COMPARATIVE SURGERY; 
WITH ILLUSTRATIVE CASES, 
By C. M. Faris, H. C. Teacher, J. F. Ortsohild, 
and F. C, Beall, 
AND AH INTRODUCTION, 
Harvey Cushing. [From The Johns Hopkins Hospital Bulletin, Vol. XVI, No. 170, 
May, 1905.] 
COMPARATIVE SURGERY; 
WITH ILLUSTRATIVE CASES, 
By C. M. Paris, H. C. Thachee, J. P. Ortschild, 
and P. C. Beall, 
AND AN INTRODUCTION, 
Harvey Cushing. 
It is the purpose of this communication to report some of 
the cases which indicate, it is hoped, a new development in 
our present plan of teaching operative surgery; for latterly 
as the work has been conducted, it has necessarily subjected 
vagrant animals to the risks and discomforts attending more 
or less serious surgical procedures carried out for the relief 
of merely hypothetical maladies. 
Four years ago an effort was made in our medical school 
—and so far as I know for the first time in any school—to 
change in a radical way those methods of conducting an opera- 
tive course, which, for the past generation, have been widely 
adopted and generally regarded as most practicable by the 
surgical teachers in the leading medical institutions. 
Heretofore it has been the universal custom, I believe, when- 
ever anatomical material has been sufficiently abundant to 
justify its being shared by the clinical departments, to employ 
the human cadaver for the practical teaching of operative 
handicraft. And though the opportunities thus offered are 
admirable in many respects the method is open to serious 
objections. If I may judge from my own experience not only 
as a participant but subsequently as an onlooker at these 
exercises, the students are usually coached in the performance of the more or less stereotyped operations principally on the 
head and extremities,—the various time-honored amputations, 
excisions of bones and joints, set ligations of vessels, etc., 
etc.,—and thus it is the perfected operation rather than the 
method of operating upon which chief emphasis is laid. 
A course of this kind, in which students are called upon to 
play an active part, may be not only an excellent surgical 
supplement to the study of human topographical anatomy but 
is useful, too, as an introduction to the handling of the sur- 
geon’s tools,—still it seems to me that the one great essential 
of modern surgery is conspicuously wanting. The paramount 
call upon the instructor, in this Listerian era, is that he shall 
emphasize and drill into his students, not as mere onlookers 
or hearers but as actual performers, the significance of that 
much-abused term surgical “ technique,” of which to-day the 
all-important element is asepsis—the first and the everlasting 
thing to be indelibly stamped on the make-up of everyone who 
proposes to undertake operative work whether as a surgeon 
or investigator. Surgical cleanliness, which must become a 
reflex matter—an operator’s second nature—and which, like 
all other reflexes, must be learned early, is necessarily disre- 
garded in the time-honored methods of teaching this branch 
in the most unsurgical surroundings of a dissecting room. 
Next in importance to the acquirement of this reflex habit of 
cleanliness is the ability to dissect and to gently manipulate 
living tissues without so damaging them as to interfere with 
perfect reactionless healing; and a third great requisite, which 
cannot be learned upon the cadaver, is an acquirement of 
skill in the proper control of haemorrhage from the large as 
well as small vessels, for the old-fashioned rough methods of 
haemostasis happily are still followed by few. Nor, finally, 
can facility in the particular technique of visceral surgery, 
whether abdominal, thoracic, or intracranial, be properly ob- 
tained through practice on the lifeless body, a fact which 
almost all of those who have been pioneers in these fields of 
work have emphasized. 
With these ideas in mind, our present course of operative 
instruction was first started upon living animals, stray dogs being used for the purpose, and so far as our opportunities 
permitted, all of the formalities, that would be observed in 
regard to a patient admitted for treatment to the surgical 
wards of the hospital, have been followed. Clinical histories, 
of which examples will be shown you, have been kept on regu- 
lar hospital history sheets; the effect of the anaesthesia on the 
pulse and respiration has regularly been recorded; the detail 
of the operative preparation both for the staff and patient has 
been followed; pathological and post-operative notes made; 
and in case of a fatality, a formal autopsy performed and its 
results added to the record. 
The work has proved so interesting to the instructor and 
seemingly so acceptable to the groups of undergraduates and 
graduate students, to whom it has been possible to extend it, 
that it is gratifying to learn of the establishment, in several 
other institutions, of courses modeled on similar lines. Our 
aim has not been to turn out a multitude of operating surgeons, 
any more than the aim of the manual training departments 
in some of our modern schools is to turn out finished cabinet- 
makers or iron-workers, but rather to teach the proper use of 
the hands and respect for the materials on which they work, 
through simple actual problems, so that not only may all 
understand the way work is done and appreciate good work 
when it is done, but also the few, who are by nature best fitted, 
may learn of their special aptitude for this particular form of 
handicraft and be encouraged to continue with it. 
After a course of training of this sort and with an acquire- 
ment of proper surgical reflexes, a student, when his turn 
comes, should be found a safe and valuable helper in the hos- 
pital operating room where blunders in technique must not 
occur; and furthermore he may with profit to himself be an 
understanding onlooker at the surgical work of others, an 
occupation, which, for those who have never taken part in or 
conducted operations themselves, must be granted to be a 
comparatively fruitless expenditure of time. 
For the carrying out of our plan of work, it has been neces- 
sary to assume lesions, for the relief of which operative 
therapy was appropriate—a stricture of the oesophagus, for example, which called for a gastrostomy of one form or an- 
other. And it has been our custom, in order that the students, 
just entering upon their first year of clinical instruction, 
might become familiar with actual cases rather than their 
text-book presentation, for them to select from the hospital 
records cases that were supposed to represent the clinical con- 
dition of the animals presented for operation. 
We have endeavored to combine this instruction in operative 
work with the necessary experimentation of the various labora- 
tories, so that, for example, when a gastric fistula was needed 
in the physiological department, for the study or demonstra- 
tion of the gastric secretion, the gastrostomy patient men- 
tioned above would suffice, and thus a double purpose be 
served, with a possible sparing of animal life. The surgical 
share, also, in many experimental investigations has been 
undertaken at the same time that the students are learning 
how to operate—how to handle the tissues and to work with 
gloved fingers, how to tie and to sponge, how gauze should be 
used in “ walling off ” the peritoneal cavity, how incisions 
should be made and how closed, and a multitude of other 
things, not the least of which is the proper feeling of responsi- 
bility for the general welfare of the anaesthetized patient. 
Though satisfactory enough in its ends the benefits arising 
from such a course are confined to the class and the preceptor 
and are entirely at the expense of the animal. There is natur- 
ally a feeling of regret in the minds of many—of none greater 
than our own—that animals, particularly dogs, should thus 
be subjected to operations, even though the object be a most 
desirable one and accomplished without the infliction of pain, 
and did expense permit, we would gladly have used animals 
with which there is an association of less acute sentiment on 
the part of all. This feeling in the past few months has been 
somewhat mitigated by the fact that, learning of our work, 
the owners of animals actually suffering from maladies of a 
surgical nature, and maladies which most veterinarians are 
loth to operate upon, have begun to bring these animals to us 
for treatment, so that there is promise of a clinic, which may furnish us with enough material to obviate in large measure 
the need of using normal animals. 
The surgical report of some of these cases will be made by 
Messrs. Beall, Faris, Ortschild, and Thacher and it can he 
seen why the title of Comparative Surgery has been chosen for 
this report. In the past the work has been conducted at a 
great disadvantage owing to our cramped quarters, and though 
every effort has been made for the comfort of the animals 
before and after the operations, not until the completion of 
the building, now being erected, will it be possible to give 
them the real hospital care and accommodation which they 
deserve. 
TWO CASES OF HAEMORRHAGIC CYST OF THE 
THYROID GLAND. 
By C. M. Paris. 
Case I.—Large tumor of the right thyroid gland,. 
The patient, a valuable and well-bred, Irish-setter dog, actively 
used every season for field work, was brought to us for operation 
by Dr. Cox in March, 1899. On the right side of the neck, in the 
region of the thyroid, was a tumor measuring on its surface 
about Bby 12 cm. (Fig. 1). The time of its first appearance was 
not ascertainable. The growth has progressively increased in 
size and of late has greatly interfered with respiration. The 
mass was very hard to the feel, roundish in outline, with a smooth 
surface, and so tense as not to impart to the fingers any sense of 
fluctuation. It was quite movable from side to side, though not 
in an up and down direction. Pressure against the tumor made 
the animal breathe with a marked inspiratory effort; but without 
such pressure and when the animal was quiet, there was no evi- 
dence of dyspnoea* The right pupil was contracted. 
Operation.—March 6, 1899. Ether anesthesia. Extirpation oj 
gland and cyst. 
The usual transverse incision (Kocher), with its convexity 
downward, was made over the tumor. The outer capsule was 
exposed after division of the platysma and anterior thyroid 
muscles. The tumor was found to be very adherent, vascular, 
and its enucleation proved most difficult. It was necessary to 
divide the right sterno-mastoid muscle and even with this expos- 
ure, in the efforts to separate the cyst from the surrounding 
5 tissues, it ruptured and several ounces of dark grumous blood- 
clot escaped. The tissues became so stained that a clean dis- 
section and individual ligation of the groups of thyroid vessels 
were precluded. Before the mass was finally freed there had been 
haemorrhage from several large vessels that had been divided be- 
fore they could be recognized and secured with clamps. The 
enucleation was finally accomplished; the divided muscles were 
reunited with fine silk and the skin closed with a subcuticular 
silver suture. No drainage was used. An intravenous saline 
infusion was given. 
Pig. 1.—Profile view of cervical tumor in Case I. 
The animal made an uneventful recovery. The wound healed 
per primam. 
Subsequent History.—The animal lived until the autumn of 
1904, four and one-half years after the operation. Death was 
said to be from old age. His shortness of breath had disappeared 
after the operation, and for several seasons he proved as useful 
as ever before as a field dog. 
Pathological Report.—The specimen is a large roundish thick 
walled (1 to 2 cm.) cyst, containing a pasty, grumous, brownish- 
red material. Its outer surface shows a somewhat shredded 
fibrous capsule dver which lie a number of very large blood- 
vessels. The inner surface of the cyst wall is divided into irreg- 
ular spaces by numerous trabeculae. On section, the walls are 
6 found to be made up of several concentric more or less distinct [lßl] 
layers, some of which are fibrous and tough, others more friable, 
having in places the color and appearance of normal parenchyma. 
Scrapings from the latter show epithelial cells with large vesicu- 
lar nuclei. Examination of the contents of the cysts showed 
cholesterin crystals and degenerated blood-cells. 
The microscopical findings will be described below 
Case II.—Large tumor of the right thyroid gland. 
A large, thoroughbred, Russian-greyhound bitch, nine years 
of age, was admitted in March, 1904, with the following history: 
Fig. 2.—Anterior view of cervical tumor in Case 11. 
She was a house pet and, having been spayed when four years 
of age, had grown very stout. Her health had been good until 
the past year when the present tumor started to develop. For 
several months she has been dull, inactive and irritable. She 
occasionally snaps when at play with the children, a thing which 
never occurred before. There has been some muscular twitching. 
