threatens syncope.
When palpebral reflex has ceased and the pupil is contracted, sen-
sibility has disappeared and m.uscular relaxation is complete. If res-
spiration and circulation take place in a regular way, anaesthesia may
be continued for a long time without danger, by adding now and
then new doses of ether.
The operation ended, the hobbles are removed from the patient,
he is left to himself until he wakes and gets up.
In order to avoid the waste of ether, which is very volatile, the
apparatus of Junker, used by some to administer chloroform, has been
recommended. In its simplest form this apparatus consists of a
graduated glass containing the anaesthetic, and closed with a cork
perforated with two holes, through which are introduced two bent
glass tubes. One of these, dipping in the liquid, carries on the other
end a Richardson bellows (s) ; the other tube, which is shorter and
does not reach the liquid, carries at the other end a pear-shaped ball
(r), which is introduced into the nostril. (Fig. 27.) As soon as the
Richardson bellows is squeezed, air is pushed into the liquid and
loaded with anaesthetic vapors and bubbles, and is carried to the
respiratory organs, without waste, through the other tube. Narcosis,
however, is quite difficult to obtain with this apparatus, even in
using one for each nostril. To make the instrument more portable,
the glass tubes have been replaced by metallic ones, and the gradu-
ated glass has been provided with a metallic hook, to hook it to the
button holes of the assistant who administers the anaesthetic. In-
halers with valves were discarded long ago. Leather muzzles,
metallic masks, sacciform inhalers, are less in use than compresses.
Often to produce sleep a large quantity of ether must be adminis-
tered — 250 to 500 grams, and even more. The waking up with ether
32
VETERINARY SURGICAL THERAPEUTICS.
is also slower than with chloroform. The animal remains stultified
for a longer time. These disadvantages are compensated by a smaller
liability to injurious effects.
Althoueh less dansrerous than chloroform, ether is not harmless, as
pretended by some. In human surgery, though less used than chlo-
roform, it counts numerous fatal cases. If Oilier, out of 40,000 anaes-
thetic operations at the Hotel Dieu, of Lyons, has not oije single
death to record, it is because of his "happy luck'' {serie heureuse).
Fig. 27. — Inhaler for etherization or chloroforming.
In Lyons itself, from 1857 to 1878, there have been six deaths due to
ether. (Vallas. )' The statistics of Giirlt, which we shall consider
later, show that, with ether, cases of death have been fifteen times
less numerous than with chloroform.
Anaesthesia, by introduction of vapors of ether into the rectum,
tried first on animals (Dupuy, Thiernesse), was highly recommended
for man by Pirogoff (1847), and recently by Daniel Molliere (1884).
It has been recommended by Cagny for horses, especially to produce
in them a certain degree of sleepiness so as to diminish some of the
dangers of casting, or permit the execution of simple operations in
the standing position. The niodtis operandi \s simple. A bottle full
of ether has on its mouth an India rubber tube which is introduced
into the rectum. The bottle is put into a water bath at 50°. The
evaporation begins at once ; the vapor enters the rectum and is ab-
sorbed by the mucus. Thirty to fifty grammes of ether are sufficient.
Experiments have failed to confirm the advantages claimed for this
method. Often, instead of the semi-anaesthesia which one intends
(') Lepine, Semaine Medicale, 1S78, p. 301.
ANESTHESIA OF THE HORSE. 33
to produce, violent reactions take place, and powerful expulsive
efforts may bring- on prolapsus recti. In man, some cases have been
seen complicated with cyanosis, collapse and true asphyxia.
This treatment is so uncertain in its effects and has such serious
inconveniences and even dangers, without any real advantage, that
it has never found favor or been adopted.
Anaesthesia produced from a combination of vapors of ether in the
rectum, and morphine and chloral, is slow in its effects and not prac-
tical.
AX.i;STHESIA BY CHLOROFORM.
When one wishes to obtain a rapid and complete anaesthesia in a
horse he must use chloroform. It is not so dangerous for solipeds
as it is claimed to be. IMoller, who employs it exclusively, has
anaesthetized hundreds of horses without a single accident. He has
produced narcosis in horses with chloroform and made numerous
experiments, of which he gave an account in the first volume of the
Monaischifie fi'ir prakiisclie lliierheilkiaide.
In those experiments, INIoller has inquired into the practical value
of the method, the dangers to which those operated upon are ex-
posed, the time required to produce the narcosis, its duration, and
the quantity of anaesthetic required. He has studied the influences
that, from these various points of view, the weight, the breed, and
the age and sex of animals might have.
