be plated with nickel or aluminium. (Ficj. 29.) Rough surfaces,
grooved jaws, joints of forceps, the ends of grooved probes, and
the eyes of needles should be carefully looked after. Complicated
instruments, and those difficult to clean, should be avoided. For
sutures, the needles of Larger or of Lamblin (figs. 30, 31, 32) are pre-
ferable to all others ; they are simple and of easy aseptisation. Instead
of syringes for injections, glass funnels with disinfected India rubber
tubes are preferable. A number of ways and of agents have been
Fig. 29. â€” Bistouries with metallic handles.
recommended to render instruments aseptic. Soaking in a strong
phenic or cresylic solution is a method used by some ; but phenic
acid dulls the edges of the bistouries, and cresylic makes them
greasy and slippery, and the opacity of the emulsion prevents their
being seen through the vase where they are deposited. Immersion
in boiling water is simple and practical. The degree of ebullition of
the water can be raised by adding common salt, or carbonate of soda,
(Bergmann, Schimmelbusch), or carbonate of potash (Terrier), or
chloride of calcium (Redard). Alteration of the instruments is pre-
vented by adding to the water I percent, of caustic soda. Baths of oil,
glycerine, or liquid vaseline, at a temperature of 1 20^ to 1 30*^, produce
a complete disinfection. When instruments are soiled by some vir-
ulent matter, such as proceeds from a septic or tetanic center, the best
â€¢way to render them aseptic is to dip them for 10 or 15 minutes in a
VETERINARY SURGICAL THERAPEUTICS.
bath of oil or of glycerine. Except in such cases, boiling in ordinary-
water or in a solution of carbonate of soda (104Â°) is sufficient. In-
struments with wooden handles are spoiled by boiling ; with them,
a careful cleaning of the handle is necessary ; the blade alone is dis-
Fig. 3 1 .
Reverdin's needle. Larger's needle. Lamblin's needle.
infected in boiling water. The autoclave, and damp or dry ovens
are the apparatus of the laboratory, or for surgery in hospitals.
Passing through the flame of an alcoholic lamp, Tedenat's "punch for
instruments" is also a rapid way of disinfecting them. The instru-
ments are placed on a metallic plate, and some alcohol is poured
over them and lighted ; a few minutes are sufficient for their sterili-
zation. They are then placed in a weak antiseptic solution or in
boiled water. Although this process is excellent for ecraseurs, forceps
TECIINIC OF ANTISEPSY AND ASEPSY. 6 1
and probes, it has the objection that.it softens the edges of the bis-
touries, sage knives and scissors. Gum probes should be cleaned
â– with alcohol at 70Â°, and then in a corrosive sublimate solution of i to
1 , 000.
Besides instruments, there are sponges, balls of cotton, of oakum,
compresses, threads and other objects of dressing used by the sur-
geon. All this surgical material must have received a special prep-
aration â€” it must be aseptic. This is the way to do it :
Sponges are cleaned under running water after being freed of their
dirt by hammering them with a mallet; they are then placed for 10
or 12 hours in a solution of permanganate of potash i to 1,000, are
well washed with sterilized water, and are placed in a strong phen-
icated solution, where they remain a month or six weeks before
being used. Then they are washed with boiled water, to remove
the excess of phenic acid soaked into them.
To-day sponges are generally discarded : they are replaced by
compresses oi gauze and the sponge-tissue sterilized in the autoclave,
or by halls ^oi hydrophilous wadding or peat wadding, also sterilized.
Many veterinarians are still using oakuvi ; it is good only when free
from the hard substances it contains, and sterilized by heat or im-
mersion in an antiseptic solution heated to 100*^. Generally it is
only soaked for five minutes in boiling water or in a solution of soda.
Eloire uses the dry heat of an ordinary oven (oven for roasting) that
is found in almost all houses ; the oven is filled with oakum, which
is heated and removed when it begins to burn.
Sterilization of silk thread is made by immersion for half an hour
in boiling water or by keeping in the autoclave at los'^ to iio'^. Im-
mersion for fifteen minutes in a strong phenic solution is sufficient.
It is kept in phenic acid solution at 5 to 100, or in corrosive subli-
mate I to 1,000.
After removing the grease of catgut with ether, the threads are left
to dry, rolled afterwards on spools, sterilized in dry heat, and pre-
served in a strong antiseptic solution of phenic acid or corrosive
sublimate, or in boiled olive oil.
