A handbook of local therapeutics / edited by Harrison Allen.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of local therapeutics / edited by Harrison Allen. Source: Wellcome Collection.

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    the hands and skin. For irrigating wounds and small abscess cavities I-2000 is generally employed. When continuous irrigation is kept ujj, and when the bichloride is employed in large cavities, a much weaker solu- tion, 1-5000 or 1-10,000, should be used. To get the best results the sur- geon must see that the solutions are freshly prepared, for if left exposed to the air for several days a chemical change takes place, slowly converting the bichloride into the proto-chloride. It has been found that a 1-10,000 hot solution is more active in destroying pus formation or for cleansing purposes, than 1-2000 used cold; hence all preparations for irrigation should be employed as hot as can be borne with comfort. General Surgery.—In the preparation of cases for operation thor- ough cleanliness is first secured by shaving the part, and vigorously scrub- bing it afterward with soap and water or turpentine; it is then washed with a strong solution of corrosive sublimate i-iooo, and, if time permit, a wet compress wrung from a warm solution is laid over it and retained with a bandage until exposed preparatory to the operation. By this means the skin and hair follicles are cleansed. In cases of Contused and Incised Wounds the same procedure is followed, the wound being washed by a stream of bichloride solution thrown from an irri- gator or from the nozzle of a syringe. When the hemorrhage is con- trolled the edges of the wound are approximated by means of a suture, either of wire, silk, or catgut. Chinese silk is to be preferred, viz., that which has been sterilized by boiling in a solution of corrosive sublimate, 1-2000, afterward in distilled water, and kept for use in alcohol. If this method of preparing sutures is carried out the risk of formation of stitch abscesses will be eliminated. Some disadvantages must be acknowledged in the use of corrosive sublimate, as, indeed, is the case with all other powerful germicides. In the first place, there exists the possibility of producing toxic effect in per- sons unusually susceptible to the action of the drug. Serous membranes absorb readily. For this reason the washing of the pleural and abdom- inal cavities with bichloride solutions is contraindicated. If such flushing be resorted to it is well to thoroughly remove all excess of fluid by rewashing with distilled water. The following case of acute poisoning is reported by W. Weiss: A large, fatty tumor had been removed. The wound was washed with a one per cent, solution of the chloride and dressed with sublimate gauze. In a few hours vomiting began, accompanied with sharp abdominal pains, death following on the third day. The autopsy revealed acute gangrenous inflammation of the colon and ilium, with parenchymatous degeneration of the kidneys. Several cases are reported where death has followed washing out of the uterus in obstetric practice, and also where hypodermic use of the drug was employed.