WOUNDS, 
Thei-r Aseptic and Antiseptic Management. 
A Paper Prepared for the Meeting of the American 
Surgical Association, 1887. 
I. Aseptic, a. By diminishing the amount of floating 
material in the air by means of filtration through cotton, for 
wounds in the process of formation. 
b. By personal cleanliness. 
c. By the subsequent seclusion of the floating material 
by investments that are proof against penetration by the dust 
floating in the air. 
II. Antiseptic. By the employment of agents which are 
unfriendly or destructive to minute organic life, in such dilution 
as not to be injurious to the wound itself. * 
a. The Spray. 
b. The dry antiseptic dressing. 
c. The wet antiseptic dressing. 
d. Drainage. 
e. Temperature. 
f. Shock. 
The importance of eliminating the greatest possible propor- 
tion of the atmospheric dust cannot be over estimated. The 
microscopist expects, that some of his cultures will be contam- 
inated by the accidental planting of germs from the air, in the 
course of exposure of the culture mediums, in the process of 
transfer of material from one receptacle to another. 
For surgical purposes,\it is important that all wounds, made 
by the surgeon shall be alike protected from atmospheric im- 
plantation. The surgeon cannot afford to be as unsuccessful 
1 2 
with his wounds as the bacteriologist with his culture mediums. 
The contamination of a wound implies complications which 
may thwart the object of a surgical operation and endanger the 
life of the patient. The complete sterilization of a wound is a 
desideratum which is certainly possible to secure, and it is in 
the scope of the present endeavor to secure some advancement 
in this direction. 
The wounds most difficult to protect from suppurative and 
putrefactive complications are those of the serous cavities. 
The condition of the internal 'parts after a laparotomy, are 
like those of a sterilized material infected to some extent. 
The reason why.all cases do not manifest the phenomena of 
decomposition, with the local abscesses and the general blood 
infection incident to decomposition is, that in some cases the 
local vital forces are sufficient to produce an exudate that walls 
in, digests and destroys the invaders, while in other cases, the 
relative force is insufficient, and the invaders wage a successful 
war and secure a focus of decomposition. 
Fluid left in the peritoneal cavity, blood clots, portions of a 
tumor left unavoidably attached, and the material of sutures 
and ligatures, are in the condition of a prize, to be won by one 
party or the other. 
The sutures and ligatures can be chemically treated by sub- 
limate or other antiseptic, so as to resist attack by either party 
for a brief period, but the blood clot, lifeless portions of a 
tumor, serum and other exudates, are ready to be attacked by 
the leucocytes exuded from the blood on the one hand, or on 
the other hand, by the germs introduced in connection with 
the air. 
There are two precautions: One is to leave as little non- 
vital material in the wound or in the abdomen as is possible 
without injurious rough manipulation of the peritoneal sur- 
faces, and the other is to permit the introduction of as few 
of the invaders as possible. It may be assumed to be imprac- 
ticable to secure complete exclusion of either class of material 
favoring decomposition; the invading germs; and the lifeless 
food for their growth and multiplication. 3 
The question is of the methods and details which will reduce 
both classes of agents to the smallest amount, and secure the 
greatest immunity for the greatest number of patients. 
I. a. It is not- necessary to the presentation of this subject, to 
go over the proof of the proposition that the bad behavior of 
wounds depends in part upon the particulate material floating 
in the air. That the agents of sepsis are not gaseous but par- 
ticulate, is proved by the preservation of a great variety of 
substances when put into open vessels plugged with cotton, 
under such circumstances as to preclude the presence of these 
agents at the beginning of the observation. The ordinary 
method of sealing test tubes by means.of cotton is a sufficient 
illustration. 
The present status of opinion is well shown in a series of 
papers in the American Journal of the Medical Sciences, by 
W. Watson Cheyne, of London. In the number for January, 
1887, p. 101, the microbes entering a wound are classed as 
1. Non-parasitic: those which are harmless though introduced in large 
quantities. 
2. Parasitic: those which require to be introduced in considerable quan- 
tity to do any mischief. 
3. Pathogenic: those which can live and multiply in the system, if only 
one microbe be introduced. 
"When bacteria are introduced, there follows a struggle for existence be- 
tween them and the cellular elements. Leucocytes quickly accumulate in 
the neighborhood of the mass of bacteria, followed by a fight for the mastery 
between the invaders and the invaded. The cells take up the bacteria into 
their interior where they are destroyed and removed, if non pathogenic. 
