{"1": {"fulltext": "1 1\\n5\u00c2\u00bb\\nI\\nfc\\n^^n", "height": "4968", "width": "3188", "jp2-path": "bacteriologysur00ston_0001.jp2"}, "2": {"fulltext": "LIBRARY OF CONGRESS,\\nChap Copyright No...\\nShelf..\\nUNITED STATES OF AMERICA.", "height": "4535", "width": "2787", "jp2-path": "bacteriologysur00ston_0002.jp2"}, "3": {"fulltext": "", "height": "4535", "width": "2787", "jp2-path": "bacteriologysur00ston_0003.jp2"}, "4": {"fulltext": "", "height": "4535", "width": "2787", "jp2-path": "bacteriologysur00ston_0004.jp2"}, "5": {"fulltext": "Bacteriology\\nAND\\nSurgical Technique\\nFor Nurses\\nBY\\nEMILY M. A. STONEY\\nSuperintendent of the Training School for Nurses, St. Anthony s Hospital, Rock\\nIsland, 111. Author of Practical Points in Nursing, Practical\\nMateria Medica for Nurses, etc.\\nEvery bit of knozvledge that we cannot use for the uplifting of our physical,\\nintellectual, or emotional life is so much -waste of time and labor. Everything taught\\nis worth the knowing, but not worth the putting away in the pigeon-holes of memory,\\nto be recalled some day by accident.\\nILL USTRA TED\\nPHILADELPHIA\\nW. B. SAUNDERS COMPANY\\n1900", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0005.jp2"}, "6": {"fulltext": "4757?\\nl_ br*u y of Co Hr\\nSEP 15 1900\\nstccw conr.\\nOflOW OWISiON.\\nOCT 9 1900\\nSUJo,\\nCopyright, 1900\\nBy W. B. SAUNDERS COMPANY\\nELECTROTYPED BY\\nWESTCOTT THOMSON, PHILADA.\\nPRESS OF\\nW. B. SAUNDERS COMPANY.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0006.jp2"}, "7": {"fulltext": "TO\\nDR. JOHN R. SLATTERY\\nTHIS VOLUME IS DEDICATED BY THE AUTHOR\\nIN GRATEFUL REMEMBRANCE OF MUCH ENCOURAGE-\\nMENT AND PERSONAL KINDNESS", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0007.jp2"}, "8": {"fulltext": "", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0008.jp2"}, "9": {"fulltext": "PREFACE.\\nThe following pages constitute the notes of a series\\nof lectures on Bacteriology and Surgical Tech-\\nnics which followed closely upon my lectures on\\nu Materia Medica. The first part of the book is de-\\nvoted to Bacteriology and Antiseptics the second\\npart to Surgical Technic, Signs of Death, Au-\\ntopsies.\\nNo attempt has been made to write a complete\\ntreatise on bacteriology, but merely to outline and\\nsimplify that branch for nurses.\\nIt was deemed advisable to add the chapter on\\nSigns of Death and Autopsies, as many nurses\\nare unacquainted with the preparations for an autopsy\\nin private practice.\\nSo many changes have taken place in surgery since\\nthe lectures were delivered that it has been necessary\\nto rewrite many of the chapters. In this I was\\nassisted by Dr. A. S. Allen and by Professors J. B.\\nMurphy, Christian Fenger, and Joseph L. Miller, of\\nthe Northwestern University Medical College. I am\\nglad of this opportunity to thank them for their\\nassistance.\\n5", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0009.jp2"}, "10": {"fulltext": "6 PREFACE.\\nFree use has been made of the works on bac-\\nteriology by McFarland, Crookshank, and Woodhead;\\nof u Aseptic Surgical Technique, n by Dr. Hunter\\nRobb Operative Gynecology, by Dr. Howard A.\\nKelly; and u Aseptic Treatment of Wounds, by\\nDr. C. Schimmelbusch.\\nI am unable to express my indebtedness to Dr.\\nJoseph P. Comegys for his valuable assistance with\\nthe manuscript and its preparation for the press.\\nI wish also to thank Drs. George L. Eyster and\\nCharles C. Carter for their friendly help and interest\\nin the work.\\nEMILY M. ARMSTRONG-STONEY.\\nSeptember, 1900.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0010.jp2"}, "11": {"fulltext": "CONTENTS.\\nPART L\u00e2\u0080\u0094 BACTERIOLOGY ANTISEPTICS.\\nCHAPTER I.\\nPAGE\\nHistory of Bacteriology 9\\nCHAPTER II.\\nBacteria as the Causes of Disease 20\\nCHAPTER III.\\nThe Theory of Antitoxins 35\\nCHAPTER IV.\\nAntiseptics, Disinfectants, and Deodorants 42\\nCHAPTER V.\\nAntiseptics (continued) 55\\nPART IL\u00e2\u0080\u0094 SURGICAL TECHNIC\\nCHAPTER VI.\\nCare of Operating-room; Methods of Sterilization; Care\\nof Instruments 62\\nCHAPTER VII.\\nInstruments Necessary in Different Operations; Keeping\\nof Charts; Surgeon s Kit, etc 71\\n7", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0011.jp2"}, "12": {"fulltext": "8 CONTENTS.\\nCHAPTER VIII.\\nPAGE\\nAnesthesia 86\\nCHAPTER IX.\\nAntiseptic Gauzes, Tampons, Bandages, Thermocautery, Saline\\nInfusions, Irrigation, etc 99\\nCHAPTER X.\\nSutures and Ligatures; Sponges; Drainage; Drainage-tubes;\\nGauze Drains; Rubber Dam; Rubber and Cotton Gloves 109\\nCHAPTER XL\\nInflammation 121\\nCHAPTER XII.\\nCatheterization; Douches; Enemata; Washing out the\\nBladder; Lavage 123\\nCHAPTER XIII.\\nOperations; Preparation of the Operating-room; The Slr-\\ngeon and his assistants i3i\\nCHAPTER XIV.\\nPreparation of Patient for Operation Care of Patient\\nduring and alter operation 1 39\\nCHAPTER XV.\\nSequels of Operations; Shock, Hemorrhage, Septic Peri-\\ntonitis, Accidents during Operations, etc 151\\nCHAPTER XVI.\\nOperations in Private Practice 161\\nCHAPTER XVII.\\nGynecologic Examinations and Operations 16S\\nCHAPTER XVIII.\\nSigns of Death; Autopsies 176", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0012.jp2"}, "13": {"fulltext": "PART I.\\nBACTERIOLOGY ANTISEPTICS.\\nCHAPTER I.\\nHISTORY OF BACTERIOLOGY.\\nThe eye is one of the most beautiful and delicately\\ncontrived organs in the body, and yet its vision un-\\naided is very limited in its scope. We see so much\\nthat we rarely stop to think of what an enormous\\nworld exists in and all about us which we cannot see\\nat all a world peopled by organisms so very small\\nthat they can be seen and studied only by the aid of\\nthe most powerful magnifying lenses, and so num-\\nerous that they are quite beyond any calculation.\\nBacteria exist nearly everywhere; they are almost\\nuniversal, except that they are not found deep down\\nin the ground nor high up in the air. They and their\\nspores, or seeds, float in the air we breathe, swim in the\\nwater we drink, grow upon the food we eat, and lux-\\nuriate in the soil beneath our feet. Wherever man,\\nanimals, and plants live, die, and decompose, bacteria\\nare sure to be present. The surface of the body never\\nescapes their establishment, and so deeply are some\\nindividuals situated beneath the epithelial cells that\\nthe most vigorous scrubbing and washing and the use", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0013.jp2"}, "14": {"fulltext": "IO BACTERIOLOGY.\\nof powerful disinfectants are necessary to remove them\\nfrom the surgeon s hands.\\nThe mouth is said to be always replete with them;\\nand, since many are swallowed, the digestive tract\\nalways contains them. The germ of pneumonia, for\\ninstance, is said to be habitually present in the mouth\\nof almost every healthy person; consequently, its\\nentrance into the lungs is only a matter of accident.\\nThe existence of these bacteria has been known for\\nmany years, but it is only during the past few decades\\nthat any great advancement in our knowledge of them\\nhas been made.\\nOver two hundred years ago a man named Athana-\\nsius Kircher, a German, mistook blood-corpuscles\\nand pus-corpuscles for small worms, and built up a\\nnew theory of the causes of disease and putrefaction\\nwith these worms as a basis of it. At the same time,\\nChristian Lange, a professor in the medical school at\\nLeipzig, expressed his opinion that the rash that\\nappeared on the skin in the eruptive fevers, etc.,\\nwas the result of putrefaction conveyed by small liv-\\ning worms in the body. Shortly after these obser-\\nvations came those of Anthony van Leeuwenhoek,\\na native of Delft, in Holland, who, in his early years,\\nhad learned the art of polishing lenses, and who was\\nable, ultimately, to produce the first really good\\nmicroscope that had yet been constructed. He saw,\\nand described with astonishing clearness, various\\nforms of bacteria found in the material taken from\\nthe teeth of an old man who never cleaned his teeth.\\nHe gave an accurate description of the rod-shaped\\nbacteria, motile and motionless; of the longer threads,\\nnow called bacilli; of the spiral threads, or spirilla;", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0014.jp2"}, "15": {"fulltext": "HISTOR Y OF BACTERIOL OG Y. 1 1\\nand of rounded micro-organisms, or micrococci.\\nAlthough he did not attempt to theorize as to the\\nmeaning of these organisms in the mouth at the\\ntime, later on, in 1713, after finding similar organ-\\nisms in the greenish pellicle formed on the surface\\nof the water in an aquarium, he came to the conclu-\\nsion that the various forms of bacteria found in the\\nmaterial scraped from the teeth found their way into\\nthe mouth through the medium of the drinking-water\\nthat had been stored in barrels, and that some of\\nthese found there a nidus in which they multiplied.\\nThis was the real beginning of bacteriology; and\\nfrom this origin the study advanced with considerable\\nrapidity in spite of ridicule and much opposition.\\nVarious opinions regarding the connection of these\\ngerms with disease and putrefaction, w 7 ere put for-\\nward; but it was not until 1831 that any important\\nadvance was made in our knowledge of this connec-\\ntion. Previous to that time a large mass of facts in\\nregard to these little living organisms was being\\ngradually accumulated, and fresh discoveries were\\nconstantly made by various workers; but since no\\nsystematic attempts to classify the newly observed\\nfacts were made, the scientific results were very small.\\nThe first real advance made in our knowledge of\\nthe presence of a contagium vivum, or living con-\\ntagious element in the production of disease and fer-\\nmentations, was made by Frederick Miiller, of Copen-\\nhagen, and was the result of a systematic attempt to\\narrange the knowledge which had been accumulated\\nduring all those years. From that time to the present,\\nthe science has made great strides; so that we have\\nnow an accurate knowledge of the bacteria which", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0015.jp2"}, "16": {"fulltext": "12 BACTERIOLOGY.\\ncause a number of different diseases. The knowledge\\nof methods and details of work is now so general that\\nthe science of bacteriology is rapidly growing, and\\nhas revolutionized already very many branches of\\nmedicine.\\nIn 1840, Henle was led to believe that the cause of\\nmiasmatic, infective, and contagious diseases must be\\nlooked for in living fungi, or other minute living\\norganisms. Unfortunatelv, at that time the methods\\nof study employed prevented him from demonstrating\\nthe accuracy of his belief. It was left for Pasteur and\\nKoch to complete the work. Davaine, in 1848, was\\nthe first to see and to recognize disease-producing\\nbacteria he saw anthrax-bacilli in the blood of sheep\\ndead of splenic fever.\\nPasteur then took up the work; and in 1857 his\\nfaultless demonstration of the germ-theory of disease\\nwas brought out as a result of his experiments on fer-\\nmentation and putrefaction, and on the bacteria of\\nwine and those of the silkworm. He showed that the\\nacetic fermentation, viscosity, bitterness, and turning\\nflat of wines are due to the action of certain organized\\nferments, and demonstrated a causal relation between\\ncertain lowly-organized parasitic organisms and spe-\\ncial diseases in animals and insects. Upon Pasteur s\\nobservations Lord Lister based his successful system\\nof the treatment of wounds, known as u antiseptic\\nsurgery.\\nWe all know of the wonderful success which now\\nmarks the operations of major surgery, and of the\\ndaring boldness of operators who attempt what was\\nutterly impossible as long as antiseptic surgery was\\nunknown. Lister, accepting the truth of Pasteur s", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0016.jp2"}, "17": {"fulltext": "HISTOR Y OF BA CTERIOL OGY. I 3\\nstatement that germs are the producers of fermenta-\\ntions concluded that germs entering wounds from the\\noutside might be the cause of suppuration; and since\\ngerms are always and everywhere floating in the air,\\nsuspended in water, and attached to the surgical in-\\nstruments, dressings, and sponges used in operations,\\nhe judged correctly that it was highly advantageous\\nto employ an antiseptic agent in order to kill any of the\\nsuspended or adherent organisms before any materials\\ncould be allowed to come in contact with wounded\\ntissues; consequently, the hands of the operator and\\nhis assistants, the surgical instruments, sponges, dress-\\nings, sutures and ligatures, were kept constantly satu-\\nrated with a solution of carbolic acid (1 40), and the\\noperation was performed under a spray of carbolic acid\\n(1 20). Carbolized dressings were used; and if the\\ndischarge was profuse, the dressings were changed\\nonce in twenty-four hours under a constant use of the\\nspray. The researches of a later date have shown, how-\\never, not only that the atmosphere cannot be disin-\\nfected, but also that the air of ordinarily quiet rooms,\\nwhile containing the spores of numerous saprophytic\\norganisms, rarely contains many pathogenic bacteria.\\nWe also know that a direct stream of air, such as is\\ngenerated by an atomizer, causes more bacteria to be\\nconveyed into a wound than ordinarily would fall\\nupon it, thereby increasing instead of lessening the\\ndanger of infection. Lister, we must remember, was\\nnot the discoverer of carbolic acid nor of the fact that\\nit would kill bacteria; but, convinced that inflamma-\\ntion and suppuration were caused by the entrance of\\ngerms from the air, instruments, sponges, and dress-\\nings, into wounds, he suggested the antisepsis which", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0017.jp2"}, "18": {"fulltext": "14 BACTERIOLOGY.\\nwould result from the use of sterile instruments, clean\\nhands, dressings, towels, and the like; and made ap-\\nplications intended to keep the surface of the wound\\nmoistened with a germicidal solution in order to kill\\nsuch germs as might accidentally enter. He also\\nintroduced the practice of concluding operations by\\nthe application of a protective dressing, such as would\\ntend to preclude the entrance of germs at a sub-\\nsequent period. Listerism has spread slowly but\\nsurely to all the departments of surgery and obstetrics.\\nSince Lister s treatment was first inaugurated,\\nmany details of its application have been variously\\nmodified and great additions to our knowledge have\\nbeen made. In bacteriology much important work\\nhas been done, and great advances are being con-\\nstantly made. There are a number of diseases, each\\none of which has been definitely proved to be caused\\nby a germ of its own, a germ which causes no other\\ndisease. There is also a list of diseases in which the\\nproof is not yet conclusive, but for which the proba-\\nbility is that a specific germ will be found. The\\nfollowing data have been gathered chiefly from the\\nworks of McFarland and Woodhead.\\nIn 1845, Langenbeck discovered that the specific\\ndisease of cattle known as actinomycosis could be\\ncommunicated to man. His observations, however,\\nwere not given to the world until 1878, one year\\nafter Bollinwr had discovered the cause of the\\ndisease in animals.\\nIn 1847, Semmelweis, on the basis of his own\\nobservations, formulated the precept that puerperal\\nfever is the result of the introduction of organic\\nferments into the puerperal genital tract. This dis-", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0018.jp2"}, "19": {"fulltext": "HISTORY OF BACTERIOLOGY. 1 5\\ncovery, established by himself and confirmed by the\\nobservations of many others, marked an era in ob-\\nstetrics. The organic ferments have since been\\nidentified as specific bacteria. Semmelweis, in this\\nway, anticipated in practical antisepsis the discover-\\nies of Lister and Pasteur; while the late Oliver Wen-\\ndell Holmes, in a paper entitled Puerperal Fever a\\nPrivate Pestilence, published in 1843, and repub-\\nlished in 1855, in treating of its prophylaxis, an-\\nticipated the teaching of Semmelweis. Semmelweis\\nwas first led to recognize the source of puerperal in-\\nfection by the case of Prof. Koletschka, of the\\nUniversity of Vienna, who, having received a dis-\\nsection-wound, became thereby fatally infected. In\\nconsequence of this, Semmelweis concluded that\\nthere was an identity between this infection and that\\nof which so many hundreds of puerperal women\\ndied. In the school for instruction in practical ob-\\nstetrics, with which he was connected, there were\\ntwo departments, one for medical students, the other\\nfor mid wives; the students going as a rule directly\\nto the obstetric w 7 ard from the autopsy-room. He\\nfirst noted the much greater mortality in the stu-\\ndents ward, and in May, 1847, began to require the\\nstudents to wash their hands in chlorin-water before\\nmaking vaginal examinations, thereby reducing the\\npuerperal mortality to a point lower than had been\\never before reached.\\nIn 1863, Davaine established by experiments the\\nbacterial nature of splenic fever, or anthrax.\\nIn 1869, the first complete study of a contagious\\naffection was made by Pasteur, in two diseases affect-", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0019.jp2"}, "20": {"fulltext": "1 6 BACTERIOLOGY.\\ning silkworms pebrine and flacherie which he\\nshowed to be due to micro-organisms.\\nIn 1875, Koch described more fully the anthrax-\\nbacillus, gave a description of its spores and the\\nproperties of the same, and was enabled to cultivate\\nthe germ on artificial media; and, to complete the\\nchain of evidence, Pasteur and his pupils supplied\\nthe last link by reproducing the same disease in\\nanimals by artificial inoculation from pure cultures.\\nThe study of the bacterial nature of anthrax has been\\nthe basis of our knowledge of all contagious mala-\\ndies; and most advances in technic have been made\\nfirst through the study of the bacillus of that disease.\\nIn 1879, Hansen announced the discovery of bacilli\\nin the cells of leprous nodules. They were subse-\\nquently clearly described by Neisser. From the\\nnature of the symptoms and from the course of the\\ndisease, leprosy up to this time was long considered\\nto be a disease similar to tuberculosis, and the dis-\\ncovery of the bacillus paved the way for the recep-\\ntion of Koch s discovery of the tubercle-bacillus.\\nIn the same year Neisser discovered the gonococ-\\ncus to be the specific cause of gonorrhea.\\nIn 1880, the bacillus of typhoid fever was first\\nobserved by Eberth, and independently by Koch.\\nIn 1880, Pasteur published his work upon\\nu chicken-cholera, an epidemic disease which affects\\nturkeys, pigeons, chickens, ducks, and geese, and\\nwhich causes almost as much destruction among\\nthem as the occasional epidemics of cholera and\\nsmall-pox produce among man.\\nIn the same year Sternberg described the pneumo-\\ncoccus, calling it Micrococcus Pasteuri, which he", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0020.jp2"}, "21": {"fulltext": "HISTORY OF BACTERIOLOGY, 1 7\\nsecured from his own saliva; and in the same year\\nPasteur also found the same organism in saliva;\\nthough it is to Fraenkel, Talamon, and particularly\\nYVeichselbaum, that we are indebted for the dis-\\ncovery of the relation which the organism bears to\\npneumonia.\\nIn 1882, Robert Koch made himself immortal by\\nthe discovery of and work upon the bacillus of tuber-\\nculosis, one of the most dreadful, and unfortunately\\nmost common, diseases of mankind. While great\\nmen of the earlier days of pathology clearly saw that\\nthe time must come when the parasitic nature of this\\ndisease w r ould be proved, and some, as Klebs, Ville-\\nmin, and Cohnheim, w^ere u within an ace of the\\ndiscovery, it remained for Koch to succeed in dem-\\nonstrating and isolating the specific bacillus, and to\\nwrite so accurate a description of the organism and\\nthe lesions it produces as to render the discovery one\\nof the most complete ever made in the history of\\nmedical science.\\nIn the same year Loeffler and Schiitz reported the\\ndiscovery of the bacillus of glanders, an infectious\\ndisease almost confined to certain of the low T er ani-\\nmals; although occasionally persons whose habitual\\nassociation with and experimentation upon animals\\nbring them into frequent contact with such as are\\ndiseased, have become accidentally infected.\\nIn 1884, Koch discovered the comma-bacillus,\\nthe cause of cholera.\\nIn the same year Loeffler discovered the diphthe-\\nria-bacillus, and Nicolaier that of tetanus.\\nOn October 26, 1885, Pasteur made the first ap-\\nplication to human medicine of his method for the\\n2", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0021.jp2"}, "22": {"fulltext": "1 8 BACTERIOLOGY.\\ncure of hydrophobia, nearly ten years before the time\\nwe began to understand the production and use of\\nantitoxins.\\nIn 1890, Koch issued to medical men what is now\\nknown as tuberculin, a brownish, syrup-like fluid\\nused in the diagnosis and treatment of tuberculosis.\\nIn 1892, Canon and Pfeiflfer discovered the bacillus\\nof influenza.\\nIn the same year Canon and Pielicke first found a\\nbacillus now thought to be the specific cause of\\nmeasles.\\nIn 1894, Yersin and Kitasato independently iso-\\nlated the bacillus causing the bubonic plague then\\nprevalent at Hong-Kong, and now threatening\\nEurope.\\nSanarelli, in 1896, reported the discovery of the\\nmicro-organism of yellow fever. His conclusions\\nwere based on the presence of a certain germ in 58\\nper cent, of cases examined, and the production of\\nsymptoms and pathologic changes in the lower\\nanimals resemble those present in man. Sanarelli s\\nobservations have been confirmed by a commission\\nof the U. S. Marine-Hospital Service; but Sternberg\\nand his assistants doubt the specific relation of the\\nBacillus icteroides, as it is called, to yellow fever.