ty ty Ye Yi HY Yi, Yj ty Zi Yj Yj Vv Ly ty Yi SF ais FRG o | Cornell University Library | SF 911.F890 Ou ment of w < « 5 Z a ul kK & a a Date Due @ OUTLINE OF THE ANTISEPTIC TREATMENT OF WOUNDS FOR VETERINARIANS. BY H. FRICK, COUNTY VETERINARIAN OF HETTSTEDT, GERMANY, Translated from the Latest German Edition by ALEX, EGER WITH ANNOTATIONS BY A. H, BAKER, V. S. PROFESSOR OF THEORY AND PRACTICE OF VETERINARY MEDICINE AND SURGERY, PHYSIOLOGY AND OBSTETRICS, CHICAGO VETERINARY COLLEGE, AND L. A. MERILLAT, V. 5S. PROFESSOR OF SURGICAL THERAPEUTICS AND DENTAL SURGERY, MC KILLIP VETERINARY COLLEGE, CHICAGO. CHICAGO: ALEX. EGER, 1900- if Entered according to act of Congress in the year 1899, by ALEXANDER EGER, in the office of the Librarian of Congress at Washington. All rights reserved. = SF - TH TRANSLATOR’S PREFACE. Being but a layman, and fearing that, by changing terms and reconstructing sentences, I might not exactly convey the ideas of the author, I simply made a literal translation, and left the arduous task of reconstructing all such sentences which would possibly impair the sense of any part, to Pro- fessors A. H. Baker and L. A. Merillat, who have also written many valuable annotations, thus bringing this little work to an up-to-date level. To these gentlemen belongs the credit of this addition to Veterinary Literature, and I hereby ex- press to them my sincere thanks for their labor in arranging the matter. If my readers, refraining from severe criticism, can obtain any useful information from these pages, I will feel fully repaid. A. E. Chicago, December 15th, 1899. PREFACE siiiosdu deniginsnae wouberiec cases aug Aor au ieee 3 INTRODUCTION wie eiaccainun taiesacas theses teeaseaaee 5 GHAPTER I. HISTORICA Ly caocaaananuieuod oy eee neem 7 CHAPTER II. INFECTION OF WOUNDB............ 15 pall aan eae nregea i454 kien PUAa Ee em aE oe a6 2. Hands and Clothing of Operator................0005 17 3. Foreign Bodies ........ cc ccc cece cc cee ne ne cence eees 18 4. Resting Place of Patient.......... 0... cc cc ee cece eens 19 * 5. Instruments and Bandaging Material................. 20° 6. Vicinity of the Wound ......... ccc cece cee ee eee eee 2 CHAPTER III. ASEPSIS, ANTISEPSIS AND DIS- INFECTION vcs.cadwads 3 cwexe ehwenda vs.cere nade 23 1. Bandaging Material: : ici. cose scsesweni vanessa canoes 23 2. Disinfection Materials ......... ccc cee ee ee eee eee eee 26 (a): Sublimate: ociaoss wipers svaauedeuaneae deeds aogies 29 (b) Lodin€:.2s sis soe 2 decseaaee ves ca eeedey ye ye ee tienes 33 CG)? TOA GEOR iz. se iatenesi dhe gers -< aipustaaeacion deed Ane leegpt 33 (d) Iodol and Iodine Trichlorid ..................06- 36 (e)} Carbolie Acid <: cesses pe eciaws adewed quicsredtadenee 36 (GE) \GreOlitie ooc0 a idikcoiinte ven east Kade eee seek ee Beee 38 (z) Salicylic ACig: eae cee ve nen shea ona aires Saeed 30 (h) “Boti¢: Acids eis paketeeeeersie adage svar eseencas 30 G) Acetic Alumina. cic esos ec cescsseveosae dessa enna 39 Cf) (CHIOBIdE: OF ZING. scenic cea ea ctingeoare wi csatee See 40 (k) Naphthalin’ a. cca cdagcesteis wrantods Gaae naive ie 40 () Dhy mol sissetesensaeoe se seeer mine tress eae eweees Al (i) Cainiphot ast ics openers eae diekos ota meme 41 Gn) “Tab aseacdsens Ba Gee Had hieric sinc aasia & say ede Anum 2 Benen values 41 (o): Tutpentine s2sciaadinwe. cose say aanne warner gees 42 (p) Oil of Turpentine...cs csi ceca sicians se ese aiess 42 (q)) SUSat oi gata rede dan ore idh wont edua ceases 42 (r) “Coffee! sine ssnt iis seinen eke aw eae eters 43 (8) ‘Saloll sco nccots cov ens page vetdn Satie Kees sexe adaule 43 (t) Bismuthum Subritricum ......... 0. cece eee ees +. 43 (i): Benzoie Acid s.25ycuber sion tig cai eie cee army + 43 CONTENTS. (v) Pictic Acid... csc .cdeameacscs4 seemed so eae wees 43 ii CONTENTS. (w) Oleum Eucalypti ..... 0.0... cc cece cece acca ee aes 44 (x) Zincum Oxydatum ......... ccc cece ee eee cence 44 (y) Zincum Sulfocarbolictm .........-.ceeeeseeeveee 44 (z) Kalium Hypermanganicum ...........cceceeeeees 44 (za) Acidum Sulphuricum ......... 0... c cece ee ee ees 44 (zb) Acidum Sulphurosum ....... av sua eae anuae ens s 44 (zc) Sulphate Salts ........... cece cece even ev eeeeves 44 (aa) Peroxide of Hydrogen ....... 0... sc cece ees 44 (DD) -RESOPCIM® ..asdsilslelet ele sea elias Ba de ons MED vos 44 (cc) Naphthalol. saviccncseiadiciatas oetvsavemaneewss 44. (dd) Aseptel ccc csucasieas cassie stan ale anenerha sae eS 44 (ee) A and B Oxynaphtoic Acid ........... 0. cece eee 44 (ff) Hydrochinon;. €teade ssi cvewaesasuessatneade occas 44 CHAPTERIV. DISINFECTION OF INFECTED CAR- RIERS AND THE WOUND...............00-005 45 De They AIR fais sew wis cavertia id's sable ate warned Sew aletecatien eas Lees 45 2. Hands and Clothing of the Surgeon....,............5 47 2. Resting Place of the Patient ........... ccc cee ee ee eee 48 4. Instruments and Bandaging Material................ 49 ’ Heat and Formaldehyde Gas......... 0. .e cece ae ee eee 51 5. Vicinity of the Wound......... cece eee cece eee ee eed 52 6; THE Wend) i soncscg cknasdd Gate deadenecadacnes 53 CHAPTER V. SUTURING AND LIGATURE MATE- RIAL, DRAINAGE BANDAGES ................ 55 CHAPTER VI. ANTISEPTIC MODE OF TREATING WOUNDS ..... Hides iotorct nie se ota tata eh tectahte nt cat de eee 62 CHAPTER VII. ANTISEPTIC OUTFIT FOR PRAC- ATED G BAe sao. nps Beicgorones ten 3 Suatbn sere andee cos pana ava oma eoenees 72 CHAPTER VIII. EXAMINATION OF WOUNDS AND THEIR PREPARATION FOR OPERATION... 75 Examples of Antiseptically Treated Cases.............. 7 Othaematoma in the Horse .............ceeeeeeececeeve 78 Contused Wounds on the Thoracic Wall................ 79 Lobulated Contused Wound on the Inner Side of the Knee Joint of the Horse, Laying the Tibia Bare.... 80 Tendon and Sheath of Tendon Wound on the Hind Legs Of 4 SL OPSE ascteithe-v acta ata ked Lae ees aves weeded 81 Nall pride con onaceieas nace s Woailad oe oe Gels ca gieenuinniwets 83 Trush with Laying Open of the Soft Parts on Both Hind HOOES: acs askeweaod ceive suid tyre Me ise devine Bana aware. 84 CONTENTS. CHAPTER IX. OPERATIONS WITH ANTISEPTIC PRECAUTIONS: ais esdideewereenvaweme tyes eg Resection of Body of Inferior Maxilla of Dog on Ac- Count Of Fracture: ccs aiiesdadiae screen dace ee chee Atheroma on the False Nostril of a Filly.............. Actinomycoma in the Regions of the Parotid Gland of a Bull—Removal—Healing in Three Weeks........... Neurectomy of the Inner and Outer Branch of the Plantar Nerves Over the Pastern Joint (High Plantar Neu- TECKOMY,)) duaah er iss seetonsdese asa Geen oy as nay adees Neurectomy of the Tibial Nerve............. 00.0 es eeeee Amputation of a Cow’s Hoof.............cc ce enec eens Grown Prick (Treads) 4 cscsns via vee seen e eed vanes vawees Nail Prick: vitivarn eds vehan donee s Suk ginennee sinh yea cueebareas Septic Inflammation of the Soft Parts of the Hoel in the Region of the Sensitive Lamina, Plantar Cushion, Frog and Sole of the Left Front Foot.............. Castration of Stallion. wc ccacca ce eee a pa decade ania 100 Condyloma of the Praeputium of the Horse—Removal, Heaiing Per Primam Intentionem in Six Days...... 103 Docking of Darl: casei se bes eee Gane maegeeartens 103 Castration of Horses in City Practice ...............00. 105 Abscess in the Levator Humeri .................000000- NeéurectOMy escscce caves vee ci areees Ves ees ue ewdens. iii PREFACE. It is an undeniable fact that the medicinal treatment of in- ternal diseases, as far as human medicine is concerned, is gradually becoming less, while the surgeon eventually draws more and more into his sphere such diseases, which, in re- gard to their therapeutics, belong in the territory of internal clinics. It is further proven that the surgeon has been able to encroach upon this territory of internal medicine chiefly through an acquisition of modern times, namely, the antiseptic treatment of wounds. The reason of this probably lies in the fact that a surgical operation in many internal diseases, for instance, of the peritoneal and thoracic cavities, without anti- septic precautions, was synonymous with death. While the surgeon in human medicine thus continues to gain in both territory and importance, the corresponding circum- stances in veterinary science are still wanting. Although for us veterinarians everything does not depend upon the sav- ing of the life of the individual, without any considera- tion of the costs, means, and effects, we should nevertheless use all means offered by science to preserve for the national wealth, all the funds invested in our domestic animals. Owing to the fact that we very frequently perform surgical operations to make animals more useful for our purposes, as well as to heal diseases, the consideration, whether the anti- septic treatment of wounds in veterinary surgery would not offer the same advantages as in human, was fully justified. However, in the attempt to utilize antisepsis in veterinary surgery the progress and results of the past did not warrant its general adoption by the veterinary profession. I have never doubted the good intentions of the veterinary practitioner to give the public better services than was possible heretofore, 4 PREFACE. being aware that it was tardily adopted only because human clinical methods are not generally applicable in veterinary surgery. As assistant in the Royal Veterinary High School, under the guidance of PROFESSOR MOELLER, I have for two years had ample opportunity to do practical antisepsis ; then through the kindness of DR. HILDEBRANDT, director of the local hospital, I was offered abundant material on which to study all the details of antisepsis. I herewith express my sincere thanks to both these gentlemen. Thus prepared, I adopted the antiseptic treatment of wounds in my private practice, and have laid down my experiences in this book. In judging this work I beg to state that the few pointers, which are to be fourid in the current literature, are hardly’ sufficient to elucidate the antiseptic method of treating wounds, and that the works on human surgery on this subject could not very well be used, as veterinary science has to figure with entirely different conditions. I have therefore endeavored to make only clearly practical statements and to employ scientific. explanations only, as far as they are necessary to render the subject comprehensible. I am well aware that this work is not complete, but should it be an incentive in causing the antiseptic treatment of wounds to be more universally adopted, and in inducing a more elaborate working out of the same for our purposes, I shall be satisfied. FRICK, HETTSEDT, GERMANY. INTRODUCTION. For the modern surgeon- there is but one fundamental maxim, which is leading and deciding in all its applications, namely: “All accidental diseases caused by wounds (erysipelas, cel- lulitis, suppuration, pyaemia, septicaemia, etc.,) are caused by the immigration of vegetable life into the wounds as well as into their surroundings.” LISTER was the first person to express himself in this sense, and he proved his opinion by the results of the “Anti- septic Treatment of Wounds,” inaugurated by him. For years the results of this method was the only proof that LISTER’S view, in regard to the accidental wound diseases, was cor- rect, until by the bacteriological investigations of R. KOCH, ROSENBACH, PASSET and others, the experimental proofs were found. Thus LISTER was the founder of a new princi- ple in the treatment of wounds, which was then, in view of the fact that it lead the chief points of consideration against septic processes in wounds, named “ANTISEPTIC.” Re- cently there was some argument in regard to whether the name “Antiseptic” was still justified, as it refers also to sup- puration, which is not a sepsis. In my opinion these argu- ments are superfluous, as the word “Antisepsis,” which has been universally adopted, and freely discussed, means the “combating of accidental diseases of wounds.” No matter how much the technics of the methods may change, LISTER’S idea, which is expressed in the above sentence, must always determine the treatment of wounds. I must abstain from a discussion of the accidental wound diseases, as the limit of this work would be transgressed. Veterinary science cannot ex- clude itself from the advantages of this method, and most 6 INTRODUCTION. clinicians, with the exception of a few country practitioners, have adopted antisepsis. No practical veterinarian will hesi- tate to adopt it, however, when it assumes a form capable of adopting itself to the very different conditions of our animals. as compared to the human. The modern antiseptic treatment of wounds as well as the remarkable successful results in surgery, which have attracted even the attention of the layman, is due to the above men- tioned maxim. It must here be acknowledged that the antiseptic methods in vogue in human surgery (for example, bandaging) cannot readily be adopted by the veterinarian, but this work should be a guide, by which, with the aid of antiseptics, we can learn to improve our methods of treating the wounds of animals aseptically. I. HISTORICAL. LISTER must undoubtedly be looked upon as the originator of the antiseptic mode of treating wounds, as he was the first surgeon who methodically attended to their treatment with this object in view. The LISTER method was introduced to Ger- man physicians in 1872 by SHULTZE, who had studied and seen the procedures of LISTER himself in Edinburg. LIS- TER, when originating this method, relied upon the well- known putrefaction experiments of SCHULZE, SCHWANN, SCHLEIDEN, SCHROEDER, DUSCH, PASTEUR, and others, and assigned the results of the above mentioned in- vestigators to the processes of decomposition in wounds. According to his conviction every decomposition in a wound could be arrested if all germs present in the wound could be killed, and the introduction of the same from outside, either through the air, or other things that come in contact with the wound, could be prevented. After several trials LISTER decided upon the following modus operandi: If a fresh wound is made, for instance, with the object of an operation, all articles in connection with it should be made germ free, that is, disinfected. LISTER used for this purpose carbolic acid. The instruments were lying in a 3 per cent. aqueous Solution of carbolic acid, the hands of the operator, of his as- sistants, also the operating table, after a preliminary thorough cleansing with soap and water, were rinsed with a 2 per cent. solution of carbolic acid; finally the air in the vicinity of the operating field was disinfected by a 1 per cent. solution of carbolic acid spray. After these preparations the field of the operation itself was disinfected, all the hair shaved off the skin, thoroughly washed with a brush, soap and warm water, and rinsed with a 2 per cent. solution of carbolic acid. 8 ANTISEPTIC TREATMENT OF WOUNDS. And now we are ready to proceed with the operation. The same is carried through under a steady spray, even as far as the bandage is concerned. As the haemorrhage must be arrested or controlled, the ligatures must also be aseptic. LISTER introduced a material for that purpose which is also used at present and which has the advantage of becoming ab- sorbed, namely, the catgut. This was made aseptic by being soaked for two months in an emulsion of one part of carbolic acid and. five parts of olive oil, and was used both for ligating vessels as well as suturing. In the latter case LISTER substi- tuted the catgut with carbolized silk, especially if the sutures had to stand a stronger strain. After inserting carbolized rub- ber tubes in the wound for drainage, LISTER put on the bandage, which, according to his idea, would save the wound from external infection. At this time he recommended wad- ding as bandaging material, on account of its property of keeping back the putrefactive germs of the air, but he did not follow this theory, as it was not reliable enough for him (we will see later that he did injustice to the wadding), and he therefore substituted gauze saturated with carbolic acid. The bandage was formed thus: On the wound itself came a piece of protective silk, then eight layers of gauze; between the sev- enth and eighth layers a piece of mackintosh was placed, and the whole thing fastened with several turns of gauze bandage. The idea of the protective silk in the bandage was to prevent the irritation caused by the wound coming in direct contact with the carbolic acid through the gauze. The secretions of the wound were to be absorbed by the carbolized gauze, but to prevent their passing through the eight layers and exposing them to infection by the air, the piece of mackintosh was in- serted. In this manner LISTER treated fresh wounds, but in wounds which were of longer standing, therefore already infected, he acknowledged that the above mentioned methods were not suf- ficient, being fully aware of the fact, that for the removal of sepsis, if present, stronger carbolic acid solutions were needed than for preventing infection of a fresh wound. On this ac- HISTORICAL, 9 count he washed all such wounds with a 2% to 5 per cent. solu- tion of carbolic acid, and he even used chloride of zinc in the form of an 8 to Io per cent. watery solution, in which case he used carbolic acid only after the removal of the infection. Not- withstanding these facts he did not succeed in making every wound aseptic, which he explained by the fact, that the car- bolic acid solution does not always enter into all the recesses and sinuses of a wound. LISTER had so much success with this method, that it was justly wondered at, for while in his own practice, prior to the antiseptic time, 45.7 per cent. cases of amputation died; this number, by the application of antiseptics, was reduced to 15 per cent. Healing of wounds by first intention became by using LISTER’S method, a rule, while in the ante antisep- tic times such occurrences were considered as exceptional and mere coincidents. Notwithstanding these successes there were numerous surgeons who claimed not to have had extra good results with this mode of treatment, but the fault was with the surgeon, not in the method. LISTER stated expressly that his successes were due mainly to the minutes! observation of all individual details, and this rule LISTER’S antagonists violated persistently. On the recommendation of SCHULTZE, R. VOLKMANN and THIERSCH undertook to put LISTER’S method to a test. Both came to the same conclusion, namely, that upon minutely observing LISTER’S rules, the advantages gained by his methods were so great that the old mode of treating wounds could not at all compare with it. The statistics fur- nished by VOLKMAN and THIERSCH left no doubt what- ever as to this fact. They both had but one objection; that is, that the carbolic acid did not prove harmless in some col- lapsed conditions, as intoxications occasionally appeared after an operation. LISTER himself does: not mention anything of carbolic intoxications, possibly he did not recognize them; however, VOLKMANN, as well as THIERSCH reported them, and they looked about for a substitute that would be harmless to the organism. THIERSCH adopted salicylic acid 10 ANTISEPTIC TREATMENT OF WOUNDS. just discovered by KOLBE, and retained the carbolic acid only to disinfect the instruments and the catgut; for all the other manipulations, such as spraying, washing of the wound, disin- fecting hands, saturating bandaging material, etc., he used sali- cylic acid. THIERSCH modified the bandage some, for the 3 to 10 per cent. salicylic wadding, which had been adopted, became impermeable on account of the drying of the wound exudations in it and obstructing their further flow. Instead of the protective silk he took fenestrated guttapercha paper, and left the mackintosh out, thus being able to saturate the bandage daily with salicylic water, and keep the deepest layers disinfected and filtered. Later on THIERSCH seldom used these moist bandages, because they were annoying to both the patient and medical staff, and superfluous in. regular antisepsis. VOLKMANN, according to his own testimony, had carbolic intoxications only while he was unfamiliar with the procedure, later he has seldom seen them; notwithstand- ing this he experimentally tried benzoic acid, especially in the. form of Benzoic wadding. After the good results that THIERSCH and VOLKMANN attained with the LISTER method, all the surgeons, which were cautious heretofore in regard to its use, dropped their prejudices and adopted it. However, complaints regarding the danger of carbolic acid became so numerous that many others like VOLKMANN and THIERSCH, looked for a substitute for it, and a period commenced in which various remedies were recommended, but only a few ever cut even a passing figure in the antiseptic treatment of wounds. - Of the antiseptics, which originated at this period and are partially in use still, the ones described below may be dis- cussed. As much as the remedies may be changed today, LISTER’S principle has been the basis upon which the various authors have worked. ; RANKE, who experimented under VOLKMANN, used thymol, which had been recommended by HAUSEMANN and LEWIN, instead of carbolic acid. In the form of a 1 per cent. aqueous solution it was adopted in many cases, on account of HISTORICAL. 11 being innocuous and sufficiently disinfectant. The only car- bolized preparation that RANKE used was carbolized catgut. KOCHER had had experience with carbolic antisepsis inasmuch as he lost several patients in rotation by intoxica- tion ; besides he also wanted to establish an aseptic condition in infected wounds. That carbolic acid, especially for the latter purpose, was not suitable, even LISTER em- phasized and he substituted chloride of zinc, but as the latter has a caustic effect in concentration (8 per cent.), and thus hinders the primary intention, KOCHER tried to find out such a concentration, which would be sufficiently antiseptic without preventing healing by first intention. After many experiments, together with AMUAT, he decided on a 1 per cent. solution in infected and 0.2 per cent. solution of the remedy in fresh wounds. Besides he modified the process so far as to omit the spray, the same as was done by TRENDELENBURG, BRUNS, and BILLROTH ere this, though they otherwise strictly followed LISTER’S method. The carbolic acid was used only for disinfecting instruments while the ligatures were prepared in oil of juniper and preserved in a 95 per cent. solu- tion of alcohol. Notwithstanding these improvements in the technique of the methods, cases came up in which one or another remedy proved inadequate; besides the procedure was still too cir- cumstantial, especially the preparation and use of the disin- fecting fluids. MOSETIG-MOORHOF recommended a pro- cedure, which in view of LISTER’S claims, was easily adopta- ble for the practical physician. He found iodoform to be a substance which proves effectual, owing to the fact that it is insoluble in wound secretions, and through the perma- nent chemical assimilation it undergoes by contacting living animal tissues, it forms a store of disinfecting material in the wound, and thereby permanently destroys all possible germs. Therewith he maintained that the bandage, which otherwise had to prevent the intrusion of micro organisms into the wound, had not to be put on with so much precision. He con- . 12 ANTISEPTIC TREATMENT OF WOUNDS. sidered the advantages of iodoform for the treatment of wounds to be as follows: First-—Iodoform is. a specific against local tubercular processes. Second—lIt is a safe antiseptic for all wounds. Third—If used in limited quantities it is absolutely harmless to the organism. Fourth—It relieves pain, limits exudation, and promotes granulation. : Fifth—It does not prevent healing by first intention if brought between two sutured wound surfaces. Sixth—It is so strongly antiseptic, that it is not necessary to use other antiseptics. For washing of the wound, there- fore, only warm water is needed, and otherwise the cleanli- ness of all things which come in contact with the wound, such as instruments, hands, sewing material, etc., is necessary. Seventh—It allows an essential simplification of the bandage. Eighth—It is possible with the aid of iodoform to make wounds of the oral cavity, and of the rectum and bladder, aseptic. MOSETIC used the iodoform in the shape of a fine powder, by strewing it on the wound washed with clean water, in a thick- ness of about one-half cm. and. then covering it with iodoform gauze. Simple absorbent cotton and gauze bandages com- pleted the dressing. In narrow wounds he applied the remedy in an emulsion (iodoform 50, glycerin 40, aq. dist. Io, gum tragacanth, 0.3), a3 iodoform gelatin. The form MIKULICZ and BIEDER recommended, iodoform ether, he did not con- sider suitable because it irritates the textures. Although MOSETIG claimed his iodoform bandage to be an ideal one for wounds, he could not deny that it possessed many disadvantages, for instance, eczemas occasionally followed and even intoxications with deadly termina- tions. Though the cause of these accidents was due chiefly to the use of too large quantities, it has been ascertained that these evidences of intoxication could be observed even in the applications of smaller quantities. Therefore, the pure iodoform HISTORICAL. 13 bandage, as MOSETIG recommended, did not become popu- lar; only the iodoform itself has maintained its place in sur- gery, and it will continue to be used, notwithstanding the newly appeared counter current which disclaims any anti- septic value for it. . Probably on account of these disclosures by MOSETIG, KOCHER abandoned his chloride of zinc method and ex- perimented with antiseptic powders, and selected the sub- nitrate of bismuth. A I per cent. watery emulsion (KOCHER always calls it mixture), is used for irrigating the wounds, while on a sutured wound the remedy is spread in the form of a thick pulp and the bandage is made out of crumpled gauze saturated with the bismuth mixture. - The bismuthum subnitricum also did not prove itself inno- cent, for KOCHER himself had a death to report as a conse- quence of bismuth poisoning, so that the bismuth treatment also did not spread further. With these the number of reme- dies recommended for the antiseptic treatment of wounds is by no means exhausted, but the remaining remedies belong en- tirely to the present antiseptic wound treatment, so that their discussion will follow in a later chapter. To those belong corrosive sublimate, as well as creolin and salol, introduced by BERGMANN and SCHEDE. For the same reason the usual bandaging materials, etc., will not be discussed, as far as the historical interest is concerned, mention of them having been made above. If we investigate how much benefit veter- inary science has gained from these acquisitions in the field of wound treatment, it must be acknowledged that the anti- septic treatment lias not as yet been in practice as much as should be expected, considering the eminent advantages which it offers. As has been mentioned above, it must be ac- knowledged that antisepsis, in the form practiced in the human, can only in a few cases be adopted in veterinary science, but LISTER’S direction can be followed in another mode. The oft repeated statement that the usual therapeutical methods of human practice cannot, in every instance, be adopted in veterinary science, is here also fully justified. The 14 ANTISEPTIC TREATMENT OF WOUNDS. occlusive bandage, for instance, is not always strictly oc- clusive in human surgery, for example, in operations around the natural body openings, and yet asepsis results on account of the procedure being modified. Therefore, if we want to prac- tice asepsis in treatment of wounds, we must transform the known healing methods of human medicine in such a manner as to carry out LISTER’S idea, considering at the same time the usual circumstances of our branch. Where the present methods:are insufficient we are obliged to find new ways to reach this aim. Upon looking over the different literature we find that when antisepsis in surgery was introduced, veterinary authors were immediately ready to make use of it, but if the procedures and details of the cases thus treated are minutely looked into we find that there is frequently nothing left of the antiseptic treatment but the application of an antiseptic. That the simple application of an antiseptic remedy cannot be called antisepsis is plain to everybody that goes deeper into the subject. Con- siderable time elapsed before PUETZ, BAYER, KORN- HOEUSER, SIEDAMGROTZKY and others demonstrated cases which left no doubt as to the applicability of antisepsis by an occlusive bandage. PUETZ, MUELLER, HOFFMAN, as well as CADIOT and ROY, who wrote special essays in regard to antiseptic treatment of wounds and their applications in veterinary sur- gery, cannot depart from the occlusive bandage, so that accord- ing to this view many wounds of the trunk which do not permit bandaging, apparently cannot be treated antiseptically. The above authors do not mention anything in regard to the anti- septic treatment of these, so that this vast category of wounds is left to the old mode of treatment. INFECTION OF WOUNDS. 