loose from their central extremity, continuously struck by the blood at
the very point where the circulation is still going on.
It is thus that, emboli or erratic clots are produced, which, carried by
the blood, go to produce infarction in the lungs, by obliterating the
small divisions of the pulmonary artery. Unless voluminous, aseptic
emboli give rise to troubles, not serious, beginning in hypera;mia and
ending in sclerosis of the thrombotic pulmonary territory. What
makes the gravity of traumatic thrombi, or of the emboli that get loose
from them or of the infarctions which produce them, is infection. Septic
or nialignaut emboli carry into the lungs infectious agents with various
virulency which give rise to metastatic abscesses or to centers for gan-
grene.
Voluminous emboli sometimes close a principal branch of the pulmo-
nary artery ; at others, they are arrested by the valvular cords of the
right ventricle. Whether aseptic or infected, they suddenly provoke
serious troubles, sometimes death in a few moments.
TRAUMATIC FEVER. I/I
When an important vein is enclosed in a traumatic center or included
in its walls, and by this fact exposed to thrombosis ; and when the
latter is already realized, one must insure the immobilization of the re-
gion, avoid explorations and useless pressures, attend to the correct ap-
plication of the dressings or necessary bandaging, and prevent the
phlogogenous action of the secretions of the wound and of the pus
upon the venous walls. Such are the general requirements. With pu-
rulent thrombosis of some superficial veins, immediate ligature, made
aseptically at some distance from the morbid center, is the surest way
to prevent infectious complications.
V.
TRAUMATIC FEVER.
The febrile reaction which occurs in subjects wounded and operated
upon is due sometimes to absorption, from the traumatic center, of
pyrogenous or septic substances (traumatic fever proper), at others, to
a secondary local affection or a diathetic determination, both provoked
by the wound (epitraumatic fever).
Ordinary traumatic fever appears, generally, the second or third day,
reaches a variable degree of intensity, according as it is aseptic or septic,
remains stationary for two or tiiree days, then gradually subsides, to
disappear from the fifth to the eighth day. After accidental wounds or
those from operations made in infected tissues, it often manifests itself
in twenty-four hours, the pyrogenous substances of the wound being
immediately absorbed. Although the fever is slight with traumas which
cicatrize by first intention, it is sometimes severe when the wounds are
extensive, deep and suppurating, and when violent inflammatory pheno-
mena occur, due to the presence of a body foreign to the wound, to a
necrosis, or a local gangrene. Any complication which occurs in a
trauma is, in general, indicated by a sudden ascension of the thermic
curve and an increase of the other phenomena of reaction. The theory
which explains traumatic fever by the absorption of the inflammatory
or septic products, to-day universally adopted, is based upon the fol-
lowing data : the puUulation on the wound of various microbes, in par-
ticular of the agents of suppuration, brings on the elaboration of pyro-
genous leucomaines absorbed by the tissues ;— with antisepsis, there is
no traumatic fever, or it is very weak ; when it is observed in wounded
animals whose wounds cicatrize by first intention, protected by antiseptic
dressings, or after subcutaneous lesions, it is almost always slight; — in
animals, septic traumatic fever is indicated by a hyperthermia of two or
three degrees ; in aseptic febrile reactions, the mercurial column does
not rise much above 39°. Notwithstanding the results obtained by the
well-known experiment of Claude Bernard from the deep puncture by a
172 VETERINARY SURGICAL THERAPEUTICS.
street nail made on a horse's foot and other researches of the same kind,
the part which the nervous system plays in the genesis of traumatic,
febrile action is secondary.
