346 ON THE PRINCIPLES OF ANTISEPTIC SURGERY 



ployed.^ The carbolic acid soon flies off and leaves nothing in contact with the 

 wound but the unirritating cyanide and the fabric charged with it. 



In changing the dressing, the skin around the wound is purified on each 

 occasion with carbolic lotion, the wound itself having been previously covered 

 with some trustworthy antiseptic material to avoid the chance of its contamina- 

 tion. These may seem minute details to refer to here ; but in truth they all 

 illustrate principle. 



In wounds alread}^ septic, attempts are made with more or less success to 

 restore the aseptic state ; but this is a matter on which it is not now needful 

 to enter. 



Abscesses, whether acute or chronic, are a field for antiseptic surgery which 

 yields very beautiful results, in striking contrast with those of former practice 

 and at the same time of great pathological interest. 



As an example of the former class let us take a case of extensive suppuration 

 of the mammary gland during lactation. Here, under the old system of poul- 

 ticing, protracted suppuration followed the evacuation of the cavity ; and in 

 spite of free incision, sinuses often remained which could only be cured by laying 

 them open throughout their extent. Under antiseptic management, the abscess 

 being emptied by a puncture sufficient to admit the introduction of a drainage- 

 tube, nothing but bloody serum is found next day upon the dressing, the serous 

 discharge diminishes rapidly, and healing is complete in a very few days, sinus 

 of the mamma being a thing unknown. 



To illustrate the chronic class may be. taken a psoas abscess consequent 

 on tubercular caries of the spine. Under free incision and poulticing, such cases 

 were almost invariably fatal. If the patient survived the acute fever of the first 

 few days, he perished after a longer or shorter period of hectic caused by protracted 

 free suppuration. But if under antiseptic precautions a drainage-tube is inserted 

 and, without the introduction of any medication into the abscess, a trustworthy 

 dressing is applied, no fever whatever occurs, and the discharge, as in the acute 

 case, is as a rule sero-sanguineous at the outset and afterwards merely serous 

 and soon trifling in amount ; and if scrupulous antiseptic care is maintained 

 a cure is almost always at last effected.^ 



^ A solution of bichloride of mercury is of little value for this object, inasmuch as it forms with the 

 two cyanides a soluble salt of very feeble germicidal power. 



" Acting on a hint derived from the Vienna practice of washing out these abscesses with a weak anti- 

 septic lotion and then introducing iodoform and closing the incision, I have of late years washed the 

 cavity with i to 10,000 solution of corrosive sublimate and stitched the wound ; dispensing with the 

 iodoform which, I believe, cannot effect what has been expected of it, while it involves a certain risk of 

 iodoform poisoning. The results have been much on a par with those of the Vienna practice. Quite 

 recently, however, we have derived very great advantage from adopting the use of the ' flushing gouge ' 

 suggested by Mr. Arthur Barker, by which the pyogenic membrane and all cheesy matter, with sequestra, 





