portant rules of general surgery. The red sheet formed by the
blood flowing from the small divided tissues veils them and also
the organs that the instrument must spare ; and although it obliges
the operator to stop his work frequently, it has no serious conse-
quences. On the contrary, arterial or venous hemorrhages may
produce abundant waste of blood ; if they occur secondarily and are
not promptly averted, often they are followed by death. They must
be prevented or attended to in order to stop them definitively. Per-
fect hemostasis is peculiarly important in the operations upon the
abdominal organs ; if blood escapes in a great quantity in the peri-
toneal cavity, the inflammation of the serous membrane is a compli-
cation seriously to be looked for. And, generally, when blood
accumulates on wounds after the closing of their edges or the appli-
cation of a dressing, suppuration takes place, and the production of
general disorders of an infectious nature is greatly assisted.
I. Preventive or Pre-operatory Hemostasis. â€” It is used princi-
pally for operations upon the extremities. In the case of animals,
digital pressure, tourniquets, or compressors are seldom employed.
Ligatures and the Esmarch process are the usual expedients.
For horses, ordinarily, circular and total constriction of a leg is
made with a loop of cord, placed round the fetlock or the coronet,
and is twisted several times round the parts or submitted to a torsion
made with a piece of wood acting as a tourniquet. The strong-
pressure made upon the vessels, where the cord is applied, cuts off
the circulation, and the hemorrhage soon stops. This ligature has
another effect besides. The conductibility of the compressed nerves
â€¢is less free, the sensibility of the regions situated below the ligature
is diminished, and the pain of the operation is thus much reduced.
Striction with an India-rubber tube or band is less primitive and
less brutal. Take a strong tube, 50 or 60 centimeters long, stretch
it in rolling it round the leg above the knee or the hock, tie both
ends together or secure them with a strong thread (fig. 34). Hemo-
static India-rubber bands and tubes are made with a metallic hook
and eye, by which they can be well secured in making the proper
The method of Esmarch is advantageous, when, having to ampu-
tate a leg (small animals), or to excise organs highly hyperaemic
((prolapsed uterus), one wishes to operate on dry tissues. The in-
VETERINARY SURGICAL THERAPEUTICS.
ventor made it known in 1873, under the name oi artificial iscliceniia.
It consists in the use of an elastic band (plain or covered rubber),
which is rolled round the leg or the mass to be removed, beginning-
at its free end. The spirals of the band, touching or partly covering
each other, must exercise upon the tissues a strong pressure, which
pushes back by degrees the blood towards the trunk.
When the blood has been pushed out of the parts which are to be
excised, a strong India-rubber cord is tied below the band, which.
Fig. 34.â€” Preventive hemostasia. Rubber ties applied above the knee and the hock.
pressing upon the arteries, closes them, and, therefore, acts as a
garrot. The band is then removed and the operation is performed
below the cord without blood. In this process, two hemostatic
means are used: the artificial ischaemia, obtained by the centripetal
pushing of the blood, which is thus kept in for the organism ; and
the striction, which keeps the tissues bloodless by preventing the
flowing of the arterial blood, and thus insures a bloodless operation.
When the part which is to be submitted to Esmarchizaiioii is the
seat of a wound, more or less extensive, this must be covered with
a coat of wadding or a compress, which is placed under the band.
When the operation is terminated, the blood-vessels are ligated and
the constricting rubber cord removed. Often then, if the stump has
not been cauterized, through the small arterioles and numerous
divided capillaries, an abundant hemorrhage spreads over it, which
is due to a vasomotor paralysis, the effect of the prolonged com-
pression. This hemorrhage is arrested with cauterization, cold irri-
gations, phenicated lotion, or by a compressive dressing.
In general practice, the Esmarch method is not rigorously applied.
Often only the circular constriction is used. Generally speaking, it
is better to use it when the tissues are seriously injured or infiltrated
with pus or infectious liquids, which, crushed in by the compressors,
might give rise to serious accidents ; but as the hemorrhage is some-
times very abundant on account of the venous stasis, it may be re-
duced by the application of a second constricting cord to the other
end of the region to be operated upon.
