336 AN ADDRESS ON 



This object is, I believe, aimed at by Dr. Bantock by boiling the water before 

 using it, but I would advise as more effectual an extremely weak solution of 

 corrosive sublim.ate, such as i in 10,000, which, as Koch has taught us, may be 

 implicitly trusted as antiseptic, while it is not appreciably irritating and involves 

 no risk of mercurial poisoning. 



In general surgery, the direct application of strong antiseptic solutions 

 is not attended with the same disadvantages as in operations in the peritoneal 

 cavity. My practice for some time past has been to wash the wound, after 

 securing the bleeding-points, with a pretty strong solution of corrosive sublimate 

 (i to 500) and irrigate with a weaker solution (i to 4,000) during the stitching, 

 and I have had no reason to complain of the results. To this, however, I must 

 make one marked exception. When applied to the healthy synovial membrane 

 of a joint, the i to 500 sublimate lotion produces inconvenient irritation, and 

 therefore, when opening an articulation — as for suturing a transverse fracture 

 of the patella — I abstain from the washing, and, as a substitute, have hitherto 

 irrigated during the whole operation with the weak solution (i to 4,000). 



And yet I must confess that I have for a long time doubted whether either 

 the washing or the irrigation was really necessar}^ These doubts have been 

 raised partly by experiments — some of which I mentioned at the London 

 Congress — which had proved to me that normal blood and serum, and even 

 pus, were by no means favourable soils for the growth of microbes in the form 

 in which they are present in the air — and partly by reflection upon the experience 

 we had when we used the carbolic spray. 



As regards the spray, I feel ashamed that I should have ever recommended 

 it for the purpose of destroying the microbes of the air. If we watch the formation 

 of the spray and observe how its narrow initial cone expands as it advances, 

 with fresh portions of air continually drawn into its vortex, we see that many 

 of the microbes in it, having only just come under its influence, cannot possibly 

 have been deprived of their vitality. Yet there was a time when I assumed 

 that such was the case, and, trusting the spray implicitly as an atmosphere free 

 from living organisms, omitted various precautions which I had before supposed 

 to be essential. Thus, in opening the pleura in empyema for the purpose of 

 evacuating the pus and introducing a drainage-tube and afterwards in changing 

 the dressings, I had previously applied over the opening a piece of cloth steeped 

 in an antiseptic lotion to act as a valve and prevent the entrance of air during 

 inspiration. But under the spray I omitted the valve and allowed the air to 

 pass freely in and out of the pleural cavity, although I used the spray at such 

 a distance from the producing apparatus that it was dry and transparent, with 

 the particles of carbolic solution necessarih^ widely separated from each other. 