She has grown very fleshy, has lost most of her hair, and the 
skin has become dry and scaly. There has been considerable 
distress for breath, with sighing and wheezing sounds particu- 
larly noticeable during her sleep, which is very restless. 
Examination.—The pulse rate is 60; the beats irregular in 
rhythm and quality. No definite exophthalmus is present though 
the eyes have the usual prominence characteristic of the hound. 
7 The right pupil is much larger than the left; both react normally 
to light. Her skin is rough and scaly though there is no eruption 
suggesting a cutaneous disease. She has lost most of her coat. 
She is very fat, and must weigh nearly 100 pounds. 
On the right side of the neck, in the region of the thyroid 
gland, is a swelling about the size of a base-ball; its surface is 
smooth, almost spherical in outline (Figs. 2 and 3). It gives no 
sense of fluctuation nor is there any bruit or pulsation. 
Considerable interest was aroused as to the diagnosis in this 
case. The tumor, prominence of the eyes, irregularity of the pulse, 
Fig. 3.—Profile of neck in Case 11. Owing to the extended 
position of the neck the tumor is less prominent than it other- 
wise appeared. 
nervousness and irritability were suggestive of exophthalmic 
goitre. Myxcedema was suggested by the change in the nutrition 
of the skin, the loss of hair, the increase in weight as well as the 
mental and physical inactivity. The animal however had been 
spayed and was reaching an age when dogs are liable to show 
such changes of coat and form. 
Operation.—March 12, 1904. Ether anaesthesia. Enucleation 
of right thyroid and cyst. The operation was conducted as in the 
former case and almost the same difficulties were encountered 
owing to the vascularity of the tumor and the adhesions about 
the capsule. In spite of all care, the cyst, as in Case I, ruptured 
during the manipulations of the tumor. Enucleation was finally 
8 accomplished. The left lobe of the thyroid was inspected and 
seemed normal in size. The wound was closed with silver as in 
the case above. Healing was absolutely without inflammatory 
reaction and recovery was uninterrupted. 
The animal lived for about a year after the operation, when at 
her owner’s request and owing to her poor physical condition, she 
was chloroformed. Though for a time after the operation her 
respiration had seemed to improve and her tremors to be less, 
the general nutritional state was not altered. The condition of 
the skin became worse; a cataract developed in the right eye. 
There were distressing attacks of paroxysmal dyspnoea with an 
extraordinary depression of the intercostal spaces during the 
inspiratory act. Thyroid extract was administered for some time 
before her death without bettering her condition. 
Pathological Note.—The gross appearances of the tumor re- 
moved at the operation differed but slightly from those of the 
tissues described under Case I. There is the same thick walled 
cyst, which, when collapsed and after hardening, measures 8 by 6 
by 4 cm., and which contains the same dark reddish, friable, 
grumous material. The surface of the cyst wall on section 
presents a laminated appearance, with superimposed fibrous lay- 
ers between which can be made out, in some areas, narrow strips 
of thyroid parenchyma. Several small cysts, the larger of which 
measures 1% cm. in diameter are to be seen in the surface of the 
section. No parathyroids can be found. 
Microscopic Exami't ation of the Hardened Tissue.—The wall of 
the cyst is for the most part made up of dense fibrous layers, 
between which, in places are zones of glandular substance. The 
cyst content is made up of a granular, faintly staining mass in 
which the shadows of blood corpuscles and cholesterin crystals 
are to be made out. Organization of this clot has begun to take 
place in some areas along the inner wall of the cyst; where new 
formed granulation tissue is more or less abundant. Such of the 
parenchyma of the gland as is still preserved, is altered from the 
normal. The vesicles, which are still recognizable as such, by 
their structure and colloid content, are much deformed, most of 
them being compressed into flattened figures that lie concentric 
with the curved layers of the cyst wall. Others of them have a 
crenated outline from the irregular incurving of the epithelial 
lining. Some of them are partly filled with blood and contain 
crystals as well as desquamated epithelial cells. The epithelium 
which remains, is for the most part fairly typical in ap- 
pearance, though the cells seem less high and contain less pro- 
toplasm than normal. In some areas the parenchymal cells are 
so massed as to have lost all resemblance to their proper gland- 
9 ular arrangement. There is no colloid in these areas, and they 
are traversed by blood-vessels having extremely delicate walls. 
Autopsy.—February 10, 1905. On opening the body the muscu- 
lature was found to be pale, the panniculus abundant. The 
abdominal and thoracic viscera were for the most part normal. 
The lower intestine was injected and on opening the bowel, a 
haemorrhagic enteritis extending from duodenum to anus was 
found. The ovaries were absent; the uterus much atrophied. A 
large cyst was present in the lower half of the left kidney. These 
organs, as were the adrenals, spleen, liver, pancreas, and stomach, 
were otherwise normal on section. There was no glandular en- 
Fig. 4.—Slightly magnified photographs of three cross-sections 
of the hardened left thyroid gland removed at autopsy from 
Case 11. 
The letter A is placed near a haemorrhagic cyst filled with re- 
cent clot; B is near a large intramural parathyroid body; C near 
a partially absorbed clot, the thick wall of which consists of com- 
pact parenchymal cells. 
largement. The heart and lungs were normal except for the 
presence of a few calcareous nodules scattered throughout the 
latter. There was no thickening or sclerosis of the aorta. The 
brain and cord were normal aside from the thickened and adher- 
ent membranes characteristic of an old animal. 
A careful dissection of the neck was made. No remnant of the thyroid was found on the side (right) of the old operation; nor 
were there any parathyroids to be found. No accessory thyroids 
were found in the mediastinal spaces. 
The remaining thyroid gland, on the left, was found to be much 
larger than normal. It measured nearly 6 cm. in its long axis, 
and its transverse diameters on section were 2 by V/ 2 cm. 
The section showed numerous small cysts, the largest measuring 
Fig. 5.—Microphotograph of section on the edge of a small or- 
ganizing hemorrhagic cyst (left upper corner). Showing com- 
pression of neighboring vesicles and hypertrophy in adjoining 
part of gland. 
about 5 mm. across, and containing a small blood-clot 
(Fig. 4, A). One large parathyroid was present on the surface, 
equatorial in position, and the section subsequently showed 
another buried in the substance of the gland (Fig. 4, B). There 
were no polar parathyroids to be found. Microscopical examina- 
tion of the liver, spleen, kidney, adrenal, and intestine added 
nothing to the knowledge gained by the gross appearances. 
Sections of the thyroid showed alterations varying all the way 
from the normal, or nearly normal, to the profound changes that had been found in the cyst wall of the gland extirpated the year 
before. The various compartments of the gland were fairly well 
outlined by delicate fibrous trabeculae. In some of these com- 
partments the colloid containing vesicles were quite well pre- 
served and lined by a single layer of low epithelium. More 
commonly, however, the epithelium was infolded and the cells 
higher in form, while between the vesicles there was a marked 
cellular proliferation (Fig. 5).1 This process had gone on in 
Fig. 6.—Edge of cyst shown in gross in Fig. 4, G. Showing zone 
of compact parenchymal cells. 
some places to such an extent that in some fields the infolding 
was so extreme and the multiplication of cells so great, that with 
the absence of colloid almost all trace of glandular arrangement 
was lost (Fig. 6). The appearances were closely akin to those 
seen in experimental thyroid hypertrophy or in advanced stages 
of exophthalmic goitre. 
1 This, as well as the following microphotographs, has kindly 
been taken for us by Mr. T. M. Wright, Jr., a simple microscope 
and ordinary camera being used for the purpose. 
12 In some of the compartments of the gland (there were four or 
five of them), haemorrhages had occurred (Fig. 4, A) so that it 
was possible to see in miniature just what had taken place on a 
large scale in the haemorrhagic cyst removed at operation. The 
extravasation seemed to have occurred in the central part of the 
lobule. This had distended and led to a thickening of the lobular 
fibrous capsule within which the parenchymal cells were massed 
and crowded together as a lining zone. Occasionally a flattened 
vesicle was to be seen containing colloid but for the most part 
the glandular structure in the zone lining the clot was com- 
pletely lost. In two of the cysts, apparently those of longest 
standing, granulation tissue was growing out into the clot and 
large epithelioid cells filled with pigment were interspersed 
among the inner layer of parenchymal cells. In two of the cysts 
no effort at repair had taken place, the clot being sharply defined 
against the compressed glandular acini of the lobule and less 
evidence of the neighboring hypertrophic change had taken 
place in these instances. 
A large parathyroid was found embedded in the substance of 
the gland near its middle, (Fig. 4, B). This, as was the case 
with the surface parathyroid, showed no apparent alteration from 
the normal. 
Discussion. 
Pathological changes in the thyroid gland of dogs are 
closely analogous to those occurring in man which are better 
known since they have been subjected to more careful study. 
Aristotle, Pliny, Galen, and Aetius are said2 to have men- 
tioned swellings, which appear to have been goitres, in the 
necks of animals. Pliny even suggested that the animal’s 
water supply might be responsible for the condition; an 
hypothesis supported by more recent writers, some of whom 
without success, have essayed to produce the malady in normal 
animals by administering in abundance the salts cantained in 
the water from those localities where the disease is most com- 
mon. Particularly in certain parts of Europe, goitre is of as 
common occurrence in the lower animals, more especially 
horses and dogs, as it is in man himself. It is known in non- 
domesticated animals, as well. One writer is said to have 
described a new species of antelope, the distinguishing feature 
2A. T. Sloan, Goitre in Animals. The Lancet, Lond., 1887, Yol. 
I, p. 1802. 
13 of which was a prominence of the neck which appeared with 
striking constancy. 
The prevalence of goitre is especially noticeable in certain 
localities, whether from hereditary or geographical influences. 
Adami8 has called particular attention to this in describing 
the so-called goitre regions of Canada and the continent of 
Europe. 
As the pathological and setiological factors seem to be so 
closely akin in man and animals, and as the veterinary litera- 
ture on the subject is difficult of access, we will not limit our- 
selves to a consideration of the comparative pathology alone. 
Simple cysts, as is well known, are of common occurrence in 
parenchymatous enlargements of the thyroids. The hemor- 
rhagic variety however is comparatively infrequent. Cysts, 
apparently of hemorrhagic origin, have been found by Dr. 
Bloodgood among the thyroids from the surgical department. 
But no instance of a large encysted clot such as occurred in 
our two cases has been met with. They are, however, not 
unknown. Thus, Bradley4 has described cases from Dr. 
Shepard’s service in the Montreal General Hospital, some of 
them the exact clinical and pathological counterpart of our 
canine cases. 
Many conjectures have been advanced in explanation of the 
way in which these haemorrhagic cysts are produced. Though 
trauma may play a part, the predisposing elements are un- 
doubtedly attributable to vascular changes. Thus, Witzel, 
noticing the ease with which the vessels of the thyroid were 
torn during operations, suggested that some structural 
alteration in the vessel wall, possibly a degenerative change, 
might be responsible for the haemorrhage. Earner noticed 
that the ruptured vessels sometimes tore longitudinally. 
