SURGERY. 



747 



upon perfect cleanliness, free drainage, and the 

 use of such applications as have been proved by 

 experience to be not only powerful germicides, 

 but innocuous to the patient. The latter con- 

 sideration is most important. 



Not to mention a host of substances that 

 have enjoyed a passing reputation as antisep- 

 tics, carbolic acid, corrosive sublimate, and 

 iodoform may be regarded as the agents now 

 almost universally in use. The former fell into 

 disrepute because of several cases in which its 

 use was followed by alarming and even fatal 

 toxical symptoms, and iodoform was introduced 

 as a substitute. But the lavish use of iodo- 

 form in extensive wounds was also attended 

 by fatal poisoning in several instances, so that 

 this agent was also viewed with disfavor. 

 However, a better acquaintance with its prop- 

 erties has led to its being restored to its former 

 place as a surgical dressing, and it is now used 

 on an enormous scale, especially in Vienna, 

 with the most satisfactory results. 



In a solution of corrosive sublimate, of a 

 strength of one part in one or two thousand, 

 we unite all of the elements of cheapness, ger- 

 micidal power, and safety. Lister, in a late 

 address, warmly advocated the employment of 

 this substance, which he regards as equal, if 

 not superior to, carbolic acid. 



Iodoform, as employed in German surgery, 

 is an extremely simple and efficient dressing, 

 much in favor with Billroth. The details of 

 the dressing are so few that they may be car- 

 ried out by any non-professional person. The 

 wound is thoroughly cleansed with the subli- 

 mate solution, a drainage-tube (now made of 

 decalcified bone) is introduced, it is sewed up 

 with silk or catgut sutures, and the surface is 

 sprinkled with powdered iodoform. Several 

 layers of gauze, impregnated with the same 

 powder, are applied, and secured with a band- 

 age. Abscesses are injected with " iodoform 

 glycerine," superficial cuts are hermetically 

 sealed with "iodoform collodion," while small 

 sticks of the same substance (made up with 

 cocoa-butter or gelatine) are thrust into deep, 

 narrow wounds, and allowed to dissolve there. 



"In Germany," says a recent writer, " the 

 reign of carbolic acid is over and corrosive sub- 

 limate reigns in its stead." This is not strictly 

 true, yet this agent is widely used. Dressings 

 of gauze, jute, cotton, peat, wood-pulp, moss, 

 and even powdered glass, are saturated with the 

 sublimate and applied directly to the wound. 



Bruns, of Tubingen, has lately introduced a 

 dressing that he calls " wood-wool." It is 

 finely ground wood, such as is used in making 

 paper, and is a clean, soft material, of extraor- 

 dinary lightness, capable of absorbing a large 

 amount of fluid. It may be applied to the sur- 

 face of the wound, after being dipped in the 

 sublimate solution. Such a dressing need not 

 be disturbed for a week or two. 



Enough has been said to give a general idea 

 of the present state of antiseptic surgery. Its 

 constant tendency is toward the simplifica- 



tion of details, cleanliness being more strongly 

 insisted upon than ever. Although surprising 

 results have been attained during the past year 

 by operators that strongly repudiate " Lister- 

 ism," these same surgeons owe their success to 

 the rigid adherence to the cardinal principle of 

 that system, cleanliness. 



Cold Water. This agent has been more sys- 

 tematically employed than formerly, in the 

 after-treatment of surgical cases. An old in- 

 vention, but one recently reintroduced, is the 

 cold-water coil, which consists of coils of rub- 

 ber or metal tubing of all shapes and sizes. 

 These may be placed upon the head, spine, ab- 

 domen, or around a wounded limb, and kept 

 cool by the action of a constant stream of ice- 

 water flowing through them. This appliance is 

 most efficacious in subduing inflammation and 

 lowering fever. It is especially useful in peri- 

 tonitis following operations within the abdomi- 

 nal cavity. 



Rectal Etherization. This novel method of ad- 

 ministering ether has recently attracted a good 

 deal of attention among surgeons. The credit 

 of the origination of this process has been given 

 to Dr. Moliere, of Lyons, but it is certain that 

 it was practiced by Pirogoff as early as 1847. 

 The modus operandi may be described in a few 

 words. The anesthetic is contained in an 

 ordinary glass flask, which is placed in a dish 

 of warm water. One end of a rubber tube is 

 attached to the neck of the bottle, while the 

 other end is inserted in the rectum. The 

 ether is gradually evaporated by the heat of 

 the water, and its vapor passes up into the 

 bowel, by the mucous membrane of which it 

 is rapidly absorbed. The patient complains, 

 within a few seconds, of an etherish taste in 

 the mouth, and the peculiar odor of the drug 

 can be detected in his breath. The pulse be- 

 comes rapid, the pupils dilate, the patient stiff- 

 ens out his limbs, and finally becomes uncon- 

 scious. The advantages claimed for this meth- 

 od are, the absence of the preliminary stage of 

 excitement, which is so often noticed when 

 the vapor is inhaled, the fact that there is less 

 liability to vomiting after recovery, and the 

 greater convenience of the surgeon, especially 

 in operations about the face. But in spite of 

 the enthusiasm with which this novelty was 

 hailed, the occurrence of several deaths as a 

 direct result of the procedure has proved that 

 it is not as harmless as was supposed. That 

 ether, the safest of anaesthetics, becomes un- 

 manageable when administered by the rectum, 

 is now certain ; there is danger of severe con- 

 gestion of the mucous membrane of the bowel, 

 and fatal cases of intestinal haemorrhage have 

 been reported. A recent writer concludes an 

 article upon this subject with these cautions : 

 Reserve rectal etherization for cases in which 

 there are positive objections to the ordinary 

 mode of administration. Never give it then, 

 except to robust adults. Never use more than 

 two ounces of ether, and remove the tube from 

 the rectum as soon as insensibility is complete. 



