THE PRACTICE

OF

VETERINARY SURGERY

By JNO. A. W. DOLLAR, M.R.C.V.S.

Corresponding Member of the Central Society of Veterinary Medicine of Paris;

Life Member of the Royal Italian Society of Hygiene;

Corresponding Associate of the Royal Spanish Society of Hygiene;

Corresponding Member of the Society of Veterinary Medicine of Brabant {Belgittm)

Honorary Associate of the Spanish Society of Arts; etc.

VOLUME I

OPKRATIVK TECHNIQUE

New York:

WILLIAM R. JENKINS

VETERINARY PUBLISHER AND BOOKSELLER

851 AND 853 Sixth Avenue

1902
[All Rights Reserved^

PREFACE.

Ten years ago, whilst studying in Milan, I was invited to undertake
certain duties as demonstrator and teacher at the Royal Veterinary
College, London. Although finally I was unable to accept the terms
of invitation the proposal so far influenced me as to bring about a
species of mental stock-taking, the first result of which was the
discovery of my own lamentable ignorance regarding much that I
had been asked to impart to others ; the second, a resolution to
amend this state of things as soon and as thoroughly as possible.
The work I then undertook has been helpful to myself, and I have
reason to believe that the portions published have not been without
value to others. The present effort is perhaps of a more ambitious
character than its predecessors, and aims at furnishing English
readers with a concise account of the most recent views regarding
the practice of veterinary surgery from the standpoint of both British
and Continental authorities. It will be divided into three volumes,
of which this is the first ; the second volume will deal with General,
and the third with Regional Surgery. The second and third volumes
are now in hand, and I trust that one, at least, may be published
shortly. Regarding that now submitted, however, I trust no one
will be deceived into ascribing to me greater merit than I possess.
Veterinary science has become too specialised for any writer to rely
solely on his own experience, and, like many much more eminent men,
I have found my chief usefulness less in enlarging than in rendering
available existing stores of knowledge. It is true I have satisfied
myself to the best of my ability of the soundness of the views put forth,

VI

PREFACE.

and I desire to be held responsible for everything I say, but otherwise
my position is really no more than that of an expositor.

On the other hand, my indebtedness is manifold. For the use of
illustrations, and for leave to extract such portions as seemed suitable
from his masterly ' Operationslehre,' I have to express my deep obligation
to Professor Dr. Bayer, of the Vienna Veterinary School. I have taken
full advantage of his permission. For information in regard to French
practice I have frequently had recourse to Professor Cadiot's * Traite
de Therapeutique Chirurgicale/ while I have received much assistance
from Professor Lanzillotti-Buonsanti's ' Trattato di Tecnica e Tera-
peutica Chirurgica degli Animali Domestici ' and from the ' Lehrbuch
der Chirurgie fur Thierarzte ' of my old friend and esteemed teacher
Professor Dr. Moller. Regarding human practice I have consulted
the well-known ' Manual of Surgery ' of Messrs. Rose and Carless.

The extent to which I have been able to illustrate the work is due
in no small degree to the liberality of Herr H. Hauptner, Luisenstrasse,
Berlin, and of Messrs. Arnold, West Smithfield, London, two of the
largest veterinary instrument makers in the world.

Once more I have the sincere pleasure of expressing to Professor
Macqueen, of the Royal Veterinary College, London, my gratitude
for greatly valued assistance in reading proof-sheets, for general
criticism on disputed points, and for never-failing support and
encouragement in prosecuting the work now concluded.

JNO. A. W. DOLLAR.

56, New Bond Street,

London, W. ;

March, igo2.

CONTENTS.

CHAPTER I.

PACK

General Remarks on Operations. — Their limitations, classification, method of
planning, preparations previous to and selection of place for, assistance required,
after-treatment . . • • • • • I

CHAPTER II.

Means of Control. — The blinds, muzzle, operating hood, bulldogs, nose and leg
twitch, loop and bridle twitch, bull-holder and leader, nose rings, mouth-gags
for horses and dogs. Restraint by fastening a fore to a hind leg, by lifting a
fore or hind leg, by securing both hind legs, the hippo-lasso. Methods of fasten-
ing oxen — The side-stick, the " cradle" or "beads," the stocks or trevis, operating
tables, casting with a cart rope, casting with hobbles, cross-hobbles, apparatus to
prevent broken back. Continental methods of casting (various), securing and
releasing limbs (various methods), Russian method of casting single-handed, the
back-strap. Securing cattle, sheep, swine, dogs, and cats for operation. Operating
tables for small animals. Cumplications attending casting, etc.

CHAPTER III.

Anaesthesia. — Introduction, historical and general.

(a) General Ancesihesia. — Anaesthesia in the horse. — -Chloroform — Partial anaes-
thesia by chloroform, surgical anaesthesia by chloroform. Apparatus and
methods — Morphine and chloroform, ether, chloral, chloral and morphine,
morphine, methylene. Anaesthesia in ruminants and swine — Chloroform,
ether, chloral, morphine, chloroform and morphine. Anaesthesia in the
dog and cat — Ether, chloroform, morphine with ether or chloroform, mor-
phine and chloral, chloroform with atropine and morphine, other methods.
Conclusions regarding general anaesthesia. Surgical anaesthesia by the
injection of cocaine into the lumbar subarachnoid space.

(i) Local Anaesthesia. — Local anaesthesia by cold — Ice and salt, ether spray,
bisulphide of carbon, methyl bichloride and anestile. Local anesthesia by
cocaine. Local anaesthesia by infiltration — Schleich's and other methods . 44

viii CONTENTS.

CHAPTER W.

PAGE

Antisepsis and Asepsis. — Historical ; Lister and Guerin's experiments, the anti-
septic and aseptic methods. Disinfection previous to, during, and after operation,
sterilisation of dressings and instruments. Antiseptics ^Carbolic acid, sublimate,
chloride of zinc, permanganate of potash, biniodide of mercury, iodoform, di-
iodoform, salol, cresyl, formalin, chinosol, nitrate of silver, boric acid, naphthol.
Antisepsis and asepsis in practice, disinfection of hands and instruments,
" aseptic " instruments, modes of preparing or disinfecting sponges, tampons,
compresses, suture and dressing materials. Disinfection of the field of operation,
of the mouth, intestine, nasal cavities, eye, external auditory meatus, vagina,
uterus, and foot. First dressing after operation . . . -71

CHAPTER V.

Division of Tissues. — Cutting and puncturing instruments and methods of using
them. Division by ligature, by the ecraseur, by the thermo-cautery. Puncture
— The bistoury, scalpel, and lancet, the trocar, suture and exploring needles.
Division of hard tissues — The farrier's knife. Bone drills, chisels, saws, and for-
ceps. The curette . . . . . . .94

CHAPTER VI.

Setoning. — Its value, positions for inserting setons, methods, seton needles and

rowelling scissors, " rowels," " issues," or " plugs " .... 107

CHAPTER VII.
Inoculation. — Its applications, instruments, and methods . . .112

CHAPTER. VIII.

Cauterisation. — Chemical caustics — sulphuric, nitric, and hydrochloric acids, caustic
potash, sublimate, arsenious acid, chloride of antimony, chloride of zinc, nitrate
of silver. The actual cautery. — Firing — Needle, point, and line firing, Degive's
firing iron, the zoo-cautery, Dechery's automatic cautery, the automatic petroleum
furnace. Antiseptic firing. Precautions to observe in firing, the three degrees of
cauterisation. " Bud " firing, deep (point) firing, penetrating firing of synovial sacs,
subcutaneous firing. After-treatment, the results of firing. Complications and
their treatment ......

CHAPTER IX.

'15

Methods of Uniting Wounds.— Healing by first intention. Methods of uniting
wounds — Adhesives, hooks, pincettes, bandages, sutures. Suture needles and
material — Silk, silkworm gut, catgut, horsehair, and wire. General directions
for inserting sutures— Preparation of the wound, kind, number, and size of
sutures, position and mode of implantation. Uniting or coaptative, and tension
sutures or sutures of relaxation, the interrupted suture, Bayer's suture, continuous
or glover's suture, figure-of-8 or pin suture, "quilled" and "button" sutures,
bowel sutures, tendon sutures, nerve sutiires , . , , 131

CONTENTS. IX

CHAPTER X.

PAGE

Phlebotomy, Scarification, and Transfusion. — Reasons for and results of blood-
letting. Instruments— The lancet, hand and spring fleams. Bleeding the horse
and ox. Complications during and after operation and the methods of dealing with
them. Dieckerhoff's bleeding cannula. Bleeding sheep, goats, swine, etc. Scari-
fication. Transfusion . . . . • ■ '45

CHAPTER XI.

Methods of Preventing or Controlling Haemorrhage — Haemostasis. — Natural
checks against bleeding. Methods of blood-clotting; red and white clots, organ-
isation of clot. Haemostatic agents — Cold, heat, styptics. Mechanical methods
of controlling haemorrhage — Esmarch's bandage and its modifications, dividing
blood-vessels by the ecraseur, tearing, blunt dissection, compression of vessels,
ligation. Methods of ligating arteries — The surgical knot, torsion, forcipressure,
acupressure, the elastic ligature . . . . 159

CHAPTER XII.

The injection of medicines into the blood-stream, subcutaneous tissue,
trachea, oesophagus, larynx, or parenchyma of organs or tissues. — Intra-
venous injection — Instruments and methods, selection of suitable medicaments.
Subcutaneous injection — Instruments, methods, and medicaments. Intra-tracheal
injection — Instruments, methods, etc. Parenchymatous injection . ■ i?'

CHAPTER XIII.

Bandaging and Dressing. — Bandage and dressing materials, mode of application,
precautions required, forms of bandages (twenty-eight figures) ; starch, glue, pitch,
water-glass, plaster, and tripolith bandages . . . .177

CHAPTER XIV.

Massage. — Varieties, preparations for, action and results of, conditions in which

massage is indicated, and methods of application . . . .190

CHAPTER XV.

Castration. — Definition of. Castration of male animals. Anatomy. Castration
without removal of testicles — Crushing the testicle, crushing the spermatic cord,
torsion of the spermatic cord, subcutaneous ligation of the cord. Castration
by removal of the testicles : dangers of this method — Haemorrhage, infective
inflammation, prolapse of bowel. Methods- — Tearing away of the testicle, scraping
the cord, crushing by the ecraseur, torsion of the cord (various methods), ligation
of the cord, simple division of the cord, division of the cord by the cautery,
castration by clams. Castration of stallions (detailed description of various
methods, including the " standing operation," castration by clams, " covered,"
" uncovered," and " semi-covered " operations, torsion of the cord, castration with
the ecraseur, ligation of the cord, and aseptic castration). Complications and
sequelae.

X CONTENTS.

Castration {continued) — page

Castration of male ruminants, castration with exposure of the testicle, " bis-
tournage," the "caustic ligature," tying the cord. Castration of sheep and goats,
castration of swine, castration of cats and dogs, castration of male birds, caponing,
etc. Complications during castration of male animals — Adhesion of testicle to
the tunica vaginalis, prolapse of omentum, prolapse of bowel, entrance of air
into the abdominal cavity. Unfavourable consequences of castration of male
animals — Bleeding, excessive swelling, castration fever, septic fever, peritonitis,
prolapse of spermatic cord, abscess formation. Treatment of such complications.
Castration of cryptorchids. — Disea.se and retention of testicle in abdominal
cavity, diagnosis of cryptorchidism, inguinal and abdominal cryptorchidism,
anatomy of the subject, inguinal and ventral operation for retained testicle. The
inguinal operation — Incision, opening the inguinal canal, perforation of the abdo-
minal walls, finding the testicle. Complications during and after operation. The
ventral operation, method and results.

Castration of female animals (oophorectomy), reasons for. Charlier's opera-
tion for cows and its modifications. Instruments, methods, and results. Castra-
tion of mares (full description), castration of sows from the flank and from
the linea alba (full description), castration of bitches, castration of birds . . 196

BIBLIOGRAPHY

'Allgemeine Chinirgie,' Frohner.

' Handbuch der thierarztlichen Arzneimittellehre,' Frohner.
Journal of Comparative Pathology and Therapeutics,'
' Lehrbuch der allgemeinen Chirurgie,' H. Moller.
' Manual of Surgery,' Rose and Carless.
' Operationslehre,' J. Bayer.
' Precis de Chirurgie,' Peuch and Toussaint.
' The Veterinarian.'
'The Veterinary Journal.'
'The Veterinary Record.'

' Traite de Therapeutique chirurgicale,' Cadiot and Almy.
' Trattato di Tecnica e Terapeutica chirurgica,' Lanzillotti-Buonsanti.
'Veterinary Medicines,' Finlay Dun-

CHAPTER I.

GENERAL REMARKS ON OPERATIONS.

The word operation covers all mechanical interference undertaken
for surgical purposes. Perfect restoration of function being usually
demanded in veterinar}^ surgery, many operations common in human
practice must either be renounced or very seldom performed, partial
recovery being worse than useless from the owner's standpoint. It is
therefore often necessary to consider whether operation is justified or
whether slaughter be not preferable. Owners as a class have quite
erroneous impressions of the results to be expected. Many are not
satisfied even when the animal's usefulness is completel}' restored
because perhaps a trifling blemish remains. Some seem incapable of
understanding that a certain time is necessary for recovery. Thej''
imagine that healing can be forced, become impatient, and in a few
moments destroy by clums}^ interference, or too early use of the animal,
the results of weeks of skill, afterwards seeking to hold the operator
answerable. In veterinary surgery the conditions for rapid healing are
much less favourable than in human practice. The imperfect sanitary
surroundings, the confinement in an air thick with micro-organisms,
the active opposition of the animal, and the impossibility of shielding
the wound from injurious external mfluences, as in human surger}',
often render success impossible even with the greatest care and fullest
perfection of detail.

Division. — Operations are divided according to varying circum-
stances. Those requiring the use of the hands alone are sometimes
known as manual operations ; the terms dressing and instrumental
operations explain themselves. We speak also of elementary or
compound, bloodless or sanguinar}^, regular or irregular ; of urgent

I

2 OPERATIVE TECHNIQUE.

operations and operations which may be deferred ; of operations on
the skin, the muscles, bones, tendons, and so forth ; operations on the
head, neck, trunk, etc., names which require no explanation. Urgent
operations are such as cannot be postponed without gravely endanger-
ing life.

The indications and contra-indications for operation must be
carefully studied. Beginners are not infrequently over hasty in this
respect. For instance they declare an operation indispensable ; the
owner refuses his consent, and nevertheless healing results under simple
treatment, or even without any treatment at all. The cliniques are
perhaps somewhat to blame for this, as only severe cases which must
be operated on are usually brought there, and even though in each
case the special grounds which render operation indispensable are set
forth, the student is apt to retain only a general impression, such as of a
tumour and of the subsequent operation, forgetting the explanatory
remarks. Such mistakes are made at lirst by everyone. Except in
the case of urgent operations, like tracheotomy, operation for strangu-
lated hernia, etc., it is first necessary to carefully consider whether the
animal's value, its chance of perfect recovery, and the probable dura-
tion of its convalescence, justify operation at all. The need for
operation and the dangers it implies must be clearly placed before the
owner. A wise practitioner, however, will not, except in very urgent
circumstances, insist on immediately operating for fear of prejudicing
his client, but after a moderate expression of opinion will wait, knowing
that the failure of other means will finally force the owner himself to
. demand operation. Definite promises should never be made in order to
gain the owner's consent, for, considering the extreme variability of
wound-healing, results can never be foretold with absolute certainty.
When it can only have a temporary good effect and the disease is likely to
return, when improvement is only to be obtained by sacrificing the
animal's usefulness, or when the patient's strength is too greatly
reduced, the practitioner's duty is clearly to deprecate operation even
if called upon to perform it. In the last connection dogs suffering
from generalised cancer are often submitted for operation in an extremely
emaciated state. Should they die under the operator's hands the fact
is related to the surgeon's discredit without any reference to the other
circumstances.

Planning the Operation. — Before performing any operation the
operator should mentally enact the details of each of the proposed stages.
I will attempt, for instance, to suggest the mental process before the
extirpation of a tumour. The tumour is situated thus ; its rela-
tions are ; it is of character. It is situated near the

GENERAL REMARKS ON OPERATIONS. 3

surface ; I can therefore enucleate it. For this purpose I require the

following instruments To reach it I must divide

How shall I fashion the primar}- incision to insure free exit to discharge

to prevent the wound gaping, and to promote healing ?

During dissection I may injure important structures, for instance . .

. . . ; should this happen what must I do immediately ?

what shall I require for the purpose ? If division of blood-
vessels is unavoidable I must check bleeding by ligation or torsion of

vessels ; dressings must afterwards be applied to promote

healing by primary intention over as large an area as possible ; how
can this be best effected ? ; where shall I insert the drainage-tube ? ; is
it possible to apply a dressing, may it not in reality do more harm than
good, and should not I attempt to protect the wound in some other
fashion ? Such a mental process is unconsciously performed before the
simplest operation, but only when rare and difficult operations are
projected does its necessity force itself on our recognition. In very
difficult cases operation may previously be performed on the dead body
and the anatomical conditions noted.

During the above process one also determines the method of
operation, for one method does not suit every case and it must be left
to the ability of the operator to select the method he regards as being
the best suited to the case in hand, the simplest to practise and as
promising the desired result in the shortest time. Circumstances
arising during the operation itself often necessitate unforeseen modifica-
tions, and test to the utmost the operator's resource and ingenuity.

The instruments selected must include not only those required for
the operation itself, but for all complications which may possibly arise.
At the same time the simpler they are, ccuteris paribus, the better.

Preparation of the Animal. — Great importance used formerly
to be attached to the preparation of the animal, which was bled and
purged secundum artem. Such methods are now nearly obsolete, and the
chief precaution required is to avoid casting an animal with a full
stomach, overloaded bowel, or distended bladder, although the fear of
rupturing the stomach, bowel, or bladder has been greatly exaggerated,
as is proved by the small mortality in animals cast for urgent operations
without reference to the state of the bowels, etc. It is however
certainly advantageous to regulate the diet for a day or two beforehand.

The seat of operation should be thoroughly cleansed, the hair
shaved off, and in the case of operations on the foot a local antiseptic
bath may be given.

Operations become necessary at all times of the day, but when a
choice is available the best time is probably the morning, as any

4 OPERATIVE TECHNIQUE.

unfavourable sequelae, like secondary bleeding, are more easily discovered
and dealt with then than in the late afternoon or evening.

Recovery is often favoured by turning the animal to grass, for which
reason spring is a very good time to choose when an option exists.
The extremes of temperature occurring in winter and summer are dis-
advantageous. Great heat favours putrefactive processes in wounds,
and flies, besides irritating the animals, often infect the parts.

Place of Operation. — When no special operating room is avail-
able, some open well-lighted spot, sheltered from wind and dust, should
be chosen. The ground should be covered with clean straw to the
depth of eighteen inches or two feet. Litter should certainly not be
used. For dogs an operating table covered with a thick plate of glass
can be used.

It is never wise to operate in boxes. If the horse is lying and
unable to rise it should be drawn into an open space.

Assistants. — In preparing for an operation sufficient reliable assist-
ance must be provided. Each assistant should be carefully instructed
beforehand in his duty, whether it be holding, casting, or fixing the
animal. To command efficiently and preserve order the surgeon must
thoroughly understand every detail himself, a knowledge which can
only be acquired by actual manual performance. Students therefore
should themselves have opportunities of casting horses, each taking
command in turn, until all know their duties. In addition to the men
required for holding, casting, and tying the horse, the operator requires
an intelligent personal assistant. An expert is not always necessary ; a
layman with some dexterity serves the purpose very well. This
assistant should wash, shave, disinfect, and prepare the field of opera-
tion; collect the needful instruments, hold retractors, sponge the
wound, etc. ; but as he then comes in contact with the wound in nearly
the same degree as the operator, the same precautions are incumbent on
him as on the surgeon in relation to disinfecting hands, nails, etc. For
extensive, complicated, and dangerous operations, however, such an
assistant is inadequate. A qualified person is then almost indispensable,
inasmuch as he should know^ immediately what to do in the event of
dangerous complications arising ; what to compress, what to grasp,
which instruments to hand, etc. There is often no time for the
lengthened explanations a la3'man would probably require.

Operations like the removal of tumours, etc., are seldom very urgent ;
the surgeon has full time therefore to make all necessar}- preparations
and to arrange for the help of a fellow practitioner. Unfortunately
however there appears to be an impression amongst many that the
practitioner injures himself in the view of the owner of the patient

GENERAL REMARKS ON OPERATIONS. 5

when he suggests a consultation with, or the assistance of, a colleague.
I consider, on the contrary, that such a request is the best means of
impressing on the owner the importance of the case, the dilficulty of
the operation, and the care which the practitioner is exercising. I am
glad that many of the younger generation of veterinary surgeons are
beginning to adopt this view and to imitate their colleagues in human
surgery.

After-treatment. — In many cases the after-treatment is even
more important than the operation itself. The animal must be care-
fully watched to prevent it tearing off the dressing, rubbing or biting
itself, lying down, etc., while the temperature, condition of the wound,
and its surroundings, etc., must be observed, §0 that any deviation
from normal may be early remarked and precautions taken in time.

CHAPTER II.

MEANS OF CONTROL.

Operation, or even local examination, is often impossible without
recourse to methods of restraint, of which an exceedingly
numerous choice is available, depending on the species of
animal and the operation to be performed. To begin with, the
horse should be securely bridled or haltered and held by a reliable
man, who will give his whole attention to the animal, and at once
check any indication of vice by calling to the animal, or similar means.

Vicious horses may often
be quieted by the application of
blinds. Before casting, a special
well -fitting winker bridle, the
lower part of which can easily
be removed, should be applied.
The winkers should be padded
and provided with straps, by
which they can be brought
together. By preventing it see-
ing, blinds often render the
animal remarkably tractable,
while they also protect the
eyes when the animal falls,
and whilst it remains on the
ground. Some persons use a
sort of leather cap or hood, which is drawn over the animal's head.
Some arrangement of the kind is indispensable when horses have to
be cast. A substitute may be extemporised from a thick piece of cloth
doubled several times, passed over the eyes, and fastened to the back of
the bridle.

Horses which bite may be muzzled.

To divert the animal's attention from the local pain, twitches are often

Fig. I. — " The blinds.

BLINDS AND TWITCHES.

applied to the upper or lower lip, or to the ear. They produce most
effect on well-bred horses. The simplest and most frequently used twitch
is formed of a strong cord, threaded through the upper end of a stout rod.

Fig. 2. — Operating cap or hood. Fig. 3. — The twitch. Fig. 4. — " The bulldogs."

The end of the rod furthest from the loop is provided with a cord, by
which the twitch, when applied, may be attached to the cheek-strap of
the bridle. This obviates the necessity for a man holding it. The rod
must never be fixed on that side of the face on which the animal will
fall when cast, and on which it may then continue
to lie for some time. When dealing with very
troublesome horses, the twitch stick may pre-
ferably be much longer, say six feet, and of pro-
portionate thickness. It is then held by a man,
who thus gains a considerable le\'erage over the
horse, and is better able to control it. Neither
iron "bulldogs" (Fig. 4) nor the loop twitch
(Fig. 5) are to be recommended. The loop twitch
not infrequently causes tearing of the angles of the
mouth, and may so bruise the sides of the cheek
that pieces slough away. A ver}^ much better
twitch is formed by passing the loop under the "--»— -^

1 , 1- ' .r . -. 1- i_ it. Fig. S- — The leg-twitch.

horse s upper lip, so that it lies above the upper -^ ''

incisors. This controls the animal almost as effectually, and is not
likely to produce a blemish.

The leg twitch is shown in Fig. 5. A stout piece of rope, about
twenty inches long, is formed into a loop, through the open ends of

8 OPERATIVE TECHNIQUE.

which a wooden rod is thrust. This is apphed to the hind hmb, about
four to six inches above the hock, and is tightened by twisting the rod.

It being impossible to apply the ordinary cord twitch to the ox, a
kind of forceps is used, which grasps the lower section of the nasal
septum. The bull-holder, as this is called (Fig. 8), is provided with
loops at the free ends of the handles, by means of which it can be
secured to the animal's horns. In the bull-holder shown in Fig. g
pressure is applied by means of a screw.

Nose-rings may here be mentioned ; the most convenient are those
which can be inserted without the assistance of an instrument.
Hauptner's pattern (Fig. lo) is very practical. It consists of two semi-
circular pieces connected by a hinge ; one end is pointed and cutting,
for the purpose of transfixing the nasal septum ; this fits into a corre-

FiG. 6. — The loop twitch.

Fig. 7. — The loop-twitch tightened by
inserting: a wooden rod.

sponding depression in the other end, and is provided with a notch to
receive the spring catch shown in the figure. Figs. 11 and 12 represent
leaders for animals in which these rings have been inserted.

To means of restraint also belong gags — instruments for holding apart
the jaws to allow of examining or operating on the cavity of the mouth
or pharynx without danger of being bitten. Some are fixed, others mov-
able, the latter allowing the mouth to be more or less opened as desired.
One of the simplest forms of fixed gag consists of a heart-shaped piece
of iron with two transverse branches fixed about four inches apart.
It is thrust into the mouth horizontally until the upper cross-piece
comes in contact with the upper molars, and then rotated so that the
upper cross-piece remains in contact with the interdental space and
the animal's chin lies in the lower rounded space. Movable gags are

BULL-HOLDERS AND LEADERS. 9

preferable. The principle is similar to that above describfed, but
the distance apart of the two transverse pieces may be altered by

Fig. 8.— Bull-holder.

Fig. 9. — Bull-holder.

means of a screw. Brogniez's gag has a semicircular bar, which con-
nects the horizontal branches resting in the interdental space of the
upper and lower jaws respectively, and which may be moved to either

Fig. 10. — Nose-rinp' for bul

Fig. 1 1. Fig. 12.
Bull-leaders.

side. This gag has the disadvantage ot requiring to be very strongly,
and, therefore, heavily made, though it certainly leaves the mouth very

10

OPERATIVE TECHNIQUE.

clear for operation. Mackel's gag is lighter, and does not require to
be fixed with the hand. The upper and lower horizontal branches are

Fig. 13. — Showing the application of nose-ring and l^ull-leader.

separated b}- the rotation of movable nuts screwing on the two vertical
connecting rods. Fig. 14 is Varnell's form. The transverse bars are
covered with india-rubber. Until recently it was b}^ far the most popular

„ Fig. IS- — Baver's niouth-gfasi' for horses and oxer:.

Fig. 16. — Ba\-cr's mouth-gag for dogs.

Fig. 14. — Varnell's mouth-

form in this country. Fig. 17 is a design of Hertwig and Fuchs, so
modified by Joger as to render it ver}' portable.

HORSE AND DOG MOUTH-GAGS.

II

During prolonged operations the gums become severely bruised, even
when the transverse bars of the gag are well covered with rubber. To
avoid this, Prof. Bayer, of Vienna, makes the grinding surface of the
molar teeth themselves the point of support for a gag. This gag is

Fig. 17. — Joger's mouth-gag for
horses. This apparatus can hi
dismounted and packed in a very
small space.

Fig. iS. — Woolf s mouth-gfag — new form.

shown in Fig. 18, which will be seen to closely resemble that used for
many years in operations on the mouth in man.

It consists of an upper and lower portion, each pro^■ided with guides
for retaining the instrument in position on the respective rows of molars.
The two portions are inclined towards each other at an angle of about

Fig. 19. — Woolf's mouth-gag — old form.

15 degrees. The back carries a handle for inserting the gag in place.
The surfaces of the two plates being roughened, after the manner of a
rasp, assist in holding the instrument firmly when pushed between the
upper and lower molars. In use the animal's tongue is grasped with

12

OPERATIVE TECHNIQUE.

one hand and withdrawn, the instrument held firmh- in the other hand
is then introduced into the mouth and pushed between the upper and
lower rows of molars as far as it will go. The instrument should be
steadied in position with one hand, whilst with the other the examina-
tion is made. As the operator himself controls the gag, he has ample
warning to withdraw his hand in case of danger. Haussmann's mouth-
gag for horses (Figs. 20 — 22) is probabh- the best and most convenient.

Fig. 20. — Haussmann's mouth-g.'ig- (openl.

Fig. 21. — Rubber-covered
plates for operations on
incisor teeth.

Fig. 22. — Haussmann's mouth-gag ^closed).

Whether it \\as first invented by Haussmann or by an unknown
American is open to question. In Germany it is known as Hauss-
mann's ; in England as the American mouth-gag. It possesses the
important advantages of pressing only on the incisor teeth, and there-
fore is not liable to injure the mouth, however long its application ; it
leaves the cavity of the mouth entirely clear, a great point when
operating on teeth ; it is relaxed in a moment, and as readily extended

HORSE AND DOG MOUTH-GAGS.

13

It can be dismounted and packed small and flat for travelling, and,
being nickel-plated and of rounded form, the parts are easily disinfected.
To permit of operations on incisor teeth
two rubber-covered plates are supplied,
which fit across the interdental space and
replace the ordinary teeth plates (Fig. 21).
The gag shown in Fig. 16 is for small dogs.
That designed by Woolf is useful both for
large and small dogs. Fig. ig shows the
older, Fig. 18 the newer improved appara-
tus. Fig. 23 represents the very simple
and effective mouth-gag for dogs and cats
introduced by Mr. Gray. M.R.C.V.S. It
is very simple and cheap, is readily adjust-
able for large or small animals, and leaves
the mouth unobstructed for operation, etc.
In operating on dogs precautions are
requn-ed to prevent the patient biting. The best and easiest method con-

^//t

%W;^^^^^^

Fig.

23. — Mr. Gray's mouth-
oae for dos's.

Fig. 24. — Pulling up and fixing a fore-foot
for operation.

Fig. 25. — Tying up the fore-leg.

sists simply in securing the mouth with tape. A loop of broad unbleached
linen tape having been slipped over the animal's nose and lower jaw

14 OPERATIVE TECHNIQUE.

and drawn tight, the end proceeding from the right side is carried
towards the left ear, that from the left side towards the right ear, and
the two fastened firmly behind the head.

In some operations on horses it is sufficient ii the ears are grasped by
a couple of powerful assistants and the head drawn forcibly downwards.
This does not completely insure the operator's safety, but it checks
attempts at rearing and striking with the front feet. This method of
drawing down the head is certainly better than fastening the animal to
a fixed object, though in cattle the best available means often is to fix
a rope around the horns and attach it to a strong ring or post.

Fig. 26. — Fastening the fore and hind pasterns together as a means of restraint.

Another means of restraint is to lift a fore or hind foot, preferably
on the side on which the operator stands ; care must be taken, however,
not to raise the limb so high as to give pain and cause the animal to
rear. A fore- foot may also be raised and kept in position by passing
a cord around the pastern and over the withers, in which position it
is held by an assistant. This plan is preferable to that next shown,
viz. of fixing the pastern to the forearm by means of a rope or strap.
In this case a small bundle of straw is often thrust into the flexure of
the knee to prevent the cord slipping off. As, however, the horse
is apt to lose its balance, a serious fall sometimes results.

LIFTING FORE- AND HIND-LIMBS.

15

To prevent striking out with the fore-feet a foot may be hfted or
both legs fastened together above the knees. Another plan is to pass
a cord or strap several times around
the forearms and fasten it to the
surcingle. Some foreign operators
fasten the fore-limb to the hind limb
of the same side by a cord passed
round the pasterns (Fig. 26). This
prevents the horse striking out, but
may cause a severe fall should it
struggle. There are several methods
of holding up a hind foot. A loop
of cord may be passed round the
neck and one of the free ends carried
along the back as far as the root of
the tail, around which a turn is taken ;
the rope is then passed once around
the pastern of the hind foot to be
held up. The horse is thus forced
to bear a great part of any strain he
may put on the limb. This is a
simpler but not a better method than
that of Hann, who carries a cord from a ring fixed to the top of the sur-
cingle, first over the back and croup, then through a crupper and through

Fig. 27. — Pulling up and fixing a hind
foot for operation.

Fig. 28. — The Hippo-lasso.

the ring of a hobble attached to the pastern, returning once more through
the crupper. By drawing on the free end of the cord the foot is raised

i6

OPERATIVE TECHNIQUE.

and can easily be held in position. In other cases the tail itself may
be utilised, the cord being first fixed to it by a " double sheet bend "

Fig. 29. —The Hippo-lasso applied.

PiG. 30. — The Hippo-lasso in operation. The horse is about to lie down.

{i. e. a special kind of knot which will not slip), and then passed through
the ring of a hobble, when by drawing on the rope the foot will be

THE HIPPO-LASSO, ETC.

17

"— uiwV^ A £, ,'J'^ J, ..^ "^ -'

Fig. 31. — Method df securing the hind legs to prevent kicking during (jperation.

Fig. 32. — Fastening a bullock's hind legs
preparatory to operation.

Fig. ■23- — Fastening one hind leg for
operation or shoeing.

i8 OPERATIVE TECHNIQUE.

raised. For dan;L(erous horses a very useful apparatus is the hippo-lasso.
It ma}' either prepare the way for using hobbles, or may even supersede
them. It consists of a front and hind portion hung by broad

Fig. 34. — Fastening a cow for operation.

straps which pass across the back just behind the forearm and
in front of the stifle-joint respectivel}-, and held together by two

Fig. 35. — The side-stick.

other straps fastened to the front and running through rings in
the back portion. By pulling on these straps the animal's fore
and hind limbs are drawn together, and it is effectually prevented

SECURING OXEN. THE CRADLE, ETC. 19

from kicking either with the fore or hind hmbs. Many horses
when thus secured he down without strugghng. To secure the
hind hmbs hobbles are apphed to the pasterns, from each of
which a broad band of webbing is carried towards the centre of
the chest from within outwards around the forearm under the
preceding portion and verticahy upwards over the withers. The
two pieces of webbing may then be tied together.

Hess describes many very useful ways of fixing oxen, of which the
best are shown in the accompanying illustrations (Figs. 32, 33, and 34).

Among other means of restraint must be numbered the side-
stick (Fig. 35), a cylindrical well-rounded stick of elm or other tough
wood fixed at one end to the head-collar and at the other to the

Fig. 36. — The " cradle " or " beads."

surcingle, thus limiting the movement of the head and neck. A
somewhat similar result is obtained by the use of the " cradle "
(Fig. 36).

"The stocks," or " trevis," is so well known as scarcely to
require description here. It was used in classic Greece. It
renders good service in certain operations, but is too clumsy,
too little adaptable, and too large for many purposes. Farriers
still use it for shoeing, and country practitioners for operations
on oxen and on heavy horses.

All vaccine institutes and most foreign veterinary schools and
veterinary hospitals now contain some form of table for controlling
horses during operation.

20

OPERATIVE TECHNIQUE.

The first aj^paratus oflliis kind of an}- practical value was Daviau's.
It consisted of a large oak table about 8x6 feet, the upper part of
the front padded with horse-hair and covered with stout leather, the
lower portion and the ends perforated with holes for the passage of
ropes, the whole pivoted on a horizontal axis, to which was attached a

Fig. 37. — Daviau's operating table. Horse secured.

rackwork quadrant. At the back was a stout framework about 2 feet
6 inches in height with four legs, so arranged that the upright table
could fold back upon it, when the whole had somewhat the appearance of
an extreme]}- massive and rather low kitchen table. In practice the horse,
already pro\ ided with a powerful head-collar, was led up to the appara-

FiG. 38. — Daviau's table. Horse in position for operation.

ius, and strong ropes attached to the head-collar were passed through
holes in the table and secured at the back to belaying-pins. At the
same time the broad horizontal strap (attached at each end to the
table) was brought round the chest and flank, and fastened by drawing
the buckles tight. The vertical straps were secured, the hobbles

OPERATING TABLES.

21

Fig. 39. — Operating table used by Mr. Dollar. The improved Vin.sot model.

22 OPERATIVE TECHNIQUE.

adjusted on the feet, and the ropes controlHng them tightened and
fastened to belaying-pins behind the table. Thus secured, the horse
and table were turned through the arc of a circle by working the crank
handle seen on the left side.

For minor operations this table served a very useful purpose, but
a patent defect was the inaccessibility of one side of the horse, and
the need, when both sides had to be operated on, of releasing, turning
round, and refastening the animal.

The most practical apparatus hitherto introduced is probably that
shown in Figs. 39 to 42. It was originally invented about i8go by
M. Vinsot, a former student of Alfort, with whom the writer has for
some years been associated. As now modified this table has proved
very successful, especiall}/ in the East, where Mr. Dollar has sent a
considerable number for the use of hospitals and bacteriological
institutes.

The main portion of the apparatus is seen roughly to consist of two
approximately rectangular end pieces, connected at the top by a strong
steel girder, and at the bottom by a strong iron rod of circular section.
These rectangular frames are further connected at 2 feet 6 inches from
the ground by two movable rods, adapted to swing open, and the
whole framework is supported and pivoted on two powerful axes,
placed as nearly as possible on a level with the general centre of gravity
of the whole machine. A double cushion, intended to support the
horse when lying, is capable of attachment to either of these side rods.

The purpose of the various rachet wheels and chains will be better
understood by reference to the figures showing the horse in position
for turning over. His head, secured by a strong head-collar and side-
ropes, rests within the padded upper portions of the front frame.
Under his body passes a strong "bed-piece" reinforced with leather
straps, the extremities of which carry iron eyes for the reception of a
chain, by tightening which he is lifted almost off his feet just before
turning over. In front this '"bed-piece" is secured in position by a
strap passing round the chest, and behind by a crupper attached to the
back chain. The chain is wound on a spindle, turned, through the
medium of gearing, by the crank handle shown. The horse's feet are
fixed by hobbles to a strong chain running along the whole length of
the bottom of the apparatus, and tightened by turning the lower of the
two crank handles seen to the right.

To support the revolving part, which weighs 7 cwt. and is capable
of accommodating horses of any size, two strong iron standards 4 feet
6 inches high, and provided with stays of 2-inch iron, are sunk in the
earth, where they are surrounded by masses of concrete weighing five

OPERATING TABLES.

23

24 OPERATIVE TECHNIQUE.

tons. This provides a practicall}^ immovable] base, on which any
accidental shocks can have no effect. Each standard carries at its
upper part a carefully turned bearing to receive the axes of the revolv-
ing part.

The forward end piece is padded inside to prevent the horse
accidentally injuring his head, and is perforated throughout its upper
part with one-inch holes to permit the head-collar ropes being passed
through and fastened to spring belaying-pins seen projecting in front.

The rods suspended from either end of the upper girder are
telescopic, and automatically stop the machine when tilted at whatever
point desired by the operator.

Lastl}', the revolving portion of the apparatus in which the animal
is fixed is secured against premature movement by four " safety
chocks '" or catches secured to the standard, and locking with the end
frames. The lever arm shown at the back and on the left side of Figs.
39 and 41 can be affixed to either end of the machine, and gives the
operator the necessary purchase for moving the animal when in
position.

The disposition of weight has been so carefully planned that
when ready for rotation horse and machine form a mass whose
common centre of gravity is within an inch or two of the horizontal
axis around which the whole moves. Very little exertion is therefore
required in handling even a heavy horse, and no undue strain is
thrown on the machine, whatever the point at which it may be brought
to rest.

In use, the horse is first provided with a strong head collar carrying
two stout lines, and the " bed-piece" is strapped tightly round his bod}'
like a horse-rug. One of the side rods is swung open, giving admission
to the machine, and the horse is walked forward until his head comes
within the front frame. At the same moment the assistant follows up
with the side bar, and, as the horse enters, drops the bar in place,
where it locks of itself. The groom passes the head collar lines through
holes in the front frame, and drawing them tight winds them in a figure
of 8 round the spring belaying-pins, while the " bed-piece" is hooked
on to the hanging " compensation bar." If a comparatively simple
operation is to be performed nothing further is needed. A hind foot
may be drawn up and fixed for examination or dressing, and the 'horse
be set at liberty a<:ain in less than a couple of minutes.

If, howex'er, an\- serious operation is required four hobbles are
affixed to the feet, the winch handles are turned (both together) until
the horse's feet begin to leave the ground, when the safety chocks are
cast off, permit ^"int; the apparatus to revolve, and depositing the horse

OPERATING TABLES.

25

Fig. 41. — The horse secured for operation.

26 OPERATIVE TECHNIQUE.

without shock or pain in a horizontal position. The animal ma\' be
placed at any dej^'ree of inclination to the horizontal, and its position on
the table is extremely safe. Broken back has never occurred within
the writer's expt-rience.

Methods of Casting. — A permanent bed is usually prepared
with six to eight inches of dry spent tan bark, covered with a
thick layer of short cut straw. Many practitioners still prefer the
straw bed to mattresses, because it is softer and because it can be re-
moved, and fresh straw supplied after each operation, whilst the mattress
must be thoroughly cleansed and disinfected. It has also the advan-
tage of being cheap, as clean straw is readily obtainable and may
afterwards be used for bedding, whilst it is a difficult matter for
veterinary surgeons in country practice to convey a mattress from
place to place. • Nevertheless, straw makes a very bad bed for
operations requiring careful antiseptic precautions, and wherever
possible should be replaced by a mattress covered with tarpaulin,
or by a proper operating table, though some of the disadvantages
of the straw bed may be overcome by covering it with a large
tarpaulin before casting the horse. Even so high an authority,
however, as Professor Bayer still adheres to the straw bed, pre-
ferring it partly because he has to teach students who, in practice,
would be unable to afford an operating table, and partly because
of the success attained in his own clinique. In support of his
recommendation he adduces a long series of cases in which the
wounds left by removal of shoulder abscesses, necrotic lateral carti-
lages, etc., healed by primary intention after suturing.

To prevent internal injuries, like rupture of abdominal viscera, the
animal should fast or only receive light food for several hours before
operation, though, as already mentioned, this precaution is not abso-
lutely indispensable. Needless to say cases calling for puncture of the
bowel or bladder must not be cast. Should it be absolutely impossible
to perform the operation in the standing posture the operator
should wait until the horse lies down, as usually occurs with moderate
frequency in these cases on account of the animal's pain. On the
other hand, in cases of hernia where the bowel is distended as a
result of strangulation, the horse should be cast to prevent him throwing
himself down in the violence of his pain, but the greatest precautions
should then be exercised. One of the simplest methods of casting is
that shown in Fig. 43. It is especially useful for young animals or
those difficult to approach, in which ordinary hobbles cannot be used.
It is also useful where the hind legs have to be drawn downwards on
either side of the body for operations in the dorsal position, inasmuch

OPERATING TABLES.

27

28 OPERATIVE TECHNIQUE.

as the application and removal of hobbles, are thereby rendered un-
necessary. In case of need a cart rope may be used. A strong bridle
or halter and a surcingle carrying a ring and rope having been applied,
a man is placed at the horse's head, and another, who holds the sur-
cingle rope, is given a position on the side towards which the animal
is required to fall. If possible the fore-foot furthest from the bed is then
lifted. On the end of the long rope is tied a fixed noose, which is placed
round the animal's neck like a collar; the free end is then passed around
both hind legs, brought forward, again passed through the loop on
the animal's shoulders, and given to the men charged with casting the

V ^ _,"' ' ^?/ o<55^^

■>»-!'^-^''«»-U

Fig 43 —Casting with the cart rope Attention is directed to the tut that
both hind pasterns are embraced in the one loop of rope.

animal. On the word being given, these men should rapidh- draw the
rope backwards towards the side to which the horse is intended to fall.
The rope thus catches in the heels just below the pastern and the animal
is thrown on its haunches. At the same moment the man holding the
cord attached to the surcingle pulls in a similar direction. The
attendant in charge of the heiid assists the movement, and the horse
falls to the ground. This method causes the least concussion, and can
even be safely used for pregnant mares. The onl}- objection is that if
the ropes be new, or the first attempt fail, the animal's heels may be
injured, but this can be a\oided by previously apphing bandages or
using cotton ropes. \\'here many horses are cast b\' this method the

CASTING WITH ROPES. 29

loop of rope passetl round the neck may advantageously be replaced by
a strong leather straj) provided with iron eyelets, through which the
rope is returned, these eyelets diminishing friction and permitting the
rope to run more freelv.

A commoner method of procedure is to form in the centre of a
long rope, a fixed loop sufficiently large to pass round the animal's

Fig. 44. — The hobbles.

neck and rest on its shoulders. The knot lies in front of the chest, and
the free ends of the rope are passed from within outwards round the
hind legs above the hocks, and back again through the neck loop. They
are then held on each side by one or two men, according to the animal's
size and weight. When all is ready one of the fore-feet is lifted, the

Fig. 45. — Crus.s-hobbles, or thigh and forearm straps.

loops of rope are slipped from above the hocks downwards into the
hollows of the heels, and the men pull steadily on the free ends of the
rope, causing the animal to subside on its hocks, whence it usually falls
gently on to its quarters. It is best if one group of men pulls outwards
at right angles to the shoulder and the other somewhat backwards.
Immediately the animal is on the ground it is pushed on to its back,

30

OPERATIVE TECHNIQUE.

the ropes are pulled tight, drawing down the hind legs level with the
abdomen, and secured to the pastern with one or two half-hitches. The
fore legs are firmly grasped, brought alongside the hind, and secured
to them by a couple of half-hitches passed round the pasterns. This
method has the advantage of requiring no re-arran^ement of the ropes to
draw down the hind legs and so expose the field of operation for castra-
tion, though, as the hind limbs are at first comparatively free, the
animal can plant them wide apart, and the force required for casting it
is somewhat greater than in the method previously mentioned. It is
usually emplo\ed when castrating colts. Some operators use a stout
leather strap collar with iron eyes for the passage of the ropes, instead

Fig. 46. — The hobbles appHed.

of merely passing them through the improvised rope loop. When the
animal is very active it is well to affix a roller or surcingle to which the
collar or neck loop can be tied ; otherwise the latter may slip off.

To work the above methods successfully requires thorough discipline
of and co-operation between the various assistants. Failure on the part
of anyone may entail serious accident or failure of the whole operation.
The method of casting, however, most frequently employed is that
illustrated in Figs. 46 and 47, which show the application of leather
hobbles. The hobble usually applied to the near fore-limb is called the
master-hobble, and carries a special key by means of which the chain
or rope is attached. Traction on the rope draws the feet together, the

CASTING WITH HOBBLES.

31

horse begins to lose its balance, and at the critical moment the rope
attached to the surcingle is pulled, one or more assistants helping if
necessary by pulling on the tail. The hobble rope should be pulled
in a backward direction, as this to some extent neutralises the strain
on the assistants, and prevents the animal's legs being pulled directly
from under it and so bringing it violently to the ground. The assistants
should be well drilled beforehand, and the operation carried out as
quietly as possible. In Fig. 47 the horse is provided with Bernadot
and Butel's apparatus for preventing broken back. The difference
between this and the Stuttgart method is clear on reference to Fig. 48.

• / tit J^^ ( I'i,'? U « •»■

Fig. 47.— The hobbles applied together with Bernadot and Butel's apparatus
for the prevention of broken back. The strip of webbing passed round the
off forearm is intended to afford a purchase when pulling the horse over in
the act of castin?.

The advantage of the Stuttgart arrangement is that the ropes run
more easily, as each only passes through one link ; and as the direction
of pull is opposite for the two groups of men, there is no tendency to
bring the horse down violently on its side.

The horse having been brought to the ground is kept down by the
man at the bridle firmly pressing on the head, and other persons sitting
on the shoulder and haunch respectively. The four feet having been
tightly drawn together are fixed by passing a key (Fig, 49) through a
link of the chain. The spring key shown is perhaps less convenient
than the D-shaped spring key, though there is no essential difference

32 OPERATIVE TECHNIQUE.

between the two. As a makeshift the chain niav be fixed by forming
a shp-knot as close as possible to the hobbles and passing a bundle of
straw through the loop. The person at the horse's head must take
care that the animal does not succeed in bending its head towards its
chest and arching its neck, because this attitude, which lacilitates con-
traction of the great muscles of the back and quarters, is often respon-
sible for fractures of the vertebrae.

To retain the head extended Bernadot and Butel invented an
apparatus consisting of a strong head-collar, from which powerful straps
run backwards above the neck, and are attached on either side to a
ring in the surcingle. The surcingle is prevented from slipping forward

Fig. 48. — Method of casting as adopted at the Stuttgart Veterinary School.

by the use of a crupper. The apparatus is applied loosely before
casting, and the straps tightened after the animal is on the ground.

The releasing of an animal depends on the method employed for
casting. Most hobbles are arranged so that all four feet are im-
mediately loosened by withdrawing the screw-key of the master
hobble, but where no such arrangement exists the fore and hind feet of
the lower side should first be set free, and then those of the upper
side. The assistants sitting on the shoulder and haunch should not
move until the man in charge of the bridle is quite prepared for the
animal's rising, and the word of command has been given. Should
the fore-quarters be on a lower level than the hind, or the back lower
than the feet, the horse may have difficulty in rising. In such case the

SECURING AND RELEASING LIMBS.

33

fore-feet must be drawn out in front of the horse, and the animal
assisted by men placed at its quarter, shoulder, and tail.

The animal having been cast, it may become necessary to release
and again secure a limb, according to the operation to be performed.
For this purpose the best material is webbing ; cords are apt to cut.
The webbing having been doubled, a running loop is formed in it and
slipped over the horse's fetlock ; the two ends of webbing are then
passed in opposite directions and held fast by assistants. The men
sitting on the shoulder and haunch can also check the animal's move-
ments by utilising their weight and by grasping the limbs with their
hands. A better method, however, is to pass a loop of webbing around
the two forearms or cannon bones. Movement in the fore and hind limbs

Fig. 49. — The hobble-
chain key.

Fig. 50. — Bernadot and Butel's apparatus for the prevention of
broken back.

which are for the moment uppermost, can also be checked by passing
a large strap or piece of webbing over the hock-joint and then around
the forearm, or by the application of the cross-hobbles shown in Fig. 45.

For operations on the fore-limb, hke extirpation of the lateral
cartilage, neurectomy, etc., Moller's method of fixing the limb to a
long plank is very useful. The plank should be well padded, and
provided with a long curved iron handle. It is less useful for hind limbs,
inasmuch as the limb can only be fixed at two points, viz. at the
fetlock and above or below the hock.

To draw a hind foot closer to a fore-foot, as in preparing for castra-
tion in the side position, a running loop is formed at the end of a piece
of webbing and slipped over the fetlock of the hind foot ; the webbing
is then carried over the withers, beneath the neck, over the front of
the chest, around the forearm, and thence backwards, passing from

3

34

OPERATIVE TECHNIQUE.

below upwards around the Achilles tendon and orice again forwards.
By pulling on the free end an assistant can then bring the limb into

Fig. 51. — Horse cast and secured. The near forearm and near thigh are
fastened together by broad strips of webbing (the cross hobbles may be used
instead), and the off fore-leg is fastened to the plank ready for operation on
the foot (M oiler's method).

h n, 52 — This hgure shows method of securing a hind limb to the plank tor
fiperation Compare with foregoing figure

the position shown in Eigs. 53, 54. Another way of attaining the
same object (the Berlin method) is shown in Fig. 55.

SECURING AND RELEASING LIMBS.

35

The method of fixing the upper hind to the upper fore-hmb is
shown in Fig. 56 ; that of fixing the lower hind to the upper fore in

Fig- 57-

For operations in the dorsal position the fore and hind limbs of each
side must first be firmly fixed together. Either rope or webbing can

Fig. 53.— The horse cast and tied. The off hind leg being drawn forward
ready for castration in the side position.

be used, the fastening being accomplished by means of a running noose
attached to the fetlock of the hind foot, and by applying one or two
half hitches to that of the fore-foot, drawing the rope tightly after each
half hitch is in position. When the horse is rolled on to its back.

Fig. 54. — The horse secured ready for castration in the side position.

care must be taken that the neck and head are kept straight and the
head is not allowed to be bent towards the chest. A piece of webbing
can then be fastened to one of the hind limbs just above the fetlock,
passed under the animal's back, and then from within outwards over
the fetlock of the opposite side. By drawing this tight the hind legs
are pressed down close to the sides and secured. In Vienna a special

36

OPERATIVE TECHNIQUE.

Fig. 55. Another method of preparing the horse for castration or similar

operation in the side position.

Fig. 56.— Fastening a hind to a fore-limb preparatory to neurectomy, firing, etc.

RUSSIAN METHOD OF CASTING.

Z1

piece of apparatus is used for this purpose. The method is as follows: —
One or two assistants grasp the horse's tail and lift the hind quarters
far enough from the ground to allow a leather band, about eight to ten
inches wide, to be slipped under. The ends of the band carry broad
iron rings. Through these and around the cannon bones of the hind
limbs broad pieces of webbing are passed, securing the hind limbs in
place. The cannon bones must be pressed downwards into a horizontal
position, whilst the parts are being fixed (Fig. 59). (Note. — In this
figure the assistants on the left side of the animal are not represented,
and the horse is purposely shown lying a little obliquely, in order
that the mode of fixation may be clearer). The operation finished,

Fig. 57. — Fastening the lower hind to the upper fore-limb preparatory to
neurectomy, firing, etc. This figure also shows the "leg twitch !4
applied.

the broad leather strap passed beneath the animal is first removed ; the
horse is then laid on his side, the limbs are released, the upper being
last of all freed from hobbles. Fig. 60 shows another method of
fixing a horse for operation as employed in the Berlin veterinary
school.

The Russian method of casting (Figs. 61 — 63) permits of a man
throwing a horse single-handed. In books the position of the
operator's hands is usually incorrect. With small horses the method
succeeds very well, though requiring some courage. The operator
stands close to that side of the horse on which it is intended to fall,

38

OPERATIVE TECHNIQUE.

and at the first trial this seems dangerous. Professor Bayer, in
referring to the operation, states that on one occasion he actually fell
under the horse. He had attempted to cast a rather large horse, and
had nearly succeeded ; the animal, however, tried to regain its equi-

FiG. 58. — The horse cast. Mode of fixing the fore and hind limbs together when
preparing for castration in the dorsal position.

librium by a slight spring, and trod on Bayer's foot, preventing his
getting clear.

A long rope carr3ang a ring at one end is used. Supposing a horse is

r^T^vsry

Fig. 59. — Preparing for castration in the dorsal position. The back strap
applied. (Vienna method.)

intended to fall on its left side, a loop is formed in the rope and passed
around the neck, the ring lying near the right elbow. The free end of
the rope is then passed around the left hind foot, again through the

CASTING THE HORSE SINGLE-HANDED.

39

ring, and is held in the operator's right hand. The operator stands on
the horse's left side looking forwards, his right elbow supported on the
horse's loins, and the bridle reins grasped in the left hand. By lifting
the left hind foot under the belly and somewhat towards the right side,
drawing the head to the right by means of the bit, and simultaneously
pressing with the elbow on the loins, the horse is caused first to recoil
on its haunches, and then to lie down on its left side. The operator
has only to hold the cord and bridle tight to prevent the animal
rising.

Cattle can be cast like horses with ordinary hobbles, the straps
being placed above the fetlocks, or by the methods shown in Figs. 64 65

Fig. 60. — Berlin method of fixing the horse in dorsal position for operation.

and Fig. 43. Another method is illustrated in Figs. 64, 65. A rope
having been fastened to the horns, is passed around the neck, chest,
and abdomen as shown. The animal is held by an ox-lead, and two
men pull on the end of the rope, when the animal usually lies down on
its side without struggling and with its feet stretched out.

F"or castration the sheep is placed on its hind quarters in a sitting
position, the abdomen being turned towards the operator. An assistant
grasps the body between his legs and holds a limb with each hand.
For carriage the fore and hind legs of each side are first tied to-
gether, the two sides being afterwards connected by a few turns of
the rope.

40

OPERATIVE TECHNIQUE.

The pig is best seized just above the hock, and can then be cast
by an assistant who grasps the ears. In the large stockyards, however,
men become very expert in casting the pig single-handed, by slipping

Fig. 6i. — The Russian method of Lasting,
single-handed , firbt position

Fig 62 — The Russian method of casting
single handed , second position

Fig. 62. — The Russian method of casting; the horse down.

a short staff between the hind legs as the animal runs. To examine
the mouth, a short stick is thrust between the jaws at the moment
when the animal squeals, and can then be used as a lever to keep them

SECURING SMALL ANIMALS. 41

open. A kind of twitch applied to the jaws is also used. x\nother
method is as follows : — Two men grasp the pig by the ears ; when the
animal cries, a slip-knot, formed on the end of a stout cord, is passed
into the mouth and fastened to the upper jaw as near as possible
to the commissure, behind the tusks. The cord is then fastened

Fig. 64. — Casting an ox; first position.

to any high point or to a ring, and the head drawn into a position
of forced extension. The animal cannot possibly escape.

The dog is either muzzled or the jaws fastened together by a piece
of tape passed around them and tied behind the ears. It is then easily
handled and secured on the operating table. Several operating tables
have been invented for dogs. In Professor Bayer's clinique the table is
a shallow glass trough about 3 feet 6 inches long and 15 inches across,
with an aperture for drainage, and suitable connections at the lowest

Fig. 65. — Casting an ox; second position.

point. This is surrounded by a detachable metal frame, the lower
surface of which carries a series of hooks at one-inch intervals for
fastening the cords by which the animal is secured. In the very
excellent clinique for small animals at Berlin, presided over, at the date
of the writer's period of study, by Prof. Frohner, the table is of similar

42

OPERATIVE TECHNIQUE.

form, but is constructed throughout of metal. Both tables, in fact,
are close imitations of those used in human surger}-.

In this countr}-, Professor Hobday has suggested a cheap and useful
table of wood, the upper surface perfectly flat and displaying numerous
incisions for receiving the small keys by which the hobbles are secured
to the table. This table, owing to the numerous perforations, is, of
course, less readily rendered aseptic than a metal or glass table, though
in actual practice the point is not of prime importance. Professor
Macqueen has recently brought before the profession an excellent
table, also of wood, designed by Claude Bernard, consisting of four
parallel leaves connected by hinges. The two outer leaves may be

Fig,

-Professor Macqueen's operating table for the dog (Claude Bernard's design).

inclined at any angle towards one another, forming a trough to receive
the animal's bod}'. Owing to its great simplicity and absence of depres-
sions likely to retain dirt, etc., this table is cheap, and responds to
most of the requirements of veterinary surger}-, while it is readily adapt-
able to animals of var3ing size, and when folded is quite portable. The
writer is indebted to the courtesy of the proprietor of the ' Veterinary
Record ' for the illustration of this latter table.

A special instrument is used in France for securing dogs suspected
of rabies. It has a long handle, and carries at the end a spring
collar which, when pressed on the dog's neck, opens and holds him
securely.