Budde observed that, in cystic thyroids, the smaller arteries 
showed a connective tissue increase in the sub-endothelial 
layer without an increase in the intima; also that a degene- 
* Adami, On .ZEtiology and Symptomatology of Goitre. Montreal 
Medical Journal, 1900, Vol. 29, p. 1. 
4 W. I. Bradley, On Haemorrhagic Cysts of the Thyroid Gland. 
Journal of Experimental Medicine, 1896, Yol. I, p. 401. rative process was demonstrable in the elastica, expressing it- 
self as a separation of the internal membrane of Henle. This 
was often associated with deposits of calcium salts and as the 
process occurred in subjects too young for sclerosis, it was con- 
sidered actiologically significant in explaining the fragility of 
the vessels described by Witzel and Earner. 
Kdnig, in speaking of the haemorrhagic cysts, calls attention 
to the extreme dilatation that may occur in the vessels of the 
thyroid—the so-called Struma aneurysmatica,—in which the 
vessels may form cirsoid aneurysms in the parenchyma, the 
veins themselves forming small cysts. Owing to an increase 
in the size of the vesicles, the supporting connective tissue 
network, in which the blood-vessels run, is pressed upon with 
resultant nutritive changes. The walls of the vesicles become 
weakened, coalescence takes place between them, and in this 
way colloid cysts result and may increase to almost any size. 
Secondary haemorrhage, occurring through the weakened and 
perhaps varicose vessels, would give the type of cyst and cystic 
content that characterizes these cases. The cysts, however, 
may not always be lined with thyroid epithelium, as might be 
expected if this were their method of formation, and Wolfner 
has on this ground been led to reject this theory in consequence. 
An extensive haemorrhage, however, might easily spread to the 
capsule of the gland and only leave a trace of the original 
parenchyma as a shell on one side of the cyst the walls of which 
become gradually thickened by new formed tissue. This was 
the condition found in the two large cysts of our dogs, but in 
the small haemorrhagic cysts in the left lobe of the last case, 
the clots were entirely surrounded by the compressed inter- 
lobular parenchyma. It is noteworthy too that in this gland 
there were no non-haemorrhagic cysts whatever. We are in- 
clined to agree with Bradley in the view that the cysts origi- 
nate from the rupture of the intralobular blood-vessels pri- 
marily, and that the haemorrhage may break into or separate 
and compress the interlobular vesicles. 
The contents of these cysts may vary from pure blood mixed 
with thyroid secretion to dark grumous material, such as we 
have observed, containing pigment, cholesterin crystals, fat 
15 globules, and coagulated necrotic material. Papilloma have 
been described as occurring within the cysts, but Bradley 
thinks they are due to irregular infoldings of the walls rather 
than to neoplastic formation. The great increase in size that 
takes place in some cases is probably due to repeated haemor- 
rhages. Doubtless the epithelium lining the cyst ceases to 
secrete, is soon replaced by granulation tissue and plays no 
part in the tumor growth. 
These cysts, when small, may become cicatrized through 
organization of the extravasated blood or the clot may remain 
in an inspissated condition for many years, as in our two cases, 
with a possible increment from time to time through fresh 
bleeding. In long standing cases the walls may become cal- 
cified or, according to some reports, even ossified. Suppura- 
tion of the contents may follow an infection. They may be 
found in either lobe and, indeed, there are reports of their 
occurrence in the accessory lobes of the thyroid. In one case 
of this sort, the writer, Pollard, thought the cyst had oc- 
curred secondary to a papillomatous growth. 
The interesting complex of symptoms, in our Case 11, had 
it not been for the animals old age, might have been mistaken 
for the clinical manifestations of myxoedema, for they closely 
resembled the symptoms shown by an animal after an ex- 
perimental extirpation of both thyroids, a physiological suffi- 
ciency of parathyroid tissue having been left intact. The 
inefficacy of the treatment with thyroid extract, however, made 
this improbable and the post-mortem findings showed that 
the remaining gland possessed an abundance of actively 
functionating parenchyma. The changes in this remaining 
lobe, aside from those secondary to the cystic processes, were 
closely akin to those brought about by physiological hyper- 
trophy, such as Dr. Halsted 5 has described, and which takes 
place in the portion of gland remaining after partial extirpa- 
tion. 
5 An Experimental Study of the Thyroid Glands of Dogs, with 
Especial Consideration of Hypertrophy of this Gland. The Johns 
Hopkins Hospital Reports, 1896, Vol. I, p. 373. A REPORT OF TWO CASES OE UTERO-YAGINAL 
PROLAPSE. 
H. C. Thacher. 
Case I.—Acute descensus of uterus, bladder, and vagina during 
parturition. 
The patient, a large animal, of mongrel fox-hound type, was 
operated upon as an emergency case, November 1, 1904. She 
had received, three weeks previously, when early in her pregnancy, 
cancer transplantations in both inguinal breasts from the first of 
Mr. Ortschild’s series of tumor cases. The wounds healed per 
primam and she had since been well and running free in the 
yard. 
Present Illness.—So far as can be told, the animal reached her 
full term of pregnancy three days ago (October 29), when by 
her actions she was supposed to be in labor. She did not, how- 
ever, succeed in delivering her pups and, seemingly as the result 
of the frequent efforts at expulsion, an cedematous mass began to 
protrude from the vagina. This prolapse has increased greatly 
in size and has apparently implicated the bladder, judging from 
the frequent efforts to micturate. 
Examination.—The patient is a full grown, well-nourished 
animal with a greatly distended abdomen and lactating breasts. 
She looks sick, shivers almost constantly, and crouches frequently 
in a straining posture. Her pulse and respiration are rapid. 
Protruding from between the labia majora is a large, pendent, 
rounded mass, measuring about 12 by 6 by 8 cm. Its surface is 
smooth, moist, cold to the touch; and the fundus of the protru- 
sion is purplish red in color, suggesting almost complete strang- 
ulation. On the dorsal surface of the tumor appears the ring- 
like external os of the uterus. The tumor fluctuates on palpa- 
tion. It does not seem to be painful or tender. 
The animal was prepared for immediate operation as it was 
conjectured that one of the pups had become fixedly engaged in 
the superior strait. 
Operation.—November 1, 1904. Ether. Reduction of prolapse: 
total hysterectomy. 
On opening the abdomen, an enormous pregnant uterus was 
exposed. This was drawn out of the wound; the hroad ligaments 
were divided and the two horns liberated. The lower part of the 
right horn was found to be softened and gangrenous. It was 
torn during the manipulations, disclosing a macerated, foul- 
smelling foetus whose head was engaged in the pelvic inlet. The 
uterus contained eight other living, full-term puppies. By exert- 
17 ing traction upon the body of the uterus, aided by pressure 
against the prolapse externally, the latter was gradually reduced. 
Not until this was accomplished did the bladder become visible 
within the abdomen. 
The uterus was then amputated as near the vagina as possible 
and the stump, after inversion and suture, was ventrally fixed in 
the parietal wound during its closure. 
The animal survived the operation only twenty-four hours. 
The chart of pulse and respiration, kept during the anestheti- 
zation, shows that the operative procedure was badly borne. 
Autopsy.—November 2, 1904. Nothing was found at the exam- 
ination to account for death, beyond a slight localized peritonitis 
about the stump of the uterus and a considerable degree of 
hydronephrosis. The ureters and pelves of the kidneys were all 
dilated. There was no deformity of the pelvis. No cultures 
were taken. 
Case II.—Recurrent vaginal prolapse, unassociated with preg- 
nancy. 
An animal of Irish-setter type, two years of age, was admitted 
for treatment January 5, 1905, with the complaint that an irre- 
ducible mass was projecting from the vulva. 
Past History.—She has been a pet dog; has always been well 
and had the best of care. Owing, possibly to lack of regular 
exercise, she has grown very heavy. She has never been preg- 
nant. In July, 1904, she was lined for the first time and sub- 
sequently suffered from a prolapse of the vagina. The protrusion 
was successfully replaced by her owner and did not reappear for 
six months. 
Present Attack.—About three weeks ago, without assignable 
cause—other than that she was at the time in heat—the prolapse 
recurred. The protrusion has resisted several forcible attempts 
at replacement and has gradually increased in size. It is a con- 
stant annoyance to the patient though it has seemingly in no 
way interfered with her health or activity. 
Status Prcesens.—The patient is a large well nourished bitch, 
weighing between 15 and 20 kilograms. Her general condition is 
excellent and aside from the local trouble, the examination proves 
negative. 
Projecting from between the enlarged labia majora is a smooth, 
tense-looking, rounded mass, about 25 cm. in circumference and 
7 cm. in length (Fig. 7). Upon the upper and posterior aspect of 
the protrusion lies the opening of the inverted vagina. The 
cervix uteri cannot be reached by the finger introduced within 
this opening. The greater part of the protrusion is covered with 
a somewhat congested, granular and thickened mucous membrane. 
18 On the lower aspect of the mass—that which comes in contact 
with the ground when squatting—there is a large superficial 
ulceration covered with a greyish slough. The tumor has a 
tough, boggy, cedematous feel and is cold to the touch though its 
circulation seems good. The orifice of the urethra is drawn down 
into view on the anterior aspect of the neck of the tumor. 
Diagnosis.—Prolapsus vaginae, et vesicce. 
Operation I.—January 6, 1905. Preliminary morphia; ether 
anaesthesia. Reduction of prolapse. Abdominal hysterectomy. 
Ventral fixation of stump. 
While the animal was being cleaned up for operation, an effort 
was made to reduce the prolapse; this was unavailing even with 
Fig. 7.—Recurrent vaginal prolapse; condition before second 
operation. 
complete muscular relaxation under the anaesthetic and with the 
hind-quarters elevated. The abdomen was opened by an 11 cm. 
intermuscular incision, through the inner margin of the right 
rectus. After exposure of the uterus, a long, steady traction upon 
its body brought about a partial reduction of the prolapse, the 
manipulations succeeding in drawing into the abdominal cavity 
the bladder whose walls were very much congested. Complete 
reduction, however, was only attained after combining pressure 
from without with the traction upon the uterus. After the re- 
duction the uterus was drawn well into the wound, was amputated close to the external os and its stump was amputated and inverted 
with mattress sutures. The broad ligaments were then divided, 
the uterine horns freed from their ovarian attachments and the 
entire uterus removed. 
The abdominal wound was closed in layers, the stump of the 
vagina being drawn up and securely fastened to the posterior 
sheath of the rectus in the hope that this would suffice to prevent 
a recurrence of the prolapse. The relaxed vaginal canal was 
packed with iodoform gauze. 
Post-operative Note.—On the following day the prolapse was 
found to have recurred in its original form and was, if anything, 
even larger than before. There were otherwise no complications 
following the operation. With the exception of a single slight 
stitch abscess, the abdominal wound healed per primam. 
Four weeks later a second and successful operation was con- 
ducted, as follows: 
Operation II.—February 3, 1905. Preliminary morphia; ether 
anaesthesia. Combined abdomino-vaginal operation. Amputation 
of prolapse by Whitehead’s method for rectal prolapse. 
