLANTAR NEURECTOMY.\\nFig. 30.\\nInstru7nents. Razor, scissors, convex scalpel, artery for-\\ncep compression forceps, tenacula, needles, suture mate-\\nreal, elastic ligature.\\nTechnique. A bandage saturated with sublimate or\\ncreolin solution is applied to the fetlock joint of the horse 24\\nhours before the operation, and the animal is cast in such a", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0073.jp2"}, "74": {"fulltext": "6o\\nPlantar Neurectomy\\nBig. 30. Plantar neurectomy. a,\\nLateral digital artery i\\\\ lateral digi-\\ntal vein 11, common lateral digital\\nnerve d, anterior branch o, pos-\\nterior branch s, superficial flexor\\ntendon p, perforans tendon z, sus-\\npensory ligament of fetlock\\nmetacarpus.\\nmanner that the median\\nside of the foot to l)e oper-\\nated upon lies upward\\nthe nerve on the median\\nside is operated on first\\n[except when both feet\\nare to be operated on\\nat once, when the me-\\ndian plantar on one foot\\nand the external nerve\\non the other are cut in\\nfirst position]. Bind the\\nfoot upon the extension\\nsplint and apply the elas-\\ntic ligature above the\\ncarpus. [With the oper-\\nating table the extension\\nsplint is not required\\nthe operation is also read-\\nily performed on the\\nstanding animal with\\nthe aid ofcocaine.] After\\nremoval of the bandage,\\nshave the site of oper-\\nation and thoroughly dis-\\ninfect the region of the\\nmetacarpus and fetlock\\nwith soap, brush, and\\nsublimate or creolin solu-\\ntion and 50 per cent,\\nalcohol. Passing the\\nfingers from before to\\nbehind with light pres-\\nsure over the region of the\\nfetlock joint, there is felt\\njust in front of the flexor", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0074.jp2"}, "75": {"fulltext": "Plantar Neutcctomy. 6i\\npedis tendon a channel-like depression extending from above\\nthe fetlock downward over it. In this chann.el lies the thread-\\nlike cord of the nerve 3 mm. thick, which glides forward\\nunderneath the fingers with an audible, palpable recoil.\\nThe site of operation lies immediatel}- above the fetlock in\\nthe ^posterior third of the metacarpus. Here stretch the\\nskin f^etween the index finger and thumb of the left hand and\\nmake a cutaneous incision between the thumb and finger\\ndirectly over the nerve 3 to 5 cm. long, the lower angle of\\nwhich lies imniediatel}- above the fetlock joint. The bor-\\nders of the cutaneous wound are held apart with tenacula\\nand by palpation of the white subcutis with the fingers, it\\nis determined if the nerve lies in the middle of the wound.\\nIf this be the case the subcutis is grasped with the forceps\\nand carefully dissected by incisions parallel to the course\\nof the nerve and the blood vessels, until the contour of the\\nnerve is clearly brought out. [We prefer extending the in-\\ncision directly upon the nerve without any tearing or pull-\\ning at the connective tissue by forceps or otherwise]. The\\nnerve is distinguished by its yellowish color, its fine longi-\\ntudinal fibers and its location behind the blood vessels.\\nImmediately above the fetlock joint the median metacarpal\\nor metatarsal nerve divides into an anterior smaller and\\nposterior larger branch. This division must be laid bare in\\norder that the operator should not erroneously cut one\\nbranch only. Immediately above this point of division the\\naneurism needle armed with the thread is passed under the\\nnerve and the tliread tied in a single knot. The pressure\\nof the thread upon the nerve causes severe struggling by\\nthe animal. The thread being held taut so that the nerve\\nis drawn above the surrounding tissues insert one blade of\\nthe scissors or a small probe pointed bistoury beneath the\\nnerve above the ligature and cut the nerve through quickly\\nat the superior angle of the wound. The nerve is then dis-\\nsected free as far as possible downward and both branches\\nexcised at the lower angle of the wound so that a section 3", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0075.jp2"}, "76": {"fulltext": "62 Digital Ne^irectomy\\nto 5 cm. long is removed. In front of the nerve lies the\\nmedian metacarpal artery and in front of this the median\\nmetacarpal vein. Tiie cntaneous vvonnd is united by a con-\\ntinuous suture and a temporary bandage applied. The ex-\\ntension splint is then removed, the foot replaced in the\\nhobble and the horse turned to the other side. Neurectomy\\nof the lateral metacarpal nerve is carried out in the same\\nway after which a sterile bandage is applied which is al-\\nlowed to remain eight days. Healing by primary union.