Mediate compression, with the fingers, of the principal arterial
trunk, which distributes blood to the parts to be operated upon, is
seldom used ; if it is employed, it must be kept up until complete
hemostasis is definitely obtained. During the operation it can be
suspended in cases where the ends of the divided arterioles are hard
to find ; small spurts of blood then indicate their location. When
the garrot has been used, it is sometimes useful for the same reason
to diminish the constriction.
A strict diet for twenty-four hours before an operation is also a
means of reducing the hemorrhage during bloody operations.
II. Hemostasis During and After the Operation. â€” Most of the
processes mentioned above are only applicable to a limited number
of regions ; and often, during the progress of an operation, the blood
flows freely from numerous small divided blood-vessels, veins or
There is only a slight hemorrhage, or none at all, when one has
recourse to the processes for bloodless exaeresis : actual cauteriza-
tion, thermo-cautery, galvano-cautery, caustics, linear crushing, tear-
ing, elastic ligature, etc.
As an excellent means of hemostatic diaeresis, actual cautery is,
also, often used to make punctures or remove tumors. It has been
abandoned for the destruction of neoplasms, since it seldom gave
good results : under the scar produced by the cauterization, the
irritated tumor would grow again. The red-hot iron, worked like
a bistoury, is still used to make some excisions. When carried to
white heat, it cuts the blood vessels too rapidly, and their oblitera-
tion is then incomplete ; if it is only dark red it cuts them, at the
same ti'me stimulating the retraction of the coats of the vessels ; so
that this heat is the proper one to obtain good hemostasis. Intro-
duced into the tissues, the actual cautery soon cools off ; and its
repeated application is necessary to divide a layer of tissue or excise
a tumor. On that account, the thermo or galvano-cautery are better
instruments ; with the zoocautery one can make punctures, deep
incisions, and excisions, without hemorrhage.
The ecraseur of Chassaignac, almost unused now by surgeons for
VETERINARY SURGICAL THERAPEUTICS.
mankind, is of frequent use in veterinary practice. It squeezes,
crushes, and divides soft tissues, somewhat like a saw. Mucous
membranes, connective tissues, muscles, blood vessels, fibrous
layers, and neoplasms give way to the progressive striction of the
ecraseur, and are cut without hemorrhage, if the instrument is worked
with the proper slowness. Its action is principally remarkable upon
blood vessels : the middle and internal coats of the arteries are
ruptured and retract upon them-
selves, while the external coat
stretches and closes the open mouth
of the vessel. Too rapidly made,
the division does not prevent hem-
orrhage ; but if one acts slowly, if
the cutting of the tissues is made by
gradual shortening of the chain, every
30 or 50 seconds of time, according
to the degree of vascularity, there is
scarcely any flow of blood. The
pain, which is very great when the
tissues are strongly compressed, sub-
sides as soon as the division begins.
In general, the wcnmd of such cut-
ting cicatrizes a little more slowly
than that made with the bistoury :
the anatomic elements of the super-
ficial layer undergo a process of
The process of tearing is princi-
pally used in the removal of tumors
well defined, with little adhesion to
the surrounding tissues. The skin
being incised, the neoplasm is is-
olated either by digital pressures
or tractions made with the hands,
vi^hich separate the parts in tearing the connective tissue ; or by
giving to the neoplasm movements of traction and of torsion ; or
by combination of the two modes. Although /eizr/^jo- is advantage-
ous in this, that it permits of saving the principal blood vessels and
nerves, it is generally very painful in regions rich in nerve rami-
fications ; it does not allow the complete removal of invading ne-
oplasms, extending to the lymphatics, and leaves "roots for new
growths, "which give rise to secondary tumors.
Dull dissection, the enucleation of Percy, is made with the dull end
of a directory or spatula. The directory is generally used, with
which the connective tissue is torn and isolated without danger of
Fig. 35.^Chassaignac's ecraseur.
hemorrhage. This is an excellent process when one has to operate
in regions of dangerous structure. It is especially used to isolate
blood vessels (ligature of the jugular) and nerves (neurotomies).
Wounds made by tearing and by enucleation behave as those made
with the bistoury ; they cicatrize nearly as easily and as quickly as
Scraping is made by removal with the drawing knife or the sharp
curette. It permits the excision, with little hemorrhage, of the
granulations and fungosities which line fistulous tracts and walls of
suppurating cavities, and the scraping of carious bones.