The prophylaxis of surgical fevers depends altogether upon antisep-
sis. With it we can, henceforth, screen our patients operated upon and
our wounded from those intoxications, considered in days gone by as
fatal, which result from the absorption of putrid liquids collected on the
exposed wounds or under the dressings. All operation on healthy
tissues, performed aseptically, ought not to be accompanied by other
than benignant phenomena of reaction and a moderate hyperthermia. If
it is made on inflamed, suppurating tissues, one should reduce to the
minimum the febrile manifestations, by minutely disinfecting the wound
and its surroundings (washings, baths) previous to the act of operating;
the diereses made with the red hot wire expose these lesions less to ab-
sorption of putrid matter and to intoxication than those made with the
bistoury. Nothing demonstrates more forcibly the influence of anti-
sepsis upon the degree of the traumatic pyrexia in animals than a com-
parison of the thermic curves taken upon subjects of an operation whose
wound had been covered with a wadded dressing, or with one of oakum,
not disinfected. We may remark, however, that even in operations and
dressings made as they should be, one does not always succeed in pre-
venting a somewhat marked elevation of temperature. At times, with
subjects whose general condition and the great functions are scarcely
disturbed, one will observe thermic ascensions which reach 1.5°, without
manifest complication from the wound, bat these cases are exceptional ;
general troubles are ordinarily in proportion to the hyperthermia ; and
when the mercury reaches 39.5°, it is wise to remove the dressing and
look. For the same reason, if the fever does not subside by the eighth,
or the tenth day, often, there is an accumulation of pus or of putrid
serosity in the wound, when a local gangrenous or necrotic complication,
has not already taken place. The irrigation of the trauma with an an-
tiseptic solution (carbolic acid.creolin or chloride of zinc) is sufficient to-
lower the temperature, sometimes to bring it back to a figure close to
normal.
W^ith exposed wounds, the same result may be obtained by disinfec-
tion, and free escape of the secretions, draining, and the use of absorb-
ing powders. The flow of the liquids being insured, if the fever con-
tinues to be high, all there is to do is to increase the antiseptic washings
and watch the surroundings of the wound ; sometimes the phlegmasia,
is very high, at others a phlegmon or lymphangitis is developing.
The internal treatment is that of fever in general. We generally
prescribe only slight purgative alkalines. Surgical fevers, however,,
being attenuated forms of putrid intoxication, it may be a good things
if they are severe, to have recourse to antiseptics and antipyretics.
TRAUMATIC ERYSIPELAS. 173
(salicylic acid, creolin, camphor, antipyrine). In some cases the weak-
ness and depression of the animals will have to be treated with stimu-
lants (coffee, alcohol, ether).
VI.
TRAUMATIC ERYSIPELAS.
Erysipelas is scarcely ever observed in animals. It is, however, an
infectious complication of wounds, produced by a streptococcus con-
sidered at first as a specific microbe. The infectious agent penetrates
the walls of the wound, reaches its cavity little by little, progresses into
the lymphatics, at times promotes phlegmous or local gangrenous acci-
dents, and may even produce serious general accidents, fatal serous or
visceral phlegmasia. Ordinarily, erysipelas is a complication of recent
wounds of the skin and of the mucous membranes; it is with contused
wounds, burns, and lesions resulting from some cutaneous diseases
(acne, eczema, follicular mange) that it is observed most commonly ;,
but any solution of continuity of the skin is favorable to its develop-
ment ; a simple excoriation is sufficient for its appearance. It also often
appears with wounds already granulating, when this protecting cover is
accidentally torn ; it is thus that erysipelas is seen with ulcers, suppu-
rating wounds, or old fistulas (auto-inoculation).
The pathogenous element has been isolated in man by Fehleisen..
]t is a streptococcus arranged in double chains, which grows well on
gelatine and on agar, where it forms whitish colonies. It does not
liquefy gelatine. Most barteriologists doubt its specificness, and claim
that it is the ordinary streptococcus. To this, it is objected that the in-
oculation of pure cultures of the streptococcus of Fehleisen promotes-
erysipelas with or without lymphangitis, while the ordinary streptococ-
cus engenders phlegmons especially. But it is now known that the
streptococcus, like many other pathogenous germs, may promote diverse
affections, very different troubles according to its actual degree of
malignity or of virulency. Very often the agent of erysipelas does not
act alone; it is associated with other microbes, most frequently with
staphylococci. The disease is contagious and is easily transmitted by the
hands, instruments, and materials for dressings. Before antisepsis, be-
fore the researches whicli have definitively proved its infectious nature,
it has frequently been seen prevailing as an epidemic in hospitals for
mankind. In veterinary practice, a great number of affections liave
been described under the name of erysipelas. The reading of tiie
published observations shows that under this title have been ranged:
