DETAILS OF ANTISEPTIC SURGERY 219 



thoroughly trustworthy. The ends of the gut were cut off near the reef-knot 

 in which it was tied. The operation was performed under the spray, and with 

 such precautions as the germ theory dictates. 



And here I may take the opportunity of enforcing one of these precautions, 

 which I observe is apt to be overlooked. If a knife or other instrument, after 

 being used during an operation, is temporarily set aside or even withdrawn for 

 ever so short a time from the antiseptic atmosphere of the spray, it must be 

 cleansed afresh with carbolic lotion, whether by means of a sponge or by rubbing 

 it in the spray near the nozzle of the apparatus, where the liquid is little mixed 

 with air, otherwise septic material mingled with the blood on the instrument, 

 faihng to be purified by merely passing rapidly through the spray, may be 

 carried in an active condition into the depths of the wound. This is one of those 

 essential points which I believe nothing but a knowledge of the great importance 

 of avoiding putrefaction and a lively sense of the presence of septic ferments 

 diffused in the world around us ^ will enable the operator to keep vigilantly 

 in mind. 



The edges of the incision were brought together by carbolized silk sutures, - 

 except at one part, where two drainage-tubes of rather small calibre were placed 

 side by side, communicating with the deepest part of the wound, and the gauze 

 dressing was applied as usual with a strip of oiled silk protective over the line 

 of incision, and the patient being put to bed, the foot and leg were enveloped 

 in cotton-wool. Next day, the dressing, being changed, was found extensively 

 stained with bloody serum, but there was no inflammatory blush or febrile 

 disturbance. On the following day the wound was again dressed, and one of 

 the drainage-tubes was removed. The spray was of course used in changing 

 the dressings, and I may remind the reader that it is of especial importance 

 that it be fairly directed on the wound during the withdrawal of a drainage-tube, 

 the place of which must necessarily be taken by air, which, if not purified bv 

 the spray, will be likely to be septic. 



The wound being exposed again after an interval of two days, the stitches 

 were found to be causing a little tension, and were therefore all removed ; but 



' If any one chooses to assume that the septic material is not of the nature of hving organisms, 

 but a so-called chemical ferment destitute of vitality, yet endowed with a power of self-multipUcation 

 equal to that of the organism associated with it, such a notion, unwarranted though I beheve it to be 

 by any scientific evidence, will in a practical point of view be equivalent to the germ theon.'. since 

 it will inculcate precisely the same methods of antiseptic management. It seems important that this 

 should be clearly understood, because it appears to be often imagined that authors who are not satisfied 

 of the strict truth of the germ theory, but substitute for it the other only possible hypothesis, invalidate 

 the antiseptic practice, which, I must repeat, is not affected in one tittle by this theoretical discrepancy. 



* Prepared by immersing a reel of the silk in melted bees-wax mixed with about a tenth part of 

 carbolic acid, and drawing the thread through a dry cloth as it leaves the liquid, to remove superfluous 

 wax. 



Q2 