The various modes of ligature are frequently employed to obtain
the mortification and elimination of tumors, and of organs, in part
or in toio (vagina, uterus). The best of these is the elastic ligature.
But these means of exseresis are useful only in a limited number
of cases. It is the bistoury which is generally used ; and often it
divides tissues in which preventive hemostasis could not have been
realized. Then the blood flows, in a stream or by spurts, as the
instrument divides small blood vessels or arterioles.
Capillary hemorrhages ordinarily stop spontaneously ; the very
small vessels are depressed by the retraction of the tissues, and
their microscopic mouths are soon obliterated. If the hemorrhages
continue in streams, they can be arrested by affusion of cold boiled
water, made with aseptic sponges or compresses, held up above the
wound, and gradually squeezed. More active are the lotions with
solution of alcohol, phenic acid or corrosive sublimate, which pro-
duce a peculiar "pickling" of the living surfaces, coagulate the
liquids, and, in general, rapidly correct capillary exudations. A
strong phenic acid solution is the most advantageous. Not to be
disturbed by these flows of blood, one must be careful to have pre-
pared lots of little balls of cotton which have been dipped in an
antiseptic solution. An assistant using these successively, after
having squeezed them to rid them of the solution, should soak up
the blood, dry the surfaces, and thus allow the surgeon to see clearly
the parts upon which he is operating. Among the hemostatics of
old surgery now out of fashion we may mention : snow, ice, ether,
chloroform, alum, metallic sulphates, perchloride of iron, nitrate of
silver, vinegar, Rabel solution, the numerous " hemostatic washes,"
the absorbing powders, â€” flour, ashes, agarics, amadou, and the
dangerous spider web.
When arterioles, small veins or canals of larger caliber are divided,
one can arrest the blood by using compression or plugging, cauteri-
zation, ligature, torsion, or " yorcipressure."
Compression is useful in cases where one has no time to look for
the end of the cut vessel. It is performed, as aforesaid, in tlie
neighborhood of wounds or upon one of its lips, by pressing with
74 VETERINARY SURGICAL THERAPEUTICS.
the finger or a ball of cotton the part where the blood vessel is
situated. It is rarely sufficient to produce definitive hemostasis.
When the operation is ended, other hemostatic means must be used.
Cauterization of raw surfaces and of vascular stumps is hemostatic
only by making a more or less thick scab, great inflammation, and
Ligating of Blood Vessels is made with silk threads or catgut. In
excisions, when a visible and isolated artery has to be divided, two
ligatures are applied upon it, between which the cutis made. If the
blood vessel â€” -artery or vein â€” is divided by accident, the ends are
secured with forceps or a tenaculum and tied up with a straight
knot. Constriction made upon an artery has the effect of dividing
its middle and internal coats, which, curving inwards in retracting,
close its mouth. The external wall shrinks, rests upon itself, and
does not give way for several days later. When catgut is used, the
ends of the ligature can be cut close to the knot ; with silk thread
only one of the ends is cut close to it, the other is brought outside
of the wound, to be pulled away with the rest of the thread when
the division of the blood vessel is complete. Hemostatic forceps
wnth broad jaws, conical or cylindro-conical, are very handy to
make these vascular ligatures. It is to immediate ligature that one
must give preference. In the cases where that is impracticable,
where the ends of the vessel are concealed deeply in the tissues, and
difficult to find, mediate ligature is resorted to. With a curved
needle, a thread is passed round the blood vessel and the soft tissues
surrounding it, and is secured with a straight knot.
Torsion, recommended by Amussat and more recently by Tillaux,
may take the place of ligature for arterioles and veins of small
caliber. With forceps, the bleeding stumps are taken hold of, gently
drawn out of the tissues and twisted. The illimiied torsion of
English surgeons consists in twisting the blood vessels until they
are torn apart. The effects are similar to those of the ligature, the
external coat forming a kind of cap which covers the clot formed,
and fixes it firmly. Ligature is surer than torsion ; in arterioles of
some caliber, the cellular coat may untwist and a secondary hemor-
Th.e /orcipressure has distanced all other hemostatic processes. It
consists in applying, upon the ends of the divided blood vessels,
fixed forceps, which are left for a variable length of time, either
until the blood vessel is closed by a clot, or only until the end of
the operation, when permanent hemostasis will be realized by the
Recommended by Koeberle and Pean, multiple forcipressure is
now used everywhere, as a means of temporary or permanent
hemostasis. Among excellent forceps recommended, those of Collin
are best and strongest (fig. 36). Their jaws are conical and dentated.
