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Bichloride of Mercury is used for the disinfection of the hands and skin and for the irrigation of wounds. Biniodid of mercury is extensively employed and in the same strengths as the bichloride. It is, however, a more powerful germicide, while being less irritative, and neither forms a mercuric albuminate nor tarnishes metal instruments.

Carbolic Acid. This acid is derived from coal tar, and although known as early as 1834 as the first antiseptic recommended and used by Lister, is not so popular since the discovery that bichloride of mercury possesses more germicidal action.

Gangrene of the skin and subjacent tissues has often been traced to the long continued use of dilute solutions of carbolic acid or of ointments containing small quantities of the drug. Gangrene of the fingers and toes is by no means infrequent as a consequence of its use. Another condition frequently seen is the systemic poisoning through absorption. One of the first symptoms noticed from such absorption is irritation of the urinary tract and carboluria. This poisoning is more apt to take place when the weaker solutions are used than when the pure acid is used, as the destruction produced by the pure acid prevents its absorption.

The effect of carbolic acid upon the urine (See Chapter II, “Carbolic Acid”) is to cause it to become smoky a short time after it is voided. The urine shows a complete absence or diminution of the sulphates, and albumin is generally present. When these symptoms present themselves, the use of carbolic acid should be withdrawn, and the administration of sulphate of soda and atropin begun. If the condition has existed for any length of time and the patient is weak and exhausted, stimulants are indicated.

Lysol is a saponified phenol, and possesses some germicidal power. It is used in strengths of 1 to 3 per cent. solutions.

Creolin is mildly germicidal and is used a great deal in from 2 to 4 per cent. solutions.

Both lysol and creolin act very much like carbolic acid, but neither possess its irritating qualities.

Formaldehyde Gas is an active germicide and very valuable as a disinfectant. It is used in the shape of formalin which is a 4 per cent. solution of the gas in water. This agent is very irritating to the normal tissues in the stronger solution, but a 2 per cent. solution of formalin may be used for the sterilization of the hands, instruments, etc.

The formaldehyde fumes are employed for the disinfection of clothing, rooms, bedding, and also for the sterilization of catheters. The fumes of the gas are very irritating to the mucous membrane and when this agent is used for the disinfection of rooms, every crevice and crack must be tightly sealed to prevent the escape of the gas.

Iodoform. The action of iodoform is not due directly to its ability to destroy germs but to its undergoing decomposition in the presence of moisture, liberating iodin and thus rendering inert ptomains that have resulted from the growth.

Iodoform Powder is rapidly absorbed by the skin and fatal cases of iodoform poisoning have occurred from treating burns with it. Iodoform is also used in ointment form and in suppositories. As it is insoluble in water it is commonly used in a 10 per cent. emulsion. The gauze is also greatly used.

The symptoms of iodoform poisoning are: delirium; odor of iodoform on the breath; presence of iodoform in the urine; eruption over the skin, and finally, coma. Iodoform is also capable of producing a localized dermatitis, with great irritation, and must therefore be used with care on all delicate skins.

Aristol, a substitute for iodoform, is a compound of iodin and thymol, producing no toxic effects and having no disagreeable odor; it does not, however, possess the germicidal qualities of iodoform. Nosophen, iodol, and airol are among the more recent substitutes.

Iodin. This drug no doubt possesses more germicidal properties than was at one time supposed. It is probably the most powerful antipyogenic known. The 7 per cent. tincture is the one most frequently used.

Acetate of Aluminum, or more properly, aluminium, is prepared by adding five parts of sugar of lead to a solution of five parts of alum in 500 parts of distilled water. Burow’s solution, see page 35, is chiefly employed as a wet dressing.

Chloride of Zinc in a solution of 15 to 30 grains to the ounce, has marked antiseptic properties, but it blanches the tissues when applied to infected wounds.

Sulphocarbonate of Zinc is less irritating than the chloride of zinc and is of the same value as a germicide.

