OUTLINE OF THE

- VETERINARIANS .

C U V I I OF H D M O NTY ETER NAR AN ETTSTE T , GER ANY ,

T ranslated f rom th e L ates t Germ an E d ition b y

W ITH ANNOTATIONS BY

' A. H. BAKER, V. S .

' pR oRE S S R or H A N D P C I C OF V I M D ICI A N D U O T EORY RA T E ETER NARY E NE S RGERY , PH I L A N D B IC CH IC V I C L L YS O OGY O STETR S , AGO ETER NARY O EGE ,

L. A. MERILLAT, V. S .

- BR OFE S S OR F U IC L T HE R A PE UT I C S A N D D L U M-C KI L L I P O S RG A ENTA S RGERY ,

V E I COEL E GE CHIC . ET R NARY , AGO

CHI CA GO

A L E X E G E R ,

N O ’ P E TRA SLAT R S R FACE .

i h Be ng but a layman , and fearing that , by c anging terms and

o e I rec nstructing s ntences , mi ght not exactly convey the

I e ideas of the author , simply made a lit ral translation , and left the arduou s task of recon structing all such sentences

t Pr which would possibly impair the sense of any part , o o

fe rs . rill sso . . . Me at A H Baker and L A , who have also written m a n any v luable annotations , th us bringi g this little work to

- - T o an up to date level . these gentlemen belongs the credit

o r I of this additi n to Veterina y Literature , and hereby ex

e e o press to them my sincer than ks for th ir lab r in, arranging the matter .

I f o my readers , refraining from severe criticism , can btain

I . any useful information from these pages , will feel fully repaid

E A . .

h D 15th 1899 . C icago , ecember ,

ONTE N TS C .

PR E FAC E I NT R ODUCTI ON A TE R I I CH P . H S T OR I CAL L A T E R I I I N ' CH P . FE CTI ON OF WOUN D S 0

1 . Air

2 . H ands and Clothing of Operator

3 . Foreign Bodies R n 4 . esti g Place of Patient I ns u m ent 5 . tr s and B andaging Material

'

6. Viéinity of the W ound

A T E R I I I . AS E S I S ANTI S E S I S AN D DI S CH P P , P I N FE CT I ON I a da n Ma e a . B n gi g t ri l 2 s n c on Ma e als . Di i fe ti t ri (a) S ublim ate (b) I odine (c ) I odo fo rm (d) I odol and I odine Trichl orid (e) Carbolic Acid (f) Creolin (g) S alicylic Acid (h) B oric Ac id (i) Ac etic Alum ina (j) Chloride of Zinc (k) N aphthalin (l) Thym ol ( m ) Cam phor (n) Tar (o) Turpentine (p) Oil of Turpentine

’ (q ) S ugar (r) Coff ee (s) S alol (t) Bism uthum S ubritricu m (u) Benzo ic Ac id (v) Pic ric Acid ii CON TE N T S .

(w) Oleu m E uc alypti (x) Zincu m Oxydatum

‘ (y) Zincum S ulfocarbolic um (z) Kalium Hyperm anganicu m (za) Ac idum S u lphu ricu m (zb) Acidum S ulphurosum (zc ) S ulphate S alts (aa) Peroxide of Hydrogen

‘ (bb) R esorc in (c c ) N aphthal ol (dd) Aseptol (cc ) A and B Oxynaphtoic Ac id

' fi d ochinon etc ( ) Hy r ,

A T E R I I I E T I N F I N E T E CAR CH P V. D S N F C O O F C D R I E R S AN D T HE WOUN D T h Air I . e

2 ands and o h n of the S u eon . H Cl t i g rg 2 R es n ac e of the a en . ti g Pl P ti t I ns u m en s and anda n Ma e al 4. tr t B gi g t ri H eat and Form aldehyde Gas

c n of the W ound . 5 . Vi i ity The ou nd 6. W

TUR I N G AN D L I GAT UR E MATE CHAPTE R V . S U R I AL R AI NAGE AN AGE S , D B D

T R I AN TI S E TI MO E OF T R E ATI N G CHAP E V . P C D WOUN D S

ANTI S E PTI UT I T FOR R AG CHAPT E R VI I . C O F P T I C E

E XAMI NAT I ON OF W OUN S AN D CHAPT E R VI I I . D T H E I R PR E PAR AT I ON FOR E xam ples of Antiseptically Treated C ases Othaem atom a in the H orse C ontused W ounds on the Tho racic W all / L obulated C ontused W ou nd on the I nner S ide of the i h in i nee o n o t e orse L a the T b a a e . K J i t H , y g i B r T endon and S heath of Tendon W ound on the Hiifd L egs of a H orse

‘ N ailprick T rush w ith L aying Open of the S oft Parts on B oth Hind Hoots S uppurating S tone Bruises CON TE N TS . iii

A TE R I X E R AT I I T TI E TI CH P . OP ON S W H AN S P C PR E CAUTI ON S R esection of B ody of I nferior Maxilla of Dog on Ac c ou nt o f Fracture Atherom a o n the Fals e N ostril of a Filly Actinom yc o m a in the R egions of the Parotid Gland of a — ~ — B ull R em ova1 H ealing in Three Weeks N eurectom y of the I nner and Outer B ranch o f the Plantar N erves Over the Pastern J oint (High Plantar N eu rectom y) N eu rectom y of the T ibial N erve ’ Am putation of a C ow s H oof Crow n Prick (Treads) N ail Pric k S eptic I nflam m ation of the S oft Parts of the H oof in the R on of the S ens ive L am ina an a u sh on egi it , Pl t r C i Frog and S ole oi the L eft Front FOOt Castration of S tallion — C ondyl om a of the Praeputiu m of the H orse R em ov al r r m am I n en on H ealing Pe P i t ti em in S ix D ays . D ocking of T ail Castration of H o rses in City Practice Absc ess in th e L evator H um eri N eu rectom y

P E E R FAC .

I t is an undeniable fact that the medicinal treatment of in

‘ ternal diseases , as far as human medicine is concerned , is gradually becoming less , while the surgeon eventually draws

re more and more into his sphere such diseases , which , in gard to their therapeutics , belong in the territory of internal I clinics . t is further proven that the surgeon has been able to encroa ch upon this territory of internal medicine chiefly through an acquisition of modern times , namely , the antiseptic

The e treatment of wounds . r ason of this probably lies in the

o fact that a surgical peration in many internal diseases , for o instance , of the peritoneal and thoracic cavities , with ut anti septic precautions , was synonymous with death . While the surgeon in human medicine thus continues to gain in both territory and importance , the corresponding circum u stances in veterinary science are still wanting . Altho gh for us veterinarians everything does not depend upon the sav

of ing the life of the individual , without any considera os ff tion of the c ts , means , and e ects , we should nevertheless use all means offered by science to preserve for the national wealth , all the funds invested in our domestic animals . Owing to the fact that we very frequently perform surgical operations to make anim als more useful for our purposes , as well as to heal diseases , the consideration , whether the anti septic treatment oi wounds in veterinary surgery would not offer the same advantages as in human , was fully justified .

However , in the attempt to utilize antisepsis in veterinary surgery the progress and results of the past did not warrant I its general adoption by the veterina ry profession . have never doubted the good intentions of the veterinary practitioner to s give the public better services than was po sible heretofore, being aware that it was tardily adopted only because human clinical methods are not generally applicabl e in veterinary surgery .

As assistant in the Royal Veterinary High School , under the P O E O E E I tw o guidance of R F SS R MO LL R , have for years had ample opportunity to do practical antisepsis ; then through DR I DE N D the kindness of . H L BRA T, director of the local

I ff . hospital , was o ered abundant material on which to study all I the details of antisepsis . herewith express my sincere thanks to both these gentlemen . I n f Thus prepared , adopted the antiseptic treatme t o wounds

“ m e in my private practice , and have laid down y exp riences in this book .

I n I o judging this work beg to state that the few p inters, n ' which are to be fou d in the current literature , are hardly f su ficient to elucidate the antiseptic method of treating wounds , and that the works on human surgery on this subject could not l very wel be used , as veterinary science has to figure with I entirely different conditions . have therefore endeavored to

make only clearly practical statements and to employ scientific . explanations only , as far as they are necessary to render the I e subject comprehensible . am well awar that this work is not

o complete , but sh uld it be an incentive in causing the antiseptic treatment of wounds to be more universally adopted , and in inducing a more elaborate working out of the same for our

I . purposes , shall be satisfied

FR I HE TT E DT E R S G MAN Y . CK, , I N ODU I TR CT ON .

For the modern su rgeom there is but one fundamental n maxim , which is leading and decidi g in all its applications , namely : “ All accidental diseases caused by wounds (erysipelas , cel lulitis - , suppuration , pyaemia , septicaemia, are caused by the immigration of vegetable life into the wounds as well as into ” their surroundings . LI STE R was the first person to express himself in this “ sense , and he proved his opinion by the results of the Anti ” septic Treatment of Wounds , inaugurated by him . For years ’ the results of this method was the only proof that LI STE R S view , in regard to the accidental wound diseases , was cor

“

. O rect, until by the bacteriological investigations of R K CH , O E N PAS S E T R S BACH , and others , the experimental proofs I T E were found . Thus L S R was the founder of a new princi of ple in the treatm ent of wounds , which was then , in view the fact that it lead the chief points of consideration against “ N I E PT I septic processes in wounds , named A T S C Re cently there was some argument in regard to whether the “ name Antiseptic was still justified , as it refers also to sup I n o uration . p , which is not a sepsis my opini n these argu “ o ments are superfluous , as the w rd Antisepsis , which has o been universally ad pted , and freely discussed , means the “ ” h combating of accidental diseases of wounds . N o matter ow I E ’ much the technics of the methods may change , L ST R S idea , which is expressed in the above sentence , must always I ai determine the treatment of wounds . must abst n from a of discussion of the accidental wound diseases , as the limit this work would be transgressed . Veterinary science cannot ex c lude itself from the advantages of this method , and most 6 I I N TR OD UCT ON .

n f o clinicians , with the exceptio of a ew c untry practitioners , have adopted antisepsis . N o practical veterinarian will hesi tate to adopt it , however, when it assumes a form capable of adopting itself to the very different conditions of our animals . as compared to the human . The modern antiseptic treatment of wounds as well as the remarkable successful results in surgery , which have attracted

. even the attention of the layman , is due to the above men tione d maxim . I t must here be acknowledged that the antiseptic methods in vogue in human surgery (for example , bandaging) cannot o readily be adopted by the veterinarian , but this work sh uld be s a guide , by which , with the aid of anti eptics , we can learn to improve our methods of treating the wounds of animals aseptically . I I . O I H ST R CAL .

LI STE R must undoubtedly be looked upon as the originator of a of the antiseptic mode tre ting wounds , as he was the first surgeon who methodically attended to their treatment with this I object in View . The L STE R method was introduced to Ger in 1 8 2 S HUL TZ E and man physicians 7 by , who had studied L I seen the procedures of LI ST E R himself in E dinburg . S T E R d , when originating this metho , relied upon the well U E S N N known putrefaction experiments of SCH LZ , CHWA , E I D E N E D E DUS P S T E U SCH L , SCHRO R , CH , A R, and in others , and assigned the results of the above mentioned vestigators to the processes of decomposition in wounds . According to his conviction every decomposition in a wound could be arrested if all germs present in the wound cou ld be

-m killed , and the introduction of the same fro outside , either through the air, or other things that come in contact with the

reventedf L I TE R wound , could be p After several trials S decided upon the following modus operandi : I f a fresh

wound is made , for instance , with the object of an operation , all articles in connection with it should be made germ free , I T E that is , disinfected . L S R used for this purpose carbolic

. acid . The instruments were lying in a 3 per cent aqueous

Solution of carbolic acid , the hands of the operator, of his as n sistants , also the operati g table , after a preliminary thorough

2 . cleansing with soap and water, were rinsed with a per cent solution of carbolic acid ; finally the air in the vicinity of the o operating field was disinfected by a I per cent . s lution of

carbolic acid spray . After these preparations the field of the hairshaved off operation itself was disinfected , all the the skin , o thoroughly washed with a brush , s ap and warm water, and

o . rinsed with a 2 per cent . s lution of carbolic acid 8 AN TI E S P TI C TR E A TME N T OF WOUNDS .

And now we are ready to proceed with the operation . The same is carried through under a steady spray, even as far as the b r andage is conce ned . As the haemorrhage must be

or . arrested controlled , the ligatures must also be aseptic LI STE R introduced a material for that purpose which is also used at present and which has the advantage of becoming ah T c sorbed , namely , the catgut . his was made asepti by being soaked for two months in an emulsion of one part of carbolic h acid and. five parts of olive oil , and was used bot for ligating I n I E sub sti vessels as well as suturing . the latter case L ST R tuted h the catgut wit carbolized silk , especially if the sutures had to stand a stronge r strain . After inserting carbolized rub

a I E n ber tubes in the wound for dr inage , L ST R put o the o bandage , which , according to his idea , w uld save the wound A he o from external infection . t this time rec mmended wad ding as bandaging material , on account of its property of keeping back the putrefactive germs of the air, but he did not

o for f llow this theory , as it was not reliable enough him (we will see later that he did injustice to the wadding) , and he Th e therefore substituted gauze saturated with carbolic acid . bandage was formed thus : On the wound itself cam e a piece h of protective silk , then eig t layers of gauze ; between the sev n h of e t and eighth layers a piece mackintosh was placed , and n the whole thing faste ed with several turns of gauze bandage . The idea of the protective silk in the bandage was to prevent the irritation caused by the wound coming in direct contact h f with the carbolic acid t rough the gauze . The secretions O the wound were to be absorbed by the carbolized gauze , but to prevent their passing through the eight layers and exposing i them to infection by the air , the piece of m ackintosh was n

s erted.

I n I E w ou nds bu this manner L ST R treated fresh , t in wounds which were of longer standing, therefore already infected, he acknowledged that the above mentioned methods were not suf

' ficient u a , being f lly aware of the f ct , that for the removal of n sepsis , if present , stronger carbolic acid solutions were eeded r o n n than for preventing infection of a f esh w u d. O this ac HI S TOR I AL C .

2 count he washed all such wounds with a % to 5 per cent . solu tion of carbolic acid , and he even used chloride of zinc in the o 8 1 0 . n f rm of an to per cent watery solutio , in which case he

o r o of used carb lic acid only afte the rem val the infection . N ot withstanding these facts he did not succeed in making every wound aseptic , which he explained by the fact , that the car bolie acid solution does not always enter into all the recesses and sinuses of a wound . I E L ST R had so much success with this method , that it was o i j ustly w ndered at, for while in his own practice , pr or to the antiseptic time , per cent . cases of amputation died ; this 1 number, by the application of antiseptics , was reduced to 5 per cent . Healing of wounds by first intention became by ’ I E t a antise using L ST R S me hod , rule , while in the ante p tic times such occurrences were considered as exceptional and mere coincidents . N otwithstanding these successes there were numerous surgeons who claimed not to have had o t extra good results with this m de of treatment , but the faul I E d was with the surgeon , not in the method . L ST R state expressly that his successes were due mainly to the minutes% ’ r t I E obse va ion of all individual details , and this rule L ST R S antagonists violated persistently . n N O n U E . O N the recommendatio of SCH LTZ , R V LKMA ’ and TH I E RSCH u ndertoo k to put LI STE R S method to a o test . Both came to the same conclusi n , namely, that upon ’ I E a minutely observing L ST R S rules , the adv ntages gained by his methods Were s o great that the old mode of treating wounds could not at all co mpare with it . The statistics fur nished by VOLKMAN and TH I E RSCH left no doubt what T o a ever as to this fact . hey b th had but one objection ; th t is , that the carbolic acid did not prove harmless in some col lapsed conditions , as intoxications occasionally appeared after

I E ' an operation . L ST R himself does not mention anything of

o carbolic intoxicati ns , possibly he did not recognize them ; NN e I E e d however, VOLKMA , as w ll as TH RSCH r porte t hem , and they looked about for a substitute that would be I E sali i a i harmless to the organism . TH RSCH adopted cyl c c d 10 AN TI S E TI TR E ATME T F P C N O WOUNDS .

us t O E j discovered by K LB , and retained the carbolic acid only to disinfect the instruments and the catgut ; for all the other n dis in manipulations , such as sprayi g, washing of the wound , fectin nd g ha s , saturating bandaging material , etc . , he used sali c li T c . I E y acid H RSCH modified the bandage some , for the 3 I O . e d to per cent salicylic wadding, which had b en a opted , became impermeable on account of the drying of the wound I d exudations in it and obstructing their further flow . nstea of the protective silk he took fenestrated guttapercha paper, and left the mackintosh out , thus being able to saturate the bandage daily with salicylic water, and keep the deepest T I E m layers disinfected and filtered . Later on H RSCH seldo used these moist bandages , because they were annoying to

ff . both the patient and medical sta , and superfluous in regular

. O N N antisepsis V LKMA , according to his own testimony, had carbolic intoxications o nly while he was unfam iliar with

e has o n t i hs n the procedure , lat r he seld m seen them ; o w t ta d ing this he experimentally tried benzoic acid , especially in the n form of B e zoic wadding . After the good results that THI E RSCH and VOLKMAN N I T E attained with the L S R method , all the surgeons , which

its o were cautious heretofore in regard to use , dr pped their

i . w c prejud ces and adopted it Ho ever, omplaints regarding the danger of carb olic acid became so numerous that many O N N T I E others like V LKMA and H RSCH , looked for a

t subs itute for it , and a period commenced in which various but o remedies were recommended , nly a few ever cut even

- i a passing figure in the antiseptic treatment of wounds . O the antiseptics , which originated at this period and are u se e d o partially in still , the on s describe bel w may be dis cussed . As much as the remedies may be changed today, LI STE R ’S principle has been the basis upon which the various authors have worked . N E O N RA K , who experimented under V LKMA N , used o HAUS E MAN thymol , which had been rec mmended by N and I n E I N . I L W , instead of carbolic acid the form of a per cent . o w as d d n aqueous soluti n it a opte in many cases , o account of

12 ANTI S E P TI C TRE A TMEN T OF WOUNDS . sidered the advantages of iodoform for the treatment of wounds to be as follows : —I First odoform is . a specific against local tubercular processes . S — econd I t is a safe antiseptic for all wounds . Third—I i used in limited quantities it is absolutely harmless to the organism . —I t Fourth relieves pain , limits exudation , and promotes granulation . — Fifth I t does not prevent healing by first intention if brought between tw o sutured wound surfaces . S —I t n ixth is so strongly a tiseptic , that it is not necessary to use other antiseptics . For washing of the wound , there d c leanli fore , only warm water is nee ed , and otherwise the ness of all things which come in contact with the wound , such as instruments , hands , sewing material , etc . , is necessary . — Seventh I t allows an essential simplification of the bandage . — E ighth I t is possible with the aid of iodoform to make wounds of the oral cavity, and of the rectum and bladder, aseptic . MOS E T I C used the iodoform in the shape of a fine powder, a by strewing it on the wound washed with clean w ter , in a thick

- an then ness of about one half cm . d covering it with iodoform S d gauze . imple absorbent cotton and gauze ban ages com I n pleted the dressing . narrow wounds he applied the remedy 0 0 a . . I O in an emulsion (iodoform 5 , glycerin 4 , q dist , gum Th . e MI tragacanth , as iodoform gelatin form KULI CZ I E DE and B R recommended , iodoform ether , he did not con

u sider suitable beca se it irritates the textures . Although MOS E TI G claimed his iodoform bandage to be o an ideal one for wounds , he c uld not deny that it possess ed n O many disadva tages , for instance , eczemas ccasionally followed and even intoxications with deadly termina tions . Though the cause of these accidents was due chiefly to the use of too large quantities , it has been ascertained that these evidences of intoxication could be observed even in the

o . applicati ns of smaller quantities Therefore , the pure iodoform HI S T RI AL O C .

a , MOSE T I G o u band ge as recommended , did not become p p lar ; only the iodoform itself has maintained its place in sur gery , and it will continue to be used , notwithstanding the newly appeared counter current which disclaims any anti septic value for it . P MOS E TI G robably on account of these disclosures by , KOCH E R abandoned his chloride of zinc method and ex erim ented p with antiseptic powders , and selected the sub

- A I nitrate of bismuth . per cent . watery emulsion (KOCH E R always calls it mixture), is used for irrigating the wounds , while on a sutured wound the remedy is spread in the form of a thick pulp and the bandage is made out of crumpled gauze saturated with the bismuth mixture . T he bis m uthu m su bnitric um also did not prove itself inno

O E r cent , for K CH R himself had a death to eport as a c o nse u enc e q of bismuth poisoning, so that the bismuth treatment also did not spread further . With these the number of reme dies recommended for the antiseptic treatment of wounds is

em by no means exhausted , but the remaining remedies belong tirel y to the present antiseptic wound treatment , so that their