The abdomen was reopened in the line of the original incision. 
The stump of the vagina was freed from its attachments to the 
abdominal wall; the bladder was, this time, found in place in the 
abdominal cavity. On catheterizing the urethra, it was ascertained 
that a loop of this canal was drawn down with the prolapsed 
tissues into the neck of the tumor. By introducing a straight 
catheter into the bladder it was possible to place the urethra in a 
position where it was unlikely to be injured in the proposed 
operation. 
An incision was then made encircling the neck of the prolapse 
about at the junction of the vulvo-vaginal mucous membrane and 
just so as to escape the urethral orifice. While the tumor was 
grasped and drawn away from the body, this circular incision 
was gradually deepened with the knife and by blunt dissection— 
the large vessels being secured as they were encountered—until the 
sub-mucous coat of the non-inverted portion of the vaginal canal 
was reached. The vagina, at this situation was then amputated 
section by section, as its edges were sutured securely to those of 
the vulval side of original incision. The abdominal wound was 
then closed as before with fixation of the vaginal stump in the 
parietal wound. 
Convalescence was without incident. As after the first opera- 
tion the ventral wound healed with a single stitch abscess. There 
has been no recurrence of the prolapse. 
Pathological Report.—The specimen consists of a piece of tissue, 
10 by 7 by 4 cm., roughly ovoid in shape and obliquely traversed 
by a lumen about 2 cm. in diameter. The tissue is firm and 
20 elastic in consistency. The outer surface is, for the most part, 
covered with mucous membrane which passes into the lumen 
above described. The surface is brownish red in color, somewhat 
granular and at one point slightly ulcerated. Within the lumen 
the mucous membrane is pink and smooth. On section the tissue 
is found to be very cedematous and somewhat vascular. It con- 
sists of a meshwork of grayish, semi-translucent bands and 
fibers, the majority of which seem to radiate from the lumen. 
The sub-mucosa is dense and thickened. The mass weighs 125 
grams in its present shrunken state. 
Discussion. 
Obstetrical complications, as illustrated by the first of these 
cases, are very common in domestic animals. Upon their 
occurrence in cattle and horses there is a large literature.0 It 
is quite common for animals to die in labor without delivery. 
This is especially true of dogs. 
The acute prolapses, which occur before and during partu- 
rition, are more frequently reported in the veterinary litera- 
ture dealing with cattle—more attention being paid to this 
animal owing to its greater commercial value. According to 
Yennerholm,7 it is of common occurrence in stall-fed and 
milch cows, particularly in animals standing in stalls with a 
floor sloping backwards for drainage. In pasture free ani- 
mals it is comparatively rare. Eelaxation of the pelvic floor 
and an extra large sized pelvic outlet? are predisposing 
factors. An unusually heavy uterus is also recognized as a 
causal factor and have played a part in producing the 
lesion in the first of our canine cases. 
As a rule, the prolapse in cattle appears only when the 
animal is recumbent and reduces spontaneously when the 
animal takes a standing posture. Barely does the condition 
seem to offer any serious obstruction to labor. The usual 
veterinary treatment is an operative one in case the prolapse 
6 Franck, Thierarzliche Geburtshilfe. Berlin, 1901. Deßruin, 
Geburtshilfe beim Rind. Wien u. Leipsig, 1897. 
7 Vennerholm in Bayer, and Frohner’s Handbuch der thier- 
arzliche Chirurgie und Geburtshilfe. Wien und Leipsig, 1897. 
8 Streble, Journal of Comparative Pathology. 1901. 
21 does not spontaneously disappear after labor. The procedure 
consists of the use of metal clamps to close the labia and pre- 
vent the descent of the tumor. 
Kitt9 mentions the fact that prolapse is common—espe- 
cially in animals dying from anthrax or black-leg—as an 
agonal occurrence. 
Case II illustrates a condition much more rare. Some 
cases of prolapse unassociated with pregnancy, have been re- 
ported in young animals—colts—suffering with “ colic.” 10 
Eeports of cases in which the bladder has formed part of the 
prolapse are still more uncommon. Franck recognizes two 
main types—one with simple inversion of the bladder, the 
other with its extrusion through the torn vagina. Very little 
attention seems to have been paid to complications of this 
nature which have arisen in dogs and the literature upon the 
subject is scant and inaccessible.11 
A EEPOET OP EIGHT CASES OF CANINE 
NEOPLASM. 
By J. F. Ortsohild. 
Case I.—Adeno-carcinoma of breast with glandular metastases. 
A small, long-haired, yellow, Skye-terrier bitch, sixteen years of 
age, a nullipara and a house-pet, was admitted to the clinic in 
September, 1904. 
History.—For the past six years the patient has been kept for 
the most part within doors and under close observation. Not 
until two months ago, was a small hard mass noticed in one of 
the breasts. It has been rapidly increasing in size and has be- 
come ulcerated. There is no history of traumatism. 
Examination shows a very old, feeble, emaciated and inactive 
dog. The mucous membranes are pale; only a few loose teeth 
remain. 
In the right, most posterior, inguinal breast, there is an ulcer- 
0 Kitt, Pathologische Anatomie der Hausthiere. Miinchen, 1901. 
10 Koepke, Berliner thierarzliche Wochenschrift. 1892. 
11 Since writing the above report a third case of prolapse of the 
nature of this supposedly more rare type, has come under our 
observation. ating, fungated growth, the size of a hickory nut (Fig. 8). The 
ulcerated surface has, upon one side, an overhanging edge, but 
there is nowhere any definite undermining of the epithelial mar- 
gin. The surrounding skin is darkly pigmented. On palpation 
the tumor is firm and has an irregular, nodular outline. The 
moist ulcerated surface is reddish in color, with some gray streaks 
made by superficial sloughs. The nipple does not seem to be 
involved in the growth, though it is somewhat retracted. 
In the subcutaneous tissue to one side of the tumor are three 
or four hard, freely movable, discrete nodules, presumably in- 
volved glands. 
Fig. 8.—Tumor of right inguinal breast of Case I. 
Operation.—October 7, 1904. Morphia; ether. Amputation of 
breast. 
The breast, the tumor, the glands and the neighboring fat of the 
inguinal region were removed in one piece, and though the sur- 
face of the tumor had been ulcerated, an effort was made to 
secure primary union and the wound was closed without drainage. 
Subsequent history.—The wound broke down in large part and 
closed slowly by granulation. Soon after the operation an ulcer 
appeared at the angle of the mouth. This ulcer proved phage- 
denic, spread rapidly and assumed the clinical appearance of a 
23 cancrum oris (noma), finally involving the gums and the adjoin- 
ing cheek. The patient died from this infection two weeks later. 
Autopsy.™— October 21. There were no visceral metastases; the 
abdominal and thoracic organs were practically normal. The 
eroding ulcer of the mouth had eaten its way into the nasal 
cavities, which were filled with pus. No cultures were taken. 
Pathological Note upon the Tumor.—The mass on section shows 
a rather homogenous surface, which is slightly moist, of a pink- 
ish gray color, and is flecked with yellowish points, which can 
easily be scraped off with the blunt edge of the scalpel. The 
Fig. 9.—Low-power magnification. Showing character of adeno 
matous growth in primary tumor. 
glands are quite deeply pigmented; the deposition of pigment 
being most marked in the centre. Their appearance led to an 
operative diagnosis of melanotic sarcoma. 
“Owing to the length of Mr, Ortschild’s report, the post- 
mortem notes, as well as the histories of the animals that were 
used for experimental transplantation, must necessarily be greatly 
abbreviated. It is hoped that his interesting observations may be 
given more in detail in a later communication. (Cushing.) Histologically, the primary growth is found to be in reality a 
carcinoma. Its most striking feature (Fig. 9), is that of a 
malignant adenoma, with a stroma infiltrated by glandular ele- 
ments. The stroma, however, is very cellular, containing large 
ovoid cells full of brown pigment granules. There are many 
cysts lined by high epithelium, some of them containing papillo- 
matous growths. 
The large metastatic nodule has similar characteristics, the 
cystic and adenomatous elements predominating (Pig. 10). In 
the lymph glands containing early metastases, the adenomatous 
structure is not apparent, the cells making up the area of new- 
formed tissue, being for the most part similar to the pigmented 
Fig. 10.—Metastatic nodule; field showing glandular and cystic 
characteristics. 
(mesoblastic?) cells of the primary growth (Pig. 11). Diagnosis: 
Adeno-cysto-carcinoma. 
Transplantations from the tumor, immediately after its re- 
moval on October 7, were made into thrbe dogs, one of which 
was practically of the same strain as the original host. Pieces of 
tissue were transplanted in one animal into the liver and between 
the transversalis fascia and peritoneum; in another case into the 
two inguinal breasts, both of which were supposed to be hyper- 
trophied (in reality, as subsequent observations showed us, the 
25 prominence of the mammse was due to underlying inguinal 
herniae—compare Mr. Beall’s report); in the third, a pregnant 
animal, a sub-peritoneal as well as a mammary inoculation was 
made. A portion of the original tumor, as well as a fragment of 
an involved gland, was used for transplantation in each animal. 
The subsequent history of these animals cannot be entered into 
here, other than to say, that the third of them is Case I, of Mr. 
Thacher’s series, and that the second was found dead, six months 
Fig. 11.—Lymph node with very early marginal metastasis, 
later, with an increase in size of the piece of tissue transplanted 
from the tumor into the right breast, and with enlarged and pig- 
mented lymphatic glands in the inguinal region of the opposite 
side, namely, that into which the fragment of glandular metas- 
tasis had been transplanted. 
Case II.—Mixed (teratomatous) tumor of the breast with mul- 
tiple metastases. 
A small, gray-haired, Skye-terrier bitch, was admitted January 
16, 1905. She had been a vagrant animal and no history was 
26 obtainable. She was an old dog, though seemingly in good condi- 
tion; not cachetic nor anaemic. She was evidently a multipara 
from the appearance of the nipples. 
Special Examination.—Scattered about the ventral surface of 
the thorax and abdomen, are numerous hard subcutaneous 
nodules, varying greatly in size (Fig. 12). The largest, evidently 
the primary growth, occupies the second left thoracic breast, on a 
Fig. 12 (Case II).—Showing situation of primary growth and 
the palpable metastases. Site of nipples indicated by solid black 
dots. 
level with the costal margin. It is made up, seemingly, of a 
conglomerate mass of separate tumors, forming in all an irregu- 
lar growth about 5 by 4 cm. in length and breadth, and 3 cm. in 
thickness. It is freely movable on the underlying tissues; is 
covered by thin, freely movable skin, under which run consider- 
ably dilated vessels. The nipple is not adherent nor retracted. 
