6i 



antisepsis is evidently not that which sees in bacteria the 

 sum and substance of all surgical evil, but that which rec- 

 ognizes and endeavors to avoid all possible sources of 

 infection. The most perfect realization of this ideal 

 which it has been my fortune to witness is seen, not 

 in King's College Hospital, but in Billroth's clinic. 

 Sponges are prepared by the abstraction of fat and sand, 

 and by at least fourteen days' immersion in five per cent, 

 carbolic acid solution, in which they remain until used ; 

 for the operation they are put in two per cent, solution ; 

 ligatures (Billroth generally uses silk) are also kept in a 

 similar solution. The skin at and around the location of 

 the proposed incision is shaven, scrubbed with a flesh- 

 brush and soap, and washed with carbolized water ; 

 hands and instruments are most scrupulously cleansed ; 

 operator and assistants wear clean linen dusters ; no 

 spray is used. Every bleeding point, however small, is 

 caught temporarily in a clamp forceps, and at the close 

 of the operation, ligated at the end of the severed vessel, 

 to diminish the amount of necrotic tissue ; the surface is 

 thoroughly irrigated with three per cent, carbolic solu- 

 tion ; a little powdered iodoform is often dusted into the 

 wound not, however, if immediate union be expected. 

 If the soft parts severed be thick, the lips of the wound 

 are approximated deeply by silver wires, and superficially 

 by closely set silk sutures. The Esmarch bandage is re- 

 moved from the limb in amputations as late as possi- 

 ble, since absorption does not occur so long as the ban- 

 dage remains, but begins very actively so soon as the 

 circulation is restored. A strip of iodoform gauze, usu- 

 ally also some powdered iodoform, is applied to the 

 seam ; then several layers of iodoformed or carbolized 

 gauze ; finally a very firm roller, starched organdine, or 

 even elastic bandage is tightly applied over the lips of 

 the wound. The first dressing remains unmolested as 

 long as possible, the time varying, of course, with the 

 case. 