Comparing the results obtained in a list at first of 126 horses (31
stallions, 38 mares, and 57 geldings), all of which were anaesthetized
until arrest of ocular reflex, he finds that the average quantity of
chloroform used is no grammes for each subject, about 25 grammes
for every 100 kilogrammes of the weight; that the time required to
produce narcosis has been in average 20 minutes ; and that its dura-
tion has been also 20 minutes. In colts i and 2 years old, anaes-
thesia was obtained in 7 to 8 minutes with 15 to 20 grammes of
chloroform. It was complete in 7 minutes, using 35 grammes of
liquid, with one 4-year-old horse, with 3 others in 8, 9, and 10 min-
utes. With 12 animals it was not complete until after 30 minutes ;
with 4 it required 35 to 40 minutes. It required 18 minutes on the
average for stallions, 19 for mares, 22 for geldings. While 7 horses
were anaesthetized, using 50 grammes, with 18 (5 males, 4 mares, 9
geldings) it took 150 grammes; an adult mare required 240, and a
thoroughbred stallion received 250.
In 28 horses which received 50 centigrammes of morphine in hypo-
dermic injections half an hour before the administration of the chlo-
roform, anaesthesia was obtained, in average figures, after 15 min-
utes with 93 grammes. For 8 horses, ether and chloroform were
3
34 VETERINARY SURGICAL THERAPEUTICS.
mixed together. This mixture required 210 grammes and half an
hour to produce sleep. No noticeable difference could be observed
by using chloroform of various productions.
Most of the animals which received morphine and chloroform ex-
hibited manifestations of greater excitement than with chloroform
alone or mixed with ether. Like Moller, Harms recommends chlo-
roform for anaesthesia of horses ; he kept, with 128 grammes, during
two hours, a large horse in a complete state of muscular resolution.
While chloroform, well prepared and preserved, and thoroughly
pure, rapidly produces sleep, if it is impure or loaded with chlorine,
anaesthesia is slower, less complete, and full of starts ; and syncope
is to be feared. To avoid alteration of the chloroform, a small quan-
tity of ether should be added to it, and it should be kept in blue or
yellow glass corked bottles, in a dark place.
Chloroform is administered, as ether is, with a sponge, a ball of
oakum, or a compress. A method rapid or powerful in its action is
dangerous and should be rejected. A slow and easy method, which
consists in allowing the entrance of a mixture of air and vapor
of chloroform, is the only one to be recommended. The assistant
must pour the anaesthetic very slowly, drop by drop (2 or 3 in each
second). From time to time the nostrils and the pituitary mem-
brane are wiped off with a cloth or some wadding to prevent the
irritating effect of the chloroform. With the same object vaseline
can be applied on the nose. Several authors (Roux, Gresswell,
Fohringer, Zangger, Hirzel) have recommended the use of special
apparatus ; but most of it is dangerous, since it prevents the entrance
of the air. It is not necessary to suspend the inhalations from time
to time, if the chloroform is poured out drop by drop.
The period of excitement lasts only a few minutes; in some sub-
jects it is scarcely observed. Soon the animal goes to sleep, into
a much deeper one than with ether. By repeating the inhalations
anaesthesia can be prolonged for an hour, an hour and a half, or two
hours, without any dangerous appearances.
When there is a cessation of the chloroform-giving after it has
been administered for a long time, temporary arrests in the respira-
tion may be manifest. Moller has seen them lasting 30, 40 and 45
seconds. Slapping of the lips and the cheeks with the hand or a
wet cloth is sufficient to stimulate reflexes and the return of respira-
tion. Some subjects seem to possess a peculiar sensitiveness to
chloroform ; with them, the first vapor gives rises to great excitement
and the progress of anaesthesia is somewat singular. A few fatal
cases have been recorded, many others have not been ; but, with
few and very rare exceptions, pure chloroform does not "kill"
except when badly administered, or given to animals having cardiac
or pulmonary affections. At the posi-r}iorte?n examination of a horse
ANAESTHESIA OF THE HORSE. 35
that had died during- the administration of chloroform, Kemp ' found
-an enormous hypertrophy of the heart and a valvular endocarditis
Avith aneurism of the aortic sigmoid valves. Following' chloro-
formic narcosis, inflammatory lesions of the pituitary membrane
and of the mucous membrane of the sinuses and also pneumonia
have been observed. (Jacobi, Ries.)
