SURGICAL SEPTICAHMIA—TRAUMATIC GANGRENE, 18f 
The prophylaxis is based upon the data of clinic and experimen- 
tation. We do not fear any longer this infection in the wounds of op- 
eration when those are made under the cover of asepsis, sewed up after- 
wards, and covered with a closing dressing. It is not much to be 
feared in wounds of operation which are exposed (castration), when the 
operation has been cleanly done by avoiding the soiling of the trauma 
with the hands, the instruments or other objects used. What is espe- 
cially dangerous, as we have said, is not the air, as it was believed by 
the promoters of antisepsis, but ‘‘ the dirt” that the surgeon, careless 
or unclean, carries.into the tissue during the operation. The virulency 
of the septic matter deposited upon instruments resists the action of 
‘disinfecting solution, so that to destroy it with certainty they must be 
sterilized by heat. (See Anfisepsy.) 
The wounded should be placed in well-ventilated and clean-kept: 
places. Gangrenous septicemia occurs almost always in recent acci- 
dental wounds, not yet protected by the granular coat, or in contused 
traumatic lesions, anfractuous, and soiled with dust, earth, mud, and 
manure ; and those are the ones which require good watching ; they are 
those which demand especially the most minute disinfection and the free 
‘antiseptic irrigations. Drainage and iodoform plugging are very useful 
for deep traumas which, in certain regions (chest, axilla, groin, per- 
ineum), extend deep into the cellular layers infected with blood and 
serosity where the germs of the frightful gangrene collect and multiply 
with a fearful rapidity. The researches of Forgue have taught us that 
jodoform is the surest agent for destroying them. One should prevent 
the gatherings into the center of the wound—into its shallows and its 
out-of-the-way corners—of clots of blood and of secreted liquids; wash- 
ings with solutions of carbolic acid, permanganate of potassium, iodine, 
and chloride of zinc should be made. Concentrated alcohol and the 
tinctures have been advised to create, on the surface of the wound, by 
the coagulation of the albuminous liquids, an isloating coat imper- 
vious to septic liquids. The strong solution of carbolic acid acts in the 
same way. Continued irrigation or washes frequently made take away 
‘the products of the secretion of wounds, interfere, by the action of ox- 
ygen, with the evolution of the vibrios, and prevent their entrance 
into the tissues. Sometimes injection appears in wounds already old 
and protected for a long time by a layer of granulations when they have 
been opened by an incision or by tearing; therefore, injuries to these 
granular covers must be avoided as much as possible. 
When septicemia has appeared, so that already the wound is sur- 
rounded by a tense swelling, crepitating, and cedematous on its borders 
_-what means are to be used? In veterinary as in surgery for man- 
kind the disease is said to be incurable and all therapeutics useless. 
But as serious as gaseous gangrene may be, when it has not yet ex- 
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