Daily Kennebec journal. [microfilm reel] (Augusta, Me.) 1870-1975, 1894-05-24
time and with one-half the discomfort that

were previously involved.
The wonderful regularity of repair ant
the rapidly of healing are two phenomens
OF the highest importance. All the dress
ings are remarkably neat, are required les
and less fre quently as the case progresses
and we see disappearing from surgery thu
eplIhe ms,-the uncleanliness of which car
only be compared with that of the pus-cov
cred wounds which they are designed t.
protect.
When one has seen wounds heal withou,
suppuration; Assesses as soon as evacu
ated, dry up and close rapidly; the greai
JOINTS when opened allow themselves to be
roughly handled without resenting it clot:
OF blood instead Of interfering with repair
contribute to its perfection; he compre.
hends that new element has entered into
surgery.
Whatever has been the progress of mod
ern surgery, the antiseptic method came at
time when the surgeon often disarmed by
surgical complications, saw his horizon
limited by cruel uncertainties. Ii was i'm
possible TO predict the results of operations
and security was so imperilled that cert ain
conditions appalled, the boldest and certain
operations were practically prohibited to
surgeons of the cities, who even though con-
summately skillful, found themselves IN
able to produce results equal to those of
their far from expert brethren in the coun-
try, where the atmosphere is untainted.
The antiseptic method came and gave an
impetus to surgery, for it provided skill
with means of success.
Compound features are the wounds in
which aseptic treatment was first applied
and in which excellent results can be OBJ
tanned. These injuries have always been
regarded as dangerous because such wounds
generally intlame and suppurate. But, as
it is now possible to protect them from the
action of septic ferments, recovery will
occur without suppuration.
Most of the fractures which occur at the
base of the skull are compound and should
be treated with all the antiseptic precau-
tons. If the fracture occurs in the middle
fossa, the petrous portion of the temporal
bone is also fractured and the membranum-
tymanum is invariably ruptured. Failure
to recognized these fractures as compound
oft-times results in death of the patient.
The ear should be carefully and thorough
ly syringed out with an antiseptic solution,
and afterwards stuffed with sterilized iodo-
form gauze, over which apply the dressings.
When the injury involves limb the first
thing to determine is the possibility of saw
ing it, and the attempt should generally be
made if the injury to the soft parts is not
too extensive, if the bones do not largely
protrude, and the skin is not extensively
lacerated if theiwarmth of the limb below the
fracture indicates the integrity of the main
artery and the nerves are not implicated.
The thorough use of disinfectants by which
putrefactive suppuration is now prevented
adds largely to our means of saving limbs
after compound fractures. Hardly any
amount of fractured bone alone would JUS
tify the surgeon to resort Immediately to
the knife, even should the bone be fractured
extensively into large joint. In such a
case, anchylosis of the joint would probably
occur; yet it would prove less evil than
that of amputation.
The injury may be rendered still more
serious by the extensive laceration of
muscles. Much will depend upon the kind
of laceration whether they are merely cut
in two, or whether the injury involves a
few or the larger number of muscles of the
limb. We should examine with great care
the conditions of the vessels; determine
whether the main trunk is whole, especially
Ill llt tu1Su UT leS. w udl Is Tie COuulllOu VI
the nerves? Does sensibility extend to
fingers or toes? If the integrity of both
artery and nerve fail and the sinking tenn
perature of the limb and the loss of sensi-
bility continues to increase, we have no
alternative but amputation.
If, after careful investigation, it is de-
cided to attempt to save the limb, the first
indication (in recent case) is to convert
the compound fracture into simple one.
All the instruments and dressing should, of
course, be sterilized and the hands of the
operator and his assistants should be purified
in a to 1000 solution of bichloride. If
the bone is not readily reduced,
enlarge the opening. If necessary, saw off
such projecting portions as will enable the
fragments to be nicely adjusted; remove
all foreign matter from the wound if blood
is effused from the ruptured veins, open
the spaces where it is collected and with the
finger or handle of the scalpel remove all
clots. Cleanse the limb with soap and
water; shave off all hairs; after which,
again wash the limb and the wound with
solution of bichloride to 2000, syring-
ing in a thorough manner to the bottom of
the wound. The washing of the cavities
should be scrupulously done. The anti
septic treatment of compound fractures de-
ponds mostly upon the pains bestowed upon
the first dressing. Close the wound with
prepared catgut sutures, placing in the de-
pendent angle drain of catgut or decalci-
fed bone; dust on iodoform; wet a piece
of protective in 2 l-2 per cent solution of
carbolic acid to divest it of all germs-for
in itself it has no antiseptlc quality-place
it upon the wound, overlapping it but
slightly in order that the discharge may
come as soon as possible to the gauze (the
antseptic substance y now take some pieces
of iodoform gauze and place them directly
upon the protective; over which apply from
six to eight thicknesses of bichloride gauze ;
between the last two layers place the imper-
vious macintosh. This dressing should reach
entirely around the limb. The dressing
should be crossed as much as possible in
such manner that the fluids, in draining,
can find no gap and will be obliged to run
over the greatest possible extent of the dres-
sing. generally apply two rubber adhesive
straps outside the dressing, at its extremi-
ties, which by their elasticity keep the dres-
sings so tight that no leakage or current of
air can carry germs under the cuirsss thus
formed.
These are the principal points in the prac-
tice of the dressings; but they are subject
Al