T o discussion will follow in a later chapter . those belong o corrosive sublimate , as well as creolin and sal l , introduced by B E RGMAN N and SCH E D E . For the same reason the usual bandaging materials , etc . , will not be discussed , as far as the historical interest is concerned , mention of them having I f e been made above . we inv stigate how much benefit veter

' inary science has gained from these acquisitions in the field of wound treatment , it must be acknowledged that the anti septic treatment has not as yet been in practice as much as should be expected , considering the eminent advantages which ao it off ers . As has been mentioned above , it must be knowledged that antisepsis , in the form practiced in the in y human , can only a few cases be adopted in veterinar ’ I T E o science , but L S R S directi n can be followed in another mode . The oft repeated statement that the usual therapeutical m ethods of human practice cannot , in every instance , be The l . adopted in veterinary science , is here a so fully justified 14 AN TI S E PTI C TR E ATME N T OF WOUNDS .

not oc occlusive bandage, for instance , is always strictly clusive u in human surgery , for example , in operations aro nd the natural body openings , and yet asepsis results on account of e the procedure being modified . Therefore, if we want to pra t ice asepsis in treatment of wounds , we must transform the known healing methods of human m edicine in such a manner L I TE ’S as to carry out S R idea , considering at the same time the usual circumstances of our branch . Where the present m ethods are insufficient we are obliged to find new ways to reach this aim . Upon looking over the different literature we find that when _ antisepsis in surgery was introduced , veterinary authors were a o immediately ready to m ke use of it , but if the pr cedures and details of the cases thus treated are minutely looked into we find that there is frequently nothing left of the antiseptic treatment but the application of an antiseptic . That the simple application of an antiseptic remedy cannot be called antisepsis is plain to everybody that goes deeper into the subject . Con siderable PUE T E O N time elapsed before Z , BAY R , K R HOE US E R S I E DAMGR OT KY , Z and others demonstrated cases which left no doubt as to the applicability of antisepsis by an occlusive bandage . P E UE L L E O N CAD I OT U TZ , M R , H FFMA , as well as R OY and , who wrote special essays in regard to antiseptic treatment of wounds and their applications in veterinary sur r n gery, cannot depa t from the occlusive ba dage , so that accord ing to this view many wounds of the trunk which do not permit T h bandaging, apparently cannot be treated antiseptically . e above authors do not mention any thing in regard to the anti

of o septic treatment thes e , so that this vast categ ry of wounds is left to the old mode of treatment . I N E TI ON OF WOUN F C DS . 15

I I . I N E I ON OF D F CT WOUN S .

r As rema ked in the introduction , we have to look for the cause of the so- called accidental diseases of wounds in the micro organisms which enter into the wound and live and mul ti l p y there . As our therapeutic percautions must be turned towards the removal of the causes of a disease , the indication for the surgeon is to keep away those pernicious living sub stances from the wound and make the ones that have invaded f it harmless . To reach this latter purpose it is not su ficient fre to put a disinfectant on the wound , as has been heretofore u quently supposed , but we have to go further and close p all sources which are apt to bring micro organisms into it . Only the knowledge of all possible sources of infection enables us to take the necessary measures to check effectually such an in fection without this knowledge we will always more or less grope in the dark and unconsciously make a mistake in either O E tw o one or another direction . K CH R distinguished dif ferent forms of infection — First Spontaneous infection . — Second I nfection by contact . E D R . KOCH R thought spontaneous infection possibly originated on account of the whole body being infiltrated with

- i ff o micro organisms , the same tak ng e ect nly if by some cause , for example , traumatism , a favorably nutritive medium for these organisms was created ; although recentlv it has been of d prov en , with the aid bacteriological culture metho s , that , in normal circumstances , vegetable parasites do not exist in I r the textures . nfection has a ce tain justification in infectious

. I f diseases , as for instance , in glanders and tuberculosis a wound arises in an individual aff ected with one of these - dis

y , eases , we can hardly expect t pical healing to follow but we mu st be prepared for a localization of the specific process in E d of the wound . BE CK R also prove that in cases osteo 16 AN TI S E P TI C TR E ATME N T OF WOUN DS . myelitis an actual infection direct from the body may follow by w av O HE of the circulation . But when K C R made his assertion regarding spontaneous infection such generalized

no t , infectious diseases did occur , to him besides the

‘ etiology of osteomyelitis was then as yet unknown , but he e imagin d that those wound infections , which we term acci Ac in . dental wound diseases , could originate such manner cording to the bacteriological and surgical experience thus far collected such possibilities of wound infection must be looked upon as a rare exception , and we must consider the substances which come in contact with the wound from the outside and which are carriers of infectious germs , as the chief source of the infection of a wound .

. Th n e following are carriers of such i fectious germs , which are important to the surgeon : — First Air . — S econd Hands and clothing of the operator . T — hird Foreign bodies (stones , sand , nails , wood splinters , pieces of earthenware , which enter into the wound simul taneou sly with the wounding . — n e Fourth Resti g plac of the patient , either during the operatio—n or afterwards . Fifth I nstruments and bandaging materials . — S . ixth Vicinity of the wound (skin , hair , nails , hoof)

AI R I . .

The fact that the air contains a large number of not only inn ocent but pathogenic germs is so undisputed that it is hardl y necessary to discuss it any further , but since we have to figure with the air as a car rier of pathogenic organisms into

. I f the wound , it must be discussed a sunbeam comes through a window we notice in the illuminated air space 2 numerous small particles of dust , 4 to 34 per cent . of Which is organic matter . As the pathogenic schizomycetes are of the same nature , there are certainly some contained in this sun I n f PODO dust . act , , who injected such dust subcutaneously

into rabbits , produced deadly septicaemia in a very short time . I N E TI ON F 7 F C O WOUN DS .

E E — H SS , also , with his well known apparatus , collected and c ultivated the germs contained in the air, and at the same time e a discover d some of the lready known pathogenic fungi . As

' far as the quantity of these organisms referred to inthe air is concerned, it has been proven that in quiet air , according to the laws of nature , the fungi fall to the bottom . But since w e have quiet air in neither our dwellings , stables , nor the out side , the quantity of fungi will vary according to the amount of n T moveme t in the air . his is not an absolute rule , as the amount of moisture in the air as well as its density cuts a t r figure , but at any rate a strong draf brings us mo e germs in the same length of time than quiet air would .

As far as the air , especially in the rooms where our patients n are , is concer ed , besides the factors named above , several oth h er factors w ich are responsible for the condition of the air , i l must be cons dered , name y , rough provender (grass , hay , I t re straw) , bedding and the animal excrements . may be marked here that the above named substances , if they are in a dry condition , easily part with some of their germs as they whirl in the air when being thrown around , but in a moist con dition they do not aff ect the air as far as its containing fungi

T he DE L E T t is concerned . experiments of CA AC and MA wi h the emanations of rotting organic substances make this latter

s upposition probable . As far as the special relation of the feed ,

r‘ to d resting place , and exc ements , woun infection is concerned , we will go deeper later . Another question which was referred s d is to during occasional discussion of infection of woun s , whether the expired air of the operator contains pathogenic % D E germs I n this case , also , the experiments of CA AC and

MALE T are decisive , as they could not detect any specific micro organisms in the expired air of horses which were af fected with specific maladies of the respiratory organs .

AN DS AN D L OT I N G OF THE O E R ATOR . 2 . H C H P As the surgeon continually operates with his hands in the t immediate vicinity of the wound , special at ention must be given to them as carriers of infection . The hands have the 18 AN TI S E P TI C TR E ATME N T OF WOUNDS .

m greatest opportunity to come in contact with infectious ger s , and the natural recesses are especially adapted to give the

I n t - micro organisms a hiding place . his regard the nail bed and matrix of the nails can be looked upon as the most danger — ous lurking holes nor should the small furrows and lines in the skin as well as the orifices of the sweat glands and the The h m . hair, be overlooked as s elters for ger s parts of h ’ h t e operator s clothing, w ich are brought nearest the wound (the coat sleeves) should be chiefly considered . The latter, on account of the porous material of which they are composed and also on account of the fact that in lying down , sitting, etc . , they come in contact with various substances , are a regular collecting vehicle for fungi , and can on this account verv easily bring about infection of a wound.

I E FOR E I GN O S . 3 . B D

Formerly the influence of an injuring foreign body , as far as he ' the healing of t wound is concerned , was explained thus Smooth cutting or piercing bodies would produce a wound without contusion , and therefore would result aseptically , while

r- o o dull , rough , splinte ing objects would cause c ntusi n and c would therefore produ e healing that would not be aseptic.

These conclusions were not based on facts , hence they are N ot and false . the contusion the resulting necrosis are the h causes of the deviation from the aseptic ealing of the wound, but the fact that bodies with smooth surfaces are less often a c rriers of infectious germs , on account of the lack of loop O holes for the same , than the nes with fissured and rough ' surfaces ; therefore the latter are more often the cause of an infection of the wound . By this is not meant that smooth sur

‘ faces are not carriers of pathogenic germs . We know that it makes no difference whatever whether the wound is contused or not , the former heal with aseptic progress exactly the same

as the latter , provided the injuring body is not infected . These foreign bodies differ from each other in regard to the ; germs they may carry not only in quantity but also in quality . O Through the investigations of K CH , GAFFKY, PAS

20 AN TI S E PTI C TRE A TME N T OF WOUN DS .

th w . germs contained in the straw into e air , and infect the ound , — %Shavings of southern pine—pinus palustris is the safest bedding for an operating room either for temporary or perma T n nent use . hey seem to retain their original a tiseptic proper B ties and wound infection can seldom be traced to them . y sprinkling them with a I per cent solution of permanganate of and potash before the operation , all dust is allayed a veritable — M antiseptic litter is the result L . A . ] The stall litter as a carrier of infection germs has to be judged from a different standpoint , because of its importance in agriculture and its different nature and management as com The pared w ith the material used as an operating bed . n stall litter is to the a imal not only a resting place , but it serves as an agent to collect the animal excrements for the purpose of On making them m ore valuable for agricultural use . this acc ount it is seldom that the best material is used for litters ;

musty , frequently already rotten straw of various plants is l thrown in , fo iage , pine needles , spoiled hay , wood shavings ,

tc . are dry peat , e , often substituted on account of lack of cheaper T or better bedding material . hough these materials them f selves are already su ficiently infested with infectious germs , the s u stinanc e of the latter increases still more on account of the urine and manure mixing with it ; not because urine and

manure are very rich in micro organism , but because these substances are excellent nutritive mediums for micro organ T f I isms . his fact has been su ficiently proven by K TT , as

as far anthrax bacilli are concerned , and it is hardly to be doubted that other pathogenic fungi find their means of life in

them . Besides if stall litter is thus looked upon as an import s ant infection carrier , it is till more so the case if we consider that on account of decomposition it has a higher temperature

which is favorable to the thriving of micro organisms . %Through experiments conducted in the bacteriological lab of Mc Killi oratory the p Veterinary College , German peat ,

which is commonly used as stall bedding, was found to contain tetanus bacilli in large numbers and tetanu s traced to this l—L M. source was always very acute and fata . A . ] I N E TI ON OF WOUN 1 F C DS . 2

I 5 . N S T R UME NTS AN D AN AGI N G M B D AT E R I AL . While in the former chapters we became acquainted with sub h stances whic transmit infection to the wound , only by chance ,

o because they do not necessarily come int contact with it , our instruments can lay claim to be of special importance as infec

‘ the ion carriers , as they are tools with which we make — I t wounds , and work upon pre existing wounds . has already been mentioned in the dis c ussion on foreign bodies that a sub stance which comes into direct contact with the wound is the more infectious if its surface is rough and torn ; This is also u the case with instruments , the smoother the s rface the fewer

o loopholes will they have for micr organisms . Besides the n construction , as well as care taken of the instrume ts , should ff by no means be looked upon with indi erence , for with a more complicated construction there is necessarily an increased n of i w a umber loopholes for m cro organisms , and the y of tak ng care of them either assists in carrying infectious germs or

in withdrawing them from these loopholes . Therefore , from this standpoint it is easily to be seen that a bistoury carried in a vest pocket or a cigar case hides more danger of infection than a scalpel which is kept in a clean etui . As far as band aging materials are concerned we have to devote a great n deal of attentio to them , as they are employed to protect the conse wound against any infection from the outside , and as a

u enc e q , are in immediate contact with the wound for a long I n time . this case the quality which makes the material suitable

w ou nd nam el its orosit serves for bandaging a , y , p y, as the cause of frequently transmitted infections through the bandaging I t ff materials . is the porosity which o ers favorable conditions r for the sojou ning of pathogenic germs , and therefore care

destr0 . should be taken to . y them

F T HE UN I I N I TY O WO . 6. V C D We could here conveniently refer to what is said in the chapter abou t the hands and clothing of the operator , but the location of wounds in domesticated animals should , on account ff of their hairiness , be judged somewhat di erently from the 22 AN TI E S PTI C TR E A TME N T OF WOUNDS .

I f E in nearly hairless human skin . KUMM L , his investiga tions in regard to the disinfection of the hands , has found that t the latter sheltered numerous microbes , how much more mus this be the case in the densely haired skin of the domestic ani mals , especially as their care is frequently neglected . This is the reason that we have to consider the localizatio n of the wound in ou r domesticated animals as an important source of infec tion , for supposing that all the other infection possibilities are not taken into consideration , some hairs from the imme diate vicinity of the wound , when the latter is first made , pene n trate into it , together with the micro orga isms sticking to

T o them . this must also be added that during the further

flow rn process of the healing of the wound , the discharges g from it soil the vicinity, and being an excellent nutritive me dium for pathogenic fungi they form direct brooding cavities for the vegetable parasites dangerous to the wound . With very insignificant modifications the circumstances are just the same with the vicinity of wounds which have their

ho-ofs seat on , claws , and tallons ; the latter parts , as modified hair formations shelters micro organisms in large numbers in their tubes , fissures and joints , simply because they are the parts which come in contact with the ground , and thus with all sorts of microbes . AS E PS I S AN TI S E S I S AND I I 23 , P D S NFE CTI ON .

E 111. P I N I E PSI AN D DI I E I AS S S , A T S S S NF CT ON .

After it has been discussed what infection is and in w hat w ay o n : it is bro—ught ab ut , the questio s arise First By what mode and by what means can we prevent the infection of a wound % Second—How are we to remove an infection already exist ing in the wound % I n compliance with these two questions we have to con sider tw o diff erent subjects according to whether the wound is already infected or not, and then if our aim is to protect a wound against infection we speak of an aseptic treatment of wounds , while disinfecting or antiseptic treatment of wounds is referred to when an already infected wound has to be lib

erated . from the infection , that is , disinfected , or made aseptic We therefore should not be surprised that the remedies u sed for the prevention of a wound infection are entirely different from those used for the removal of an already present infec tion, hence the remedies used in the treatment of wounds are divided into two groups , namely — ir t . F s —Bandaging materials Second D isinfectants .

AL I AN AGI N G MATE R I S . . B D All substances which are to be used for bandaging purposes must possess certain qualities to obtain the desired eff ects . First—They must be porous so as to be able to absorb the discharges of the wound . Second—They must be free from infectious germs so as not to be a source of infection to the wound in itself . — and Third They must be soft, elastic flexible so as not to cause any pressure on the wound and must adapt themselves - 24 AN TI E S PTI C TRE ATME N T OF WOUN DS . to the corresponding parts of the body without forming any gaps . The eff ect of these bandaging materials explains itself as follows I f t there are no infectious germs present in the wound , heir and al introduction can onl y take place from the outside , though these porous bandaging materials permit the air to come on the surface of the wound , still all the germs suspended in the air are mechanically filtered through the bandage , so

' that , as other bodies are prevented from entering the wound , only the bandaging material is left to transmit infection . As the latter comes in use only in an aseptic condition , that is , free from infectious germs , so that the pure wound does not

u . get infected from the o tside , complications cannot take place I n the further course another possibility arises that the thus aseptically kept wound may get infected ; the separated wound discharges would gradually push forward and would serve the micro organisms as an entering channel , but this forward gushin g under the bandage is prevented because the porous O bandaging material absorbs the discharges . nly in longer f lasting , profuse discharges could such possibilities take e fect ,

l r si notwithstanding the po o ty of the bandage . That the procedure just described to prevent wound infec tion is not only a formation of clearly theoretical d elibera r tions , but can be also car ied out practically has been proven N E UBE R by , but we have to take into consideration that we can get the same results quicker and cheaper if we substitute

o . several points of this m dus operandi by other rules Thus , for instance , the preparation of germ free bandaging material is a very tedious procedure without the application of such h h c emical agents t at kill vegetable germs , therefore , nowadays these bandages are impregnated with such substances , which I n we will know later as disinfectants . this mode the germs contained in the bandage are killed and at the same time these bandages are furnished with a supply of disinfecting remedies that protect the wound against invading germs by making the discharges absorbed by the bandage unfit as a nutritive me dium for microbes . AS E S I S , AN TI S EPS I S AND I S I N E TI 25 P D F C ON .

n o Amo g the most p pular bandaging materials , as far as

is using them for the above purposes concerned , the following may suffice ; the corresponding advantages of one or another

e : materia—l will be fur—ther explained at the close of this chapt r First Wadding The wadding (all fat removed) is most frequently used in the form of a simple fatless bandaging wad ding for the padding of bandages , or impregnated as a I O . I O . 4 to per cent salicylic wadding , 3 to per cent ben 1 0 20 zoic wadding, to per cent. boracic acid wadding and 1 0 20 thymol wadding, to per cent . iodoform wadding, o . 5 per

. o cent sublimate wadding, for the abs rption and disinfection of the discharges . — — Second Jute The best fiber of corchorus capsularis has been lately introduced and is u sed the same as the w adding I O as a 5 per cent benzoic jute , 5 to per cent . carbolic jute , 5 to

I o er . e p cent salicylic jute , and per cent . sublimat jute . — — Third Wood wool wadding The wood wool is manufact u red by the grinding of soft woods ; by working it together

so— with fatless wadding, the called wood wool wadding is pro du c e d . Both products are used as sublimate wood wool wad ding (o . 5 per cent), and creolin wood wool wadding . Fourth—Sawdust—is used frequently as a surrogate of wood wool and is mostly soaked in a per cent . sublimate solution . ifth— — F Hemp , flax , oakum These materials are chiefly used in country practice . Lately the oakum , after being previously cleaned , has found some propagation as sublimate oakum .

— m oss a — Sixth Moss , p p The moss , such as is used for ban da in ff S ha g g purposes , is made by the dryingof the di erent p g e S c m bifolia S num vari ties , chiefly phagnum y and phagnum cuspidata and is used now mostly in the form of the HAGE m os s a s I er DOML E I S E R I N G m osspaps . To disinfect p p p

cent . sublimate is used , in which the paps are dipped prior to using . — — N E U E Seventh Peat Recommended by B R , is useful if impregnated as iodoform peat , carbolic peat and sublimate peat . 26 AN TI S E TI TR P C E A TME N T OF WOUNDS .

E — — ighth Gauze , mull (muslin) Both materials are much liked in a fatless condition , as they hold well together . They I are used in the shape of benzoic acid gauze (5 to O per cent . ) a boric cid gauze , carbolic gauze , creolin gauze, iodoform gauze

1 0 0 t 1 0 ( to 5 per cen ), salicyl gauze ( per gauze ; s eros u blim ate gauze, tartaric acid gauze and thymol gauze . — — N inth Glass wool This r epresents a confusion of the E finest glass threads , and is warmly recommended by KU M E L M L . T —S —T enth and , cokes , ashes hese substances are used by E DE in SCH with advantage , especially for the filling in of oi juries the bones in the shape of sublimate sand .

2 I I . T D S N FE C I ON MAT E R I AL S .

The t word disinfection explains itself , so hat a definition is , a an in perh ps , unnecessary , especially as the conception of fection has f been su ficiently explained , but to be explicit , dis

of infection means nothing else than the removal the infection , and as the existence of an infection is to be looked for in the

and r wound , as far as life actions of micro o ganisms are con cerned , the object of the disinfection is simply to make these D micro organisms innocuous . isinfection of a wound , or an instrument , or the operating field , etc . , therefore means mak ing innocuou s the infectuous germs located in the respective media .