SECURING SMALL ANLMALS. 43

For castration and other operations on the cat, the skin at the
back of the neck is grasped with one hand, that over the lumbar region
with the other, and the subject firmly pressed down on a table.
Another method is for the assistant to grasp the hind limbs on either
side between the second and third fingers, the fore-limbs between the
index and second fingers, and the skin on either side of the head with
the index finger and thumb. Thus held the animal is quite powerless.
Troublesome patients may be wrapped in a thick cloth to prevent
scratching and biting. It is sometimes recommended to thrust the
animal into a narrow sack or into a boot. These methods, of course,
are primitive and onl}- suitable for trifling operations. For more com-
plicated operations one or other of the above-mentioned tables ma}' be
used.

Complications. — Application of the above-described methods of
restraint are not infrequently followed by injuries or complications. The
animal begins to resist immediately the hobbles are applied. A horse
often struggles, kicks, or moves away on finding the free use of its limbs
checked, and may fall awkwardly, breaking the jaw, neck, shoulder,
or a limb bone, according to the incidence of the shock. Fracture of
the pelvis or of ribs is not infrequent when horses are cast suddenly and
violently. Even when secured, the muscular efforts consequent on
struggling may cause fractures of vertebra;, of the pelvis, of the cannon
bone, OS calcis, etc., rupture of abdominal viscera, of large vessels,
important muscles, or of tendons, not to mention the skin wounds and
contusions which almost always occur. Pressure on nerves such as
the facial or radial, due to lying long in one position, may be
followed by cramp or paralysis.

CHAPTER III.

ANESTHESIA.

Anaesthesia may be divided according to its nature and extent
into general and local. We shall consider these in order.

The first operation under ether was performed on the 14th October,
1846, by Warren, in the Faculty of Medicine at Boston. Boots and
Lister first employed ether in England. During 1847 several veterinary
surgeons published experiments showing the advantages of its use
in operations on the horse.

Notwithstanding certain drawbacks ether was at first exclusively
used, but on the loth November, 1847, Simpson drew attention to the
anaesthetic qualities of chloroform, which he declared superior to its
predecessor. Chloroform soon displaced ether, maintaining its supre-
macy in man until a relatively recent date. In animals, save perhaps
the dog and cat, it is still the anaesthetic par excellence.

Other substances have been introduced during recent years. The
first departure was probably the mixture of ether and chloroform, with
or without alcohol. The rectal administration of ether was then
suggested, followed by the use of morphine, the intra-venous, intra-
rectal, or intra-peritoneal injection of chloral, the inhalation of
chloroform in association with subcutaneous injections of morphine and
atropine, and the administration of benzine, paraldehyde, urethane,
hypnone, methylene, and amylene. When, as in oxen, the fliesh would
be used for human food in case of the operation failing, large doses
of alcohol are often given.

In general anaesthesia the patient is thrown into a more or less
profound artificial sleep. It is not al\va3's necessary, however, to act
on the entire individual. Sometimes the operation only affects a very
limited area, and local anaesthesia suffices. Local anaesthesia is
generally produced by the application of ice or freezing mixtures, by

ANAESTHESIA. 45

the spraying of certain liquids, like ether, ethyl chloride, or anestile, or
b}' the subcutaneous injection of cocaine, eucaine, or stenocarpine
solutions.

Anaesthetics have a less extended usefulness in animals than in
man. Pain should be spared as far as possible, but expense must
always be considered, and anaesthesia has its drawbacks. For most
minor operations, the means of control at our disposal are sufficient
without general anaesthetics, but certain operations cannot be performed
without them. In reduction of hernia, delivery in cases of dystokia,
laparotomy, and in all cases where one works in dangerous proximit}'
to important organs, the animal's struggles render anaesthesia almost
indispensable. It is also necessary for delicate operations on or in the
vicinity of the eye, and for all serious operations on valuable horses,
whose struggles are particularly violent. Moller recommends anaesthesia
in castrating horses with ver}- powerful dorsal muscles. In ruminants
anaesthesia is seldom resorted to save in difficult parturition. In carnivora,
and especially in the dog, its principal indications are in laparotomy,
difficult parturition, amputations, and certain operations on the head.

Anaesthesia is contra-indicated (i) in diseases of the heart (lesions
of the valves or myocardium, dilatation, and hypertrophy) ; (2) diseases
of the respiratory tract (emph3'sema, pneumonia, and chronic pleurisy).

Ether is the best anaesthetic for subjects with emphysema and dila-
tation of the right heart, chloroform for those with affections of the left
heart, chloral when the pulse is intermittent (Arloing).

Death may be caused by pushing administration too rapidly ;
in certain rare cases it may also result from accidents like vomiting,
the vomited material passing into the trachea and lungs, and
producing mechanical pneumonia. Such a termination is much to
be feared in man unless the patient be properly prepared, but it
very seldom occurs in the horse. If in operations on the face, such as
trepanation of the facial sinuses or nasal cavities, or extraction of
molar teeth, an anaesthetic be employed, the head should be placed in
a depending position, so as to favour escape of blood, which might
otherwise enter the respiratory tract and produce suffocation.

(a) General Anesthesia.

Narcosis being the result of a special action exerted directly on
nerve-centres by the anaesthetic agent, the first necessit}' is to insure a
sufficient quantity of the anaesthetic arriving at those centres. While
fixed anaesthetics can be administered by various channels, such as the
\eins, mucous and serous surfaces, the subcutaneous tissue, etc., vola-

46 OPERATIVE TECHNIQUE.

tile anaesthetics must penetrate by the respiratory mucous membrane.
Injected into the tissues or veins, fixed anaesthetics traverse the
pulmonary capillaries without sensible change, and act promptly on
the nerve-centres ; volatile anaesthetics, similarly administered, escape
in large measure through the walls of the pulmonary vessels, are
expired, and fail to reach their destination in sufficient quantity to pro-
duce much effect. On the other hand, volatile substances, introduced
in a state of vapour into the respiratory tract, are freely absorbed by
the blood circulating in the lungs, which blood, passing thence to the
left heart and general arterial syitem, rapidly produces anaesthesia.

Anaiisthetics administered by the respiratory tract produce a series
of phenomena in the following order :■ — (i) period of excitation ;
(2) period of anaesthesia or surgical period ; (3) period of collapse
or intoxication.

The period of excitation, due firstly to the action of anaesthetic
vapours on the nerve terminations in the mucous rpembrane of the
upper respiratory tract and paralysis of the cerebral inhibitory
centres, and afterwards to the • action of these vapours on the
great nerve-centres themselves, is characterised by perverted sensa-
tion, excitement, and hyperaesthesia of sense organs. Violent struggling
occurs, respiration and circulation become accelerated, the mucous
membranes injected, and the pupil dilated ; the heart's action, however,
soon slows, respiration becomes easier, more regular, and more exten-
sive, the pupil contracts, excitement diminishes, and sleep commences.
During this period anaesthetics may, in animals predisposed to such
complications, produce respiratory or cardiac syncope or asphyxia
from spasm of the glottis.

The period of anaesthesia is characterised by suspension of activity
in the nerve centres, i. e. the cerebral lobes, medulla oblongata, and
mesocephalon. The animal is plunged in artificial sleep. The excito-
motor centres are paralysed, the muscles relaxed, the limbs when
raised fall inertly. Respiration is slow, the movements of the chest
wall are diminished, but those of the fiank more marked than ordinary.
The heart is accelerated, on account of paralysis of the moderator
centre, but the pulse remains regular and full up to the moment when
intjoxication occurs. Vision is no longer co-ordinated, while the pupils
remain contracted and immobile. x\s sensation is lost in the various
upl^ions reflexes cease.

Sensation does not disappear simultaneously in all tissues and all
regions, being last retained by organs under spinal control. The limbs
and trunk are first affected, then the organs of sense and those supplied
by branches of bulbar origin, finally those supplied by the sympathetic

ANAESTHESIA. 47

system. The nasal, buccal, auricular, and genital mucous membranes
exhibit reflexes long after other parts have become insensitive. Even
when ansesthesia appears complete, struggling often results immediately
the knife touches the diseased region. This is due to certain diseased
tissues retaining a morbid sensibility even after neighbouring healthy
tissues have entirely lost sensation. Inflamed parts especially retain
their sensibility long after healthy tissues. Once established, anaes-
thesia can be maintained by very small doses of the agent employed ;
larger amounts are danger-ous, as being liable to induce the third stage
of anaesthesia, viz. collapse or intoxication. This is characterised by
progressive retardation of respiration and circulation, and by sudden
dilatation of the pupil. Respiratory movements become superficial and
cease for comparatively long periods; the heart's action diminishes,
the pulse is small, soft, and irregular. Finally the medulla becomes
intoxicated, respiration is arrested, the heart ceases to beat, and death
occurs by respiratory syncope. ^

The phenomena of anaesthesia yary according to whether ether,
chloroform, or another anaesthetic is'employeidi -With ether the period
of excitement is longer and more pronounced than with chloroform.
With certain fixed anaesthetics the phase of excitement is suppressed
or little marked. Although the exact action of chloral is still open to
discussion, it is known to produce immediate and profound anaesthesia
without preliminar)- disturbance when administered intra-venously. On
the other hand, salts of morphine sometimes produce lively excitement
prolonged for some hours. The difference, however, interests physiolo-
. gists more than practitioners. The chief point for the latter is the
degree of toxicity of these agents, i. c. the danger attending their use.
No general anassthetic is without danger, and even in veterinary surgery,
where their employment is limited, every practitioner has probably had
a fatal case.

AncEdlicsia in the Horse.

Chloroform probably produces the most rapid and complete anaes-
thesia in the horse. It is not so dangerous for solipeds as has been
suggested.. The writer, whose experience extends to over four hundred
cases, has only seen two fatal results, which occurred after deep surgical
anaesthesia had been maintained, in one case for over two hours, a^
in the other over three. Needless to say, recovery of consciousness
is slow after prolonged operations, and the animals may not rise for
half an hour to an hour after their termination, but given reasonable
care in administration chloroform fulfils all requirements.

48 OPERATIVE TECHNIQUE.

In company with Dr. Clarke, the writer attempted on several
occasions to kill animals b}' the administration of air saturated at
ordinary temperature with chloroform vapour, but the experiments all
proved the extreme difficulty of the attempt. Where, however, the
animal is partially asphyxiated, as in using several of the common
veterinary inhalers, death can be produced in eight to ten minutes. By
using a special apparatus, by means of which absolutely pure chloro-
form vapour, without admixtitrc of air, was administered, death was pro-
duced in one and a half minutes. The heart's action continued for
several minutes after respiratory arrest. MoUer, who employs chloro-
form exclusively, has administered it to more than 500 horses without a
single accident.

As a basis for investigation, Moller noted in each of his cases
the time required to produce surgical anaesthesia, the amount of
chloroform used, the breed, age, sex, and weight of the animal. The
following is a resume of the more important results. In the case of 126
horses (31 stallions, 38 mares, and 57 geldings) ansesthetised with
chloroform, the corneal reflex was abolished in an average period of
20 minutes by the administration of an average quantity of 28 fluid
drachms of chloroform ; the quantit}' per unit of body-weight was
I : 4000 ; anaesthesia usuall}- lasted about 20 minutes.

Whilst in one to two years old foals 4 to 5 drachms of chloroform
usually produced anaesthesia in 7 to 8 minutes, the shortest time
observed in full-grown horses was in one case 8 minutes, in one case 9
minutes, and in two cases 10 minutes. Twelve of the above 126 horses
required 30 minutes, and four from 30 to 40 minutes. In stallions the
average period was 18, in mares ig, and in geldings 22 minutes. The
stallions on an average consumed 30 drachms of chloroform ; 7 horses
(3 stallions, 2 mares, and 2 geldings) took, however, less than 12^
drachms ; on the other hand 18 (5 stallions, 4 mares, and g geldings)
required 38 fluid drachms or over. One gelding received 60 fluid
drachms, and an English thoroughbred 62. V fluid drachms. The average
age of the stallions was 5, of the mares g, and of the geldings 7 years.

It is worth noting that the quantity of chloroform used depends
partly on the method of administration. Apart from the quantity lost
by leakage or evaporation, less is required when administration is slow
than when it is rapid. The quantity used, therefore, often stands in
inverse proportion to the pre-anaesthetic period.

Breed seems to have little relation to the anaesthetic influence of
chloroform ; it neither affects the quantity required nor the pre-
anaesthetic interval to any appreciable extent. On the other hand, it
was noted that geldings on an average required considerabl}^ more
chloroform than stallions and mares.

Twenty-eight horses received subcutaneous injections of 75 grains
morphine before administration of chloroform. In these cases the
average quantity of chloroform used was 24 fluid drachms, and the time
interval before complete anaesthesia 15^ minutes.

PARTIAL AX.ESTHESIA. 49

Eight horses were given a mixture of equal parts chloroform and
ether. The average quantity used was 54 fluid drachms, and the time
interval 30 minutes.

Needless to say the sample of chloroform used must be pure, and
should contain no free chlorine, which produces excessive irritation.
To prevent chloroform undergoing change by keeping, a little ether is
added to it and the liquid placed in yellow bottles with ground stoppers
and stored in a cool dark place. Another method consists in adding
I part in 1000 of sulphur which has previously been washed with
ammonia, and afterwards with water.

Partial Anaesthesia by Chloroform. — As anaesthesia by
chloroform is generally preceded by a short excitation period,
during which the animals neigh, become uneasy, and often struggle
violently, casting by hobbles or on an operating table is an almost
unavoidable preliminary. This, of course, is a drawback, especially
when an operating table is not available, and if general anaes-
thesia could be carried out in the standing position it would prove
a great convenience. The writer frequently tested this method,
and for some time had such satisfactory results as almost to
convince him of its general practicability, but an attempt to chloro-
form a heavy cart-horse for shoeing was followed by such disas-
trous consequences, and so gravely endangered the operator's
own life, that he finally renounced the method for any but light
animals. Ponies, cobs, and light saddle and trap horses may be
anaesthetised in the standing position by the use, preferably, of
Cox's inhaler. A strong head collar or halter should be applied,
and the animal firmly secured, as greater danger is to be anticipated
from its becoming loose than from throwing itself down during
the preliminary period of anaesthesia. Administration should be
slow as excitement is thus best avoided. The writer has found
that many animals will stand quietly until the corneal reflex
becomes quite languid, and is almost abolished. This is the best
condition for shoeing troublesome horses. If cutting operations are in
question, anaesthesia must be pushed considerably beyond this stage,
and the animal will certainly fall, a result, however, which need be
productive of no inconvenience if a deep straw bed has previously been
provided.

Apparatus. — Chloroform can be administered from a towel,
sponge, tampon of tow, or a linen compress, but in England Cox's or
Carlisle's muzzle is usually employed. Although the rapid method is

4

50 OPERATIVE TECHNIQUE.

considered dangerous by some, it is that most commonly used in
England.

Abroad great precautions are taken. The chloroform is given from
a compress, and by one nostril only, being added drop by drop at the
rate of two or three drops per second. To avoid irritation, produced
b}' the liquid coming in contact with the skin or mucous membrane,
the nose may be smeared with vaseline.

Being very volatile, chloroform can be given by a modification
of Junker's apparatus. In its simplest form this consists of a tall
glass cylinder, containing the anaesthetic, closed by a bung or
large rubber cork pierced with two holes, giving passage to wide
glass tubes. One tube passes to the bottom of the glass ; to
this is affixed the bellows; the other, which onh' just passes through
the cork, is provided with a rubber tube which can be slipped
into the animal's nostril. By working the bellows, air is forced through
the liquid, becomes charged with the anaesthetic, and, passing into the
nostrils, is inhaled. A large form of this apparatus, made in copper and
worked by a foot bellows, was very successfully used by Dr. Clarke
(who invented it) and myself during 1887-g in operations for roaring.
The glass bottle was replaced by a copper C3dinder about fifteen inches
in height and four in diameter, the glass tubes by large metal tubes
about three quarters of an inch diameter. The long tube passed to the
bottom of the copper cylinder and through a circular plate of per-
forated metal. The blast of air was thus broken up into innumerable
small bubbles, which became thoroughly saturated with the anaesthetic
vapour. As after prolonged use the apparatus grows extremely cold,
and is apt to become clogged from the freezing of water vapour
derived from the blast of air, it was found advantageous to place it
in a bucket containing warm water. Later forms of Dr. Clarke's
apparatus are surrounded with an outer metal receiver for containing
hot water.

A simple form of inhaler was suggested by Mr. J. Koalfe Cox,
F.R.C.V.S. It consisted of a leather tube covered with stout canvas,
which could be drawn together at either end by a strong drawstring.
The tube was slipped over the animal's nostrils and into its mouth, the
drawstring tightened and attached to the halter. A sponge saturated
with the antesthetic was then introduced, and the supply of air
controlled by regulating the size of the external opening. The Carlisle
inhaler is more complicated, but probably not more efficient. It
envelops both the upper and lower jaw, thus differing from Cox's, and
is provided \\ith a metal sliding sponge-holder on which the chloro-
form is poured. As sent out it gravely impedes respiration, and for

GENERAL ANyESTHESIA.

51

use the writer has modified it by removing the lower solid end, so that
the only obstacle between the animal's nostrils and the outer air is the
comparatively pervious layer of sponge for receiving the chloroform.
Thus altered it uses rather more of the anaesthetic, but is infinitel}'
safer.

Fig. 67. — Clix's chloroform muzzle

Fig. Q-ja. — Arnold's modified Carlisle
chloroform muzzle.

Surgical An.esthesia by Chloroform. — Chloroform is usually
administered as follows : — Food having, if possible, been withheld
for twelve hours, the horse is cast, and girths or other impedi-
ments to free respiration loosened or removed. During inhalation,
attention must be given to the breathing and the pulse. Both
are at first accelerated, but later become regular. Unless when
using one of the ancesthesia cum asphyxia muzzles, the excitation
stage is seldom attended with danger, only lasts a minute or two,
and is succeeded by the period of depression.

The first stage of anaesthesia (excitation) is often accompanied b}^ a
peculiar rotary movement of the eye (nystagmus) ; in some animals the
eyelids close, opening again when anaesthesia is complete. If, soon
after the period of excitement has passed, respiration or circulation
becomes impeded, or if respiration be laboured, very rapid, or interrupted,
if the pulse be small, frequent, irregular, or intermittent, administration
must be stopped. General muscular twitching may also occur, and

52 OPERATIVE TECHNIQUE.

calls for similar precaution. Rattling in the throat, a serious symptom
in man, is of less importance in horses. In the event of its occurring,
the tongue should be grasped and drawn forward. Even then the
noise does not always cease, being probably due to vibration of
the relaxed soft palate, which is set in motion by the stream of
air passing through the mouth during respiration.

The loss of sensibility, muscular weakness, character of the pulse
and respiration, variation in the pupil, and the persistence or loss of
the corneal reflex indicate the degree of anaesthesia.

Complete anaesthesia is characterised by disappearance of the oculo-
palpebral reflex and contraction of the pupil. At this stage should the
conjunctiva or cornea be touched no movement of the eyelids follows,
and touching the cornea has therefore become the usual test of anaes-
thesia. When the corneal reflex ceases inhalation may be stopped, to
be resumed with its reappearance. The test is doubly valuable : it
shows anaesthesia to be complete, whilst its disappearance is usually long
antecedent to the period of intoxication. Too much weight, however,
cannot be attached to the advice " watch the breathing:." The
breathing, and not the pulse or any other sign, is the only safe guide in
administering an anaesthetic. The abolition of the corneal reflex
usually occurs long before respiration is endangered, so that it is a
convenient guide ; but its occurrence is subject to irregularity, and it
must never be relied on to the exclusion of the breathing.

Variations in the pupil also afford valuable information. As anaes-
thesia becomes pronounced, the pupil, dilated during the period of excite-
ment, contracts. During anaesthesia it remains contracted and immobile,
dilating slowly as sensibility returns. Rapid dilatation at an advanced
stage of anaesthesia is a sign of bulbar intoxication and of imminent
syncope.

When the corneal reflex is lost and the pupil contracted, sensibility
has disappeared, and muscular relaxation is complete. Provided
respiration and circulation continue regular, anaesthesia can then
be prolonged for periods of two or even three hours without danger by
occasionally administering further small doses of chloroform.

On completion of the operation the hobbles are removed ; but
the horse is left undisturbed until it rises of itself, which will usually
happen in a quarter to half an hour. Should the animal be forced
to rise before consciousness has entirely returned, it walks unsteadily,
" bores" forward like an animal with brain disease, and may fall. To
support it an assistant may walk on each side, with a hand on the
point of the hip, and one behind holding the tail.

Administered with the foregoing precautions chloroform becomes

GENERAL ANAESTHESIA. 53

a perfectly safe anaesthetic for the horse, and though individual
animals show special susceptibility to its action, yet in general the
danger is infinitely less than was formerly imagined.

Fatal issues result either from asphyxia or syncope.

Asphyxia usually occurs during the period of excitation, especially
if some closed muzzle like the Carlisle muzzle or its modifications be
used; first breathing stops, and after a short interval the heart's
action fails.

Asphyxia may also happen towards the end of the ansesthetic
period if administration has been pushed far and is suddenly checked.
In such case the sides of the chest, face, or lips should be smartly
struck with the hand or a wet towel to provoke reflexes -and
restore respiration. \\^hen arrest continues for an appreciable
period (the writer has timed arrests of thirty to forty-five seconds),
artificial respiration may be resorted to. A fairly heavy assistant
stands between the animal's legs and presses with his entire weight
on the animal's chest, rising again almost immediately. This is
repeated at intervals of about four or five seconds. The shock
should not be violent ; but the man's whole weight should be
employed, and special attention must be given to regularity in the
process. In the horse it rarely happens that the tongue recedes
and by covering the opening of the larynx causes asphyxia. Should
any indication of this — like loud snoring, etc. — occur, the tongue
should immediately be grasped and drawn forward.

In cases of respirator}- failure some French investigators have
recently recommended the system practised in man for resuscitation
from drowning, viz. repeated rhythmical traction on the tongue
(lingual traction) at intervals of two to four seconds. The theory
is that the superior laryngeal nerve and respiratory centre are thus
stimulated, and in man remarkable effects have been produced,
more than one person having recovered after apparent respiratory
arrest extending over an hour, A small apparatus worked by
electricity has been made to carry out the process.

Impending Cardiac Syncope is indicated by irregularity of the
pulse, widely dilated pupil, weak heart's action, cessation of
haemorrhage, or the escape of a few drops of dark-coloured blood
from the seat of incision. The head should immediately be
lowered as far as possible, artificial respiration commenced, cold
water dashed on the head, the chest wall smartly slapped, and
if time permit, subcutaneous injections of sulphate of strychnine or
ether should be given. Cardiac syncope may also be combated by
intermittent pressure on the heart region, at the rate of 120 to

54 OPERATIVE TECHNIQUE.

140 times per minute, or by the intra-venous injection of warm
normal salt solution. Hobday recommends small doses of prussic
acid. Rosenberger believes that in man heart failure is due to
stimulation of the vagus, owing to irritation of the respiratory mucous
membrane by the chloroform vapour ; he recommends previously
painting the membrane with cocaine solution. The precaution is
unnecessary in horses. In proof of the irritation produced, however,
one may often note in well-bred horses certain symptoms of sore
throat, such as coughing, etc., during the few days next succeeding
the operation. Recovery usually occurs without treatment.

Morphine and Chloroform. — When morphine is previously adminis-
tered the animals sometimes show considerably more excitement than
when chloroform alone is employed ; and as, generally speaking, the pre-
liminary use of morphine neither lessens the pre-anaesthetic period nor
decreases the amount of chloroform required, it is rather a drawback
than a help. Chloroform and ether mixtures present no advantages
over chloroform alone, except in cases of heart affection.

Ether was the first and, in man, remains the favourite anaesthetic
It is administered in progressive doses from a sponge, tampon of tow,
or linen compress, or by means of Cox's or Carlisle's inhaler. An
ordinary deep leather bucket muzzle is a very good substitute, pro-
vided care is taken to prevent the liquid coming in contact with the
mucous membrane of the nostril. If necessary, inhalation is occasion-
ally stopped, and when surgical anaesthesia is complete the dose is
considerably reduced. During the whole time respiration and the
reflexes must be closely observed.

The horse having been cast, anything which might impede respira-
tion, or compress the larynx, the lower portion of the neck, or the
thorax, is removed. If Cox's muzzle be employed the procedure is
precisely similar to that in giving chloroform ; otherwise a linen pad
about eight to ten inches square is placed over the nostrils, and ether
dropped on it in small quantities. The distance from the nostrils
regulates the rapidity of administration and the amount given.

The mucous membrane of the upper respiratory passages being
irritable^ considerable excitement is at first produced ; the animal
neighs, struggles, and is sometimes very violent ; respiration and
circulation are accelerated. This stage sometimes lasts for ten minutes,
and is succeeded by that of surgical anaesthesia.

The quantity of ether used is often considerable, from ten to twenty
fluid ounces, sometimes even more. Recovery is slower than after
chloroform.

Though less dangerous than chloroform, ether is not, as some

GENERAL ANAESTHESIA. 55

suggest, absolutely innocent, and has claimed a number of victims in
human surgery. Nevertheless Gurlt's statistics show the mortalit}'
from chloroform to be fifteen times greater than that from ether.

Anaesthesia can be produced by the introduction of ether vapour into
the rectum. It was tried first on animals by Dupuy and Thiernesse,
adopted for man by Pirogoff (1847), and recently b}' Daniel Molliere
(1884), and has been recommended by Cagny for the purpose of
producing a certain degree of drowsiness in horses to facilitate casting
or to permit of trifling operations in the standing position. The
system is simple ; a flask or tube with a. narrow neck is partially filled
with ether ; one end of a rubber tube is slipped over the neck, and the
other end introduced into the rectum. The flask is placed in water
heated to 120° F. Ether vapour is at once given off, enters the
rectum, and is absorbed by the mucous membrane. One and a half to
two ounces of ether are sufficient. Experience does not show this
method to have any marked advantages. In place of partial anaesthesia
active excitation often follows. Such violent expulsive efforts are some-
times made as to produce rectal prolapse. In man cyanosis, collapse, and
even a kind of asphyxia have resulted. The uncertainty and serious
inconvenience of this method have prevented its being commonly
adopted. Mixed anaesthesia, produced by the injection into the rectum
of ether vapour and the subcutaneous administration of morphine and
chloral, is slow in its effects and of little practical utility.

In English human surgery a favourite method is to obtain anaes-
thesia with nitrous oxide and maintain it with ether. The method has
many advantages, and has come largely into use.

Chloral is usually injected intra-venously, alone or after hypodermic
injection of morphine. Intra-venous injection of 20 to ^^ per cent,
solutions produces very rapid and complete anaesthesia. Though declared
dangerous by human surgeons, this method has been recommended in
France and Denmark for the horse, on account of the ease with which
injections can be made into the jugular. The solution, which may be
of any strength between 10 and ^^ per cent., must be freshly prepared,
and should contain a little carbonate of soda to insure its being
alkaline.

Intra-venous injection requires very special precautions. The point
of operation must be thoroughly disinfected, and all instruments should
be sterilised. Everything being ready, an assistant compresses the vein
low down in the jugular furrow ; the operator then draws the skin in
the direction of the head with one hand, while with the other he
thrusts a needle or fine trocar into the distended vessel, taking a
very oblique course from above downwards, i. e. almost parallel

56 OPERATIVE TECHNIQUE.

with the vessel. Humbert recommends dividing the operation into
two stages, first dividing the skin, then, after having raised the vein,
introducing the needle or trocar. When the operation is done
standing he chooses by preference the right jugular. The discharge
of a little jet of blood through the cannula when the trocar is with-
drawn sho\\s that the operation has been well performed. An
assistant holds the cannula firmly, and inclined towards the general
line of the neck. The operator next introduces into the opening
of the cannula a special metal plug connected to a rubber tube,
^^hich slips over the nozzle of the injecting syringe, and opening
the tap, injects the necessar\- quantit}' of chloral solution ; needless
to say, great care must be taken not to inject air. The operation
concluded, he frees the cannula from the rubber tube, allows a little
blood to escape, and quickly removes the cannula, supporting the
skin meanwhile with the fingers of the left hand. Colin gives the dose
as two and a half to three and a half drachms ; Arloing three to
six drachms : and Nocard one and a quarter drachms per hundred
pounds of body-weight. Anaesthesia appears almost immediately.
It is more or less profound, and continues for a greater or less
time according to the amount of chloral injected. In a fe\\' seconds
the animal is asleep, the muscles are completel}' relaxed, the mucous
membranes slightly cyanotic, and the respiration and circulation,
though disturbed for a moment, rapidl}^ recover their normal rh}thm.
The animal recovers slowly, remaining stupefied for a time, and
sometimes suffering from general trembling of the bod}' muscles. At
the end of half an hour to two hours the horse rises, resting for a
time on its haunches. ^Io\ement of the hind limbs is irregular
and uncertain. This weakness sometimes persists for one or two
hours.

When the dose has been too large, or the subject is specially sus-
ceptible to the action of chloral, the sleep is very deep, the mucous
membranes become darker and darker in colour, the pupil dilates,
respiration and circulation become slower and slower, the temperature
falls, and death may result.

If the operation be not performed antiseptically, if the opposite
coat of the vein be injured when introducing the cannula, or if
the solution obtain entrance to the perivenous tissue, grave results
almost alwa}s follow. The majorit}^ of those who have tried this
inethod have had at least some cases of phlebitis, and, in consequence,
have abandoned it. Phlebitis usually appears between the second
and fourth days ; a swelling, sometimes circumscribed, sometimes
diffused, occurs in the jugular furrow. Suppuration follows; frequentl}-

GENERAL ANESTHESIA. 57

a portion of tissue becomes gangrenous. In one case mentioned b}-
Cadiot the vein was destroyed throughout ahnost the entire length of
the neck. Furthermore, chloral acts as a vaso-dilator, increasing
haemorrhage during operation. Finall}-, although it has been little
used, chloral is responsible for a considerable number of deaths.
Moller killed a number of horses b)- injecting twelve and a half
drachms in solution. As the horses were not weighed, it might be
said that this dose was too large, but Cadiot has had a death with
the prescribed dose, where the quantity administered did not exceed
one and a half drachms per hundred pounds of body- weight. Fifteen
to twenty minutes after administration, when the operation was almost
complete, respiration ceased, and a few seconds later death resulted,
despite efforts made to establish artificial respiration.

Although when performed antiseptically and by skilled operators
intra-venous injection ma}' be innocent, it has given such bad results in
the hands of the majority that it has been renounced, among others, by
veterinar}' surgeons of the eminence of Peuch, Trasbot, Moller, and
Cadiot.

Administered b}- the mouth in doses of ten to twenty drachms
diluted solutions of chloral produce drowsiness, loss of co-ordination
of movement, but not complete anaesthesia. The method, however,
is of value in practice.

Chloral and Morphine. — To avoid the accidents resulting from
intra-venous injection of chloral Cadeac and Malet associated chloral
with morphine. They claim to produce complete anaesthesia by sub-
cutaneously injecting a solution of fifteen grains of hydrochloride of
morphine, and at the end of ten minutes giving an enema containing
twenty to twenty-five drachms of chloral.

Anaesthesia is not always produced. It appears slowly, and some-
times only after prolonged excitement. Esser recommends this method
where chloroform is contra-indicated.

Morphine, in the form of subcutaneous injection, has been recom-
mended to quiet small animals, and in the horse to produce slight
anaesthesia for trifling operations in the standing position. According
to the animal's size the dose varies from three to seven grains. In
certain horses morphine produces somnolence and more or less pro-
nounced relaxation of muscular tissue. Irritable or even dangerous
animals become quiet and easy to handle. Others, however, even
after large doses, show excitement lasting several hours. The patients
act violently, exhibit disordered movements, kick, and thrust their
heads against the wall, as in indigestion complicated with brain
mischief. Morphine must, therefore, be considered uncertain as an

58 OPERATIVE TECHNIQUE.

anaesthetic ; nevertheless, it renders some service, and in small doses is
devoid of danger. Opium or Indian hemp is, however, usually pre-
ferable.

Methylene is inferior to chloroform, as are hypnone, urethane,
paraldehyde, and benzine. Inhalations of the latter substance
first produce excitement, in about ten minutes distinct dulness, and
later a quiet sleep, which can be prolonged by fresh inhalations.

Anasthesia in Riiininants and Swine.

Anaesthesia is seldom resorted to in ruminants or in the pig.
Tabourin and Saunier, who made a long series of experiments
with chloroform and ether, came to the following conclusions : —

1. That in oxen, ether produced anaesthesia without difficulty.

2. That the animals succumbed to its action more readily each time
anaesthesia was repeated. 3. That chloroform was so much more
energetic than ether as to warrant its entirely displacing the
latter, despite its higher price. Given by the mouth 12 to 18 fluid
drachms of chloroform only produced incomplete anasthesia.

Frohner failed to obtain any anaesthetic action from doses of
10 drachms of chloral ; given by the mouth, 6 to 10 drachms pro-
duced unsteadiness of the hind quarters in fifteen minutes; 12 to iS
drachms, however, caused the animals to fall and lose consciousness
and sensation ; unconsciousness lasted three hours. Negotin recom-
mended this method and dose.

Guinard found morphine useless in ruminants, and especially in
goats ; it failed to produce even a sedative effect. Goats are not
injured by 400 times the full dose for man.

Malzew gave ten oxen chloroform in combination with morphine.
Two to three grains of morphine were subcutaneously injected,
and three to twelve minutes later chloroform was administered. In
seven cases anaesthesia commenced after the lapse of ten to forty
minutes, in three it could not be induced. From 4 to 19 fluid
drachms of chloroform were used. On return of consciousness
none of the oxen showed anything abnormal. Goats and sheep
are easily anaesthetised in five to ten minutes with 2^ to 5 fluid
drachms of chloroform.

In general the above also applies to swine, and chloroform
would probably prove the best material ; Negotin found it harmless.

Harms succeeded in abolishing sensibility to pin-pricks in ten
minutes by giving benzine vapour. Chloral hydrate is often given
to cows when calving, in order to dull labour pains ; complete
anaesthesia is, of course, unnecessary.

GENERAL ANAESTHESIA. 59

As, however, in the event of operation faiHng oxen may afterwards
require to be slaughtered, alcohol is usually preferred to any sub-
stance which might taint the flesh. Most practitioners give a
large dose of alcohol or rum ; in the case of oxen, one to two
pints. In five to ten minutes the action begins, and as intoxication
proceeds the muscles relax.

AncEsthesia of the Dog and Cat.

Ether or Chloroform may be used ; the latter is preferable.
Respiration may take place by either the mouth or nose, but it is
dangerous to forcibly close the jaws, especially by muzzling the
animal with tape. Guinard lays special stress on the need for keeping
the dog's mouth open while giving chloroform ; given by the nose
alone chloroform is apt to produce so active a stimulation of the vagus
as sometimes to inhibit the heart's action.

The dog is placed on its chest or side, the jaws opened,
or fixed in an open position by a gag. Chloroform can be
given by applying to the animal's nostrils a pad of tow or a
small sponge moistened with chloroform. Another method is to
form a cone of stout brown or blotting paper, at the bottom of
which is placed a small loose ball of cotton wool to receive
the chloroform. A conical muzzle, like Krohne's for human use,
or an ordinary Junker's inhaler is probably the most convenient
apparatus, though necessarily more costly than the paper cone.
Whatever the method adopted, administration should always be slow.

Ether is given in a similar way, but the excitation period is
longer, and the slumber produced less deep. On the other hand, ether
anaesthesia may be prolonged for considerable periods without danger.

Hueppe claims to have produced anaesthesia in dogs b}^ injecting
2\ drachms of ether into the external ear.

To obtain more rapid narcosis, and diminish danger of collapse,
morphine has been recommended in combination with ether or
chloroform. Moller first injects from three quarters to one and a half
grains of hydrochloride of morphine hypodermically, and after a short
interval gives ether in the usual way.

Cagny administers ether vapour by the rectal mucous membrane.
Its action, however, is uncertain, and it sometimes causes violent
straining.

As in the horse, intra-venous injection of chloral is dangerous.

Morphine in the form of subcutaneous injection, and chloral in
enema, have been advantageously combined. The dose of morphine
is at the rate of two minims of a 2 per cent, solution, and of chloral

6o OPERATIVE TECHNIQUE.

seven and a half grains, per pound of body-weight. Roucher has
sHghtly modified this method. The bowel is cleared with a soap and
water or glycerine enema, and a subcutaneous injection of morphine in
the proportion of Jrrth grain of hydrochloride of morphine per lb.
of body-weight administered, followed by an enema of one drachm ot
chloral hydrate in linseed emulsion. If necessary the dose may be
repeated in seven to eight minutes ; very large dogs may require a
third, or even a fourth. The disadvantages are the same as in the
horse. Anaesthesia is slow and haemorrhage abundant.

Richet has recommended intra-peritoneal injections of chloral
alone or associated with morphine. Injected into the peritoneum
chloral produces complete anaesthesia in about ten minutes. The
injection is made with a Pravaz's syringe, the greatest care being
taken in regard to asepsis. When well diluted, chloral is tolerated
by the peritoneum. Morphine added to the chloral prolongs anaes-
thesia to about one hour without danger of syncope. In this
method the doses are, hydrochloride of morphine "02 grain, chloral
four grains, per pound of weight. The method, however, does not
seem to have proved permanently successful, dangerous complications
sometimes occurring.

Frohner regards urethane as one of the best agents for the dog, and
has tried hypnone and paraldehyde with good results. Desoubry gives
from 22 to 30 grains of sulphonal to dogs of 40 lbs. body-weight, and
highly praises the method.

In the dog and cat, however, the best method probably consists
in using chloroform after a preliminary injection of atropine and
morphine. The morphine modifies excitement at the commencement
of anaesthesia ; the atropine prevents cardiac syncope by suspending
the function of the cardiac moderating centre and of the arresting fibres
of the pneumogastric. The solution is prepared as follows :

Hydrochloride of morphine . . .3 grains.

Sulphate of atropine . . . . '3 grain.

Distilled water . . . . . 2i fluid drachms.

This solution is injected in the proportion of five minims per
pound of body-weight. In twenty to twenty-five minutes the solution
produces its effect, and chloroform inhalation can be commenced.
A drachm or two is sufficient to produce complete anaesthesia,
which can be prolonged for one or two hours. The solution used in
man is as follows :

Hydrochloride of morphine . . • i^ grains.

Sulphate of atropine .... "08 grain.

Distilled water 2-I- fluid drachms.

GENERAL AN/ESTHESIA. 6i

This solution is also preferable for the dog. Ten minims are
given to animals of small size, twenty to forty minims to animals
of medium size, and sixty to eighty minims to large dogs.
Chloroform is administered at the end of twenty-five minutes.
This method produces deep and prolonged anaesthesia. There is
no danger of syncope.

The cat is very susceptible to the action of most anaesthetics.
Death may result from giving an overdose, from pushing the anaes-
thetic rapidly, or from prolonging its action.

A convenient method consists in placing the animal under a bell-
jar containing a small sponge or a tampon of wadding saturated with
chloroform. The animal soon loses consciousness and falls, when it is
removed and the operation performed. This method, however, is not
without danger ; the period of anaesthesia is short, and if repeated
inhalations are given there is some danger of the animal succumbing.
A modified Junker's apparatus is preferable. Miiller, of Dresden,
confirms the common experience that cats are poisoned in a few
minutes if chloroform be given rapidly, although they bear considerable
doses of ether very well. F'orty-five grains of chloral hydrate in the
form of enema also proved fatal.

The combination of atropine, morphine and chloroform, as given
above, may be employed, but the cat, being extremely sensitive to the
action of morphine, which in it produces great excitement, the dose
should not exceed "002 grain insteadof'02grainperpound of body-weight.
Guinard recommends another method permitting of prolonged anaes-
thesia. He gives a hypodermic injection of hydrochloride of morphine
at the rate of "02 grain per pound of body-weight, and at the end of a
quarter of an hour to twenty minutes, when excitement diminishes, he
places the cat under a bell-jar with a sponge saturated with chloroform.
The animal should be removed when anaesthesia first appears, but inhala-
tion is best continued for a few moments afterwards. Thus obtained,
anaesthesia can be kept up for forty-five minutes. The excitement due
to morphine reappears as anaesthesia diminishes, and may persist for
some time.

Negotin recommends Billroth's mixture (chloroform 3 parts,
ether and alcohol aa i part) or Wachsmuth's (chloroform 5, rectified
oil of turpentine i part) for dogs and cats. The ordinar^•
A.C.E. mixture (ether 3, chloroform 2, alcohol i) is better than
equal parts of ether and chloroform.

Negotin had indifferent results in carnivora and horses with
bichloride of ethylene, and in cats and dogs with bromoform.

62 OPERATIVE TECHNIQUE.

Monkevs may be placed in a close cage covered with a cloth,
and containing in one corner a tampon of cotton wool saturated
with chloroform. The animal at first struggles, and then begins
to fall about the cage or to lean against the walls, at which stage
it is removed ; if the operation lasts for some time a further
inhalation is given.

Birds may be placed under a bell-jar containing a sponge or
cotton-wool tampon saturated with chloroform. One edge of the
jar may be slightly raised to allow air to enter. Hering states
that birds may be hypnotised by placing the head under one of
the wings, and then rapidh- turning the bird's body several times
around its long axis.

Conclusions regarding General Anaesthesia. — The above
conclusions may be summarised as follows :

1. For horses the best anaesthetic is chloroform (inhaled) in
doses of I to 8 fluid ounces ; average dose, say, 3 ounces.

2. For oxen : chloral hydrate, in doses of 12 to 20 drachms, or
whisky, brandy, or spirit in doses of i to 2 pints.

3. For sheep, goats, and swine : chloroform (inhaled) in doses
of 24 to 5 drachms.

4. For dogs and cats : morphine (subcutaneously) in doses o
•75 to 1*5 grains, or equivalent doses of morphine and atropine,
followed by inhalations of ether, chloroform alone given in small,
carefully-increased doses, or mixtures of chloroform with ether,
alcohol, or oil of turpentine.

Surgical An.esthesia by the Injection of Cocaine into the
Lumbar Subarachnoid Space.*

The event of the surgical 3-ear igoo in Paris was undoubtedly
the impetus given by Tuffier to the method of inducing anaesthesia
by medullary injections of cocaine, a suggestion previously made and
acted upon by Bier, of Kiel, Seldowitsch, of Russia, and Corning,
of Chicago. Tuffier was first led to use it as a means of relief in the
case of a young man suffering from an inoperable osteosarcoma of the
ilium whom morphia failed to relieve. The result of the injection of
cocaine was striking. The patient, who was cr"Ouching down in the
position of greatest ease, felt the pain disappear in a few minutes, and
was even able to rise. There was at the same time absolute anaesthesia
reaching to the umbilicus. Unfortunately the relief lasted only a few

* See ' Lancet,' January I2th, 1901.

GENERAL AN/ESTHESIA BY COCAINE. 63

hours, and the injection was repeated two days later with similar
effect, pressure over the tumour for some hours causing no
pain whatever. A few days later a similar injection was tried
for a patient with a recurrent sarcoma of the thigh, and to
Tuffier's surprise he was able to remove the tumour completely with
absolutely no pain to the patient, the angesthesia lasting over an hour.
At first, therefore, used only in the surgery of the lower limbs,
Tuffier rapidly extended its use to operations upon the perinseum, the
rectum, the anus, the bladder, the ureter, the kidney, and such lapa-
rotomies as h3'sterectomy, removal of the appendix, and even gastro-
enterostomy. Finally, removal of the breast has been effected with
complete anaesthesia. Convinced of the absolute harmlessness of the
injections, Tuffier then used them in general gynaecology, and performed
such operations as hysteropexy, drainage of salpingitis, ovariotomy,
vaginal hysterectomies, etc., with equal success.

Technique. — The details of the technique followed were given in
the Scuiainc Mcdicalc of May i6th, igoo, and later Tuffier was
careful to disclaim any originality, save in some practical technical
points of his procedure. An ordinary hypodermic syringe will
suffice, provided its construction admits of absolute sterilisation.
The best, therefore, is the glass syringe made by Luer, which
can be boiled without injury, and which never gets out of order.
The needle should be strong, of platinum, about nine centimetres
in length — /. e. three and a half inches — with its penetrating-
sharpened portion cut very short. The solution of cocaine used
is 2 per cent., and must be freshly prepared and sterilised. It
seems, however, probable that in the long run weaker solutions will
become of more frequent use, and that the solution of cocaine used
will vary from i in 100 to as little as i in 400. The patient should be
seated bent forward slightly, with both arms in front of him. The
lumbar region is thoroughly cleansed, and the anatomical landmarks
are noted. It will be found that a horizontal line between the two
highest points posteriorly of the iliac crests passes immediatel}-
below the fourth lumbar spinous process. Above or below this line in
the intervertebral space the needle will freely enter the medullary
canal. The left index then marks the fourth spinous process, and the
patient is told to bend well over forwards, thus increasing the space
between the vertebras by nearly three fifths of an inch. The needle
alone is then entered at about a centimetre (two fifths of an inch) to
the right of the middle line, in a direction forwards and inwards in the
third or fourth lumbar interspace, as may be selected. The third
lumbar interspace is that commonl}- chosen, but the fourth may be
punctured with equal facility and effect, and Legueu frequently injected
the cocaine into the second lumbar space. It is interesting to recollect
that Coming's first injection was made between the twelfth dorsal and
the first lumbar vertebra. The needle thus pierces the skin, the sub-
cutaneous tissue, the lumbar fascia, the sacro-lumbar muscles, and the
quadratus lumborum, and enters the spinal canal through the Hga-
mentum flavum, which alone offers any noticeable resistance.

As the needle enters the subarachnoid space the absence of

64 OPERATIVE TECHNIQUE.

resistance is at once felt, and almost at once the clear, yellowish
cerebro-spinal liquid escapes drop by drop. The syringe has been
already prepared, containing from one to two cubic centimetres of the
2 per cent, solution, i. c. from one to two centigrammes of cocaine
(from twenty to thirty minims, containing about a quarter of a grain of
cocaine), and is now fitted to the needle, and the solution is very
slowly injected. The quantity of cocaine injected, it will thus be seen,
is very small, and yet the anaesthesia resulting will last about one and
a half hours. The little puncture is then sealed with collodion, the
patient lies down, and an assistant at once begins to cleanse and to
prepare the field of operation. The analgesia passes gradually from
the feet upwards, and for a laparotomy it may be necessary to wait
from ten minutes to a quarter of an hour before commencing.

Tufher, whose experience is probably greatest of living surgeons,
has not yet observed an accident which he could attribute to the in-
jection or to the cocaine. He has by this method performed over 200
operations, of which more than half have been intra-peritoneal.
Legueu prefers eucaine to cocaine, owing to its lesser toxicity and its
greater stability during sterilisation by heat. Hydrochloride of eucaine
may be sterilised either in an autoclave or by heating the solution for
half an hour on three successive days to 100° C. Hydrochloride of
cocaine, on the other hand, will decompose at this temperature.
Legueu's conclusion, after some weeks' experience and over fifty opera-
tions, is that as a method of anaesthesia it is destined to take an im-
portant place in a great number of operations, and specifies all below
the level of the umbilicus, all operations on the perinaeum, the lower
urinary passages, the lower limbs, always supposing that muscular
contractions do not too greatly embarrass the surgeon. Some draw-
backs, such as incompleteness of the anaesthesia produced and signs
of poisoning, have been noted by one or two observers.

Messrs. Cuille and Sendrail, of the Toulouse Veterinary School,
have tested this method in the horse, ox, and dog. They report that
their first experiments have given complete satisfaction.

Horse. — They employ a trocar about 4 inches long by y^ of an inch
in diameter. The place where the puncture is made is found midway
along a line joining the internal angles of the two ilia. Implanted
vertically at this point the trocar enters the neural canal, traversing
the lumbo-sacral space. It is the only accessible spot ; further forward
the vertebral laminae are too close together and imbricated. During
the operation the animal scarcely moves. The application of a twitch
and the lifting of a fore-foot are the only precautions required. Dis-
infection of the cutaneous surface, sterilisation of the needle, syringe,
and solution, are absolutely necessary.

First experiment. Aged mare. Injection of i fluid drachm of 2
per cent, solution of cocaine. Five minutes later the subject rocked
slightly; when made to move she showed weakness behind, and went
over on her side. The students practised neurectomy on all four legs.
Cutting through the nerves of the hind limbs caused no pain, but
section of the nerves in the fore-limbs produced pain, manifested by
struggling of all the limbs.

GENERAL ANAESTHESIA BY COCAINE. 65

In the second case the operation of ovariotomy was performed
without any exhibition of pain.

Third experiment. Aged mare, medium size. Injected 30 minims of
cocaine sohition. The gait was like that of the former animal. Ten
minutes later ovariotomy was performed without any movement what-
soever ("dans le calme le plus parfait"). The sensibility of different
parts of the hind limbs, flanks, and lower aspects of abdomen was
tested by pyropuncture ; there were no signs of pain. Plantar
neurotomies were performed upon the hind limbs forty minutes after
the injection without pain, the animal lying down.

Bovines. — The same trocar as for the horse was used. Puncture was
made at the same point. Leaving aside the toughness of the skin, the
operation is easier than in the horse, the lumbo-sacral space being a
little wider.

Sixth experiment. An old Lourdes cow. Injected 75 minims of 2 per
cent, solution of cocaine. Three minutes later the animal flexed her hind
limbs ; after five minutes she showed weakness, and for a short time
literally sat down ; then she lay down on her side. Pricked deeply in
different parts of the hind limb, she did not move. When the prick-
ings were done in the fore-quarters as far as the line of cartilages of
the asternal ribs, she showed pain. An hour later the animal got up
voluntarily. The spinal cord, spinal meninges, and cauda equina
were perfectly normal.

Dog. — The best point for the operation is again in the lumbo-
sacral region, taking the same landmarks as before. A hollow needle
of a Pravaz syringe, 2\ inches long and yg- inch in diameter, is the
most suitable. The animal stood up, the head kept firmly in position
by an assistant, but did not resist the operation.

Ninth experiment. A male mastiff of average size received 30 minims
of the cocaine solution. Several minutes later he fell upon his hind
quarters, the limbs extended, and progressed by means of the fore-
limbs as an animal attacked with complete paraplegia. Sensibility was
tested by the aid of the zoocautery, and was found to be non-existent
behind the hypochondriac regions, but preserved in front. Forty-five
minutes later the animal got up, and sensation only commenced to
reappear at the end of an hour. The dog then went to his kennel and
ate his food with relish.

Tenth experiment. Made upon the same animal the day following
the previous experiment. The animal did not appear to have suffered
from the experiment of the previous evening. He received 15 minims of
the solution. Five minutes later the gait was somewhat altered, but
walking was still possible ; the analgesia extended over the same area as
the previous day. An hour later, the condition of the animal being appa-
rently normal, 15 minims were injected in the region of the bulb in the
occipito-atloid space without puncturing the medulla. A few seconds
later the animal became helpless ; he could only advance by crouching
on the ground with his paws in front of him, moving upon his sternum.
He vomited. The analgesia involved the anterior part of the body, the
head excepted. Two hours later he progressed more easily, and went
to his kennel, where he ate his food. During the succeeding days and

5

66 OPERATIVE TECHNIQUE.

for a month afterwards he showed nothing abnormal. Killed at the
end of the month, no trace whatever could be found of the injections.
All his organs were perfectly healthy.

These experiments — as yet not numerous, which the investi-
gators intend to pursue — show, nevertheless, in a convincing manner
that analgesia produced by cocaine injected into the neural canal is
applicable in veterinary surgery, and that, with proper precautions,
there is no danger. (It is worthy of note that not one of the subjects
of experiment, not even those which had received manifestly too
great a dose of cocaine, exhibited any abnormal respiratory or circu-
latory symptoms.) The doses used were fifteen to seventy-five minims
of a 2 per cent, solution of cocaine for the horse or ox. For dogs
fifteen minims should not be exceeded.

(b) Local Anesthesia.

The dangers of general anaesthesia have stimulated the search for
means of rendering insensitive the region of operation alone. Pro-
longed compression of tissues and mediate compression of the nervous
trunks supplying the part are very imperfect methods. For a long
time ice refrigerating mixtures and ether spray were exclusively used.
Cocaine was afterwards discovered, and soon became popular.

Anesthesia by Cold. — The prolonged action of cold renders
superficial tissues bloodless and diminishes or even abolishes sensibility.
Refrigerant mixtures have been used in operations like neurectomy.

Crushed ice and salt, mixed in the proportion of 2 to i are packed
into a long bag and applied to the region of operation. In a few
minutes, especially if the bag is pressed firmly into contact with the
part, the skin becomes cold, firm, and insensitive, and incisions unless
deep neither provoke pain nor haemorrhage. The anaesthesia, however,
is of short duration, and operation must be rapid.

By projecting an ether spray on the parts the temperature is soon
so far reduced that trifling operations may be performed without pain.
The action is rendered more rapid and complete by previously apply-
ing an Esmarch bandage. It is difficult, however, to render inflamed
parts insensitive, and for this purpose refrigerating mixtures are pre-
ferable.

Bisulphide of carbon has no advantage over ether.

Methyl bichloride and anestile, successfully used in man for trouble-
some neuralgia, are almost too active, and though rendering the skin
insensitive in a few seconds not infrequently freeze it, causing more or
less extensive necrosis.

Local Anesthesia by Cocaine. — Cocaine is almost insoluble in
water, but the greater number of its salts dissolve freely. The most

LOCAL ANAESTHESIA. 67

frequently employed is hydrochloride of cocaine of i to 10 per cent,
strength. The addition of a trifling amount of bichloride of mercury
insures the solution keeping. Reclus recommends the following formula :

Hydrochloride of cocaine . . . .1^ grains.

Sublimate ...... -03 grain.

Distilled water . . . . . • 2-i- fluid drachms.

A few drops of this solution placed between the eyelids render the
superficial layers of the cornea insensitive in three minutes.

By repeating the application at two-minute intervals the cornea, the
conjunctiva, and eyelids are often completely insensitive in less than ten
minutes, and anaesthesia lasts a quarter of an hour. The pupil dilates,
but as a rule the iris is not rendered insensitive unless the injection is
made into the anterior chamber. By this method puncture of the
cornea and removal of foreign bodies fixed in the conjunctiva are
rendered easy. Five or six subconjunctival injections made around
the ball of the eye permit the eye itself to be removed without great
pain. Cocaine acts equally well on other mucous surfaces, and under
certain conditions may be useful in painful inflammations of these
membranes. The most recent experiments appear to show, however,
that the blanching and anaesthesia are followed by congestion of the
parts, and the use of cocaine in gargles, etc., for inflamed pharynx has
been abandoned in human surgery, the after effects being bad.

By a series of small injections along the course of a proposed in-
cision operation is rendered painless, provided the seat of operation be
in a mucous membrane or in the skin. A Pravaz's syringe fitted with a
long fine needle is used, the needle being inserted into the subcutaneous
connective tissue, or, better, into the thickness of the epidermis, follow-
ing the direction of incision. As the needle is gradually withdrawn
the piston is slowly pressed home, leaving the track filled with fluid.
The anaesthetic qualities of cocaine are increased by previously injecting
morphine.

Arloing states that cocaine has no effect on the nerve-cells, its
action being confined solely to the terminal fibres of sensory nerves.

Its toxicity varies according to species. In the dog the dose varies
from f to i^ grains. Strong solutions offer no advantages and are
dangerous. Cocaine solutions of whatever strength, lose, more or less
completely, their anaesthetic quality on becoming acid, but this can be
restored by neutralising the liquid.

Local Anaesthesia by Infiltration. — Dr. Schleich produces
local anaesthesia by causing artificial oedema in the region of opera-
tion. He performed amputation and even laparotomy successfully.

68 OPERATIVE TECHNIQUE.

He showed that it is not necessary to inject strong solutions of
the anaesthetics which might produce poisoning, but that quite weak
solutions, even a "i per cent, solution of chloride of sodium, suffice,
and that in all cases of anaesthesia, other factors than the mere
chemical constitution of the substance play an important part. The
injection of fluids under fairl}^ high pressure into the skin and sub-
cutaneous tissues renders the whole area affected completely insensitive.
Should the tissues be cut through no blood flows.

This method produces anaesthesia by the co-operation of four
factors — the pressure induced by the mechanical action of the liquid,
cold due to the temperature of the solution, anaemia caused by the
cold and pressure, and a chemical change produced in the nerve
endings. The undermentioned formulae, which ha\e been used in
human practice since 1894, have been lately used upon horses and
dogs by Podkopajeu and Negri, who recommend them for their
simplicit}', harmlessness, and cheapness.

The condition lasts, however, for not longer than twenty minutes.
Schleich's experiments showed that the best results attended the use of
a combination of cocaine, sodium chloride, and morphine. He recom-
mends the following formulae for use in man :

r Hydrochloride of cocaine

h

„^ 1 i- r Hydrochloride of morphine

btronar solution -J ^/, -j r j-

° I Chloride of sodium

I Water

0-20
002

0-20

100

7 fluid drachms injected at each operation.

r Hydrochloride of cocaine . . . o'lo

,. , ^ , ^ 1 i- I Hydrochloride of morphine . . 002

Moderately strongf solution^ ^/, -j r -i- ^.^„

-' '^ I Chloride 01 soduim . . . o 20

V Distilled water .... lOO
14 fluid drachms injected at each operation.

/"Hydrochloride of cocaine .... O'OI

.,. 1 , ,- I Hydrochloride of morphine .... o'OOs
V\ eak solution -, r-i"i -j r j- ^.^^

I Chloride or sodium .... o 20

V Distilled water ..... lOO
Use up to 140 fluid drachms at each operation.

He renders even the first prick of the needle painless b}- previously
spraying the point of puncture with a mixture of four parts of sulphuric
ether and one part of petroleum ether. Mucous membranes are
rendered insensitive by dabbing with lo per cent, carbolic solution, or
with a solution of cocaine. The needle is slowly introduced into the
skin itself in a direction parallel with the surface, and must not enter
the subcutaneous tissue. As soon as the point has travelled a quarter
to half an inch beyond the primary puncture the piston is gently
pressed, causing a bleb to rise in the skin. The S}Tinge is then
slowl}- withdrawn, and again introduced within the peripher}^ of the

LOCAL AN.ESTHESL\ BY INFILTRATION. 6g

little blister previously produced. This is quite painless, as the area
has now become insensitive. A further blister is thus produced, and
the operator proceeds in the same way until a chain of blisters is
formed covering the entire length of the incision presently to be made.
Each of these points of artificial oedema is anaesthetic. The method
succeeds, not only in the case of skin and mucous membranes, but in
serous and synovial membranes, muscles, nerves, and the periosteum.
Even bones and the bone medulla can be rendered anaesthetic by
subperiosteal injections. Deeper-l3ang tissues can, of course, only be
rendered angesthetic after the more superficial have been so treated.
The condition persists for fifteen to twenty minutes ; should an
operation last longer the process must be repeated. In preparing for
the insertion of sutures for instance, the needle of the syringe is passed
from the cut surface towards the skin, so that the path which the
suture needle will afterwards take is rendered cedematous. The bleed-
ing from tissues thus rendered cedematous is remarkably slight ; on
incision the injection fluid is first of all discharged without admixture
of blood, then little points of bright arterial blood appear in the fluid
from the wound.

