Value Of Antisepsis

These last 20 years surgery has beeu advancing at an almost vertiginous pare. and its progress and improvoment are due to the universal practice of antisepsif and to the adoption of proper dressings. The most daring operations are now crowned with success, and different viscera which had previously been carefnlly avoided by surgeons ai-e treated safely and to the welfare of the patients. It is an every day occurrence to see the abdominal cavity opened either to remove a tumor or tomakesome operationon the intestines. The brain islaid bare to f ree it from some compression from which it is suffering or to open an abscess and give a free exit to tle pus. Under all these circumstances the surgeon intervenes with perfect security when he has minutely taken the necessary precautions to protect the wound he creates from infection by germs. These dangerous germs are both within the patients and about thern, and for this reason it is absolutely indispensable to disinfect the spot that the operation is to affect and also everything connected with the operator, his instruments or assistants. As for the germs floating in the atmosphere, some surgeons endeavor to counteract their effect by spraying antiseptic liquids about the room during the operation. The point to be guarded again8t above all others is infection of the seat of intervention, and this can be accomplished by destroying the germs that may have already invaded it or by closing up all access to it on the part of those that may be about it. The former can be effected by the use of antisepsis and the latter by asepsis. Complications ajising from firearm wounds seem to result from the action of germs which are not carried by the proyectiles, as inight be supposed at first thought, but by the patients' clothing. In one of the late meetings of the Societe Imperio-Royale des Medecins de Vienne, M. Habaxt reported the experiments he had undertaken in this connection with M. Faulhaber concerning the infection of firearm wounds. These two investigators, using regulntion rifles, fired at boxes of gelatin, uí which some were sterilized or coverad with sterilized blotting paper, others surrounded with pieces of oíd uniforma and others with pieces of uniforma dipped in pure cultures oí' staphylococci. In the first case the track of the bullet remained asceptic; in the second were found, in addition to pieces of cloth, a variety of microbes, while in the third the boies contained nothing but staphylococci. In short, a bullet striking the body of a soldier or a piece of shell entering his flesh stands every chance of creating an mfected wound. It is therefore iinperative to treat all wounds in wartime antiseptically, and we owe a great debt to the different authorities who in time of peace are preparing a sufficient stock of packages of dressing to supply each soldier or officer on the day war may break out. This small package of dress ing with which each soldier is to be f ur nished is to be placed, in the Prenci army, in a pocket specially prepared fo it and is certain to render great serv ices, whether used by the wounded man himself or by the ambulance corps Ho wever temporary this remedymay be it will still haye the advantage of sup plying the regimental surgeon with al most enough dressings for the first de mands on the battlefields without hi having to make use of his stores, and i will rapidly place the wounds out o reach of the danger of infection arisiug from contact with clothing, hands or the ground. A Germán army surgeon, M. Koerfer has been testing the value of inhalations of chloroform in the cerebro-spinal form of sunstroke, and in the case of two sol dièrs very seriously affected with uncon sciousness, convnlsions, hypersesthesia of the skin, livid skin and weakenet pulse, the prolonged administration o: chloroform succeeded in putting an ene to all the symptoms. The favorable effect of the chloroform showed itsel: as soon as its use was commenced by marked improvement in the pulse, bul the convulsions did not cease altogethei until the narcosis had been kept up for an hour and a quarter in one case anc for a quarter of an hour in the other. The use of cold water and hypodermic injection8 of ether, Ê which recourse was had in the first case, where the symptoms were particularly serious and before the chloroform was tried, were found to be powerless and to have no other effect than to bring on or increase the convulsive attacks each time they were tried. With this patiënt M. Koerfer also made an injection of two centigrams of morphine toward the end of the chloroform seance, and when the man began to come out from the effect of the chloroform he feil asleep again under the influence of the morphine, and on awakening finally the convulsive attacks had entirely disappeared. Chloroform acts in these cases by stopping the convulsions which help to raise the temperature of the body by lessening the production of heat and also by facilitating the radiation of the heat of the body. Hypodermic injections of ether are given to prevent asphyxia, and caffeine administered in the same way has a twofold purpose, to increase or re-establish the urinary secretion and to tonify the system in general. In the future it will be well to bear in mind the usefulness of chloroform in these very severe cases of