ON RECENT IMPROVEMENTS IN THE DETAILS 



OF ANTISEPTIC SURGERY 



[Lancet, 1875, vol. i, pp. 365, 401, 434, 468, 603, 717, 787.] 



Since the delivery of my address at the Plymouth meeting of the British 

 Medical Association in 1871,^ various improvements have suggested themselves 

 in the means of carrying out the antiseptic principle. Some of these improve- 

 ments have been the results of more extended experience with the materials 

 previously in use, while others have consisted in the employment of new anti- 

 septic substances. 



With regard to materials previously in use, I wish in the first place to correct 

 what I fear was a mistake made in the Address as to the strength of the watery 

 solution of carbolic acid to be used for the sponges during operations, and for 

 the cloths employed for washing and guarding wounds in changing dressings. 

 Anxious to reduce the strength of the solution as much as possible, in order to 

 avoid needless irritation of the tissues by the acid and at the same time to pro- 

 mote the comfort of the operator, I had thought myself justified by experience 

 in recommending a lotion as weak as i to 100. I have since had reason to 

 believe that in so doing I had gone beyond the limits of safety ; so that I have 

 returned to the i to 40 lotion for the purposes referred to, while the saturated 

 watery solution (i to 20) is still employed for purifying the epidermis of a part 

 about to be operated on, for cleansing dirty instruments and sponges, and also 

 for washing accidental wounds, so as to destrov once for all any septic organisms 

 that may have been introduced into them.- 



A solution of carbolic acid of the strength of i to 40 is that which I would 

 advise for providing an antiseptic atmosphere in the form of spray when the 

 particles of the liquid are dispersed by means of air impelled by hand-bellows or 

 a condensing pump. But I have of late found it more convenient to use high- 

 pressure steam as the motive power, on the principle of Siegle's steam inhaler, 



^ See p. 172 of this volume. 



- For cases of compound fracture seen for the first time several hours after the accident, I have 

 of late used a still stronger antiseptic in the form of one part of carbolic acid dissolved in five parts of 

 spirit of wine, introduced into the recesses of the wound by means of a gum-elastic catheter connected 

 with a syringe by a piece of caoutchouc tube. In this way the antiseptic is made to penetrate the 

 coagula in the various parts of the wound more effectually than it could be by forcing it in through the 

 external orifice, while at the same time we avoid the needless disturbance which this procedure may 

 entail in consequence of the irritating liquid being driven for a greater or less distance through the 

 cellular interstices of uninjured parts. 