15 II. INFECTION OF WOUNDS. As remarked in the introduction, we have to look for the cause of the so-called accidental diseases of wounds in the micro organisms which enter into the wound and live and mul- tiply there. As our therapeutic percautions must be turned towards the removal of the causes of a disease, the indication for the surgeon is to keep away those pernicious living sub- stances from the wound and make the ones that have invaded it harmless. To reach this latter purpose it is not sufficient to put a disinfectant on the wound, as has been heretofore fre- quently supposed, but we have to go further and close up all sources which are apt to bring micro organisms into it. Only the knowledge of all possible sources of infection enables us to take the necessary measures to check effectually such an in- fection; without this knowledge we will always more or less grope in the dark and unconsciously make a mistake in either one or another direction. KOCHER distinguished two dif- ferent forms of infection: First—Spontaneous infection. Second—Infection by contact. DR. KOCHER thought spontaneous infection possibly originated on account of the whole body being infiltrated with micro-organisms, the same taking effect only if by some cause, for example, traumatism, a favorably nutritive medium for these organisms was created; although recently it has been proven, with the aid of bacteriological culture methods, that, in normal circumstances, vegetable parasites do not exist in the textures. Infection has a certain justification in infectious diseases, as for instance, in glanders and tuberculosis. Ifa wound arises in an individual affected with one of these dis- eases, we can hardly expect typical healing to follow, but we must be prepared for a localization of the specific process in the wound. BECKER also proved that in cases of osteo- 16 ANTISEPTIC TREATMENT OF WOUNDS. myelitis an actual infection direct from the body may follow by way of the circulation. But when KOCHER made his assertion regarding spontaneous infection such generalized infectious diseases did not occur ,to him, besides the etiology of osteomyelitis was then as yet unknown, but he imagined that those wound infections, which we term acci- dental wound diseases, could originate in such manner. Ac- cording to. the bacteriological and surgical experience thus far collected such possibilities of wound infection must be looked upon as a rare exception, and we must consider the substances which come in contact with the wound from the outside and which are carriers of infectious germs, as the chief source of the infection of a wound. The following are carriers of such infectious germs, which are important to the surgeon: First—Air. Second—Hands and clothing of the operator. Third—Foreign bodies (stones, sand,. nails, wood splinters, pieces of earthenware, etc.,) which enter into the wound simul- taneously with the wounding. Fourth—Resting place of the patient, either during the operation or afterwards. Fifth—Instruments and bandaging materials. Sixth—Vicinity of the wound (skin, hair, nails, hoof). 1 AIR, The fact that the air contains a large number of not only innocent but pathogenic germs is so undisputed that it is hardly necessary to discuss it any further, but since we have to figure with the air as a carrier of pathogenic organisms into the wound, it must be discussed. If a sunbeam comes through a window we notice in the illuminated air space numerous small particles of dust, 24 to 34 per cent. of which is organic matter. As the pathogenic schizomycetes are of the same nature, there are certainly some contained in this sun dust. In fact, PODO, who injected such dust subcutaneously into rabbits, produced deadly septicaemia in a very short time. INFECTION OF WOUNDS. 17 HESSE, also, with his well-known apparatus, collected and cultivated the germs contained in the air, and at the same time discovered some of the already known pathogenic fungi. As far as the quantity of these organisms referred to in the air is concerned, it has been proven that in quiet air, according to the laws of nature, the fungi fall to the bottom. But since we have quiet air in neither our dwellings, stables, nor the out- side, the quantity of fungi will vary according to the amount of movement in the air. This is not an absolute rule, as the amount of moisture in the air as well as its density cuts a figure, but at any rate a strong draft brings us more germs in the same length of time than quiet air would. As far as the air, especially in the rooms where our patients are, is concerned, besides the factors named above, several oth- er factors which are responsible for the condition of the air, must be considered, namely, rough provender (grass, hay, straw), bedding and the animal excrements. It may be re- marked here that the above named substances, if they are in a dry condition, easily part with some of their germs as they whirl in the air when being thrown around, but in a moist con- dition they do not affect the air as far as its containing fungi is concerned. The experiments of CADEAC and MALET with the emanations of rotting organic substances make this latter supposition probable. As far as the special relation of the feed, resting place, and excrements, to wound infection is concerned, we will go deeper later. Another question which was referred to during occasional discussions of infection of wounds is, whether the expired air of the operator contains pathogenic germs? In this case, also, the experiments of CADEAC and MALET are decisive, as they could not detect any specific micro organisms in the expired air of horses which were af- fected with specific maladies of the respiratory organs. 2. HANDS AND CLOTHING OF THE OPERATOR. As the surgeon continually operates with his hands in the immediate vicinity of the wound, special attention must be given to them as carriers of infection. The hands have the 18 ANTISEPTIC TREATMENT OF WOUNDS. greatest opportunity to come in contact with infectious germs, and the natural recesses are especially adapted to give the micro organisms a hiding place. In this regard the nail-bed and matrix of the nails can be looked upon as the most danger- ous lurking holes—nor should the small furrows and lines in the skin as well as the orifices of the sweat glands and the hair, be overlooked as shelters for germs. The parts of the operator’s clothing, which are brought nearest the wound (the coat sleeves) should be chiefly considered. The latter, on account of the porous material of which they are composed and also on account of the fact that in lying down, sitting, etc., they come in contact with various substances, are a regular collecting vehicle for fungi, and can on this account very easily bring about infection of a wound. 3. FOREIGN BODIES. Formerly the influence of an injuring foreign body, as far as the healing of the wound is concerned, was explained thus: Smooth cutting or piercing bodies would produce a wound without contusion, and therefore would result aseptically, while dull, rough, splintering objects would cause contusion and would therefore produce healing that would not be aseptic. These conclusions were not based on facts, hence they are false. Not the contusion and the resulting necrosis are the causes of the deviation from the aseptic healing of the wound, but the fact that bodies with smooth surfaces are less often carriers of infectious germs, on account of the lack of loop- holes for the same, than the ones with fissured and rough surfaces; therefore the latter are more often the cause of an infection of the wound. By this is not meant that smooth sur- faces are not carriers of pathogenic germs. We know that it makes no difference whatever whether the wound is contused or not, the former heal with aseptic progress exactly the same as the latter, provided the injuring body is not infected. These foreign bodies differ from each other in regard to the germs ; they may carry not only in quantity but also in quality. Through the investigations of KOCH, GAFFKY, PAS- INFECTION OF WOUNDS. 19 TEUR, HESSE and NICHOLAIER it is ascertained that in ordinary garden soil two bacilli can be found, which have caused great devastation in cases of operations and some- times in very trivial injuries, namely the bacillus of malig- nant oedema and of tetanus. As our domesticated an- imals, not only while at work but also while at rest, come in continuous contact with the ground and all such subjects that are smeared with earth, it produces oedema or tetanus if they get injured. Therefore the soil and all the items that come in direct con- tact with it, as far as foreign bodies that are capable of in- fecting a wound is concerned, should be considered as the main cause, and, therefore, all wounds coming in touch with them should be considered accordingly. 4. RESTING PLACE OF THE PATIENT. If the resting places of our animals are specially discussed, although as far as treatment of wounds is concerned, they be- long to the list of foreign bodies which bring about an infection, it is done for the reason that they belong to the carriers of in- fectious germs, which in one respect offer a very favorable nutritive medium for pathogenic micro organisms. On the other hand they come into a very intimate and long lasting - contact with the wounds. In practice the operating bed, as an infection communicator, must be strictly separated from the stall litter, as it is the latter especially which comes into close contact with the wound, and doubtlessly as a result of the admixture of animal excretions, is more strongly polluted. To prepare an operating bed we usually use straw of the dif- ferent grain varieties in country practice. Only in rare excep- tions we have other material, such as sand or tan bark at our disposal; therefore during an operation the patient lies on a material, which, as a consequence of its origin, that is, be- cause it grows in the field and is more or less soiled with earth, possesses a certain amount of pathologic germs, and therefore contains dangerous elements for wounds. This danger rises cn account of the patients while lying down, often struggle with pain, kick with their feet, and thus whirl the noxious 20 ANTISEPTIC TREATMENT OF WOUNDS. germs contained in the straw, into the air, and infect the wound. [Shavings of southern pine—pinus palustris—is the safest bedding for an operating room either for temporary or perma- nent use. They seem to retain their original antiseptic proper- ties and wound infection can seldom be traced to them. By sprinkling them with a 1 per cent solution of permanganate of potash before the operation, all dust is allayed and a veritable antiseptic litter is the result—L. A. M.] The stall litter as a carrier of infection germs has to be judged from a different standpoint, because of its importance in agriculture and its different nature and management as com- pared with the material used as an operating bed. The stall litter is to the animal not only a resting place, but it serves as an agent to collect the animal excrements for the purpose of making them more valuable for agricultural use. On this account it is seldom that the best material is used for litters; musty, frequently already rotten straw of various plants is thrown in, foliage, pine needles, spoiled hay, wood shavings, dry peat, etc.,are often substituted on account of lack of cheaper or better bedding material. Though these materials them- selves are already sufficiently infested with infectious germs, the sustinance of the latter increases still more on account of the urine and manure mixing with it; not because urine and manure are very rich in micro organism, but because these substances are excellent nutritive mediums for micro organ- isms. This fact has been sufficiently proven by KITT, as far as anthrax bacilli are concerned, and it is hardly to be doubted that other pathogenic fungi find their means of life in them. Besides if stall litter is thus looked upon as an import- ant infection carrier, it is still more so the case if we considér that on account of decomposition it has a higher temperature which is favorable to the thriving of micro organisms. [Through experiments conducted in the bacteriological lab- oratory of the McKillip Veterinary College, German peat, which is commonly used as stall bedding, was found to contain tetanus bacilli in large numbers and tetanus traced to this source was always very acute and fatal—L. A. M.] INFECTION OF WOUNDS. 21 5. INSTRUMENTS AND BANDAGING MATERIAL. While in the former chapters we became acquainted with sub- stances which transmit infection to the wound, only by chance, because they do not necessarily come into contact with it, our instruments can lay claim to be of special importance as infec- tion carriers, as they are the tools with which we make wounds, and work upon pre-existing wounds. It has already been mentioned in the diseussion on foreign bodies that a sub- stance which comes into direct contact with the wound is the more infectious if its surface is rough and torn: This is also the case with instruments, the smoother the surface the fewer loopholes will they have for micro organisms. Besides the construction, as well as care taken of the instruments, should by no means be looked upon with indifference, for with a more complicated construction there is necessarily an increased number of loopholes for micro organisms, and the way of tak- ing care of them either assists in carrying infectious germs or in withdrawing them from these loopholes. Therefore, from this standpoint it is easily to be seen that a bistoury carried in a vest pocket or a cigar case hides more danger of infection than a scalpel which is kept in a clean etui. As far as band- aging materials are concerned we have to devote a great deal of attention to them, as they are employed to protect the wound against any infection from the outside, and as a conse- quence, are in immediate contact with the wound for a long time. In this case the quality which makes the material suitable for bandaging a wound, namely, its porosity, serves as the cause of frequently transmitted infections through the bandaging materials. It is the porosity which offers favorable conditions for the sojourning of pathogenic germs, and therefore care should be taken to.destroy them. 6. VICINITY OF THE WOUND. We could here conveniently refer to what is said in the chapter about the hands and clothing of the operator, but the location of wounds in domesticated animals should, on account of their hairiness, be judged somewhat differently from the 22 ANTISEPTIC TREATMENT OF WOUNDS. nearly hairless human skin. If KUMMEL, in his investiga- tions in regard to the disinfection of the hands, has found that the latter sheltered numerous microbes, how much more must this be the case in the densely haired skin of the domestic ani- mals, especially as their care is frequently neglected. This is the reason that we have to consider the localization of the wourid in our domesticated animals as an important source of infec- tion, for supposing that all the other infection possibilities are not taken into consideration, some hairs from the imme- diate vicinity of the wound, when the latter is first made, pene- trate into it, together with the micro organisms sticking to them. To this must also be added that during the further process of the healing of the wound, the discharges flowing from it soil the vicinity, and being an excellent nutritive me- dium for pathogenic fungi they form direct brooding cavities for the vegetable parasites dangerous to the wound. With very insignificant modifications the circumstances are just the same with the vicinity of wounds which have their seat on hoofs, claws, and tallons; the latter parts, as modified hair formations shelters micro organisms in large numbers in their tubes, fissures and joints, simply because they are the parts which come in contact with the ground, and thus with all sorts of microbes. ASEPSIS, ANTISEPSIS AND DISINFECTION. 23 III. ASEPSIS, ANTISEPSIS AND DISINFECTION. After it has been discussed what infection is and in what way it is brought about, the questions arise: First—By what mode and by what means can we prevent the infection of a wound? Second—How are we to remove an infection already exist- ing in the wound? In compliance with these two questions we have to con- sider two different subjects according to whether the wound is already infected or not, and then if our aim is to prgtect a wound against infection we speak of an aseptic treatment of wounds, while disinfecting or antiseptic treatment of wounds is referred to when an already infected wound has to be lib- erated from the infection, that is, disinfected, or made aseptic. We therefore should not be surprised that the remedies used for the prevention of a wound infection are entirely different from those used for the removal of an already present infec- tion, hence the remedies used in the treatment of wounds are divided into two groups, namely: First—Bandaging materials. Second—Disinfectants. 1. BANDAGING MATERIALS. All substances which are to be used for bandaging purposes must possess certain qualities to obtain the desired effects. First—They must be porous so as to be able to absorb the discharges of the wound. Second—They must be free from infectious germs so as not to be a source of infection to the wound in itself. Third—They must be soft, elastic and flexible so as not to cause any pressure on the wound and must adapt themselves 24 ANTISEPTIC TREATMENT OF WOUNDS. to the corresponding parts of the body without forming any gaps. The effect of these bandaging materials explains itself as follows: ¢ If there are no infectious germs present in the wound, their introduction can only take place from the outside, and al- though these porous bandaging materials permit the air to come on the surface of the wound, still all the germs suspended in the air are mechanically filtered through the bandage, so that, as other bodies are prevented from entering the wound, only the bandaging material is left to transmit infection. As the latter comes in use only in an aseptic condition, that is, free from infectious germs, so that the pure wound does not get infected from the outside, complications cannot take place. In the further course another possibility arises that the thus aseptically kept wound may get infected; the separated wound discharges would gradually push forward and would serve the micro organisms as an entering channel, but this forward gushing under the bandage is prevented because the porous bandaging material absorbs the discharges. Only in longer lasting, profuse discharges could such possibilities take effect, notwithstanding the porosity of the bandage. That the procedure just described to prevent wound infec- tion is not only a formation of clearly theoretical delibera- tions, but can be also carried out practically has been proven by NEUBER, but we have to take into consideration that we can get the same results quicker and cheaper if we substitute several points of this modus operandi by other rules. Thus, for instance, the preparation of germ free bandaging material is a very tedious procedure without the application of such chemical agents that kill vegetable germs, therefore, nowadays these bandages are impregnated with such substances, which we will know later as disinfectants. In this mode the germs contained in the bandage are killed and at the same time these bandages are furnished with a supply of disinfecting remedies that protect the wound against invading germs by making the discharges absorbed by the bandage unfit as a nutritive me- dium for microbes. ASEPSIS, ANTISEPSIS AND DISINFECTION. 25 Among the most popular bandaging materials, as far as using them for the above purposes is concerned, the following may suffice; the corresponding advantages of one or another material will be further explained at the close of this chapter: First—Wadding—The wadding (all fat removed) is most frequently used in the form of a simple fatless bandaging wad- ding for the padding of bandages, or impregnated as a 4 to Io per cent. salicylic wadding, 3 to 10 per cent. ben- zoic wadding, 10 to 20 per cent. boracic acid wadding and thymol wadding, 10 to 20 per cent. iodoform wadding, 0.5 per cent. sublimate wadding, for the absorption and disinfection of the discharges. Second—Jute—The best fiber of corchorus capsularis has been lately introduced and is used the same as the wadding as a5 per cent benzoic jute, 5 to 10 per cent. carbolic jute, 5 to IO per cent. salicylic jute, and 0.5 per cent. sublimate. jute. Third—Wood wool wadding—The wood wool is manufact- ured by the grinding of soft woods; by working it together with fatless wadding, the so-called wood wool wadding is pro- duced. Both products are used as sublimate wood wool wad- ding (0.5 per cent), and creolin wood wool wadding. Fourth—Sawdust—is used frequently as a surrogate of wood wool and is mostly soaked in a 0.5 per cent. sublimate solution. Fifth—Hemp, flax, oakum—These materials are chiefly used in country practice. Lately the oakum, after being previously cleaned, has found some propagation as sublimate oakum. Sixth—Moss, mosspap—The moss, such as is used for ban- daging purposes, is made by the drying of the different sphag- num varieties, chiefly sphagnum cymbifolia and sphagnum cuspidata and is used now mostly in the form of the HAGE- DOMLEISERING mosspaps. To disinfect mosspaps I per cent. sublimate is used, in which the paps are dipped prior to using. Seventh—Peat—Recommended by NEUBER, is useful if impregnated as iodoform peat, carbolic peat and sublimate peat. 26 ANTISEPTIC TREATMENT OF WOUNDS. Eighth—Gauze, mull (muslin)—Both materials are much liked in a fatless condition, as they hold well together. They are used in the shape of benzoic acid gauze (5 to Io per cent.) boric acid gauze, carbolic gauze, creolin gauze, iodoform gauze (10 to 50 per cent.), salicyl gauze (10 per cent.), sublimate gauze, serosublimate gauze, tartaric acid gauze and thymol gauze. Ninth—Glass wool—This represents a confusion of the finest glass threads, and is warmly recommended by KUEM- MELL. : Tenth—Sand, cokes, ashes—These substances are used by SCHEDE with advantage, especially for the filling in of in- juries of the bones in the shape of sublimate sand. 2. DISINFECTION MATERIALS. The word “disinfection” explains itself, so that a definition is, perhaps, unnecessary, especially as the conception of an in- fection has been sufficiently explained, but to be explicit, dis- infection means nothing else than the removal of the infection, and as the existence of an infection is to be looked for in the wound, as far as life and actions of micro organisms are con- cerned, the object of the disinfection is simply to make these micro organisms innocuous. Disinfection of a wound, or an instrument, or the operating field, etc., therefore means mak- ing innocuous the infectuous germs located in the respective media. The ways which are at our disposal are various. First—We remove from the article which is to be disinfected all pathogenic germs. Second—We certainly leave the microbes in their substra- tum but (a) we kill them direct, or , (b) we make the nutritive medium in which they grow unfit for their future growth, and thus cause their death. Following the maxim “Cessante causa cessat effectus” the removal of the micro organisms from the focus of infection would be the. most rational way to get rid of an infection, but in many cases it is impossible to follow this indication, as we ASEPSIS, ANTISEPSIS AND DISINFECTION. 