the erythemas produced by the sun or the eating of buckwheat, the
cutaneous quittor, anthrax, rouget and even eczema. With the excep-
174 VETERINARY SURGICAL THERAPEUTICS.
tion of a few recent facts, all were falsely named, or they do not posses.-;
the stamp of exactitude demanded in scientific researches. No doubt,
however, erysipelas exists in animals. It is inoculable by subjects of
our domestic species ; Fehleisen has studied it experimentally on
swine and on rabbits ; Moller, Hoffman, and Lucet have seen it on the
horse ; Rychner and Lucet on cattle ; Frohner on dogs (4 cases only
out of about 70,000 patients).' We ourselves have seen it several
times on horses and in dogs. The principal characteristics of cutane-
ous erysipelas, since they are concealed by the hair, and, in the case
of the horse, by the pigment of the skin, are much less evident than in
man. That is why, in veterinary practice, it has been mistaken to this
day with phlegmon, lymphangitis or the septic processes. In general,
it seems less serious in animals than in man ; fatal cases, however,
have been noted in the case of dogs and solipeds. Upon the horse of
Lucet, erysipelas acted like septicaemia and killed it in forty-eight
hours.
The prophylaxis of erysipelas from operations is that of all infec-
tious accidents which may complicate wounds made by the surgeon.
Operate quickly, take all antiseptic precautions, protect the wound
against post-operatory infection. Those are the means. But it is not
so easy to prevent them with old accidental wounds, infected and sup-
purating. Although these can be cleansed, even their dressings re-
newed without tearing the granulations when they are enlarged or
treated with the bistoury, new roads of entrance are necessarily opened
to the micro-organisms. The chances of infection will be reduced to
the minimum by previously washing the granulating surfaces and ex-
cisii^g them with the red-hot cautery.
When the erysipelas is developed, the treatment must be local and
internal. If it is limited to the peritraumatic zone, tepid carbolic or
corrosive sublimate solutions, used as lotions, irrigations, baths or
nebulizations, according to the case, then followed by applications of
boricated or cocained vaseline, are almost always sufficient to prevent
its extension — often they have a beneficial action on the general con-
dition ; and soon the temperature lowers. The same treatment should
be carried out if there are phyctenes or lymphangitis. With erysipe-
latous wounds of the extremities, combined with lymphangitis and
diffuse swelling of the extremities, long antiseptic baths (solution of cor-
rosive sublimate, i in 1,000, or of carbolic acid 2 f/, are very advan-
tageous.
Phkgnionons erysipelas must be treated more actively. When a
severe oedematous tumefaction announces the inflammation of the sub-
cutaneous connective tissue, one must make, over the whole involved
1 Frohner, Herlin. Tliieiarztl Wochurschr, 1S94, p. 368.
PURULENT INFECTION — PYOII^MIA. 175
surface, scarifications or deep cauterizalions which permit the exit of
the inflammatory exudation and open to antiseptics admission to the
deep layer of the dermis, the subcutaneous region and the lymphatic
radicules where streptococci are niuuerous. As soon as fluctuation
indicates the presence of abscesses in the neighborhood of the wounds,
along the lymphatic vessels or in their glands, these abscesses must
be immediately opened and treated antiseptically. Diffuse swellings,
which sometimes occur on the legs, should be carefully watched, and if
the formation of deep abscesses is suspected they should be probed
with fine punctures. Scarifications or deep point firing, tepid antisep-
tic irrigations or baths are still the best means to prevent gangrene of
highly inflamed tissues ; if, however, sloughs take place, the treatment
should be completed by that for moist gangrene.
Complications of the viscera, of the large serous membranes, and of
articulations are treated by methods especially marked out for each of
those.
Slight cases receive for general treatment tonic douches, light
purgatives or alkalines. The other cases receive antiseptics, alcohol,
extract of cinchona, and sulphate of quinine, according to the species
under treatment.
vir.
PURULENT INFECTION— PYOH/EMIA.
Produced by the penetration of pyogenic microbes into the circula-
tion and their diffusion through the organism, purulent infection — â–
^yohcemia — is a complication of suppurative wounds. While septicae-
mia is ordinarily a precocious accident of traumas, pyohasmia is a late
episode of the same, but not the less dangerous. Likely to occur in all
species, particularly common in horses, rather rare in dogs, swine and
sheep, it is exceptional in cattle, goats and birds.
It may break out at any moment with extensive, deep, anfractuous
wounds, which suppurate abundantly ; with sinuous fistulas, having
several tracts which present necrotic lesions of synovial membranes,
tendons and bones ; with suppuration of the synovial membranes ; or
with suppurative inflammation of the veins or of the lymphatic trunks.