According to Schleich the injection of distilled water also induces
local anaesthesia. A solution of "2 per cent, chloride of sodium sets
up local anaesthesia without previous hyperaesthesia ; 3 per cent,
solutions of sugar produce more or less pronounced anaesthesia.
Pietro Ghisicui has experimentally studied at the Turin Veterinary
School the results obtained by the above-mentioned formulae, and by
distilled and sterilised water.

The quantity of cocaine solution or of distilled and sterilised water
employed varied ; generally he used from 2^ to 16 drachms of the
strong solution, 3 fluid ounces of the moderately strong solution,
4i fluid ounces of the weak solution, instead of i^ to 4^ fluid ounces
of water. He noted a fleeting hyperaesthesia during the operation,
the tissues became turgescent, infiltrated, cedematous, and anaemic.
The oedema produced by the water and by the solution of Schleich
disappears after eight or nine hours. The vitality of the tissues is
unaltered, and cicatrisation takes place regularly. Complications,
such as stupefaction, nervous or functional troubles, etc., have not
been observed.

From twenty-two experiments made with water, and the same
number with Schleich's solution, the author draws the following
conclusions :

Anaesthesia by infiltration should be more common in veterinary
practice. Schleich's method is very useful, practical, and cheap.

70 OPERATIVE TECHNIQUE.

Solutions of cocaine may be replaced by distilled and sterilised
water, with which complete local anaesthesia is obtained, lasting as
long as that produced by Schleich's solution. In laparotomy w'ater
and cocaine solutions have an unsatisfactory effect, apparently due
to the ready distension of the tissues, which prevents the requisite
action of the fluids.

Bayer has tried Schleich's method in animals, and with such good
results that he recommends it strongly, especially where difficulties
exist in casting a horse. As an experiment, he made an incision about
four inches long through the mucous membrane of the tongue and
then sutured the wound. He also trephined the superior maxillary
sinus without causing any apparent pain. The horse was operated on
in the standing position, and was not restrained by twitches or other
appliances. In another case, having cast but not chloroformed or
twitched the horse, he divided the median nerve without causing any
struggle. In this instance the nerve sheath was injected. At the
point of operation the nerve was anaesthetic, but pressure with the
point of the needle at any spot beyond the oedematous zone produced
lively reaction. M oiler successfully performed an extensive operation
for hernia on a horse without casting. This method is particularly
useful in dogs, w^hich seem specially susceptible to the action of
chloroform, and not infrequently die as a consequence of prolonged
administration.

""Si'^J^^m

CHAPTER IV.

ANTISEPSIS AND ASEPSIS.

Although infection of wounds has always attracted the attention
of the surgeon, he has until recently been ignorant of its nature, of its
cause, and of the methods of avoiding it. During the first half of the
last century infection of exposed wounds was attributed to impure and
exhausted air, especially to the hospital atmosphere and to air charged
with the miasma of putrefaction. The works of Pasteur and Tyndall
seem to confirm the truth of this idea, by showing that it is not the air
itself which has injurious properties, but only the germs it carries in
suspension. Sterile organic fluids exposed to the atmosphere immedi-
ately begin to ferment, but provided they be kept from contact with all
but optically pure air filtered through cotton wool they undergo no
change. It was therefore concluded that decomposition and putre-
faction are due to little animate bodies, suspended in the atmo-
sphere,— /. c. germs or microbes — which under favourable conditions
break down organic substances. Save for micro-organisms there
would be no decomposition and no putrefaction. Extending the logical
process, Lister was of opinion that the same process went on in injured
tissues exposed to the action of air as occurred in organic liquids.
Septic changes in wounds therefore represent a kind of fermentation.

The first important researches with the object of preventing such
complications are relatively recent. In 1865 Lister, inspired by
Pasteur's work on fermentation, began those experiments which
eventuated in the formulation of his "antiseptic method;" while in
1870 Guerin, following up the same work and that of Tyndall, invented
his surgical dressing.

Guerin applied to wounds the experimental conditions necessary for
preserving organic materials from change when in contact with the air.

72 OPERATIVE TECHNIQUE.

shielding the injured tissues by thick layers of cotton wool. Lister, on
the other hand; sought to destroy microbes present in the wound or
introduced during operation, by means of chemical substances. Lister
first rendered the wound aseptic and afterwards protected it by a
germicidal barrier.

Let us consider the surgical dressing. At lirst Guerin did not
seek primary union of the wound, only attempting to reduce the
discharges and to avoid infection. Bleeding having ceased, he washed
the wound with tepid water, afterwards with a mixture of water and
camphorated alcohol. In some cases he sutured the wound and cut
the threads short, covering the parts with several layers of wadding.
In extensive operations on the limbs the region was enveloped in many
layers of wadding suitably affixed. The outer bandages were applied
tightly, and if during the next few days the degree of compression was
considered insufficient, or if the discharges penetrated the whole thick-
ness of the wadding, fresh bandaging was resorted to. At first the
dressing was left in position for twenty to twenty-five days, later it was
replaced at the end of twelve to fifteen days. As a rule on removing
the first dressing the wound was found to be granulating throughout.
With a second dressing left in position for eight to ten days cicatrisa-
tion was complete.

To obtain primary union various modifications were made in this
method. Thus bleeding was more thoroughly checked, and the lips
of the wound carefully closed with deep sutures of some material
like catgut, which would gradually disappear. Despite its many
advantages this dressing of cotton wool concealed the state of the
wound. The thermometer certainly gave indications of unfavourable
changes, but as considerable fever sometimes occurs even when wounds
are doing well, time was lost, and it was not infrequently necessary to
remove the dressings, thus exposing the patient to danger. Further,
although atmospheric germs could not enter the wound through the
layers of cotton wool, those already there or introduced during opera-
tion were not destroyed, and frequently multiplied with great rapidity.

Compared with the older dressings that of cotton wool constituted
an immense stride in the surgical art, but, nevertheless, its use did not
become general. The greatest success was reserved for Lister's
dressing, which was more practical and also more certain in its
results.

To prevent infection Lister sought to destroy all infectious materials
in and around the wound as well as in the neighbouring air. Com-
pleting this process, he took care that the hands of the surgeon and his
assistants, the instruments, sponges, compresses, and all materials used

DEVELOPMENT OF ANTISEPSIS. j^

as dressings should be rendered thoroughly aseptic. The wound
having been cleansed of organisms was covered with a material
saturated with an antiseptic, and precautions taken to prevent accumu-
lation within it of the serosity exuded by all injured tissues. Lister
long preferred carbolic acid in solutions of i in 20 to i in 40. With
the strong solution he disinfected the instruments, sponges, and seat of
incision, and once the operation was over, the wound throughout. The
weaker solution he used for disinfecting the hands of the surgeon and
his assistants, and for washing out sponges during operation. To
prevent the wound being infected by atmospheric germs he introduced
an antiseptic spray, the vapour of which covered the entire area of
operation. After operation and before the spray had ceased acting all
bleeding was checked, vessels were ligatured with catgut, the threads
were cut short, and the lips of the wound brought together with
catgut sutures. Drainage-tubes were inserted to permit serosity, etc.,
to escape, and the dressing was then applied.

The region of operation was first covered with a strip of protective
consisting of oiled silk, the object being to prevent prolonged action of
the carbolic solution on the wound, as this proved too irritant. Over
the protective was applied carbolised gauze, doubled six or eight times,
the last two layers being separated by a layer of mackintosh to prevent
the carbolic acid evaporating, and to force the wound discharges to
traverse the entire thickness of the dressing before escaping. All these
materials were fixed in place by bandages of carbolised gauze.

The action of the carbolic acid on the tissues produced an abundant
discharge. At the end of twenty-four to twenty-eight hours, therefore,
it was necessary to remove the dressing, examine the wound, the
condition of the sutures and draining-tube, if necessary to remove
the latter and replace them after thoroughly washing in strong
carbolic solution, and to apply a new dressing, everything being done
under the spray. Whenever pain or any marked elevation of tempera-
ture appeared to demand it, the wound was re-dressed with the same
precautions. Such was the method for surgical wounds in tissues
primarily free from infection.

For all recent accidental wounds with irregular margins the applica-
tion of a dressing was preceded by a careful cleansing with 10 per
cent, carbolic solution. Suppurating wounds received more complex
preparation, being curetted and scrupulously cleansed with 10 per
cent, chloride of zinc solution. As in them the irritant action of
carbolic acid was not to be feared the protective was suppressed.

Lister's method of dressing rapidly spread throughout all Continental
countries. Though it at once displaced the old methods, it possessed

74 OPERATIVE TECHNIQUE.

some drawbacks, such as the minuteness of detail required, the time
demanded for its appKcation, its high price, and the dangers resulting
from the poisonous nature of the antiseptic employed — carbolic acid.
While, therefore, respecting the great principles laid down by the
inventor, surgeons set to work to perfect and especially to simplify it.
Carbolic acid was replaced by salicylic and thymic acids, by chloride
of zinc, subnitrate of bismuth, corrosive sublimate, and iodoform.
For carbolised gauze was substituted ordinary tarlatan preserved in
dilute carbolic solution until the moment of use, or muslin kept for
a week in strong carbolic solution. For drainage purposes tubes
of decalcified bone were suggested, because they became absorbed,
irritated the tissues little, and necessitated less frequent renewals of
the dressing. The protective was shown to be useless, and drainage
was suppressed except when immediate union appeared uncertain.
The technique of dressing, the antiseptics, and the strength of solutions
have been varied infinitely.

Believing that the principal point was to prevent atmospheric
germs gaining access to the wound, Guerin paid less attention to dis-
infecting hands, instruments, and dressings, and his good results were in
a large measure due to scrupulous observance of cleanliness, and to the
habit he had formed of thoroughly washing the hands and cleansing
the region of operation and its neighbourhood with soap and cam-
phorated alcohol before operation.

Lister's method was more certain, but also had imperfections and
shortcomings. The success which attended the introduction of
antiseptics was certainly not due to carbolic acid alone. The anti-
septic was credited with greater bactericidal powers than it possessed.
The belief in its abilit}- to rapidly and completely disinfect instruments,
hands, and the region of operation was exaggerated. In Lister's, as in
Guerin's practice, the most important factor was the rigorous cleanli-
ness of the hands, of the instruments, and of the dressings. Antiseptic
treatment of wounds might never have survived had not observance
of cleanliness largely assisted it.

To protect wounds from the action of atmospheric germs was the
chief preoccupation alike of Lister and of Guerin. Numerous
observers, however, have shown that infection is almost alwaj-s
produced by the hands of the operator or his assistant ; by the instru-
ments, dressings, or liquids employed ; not by atmospheric germs.
Contrary to the belief generally held when antisepsis was introduced,
entrance of air is little to be feared, and atmospheric germs, formerly
regarded as so formidable, can almost be left out of account. Those
which fall into a wound are generally destroyed by the phagoc}'tes.

ANTISEPTIC AND ASEPTIC METHODS. 75

Those, however, introduced by insufficiently cleansed hands, instru-
ments, and dressings are not only much more numerous but infinitely
more dangerous. Septicaemia, once so common after hospital operations^
was not due, as believed, to the introduction of atmospheric germs,
but to organisms carried by dirty instruments, which had either
undergone only a semblance of cleansing, or had even passed from the
post-mortem room to the operating theatre !

The principal source of contamination being recognised, the
disinfection of instruments, hands, and dressings received greatly
increased attention. Bacteriological researches and some clinical
investigations showed that disinfection by chemical agents is not
always complete even when concentrated solutions are used. Organic
substances, even in thin layers, are not always readily penetrated by
liquid antiseptics, and the deeper strata may retain virulent organisms
in spite of the prolonged action of such liquids. Chemical disinfectants
are therefore reserved for the seat of operation, and the hands ;
instruments, ligatures, drainage-tubes, and other materials used for
dressing are subjected to the action of boiling water, glycerine^
heated oil, or simply to a high degree of dry heat. The simplest and
most practical method is that of boiling in water, with or without
the addition of sodium carbonate. Although it does not give absolute
security — certain spores resisting even a temperature of 212° F. —
it is almost always sufficient.

In hospital practice Chamberland's autoclave and dry heat stoves
are very useful, the former being used for sterilising objects preserved
in liquids where temperatures of 120° to 150° C. are required. Although
during the last few years Continental surgeons have practised
antisepsis in all its details and continued to perfect its technique,
English and American surgeons are more and more abandoning the
use of chemical bactericides and resorting almost entirely to the
observance of rigorous cleanliness ; in a word, they are abandoning
antisepsis for asepsis. In veterinary surgery, however, the latter
method will probably never obtain the same favour as the former.
Strictly speaking, antisepsis and asepsis do not stand in opposition,
but rather form mutual complements one of the other, aseptic
methods being preventive, antiseptic curative ; their association is
often advantageous. Antisepsis is resorted to when the region of
operation includes a suppurating wound, a fistula, or an ulcer, or
when reunion by first intention has failed. Antiseptics are then
employed to disinfect the seat of operation, the hands, the instru-
ments, and the dressing materials. The aseptic method, on the
other hand, is applicable to operations on infection-free tissues

76 OPERATIVE TECHNIQUE.

which might become inflamed under the action of antiseptics, to
hmited cases of necrosis, and to intoxications; but if asepsis can be
ensured, it is useless to apply to healthy tissues strong antiseptic
solutions. Of the two principles — "antisepsis before and during,"
*' antisepsis before, asepsis during " — the former is preferable in our
practice on account of the chances of the wound, the hands, and the
instruments becoming infected during operation. Even in human
surgery, where, thanks to better surroundings and to special apparatus,
rigorous asepsis can much more readily be obtained, and where the
operator can count on highly skilled assistants, antisepsis, nevertheless,
has its uses.

Among the organisms producing surgical infections two species,
micrococci and bacilli, stand pre-eminent. Whilst the former are
usually quickly killed by heat and the principal antiseptics, the latter
resist to a varying degree, depending on whether they have attained
the adult rod-like form or exist as spores. The adult bacilli are easily
killed, the spores on the other hand are strongly resistent. Certain
spores, like those of tetanus and septiccemia, exhibit most extra-
ordinary vitality.

When dry, all microbes resist the action of heat and antiseptics
to a higher degree and for a longer time than when moist. The most
convenient method of destroying them is exposure to moist heat.
Whilst steam at 212° F. kills the majority of pathogenic microbes,
the dry temperature required for the same result varies from 290° to
330° F. Moisture considerably enhances the destructive action of high
temperatures and of antiseptics. Few pathogenic microbes resist
steam heat for more than a few minutes. Many die at 175°, 160°, and
even 150° F., but the spores of tetanus and of some septic organisms
endure higher temperatures than 212° F. without destruction. The
following table shows the temperatures at which the organisms of chief
surgical interest are destroyed :

Staphylococcus pyogenes aureus is destroyed in ten minutes by a temperature of 137° F.
,, ,, albus

„ ,, citreiis

Streptococcus of erysipelas

,, strangles

The bacillus of tetanus

,, ,, tuberculosis

,, ,, ^ glanders

Anthrax spores are destroyed in ten minutes by a temperature of
Tetanus spores ,, ,, ,, ,,

Septicaemia spores „ „ ,, „

Tetanus spores are destroyed in fifteen minutes by a temperature of
212° F. and in five minutes by a temperature of 240° F. At ordinary

144°

F.

13'°

F.

,, 140°

F.

167°

F.

., 167^

F.

131°

F.

. 212°

F.

. 220°

F.

■ 247^"

F.

ANTISEPTICS. ^j

temperatures they resist 5 per cent, carbolic solution for more than
ten hours. The septicaemia organism resists 212° F. for a quarter of
an hour. In a dry state it is destroyed in ten minutes by a tem-
perature of 250° F. The organism of black-quarter is destroyed in ten
minutes by immersion in boiling water. When dry it resists a tem-
perature of 250° F. for ten minutes. Moist anthrax spores are destroyed
in a few minutes b}- a temperature of 212° to 220° F. When dr}'
they are onl}- killed after ten minutes' exposure to a temperature of
240° F.

Antiseptics.

Carbolic acid is used in solutions of i, 2, or 5 per cent, strength.
The 5 per cent, is for disinfecting the instruments, seat of operation,
abscess cavities, suppurating wounds, and sometimes for exciting slight
adhesive inflammation when inserting intestinal sutures. It is unsuit-
able for operation and recent wounds, because it strongly irritates the
tissues and produces free serous exudation, thus impeding immediate
union. The 2 per cent, solution is suitable for irrigating fresh
wounds, for disinfecting the hands, and for rinsing out the wound
during operation. The i per cent, solution is used for disinfecting
certain mucous surfaces and for obstetrical operations.

Sublimate or bichloride of mercury solution is one of the most useful
chemical antiseptics. Koch states that a i in 1000 solution destroys
bacteria and most micro-organisms in a few minutes. On account of
its toxic character many surgeons restrict its use to the disinfection of
the skin and vaginal mucous membrane. For other mucous surfaces
and for deep wounds they regard it as dangerous. Nevertheless, in
weak solution it is valuable for irrigating surgical and accidental
wounds, as it irritates tissues less than carbolic acid. It blackens
metallic instruments, destroys their polish, and injures their edge. For
obstetrical operations it is sometimes replaced by biniodide of mercury.
The strong solution of sublimate is prepared as follows :

Sublimate . . ,1 part.

Tartaric acid . • . .5 parts.

Boiled water . . . 1000 ,,

The weak solution contains double the above quantity of water.
Solutions of I in 3000 to i in 5000 can be used for most mucous mem-
branes. As, however, it is decomposed by alkaline salts, distilled water
must be used for making solutions, or a small quantit}' of acetic or
salicylic acid added to ordinary water before use. To prevent
sublimate solutions being decomposed by contact with albumen, five

78 OPERATIVE TECHNIQUE.

parts of chloride of sodium or ammonium to each part of sublimate
are added in preparing them. A convenient method of preparing
sublimate solutions is offered by the tabloids, etc., manufactured by
various wholesale chemists. An excellent material for disinfecting the
surgeon's hands is obtained by dissolving two parts of sublimate in looo
parts of rectified spirit. Prick's wound gelatine for covering wounds
after operation is prepared by soaking gelatine in i in lOOo sublimate
solution, dissolving by heat, and adding lo per cent, glycerine. It
adheres better than collodion.

Chloride of zinc, formerly used for treating unhealthy wounds, is a
powerful antiseptic. In 5 per cent, solution it rapidly destroys most
spores (Koch), but it is caustic. The 10 per cent, solution is useful
for disinfecting fistulae, abscesses, and suppurating or septic wounds.

Socin's paste, consisting of 50 parts oxide of zinc, 50 parts water,
and 5 parts chloride of zinc, is used in veterinary practice ; applied to
aseptic sutured wounds it forms a kind of protective varnish, replacing
a dressing. It is specially useful for wounds about the head and in the
upper regions of the body.

Permanganate of potash is also a good antiseptic, devoid of toxic
properties. It owes its microbicidal powers to the oxygen which it
disengages. Producing no irritation it can be used for all wounds,
especially those in mucous membranes. A strength of 1 in 1000 is
useful for disinfecting the mouth, nasal cavity, vagina, rectum, and
serous cavities. A 10 per cent, solution is used for infected wounds,
and occasionally for the hands. The stain can be removed by plunging
the hands into a 10 per cent, solution of bisulphite of soda to which
has been added a few drops of hydrochloric acid.

Biniodide of mercury is stated to be thirty times more active than
sublimate, and of a strength of i in 10,000 to i in 20,000 is used for
disinfecting the vagina and mucous membrane of the uterus. This
solution neither irritates the hands nor the lips of wounds, and does
not injure instruments.

Iodoform, long used for treating wounds and ulcers, is especially
useful in checking suppuration. Its action is slow. Being both
antiseptic and analgesic it assists cicatrisation, retards decomposition
(jf wound discharges, and diminishes pain. Powdered over the lips of
wounds before suturing it does not prevent immediate union. Dusted
in a thin layer into wounds with loss of substance it keeps them
aseptic for 5, 6, or 7 days, constituting a kind of disinfecting
reserve. Used freely and over large areas it may, in recent wounds,
become dissolved in the fatty materials often contained in the
serous exudate, giving rise to intoxication. Its disadvantages are its

ANTISEPTICS. 79

disagreeable odour and high price. Three preparations of iodoform
are used in surgery, viz. saturated solution in ether, a lo per cent,
emulsion in glycerine, and a lo to 20 per cent, ointment in vaseline.
The glycerine emulsion is useful in the treatment of abscesses, tuber-
culous cavities, and contused wounds, like those caused by carriage
poles, etc. Gauze and wadding impregnated with iodoform are
largely used as antiseptic dressings. They contain 10, 20, and 30 per
cent, of iodoform. Iodoform wadding is used to fill the cavities of
wounds, and in dressings applied after operation on the vagina.

Di = odoform contains 95 per cent, of iodine, whilst iodoform
contains only 69 per cent. It is a yellow material, insoluble in water,
slightly soluble in alcohol, but very soluble in most hydrocarbons.
It keeps well in darkness, is very sensitive to the action of light, and
is without odour. It is one of the most active promoters of healing
known, though of very slight microbicide power.

Salol contains about 40 per cent, of carbolic acid, occurs in powder
form, like iodoform, and has the advantage of possessing no smell. It
is sometimes used for preparing gauze and wadding.

Cresyl or creolin is very widely used as an antiseptic in veterinary
surgery. Being miscible in all proportions with water, alcohol, and
glycerine, very slightly toxic, and not attacking either the operator's
instruments or hands, it is largely employed. A 3 to 5 per cent,
solution is used for disinfecting instruments, infected wounds, and the
skin before operation, A i per cent, solution is prepared for disinfect-
ing deep wounds, mucous membranes, the uterus, etc. It has, how-
ever, the drawback of rendering instruments slippery, and its milky
solution prevents their being seen. A 10 per cent, alcoholic solu-
tion and a 10 per cent, ointment prepared with vaseline are largely
used.

Formalin consists of a 40 per cent, aqueous solution of formaldehyde.
Diluted with four to five hundred parts of water, it becomes a useful
disinfectant for the hands, seat of operation, and accidental wounds.
Strong solutions are irritant and caustic. Tannoform, glutol and
amyloform are compounds of formaldehyde with tannic acid, gelatine,
and starch respectively. They form useful dry dressings for open
wounds, but are of greatest service when preceded by the application
of a liquid disinfectant.

Chinosol is a yellow, crystalline powder, derived from coal tar. A
solution of one part in forty thousand prevents bacterial development,
and a grain dissolved in six drachms of water is said to be equal in
antiseptic power to a 2.3 per cent, solution of carbolic acid. Solutions
for surgical purposes vary in strength between i in 1200 and i in 60.

8o OPERATIVE TECHNIQUE.

Combined with starch or French chalk chinosol forms an efficient dry
dressing.

Nitrate of silver of a strength of i to 2 percent., or of i per 1000, is
used with success for disinfecting certain inflamed mucous membranes.

Boric acid is httle used in solution, but as a dry powder is widel}-
employed for dressing wounds after operation. Its irritant properties
are slight, and being non-volatile its action is long continued. A
saturated solution is of great value for operations on the eye, and
for disinfecting the mucous membranes of the buccal and nasal cavities,
the rectum, vagina, and bladder.

Naphthol of a strength of i in 1000 is a feeble antiseptic. Naphthalin
has the same properties as naphthol, exercises a stimulating action on
the tissues, and promotes granulation of wounds. Camphorated naphthol
is a yellowish-brown, s\-rup3' liquid, produced b}' triturating one part of
naphthol with two parts of camphor. Camphorated salol is an opales-
cent liquid, produced by warming together equal parts salol and powdered
camphor. Camphorated thymol is an almost limpid fluid, produced by
triturating one part of thymol with two parts of camphor. These three
products are used in treating suppurating wounds.

Sterilised salt solution consists of boiled water containing six to
seven grammes of chloride of sodium per litre, and is very useful in
washing out the abdominal cavity during or after operation.

The number of antiseptics increases every day, but the more recent
have no marked superiority over those mentioned. Carbolic acid,
sublimate, chloride of zinc, and iodoform still maintain their position.

Antisepsis and Asepsis in Practice.

We shall now consider what antiseptics are best suited for dis-
infecting the hands of the surgeon and his assistants, the instruments,
dressings, and field of operation, and how they^can best be employed.

Disinfection of the Hands, — Fiirbringer's experiments have
shown how difficult it is to render the hands aseptic. The matter is,
however, of the highest importance, as the operator's hands are not
infrequently the means of infecting operation wounds, and the surgeon
who desires to avoid after-complications will take especial care in this
respect. The spaces beneath the nails, the folds of skin at their base,
the folds of the skin itself, and the orifices of skin-glands are all refuges
for microbes, to destroy which demands the most minute precaution.
In some cases it is impossible to render the hands completely aseptic.
Kiimmel and others have shown that after soiling with pus or with
putrid or septic liquids from infected wounds or dead bodies, it is

i

DISINFECTION OF INSTRUMENTS. 8i

impossible to render the hands absolutely sterile for forty-eight hours.
The surgeon should bear this in mind when operating in regions like
the peritoneal cavity, and in performing laparotomy, ovariotomy, or
cryptorchid operations. He should either defer operation for some
days or redouble his precautions ; neglect in this respect explains
failure where apparently all the conditions for success have been
present. The nails should first be cut short, and all foreign material
mechanically removed from under and around them. The hands and
forearms should next be washed for some minutes with soap and warm
water, and scrubbed thoroughly with a brush or a Turkish flesh glove.
They are then washed with rectified spirit, a-nd lastly with i in looo
solution of sublimate. The alcohol dissolves fatty materials which
would otherwise impede the action of the antiseptic, and enables the
latter to penetrate some distance into sebaceous ducts, etc. More
complex methods have been suggested, but the above is sufficient. In
veterinary surger\' the precautions usually taken only extend to
thoroughly cleansing nails, washing the hands with hot water and
soap, and thoroughly rubbing them for some minutes with i in lOOO
sublimate solution or 3 per cent, solution of creolin. The hands must
be rendered aseptic and kept aseptic throughout the operation. For
this reason the operator should avoid touching the skin surrounding
the point of operation, the table, the straw or any object which has
not been disinfected. ^Even when nothing suspicious has been touched,
it is well during operation to plunge the hands from time to time in a
disinfectant; should the hands actually have been soiled, they must
immediately be cleansed again. The precaution must be rigorously
observed during operations in the peritoneal cavity, where an act of
forgetfulness may entail the patient's death. During operation the
surgeon and all his immediate assistants should wear linen operating
coats which can readily be washed.

Disinfection of Instruments. — The handles of modern instru-
ments are generally made of German silver, nickel, or aluminium.
They should present no unnecessary ornamentation, depressions,
grooves, corrugations, or spots likeh' to hold dirt. Instruments like
scissors, forceps, etc., should be capable of disarticulation for cleansing
purposes, and complicated instruments difficult to clean should be dis-
carded. Wherever possible instruments should be in one piece, like
the retractors in Figs. 75, 76, and "]"] ; for more complicated instruments
the French joint, as shown in the lion forceps, Figs. 78 and 79, is the
best. For sutures, Larger's or Mooij's needles are preferable to
others, being simple and readily sterilised. For syringes with pistons
one can often substitute a simple glass tube carrying a rubber ball, the

6

82 operativp: technique.

piston being then replaced b}- a column of air. Man}' methods and
jnaterials for rendering instruments aseptic have been recommended.
Immersion in carliolic or creolin solution is advised by man}' surgeons,
but carbolic solutiou attacks the cutting edge of bistouries, and creolin

Fig. 6o.

Fig. 68.

Fig. 70.

Fig. 72

Figs. 68 — 73. — Scalpt-l.s.

renders instruments slipper}', while the opacity of the emulsion prevents
instruments being distinguishable one from another. Immersion in
boiling water is a simple and practical method. The boiling-point is

Fig. 74. — Dissecting forceps.

raised by the addition of common salt, car'nonate of soda, carbpnate of
potash, or chloride of calcium, and an}' detrimental effect on metallic
instruments can be prevented by adding i per cent, of caustic soda.
Where a higher temperature of 250*^ to 260° F. is required the bath may

DISINFECTION OF INSTRUMENTS.

83

be of oil, glycerine, or melted vaseline. When instruments havf been
soiled with a particularh' virulent discharge, like that of tetanus, septi-
caemia, etc.. the best method is to immerse them for ten minutes to a
quarter of an hour in the oil or ghxerine bath. Otherwise pro-
longed boiling in ordinar\' water or carbonate of soda solution is
sufficient. The vessel in w^hich this boiling takes place should be
provided with a tight lid, so that after boiling the whole may be
placed on one side to cool. Immediatelv before operation the instru-

FiG. 75. — Curved scissors with Germai
aseptic joint.

Fig. 76. — Curved scissors Fiu. 77. — Straight scissors
with French aseptic joint, with French a,septic joint.

ments are removed from it, and placed in trays containing an anti-
septic solution (3 per cent, carbolic), in \vhich they remain until
required for use. Should the operator have finished with an instrument
for the moment it should be immediately returned to the solution, and
never allowed to come in contact with the straw or be laid on the
animal's body. Trays of glass or porcelain are very useful, though vul-
canite is also largely employed, being much less brittle. All vessels
of the kmd must be subjected to a thorough cleansing before use. As
the wooden handles of instruments are injured by boiling, the handle

84

OPERATI\E TECHNIOUE.

should be thoroughly cleansed and the blade alone disinfected in boiling
water.

x\utoclaves, steamers, or stoves are only used in the laboratory or in
hospital practice.

Disinfection with burning alcohol is another rapid method of
disinfecting instruments. The instruments are placed on a metallic
plate previously rinsed with a little alcohol, which is then ignited.

Fk;s. Hi , 82. — Lion forceps, with French aseptic
joint for cleansing and sterilising'.

A few minutes suffice to render
them sterile, when they can be
placed in a weak antiseptic solu-
tion or in boiled water. Although
excellent for ecraseurs, forceps,
Fig. 78. Fig. 79. Fig. 80. directors, etc., this method is apt

Retractors with metal handles for aseptic ^^ damage the temper of bistouries,

snrgery. * .

scalpels, and scissors.

Gum-elastic probes are washed in strong alcohol and afterwards in
I per 1000 sublimate solution.

In addition to instruments the surgeon employs sponges, tampons,
cotton or tow compresses, suture threads, and various dressing
materials. All surb materials should previously have been rendered
aseptic. After ha\ing been beaten with a wooden mallet, the sponges
are washed in running water, placed for ten to twelve hours in a i in

STERILISATION OF SUTURE MATERIAL, ETC.

85

1000 solution ot pertTianganate of potash, washed in boiled water, and
afterwards placed in stron.i,' carbolic solution, where they should remain
for at least two to three weeks before use. Immediately before use
they are washed in boiled water, to remove the excess of carbplic with
which the}- are saturated. At the present time sponges have generally
been given up, and com-
presses of gauze or sponge
tissue sterilised in the
autoclave, and tampons o^
absorbent wool or turf
tissue are preferred. Many
veterinar}-' surgeons still use
tow. This is unsuitable un-
less it has been thoroughly

Fk

-Steam steriliser for instruments f,packed
for transport).

cleansed and sterilised by heat or by immersion in a boiling antiseptic
solution. When used the method generally adopted is to plunge the
tow for five minutes into boiling water or into a boiling soda solution.

Silk thread is sterilised by immersion for half an hour in boiling
water, or by exposure to a temperature of 220° to 230'^ F. in the autoclave.
Immersion for a quarter of

an hour in strong carbolic
solution is also sufficient.
It is preserved in glass
holders (see Figs. 85 — 88)
in 5 per cent, carbolic solu-
tion, or in I in 1000 subli-
mate solution.

Catgut is deprived of
adherent fat by immersion
in ether, and after drying is
wound on bobbins. These
can be sterilised b\- dr\'
heat, and preserved in a
strong sublimate or car-
bolic solution or in boiled
olive oil.

Silkworm li^jature is

Fu.. S4.

-Steam steriliser lor instruments
(open in use).

treated with ether boiled for half an hour in water, and then placed in
tubes containing 2 per 1000 solution of sublimate.

Paraffined thread is prepared by immersing hemp thread, previously'
saturated with ether or oil of turpentine, in melted paraffin. To
remove an}- stiffness it may be passed through a cloth before use

OPERATIVE TECHNIQUE.

Fig. 85. — Silk-holder for hospital use.

This thread is flexible, does not absorb organic liquids, nor cut out
rapidl}-. It is, therefore, especially useful for sutures intended to
remain long in position.

Drainage-tubes are preferably formed of red rubber. After thorough
\yashing in concentrated permanganate of potash solution the}' are left
for twenty minutes in boiling water, transferred to tubes containing 2
per 1000 solution of sublimate, and finally sterilised by exposure to a

temperature of 120° for half
an hour. They are sometimes
replaced by bundles of stout
antiseptic silk or catgut,
along which drainage pro-
ceeds, or by slips of antiseptic
gauze.

The above methods of
procedure for sterilising com-
presses, suture materials, and
drainage-tubes are not abso-
lutely indispensable. The
method usually employed in veterinary surgery is to immerse them for
five to ten minutes in strong boiling carbolic, creolin, or sublimate solu-
tions. Bang considers this sufficient.

The field of operation and surrounding parts must be most
carefully cleansed. In all animals the skin is covered with extremely
numerous and varied micro-organisms, among which the Staphylococcus
albus and aureus are particularly abundant. It is, therefore, always

important to disinfect
the parts. If the skin
is health}', the hair is
clipped away with
scissors or removed with
a clipping machine, the
parts thoroughly soaped,
shaved, scrubbed, and washed with boiled water. After being dried
with a sterilised compress, the parts are rubbed with alcohol or ether to
remove fatt}' materials from the surface, and are finally washed with
strong carbolic, or i in 1000 sublimate solution. If the skin is infected,
or the seat of an ulcer, suppurating wound, or fistula, it is necessary,
the day before operating, or even some days in advance, to curette
the wound, afterwards proceeding as just indicated. In abdominal
operations, exposing the peritoneum, special care must be taken in
shaving and disinfecting a wide area, while the operative area should

Fig. S6.— Portable silk-holder.

DISINFECTION OF THE AREA OF OPERATION. 87

be covered with towels recentl}' boiled or soaked in an effecti\-e dis-
infectant. Convenient irrigators for holding the above 'lisinfectant
solutions are shown in Figs, go, and gi.

These two principal methods, however, are not applicable to all
surfaces. They may require niodihcation in certain regions. In all
mucous membranes it is necessary to remove the mucus from the
surface by freel}- washing with hoilt-d water in order to permit anti-
septic solutions to act in<_)re
freely.

The mouth is always in-
fected with micro-organisms,
and is difficult to disinfect.
In large animals disinfection
is confined to washing freel}-
with water followed by 2 to 4
per cent, solutions of boric
acid, I in 1000 of permanganate ot potash, or i per cent, of
chloral. In the dog decayed teeth should be removed, and,
if necessary, the gums swabbed with tincture of iodine or creolin
solution.

To promote intestinal antise[)sis pre\ioiis to intra-peritoneal opera-
tion, the bowel should be emptied li\- a smart purge, the animal
placed on a reduced or milk (bet, while antiseptic- '^nlistnnrcs can be

Fig. 87. — Sterilised silk in portable sealed tubes.

Fig. 88. — Showing method of withdrawing silk.

administered by the mouth. Saline purgatives in small repeated doses
are valuable as a preparation, after which naphthol, betol, or creolin
may be gi\'en in the proportion of 50 centigrammes to i gramme for
small animals, and 5 to 10 grammes for the horse and ox. Rectal
injections of a solution of i in 1000 permanganate of potash, i to 2
per cent, creolin, i to 2000 sublimate, or 4 per cent, boric acid, complete
the preparation. When, during operation, the bowel is divided, the
ends withdrawn from'the peritoneal cavity are kept closed by clainps

88

OPERATIVE TECHNIQUE.

or b}' pressure with warm sterilised compresses, en re l)ein<; taken
to avoid soilin^^ the peritoneum b}^ material escaping from the
incision ; the bowel must not be returned until it is certain that the
wound has been completely closed and the serous coats arouuLl the
suture touched with a strong carbolic solution in order to produce a
slight adhesive inflammation. For eight to ten days after operation
only small quantities of liquid nourishment, such as milk and beef- tea
for FTiiall animals and hay-tea for others, should be given. Ordii ar\'
food is then gradually resumed.

In disinfecting the rectum, the food is diminished for se\eral da\s
in advance, and the same materials are prescribed as
tor intestinal antisepsis. In additi<m, however, the
rectum must be frequeiitK' irrigated. The anus is dis-
infected in precisely the same way as the healthy skin.

The nasal cavities can Ije rendered aseptic by
washing out with sterilised lukewarm water, and afier-
waids by injecting a i in 5000 solution of sublimate or
a I in 1000 solution oi permanganate of potash.

The e^e demands special precautions. It can be
1 allied with sterilised water, 4 per cent, boric solution,
1 in 150 or 200 creolin solution, or the following solu-
ti()n of biniodide of mercury recommended for man by
Pan as :

Biniodide of mercury . 5 to 10 centigrammes.
Absolute alcohol . . ^o grammes.

Boiled filtered water 1000 grammes.

Sublimate must also be greatl}- diluted (i in 5000).
The instruments must be perfectl\- sterilised, especially
||1^|| if the globe of the CN'e is to be opened.

Disinfection of the external auditory meatus is
carried out with weak antiseptic solutions. The skin
Fig. 89. — Drainage is cleaused with warm water and soap, dried, and
tubes in sublimate irrigated with 3 to 4 per cent, boric acid solu-

or carbolic solution. ° u t r

tion, I in 1000 permanganate ot potash, or i in
5000 sublimate solution. If discharge is abundant, the use oi bismuth,
salol, or iodoform is indicated.

Antisepsis of the vagina is usually easy. Soap solution is used for
cleansing the mucous membrane, which is afterwards irrigated with
4 per cent, boric, 2 per cent, creolin, or i in 2000 sublimate solution.
These irrigations are repeated on several successue days. Instead
of syringes, irrigators consisting of a glas^ reservoir and an india-
rubber tube can be used. It is difficult howe\-er, to disinfect the

PREPARATIONS FOR OPERATING.

89

vagina when the mucous membrane is the seat of polypi, ulcerating
tumours, or when it has been infected during removal of a putrid
foetus.

The uterus is disinfected in the same way as the vagina, a long
india-rubber tube being employed.

Beyond passing the catheter few operations are performed on the
bladder. In this case preventive treatment is of the greatest import-
ance. Until now the dangers of catheterisation, as
usuall)^ practised, have not received sufficient atten-
tion. Acute cystitis and its various complications
may follow the introduction of soiled catheters, which
are cleansed with difficult}' and are more or less
septic.

Catheters should be disinfected by prolonged
immersion in strong antiseptic solutions, and after-
wards be kept in a special case.

In operations on the foot, local antisepsis is
ensured b}- the following method : — The shoe is
removed, the plantar surface of the hoof thmned, the
hair clipped away from the whole limb up to the
knee, the hoof thoroughh brushed with hot water
and soap, freely washed with an antiseptic solution,
in which it should be immersed for a quarter of an
hour to twenty minutes, then enveloped in com-
presses saturated with an antiseptic, and fixed in
position b}' mtans of tarlatan bandages. Linseed
poultices prepared with a strong disinfectant solution
certainl}' soften the horn, and ma\ be useful, but
from the point of view of antisepsis the superiorit\' ot
compresses cannot be gainsaid.

Before commencing operation, the ligatures,
suture and dressing materials should be placed in a
sterilised dish. Two other dishes or plates contain- Fig. 90.— irrigator for
ing an antiseptic solution are provided for the instru- JanSg on wall ^°^
ments and cotton wool tampons used for absorbing
blood. ImmediateU the skin is incised blood Hows, becoming more
abundant as the mcision extends, and concealing the point of operation.
This haemorrhage is from small vessels, and can be checked by con-
stantly mopping the parts with tampons of cotton wool taken from
the antiseptic solution. Carbolic solution checks bleeding, causing
the tissues to contract and bleeding vessels to close, but it has the

90

OPERATIVE TECHNIQUE.

disadvantage of producing superficial necrosis. Provided there is no
infection, simple boiled water, or water containing a little common
salt, is sufficient. When arterioles or small veins are cut, they can be
picked up with forceps and ligatured with silk or catgut. In most
inflamed tissues haemorrhage is abundant, even when no large vessel
has been cut. In such case the thermo-cautery is sometimes useful ;
by passing it at a red heat lightly over the lips of the wound bleeding is
checked. The thin aseptic scar thus produced does not necessarily
prevent union by primary intention, as it may be completely absorbed.
The same is true of ligatures left in wounds. Catgut is digested by

the tissues, or destro3'ed in a few
days by large migrating cells,
and by the new cell elements ;
silk becomes encysted, and is
slowly absorbed.

To obtain primary union,
the wound must be scrupulously
guarded against infection. All
bleeding must be stopped, and
the tissues brought exactly into
apposition. A thin layer of
blood in an aseptic condition
between the lips of the wound
does not prevent primary union ;
the tissues tolerate it, and it is
even utilised in the process of
repair ; but large clots are
absorbed with difficulty, and
present a very favourable soil
for the growth of pathogenic

Fig. 91. — Portable irrigator.

microbes. The bleeding surfaces are dried as far as possible,
covered with antiseptic vaseline [vaseline 50, powdered boric acid
5, iodoform i], closely approximated throughout their extent, i.e.
both superficially and deeply, and every effort made to secure
contact. When coaptation is not perfect in the depth of the
wound, a space is left for the accumulation of blood and serosity,
in which any retained germs multiply rapidly. Where the wound
implicates several different laj^ers, it may become necessary, in order
to keep these closely in apposition, to pass a number of deep sutures
of catgut or silk fixed at their extremities to little rolls of gauze [deep
or anti-tension sutures], in addition to inserting superficial sutures of
silk or silkworm ligature. Lastly, the surface is washed with sublimate

I

OPERATIONS WITHOUT ANTISEPTICS. 91

solution, dried with tampons of absorbent wool, and covered with a
film of iodoform collodion, or with a dressing of surgical wool.

When it is impossible to briqg the surfaces of the wound per-
fectly together, or when there has been much loss of substance,
provision must be made to prevent the accumulation of discharges
by inserting one or more rubber drainage-tubes, a carefully disinfected
plaited horsehair tape, a strand of plaited silkworm ligatures, or a
strip of gauze. Rubber drainage-tubes are generally employed. They
can be fixed to the lips of the wound by a silk or silkworm-gut suture.
Their presence allows antiseptic injections to be made into the bottom
of the wound without touching the sutures.

The above are the measures required to absolutely prevent
infection of operative wounds. Minutiae and superfluous details
have been omitted. Most human hospitals contain highly' com-
plicated installations for absolutely ensuring success, permitting the
operator to obtain union by primary intention, and to avoid bad
consequences even after prolonged manipulation within the abdominal
cavity. Almost all the veterinary schools of Europe similarly
contain operating theatres provided with installations and material
for facilitating the practice of asepsis and antisepsis.

It is not indispensable rigorously to follow this technique in every
case to obtain good results. Even in human operations performed
outside hospitals or special nursing institutions the surgeon is able
to insure a sufficient antisepsis without such complicated measures.
Degive, who published a series of one hundred castrations of
cr3'ptorchids without a single casualty, certainly did not conform
in every respect to the rules of antisepsis. Although very important
when operating in a contaminated area like the atmosphere of a
hospital, such rules can be parth' neglected in operations prac-
tised under more favourable circumstances, in either town or
country. Even without such an array of instruments, vessels,
antiseptics, and dressing materials, asepsis can be so nearly secured
as to ensure good results. Moreover many operations must be
performed on the spot, and with the means at hand, if the patient
is to be saved. In such cases one operates under a shed or in
the open air. To prevent dust produced by the animal's struggles
soiling the seat of operation, the bed may be slightly moistened.
Two large dishes contain respectively a strong solution of common
salt and boiled water. The seat of operation having been denuded
of hair, either with a clipping machine or by shaving, is thoroughly
scrubbed with soap and water by means of a nail-brush, and

92 OPERATIVE TECHXIOUE.

then rinsed with boiled salt water. The surgeon, after having
thoroughly cleansed his nails, washes his hands and forearms in
the salt solution. A basin in which a little alcohol has been ignited
is filled 'vith boiled water for the purpose of cleansing the hands
during operation. The instruments can be disinfected by passing
them through the flame of an alcohol lamp, or by moistening them
wath alcohol which is afterwards ignited, or even by immersing
them for five m- ten minutes in a boiling i per cent, solution of
carbonate of soda, /. c. ordinary' washing soda. To disinfect cloths,
tampons for cleansing the wound, suture material, and tow, boiling
salt solution can be used.

The seat of operation is protected by a "dressing" formed of
layers of surgical wadding or tow. suitabl}- arranged and fixed in
position by bandages [see Chapter on " Bandaging and Dressing")-
Dressings applied to the upper regions of a limb should either
be comparative!}' loose or should extend to all the parts below,
in order to a\oid interference wiih circulation rtnd such consequences
as swelling and sloughing.

The first dressing is exceedingl}- important. \'er)- often it
deteriTiines the entire after-course of the wound. It can be left in
place for a var3dng time. If the patient's general condition is
good, and the fever is sHght, and if the dressing remains dry,
it need not he renewed for t\\el\e to fifteen da}S in winter, and
from eight to ten da}-s in summer, if. during removal, the deep
la}'ers of wadding adhere to the skin, tlie\- should be moistened
and softened with a warm antiseptic solution, or in the case of
the foot by placing the extremity in a bucket containing the liquid.
The skin should be carefulh' cleansed with tampons of cotton wool.

Where primary union has occurred the wound is found cicatrised
on removal of the first dressing ; if, however, it is only progressing
favourabl}', nothing more is needed than the application of a fresh
dressing, the same precautions being observed as on the first occasion.
Care must be taken to avoid disturbing the wound or moving the lips ;
drainage-tubes can be replaced after disinfection, fresh ones of similar
calibre but of shorter length can be substituted, or drain, ige-tubes may
altogether be discontinued. When the wound is suppiuati ng the
s tures must he cut, the drainage-tubes removed, and the whole cavit}'
freely washed out, avoiding injury to granulating surfaces. A new
dressing, wit . or without drainage, may be applied, or the wound may
be left open and treated with antiseptic liquids or powders. The latter
absorb wound discharges, check the growth of germs on the surface,
and diminish the absorption of toxic products.

TREATMENT AFTER OPERATION. 93

Special precautions are required to combat such local complications
as abscess formation, burrowing of pus, phlebitis, lymphan^^ntis,
necrosis or caries- This is not the place for considering them. We
need only say that prolonged immersion in warm antiseptic solutions
produces remarkably s^ood results in infected wounds of the extremities,
and that spraying with similar solutions is an excellent method of
disinfecting cavities in regions to which continuous irrigation is
inapplicable.

Speaking generally in veterinary practice, preference should be
given to such methods as are simple and relatively cheap, but expense
should be regarded as of secondary importance when dealing with
penetrating wounds of the thorax, abdomen, articulations, tendon-
sheaths, and with injuries to tendons, cartilages, and bones. It then
becomes the duty of the veterinary surgeon to prevent, by every means
in his power, grave infectious complications resulting from such wounds.
The unfavourable conditions under which he habitually works, and
the intractability of most of his patients, render primary union of
operative wounds in the greater number of cases uncertain. Although
in the country it is unnecessary to practise asepsis and antisepsis
as rigorously as in a great human hospital, it would be the less
excusable to entirely neglect such principles, inasmuch as we know
very well the grave consequences which may follow. If unable to
satisfy all the demands of the antiseptic system, we should at least
observe its broad principles.

CHATTER V.

DIVISION OF TISSUES.

Cutting and Puncturinc; Instruments. — The first method of
dividing soft tissues is l)y means of cutting instruments like knives or
scis-ors.

Knives are of var^nng form and size : those in which the blade and
handle are immoveable are termed scalpels ; those in which the blade is
protected with scales and turns on a liinge. bistouries.

Knives, again, may be divided into sharp-pointed and guarded or
probe-pointed ; either of these .ma\- be straight, convex, or concave.

Scissors are either sharp or round pointed, and flat or curved in the
blades (see Figs. 75, 76, and 77, p. 83).

In making primar}- incisions a knife w ith a convex cutting edge is
usuall\- employed, and is grasped after the manner of a table knife
(Fig. 92). In making long incisions the knife is held like a violin bow
(Figs. 93, 94). For liner dissection the knife is employed after the
manner of a pen (Fig, 95).

^n dividing tissues from within outwards the knife is grasped in a
similar way, but the cutting edge is now directed upwards (Figs. 96, 97,
and 98). Incisions are made b}- a light, drawing movement of the
whole hand, usually from left to right, seldom in the opposite
direction.

The parts to be divided should be rendered tense b\- placing the
thumb of the left hand on one side, and the index linger on the other
side of the line of incision, and employing gentle traction (Fig. 99)^ To
more effectually stretch the skin the operator may employ the fingers
of the left hand on one side, whilst an assistant exercises traction on
the other side of the line of incision (Fig. 100). When important vessels

INCISION.

95

lie immediately beneath the point of incision it is sometimes con-
venient to raise the skin in a fold (Fig. loi).

\\'hen considerable force is required in makinsj: an incision the

Fig. Q2.

Fig. 01.

thumb may be tirni]\- applied to the skin, and the knife guided !>}' the
other fingers (Fig. 102) ; this prevents deviation from the straight line.

S^

Fig. 94.

Fig. 95.

In dividing very hard tissues, like horn and bone, the knife employed
is grasped with the whole hand (Fig. 103).

Fig. 96.

Fig. 97.

Incisions should be made rapidly and, if possible, of the predeter-
mined length at one stroke. Too short an incision impedes the
deeper stages of the dissection, and is no advantage, for the linear

cicatrix which ma}- remain is of even
less importance in animals than in
man. Moreover, the irregularity of
the incision produced by a series of
cuts greatl}- militates against rapid
healing.

Scissors are held as shown in
Fig. 104, the thumb and ring finger in the rings, the index finger
on the joint.

In dividing soft tissues the knife is either guided by a director

Fig. 98.

g6

OPERATIVE TECHNIQUE.

or by the finger (Figs. 105 and 106). In the former case the director,
hghtly held between the thumb and index finger, is introduced into an
already existing opening in the tissues, a convex or pointed knife is

Fig. 99.

slipped into the channel and steadily thrust orward with a lifting
movement, so that at the end of the stroke it is nearly at right angles

^z-/'

Fig. 100.

to the long axis of the director. In some cases it may be necessary
to make the stroke towards the operator (Fig. 107).

Fig. ioi.

Where important organs might be endangered the operator grasps
with forceps and raises a portion of the tissue to be divided, the

USE OF CUTTING INSTKUiMENTS.

97

ei^hbourini; portion being similarly raised by an assistant, and the
parts dixided between the two forceps. The forceps are then reapplied
and the dissection so continued.

Fig. I02,

Fh;. 103.

For holding the edges of wounds apart sharp hooks or retractors
are employed (Figs. 78 to 80).

Fig. 104

Loose tissues may either be torn apart b\' forceps, or divided with
a blunt object like the handle of a scalpel or the rounded end of a

Fig. 106. Fig. 107.

director. This method is used in exposing nerves and vessels. The
torceps are held in the manner of a pen (Fig, 108).

7

98

OPERATIVE TECHNIQUE.

When larger tracts of tissue are in question the fingers of both
hands may be employed Although wounds so made are really torn
wounds, and bleed relatively little, they often heal very rapidly.

Ligatures. — Soft tissues may be divided by passing around them
a thin tightly-stretched cord. Linear necrosis continues at the point
of ligation until the cord becomes slack, but inasmuch as many
materials like reindeer sinew or metallic ligatures are comparatively
inelastic, the ligature may after a time require to be reapplied, and
large masses cannot be dealt with by a single ligature, but require
several. In such cases the elastic ligature is exceeding useful.
Being applied in a tensely stretched condition it '" follows up " the
parts as they yield. As stated, the ligature is applied in a stretched
condition. After being firmly tied with a string or silk thread the ends
are released, and as they immediately return to their previous volume
they so greatly exceed the area of the knot as to render impossible

Fig. log. — Diagram showing elastic
ligature applied.

(. I lo. — Dia-
onun to show ex-
tent to which
contraction pro-
ceeds.

any chance of retraction. Fig. 109 shows a ligature applied to a rod.
and Fig. no, the same ligature removed, to exhibit the degree to which
it finally contracts. Solid rubber cords are better than drainage-tubes,
which are apt to break when tied. An erroneous belief pre\ails that
the thicker the part to be divided the thicker must be the rubber cord,
but in reality a thin cord has a relatively greater power of contraction,
and is therefore more useful. The surfaces left by the elastic ligature
granulate readily. This method is especially useful in ligaturing
very vascular tissues because vessels are securel}' closed before
division occurs.

The Eckaseur. — The ecraseur effects the same result in a similar
but more rapid fashion. It consists of an articulated steel chain,
the loop of which is passed around the part to be divided and
drawn tight until the tissue is iinall}- crushed through. Chas-
saignac's ecraseur (higs. iii and 112) acts by means ot the two rods

THE ECRASEUR.

99

Via. 1 1 1 .- -Chassaisfnac's errasenr.

Fig. 112. — Chassaignac's ecraseur dismounted,
shovvine rack.

100

OPERATIVE TECHNIQUE.

H H^, H H^, which are provided with teeth controlled b}- the two
spring pawls BB. By slightl}' depressing the handle GG on either
side, one of these rods is drawn forward a tooth and immediately
secured by its corresponding pawl, wdien it becomes the fixed point
through the medium of which the opposite rod is drawn downw^ards.
The lower ends of the two rods thus act alternately as fixed points on
which the handle G G swings. Reference to the figures will show that
movement of this handle in the method described will cause the rods
gradually to descend, drawing the loop of the ecraseur A" within the
tube C, and slowly dividing any tissue enclosed within the loop K.
In later ecraseurs, such as Fig. 113, the movement is effected by a screw.
At Professor Dewar"s request Messrs. Arnold have produced an
ecraseur with a particularly neat and effective catch b}' means of which
the screw can be thrown into and out of action very readil}'. When
the catch is in the position marked "free" the "slack" of the chain

LOCKED

Fig. 113. — Professor Dewar's ecraseur.

can be taken up so that the instrument is ready to commence cutting
as soon as put in operation. By slipping back the catch the chain
becomes locked to the screw, and the apparatus is read}' for use.
The screw movement is much preferable to the rack originally fitted in
the Chassaignac instrument. The instrument is long enough for the
castration of mares and cows in the standing position, and as the
chain is bevelled on one edge it crushes through instead of cutting the
tissues, thus avoiding a frequent cause of post-operative haemorrhage.
On the other hand it may be reversed if \-ery fibrous tissues require
to be divided.

Small and even medium-sized vessels ma}- be divided in this way
without_ bleeding. The actionjleiy)ends to 3i).meexte oa.ihe rapidit}-
yifhwhi£:h the process. is. carried out. The slower the n-fcjvement the
Ifess the bleeding. .For this reason very vascular tissuegj should be
v]er}' slowly divjded, and pauses should.-occasionally be ma.i^ ; between
each movement bl th!e:ha-n"dles, or eacti complete rotation! of the screw.

////t?

DIVIDINCx TISSUES WITH THE THERMO-CAUTERY. loi

Fig. 114. — Paqiielin's cautery in box.

Fk;. 116

Fig. 115, — Paquelin's cautery in action.
Fig. 117. Fig. 118.

Fig. 120.

Figs. 116 — uo. — Platinum heads for Paquelin's cautery.

102

OPERATIVE TECHNIQUE.

fifteen to thirty seconds may be allowed to elapse. Speciall}' thick
tissues may be divided in two portions, the centre being perforated,
and the chain applied alternately to either side.

The Galvanic or Thermo-cautery.— In the galvanic cautery
a loop of platinum wire is passed around the tissue to be divided,
and after being raised to a bright red heat by the passage of an
electric current, is graduall}- drawn tight. On account of its com-
plications and expense, however, this instrument is ver}' seldom
used in veterinar}' surgery, especiall}^ as Paquelin's thermo-cautery
(Figs. 114, 115) renders almost equall}- good service and is much cheaper.
The thermo-cautery consists of a hollow platinum terminal which
ma}' be of varying shape. After being heated in a spirit flame it is kept
at a bright red heat by injecting a mixture of ether or benzine vapour
and air into the head. Tissues divided by this instrument bleed ver}^
little, though the scab produced by the cautery must have a certain thick-
ness, to attain w^hich the division must be made deliberately. The
wounds produced heal comparatively slowly.

Puncture. — A puncture is an incision of considerable depth but
of comparatively small diameter. Puncture to permit fluids or gases

P'lc;. I2T,

Fig. 121.

Fig. 122

to escape from cavities, like the thorax, abdomen, or bowel, is termed
paracentesis. To prevent the entrance of air into deeper seated tissues
or into the cavity to be opened, the skin is often drawn to one side
before operation, so that returning afterwards to its ordinary- position it
closes the deeper opening. Subcutaneous puncture ma}- also be prac-
tised by first introducing the perforating instrument horizontally a
short distance under the skin, and, after altering its direction, making
the desired puncture ; the walls of the opening immediately collapse on
the removal of the instrument.

An ordinary pointed knife, bistour}', scalpel or lancet may be used
for puncturing. Either of the former is held like a pen, the thumb

PARACENTESIS.

103

on one, the index and middle finger on the other side, the httle finger
being used as a support. The point is caused to enter vertically b}'
extending the previously bent fingers. In withdrawing the instrument
the opening may, if necessar}', be enlarged, Figs. 121, 122.

In using a bistoury or lancet the handle is held at right angles to
the blade. Many persons grasp the blade, only leaving uncovered
sufiicient to penetrate to the desired depth : but this method, how-

FiG. 124. — Trocar ft)r
tapping the chest.

Fig. 125. — -Trocar for
tapping bowel.

