The rules of aseptic and antiseptic surgery : a practical treatise for the use of students and the general practitioner / by Arpad G. Gerster.
- Árpád Gerster
- Date:
- 1888
Licence: Public Domain Mark
Credit: The rules of aseptic and antiseptic surgery : a practical treatise for the use of students and the general practitioner / by Arpad G. Gerster. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![Sanguinolent serum was discharging from the drainage-tube. Dressings renewed. Oct. 16.—Tumor much diminished in size. Drainage-tube removed. Oct. 20.— Wound firm]}- healed; outline of neck normal. Throughout, normal temperatures. Here we see that undoubtedly secondary venous haemorrhage had taken place into the large cavity of the wound. The distention did not reach a sufficient degree to produce a rupture of the line of sutures. The enormous clot was rapidly absorbed, and the wound healed without suppuration, though not by primary adhesion. If the wound had not been aseptic, putrefaction of the clot and dangerous septic processes would have inevit- ably followed. Still more curious is the course of an aseptic wound that is not united at all, but is left gaping, provided that suitable means are employed to preserve its aseptic character. Case.—Mrs. C. T.. aged forty-three, came from Ohio to have a syphilitic defect of the nose repaired. Total rhinoplasty, Sept. 18, 1883, at Mount Sinai Hospital. A suitable flap containing the periosteum was raised from the forehead. The edges of the frontal wound could not be drawn together, therefore a properly shaped, well-disinfected piece of rubber tissue was laid on it, and this was covered with an iodoform dressing. Sept. 23.—Stitches removed from nasal sutures. Dressing on forehead dry, therefore it was left undisturbed. Oct. 1.—Dressing of frontal wound being removed, the rubber- tissue covering became visible; after this was taken away the edges of the wound were found to be cicatrized to the width of half an inch on both sides. A moist, fresh-looking remnant of the blood-clot was still covering a strip of the middle of the wound. No suppuration whatever. Dressings renewed. Oct. 6.—Entire wound cicatrized with the exception of a spot as large as a penny at the upper end. Oct. 10. —Discharged cured. Here, then, is an example of the now commonly observed fact that a gaping defect will cicatrize over without suppuration if putrefactive changes be excluded from the clot filling up the gap. This observation involves a radical difference from the old tenet that whatever wound does not heal by primary adhesion must heal by suppuration. A third possibility has become demonstrable, for which older pathology had no explanation. It is necessary to state that in both of the latter examples the condition of a dustless atmosphere during the time of the operation was not present; the operations were done in ordinary rooms, openly communicating with the dusty streets of New York, yet the behavior of the wounds was per- fectly correct. The extreme difficulty of preparing and maintaining a dustless atmos- phere in a room of an inhabited locality is well known to everybody, and, as a matter of fact, the general practitioner must and will have to do his surgery in more or less dusty rooms. Since the procurement of this con- dition is practically unattainable, frequent irrigation or rinsing of the wound becomes a necessity. But even a constant and powerful stream of fluids will not be able to dislodge all the particles of dust that may have settled down upon and insinuated themselves into the nooks and crevices](https://iiif.wellcomecollection.org/image/b21023220_0024.jp2/full/800%2C/0/default.jpg)
