{"1": {"fulltext": "", "height": "4804", "width": "3156", "jp2-path": "asepsisorsurgica00roge_0001.jp2"}, "2": {"fulltext": "LIBRARY OF CONGRESS.\\nChap........ Copyright No,......_\\nShell_ _5l7\\nUNITED STATES OF AMERICA.\\n7^-t", "height": "4658", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0002.jp2"}, "3": {"fulltext": "", "height": "4777", "width": "3133", "jp2-path": "asepsisorsurgica00roge_0003.jp2"}, "4": {"fulltext": "", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0004.jp2"}, "5": {"fulltext": "ASEPSIS\\nOR\\nSurgical Cleanliness\\nA Manual for Physicians, Students and Nurses\\nBY\\nL. D. ROGERS, A. M., M. D,\\nPROFESSOR OF SURGERY IN THE NATIONAL\\nMEDICAE UNIVERSITY, CHICAGO.\\nCHICAGO\\nPEOPLES HEALTH JOURNAL CO.,\\n1900.\\n1", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0005.jp2"}, "6": {"fulltext": "TWO COPIES RECEIVE^\\nLibrary of c\u00c2\u00a9Bgre\u00c2\u00ab^\\nMAR 28 1900\\nKsgUfer of Copyrfghf^\\n1K\\n56663\\nCopyright 1900\\nBy L. D. ROGERS.\\nSECOND COPY,\\n\u00c2\u00ab3 o o", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0006.jp2"}, "7": {"fulltext": "PREFACE.\\nOne Sunday morning, some five years ago, a\\nbright, active, robust woman about thirty years\\nof age called on the writer and introduced herself\\nby saying in the most engaging manner: Pardon\\nme, Doctor, for disturbing you upon the Sabbath,\\nbut I have come to offer you my services. I am\\na medical stenographer. I see by your ad in\\nthis morning s Tribune that you are in need of\\nsuch a person.\\nA few moments conversation made it evident\\nthat she was a lady of rare intelligence and an\\nexpert nr her chosen field, being able to spell\\nreadily the most difficult medical terms and to\\nwrite them with the machine almost as rapidly as\\nthey could be spoken. Her references showed\\nthat she had done special work for many promi-\\nnent physicians and surgeons.", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0007.jp2"}, "8": {"fulltext": "IV PRE FA CE.\\nShe was subsequently engaged for the special\\npurpose of taking dictations for this book on\\nSurgical Cleanliness. To our encouragement and\\ndelight she entered upon her work with intelli-\\ngent enthusiasm and seemingly took as much\\npride in its proper and early completion as the\\nauthor himself.\\nHowever, before the manuscript was half com-\\nplete she surprised us one day by announcing, that\\nshe had an abdominal tumor and had already made\\narrangements to enter a hospital at once to un-\\ndergo an operation for its removal. Our sugges-\\ntion to postpone matters for further deliberation\\nwas rejected and we accepted her invitation to be\\npresent at the operation, as a spectator. An\\novarian cyst, the size of an orange, was removed.\\nOn the third day after the operation she had a\\nchill. Her temperature rose, and from that time\\nshe suffered horribly until the thirteenth day,\\nwhen she died. We were also present at the\\npost mortem examination, which revealed a quart\\nof pus in the abdominal cavity, and fully a pint\\nin each pleural cavity.\\nSuch a pronounced case of blood poisoning w r e\\nnever expect to witness again. Why did she have", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0008.jp2"}, "9": {"fulltext": "PREFACE. v\\nblood poisoning? Undoubtedly some one was not\\nsurgically clean during that operation. It may\\nhave been a nurse or an assistant or the operator\\nhimself. Possibly, the instruments or dressings\\nwere infected by the touch or the breath of an\\nunclean spectator. Perhaps the nurse who pre-\\npared the instruments and dressings, or the one\\nwhich prepared the field of operation, was not\\nconscientious in performing her work thoroughly.\\nSince the life of Lilian Bonner was thus sacrificed\\nby the lack of surgical cleanliness in an established\\nhospital under the hands of a reputable surgeon,\\nwe have not deemed it necessary to offer any\\napology for the publication of this book.\\nThis volume is the outgrowth of a lecture first\\ndelivered several years ago before the students of\\nthe National Medical University. It has since\\nbeen revised several times, and repeated to stu-\\ndents and nurses with a view of preparing them\\nto enter the operating room and be safe assistants.\\nFew things are more exasperating to a clean sur-\\ngeon than to have present during an operation\\nofficious persons who have no idea of surgical\\ncleanliness.\\nIf spectators possess even a theoretical know-\\nledge of the subject it is a great comfort to the", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0009.jp2"}, "10": {"fulltext": "VI PREFA CE.\\nsurgeon and an inmense advantage to the patient.\\nThey will know enough to keep out of the way of\\nthe operator, the assistants and the nurses. They\\nwill stand off at such a distance that they cannot\\nbreathe, spit or shake germ laden particles into the\\nwound. They will touch not, handle not any-\\nthing with unclean hands. They will also know,\\nthat in order to get the hands surgically clean it\\nrequires a good deal more than simply rinsing\\nthem off in a basin of water containing a few\\ndrops of some antiseptic. They will have learned,\\nthat the song of the surgically clean surgeon is\\nscrub! scrub! scrub! for ten minutes with the\\nscrub brush, scrub! soap and water!\\nI,. D. R.\\n441 Dearborn Ave., Chicago, March i, 1900.", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0010.jp2"}, "11": {"fulltext": "CHAPTER I.\\nIn the dirt under our finger nails, in the creases\\nand folds of the skin, upon the hair, in the secre-\\ntions from the nose, the mouth, the eyes, the ears,\\nand from all the other orifices of the body there\\nmay be found by the aid of the microscope, germs\\nwhich are capable of spoiling the best efforts of the\\nmost skillful surgeon.\\nThese germs are the cause of pus, the yellow,\\ncreamy, or dirty mattery discharge seen in boils,\\nabscesses and all unhealthy wounds. No genuine\\npus can occur without them. They are always\\npresent in pustules, in boils, in abscesses, in fel-\\nons, in carbuncles, in purulent inflammation, and\\nwherever there is suppuration or maturation.\\nNone of these affections can occur without them.\\nThey are the cause of every one of them. They\\nare always the cause of septicemia, pyeamia and\\nblood poisoning in general. Without these germs\\nit would be impossible to have a case of blood poi-\\nsoning or child-bed fever.\\n7", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0011.jp2"}, "12": {"fulltext": "8 SURGICAL CLEANLINESS.\\nThey are the surgeon s most dangerous enemy.\\nThey may transform the simplest operation into\\none of great gravity. They have often brought\\nabout a fatal result where it was least expected.\\nWe have recently Seen a young man whose left\\nknee was as stiff as though there had never been\\nany joint. A few years ago he accidentally ran a\\nsewing needle into it. Either by the needle or by\\nthe instrument of the doctor who searched for it\\npus germs were conveyed into the joint. An ab-\\nscess resulted which entirely destroyed the joint\\nand nearly the life of the boy.\\nThis case reminds me that some thirty years ago\\nwhen a small boy we were told that if the knee\\nwas injured so that the joint water escaped, it\\nwould always after that be stiff. Now, we know\\nthat the cavity of the knee joint, as well as that\\nof any other cavity of the body, may be opened\\nwith impunity, provided that pus germs do not\\ngain admittance.\\nFormerly, it was supposed that the formation of\\npus in a wound was a natural and necessary step\\nin the process of healing. Now the suppuration\\nof a wound is regarded as an unnatural, unneces-\\nsary and dangerous complication. Instead of facil-\\nitating healing it greatly retards.\\nHow the view of surgeons regarding pus has\\nchanged during the past quarter of a century is\\nwell illustrated by the following two incidents, the\\ntruthfulness of which we do not question.", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0012.jp2"}, "13": {"fulltext": "SURGICAL CLEANLINESS. 9\\nIt is related that in the year 1870 one morning\\nas the surgeon-in- chief of a large hospital was mak-\\ning his usual rounds of the surgical wards, he\\nsaid to the house surgeon\\nHow is that amputation case to-day?\\nDoing splendidly, was the reply, the wound\\nis suppurating beautifully.\\nThat s good, said the chief, and passed on\\nsmiling, evidently satisfied with the condition of\\nthe case.\\nThe second incident is said to have occurred in\\nthe year 1895, in the same ward of the same hos-\\npital, but the surgeons and the patient were differ-\\nent. The surgeon- in- chief one morning asked the\\nsame question that his predecessor had asked just\\ntwenty- five years before. The answer was\\nDoing badly, sir, the wound is suppurating.\\nThe exclamation of the chief upon hearing this\\nwas more emphatic than elegant. It was evident\\nthat he was disappointed and chagrined.\\nThe reason for it is easily understood when it is\\nknown that the modern surgeon very rightly con-\\nsiders it a positive disgrace to have pus occur in\\na w r ound of his own making. It is almost con-\\nclusive evidence that he or his assistants or his\\nnurses have been unclean from a surgical stand-\\npoint.\\nIn the light of modern surgical science, avoida-\\nble uncleanliness must be classed as criminal\\ncarelessness.", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0013.jp2"}, "14": {"fulltext": "io SURGICAL CLEANLINESS.\\nAn old soldier who lost a leg in the Civil war\\ntold us that a few days after his thigh was ampu-\\ntated the assistant surgeon ventured the opinion\\nthat the wound would heal by first intention, that\\nis, without suppuration. On hearing this the\\nsurgeon of the regiment ridiculed the young sur-\\ngeon unmercifully for entertaining for a moment\\nthe absurd idea that an amputation could heal\\nwithout suppuration. But bacteriology, that sci-\\nence which has practically grown up since 1882,\\nwhen Dr. Robert Koch discovered the bacillus of\\ntuberculosis, has taught us that any wound which\\nis kept free from pus germs, that is aseptic (sur-\\ngically clean), will heal without suppuration and\\neven without inflammation.\\nThe discovery of this single truth has caused\\nthe most astonishing reduction in the mortality of\\nsurgical cases. No other discovery in the whole\\nrealm of surgery, either ancient or modern, equals\\nin importance the simple fact which may be ex-\\npressed in a sentence of five words, namely\\nAseptic wounds heal without suppura-\\ntion.\\nA quarter of a century ago, before this golden\\ntruth was discovered, the most experienced and\\nskillful surgeons regarded the result of their oper-\\nations as a matter of chance. If their patients\\nescaped the scourges of surgery, namely suppur-\\nation, purulent edema, hospital gangrene, erysip-\\nelas and tetanus, it w r as considered rare good luck,", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0016.jp2"}, "15": {"fulltext": "SURGICAL CLEANLINESS. n\\nand in no way due to their knowledge or skill. In\\nthese days he knows that he will have no pus if\\nhe has been clean surgically.\\nAfter a bloody operation the surgeon had no more\\ncontrol over the outcome of it than the farmer has\\nover the mighty elements which develop or blast\\nthe crops he has planted.\\nIn pre-aseptic times the mortality from amputa-\\ntion reached sixty per cent. In Nussbaum s\\nclinic, at Munich, it is said that eighty per cent,\\nof all wounds were attacked with hospital gan-\\ngrene. Erysipelas was the rule rather than the\\nexception. It was the custom not to suture scalp\\nwounds because they always suppurated. Sutur-\\ning, by retaining the secretions, seemed to favor\\nthe development of erysipelas. During one year\\nin this clinic out of seventeen cases of amputation\\neleven died of pyaemia. It was a rare occurrence\\nto see a case of open or complicated fracture which\\nwas not attacked in a few days with septicaemia or\\none of its companion diseases and end fatally.\\nThe rule was, therefore, to amputate the limb\\nwhenever there was an open fracture, that is,\\none where the air communicated with the bone.\\nSince writing the foregoing we have visited the\\nhospitals of Munich. We did not see a single case\\nof blood poisoning of any kind. We noticed that\\nthe strictest surgical cleanliness was observed in\\nall operations. Before the days of antiseptics the\\nFrench hospitals showed a death rate of fifty-two", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0017.jp2"}, "16": {"fulltext": "12 SURGICAL CLEANLINESS.\\nand one-half per cent, after all major operations.\\nFrom 1850 to 185 1 there were treated in the\\nPennsylvania hospital at Philadelphia one hundred\\nand sixteen cases of compound fracture. Exclud-\\ning the cases in which amputation was performed,\\nthere were fifty-one deaths a mortality rate of\\nforty-four per cent.\\nDuring the same period in the New York hos-\\npitals, one hundred and twenty-six cases of com-\\npound or open fracture were treated. Excluding\\namputation cases, sixty-eight died a mortality\\nrate exceeding forty-eight per cent.\\nDuring the period from 1866 to 1876 there w T ere\\ntreated in the surgical clinics of Vienna and Zur-\\nich one hundred and eighty cases of open fracture.\\nExcluding amputation cases, the death rate w r as\\nforty-one per cent. At St. Petersburg one hun-\\ndred and six cases of open fracture resulted in a\\nmortality of sixty-eight per cent.\\nDuring the period from 1841 to 1861, in Guy s\\nhospital, London, there were fifty deaths out of\\ntwo hundred and eight cases treated- a mortality\\nrate of twenty- four per cent.\\nThe average mortality for these seven hundred\\nand thirty-six cases of open fracture, representing\\nall the great hospitals and surgeons in the world,\\nwas forty -five per cent.\\nUpon the introduction of antiseptic methods\\nthe mortality rate in open fractures dropped to\\nfour per cent.", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0018.jp2"}, "17": {"fulltext": "SURGICAL CLEANLINESS. 13\\nIn Volkmann s clinic, at Halle, the mortality\\nrate in open fractures was above forty per cent.\\nHis predecessors for a number of generations had\\nhad about the same result in such cases.