214 ON RECENT IMPROVEMENTS IN THE 



What is needed is something that shall prevent the putrefaction from spreading 

 from the points where it may exist to the rest of the wound. This object is 

 attained by first washing the cut surface with the solution of chloride of zinc, 

 40 grs. to I oz. of water — a practice of the utmost value in all cases where, in 

 consequence of the presence of sinuses or the situation of the part, as the mouth 

 or perineum, it is impossible to exclude causes of putrefaction from the wound. 

 When sinuses are present, I formerly advised their injection with solution 

 of the chloride by means of a syringe before the commencement of the operation. 

 But though this is undoubtedly the most efficient mode of introducing the 

 liquid into the recesses of the sinuses, I have found that the force with which 

 the solution is driven in by the syringe may cause it to burst through the pyogenic 

 membrane of the sinuses and become effused into the cellular tissue. This 

 accident, in two instances (one of caries of the wrist and one of amputation 

 through the condyles of the femur) led to extensive loss of vitality of the integu- 

 ment, and hence for the last three years I have contented myself with injecting 

 the sinuses at the conclusion of the operation, when, the sinuses being freely 

 open at the wound, the risk referred to no longer exists. 



Chloride of zinc, I may remind the reader, has this remarkable peculiarity 

 among all antiseptics that I have tried, that a single application of it to a recent 

 wound in a solution of the strength above mentioned, though it produces no 

 visible slough, yet prevents the occurrence of putrefaction in the cut surface for 

 days together, in spite of the access of septic material ; ^ and if the discharges 

 have opportunity to flow freely away, as after the removal of a tumour of one 

 of the jaws or a portion of the tongue, there may be absolutely no odour from 

 first to last, the divided textures being thus guarded from the bad effects of 

 putrefaction during the dangerous period before they have been covered by 

 the protecting layer of granulations. 



But in the wound of the foot which we are considering, if any permanent 

 dressings were employed, the blood and serum effused in the early periods of 

 the case, and accumulating more or less in the interior, would not be prevented 

 from putrefying by the chloride on the cut surface. And it is only in rare cases 

 that the injection of the sinuses with the chloride has the effect of eradicating 

 all putrefaction from them. This is a thing to be aimed at, but hardly expected. 

 In order, therefore, to avoid the extension of putrefaction from any septic point 

 in the wound, the antiseptic dressing must be frequently changed ; and this 

 is conveniently done with pieces of lint dipped in the oily solution of carbolic 

 acid (i to 10), the oil preventing the lint from sticking in the wound, so that it 



^ For the introduction of this invaluable antiseptic into surgical practice the profession is indebted 

 to Mr. Campbell De Morgan, of the Middlesex Hospital, London. 