Peroxide of Hydrogen when used as a 15 volume mixture or diluted, seems to have a direct action upon pus generation by destroying microorganisms of the pus. It is frequently employed for sterilizing abscess cavities, and for hastening the separation of necrotic tissue.

This agent has also a marked hemostatic power and is used to some extent on this account in nose and throat work. Its hemostatic power is also observed in bone cavities. Care should be taken never to use it unless there is a free exit, as it increases rapidly in volume after coming in contact with dead tissue or pus, and serious accidents have happened from its improper use; for instance, if it is injected into an abdominal sinus where free escape is not provided for, the distention will result in ruptures of the sinus and infiltration of the surrounding tissues; possibly of the peritoneal cavity. The distention produced by it is also quite painful and therefore only a small quantity, or a much diluted solution should be introduced into cavities.

Boric Acid is not very actively antiseptic, but even in a saturated solution it is not irritating. Where bichloride or carbolic dressings have produced irritation of the skin, or burns, a boric acid ointment is a very satisfactory substitute.

Salicylic Acid is an antiseptic of value. It is generally used in the form of an ointment. It is but slightly soluble in water.

Potassium Permanganate by its rapid liberation of oxygen, acts as an antiseptic of proven merit for the disinfection of foul wounds and ulcers. It is also used satisfactorily for disinfecting the hands in preparation for operations, in the form of a 5 per cent. solution, any stain being removed later by a saturated solution of oxalic acid.

Alcohol possesses marked antiseptic properties and is one of the best agents for the sterilization of the hands of the surgeon, and for the skin of the patient. A 60 or 75 per cent. solution of alcohol is much more efficacious as a skin disinfectant than a 95 per cent. solution. This is because the purer alcohol is much less penetrating than the dilute. It is also used when diluted with water, one part to four, as a dressing for granulating wounds. It is efficacious in limiting the action of carbolic acid, when this agent has been applied in full strength.

It is a useful agent in which to store certain materials such as ligatures, sutures, etc.

Silver Nitrate possesses undoubted antiseptic properties, and solutions of varying strengths are decidedly antiseptic. These solutions are from 5 grains to the ounce, to 60 grains to the ounce.

The solid stick of nitrate of silver is used for destroying exuberant granulations. Among the different silver preparations on the market, protargol and argyrol are the best known. Both of these are extensively used in the treatment of inflammations of the mucous membranes.

The unguentum of Crede, is an ointment of silver which is used in cases of septic infection and also in localized inflammations. From 15 to 45 grains of silver can, in this form be rubbed into the skin. It is absorbed and undoubtedly exercises an antiseptic influence on the infecting microorganisms.

Saline Solution, or normal, or isotonic salt solution, as it is called because of its close approximation to the blood serum, consists of a solution of 7 per cent. of sodium chloride in plain sterilized water. Roughly speaking and for ordinary purposes, this solution can be made by adding an even teaspoonful of ordinary table salt to one pint of boiled water and then reboiling the mixture.

It can be stored for a limited time in sterile glass jars, which are sealed with sterile cotton. The jars can be heated to whatever temperature is required for use. This solution is the one which is generally used for irrigating wounds and cavities; it is non-irritating and possesses no antiseptic quality. When a moist dressing is desired there is no solution comparable to it, largely because of its non-irritating quality. It has at times a slight irritating effect upon the kidneys and when large quantities of it are used it is better to dilute it.

Pure Oxygen and Ozone have been used, and the latter is more effectual. It has been found that oxygen but slightly retards the growth of bacteria, but both ozone and oxygen produce a hyperemia, and retard the growth, especially of anaerobic organisms. Pure oxygen in the abdominal cavity produces a marked hyperemia and a leukocytosis. Ozone has been put to some practical use in this country but the results have not been sufficiently studied.

Sunlight has a marked retarding effect on some bacteria and actually destroys them. The anthrax spore is said to be killed very promptly by exposure to strong sunlight and it is claimed that the tubercule bacillus is slowly destroyed by it.

Electricity and the X-rays also produce a marked retarding effect on the propagation of certain microorganisms.