itself under two principal aspects : ist, under the form of rods {baton-
nets) or of threads, more or less long and mobile; 2d, under that of
germ-corpuscles. A completely developed adult is killed by the oxygen
of the air and by that which liquids hold in suspension ; but the spores
are not at all affected by this agent. If the septic elements contained
in liquids or solid matter forming a coat of a certain thickness, are
exposed to the air, notwithstanding the action of oxygen, the vibrios
concealed in the depth of this coat multiply and develop spores — the
*' vestals " of septic virulency — in spite cf oxygen and most micro-
bicide agents. It is these spores confined in septic matters which
constitute the agents of contagion ; after desication and disaggregation.
of this matter, they form the septic dust, the seed which transmits every-
where the dangerous infection.
Fresh virulent serosity energetically resists antiseptics. The most
powerful of those seems to be sulphurous acid. Permanganate of po-
tassium, I in 20, only attenuates the virulency. Corrosive sublimate, i
in 1000 or I in 500, is without action upon it. Carbolic acid, 3, 2, or even
I in 100, destroys the dry virus after six hours' contact. Putrefaction
kills it also. But matter dried between 15-38° C, before putrefaction
takes hold of it, preserves its virulency for years (Chauveau &: Arloing).
The already old experiments of Billroth, then those of Jeannel and
Laulanie (1885) have shown that septic elements do not pass througii
granulating membranes. Wounds entirely covered with intact granula-
tions are protected from septicaemia. They can be sprinkled, with im-
punity, with septic liquids, even covered afterwards with a dressing,
and not be infected ; and though they absorb a certain quantity of
ptomaines, no serious symptoms of poisoning appear. But, should the
granulating membrane be chafed and the barrier that it forms be re-
moved from any place, no matter how small, the condition is realized
for septicaemia. The vascular apparatus, when perfect in the consti-
tution of the walls of its numerous canals, is not very favorable ground
l80 VETERINARY SURGICAL THERAPEUTICS.
to the development of the septicasmic process. One may inject with
impunity into the veins of a susceptible animal filtrated septic serosity,
free from its figurated elements and containing only ptomaines (Chau-
veau & Arloing). Although serosity, not filtrated, injected in rather
large quantity, produces death with generalized lesions, which are par-
ticularly marked in the serous membranes, small doses of this serosity.
do no harm, providing the vascular walls have no solution of continuity
to allow the irritation of the septic germs into the tissues ; but if a sub-
cutaneous trauma is started in an animal in which virulent serosity has
been injected, a septic center appears at the injured spot. We may re-
call the celebrated experiment of the double-twisting (bistourage)
made by Chauveau (1868), always repeated with the same results: the
testicular traumatic center produced after the injection of the septic
corpuscles into the general circulation became invariably the starting-
point of a fatal septicEemic process.
The smallest solution of continuity may be the starting-point of sep-
ticaemia ; it occurs, however, always by preference on extensive and
deep wounds. Its appearance is singularly excited by the contused
condition or the ischsemia on a large surface of the injured tissues by the
presence of cul de sacs, or anfractuosities where oxygen has difficult access,
or by the presence of blood clots, of small spots which will gangrene or
are already mortified. Even in recent wounds septiccemia has little show
when the injured surface is widely exposed to the action of air, especially
when it is submitted to continued irritation with aerated water. In
those conditions the septic vibrios which mark its surface are destroyed
by the oxygen and the spores remained inactive (Pasteur).
Independently of puerpei'al sepiic(£7?iia, which is a streptococci in-
fection (Chauveau), there are traumatic septicaemias which are not due
to the bacillus scpticus gangreiice. These infections are produced
by micro-organisms — some of which are known (streptococci, bacil-
lus of Novy), while others remain to be studied. We wish only to
mention them.
Gaseous gangrene, more or less rapid in its progress, is announced by
phenomena which mark it well. The suddenness of its invasion ; the se-
vere phlegmasia which takes place round the wound and spreads rapidly
in all directions ; the cedematous circle which binds it ; the progressive
mortification and the putrefaction which follow it soon ; the foetid odor
exhaled from the septic center ; the hyperthermia and the other gen-
eral symptoms, form a clinical picture which cannot be mistaken for
any other, at least in horses, and in most of the other species. Except-
ing the tumor of symptomatic anthrax, which cattle have, all the other
inflammatory, crepitating tumefactions observed in animals and pro-
duced by different microbes have in common, together with septic
swelling, only crepitation.