\\nIn the years 1871 and 1872 the death rate was\\nso enormous from pyemia and erysipelas that this\\ndistinguished surgeon was on the point of closing\\nhis wards. Out of twelve cases of open fracture\\nunder his care all died. As a last resort, he began\\nthe use of the antiseptic methods then being intro-\\nduced by Sir Joseph L,ister. During the succeed-\\ning ten years, up to 1 88 1, he had one hundred\\nand thirty-five cases of open fractures and did not\\nlose one from blood poisoning. His mortality\\nrate in all cases dropped to six per cent.\\nIt was our privilege to see every case in the\\nwards of this most interesting of all German hos-\\npitals. We know that the death rate now is very\\nsmall.\\nLister observed, as had many surgeons before\\nhim, that simple fractures those in which the\\nskin was not broken were attended with but little\\nrisk to life, while Open fractures had a general\\nmortality rate, as we have already seen, of forty-\\nfive per cent.\\nHe reasoned that the atmosphere must contain\\nsome deleterious element which decomposed the\\nblood and rendered it a poisonous irritant, causing\\nsevere constitutional disturbances and frequently\\ndeath.", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0019.jp2"}, "18": {"fulltext": "14 SURGICAL CLEANLINESS.\\nIn an article in the London Lancet during Sep-\\ntember, 1867, he first published his theory of\\nantiseptics. Lister discovered no new principle.\\nHeuter had said twenty-five years before: No\\ngerm, no pus. As early as the year 1837,\\nSchawnn had demonstrated the connection be-\\ntween putrefaction and micro-organisms.\\nBut it was the precision and accuracy of Pas-\\nteur, a quarter of a century later, which convinced\\nthe scientific world of this truth and gave Lister\\nthe foundation upon which to build his system of\\nantiseptics.\\nLister attempted to keep the germs out of the\\nwounds by protective bandages and also to destroy\\nthem by a germicide.\\nOn account of its deodorizeng qualities he se-\\nlected carbolic acid. He washed and sprayed\\nwounds with a solution of this agent. Then\\nwrapped them in gauze impregnated with it and\\nover all he placed an air-tight dressing.\\nDuring the period from 1864 to 1866, inclusive,\\nLister operated at Glasgow. His mortality rate\\nfor all kinds of operations was nearly 46 per\\ncent. From 1867 to 1869 he employed his anti-\\nseptic methods to a limited extent and his mor-\\ntality rate sank to 15 per cent. From 1 871 to 1876\\ninclusive, after he had improved details, he treated\\n553 grave surgical cases with a death rate of\\nthirty-six hundredths of one per cent.\\nThus it is seen that his death rate before he", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0020.jp2"}, "19": {"fulltext": "SURGICAL CLEANLINESS. 15\\nemployed antiseptic methods was 127 times\\ngreater.\\nNotwithstanding this immense reduction in the\\nmortality rate obtained through L,isterism subse-\\nquent knowledge has shown that while the prin-\\nciple upon which he acted was entirely correct his\\ntechnique or method was imperfect.\\nHe inaugurated a new era in the surgical\\nworld, which has led to more advancement in\\nsurgery during the last twenty years than during\\nthe previous two thousand years.\\nNotwithstanding the unquestioned truth of his\\ntheory and superior results achieved by it, time\\nwas required for its introduction and adoption into\\nthe great surgical clinics and hospitals of the\\nworld.\\nAs late as 1876 the famous old surgeon Van\\nLangenbeck said to his students: A new method\\nhas been advanced by an English surgeon who\\npredicates the principle of wound treatment upon\\nthe destruction of organic germs w T hich he assumes\\nto be the cause of wound disturbances. The ex-\\ncellent results claimed by him are not in accord\\nwith what we obtain. Hence, I can hardly grasp\\ntheir perfection. Yet, notwithstanding my exper-\\nience, I feel it incumbent upon me to test them in\\npractice.\\nThe extent of the adoption of Iyisterism in the\\nUnited States may be estimated by recalling some\\nfacts connected with the treatment of the case of", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0021.jp2"}, "20": {"fulltext": "16 SURGICAL CLEANLINESS.\\nPresident Garfield. During the month of June,\\n1 88 1 he was shot in the back. We were recently\\ntold by one of the surgeons who attended him that\\nthey each inserted their fingers into the wound\\nwithout even taking the precaution to wash their\\nhands. In the light of surgical science of to-day,\\nit is easily understood why the lamented president\\nhad septicaemia, dying three months later of\\npyaemia a victim of ignorance. He is supposed\\nto have had the best surgical skill the nation could\\nafford at that time. At the present the poorest\\npauper who attends the free dispensary receives\\nbetter treatment than our president received only\\neighteen years ago.", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0022.jp2"}, "21": {"fulltext": "CHAPTER II.\\nWhile Pasteur had proved that putrefaction was\\ndue to germs and Lester had done much toward\\ndevising methods to successfully overcome their\\ndeleterious effects it remained for Koch to inaug-\\nurate a line of scientific investigation, beginning\\nwith the discovery of the bacillus of tuberculosis\\nin 1882 and reaching its climax in 1885 by the\\ndiscovery and complete identification of the more\\nimportant of the pUS germs.\\nUp to the present about twenty different germs\\nhave been identified which are capable of produc-\\ning pus. To all of these the term pyogenic is\\napplied, meaning pus producing.\\nThe yellow pus germ is the one of greatest im-\\nportance to the surgeon. Its scientific name is\\nstaphylococcus pyogenes aureus. The\\nword staphylo is derived from the Greek and\\nsignifies a bunch of grapes. COCCUS is also from\\nthe same source and originally meant a pill or ker-\\nnel. It is now applied to all germs having a glo-\\n17", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0023.jp2"}, "22": {"fulltext": "1 8 SURGICAL CLEANLINESS.\\nbular shape. The first part of the word pyo-\\ngenes means pus, the second part generating or\\nproducing. Aureus, of course, indicates golden\\nor j^ellow, and is used because this germ produces\\na yellow pus. This long name is applied therefore\\nto globular-shaped germs which are found in clus-\\nters resembling bunches of grapes, and which pro-\\nduce pus of a golden yellow. If a small particle\\nof yellow pus be implanted in sterilized gelatine\\nand kept at blood temperature for two or three\\ndays the gelatine will become liquified around and\\nabout the point of implantation of the pus, and a\\ngolden deposit appear. This yellow deposit and\\nthe liquefaction of the gelatine are two character-\\nistics which taken together distinguish this germ\\nfrom all others.\\nAnother way of ascertaining the presence of this\\ngerm is to implant upon the cut surface of a boiled\\npotato a minute quantity of material suspected of\\ncontaining the germ. Place it in a sterilized tea\\ncup or glass jar and cover tightly with a piece of\\nsterilized window glass so that no other germ can\\ncome in contact with the contents. If the yellow\\npus germ is present after two or three days, dur-\\ning which time the potato has been kept in a room\\nat blood temperature, the characteristic yellow\\ndeposit will be seen at the point of implantation,\\nand a marked softening of the substance of the\\npotato will be observed.\\nIf a small quantity of this yellow deposit from", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0024.jp2"}, "23": {"fulltext": "SURGICAL CLEANLINESS. 19\\neither the potato or gelatine be transplanted into\\na fresh wound upon a guinea pig or any other\\nsusceptible animal or human being, suppuration\\nwill occur, amounting in some cases to general\\nblood poisoning and even death.\\nGar re inoculated a small wound on the end of\\nhis ringer with a small quantity of pure culture of\\nthis germ. An ulcer formed around the margin\\nof the finger nail. From the pus thus formed he\\nmade cultures of the germ and then rubbed a con-\\nsiderable quantity upon the unbroken skin of his\\nleft forearm. A large carbuncle formed, sur-\\nrounded by daughter carbuncles, at the point of\\napplication of the culture. They ran the usual\\ncourse, requiring several weeks before healing was\\ncomplete. Seventeen scars were left to bear testi-\\nmony to the success of the experiment.\\nIf such results follow the simple rubbing of the\\ngerm into the unbroken skin what must be expec-\\nted when it is conveyed directly into a wound by\\ndirty fingers or dirty instruments\\nThe Staphylococcus pyogenes aureus,\\nthe yellow pus germ, is found in greatest abun-\\ndance upon the skin and mucous membranes.\\nParticularly where the skin lies in folds and is\\nmoist, as for instance, the arm pits and the groins.\\nIt may be found at all the orifices of the body and\\nin all of the secretions. It may be found upon\\nsoiled clothing, unwashed instruments, in dust\\nupon the furniture and upon the floor or walls.", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0025.jp2"}, "24": {"fulltext": "20 SURGICAL CLEANLINESS.\\nIt is sometimes found in water and occasionally in\\nthe air.\\nA single yellow pus germ is seven-tenths of a\\nmikron in diameter. It would take 40,000 of\\nthem placed in a line to measure one inch. A\\nthousand of them could be packed wdthin a red\\ncorpuscle.\\nThe yellow pus germ has been found not only\\nin furuncles or carbuncles, but in pustular affec-\\ntions of the skin and mucous membranes, namely:\\nimpetigo, sycosis, phlytenular conjuntivitis, pur-\\nulent conjuntivitis, acute abscesses of the lympha-\\ntic glands, salivary glands, tonsils and mammary\\nglands, and in metastatic abscesses and purulent\\ncollections of joints, in acute suppurative osteo-\\nmyelitis and suppurative endo-carditis.\\nAfter the discovery and identification of this\\npus germ the intensely practical question arose as\\nto w T hat w r ould destroy it or neutralize its deadly\\nravages.\\nNumerous experiments have been made with it\\nas w y ell as with all the other important pathogenic\\ngerms to determine the thermal death point.\\nIt has been found that an exposure of 10 minutes\\nin water at a temperature of 143.6 Fahrenheit w 7 ill\\ncompletely kill the staphyloccocus pyogenes\\naureus. Boiling water (212 degrees Fahrenheit)\\nis therefore more than sufficient to destroy it. It\\nbecomes then an easy matter to disinfect and make\\nsurgically clean any instrument or article w r hich", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0026.jp2"}, "25": {"fulltext": "SURGICAL CLEANLINESS. 21\\ncan be boiled, but the great problem is how to\\nrender the skin and catgut or other aninaml sub-\\nstance free from these germs.\\nA one per cent, solution of carbolic acid will de-\\nstroy the germ in two hours.\\nA solution of bi-chloride of mercury of one to\\none thousand per cent, will kill the germs within\\neight seconds.\\nThe bin-iodide of mercury has twice the anti-\\nseptic power of the bi-chloride of mercury.\\nThus far we have described only the staphylo-\\ncoccus pyogenes aureus, the most common and the\\nmost important of all the pus producing germs.\\nBefore discussing antiseptics in detail we shall\\nenumerate and describe other germs against which\\nthe surgeon has to contend.\\nThere are several varieties of the staphylococcus\\npyogenes. We have fully described one, the\\naureus. The albus is another. It is found\\nchiefly upon the skin. In every respect, except\\nin color, it closely resembles the aureus the sur-\\nface cultures upon nutrient agar or potato have a\\nmilk-white color. It lacks the golden hue so\\ncharacteristic of the aureus. Hence its name,\\nalbus, which implies white. It is less virulent\\nthan the aureus.\\nFor the purpose of testing the comparative\\npathogenic properties of the yellow and white pus\\ngerms, an instrument infected with the yellow\\nwas stuck through the cornea of the eye. Pan-", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0027.jp2"}, "26": {"fulltext": "22 SURGICAL CLEANLINESS.\\nof the eye developed within thirty hours. When\\nthe instrument was infected with the white pus\\ngerms, the panophthalmitis did not develop until\\nsixty or seventy-two hours had elapsed.\\nWhen the instrument was inserted in a through-\\nly sterilized condition, that is entirely free from\\nall germs, no inflammation of the eye followed.\\nThe wound readily healed without causing any\\ntrouble whatever.\\nA bacteriological examination of nineteen cases\\nof panophthalmitis demonstrated the white staphy-\\nlococcus in ten and the yellow in nine.\\nThere is a variety of the white pus germs,\\nnamed by Welch, staphylococcus epidermis albus.\\nIt is regarded as a regular inhabitant of the nor-\\nmal skin, just as the bacillus coli communis is of\\nthe intestinal canal.\\nIt liquifies gelatine and coagulates milk more\\nslowly than the ordinary pus germ. A peculiarity\\nof this geim is that it is very often found in layers\\nof the epidermis deeper than can be reached by\\nany known means of cutaneous disinfection. After\\nsterilization of the surface of the skin so that\\nscrapings develop no germs, the presence of this\\ngerm may be demonstrated in a piece of the skin,\\nor on a suture which has passed through the en-\\ntire thickness of the skm. This skin coccus may\\noften be found in wounds without causing suppur-\\nation.\\nIt is likely, however, to cause suppuration if", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0028.jp2"}, "27": {"fulltext": "SURGICAL CLEANLINESS. 23\\nthere is any foreign substance in the wound. It\\nis therefore, a common cause of stitch abscesses.\\nIt is likely to follow down drainage tubes and\\ncause suppuration. This explains how stitch ab-\\nscesses may sometimes occur after an operation\\nwhich has been performed under perfectly aseptic\\nprecautions.\\nLockwood, of London, has described a diplo-\\ncoccus epidermis albus which closely resembles the\\nordinary white pus germ. It produces a peculiar\\nodor as it grows, such as is smelled when unclean-\\nly persons remove their chothing.\\nIncidentally, w r e would call attention to the fact\\nthat the bacillus prodigiosus produces a deep red\\ndeposit and this, perhaps, accounts for the blood-\\nred stains seen in the clothing about the armpits\\nof some persons.