27 would be obliged simultaneously to remove the infected sub- stratum with the infection germs in the immediate surround- ings of the wound, so that probably in a wound of the size of a quarter of a dollar we would make a defect the size of a palm or larger. Nothwithstanding this, however, we follow these in- dications as far as advisable, for we remove with a knife, scis- .sors, sharp spoon or curette, necrotic shreads of tissue gran- ulation surfaces of diseased bones, foreign bodies from the wound, etc. Thus we use the purely surgical adjuvants to at- tack infection mechanically, but we do not always succeed in reaching our object, for very frequently we would by using this method against infection, “‘spill the bath with the child,” by simply destroying the infected organism. Thus in the most frequent cases the other method only is left us, namely the killing of the microbes, and this mode is the most popular and is looked upon as the most essential, though not altogether justly, in the antiseptic treatment of wounds. The above mentioned two methods of killing micro organ- isms: First—Direct killing of the microbes. Second—Withdrawing of the existence condition of the mi- crobes by changing the nutritive medium, should not only the- oretically, but also practically, be strictly separated, for the action of various remedies, which we use later in the treat- ment of wounds, can only be understood if we clearly compre- hend the two above mentioned possibilities. As far as the direct killing of the micro organism is con- cerned, the fact that they are vegetable living subjects with protoplasmic bodies is sufficient reason that the microbe will die if we change this protoplasmic body so that it cannot govern its nourishment and multiplication. We reach this end by certain chemical substances, which act as poison on the protoplasm of the micro organisms, and are called “Disin- fectants.” The question of destroying the causes of infection by chang- ing the nutritive medium is an entirely different one. We know that one of the most important requisites of existence for 28 ANTISEPTIC TREATMENT OF WOUNDS. all micro organisms is moisture; rapid drying as welf as nat- ural lack of moisture are not favorable conditions for the growth and life of those small vegetable organisms. There- fore, all means, which energetically withdraw moisture, cause a condition which hinders their growth and action. Hand in hand with this withdrawal of moisture, a change in the tissues on which these microbes have settled, usually takes place, for instance, in wounds where by the use of strongly drying reme- dies a coagulation of the albumen takes place so much that a fit nutritive medium no longer exists. The rem- edies we use for the purpose of disinfection are so hetero- geneous that we need not wander at this, especially if we consider. the different ways by which we attain the desired effects through disinfection. In view of the above mentioned theories, however, their action cannot be said to be so ex- clusive that one remedy will kill the microbes only, while an- other will only deprive them of the possibilities of existence by changing their nutritive medium, or that a third will only re- move them from the infected medium. Most disinfectants act simultaneously in two or more ways, so that classification ac- cording to their own action is impossible. As to nature, how- ever, they may be classified into: _ First—Physical disinfection agents. Second—Chemical disinfection agents. Among the physical agents we class all those surgical in- struments with whose aid we can remove infected material in a purely mechanical way, for instance, the knife, scissors, sharp scoop, etc., also the high degrees of heat in the form of the fir- ing iron or thermo-cautery of Paquelin, and finally the with- drawal of moisture, namely, exsiccation and permanent irriga- tion. The action of these remedies has been mostly discussed above; we will therefore not go into further details here, nor as to their uses; an opportunity in future chapters for that will be found. We will now discuss those chemical agents which are hostile to the development of micro organisms. The rotation in which they are taken up depends on their ASEPSIS, ANTISEPSIS AND DISINFECTION. 29 utility. The value, action and use of these disinfectants will be briefly discussed, but as far as the more special action, as well as their chemical properties are concerned, pharmacologi- cal text books must be referred to. (a) SUBLIMATE (Hg Cl). (Mercuric Chlorid). The credit of introducing sublimate into surgery is due to VON BERGMANN, for, although BINZ in 1867 and BUCK- HOTZ in 1875, experimentally ascertained the antiseptic prop- erties of sublimate, VON BERGMANN used it as a disinfect- ant in-surgery in the year 1878 for the first time. To the labors of KUEMMELL and SCHEDE it was reserved, however, to draw the attention of surgeons to this agent, while KOCH, with the aid of the solid nutritive medium discovered by him, made exact and decisive experiments in regard to the antiseptic value of sublimate. The sublimate, according to the investigations of KOCH, must be looked upon as the disinfectant possessing the strong est bactericide action, because a I per cent. solution kills an- thrax spores in a few minutes, which thus far are known as the most resistant. Though in reference to the surgeon, there have not been sufficient investigations made to tell how strong sublimate solutions are necessary to destroy wound-infection germs, practice has proven to us that here also a I per cent. so- lution completely suffices. Therefore sublimate fills one de- mand of the surgeon, for weak solutions contain stronger an- tiseptic powers than any agent thus far known. It should not go unnoticed, however, that according to the investigations of SCHILL and FISHER tuberculosis bacilli possess an extra- ordinary ability to resist sublimate. However, as we seldom have an opportunity to treat tubercular processes surgically, this objection to sublimate does not greatly concern the vet- erinarian. We need to discuss the second requisite which the veter- inarian demands from disinfectants, nams'y, that it be harmless to animal organisms. That in human surgery precaution in 30 ANTISEPTIC TREATMENT OF WOUNDS. the use of sublimate has to be taken is due to the different individual predispositions toward mercurial preparations, pro- ducing in some cases eczemas, in another intoxications, while a third one will not be affected whatever. That much of this is exaggerated is proven by the successful results of VON BERGMANN, KUEMMELL, SCHEDE and MIKULICZ; the latter even in laparotomy washes out the peritoneal cavity with a 0.5 per cent. solution of sublimate. KROENLEIN uses sublimate (1:1000-3000) in wounds of the rectum, ab- domen, and in empyema without apparent toxic effects. In veterinary surgery the condition is different. The fear of the toxic effect of sublimate on our domesticated animals, and especially ruminants, is groundless, of which facts TRIN- CHERA especially makes mention. I used for the past three years in all surgical operations, as well as for the irrigation of all infectiously diseased mucous membranes (nose, mouth, vagina, uterus), only sublimate as an antiseptic, and must acknowledge that even in ruminants I did not notice any disadvantageous effects. The experi- ments of DOLERIS and BUTTE, who operated on the mu- cous membranes and fresh wounds of dogs, rabbits and guinea pigs with sublimate water I:1000) have proven that its use on mucous membranes is entirely free from danger; but deep wounds have to be treated somewhat more carefully. Unless the injurious effects of a 1 per cent. solution of sublimate is doubtlessly proven in the treatment of wounds of our domes- ticated animals, I consider the fear of the virulence of sub- limate, in external applications as prejudice. Later on I will have opportunity to illustrate with examples that sublimate is not dangerous. Amongst the numerous preparations of sublimate used in surgery the following are recommended as practical: (a) Sublimate triturates (ANGERER) are made by a com- pression of hydrargyrum bichloridum and natrium chloratum equal parts and on account of their convenient form 20 tablets can be carried in a test tube in the pocket without incon- venience, and owing to their solubility they are extraordinarily suitable for the practical veterinarian. ASEPSIS, ANTISEPSIS AND DISINFECTION. 31 1 oi) $3 (b) Sublimate water is easily had by dissolving a sub- limate tablet in water. It is used for the disinfection of wounds and their region, of the hands, and in case of neces- sity also of the instruments; sublimate does not affect the instruments as bad as is usually supposed, and the operat- ing instruments especially do not get dull. In such sublimate water I'usually also soak my bandaging materials shortly be- fore putting it on by simply dipping the wadding, bandage, etc., into the water and then wringing it out moderately. (c) Sublimate glycerine gelatine I recommend for covering superficial excoriations and sutured wounds. Simple gelatine, also glue, can be used by soaking it in as little as possible 1 per cent. sublimate water solution and then dissolving it by slight heating. To the glue thus formed 5 per cent. of glycerine is added to prevent the preparation from getting brittle. For using, the preparation is melted by a gentle fire, and with a camel’s hair brush applied to the parts. I no longer use this preparation, as I have discovered more convenient remedies. Recently LISTER mentions a few more sublimate prepara- tions, which, chiefly on account of their price, have no special value in veterinary surgery, namely, the serosublimate and the double chloride of mercury. The former consists of a I per cent. solution of sublimate in horse blood serum, on ac- count of the albumen, it sticks better on the bandaging material and does not irritate sensitive skin. The latter is a mixture of hydrarg. bichlor. corr. with ammon. chloridum 2-5; from this salt watery solutions (1:2000) slightly colored with blue anilin colors are used for the impregnation of the bandaging ma- terial. The bandaging materials thus dyed are a reagent for suppuration, for as soon as there is any trace of suppuration the .blue anilin coloring matter gets white. Besides, this preparation is said to be less volatile and poisonous. [The high value of mercuric chlorid in veterinary operations has been repeatedly and forcibly demonstrated especially to the surgeon, who has by experimentation compared the re- sults obtained with that of other antiseptics. In points of uniformity of action, reliability, effectiveness and economy it is 32 ANTISEPTIC TREATMENT OF WOUNDS. equalled by no other known drug. It must, however, be ap- plied only with a full and detailed knowledge of its peculiarities in order to obtain those delicate results which the surgeon seeks in his operations. The following points must be born in mind: — First—That it must be applied in such concentration as the work at hand demands, as follows: : (A) 1 to 200 solution. This strong concentration is useful to hurriedly disinfect an operating field and vicinity when for any justifiable reason there is no time for a systematic disinfection. I use it repeatedly and with excellent results to purify the scrotum and surrounding field in castration. (B) 1 to 500 solution. This strength is the one generally used to purify the seat of operation after the usual scrubbing with soap and water, to wash the surgeon’s hands before and repeatedly during the operation, and to soak the protective bandages. (C) 1 to 1000 solution. For general use in wounds already infected for the purpose of rendering them aseptic, and for the after treatment cf wounds that must granulate. : (D) 1 to 1500, to 1 to 2000 solution. This strength is applied in irrigating and bathing the wound during the opera- tion and is specially weakened so as not to prevent immediate union, by destroying the vitality of the tissues. This strength is also suitable for irrigating the vagina, rectum, uterus, or -internal cavities. Second—That it is rendered more or less inert by com- bining with the constituents of tap, well or spring water, This fault is obviated in a measure by adding 1 per cent. of sodium chlorid to the solution and by making solutions only for im- mediate use, or by using distilled water. : Third—That it is immediately rendered inert when it comes in contact with blood, and therefore sponges or cotton used for baling must not be carried into the vessel containing the solution. I always use a small porcelain vessel for baling. with which the solution is dipped from a larger container and in this way prevent the entire solution from becoming polluted with blood early in the operation. ASEPSIS, ANTISEPSIS AND DISINFECTION. 33 Fourth—That it should be used in the form of soluble tab- lets to itisure accuracy in the concentration of the solution. Prof. Frick leaves the impression that mercuric chlorid is not specially injurious to edged instruments which is in direct conflict with my experience. The dark color it imparts to polished or plated instruments is readily removed when they are not left too long in the solution, but aside from this objection, if such it is, the keenness of a sharp knife is almost immediately destroyed when placed in a solution strong enough to disinfect it—L. A. M.J (b) IODINE. Iodine has for a long time played a leading role in surgery, but it cannot attain a special place in the treatment of wounds, un account of its unpleasant properties of being very volatile and caustic, although its antiseptic qualities are pre-eminent. However, DAVAINE, DOTTER, and ANDRIEUX recom- mend tr. iodine diluted as a remedy in wound treatment. Much more importance is given in treatment of wounds to a com- pound of Iodine, namely, (c) IODOFORM. Iodoform (CHI3) was introduced in the year 1822 by SERULLAS, but MOSETIG and MOORHOF first showed that it is a very useful preparation for the treatment of wounds. The hopes which MOSETIG placed in iodoform as well as the effects which he claimed it to have, were not en- tirely confirmed, in fact the contrary was proven. Judgments of HEYN, ROVSING, SATTLER, BAUMGARTEN, SCHNIRER are not correct. If these authors take the actions of iodoform on the cultures of the micro organisms as a standard for the antiseptic properties of the remedy, they evidently do not consider one factor, which for the under- standing of its action is indispensable, namely that iodoform gets separated into free iodine only when it comes in contact with living animal cells and that this free iodine represents the antiseptic agent of the iodoform. KOENIG, BEHRING 34 ANTISEPTIC TREATMENT OF WOUNDS. and BRUNS met with good success in their experiments, so that especially its antituberculous action is not to be doubted. However, iodoform has but a certain limited value in surgery and on this account, extravagant use of it is discouraged. If we do not consider these clearly theoretical and experimental results, practice has shown that we possess a very valuable remedy in iodoform, as it possesses excellent qualities in certain conditions. The action of iodoform depends upon the different modes of application as follows: First—As powder it does not dissolve in wound exudates, but absorbs the latter, and thus excellently dries the wound surfaces, so that but little discharge appears; besides, it di- rectly restricts the discharges of the wound. Second—lIt certainly promotes granulation, because I have often observed that peripheral pieces of ligated vascular stumps, which otherwise regularly undergo necrosis, granulate pro- fusely, by being treated with iodoform. Possibly an explana- tion for this is the known close relation of Iodine with the cell nuclei. / Third—It acts anaesthetically. Fourth—By coming in contact with living animal cells the pure iodine gets permanently separated from the iodoform, and this pure iodine acts antiseptically. Fiith—It certainly has antituberculous actions (BURNS). In human surgery it has been observed that iodoform, be- sides the valuable qualities just mentioned has many injurious ones inasmuch as in a human being iodoform poisoning as well as iodoform eczemas sometimes appear after the use of the remedy. In veterinary practice thus far, iodoform intoxications after external applications have been known in dogs only (GOOSENS, ALBRECHT, FROHNER). I had no op- portunity thus far to notice this probably because I did not use excessive doses, which ALBRECHT and GOOSENS give as their cause. Experimentally, POLJAKOW ascertained the toxic doses for warm blooded animals to be as follows: 0.5 ° ASEPSIS, ANTISEPSIS AND DISINFECTION. 35 per kgm. body weight if brought into the serous sack, 1 gm. in the stomachand 1.5-2 gm.in subcutaneous applications. Owing to the popularity of iodoform treatment, we should more fre- quently hear of intoxications if our animals were sensitive to iodoform; in proper doses, therefore, iodoform can be con- sidered free from danger as far as our domestic animals are concerned. Eczemas, such as are frequently seen in the hu- man as a consequence of the use of iodoform have not as yet been recorded in our practice. Of the frequently mentioned iodoform preparations, the following are in use and very prac- tical. First—Iodoform powder I prefer to iodol substillisime pulv., because it can be strewn in a thin layer on the surface of wounds which have to be treated without a bandage. Second—Iodoform sugar (5-10 per cent.), an excellent des- sicant remedy. It forms a dry scab on such wounds that do not permit a bandage, thus causing the wound to heal under the scab. Third—Iodoform tannin (50 per cent). In profusely dis- charging wounds, especially wounds of a joint, this is a good remedy to prevent excessive secretion, especially synovial flow. Fourth—Iodoform ether (5-10 per cent.) is the most con- venient remedy for sinuous wounds such as fistulas. Fifth—Iodoform gelatine (25 per cent.) is manufactured mostly in tablet form and is very well adapted for fistulous canals, as little rods can be cut from these tablets, which are flexible and are therefore easily introduced into these canals. Sixth—Iodoform sticks (iodoform 9, cocoa butter 1) are used for the same purpose as the rods of iodoform gelatine. Seventh—Iodoform boric acid (10 per cent.), for the same purpose as iodoform sugar, is less dessicant. Eighth—Iodoform collodion (5-10 per cent.) to cover shal- low small wounds or excoriations, as well as to daub over fresh sutures, where a bandage cannot be put on. This remedy thas the disadvantage that it does not stick to moist skin and easily gets brittle. 36 ANTISEPTIC TREATMENT OF WOUNDS. (d) IODOL AND IODINE TRICHLORID. These two iodine preparations have been lately recom- mended in human surgery as a substitute for iodoform, as iodol is non-odorus and iodine trichlorid does not have such unpleas- ant odors as Iodoform. Besides, both are said to be non- poisonous. These two preparations are too costly for veter- inary purposes and are, therefore, not recommended, especially as the odor of iodoform is only objectionable in canine practice, The application of iodol is exactly the same as of the iodo- form, while the soluble iodine trichlorid is used as a 1 per cent. watery solution. (e) CARBOLIC ACID. Carbolic acid is a preparation which Lister, in 1864, intro- duced into the antiseptic treatment of wounds, and in which, until lately, too much confidence has been placed, inasmuch as we now have remedies which are more trustworthy and less dangerous. According to the investigations of KOCH, BUCHOLTZ, V. ESMARCH, EISENBURG and others, carbolic acid is a germicide. If, however, we take into consideration the con- centrations which said investigators state to be necessary to act antibacterially, we find carbolic acid to be an entirely un- reliable antiseptic for surgical purposes, because it takes at- least 3 per cent., occasionally even 5 per cent. watery solutions to assure effective action. LISTER himself knew this fault of carbolic acid, but he then did not possess a better remedy and therefore it has been the steady aim of all surgeons to discover better agents than carbolic acid. Notwithstanding this, carbolic acid has held its place, and will hold it, because it is indispensable for certain purposes. In addition to the mentioned unreliability of carbolic acid it has other properties which must be considered in its ap- plication, namely, its virulence in the required concentrations and the irritation caused by sucl: solutions on tle wound and its surroundings. In literature we often find reports of carbolic poisoning, so that it is not necessary for me to add any new ASEPSIS, ANTISEPSIS AND DISINFECTION. 37 ones. It is sufficient to emphasize the fact that all our domes- ticated animals, especially cats and dogs, wiil occasionally get carbolic intoxication. (SCHMIDT, GROSSWENDT, GOTTESWINTER, SCHUMANN, SCHAEFER, VAN LEUWENJU, , etc.) ° Besides its foregoing qualities the irritation which carbolic acid causes on the surface of wounds and to which LISTER calls attention, is unfavorable as far as the application of this remedy in the treatment of wounds is concerned. All wounds treated with a 3-5 per cent. watery solution secrete profusely, therefore they come into a condition which we do not consider beneficial but rather detrimental to the healing of the wound. Carbolic acid is applied now as carbolic water (1-5 per cent.). It is only used in exceptional cases for irrigation of fresh wounds in from 2-3 per cent. and in old infected wounds in 5 per cent. solutions. The 3 per cent. solution is most gen- erally used and chiefly for the disinfection of instruments. All other preparations of carbolic acid (carbolic oil, carbolic spirits, etc.,) are, according to KOCH’S investigations, totally ineffectual. [It is undeniable that the unreliability of carbolic acid is be- coming more and more apparent. It has, however, one indica- tion through which it will retain a place in veterinary surgery and that is to keep instruments aseptic during operations. This precaution is seldom necessary in human surgery and the use of antiseptics on instruments can only be regarded as a reflec- tion on the work of the assistant who is entrusted with their care. But the veterinarian usually operates in a contaminated atmosphere and the chances of instruments ‘becoming infected in other ways are greater than in the human operating room ; therefore it is not only advisable but éssential to place the in- struments in an antiseptic medium when not in use during an operation. For this purpose carbolic acid is highly com- mendable. It is used in a 5 per cent. aqueous solution con- tained in a flat tray. This precaution also serves the purpose of disinfecting the tips of the surgeon’s fingers, because in 38 ANTISEPTIC TREATMENT OF WOUNDS. reaching for an instrument they come in contact with the anti- septic fluid—L. A. M.] (f) CREOLIN. First investigated by ATTFIELD, it was recommended by FROEHNER as antiseptic in Germany in 1887 and later V. ESMARCH and EISENBERG experimentally as- certained that anthrax spores are killed in two days in a 3 per cent. watery solution, the sitppuration producing microbes in one minute in 3 per cent. solutions, and in ten seconds in 5 per cent. solutions. The antiseptic properties of creolin are there- fore certainly not to be doubted, but nevertheless I have not thus far adopted creolin for general use, as for country prac- tice it is not easily transported, for while we can comfortably and in large quantities carry the sublimate pastilles, it is diffi- cult to carry as much creolin as is necessary in operations. I think, as is the case with every new antiseptic, the enthusiasm will gradually slacken and the application of the remedy will be limited to certain cases, especially as BAUMGARTEN has recently proved the poisonous character of creolin. The sup- posed non-poisonous character of creolin was a_chief reason for its popularity. Creolin is applied as (a) Creolin water (0.5-2 per cent. watery solutions better than emulsions) to irrigate and rinse out all kinds of wounds. (b) Mixture of creolin (2 per cent.) with boric acid for use as powder on wounds. [Creolin is a disappointment so far as performing antiseptic operations is concerned. Its place in veterinary surgery is for the purpose of irrigating large wounds, internal cavities, sin- uses of the head or in any condition where there is danger of intoxication from more potent remedies. There are a number of cheaper substitutes sold on the American drug market, but their popularity depends more upon the amount of water they will color white than on the amount they will actually disinfect. In the absence of more reliable preparations, however, the veterinarian is justified in ASEPSIS, ANTISEPSIS AND DISINFECTION. 39 recommending them for large foot baths or for any purpose where a large amount of antiseptic fluid is needed. The action of these products on water together with their innocuousness recommends them in obstetrical operations.— L.A.M] (g) SALICYLIC ACID. THIERSCH, in his efforts to discover a substitute for car- bolic acid, found in salicylic acid just discovered by KOLBE, a remedy with which he constructed a regular antisepsis. Now we know, specially owing to the recent investigations of SAM- TER that Salicylic acid is a totally unreliable antiseptic, so that this long since abandoned remedy will soon have but historical value. Now it exists only in the form of salicyl wadding for surgeons. (h) BORIC ACID. LISTER first recommended boric acid and experimented much with it, but it has never reached an important place as an antiseptic, as it acts much weaker than carbolic acid. It is applied in the form of: ~ (a) Powder or mixed with creolin (2 per cent.) as lycopo- dium on wounds, especially near the end of the healing process when it hastens the forming of the scar. (b) Boric water (4 per cent.) as wound water on such places where the virulence of carbolic acid and of the sublimate is feared, for instance, in the nose, in the mouth, on the eyes, etc., etc. (i) ACETIC ALUMINA. Acetic alumina was first applied by BUROW and has been adopted on account of being non-poisonous and having good antiseptic properties. In every instance where the usual anti- septics cannot be made use of, either on account of virulence or because the patient cannot endure them, the liquor aluminae aceticae (8 per cent.) is indicated. In veterinary science this preparation has been in use for a long time (acetate of lead alum solution). It is applied in the form of: 40 ANTISEPTIC TREATMENT OF WOUNDS. Watery solution of acetic alumina (2-4 per cent.) as disin- fectant for all-wounds. Gj) CHLORIDE OF ZINC. Chloride of zinc was used in surgery prior to LISTER’S time, but LISTER was the first one to use it (8 per cent.) to disinfect wounds. LISTER and KOCHER used 0.2 per cent. solutions for the rinsing out of wounds and applied it as a regular antiseptic, but KOCH’S investigations soon proved that too much confidence was placed in chloride of zinc, as in 5 per cent. solutions anthrax spores lived after one month. I use only a: Chloride of zinc solution (10 per cent.) to wipe out infected wounds after the walls have been first thoroughly scraped with the sharp spoon. [BURNETT'S disinfecting fluid (20 gr. zine chlorid to I drachm water) in the strength of 1 part to 4o of water is indeed a useful and effectual antiseptic for veterinary pur- poses. It deserves a more general use especially in disin- fecting old, suppurating or fetid wounds. In a fresh open wound it will prevent septic processes longer than any other drug.—L. A. M.J (k) NAPHTHALIN. According to Fisher’s investigations, Naphthalin is a power- ful antiseptic which has but one fault, viz: that it is insoluble in water. SCHADRIN, POPOW and others, however, have doubtlessly proven the usefulness of this remedy; especially does it.help granulation. BOUCHARD and PANNAS noticed that upon long in- ternal application cloudiness of the crystal line lense with for- mation of cataract (Naphthalin cataract) occurs, but thus far external applications on our domesticated animals have had no bad effects. Amongst the forms used the following are recommended: Naphthalin powder, pure or mixed with 5-10 per cent. alum, sugar or boric acid (SCHADRIN), naphthalin salves (5-10 per cent.). ASEPSIS, ANTISEPSIS AND DISINFECTION. 