Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

Date:: 1895

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

244/1272 (page 212)

$valuable means of preventing putrefaction and infection. This discrepancy is said to be explained by the fact that iodoform breaks up in the presence of pus, so that pure iodine is liberated. Ptomaines are also said to break up iodoform in the same way and at the same time to be themselves destroyed. Free iodine is w ell known to be one of the most powerful of all antiseptics, and thus tbe power of iodoform in checking decomposition and suppuration is fully explained. If much iodoform is used, iodine can always be detected in the urine in the form of iodides ; but iodoform does not appear; this is further evidence of its breaking up, either in the wound or the blood. Iodoform possesses very marked toxic properties, but the effect produced seems to depend to a great extent upon an idiosyncrasy on the part of the patient. The symptoms of iodoform poisoning are very various, and differ somewhat in children and adults. Amongst the most marked effects have been au elevation of temperature reaching 104° F., without other serious constitu- tional disturbance, and without any unhealthy appearances in the wound. Loss of appetite with progressive emaciation is common ; the patient com- plaining that everything tastes and smells of iodoform. Vomiting, however, is not a frequent sympbom. The effect on the pulse is often very marked, especially in children ; the frequency is greatly increased, reaching 140 or even 180, and at the same time the force is comspondingly diminished. Its effects on the brain are often very serious ; in some cases in adults it seems to have caused violent maniacal delirium, in others persistent drowsiness has been noted, with great mental depression. In children drowsiness is more common, and occasionally the symptoms may closely resemble those of tubercular meningitis. In other cases rapid collapse has followed the use of iodoform, for which no cause but the drug could be found. Many fatal cases have occurred in Clermany; but the quantities applied have been in some cases so enormous that this is scarcely to be wondered at. As an external dressing to a wound, the edges of which have been brought accurately in contact, it has never been known to cause poisoning, though when applied on the raw surface left by a large burn it may give rise to some of the above-mentioned symptoms. The urine, in all cases of iodoform poisoning, has been found to contain iodine. The treatment consists in the immediate and complete removal of the drug, which will usually be followed by speedy disappearance of the symptoms. Iodoform very rarely causes any local irritation. It is said to have little or no power of destroying the virus of erysipelas. Potassium permanganate, a solution of which is known as Condy's fluid, is a powerful oxidising agent. It possesses very active powers as a disinfectant, destroying the smell of decomposing matter even when used in very dilute solutions. According to Miquel, it prevents the growth of organisms when in the proportion of about two grains to the ounce of water. In the strength of about twenty grains to the ounce it will kill the spores of the bacillus anthracis, but such a solution cannot be used in surgery, as it stains everything with which it comes in contact a deep brown colour. The weaker solution forms a valuable lotion or wash for foul wounds. It possesses practically no toxic properties. Aluminium acetate, in the strength of about ten grains to the ounce, has been recommended as a non-poisonous antiseptic by ]\Iaas, and has been exten- sively used in Germany. Both the acetate and the subacetate of lead possess antiseptic properties,$