The growth is not sensitive on pressure and is very hard to the 
feel. From this main growth, a chain of nodules, varying in size 
27 from a buckshot to a large pea, spreads across the mid-line onto 
the right side. Though some of these nodules are fused, they, 
for the most part, are individually movable. The chief collection 
of them is clustered into a prominent tumor, almost as large as 
the primary growth (Figs. 13 and 14). A chain of these nodules, 
extending up toward the right axilla, can be palpated through 
the skin of the thorax. Higher up on the left side, above the 
Fig. 13.—Photograph after patient was shaven in preparation for 
operation. 
axillary nipple, can be felt a similar chain. Two other large 
clusters are present, one over the left pectoral region, and another 
over the left inguinal breast, which was supposed to be hyper- 
trophied (in reality overlying an inguinal hernia). There are 
a number of other individual nodules all of which are firm, but 
without the stony hardness possessed by the primary growth. 
No masses are palpable within the abdomen. 
Operation.—January 16, 1905. Morphia; ether. 
Through three separate incisions, the main tumor, together 
28 with the second left breast and the surrounding tissue, the mass 
of discrete nodules, together with the adjoining second right 
breast, and the larger one of the individual tumors, were re- 
moved. The wounds were closed without drainage. 
Pathological Note.—The primary tumor presents, in gross, an 
Irregular, nodular surface like that of a compact bunch of grapes. 
Fig. 14.—Same as Fig. 13. To show prominence of primary- 
tumor and projecting nipple. 
The surface is of a pinkish white color with some few points of 
haemorrhage. The rounded nodular projections are smooth and 
glistening. The mass is firm and rock-like in consistency. On 
section, bony resistance is met with, the knife penetrating only 
with the exertion of considerable force. The surface of the sec- 
tion shows an outer shell consisting of a layer of cancellous hone, 
varying in thickness from Ito 2 cm. Radiating from this shell, 
into the substance of the tumor, are delicate bony trabeculae, 
visible to the naked eye. In the central portion are irregular 
29 islands of non-calcified tissue. These islands are for the most 
part, whitish-gray, more or less translucent, and made up of soft 
tissue. Cartilaginous areas are to be made out. 
The metastatic mass and the discrete nodule that were re- 
moved, resemble one another on cross section, very closely. They 
present a very cellular and granular appearance, with a more 
translucent cortical zone and a dark, pigmented center or medulla. 
No bony trabeculae or cartilage can be detected. Some of the 
nodules are evidently lymph glands containing macroscopical 
areas of new growth. 
Fig. 15.—Field from primary tumor of Case II; showing bony 
trabeculae, separated by a strip of fibrous tissue from an adeno- 
matous area with cyst formation. 
Microscopically, the tumor shows, in addition to the bony 
trabeculae and cartilaginous areas, that are discernible with the 
naked eye, that the cellular areas are most diverse in structure 
(Fig. 15). Some of them are of a pure adenomatous type; others 
resemble carcinoma simplex. There are fields of closely packed, 
large, and small round epithelial cells, and in places the loose 
meshwork resembles embryonic connective tissue. In other 
places the tumor shows true osteoid tissue. The lamellae of the 
bone are uniform, have no Haversian systems, and are lined by 
30 numerous osteoblasts. The spaces between these lamellae are 
filled with a meshwork of spindle cells in which are also found 
large cells resembling epithelial cells. Several areas show 
squamous epithelium. In many places there is no sharp de- 
markation between stroma and epithelial cells, one being invaded 
by the other. In the metastases, the neoplastic elements are 
mainly adeno-carcinoma (Fig. 16), with no cartilage or bone. 
Were it not for the cartilage and bone, the tumor could be cor- 
rectly called an adeno-carcinoma. 
Transplantations and Injections.—An emulsion of the original 
tumor was made immediately after the operation by grinding 
fragments of it in a mortar with sterile salt solution. The 
Fig. 16.—Metastasis from Case 11. Field showing pure adenoma 
with cyst formation. 
pulp thus obtained was used for injections. Portions from the 
metastatic nodules were similarly treated. This method was fol- 
lowed, owing to the success that has attended it in the trans- 
plantation from mouse to mouse of a malignant carcinoma sim- 
plex through many generations by Drs. Cloues and Gaylord at 
the Gratwick Laboratory. 
Inasmuch as it was surgically impossible to remove all of the 
involved nodules from the original host, it was considered justi- 
fiable to use this dog for control inoculations from her own 
tumor. Before she came out of the anaesthetic, therefore, a small portion of the original bony tumor was aseptically inserted under 
the skin in the right axillary region. A small piece from one of 
the involved glands was similarly implanted on the left. In 
addition, 2 cc. of the emulsion from the gland were injected under 
the skin at the suprasternal notch and a similar quantity of the 
primary tumor emulsion into the subcutaneous tissue between the 
scapulas. Corresponding implantations and injections were made 
into four other animals. One of these animals, a very old dog, 
died of an intercurrent infection two weeks later and before any 
macroscopical growth could have occurred; but in the subcuta- 
neous tissues of this animal, at the site of the inoculations of the 
glandular emulsion, there were found, microscopically, numerous 
clusters of viable epithelial cells. The other four of the series 
were killed about five weeks later by a vicious bull dog that was 
inadvertently let into the yard. The bodies were too much muti- 
lated to be of any pathological value, though a fresh series of 
transplants was made from the remaining tumors of the original 
host. 
Case 111.—Cysto-adenoma of the breast with metastases. 
A small, short-haired, very stout, almost toothless, decrepit and 
inactive, old, black-and-tan bitch was admitted for operation, 
January 16, 1905. She was a vagrant dog without a history. 
The condition of her nipples evidenced previous pregnancies. 
Examination.—In the second left breast, there is a firm, oval 
nodule, about the size of a pea. There is no retraction of the 
nipple nor any discharge from it. A chain of three distinct 
nodules, similar to the above, is present in the second right 
breast. The nipple is not retracted but discharges a thin, yellow- 
ish fluid on pressure. In the third left breast, there is an indis- 
tinct mass of very firm tissue, suggesting matted glands. In the 
third right breast, there is a large oval mass, evidently the 
primary growth, 2 cm. in length by 1% cm. in breadth and 1 cm. 
in thickness. This is firm, though not of bony hardness, freely 
movable, not adherent, circumscribed and irregularly nodular. 
The inguinal breasts are free from nodules but prominent owing 
to small underlying inguinal hernise. 
Before the patient was subjected to operation, she died from a 
phagedenic buccal infection that seemed to originate in the gums 
about her few remaining and diseased teeth. 
Autopsy.—January 29, 1905. The largest tumor, upon re- 
moval, is found to be irregularly nodular, smooth, encapsulated, 
and somewhat elastic in consistency. It is generally light in color, 
mottled with white and dark brown areas. The surface, upon 
section, is granular and shows the same mottled appearance seen 
on the outer surface. The metastases have the same general as- 
pect as this primary tumor. 
32 The examination was otherwise negative, except for the pres- 
ence of calculi in the bladder and urethra and the extensive 
ulceration of the mouth. 
Microscopic examination shows the tumor to be divided into 
compartments by fibrous bands radiating through it from the 
capsule. Except that there are no bony or cartilaginous ele- 
ments discernible, the general structure of the growth is not 
unlike that found in Case 11. The predominating type of tissue 
is adenomatous. This is cystic in places (Fig. 17). The cysts, 
some of them very large, are lined by high columnar epithelium 
and in many cases contain papilliform ingrowths. Many of the 
Fig. 17.—Section of tumor of Case 111. Showing the more cystic 
portion of an adenomatous field. 
cysts—and these have a lower form of lining epithelium—contain 
a homogenous mass of waxy looking secretion. Some of the 
areas are densely cellular, having the character of spindle-cell 
connective tissue. But even in these densely packed fields there 
are to be made out structures resembling epithelial glands. 
Case IV.—Mixed (teratomatous) tumor of the hr east with 
metastases. Lipoma. 
A valuable, black and brown, Gordon-setter bitch, 8 years of 
age, was brought in by her owner, February 3, 1905. History.—Until the present trouble developed, she had been a 
strong and healthy dog, used for active field work. She has had 
five litters of pups. The last litter was whelped nine months ago. 
When the pups were a month old, one of them bit the patient in 
the most posterior right inguinal breast. The breast became 
sore and a short time afterwards she developed, what her owner 
calls, “ a milk breast.” The mass remained small and did not 
Fig. 18.—Right inguinal tumor in Case IV 
become particularly noticeable until four months ago, but since 
then it has been enlarging rapidly. 
Examination.—The animal has a glossy coat and seems in ex- 
cellent general condition. In the posterior inguinal region of the 
right side, between the last two breasts, there is a large irreg- 
ularly oval mass (Pig. 18), measuring 10 by 7 by 8 cm. The 
tumor hangs pendent from the abdomen and is freely movable 
over the underlying structures. The overlying skin, though not 
adherent, is somewhat thinned out and injected; and at the most 
dependent part has become abraded leaving a superficial area of ulceration about 4 cm. in diameter. The mass is irregularly, 
coarsely nodular, for the most parf very resistant to pressure, 
though having several areas which are less firm and suggest the 
elasticity of tense cysts. The nipples are not retracted nor is 
there any discharge from them. The inguinal glands are pal- 
pably enlarged on this side. 
In addition, there is a small mass under the skin of the left 
pectoral region, oval in shape and about 3 cm. in diameter. It is 
lobulated, firm, freely movable under the skin, and not adherent 
to the tissues beneath. The highest nipple on the left, closely 
Fig. 19.—Photograph, % natural size, of gross appearance of 
tumor from Case IV; mid-section showing more cellular part of 
tumor, no bone or cartilage being visible. 
adjoining this tumor, is markedly retracted, but the gland itself 
does not seem to be, in any way, involved by this growth. 
Operation.—February 3, 1905. Ether anaesthesia. Amputa- 
tion of breasts and tumor. 
The tumor with the two adjoining breasts and involved lym- 
phatic glands was removed in one piece. The broad spindle- 
shaped opening in the skin was closed without drainage. The 
tumor over the left pectoral region was similarly excised to- 
gether with the neighboring mamma. 
35 Subsequent History.—Both wounds healed by primary union 
leaving almost invisible scars. The patient has remained well. 
Pathological Note.—After removal, the tumor presented the 
same general characteristics described above. The cystic areas 
were, however, more in evidence especially in the lower and 
more posterior part of the tumor. The growth on section is 
found to contain hone, cartilage, cysts, fibrous and cellular areas, 
all of which are discernible to the naked eye. The dense fibrous 
tissue is particularly abundant in the centre of the growth, with 
bands which radiate out towards the periphery (Fig. 19). 
Fig. 20.—Microphotograph of field with bony trabeculae. Case IV, 
Within these septa the more cellular areas have an opaque, yel- 
lowish, granular appearance, and upon pressure exude a dirty 
yellow substance. 
Microscopial examination.—The mass is a mixed tumor, very 
similar to that of Case 11, the description of which might well 
apply to this tumor. There are found all the areas noted with 
the naked eye, cartilage, bone, cysts, fibrous and cellular tissue. 
Large cystic areas, lined by a low epithelium are found in which 
a coagulated fluid is present. Other cysts show papillomatous 
ingrowths. Some areas are purely adenomatous; others are en- tirely fibrous; while still others show tissue resembling em- 
bryonic connective tissue (Figs. 20 and 21). As the adeno- 
carcinomatous elements predominate, were it not for the bone and 
cartilage, the diagnosis of adeno-carcinoma would be made. 