\\nThe streptococcus pyogenes is next in im-\\nportance to the staphylococcus pyogenes aureus.\\nIt is supposed to be identical with the erysipelas\\ngerm, known as the streptococcus of erysipelas.\\nThis germ is found in chains and not in grape-like\\nbunches, as is the staphylococcus. The word\\nStrep to refers to a chain. Hence the term strep-\\ntococcus pyogenes refers to pus-producing, globu-\\nlar germs so arranged as to give a chain-like\\nappearance. It is frequently spoken of as the\\nchain coccus. Usually five to ten of these germs\\nare seen in a string. This arrangement facilitates\\nthe passage of a group of them through lymphatic", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0029.jp2"}, "28": {"fulltext": "24 SURGICAL CLEANLINESS.\\nvessels more readily than the bunched arrange-\\nment of the staphylococcus. Probabty this ac-\\ncounts for the fact that we more often find the\\nlatter in circumscribed, localized suppuration and\\nthe former in diffused suppuration, as lymphangi-\\ntis, cellulitis, and erysipelatoid inflammations.\\nThe spreading nature of erysipelas may be ex-\\nplained by the proneness of this germ to insinuate\\nitself along the lymphatics. It also explains the\\nred streaks which may often be seen extending up\\nan arm or leg after an infected wound of the hand\\nor foot. In the lymphatics the streptococcus py-\\nogenes causes lymphangitis, and when it reaches\\na lymphatic gland it sets up a suppurative adenitis.\\nThis again explains the enlarged and sore glands\\nthat may be felt when an infection at an extrem-\\nis traveling toward the trunk.\\nThe streptococcus pyogenes causes acute sup-\\npuration almost as frequently as the staphylococcus\\npyogenes aureus. Out of thirty-nine cases of\\nacute pus formation it was found to be the sole\\ncause in fifteen of them and in five of the remain-\\ning cases it w r as found associated with the staphy-\\nlococcus.\\nIt is found almost invariably associated w T ith\\npuerperal or child-bed fever. This fact explains\\nthe observation made long before the days of bac-\\nteriology, namely if a physician went from a\\ncase of erysipelas to a confinement case the wo-\\nwas almost certain to have child-bed fever. This", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0030.jp2"}, "29": {"fulltext": "SURGICAL CLEANLINESS. 25\\nwas such a common result that conscientious phy-\\nsicians in former times would not attend an obstet-\\nrical case at the same time they were visiting a\\ncase of erysipelas.\\nSince physicians have learned how to disinfect\\nthemselves of all pyogenic germs they may now\\nattend at the same time, without jeopardizing the\\nlire of the woman, a case of erysipelas and one of\\nobstetrics provided, of course, that they disinfect\\nthoroughly.\\nIn former times it was noticed that if a physi-\\ncian had one case of child-bed fever he generally\\nhad several in succession. It was a co union oc-\\ncurrence for some certain physician to have so\\nmany cases of puerperal fever that he would be\\ncompelled to give up obstetric practice for months.\\nWhile visiting near Ogden, Utah, in 1894, w T e\\nheard of a country doctor who had lost nine wo-\\nmen from child-bed fever in rapid succession.\\nPopular indignation became so great that he w r as\\ncompelled to abandon obstetric practice entirely.\\nIt was very evident that he did not understand\\nsurgical cleanliness.\\nIt should be remembered that the streptococcus\\npyogenes is a widely distributed micro-organism.\\nIt may be found in almost as many different places\\nas the stapnylococcus. A favorite abode, how-\\never, is upon the mucous membrane at all the\\norifices of the body, even in cases of apparently\\nhealthy persons. Its presence in the vagina wall", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0031.jp2"}, "30": {"fulltext": "26 SURGICAL CLEANLINESS.\\nexplain why it is commonly, if not always present\\nin child-bed fever.\\nIts presence in the mouth will account for some\\nof the cases of blood poisoning following a bite by\\na human being.\\nHow the presence of this germ in the nasal se-\\ncretions may be the source of serious infection is\\nillustrated by the experience of a Philadelphia\\nphysician many years ago. No matter what pre-\\ncautions he took his obstetrical cases usually de-\\nveloped child-bed fever. He had forty-five cases\\nin one year. Other physicians in the same neigh-\\nborhood, who took far less precaution than he,\\nhad little trouble of this kind.\\nIt is related that in order to rid himself of the\\nmysterious influence which seemed to attend upon\\nhis practice he left the city for ten days, and be-\\nfore waiting on the next parturient case he had\\nhis hair shaved off and put on a wig, took a hot\\nbath and changed every particle of his apparel,\\ntaking nothing with him that to his knowledge he\\nhad worn or carried on any former occasion. Mark\\nthe result. The lady, notwithstanding that she\\nhad an easy parturition, was seized the next day\\nwith child-bed fever and died on the eleventh day\\nafter the birth of the child. Two years later he\\nmade another attempt at purification and the next\\ncase fell a victim to the same disease. An ex-\\nhaustive investigation developed the fact that the\\nunfortunate doctor was afflicted with a persistent,", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0032.jp2"}, "31": {"fulltext": "SURGICAL CLEANLINESS. 27\\npurulent nasal catarrh which doubtless, kept his\\nhands infected. The benefits which the practice\\nof obstetrics have derived from bacteriology ex-\\nceed the most extravagant estimates.\\nBuchanan, in his valuable little book entitled,\\nAntisepsis and Antiseptics, says that about\\nthirty years ago the mortality in lying-in hospitals\\nwas so great that the International Congress of\\nPhysicians and Surgeons, at its session in Brus-\\nsels recommended the abolishing of such institu-\\ntions.\\nObservations in Europe and America, extend-\\ning over a long period of time, confirm the fact\\nthat wherever a large number of lying-in women\\nwere congregated puerperal septicemia prevailed,\\nand the death rate was appalling.\\nIn the years 1760, 1768 and 1770, the disease\\nprevailed to such an extent in London that in\\nsome of the maternity hospitals nearly all of the\\npatients died. In the Royal Infirmary at Edin-\\nburg, in the year 1773, almost every woman as\\nsoon as she was delivered, or perhaps twenty- four\\nhours after, was seized with it and all of them\\ndied.\\nIn the Maison d Accouchments at Paris dur-\\ning several years the death rate was so high that\\nof every three women who entered the institution\\none died.\\nIn the hospitals at Vienna in 1823 nineteen per\\ncent, of the cases died in 1842 sixteen per cent.", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0033.jp2"}, "32": {"fulltext": "28 SURGICAL CLEANLINESS.\\nIn the lying-in hospital at Berlin in 1862\\nhardly a single patient escaped death from child-\\nbed fever. As a result of this terrible mortality\\nthe institution was closed.\\nNow, conditions are reversed. A woman runs\\nless risk of incurring child-bed fever in a well-\\nregulated lying-in hospital than she does at home.\\nNow, in many of the large lying-in hospitals,\\nthe death rate from puerperal fever is about one-\\ntenth of one per cent., or one in a thousand.\\nMaster Smiley, the chief medical officer of\\nthe Rotunda Hospital at Dublin, within whose\\nwalls 220,000 women have been delivered within\\nthe past 145 years, told us during our recent visit\\nto the famous institution that they scarcely knew\\nwhat child-bed fever was.\\nDr. Griffith, attending physician at the Queen\\nCharlotte Lying-in Hospital, London, where about\\n1,200 women are confined annually, told us that\\nfor several years they had had no deaths from\\nchild-bed fever.\\nIn the New York Maternity Hospital, from\\n1875 to 1883 inclusive, 3,504 women were con-\\nfined. Of this number 146 died from puerperal\\nfever. Beginning with the year 1884, antiseptic\\nmethods were emplo3 r ed. From that time until\\n1891 inclusive, 3, 170 women were delivered with\\nonly seven deaths from child-bed fever.\\nSince the era of antiseptic and aseptic methods,\\nMerman, of Manheim, reports 700 deliveries in", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0034.jp2"}, "33": {"fulltext": "SURGICAL CLEANLINESS. 29\\nsuccession before a death occurred, and Braum, of\\nVienna, reports two deaths in 1,004 cases.\\nThe latest researches indicate conclusively that\\nthe streptococcus pyogenes is the usual cause of\\nchild-bed fever. In 81 cases of puerperal fever\\nthis was found in the discharges from 35 of them,\\nwhile an examination of the discharges of 57 wo-\\nmen who were free from puerperal fever during\\nconfinement did not reveal this germ in a single\\ninstance. In ten fatal cases of child-bed fever\\nthe streptococcus in every case was found in the\\ndischarges during life and in the organs after\\ndeath.\\nThe streptococcus is more easily destroyed than\\nthe staphylococcus. The former is destroyed in\\nten minutes at a temperature of 130 while the\\nthermal death point of the latter is 144 The\\nstreptococcus is killed within eight seconds in a\\nthree per cent solution of carbolic acid.\\nIn the mouth beside the streptococcus already\\ndescribed more than one hundred different germs\\nhave been identified. The decay of the teeth is\\ncaused no doubt by certain germs. Most of the\\ngerms found in the mouth are harmless, and may\\neven serve a useful function.\\nOne of the most important germs commonly\\nfound in the mouth is the pneumocOCCUS the\\npneumonia germ. It is often found in the saliva\\nof an apparently health} person. The virulency\\nof this germ varies in different persons; and it also", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0035.jp2"}, "34": {"fulltext": "30 SURGICAL CLEANLINESS\\nvaries in the same person at different times. Sa-\\nliva containing the pneumococcus injected into\\nsusceptible animals mice, rabbits and guinea pigs\\nwill kill them at one time, while at another it\\nmay not. This fact demonstrates the marked\\nvariability in the degree of virulence of this germ.\\nNext to the staphylococci and streptococci, it is\\nthe most common cause of inflammation. It is\\nbelieved to be the sole specific cause of acute lobar\\npneumonia, and very often the cause of broncho-\\npneumonia, abscess of the ear and meningitis.\\nThe list of diseases which it is capable of produc-\\ning is very long. It may cause inflammation any-\\nwhere in mucous or serous membrane. It can\\ncause an abscess in any part of the body. It is\\nthe most frequent cause of pus in the pleural cav-\\nity, that is, pleural empyemia. This germ is de-\\nstroyed in ten minutes in water at a temperature\\nof 126 Farhenheit. It may live four months in\\ndried blood or sputum. While it may cause the\\ngravest diseases, it is generally a benign organism\\nin comparison with the streptococcus.\\nBacillus coli communis is the name of a\\ngerm that is a constant inhabitant of the intestine.\\nIt is also found widely distributed outside of the\\nbody. It is an important factor in inflammation\\nof the urinary tract and the ducts of the liver. It\\nis found as a rule in appendicitis and peritonitis,\\nbut in these conditions it is often associated with\\nother germs. It may be found in inflammations", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0036.jp2"}, "35": {"fulltext": "SURGICAL CLEANLINESS 3\\nin any organ of the body. One of its pecularities\\nis to invade tissue already occupied by other bac-\\nteria or previously damaged. An idea recently\\nadvanced accounting for appendicitis in bicycle\\nriders is that the appendix by the violent contrac-\\ntion of the psoas muscle, causes a fertile soil for\\nthis germ to develop appendicitis.\\nThe gonococctlS, discovered by Neisser dur-\\ning 1879 in gonorrhoeal pus, has been proven to\\nbe the specific cause of gonorrhoea. But it was\\nnot until 1885 that it was made to grow outside of\\nthe human body. Bumm first cultivated it in\\nhuman blood serum. The germ is found in pairs\\nof biscuit-shaped bodies, with the flattened sides\\nagainst each other. The peculiar feature of this\\ngerm is that it is often found included within the\\nwhite blood corpuscle cell. It is strictly a human\\nparasite. Pure cultures of it implanted in the\\nhealthy human urethra will invariably be followed\\nby a genuine attack of gonorrhoea.\\nThis germ grows readily upon the conjunctiva,\\nthe mucous membrane lining the eye and covering\\nthe front of the eyeball. The inflammation caused\\nby it in this situation is called gonorrhoeal oph-\\nthalmia, and may be so severe as to cause destruc-\\ntion of the eye. New-born infants sometimes\\nhave their eyes infected from their mother, the\\ngonorrhoeal discharge from the mother coming in\\ncontact with the infant s eyes at birth. Again,\\nnurses caring for infants with gonorrhoeal oph-", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0037.jp2"}, "36": {"fulltext": "32 SURGICAL CLEANLINESS\\nthalmia have conveyed the germs to their own\\neyes through lack of disinfecting their hands after\\ntreating the child s eyes. Patients with gonor-\\nrhoea have conveyed the disease to their own eyes\\nWith their infected hands. The germs live but a\\nvery short time outside of the human body, so\\nthat the disease is not often, if ever, conveyed\\nthrough some inanimate object, such as the seat\\nof a water closet.\\nwe recall two cases we have had under our care\\nof little girls, not to exceed five years of age, who\\ncontracted the disease while sleeping with their\\ninfected mothers.\\nThis germ may cause salpingitis, pyosalpinx and\\novarian abscess, also peritonitis. It may even\\ncause inflammation of the joints, and of the cover-\\ning of the heart. The fact that this germ can\\ncause gonorrhoeal rheumatism has been demon-\\nstrated as follows The contents of the affected\\njoint have been examined the gonococcus found\\nto be the only germ present cultures from the\\ncontents of the joint have been made and the pro-\\nduct injected into the healthy urethra, resulting\\nin a genuine case of gonorrhoea. The so-called\\ngonorrhoeal rheumatism is differentiated from the\\ntrue by the simple fact that it affects but one joint\\nwhile the latter affects several in succession.