\\nDIGITAL NEURECTOMY.\\nFig. 31-\\nhistrumetits Razor, scalpel, probe pointed scalpel, te-\\nnacula (2), aneurism needles (2), bandages.\\nTecJiJiiqtie. Restraint of animal the same as for the plantar\\noperation. Extending downwards from the fetlock joint\\ntoward the coronet, between the posterior border of the pha-\\nlanges and the deep flexor tendon there is a slight furrow at\\nthe posterior part of which, close to the external margin of the\\ntendon, lies the median or principal digital nerve (the chief\\nbranch of the metacarpal or metatarsal) accompanied in\\nfront by the digital artery, in front of which lies the digital\\nvein. Immediately behind the nerve and generally lying a\\ntrifle deeper, is quite commonly found a second venous trunk\\nof considerable size. Near the middle of the first phalanx\\nthe nerve is crossed externall}^ in an oblique direction from\\nabove to below and from behind to before by a white liga-\\nmentous band slightly broader than the nerve extending\\nfrom the posterior region of the fetlock to the lateral cartilage\\nof the pedal bone. This must not be mistaken for the nerve\\nand need not be if it is remembered that the nerve is accom-\\npanied on the same plane and in a like direction by the\\nsatellite artery and vein, the former being enclosed with the\\nnerve in a fibrous sheath. Midwa}^ between the fetlock and", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0076.jp2"}, "77": {"fulltext": "Digital Neurectomy\\n63\\ncoronet and over the groove between llie flexor pedis tendon\\nand the phalanges shave and disinfect an area 4 lo 5 cm.\\nI\\nFig. 31. Digital (low plantar) neurectomy. V, vein; A, artery\\nA^, nerve.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0077.jp2"}, "78": {"fulltext": "64 Neurectomy of the Median Nerve.\\nsquare. In the center of tliis area nt the anterior border of\\nthe flexor tendon, with the scalpel held perpendicular to the\\nskin, make an incision from above downwards a distance of\\nfrom 2 to 3 cm., cutting cleanly through the skin and sub-\\ncutaneous fascia down upon the nerve. The incision is\\nfavored by tensing the skin between the thumb and index\\nfinger of the left hand, but care should be taken to not dis-\\nplace it backwards or forwards. Dilate the wound by pres-\\nsure with the thumb and index finger or otherwise and care-\\nfully incise longitudinally the fibrous sheath enveloping the\\nnerve and artery. Pass an aneurism needle beneath the\\nnerve, and follow with a second aneurism needle immediately\\nbeside the first. Draw the two apart, one toward the toe,\\nthe other toward the fetlock, and separate thereby the nerve\\nfrom the surrounding tissues. Remove one aneurism needle,\\ninsert the probe pointed scalpel beneath the nerve, and di-\\nvide it at the upper angle of the wound and excise a section\\nof nerve 3 cm. long. Disinfect and i)andage with or with-\\nout sutiu ing wounds. Leave bandage in place 6 to 8 days.\\nNRURECTOMY OF THE MEDIAN NERVE.\\nFig. 32.\\nInstnimeJits. Razor, scissors, convex scalpel, artery and\\ncompression forceps, tenacula, aneurism needle, suture\\nmaterial.\\nTechyiiqite. The operation is performed on the median\\nsurface of the humero-radial articulation on the recumbent\\nhorse after the affected foot has been removed from the hob-\\nbles and bound upon the extension splint [or fully extended\\non the operating table]. The foot is drawn out firmly from\\nthe shoulder, inclined somewhat forward. The operator\\nkneels between the neck and the forearm and, after the\\nregion of the elbow joint is washed with soap and water,\\n.searches for the median nerve where it glides over the pos-", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0078.jp2"}, "79": {"fulltext": "Neiirectomy of the Median Nerve. 65\\nterior part of the joint to disappear behind the radius.\\nShave the skin at this point, disinfect it with soap, sublimate\\nor creolin solution and 50 per cent, alcohol. The nerve lies\\nas a rule somewhat in front of the middle of the median side\\nof the forearm [on a line with the postero-internal margin\\nof the radius] and can be felt lying somewhat deeply about\\nFig. 32.