Fig. 126. — Trocar for
puncture of rumen.

ever, has the disadvantage that in case of a mistake in regard to the
thickness of the tissues to be divided the fingers must be moved, more-
over the operator runs considerable risk of wounding himself. The
surgeon should possess sufficient delicacy of touch to know when
opposition ceases, that is when the cavity is entered. Supporting the
instrument with the fingers in the method described assists in this
respect.

104

OPERATIVE TECHNIQUE.

The real puncturing instruments are suture and exploring needles
and trocars.

Suture needles are held with the thumb on the concave, the index
and middle fingers on the convex surface. Fig. 123. In using small,
fine needles, a needle-holder is of great service, Figs. 155 to 157.

Pins are grasped with the middle finger and thumb, the index
finger being placed on the head, or they may be inserted by means of a
needle-holder.

The trocar consists of a pointed steel rod provided with' a metal
shield or tube, exactly corresponding with it in other respects but
a trifle shorter. The rod ma)' be of varying length and thickness,
straight or curved, cylindrical or oval. The point is usually tri-
angular in section. At the lower end of the cannula, where it abuts
on the handle, are one or a pair of rings to permit
of its being fixed into position b}^ tapes. As
a rule the upper end of the cannula discloses
two short slits, which permit tlie parts to spring-
slightly and apply themselves closely to a trifling
circular depression formed just below the point of
the trocar. This device causes the instrument
to enter much more easily, as the union of the
trocar and the cannula then presents no projec-
tion. The handle of the trocar is grasped in the
hollow of the hand, the fingers and thumb steady
the stem, and in use the instrument is thrust into
the cavity to be penetrated with a single rapid
movement. The cannula is then fixed with the
left hand and the stilette or trocar removed with
the right. While withdrawing the cannula the
skin in the neighbourhood of the puncture
should be pressed down with the thumb and
index finger of the left hand to prevent it being
Fig. 127. Fig. 128. lifted.

Division of Hard Tissues. — The horn of the hoof is divided with
a special knife grasped with the whole hand. Fig. 103. Bones are
divided with drills, chisels, saws, and forceps. The bone is prepared for
sawing by removing the periosteum with a chisel or gouge, Figs. 127-8.
Files and rasps are sometimes used to remove sharp edges or projecting
points from sawn surfaces. In this connection^ the sharp spoon or
curette, Figs. 129-31, used for scraping diseased bones and cartilages,
unhealthy granulations, callous walls of sinuses, etc., deserves mention.
It is not sufficiently known or valued in veterinary surgery. It con-

THE CURETTE.

105

sists, as the name indicates, of a small steel spoon with a sharp edge
attached to a stem and handle. The most useful are the smaller because
the}' can readily be passed into sinuses, in certain cases into bones, and
into all hollow spaces formed of diseased tissue. A selection of various
si;^es ought, however, to be kept. Curettes are sometimes formed with

Fig. 130. — Curette.

Fig. 129. — Curette.

Fig. 131. — Curette with irrigating attachment.

hollow handles, and an arrangement by which a stream of disinfecting
fluid can be caused to flow from the bottom of the bowl. Fig. 131 ; the
material loosened is washed awav bv the stream of fluid. The curette

Bone forceps.

is held in the full hand and used with considerable pressure. The
sharp edge of the spoon removes necrotic tissue whilst gliding over
firmer health\- parts without affecting them. Particular care must be

Fig. 133. — Frame saw for bone.

taken to remove everything of a diseased nature, without which rapid
healing need not be expected.

The chisel and gouge, Figs. 127 and 128, are now seldom employed
for dividing bones because of the danger of shattering the bone when

io6

OPERATIVE TECHNIQUE.

using the mallet or hammer. They have largely been replaced by
bone forceps, Fig. 132, which are made with blades either at right angles
to the long axis of the forceps or parallel with it. Each form has
special uses.

Saws are of several forms. The frame saw (Fig. 133) consists of a
blade, a frame, and a handle. The blade is made somewhat finer
towards the back, so as to saw freeh' and not become fixed in the
furrow. It is secured at one end by a screw for regulating the tension,
and at the other carries a small rivet which prevents the blade slipping
through the slot into which it is introduced. The frame is either
quadrangular or semicircular. The handle was formerly provided
with depressions to fit the fingers. As, however, this rendered it
difficult to clean, modern saws are provided with plain curved handles.

Fig. 134. — Chain saw.

The nature of chain saws is almost sufficiently indicated b}' their
name. They consist of a number of articulated links, carr3'ing on one
side saw teeth (Fig. 134). On account of their cost, however, they are
not much used in veterinary surgery. The end of the chain is passed
around the bone by means of the needle and thread shown, and is then
attached to the handle ; by drawing the chain to and fro the bone is
graduall}' sawn through. A trephine consists of a hollo^^' steel
cylinder bearing teeth on its free border. A central terminal
steel point is usually added to steady the trephine in position, and by
rotating the handle alternately towards the right and left a circular
piece of bone is gradually cut through. Trephines are mostly used for
opening the sinuses of the face.

CHAPTER \T,

SETONING.

In certain conditions it used to be, and to some extent still is. the
custom to set up chronic inflammation and suppuration under the
skin in order to influence processes going on in the neighbourhood.
For this purpose setons consisting of a broad piece of tape or cord
of plaited horsehair are passed beneath the skin by means of special
instruments.

Although active inflammatory processes in the skin certainh'
appear to affect the condition of deep-seated tissues, this action
is probably not so important as is believed, and when visible im-
provement occurs one is not without a suspicion that the indispensable
rest has pla3'ed an important part in producing the result. Blisters
achieve somewhat similar results without leaving the mark which
always occurs to a greater or less extent after setoning. The use
of setons to eftect healing of abscesses and ha;matomata was
frequent in former times. Inasmuch as healing may be produced
much more rapidly and satisfactorily by opening the haematoma at
the deepest point and applying steady pressure, the use of setons
for this purpose is not to be commended, nor is it any more
advisable in the treatment of sinuses, because it does not prevent
the continued formation of pus nor the extension of chronic in-
flammatory processes or necrosis in the deep parts, without which
the sinus would heal of itself. Such canals may be much better
and more rapidl}' dealt with by direct operation and the removal
of all diseased tissue by the curette. For these reasons the employ-
ment of setons has greatly diminished, and, inasmuch as their use
invariably entails prolonged rest, there is always some reason for
casting doubt on its direct beneficial result. As, however, opinion is

io8

OPERATIVE TECHNIQUE.

still divided on the point, and as many practitioners appear to
place faith in the operation, a diagram is furnished below show-
ing the position in which setons are introduced for various con-
ditions. Setons are inserted with a special needle (Fig. 136), from
eight to sixteen inches in length, and usually made of steel or
soft iron. The point is spatulate and of steel, the body is usually
flattened and often divided into two parts, which can be screwed
together. The eye is sometimes at one end, sometimes at the other.
For the purpose of passing frog setons Sewell invented a special
needle (Fig. 136A). For operating on ha;matomata, etc., the
needle shown in Fig. 136B is used. It consists of two cylindrical

Fig. 135. — Schema showing positions in which setons may be inserted.

portions about three sixteenths of an inch in thickness, which can
be screwed together. The point resembles a three-sided pyramid.

Should the animal prove ver}' troublesome it may require to be
cast before a seton can be inserted, but as a rule it is sufficient to
apply a twitch and lift one of the fore-feet. Speaking broadly, it
is best to pass the needle from below upwards, as should the
animal struggle it is more easily withdrawn, while it is less likely
to go astray. Should it be inserted in the opposite direction- and
an error be made necessitating change of direction, a pocket is
left in which pus may accumulate.

Views differ as to the depth to which setons should be inserted.
Some prefer the subcutaneous tissue, others penetrate beneath the

SETONING.

109

panniculus. The latter method, however, is sometimes followed
by troublesome extension of the suppurative process, and is not
to be recommended.

Having selected the lowest point, the skin is raised in a fold
and either divided- with special scissors or with a knife. The point
of the needle is then introduced, with its flat side towards the

Fig. 136. — Seton
needle with eye
in head and also
at base.

Fig. 136A.

Fig. 137. — ^^Rowelling scissors,
for making the preparatory
incision when insertina; j,eton.

Fig. 136B.

skin, and the needle thrust forward, its course being carefully
noted, and if necessary controlled by the fingers of the left hand.
The needle used in France possesses a sharp point, and therefore
readily penetrates the skin at the end of its course : but with the
common English needle it is necessar\' to make an incision for

no OPERATIVE TECHNIQUE.

exit. The point of the needle is then grasped with fingers or
forceps, and withdrawn through the upper orifice, bringing with
it the tape with which it has been threaded. If, however, the
eye is in the point of the needle the tape is not inserted until the eye
appears through the upper wound. The tape is then passed and the
needle withdrawn, leaving the tape in position. The tape, which
must be at least twice as long as the channel to be produced, is
secured by firmly tying the ends together or by attaching each
end to a transverse piece of rubber tube. The disadvantage of
uniting the ends consists in the danger of the loop so formed
catching on a hook or other object or being grasped in the horse's
teeth, and the entire seton being torn out. To prevent this the
horse should be tied up or a side-stick applied. In dogs a muzzle
must be put on.

To increase the action the seton is smeared with irritants, and
is daily moved up and down. As soon as suppuration occurs, free
drainage should be secured by fomenting the orifices daily and gently
stroking the channel from above downwards. The seton may be
left in position from eight to twenty-one days. To remove it the
upper end is snipped off with scissors and the tape drawn downwards.

Inserting a frog seton demands certain special precautions.
The horn around the point of the frog having been thoroughly
thinned, an incision is made above the bulbs of the heel, and the
special needle, with its convex side directed towards the tendons,
is thrust downwards towards the point of the frog, the foot mean-
while being extended as far as possible. The needle should appear
near the point of the frog. The ends of the tape are knotted
together and a dressing applied.

Blood-vessels may be wounded in passing setons, but as only
small twigs are usually affected no special precautions are called
for. Where nerves are injured paralysis may result, and in some
cases tendons, tendon sheaths, and joints have been opened. Passage
of a seton under fasciae or the panniculus sometimes produces extensive
suppuration and burrowing of pus. \\^here a seton is left too long
in position the walls of the channel become thickened ; whil^
should the animal not be carefully secured and watched the seton
itself may be torn out.

An operation now almost entirely discarded is the insertion of
" rowels," " issues," or " plugs." An issue was produced by incising
the skin and thrusting a foreign bod}', like a fragment of leather or
of white or black hellebore, into the subcutaneous tissue. In
horses the spot most often chosen was the chest, close to the

ROWELS, ISSUES, OR PLUGS. iii

ensiform cartilage, although other places, such as the forehead,
cheeks, jugular furrow, side of the neck, front of the chest,
shoulder, abdomen, and even the hoof were sometimes selected.
In cattle the dewlap is usually preferred.

The horse was twitched, and a fore-foot lifted or the hind foot
secured ; an incision was then made at the spot chosen, the skin
separated from the subcutaneous tissue to form a pocket, and the
issue inserted. When the issue was inserted at a point where the
surface of the body was nearly vertical, the skin was separated
from below upwards in order to prevent pocketing and accumulation
of pus. The fragment of leather was usually circular in shape,
and covered with tow smeared with some irritant. It was doubled
before being inserted, and afterwards flattened out to prevent its
escaping from the incision.

- <

^ ^

CHAPTER VH

INOCULATION.

By inoculation is meant the intentional conveyance of infectious
material to a healthy subject. A wider meaning is sometimes attached
to the term, causing it to extend to the products of micro-organisms
such as antitetanic and antidiphtheritic serum, mallein, etc. The
reasons for inoculation vary. At the present day inoculation is a most
important process in studying the life history of bacteria, their nature,
virulence, mode of action, etc. Animals, again, are inoculated to
protect them against certain diseases, like pleuro-pneumonia contagiosa,
black-quarter, anthrax, and swine plague (rouget du pore), to produce
new (modified) infectious material (vaccine), and finally, though not
very often, to shorten the duration of epizootic diseases. Various
forms of needle are used for inoculation. The oldest is Sick's (Fig. 138).
A longitudinal furrow in the middle of the head holds the infective
material. From the centre of the lancet-shaped head the sharp
cutting borders converge to form a fine point.

Fig. 139 represents Pessina's needle. In use the furrow is filled
with infectious material, the needle thrust under the skin, revolved
and withdrawn, leaving the infective material within the wound.
Inoculation may also be performed by first slightly scarifying, reall\'
only irritating the skin, and then rubbing in the infective material. To
produce a large number of incisions at one stroke a special compound
spring scarifier has been made, though it is not indispensable.

Sticker employs a special needle (Fig. 140) for pleuro-pneumonia
inoculations. It consists of a hollow needle provided with a small
opening just below the slightly curved point. The handle has a
movable pressure button, which injects a small quantity of fluid into

INOCULATING INSTRUMENTS.

Tii

the wound through the before-mentioned aperture. The needle is
thrust under the skin, and the infective material injected by pressing

Fig. 141. — Sterilisable syringe; ready for use

Fig. 142. — Sterilisable syringe ; dismounted.

on the button. The instrument is really only a kind of syringe tor
subcutaneous injection.

114

OPERATIVE TECHNIQUE.

Nowada}'S, however, syringes are almost universally emplo\'ed for
protective inoculation, as well as for the injection of mallein and
tuberculin for diagnostic purposes, an operation which is closel}' akin
to inoculation, and is carried out in a similar wa}-. As a rule the stem
of the syringe carries a movable stop which can be fixed at a pre-
arranged point, allowing only the exact amount of material to be
injected at each operation. Such syringes are now made with asbestos
or metal plungers, and can be taken to pieces, or are of such a nature
as not to be injured by boiling.

Before making the injection the point of operation should be
shaved and thoroughly disinfected. Care must be taken that the fluid
really penetrates beneath the skin and not into it or into the muscular

tissue, as often happens. Ne-
glect of these precautions, and
failure to thoroughly sterilise
the instruments, explains most
of the cases of inflammation,
abscess formation, and other
complications after inoculation.
It almost appears as if the action of the infective material varies
according to whether it enters the skin or subcutaneous tissues,
a fact which probably explains the totally different results produced
by two different operators with one and the same material. The best
plan is to raise a fold of skin with the left thumb and forefinger and
rapidly thrust the needle through the skin in the length of the fold.
The fluid is spread over a larger surface b\- gently manipulating the
parts after removing the needle.

After each injection the syringe and needle must be thoroughl}-
washed and boiled, or at least disinfected.

As a rule no special restraint is needed, as the pain is very trifling.
In large vaccine institutes the animals are usuall}- secured on movable
operating tables.

Fig. 143. — Roux's sterilisable syringe without
piston.

CHAPTER YUl.

CAUTERISATION.

The destruction of tissue b}- chemical substances or by burning'
is termed cauterisation. Such chemicals are comprised under the
genera' heading of caustics, whilst the red-hot iron or other heated
instrument is termed the actual cautery. Cauterisation produces a
scab or scar. The dead tissue is separated by reactive inflammation,
and is cast off; healing follows by granulation. Apart from destroying
diseased tissues and stimulating repair in strained or chronically
inflamed tissues, cauterisation is often invoked merely to produce very
active irritation, sometimes to hasten granulation and cicatrisation, or
to close bleeding vessels b}- means of a scab, and thus to check haemor-
rhage.

Chemical Caustics

May be divided into fluid and solid. Fluid caustics can be applied in
small quantities with a brush, glass rod, or pledget of cotton wool, etc.,
to the point to be cauterised, care being taken never to apply so much
as to render possible the spread of the caustic beyond its intended
position. If considered necessary to exact]}- delimit the extent of
tissue to be cauterised the skin may be shaved, and a plaster containing
an aperture of the desired size applied, or a mass of soft plaster may
be formed into a roll and affixed to the skin around the point to be
operated on, forming a little basin to receive the caustic and protect
adjacent parts.

Of fluid caustics may be mentioned :

Sulphuric acid, which acts very rapidly and powerfully on account

ii6

OPERATIVE TECHNIQUE.

of the energetic way in which it removes water from living tissues
and coagulates albumen. It produces a hard black scab, which
remains in position a very long time.

Fuming nitric acid produces a yellow scab, which is at first softer
than that produced by sulphuric acid, but. later becomes dry and hard.
The yellow colour is due to the formation of xanthoproteic acid, a
combination of nitric acid with albumen.

Hydrochloric, carbolic, and chromic acids act less powerfully
than nitric or sulphuric acid.

Among solid agents, caustic potash exercises a very marked and
penetrating action. It can be applied solid or in solution. Sticks of
fused caustic are to be preferred. The point is pressed on the part
to be cauterised until the intended amount of action has been
produced. Caustic potash, like some caustics previously mentioned,
acts by abstracting moisture from the tissues. It forms a greyish-
yellow scab sometimes mixed with blood. /\s this scab readily

Fu;. 144. — Line firing iron and handle (interchangeable).

breaks down and becomes fluid, the surrounding parts must be
carefully protected from its effects. A special caustic is used in
Vienna, consisting of six parts of caustic lime and five of caustic
potash moistened with alcohol to form a paste, which can then be
applied to the skin to the extent required. This paste does not run
or spread.

Sublimate (bichloride of mercury) is also a powerful caustic. It
destroys tissues by combining with their albumen, and forms a soft
grey scab, which afterwards darkens and slowly separates. Sublimate is
employed as a powder, paste, or solution. Sublimate collodion con-
sists of five parts sublimate dissolved in thirty parts of collodion.

Arsenious acid, or white arsenic, is usually employed in the form of
paste. The action is slow, the scab firm and durable.

Chloride of antimony, otherwise known as butter of antimony, has
a powerful action, and produces a whitish, at first soft and afterwards
hard, sharply defined scab.

CHEMICAL CAUSTICS.

117

Chloride of zinc is an energetic caustic, and may advantageously
be used b}- mixing one part zinc chloride with one to four parts of
flour, water being added to form a paste.

Nitrate of silver and the sulphates of copper and zinc are perhaps
the caustics most generally employed. Nitrate of silver, or lunar
caustic, has only a superficial action. The scab is at first white and
soft, later becoming dark
under the action of light.
Sulphate of copper is
cheaper than lunar caus-
tic, and is sometimes
used to destro}- exuberant
granulations. The same
is true of sulphate of zinc,
which is perhaps less fre-
quently emploN'ed.

The longer the caustic
remains in contact with
the tissues the more ex-
tended is its action, as it
continues to spread from
the fresh scab. Where
the action proves insuffi-
cient it may be renewed
as soon as the scab is
shed. For destroying
new growths, caustics in
the form of pastilles or
rods are sometimes used,
an incision being made
in the growth for their
introduction. In other
cases solutions are in-
jected. These methods,
however, are not to be
commended because the
range of action of the caustic cannot be controlled. Sometimes
a portion of the growth is left, necessitating a second operation ;
sometimes the action of the caustic extends to healthy tissue with
unfortunate results. The caustics, and especially the more active,
produce severe and continued pain during their action.

Fig. 145. — Bud, point, line, and disc firing irons.

Ill

OPERATIVE TECHNIQUE.

The Actual Cautery — Firing.

Although much less used than in the early part of the century
firing still continues very popular, and is employed with success in
many conditions which have resisted all other treatment. Without
doubt it gives lively pain, necessitates a certain period of rest, and

Fig. 140. — Needle firing iron with interchmgeable needles.

sometimes leaves indelible marks, but these drawbacks are more than
counterbalanced by its many advantages. Among the indications for
the employment of the actual cauter\-, the most frequent are chronic
affections of tendon sheaths, of bones and articulations, synovitis.

Fig. 147. — Degive'.s needle firing apparatus packed in box.

hydrarthrosis, sprains, luxations, exostosis, periostosis, enlarged joints,
caries, or necrosis. It is also employed m disease of tendons,
chronic inflammatory changes in connective tissue, and as a remedy
for certain cysts. Furthermore it is used to divide tissues, to remove
chronic lymphatic thickening, to stimulate the healing of tistulse.

APPLICATIONS OF FIRING.

iig

indolent ulcers, and poisoned wounds, in the treatment of tumours
and septic engorgements, and to check haemorrhage. Distinc-
tions have been made between mediate and immediate, super-
iicial and deep or penetrating firing. In mediate cauterisation, a
glowing iron is brought close to the spot to be acted on so that the
parts are merely heated by radiation ; in immediate cauterisation, the
instrument is brought in actual contact with the tissues. Surface firing,
;. e. firing extended areas all over, and the application of burning
pastilles (moxas) are now entirely abandoned.

The only methods at present used are (i) superficial firing in the form
of points or lines, the instrument not passing deeper than the epidermis
itself; (2) deep firing in fine points, where the skin is penetrated at

Fig. 148.-— Degive's apparatus ready for action. The reservoir in the handle is
filled with sponge saturated with benzine vapour. The bellows pump air
through this reservoir. The stream of benzine-laden air is mixed with a stream
of pure air controlled by the two-way tap at the base of the handle, and burns
with an intensely hot blue flame in the hood. The tap at the base of the handle
regulates the size of the flame, and therefore the temperature.

one or a number of spots ; (3) needle firing, in which the instrument
penetrates as deep as the muscles, tendons, ligaments, bones, or synovial
sacs ; (4) subcutaneous firing, practised after the skin has been divided
with a knife.

The instruments used for line firing are provided with heads
resembling wedges or triangular prisms. The cauterising margin
should be slightly convex, smooth throughout and rounded at the
angles ; a slight curve in the stem is thought by some to be advan-
tageous. With instruments of this form it is easy to follow the inequali-
ties of the parts and to ensure each part being subjected to the same
action. Fig. 144 shows the ordinary form of the English firing iron.
It is suitable for most purposes. The length of stem varies according
to whether it is intended for use on the animal in a standing position or

I20 OPERATIVE TECHNIQUE.

when cast. Messrs. Arnold make these instruments in many forms, all
fitting one handle. The head of the point or bud-firing iron consists
of a more or less elongated cone ; for deep firing it is drawn to a much
finer point. Needle firing is performed with very fine points, capable
of penetrating the tissues deeply. It was formerly the custom to use
stout needles, about four inches in length, which were brought to a
red heat in a charcoal furnace, grasped with pincers or forceps and
plunged into the tissues. These were replaced by instruments con-
sisting of a heavy cone-shaped head, with a central aperture through
which a suitable needle could be passed. The head was first heated,
and when red, the needle was dropped into position. In the greater
number of such instruments, however, the needles become cold very
rapidl}-, and the large head cauterises the skin around the perforation.
To protect the skin it becomes necessary to place a small disc of iron
with a central aperture over the point of operation. Several instruments
with movable needles have been invented. Degive's (Figs. 147 and 148)
is probably the best, though similar instruments have been produced by
Bourguet and De Place. It consists of a handle, which also acts as a
benzine reservoir and saturator, carrying at its extremity a small iron
box with a conical base, through which is drilled a hole for the passage
of the needle. This latter is held on a movable arm, which permits it
either to be extruded through the base of the box or to be retracted
within the latter by a spring. A bellows and benzole container supply
the heat, the flame playing within the cavity of the iron box. Each
time a puncture is to be made the red-hot needle is extruded from the
point of the box and thrust into the tissues. The action of the spring
automatically returns it to the interior of the box, where the flame
almost immediately renders it hot again.

The two following firing instruments were described by the writer
some years ago (see ' Veterinarian,' February, 1898, p. 70). The first
has been used by him in his practice for nearly ten years, the second
for nearly four, and both have been found very satisfactory. The first
is Graillot's Zoo-cautery (Fig. 149).

It is an adaptation of Paquelin's, which depends for its action on
the peculiar propert}^ possessed by metallic platinum, and in an even
higher degree by platinum in a finely divided state (platinum-black),
of bringing about chemical combination between oxygen and hydrogen
gases, or between oxygen and certain h}'drocarbon vapours, without
the intervention of a flame. The zoo-cautery consists, as shown
by the annexed rough sketch, of three principal parts, viz. the handle,
forming a benzoline reservoir, the stem, and the head.

The handle (b) is formed of thin metal, spun on a lathe and

DEGIVE'S AND GRAILLOT'S CAUTERIES.

121

corrugated, both to afford a better grip and to increase the surface from
which evaporation takes place. Its interior is packed with fragments of
sponge saturated with benzohne, and through the centre passes a small
tube, which conveys a portion of the air
pumped into the apparatus directly to-
wards the stem, without passing through
the sponge. At the extreme end of the
handle is a nipple, over which is slipped
the india-rubber tube of the bellows, and a
little two-way stopcock (a), which when
turned in a line with the handle allows
air to pass freely both through the small
(direct) tube mentioned, and also through
the mass of sponge in the handle ; but
when turned at an angle gradually shuts
off the stream from the sponge-packed
part until at last (at right angles) it admits
air alone through the direct tube. By
examining the top of the handle before
screwing in the stem the small direct air-
tube will be seen projecting upwards
through the mass of sponge.

The stem (c) is merely a strong metallic
tube supporting the head, and conveying
to it the mixed air and benzoline vapour
delivered from the handle. At its upper
part is a clamping nut, by means of which
the head can be set in a line with, or at
any angle to, the stem.

The head consists of a hollow nickel
shell carrying at its extremity the cauter-
ising surface or point, made of platinum-
iridium alloy, and lined within b}' frag-
ments of fine platinum gauze to assist
the combustion of the vapours. Special
attention is directed to the screw (d)
shown on each of the heads, as it pla3'S
an important part in the working of the

apparatus. Fig. 149.— The zoo-cavitery.

To start the cautery in action, the stem is first unscrewed, and
benzoline poured into the handle from the upper end until it-
overflows. The handle is then inverted, and all excess of benzoline

122

OPERATIVE TECHNIQUE.

allowed to flow away, leaving the sponge saturated. The parts
are then screwed together, the bellows affixed and started, the
little two-way stopcock (a) at the bottom turned nearly at right

angles, the small screw (d) in the
head opened as far as possible, and
a light applied to the holes shown in
.2 the head. If all is acting properly, a
I strong bluish flame will be seen within
^ the head, and a rather loud hissing
■Z sound will be heard. If not, the bottom
^ stopcock is turned one way or the
'i. other, so as to alter the proportions of
^ air and benzoline vapour passing to
'4 the head, until the flame appears and
i burns steadilv. In a minute or two
^ the entire head will become strongly
J heated, and if the top screw (in the
■g head) be then turned home, the blue
■^ flame will disappear, the hissing noise
Z will cease, and the point of the cautery,
.5 previously quite dull, will suddenly
.5 begin to glow, and soon attain a bright
^ reddish-white heat. The reason of this
y is that the direct flame is extinguished,
? and the vapours are caused to burn

0 witliin tJie platimiiii point or head. The
^ instrument is now ready for use, and
>^. will continue acting for twenty minutes
= to half an hour by simply workmg the
r; bellows. Should the heat decline, a

1 slight turn of the lower stopcock will
I admit more benzoline vapour, and re-
'■^, store the required temperature. If
V; employed in the open air some pre-
's caution is required when starting to

shield it from draughts. A point of

considerable importance is to obtain

the right kind of benzoline ; the

F"^- 150. common benzoline sold in oil-shops

for use in cabmen's lamps or in the little cheap night lamps seems

to answer best.

The second instrument shown (Fig. 150) is quite different in principle

DECHERY'S AUTOMATIC CAUTERY. 123

from that of Paquelin, and has the great advantage of being automatic
in action when once started, and of requiring no bellows. Every one has
probably seen the flaring, roaring lamps used in carrying on railway
works, large building operations, etc., at night ; the roaring noise and
the intense light, distinguish them from others. Dechery's cautery is
a modified reproduction of one of these. It may be divided into
reservoir (a a), vapour-chamber (b), and burner. The illustration
shows these, the essential portions of the interior being indicated by
dotted lines.

To resist the considerable pressure at which it works, the
instrument is strongly made of nickelled brass. The reservoir is shut
off from the vaporising chamber by a conical valve, worked by means
of a long spindle (c) carrying at its extreme end a milled nut. The
vaporising chamber consists of a small brass casting, hollow in the
centre, and presenting two apertures — that at the bottom, through
which the benzol enters, being closed by the conical end of the
spindle ; and a second, extremely small one at the side, through which
the vapour issues at high pressure. As will be noted (see Fig. 130), this
minute stream of high-pressure benzol vapour then rashes through a
rather wide tube, inducing in its passage a smart current of air, with
which it becomes intimately mixed, and finally burns in the head with
a bright blue, smokeless, but intensely hot flame.

To start the apparatus the large bottom nut is unscrewed, and the
reservoir filled with carefully filtered benzol. (It is important to filter
the benzol carefully, as the smallest speck of foreign matter may choke
the minute orifice in the vaporising chamber from which the vapour
issues.) The parts are then screwed together, the valve spindle turned
home, and the head heated in a spirit-lamp flame for two or three
minutes. This warms the head and vaporising chamber, and prepares
the apparatus for starting. As, however, there is at first no positive
pressure within the apparatus, the benzoline would not flow mto the
vaporising chamber, and it therefore becomes necessary to heat the
stem, so as to cause the benzoline to expand and to flow out when the
valve is opened. The flame is therefore advanced a little, and allowed
to play round the top of the stem for a minute or two, when, on
opening the valve by turning the milled head with the fingers, a few
drops of benzoline are injected into the heated vaporismg chamber, are
converted into gas, rush out into the head, become mixed with air,
and burn into the outer part of the head, as above described. If the
apparatus has been sufficiently warmed at the outset it now becomes
self-acting, the heat of combustion being conducted to the vapour-
chamber and the stem to a sufficient degree to promptly convert the

124 OPERATn'E TFXHNIQUE.

benzol into gas as it issues from the reservoir, and to keep the benzol
in the reservoir itself nearly at boiling-point. It may be imagined,
however, that the pressure in the apparatus would become dangerous
and involve an explosion. Two safeguards are provided against this.
Firstly, the apparatus is very strong ; and secondly, an undue pressure
in it would force benzoline outwards in such quantit}' as to produce
large white flames, and thus give timely notice of danger. In practice
the author has found the apparatus remarkably steady and reliable.
The firing points and edges are easily heated to a bright cherry red,
and the apparatus works without any regulating for twenty minutes to
half an hour, when a turn of the milled head will enable cne to
continue for another quarter of an hour, a sufficient period to finish
any ordinary operation.

As the whole apparatus would otherwise become unpleasantly
warm, the main body of the reservoir is covered with a tube of
insulating material, — " vulcanised fibre."' The fact that the expensive
platinum heads and points are entirely dispensed with permits of the
apparatus being sold at a very reasonable sum.

For heating the ordinary iron a forge or small stove is usually
employed. Charcoal or coke is preferable to coal. Within recent
years, however, advantage has been taken of the numerous automatic
lamps, burning petroleum spirit or benzole, to produce a convenient
and easily transported stove. In these lamps the pressure produced
within the bod\' of the lamp b}' warming the fluid, causes a small
quantity to mount through a capillary tube into a chamber sur-
rounding the flame, which chamber is therefore always at a high
temperature. Arrived here the liquid is rapidl}- transformed into
gas, and escaping through a small hole, emerges in the form of a
powerful jet which sucks air through orifices surrounding it, and when
ignited burns with a very intense flame. B}- adapting to such a lamp
a suitable hood for receiving the heads of the firing irons an excellent
portable furnace is produced.

A very good form of automatic petroleum furnace is that shown
in Fig. 151. The reservoir {a) contains ordinary paraffin oil, with
which it is filled through the plug [b). To set the apparatus in
action, the small air-pump (c) is worked for a minute or two,
until the air pressure in the reservoir is sufficient to force the
oil up to the burner (/). A little methylated spirit is then poured
into the ring at the base of the burner and ignited, thus heatmg
the burner. On then cautiously relaxing the screw (C), a fine
stream of petroleum flows into the burner, becomes vaporised,
and issues as a powerful jet from a small orifice at the base of

ANTISEPTIC FIRING.

12 =

the tube (/), shown as a dotted line. This jet aspirates strong
currents of air through the holes in the burner, mixes with this
air, and burns with an intensely hot blue flame within the hood {g).

Whatever the method of firing adopted, certain general principles
must be observed. The preparation of tJie animal is important.
If casting is necessary it should preferably be done on an empty
stomach ; if the animal is very vigorous and plethoric, the food
allowance should be reduced during the previous days, and laxatives
may be administered. The point of operation must be thoroughly
cleansed, and the hair cut either with a machine or with scissors,
but in deep firing, implicating
synovial membranes, antiseptic
precautions are necessar}-. The
cleaner the skin the less the danger
of after-infection. For this rea-
son, when firing in deep points,
the writer usually applies over
the whole area of operation a
dressing wetted with 5 per cent,
carbolic solution, which is allowed
to remain in position for twenty-
four hours, and to become dry
by evaporation. It is removed
immediately before operation, and
is afterwards replaced by a dry
dressing of boric acid and surgical
cotton wool supported by a band-
age. Where the points are less
deeph' introduced it suffices to
smear the parts freely with boro-
glyceride after operation, omitting
the cotton wool, etc. No blister is used. In applying the iron to
certain regions where the skin is very mobile, it is well, if casting
is necessary, to mark the outlines of the surfaces to be fired before-
hand. Quiet horses are usually fired in a standing position, a twitch
being applied to the nose, and the foot lifted to prevent accidents.
In more extensive operations the parts may be rendered anaesthetic
by subcutaneous injection of cocaine, or by the application of an
elastic bandage or cord.

The most convenient apparatus for controlling animals when
being fired is undoubtedly the operating table previously described.
Firing, however, causing considerable pain, it is often necessary

Fig. 151. — Autumatic petroleum furnace and
protecting hood for heating firing irons.

126 OPERATIVE TECHNIQUE.

where no such operating table is at hand to cast the animal.
In operating on the external surface of a limb, the horse is cast
on the opposite side. If the application is made around a joint,
the animal should be cast on the diseased side and the inner
face of the limb first operated on. In firing two limbs, the external
surface of the one limb and the internal of the other are first
completed, and when turning the animal over provision must be
made against the cauterised surfaces being soiled.

Various manoeuvres are sometimes necessar}-. As a rule the
limb to be fired is left in the hobbles, while the opposite limb is
released and either carried backward or forward. When the pastern
or coronet is to be fired, the two limbs can be fastened together
above the knee or hock respectively, the diseased limb being
released from the hobble and drawn forward or backward by an
assistant using a broad strip of webbing.

The important point is to trace equally spaced straight lines,

and to extend beyond the diseased region. Converging lines should

never cross or unite, the points of crossing being ver}' liable to

slough (see Fig. 152). The spaces between the lines vary according

, y to the thickness of the skin and the extent of the

\ / cauterised region. Closely placed superficial lines

\^i/ are preferable to others more distant and more

\ / deeply penetrating, x^s a rule a space from three

eighths to three fourths of an inch should divide

Fig. 152. — Pattern for ,1 ,• t t- ^\ ^ • n ^ ^ t 1 ^i

line firino". The lines the Imes. In r rance the custom is first to lightly

do not meet. mark out the design, and afterwards to pass over

the lines a number of times. The iron is used at a dull or bright red,

the latter being the maximum temperature allowed, and is passed

slowly along the marked-out design without pressure, the blade of the

cautery being always kept perpendicular to the surface. The iron

should never be passed twice in immediate succession along the same

line, and if the French method be adopted, the lines must be retraced

in regular order, otherwise sloughing is apt to occur. When the

cauterised surface is very small, it is well to wait for a short time

between the first and second series of applications.

The operator judges when the cauterising action is sufficient by

the appearance of the base of the lines, the exudation which has

occurred, the infiltration of the skin, and the degree of separation

shown by the epidermis. Judged b}' these standards, three degrees

of cauterisation may be distinguished. In the first the lines are

shallow and contain a few little drops of serosity. Their base is

of a golden yellow, the skin is little infiltrated, and the epidermis

LINE AND PUNCTURE FIRING. 127

is still adherent. In the second the lines are deeper, their base
yellowish brown, exudation is more marked, and the epidermis is
loosened. In the third the epidermis is almost cut through, the
margins of the lines tend to gape and produce irregular cicatrices,
the serous discharge from their base is abundant, and the skin
is often covered with blisters. In the French system the iron is
heated to a cherry red, and is passed along each line five or six times
in light firing, eight to ten in ordinary firing, and twelve to fifteen
in severe firing. It is clear, however, that the number of passages
must vary with the weight and temperature of the cauter}-, the
judgment of the operator, and the thickness of the skin.

Superficial puncture or bud firing can often be performed in
the standing position. The points must form a regular figure,
those of one line corresponding to those of others adjacent. As
a rule the points are separated by intervals of three eighths to
half an inch, though they may be massed a little more closely
where the most intense action is required. Here again the French
prefer to apply the iron a number of times to the spots seriatim.
The completion of the process is judged of b}- the same indica-
tions as in line firing. In England, however, it is unusual to apply
the iron more than once, or at the most twice, a method which
appears to be perfectly successful, and when combined with the
after-application of a blister, to have the advantage of leaving less
mark than the French method.

In deep point firing the cautery passes completely through the
skin and into the subcutaneous connective tissue. The points must
be disposed regularly, and at equal distances, though they may be
placed rather more closely together than when firing the skin
alone. With gentle pressure the cautery rapidly perforates the skin..
This method has the advantage of being easy and rapid to carry
out, and of producing a more intense and deeper action than that
previously considered. The iron should never be applied more than
twice. A light blister may be applied a few days after operation.

Until comparatively recent times the danger of penetrating
synovial' sheaths, etc., was regarded as excessive, and although a
few practitioners like Basch, Fischer, and Robertson recommended
puncture with fine pointed irons, the method was never extensively
accepted, and when practised not infrequently led to disaster. In
1867 Bianci recommended puncture of dropsical synovial sheaths
with the red-hot needle, a system which, after long discussion and
some modification, is now becoming more and more popular. Care-

128 OPERATIVE TECHNIQUE.

fully practised it is not dangerous, even for articular cavities, and
considering the intensity of its action and its therapeutic value it
constitutes a great advance on old methods. The point, however, must
be extremely fine, those usually employed not exceeding one twenty-
fourth to one sixteenth of an inch in thickness. When of iron these
are difficult to make and to keep in order; platinum points like those
supplied with the zoo-cautery are preferable. The punctures are
best made in a regular design at intervals of about three eighths
of an inch. The method of procedure is important : the needle,
at a red heat, is sharply thrust to the required depth, and immediately
withdrawal. There is no disadvantage in passing the needle more than
once into fibrous or osseous tissues, — indeed, this is necessar}- to pro-
duce intense effects; but in dealing with synovial membranes the passage
of even a fine needle more than once is dangerous. On the other
hand, no bad results need be feared either from penetrating "a
joint or a synovial sheath, provided the puncture be made with a
single application. The minute channels are aseptic when made
with a red-hot instrument, and provided the needle be sufficiently
fine, and the operation completed with one movement, they remain
so. It is not necessary, however, in dealing w'ith dropsical synovial
sheaths that all the points should penetrate the sac ; as a rule one
actual puncture is sufficient. In other tissues two or three
punctures may be made. In certain cases the operation may be
terminated by the application of a blister.

The emollient dressings formerly employed after firing appear in
the light of later experience to be contra-indicated, as they favour
suppuration, retard healing, and tend to increase the area of the
wounds and of the subsequent cicatrices. They should certainly not
be employed immediately after operation. When the inflammation of
the skin after firing is intense, antiseptic lotions or powders may be
employed. If, on the other hand, the reaction is insufficient, a blister
of biniodide of mercury or cantharides may be applied on the second
or third day after firing.

The results of firing vary greatly according to the method
employed. A day after superficial firing considerable swelling and
more or less abundant exudation, especially from the lines or points,
will be observed. The liquid dries, forming yellowish-grey crusts,
covering the whole region. The horse has pain in moving, shows
marked lameness and intense local itching. As long as this continues
it must be closely watched, and care taken to prevent the parts being

TREATMENT AFTER FIRING. izq

bitten, scratched, or rubbed against neighbouring objects. The best
method is either to tie the animal up short to a ring above the manger,
apply a cradle or sidestick. or a dressing to the -parts themselves. It
is sometimes necessary to use a pair of hobbles connected b)- a short
stout stick to limit movement of the legs as much as possible. The
crusts become loose towards the eighth, tenth, or fifteenth dav ; to
assist separation the parts may be bathed with warm ^^•ater, oi-
preferably dressed with an antiseptic ointment.

If the skin tends to crack, the parts are covered with boric vaseline
or glycerine. At a later stage the scabs produced b}' the cautery
disappear ; when extending deeply and implicating the whole thickness
of the skin they are sometimes very adherent, and only separate after
a suppurative inflammation, leaving exuberant granulations, which are
followed by indelible scars, the covering of hair never being restored.

While these processes are going on at the surface the subcutaneous
tissues have become hyperasmic and inflamed, infiltrated with an
abundant exudate, and the seat of active cellular proliferation. This
condition is later followed by resorption, consolidation, and com-
pression, results to which firing owes its beneficial action.

The effects of deep point firing are still more marked. The limb
often becomes greatly enlarged, although a free serous discharge occurs
through the skin. The small, closely-packed cicatrices in the skin and
cellular tissue resulting from such firing form a kind of permanent
compress which is much superior to bandages. It is certain that the
retraction of these islands of new tissue exerts on the diseased part
active compression resembling that produced by an elastic bandage
The treatment of the patient difters in no essential respect from that
required after superficial firing. The symptoms shown after deep
needle firing depend on the depth of penetration and the nature of
the tissues involved. Active inflammation always results in the region
cauterised. The limb becomes greatly swollen, sometimes very hot
and painful, while the animal shows more or less marked fever.
Moreover, when a dropsical synovial sac has been opened synovia is
frequently discharged, sometimes in large quantities, forming a
yellowish-grey albuminous laj^er, which may even flow downwards
over the foot or reach the ground.

At the end of two or three days this synovial discharge hardens, the
apertures become obliterated, and the discharge ceases. The crusts
separate during the second week ; the scars begin to disappear towards
the twentieth day, leaving in their place little reddish cicatrices.
Swelling of the parts sometimes persists for a long time, but can be
diminished b}' exercise and massage. The hair rapidly grows again,

9

130 OPERATIVE TECHNIQUE.

and almost entirely masks the little smooth cicatrices left by the
cautery. This is one of the chief advantages of this method.

Whatever the degree of firing and the mode employed, a certain
period of rest is needed. As a rule, after the lapse of the first or second
week, it is well to exercise the animal daily for twenty minutes to half
an hour. If possible the animal should be sent to grass at the end of
two or three weeks, the rest given extending from one up to three
months. In injuries to the tendons in spavin and some other con-
ditions such rest is absolutely essential.

The operation may be complicated in various ways. Thus the skin
may be divided and a gaping wound produced ; capillary haemorrhage
may result, or the fired surfaces may be torn. Such results may,
however, be avoided by reasonable care. Loss of skin and the forma-
tion of large cicatrices following too severe a use of the iron are more
serious. When such results threaten means must at once be taken to
prevent sloughing. The frequent application of the cold spray is
one of the most common methods ; if conjoined with an antiseptic
lotion it is more useful, it cleanses the parts, and removes the irritating
exudate which exaggerates the inflammatory symptoms. Lotions and
astringent compresses moistened with weak acetate of lead, Goulard's
extract or alum solution have also been recommended. Lukewarm
antiseptic baths followed by dusting with iodoform or a mixture of
iodoform and tannin are preferable. Nocard highly recommends
spraying with an ethereal solution of iodoform. He says that it
abolishes suppuration, and checks the microbic infection of the wounds
resulting from the removal of the scabs. Haemorrhage resulting from
puncture of a vein or arteriole by the needle is without danger. It
either ceases spontaneously, or can be stopped by introducing into the
little cutaneous puncture a small tampon of wadding, or by applying a
compress dressing.

Subcutaneous cauterisation, recommended in Italy, appears to
present no marked advantages, and may be dismissed here with the
statement that the skin is first divided, the edges held apart, and the
globular-headed iron applied directly to the deep-seated structures
thus exposed. In times past it was not unusual to fire sound horses
with the idea of preventing the formation of ring-bones, spavins, etc.
Needless to say, such a course is not only inhuman but absolutely
useless.

CHAPTER IX.

METHODS OF UNITING WOUNDS.

Healing by first intention with the formation of a mere linear
cicatrix is the surgeon's ideal, but can only be attained when the
margins of the wound are accurately united and held steadily in
position. Given these conditions, healing by primary intention is
assured in an aseptic wound. Apposition is best effected by
sutures, /. c. by drawing together the edges of the wounds by
stitches ; though some wounds may be united by the use of
adhesives like collodion, wound gelatine (either alone or with the
addition of oxide of zinc), sticking-plaster, emplastrum adhaesivum,
pitch plaster, or strips of fabric fastened to neighbouring parts by
common glue.

The wound is disinfected, the hair shaved from the neighbouring
parts, the skin dried, and slender strips of plaster applied at right
angles to the long axis of the wound. Once these firmly adhere,
the edges of the wound are pressed firmly together, the free ends
of the strips of plaster carried straight across with some tension,
and fastened on the opposite side. Another method is to fix strips
on either side alternately, and by drawing in opposite directions
on opposing pairs to bring together the lips of the wound. A
third method consists in fixing a somewhat broad strip of plaster
along each edge of the wound and uniting the strips by sewing.
Degive uses rubber bands to draw together the strips in place of
sewing.

In using collodion the edges of the wound are pressed together
with the fingers, the collodion applied thickly, and the wound held
until such time as the dressing has had time to dr}-. Strips of
linen may also be saturated with collodion, and applied rapidly
across the edges of the wound whilst the lips are pressed together.

132

OPERATIVE TECHNIQUE.

In animals, however, this method of uniting wounds can only
be used in rare instances, partly because of the presence of hair,
partly because of the animal's resistance and the \-iolent contraction
of its muscles, especially of its panniculus muscle. If plaster is
applied, even in broad strips, over the hair it soon looses its hold,
and the wound gapes or the continuous pull tears out the hair
with a similar result. When the hair is shaved and the strips
applied directly to the skin, the}' are apt to become detached by

the rapidh' growing new hair
before firm union of the wound
surfaces has taken place.

The method of uniting
wounds by small hooks, pin-
cettes, etc., though widely
used in human surgery, is
useless in our patients.

Bandages, however, can be
employed with greater success.
In man}' positions, for example
in the extremities, union can
be effected by using bandages
without the help of sutures ;
but the method is never
thoroughly reliable, for which
reason bandages are best
utilised to reinforce or assist
sutures, to neutralise excessive
tension and tearing out of the
threads, or to check move-
ment, and thus ensure the
most favourable conditions for

Fig. 153. — Largu's suture
needle ; metal handle for
aseptic surgery.

Fig. 154.
De Mooij's suture
needle all in
metal, for asep-
tic surgery.

union.

Little attention was for-
merl}' given to the proper use

of sutures, and it was thought that in animals wounds seldom healed by
primary intention, the reason being that operators took little pains to
ensure antisepsis, and consequently the sutures rapidly tore out. All
this is now changed. Many of the contra-indications formerly given are
no longer recognised. In times past only fresh wounds were sutured,
and old wounds were always "freshened " before being united. It is
true that fresh wounds present the most favourable conditions for
healing by first intention, but it is also possible to bring together granu-

METHODS OF UNITING WOUNDS.

^35

Fig. 155. — Needle-hoider 1 Reiner's).

lating surfaces and effect healing. Furthermore, bruised or torn wounds
were not sutured, though even they may heal by primary intention,
provided the margins are not absolutely crushed, have not lost
their vitality, and have not been cut off from the circulation.
Tissues in which the circulation has been reduced to an absolute
minimum may still retain their vitality by means of the "plasmatic'"
infiltration until circulation of blood by"the formation of new blood-
\-essels becomes pos-
sible; and small frag-
ments of dead tissue
can be cast off \\ith-
out imperilling primar\-
union.

Deep wounds were
left open because reten-
tion of discharges was
feared. By using drain-
age - tubes, however,
these can nowadays be
united without bad con-
sequences. On the other hand, great tension, especiall}' in wounds
with loss of substance, contra-indicates the use of sutures, which
would rapidly cut out, and would therefore only be a drawback.
Moreover, those portions of the lips of the wounds enclosed within the
threads might themselves die, increasing the loss of substance.

It is inadvisable to remove irregular fragments from the edge of
the wound — to " regu-
late " the wound, as
the old school had it, —
because although the
lips thus more closely ap-
proximate to a straight
line, sound tissue may

156. — Showing method of using needle-holder.

Fig. 157. — Needle-holder (Hagedorn's)

be removed, the wound is enlarged, and the tension on the sutures
must be increased.

Sutures are therefore only contra-indicated when marked tension
exists, or when the wound shows septic infection or is offensive.
Almost all wounds in animals are more or less infected, but by the
free use of antiseptics such infection may be reduced to a minimum.

For suturing wounds we require needles and various kinds of
suture material. Needles are either simple or provided with a
handle, and may be straight or curved ; some of the latter again

134

OPERATIVE TECHNIQUE.

being curved throughout, and representing the segment of a circle
or elHpse, others half curved, only the anterior half being curved,
the posterior being straight. The last two are the most useful.
Some needles are curved in the plane of their greatest thickness
in order to ensure greater stiffness. They are, however, less easily
grasped and directed. In modern needles the point is almost
always lancet-shaped and double cutting. Numerous complicated
arrangements have been introduced to facilitate threading, but
have not met with much popularity. One of the most practical is

shown in Fig. 158. Com-
pound or handled needles
are fixed in a handle and
carry the eye close behind
the point (Fig. 153). They
are passed through the edges
of the tissue until the eye
k is exposed, and then threaded
and withdrawn, bringing the
thread with them. When
using small or sharply cur\ed
needles, working in the
depths of a wound or sutur-
ing firm tissues, a needle-
holder (Figs. 155 to 157)
is almost indispensable. In
case of need a pair of dressing
forceps efficiently replaces the
special needle-holder.

The chief suture materials
are aseptic silk, silkworm gut,
and catgut, none of which
impede healing. Catgut is
very useful, as it becomes

Fig. 15S. — Suture needles.

absorbed after a time, and therefore the stitches require no further
attention ; but sometimes this occurs very rapidly, with the result
of releasing still ununited portions of the wound and allowing the
lips to open. To overcome this difficulty, bichromatised catgut, which
onl}' dissolves very slowly, is emplo3'ed, but silk is preferable for all skin
wounds, and can even be used for abdominal operations, as if properly
sterilised it does not irritate and becomes encysted or disappears. A
number of difterent sizes must be provided of each of these materials.
Silkworm gut is very smooth, non-absorbent, and unirritating ; it is

SUTURE NEEDLES AND MATERIALS. 135

largely employed for suturing skin wounds where immediate union
is of much importance. Soft metallic wire and prepared horsehair are
also used. To preserve silk and catgut in an aseptic condition the
special holder shown in Fig. 82 is ver}' practical.

General Directions for inserting Sutures. — Before in-
serting sutures bleeding must have completely ceased. Capillary
haemorrhage is sometimes stopped by the sutures themselves, the
bleeding surfaces being pressed together ; but any large bleeding
vessels should be ligatured or twisted, otherwise the object of
suturing will be defeated. All foreign bodies, and not merely those
of a macroscopic character like fragments of dirt from the wounding
body, or of crushed tissues, clots of blood, etc., but also organisms
which would set up inflammation and suppuration, must be removed.
This is effected by shaving the hair from around the wound and wiping
and rinsing the parts carefully. Wounds are in the most favourable
condition for union when all bleeding has ceased and the surfaces
are covered with a thin film of clear serum. Although in human
surgery only sterilised, that is, aseptic, dressings and sterilised
water are used, it is much better in animals to use some antiseptic,
because in their case wounds are much oftener infected from the
beginning, and have usually been inflicted a considerable time before
coming under the surgeon's notice.

The preceding measures having been carried out. the lips of
the wound are approximated, and a decision formed as to the
number, kind, and arrangement of the sutures to be used. The
number, of course, depends on the size of the wound, and the kind
on the tissue to be united — whether it be skin, bowel, muscle, etc.
The first suture is best inserted where the parts are most out of
line. In very long wounds a series may first be placed at somewhat
long intervals, so as to ensure the approximately correct apposition
of the edges before proceeding to final closure.

Sutures must be so inserted as to bring the lips of the wound into
close contact at all points, and it is better to err on the side of using too
many than too few. In mucous membranes, bowel, etc., more sutures
are necessary than in the case, say, of skin. Their distance apart
ranges between three sixteenths and three eighths of an inch. The
points of entrance and margins should be at equal distances from the
borders of the wound, and in the case of the skin not less than three
eighths of an inch. The old rule, however, that the needle should be
inserted at a distance from the edge equal to the depth of the wound,
so that the surfaces should touch throughout their extent and no open
space remain below the suture, is not always to be followed ; one is

136 OPERATIVE TECHNIQUE.

sometimes obliged to seek primary union of the skin, leaving union
of the depths to follow by granulation. A drain'^age-tube may then be
inserted to facilitate discharge, care being taken to select the most
dependent point for its exit ; but considerable doubt has been thrown
on the efficacy of drainage-tubes, and after being replaced by gauze,
plaited horsehair, etc., they have been finalh' abandoned by a good
many operators. They are, however, useful in properly selected cases.
Retention of discharge must be carefully prevented, because not only
would such discharge thrust apart the deeper surfaces of the wound,
but it would greatl}' favour the multiplication of micro-organisms.

When rapid healing of deep wounds is of great importance, the
deeper seated structures should be united with aseptic material, and
the threads cut short before the skin wound is closed. These " buried
sutures," if aseptic, cause neither irritation nor suppuration. In pene-
trating wounds involving the peritoneum the serous surfaces must first
be brought together, then the muscles, and finalh' the skin ; similarly in
extensive wounds of tendon sheaths and joints, the tendon sheath or
capsule of the joint is first to be united and afterwards the skin.

To avoid displacing the margins sutures should be inserted at right
angles to the long axis of the wound. They should merely bring the
surfaces into contact and hold them together ; the most frequent error
in this respect is to draw them too tight, causing them to cut out or even
to produce local necrosis of the lips of the wound. They should be left
in position until the new tissue has become sufficiently firm. Primary
union occurs ^\■ithin three to five days or not at all ; the changes in
the wound after this time onh' inlluence the firmness of the cicatrix.
The usual direction, to remo^•e sutures between the fourth and sixth
da3-s, without reference to the size, degree of tension, mobility, etc., of
the wouiid, is apt to be followed by tearing apart of the newly formed,
tender tissues within the succeeding twenty-four hours, necessitating
a fresh operation. Some practitioners seem to dread a trifling amount
of cutting, but it is of no particular consequence. When sutures
threaten to cut out, either from being drawn too tight or from local
swelling, it is often ad^'isable quickly to insert a few fresh ones rather
more distant from the edges, so as to avoid the need for entire!}'
resuturing the parts, which is not always successful. Sutures of
aseptic material may be left eight or even fourteen days in position
without causing suppuration.

Sutures may be divided into uniting or coaptative, which serve to
draw wounds together, and tension sutures or sutures of relaxation,
which counteract the pull exercised b}- the tissues and thus relieve
tension on the uniting sutures.

INSERTING SUTURES.

^37

The greater number of special sutures described from time to time
have only an historical interest.

Skix Sutures. — The most important and the most commonl\- used
is the plain interrupted suture shown in Fig. 159, which can be employed
in almost all cases. It is made by passing a thread through the opposing
lips of the wound, drawing the free ends together, and tying them firmly
towards one side of the wound. The needle carrying the suture is

r

Fi.

Fig. 160. — Insertino; the suture.

grasped in the right hand, the thumb on the concave, the index and
middle fingers on the convex side (Fig. 160), or a needle-holder may be
used (Fig. 156). The edges of the wound are successively raised with
the fingers of the left hand or with forceps, and the needle passed
through them first from without inwards, then through the opposite
lip from within outwards (Fig. 160). A better method, however, is to
raise both lips together, producing a somewhat deep fold, through
the upper part of which the needle
is passed with a single thrust (Fig.
161). This secures a larger surface
for union ; when only the extreme
edges of the skin are brought into

contact, rapid union is much less Fig. 161. — Methods of suturing to secure

, • T-1 ,• , largest possibb surface for adhesion.

Certam. The comparative poverty a: Interrupted suture, a Z?. Suture

of blood-vessels in the skin of of rela.xation.

animals as compared with that of man explains the difficulty with
which skin surfaces alone unite, or when united hold together
under tension. The appearance of a wound sutured in the above-
described manner is certainly somewhat unsatisfactory, but there
need be no fear of the fold remaining. As soon as the threads are
absorbed or removed the fold disappears, leaving only a narrow
cicatrix. To relieve tension in wounds so united it is generally
desirable to insert one or more " relaxation " sutures.

138 OPERATIVE TECHNIQUE.

Sutures ma}- be tied successively as inserted, or tying may be
deferred until all are in place. In animals it is usually best to tie them
as one proceeds. The fear of them tearing out when the animal rises
is unjustified, provided a sufficient number have been used and one or
more " relaxation " or " tension " sutures have been inserted. Bayer
always sutures wounds left after the removal of elbow tumours (capped
elbow), and although the sutures are exposed to great strain on the
animal rising he has never seen them tear out. In this country, of
course, such tumours are not infrequently removed in the standing
position under local anaesthesia, and the danger of tearing out is
therefore comparatively trifling.

The knots should lie to one side or other of the line of union, not on
the wound. The threads are cut off short. When the lips of the
wound are thin they often tend to turn inwards when sutured and to
delay union. This cannot take place where a fold is raised, but should
it occur it can easily be rectified by raising the edges with dissecting
forceps and holding them in this position until the sutures are tied.

In tying a surgical knot the free end of the thread is twisted twice
around the fixed end when forming the first portion of the knot. To
remove sutures the knots are grasped with forceps, the loops lifted
sufficiently to allow the points of the scissors to be slipped gently
beneath, and the threads cut and withdrawn. Should a thread stick,
the lips of the wound may be supported with the free hand whilst the
thread is being extracted. As already remarked, catgut is completely
absorbed, so that only the portion of the suture outside the wound
requires removal.

The continuous suture or glover's stitch (Fig. 162) is, after the
interrupted (Fig. 159), probably that most commonly employed. It
begins at one end of the wound like an ordinary interrupted suture.
After t}-ing the first suture the thread, however, is not cut oft',
but is carried obliquel}' across the lips of the wound and rein-
serted on the opposite side, the needle being passed once more
at right angles through the edges of the wound, which must be
held in close apposition. In this wa}- the thread passes con-
tinuously from one end of the wound to the other. At the point
where it finally emerges it is cut off and tied at one side of the
wound, so that the beginning and end resemble an ordinary inter-
rupted suture. Another method consists in leaving the ends, free
until the suture is complete, when they can be knotted together,
forming a long loop. In removing this suture the thread is divided at
each loop, and the fragments withdrawn one by one. The glover's
stitch has the advantage of being rapidl}' inserted, but many regard it

CONTINUOUS, BLANKET, AND PIN SUTURES. 139

with disfavour. Despite the greatest precautions the wound cannot
always be maintained aseptic. If the glover's stitch has been used,
and it should become necessary to relax or remove a thread here and
there, the whole wound reopens.