SURGICAL SEPTICAEMIA — TRAUMATIC GANGRENE. l8r
The prophylaxis is based upon the data of clinic and experimen-
tation. We do not fear any longer this infection in the wounds of op-
eration when those are made under the cover of asepsis, sewed up after-
wards, and covered with a closing dressing. It is not much to be
feared in wounds of operation which are exposed (castration), when the
operation has been cleanly done by avoiding the soiling of the trauma
with the hands, the instruments or other objects used. What is espe-
cially dangerous, as we have said, is not the air, as it was believed by
the promoters of antisepsis, but "the dirt" that the surgeon, careless
or unclean, carries into the tissue during the operation. The virulency
â– of the septic matter deposited upon instruments resists the action of
•disinfecting solution, so that to destroy it with certainty they must be
sterilized by heat. (See Antisepsy.)
The wounded should be placed in well-ventilated and clean-kept
places. Gangrenous septicaemia occurs almost always in recent acci-
dental wounds, not yet protected by the granular coat, or in contused
traumatic lesions, anfractuous, and soiled with dust, earth, mud, and
manure ; and those are the ones which require good watching ; they are
those which demand especially the most minute disinfection and the free
antiseptic irrigations. Drainage and iodoform plugging are very useful
for deep traumas which, in certain regions (chest, axilla, groin, per-
ineum), extend deep into the cellular layers infected with blood and
serosity where the germs of the frightful gangrene collect and multiply
with a fearful rapidity. The researches of Forgue have taught us that
iodoform is the surest agent for destroying them. One should prevent
the gatherings into the center of the wound — into its shallows and its
out-of-the-way corners — of clots of blood and of secreted liquids ; wash-
ings with solutions of carbolic acid, permanganate of potassium, iodine,
and chloride of zinc should be made. Concentrated alcohol and the
tinctures have been advised to create, on the surface of the wound, by
the coagulation of the albuminous liquids, an isloating coat imper-
vious to septic liquids. The strong^solution of carbolic acid acts in the
same way. Continued irrigation or washes frequently made take away
the products of the secretion of wounds, interfere, by the action of ox-
ygen, with the evolution of the vibrios, and prevent their entrance
into the tissues. Sometimes injection appears in wounds already old
and protected for a long time by a layer of granulations when they have
been opened by an incision or by tearing; therefore, injuries to these
granular covers must be avoided as much as possible.
When septicaemia has appeared, so that already the wound is sur-
rounded by a tense swelling, crepitating, and oedematous on its borders
— what means are to be used? In veterinary as in surgery for man-
kind the disease is said to be incurable and all therapeutics useless.
But as serious as gaseous gangrene may be, when it has not yet ex-
l82 VETERFNARY SURGICAL THERAPEUTICS.
tended over a large surface, where it is limited to a region regular in its
external conformation and formed of muscular layers, when its evolu-
tion is not "fulminating," and when the organism is not seriously intoxi-
cated, art is not disarmed ; a powerful intervention may yet be fol-
lowed by success. It must be acknowledged, however, that the number
of recoveries has been exaggerated, by reporting, under the name of
" septic gangrene," oedematous or crepitating tumefactions which had
nothing septicaemic in their nature.
Every subject affected with septicaemia must be placed in a place
where the air can be frequently changed and where the fioor and walls.
can be sprinkled with disinfecting volatile liquids : the antiseptic vapors,
will spread in the air, penetrate into the organisms by the lungs, and
may act favorably against incipient intoxication.
Excision of the aseptic tissues with the knife is a process that we da
not recommend. It is always difFcult, and often impossible to mark
the correct line of demarcation ; the w^ound thus produced has often a
great extension and depth ; and no matter how large the ablation may
be, there almost always remains an infected zone, the ground occupied
by the bacilli extending beyond the marks made by the surgeon. Inter-
ference should consist in deep, numerous scarifications made on all the
contaminated surface and a little beyond its outlines. The cautery is
to be preferred to the bistoury to make them. These scarifications allow
the escape of putrid liquids and gases accumulated in the sphacelated
parts, and of the serosity gathered in the oedematous region. After-
wards should follow, several hours apart, antiseptic injections of a:
strong solution of carbolic acid, corrosive sublimate, or permanganate
of potassium, which, thus carried directly into the bottom of the infected
tissues, may arrest the pullulation of the septic agents. A long trocar
may be used to make them penetrate deeply. The entire surface of
the gangrenous center must also be irrigated with the disinfecting liquid..