\\nEpidemic cerebrospinal meningitis, or spotted\\nfever, is now known to be caused by a specific germ\\npresent in the cerebrospinal fluid of patients suffering\\nfrom this disease. The route of infection is not\\nfully determined, but it is probably through the\\nnose.\\nMalta-fever, a disease of the Mediterranean islands,\\nand occasionally of the Antilles and Central and", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0022.jp2"}, "23": {"fulltext": "HISTORY OF BACTERIOLOGY. 1 9\\nSouth America, is due to a micrococcus discovered\\nby Bruce, and called Bacillus melitensis.\\nMalarial fever is an infectious disease; but, unlike\\nthose mentioned, it is not caused by a vegetable germ,\\na bacterium, but by a microscopic animal, the Plasmo-\\ndium malaricz, which is found in the blood of the\\nafflicted individual. How it enters the blood is not\\ndefinitely known, but the best authorities hold that\\nits entrance is brought about by the stings of mos-\\nquitoes.\\nThere is a widespread belief that malignant\\ntumors cancers and sarcomas are due to infection\\nwith parasites. The nature of the parasite is as yet\\nunknown; but the latest researches point to a tiny\\norganism, a yeast-plant or blastomycete.", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0023.jp2"}, "24": {"fulltext": "CHAPTER II.\\nBACTERIA AS THE CAUSES OF DISEASE.\\nDiseases may be divided into two great classes\\nthe constitutional, which are due to such causes as\\nerrors in diet, alcoholic excesses, overwork, or age;\\nand the infectious or contagious, which are due to the\\nintroduction into the body of a living poison. We no\\nlonger look upon infectious and contagious diseases\\nas due to an unexplainable something, whose source\\nwe cannot know, whose course w 7 e cannot predict, and\\nwhose end cannot be hastened by any efforts on our\\npart. Investigation has shown that we are no longer\\nfighting an unknown enemy in the dark, but that we\\nhave before us a definite, living thing, whose part in\\nthe plan of creation is as surely fixed as our own,\\nwhose life-history can be told, and whose growth is\\nas dependent on the right amount of light, food, heat,\\nand air as that of the rose in our garden.\\nThe word bacteria is a general name for all the\\nplant micro-organisms. Of these there are many\\ndifferent classes with different names. They vary\\nmuch in shape and size, some being round, some\\nthread-like, some rod-shaped, and some of a spiral\\nform. Each single organism consists of a small speck\\nof protoplasm or vegetable albumin, to which maybe\\ngiven the name of a cell; and these cells are so minute\\nthat they can be seen only with the aid of the best\\n20", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0024.jp2"}, "25": {"fulltext": "BACTERIA AS THE CAUSES OF DISEASE. 21\\nmicroscopes at our command. The rounded organisms,\\nor micrococci, as they are called, are seldom more than\\n25-J^o \u00c2\u00b0f an mc U diameter the elongated cells\\naverage a little more perhaps, and are from x^Jou\\n\u00e2\u0096\u00a01\\nn\\np IG x \u00e2\u0080\u0094Various forms of bacteria: i and 2, round and oval micro-\\ncocci; 3, diplococci; 4, tetracocci, or tetrads; 5, streptococci; 6, bacilli; 7,\\nbacilli in chains, the lower showing spore-formation; 8, bacilli showing\\nspores, forming drumsticks and Clostridia; 9 and io, spirilla n, spirochete\\n(McFarland).\\nto g^ of an inch in length. Different forms nat-\\nurally vary from this standard of size; but these fig-\\nures will give a good idea as to the actual size of\\nthe forms under consideration.\\nThe fungi connected with disease in man are divided\\ninto three classes\\n1. Moulds, or hyphomycetes.\\n2. Yeasts, or blastomycetes.\\n3/ Bacteria, or schizomycetes.\\nSome bacteria, or schizomycetes, induce the various\\nfermentations; while others are productive of putre-\\nfaction, and are called saprophytes. Others, again,\\nknown as the pathogenic bacteria, are the cause of\\nvarious diseases; while those which do not ordinarily\\ncause disease are known as the non-pathogenic bac-\\nteria. The chief forms of bacteria are\\n1. The coccus berry-shaped or spherical bacte-\\nrium.\\n2. The bacillus rod-shaped bacterium.\\n3 The spirillum corkscrew bacterium.", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0025.jp2"}, "26": {"fulltext": "22 BA CTERIOL OGY.\\nAnd these, which are species relatively monomorphous\\ni. c., preserve their shape are practically the only\\nones with which we have to do.\\nThe cocci are named according to their arrange-\\nment with one another; if, for instance, they are in\\npairs, they are called diplococci; if in a chain, they are\\na b c d e f\\ng h i j\\nFig. 2. Diagram illustrating the morphology of cocci a, coccus or\\nmicrococcus b, diplococcus c, d, streptococci e, f y tetragenococci or\\nmerismopedia; g t h, modes of division of cocci; i, sarcinse y, coccus with\\nflagella k, staphylococci (McFarland).\\ncalled streptococci; if in a cluster, like a bunch of\\ngrapes, they are called staphylococci; and if in an\\nirregular mass, stuck together by a thick substance,\\nthey constitute a zooglea. Those developing in fours\\nare called tetrads; in eights, sarcinse.\\nThe cocci are also named according to their func-\\ntions, as, for instance, u pyogenic, or pus-forming;\\nthe specific name also describing the form, arrange-\\nment, color, and function; for example, Staphylo-\\ncoccus pyogenes aureus signifies a spherical colorless\\nmicro-organism forming a yellow pigment, arranging\\nitself with its fellows into the form of a bunch of\\ngrapes, and producing pus.\\nBacteria reproduce in two ways By direct division\\n(fission) and by the development of spores or seeds", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0026.jp2"}, "27": {"fulltext": "BACTERIA AS THE CAUSES OF DISEASE. 23\\n(sporulation). The most common mode is by binary\\ndivision, one body dividing itself so as to form two\\nother bodies; these two re-dividing, and so on, It\\ncan readily be imagined how quickly an appalling\\nincrease in their numbers can be thus brought about;\\nbut fortunately this multiplication only takes place to\\nadvantage under certain favorable conditions; if these\\nare not present, the bacterium begins to degenerate,\\nbut usually does not die until it has left behind a spore.\\nWhen the formation of a spore is about to commence,\\na small bright point appears in the protoplasm, and\\nincreases in size until its diameter is nearly or quite\\nas great as that of the bacterium. As it nears perfec-\\ntion a dark, highly refracting capsule is formed about\\nit. As soon as the spore arrives at perfection the bac-\\na b c d e f\\nFlG. 3. Diagram illustrating sporulation: a, bacillus inclosing a small,\\noval spore; b, drumstick-bacillus, with terminal spore; c, Clostridium, with\\ncentral spore d, free spores e and f t bacilli escaping from spores\\n(McFarland).\\nterium seems to die, as if its vitality were exhausted\\nin the development of the permanent form. As soon\\nas the young bacillus escapes it begins to increase in\\nsize, develops around its soft protoplasm a character-\\nistic membrane, and having once established itself\\npresently begins the propagation of its species by fission.\\nIn those forms of organism in which spores are not\\nfound the germs die very rapidly unless the conditions\\nfor their nutrition and multiplication remain very\\nfavorable. If all bacteria were of this kind, it would\\nbe possible to exterminate them with consider-", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0027.jp2"}, "28": {"fulltext": "24 BA CTERIOL OGY.\\nable rapidity. Spores will survive a great heat, a\\nheat which will kill the organism from which the\\nspore came; they will also live under a treatment\\nwith germicidal solutions which renders the bacteria\\ninactive. In other words, the spores are much more\\nresistant to the effect of germicides than the bacteria\\nthemselves. Cold does not kill them; they live\\nthrough it and develop whenever favorable surround-\\nings for their growth present themselves. They may\\nlie dormant in the system for years, waking into\\nactivity only when they come into contact with some\\ndamaged, weakened, or diseased part which affords\\nthem a nest in which to develop and multiply, the\\ncellular activity of the weakened part being unable to\\ncope with the organisms.\\nThe conditions which influence the growth of bac-\\nteria are, first, a temperature ranging from 85 to 104\\nF. some forms requiring a higher and some a lower\\ntemperature. Some forms of bacteria are not influ-\\nenced in their growth by the presence or absence of\\nlight. To some, sunlight is destructive. A few\\nhours exposure to the sun is fatal to the anthrax-\\nbacillus and to cultures of the Bacillus tuberculosis.\\nThe rays of the sun, however, must come into contact\\nwith the germs and are usually active only on the\\nsurface of cultures.\\nThe majority of bacteria grow best when exposed\\nto the air. Some develop better if the air is with-\\nheld; some will not grow at all if the least amount\\nof oxygen is present. Those that grow in oxygen are\\ncalled the aerobic bacteria, and those that will not\\ngrow in the presence of oxygen are the anaerobic\\nbacteria.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0028.jp2"}, "29": {"fulltext": "BACTERIA AS THE CAUSES OF DISEASE. 2$\\nA certain amount of water is always necessary for\\nthe growth of bacteria, though the amount required\\nmay be very small. If dried, no form will multiply\\nand very many forms will die.\\nA soil consisting of highly organized compounds is\\nalso necessary for their growth and multiplication, and\\nslight modifications in it may prove fatal to some\\nforms of bacterial life, but be highly advantageous to\\nothers.\\nWith age bacteria lose their strength and die. So\\nwe see that a suitable soil, and a proper amount of\\nlight, heat, and air are absolutely necessary for the\\ngrowth and development of bacteria, for they carry\\non all the functions of a higher organized life; they\\nbreathe, eat, digest, excrete, and multiply.\\nThe disease-producing bacteria effect entrance into\\nthe interior of the body through the skin and super-\\nficial mucous membranes, wounds, alimentary canal,\\nrespiratory tract, and placenta.\\nThe entrance of bacteria into the tissues through\\nthe sound skin is very rare indeed, although some\\nauthorities claim that infection has taken place\\nthrough the rubbing of bacteria or their spores upon\\nthe skin. The dangers of infection through the\\nbroken skin are well recognized; hence every wound,\\nno matter how slight, should be protected as soon as\\npossible.\\nBacteria enter the alimentary canal through the\\nfood and drink. Typhoid infection has taken place\\nthrough the rectum, its occurrence being due to the\\nwearing of underclothing previously worn by typhoid\\nfever patients, and to the use of enema syringe tips\\nwhich had not been sterilized after their previous use.", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0029.jp2"}, "30": {"fulltext": "26 BACTERIOLOGY.\\nBacteria enter the respiratory tract through the\\nmouth and nose, as in a deep inspiration, or an act\\nof coughing, sneezing, or the like. Pneumonia\\nand tuberculosis are said to be the result of in-\\nspiration of the specific organisms. The direct\\ntransmission of bacteria from a parent to the fetus\\nhas long been a disputed question, but is now gener-\\nally conceded. The micro-organisms pass through\\nthe placenta and infect the fetus. Tuberculosis of\\nthe ovaries, Fallopian tubes, and uterus may origi-\\nnate through the blood, and infection from without\\nthrough the vagina. Infection through the blood is\\nevidenced by the general tuberculosis of all the vis-\\ncera. Infection from without may result in tuber-\\nculosis of the uterus, ovaries, and Fallopian tubes.\\nThe channels by which bacteria can enter the\\nbody are, then very numerous; and there is scarcely\\na moment in which some part of the body is not in\\ncontact with them. All the disease-producing germs\\nhave their favorable seat in some part of the body\\nwhere they grow more or less luxuriantly, and in the\\nsecretions and excretions of which the chief source\\nof their infection lies. The pneumonia-germ prefers\\nthe lungs; the typhoid fever germ selects the lower\\nportion of the small intestine; the diphtheria-germ\\nthe throat; the cholera-germ the intestinal tract;\\nthe germ of tuberculosis prefers the lungs, but it is\\ncalled a iC medical tramp, because it will lodge in\\nany part of the body and make its home there.\\nHence we hear of tuberculous glands of the neck,\\ntuberculous knee, intestinal tuberculosis, tuberculosis\\nof the kidney, bladder, uterus, ovaries, Fallopian\\ntubes, tuberculous peritonitis, etc. A tuberculous", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0030.jp2"}, "31": {"fulltext": "BACTERIA AS THE CAUSES OF DISEASE. 2J\\narea is always a danger to the system, and may infect\\ndistant organs or give rise to a general tuberculosis.\\nTo prove that a microbe is the cause of a disease it\\nmust fulfil Koch s circuit. It must always be found\\nassociated with the disease, and it must be capable\\nof forming pure cultures outside the body. These\\ncultures must be capable of reproducing the disease,\\nand the microbe must again be found associated with\\nthe morbid process thus reproduced. In other words,\\nwe must prove the bacteria to be always present; we\\nmust then isolate them, then prove that they can\\nproduce the disease in a healthy animal, and, finally,\\nhaving succeeded in doing all this, we must prove\\nthat no other form of bacteria can produce the\\ndisease, and that where these bacteria cannot be\\nobtained the existence of the disease is impossible.\\nAll these requirements have been met in many\\ninstances, and now there are a large number of dis-\\neases each one of which has been definitely proved to\\nbe caused by a germ of its own, a germ which pro-\\nduces that disease and no other. Most of the germs\\nneed a special train of circumstances in order that they\\nmay be active, so that, fortunately for us all, the\\nmere presence of the germ itself is not sufficient to\\nproduce the disease. For instance, we know that\\ndiphtheria is caused by a germ of its own which\\ncauses that disease and no other; still, exposure to\\nthat germ does not invariably produce diphtheria if\\nit did, we should all be infected with it. This is\\nbecause other conditions than the mere presence of\\nthe germs are needed to produce the disease. The\\ngerms must be active, and they can act only under\\ncertain conditions. It will usually be found that the", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0031.jp2"}, "32": {"fulltext": "28 BACTERIOLOGY.\\nattack of the disease has been preceded by a local\\ninflammation of the throat, thus making a suitable\\nplace for the specific action of the diphtheria-germs.\\nIn typhoid fever the germs require a suitable condi-\\ntion of the bowels before they can produce the dis-\\nease. This is also true of cholera, and explains why\\ntaking care of the health makes such a difference in\\nthe taking of this disease. The germs find their way\\ninto the body through the food and drink. Cases are\\nreported that show how the germs enter drinking-\\nwater, which is sprinkled over vegetables sold in the\\nstreets of cholera-infected districts, how they are car-\\nried about in clothing, and taken to articles of food\\nupon the table by flies which have preyed upon chol-\\nera excrement. Healthy lungs are not a suitable loca-\\ntion for the development and activity of the germs of\\ntuberculosis. If we are not fully in good health, or\\nif we inherit a tendency to this special disease, we\\nmay acquire it very readily, since we often inhale the\\ngerms of it. Should the disease take root in our\\nlungs, it may be controlled to a certain extent by a\\nchange of climate and surroundings; by going, for\\nexample, from a low and damp locality to the mild\\nand dry atmosphere of Colorado, the Carolina moun-\\ntains, Southern California, or of the other South-\\nwestern States, where there are few cloudy days and\\nwhere violent atmospheric changes are rare. The\\ngerms there cannot be so active, for the air is stimu-\\nlating, pure, and invigorating to the nervous system.\\nThe rarefaction of the air causes deep and strong\\ninvoluntary respiratory movements, and there is con-\\nsequently enforced a better ventilation of the lungs\\nand a better oxygenation of the blood, in conse-", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0032.jp2"}, "33": {"fulltext": "BACTERIA AS THE CAUSES OE DISEASE. 29\\nquence of which there follow more active tissue-\\nchanges throughout the body and a strengthening\\nof the respiratory muscles.\\nOn finding favorable conditions it takes germs some\\ndays to develop and produce the disease; this time is\\nknown as the period of incubation.\\nThe question is often asked, Why, when we are so\\nconstantly in contact with disease-germs, do we not\\ncontract the diseases? All bacteria leave the body\\nthrough the skin, lungs, kidneys, or bowels; and\\nby a faithful use of disinfectants and antiseptics\\nthe germs may be kept confined to their original\\nposition. After their escape from the body they are\\ndifficult to control. The scales of skin or dandruff\\nfrom a case of scarlet fever, measles, or small-pox, or\\nthe dust that arises from the dried sputum of a\\npneumonia or tuberculosis patient, or the poisonous\\nmaterial which may enter our drinking-water from\\ntoo close proximity of the well and the sewer into\\nwhich typhoid discharges have been emptied, may\\nreadily be the means of propagating disease. These\\nsources of infection should be scrupulously avoided.\\nAnother protective factor is the natural or acquired\\npower of resistance to disease-producing germs.\\nImmunity is either natural or acquired. Of\\nacquired immunity w 7 e have two varieties, that which\\ncomes from acclimatization, and artificial immunity.\\nBy natural immunity is meant the natural and\\nconstant resistance to disease-producing germs. The\\nindividual is immune by Nature, and sometimes by\\nracial characteristics. Acquired immunity is a\\npower of resistance attained through various cir-\\ncumstances. Thus, a single attack of some of the in-", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0033.jp2"}, "34": {"fulltext": "30 BACTERIOLOGY.\\nfectious and contagious diseases usually confers im-\\nmunity against subsequent attacks. Such immunity\\ngenerally follows an attack of typhoid fever, small-\\npox, scarlet fever, mumps, whooping-cough, measles,\\nor yellow fever. Second attacks may occur but, as\\na rule, a patient who has had an attack of one of\\nthese diseases has immunity for life. Influenza,\\npneumonia, cholera, diphtheria, and erysipelas are\\namong the diseases in which one attack is not\\nprotective. Vaccination usually insures immunity\\nagainst small-pox; but this is ordinarily not so com-\\nplete or permanent as that resulting from an attack\\nof the actual disease.\\nAcclimatization immunity is exemplified by vari-\\nous diseases which do not trouble natives or those\\nlong resident, but which may affect strangers not im-\\nmured to the climate.\\nRacial immunity is that in which certain races are\\nsafe from certain diseases; for instance, negroes sel-\\ndom suffer from yellow fever, but are more suscep-\\ntible than whites to small-pox. It is asserted that the\\nArabs seldom or never have typhoid fever. An analo-\\ngous example is afforded by the fact that white mice\\nare not affected by the same diseases as the gray\\nmice are, even though subjected to the same influ-\\nences in respect to climate, food, etc.\\nArtificial immunity may be produced in various\\nways. It is said that an injection of the antitoxin of\\ndiphtheria will give protection against the disease for\\nfrom four to eight weeks. Tetanus has been prevented\\nin a similar manner. It is impossible here to enter,\\nexcept to a slight degree, into the consideration of\\nthe many theories of immunity, since they are very", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0034.jp2"}, "35": {"fulltext": "BACTERIA AS THE CAUSES OF DISEASE. 3 1\\nintricate, and not one has been advanced so far that\\ncan clearly explain it. The theory of phagocytosis\\nand the theory of antitoxins are the two most im-\\nportant.\\nPhagocytosis is the destruction of bacteria by the\\nwhite cells of the blood and the cells of fixed tissues.\\nThe cells which eat up and destroy the germs are called\\n11 phagocytes. When the two meet a battle occurs,\\nthe bacteria fighting the cells with their active fer-\\nments, while the cells on their side put forth every\\neffort to protect the body against the assaults of the\\ndisease. In a majority of the cases the bacteria win\\nto the extent that the phagocytes die; but others take\\ntheir place until the infection is overcome or the\\npatient dies. The white blood-cells and tissue-cells\\nhaving thus been educated to withstand the poison,\\ntheir descendants inherit this capacity and are born\\ninsusceptible. This theory w r as suggested by Carl\\nRoser in 1881. Sternberg and Koch afterward put\\nforth the same view, but it is usually credited to\\nMetschnikoff, who published his observations in\\n1884. The theory is now known as the u Metschni-\\nkoff theory of phagocytosis/ and assumes an educated\\nwhite corpuscle and body-cell.\\nThe other theory the so-called antitoxic theory\\nis founded on numerous more or less convincing ex-\\nperiments. If an animal be injected with certain\\npathogenic bacteria or their toxins in gradually\\nascending doses, it can be immunized to doses that\\nunder other circumstances would prove fatal. The\\nblood-serum of an animal thus immunized has the\\npower, when injected into another animal, of ren-\\ndering it also immune to the bacteria that have", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0035.jp2"}, "36": {"fulltext": "32 BACTERIOLOGY.