\u00e2\u0080\u0094 Median neurectomy. Median surface of thejight humero-\\nradial articulation. a, Brachial artery; median nerve; z\\\\\\nbrachial vein antibrachial fascia sterno-aponeuroticus\\nmuscle.\\n5 to 6 mm. in diameter. The position of the nerve varies\\nwith the different position of the forearm. In fat and fleshy\\nhorses the identification of the nerve is more difficult. The\\nnerve can even be felt upon the standing animal, andTde-\\ntermined whether it will be difficult to find or not. With", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0079.jp2"}, "80": {"fulltext": "66 Neurectomy of the Median Nerve.\\nthe nerve lying between the thnnib and index finger of the\\nleft hand, stretch the snperposed skin and immediately upon\\nthe nerve and parallel to it make an incision 5 cm. long,\\nfirst through the skin, then through the sterno-aponeuro-\\nticus muscle. Any hemorrhage from the skin, subcutis, or\\nmuscle, is checked. The tenacula are inserted in the lips\\nof the wound, and these being drawn apart the white anti-\\nbrachial fascia is brought to view and a search is made\\nwith the index finger to determine if the nerve lies in the\\nmiddle of the wound, the fascia is divided immediately over\\nthe nerve with the scalpel and an oval piece of it excised\\nwith the scissors. If much fatty tissue is found between the\\nlayers of fascia it may be teased out carefully with two pairs\\nof forceps and cut awa}^ with the scissors. There now\\ncomes to view a delicate reddish colored fascia-like mem-\\nbrane, the nerve sheath, behind which a blue cord, the\\nbrachial vein, is visible, the latter being intimately con-\\nnected with the nerve sheath. The vein lies mostly behind\\nand beneath the nerve and projects out over the anterior\\nborder of the same. [The operator needs be careful not to\\nprick this vein with tenacula, as the hemorrhage therefrom\\nis exceedingl} annoying during operation.] Still farther\\nforward may be felt the pulsating brachial artery. Incise\\nthe nerve sheath carefully and divide it upward and down-\\nward with the .scissors, whereupon the yellowish and dis-\\ntinctly fibrous nerve comes into plain view, or carefully part\\nthe nerve from the vein with the handle of the scalpel.\\nCarry the aneurism needle beneath the nerve from behind\\nforward and tie the thread around the nerve. The horse\\nusually reacts by powerful struggles. Draw the thread\\nfirmly so that the nerve is lifted up and cut it through at\\nthe superior angle of the wound by a sudden clip with the\\nscissors [or with the probe pointed scalpel]. After the peri-\\npheral end of the nerve has been laid bare to the lower\\nangle of the wound, a distance of at least 3 cm., it is ex-\\ncised. Tamponade the wound with dry iodoform gauze", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0080.jp2"}, "81": {"fulltext": "Neurectomy of the Ulnar Nerve. 67\\nand approximate the skin with a cuiitiiiuous suture. The\\ntampon and sutures remain from i to 2 days. Since the\\nsensation of the lower part of tlie g is also maintained by\\nthe deep branch of the ulnar nerve which below the carpus,\\ncovered by the tendon of the oblique flexor of the carpus,\\ncommunicates with the lateral plantar nerve, neurectomy of\\nthe median nerve does not completely effect the desired end.\\nIn order to produce complete anaesthesia, therefore, from\\nmedian neurectomy, it is necessary at the same time to\\nperform ulnar neurectomy. (Compare follow^ing chapter.)\\nNEURECTOMY OF THE ULNAR NERVE.\\nFig- 33-\\nhistruvients. Same as preceding.\\nTechjiique. Above and behind the carpus there may be\\nfelt a groove between the external and the middle flexors of\\nthe carpus. At this point 10 cm. above the pisiform bone\\nthe skin is shaved and disinfected and an incision 6 cm long\\nmade through the skin and antibrachial fascia. This in-\\ncision extends just outside the median line of the posterior\\nsurface of the radius in such a way that the superior angle\\nof the wound is about i cm. farther outward than tlie lower.\\nBeneath the fascia between the aforementioned muscles is\\nseen the ulnar nerve, on the median or inner side of it the\\ncollateral ulnar vein and between the two and somewliat\\ndeeper the collateral ulnar artery. The nerve, about 3 mm.