In the blanket or button-hole stitch (another form of continuous
suture) the needle, after traversing the lips of the wound, is carried
under the slack of the thread, so that the loop of each stitch as it is
tightened is maintained at right angles to the edge of the wound,
whilst the intermediate portion lies parallel to it.

The pin suture, also known as the twisted or figure-of-8 suture
(Fig. 163), though much praised by certain operators is less often used
than formerly. It is employed where the edges of the skin are very thin
and without much subcutaneous tissue, as, for example, in the eyelid,
wing of the nostril, skin of the cheek, lip, etc., and where the margins

Fig. 162. — Continuous or sflover's stitch.

Fig. 163. — Figure-of-S or pin suture.

show a tendency to roll inwards. The pin then acts as a support for
the edges of the skin. The pins are usuall}- from one and a half to
two inches in length, and parallel sided. The}- should be flexible, and
ma}' be of brass, copper, silver, etc. Ordinary pins, however, are
very commonly used. They are sometimes inserted with a special
instrument which holds the pin in a short tube and, by means of a
pear-shaped handle like that of an awl, permits greater power to be
exerted. The pins are passed at some distance from the edges of the
wound, and a thread wound around the free ends in a figure-of-8.
Where several pins are inserted in series one thread may be used for
securing the whole, as in Fig. 163 ; in other cases a separate thread
is employed for each. When secured the points of the pins are cut off
with powerful cutting pliers. In remo^'ing pin sutures the margins of
the wound should be pressed gently together \\-ith the fingers of one

140

OPERATIVE TECHNIQUE.

hand, when the threads can be cut and the pins removed. Threads
gkied to the skin by discharges may, if aseptic, be left in position.

Another form of suture comparatively little employed is the so-
called shoemaker's stitch. It is used in removing hernial sacs, new
growths, etc. An awl-like needle carrying a long thread is passed
through the new growth, and the loop is cut, leaving the growth
transfixed with two threads. By tightly tying together the free ends
of these threads on opposite sides the circulation in the peripheral
portion of the growth is stopped, causing the part to become necrotic
and fall away. By using a series of such sutures large growths may
effectually be removed.

Of tension sutures or sutures of relaxation there are several
varieties. Ordinary interrupted sutures may be used for this purpose
if more widely spaced and inserted further from the edges of the
wound and to a greater depth than usual (see Fig. 164).

Fig. 164. — Ordinary deeply placed
interrupted sutures used as
sutures of relaxation.

Fig. 165. — So-called "quilled" suture.

To equalise and distribute pressure, thus preventing the stitches
cutting through the skin, the suture shown in Fig. 165 is often
used. It is formed by passing a number of double sutures through
the lips of the wound in such a way that the loops lie on one
side, the free ends on the other. A small cylinder of any kind, like a
quill or roll of gauze, is then slipped through the loops ; the free ends
are drawn tight and tied over a similar cylinder inserted on the
opposite side. The cylinders extend for some distance beyond the
ends of the wound.

It happens, howe\-er, at times that animals lie on the part so
secured, and the c}-linders are apt to cause pressure necrosis, making
it necessary to remove the whole of the sutures despite their still being
required. A modification was therefore introduced in which small
rolls of gauze are employed for each complete suture, allowing one to

TENSION SUTURES— SUTURES OF RELANATION. 141

be removed without disturbing the rest (Fig. 166). As, however, these
rolls of gauze become hard when saturated with blood or discharge,
they may advantageously be replaced with small pieces of disinfected
rubber tube, w'hich can easily be cleaned, and which yield slightl}'
when swelling occurs. In long wounds comparatively thick drainage-
tubes may be used, sufficiently long to extend beyond the ends of the
wound, thus reproducing the old form of suture shown in Fig. 165.
This secures the advantages of greater cleanliness and a certain
yielding quality, which permits of the longitudinal tube adapting itself
to irregularities of surface, and thus exercising more regular pressure.
Should a suture threaten to cut, the drainage-tube may be divided at
any point, and the compound suture converted into interrupted ones.

Another form of tension suture is shown in Fig. 167. The free ends
of the silver wire are passed through small oval plates of any light

; '1

]tlt:X-^t^X^.

fc^..*%&-."S

CyO

Fig. 166. — Interrupted sutures combined
with sutures of relaxation.

—Tension suture iii
position.

metal like aluminium, and secured by perforated shot slipped over the
wire and compressed by pliers. Occasionally the plates are omitted,
and small leaden shot or glass beads alone used. The suture is then
secured by forming a rather large knot above the bead at each end.

Bowel Sutures. — For uniting the walls of the bou^el many com-
plicated methods have been proposed, some of which certainly were of
value in pre-antiseptic days, but are now discarded. Possessing as we
do suture materials which may safely be abandoned in the abdominal
cavity wdthout setting up suppuration, peritonitis, etc., many special
precautions are now unnecessar}-. The sutures hereafter described
are those most frequently employed and easiest to use. In devising
a bowel suture, it must be borne in mind that mucous membrane
will not readily unite with mucous membrane on account of the
continuous secretion occurring, and that the surfaces to bring together

142

OPERATIVE TECHNIQUE.

are either the muscular or serous coats, the latter of which shows a
great readiness to adhere and unite. Sutures must also ensure perfect
closure of the bowel woimd and absolutely prevent bowel contents
exuding. They should, therefore, be inserted about every one
eighth of an inch. On account of the thinness of the walls slender
needles are necessary. Special fine curved needles or fine sewing
needles can be employed. Aseptic silk is probably the best sewing
material ; catgut is less adapted for the purpose as it is sometimes too

Fig.

— Schema of Jobert's suture
mow abandoned).

Fig. 169. — Schema showing Jobert'
suture in section.

rapidly absorbed, the sutures yielding before the. union of the surface
has occurred. To prevent this, catgut rendered partially insoluble by
the action of chromic acid has been introduced, but boiled silk has no
such disadvantage and serves every purpose.

The first and simplest form of suture was Jobert's. The needle was
first passed through the serosa at some distance from the wound.

Fig. 170. — Lembert's bowel stitch.

Fig. 171. — Lembert-Czerny bowel stitch.

penetrated the entire thickness of the bowel, and emerged close to the
free border of the wound. The opposite lip of the wound was transfixed
in a similar way. The ends were then knotted together and cut off
(Fig. 168). This suture brought the serous coats into apposition, as
shown in Fig. 169, but had the disadvantage that the threads passed
through the lumen of the bowel, and might thus convey septic material
from it into the peritoneal cavity, producing infection and inflammation
in the track of the suture, resulting later in peritonitis.

BOWEL AND TENDON SUTURES. 143

For this reason Jobert's suture was discarded in favour of Lam-
bert's, in which the threads are passed in a similar way but do not
penetrate the mucous membrane, only extending to the muscular coat
(Fig. 170).

Czerny reinforces Lembert's stitch by interrupted sutures uniting
the mucous membrane, Lembert's stitch being employed to bring the
serous surfaces into apposition ; he thus unites the edges of the wounds
twice. The tirst series do not penetrate deeper than the submucous
tissue. This system, however, is difficult to carry out. It is much
easier if the suture begins and ends in the serous coat ; the knots then
lie externally between the two surfaces of peritoneum.

In isolated instances it may be desirable to unite the mucous
membrane itself. In such cases the first half or more of the incision
should be sutured from within, and the knots tied on the inner surface.
As, however, the wound becomes smaller this is no longer possible,
and the remaining half of the wound must be united with sutures
penetrating to the submucous coat but tied externally. The whole of
the wound having thus been closed, the serous surfaces are brought
together in the manner above indicated. It might be advisable in
cases where other tissues lined with mucous membrane are divided, as
for instance the eyelids, cheeks, salivary or urinary ducts, the cesophagus
or bladder, to proceed as above, uniting mucous membrane to mucous
membrane. The apposition of secreting surfaces should be avoided.

Tendon Sutures. — In man recently ruptured tendons are united
by deep catgut or reindeer tendon ligatures left in position. In such
case the paratendinous connective tissue is turned inwards like the
serous coat in the last instance, because it contains the vessels and
most readily unites. The needle is inserted about a quarter of an inch
from the divided end of the tendon, carried (say) downwards beneath
the superficial layers of tendon fibres, brought out through the torn
surface, and passed through the opposite end of the tendon after a
similar but reversed fashion. The ends are knotted and cut off. If
necessary, a complete ring of sutures ma}^ thus be inserted around the
tendon, after which the outer wound is closed. It is often extremely
difficult to insert sutures because the muscles retract the ends of the
tendon to a considerable distance. The divided ends mav, however,
often be approximated by placing the limb in a special position, in
which it must afterwards be fixed by the application of a dressing,
plaster bandage, or splint, etc., secured as circumstances will permit.
This procedure might be imitated in small animals. In the present
condition of our science, however, it is practically impossible to
insert sutures in those tendons which are most frequently ruptured,

144 OPERATIVE TECHNIQUE.

viz. the flexor pedis perforans or perforatus in the horse, because
these act not only as prolongations of the flexor muscles, but as a
weight-carrying apparatus, and the dead load which rests on them is
much greater than any sutures could bear, even though reinforced b}'
unyielding dressings and favoured by immobilisation of the extremities
in the best position for a number of weeks.

Nerve Sutures. — In suturing nerves one end of the nerve-sheath
is united to the opposite end, the suture not penetrating beyond the
paraneurotic tissue.

CHAPTER X.

PHLEBOTOMY, SCARIEICATION, AND TRANSEUSION.

By phlebotoni}' is meant the surgical openincr of a vein for the
purpose of removing blood. Although bleeding is almost invariably
practised on veins, arteries may be utilised for the same purpose, and
the old term blood-letting included venesection or phlebotomy and
arteriotoni}-. Bleeding from capillary vessels is usually effected by
scarification or the application of leeches.

Bleeding may be divided into general and local. General bleeding
consists in removing a large volume of blood with the object of
lowering blood-pressure throughout the body ; local bleeding, on the
other hand, is undertaken to reduce the quantity of blood in the part
operated on or in its immediate vicinity, i. e. to improve the conditions
in a circumscribed area.

Bleeding from arteries and capillaries is much less commonly
performed than from veins, and venesection, formerly practised in the
most widely differing localities, tends to become more and more
confined to the jugular vein. In former times bleeding was popular
in all acute and feverish conditions, and was so excessively prac-
tised that a reaction naturally set in. It has now almost fallen
into desuetude, a result accelerated and confirmed by the entirely
different views now held as to the value of general bleeding. In
bacteriological laboratories, of course, bleeding is a necessary pre-
liminary to the preparation of protective sera, and is also resorted to
for obtaining blood for microscopical or bacteriological experiments.
The periodical bleeding of animals in spring to keep them in good
health is still practised in a few parts of the country, but is rapidly

10

146 OPERATIVE TECHNIQUE.

dying out. The innate vitalit}' of ancient superstitions is well illus-
trated by its having survived so long.

The chief results of blood-letting are as follows :

1. The reduction in quantity of the circulating fluid is at once
followed b}^ diminished blood-pressure in all the vessels and changes
in the circulation favourable to the relief of local congestion.
Congestion in important organs like the lungs and brain, and
possibly also the sensitive laminae of the feet, therefore constitutes
the chief indication for bleeding.

2. The blood withdrawn contains a large quantity of nutritive
material and blood-corpuscles, both of which are of great importance
to the organism when struggling with microbic infections ; in
such diseases, therefore, blood-letting is seldom advisable. As it is
also known that inflammatory processes in the body most commonly
result from infection, the fact renders blood-letting still more question-
able as a means of combating inflammation.

On the other hand, a certain amount of infective or toxic substances
is also removed with the blood, but as general bleeding weakens the
patient, and as active resorption from the great body cavities follows,
it may happen that a greater amount of injurious material is eventually
absorbed than is removed from the circulation. In general, therefore,
bleeding is seldom resorted to in infective or toxic diseases. The good
effects sometimes obtained in lumbago and laminitis may perhaps be
referred to the above causes.

3. As mentioned, active absorption from the tissues and body
cavities follows bleeding, and the fluid constituents of the blood are
thus replaced. This explains the value formerly attached to the
practice as a means of promoting resorption. In opposition to this
is the fact that the proportion of water in the blood is thereby
relatively increased, and with it the tendency to fresh exudation.
Experience shows, in fact, that little can be expected of bleeding
in this direction.

4. Bleeding is followed by a temporary increase of tissue meta-
bolism, as shown by augmentation in the quantity of nitrogenous
compounds and phosphoric acid voided in the urine. Such a result
can scarcely be interpreted as favouring recovery.

It would appear that bleeding plays no great therapeutic rule,
and when we recall that it is contra-indicated both in extreme youth
and age, in constitutional weakness, pregnancy, etc., there is little
wonder if it is now comparatively little practised. Its most important
indications are in dangerous conditions resulting from marked dis-
turbance of circulation in important organs like the lungs and brain.

BLEEDING LANCETS.

147

It is also valuable in other diseases like laminitis and lumbago,
in which, however, its exact iiwdiis operandi is obscure.

At the present day horses are almost invariably bled from the
jugular vein ; formerly it was the custom to bleed from the sub-
cutaneous thoracic vein in diseases of the chest, from the mammary
vein in diseases of the udder, from the transverse facial vein in diseases
of the eye, and from the digital vein in diseases of the foot, but
experience slowly convinced operators that no advantage was thus
gained. The jugular vein is now almost invariably chosen because
it is easy to find, conveniently situated as regards height, etc., and
while blood-pressure within it is low, a considerable volume of
blood may be obtained in a short time. The spot chosen is the
junction between the upper and middle thirds of the neck, where

Fig. 172. — Bleeding lancets.

the subscapulo-hyoideus muscle intervenes between the vein and
the carotid artery, which is therefore less likely to be injured.

The average quantity of blood abstracted at one time is, in flie ox,
10 to 16 pints, the horse 8 to 12 pints, the pig i to i| pints, sheep | of
a pint, and dog h a pint, in fowls 2k to 10 fluid drachms; individual
peculiarities, however, must be taken into account in each case.

Instruments. — The simplest instrument is the lancet (Fig. 172).
It consists of a thin oblong fragment of steel, the upper third ground
to an extremely keen double cutting edge. The whole is enclosed
between two scales which protect it when not in use. Several forms
are used, the varieties of which are shown in Fig. 172. The English
lancet (a) has a relatively obtuse point ; the German {b) is somewhat
more acute; in the Italian (c) the blade is narrower from the
commencement, and the cutting edge relatively long and slender; d is

148

OPERATIVE TECHNIQUE.

the sabre-shaped or abscess lancet, ha\-in,i; one convex and one concave
cutting edge.

To bleed with the lancet, though apparently easy, requires con-
siderable practice ; the \arying thickness and resistance of the skin in
different animals making it difficult to judge of the exact amount of
pressure required to open the vein without transfixing it.

For this reason other instruments have come into use. The
simplest of these is the fleam (Fig. 173). The handle extends some-

FlG. 17^.

F"iG. 173. — Simple
fleam.

Im ,, 171). — L'asc of fleams.

Fig. 177. — -
Blood-stick.

\vhat beyond the insertion of the actual cutting part, and is intended
to prevent the instrument entering too deeply. Sometimes the back of
the handle is provided with a broad surface (Figs. 174 and 175) on which
the blow of the blood-stick is delivered. Combined fleams having a
number of blades in one setting are also common (Fig. 176). The
fleam is caused to penetrate the vein bv a sharp blow from the' hand
or blood-stick (Fig. 177). With the latter the necessary force can
better be estimated, and the inconvenience of either failing to
penetrate the vessel or completely transfixing it equally avoided ; in

SPRING FLEAMS.

149

deli\-eriiic^ the stroke the arm should not be moved as a whole, but
only from the elbow.

Sprin^^ fleams (Figs, 178 and 179) are intended to overcome the fore-
going difficult}'. They always cut to a given depth, and produce a wound
of gi\-en size. The case of the fleam is provided with an opening (C)
for the passage of the fleam (F), which is withdrawn into the case and
set by drawing back the cocking lever (A), leaving the plate [C) free
for application to the vein. Having placed the instrument accurately
in position the operator depresses the trigger (D), releasing the fleam,
which makes a rapid to-and-fro movement, dividing the skin and
opening the vein. As the instrument is readily placed in position,

F"iG. 17S. — Spring fleam :
old form.

Fig. 179. — Spring fleam : later form.

calls for no skill on the operator's part, always cuts in the right
direction and to the right length and depth, and can be regulated, it
continues to enjo}' some popularity, despite its being complicated and
difficult to clean.

When bleeding oxen a bleeding string is required, i.'e. a stout
cord provided at one end with a ring. By passing the cord round the
neck and through the ring and drawing it tight, temporary engorge-
ment of the jugular is produced, which facilitates operation. Except
for very heavy, fat animals it is not used in equine practice.

The blood should be received in a vessel of measured capacit\-, so
that the amount removed ma\- be accurateh' known.

The skin wound is almost invariabl\- closed with a pin suture,

150 OPERATIVE TECHNIQUE.

though it is difficult to know why the ordinary interrupted suture
should so entirely have been displaced for this purpose. A word
of caution is required against using hairs from the mane or tail
to complete the suture, as was the old fashion. These hairs not
infrequently formed the centre from which radiated an acute phlebitis.

The jugular vein lies in the "jugular furrow," formed above by
the mastoido-humeralis and below by the sterno-maxillaris muscles.
Beneath the skin and loose connective tissue lies the panniculus,
which, though very thin in the upper portions of the neck, becomes
over half an inch in thickness in the lower. In the upper half
of the jugular furrow " the vein rests on the subscapulo-hyoideus
muscle, which there separates the vessel from the carotid artery ;
but in the lower half the vein rests on the side of the trachea, and is
in direct contact with the carotid, which lies above and slightly
internal to it " (see Fig. ig8). On account of this arrangement the best
position for opening the vein without endangering the carotid artery
is at the division between the upper and middle thirds of the neck.

Operation on the horse. — When using the spring fleam it is of little
importance on which side the operation is performed, though some slight
advantage accrues from selecting the right. The same is true of the
lancet, but the fleam can be used most conveniently on the left. At
the junction of the upper and middle thirds of the neck a small
area of skin should be shaved and disinfected. This preparation
minimises danger of phlebitis. (Figs. i8o and i8i.) The horse is
then bridled, and the head held exactly in the middle line by an
assistant. Troublesome horses may be twitched, and the fore-foot
on the side of operation may be lifted. \\'hen using the ordinary
fleam the horse's eyes should be covered, because at the moment
of striking the blow the animal is apt to start, defeating the
operator ; but of course this is not likely to occur in using the
lancet or spring fleam. Having cocked the spring fleam, the
operator stands beside the animal's shoulder, and with the thumb
or fingers of the left hand compresses the vein, causing it to rise.

Should there be any doubt as to the exact spot to select, the
pressure may be relaxed and repeated once or twice, when the
rising and falling of the vein will render its position evident.
Immediately it appears clearly the plate of the fleam is adjusted
just over it and parallel with its long axis, the trigger is -gently
pressed, and the incision made. The fleam is then removed, and
the vein compressed below the incision until the necessary quantity
of blood has been taken.

If the vein has only been stabbed, the blood flows in drops

BLEEDING FROM THE JUGULAR.

151

or in a very thin stream. In such case operation should not be
repeated at the same point. Sometimes the blood at first flows
in a thick stream, but soon diminishes in spite of continued com-
pression. This is due to the skin having shpped to one side and
covered the wound in the vein, or to a fragment of subcutaneous
tissue having interposed itself. By slightly moving the skin or
the horse's head, or by inserting the finger in the animal's mouth
and so causing it to make chewing movements, the flow is restored.
Occasionally the vein is opened over a valve, which falls into the
wound and obstructs the stream.

Fig. 180. — Bleeding with the spring
fleam ; off side.

Fig. 181. — Bleeding with the spring fleam;
near side.

Jets of bright red blood alternating with the darker stream show
that the carotid has been injured, but as a rule the opening in
that vessel is very small, and closes if pressure be removed, the
external wound be sutured, and a dressing applied, though some-
times an aneurysm or aneurysmal varix results. Should the opening,
however, be large the animal may even bleed to death, unless the
carotid be immediately ligated. The vessel should then be firmly com-
pressed by an assistant, the existing cutaneous wound enlarged for a
distance of three to four inches, the panniculus and connective tissue
divided, and the carotid exposed by blunt dissection. The artery should

152 OPERATH'E TECHNIQUE.

be grasped with the fingers, drawn forward, freed from the nerves
which accompany it, and, on account of the collateral circulation,
doubl}- ligated. To prevent the \essel tearing through at the seat of
ligation in consequence of continued tension it is divided between the
ligature, and the ends allowed to retract. Care must be taken in
separating the recurrent nerve and in cleansing the wound, as
mechanical injury to the nerve or irritation produced b}' local suppura-
tion may be followed b}- paralysis and "roaring." Other methods like
continued compression of the artery and closure of the skin with
sutures have been recommended. Compression might in isolated cases
be followed by haemostasis, but closure of the skin wound is dangerous.
Experiment shows that a large hasmatoma usuall}' develops, and
pressure on the trachea may become so severe as to cause suffocation.
Should the carotid be damaged the patient should be kept under
observation. The accident, however, is rare.

Sometimes a small artery in the region of operation is divided, and
gives the impression of the carotid having been injured. Injury of
the vagus or sympathetic nerve seldom occurs. Perforation of the
trachea can only be caused by gross carelessness, but if opened suffi-
ciently for blood to enter the lungs, it might give rise to troublesome
symptoms.

The low or even negative blood-pressure in the jugular vein
renders that vessel specially convenient to bleed from, but at the
same time entails a certain danger of air being aspirated into it,
with suddenly fatal result. As a rule, even if the vessel be not
compressed below the incision, sufficient blood flows from above to
preserve a slight positive pressure. Should this pressure from above
fail, however, as would happen were the vessel compressed . above
the wound, the down-rushing column of blood would aspirate air into
the vessel, and a gurgling or bubbling sound be heard, indicating
to an experienced operator the serious character of the accident.
A deep inspiration is also followed b}' so rapid a rush of blood
towards the heart as to dangerously favour the in-draught of air
through the wound. Such accidents cannot well occur while the
escaping stream of blood is well marked ; they onl}- happen after
it slackens or ceases. Immediately the sound is heard the vein
should be compressed as low down in the neck as possible, and
attempts made to expel the air by strokmg the vein from below
upwards. After operation animals not infrequentl}' lean against the
manger or on the head-collar rope, and ma}- thus compress the
vein above the wound, with the result that air obtains entrance.
For this reason the wound should alwavs be sutured.

PRECAUTIONS DURING AND AFTER BLEEDING. 153

In many cases the entrance of small quantities of air produces no
bad result ; but in others the animal at once begins to sway to and
fro, falls to the ground, shows violent cl3spncea, sweats, and may
die in a few minutes.

Sufficient blood having been taken, the skin is closed either with
a pin or interrupted suture. In the former case the pin is cautiously
removed in thirty-six to forty-eight hours, the parts being supported
with the fingers of the left hand whilst those of the right rotate
and remove the pin. In closing the wound care must be taken
not to exercise much traction on the edges, as this might cause
separation of the skin from underlying tissues, and extensive
extravasation. Similarl}-, if during bleeding the outer opening be
obstructed, blood accumulates
under the skin. Such extravasa-
tion would be of little con-
sequence were it not that by
compressing the vein it ma}- lead
to thrombus formation, and that
it always supplies a favourable
medium for the further develop-
ment of the micro-organisms which
almost inevitabl}' enter. Failure
to remember these facts, and to
observe necessary cleanliness, ac-
count for most cases of suppura-
tion and phlebitis and the train
of complications which follow
them.

To prevent the animal injuring
or infecting the wound, by lean-
ing against or rubbing itself on the manger, etc., it should be
secured by pillar reins or be tied up short. Nor should it bt
worked soon after bleeding, because the pressure of the collar on
the vein or the rise in blood-pressure consequent on exertion may
cause the lips of the wound to spring open.

In operating with the spring fleam on the left side, the instrument
IS held in the reversed direction— that is, with the blade pointed
downwards (Fig. iSi), or the vein may be compressed with the
right hand and the fleam held with the left.

The right jugular is easier to open witn the lancet (Fig. 182).
The position of the operator is similar— that is, near the animal's
shoulder. After wetting and smoothing the hair the vein is compressed

Fiu. 182. — Bleeding with the lancet.

154

OPERATIVE TECHNIQUE.

lightly below the point of operation and caused to appear distinctly.
The incision is, as before, at the most prominent point and close to the
operator's fingers, because here the vein is more or less fixed. The
lancet is thrust inwards and slightly upwards, so as to produce a suffi-
ciently large wound, though care must be taken not to absolutely slit
open the vessel, as is sometimes done from over-anxiety. It then
becomes difficult to stop the flow, and it may be necessary to ligate the
vein, in addition to which there is danger of air entering the vessel. The
incision should be in the centre line of the vein ; the upper (or posterior)
aspect of the vessel must be avoided, as injury to the carotid artery
may readily result from incisions in this direction.

In using the ordinary flean) (Fig. 183) the operator, standing
opposite the animal's left shoulder, holds the fleam lightly between

the index finger and
thumb of the left hand,
compresses the vein
) with the other fingers,
and with a short, smart
blow from the blood-
stick, or failing this,
from the edge of the
right hand, drives the
fleam into the vein.
The fleam must be
held exactly at right
angles to the skin over
the highest prominence

Fig. i83.-Bleeding with the fleam and blood-stick. ^^ ^^^^ ^^-^^ otherwise

the vessel will be opened on one side or the instrument will slip
past it.

Dieckerhoff and Caspar have recently recommended a special
trocar and cannula for bleeding. As this instrument had been used
for some years for intra-\'enous administration of drugs, it occurred to
them that it might be equally useful for withdrawing blood, especially
where it was desirable to shield the withdrawn blood against con-
tamination, as in preparing protective serum. The cannula has the
great advantage over the fleam that it can be inserted several times
at the same place. In operating, the vein is raised, thq skin
divided, and the vein exposed. The operator, standing on the
animal's near side, then thrusts the cannula, carrying its shield,
steadily into the vein for a distance of three or four inches, when
bleeding follows. Some dexterity is required, but the method

BLEEDING CATTLE, SHEEP, AND GOATS.

DO

is particularly useful for laboratory work, and avoids almost all
the risks formerly appertaining to phlebotomy of the jugular.
When the necessary amount of blood has been abstracted, a blunt
trocar is inserted into the cannula to prevent air entering the vein,
and the combined instrument withdrawn. The wound is dressed
antiseptically and closed with a single suture, or may be left open.

In cattle the jugular vein is also opened. The animal's head is
raised by grasping the horns and the eyes covered. The hair is
clipped away from the seat of operation, the bleeding cord previously
mentioned adjusted, and the vessel opened just above the point of
compression by means of the fleam. The operator stands as in
bleeding a horse. In small cattle one may even stand on the side
opposite to that of operation and lean over the animal. This

Fig. 1S4. — Dieckerhoff's bleeding cannula.

method has the advantage that the operator cannot well be struck
by the animal when, as occasionally happens, it kicks in a forward
direction. On account of the loose arrangement of the skin in oxen it
is not necessary, though it is advisable, to insert a suture.

Bleeding from the mammary vein was formerly practised in diseases
of the udder and of abdominal organs, but possesses no special advan-
tage over bleeding from the jugular, while it is less easily carried out,
and is dangerous to the operator, who has to work in a constrained
position, and runs grave risk of being kicked by the patient. Moreover
the wound is very liable to infection.

Sheep and goats may also be bled from the jugular, but as a rule
the facial vein in the neighbourhood of the fourth molar is selected.
It yields little blood, but this is by no means an unmitigated evil, as
sheep and goats are very liable to serious symptoms after bleeding.

156 OPERATIVE TECHNIQUE.

As in swine the jugular lies deep and is covered with fat, it is
seldom opened, the lingual vein being preferred. A wooden rod being
thrust between the teeth, the tongue is drawn forward, and the vein
opened just over the fraenum linguae. Bleeding ceases spontaneously.
In addition the transverse facial and anterior auricular veins are
occasionally used. The internal saphena vein of the hind limb is also
the seat of operation. It is compressed by applying a cord or bandage
between the hock and stifle joint.

In dog-s and cats the jugular, or the internal saphena vein of the
hind limb, is the vessel usually indicated in text-books, but the opera-
tion is scarce!}- ever .performed.

Arteriotomy. — The opening of an arter}^ is very seldom resorted
to. The operation is carried out in the same way as phlebotomy, or
the artery is exposed, divided, and, at the conclusion of the operation,
ligated.

Scarification. — Bleeding from capillaries is effected b} scarification,
cupping, or the application of leeches. Leeches are little used in
veterinary surgery; the quantity of blood removed is trifling, the pro-
cedure troublesome and, considering the price of good leeches, costl}'.
Scarification consists in making a number of comparatively shallow
cuts in the tissue. It is seldoni employed on account of suppuration
and destruction of tissue frequenth' resulting. For cupping, which is
also rarel}' resorted to, a scarifier or lancet and a cupping-glass are

necessary. The scarificator (Fig. 185) con-
sists of a metal box containing many small
fleams and the mechanism for operating
them. The blades can be raised or lowered by
a screw, and the depth of incision regulated.
The fleams, twelve to sixteen in number,
are set and released in a precisely similar
manner to the blades of the spring fleam
previously described. Cupping-glasses are
hemispherical in shape, with edges ground
to a true surface. The centre is pierced
by a small hole,, and carries a short hollow
stem to which a strong rubber ball is fixed.
Fig. i85.-Scarificator. ^he scarificator is applied to the shaven

and disinfected skin, released, and applied
a second time at right angles to its previous position so as to
produce cross cuts ; the rubber ball on top of the cupping-glass is then
compressed, the glass applied to the scarified area, and the ball
released, causing a partial vacuum. When partially filled with blood,
the glass is removed, emptied, and again applied until the necessary
quantity of blood has been taken. i\ dressing is afterwards applied
ovc-r the seat of operation.

In remo^'ing blood for the preparation of protective serum ordinary
methods are unsuitable, because organisms mav obtain entrance to

k

SCARIFICATION AND TRANSFUSION. 157

the stream of blood and the receiving vesseL The \ein is therefore
exposed, and a trocar provided with a rubber tube connection is
inserted in it. The glass c}-hnder to receive the blood is closed with
parchment paper, and covered with a mo\"eable metal cap pro^•ided
with an openmg. All the instruments and apparatus are, of course,
most careiully sterilised.

In use the parchment is pierced through the opening in the metal
cap, and the rubber tube lowered into the cylinder so. that the stream
of blood comes as little as possible in contact with the air and forms
no foam. Immediately the vessel is tilled the tube is withdrawn, the
cap turned round, and the opening in the paper thus co\-ered.

Transfusion. — By transfusion is meant the conve}-ance of blood
from one individual into the vessels of another. It is only emplo3-ed
where fatal exhaustion threatens in consequence of severe loss of
blood or blood poisoning, especiall}- such as follows the respiration
of carbonic acid, ordinary illuminating gas, chloroform, etc. The
instruments required are a knife, forceps, scissors, a cannula, and a
glass funnel with rubber tube.

The healthy animal is bled into a tall vessel placed in water at
blood-heat. The blood is then whipped until all hbrin is separated so
that no clots may form, which might produce emboli in the vessels of
the recipient. ^ In the meantime a large vein or even an artery in the
subject is opened, the cannula inserted, and some blood allowed to
escape in order to expel all air from the cannula. The detibrinated
blood having been filtered through fine linen is used to fill the s\ringe
or funnel, care being again taken that no air remains in the instru-
ment. The syringe or tube from the funnel is then connected with
the cannula, and the blood passed slowly into the \eins of the subject.
This process is termed mediate transfusion.

After transfusion it sometimes happens that the body temperature
falls, cyanosis and severe dyspnoea set in, followed by hcemoglobinuria,
or even death. The cause of this intoxication is probably the presence
of fibrin ferment in the transfused blood. To prevent this the "blood
is often conveyed direct from blood-vessel to blood-vessel by a
connecting rubber tube. This operation is termed immediate trans-
fusion. Apart from the difficulties of the process and the impossibility
of controlling the quantity of blood introduced, there is considerable
danger of the formation of clots. Considering its risks transfusion
is nowadays practically abandoned, especially as it has been shown that
the dangerous symptoms depend not so much on the want of blood as
on the sinking of blood-pressure. The whole value of transfusion,
therefore, lies in its providing a sufficient quantity of fluid for the heart
to act upon.

Similar results may safely be obtained b\' intra-\'enous injection of
"6 per cent, watery chloride of sodium solution, to which has been
added a few drops of carbonate of potash solution, or, still more
simply, by subcutaneous injection of the same solution.

The process is most applicable to dogs. To prex'ent dangerous
anaemia of the brain during the preparation of the solution, etc., the
animal's head is allowed to hang over the edge of the operating table.

158 OPERATIVE TECHNIQUE.

or the hind hmbs may be Ufted, the body enveloped in hot clothes,
and ether injections given. Even after injecting physiological salt
solution, heat must be applied to the body, and warm fluids like
milk, etc., should be administered unless the}- can voluntarily be
taken. Warm wine or beer beaten up with eggs, or warm milk with
the addition of brandy, are also useful.

CHAPTER XI

METHODS OF PREVENTING OR CONTROLLING
HT:M0RRHAGE— HiEMOSTASIS.

The first check to the flow of blood from a divided vessel results
from the contraction of the elastic fibres and muscular coats and the
mechanical closure of the bleeding orifice. The flow being checked a clot
soon forms, which seals the aperture, partly b}- its contraction, parti}'
by acting as a plug or cap. The slower the flow the more quickly does
such a clot form. The cardiac weakness following on loss of large
quantities of blood therefore favours cessation of bleeding.

In incised wounds, the divided ends of the vessel retract into the
tissue, which then closes over them and checks haemorrhage. The
outer coat of torn and crushed vessels often becomes twisted into a kind
of cord, while the intima is induplicated after the fashion of a \alve.
Bleeding is therefore often slight even when ver}- large vessels have
been torn or crushed. A clot having once formed extends, as a rule,
up to the next collateral branch of the injured vessel.

The exact nature of the changes by which a divided vessel
is closed is not 3-et clear, and although we know that a thrombus
forms, yet the reason of its formation is still disputed.

Briicke has shown that the movement of the blood and the influence
of the undamaged tunica intima are the two essential factors in pre-
serving the fluidity of the blood, but authorities differ as to the exact
mechanism by which thrombi are formed. It was formerly believed
that the blood simply clotted, as happens under the influence of the
fibrin ferment on the fibrinogen when blood is withdrawn from a
vessel. Later investigations have shown, however, that the thrombus
does not always consist of coagulated blood, and thrombi have been

i6o OPERATIVE TECHNIQUE.

divided into two classes — the red and the white. Zahn states that
white thrombi result from accumulation of white blood -corpuscles in
the lumen of the vessel ; others, however, regard white thrombi as being
formed b\' " blood-plaques," /. e. small, colourless, discoid elements, the
origin and significance of which are still doubtful. These are said to
adhere to the injured portion of the intima coat, and finall)' to entirely
close the lumen of the vessel.

Red clots result from coagulation of the blood, but in the living body
they occur much less frequently than the white, though they are seen
after severe damage to the vessel wall implicating the intima ; they
are commonest in infectious diseases. Red clots are, therefore, most
commonlv seen in inflammatory diseases of the vessels and in pyaemia.
Sometimes white and red clots may be formed simultaneously in the
same vessel.

Ligation of an artery is not always followed by thrombus formation ;
should the tunica intima not be gravely damaged or infected, the
endothelium proliferates and the walls become adherent. In other
cases a white thrombus forms, or if the parts be severely injured or the
circulation be gravely impeded a red thrombus may be produced.

Pathological clotting demands not only the presence of fibrinogen
and fibrinoplastic substance but also of fibrin ferment, which is furnished
by the injured cells. In this case the essential part is played by the
endothelium of the vessel, which, owing to defective circulation, under-
goes degenerative changes, and thus brings about clotting.

The thrombus either become converted into organised connective
tissue or it softens and breaks down. The former is the more favour-
able development, and consists in the gradual replacement of the
thrombus by connective tissue, which usually results from proliferation
of the endothelial lining of the vessel. The endothelium is first con-
verted into polymorphous " formative cells," which rapidly multiply,
extend into the thrombus and replace it, leaving of the original thrombus
only a pigment residue (oxy hydrate of iron). From the vasa vasorum
new blood-vessels extend into the new tissue,' converting it practically
into connective tissue. The thrombus thus plays a passive part, being
gradually replaced by fibrous connective tissue. These changes occur
with comparative rapidity ; vascular new tissue may be found at the
point of ligation eight days after operation ; in three to five weeks the
thrombus, which, like a cicatrix, gradually contracts, is entirely organised.
Where, however, the intima is extensively diseased, or where general
constitutional disturbance exists, the changes proceed more slowly.
Sometimes the new^ connective tissue becomes permeated with hollow^
spaces (Rokitansky's sinusiform degeneration), and the lumen of the
vessel m.ay thus be again partially restored. Finally, the thrombus may
become calcified, so that it resembles a stone. To the occurrence of
this change in venous thrombi is due the production of " phleboliths."

Circulation is usually restored by collateral circulation, the smaller
vessels enlarging and conveying the blood by parallel paths. This
change also is often very rapidly effected, as shown by Nothnagel's experi-
ments on rabbits. Six days after ligation of an important vessel the
muscular coats of the dilated collateral vessels were found to be

HEMOSTATIC AGENTS. i6i

thickened. This result was formerly attributed to rise in blood-
pressure, but was regarded by Nothnagel as due to more rapid move-
ment of the blood in the vessels in question, and to the resulting
increased nutritive supply.

Hasmostasis by a plug or thrombus is, however, only a provisional
measure. Its purpose may be frustrated by suppuration occurring in
the walls of the vessel and extending to the clot, which then breaks
down : or increasing blood-pressure may drive out the plug, an
accident most likel}' to occur where the vessel is injured close to a
collateral branch. In such cases secondary bleeding follows. Final
closure of the vessel is -only brought about by organisation of the clot
and the cicatrix in the tissues surrounding the vessel, and by the union
of the walls of the vessel itself.

Haemostatic agents are very numerous, but of very varying utility.
Many have now been entirely discarded; they persisted from pre-anti-
septic times, when ligation was only too frequently followed by
suppuration with separation and discharge of the ligature. They may
be divided into (i) thermic, (2) chemical, (3) mechanical.

Of thermic agents the most popular is cold ; it is, however, only
useful for checking bleeding from capillaries or comparatively
insignificant vessels, and even then is uncertain. The result depends
on reflex contraction of the walls of the vessel and surrounding
tissues checking the flow of blood. When a strong stream of water
is used contraction of the tissues is increased by the mechanical
stimulus. Heat is usually applied by means of the cautery ; the
tissue, together with a portion of the escaping blood, is carbonised
and forms a firmly adherent scab which closes the lumen of the vessel.
This succeeds well in the case of small vessels, but is of comparatively
little value in dealing with the larger. To check bleeding from already
existing wounds the cautery should be of a bright red or almost
white heat, because a firm scab is required, and one wishes to prevent
the cautery adhering to the wound. When, however, it is used to
make incisions the instrument should be red and should be moved slowly.
Owing to its greater convenience, however, the galvano-cautery has
almost entirely replaced the hot iron for removing growths. Although
the resulting scab is sterile, and if very small may even undergo absorp-
tion, it is impossible to effect primary union between wound surfaces so
treated. For this reason the cautery as a haemostatic instrument has
largely been discarded, though in castration it is still used to close the
divided spermatic artery. It may be remarked in passing that bleeding
from hollow organs like the uterus is often best controlled by hot

II

l62

OPERATIVE TECHNIQUE.

irrigations. In human surgery steam of boiling water has recently
been used with good effect for checking uterine bleeding.

Most styptics combine rapidly with the blood, and form with it a
clot which adheres to the wound and closes the injured vessel. Some
act by causing contraction of the vessel and surrounding tissues.
Among those formerly employed were oak bark powder, tannin,
mineral acids and their salts, alum, nitrate of silver, acetic acid,
creosote, carbolic acid, alcohol, oil of turpentine, etc. Perchloride of
iron in the form of liq. ferri perchlor. diluted with three parts of water
was often used to moisten tampons which were applied to the bleeding

spot. Among the most useful are
mixtures of alcohol and water and
carbolic or sublimate solutions, but
under any circumstances styptics are
only of use in dealing with capillaries
and small vessels. In human surgery,
a light brown powder, consisting of
the soft hairs from the stem of an
East Indian tree fern {Cibotiinn Cnm-
niinghii), is used externally. To
check bleeding resulting from internal
injuries, extract of ergot {Sccalc cor-
nniitni) has also been used with suc-
cess. More recently it has been
largely replaced by extractum hydras-
tis Canadensis (golden seal). In
operative wounds all powerful styptics
prevent healing by first intention owing
to their caustic effect on the wound
surfaces.'

We may now consider mechanical
methods of dealing with haimorrhage.
As a pre\'entive, especially when
operating on limbs, the application of a tourniquet (Fig. i86) or one or
another form of Esmarch's bandage is the means usually employed.

In the horse the most primitive method consists in passing a loop
of stout cord or webbing around the limb and tightening it by the
rotation of a stout stick slipped through it. The pressure thus exercised
on the vessels checks circulation, and haemorrhage during operation is
virtually ////, while owing to compression of the nerves sensation
below the ligature is dulled and the pain of operation greatly
diminished.

Fig. 1 86. — The tourniquet.

ESMARCH'S METHOD. 163

A more refined method is to use a rubber cord or tube. A rubber
cord as thick as a man's forefinger and twenty to thirty inches in length
is passed around the Hmb above the knee or hock in a stretched
condition," The ends are united by a simple knot or a strong cord.

Esmarch's method is most valuable when, in amputating limbs in
small animals or excising some very vascular organ like the uterus, one
wishes to minimise bleeding. When properly carried out it enables
operations to be performed as though on the dead body ; no bleeding
occurs, and all parts, the normal as well as the pathologically altered,
are distinctly visible. Its inventor published a description of the
system in 1873 under the title of ' Artificial Ischa^mia.' It consists in
applying an elastic bandage, formed preferably of vulcanised rubber
(though a fabric of rubber threads covered with cotton is sometimes
used), to the limb or organ to be removed, commencing always at the
periphery. The strong pressure exercised by the spirals of the bandage
as they advance over the tissues gradually drives the contained blood

towards the trunk. When the parts - _.

to be excised have thus been rendered .-'''"' "'^-x^

bloodless a thick rubber cord is applied

with considerable pressure immediately / \

above the bandage. This compresses (
the arteries and practically brings circu-
lation to a standstill. The ends of the
cord are secured by tying or preferably
as shown in Fig. 1S7. The cord is

stretched and slipped into the first of Fig. 187.— Catch for rubber cord used
the incomplete cylinders; is then with Esmarch's bandage.

carried once or twice around the limb, stretched tightly to allow it to
be inserted in the second cylinder, and then sharply released. Its
elasticity causes it to swell up and to be firmly held in position within
the cylinder. The bandage is then removed and the operation
performed below the cord.

In this method two systems are associated, the blood being first
expelled from the parts and the bloodless condition afterwards main-
tained by the tourniquet-like action of the rubber cord. When the
part to be enveloped in the bandage is the seat of a wound of any
notable extent the latter can first be covered with a layer of w^adding
or with a compress. The operation terminated and the vessels ligated
the cord is cautiously loosened. It not infrequently happens, if the
surface has not been cauterised, that abundant haemorrhage follows
from the numerous small arterioles and capillaries, due in large
measure to vaso-motor paralysis, the effect of prolonged compression.

i64 OPERATIVE TECHNIQUE.

This can be checked by the cauter}-, by cold irrigations, the use of
carboHc lotion, or by a compress dressing.

In veterinary practice Esmarch's method is not usually applied in
its entiret}'. the operator often being satisfied with ftie application of
the cord. Speaking generall}-, this is the best method of operating
when the tissues have undergone much change, and are infiltrated with
pus or infectious fluids which might be pressed back into sound tissue by
the bandage and produce very grave results. The haemorrhage, which,
in consequence of venous stasis, is sometimes considerable, may be
checked by applying a second elastic tourniquet on the opposite side of
the region of operation. ^

The methods just described are onl\' applicable to certain regions,
so that when operating elsewhere other methods of dividing tissues are
sometimes resorted to, such as crushing with the ecraseur, blunt
dissection, tearing, and the use of the elastic ligature. We have already
alluded to the use of the cautery, galvano-cautery, and caustics. The
ecraseur (Figs, iii to 113), though almost discarded by human
surgeons, is still much used in veterinar}- practice. It crushes soft
tissues, though to some extent it also acts like a saw. Mucous mem-

FiG. 1S8. — Director.

branes, connective and fibrous tissues, muscles, vessels, neoplasms, are
all cut without haemorrhage if the instrument is worked sufficiently
slowly. Its action is especially remarkable in vessels : the middle and
internal coats rupture and retract whilst the external coat is stretched
and twisted in such a way as to effect almost complete closure. The
secret of avoiding haemorrhage is to work the instrument slowly. Pain,
which is very severe as compression begins, diminishes with commencing
section. As a rule the surface of section cicatrises less rapidly than
that made b}^ the knife, owing to superficial cell necrosis.

Tearing i^ chiefly used in removing sharply defined tumours which
are only slightly adherent to neighbouring tissues. The skin having
been incised the growth is isolated by pushing aside or tearing through
the surrounding tissues with the fingers, or by a combination of these
methods. Although valuable on account of not endangering important
vessels or nervous trunks, this method gives very acute pain where the
parts are richly supplied with nerves, and is inapplicable to such new

BLUNT DISSECTION,

165

growths as spread by. the lymphatics, inasmuch as extirpation is incom-
plete and secondary tumours soon grow.

For blunt dissection the end of a director or a small spatula may
be used. The movement is of a stabbing or thrusting character, the
point tearing through the connective tissue and isolating the part

Fig. 1S9. — Liijating an aitery, firbt stage.

without danger of haemorrhage. This method is excellent when ope-
rating in dangerous regions. It is particularly useful for isolating
vessels, as in ligaturing the jugular vein or carotid artery, and in
neurectomy. The wounds produced by blunt dissection heal almost as
quickly as those made with the knife. Different methods of ligation
are often employed to cause sloughing of tumours, organs or portions
of organs, like the vagina and uterus, and thus ensure bloodless removal
The most generally useful is the elastic ligature.

Fig. 190. — Ligating an artery; second stage.

When arterioles, small veins, or vessels of larger size are divided,
bleeding can only be checked by compression, packing the wound,
cauterisation (already noticed), ligation, torsion, or forcipressure.

Compression is useful where one cannot stop to ligate the divided
vessel. The portion of the wound where the divided vessel is seated is

i66

OPERATIVE TECHNIQUE.

compressed either with the finger or with a tampon of cotton wool
(immediate compression). In the event of this faihng, the main vessel
supplying- the parts is compressed at the point nearest the w^ound,
where it can be brought directl}^ against a bone (mediate compression).
This plan rarely stops bleeding completely, however, and at the end
of the operation one is obliged to resort to some other method. In
dealing with hollow wounds long strips of antiseptic gauze, tarlatan,
or muslin ma}- be packed into the cavit}' under pressure, and the lips
of the wound provisionally united b}' a few sutures. This usually
checks bleedinc: from small vessels.

J

Fig. 191. — ^Greig-Smith's artery
forceps.

Fig. 192. — Spencer Wells' artery forceps
(with separable limbs for cleaning).

Ligation is effected with threads of silk or catgut ; chromic
gut is the best. \^'hen an arter}' crosses the field of operation,
and must be divided, it is isolated, ligatured in two places, and the
section made between the two ligatures. If a \'essel, whether
arter}' or vein, is accidentally divided, the ends are grasped with
forceps or a tenaculum and strongly ligatured as high up as possible,
using a surgical knot. In the case of an arter}-, the object is to di^•ide
the inner and middle coats, which retract, and become incurved
towards the axis of the vessel, whilst the external stretches slightly,

LIGATION OF ARTERIES.

167

and its surfaces are brought into close apposition one with another.
When using- catgut the ends of the knot may be cut short, but in the
case of silk only one is cut short, the other being brought outside the
wound unless asepsis be assured. It is withdrawn a day or two later,
when the vessel has been cut through. Wells or Greig-Smith's
forceps, with large jaws of conical or cylindro-conical section, are very
convenient when ligating vessels. The ligature, on being tightened,
slips over the nose of the forceps, and surrounds the vessel. Immediate
ligation is always to be preferred. Where it is impracticable, as when
the ends of the vessels have retracted deeply within the tissues and
cannot be discovered, or when the tissues are very friable and break
away as grasped, mediate ligation, or ligation in p,G. 193. fig. 194.
the continuity of the vessel, may be performed.

The instruments required are a scalpel, two
retractors, dissecting forceps, a director, ligatures,
and aneur3'sm needle (Figs. 193 and 194), i.e.
a curved needle with fixed handle. The method
is as follows : — The skin is incised directly over the
artery, the lips of the wound are drawn apart with
retractors, and dissection cautiously continued
until the arter}- appears. A fold of the artery sheath
is then lifted and divided, leaving the artery itself
free. If preferred the artery sheath may be torn
through, using two pairs of dissecting forceps.
The arter}' is freed from its sheath for some
distance (Fig. 189), which is semi-schematic. One
margin of the sheath is lifted with forceps and
drawn slightly away from the artery, around which
the ligature is passed b}- means of an aneurysm
needle. Care must be taken that only the artery,
and not the accompanying vein or nerve, is in-
cluded in the ligature. One end of the ligature is held fast with the
fingers or forceps and the needle drawn back, leaving the thread around
the vessel. The knot is tied in the manner before indicated, and shown
in the semi-schematic illustration, Fig. 190. The ends of the ligature
are then cut off short, and the wound sutured and dressed. After liga-
tion the neighbouring parts are nourished by collateral anastomosing
branches (Fig. 195). In injuries of large vessels, however, the existence
of this collateral circulation is sometimes responsible for secondary
bleeding from the peripheral ends should the vessel not have been
ligatured both in front of and behind the injured spot. In former
times it was considered dangerous to ligature veins. Nowada3'S no

Figs. 193, 194. — Aneu-
rysm needles.

i68

OPERATIVE TECHNIQUE.

distinction is made between veins and arteries. Large veins, however,
should be doubly ligatured for similar reasons to those above stated,
and also because in the case of large veins air might possibly be
aspirated through that portion of the vein nearest the heart with fatal
consequences.

Torsion may replace ligation in dealing with small arteries and veins.
The mouth of the bleeding vessel is seized with forceps, drawn slightly
forward, and the forceps rotated on their axis. To make quite sure of

obliterating the vessel some surgeons
continue torsion until the coats
rupture (unlimited torsion). As in
ligation, the middle and internal
coats are ruptured, and become in-
duplicated ; the external coat being
stretched and twisted forms a kind
of cap, which covers the clot, and
gives it much greater firmness.
Ligation, however, is always more
certain than torsion. In arterioles
of considerable size, moreover, the
fibrous coat may untwist, giving rise
to secondary haemorrhage.

Forcipressure by means of arter\'
forceps has largely replaced other
means of checking bleeding. It
consists in appl}'ing to the mouths of
divided vessels special forceps (Wells'
form is the best), which are left in

Fig. I95.-Figure showing restoration of POsition for a varying time, some-
blood-supply by collateral vessels after times Until the vcsscls are blocked

ligation of main trunk; from a pre- , , . i .-i i-

paration of the femoral artery of a ^y clot, SOmetmieS Only Until llga-

large dog eight months after ligation, ^ures can be applied. If during
operation a small artery is divided forceps are immediately applied.
By using a number incisions may be made through very vascular
tissues with little interruption or loss of blood. To keep the operative
field clear they are held to one side by an assistant. It is not
necessary that all should be left in position until the end of the
operation ; arteries of very small dimensions, if compressed for a few
minutes, no longer bleed when the forceps are removed. Should a
large vessel be divided, it can be grasped and closed with Wells'

TORSION, FORCIPRESSURE, AND ACUPRESSURE. 169

forceps, and immediately ligatured ; this prevents the seat of operation
being obscured with blood.

In human surger}-, when dealing with deeply situated vessels, which
it would be difficult to isolate and ligature, the forceps are sometimes
left in the wound until the blood-vessel has become entirely filled
with clot. In such case they are fixed between the layers of the
dressing or between the lips of the wound, and removed at the end of
twenty-four to forty-eight hours, according to the size of the vessel to
which they have been applied. Needless to say, forceps, threads, and
instruments must all be aseptic, an indispensable condition if one
wishes to effect primary union or prevent accidental infection.

Acupressure never found much favour in veterinary practice as com-
pared with human surgery, because animals are too difficult to control.
At the present day it has lost much Fig. 196/;.

of its value, inasmuch as materials
for ligaturing vessels are available
which can be left permanently in
position without danger. Acupres-
sure is effected by thrusting a pin
vertically into the soft tissues about

three eighths to three fourths of an

inch from the arter}^, carrying it in

a horizontal direction over or under

the artery, and causing it to emerge

a similar distance on the opposite

side of the vessel. The opening of p^^^ ^^g^^ iges.-Method of practising

the artery is thus pressed either acupressure.

against soft parts, or, better still, against a bone (see Figs. 196 a and

196 b). When this is ineffective or impossible to carry out, two needles

are employed, one passed below, the other above the vessel.

The elastic ligature is an excellent means of stopping bleeding.
Applied with tension to a certain thickness of living tissue the rubber
loop continues to diminish in diameter, and to cut until it becomes
entirely relaxed. This constitutes a great advantage over the simple
ligature, the action of which, though at first severe, rapidly diminishes
and soon comes to a standstill, necessitating a new ligature being
applied, or the old one tightened soon after the superficial layers of
tissue have been divided. The elastic loop has no action on inert
bodies, even though comparatively soft, or on dead tissues, but rapidly
divides all living tissues like skin, muscle, vessels, tendons, or even bone.
Nothing living can resist it. Division proceeds without haemorrhage,

170 ■ OPERATIVE TECHNIQUE.

the walls of vessels becoming adherent before yielding and the lumen
being blocked b}' a thrombus. Cicatrisation is rapid, and the wound
is relatively small.

The applications of the elastic ligature are numerous, the method
of application simple. \'ulcanised rubber tubing or cord, of a thick-
ness proportionate to the mass to be divided, is used. An assistant
holds one end of the cord while the operator grasps and stretches
the other, passing it three or four times around the pedicle of the
growth. The two ends are held in a crossed position by an assistant,
when they can be tied together with an ordinary thread.

In removing tumours with well-defined pedicles the elastic band
is easily applied, but when the tumour is more or less sessile it is
necessary to transfix it with one or two long needles crossed at right
angles to prevent the ligature slipping off.

Since Rossignol and Cagny's experiments the castration of lambs
b}' the elastic ligature has become very common in France. Rossignol
had only three cases of tetanus after castrating two thousand two to
three months old lambs during very hot weather. It is equally useful
for bovines. In Egypt, Slot operated on nearly two thousand bulls or
buffaloes during 1S85 without accident or complication of any kind.
The method was as follows : — The scrotal region and ligature were
disinfected ; during the next few days the parts were moistened with
an antiseptic ; on the sixth to the eighth day the gangrenous parts
were cut away, and the stump smeared with a little recently boiled tar.
Generally the animals returned to work on the fifteenth to the twentieth
da}'.

The elastic ligature has been tried in the castration of solipeds, but
grave complications like tetanus, septiccemia, and peritonitis have
caused the method to be abandoned. Its applications, however, are
many. \\'hen the prolapsed uterus cannot be reduced, or is the seat
of grave change, a strong elastic ligature may be applied at the base,
the parts amputated an inch or two beyond, and the stump disinfected
and returned. Loss of blood ma}- be prevented b\' apphing an
Esmarch bandage before operation. Cagny has recommended the
elastic ligature for docking. The most painful part of this operation is
not the division of the tissues, but their cauterisation, and in certain
high-bred animials the application of the iron causes violent struggling.
Cauterisation can be dispensed with b}- applying before section .an
elastic bandage to the tail just above the point of di\ision. It has
been suggested that the bandage should be left in position for a week,
but this would be dangerous, and it is sufficient to leave it t\vent\-four
to forty-eight hours.

CHAPTER XII.

THE INJECTION OF MEDICINES INTO THE BLOOD-
STREAM, SUBCUTANEOUS TISSUE, TRACHEA,
(ESOPHAGUS. LARYNX, OR PARENCHYMA OF
ORGANS OR TISSUES.

I. Intravenous injection. In former times bleeding was often a
preliminary to intravenous injection of medicines. In horses, for
instance, the jugular vein was opened with the fleam, and the medicine
injected by micans of a funnel and tube. Apart from the danger of thus
introducing air into the vein phlebitis often followed. At the present
time syringes with hollow needles are alone used for intravenous
injection. They are preferably of considerable size, holding up to i^
fluid ounces, or better still, are double-acting, drawing in the injection
fluid on the up stroke and passing it into the vein on the down stroke.
This arrangement avoids the necessity for continually removing the
needle, and so minimises injury to the intima of the vessel, a fruitful
cause of thrombosis and phlebitis. The injection may also be made by
means of a funnel and rubber tube connected with the hollow needle. •

Only certain materials are suitable for intravenous injection ; they
must, for instance, at least conform to the following requirements : —
They must be fluid, i. e. form perfect solutions without sediment ; for
this reason the fluid should be carefully Altered before injection. They
must be miscible with the blood. Oils, etc., therefore, may not be used,
as they might produce thrombi. They must not undergo any marked
decomposition which might lead to clotting of the blood ; so that
acids, concentrated alcohol, etc., must be avoided. They must be fairly
active, as the injection of large quantities of fluid into the blood-stream
might prove disastrous. An exception exists in the case of normal
salt solution (-6 per cent, sodium chloride solution) when injected

172 OPERATIVE TECHNIQUE.

to prevent collapse after haemorrhage. LEistly, they must be approxi-
mately of the normal body temperature, and as far as possible sterile.

In consequence, the number of materials fitted for intravenous
injection is limited to a few alkaloids, etc., and since the introduction of
hypodermic medication even these are less and less frequently given by
the veins. The intravenous method has the advantage of producing
its immediate effects, while subcutaneous injections require at least
four or five minutes, but this advantage is more than offset by the time
required to prepare the solutions and the seat of operation previous to
intravenous injection. Materials, however, like chloral hydrate, veratrin,
etc., which prove locally irritant, and which therefore cannot be
given subcutaneously, may be administered by the veins.

