26o DEMONSTRATIONS OF ANTISEPTIC SURGERY BEFORE 



joint having been opened, two drainage-tubes, each about J-inch in diameter, 

 were inserted side by side ; an obstructing band within the articulation being 

 divided by a probe-pointed knife guided by the finger so as to permit them 

 to be introduced fairly into the cavity. He commented on the various steps 

 as he proceeded, urging again the absolute necessity of having all the instru- 

 ments thoroughly aseptic, and went on to say] — One learns after a while to do 

 these little purifications instinctively, but at first it requires thought, intelligence, 

 and constant care, particularly to any one who has been in the habit of operating 

 without having to attend to these minutiae. Would that we could get rid of 

 all complications in the system ! If we could dispense with the spray, no one 

 would rejoice more than myself ; but until somebody wiser than I am can 

 supply some better means, we must continue to use it. There is, I find, con- 

 siderable thickening of the textures in the vicinity of the joint, and this is the 

 cause of the swelling which is still apparent, though the synovial capsule is 

 now empty. The outer orifices of the drainage-tubes are made transverse or 

 oblique, as required, in order that they may lie flush with the surface of the 

 skin, and when retained in this position by means of the threads which you see 

 attached to their margins, they discharge their functions perfectly. 



The operation having now been performed, the next point is so to dress 

 the wound as to make sure that nothing septic will get in before next dressing ; 

 this must be not a matter of hope but of certainty. The material which we 

 have used for some time past is an open cotton cloth, with the fibres impregnated 

 with a mixture of carbolic acid and common resin.^ Common resin holds carbolic 

 acid with extreme tenacity, and in consequence of this gives it off so slowly 

 as to be unirritating to the skin ; yet at the temperature of the human body it 

 furnishes a sufficient supply of the acid for a trustworthy antiseptic dressing. 

 But at the ordinary temperature of the air in this country, the antiseptic is 

 evolved so slowly from the gauze that the fermentative energy of septic dust 

 is not at once extinguished by falling upon it, as it is by mingling with a strong 

 watery solution ; and if the gauze were applied dry, some active septic particle 

 adhering to its surface might enter the blood or serum at the outlet of the 

 wound, and propagate putrefaction to the interior. There was a time when 

 I used to have occasionally in my practice putrefaction which I could not explain, 

 but which I afterwards saw must be due to this cause, and the difficulty was 

 then at once overcome by dipping the lowest piece of gauze in a watery solution 

 of carbolic acid. This solution which I am now using, having been mixed with 

 blood from the wound, has a very dirty appearance. A surgeon, who went 



* For details regarding the composition and mode of preparation of the antiseptic gauze, see Lancet, 

 March 13, 1875 (p. 210 of this volume). 