\\nin diameter is picked up with the aneurism needle, severed\\nat the upper and lower angles of the wound, the lips of the\\nwound united by a continuous suture and a bandage ap-\\nplied. Healing by first intention. This operation is, as\\nhas already been remarked, only carried out in connection\\nwith neurectoni} of the median nerve.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0081.jp2"}, "82": {"fulltext": "68\\nNeurectomy of the Ulnar A^erve,\\nFig. 33. Ulnar neurectomy. Right forearm seen from behind, e,\\nExternal flexor of the carpus oblique (middle) flexor of the\\ncarpus a, collateral ulnar artery b, antibrachial fascia n, ulnar\\nnerve.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0082.jp2"}, "83": {"fulltext": "Boss/ s Double Xeurectoviy for Spavin. 69\\nBOSvSrS DOUBLE NBURKCTOMY FOR SPAVIN.\\nI. NEURECTOMY OF THE POSTICRIOR TIBIAL NERVE.\\nInstrinncnts. As in preceding.\\nTecjuiique. The opeiation is performed on the recumbent\\nhorse on llie innei side of the leg 10 cm. above the summit\\nof the OS calcis. The upper foot is bound forward hy means\\nFig. 34.\u00e2\u0080\u0094 Sciatic neurectomy. Right hind leg viewed from the median\\nside. Crural fascia sciatic i tibial 1 nerve plantar vein.\\nof a side Hue [or with the operating table the upper foot is\\nsecured in tlie advanced position]. Tiie tibial (sciatic)\\nnerve is tlien souglit for by grasping the leg with the left", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0083.jp2"}, "84": {"fulltext": "yo Bossi s Doud/e Neurectomy for Spavin.\\nhand from behind in sucli a manner that the thumb rests\\nabove and the forefingers below the leg. Reaching forwsrd\\nwith the fingers to the deep flexor of the foot grasp the leg\\nwith moderate firmness and draw the hand slowly backward.\\nImmediately behind the perforans muscle and between this\\nand the tendo- Achilles the nerve nearly i cm. in diameter\\nglides away forward from between the fingers with a pal-\\npable and audible recoil. If the nerve can not be found in\\nthis manner the hock should be strongly extended, by which\\nmeans the nerve is caused to recede from the perforans\\nmuscle, so that it can readily be felt near the middle of the\\ngroove extending between the tendo Achilles and perforans\\nmuscle. At this point the skin is shaved, disinfected and\\nan incision made through it 5 cm. long, parallel tothetendo-\\nAchilles. The white rigidly-stretched crural fascia is now\\ndivided in the same direction after which it should be deter-\\nmined by palpation that the nerve lies in the middle of the\\nwound, excise with the scissors an elliptic or oval piece of\\nthe fascia or hold apart the fascia along with the lips of the\\ncutaneous wound by means of the tenacula. In poor horses\\nthe contour of the nerve covered only by loose connective\\ntissue stand out prominentl}^ in fat horses the nerve is sur-\\nrounded by a large amount of adipose tissue. After this fat\\nand connective tissue has been grasped with forceps it may\\nbe excised. The tibial nerve is now in sight, immediately\\nbefore it lies the plantar vein and on the lateral side (be-\\nneath the nerve as the animal lies) is situated the recurrent\\ntibial artery separate these completely from the nerve with\\nthe handle of the scalpel, pass the aneurism needle from be-\\nfore backward beneath the nerve and cut it off at the upper\\nand lower angles of the wound removing a section of nerve\\nat least 5 cm. long. Suture the cutaneous wound aud apply\\na bandage allowing it to remain eight days. Healing by\\nfirst intention.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0084.jp2"}, "85": {"fulltext": "Bossi s Double Netwectomy for Spavhi. 71\\nII. ANTERIOR TIBIAL NEURECTOMY.\\n[Neurectomy of the Deep Branch of the Peroneal Nerve.]\\nFig. 35.\\nInstruments. As in preceding.\\nTechniqjie. Confine as in preceding with affected leg\\nuppermost. Locate the furrow dividing the extensor pedis\\nlongus and lateralis peroneus) muscles and shave and disin-\\nfect the skin over an area 6 cm. long by 3 cm. wide directly\\nover this depression and extending upw^ard from a point\\n6 or 7 cm. above the tibio-astragaloid articulation.