Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
=Eucalyptol= (_W. Schultz_).—A nonpoisonous volatile oil of considerable
antiseptic power. Soluble in alcohol, and used in three-per-cent
solution. It is claimed to quickly reduce the temperature in a wound. It
was much used by Lister on gauze dressings, the formula of which is given
elsewhere.
=Glycerin.=—It is said to have certain antiseptic power, but is used
principally as a staple solvent of carbolic and boric acid. Soluble in
all proportions in water and alcohol.
=Hydrargyrum Bichloratum Corrosivum= (_v. Bergman_, _Schede_, _Buchholz_,
_Billroth_, _R. Koch_).—The most valuable and effective, although the
most toxic of all antiseptics. It appears as a white crystalline powder.
A 1-50,000 watery solution is efficacious as a germicide (Koch; anthrax
bacilli killed by 1-20,000 solution). Albumen decomposes the bichlorid,
forming a white insoluble precipitate, albuminate of mercury. The same
effect takes place in aqueous solutions allowed to stand for a time—the
resultant being either calomel or metallic mercury. The addition of
sodium or ammonium chlorid or a weak acid, such as tartaric, prevents
this. As much sodium as of the sublimate, weight for weight, should be
used (Koch). When tartaric acid is used for this purpose, five times the
weight of the sublimate is employed.
For all surgical purposes, except in irrigation, solutions of 1-500 and
1-1,000 are used. For the sterilization of wounds and during operations a
1-3,000 is employed.
For the ready preparation of such solutions sublimate tablets can be
obtained, properly mixed with one of the above-named salts. The dyed
tablets are to be preferred, to prevent error on the part of the user.
Tablets containing 1 gm. sublimate, 1 gm. sodium chlorid, and colored
with eosin, are advocated by Angerer.
As metallic substances immediately decompose the bichlorid in solution,
instruments cannot be placed in it, nor may it be kept in metallic
vessels, glass being preferred.
Alcoholic solutions of sublimate are used to cover catgut, silk, and
rubber drainage tubes.
Since sublimate is extremely toxic, great care must be used to prevent
its absorption or retention in wounds. A strong solution must immediately
be followed by a weaker one.
Toxic symptoms resemble arsenic poisoning very much, and are ushered in
by an acute irritation of the wound, especially if moist sublimated gauze
has been used, vertigo, and vomiting. The mucous membrane of the mouth
becomes affected, followed by salivation and bleeding from the gums.
There may be intestinal hemorrhage and an inflammation of the entire
intestinal tract and kidneys, increasing in severity and resulting in
death.
The early symptoms must be at once met by removal of the cause. Albumen
and milk should be given internally, with stimulants as needed. The mouth
is to be rinsed out at frequent intervals with a saturated solution of
chlorate of potash.
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