INIuriate of morphine, 2.5 milligrammes for each kilograriime of the
animal.
Chloral, 5 decigrammes.
Frohner has sometimes used urethane, hypnone and paraldehyde.
But the most preferable method with this species of animal is that
of Dastre and Morat. It consists in using chloroform after an injec-
tion of apomorphine. With the morphine, the excitement of the
beginning of anaesthesia is .suppressed ; with the atropine, cardiac
syncope is prevented by arresting the functions of the cardial moder-
ating center, and of the vaso-motor fibres of the pneumogastric
nerve, " the centrifugal road of the syncopal reflex." Here is the
method : First the solution of apomorphine is injected under the
skin :
Muriate of morphine 2 decigrammes.
Sulphate of atropine 2 centigrammes.
Distilled water 10 grammes.
used in a dose of ^ cubic centimeter for each kilogramme of the
weight pf the animal.
When this solution has produced its effect (after 20 or 25 minutes),
the inhalations of chloroform are begun. Several grammes are
sufficient to produce a complete anaesthetic, which lasts one and two
hours.
AN.-ESTHESIA OF THE DOG AND CAT. 4I
For man, Aubert has recommended the use of the following-
mixture, which contains a smaller proportion of morphine, and
especially of atropine :
Muriate of morphine lo centigrammes.
sulphate of atropine 5 milligrammes.
Distilled water lo grammes.
This solution is also preferable for dogs. Half of a cubic centimeter
is an injection sufficiently large for a small-sized dog, one or two
cubic centimeters for subjects of middle size, and three or four for
large dogs. After 15 or 25 minutes, the chloroform is administered.
By this process, a deep sleep of long duration is obtained — there
is no danger of syncope. (Kaufman, Desoubry. )
Cats are very susceptible to the various anaesthetics. Administered
in slightly too strong doses, or too rapidly, or for too long a time,
there is danger of death.
A simple and easy method consists in placing the animal under
a glass bell, where small sponges, or pieces of wadding, moistened
with chloroform have been placed. Soon the patient totters and
falls ; it is taken from under the glass cover and operated upon.
This manner of chloroforming is not without danger; it only
produces short sleep, and if new inhalations are made, the animal
may die.
The process of Dastre and Morat is the best ; but as the cat is
extremely sensitive lo the action of morphine, which produces in it
a very strong excitement, the dose must not be above o gram. 0005
(instead ogram. 005) for each kilogramme. Guinard, who gives the
methods mentioned above, has also recommended another which
allows one to bring about a long state of narcosis. He injects
hypodermically muriate of morphine, in doses of ogram. 005 for
each kilogramme of the animal ; then, as soon as the phenomena of
excitement subside (after fifteen or twenty minutes), he places the
cat under a glass bell with a few sponges impregnated with chloro-
form. As soon as signs of narcosis are apparent, the animal is
removed from the cover, and the inhalations continued a few
moments. Anaesthesia lasting forty-five minutes can thus be obtained.
The excitement which attended the taking of the morphine in the
beginning reappears when the animal wakes up, and lasts sorrte time.
ANAESTHESIA OF THE IMONKEY.
The veterinarian may be called to perform some operations
(puncture of abcesses, removal of tumors, or the extraction of the
canines) on monkeys kept in captivity. Some of these animals are
so easily handled that aneesthesia with them is useless ; but there
are others which are strong and dangerous, and which must be
42 VETERINARY SURGICAL THERAPEUTICS.
ansesthesized. Chloroform is the best agent to use. This animal is
placed in a narrow cage which is covered with a blanket ; at inter-
vals of half a minute to a minute, balls of oakum or wadding
moistened with chloroform are thrown into the cage ; soon the
subject becomes benumbed, staggers, falls against the sides of the
cage, crouches down ; now is the time to take hold of it — it is de-
fenceless. (Percheron.) If the operation is to last some time, a few
inhalations of chloroform are given.
It is prudent to replace the animal in its cage until it has recovered.
ANESTHESIA OF BIRDS.
Narcosis is easily brought about in birds. Chloroform is more
commonly used. The animal is placed under a glass bell, gently
raised on one side to allow the entrance of air ; small balls of
wadding saturated with chloroform are introduced under it. Soon
the bird totters and goes to sleep without any symptoms of excite-
ment. Inhalations can be kept up, if the operation is to last very long.