In man, cases of death during anaesthesia by chloroform are rare,
none having ever been observed by the surgeons who daily perform
many operations in the hospitals. Konig has given it to 7000
patients and Nussbaum to 15,000 without a single accident. When
Billroth lost his first patient, he had already used it without harm in
12,500 cases. General statistics from German surgeons, however,
show more serious losses : 99 deaths out of 285,380 persons put to
sleep, or i for every 2,880. At the last German Congress of Surgery,
Gurlt reported from 163,490 cases 61 deaths, an average of i in
2,680. From 32,725 chloroform cases, there were 17 deaths, i for
1,924 ; when a mixture of ether and chloroform was used, the
mortality was i in 8,014; when ether, i in 26,268.^ Lepine says
that, taking into consideration the number of accidents unpublished,
"it can be assumed that there is at least one case of death out of
1,200 where chloroform is used." ^ On that amount Korte, Landau,
Vogel,4 Poncet, Augagneur, Gangolphe s have tried to have the use
of ether prevail.
Graded mixtures of air and chloroform (method of Clover and
P. Bert), recently recommended by Dubois, require the use of special
apparatus, which is not used for animals.
The Comhiiiation MelJiod — inhalations of chloroform after injection
of morphine and atropine — recommended for dogs by Dastre and
IMorat, can be used for anaesthesia of solipeds. To a horse of middle
size an injection of 10 or 15 centigrammes of muriate of morphine
and 5 milligrammes of sulphate of atropine, in a solution of 10
grammes of distilled water, is given. Half an hour after the injec-
tion, the animal is thrown and the administration of chloroform
begins ; anaesthesia takes place rapidly. In the experiments that we
have made with Desoubry, it was obtained in about 7 minutes.
The average dose of chloroform required was about 65 grammes.
The same substance administered alone would not produce narcosis
in less than 15 minutes; the average quantity required would be
120 grammes. Non-appearance or diminution of the period of ex'»
citement, and the certainty of avoiding cardiac syncope, are the
principal advantages of this method.
1 Kemp, A merican Veter. Eevieiu, 1883, p 498.
^ Gurlt, Deutsche ined. Zeiiung, 1894, Berlin. Thierarztl. IVochenschr., 1894, p. 357.
' Lepine. Semaine Medicale, 1S94, p. 301.
' Korte. Landau, Vogel, Ibid., 1894, p. 62, iii, 126.
^ Poncet, Augagneur, Gangolphe, Mercredi midical, 1894, p. 211, 225, 247.
36 VETERINARY SURGICAL THERAPEUTICS.
ANAESTHESIA WITH CHLORAL.
As an anaesthetic for the horse, chloral is used alone, in intravenous;
injections or associated with hypodermic injections of morphine and
administered in rectal enemas.
Intravenous Injections. — Investigations of Ore and of Vulpian
have shown that a i — 3 or i — 5 solution of chloral injected in the
venous apparatus, produces a very rapid complete anaesthesia. This
method, declared dangerous by Colin, which surgeons for mankind
(Gosselin, Trelat, Lefort) have immediately condemned, has been
recommended in France and in Denmark for the horse, on which an
intravenous injection is easily made at the jugular.
This method, studied in 1875 by Humbert, who succeeded in the
case of a great number of animals, without an accident, and rec-
ommended by him in 1884, is excellent for producing a deep
narcosis in horses used for experiments or for the practical services-
of surgery (Nocard). The apparatus of Dieulafoy is used with a
filtered solution of i — 10, i — 15 or i — 3, which is injected into the
jugular in variable quantities, according to the subject. When fresh,
the solution is neutral ; if it becomes acid, a small quantity of car-
bonate of soda should be added to it.
When an intravenous injection is applied for a therapeutic pur-
pose, it requires a somewhat delicate management. The rules of
antisepsis — disinfection of the region, asepsis of the trocar or of the
needle — must be strictly observed. When everything is prepared,
an assistant presses the vein at the lower end of the jugular groove,
the operator stretches the skin towards the head with one of his-
hands and with the other pushes firmly into the dilated blood-ves-
sel, a hollow needle, or a fine trocar, held very obliquely downwards
and backwards. Humbert advises the introducing of the needle by
two steps : he perforates the skin first, dilates the vein, and then runs
through into it ; when the operation is done with the animal stand-
ing he prefers the right jugular to operate upon. The escape of"
blood through the canula, after the trocar is withdrawn, indicates-
that it has penetrated into the vein. An assistant then holds the
canula in position. The operator at this moment connects the
mouth of the canula with an India-rubber tube, fitted to the syringe
holding the fluid, and slowly pushes into the vein the quantity which
is to be injected. This done, the tube is removed, a little blood
escaping washes out the cavity of the canula, which is then retracted
suddenly without raising the skin. Colin indicates as an anaes-
thetic dose 20 or 30 grammes of chloral ; Arloing, 25 to 50 grammes,
Nocard, 10 grammes for every 100 kilogrammes of the weight of the-
animal. Anaesthesia follows almost immediately ; it is more or less,
profound, and varies in duration according to the chloral injected.
