Publisher's Synopsis
Excerpt from An Aseptic Atmosphere: Club Foot; A Rectal Obturator; Palatoplasty
The experimental evidence by inoculation may be illustrated by a quotation.
In the "Monograph on Micro-organism and Disease," by Dr. E. Klein, p. 48 (McMillan & Co., 1884), Orth is quoted as having cultivated artificially the micrococci of erysipelas, and afterward reproduced the disease in rabbits by inoculation. Fehleisen found the micrococci only in the lymphatics of the affected parts, and those he cultivated artificially for fourteen generations (which it took two months to do) on peptonized meat extract, gelatine, and solid serum. The micrococci form a whitish film on the top of the nourishing material, and when inoculated into the ears of rabbits, a characteristic erysipelatous rash makes its appearance after from thirty-six to forty-eight hours, and spreads to the roots of the ears and further on to the head and neck. The animals do not, however, die from it. In the human subject, he produced typical erysipelas after inoculation with the pure cultured micrococcus in from fifteen to sixty hours. These inoculations were made for the purpose of curing certain tumors, one of lupus, one of cancer, and one of sarcoma. Fehleisen also in several instances carried out a second inoculation successfully, within a few months. He found that a three per cent, solution of carbolic acid and a one per cent, solution of mercuric bichloride destroyed the vitality of these micrococci.
That the material is also capable of being transmitted through the air, and of fixing itself upon wounds or abraded places, is proved by the strongest possible circumstantial evidence. This being admitted, the problem of prevention resolves itself into that of exclusion of the matter from contact with the susceptible part, or destroying it between the moment of contact and the time of its development into disease.
The spray of carbolic acid as devised by Lister, acts probably not by destroying the septic microbes, nor by excluding them, but by rendering the conditions unfavorable for their development The spray prevents the drying of the exposed wound surfaces; prevents the incipient changes which precede apparent decomposition, at the same time that the germs themselves are depriv a of the surroundings most favorable for their development. In the meantime, the germs are destroyed by the white blood corpuscles before they have developed the conditions of attack. The drip or douche of carbolic acid, or of mercuric bichloride, acts in the same way to wash away or to neutralize the activity of such germs as may fall upon an exposed surface.
While this may be said of ordinary septic germs, it is not so certain that pathogenic germs, like those of erysipelas, can be neutralized by the action of a spray or a douche, if they are once implanted upon the surface of the living tissue.
These methods are liable to failure in cases of wounds of irregular surfaces, on which it is difficult or impossible to secure an adequate application to the whole surface, of sufficient intensity and duration to destroy the invading virus. The exposure having been made, however, the chemical or the germicide agent is the only thing that can be relied upon to prevent the natural consequences. The perpetual drip of a weak solution of carbolic acid (one per cent, solution) has been proved to be capable of preventing the development of erysipelas, and of putrefactive changes detrimental to the healthy healing of wounds.
The perpetual bath, antiseptically medicated, is applicable to the feet and the fore-arms, and by lying in the water, it is applicable to the whole body, except the upper part of the neck and the head. Some very satisfactory results have been obtained by this method of management.
It must be admitted, however, that many wounds do not admit of the prolonged application of this or of any other agent capable of neutralizing an infection whose .