\\noriginally been used; and in some cases the serum\\nis even capable of curing the disease after it has\\ndeveloped in another animal. These properties with\\nwhich the blood-serum has become endowed depend\\nupon the presence of what are called antitoxins and\\nantibacterial bodies. In man also, after recovery\\nfrom certain infectious diseases, it is possible to\\ndemonstrate in the. blood-serum the presence of anti-\\ntoxic substances; and it is now the general belief\\nthat immunity, at least of the acquired form, is due\\nto such antitoxins. The uses and practical prep-\\naration of antitoxins will be described in the next\\nchapter.\\nThe most important of the special surgical micro-\\norganisms i. e., those most frequently met with in\\nsurgical work are the following, the majority being\\npus-producers\\ni. Staphylococcus Pyogenes Aureus This is the\\nmost common form; it is quickly killed by carbolic\\nacid (i 20), bichlorid of mercury (1 1000), or by a few\\nmoments boiling. It is found in the mouth, alimen-\\ntary canal, and under the nails; it lives in the eyes,\\nnose, ears, mouth, in the superficial layers of the skin,\\nand is distributed in the water, soil, and air, especially\\nin the dust of houses and surgical wards where the\\nproper precautions are not taken.\\n2. Streptococcus pyogenes is a most important path-\\nogenic micro-organism, and is thought by many\\nauthorities to be identical with the streptococcus of\\nerysipelas. The Streptococcus pyogenes is frequently\\nassociated with internal diseases, and has been found\\nin the uterus in cases of infective puerperal endome-\\ntritis, ulcerative endocarditis, acute septicemia, and", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0036.jp2"}, "37": {"fulltext": "BACTERIA AS THE CAUSES OF DISEASE.\\nother diseases. It is one of the most common causes\\nof post-operative peritonitis.\\n3. The Bacillus colt communis is always present in\\nthe intestine, and is thought to be a frequent cause\\nof acute suppurative peritonitis.\\n4. The Staphylococcus pyogenes albics resembles the\\naureus in form, but is less virulent. It is a common\\ncause of suppuration, and although it has been found\\nalone in acute abscesses, it is usually associated with\\nother pyogenic cocci, chiefly the Staphylococcus pyo-\\ngenes aureus.\\n5. The Staphylococcus epidermitidis albus is a micro-\\ncoccus which is almost always present upon the skin,\\nnot only upon the surface, but also in the Malpighian\\nlayer.\\n6. The Staphylococcus pyogenes citreus is not quite\\nso common nor so pathogenic as the other forms, and\\nis less important.\\n7. The Bacillus pyocyaneus exists in pus (especially\\nin open wounds), and gives to it a peculiar bluish or\\ngreenish color.\\n8. The Bacillus aerogenes capsulatus is a gas-pro-\\nducing bacillus that sometimes causes death after\\noperations on the uterus; it may also enter through\\naccidental wounds.\\n9. The Bacillus tuberculosis is the cause of all tuber-\\nculous processes. The chief cause of the spread of\\ninfection is found in the dried sputum, which becomes\\npulverized and is then inhaled as dust and since\\none patient may expectorate as many as four billion\\nbacilli in twenty-four hours, his capacity for harm is\\nverv considerable. The bacilli retain virulence for five", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0037.jp2"}, "38": {"fulltext": "34 BACTERIOLOGY.\\nmonths in dried sputum, and in putrid sputum for\\nforty-three days.\\n10. The Micrococcus laiiceolatus, known also as\\nStreptococcus lanceolatus, pneumococcus, and Diplo-\\ncoccus pneumoniae, is the cause of croupous pneu-\\nmonia and of many of the acute inflammations of the\\nserous membranes of the body. It is also a pus-pro-\\nducer, and has been found in empyema and acute\\nabscesses.\\nii. The bacillus of tetanus is found particularly in\\ngarden-soil, in the dust of halls, walks, cellars, street-\\ndirt, and in the refuse of stables. It is not a pus-\\nproducer. Tetanus is a disease due to the absorption\\nof its toxins, which poison the nervous system pre-\\ncisely as would dosing with strychnin.\\n12. The diphtheria-bacillus causes the dreaded dis-\\neases diphtheria and membranous croup, as well as\\ninflammations of the eyes and nose; at times it also\\nattacks open wounds.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0038.jp2"}, "39": {"fulltext": "CHAPTER III.\\nTHE THEORY OF ANTITOXINS.\\nGreat progress has been made of late in the field\\nof serum-therapy, though much remains open to ques-\\ntion and many recorded facts cannot yet be explained.\\nThe field for the investigator is perhaps larger than\\never before. For a better understanding of the sub-\\nject of antitoxins and their therapeutic application, a\\nfew essential facts should be borne in mind. An anti-\\ntoxin is not the direct result of bacterial action, but\\nis properly described as an unknown body resulting\\nfrom the resistance of the healthy organism to the\\ntoxins of pathogenic bacteria. According to the pre-\\nvailing theory, antitoxins are the products of the\\nbody-cells, formed under the influence of the bacterial\\ntoxin. In therapeutic practice the antitoxic body\\ncomes to us in the blood-serum of an animal, usually\\nthe horse. When properly prepared and properly\\nkept in aseptic containers the antitoxins are not at all\\ndangerous; they are as innocuous as an equal amount\\nof blood-serum or normal salt solution administered in\\nthe same way. Antitoxins are used both to counteract\\nthe effects of the toxins which are elaborated by path-\\nogenic bacteria in the body, and to render the sys-\\ntem immune, so that it may resist the action of the\\nbacteria should they gain access to the body. The\\nantitoxins do not destroy the bacteria; in other words,\\n35", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0039.jp2"}, "40": {"fulltext": "36 BACTERIOLOGY.\\nthey are not germicides. In fact, the antitoxic serums\\nare themselves good culture-media. One theory of\\ntheir action is that they neutralize the toxin, thus\\ngiving the natural bactericidal powers of the body an\\nopportunity to exercise their function.\\nThe following is a brief description of the process\\nemployed in the laboratory of Parke, Davis Co.,\\nfor the preparation of diphtheria-antitoxin\\nYoung horses in perfect condition are selected and\\nkept under careful observation by an expert veterina-\\nrian for three or four weeks. During- this time thev\\nare carefully tested with tuberculin for the possible\\nexistence of unsuspected and undeveloped tubercu-\\nlosis, and with mallein for glanders. When a horse\\nis found to be perfectly healthy it receives its first\\ndose of diphtheria-poison, or more properly a solution\\nof the toxin of the diphtheria-bacillus. This is pre-\\npared in the following manner A culture is obtained\\nfrom the throat of a patient suffering from a virulent at-\\ntack of diphtheria. The diphtheria-bacill us is isolated\\nfrom this culture and planted in a flask of bouillon\\nor beef-tea, which is then kept in an incubator from\\nthree to four weeks. At the end of this time it has\\nattained its maximum toxicity and the bacteria begin\\nto die of their own poison. The toxin which thev\\nhave elaborated in the course of their existence: is held\\nin solution in the beef-tea. This bouillon solution\\nof toxin is then filtered through porcelain to remove\\nthe bacterial cells and any other extraneous matter.\\nIt is then ready for injection into the horse. About\\none-tenth of one cubic centimeter is injected intra-\\nvenously. The horse responds with all the constitu-\\ntional symptoms of diphtheria, such as a chill, fever,", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0040.jp2"}, "41": {"fulltext": "THE THEORY OF ANTITOXINS. 37\\nloss of appetite, more or less pharyngeal paralysis,\\nwith regurgitation of food. Sometimes deatli occurs\\nfrom heart-paralysis. Upon recovery, which comes\\nwithin a few days, a slightly larger dose is given.\\nThis treatment is continued for about one year, at the\\nend of which time the horse will take from 2000 to\\n3000 times the initial dose without reaction. It is\\nthen ready for bleeding. About 6000 cubic centi-\\nmeters of blood are drawn from the external jugular\\nvein. This is allowed to clot, and the serum obtained\\nis known commercially as antitoxin. It is customary\\nto add an antiseptic, such as trikresol, to preserve the\\nserum.\\nIn preparing the streptococcus antitoxin a culture\\nis made of bacteria obtained from two sources ery-\\nsipelas and puerperal septicemia. This is done be-\\ncause some eminent bacteriologists believe that the\\nstreptococcus of erysipelas is not identical with the\\nstreptococcus of puerperal fever. It is but fair to say,\\nhowever, that others equally eminent assert the iden-\\ntity of the two streptococci. To meet the possibility\\nof the non-identity of the organisms, a culture ob-\\ntained from the two sources is used. Its virulence is\\nincreased by passing it through rabbits. After pass-\\ning through about fifty rabbits a culture is planted in\\nbeef-tea, and the same course pursued as for diphthe-\\nria-antitoxin. Antitubercle serum is obtained by im-\\nmunizing horses with the original Koch s tuberculin.\\nAs to the therapeutic action of antitoxin, little or\\nnothing is known positively. It seems reasonable to\\nconclude from experimental evidence that the anti-\\ntoxin neutralizes the toxin in the body and thereby\\ngives the natural germicidal powers an opportunity", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0041.jp2"}, "42": {"fulltext": "38 BACTERIOLOGY,\\nto dispose of the bacteria. It may be that it has the\\nadditional property of stimulating the phagocytic and\\npossibly other bactericidal functions. The following\\nexperiments made by Martin and Cherry in England,\\nand described in the Journal of the American Medical\\nAssociation of August 27, 1898, are of interest in this\\nconnection. Behring, Ehrlich, and Kanthack have\\nadvocated the theory that the antagonism between\\ntoxins and antitoxins is a chemicone, somewhat anal-\\nogous to the neutralization of an acid by an alkali;\\nwhile Buchner, Metschnikoff, and others have main-\\ntained that it is indirect and operates through the\\ncells of the organism. Martin and Cherry used a\\nsnake-venom antitoxin. A large number of guinea-\\npigs were used. At 6o\u00c2\u00b0C. the antitoxin was destroyed,\\nwhile the venom retained its virulence. In the con-\\ntrol-experiment with the venom only, all the animals\\ndied within a few hours. A number of mixtures were\\nmade of 1 c.c. of antitoxin with twice the fatal dose\\nof venom; others with three or four times the fatal\\ndose. These mixtures were allowed to stand at the\\nusual laboratory temperature (20 to 23 C.) for two,\\nfive, ten, fifteen, and thirty minutes respectively, then\\nheated to 68\u00c2\u00b0 C, and afterward injected.\\nAs remarked above, this heat destroyed the anti-\\ntoxin, so that none was injected. The animals sub-\\njected to the mixture of the stronger doses of ten min-\\nutes or less died or were seriously affected; all of those\\nreceiving the fifteen-minute mixture survived; while\\nthe thirty-minute mixtures produced no symptoms\\nwhatever. Similar results were obtained with diph-\\ntheria-antitoxin and toxin. These experiments seem\\nto show, as far as anything can, that the neutraliza-", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0042.jp2"}, "43": {"fulltext": "THE THEORY OF ANTITOXINS. 39\\ntion of toxins may occur in the test-tube, and that the\\nvital processes in the organism and the body-cells are\\nnot essential. These gentlemen made further exper-\\niments by passing a mixture of toxins and antitoxins\\nthrough a Pasteur-Chamberland filter. This was po-\\nrous for toxin, but not for antitoxin, owing to the\\ndifference in the size of their molecules. The toxin\\nwhich passed through the filter, after having been\\nmixed with antitoxin, was neutral. The unavoidable\\nconclusion from this experiment is that the toxin was\\nneutralized before filtration.\\nExperiments have been tried in order to prove the\\ntheory that toxins are albumoses and antitoxins globu-\\nlins; but these experiments do not appear to be con-\\nclusive as to this point.\\nThe supposition that the administration of antitoxin\\nis followed by a stimulation of the germicidal powers\\nof the body seems to be reasonable, at least in the\\ncase of the antistreptococcic serum, since the strepto-\\ncocci disappear with the passing away of the signs\\nand symptoms. On the other hand, the Klebs-Loeff-\\nler bacillus is found in the throat for weeks and even\\nmonths after the disappearance of all symptoms of\\ndiphtheria in cases treated with the antitoxin.\\nThe present status of diphtheria-antitoxin may be\\npresented in a few words. It has established itself as\\na specific in the treatment of this disease. During\\nthe past year the use of larger doses has become more\\ngeneral, and it seems certain that better results were\\nobtained. The administrators of the Chicago Depart-\\nment of Health give 2000 units in all cases of sus-\\npected diphtheria, and employ 1000 units as an im-\\nmunizing dose. During the months of November", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0043.jp2"}, "44": {"fulltext": "40 BA CTER10L OGY.\\nand December, 1898, this department treated 219\\ncases of bacteriologically proved diphtheria all char-\\nity cases with a death-rate of 4. 1 per cent. Some\\ntwo and a half years ago, when antitoxin was not used,\\nthe death-rate from diphtheria treated by this depart-\\nment was about 35 per cent.\\nAntistreptococcic serum gives promise of being\\nsecond only to the diphtheria-antitoxin in point of\\ntherapeutic value. It has been most successful in\\nerysipelas and puerperal septicemia. Cases of scarlet\\nfever are reported in which it has been useful in\\nshortening the duration of the disease and in pre-\\nventing unfortunate complications and sequelae, such\\nas otitis media and other suppurative processes due to\\nstreptococci.\\nA mixture of the toxin of the streptococcus of\\nerysipelas and the products of a harmless germ, the\\nBacillus prodigiosus, is used by Coley and others as an\\ninjection in malignant tumors that are past the stage\\nof operation or are so situated that an operation is im-\\npossible.\\nIt is to be regretted that tetanus-antitoxin does not\\nin clinical use do all that it will do in the laboratory.\\nIt has been used in a considerable number of cases,\\nbut in nearly every instance without any result that\\nwould justify us regarding it as a great curative\\nagent. Nevertheless, it should be used early in\\nevery case of tetanus and in large doses, because it is,\\nlike the other serums, harmless and the patient has a\\nsomewhat better chance of recovery.\\nOne or two cases have been successfully treated\\nwith intracerebral injections of antitoxin, the theory\\nbeing that the antitoxin should be placed where it", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0044.jp2"}, "45": {"fulltext": "THE THEORY OF ANTITOXINS. 4 1\\ncould neutralize the toxin which is producing the\\nconvulsions by means of its action on the nerve-\\ncenters. The value of this method of administration\\nhas not been proved.\\nAs a preventive measure the use of tetanus-anti-\\ntoxin is strongly commended.\\nThe antitubercle serum has not shown itself to\\nhave more value than a great number of other\\nremedies vaunted as specifics in tuberculosis.\\nMethod of Injecting Antitoxin. The serums and\\ntoxins are given hypodermically, the injection being\\nmade into the back, thigh, side of the breast, or over\\nthe chest. Perfect antisepsis for the operation is\\nabsolutely necessary. The puncture-wound is closed\\nwith a collodion dressing. It is not necessary to use\\nmassage for the purpose of causing more rapid ab-\\nsorption of the injected serum the swelling gener-\\nally disappears in a short time of itself. Sometimes\\nthe site of the injection becomes very painful. In\\ncertain cases, pains in the joints and various skin-\\neruptions (erythema, hives) develop after the injec-\\ntion. They are not of great moment, but the physi-\\ncian s attention should be called to them.\\nThe reaction following an injection of Coley s\\nmixture is sometimes severe, and may correspond\\nto the symptoms beginning an attack of erysipelas\\nchill, local redness, and high temperature.", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0045.jp2"}, "46": {"fulltext": "CHAPTER IV.\\nANTISEPTICS, DISINFECTANTS, AND\\nDEODORANTS.\\nSubstances which retard or check the growth of\\nbacteria amid otherwise suitable surroundings are\\ncalled antiseptics.\\nArticles and wounds which are entirely free from\\nbacteria and their spores are termed aseptic or sterile.\\nDisinfectants or germicides entirely destroy the\\nvitality of bacteria. Excessive heat, dry or moist, is\\na true disinfectant, because it entirely destroys bac-\\nteria, while cold is an antiseptic; it does not kill bac-\\nteria, but retards their development.\\nA chemic agent which will cause the death of bac-\\nteria is called a germicide.\\nA deodorant is an agent that destroys bad odors.\\nA disinfectant is an antiseptic, and may be a deodo-\\nrant; but because a substance has the power to de-\\nstroy bad odors it does not follow that it has the power\\nto destroy the bacteria which are the cause of the\\nodor. Carbolic acid, for instance, is a disinfectant\\nand deodorant; while Piatt s chlorides is a prompt\\ndeodorant, but has almost no disinfectant power.\\nThe power of a chemic agent to destroy bacteria\\ndepends on several conditions\\nFirst. The kind of bacteria, some being easily killed\\n42", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0046.jp2"}, "47": {"fulltext": "ANTISEPTICS, DISINFECTANTS, AND DEODORANTS, 43\\nby an agent which is entirely harmless to others.\\nSpores are much more resistant than the bacteria from\\nwhich they are derived.\\nSecond. The number of bacteria present.\\nThird. The temperature at which the exposure to\\nthe disinfecting agent is made; the higher the tem-\\nperature the greater the effect.\\nFourth. The strength of the solution; a small quan-\\ntity of a strong solution of corrosive sublimate is\\nmuch more efficient than a large amount of a weak\\nsolution.\\nFifth. The nature and quality of the associated\\nmaterial. If the bacteria are associated with a large\\namount of organic matter, the chemical agent used\\nmay combine with the latter and may thus be con-\\nverted into an ineffective material before it has an op-\\nportunity to act upon the bacteria. This result must\\nbe especially guarded against in the disinfection of\\nsputum and fecal matter.\\nThe agents capable of destroying bacteria are num-\\nberless but there are many which cannot be employed\\nin practice because they are too weak or act too slowly,\\nor are too poisonous, or too expensive for general use\\nin the required quantity, or are too destructive to the\\nobjects with which they come in contact. Water at\\na high temperature cannot be used for the disinfec-\\ntion of the hands of the surgeon or of the field of oper-\\nation, or of organic substances in general. Corrosive\\nsublimate cannot be employed in the sterilization of\\ninstruments, since it corrodes and blackens them; it\\nalso discolors clothing and furniture when used in\\nstrong solutions. Potassium permanganate stains\\neverything with which it comes in contact; it also", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0047.jp2"}, "48": {"fulltext": "44 ANTISEPTICS.\\ncauses pain and burns if used in very strong solu-\\ntions.\\nBy long-continued action in concentrated solution\\nsome of the agents which arrest the growth will finally\\nlead to the death of those bacteria which have been\\nsubjected to them. Many agents, however, which\\narrest the growth of bacteria, are not capable of de-\\nstroying them, and particularly their spores. Cold,\\nfor example, will arrest the development of bacteria\\nbut has no power to destroy anthrax-spores even when\\napplied with the most extreme intensity. The resist-\\n.ance of spores is one of the strangest phenomena in\\nnature; some can be boiled and some can be subjected\\nto the intensely cold action of liquid air without per-\\nishing. The chief disease-producing bacteria which\\nform spores and those which do not are\\nNon-spore-forming\\ni. Streptococcus pyogenes.\\n2. Staphylococcus pyogenes aureus, albus, and\\ncitreus.\\n3. Streptococcus of erysipelas (believed to be iden-\\ntical with the Streptococcus pyogenes).\\n4. Diphtheria-bacillus.\\n5. It is doubtful whether the tubercle-bacillus is\\nspore-forming. The weight of opinion favors the\\nabsence of spores in this organism.\\nAmong the spore-forming pathogenic organisms\\nare\\n1. Bacillus of malignant edema.\\n2. The tetanus-bacillus.\\n3. The anthrax-bacillus.\\nThe germicidal or disinfecting agents at our com-\\nmand are of two kinds chiefly, heat and chemic", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0048.jp2"}, "49": {"fulltext": "ANTISEPTICS, DISINFECTANTS, AND DEODORANTS, 45\\nagents. The term disinfection n is employed for\\nthe action of chemic agents, and u sterilization n for\\nthe action of heat.\\nAmong all germicidal or disinfecting agents heat is\\nentitled to the first place, and fire, for its thorough-\\nness, is superior to all others. All infected articles\\nof little value, books, playthings, etc., that can be\\nburned should be thus destroyed, as should also spu-\\ntum and bowel-movements. The very best way to\\ntreat the latter is to mix them with sawdust and then\\nto burn them.\\nIn surgical work, for the perfect sterilization of\\narticles capable of withstanding it, fire is preferable\\nbecause of its certain action. Edged instruments and\\nforceps may be exposed for a very short time to the\\ndirect flame; but if continued too long the temper of\\nthe steel is affected.