AN/ESTHESIA OF THE HORSE. 3/
In a few moments the animal sleeps, the immobility is complete, the
muscular relaxation perfect, the mucous membranes have a slight
'Cyanotic tinge, the respiration and circulation, disturbed for a mo-
ment, return to their normal rhythm. The wakening is slow ; the
subject remains stupefied for some time, and in some instances is
-seized with a general trembling. After a lapse of time, varying from
half an hour to two hours, the animal gets up staggering, very weak
m the hind quarters ; comatose manifestations may last for one or
two hours after.
When the dose injected has been too large, or the subject is very
^susceptible to chloral, the sleep is very deep, the mucous membranes
become darker and darker, the pupil is dilated, respiration and cir-
culation become slow, the temperature lowers, and death may
follow.
If the operation has not been done antiseptically, if the vein has
been run through and through, or torn during the operation, and if
by any chance some chloral has escaped in the perivenous tissue, it
is rare good luck if serious accidents do not follow. Almost all the
veterinarians who have tried this method have seen complications of
phlebitis produced, and so have given it up. Phlebitis appears gen-
•erally from the second to the fourth day ; it is manifested by a swell-
ing of the jugular groove — a swelling which, sometimes limited and
^sometimes diffused, ends in suppuration ; frequently, there are ne-
crotic lesions. In one case we .have seen the vein destroyed and
sloughed away throughout almost the whole extent of the neck.
The vaso-dilating action of the chloral has also been objected to, as
it increases hemorrhage in bloody operations. Though it has been
but little used, chloral, like other anaesthetics, has its list of fatali-
ties. Moller has killed several horses by injecting chloral into their
jugular in doses of 50 grammes. Doubtless one may say that this
was too large a dose, as long as the weight of the animals was not
known. In 1889, one of our confreres asked us to assist in firing one
•of his horses. The animal being very nervous, it was agreed to give
it chloral by means of an intravenous injection. The dose used
was not above 10 grammes for each 100 kilogrammes of its vveight.
During the first part of the operation the horse had some slight re-
•actions. After fifteen or twenty minutes, when the operation was
-almost finished, respiration stopped, and a few moments later, not-
-withstanding the methodical pressure applied upon the thorax to
guard against asphyxia, the animal died.
If intravenous injections, performed aseptically by experienced
hands, is declared harmless, it has unfortunately given to many prac-
-titioners such results that they had to give it up. " In the case of
man," says Dujardin-Beaumetz, "the serious accidents which have
-occurred have forced this procedure to be abandoned." ' Peuch de-
I. T)v:ATiDi>;-V>E\UMETZ.—L'iirideyor»!7t/er,/>. 41.
38 VETERINARY SURGICAL THERAPEUTICS.
dares that it will remain " a procedure confined to the laboratory : "
Trasbot and Moller condemn it ; and for ourselves, we have wholly
restricted its use to patients used in our surgical experiments.
Chlo7'al and Morphine. — To diminish accidents resulting from the
intravenous injection of chloral, Cadeac and Mallet have proposed
to bring about anaesthesia by associating it with morphine. Accord-
ing to their experiments, complete anaesthesia is brought about by
injecting into the subcutaneous conjunctive tissue a solution of So
centigrammes to i gramme of muriate of morphine, followed in lo
minutes by a rectal injection of Soto loo grammes of chloral.
Narcosis is not always readily brought about. It takes place
slowly, and is at times preceded by a somewhat long period of ex-
citement. Esser advises this means in cases in which the use of
chloroform is prohibited.
Inhalation of the vapors of chloral does not produce anaesthesia,
or even sleep. Subcutaneous injections of chloral in aqueous solu-
tion give rise to diffused gangrenous abscesses with abundant sup-
puration. Administered in sufficient doses (40 to 50 grammes per
mouthful), in weak solution, chloral gives rise to numbness, drowsi-
ness, and inco-ordination of movements, but no -complete anaesthe-
sia. This process may, however, be used advantageously in ordi-
nary practice. (Harms.)
ANAESTHESIA WITH JIORPHINE.