The small tumor from the left pectoral region, macroscopically, 
is a fatty tumor, a diagnosis confirmed by histological examina- 
tion. 
Transplantation from the malignant tumor was made into one 
dog. 
Case Y.—Intra-cystic papilloma of the breast, with metastases 
Fig. 21.—Fibrous and cystic area from tumor of Case IV 
The patient, a valuable black, Gordon-setter bitch, ten years of 
age, was brought in by her owner, February 15, 1905. 
History.—She had always been well and actively used as a 
field dog. When nine months of age she had her first litter 
of pups. A second litter was whelped three years ago when 
she was seven years old. One of the pups of this litter in suck- 
ling injured the right inguinal breast. Apparently an abscess 
formed, which discharged pus. This finally healed, leaving a 
small palpable nodule in the breast. The mass has increased 
slowly in size up to the present time and has become so large 
37 that it incapacitates her from active exercise (Fig. 22). The 
owner has never noticed any discharge from the nipple. 
Examination.—The animal has a glossy coat and seemingly is 
in the best of condition. In the right inguinal region between 
the two most posterior breasts, is a large, heavy pendent mass, 
measuring 10 cm. in length, by 6 cm. in breadth and thickness. 
It is freely movable over the underlying tissues. The overlying 
skin is thin and injected but not adherent to the tumor. It is 
Fig. 22 (Case V).—Large pendent tumor at right inguinal breast, 
without abrasion. The mass is irregularly lobulated, hard, and 
firm, but not of bony consistency. There are several softer, 
elastic and fluctuating areas suggesting cysts. Under the last 
breast and extending from it towards the inguinal region is a 
deeper lying soft swelling. The nipples are not retracted. On 
compressing the tumor there shot out from the inguinal nipple, 
for a distance of several feet, a fine stream of serous blood-stained 
fluid. 
In the region of the left most posterior inguinal mamma are a number of discrete rounded nodules, varying in size up to 1 
cm. in diameter. They are freely movable under the skin and to 
the feel resemble the firmer areas of a primary growth. The 
neighboring nipple is not retracted nor can any discharge be 
expressed from it. The inguinal glands are enlarged on both 
sides. 
Just posterior to the third and to the fourth mammae on the 
left side are two nodules the size of cherries, that possess charac- 
teristics resembling those of the firmer portions of the main 
tumor. 
Operation.—Feb. 15, 1905. Morphia; ether. Amputation of 
breasts and tumor. The large tumor with the two adjoining 
mammae was removed with a wide margin of healthy tissue. 
After removal of the tumor and the breasts the deeper lying mass 
Fig. 23.—Median section of tumor from Case V (y2 natural 
size). Showing cyst with intracystic vegetations in upper half of 
section (I) and compact tissue in lower half (71). Breast and 
nipple (A) in right upper corner. 
described above was examined and found to be a small right 
inguinal hernia. This was operated upon by Mr. Beall and is 
Case 111 of his series. One of the nodules—that posterior to the 
third left breast—was also removed, through a separate incision, 
and the wound closed with interrupted silk sutures. 
Subsequent Note.—The wound, made by the larger operation on 
39 the right side, superficially broke down in part and healed by 
granulation. The smaller wound healed by primary union. The 
animal died eleven days after operation from a very virulent 
infection of the left hind foot. 
Pathological Note.—-The tumor is encapsulated, of a reddish 
color, with small somewhat translucent and more whitish nodular 
areas, varying in size from a fine shot up to that of a buckshot or 
larger, and surrounded by darker areas. Its surface is very 
vascular. 
Upon section (Fig. 23), the tumor is found to be made up of 
Fig. 24.—Microphotograph of tumor. Case V, showing alveolar 
arrangement. 
two more or less distinct areas. The anterior portion consists of 
comparatively solid tissue, but posteriorly the knife enters a large 
cyst which contains thin blood-stained fluid similar to that which 
could be expressed from the nipple before the operation. The 
cavity of the cyst measures sby4 by 3 cm. Its outer wall is very 
thick, especially in the most ventral portion, where it measures 
2 cm. The wall in these thick areas is mainly fibrous, somewhat 
firm and elastic, and contains several small, round, yellowish 
areas. 
40 The inner surface of the cyst wall is very irregular, numerous 
pockets being formed by the irregularities. The entire right half 
of the cyst—and to a less extent the remainder—is lined with 
coarse vegetations. The surface of these fungous ingrowths, some 
of which are distinctly pedunculated, is coarsely granular and 
presents a very ragged appearance. The vegetations are reddish 
in color and lodged between the larger projections are numerous 
reddish coagula. These papillary ingrowths present, on sec- 
tion, an appearance similar to that of the isolated areas in the 
cyst wall, as well as that of the more solid portion of the tumor. 
This solid part of the growth seems to be made up of compact 
masses of papilliform growths such as individually project into 
Fig. 25.—Microphotograph of metastasis to lymph gland from 
Case V. 
the cyst cavity. Between the masses of cellular tissue can be 
made out smooth walled channels, many of them containing shreds 
of blood coagula. The stalks of the cell masses contain a large 
amount of fibrous tissue. The cut surface is smooth, moist, yel- 
lowish and homogeneous, having a slightly granular appearance. 
Upon pressure there exudes a thick, semi-fluid, dirty, yellowish 
substance. 
The whole tumor presents the characteristic appearance of an 
intracystic papillomatous growth. In the still cystic portion of the tumor the ingrowth only partially fills the cavity. The 
more solid portion apparently represents a pre-existing cyst that 
has become completely obliterated by the ingrowth. The metas- 
tatic nodule is similar, in all respects, to the solid portion of the 
original tumor. 
Microscopical examination shows the tumor to be a very cellu- 
lar one (Fig. 24). In some areas there are numerous fibrous 
bands running in all directions, dividing the tumor up into 
alveoli. In these alveolar areas the epithelial cells are compact, 
often filling the entire space. In other areas the appearance is 
Fig. 26.—Microphotograph of metastatic nodule; field with adeno- 
matous and myxomatous areas. 
adenomatous, while in still others, the appearance is that of intra- 
cystic papillomatous growths. The section of the papilliform 
growths in the large cyst shows them to be almost entirely made 
up of cells of an epithelial nature, similar to those in the other 
areas of the tumor. 
The metastasis to the lymph gland preserves the general char- 
acter of the original tumor (Fig. 25). The alveolar arrangement 
and the papillomatous structure is beautifully shown. The metas- 
tatic nodule (Fig. 26) shows dense fibrous bands in places, also 
42 large areas of myxomatous tissue in others, and preserves the 
intracystic and adenomatous character of the original tumor. 
Transplantation from this growth was made into two dogs. 
Case VI.—Fihro-lipoma of the vaginal wall. 
History.—Small, fox-terrier hitch, eight years old, a house pet, 
was brought to the clinic, March 17, 1905. She had her first and 
only litter of pups seven years ago. Last July a lump, the size 
of a small pigeon’s egg, was noted in the perineal region. This 
swelling grew slowly at first, hut during the last few months has 
Fig. 27 (Case VI).—Showing size and position of tumor. The 
dilated vaginal opening, blocked by the growth, is visible at the 
lowermost portion of the tumor in this view. 
increased rapidly in size. The mass, has caused no inconvenience 
to her so far as the owner has noticed. 
Examination shows a small, old, active, fox-terrier bitch, very 
fat and in good general condition. The patient has difficulty in 
passing water. In the perineal region there is a marked posterior 
bulging of all structures making a solid mass outside the pelvis, 
considerably larger than a closed fist. The opening into the 
vagina is apparently blocked by this mass, a portion of which the 
size of a twenty-five cent piece, covered merely by mucous mem- brane, is externally visible through the vulva. This mucous 
membrane is dark red, hyperaemic and slightly ulcerated. The 
skin over the mass is not adherent but is thin. The mass seems 
to project through the pelvic outlet, is circumscribed, very firm, 
somewhat elastic, and of a tenseness suggestive of a distended 
bladder such as was observed once in a hernia case. (See Mr. 
Beall’s first hernia case in fox-terrier.) In the anterior area the 
surface is more irregular. There are no enlarged glands palpa- 
ble in the groins. 
The extraordinary appearance of the mass is shown in the 
photographs (Figs. 27 and 28). It was supposed to represent a 
large prolapse containing bladder and intestine. 
Fig. 28 (Case YI).—Profile view of large fibro-lipoma of anterior 
vaginal wall. 
Operation.—March. 17, 1905. Ether. Enucleation of tumor. 
The mass was found to be a large, solid, fibroid tumor of the 
vaginal wall and was enucleated through a median incision, ex- 
tending from near the tip of the vulva to the mid-hypogastric 
region. Under the belief that the abdominal viscera made up 
part of the supposed prolapse, it was intended to open the abdom- 
inal cavity. Not until the tumor was almost entirely enucleated, 
did it become evident that it had no real connection through the 
pelvis and could not be other than an isolated growth. It was so 
44 definitely encapsulated that, mostly by blunt dissection, could it 
be freed from the surrounding tissues. Only in one place was it 
adherent, viz., at the spot where it was covered merely by the 
exposed vaginal mucous membrane, and owing to this close attach- 
ment, the vaginal wall was torn during the enucleation and its 
lumen opened. 
This rent in the vagina was first closed with interrupted sutures 
and the great gapping wound, from which the tumor was re- 
moved, was closed by drawing together the walls so as to obliter- 
ate the great dead spaces that would otherwise remain. 
Subsequent History.—Wound healed by granulation. 
Pathological Note.—The mass removed measures 11 cm. in 
length, 9 cm. in breadth, and 6 cm. in thickness. It is definitely 
encapsulated. The surface is smooth and of a reddish yellow 
color; surface vessels bein injected. The mass is irregularly 
lobular. The small area noted as being visible through the vulva 
is covered by adherent mucous membrane, measuring 2 cm. in 
diameter, which is hyperaemic and slightly ulcerated. The mass 
is solid, firm, somewhat elastic and of uniform consistency. 
The cut surface is moist, glistening, not granular, but of a 
fibrous appearance. The general color is creamy white with 
numerous pearly white, glistening bands of tissue running irreg- 
ularly through the mass. Nothing exudes upon pressure. There 
are some areas where the tumor does not appear so fibrous and 
where grossly there is a suggestion of myoxmatous tissue. 
Microscopical Examination.—The sections of the tumor show it 
to be made up chiefly of fatty tissue, in which are scattered nu- 
merous irregular strands and areas of dense fibrous tissue. The 
tumor is a pure fibro-lipoma. 
Case VII.—Diagnosis. Hygroma. 
History.—Long-haired, black and white, English setter, five 
years old, a valuable animal and a pet, was brought to the clinic, 
March 10, 1905. The dog has always been well. About 5 months 
ago a swelling was noted over the right shoulder. This swelling 
has persisted up to the present time. No further history was 
obtainable. 