41 (l) THYMOL. RANKE introduced thymol for treatment of wounds, and its power for checking the development of bacteria was ascer- tained experimentally by SAMTER;; but for veterinary prac- tice thymol is too expensive. In canine practice it can be oc- casionally used as a 1 per-cent. aqueous solution if the ex- pense does not prohibit it. (m) CAMPHOR. In surgery camphor was used before the antiseptic era, es- pecially in bruises and gangrenous and ichorous wounds. Al- though camphor possesses good antiseptic properties it is not very suitable for treating wounds. However, in case of neces- sity, camphor, in the universal form of spirits of camphor is a good disinfectant. It is usually applied in the form of: (a) Camphor gruel (with but little alcohol) as a good dis- infectant in gangrenous wounds and bruises. (b) Spirits of camphor (1 :7 alcohol 1 :2 water) to rinse out wounds and to soak the bandage, in cases of necessity only. (n) TAR. Tar, that is, charcoal tar, has been in use for some time, but it has not been given the deserved importance as an anti- septic. On account of its containing carbolic acid, creosot, naphthalin and many other antiseptic aromatics, tar, es- pecially in cattle practice, is to me nearly indispensable, the action being in every regard satisfactory so that I can recom- mend the application of tar as an antiseptic especially in foot and hoof diseases, as the preparation is very cheap and can be obtained in every rope maker’s shop. I use: (a) Tar (clear) in claw diseases, if they are much spread amongst cattle and hogs, where it is not possible to put on daily a number of bandages; also, in order to make bandages moisture proof, to paint the bandage; and lastly, in all hoof and claw diseases which are forming scars. (b) Plaster of paris and tar (5-10 per cent.) and boric acid XN 42 ANTISEPTIC TREATMENT OF WOUNDS. and tar (2-5 per cent.) are well recommended, but are not in- dispensable. (c) Tar with ferram sulphas aa if we intend to dry up strongly secreting hoof and claw wounds. (0) TURPENTINE. AMBROSIUS PARE (1550) knew the antiseptic properties of turpentine which make it, as well as tar, suitable for the treatment of hoof and claw wounds, especially in easily bleed- ing wounds. The only unpleasant effect was the irritation it produced on granulations, causing pain. It has the disadvan- tage of producing pain by irritating the surface to which it is applied. (p) OIL OF TURPENTINE,. The antiseptic properties of the oil of turpentine have been experimentally ascertained by GRAWITZ and DE BARY and confirmed also by KOCH. Later investigators claim to have had negative results, but it has yet to be proven that the statement backed up by KOCH, GRAWITZ, and DE BARY that the preparation in a proportion of 1-75,000 does not act antiseptically is a mistake. Notwithstanding its antiseptic properties, oil of turpentine is only used in cases of necessity on account of the irritation it causes. (q) SUGAR. As an old public remedy against strongly granulating wounds, sugar in the shape of powder has long been in use, but in surgery it was first introduced by LUCKE as an anti- septic. Sugar acts antiseptically on the wound by excellently drying it up and by its forming concentrated sugar solutions (just as in canning fruits), which prevent the settling of mi- crobes. Frequently a dry scab forms on wounds treated with sugar, under which an antiseptic healing takes place. As sugar can be found in nearly every household and its cost is not great, I can, according to the experience which I have had with it, recommend it. It is best applied in the form of: Powdered sugar (clear or mixed with 5 per cent. powdered -ASEPSIS, ANTISEPSIS AND DISINFECTION. 43 iodoform). In this form I use sugar in all wounds on the sur- face of the body when a bandage is unnecessary and which on account of thetr condition (not bruised) allow healing by a scab. (r) COFFEE. Roasted coffee contains, in addition to 5 per cent. of tannic acid, several aromatic substances, so that it possesses anti- septic properties. On this account OPPOLZER used it in .the form of powder for the treatment of wounds. VOIGT also recommends it for veterinary use. I frequently use powdered coffee, as it is easily obtained, but I would use it only in case of necessity, as its action is not entirely reliable. (s) SALOL. Salol has been recommended by SAHLI instead of iodo- form, as it is said to. be non-poisonous when applied ex- ternally. (t) BISMUTHUM SUBNITRICUM. KOCHER recommended this preparation for the treatment of wounds and he reported good results, but this remedy has not become popular. (u) BENZOIC ACID. According to BUCHHOLTZ it acts stronger antiseptically than salicylic acid (1:1,000), but on account of the cost this remedy will not gain importance in veterinary surgery. The only preparation of benzoic acid which is used to any extent in human surgery is the benzoic acid wadding. (v) PICRIC ACID. SOZEWITSCH tested picric acid for its antiseptic proper- ties and proved that it acts stronger than carbolic and salicylic acid. Picric acid as an antiseptic has not become popular, nor is it altogether non-poisonous, especially when used on small domesticated animals. 44 ANTISEPTIC TREATMENT OF WOUNDS. (w) OLEUM EUCALYPTI. Oleum eucalypti possesses good antiseptic properties and is recommended especially by English physicians (ALL- MANN, NUNN)as salve, and for the soaking of wadding, etc. Besides the above mentioned remedies which possess directly antiseptic properties, there are many other remedies for the antiseptic treatment of wounds recommended, but they cannot gain any foothold, partly because their antiseptic properties are insufficient, and partly because their application is not very convenient, for instance: (x) ZINCUM OXYDATUM. (y) ZINCUM SULFOCARBOLICUM. (z) KALIUM HYPERMANGANICUM. (za) ACIDUM SULPHURICUM. (zb) ACIDUM SULPHUROSUM. (zc) SULPHATE SALTS. (aa) PEROXIDE OF HYDROGEN. (bb) RESORCIN. ; (cc) NAPHTHALOL. (dd) ASEPTOL. (ee) A AND B OXYNAPHTOICACID. (f) HYDROCHINON, ETC. In addition to the remedies which we use in antiseptic wound treatment, we would now have to discuss the draining and suturing materials, but as they do not belong directly to the bandaging materials and disinfectants, I will treat them separately in a future chapter, and only mention something in regard to the way of using these remedies in order to fulfill the stipulations of antiseptic wound treatment. DISINFECTION OF INFECTED CARRIERS, ETC. 45 IV. DISINFECTION OF INFECTED CARRIERS AND THE WOUND. We have seen in one of the above chapters that the infection of wounds is transmitted by certain substances coming in con- tact with the wound, namely, infection carriers. At the same time we did not consider those infectious diseases of domes- ticated animals which cause wound infection through the blood, as for instance, tuberculosis, glanders, anthrax, etc. As they do not give us cause for any surgical interference the main object in the antiseptic treatment of wounds is to make all the germs that stick to the infection carriers innocuous. The most important task for the surgeon must therefore be the dis- infection of all the infection carriers, which during treatment, necessarily come in contact with the wound. We will there- fore discuss the disinfection of these infection carriers in the same rotation as we have adhered to above. 1. AIR. Infection through the air, according to our experience to- day, happens more infrequently than was formerly supposed, but in human surgery it is still recognized, and we also must not undervalue its importance, especially since in treatment of wounds, we are assigned to rooms where there is a. strongly agitated air, and therefore is rich in germs. Only at times, for instance, in the case of smaller animals or in hospitals, can we have conditions similar to those the human physicians find in their treatment in closed rooms. Owing to this difference of conditions, we can only in a few cases disinfect the air, namely, when we operate in closed rooms free from currents. LISTER attempted to disinfect the air in closed rooms by the spray, and for this purpose he sprayed carbolic solutions 46 ANTISEPTIC TREATMENT OF WOUNDS. through forge bellows. Now in clinics, if sprays are used at all, the steam spray is adopted. The disinfectant is sprayed near the point of operation by means of a stream of steam. For private practice certainly a steam spray cannot be made use of, and if a spray is to be employed at all, it can be pro- duced with a Richardson sprayer with which a 2% per cent. carbolic solution can be easily converted into a spray. It is different in country practice, however. Here, as a rule, an operation must be performed suddenly and we are com- pelled often to operate in the field without a spray. It is diffi- cult, however, to disinfect the air in closed rooms by means of a carbolic spray; consequently it is an impossibility if we are compelled to perform an operation in the open air. The spray, therefore, is of no use in country practice, especially if we take into consideration the annoyance to the operator which it connected with its use and to the wound itself. In human surgery in most cases the use of the spray is dispensed with, and only on rare occasions, for instance, on opening the peri- tofieal cavity, it is still used. . For these reasons we try, in country practice, to protect the wound from germs contained in the air by trying to avoid all such causes as would aid in bringing these germs into the air, the most important of which is the air current. We therefore lay or stand the patient in a place where the air is as quiet as possible, and avoid, if possible, operations in windy weather. We further prevent the patient from mak- ing strong movements, especially with the feet, so as not to disturb the air. To possibly prevent the latter morphia narcosis and also moistening the floor of the operating place with sublimate water is recommended. Nothing more can be done to disinfect the air, and according to my experience, these precautions are ample, for should some micro organisms actually enter the wound via the air it would certainly be made innocuous by irrigating the wound. [The air is no longer regarded as an important medium for carrying infection to the wound during an operation, and there- fore the famous “Phenicated Cloud” (carbolic spray) is now en- DISINFECTION OF INFECTED CARRIERS, ETC. 47 tirely discarded in human surgery. For veterinary operations occasional irrigation with weak solutions’ of mercuric chlorid is sufficient to render innocuous any organism that find their way to the wound through this medium.—L. A. M.J 2. HANDS AND CLOTHING OF THE SURGEON. As the surgeon continually uses his hands on the wound, special care must be given to them. KUEMMELL and FORSTER tried to ascertain experimentally what mode of cleaning and disinfecting is necessary to make the hands free from bacteria. Both authors agree that a five minutes’ wash- ing and brushing with warm water and potash soap is neces- sary, they disagree however, in regard to additional neces- sary disinfection, inasmuch as ‘after having first washed the hands KUEMELL recommends bathing them in a five per cent. solution of carbolic acid or liquor chlori, and not with mercuric chlorid, while FORSTER adopted the latter and condemned the former. According to my experience, it is en- tirely sufficient if the hands and forearms, after carefully clean- ing them with soap and a sharp brush, the nail bed and matrix ’ being chiefly considered, are well washed with a 0.1 per cent solution of mercuric chloral. It is best if the finger nails are kept shortly trimmed so that they do not hold dirt. As for the clothing of the surgeon, the coatsleeves espe- cially deserve particular attention. As they are not easily disinfected, I either take off my coat entirely or bare the arm by rolling up the sleeves above the elbow. The use of spe- cial clothing for operations or treatment of wounds in country practice cannot be practically carried out. [Veterinary surgeons are not all equipped with an arti- ficially heated operating room and therefore, in cold weather, it would be very uncomfortable to perform operations with bared arms, especially if the procedure is a long one or a num- ber of operations must be performed, as is often the case in both city and country practice. Under these adverse circum- stances, the surgeon may wear a newly laundried jacket, ster- ilized if possible. Another method is to wear rubber sleeves. & 48 ANTISEPTIC TREATMENT OF WOUNDS. These can be purchased at instrument dealers generally at very small cost. They are durable and easily disinfected with- out injuring the material—L. A. M.J] 3. RESTING PLACE OF PATIENT. The resting place of our domesticated animals coming into very close contact, partly temporarily and partly constantly, with most parts of the body, plays an important role, as far as the treatment of wounds is concerned, owing to the presence of great numbers of infectious germs. If we take into con- sideration the analogous circumstances in human, we notice that here absolute cleanliness of the sick bed cannot be accom- plished either; however, owing to the fact that in the human we can bandage up every part strictly occlusively, except wounds in the natural body openings, the importance of the bed is not so great as the resting place of our domestic ani- mals. As we are only able to put a strictly occlusive bandage on the limbs, all the wounds on other parts are exposed to in- fection through the litter. A-disinfection of the litter is im- possible ; therefore, in order to prevent an infection through it, the following proceedings are indicated: Keep the litter as clean as possible, that is, have all manure and urine carefully removed; moisten moderately the litter material itself (grain or straw is the best), and avoid shaking it up. Ifthe patients, on account of pain, cannot lie quietly, it is Lest to compel them to stand, especially during the first five to six days, after which time a healing per primam intentionem follows; or until sufficient granulation takes place to give the wound protection against infection. While performing many operations, we are obliged to cast our patients, and thus an opportunity is offered for freshly made wounds to become infected. In some clinics (Berlin, Stuttgart, etc.) this source of infec- tion has been removed by using on an operating table, leather covered mattresses, but for country practice such complicated apparatus is not convenient, and we have to depend chiefly on DISINFECTION OF INFECTED. CARRIERS, ETC. 49 straw, hence have to consider the dangers connected with its use, I prepare my place for operation on the so-called dung hill, only in case of necessity; as a rule, I have it made on the ground out of grain straw and have it lightly sprinkled with water. Where the soil permits it (light, sandy soil), we can make an operating ground by digging up the soil, which has the advantage that the irrigating fluids are easily absorbed, so that the patients are lying drier than on straw. [Infection from this source is easily obviated. Dust should be allayed by light sprinkling with an antiseptic solution (Po- tassium Permanganate) and a sterilized rug, or, still better, a clean rubber sheet is spread over the bed beneath the oper- ating region. Such a sheet should be in the equipment of every surgeon. It matters not whether the bedding is straw, shav- ings, soil, or the dung hill, such a sheet, in the absence of any dust, will perfectly exclude infection from the litter—L. A. MJ 4. INSTRUMENTS AND BANDAGING MATERIAL. As mentioned in a preceding chapter the usual care of in- struments, as well as their construction, favors infection, and therefore they must be dealt with acordingly. All surgical instruments should be as simple as possible so that they can be easily and thoroughly cleansed, their sur- faces must be as smooth as possible without furrows and grooves, therefore, especially knives, they should consist of one piece. Joined instruments (torsion forceps, scissors, etc.,) must be easily taken apart, so as to allow their being cleaned thoroughly. In regard to the care of instruments, since, in country practice, the smaller instruments have to be carried mostly in the pocket, it is advisable to have them in cases. All cases that do not close well are not recommended, as they give the instruments but little protection against dirt. This is es- pecially the case with cigar cases and the pockets of the 50 ANTISEPTIC TREATMENT OF WOUNDS. clothing, which are often used to carry instruments, already none too clean. To properly disinfect instruments they should be placed in a three per cent. solution of carbolic acid, if no carbolic acid is at hand in a o.1 per cent. solution of mercuric chlorid, as the instruments get but little affected, and stay sharp. TRENDELENBURG in BONN has his instruments lying permanently in a sublimate solution; although they turn black on this account, and separate occasionally, the cutting edge of the instruments does not get affected. (See Annotation, Page 32.) The one instrument which is especially noteworthy on account of its infectiousness, is the sponge. It is still used very often, but possesses so many dangers, that I often wonder how, even in human surgery, there can still be de- fenders of the sponge. According to KUEMMELL the disinfection of sponges can be accomplished with sufficient safety by boiling them out and putting them for four or five minutes in a 5 per cent. solution of carbolic acid or 0.1 per cent. sublimate water. But it is well to get used to other utensils, because disinfected sponges are not always to be had in country practice. To clean the part or place to be operated on, I prefer to use bandage wadding, and I have had no cause thus far to resort to the sponge. As to the disinfection of bandaging material, there is but little to be said, for as mentioned before it is prepared by soak- ing the bandage material with the desired disinfectant. I prepare my disinfected bandage material myself by simply soaking it prior to putting on the bandage, in the disinfection fluid and pressing it out moderately. This procedure is cheap and besides necessary, as dry bandages fit badly to the form of the body and absorb fluids to a greater extent. [The methods described above are not entirely adequate and may prove a source of repeated disappointment. Of course cleanliness alone is half the battle in dealing with in- struments as well as in all the steps of aseptic treatment, but to simply bath even very clean instruments in a 5 per cent. DISINFECTION OF INFECTED CARRIERS, ETC. 51 carbolic solution is not regarded as sufficient by the expe- rienced surgeon of today. Modern methods may be de- scribed under two headings.—first, by the use of heat, and second, with formaldehyde gas. Heat. Metallic instruments should be boiled for at least fifteen minutes in a I per cent. sodium carbonate solution, and when spread out for the operation they should be placed in a tray containing a 3 per cent. carbolic solution. As has been stated before this latter precaution is not considered necessary in human surgery, but the chances of instruments becoming contaminated during an operation is much greater in veterinary practice. Aftér the operation they should be carefully dried and replaced into the sterilizer, or in the ab- sence of such an equipment, in a dust-proof case. Sponges are, indeed, treacherous, and yet no other article can readily supplant them for baling blood from a wound during operations.. Cotton, gauze, oakum, etc., are very poor substitutes for this purpose in spite of the fact that they are less liable to carry infection into a wound. Sponges are here to stay, however, so far as veterinary operations are con- cerned, and therefore we should make the best of the situa- tion and adopt the best method of sterilizing them, which consists of boiling and then wringing them from a I to 500 mercuric chlorid solution, or with formaldehyde gas, as de- scribed in the following paragraph. Bandages, wadding and ligatures are made entirely safe by soaking for fifteen minutes in mercuric solution of the same strength. Ligatures may be boiled, but this is not absolutely necessary in the case of bandages and wadding, as soaking them in such a concen- trated solution is certain to destroy any organisms they may carry. Even when these materials are boiled or subjected to dry heat the soaking should not be omitted, because it is an antiseptic bandage and not simply an aseptic one that is de- sired to cover veterinary operations. ForRMALDEHYDE Gas. The use of this gas for sur- gical sterilization requires special apparatus, namely a for- maldehyde sterilizer, with which metallic instruments, wooden 52 ANTISEPTIC TREATMENT OF WOUNDS. tools, bandages, wadding and all manner of materials can be promptly disinfected with but little trouble. The apparatus consists of a strong copper chamber, the inside of which is supplied with drawers and compartments. A suitable size for the veterinary hospital is 33 inches high, 16 inches wide, and 12 inches deep. The front is furnished with a glass door which permits a good view of the interior. The gas is generated at the bottom by a formaldehyde lamp and the outlet at the top is closed with a damper to prevent escape of gas into the room. In from ten to twenty minutes all the contents, even the very center of tightly rolled band- ages, folded towels, etc., are perfectly disinfected. When the operator desires to withdraw instruments of dressings the damper is turned and the gas allowed to escape. PROF. I. D. RAWLINGS, Chicago, who has conducted an extensive series of experiments to determine the efficacy of formaldehyde gas for surgical sterilization reports the fol- lowing as a fair sample of his many experiments: Squares of gauze soaked in bullion cultures of staphylococus pyogenes aureus were placed on surgical towels, which were carefully folded over them and subjected to the action of the gas in the upper division of the sterilizer. One square removed in five minutes and placed in bullion gave growth after 24 hours in the incubator as did those removed after 714 and 10 min- utes, but those removed after 1214 minutes remained sterile after 72 hours in the incubator at 37 C. The same results were obtained from sponges soaked in bullion cultures of pus micrococci. L. A. MJ 5. VICINITY OF THE WOUND. In our domestic animals, which have a more or less hairy skin, it is not to be wondered at that the vicinity of the wound is very frequently the cause of a wound infection. If in the human being, with his scantily haired skin, it is im- portant that all germs in the region of the wound be removed, it can be readily understood that it is all important to dis- infect the vicinity of the wound thoroughly. For in our DISINFECTION OF INFECTED CARRIERS, ETC. 53 domestic animals, on account of their mode of living, and on account of the very frequent lack of proper care of the skin, the vicinity of the wound is full of dirt and dried exudations. This fact is often overlooked while the surface of the wound is being treated with all sorts of disinfecting material. This neglect of the vicinity of the wound permits a luxurious growth of pathogenic germs in the unshorn hair. Very fre- quently I have heard such treatment of wounds called anti- septic. 6. THE WOUND. From a theoretical standpoint we distinguish two kinds of wounds—aseptic and infected wounds. In practice this differ- ence is also justified, for experience has taught us that it is a good deal easier to keep a non-infected wound aseptic, than to make an infected wound aseptic. We therefore have to take measures accordingly, that is, we have to proceed differently with infected than non-infected wounds. Practice has proven that it is safer to consider every wound that we did not make ourselves and know to be aseptic, as infected and to treat it accordingly. The reasons for this is plain. First—We usually get patients to be treated which have had an open wound for some time. Second—The mode of living and use of our domestic an- imals causes infection to take place simultaneously with the * wounding. Third—We are not able to diagnose positively the prelim- inary stages of a wound infection. All symptoms which are, as a rule, considered a criterion for a wound infection, namely, rise of temperature, changes in the wound, its color, exuda- tion, swelling, etc., appear only in the advanced stages of in- fection and occasionally without the latter. The treatment of aseptic wounds is a purely prophylactic one, that is, it is only necessury to prevent pathogenic germs from entering the wound in the usual ways. This is one rea- son why I am not going to discuss the necessary modes of procedure at present, as we will take it up later, when meth- ods of wound treatment will be described. However, disin- 54 ANTISEPTIC TREATMENT OF WOUNDS. fection of infected wounds will be given the deserved atten- tion here. The disinfection of a wound consists in making innocuous all pathogenic germs that have entered into it and are living there. We have the following ways to do that: First—Removal of the microbes. Second—Killing of the microbes. (a) Through chemical means, which directly kill the mi- crobes. (b) By changing the substratum so that the microbes can- not find a suitable condition for vitality, and hence, die. If we have to treat a simple three or four-day-old wound of the soft parts with smooth walls, a thorough rinsing out with a I per cent. sublimate or 5 per cent. carbolic solution is suificient to disinfect it. This simple rinsing, however, does not suffice if we have a granulating wound or one with sinuses, or a contused wound. In such cases the conditions favoring the. settlement of micro organisms must be first removed, and for this purpose the cutting instruments only are useful. It is best to scrape off the granulating surfaces with the sharp scoop, cut off with the scissors or knife all shreds of tissue, which cleave to the fissures, even up the edges of the wound, remove all foreign bodies, or, in a word, change the fissured wound, with the aid of the surgical instruments, into as smooth a one as possible. With this dressing of the wound, especially with the sharp scoop, a large portion of the mi- crobes present in the wound are removed, and we disinfect in this manner. Only after the coarsest portion of the disinfec- tion has thus been mechanically performed, do we use, as in a simple wound, the disinfecting fluids to irrigate it. Occasionally it happens, owing to larger surface hemor- rhages, especially in cavity or socket wounds, that we are prevented from proceeding in the above manner. In such cases the use of heat is recommended to attain a sufficient disinfection. For this purpose PAQUELIN’S Thermo-Cau- tery is to be recommended, because with it we can con- veniently disinfect larger surfaces by simply searing’ them DISINFECTION OF INFECTED CARRIERS, ETC. 55 a over with the firing iron. At the same time, the heat acts on the surroundings of the wound so that some microbes, on which neither the knife nor sublimate had any effect, are thus destroyed. In case of necessity the firing irons can be used for this purpose, but some have the disadvantage of get- ting cold too quick. To cool off the highly heated textures afterwards, the wound surface after the application of the hot iron may be irrigated with a disinfecting fluid. Though it is not necessary in most of the wounds of the soft parts to use such strict measures as far as the sharp scoop and scissors are concerned, these precautions are a necessity in all wounds of the bones, cartilages, and tendons. These parts, owing to their anatomical relation, seem to get diseased to a greater extent, therefore, these tissues must be worked upon energetically with both the sharp scoop and ‘chisel and eventually the Paquelin burner before the applica- tion of chemical disinfecting materials are to be thought of. In these ways we can always succeed in disinfecting an infected wound and I would especially call attention to the mechanical disinfection, that is, to the use of the cutting instruments and of fire, as they play the chief role with me in wound disinfection, while the chemical agents come second- ary. The most effectual amongst them is the sublimate ; car- bolic acid does not develop a sufficient action until a 5 per cent. solution is used, and then it irritates the wound. 