Th re e ways which a at our disposal are various . — First W e remove from the article which is to be disinfected all pathogenic germs . — Second W e certainly leave the microbes in their s ubstra tum but w e (a) kill them direct , or (b) we make the nutritive medium in which they grow unfit for their future growth , and thus cause their death . “ Following the maxim Cessante causa c es sat effectu s the removal of the micro organisms from the focus of infection

- n would be the most rational way to get rid of an infectio , but in many cases it is impossible to follow this indication , as we

28 AN TI S E P TI C TRE ATME N T OF WOUNDS . all micro organisms is moisture ; rapid drying as well as nat ural lack of moisture are not favorable conditions for the growth and life of those small vegetable organisms . There fore , all means , which energetically withdraw moisture , cause a condition which hinders their growth and action . Hand in h hand with this withdrawal of moisture , a c ange in the tissues o n which these microbes have settled , usually takes place , for instance , in wounds where by the use of strongly drying reme dies a coagulation of the albumen takes place so much that a fit nutritive medium no longer exists . The rem edies we use for the purpose of disinfection are so hetero

eneous n y g that we eed not wonder at this , especiall if we consider the different ways b y which we attain the desired I n effects through disinfection . view of the above mentioned theories , however, their action cannot be said to be so ex e an lusive that one remedy will kill the microbes only , while other will only deprive them oi the possibilities of existence by

t e re changing heir nutritiv medium , or that a third will only M move them from the infected medium . ost disinfectants act that ' class ific ation ac simultaneously in two or more ways , so cording to their own action is impossible . As to nature , how

: ever , they may be classified into — First Physical disinfection agents . — S econd Chemical disinfection agents . Among the physical agents we class all those surgical in strum ents with whose aid we can remove infected material in a purely mechanical way , for instance , the knife , scissors , sharp

. fir scoop , etc , also the high degrees of heat in the form of the

- Pa u elin ing iron or thermo cautery of q , and finally the with drawal of moisture , namely . exsiccation and permanent irriga

The of s tion . action the e remedies has been mostly discussed

above we will therefore not go into further details here , nor as to their uses ; an opportunity in future chapters for that will

be found . We will now discuss those chemical agents which are hostile

to the development of micro organisms . The rotation in which they are taken up depends on their AS E S I S AN P , TI S E S I S AND I S I N E TI 2 P D F C ON . 9

. n utility The value , actio and use of these disinfe ctants will

, be briefly discussed but as far as the more special action , as well as their chemical properties are concerned harm ac olo i , p g cal text books must be referred to .

a S U L I MAT E H 1 ( ) B ( g C 2) .

(Mercuric Chlorid) . T he credit of introducing sublimate into surgery is due to

VON E N N I N 1 B RGMA , for , although B Z in 867 and BUCK O 1 8 H TZ in 75 , experimentally ascertained the antiseptic prop t VON E M e ties of sublimate , B RG A N N used it as a disinfect

in - 1 8 8 T ant surgery in the year 7 for the first time . o the labors of KUE MME L L E D E and SCH it was reserved , how ever, to n n O H draw the attentio of surgeo s to this agent , while K C ,

o o with the aid of the s lid nutritive medium disc vered by him , made exact and decisive experiments in regard to the antiseptic of value sublimate . O The sublimate , according to the investigations of K CH , must be looked upon as the disinfectant possessing the strong 1 . n est bactericide action , because a per cent solution kills a thrax spores in a few minutes , which thus far are known as the T most resistant . hough in reference to the surgeon , there have not been sufficient investigations made to tell how strong sublimate solutions are necessary to destroy wound - infection 1 germs , practice has proven to us that here also a per cent . so T lu tion com pletely suffices . herefore sublimate fills one de

an mand of the surgeon , for weak solutions contain stronger I t tiseptic powers than any agent thus far known . should not

“ go unnoticed , however , that according to the investigations of SCH I LL and FI S H E R tuberculosis bacilli possess an extra

. w e ordinary ability to resist sublimate However , as seldom have an opp ortunity to treat tubercular processes surgically , this objection to sublimate does not greatly concern the vet

erinarian . We need to discuss the second requisite which the veter ‘ m m r inarian demands from disinfectants , a y , that it be harmless to animal organisms . That in human surgery precaution in 30 AN T I S E PTI C TR EATME NT OF WOUNDS . the use of sublimate has to be taken is due to the different individual predispositions toward mercurial preparations , pro ducin g in some cases eczemas , in another intoxications , while T a third one will not be aff ected whatever . hat much of this is exaggerated is proven by the successful results of VON E M N N KUE MME L L S E D E I U I B RG A , , CH and M K L CZ ; the latter even in laparotomy washes out the peritoneal cavity KR OE N L E I N o . with a per cent . s lution of sublimate

- 000 r ab uses sublimate 3 ) in wounds of the ectum , I n ff . domen , and in empyema without apparent toxic e ects

The veterinary surgery the condition is different . fear of the ff toxic e ect of sublimate on our domesticated animals , and T I N especially ruminants , is groundless , of which facts R E CH RA especially makes mention . I used for the past three years in all surgical operations , as well as for the irrigation of all infectiously diseased mucous

o membranes (nose , m uth , vagina , uterus), only sublimate as an antiseptic , and must acknowledge that even in ruminants

I i ex eri did not notice any d sadvantageous effects . The p DO E I S and UTT E m u ments of L R B , who operated on the n cous membra es and fresh wounds of dogs , rabbits and guinea pigs with sublimate water 1 : 1 000) have proven that its use on mucous membranes is entirel y free from danger ; but deep wounds have to be treated somewhat more carefully . Unless f 1 the injurious e fects of a per cent . solution of sublimate is doubtlessly proven in the treatment of w ounds of our domes ticated I animals , consider the fear of the virulence of sub limate , in external applications as prejudice . Later on I will have opportunity to illustrate with examples that sublimate is not dangerous . Amongst the numerous preparations of sublimate used in surgery the following are recommended as practical : (a) Sublimate triturates (AN GE RE R) are made by a com pression of hydrargyrum bichloridu m and natrium chloratum equal parts and on account of their convenient form 20 tablets can be carried in a test tube in the pocket without incon venienc e , and owing to their solubility they are extraordinarily suitable for the practical veterinarian . AS E S I S AN TI S E S I S AND I S I N E TI 31 P , P D F C ON . i h f gi (b) Sublimate water is easily had by dissolving a sub I limate tablet in water . t is used for the disinfection of n wounds and their region , of the hands , and in case of ec es sity also of the instruments ; sublimate does not affect the

instruments as bad as is usually supposed , and the operat I n ing instruments especially do not get dull . such sublimate

' water I u sually also soak my bandaging materials shortly be on fore putting it by simply dipping the wadding , bandage , etc . ,

into the water and then wringing it out moderately . (c) Sublimate glycerine gelatine I recommend for covering

al n u superfici excoriatio s and sutured wo nds . Simple gelatine , also glue , can be used by soaking it in as little as possible 1 l per cent . sub imate water solution and then dissolving it by slight heating . To the glue thus formed 5 per cent . of glycerine is added to prevent the preparation from getting brittle . For using, the preparation is melted by a gentle fire , and with a ’ I camel s hair brush applied to the parts . no longer use this

I . preparation , as have discovered more convenient remedies Recently LI ST E R mentions a few more sublimate prepara tions , which , chiefly on account of their price , have no special l s erosu blim ate va ue in veterinary surgery , namely , the and 1 the double chloride of mercury . The former consists of a ac per cent . solution of sublimate in horse blood serum , on count of the albumen , it sticks better on the bandaging material T he and does not irritate sensitive skin . latter is a mixture of hloridu m 2— l r . . c bic h o . ; hydrarg. corr with ammon 5 from this salt watery solution s (1 :2000) slightly colored with blue anilin colors are used for the impregnation of the bandaging ma

The terial. bandaging materials thus dyed are a reagent for

a suppuration , for as soon as there is any tr ce of suppuration the blu e . , . anilin coloring matter gets white Besides this preparation is said to be less volatile and pois onous . , %The high value of mercuric chlorid in veterinary operations has been repeatedly and forcibly demonstrated especially to re the surgeon , who has by experimentation compared the I n of s ults obtained with that of other antiseptics . points ff uniformity oi action , reliability , e ectiveness and economy it is _ 32 AN TI E S PTI C TR E A TME N T OF WOUN DS .

I t a equalled by no other known drug . must , however, be p plied only with a full and detailed knowledge of its peculiarities in order to obtain those delicate results which the surgeon seeks in his operations . The following points must be born in mind : — First That it must be applied in such concentration as the

as : work at hand demands , follows

1 200 n T is (A) to solutio . his strong concentration useful to hurriedly disinfect an operating field and vicinity when for any justifiable reason there is no time for a systematic disinfection . I use it repeatedly and with excellent results to purify the scrotum and surrounding field in castration . I 00 T al (B) to 5 solution . his strength is the one gener ly used to purify the seat of operation after the usual scrubbing ’ with soap and water , to wash the surgeon s hands before and t repeatedly during the opera ion , and to soak the protective bandages . I (C) to 1 000 solution . For general use in wounds already

. of infected for the purpose rendering them aseptic , and for the f after treatment o wounds that must granulate . D 1 1 00 1 2000 . T ( ) to 5 , to to solution his strength is applied in irrigating and bathing the wound during the opera tion and is specially weakened so as not to prevent immediate union , by destroying the vitality of the tissues . This strength

for i is also suitable irrigating the vag na , rectum , uterus , or i nternal cavities . S econd—That it is rendered more or less inert by com T bining with the constituents of tap , well or spring water , his 1 fault is obviated in a measure by adding per cent . of sodium chlorid to the solution and by making solutions only for im n or . mediate use , by usi g distilled water Third—T hat it is immediately rendered inert when it comes in contact with blood , and therefore sponges or cotton used for baling must not be carried into the vessel containing the I al solution . ways use a small porcelain vessel for baling , with which the solution is dipped from a larger container and in this way prevent the entire solution from becoming polluted with blo od early in the operation . AS E S I S AN T P , I S E S I S AN D I S IN E P D F CTI ON . 33 — Fourth That it should be used in the form of soluble tab irisu re lets to accuracy in the concentration of the solution .

Pro-f . Frick leaves the impression that mercuric chlorid is not specially injurious to edged instruments which is in direct

conflict with my experience . The dark color it imparts to polished or plated instruments is readily removed when they

in o are not left too long the s lution , but aside from this

objection , if such it is , the keenness of a sharp knife is almost

immediately destroyed when. placed in a solution strong i — t. L . M . enough to disinfect A . ]

b I I ( ) OD N E . I odine has for a long tim e played a leading role in surgery,

but it cannot attain a special place in the treatment of wounds , on account of its unpleasant properties of being very volatile

- and caustic , although its antiseptic qualities are pre eminent . w DAVAI N E D O E Ho ever, , TT R , and AN DRI E UX recom

tr. o mend i dine diluted as a remedy in wound treatment . Much more importance is given in treatment of wounds to a com oi I d e pound o ine , nam ly ,

c I R ( ) OD OFO M .

I odoform (CHI 3) was introduced in the year 1 822 by E R UL L AS MOS E T I G S , but and MOORHOF first showed that it is a very useful preparation for the treatment of M E TI wounds . The hopes which OS G placed in iodoform as

ff i to en well as the e ects which he cla med it have , were not tirel r o . y c nfirmed , in fact the contra y was proven Judgments E N R OVS I N T E B U E N of H Y , G , SA TL R , A M GART , I f SCHN I RE R are not correct . these authors take the actions of iodoform on the cultures of the micro organisms t as a standard for the antiseptic proper ies of the remedy , they

on e for evidently do not consider factor , which the under standing of its action is indispensable , namely that iodoform gets separated into free iodine only when it comes in contact with living animal cells and that this free iodine represents E N I E I d . O N the antiseptic agent of the io oform K G, B HR G 34 AN TI S E TI TRE A P C TME N T OF WOUN DS .

UN and B R S met with good success in their experiments , so that especially its antituberculous action is not to be

e . o doubt d H wever , iodoform has but a certain limited value in surgery and on this account , extravagant use of it is I f discouraged . we do not consider these clearly theoretical and experimental results , practice has shown that we possess a very valuable remedy in iodoform , as it possesses excellent qualities in certain conditions . The action of iodoform depends upon the different modes of application as follows — First As powder it does not dissolve in wound exudates , but absorbs the latter , and thus excellently dries the wound surfaces , so that but little discharge appears ; besides , it di

’ r ectly restricts the discharges of the w ou nd . —I t I Second certainly promotes granulation , because have often observed that peripheral pieces of ligated vascular stumps , r which otherwise regula ly undergo necrosis , granulate pro fu s l P e t . y, by being treated wi h iodoform ossibly an explana tion for this is the known close relation of I odine with the cell nuclei . — Third I t acts anaesthetically . — Fou rth By coming in contact with living animal cells the o pure i dine gets permanently separated from the iodoform , and this pure iodine acts antiseptically . —I t Fifth certainly has antituberculous actions (BURN S) . I n be human surgery it has been observed that iodoform , sides the valuable qualities just mentioned has many injurious ones inasmuch as in a human being iodoform p oisoning as well as iodoform eczemas sometimes appear after the use of the remedy . I n veterinary practice thus far, iodoform intoxications after external applications have been known in dogs only S E N E T FR HN E R OO O . I (G S , ALB R CH , ) had no op portunity thus far to notice this probably because I did not use E ' excessive doses , which ALB R CHT and GOOSE N S give as E P L A . O K their cause xperimentally , J OW ascertained the toxic doses for warm blooded animals to be as follows :

36 AN TI E S PTI C TRE A TME N T OF WOUNDS .

d ( ) I OD OL AN D I OD I N E T R I CH L OR I D .

These two iodine preparations have been lately recom in mended human surgery as a substitute for iodoform , as iodol

' is non - odoru s and iodine trichlorid does not have su ch u npleas

I . ant odors as odoform Besides , both are said to be non poisonous . These two preparations are too costly for veter inar es eciallv y purposes and are , therefore , not recommended , p as the odor of iodoform is only objectionable in canine practice , The application of iodol is exactly the same as of the iodo

o 1 . f rm , while the soluble iodine trichlorid is used as a per cent w atery solution .

R (e) CA B OL I C AC I D .

L 1 86 Carbolic acid is a preparation which ister , in 4 , intro du c ed into the antiseptic treatment of wounds , and in which , n until lately , too much co fidence has been placed , inasmuch as we now have remedies which are more trustworthy and less dangerous . O U O T According to the investigations of K CH , B CH L Z , E E I E . N U V SMARCH , S B RG and others , carbolic acid is a

I f w n con germicide . , ho ever, we take into consideratio the c entration s w hich said investigators state to be necessaryto antibacteriall u n act y, we find carbolic acid to be an entirely reliable antiseptic for surgical purposes , because it takes at

. . o least 3 per cent , occasionally even 5 per cent watery s lutions L I TE to assure effective action . S R himself knew this fault of carbolic acid , but he then did not possess a better remedy and therefore it has been the steady aim of all surgeons to N discover better agents than carbolic acid . otwithstanding

has this , carbolic acid held its place , and will hold it , because it is indispensable for certain purposes . I n additi on to the mentioned unreliability of carbolic acid it has other properties which must be con sidered in its ap n its d plication , amely, virulence in the require concentrations and the irritation caused by such solutions on the wou nd and I n its surroundings . literature we often find reports of carbolic

m e p oisoning , so that it is not necessary for to add any new AS E S I S AN TI S E S I S D 37 P , P AN DI S I N FE C TI ON .

I t ones . is sufficient to emphasize the fact that all our domes ticated l n animals , especial y cats and do gs , will occasio ally get n MI D . GR OS S W E N DT carbolic intoxicatio s (SCH T , , GOTTE S W I NT E R UM N N E E VAN , SCH A , SCHA F R . L E U E W NU . , etc ) B esides its foregoing qualities the irritation which carbolic acid causes on the surface of wounds and to which L I ST E R n e l n calls attentio , is unfavorabl as far as the app icatio of this remedy in the treatment of wounds is concerned . All wounds — n treated with a 3 5 per cent . watery solutio secrete profusely , therefore they c ome into a condition which we do not consider

r beneficial but rathe detrimental to the healing of the wound .

Carbolic acid is applied now as carbolic water ( 1 5 per I t is only used in exceptional cases for irrigation of fresh

- wounds in from 2 3 per cent . and in old infected wounds in o 5 per cent . solutions . The 3 per cent . s lution is most gen erally used and chiefly for the disinfection of instruments . l All other preparations of carbo ic acid (carbolic oil , carbolic O ’ spirits , are , according to K CH S investigations , totally ineffectual . %I t is undeniable that the unreliability of carbolic acid is be I t w coming mor e and more apparent . has , ho ever , one indica tion through which it will retain a place in veterinary surgery and that is to keep instru ments aseptic during operations . This precaution is seldom necessary in human surgery and the use of antiseptics on instruments can only be regarded as a reflec tion on the work of the assistant who is entrusted with their

care . But the veterinarian usually operates in a contaminated atmosphere and the chances of instruments b ecoming infected in other ways are greater than in the human operating room ; therefore it is not only advisable but essential to place the in in stru m ents in an antiseptic medium when not use during

an operation . For this purpose carbolic acid is highly com o I t per cent . aque us solution con mendable . is used in a 5

h tained in a flat tray . T is precaution also serves the purpose ’ of disinfecting the tips of the surgeon s fingers , because in 38 AN TI S E T P I C TR E A TMEN T OF WOUNDS . reaching for an instrument they come in contact with the anti fl uid —L septic . . A . M . ]

R E L I N (f) C O . T I D First investigated by AT F E L , it was recommended by FR OE HNE R as antiseptic in Germany in 1 887 and

E rim entallv later V . SMARCH and E I S E N B E RG expe as c ertained that anthrax spores are killed in two days in a 3 per

. o u a cent watery soluti n , the s ppur tion producing microbes in one minute in 3 per cent . solutions , and in ten seconds in 5 per

. The cent solutions . antiseptic properties of creolin are there I fore certainly not to be doubted, but nevertheless have not

for thus far adopted creolin general use , as for country prae tice it is not easily transported , for while we can comfortably

a diffi and in large quantities carry the sublimate p stilles , it is I cult to carry as much creolin as is necessary in operations . think , as is the case with every new antiseptic , the enthusiasm will gradually slacken and the application of the remedy will be U TE N limited to certain cases , especially as BA M GAR has recently proved the poisonous character of creolin . The sup — a chief posed non poisonous character of creolin was , reason for its popularity . Creolin is applied as

- (a) Creolin water 2 per cent . watery solutions better than and emulsions) to irrigate rinse out all kinds of wounds .

(b) Mixture of creolin (2 per cent . ) with boric acid for use as powder on wounds . %Creolin is a disappointment so far as performing antiseptic I ts operations is concerned . place in veterinary surgery is for the purpose of irrigating large wounds , internal cavities , sin uses of the head or in any condition where there is danger of intoxication from more potent remedies . There are a number of cheaper substitutes sold on the

American drug market , but their popularity depends more upon the amount of water they will color white than on the I n amount they will actually disinfect . the absence of more reliable preparations , however, the veterinarian is justified in AS E S I S AN TI S E S I S AND I S I N E 39 P , P D F C TI ON . recommending them for large foot baths or for any purpose

where a large amount of antiseptic fluid is needed . The action of these products on water together with their

ne o innocuous ss recommends them in bstetrical operations .

L . A . M ]

' S AL I Y L I (g) C C ACI D .

I E S f TH R CH , in his e forts to discover a substitute for car e OL E boli acid , found in salicylic acid just discovered by K B , a

N ow remedy with which he constructed a regular antisepsis . we know, specially owing to the recent investigations of SAM T E R that Salicylic acid is a totally unreliable antiseptic , so that this long since abandoned remedy will soon have but historical value . N ow it exists only in the form of salicyl wadding for ‘ surgeons .

(h) B OR I C AC I D . LI STE R first recommended boric acid and experimented

r much with it , but it has never reached an impo tant place as I t an antiseptic , as it acts much weaker than carbolic acid . is applied in the form of l co o (a) Powder or mixed with creolin (2 per cent . ) as y p diu m on wounds , especially near the end of the healing process when it hastens the forming of the scar . o (b) Boric water (4 per cent . ) as w und water on such places where the virulence of carbolic acid and of the sublimate is

. , feared , for instance , in the nose , in the mouth , on the eyes , etc etc .

(i) AC E T I C AL UMI NA . Acetic alumina was first applied by BUR OW and has been

adopted on accou nt of being non - poisonous and having good I n‘ antiseptic properties . every instance where the usual anti on o septics cannot be made use of, either acc unt of virulence or alu m inae because the patient cannot endure them , the liquor I n . aceticae (8 per cent . ) is indicated veterinary science this preparation has been in use for a long time (acetate of lead I t alum solution) . is applied in the form of 40 AN TI E S PTI C TRE ATME N T OF WOUNDS .

e - dis in Wat ry solution of acetic alumina (2 4 per cent . ) as fectant for all w ounds .

