Treatment. 671 



Treatment. In the first stage cold applications to the head 

 and purgatives are indicated to alleviate the symptoms pro- 

 duced by the inflammation. 



In the second stage only removal of the cyst by trepanning 

 can lead to recovery. 



Under the following circumstances surgical interference is indi- 

 cated: a superficial and accurately localized situation of the cyst, the 

 appetite maintained to some extent, and the animal in satisfactory 

 condition, the absence of spontaneous convulsions, and finally, when 

 slaughter is not desirable. In connection with the operation in cattle, 

 the breed of the animals must be taken into consideration. Results 

 obtained by a number of Bavarian veterinarians (Imminger, Braun, 

 Diem) show that trepanning is attended with great difficulty in the 

 case of Simmenthal cattle on account of the extraordinary thickness 

 of the cranial bones, the tough structure of the cysts ; and finally, the 

 special susceptibility of the animals to the operation. Diem's results 

 (87% of cures) indicate that, provided certain precautions are taken 

 (ligation of blood vessels, the cyst be not probed about or infected, the 

 wound be thoroughly cleansed and washed out after operation) as 

 good results may be obtained with this breed as with others. The 

 species of the diseased animals should also be taken into consideration. 

 Sheep are of less value than cattle, and not infrequently they harbor 

 a large number of cysts, points which are opposed to the operation 

 being undertaken, and to its success. In cases in which the symptoms 

 indicate the presence of cysts, but their exact situation cannot be de- 

 termined, it is advisable to wait for two to eight weeks in the case of 

 cattle so that the chance of localizing the parasite may be increased. 

 According to Diem, pregnancy is no liar to the operation. 



In operating, the entire cyst should be removed, the results 

 following removal of the contents only being less favorable. 

 As a general rule, it appears to be advisable to remove the 

 liquid slowly and with pauses as a sudden alteration of in- 

 tracranial pressure may cause fatal paralysis or general con- 

 vulsions and hemorrhage. 



The seat of operation depends upon the case and especially upon the local 

 lesions presented by the cranial wall (see pages 666 and 667). If such indications 

 be absent the operation should be undertaken only at the special desire _ of the 

 owner. With experience the cyst will in most cases be found, and especially if 

 the animals have shown symptom of moving in circles or forwards. In horned 

 breeds of sheep the middle portion of the occipital lobe lies 12 mm. in rams and 

 16 to 20 mm. in ewes behind the middle point of the line joining the horn cores, 

 and the frontal lobes immediately behind the inner portion of the horn or the 

 horn core. In hornless breeds the following are the guiding points: The area 

 included between lines joining the bases of the ears and the eyes and lines joining 

 the base of each ear with the eye on the same side is divided medially by a vertical 

 line, and the operation is carried out at the mid-point of the areas so marked out. 

 In cattle the proper seat of the operation is at a point 4 cm. above a line joining 

 the brows of the eyes and 1.5-2 cm. from the middle line (Albrecht). In any case 

 the middle line must be avoided so as to escape injuring the longitudinal sinus. 

 More exact directions will be found in text books on surgery, and references to 

 the operation in cattle will be found in the publications of Merkt, Albrecht, Diem 

 and Pfab. 



In cases in which the operation is successful and recovery 

 is going to take place, there is a striking improvement in the 



