Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
Such solutions, by virtue of their irritant nature, increase the serous
discharge from a wound for about twenty-four hours, for which proper
drainage must be provided, as by its collection it would add to the
danger by increasing inflammation and suppuration, and, by absorption,
even produce toxic effect generally.
When a cold solution is used it should be prepared by vigorous stirring
to separate the globules of the acid. Hot water insures perfect
distribution. After an infected wound is washed with it, the solution
should not again be used, nor should any of the acid be permitted to
remain in the spaces about the wound. It will be found that many patients
cannot tolerate such dressings, and that others must be substituted.
Large surfaces should never be exposed to carbolic solutions, because
the skin absorbs them readily, followed by untoward results. Dangerous
symptoms have been known to result from the internal administration of
seven drops of the acid, and fatal termination has followed its use as a
surgical dressing (Bartley).
Mild acid poisoning is first noted in the urine, which turns olive green.
If the agent is continued, the urine appears dark and turns almost black
on standing. The coloring is due to the presence of indican. If the
absorption is not prevented beyond this there is dull frontal aching,
tinnitus aurium, dizziness, fainting, severe and uncontrollable vomiting.
Untoward symptoms are noted by albuminuria, total absence of sulphates in
the urine, a contracted and inactive pupil, elevation of temperature,
unconsciousness, muscular contraction, and death.
The treatment consists in immediately removing the cause and employing
another antiseptic. Support the patient with stimulants, freely given.
Cracked ice and brandy to allay the vomiting. Small doses of sodium
sulphate, frequently repeated, as a means of converting the acid into
nonpoisonous sulphocarbolate (Bauman). Albumen and milk internally.
Magnesium sulphate, five per cent.
=Chromic Anhydrid.=—Improperly called chromic acid. Made by adding one
and one half parts sulphuric acid, c. p., to one part of concentrated
solution of dichromate of potash. Appears in saffron-colored crystals.
It acts as a caustic upon tissue, and, although a splendid antiseptic,
cannot be used for such purposes, but is well adapted for the preparation
of catgut, as mentioned.
=Creolin.=—Is an antiseptic prepared from coal by dry distillation, and
is used to stimulate granulations, being much more powerful than carbolic
acid. It is nonirritant and practically nontoxic. Used in two-per-cent
aqueous solutions, in which it appears as a turbid but effective mixture.
It is well suited for cleansing the hands, a five-per-cent solution
having none of the irritating or anesthetic effect of carbolic acid.
Owing to the opacity of the aqueous solution, it is not suitable for the
immersion of instruments for operation.
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