When, however, the bacteria are virulent, the cells are themselves destroyed, 
undergoing degeneration, while the bacteria multiply, living upon the tissues 
which they decompose." 
Cheyne discusses the question of the elimination of microbes 
and thinks that those which are not destroyed and decom- 
posed in the system get out chiefly through the kidneys. 
In the same direction is this quotation from Klein, (Mi- 
cro-organisms and Disease,) p. 167: 
"Amongst the legion of different species of micrococci and bacilli floating 
in putrid substances, the great majority are quite harmless; when introduced 
into the body of an animal they are unable to grow and multiply and there- 
fore are unable to produce any disturbance. 
"But some few species there are which, although ordinarily growing and 4 
thriving in putrid substances, possess this power, that when introduced into 
the body of a living animal, they set up there a specific disease." 
In the same direction is a statement from Staheli, of Bale, 
(in the Revue de (Jhirurgie for August, 1886, p. 688): 
"Fifty-nine wounds were dressed with oxide of zinc, of which forty-seven 
united by the first intention, and in fifteen of these cases micro-organism were 
found. In the cases of union, notwithstanding the presence of micro-organism, 
these are called inoffensive marauders, such by their nature or by their quantity. 
"It is well known that the question of a simple abscess or of a septicaemia 
depends upon the quantity of microbes injected." 
His principal conclusions are: 
1. Under a dressing of oxide of zinc, wounds can be put beyond the reach 
of micro-organisms. 
2. In general, the micro organism found in the secretions existed there 
already at the time of the operation. 
3. Union by the first intention is most generally prevented by the pres- 
ence of the staphylococcus pyogenes, s. p. aureus and s. p. albus. 
4. The wound secretions are good culture mediums. 
These microbes go in class second of Klein. 
This classification is further extended by Bosenbach quoted 
in Micro-organisms in Diseases, New Sydenham Society, 1886, 
p. 415: t 
1. Staphylococcus pyogenes aureus. 
2. " " albus. 
3. " " citreus. 
[ * Knapp adds: 
4. Micrococcus tenuis.] 
5. Streptococcus pyogenes. 
This last is similar to the micrococcus of erysipelas. It has 
special characteristics corresponding with Ogston's observation 
of the different modes of invasion of the staphylococcus and 
the streptococcus. 
"The latter can penetrate into the living tissue, grow through it and live 
on it for a considerable time before suppuration occurs and the tissue breaks 
down. The same is true of the micrococcus of erysipelas. These two are 
supposed to act together, adding the suppurative element to that of erysipelas." 
The last would arrange themselves in the class of pathogenic 
microbes of Klein. 
Dr. Harold C. Ernst in a report in the transactions of this 
society for the last year makes thirteen pus-producing microbes. 
A Sterilized Atmosphere. To render the air aseptic, it may 
*New York Medical Record, December 25th, 1886, p. 702. 5 
be kept still as in a closed box, or it may be strained through 
some thing which will hold the floating particles, or it may be 
carried for a considerable distance along some plane surface 
lined with glycerine or other substance to which the particles 
will stick. 
The settling process is inapplicable for surgical purposes, 
because, however perfectly the floating material may have set- 
tled to the floor, the use of a room must disturb the air and 
bring a portion of the dust up again to float as before, and 
besides, the entrance of persons must of course permit the in- 
troduction of additional air which has not undergone the set 
fling process. 
The volumes of transactions of the last two meetings of this 
society contain descriptions of a device for separating these 
floating agents from the air by means of water. The plan was 
found to be? reasonably successful, but some material would 
always get through as proved by potato cultivations; fresh 
slices of potato being exposed for twenty minutes in the air 
thus treated, and then sealed up. 
The present purpose is to explain a device for sterilizing air 
by passing it through cotton. To overcome the friction and 
drive away non-sterilized air surrounding a wound which is 
being made in a surgical operation, the force of a fan is em- 
ployed which is run by an engine. By establishing a hurri- 
cane on one side of the cotton, a moderate wind is secured on 
the other, having a force sufficient to overcome the effect of 
light specific gravity in the warm sterilized air. For surgical 
purposes, the addition of a small amount of steam is desirable, 
in order not to dry the exposed moist surfaces, and an arrange- 
ment for that purpose is seen in the drawing. 