\\nThis germ imbeds itself in the epithelial cells so\\nthat it cannot always be reached by disinfectants.\\nThe germ may lie dormant a long time and lead", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0038.jp2"}, "37": {"fulltext": "SURGICAL CLEANLINESS. 33\\nthe individual to believe that he is cured. But\\nany undue congestion to the sexual organs causes\\na reappearance of the disease. It is a common\\noccurrence for a man who supposes himself cured\\nof the disease to marry an innocent, healthy wo-\\nman, who soon after marriage is attacked with\\ngonorrhoea in the most violent form. The disease\\nin her may end in an ovarian abscess, or an inflam-\\nmation of the fallopian tubes causing sterility.\\nStill graver trouble may occur. A peritonitis may\\nbe set up, causing her death, or a condition be\\nbrought about necessitating an operation for the\\nremoval of her ovaries, or womb, or all of her sex-\\nual organs.\\nThe bacillus of typhoid has been recently\\ndiscovered to have some pyogenic properties.\\nSuppuration of bone following an attack of typhoid\\nfever is often caused by this germ alone. The\\nusual habitat of the typhoid germ is in the intes-\\ntines, or rather some of the mesenteric glands. It\\nis worth while to incidentally note that there is a\\nchemical difference between it and the bacillus\\ncoli communis, another inhabitant of the intestines\\nalready described. Cultures of the latter turn\\nblue litmus paper red, showing acid reaction,\\nwhile the typhoid germ does not.\\nSpeaking of typhoid germs reminds us of the\\ndiscovery by which typhoid can be diagnosed from\\na drop of blood.\\nFrom the patient a few drops of blood are se-", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0039.jp2"}, "38": {"fulltext": "34 SURGICAL CLEANLINESS.\\ncured by pricking the finger with a needle and\\nthen smearing a drop or two upon a piece of clean\\nglass a bit of window glass will do upon which\\nit is allowed to dry. The piece of glass is then\\nsent to a bacteriological laboratory, where they\\nhave pure cultures of typhoid germs. The live\\ntyphoid germs are in constant motion, which is\\nvery striking when seen under the microscope.\\nNow, if the dried blood on the glass be moist-\\nened with a few drops of pure water, and the so-\\nlution thus formed be poured into a live culture of\\ntyphoid germs the characteristic motion of the\\ngerms will stop almost instantly if the person from\\nwhom the blood was taken has typhoid.\\nThis recent discovery has been tested and found\\ngenerally reliable. Thus, another triumph for\\nbacteriology, the youngest of the medical sciences,\\nis added.\\nIt will be of invaluable service in making an\\nearly diagnosis of typhoid and in differentiating\\ntyphoid from other diseases which in their earlier\\nstages may be confounded with it.\\nThe typhoid germ reaches the intestines through\\nthe mouth, being usually taken into the stomach\\nwith the food or drink. Impure drinking water\\nis the most common source of typhoid. When-\\never an epidemic of typhoid occurs in any locality\\nwe may at once safely assume that the water or\\nmilk supply is contaminated.\\nBoiling the water and the milk is the most ef-", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0040.jp2"}, "39": {"fulltext": "SURGICAL CLEANLINESS. 35\\nfective means of preventing the disease. When a\\ncase of typhoid occurs in a family it is not unusual\\nfor the nurse and other members of the family to\\ntake the disease. From this fact it has been sup-\\nposed that the germs of the disease might be car-\\nried in the atmosphere. This may be true, but\\nwe are inclined to attribute it to the use of the\\nsame infected drinking water, milk or food, possi-\\nbly from eating from the same dishes or drinking\\nfrom the same glass used by the patient.\\nWe have no doubt that a careless, ignorant dish-\\nwasher may wash the dishes so slovenly and in\\nwater insufficiently hot to destroy the germs, It\\nrequires water at a temperature of 133 degrees\\nFahrenheit for ten minutes to destroy or kill ty-\\nphoid germs.\\nThe typhoid germ is one of the most difficult of\\ndisease germs to destroy. Some of the most\\npowerful antiseptics will prove ineffective when\\nadded to the intestinal discharges from the typhoid\\nfever patient. It is generally conceded that chlo-\\nride of lime is the most practical, and should be\\nplaced in the vessel before and after receiving the\\ndischarges.\\nToo much care cannot be taken in thoroughly\\ndisinfecting all discharges from the typhoid fever\\npatient at once. All soiled clothing and cloths\\nshould be burned or immersed in boiling water.\\nThe bacillus of tuberculosis, the germ of\\nconsumption, more often concerns the surgeon", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0041.jp2"}, "40": {"fulltext": "36 SURGICAL CLEANLINESS.\\nthan that of typhoid. It is estimated that one-\\nfourth of all chronic surgical cases are tubercular.\\nOf the seventy hospitals we visited during our re-\\ncent trip abroad, we do not remember visiting a\\nsingle general hospital in which we did not see\\nseveral tubercular cases.\\nAs stated in the first chapter, the consumptive\\ngerm was discovered by Dr. Koch in 1882. Its\\nlength is about one-half the diameter of a red blood\\ncorpuscle. It requires boiling water to kill them,\\nwhile the most resistant pyogenic germ, the staph-\\nylococcus, is destroyed at a temperature of 144\\ndegrees Fahrenheit. On the other hand, the for-\\nmer is destroyed by a three per cent, solution of\\ncarbolic acid, while the latter requires five per\\ncent.\\nIt may be said without a very great deviation\\nfrom the truth that the consumptive germ is omni-\\npresent. This certainly is true in all our large\\ncities and in certain districts, while in some of the\\nhigher regions of this and other countries it is ab-\\nsent unless transported there by human beings.\\nWhile the typhoid germ has never been known\\nto affect animals, especially cattle, tuberculosis\\nmay be conveyed to human beings by using milk\\nfrom a tuberculous cow.\\nNo doubt tuberculosis is most commonly dis-\\nseminated by the expectorating of consump-\\ntives upon floors and sidewalks, where the sputa\\ndries and is ground up into dust and blown every-", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0042.jp2"}, "41": {"fulltext": "SURGICAL CLEANLINESS 37\\nwhere to be breathed in by susceptible persons,\\nwho sooner or later develop consumption of the\\nlungs or tuberculosis of some gland, joint or bone.\\nA number of cities have already passed ordinances\\nw r hich prohibit expectoration upon the sidewalks\\nand in public buildings and conveyances.\\nThe question of quarantining consumptives is\\nbeing agitated by the boards of health of some of\\nthe western states. In fact, California has al-\\nready taken steps to prevent consumptives enter-\\ning the state.\\nIt should be remembered that what was formerly\\ncalled Scrofula, white swelling, hip joint disease\\nand Potts disease of the spine, are only other\\nnames for that disease, which wdien it attacks\\nthe lungs we call consumption or pulmonary\\ntuberculosis. The same germ causes all of these\\nconditions to which in the past different names\\nwere given. Bone, joint and glandular tuber-\\nculosis come within the domain of the surgeon.\\nUnder no other circumstances is surgical cleanli-\\nness more necessary than when operating upon\\nany part affected with tuberculosis. If absolute\\nsurgical cleanliness is not secured during the ope-\\nration and maintained after it, the wound is not\\nlikely to heal. In no other place do pyogenic\\ngerms flourish so readily as in tissues affected\\nwith tuberculosis. Iodoform restrains the growth\\nof tubercular germs as well, if not better, than\\nany other agent.", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0043.jp2"}, "42": {"fulltext": "CHAPTER III.\\nSTERILISING.\\nThus far we have explained the importance of\\nSurgical Cleanliness and showed the relation be-\\ntween certain germs and certain diseases. We\\nhave also indicated what constitutes Surgical\\nCleanliness and made a few suggestions as to\\nsecuring it. We shall now enter into the\\ndetails.\\nWe have already stated that no germ of disease\\ncan survive contact with boiling water. This is\\nabsolutely true in case of all pus forming germs,\\nbut it is not quite true in the case of spore\\nforming germs. Boiling water will destroy the\\nadult germs, but the spores will sometimes survive\\neven boiling water. This is true of the germs of\\ntuberculosis. In order to kill the Spores and to\\nrender water absolutely sterile, it is necessary to\\nboil the water three times on different days. On\\nthe first day the water is raised to the boiling\\n38", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0044.jp2"}, "43": {"fulltext": "SURGICAL CLEANLINESS. 39\\npoint for half an hour and then allowed to stand\\nin a warm room, which gives the spores an oppor-\\ntunity to develop into adult germs. On the second\\nday the water is boiled again and allowed to stand\\nin a warm place. On the third day the process of\\nboiling is repeated for the purpose of destroying\\nany spores or germs that may have survived the\\nsecond boiling.\\nWater thus treated is spoken of as thrice\\nboiled and may be considered absolutely Sterile.\\nAfter water is rendered sterile by the three\\nboilings great care must be taken to keep it\\nsterile by putting it into closed vessels, which\\nhave been previously sterilized. Every operating\\nroom should have two or three large vessels full of\\nsterilized water. A tin wash boiler with a tight\\nfitting cover will answer for a vessel, although\\nlarge glass jars with ground glass covers are now\\nmade for the purpose.\\nAfter the hands have been thoroughly sterilized\\nwith chemicals, sterilized water may be used to\\ncleanse them from the chemicals. Again, the\\nsterilized water may be used to wash off the\\nchemicals from the field of operation. The\\ngreatest use for sterilized water is in washing an\\naseptic wound. One in which there are no poison-\\nous element, but needs to be washed out for the\\npurpose of clearing away the blood, so that the\\noperator may inspect it thoroughly. However\\nsponging the blood aw 7 ay with pieces of sterile", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0045.jp2"}, "44": {"fulltext": "40 SURGICAL CLEANLINESS\\ngauze is more popular now than irrigating with\\nsterile water. During the operation the surgeon\\nhas often occasion to wash off the blood from his\\nhands. Here again the sterilized w 7 ater should\\nbe used, provided the hands have not become\\ninfected by touching something not surgically\\nclean. In case they have become surgically\\nunclean he must go through the usual process\\nof sterilizing his hands, finally washing them\\nin sterilized water.\\nThis naturally brings us to the question, how\\ncan the hands be Sterilised? If we could immerse\\nthem in boiling water and keep them there ten\\nminutes, it would be a simple matter. This being\\nphysically impractical we must consider other\\nmeans. Two or three different methods of ster-\\nilizing the hands are in vogue. The most com-\\nmon one is as follows:\\nScrub the hands with soap and very warm water\\nfor five minutes. The scrubbing should be done\\nthoroughly with a good brush, green soap or old-\\nfashioned lye soap, such as our grandmothers used\\nto make, is the best. Next, the hands should be\\nwashed with ether, for the purpose of dissolving any\\nparticles of fat or grease that may remain. The\\nfinger nails should be thoroughly cleansed while\\nscrubbing with the soap and water. Next, the\\nhand should be immersed for a minute or two in\\na solution of bi-cloride of mercury in the propor-\\ntion of one to one- thousand, after which the hands", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0046.jp2"}, "45": {"fulltext": "SURGICAL CLEANLINESS. 4 1\\nmay be rinsed in sterilized water, for the purpose\\nof washing off the extra amount of the chemicals.\\nThe laboratory tests show that bi-chloride of mer-\\ncury is the most powerful antiseptic agent known;\\nyet two facts regarding it should be kept in mind.\\nIt will not penetrate grease or fat; and that this\\nchemical does not distribute equally over the sur-\\nface. In some places there w T ill be a collection of\\nthe chemical, while in others there will be none.\\nEther must be used to remove the fat and grease\\nbefore it is practical to use the bi-chloride. The\\nsecond objection may be overcome by immersing\\nthe hand just before using the bi-chloride in a\\nsolution of ammonia and borax. This will cause\\nthe bi-chloride to be equally distributed over the\\nsurface of the skin. A common salt solution will\\ndo the same.\\nAnother method which is very common and\\nmuch more practical, is to scrub the hands with\\nsoap and water thoroughly for five minutes and\\nthen immerse them in a five per cent solution of\\ncarbolic acid A solution of this strength of car-\\nbolic acid gives an unpleasant biting sensation\\nand may be followed by dizziness. While carbolic\\nacid is far less powerful as an antiseptic than bi-\\nchloride of mercury, it is far more practical, be-\\ncause it readily penetrates fatty substances and\\nuniformly distributes itself over the surface of the\\nskin. Carbolic acid was the first surgical anti-\\nseptic employed by leister. The laboratory test", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0047.jp2"}, "46": {"fulltext": "42 SURGICAL CLEANLINESS\\nby Koch showed bi-chloride of mercury so much\\nmore powerful than carbolic acid that surgeons\\nfor a w 7 hile showed a preference for the bi-chloride.\\nLater the two objections to the bi-chloride which\\nwe have mentioned w r ere discovered; besides an-\\nother, namely, its poisonous effect upon the\\nwound. Cases of general poisoning have re-\\nsulted from its use; besides death to some of the\\ntissues of the wound. Recently carbolic acid has\\nbeen more in favor; it is also open to the same\\nobjection of sometimes causing destruction of\\ntissues and general poisoning. A New York\\nsurgeon states that he has been obliged to am-\\nputate several fingers, which w 7 ere in the beginn-\\ning slightly injured but dressed w T ith too strong a\\nsolution of carbolic acid. The excessively strong\\nsolution of the carbolic acid caused gangrene of\\nthe fingers.