\\nAt a point 8 to 10 cm. above the flexure of the hock make\\nan incision 5 or 6 cm. long over the line of division between\\nthe two extensors of the foot, through the skin, the tibial\\naponeurosis and the special aponeurosis enveloping the ex-\\ntensors. Superficially the operator passes near by the\\ncutaneous division .of the anterior tibial nerve. Separating\\nthe two muscles for their entire thickness there is found\\nlying deeply 3 to 6 cm. from the surface, and accompanied\\nby a small artery and vein, immediatel} against the flexor\\nmetatarsi magnus, the deep lying branch of the peroneal\\nnerve. Pass the aneurism needle beneath it and remove a\\npiece 3 to 4 cm. long. Close the cutaneous wound with in-\\nterrupted sutures and dress antiseptically without bandage.\\nThis operation is performed only in connection with the\\npreceding and for the same purpose as ulnar, with median\\nneurectomy, 2. e., to complete the anaesthesia of the tarso-\\nmetatarsal parts.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0085.jp2"}, "86": {"fulltext": "72\\nBossi s Double A^eitredomy foi- Spavin,\\n^f-j -mtA\\nN\\n^^s^^\\nFig. 35. Anterior tibial (peroneal) neurectomy, P, Peroneus muscle\\nE, extensor pedis longus muscle tV, deep branch of the peroneal\\nnerve.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0086.jp2"}, "87": {"fulltext": "Resection of tJic Lateral Cartilage. 73\\nRESECTION OF THE LATERAL CARTILAGE.\\n(Ouittor Operation.)\\nFig. 36 and 37.\\nhistruvients. Elastic bandage, drawing knife, scissors,\\nrazor, hoof plane, tooth splinter forceps or other heavy\\nforceps for the removal of the horn, artery forceps, double-\\nedged sage knife, curette, needle holder, thread, needles,\\niodoform ether, iodoform gauze, tampons, absorbent cotton,\\nbandages.\\nTechnique. A few hours before the operation the affected\\nfoot of the horse is placed in a bath of creolin .solution after\\nhaving first made a semicircular groove in the horn of the\\nlateral wall and quarter down to the horny lamina. The\\noperation is i)erformed upon the recumbent anaesthetized\\nanimal, in such a position that the diseased cartilage of the\\naffected foot lies upwards. After the application of the\\nelastic bandage the groove in the horn is deepened with the\\ndrawing knife down to the .sensitive laminae without injuring\\nthem. The groove must be .so located that it reaches the\\nanterior end of the lateral cartilage, remaining a few cm.\\ndi.stant from the bearing surface of the wall and .so that the\\nlower semicircular border approaches the .sensitive laminae\\nabruptly. The hair on the coronary band is clipped or\\nshaved and the entire foot up to the fetlock joint thoroughly\\ncleansed wnth brush, soap, creolin or sublimate solution and\\n50 per cent, alcohol. The levator is then inserted beneath\\nthe lowest part of the semicircular piece of horn wjiich has\\nbeen isolated, the horn is elevated from the sensitive struct-\\nures somewhat, grasped with the splinter forceps and care-\\nfully loosened from the sensitive laminae by drawing upward\\nin the direction of the lamina and by drawing backward\\nfrom the coronary papillae and keraphyllous tissue. After\\nthe coronary- band has been smoothed with the scissors,\\nmake two perpendicular incisions through the skin of the\\ncoronary band and the coronary band itself, one behind the\\n6", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0087.jp2"}, "88": {"fulltext": "74\\nResection of the Lateral Cartilage\\nanterior and the other in front of the posterior border of the\\ngroove in the horn and connect the two b} means of a semi-\\nFiG. 36. Resection of the lateral pedal cartilage. Horny wall re-\\nmoved sensitive laminae and cutaneous flap held upwards. Posteri-\\nor half of the cartilage excised. Sensitive laminse Z\u00c2\u00a3/, coronary\\nband k, anterior half of cartilage h, cavity caused by the re-\\nmoval of the posterior half of the cartilage n, necrotic cartilage\\nparachondral surface of the skin and sensitive laminae s, per-\\npendicular, crescent-shaped incision in the horny wall g, fistula.\\ncircular incision in the sensitive laminae. This U-shaped\\nincision must be so made that between it and the horny wall", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0088.jp2"}, "89": {"fulltext": "Resection of the Lateral Cartilage.\\n75\\nthere is left an area of sensitive laniince at least 2 cm. wide.