The surgical necessity for a temperature equal to that of the 
body, is secured by gas jets in the course of the pipe carrying 
the sterilized air. In this scheme the particulate material is 
supposed to be arrested by the cotton, which, at the end of the 
necessary period can be burned. 
The arrangement is in the form of a chest of drawers, the 
outside of the chest being a cube of fifty inches. There are 6 
two chests. There are three drawers in each chest, each hav- 
ing an area of cotton 40x40 inches; equal to 1,600 square 
inches; the area of the six being 9,600 sqnare inches. There 
are two air tight floors, besides the lower floor of the box; one 
below the upper shelf and one below the middle shelf. The 
air enters above each shelf of cotton, and escapes below it. A 
sheet of woven wire with three-quarter inch openings serves as 
the support for the cotton, which is about an inch in perpen- 
dicular thickness. The arrows show the course of the current 
of air. 
Observations are in progress to prove the approximation to 
perfection, of this device for depriving the air of the material 
in it, which is capable of starting and perpetuating changes in 
organic substances. 
An experiment to determine the penetrability of cotton by 
gases while the particulate material is arrested, hac been made 
by burning sulphur in the air previous to its passage through 
the cotton, and finding that the sulphur dioxide passes readily 
through, while the particles which ordinarily give a blue tinge 
to the sulphurized air, have been arrested in the cotton mesh, 
leaving the air perfectly transparent. 
The room in which this scheme has been worked out for 
surgical purposes, has a capacity of 3360 cubic feet. 
The blower (No. 00 of the Sturtevant manufacture) revolves 
3512 times in a minute. This is a rate of speed which makes 
very little noise and is sufficient for the purpose. At this rate 
of speed, it is estimated by the manufacturer to carry 662 cubic 
feet of air in one minute. This rate of air supply would com- 
pletely change the air of the room in five minutes. 
There are, however, three elements of loss, viz: the slipping 
of the band, the escape by leakage through a long pipe, and 
the resisting influence of friction by which the fans of the 
blower slip on the air which they propel. It may be assumed 
that this loss amounts to one-half. The air of the room would 
then be completely changed once in ten minutes. 
The accompanying cut illustrates an arrangement for sani- 
tary as well as for surgical purposes. 7 
a, Inlet pipe. c, c, c, 3 cotton Alters for Inlet 
aa, Outlet pipe. cc, cc, cc, 3 cotion Alters for exit. 
b, Ascending inlet pipe, da, da, da, 3 doors under the inlet Alters. 
bb, Descending outlet pipe. dd, aa, dd, aa, dd, aa, 3 Aoors under the outlet Alters. 
E, Ascending inlet pipe. 
H, Ascending surgical pipe. 
O, Descending surgical pipe, to be raised or lowered. 
K, Thermometer. 
Under g and over gg is the oblique surgical branch of the inlet pipe. 
Gas, Gas Aame for regulating the temperature of the air escaping from O. 
S, Steam jet for regulating the moisture of the same air. 
g, At tne top of the straight pipe g is an eye looking at the name below. Above g is the 
curved end of the inlet pipe for the sanitary use of puriAed air. 
gg, Over gg is a screen to interrupt the straight horizontal blow of the same air. 
EE, Descending outlet pipe. 
F, Canopy. 
FF, Canopy let down. 
L, Surgical table in section. 
M, Sanitary bed in section. 
The important objects are in section. 8 
A practicable plan of observation or test of the parity of the 
air thus treated, is to expose for twenty minutes, a series of 
slices of fresh boiled potato, or sterilized flasks or test tubes 
containing sterilized liquid, to the filtered air. These objects 
are placed on a table within the scope of the inflowing air 
which has passed through the cotton, after which the exposed 
material is sealed up for future observation. Similar material 
sterilized in the same way is to be exposed to the open air the 
same length of time and sealed the same way. 
Another set of the same kind of preparations is subjected in 
the same way and for the same length of time, in any room in 
which it is desirable to test the condition of the air. Some 
observations have been made showing the superior purity of 
air thus treated, but perfection has not been reached. 
The cotton is found not to arrest the particulate material in 
motion to the same extent as in still air. The cotton plug of 
a test tube is not the seat of any motion whatever. If, how- 
ever, the attempt is made to blow through a tube closed with 
cotton, the analogy is perfect-the particulate material will 
gradually travel through, and in a little while it will become 
necessary to renew the cotton. 
b. For completeness of classification, mention should not be 
omitted of personal cleanliness. The hair brush and nail brush 
are not less important than a bath and clean clothes. Neglect 
of these may forfeit the good results of any amount of pains- 
taking in everything else. The surgeon is very likely to forget 
himself and to put his dusty head directly over a wound which 
he unconsciously plants with whatever may fall from it. 