\\nThe Weir method is highly recommended by\\nsome. We have found it hard on the hands. After\\nthe usual scrubbing w T ith hot w r ater and green soap\\nplace in the palm of the hand a scant tablespoon-\\nful of commercial cloride of lime, than nearly as\\nmuch washing soda, add water and rub until the\\nmixture resembles thick cream. Rub it into the\\npalms, hands and arms until all particles of lime\\ndisappear or until a sense of coolness occurs, w r hich\\nwill be felt in usually four minutes. Rinse the\\nhands in sterile water, when they are said to be\\nsurgically clean.", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0048.jp2"}, "47": {"fulltext": "SURGICAL CLEANLINESS. 43\\nThere is another method that we like best of all.\\nIt has stood the crucial bacteriological test. We\\nmean by this that when this method has been em-\\nployed, scrapings from the hands placed in a cul-\\nture medium will not grow germs. The method\\nis as follows: Scrub the hands for five minutes\\nwith very warm water and green soap, as in the\\nother methods, then immerse the hands in a satu-\\nrated solution of permanganate of potash, until\\nthey are colored to a mahogany brown. Next,\\nimmerse them in a saturated solution of oxalic\\nacid until they are decolorized, and lastly in ster-\\nilized water, when they may be considered abso-\\nlutely sterile.\\nThere is still another method of rendering the\\nhands surgically clean. It consists simply in\\nscrubbing the hands very thoroughly with, green\\nsoap and very warm water, and then bathing them\\nwith alcohol We know a surgeon who performs\\nperhaps twenty operations a week and uses no\\nother means for cleansing his hands. He tells us\\nthat he gets good results. This is certainly the\\nsimplest of all the methods we have enumerated.\\nHe objects to the frequent use of the bi-chloride\\nof mercury, because it roughens the hands. This\\nlast method, however, will not stand the bacteri-\\nlogical test which should be our guide in choosing\\na method of sterilizing the hands.\\nA young medical student, who knew but little\\nabout surgical cleanliness, was asked by his pro-", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0049.jp2"}, "48": {"fulltext": "44 SURGICAL CLEANLINESS.\\nfessor to wash his hands until they appeared to\\nbe clean. The professor then scraped off a little\\nof the epidermis from the student s hands and\\nplaced it in a culture medium. In about three\\ndays there was a luxuriant growth of germs. As\\nalready suggested, special care must be given to\\nthe finger nails. The nails should be evenly\\ntrimmed. The nail cleaner and nail brush should\\nbe conscientiously used.\\nAfter the hands are once sterilized they will\\nreadily become surgically unclean, unless great\\nprecautions are taken. The tendency is great to\\ntouch something unclean. For instance, the\\nscratching of the head, the smoothing back of\\nthe hair, taking hold of the table or chair, or\\nthe clothing of the patient, or the shaking of\\nhands with a visitor, or rubbing against some one,\\nor against one s own clothing, or wiping the nose\\nwith a pocket handkerchief. The latter is an ar-\\nticle that is especially filthy from a surgical stand-\\npoint. All of these things must be avoided. After\\nthe hands are once surgically clean, the motto\\nshould be, Touch not! A sterilized surgical\\ngown entirely covering the clothing should be put\\non. This will protect the hands from one s own\\nclothing.\\nNext in order is the sterilizing of the instru-\\nments. So far as the metal instruments are con-\\ncerned it is an easy matter for they can be boiled,\\nand as already stated, boiling water destroys all", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0050.jp2"}, "49": {"fulltext": "SURGICAL CLEANLINESS. 45\\npus germs. If carbonate of soda be added to the\\nboiling water in the proportion of 1 per cent, it\\nwill not only increase the disinfecting power of\\nthe boiling water, but it will prevent the instru-\\nments from rusting. This is a valuable point that\\nshould not be forgotten, for if instruments are put\\ninto cold water without the soda they will often\\nrust within an hour. The common washing soda\\nwill answer the purpose. After the instruments\\nhave been in the soda solution they are easily pol-\\nished. Five minutes of boiling will thoroughly\\nsterilize the instuments, provided the water con-\\ntains soda. After instruments have been boiled\\nsome are in the habit of keeping them in a solu-\\ntion of carbolic acid throughout the operation.\\nInstruments should never be put into a solution\\nof bi-chloride of mercury, because it will corrode\\nthem.\\nThe next link in the technique of performing an\\naseptic operation is the preparation of the field of\\noperation. It is scarcely necessary to [state that\\nthe skin over the area to be operated on must be\\nthoroughly scrubbed with soap and warm water,\\nwashed with ether and then with bi-chloride of\\nmercury, in the proportion of one to one thousand\\nand finally with alcohol. In case of an operation\\nupon the abdomen, a poultice of soap is sometimes\\nplaced over the abdomen and allowed to remain\\nfor a number of hours. Sometimes a compress\\nwrung out of a carbolized solution ranging from 2", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0051.jp2"}, "50": {"fulltext": "46 SURGICAL CLEANLINESS\\nto 5 per cent is bound over the field of the opera-\\ntion and allowed to remain until the surgeon is\\nready to use the knife. I have seen the skin\\nblistered from using these drugs too strong or\\nleaving compress on too long. The skin should\\nbe examined at the end of two hours. If there is\\nany hair over the parts to be operated upon it\\nshould be shaved off before the compress is ap-\\nplied. When time permits, it is customary to pre-\\npare the field of operation the day before, and\\nthen apply one of the compresses we have men-\\ntioned and allow it to remain until the patient is\\nupon the operating table. The part is then again\\nthoroughly washed with soap and water, next\\nwith ether, then with bi-chloride and finally with\\nalcohol.\\nWhat w r e have said before in regard to unequal\\ndistribution of the bi-chloride should not be for-\\ngotten. This may be prevented by washing the\\nparts with a solution of ammonia and borax be-\\nfore applying the bi-chloride. If the wound made\\nby the surgeon is aseptic, that is, if it is free\\nfrom germs or other infective substances, it should\\nbe irrigated w 7 ith nothing but sterilized w T ater pre-\\npared in the manner stated in the preceding chap-\\nter, or sponged with pieces of sterilized gauze. If\\nthe wound is septic, then it may be irrigated with\\na solution of bi-chloride of i to 4,000 parts, or a 2\\nper cent solution of carbolic acid. In this con-\\nnection we should state the fact that a solution of", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0052.jp2"}, "51": {"fulltext": "SURGICAL CLEANLINESS 47\\nbi-chloride as weak as 1 to 10,000 will cause tissue\\nnecrosis in a fresh, aseptic wound, that is, it will\\ncause some of the cells in the walls of the wound\\nto die, a condition of things that is not desirable.\\nA number of other chemicals may be used to\\nirrigate a septic wound. Boric acid, acetate of\\naluminum and certain preparations of silver. The\\nlast are coming into favor and are likely to super-\\ncede all others. The antiseptic power of certain\\nproducts of silver is very great. It has the ad-\\nvantage of being less harmful than the bi-chloride\\nof mercury. It is a fact that certain bacteria will\\nnot grow in water contained in a silver cup.\\nFormalin is increasing in popularity. The\\nclaim is made that it is the most powerful of all\\nantiseptics and that it is not poisonous. In cases\\nof aseptic wounds it is best not to irrigate at all.\\nInstead of using a solution to wash away the\\nblood, sponge the wound with dry sterilized\\ngauze until all bleeding is stopped and the\\nwound is free of blood. It seems to us that\\nthe washing of a clean wound even with ster-\\nilized water must have a deleterious effect upon\\nthe tissue cells most exposed. It surely washes\\naway a part of their nutrition.\\nIt is a common poetical statement, that life\\nsometimes hangs by a single thread. In surgery\\nit is often a reality. The thread or suture ma-\\nterial may be the factor in determining the fate\\nof a patient. It is scarcely necessary to say, that", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0053.jp2"}, "52": {"fulltext": "48 SURGICAL CLEANLINESS\\nwhatever substance is used for the stitches it must\\nbe surgically clean. If the suture material is sil-\\nver wire it can be readily sterilized by boiling it.\\nIf it is silk thread it may be treated in the same\\nway, but if the suture is made from some animal\\nsubstance, such as cat gut, silk worm gut or\\nkangaroo tendon, it cannot be boiled without\\ndestroying its usefulness. Silver wire is but little\\nused at the present time. The chief objection to\\nit is the fact that it has to be removed. The\\nsame objection applies to silk thread, although it\\nis possible for both of these to remain deeply im-\\nbedded in the flesh without causing any dis-\\nturbance. Silver, we have just noted, has great\\nantiseptic power. Therefore, it is not likely to\\ncause stitch abscesses. It is non irritating and\\nhas great strength. We saw exhibited in Uni-\\nversity Hospital, Iyondon, an X-Ray picture of a\\nsilver wire suture w 7 hich had been in the knee five\\nyears and caused no annoyance.\\nCat gut is made from the intestines of sheep.\\nThe best cat gut is said to corne from Germany in\\nthe form of violin, guitar or banjo strings, Cat\\ngut slips easier than silk and requires more care\\nin tying. Cat gut is more irritable and less dur-\\nable than silk. Chromicized cat gut however does\\nnot absorb under ten days. Cat gut prepared with\\nformalin may be weeks in absorbing. Cat gut\\nbeing an animal substance cannot be boiled in\\nwater without destroying its usefulness. It may", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0054.jp2"}, "53": {"fulltext": "SURGICAL CLEANLINESS. 49\\nbe boiled in ether or alcohol to remove the fat it\\nnormally contains. It has been stated that cat gut\\nboiled one hour in alcohol is more servicable than\\nwhen prepared with chemicals. In all methods of\\npreparing it cat gut is usually treated first with\\nether to remove the fat. Then it is preserved in\\nsome germicidal substance or it is subjected to\\nmoist or dry heat to such a degree as will destroy\\nall germs which are always found deep in its sub-\\nstance when it comes from the manufacturers.\\nPlacing pieces of cat gut about twenty inches\\nlong in double envelops and then baking them in\\nan oven heated to about 350 degrees F. is a\\nmethod that is growing in popularity. The nurse\\nor assistant removes the outer envelop without\\ntouching the inner one which is opened by the\\nclean hands of the surgeon. Thus infection of the\\ncat gut is avoided.\\nSilkworm gut is sterilized by boiling. It is\\nfirm, smoothe, and not likely to become infected.\\nIt should always be used in closing wounds of skin\\nwhere the least scar possible is desired, especially\\nupon the face where regard is had for cosmetic\\nresults. Stitch abscesses are not likely to follow\\nits use. It does not absorb. Horse hair stands\\nnext to silk worm in closing cutaneous wounds.\\nIt may be sterilized by boiling.\\nCat gut ordinarily absorbs within four or five\\ndays and for this reason does not have to be re-\\nmoved. This absorbable quality makes it", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0055.jp2"}, "54": {"fulltext": "50 SURGICAL CLEANLINESS.\\nvery desirable. The great disadvantage that it\\nhas is the difficulty of sterilizing it. Perhaps a\\nhundred different methods have been suggested.\\nMany of them will stand the bacteriological test\\nin the laboratory, but after they have been buried\\nin the living tissues a number of days, suppura-\\ntion will take place around them and we have\\nstitch abscesses. A single stitch abscess may\\ncause entire failure of an operation. The most\\napproved method at present is to keep the cat gut\\nin a solution consisting of i part iodoform, 2 parts\\nether and 7 parts alcohol. The solution should\\nbe in a wide mouth bottle or glass jar with an\\nair tight cover or stopper. The cat gut should be\\nin the solution at least a week before it is used.\\nIt may, however, be kept in solution almost in-\\ndefinitely. Cat gut kept in carbolized oil will not\\nalways stand the crucial test.\\nIf drainage tubes are used, they must, of course,\\nbe thoroughly sterilized, whether they be of rubber\\nor of glass. This may be accomplished by boiling\\nin a one per cent soda solution. If a gauze drain-\\nage is used sterilized iodoform gauze is best and\\nmost commonly used. After the wound is sutured\\nthe line of incission should be dusted with iodo-\\nform powder and over this should be laid iodoform\\ngauze or plain aseptic gauze. Over this may be\\nplaced a layer of cotton and again other layers of\\nplain gauze, and finally the roller bandage to re-\\ntain the dressing in place. Iodoform, however, is\\nbeing succeeded by less odoriferous agents.", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0056.jp2"}, "55": {"fulltext": "SURGICAL CLEANLINESS. 51\\nIt is essential that all dressings of a wound\\nshould be aseptic. Gatue and bandages are\\nreadily sterilized by boiling. But after the boil-\\ning it requires a great deal of care to dry them\\nwithout their becoming re-infected by the germs\\ntransported by the dust of the atmosphere or by\\ncontact with unclean tables, vessels or hands.\\nWe recently saw on exhibition at the surgical\\ninstrument store of Truax Co., Chicago, an\\napparatus costing about one hundred and seventy-\\nfive dollars which not only boils or steams the\\ngauze but also dries it without removal from the\\ncylinder in which it is placed. Only a few can\\nafford the luxury of such an apparatus. There\\nare however a number of sterilizers on the market\\ncosting less than twenty dollars which steam the\\ngauze or linen until it is thoroughly sterile, and\\nfinally leaves it dry. New and improved steril-\\nizers are being constantly placed upon the market.