An aseptic atmosphere; club foot; A rectal obturator; Palatoplasty.

  • Prince, David, 1816-1889.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: An aseptic atmosphere; club foot; A rectal obturator; Palatoplasty. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    The notion of the excellence of blood as a wound dressing is an old popular tradition, and there is some truth in it, but the exposure to the air of non-putrefaction dressing impervious to floating atmospheric dusi must be far superior to the surface of a blood clot with its aon-sterilized retaining bandage. The surface of clot thus exposed, invariably becomes putrid in this climate, and in dryness London can have no superiority over us. That a dressing of undiluted blood may be better than non-sterilized dressings may readily be conceived, but in this day it is a queer freak to scoff at antiseptic agents and rely upon such a perishable defense against atmospheric putrefaction as blood. It is true, blood is a natural dress- ing, but the instinct of the dog leads him to lick it off. The wet dressing, the lotion being carbolized or sublimated water, is sure, but more troublesome. In this plan of management the omission of fresh application of carbolic acid for some hours is disastrous. The agents of decomposition pass readily through the damp dressings to the wound and to its fluid or its solid or semi-solid contents. The discontinuance of a sublimate wash after beginning on the wet plan, leaving the dressings to become partially dry, is less dangerous. The mercurial does not go off into the air like carbolic acid, but it may be absorbed, or by dryness become inactive along the surfaces sur- rounding a wound, permitting the microbes of decomposition to pass in Constantly wet or constantly dry, should therefore be the maxim. If, before the dressing is applied, the wound has become infected with germs beyond the power of the exudates to digest and destroy them, the dry method must be a failure. Only the frequent or perpetual drip, or the bath, can insure against suppuration and putrefactive com- plications. In the case of long exposure to the air, as in accidental wrounds, the wet dressing should be employed so as to secure the perpetual presence of the antiseptic until the time when the exudates upon the surfaces of the wound have become replaced by organized material. After that, the more convenient form of dry dressing may be employed with safety, the purulent product being carefully wrashed away sufficiently often. From these considerations, the application of a dressing perpetually wet with an antiseptic lotion must be the safest for wounds exposed a considerable time to the air, and especially to gun shot wounds present- ing irregular and ragged surfaces, some of which are likely to be ne- crosed, though under a careful antiseptic drip or bath they need never present any smell or other sign of gangrene. This is a distinction im- portant to secure. The necrosed tissues following a gunshot injury or a telipes operation, behaves like catgut ligatures. They are absorbed if not too large or too resisting for the digestive powers of the lecucosytes, or they remain for a gradual odorless maceration or final expulsion. If exposed to the action of suppuration and putrefaction germs they mor- tify and smell. MANNER OF OPERATING. For cases in which, on account of age or the degree an , resistance of the deformity, it is necessary to remove a portion of the tr.rcal bones, the following method is recommended: