Volume 1

Operative gynecology / by Howard A. Kelly.

  • Howard Atwood Kelly
Date:
1901, ©1898
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Operative gynecology / by Howard A. Kelly. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    26/622 (page 2)
    and of the fluids in the wounded area suffice to inhibit the growth or the pathogenic manifestations of the invading bacteria. It is largely to these natural inhibitive forces of the living tissnes that we must ascribe the good results obtained in many surgical operations conducted even under a bad technique. It would, however, be a serious error to rely exclusively in surgical tech- nique upon the germ-destroying powers of the living tissues and fluids of the body, great as these undoulitedly are and important as it is not to interfere with these natural germicidal agencies. In a large proportion of the cases in which bacteria have been found in so-called aseptic wounds the bacteria have been either non-pathogenic or possessed of little virulence. It is exceptional to find virulent pyogenic bacteria in wounds without any manifestations of their pathogenic activity. The most common invader of wounds of the skin is a variety of the staphy- lococcus pyogenes alb us called by Welch (Conditions underlying the Infection of Wounds: Trans, of the Congress of Americcm Ph>/sicia?is and Surgeons, vol. ii) the staphylococcus e p i d e r m i d i s a 1 b u s, as it is a regular inhabitant of the epidermis and hair follicles. The investigations of Drs. H. Robb and A. A. Ghriskey (Johns UojjM/ts Hospital Bulletin, vol. iii, p. 37, 1892) have shown that most wounds through the skin sooner or later become contaminated with this organism, and yet its presence may not interfere with primary union. An important point relating to the presence of the staphylococcus epidermidis albus in the healthy skin is that it lies so deeply in the epidermis or hair follicles that chemical disinfection of the superficial layers of the skin does not destroy it, as may be demonstrated ])y the following experiment: After thorough disinfection of the skin by perman- ganate of potash and oxalic acid, in the way subsequently described, cultures made from scrapings of the surface usually show no growth. If, now, ster- ilized silk sutures be passed one or more times through the skin in the disin- fected area, and a tube of nutrient agar-agar be inoculated with the sutures, the presence of the white staphylococcus, often in pure culture, can be demonstrated in parts of the epidermis deeper than those acted upon by any chemical methods of disinfection of the surface of the integument. Welch believes that the staphylococcus epidermidis albus is but rarely pyogenic, and that its pathogenic activity depends largely upon de- creased resistance in the germicidal forces of the wound area. The most recent bacteriological and practical experiments on infection of wounds point conclusively to the fact that the skin is a common habitat for various organisms, and that this must be taken into careful consideration in the preliminary disinfection of all operative fields. As already stated, in a large proportion of cases these organisms are non-pathogenic, and a fresh wound containing them may, from a surgical standpoint, be regarded as aseptic when the process of healing is in no way interfered with. Cultures taken from beneath the most carefully applied surgical dressings very frequently show growths which can be accounted for only on the supposi-