(j) CH L OR I D E OF Z I N C . Chloride of zinc was used in surgery prior to L I ST E R ’S

L I S TE u se 8 . time , but R was the first one to it ( per cent ) to n L I TE E disi fect wounds . S R and KOCH R used per cent . solutions for the rinsing out of wounds and applied it as ’ O S o o a regular antiseptic , but K CH investigati ns soon pr ved that too much confidence was placed in chloride of zinc , as in I 5 per cent . solutions anthrax spores lived after one month . use only a : t Chloride of zinc solution (1 0 per cent . ) o wipe out infected wounds after the walls have been first thorou ghlv scraped with s the harp spoon .

’ U N E TT I %B R S disinfecting fluid (20 gr . zinc chlorid to drachm water) in the strength of I part to 40 of w ater ‘ is indeed a useful and effectual antiseptic for veterinary pur

I t m poses . deserves a more general use especially in disi f in ect . I n g old , suppurating or fetid wo unds a fresh open wound it will prevent septic processes longer than any other — M drug L . A . ]

(k) N APH T HAL I N .

’ to N According Fisher s investigations , aphthalin is a power

: ful antiseptic which has but one fault , viz that it is insoluble

S CHAD R I N POPOW o in water . , and others , h wever , have doubtlessly proven the usefulness of this remedy ; especially h l d it e . oes . p granulation B OUCHARD and PAN NAS noticed that upon long in~ ternal application cloudiness of the crystal line lense with for

of N mation cataract ( aphthalin cataract) occurs , but thus far external applications on our domesticated animals have had no bad effects . Amongst the forms used the following are recommended N —1 0 c aphthalin powder , pure or mixed with 5 per ent . alum ,

S CHADR I N - sugar or boric acid ( ), naphthalin salves (5 1 0 per cent) . A E ” S S I S , AN TI S E S I S AND I S I N E TI 41 P P D F C ON .

1 T YM L ( ) H O .

N E m RA K introduced thymol for treat ent of wounds , and its power for checking the development of bacteria was ascer tained experimentally by SAMTE R but for veterinary prae n tice thymol is too expe sive . I n canine practice it can be 0c casionall I ' ~ y used as a per cent . aqueous solution if the ex pense does not prohibit it .

m AM R ( ) C PH O .

I n es surgery camphor was used before the antiseptic era , eciall p y in bruises and gangrenous and ichorous wounds . Al though campho r possesses good antiseptic properties it is not

. o nec s very suitable for treating wounds H wever, in case of e s it y, camphor , in the universal form of spirits of camphor is a

I t ' good disinfectant . is usually applied in the form oi (a) Camphor gruel (with but little alcohol) as a good dis u infectant in gangreno s wounds and bruises . (b) Spirits of camphor (I : 7 alcohol I :2 water) to rinse out o w unds and to soak the bandage , in cases of necessity only .

n T ( ) AR .

Tar ha a , that is , c rco l tar , has been in use for some time , but it has not been given the deserved importance as an anti

f - . On o creosot septic account its containing carbolic acid , ,

r es naphthalin and many othe antiseptic aromatics , tar ,

’ eciall to p y in cattle practice , is me nearly indispensable , the action being in every regard satisfactory so that I can rec om mend the application of tar as an antiseptic espe cially in foot

and hoof diseases , as the preparation is very cheap and can ’ I : be obtained in every rope maker s shop . use

(a) Tar (clear) in claw diseases , if they are much spread amongst cattle and hogs , where it is not possible to put on daily a number of bandages ; also , in order to make bandages moisture proof, to paint the bandage ; and lastly , in all hoof and claw diseases which are forming scars .

- (b) Plaster of paris and tar (5 1 0 per cent . ) and boric acid 42 AN TI S E TI R P C T E ATME N T OF WOUNDS .

2 - in and tar ( 5 per cent . ) are well recommended , but are not s di pensable . (c) Tar with ferrum sulphas aa if we intend to dry up s strongly ecreting hoof and claw wounds .

0 T R E ( ) U P N TI N E .

AMBROSI US PARE (I 550) knew the antiseptic properties of turpentine which make it , as well as tar , suitable for the

o treatment of hoof and claw w unds , especially in easily bleed Th ing wounds . e only unpleasant effect was the irritation it I t disadvan produced on granulations , causing pain . has the tage of producing pain by irritating the surface to which it is applied . OI L F TUR E T I N E (p) O P N .

The antiseptic properties of the oil of turpentine have been experimentally ascertained by GRAWI TZ and DE BARY

L a s and confirmed also by KOCH . ter investigator claim to h have had negative results , but it has yet to be proven t at the O I DE statement backed up by K CH , GRAW TZ , and BARY that the I — ooo preparation in a proportion of 75, does not act N antiseptically is a mistake . otwithstanding its antiseptic properties , oil of turpentine is only used in cases of necessity on account of the irritation it causes .

AR (q ) S UG . As an old public remedy against strongly granulating wounds , sugar in the shape of powder has long been in use , but in surgery it was first introduced by L UCKE as an anti septic . S ugar acts antiseptically on the wound by excellently drying it up and by its forming concentrated sugar solutions

(just as in canning fruits) , which prevent the settling of mi c rob es dr u . Frequently a y scab forms on wo nds treated with u s gar, under which an antiseptic healing takes place . As sugar can be found in nearly every household and its cost is I not great , can , according to the experience which I have I t o . e had with it , rec mmend it is best appli d in the form of : P owdered sugar (clear or mixed with 5 per cent . powdered

44 AN TI E S PTI C TREATMEN T OF WOUNDS .

L E E AL Y TI (w) O UM UC P . Oleum eucalypti possesses good antiseptic properties and is recommended especially by E nglish physicians (ALL

MANN NUNN w d . , ) as salve, and for the soaking of ad ing, etc B esides the above mentioned remedies which possess directly

thei e antiseptic properties , are many other remedies for the antiseptic treatment of wounds recommended , but they cannot

s gain any foothold , partly becau e their antiseptic properties

ffi e are insu ci nt , and partly because their application is not : very convenient , for instance

(x) ZI N CUM OX YDATUM .

(y) ZI N CUM S UL FOCA R BOL I CUM .

(z) KAL I UM HYPE R MAN GAN I CUM.

(za) ACI DUM S UL PHUR I CUM . A I L PH R M (zb) C DUM S U U OS U . A AL T (zc) S UL PH TE S S .

(aa) PE R OX I D E OF H Y D R OGE N . R I (bb) R E S O C N . A (c c ) NAPHTH L OL . T (dd) AS E P OL . X APHT I A (cc ) A AN D B O YN O C CI D . T Y R O I N ON E C. (ff) H D CH , I n addition to the remedies which we use in antiseptic a a wound tre tment , we would now h ve to discuss the draining and suturing materials , but as they do not belong directly to I the bandaging materials and disinfectants , will treat them r sepa ately in a future chapter, and only mention something in regard to the way of using these remedies in order to fulfill the stipulations of antiseptic wound treatment . I S I N E TI ON OF I N E TE AR R I E R E T 4 D F C F C D C S , C. 5

I D V . I S I N FE CT I ON OF I NFE CTE D CARRI E RS AN D THE OUN D W .

We have seen in one of the above chapters that the infection of wounds is transmitted by certain substances coming in con

tact with the wound , namely , infection carriers . At the same time we did not consider those infectious diseases of domes ticated animals which cause wound infection through the

, for blood as instance , tuberculosis , glanders , anthrax , etc . As they do not give us cause for any surgical interference the main , object in the a ntiseptic treatment of wounds is to make all the Th the germs that stick to infection carriers innocuous . e most imp ortant task for the surgeon must therefore be the dis of e d infection all the infection carri rs , which uring treatment ,

necessarily come in contact with the wound . We will there fore discuss the disinfection of these infection carriers in the

same rotation as we have adhered to above .

A I . I R .

I t nfec ion through the air, according to our experience to o s day , happens m re infrequently than was formerly suppo ed ,

but in human surgery it is still recognized , and we also must s in not undervalue its importance , especially ince treatment of

stron l wounds , we are assigned to rooms where there is a g y O agitated air , and therefore is rich in germs . nly at times , for

m can instance , in the case of smaller ani als or in hospitals , we have conditions sim ilar to those the human physicians find

lii ff in their treatment in closed rooms . Owing to t s di erence

of conditions , we can only in a few cases disinfect the air ,

n o o . amely , when we perate in closed ro ms free from currents LI ST E R attempted to disinfect the air in closed rooms by

for the spray , and this purpose he sprayed carbolic solutions 46 AN TI S E PTI C TREATMEN T OF W0UNDS .

at through forge bellows . Now in clinics, if sprays are used all , the steam spray is adopted . The disinfectant is sprayed near the point of Operation by means of a stream of steam . For private practice certainly a steam spray cannot be made use of, and if a spray is to be employed at all , it can be pro duced with a Richardson sprayer with which a 2% per cent . carbolic s olution can be easily converted into a spray . I t ff is di erent in country practice , however . Here , as a rule , an operation must be performed suddenly and we are com I t th pelled often to operate in the field without a spray . is di cult, however, to disinfect the air in closed rooms by means of a carbolic spray ; consequently it is an impossibility if we are compelled to perform an Operation in the open air . The spray, therefore , is of no use in country practice , especially if we take into consideration the annoyance to the operator which I n it connected with its use and to the wound itself . human surgery in most cases the use of the spray is dispensed with , i and only on rare occasions , for instance , on open ngthe peri n l to ea . cavity, it is still used

For these reasons we try, in country practice , to protect the wound from germs contained in the air by trying to avoid all such causes as would aid in bringing these germs into the air, the most important of which is the air current . We therefore lay or stand the patient in aplace where the air is a as quiet as possible , and avoid , if possible , oper tions in windy weather . We further prevent the patient from mak

- ing strong movements , especially with the feet , so as not to disturb the air . To possibly prevent the latter morphia narcosis an d also moistening the floor of the operating place with sublimate water is recommended . Nothing more can be

and r x ri done to disinfect the air, acco ding to my e pe ence , these precautions are ample , for should some micro organisms actually enter the wound via the air it would certainly be made innocuous by irrigating the wound. %The air is no longer regarded as an important medium for n carrying infection to the wound during an operation, a d there “ ” fore the famous Phenicated Cloud (carbolic spray) is now en I S I N E TI ON OF I N E TE ARRI E R E 47 S TC. D F C F C D C , tirel y discarded in human surgery . For veterinary operations occasional irrigation with weak solutions of mercuric chlorid is suffi cient to render innocuous any organism that find their w av the n h — L . . M . to wou d through t is medium . A ]

2 AN S A N D L T E . H D C O H I N G OF T HE S UR G ON .

As the surgeon continu ally uses his hands on the wound ,

' K E MME L L special care m ust be given to them . U and FORSTE R tried to ascertain experimentally what mode of cleaning and disinfecting is necessary to make the hands free ’ from bacteria . Both authors agree that a five minutes wash ing and brushing with warm water and potash soap is nec es h neces sary , they disagree owever , in regard to additional

as affer sary disinfection , inasmuch having first washed the

’ hands KUE ME L L recommends bathing them in a five per

cent . solution of carbolic acid or liquor chlori , and not with

r ' hl r R S TE R m ercu iC c o id, while FO adopted the latter and

en condemned the former . According to my experience , it is

ir l f t e y su ficient if the hands and forearms , after carefully clean

shar b rus h ing them with soap and a , the nail bed and matrix p‘

being chiefly considered , are well washed with a per cent I solution of mercuric chloral . t is best if the finger nails are

kept shortly trimmed so that they do not hold dirt . c oatsleeves As for the clothing of the surgeon , the espe

c ially deserve particular attention . As they are not easily d I off disinfecte , either take my coat entirely or bare the arm The by rolling up the sleeves above the elbow . use of spe

c ial clothing for operations or treatment of wounds in country

practice cannot be practically carried out . %Veterinary surg eons are not all equipped with an arti

fic ially heated operating room and therefore , in cold weather , it would be very u ncomfortable to perform operations with o bared arms , especially if the pr cedure is a long one or a num f ber of operations must be per ormed , as is often the case in U both city and country practice . nder these adverse circum

suf eon laundried , stances , the g may wear a newly jacket ster

h . ilized if possible . Anot er method is to wear rubber sleeves 48 AN TI E S P TI C TR E A TME N T OF WOUN DS .

These can be purchased at instrument dealers generally at very small cost . They are durable and easily disinfected with n — . L M . out i juring the material . A . ]

- R E T I AT I E N T . 3 . S N G PL AC E OF P

The resting place of our domesticated animals coming into

s artlv very clo e contact , partly temporarily and p constantly , with most parts of the body , plays an important role , as far

5 t the reatment of wounds is concerned , owing to the presence I f of great numbers of infectious germs . we take into con sideration the analogous circumstances in human , we notice that here absolute cleanliness of the sick b ed cannot be a ecom

lis hed to p either ; however , owing the fact that in the human

occlus ivel we can bandage up every part strictly y, except wounds in the natural body openings , the importance of the bed is not so great as the resting place of our domestic ani mals . As we are only able to put a strictly occlusive bandage ln on the limbs , all the wounds on other parts are exposed to fe i n A - im ct o through the litter . disinfection of the litter is

' in n infection thro u h possible ; therefore , order to preve t an g it , the following proceedings are indicated

Keep the litter as clean as possible , that is , have all manure and urine carefully removed ; moisten moderately the litter material itself (grain or straw is the best) , and avoid shaking it I f u . o is p the patients , on account of pain , cann t lie quietly , it

' c du rin the best to ompel them to stand , especially g first five to six days . after which time a healing per primam intentionem follows ; or until sufficient granulation takes place to give the wound protection against infection .

While performing many operations , we are obliged to cast ff our patients , and thus an opportunity is o ered for freshly n made wounds to become i fected . I n n some cli ics (Berlin , Stuttgart , etc . ) this source of infec

' tion has n been removed by usi g on an operating table , leathe r covered mattresses , but for country practice such complicated apparatus is not convenient , and we have to depend chiefly on I I S N E TI ON OF I N E TE ARR I E R 49 D F C F C D, C S , E TC. straw , hence have to consider the danger s connected with its use . I s o - prepare my place for operation on the called dung hill , I only in case of necessity ; as a rule , have it made on the ground out of grain straw and have it lightly sprinkled w . ith water Where the soil permits it (light , sandy soil), we can make an operating ground by digging up the soil , which has the advantage that the irrigating fluids are easily absorbed , the so that patients are lying drier than on straw . I D % nfection from this source is easily obviated . ust should be allayed by light sprinkling with an antiseptic solution (P0 tassiu m P ermanganate) and a sterilized rug, or, still better, a clean rubber sheet is spread over the bed beneath the oper i ating reg on . Such a sheet should be in the equipment of every

. I t shav surgeon matters not whether the bedding is straw , ings , soil , or the dung hill , such a sheet , in the absence of any — L . dust , will perfectly exclude infection from the litter . A . M]

. I N S T R UME N TS AN D A A I AT E R I AL 4 B N D G N G M .

As mentioned in a pre ceding chapter the usual care of in s tru m ents h , as well as t eir construction , favors infection , and

r in l therefore they must be dealt with aco d g y. All surgical instruments should be as simple as possible so s that they can be easily and thoroughly clean ed , their sur

' faces must be as smooth as possible without furrows and grooves , therefore , especially knives , they should consist of n one piece . Joined instruments (torsio forceps , scissors , must be easily taken apart, so as to allow their being cleaned thoroughly . I n the o regard to care of instruments , since , in c untry l practice , the sma ler instruments have to be carried mostly

the pocket , it is advisable to have them in cases . All cases that do not close well are not recommended , as they give the es instruments but little protection against dirt . This is pecially the case with cigar cases and the pockets of the 50 AN TI S E PTI C TR E ATME N T OF WOUN DS .

d clothing, which are often used to carry instruments , alrea y none too clean . To properly disinfect instruments they should be placed c in a three per cent . solution of carbolic acid , if no arbolic acid is at hand in a per cent . solution of mercuric chlorid ,

ff . as the instruments get but little a ected , and stay sharp T RE N D E L E N B URG in B ON N has his instruments lying permanently in a sublimate solution ; although they turn black on this account , and separate occasionally , the S ee cutting edge of the instruments does not get affected . ( P Annotation , age The one instrument which is especially noteworthy on I t account of its infectiousness , is the sponge . is still used I very often , but possesses so many dangers , that often wonder how , even in human surgery , there can still be de p P fenders of the sponge . According to KUE MME L L the disinfection of sponges can be accomplished with sufficient safety by boiling them out and putting them for four or five minutes in a 5 per cent . solution of carbolic acid or per w cent . sublimate water . But it is ell to get used to o ther utensils , because disinfected sponges are not always to be T had in country practice . o clean the part or place to be I I operated on , prefer to use bandage wadding , and have had no cause thus far to resort to the sponge .

As to the disinfection of bandaging material , there is but

little , to be said , for as mentioned before it is prepared by soak I ing the bandage material with the desired disinfectant . prepare my disinfected bandage material myself by simply soaking it prior to putting on the bandage , in the disinfection

fluid and pressing it out moderately . This procedure is cheap and besides necessary , as dry bandages fit badly to the

form of the body and absorb fluids to a greater extent . %The methods described above are not entirely adequate and may prove a source of repeated disappointment . Of course cleanliness alone is half the battle in dealing with ln strum ents as well as in all the steps of aseptic treatment , but to l a simp y bath even very cle n instruments in a 5 per cent .

52 AN TI E S P TI C TR E ATME N T OF WOUNDS .

tools , bandages , wadding and all manner of materials can be promptly disinfected with but little trouble . The apparatus consists of a strong copper chamber , the inside of which is supplied with drawers and compartments .

A suitable size for the veterinary hos pital is 33 inches high , 1 6 1 2 . inches wide , and inches deep The front is furnished with a glass door which permits a goo d view of the interior . The gas is generated at the bottom by a formaldehyde lamp and the outlet at the top is closed with a damper to prevent I n escape of gas into the room . from ten to twenty minutes all the contents , even the very center of tightly rolled band ages , folded towels , etc . , are perfectly disinfected . When the operator desires to withdraw instruments of dressings the i h damper s turned and t e gas allowed to escape .

P I . D . L I O . N R F RAW GS , Chicago , who has conducted an extensive series of experiments to determine the efficacy of formaldehyde gas for surgical sterilization reports the fol lowing as a fair sample of his many experiments : Squares of gauze soa ked in bullion cultures of staphylococ us pyogenes aureus were placed on surgical towels , which were carefully folded over them and subjected to the action of the gas in i ne the upper d vision of the sterilizer . O square removed in five minutes and placed in bullion gave growth after 24 hours in the incubator as did thos e removed after 7% and I Q min

‘ m inutes rem ained utes , but those removed after sterile 2 Th after 7 hours in the incubator at 37 C . e same results were obtained from sponges soaked in bullion cultures of

M . pu s micrococci . L . A . ]

I I T H I N I Y F T E W D . 5 . V C O OUN

I n our domestic animals , which have a more or less hairy skin , it is not to be wondered at that the vicinity of the I f wound is very frequently the cause of a wound infection .

im in the human being, with his scantily haired skin , it is portant that all germs in the region of the wound be removed , it can be readily understood that it is all important to dis oi infect the vicinity the wound thoroughly . For in our I S I N E TI ON OF I NFE CTE D AR R I E R E T 53 D F C C S , C.

domestic animals , on account of their mode of living, and on l account of the very frequent ack of proper care of the skin , the vicinity of the wound is full of dirt and dried exudations . This fact is often overlooked while the surface of the wound f is being treated with all sorts o disinfecting material . This neglect of the vicinity of the wound permits a luxurious

fre growth of pathogenic germs in the unshorn hair . Very quently I have heard such treatment of wounds called anti septic .

