6o 



Fischer employs naphthalin ; Schede and others report 

 excellent results from corrosive sublimate ; Langenbeck 

 and Billroth regard iodoform as satisfactory. 



To secure cleanliness freedom of the wound from all 

 putrefiable materials surgeons now more generally ap- 

 preciate the importance of ligating or twisting every ves- 

 sel, however small, which could bleed when, with the 

 discontinuance of the anaesthetic, the heart's impulse be- 

 comes stronger. The application of a firm, even, elastic 

 bandage over the lips of the wound is often used, also, 

 to accomplish the same object. For absorption of pu- 

 trefiable materials Esmarch has used with great satisfac- 

 tion turf enclosed in gauze bags ; Schede is pleased with 

 sand, previously heated and soaked in corrosive subli- 

 mate solution, which is poured directly into the wound. 

 Perhaps one of the most important of antiseptic measures 

 is the deep closure of the wound ; whenever the lips of 

 the wound are thick as in abdominal sections and thigh 

 amputations the use of silver wire and lead plates for 

 approximation of the deeper surfaces is essential to pre- 

 vent the accumulation of blood in the pockets otherwise 

 present, and the consequent danger of sepsis. 



Antiseptic surgery, then, is not comprised in the spray 

 and carbolic acid ; it is not simply a question as. to the 

 relative anti-bacterial properties of this, that, and the 

 other so-called antiseptic agents. It is an attempt to 

 prevent the entrance into, as well as the formation 

 within, a wound of all substances, organized and unor- 

 ganized, which can interfere with cell-nutrition. It com- 

 prises, first, the exclusion or removal of all putrefiable 

 materials blood, pus, necrosed tissue (a point to which 

 the Listerian school seems inclined to ascribe a subordi- 

 nate place; witness Cheyne's "Antiseptic Surgery"); 

 second, the exclusion of all ferments, bacterial or other ; 

 and, since neither of these can always be accomplished, 

 since even under the most perfect Lister or other dress- 

 ing, both putrefiable materials and bacteria may be 

 present ; third, the establishment of conditions incompat- 

 ible with bacterial development. The most complete 