\\nWe must remember that after sterilization there is\\nalways the danger of contamination, and the articles\\nmust, therefore, be carefully protected immediately\\nafter sterilization. If they are left uncovered for dust\\nto collect upon them, the object of sterilization is\\ndefeated.\\nHeat may be applied in the form of hot air, moist\\nair (steam), or boiling water.\\nBoiling water kills germs on contact, and de-\\nstroys anthrax-spores, as a rule, in from two to four\\nminutes.\\nMoist heat (steam) is the next most powerful agent.\\nIt is more thorough and more penetrating than hot air.\\nSteam exerts its full influence only when the air is\\nsaturated with it. Saturated steam may be simple\\nsteam (quiescent), live steam (circulating steam),", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0049.jp2"}, "50": {"fulltext": "4.6 ANTISEPTICS.\\nhigh-tension steam (confined under a certain press-\\nure), or superheated steam (that which has been\\nheated secondarily by conducting it through iron\\npipes which have been raised by flame to a tempera-\\nture of about ioo\u00c2\u00b0 C).\\nLive steam destroys anthrax-spores in from five to\\nfifteen minutes, according to their degree of resist-\\nance.\\nDisinfection by steam is applicable to clothing,\\nlinen, blankets, towels, surgical dressings, instru-\\nments, curtains, carpets, brushes, mattresses, pillows\\n(the two latter should be ripped open), and a number\\nof delicate fabrics. It is not applicable to linen\\nsoiled by feces, blood, or pus, since the stains would\\nbecome fixed by the process, nor to rubber articles.\\nUnder certain conditions many articles are exposed to\\nthe action of steam for one hour on three successive\\ndays, being kept during the intervals at a tempera-\\nture of 70 to 8o\u00c2\u00b0 C. to favor the development of\\nbacteria. This is called intermittent n or frac-\\ntional M sterilization, the object of which is to kill all\\nbacteria that may have developed from spores that\\nescaped the first steaming. The last sterilization is\\nfor the purpose of making sure.\\nHot air is inferior to both steam and hot water.\\nSteam at a temperature of ioo\u00c2\u00b0 C. is more effectual\\nthan hot air at a much higher temperature. Accord-\\ning to investigations, exposure to a temperature of\\n150 C. (302 P.) for one and a half hours in a hot-\\nair sterilizer will kill all known bacteria and their\\nspores.\\nThe list of chemic substances used as germicides\\nis constantly changing, and those which are now", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0050.jp2"}, "51": {"fulltext": "ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 47\\nconsidered the most valuable may in a little while be\\nconsidered not so effectual as newer ones. Among\\nthe recognized antiseptics and disinfectants now in\\nuse are\\nCarbolic acid, derived from coal-tar by distillation.\\nWhen pure, it is a solid, white, or faintly rose-\\ncolored, crystalline body, readily soluble in water,\\nalcohol, or glycerin. On exposure to air it absorbs 5\\nper cent, of moisture. A solution frequently employed\\nis one of 5 per cent, strength. To make a 5 per cent,\\nsolution, 1 part of carbolic acid is added to 20 parts\\nof very hot water and the whole shaken thoroughly.\\nAny excess of carbolic acid above that strength\\nfalls to the bottom of the vessel as pinkish globules.\\nBefore using the solution care must be taken that the\\nglobules have been dissolved, or they will burn any\\nliving tissue with which they come in contact. Car-\\nbolic acid is considered now to be the most reliable\\nand useful of all the germicides and antiseptics. It\\nhas the advantage over corrosive sublimate in that it\\ndoes not discolor instruments nor clothing; but, on\\nthe other hand, it irritates and benumbs the skin.\\nPure carbolic acid is a reliable disinfectant for instru-\\nments. If an instrument that is indispensable hap-\\npens to fall to the ground during an operation, it is\\nlaid for a few moments in pure carbolic acid, and\\nthen rinsed with sterile water, and is ready for use.\\nLong-continued submersion in the acid will, how-\\never, deprive knives and scissors of their temper and\\nedge. Symptoms of poisoning have been produced\\nby the absorption of the drug from surgical dressings\\nand from the use of carbolic solutions for irrigation.\\nThe first evidences of poisoning are a very dark", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0051.jp2"}, "52": {"fulltext": "48 ANTISEPTICS.\\ngreenish or a blackish coloration of the urine, head-\\nache, giddiness, ringing or singing in the ears, and\\nlassitude. The odor of carbolic acid is to a cer-\\ntain extent a protective against accident; yet fatal-\\nities occasionally occur. The antidote of carbolic\\nacid is milk and lime-water or flour and water.\\nThe strength of the solutions used varies from\\n1:80 to 1:20. The acid is bought usually in the\\nliquid form, having a strength of 95 per cent. To\\nmake a solution 1:20 (5 per cent.), 1:40 {2% per\\ncent.), 1:50 (2 per cent.), 1:80 {1% per cent.), 1\\nounce of the 95 per cent, solution is added to 20, 40,\\n50, or 80 ounces of water. When obtained in the\\nsolid form, it may readily be liquefied by placing the\\nbottle in a vessel of hot water.\\nCorrosive sublimate, or bichlorid of mercury, has,\\nlike carbolic acid, the advantage of being both effica-\\ncious and cheap. It has the disadvantages that it\\nis decomposed by alkalies, that it is precipitated by\\nalbumin, and that it corrodes metals. It is used in\\nstrengths of from 1:10,000 to 1:500. The solution\\nshould be made as it is needed, because in old solu-\\ntions most of the soluble corrosive sublimate has\\nbeen converted into insoluble calomel, and the solu-\\ntion is not germicidal. By using the compressed\\ntablets now on the market fresh solutions are readily\\nmade. A tablet usually contains the requisite amount\\nof corrosive sublimate to make when added to one\\npint of water a 1: 1000 solution, and by increasing or\\ndiminishing the amount of water the strength of the\\nsolution may be altered at pleasure. The tablets\\nare very convenient, and almost compel accuracy\\nin the preparation. Corrosive sublimate is of less", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0052.jp2"}, "53": {"fulltext": "ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 49\\nvalue for the disinfection of the excreta than car-\\nbolic acid, as it hardens the albuminous material\\nwhich covers the outside of all fecal masses, and\\nthus protects the inside from the desired action.\\nTartaric acid, chlorid of sodium, or chlorid of ammo-\\nnium is often added to prevent this. Compressed\\ntablets, each containing tartaric acid or ammonium\\nchlorid and 7*/^ grains of corrosive sublimate, or\\nequal parts of chlorid of sodium and corrosive sub-\\nlimate, are in common use. The convenient form in\\nwhich this drug is put up and the readiness with\\nwhich it can be used in surgical and medical work\\nhave made its adoption universal. Its poisonous\\ncharacter must be kept constantly in mind. The\\nfirst symptoms of poisoning in consequence of the\\nabsorption of the bichlorid are profuse salivation,\\nfetid breath, a metallic taste in the mouth, sore\\nteeth, spongy gums, and swollen tongue. Should\\nany of these symptoms appear they should at once\\nbe reported to the surgeon. As the solution has no\\nodor, it is occasionally swallowed in mistake. Should\\nthis occur, symptoms of a violent gastro-enteritis\\nappear vomiting, burning pain, bloody stools the\\nkidneys are also affected, and an acute Bright s dis-\\nease develops. The immediate treatment of this\\nacute poisoning consists in the giving of white of\\negg^ flour, or milk and lime-water, and washing out\\nof the stomach.\\nThere are other products of coal-tar distillation akin\\nto, but not so poisonous as, carbolic acid. Among\\nthem are the following\\nCreolin. This is a non-irritant and practically\\nnon-toxic germicide. Though toxic symptoms have\\n4", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0053.jp2"}, "54": {"fulltext": "50 ANTISEPTICS.\\nbeen reported, it certainly is the least poisonous of\\nthe powerful germicides now in use. Its chief disad-\\nvantage is that when mixed with water it forms an\\nopaque emulsion; consequently it is inapplicable for\\nthe sterilization of instruments, since they could not\\nreadily be found in it. For cleansing the hands and\\nfor irrigation, creolin is used in strength of from\\n2 to 5 per cent. To make a 2 per cent, solution,\\n2 1 teaspoonfuls of creolin are added to 1 pint of\\nwater.\\nLysol is a brown, oily-looking, clear liquid, with a\\ncreosote-like odor, obtained from tar-oils. When\\nadded to ordinary hard water it forms a clear, soapy\\nliquid, as it precipitates the lime-salts in the water,\\nbut is clear if distilled water, alcohol, or glycerin\\nbe mixed with it. Its antiseptic properties under\\nno circumstances are impaired. On account of its\\nsaponaceous character it cannot be used for instru-\\nments, because it renders them slippery. It is much\\nemployed in surgery and gynecology, in solutions of\\nfrom 1 to 5 per cent. To make a 1 per cent, solution,\\n5 drams are added to gallon of w r ater. Its chief\\nadvantage over other antiseptics lies in its non-irri-\\ntant and much less poisonous properties. It can be\\nused for the disinfection of everything in the sick-\\nroom.\\nSozal is an antiseptic obtained in small crystals\\nwhich have an odor of coal-tar. It is said to possess\\nthe same advantages as corrosive sublimate without\\nits toxic properties. The crystals are readily soluble\\nin water, glycerin, or spirit.\\nSctprol is a dark-brown oily fluid with an odor of\\ncarbolic acid. When mixed with water it divides", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0054.jp2"}, "55": {"fulltext": "ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 5 I\\ninto oil drops, some of which fall to the bottom of\\nthe vessel, while others float on the top of the water,\\nconsequently it cannot be used for surgical purposes.\\nIt is a powerful disinfectant, especially valuable in\\ndisinfecting excreta, and possesses the property of\\ndiffusing evenly through the material- to which it is\\nadded.\\nOther disinfectants outside of the coal-tar products\\nare\\nIodoform is largely used as a surgical dressing. It\\nhas no decided antiseptic properties. It does good by\\nabsorbing the liquids of the wound, thereby remov-\\ning the nidus for germ-growth. When applied to\\nlarge moist surfaces it gives off free iodin. It prevents\\ndecomposition and inhibits, but does not destroy, the\\ngerms of putrefaction and pus-formation if they are\\npresent before its use. When applied to raw sur-\\nfaces it is occasionally absorbed into the system,\\nand causes symptoms of poisoning. On account\\nof this danger salol is often substituted for it, as\\nis also a mixture of iodoform, 1 part to 7 parts of\\nboric acid, it being both antiseptic and unirritating.\\nThe symptoms of absorption are headache, loss of\\nappetite, rise of temperature, a rapid, feeble pulse,\\nrestlessness, and insomnia. These symptoms may\\npass away if the dressing is removed and discontinued.\\nIn grave cases there is marked anxiety, a bright-\\nred eruption appears on the face and limbs, and\\nthere is retention of urine, with stupor, delirium,\\ncollapse, and death. Some patients are very sus-\\nceptible to the toxic effects of the drug. It has a\\npenetrating odor, which many persons find disagree-\\nable. Spirit of turpentine will at once remove the", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0055.jp2"}, "56": {"fulltext": "52 ANTISEPTICS.\\nobjectionable odor from the hands, instruments, and\\nvessels that have been in contact with the drug. Iodo-\\nform darkens upon exposure to a bright light and is\\nlikely to cake when it becomes moist. It is used for\\nimpregnating gauze-dressings, for dusting on ulcers\\nand wounds, and for injections, dissolved in ether or\\nolive oil, into sinuses or tuberculous abscesses. It is\\nalso used in the form of ointment.\\nIodol is a pale yellow crystalline powder, almost\\ninsoluble in water, but readily soluble in ether and\\nalcohol, less so in glycerin or oils. It is often used\\nas a substitute for iodoform, having the same proper-\\nties. Like iodoform, it darkens if exposed to a bright\\nlight. It is used in the form of powder, solution, and\\nointment, and has the advantage of not being so poi-\\nsonous as iodoform.\\nFormaldehyd is a gas formed by the partial oxida-\\ntion of wood alcohol. Its use is greatly facilitated by\\nhaving it combined with water and in a known def-\\ninite proportion, so that the quantity used may be\\ncertain and definitely known. Its solution in water\\nis called formol, formal, and formalin, and contains\\nabout 40 per cent, of formaldehyd gas. Formal-\\ndehyd is non-poisonous, colorless, with a pungent,\\nirritating odor, and possessing great antiseptic, disin-\\nfectant, and deodorant powers. Its activity as a ger-\\nmicide is considered to be equal, if not superior, to\\nthat of bichlorid of mercury, and it is available in\\nmany cases in which the latter cannot be used. It\\ndoes not corrode or tarnish metals, nor injure the\\nfinest fabrics either in texture or color. As a deodo-\\nrant it removes immediately the odor of feces, urine,\\nseptic or gangrenous material. It is used externally", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0056.jp2"}, "57": {"fulltext": "ANTISEPTICS, DISINFECTANTS, AXD DEODORANTS. 53\\nin the form of solution, spray, or vapor, and is some-\\ntimes added to powders. In solution as a wash or\\nirrigation in wounds, etc., it is employed in strengths\\nvarying from 0.5 to 20 per cent. As a dusting-pow-\\nder it is used in combination with gelatin. Sheets\\nof moist gelatin after exposure to formalin fumes are\\nground to a coarse powder, and are used in the dress-\\ning of wounds. A slight disadvantage is that for four\\nor five hours after its use on a raw surface it produces\\nmore or less pain of a burning nature. In the form\\nof vapor it is used for sterilizing instruments and sur-\\ngical dressings, and for the fumigation of the sick-\\nroom and its contents. The simplified method of\\nfumigating consists of diluting one pound of forma-\\nlin with three times its volume of hot water, and\\nboiling over a flame for half an hour. The generated\\ngas is very penetrating, and having the same specific\\ngravity as the air soon permeates the room in which\\nit is confined, and kills all germs, not protected by\\nmoisture, in about three hours. Special portable\\nforms of apparatus have been devised for purposes\\nof room-disinfection. Spray disinfection of rooms\\nwith a 2 per cent, formalin solution is also very\\nsatisfactory.\\nFor the sterilization of instruments a 1 2000 solu-\\ntion is used. Formalin is also used in the preparation\\nof catgut. The catgut is wound on a glass spool,\\nnot too tightly, and soaked for two days in equal parts\\nof ether and alcohol, after which it is rinsed in pure\\nalcohol for a few moments and transferred to glass\\nbottles with tightly fitting covers, and which have\\nbeen previously sterilized, containing equal parts of\\nformalin and alcohol, enough more than to cover the", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0057.jp2"}, "58": {"fulltext": "54 AXTISEPTICS.\\ncatgut. After one week the catgut is taken out and\\nboiled for half an hour in normal saline solution, and\\nis then placed in sterilized bottles containing alcohol\\n\u00e2\u0080\u00a2until needed.\\nFormaldehyd vapor when inhaled irritates the\\nlungs. It also irritates the eyes and nostrils, causing\\nthem to smart.\\nA fatal case of formalin-poisoning is reported, the\\namount taken being about 3 ounces of a 4 per cent,\\nsolution. Immediately after taking there were pain\\nin the stomach and vomiting. The vomited matter\\nwas blood-stained and had the pungent odor of for-\\nmalin. The patient died of heart-failure thirty-two\\nhours afterward. The treatment consisted in albu-\\nmin-water, free emesis, heart-stimulants, and normal\\nsaline solutions given both hypodermically and intra-\\nvenously.\\nAristol (thymol iodid) is a reddish-brown powder\\ncontaining about 45 per cent, of iodin. It is used as\\na substitute for iodoform. It has not the disagreeable\\nodor of iodoform, and its use is attended with less\\ndanger of poisoning. It is used in the form of fine\\npowder or ointment, the strength of the latter vary-\\ning from to 1 dram to 1 ounce of pure lard.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0058.jp2"}, "59": {"fulltext": "CHAPTER V.\\nANTISEPTICS (Continued).\\nPeroxid of hydrogen is a popular antiseptic. It\\nis an excellent agent for the destruction of pus-\\ncocci. When poured or injected into a wound,\\neffervescence takes place, the result of chemic reac-\\ntion between the wound-secretions and the hydro-\\ngen peroxid. This active frothing serves to carry\\noff any shreds of tissue in the wound that cannot\\neasily be reached. The peroxid is also applied to\\nthe throat in diphtheria to destroy and remove the\\nfalse membrane. It readily decomposes by coming\\nin contact with metals; consequently, if used as a\\nspray, a glass atomizer must be employed. The per-\\noxid of hydrogen in common use is a clear, odorless\\nfluid, having a bitter taste. The official solution\\ncontains 3 per cent, of the pure dioxid, which corre-\\nsponds to about ten volumes of available oxygen, and\\nit is upon its readiness to yield oxygen that its\\nactivity depends. The solution should be kept in a\\ncool, dark place, and the cork forced tightly into the\\nbottle.\\nBoracic acid (boric acid) is a mild antiseptic. It is\\nnon-irritating and practically non-poisonous. It is\\ntherefore frequently used to wash out cavities, for\\ninjections, and in ophthalmic and aural practice. It\\nis used in the form of powder, solution, ointment, and\\ngauze. In solution, a saturated solution is used (a sat-\\n55", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0059.jp2"}, "60": {"fulltext": "56 ANTISEPTICS.\\nurated solution is one in which the water dissolves as\\nmuch as it will of the drug; the remainder lying at the\\nbottom of the vessel as an indication that the solution\\nis sufficiently strong). It is easily made by placing\\none-half pound of boric acid in a half-gallon bottle\\nfilled with boiled water and shaking thoroughly until\\nsaturated. It is impossible to use a solution which\\nis too strong, because the water cannot take up any\\nmore than i in 30 (about 4 per cent.), which is the\\nusual strength used. In rare cases it acts as an irri-\\ntant to the skin and produces an eczematous condi-\\ntion.\\nBoroglycerid is a non-poisonous antiseptic solution\\nmade from boric acid and glycerin, and is used as a\\nwash, an irrigation, and for saturating tampons.\\nThiersch s solution is an antiseptic of moderate\\npower, unirritating and non-poisonous; it contains\\nsalicylic acid, 2 parts; boric acid, 12 parts; hot\\nwater, 1000 parts.\\nAlcohol. Absolute alcohol is an antiseptic and dis-\\ninfectant used for cleansing the skin, for the prepara-\\ntion of sutures and ligatures, and for the disinfec-\\ntion of cutting-instruments. To sterilize the hands,\\nthey are scrubbed for five minutes with soap and hot\\nwater, then scrubbed for the same length of time in\\nabsolute alcohol, and finally rinsed in an antiseptic\\nsolution. The results obtained by the disinfection\\nand cleansing of the skin with alcohol have been as-\\ncribed to the solvent action of the alcohol upon the\\nfatty matters on the skin, thus allowing corrosive\\nsublimate and other antiseptics to come into imme-\\ndiate contact with the bacteria. Scrubbing the\\nhands in absolute alcohol for five minutes takes up", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0060.jp2"}, "61": {"fulltext": "ANTISEPTICS. 57\\nboth the fatty matters of the skin and also the bac-\\nteria, which are thus washed away.\\nPotassium permanganate, or permanganate of\\npotassium, is an antiseptic, disinfectant, and deodor-\\nant, depending for its action on its oxidizing prop-\\nerties. It parts with its oxygen very readily to\\norganic substances and becomes inert. Its chief dis-\\nadvantage is that it stains everything a brownish-\\nblack color. It is used in solutions varying from\\nniooto 1:10. When employed for sterilizing the\\nhands, it is followed by oxalic acid solution, which\\nhas the property of removing the stain. It is also\\nused on wounds, especially those which have an\\noffensive discharge, as, for example, gangenous\\nulcers, on which it acts as a deodorant as well as a\\ndisinfectant. It may also be employed to disinfect\\nbowel-movements, to flush water-closets, etc. Its\\nadvantages are that it is non-poisonous in ordinary\\nstrengths, rapid and complete in its action, and\\nshows by its change of color from reddish-purple to\\na brown whether it is acting or whether it is ex-\\nhausted. The strength of the solution generally used\\nis from 20 to 1 6 grains of the crystal to 1 pint of\\nwater.\\nOxalic acid is a powerful germicide, though it is\\nnot used alone, but to remove the stains of potassium\\npermanganate from the skin. It is very poisonous\\nand quite irritating, but the irritation can in a meas-\\nure be avoided by immersing the hands and forearms\\nafterward in either plain water or lime-water. A\\nseries of experiments by Dr. Howard A. Kelly, to\\ndetermine the relative part played by these two\\nchemicals in the process of disinfection, led to the", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0061.jp2"}, "62": {"fulltext": "58 ANTISEPTICS.\\nconclusion that both the permanganate of potassium\\nand oxalic acid were germicides, but that the oxalic\\nacid at a temperature of about 40 C. (104 F.) is a\\nmuch more powerful germicide than the permangan-\\nate of potassium. Oxalic acid also removes perman-\\nganate stains from white goods, and ammonia will\\nremove the stains from black goods.