In horses, phlebitis of the jugular, poll-evils, disease of the withers,
tendinous quittor, purulent arthritis and synovitis, gangrene of the
tegumentary membrane of the foot and the caries of the as pedis are the
surgical affections which are mostly accompanied by it. Independently
of the ordinary purulent absorption, there exists in that species specific
pyoha;mias related to some infections (distemper, glanders). In
cattle, it has been observed as a complication of extensive suppurating
1/6 VETERINARY SURGICAL THERAPEUTICS.
contused wounds ; most commonly, it has as starting point several
external phlegmasias related to somt infection and carrying with itself
gangrenous or necrotic lesions (aphthous fever). The same thing occurs
in small ruminants. In dogs, its ordinary causes are complicated
fractures, crushings, and other traumatic lesions of the bones of
the extremities. In young animals of any species, more especially
colts and calves, it is almost always due to the suppurative inflam-
mation of the umbilical vein, phlebitis of the cord.
Its etiology consists in the existence of a suppurating trauma , several
conditions, however, inherent in this, in the wounded subject, and in
the surroundings, promote its development ; these are especially : the
depth of the wound, its anfractuous conditions, the underminings in
which the pus collects, the generally bad state of health, the heaviness
and the overworked condition of the patient, the want of ventilation
and defective hygienic surroundings in which the animal is placed.
Purulent infection is produced by the ordinary microbes of suppura-
tion, generally streptococci or staphylococci. The most constant of
those, the one that plays the greatest part, is the ordinary (vulgar)
streptococcus. It acts alone or in concert with staphylococci. It is
known that the latter possess various degrees of virulency, and that,
alone, they may give rise to pyohamia ; but cases of this kind are
rare. In three cases of purulent infection studied by us from the
bacteriological point of view, we have twice found streptococci and
once associated with staphylococci.
How do those microbes reach the blood ? By what mechanism can
they promote the metastatic abscesses and the other lesions of pyoha;-
mia? The mode of infection, very different in different cases, is ofteu
complex. With suppurative phlebitis, infecting emboli may get de-
tached from the intra-venous clot which is infected with pyogenic
microbes, and be carried by the blood into the lungs and other organs.
Within the walls of fistulous tracts, due to and kept up by necrotic
lesions (disease of the withers, of the neck, tendinous quittor), there
'exist phlebitis and lymphangitis from which the infection may start.
"Without phlebitis in old suppurating wounds the granulating surface
may be torn ; " the wound is wounded " in one place ; there the tissues
are no longer protected by their guarding cover, and the blood and
lymphatic vascular canals are open to the agents of suppuration. The
modifications presented by purulent infection in its mode of expression,
its march and gravity, are especially due to the variable virulency of the
microbian species which produce it.
The propyhlaxis demands the same general precautions as that of
septicaemia. It is by the wound that the pyogenic microbes penetrated
Into the economy ; so that careful attention must be given to the
'wound to prevent infection. With wide, deep, irregular wounds, one
PURULENT INFECTION — PVOH^MIA. 1 7/
Tiiiust avoid the stagnation of the pus. Frequent antiseptic washes and
•continued irrigation are the best means to use. Often enlarging
incisions, counter-openings and drainage have to be made ; though one
•ought, in a general way, to avoid the wounding of granulating layers ;
there should be no hesitation, however, if the case is urgent. The red
hot iron, a sharp or a long pointed cautery, is better than the bistoury :
the eschar remains adherent to the tissues underneath until they are
lined with granulations, the penetration of the micro-organisms cannot
take place as upon bleeding surfaces. The washings should be com-
pleted by irrigations with an antiseptic solution, sufficiently strong to
destroy the germs still adherent to the granulations.
For anfractuous wounds, carbolic or corrosive sublimate nebuliza-
lion are very advantageous. If they exist on the legs, long tepid anti-
septic baths of twenty minutes or half an hour and repeated several
times a day should be prescribed. Antiseptic or simply absorbing
powders may also be useful.
Attention to hygiene should not be overlooked : spacious, well
ventilated, moderately warm locality ; food of good quality : for weak
patients, if appetite remains, abundant feeding, milk, tonics, a stim-
ulant (alcohol, hay tea).
