On the dressing of stumps : old method, Lister's antiseptic plan, the Bordeaux treatment of stumps, Burow's plan, modified by the author, comparative statistics / by Louis Bauer.

  • Bauer, Louis, 1814-1898.
Date:
[1877]
Catalogue details

Licence: Public Domain Mark

Credit: On the dressing of stumps : old method, Lister's antiseptic plan, the Bordeaux treatment of stumps, Burow's plan, modified by the author, comparative statistics / by Louis Bauer. 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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    introduced into some of the cavities. It is also employed when a constant direct con- tact of the antiseptic with the wound is necessary, as in caries—or where the gauze dressing cannot be applied, as in abscess of the rectum. 4. Solution of Chloride of Zinc (8 per cent.) 1 part of liq. zinc, chlor. mixed with three parts of water. Where wounds have been exposed unprotected to the access of atmospheric air, or where, from mistake in dressing, aseptic wounds have become sep- tic, they are swabbed out with this solution. It is more effective than carbolic solution, but too powerful for permanent use in the dressings. 5. The Spray. In order to prevent the entrance of living germs, during an opera- tion or dressing, a spray of “ carbolized water” is directed on the wound. The best instrument for this purpose is “Lister’s spray,” a steam atomizer which throws a large cone of finely divided spray. It is almost indispensable in long operations and where a considerable space of tissue is ex- posed. In its absence it may be replaced by the ordinary steam atomizer, of which two ought to be at hand, as they are soon exhausted. Their suction tube is unneces- sary and a glass tube, drawn to a fine point, and bent at an acute angle, to throw the steam against wounds without necessity of tipping the instrument, may take its place. In the absence of these, or for short dress- ings, Richardson’s spray apparatus may be used. It has, however, serious defects ; it gives out frequently without apparent cause, is very fatiguing, and wets the wound too much, as the spray is not as finely divided as that of the steam atomizer. 6. The Protective is oiled silk, coated with copal varnish, to render it impermea- ble, and then covered with a thin layer of one part dextrine, two parts starch, and sixteen parts “carbolized solution,” to facilitate adhesion of the disinfecting fluids into which it is dipped before being applied to the wound. The purpose of the “pro- tective ” is to prevent the irritating effect of the contact of the antiseptic with the wound. It is placed immediately over this, overlapping it but little. 7. The Antiseptic Gauze, a peculiar un- starched cotton gauze, selected by Mr. Lister on account of the facility with which secretions penetrate its meshes. It is pre- pared with antiseptics, and thus, after ab- sorbing the wound fluids, it prevents their decomposition. Pieces of cotton gauze,, six yards in length and one yard in width, 1 are to be placed in a zinc trough and heated 1 in the water-bath for several hours, afterr i which they are spread out and a hot mixture 1 of one part cryst. carbolic acid, five com-- 1 mon resin and seven paraffine is poured over them by means of a syringe. They < are then returned to the trough and submit- i ted to pressure for some hours, to cause an even distribution of the fluids. The resin is to hold the carbolic acid more firmly, and < prevent it from being washed out or evapo- - ; rated too quickly. The paraffine diminishes adhesion of the dressing. This gauze is prepared iu factories in Germany, the best: ( known being the “International” factory, , i at Schaffhausen, Switzerland. Its great. ( cost (20 cents a yard in the factory) is a . considerable drawback I have, therefore,.. ! tried to replace it by cheaper material, and i to prepare it myself, and have successfully used old mosquito netting for this purpose.. t As this is really the only part of Lister’s - i dressings for which the Arm}' Supply Table ( does not furnish the materials, it may be of! ( interest to learn how it is done. Old mos- - c quito bars, which have become useless for v their legitimate purpose, are steeped, or, a perhaps better, boiled in lye, to remove all j dirt and render them more hygroscopic.. ,i The}’ are then immersed in the hot resin t mixture, which may be heated in a tin bucket on the stove. To remove the sur- - ] plus liquid they are passed through a t clothes-wringer, allowed to cool, stretched into shape, and put away in a closed vessel 1 r or wrapped up in oiled muslin. The clothes-wringer is easily cleaned with boil- ing water and a cloth. I have used this j antiseptic netting with the same results as • , the imported gauze. The gauze is used wet with carbolized j water in immediate contact with the “ pro- tective,” folded in about six thicknesses and . overlapping the “protective” several inches. ■ The remainder of the gauze is applied dry. j Lister considers eight layers, largely over- lapping the wound, sufficient. Between the . seventh and eighth layers he inserts the [ “ McIntosh.” 8. The McIntosh, common rubber cloth, is used to keep the secretions of the wound from finding their way immediately to the surface, and to compel them to permeate the whole dressing, thus being constantly in contact with the carbolic acid. It is cut an inch smaller than the gauze, that the