Examination.—The patient is a very active dog, in excellent 
condition. Mucous membranes are of a good color. The coat is 
glossy and smooth. Upon palpation a small mass about the size 
and shape of a pigeon’s egg is palpable in the right scapular 
region. This mass is circumscribed, firm, elastic, and smooth, 
shows a slight fluctuation, and is not adherent to skin or under- 
lying structures. 
Operation.—March 17, 1895. Morphia; ether. Amputation of 
tumor. 
45 The mass, together with a large spindle-shaped portion of over- 
lying, thick skin, was removed in one piece. The wound was 
closed without drainage, with interrupted fine silk sutures. 
Subsequent history was uneventful. 
Pathological Note.-—The mass removed was found to be a cyst 
with a thin semi-tr.inslucent wall and of a bluish appearance. 
The contents of the cyst appear to be a clear fluid. The entire 
mass was placed in Zenker’s solution for microscopical sections. 
Microscopical Note.—The cyst wall is found to be composed of a 
dense layer of fibrous tissue, supporting, on its inner surface, a 
single layer of high, columnar epithelium. The inner surface is 
smooth and regular. The structure resembles that of a serous 
cyst. 
Case VIII. Diagnosis. Adenoma. 
History.—Long-haired, grayish yellow, Scotch-terrier dog, ten 
years old, a pet, was brought to the clinic, March 14, 1905. The 
dog has been apparently well until two years ago. At that time 
a small swelling, about the size of a pigeon’s egg, was noticed in 
the left groin. At first, this swelling increased in size very slowly 
and remained at the original site. About six months ago the mass 
rapidly grew in size, gradually became more and more pendent as 
it increased in size, until it assumed its present proportions and 
position. 
Examination shows an old, very active dog, seemingly in good 
health. Mucous membranes are of good color. Abundant pannic- 
ulus adiposus is present. When the dog is standing upon all 
four feet, there is a large mass hanging by a pedicle, free from 
the abdominal wall at the side of the penis (Figs. 29, 30 and 31). 
The long pedicle is apparently composed of little more than skin and 
numerous large vessels, which can be palpated through it; one of 
these a large pulsating artery. One side of the pedicle forms a 
portion of the sheath of the penis. The mass just swings clear of 
the ground when the dog walks. The mass itself measures 12 cm. 
in length, by 10 cm. in breath, by 5 cm. in thickness, is covered 
by thin skin which is generally deeply pigmented, with the ex- 
ception of several areas over the lower surface where there is an 
absence of pigment, suggesting healed abrasion and where there 
are several areas of recent abrasion. The mass is very soft, 
almost spongy on palpation. It is not definitely circumscribed, 
nor lobulated, though the surface is somewhat irregular. Some 
areas are definitely firmer than the rest of the mass. The entire 
tumor is very vascular. 
The left inguinal glands are much enlarged and firm. 
It was exceedingly difficult to make a clinical diagnosis. The 
case was brought in as one of hernia and had many points of resemblance to a hernia or a large varicocele in man though the [1941 
scrotum was not involved. It resembled also a pendent lipoma 
such as is met with in man. The enlargement of the glands was 
accounted for by the ulcerated surface of the tumor. This tumor 
is exceedingly interesting because of the difficulty of diagnosis, 
because of its pendent nature and its rich blood supply and, 
further, because it is our only instance of a tumor, other than a [l9s] 
cyst, occurring in a male dog. 
Fig. 29 (Case VIII).—Showing pendent nature of tumor with ani 
mal on all fours. 
Operation.—March 17, 1905. Morphia; ether. Amputation of 
tumor and pedicle, and removal of mass of enlarged inguinal 
glands. 
A long incision was made from the tip of the penis to the 
groin and carried along each side of the base of the pedicle. 
The large vessels were secured and the tissue containing the 
glands of the inguinal region, together with the tumor, was 
47 removed in one piece. The wound was closed with interrupted 
silk sutures, a new sheath of skin being made for the penis. 
Subsequent History.—The wound broke down in part, healing 
slowly by granulation. 
Pathological Note.—On section the tumor mass removed shows 
a dark red, much congested surface, which is moist, glistening, 
and granular. The whole tumor appears to be made up of very 
cellular tissue divided into small areas or lobules by a small 
amount of fibrous tissues; the picture resembling somewhat that 
Fig. 30 (Case YIII).—Profile view of growth with patient in erect 
posture. 
of a thyroid. These lobules appear to be made up of smaller 
circular areas about the size of a pin head, which project from 
the surface upon pressure. Several small cysts are also to be 
noted, in two of which are small smooth bodies resembling papil- 
lomatous growths. There is a possibility of these being thrombi 
in blood spaces or vessels. There are numerous large channels 
with thin smooth walls running through the mass. In the lower 
most dependent portion is a large island of fibrous tissue, firm, 
48 and of a pinkish color. In the subcutaneous tissue of the pedicle 1 
are found two sebaceous cysts each about the size of a large pea, 
resembling those found in man. 
The inguinal glands are firm and present upon section a moist, 
deeply pigmented, congested center, with a paler periphery. 
Microscopical examination shows the entire tumor to be made 
up of lobules, varying greatly in size. There is a very small 
amount of connective tissue around each lobule. The cells, mak- 
ing up the lobules, are chiefly large, granular, polygonal cells, 
Fig. 31 (Case VIII).—Front view. Growth suspended by penile 
sheath when animal is in this position. 
with relatively clear, poorly staining nuclei. The stroma also 
appears to be very cellular. In many areas, the large cells form 
a solid lobule; in others, they surround alveoli; and in still other 
places alveoli are found, lined by cuboidal cells, and containing 
a peculiar substance, resembling cell detritus. 
Histologically the enlarged lymphatic glands show merely a 
condition of endothelial hyperplasia. 
49 The tumor was diagnosed as an adenoma, from its alveolar 
structure though it was impossible to say from what glandular 
tissue it had originated. 
Discussion, 
Tumors, and particularly carcinomata are of common occur- 
rence in dogs. Gratia and Lienaux1 report a series of six 
cases of carcinoma of the breast, which were used by them 
for inoculation experiments. E. Semmer,2 of Dorpat, found 
among 3535 dogs, admitted to his clinic, 354 cases of tumor. 
Of this number about 8% were carcinomata. M’Eadyean3 
reports a series of 14 cases of tumor of the mammary glands 
of dogs. ErohneEs4 figures for a period of eight years, end- 
ing with December, 1894, are exceedingly interesting. Dur- 
ing this time, there were admitted to the veterinarian hospital 
and polyclinic in Berlin 60,471 dogs. Of this number 3871 
had tumors, about one dog in every twenty. There were 
1154 carcinomata; about 40% of all tumors, therefore, were 
of this nature. 
Carcinomata of the skin and mammae are the most com- 
mon. These tumors generally appear late in the life of the 
dog. In my series of cases the age was obtainable in six 
cases; the youngest being five years and the oldest being six- 
teen years y)f age, Erohner has never observed a carcinoma 
in a dog less than two years old. These tumors are most 
common in dogs between five and ten years of age, and occur 
more frequently in females than in males. Although carci- 
nomata are the most common tumors of the breasts, neverthe- 
less, fibromata, enchondromata, and sarcomata are not infre- 
quently met with. 
It seems to be a common opinion among veterinarians that 
when a tumor of the mamma has a bony structure, such as 
several of our cases exemplify, it is undergoing retrogressive 
changes or a process of self-healing. This view does not seem 
to me to be the correct one, in the light of my limited number 
of cases. The adenomatous portions of the tumors appear to 
be the portion that metastasizes. 
I have been unable to find, in the literature at my com- 
mand, any tumor corresponding to Case YIII, except one re- 
50 ported by Kitt.5 The one described by him occupied a simi- 
lar position, was the same shape, and presented a similar gross 
appearance before removal. However, from his description 
after removal, the tumors do not resemble one another. Kitt’s 
tumor was an adenoma sebaceum {Talgdrusenadenom). 
Bibliography. 
1. Gratia et Lienanx: Eecherches experimentales sur 
Pinocubilite du cancer. Annales de Medecine Yeterinaire, 
Bruxelles, 1894. 
2. E, Semmer; Tnmoren. Lehrbuch der Allgemeinen 
Chirnrgie und Operationslehre, Moller, 1893. 
3. M’Fadyean: Tumors in Domesticated Animals. Jour- 
nal of Comparative Pathology and Therapeutics, Yol. 111, 
1890. 
4. Frohner: Yorkommen der Geschwiilste beim Hiinde. 
Monatshefte fiir praktische Thierheilkunde, Band VI, 1895. 
5. Kitt: Pathologisch-Anatomischen Diagnostik der 
Thiermedicin, Vol. I, 1895. 
6. Johne: Ueber Geschwiilste. Yortrage fiir Thier- 
aerzte, Serie IY, Heft. 8-9, 1882. 
7. Birch-Hirschfeld: Die Geschwiilste. Grundriss der 
Allgemeinen Pathologie, 1892. 
CASES OF HERNIA IN DOGS. 
F. C. Beall. 
Case I.—Large irreducible, right, inguinal hernia: enterocele; 
cystocele. 
The patient, an old fox-terrier bitch, was admitted November 
5, 1904. The only history obtainable from her owner, beyond the 
fact of several pregnancies, states that for six months there has 
been a noticeable tumor in the lower abdominal region. This 
has been progressively enlarging. For the last two months the 
dog has been losing in weight and strength. Latterly she has 
been vomiting almost every day. There has been constant drib- 
bling of urine. 
Examination shows an old, seemingly well bred, though poorly 
nourished, animal with pale mucous membranes. Hanging from the left half of the abdomen is a large, soft 
tumor (Figs. 32 and 33), covered by normal, freely movable skin, 
which has a faintly bluish tinge. Coursing irregularly over its 
surface are ridges made by several greatly dilated subcutaneous 
veins. The tumor is generally smooth and rounded except near its 
base on the median surface. Here, the two lowest mammary glands 
have been drawn out onto the tumor by the stretching of the 
skin, and, in consequence, an area about the size of the hand is 
roughly and loosely folded. On the posterior wall of the tumor, 
Fig. 32 (Case I).—Large right inguinal hernia containing intes- 
tines and greatly distended bladder. 
just below the symphisis pubis, as the patient stands, is a pur- 
plish ecchymotic area. Palpation of the contents of the tumor 
show that it is composed of two distinct parts. One, a more or 
less pear shaped mass, constitutes its main bulk and is every- 
where, except just at its base, in contact with the overlying skin, 
though not attached at any point. This portion of the tumor is 
distinctly pedunculated, rather firm and elastic, giving the im- pression of a very thick walled cyst without distinct fluctuation. 
Around the base of this harder mass, especially on the median 
side, can be made out a softer, irregular, “ wormy ” mass that 
does not seem to be connected with the firmer portion of the 
tumor. It can be traced across the median line to the right 
inguinal ring which is easily made out. In this soft mass at the 
base of the tumor, peristaltic movements were discernible while 
the animal was being cleaned up for operation. The tumor 
could not be reduced by taxis even under the ansesthetic. 
Fig. 33 (Case I).—Lateral view of hernia sac. 
Operation.—November 11, 1904. Morphia; ether. Herniotomy. 