56 ANTISEPTIC TREATMENT OF WOUNDS. V. SUTURING AND LIGATURE MATERIAL, DRAIN- AGE BANDAGES In the preliminary chapters we have learned the method of disinfecting a wound; now, therefore, we should discuss how to keep this disinfected wound aseptic and make it heal, were it not necessary before we proceed in this routine, to take into closer observation a few substances, which, although they are not essential to the aseptic treatment of wounds, are often used. To ligate vessels and to sew up wounds, which should heal by direct union, we are in need of a substance which should possess certain qualities for the purpose of treating wounds antiseptically, viz. : First—It must be disinfected so as not to infect the wound. Second It must not, if it stays in the tissue, act as a foreign body in such a way that, after a healing of the wound has been effected, a reaction for the purpose of eliminating the suturing and ligating material shall take place. It is again LISTER that furnished us such a material in catgut. He laid twisted sheep-guts for two to three months in a 20 per cent carbolized oil and preserved them in it for further use. The advantages of this catgut were so numerous that it imme- diately displaced all other materials, for it healed in the wound and finally became absorbed without causing the slightest irritation. Now the catgut manufacture, according to LIS- TER, is much in use, but it has the fault of being too ex- pensive for veterinary purposes, besides the knots, consid- ering the large numbers we use, do not hold well, so that the ligatures and sutures easly open up. With the discovery and introduction of other antiseptics and in the same pro- portion as carbolic acid, on account of its being poisonous, commenced to be interdicted, other methods of pre- SUTURING MATERIAL, DRAINAGE BANDAGES. 37 paring catgut were introduced; thus the chromic acid cat- gut (LISTER), juniperus catgut (KOCHER), and sublimate catgut (SCHEDE), originated. Amongst all these new prepa- rations, none became popular, and the old LISTER carbolic catgut is chiefly used. For such sutures and ligatures that do not have to stand a long strain, catgut is sufficient, but in our domestic animals with their strongly developed muscles the catgut cannot stand the strain of the muscles on account of the changes which take place after a little time in it. Therefore I abandoned the catgut and used only silk. The fear that the silk may not act as a foreign body, because it is not absorbed, is not justified. I prepare disinfected silk for myself by soaking plain twisted raw silk in a 2 per cent. solution of sublimate water and also keep it there to be used when needed. Formerly I boiled the raw silk thoroughly, and only after that preserved it in the sub- limate solution, but I found that preserving it is amply suffi- ‘ cient for disinfection. In case of necessity, if I did not have any disinfected silk with me, I obtained a substitute by simply soak- ing the silk in a I per cent. sublimate solution, which had the same effect on the tissues as disinfected silk; however, I ven- ture this only if absolutely necessary. The disinfected silks generally sold, such as carbolic, subli- mate, and iodoform silks are too expensive for veterinary use. Beside catgut and silk no other suturing materials can be substituted in the antiseptic treatment of wotinds, although there have not been any lack of other preparations and substi- tutions, thus for instance, VIGEZZO recommended horse hair which he prepared, for suturing and ligating. : [Kangaroo tendon is prepared in Australia, and is being extensively used especially where great strength in the suture is required. It softens and becomes absorbed as readily as cat- gut. A. H. B.J The healing per primam intentionem has at all times been the ideal treatment of wounds, but it is impossible to succeed in healing all wounds thus, especially wounds that have lost much substance. Even if the surgeon succeeds, in the latter 58 ANTISEPTIC TREATMENT OF WOUNDS. case, in directly connecting the skin and the superficial layers of the tissue by suturing, cavities are left at the bottom, which easily lead to an accumulation of exudations, and which are thus direct breeding cavities for infectious germs. To pre- vent such conditions and yet at the same time to bring the greater part of a wound to a close prima intentione, such cavities have to be kept accessible for disinfection. Drainage serves this purpose, that is, the exudations are drained from the tissue cavities by means of tubes, which are manufactured trom different materials. LISTER used rubber hose as drain tubes, which were of different diameters and had side openings for the escape of the exudations. These drainage tubes are first disinfected by put- ting them in a 5 per cent. carbolic or sublimate solution, and are then used. SCHEDE used instead of rubber tubing pigtails made oi twisted glass threads ; also skeins of horsehair or catgut threads were recommended, but, although capillary attraction acts favorably in this mode of drawing off the exudations, a gener- alization of this method has not been accomplished. Likewise the use of absorbable drainage tubes. such as NEUBER made out of decalcinated bird bones did not become popular, al- though these drains, on account of their being absorbed, do not possess the disadvantages of the rubber drains. Though the drainage doubtlessly offers many advantages to the healing of the wound, certain disadvantages are attached to it so that partly by changing the material and partly by taking special technical measures, we try to avoid these disadvantages. Since we are never entirely successful, it is necessary to limit them by following certain rules when adjusting a wound drainage so as to avoid as much as possible any hindrances to the heal- ing of the wound. First of all, the drainage tube being always a foreign body, prevents a direct union of the respective parts on account of its lying between the surfaces of the wound. Therefore, it is compulsory, if the wound heals regularly oth- erwise, to change the bandage after a time in order to remove this drainage tube. SUTURING MATERIAL, DRAINAGE BANDAGES. 59 Even NEUBER’S absorbent drainage tubes did not do away with the necessity of changing the bandage, because they do not cling to the parts of the wound as well as the more elastic rubber tubes. From these facts the rule follows: That every drainage tube should remain in the wound no longer than is absolutely necessary. As narrow tubes are apt to get easily clogged by coagulum and hence cease to perform their function, tubes with com- paratively wide lumen should be always used. Drainage tubes with light walls are very easily crushed, especially in the muscles, therefore the walls should be as strong as possible so as to withstand the pressure of the tis- sues. An essential disadvantage for the wound lies in the fenes- tral openings of the drainage tubes because the granulation proliferates into the latter, thus nearly always causing lacera- tions and haemorrhages on these granulation knobs when the drainage tube is taken out. Unfortunately we are not able to prevent this, for without these fenestral openings drainage would hardly be effected. Too narrow, as well as too long tubes are apt to clog up, and therefore it is necessary to lead them out by the shortest possible way, and instead of a single long drainage tube, to use several short ones. [Proper drainage of wounds, as a principle in surgery, being a sine qua non, and rubber tubes proving quite unsat- isfactory, glass tubes were used, which had the advantage of strong walls to resist the pressure of encroaching granu- lations and adjacent muscles, but during the last few years antiseptic gauze and oakum have taken the place of tubes almost entirely. It is impossible in veterinary practice to keep the tubes in position on account of the restlessness of our patients, but gauze and oakum are easily kept in place by the bandage. Gauze, being a thick, open-meshed, woven cloth is peculiarly adapted for the packing of wounds, and is obtainable in all drug stores, ready for use. In its preparation, after being thoroughly washed, it is impregnated with some 60 ANTISEPTIC TREATMENT OF WOUNDS. antiseptic, such as bichloride of mercury, iodoform, boric or carbolic acid. It maintains asepsis in aseptic wounds, and helps to disinfect septic ones. It takes up the exudations so perfectly that it is not necessary to change the bandage oftener than once every two or three days in wounds with medium- sized cavities that have not become septic, but in septic wounds and those attended with profuse exudation, absolutely requiring drainage, the bandage needs to be changed usually twice a day. For all wounds requiring drainage in the smaller animals and the smaller wounds in the larger animals antiseptic gauze is the ideal packing. Oakum is more suitable for the larger wounds, especially those with cavities in them that re- quire the maintenance of a free externa! opening till they fill up from the bottom with solid, healthy granulations. It takes up the exudations and maintains a good drainage better than other substances. Before being used it should be soaked for ten or fifteen minutes in a one per cent. solution of bichloride of mercury, or a five per cent. solution of carbolic acid or other antiseptics. A. H. BJ Another drawback to the use of drainage tubes is their lia- bility to either fall out, or be drawn into the wound. In our domesticated animals the former usually occurs. This‘ can, however, be avoided by suturing the outer end of the tube to the edge of the wound. As wound exudates do not always absorb, one of the import- ant demands, without which the best applied drainage does not perform its function, is to allow them to flow downward ac- cording to the laws of gravity. This may require counter openings for the sole purpose of establishing proper drainage. On account of these drawbacks attempts were made to en- tirely discard the use of drainage in human surgery. As a matter of fact, it is possible to attain good results without drainage, and as, especially in veterinary surgery, these mis- haps appear rather frequently, we must discover and eventually adopt only such measures which will make drainage unneces- sary. SUTURING MATERIAL, DRAINAGE BANDAGES. 61 The methods, which have thus far been frequently applied in place of drainage, are (ist) The depressed suture. (2nd) The row of sutures. (3rd) The secondary suture. These three styles of suturing will not be discussed any further here, as they really belong to the domain of surgery. The last material to consider in the adjustment of an anti- septic bandage is the cord or band which holds it in place. As the only object of this cord is to retain the bandage in place, its form and construction is really of no great import- ance; but opinions, as far as veterinary science is concerned, differ-somewhat on this subject. Hence I will make a few re- marks about it. | It has always been supposed that the bands should be firmly woven so as to stand the strong strain caused by the violent movement of our domestic animals. Therefore linen bands with woven edges were used, and for the hoof a special style of fastening, the so-called chain bandaging, has been invented. My experience, however, has taught me that these linen bands, on account of their lacking elasticity, squeeze the wound and do not cling to the body; also, that the successive turns slip from each other, thus permitting the bandage to get easily loose, and finally come off. In a word, I found that linen bands, aside from their high price, are the most unfit material for bandages in existence. On this account I now use only cambric and mull bands 5 m. in length and 7 cm. in width. They have all the advantages and are much cheaper than linen. Before putting them on, I usually soak them in a 1 per cent. sublimate solution, to make them fit better as well as to disinfect them. 62 ANTISEPTIC TREATMENT OF WOUNDS. VI. ANTISEPTIC MODE OF TREATING WOUNDS. I have stated in a former chapter that the method of treating wounds in human surgery cannot entirely be utilized in vet- erinary surgery, because veterinarians, in contrast to human surgeons, cannot always apply a strictly occlusive bandage. In human surgery, where the wound is left to itself, banda- ging is the one method of treating it, while in veterinary sur- gery we must distinguish between wounds which can be bandaged and those which cannot. Most veterinary authors seem to be of the opinion that antisepsis is impossible with- out an occlusive bandage, but as this is not the case, we will have to consider those methods by which wounds can be treated antiseptically without them. These methods and the possibilities in this direction will be explained in this chapter. In view of the above fact we distinguish: Ist. Wound treatment with the occlusive bandage. (a) Dry bandage. (b) Moist bandage. and. Open wound treatment. (a) Treatment under the dry scab. (b) Irrigation with antiseptics and afterwards dusting with iodoform. The object of a dry occlusive bandage is to keep an aseptic wound aseptic. This is reached by the following means: The disinfected wound is covered with a pad of jute, which is moistened with a I per cent. solution of sublimate water. On top of this pad we put wadding, gauze, or any bandaging material which should be disinfected by dipping them in a 1 per cent. solution of sublimate, and which should extend con- siderably beyond the wound on all sides. With the aid of a ANTISEPTIC MODE OF TREATING WOUNDS. 63 cambric or mull band, which is also moistened with sublimate water, this material should be bound on tightly. After these general statements in regard to dry occlusive bandages, I find it necessary to give more particulars in re- gard to the necessary disinfectants and various other points that may be worth mentioning, as failures may easily be re- corded if trifles are disregarded. When discussing the various disinfectants, I have mentioned that we possess in sublimate both a reliable, and, if properly used, harmless disinfectant, which, besides, is easily trans- portable, especially for country practice, and can be conven- iently dosed if made in the form of Angerer pastilles. More- over, on account of its cheapness, it can be easily understood why I use only sublimate as a disinfectant. For a long time in a greater or less degree the ability to absorb wound exudations was of importance in deter- mining what bandaging material to use. However, as SCHEDDE’S remarks, considering the small amount of exudation which flows from an aseptic wound, any bandaging material is sufficient to absorb them. Therefore, it is not surprising that I take the price into consideration only when selecting bandaging material, and either use jute or fatless waddirig. I stated that usually a pack of sublimate jute is put on the wound, which is especially advisable in sutured wounds. In open wounds with pockets, the objection could be easily raised that the jute pack by coming in direct contact with the granulations, might cause a damaging irri- tation or that it might stick to the wound and injure the granu- lating surface. Finally it would not be impossible for single threads of the jute pack to prove injurious later by healing in the wound. All these disadvantages actually take place, if wadding is used, but I have not as yet noticed them with jute; on the contrary, I found that in pocket wounds, the jute pack very effectually carries the exudation outwards. Frequently I use, on account of these draining qualities of the jute, splices of the same for drainage. As I soak the bandaging material and band in a sublimate 64 ANTISEPTIC TREATMENT OF WOUNDS. solution before putting them on, it is not exactly proper to call such a bandage “dry,” but-it should be remembered that such bandages dry very fast, so that, although moistened, they very soon dry by evaporation. The causes which compel us to proceed thus, when a dry occlusive bandage is put on, are as follows: (a) If we put the bandaging material on dry, it does not fit tightly to the shape of the body, thus forming dead space (cav- ities) in the bandage,.which frequently are the cause of accu- mulation and decomposition of the exudation, and the loosen- ing of the bandage. (b) Furthermore, this preliminary soaking is necessary be- cause, on account of its cheapness, I procure bandaging ma- terial which is not disinfected, and I disinfect it myself in this way. (c) Besides, dry bandaging material absorbs the exudation poorly, and, if the exudation formed soon after putting on the bandage is not carried into the deeper layers of the bandage, it dries up in the immediate vicinity of the wound and makes the bandage unfit for absorbing more. (d) In our domesticated animals it is essential that the band- age should be put on rather tight, as, on account of the rest- lessness of the patient, the bandage usually pets somewhat loosened. By all means we should not forget that excessive pressure on a part of the bandage may easily cause bandage necrosis. I found that this moistening of the bandaging ma- terial before putting it on is of the greatest help in maintain- ing it. Ifthe band that holds the bandage on is drawn close, the band after the bandage has dried up gets longer so that the bandage will be somewhat loose. While the bandaging material dries tip and at the same time expands, it provides for the filling of the space between the body and the band, and a sufficiently tight hold. Finally, the question as to how long such a bandage should be allowed to remain unmolested must be considered: The advantage lies in the fact that a daily cleansing and treatment of the wound, which in the preantiseptic era was ANTISEPTIC MODE OF TREATING WOUNDS. 65 considered necessary, is superfluous. -The endeavor of every surgeon is, if possible, to bring about the healing of the wound under one ‘bandage; however, a change of bandage is indis- pensable in certain cases, and therefore a minute knowledge of all the circumstances which make such change necessary is required. Though we could easily ascertain. how the wound is pro- gressing by taking off the bandage, we would at the same time expose the wound to new dangers. Therefore, we have to be on the lookout, as in internal diseases, for symptoms, which tell us what takes place under the bandage. Though these symptoms are not as numerous as they are in internal dis- eases, it takes practice to decide from them whether the band- age should be changed or not. LISTER, by his bi-chloride of mercury bandage, as pre- viously mentioned, attempted to use the bandage itself as a reagent for the procedures of the wound; but this does not seems to me to completely solve the question, as- wound exu- dations, especially pus, produce the necessary discoloration only, if they soak through-the bandage. We do not there- fore obtain any disclosure as to the condition of the wound unless the exudation is abundant. One of the most important symptoms for determining the processes going on in the wound is undoubtedly the tempera- ture of the body. Every rise in body temperature during the healing of a wound, is, if no other illness is present, due to some abnormal action in the wound. To avoid mistakes, we certainly must, in accordance with VOLKMANN and GENZMER’S theory, strictly draw the line between septic and antiseptic fever. These authors frequently call our atten- tion to the fact that frequently high fever up to 41° C. occurs in patients with a completely aseptic healing of the wound, and that the patients alluded to did not show signs of any con- stitutional disorder. This aseptic fever is of no importance in healing wounds, and the question arises, how are these two styles of traumatic fever distinguished from each other? As already mentioned, aseptic fever consists chiefly of a rise in 66 ANTISEPTIC TREATMENT OF WOUNDS. temperature without any disturbance of the general constitu- tion and is caused, according to the theory of VOLKMANN and GENZMER, simply through resorption of bland wound exudations. The.case is entirely different with aseptic fever. In it we find, besides a rise in temperature, a great nervous prostration, so that some horses stagger with the hind parts, and if slightly pushed with the hand stumble sideways, and even fall down. Furthermore, such patients suffer from com- plete loss of appetite and dizziness with stupor. To return to our subject as to the importance of traumatic fever in judging the healing of the wound, only septic fever necessitates a change of the bandage, while the aseptic fever is of no importance. Naturally there are septic fevers which show the above mentioned symptoms in only a small degree, for instance, the appetite is irregular with a temperature of from 39° to 40° C. In such cases we should not immediately change the bandage but wait and see as to whether this con- dition lasts longer than twenty-four hours or gets worse. In the latter case the bandage must be changed immediately; however, if the temperature returns to its normal condition in the specified time, we omit taking off the bandage. Another, though not absolutely reliable, symptom of the wound-healing processes is the painfulness of the wound and surroundings. This symptom is unreliable inasmuch as the varied sensibilities of single individuals are shown in the pain- fulness of the wound. While dogs with wounded limbs as a rule put no weight whatever on them, oxen with even large hoof defects still work, although with pain. Just as different sometimes is the degree of sensibility even between individuals of the same animal species, thus, for instance, well bred horses do not, in slight hoof affections, put any weight on the affected limb, while working horses of a lower grade frequently show, even in severe affections, but insignificant pain. We can thus see that the painfulness has but a relative value according to circumstances, and I consider, as a rule, that only a pain which remained the same for over five days, and an increasing pain- ANTISEPTIC MODE OF TREATING WOUNDS. 67 fulness after surgical encroachment, necessitates a change of bandage. : [One of the main indications of sepsis is more or less exten- sive swelling. Aseptic wounds, as a rule, swell very little — A. H. BJ Amongst the many causes to which an increased painful- ness of a wound, especially the nondisappearance of present pain, is due, we will only mention the one that has any rela- tion with the bandage, namely, pressure on any part by the bandage. If the bandage is put on too tight it necessarily presses the soft parts, especially in the hoof, and creates pain. Profuse exudation may be the cause for change of bandage, especially in a case where an articular cavity sheath of a tendon etc., which has been opened, furnishes its normal exudation, and then easily saturates through the bandage. Although this saturation of the bandage with the secretion of serous or synovial membranes is not an absolute indication for chang- ing the bandage, it is a good idea to do so, as these serous se- cretions form an excellent nutritive channel for micro organ- isms. Though we could, by placing over such bandage that has imbibed pure serous secretions a thick layer of disinfected bandaging and fastening it with a band, avoid bad results, it is not advisable to allow such cases to go into extremes, espe- cially in country practice, where the patient is not seen every day. If the saturation of the bandage with bland exudations was not such as to be decisive for the change of the bandage, every imbibition by the bandage of exudations other than bland, which are immediately recognizable on the body tem- perature, must lead us to put on another bandage, for other- wise the whole antisepsis of the wound is illusory. That a bad fitting, loose bandage does not perform its function and is therefore worse than no bandage whatever, is a fact which is well known, therefore, it goes without saying that the loosen- ing of a bandage always necessitates a change. In conclusion, we may mention ‘one more symptom on which, in human surgery, a certain value is placed; I mean 68 ANTISEPTIC TREATMENT OF WOUNDS. the scent of the bandage. In our domesticated animals the scent of the bandage is nearly valueless, for even in an en- tirely aseptic condition of the wound and its vicinity, espe- cially with a moist bandage, a scent which is like that of old cheese or a sweating foot, is observed. This scent, which is chiefly found in hoof bandages, originates from decayed epi- thelium, especially hoofhorn, and has nothing whatever to do with the wound, and is of no importance whatever. (2) The moist occlusive bandage differs only in its pur- pose and treatment from the dry one, so that nearly everything that is said of the latter is of value for the moist bandages. If we want to put a moist occlusive bandage into use we use the same modus operandi as with a dry bandage, only we have to see that the bandage should be permanently moistened with antiseptic fluids. In human surgery this moisture is kept up by placing between the layers of bandaging material gum paper or any non-porous material. By this method an evap- oration, drying of the moisture contained in the bandage as well as perspiration is prevented and the intended object reached. Although the bandage under these conditions stays moist, an increase of disinfecting matter will by no means be obtained, therefore, as the disinfection means will gradually be used up, a scarcity of the latter will result; besides, by the mentioned mode a maceration of the skin which often results in eczema and its consequences will be started. For these latter reasons I abandoned this mode of moist bandaging, the more so as the bandages of our domestic animals so easily get in- fected, especially on the extremities, which necessitates a re- peated disinfection. This disinfection is reached by simply having.a & per cent. sublimate solution poured upon the bandage several times a day. Experience has taught me that no intoxication arises by this treatment and I have decided to use a moist sublimate bandage as a rule in all fresh wounds, and until the first change is necessary, and I have thus gained complete asepsis even in hoof bandages, which are exposed to infection. ANTISEPTIC MODE OF TREATING WOUNDS. 