\\nPotassium permanganate is frequently used in a\\nsolution called Condy* s fluid, which contains 16\\ngrains of permanganate of potassium crystals to 1\\nounce of water. It is a disinfectant and deodorant.\\nPyoktanin (methyl-violet, methyl-blue, blue pyok-\\ntanin), an aniline derivative, is a disinfectant and\\nantiseptic. It occurs in two colors, blue and yellow,\\nthe yellow variety being used in ophthalmic practice\\nonly. Its great disadvantage is that it stains every-\\nthing with which it comes in contact. The stains,\\nhowever, may be removed with alcohol or Labar-\\nraque s solution. It is used in the form of powder,\\nointment, and in solutions of the strength of 1:500\\nand 1: 1000.\\nLabarraqne* s solution is a solution of chlorinated\\nsoda, and is made from chlorinated lime and sodium\\ncarbonate. It is used as an antiseptic in solutions of\\n1: 10, and for cleansing purposes.\\nChlorinated lime, or chlorid of lime, is one of the\\nbest disinfectants for drains, infected clothes, bowel-\\nmovements, sputum, and urine. It is also a power-\\nful deodorizer. It loses its strength if exposed to\\nthe air. The standard solution contains 6 ounces\\nto 1 gallon of water.\\nSulphuric and hydrochloric acids are employed in\\n4 per cent, solutions for the disinfection of excretions,", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0062.jp2"}, "63": {"fulltext": "ANTISEPTICS. 59\\nequal parts of the solution and the substance to be\\ndisinfected being used.\\nIchthyolis a dark-brown thick liquid, with a highly\\ndisagreeable odor; it is used extensively as an antisep-\\ntic, astringent, sedative, and alterative in many skin-\\ndiseases, various inflammatory affections, wounds,\\nabscess-cavities, etc. It is employed externally in\\nthe form of a thick liquid and ointment. Before the\\napplication of ichthyol the affected parts are washed\\nwith warm water and soap, and gently dried. After\\npainting, or after inunction, the parts are covered\\nwith absorbent cotton or flannel and gutta-percha\\ntissue. The applications are best employed morning\\nand evening. Many patients object strongly to\\nit on account of its disagreeable odor. This may\\nbe disguised by the addition of oils of citronella\\nand eucalyptus, i part of each to 50 parts of ichthyol\\nor ichthyol (9 parts) may be combined with oil of\\nturpentine (1 part). Ichthyol is said to have a re-\\nmarkably efficacious action upon recent burns in re-\\nlieving the pain and facilitating healing. It is also\\nused in combination with the compound stearate of\\nzinc. The stains of ichthyol may be removed by\\nboiling the stained articles in soap and water, or by\\nwashing them with potash-soap or soap-spirit.\\nBalsam of Peru is used as an external application to\\nwounds, it having both an antiseptic and a stimulant\\naction. Glycerin is sometimes used as a menstruum\\nfor ichthyol and balsam of Peru because of its dehy-\\ndrating effect upon the granulation-tissues of a\\nwound, whereby they are held more in check and do\\nnot form so rapidly.\\nOrthoform is an antiseptic and a local anesthetic", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0063.jp2"}, "64": {"fulltext": "60 ANTISEPTICS.\\nhaving a decided action when applied to raw sur-\\nfaces or exposed nerve-endings. It owes its anti-\\nseptic action to benzoic acid. It is a white, crystal-\\nline powder, without odor or taste, entirely non-poi-\\nsonous, is slowly absorbed, and is used in the form\\nof powder or ointment. In rare cases it causes severe\\ninflammation and even sloughing of the skin.\\nOrthoform hydrochlorid is a combination of ortho-\\nform and hydrochloric acid, and is also an anes-\\nthetic.\\nMustard, vinegar, and normal salt solution are also\\nantiseptic.\\nSterilized vinegar is said to be equal in antiseptic\\npower to a i 2000 solution of corrosive sublimate.\\nIt is less irritating to the tissues than bichlorid, and\\nis said to stimulate the healing process in open\\nwounds instead of retarding it, as mercury some-\\ntimes does. It is sometimes used during an oper-\\nation for irrigation, especially if there is much capil-\\nlary hemorrhage, which, on account of its astringent\\naction, it controls. It is also used for the disinfec-\\ntion of the hands, surgical operating-rooms and wards,\\nand to remove blood-stains from the hands.\\nMustard is used for the disinfection of the hands\\nand arms of the surgeon and his assistants, and of\\nthe field of operation. After scrubbing the hands and\\narms with a stiff brush and green soap, the water\\nused being as hot as can be borne, one teaspoonful of\\nmustard is rubbed in very thoroughly for about three\\nminutes, after which it is washed off with hot steril-\\nized water. The field of operation is prepared in the\\nsame way.\\nResorcin is an antiseptic and deodorant, used in", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0064.jp2"}, "65": {"fulltext": "ANTISEPTICS. 6 1\\nthe form of solution, powder, or ointment in strengths\\nvarying from 2 to 20 per cent. As a powder it is\\nusually mixed with boric acid, 1 20 or 1 10. It is\\nnot absorbed by the unbroken skin and produces\\nvery little irritation on the cutaneous tissues.\\nDermatol, also called bismuth subgallate, is used\\nas a substitute for iodoform in the dressing of wounds.\\nIt is an antiseptic, sedative, and astringent.\\nProtargol is an albuminous compound of silver,\\ncontaining about 8 per cent, of the metal. It\\nis a powerful antiseptic, causing neither pain nor irri-\\ntation when applied to raw surfaces. It is considered\\na valuable application in the treatment of wounds,\\nand inflammatory surfaces discharging freely. It is\\nsoluble in water to the strength of about 50 per cent.,\\nand forms a clear light-brown fluid.\\nListerine is a proprietary antiseptic solution used\\nextensively on wounds, for cleansing the mouth,\\nthroat, and nose, etc.\\nBicarbonate of sodium has been used with marked\\nsuccess as an antiseptic in the treatment of foul sup-\\npurating wounds and ulcers in a strength of 2 per\\ncent. A i-per-cent. solution has long been used in\\nwhich to boil surgical instruments. The soda adds\\nto the disinfectant power of the boiling water.\\nThere are numerous other antiseptics of proprietary\\nnature; but it is hardly necessary to refer to them.\\nChemists are constantly adding new preparations to\\nthe long list already in use.", "height": "4951", "width": "2878", "jp2-path": "bacteriologysur00ston_0065.jp2"}, "66": {"fulltext": "PART II.\\nSURGICAL TECHNIC\\nCHAPTER VI.\\nCARE OF OPERATING=ROOM METHODS OF\\nSTERILIZATION CARE OF INSTRUMENTS.\\nIn almost all large hospitals there are three operat-\\ning-rooms, one for general surgical, one for gyneco-\\nlogic, and one for septic operations.\\nThe operating-room for septic cases should be far\\nremoved from the others, and neither surgeon nor\\nnurse attending this room should have anything to\\ndo with the others. Rooms should also be set apart\\nexclusively for dressing the cases, thus extending the\\nbenefit of an isolation of operating-rooms and adding\\ngreatly to the convenience of hospital work.\\nThese dressing-rooms are otherwise very desirable,\\nfor besides having everything at hand with which to\\ndo a dressing properly, the nurse in charge of the\\npatient has the opportunity to turn and make up the\\nbed afresh during the patient s absence. Stretchers\\nare used to convey patients to and from the operating-\\nand dressing-rooms. The wheels generally have\\nrubber tires, the top board is detachable and has four\\nJ.\\nhandles, two at each end. At least four stretchers are\\nnecessary in a large hospital.\\n62", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0066.jp2"}, "67": {"fulltext": "Plate i.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0067.jp2"}, "68": {"fulltext": "", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0068.jp2"}, "69": {"fulltext": "STERIL IZA TION. 63\\nThe material used in the construction and furnish-\\ning of an operating- and dressing-room should be of\\nmarble, metal, porcelain, and glass, all of which can\\nreadily be made aseptic. The water-faucets should\\nbe controlled by automatic foot-valves, so as to avoid\\nFIG. 4. Wheeled stretcher.\\ncontamination by turning on the spigots with the\\nhands after they have been rendered aseptic.\\nThe operating-room should be kept clean, and\\nshould be swept and dusted every day, and rubbed\\nover with a damp cloth; in short, it should be\\nin such a condition as to be ready for an operation at\\na few moments notice. The supplies for dressings\\nshould not be allowed to run down, and the instru-\\nments should always be in a first-class condition. The\\nemergency bundle, containing everything necessary\\nfor an emergency operation, should be kept in readi-\\nness.\\nSterilisation. Sterilization mav either be drv or", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0069.jp2"}, "70": {"fulltext": "64 SURGICAL TEC ff NIC.\\nmoist; moist heat is preferable, because it is more\\nthorough and more penetrating than dry heat. For\\ndry sterilization the towels and dressings are placed\\nin covered tin pans in an oven the temperature in\\nwhich ranges from 160 to 21 2\u00c2\u00b0 F. For moist or\\nsteam sterilization, a Kellogg, a Sprague, or an Arnold\\nsteam sterilizer is used. The heat must be con-\\ntinued for fully one hour before the operation.\\nRegarding the sterilization of instruments surgeons\\ndiffer; some prefer to have their instruments wrapped in\\na towel and put into the Schimmelbusch or Arnold\\nsterilizer and allowed to boil for half an hour in a 1\\nper cent, solution of carbonate of sodium to prevent\\ntheir rusting. The water must boil before the instru-\\nments are placed in it. All edged instruments to be\\nboiled in the soda solution should be wrapped in cot-\\nton and packed so firmly that they will not be tossed\\nagainst one another bv the solution as it becomes\\nagitated in boiling. This agitation seems to be the\\nreason why they lose their edge. Many operators\\nprefer to have their edged instruments and needles\\nplaced in a dish containing 95 per cent, carbolic acid\\nfor half an hour; then just before the operation they\\nare taken out and rinsed with sterilized water.\\nAfter sterilization the instruments are transferred\\nto the instrument- table, or to shallow 7 porcelain or\\nglass trays, in which they lie covered with sterilized\\ntowels until required.\\nInstruments and dressings are now sterilized with\\nformaldehyd w 7 ith excellent results, one great advan-\\ntage being that neither the solution of formalin nor\\nthe gas injures the instruments in any way or dulls\\nthe edge of knives, scissors, or needles. A Schering", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0070.jp2"}, "71": {"fulltext": "Plate 2.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0071.jp2"}, "72": {"fulltext": "", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0072.jp2"}, "73": {"fulltext": "STERILIZA TION. 65\\nlamp is usually used either with a 40-per-cent. solu-\\ntion of formaldehyd or with formalin pastils. The\\nbest results seem to be obtained with the pastils. One\\nFig. 5. Apparatus for sterilization of instruments, etc.\\npastil is constantly being evaporated in the upper cup\\nof the lamp; but when rapid evaporation is required\\nFig. 6. Instrument-sterilizer\\nthe upper cup is removed and the pastils are placed\\nin the lower part.\\nDuring the operation, instruments which have\\n5", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0073.jp2"}, "74": {"fulltext": "66\\nSURGICAL TECHXIC.\\nfallen to the floor and are needed for further use are\\nrinsed in cold water and laid for a few moments in\\nthe 95 per cent, carbolic acid, then rinsed with steril-\\nized water.\\nAfter the operation the instruments should be\\ntaken apart, washed in cold water to remove all\\nblood, pus, and tissue-particles, and then thoroughly\\nscrubbed with green soap. Instruments with perma-\\nnent joints, which fortunately are seldom seen now,\\nFlG. 7. Sterilizer for instruments and dressings a, for dressings b, for\\ninstruments c, water and solution of carbonate of sodium to prevent rust-\\ning.\\nmust receive special attention, since it is difficult to\\nget them surgically clean. After being scrubbed the\\ninstruments are rinsed in hot sterilized water, wiped\\ndry with a soft towel, and then laid away in the\\ncase. The knife-blades must be rolled in cotton.\\nThe important points to be remembered in cleaning\\ninstruments after an operation are:", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0074.jp2"}, "75": {"fulltext": "S TRRIL TZA TION. 6?\\nFirst, all instruments that can be so dealt with\\nmust be taken apart and the rough catches thoroughly\\ncleansed.\\nSecond, they must be dried carefully in order to\\nprevent rusting; for instruments once rusted seem\\nalways to have a tendency to return to that condi-\\ntion.\\nInstrument-trays are made of glass, porcelain, agate-\\nware, or hard rubber; and are rendered aseptic by\\nbeing first scrubbed with green soap and warm water,\\nafter which they are filled to the brim with i 500 cor-\\nrosive sublimate, which is allowed to remain in them\\nfor half an hour. When needed they are rinsed with\\nsalt solution or sterile water. Many surgeons prefer\\nthe trays filled with enough sterile water to cover the\\ninstruments, while others again prefer the instru-\\nFlG. 8. Agateware tray.\\nments to be laid dry on the glass table, which has\\nbeen previously covered with a sterilized sheet or\\ntowels.\\nEvery operating-room nurse should be familiar\\nwith the names of the instruments necessary for each\\ndifferent operation, so as to be able to lay them out\\nwhen occasion requires. Many nurses get together\\nafter school-hours and make believe an operation\\nis to take place. Each nurse has her duty assigned", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0075.jp2"}, "76": {"fulltext": "68 SURGICAL TECHXIC.\\nto her, and each tries to fulfil it in a thoroughly\\nprofessional, dignified, and quiet manner. Practice\\nof this kind is never lost.\\nIn the operating-room should be kept two large\\nledgers, in one of which the house-surgeons, after\\nmaking the morning- rounds with the visiting sur-\\nFlG. 9. Hard rubber tray.\\ngeons, should record the number of operations to be\\nperformed the next day, the time, name of operator,\\netc. The operating-room nurse is thus made ac-\\nquainted, by consulting the book, of the amount of\\nwork before her for the next day, and the character\\nof the operations for which she has to prepare.\\nFIG. 10. Robb s aseptic ligature-tray white porcelain.\\nOn the morning of the operations she makes out a\\nlist of the floor and number of private room or letter\\nof ward and number of bed, from which the patients\\nare to be brought to the operating-room, and the order", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0076.jp2"}, "77": {"fulltext": "STERILIZATION.\\n6 9\\nin which the operator wishes them. This list is given\\nto the male attendant, who brings up the patients in\\nsuccession, in such a way that while one patient is\\nbeing operated on the next is being anesthetized. The\\nhead nurse in the operating-room has two or three\\nsets of instruments, and during one operation an as-\\nsistant nurse is sterilizing the instruments and making\\npreparations for the next operation. There is then\\nno waiting 011 the part of the operator, for as the\\npatient operated on is wheeled out of the operating-\\nroom the next patient is wheeled in. The following\\nchart will give an idea as to the way the book is made\\nout and the order in which the operations are writ-\\nten. The emergency-operations, accidents, etc., are\\nalso recorded, but after the performance of the ope-\\nration.\\nDate.\\nOperation.\\nFloor. l\\nTime.\\nOperator.\\nRoom\\nWard.\\n-d\\nFloor.\\nMar. 11.\\nLaparotomy.\\nVaginal hysterec-\\ntomy.\\nCholecystostomy.\\n4th.\\n8. A M.\\n8.30\\n9.00\\n9.30\\nDr. Murphy.\\nJohnson.\\nFenger.\\n19\\n21\\n24\\n16\\n3d.\\nAppendicectomy.\\nlO.OO\\nIO.45\\nMorgan.\\nKindig.\\nR\\nD\\n10\\n6\\nAmputation, breast\\nII.30\\n2. P.P.I.\\nCarter.\\nAndrews.\\n24\\nD\\n9\\n4th.\\nAppendicectomy.\\n3.OO\\nFenger.\\n21\\n2d.\\nCesarean section.\\n4.OO\\nEyster.\\n21\\n4th.\\nAppendicectomy.\\n3d.\\n6.30\\nComegys.\\n29\\n2d.\\nThe second book gives the date on which the\\npatient was prepared for operation, by whom pre-\\npared, etc., as, for example\\n1 Clean operating-room, fourth floor septic, third floor.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0077.jp2"}, "78": {"fulltext": "7o\\nSURGICAL TECHNIC.\\nDate of\\nPreparation.\\nPrepared by\\nAntiseptic\\nused.\\nOperator.\\nFloor.\\nRoom.\\nMarch 10.\\nE. A. S.\\nCorros. sub.\\nDr. Eyster.\\nFourth.\\nNo. 21.\\nDate of\\nOperation.\\nHour.\\nSutures\\nused.\\nLength of\\ntime prepared.\\nStitches\\nremoved.\\nCondition.\\nMarch n.\\n4 P. M.\\nSilkworm-\\ngut.\\nTwo hours\\nboiling.\\nMarch 19.\\nAseptic.\\nA book should also be kept in each dressing-room\\nshowing the number of cases dressed each day, the\\ndressing used, and progress since the last dressing.\\nIt should be kept for the convenience of the dressing-\\nroom nurse in making an estimate of dressings for the\\nnext day, and for the convenience of the surgeon in\\nknowing what patients are dressed, their condition,\\nand in knowing when they are to be again dressed.\\nIt will also recall condition of last dressing.\\nRoom or\\nWard.\\nNo. 29,\\n2d floor.\\nDiagnosis. Operated\\nAppendicitis. March 11\\nOperator.\\nDr. Come-\\ngys.\\nDressed.\\nMarch 17.\\nDied or\\nDischarged\\nDischarged\\nApril 2.\\nRemarks.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0078.jp2"}, "79": {"fulltext": "CHAPTER VII.\\nINSTRUMENTS NECESSARY IN DIFFERENT OPE=\\nRATIONS, KEEPING OF CHARTS, SURGEON S\\nKIT, ETC.\\nIn many hospitals, small ones especially, where\\nthere are no medical students or house doctor, the\\nnurse has more responsibility than in larger institu-\\ntions, and becomes closely familiar with such details\\nas taking the history of the patient; the arranging\\nand sterilization of instruments; assisting the oper-\\nator, giving the anesthetic, and writing out the re-\\nport of the operation. The following charts will be\\nof use in keeping the important features of this line\\nof duty in mind. When taking the patient s history\\nit is a good plan to allow her to describe her con-\\ndition in her own words. Any peculiarities of the\\npatient s manner and other points which may be\\nobserved can be noted, and afterward the questions\\nnecessary for making out the charts may be asked.\\nFamily History.\\nAge. Health. Disease. Cause of death if dead-\\nFather.\\nMother.\\nBrothers (number).\\nSisters (number).\\nWife or husband.\\nChildren (number).\\n71", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0079.jp2"}, "80": {"fulltext": "J2\\nSCRGICAL TECHNIC.\\nUncles or aunts with epilepsy, insanity, tuber-\\nculosis, or consumption.\\nj.\\nPersonal History.\\nWhen born. Where lived. Peculiarities of cli-\\nmate. Occupations. Habits (as to eating,\\ndrinking, sleeping, etc.). Appetite. Condi-\\ntion of bowels. Nervousness. Culture.\\n(When Female.)\\nSexual History.\\nI. Menstruation,\\n(a) First at what age.\\n(b) Regularity. No. days.\\n(c) Duration. No. days.\\n(d) Amount.\\nr Color.\\n(e) Character of discharge\\nConsist-\\nency.\\nOdor.\\nIntermenstrual discharge.\\n(g) Dysmenorrhea when.\\nTT jj f Number.\\nII. Fregnanctes\\nI Sickness or peculiarities.\\n{Number.\\nSickness.\\nFever.\\nIV. Labors.\\n{a) Number.\\n(b) Character\\nEasy.\\nDifficult.\\nSpontaneous.\\nInstrumental.\\n(c) Peculiarities.\\n(d) Sickness post partum, if any.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0080.jp2"}, "81": {"fulltext": "SURGEON S KIT. 73\\nPrevious Illness.\\nStarting- with childhood, give different sicknesses\\nand age at which same occurred, following life\\nof patient to present time simply with reference\\nto sickness, including appetite, bowels, urine,\\nheadaches, pains, coughs.\\nPresent Sickness.\\nDate.\\nOnset. Character. Chills P ains locations, se-\\nI verity, etc. Peculiarities.\\nProgress and changes to present time.\\nChanges. Appetite. Bowels. Urine, etc.\\nExamination.\\nThe packing of a surgeon s bag is often done by\\nthe operating-room nurse. Many surgeons use the\\ntelescope valise, or kit, as it is more commonly called;\\nwhile others employ a regular surgeon s bag. Be-\\nfore the bag is packed the nurse makes out the list of\\nnecessary articles, and as each article is put in it is\\nchecked off the list. When packed, a copy of the\\nlist is securely pinned upon a towel inside, where the\\nsurgeon can see it on first opening the bag. The kit\\nis packed by first laying in two large sterilized\\ntowels, the ends of which hang over the edges of the\\nbag. Together with the instruments, which are\\nplaced in a linen instrument-roll, and the dressings,\\nthe kit should contain three new nail-brushes, soap,\\nrazor, oxalic acid and permanganate of potassium\\ncrystals in bottles, hypodermic syringes with tablets\\nof strychnin sulphate (gr. g 1 atropin sulphate (gr.\\nj-Jq), and morphin sulphate (gr. ether and chloro-\\nform (with cone and mask), tablets of corrosive sub-", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0081.jp2"}, "82": {"fulltext": "74 SURGICAL TECHXIC.\\nOPERATION BLANK.\\nService of Dr.\\nDate. March 10, 1899.\\nName\\nI. PREPARATION OF PATIENT FOR OPERATION.\\nII. ANESTHETIC. ANESTHETIST.\\nTemperature.\\nBefore operation.\\nAfter operation.\\nPulse. To be taken ever} 7 five minutes.\\nIII. PREPARATION OF FIELD OF OPERATION.\\nIV. POSITION OF PATIENT DURING OPERATION.\\nV. PRIMARY MANIPULATIONS.\\nVI. INCISION AND HISTORY OF OPERATION.\\nVII. TREATMENT OF WOUND.\\nVIII. DRAINAGE.\\nIX. CLOSURE OF WOUND.\\nX. DRESSING.\\nXL RECOVERY FROM ANESTHETIC.\\nXII. AFTER-TREATMENT.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0082.jp2"}, "83": {"fulltext": "SUKGEON S KIT.