Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • Erichsen, John
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

    352/1244 (page 324)
    is sold ready prepared. It is very absorbent aud elastic, and makes an excel- lent dressing. The Sal Alembroth Gauze and Wool (j). 2ou), introduced by Sir Joseph ]jister, have lately been used to some extent and with good results iu most cases. The gauze is elastic in mass and very absorljent. The dressing is thus applied. A piece of the gauze al)0ut four layers thick is (li])])ed in a 1 ill iOW) solution of perchloride. This Avashes out the sal aleinbroth, and leaves the gauze aseptic and quite free from irritating properties. This piece of gauze squeezed as dry as possible is applied next the wound. Over this a mass of the gauze some ten or twenty layers thick is applied, and <»ver tliat again the wool. The whole is secured by a bandage. The wool, containing 2 per cent, of the salt, might irritate the skin if applied directly to it. 'Wq chief fault of the dressing is that it will not deal satisfactorily with large quantities of discharge. Owing to the great solubility of the sal alembroth it is readily washed away and thus the dressing may fail as an antiseptic. If the discharge is small in amount and dries in the dressing, the result is all that can be desired. Salicylic Wool, Salicylic Jute and Tow, Salicylic Silk, Iodoform Wool, are all applied in the same way as Cluerin's cotton-wool dressing (p. ol5), from which they dift'er only in the presence of the chemical anti- septic. The salicylic and iodoform wools have been extensively used at UniA-ersity College Hospital during the last few years with the most saris- factory results, the wounds frequently heaUng under a single dressing. In operations in which a prolonged discharge of small amount may be expected, as in those for carious bone, it is often convenient to apply a piece of protective oiled silk over the v. ound to prevent scabbing which might hinder the escape of any pus or serous fluid. Carded Oakum, Tenax or Marine Lint is a cheap antiseptic dressing, but it is not adapted for direct application to a wound, as it is too irritating. It may, however, be applied over one of the absorbent dressings aboA'e men- tioned in order to economise the more expensive material. Iodoform Treatment of Wounds was first introduced in Vienna in Billroth's wards, and is still much used there, according to J^Iosetig v. Moorhof, with the most satisfactory results. It is thus carried out. In the case of an operation the instruments may be disinfected with carbolic acid, and the sponges washed in some weak antiseptic solution, but this is not regarded as essential. The bleeding is arrested by catgut ligatures or torsion, and the wound cleaned. The raw surfaces are then freely dusted with finely powdei-ed iodoform, drainage-tubes are inserted, and sutures applied in the usual way. The external dressing is composed of any absorbent material, such as gauze, wool, moss, itc, which may be impregnated with iodoform : but for prevention of sepsis reliance is placed rather on the iodoform in the wound than on that in the dressing. The advantages claimed for this treatment are, that it relieves pain by the anodyne action of the iodoform, that it is simple and efficient, and that the portable nature of the antiseptic makes it applicable in military surgery and in country practice. On the other liand the antiseptic properties of iodoform have been denied, it has been said to fail entii-ely in the prevention of erysipelas, and to be liable when used in this way to give rise to iodoform-poisoning. That iodoform does possess powerful antiseptic properties can hardly be doubted. In open