69 As to the incidents in the wound also as to whether a change of bandage has to follow, the symptoms mentioned in the dry occlusive bandage (with exception of the saturation of the bandage), give us the desired information. (3) In human wounds, which are not treated at all, we fre- quently see a healing take place without any pus or abnor- mality in the healing process. By inquiring into the reasons. and what takes place in the healings of these wounds we find that nature, by certain processes, is able to frustrate such wound diseases which are due to infection. We notice that such wounds, on account of the drying up of the exudations, form a dry scab under which healing takes place, just the same as we notice by adopting the bandaging methods previously described. Healing under a dry scab is also possible in our domestic animals, but less so than in the human, be- cause of the work they do as well as on account of the greater danger of infection and its consequences. Notwithstanding these unfavorable conditions, healing under the dry scab is possible in our domestic animals under certain circumstances. As it is impossible for us to put on a bandage on many wounds of the body, the question arises whether this natural process of the healing under the dry scab may not be arti- ficially imitated. After many experimerts in this direction, T obtained a result not to be undervalued, as I succeeded, with but few excepticns, in all wounds where no violent or forcible motion takes place or any specially profuse exudation is pres- ent, that is, in wounds not located around or on the joints, by spraying iodoform sugar or iodoform tannin on the wound surface to produce a dry scab which is sufficient to pro- tect.the wound against infection. Considering what was said above in regard to the life conditions of micro organisms, the effect of this method explains itself. On account of the exu- dations having been reduced to nearly nothing, one of the most necessary stipulations for the growth of microbes, name- ly, the moisture, is lacking. Furthermore, the little exudation which exists turns, on account of the sugar present, into-a concentrated sugar solution, which latter also does not form 70 ANTISEPTIC TREATMENT OF WOUNDS. a suitable nutritive medium for vegetable life substances. Be- sides, the iodoform, when coming into contact with granu- lation, produces vigorous antiseptic effects. Where it is necessary to dry up a wound surface effectually, that is, to restrict exuberant granulation, I do not know of a better remedy than iodoform sugar, considering the, de- mands of antisepsis. In case of necessity, I have used also pure sugar with the same result. c The iodoform tannin I used for healing purposes under the dry scab only, for if the discharge has a synovial character, the sugar is not capable of coagulating and drying up the great quantity discharged. Here iodoform tannin is more effectual. (4) In all cases in which we can neither apply a bandage nor succeed in bringing on a scab healing, we have to resort to “the open wound treatment” in a closer sense of the word. However, as I mentioned above, I very frequently succeed in healing wounds under the dry scab, and only in such wounds of the trunk, which are either located in the vicinity of the - natural body openings or are bruised wounds, and as such have to cast off first all necrotic parts, or are such which, on account of strong unavoidable movements, do not permit scab formation, do I resort to open treatment of wounds. The antiseptic treatment of such wounds is as follows: The wound as well as vicinity is freely rinsed and carefully cleansed with a I per cent. sublimate water solution, and then the sur- face is thinly covered with powdered iodoform. For the latter manipulation I prefer to use rubber ball syringes such as are used for spraying insect powder. They are practical, and on account of their cheapness are preferable to the expensive iodoform sprays. Now there is only left for us to discuss the conditions which would indicate the adoption and use of any of the above meth- ods, but we have to restrict ourselves to the general indications which are mentioned before, when the different methods were separately discussed, as we are often compelled to transgress from the original to another mode of treatment during the process of healing of some wounds. ANTISEPTIC MODE OF TREATING WOUNDS. 71 It would be carried too far were we to describe all the details of the course of a wound and all indications for further treat- ment which may follow. In judging single cases practice must aid us in using the necessary practical judgment and pre- caution. Therefore, I can only recommend to everyone who is desirous of thoroughly posting himself as to the technics of the antiseptic treatment of wounds, to go through the sepa- rate details of the modus operandi either in a clinic or in practice. It is thus learned much faster and with more thor- oughness (which is pre-eminent) than is possible from books: 72 ANTISEPTIC TREATMENT OF WOUNDS. VII. ANTISEPTIC OUTFIT FOR PRACTICE. In former chapters we learned of the necessary precau- tions, materials, etc., necessary in the antiseptic treatment of wounds. Should we draw a conclusion from these statements as far as carrying out the antiseptic treatment of wounds in country practice is concerned, it would be evidence in itself to justify the remark (untrue though it be) which is often made in regard to antiseptics in country practice, namely, that it is too complicated to be of practical value to the country veter- inarian. I acknowledge myself that such an apparatus as re- ferred to in former chapters, could be conveniently kept in a clinic but could not be very well lugged around by the country practitioner. As thus far in our literature there are no suggestions as to what the antiseptic outfit of the practical veterinarian should consist of, I will put my own experiences down as a basis for the following: The facts mentioned in the last chapter should by no means be considered the limit; they should only prove as the intention of this book indicates, that antisepsis in country practice can be carried through, and country practi- tioners should furthermore be urged to follow up this plan. I, at least, shall accept and be very grateful for any improve- ments and teachings that may be offered at any time. The instruments play an important role as infection trans- mitters, and on this account I have given up the use of leather pocket or bandage cases, as they contain much that is super- fluous, and besides, the material which they are made of is en- tirely inaccessible to disinfection, I carry only an antiseptic case with me such as made by HAUPTNER, Berlin, and which, as they are manufactured entirely out of metal, can be easily dis- or ANTISEPTIC OUTFIT FOR PRACTICE. 73 infected by putting them into a carbolic solution. These cases fill all requirements which I expect from an instrument case and-which I have to carry with me for treating wounds. As a disinfectant I use sublimate which I carry with me in a glass tube in the shape of 22 ANGERER’S pastilles. As bandaging material, two bands (cambric or mull bands, 5 m. long, 7 cm. wide), with a corresponding quantity of jute wadding or other bandaging material that can be conveniently carried along. With these few remedies a regular antisepsis can be car- ried out, and I mostly limit myself in my practice to them, for the more simple an apparatus is, the more simple is its application. ; My placing this simple antiseptic outfit first is to show that without any special inconvenience everything can be carried along to comply with the requirements of antisepsis, and that many of the items mentioned in the preliminary chapters rep- resent a luxury to a certain extent, that can be carried along if we are not too particular as to the cost and room. For in- stance, he who rides in his own vehicle, while practicing, can conveniently carry iodoform, carbolic acid, disinfected silk, several bandages, etc., etc., besides the above mentioned out- fit. In hospital practice we can have even more conveniences, for instance, irrigators, iodoform sprays, etc. However, as mentioned above, I confine myself to the most necessary, and as a rule carry only the first mentioned items with me; if, however, I know that an operation will be necessary, I also take along the following articles:—iodoform, pure carbolic acid, brush, 200-300 g jute or fatless wadding, 4 or 5 cambric and mull bands each 5 m. in length, 7 cm. wide. All this can be easily transported in a small tin box. , On farms with much live stock it is well to keep at hand all such materials for disinfection. Some farms in my locality have, on my advice, furnished themselves with bandaging cases, which contain the following: : 1,000 grams jute (in plaits). 5 1,000 g¢ fatless wadding. 74 ANTISEPTIC TREATMENT OF WOUNDS. 500 g pure carbolic acid. 500 g pure sublimate spirit (1:5). 500 g iodoform (powdered). 20 cotton bandages. 20 muslin bandages. Iodoform spray. Esmarch tube. Disinfected silk. Drainage tube. Brush for antisepsis. EXAMINATION OF WOUNDS. 75 VIII. EXAMINATION OF WOUNDS AND THEIR PREPARATION FOR OPERATION. As the proper treatment of a wound cannot be carried on without a thorough knowledge of its nature and the conditions present, the first stipulation is a thorough examination. Very frequently we are compelled to go at this examination manu- ally, that is to use instruments (probes) for the purpose; in every instance danger of infection during examination is pres- ent, our hands, vicinity of the wound, and instruments being carriers of infection, as already referred to above. It should, therefore, be made a rule, that in examining wounds a direct contact with them should. be avoided as much as possible and only with certain precaution should a manual examination or one with the aid of instruments be undertaken. I proceed, therefore, in examining wounds, considering the rules of anti- septics, as follows: If the condition of a wound (depth, length, affected tis- sues, possible foreign bodies, character of the wound surface, the discharge, vicinity) can be sufficiently recognized and judged by mere inspection, I do not-touch the wound, and therefore obviate the use of special antiseptic precautions in the examination. When a manual or’ instrumental examination is necessary, I prepare by dissolving one sublimate pastille in one-half pint of water a sublimate solution (the best way is in.a clean wash bowl), disinfect the hands in same, after their having been washed clean with water and also dip the instruments in the same solution, and then thoroughly clean the vicinity of the wound. The hair, with the dirt and discharges, is trimmed short, to about 5 cm. from the edge of the wound, and eventually with 76 ANTISEPTIC TREATMENT OF WOUNDS. soap and brush in a rather large circumference the vicinity of the wound is washed and finally disinfected with sublimate water, which is either directly poured on, by means of a pot, irrigator, etc., or is put on with the aid of a wadding or jute compress. After this disinfection of the vicinity of the wound it is irrigated thoroughly with sublimate water and only now follows the examination, with disinfected hands and instru- ments. These manipulations may seem tedious, but they are per- formed much faster than they are described here, and habit has much to do with it, so that I proceed in the described method nearly entirely mechanically. By these means the dan- ger of wound infection during the examination is nearly entire- ly prevented, and then I am of the opinion that many of the wounds would heal much better if they were not permanently infected through their uselessly coming in contact with the instruments, as well as hands, of both professional and non- professional persons, that are not disinfected. Similar preparations, as described at the examination of wounds, are necessary to perform operations with antiseptic precautions. The field of operation stands first in need of being prepared. Though in human surgery we almost al- ways succeed in disinfecting an operating field in a short time, even here it has been decided, especially in opening any cavi- ties of the body, to prepare the operating field days before, and the so-called preparatory bandages or poultices are ap- plied. These bandages are for no other purpose than to bring about a thorough disinfection. As the disinfection of the oper- ating fields in our domesticated animals for reasons formerly given, is much more difficult than in the human, I make such preparation of the operating territory in advance whenever possible, for success depends upon a careful disinfection. To obtain my object, I proceed as follows: If a bandage can be put on, for instance, on the extremities, after the operat- ing field is priorily cleansed, we apply the bandage (hoofs are cleanly trimmed), which is daily moistened with a sublimate EXAMINATION OF IVOUNDS. 77 solution. It is practical to use heavy sack linen for such bandages, to prevent their being tread through. Where such bandaging is not practical, the operating field is to be thoroughly washed, eventually the hair Himmed. off, and afterwards irrigated with sublimate water. Unfortunately, it is not always possible to carry out this ef- fectual preparation of the operating field, hence there is noth- ing left for us but the disinfection, which was formerly de- scribed in all details. If I perform an operation with antiseptic precautions, and I do this in every instance, | supply myself before commenc- ing it with the following materials, provided I did not bring them along with me: (1) Five or ten litres of sublimate water. For this purpose I dissolve in one-half to one bucket of water (a well-washed horse pail will suffice) five or ten Angerer’s sublimate pastilles. Instead of the irrigator I use a clay pot with a nozzle, with the aid of which the wound can be conveniently washed. . (2) A washbowl with carbolic water (3 per cent.) to put in and disinfect the instruments. (3) a piece of soap. (4) a brush. (5) disinfected silk. (6) bandaging material. (7) iodoform powder. As stated before, all these above mentioned items cannot be carried along permanently, therefore we meet with cases where we have to be contented with the outfit described above, it being the one I always carry along. For dis- infecting instruments, sublimate water must then be sub- stituted, the disinfected silk is replaced by raw silk, which 1s saturated in sublimate water. As bandaging material we can, in case of necessity, use linen compresses, namely, small linen sacks filled with fine sand and saturated in sublimate water, while linen bands come in place of cambric and mull bandages. During a military drill of six weeks, in which I recently 78 ANTISEPTIC TREATMENT OF WOUNDS. took part (army veterinarians very seldom have a pharmacy handy, and the medicine case which is carried along on the freight trucks, though it contains a good deal, does not suffice for the demands of antisepsis), I treated almost typically ali saddle galls, contused, lacerated and bruised wounds as fol- lows: After the wound has been dressed, and well washed with mild vinegar water, a thick layer of powdered sugar is applied. With this simple, easily administrable method, I al- ways succeeded in healing the wound, under the dry scab, so that I can especially recommend this method in case of necessity. EXAMPLES OF ANTISEPTICALLY TREATED CASES. In the following examples, which I discretionally select from among a number in my country practice, I shall endeavor to show the practical application of this treatment, as not every- body has an opportunity to visit various clinics to particu- larly study the procedure. OTHAEMATOMA IN THE HORSE. A heavy Belgian working horse possessed for some time on the inner surface of the left ear a haematoma of the size of a hen’s egg, connected with strongly inflamed swelling of the whole concha, as well as the vicinity of the ear. As the swelling already showed numerous erosions and the horse was shaking his head considerably, and permitted the touching of the latter by force only, a removal of the trouble became necessary. The following treatment was indicated: Removal of the swelling through the fissures of same, and as on account of suppuration the auricular cartilage, if not the whole ear could be easily destroyed, strict antiseptic treatment of the wound was imperative. After the hair on the swelling had been clipped off, the ex- ternal auditory canal was cleaned with soap and water, and rinsed out with sublimate water, and then stopped up with a cotton wool tampon saturated in glycerin. The rest of the ear was also washed with soap and disinfected, so that after a EXAMPLES OF ANTISEPTICALLY TREATED CASES. 79 disinfection of the hands and instruments, the opening of the swelling with an endeuxtemps oval amputation could follow. A large tablespoonful of a turbid grayish-red fluid, contain- ing numerous pieces of cartilage, was evacuated. The cavity of the wound was then irrigated with sublimate water, and after dusting with iodoform, was tamponed with gauze moistened with sublimate water. Over the wound and the whole ear, wadding was put, then a pair of linen protective hoods, such as are used to ward off flies, was pulled over the ears, and on the lateral portions the halter was fastened. The whole bandage was saturated once a day with sublimate water and was changed every four days, while at the same time the wound was rinsed out with sublimate water and a little iodo- form was strewn into it. Within the three weeks which passed until the wound completely healed, a few pieces of cartilage came off, but there was hardly any exudation from the wound, proving the wound’s course to be typically aseptic. CONTUSED WOUNDS ON THE THORACIC WALL. A well-bred carriage horse from some unknown reason re- ceived a contused wound on the left thoracic wall. The wound: was 20 cm. in length, gaped 3 cm. and showed at the bottom the ribs still covered with periosteum. It extended horizontally to the olecranon. Otherwise the wound had the aspect of any fresh wound. As the horse was used for pleasure, it was desired that he should have no disfiguring scar, not even a harness scar, so I had to endeavor to heal the wound per priman intentionem. Treatment—Cutting off of the hair in the vicinity of the wound, disinfection of the wound and vicinity with soap and a I per cent. sublimate solution, after scraping with sharp scoop, disinfection .of the hands, and suturing the wound. The sin- gle stitches of the interrupted suture were put very close, and in the center of the wound a space 3 cm. long was left without suture, so as to allow the cavity of the wound to be treated antiseptically. The latter was rinsed out daily with a I per cent. sublimate solution, also the wound itself externally, then 80 ANTISEPTIC TREATMENT OF WOUNDS. a little iodoform ether (5 per cent.) was injected into the cavity. The wound healed within fourteen days without form- ing a conspicuous scar: the sutured part healed per primam intentionem, the other by granulations with a purely aseptic course. To prevent any infection during the healing, the horse was turned backwards in the stall, and the head was tied up high on both sides, so that the animal could not lie down nor lick the wound. SUPERFICIAL AND MUSCULAR WOUND OF THE PELVIS. A heavy Hanover draught horse, while stepping back, ran against an iron pillar, and thus received a flap wound of the gluteal muscles on the left side. Three lobes (flaps) were formed, and in the center of the wound a large piece about the size of a man’s fist was torn out of the senutendinon muscle, which was connected with the muscle with but a few connec- tive tissue bands. Treatment—After removing the piece of muscle and dis- infecting the vicinity of the wound and the wound itself by a I per cent. sublimate solution, the two side laps were sutured with an interrupted suture, while in the cavity which was formed by the removal of a portion of the muscle and also on the sutures, powdered iodoform sugar (5 per cent.) was thickly applied. A dry scab formed, under which the wound healed up without any reaction (formation of pus, swelling, etc.,) whatever. Whenever a moist spot appeared on the wound a thick layer of iodoform was put on to keep the scab con- tinuous. C LOBULATED CQNTUSED WOUND ON THE INNER SIDE OF THE KNEE JOINT OF THE HORSE, LAY- ING THE TIBIA BARE. A Hanover work horse was kicked by another horse under the belly, so that on the inside of the left knee joint a lobulated wound of the size of a large plate was formed, through the center of which the tibia was laid bare, exposing the periosteum in a spot the size of a twenty-five-cent piece. Treatment—After liberally rinsing out the wound with a EXAMPLES OF ANTISEPTICALLY TREATED CASES. 81 one-tenth per cent. solution of sublimate, all necrotic as well as probably dying shreds were removed and the wound to com- mence with, was treated as “open.” The wound and vicinity were twice daily rinsed with sublimate water, and powdered with iodoform. On the sixth day the wound was clean, and treatment with iodoform sugar, in order to obtain the form- ing of a scab, was resorted to. On the tenth day a dry scab was formed, under which the wound healed, so that after four weeks the animal was capable of resuming work. The defi- nite cicatrisation came into effect after six weeks. Formation of pus, or swelling of the vicinity, during the process, was not present. TENDON AND SHEATH OF TENDON WOUND ON THE HIND LEGS OF A HORSE. The following case is especially interesting on account of the complications in its course, and refers to a cob, that received a wound on his hind legs by a plowshare, on the fifteenth of May, and the following were the conditions: In the center of the left metatarsus.there was a superficial- wound 10 cm. long, which extended from below outwards, and in front obliquely upwards, behind and inwards, exposing the inner edge of the perforatus flexor tendon. The wound gaped in the center about 2 cm., the edges were rather smooth and covered with coagulated synovia. The vicinity of the wound was not swollen, but was covered with coagulated synovia. After removal of the exudations and coagulated synovia present in the wound, by means of a I per cent. sttblimate solu- tion, the intact tendon of the flexor pedis perforatus came into view. In the center the wound had a depth of 2 cm. These holes were caused by the flexor pedis perforans tendon being half severed. The walls of the cavity of the wound were moderately smooth, and were but partly covered with blood coagulum, but not as yet with granulations. By running the finger down on the upper sheath of the tendon of the flexor pedis perforans, a clear wine yellow, threadlike synovia was 82 ANTISEPTIC TREATMENT OF WOUNDS. evacuated. However, an opening, or a further filling up of the lower tendon sheath of the perforans could not be ascertained. Besides, the mentioned solutions of continuity, the recurrent metatarsal artery, as well as the outer branch of the plantar nerve was cut through. The state of the wound clearly indicated the following treatment: If we did not succeed in preventing the infection of the wound, a suppuration in the wound and in the opening of upper tendon sheath of the flexor pedis perforans, would necessarily result, and then certainly a recovery of the patient would be out of the question. 4 After the hair in the vicinity of the wound was trimmed and the leg cleansed with soap from the ankle joint upwards and washed with a 1 per cent. sublimate solution, it was then thor- oughly rinsed out with a 1 per cent. sublimate solution and then in its rear angle three, and in the front two sutures of: sublimate silk were inserted. In the remaining cavity, a car- bolized jute tampon, powdered with iodoform, was inserted, and the whole metatarsus was surrounded with several layers of sublimate wood wool wadding, and wrapped around by means of cambric bands. On the 19th of May I visited the patient again and found a regular agglutination of the wound as far as the sutured parts were concerned, the cavity of the wound was covered with nice pale red granulation; however, the synovial flow still con- tinued. The temperature was 38.2 degrees (REAUMUR), and there was no trace of suppuration. The bandage was again put on exactly as on the 15th of May, and the owner ° was ordered to saturate same once daily with a 1 per cent. sub- limate solution. The tendon of the flexor pedis perforans on the injured spot and the tendon of the flexor perforatus at the top of the sesa- moid was totally torn asunder; the wound was gaping owing to the sutures being torn out about 10 cm. and the tendon stump of the perforatus protruded out of the wound about the length of to cm. The lower tendon sheath of the perforans was also open and synovia flowed from it. EXAMPLES OF ANTISEPTICALLY TREATED CASES. 83 Notwithstanding these complications, I continued the treat- ment by first of all cutting off the stump referred to above 10 cm., then diligently rinsing out the wound with 1 per cent. sub- limate water and. bandaging up as above described. By renewing bandage on the Ist and 4th of June the course of the wound was a purely aseptic one, only the sur- face of the wound did not granulate satisfactorily as the upper tendon stump proliferated to a full hen’s egg size granuloma, which did not come in contact with the lower stump. I de- cided on the gth of June to cut off this granuloma at its base with the scissors, so that about 5 cm. of the ospedis flexor ten- don was lost. When I again visited the patient on the 16th of June, I found an altogether aseptic granulating wound of about the size of a hand, which on the edge already showed a new forma- tion of epithelial covering. Synovia did not flow out of either of the flexor sheaths that were open. It was cleaned with a I per cent. solution of sublimate and tied up again so that on the 23d of June I found a considerable smaller wound surface, which I endeavored to cure by means of a scar under a dry scab, as there was sufficient granulation formed. To gain this object I had the wound powdered daily with iodoform sugar (5 per cent.) until a dry scab formed. On the 8th of July the patient walked around in the stall, though the pastern joint was somewhat weak as yet, the horse did not show any pain, and four weeks later could resume its service as coach horse again. On the wound there was an en- tirely dry scab, and it was hardly the size of the palm of the hand. NAILPRICK. In course of time I have had under my treatment the most various forms of Nailpricks (with or without injury to the flexor tendon, navicular bone, frog cushion, and os pedis), and I adopted the following rule as to treatment: Cutting down, occasionally removing all of the horn in the vicinity of the punctured wound, plugging of the puncture- 84 ANTISEPTIC TREATMENT OF WOUNDS. canal which is widened with the sharp spoon up to its base, with a jtite compress, which is saturated ina I per cent. solu- tion of sublimate. On the top of this tampon a pledget of jute, fastened by means of a covering iron, is placed, and kept moist by occasionally pouring sublimate water on it. A change of this bandage is necessary every three or four days. Under such treatment all fresh nailpricks heal nearly with- out an exception within from eight to fourteen days, on ac- count of the antisepsis, which prevents suppuration and its consequenices. The therapy of all nailpricks, in which the pain does not become materially alleviated within five or six days after the course of treatment as above mentioned, or when fever sets in, (especially in nailpricks, which perforate the flexor tendon, that is, old nailpricks, where necrosis in the depth of the punc- ‘ture canal takes place) is a surgical one, and will be discussed later. THRUSH WITH LAYING OPEN OF THE SOFT PARTS ON BOTH HIND HOOFS. As a consequence of permanent standing in urine soaked peat litter, on both hind hoofs of a horse the frog was so badly macerated, and the side lacunae so putrefied, that in the latter the hoof cutis vera was laid open. The disease was diagnosed as frog canker, and was accordingly treated chiefly with plum- bum nitricum. This treatment did not heal the wound, and the owner was recommended to have the animal destroyed. On my recommendation the horse was treated in such a way as to have the wound rinsed with a 1 per cent. sublimate water and bandaged up afterwards with iodoform tannin (5 per cent.) and jute. In the course of four weeks, healing re- sulted, during which time the horse worked along in the field. SUPPURATING STONE BRUISES. As a rule in suppurating stone galls we simultaneously find necrosis of the soft parts in larger or smaller dimension and EXAMPLES OF ANTISEPTICALLY TREATED CASES. 