A long incision was made through the skin on the mesial side 
of the neck of the tumor. The sac was exposed and liberated as 
well as possible, but owing to its large size was very awkward to 
handle nor could any of its contents be reduced until it had been 
opened and the inguinal ring identified and incised in the line of 
the external oblique fibres. 
In addition to the round ligament, which in the dog normally 
53 passes through the inguinal ring with a process of peritoneum, 
the sac contained about 200 cc. of a pale straw colored fluid, a 
free, irregularly shaped blood-clot, the size of a walnut, several 
loops of small intestine, one of which was a dark bluish color— 
apparently almost strangulated—and a very large distended 
bladder, measuring 12 by 6by 8 cm. (The length of the bladder, 
normally, in a dog of this size is about 3 cm.) The surface 
over the fundus of the bladder was congested, granular and cov- 
ered in part with a fibrinous deposit, evidencing an old 
haemorrhagic peritonitis and doubtless the source of the free blood- 
clot found in the sac. Some difficulty was experienced in re- 
ducing these structures; this was particularly true of the bladder 
and a considerable enlargement of the ring was necessary be- 
fore it could be replaced in the abdomen. The sac, which was 
very thin and tore in several places despite the greatest care, 
was then freed; its neck was ligated and the fundus cut away. 
The abdominal wound was closed in layers, the internal oblique 
fibers having been brought down to Poupart’s ligament and se- 
cured by imbricating as were also the edges of the external 
'oblique aponeurosis. The operative procedure differed but little 
from that advocated for the corresponding lesion in man. The 
only anatomical differences lay in the presence of a large venous 
radicle from the epigastric which passed through the external 
ring. 
Post-operative.—Though the animal stood the operation well 
and no serious complications were anticipated, she was found 
dead the following morning. 
Autopsy.—The examination revealed the following conditions: 
The whole mucosa of the stomach, except just around the pylorus, 
was thickly studded with deep ulcers, some of them extending 
through all but the serous coat of the stomach wall. The ulcers 
were sharply outlined and had elevated haemorrhagic edges show- 
ing that they could not have been due to post-mortem digestion. 
The right kidney was completely atrophied, its substance being 
represented by a dense fibrous tissue only 4 mm. in thickness. 
The ureter in this side, though patent throughout, was only 
about one-third the size of the one on the left. The bladder was 
very large—lo cm. in its longest axis—and presented the appear- 
ances described with the operation. The walls were about y2 cm. 
in thickness. The mucous membrane was swollen, rough and of 
a dark red, almost black color at the fundus. The other organs 
were practically normal. 
Anatomical Diagnosis.—Recent operative wound. Chronic, 
round ulcers of the stomach. Obstructive hypertrophy with con- 
gestive inflammation of the bladder. Atrophy of right kidney and 
ureter. Case II.—Bilateral inguinal hernia. 
The patient, a little, old, shaggy-haired hitch, of Skye-terrier 
type, was admitted January 13, 1905. The history obtained from 
her master is as follows: The dog is eight years old. She has 
twice been pregnant, having had only one pup at the first, and 
two at the second occasion. She is a very active dog and her 
owner thinks the ruptures are due to “ jumping after cats ” 
Fig. 33 (Case II).—Large left and small right inguinal hernise. 
against high palings. Two years ago and not until two years 
after the second pregnancy, a tumor was first noticed in the left 
inguinal region. When first seen it was small and reducible. It 
has gradually increased in size until now it is about as large as 
a closed fist (Fig. 33). A second tumor was noticed on the right 
side about two months ago. It is now about the size of an egg. 
The larger tumor, on the left side, is not reducible; the one on 
the right usually disappears of itself when the dog is relaxed 
and placed upon her back. 
55 Operation.—January 13, 1905. Radical cure of left inguinal 
hernia. 
The sac was cut down upon by an oblique incision, carried up- 
ward and outward from the external ring in the line of the exter- 
nal oblique fibres. The sac was dissected out, opened, its contents 
—in this case small intestine only—replaced in the abdominal 
cavity. The sac was ligated at the external ring and excised. 
The wound was closed in layers with fine silk interrupted sut- 
ures, imbricating the external and internal oblique muscles as in 
Case I. 
Recovery was uneventful. The wound healed per primam. 
Operation 2d.—February 10, 1905. Radical cure of right in- 
guinal hernia. 
An operation similar to that above described, was performed 
upon the right side, where the small hernia had, in the interim, 
increased in size almost to that of the original large left hernia. 
The recovery was rapid and complete with primary union. 
Case 111.—Small right inguinal hernia. 
The patient, a fine large Gordon-setter bitch (No. V, of Mr. 
Ortschild’s series), was operated upon by Mr. Ortschild and my- 
self, February 15, 1905, for the removal of a large malignant 
tumor of the right inguinal breast. In the fatty tissue under the 
breast a small hernial sac, containing the prolapsed round liga- 
ment and its meso-ligamentum, was unexpectedly found. The 
hernia was treated as iri the other instances. 
Disoussion. 
Hernia, as is well known, is frequently met with in the dog. 
The most common form, perhaps, is the mid-ventral, either 
epigastric or umbilical, of which we have seen several in- 
stances. These ruptures occur in both sexes with about equal 
frequency and, according to our experience, are usually small 
and not productive of symptoms. They are usually congenital. 
Inguinal hernia, on the other hand, aside from the very rare 
congenital form, is very much more common in the female 
and, as in the cases cited above, may reach a seriously in- 
capacitating size. The smaller inguinal hernias, such as the 
last case illustrates, are probably not at all uncommon in 
bitches and we have heretofore in the clinic doubtless over- 
13 Un caso di ernia doppia in un cane. Mod. zooiatro, Torino, 
1900, XI (221-6). looked them many times. What were at first considered to 
be merely hypertrophied inguinal mammae, have, on several 
occasions, been found to be normal breasts whose prominence 
was due to an underlying rupture. In one of Mr. Ortschild’s 
cases a piece of tumor had been implanted in one of these 
supposedly enlarged breasts which increased further in size 
and led us to believe that the tumor itself was enlarging. The 
dog became emaciated and one morning was unexpectedly 
found dead. The autopsy disclosed a hernia containing a 
strangulated loop of small intestine. 
All of the cases but one, that I have been able to find in the 
veterinarian literature, have occurred in the female. This 
was a case of Parascandale’s.13 The greater frequency of this 
form of hernia in the female is doubtless to be explained on 
anatomical grounds. The broad ligaments of the dog’s bicor- 
nuate uterus are attached to the horns just as the mesentery is 
to the intestine, forming the mesometria. The round liga- 
ments arise as processes from the broad ligaments at about 
their middle and run backwards to the inguinal canals (the 
uterus of the dog, it is to be remembered, is for the most part 
an abdominal organ) carrying with them processes from the 
broad ligaments. Each round ligament, as it passes through 
the inguinal canal, is practically free, being attached only 
loosely to the dorsal wall of the canal by folds of peri- 
toneum which are continuous with those of the broad 
ligament. The canal is lined by an extension of peri- 
toneum (analogous to the Canal of Nuck) which passes 
about 2 cm.—in a medium sized dog—beyond the ex- 
ternal abdominal ring. There exists normally, therefore, 
a peritoneal diverticulum which traverses the abdominal 
parietes. With the dog on its four feet this sac looks back- 
ward, inward, and slightly upward and the pressure of the 
abdominal contents on its upper wall probably serves to keep 
it entirely closed. During pregnancy, however, the round 
ligament is put on a stretch by the enlarged uterus, and this 
seemingly tends to loosen and weaken the surrounding struc- 
tures and to enlarge the whole canal. After pregnancy the 
relaxed tissues would allow the small peritoneal sac to sag and 
57 point downward, instead of upward, so that with an enlarged 
opening the prolapse of abdominal viscera would be compar- 
atively easy. That the frequency of inguinal hernia in the 
female dog is due, in great part at least, to the weakening 
effects of pregnancy on the abdominal wall, is shown by the 
fact that this form of hernia is almost unknown in the male 
dog. And this, notwithstanding the fact that the tunica 
vaginalis of the testicle retains its peritoneal connection 
through the inguinal ring and does not become obliterated as 
in man.14 
The viscera, most often found in these canine hernias, are 
the round and broad ligaments of the uterus, the uterus itself 
(sometimes even the pregnant uterus), the small intestine, 
14 The persistence of these peritoneal canals is very commonly 
regarded as a favoring cause of inguinal hernia (of the so-called 
congenital variety) in man and his erect posture may suffice to 
make this the more probable. Bland Sutton, however (Trans- 
actions of the Pathological Society. London, Vol. XXXIX, 1888), 
has called attention to the fact that these peritoneal processes 
remain patent in the monkey and yet inguinal hernia is a rare 
malady in these animals. He has made a report upon a single 
instance of the condition. 
He says, “ Some surgeons are of the opinion that a patent 
funicular pouch is to be regarded as predisposing to the occur- 
rence of a hernia.” * * It is, however, a remarkable fact that, 
among mammals, obliteration of this process above the testis is 
altogether exceptional, indeed, in the majority this process not 
only remains open but freely communicates with the peritoneal 
cavity. The only exceptions which have come under my notice 
are the chimpanzee and the gorilla. Professor Owen has found 
the process obliterated in a chimpanzee. In three specimens of 
this mammal dissected by me the process was patent. * * * * * 
Up to the present time I have examined post mortem more than 
800 monkeys, including examples of all the chief species, ex- 
cepting the gorilla. In every male, the funicular process was 
unobliterated and communicated freely with the peritoneal cavity. 
There was no separation of a piece to form a tunica vaginalis. 
* * * * Theoretically, if an unobliterated funicular pouch predis- 
poses to hernia, this accident should occur in monkeys frequently. 
So far I have only seen three cases. In each instance they were 
of the variety known as congenital, the contents completely sur- 
rounding the testis.” and the omentum. Our first case is of interest in that the 
sac contained the entire bladder which had become greatly 
distended and hypertrophied. I have been unable to find any 
other case of cystocele reported as occurring in the dog 
although the possibility of its occurrence is mentioned. 
The malady in the canine does not seem to be commonly 
attacked on modern surgical principles by veterinary surgeons. 
A series of twelve cases has been reported by Hobday from 
the Eoyal Veterinary College of London.15 
In his Operationslehre fur Tierarzte, Bering states that in- 
guinal hernias are most commonly met with in stallions and 
boars, rarely in oxen, sheep, and dogs, and very exceptionally 
after castration. He describes, in addition to the more com- 
mon forms which we have met with, several other varieties of 
hernia that occur in animals and which are anatomically simi- 
lar to those met with in man. 
15 Hobday, Operative Treatment for Hernia in the Dog. Veteri- 
narian, London, 1896, LXIX, 195-200. Cf. also, Einige Beobacht- 
ungen fiber Hernien. Wchnscbr. f. Tierb. u. Viehzucht, Miinchen, 
1897, LXI, 217, 225, 229. Duscourneau, Hernie inguinale irre- 
ductible chez la chienne. Bull. Soc. Centr. de Med. Vet., Paris, 
1901.