It is one good office of the appliance, illustrated on page 7, 
to prevent the head from coming directly over a wound and to 
blow away from it any dust which may fall from the head. 
c. Dry aseptic dressing impenetrable by particulate material. 
The prevention of the approach of the agents ofsepsis to a 
wound, after it is once made, was about twenty years ago 
a study by Guerin, of Paris. He employed cotton in large 
volume and refrained from examining the wound for many 
days. He was often successful in avoiding putrefaction, but 9 
the failures were too numerous for the general popularity of 
the method. 
The employment of air tight enclosures, has been followed 
by no better success than the employment of cotton which per- 
mits the flow and change of the air. The cause of failure was 
obviously, the implantation of the germs of decomposition 
which proceeded to develop putrefaction and pathological 
changes under the seal intended to keep them out. 
Once the invaders are in, of such kind or force as to make 
head against the resident forces, they cannot be smothered in 
this way. 
II. Antiseptic. The first attempt of Joseph Lister to neu- 
tralize the material falling upon a wound from the air was 
made in Glasgow nearly twenty-five years ago. (See the Bien- 
nial Retrospect of the New Sydenham Society for 1865-'66, 
page 219.) After this sterilization, the wound was protected 
by medicated cotton or gauze from the approach of any more 
atmospheric dust. 
Up to that time, it had generally been thought the safest 
way, in the absence of the attempt to secure union by adhesion, 
or in the failure of it, to keep the wound clean by frequent or 
perpetual irrigation. During our civil war many substances 
were tried as wound lotions with varying success, all of which 
afterward yielded to the superior value of carbolic acid. 
The desideratum has been to find some agent which could be 
employed in sufficient dilution to be safe to the exposed wound 
tissues, and yet destructive to organic invaders when brought 
to the same surfaces. Nothing has yet been discovered supe- 
rior to carbolic acid. 
a. The spray. It may be most convenient here to notice the 
employment of carbolic spray during the formation of wounds 
or immediately afterwards. It is well enough settled that it is 
not a germicide, but it does not follow that it is useless. 
One of the important things to be secured, is such a state of 
the exposed tissues as will most favor the production of a 
rapidly organizing exudate, capable of enclosing such germs or 
organic agents as may fall upon the surfaces and digest or 10 
dissolve them. It may be supposed from what is observed, 
that the carbolic solution benumbs the organic invaders and 
retards their development until the cells in the exudates have 
had time to develop their digestive fluid by which the invaders 
are destroyed. 
The criticism, therefore, that the spray carries more, dust 
into a wound than would otherwise go there, is of no force if, a 
circums'ance is secured favoring the destruction of this organic 
dust. The effects of various irrigations, made in the progress 
of a surgical operation, are partly explained in the same way. 
b. The dry antiseptic dressing. It is in the scope of this 
paper to mention the dry treatment and the wet. The pre- 
ponderating force of Lister's opinions has given the dry treat- 
ment the general acceptance. Two circumstances, however, are 
necessary to the success of the dry treatment. 
First, the primary absence of the atmospheric dust, or that 
the floating particles lodging upon the surfaces shall be de- 
stroyed by the antiseptic agents-carbolic acid, sublimate solu- 
tion or other substances, or by the digestive character of the 
exudates from the wound, or that there shall be included in 
the dressing some agent which is capable by its presence of 
preventing septic changes. 
It may be claimed that, if nothing is present in the air ex- 
cept the ordinary agents capable of effecting the decomposition 
of animd substances, the dry method is generally successful, 
but if there be exposure to pathogenic microbes or their germs, 
as those of erysipelas and gangrene, the dry dressing may be 
disastrous. There is no known vapor that is safe to the tissues 
and at the same time destructive to these agents. 
The employment of oil containing ten per cent, of carbolic 
acid may be called a dry dressing and comes the nearest to the 
indications, excluding all air and coming in direct contact with 
all exposed surfaces. Though this may not be a germicide, 
yet it is impossible for germs to develop or grow in it. The 
question again arises, what will happen if pathogenic germs 
have been introduced below the cutaneous line of union, and of 
course beyond the reach of any agent employed in the dressing? 11 
The complete aseptic condition of the wound being secured, 
it is not important that the dressing should be any more than 
aseptic. The antiseptic agents can only act upon the surfaces. 