\\n75\\nlimate and sodium chlorid, iodoform gauze, plain\\ngauze, gauze sponges, white suits, caps and canvas\\nshoes for the operator and assistants, Kelly pad,\\nrubber gloves, brandy, alcohol, safety-pins, absorb-\\nwmmmm\\nFlG. ii. Canton-flannel roll for instruments.\\nent cotton, twelve towels, a rubber apron, ligatures,\\nsutures, and rubber and glass drainage-tubes. The\\nglass-ware should be packed in the middle, to pre-\\nvent breakage. When the kit is packed a third\\ntowel is laid over the contents, the edges of the other\\nFig. 12. Instruments wrapped in canton-flannel roll.\\ntwo are brought up, and all pinned together with\\nsafety-pins.\\nThe instrument-rolls are very serviceable in econo-\\nmizing space and in keeping the instruments as", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0083.jp2"}, "84": {"fulltext": "y6 SURGICAL TECHNIC.\\nnearly aseptic as possible. They are made of linen,\\ncanton flannel, or toweling, one yard long; and\\nthrough the middle of each are adjustable loops in\\nwhich the instruments are placed. When soiled the\\nrolls may be washed and sterilized.\\nLIST OF INSTRUMENTS NECESSARY IN DIFFERENT\\nOPERATIONS.\\nInstruments for Perineorrhaphy.\\nCatheter, glass, small, i\\nCatheter, glass, large, i\\nForceps, hemostatic, small, 6 pairs.\\nForceps, hemostatic, intermediate, 3\\nForceps, hemostatic, long, 3\\nForceps, hemostatic, long dressing-, 1 pair.\\nForceps, hemostatic, tissue- (rat-tooth), 2 pairs.\\nForceps, hemostatic, bullet-, 2\\nForceps, hemostatic, volsella, 2\\nScalpels, 2\\nUterine sound and applicator.\\nTenacula, straight, 1 pair.\\nTenacula, curved, 2 pairs.\\nTenacula, shepherd s crook, 1 pair.\\nScissors, straight, 1\\nScissors, right-angle, 1\\nScissors, left-angle, 1\\nSponge-holders, 6\\nNeedles. Sutures, silk of various sizes,\\nand silkworm-gut.\\nNeedle-holder. Sims speculum. Retrac-\\ntors. Leg-holder. Sterilized stockings.\\nGlass nozzles. Irrigation dressings.\\nTenacula are used to catch and hold movable tis-", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0084.jp2"}, "85": {"fulltext": "LIST OF INSTRUMENTS. J J\\nsues which are being sutured, to hold the cervix\\nuteri, etc. There are two kinds, the curved and the\\nstraight; and of the curved there are three varieties:\\nthe shepherd s crook, the simple curved, and the cor-\\nrugated. The shepherd s crook is much used in\\nvaginal operations, and has the advantage over the\\nothers that when once it is put in place it can be\\ndropped without losing its hold on the tissues.\\nInstruments for Trachelor\\nrhaphy.\\nCatheter, glass,\\ni\\nTwo-way catheter,\\ni\\nCurette, dull,\\ni\\nCurette, sharp,\\ni\\nCurette, spoon,\\ni\\nDilators, different sizes.\\nForceps, hemostatic,\\n8 pairs.\\nForceps, volsella,\\ni pair.\\nForceps, bullet-,\\n2 pairs.\\nForceps, long dressing- (Kelly),\\ni pair.\\nForceps, tissue- (rat-tooth),\\n2 pairs.\\nScalpels,\\n2\\nSpeculum, Sims, small,\\nI\\nSpeculum, large,\\nI\\nShot-compressor and shot.\\nRetractor, small,\\nI\\nRetractor, medium,\\nI\\nScissors, straight,\\ni pair.\\nScissors, curved,\\ni\\nTenacula,\\n2 pairs.\\nNeedles, curved, various\\nsizes,\\nshort,\\nstout, straight.\\nNeedle-holders,\\n2", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0085.jp2"}, "86": {"fulltext": "78 SURGICAL TECHNIC.\\nUterine sound and applicator.\\nSterilized stockings. Leg-holder.\\nCatgut and silkworm-gut sutures.\\nInstruments for Dilatation of Cervix and Curetting\\nof Uterus.\\nCatheter, glass, small, i\\nCatheter, two-way, for irrigation, i\\nCuret, sharp, I\\nCuret, Martin s double blunt, I\\nCuret, curved, sharp, i\\nDilators (Hank s rubber, all sizes).\\nDilator, GoodelPs, i\\nForceps, long dressing-, i pair.\\nForceps, bullet-, i\\nUterine sound and applicator.\\nSims specula, large and small.\\nKelly perineal pad. Sterilized stockings.\\nIrrigator. Glass nozzles. Dressings.\\nSmall sponges. Cotton pledgets.\\nChurchill s tincture of iodin.\\nCarbolic acid, 95 per cent. Leg-holder.\\nInstruments for an Abdominal\\nOper\\nation.\\n(Arrange for Trendelenburg Position\\nf.)\\nForceps, small, hemostatic,\\n6 pairs,\\nForceps, medium,\\n6\\nForceps, pedicle-,\\n4\\nForceps, long,\\n4\\nForceps, long dressing-,\\n1 pair.\\nForceps, for drainage-tube,\\n1\\nForceps, Billroth,\\n2 pairs.\\nForceps, bulldog,\\n1 pair.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0086.jp2"}, "87": {"fulltext": "LIST OF INSTRUMENTS. 79\\nForceps, rat-tooth, 2 pairs.\\nAspirator. Scalpels. Vaginal packer.\\nUterine sound.\\nPaquelin s thermocautery.\\nSponge-holders. 6\\nScissors, long and small, 1 pair of each.\\nRetractors, Lange s large, 1 pair.\\nVolkmann s 6-prong retractors, 1\\nVolkmann s 4-prong retractors, 1\\nLong and small probe and director.\\nNeedle, aneurysm-, 1\\nNeedle, transfixion, right curved, 1\\nNeedle, transfixion, left curved, 1\\nNeedle, transfixion, pedicle, 1\\nNeedles, large, small, and intermediate,\\ncurved and intestinal.\\nMurphy anastomosis button (sizes 1-4).\\nMurphy s forceps for holding button, 1 pair.\\nMurphy s forceps, intestinal clamp, 1\\nMurphy s forceps, introducing, 1\\nFlat dissector (Fenger).\\nDrainage-tubes, glass or aluminum, as-\\nsorted sizes.\\nNeedle-holders, 2\\nDressings, ligatures, and sutures of silk-\\nworm-gut, and various sizes of silk\\nand catgut.\\nLaparotomy sheet. Saline solution.\\nSmall bolsters, made of non-absorbent\\ncotton covered with gauze, six\\ninches by three, to retain the intes-\\ntines and to keep them from encroach-\\ning upon the site of operation.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0087.jp2"}, "88": {"fulltext": "80 SURGICAL TECHNIC.\\nExtra, for Cysts or Tumors.\\nTrocars, large and small. Rubber tubing.\\nNelaton s forceps.\\nBillroth s tumor-forceps, 2 pairs.\\nExtra, for Vaginal Hysterectomy.\\nSterilized stockings. Leg-holder.\\nClamp-forceps, 6 pairs.\\nUterine sound. Dissecting forceps. Long\\nand short tenacula. Speculum. Curet.\\nInstruments for Operations on the Brain a7id Spine.\\nForceps, hemostatic, medium, 6 pairs.\\nForceps, hemostatic, small, 6\\nForceps, rat-tooth (tissue-), 2\\nForceps, bone, three kinds; long-jaw for-\\nceps.\\nTrephine three sizes, small and medium.\\nChisels, various sizes. Hammer.\\nScalpels, 2\\nScissors, 2 pairs.\\nCurets, sharp and dull.\\nNeedles. Sutures. Ligatures. Saline\\nsolution. De Vilbis forceps.\\nInstruments for Amputation of a Limb.\\nEsmarch bandages, 2\\nPeriosteotome, i\\nLong amputating-knife.\\nMedium amputating-knife.\\nScalpels, large and medium.\\nBone-saw. Chain-saw.\\nForceps, small hemostatic, 6 pairs.\\nForceps, medium hemostatic, 6 u", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0088.jp2"}, "89": {"fulltext": "LIST OF INSTRUMENTS, 8 1\\nForceps, bone-cutting, straight, curved,\\nand angular.\\nForceps, gouging.\\nForceps, rat-tooth (tissue-), 2 pairs.\\nForceps, retractor, 1 pair.\\nScissors, large and small, 1 pair of each.\\nBone-pins.\\nFour-prong retractors, 2\\nThree-tailed gauze retractors, 2\\nDressings. Sutures. Ligatures of silk,\\ncatgut (various sizes), and silkworm-\\ngut.\\nInstruments for the Month and Throat,\\nHead-mirror. Snare of silver wire.\\nVolsella forceps for tonsils.\\nUvulatome. Tonsillotome, 2\\nSponge-holders, 6\\nUvula scissors with and without claws.\\nTongue-depressor.\\nA self-fastening mouth-gag\\nTrachea-dilator.\\nTrachea-tubes. Intubation-tubes.\\nLong forceps, 1 pair.\\nLong curved forceps, 1 u\\nLong straight scissors, 1 il\\nThroat-mirror (laryngoscope).\\nAngular forceps, 1 pair.\\nAngular scissors, 1\\nLong, slender curet.\\nGottstein knife (for adenoids).\\nGradle forceps (for adenoids).\\nBistoury. Flexible probe.\\n6", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0089.jp2"}, "90": {"fulltext": "82 SURGICAL TECHNIC.\\nEsophageal sound and dilator.\\nFish-bone catcher for foreign bodies.\\nInstruments for the* Nose.\\nPolypus-snare. Silver applicator.\\nNasal curet.\\nSaw with reversible blade for cutting up\\nor down.\\nNasal scissors, with and without saw-\\nteeth.\\nNasal bone-scissors.\\nNasal bone-scissors, turbinated.\\nNasal polypus-forceps.\\nSeptum-straightening forceps, i pair.\\nNasal speculum.\\nSeptum-knife.\\nElectrocautery for hypertrophied turbin-\\nates and for hemostasis.\\nChromic acid. Applicators.\\nIodoform-strips for packing.\\nMonsell s solution for hemostasis.\\nInstruments for the Ear.\\nFor JMastoid Opei ations.\\nForceps, hemostatic, small, 8 pairs.\\nScalpels, small and medium, i each.\\nChisels and gouges, various sizes.\\nMastoid drills and bone-trephines, 2\\nMallet.\\nEar-speculums, various sizes.\\nDiagnostic tube and otoscope.\\nEar-syringe (hard rubber).", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0090.jp2"}, "91": {"fulltext": "LIST OF INSTRUMENTS. 83\\nSponge- and cotton-holder.\\nSmall cnret.\\nIrrigator.\\nFor Middle-ear Operations.\\nEustachian catheter, and Politzer s air-\\nbag.\\nCurets. Ear-scoop.\\nSnare and wire.\\nHead-mirror.\\nCotton-holder.\\nTympanum-perforators.\\nEar-aspirator for cleansing middle ear.\\nCase of tuning-forks and hammer.\\nEar-scissors.\\nEar-speculum, various sizes.\\nSlender polypus-forceps, 1 pair.\\nSlender scalpels.\\nEar-probe. Irrigator.\\nInstruments for Rectal Operations.\\nRectal speculum.\\nForceps, small hemostatic.\\nForceps, hemorrhoid.\\nScalpel. Paquelin s cautery.\\nRectal bougies.\\nSterilized stockings. Leg-holder.\\nKelly perineal pad.\\nIrrigator. Dressings. Sutures. Liga-\\ntures.\\nCurets, sharp and dull, 1 pair of each.\\nSaw and chisels for Kraske s operation.\\nMetal probes for tracing fistulae.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0091.jp2"}, "92": {"fulltext": "84 SURGICAL TECHNIC.\\nInstruments for Urethral a7td Bladder Operations.\\nSet of sounds, curved and straight.\\nCatheters, various sizes.\\nUrethral forceps, i pair.\\nArtery-dilators, various sizes.\\nEndoscopes with calibrators, various\\nsizes.\\nUrethral searcher.\\nHead-mirror. Return-irrigator.\\nSounds and dilators (usually the same).\\nScalpels, artery-forceps, lithotrites.\\nStone-forceps, litholapaxy set.\\nCurets, etc., for suprapubic or perineal\\nlithotomy, or for litholapaxy, opera-\\ntions on tumors, etc.\\nNecessary for Dressings after Gynecologic\\nOperations.\\nSims speculum.\\nBullet-forceps, i pair.\\nLong dressing-forceps (Kelly).\\nApplicator. Scissors, straight, i u\\nChurchill s tincture of iodin.\\nCarbolic acid, 95 per cent. Ichthyol.\\nBalsam of Peru and glycerin.\\nGlycerin (pure). Vaselin.\\nTampons. Boric acid solution.\\nIrrigator. Kelly perineal pad.\\nAndrews stitch-cutter for the removal\\nof silkworm-gut stitches from the\\nvagina and cervix.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0092.jp2"}, "93": {"fulltext": "LIST OF INSTRUMENTS. 85\\nFor Cystoscopic Examination.\\nHead-mirror.\\nUrethral calibrator and dilator.\\nUrethral searcher.\\nVesical specula with obturators.\\nEvacuator for removing urine.\\nLong-mouthed toothed forceps.\\nApplicator.\\nCocain solution, 10 per cent.\\nBoroglycerid to lubricate the speculum\\nand dilator.\\nIn private practice a head-mirror or reflector can\\nbe improvised with a lamp or candle and a mirror.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0093.jp2"}, "94": {"fulltext": "CHAPTER VIII.\\nANESTHESIA.\\nAnesthetics are divided into two classes, local\\nand general. In local anesthesia the patient does\\nnot lose consciousness; bat in general anesthesia\\nconsciousness is put in abeyance, the brain, together\\nwith the rest of the body, is narcotized, and there\\nis profound sleep from which the patient awakens\\nslowly. Both classes of anesthetics are used in sur-\\ngery.\\nWe have practically four general anesthetics, one\\na gas, nitrous oxid, and three in liquid form: ether,\\nchloroform, and ethyl bromid. The last three are\\nthose which are used in surgical work, while the first\\nis chiefly employed in dentistry. The administration\\nof the anesthetic is a duty which often falls to the\\nhead nurse, especially in small hospitals, in private\\npractice, and in emergency cases.\\nThe anesthetic should be administered in a room\\napart from the operating-room, so that the patient\\nmay be spared the sight of the preparations for the\\noperation and the necessary display of instruments.\\nBefore giving the anesthetic the urine, heart, lungs,\\nand mouth are examined, the mouth because patients\\nare apt to deny the presence of false teeth, and male\\npatients have been known to go to the anesthetizing\\nroom with tobacco in their mouths. The patient s", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0094.jp2"}, "95": {"fulltext": "ANESTHESIA. 8?\\nhabits should be inquired into. Alcoholic patients\\npass through the exciting stage of anesthesia with\\nconsiderable struggling; they are also more liable to\\ncongestions.\\nAn anesthetic must never be given on a full stom-\\nach, because the patient may vomit, and particles of\\nfood may lodge in the larynx and trachea and result\\nin strangulation. The bladder and bowels must\\nalways be emptied, or they may act involuntarily.\\nFalse teeth must be removed, as there is danger of\\ntheir being swallowed.\\nAbsolute silence must be maintained while the\\nanesthetic is being administered, as anything said\\nmay be heard by the patient and be repeated. What-\\never is said by the patient during the anesthetic state,\\nor while going into or coming out of it, must be kept\\nabsolutely secret. Family secrets and other things\\nmay be told which might make great trouble if they\\nwere repeated. So a religious silence must be ob-\\nserved by every one with regard to any statement\\nthat the patient may make while intoxicated. Care\\nmust also be taken that the operation is not dis-\\ncussed. Many patients have been made very un-\\nhappy through carelessness on this point; for they\\ncan often hear everything that is said by the doctors,\\nstudents, and nurse, but are totally unable to make\\nany sign by which a bystander may know that they\\ncan hear. These are about the first lessons that\\nshould be impressed upon a nurse when she be-\\ngins her operating-room service. Oliver Wendell\\nHolmes, in his Medical Essays, says: It is a ter-\\nrible thing to take away hope, even earthly hope,\\nfrom a fellow-creature. Be very careful what names", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0095.jp2"}, "96": {"fulltext": "88 SURGICAL TECH NIC.\\nyou let fall before your patient. He knows what it\\nmeans when you tell him he has tubercles, or Bright s\\ndisease; and if he hears the word carcinoma, he will\\ncertainly look it out in a medical dictionary, if he\\ndoes not interpret its dread significance on the\\ninstant.\\nIt is not always best that the patient should know\\nthat she has carcinoma; if she hears that word, she\\nwill feel that it is a sentence of death sooner or later,\\nand her life will be made miserable, whereas, if she\\nis not informed as to the nature of her condition, her\\nlife can often be made more comfortable.\\nThe giving of the anesthetic is by no means a sub-\\nordinate duty. It requires a very skilled and trust-\\nworthy assistant, one who is competent to act in case\\nof emergency, because the life of the patient is as\\nmuch in the hands of the anesthetist as in those\\nof the operator. The anesthetist s whole attention\\nmust be given to the administration of the drug.\\nConsequently, he cannot also watch the operator.\\nThe majority of patients are opposed to giving up\\nconsciousness, and often it costs a great struggle. It\\nis here that a nurse should inspire her patient with\\nconfidence. Although we see many operations in\\nthe hospital in a single day, yet to the patient it is\\nthe one great event in his or her life.\\nSome patients have an idea that an operation is\\nmere butchery; while others who have any control\\nover themselves can be shown the operating-room in\\nreadiness for work. A few cheering words convey-\\ning the right meaning are all that is needed, but we\\nshould remember that these are needed.\\nIn all operations in which an anesthetic is em-", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0096.jp2"}, "97": {"fulltext": "ANESTHESIA. 89\\nployed, even in those of a minor character, it is well\\nto be prepared for accidents, such as heart-failure,\\narrest of respiration, or hemorrhage. There should\\nbe a hypodermic tray, with bottles containing solu-\\ntions of strychnin sulphate, atropin sulphate, digit-\\nalis, whiskey, nitroglycerin, morphin sulphate, and\\ncamphorated oil. Two hypodermic syringes in good\\norder should be in readiness. An oxygen-inhaling\\napparatus is a valuable adjunct to an operating-room,\\nand may prove useful in respiratory failure. It is\\nalso advisable to have a small faradic battery near\\nat hand. A quantity of normal saline solution\\nshould always be in readiness for injection under\\nthe skin.\\nThe Allis inhaler is generally used, and in its\\nabsence a cone is to be preferred to a sponge, since a\\ncone is always fresh and clean. An ether cone is\\nmade by folding a newspaper; or a straw cuff may be\\nshaped to fit over the nose and mouth, a stiff towel\\nbeing folded around and secured with safety-pins, and\\na clean handkerchief or piece of cotton placed inside.\\nEther should be given slowly; the cone should not\\nbe filled with ether and put over the face, entirely\\nsmothering the patient. The patient should be in-\\nstructed how to inhale it, slowly and deeply, and also\\nto close the eyes, because ether is an irritant to them.\\nAbout two tablespoonfuls of ether are poured into\\nthe cone, which should be held a little distance from\\nthe patient s face, and as he becomes accustomed to\\nthe vapor and comes under its influence the cone may\\nbe brought nearer the strangling sensation, of which\\nso many patients complain, is then in a measure\\navoided. A little patience exercised at the beginning", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0097.jp2"}, "98": {"fulltext": "9 o\\nSUR GICA L TE CHNIC.\\nobtains more satisfactory results and less shock than\\nwhen the drug is crowded, and force is used to re-\\nFig. 13. Allis s aseptic ether-inhaler.\\nstrain the struggles of the patient. Ether generally\\nfirst produces choking and coughing, followed by ex-\\ncitement that is fol-\\nlowed by the muscles\\nbecoming rigid, the\\nface may be cya-\\nnosed, and the breath-\\ning stertorous or snor-\\ning this stage passes\\naway, the muscles be-\\ncome relaxed, and the\\npatient is in a state of\\ninsensibility.\\nThe lower jaw must\\nbe kept forward by placing the thumbs behind the\\nangles of the jaw. Gentle pushing of the jaw for-\\nward and upward, which brings the upper behind the\\nFig. 14. Method of pushing the lower\\njaw forward to prevent obstruction to\\nbreathing.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0098.jp2"}, "99": {"fulltext": "ANESTHESIA, 9 1\\nunder teeth, keeps the tongue from slipping back and\\nobstructing the larynx, and gives free access of air to\\nthe lungs. Should the tongue slip back, it may be\\npulled forward with the fingers or with a pair of for-\\nceps. Holding the tongue forward by means of pass-\\ning a suture through the tongue with a needle should\\nnot be done; neither should too much pressure be put\\non the tongue-forceps, for that will cause the tongue\\nto become sore and swollen, and after the patient recov-\\ners from the anesthetic, about the first thing of which\\nshe complains is the soreness of tongue and jaws. Fre-\\nquent inspirations of fresh air should be given. When\\ncompletely etherized only a small quantity of the\\ndrug is needed to keep the patient under its influence.\\nThe eyeball should not be touched in order to ascer-\\ntain if the patient is completely narcotized it is\\nliable to cause conjunctivitis. Press down the upper\\neyelid on the eyeball if the patient makes no move-\\nment, and is perfectly relaxed, then insensibility is\\ncomplete. Bronchorrhea usually occurs during the\\nearlier stages of anesthesia; but if proper care is taken\\nnot to crowd the ether at the start, the mucus secreted\\nwill not be of sufficient amount to cause any distress-\\ning symptom. When it does occur, the head should\\nbe turned to the side and the mouth wiped with a\\ngauze sponge in a sponge-holder. Bronchorrhea may\\nprove to be a distressing complication to the admin-\\nistration of the anesthetic, inasmuch as the free secre-\\ntion in the bronchi and bronchioles may interfere\\nwith thoroughly anesthetizing the patient, and the\\npatient is more prone to nausea from swallowing the\\nmucus, which is probably soaked with ether. If the\\npatient seems inclined to vomit, the ether should be", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0099.jp2"}, "100": {"fulltext": "92 SURGICAL TECHNIC.\\npushed, which will generally ward it off; should she\\nvomit, her head should be turned to one side, to\\nallow the matter to escape more easily from the\\nmouth. If the operation is about the neck or chest,\\nthe head must be turned to the opposite side, to pre-\\nvent vomited matter from getting into the wound.\\nVomiting is usually due to incomplete anesthesia and\\nthe admixture of too much air with the vapor. The\\nanesthetic must be persistently given until the vomit-\\ning ceases and complete relaxation occurs.\\nThe mucus should be constantly wiped from the\\npatient s mouth. The pupils should remain con-\\ntracted all through etherization, and dilate when the\\npatient is returning to consciousness. Dilated pupils\\nmean one of two things: either that the patient is com-\\ning out of the anesthetic influence, or that she is too\\ndeeply anesthetized. We can readily ascertain which\\ncondition the patient is in by pouring a little ether\\ninto the cone. If she is coming out, she will cough,\\nstop breathing, and give other signs of discomfort;\\nwhile if too deeply etherized she will breathe on\\nsteadily and not notice the fresh supply of ether; and\\nthe pupils will remain dilated until the muscles of\\nthe eyes regain their tone, when they contract. The\\nsudden dilatation of the pupils is generally a sign of\\nimminent death. It is very important for the anesthet-\\nist to watch carefully the respirations, because ether\\nkills by suffocation, the heart usually beating long after\\nthe respirations have ceased. The anesthetist should\\nspeak out if the pulse is growing rapid, feeble, irreg-\\nular, or intermittent; if the respirations are becoming\\nlow, rapid, or gasping; if the face is becoming pale\\nor blue; if the pupils are gradually dilating; or if", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0100.jp2"}, "101": {"fulltext": "ANESTHESIA. 