ON THE PRINCIPLES OF ANTISEPTIC SURGERY 34J 



Confirmation of this opinion has lately come from an unexpected quarter. 

 The glowing accounts published by Koch ten years ago ^ of the antiseptic pro- 

 perties of corrosive sublimate, led us to adopt solutions of tliat substance in 

 place of the i to 40 carbolic lotion for washing and irrigating our wounds. But, 

 beautifully conclusive as Koch's experiments appeared, it turns out that the 

 effects of the bichloride supposed to be due to germicidal action were in reality 

 caused by the inhibitory power which, as was shown by Koch, that agent possesses 

 even when present in extremely minute proportions ; and that if, instead of being 

 merely washed away, however carefully, from the objects on which it has 

 been made to act, it is got rid of entirely by converting it into inert sulphide, 

 the original reports have to be toned down to an extraordinary degree. Instead 

 of the resisting spores of anthrax being killed, as we were at first led to believe, 

 by being dissolved in 20,000 parts of bouillon acting for ten minutes, we now 

 learn that a solution of twenty times that strength fails to deprive them of 

 vitality by an action of some hours' duration.- And even some sporeless micro- 

 cocci resist the germicidal action of the bichloride in a most unexpected manner. 

 Thus Behring found that the Staphylococcus pyogenes aureus was not destroved 

 completely by a i to 1,000 solution of sublimate in bouillon acting for twentv-five 

 minutes at about the ordinary temperature of wounds, 22° C.^ Such being the 

 case, we cannot suppose that corrosive sublimate as I have used it can have 

 acted with germicidal effect upon that microbe. My practice has been to abstain 

 from irrigation during the operation, and at its conclusion wash the wound 

 with I to 500 solution and irrigate during the application of the sutures with 

 a I to 4,000 lotion. As regards the washing, considering its very brief duration 

 and also that the germicidal action of sublimate is greatly interfered with by 

 albuminoid substances, such as the coagula in which the microbes are entangled, 

 I cannot conceive that the process can have acted destructively on any of the 

 Staphylococcus pyogenes aureus which might have been deposited on the wound 

 from the atmosphere. And as to the irrigation, it was obviously simply nuga- 

 tory with respect to that species of microbe. 



Nevertheless entire success attended this use of the sublimate ; and we are 

 therefore forced to conclude either that the Staphylococcus pyogenes aureus, 

 which seems to be the most frequent cause of suppuration in man, never fell 

 upon our wounds during the space of about seven years from the air of our 

 operating theatre, or else that, although present, unharmed by our sublimate 

 lotions, it failed to develop. It has, indeed, been shown by experimental 



' Vide ' Ucbcr Dcsinfcclion ' by Dr. Robert Koch, Mittliciluii^cn dcs Kaiscrlichcn Gcsundhciisamtcs, 

 Band I, Berlin, 1881. 



^ Vide Behring, op. cit., \i\-<. ^^1, 4.43. 

 ^ Vide Behring, op. cit., p. 404. 