6 . T HE W OUN D . From a theoretical standpoint we distinguish two kinds of — I n ff wounds aseptic and infected wounds . practice this di er

for ence is also justified , experience has taught us that it is a

- u good deal easier to keep a non infected wo nd aseptic , than to make an infected wound aseptic . We therefore have to take ff measures accordingly , that is , we have to proceed di erently — P with infected than non infected wounds . ractice has proven that it is safer to consider every wound that we did not make k ourselves and now to be aseptic , as infected and to treat it accordingly . The reasons for this is plain . — First W e usually get patients to be treated which have had an open wound for some time . — Second The mode of living and use of our domestic an im als causes infection to take place simultaneously with the wounding . — Third W e are not able to diagnose positively the prelim inary stages of a wound infection . All symptoms which are , as a rule , considered a criterion for a wound infection , namely , exu da rise of temperature , changes in the wound , its color, in tion , swelling, etc . , appear only in the advanced stages of fection and occasionally withou t the latter . The treatment of aseptic wounds is a purely prophylactic

a one , that is , it is only necess ry to prevent pathogenic germs from entering the wound in the usual ways . This is one rea son why I am not going to discuss the necessary modes of

procedu re at present , as we will take it up later , when meth m ods of wound treatment will be described . However, disi 54 AN TI E S S P TI C TR E A TME N T OF WOUND . fection of infected wou nds will be given the deserved atten i t on here . The disinfection of a wound consists in making innocuous all pathogenic germs that have entered into it and are living there . —We have the following ways to do that First —Removal of the microbes . Second Killing of the microbes . T (a) hrough chemical means , which directly kill the mi b c ro es . (b) By changing the substratum so that the microbes can

a . not find suitable condition for vitality, and hence , die

I f we have to treat a simple three or four- day - old w ound of oo the soft parts with sm th walls , a thorough rinsing out with

'

1 . i a per cent sublimate or 5 pe cent . carbolic solution is f T su ficient to disinfect it . his simple rinsing , however , does not f su fice if we have a granulating wound or one with sinuses , or a n I . contused wound . such cases the conditions favoring the settlement of micro organisms must be first removed , and I t for this purpose the cutting instruments only are useful . is best to scrape off the granulating surfaces with the sharp off h scoop , cut wit the scissors or knife all shreds of tissue , which cleave to the fissures , even up the edges of the wound ,

n fissured remove all foreign bodies , or , in a word , cha ge the

i o wound , with the aid of the surgical nstruments int as

- smooth a one as possible . With this dressing of the wound , especially with the sharp scoop , a large portion of the mi c rob es present in the wound are removed , and we disinfect in

O t disinfec this manner . nly after the coarsest por ion of the

nhas tio thus been mechanically performed , do we use , as in a simple wound , the disinfecting fluids to irrigate it .

h m r Occasionally it happens , owing to larger surface e o rha es g , especially in cavity or socket wounds , that we are I n prevented from proceeding in the above manner . such cases the use of heat is recommended to attain a suffi cient ’ PA UE L I - disinfection . For this purpose Q N S Thermo Cau e tery is to be recommended , because with it w can con veniently disinfect larger surfaces by simply searing them I S I N ECTI ON OF I N E TE CARRIE R 55 D F F C D S , E TC.

I o ver with the firing iron . At the same time , the heat acts o on the surr undings of the wound so that some microbes , t had an ff on which neither the knife nor sublima e y e ect, are I n thus destroyed . case of necessity the firing irons can be s used for this purpose, but ome have the disadvantage of get too ting cold quick . To cool off the highly heated textures afterwards , the wound surface after the application of the hot iron may be irrigated with a disinfecting fluid . Though it is not necessary in most of the wounds of the soft parts to use such strict measures as far as the sharp

o r sc op and scissors are concerned , these precautions a e a s all d nece sity in woun s of the bones , cartilages , and tendons .

These parts , owing to their anatomical relation , seem to get m diseased to a greater extent , therefore , these tissues ust be worked upon energetically with both the sharp scoop and chisel and eventually the Paquelin burner before the applica tion of chemical disinfecting materials are to be thought of . I n these ways we can always succeed in disinfecting an infected wound and I would especially call attention to the h mechanical disinfection , t at is , to the use of the cutting n instruments a d of fire , as they play the chief role with me in wound disinfection , while the chemical agents come second ‘ f ary . The most ef ectual amongst them is the sublimate car bolie acid does not develop a sufficient action until a 5 per

d and o . cent . solution is use , then it irritates the w und 56 AN TI S E PTI C TREATME N T OF WOUNDS .

S UT U I N AN D I T U E M T E I L D I N V . R G L GA R A R A , RA AGE BAN DAGE S

I n the preliminary chapters we have learned the method of disinfecting a wound ; now , therefore , we should discuss how to keep this disinfected wound aseptic and make it heal , were it not necessary before we proceed in this routine , to take

o v u int closer obser ation a few substances , which , altho gh they are not essential to the aseptic treatment of wounds , are often used .

T o ligate vessels and to sew up wounds , which should heal d by direct union , we are in need of a substance which shoul possess certain qualities for the purpose of treating wounds

l . : antiseptica ly , viz — First I t must be disinfected so as not to infect the wound .

S I t not sta s econd must , if it y in the tissue , act as a foreign body in such a way that , after a healing of the wound has ff been e ected , a reaction for the purpose of eliminating the I t suturing and ligating material shall take place . is again

LI STE R that furnished us such a material in catgut . He laid twisted sheep - guts for two to three months in a 20 per cent carbolized oil and preserved them in it for further use . The advantages of this catgut were so numerous that it imme diatel y displaced all other materials , for it healed in the wound and finally became absorbed without causing the slightest L I . N ow u r S irritation the catg t manufacture , acco ding to TE R , is much in use , but it has the fault of being too ex consid pensive for veterinary purposes , besides the knots ,

ering the large numbers we use , do not hold well , so that n the ligatures a d sutures easly open up . With the discovery and introduction of other antiseptics and in the same pro

o porti n as carbolic acid , on account of its being poisonous , commenced to be interdicted , other methods of pre S UT UR I N G MA TE R I A L D , R A I N A GE BA N D A GE S . 57 paring catgut were introduced ; thus the chromic acid cat I E O E gut (L ST R), juniperus catgut (K CH R), and sublimate E DE catgut (SCH ), originated . Amongst all these new prepa I E rations , none became popular , and the old L ST R carbolic catgut is chiefly used . For such sutures and ligatures that do not have to stand f e a long strain , catgut is su ficient , but in our dom stic animals with their strongly developed muscles the catgut cannot stand the strain of the muscles on account of the changes which take T I a place after a little time in it . herefore bandoned the catgut Th and used only silk . e fear that the silk may not act as a I foreign body, because it is not absorbed , is not j ustified . prepare disinfected silk for myself by soaking plain twisted raw silk in a 2 per cent . solution of sublimate water and also I keep it there to be used when needed . Formerly boiled the a raw silk thoroughly , and only fter that preserved it in the sub

I suffi limate solution , but found that preserving it is amply i I n I cient for disinfect on . case of necessity , if did not have any I disinfected silk with me , obtained a substitute by simply soak

I . ing the silk in a per cent sublimate solution , which had the f I same e fect on the tissues as disinfected silk ; however , ven ture this only if absolutely necessary .

The h disinfected silks generally sold , such as carbolic , su li mate , and iodoform silks are too expensive for veterinary use . Beside catgut and silk no other suturing materials can be u substituted in the antiseptic treatment of wo nds , although there have not been any lack of other preparations and substi tutions VI GE ZZO , thus for instance , recommended horse hair which he prepared , for suturing and ligating .

%Kangaroo tendon is prepared in Australia , and is being extensively used especially where great strength in the suture I t is required . softens and becomes absorbed as readily as cat B gut . A . H . . ] The healing per primam intentionem has at all times been the ideal treatment of wounds , but it is impossible to succeed in healing all wounds thus , especially wounds that have lost c E mu h substance . ven if the surgeon succeeds , in the latter 58 AN TI S E PTI C TR EATME N T OF WOUNDS .

case , in directly connecting the skin and the superficial layers n m of the tissue by suturi g, cavities are left at the botto , which easily lead to an accumulation of exudations , and which are T o thus direct breeding cavities for infectious germs . pre vent such conditions and yet at the same time to bring the greater part of a wound to a close prima intentione , such n D cavities have to be kept accessible for disinfectio . rainage o serves this purpose , that is , the exudati ns are drained from the tissue cavities by means of tubes , which are manufactured

f r from di fe ent materials .

L I S TE e R used rubber hose as drain tub s , which were of different diameters and had side openings for the escape of the T exudations . hese drainage tubes are first disinfected by put in ting them a 5 per cent . carbolic or sublimate solution , and are then used . SCHE D E used instead of rubber tubing pigtails made of twisted glass threads also skeins of horsehair or catgut threads

u were recommended , but , altho gh capillary attraction acts

off n favorably in this mode of drawing the exudatio s , a gener h L alization of this method has not been accomplis ed . ikewise

- the use of ab sorbable drainage tubes . such as N E UBE R made

decalc inated n al out of bird bo es did not become popular ,

on t though these drains , accoun of their being absorbed , do h T not possess t e disadvantages of the rubb er drains . hough the drainage doubtlessly offers many advantages to the healing

so of the wound , certain disadvantages are attached to it that partly by changing the material and partly by taking special to technical measures , we try avoid these disadvantages . Since necessar t we are never entirely successful , it is o limit them y‘ by following certain rules when adjusting a wound drainage so as to avoid as much as possible any hindrances to the heal ing of the wound . First of all , the drainage tube being always

‘ a foreign body , prevents a direct union of the respective parts f on account of its lying between the surfaces o the wound .

T e oth herefore , it is compulsory , if the wound heals r gularly erw is e , to change the bandage after a time in order to remove this drainage tube .

0 6 AN TI S E PTI C TRE ATME N T OF WOUNDS .

- - bo or antiseptic , such as bichloride of mercury , iodoform , ric I t carbolic acid . maintains asepsis in aseptic wounds , and n I t helps to disinfect septic o es . takes up the exudations so perfectly that it is not necessary to change the bandage oftener than once every two or three days in wounds with medium n sized cavities that have ot become septic , but in septic wou nds and those attended w ith profuse exudation , absolutely

requiring drainage , the bandage needs to be changed usually

e r twice a day . For all wounds r quiring drainage in the smalle animals and the smaller wounds in the larger animals antiseptic O au ze is the ideal packing . akum is more suitable for the Og re larger wounds , especially those with cavities in them that quire the maintenance of a free external opening till they fill I t up from the bottom with solid , healthy granulations . takes up the exudations and maintains a good drainage better than for other substances . Before being used it should be soaked

r ten o fifteen minutes in a one per cent . solution of bichloride n or of mercury , or a five per cent . solutio of carbolic acid other i B antisept cs . A . H . ] Another drawback to the use of drainage tubes is their lia I n bilit e l . y to ither fal out , or be drawn into the wound our This n domesticated animals the former usually occurs . ca , h to owever , be avoided by suturing the outer end of the tube the edge of the wound . t As wound exudates do not always absorb , one of the impor ant demands , without which the best applied drainage does not

ac perform its function , is to allow them to flow downward h T cording to t e laws of gravity . his may require counter

“ openings for the sole purpose of establishing proper drainage . On account of these drawbacks attempts were made to en tirel y discard the use of drainage in human surgery . As a matter of fact , it is possible to attain good results without

r drainage , and as , especially in veterina y surgery , these mis haps appear rather frequently , we must discover and eventually adopt only such measures which will make drainage u nneces sary . S UT UR I N G MA TE R I A L D , R A I N A GE BA N D A GE S . 61

The methods , which have thus far been frequently applied in place of drainage , are I st ( ) The depressed suture . 2nd ( ) The row of sutures . rd (3 ) The secondary suture . T hese three styles of suturing will not be discussed any further here , as they really belong to the domain of surgery . T he last material to consider in the adjustment of an anti septic bandage is the cord or band which holds it in place . As the only object of this cord is to retain the bandage in

and place , its form construction is really of no great import

' ance but opinions , as far as veterinary science is concerned, ’ differ r s om ew hat I on this subject . Hence will make a few re i marks about t. I t has always been supposed that the bands should be firmly woven so as to stand the strong strain caused by the violent T movement of our domestic animals . herefore linen bands with woven edges were used , and for the hoof a special style of

- s o . fastening, the called chain bandaging, has been invented

My , experience , however, has taught me that these linen bands ,

s on account of their lacking ela ticity , squeeze the wound and do not cling to the body ; also , that the successive turns slip from

each other, thus permitting the bandage to get easily loose , n I ff . I and finally come o a word , found that linen bands . aside from their high price , are the most unfit material for n I onlv bandages in existence . O this account now use

h . cambric and mull bands 5 m . in length and 7 cm . in widt They have all the advantages and are much cheaper than I I linen . Before putting them on , usually soak them in a

u fo per cent . s blimate solution , make them fit better as well as to disinfect them . 2 6 AN TI S E PTI C TR EA TMEN T OF WOUNDS .

TI E PT I T I OUN D . VI . AN S C MODE OF T RE A N G W S

I have stated in a form er chapter that the method of treating wounds in human surgery can-not entirely be utilized in vet

r n erinary surge y, because veterinarians , in contrast to huma

d . surgeons , cannot always apply a strictly occlusive ban age I n o d human surgery , where the w und is left to itself, ban a ging is the one method of treating it , while in veterinary sur gery we must distinguish between wounds which can be o bandaged and those which cannot . Most veterinary auth rs seem to be of the opinion that antisepsis is impossible with o ut an occlusive bandage , but as this is not the case , we will have to consider those methods by which wounds can be m treated antiseptically without the . These methods and the possibilities in this direction will beexplained in this chapter . I n view of the above fact we distinguish :

I s t. Wound treatment with the occlusive bandage . D r (a) y bandage . M (b) oist bandage . 2m d. Open wound treatment .

(a) Treatment under the dry scab . (b) I rrigation with antiseptics and afterwards dusting with iodoform . The object of a dry occlusive bandage is to keep an aseptic T wound aseptic . his is reached by the following means : The o disinfected wound is c vered with a pad of jute , which is moistened with a I per cent . solution of sublimate water . On top of this pad we put wadding , gauze , or any bandaging material which should be disinfected by dipping them in a I

~ per cent . solution of sublimate , and which should extend con s iderabl y beyond the wound on all sides . With the aid of a AN TI S E TI MO E OF TR E ATI N G N 63 P C D WOU DS .

h cambric or mull band , whic is also moistened with sublimate water , this material should be bound on tightly . After these general statements in regard to dry occlusive I ~ bandages , find it necessary to give more particulars in re gard to the necessary disinfectants and various other points

re that may be worth mentioning , as failures may easily be

if trifl es corded are disregarded . I When discussing the various disinfectants , have mentioned in that we possess sublimate both a reliable , and , if properly used , harmless disinfectant , which , besides , is easily trans m portable , especially for country practice , and can be conve ien l t y dosed if made in the form of Angerer pastilles . More

on over, account of its cheapness , it can be easily understood why I use only sublimate as a disinfectant . For a long time in a greater or less degree the ability to absorb wo und exudations was of importance in deter

e mining what bandaging material to use . Howev r . HE D DE ’ e i as S C S remarks , consid r ng the small amount of exudation which flows from an aseptic wound , any bandaging T f . material is su ficient to absorb them herefore , it is not surprising that I take the price into consideration only when selecting bandaging material , and either use jute or

’ I s fatless wadding . tated that usually a pack of sublimate

ut o e jute is p on the w und , which is especially advisabl in I n sutured wounds . open wounds with pockets , the objection could be easily raised that the jute pack by coming in direct t 1rr1 contact with the granulations , migh cause a damaging tatio n or that it might stick to the wound and injure the granu it b lating surface . Finally would not be impossi le for single threads of the jute pack to prove injurious later by healin g in

the wound . All these disadvantages actually take place , if I t t ; wadding is used , but have not as yet noticed them wi h ju e I u t u on the contrary , fo nd that in pocke wo nds , the jute pack t very eff ectually carries the exudation outwards . Frequen ly

n , I use , o account of these draining qualities of the jute splices of the same for drainage . As I soak the bandaging material and band in a sublimate 64 A N TI S E PTI C TRE A TME N T OF WOUN DS .

solution before putting them on , it is not exactly proper to “ ” bu t . i call such a bandage dry , t should be remembered that o e such bandages dry very fast , so that , although m ist ned , they very soon dry by evaporation . The causes which compel

us to proceed. thus , when a dry occlusive bandage is put on , are as follows :

I f s (a) we put the bandaging material on dry , it doe not fit

a d tightly to the sh pe of the bo y , thus forming dead space (cav

banda e . w hich the ities) in the g , frequently are cause of accu m ulation o n and decomposition of the exudation , and the lo se of ing the bandage . be (b) Furthermore , this preliminary soaking is necessary on I o cause , account of its cheapness , pr cure bandaging ma terial I c which is not disinfected , and disinfe t it myself in this w ay .

(c) Besides , dry bandaging material absorbs the exudation poorly , and , if the exudation formed soon after putting on the bandage is not carried into the deeper layers of the of bandage , it dries up in the immediate vicinity the wound and makes the bandage unfit for absorbing more .

’ (d) I n our domesticated animals it is essential that the band age should be put on rather tight , as , on account of the rest

the lessness of the patient , bandage usually gets somewhat n loosened . By all means we should ot forget that excessive pressure on a part of the bandage may easily cause bandage

I o necrosis . found that this m istening of the bandaging ma terial before putting it on is of the greatest help in maintain I f ing it . the band that holds the bandage on is drawn close , the band after the bandage has dried up gets l onger so that the bandage will be somewhat loose . While the bandaging e u mat rial dries p and at the same time expands , it provides

and for the filling of the space between the body and the band , a sufficiently tight hold . F inally , the question as to how long such a bandage should be allowed to remain unmolested must be considered ' The advantage lies in the fact that a daily cleansing and treatment of the wound , which in the preantiseptic era was AN TI S E TI MO E OF TR E A TI N 65 P C D G WOUNDS .

d s . h consi ered necessary, is superfluou T e endeavor of everv surgeon is , if possible , to bring about the healing of the wound

” under one bandage ; however , a change of bandage is indis

ta and ' therefore pensable in cer in cases , a m inute knowledge of all the circumstances which make such change necessary is required .

o - how Th ugh we could , easily ascertain the wound is pro off gressing by taking the bandage , we would at the same time expose the wound to new dangers . Therefore , we have to be on the lookout , as in internal diseases , for symptoms , which t u s a ell wh t takes place under the bandage . Though these symptoms are not as numerou s as they are in internal dis it eases , takes practice to decide from them whether the band

r age should be changed o not .

I E bi- o L ST R , by his chl ride of mercury bandage , as pre viou sl t y mentioned , a tempted to use the bandage itself as a reagent for the procedures of the wound ; but this does not

o - seems to me to completely s lve the question , as wound exu t dations , especially pus , produce the necessary discolora ion

- do o . only , if they s ak through the bandage We not there fore obtain any disclosure as to the condition of the wound unless the exudation is abundant . One of the m ost important symptoms for determining the processes going on in the wound is undoubtedly the tempera E ture of the body . very rise in body temperature during the healing of a wound , is , if no other illness is present , due to some abnormal action in the wound . To avoid mistakes , we O N N certainly must , in accordance with V LKMA and

’ GE N ZME R S theory , strictly draw the line between septic

u and antiseptic fever . These a thors frequently call our atten “ tion to the fact that frequently high fever up to 4 1 C . occurs

of in patients with a completely aseptic healing the wound , i and that the patients alluded to did not show signs of any i con e n stitutional disorder . This aseptic f ver is of no importa ce in

healing wounds , and the question arises , how are these two styles of traumatic fever distinguished from each other % As s o f already mentioned , aseptic fever consi ts chiefly a rise in 66 AN TI S E P TI C TR E ATME N T OF WOUN DS . temperature without any disturbance of the general constitu eo O N N tion and is caused , according to the th ry of V LKMA GE N ZME R ‘ r and , simply through reso ption of bland wound

- i ff . exudations . The case is ent rely di erent with aseptic fever I n it we find , besides a rise in temperature, a great nervous prostration , so that some horses stagger with the hind parts , f and i slightly pushed with the hand stumble sideways , and

u ntherm ore ff f even fall down . F , such patients su er rom com plete loss of appetite and dizziness with stupor . T o return to our subject as to the imp ortance of traumatic l ever in judging the healing of the wound , only septic fever i necess tates a change of the bandage , while the aseptic fever is of no importance . N aturally there are septic fevers which show the above mentioned symptoms in only a small degree , for instance , the appetite is irregular with a temperature of

° ° t 0 I n from 39 o 4 C . such cases we should not immediately change the bandage but wait and see as to whether this con —u u I n dition lasts longer than twenty fo r ho rs or gets worse . the latter case the bandage must be changed immediately however , if the temperature returns to its normal condition in

off the specified time , we omit taking the bandage .