\\nThe isolated flap is now dissected closely against the os pedis\\nand its ala and later from the lateral surface of the carti-\\nlage, the operator first lifting the flap with i)incers, later\\nwith the left hand. Above the cartilage toward the fetlock\\nFig. 37. Resection of lateral cartilages. Completed operation\\nsutures\\nthe operator must keep the fingers of the left hand against\\nthe external skin in order to avoid cutting through it or\\nthinning it too much at this point. The flap is held\\nturned upwards by an assistant. As a rule there is now\\nseen a prominent greenish colored necrotic piece of cartilage\\nsurrounded by brownish red masses of granulations. By\\nmeans of an incision through the cartilage parallel to the", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0089.jp2"}, "90": {"fulltext": "76 Resection of the Lateral Cartilage.\\naxis of the foot, divide the cartilage into. anterior and pos-\\nterior halves and extirpate the latter first, by dissecting it\\nout on the outer and inner side from the parachondral tissue\\nwith the double-edged sage knife. The point of the sage\\nknife must be constantly directed against the cartilage.\\nSince the inner surface of the anterior half of the cartilage\\nlies immediately against the capsular ligament of the corono-\\npedal articulation the latter should be sharply extended by\\nwhich means the capsular ligament is drawn away from the\\ncartilage before its extirpation. The anterior half of the\\ncartilage is then removed in the same way, except with\\nthe greatest possible care. Remnants of cartilage and\\ngranulations are to be removed with the curette. Tlien\\ncut away with the scissors and knife any remnants of\\ncartilage adherent to the flap, thin if necessary the entire\\nflap and excise the fistulous openings. After thorough\\ndisinfection of the entire field of operation return the flap to\\nits former position and retain it there by a sufficient num-\\nber of interrupted sutures, irrigate the wound surface with\\niodoform ether and cover the parts over with iodoform\\ngauze and tampons which rest firmly upon the perpendicular\\nwall of horn. Finally invest the hoof and pastern up to the\\nfetlock joint with oakum and lay a muslin bandage over it,\\nthe turns of which must extend from above downward.\\nThe bandage is protected by means of a leather shoe or\\npieces of sacking and the elastic bandage removed. If the\\nanimal is tree from fever, feels well and eats well, the\\nbandage is left in position from 12 to 14 days. Healing by\\nfirst intention.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0090.jp2"}, "91": {"fulltext": "Resection of the Flexor Pedis Tendon.\\n11\\nRESECTION OK THE FLEXOR PEDIS TENDON.\\nInstninients. Elastic bandage, drawing knife, doul)le-\\nedged sage knife, scissors, tenaculum forceps, curette,\\nl^andage material.\\nTechnique. Before the operation the horn of the sole, the\\nfrog and the bars are thinned down until the soft parts can\\nbe seen through them and an antiseptic bandage applied\\nsaturated with creolin solution. Cast the horse [or confine\\non operating table] chloroform and bind the foot to be oper-\\nFiG. 38. Resection of the flexor pedis tendon. vSolar surface of the\\nfoot, r, Semilunar crest of os pedis os pedis r, navicular-\\npedal ligament 5, navicular bone b, flexor pedis tendon e,\\nsensitive lamintt of the bars st, fatty frog sensitive frog\\n/f, horny frog.\\nated upon to the foot diagonal to it, [or on the operating\\ntable secure it firmly] apply the elastic bandage to the foot\\nand carefully disinfect the hoof with soap, brush, creolin\\nor sublimate solution and 50 per cent, alcohol. Then make\\nUrfCi", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0091.jp2"}, "92": {"fulltext": "78 Resection of the Flexor Pedis Tendon.\\na transverse incision tiirough the base of the frog 2 to 3 cm.\\nfrom the balls through the horny frog, the sensitive frog,\\nand the fatty cushion down to the flexor pedis tendon.\\nFollow this by two curved incisions extending forward and\\ninward in an oblique direction corresponding to the semi-\\nlunar crest of the os pedis, the line of incision being- about Yq,\\ncm. outward from the lateral groove of the frog and uniting\\nat the apex of the frog. This triangular piece of frog which\\nhas been isolated by the incision is now grasped with the\\npincers and dissected away. As a general rule the operator\\nfinds that he has not yet reached the flexor pedis tendon\\nbut only the fatty cushion which covers the latter. The\\nremnants of the fatty frog should be removed with the\\ndouble-edged sage knife by means of a horizontal incision,\\nand there is then seen the greenish or yellowish