The interior of a closed wound must behave under a dry dress- 
ing, well or ill, as there may be agents producing decomposi- 
tion introduced from without or coming from within through 
the course of the circulation. 
It has been generally assumed that there must be a breach 
of surface for the entrance of the germs of purulent infection. 
A crucial observation was made by Dr. Garre, assistant professor in Socie's 
private laboratory in Bale, Switzerland, an account of which is given in "Mi- 
cro organisms in Diseases," p. 441, New Sydenham Society, 1886. 
"On June 17th, 1883, a pure cultivation of the third generation from the 
pus of the same case of osteomyelilis (employed in previous observations) 
containing staphylococcus pyogenes aureus, was employed in the following 
mnnner: ' 
"After washing my left arm with distilled water, I took the whole of the 
cultivation from the test tube and applied it by rubbing over the region of 
the supinators in the same manner that one rubs an ointment upon the skin. 
Agar agar was rubbed over the right arm. Nothing pathological could be seen 
upon either fore arm. % 
"Hypermmia, with a sensation of warmth, became apparent on both sides 
and disappeared in less than an hour. Six hours later, there was a burning 
sensation in the skin upon which the inunction of micro-organisms had been 
made, which steadily became more intense and disagreeable. The sensation 
was like that produced by nettles. Redness and turgescence became more 
evident. 
"In the course of the evening, pustules of the size of a pin's head devel- 
oped around some hairs, and in the morning these were fully developed, so 
that pus was obtained for inoculation. On the eighth day, pus from the 
depth of the abscesses was inoculated. 
"With the exception of some neighboring furuncles, the suppuration had 
come to an end in three weeks, leaving seventeen scars. 
"From this observation it is evident that furuncle, carbuncle and whitlow 
are infectious diseases, and that they can be caused by the same coccus as is 
found in acute osteo-myelitis, and that the yellow producing coccus found in 
these affections is identical." 
This observer goes on to remark that the mode of application purposely 
employed in this experiment is in close analogy with what often happens 
accidentally. He thinks that in furuncle, the infection finds its way through 
the ducts of the cutaneous glands, and that there are no grounds for assum- 
ing that the secretory organs of the skin behave differently towards infec- 
tious invaders, from those of the mucous membranes. He refers to the effects 
of the germs of anthrax taken with food and to cholera and typhoid fever 
with reference to which it is not assumed that there must be some abrasion 
or wound of the surfaces. 
Dr. II. Knapp, in the Archieves of Ophthalmology for 1886 and in the New 
York Medical Record for Dec. 25th, 1886, gives a narrative of a large number 12 
of experiments upon the eyes of different animals, going through the ordi- 
nary surgical operations and employing one eye for a clean operation and 
employing some pyogenic infection in the operation upon the other eye. 
He draws from his observations the inference, that pyogenic microbes 
cannot attack healthy living tissues. They may live in the healthy fluids of 
the body, but they must wait for some deterioration of the vital forces before 
they can attack the tissues and develop an exudation which is the essential 
element of pus. The leucocytes occupy the position of accidental intruders 
into the exudate which is the work of the pyogenic microbe. 
It is not enough for the surgeon to employ antiseptic precautions; the 
poison of an abscess about the teeth or elsewhere may give occasion to the 
entrance into the blood of pyogenic microbes which may enter a wound by 
the back door. 
In one of his experiments the left eye operated on septically showed the 
pus coccus, while there was no suppuration in the right eye operated on anti- 
septically, but some pyogenic microbes and an abundance of these in the 
blood and in the kidneys. The microbes of the right eye seem to have come 
round from the left through the circulation. 
From the facts and considerations adduced, it follows that external anti- 
septic precautions are not sufficient to prevent suppuration; that there is a 
back door through which the pyogenic microbes may enter, coming through 
the blood supply, traveling in the streams of the circulation, innocently as 
long as no tissue with depreciated vitality is presented, but ready to deposit 
themselves and to multiply when a diminished resistance is afforded; pro- 
ducing in one case a spontaneous abscess, and in another, a suppuration in a 
wound or on an abraded surface, such as the peritoneum after its exposure to 
the air and to rough handling with fingers and sponges. 