Unless a subject is possessed of an excessive susceptibility to
anaesthetics, — one of those "predisposed to" syncope," which one
comes upon in all species, one may avoid complications and accidents
by observing the following rules : Give anaesthetics to animals only
when they have an empty stomach ; use a product pure and free
from adulterations ; administer the ether or the chloroform slowly
so as to allow also the entrance of a certain quantity of air ; if chloral
is used, introduce the solution also very slowly ; and carefully watch
the reflexes.
In anaesthesia by ether or chloroform, there are at times, during the
period of excitement, spells of coughing and panting for breath :
these are of short duration. Yet, at this stage, the irritation of the
mucous membranes of the first air passages may give rise to a
respiratory syncope, which is also possible at the moment when the
anaesthetic vapors make their impressions upon the encephalic
elements, and later on, by bulbous intoxication. Respiratory
syncope is indicated by superficial inspirations, very rapid, or
sometimes very slow and incomplete. While the action of the
heart persists, respiration can be re-animated by various means :
slapping of the lips, of the face, or of the neck, methodic pressure
upon the chest, rhythmic tractions of the tongue (Laborde), and
artificial respiration. In complete anaesthesia, short arrests of respi-
ration may be observed, which are syncopal in nature.
Like respiratory syncope, c^rJ/ac sy«co/>e is precocious, secondary^
or terminal ; since it is brought on by the irritation of the pituitary,
the sudden action of the anaesthetic upon the encephalon, or by
bulbary saturation. It is manifested by repeated, very short, and
LOCAL AN/ESTHESIA. 43
later by intermittent arterial systole. As soon as the pulse is irreg-
ular and the visible mucous membranes are becoming- pale, cardiac
syncope is imminent ; inhalations must be suspended at once, the
head inclined, the respiration kept up, and rhythmic traction upon
the tongue performed.
In small animals, during the ancesthetic sleep, it may happen that
the tongue, retracted in the mouth, presses with its root against the
epiglottis and closes the larynx. Respiration becomes embarrassed,
and then its sounds suddenly cease. If this accident occur, tractions
upon the tongue must be immediately applied to relieve the larynx.
At the beginning of anaesthesia, in the stage of excitement, alarm-
ing symptoms may be manifested (general stiffness, staring eyes,
cyanosed membranes, and arrest of respiration), due to the closing of
the glottis by spasms of the laryngeal muscles. If these symptoms
appear, anaesthesia must be at once stopped, applications of cold
water must be made upon the head and the face or chest slapped
with a cloth dipped in cold water.
Intoxication by the inhalation of too great a quantity of ether or chlo-
roform is not to be feared unless anaesthesia has been badly applied
or carried too far.
LOCAL ANAESTHESIA.
The dangers of general anaesthesia have suggested the idea of find-
ing means by which only the region to be operated upon should be
anaesthetized. Continued pressure over the tissues and the mediate
compression on the nerves being very imperfect in their result, ice
freezing mixtures or nebulization of ether have been successfully em-
ployed. Then came cocaine, the use of which has now become
general.
Ax.%;sTHESiA BY CoLD. — I. Freezing Mixtures. — The continued ap-
plication of cold upon superficial tissues produces in them modifica-
tions, which bring on ischaemia, numbness, a diminution, and
even an abolition, of sensibility.
During this century cold has been resorted to for the purpose of
performing some short operations upon the skin and the first sub-
cutaneous layers, where refrigeration might, without inconvenience,
be rapidly realized.
In veterinary surgery it has been resorted to for operations on the
lower parts of the extremities. Ice and common kitchen salt are
mixed in equal parts or in the proportion of two to one. This mix-
ture is placed in a bag or wrapped in a cloth and applied upon the
parts to be operated upon. In a few minutes this becomes cold.
44
VETERINARY SURGICAL THERAPEUTICS.
hard, and insensible, especially if, with this application, pressure is
made upon the skin.
The surgical action, when it is not too deep, produces no pain and
no hemorrhage. But as the anaesthesia is of short duration one
must operate quickly.
