The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis.
- Wharton, Henry R. (Henry Redwood), 1853-1925
- Date:
- 1902
Licence: Public Domain Mark
Credit: The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis. 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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![which has already taken place. Diphtheria, hydrophobia, tetanus, anthrax, glanders, and even pneumonia, are instances in which partial success has been obtained by this method, but it is rarely that any effect can be obtained except at the very beginning of an infection. Methods of Sterilization.—Most important to the surgeon is the question how to exclude or destroy micro-organisms, a question which is very difficult to answer definitely on account of the variations in the vitality of the germs and the possibility of numerous errors in the experiments. Thus, it was long thought that a solution of bichloride of mercury, 1 to 1000, would kill germs, and even spores, with certainty and rapidity, three minutes being the longest time of exposure supposed necessary ; but these conclusions have proved erroneous. The usual method of testing such solutions was to put in them a thread impregnated with the germ to be tested, and then inoculate suitable media with the thread, concluding that if the culture medium remained sterile it i^roved that the germs had been killed. But it has been fouud that the negative results thus obtained were worthless, for enough of the chemical remained in the thread and the germs to prevent the latter from developing and to keep the culture sterile, although the bacteria were still alive. Washing with water and alcohol proving insufficient to remove the antiseptics, it was found necessary to neutralize them by chemical action, such, for instance, as the use of sulphide of ammonium to precipitate the bichloride of mercury, and then it was dis- covered that experiments which had given negative results under the old methods produced abundant cultures (Geppert). By this method it was found ihat anthrax spores survived ten and even twenty-four hours' immer- sion in a 1 to 1000 bichloride solution, and that even the staphylococcus pyogenes aureus would survive after being kept for twenty minutes in the same solution. Exactly how the chemical antiseptics act in thus suspending growth in living organisms and yet leaving them capable of restoration is not understood, the most probable explanation being that the antiseptic enters into combination with the capsule of the cell, and can be freed from it by breaking up this chemical combination. It has long been known that very minute quantities of germicidal substances, and some substances which are not germicidal, would prevent the growth of bacteria, so that it is not surprising that chemical disinfectants should act in this prolonged, inhibitory way. It must be remembered that in operative surgical work no such sec- ondary reagents are used, and that germs which do not develop within a short time after inoculation will be destroyed generally by the action of the tissues. If nonabsorbable materials such as silk sutures are buried in wounds, however, quiescent germs contained in them might be protected from the germicidal action of the tissiies long enough to recover from the temporary inhibition of the sterilizing agent, and might begin to grow and cause infection weeks or months after the wound had healed. While, there- fore, these results do not entu-ely invalidate the present methods of steriliza- tion for operations, they should stimulate us to the discovery of better means, and especially to the thorough ap]Dlication of the methods upon which we are now dependent, in order to obtain the best possible results from them. We should avoid the introductioa of non-absorbable material into wounds](https://iiif.wellcomecollection.org/image/b21204287_0022.jp2/full/800%2C/0/default.jpg)