Silk-worm gut, also freed from grease with ether, is left for half
an hour in boiling water and kept in glass tubes filled with a corrosive
sublimate solution 2 to 1,000.
Paraffined thread is prepared by dipping into melted paraffin linen
thread which has been soaked in ether or spirits of turpentine (Pecus).
Since it is a little rough when it has cooled, it is made smooth by
polishing with a fine cloth. This thread is supple, does not absorb-
organic liquids, and cuts the tissues but little. It is especially useful
for sutures which are to remain long in position.
Red rubber drain tubes are preferable to all others. After being
washed in a concentrated solution of permanganate of potash, they-
62 VETERINARY SURGICAL THERAPEUTICS.
are left for 20 minutes in boiling- water, and then placed in glass
tubes containing a corrosive sublimated solution 2 to 1,000, and ster-
ilized by exposure to a temperature of 120*^ for half an hour.
These manipulations, prescribed for the sterilization of compresses,
threads and drains, are not strictly necessary. Immersion for 5 or
10 minutes in a phenic, cresylic or strong corrosive sublimate solu-
tion, carried to ebullition, is the common practice in veterinary
surgery. It is considered sufficient (Bang).
The operative field and its surroundings must be carefully purified.
In all animals, the skin, even in a state of perfect cleanliness, is
occupied on its surface by numerous micro-organisms of very many
kinds, among which the staphylococci (staphylococcus albus and
aureus) are especially abundant. It is, therefore, always indispen-
sable to proceed to the disinfection of the region to be operated upon.
If the skin is sound, the hair should be cut with scissors and the
tegument soaped, shaved, brushed and washed with boiled water.
After having been dried with sterilized compresses, friction with
alcohol or ether should be made to remove the greasy substances on
its surface. This is completed by a last washing with a strong
phenic acid solution or corrosive sublimate i to 1,000. If the skin
is infected, if the region is the seat of an ulcer, suppurating trauma-
tism or a fistula, one must, the day before the operation, or several
days before, scrape the wound with the curette, and then proceed
as indicated. These two methods are not applicable to all surfaces.
They must be modified for certain regions ; for the mouth, the nose,
the ear, vagina, uterus, bladder, rectum and the foot. The surgery
of those regions requires a special technic. In the case of all
mucous membranes, in order to permit the more complete action of
antiseptic solutions, a free washing with boiled watershould be made,
to remove the mucus deposited on their surface.
The mouth is a cavity always inhabited by micro-organisms, and its
disinfection is difficult. In large animals, free washings with water,
and cleansing with solutions of boric acid (2 to 4 per cent. ), of perman-
ganate of potash (i percent.), are sufficient. In the case of dogs, loose
teeth and diseased roots should be extracted. Gums are to be
touched with a tincture of iodine or solution of creosote.
Intestinal antisepsis, employed in cases where the intestines are to
be the seat of the operation, or when manipulations are to be made
in the peritoneal cavity (laparotomy, ovariotomy, cryptorchidy), de-
mands the following precautions : purgation, low diet or milk diet,
and administration of antiseptic agents. Saline purgatives given in
small doses for several days do well to prepare the asepsis of the in-
testines ; afterwards, naphthol, betol, or creolin (50 centigrammes
io I gramme for small anihials, 5 to 10 grammes for horses and cat-
tle). Enemas of solutions of permanganate of potash (i per cent.), of
TECHNIC OF ANTISEPSY AND ASEPSY 63
cresol (i to 2 per cent. ), corrosive sublimate (i to 200), or of boric acid
(4 per cent. ), complete the antisepsis previous to the operation. Dur-
ing intestinal diaeresis, the parts taken out of the abdomen should be
spread upon warm sterilized compresses ; the peritoneum should be
kept free from any matter that may escape from the incision ; the
intestines should not be returned to the abdomen without perfect
closing of the wound, and not until after the serous membrane, round
the stitched parts, has been touched with a strong phenic acid solu-
tion, so as to give rise to slight adhesive inflammation. After the
operation, for eight or ten days, the patient should receive only liquid
food in small quantities (milk and bouillon for small animals, milk
and hay tea for the others) ; the animal should receive its ordinary
rations by degrees.
Rectal asepsis. â€” For this a low diet should be taken for several days,
and the same agents as those used for intestinal asepsis should be em-
ployed, especially the rectal irrigations. Disinfection of the anus is
accomplished as in the case of the healthy, sound skin.