For horses, subcutaneous injections of muriate of morphine have
been recommended to produce drowsiness or a slight anaesthesia
which will permit the performance of some operations upon ani-
mals standing up. According to size, 20 to 50 centigrammes-
are injected. The doses of one, one and one-half and two grammes
(Giirlt) are useless. In some animals, morphine brings on drowsi-
ness, numbness and a muscular relaxation more or less marked ;
some animals which are nervous, restless, or dangerous, thus
become quiet and easy to handle ; but with others, the object is
not reached even with large doses, and phenomena of excitement,
which may last several hours, will occur. The patients are very-
restless, give themselves to violent struggles, rear, shake their heads,
push them against the wall as in indigestion complicated with brain
troubles. We have seen these manifestations last for several hours.
Many practitioners have observed similar cases. This process is-
then uncertain in its results, but may be of some benefit ; and when
the dose is small, is perfectly harmless.
The bichloride of methylene, experimented with by Nigotin in-
anaesthesia of the horse, has proved inferior to chloroform, as were
ANESTHESIA OF RUMINANTS AND SWINE. 39
hypnone, urethane, paraldehyde and benzine. Inhalations of the last
agent had brought on a state of excitement, followed by drowsi-
ness after about lO minutes and afterwards a quiet sleep, which
might be continued by renewed inhalations (Harms).
ANAESTHESIA OF RUMINANTS AND SWINE.
On these animals, few operations are performed with anaesthesia.
The experiments of Tabourin and Saunier have shown that ether
and chloroform may be administered to the large ruminants without
running any greater risks than with other animals. Nigotin thinks
ether dangerous for cattle and recommends chloral (50 to 75 grammes)
given per mouthful. Harms suggests the inhalation of benzine.
But for animals which are to be butchered, when a certain degree of
anaesthesia is to be obtained for surgical purposes alcoholic prepara-
tions are preferable. For small bovines, the best way is to give them
a large dose of brandy or of rum (one-half to one litre). After five
or ten minutes, numbness begins, and by degrees becomes more
accentuated. Intoxication brings on perfect relaxation of the
muscles.
ANESTHESIA OF THE DOG AND CAT.
In laboratories, for the performance of the operations necessitated
by the study of physiology and experimental pathology (removal of
the spleen,' of the kidneys, of the pancreas, of the liver, secretion of
the stomach, or removal of the thyroid gland), anaesthesia of these
animals is often required. But, for surgical operations, these animals
are rarely put under the influence of an anaesthetic. Practitioners pre-
fer to operate in private, with the subjects wholly conscious ; they
thus avoid inopportune surprise and loss of time. Except laparatomy,
Caesarian operations, the dislocation or removal of the crystalline
lens, or the removal of some malignant' growths, operations can be
easily performed on dogs without anaesthesia. Even kelotomy is
a very simple operation, without narcosis.
Some recommend ether, others prefer chloroform. In the case of
carnivorous animals, since respiration takes place through the
mouth as well as through the nose, it is dangerous to suppress the
former air passage by closing it with a ligature or a muzzle. The
dog should be held in a costal position, with its jaws free or kept
apart with a speculum ; chloroform should be given through the
nostrils or both through them and through the mouth, by placing
near these openings a pad of wadding or a small sponge moist with
chloroform. This process, as in the case of other animals, is not free
from danger. Ether is administered in the same manner.
To obtain a more rapid narcosis and reduce the dangers, the
40 VETERINARY SURGICAL THERAPEUTICS.
association of morphine with ether or chloroform has been recom-
mended. Moller injects first under the skin 5 or 10 centigrammes of
muriate of morphine, and after a short while, etherizes. Cagny
administers vapor of ether through rectum. Others use morphine
and chloroform.
As in the case of horses, intravenous injection of chloral is
dangerous.
INIorphine in subcutaneous injections and chloral in enemas have
been used with advantage (Cadeacand Malet, Esser, Guinard). Here
is the formula of their use :
Muriate of morphia, 5 milligrammes for each kilogramme.
Chloral, i gramme.
The objections are the same as for horses, — slow anaesthesia,
abundant hemorrhage.
Ch. Richet has recommended intraperitoneal injections of chloral
alone or associated with morphine. Injected into the peritoneum,
chloral brings, in about 10 minutes, a complete anaesthesia. The
injection is made with a syringe of Pravaz sterilized. The intestines
escape the needle and the peritoneum supports diluted chloral
perfectly.
Muriate of morphine added to chloral produces a longer anaesthesia
(about an hour), and is said to be without danger of syncope.
In this method, the doses are :