When, during an operation, the blood suddenly escapes from the
mouths of a divided artery, an assistant takes hold of them with the
forceps, and keeps them off the field of the action of the bistoury.
With these forceps, dia-resis upon vascular structures can be made
without arrests and without noticeable escape of blood. They can
be applied in various numbers, as they are required ; all are left in
place until the end of the operation ; they are pressed upon the small
arteries for a few minutes only, and when they are taken off the
hemorrhage has stopped. If large vessels have been divided, their
ligature can be readily made. At times the forceps are left long
Fig. 36.â€” Forceps.
enough to produce a permanent hemostasis ; when, for instance,
they have been applied upon deeply situated blood vessels, difficult
to isolate and ligate. They are then fixed between the various
pieces of the dressing or between the lips of the wound. They are
removed after 24 or 48 hours, according to the size of the blood
vessels they served to obliterate.
The necessary forceps, threads, and all objects used, must be
made antiseptic, an indispensable condition to obtain cicatrization by
first intention, or if one wishes to avoid accidents by infection.
For wounds of cavities whose walls bleed abundantly, phtgging
with lodo/ormed gauze is also a good way to obtain hemostasis after
76 VETERINARY SURGICAL THERAPEUTICS.
Elaslic ligature is an excellent means of hemostatic exeresis. Used
"first in human surgery (Dittel, Grandesso Silvestre), it was afterward
tried in veterinary by Guerin, Rossig-nol, Nocard, Cagny, who have
studied its principles and modus operandi. If it be applied to a
certain thickness of living tissues, the stretched India-rubber cord
acts in a constant manner, as long as it has not returned to its
primitive dimensions ; in proportion as the tissues are divided, the
loop diminishes in diameter and produces its dieretic action upon
the deep layers. This is a great advantage over the simple ligature,
whose brutal, immediate action becomes weaker quickly and is ex-
hausted when reaching large peduncles. As soon as the superficial
layers are divided, the cord acts only as a foreign body ; to com-
plete the ablation, it is often necessary to apply a second ligature or
to tie up the first.
The elastic loop is without action upon inert bodies, even the less
resisting, or upon dead substances, but it rapidly divides the Hying
ones ; skin, muscles, blood vessels, tendons, and bones. Nothing
resists it, and the diaeresis is made without hemorrhage ; the walls of
the blood vessels collapse before they are divided, and this cavity
is obliterated by thrombosis. Cicatrization is quick ; and often the
wound is relatively small. Its uses are numerous : its application
, is simple. A vulcanized tubular, or firm, cylindrical, or prismatic
cord, of a size proportioned to the mass to be divided, is used. An
assistant holds one end, the operator seizes the other, stretches the
cord, rolls it round the peduncle ; three or four times are sufficient ;
and, to fasten both ends, crosses them, passes them to an assistant,
and passing an ordinary thread under their crossing, fastens them
well together with a straight knot.
For the extirpation of tumors, when the neoplastic mass has a well
defined peduncle, the application of the elastic loop is easy. When
the tumor is wide and not well defined, it is proper to pierce it through
with one or two metallic needles to secure the fixity of the ligature.
Rossignol has succeeded in obtaining in fifteen days the slough of a
tumor from the shoulder, having a diameter of 20 centimeters and
weighing t6 pounds; and in twelve days, that of a growth of the
hock weighing 3 kilog. Other analogous facts have been recorded.
Since the experiments of Rossignol and Cagny, the castration of lambs
with elastic ligature is much practised. 2000 animals, 2 and 3 months old,
were castrated, during warm weather, by Rossignol, with only 3 cases of
tjtanus. This process is evidently superior to " tearing." It is also good
for cattle.* In Egypt, in 1885, Piot operated upon nearly 2,oco bulls and
buffaloes, without an accident or complication of any kind. Disinfection of
the scrotal region, soaking of the cord in the Van Swieten solution; after-
wards, antiseptic washes, after six or eight days cutting away of the morti-
* We have successfully castrated two llamas belonging to the Zoological Garden of New York, and
4hree camels of the famous Barnum & Bailey Menagerie, with the use of the elastic ligature. (T.)