Nasal cavities are rendered aseptic by washes and with sterilized
tepid water, followed by solutions of corrosive sublimate, i to 5,000,
or of permanganate of potash, i to 1,000.
The eye is an organ requiring delicate asepsis. It may be washed
with sterilized water, a boric solution, 4 per cent., cresol, i to 150-
200, or the following, recommended by Panas, for man :
Bi-iodide of mercury 5 to lo centigrammes.
Absolute alcohol 20 grammes.
Boiled filtered water 1,000 grammes.
Corrosive sublimate must be used only in very weak solutions (i to
5,000). Instruments must be sterilized, especially if the operation is
to be on the eyeball itself.
The disinfection of the auditory canal is made with weak antisep-
tic solutions. The skin is cleansed with tepid water and soap ; after
it is well dried, injections are made of boric acid (3 to 4 per cent.), of
permanganate of potash (i to 1,000), or corrosive sublimate (i to
5.000). If the secretion is abundant, it is advantageous to use pow-
ders of bismuth, iodoform, salol, or dermatol.
Antisepsis of the vagina is easy in most cases. First a soap wash-
ing of the mucous is made ; then it is thoroughly irrigated with a
boric (4 per cent.), cresyl (2 per cent.), or corrosive sublimate solution
(i to 2,000). These irrigations are repeated for several days. Instead
of a syringe, it is better to use an irrigator like that recommended
for women by Tarnier, consisting of a glass reservoir with an India
rubber tube, the extremity of which is introduced into the vagina.
Vaginal disinfection is difficult when the mucous membrane is the
seat of polypuses, ulcerated tumors, and in cases where it has been
contaminated by the putrified afterbirth.
64 VETERINARY SURGICAL THERAPEUTICS.
Asepsis of the uterus demands the same measures as that of the
vag-ina. With an India rubber tube, the uterine cavity is washed
with tepid irrigations of a harmless antiseptic sokition (boric acid
or cresol). Corrosive sublimate (i to 3,000), or bi-iodide of mercury
(i to 20,000) can be used.
With the exception of catheterism, but few operations are per-
formed upon the bladder. In this case what is important is prophy-
lactic asepsis. The dangers likely to follow urethral catheterism, as
practised to-day, have been hitherto entirely overlooked. Acute
cystitis and its numerous complications may be the consequence of
the introduction into the bladder of dirty catheters, which are never
cleaned, and are, therefore, more or less septic. Urethral probes
should be disinfected by a long immersion in a strong antiseptic so-
lution, and should be kept in special cases.
In operations on the foot, local antisepsis may be obtained as fol-
lows : The shoe having been taken off, the plantar surface is thor-
oughly cleansed, the hair is cut short upon the entire phalangeal
region, the hoof and the skin are thoroughly washed with soap and
warm water, then with an antiseptic solution, in which they are
soaked for fifteen or twenty minutes, and finally the feet are covered
with moist antiseptic compresses, wrapped in a cloth and secured by
bands of gauze. A cataplasm of linseed softens the hoof and may
be useful, providing it is prepared with a somewhat concentrated
antiseptic solution ; but for asepsis, compresses are undoubtedly bet-
Before beginning the operation the threads for ligatures and for the
sutures and the dressing materials should be placed in one bowl or
on a plate, while in others, containing the antiseptic solution, should
be kept the instruments with absorbing cotton to take up the blood.