colored\\nnecrotic flexor pedis tendon which may at times be covered\\nwith reddish colored granulations. vShould the operation be\\nindicated on account of a suppurative pododermatitis the bars\\non the affected side must be excised along with the other\\nportions. The position and extent of the navicular bone\\ncan be determined by feeling through the flexor tendon. A\\ntransverse incision is then made over the middle of the\\nnavicular bone through the flexor pedis tendon to the bene,\\nthe lower end of the tendon is grasped with the tenaculum\\nforceps and lifted up from the navicular bone with the aid\\nof two lateral curved incisions. Between the inferior\\nborder of the navicular bone and the semilunar crest of the\\nOS pedis stretches the capsular ligament of the inferior\\narticulation of the navicular bone and os pedis reinforced\\nby dense fibrous bands. The flexor pedis tendon is united\\nto this by a few bundles of fibres. Dissect the tendon care-\\nfully away from the capsular ligament and beyond from the\\nsemilunar crest of the os pedis. If necrotic or discolored\\npieces of the fatty cushion or the tendon still remain, remove\\nthe.se with scissors, scalpel or curette. With the latter\\ncurette the roughened cartilage of the navicular bone and", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0092.jp2"}, "93": {"fulltext": "Amputatio7i of tlic Cla^vs in Cattle. 79\\nremove necrotic portions of hone. In extensive necrosis of\\nthe suspensory ligaments of the heel and of the ligaments\\nextending from the fetlock joints to the lateral cartilage the\\nnecrotic ligament as well as the neighboring fatty cushion\\nwith its numerous elastic fil)ers, must be resected. Disin-\\nfect the operation wound, irrigate with iodoform ether and\\ntanfponade it with dry iodoform gauze. Over this apply a\\nfirm pad of oakum, enclose the entire hoof up to the fetlock\\nin oakum and apply over this a bandage. Over the band-\\nage apply a leather shoe or heavy canvas and remove the\\nelastic bandage. In the absence of fever the bandage\\nremains in position for eight days.\\nAMPUTATION OF THE CLAWS IN CATTLE.\\nFigs. 39 and 40.\\nhistriiments. Half round rasp, double edged sage knife,\\nscissors, convex scalpel, artery forceps, drawing knife,\\nelastic bandage.\\nFig. 39. Amputation of the claws of cattle, d, Horny wall, rasped\\nthin g, articular condyle of 2nd phalanx a, b, c, course of in-\\ncision.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0093.jp2"}, "94": {"fulltext": "8o\\nAfupiitation of the Claivs in Cattle.\\nTechnique. Cast the animal and secure the foot to be\\noperated upon in an extended position, apply the elastic\\nbandage after disinfecting the claws with soap and brush\\nand creolin solution, rasp away the horn on the lateral side\\nof the diseased claw, especially at the posterior part of it,\\nFig. 40. Amputation of the lateral claw of cattle. Median claw pre-\\nserved. Viewed from the solar surface outward, a, External\\ncorono-pedal ligament internal do k, tendon of the flexor\\npedis muscle g, distal articular surface of the 2nd digit g^\\narticular surface of 3rd digit g navicular bone lateral claw\\nin, median claw b, bulb of the heel.\\nuntil the horny wall becomes so thin that it can be readily\\npressed in with the fingers. The corono pedal articulation\\ncan be felt, about 3 cm. below the coronary band, by\\ngrasping the claw with the left hand in -uch a manner that", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0094.jp2"}, "95": {"fulltext": "A))iputation of the Claivs i)i Cattle. 8i\\nthe thumb rests upon the thinly rasped horn while with the\\nother hand the claw is moved from side to side. At the\\nlowest point of the articulation push the double-edged sage\\nknife into the joint, the cavit}^ of the knife being directed\\ntoward the fetlock, and make in the joint a curved incision\\nat first forward and upward to the neighborhood of the coro-\\nnary band then wntli strong flexion of the foot a second\\ncurved incision backward and upward which, however, ex-\\ntends only to the navicular bone. B} this incision the\\noperator divides the horn, the sensitive lamina, the external\\ncorono-pedal ligament and the capsular ligament of the\\ncorono-pedal articulation. Pass the knife between the\\nnavicular and pedal bones and extend the incision down-\\nwards perpendicular to the solar surface to the sole, sepa-\\nrating the navicular bone from the os pedis. In this\\nmanner the navicular bone is preserved as well as the ball\\nof the heel, the latter of which is of special significance in\\nhealing. The inner wall of the claw with the powerfully\\ndeveloped corono-pedal ligament is divided from before\\nbackward. After the vessels which can be seen are ligated\\nthe articular surfaces of the navicular and coronary bones\\ncuretted and the necrotic remnants of tendon removed an\\nantiseptic bandage, preferably of tar, is applied and a\\nleather shoe or canvas covering placed over it for protection.