Trasbot finds the best local treatment of septicaemia in cauterization
in points quite large and deeply penetrating into the septic swelling,
with injections of tincture of iodine two or three times a day into the
points, and iodine coatings painted with a brush over the invaded
region. Many times has it been " very efficacious '' in one of the most
dangerous forms of traumatic gangrene.
The introduction into the circulation of the toxic substances elaborated
on the gangrenous surface produces an increasing depression in the pa-
tient. If it is yet willing to take liquids let them be added to these diffusible
stimulants (wine, alcohol) or antiseptics (cresyl, carbolic acid, camphor,,
tannin, cinchona). If not, those medicaments should be administered
through the rectum. Cresyl, naphtaline, and subnitrate of bismuth
are useful in septic diarrhoea. Subcutaneous injections of ether or of
caffeine should be prescribed if the heart is weak.
PUTRID INFECTION— CHRONIC SEPTICEMIA. 183
In cases where the diseased process is recent, there is some hope of
recovery ; but as soon as an extensive territory is invaded by the
bacilli, the infection is generalized, and the organism deeply intoxi-
cated, there is no agent that can arrest the progress of septicaemia.
Local disinfection, tonics, and diffusible stimulants administered in-
ternally, only extend by a few hours a useless fight. By the extreme
weakness of the subject, the depression of the pulse, the coolness of
the body, it is easy to see that death is approaching.
The researches of Chamberland and Roux have shown that it is pos-
sible to give animals immunity from gangrenous septicaemia, by inject-
ing into them a sufificient dose "of a completed culture of septic vibrios,
freed from all the microbes which have proliferated ; that is, by having
been heated to 110° for 10 minutes." This is a peculiar fact of the
method of vaccination with soluble substances. The continued action
•of heat and of antiseptics upon the virulent pus furnished by tritura-
tion of the muscles of an animal killed by traumatic gangrene, has also
given to Cornevin vaccines capable of freeing animals from this disease.
But the duration of the immunity lasts only from fifteen days to a
month. On this account, these means of giving immunity have not
been used outside of the laboratory ; they are without practical ap-
plication
PUTRID INFECTION — CHRONIC SEPTIC/E.MIA.
Under the names of putrid infection, chronic septicccniia, and putrid
intoxication, have been described complications of traumas, and morbid
conditions which are variable in their characteristics and their progress,
and remain still doubtful as to their boundaries and nature. Putrid
intoxication differs from septicaemia and purulent infection ; it is not
accompanied, like the first, by gangrenous phlegmasia of the peritrau-
matic zone ; and at the autopsy of those that die with it, metastatic
abscesses are not found disseminated through the organs, as in the
second. Complication of large suppurating or gangrenous wounds, it
seems due especially to the absorption of putrid liquids, and of soluble
poisons accumulated on the wounds. Colin proved this experimentally.
In some cases, at the same time that the ptomaines are absorbed, the
organism may be invaded by microbes of various species and virulency :
micrococci, staphylococci, and bacteria. Putrid intoxication has a
march more or less rapid. According to the quantity, the degree of
nocidily of the toxic products, and the pathogenous activity of the
micro-organisms which have entered the blood vessels. It may kill in
a few hours, even in twenty-four hours ; but, ordinarily, it proceeds
more slowly, and in its principal clinical characteristics differs little
/rom pyohaemia.
'Vhe prop/iy/actic traztinent demands the same means as that of puru-
l84 VETERINARY SURGICAL THERAPEUTICS.
lent infection. Putrid intoxication has, moreover, become very rare,
since the era of antisepsis. The extensive purulent centers, the bur-
rows, and the underminings where pus decomposes and putrefies, should
be frequently cleansed and irrigated with strong disinfecting solu-
tions. If the matter secreted by the wound is retained on account of
its disposition, enlargement of the wound and counter-openings should
be made with the cautery, and perfect drainage secured.