As soon as the skin is cut the blood oozes out, and its flow in-
creases as the cut is increased ; the field of operation is covered with
it. As long as the hemorrhage takes place, extending through the
small blood vessels, the blood should be taken up by the wadding of
cotton balls, which are taken out of the antiseptic solution as they
are needed. Irrigations with a strong phenic acid solution stimulate
hemostasis, the tissues shrink, the vascular openings contract ; but
these irrigations have the objection of producing a superficial ne-
crosis. Unless infection exists, simple boiled or slightly salted water
is sufficient. When small arteries, or veins of some size, are cut
through, they are closed with the forceps or ligated with silk or cat-
gut. In most inflamed tissues an abundant hemorrhage follows,
even if there are no large blood vessels. In these cases thermo-
cautery is advantageous ; the blade, heated red hot and passed over
tlie edge of the wound, is sufficient to stop the hemorrhage. The scab
formed is very thin and aseptic, and does not interfere with cicatriza-
TECHXIC OF ANTISEPSY AND ASEPSY. 65
tion by first intention ; in fact, it may be entirely absorbed. Such is
the case also of ligatures left in the wounds ; they are digested by
the tissues, destroyed in a few* days by the migratory cells and by
newly formed elements (catgut), or are encysted and slowly ab-
If immediate reunion be looked for, every care necessary to prevent
the wound from being contaminated should be resorted to. Perfect
hemostasis and an exact closing of the wound are two essential
conditions. A thin bloody aseptic layer, interposed between the
edges, does not prevent primitive union ; tissues support it and in fact
utilize it for the process of repair ; but large clots are absorbed with
difficulty and form a ground most favorable to the multiplication of
pyogenic microbes. Raw surfaces, dried as completely as possible,
and covered with antiseptic vaseline (vaseline 50, pulverized boric
acid 5, iodoform i), are to be brought close together throughout
their whole extent, in their superficial and their deep part ; the
contact must be uniforvi and entire. When the contact does not
exist in the depth of the wound, a dead space is left, where the
blood and the serosity gather, an " antiplastic" center, where the
germs which may remain in it will rapidly multiply. In cases
where the wound involves several layers of tissues, it is necessary,
in order to keep them close together, to add to the silk or silk-worm
gut stitches on the surface, some catgut or silk sutures lower down,
held at their extremities by small rolls of gauze (quilled suture).
Washing the suture with corrosive sublimate, drying it with wadding,
and covering it with iodoform collodion or a cotton dressing, com-
pletes the operation.
In wounds, where the perfect adaptation of the edges is not pos-
sible, or in traumatism with loss of substance, one must provide for
the escape of the secretions of the wound by drainage obtained
either with one or with several rubber tubes (tubular drainage), or
with disinfected horse hair or silk-worm gut (capillary drainage), or
again with gauze (draining tent). Rubber drain tubes are mostly
used. They are secured to the lips of the wounds with thread, silk,
or hair. They allow antiseptic injection without interfering with
Such are the measures required by asepsis and antisepsis, in order
to give subjects operated upon, as nearly as can be, absolute protec-
tion against infection. And many are the superfluous details which
we have omitted.
In most hospitals for human patients, a perfect appliance of special
apparatus for disinfection, and of numberless precautions, insure,
for a certainty, the success of the operation ; the surgeon can always
obtain, when he wants it, reunion by first intention, and render
harmless the long manipulations he has to make in the abdominal
66 VETERINARY SURGICAL THERAPEUTICS.
cavity. Almost all the Veterinary Schools of Europe and of the
New World have also rooms for operations, provided with appliances
and material which make easy the practice of asepsis and antisepsis :
such as the Daviauand Vinsot apparatus, â€” mattress for casting large
animals ; special tables with metallic cover for other animals, the
Chamberland autoclave, drying ovens, fixed and movable reservoirs
for antiseptic mixtures, etc.
Fortunately, it is not necessary to follow strictly this technic,
in order to have, in the case of all kinds of animals, long lists of suc-
cessful operations, without excepting those that are performed on the
abdomen. Even in the case of man, when the operation is to be
made outside of the hospitals, the surgeon, with less complicated
means, knows how to realize a sufficient antisepsis and obtain an
"almost complete immunity.*'
Our colleagues, who have given lists of loo castrations on cryp.tor-
chids, without a single failure, have certainly not complied with all
these rules of antisepsis. Although these are very important, when
one operates in an infected center, in the atmosphere of an hospital,
with instruments "to do everything" (a tout fair'e), they may be
partly neglected for operations performed under more favorable cir-
cumstances, either in cities or in the country. Without such abun-
dance of instruments, of vases, antiseptic agents and materials for
dressings, conditions of asepsis can be realized, sufficient to insure
satisfactory results in operation. There are, besides, circumstances
in which a surgical interference must be immediate, in which the
patient cannot be saved except by an operation made immediately,
and that, too, with whatever means one may have at his command.
In such cases, let us see how to proceed : The operation should
be performed under a shed or in the open air, without neglecting to
utilize the "sterilizing action of the sun." One should see that dust
raised by the struggles of the animal be not permitted to accumulate
in large quantities over the field of operation ; to do this a light
sprinkling of the bed is an excellent precaution (Moller.) Two large
basins should be used to prepare a solution of common salt (6 to 7 per
cent) in boiled water. The region to be operated upon, clipped or
shaved, should be well scrubbed with soap or with a rough towel,
then washed with the salted water. After cleaning his nails, the
surgeon should wash his hands and forearms with the same solution
and soap. An earthen bowl passed through the flame of the alcohol
lamp should be used for the ablutions during the operation.