Injection with the ordinary syringe is carried out as follows : —
After preparing the solution and carefully bringing it to blood-heat, the
operator grasps the shaft of the hollow needle between the index and
middle fingers of the right hand, the thumb resting on the broad
expanded base. The right jugular vein is compressed with the thumb
of the left hand and the needle thrust obliquely downwards through the
skin covering the most prominent part of the swollen vein at the spot
usually chosen for bleeding. As the animal is often restless at this
stage the right hand is simply pressed against the neck without for the
moment attempting to introduce the needle further. As soon as it
becomes quiet the needle is sharply thrust a little further in the same
direction. If the attempt has been successful blood will flow from the
open end of the needle when the thumb is removed, showing that it
has entered the vessel ; otherwise another trial must be made. The
needle is introduced as close as possible to the point compressed by
the thumb, as the vein is partially fixed there and is less likely to evade
the needle. Once introduced into the vein the needle should be
moved as little as possible to prevent injuring the intima. Having
satisfied himself that the syringe contains no air, the operator then
affixes it to the needle and steadily injects the contained fluid into
the vein.

The double-acting syringe is employed in a similar way. One
nozzle is connected by a rubber tube with the needle inserted in the
vein, the other by a similar tube with the vessel containing the injection
fluid. After injecting the contents of the syringe into the vein the
two-way tap is turned and the barrel of the S}'ringe again filled by
drawing back the piston. By returning the tap to its original position
and once more pressing down the piston a second quantity is injected ;
the process can be repeated as often as desired. The method is very
convenient, but as it necessitates the application of a sideline or of

INTRAVENOUS INJECTION.

173

panniciihis

jugular veiri

M slernc
t hyreoid.
Bm sterno-hyoidci

l-^fntrnl

Fig. 197. — Transverse section of the neck at right angles to its long diameter. The section
passes throuo-h the third cervical vertebra, a, Portion of the head of the fourth cervical
vertebra; 6 6, Vao-us and sympathetic nerves; cc, Recurrent nerves.; dd, Dorsal branches
of spinal accessory nerve ; e l\ Intertransversales colli muscles ; /, Muscular twigs of the
cervical nerves ; ^ g, Tracheal lymph duct ; /, h, Transverse processes of cervical vertebra ;
/, Intervertebral disc of cartilage; mm, Vertebral artery and vein ; n, Lymphatic nerve
twig; o, Spinal cord; p, Membranes of the cord; q, Vessels of the cord; r, Carotid
artery. (After Ellenberger and Baum.j

174

OPERATIVE TECHNIQUE.

hobbles it is usually replaced by the use of a glass funnel and rubber
tube, which has the additional advantage of being very much cheaper
than the s3Tinge.

In this case the needle is introduced as before and the funnel
attached to the end of the rubber tube which should be filled with, say,
warm normal salt solution, so that all air is excluded, and should
be closed with a pinch-cock for controlling the flow.

One of the drawbacks of intravenous injection is the tendency to
thrombosis of the vein in consequence of injury
to the tunica intima by the needle. This danger,
however, as well as that of the entrance of air, can
be avoided by skilful manipulation. By proper
care in choosing the drug and carrying out the
above manipulation bad results are avoided.

2. In subcutaneous or hypodermic injection,
which has largely replaced the above method, the
drug is injected by means of a syringe and hollow
needle into the loose connective tissue beneath
the skin. A graduated syringe holding about 2
to 4 fluid drachms is used and the injection made
at a spot clear of the harness and where the skin
is freely movable, /. e. where subcutaneous tissue
is abundant. The side of the neck, breast, behind
the elbow, and flank are convenient positions.

Hypodermic solutions should as far as possible
be sterile and unirritating. The various alkaloids
are most useful. The syringe and needle should
be thoroughly clean and preferably sterilised by
boiling or by thoroughly washing out with 5 per
cent, carbolic or creolin solution. This precaution
is doubly necessary when the syringe has been
previously used for animals suffering from con-
tagious disease. Some operators also disinfect
the seat of injection, though this precaution is
perhaps scarcely necessary.
Raising a fold of skin with the thumb and index flnger of the left
hand the operator passes the needle either along the fold or at right
angles to it into the subcutaneous tissue. It occasionally happens that
a blood-vessel is penetrated, as shown by the escape of a few drops of
blood, and, under these circumstances, it might be dangerous to inject
insoluble substances like veratrin. In such case the needle is slightly
withdrawn, and if the bleeding ceases the syringe ma}- then be fitted to

Fig. 198. — Double
acting syringe.

INTRATRACHEAL INJECTION. 175

the needle, the fluid slowly injected, and the needle withdrawn ; by
softly stroking the skin, the injection is dispersed over a larger area in
order to promote rapid absorption.

3. Intratracheal injection is practised for the purpose of treating
disease of the upper air-passages like chronic laryngeal or tracheal
catarrh, to kill parasites present in the trachea and bronchi, and as
a means of combating certain general disorders like purpura haemor-
rhagica and ha^moglobinuria. As absorption occurs very rapidly from
the tracheal and bronchial mucous membrane this system of medication
has a rational basis, but, as a rule, more convenient and less dangerous
methods deserve preference. From the experiments made it has
become clear that the tracheal mucous membrane is far less sensitive
than was formerly imagined, and that irritants like tinctures and oil
of turpentine are really very well borne. As, however, the tracheal
mucous membrane cannot be disinfected the small punctured wound
does not heal aseptically, and although in healthy animals little need
be feared, yet, should inflammatory action set in, as may readily occur
in purpura, serious consequences may follow ; recent experience shows
that gangrene of the tracheal mucous membrane and even of the lungs
sometimes occurs. The needle must be cautiously inserted, and as it
is sometimes subject to considerable stress during the animal's struggles
it should be stout in order to avoid breakage. In the event of this
occurring the broken fragment must at once be grasped with forceps,
or, if it be invisible, a cutaneous incision must be made in order to
detect and remove it.

Intratracheal injections maybe made with a speciall\' large ordinary
syringe provided with stout needles, with a large Pravaz syringe,
or with Dieckerhoff's syringe, which is used in conjunction with
a special trocar and cannula. The animal's head is raised, and
the operator, stretching the skin covering the front of the trachea
with the Angers of the left hand, thrusts the needle or trocar through
the space between two tracheal rings. Removing the stilette he inserts
the nozzle of the ready-filled syringe in the mouth of the cannula and
slowly injects the contents into the trachea. In horses, from 7 to 8
fluid drachms may thus be administered.

Dieckerhoff also recommends intralaryngeal and mtrapharyngeal
injections. The method is similar to that above described. A curved
needle, with its concavity directed upwards, is passed between the
cricoid cartilage and the first ring of the trachea, traversing the crico-
tracheal ligament, and fluid is thus injected into the larynx or pharynx.
In chronic laryngitis Dieckerhoff recommends subnitrate of bismuth or
I per cent, iodine solution (Lugol's solution) repeated every few days.

176 OPERATIVE TECHNIQUE.

4. Parench}matOLis injection consists in introducing solutions of
drugs into the parenchyma of organs, like the thyroid or lymphatic
glands, or into muscles or pathological new growths. The active
agents are thus brought into immediate contact with the affected
tissues. In veterinary surgery actinomycotic growths are the
commonest objects of such treatment, though tumours and the
swellings of goitre have also been injected, but with var}'ing results.

Solutions of acetic, carbolic, or lactic acids, iodine, zinc chloride,
papain, etc., have all been used for parenchymatous injection. In the
hands of several operators iodine and papain have given good results
when employed against soft new growths and goitre.

A rather stout needle is inserted — if possible, into the centre of the
organ or growth (sometimes a specially long needle is required), and
the solution injected. A few drops are often sufficient. Slight pressure
should be kept on the piston during withdrawal. Sometimes several
injections are made at different points. The operator judges of the
need for repeating the operation by the condition of the diseased
parts, and by the reaction which follows. As a rule one should wait
until all signs of the previous treatment have disappeared.

The principle of parenchj-matous injection is not new, for a some-
what similar process, viz. the introduction of solid caustics like arsenic
and sublimate, has been in use since very early times.

CHAPTER XIII.

BANDAGING AND DRESSING.

Since the introduction of antiseptic wound treatment dressings play
a much more important part than formerl}', when open wound treat-
ment was the usual custom. The}' not only shield the wound from
infection and absorb wound secretions but favour healing b}- primary
intention, and retain soft parts in contact very much as callus
formation fixes the broken ends of bones. Dressings are also useful to
retain given parts in predetermined positions and to exercise pressure.
Unfortunately, in veterinary surgical treatment, dressings cannot always
be made secure owing to the animal's restlessness and the mobility of
its skin, while the dangerous results which may follow displacement of
or pressure by dressings are often so considerable as to deter practi-
tioners from their use altogether.

The best materials for dressings are gauze or muslin, jute, and
absorbent cotton wool, supplemented when necessary by the use of the
cheaper wood wool, prepared peat, oakum, etc. Uncleansed tow%
which was formerly much used in veterinarv surgery, should be
absolutely discarded except as a padding for splints, etc. The special
merits of each material will be considered later. Compresses may be
of linen, cotton, flannel, etc. To cause them to fit properly without
creasing they must often be slit at the edges. Dressings and com-
presses are secured in position in various ways, the commonest being
by the use of bandages. These were formerly of linen or flannel, but for
surgical purposes nothing surpasses calico, tarlatan, or cotton bandages
which can either be cut of suitable size and length from a large piece
of stuff or, better still, bought ready for application from the surgical
apparatus dealers. In addition to cheapness they have the advantage

12

178

OPERATIVE TECHXIOUE.

they soon lose

of adapting themselves readil}- to irregularities of surface and of being
very absorbent. I^lanncl bandages stretch irregularh- in use, and as
their elasticity hnall}- become wrinkled. Knitted

bandages are xery elastic
and even after long use
may by proper treatment be
rendered almost as effective
as when new.

Bandages intended for
fixing parts immovabU' in
position may be saturated
with dextrin and dried. The}'
can also l)e bought read}"
prepared, requiring only to be
thorougliK' moistened before
use, \\hen the turns adhere
strongly, forming practicall}- one mass. To i^romote absorption of
extravasated fluids elastic bandages are ver\- useful. Some are made
of elastic thread co\-ered with cotton or silk, others of pure rubber :

the latter, on account of their durability and
the ease with which the\- can be cleansed, are
to be preferred in spite of their higher price.
B}- intelligent application excellent results ma}'
be obtained with these bandages, though care-
less use of them ma\' also do great harm. The
most important point is to apply them with equal pressure through-
out. A very good plan is for the opfrator first to test the effect of
the bandage on his own person, for example on the arm. Even

with apparently slight
pressure he will soon
tind it unbearable. As
such elastic bandages
cannot safelv be placed
in unskilled hands>
and as continued pres-
sure is often desirable,
elastic stockings or
__ gaiters can be used.

^"' -'" They may be safely

applied b\- any groom provided they In properl}- m the first
instance.

As a rule bandages should not exceed 2I to 4 inches in width

Fh

MATERIAL FOR AND FORM OF BANDAGES. 179

except such as have to be appHed to the horse's bod}-. The
more slender the part to be bandaged the narrower must be the
bandage, it being particular!}- difticult to apply broad bandages without
producing creases, especially in the neighbourhood of joints. Before
application the bandage must be rolled ; one end is first folded several
times on itself forming a small cylinder which serves as an axis for
further rolling ; the
best method is shown
in Fig. 199.

Bandages may be
either single, double,
or many tailed. The
single ended ban-
dage, forming a single
roll, is that most
in use. The double
ended (Fig. 200) ^''g- 202.

is rolled from both ends towards the centre, as is the multiple
bandage, which, however, is now seldom seen. A very useful appa-
ratus for rolHng bandages is that shown in Fig. 201.

Bandages should always be applied from the periphery towards the
centre, never in the opposite direction, which would lead to congestion
of the vehis and l}-mph vessels.
This precaution is often over-
looked, the operator com-
mencing in the middle of a
limb. The simple experiment
of appl}-ing a bandage to the
middle of the forearm will
soon convince anyone of the
undesirability of this course ;
the veins of the hands become
enormousl}- swollen. In hoofed
animals we cannot commence ^,- ^^

at the extreme periphery, but ^~ ---.^^
the bandage should certainly ^'^- ^°3-

begin about the cornet and not, as is so commonly the custom, above
the fetlock-joint. Simple circular turns, by which the bandage is
applied to one spot alone, are now seldom employed for the reasons
previously given, but the\- form the commencement and end of other
methods. In spiral bandaging the upper edge of each turn is covered
b}' the lower portion of the next in order ; as each succeeding turn is

i8o OPERATIVE TECHNIQUE.

applied it is temporarily fixed in position b\- the index finger or thumb
of the left hand until the next turn overlaps and fixes it in position.
The first circular turn should be double to give greater security ; those
following take a gradual upward spiral course. On regions of conical
section like the forearm, or such as are not truly cylindrical, spiral
bandaging can only be successfully carried out by using very elastic
cotton bandages, otherwise the lower edges of the bandage always
project. This, however, can be avoided by reversing the bandage at
each turn as shown in Fig. 202, the upper and lower edges changing
places. The bandage, held in the hollow of the right hand, is drawn
tight, rotated, and the folded point fixed with the thumb or index finger
of the left hand. The bandage is then rapidly passed round the limb,
and again drawn tight, the thumb of the free hand keeping the fold fiat
meanwhile. These precautions, however, are scarceh- necessary when
using knitted, elastic, or calico bandages, especially where the latter
are moist. To maintain pressure on a joint like the fetlock the figure-
of-8 shown in Fig. 203 is useful. The bandage is passed once or twice
around the pastern, thence obliquely upwards over the anterior surface
of the fetlock, behind the joint and then forwards and downwards in a
direction opposite to that of the previous turn. The position of each
succeeding figure-of-8 should be slightly varied so that the entire
surface of the joint is covered. To secure the degree of tension required
to keep the bandage in place without causing undue pressure at any
point requires some practice. Until this knowledge is acquired it is
better to err on the side of slackness.

When moist applications are needed it is often best to soak the
bandage before use, otherwise it contracts when wetted and may cause
greater pressure on the diseased part than is intended. For the same
reason moist bandages, which will afterwards be allowed to dry in
position, may be drawn rather tighter than if they had been applied
dry, the pressure diminishing as the moisture evaporates. It is not
possible to fix dressings in all positions with bandages. In many
cases considerable ingenuity is required to secure the desired fit, and
the following illustrations (redrawn from Bourgelat) are intended to
assist operators in this task. In the illustrations (Fig. 204 et seq.)
indications are given of where a fold or a gusset is needed and where a
portion of the cloth is to be reinforced with lining. In many places,
however, even these applications do not meet all the requirements of
antiseptic wound treatment. Thus after removal of the large growths
which occasionally form in the shoulder region in consequence of
collar pressure Bayer prefers the following device : — He first inserts
sutures of relaxation, using drainage-tubes of large size. The sutures

MODE OF APPLYING BANDAGES.

i8i

Fig. 204.

Fig. 205.

Fig. 206.

Fig. 207.

Fig. 208.

Fig. 209.

i82 OPERATIVE TECHNIQUE.

are passed at a distance of i^, inches from the margin of the wound
and comparatively deepl}' ; the number inserted naturally depends on
the size of the wound. A drainage-tube is then inserted and the
wound closed with closely placed interrupted sutures. Bayer insists
on the importance of drawing up a fold of skin, thus producing a ridge
h inch high before inserting these sutures. A large piece of iodoform
gauze is spread over the whole field of operation and fixed to the
rubber tubes used for securing the sutures of relaxation. The gauze
covers the drainage-tube. The horse is then allowed to rise and the
space marginated by the rubber tubes is protected with a pad of
dressing material which is caused to press on the wound by thrusting
broad strips of thin elastic wood, similar to that used in the manu-
facture of hat boxes, under the rubber tube on either side. This
brings the surfaces of the wound together and facilitates union. The
trifling local prominences caused by the stitches do not prevent the
application of a well-fitting collar and usually disappear in a month
or two. leaving a scarcely visible linear scar.

The dressings used in fractures of hones may be divided into two
kinds, viz. those of a temporary character — termed provisional — and
those intended to be more lasting — permanent dressings. The choice
for the first dressing is often very restricted, and whatever first comes
to hand may require to be used. In this case broad strips of linen or
even of sacking are sometimes first applied as a padding and support,
and the splints, formed of flat pieces of wood, are applied on either side
of the long axis of the bone and fixed in position by cords or straps.
Pieces of wood may be replaced by bundles of straw. The broken
part being thus protected the horse should be removed as rapidly as
possible to the stable, and the permanent dressing applied. If time
permit the supporting pieces of wood maybe sewn between linen pads.
To increase the firmness of the dressing rolls of straw, lengths of sole
leather, straw board or bark or pieces of lead moulded to the shape of
the part, can be employed in place of wooden splints.

Permanent dressings are prepared with starch, dextrin, plaster,
tripolith, glue, gutta-percha, plastic cardboard, and poroplastic felt.
When applying any of these care must be taken that the broken parts
are first replaced as nearly as possible in their natural positions, and
so retained until the dressing has become quite hard. The dressing
must not press unduly on any point as this would cause sloughing of
the skin, a complication specially liable to occur where prominent
bony processes have to be included in the dressing. The portions to
be covered and their immediate neighbourhood are therefore first
supported by the application of a sheet of linen, over which wadding

WOUND AND FRACTURE DRESSINGS. 183

Fig 210.

Fi.;.

Fig. 212.

Fig. 213.

Fig. 2I-|.

Fig. 215.

184 OPERATIVE TECHNIQUE.

or some soft material is thickly applied and is retained in position with
a soft bandage. Instead of wadding, soft flannel bandages can be
employed ; these perhaps fit better and are preferable. After thus
filling up all irregularities of contour and bringing the dressing to a
level surface, the permanent bandage, impregnated with some harden-
ing material, is applied.

A common error is to apply the dressing to the fractured point
alone. It is, however, absolutely necessary to extend it upwards
beyond the next joint and downwards as far as the hoof or claw. Any
weight thrown on the limb is thus transferred to the bandage, which
acts somewhat like a cylindrical crutch, the broken bone being relieved
of pressure and preserved from any movement likely to prevent
union.

In applying s^arc/i bandages the parts are padded as described, and
cardboard splints, rendered pliable by immersion in hot water, are
applied. These are fixed in position with bandages completely
saturated with starch. Some operators prefer to omit the cardboard
splints. The gravest disadvantage, however, of this dressing consists
in the fact that it requires twenty-four hours to become thoroughly
hard. Starch may advantageously be replaced by ordinary glue,
prepared as for carpenters' use. Dextrin bandages are applied like
starch bandages but are somewhat dearer. The hardening mixture is
usually composed of: Dextrin 100 parts, spirit of camphor 60 parts,
water 500 parts.

Glue bandages are sometimes used, but harden rather slowly.
Bandages or strips of linen are smeared on one side with melted glue,
dried, and rolled up with the dressed side outwards ; they are immersed
in hot water just before application. Another method consists in
thoroughly saturating ordinary bandages in hot thin glue immediately
before use.

Pitch bandages are prepared by drawing long strips of linen through
fluid pitch and hanging them up to cool. In use comparatively short
lengths are applied at one time as each must be softened and made
adhesive by warming. They are extremely unpleasant to handle.

Water glass is utilized for permanent dressings by painting an
ordinary bandage with a solution of water glass as each turn is applied,
or a very loosely rolled bandage may be saturated with the fluid before
use. This dressing hardens more quickly than starch, but not so
rapidly as plaster or tripolith. It is, however, lighter and more elastic
than plaster. Water glass solution, when mixed with chalk, magnesite,
Portland cement, etc., produces a stronger dressing, which also
hardens more rapidly.

STARCH, PITCH, AND PLASTER BANDAGES. 185

f

Fig. 216.

Fig. 217.

tf^

?nj

^

t

•SR.

»»

Vi

♦ 1

?^

^1

%

4

3^

^.

h

■^fv*J

Fig. 218.

Fig. 2ig.

Fig. 220.

iS6 OPERATIVE TECHNIQUE.

The most generally useful, however, are planter and tvipoliih
baiidai^cs. Modellers' dr}^ plaster is rubbed into ordinary loosely
woven bandages which are then rolled up, care being taken that as large
a quantity as possible of the plaster is retained in the material. Just
before use they are saturated with water (preferably containing a little
dissolved alum, which hastens setting) ; they are then gently squeezed
and at once applied to the parts, which have previously been padded
as above described. The first folds should be applied around the free
extremity of the limb and bandaging continued upwards, care being
taken not to use much pressure. The piece of linen placed next the
skin should extend beyond the limits of the bandage so that when the
latter is complete the edges of the linen can be turned up after the
manner of a cuff, enveloping the wadding or other padding material.
This gives the dressing a rounded edge, and prexents any pressure on
or rubbing of the skin. After complete application the surface of the
dressing may be smoothed with the wet hands, or some thin plaster
may be spread over it and smoothed off. Depending on its thickness
the bandage sets in from tifteen to thirty minutes, during which time
extension or flexion of the limb must be prevented. Plaster of Paris,
if long kept or allowed to become damp, sometimes fails to set, but a
little care in storage will prevent this. If desired, setting may be
delayed by adding glycerine to the water used in mixing the plaster.
To further support the dressing thin pieces ot wood or splints of zinc
or tinned iron may be inserted between the layers.

Hertw^ig suggests oiling the skin, and slipping over the limb
an arrangement resembling the leg of a pair of drawers into which
thin plaster is poured. This might certainly be tried under very
special circumstances, and would appear to promise security
against irregular local pressure, but though attractive in theory would
probably prove extremely difficult to carry into practice. Moreover,
should swelling tend to occur at any point the unyielding character of
the dressing might cause very serious results.

Instead of pure plaster a mixture of one part cement to two or
three parts of plaster has been recommended. It appears to present
no special advantages.

Tripolith, a grey powder of unknown composition, is sold com-
merciail)'. It hardens in much less time than plaster, and has the
advantage of keeping well, even in open vessels. Dressings made with
it are lighter and cheaper than those made with plaster, but as it
hardens so very rapidly only one or two bandages should be moistened
at a time.

All the above dressings can be made waterproof by varnish or shellac

APPLYING PLASTER BANDAGES.

187

Fig. 223.

Fig. 222.

Fig. 224.

Fig. 226

Fig. 22:

k

1 88

OPERATIVE TECHNIQUE.

solution, which also gives them greater durability. While the plaster
is setting it is-absolutely necessary that the limb should be retained in
the proper position, as any movement breaks and therefore usually
entirely spoils the dressing.. For this reason small animals must be
kept lying ; larger animals should be placed in slings.

Fk

>28.

Fig. 22g.

These dressings, especially when of plaster, are. often very difficult
to remove, especially if one wishes to remove the bandage in two parts
so as again to utilize it. To facilitate the operation special scissors
have been designed, but the}' are very costly and rapidl}^ become worn,

Fig. 230.

while the same object can be attained almost as well, though s.ome-
what less rapidly, with a strong pocketdcnife, the line through which
the incision is to be carried being first thoroughly moistened with
warm water or, better still, with hydrochloric acid. In the latter case
of course, the instrument used for cutting suffers very considerably.

REMOVING PLASTER BANDAGES. 189

Gutta-percha dressings are less frequently emplo\ed in veterinary
surgery on account of their cost. The material is in the form of tiat
plates, which become plastic on immersion in warm water, and can
then be pressed closely in contact with the injured part, which should
first be well oiled. The soft mass adapts itself with the greatest
facility to all prominences and depressions, and rapidly becomes hard
under a stream of cold water. The advantages of gutta-percha are its
slight elasticity, the ease with which it can be kept clean, its
impermeabilit}' to fluids, and the facility with which it can be removed.
Moreover, the same material ma}- be used repeatedly, so that its first
cost is really the chief objection. For small animals like dogs it is
particularly useful, and in fracture of the lower jaw in larger animals it
renders excellent service, a kind of hollow splint being formed, in
which the jaw is embedded.

Poroplastic felt consists of felt impregnated with a resinous
solution. It is made in sheets of varying size and thickness up to
three feet square and | inch in thickness. By immersion in boiling
water or exposure to dry heat it becomes quite plastic, and may
readily be moulded to the shape of the injured part. It becomes firm
on cooling, but a " setting " process continues for some time after-
wards, so that its greatest strength is not attained for six or eight
hours. Its porous character readily permits of transpiration, and the
skin is therefore much less apt to become macerated by retained
perspiration, as occasionally happens when gutta-percha splints are
used. The writer has seen very excellent results from the use of this
material in the setting of fractured limbs in racehorses.

CHAPTER XIY.

MASSAGE.

The term massage includes various forms of mechanical treatment,
which, according to the demands of the case in (]nestion, are either
applied singly or in combination, in order to bring about particular
curative results. The terms mechanical treatment and mechano-
therapy have also been coined, but the word massage is much more
frequentlv employed, and therefore understood. We ma}' distinguish —

1. Gentle stroking of the diseased parts with the fingers or open hand
in the direction of the flow in veins and lymph vessels, that is, from
the peripher\' towards the centre. The maximum pressure to be
applied in such case should at first not exceed that produced by the
weight of the operator's hand.

2. Brisk rubbing or pressure followed b\- stroking from the
periphery towards the centre.

3. Beating of the parts with the open hand or fist, or with the
edge of the hand, or a special percussion iiammer.

4. Kneading, in which the affected part, usually a muscle or
tendon, is lifted as high as possible with one hand, and tlien squeezed
in preciselv the same manner as one would press out a moist sponge to
squeeze out its contents.

5. Active and passive movements.

To prevent formation of pustules at the roots of the hair, which
would put a stop to furtlier massage, it is usual in human practice to
shave the affected spot and coat the parts with some lubricant, but
this is not absolutely needful. According to the effect produced
massage is applied for periods extending to an hour or more daily,
provided, of course, that the reaction in the affected parts permits of

b

MASSAGE. 191

it. In the intervals the patient himself has to earn- out certain
movements with care. At tirst massage generally causes pain, which,
however, disappears on each occasion during the process, and is
replaced by a pleasant feeling of warmth, flexibilit}', and increased
power in the parts.

From the above it will be seen that massage favours increase of
bodil}' strength and endurance, but its best effects can only be
obtained by practice and by a thorough knowledge of the pathological
processes to be combated, the exact anatomy of the diseased parts,
and the physiological effects of the different massage manipulations.
Experiment shows that the effects vary, similar manipulation being
irritant or soothing, inclined to produce or to dissipate inflammation,
and to alleviate or arouse pain, according to the personal idiosyncrasy
of the patient. The operator must first clearl}' conceive the changes
he desires to effect in the diseased parts, as only then can he reason-
ably expect to effect improvement^ or even to know whether massage
is likely to be of benefit apart from choosing the exact system to be
followed in the case in question. V'-

The action of massage depeij,i(,ls on its favouring and increasing
absorption, accelerating circulation, apd relieving pam. By stroking
centripetall}', not only is circulatfe4\ in the collecting vessels locally
stimulated and tension relieved, put ^l^echanical congestion in parts
removed from the centre is lessi^ried, and exuded l3miph absorbed,
while accumulated exudates and ^Extravasations in the tissues them-
seh'es are distributed over a larder a'^a, are brought in contact with
numerous absorbents, and are mechSiniCally assisted in entering them.
For these reasons it is best to coBiimerice not at the diseased spot
itself but on the central side of it, and graduall}' to approach the
diseased spot in order to first cleai":^ space, into which the exudate or
extravasation may more readih- flow.

Alosengeil's experiments prove it possible to remove fluid even from
joints by pressure and stroking. He injected Indian ink into the
s}'no\ial cavities of rabbits, and in twc or three minutes reduced the
joints to their normal form by massage. On j!)os/-;»or^^;;? examination
the Indian ink was found in the nearest lymphatic channels, vessels,
and glands.

Massage promotes active resorption, diminishes swelling of tissues,
and therefore pressure on the sensor}- nerves they contain, a fact
parti}- explaining the decrease of pain. Massage also directly
stimulates nerves, at first increasing, but afterwards diminishing
their irritability. Newly formed adventitious tissue and vessels
may be broken down by powerful pressure and rubbing. The

192 OPERATIVE TECHNIQUE.

extravasate thus produced, together with the cells of the broken down
tissue, may be rapidly absorbed.

Infiltrations, even of cartilaginous hardness, may be dispersed by
repeated and long continued massage, and callus formations, so long as
they are not of bony hardness, may be markedly diminished.

Muscles are stimulated to contraction, which, as is well recognised,
constitutes an important factor in favouring absorption. Not only
healthy but relaxed and semi-paralysed muscles again respond to
stimulation, as shown by the electric current, a fact explained by the
increase in supply of nourishment to the part. Muscular exhaustion
following exertion is soon removed by kneading, both because meta-
bolic products which accumulate in muscles during work are more
rapidly absorbed, and because at the same time nutritive material is
brought to the parts. The capacity of the muscle for exertion may
even become greater than it was before the period of exhaustion set in.

Massage is of special service in diseased conditions dependent on
hypersemia, extravasations, exudations, thickening of tissue, adhesions,
in short, on the results of non-specific inflammation, the products of
which therefore not being of bacterial origin ma}' be absorbed into the
blood without producing bad results.

Considering now for a moment the relation between the individual
manipulations in massage and the varying diseased conditions to which
they may be applied, we find that stroking is specially indicated for the
removal of extravasations and inflammatory products, and usualh' forms
the best conclusion to more vigorous manipulations. Rubbing benefits
cases of partially organised inflammatory products, infiltration of
muscles, distension of tendon sheaths, commencing new bony
growths, etc. Kneading is recommended for inflammatory swelling of
muscles in muscular rheumatism, and in inflammation and thickening of
tendons. The parts are percussed or gently struck in order to arouse
or depress nervous sensibility. The most remarkable effects have been
claimed for an electric "vibrator" which inflicts several hundred
slight blows per second on any given part. The number and strength
of these blows can be regulated within very wide limits.

Massage is largely applicable to animals as well as to man. We
have to deal with many forms of inflammatory swelling resulting from
pressure, thickening of the skin and subcutaneous tissue of the ex-
tremities, bruising of the margins of joints, the early stages of exostbses,
periostitis, inflammation of tendons and tendon sheaths, adhesions of
tendons, etc., to one another or to neighbouring tissues, distension of
synovial and mucous bursae, induration of the udder, impaction of
the bowels, tympanites, etc. In the treatment of most of these

ACTION OF MASSAGE. 193

diseases friction, which we must now regard as a kind of massage, has
been utiHsed since ancient times. It is true that the stroking or rubbing
is as often as not in the opposite direction to that of the circulation, and
absorption, if occurring, must take place by collateral paths, inasmuch
as the diseased spot lies between the material which is thus pressed
towards the periphery and the centre of circulation. Furthermore,
rubbing differs from stroking, inasmuch as considerable pressure is
employed, and new tissue and recently formed vessels may quite possibly
be broken down, the further changes then occurring as above noted.
The same is true of the system of pressing on and rubbing recent
exostoses with a flat piece of wood, which was customary in former
times, but the comparative inefficiency of this rudimentary massage
lies not so much in the fact of the operator faihng to observe the proper
direction as in his altogether neglecting treatment until far too late,
until, in fact, the products of inflammation had become completely
organised.

As long ago as 1880 Bayer pointed out in his first publication on
massage that in our practice we cannot expect the extensive and
successful application of massage which obtains in man. We have
already noted that in man the hair is removed and the skin lubricated
to prevent pustular eruption. In animals, however, we cannot shave
an entire limb, and even if the hair were removed we are able to apply
massage in the proper centripetal direction only in a few places, like
the neck and back ; at almost all other spots where massage is to be
emplo}-ed we are forced to work against the du'ection of the hair, which
is very difficult. Bayer attempted to overcome this difficulty by the
use of massage rollers consisting of small hollow cyhnders covered with,
or entirely constructed of, rubber. Such instruments, however, cannot
replace the hand, which so readily adapts itself to the varying contour of
the body and allows so much more perfect an estimate to be formed of
the pressure employed than can be obtained in any other way. The exact
degree of pressure to be used is difficult to judge, and can only be
learned by practice and experience. Excess causes injury and delays
improvement, as one often sees when the treatment has to be left in lay
hands. Bayer prefers to forego massage altogether rather than lea^'e
the manipulation to the owner or coachman. The pain caused by
pressure and kneading, especially where much force is employed,
sometimes renders it necessary to resort to means of restraint. The
action of massage is considerably increased by substituting for mere
lubricants ointments containing substances which promote absorp-
tion.

x\ctive and gradualh' increasing exercise produces similar results.

13

194 OPERATIVE TECHNIQUE.

chiefly by improving blood and lymph circulation and increasing
metabolic changes.

Massage being applicable in a large number of animal diseases and
their sequelae, we may briefly consider those in which it seems more
particularly indicated. In infiltration of the cornea with milky deposit,
not due to cicatricial formation, massage is applied in the form of circular
and radiating rubbing. As horses with disease of the eye usually
resist interference, it is necessary to proceed with caution. The hand
is first passed over the side of the face furthest removed from the eye
and gently advanced more and more closely to the diseased eye.
Placing the points of the index and middle fingers ver}' lightly on
the upper eyehd the lid is caused to move over the surface of the
cornea with circular and radiating movements. Very good results may
be obtained in this way alone, but a small quantity of some resorptive
ointment, like the yellow or red oxide of mercury ointment, may, in
addition, be introduced into the conjunctival sac. Bayer also recom-
mends iodoform ointment and iodoform in powder.

Massage is particularly valuable in inflammation of tendons and in
recent cases of thickening of the tendon, but only when the condition
is circumscribed. When the entire tendon is thickened the effect is
much less satisfactory. On the other hand, excellent results may be
obtained in thickening of the flexor pedis perforans, though considerable
patience and perseverance are required. The foot being lifted, the
upper part of the thickened spot is grasped between the thumb and
fingers and kneaded, at first very gently, afterwards more strongly, but
without excessive pressure. The operator gradually works further
down. Manipulation being complete, the horse is exercised for a short
time and a wet bandage applied.

In dispersing the soft enlargement resulting from periarthritis the
thumbs are most employed. The periphery is first manipulated, the
thumb being applied to the soft tissue with considerable pressure.
This tends to break up the soft deposit, which is then further dispersed
by powerful stroking movements with the thumb. The horse is after-
wards exercised. Passive movement of the joint can only be carried
out satisfactorily in small animals.

Vogel recommends massage in various diseases of the udder.' Old
practitioners appear to have recognised its good effects, as shown by
their advising frequent milking, which really acts as a kind of massage.
Vogel, however, lays stress on the suggestion that the veterinary
surgeon himself should first carry out the operation, because rough or
excessive manipulation often causes a relapse. The hard masses of
tissue are grasped and kneaded or rolled under the fingers. This

I

ACTION OF MASSAGE. 195

manipulation is sometimes so painful that some means of control are
required.

Massage of the abdomen is most useful in ruminants and dogs. In
ruminants it arouses peristalsis, so that in fifteen to twenty minutes
the overloaded and torpid rumen may often be set in action. The best
method of manipulation is to station on either side of the abdomen a man
who, laying his clenched fists close together on the animal's side, makes
regular powerful kneading movements from below upwards. Where
severe tympanites or obstinate chronic impaction of the omasum exists,
or rumination has been suppressed for several days, the power of the
operator's arms is insufficient, and Vogel suggests the operator sitting
on a stool and using the soles of the feet. Counter-pressure must, of
course, be exercised on the right side.

In dogs the abdomen can be massaged with the animal either in
the upright or prone position. The points of the fingers alone may be
used, or where over-distended portions of the bowel can be felt the
open hands may be employed. The coil of intestine is grasped with
the fingers and the contents broken down and forced onwards. With
the animal in the standing position one operates in a similar way, the
points of the fingers being slowly pressed from either flank into the
depths. The individual portions of bowel may be kneaded and peristalsis
aroused by suddenly releasing the parts after subjecting them to stead}-
pressure. In this way even severe constipation may be cured and
more serious operation often avoided.

CHAPTER XV.

CASTRATION.

For economic reasons, the removal of the testicles or ovaries,
or the destruction of their functions, often becomes necessar}'. The
gelding is, for most purposes, more useful than the stallion ; its
formation is modified, it is usually more tractable, and it can be
worked in company with mares, a proceeding which is seldom safe
in the case of stallions. The iiesh of pigs and birds becomes more
palatable, and the animals fatten more readily after castration.
Sheep fatten more quickly, and their wool becomes finer and
more abundant. The milking period is prolonged in the castrated
cow, and the danger of unsuitable animals breeding is removed.
Dogs are less liable to stray, and bitches cease to attract strange
dogs. Finally, certain diseases of the generative organs are some-
times cured by operation. Thus in man castration has been
employed for the reduction of enlarged prostate, and in the dog
operation for the same object was suggested b}' Dr. Clarke (see
' Veterinarian,' 1895, p. 431). More recently Professor Hobday claims
to have had success in this direction. The pathological enlarge-
ment of the gland gradually diminishes. In man osteomalacia is said
to have been beneficially affected by castration, but how far the
procedure is likely to succeed in animals remains to be proved. On
the other hand, " spaying " in cows often removes nymphomania.
Castration is also indicated by the presence of malignant tumours a4id
fistulae, and in certain injuries of the testicles, in inguinal hernia, and
in the disease known in France as inaladie dii coit.

Castration seems to have been performed on animals since the
earliest times, and is still an exceedingly common operation.

CASTRATION— ANATOMY. 197

Owing to the essentially different methods of procedure in male and
female animals, castration will be treated of separately in each sex.

Castration of Male Animals.

Experience shows that male animals are best castrated young.
Many of the advantages claimed for operation, such as the change
in bodily form, are lost when it is too long deferred.

Excluding the first few weeks of life, most domesticated animals
undergo operation during the first }-ear. The horse is an exception,
because in it the testicles lie within the inguinal canal during
part of the first year, towards the end of which they usually
descend into the scrotum, and so become readily accessible. More-
over, horses castrated during the first year often assume a female
type, whilst those in which operation is deferred develop to a
greater extent. Nevertheless, animals can be, and racehorses some-
times are, castrated before the expiration of the first year in
order to hasten the advent of their period of usefulness. The
operation then resembles that on inguinal cryptorchids.

Anatomy. — The testicles, removal or disabling of which is aimed
at in castration, are suspended in the scrotum b}^ means of the
testicular cords. The scrotum and the structures it encloses may be
divided from without inwards into the following layers :

1. The outer skin. This is soft and thin, usually hairless, in the
horse black and shining ; it is very extensible, and is directly con-
tinuous with the common integument. In ruminants the scrotum
shows a distinct neck ; the skin covering it is light coloured, and
exhibits little hair. In swine the scrotum, which is broad and smooth,
lies between the hind quarters, close under the anus ; in carnivora it is
somewhat further forward.

2. Beneath and intimately connected with the skin is the tunica
dartos, which consists of a modified subcutis abundantly supplied with
unstriated muscular fibres, elastic and white fibrous tissue. Above
it is connected with the yellow elastic abdominal tunic, while a
prolongation of the tunica dartos, the septum scroti, serves to divide
the scrotum into two equal portions. Strictly speaking, the skin and
tunica dartos together form the scrotum.

3. The spermatic fascia, continuous with the tendon of the external
oblique muscleT

4. The cremasteric fascia, continuous with the internal oblique
muscle.

5. The infundibuliform fascia, continuous with the transversalis
muscle.

6. The tunica v.aginalis reflexa, a layer of serous membrane con-
tinuous with the abdominal peritoneum.

igS OPERATIVE TECHNIQUE.

Professor McFadyean remarks of layers 3, 4 and 5 that the dis-
sector will probabl}' be unable to discriminate between them. These
three layers, being adherent, are often referred to by Continental
surgeons as the processus vaginalis communis or common vaginal
sheath. Though anatomically incorrect, this method of regarding
the three coverings is sometimes convenient to the surgeon as
obviating a lengthy description. The tunica vaginalis reflexa is
sack-like in form ; above, where it lies in the inguinal canal, it
is much narrower than below, where it surrounds the testicles.
Its narrowest point is rather more than an inch below the inner
inguinal ring, thence it gradual)}' dilates as it descends ; as a
whole its outline resembles that of an hour glass. In the space
enclosed by this prolongation of the vaginal tunic are found the
testicle and spermatic cord ; in the horse the testicle lies horizon-
tall}*, in ruminants vertically, with the epidid}'mis pointing downwards.

7. The testicular cord is a flattened, longish, fan-shaped structure,
connected at its lower, broader end to the testicle, whilst its upper
portion extends into the abdominal cavity. It is invested by the
visceral layer of the tunica vaginalis, a prolongation of the visceral
peritoneum, and consists of the following parts :

(a) The vas deferens, which is placed at the posterior part of the
spermatic cord, is a thick-walled tube, representing the excretory
duct of the testicle, in large animals of the size of a goose-quill,
surrounded by a fold of peritoneum and situated on the inner side of
the spermatic cord; by its convolutions it forms the epidid}mis, ihe
anterior enlargement of which is termed the globus major on account
of its greater size, the posterior the globus minor; the intermediate
part is called the body. The vas deferens enters the peritoneal
cavity through the inguinal canal, passes backwards, surrounded by a
special fold of peritoneum, towards the upper surface of the urinary
bladder and empties b}' the ejaculatory duct into the urethra.

{b) The spermatic vessels and nerves. The spermatic artery lies in
the front part of the spermatic cord and is accompanied by the large
and tortuous spermatic veins, the convolutions of which form the plexus
pampiniformis. The upper portions of the vessels pass, enveloped in
a fold of peritoneum, from the inner inguinal ring to the posterior
aorta and the posterior vena cava respectively.

The anterior portion of the cord (the vascular portion) therefore
contains the important blood-vessels, whilst the posterior is com-
parativel}' poor in vessels, a point of great importance in connection
with castration. The parietal layer of the tunica vaginalis, which
surrounds the spermatic cord just as the parietal layer of peritoneum
surrounds the abdominal viscera, extends from the posterior wall of
the vaginal space to the posterior septum of the spermatic cord, and
thus binds the cord to the scrotum.

The inguinal canal consists of a. flattened, funnel-shaped space
between the abdominal coats, communicating above through the
medium of the inner abdominal ring with the peritoneal cavity, and
below by the outer abdominal ring with the interior of the scrotum.
The outer abdominal ring, an cval opening between the inner and outer

CASTRATION BY CRUSHING THE TESTICLE. 199

limbs of the tendon of the external oblique abdominal muscle, can be
enlarged by drawing back the hind limb of the corresponding side.
The ring can then be felt b)- passing the hand gently upwards along
the inner surface of the thigh and some estimate of its size can be
made, a matter of importance under certain circumstances.

In the horse the inner abdominal ring is an opening about f inch
to It, inches long, between the posterior border of the inner oblique
muscle a:nd the reflected portion of the external oblique tendon,
i.e. Poupart's ligament; it lies just in front of the transverse portion
of the OS pubis, inclined obliquely forwards and outwards ; f inch
nearer the middle line lies the subcutaneous abdominal artery.

Castration does not necessarily imply removal of the testicles.
The function alone of the testicle can be destroyed, but as the process
is necessaril}^ less certain than that in which the testicles are removed,
the latter is very generally preferred. No description of the subject,
however, could reasonably be regarded as complete which omitted
reference to the former method. A short description will first be
given of

I. Castration witJiuiit removal of the testicles.

1. Crushing the Testicle. — A method formerly used, especially
in Spain, consisted in first applying clams to the scrotum and then
crushing the testicles singly by blows from a wooden hammer.
Violent inflammation was thus produced which ultimateh' led to
degeneration and loss of function of the testicle. Apart Irom the
uncertainty of the result, the method was barbarous and painiul in the
extreme. The same is true of the system of perforating the testicle
with a glowing iron.

2. Crushing the Spermatic Cord. — The neck of the scrotum
was included in wooden clams which were hammered for several
minutes with a wooden hammer. The operation was usually per-
formed on calves. When successful, the testicles gradually became
atrophied in consequence of thrombosis of the spermatic vessels.
Steers are still castrated by this method in India. The operator
strikes the spermatic cord, which is supported by a wooden block,
several times with a wooden hammer. The operation, if it may so be
called, is also performed on sheep and goats, the reason of its adoption
being the danger in a hot climate of inflicting surgical wounds and the
fact that after-treatment is thus dispensed with.

Siebold recommends a somewhat similar method for bulls and goats.
A wooden clam, about 8 inches long and ij inches wide, provided with
a screw for closing it, is applied tightly to the neck of the scrotum for
several minutes. The scrotum remains intact but the spermatic

200 OPERATIVE TECHNIQUE.

vessels become thrombosed, and in from three to ten weeks the
testicles atrophy. On slaughter of animals thus treated the spermatic
vessels are found blocked. The method is still sometimes used in
calves.

3. Torsion of the Spermatic Cord was formerly much employed
in France for bulls, and is known as bistotirnagc. The animal's head
was fastened up tightly and the operator, standing behind the animal,
grasped the scrotum in both hands and drew one testicle as far back-
wards as possible. On releasing the scrotum the testicle was drawn
upwards. By repeating this manoeuvre several times the cremaster
muscle was temporarily paralysed and could no longer retract the
testicle.

As soon as this result was attained the spermatic cord was grasped
close above the epididymis with the thumb and first and second fingers
of the left hand, while with the fingers of the right hand the testicle
was rotated, the lower end being brought to the top. In this position
the testicle was grasped with both hands, rotated several times on its
long axis, and then thrust into the inguinal canal. The remaining
testicle was similarly treated and a ligature applied around the scrotum
close to the outer abdominal ring and left in position for forty-eight
hours. At first some swelling developed but soon afterwards dis-
appeared, and the testicles underwent atrophy. The original pro-
cedure, which in practised hands scarcely required five minutes, has
since been repeatedly modified, and has been practised on horses.
Morot recommends rotating the testicles from 6 to g times in
bulls and g to 12 times in rams, and then to allow the testicles
to resume their natural position ; the application of a ligature
is unnecessary. The animals are said to show less pam and can at
once be returned to pasture. This method, however, requires more
exertion and skill on the part of the operator.

4. Subcutaneous Ligation of the Spermatic Cord was first
recommended by Martin for bulls, rams, and dogs. It is well adapted
for castrating goats provided antiseptic precautions be observed. The
animal is placed on its back and its legs are held by two strong assistants ;
the hair is shaved away from either side of the neck of the scrotum and
the skin disinfected secnndinn aricni. The spermatic cord of one side
is then thrust against the outer wall of the scrotum by means of the
finger and thumb and a tolerably strong silk thread passed from behind
forwards through the neck of the scrotum on the inner side of' the
spermatic cord by means of a needle about two inches long. The free
end of the silk thread is then passed through the eye of an otherwise
similar but 6/;/7z/-pointed needle which is returned, first through the

TORSION AND LIGATION OF SPERMATIC CORD. 201

point of exit, then through the scrotum on the outer side of the
spermatic cord, and lastly through the point of entry. The thread
thus forms a loop surrounding the spermatic cord. The two ends are
tightly tied together, the loose portions snipped off close above the
knot, and the ligature allowed to pass into the scrotum ; the little
puncture is painted with iodoform collodion. The other spermatic
cord is treated in precisely the same way. Provided proper care be
taken regarding antisepsis neither inflammation nor suppuration occur
and the animal seems to suffer comparatively little. The testicles
swell somewhat during the next few days, but atrophy commences m
from three to four weeks and the glands gradually and almost com-
pletely disappear. Moller states that ligation is followed by necrosis
as he ascertained by experiment. To avoid the use of two needles
Schmey invented a needle with the eye near the point and a screw-
joint in the centre of the shank. The silk thread was passed as usual
on the inner side of the cord, after which the two portions of the needle,
enclosed within the scrotum, were unscrewed, the spermatic cord
pushed between them, and the needle again united and withdrawn.
Failing this needle or even a sharp and a blunt needle, the ligature
may be returned by using the blunt end of an ordinary needle, i. e. by
simply using the needle reversed during the second portion of the
operation. Asepsis is not difficult of attainment if properly sterilised
silk be used. Goats being rather prone to complications after ordinary
castration, with incision of the scrotum, this method deserves con-
sideration. The ligatures must, however, be drawn very tight,
otherwise the operation fails and the activity of the glands still
continues.

In operating on bulls the hind limb on the side selected should be
drawn forward so that the operator, by kneeling down, can grasp the
neck of the scrotum. The operation is otherwise similar to that above
described.

Dentler recommends subcutaneous, or better still intrascrotal,
section of the spermatic cord for calves and goats, but the method
has not been well received by most practitioners on account of
the danger of bleeding, suppuration, and other troublesome com-
plications.

That sexual impulse is not removed by ligation of the vas deferens
alone is shown by the following experiment. One sometimes finds
cryptorchids in which the epididymis lies in the inguinal canal while the
testicle itself is in the abdomen. In one such case ^loller ligatured
and snipped off the epididymis without removing the testicle. The

202. OPERATIVE TECHNIQUE.

passage of semen then ceased but sexual desire remained as before
until by a second operation the testicle was removed.

II. Castration by Removal of tJic Testicles.

At the present time the commonest method of castrating horses,
bulls, and carnivorous animals is by removing the testicles. The
testicles are removed either alone or with portions of the scrotum,
though the latter method is onl}- usual in calves and goats, where a
ligature is passed round the neck of the scrotum. A running noose is
formed in a strong piece of cord, slipped round the upper part of the
scrotum and drawn tight. Provided it be drawn sufficiently tight in
the first instance the scrotum and its contents fall away in from eight
to fourteen days, otherwise the loop must again be tightened. Wooden
or iron clams have been used to replace the ligature. Both methods
inflict needless pain and are seldom used except in calves, which,
however, also suffer much more from clams or ligatures than from the
more surgical method of opening the scrotum. Piot claims to have
castrated two thousand bulls in Egypt without loss by using the elastic
ligature, which is also valuable in the case of goats. The operation is
easy and rapid and in\'olves no loss of blood. The elastic cord is
applied in a stretched condition, the ends are tied, and the testicles cut
away about an inch below the ligature. Care must be taken to
prevent the animals licking or gnawing the ligature which might thus
be torn away.

Castration by removal of the testicles is accompanied by various
dangers, which must be carefulty kept in mind when operating. They
are :

1. Haemorrhage from the spermatic ^•essels, which under certain
circumstances may prove fatal.

2. Infective inflammation of the spermatic cord, which almost
always follows opening of the scrotum and may extend to the
peritoneum, causing fatal peritonitis. Owing to uncontrollable cir-
cumstances aseptic healing is seldom possible, and therefore specific
infection, i. c. infection with septic organisms, is not always avoidable,
though proper precautions in regard to cleanliness and dramage usually
prevent it.

3. In those forms of operation in which the tunica vaginalis is
opened, some danger of prolapse of bowel or omentum always exists.
As a rule, however, such an accident only occurs when the inner
abdominal ring is unusuall}' dilated, or when inguinal hernia exists, for

DANGERS OF CASTRATION. 203

which reason the scrotum and outer abdominal ring must always be
carefully examined prior to operation.

The commonest methods of dividing the spermatic cord are:

1. Tearing Away of the Testicles.— This method is still
extensively used in the case of calves, lambs, and swine ; after opening
the scrotum the testicle is grasped and forcibly torn away. In
countries like Russia and Australia, where very large numbers of lambs
have to be castrated, the system is still followed ; lay castrators in
South Germany also continue its use. Should the central portion of
the cord not be firmly held, however, the fold of peritoneum which
surrounds the spermatic \'essels within the abdomen is torn across or
the divided end of the cord is withdrawn into the abdomen, where it
becomes adherent to the peritoneum near the inner abdominal ring ;
in either case the bowel may be incarcerated, with fatal results ("gut-
tie").

2. Scraping the Cord is most commonly practised in young
animals, and in swine and sheep. After opening the tunica vaginalis,
the cord is laid across the left index finger and scraped with a blunt
knife until divided. The blood-vessels are thus torn, and bleeding is
usually trifling. Dawson and Hurford have successfulh' emplo}ed this
method with horses ; the posterior portion of the cord was simpl}- cut
through and only the vessels were scraped.

3. Crushing by Means of the Ecraseur. — During recent years
many English and American practitioners have adopted the ecraseur
for castrating stallions, the chain or loop of the ecraseur being passed
round the spermatic cord, which is slowly crushed. The ecraseur has
also found increased favour in Germany, Belgium, and other countries.

In England an instrument known as the emasculator is now largely
used. Its construction, however, is more complicated than that of the
ecraseur, and it is therefore more difficult to keep clean.

4. Torsion of the Spermatic Cord. — In performing this opera-
tion the posterior half of the cord is divided with a knife, and the anterior,
containing the blood-vessels, is twisted round its long axis until it rup-
tures. In horses and bulls, after opening the scrotum and applying a clam
or pair of forceps just above the epidid3anis, in order to fix the vascular
part, the cord, together with the testicle, is remo\'ed b}' rotating the
testicle and cord either with a second pair of forceps or with the
hands. In sheep, swine, and carnivora, the spermatic cord is fixed
between the thumb and the fore-finger of the left hand, while the
testicle is rotated with the right hand; the simplest method, after
dividing the cremaster muscle; with scissors, being to thrust the index
finger of the right hand through the centre of the cord immediately

204

OPERATIVE TECHNIQUE.

above the epididymis, and using the incision so made as a means

of grasping and rotating the cord.

The most popular of the older forceps for hxing the spermatic cord

is Togl's, which is made
of two different sizes,
one for horses and
bulls, and one for small
animals. Its original
form has been variously
modified by different
operators. Moller uses

smaller forceps provided with longer limbs, which give greater leverage

and are easier to hold. In France Renault's forceps are most used.

In England, Robertson suggested a special form of torsion forceps,

Fig. 232. — T'gl's forceps for holding the spermati
cord.

Fig. 233. — Kaiser's forceps for holding cord.

which has been adopted by Moller. In former times iron clams were
used instead of forceps.

In torsion of the spermatic cord it is naturally of importance to

Fig. 234. — Moller's forceps for holding cord.

produce entire closure of the blood-vessels. This is partly secured by
firmly compressing the portion of the cord grasped in the first pair

TORSION OF THE SPERMATIC CORD.

205

of forceps, and thus crushing the walls of the blood-vessels, a condition
favoured by roughening the jaws of the forceps, and partly by rotating
the second pair of forceps very slowly, in which case the blood-vessels
are the last parts to be torn through.

Most forceps are defective, inasmuch as the}' take too broad a hold
of the spermatic cord, and thus render the effects of torsion irregular.

Fig. 235. — Bayer's forceps with screw and instantaneous release. For
holdino' the cord.

The anterior and posterior margins of the spermatic cord are torn
through after the second forceps has been turned once or twice, and
the blood-vessels are divided without having first been sufficiently
twisted. Bleeding is then very liable to occur, especially if a second
forceps be used for turning, and if the hold on the spermatic cord be
too short. To ensure regular torsion the spermatic cord should first
be rolled together into a cylindrical mass, as occurs in using Togl's
forceps. The blood-
vessels thus become
the last portions to
rupture, and only
yield after prolonged
twisting. The torn
portions of the sperm-
atic cord appl}' them-
selves around the
lumen of the vessels,
which the}- com-
pletely close, so that no bleeding occurs. As, however, with Togl's
ordinary forceps it is difficult to compress the spermatic cord sufficiently,
the handles have since been niuch lengthened and the jav.'s shortened, a
modification which has greatly increased their efficiency.

The cord should be rotated quite slowly. The testicle is grasped
with the hands, or with a second forceps, and regularly and slowly

Fig. 236. — Robertson's forceps for torsion of the cord,
as adopted by Moller.

206

OPERATIVE TECHNIQUE.

turned until the spermatic cord tears through. As a rule fifteen
to twenty turns are necessary, sometimes even more. Where a second
forceps is used for twisting it should not be applied too near the first,
a space of f inch or ij inches being left between the two.

After dividing the non-vascular portion of the cord with scissors
the best method is to grasp the vascular part about § inch to ij inches
above the epididymis with forceps, and compress it firmly. The testicle
is then grasped with both hands and rotated as above described. The
vas deferens breaks first, whilst, on account of their greater elasticity,
the blood-vessels, especially the spermatic artery, are the last portions
to yield. Special care is therefore needed towards the latter part of
operation. The vessels should never be torn through, but torsion
should be continued until the cord is completely divided. By pulling

Fiu. 237. — Bayer's forceps in use. Many operators prefer Toil's forceps, wliich
roll the cord together into a cylindrical mass I see text).

on it the elastic artery is drawn from within the shelter of the other
tissues, and being no longer surrounded and supported by them, is apt
to bleed. The \essels having been twisted thron,^h, the testicle is
placed on one side, and the fixation torceps slowly and cautiously
relaxed. Should bleeding occur the forceps are again closed, the
bleeding vessels grasped with Wells forceps and twisted, or ligatured
with the above-mentioned precautions. Should the bleeding cord slip
beyond the forceps, it may be regained by first seeking the processus
vaginalis, and passing the fingers within. After operation is com-
plete care must be taken that the cord returns within the processus
vaginalis, and that the edges of the scrotum are drawn somewhat
downwards.

LIGATION, ETC., OF THE SPERMATIC CORD. 207

5. Ligation of the Spermatic Cord, that is, of the anterior vas-
cular portion, has been repeatedly recommended by various operators.
At first sight this method appears the most natural and surgical ;
nevertheless it has not found general acceptance. Even those
operators who first recommended it have since given it up. It is
certainly not suitable for all species of animals, and although
carnivora and old boars can readily be castrated in this way, and
although with certain precautions the method is also practicable in
ruminants, yet it cannot be recommended for horses.

In this operation the spermatic cord is exposed, the non-vascular
portion divided with scissors, and after ligaturing the anterior part with
disinfected hemp, catgut, or silk, or applying an elastic ligature, the
cord is snipped off \ inch below the ligature. Other operators perforate
the cord, ligature the anterior portion, and then divide the entire cord.

Lafosse recommended simple ligation of the spermatic artery.. By
stretching and flattening out the cord on the index finger of the left
hand, and feeling carefully with the thumb the artery may be
recognised as a stout pulsating vessel in the anterior portion of the
cord. A needle is passed behind the artery, about ij inches to 2
inches above the testicle, and ligation performed, after which the
spermatic cord is divided ij inches below.

6. In former times Lafosse recommended Simple Division of the
Spermatic Cord. Experiments made by him, Barthelemy, Goubaux,
Hering, and others showed that under certain circumstances this
method is not followed by fatal bleeding, even in large animals. At
the same time, there is absolutely no ground for suggesting that it is a
safe procedure. In many cases severe bleeding occurred, and although
not proving fatal, nevertheless greatly weakened the animals. One
horse lost 27 pounds of blood. In carnivora this method of castration
is not followed by severe bleeding, though even in their case it is not
reliable.

