HISTORY OF ANTISEPTIC SURGERY 369 



Epidermis is a substance for which carboUc acid has special attraction ; 

 and this, coupled with the facility with which the acid blends with oily matters, 

 renders it peculiarly fitted for purifying the skin about the seat of operation 

 and the surgeon's hands. Another property which aids its action as a detergent 

 is its great penetrating power, not limited by the products of its chemical action 

 upon organic substances. 



I used the i to 20 watery solution for rendering the patient's skin and the 

 hands of myself and my assistants aseptic throughout the 40 years during which 

 I practised on the antiseptic principle, and I never had any reason to doubt its 

 efficacy. No long time is required for its action. In my private practice 

 the purification of the skin was, as a rule, not begun till I entered the patient's 

 room to perform the operation. The part concerned was then thoroughly washed 

 with the I to 20 carbolic solution, and was kept covered with lint soaked 

 with the same lotion while the instruments were being attended to and the 

 anaesthetic administered ; the whole process occupying onh^ about a quarter 

 of an hour. Yet experience showed that this brief period was sufficient. 



It may perhaps be argued that under the carbolic putty or any other dressing 

 containing carbolic acid, that volatile agent was perpetually acting on the skin, 

 and may have made up for deficiences in the original purification. But during 

 several years before I gave up practice, the dressings did not owe their virtues 

 to any volatile antiseptic. 



I may mention in illustration one of my latest operations. The patient 

 was a lady advanced in years, with a large ventral hernia below the umbilicus. 

 It was producing serious symptoms ; and attempts to reduce it having failed, 

 her condition had become exceedingly grave. I only began to disinfect the 

 skin when she was already partly under the influence of the anaesthetic. The 

 umbilicus contained some drops of opaque liquid of a highly offensive character. 

 I cleansed its folds carefully with the i to 20 carbolic solution, and washed the 

 skin over and around the sac with the same lotion. The sac was opened by 

 a median incision, the upper end of which extended to the umbilicus. Into 

 further details of the operation I need not enter. On changing the dressing 

 (of cyanide gauze) it appeared that, in her frail condition, the margins of the 

 skin at the upper end of the incision had lost their vitality over an extent of 

 about half an inch in length and one-tenth of an inch in breadth at eacli side. 

 I afterwards left the dressing unchanged for several days, wlien I found that 

 the sloughs, the upper ends of which encroached on the mnbihcus, so foul before 

 the operation, had been replaced by new living tissue, and complete cicatrization 

 had occurred without the formation of a })article of pus. 



I cannot but think it a happy circumstance that the substance which 