CAUTERIZATIONâ€” FIRING. 7/
fied tissues, and application on the stump of a coat of tar, previouslv
submitted to boiling; such are the precautions to be observed.
Generally, those operated upon can resume their work towards the
fifteenth or twentieth day.
Elastic ligature has . been tried for the castration of solipeds.
Applied upon the exposed spermatic cord, as in the uncovered
process, the rubber ligature amputates the testicle in two ox three
days. But serious complications (tetanus, septicaemia, peritonitis)
have been so common, that this mode of castration has been rejected
in ordinary practice. In 1880, out of 20 castrations, Tapon had
5 deaths. Pinel says, he was more fortunate in tying the ends of
the rubber with a piece of twine. In this way, the spermatic cords
can no longer be drawn vip into the inguinal canals, so rich in con-
nective tissue, and on that account so easily inoculated. Using an-
tiseptic measures, this veterinarian had only one serious accident
out of 400 operations. The application of the rubber cord over the
skin, is followed by the slough of the testicle in 3 or 4 days ; but
there is a large wound remaining (Cagny).
Elastic ligature has other uses. When, in prolapsus of the uterus,
the organ cannot be reduced, or is the seat of extensive lesion, a
strong rubber ligature can be applied at its base, the organ amputated
below it, the stump thoroughly disinfected and then returned into
position. All hemorrhage can be prevented by the application of
the Esmarch bandage before the prolapsed uterus is amputated.
Cagny has recommended elastic ligature for the amputation of the
tail of a horse. The most painful part of this operation is not the
section of the tissues, but the cauterization ; and in certain breeds
of horses, the application of the red hot iron gives rise to violent re-
actions. One may avoid the cauterization by placing, before the
amputation, an India-rubber ring immediately above the place where
it is to be made. Some say it must be left on for eight days, but it
may be taken off after 24 or 48 hours. Its use in our hands for removal of
large cap. elbow, has not given us good results, on account of the large
wound left after the sloughing of the growth, which in one case required no
less than three months before complete cicatrization occurred. Elastic
ligature has also been used to obtain temporary hemostasis in bloody
operations upon the extremities.
We shall not stop for the consideration of cauterization with chemical
agents. This was much practised in former times to slough altered struc-
tures or to destroy neoplasms; to-day it is almost abandoned. It is a long,
painful process, and is not even good f )r most tumors; under their super-
ficial layers when destroyed, the irritated neoplasm grows, granulates, and
VETERINARY SURGICAL THERAPEUTICS.
spreads. A few cutaneous benign tumors, rebel ulcers and "canker" of
the foot represent about the only actual calls for its use.
From the beg-inning- of the art, at Cuidus and at Cos, actual
cauterization was believed to be the most energetic therapeutic
agent. Hippocrates thus spoke of it in one of his aphorisms :
"What drugs do not cure, fire will ; what is not cured by fire can
be looked upon as incurable.'' ' After having been used largd manu,
cauterization was ignored for many centuries. Solleysel rehabilitated
it for our patients, and laid down its first rules in his '' Par fait
MareschaV (1664.) "To well apply firing, three things must be
observed : ist, That the one who applies operate with light hand, and
does not press too heavily upon the skin with the iron knife ; 2d, that
the instruments be only at a red and not a white heat ; 3d, that
they be heated only with charcoal I have had firing
applied hundreds of times in many places with great success ;
horses have always been benefited by it It is of great
importance to prevent the horses from scratching, rubbing, biting or
licking the cauterized parts, since no matter how well the operation
has been performed, if these precautions are not taken, the parts will
be deformed In firing, unless it is absolutely necessary,
and then never in other than the necessary places, should the skin
be cut ; it should be cauterized by degrees without hurry, until it
has taken a sherry color. . . . Time is necessary to fire well ;
and it gives better results if the firing is done with irons moderately
hot, passed five or six times in the same line, than with very hot
irons which cut through at once or burn only the hair, as blacksmiths
do When firing is finished, one may spread over the
cauterized parts a layer of lard or of yellow wax, melted and mixed
with melted black pitch ; after nine, ten, or twelve days, all is
washed every day with alcohol Every one has his way
of firing ; some make use of silver knives, others of brass or copper