\\nThe general principle in all is the same. In cases\\nof emergency at a farm house remote in the\\ncountry we have used the teakettle and dish pan\\nfor sterilizers. We have had gauze, linen and\\ntowels satisfactorily sterilized many a time by\\nboiling them in an ordinary tin wash boiler.\\nAfter gauze is sterile and dry it should be placed\\nin some absolutely clean vessel so that it w T ill not\\nbecome re-infected. In most hospitals large glass\\njars having tightly fitting covers are commonly\\nused. In taking the gauze from these it is more", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0057.jp2"}, "56": {"fulltext": "52 SURGICAL CLEANLINESS,\\nconvenient and more cleanly to use a long pair of\\nsterilized forceps than the hands. The linen op-\\nerating gowns worn by the surgeons and his\\nassistants should be sterilized by boiling. After\\nwhich they should be dried and kept wrapped up\\nin sterilized linen until they are needed.\\nTo prepare iodoform gatue several methods\\nare in use, but the simplest way known to us is\\nto thoroughly saturate sterilized gauze with a mix-\\nture of ether and iodoform, in which the iodoform\\nis present in the proportion of ten per cent. The\\ngauze is then placed in an open shallow vessel or\\non a large clean plate and covered with a layer of\\nsterilized gauze to protect it from the dust of the\\natmosphere. In a short time the ether will evap-\\norate and leave the iodoform evenly deposited upon\\nthe fibres of the gauze. When it has become dry\\nit should be preserved in clean and tightly closed\\nvessels. Before it is stored away it may be ren-\\ndered still more antiseptic by immersing it in a\\nsolution of bichloride of mercury in the proportion\\nof one to one thousand. It should never be for-\\ngotten, however, that this last agent is a powerful\\npoison. We have no doubt but that it will soon\\nbe supplanted in surgery by formalin or some of\\nthe other newly discovered ant iseptics which are\\nequally or more effective as an antiseptic and less\\npoisonous.\\nTo prepare a 10 per cent iodoform gauze, the\\nfollowing has come to our notice since writing the", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0058.jp2"}, "57": {"fulltext": "SURGICAL CLE INLTNESS. 53\\npreceding: Take by weight 50 parts gauze, 40\\nparts glycerine, and 10 parts iodoform, add 200\\nparts of alcohol, and iod parts water, mix well.\\nThe alcohol and water will evaporate. The glyc-\\nerine and iodoform will remain in the gauze. This\\nmethod is accurate and the iodoform is not changed\\nby the presence of ether as in the preceding method.\\nThe most suitable gauze weighs one ounce to the\\nsquare yard.\\nBoric acid, carbolic acid and other agents\\nmay be incorporated into gauze by saturating\\nsterilized gauze with a solution of any one of\\nthem and then allowing the liquid portion to evap-\\norate. As already stated, iodoform gauze is more\\ncommonly used at present. Its germicidal power\\nis small, its drying quality however is great.\\nThis accounts for the fact that while pus germs\\nmay continue to live in iodoform they do not\\nthrive. The biniodide of mercury has several ad-\\nvantages over the bi-chloride of mercury. It is\\nsaid to be less poisonous, less likely to precipitate\\nand more powerful as a germicide.\\nIf our surgical operations could always be abso-\\nlutely free of all pus germs then there would be\\nno occasion to use antiseptic gauze or any anti-\\nseptics. In fact many surgeons now use but little\\nif any antiseptics, but they are scrupulously\\nclean. Simple, plain aseptic gauze would answer\\nall purposes and would be idealy consistent with\\nour theory of perfect aseptic surgery. So long as", "height": "4658", "width": "2803", "jp2-path": "asepsisorsurgica00roge_0059.jp2"}, "58": {"fulltext": "54 SURGICAL CLEAXLIXESS\\nit is practically impossible to do an absolutely\\naseptic operation, that is an operation in which\\nnot a single germ remains in the wound or in the\\ndressings, it will be more satisfactory to use anti-\\nseptic gauze, that is gauze which has been im-\\npregnated with one or more of the various anti-\\nseptic agents.", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0060.jp2"}, "59": {"fulltext": "CHAPTER IV.\\nREDRESSING.\\nIf a wound is aseptic, if the sutures are aseptic,\\nif the dressings are aseptic, a redressing will\\nnot be necessary under ten days. The symptoms\\ncalling for a change of dressing is a rise of tem-\\nperature, increase of pain, an increase of mois-\\nture and odor. So long as there are none of\\nthese no change of dressing is needed, and no\\nchange should be made at least within nine days,\\nthe time required for wounds to heal under the\\nmost favorable conditions.\\nIn case a wound is not clean as shown by the\\nsymptoms just mentioned, the sooner it is dressed\\nthe better. It must be redressed at least once a\\nday thereafter. In some cases it is imperative to\\ndress an infected wound two or three times a\\nday. This is especially true where pus is burrow-\\ning into the neighboring parts and destroying\\ntissue that should be saved. After the dressing\\n55", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0061.jp2"}, "60": {"fulltext": "56 SURGICAL CLEANLINESS\\nis removed and as much matter as possible is\\nwiped away by means of dry sterilized gauze, the\\nwound should be washed with a warm sterilized\\nnormal salt solution, that is, warm sterilized water\\nwith about one teaspoonf ul of salt in each pint of\\nwater. We have just read, that recent investi-\\ngators find that the blood serum contains nearly\\none per cent salt instead of seven parts to the\\nthousand, as we have been taught heretofore. If\\nthis be true, we should make a normal salt solu-\\ntion nearly one per cent salt; that would require\\nalmost a teaspoonf ul and a quarter to the pint.\\nThe normal salt solution is rapidly superceding\\nsolutions of carbolic acid, bi-chloride of mercury\\nand other chemicals for irrigating and douching\\npurposes. Yet, there are cases where we may re-\\nsort to these poisonous agents with satisfaction.\\nWhile speaking of normal salt solution we must\\ndigress long enough to call attention to the great\\nvalue of this agent in case of shock and excessive\\nhemorrhage. Many a person well nigh pulseless\\nfrom loss of blood and death seemingly inevitable,\\nhas been revived speedily by simply injecting un-\\nder the skin from one to two quarts of normal\\nsaline solution. The method of introducing it is\\nas follows. In the end of the tube of a fountain\\nsyringe tie a large hypodermic needle. Fill the\\nsyringe bag with normal salt solution at tempera-\\nture of ioo. Insert the needle in the loose folds\\nof skin, particularly under the breast. Avoid in-", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0062.jp2"}, "61": {"fulltext": "SURGICAL CLEANLINESS. 57\\njectiug air. Unless surgical cleanliness is observed\\ntroublesome abscess may follow where the needle\\nentered.\\nWe can recall a number of cases of surgical\\nshock, hemorrhage, congestive chill, blood poi-\\nsoning, revived and in all probability saved by in-\\njecting normal salt solution. This agent is used\\nby many surgeons in washing out the abdominal\\ncavity after it has become infected by the rupture\\nof an internal abscess, or in case of purulent peri-\\ntonitis. A distinguished surgeon has j ust reported\\nthe recovery of an apparently hopeless case of\\npurulent peritonitis. He attributes her recovery\\nto the fact that during the first seventy-two hours\\nafter the operation in which he opened the ab-\\ndomen, he caused three hundred gallons of warm\\nnormal salt solution to run into and out of the ab-\\ndominal cavity, thus keeping its contents bathed\\ncontinually with it.\\nOne of the most useful agents in cleaning a\\nwound of pus is peroxide of hydrogen. It is\\nnot poisonous. As soon as it comes in contact\\nwith pus it sets up an efferversence resembling\\nthe foam on soda water. The pus corpuscles are\\nactually consumed by the peroxide of hydrogen.\\nA chemical union occurs which disintegrates the\\npus. If there is any objection to the use of per-\\noxide of hydrogen it is the quality of being\\nslightly irritating. We can remember when this\\nagent was introduced into surgery about fifteen", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0063.jp2"}, "62": {"fulltext": "58 SURGICAL CLEANLINESS.\\nyears ago. Before that its only commercial use\\nwas to bleach the hair of actresses.\\nWhile speaking of the abdominal cavity and its\\ncontents we will here digress again a little to state\\na most important caution. The medical journals\\nare just now discussing the case of a distinguished\\nsurgeon who has been sued for $10,000 damages,\\nbecause a sponge was overlooked and sewed up in\\nthe abdomen, causing the death of the patient.\\nIt may be surprising to our readers, but neverthe-\\nless this is a very common mistake. Not only\\nsponges, but scissors, forceps and other instru-\\nments have been employed during an abdominal\\noperation and left inside by mistake. We attended\\na convention of gynecological surgeons once during\\nwhich this oversight was discussed. More than\\ntwenty-five of such mistakes were confessed then\\nand there. The unfortunate surgeon who has re-\\ncently been sued defends himself by stating, that\\nit was the duty of the surgical nurse to count the\\nsponges, and that when he was ready to close up\\nthe abdomen he asked the nurse the usual quest-\\nions. Have you counted the sponges? Are they\\nall out? She answered in the affirmative and he\\nclosed the wound. The trial of this case will\\nprobably determine to what extent the nurse is\\nresponsible. Must she bear a part of it or must\\nthe surgeon bear all the blame?\\nThere are several places upon the body where\\nspecial attention to surgical cleanliness is of very", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0064.jp2"}, "63": {"fulltext": "SURGICAL CLEANLINESS. 59\\ngreat importance. For instance, an infection of\\nthe eye requires prompt and constant attention to\\nmake it surgically clean. The eyes of a large per\\ncentage of new born infants become infected\\nduring the first or second week after birth. If\\nthey are not treated promptly with a view to se-\\ncure surgical cleanliness the sight of one or both\\neyes are often lost. A thorough knowledge of\\nthis subject would have made blind asylums hardly\\nnecessary. In some countries stringent laws have\\nbeen passed in regard to the care of the eyes of\\nthe new born. One advanced practitioner tells us\\nthat he washes out the eyes of every infant soon\\nafter birth with a two per cent solution of nitrate\\nof silver. It is a safe practice for the nurse or\\nmother to wash out the infants eyes with a two or\\nthree per cent solution of boric acid. Especially\\nshould this be done upon the slightest appearance\\nof a discharge from the eye.\\nA discharge from the ear is often followed by\\nserious concequences if surgical cleanliness is not\\nobserved. The cleaning of the ear is not an easy\\nmatter. Some are opposed to throwing any kind\\nof a solution forcibly into the ear. If the head be\\nplaced on the side with the affected ear upward\\nthere cannot be any very great risk in pouring\\ninto the ear a warm medicated solution of glycer-\\nine. Pure or medicated glycerine being heavy will\\ncause the pus to rise to the surface and float out.\\nIncidentally we would say that one of the most", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0065.jp2"}, "64": {"fulltext": "60 SURGICAL CLEANLINESS.\\neffective applications for relief of acute earache is\\nto pour into the ear a solution consisting of one\\npart carbolic acid and nine parts glycerine. Boric\\nacid powder is often blown into the ear to dry up\\na discharge. This is open to the serious objection\\nthat the powder sometimes forms a crust and\\nblocks the escape of the pus. Instead of aiding\\nthe egress of the matter the result is the opposite.\\nThe pus is forced to burrow in some direction that\\nmay cause serious complications, for instance into\\nthe brain.\\nIt is a frequent occurrence for an abscessjto\\nform at the root of a tooth and spread into the\\nneighboring tissue, causing much damage. It is\\nsafe to say that if the mouth could be kept always\\nsurgically clean we w r ould have no such abscesses\\nwhich often follow 7 dow r n the lymphatic channels\\ninto some gland of the neck, causing it to swell up\\nand break down from suppuration.\\nThe tonsil is often the seat of an abscess which\\nis called suppurating tonsillitis or quinsy. Pus\\ngerms lodge in the crypts of the tonsils. A chill-\\ning of the neck or w r hole body is followed by a\\ncongestion, which puts the tonsils in a favorable\\ncondition for the development of abscess and other\\ntroubles far more serious. Suppurative endocar-\\nditis and death have followed abscess of tonsil.\\nMany troubles called rheumatism have started\\nwith suppurative tonsilitis. It is now believed,\\nthat the pus from the tonsil gets into the lym-", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0066.jp2"}, "65": {"fulltext": "SURGICAL CLEANLINESS. 6 1\\nphatic channels and is carried into the blood ves-\\nsels and heart. Sudden death during diphtheria\\nis a common occurrence. It is credited to heart\\nfailure. The cause no doubt is the absorption of\\nthe germs or their toxins into the circulation.\\nA disinfecting of the throat becomes an important\\nmatter. Many agents have been used. Alcohol\\nand water in equal parts is a simple and convenient\\ngargle. It is believed to possess great merit.\\nSeilers tablets make a good, mild gargle. A\\ngrain of permanganate of potash in a glass of\\nwater is a very excellent disinfecting gargle. It\\npossesses much merit and has stood the test of\\nlong usage. A combination of salt, water and\\nvinegar is a domestic gargle which stands well the\\nlight of modern science. We have already dis-\\ncussed the value of salt water in surgery.