2. Nehulization of Elher. — To produce local anaesthesia upon the
operating field a throwing of vapors of ether has been tried. To
increase the effects of the ether some was poured over the surface of
the skin drop by drop and the evaporation stimulated either by a
strong draft of air or by blowing over it with a bellows. Richard-
son has rendered local etherization more practical by the use of the
atomizer bearing his name, (Fig. 28.) With ether at 40° one may
•obtain with this atomizer a local ischaemia and anaesthesia which
permit a painless performance of slight operations (cutaneous diere-
sis and exeresis). The action of the evaporation is more rapid and
Fig. 28. — Richardson's atomizer.
complete if, before the nebulization, a bandage o. Esmark has been
applied. Inflamed structures are quite difficult to anaesthetize. For
them freezing mixtures are better.
Sulfide of Carbon possesses no advantage over ether.
Chloride of Methylene, used with much success for man m obsti-
nate cases of neuralgia, has a too powerful freezing action. It ren-
ders the skin insensible in a few seconds, often freezing it, and
â– occasions a more or less extensive slough.
AncBsthesia with Cocaine. — In 1862 Schroff had already shown that
Ihe lingual mucous membrane could be rendered insensible with a
solution of cocaine. The same result was observed by Fauvel in
the case of the pharynx. In 1884 Roller recommended it as an excel-
lent anaesthetic for the membranes of the eye and of the larynx. Vul-
LOCAL AN.-ESTIIESIA. 45.
pian and Panas made it popular in France. Reclus published some-
excellent papers on its application. Labat proved that it could be
used with benefit for animals.
Cocaine is almost insoluble in water, but most of its salts in any
proportion are readily dissolved by it. The most generally used is
the muriate of cocaine in solution of i per 100. The addition of
a small quantity of corrosive sublimate insures the purity of the
solution for preservation. We use the formula recommended by
Reclus.
Muriate of cocaine lo centigrams
Sublimate 2 milligrammes
Distilled water lo grammes
With a few drops of this collyrium dropped between the eyelids
the superficial layers of the cornea are rendered insensible in three
minutes.
By repeating- this process at intervals of two minutes anaesthesia
of the cornea, of the conjunctiva, and of the eyelids is complete in
less than ten minutes, and lasts for fifteen. The pupil dilates ; but,
generally, the anaesthesia of the iris is only obtained by an injection
made into the anterior chamber. With cocaine, puncture of the
cornea and the extraction of foreign bodies incrusted in it are made
easily. Five or six injections under the conjunctiva, round the ball
of the eye, will permit its entire removal without great pain.
The action of cocaine is not less remarkable upon other mem-
branes. On that account its use is prescribed for painful inflamma-
tion of these structures. Subcutaneous and submucous injections
of cocaine will remove sensibility from superficial tissues, and per-
mit various operations to be performed. By injections in linear or
circular tracts the area of the influence of the anaesthetic can be
increased. A long and fine canula, fitted to a Pravaz syringe, is
introduced through the skin into the subcutaneous cellular tissue, or,
better, into the thick dermis, following the direction of the incision to-
be made. Then it is withdrawn gradually while the piston of the
syringe is pushed in. In this way the solution is diffused in a linear
track. (Reclus.) The anaesthetic power of cocaine is increased by
a previous injection of morphine.
Cocaine has no action upon nervous cells. It acts exclusively
upon the terminal fibres of the sensitive branches. (Arloing. )
Its toxicity varies according to the kind of animal. For dogs,
more than 5 to 10 centigrammes are dangerous. Concentrated solu-
tions have no advantages and are dangerous. In every degree of
concentration, solutions of cocaine, when they become acid, lose,
more or less completely, their anaesthetic properties, which can be-
restored if the liquid is rendered neutral.
46 VETERINARY SURGICAL THERAPEUTICS.
III.
SURGICAL ANTISEPSIS AND ASEPSIS.
Although infectious complications of traumatism have, at all times,
occupied the attention of surgeons, until modern times surgical art
was powerless to prevent them, because their nature and their par-
ticular cause were unknown. In the first part of this century, they
were supposed to be due to the action, upon the exposed wounds,
of the impurity and vicious condition of the atmosphere of hospitals,
or of the air loaded with the viiasinas of putrefaction. The labors of
Pasteur and of Tyndall seemed to justify the correctness of this
idea, although they showed that it is not the air itself which pos-
sesses injurious properties, but the germs that it contains in sus-
pension.