The instruments should be disinfected by passing them through
the flame of an alcohol lamp, or a wax candle, or that of a straw
fire, etc., or by dipping them for 5 or 10 minutes in a boiling solution
of carbonate of soda (i per cent.) Boiling salt water will be used to
disinfect the towels, threads, oakum, etc.
TECHNIC OF ANTISEPSY AND ASEPSY. 6";
The wound to be operated upon must be protected by a dressing.
It should be covered with layers of wadding- or oakum, arranged as
the case demands, and secured with bands. For operations upon
the foot, the general wrapping that we have been using for about lo
years is far superior to the ancient "pads" supported by patholo-
gical shoes made ad hoc.
Dressings applied to the superior regions of the extremities should
be moderately tight, or cover the entire part situated below the seat
of the lesion, so as to avoid gangrene and the arrest of the circulation.
The first dressing is very important ; often it decides the progress
of the wound. It should be left in position a variable length of
time. If the general condition of the patient is good, the traumatic
fever moderate, the hyperthermia little marked; and if, besides, the
dressing remains dry, it should not be renewed under 12 or 15
days in winter, 8 to 10 in summer. The band or gauze should be
taken off and then the superficial layers of wadding in succession ;
if under these the others adhere to the skin, they should be softened
or detached with a tepid antiseptic liquid. If it be a foot dressing,
the whole should then be soaked in a pail and the skin should be
carefully cleansed with wadding or cotton.
In the cases where immediate union has been obtained, in general,
the wound is cicatrized when the first dressing is removed ; if it only
be in good condition, a second dressing is put on with the same
attentions as for the first. Mechanical interferences and stretchings
â– of the edges should be avoided ; if one or several drains are in the
wound, they should be replaced after having been disinfected, or
should be changed for others smaller. When the wound suppurates,
the sutures should be cut, the drains taken out and free antiseptic
irrigation should be made ; and to avoid injuries to the granulating
surface and inoculations of a post-operative nature, at times a new
dressing, with or without drainage, is applied ; at others the wound
is left uncovered, protected only by antiseptic liquids and powders ;
the latter absorb the secretions of the wounded surface, prevent the
pullulation of germs and diminish the absorption of toxic products.
Various modes of treatment present themselves when local com-
])lications (abcesses, undermining, phlebitis, lymphangitis, necrosis,
caries) have occurred. This is not the place to consider them. Let
us say, however, that continued bathing in warm antiseptic solutions
acts marvelously with the infected wounds of extremities, and that
atomizing with the same solution is excellent for disinfecting anfrac-
tuous parts of the regions where bathing is not possible. With
wounds of a bad nature, exposed necrosis, or fistulae, one may utilize
with advantage the steam atomizer of Championniere (fig. 33).
Generally, in veterinary medicine, antisepsis must be simple and
not costly ; but no matter what the expense may be, it must be
VETERINARY SURGICAL THERAPEUTICS.
carried out in penetrating wounds of the thorax, of the abdomen-^
articulations, tendinous sheaths, tendinous lesions, or of the carti-
lages or bones. What we must expect of it is to protect our patients,
wounded or operated upon, against serious infectious complications
of wounds ; but the unfavorable conditions under which we ordi-
narily perform the operations, and the restlessness of most animals,
render uncertain the cicatrization by first intention of wounds of
Fig- 33 â€”Lucasâ€” Championniere's atomizer.â€” 5, boiler; //, spirit lamp ; Z*, vase containing the anti-
And although it be not necessary to make use of asepsis and anti-
sepsis as strictly in the country as in hospital centers, wherever one
uses the bistoury they must not be entirely ignored, as in such
cases the omission would be the more blameworthy the better the
serious possible consequences are known. Everywhere to-day, as
in days gone by, when we commit that error, the small incision in
the skin is a door open to infection and to death. If Ave cannot com-
ply with all the exigencies of antisepsis, at least we must observe its-
great rules â€” operate with cleanliness, and do not injure the patients.
That is the first precept of the art : Prinio non nocere.
To reduce to the minimum the hemorrhage that takes place durhig
5111 operation, and to guard against that which may follow, are im-