\\nAs for vinegar it has been shown to possess con-\\nsiderable antiseptic power. One eminent anthority\\nhas gone so far as to say that it is as powerful as\\nbi-chloride of mercury. It is related that once\\nupon a time during a cholora epidemic two men\\nrobbed the clothing of the dead with impunity, so\\nfar as taking the disease. The secret of their im-\\nmunity was said to have been due to the fact that\\neach morning before going out upon their ghonlish\\nexpedition they bathed their entire bodies with\\nvinegar.\\nA one per cent solution of carbolic acid makes a\\nuseful gargle. One of the most effective and at", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0067.jp2"}, "66": {"fulltext": "62 SURGICAL CLEANLINESS.\\nthe same time one of the most dangerous to use\\nas a gargle, is a solution of bi-chloride of mercury.\\nIt should not be used in the throat stronger than\\none part in ten thousand. We have known\\nnurses to use it successfully to gargle their own\\nthroats, while nursing cases of diphtheria.\\nThe disinfecting of the stomach does not con-\\nform to the usual rules of disinfection. A normal\\nstomach disinfects itself. The free hydrochloric\\nacid which is normally present in the gastric juice\\nis a natural antiseptic, and when the stomach is\\nin a healthy condition it keeps the stomach in pure\\ncondition. When the stomach becomes over loaded\\nor when by disease the gastric j uice becomes ab-\\nnormal, disease germs may exist in the stomach.\\nIt is at once apparent that poisonous chemicals\\ncannot be used to cleanse the stomach. Much can\\nbe done towards cleaning the stomach by washing\\nit out with plain water, or water containing a\\nsmall quantity of boric acid or bicarbonate of soda.\\nThe stomach tube consists of a rubber tube, about\\nthree eight of an inch in diameter and about two\\nfeet long. The upper end of the tube is expanded\\ninto a funnel so that water can be readily poured\\ninto the tube. The tube is lubricated; the best\\nsubstance for this purpose being the white of an\\negg. The small end of tube is placed far back\\ninto the patients mouth and told to swallow it\\nrapidly. This is usually accomplished after a little\\nurging on the part of the physician or nurse. As", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0068.jp2"}, "67": {"fulltext": "SURGICAL CLEANLINESS. 63\\nsoon as it is inserted, the fluid is poured into the\\nfunnel end of the tube. When ii is desired to\\nevacuate the stomach after it is filled with the\\nwashing fluid, the funnel end of the stomach\\ntube is lowered beneath the level of the stomach.\\nThereupon the contents of the stomach is at once\\nsiphoned out.\\nStrong antiseptics should not be used in the\\nrectum, because they are likely to be absorbed\\nand cause general poisoning. We saw- one case\\nand have read of others, where a strong carbolized\\nsolution injected into the rectum was followed by\\na sort of a convulsion and unconsciousness.\\nStronger antiseptics may be used in the vagina.\\nYet some persons are very sensitive to chemical\\npoisons used in a vaginal douche. We recall a\\ncase where a solution of bi-chloride in the propor-\\ntion of 1 to 4000 w r as followed by salivation or at\\nleast marked ptyalism. A solution of 1 to 8000 of\\nbi-chloride of mercury is sufficiently strong to use\\nin a vaginal douche. Boric acid, carbolic acid,\\npermanganate of potash as well as many other an-\\ntiseptics may be used in the vaginal douche. In\\ncase of genorrhseal infection the permanganate of\\npotash solution in the proportion of one grain to\\nthe pint, or a little stronger, gives good satis-\\nfaction.\\nThere is one antiseptic which we have neglected\\nto emphasize and that is mustard flour. It has\\nthe advantage of being a vegetable instead of a", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0069.jp2"}, "68": {"fulltext": "64 SURGICAL CLEAXLIXESS.\\nmineral, as nearly all other antiseptics are. It is\\nnot poisonous. It is said to be nearly as powerful\\nas bi-chloride of mercury. It can be mixed in\\nwater and used to wash the hands, or it can be\\nused as a douche. It could be used in the stomach.\\nIn fact, it is the only powerful antiseptic that we\\ncould safely use in the stomach. A number of\\nsuccessful surgeons use nothing else but mustard\\nflour water in which to sterilize their hands.\\nSpeaking of vegetable antiseptics reminds us\\nof another one, and that is turpentine. It has\\nreally great antiseptic power. The late Mr. Tait,\\nthe world s most famous gynecological surgeon,\\ncondemned antiseptics but we recall the fact, that\\nhe used turpentine quite freely in washing his\\nhands and for other purposes.\\nThe disinfection of the bladder is often neces-\\nsary. It can be disinfected by giving the patient\\nfour times a day a cup of warm water to drink in\\nwhich is dissolved from five to ten grains of boric\\nacid. This way is very easy and generally satis-\\nfactory. It is surprising how quickly the foul am-\\nmoniacal odor of the urine disappears after this\\ntreatment is begun. The boric acid escapes through\\nthe kidneys.\\nThere are cases in which it is necessary to wash\\nout the bladder. Here again, a solution of boric\\nacid is about the only antiseptic we can safely em-\\nploy in washing out the bladder. Three teaspoons\\nf ul of boric acid may be dissolved in a quart of", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0070.jp2"}, "69": {"fulltext": "SURGICAL CLEANLINESS. 65\\nwater. This will make approximately a one per\\ncent solution. A weak solution of iodine may be\\nused in some conditions of the bladder, especially\\ntuberculosis.\\nThere remains still another place upon the body\\nwhere surgical cleanliness will save a vast amount\\nof suffering. We refer to the nipples of nursing\\nwomen. Abscess of the breast is always caused\\nby an infection. The pus germs find entrance\\nthrough some abrasion or irritation about the\\nnipple. If the breast is left surgically clean it\\nwill be impossible for a woman to have a broken\\nbreast, one of the most painful affections known\\nto women. Before and after the child nurses the\\nnipples should be cleansed. Before the child is\\never put to the breast, the nipples should be\\ncleansed with soap and water. Then washed with\\na boric acid solution and finally washed with\\nalcohol.\\nThe wearing of thin rubber gloves while op-\\nerating is gaining favor with surgeons. If the\\ngloves are thoroughly sterilized, which can be\\nreadily done by boiling, no infection can possibly\\noccur to the wound from the operators hands.\\nWe know of one very successful surgeon, who\\nwill not operate without gloves and will not per-\\nmit any one to assist him who does not wear them.\\nKnowing how difficult it is to sterilize the hands\\nand how much labor it takes to teach assistants\\nhow to sterilize their hands, we must endorse the", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0071.jp2"}, "70": {"fulltext": "66 SURGICAL CLEANLINESS.\\nposition this surgeon has taken, but gloves are\\nnot always at hand and they are expensive. Be-\\nsides they are likely to be ruptured in the midst\\nof an operation. The finger nails should re-\\nceive great attention as to cleanliness. They\\nshould be manicured often. In the debris un-\\nder the finger nails is a favorable place for pus\\ngerms. It is scarcely necessary to say, that the\\nOperating room should be clean and free from\\ndust. It is a fact that pus germs are not very\\nabundant in the dust of the atmosphere. If the\\nfloor is washed with an antiseptic solution a half\\nhour before the operation there cannot be much\\ndust stirred up, and the dust previously in the\\natmosphere will be largely precipitated to the floor\\nand held there by the moisture.\\nI/aughing, coughing, sneezing and unneces-\\nsary talking should be avoided in the operating\\nroom. There are very few persons whose mouths\\nare so clean as not to have some decayed teeth\\nwith ulcerating roots and abscesses of the gums.\\nUnless care is taken a small particle of saliva laden\\nwith pus germs might easily be thrown from the\\nmouth into the wound. The operator and his as-\\nsistants should avoid breathing into the wound.\\nFew surgeons can perform a major operation\\nwithout perspiring freely. Care should be\\ntaken that the perspiration does not drop from\\nthe surgeons face into the wound. A watchful\\nnurse will see that the perspiration is wiped away", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0072.jp2"}, "71": {"fulltext": "SURGICAL CLEANLINESS. 67\\nas often as necessary. It is well to cover the hair\\nand beard with gauze to guard against infected\\nparticles falling from thern into the wound.\\nIt seems almost unnecessary to state that spec-\\ntators with unsterilized hands and unclean cloth-\\ning should keep away from the operator and his\\nassistants. Yet this caution is necessary. We have\\nseen intelligent persons who would be supposed to\\nknow better rub up against the surgeon or his as-\\nsistants wholly unmindful that they were risking\\nthe success of the operation.\\nThe Sterilisation of Catheters and\\nBougies.\\nNicoll gives the following directions for the\\nsterilization of catheters and bougies:\\nBougies.\u00e2\u0080\u0094 Gum-elastic bougies will not bear\\nheating to a temperature sufficient for steriliza-\\ntion. Soaking for fifteen minutes in carbolic acid\\nsolution 1 in 20, for half an hour in 1 in 40, or\\nfor an hour in perchloride of mercury 1 in 1000,\\nrenders the surface so sticky that the towel ad-\\nheres in the process of drying, and the bougie be-\\ncomes covered with fluff. After several soakings\\nthe surface becomes permanently dull and sticky\\nand unfit for use. Dr. Schimmelbusch says that\\na smooth bougie or catheter can mechanically be\\nmade externally free from germs by rubbing it\\nwith a piece of sterilized gauze and warm water.", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0073.jp2"}, "72": {"fulltext": "68 SURGICAL CLEANLINESS.\\nTo test this, series of six gum-elastic bougies in\\nuse from six to eighteen months, after being em-\\nployed in cases of stricture, were washed with\\ntepid water and soap, rinsed in cold running\\nwater, and dried by thorough light friction\\nwith sterilized gauze. They were then rubbed\\non the surface of acid and alkaline agar tubes.\\nIn one case colonies of an unidentified coccus ap-\\npeared, in another a patch of penicillium. The\\nother ten tubes remained sterile. Six bougies\\nsoiled with pus were similarly treated; all the\\ntubes remained sterile. In other experiments in-\\nstead of the gauze an ordinary towel fresh from\\nthe laundry was used, and similar results were ob-\\ntained. It appears, therefore, that antiseptic solu-\\ntions which rapidly destroy instruments are un-\\nnecessary for sterilization.\\nCatheters Red rubber catheters (Jacques) may\\nbe sterilized by boiling or steaming, or may be\\nsoaked for months in carbolic solution, i in 20,\\nor perchloride of mercury, 1 in 1000, without\\ndamage. A rubber catheter may be used daily\\nfor six months without becoming unfit for use, if\\nwashed every day with hot water and soap and\\nput to soak in carbolic lotion for the remainder of\\nthe twenty- four hours. But there are certain red\\nrubber catheters which rapidly deteriorate under\\nrepeated boiling, and all rubber catheters ulti-\\nmately do so. Prolonged and repeated soaking\\nin antiseptics has little effect. By experiments the", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0074.jp2"}, "73": {"fulltext": "SURGICAL CLEANLINESS. 69\\nwriter has proved that rubber catheters, boiled,\\nsteamed or soaked for four hours in the lotions\\nmentioned, are rendered sterile internally and ex-\\nternally. But gum-elastic catheters, like bougies,\\nwill not stand the lengthened and repeated soaking\\nnecessary for sterilization. There is no entirely\\nreliable method. For practice the writer has form-\\nulated the following rules:\\n1. Avoid as far as possible the employment of\\ncatheters. In cases of stricture it can only be very\\nexceptionally that a catheter is called for. Bou-\\ngies, which are readily sterilized, will do all that\\nis necessary. 2. Where a catheter must be em-\\nployed, use where possible a red rubber Jacques\\ncatheter in preference to a gum-elastic. In reten-\\ntion from atony, spinal paralysis, reflex nervous\\neffects and other causes, and in many cases of\\nprostatic retention, the former answers as well,\\nand is as readily sterilized by boiling or immersion\\nin an antiseptic solution as is a metal catheter.\\n3. Where the red rubber fails to pass, the use of\\nmetal catheters, especially by the patient, does not\\ncommend itself as free from risk of injury.\\nGum- elastic catheters must therefore be used.\\nIf the urine is very septic the writer destroys the\\ncatheters used. If the urine is not very purulent\\nor offensive, he washes the catheters externally\\nwith soap and water, and then with antiseptic so-\\nlutions, which is followed by internal steaming.\\nThose that survive he retains. When the regular", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0075.jp2"}, "74": {"fulltext": "70 SURGICAL CLEANLINESS.\\nuse of a gum-elastic catheter is necessary, the\\npatient is supplied with a catheter with a well-fin-\\nished interior. After use he thoroughly washes it,\\nholds it under the tap for a few minutes and lays\\nit aside in boric acid, weak perchloride, or other\\nweak antiseptic. This only offers a reasonable\\nchance of asepsis, but it is useless to expect an\\naverage patient to carry out more elaborate plans.\\nThe writer has had glass tubes constructed, which\\nare filled with the antiseptic solution, in which\\nthe catheter is placed after use. The solution\\nvaries in strength according to the kind of cathe-\\nter; for gum-elastic catheters it must be weak,\\nred rubber catheters will stand anything.\\nPreparation of the Abdomen for\\nOperation.\\nThe following procedures are carried out in the\\nJohn Hopkins Hospital in the preparation of the\\nabdomen for operation:\\nOn the day before the operation the ward nurse,\\nusing a gauze mop, washes the skin with green\\nsoap and water. With disinfected hands she then\\nwashes the area with alcohol, ether and mercuric\\nbichloride solution i i ooo) A large sterile gauze\\nshield is then laid over the cleansed part, this being\\nheld on with tapes. In the operating-room, after\\nthe patient is anesthetized and on the table, the\\npreparation is continued in two stages. The first", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0076.jp2"}, "75": {"fulltext": "SURGICAL CLEANLINESS. 