Report on aseptic and septic surgical cases : with special reference to the disinfection of skin, sponges, and towels / by C.B. Lockwood.

  • Lockwood, Charles Barrett, 1856-1914.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Report on aseptic and septic surgical cases : with special reference to the disinfection of skin, sponges, and towels / by C.B. Lockwood. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    soft soap and hot water, so much grease remains that they collect in drops, and, to use a homely phrase, run away like water off a duck's back. Also, as I pointed out in the pre- vious report, the bacteria of the skin reside, not only upon its surface, but also in its depths ; concealed in hair follicles, sebaceous glands, and sweat ducts. Thus the bacteria of the skin are not only situated in rather inaccessible places, but they are also protected from ordinary lotions by the greasy substances by which they are surrounded. I therefore began to remove as much of the fat as possible with ether, and after- wards wash the skin with chemicals dissolved in alcohol. The last, however, seemed unsuitable for the dressing, which is usually applied for some hours before the operation, and, therefore, glycerine was used. This drug has the merit of not only dissolving the disinfectants quickly and well, but it also seems to have considerable power of penetrating the skin, and, as it absorbs moisture, there is no fear of its evaporation. Our first essay in applying these new expedients excited our most sanguine expectations. At the beginning of the year I was about to remove the breast and axillary glands of a woman for carcinoma. Before the operation she had the usual bath, and the house surgeon, Mr. Murrell, to whom I am much obliged, prepared the skin in the following way : It was thoroughly scrubbed with a nail brush, soft soap, and hot water, and then with soft soap and carbolic lotion, 1 in 20. Next it was thoroughly washed with ether, and covered with carbolic gauze, which had been soaked and saturated with a solution of perchloride of mercury in glycerine, strength 1 in 2,000. This remained in contact for twenty- four hours, and caused no eczema or blistering. A bit of the skin was put in broth, and is now quite sterile and almost quite unaltered, although more than nine months have elapsed. The wound in this case was very extensive, and was brought together with some tension; it healed, however, by first intention,and cultures inoculated from it remained sterile. The skin was also sterile in another case, which was pre- pared in almost the same way. Before operating for the radical cure of an inguinal hernia, with transplantation of a misplaced testis into the scrotum, the skin was shaved, scrubbed with soft soap and a nail brush, rubbed with ether, scrubbed again with soft soap, rinsed with carbolic lotion 1 in 40, and covered for twenty-four hours with carbolic gauze soaked in sublimate glycerine 1 in 2,000. This case healed by first intention under the dressing, and nothing grew in culture media which was inoculated from it. But our next attempts to disinfect the skin with solutions of carbolic acid and with sublimate glycerine were unsuccess- ful. Before operating upon a youth for the radical cure of inguinal hernia the skin was prepared by shaving, washing, and scrubbing with soft soap and water, washing with car- bolic lotion, and covering with sublimate glycerine 1 in 2,000 for nearly twenty-four hours before the operation. This skin grew diplococcus epidermidis albus, and a bacillus which grew upon the surface of the broth with a greyish-white pellicle. Perhaps this was the ordinary bacillus epidermidis. This wound was one of the few radical cures which has sup- purated, and the pus contained the same bacillus and also staphylococcus aureus. Whence the latter came I do not know, but contradictory results have been common in this investigation and are faithfully recorded.