While the knowledge of the liability to suppuration in wounds without 
deriving from the air the causative agents, tends to diminish confidence in 
the immunity supposed to be secured by the external applications of anti- 
septic surgery, it at the same time directs the attention to the internal prepar- 
ation of the patient which has been long known to be important in securing 
good surgical results. 
These internal elements of treatment are the use of medicines which are 
supposed to be antagonistic to the development and multiplication of those 
parasitic microbes, -which occasion fever with a suppurative tendency to local 
suppuration with febrile symptoms. Among the most valuable of these 
medicines are quinine and iron. 
c. The wet antiseptic dressing furnishes the greatest num 
her of safe-guards against disaster in the management of 
wounds. Though the agents are not of sufficient strength to 
be germicides (or ought not to be) any germ development is 
in an offensive soil and can come to nothing. If the germ of 
any pathogenic microbe is included in a wound it will interfere 
with adhesion, or break up one already formed, and when the 
liquid of the antiseptic dressing is present it is ready to go 13 
into the breach of continuity and stop the further devastation. 
On surfaces covered with hairs, though shaven ever so short, 
the dry material of a dry dressing is liable to be lifted up by 
the rise of the short stubs in the growth of the hairs, permit- 
ing the entrance of germs of decomposition to any unorganized 
exudate and occasioning its speedy decomposition. 
The best agent for the wet dressing is doubtless carbolic acid 
in such dilution as to be slightly sweet, and applied once in 
twenty minutes so as to be always fresh. No redness of sur- 
face is occasioned by the application of carbolic acid in such 
dilution. 
Unfortunately, however, there is danger of producing pneu- 
monia when this plan of treatment is employed upon wounds 
of the breast or wounds any where over the ribs. Great care 
is necessary to avoid cold application to wounds upon the chest. 
When there is fear that the requisite degree of warmth may 
not always be secured, a compromise may be made by very 
frequent changes of a dry antiseptic dressing with a thorough 
antiseptic irrigation. In all other parts of the body, the tem- 
perature may be made to suit the feelings of comfort of the 
patient. 
The greater the precaution against the implantation of germs 
of decomposition in a wound, the safer is the employment of a 
permanent dry dressing. The longer the exposure to ordinary 
air the greater will be the necessity for a wet dressing. 
Wounds of accidents are generally exposed a considerable 
time, and for this reason there is the greater necessity for treat- 
ing them with a wet dressing by a compress to which antisep- 
tic liquid is applied every twenty minutes by irrigation: the 
antiseptic fluid falling in drops upon the wound or by a per- 
petual bath. The bath is especially applicable to gun shot 
wounds in which there is a large amount of material destined 
to slough. 
d. Drainage is employed to meet a difficulty by discharging 
fluids which most readily decompose if left enclosed in a wound, 
or permitting the escape of the products of decomposition. 
The question of provision for drainage is that of the 14 
greater or less realization of the exclusion of the agents of 
decomposition, introduced from without at the time of an in- 
jury or operation, or arising within and coming from the cir- 
culation; compared with the further question of the introduc 
tion of infection along the surface of the tube employed for 
drainage. Another question is that of the comparative forces 
of vitality to master and destroy the agents introduced from 
without, and the power of these agents to resist the digestive 
or destroying vital forces. 
It is well known that fluids retained in a wound, and which 
resist the absorbing power of the living surfaces, have a strong 
tendency to pass into decomposition. The microbes introduced 
from without are shielded from the direct attack of the exuded 
leucocytes with their digestive forces. The liquid is therefore 
in the condition of broth in a flask which has had its steriliza- 
tion impaired by the introduction of microbes ever so few. If 
the fluid is a proper culture medium, it is a question of time, 
and the forces of nature can only resist by the establishing of 
a limiting exudate, resulting in the formation of an abscess 
The removal of the liquid contents of a wo'und is attempted 
by capillary drainage, the best agent, doubtless, being steril- 
ized fiddle strings, cut short enough. Under favorable condi- 
tions these will be subsequently absorbed. 
In case of drainage by tubes, it is evidently necessary to 
aspirate and irrigate with such frequency as to prevent the 
colonization of the wound from without, after it has been 
finally closed up. The form of the drainage is of less import- 
ance than the carefulness of the management. 
A plan of drainage for the peritoneal cavity, and applicable 
to other parts, has been introduced by Miculicz of Cracow, for 
the purpose of preventing the entrance of microbes along the 
outside of the drainage tube. 