Another , though not absolutely reliable , symptom of the wound - healing processes is the painfulness of the wound and T surroundings . his symptom is unreliable inasmuch as the varied sens ibilities of single individuals are shown in the pain fulness of the wound . While dogs with wounded limbs as a t rule put no weight whatever on hem , oxen with even large

u hoof defects still work , altho gh with pain . Just as different sometimes is the d egree of sensibility even between individuals a of the same animal species , thus , for inst nce , well bred horses not ff do , in slight hoof a ections , put any weight on the aff ected l of o imb , while working horses a l wer grade frequently show , ff even in severe a ections , but insignificant pain . We can thus see that the painfulness has but a relative value according to I circumstances , and consider, as a rule , that only a pain which r remained the same for ove five days , and an increasing pain

68 AN TI S E P TI C TR E ATME N T OF WOUN DS .

I n the scent of the bandage . our domesticated animals the

f en scent o the bandage is nearly valueless , for even in an tirel y aseptic condition of the wound and its vicinity , espe c iall o old y with a m ist bandage , a scent which is like that of

e w e tin f T s a oot o . chees or a g , is bserved his scent , which is

' fou nd in chiefly hoof bandages , originates from decayed epi

hoofhorn thelium , especially , and has nothing whatever to do with the wound , and is of no importance whatever . (2) The moist occlusive bandage differs on ly in its pur

a pose and treatment from the dry one , so th t nearly everything that is said of the latter is of value for the moist bandages . I f we want to put a moist occlusiv e bandage int o use we use n the same modus operandi as with a dry bandage , o ly we have to see that the bandage should be permanently moistened with I n t antiseptic fluids . human surgery this mois ure is kept up by placing between the layers of bandaging material gum

- paper or any non porous material . By this method an evap

r oi o oration , d ying the m isture contained in the bandage as well as perspiration is prevented and the intended obj ect n reached . Although the bandage under these co ditions stays b moist , an increase of disinfecting matter will y no means be e obtained , ther fore , as the disinfection means will gradually

u be sed up , a scarcity of the latter will result ; besides , by the mentio ned mode a maceration of the skin which often results in ecz ema and its consequences will be started . For these latter I reasons abandoned this mode of moist bandaging , the more so as ‘ the bandages of our domestic animals so easily get in

' fected re , especially on the extremities , which necessitates a T n peated disinfection . his disi fection is reached by simply having a 5 per cent . sublimate solution poured upon the E bandage several times a day . xperience has taught me that

' no intoxication arises by this treatment and I have decided to use a moist sublimate bandage as a rule in all fresh wounds , I and until the first change is necessary , and have thus gained complete asepsis even in hoof bandages , which are exposed to infection . AN TI S E TI MO E OF TR E ATI N 69 P C D G WOUNDS .

As to the incidents in the wound also as to whether a change of bandage has to follow , the symptoms mentioned in the dry occlusive bandage (with exception of the saturation of the

bandage), give us the desired information .

' (3) I n m ire hur an wounds , which are not treated at all , we quently see a healing take place witho ut any pus or abnor m alit y in the healing process . By inquiring into the reasons . and what takes place in the healings of these wounds we find b o that nature , y certain pr cesses , is able to frustrate such w ound diseases which are due to infection . We notice that

such wounds , on account of the drying up of the exudations ,

form a dry scab under which healing takes place , just the same as we notice by ad opting the bandaging methods previously

described . Healing under a dry scab is also possible in

our domestic animals , but less so than in the human , be cause of the work they do as well as on accou nt of the greater d anger of infection and its consequences . N otwithstanding

these unfavorable conditions , healing under the dry scab is

in m s possible our do estic animal under certain circumstances . As it is imp ossible for us to put on a bandage on many , s wounds of the body , the que tion arises whether this natural process of the healing under the dry scab may not be arti fi i ll c a t . n d I y imi ated After many experime ts in this irection ,

r I obtained a result not to be unde valued , as succeeded , with

o V o but few excepti ns , in all wounds where no i lent or forcible motion takes place or any specially profuse exudation is pres 10cated on in ent , that is , in wounds not around or the jo ts , by spraying iodoform sugar or iodoform tannin on the wound surface to produce a dry scab which is sufficient to pro

n t tect the wound against infection . Co sidering wha was said above in regard to the life conditions of micro organisms , the On u effect of this method explains itself . acco nt of the exu to dations having been reduced nearly nothing, one of the most necessary stipulations for the growth of microbes , name

l is . y, the moisture , lacking Furthermore , the little exudation

o the into ‘ a which exists turns , on acc unt of sugar present , n concentrated sugar solutio , which latter also does not form 70 AN TI S E P TI C TR E ATME N T OF WOUNDS .

a suitable nutritive medium for vegetable life substances . B e

’ o t u n sides , the iodoform , when coming int con act with gra

ff . lation , produces vigorous antiseptic e ects eff Where it is necessary to dry up a wound surface ectually , I not that is , to restrict exuberant granulation , do know of

o a better remedy than iodoform sugar, c nsidering the, de I n I mands of antisepsis . case of necessity , have used also pure sugar with the same result . The iodoform tannin I used for healing purposes under the

h a no dry scab only, for if the disc arge has sy vial character , the sugar is not capable of coagulating and drying up the great

h ff . quantity disc arged . Here iodoform tannin is more e ectual (4) I n all cases in which we can neither apply a bandage nor succeed in bringing on a scab healing, we have to resort “ ” to the open wound treatment in a closer sense of the word . I V However , as I mentioned above , ery frequently succeed in

o dr nd healing w unds under the y scab , a only in such wounds of the trunk , which are either located in the vicinity of the

01' natural body openings are bruised wounds , and as such

off o n have to cast first all necrotic parts , or are such which , a o account of strong unavoid ble m vements , do not permit scab I r u formation , do reso t to open treatment of wo nds . The antiseptic treatment of such wounds is as follows T he wound as well as vicinity is freely rinsed and carefully cleansed

I . with a per cent sublimate water solution , and then the sur face is thinly covered with p owdered iodoform . For the latter manipulation I prefer to use rubber ball syringes such as T are used for spraying insect powder . hey are practical , and on account of their cheapness are preferable to the expensive iodoform sprays . N ow there is only left for us to discuss the conditions which would indicate the adoption and use of any of the above meth bu t ods , we have to restrict ourselves to the general indications ic o f wh h are menti ned before , when the di ferent methods were f separately discussed , as we are o ten compelled to transgress from the original to another mode of treatment during the n process of heali g of some wounds . ANTI S E TI MO E OF TR EATI N N 71 P C D G WOU DS .

I t would be carried too far were we to des cribe all the details of the course of a wound and all indications for further treat I n ment which m ay follow . judging single cases practice must aid us in using the necessary practical judgment and pre T n . o I r caution heref re , can only recommend to eve yo e who is desirous of thoroughly posting himself as to the technics of a o o the antiseptic tre tment of wounds , to g thr ugh the sepa rate details of the modus operandi either in a clinic or in

I t o -r practice . is thus learned much faster and with m re tho ou ghnes s (which is pre - eminent) than is possible from books; 72 AN TI S E PTI C TRE ATME NT OF WOUNDS .

T I E PTI I E . VI I . AN S C OUTFI T FOR PRACT C

I n former chapters we learned of the necessary precau tions , materials , etc . , necessary in the antiseptic treatment of wounds . Should we draw a conclusion from these statements as far as carrying out the antiseptic treatment of wounds in

% country practice is concerned , it would be evidence in itself to justify the remark (untrue though it be) which is often made in regard to antiseptics in country practice , namely , that it is too complicated to be of practical value to the country veter in ri n I re a a . acknowledge myself that such an apparatus as to ferred in former chapters , could be conveniently kept in a clinic but could not be very well lugged around by the country practitioner . As thus far in our literature there are no suggestions as to what the antiseptic outfit of the practical veterinarian should I consist of , will put my own experiences down as a basis for the following : The facts mentioned in the las t chapter should by no means be considered the limit ; they should only prove as the intention of this book indicates , that antisepsis in

t t rac ti coun ry practice can be carried through , and coun ry p tioners o should furthermore be urged to foll w up this plan . I and , at least , shall accept be very grateful for any improve f ments and teachings that may be o fered at any time . The instruments play an important role as infection trans m itters I , and on this account have given up the use of leather pocket or bandage cases , as they contain much that is super n and n fluo s , besides , the material which they are made of is e tirel I r y inaccessible to disinfection , car y only an antiseptic case HAUPT N E R with me such as made by , Berlin , and which , as they are manufactured entirely out of metal , can be easily dis A N TI S E P TI C OUTFI T FOR PR A 3 C TI CE . 7

a infected by putting them into a c rbolic solution . These cases fill all requirements which I expect from an instrument case — I and which have to carry with me for treating wounds . As a disinfectant I use sublimate which I carry with me

’ 20 A E R E R in a glass tube in the shape of N G S pastilles .

As bandaging material , two bands (cambric or mull bands ,

5 m . long, 7 cm . wide), with a corresponding quantity of jute wadding or other bandaging material that can be conveniently carried along . With these few rem edies a regular antisepsis can be car I ried out , and mostly limit myself in my practice to them , for the more simple an apparatus is , the more simple is its i applicat on . . My placing this simple antiseptic outfit first is to show that without any special inconvenience everything can be carried along to comply with the requirements of antisepsis , and that many of the items mentioned in the preliminary chapters rep

‘ a x resent lu ury to a certain extent , that can be carried along if in we are not too particular as to the cost and room . For stance, he who rides in his own vehicle , while practicing, can d e conveniently carry io oform , carbolic acid , disinfect d silk, e several bandages , etc . , etc . , besides the abov mentioned out I n n fit . hospital practice we can have even more co veniences ,

r . for instance , i rigators , iodoform sprays , etc However , as I mentioned above , confine myself to the most necessary , and t as a rule carry only the first men ioned items with me ; if, I however I know that an operation will be necessary , also , — take along the following articles iodoform , pure carbolic

200- 00 d acid , brush , 3 g jute or fatless wad ing, 4 or 5 cambric

n . . . and mull ba ds each 5 m in length , 7 cm wide All this can be easily transported in a small tin box .

On farms with much live stock it is well to keep at hand all such materials for disinfection . Some farms in my locality n banda m have , on my advice , fur ished themselves with g g n cases , which contain the followi g

grams jute (in plaits) .

g fatless wadding . 74 A N TI S E P TI C TREATME NT OF WOUNDS .

c b i g pure ar olic ac d . p ure sublim ate Spirit

20 co tton 20 n m uslin ba dages . I od oform

“ E lan-march

i inf - l D s ected si k .

76 ANTI S E PTI TR EATMEN T OF WOUNDS . . C

” soap and brush in a rather large circumference the vicinity of the wound is washed and finally disinfected with Sublimate

h , water, whic is either directly poured on , by means of a pot

: on irrigator , etc . , or is put with the aid of a wadding or jute of o compress . After this disinfection the vicinity of the w und it is irrigated thoroughly with sublimate water and only now instru follows the examination , with disinfected hands and ments . T hese manipulations may seem tedious , but they are per o f rmed much faster than they are described here , and habit t I has much to do with it , so hat proceed in the described

method nearly entirely mechanically . By these means the dan ger of wound infection during the examination is nearly entire l I y prevented , and then am of the opinion that many of the wounds would heal much better if they were not permanently infected through their uselessly coming in contact with the

instruments , as well as hands , of both professional and non

professional persons , that are not disinfected .

S as i imilar preparations , described at the exam nation of

wounds , are necessary to perform operations with antiseptic Th precautions . e field of operation stands first in need of al being prepared . Though in human surgery we almost in ways succeed disinfecting an operating field in a short time ,

even here it has been decided , especially in opening any cavi

ties of the body , to prepare the operating field davs before ,

and the so - called preparatory bandages or poultices are ap T plied . hese bandages are for no other purpose than to bring

about a thorough disinfection . As the disinfection of the oper ating fields in our domesticated animals for reasons formerly f I given , is much more di ficult than in the human , make such preparation of the operating territory in advance whenever

. possible , for success depends upon a careful disinfection I : I f T o obtain my object , proceed as follows a bandage

can be put on , for instance , on the extremities , after the operat

rioril ing field is p y cleansed , we apply the bandage (hoofs are

cleanly trimmed), which is daily moistened with a sublimate E XAMI NATI ON OF W N 77 OU DS .

solution . I t is practical to use heavy sack linen for such

bandages , to prevent their being tread through .

Where such bandaging is not practical , the operating field

off is to be thoroughly washed , eventually the hair trimmed ,

and afterwards irrigated with sublimate water . U nfortunately , it is not always possible to carry out this ef fectual preparation of the operating field , hence there is noth f ing left for us but the disin ection , which was formerly de in scribed all details . I f I perform an operation with antiseptic precautions , and

I e I s do this in every instanc , upply myself before com m enc I ing it with the following materials , provided did not bring them along with me '

1 I ( ) Five or ten litres of sublimate water . For this purpose dissolve in one - half to one bucket of water (a well—washed ’ horse pail will suffice) five or ten Angerer s sublimate pastilles . I of irri ator I nstead the g use a clay pot with a nozzle , with the aid of which the wound can be conveniently washed .

(2) A washbowl with carbolic water (3 per cent . ) to put in and disinfect the instruments .

(3) a piece of soap .

(4) a brush .

(5) disinfected silk .

(6) bandaging material .

(7) iodoform powder .

As stated before , all these above mentioned items cannot be carried along permanently , therefore we meet with cases where we have to be contented with the outfit described

I . above , it being the one always carry along For dis infecting instruments , sublimate water must then be sub

15 stituted , the disinfected silk is replaced by raw silk , which saturated in sublimate water . As bandaging material we can ,

in case of necessity , use linen compresses , namely , small linen sacks filled with fine sand and saturated in sublimate water , while linen bands come in place of cambric and mull bandages . I During a military drill of six weeks , in which recently 78 A NTI S E PTI C TRE ATME N T OF WOUNDS . took part (army veterinarians very seldom have a pharmacy handy , and the medicine case which is carried along on the ffi freight trucks , though it contains a good deal, does not su ce I all for the demands of antisepsis), treated almost typically d saddle galls , contused, lacerated and bruise wounds as fol

: d and lows After the wound has been dresse , well washed r with mild vinegar water, a thick laye of powdered sugar is I al applied . With this simple , easily administrable method, ways succeeded in healing the wound , under the dry scab , so that I can especially recom mend this method in case of necessity .

E XAMPL E S OF ANTI S E PTI CAL L Y TR E ATE D CAS E S . I n h I the following examples , w ich discretionally select from I among a number in my country practice , shall endeavor to show the practical application of this treatment , as not every body has an opportunity to visit various clinics to partien larly study the procedure . .

OT AE MAT MA I THE R E H O N HO S . A heavy Belgian working horse possessed for some time on the inner surface of the left car a haematoma of the size ’ of a hen s egg, connected with strongly inflamed swelling of

the . the whole concha , as well as vicinity of the ear As the swelling already showed numerous erosions and the horse was

a n sh king his head co siderably, and permitted the touching of the latter by force only , a removal of the trouble became necessary . The following treatment was indicated : Removal of the

swelling through the fissures of same , and as on account of

suppuration the auricular cartilage , if not the whole ear could th be easily destroyed , strict antiseptic treatment of e wound

was imperative . l off After the hair on the swelling had been c ipped , the ex and and ternal auditory canal was cleaned with soap water , w rinsed out w ith sublimate water, and then stopped up ith

a cotton wool tampon saturated in glycerin . The rest of the d d ear was also washed with soap and isinfecte , so that after a E XAM LE P S OF AN TI S E PTI CAI L Y TR E ATE AS E 79 D C S .

n disinfection of the hands and instrume ts , the opening of the endeuxtem s swelling with an p oval amputation could follow . A large — fl tablespoonful of a turbid grayish red uid , contain c ing numerous pie es of cartilage , was evacuated . The cavity

of the wound was then irrigated with sublimate water, and after dusting with iodoform , was tamponed with gauze s moi tened with sublimate water . Over the wound and the n whole ear, waddi g was put , then a pair of linen protective

off hoods , such as are used to ward flies , was pulled over the

ears , and on the lateral portions the halter was fastened . The whole bandage was saturated once a day with sublimate water and was changed every four days , while at the same time the wound was rinsed out with sublimate water and a little iodo form was strewn into it . Within the three weeks which passed

‘ until the wound completely healed , a few pieces of cartilage

“ ff w as came o , but there hardly any exudation from the wound . ’ proving the wound s course to be typically aseptic .

NTUS E N N T HE T R L CO D WOU D S O H O ACI C WAL .

A well - bred carriage horse from some unknown reason re cei The ved a contused wound on the left thoracic wall . w u n o d w as 20 . t . cm in leng h , gaped 3 cm and showed at the I bottom the ribs still covered with periosteum . t extended horizontally to the olecranon . Otherwise the wound had the aspect of any fresh wound .

As the horse was used for pleasure , it was desired that he r I should have no disfigu ing scar , not even a harness scar , so : had to endeavo r to heal the wound per prim an intentionem . — Treatment Cutting off of the hair in the vicinity of the

wound , disinfection of the wound and vicinity with soap and a

1 per cent . sublimate solution , after scraping with sharp scoop , disinfection . oi the hands , and suturing the wound . The sin gle stitches of the interrupted suture were put very close , and in the center of the wound a space 3 cm . long was left without the suture , so as to allow cavity of the wound to be treated 1 antiseptically . The latter was rinsed out daily with a per

, cent . sublimate solution , also the wound itself externally then 80 AN TI S E TI T P C R EATME N T OF WOUNDS .

a little iodoform ether (5 per cent . ) was injected into the Th cavity . e wound healed within fourteen days without form ing a conspicuous scar : the sutured part healed per primam n intentionem , the other by granulatio s with a purely aseptic

. T o course prevent any infection during the healing, the horse was turned backwards in the stall , and the head was tied up h high on both sides , so t at the animal could not lie down nor lick the wound .

E R I I A F T HE E L I S UP F C L AN D MUS CUL AR W OUN D O P V S .

A heavy Hanover draught horse , while stepping back , ran against an iron pillar , and thus received a flap wound of the T gluteal muscles on the left side . hree lobes (flaps) were d forme , and in the center of the wound a large piece about the ’ s enu tendinon size of a man s fist was torn out of the muscle , which was connected with the muscle with but a few connec tive tissue bands .

‘ — Treatment After removing the piece of muscle and dis infecting the vicinity oi the wound and the wound itself by a

1 per cent . sublimate solution , the two side laps were sutured with an interrupted suture , while in the cavity which was formed by the removal of a portion of the muscle and also on the sutures . powdered iodoform sugar (5 per cent . ) was thickly applied . A dry scab formed , under which the wound healed up without any reaction (formation of pus , swelling,

whatever . Whenever a moist spot appeared on the wound a thick layer of iodoform was put on to keep th e scab con tinu u o s .

L OB UL AT E D CONTUS E D W OUN D ON T HE I N N E R S I DE OF T HE N E E OI N T OF T HE OR S E L AY K J H , I T H I I AR N G E T B A B E . A Hanover work horse was kicked by another horse under the belly , so that on the inside of the left knee joint a lobulated u wound of the size of a large plate was formed , thro gh the center of which the tibia was laid bare , exposing the periosteum

- five - e in a spot the size of a twenty cent piec . T reatment—After liberally rinsing out the wound with a E XAM LE S OF AN TI S E TI ALL Y TR E ATE A E 81 P P C D C S S .

- one tenth per cent . solution of sublimate , all necrotic as well as probably dying shreds were removed and the wound to com “ ” Th . e mence with , was treated as open wound and vicinity were twice daily rinsed with sublimate water, and powdered

. On with iodoform the sixth day the wound was clean , and t reatment with iodoform sugar , in order to obtain the form n ing of a scab , was resorted to . O the tenth day a dry scab was formed , under which the wound healed , so that after four

defi weeks the animal was capable of resuming work . The nite cicatrisation came into effect after six weeks . Formation of pus , or swelling of the vicinity , during the process , was not present .

T E N D ON AN D S H E AT H OF T E N D ON W OUN D ON T HE E H I N D L E GS OF A H OR S . The following case is especially interesting on account of the

c ob complications in its course , and refers to a , that received a b wound on his hind legs y a plowshare , on the fifteenth of

May , and the following were the conditions

I n l m etatarsu s ~there su erficial the center of the eft . was a p n 1 0 . wound cm lo g , which extended from below outwards , and in front obliquely upwards , behind and inwards , exposing the inner edge of the perforatus flexor tendon . The wound

2 . gaped in the center about cm , the edges were rather smooth

T he and covered with coa gulated synovia . vicinity of the

wound was not swollen , but was covered with coagulated synovia . After removal of the exudations and coagulated synovia

. present in the wou nd , by means of a I per cent sublimate solu

flexor tion , the intact tendon of the pedis perforatus came

2 . I n the , into view . the center wound had a depth of cm n These holes were caused by the fl exor pedis perforans tendo

being half severed . The walls of the cavity of the wound were

moderately smooth , and were but partly covered with blood n . coagulum , but not as yet with granulations By run ing the finger down on the upper sheath of the tendon of the flexor o i , pedis perforans , a clear wine yellow threadlike synov a was 82 AN TI S E TI T P C RE ATME N T OF WOUN DS .