93\\nthe extremities are cold and there is profuse perspira-\\ntion. A very long anesthesia may lead to secondary\\nprostration and collapse, and secondary shock from\\nthat cause alone. In other words, the prostration of\\nthe anesthetic is added to the effects of the oper-\\nation.\\nPrimary anesthesia is that moment of temporary\\nunconsciousness which comes on after the patient has\\ntaken a few inhalations, before the stage of excite-\\nment.\\nIn etherizing young children it is best to put them\\non the back and at once to place the ether-cone over\\nthe mouth and nose without temporizing. If their\\npleadings to have the cone taken away are listened\\nto (and they are hard to resist), their agony will only\\nbe prolonged and the operation delayed. Children\\nare quickly etherized, and very rapidly recover from\\nthe influence of the ether.\\nDeath from ether is slow, by paralysis of the res-\\npiration, the signs of danger being a blue and\\nlivid skin, and low, shallow, gasping respirations.\\nEther is very inflammable; hence the can should\\nnever be opened near a light or fire.\\nNausea and vomiting are very common after ether,\\nbut are usually over at the end of eighteen hours.\\nShould vomiting persist until the following day, it\\nmay be due to shock or to some cause other than\\nether. It may be relieved by the inhalation of hot,\\nstrong vinegar fumes; a cloth wet with vinegar\\nplaced over the mouth and nose; teaspoonful doses\\nof very hot water, either plain or with four grains\\nof bicarbonate of sodium added to one ounce of\\nwater; crushed ice; champagne and ice; small doses", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0101.jp2"}, "102": {"fulltext": "94 SURGICAL TECHNIC.\\nof brandy and ice; black coffee; aromatic spirits of\\nammonia, or sometimes tea. Cocain, one-fourth\\ngrain every two hours for five doses, has been suc-\\ncessful in severe cases; also a mustard-leaf applied\\nover the stomach, and the washing out of the stomach.\\nOxygen gas is now frequently administered both to\\nlessen nausea and to hasten consciousness. As a last\\nres6rt, when all other treatment fails and there is\\ndanger that the severe retching will exhaust the\\npatient, morphin, one-sixth grain, is injected over\\nthe epigastrium.\\nChloroform is similar in its action to ether, and is\\noften to be preferred to it, because it is pleasanter to\\ntake, rapidly recovered from, does not produce excite-\\nment or subsequent vomiting, and the patient is\\nbrought more quickly under its influence. It is,\\nhowever, more depressing to the heart than ether,\\nand therefore more dangerous. The patient is not\\nallowed to rise until all effects have passed off. To\\ngive chloroform, a few drops may be sprinkled on\\nan Esmarch inhaler, a handkerchief, a towel, or a\\nsmall wire framework covered with gauze. Where\\nthe operation is on the mouth, so that all available\\nspace and light is demanded, after the patient is fully\\nanesthetized it is administered on a small gauze sponge\\nclamped in forceps which are held several inches\\nabove the mouth. Vaselin should first be spread over\\nthe face, and especially around the lips and nose, to\\nprevent the burning which might occur should any\\nof the fluid drop. The same symptoms are to be\\nwatched for as in the case of ether. Death from\\nchloroform is almost always sudden, from paralysis\\nof the heart; the pupils become dilated, the face pale,", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0102.jp2"}, "103": {"fulltext": "ANESTHESIA. 95\\nand the pulse flickering. These symptoms usually\\ncome on with little or no warning.\\nEthyl bromid is often used as a substitute for chloro-\\nform, which it resembles in its action, except that it\\nis more prompt. It is employed in minor operations\\nand gynecologic examinations. About half a dram\\nis poured on a folded towel, or chloroform-inhaler,\\nand held close to the mouth and nose. The same\\namount is added at intervals until the patient is com-\\npletely narcotized. The stage of excitement is short,\\nand its elimination is rapid. It leaves a disagreeable\\nodor of garlic on the breath, which may last several\\ndays; but, on the other hand, the patient recovers\\nrapidly, and may be able in a very little while to\\nresume work.\\nEthyl bromid is also used as a local anesthetic in\\nthe form of a spray.\\nSchleich? s anesthetic consists of one and a half\\nounces of chloroform, one-half ounce of petroleum\\nether, and six ounces of ordinary ether. It is given\\nin an Esmarch inhaler, and is considered to be safer\\nthan chloroform. Unconsciousness is obtained usu-\\nally in one minute and a half; there is no excite-\\nment, and the reaction is rapid. There are three\\nforms of this solution, the other two being weaker.\\nLocal anesthetics are those which abolish the\\nsensibility of the peripheral nerves of a particular\\narea (Brunton).\\nCocai)i is the best one that we have at present; the\\nothers are ethyl chlorid, eucain, menthol-chloral,\\northoform, freezing with ice and salt, carbolic acid,\\nalcohol, ether, the so-called infiltration-anesthesia,\\netc.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0103.jp2"}, "104": {"fulltext": "96 SURGICAL TEC ff NIC.\\nIce. The disadvantage of using ice is that it is\\nalways followed by a reaction, the blood-vessels\\nbecoming filled with blood; and the patient suffers\\nthe pain and tingling sensation which follow intense\\ncold. It is used in the following w r ay To a little,\\nfinely-chopped ice is added about a quarter the\\namount of salt; this mixture is placed in a piece of\\ngauze and laid over the part, which in about ten\\nminutes becomes white and numb.\\nEiicain is much used as a local anesthetic in sur-\\ngery of the nose, throat, and ear in strengths of 2,\\n5, and 8 per cent. In the onset its action is slightly\\nslower than that of cocain, from five to ten minutes\\nelapsing before the patient is ready for operation,\\nbut when established the anesthesia is fully equal to\\nthat of cocain. The duration of the anesthesia is\\nfrom ten to twenty minutes, fifteen minutes being\\nthe most usual time.\\nCocain hydrochlorate is a very good anesthetic. It\\nis ordinarily employed in a 4 per cent, solution, and\\nis principally applied to the mucous membranes,\\nsuch as the eye, the mouth, the nose, the urethra,\\netc. It is not so effective when applied to the sound\\nskin; in order to produce anesthesia there it must be\\ninjected subcutaneously, when it gives rise to a rapid\\nedema of the tissues. It has the power of shrinking\\nup the blood-vessels and temporarily driving the\\nblood out of the parts, which is quite an advantage\\nin minor operations.\\nEighteen grains of cocain hydrochlorate to one\\nounce of water is a 4 per cent, solution. One grain\\nof boric acid added to the solution will prevent the\\ndevelopment of fungi, and the solution remains", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0104.jp2"}, "105": {"fulltext": "ANESTHESIA. 97\\naseptic. The solution should be kept in a cool spot,\\nfor if placed in a temperature higher than 6o\u00c2\u00b0 P. it\\nbegins to lose its anesthetic properties.\\nThe use of the cocain discoids enables the nurse to\\nprepare a desired amount of a fresh solution at a mo-\\nment s notice. They are convenient and safe, and\\ncontain accurately weighed quantities of pure cocain.\\nThe phenate of cocain is a local anesthetic, used in\\nfrom 5 to 10 per cent, solutions. It takes longer to\\nact than the hvdrochlorate; it also coagulates the\\ntissues and lessens absorption.\\nEthyl chlorid is a local anesthetic, acting by freez-\\ning the parts. It is put up in glass tubes. The cap\\nis removed from the tip of the tube and the bulb held\\nin the palm of the hand, the warmth of which causes\\nthe liquid to escape in a vaporized stream. The tube\\nis held a little distance from the part to be operated\\nupon, which whitens and is ready for operation in\\nabout fifteen seconds.\\nThe method of infiltration-anesthesia (local anes-\\nthesia by injection of solutions in the skin) was in-\\ntroduced by Schleich, who claims that a weak solu-\\ntion of cocain hvdrochlorate, with common salt, and\\na small amount of morphin, will produce a thorough\\nand prolonged anesthesia. There are three prepara-\\ntions, each of which is put up in tablet-form, contain-\\ning the proper proportions\\nNo.\\ni. Strong.\\nCocain. hydrochlor.,\\ni gr.\\nMorph. hydrochlor.,\\nig r\\nSodium chlorid,\\ni gr.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0105.jp2"}, "106": {"fulltext": "98 SURGICAL TECHiXIC.\\no. 2. Noi maL\\nCocain. hydrochlor.,\\nig*.\\nMorph. hydrochlor.,\\nJgr.\\nSodium chlorid,\\n1 gr.\\no. 3. Weak.\\nCocain. hydrochlor.,\\n2V g r\\nMorph. hydrochlor.,\\nigr.\\nSodium chlorid,\\n1 gr.\\nThe tablets should be dissolved in distilled sterilized\\nwater.\\nAlcohol and ether are local anesthetics, as is also\\nany agent which evaporates rapidly and produces\\ncold.", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0106.jp2"}, "107": {"fulltext": "CHAPTER IX.\\nANTISEPTIC GAUZES, TAMPONS, BANDAGES,\\nTHERMOCAUTERY, SALINE INFUSIONS, IR-\\nRIGATION, ETC.\\nSurgical Dressings. Gauze and absorbent cot-\\nton are now almost universally used as wound-dress-\\nings. A dressing may be aseptic or antiseptic. An\\nantiseptic dressing absorbs from the wound all dis-\\ncharges, prevents the access of germs to the wound\\nfrom the outside, and also destroys all germs that may\\ncome in contact with it. An aseptic dressing has the\\nsame properties, with the exception that it cannot\\ndestroy germs.\\nIn selecting gauze for dressings, that which pos-\\nsesses the greatest absorbent power should be secured.\\nIt should be soft, pliable, and free from irritating and\\ngritty materials.\\nWhen applied to a wound, it should be unfolded\\nand laid on loosely it thus forms a softer dressing\\nand more readilv absorbs the discharges.\\nAbsorbent cotton is ordinary cotton deprived of its\\noil, in order to render it absorbent. Laid over gauze,\\nit acts as a sieve through which germs cannot pass\\nalso as a springy protective, by means of which the\\nwound is protected from undue pressure.\\nAntiseptic dressings are made by impregnating gauze\\n99\\nLore.", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0107.jp2"}, "108": {"fulltext": "100 SURGICAL TECHNIC.\\nwith an antiseptic, such as bichlorid of mercury,\\niodoform, etc.\\nTo make bichlorid gauze, the gauze after the initial\\nboiling is immersed in a i iooo bichlorid solution for\\ntwenty-four hours, after which it is dried, cut into\\ndressings, and packed in glass sterilized jars.\\nIodoform gauze may be made after the following\\nformula\\nCheese-cloth,\\n5 yards*\\nAlcohol,\\n8 ounces.\\nIodoform,\\n3\\nEther,\\n7\\nGlycerin,\\n3\\nShake the alcohol and iodoform together in a sterile\\nbottle for fifteen minutes, then add the glycerin, and\\nlastly the ether. Put all into a sterilized stone jar\\nthen rub the mixture into the gauze thoroughly, and\\ncut the latter into strips two inches wide. Each strip\\nis rolled up separately, and several strips are placed\\nin a sterilized jar. When required for use a strip is\\ntaken out with sterile forceps.\\nIn some cases an emulsion of iodoform is rubbed\\ninto the gauze. This emulsion, according to Wharton,\\nis made by adding three drams of iodoform to six\\nounces of Castile soap-suds. This suffices to impreg-\\nnate eighteen ounces of moist gauze.\\nThe iodoform glycerin or oil which is used for\\ninjections into wounds is prepared by taking\\nIodoform, 5 grams (75 grains).\\nGlycerin, 100 c.c. (3I ounces).\\nMix and place in a wide-mouthed flask of thin", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0108.jp2"}, "109": {"fulltext": "SURGICAL DRESSINGS. IOI\\nglass, and sterilize for one hour, plugging the flask\\nafterward with sterilized cotton.\\nPotassium-permanganate Gauze. The formula for\\nthis is as follows\\nPotassium permanganate, 160 grains.\\nHot water (distilled), 33 ounces.\\nThe gauze is cut and rolled as for iodoform gauze,\\nand saturated thoroughly in the above solution. It\\nshould be preserved in colored glass jars.\\nBismuth gauze is made after the subjoined\\nformula\\nBismuth subiodid,\\n11 drams.\\nGlycerin,\\n7\\nWater (distilled),\\n4^2 ounces.\\nMix and rub thoroughly into the meshes of gauze,\\ncut, and preserve the same as iodoform gauze.\\nIn emergency cases old sheets and clean linen may\\nbe cut to the desired size and sterilized in an oven.\\nCollodion Dressing. Collodion is a preparation of\\npyroxylin in alcohol and ether. On evaporation of\\nthe alcohol and ether a thin, impervious film of col-\\nlodion is left. The collodion is either painted over\\nthe surface of the wound by means of a clean stick of\\nwood or an applicator with sterile cotton fixed to the\\nend, or thin layers of absorbent cotton are saturated\\nwith it, laid on the wound, and allowed to dry. Col-\\nlodion is used only when the wound is aseptic. Vari-\\nous antiseptic agents, such as iodoform, boric acid,\\netc., maybe dissolved or suspended in the collodion.\\nThe surface of the wound must be perfectly dry, or\\nthe collodion will not adhere. An ordinary dry", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0109.jp2"}, "110": {"fulltext": "102 SURGICAL TECHXIC.\\ndressing may be applied over the collodion as a further\\nprotective.\\nHorsley^ s wax is made of seven parts of beeswax\\nto one part each of almond oil and salicylic acid.\\nRubber adhesive plaster is at times used in the later\\nstages of wound-healing, for the purpose of drawing\\nthe edges together. The chief objection to its use is\\nthat it cannot be thoroughly sterilized. A protective\\ndressing may be applied over it in the usual way.\\nRubber plaster is also used to take the place of band-\\nages where these are inconvenient or difficult of\\napplication.\\nOiled silk or rubber protective is used when it is\\ndesirable to prevent sticking of the dressings to the\\nwound, as in ulcers, skin-grafting, etc. The mate-\\nrial is applied in narrow strips which overlap each\\nother like shingles. The strips are sterilized by wash-\\ning in cold soap-suds and soaking them in a i 250\\nsolution of corrosive sublimate. They are then rinsed\\nin sterile water or saline solution, in which they are\\nallowed to float until needed by the surgeon.\\nTents are small strips of rolled gauze used to\\nkeep a wound open for the escape of pus. They\\nare rarely employed at present, having been replaced\\nby the drainage-tube. The term tent more fre-\\nquently designates a conical or cylindrical pencil of\\nsponge, sea-tangle, and other substance, employed for\\ndilating a narrow r channel, such, for instance, as the\\ncervical canal. When introduced, the tent expands\\nfrom the absorption of moisture, and this dilates the\\npart.\\nTampons are made of absorbent cotton, lambs\\nwool, or gauze, and are about seven inches long, one", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0110.jp2"}, "111": {"fulltext": "BANDAGES.\\nJ \u00c2\u00b03\\nand one-half inches wide, and one-half an inch thick.\\nThey are folded and tied in the middle with a strong\\nwhite thread or fine twine, leaving long ends by\\nwhich to remove the tampon. The so-called kite-tail\\ntampon is made by fastening several of these pieces\\nof cotton to a thread about two inches apart. The\\ntampons may after sterilization be kept in a dry,\\nsterile jar, or they may be thoroughly soaked in water\\nand then kept in glycerin. Tampons are principally\\nused for introduction into the vagina. Previous to\\nintroduction they may be dipped into various special\\nsolutions. They are generally removed from the\\nvagina on the day after the application.\\nBandages. In addition to the well-known roller-\\nbandage, special bandages find frequent employment,\\nFig. 15. The Scultetus bandage.\\nFig. 16. T-bandage.\\nparticularly after abdominal operations. The most\\nimportant are the Scultetus and the T-bandages.\\nThe Scultetus bandage is used for surrounding- the\\nabdomen. It is made by taking two pieces of\\nflannel or of cotton, each one yard long and four\\ninches w 7 ide, the two pieces being placed four inches", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0111.jp2"}, "112": {"fulltext": "104 SURGICAL TECHNIC.\\napart; across them are sewed five other pieces of the\\nsame length and width, each piece being overlapped\\nby the one above it by one-half its breadth. This\\nbandage is placed under the patient s back, the cross-\\nstrips are folded over the abdomen from below\\nupward, and the lower ends of the vertical strips are\\nbrought up between the thighs and pinned to the\\nfront of the bandage. This keeps the bandage from\\nwrinkling and retains it in position.\\n~X -bandage. The T-bandage, which is used to\\nsecure dressings on the anus or the perineum, is\\nmade of two strips of bandage, each about five inches\\nwide. To the middle of one strip, which is to go\\naround the waist, the end of the other strip is sew r ed,\\nwhich forms a letter T. This latter strip is brought\\nforward between the thighs and pinned to the front,\\nthus securing the perineal dressing.\\nAntiseptic Powders. Reference has already\\nbeen made to these. Those most frequently em-\\nployed are iodoform, boric acid, acetanilid, dermatol,\\nand mixtures of these various kinds. Iodoform and\\nboric acid are generally combined in the proportion\\nof one of the former to seven of the latter. The\\npowders are kept in sterilized glass salt-cellars with\\nsilver-tops, which are covered with gauze when not\\nin use, or in sterile wide-mouth bottles over which a\\npiece of gauze is stretched. As the bottle may not\\nbe thoroughly clean on the outside, it should be\\nhanded to the surgeon wrapped in a sterile towel up\\nto the top.\\nThe thermocautery, known also as the Paquelin\\ncautery, because of its invention by Paquelin, of\\nParis, is frequently employed in surgery to control", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0112.jp2"}, "113": {"fulltext": "THE THERM OL AUTER\\nI05\\nbleeding, and also to produce counter-irritation.\\nThe efficacy of this instrument depends on the fact\\nthat when the vapor of some highly combustible car-\\nbon compound is driven over heated platinum its\\nrapid incandescence is sufficient to maintain the heat\\nof the metal. Platinum points of various shapes and\\nsizes are attached to a rubber tube, which is con-\\nnected with a metal container half full of benzine\\nor alcohol, the vapor of which is pumped through\\nthe tubing and holder into the platinum point. In\\nFig. 17.\u00e2\u0080\u0094 Paquelin s thermocautery.\\norder to prepare the instrument for use, a sponge\\nis first placed in the bottom of the container, and\\nover that is poured a small quantity of benzine or\\nalcohol. Two pieces of rubber tubing, the one with\\na bulb, and another to the handle of which is screwed\\nthe platinum point, are connected by means of the\\nstopper to the container. The tip of the platinum\\npoint is held in the flame of an alcohol lamp until\\nit begins to glow, after which the flame is extin-\\nguished, and the action of working the bulb gently", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0113.jp2"}, "114": {"fulltext": "106 SURGICAL TECHNIC.\\nforces the air charged with benzine through the\\ntubing to the point, where it ignites and keeps the\\npoint glowing.\\nAfter using, the container should be completely\\nclosed, and the points while hot must be removed\\nfrom the handle and laid away to cool; they must\\nnot be put into water, but wiped perfectly clean.\\nThe handle when cool must be removed from the\\ntubing, and each part must be carefully laid in its\\nown compartment in the case.\\nNormal saline solution is made to correspond as\\nnearly as possible in specific gravity with the normal\\nserum of the blood. The formula suggested by Dr.\\nLocke of Boston and Dr. H. A. Hare, containing\\nin one quart calcium chlorid 0.25 gm., potassium\\nchlorid o. 1 gm., sodium chlorid 9 gm., is usually\\nemployed. It not only gives the heart a better\\nfluid to work upon, but it restores to the blood that\\ncoagulable quality which is diminished or lost by\\nhemorrhage. Tablets containing this formula have\\nbeen devised, and are usually used. One tablet added\\nto one quart of water gives the correct strength. In\\nabsence of the tablets one teaspoonful of table salt\\nis added to one pint of water. It is absolutely neces-\\nsary whatever formula is used that the solution and\\nall the apparatus used be properly sterilized. If the\\nwater contains particles that cannot be strained out\\nand there is no filter at hand, the water should stand\\nuntil the sediment settles, when the fluid can be\\npoured off, resterilized, and used. This solution is\\nplaced in an irrigator or a fountain-syringe which has\\nbeen thoroughly sterilized with hot water and corro-\\nsive-sublimate solution, and subsequently rinsed with", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0114.jp2"}, "115": {"fulltext": "IRRIGATION. 107\\nboiled water. A long hypodermic needle, which has\\nalso been thoroughly sterilized, is fastened to the end\\nof the rubber tube connected with the irrigator or\\nfountain-syringe. The solution may be kept in a\\npitcher and poured into a glass funnel to which the\\nrubber tube is attached. The temperature of the solu-\\ntion should be about ioo\u00c2\u00b0 F. The solution is intro-\\nduced under the skin of either the chest, the abdo-\\nmen, the thigh, the arm, or between the shoulder-\\nblades. From a pint to two quarts are injected at\\none time. The part selected for the injection is to\\nbe sterilized thoroughly in advance. Saline infusion\\nis also given by the rectum, a long rectal tube being\\nused.