DETAILS OF ANTISEPTIC SURGERY 213 



time, it may be washed out with the i to 20 watery solution before being smeared 

 with the oil. Washing urethral instruments with such a lotion will probably 

 have the further important advantage of securing us against the conveyance 

 of specific virus from one patient to another by their means. For a protracted 

 experimental investigation into the subject of putrefaction and other fermentative 

 changes having proved to me the perfect efficiency of the i to 20 watery solution 

 of carbolic acid in destroying minute organisms of a fungoid or bacteric nature, 

 I feel that we can hardly be wrong in assuming its destructive effect upon the 

 viruses alluded to, which, though not proved to be organisms, analog\' leads 

 us to regard as in all probability of such a nature. If this be so, the use of such 

 a lotion and lubricating oil for specula and other articles used in female com- 

 plaints will prevent in the other sex the lamentable results which have now 

 and then occurred from instrumental infection. 



Cases from time to time arise in which it is desirable to have an antiseptic 

 in constant active operation on the interior of a wound, necessitating the frequent 

 renewal of the dressing ; and for this purpose a solution of carbolic acid in about 

 ten parts of olive oil answers well.^ As an example of its use in this wa}', I may 

 mention a practice which I have adopted of late years in caries limited to the 

 middle or anterior part of the tarsus and accompanied by sinuses. Cutting 

 right across the soft parts of the dorsum of the foot, including the tendons, 

 vessels, and nerve, I open the tarsus completely from side to side at the diseased 

 part, when, the foot being bent upon the sole as upon a hinge, the carious portions 

 are exposed with perfect freedom for inspection and operation, and all bones 

 or portions of bones that appear suspicious are removed, the procedure being 

 rendered much more precise and satisfactory by the bloodless method of operat- 

 ing which I have for many years pursued — viz. emptying the limb of blood by 

 raising the foot to the utmost for a few minutes, and then apph'ing a tourniquet 

 as rapidly as possible and so tightly as to prevent an}' circulation in it.'- The 

 vessels having been secured, it remains to dress the wound. If this were done 

 in such a way as to permit unchecked putrefaction in it, there would be great 

 risk of serious disturbance from the extension of putrefactive suppuration into 

 the tarsal joints opened in the operation. On the other hand, as the sinuses 

 communicating with the wound already contain putrescent materials, it would 

 be useless to operate under the spray and apply an external gauze dressing. 



' Linseed oil is objectionable from the permanent staining it produces in linen. Boiled linseed oil 

 is, indeed, far better than any other oil for mi.xing with whitening and carbolic acid to form the antiseptic 

 paste or putty, which has long since been superseded by the gauze, but which on an emergency, in 

 absence of the gauze, might still be used with advantage in some cases. 



^ Since Professor Esmarch lias published his method, 1 have substituteti an india-rubber tube for 

 the tourniquet with advantage. 