The outset of pyohsemia is slow. Often the wound is but little
â– changed ; the granulations are pale, soft, flabby, and suppuration is less
abundant ; but there is no other prominent symptom, no diffuse tume-
faction, no oedema. As to general disturbances, they are those of a
strong traumatic fever, with febrile rushes, chills, sudden thermic
risings, inappetency, dulness, a kind of typhoid condition with dull
coloration of the mucous membranes and an irregular pulse ; their mean-
ing is positive, even when the patient has been previously under the
influence of a more or less marked febrile reaction. To inspect the
wound, enlarge it, cleanse it well, sponge its cul-de-sacs with strong
disinfecting solution (chloride of zinc, carbolic acid, corrosive subli-
mate), dust it with iodoform and irrigate it continually with cold water.
This must be done at once.
Cautery is useful to destroy the fungus granulations which conceal
putrid centers, and to reach the infectious germs deep down. To try
to " render the wound aseptic," as advised by some, is evidently an
illusion ; but it must be purified as much as possible. If purulent
superficial collusions appear, they must be opened at once and treated
as ordinary abscesses.
The internal treatment, most uncertain in its results, consists in the
administration of agents able to build up the strength, impede the pullu-
lation of the microbes and neutralize the effects of their toxines. Among
the numerous substances recommended, those that are most used are :
alcohol, coffee, sulphate of quinine, carbolic acid, creosote, creolin, spirits
178 VETERINARY SURGICAL THERAPEUTICS.
of turpentine, and salicylate of soda. They are introduced niostlv
through the digestive mucous membranes (mouth, rectum), some br
hypodermic injections (carbolic acid, sulphate of quinine). U is better
to administer them under the form of rectal injections than by force
through the mouth. Lately, hypodermic and intravenous injections of
weak solutions of corrosive sublimate have been tried for man. While
the first proved insufficient, the intravenous injections (30 to 40 milli-
grammes of corrosive sublimate in 8-10 injections) by the method of
Bacelli, have given Kermarsky several successes. It is a method which
might be tried with animals. The patient should be kept up on tonics,
milk, hay-tea, and soups. If anorexia is present, nutritious rectal in-
jections should be given.
The same as for septicaemia, when already the organism is thoroughly
infected and intoxicated, whatever antiseptics nre used, and no matter
what is the dose or the mode of administration, the bacterians still
triumph. There is chance of success only at the beginning of the in-
fection. As proof of the possibility of recovery from pyoha^mia, facts,
it is true, have been mentioned in which, at the post-mortem examin-
ation of some horses, caseous purulent centers, disseminated through
the viscera, were found ; but a close study of these facts shows that
they were of tuberculous or glanderous nature, and due to chronic
purulent injection. We do not know that, up to this time, authentic
cases of the cure of confirmed pyohaemia in horses, as expressed by the
clinical signs which announce visceral infection, have ever been
reported.
VIII
SURGICAL SEPTICEMIA.— TRAUMATIC GANGRENE.
A fo'rmidable complication of traumas is surgical septicaemia, an
infectious, microbian disease, produced by the sc/Zir I'ibrio or bacillus
septic us gangrcnus.
All animal species are subject to it, but all are not equally liable ; and in
each species, all the individuals do not possess like aptitude to contract
it. It is most frequently observed in horses, less commonly in dogs,
swine, and ruminants ; among the latter, cattle are only exceptionally
affected.
Old surgery had clearly mentioned the condition in which traumatic
septicEemia occurs. It was known that recent wounds, contused, irreg-
ular, with crushed or sphacelated borders, were principally liable to
it. The dangerous influence of overcrowding, limited quarters, close
air, and atmosphere vitiated by agglomeration of the sick were all
recognized. It is nearly a century since Barthelemy and Dupuy made
the first experiments at Alfort to tl.rew light on the pathogeny of this
SURGICAL SEPTICyKMTA — TRAUMATIC GANGRENE. I 79
disease in the cases of horses. Iti 1840, Renault, after having insisted
upon the dangers of the exposure of wounded tissues, incriminated, as
conditions of its development, the presence in wounds of clots of blood,
of mortified tissues, of putrefied organic matter, and the contact of those
clots and of those tissues with the warm, damp atmosphere, loaded
"with the " miasmas " of putrefaction. After Bottini had demonstrated
its transmissibility, it was no longer disputed that the infection is car-
ried, especially to accidental traumas, not by the air, but by solids and
liquids, by contaminated objects, pus and putrid serosities, earth and
manure.
The researches of Chauveau and Arloing have established that the
septic vibrio of Pasteur is the agent of the gangrenous septicaemia of the
human and of the animal species. This anaerobiotic vibrio presents