THE ANTISEPTIC MANAGEMENT OF WOUNDS 357 



We seem thus able to understand how iodoform dusted over the cut surfaces 

 of a wound may have great antiseptic efficacy, more especially as it remains for 

 a long time unconsumed among the tissues, and is remarkably free from irritating 

 properties. In circumstances where it is impossible to exclude septic agencies, 

 as in operations upon the mouth or the rectum, or when putrid sinuses are present, 

 iodoform is of very high value. Before applying the iodoform in such cases 

 we mop the cut surface with a solution of chloride of zinc, 40 grs. to the ounce of 

 water, which has a remarkable power of retarding septic changes in wounds 

 in the presence of contaminating materials. On the field of battle iodoform 

 is probably the best means at present at our disposal. Again, in compound 

 fractures, while we endeavour to purify the wound with strong carbolic lotion, 

 we cannot be certain of entire success in this respect, and I should be sorry to 

 dispense with iodoform. 



But if you operate when the integument is unbroken, with a sufficient 

 space around you for the application of a dressing, I would not recommend 3-ou 

 to use it. To apply it to the interior of the wound would be then entirely super- 

 fluous, provided that you have taken care to avoid its contamination while 

 operating, and have at your disposal some trustworthy material for preventing 

 the subsequent access of septic mischief. This, as we have seen, iodoform cannot 

 be expected to do. A porous material impregnated with it, when soaked through 

 and through with blood or serum, will allow the microbes of external defilement 

 to propagate in its substance, though doubtless more slowly than if the iodoform 

 were absent. It is essentially in the interior of the wound that the virtues of 

 iodoform are displayed ; and the original Vienna practice of dusting the cut 

 surface with the powder, and apptying simple absorbent cotton externally, gave 

 • results w^hich were much extolled at the time, and were probabh' not far inferior 

 to those obtained by the use of iodoform wool or iodoform gauze. An iodoform 

 dressing affords no security against the penetration of septic microbes to the outlet 

 of the wound. At the same time, it is easy to see that circumstances may often 

 arise in which iodoform dusted over the cut surfaces may fail to act effectually ; 

 as, for example, when those surfaces are separated by extravasated blood. 



Any material that is merely aseptic, such as cotton-wool or gauze sterilized 

 by heat, having nothing in its substance to check in any degree the development 

 of microbes, will allow the septic evil to spread freely to the wound from the 

 external world, if blood or serum happens to penetrate at any point to the exterior. 

 In addition to this fatal objection such a dressing has other disadvantages. 

 The necessary sterilizing apparatus, though it ma\' be provided at a public 

 institution, cannot well be at the disposal of the private practitioner. And, 

 further, the merely aseptic material, liaving no power to correct any accidental 