71\\nstage is done by an assistant whose hands are not\\nnecessarily completely sterile. The second stage\\nis done by the assistant with clean hands. The\\nfirst stage consists in removing the ward dressing,\\nlathering with green soap and water, shaving and\\nflushing; washing wdth green soap and water, em-\\nploying a gauze wash-ball; flushing with ether,\\nwashing off with sterilized water. The second\\nstage consists in washing thoroughly with green\\nsoap and water, using a wash-ball; flushing with\\nether, flushing with alcohol, and flushing with\\nmercuric bicloride (1: 1000). In those cases with\\nold scarred skins or slight dermatitis, potassium\\npermanganate and oxalic acid are also used.\\nThere is then a final flushing with sterile water.\\nThis whole process is done in from ten to twelve\\nminutes.", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0077.jp2"}, "76": {"fulltext": "CHAPTER V.\\nCurrent Opinions on Disinfection.\\nAt a meeting of the Chicago Medical Society,\\nJan. 17, 1900, the subject of disinfection was dis-\\ncussed. The following is the essence of the con-\\nclusions and present opinions of several eminent\\nsurgeons who took part in the discussion:\\nFor mental, physical and antiseptic reasons the\\npatient should enter the hospital 24 to 48 hours\\nbefore the operation. The preliminary steps in dis-\\ninfection is mechanical, consisting largely of rub-\\nbing away masses of loose epidermal scales to\\nwhich germs are attached. This is best accom-\\nplished by soap and warm water applied with a\\nstiff nail brush. All agreed that too much confi-\\ndence is placed in so called antiseptics. All of\\nwhich are more or less poisonous, and if used in\\nsufficient strength to kill germs, will injure the\\ntissues. A general bath should be the first step in\\npreparing a patient for the operation. Schleich s\\n72", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0078.jp2"}, "77": {"fulltext": "SURGICAL CLEANLINESS. 73\\nmarble dust soap was recommended as better\\nthan green soap. It should be used with a piece\\nof sterilized gauze and not with a brush.\\nRubber gloves were recommended. They\\nshould be prepared as follows: Wash in- and out-\\nside with a 10 per cent solution of sodium carbo-\\nnate. Rinse in sterilized water, dry for one\\nminute over a gas flame, reversing. Dust inside\\nliberally with sterilized soap, shoe powder.\\nWrapp in double layer of sterilized gauze and\\nput in a formaldehyde sterilizer for two hours.\\nThen lay away wrapped in sterilized towels labeled\\nwith size and date of sterilization. This method of\\nsterilizing gloves has been found to be superior to\\nall others. Repeated and numerous tests for germs\\neven two weeks after this method has been em-\\nployed has revealed no germs in the gloves.\\nIn dry operations woven gloves have a place.\\nCotton is safer than silk, but neither compares\\nwith rubber. Cotton gloves are cheaper than rub-\\nber. Cotton gloves may be used in both aseptic\\nand septic operations. In the former to protect\\nthe patient from being infected by unclean hands,\\nand in the latter condition to protect the operators\\nfrom being inocculated with septic matter. Nu-\\nmerous bacteriological tests of the inside and of\\nthe outside of cotton gloves, after operations,\\nshowed that the operator s gloves were infected on\\nthe inside in two thirds of the cases, while the in-\\nside of the gloves worn by the nurse, who handed", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0079.jp2"}, "78": {"fulltext": "74 SURGICAL CLEANLINESS.\\ninstruments, ligatures, sponges and dressings to\\nthe operator, were not infected at all. Illustrat-\\ning the fact that the exertions and perspiring of\\nthe operator brought the germs to the surface\\nthrough the sweat glands, which was not the case\\nwith the hands of the nurse who was compara-\\ntively inactive.\\nTheoretically it is well nigh impossible to thor-\\noughly and absolutely sterilize the skin of the\\npatient or that of the operator. Practically it is\\nan easy matter to secure a degree of surgical\\ncleanliness that will insure healing by first inten-\\ntion. Theoretically strong chemical disinfectants\\nare required for the purpose of sterilizing the\\nhands, but practically careful washing with the\\nmildest soap and water, following with a rinsing\\nwith alcohol is absolutely sufficient and very much\\nsafer for the patient, because hands roughened by\\nthe use of strong antiseptics are much more likely\\nto become hopelessly septic, than those that are\\ncovered with smoother, healthy skin. It is easy\\nto keep the hands sterile, after they have once\\nbeen rendered aseptic. And yet, no task is more\\ndifficult in a surgical clinic than to keep all hands\\ninterested clean.\\nDeep stitches through the skin make a direct\\ncommunication for the germs in the skin to pass\\ninto the deeper aseptic tissues. But such stitches\\nnever cause infection, so long as they are not\\ndrawn too tight. Tension causes pressure necrosis,", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0080.jp2"}, "79": {"fulltext": "SURGICAL CLEANLINESS. 75\\nthat is, the nutrition is cut off by pressure, and\\ndeath of the part follows, making a fertile soil\\nfor the development of the germs, to result in\\nstitch abscesses or something more serious. Cat\\ngut stitches are safe if not drawn too tightly.\\nTheoretically a surgeon may sterilize his hands\\nafter dressing pus cases and operate immediately\\nupon clean cases, but practically such a custom is\\nfollowed by bad results through accidental infec-\\ntion. In spite of the greatest care, something that\\nwas used in connection with the unclean cases will\\naccidentally come in contact w 7 ith the skin. It is\\nbetter therefore to operate upon clean cases first,\\nand dress or operate upon the unclean ones last.\\nThe surgeon and his assistant should be careful\\nnot to breathe or speak into the wounds.\\nWhenever drainage is used in clean wounds it\\nshould be removed within twenty-four hours. If\\nit is done this early, infection is not likely to oc-\\ncur from drainage. The peritoneum is rarely if\\never infected from the air. In some cases of peri-\\ntoneal infection the abdomen may be filled with\\nnormal salt solution, and so dilute the poisons as\\nto tide the patient over the danger point. The\\nperitoneum is more likely to be infected from the\\nsurgeon s hands or the patient s skin. Blood clots\\ncan be removed from the peritoneum better by a\\ndry aseptic sponge than by an irrigating fluid.\\nIntra-venous injection of normal salt solution is\\nthe best method of treating shock.", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0081.jp2"}, "80": {"fulltext": "76 SURGICAL CLEANLINESS.\\nPuerperal Sepsis.\\nWe can think of no more fitting way to close\\nthis volume on Surgical Cleanliness than by a\\nbrief survey of the steps that have led up to the\\ndiscovery of the fact that puerperal sepsis and\\nsurgical fever or blood poisoning are one and the\\nsame. More than fifty years ago, a few medical\\nwriters intimated this truth, but they were sever-\\nely ridiculed and abused by the authorities and\\nleading men of their time. What was hinted at\\nforty years ago has become universally recognized\\nas truth during the last five or ten years.\\nDr. Oliver Wendell Holmes s article on The\\nContagiousness of Puerperal Fever, in 1843 must\\never remain a Classic. The closing paragraph of\\nHolmes s paper was as follows:\\nI have no wish to express any harsh feeling\\nwith regard to the painful subject which has come\\nbefore us. If there are any so far excited by the\\nstory of these dreadful events that they ask for\\nsome word of indignant remonstrance to show\\nthat science does not turn the hearts of its follow-\\ners into ice or stone, let me remind them that\\nsuch words have been uttered by those who speak\\nwith an authority I could not claim. It is as a\\nlesson rather than a reproach that I call up the\\nmemory of these irreparable errors and wrongs.\\nNo tongue can tell the heart-breaking calamity\\nthey have caused; they haye closed the eyes just", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0082.jp2"}, "81": {"fulltext": "SURGICAL CLEANLINESS. 77\\nopened upon a new world of love and happiness;\\nthey have bowed the strength of manhood into\\nthe dust; they have cast the helplessness of in-\\nfancy into the strangers arms, or bequeathed it,\\nwith less cruelty, the death of its dying parents.\\nThere is no tone deep enough for regret, and no\\nvoice loud enough for warning.\\nThe woman about to become a mother, or with\\nher new-born infant on her bosom, should be the\\nobject of trembling care and sympathy wherever\\nshe bears her tender burden or stretches her aching\\nperiod. The very outcast of the street has pity\\nupon her sister in degradation, when the seal of\\npromised maternity is placed upon her. The re-\\nmorseless vengeance of the law brought down\\nupon its victim by a machinery as sure as des-\\ntiny, is arrested in its fall at a w r ord which re-\\nveals her transient claim for mercy. The solemn\\nprayer of the liturgy singles out her sorrows from\\nthe multiplied trials of life, to plead for her in the\\nhour of peril. God forbid that an} member of the\\nprofession to which she trusts her life, doubly\\nprecious at that eventful period, should hazard it\\nnegligently, unadvisedly, or selfishly.\\nHolmes s theory that child-bed fever was con-\\ntagious, and his appeal for surgical cleanliness\\nbrought down upon him the severest ridicule of\\nthe most brilliant minds of his age. Notwith-\\nstanding this abuse, the doctrine of The Con-\\ntagiousness of Puerperal Fever grew. To Hirst", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0083.jp2"}, "82": {"fulltext": "78 SURGICAL CLEANLINESS.\\nin his excellent work upon Obstetrics we are in-\\ndebted for the following remarkable narrative:\\nIn 1846 a young assistant in the Maternity-\\nDepartment of the General Hospital of Vienna,\\nnamed Semmelweiss, was struck with the fright-\\nful mortality in one of the Maternity Wards of\\nthe General Hospital, while in a neighboring\\nward the death-rate was scarecely one- tenth as\\ngreat. He discovered that in the first ward the\\nwomen were attended by students who were in\\nthe habit of coming fresh from post-mortem ex-\\naminations in the Pathological Department to the\\nbed-sides of the parturient patients. In the sec-\\nond ward the women were attended solely by mid-\\nwives.\\nSemmelweiss conceived the idea that the\\nstudents carried on their hands putrid products\\nfrom the post-mortem table to the lying-in women\\nwhom they examined. And that these products\\nwere responsible for the large number of fatal in-\\nflammations and fevers that followed the student s\\nwork. He consequently ordered that no student\\nshould examine a woman until he had washed his\\nhands in chlorin-water. The results of his regu-\\nlation were fairly startling, as is shown in the ac-\\ncompanying table:\\nConfinements. Deaths. Per Cent.\\n1846 4010 459 n*4\\n1847 3490 176 5\\n1848 3556 45 1*27", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0084.jp2"}, "83": {"fulltext": "SURGICAL CLEANLINESS. 79\\nIt should be stated that the rule compelling the\\nstudents to wash their hands in an antiseptic so-\\nlution was put into effect in the middle of the\\nyear 1847.\\nSemmelweiss recognized the transcendent im-\\nportance of his discovery. He foresaw something of\\nthe lives preserved, the homes kept from bereave-\\nment, the mothers saved to their children, the\\nwives to their husbands, in millions of families;\\nthe incalculable diminution of human suffering\\nwhich his discovery promised to the world; but\\nhis was not the calm and confident soul of a Har-\\nvey, wise enough to know that the truth is mighty\\nand shall prevail: sure that mankind must accept\\nit some day, and content to bide his time. Sem-\\nmelweiss nature was not great enough for such\\npatience. He fumed and fretted his life away in\\nvain efforts to obtain recognition for his great\\nprinciple of chemical disinfection. He preached\\nhis new doctrine in season and out of season, en-\\ndeavoring to impress it upon his immediate col-\\nleagues, and upon the medical societies and peri-\\nodical medical literature of the time in Europe.\\nDuring the latter days of his professorship in\\nBuda-Pesth he would even stop aquaintances\\nupon the street to importune them with his\\nviews. But he got for his pains nothing but\\nridicule, contumely, opposition, or indifference.\\nHe finally lost his mind entirely, from chagrin\\nand disappointment, ending his life in a lunatic", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0085.jp2"}, "84": {"fulltext": "8o\\nSURGICAL CLEANLINESS.\\nasylum in Vienna, where he died, strangely e-\\nnough, from a septic wound on his finger re-\\nceived during an operation performed just before\\nhis commitment to the asylum.\\nMore than twenty years after Semmelweiss\\ndiscovery, the mortality of many lying-in hospitals\\nin Europe remained as high as ten percent. Then\\ncame the brilliant work of Pasteur in the field of\\nbacteriology, the acceptance of the germ theory in\\ndisease, the application of antisepsis to surgery by\\nLister, and the adoption of the system almost im-\\nmediately by obstetricans. From that day to this\\nthere has been a steady and increasingly rapid ac-\\nquisition of knowledge of the etiology of septic in-\\nfection, and of its most successful preventive and\\neurative treatment.\\nIt is to be hoped that the medical world of to-\\nday and of the future can never again be deaf and\\nblind to such an appeal as that of Holmes, or to\\nsuch a demonstration as that of Semmelweiss", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0086.jp2"}, "85": {"fulltext": "", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0087.jp2"}, "86": {"fulltext": "", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0088.jp2"}, "87": {"fulltext": "", "height": "4650", "width": "2986", "jp2-path": "asepsisorsurgica00roge_0089.jp2"}, "88": {"fulltext": "1111111\\niSM\\nWmmmm\\n11111- \u00c2\u00bbHl\\nMil* I m lillil", "height": "4725", "width": "2961", "jp2-path": "asepsisorsurgica00roge_0090.jp2"}}