As soon as the first indications of putrid intoxication are present
more care must be given to the traumas, disinfecting irrigations must
be repeated, nebulizations or baths increased, as the region permits.
If this is large and extended, its superficial layer should be destroyed
•with the red-hot iron ; in this way, an obstacle to the absorption of the
putrid poison will be established. On wounds that suppurate freely,,
one should use absorbing and antiseptic powders : coal, coal-tar, cresyl>,
tannin, alone or mixed with iodoform. There should be administered
internally, tonics and stimulants (sulphate of quinine, carbolic acid,,
salicylic acid, creolin, alcohol, hay teas). When animals have no
diarrhoea, according to some veterinarians, it is well to cause one, ia
order to hasten the elimination of the absorbed toxic matters.
IX.
TETANUS.
This toxi-infectious disease, frequent in horses but rare in the other
animals, is produced by an anacrobiotic bacillus — the bacillus of Nm>^
la'ier — which penetrates into the organism through a solution of con-
tinuity and gives birth to poisons, whose action upon the nervous
centers promote tetanic convulsions.
Up to our time, there were recognized : i, -x traumatic tctaniis,\\^\\v\^^
a wound for starting-point ; 2, a spontaneous tetanus, able to appear in
the absence of a trauma. This old conception of the duality of tetanus
still has advocates in both medicines. Facts are adduced in its favor
to the effect that the disease has made its appearance without being
preceded by a visible lesion of the tegument which would permit the
passage of the tetanigdnous agents ; but these facts are far from pos-
sessing the value attached to them. If, indeed, the specific bacillus
has a marked predilection for deep, anfractuous traumas, with bruised
borders, ischaemic or gangrenous, there are other ways of entrance which
jnay remain easily overlooked ; such as the superficial wounds of the
skin, concealed by the hair, so common in regions in contact with the
harness or on the extremities ; such as the lesions of the velvety tissue^
â– which occur in the median lacunas of the frog when this is thrushy, or
at the commissures of the plantar sole, when there is a loose portion oF
the wall ; and such as the wounds of all kinds developed on the mucous
TETANUS, 185
membranes. And when tetanus appears, the trauma, which has permitted
the passage of the pathogenous agents, can be entirely cicatrized. For
these reasons, the numerous observations of " spontaneous tetanus " col-
lected in the past and those that are reported in our own day cannot be
seriously opposed to the results of experimental researches, wiiich have
shown, as irrefutable, the demonstration that tetanus is always traumatic,
always inoculated and always microbian. Without a wound and without
the Nicolaier bacillus there is no tetanus. There is no occasion to make
exceptions for the cases of " tetanus consequent upon a contusion ; " in
these, either there has been, on the surface of the injured part, destruction
of the epidermis and introduction in that place of the specific elements
through a lesion to all appearance closed, but in reality open, or the
disease has had for its starting-point another solution of continuity,
cutaneous or mucous, which remained unseen, and the incriminated
contusion is only an incidental accident, having no relation to the
tetanic complication except that resulting from their coexistence.
Enzootics of tetanus have no other cause than the microbe, the trauma,
and the cold, which promotes its infection. If the Nicolaier bacillus
is the efficient cause of tetanus, some etiological factors noted by old
observers remain as adjuvant causes of infection. Powerless to pro-
duce the disease, they diminish the resistance of the organism, and
although their mode of action may be obscure they do not the less
render the soil favorable to the development of specific germs. The
most efficacious of these occasional causes is damp cold. Numerous
are the facts collected in veterinary medicine, which show the disastrous
influence of a damp and cold atmosphere. Those related by military
surgeons are still more convincing than ours ; sometimes, there have
been counted by hundreds cases of tetanus in wounded animals exposed
to the cold of night. In the polyclinic at Vienna, Roll has seldom
observed isolated cases of traumatic tetanus; he has seen it almost
always in several animals at a time. We have made the same observation
at the clinic of Alfort. Months may elapse without a single case being
brought to the consultation, then a time arrives — almost always after
a lowering of the temperature — when several are seen in a week, even
a day, upon animals coming from different localities. One must
acknowledge, however, that the pathogeny of the disease is not entirely
elucidated, and that certain conditions of its etiology remain yet unknown.