85 the indications, therefore, are as follpws: Removal of ne- crosed parts, laying open the wound surface by cutting out the neighboring horn, and disinfected treatment of the wound. I therefore proceed thus: After the shoe is removed, by means of a brush and soap the whole hoof is thoroughly cleansed. Then, after disinfect- ing with a 1 per cent. sublimate solution, the wound is laid open by removing all undermined horn. Necrotic corium of the hoof is removed, and then another plentiful rinsing with sublimate water follows. After this, either iodoform, or if such cannot be obtained, powdered sugar in a thick layer or granu- lated coffee, is strewn on the wound, and a moist sublimate bandage put on. After eight days at the latest, such a new formation of horn is present that after shoeing the horse and putting on a few turns of a tarred bandage, the patient can be put to work. 86 ANTISEPTIC TREATMENT OF WOUNDS. IX. OPERATIONS WITH ANTISEPTIC PRECAU- TIONS. RESECTION OF BODY OF INFERIOR MAXILLA OF DOG ON ACCOUNT OF FRACTURE. A spaniel was bitten by a large Leonberg dog and the latter fractured both rami of the former’s lower jaw closely behind their union (body), so that the lower lip and poy of the lower jaw was pendulous. After narcotising the dog by means of a morphium injec- tion, I resected the fractured portion of the inferor maxilla, , also the corresponding part of the lower lip. As I was afraid at that time of the poisonous action from applying sublimate on mucous membrane, the operating region was washed with salicylic water (0.3 per cent.) and the instruments as well as hands disinfected in the same solution. I then made two incisions commencing sidewise on the edge of the lower lip at the height of the fracture, and coming together, going down- wards at the mental angle, so that a wedge-shaped portion of the lower lip with the part of the lower jaw situated on it was removed. The two rami of the lower jaw were fastened to each other with a sling made out of silver wire, and the wound on the lip was sutured with silk saturated in salicylic water. In the space between the lip and the fractured ends of the lower jaw rami some iodoform and a gauze tampon were placed, and within the first three days the patient received only drinking water. After six days the sutures could be re- moved from the lip wound, as a healing per primam inten- tionem took place. After the course of fourteen days, a few bone splinters came off. The silver wire was removed after three weeks, as the two rami now adhered closely to each other. OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 87 After six weeks complete healing took place so that the dog could chew small bones. ATHEROMA ON THE FALSE NOSTRIL OF A FILLY. On the outer wall of the left false nostril of a filly a tumor the size of a fist was present, which proved to be an Atheroma, it having been previously opened up several times without suc- cess. A radical operation was decided upon in order to re- move the continually recurring tumor. After casting the horse, the skin right above the swelling was washed with soap, the hair was trimmed, and the field of operation disinfected with 1 per cent. sublimate water. After splitting open the skin, the sac of the tumor proved to be so thin that its contents evacuated immediately through a fissure. The encysted tumor was excised and after the wound was thoroughly rinsed in a I per cent. solution of sublimate water, it was saturated with sublimate silk. The suture and linear wound were powdered over with iodoform sugar (5 per cent.), so that after a formation of dry scab a healing of the wound, priman intentionem, took place after six days. As an interesting fact I might as well mention here that during my presence six months later on the same farm, I was requested by the owner to again examine the filly’s nose as the sutures apparently had not yet come out. As a matter of fact, all sutures were still present, without, however, any suppura- tion or irritation of the vicinity being present. The sutures were simply healed in, so that I had to remove them with the scissors. ACTINOMYCOMA IN THE REGION OF THE PAROTID GLAND OF A BULL—REMOVAL—HEALING IN THREE WEEKS. A Simmenthal bull had a hard painless tumor in the region of the left parotid gland, which was supposed to be an ac- tinomycoma, and later proved to be such. As all my former modes of treatment (cauterization, cutting open, pungent 88 ANTISEPTIC TREATMENT OF WOUNDS. salves, etc.,) proved ineffectual, I resorted to the knife to re- move the swelling. In a dorsal position with head stretched backwards the hair was trimmed off the tumor, the field of operation washed with soap and disinfected with sublimate water. Hands and in- struments were also treated the same. The skin as well as the platysma myodes were cleaved in a direction from the front backwards to a length of about 15 cm. and the tumor up to its pedicle was decorticated, and it was no- ticed at the time that the jugular vein was partly grown around by the tumor. The pedicle, in order to prevent bleeding as much as possible, was torn off by twisting the tumor. The cav- ity in the wound, which was at least double the size of a fist, was rinsed out lavishly with sublimate water, and then the skin, as well as the nearby sections of muscle, were closely sutured with sublimate silk. When the bull got up, a secondary hem- orrhage into the wound cavity took place, forming a tumor the size of a man’s hand. Notwithstanding this the sutures were left intact, as the blood did not percolate, and the tumor was rinsed once daily with sublimate water. The haemorrhage absorbed and the wound healed up prima intentione, so that after three weeks the swelling was no longer visible. In this case also the ‘*healed-in” sutures had to be re- moved later. NEURECTOMY OF THE INNER AND OUTER BRANCH OF THE PLANTAR NERVES OVER THE PASTERN JOINT. (HIGH PLANTAR NEURECTOMY.) Neurectomy is an operation which, considering the many important advantages that it offers in the treatment of many hoof and toe ailments, and considering the fact that the great fear of bad results is not justified, should be much more fre- quently performed than it really is. To express myself briefly, I will state that in my opinion (especially, in draught horses) neurectomy is always indicated in all such cases (where there is a chronic ailment of any part, from the pastern joint down- OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 89 wards, including the lower sheath of tendon of the flexor pedis perforans), which are painful, but do not show any acute in- flammatory systems, and which do not yield to any derivative treatment such as firing, blisters, etc., within six weeks. Although there is but one incision (surgical wound) made if the median nerve is cut through on the inner surface of the arm at the height of the elbow joint, I concluded for the following reasons instead of neurectomy of the median nerve, to perform the operation on its inner and outer branch over the pastern joint. With this mode certainly we have to operate upon the inner as well as the outer side of the pastern joint, and, therefore, we have to turn the horse after operating on one side, but whoever had frequent opportunities to perform neurectomy of the median nerve, has certainly convinced himself that it is not such an easy operation as it appears to be. On the ca- daver certainly with one single incision the median nerve can be exposed, as I have had ample opportunity to observe at the surgical exercises of the Royal Veterinary High School; en- tirely different, however, are the conditions on the living animal. The median nerve at the elbow, where it has to be éxposed in order to cut it through, is covered by the flexor metacarpi in- ternus. The latter muscle stretches itself, on account of the exertions which the horse makes to liberate himself from the hobbles, so tensely, that it hides the nerves located under it both to the eye and the finger. Besides, in this vicinity, in fact, close to the nerve, lies the vena radialis, vena mediana and vena collateralis radialis inferior. All these three have a rather tolerable lumen, and are easily injured when the nerve is searched for, so that the severe haemorrhages cause quite a difficulty in finding it. For the practitioner, who does not have all helping material and assistance at his disposal same as the clinical teacher, the difficulty to find the median nerve on the mentioned spot, would be sufficient to cause him to abandon the operation. Another cause, however, besides this one, induced me to pre- fer neurectomy of both branches of median nerve on. the past- 90 ANTISEPTIC TREATMENT OF WOUNDS. ern joint rather than cutting through the body of that nerve, I have noticed cases where, undoubtedly, the median nerve was totally cut through, and notwithstanding this, the sensi- bility did not immediately disappear after the operation. The plea that the muscular sensation in stepping on the corona produces a deceptive sensibility is frail, owing to the fact that needle pricks were also felt on the coronet, I think an explana- tion for these appearances lies in anatomical conditions, for it is well known that a connecting branch from the ulnar nerve leads at the top of the root of the metacarpus to the outer branch of the median. Possibly through this branch of the ulnar nerve, sensitive fibres enter into the outer branch of the median and thus transmit sensibility into the parts provided for by the latter, although its body is cut through. To prevent this eventuality, I do not cut through the body of the median, but both of its branches close to the pastern joint. I attend to the operation as follows: After securing the horse, I trim the hair off, wash the skin with soap, disinfect it with a I per cent. sublimate solution, and with an incision from 4 to 5 cm. long, close above the pastern, I expose the nerve. It is practical to make the first incision the proper depth, so that the nerve can at once be seen at the bottom. If only the skin is cut open, as is usually recommended, the connective tissue must then be removed by means of scissors and small forceps. This leads to unnecessary hemorrhages and a shredded condition of the wound, and thus considerably interferes with the finding of the nerve as well as delays the healing. As soon as I know the nerve to be lying at the bottom of the wound, which can be easily determined on account of the violent movements of the pa- tient, when the supposed nerve is pricked with the knife or pinched with the forceps, I carry, by means of the Dechamp needle, a sublimate silk thread under the nerve, also through the neighboring connective tissue, and then tightly fasten the thread around the nerve, during which performance the pa- tient struggles violently. Next thing the nerve, centrally from OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 91 the ligature, is cut through with one short cut, and a piece about the length of 1.5 cm. is taken off the peripherial stump. Should any hemorrhage show itself now, owing to a small vein or artery being injured, or even if a lateral artery of the toe having been cut through, it is simply undertied with sub- limate silk, otherwise these incidents are of no importance. After a liberal rinsing out of the wound with sublimate water, I suture the wound with sublimate silk, making close stitches. Cut through the other branch of the nerve in the same manner as above described, and after the horse stands up, I put on a moist sublimate bandage. To this we add a few layers of absorbent cotton saturated with sublimate water around the leg, extending from the hoof half way up the metacarpus, which are tightened with closely placed bands. The after treatment consists of a moistening of the bandage with sublimate water twice daily during the first three or four days, while after that, up to the 12th day after the operation, the saturation is made but once a day. After that time the patient can be put to work with the bandage still on, healing takes place as a rule prima intentione and only, if the patient is worked before the twelfth day, the scab is apt to burst open again, which, however, has no other effect than to prolong the healing. NEURECTOMY OF THE TIBIAL NERVE. The same indications which justify neurectomy on the front leg are often present on the hind one. Here, however, the trunk of the nerve to be looked for can be easily detected (tibial nerve), so that it is unnecessary to cut through its in- ner and outer branch separately. The anatomical conditions also do not contra-indicate the operation on the nerve trunk. As accurate information in literature as far as the anatomical conditions, which are of importance in this operation, are con- cerned are thus far only given by EICHBAUM. (Fasciae of the horse. Betlin Arch. Vol. 15.) I will briefly describe them here. The tibial nerve, as a branch of the sciatic nerve, ap- pears on the miedial side of the leg under the gastrocnemii 92 ANTISEPTIC TREATMENT OF WOUNDS. muscles, and lies most superficially about 20 cm. above the astragalus. In a better bred horse it is higher, according to the length of the tibia. The point of operation is located, so that in larger, well-bred horses the operation must be per- formed up to 25 cm. above the protuberance of the astragalus, while in commoner, smaller horses, 15 cm. is the limit. At this point the nerve is located in the space between the mus- cle bellies of the flexor pedis, which is surrounded by a muscle sheath, on one side, and the lamellar ligament, which origi- nates by the uniting of the superficial and deep laminae of the fascia of the leg and in front of the tendo-Achillis, goes down- ward, inserting itself on the astragalus, on the other side. In the median direction the nerve lies close to the deep lamina of the fascia of the leg, and outwards, then follows the superficial lamina of the fascia of the leg, (fascia superficialis of the hind leg,) and finally the skin. Besides this, the nerve is accom- panied by the small artery, recurrent tibial artery, also by the plantar vein, the latter, however, does not seem to be constantly present, as I missed it frequently. The performance of the operation is as follows: After laying the horse down, I have the top hind leg elevated some by an assistant. I did not find it necessary to untie the leg, and then cut at the specified place with a disinfected knife through the skin to the length of from 4 to 5 cm., after the hair has been trimmed off, the skin washed with soap and dis- infected with a I per cent. sublimate solution. Now I assure myself, by touching it with the finger again, that the superficial incision is located exactly above the above mentioned interstice in which the nerve lies; should this latter not be the case, the incision can be enlarged accordingly, or if such enlargement should not suffice, a fresh incision had bet- ter be made. If the superficial wound and the space between the flexor pedis muscle and the lamellar ligament, which is formed by the union of the superficial and deep laminae of the fascia of the leg, are not exactly over each other, we reach, by cutting the facia located under the skin of the hind leg, into the space between the lamellar ligament and the OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 93 tendo Achillis, and naturally, notwithstanding we zealously look for it, we do not find the nerve. If both the superficial wound and nerve correspond, we cut through the above men- tioned fasciae which covered the nerve, with a long cut, which can be even longer than the superficial one, and find the tibial nerve in the space referred to. In fat horses the nerve is al- ways surrounded by abundance of fat. I, therefore, with the aid of the Dechamp needle in every instance, pull out the nerve with the fat, recurrent tibial artery, and plantar vein and dissect the nerve out of them, then a thread of sublimate silk is by means of the above mentioned needle, carried under the nerve and tied down. After a piece of the tibial nerve from 2 to 3 cm. long is cut out, we convince ourselves by examining the por- tion cut out, as well as by our pricking the crown of the hoof, that both branches of the nerve have been taken hold of, for it sometimes occurs, that in the preliminary division of the tibial nerve, but one branch is cut through, thus making the object of the operation a failure. The wound is rinsed well with sublimate water and closely sutured with sublimate silk without any regard to possible bleeding, which is of no im- portance, and besides, does not prevent healing per prima in- tentione. The after treatment consists of daily powdering the suture with iodoform sugar (5 per cent.) to produce a dry scab, as a bandage cannot be very well placed there. In fourteen days, at the utmost, the patient can again be put to work. AMPUTATION OF A COW’S HOOF. A heavy Dutch cow acquired a whitlow on the outer hoof of the hind foot with a subsequent decomposition of the hoof joint. As the cow, as a consequence of this, became rather — thin, I decided to amputate the hoof, which proved to be the more necessary, as there was evidence of caries of the ampu- tated hoof. : The hoofs, as well as the whole leg up to the ankle joint, were cleansed with soap and water, and thoroughly washed with a 1 per cent. sublimate solution. 94 ANTISEPTIC TREATMENT OF WOUNDS. By a circular amputation, closely above the edge of the hoof, the latter was without much difficulty excised. Haemorrhage did not take place, as all vessels were thrombosed. The whole operating field, including the wound, was rinsed out with a sublimate solution, and by means of jute, which was saturated with sublimate water, and a few cambric bands, a bandage was put on which reached half way up the metatarsus. To pre- vent any moisture and dirt from penetrating through the ban- dage it was painted over with tar. The after treatment consisted of pouring in sublimate water behind the bandage daily, and changing the bandage every fourteen days. With this treatment the wound healed within eight weeks, without any trace of pus or even exudation worth mentioning. CROWN PRICK. (TREADS.) As in nail prick the importance of crown prick depends en- tirely upon how deep the injuring body has entered. As to the mode of treatment, however, there is no difference at all between the various forms of the trouble, as a superficial in- jury is apt to cause disease to the deeper lying tissues, on ac- count of a slowly encroaching suppuration downwards. By all means surgery has to be resorted to, and according to the size and circumference of the injury, oceasionally more and at other times less horn, etc., has to be removed, so.that some- times the operation can be performed, on the horse standing, while at other times he has to be laid down, especially in more severe injuries. I proceed as follows: After the hair and coarse shreds of tissue in the vicinity of the injury have been removed, a cleansing with soap and water follows, and finally disinfection by free after rinsing with one per cent. sublimate water. ‘After that the horn in the neigh- borhood of the wound is thinned, occasionally entirely re- moved as far as the connection between the horn and flesh wall is loosened. All foreign bodies and hair which may have en- tered into the wound, as well as all necrotic or dying shreads of tissue, are removed. It is also well to trim off all irregu- OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 95 larities of the wound’s edge or soft parts as the formation of the horn later would be irregular. After a thorough disin- fection of the wound with a one per cent. sublimate water it is covered with iodoform and a pressure bandage is put on which is, during the first 4 or 5 days, saturated at least three times daily with a sublimate solution. If no peculiarities (fever, increased pain, etc:,) appear in course of time, such a bandage can safely stay on for 8 days, and according to the depth of the injury from 8 to 20 days. A new growth of horn will appear so fast that after putting on a few tarred bands the animal can be put to work again. NAILPRICK. In many cases the injury caused to the hoof by a foreign body is such, that deeper lying portions, such as the flexor pedis perforans, navicular bone and hoof joints become af- fected. In such cases it is not sufficient to tamponize the canal and keep it aseptic, as more or less necrosis of the injured parts often takes place. These necrosed parts cannot be simply shoved out of the punctured canal, but it is necessary to en- large the canal and to lay it open up to its base. Before dis- cussing the operation itself any further, I would like to annul the objection, that it is impracticable to perform an operation ' whenever the navicular bone or the coffin joint is injured. This is actually not so, for under antiseptic precautions such injuries heal without any trouble provided that the operation is performed in time, before any important changes or destruc- tion of the parts alluded to has taken place. Should a suppura- tion of the coffin joint, or extensive necrosis of the os pedis, frog cushion or the flexor tendon already be present, then cer- tainly an operation would not be advisable, for the certainly bad results would be claimed to have been.caused by the oper- ation. After this explanation, and also what I have previously said regarding the treatment of nail prick, I would formulate the in- dications for the operation as follows: Should the injuring body perforate the flexor pedis perforans 96 ANTISEPTIC TREATMENT OF WOUNDS. an immediate operation is always indicated, for should we in these cases tise such treatment as mentioned formerly and wait for the result, we would as a rule notice an increased pain, set- ting in of tever, etc., etc., which is a sign of spreading of the af- fection, which makes a success of the operation more or less doubtful. In all other cases in which the flexor pedis perforans re- mained intact, say that either the frog cushion, or only, the os pedis is injured, an operation is only then necessary if necrosis sets in deeply, or if the pain without any further visible cause continues in the same spot longer than from 8 to 14 days, or if finally some complications arise (remaining of a portion of the injuring body, suppuration, etc.). In performing the operation I use the folowing modus oper- andi: After casting the horse, the injured foot is tied on top of the diagonal foot and an Esmarch compress bandage is applied. As I lay the horse on the affected side, the sole of the foot, which is as a rule the field of the operation, on account of the above-mentioned mode of tying (on the diagonal foot), is turned upwards, and thus permits a full view of the field of operation. Within the opening of the puncture (to a circum- ference of from a quarter to a half dollar piece) the already previously thinned sole or frog is entirely cut down, the whole hoof having been previously cleaned with soap and water and disinfected by pouring a solution of sublimate water on it. Then the soft parts, by means of a disinfected laurel leaf knife, are cut down in cone form, so that the point of the cone is lo- cated at the base of the puncture canal, while the axis is formed by the punctured canal itself. The base of this cone corresponds in regard to circumference and location ‘o the sur- face of the sole as well as frog of which the horn has been re- moved. We don’t need to be too anxious in regard to that, especially regarding the frog, as no tissue grows and regen- erates as well as the hoof matrix, so that I have frequently cut out the whole fleshy frog, without any damage to its shape and formation. OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 97 If we in this way create a funnel shaped wound we can, with one glance, see in what direction the wound, or any changes in its condition are located. If the flexor pedis perforans should be found to be punctured through, or necrotic, it should be reduced in such a way that the rear frog surface in its center part is laid bare. If we then see that the navicular bone also has been injured, or that the canal penetrates still deeper, I bore the canal out with a sharp scoop so that all diseased bony tissue is removed, even an opening of the navicular-coffin joint can, under antiseptic pre- cautions, be ventured in this way, with no danger whatever. Very often we find, especially if the flexor pedis perforans is intact, the inflammatory and suppurative process creeping along in the frog cushion, so that it is pierced by numer- ous canals in the region of the plantar cushion and the cushion fossa. These canals I scrape out with a sharp scoop, and eventually I place a drainage tube of rather large caliber through the fleshy frog, which is led into the operation wound and carried out by an opening through the fossa. The after treatment consists chiefly in a regular disinfection of the wound. To obtain this object I put on a moist subli- mate bandage, which can, if the course is normal, stay there from 14 days to three weeks if necessary, changed every three or four days. If an opening is made in the fossa for drainage purposes, the bandage must cover the pastern joint, and has to, in this case, be changed oftener. The reason for the necessity of frequent bandaging in such a case is not the drainage itself, but the fact that the drainage is conditional, as a rule, on the strongly secreting processes of the frog cushion, which causes a quick saturation of the bandage. If there is but one wound made on the plantar surface of the hoof, one moistened sublimated bandage, reaching up to the pastern, is sufficient. Lately in such cases I have simplified the bandage so that I merely put a covering iron on it, and the space between the cover and sole I pad with absorbent cotton, while a few layers of cotton and bandage tours are put around 98 ANTISEPTIC TREATMENT OF WOUNDS. the plantar cushion and wall to prevent an infection of the wound from behind. No matter whether the bandage covers the pastern joint or only reaches the pastern, or whether the covering iron is used, in every case I have the bandage moistened with sublimate water two to three times daily, during the first six days, one- half per cent., and after this, provided the course is normal, only once daily. If these instructions are carried out precisely,the wound, as a rule, heals after six weeks, and the patient can resume his work. The only evil that cannot be prevented by antisepsis, is that, in some instances, (it is by no means the rule), a painful- ness is left in the new cicatricial tissue. In this case neurectomy is indicated, as I formerly stated when discussing neurectomy. I perform neurectomy in all cases of nail prick when, after the wound is healed, a painfulness, without any appear- ances of inflammation (such as can be recognized, or the miss- ing of an increased artery pulsation) is present. SEPTIC INFLAMMATION OF THE SOFT PARTS. OF THE HOOF IN THE REGION OF THE SENSITIVE LAM- INA, PLANTAR CUSHION, FROG AND SOLE 7 OF THE LEFT FRONT FOOT. At the request of the owner a bar shoe was put on a horse’s | foot. Shortly afterwards the horse commenced to go lame. An examination showed a severe inflammation of the parts mentioned in the heading. Cooling bandages did not improve it any. In the course of two days the corresponding horn parts commenced to get loose, so that to check this process an -operation had to be resorted to. The indications for the treat- ment, therefore, were simply as follows: 1.—Removal of all horny portions as far as they covered any infected soft parts. 2.—Reducing as much as possible all infected, that is, ne- crotic hoof matrix. 3.—Careful disinfection of all wounds, OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 99 The ‘horse was laid down, the lame foot downwards. The left fore foot was tied on to the right hind foot and an Esmarch bandage applied. After thoroughly washing the whole foot up to the pastern joint, with soap and water and disinfecting with plenty of sublimate water, the following horn parts on the inner side of the hoof were cut out: wall of the sensitive lamina, plantar cushion, corner prop bar and plantar frog. These parts were severed from the hoof matrix and exposed grayish red, turbid serum. Asa consequence of these changes, which represented the commencement of the necrosis, the correspond- ing soft parts of the horny portions removed, also had to be cut down and the pad of the crown as far as the hornwall, was re- moved, as well as the inner plantar cushion, which showed the same condition. The wound, fully the size of a palm, in which the lateral car- tilage ribs were laid bare, was plentifully rinsed out with subli- mate water and powdered with iodoform. On the wound a few tours of gauze were put, and then absorbent cotton and ban- dage, reaching up to the pastern joint, was laid on. As in all hoof operations, I ordered the bandage to be sat- urated with sublimate water one-half per cent. three times daily, during the first six days after the operation, then until the fourteenth day but once daily. When changing the bandage after fourteen days, it was evi- dent that the wound had exudated but little, but was already all covered with granulation, while on the edges quite a new for- mation of horn was noticeable. The bandage was changed twice more, in intervals of four- teen days, and seven weeks after the operation the patient was able to do easy work, having been shod with a bar shoe. The horse, after a regular hoof formation had come into effect, re- sumed his work as carriage horse without going lame. CASTRATION OF STALLION. According to BAYER’S procedure, also considering that with antisepsis, the dangers, which undoubtedly lie in the pres- 100 ANTISEPTIC TREATMENT OF WOUNDS. ent methods of castration, are very much reduced, in fact can be entirely avoided, I very often perform castration, with anti- septic precautions, with brilliant results. For reasons, speci- fied in my special pamphlet regarding castration under anti- septic precautions (German periodical for Veterinary medi- cine and comp. Path. Vol. 14) I did not exactly adopt BAY- ER’S modus operandi, but adhered to the following useful method for private practice: The horse receives, half an hour before he is laid down, five decigrams of Morph. hydrochl. subcutaneously to reduce the sensibility, which is to the interest of the patient, (preventing fractures), as well as the surgeon and the method. After the horse is placed in a dorsal position, the scrotum and vicinity (penis, inner surface of thigh, etc.,) are thoroughly cleansed with soap and water with a sharp brush, and then rinsed off with lot of sublimate water one to one thousand or two thou- sand. The testicle is then taken hold of with the left hand in the usual manner, and the scrotum opened with one incision, just big enough to allow the testicle to pass through, (from 6 to 7 cm.). An assistant then immediately pours sublimate water on the protruding testicle, so as to make any possible appear- ‘ing micro organisms harmless. Then the so-called mesentery of the testicles close by the epididymis is pushed through the center with the finger, and the two portions of the spermatic cord thus treated, are each ligated,*by tightly fastened threads of sublimated silk. To prevent the slipping off of these cords the testicle is cut off so that a small piece of the epididymis is left on the spermatic cord. These ligated stumps do not affect the antiseptic healing of the wound any, as they are (BAYER’S statement) aseptic, and as a consequence become simply resorbed. After the ligature threads are cut off short, the scrotal cavity is again thoroughly rinsed out with sub- limate water, and then the scrotal wound is sutured with from’ five to six sutures in such a way that the stitches commence about one and a half cm. from the wound’s edge, and simul- taneously get hold of the common tunica testis. The same procedure is gone through with the other testicle, and then OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 101 the horse can get up. Then, with the horse standing, the field of operation is again rinsed out with sublimate water and the tail tied up. The latter is important to prevent the tail from dirtying the wound. The disinfection of the instruments (knives, scissors, and needles) necessary for the operation is effected by simply dip- ping them in sublimate water every time vefore they are used. The after treatment consists in merely letting the patient stand for six days, tied high, so as to prevent his dirtying or dragging the wound on the litter, and rinsing out the field of operation daily once or twice with sublimate water. A bandage or stispensory is not put on, as an occlusive bandage on the horse in this region is impossible. Besides, a dry scurf forms on the wound shortly, which keeps the wound closed. In the course of the next two days oedema sets in in the vicinity of the penis, which disturbs the circulation some, but is of no importance. This disappears quickly when the pa- tient can take exercise again, which is about six days after the operation. Occasionally fever sets in on the second day after the opera- tion, which rises even to 39.80 c; however, this is a simple re- sorption fever, which mainly differs from the consecutive sep- tic wound fever, for the patients are lively and eat their food heartily, while the latter form of fever is always associated with the general symptoms of loss of appetite, depression, dis- inclination to walk, etc., etc. We may also mention as a complication, which, however, seldom delays healing, those hemorrhages which set in after the horse arises from the operation. BAYER mentions this accumulation of blood into the scrotal cavity, and thinks it to be the blood which flowed into this cavity during the operation, but according to my observation this haemorrhage originates from the veins that are cut through when the scro- tum is opened, and which are located between the common tunica and the dartos. During the operation, on account, of the dorsal position of the patient, there is no recurrent mo- tion in these veins, which, however, comes into effect imme- 102 ANTISEPTIC TREATMENT OF WOUNDS. diately when the horse gets up. As stated, this haemorrhage, which does not always take place, interferes with healing per primam intentionem only when it is profuse, so that the wound edges are forced apart by the pressure. Blood effusions, up to the size of an infant’s head, are resorbed without any harm. If a profuse effusion of blood follows, so that a healing per primam intentionem is not expected, the sutures are removed on the fourth or fifth day, the scrotal wound is made a little larger, and the healing with granulation follows, upon a daily rinsing out of the wound with sublimate water, in four weeks at the latest. A noteworthy fact which I noticed was that even in this healing per secundam intentionem suppuration never took place. I have castrated in this manner twelve horses of various types, from the pony up to the Hanover race, English full blood, and heavy Belgian, and gained the following results: Seven times healing per primam intentionem on both sides, twice on one side, and three times per secundam intentionem, so that out of twenty-four wounds 16, or 2-3 per cent. healed up per primam intentionem. I cannot record thus far any losses or after affects (spermatic cord fistula, peritonitis, etc.). To pacify anxious minds, who may think that tying up the spermatic cord with two ligatures of sublimate silk, which are left there, they possibly act as foreign bodies and produce an in- flammatory process on the spermatic stump, I may state, that disinfected silk heals in as well as catgut, the only difference being that silk does not get resorbed. I noticed in a post mor- tem I held on a horse that died from colic, and which I cas- trated the year previous, that the ligatures on.the spermatic stumps were smoothly healed in, without any trace of reaction in that vicinity. CONDYLOMA ON THE PRAEPUTIUM OF THE HORSE— REMOVAL—HEALING PER PRIMAM INTENTI- ONEM IN SIX DAYS. A heavy Belgian work horse had‘a wart the size of a dove’s egg on the point of its prepuce, which on account of its OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 103 frequent reappearing, was removed several times, partly by elastic ligature, and partly by simply cutting it off and cau- terizing with nitric acid. Notwithstanding this, the wart always reappeared, and as it finally grew to be the size of a man’s fist, I proposed to the owner a radical operation, to which he consented. The horse.was laid down on his left side and the right hind leg tied to the right front one. Prepuce and vicinity, also the condyloma, were thoroughly cleansed with soap and water and disinfected with sublimate water (1 per cent.). By means of a semilunar incision the swelling was removed as far as possi- ble from healthy parts, bleeding vessels were torsioned, and the - wound united with close buttoned sutures. Although the urine always had to come in contact with the wound when evacuat- ing, and although the prepuce secretion. cannot by any means be considered aseptic, the wound healed by first intention in six days. The after treatment consisted of once daily rinsing the field of operation with sublimate water. The sutures put in are still there to this day. DOCKING OF TAIL. It often happened to me that horses full of temper resisted the regular method of docking, in as much that after having cut off the tail with the docking shears, they struggle consid- erably before the cauterization to stop the hemorrhage. On account of this, bleeding takes place, which, although not very dangerous, disquiets the owner. In such cases I proceed as follows: : After the hair of the tail is trimmed off the place where it is to be docked and the skin is cleansed with soap and water and disinfected with sublimate water (1 per cent.), I put on a tight ligature or rubber tube about 3 or 4 cms. above the point of operation to prevent hemorrhage. Then on each side of the tail I make an incision, so that the two incision surfaces form a V, the point of which is directed towards the root of the tail and rests on the spot where the vertebral column of the tail is to be severed. Thus two flaps are created, which are 104 ANTISEPTIC TREATMENT OF WOUNDS. used later as a-cover for the amputation stump. If possible we must try to make the cuts so that the vertebral column of the tail is severed through a symphysis. The only cut vessel I tie is the middle tail artery, by means of sublimate silk; the side tail arteries are secured by uniting the above mentioned flaps with sutures. After the surface of the wound has been well rinsed with sublimate water, I sew up both flaps with sublimate silk, mak- ing the sutures as closely together as possible. An after treatment is hardly necessary, as healing takes place promptly. The sutures, also, I hardly ever have to remove. Exactly as described above I proceed in dogs, as in the latter, on account of their licking the tail and hitting it against the cage, more haemorrhage, even necrosis of the end of the tail, takes place. In rare cases I noticed in dogs, that after simply chopping off and cauterizing the tail, a connective tissue proliferation formed on the amputation stump, which reached the size of a child’s fist. Whether this was a mycofi- broma I leave undecided, as I did not make a very thorough examination, as at the time when I noticed these things the term mycofibroma was unknown. CASTRATION OF HORSES IN CITY PRACTICE. [In this country. a great majority of the horses are cas- trated as colts before they are offered for sale on the city marts, and therefore the city practitioner does not, proportionately, perform as many of these operations as the country veterin- arian. But when we seek information from this source or from the non-professional oophorectomist, we do not hear of methods that would inspire confidence or that we would be’ justified in adopting in city practice in view of the present knowledge of septic processes in wounds. In fact we learn that the operation is usually performed without regard for the dangers of wound infection and its consequences, ordinary cleanliness of the instruments and the meager use of some an- tiseptic liquid being the only precaution used to prevent sep- tic sequelae. When called to task for this condition of affairs, OPERATIONS WITH ANTISEPTIC PRECAUTIONS, 105 we are told that the mortality is not great and that the time, trouble and expense of the task of operating under strict asepsis cannot be expected in the face of the small remunera- tion allowed for the operation. But the fact that death is a possi- bility is sufficient reason for the general adoption of better methods, which, if carried out, would soon result, in the passing of the non-professional castrator and subsequently in better remuneration for the educated and skillful surgeon. In any event, if the veterinarian of the large cities operated in the same careless manner, the mortality would be alarming. During the last few years the high price of carriage horses has resulted in bringing many trotting bred stallions to this market (Chicago) to be castrated and sold for the above pur- pose, and it has fallen to my !ot, from time to time, to operate on a large number of such animals. The stables in which they _are kept are never free from the usual infectious respiratory diseases so common in the Chicago Horse Market, and it has by no means been an uncommon occurrence for recently cas- trated animals to contract such diseases as early as the first, second or third day after the operation; and besides this un- pleasant feature the stables are in close proximity to the slaughter houses, fertilizing factories, hair fields, glue factories, the dead animal platform and the open sewer (the Chicago River). Confronted with such circumstances, the castration of valuable adult horses was always a hazardous undertaking, and after fighting with septic processes in a number of cases, I adopted the following method which thus far has given flat- tering results, and in spite of the fact that a number of animals operated unfortunately contracted various asthenic diseases of the air passages before the healing process was complete, no deaths have ever followed. I provide myself with the following equipment: (a) Scalpel, ecraseur, a slender grappling forcep about 2 decimeters in length, and a sponge, all of which have been ster- ilized by boiling and conveyed to the place of operation in a sterilizer or wrapped in a sterilized towel. (b) Mercuric chlorid triturates. 106 ANTISEPTIC TREATMENT OF WOUNDS. (c) Carbolic Acid, 95 per cent. ‘¢d) Iodoform powder. (e) An emulsion consisting of Thioform 30 grams, Sodium bicarbonate 30 grams, and Glycerine 240 grams. (f) An ointment consisting of Thioform or Iodoform 15 grams, and Lanolin 240 grams. (g) A large clean tray for the instruments. (h) Clean metal pails for the antiseptic solutions. (i) Casting harness and twitch. The Operation :— ist Step:—The animal is placed in the dorsal position, the legs well parted and the scrotum, sheath, penis and posterior abdominal region energetically scrubbed with soap and hot water and then sponged for a time with a solution of mercuric chlorid, 1-200. and Step :—The scrotum is dried moderately with the steril- ized sponge and then sprinkled with iodoform powder, which is rubbed in well until a dry crust results. 3rd Step:—The testicle is then exposed by an incision as small as possible, and now instead of grasping it with the hand it is pulled from the scrotum with the forceps. The ecraseur chain, without permitting it to touch the hands, is passed over the forceps and testicle and adjusted to the proper place upon the spermatic cord. When the cord is sufficiently crushed, twist the testicle off with the forcep before loosening the ecra- seur. Hold the cord in the center of the wound with the ecraseur and pour 120 grams of the emulsion into the scrotum and disseminate it by circular motions of the ecraseur, which is still holding the cord. 4th Step :—The ecraseur is now loosened and placed in a tray containing a 10 per cent. solution of carbolic acid, where the scalpel, sponge and forcep have been previously laid. As the in- struments were aseptic, it was not necessary to place them in such solution for the first testicle, but as they have now been in contact with the hands of both the assistant and surgeon, their disinfection is very essential to insure success. 5th Step :—Remove the opposite testicle in the same manner a OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 107 and then anoint the whole field with the thioform or iodoform unguent. 6th Step:—Untie the animal carefully and prevent, if pos- . sible, any particles of the litter from falling upon the region, then tie him in a clean compartment. _The after treatment consists of keeping him in the standing posture without exercise for four days, or even much longer, if conditions warrant. If there is no haemorrhage from the sper- matic cord, the thioform emulsion will adhere to the exposed tissues and perfectly prevent infection, while if considerable haemorrhage takes place, it will be washed out and the wound will only be aseptic instead of antiseptic. The slight haemor- rhage from the scrotum is of no particular consequence, as it does not molest the emulsion in the deeper parts, but as the antiseptics are thus washed off from the scrotal incision the wound will become slightly infected and an oedema of the sheath will result. A clear sanguinous serum will discharge from the wound and when such secretion lodges upon the legs it must be removed with an antiseptic solution. Moderate ex- ercise may be given about the fifth or sixth day, and unless there appears evidence of failure of the purpose no manual examination of the wound should be made. Note :—For information regarding thioform, I am indebted to Prof. Dr. Hoffmann, Professor of Surgery, at the Royal Veterinary High School in Stuttgart, Germany. L. A. MJ NEURECTOMY. [Inasmuch as the removal Of a portion of the posterior dig- ital nerve isthe onlytreatment for navicular arthritisthat proves at all satisfactory; and as this operation, as usualy performed, leaves quite a large cicatrix, which is, a conspicuous advertise- nient of the existence of this incurable disease, it is desirable to get union of the skin after the operation by first intention, It can be done by the observance of the principles of antiseptic . surgery and the intelligent use of proper dressings. It is pre- ferable to put the horse on an operating table, to avoid the dirt and dust of the litter, incidental to casting him; tie the 108 ANTISEPTIC TREATMENT OF WOUNDS. legs together above the knees, remove the leg to be operated upon from the hobble, tie a strap around the foot and draw it forward to tense the tissues of the leg in their natural posi- tions relative to each other; clip, or, better, shave, the hair from the field of operation, wash it well with soap and water, rinse it with a three per cent. solution of carbolic acid, then, with sterilized instruments and hands, make an incision one inch long just below the fetlock over the nerve, take it up with a hook, dissect it out carefully, give it gentle traction down- wards, to stretch it a little and cut it off as close as possible to the upper end of the incision, then catch the lower portion with the artery forceps and roll it downwards with consid- erable force so as to remove as much of the nerve as possible, taking out at least an inch and a half. Now pour into the wound a little of a one per cent solution of bichloride of mer- cury ; after letting it soak for a minute lay a piece of absorbent cotton over it and bandage temporarily. Turn horse over and repeat the same details on the other side after removing the bandage. After rinsing both wounds again with the bichloride lotion, apply a dry dressing of powdered boracic acid and iodoform in equal parts with a piece of absorbent cotton large enough to reach around the pastern and bandage rather tight- ly so as to press the edges of the skin together. Do not touch it till the 4th day, then if the operation was well done, union will have taken place without visible granulation. If there is any suppuration, rinse it out with a one-fifth per cent solution of bichloride and do it up again with the dry dressing. After removal of the section of the nerve a stitch may be taken in the skin if the surgeon prefers. During the operation if there is haemorrhage enough to be inconvenient mop the wound with wads of absorbent cotton, never with a sponge. In about two weeks the horse is ready for work with no lasting evidences of the operation but a white line that becomes hidden by the hair. ABSCESS IN THE LEVATOR HUMERI. A tumor containing a small deep seated abscess often occurs in the levator humeri just above the shoulder joint, that, in OPERATIONS WITH ANTISEPTIC PRECAUTIONS. 109 its acute stage, is large, hot and painful, and is often cut out bodily by stupid surgeons, which nearly ruins the muscle. Af- ter poulticing it for five days clip off the hair and make a punc- ture into the center of the tumor large enough to insert the index finger. An abscess will be found there containing from one to four drams of pus. Rinse it out with a one per cent solution of bichloride of mercury for three or four minutes and pack it with a pledget of clean oakum to maintain drainage. Poultice it for about five days with linseed meal soaked well in boiling water, dressing it once a day. The horse will usually be ready for work in 2 or 3 weeks. Other abscesses may be treated similarly, omitting the poul- tices, and reducing the strength of the bichloride to one-fifth per cent after the third day, without any suppuration during the filling of the cavity and resolutions of the inflammation. A.H.BJ 110 ANTISEPTIC TREATMENT OF WOUNDS. INDEX. Abscess in the Levator Humeri ............e cece eee ee renee 108 Acetic Alumina ............. isinkaa sie Rasewey wias wanes 39 Acidum Sulphuricum ......... ccc. cece eee e cree cence eens 44 Acidum Sulphurosum ,.......... ccc cece cece cn cece eeeneee 44 Actinomycoma in Region of Parotid Gland of Bull........ 87 DRIP spose cae Se ges ache ganaasaih Silen Pk SSA ESTEE BeRASE BONEN AS 16, 45 Amputation of Cow’s Hoof........ cece sees cee eee e eee eeeee 93 Angerér’ Pastilles: wcuvieccssncming cheese avadiavs ceseeount 30, 63 Antiseptic Mode of Treating Wounds.............0.eeeeees 62 Antiseptic Outfit for Practice... .... cc cece cece ee eee ee ee eee 72 Asepsis, Antisepsis and Disinfection ..............cseeeeeee 23 Aseptic: ever: sad. sco seen. vis comtaode oan ex eas wees 66 ASE DOL © eyia sarc. Shas Gee seat ck SOARS Rae ee Se eG AERO ENS 44 ASHES: tone cscwauicne cea Paisavcnttae wotiigra cptitat Adee manatee evens e 26 Atheroma on False Nostril of Filly............. 2. cece eee 87 Pianiddge, Dry” a hsi san caeatinr en stachnas cde ea aneeind oa a8Ns 62 Bandage, Most: a xinccevwncteaed be atetiaui cide oeeeked eos 62 Bandage, Moist Occlusive .........ce cece eee ee ec ee ec eens 68 Bandaging: Materials 22. cccse0 cnciias he cas ue sinew secs as wae 23-61 Beni ZO16 ACI: cite aa 65 winddsaiad 4 Bids acousnonce,’ bao aa eierw eae 43 Bismuthum Subnitricum ......... 0. cc cee eee cece eee eeeee 13-43 Borie: Acid. can yeveis avers cee iss wnhedetier st sa aeensie sees. 39 BORIC: Wate iste: Sos csiais seghoteceierv ave stecgdactnevevate erace AG Siuateeee Ss SSIS 39 Burnett’s Dininfecting Fluid............. ccc cece eee eee ees 40 Gamphor: s viisceecs veacanense res sos whee dein os wghasere d's a lar 41 Camphior Grttel 256: cicscsiacscace ch nous aieinerw a siaarecaronnie ees Gavaeaee 6 4I Camphor,, Spirits: Of sae siaciee erase vise Sa ge eee KO aes 41 Carbolice:-Acid!: 4 9 asch dau ins Gee Sawer's oa ORR esas adeieaaes 36 Carboli¢. Spray: ess cscoasers is cantadsnes eva eee tes eee 46 Carbolizéd: Silk: psccesicwlie-.cauiawans teres es aeacteure a aeqerecdied 8 Castration:of Stallion i wiis sdeuacsule sees news: sebatdneuret's 99 Castration of Horses in City Practice .......... ccc eee ee eee 105 CAE R UES wa isveceres s oaralesaseleecava. a a:e: Ges ionecasain aR oanoraiils ar ere ve 8 Chlorid,. Mercurie: 0% cnccicin sss cess awsrea-sisvenieienas ee we aeuiorels.e 29-31 INDEX. Chloride of Zine ........ ccc ce cee cece daielne nei aes tobe aeleiieets II COM Cera iz ae cet ive orate dvttaty. aa ayomteieva sicesteuies eebeee tte oe Sree 43 Cokes.» s2icsleg uw poimtean uhak itoedea 2540 os SaaGan beeen noni 26 Condyloma on Praeputium of Horse.............. Bho ate ehs 102 Contused Wounds on Thoracic Wall...........ccccecceeees 79 Corrosive Sublimate 2.0.0.0... 0. ccc ce ceee ees tulemredchawareees 13 Creosote: ssiainsins ine uuice kee poastasaites chen evedenseeeaase gente 13 Creohitt cs suts.chsha iawn dduceunins lac aaehee nes M44 a8 nie 3S Creolin, Mixture. ofiies oii aveasivcrciancecdens svceeauaaioed 38 Creolin: “Water: csiniinx aes. didioisies-0.4 aia onan abies gyn sofiecounancs 38 Crown Priche is jaacu conamsapnauataceck wade aoae nededomeks 04 Disinfection Materials ........... ccc e eee c cece eee en cece enees 26 Disinfection of Infected Carriers and the Wound........... 45 Docking of “Vail nacs Kuntevenrciea vadedauss