The Bradshaw Lecture on Antiseptics in Surgery

J. Wood
1885 BMJ (Clinical Research Edition)  
INSTANOES of great success in the use of the carbolic spray and gauze method have occurred to most surgeons who have practised it. One instance occurred in my practice, which I will occupy a few minutes in relating. A youth, aged 16, was sent to me with an enormous abscess, filling the left abdominal and lumbar regions, and extending under Poupart's ligament as far down as the knee. It was associated with a prominent projection of the third lumbar spinous process. The patient was much
more » ... and very weak, while much hectic fever and depression gave evidence of the approach of a fatal termination. The tumour was aspirated several times, but a semisolid pulpy mass of ddbris, which would not pass the aspirating tube, always remained, and the pus reaccumulated rapidly. I then, with all the precautions possible, and under the spray, made a free incision outside the prominent lumbar spinous process, evacuated, by gentle sponge-pressure, the pulpy and other contents of the abscess, and found and removed a piece of exfoliated bone from the side of the body of the diseased vertebra Very little discharge of any kind afterwards appeared. The patient was placed on an inclined plane, with the shoulders lower than the pelvis and legs, a bandage was placed on the leg and abdomen, and double extension was applied to the feet. He recovered rapidly, and the thin discharge which followed was aseptic throughout, without even a sour smell. The patient is now walking about well, with the wound quite healed. This case illustrates forcibly the remarkable power which carbolic acid possesses in preventing the formation of pus-cells. A similar effect is seen in its action upon granulating surfaces. If continued after cicatrisation commences, it retards the progress of healing by destroying (when in a more or less concentrated form) the epidermal nuclei. Then the discontinuance of the carbolic applications accelerates healing. This property seems to be not entirely dependent upon its antiseptic power. Nitrate of silver possesses ten times its antiseptic power, but, as is well known, it promotes the cicatrisation of a sore. The sulphates of copper and iron, with four times its antiseptic power, also promote cicatrisation. Carbolic acid, especially in the form of spray, but also when the solution is simply injected, has, again, the advantage of giving off its vapour at the temperature of the body, so that it enters and fills abscess and empyemic cavities, sinuses, and burrowing tracks, where putrefaction may be lurking, to spread again septic influence. The more solid non-vapourisable antiseptics, even though more powerful in direct contact, cannot do this. On the other hand, the vaporisable nature of carbolic acid, and of some other antiseptics, makes them more difficult to retain in the dressings. Although, by the use of paraffin and resin, with its jacqurnette covering, Sir Joseph
doi:10.1136/bmj.2.1303.1147 fatcat:bwjwiok6vjetndq2kfnoe5rroy