Alcohol (absolute).—This is a well-known antiseptic, but, because of its ready evaporation, is especially used for the hands, as described, and to cover sharp-edged instruments after sterilization.
Aluminum Acetate (Bürow, H. Maas).—A powerful, nontoxic antiseptic. Is used only in two- to five-per-cent solution. According to Primer, it arrests the development of schizomycetes, and in twenty-four hours destroys their propagation. It readily removes offensive odors of wounds; its great objections are that it injures the instruments, and, because of its astringent nature, roughens the skin of the hands. This, however, makes it particularly useful for sponging to arrest capillary oozing.
Boric Acid (Lister).—Not a powerful, but nonirritating, antiseptic. For this reason it is used extensively in cleansing mucous membranes, and, when associated with salicylic acid, as in the well-known Thiersch solutions, composed of salicylic acid, 2 gms.; boric acid, 12 gms.; water, 1,000 gms., is much used in skin-grafting operations. It is not very soluble in cold, but readily in hot, water and alcohol. The saturated solution is prepared by adding ℥j to the pint of boiling water.
Benzoic Acid.—Nonirritating, moderate antiseptic (Kraske); is prepared in 1-250 solutions. Soluble in hot water and alcohol, but sparingly in cold water.
Carbolic Acid (Phenylic Acid).—Not a powerful, but a much-used antiseptic. The purest acid should be used. It appears as a colorless crystalline solid, liquefied by the addition of five per cent water. If more water is added the solution becomes turbid, clearing when 1-2,000 is reached.
It is readily soluble in glycerin, alcohol, ether, and the fixed volatile oils. Solutions in alcohol and oils have no antiseptic effect (Koch). The 1-20 aqueous solution is recommended by Lister.
The aqueous solutions used in surgery are 1-20 and 1-40. The weaker is used for the operator’s hands, to cover instruments, as already mentioned, and to impregnate sponges. The stronger solution is used for the carbolic spray, to cleanse the unbroken skin about the site of operation, and to disinfect wounds. Either solution, when applied to an open wound, whitens the raw surface, coagulates the albumen, and causes considerable irritation, which subsides quickly and is followed by numbness.
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.