While organic substances exposed to the action of the air enter
immediately into fermentation, they do not undergo any kind of
alteration in contact with air optically pure, which has been filtered
through wadding. It is the animated atoms, the germs in suspen-
sion in the atmosphere, the microbes, which give rise to the decom-
position of those substances and to the putrefaction which is devel-
oped in the tissues as soon as life has left them. Without micro-
germs there would be no decomposition or no putrefaction. Logic-
ally, it became evident that the same process ought to take place in
wounded structures, exposed to the action of air, and of its germs.
The phenomena which characterize septic complications of wounds
should be essentially those occurring in fermentations.
The first important researches made for the purpose of preventing
these complications are comparatively recent. It was in 1861 that
Lister, inspired by the labors of Pasteur upon the subject of fermen-
tation, made the experiments which brought him to conceive of the
antiseptic method ; and in 1870, A. Guerin, guided by the same dis-
coveries and those of Tyndall, originated the wadded dressing. It
is but just to say, that in 1865, Lefort had already said that conta-
gion is the great cause of those complications.
Guerin, in the case of wounds, realized the experimental condi-
tions which protect qrganic matter from the alterations of which the
micro-organisms of the air are the agents ; with thick layers of wad-
ding he protected the divided tissues from the action of germs.
Lister had for object to destroy, with chemical agents, the microbes
which corrupted the wound or which might be deposited in it dur-
ing the operation ; he rendered the wound aseptic and then pro-
tected it by a true germicide obstacle.
Let us first consider the wadded dressing.
At first Guerin did not attempt to obtain immediate union ; he
SURGICAL ANTISEPSIS AND ASEPSIS. 47
only tried to reduce to the minimum the secretions and prevent acci-
dents from infections. Hemostasis insured, he washed the wound
with tepid water, then with a mixture of water and camphorated
alcohol ; in some cases he saturated the wound with it, cut the
threads of the sutures close to the skin, and then covered the whole
with several layers of wadding-. In serious operations upon the ex-
tremities, those were wrapped up in sheets of wadding superposed
in such a way that the leg seemed to be three times its ordinary size.
The wadding- was then fixed tight with linen bands properly applied ;
the whole of it was to be sufficiently pressed to give on percussion
" a resonance resembling that of the normal thoracic cavity." If, on
the following days, the degree of pressure proved insufficient, new
bands were applied, and if the dressing appeared to be run through
by the serosity of the wound, other layers of wadding were applied
over it. This dressing was first left in place for 20 or 25 days ;
later, it was changed after 12 or 15 days. Generally, when the first
dressing was taken off, the wound was granulating throughout its.
whole, extent. After a second dressing, having been left 8 or 10
days, often cicatrization was complete.
Several modifications of this method have been introduced which
permitted reunion by the first intention. First, the hemostasis was
made more vigorous and the edges of the wound were fixed together
with absorbable thread (catgut) placed more or less deeply. Besides
its numerous advantages, the wadding-dressing had the disadvan-
tage of concealing from the surgeon the condition of the trauma-
tism. It is true the thermometric observations informed him of the
complications likely to occur ; but as it sometimes happens that
thermometric elevations show themselves in the case of patients
whose wounds are doing well, much time was lost, and patients
were exposed to complications by uncovering wounds in process of
cicatrization. And again, although in protecting the wounds by-
layers of wadding atmospheric germs were prevented from reach-
ing the divided tissues, those which had already been deposited on
them during the operation were not destroyed ; and these, though
under restraint {mal a Taise), were nevertheless multiplying, often
with great rapidity.
Still, compared with the old dressings, the wadded apparatus was
an immense advance in the surgical art. It was employed, how-
ever, but little ; and was obliged to make room for the Listerian
dressing, more practical and more trustworthy in its results.
To prevent the infection of the wound, Lister strived to surround
it with an atmosphere freed from infectious elements and to destroy
the germs of the surrounding aerial layer, those deposited on the sur-
face of the wound, on the hands of the surgeon and his assistants,
upon the instruments, the sponges, the compresses, and all objects
48 VETERINARY SURGICAL THERAPEUTICS.
of dressing'. The wound, free from infectious germs, was covered
with material impregnated with an antiseptic, and care was taken to
prevent the accumulation of the serosity secreted by the wounded
surfaces. As microbicide agents, Lister used especially phenic acid, and
in I to 20 solution (strong) or i to 40 (weak). With the strong solu-
tion, he disinfected the instruments, the sponges and the region ;
and, when the operation was concluded, the wound over its whole
surface. The weak solution was used to wash the hands of the sur-
geon and assistants, to moisten the sponges and clean them during-
the operation. To prevent the contamination of the wound by
atmospheric germs during the operation, a " phenicated cloud"
{spray), made with a Richardson atomizer or a vapor nebulizer and a
solution of phenic acid, was thrown over the field of operation. After
the operation, and before the spray was arrested, as soon as hemo-
stasis was obtained, by catgut ligatures cut short to the knot, the
edges of the wound were brought together with sutures of the same
nature. Drainage tubes were fixed to allow the escape of the
secreted fluids, and the dressing was applied.
