The operations of surgery : intended especially for the use of those recently appointed on a hospital staff and for those preparing for the higher examinations / by W.H.A. Jacobson.

  • W. H. A. Jacobson
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The operations of surgery : intended especially for the use of those recently appointed on a hospital staff and for those preparing for the higher examinations / by W.H.A. Jacobson. Source: Wellcome Collection.

    31/1280
    XXVll disputed, there is no doubt as to its value. Whether it attacks directly microbes or ptomaines, whether it only acts indirectly by drying up the secretions of the wound, there is no doubt that iodoform, though by no means a powerful germicide, has a marked effect in preventing putrefaction. It is especially useful when very finely powdered and mixed with boracic acid powder, and carefully dusted in small quantity into the crevices of a wound, just before this is closed. It may also be used with collodion, or with ether (i in 8), in operations about the mouth lips, jaws vagina, rectum. Iodoform gauze has all the softness and pliability of sal alembroth gauze, but is much more expensive. The great objec- tion to iodoform, its smell, considered tell-tale from the original associa- tion of this drug with soft chancres, has not yet been satisfactorily met. I have tried the following, but my experience is that, however skilfully the chemist disguises, at first, the disagreeable odour of this drug, it is apt to betray itself later, as the more volatile scent disappears. Oil of sanitas 3ss,' iodoform 3ss, vaseline 3] has been recommended by Mr. Hutchinson. If it be desired to disguise the odour of iodoform m powder, Tonquin bean, balsam of Tolu, oil of peppermint may be added, but the success will be only partial. The addition of finely powdered coffee, freshly roasted, is somewhat more successful. Iodol, with finely pow- dered boracic acid, is a good substitute, but is more expensive, and, in my experience, sometimes fails altogether. It is not only odourless, but devoid of poisonous properties. Harmful effects of'iodoform.—In some cases delirium, stupor, an irregular temperature, nausea, vomiting have been noticed. These poisonous effects are especially to be dreaded when iodoform is used over a very large surface in a weakly patient, in a cavity where it is retained, or in cases where it is used in crystals, which are not readily removed, or in excessive amounts. The influence of iodoform upon other than septic germs must be alluded to. The question of its anti-tubercular action still remains open. In Germany an emulsion of iodoform and glycerine has been largely used in cold abscesses. From my experience in three cases of spinal abscess, this use of the drug is futile, the abscess remaining quiescent, and, when laid open many weeks after, being found to contain a greenish treacly fluid with altered pus. vi. Salicylic Acid.—This is used, in this country, chiefly as a w ool or as a cream. The former is prepared with 3 or 10 per cent, by weight of the acid, glycerine being added to make the crystals stick better to the wool. It is an elastic and reliable dressing, but its irritating effect upon the respiratory passages is well known. I therefore much prefer the sal-alembroth wool. Salicylic acid cream, made by mixing the crystals with glycerine and carbolic acid (1 in 10 of these) so as to form a paste, is a very valuable application where a dressing lias to be left on presence of moisture have the power of decomposing iodoform and Betting iodine free ; it thus may act as a. powerful germicide.