Modern surgery, general and operative / by John Chalmers DaCosta.

  • Da Costa, J. Chalmers (John Chalmers), 1863-1933.
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: Modern surgery, general and operative / by John Chalmers DaCosta. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    out that when antiseptics are used cell-division begins late and progresses slowly. Germicides are not efficient in fatty tissue, as bacteria surrounded with oil cannot be reached by the drug, and the chemical is irritant and apt to induce fat necrosis (Haenel, in Deutsch. med. Woch., 1895, No. 8). Corrosive Sublimate.—Many chemical agents will kill bacteria, one of the most popular of them all being corrosive sublimate. Koch showed that corrosive sublimate is an efficient test-tube germicide when present in the proportion of only 1 part to 50,000. It is used in surgery in strengths of 1 part of the salt to 1000, 2000, 3000, or more parts of water. Badly infected wounds are occasionally irrigated with solutions of a strength of 1 : 500. Contact with albumin precipitates from a solution of corrosive sublimate an insoluble albuminate of mercury which forms a white layer upon the surface of the wound, is not a germicide, and prevents deep diffusion of the mer- curial fluid. In surgical operations by the antiseptic method the mercurial salt should be combined with tartaric acid in the proportion of 1 to 5, which com- bination prevents the formation of the insoluble albuminate of mercury. But though corrosive sublimate under certain conditions is extremely pow- erful, it is not always absolutely reliable. Many spores are very resistant to its action. Even a 1 per cent, solution of bichlorid of mercury is not certainly destructive to the spores of anthrax. Geppert tells us that anthrax spores may be active after a twenty-five-hour immersion in a 1 : 100 solution of sublimate (Schimmelbusch). In the presence of hydrogen sulphid corrosive sublimate is useless, inert and insoluble sulphid of mercury being precipitated; hence corrosive sublimate is without value as a rectal antiseptic; in fact, Gerloczy has proved that a concentrated aqueous solution of sublimate will not disinfect an equal quantity of feces. Corrosive sublimate contained in dressings after a time undergoes decomposition and ceases to be a germicide. It is not germicidal in fatty tissues because it is unable to attack bacteria which are coated with oil. Corrosive sublimate is very irritating to the tissues and causes copious exudation. Hence, if an extensive wound has been irri- gated with this agent, drainage must be employed to obtain exit for the wound fluid. In some wounds which have been irritated by corrosive sublimate the tissues seem to loose to a great extent their power of resistance to bacteria and infection may be actually facilitated by irrigation with bichlorid of mercury. In rare instances corrosive sublimate is absorbed and produces poisoning. In spite of these shortcomings and drawbacks it is a valuable aid to the sur- geon and is very frequently used, especially upon the skin of the patient and the hands of the operator and his assistants. It should be dissolved in distilled water. Ordinary Water causes a precipitate to form (common salt prevents the formation of this precipitate). Because of the fact that corrosive sublimate is poisonous and very irritant, it should not be used upon serous membranes. It is absorbed quickly from serous membranes and destroys the endothelial cells and should not be in- troduced into the pleural sac, into joints, or into the peritoneal cavity. It should never be put within the dura, and should not be applied, in strong solution at least, to mucous membranes. It should not be introduced into the rectum for three reasons: First, it is intensely irritant and causes pain and inflammation. Second, it is useless, being largely and promptly converted into insoluble and inert sulphid of mercury. Third, a poisonous dose may k absorbed. Instruments cannot be placed in corrosive sublimate without being dulled, stained, and corroded. It is better to make the solution at the time it is needed, so as to have it fresh, for in old solutions much of the soluble corrosive sulbimate has been converted into insoluble oxychlorid of mercury, and the fluid has ceased to be germicidal. In order to make up fresh solutions use tablets, each of which contains about 7i grains of the drug—one of these tablets added