The microbe of tetanus has been found in various media. It is
especially telluric : has for principal abode the superficial layers of the
ground, where it is found more or less abundant according to countries
and localities of the same region. It is very common in the northwest
part of the Paris suburbs ; more than three-quarters of the animals which
we have treated came from there. It is found in dust, hay, water,
dung, contents of the intestines, and on the surface of animals' bodies.
l86 VETERINARY SURGICAL THERAPEUTICS.
Kitasato has succeeded in isolating it in pure cultures (1889). It
is polymorphous ; sometimes it has the form of a regular rod (baton-
net) with blunt ends, or of a delicate rod, short and sporulated
(batonnet en battant de cloche), or of a spore. Under its bacillar
form it is very vulnerable, succumbs in a few minutes to the action
of a heat of 75°, or to the action of most antiseptics; but the spores,
which are constantly in tetanic matters, enjoy a great vital energy;
they resist the action of antiseptics and require a temperature of
105° and 115° to destroy them.
Vaillard and Vincent have observed that pure cultures of tetanic
bacilli or spores act only by the toxines that they contain. Not only the
microbe does not propagate in the tissues where it is deposited, but it
disappears rapidly, and if, before it is inoculated, it is deprived of the
toxine to which it is associated, the disease does not develop. It can-
not produce its worst effects except when acting with some chemical
substances or some ordinary microbes, especially the pyogenous.
Inoculated alone, it is rapidly surrounded and destroyed by phagocytes ;
in company with other micro-organisms, as it occurs with wounds in
ordinary circumstances, these attract the phagocytes, absorb their
activity and leave to the tetagenous elements all freedom to act. From
the wound where it is elaborated, the tetanic toxine spreads and arrives
in the blood vessels ; it fixes itself in the elements of the centers. The
nervous cells contain in their protoplasm groups of elements possessing
a special affinity for tetanic toxine, which they attract with great force;
once the toxine is fixed on these elements, it remains on them for a
long time and the lesions of the cells disappear but slowly. They take
place as long as the wound remains infected, as long as the microbian
pullulation lasts ; ultimately, it penetrates either in small quantity
(chronic tetanus) or in doses rapidly fatal (acute-tetanus). Thus are
explained the persistency and increasing severity of the symptoms.
The tetanic toxine gives rise to very different effects, according to
the doses in which it is injected. On this, we have (i) doses that
kill ; (2) weaker doses, which give rise to more or less serious dis-
turbances, but are not fatal ; (3) still weaker doses, allowing immuniza-
tion of animals without producing visible troubles.
In 1 891 Behring and Kitasato found that the liquids of animals
made refractory to tetanus by the injection of toxine had obtained
antitoxic properties. Those liquids (humours) contain an antitoxine
which may inhibit, render harmless, an enormous proportion of tetanic
poisons. The injection of a small quantity of serum renders animals
refractory to tetanus insensible to the action of a large dose of toxine.
It allows preventive and therapeutical interference. Kitasato having
found that antitoxine subsists for some time in the organism of the
horse, recommended already serum to treat the disease in that animal.
TETANUS. 187
Antitoxine is possessed of affinity for toxine and draws it away from
the nervous centers which it particularly prefers ; but it is without
action upon the toxine already fixed by the nervous cells. Recently
Wasserman has shown that tetanic poison loses also its toxic proper-
ties when it is mixed with the crushed cerebral substance of a healthy
animal.
All traumatic lesions can be followed by tetanus, whatever their
extent, depth, or serious nature may be. Observation has shown their
frequency after wounds of the lower regions of the extremities, of the
genital organs or of the head. Bruised, irregular wounds, gun-shot
wounds, those by tearings, crushings, those containing foreign bodies,
fistulae, pricks, burns, congestions, are peculiarly exposed to it.
In horses, the traumatic lesions which are most commonly followed
by tetanus are : Punctured wound of the foot by nails, corns, quitters,
interferings and wounds made by harness. In most cases it follows
deep, irregular wounds, involving tendons, bones, articulations and
nerves, or those containing a foreign body — splinter of wood, projectile,
metallic fragment, piece of leather or cloth, vegetal parcel or small
gangrenous stricture.
Wounds of operation, like accidental traumas, may be complicated
with tetanus (Jctanus of operation). It has been observed very often
after castration of males, the introduction of serum, various foot oper-