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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    Much may be done by drainage and the introduction of disinfecting liquids, but it is necessary that they shall be of feeble force, in order not to irritate the delicate surfaces or not to poison the general system by absorp- tion through the surfaces to which they are applied. It follows from these considerations, that the prevention by disinfecting agents should be the least favored method, and to be employed where the prevention by exclusion is impossible or has been neglected. The exclusion is of two kinds: the immediate and temporary; and the permanent. 1st. The exclusion of those agents from the air which surrounds the patient at the time of an operation, by means capable of purifying the whole atmosphere of an apartment, or the portion of it which surrounds the wound in the progress of formation; and 2d. The permanent exclusion of an infected atmosphere by the mode of dressing. This implies, that while the atmosphere of a whole room may be made aseptic during the time in which an operation may be performed, it may be too troublesome or too expensive to secure a perpetual purification of the apartment occupied by the patient during his recovery. It is implied, that the exposed wound surface may be effectually secluded from contamination by such a character of the dressings as to make it certain that the infection will be arrested or destroyed. We have our subject classified by the nature of things; as 1. Antiseptic applications during the progress of cure. 2. The arrest of the access of infection during the progress of cure by the -character of the dressing first applied and allowed to remain. 3. The purification temporarily of the air of an apartment in which a surgical operation may be performed. 1st. The plan of the first method is that of a perpetual irrigation, or a perpetual bath. 2d. The second plan is that of a dressing impervious to the floating ob- jects in the air, and it includes the Lister dressing. It is found that it is of no advantage to have the dressing air-tight or water-tight, but that a material with fine meshes, like that of cotton, will answer the purpose. If the wound is exposed under a spray or douche, and aseptic cotton, wool, or other similar material, be applied and retained, the agents of septic changes cannot enter as long as the material of the dressing is entirely dry. It is, therefore, convenient to have the cotton or other sub- stance previously treated with a solution of mercuric bichloride or other antiseptic, the water being dried out before the use of the material for dress- ing. Otherwise the dressing, infiltrated with the exudations from the wound, becomes putrid, requiring its removal sooner than is necessary with a dressing capable of preserving from putrefaction any fluids that may get into it. In applications of gypsum it is convenient to wet it with a solution of Hg. CI 2. 3d. The plan of the third class, is that of securing the freedom of a whole apartment from floating minute particulate material of all kinds dur- ing the time necessary for the performance of a surgical operation, or the ex- clusion of air dust from the portion of air surrounding a wound and entering into it. It is exceedingly probable, that if the cavity of the peritoneum or any other closed cavity, can be opened in an atmosphere free from floating ma- terial, and closed again after a short period, the conditions will be the same as though the work of removing a tumor, or other operation, had been done subcutaneously, so as to exclude the contact of air. The_ continued purity of animal and vegetable liquids sterilized and placed in vessels closed by sterilized cotton, admitting free access of gases but sifting out particulate material, affords the strongest probability to the assumption that the septic changes occurring in wounds and in closed cavi- ties into which air has entered, would not occur, if the air were free from such material as might be filtered out by passing through cotton or other