ANTISEPTICS have lately attracted a great deal of notice in the treatment of inflammation, especially resulting from wounds.
The article most used at the present time for this purpose is carbolic acid. Lister is its chief advocate, and under his authority it has established a position which deserves attention.
It is based upon the germ theory of disease, which is founded upon the observations of Pasteur. The theory supposes that animal decomposition is clue, not to the chemical action of oxygen, or any other gas, but to the presence of organic germs floating in the atmosphere. Carbolic acid is used on account of its known destructive effects upon low forms of organic life.
These low forms of vegetable organisms, which float in the air in great abundance as constituents of the dust, are called by naturalists bacteria, of which there are many varieties. Whenever they find entrance into the body, there putrefaction is produced.
These vegetable parasites are capable of a wonderful power of multiplying their species, a single germ producing in a few hours many thousands. Once admitted into the body, they find their way everywhere, into the muscles, into the blood, into the different organs of the body, and they spread destructive fermentation and putrefaction wherever they go.
In accidental wounds, it is first necessary to kill any septic organisms which may have been introduced from the air or from contact with foreign bodies. We do this by thoroughly bathing the surfaces with a solution of carbolic acid, of the strength of one part of the acid to twenty of water.
When the wounds are made by the surgeon, the germs are destroyed by means of a spray imbued with the acid. This spray is produced by an atomizer, of which there are many kinds, and is thrown continually on to the surface of the wound, until the completion of the operation, including the ligaturing of the vessels and the final stitching together of its edges.
Lister also recommends the use of carbolized catgut for ligatures, being of an animal substance and finally absorbed.
When the operation is fully completed, the antiseptic dressings are applied. Besides these antiseptic precautions, in cases of large and deep wounds a drainage tube is introduced to allow for the escape of the serum.
The antiseptic dressings consist of first, the protector; second, the carbolized gauze; third, the mackintosh; and fourth, another layer of the gauze, and a bandage of the same to keep the whole in place. For the purpose of protecting the cicatrizing parts from the irritating effects of the gauze, a layer of oil silk coated on both sides with copal varnish, and afterwards brushed over with dextrin, to enable it to become uniformly moistened when dipped into a watery solution of the acid, is applied directly over the wound, the ends of the drainage tube protruding about an inch from each extremity of the incision. The wound is then covered with a layer of antiseptic gauze dipped into a solution of one to forty of the acid. There are then superimposed six other layers of dry gauze; then the mackintosh or a piece of rubber cloth; then an eighth layer of gauze large enough to cover in all the remainder, and finally a bandage of the same.
When the dressings are renewed, it is to be done under the spray', great care being taken not to admit any non carbolized air.
The dressings are not to be changed until the discharge has begun to soak through and appear below the edge of the rubber cloth.
Use dry dressing wherever practicable. Where much pus is being discharged this is out of the question, but where no pus is issuing, or in wounds that are entirely closed in, a dry sterile dressing which is aseptic, or germ free, rather than antiseptic or germ kill, is the best method.
The antiseptic gauze is made by impregnating cotton cloth of open texture with a mixture of carbolic acid one part, resin five parts, paraffin seven parts. The resin acts as a vehicle for the acid, while the paraffin is added to prevent inconvenient adhesiveness.
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