7. Division of the Spermatic Cord by the Cautery is
one of the oldest methods of castration, and even yet is frequently used
in horses and bulls. It is undoubtedly, however, painful, and, as
equally reliable and less painful methods are available, has been relin-
quished by many. A heavy hatchet-shaped iron, which will retain its
heat for a considerable time, is used. The spermatic cord is exposed
as above indicated, and a broad iron or wooden clam is applied
immediately above the epididymis, serving both to fix the cord and
guard neighbouring parts from the heat. The spermatic cord is
divided about an inch below the clam, and the stump repeatedly
touched with the back of the iron, until, on cautiously relaxing the

208

OPERATIVE TECHNIQUE.

clam, bleeding is seen to have ceased. To prevent the iron adhering
to the stump of the cord some operators apply a little oil before
cauterising.

8. Castration with Clams. — On the Continent this method was
until recenth' the most popular for horses, bulls, and old boars. It
ma}' be divided into two varieties :

(a) Castration witli exposure of the testicle.

(b) Castration witJwnt exposnre of tJie testicle {the covered operation).

(a) In the first method a long incision is made through the lower
surface of the scrotum, parallel with the middle line, di\'iding the outer
skin, tunica dartos, and external vaginal covering, exposing the testicle
and spermatic cord. The cord, having been flattened out, is then

Fig. 238. — Wooden clams.

enclosed in a pair of clams, consisting of two pieces of wood about four
to eight inches long, and i inch to -f inch broad, united at one end by
means of a cord or hinge. The open ends are brought together with
special forceps and powerfully compressed, allowing a second cord, a
small iron ring, or a leather cap to be applied for the purpose of
fastening them together. After twenty-four hours the clams are
removed, though the}' may be left in position for two or three days, or
still longer.

The clams should be made of hard, tough, light wood, like birch,
ash, or hickory. The edges should be well rounded to prevent
injury of and bleeding from the plexus pampiniformis, which is

CASTRATION BY CLAMS.

209

apt to occur in consequence of the sharp edges. The clams are
either half round in section, or the flattened crushing surface is
exxavated, allowing greater pressure to be exerted on the narrower
surfaces left. The latter form deserves preference. The central ex-
cavation is often filled with some
caustic, like sulphate of copper, red
precipitate, or sublimate and flour
paste. The reason for using caustics
was to ensure complete necrosis of
the portions enclosed within the
clams, but it is better to use a dis-
infectant, which prevents decompo-
sition in the necrotic portion of the
cord, and infection of the neighbour-
hood.

Moller recommends a concen-
trated solution of sublimate in gum
arable mucilage, painted two or three
times over the pressure surfaces of
the clams. Schlammp first applies
to the clams a strip of gauze, satu-
rated with sublimate solution, which adheres firmly on dr3'ing and
greatly facilitates removal of the clams after operation.

The furrow on the pressure surfaces of the clams was probably first
used with the idea of preventing the clams slipping off, an object which,
without doubt, it fulfils. It also facilitates the application of dis-
infectants, however, and increases the intensity of the pressure, inas-
much as it concentrates it on a narrower surface.

Various forceps and screws have been constructed for closing the
clams, but the instrument most commonly used is shown in Fig. 240.

Fig. 239. — Iron clams.

Fig. 240. —Forceps for closing wooden clams.

Should no reliable assistant be available for holding the forceps
whilst the operator ties the clams, the forceps may be provided with a
catch near the base, in which case they may also, in case of emergency,
be used as "bull-dogs." The screw instrument (Fig. 241) permits
the operator to dispense with assistants. Iron clams (Fig. 239) are

14

210 OPERATIVE TECHNIQUE.

sometimes used ; they are less liable to yield or bend, but in most
cases are too heavy.

(b) In castration by the covered operation all the coverings of the
testicle outside the tunica vaginalis retlexa (or tunica vaginalis scroti)

are carefull}/ divided,
and afterwards stripped
from the testis and cord
as high as may be re-
quired. The clam is
applied to the cord
above the epididymis
and over the external or
parietal vaginal cover-

FiG. 241. — Screw instrument for closing wooden clams. ^^S' 3-nCl IS lastened aS

above described. The
testicle and lower end of the vaginal sheath are removed with scissors ;
the clams are left in position for twenty-four to forty-eight hours, and
in cases of hernia it is advisable not to remove them until the third to
fifth day after operation.

I. Castration of Stallions.

For reasons already given the second 3'ear of life is that usually
selected for operation, as it appears the most generally suitable
period, and the animal probably suffers less pain than it would at
a later period. In this country, however, many animals are castrated
during the first year. Stallions of any age can be castrated without
danger, provided no disease of the organs of generation exist, and
the ordinary rules of antisepsis are observed.

Before operation the scrotum is examined, to detect the existence
of rupture, and note is taken of the strength of the spermatic cord, and
width of the inguinal ring.

Foals are best kept without food on the morning of the day of
castration ; older, more excitable, and more powerful animals should
have been kept on short diet for some days before, or have been
regularly worked. Some authorities condemn restricting the diet of
animals before operation, because it favours prolapse of omentum, or
bowel, and castrate yearlings without any such preparation. Such
points are probably of little importance, though it cannot be denied
that the small bowel is less likely to pass the inner abdominal ring
and the inguinal canal when full than when empty. Racehorses

CASTRATION WITHOUT CASTING. 211

should not be castrated when in training^, as their muscular strength
is so great that limbs may be broken during operation. In England,
America, and France, horses are sometimes castrated in the standing
position, though this is certainly not favourable to proper performance
of the operation, as is conceded even by supporters of the method.
It succeeds well enough in foals and quiet phlegmatic animals, which,
however, can also be cast without much danger. Joyeux is believed
to have been the first to castrate horses standing. The method was
afterwards modified by the American castrator Miles, and more recently
has been recommended by a number of operators in England, and by
Salinier, Cagny, and others in France. Joyeux operated from the
right, Miles from the left side, both with clams, the former by the
covered, the latter by the exposed method.

Joyeux applies blinds and a twitch, and fastens the horse up short by
means of a strong head collar. After placing hobbles on the hind feet,
connected to a cord passing round the neck, the operator takes up his
position facing the horse's right flank ; with his left shoulder somewhat
lowered and his left arm advanced he then grasps the scrotum and
draws the testicles one by one downwards, the left hand gliding down-
wards along the course of the spermatic cord. Immediately the cord
has been secured by the left hand, the layers of the scrotum are succes-
sively incised from in front backwards, care being taken to protect the
left thumb. On dividing the outer skin and tunica dartos, the testicle
descends, whereupon the operator separates these tissues from the pro-
cessus vaginalis, until the assistant, who stands at the horse's left side,
can slip a pair of clams from behind over the spermatic cord. This
accomplished the operator grasps the forward end of the clams, applies
the forceps or screw, and the assistant ties the clams. During the opera-
tion the forceps must be pressed towards the abdomen, and in a back-
ward direction in order to prevent the spermatic cord being torn
through. After snipping off the right testicle the left is removed in
the same way.

Salinier operates by means of caustic clams, and first of all applies
a ligature around the neck of the scrotum. Whilst the operator draws
the testicles downwards the ligature is applied and tied by an assistant ;
the more tightly it is drawn the quieter does the horse remain
during operation. Trasbot, whose practical experience is very great,
altogether condemns castration in the standing position.

Miles castrates foals from the left side. He ties the animal up
short with the right side against the wall, and thrusts a scaffold pole
or similar piece of round wood against the animal's left thigh in order

212 OPERATI\'E TECHNIQUE.

to prevent it kicking the operator. The clams are appHed over the
uncovered spermatic cord and fastened with a leather ring, which is
slipped over their conical end. This obviates the somewhat tiresome
necessity for tying.

In England, castration in the standing position has recently been
considerably practised. Griffith describes the operation as follows : —
An assistant stands at the animal's left side, with his right shoulder
against the animal's left. A second assistant holds and hands the
necessary instruments.

The operator, who also stands on the animal's left side, slips his
left hand along the animal's abdomen as far as the scrotum, grasps the
right testicle, and draws it down to the bottom of the scrotum, which
is immediatel}' opened by an incision with the right hand from before
backwards. He then discards the knife. The left hand at once
grasps the protruding testicle and draws it backwards, whilst
the right hand passes the open clam between the hind limbs and
slips it from behind forwards over the spermatic cord. There-
upon the left hand seizes the free ends of the clam and presses
them together. As soon as it has been ascertained by means
of the right hand that onl}' the spermatic cord, and not a portion
of the scrotum is included in the clam, the latter is grasped with
special forceps and firmly pressed together. The front ends are then
secured with string and the testicle cut away. The left testicle
is removed in a similar way. Griffith states having thus castrated
140 horses, varying in age from one to twelve years, during the course
of one summer, without any noteworthy mishap.

Abroad it is usual to cast the horse for castration on the left
side, the feet and hind quarters being somewhat higher than the
body, though the dorsal position also has advocates. The right
hind limb is released, drawn forward until the hoof is nearly in
contact with the animal's chest and the whole limb is somewhat
abducted, and is then resecured. It must not, however, be drawn
too far forwards (the furthest allowable point is the elbow of the
right foreleg) ; on the other hand, should it not be drawn suffi-
cientlv far the operator may be injured by the point of the hock.
The liberated limb should not be fastened unyieldingly, as otherwise
the animal ma}' make violent extension movements, the resistance
to which may cause fracture. It is preferable to pass a piece of
webbing around the fetlock and hoof, and fix the limb in a position
of plantar flexion.

The dorsal position has the advantage that prolapse of bowel is

CASTRATION OF STALLIONS BY CLAMS.

213

less likely to occur, but it necessitates more assistants ; the side
position is equally useful, provided a careful examination be made
before operation.

Nervous thoroughbred animals should be anaesthetised to prevent
accidents like broken back, which are sometimes caused by the violent
struggling occasioned when the clams are compressed. Since adopting
this precaution Moller has had no cases of broken back. Roder claims
to have rendered even the application of clams painless by injecting
cocaine into the scrotal subcutis.

(a) Castration of the Stallion by the Application of Clams.
— Although this method receives first notice it has of late 3^ears been
largely replaced by torsion of the spermatic cord, an operation which
has found increasing acceptance and on the whole seems preferable.

(a) Castvaiion icith exposure of the testicle. The normal condition
of the spermatic cord and outer abdominal ring having first been
ascertained by palpation,
an assistant cleanses the
scrotum and surrounding
parts with soap and water,
rinses them with subli-
mate solution, and after-
wards carefully mops up
all superfluous . moisture
with a clean cloth or
tampon of cotton wool,
giving particular attention
to the fold of skin between
the inside of the thigh and
the scrotum, so that no
fluid may be left to find its
wav into the wound during:

Fig. 242.

operation. Kneeling behind the horse the operator first grasps the
left testicle by passing the left hand from before backwards around
the left spermatic cord. In carrying this out, the open right hand
is thrust between the scrotum and the surface of the left thigh,
whilst the left hand endeavours to grasp the spermatic cord from in
front, and to thrust the testicle towards the base of the scrotum. The
correct position of the testicle is known by the fact that the scrotal
raphe lies parallel to the testicle, on its inner side. In the case of
young animals it facilitates the task of securing the testicles if a ligature
be passed around the scrotum before the animal is cast. The skin

214

OPERATIVE TECHNIQUE.

^•■

'V,^>

/

covering the testicle is next rendered tense and a long incision made
through it, parallel to and about an inch from the scrotal raphe, by
means of a sharp convex knife. This incision divides the outer skin,
tunica dartos, and other loose coverings, and may extend into the
substance of the testicle itself without detriment. Some operators first
incise only the skin and tunica dartos, opening the sac of the tunica
vaginalis with a second incision. Nothing is gained b}- this method.
It is, however, of great importance to make the incision in all three
coats as large as possible, in order to provide for effective drainage at a
later stage. This is particularl}' true in the case of the sac of the tunica
vaginalis. The testicle will often appear even if the scrotum be insuffi-

cientl}' opened, but such
1, . ' a method is to be

avoided. Pflug and
Briicher recommend
first incising the tunica
vaginalis reflexa in front
and afterwards behind,
leaving a portion in the
middle undivided, and
afterwards uniting the
two incisions. This en-
sures a long opening,
which, if necessary, ma}'
be extended with scis-
sors.

\\'hen performing
castration aseptically,
however, the exit should
be small, as healing is
thereb}- fa\-oured.
The operator now discards the knife, grasps and draws forward the
exposed testicle with the right hand, whilst with the left he thrusts
back the scrotum and other loose envelopes, so as to expose the cord
sufficiently to permit of the application of clams. iMore extensive
exposure than this should be avoided, as it only favours infection. At
this moment, as a rule, animals endeavour to retract the testicle by
means of the cremaster. One therefore waits a few moments,
exercising strong but steady traction on the testicle, and drawing it
forward sufficiently for the clams to be applied above the epididymis.
The necessary movements should be made slowly, and excessive
tension or dragging on the cord should be avoided. Should contrac-

FiG. 243.

CASTRATION OF STALLIONS BY CLAMS.

215

tion ot the cremaster muscle be long continued, the animal may be
struck smartly with the open hand, but as a rule the testicle can be
drawn forward without difficulty as soon as the first struggles have
subsided.

The operator then grasps a suitable clam with the left hand
and passes it from in front backwards over the spermatic cord (which
should be flattened out as much as possible), giving the clam such
a direction that it will hang horizontally when the animal is standing,
and will at least be above the epididymis. When the cord is
exceptionally long the clam should be applied proportionally higher ;
it may, in fact, be placed as high as possible, without exercising undue
tension on the cord.

The posterior (open) ends of the clam having been compressed \\'ith
the fingers of the left
hand so that it firmly
grasps the spermatic
cord, the testicle may
be released and, the
hold on the clam hav-
ing been transferred
from the left to the
right hand, the screw
or forceps may be
applied. During the
closure of the clam by
either of these instru-
ments the animal
usually becomes rest-
less, and struggles
unless previously an-
aesthetised. To prevent injury or tearing ot the
the twitch may be shaken whilst the forceps or
closed, and the clam itself can be pressed against the animal's
abdomen. The operator should have made sure while applying the
clam that no part of the scrotum was included in it, but in any
case at this stage of the operation he should again examine the parts
before finally securing the clam with cord. Care is also required to
prevent the spermatic cord slipping beyond the crushing surface of the
clam. Provided all is found satisfactory, the clam is secured by a
surgical knot, drawn very tightly. The spermatic cord is then divided
with scissors, one half to one inch below the clam. Should the
spermatic cord be ^'ery short a fragment of the epididymis ma}' be left

^

Fig. 244.

l£"'i-

spermatic
screw is

cord
being

^j6 OPERATIVE TECHNIQUE.

adherent to it. Formerly it was usual to incise this with scissors
at two or three points, but the practice is irrational.

The right testicle is then removed in a similar way, care being
taken not to displace the clam already applied or to throw any
strain on the left spermatic cord. The wound and inner surface
of the left thigh are then carefully cleansed, the clams gently arranged
one above the other, with their posterior ends crossing, the sheath
is drawn somewhat forward, the exposed stumps of the spermatic
cords are powdered with iodoform, and the horse is allowed to rise.

Formerly it was usual to divide the posterior non-vascular portion
of the cord before applying the clam. The method is not commend-
able, because the clam
is then only suspended
by the anterior portion
of the cord, which
readily yields, allowing
the clam to descend.
In the method de-
t- scribed the clam, on
the contrary, is sus-
pended by the cre-
niaster and the vas-
cular portion of the
cord.

The horse is placed
in a quiet well-venti-
lated stall, is tied up
short in order to pre-
vent its lying down,
Fig. 24s. . °

and receives light,

easily digested food. Its tail, which should previously have been
plaited, is now fastened to one side by attachment to the surcingle or to
the shank of a web halter passed round the neck. Most animals will
at once take hay, which should be given, as feeding distracts attention
from the seat of operation, and prevents restlessness. Should the animal
strain greatly, it should be watched, and, if restless, should be checked
by the attendant calling to it or lightly touching it with the whip.

When the spermatic cords prove exceptionally long, the clams rnay
be applied higher. As a general principle, they should be placed as
high as possible, without exercising any violent strain on the cord.
Under no circumstances should the clams after castration hang so low
as to leave a portion of the spermatic cord visible above them, as in-

"THE COVERED OPERATION." 217

fection of the parts is thus favoured, leading at a later stage to com-
plications like scirrhous cord, or to severe inflammatory processes.
This is more likely to occur in weakly animals, for which reason the
clams selected should be very light, and should be placed as high as
conveniently possible ; they may also be supported by two or three
sutures passed through the edges of the scrotal wound. Regarding
removal of the clams we shall later give directions.

{b) For castration without exposure of the testicle (the covered
operation) the animals are prepared and cast in precisely the same
fashion as before described. The operator first grasps the left (lower)
testicle or spermatic cord, taking particular care that the scrotum is
tightly stretched over the testicle. The incision is at the same point,
but is made very long, dividing, however, only the skin and tunica
dartos, and exposing the loose connective tissue, which lies between
the latter and the common vaginal sheath.* The edges of the wound
open widely when the incision reaches this layer. By light cautious
strokes with the knife this tissue is divided in the longitudinal axis of
the testicle until the tunica vaginalis reflexa, readily recognised by its
gre\ish-blue colour, is exposed. The knife is then discarded, the
operator grasps the testicle with the right hand and with the left
endeavours to free the tunica dartos, etc., from the tunica vaginalis
reflexa sufficiently far for a clam to be applied to the spermatic cord
above the epididymis. The connective tissue should, if possible, be
entirely stripped away from the exposed portion of the tunica vaginalis,
not only to facilitate application of the clam, but to prevent infectious
sequelse. Before the clam is applied the operator must once more
convince himself by manipulation of the common vaginal sheath
that only the spermatic cord is present. The clam, which must be
somewhat larger than that used in the last operation, is applied
as before described, care being taken that it includes the whole
of the spermatic cord. After carefully tying the clam, the testicle
and base of the processus vaginalis are removed with scissors.
The second testicle is removed in a similar way, the parts are
cleansed, the clams arranged as before described, and the sheath
drawn forwards. The horse is then allowed to rise. The after-treat-
ment is as above described.

A modification of this method recently introduced by Degive

* "Common vaginal sheath" and "processus vaginalis communis " are surgical terms
authorised by the Berne Anatomical Congress to describe the three adherent layers
described in Professor McFadyean's 'Anatomy' as (i) spermatic fascia; (2) cremasteric
fascia; and (j) infundibuliform fascia. See also note on "Anatomy" at the commencement
of this chapter.

2i8 OPERATIVE TECHNIQUE.

consists in opening the tunica vaginalis and exposing the testicle,
but when applying the clams, grasping and drawing down the edges of
the vaginal sheath so as to include them in the clams. The vaginal
sheath having been exposed as above described, the testicle is grasped
with the right hand and drawn slightly forwards, in consequence
of which the outer skin and tunica dartos retire, and a portion of the
vaginal sheath is exposed. A fresh hold of the spermatic cord is
then taken with the left hand, whilst with the right the base of the
tunica vaginalis is opened sufficiently to allow the testicle to be extruded.
The anterior and posterior portions of the base of the sac thus
come to form blind sacs. Into the posterior of these the operator at
once thrusts the index finger of the left hand, into the anterior the
thumb of the right, and drawing the vaginal sheath forward, together
with the spermatic cord, enables an assistant to pass a clam from in
front backwards just above the epidid3anis, embracing both the vaginal
sheath and the spermatic cord. The ends of the clam are pressed
into contact and fastened with a surgical knot, and the spermatic cord
is divided about an inch below the clam.

This represents a middle course between the operations of castra-
tion with and without exposure of the testicle, being, in fact, castration
with exposed testicle, but with covered spermatic cord. It requires
some practice, because the vaginal sheath is very apt to elude the
operator, and it is difficult to again grasp and draw it forward.
Attempts were made by apph-ing a pair of forceps to overcome this
difficulty and facilitate operation, but they necessitated the presence
of a skilled assistant. Moreover, the onh' ad\-antage this method has
over the covered operation is, that when the common vaginal sheath is
short, it is less likely to be overstretched. It is, however, useful
when one has to deal with scrotal hernia which has only been dis-
covered at the moment of opening the tunica vaginalis. In old
stallions in which castration by the covered operation, or by Degive's
method just described, is particularly necessary, the processus vaginalis
is usually so long that clams may easily be applied.

The removal of the clams is of scarcely less importance than their
application. In castration with exposure of the testicle the clams are
usually removed after twenty-four hours, in many parts even earlier ;
in }'oung animals especially they may be removed without danger
within five to six hours after operation. In Sweden and Denmark,
Tidholm's method is commonly used for castrating horses. Clams are
applied to the spermatic cords, which are firml}- compressed. The
clams, however, are almost immediateh^ removed, a ligature is applied,
and the testicles removed. In castration by the covered method, the

REMOVING THE CLAMS AETER CASTRATION. 219

clams are usually left in position for forty-eight hours, though Degive
recommends leaving them three to live days. Moller also approves
the longer period, and finds that inflammatory symptoms are then less
marked, and fever rarer than when the clams are removed forty-eight
hours after operation. This is explained partly by the fact that after
the clams have been several days in position the necrotic stump of the
spermatic cord is not so liable to be retracted upwards, carrying septic
material into the upper portion of the sac of the tunica vaginalis. It must
also be remembered that after a few days the edges of the wound
become infiltrated with plastic material, and are therefore less likely
to be infected than twenty-four hours after operation. At the time of
removing the clams, however, the greatest care cannot prevent
circumstances arising favourable to the absorption of wound dis-
charges. It is common experience that inflammatory swelling or
fever first appears on removal of the clams. Provided their position
be satisfactory the clams may be left on for four or five days ; other-
wise, and especially if they are so pendent that the cord shows above,
they must be removed as soon as possible. The operation is carried
out in the following way :

A bridle is applied and held by a capable assistant, and one of the
animal's fore feet is lifted. It is best first to attempt removal without
using the twitch ; should the attempt fail it can be applied. Having
provided himself with a strong, clean pocket-knife, the operator places
himself at the horse's left side, the left hand resting on the animal's
loins, and, using curved scissors, endeavours first of all to clip away the
portion of the spermatic cord hanging below the clams. The thumb
of the right hand is then placed against the front of the clam, the
knife is slipped between the back ends and the string uniting them is
divided. At the same time the knife is rotated in the hand, forcing
the two portions of the clam apart. Discarding the knife for a
moment the operator seizes the free ends of the clam with both
hands, and slowly opens them as far as possible. The spermatic
cord is then usually found to be adherent to one side of the clams.
Should not the artery have become thrombosed a bluish-red line
appears in the parchment-like remnant of the cord, and extends
towards the cut margin until finally a few drops of blood fall. In
such case a silk thread must be passed round the vessel at the margin
between the healthy and the crushed portions of the cord by means of a
sharply curved needle, drawn tight and knotted. If no bleeding occur
the cord is cautiously separated by sliding the thumb from in front back-
wards along the depression in the centre of the clam. The operator
then throws the clams to one side, rinses his hands in sublimate solution

220 OPERATIVE TECHNIQUE.

or other disinfecting fluid, and endeavours to free the spermatic cord
from any adhesion with the scrotum by passing the index finger around
the stump of the cord. After castration with exposure of the testicle,
the finger can be passed around the spermatic cord, breaking down
any adhesions between it and the common vaginal sheath. If neces-
sary the operator grasps the edges of the wound arid draws them
downwards. In any case the spermatic cord must be returned
into the sac of the tunica vaginalis or into the scrotum. The escape
of considerable quantities of discharge is a favourable symptom, showing
that the adhesions which favoured retention are broken down.

x\fter removing the second clam in a similar way a strong stream of
clean cold water or sublimate solution should be directed on the
scrotum ; it has the double effect of partially cleansing the wound
and — much more important — of causing retraction of the spermatic
cord. Vicious horses occasionally require to be cast for the above
manipulation.

After removal of the clams the horse should be exercised daily for
half an hour or longer in a place free of dust ; in the country full-grown
horses are at once put to light work. Experience has shown that
long rest in the stable is disadvantageous. The good effects of
movement and exercise are largely due to the fact that they favour
escape of discharge. For a similar reason it is important to make
the incision through the scrotum as large and dependent as possible.
The extensive swellings which sometimes follow castration are almost
exclusively due to want of cleanliness in operation or to retention of
wound discharges.

No special treatment of castration wounds is necessary. The
wound and neighbourhood should be cleansed daily with a clean
sponge and boiled water until suppuration ceases. When high fever
or severe swelling occurs, the wound should be opened with the dis-
infected hand, and any irritant discharge allowed to escape, after
which the parts should be freely washed out with a disinfectant fluid.

In the horse castration with clams is still widely adopted on the
Continent. British operators, on the other hand, seem to be rapidly
relinquishing it. In two-year-old horses, bad results are seldom seen,
provided the necessary care and cleanliness are observed. The
greatest danger results from using dirty instruments and clams,
especially if soiled with virulent infective material. Practitioners
should exercise scrupulous care in this respect, and should carefully
disinfect all instruments used on animals suffering from septic diseases.
New clams should be used on each occasion.

CASTRATING STALLIONS BY TORSION. 221

In castrating foals the tunica vaginalis reflexa is always opened and
the testicle exposed unless signs of hernia exist. In older stallions,
especially when the outer abdominal ring is of abnormal size, the
covered method, or Degive's operation (in which the spermatic cord is
not exposed), is preferable, as it prevents prolapse of the bowel.
Should the common vaginal sheath appear fairh' long, the covered
method may be emplo}'ed. Where, however, it is little developed, the
application of clams might cause dragging and severe pain, in which
case Degive's method deserves preference.

Castration with clams has the drawback of necessitating a second,
or even a third, professional visit. The precautions needed in removing
clams are too important to be entrusted to laymen ; rapid healing ot
the wound and avoidance of later complications can onh- be assured
by the operator's personal attention.

(b) Division of the Spermatic Cord with the Actual
Cautery. — -A second method, sometimes used in the horse, consists in
dividing the spermatic cord with the actual cautery. It has alread}'
been described, and has the advantages over castration with clams that
it is aseptic, and that operation is at once complete. Provided proper
care be taken, secondar}- bleeding is rare, and the local reaction,
evinced by swelling, etc., is seldom more marked than after other
methods. Care must be taken, however, to make the incision in
the scrotum and tunica vaginalis reflexa sufficienth- large to ensure free
drainage.

(c) Torsion of the Spermatic Cord if carefully performed is also
a reliable method, and has the great advantage of rendering a second visit
unnecessary. It also seems less painful than castration with clams,
which, even if skilfull}^ carried out, must cause a certain strain of the
spermatic cord. Moreover, healing is more rapid after torsion.
Sloughing of the portion of the cord included in the clams must
necessaril}' take a very considerable time. In torsion such delay is
avoided, because the stump of the spermatic cord seldom becomes
necrotic. Severe swelling, so marked after castration with clams, is
therefore relatively uncommon, and scirrhous cord is a rare sequel.

The chief and practically the only objection to this method consists
in the danger of secondary haemorrhage. By using proper forceps,
and operating carefully, bleeding can, however, be reduced to a
minimum, even in the case of old horses. Nevertheless the owner's
attention should be drawn to the fact that slight bleeding may occur,
though it is not of importance. MoUer used formerly to check bleeding
after this operation by introducing a mass of sterilised tow into each
of the scrotal cavities, and securing them with a couple of sutures.

222 OPERATIVE TECHNIQUE.

but this appears bad surgery, and he has since discarded the
apphcation as unnecessary. It may, however, be utihsed in case of
need. The owner can readily remove the tow at a later period.
Moller and many others recommend this method for castrating
stallions, and during the past few years it has made numerous
converts in Germany.

(d) Castration with the Ecraseur. — In America and England
the ecraseur has been much used for castrating stallions. After exposing
the testicle and spermatic cord the chain or wire of the ecraseur is
passed over the testicle and slowly drawn tight, dividing the cord just
above the epididymis. The method has found acceptance at the hands
of many practical men, though it seems to possess no particular
advantage over carefully performed torsion.

(e) Ligation of the Spermatic Cord cannot be recommended for
horses. Its disadvantage consists in the fact that the ligature n^aterial
remains in the wound, keeping up chronic inflammation, and frequently
leading to the formation of scirrhous cord. The use of catgut does,
not overcome this drawback because catgut is not absorbed from the
stump of the spermatic cord, as from an aseptic granulation surface;
experiment has shown that absorption requires at least one or two
weeks. Moreover ligation of the spermatic cord is not so easy as
might be imagined. Even when the ligature seems quite tight it is
apt to work loose, on account of the action of the elastic tissues of the
cord on the knots. Serious bleeding may thus be produced. Should
the operator decide on ligaturing the cord, however, two methods are
open to him. In the first the middle of the spermatic cord is
transfixed by means of the finger, and the anterior and posterior
portions are ligatured separately, care being taken that the anterior
ligature is drawn particularly tight. In the second the entire cord
is included in one ligature of sterilised catgut or silk. Some operators
leave one end of the ligature sufficiently long to protrude beyond
the wound, so that in a week after castration it may be removed, but
this is unnecessary if antisepsis be observed. Again, the elastic liga-
ture can be selected. Moller prefers catgut, because the elastic liga-
ture acts slowly, and must therefore remain a considerable time in
position. The most surgical method is ligation of the spermatic
artery in continuity, and when carefully performed with aseptic
precautions is quite safe.

Finally, it should be said that in castration less depends on the
method than on the way it is practised. As the method most
commonly used is usually best carried out, it results that many prac-
titioners after a short trial of a new method, return to their older

ASEPTIC CASTRATION. 223

procedure. Handiness and cleanliness exercise a marked influence on
the success of operation. As regards cleanliness, one can never be too
thorough, and although complete asepsis may not be secured, cleanli-
ness, nevertheless, remains an important factor in ensuring success.

(f) Aseptic Castration.^As was to be expected, soon after the
theory of antisepsis became popular, experiments were made to ensure
castration wounds healing by primary intention. Bayer first approached
this problem in 1881, and was followed at a later date by Frick.
Bayer had four successful results among fifteen horses operated upon.
At that time he simply divided the cord and ligatured bleeding vessels,
but frequently had secondary bleeding owing to the vessels escaping
from the ligatures. He then resorted to simple ligation of the entire
cord. Here also he had healing by first intention, but the horse was
often compelled to lie down soon after operation on account of
enormous swelling of the scrotum. In every instance he found that
the ligature had slipped off. In one instance he noted the accident
occurring. At every pulsation of the spermatic artery the ligature
yielded, at first almost imperceptibly, afterwards at a faster rate.
When the ligature was held with the finger the cord was drawn out of
the loop. For this reason he now transfixes the cord and ligates it in
two parts. Frick had seven successes among twelve cases. Guttman
castrated two horses, two boars, two dogs, and a goat with antiseptic
precautions, in each case obtaining healing by primary intention.
Plosz was equally successful with six stallions.

One must not forget, however, that observance of the necessary
principles of asepsis is much more difficult in private practice than in
clinical institutions. Moller operated several times, but with varying
results. The animals should be prepared, cast, and anaesthetised as
above described. The necessary arrangements having been made, and
the hands, instruments, and ligatures sterilised, the first step consists
in thoroughly disinfecting the field of operation. The scrotum and its
surroundings are carefully washed with soap and water, rubbed with
alcohol, and rinsed with sublimate or other disinfecting solution. The
upper hind limb and the hobbles restraining it should be moistened
with a wet sponge, to prevent hairs falling on the operation wound.
The other precautions are similar to those suggested in connection
with antiseptic operations.

The operator first grasps the right testicle, presses it towards the
base of the scrotum, incises the tunica dartos and tunica vaginalis,
though not to the same extent as previously indicated, and allows
the testicle to protrude. Having secured this, he ligatures the
spermatic cord with two or three ligatures, according to its thickness.

224 OPERATIVE TECHNIQUE.

To facilitate operation, compression forceps are applied to the cord,
and the ligatures applied below them, catgut or silk being used. The
ligature is placed above the epididymis, and the spermatic cord divided
half an inch below the point of ligation. Any blood that may have
escaped is removed with sterilised pledgets of cotton wool, the wound
in the scrotum closed with button sutures, the tunica vaginalis, if
possible, being included, though this is often difficult. The sutures
should be inserted deeply, so as to bring the subcutis in contact over a
considerable area. After the left testicle has been removed in a similar
way, the surface is rinsed with a disinfecting fluid, powdered with
iodoform or iodoform and tannin, and covered with a thin layer of
wadding, which adheres to the skin by means of the tannin, and
remains as a protection after the horse rises.

Bayer has also removed both testicles through a single opening.
After operation the horse was allowed to rise, and the scrotum
covered with iodoform gauze, a mass of cotton wool applied below it,
and the whole secured by a suspensory bandage consisting of a
triangular piece of linen, to the corners of which tapes were attached.
The narrower end fitted between the hind legs ; the tape from this
was passed alongside the tail, over the croup, and fastened to a roller
strapped round the chest. The other tapes w^ere passed over the back
and knotted together. The tail was suitably secured.

The difficulties in obtaining asepsis are less apparent during
operation than afterwards, inasmuch as a bandage is difficult to apply,
and a really secure protection against infection can scarcely be
devised.

The right (upper) testicle should first be removed, so that when
operating on the second testicle, the first operation wound may not be
soiled. Irrigation of the wounds is usually neither necessary nor
desirable, as it retards healing. Should, however, the wound have
been soiled, it should be w^ashed out with a free stream of antiseptic
fluid.

Aseptic castration has not yet been seriously practised, and is
scarcely likely to become common on account of its great inherent
difficulties. Whilst ordinary castration, with exposure of the testicle,
can be performed in from four to ten minutes, aseptic castration
demands from half to three quarters of an hour. The preparation is
troublesome, and anesthesia becomes necessary. Moreover, it offers
no great advantages. Castration by ordinary methods is seldom
followed by bad results. Nielsen castrated forty-one stallions and
eleven boars by torsion, without using sutures, and only saw swelling
and suppuration in two of the stallions, a result which bears favourable

CASTRATION OF MALE RUMINANTS. 225

comparison with those afforded by aseptic castration, and is worthy of
serious consideration in choosing a method. The troublesome and
tedious preparation required by the aseptic method is in no way
commensurate with the advantage to be gained. This, however,
seems less serious than the fact that one can never depend on
attaining absolute asepsis, the operation wounds being necessarily
of such a character as to heal with considerable difficult)', the incisions
being too small to permit of free drainage, and fluids, etc., being apt to
be retained ; severe local inflammation and serious feverish symptoms
are then very liable to occur. The difficulties inherent to asepsis
result partly from external circumstances, such as the difficulty of
applying a dressing, which many animals will absolutely not endure,
and partly to the fact that even with the greatest care bleeding cannot
alwaN's be prevented. This usually sets in after the animal has risen,
and originates in the veins of the common vaginal sheath. Blood
is poured into the scrotum, and endangers aseptic healing. In
cryptorchids, in which this sheath is absent, antisepsis is there-
fore more easily attained than in ordinar}' stallions, as is shown by the
experience of Bayer, Guttmann, Plosz, and others. Until these
difficulties can be overcome aseptic castration will remain a strictly
academic operation.

Castration of the ass calls for no particular modifications.
Weber states having had fatal bleeding after torsion of the spermatic
cord, a result, he believes, due to the fact that in these animals
the cord is unusually fragile, and is apt to tear.

2. Castration of Male Ruminants.

Although the same principles apply to the castration of ruminants
as to that of horses, yet variations in anatomical arrangement of the
organs of generation and in external circumstances necessitate
numerous modifications. Apart from goats, which appear particularly
sensitive to ordinary methods of castration, ruminants seem to bear
operation better than horses. Bull calves may be castrated b}- torsion
or ligation, the elastic ligature being used if desired. Older animals
are usually castrated with clams by the covered method. The applica-
tion of clams or of a ligature to the entire; scrotum is seldom practised,
except by laymen.

Bulls bear castration best during the first few months of life, an
age at which the operation is also most easily performed. Should the
animals be intended for draught purposes, however, castration is
commonly postponed until the second year, as the neck and shoulders
are then better developed. •

15

226 OPERATIVE TECHNIQUE.

The operation is usually performed in the standing position ; only
old vicious bulls are cast. For operation in the standing position the
animal is tied up as short and as strongly as possible, a bull holder is
applied, and a fore foot lifted. The hind feet may, if necessary, be
secured by a rope passed around the neck, though this is seldom
necessary. One or two strong assistants may be placed on either side
of the quarters to prevent the animal moving laterally.

The operator stands behind the animal, grasping the scrotum with
the left hand. When castrating with clams, he incises the base of the
scrotum and the tunica vaginalis, applies the clams as in the horse, and
removes the testicle. The clams are left in position for twenty-four hours,
or even longer, but animals may be allowed to lie down before this.

Division of the spermatic cord with the actual cautery is performed
as in the horse. Young bulls may be castrated by twisting or scraping
the cord in the above-described manner.

" Bistournage," i. e. torsion of the spermatic cord within the
scrotum, is also worthy of notice. When successful it is followed by
atrophy of the testicle.

It has chiefly been practised on bulls, rams, and goats, but in a few
cases also on stallions.

The operation may be divided into four stages. The operator first
endeavours to loosen the connection between the dartos and the under-
lying tunics (common vaginal sheath) by forcibly thrusting the testicles
upwards and downwards. For this purpose he first grasps the scrotum
above the testicles with both hands and rapidly thrusts the testicles
towards the base of the scrotum, where he fixes them by means of the
right hand. With the left hand he then grasps the lower part of the
scrotum and pulls it vigorously to and fro. Next, he takes hold of the
scrotum with the right hand immediately above the left, and in this
way pushes the testicles towards the inguinal canal. The testicles are
again pulled backwards and the above-described manipulation repeated
until the testicles can be freely moved in all directions (Fig. 246).
During this manipulation the rupture of the connection between the
skin and underlying tunics can be distinctly felt. In the second stage
one testicle is forced to the base of the scrotum and fixed in this
position with the fingers of the left hand, which grasp the spermatic
cord close above the gland (Fig. 247). The lowest part of the scrotum
is held with the right hand, which next co-operates with the left, im-
pressing the upper end of the testicle downwards and forwards and the
lower end upwards and backwards, thus rotating the testicle at an
acute angle to the spermatic cord. The testicle is prevented from re-
turning to its normal position by the left hand grasping the scrotum

BISTOURNAGE.

227

and spermatic cord just above the half-rotated testicle. The hands
now occupy their original position and the manipulation is repeated.

Third stage (Fig. 248). The right hand grasps the testicle and turns
it from left to right, the left hand at the same time pressing the sper-
matic cord from right to left. This produces a half-turn in the
spermatic cord ; the part played by the hands is now reversed, the
left hand pushes the testicle from left to right, the left hand thrusting
the spermatic cord from right to left, making the twist complete. This
manipulation is repeated from two to four or iive times, depending on
the length of the spermatic cord.

Fourth stage. The above operations having been performed on

Fig. 246. Fig. 247.

each of the testicles, the lower part of the scrotum is grasped with both
hands and the testicles pushed as far towards the inguinal canal as
possible. Both should rest at the same height. \\'hilst the empty
lower part of the scrotum is held fast with the left hand just below the
testicles, the right hand passes a loop of cord (one end of which the
operator holds in his teeth) three or four times around the scrotum,
between the left hand and the testicles, so that the latter cannot slip
downwards, and ties the ends together (Fig. 249). The loop, however,
must not be drawn so tight as to stop circulation in the lower part of
the scrotum ; it is only required to keep the testicles in the position

228

OPERATIVE TECHNIQUE.

given them until the exudation and swelHng which follow the above
manipulation can fix the spermatic cords in place, and thus prevent the
cords untwisting. The loop is removed in twenty-four to forty-eight
hours.

When the union between the dartos and the common vaginal sheath
is very firm, operation proves much more difficult, or ma}' be impossible.
In such case it may again be attempted on the succeeding day, the
exudation between the layers of the scrotum produced by the first
manipulation often rendering subsequent handling much easier.

The animals show great pain after operation, become very restless,
and often throw themselves down. Some show peculiar spasmodic
contraction of the masseter muscles and of the muscles of the neck.

/

Fig. 248.

Fig. 249.

The legs become rigid, and the animals exhibit s}'mptoms recalling
those of str3'chnine poisoning. These appearances, however, only last
from two to four hours, after which the animals appear to have perfectl}^
recovered. The scrotum then begins to swell and continues to increase
in size. In the upper part of the swelling the testicles can be felt; the
lower part consists only of the infiltrated and swollen scrotum. The
swelling having attained its height remains stationary for some days,
and then gradually disappears ; the testicles slowly undergo atrophy
for a period of several months.

Occasionally the testicles rotate after removal of the loop of cord,
and the operation proves futile. Failure is shown by the spermatic
cord again becoming soft ; when the operation has been successful the

CASTRATION BY CAUSTIC LIGATURE. 229

cord feels hard and distended. In such case operation must be re-
peated, but is then usually rendered much more difficult by adhesions
having occurred between the layers of the scrotum. These adhesions
become firmer and more intimate as time passes ; in the course of even
a few days a repetition of the process proves impossible, and castration
must be performed in some other way.

In South Germany, and especially in Bavaria, bulls are very often
castrated with the " caustic ligature," that is, a strong cord saturated
with a mixture of equal parts of sublimate and gum arabic dissolved in
twice their volume of water. Many experienced operators warmly
recommend this method, though some have noticed after-symptoms of
mercurial poisoning, especiall}' in young animals. An extensive erup-
tion, which may persist for a month or six weeks, occurs over the
whole body, and is accompanied by local depilation. This has been
attributed to excess of sublimate in the ligature, and some operators
therefore recommend saturating the cord with a solution of three parts
of sublimate in thirty parts of collodion. The caustic ligature has the
advantage of more rapidly dividing the spermatic cord, and therefore
of separating sooner, whilst the sublimate exercises a disinfecting action
both on the cord itself and on the wound. Some practitioners, how-
ever, have noted severe swelling after this operation. Eckmayer
ligatures the exposed spermatic cord with carbolised silk, and removes
the testicle half an inch below the ligature. He operated thus on more
than 100 calves without any bad result. Gunther recommends the
use of the elastic ligature for bulls.

Another method of castration has been recommended. After
opening the scrotum the spermatic cord is perforated between
the vascular and non-vascular portions with a knife, and the
index finger of the left hand is inserted in the slit so produced. The
testicle being removed with the knife, the stump of the cord is passed
through the slit, and tied in a knot. Should bleeding not immediately
stop a second or third knot may be tied. Some operators first divide
all the non-vascular portions of the cord with the knife, then, after
grasping the blood-vessels firmly with the finger and thumb or with
forceps, divide these low down near the testicle. One or more knot«i
are then tied as high as possible on the vascular cord and drawn tight.
As soon as the operator is satisfied that bleeding is no longer to be
feared the free end of the vascular cord is snipped away three quarters
of an inch below the knot or knots ; the latter are returned into the
sac of the tunica vaginalis and thrust as high up as the fingers
can reach. The method is particularly recommended for old

230 OPERATIVE TECHNIQUE.

bulls, and is carried out in the following manner : — The animal
is placed with its right side against the wall, and its left hind
foot is fixed by means of a cord passed around the neck. An
assistant standing opposite the hind quarters holds the limb by the
Achilles tendon with his right hand, and draws it outwards. As in
calves the sperm.atic cord is not fully developed, the knot is sometimes
difficult to tie. The greatest cleanliness must be observed.

Wehrhahn has shown that bulls may be castrated aseptically,
though only at the cost of much time and care.

Sheep are best castrated between the fourth and sixth weeks.
The animal is laid on a table (lambs are held by the legs), the limbs
being grasped by an assistant or tied together ; old rams should be
placed on the back, and held by a couple of strong men: In lambs,
scraping or torsion is the best method. Old rams may also be castrated
by torsion, provided sufficient care be taken, though ligation is also
successful. Clams are very seldom used in sheep. The scrotum is
either opened as in the horse, or its base is cut off, a method which
ensures free drainage.

Goats are best castrated by subcutaneous ligation of the spermatic
cord or b}- means of the elastic ligature, as before mentioned.

3. Castration of Swine.

Swine are usually castrated during the first few weeks or months
of life, though not infrequently one is required to operate on old boars.
No particular danger attends operation on these animals provided
that previous to casting the scrotum and inguinal canal be examined for
inguinal hernia, which in them occurs with some frequency. The pig
being laid on its back on a table and held b}- one or two assistants,
the operator presses the testicles towards the base of the scrotum with
the left hand. He then incises the covering of the testicles, parallel to
the scrotal raphe, and about f to i inch distant from it, allowing
the testicles to protrude. Although in young animals simple division
of the spermatic cord with scissors is not always attended with
danger, yet torsion is preferable, and is carried out, after dividing the
posterior portion of the cord, by passing the index finger through the
spermatic cord, just above the epidid3^mis, whilst the cord is grasped a
short distance above the epididymis with the thumb and index finger
of the left hand. The index finger of the right hand is then rotated,
and the cord twisted until the testicle falls away. Another method
consists in dividing the posterior part of the cord with a knife, laying
the remaining portion on the index finger of the left hand, and scraping
it with a blunt knife until completely divided.

CASTRATION OF SMALL ANIMALS. 231

Older boars are best castrated with clams or ligature. The opera-
tion can be performed in the standing position, though the animal's
head must be firmly secured, and its hind limbs fixed by passing a
couple of poles .between the legs, so that it can neither lie down nor
move to either side. The operation is, however, most conveniently
performed with' the animal lying on one side. No particular after-
treatment is necessary, but the animal should be placed in a separate,
cool, clean stall. The clams can be removed after twenty-four hours,
though they are generally left in position until they spontaneously fall
awa}-. Griin recommends castrating boars by ligating the spermatic
cord with a dry, thin catgut ligature.

4. Castration of Cats and Dogs.

Dogs bear castration well at all ages. The animal is placed on its
back, and the processus vaginalis opened as above described. In
young animals the spermatic cord may be simply snipped through with
scissors or scraped with a knife. The point of division is just above the
epididymis. In older animals ligation is preferable, as bleeding may
be prolonged by the animal licking the parts. Cats are similarly
treated. Some operators fix the animal by enveloping the fore-part in
a sack ; an assistant holds the hind legs. Scraping, twisting, or
ligation may be used.

5. Castration of Birds

is on the whole simple, though the operation requires some practice.
The cock is the bird most often castrated ; the bean-shaped
testicles lie in the abdomen. Operation is performed between the
second and third weeks of life, when the habit of crowing com-
mences and the comb assumes a red colour. An assistant holds the
bird on its back in his open hands, with its beak pointing towards
the operator, and presses down the feet wath his thumbs. The
feathers are plucked out or cut away for a distance of about f inch
in front of the anus, and a transverse incision about li inches
in length made through the thin abdominal wall. At this stage care
is required to avoid damaging the abdominal contents. The incision
is preferably made with button-pointed scissors, the thin abdominal
wall being raised in a fold with dissecting forceps, incised with scissors,
and the incision enlarged to the necessary extent. The operator then
passes the disinfected index finger of the right hand into the abdominal
cavity to the spot where, externally, the posterior angle of the scapula
may be felt on the ribs, meanwhile pressing the abdominal contents to
one side. At this point there lies, on either side of the vertebral
column, a firm body, the size of a horse-bean — the testicle — which is
first separated from the ribs by means of the bent finger, and then
drawn backwards through the wound where it is simply pinched off.

232 OPERATI\'E TECHNIQUE.

The removal of the testicle is indeed scarcely necessary, it being
sufficient to remove it from its original position. An}' protruding bowel
is returned, and the wound in the abdominal wall united with closely
placed stitches. The bird is placed alone in a dry run, and is given
soft food and clean water. Recovery is complete in about eight days.

Complications during Castration of Male Animals.

1. Adhesion of the Testicle to the Tunica Vaginalis
Reflexa. — This condition is only of importance in the operation with
exposure of the testicle, and the adhesion may often be simply broken
down by means of the thumb or round-pointed scissors. Where it is
more extensive and firm, as shown by the fact that the testicle fails to
protrude after incision, although it may even have been incised, a
second incision may be made to one side of the testicle and enlarged
with button-pointed scissors until the testicle is freed. In the event of
this also failing, the tunica vaginaHs can be divided with scissors above
the testicle or epididymis, and the base of the tunic removed together
with the testicle. Should the adhesion extend to the spermatic cord,
castration must be completed by the covered method. Such adhesions
are said to be very common in Russia in consequence of the scrotum
being frozen.

2. Prolapse of the Omentum. ^ — In horses and swine portions
of the omentum are not uncommonly found in the scrotum, although
large portions should be recognised on examining the scrotum prior to
operation. Smaller pieces may escape observation, however, and when
the tunica vaginalis is opened, often become greatly enlarged in a short
time, in consequence of the animal straining. The condition is seldom
dangerous. The operator waits until the straining ceases, gently draws
the piece of omentum forward, and, if it be limited, snips it off with
scissors. Should it contain important blood-vessels, these must be
ligatured with sterilised catgut or silk, cut through, and the remainder
of the omentum returned into the inguinal canal and thrust back into
the abdominal cavity. The omentum seems little prone to inflammatory
processes; danger of peritonitis is small.

3. Prolapse of the Bowel. — Though prolapse of omentum is
seldom of particular importance, that of the bowel is very serious. In
order to avoid this complication, the scrotum and spermatic cord must
be very carefully examined before castration. A loop of bowel may,
however, pass into the inguinal canal during operation, or a portion
too small to be recognised with certainty by external manipulation
may have been present in the tunica vaginalis beforehand. Under such
circumstances, the prolapsed portion very rapidly increases in size

COMPLICATIONS DURING CASTRATION. 233

during operation, in consequence of the animal's struggles. Prolapse
is favoured by dragging on the spermatic cord, which dilates the inner
abdominal ring. It occurs oftenest in old stallions, either during
castration or after the animal has risen. Occasionally it appears later,
sometimes when the clams are removed.

Immediatel}' the bowel appears, however small may be the poition,
the animal should be placed on its back and the hind quarters raised
as high as possible. The greatest care should be taken to prevent the
bowel being soiled or injured. Whilst the animal is being moved, the
operator should tirml}- grasp the scrotum to prevent the prolapse
further developing, which, under some circumstances, it very rapidly
does. As soon as straining ceases, the bowel must be returned through
the inguinal canal into the abdominal cavity. Should this prove
difficult, the operator may pass one arm into the rectum and assist
reposition by pulling en the affected portion of bowel. Under some
circumistances, anaesthesia and enlargement of the inner abdominal ring
may become necessary.^ To prevent a recurrence of the prolapse,
clams are applied to the tunica vaginalis; as in herniotomy for inguinal
hernia, the tunica vaginalis may be twisted around its long axis.
After-treatment is similar to that in the operation mentioned.

4. Entrance of Air into the abdominal cavity is, of course, only
possible when the tunica vaginalis is opened, and is recognised by a
sudden gurgling or bubbling noise. It is favoured by abnormal
patency of the inner abdominal ring, is of rare occurrence, seldom of
much importance, and only dangerous when blood passes into the
abdominal cavity along with the air. In such case peritonitis may
result from the introduction of infective material. Immediately the
noise is heard, the operation wound should be covered with the hand.
Air which has entered cannot be removed artificially from the abdominal
cavity, but is soon absorbed, and is usually uninjurious.

Unfavourable Consequences of Castration of Male Animals.

No special treatment is necessary after castration. Horses are
placed in a quiet stall provided with clean bedding. They should
be tied up, and, for a time, kept under observation, in order to see
whether straining occurs, in which case the animal must be checked by
calling to it or by striking it lightly with a whip, as prolonged straining
might easily cause prolapse of the bowel. For the next few days — or,
after castration with clams, from the day when the clams are removed —

* For a description of the latter operation, see the writer's translation of Moller's
' Veterinary Surgery,' p. 257.

234 OPERATIVE TECHNIQUE.

the animal is walked for a half to one hour daily ; in the country it may
be put to light work. Movement favours the escape of discharge, and
also tends to prevent the spermatic cord adhering to the skin wound,
or the wound itself closing, which is sometimes followed by severe
local inflammation, burrowing of pus, and abscess formation.

During the first few days after operation it is therefore advisable to
cleanse the wound with boiled water or a disinfecting fluid at least
once daily, in order to prevent the edge of the scrotal w^ound adhering.
At a later stage this cleansing process is necessar}' for the removal of
pus, and must therefore be continued until suppuration ceases. Pro-
vided no marked swelling or other complication appears, the animal
may be returned to light work in from eight to ten days.

The most serious consequences of castration are :

I, Bleeding. Apart from trivial skin bleeding haemorrhage is
almost entirely confined to cases where the spermatic cord has been
twisted, scraped, or torn through, and is very rare after castration with
clams. Even after torsion, etc., fatal bleeding is rare. The trifling
haemorrhage resulting from division of cutaneous vessels occurs onl}- in
drops, is of no importance, and alwa3''s ceases of itself. Sometim.es,
however, blood escapes in a fine stream, and the operator's first task is
to discover whence it comes. It may discharge from the side of the
clams, and is then usually derived from the skin wound or processus
vaginalis ; such bleeding may be readily checked b}- the use of tampons.
Should it originate from the stump of the spermatic cord and dis-
charge below the clams greater care is required, and ligation of the
bleeding vessel becomes necessary. The slight bleeding which some-
times follows castration b}' torsion ma}' be stopped, by plugging the
scrotum with tampons ; more severe bleeding calls for ligation of the
spermatic cord. The operator slips a loop over the left hand, with
which he seeks for the spermatic cord : as soon as this is grasped, the
right hand passes the loop around the cord ; with the help of an
assistant the operator then draws the loop tight, without, however,
knotting it, as it may become needful to remove the ligature during the
next few days. The ends are left sufficiently long to protrude beyond
the operation wound.

When the clams are removed bleeding sometimes results from
tearing of small veins. Some care is therefore required in removal ;
the best preventive of bleeding is to leave the clams in position for two
or three days. As a rule, haemorrhage of this kind ceases spon-
taneously, but should it persist, the affected side of the scrotum may
be plugged with cotton wool or tow. In the case of a stallion that had
been castrated three weeks before, Dotter checked bleeding by inject-

COMPLICATIONS AFTER CASTRATION. 235

ing fort\--Hve minims of a 10 per cent, solution of ergotin ; bleeding
stopped in twelve minutes.

2. Excessive swelling in the neighbourhood of the castration
wound, especially about the sheath. As a rule, severe swelling is due
to retention of discharge, consequent on the edges of the wound
adhering, or to the operative wound having been too small. Long rest
in the stable also favours retention of discharge and swelling. Should
the operator be unskilled in grasping the testicle, he is apt (especially
in foals) to make the incision too far back ; the anterior portion of the
scrotum then forms a pocket in which discharge accumulates, producing
great swelling of the sheath. Exercise both favours discharge and
tends to prevent adhesion between the spermatic cord and surrounding
tissues, which in itself is a frequent cause of discharge being retained.
In other cases swelling results from virulent infection of the wound.
This can only be prevented by proper attention to cleanliness, for
which reason dusty places should be avoided for operating, and the
straw bed should previously be moistened.

When unusual swelling occurs, the disinfected finger should be
inserted in the operative wound, and attempts made to secure free
exit for discharge. As a rule discharge accumulates more frequently
when the spermatic cord is adherent to the edges of the wound, for
which reason the spermatic cord is first sought for and the index finger
passed round it in order to break down adhesions ; the v/ound is then
rinsed out with a disinfecting fluid, after which the animal is given
walking exercise. Virulent infection is best avoided by observing the
principles of antisepsis.

3. Castration fever. After castration without antiseptic precautions,
trifling fever often appears, even wdthin twenty-four hours. According
to Frohner's observations on igo horses, it occurred in all but 27 per
cent. ; 49 per cent, showed moderate, 18 per cent, somewhat severe,
and 5 per cent, high fever. Fever most frequently appears soon after
the clams are removed, especially if this be done within the first two
da}'s after castration.

Where fever is moderate, the animal should receive walking exer-
cise for half an hour a day. Should the temiperature in the horse rise
above 103° F., the wound must be carefully examined with the disin-
fected forefinger, any discharge allowed to escape, and the parts
washed out with a disinfectant. As a rule the temperature then falls
in a few hours.

4. Septic fever is evidenced by high rise in temperature, frequent
pulse, and severe general disturbance. The pulse, which in simple
wound fever scarcely rises above normal, is then not only frequent,

236 OPERATIVE TECHNigUE.

but small and weak, and the appetite is usually completely in abeyance,
even water being sometimes refused. Not infrequently, the castration
wound shows no swelling whatever, a symptom which, when asso-
ciated with high fever, is always serious. On the other hand, severe
and widespread swelling, sometimes extending as far as the breast,
may occur. Such symptoms call for energetic treatment. The most
important point is to thoroughly and repeatedly cleanse the wound
with a lukewarm disinfectant ; other symptoms must be treated as
they arise. Careful regard to cleanliness during operation is the best
safeguard against such complications, and it is worth remembering
that the directions given to the owner regarding the cleansing of the
operation wound are often entirely disregarded. A perfectly new
sponge or piece of linen which has been thoroughly boiled in clean
water should be used ; with this sponge and the cooled water the
cleansing is performed ; the operation is easy and entails little
expense.

5. Peritonitis. Inflammation of the peritoneum may follow
castration either in consequence of the wound being septically
infected, or of discharge being retamed. In either case infectious
material is carried upwards by the stump of the spermatic cord from
the neighbourhood of the scrotum towards and eventually into the
peritoneal cavity. High fever, restlessness, abdominal pain, and
loss of appetite are the most important symptoms. Treatment
consists in thoroughly cleansing the wound and providing for escape
of discharge. Should peritonitis accompany septic infection, the
prognosis becomes extremely grave.

6. Prolapse of the spermatic cord consists in protrusion of the
spermatic cord beyond the wound in the scrotum. It may be caused by
dragging on the cord, by applying the clams too low, or by using too
heavy clams. Prolapse is not infrequent in weakly animals, especially
if the adhesions between the spermatic cord and outer skin be not
broken down when the clams are removed. Should the spermatic
cord not be soon returned into the scrotal wound or tunica vaginalis
a spermatic fistula results and is often succeeded by scirrhous cord, a
condition which will more fully be described in a later volume.

When prolapse accompanies castration with clams, the clams
should be removed, and attempts made to release the prolapsed cord
and thrust it back again into the processus vaginalis or scrotum. A
strong stream of cold water directed on the parts often results in the
cord being retracted. Failing retraction, another pair of clams must
be applied at a higher point, or the cord be ligatured above the
prolapsed part.