. u of evacuated However, an opening, or a f rther filling up the lower tendon sheath of the perforans could not be ascertained . i Besides , the mentioned solutions of continu ty , the recurrent metatarsal artery, as well as the outer branch of the plantar

u nerve was c t through . The state of the wound clearly indicated the following treatment : I f we did not succeed in preventing the infection

su urat1 n 1n of the wound , a pp o the wound and in the opening of fiexor upper tendon sheath of the pedis perforans , would

and necessarily result , then certainly a recovery of the patient u would be out of the q estion . After the hair in the vicinity of the wound was trimmed and the leg cleansed with soap from the ankle joint upwards and I S washed with a per cent . sublimate olution , it was then thor oughly rinsed out with a I per cent . sublimate solution and then in its rear angle three , and in the front two sutures of I n sublimate silk were inserted . the remaining cavity , a car bolized o h jute tampon , p wdered wit iodoform , was inserted , and the whole metatarsus was surrounded with several layers

a of sublimate wood wool wadding, and wrapped round by

o-f means cambric bands . On the l gth of May I visited the patient again and found a regular agglutination of the wound as far as the sutured parts were concerned , the cavity of the wound was covered with nice pale red granulation ; however, the synovial flow still con

. E U U tinned The temperature was degrees (R A M R), a and there was no tr ce of suppuration . The bandage was 1 th Ma again put on exactly as on the s of y, and the owner

was ordered to saturate same once daily with a I per cent . sub limate solution . The tendon of the fiexor pedis perforans on the injured spot and the tendon of the fl exor perforatus at the top of the sesa moid was totally torn asunder ; the wound was gaping owing out a bout I O to the sutures being torn cm . and the tendon stump of the perforatus protruded out of the wound about the 1 0 Th length of cm . e lower tendon sheath of the perforans

was also open and synovia flowed from it .

84 AN TI S E TI TRE ATME N T F P C O WOUN DS .

h canal w ich is widened with the sharp spoon up to its base , u with a j te compress , which is saturated in a I per cent . solu

. On tion of sublimate the top of this tampon a pledget of jute ,

o fastened by means of a c vering iron , is placed , and kept moist by occasionally pouring s ublimate water on it . A o f change this bandage is necessary every three or four days . Under such treatment all fresh nailpric ks heal nearly with an out exception within from eight to fourteen days , on ac oi count the antisepsis , which prevents suppuration and its consequences .

The h nail ric ks t erapy of all p , in which the pain does not become materially alleviated within five or six days after the course of treatment as above mentioned , or when fever sets in ,

nail ricks fl exor (especially in p , which perforate the tendon ,

nail ric ks u nc that is , old p , where necrosis in the depth of the p ture canal takes place) is a surgical one , and will be discussed later .

T H R US H W I T H L AYI N G OPE N OF T HE S OFT PAR TS N T I N O B O H H D H OOFS .

As a consequence of permanent standing in urine soaked

o peat litter, on both hind h ofs of a horse the frog was so badly

' r the s ide utrefied t mace ated , and lacunae so p , that in the lat er

T he the hoof cutis vera was laid open . disease was diagnosed as frog canker , and was accordingly treated chiefly with plum

i ric u m T n t . bum his treatment did not heal the wound , and the

e owner was recommended to have the animal d stroyed . On my recommendation the horse was treated in such a way as to have the wound rinsed with a I per cent . sublimate water and bandaged up afterwards with iodoform tannin (5 I n . . re per cent ) and jute the course of four weeks , healing su lted n , during which time the horse worked alo g in the

field .

S U UR AT I N G S TON E R UI S E PP B S . As a rule in suppurating stone galls we simultaneously find necrosis of the soft parts in larger or smaller dimension and E XAM LE S OF AN TI S E TI 85 P P CALL Y TRE ATE D CAS E S .

h ne the indications , t erefore , are as follows : Removal of c ro sed parts , laying open the wound surface by cutting out the neighboring horn , and disinfected treatment of the wound . I therefore proceed thus :

After the shoe is removed , by means of a brush and soap the whole hoof is thoroughly cleansed . Then, after disinfect I d ing with a per cent . sublimate solution , the wound is lai N open by removing all undermined horn . ecrotic corium of n the hoof is removed , and then a other plentiful rinsing with sublimate water follows . After this , either iodoform , or if such

ranu cannot be obtained , powdered sugar in a thick layer or g

on lated coffee , is strewn the wound , and a moist sublimate

bandage put on . After eight days at the latest , such a new formation of horn is present that after shoeing the horse and d putting on a few turns of a tarred ban age , the patient can be

put to work . 86 AN TI E S P TI C TR E A TME N T OF WOUNDS .

1 P PR E CAU x. O E R ATI ONS W I T H ANTI SE PTI C

TI ON S .

R E S E CTI ON OF B ODY OF I N FE R I OR MAXI L L A OF D OG ON A OUNT F CC O FR ACTUR E . A spaniel was bitten by a large L eonberg dog and the latter fractured both rami of the former ’s lower jaw closely behind h their union (body), so t at the lower lip and body of the lower jaw was pendulous . After narcotising the dog by means of a morphium injec I t infer r tion , resected the frac ured portion of the o maxilla , I also the corresponding part of the lower lip . As was afraid at that time of the poisonous action from applying sublimate on mucous membrane , the operating region was washed with i sal cylic water per cent . ) and the instruments as well as I hands disinfected in the same solution . then made two incisions commencing sidewise on the edge of the lower lip at e the height of the fracture , and coming tog ther, going down

at - wards the mental angle , so that a wedge shaped portion of the lower lip with the part of the lower jaw situated on it was

removed . The two rami of the lower jaw were fastened to

each other with a sling made out of silver wire , and the wound

the on lip was sutured with silk saturated in salicylic water . I n the space between the lip and the fractured ends of the lower jaw rami some iodoform and a gauze tampon were

and h i placed , within the first t ree days the pat ent received only u t e drinking water; After six days the sut res could be

moved from the lip wound , as a healing per primam inten

nem . tio took place After the course of fourteen days , a few

bone splinters came off . The silver wire was removed after

three weeks , as the two rami now adhered closely to each other . O E R ATI ON S P WI TH AN TI S E PTI C R E AUTI ON 87 P C S .

After six weeks com plete healing took pla ce so that the dog

could chew small bones .

AT E R OMA ON THE AL S E N OS T R I L OF A I L Y H F F L .

On the outer wall of the left false nostril of a filly a tumor the size of a fist was present , which proved to be an Atheroma , I t havingbeen previo u sly opened up several times without suc cess . A radical operation was decided upon in order to re move the continually recurring tumor n After casti g the horse , the skin right above the swelling of was washed with soap , the hair was trimmed , and the field I operation disinfected with per cent . sublimate water . After splitting open the skin , the sac of the tumor proved to be so its thin that contents evacuated immediately through a fissure . The encysted tumor was excised and after the wound was I thoroughly rinsed in a per cent . solution of sublimate water , it was saturated with sublimate silk . The suture and linear wound were pow dered over with iodoform sugar (5 per so that after a formation of dry scab a healing of the wound .

rim an . p intentionem , took place after six days As an interesting fact I might as well mention here that I during my presence six months later on the same farm , was ’ requested by the owner to again examine the filly s nose as the sutures apparently had not yet come out . As a matter of fact , all sutures were still present , without , however, any suppura tion or irritation of the vicinity being present . The sutures I h were simply healed in, so that had to remove t em with the scissors .

OF THE AR OTI ACT I N OMY COMA I N T HE—R E GI ON — P D GL AN D OF A BUL L R E MOVAL H E AL I N G

I N T H R E E W E E KS .

A Simmenthal bull had a hard painless tumor in the region

% ac of the left parotid gland , which was supposed to be an

c om a and . tinom y , later proved to be such As all my former '

z , modes of treatment (cauteri ation , cutting open pungent 88 AN TI S E TI TRE ATMEN T F P C O WOUNDS .

salves , ff I r proved ine ectual , resorted to the knife to e w move the s elling . I n a dorsal position with head stretched backwards the hair off was trimmed the tumor, the field of operation washed with in soap and disinfected with sublimate water . Hands and strum ents were also treated the same . Th e skin as well as the platy sma myodes were cleaved in a direction from the front backwards to a length of about I 5 cm . n and the tumor up to its pedicle was decorticated , and it was o ticed at the time that the jugular vein was partly grown around

The . d by the tumor pedicle , in or er to prevent bleeding as

off The much as possible , was torn by twisting the tumor . cav ity in the wound , which was at least double the size of a fist , was rinsed out lavishly with sublimate water , and then the skin , as ell as the nearby sections of muscle , were closely sutured t . V with sublimate silk the bull got up , a secondary hem o rrha e i g into the wound cav ty took place , forming a tumor the ’ n size of a man s and . N otwithstanding this the sutures were left intact , as the blood did not percolate , and the tumor was rinsed once daily with sublimate water . The haemorrhage absorbed and the wound healed up prima n inte tione , so that after three weeks the swelling was no longer “ ” I n —in re visible . this case also the healed sutures had to be moved later .

N E UR E CT OMY OF T HE I N N E R AN D OUT E R B R AN CH OF T HE PL ANTAR N E R VE S OV E R THE PAS TE R N I T TA I G L AN R N E UR E T MY . J O N . (H H P C O )

N eurectomy is an operation which , considering the many important advantages that it offers in the treatment of many

and hoof toe ailments , and considering the fact that the great

fi fre fear of bad results is not justi ed , should be much more quently performed than it reallyis . To express myself briefly , I will state that in my opinion (especially , in draught horses) neurectomy is always indicated in all such cases (where there is a chronic ailment of any part , from the pastern joint down O E R ATI ONS P WI TH AN TI S E TI R E AUTI N 89 P C P C O S .

wards , including the lower sheath of tendon of the flexor pedis

perforans), which are painful , but do not show any acute in flam m ator y systems , and which do not yield to any derivative

. treatment such as firing, blisters , etc , within six weeks . Although there is but one incision (surgical wound) made if the median nerve is cut through on the inner surface of

the arm at the height of the elbow j oint , I concluded for the

following reasons instead of neurectomy of the median nerve , to perform the operation on its inner and outer branch over

the pastern joint . With this m ode certainly we have to operate

upon the inner as well as the outer side of the pastern joint , and ,

, therefore we have to turn the horse after operating on one side , but whoever had frequent opportunities to perform neurectomy

of the median nerve , has certainly convinced himself that it

n is not such an easy operation as it appears to be . O the ca daver certainly with one single incision the median nerve can I be exposed , as have had ample opportunity to observe at the surgical exercises of the Royal Veterinary High School em tirel ff y di erent , however, are the conditions on the living

animal .

T he median nerve at the elbow , where it has to be exposed in

fl exor in order to cut it through , is covered by the metacarpi n ter u s . The latter muscle stretches itself, on account of the exertions which the horse makes to liberate himself from

o it the h bbles , so tensely , that hides the nerves located under it both to the eye and the finger . Besides , in this vicinity, in fact , close to the nerve , lies the vena radialis , vena mediana

~ and vena collateralis radialis inferior . All these three have a rather tolerable lumen , and are easily injured when the nerve is searched for , so that the severe haemorrhages cause quite a difficulty in finding it .

For the practitioner, who does not have all helping material the and assistance at his disposal same as the clinical teacher, difficulty to find the median nerve on the mentioned spot, would be sufficient to cause him to abandon the operation .

Another cause , however, besides this one , induced me to pre fer neurectomy of both branches of median nerve on the past 90 AN TI S E TI TRE A TME N T F P C O WOUNDS .

o ern j int rather than cutting through the body of that nerve , I have noticed cases where , undoubtedly, the median nerve was totally cut through , and notwithstanding this , the sensi bilit y did not immediately disappear after the operation . The plea that the muscular sensation in stepping on the corona h produces a deceptive sensibility is frail , owing to the fact t at I e n needle pricks were also felt on the coronet , think an xpla a m tion for these appearances lies in anato ical conditions , for it is well known that a c onnecting branch from the ulnar nerve leads “ at the top of the root of the metacarpus to the outer P branch of the median . ossibly through this branch of the ulnar nerve , sensitive fibres enter into the outer branch of the median and thus transmit sensibility into the parts provided for by the latter , although its body is cut through . I T o prevent this eventuality , do not cut through the body

of the median , but both of its branches close to the pastern joint . I attend to the operation as follows : After securing the I off horse , trim the hair , wash the skin with soap , disinfect it I with a per cent . sublimate solution , and with an incision from

I rv . 4 to 5 cm . long, close above the pastern , expose the ne e I t a is pr ctical to make the first incision the proper depth , so

I f o that the nerve can at once be seen at the bottom . nly the skin is cut open , as is usually recommended , the connective tissue must then be removed by means of T scissors and small forceps . his leads to unnecessary

o hemorrhages and a shredded condition of the w und , and thus considerably interferes with the finding of the nerve as I well as delays the healing . As soon as know the nerve % easil to be lying at the bottom of the wound , which can be v determined on account of the violent movements of the pa tient , when the supposed nerve is pricked with the knife or I f D pinched with the forceps , carry , by means o the echamp

needle , a sublimate silk thread under the nerve , also through the neighboring connective tissue , and then tightly fasten the a thread around the nerve , during which performance the p N tient struggles violently . ext thing the nerve , centrally from

92 AN TI S E TI TR E ATME P C N T OF WOUNDS .

muscles , and lies most superficially about 20 cm . above the I n astragalus . a better bred horse it is higher, according to

The the length of the tibia . point of operation is located , so

- that in larger, well bred horses the operation must be per u 2 formed p to 5 cm . above the protuberance of the astragalus ,

I . while in commoner, smaller horses , 5 cm . is the limit At this point the nerve is located in the space between the mus fl cle bellies of the exor pedis , which is surrounded by a muscle sheath , on one side , and the lamellar ligament , which origi nates by the uniting of the superficial and deep laminae of the

the - fascia of the leg and in front of tendo Achillis , goes down I n on . ward , inserting itself the astragalus , on the other side the median direction the nerve lies close to the deep lamina of and the fascia of the leg, outwards , then follows the superficial

su erficialis lamina of the fascia of the leg, (fascia p of the hind

e leg, ) and finally the skin . Besides this , the nerve is a com

anied a p by the small rtery , recurrent tibial artery , also by the o plantar vein , the latter , h wever, does not seem to be constantly

I . present , as missed it frequently The performance of the operation is as follows : I After laying the horse down , have the top hind leg elevated I some by an assistant . did not find it necessary to untie the

leg , and then cut at the specified place with a disinfected knife

through the skin to the length of from 4 to 5 cm . , after the off hair has been trimmed , the skin washed with soap and dis

infected with a 1 per cent . sublimate solution .

N ow I assure myself, by touching it with the finger again , that the superficial incision is located exactly above the above mentioned interstice in which the nerve lies ; should this latter

not be the case , the incision can be enlarged accordingly , or f h if such enlargement should not su fice , a fres incision had bet I f the ter be made . the superficial wound and space between

the flexor pedis muscle and the lamellar ligament , which is formed by the union of the superficial and deep laminae of o the fascia of the leg , are not exactly over each ther, we

c d reach , by cutting the facia lo ate under the skin of the hind

leg, into the space between the lamellar ligament and the OPE RATI ON S WI TH AN TI S EPTIC PR E AUTI 93 C ONS .

tendo Achillis , and naturally , notwithstanding we zealously

, look for it we do not find the nerve . I f both the superficial

d w e wound and nerve correspon , cut through the above men tion ed a o r f sciae which c vered the ne ve , with a long cut , which n can be even lo ger than the superficial one , and find the tibial

: nerve in the space referred to . I n fat horses the nerve is al of I ways surrounded by abundance fat . , therefore , with the D aid of the echamp needle in every instance , pull out the nerve

with the fat , recurrent tibial artery , and plantar vein and dissect t the nerve out of them , hen a thread of sublimate silk is by

means of the above mentioned needle , carried under the nerve and . 2 tied down After a piece of the tibial nerve from to 3 cm . o l ng is cut out , we convince ourselves by examining the por

, tion cut out as well as by our pricking the crown of the hoof,

that both branches of the nerve have been taken hold of, for it

sometimes occurs , that in the preliminary division of the

tibial nerve , but one branch is cut through, thus making the

object of the operation a failure . The wound is rinsed well with sublimate water and closely sutured with sublimate silk im without any regard to possible bleeding, which is of no in portance , and besides , does not prevent healing per prima ion tent e. The after treatment consists of daily powdering the suture

with iodoform sugar (5 per cent . ) to produce a dry scab , as a I n bandage cannot be very well placed there . fourteen days , at the utmost , the patient can again be put to work .

A F ’ AMPUT TI ON O A COW S H OOF. A heavy Dutch cow acquired a whitlow on the outer hoof of the hind foot with a subsequent decomposition of the hoof of joint . As the cow, as a consequence this , became rather I d thin , decide to amputate the hoof, which proved to be the am u more necessary, as there was evidence of caries of the p tated hoof .

The hoofs , as well as the whole leg up to the ankle joint , were cleansed with soap and water , and thoroughly washed with a I per cent . sublimate solution . 94 ANTI E S PTI C TREATMEN T OF WOUNDS .

By a circular amputation , closely above the edge of the hoof, the latter was W ithout much difficulty excised . Haemorrhage T he did not take place , as all vessels were thrombosed . whole O n perating field , includi g the wound , was rinsed out with a h sublimate solution , and by means of jute , whic was saturated w few ith sublimate water , and a cambric bands , a bandage was put on which reached half way up the metatarsus . To pre vent any moisture and dirt from penetrating through the ban

( a l ge it was painted over with tar . The after treatment consisted of pouring in sublimate water behind the bandage daily , and changing the bandage every fourteen days . With this treatment the wound healed within k eight wee s , without any trace of pus or even exudation worth mentioning .

R T R E A . C OWN PR I CK . ( D S )

As in nail prick the importance of crown prick depends en

t ti ely upon how deep the injuring body has entered . As to

ff at the mode of treatment , however, there is no di erence all in between the various forms of the trouble , as a superficial

ac jury is apt to cause disease to the deeper lying tissues , on count of a slowly encroaching suppuration downwards . By all means surgery has to be resorted to , and according to the

cc size and circumference of the injury, o asionally more and

s o t hat at other times less horn , to be removed , some

times the operation can be performed, on the horse standing, while at other times he has to be laid down , especially in more I : severe injuries . proceed as follows After the hair and coarse shreds of tissue in the vicinity of the injury have been removed , a cleansing with soap and water

a follows , and finally disinfection by free fter rinsing with one A per cent . sublimate water . fter that the horn in the neigh b orhood re of the wound is thinned , occasionally entirely moved as far as the connection between the horn and flesh wall

All a en is loosened . foreign bodies and hair which may h ve tered shreads into the wound , as well as all necrotic or dying I t i . off rre u of tissue , are removed is also well to trim all g

96 AN TI S E TI P C TRE ATME N T OF WOUNDS .

an immediate operation is always indicated , for should we in these cases use such treatment as mentioned formerly and wait for the result , we would as a rule notice an increased pain , set

f ai etc . . ting in of ever . , etc , which is a sign of spreading of the fection , which makes a success of the operation more or less doubtful . I n all other cases in which the flexor pedis perforans re mained intact , say that either the frog cushion , or only the os h pedis is injured , an operation is only t en necessary if necrosis sets in deeply , or if the pain without any further visible cause 8 I continues in the same spot longer than from to 4 days , or if finally some complications arise (remaining of a portion of the injuring body , suppuration , I n performing the operation I use the folowing modus oper and1

After casting the horse , the injured foot is tied on top of E the diagonal foot and an smarch compress bandage is applied . I f As lay the horse on the a fected side , the sole of the foot which is as a rule the field of the operation , on account of the abovee m entioned a mode of tying (on the di gonal foot) , is turned upwards , and thus permits a full view of the field of operation . Within the opening of the puncture (to a circum ference of from a quarter to a half dollar piece) the already previously thinned sole or frog is entirely cut down , the whole hoof having been previously cleaned with soap and water and disinfected by pouring a solution of sublimate water on it .

Then the soft parts , by means of a disinfected laurel leaf knife , are cut down in cone form , so that the point of the cone is lo cated at the base of the puncture canal , while the axis is formed by the punctured canal itself . The base of this cone corresponds in regard to circumference and location to the sur face of the sole as well as frog of which the horn has been re ’ d moved . We don t nee to be too anxious in regard to that , especially regarding the frog, as no tissue grows and regen I erates as well as the hoof matrix , so that have frequently cut out the whole fleshy frog , without any damage to its shape and formation . O E RATI ON S WI TH AN TI S E TI RE A P P C P C UTI ON S . 97

I f we in this way create a funnel shaped wound we can , with

, one glance see in what direction the wound , or any changes in its condition are located . I f the fl exor pedis perforans should be found to be punctured through , or necrotic , it should be reduced in such a way that

the rear frog surface in its center part is laid bare . I f we then h a see t at the navicul r bone also has been injured , or that the I canal penetrates still deeper, bore the canal out with a sharp scoop so that all diseased bony tissue is removed , even an

- coffi n opening of the navicular joint can , under antiseptic pre in cautions , be ventured this way , with no danger whatever .