(Proceedings of the German Congress of Surgeons, April 
1886, from Uevue de Clwrurgie, Dec. 1886, p. 1019). 
He prepares a piece of iodoform gauze of the size of a pocket handker- 
chief and attaches a strong silk filament to the center. This is kept in a 
five per cent, solution of carbolic acid during an operation, and when the 
tumor has been removed and the peritoneum of the lower part of the wound 15 
has been stitched to the skin, the gauze is placed in the pelvis so that the 
silk filament goes to the bottom of the pocket, while the periphery is arranged 
like a tobacco pouch. The silk filament occupies the center around which 
more gauze is introduced. The gauze thus comes in direct contact with the 
abdominal wound on the one hand, and the intestines on the other. The mid- 
dle portion of the gauze can be removed and new gauze can take its place as 
long as liquid soaks into it. 
At the end of forty-eight hours, the little bundles of gauze which fill the 
sac are removed, and in four days the sac itself is drawn out by means of the 
silk filament attached to the bottom of the funnel of gauze. This is replaced 
by a large rubber drain which is shortened from day to day. 
A modification of this method is made by putting into the 
centre of this cone of sublimated thin silk or wool fabric hav- 
ing a thread attached to the apex a glass tube having the thread 
to come from the apex of the cone through the tube and out 
upon the exterior. A moderate amount of absorbing material is 
placed around the tube and inside the cone, each mesh of the 
absorbing material is to be afterward removed by a string attach- 
ed; while the tube itself is to be plugged with absorbent steril- 
ized cotton. The tube is to be aspirated every few hours until 
there is no more liquid produced. The object of the silk or 
wool material, is to make a connection with the surfaces un- 
til the natural seal by the exudations prevents the entrance of 
microbes into the general peritoneal cavity. After the with- 
drawal of the tube, the cone can be gradually inverted by draw- 
ing upon the apex by means of the string until the whole is 
pulled out. 
e. Temperature. It is well known that many kinds of 
minute organisms (notably that of yellow fever) develop and 
multiply only in a temperature of considerable elevation. Many 
others show different effects upon animal life as they are de- 
veloped in different degrees of temperature, being mild and 
capable of safe inoculation when derived from a cultivation at 
low temperature, and showing extreme virulence when derived 
from a cultivation at high temperature. 
From the behavior of suppurative and septic agents it is 
probable that many of them are both cause and effect of high 
temperature. It follows from this that the suppression of 
high temperature is a desideratum and that the subject has a 
place in a classification of antiseptic surgery. 16 
The application of cold may be therefore supposed to prevent 
the development of superative and septic agents on the one 
hand, and on the other hand, to control the temperature which 
has resulted. This means is both preventive and curative, and 
on this account, should be resorted to as soon as the tempera- 
ture rises above the normal standard. 
Whetlier the plan of dressing be wet or dry, the external 
management of temperature is equally applicable. In the wet 
method, the temperature is in the water applied, and in the 
dry method, it is in water enclosed in tubes which being cold, 
absorbs heat as it flows through the coil. The best test of fit- 
ness is the comfort of the patient; and it is found that in any 
elevation of temperature, cooling applications are pleasant. 
The second means of controlling temperature is by medicine. 
Quinine has for a long time been known to depress tempera- 
ture when given in doses of .6 gram (10 grains) or more, but 
so far as is now known to the writer, antipyrin is superior to 
all the old remedies. It is given in dose of 1 gram (15 grains) 
and repeated several times a day if necessary. 
f. Shock. The occurrence of shock has relation to the subject 
in the influence of depression of vitality upon the course of 
recovery. The ordinary sequence of great depression of tern 
perature is an elevation of reaction and in the attending per- 
turbation there may be a chill which instead of being an event 
in the natural course of restoration, only aggravates the pre- 
viously existing dangers. Wasting of the nervous energy is 
associated with the depression of temperature, though not in 
necessary parallelism with it. 
The conservative agents therefore divide themselves into 
three classes---those which prevent nervous irritation, those 
which stimulate the heart's action, and those which keep up 
temperature; narcotics and cardice stimulants, and the external 
application of heat. 
Morphia .016 with Atropia .00065 given before or during 
an operation may be regarded as preservative of temperature, 
when digitalis in a hypodermic dose of six drops of the tinc- 
ture may be trusted to conserve the power of the heart. 
Heat is best applied to the lower extremities.