To disinfect a wound thoroughly after infection has occurred requires a drug that hill penetrate the deeper layers of the infected tissue. This power is found in tincture of iodine. \Viten the tincture is applied liberally over the carefully dried wound surface, fifteen minutes afterward the tissues evidence of permeation. and no cultures can be ob tained from such areas. If the bacteria are not destroyed, the soil is rendered unfavorable to their further develop ment. No general disturbance observed in the large number of patients on whom the iodine treatment was tried. Beek (Medical Record. Aug. 3, tow).
If the dangerous, though apparently insignificant, wounds to which surgeons or anatomists are exposed were immedi ately treated as if they were snake-bites and thoroughly cauterized in the manner recommended in the last article much suffering would be saved them.
Amputation for infected wounds when there are symptoms of septieremia is useless. All punctured or lacerated wounds should be treated with moist aseptic or antiseptic bandages in order to allow free egress to any germs that may have entered. In ease of actually developed phlegmonous infection, deep, broad incisions are required. There is no such thing as local sepsis without participation of the whole organism. Amputation should only be considered for parts that have become gangrenous. H. Dfierfler (Mfinehener med. 1Vochen., Apr. 23 and 30, 19011, Case of blood poisoning attended by phlegmonous infiltration of the entire arm, extending to the shoulder, with areas of circumscribed gangrene. Free incisions permitted the evacuation of a considerable quantity of pus; the spread of the inflammation ceased, and the patient finally recovered with good use of the arm except where a sear, as the result of the gangrene, slightly limited the extension at the elbow. Schmidt (Miinehener med. Wochen., May 21, 1901).
The medical treatment is of little avail; indeed, remedies tend more to de bilitate the patient than otherwise. portant, however, is the use of tonics, especially alcohol and digitalis, strychnine, and nutritious diet — all agents calculated to antagonize the gen eral adynamia.
Intravenous injections of salt solu tion found advantageous in two eases of septieremia. Hayetn's solution or sim ple salt water may be used in quantities varying- from 25 to 38 thfidonnees, and rarely as much as 64 iluidounces. It is of great importance to prevent the en trance of air into the vein. The artificial
serum is an excellent resource. to which should be added all the others possible. .Michaux (Le Bull. M(d., Jain. 12, '96).
Several eases of septic disease of the adnexa reported in which subcutaneous injeet ions of saline solution were admin istered and soon after operation, in quantities varying from 200 to 500 gralnu»es. injections of artificial serum possess great value in eases of general septic infection, especially at the onset of the disease. The circulation is re:rn hated, the heart-action increased. and the •erebro-spinal system and nutritive func tions arc stimulated. Diuresis is in creased within a few hours. but no ap preciable amount of toxic matter is elim inated. Improvement in the general con dition is to be ascribed to dilution of the toxins in the blood. This process of dilu tion should be eons hilted as long as fresh toxins develop. by the gradual injection of moderate quantities of saline solution.
Intravenous injections should be re served for eases in which a very rapid action is necessary. Margin and Bay nand (Wratch. No. 20. '97).
1. If proper precautions are taken. the risks attending the use of antistrepto eo•cie serum are nil. 2. Although no streptococci may be found in the blood, benefit may attend the use of the serum. 3. In really serious septic cases. corrosive sublimate (1 to 2000). used fearlessly, is the only reliable antiseptic. 4. In sep ticaemia after labor the focus of mis chief may he other than uterine. Ar thur W. Sharp (Brit. Med. Jour.. Feb. 27. '97).
In septiemia ; 1. The yeast-nucleinie acid should be given at the earliest pos sible moment that septic infection is sus pected. 2. The nnelein should always. in septicaemia at least. be given hypoder mically if possible. If the 1-per-cent. solution is used, at least from 30 to 40 minims, undiluted, may be given every three or four hours. If the 5-per-cent. solution should be used, from 10 to 15 minims may be given every three or four hours, but ought to be diluted with dis tilled or at least with sterile water. 3. The injection region should be examined daily in order to determine if local action can have anything to do with the pa tient's increased temperature and pulse rate. If it has, it is due to one of two things: either to insufficient dilution of the 5-per-cent. nuelein solution or to im perfect preparation of the skin or syr inge. Walter Courtney (Med. News, Sept. 25, '07).