' Very often we find , especially if the fl exor pedis perforans is intact , the inflammatory and suppurative process creeping along in the frog cushion , so that it is pierced by numer ous canals in the region of the plantar cushion and the cushion I an . d fossa These canals scrape out with a sharp scoop , eventually I place a drainage tube of rather large caliber through the fleshy frog, which is led into the operation wound and carried out by an opening through the fossa . The after treatment consists chiefly in a regular disinfection I subli of the wound . To obtain this object put on a moist d mate ban age , which can , if the course is normal , stay there from I 4 days to three weeks if necessary, changed every three or four days . d s I f an opening is made in the fossa for rainage purpose , the bandage must cover the pastern joint , and has to , in this n e n . case , b cha ged oftener The reason for the ecessity of frequent bandaging in such a case is not the drainage itself, but the fact that the drainage is conditional , as a rule , on the strongly secreting processes of the frog cushion , which causes a quick saturation of the bandage . I f there is but one wound made on the plantar surface of the

d n , hoof, one moistene sublimated ba dage reaching up to the I pastern is sufficient . L ately in such cases have simplified , the bandage so that I merely put a covering iron on it , and the space between the cover and sole I pad with absorbent cotton , while a few layers of cotton and bandage tours are put around 98 AN TI S E TI N P C TRE ATME N T OF WOU DS . the plantar cushion and wall to prevent an infection of the wound from behind . N o matter whether the bandage covers the pastern joint or

only reaches the pastern , or whether the covering iron is used , in every case I have the bandage moistened with sublimate water two to three times daily , during the first six days , one t half per cen , and after this , provided the course is normal , only once daily .

I f as these instructions are carried out precisely , the wound , a rule, heals after six weeks , and the patient can resume his

The work . only evil that cannot be prevented by antisepsis , is that , in some instances , (it is by no means the rule) , a painful I n ness is left in the new cicatricial tissue . this case neurectomy

I m . is indicated , as formerly stated when discussing neurecto y I m perform neurecto y in all cases of nail prick when , after the wound is healed , a painfulness , without any appear

nc es r a of inflammation (such as can be ecognized , or the miss ing of an increased artery pulsation) is present .

S E PTI C I N FL AMMATI ON OF T HE S OFT PAR T S OF T HE H OOF I N THE R E GI ON OF T HE S E N S I T I VE L AM I NA L ANTAR US I ON R OG A N D S OL E , P C H , F T R N T T OF T HE L E F F O FOO .

At the request of the owner a bar shoe was put on a horse ’s

o . foot . Shortly afterwards the horse commenced to g lame An examination showed a severe inflammation of the parts mentioned in the heading . Cooling bandages did not improve

I n it any . the course of two days the corresponding horn parts commenced to get loose , so that to check this process an operation had to be resorted to . The indications for the treat ment , therefore , were simply as follows

I — . Removal of all horny portions as far as they covered any infected soft parts . — 2 . Reducing as much as possible all infected , that is , ne crotic hoof matrix . — 3 . Careful disinfection of all wounds .

100 AN TI S E PTI C TR E ATMEN T OF WOUNDS .

e in . fact ent methods of castration , are v ry much reduced , can I be entirely avoided , very often perform castration , with anti septic precautions , with brilliant results . For reasons , speci fied in my special pamphlet regarding castration under anti septic precautions (German periodical for Veterinary medi

P . 1 I cine and comp . ath . Vol 4) did not exactly adopt BAY E R ’S modus operandi , but adhered to the following useful method for private practice :

T he horse receives , half an hour before he is laid down , five

h dr hl decigrams of Morph . y oc . subcutaneously to reduce the sensibility , which is to the interest of the patient , (preventing fractures), as well as the surgeon and the method . After the horse is placed in a dorsal position , the scrotum and vicinity

(penis , inner surface of thigh , are thoroughly cleansed e r d off with soap and water with a sharp brush , and th n inse with lot of sublimate water one to one thousand or two thou

The sand . testicle is then taken hold of with the left hand in the usual manner , and the scrotum opened with one incision ,

o 6 just big enough to all w the testicle to pass through , (from to 7 cm) . An assistant thenimmediately pours sublimate water on the protruding testicle; so as to make any possible appear

so - ing micro organisms harmless . Then the called mesentery of the testicles close by th e epididymis is pushed through the

r and cente with the finger , the two portions of the spermatic li ated ' b cord thus treated , are each g , y tightly fastened threads ff of sublimated silk . To prevent the slipping o of these cords the testicle is cut off so that a small piece of the epididymis is left on the spermatic cord . These ligated stumps do not ff a ect the antiseptic healing of the wound any , as they are E ’ (BAY R S statement) aseptic , and as a consequence become l . off simply resorbed After the igature threads are cut short , the scrotal cavity is again thoroughly rinsed out with sub

' ' the limate water , and then scrotal wound is sutured with from five to six sutures in such a way that the stitches commence ’

. about one and a half cm from the wound s edge , and simul

' n u l ta eo s y get hold of the common tunica testis . The same z I S procedure gone through with the other testicle , and then O E R ATI ON S WI TH AN TI S E TI R E AUTI N 101 P P C P C O S .

. the horse can get up Then , with the horse standing, the field of operation is again rinsed out with sublimate water and t e h tail tied up . The latter is important to prevent the tail from dirtying the wound .

T he disinfection of the instruments (knives , scissors , and needles) necessary for the operation is eff ected by simply dip

b o ping them in sublimate water every time ef re they are used . T he after treatment consists in merely letting the patient stand for six days , tied high , so as to prevent his dirtying or dragging the wound on the litter , and rinsing out the field of

operation daily once or twice with sublimate water . A bandage

as or suspensory is not put on , an occlusive bandage on the

horse in this region is impossible . Besides , a dry scurf forms

on the wound shortly , which keeps the wound closed . I n the course of the next two days oedema sets in in the vicinity of the penis , which disturbs the circulation some , but is of no importance . This disappears quickly when the pa a tient can t ke exercise again , which is about six days after the operation . Occasionally fever sets in on the second day after the opera

8 0 re tion , which rises even to 39 c ; however , this is a simple m ff sorption fever, which ainly di ers from the consecutive sep tic wound fever , for the patients are lively and eat their food heartily , while the latter form of fever is always associated with the general symptoms of loss of appetite , depression , dis inclination to walk , etc . , etc .

We may also mention as a complication , which , however , seldom delays healing, those hemorrhages which set in after E the horse arises from the operation . BAY R mentions s this accumulation of blood into the scrotal cavity, and think it to be the blood which flowed into this cavity during the

operation , but according to my observation this haemorrhage originates from the veins that are cut through when the scro

tum is opened , and which are located between the common D tunica and the dartos . uring the operation , on account of the dorsal position of the patient , there is no recurrent mo ff tion in these veins , which , however, comes into e ect imme 102 AN TI S E P TI C TRE ATME N T OF WOUNDS . diatel t . y when the horse ge s up As stated , this haemorrhage , t h which does not always take place , in erferes wit healing per primam intentionem only when it is profuse , so that the wound ff edges are forced apart by the pressure . Blood e usions , up to ’ I f ar t . the size of an infant s head , e resorbed withou any harm ff a profuse e usion of blood follows , so that a healing per not primam intentionem is expected , the sutures are removed

or on the fourth fifth day , the scrotal wound is made a little larger, and the healing with granulation follows , upon a daily rinsing out of the wound with sublimate water , in four weeks I at the latest . A noteworthy fact which noticed was that even in this healing per secundam intentionem s uppuration never took place . I have castrated in this manner twelve horses of various on E types , from the p y up to the Hanover race , nglish full the : blood , and heavy Belgian , and gained following results

Seven times healing per primam intentionem on both sides ,

er twice on one side , and three times p secundam intentionem ,

- - 1 6 2 . so that out of twenty four wounds , or 3 per cent I h f r healed up per primam intentionem . cannot record t us a ff any losses or after a ects ( spermatic cord fistula , peritonitis ,

T o pacify anxious minds , who may think that tying up the

spermatic cord with two ligatures of sublimate silk , which are

the / os s ibl in left there , y p y act as foreign bodies and produce an

fl m m ator I a y process on the spermatic stump , may state , that ff disinfected silk heals in as well as catgut , the only di erence I being that silk does not get resorbed . noticed in a post mor I tem I held on a horse that died from colic , and which cas

trated the year previous , that the ligatures on . the spermatic h stumps were smoothly healed in , wit out any trace of reaction

in that vicinity . CON D YL OMA ON T HE PR AE PUT I UM OF THE H OR S E R E MOVAL—H E AL I N G PE R PR I MAM I NTE NT I

ON E M I N S I X DAYS .

' ’ A heavy Belgian work horse had a wart the size of a dove s

egg on the point of its prepuce , which on account of its

104 AN TI S E TI R P C T E ATMEN T OF WOUNDS .

a I f used later as cover for the amputation stump . possible we must try to make the cuts so that the vertebral column of

the tail is severed through a symphysis . The n I s o ly cut vessel tie is the middle tail artery, by mean of sublimate silk ; the side tail arteries are secured by uniting the above mentioned flaps with sutures . After the surface of the wound has been well rinsed with I sublimate water , sew up both flaps with sublimate silk , mak ing the sutures as closely together as possible .

An after treatment is hardly necessary, as healing takes place Th . e I . promptly sutures , also , hardly ever have to remove E I xactly as described above proceed in dogs , as in the latter , on account of their licking the tail and hitting it against the the cage , more haemorrhage , even necrosis of end of the

I n : . I tail , takes place rare cases noticed in dogs , that after

off simply chopping and cauterizing the tail , a connective tissue proliferation formed on the amputation stump , which ’ m c fi reached the size of a child s fist . Whether this was a y o

I d as I not ver h broma leave undeci ed , did make a v thoroug I examination , as at the time when noticed these things the term m ycofibrom a was unknown .

H CAS T R AT I ON OF OR S E S I N CI T Y P R A CT I C E .

%I n this country. a great m ajority of the horses are cas trated f as colts before they are o fered for sale on the city marts ,

o and therefore the city practitioner does not , prop rtionately , perform as many of the s e operations as the country veterin

ut arian . B when we seek information from this source or

- oo horectom ist from the non professional p , we do not hear of methods that would inspire con fidence or that we would be ‘ justified in adopting in city practice in view of the present I n knowledge of septic processes in wounds . fact we learn that the operation is usually performed without regard for the d dangers of wound infection and its consequences , or inary cleanliness of the instruments and the meager use of some an tiseptic liquid being the only precaution used to prevent sep ff tic sequelae . When called to task for this condition of a airs , O E R A P TI ONS WI TH AN TI S E PTI C RE AUTI ON 105 P C S .

we are told that the mortality is not great and that the time , trouble and expense of the task of operating under strict o asepsis cann t be expected in the face of the small remu nera tion allowed for the operation . But the fact that death is a possi bili ty is suffi cient reason fo r the general adoption of better methods , which , if carried out , would soon result in the passing — , of the non professional castrator and subsequently in better

remuneration for the educated and skillful surgeon . I n any

event , if the veterinarian of the large cities operated in the n same careless manner , the mortality would be alarmi g . D uring the last few years the high price of carriage horses has resulted in bringing many trotting bred stallions to this market (Chicago) to be castrated and sold for the above pur lot pose , and it has fallen to my , from time to time, to Operate on a large number of such animals . The stables in which they are kept are never free from the usual infectious respiratory

s o o diseases common in the Chicag Horse Market , and it has by no means been an uncommon occurrence for recently cas trated c a s animals to contra t such diseases as early the first, second or third day after the operation ; and besides this nu pleasant feature the stables are in close proximity to the

a slaughter houses , fertilizing f ctories , hair fields , glue factories , the dead animal platform and the open sewer (the Chicago

River) . Confronted with such circumstances , the castration d of valuable adult horses was always a hazar ous undertaking,

s c and after fighting with epti processes in a number of cases , I adopted the following method which thus far has given flat tering results , and in spite of the fact that a number of animals operated unfortunately contracted various asthenic diseases of the air passages before the healing process was complete , no deaths have ever followed . I provide myself with the following equipment force t 2 (a) Scalpel , ecraseur , a slender grappling p abou t decimeters in leng h , and a sponge , all of which have been ster ilized by boiling and conveyed to the place of operation in a sterilizer or wrapped in a sterilized towel .

(b) Mercuric chlorid triturates . 106 AN TI S E P TI C TR E ATME N T OF WOUNDS .

(c) Carbolic Acid , 95 per cent . I ( d) odoform powder .

f rm 0 (e) An emulsion consisting of Thio o 3 grams , Sodium

0 2 0 . bicarbonate 3 grams , and Glycerine 4 grams (f) An ointment consisting of Thioform or I odoform I 5

2 0 . grams , and Lanolin 4 grams

(g) A large clean tray for the instruments .

(h) Clean metal pails for the antiseptic solutions .

(i) Casting harness and twitch . The Operation : — I st S tep The animal is placed in the dorsal position , the

% s legs well parted and the crotum , sheath , penis and posterior abdominal region energetically scrubbed with soap and hot

water, and then sponged for a time with a solution of mercuric

- 1 200. chlorid , — 2nd S tep The scrotum is dried moderately with the steril

ized sponge and then sprinkled with iodoform powder, which

is rubbed in well until a dry crust results . — 3rd Step The testicle is then exposed by an incision as n small as possible , and now instead of graspi g it with the hand T he it is pulled from the scrotum with the forceps . ecraseur m chain , without per itting it to touch the hands , is passed over the forceps and testicle and adjusted to the proper place upon d f the spermatic cord . When the cor is su ficiently crushed , twist the testicle off with the forc ep before loosening the ecra

t sen . Hold the cord in the center of the wound with the ecraseur and pour 1 20 grams of the emulsion into the scrotum

and disseminate it by circular motions of the ecraseur , which

is still holding the cord . — 4th Step The ecraseur is now loosened and placed in a tray

I O . containing a per cent solution of carbolic acid , where the

force . in scalpel , sponge and p have been previously laid As the

ru m ents s t were aseptic , it was not necessary to place them in

such solution for the first testicle , but as they have now been in

contact with the hands of both the assistant and surgeon , their

disinfection is very essential to insure success . — sth Step Remove the opposite testicle in the same manner

108 AN TI S E TI TR E A TM P C E N T OF WOUNDS .

legs together above the knees , remove the leg to be operated u f o pon r m the hobble , tie a strap around the foot and draw it forward to tense the tissues of the leg in their natural posi tions relative to each other ; clip , or , better, shave , the hair a r from the field of operation , wash it well with so p and wate ,

‘ l n rinse it with a three per cent . so utio of carbolic acid , then , one with sterilized instruments and hands , make an incision n inch lo g just below the fetlock over the nerve , take it up with

o e a ho k , dissect it out carefully, giv it gentle traction down w ff ards , to stretch it a little and cut it o as close as possible h to the upper end of the incision , t en catch the lower portion with the artery forceps and roll it downwards with consid e crabl force so as to remove as much of the nerve as possible , N ow taking out at least an inch and a half . pour into the wound a little of a one per cent solution of bichloride of mer cury ; after letting it soak for a minute lay a piece of absorbent cotton over it and bandage temporarily . Turn horse over and repeat the same details on the other side after removing the n bandage . After rinsing both wou ds again with the bichloride

o lotion , apply a dry dressing of p wdered boracic acid and iodoform in equal parts with a piece of absorbent cotton large enough to reach around the pastern and bandage rather tight l Do y so as to press the edges of the skin together . not touch th e it till the 4 day , then if the op ration was well done , union will have taken place without visible granulation .

I f e a - fifth ther is any suppuration , rinse it out with one per cent solution of “bichloride and do it up again with the dry r dressing . After removal of the section of the ne ve a stitch may be taken in the skin if the surgeon prefers . During the operation if there is haemorrhage enough to be u inconvenient mop the wo nd with wads of absorbent cotton , I n never with a sp onge . about two weeks the horse is ready for work with no lasting evidences of the operation but a white line that becomes hidden by the hair .

E AT R AB S C E S S I N THE L V O H UME R I . A tumor containing a small deep seated abscess oftenoccurs r s in the levator hume i ju t above the shoulder joint , that , in O E RATI ONS WI TH AN TI S E PTI E N 109 P C PR CAUTI O S . its ou t acute stage , is large , hot and painful , and is often cut Ai bodily by stupid surgeons , which nearly ruins the muscle . ter poulticing it for five days clip off the hair and make a punc ture into the center of the tumor large enough to insert the index finger . An abscess will be found there containing from o f one to f ur drams o pus . Rinse it out with a one per cent s olution of bichl oride of mercury for three or four minutes and pack it with a pledget of clean oakum to maintain drainage . Poultice it for about five days with linseed meal soaked well in boiling water, dressing it once a day . The horse will usually be ready for work in 2 or 3 weeks .

Other abscesses may be treated similarly, omitting the poul to —fifth tices , and reducing the strength of the bichloride one per cent after the third day , without any suppuration during the filling of the cavity and resolutions of the inflammation .

H. B. A . ] AN TI S E PTI C TREATMENT OF WOUNDS .

INDE X.

Ab sc ess in the L evator H um eri Acetic Alu m ina Acidu m S ulphu ricu m 44 Acidum S u lphu rosum

Actinom ycom a in R egion of Parotid Gland of B-ull

’ A m putation of Cow s H o of Angerer Pastill es Antiseptic Mode of T reating W ou nds

Antiseptic Outfit for Practice .

Ase s s An se s s and s n ec o n. p i , ti p i Di i f ti Aseptic Fever

Atherom a on False N ostril of Filly

anda e D r B g , y Banda e Mo s g , i t anda e Mo s Oc c u s e B g , i t l iv Bandagm g Material s B enzoic Acid Bism u thum S ubnitricum B oric Ac id B 0ric Water ’ B urnett s Dininfecti ng Flu id

C am phor Gruel am ho S r s of C p r, pi it Carbolic Ac id Carbolic S pray Carbolized S ilk Castration of S tallion Castration of H orses in City Practice C atgut h o d Me cu ic C l ri , r r

1 12 AN TI S E PTI C TRE ATME N T OF WOUNDS .

I odoform S ugar I odoform T annin I odol I rrigation w ith Antiseptics

un e Oil of j ip r,

Kaliu m Hyperm anganicu m Kangaroo Tendon

nee o n o f r e L b u a ed Wound on I nne S ide of . K J i t H o s , o l t r

Li ster Method L obulated C ontus ed W ou nd on I nner S ide of Knee J oint of H orse 80

Material for Operation with Antiseptic Precaution Mercuric Chlorid M crobes n of the i , Killi g M c obes R em ova of the i r , l a Moss, Mos sp p

Nailprick Naphthalin N aphthalin Powder N aphthalin S alve N aphthalol N eurec tom y N eu ec om h lan a r t y, Hig P t r N eu rectom y of the Tibial N erve

0aku m Oc clusive B andage Oil of J uniper Oil of Tu rpentine Oleu m E ucalypti Open W ound Treatm ent Operations w ith Antiseptic Precautions Othaem atom a in the H orse n h oic A cid A and Oxy ap t , B

Peat ea Ge m an P t, r e v s S u e fic a and Mu scu a Wound of P l i , p r i l l r Peroxyde of Hydrogen I N D E X . 113

Picric Acid Pinus Palustris Potassium Perm anganate Prefac e

es ec ion f od R t o B y of I nferior Maxilla of a D og on Account o f Fracture R esorcin R esting Plac e of the Patient

Salicylic Ac id S alicylic Wadding S alol S and S awdust S epsis S eptic Fever S eptic I nflam m ation of the S oft Parts o f the H oof S ilk “ S outhe n ine S ha n s of r P , vi g S pirits of Cam phor S ubli m ate S ublim ate Glycerine

' S ublim ate Triturates S ublim ate Water S ubnitrate of Bi sm uth S u gar S ulphate S alts S u e ficia and Mu sc ula W ou nd of e s p r l r P lvi a S utu ring and L igature

T em perature o f the B ody Tendon and Sh eath of T endon W ound on Hind L eg of H orse

' Tho ac c Wa l on used W ounds on r i l , C t r n in o Thrush with L aying Open of S oft Pa ts o H d H ofs . T hym ol

n ou nds An s e ic Mode of Treati g W , ti pt

nde t D r S cab . i T reatm ent U r he y , Turpentine en ne Oil of Tu rp ti , 114 A NTI S E PTI C TR E ATME N T OF W0UNDS .

Vic inity of the Wound 21 - 52

Wadding W ood W ool W adding W ound Th , e W ou nd Trea m en O en t t, p

‘ W ound Trea m e n s w ith the Occ lusiv-e an a e t t , B d g W ounds E am na ion of , x i t . W ou nds The r e a a on for O era on , i Pr p r ti p ti

Zincum Oxydatu m

‘ Zincu m S ulfocarbolicum