COMPLICATIONS AFTER CASTRATION. 237

7. Abscess formation in or about the scrotum results from retention
of discharge, from the primary incision being made at the wrong point,
or being of too small size. The decomposing discharge leads to sup-
purative inflammation in the connective tissue and finally to abscess
formation. In this case the swelling is more marked at the spot where
the abscess will finall}' break, and is often hemispherical in shape.
Immediately such symptoms are noted, the wound must be examined,
and the abscess cavity freely exposed or a counter-opening made.
Occasionally it is advantageous to insert a drainage-tube.

Cryptorchidism and the Castration of Cryptorchids.

In the horse and dog, less frequently in other species, the testicles
are sometimes either absent or in a state of rudimentary development.
Leisering found the testicles of a stallion, which had ineffectually
covered forty mares, almost normal in size, but flabb}- in texture,
wanting the tense normal character. Their arteries were distended,
their connecti\'e tissue thickened, the semen ^^•atery, transparent, and
containing many round-cells, but onl_v isolated spermatozoa. Testicles
which have been retained in the abdominal cavit)' often show similar
appearances. This condition (retentio testis) is not infrequent in
stallions of the coarse, heavy variety, but is also seen in other animals.
Leisering and Gurlt found the testicles of a dog still in the abdominal
cavity ; Preusser has seen the same thing in pigs, and Kaiser in bulls.
Imminger considers the cryptorchid condition as common in bulls as
in horses, and he was able to establish the hereditary character of the
condition in certain cases. This abnormality is termed retentio abdo-
minalis when the testicle lies near the upper wall of the abdomen,
retentio iliaca when it is near the inner abdominal ring, and retentio
inguinalis when it is within the inguinal canal. The apparent absence
of one or both testicles thus produced is termed monorchismus or
cryptorchismus. During the first few months of life in the foal the
testicles certainly lie in the inguinal canal, but towards the end of the
first year they again descend into the scrotum.

Gurlt saw a horse in which the testicles occupied a very rare
position, viz. in contact with, and adherent to, the diaphragm. Some-
times they lie outside the abdominal cavity, but not in the scrotum
(ectopia of the testicle) ; thus the testicles have been found below the
diaphragm or in the crural canal : the first condition is termed ectopia
abdominalis, the latter ectopia cruralis. In dogs Moller has found one
or both testicles lying beneath the skin next the glans penis ; in a bull,,
one testicle was met with in the subcutis of the flank.

238

OPERATIVE TECHNIQUE.

Supernumerary testicles are said to have been seen in horses and
mules. Cox found three testicles in a certain horse, and Oliver as
many as four in a mule. The accuracy of these observations may,
however, be questioned, as a thorough description of the supernumerary
organs is wanting, and one cannot help thinking that these were cases
of mistaken diagnosis.

The significance of all these conditions is self-evident. Both anor-
chidism and defective development of both testicles make the animal
useless for stud purposes. The same is usually also true of cryptor-

he section is
rill" to the

Fig. 250. — Section through the walls of the left inguinal canal,
through a line drawn from the centre of the lower abdomina
antero-external angle of the ilium.

s. Skin. C.T. Connective tissue and fascia beneath the dartos. T.D. Tunica
dartos. a.o.a.e. Aponeurosis of the obliquus abdominis externus muscle.
.\.L. Anterior lip of the lower abdominal ring. p.l. Posterior lip of the lower
abdominal ring. i.e. Inguinal canal and its contained connective tissue.
0..\.I. Obliquus abdominis internus muscle. .\.T..\. Aponeurosis of the trans-
verse abdominal muscle. p. Peritoneum. P. I,. Poupart's ligament. F.T.
Fascia of the thigh. c..\. Crural arch. e.i. E.xternal angle of the ilium.

chismus, for testicles when retained in the abdominal cavity are
generally atrophic, lax, and either contain degenerated spermatozoa or
none at all ; on the other hand, retained testicles sometimes yield
abundance of spermatozoa. The question of the fertility of cryptor-
chids was first raised by Gurlt when studying the function of the
spermatozoa ; his experiments seem to deny fertilising power under
such circumstances, for he was unable to discover spermatozoa in the
retained testicle. Since then the same question has been variously

CRYPTORCHIDISM.

239

answered. Peters considers such animals not fertile, though quite
capable of coitus, ^^'esche, on the other hand, states having seen
fertile cr\'ptorchids ; he refers, however, to a case of cr\-ptorchismus
inguinalis. A final answer can scarcely be given. The animal's fertility
clearly depends on the development of the testicles. The great majority

Fig. 251. — Transverse section in a perpendicular plane through the posteiior
abdominal region, together with a part of the supralumbar, iliac, and prepubic
regions (normal).

PT. Peritoneum. P..\. Branch of prepubic artery, p. v. Branch of prepubic
vein. u..\.R. Upper abdominal ring. s.c. Spermatic cord. v.d. Vas deferens.
p.L. Poupart's ligament, turned downwards, the deep surface visible. L .\. Long
adductor of the thigh. l.i.f. Lumbo-iliac fascia. i. Iliacus. P..M. Psoas
magnus. t.p.p. Tendon of the psoas parvus, p. Pelvis, r. Rectum, bl. Bladder.
L.B. Lateral ligaments of the bladder with the obliterated umbilical artery.
O.A.I. Internal oblique abdominal muscle, c. Cremaster. c.T. Layer of con-
nective tissue which surrounds the upper border of Potipart's ligament, the
posterior margin of the internal oblique abdominal muscle, the cremaster, and
the peritoneum.

of retained testicles certainly appear degenerated, and contain no
spermatozoa. Paugoue speaks of a stallion in which both testicles
were retained, and whose progeny numbered amongst them five cryptor-
chids or monorchids, thus apparently proving the condition to be
hereditary.

240 OPERATIVE TECHNIQUE.

The retained testicle is often the seat of dropsical cysts and not
infrequently malignant new growths like sarcoma, carcinoma, etc.
Leisering, in the case of a dog, found the retained testicle attacked
with cancer ; the same condition has been seen in horses. In man,
such testicles still more frequently become diseased, so that early
removal is generally necessary.

The same necessity does not exist in the horse, though removal
often becomes desirable on account of sexual excitement (particularly
in spring) greatly interfering with the animal's usefulness. Many
cryptorchids are too vicious for use. The flesh of cryptorchid swine
has usually a repulsive taste, which, according to Koch, is retained
even by the salted meat, and is more intense the more completely the
testicles have developed.

Diagnosis is sometimes very easy, but, on the other hand, is some-
times very difficult ; the exhibition of sexual appetite, alone is not a
reliable symptom, for "rig" horses sometimes behave like geldings and
geldings like stallions. Nor is the castration scar to be relied on. The
operator may have removed both testicles through one incision, or, as
more frequently happens, he may have opened one side of the scrotum
without finding the testicle.

Cadiot states that where the testicle has really been removed the
scar always shows a funnel-shaped depression surrounded with wrinkles ;
by passing the finger from before backwards along the sheath, a cord,
varying in size between a goose-quill and the little finger, can almost
alwa}'S be felt ; this represents the stump of the spermatic cord, and
can be traced as far as the inguinal ring. On the side f)f the retained
testicle this cord is absent, and instead, one feels a triangular groove.
Occasionally the gubernaculum testis is unusually de\'eloped, and may
be mistaken for the stump of the cord, but in such case the cicatrix is
absent.

To distinguish between inguinal and abdominal cryptorchidism
Cadiot proposes the following method of examination : — The points of
the fingers are brought together, forming a cone, and are pushed
towards the inguinal ring ; the testicle when in the canal is recognised
as a rounded, thick, movable object. By examining the inner abdo-
minal ring of either side per rcciuvi there will be found on the side of
the retained testicle a thin cord passing into the ring, which cord
cannot be caused to move by drawing the sheath downwards. Should
the animal have been castrated, however, the cord will descend as soon
as an assistant moves the sheeith.

Where the testicle lies in the abdomen itself the inguinal canal is
necessarily empty, and the space usually lined by the tunica vaginalis

CASTRATION OF CRYPTORCHIDS.

241

communis is absent. To find the testicle under these circumstances
Moller recommends passin.q the hand into the rectum, and after first
discovering the anterior edge of the os pubis examining the floor of the
abdomen with the outstretched fingers in front of, and for four to six
inches on either side of, the Hnea alba. As a rule, the testicles are
soon found ; in other cases the rectum requires to be thoroughly
emptied and the search renewed. Should' the operator be in doubt as
to the nature of the body found he ma\' compress it, when, in the event
of its being the testicle, the horse usually struggles. Degive passes the
hand downwards alont! the sides of the abdomen to the middle line.

Fig. 252. — A case of abdoinin il crxptorchidism,

T. Ttsticle. p. P'old of peritoneum surrounding the spermatic rord.

V. Vas deferens. R. Rectum.

Frohner endeavours to draw the testicle backwards towards the pelvic
cavitv, in order to bring it into a better position for examination.
Masses of faices sometimes mislead the operator, but may be dis-
tinguished from the testicle by the fact that they are usually firm and
rounded, and may be broken down without causing pain, whilst the
testicle is flat, flabby, sharply marginated. ver_\- easily displaced, always
retains its shape, and is sensitive to pressure. Sand compares the feel
of the testicle to that of a small bag filled with mercury. The above
examination is onlv for the purpose of determining whether the testicle

16

242 OPERATIVE TECHNIQUE.

is or is not retained, and is of no value for operative purposes, inas-
much as the position of the gland is often entirel}' altered when the
animal is cast. Furthermore, it should not be deferred until im-
mediately before operating, as the soiling of the hands and arms
immensely increases the diiftculty of properly disinfecting them.

The anatomical relations of the parts are very clearly shown in
the accompanying figures, redrawn from Cadiot's work.

Frohner divides the methods of operation into two groups, viz. the
inguinal and ventral.

In the inguinal operation the incision is made in the neighbourhood
of the outer abdominal ring, and extended by blunt dissection towards
the inner abdominal ring, in the neighbourhood of which the
abdominal cavity is opened. In the ventral operation laparotomy is
performed either in the region of the flank or from the lower surface of
the abdomen.

Cadiot recommends onl}- castrating such rig horses as are dangerous
or difficult to handle, and in other cases abstaining from operation.
He considers the beginning of the fourth 3-ear the best period, as the
descent or partial descent of the testicle often occupies a long time,
and when the testicle is onl}' partialh' developed the inguinal operation
proves difficult and sometimes dangerous. The operation demands
care and practice, but with antiseptic precautions loses much of its
danger, and is often of great service.

The operation is easiest in horses which have been kept low for
some weeks and are in thin condition, because in them there is less fat
in the inguinal region. Some days before operation a dose of physic
is given to empty the bowel, and from that time the animal receives
only a limited amount of concentrated food like oats, with a little
hay, but no straw. On the morning of operation the bowel is emptied
by a subcutaneous injection of arecolin. Clysters are contra-indi-
cated.

Thus prepared, the horse is cast on the side opposite the seat of
operation; the hind quarters are half rolled over, and lie somewhat
higher than the fore. The upper hind foot is then drawn forward and
fixed in a position of abduction and flexion, as in ordinary castration.
By previouslv cleansing the hoofs and lower part of the limbs and
surrounding them with moist cloths, and by moistening the hair- on
the upper part of the thigh the point of operation is protected against
infection.

Three dishes, each containing 2 to 3 per cent, carbolic or i per cent,
chinosol solution, are necessary. After boiling, the instruments are

INGUINAL OPERATION ON CRYPTORCHIDS. 243

placed in one and the ligatures and needles in the second ; the third is
used by the operator for moistening his hands before introducing them
into the abdominal cavity ; in a fourth empty dish, pledgets of
sterilised cotton wool are in readiness. It is also well to have at hand
a vessel with a lip, to use as an irrigator.

All being ready, the animal is chloroformed, during which time the

I.e. I.e.

O.C.

■+

"l.-n--^-

\

Fig. 253. — Inguinal canal, viewed from the flank. The external lip of the left
inguinal ring has been removed. The aponeurosis of the external oblique
abdominal muscle has been cut through a little in front of the spot where it
divides. The inner oblique abdominal muscle has been separated from
Poupart's ligament to a point near the inner commissure of the inguinal canal,
p. Poupart's ligament, o.aa. Obliquus abdominis internus muscle, i.e. i.e.
Inner commissure of the inguinal canal. a.o..\.e. Aponeurosis of the obliquus
abdominis externus muscle divided and reflected, i.e. Inner commissure of
the lower abdominal ring. o.c. Outer commissure, divided, a.l. Anterior lip.
P.L. Posterior lip. U..A.R. The dotted line indicates the position of the upper
abdominal ring. o. The dotted line indicates the position in which the open-
ing is made in operating for abdominal cryptorchidism. H. Hind limb,
abducted.

V:

seat of operation is scrubbed with soap and water, washed with ether
or turpentine, and disinfected with carbolic or sublimate solution. The
inguinal region, sheath, lower surface of the abdomen, and inner
surface of the thigh must all be included. The disinfected sheath is
plugged with a tampon of cotton wool. As soon as narcosis is
complete, the assistants holding the dishes place themselves near the

fcxr*

244 OPERATIVE TECHNIQUE.

operator, who has carefully disinfected his hands and arms and thrust
his sleeves back above the elbow. The position is the same as in
castration. The operation is divided into the following stages :

1. Incision. — An incision is made through the skin, about two to
three inches long, over the outer inguinal ring (perhaps slightly nearer
the middle line) and parallel with it, and the subcutaneous tissue and
fascia 13'ing at this point are divided to the same extent. Any bleeding
vessels are at once ligatured, and blood removed with sterilised
pledgets of tow.

2. Opening the inguinal canal. — The loose connective tissue in the
inguinal canal must now be thrust on one side, both index fingers and
possibl}' the thumbs being emplo}'ed, and an entrance effected in the
direction of the inner abdominal ring. The index and middle fingers
of the hand corresponding to that particular side of the animal are
then passed into the inguinal canal to make sure whether the processus
vaginalis and remainder of the spermatic cord lie there. Should the
testicle be met with at this stage (retentio inguinalis), the operation
becomes very simple, being, in fact, just like ordinary castration.
Sometimes a more or less degenerated process of the- tunica vaginalis,
perhaps as large as the finger of a glove, together with the end of the
epididymis, may be felt in the inguinal canal. In that case the inner
abdominal ring must be examined by introducing the index finger, and
its width discovered. Generally it is very narrow, and would not even
permit the passage of the rudimentar}- testicle. As it is difficult to
dilate, I prefer in such cases to ignore the process of the tunica
vaginalis, and seek an entrance to the abdominal cavity alongside of
it. When the inner abdominal ring appears wider, the processus
vaginalis is to be divided and the operation continued as after
perforation of the abdominal walls.

3. Perforation of the abdominal icalls. — By passing the fingers,
nearly to the last knuckle, into the inguinal canal, the abdominal wall
can be felt in the depths. The posterior border of the obliquus
abdominis and the fibres of the obliquus internus can be clearly
distinguished. Close behind the latter is a mass of loose connective
tissue. Degive makes his perforation at this point. Like Bang, I
prefer entering through the inner oblique abdominal muscle at the
inner wall of the inguinal canal, somewhat nearer the median line than
the inner abdominal ring. This produces a "button-hole woun'd,"
which does not gape, but, on the contrar}-, soon comes together again
and prevents prolapse of the bowel. A vigorous thrust with the index
and middle fingers during inspiration carries them through the
abdominal wall into the peritoneal cavity. Different animals, however,

INGUINAL OPERATION ON CRYPTORCHIDS. 245

present great differences in this respect ; in some perforation is easy,
in others it requires considerable force.

4. Finding the testicle or spermatic cord is always the most
difficult part of the operation for the unpractised ; nevertheless it
can generally be effected with the first two fingers, and without in-
troducing the entire hand. As soon as the abdominal wall is perforated,
search is made on all sides for the testicle, epididymis, or spermatic

Fig. 254. — Transverse section of the posterior abdominal region in a vertical
plane. This figure shgws the insertion and arrangement of the obliquus
abdominis internus and the cremaster. The peritoneum and transverse
abdominal muscle have been removed.

o..\ I. Obliquus abdominis internus. p.m Posterior margin of same. c.
Upper portion of the cremaster muscle (dividedj. R..\. Rectus abdominis
muscle. L..\.R. The dotted line shows the position of the lower abdominal
ring. L'.A.R. The dotted line indicates the upper abdominal ring. L. The
dotted line shows the point at which the hand pierces the peritoneum in the
operation for abdominal cryptorchidism, p. Pelvis. R. Rectum, bl. Bladder.

cord. The testicle may easily be mistaken for an empty loop of bowel,
but is distinguished by its sharper outline and greater firmness ;
pressure on it causes struggling. The end of the epididymis is
recognised as a soft mass, containing harder, firmer cords. The
spermatic duct can be felt as a hard cord, and is very useful for
discovering and drawing forward the testicle, for its slight size and

246 OPERATIVE TECHNIQUE.

thread-like hardness render it easily recognised. It can, rrtoreover, be
brought forward with much less difficulty than the testicle itself, which,
when grasped and pulled on, causes struggling. The object to seek,
then, is a very small body, possessing a hard, string-like cord
(spermatic cord). As a large mesenteric artery might be mistaken
for it, the cord should be examined to detect pulsation. It is much
easier to discover the spermatic cord than the testicle. When drawn
forward, the spermatic cord is recognised by its light colour. By
gently pulling on it the testicle is drawn upwards through the opening,
though in exceptional cases the testicle may be so large as to offer
considerable resistance. As soon as the testicle appears outside the
wound, two, or if it be very large, three, carefully disinfected catgut or
silk ligatures are passed round the spermatic cord, which is then cut
off half an inch below the point of ligation, and allowed to return to
the inguinal canal. Not infrequently, however, the cord cannot be
brought into the wound. The testicle must then be recognised by
touch, and removed with the ecraseur. In cases of double-sided crypt-
orchidism the operation may be performed on each side in succession,
or, if the spermatic cords be sufficiently long, both testicles may be
removed through one wound. Some authorities allow an interval of a
month to elapse between the first and second operations. The wound
is closed with five to eight silk threads, powdered with iodoform-tannin
(i — 3) or boric acid, and covered with a layer of wood-wool or carbolic
wadding. Only when the spermatic cord or wound has been soiled is
it necessary to wash out with sublimate solution.

This completes the operation, and the animal can be allowed to
rise. Once on its feet, a suspensory bandage can be applied if thought
necessary, but must be omitted if the animal be restless. The patient
is tied up for four days and kept on half rations, after which it may be
allowed to lie down, still wearing the dressings, which are removed,
however, after six to eight days.

To diminish the danger of prolapse of the bowel the stall should be
higher at the back than at the front, so as to elevate the animal's
hind quarters. The tail should be plaited and fastened to one side.

Should the bowel protrude during operation the inguinal canal may
be plugged with antiseptic gauze after removing the testicle. The
skin must be sutured. Degive also sutures the external abdominal ring.
A loop of intestine may descend after operation. In such case attempts
may first be made to return it by passing the hand into the rectum
and exercising traction, but if the intestine has been exposed to the air
the horse must be cast, the gut well disinfected and carefully replaced.
Bang sutures the muscular wall of the abdomen or the peritoneum.

i

COMPLICATIONS OF CRYPTORCHID OPERATION. 247

Peritonitis or septicaemia is usually rapidly fatal, though the first
occasionally takes a chronic course of several weeks before death
supervenes.

As a rule, little or no pus is formed, but should it appear, the front
and back stitches in the skin wound may be loosened, and the latter
washed out once daily with carbolic, creolin, or sublimate solution.
Provided fever or loss of appetite is not marked, after-treatment is
unnecessary, and the animal may return to work in about fourteen days.

I.C.L.A.R. r.T. P

Fig, 255. — The prepubic and inguinal regions seen from below. fOn either side
of the middle line is visible the lower abdominal ring and the entrance to the
inguinal canal.)

l.c.L A.R. Inner commissure of the lower abdominal ring. o.(".l..\.r. Outer
commissure of the lower abdominal ring. i.l. Inner lip. o.l. Outer lip.
O.A.I. Obliquus abdominis internus muscle, t. Testicle covered with the tunica
vaginalis propria. It has descended as far as the lower abdominal riny
(inguinal cryptorchidism), g. Fibrous band representing the gubernaculum
testis. L. The dotted line shows the position and direction of the opening
made in the obliquus abdominis internus muscle when operating by Bang and
Moller's method. c.T. Common tendon of the abdominal muscles. P. Section
through penis, s. Skin m. Median line.

Sometimes great difficulty is experienced in finding the testicle.
One operator recommends passing the hand towards the bladder,
finding the vas deferens, and tracing it back towards the testicle.
Occasionally the testicle cannot be found. Even so skilled an
operator as Degive failed m four instances; Sand relates two, Bayer
one or more. Should it prove impossible to withdraw the testicle
Degive divides the spermatic cord, and allows the testicle to fall back
into the abdomen. When the enlargement is cystic Degive brings the
testicle near the inguinal ring, thrusts a fine trocar through the

248 OPERATIVE TECHNIQUE.

abdominal wall, draws off the fluid, and is then able to pull the col-
lapsed gland into the canal and remove it. Professor McQueen
ruptures dropsical cysts with the finger and thumb.

If other means of finding the testicle fail, the disengaged hand can
be introduced into the rectum, and attempts made to force the testicle
through the opening ; but this should ba a last resort, on account
of the difficult}- of afterwards disinfecting the hand. Thus exposed,
the testicle is secured with a cord co\ered with cotton wool, the
hand which has been introduced into the rectum is at once cleansed
and thoroughl}- disinfected, and the operation proceeds as above
described.

\Mien the spermatic cord is \'er\' short it renders ligation par-
ticularl}- difficult. Dtgi\e under such circumstances emplo}s the
ecraseur.

In one case Moller was unable to find the testicle. He therefore
introduced the entire hand into the abdominal cavity (a proceeding
which is nuich less risk\- than is often supposed) and disco\'ered a
soft bod}- the size of two fists. This he at first took to be the urinar}'
bladder, which further examination showed, however, to be in its
normal position, whilst the soft bod\' la}- near the inner abdominal ring,
was movable, and carried at one end a firm object which resembled a
testicle. Convinced that he had to deal with a degenerated testicle,
he extended the opening in the skin and abdominal walls sufficiently
far to allow the testicle and spermatic cord to be ligatured. After
remo\ing the testicle and suturing both the skin and abdominal walls
with strong silk (interrupted sutures), reco^■er}• occurred without com-
plication.

A closer examination showed that the testicle had almost entirel}-
disappeared, and a c\st containing sixteen ounces of serum, and having
a circumference of fourteen inches, had formed in the spermatic cord.
At the lower end of the cord lay a lipoma, about the size of a duck's
egg, and partly ossified. He was inclined to regard this tumour as the
degenerated testicle until his attention was directed by Degive, who
has repeatedly seen similar cases in his extensive practice, to h}-drocele
of the spermatic cord. Degive scratches the h}'drocele with the finger-
nail until it discharges into the abdominal ca\'it}', when the testicle
can easily be removed.

Castration of cryptorchid boars is similar to that of horses, with the
one exception that a flank incision is preferable. Levens describes a
case where the castrator had removed the boar's kidney instead of the
testicle, as was discovered on slaughtering the animal. The other
kidney had undergone compensatory h3'pertrophy.

VENTRAL OPERATION ON CRYPTORCHIDS.

249

The ventral operation can either be performed from the flank or
the lower surface of the abdomen. Both methods have been recom-
mended, but neither is now much practised.

The horse having been cast and placed on its back, the seat of
operation is thoroughly cleansed and disinfected. Gunther, who
adopted the low operation, made a longitudinal incision of about four
to five inches, commencing opposite the free extremity of the sheath
and 2 to 2h inches distant from it and passing backwards. This

Fig. 256. — Showing position of incision in inguinal operation for cryptorchidism.

incision exposed the ^'ellow elastic abdominal tunic, which was next
incised until the rectus abdominis muscle came in view. The rectus
abdominis was partly cut and partly torn through as far as the tendon
of the transversalis abdominis, the fibres of which were divided ; the
peritoneum, thus exposed, was penetrated with a sharp thrust with
the forefinger. By inserting and spreading out the other fingers the
opening in the transverse muscle was sufficiently enlarged in the

250 OPERATIVE TECHNIQUE.

direction of the muscular fibres to permit of the hand entering easil}'.
The paralysing effect on the arm, due to muscular contraction, which
proves so troublesome in certain other methods, was thus prevented.

Should difficulty be experienced in finding the testicle Giinther
advised passing the hand towards the bladder, discovering the vas
deferens, and following it up to its point of origin in the testicle.
Another method consists in finding the spermatic artery at its point
of origin, and tracing it as far as the testicle.

Giinther strongly recommended this mode of operation, but later
authorities by no means support him. Frohner condemns it entirely.
He. lost two out of four horses operated on : one died in consequence
of the stump of the spermatic cord protruding between the widely
spaced sutures in the yellow elastic abdominal tunic and becoming
infected, thus setting up fatal peritonitis. In the second case the
elastic tunic and the skin were very carefully sutured, notwithstanding
which a prolapse of bowel occurred on the fourth day. The bowel
was thoroughly disinfected and returned, but septic peritonitis occurred
and proved fatal. In the next two cases Frohner sutured each layer
of tissue separately, firstly the peritoneum, then the rectus abdominis,
then the yellow elastic tunic, and finally the skin. Both cases did
well. Frohner, however, draws attention to the inconvenience and
difficulty of the procedure. Bayer has twice successfully operated by
this method.

Castration of Female Animals (Oophorectomy).

The castration of female animals, consisting in removal of the
ovaries, is less frequently performed than the corresponding operation
in the male. It is said to have certain valuable economic results ; thus
young pigs and cows are thought to fatten more satisfactorily after-
wards, and milch cows to remain longer in milk ; bitches are castrated
to prevent their breeding, and to avoid the unpleasantness associated
with their coming on heat. Sows and cows are the most common
subjects of operation, and for this reason will first be considered.

I. Cows not only fatten better, but their milking period is con-
siderably prolonged after castration. As earl}- as 1850 Charlier
recommended castrating cows thirty to forty days after the birth of the
second or third calf, following which the yield of milk was said to-
remain steady as at the time of castration. Although this expectation
has not been entirely fulfilled, cows are still castrated in order to
prolong their milk-yielding period, and to increase their capacity for
fattening. The operation has been sporadically revived and again

OOPHORECTOMY. 251

abandoned. At the time of the writer's stay in Germany and Austria
(1892 and 1893) it was extensively practised, but later inquiries show
that it has been again rehnquished, and is now seldom spoken of.
Attempts have also been made to practise it extensively in England,
but without much success. Even although peritonitis is avoided, the
rumen is apt to become adherent to the wall of the abdomen and
digestive disturbance to follow. Hendrickx claims that in one respect
castration acts as a prophylactic against tuberculosis, inasmuch as it
prevents the bearing of calves by animals suffering from or disposed
to this disease. As the calves of old animals are particularl}' inclined
to contract tuberculosis, Hendrickx recommends castrating cows at
the age of eight years.

Castration is successfully employed in cows as a cure for n^'mpho-
mania. Albrecht operated on fifty animals with this object , forty-
two were completely cured, in three cases the operation failed, and
in five cases was only partially successful. Of twenty-five after-
wards operated on, twenty-three were cured. After castration the
broad uterine ligaments again become tense, the milk secretion and
character of the meat improve, and the proportion of fat in the milk
increases.

The old operation of removing the ovaries by the right flank was
wisely abandoned in favour of the method introduced by Charlier, viz,
removal through the vagina. That the latter deserves preference,
except in those cases where strict antisepsis can be observed, is shown
by Lanzillotti's observations. At the present time Charlier's method
is almost exclusively employed.

In the cow the ovaries lie below the transverse processes of the
fourth to the sixth lumbar vertebrae, level with the external angle of the
ilium, but about 2 to 2j inches nearer the middle line. They are nearly
the size of walnuts, are flattened, rounded, and of firm consistence,
for which latter reason they are easy to recognise. When diseased,
however, as in nymphomania, either one or both may be very much
enlarged.

Charlier's operation is performed as follows : — The animal, which
must be in good health, receives half rations on the evening before, and
no food whatever on the morning of operation. The operation is best
performed with the animal in the standing position, and in its stall.
The head is fastened up short, and two men standing near the hind
quarters prevent the animal moving to either side. One of these men
holds the tail whilst both grasp a round pole passed under the cow's
body to prevent it lying down. In case of severe straining, on the
other hand, they place the pole on the cow's back, on which they

2=^2

OPERATIVE TECHNIQUE.

press. The rectum is emptied before operation. For this purpose
Hoffmann injects six fluid drachms of glycerine. The necessary
instruments are — (i) a vaginal speculum : (2) forceps for torsion of the
ovaries, or a metallic finger-stall for scraping through their attachments,
or. again, a long ecraseur ; (3) a bistoiiri cache.

Although, on account of the impossibility of thoroughly disinfecting

Fig. 257. — Transverse section of the posterior abdominal region in a vertical
plane. The subject is a mare, and the section passes just in front of the first
lumbar vertebra. The figure shows the position of the uterus as seen from
below and that of the ovaries above the broad uterine liorament.

o. Ovary, h. Horns of the uterus, u. Uterus, u.l. Broad uterine ligament.
R. Rectum. .\.\v. Abdominal wall. p. Pelvis, i.l.v. First lumbar vertebra.

the vagina, asepsis cannot be insured, yet all ordinary antiseptic pre-
cautions should be observed, the vulva and entrance to the vagina-
being washed with soap and water and freely rinsed with a disinfectant.
Hlirliman recommends injecting a 2 per cent, carbolic solution into
the vagina and afterwards drying the parts with sterilised cotton wool.
One per cent, sublimate solution has been recommended for this

OOPHORECTOMY— CHARLIER'S OPERATION.

-Do

purpose, but is unsuitable because it causes severe irritation of the
nuicous membrane and straining, both of which interfere with
operation. Needless to say the hands and instruments must be care-
fully disinfected.

The vaginal speculum is introduced in the closed condition, and
opened by screwing the handle. The right hand, holding the

A.W.

Fig. 258. — Transverse section of the posterior abdominal region in a vertical
plane. The subject is a cow, and the vertical plane passes in front of the last
lumbar vertebra. The figure shows the position of the uterus and the insertion
of the ovaries in the uterine ligaments (seen from above).

o. Ovary, h. Horn of the uterus, u. Uterus. B.u.L. Broad uterine liga-
ment. V. Vagina. r. Rectum. p. Pelvis. .\.\\. Abdominal wall. l.l.v.
Last lumbar vertebra.

closed histouri caclie, is then introduced into the vagina, through
the upper wall of which an incision about 2 to 2^ inches in length
is made. The bistoury is then laid aside, the vaginal speculum
removed, and the index and middle fingers of the right hand are
passed through the vaginal wound into the abdomen, where the
left ovary is first sought, and drawn into the vagina. The forceps

254

OPERATR'E TECHNIQUE.

for twisting off the ovary are next introduced with the left hand,
and whilst the right hand, the thumb of which is covered with
the metallic thumb-stall, grasps the ovarian ligament, the left slowly
rotates the forceps until the ovary is freed. The right ovary is
removed in a similar fashion, the right hand, however, taking the
place of the left, and vice versa. No special after-treatment is required.
Any blood which may have passed into the vagina during operation is
removed with the hand or with a clean sponge. The vulva is washed

Fig. 259. — Longitudinal section in a vertical plane through the urino-genital

organs of a mare.

o. Left ovarv. b.u.l. Broad uterine ligament, l.h. Left horn of the uterus.

u. Uterus, v. Vagina, bl. Bladder. R. Rectum, p. Section through pelvis.

A.w. Abdominal wall. e.s. Excavatio superior, e.r. Excavatio recto-vaginalis.

E.v. Excavatio vesico-vaginalis. e.i. Excavatio inferior.

once or twice a day with a disinfecting fluid. Healing proceeds
regularly, and without complication. No special difficulty is usually
found in operating, and after some practice the operation is not
difficult.

When this method became better known many modifications were
proposed.

Charlier himself afterwards constructed another form of vaginal
speculum, because the arms of the first sometimes proved too weak.
Further modifications have since been effected by different operators.
Colin incised the upper vaginal wall close behind the os uteri with a

OOPHORECTOMY— CHARLIER'S OPERATION,

^55

guarded bistoury (Fig. 263), without using a speculum; whilst Richter, in
order to avoid injuring the rectum, recommended forming a fold in the
upper wall of the vagina, and incising this with a bistouri cache- {listened
to a long arm, or with special long scissors. Hurliman also dispensed
with the speculum, and to escape injuring the rectum pressed the
lower wall of the vagina downwards towards the bladder. Ostertag
recommends incising only the mucosa, and breaking through the
muscular and serous coats with the finger.

Danger of injury to the rectum is not great provided the above-
described precautions are observed.

When twisting off the ovaries, the lower, thicker portion of the

Fig. 260. — Longitudinal section in a vertical plane through the urino-genital
organs of a cow.
o. Left ovary, l.h. Left horn of uterus, u. Uterus, b.u.l. Broad uterine
ligament. c. Neck. v. Vagina. bl. Bladder. UR. Urethra. u.v. Valve
covering the opening of urethra. R. Rectum. p. Section of the pelvis. .\.w.
Abdominal wall. e.S. Excavatio superior. e.r. Excavatio recto-vaginalis.
E.v. Excavatio vesico-vaginalis. e.i. Excavatio inferior.

ovarian ligament may be cut through wath long scissors (Fig. 264) and
the rest divided b}' torsion. Special forceps have been invented to fix
the ligament. Colin uses for this purpose small iron clams (Fig. 269).
The ovarian ligament is grasped with one or other of these instru-
ments, and the ovary removed with the hand. Should the ovary still be
adherent after twenty or thirty rotations, the ligament may be scraped
through by means of a steel finger-stall, which, however, is seldom
needed, torsion being usually sufficient. Of late years the ecraseur
has been largely employed for removing the ovaries, but it must be of
greater length than usual ; it greatly facilitates operation. The

256

OPERATIVE TECHNIQUE.

experiment has been tried of simply dividing the ovarian Hgament
with a knife, but it is dangerous, and may be followed by severe
bleeding or even by death. Hiirliman divides the ovarian ligament
with scissors up to the point through which the arter}^ passes.

Open.

Fig. 261. — Charlier's vaginal
speculum (early form).

Closed. Open.

Fig. 262. — Charlier's vaginal speculur
(later form).

and ligatures the vessel with sterilised silk. The artery may be
identified by its pulsation.

To prevent air and infective material entering the peritoneum it
has been recommended not to draw the ovarv into the vagina, but to pass

(30PHORECTOMY~THE ANTISEPTIC METHOD. 257

a ligature provided with one short and one long end over the thumb,
index, and middle fingers of the left hand and into the abdomen, to
slip the loop over the ovary, and draw it tight with the right hand.
The ends are cut off about three eighths of an inch from the knot, and the
ovary usually removed at a similar distance from the ligature. One
operator claims to have remox'ed both ovaries in twelve minutes.

Without doubt this method securely guards against bleeding, but
whether it guards equally well against peritonitis
appears very doubtful. Even though ligatures are
carefully sterilised they are very apt to become
soiled in the vagina, and so cause peritonitis. For
this reason removal of the ovaries by torsion or by
the ecraseur appears preferable, and offers equal
security against bleeding.

Hoffmann describes the antiseptic method. The
vulva and neighbouring parts are thoroughh' brushed
with warm soap and water, warm water is injected
into the vagina, and the parts are cleansed with the
disinfected hand. After removing the ^\•ater with
the hand or with the help of a rubber tube, Hoff-

mann rinses out the vagina with a disinfecting fluid.

Fig. 263. — Guarded
bistoury for incis-
ing upper wall of
vao-ina.

such as a 3 per cent, creolin solution, and again

washes it with the left hand. The speculum is

then passed as far as the os uteri with the same hand, and the right

hand, carrying a bistouri cache, being introduced, an incision is made

through the upper wall of the vagina. The ri;;ht hand is then passed

Fig. 264, — Scissors for dividing ovarian ligament.

through the opening into the peritoneal cavity, the left ovary is found,
grasped between the index and middle fingers, and drawn into the
vagina, where it is twisted off by means of forceps. The right ovary is
removed with the left hand. To prevent straining after operation a
pole is passed over the animal's loins. A few hours after the operation
the temperature rises to 102-3° F-j but falls to normal within the next

17

258

OPERATIVE TECHNIQUE.

few days. Should it, however, remain high, the vagina is washed out
with creoHn solution.

2. Female lambs are seldom castrated. Obich operated on ten
weeks old animals from the left flank. The incision was sufficiently

Fig. 267. — Metal finger-
stall for scraping through
the ovarian ligament.

KiG. 266. — Forceps for
grasping ovarian liga-
ment in torsion of the
ovary.

Fig. 269. — Finger

clamps for grasp- Fig. 270. — Guarded bis-

FiG. 265. — Forceps for grasping ovarian ing ovarian Hga- toury for incising upper

ligament in torsion of tlie ovary. ment (Colin). wall of vagina (Colin).

large to admit the index and middle fingers into the abdomen. The
ovaries were drawn towards the opening and were snipped off with
scissors. In twelve cases healing was uninterrupted, but in one lamb
an abscess occurred at the point of operation.

OOPHORECTOMY IN MARES.

259

Hering castrated six two-year-old sheep from the flank for the
purpose of discovering whether the yield of wool would prove greater
after operation. In two only the left ovary could be reached. The
operation was well borne, though it failed in its object.
The animals fattened earlier than their fellows.

3. Mares are only castrated for nymphomania, a
disease which appears to be more frequent in coarse
than in well-bred animals. Cadiot has frequently per-
formed this operation during the past few years, and
on the whole has had good results, although in some
cases the object, viz. to render animals quieter and
more tractable, has not been attained, a point to which
Harms and Thomassen had previously directed atten-
tion. In mares, however, castration is always more
difficult and more hazardous than in cows.

The principal danger consists in the well-known
sensitiveness of the horse's peritoneum. The difficulties
consist partly in the fact that irritable and well-bred
animals can seldom be operated on in the standing
position, this only being possible, as a rule, in coarse-
bred horses, which can be restrained in a trevis.
Furthermore, in the mare the ovaries are much further
removed from the vulva, and the ovarian ligament is
shorter than in the cow, so that it is impossible to
draw the ovaries into the vagina, in order to effect tor-
sion. The operator therefore has to introduce both
the hand and the instrument into the peritoneal cavity,
necessitating a much larger vaginal wound.

In the standing position the operation resembles
that in the cow. Should a trevis not be at hand the
hind limbs must be fastened with ropes, and a couple
of strong poles or a strong sack be held under the body
to prevent the mare lying down. The rectum must be
entirely emptied. Hard fseces in the rectum are liable
to cause injury to the bowel when the vagina is incised.
As in the cow, the vaginal wall is divided above the os
uteri, after preliminary cleansing and disinfection of the
vagina, the vulva, and its neighbourhood. The injec-
tion of irritating fluids into the vagina must be avoided. Even i per
cent, sublimate solution, especially if used warm, irritates the mucous
membrane considerably, and causes straining, which interferes with

26o

OPERATIVE TECHNIQUE.

operation. -The best disinfectant is a cold 2 per cent, solution of lysol
or creolin. After perforating the vagina, the right hand is introduced
into the peritoneal cavity, and the ovary sought for below the last lumbar
vertebra, close to the external angle of the ilium, where it lies among
the folds of intestine. In mares suffering from nymphomania the
ovaries are often as large as a duck's egg. They can be distinguished
by their firm consistence and their mobility. The left ovary is grasped
with the right hand, and a long ecraseur having been introduced with
the left ha,nd, the chain is thrust over the ovary, a somewhat difficult
manoeuvre. The operator steadies the ecraseur with the left hand,
whilst an assistant turns the screw, and so tightens the chain. At this
stage the operator must make sure, by feeling with the right hand, that

Fig. 271. — Ovariotomy with tiie ecraseur (Cadiot's method).

no portion of bowel is included in the loop of the ecraseur. As soon as
the chain begins to divide the ovarian ligament it encounters greater
resistance, and the screw should be turned more slowly until the ovary
falls into the operator's hand, whereupon it and the ecraseur are
retracted. After similarly removing the right ovary (the left hand here
replaces the right) the operator endeavours to withdraw any ex-
travasated blood from the vagina by means of the hand. The animal
is then placed m a quiet, well-bedded stall, with the hind quarters on
a somewhat higher level than the fore. After-treatment is similar to
that in cows.

In the mare the use of the ecraseur is undoubtedly preferable to
torsion of the ovarian ligament with forceps, the risk of injuring the

OOPHORECTOMY IN MARES.

261

bowel being much less. The ecraseur must be considerabh- longer
and stronger than those in common use ; Delamotte uses one twenty-
four inches in length. The chain or wire of the ecraseur must also
be stronger, otherwise it is very liable to break.

The operation becomes much more difficult when the animal has
to be cast ; to prevent the straining which always occurs under these
circumstances, deep anaesthesia is necessary ; otherwise the operation
is as above described. A few mares were operated on in this way at
the Berlin Veterinary College during the writer's period of study
there. One was an emaciated experimental animal with a short

Fig. 272. — Longitudinal incision in a vertical plane through the posterior abdo-
minal region, pelvis, and urino-genital organs of a cow. The section is
somewhat to the right side of the median plane. The figure illustrates the
second stage of ovariotomy : the hand is grasping the left ovary.

o. Ovary. u. Uterus. v. Vagina. r.h. Right horn of the uterus (cut
through). L.H. Left horn of uterus. b.u.l. Broad uterine ligament. R.
Rectum. bl. Bladder. p. Pelvis. .\.\v. Abdominal wall. E.s. Excavatio
superior. e.r. Excavatio recto-vaginalis. e.v. Excavatio vesico-vaginalis.
E.I. Excavatio inferior.

croup, in which operation proved comparativel}' eas)'. The next
was a more powerful animal with a longer croup, and could only
be castrated after deep chloroform anjesthesia. Though very difficult,
the operation succeeded. During the following few da5's there was
little disturbance, and the animal eventually proved cured. Cadiot
places the animal in a trevis, which is a great advantage. He
adopts Colin's method of cutting through the peritoneum, and con-
demns the suggestion to divide it with the fingers, on account of the
serosa dissecting off and forming a pocket. Cadiot's general procedure

262 OPERATIVE TECHNIQUE.

resembles that in cows, but he lays special stress on disinfection of the
vulva and vagina. The parts are injected and washed with 3 per cent,
creolin solution daily for two or three days before operation. He also
draws attention to the fact that immediately after operation animals
are apt to show colic, which continues from two to four days. He
condemns irrigation of the vagina after operation.

Castration of cows and mares is apt to be followed by chronic
inflammation and suppuration in the neighbourhood of the vagina,
which may continue for months, and even prove fatal. Adhesions may
also occur between the vagina and bowel or wall of the abdomen, and
lead to twist of the bowel, with fatal results. Bourges saw a mare die
of twisted intestine caused in this way three months after castration.
Delamotte reports the case of a mare in which abscess formation
followed castration. Luckily the abscess discharged into the vagina,
and recovery occurred.

4. The castration of sows is gradually being discontinued. The
improved races of swine exhibit sexual appetite to a less degree than
the old breeds. They remain on heat for a shorter time, and their
fattening suffers little in consequence, so that castration has become
more or less superfluous. The operation is not difficult, but requires
much practice, and is seldom performed by veterinary surgeons.
However, as the veterinary surgeon must have at least a theoretical
acquaintance with it, a short description of the method is appended.

It is usually performed at the age of four to eight weeks — seldom
in old breeding sows, although they bear the operation well — but must
not be performed while the animal is on heat. The best time for
castrating old animals is from four to six weeks after parturition.

In swine the ovaries hang from the long bowel-like horns of the
uterus, which possesses no distinct neck or mouth, for which reason it
is possible to reach both ovaries from one flank, or to introduce a
director into the uterus, and by thrusting the organ towards the linea
alba to remove the ovaries from the abdominal floor. For this reason
two methods of operation are in use, one from the flank and one from
the lower wall of the abdomen. The first is practised as follows :

The animal is placed on the right side, with the head and neck on
the ground, and the hind quarters lying in front of the left knee of the
operator, who sits on a stool. The hind legs are held extended
backwards under the operator's left arm by an assistant, whilst the
operator himself presses the animal's head and neck on the ground
with his right foot.

The knife usually employed has a short broad blade, with a rounded

CASTRATION OF SOWS. 263

cutting edge, and is unprovided with a spring, so that it can easily be
opened or shut with one hand. After cHpping away the bristles the
primary incision is made in the left flank, about ij to if inches in
front of the outer angle of the ilium, in the direction of the outer
abdominal muscle, that is, from above forwards and downwards.
Other operators make it at right angles to the vertebral column. The
opening must be sufficiently large to permit of the right index finger
being introduced, and the abdominal muscles and peritoneum being
pierced. During an inspiration, or at the moment when the pig
squeals, the finger is suddenly thrust through the abdominal tunics,
thus preventing the peritoneum dissecting away from the abdominal
wall, which would not only render the operation difficult, but might
also lead to troublesome sequelae. With the index finger in the
abdominal cavity, the operator first secures the left ovary, which is the
size of a bean, of firm consistence, and lies nearl}^ equidistant from the
external angle of the ilium and the middle line of the sacrum. When
the ovary or the uterus is grasped the animal usually squeals, a fact of
considerable importance in guiding the operator. The left ovary is
drawn outwards and held by the right hand, whilst the index finger
and thumb of the left hand gradually bring the left horn of the uterus
into the wound, and finally into the right hand. As soon as the
point of union of the two uterine horns becomes visible, the operator
draws forward the right horn, together with the right ovary, in a
similar fashion. Both ovaries are now nipped or torn off with the
finger nail, or cut off with a knife. In young animals the entire
uterus is often removed without bad effect. In older sows only the
ovaries are removed, and care must be taken not to draw forward the
body of the uterus. The uterine horns are then returned to the
peritoneal cavity, the skin wound is sutured, and the animal placed
alone in a clean, cool stall. During the ensuing twelve hours it
should only receive clean water or small quantities of readily digestible
food. On the following days gentle exercise may be given.

Many modifications of these methods have been suggested. Thus
the operation may be performed with antiseptic precautions, which,
however, experience shows to be unnecessary. In older sows, the
abdominal muscles are also cut through, leaving only the peritoneum
to be divided with the finger. Should the operator attempt to divide
the muscles by means of the finger in such animals, a pocket is
formed into which a coil of intestine may pass, become adherent, and
cause death, either from peritonitis or from incarceration. In such
cases the operator is often erroneously blamed, it being thought that
he has sutured the bowel to the abdominal wound.

264 OPERATIVE TECHNIQUE.

Beginners are advised to perform one or two experimental operations
in order to gain some experience, otherwise they may be unable to find
the ovaries. The extreme dexterity which can be attained, however, is
shown by the professional castrator. Bowman, for a wager, castrated
100 sows in 160 minutes.

Castration from the white line is less frequently performed, though
for unpractised operators it is easier than the former. The animal is
hung up by its hind legs, or placed on its back on a table, and a bent
director, the shape of a ver}' elongated S, and about ten inches long, is
passed along the upper wall of the vagina and uterus, so as to avoid
the meatus urinarius. The director is pressed against the lower
abdominal wall, about two inches in front of the anterior edge of the
OS pubis. A special spade-shaped knife is then passed through the
abdominal wall, either towards the outside of the last left teat, or
close to the linea alba. With the help of a blunt hook, the uterus is
then found from this point, a comparatively easy task, inasmuch as the
organ can be pressed towards the opening by means of the director
previously introduced. With the uterus as a guide, one of the horns
is discovered and the ovary removed ; the second is operated on in a
similar fashion. The skin wound is closed with button sutures, and
usually heals by primary intention in five to six days. After-treatment
is as above described.

The most important sequelae to be dreaded are fatal bleeding and
peritonitis. Death from bleeding seldom results after the first- twenty-
four hours, but peritonitis may prove fatal within a period of from
three to thirty-six days. Such results are favoured by the custom
observed in some places of driving swine soon after castration. Fatal
bleeding is best prevented by nipping or twisting off the ovary ;
peritonitis b}' observing antisepsis, as in all operations on the peritoneal
ca\ ity.

5. Castration of bitches is seldom performed, and onh- for the
purpose of avoiding inconvenience caused by the animal coming on
heat. When young, and not too fat, these animals appear to bear
operation well. The manipulation is more difficult than in swine, and
can only be mastered by considerable practice, especially when the
operation is performed from the Hank, as in swine. In the bitch, the
ovaries lie much further forward, near the kidneys ; they are small and
enveloped in fat ; the ovarian ligament is short.

The bitch may be secured like the sow, or may be laid on its side
on a table. The incision is made about ij inches from the external
angle of the ilium, and the same distance from the transverse processes

CASTRATION OF BITCHES. 265

of the lumbar vertebrae. It should be about if inches in length, and
should follow the direction of the outer oblique abdominal muscle,
which may be divided at the same time as the skin. In the event of
the operator desiring to remove both ovaries from one side, which is
only possible in small animals, the incision must not be made too tar
forward. On the other hand, when an incision is made on either side,
each may be placed somewhat further forward.

The abdominal wall is pierced with the index finger of the right
hand as in swine, and the linger is passed towards the under surface
of the fifth or sixth lumbar vertebras in order to find the ovary, which
is the size of a bean, and lies close behind the kidney. Though the
ovary may not be found, the horn of the uterus is almost immediately
encountered and should be drawn forward, when the ovar}- will be
discovered, and can be nipped or cut off. B}- utilising the left horn of
the uterus, the right may also be drawn forward and the ovary
removed in a similar way. Both horns of the uterus are then returned
to the peritoneal cavit}-, and the skin wound is sutured.

To prevent the peritoneum stripping away from the abdominal
wall and forming a pocket, some operators, after dividing the outer
skin and abdominal muscles with a knife, perforate the peritoneum with
a director instead of with the finger. The director is then thrust into
the abdominal cavity, and the opening enlarged b}- passing the knife
along its groove. This prevents injury to the bowel.

It is often difficult to draw forward the right ovary, especially if
the incision be made far forward. Some of the most experienced
operators recommend making a second incision in a similar position
on the right side, and repeating the process.

Castration from the linea alba is easier for beginners, and is
performed as in swine. When, however, the udder is well developed,
or the animal is old, difficulties arise. The animal is placed on its
back on a table and anaesthetised. A strong director, with a slightl}'
bent end, is passed along the upper wall of the vagina into the uterus.
It is certainly not so easy to introduce as in swine, but the difficulty is
overcome by pressing the end of the director towards the upper wall
of the vagina. Arri\-ed in the uterus, the end is then turned towards
the lower abdominal wall, so that its presence can be recognised
about ij to 2 inches in front of the edge of the os pubis. At this
point an incision ij to 2 inches in length is made close to the linea
alba, the peritoneum is pierced with the finger, and with the help of
the director the uterus is discovered ; from this the ovaries are easily
found, and can be removed by torsion, or by nipping or tearing off.
The skin wound must be carefully sutured and treated antisepticall}-.

266 OPERATIVE TECHNIQUE.

It has been suggested that in young animals a double ligature might
be applied close behind the point of bifurcation of the uterus, and the
organ divided between the two ligatures without the operator troubling
to discover the ovaries. Whether this would destroy the sexual
appetite or only the reproductive powers seems doubtful.

Several German veterinary surgeons recommend operating in the
linea alba, breaking through the broad uterine ligament, and cutting
off the ovaries after ligation with catgut. The abdominal muscles are
united with catgut, the skin with silk, and a surgical dressing is
applied by means of a bandage enveloping the whole body.

6. Castration of birds consists in dividing the oviduct. The birds
are held by an assistant as in caponing, and an incision about $ to i^-
inches in length, and about the same distance from the anus, is made
through the abdominal wall. The disinfected forefinger is introduced,
the rectum thrust to one side, and the oviduct, which lies below the
rectum, and can be recognised by its white colour, is grasped with
forceps. The duct is then drawn forward, and cut across with scissors
about three quarters of an inch in front of its junction with the rectum.
Some operators excise a portion. After returning the ends the wound
is sutured as w-as described in connection with caponing.

By slowly exercising pressure on the lower portion of the bird's body
the oviduct can be forced outwards through an incision made above
the anus. It is then cut through, and the incision sutured.

During the ensuing three or four days the birds are kept apart in a
cool quiet place, and receive light food.

Extirpation of the ovaries is dangerous in hens, and as castration
by division of the oviduct is sufficient, ovariotomy is not practised.

I N D E X.

Acupressure
Anaesthesia

— apparatus for

— dangers of

— general

— in cat and dog

— in ruminants and swine .

— indications in .

— inhalers for

— local

— — by cocaine .

— — -by infiltration

— partial

— Schleich's local

— stages of . ■ .

— surgical

— various agents for producing
Antisepsis and asepsis

— — Guerin's experiments

— — in practice .

— — Lister's experiments .
Antiseptic and aseptic methods,

cations of

— agents (various)
Arnold's inhaler
Arteries, torsion of.
Arteriotom}'
Artery forceps

Bandages, elastic .

— glue .

— pitch

— plaster

ippl

PAGE

PAGE

. 169

Bandages, starch

184

• 44

— tripolith

186

• 49

— water glass

184

• 53

" Beads," the

19

• 45

Bernardot and Butel's apparatus to

59

prevent broken back .

31

• 58

" Bistournage"

226

• 52

Bleeding .

145

50

— cannula (Dieckerhoff's) .

155

. 66

— dangers of

152

66

— results of

146

. 67

"Blinds"

6

• 49

Blood-stick

148

• 67

Blood-vessels, ligation of

166

• 51

Blunt dissection

165

• 51

" Bulldogs," the

7

■ 54

Bull-holder

8

• 71

Bull-leaders

9

• 72

. 80

Carlisle's inhaler

51

■ 73

Casting, Berlin method

36, 39

— by cart rope .

28

75

— cattle

39

• 77

— methods of

26

• 51

— Russian method

37

. 168

— Stuttgart method

31

. 156

— Vienna method

38

. 166

Castration

196

— aseptic

223

. 178

— by caustic ligature

229

. 184

— by clams . . 20

8,213

. 184

— by crushing spermatic cord

199

. 186

— — testicle

199

26S

INDEX.

P.\GE

P.\GE

Castration by crushing testicle

with the

Elastic bandage

. 178

ecraseur

203

— ligature

98, 169

— by division of cord with ca

utery

207

221

— — castration by

. 170

— by ligation of cord

200

222

Esmarch's bandage

• 163

— by scraping the cord

203

Eye, disinfection of

. 88

— by simple division of cord

207

— by tearing away testicle .

203

Firing

. 118

— by torsion of the cord

200,

203

221

— antiseptic

■ 125

— complications during and after

232

233

— complications after

130

— dangers of

202

— irons

. 119

— fever

235

— — petroleum furnace for heat

ing. 125

— for cure of enlarged prostate

196

— precautions to be observed

. 126

— of birds

231

— results of

. 128

— of bulls

225

— treatment after

. 128

— of cats

231

Fleams .

. 148

— of cryptorchids

237

Foot, disinfection of

. 89

— — inguinal operation for

242

Forceps, artery . . .

. 166

— — ventral operation for .

249

— bone

• 105

— of dogs

231

— castration (various)

. 204

— of female animals

250

— dissection

. 82

— of goats

230

— lion .

. 84

— of sheep

230

Forcipressure

. 168

— of stallions

210

— of swine

230

Gouge

. 104

Caustics (various)

"5

Cauterisation

115

Haemorrhage, methods of controll

ng . 159

Cautery, actual

118

Haimostasis

■ 159

— Dechery's

I22_

Hsemostatic agents

. 161

— Degive's

119

Heat, disinfection by

■ 76

— galvanic

102

Hippo-lasso

15

— Graillot's

121

Hobbles .

• 29

— Pacquelin's

lOI

— thernio-

1 02

Injection, hypodermic

• 174

Charlier's operation (oophorectomy)

251

— intratracheal .

• 17s

Chisel .

104

— intravenous

■ 171

Clarke's (Dr.) inhaler

50

— parenchymatous

. 176

" Covered operation," the

210,

217

— subcutaneous .

•' 174

Cox's inhaler

50

Inoculation

. 112

" Cradle," the

19

— needles

• "3

Cryptorchidism

237

— syringes

• "3

Curette . ' .

104

Instruments, "aseptic"
— cutting

. 82
• 95

Dogs, securing for operation.

13. 41

— disinfection of.

. 81

Drainage-tubes, disinfection of

86

— puncturing

95. 102

Dressing, gutta-percha

189

Intestine, disinfection of

. 87

— plaster, etc.

186

Irrigator, portable .

. 90

— poroplastic felt

189

" Issues "

. 1 10

Dressings, surgical

92,

177

Lancets .

• 147

Ear, disinfection of

88

Leg-twitch

7

Ecraseur

98,

164

Lifting feet (horse)

13

INDEX.

i6g

Ligation of blood-vessels
Ligatures

— elastic

— — castration by
Limbs, securing and releasin
Loop twitch

Massage .

Mouth, disinfection of

Mouth-gags

— Bayer's

— Gray's

— Haussmann's

— Joger's

— Varnell's

— Woolf's

Needle-holders
Needles, suture
Nose, disinfection of
Nose-rings
Nystagmus

Oophorectomy

— Charlier's operation
Operating cap

— tables
Operations, general antiseptic precau

tions before and during

— general remarks on
Oxen, securing for operation

Paquelin's cautery .

Paracentesis

Phleboliths

Phlebotomy

Pigs, securing for operation

" Plugs "

Puncturing instruments

Retractors
Roux's syringe
Rowelling scissors .
" Rowels ''

PAGE

1 66

98

98, 169

170

33 < 38

Saw, chain
— frame
Scalpels .
Scarification

190

87

8

10

13

10
II

133
132

51

250

251

7

20

17

lOI

103
160

145

40

no

102

84

114

109
no

106

105
. 82

145, 156

Scissors .

Seton needles

Setons

Sharp spoon

Sheep, securing for operatio

Side-stick

Skin, disinfection of

Spaying .

Sponges, disinfection of

" Standing operation," the

Steriliser, steam

Stocks

Styptics .

Suture materials

— — disinfection of

— needles
Sutures, bowel

— buried

— button

— coaptative

— continuous

— directions for inserting
• — figure-of-8

— glover's

— interrupted

— nerve

— pin .

— quilled

— relaxation

— tendon

— tension

— uniting
Syrmge, Roux's

— sterilisable

Thrombus formation

Torsion of arteries .

Tourniquet

Transfusion

Trephine .

Trevis

Trocar

" Twitches "

Uterus, disinfection of

Vagina, disinfection of

Wounds, methods of uniting

14.=

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