The region of operation was first covered with a pj-o/eclivehcivA of
silk, very thin, gummed, and impermeable, for the purpose of pre-
venting the prolonged action upon the wound of the too irritating-
phenol ; above this, phenicated (carbolated) gauze folded in eight
layers, the last two having between them an impermeable cover of
caoutchouc to prevent the evaporation of the phenol and oblige the
liquids secreted by the wounds to run through the whole thickness
of the dressing before reaching the outside. All of these were kept
in place by bands of carbolated gauze. Since the action of the phe-
nol upon living tissues gives rise to an abundant secretion, the
dressing ought to be taken off after 24 or 48 hours, the wound exam-
ined, as also the sutures and the drains ; if necessary, take these off,
and replace them after a thorough washing with a solution of phe-
nic acid, and then a new dressing applied. All of this should be done
under the spray. Later dressings more or less frequent were made
with the same care; the wound was looked at only when it became
painful or when there was a noticeable rise of temperature. Such
was the method used for wounds in operations made upon tissues
free from all external contamination.
For recent traumatic lesions more or less irregular, the application
of the dressing was preceded by a careful washing made with a con-
centrated solution of phenic acid (i to 10). Suppurating wounds required
a more complicated preparation ; they were first treated with the
curette, then very carefully washed with a solution of chloride of
zinc (i to 10). As the irritating action of the phenol was not to be
feared, the protective band was dispensed with.
The Listerian dressing extolled by Championniere and Terrier in
SURGICAL ANTISEPSIS AND ASEPSIS. 49
France, and by Wolkmann and Billroth in Germany, soon became
popular in every country. Everywhere it took the place of the old
ones ; but, advantageous as it was, it was soon found to have many
faults ; such as, its many details, and the time required to apply it,
its expensiveness, and the toxicity of the phenic acid. Everywhere, sur-
geons set about improving it, and above all simplifying it, while re-
specting the principal rules established by its author. For phenic
(phenol) acid, Thiersch substituted salicylic acid ; Lewin, thymic
acid ; Kocher, chloride of zinc and sub-nitrate of bismuth ; Bergmann,
corrosive sublimate ; Mosetig-Moorhof, iodoform. The phenicated
gauze was replaced by rough netting (gauze) kept in phenol (vi^eak
solution) until ready to use (Bardeleben), and by muslin soaked for
a week in a strong phenic solution (Bceckel). Neuber proposed to
use for drainage, tubes made of decalcified bones, which would be
resorbent, irritate the tissues but little, and avoid the too frequent
renewal of the dressing. The protective band was recognized as
useless, and drainage was used only when it was pretty evident
that immediate reunion would not take place. The technic of the
dressing, the microbicide agents, and the strength of the solution,
were all changed indefinitely.
Guerin, holding to the principal idea resulting from the new doc-
trine, prevented the entrance into the wound of the germs of the
air. He was less occupied with the infection through the hands,
instruments and objects of dressings ; and if he nevertheless ob-
tained good results, he owed them in a great part to "cleanliness,"
to an excellent habit which he had, before working, of washing his
hands and cleaning with soap and camphorated alcohol the region
to be operated upon and its surroundings.
Lister's method was more sure, but it also had its imperfections
and its errors. Evidently the success which marked the beginning
of antisepsis was not exclusively due to phenic acid. To it v;as at-
tributed a vigorous bactericide action that it did not possess. The
belief in rapid and complete disinfection, by phenic acid, of the in-
struments, hands, and operative field were fallacious. In the pro-
cess of Lister, as in that of Guerin, what was important was the
severe cleanliness of the hands, instruments, and objects of dress-
ing. Notwithstanding phenic acid, say Terrillon and Chaput, "an-
tisepsis would never have come out of its limbus if cleanliness had
not helped it to make its entrance into the world." '
Protect the wounds from the action of the germs of the air. Such