\\nThe bandage remains for 12 or 14 days.", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0095.jp2"}, "96": {"fulltext": "APPENDIX.\\nTHE BAYER SUTURE.\\nFig. 41 and 42.\\nInstrumerits i. lyarge curved suture needle armed with\\na strong silk thread, about 20 cm. long, which is doubled\\nand passed through the e3 e in such a manner that the\\nclosed end extends considerabh- beyond the open ends.\\nFig. 41. Retention, and continuous approximation sutures, d^ d d^^\\nDrainage tubes f, retention suture (closed end) e^ open end\\nb, fixation suture for the drainage tube f, continuous approxi-\\nmation suture.\\n2. Small needles and thread. 3. Needle forceps. 4.\\nDrainage tubing preferably two very large and one small\\nwith lateral openings. 5. Thin wooden splints 15 cm. long.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0096.jp2"}, "97": {"fulltext": "Th e Baj} er Su tu re\\n83\\n3 to 4 cm. wide, with rounded ends. 6. Iodoform gauze.\\n7. Iodoform ether i 10.\\nTechnique. After the skin has been shaved over an area\\nhaving a radius of 5 to 6 cm. from the wound, the suture\\nneedle is inserted 2 to 3 cm. from the lips of the wound\\nthrough the skin and subjacent tissues, a strong drainage\\ntube;(t/ passed through the clo.sed end of the suture and\\nthe thread drawn tight. The needle is then pas.sed through\\nFig. 42, Splint bandage, d, d d Drainage tubes retention\\nsuture];, (closed end); e^ do, open end; 7, iodoform gauze 5,\\nsplints.\\nthe opposite lip of the wound from within to without at the\\nsame distance from the lips of the wound, the .second large\\ndrainage tube {d is laid between the open ends of the\\ndouble silk thread and these are tied upon the drainage\\ntube with a triple knot, after the} have been drawn\\nsufficiently tight that the approximated wound lips form a", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0097.jp2"}, "98": {"fulltext": "84 The Bayer Suhire.\\ncrest. If the lips of the wound can be grasped with the\\nhand and held together in such a manner as to form a ridge\\n3 or 4 cm. high, the suture needle can be passed through\\nboth lips of the wound simultaneously. The first suture\\nshould be located about 3 cm. beneath the upper angle of\\nthe wound, the other retention sutures follow at distances of\\nabout 5 cm. from each other and are applied in the same\\nway. The lips of the wound are united by continuous\\napproximation sutures like an overcasted seam. This suture\\nends at least 2 cm. above the lower angle of the wound.\\nThe third drainage tube is introduced into the latter and\\nfixed by a special suture. The entire cutaneous surface\\nlying between the drainage tubes is covered with iodoform\\ngauze, and between each iwo retention sutures there is laid\\nover this gauze the wooden splints previously cut to the\\nproper size, the ends of which are shoved under the tubing.\\nThe upper and lowermost splints must be bound to the\\ndrainage tubing by means of sutures passed through the\\ntubing. The entire bandage is finally saturated with iodo-\\nform ether. The bandage and retention sutures remain\\neight days, the approximation sutures fourteen days.", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0098.jp2"}, "99": {"fulltext": "", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0099.jp2"}, "100": {"fulltext": "", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0100.jp2"}, "101": {"fulltext": "", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0101.jp2"}, "102": {"fulltext": "3\u00c2\u00a3P6- mc", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0102.jp2"}, "103": {"fulltext": "", "height": "3553", "width": "2249", "jp2-path": "courseinsurgical00pfei_0103.jp2"}, "104": {"fulltext": "", "height": "3553", "width": "2362", "jp2-path": "courseinsurgical00pfei_0104.jp2"}}