THE ANTISEPTIC MANAGEMENT OF WOUNDS 351 



may be performed with just the same simpHcity as in former years. What 

 we have to attend to is to prevent the entrance into our wounds during operations 

 of the grosser forms of septic mischief, such, for instance, as exist in impure 

 sponges, on dirty instruments, or in any unclean material upon our hands or on 

 the skin of the patient. Then, again, the entourage of the seat of the operation 

 must be considered. To speak first of this last point, we cover the region round 

 about the field of operation with towels soaked in a trustworthy antiseptic 

 solution, and then we are quite sure that if we touch any neighbouring object 

 there can be no chance of our contaminating the wound as the result of this 

 contact. 



As to the best means of purifying the sponges, &c., it appears that there is, 

 after all, nothing better than the agent which I happened to employ first — 

 carbolic acid. There was a time when, in consequence of Koch's publications 

 on the subject of corrosive sublimate, it to a large extent displaced carbolic acid 

 in the practice of surgeons. It turns out, however, that Koch, able as he is, 

 was misled on a certain point which led him greatly to exaggerate the germicidal 

 power of corrosive sublimate, and that in truth it is for surgical purposes very 

 inferior to a solution of carbolic acid in water. It is a happy thing for us as 

 surgeons that those organisms w^hich have the most resisting spores do not trouble 

 us in surgical work. For instance, the hay bacillus, which is sure to grow in 

 an infusion of hay left exposed for a w^hile, has spores of an exceedingly resisting 

 kind ; but supposing the hay bacillus to get into a wound it would do no harm 

 whatever. Again, the anthrax bacillus has very resisting spores, but if we take 

 good care that the catgut which we use for tying bleeding vessels has been 

 treated with an antiseptic that will certainly kill any spores of anthrax with 

 which the sheep might have been affected that furnished the intestines for the 

 catgut, we shall never have any chance of anthrax getting into our wounds. 

 What we have to deal with as our surgical enemies in the shape of microbes are 

 almost exclusively sporeless micrococci. Some of these, however, are much more 

 resisting than others. The Staphylococcus pyogenes aureus — a \'ery common 

 cause of suppuration — is very resisting. Now it has been shown that in such 

 solutions as would be used in surgery carbolic acid destroys this organism much 

 more rapidly than bichloride of mercury does.^ 



There is, however, one spore-bearing bacillus with which we have to deal 

 but too often as surgeons, namely the tubercle bacillus. Some experiments 

 were made a few years ago by M. Yersin, at the Institut Pasteur, on the germi- 

 cidal action of various agents upon tubercle bacilli grown in pure culture on 

 glycerine jelly. I will not enter into the details of his experiments, but if you 



' See Behring, ♦ Ueber Dcsinfcction,' 6:c., Zcitschrift fiir Hygiene, Ncunter Band, 1S92, p. 417- 



