Further report on aseptic and septic surgical cases : with special reference to the infection from the skin / by C.B. Lockwood.

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

Licence: Public Domain Mark

Credit: Further report on aseptic and septic surgical cases : with special reference to the infection from the skin / 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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    in later plate cultures the rapidly-growing bacillus crowded them out. Especial care had been taken in the preparation of this case. The day before the operation the patient had had a bath; the skin of the breast had been scrubbed with hot soap and water until, as the sister said, the patient almost cried ; next the skin had been rubbed with carbolic lotion—1 in 20—and, finally, it had been enveloped in an antiseptic dressing for eighteen hours before the operation. At the ope- ration it was abundantly rubbed and washed with perchloride of mercury lotion—1 in 1,000. I need not comment upon these aseptic cases ; they are but a proportion of the operations which I have done since the last report. Many others which ran the same course are ex- cluded because of the difficulty of being present to obtain in- oculations when the dressings were removed. Septic Wounds. Septic wounds group themselves into two classes; each with clear characters. In the first class the depths of the wound are infected before repair has begun. In these the in- fection is introduced at the operation, or spreads from an un- disinfected sinus or septic focus, or is admitted through a defective dressing and along drainage tubes. The local and constitutional symptoms of this deep infection are acute and severe, and are well known. In the second class of sep- tic wounds the superficies of the wound becomes infected after repair has begun. The symptoms of this superficial infec- tion are so trivial as to be usually ignored. About the fifth day or earlier there is a slight rise of temperature with loss of appetite, and the wound becomes uncomfortable. If blood clots or bruised and injured tissues in the depths of the wound become infected the constitutional disturbance is greater; there is pain, and the clot is disorganised and liquefied, and has to escape. The first two septic cases exemplify infection of the depths of the wound by undisinfected sinuses ; the third the effect of superficial infection when blood clot is involved; the fourth and fifth are cases of superficial infection from the skin. I have had since the last report but one case in which it seemed probable that infection occurred at the operation. It was a primary amputation through the leg. Unfortunately I was unable to inoculate cultures from it. The exact source of infection was never traced, but a few hours before I had trephined in the same theatre a case of the most septic kind of mastoid abscess, and it is possible that some sponge or appliance which had been infected from it had been inadver- tently used for the amputation without having been disin- fected. Infection from Pre-existing Septic Foci. Case viii. Amputation of Thigh for Old-standing Suppurative Synovitis of Knee; Imperfect Disinfection of Sinus.—The patient was a delicate woman, aged 35, who had suffered with her right knee for nearly thirty years. There was a sinus towards the outer side of the thigh, which had been discharging for nearly twenty years; it led upwards towards the shaft of the femur, and probably communicated with the knee-joint. The knee-joint and limb had undergone the changes which are usual when chronic suppurative arthritis is engrafted upon tuberculous disease. The joint was almost ankylosed in the flexed position, the tibia being dislocated backwards and