DETAILS OF ANTISEPTIC SURGERY 245 



spread of putrefactive fermentation outwards from the saliva and buccal mucus. 

 For it would appear that the living tissues of the cut surfaces, provided that 

 their vital energies are not impaired by inflammatory disturbance, operate 

 upon a thin layer of blood or lymph (hbrine) between them in the same sort 

 of way as the mucous membrane of a perfectly healthy urethra acts upon the 

 mucus or residual urine contained in it, as before alluded to in connexion with 

 the case of hypospadias : that is to say, the healthy living tissues prevent the 

 development of septic organisms in their immediate vicinity ; and this I believe 

 to be the explanation of the possibility of primary union without antiseptic 

 treatment. Thus the process of primary union is a sort of natural antiseptic 

 arrangement so far as the materials between the cut surfaces are concerned ; 

 and hence it is quite reasonable to employ external antiseptic means after a 

 plastic operation in such a situation. And, in point of fact, it will be found 

 well worth while to apply a strip of tine rag spread with boracic ointment 

 sufficiently broad to cover the lips of the wound and the points punctured by 

 the sutures, retaining it in position by a somewhat broader strip of unprepared 

 gauze, with its edges glued down with collodion. The result is that, the surface 

 being kept moist and at the same time free from putrefaction, the occurrence 

 of the troublesome pustules which are so often seen under scabs in the line of 

 incision or about the stitches is prevented, and the union along the cutaneous 

 margins, which it is so important to secure, is attained with much greater 

 certainty and perfection. The ointment should not be applied till oozing of 

 blood has ceased ; and until this has occurred, the wound is kept covered with 

 a piece of boracic lint. 



I need hardly remark that to operate under the spray when the wound 

 communicates with the septic buccal cavity would be an absurdity. The use 

 of carbolic lotion should also be avoided, on account of the irritation which it 

 occasions to the tissues. There is, however, no objection to ha^'ing the sponges 

 rendered pure by wringing them out of the mildly acting boracic lotion. 



In operations of this kind silver wire for the deeper stitches and horsehair 

 for the superficial ones answer extremely w^ell ; the rigidity of the wire enabling 

 it to give valuable support, while both these kinds of material are mechanicall\- 

 antiseptic, since they afford no nidus for putrefactive fermentation in their 

 substance, and both are so smooth in surface as to be in that respect quite 

 unirritating. For microscopic examination of horsehair shows that its external 

 epithelium, unlike tli(^ imbricated arrangement which ]-)re vails in many hairs, 

 such as those of the mouse or of the human head, is so arranged as to produce 

 perfect smoothness, a circumstance which is probably further \aluable from the 

 facility with which adhering dust can be remo\'ed. 