\\nIn hospitals it is customary to keep on hand flasks\\nof saline solution. These flasks are sterilized before\\nfilling; afterward they are stopped with sterile cot-\\nton-plugs and sterilized again by boiling for one\\nhour on three successive days.\\nNormal salt solution is used for irrigation and for\\ninjections in cases of shock, in acute diabetic and\\nuremic coma, hemorrhage, puerperal infection and\\neclampsia, etc.\\nIrrigation. Irrigation, or flushing, is employed\\nto cleanse wounds and wash out cavities, such as\\nthe uterus, the abdomen, etc. The solutions em-\\nployed are various. Many surgeons use sterile salt-\\nsolution or plain boiled water. Antiseptic solutions,\\nsuch as bichlorid solution (1 10,000 to 1 1000), boric\\nacid solution, etc., are used especially for septic\\nwounds and surfaces. For purposes of irrigation a\\nconcial glass vessel, with a tube at the bottom to\\nwhich a rubber tube is attached, is commonly em-", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0115.jp2"}, "116": {"fulltext": "108 SURGICAL TECH NIC.\\nployed; a fountain-syringe will also answer the pur-\\npose. The irrigating-nozzle is usually of glass.\\nThe solution should be warm; when it is desired to\\ncheck hemorrhage, it is used quite hot (no\u00c2\u00b0-i20\u00c2\u00b0 F.).", "height": "4959", "width": "3120", "jp2-path": "bacteriologysur00ston_0116.jp2"}, "117": {"fulltext": "CHAPTER X.\\nSUTURES AND LIGATURES; SPONGES; DRAIN=\\nAGE; DRAINAGE=TUBES; GAUZE DRAINS;\\nRUBBER DAM; RUBBER AND COTTON\\nGLOVES.\\nSutures, which are used to bring together the\\nedges of a wound, may be of silver ware, silkworm-\\ngut, twisted Chinese silk, kangaroo-tendon, catgut,\\nand horse-hair. Of these, silkworm-gut, catgut, and\\nsilk are most commonly used.\\nCatgut is made from the intestine of the sheep. It\\nis largely used for suture-material within the abdom-\\ninal cavity or deeper layers of tissues, because it is\\nabsorbed by the fluids of the body, and does not\\nremain after the healing of the external wound to\\nconstitute a foreign body.\\nKangaroo-tendon is prepared from the split sinews\\nof the tail of that animal, and was introduced by\\nDr. H. O. Marcy of Boston. It is obtainable in any\\nsize, and comes in pieces of about twenty inches in\\nlength. Its advantage over catgut consists in its\\ngreater strength. It is more easily sterilized, and\\ndoes not lose its strength during perfect sterilization.\\nIt is particularly of value in buried sutures and liga-\\ntures and continuous sutures at the surface.\\nTo prepare the kangaroo-tendon the following\\n109", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0117.jp2"}, "118": {"fulltext": "IIO SURGICAL TECHNIC.\\nmethod may be used: The tendon having been\\nsoaked in absolute ether for forty-eight hours, is\\nboiled at a temperature of ioo\u00c2\u00b0 C. in alcohol for\\none hour. This temperature is maintained by means\\nof a water-bath. It is then put in mercuric chlorid\\nsolution, consisting of mercuric chlorid 40 grains,\\ntartaric acid 200 grains, and alcohol 12 ounces, for\\nten minutes. It is then placed with sterilized forceps\\nin sterilized glass-stoppered jars containing bichlorid\\nof palladium T grain to 1 pint of absolute alcohol.\\nSilkworm-gitt is prepared for use by soaking for\\nforty-eight hours in ether and one hour in 1 1000\\ncorrosive sublimate; it is then kept in a long tube of\\nalcohol, though many surgeons prefer it made asep-\\ntic by boiling two hours before the operation. It is\\nseldom used as a buried suture, but chiefly in closing\\nwounds with interrupted sutures.\\nCatgut. There are various methods of sterilizing\\ncatgut, among them the methods of Leavens and Fow-\\nler, by which catgut is kept in alcohol in sealed tubes,\\nthe preparation by formalin recently proposed by Senn,\\ncumol catgut, etc., all equally effective if judiciously\\ncarried out. The gut used should be of the very best\\nquality. The following are the most popular methods\\nof preparation\\n1. Six strands of catgut, each fourteen inches long,\\nare wound on glass reels and soaked in ether for twenty-\\nfour hours to remove all fatty substances. The spools\\nare then removed with sterilized forceps and dropped\\ninto covered glass jars, containing 95 per cent,\\nalcohol, care being taken that the catgut is com-\\npletely submerged and that allowance is made for\\nevaporation. The mouth of the jar is covered with", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0118.jp2"}, "119": {"fulltext": "SUTURES AND LIGATURES. Ill\\nabsorbent cotton and the jar placed on a water-bath,\\nthe water of which is gradually heated until the\\nalcohol boils, when the jar is removed. This opera-\\ntion is repeated on two successive days. On the third\\nday of sterilization the absorbent cotton is removed,\\nand a glass cover, fitted with a rubber protective to\\nprevent evaporation, is screwed on.\\n2. The catgut is soaked for twelve hours in a corro-\\nsive sublimate solution (i iooo), and afterward from\\ntwenty-four to forty-eight hours in oil of juniper.\\nThe spools are then transferred to covered glass jars,\\ncontaining sufficient absolute alcohol to cover the cat-\\ngut completely. The alcohol is changed every two\\nweeks.\\n3. Strands of catgut are soaked for twenty-four\\nhours in oil of juniper, after which they are wound\\nupon glass reels, and placed in covered glass jars con-\\ntaining absolute alcohol.\\nThe method used by Dr. F. W. Johnson, of Bos-\\nton, Mass., is as follows: The gut is soaked in ether\\nfor several days. It is then cut into the desired\\nlength, each length being thoroughly stretched (the\\nstretching prevents kinking and twisting). The gut\\nis then soaked for twenty-four hours in absolute\\nalcohol, to take out as much of the water as possible.\\nIt is then covered with a solution of bichromate of\\npotassium in absolute alcohol (fifteen grains to the\\npint), and remains in this twelve hours. Each\\nlength is coiled up, wrapped in waxed paper, and put\\nin an envelope, which is sealed. The sealed envel-\\nopes are put in a dry oven, and baked for one hour\\nat a temperature of ioo\u00c2\u00b0 C. This removes all moist-\\nure. On the following day the sealed envelopes are", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0119.jp2"}, "120": {"fulltext": "112\\nSURGICAL TECHNIC.\\nbaked three hours at a temperature of 140 C. The\\ngut is now ready for use. The envelopes are kept in\\na glass jar. An assistant tears open one end of an\\nenvelope, undoes the wax paper without touching\\nthe catgut, and hands it to the operator. In this\\nway the gut is touched by no one, and touches\\nnothing until picked up by the fingers of the opera-\\ntor. (For preparation of catgut by formalin, see\\nFormaldehyde p. 53.)\\nSilk is sterilized by being boiled for two hours\\nbefore the operation. Five yards each of various\\nFig. 18. All-glass ligature-box, hospital size six large spools.\\nsizes of twisted Chinese and pedicle silk are wound\\non glass spools and allowed to boil for two hours\\nbefore the operation. When called for by the oper-\\nator the pan containing the silk is handed to him,\\nand he takes out the required size with sterilized\\nforceps. In this way the sutures and ligatures are\\ntouched by no one but the surgeon himself. It is\\nalways a good plan to sterilize fresh silk for each", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0120.jp2"}, "121": {"fulltext": "SPOXGES. 1 1 3\\nmajor operation. By so doing we are sure of it\\nbeing perfectly aseptic.\\nSilver wire is sterilized by means of dry heat or by\\nboiling in a i per cent, soda solution with the instru-\\nments. Usually the latter is preferred.\\nThe interrupted suture is made by passing catgut\\nor silk through the skin from one side of the wound\\nto the other; then both ends are drawn together and\\ntied in a double knot. The continuous suture is the\\nordinary over-and-over stitch from one end of the\\nwound to the other. The button suture is made by\\npassing wire across the bottom of the wound, bring-\\ning out the ends about one inch from the edge of the\\nwound, and securing each end with a button. The\\nshotted suture is one in which the ends of the suture,\\nafter it is introduced, are passed through a perforated\\nshot, which is then clamped.\\nStitch abscesses are usually produced by unclean\\nsuture-material. They may be caused by tying the\\nstitches too tightly; but as a rule they occur when\\nthe sutures are not carefully sterilized. This is the\\nreason why so many operators prefer their silk and\\nsilkworm-gut boiled immediately before using.\\nSponges. Sponges are used to wash wound-sur-\\nfaces and to absorb or soak up fluids. The sponges\\nmost commonly employed are in the form of the\\ngauze pads, the cut edges being folded over and\\nloosely hemmed, and of square pieces of gauze, each\\npiece being rolled loosely in the form of a ball, the\\nfree end being tw T isted and tucked in. The marine\\nsponges are not often used at the present time. Gauze\\nsponges are never employed more than once. Those\\nused in operations are afterward destroyed; those not", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0121.jp2"}, "122": {"fulltext": "114 SURGICAL TEC II NIC.\\nused are resterilized, placed in sterilized towels, and\\ndeposited in covered glass jars, which are not uncov-\\nered until called for at an operation.\\nThe great advantage of gauze over a marine sponge\\nis that it can be thoroughly sterilized.\\nIf marine sponges are required for an operation, the\\ndark-colored ones should be bought. They do not look\\nso attractive, but they are the finest sponges; they are\\nuncut and u unbleached, and give more service\\nthan the clearer-looking ones, which are partly or\\nwholly bleached. The bleached and cheaper sponges\\nhave been made by cutting one large sponge into\\nseveral small ones; or by cutting off portions that\\nwere torn in taking the sponges from the ocean.\\nMarine sponges should be prepared as follows: i.\\nLay them in a stout cloth and pound sufficiently to\\nbreak up grit and lime. 2. Rinse with warm water\\nuntil it remains clear. 3. Immerse in hydrochloric\\nacid solution (two drams to one quart of water) for\\ntwenty-four hours. 4. Immerse in saturated solution of\\npermanganate of potassium, followed with oxalic acid,\\nthen pass them through lime-water to take out all\\nthe oxalic acid, and rinse well in plain sterile water;\\nafter which they are immersed for twenty-four hours\\nin a 1:1000 corrosive sublimate solution. They are\\npreserved until used in a 3 per cent, carbolic acid\\nsolution.\\nWhen wanted for use the sponges are lifted out of\\nthe jar with long dressing-forceps and rinsed in plain\\nsterile water.\\nGatl^e pads for abdominal operations are made of\\neight thicknesses of gauze about eight inches square,", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0122.jp2"}, "123": {"fulltext": "BRUSHES. I 15\\nwith the edges tucked in and hemmed to prevent\\nfraying.\\nGau^e, now considered the most valuable of\\ndressings for wounds, is cut into sections of four\\nthicknesses and folded into dressings. A large num-\\nber of these are sterilized for two hours, when they\\nare removed with perfectly aseptic hands and placed\\nin sterilized jars.\\nAbsorbent cotton used in dressing cases is pre-\\npared in the same way.\\nNeedles of various shapes and sizes required for\\nan operation are sterilized with the instruments.\\nMany operators prefer the needles to be threaded,\\nthen attached to a towel, which is folded, enveloped\\nin another towel, and securely fastened. These bun-\\ndles are sterilized and are not opened until called\\nfor by the operator or his assistants. After the opera-\\ntion is completed the sutures and ligaments which\\nhave not been used are carefully dried and resterilized.\\nIn choosing the needles care must be taken that only\\nsharp needles and strong sutures and ligatures are\\nselected for use.\\nSheets, gowns, and towels used in operations are all\\nmade into convenient bundles and sterilized for two\\nhours prior to an operation. Bundles once opened\\nare not used again for other operations until they are\\nresterilized.\\nEmergency bundles containing everything neces-\\nsary for an emergency operation are stored in cases\\nprovided for them; but if not used for forty-eight\\nhours, are again sterilized before being used.\\nBrushes. Small hand brushes having a strong\\nwooden back and stiff bristles are used for scrubbing", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0123.jp2"}, "124": {"fulltext": "Il6 SURGICAL TECHNIC.\\nthe hands, field of operation, and the instruments.\\nThey should be boiled two hours before the operation,\\nthen placed in ajar containing- a i iooo corrosive\\nsublimate solution. A separate brush should be re-\\nserved for the patient, and should be so marked. A\\nseparate brush should also be used for the cleansing\\nof the vagina or rectum. Brushes used in purulent\\nwounds, cancer, etc., should be destroyed after the\\noperation. The same brush should never be used\\ntwice by the same person without being resterilized,\\nand no two persons should use the same brush.\\nDrainage. The object of drainage is to carry off\\nto the surface the secretions and discharges of\\nwounds and cavities. The retention and accumula-\\ntion of these would interfere with healing, and, in\\nthe case of septic discharge, involves the danger of\\ngeneral infection. Drainage may be secured by\\nmeans of rubber or glass tubes, or by strands of\\ngauze or silk. In case of abdominal section the\\nglass drainage-tube is usually preferred to gauze\\ndrainage, because it gives freer drainage, does not\\nrequire a large opening in the abdominal walls, and\\nis less likely to cause hernia; a sinus is more apt\\nto follow T the use of gauze drainage, and without\\nanesthesia its removal is painful. Gauze soils the\\ndressing and edges of the wound. With the glass\\ndrainage-tube, if properly taken care of, the dressings\\ncan be kept as sweet and clean as when put on. By\\nbacteriologic examination the secretions in the glass\\ndrainage-tube have been found on the third day free\\nfrom pathogenic bacteria. The chief objections to\\ndrainage of dependent pockets in the pelvis or abdo-\\nmen, as formulated by Dr. J. G. Clark, of the Uni-", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0124.jp2"}, "125": {"fulltext": "DRAINAGE. 117\\nversity of Pennsylvania, are, first, that the fluids are\\nfrequently not removed, but, on the contrary, are pent\\nup by the gauze drain; and, second, instead of remov-\\ning infection, the gauze or tube may be the means\\nof introducing it from the outside into the degener-\\nated fluids. To overcome the dangers of dependent\\npockets and dead spaces in the pelvis, Dr. Clark sug-\\ngests the elevation of the patient s body after operation\\nto a sufficient height to start the flow of fluids from the\\npelvis toward the diaphragm, and thus promote the\\nrapid elimination, by the normal channels of exit\\nfrom the peritoneal cavity, of infectious matter, and\\nof vital fluids that may stagnate in these pockets and\\nform a culture-medium for pyogenic organisms.\\nThe technic of postural drainage through the ab-\\ndomen, which has met with such good results, is\\nvery simple. After the operation proper a large\\nquantity of normal saline solution is poured into the\\nabdomen and allowed to remain, and the foot of the\\npatient s bed is raised twenty inches for about thirty-\\nsix hours after the operation. The result is that the\\nexudate, if infected, is greatly diluted and may all\\nbe absorbed by the peritoneum; if inflammatory, it is\\nkept liquid, and organized exudates are avoided. The\\npressure of the viscera is removed, intestinal adhe-\\nsions are avoided, peristalsis does not cause pain by\\nirritation, the patient suffers less distress and discom-\\nfort, and convalescence is naturally more rapid.\\nCare of Drainage-tubes. If a glass drainage-tube\\nis in the abdomen, the care of it is usually left to the\\nnurse. She must each time, before drainage, thor-\\noughly scrub and sterilize her hands. A svrino-e is used\\nto withdraw any fluid remaining and for injecting irri-", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0125.jp2"}, "126": {"fulltext": "Il8 SURGICAL TECHNIC.\\ngating solutions. The syringe must be washed first\\nwith boiling water, the water being passed through\\nit several times, then with corrosive-sublimate solu-\\ntion (i iooo), followed with boiling water; the\\nsyringe is then to be laid in the corrosive solution\\nuntil the nurse has washed her hands a second time\\nand unpinned the dressing covering the tube. The\\nrubber tube attached to the syringe is passed down\\nthe center of the drainage-tube to the bottom, then\\nwithdrawn a little, so that onlv the fluid will be\\ndrawn up, and not the tissue of the pelvis. The\\nsyringe-piston is to be slowly and steadily drawn up.\\nWhen removing the syringe the nurse should be\\ncareful that blood does not drop on the dressing.\\nThe mouth of the tube is to be covered while the\\nsyringe is being emptied, and the corrosive and hot\\nwater are to be passed through the syringe before\\nagain putting it down the tube.\\nSome surgeons place a piece of tw T isted gauze into\\nthe tube, which sucks up the fluid. This gauze is\\nchanged at stated intervals, and the tube is cleaned\\nwith a small piece of sterilized cotton or gauze fast-\\nened on the end of a pair of long forceps; then a\\nfresh twist of gauze is inserted. The amount of\\nfluid drawn and its character must always be reported\\nby the nurse. When the drainage-tube is to be\\nremoved, the nurse should observe the same precau-\\ntions as she would for a dressing.\\nGlass drainage-tubes are made aseptic by boiling\\nfor tw y o hours before the operation.\\nPreparation of Rtibber Drainage-tubes. Cut tubing\\ninto desired lengths, slip each piece over a glass rod,\\nand scrub with a stiff brush and green soap. Rinse", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0126.jp2"}, "127": {"fulltext": "GLOVES.\\nug\\nin sterile water until entirely free from soap. Boil for\\none hour in a i per cent, solution of sodium bicar-\\nbonate; rinse again several times in sterile water, and\\nput into sterile jars and cover with alcohol or carbolic\\nFig. 19. Drainage-tubes a, glass b, rubber.\\nacid, 1 20. The jar is kept covered except when the\\ntubes are being put in and taken out by sterilized\\nforceps.\\nRubber Dam. Rubber dam is sterilized by boil-\\ning in 1 per cent, s oda solution, and is afterward trans-\\nferred to a glass jar containing 1 20 carbolic acid\\nsolution.\\nGloves. Rubber and cotton gloves are much\\nemployed in surgical work, and with very good re-\\nsults. They prevent infection by the surgeon s and\\nassistants hands, which even with the greatest care\\ncannot be rendered completely sterile. The cotton\\ngloves are sterilized by dry heat. The rubber gloves\\nare sterilized by boiling one hour in a 1:20 solution\\nof carbolic acid, after which they are transferred to a\\nbasin of sterilized water until required for use. To\\nput them on, they are filled with sterile water until\\nthe whole glove becomes distended, after which they\\nare easily slipped on. Some surgeons wear the\\ngloves to protect the hands after they have been", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0127.jp2"}, "128": {"fulltext": "120\\nSURGICAL TECHXIC.\\nsterilized and remove them when all is ready for the\\noperation.\\nFig. 20. Finger cots.\\nGreen Soap.\\nCaustic potash,\\nLinseed oil,\\nAlcohol,\\nFig. 21. Rubber gloves.\\n13 ounces.\\n(C\\n40\\n4\\nHeat the oil in a vessel to 140 F. or till it is too hot\\nfor the fingers. Dissolve the potash in 67 ounces of\\nhot water. Add the alcohol and let it cool. Then add\\nthe heated oil, stirring constantly until mixed. L,et\\nthe mixture stand twelve hours and add alcohol.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0128.jp2"}, "129": {"fulltext": "CHAPTER XI.\\nINFLAMMATION.\\nu Inflammation is that succession of changes\\nwhich occurs in the living tissue when it is injured,\\nprovided the injury is not of such a degree as at once\\nto destroy the structure and vitality of the tissue n\\n(Sanderson).\\nThe changes are, first, changes in the vessels and\\ncirculation; second, a passing out of fluids and solids\\nfrom the vessels; and third, changes in the perivas-\\ncular tissue\u00e2\u0080\u0094 L e-., the tissues about the blood-vessels.\\nThese three changes produce the characteristic phe-\\nnomena of inflammation heat, redness, swelling,\\npain, and loss of function.\\nThe first change in an inflamed area is a dilatation\\nof all the vessels the arterioles, capillaries, and\\nvenules. As a result, there is an increased activity\\nin the circulation and an increased flow of blood to\\nthe part, a condition known as active hyperemia.\\nAfter a time the blood-current begins to slacken;\\nthen the white cells approach the vessel-wall and\\nbegin to pass through it (emigration of white cells).\\nThere is also a passing out of plasma or fluid from\\nthe blood, and in severe cases of inflammation the\\nred cells may also pass out. If we now examine the\\ninflamed area with a microscope, we find an enor-\\nmous number of cells, chiefly white blood-cells, in\\n121", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0129.jp2"}, "130": {"fulltext": "122 SURGICAL TECHXIC.\\nthe tissues about the vessels. Fibrin in the form of\\ndelicate granules and fibrils may also be present.\\nInflammation is a process which is directed to the re-\\nmoval of an irritant, which may be either a portion of\\nan injured tissue or a foreign body or material. After\\nthis result has been accomplished healing or regen-\\neration takes place. If the inflammation was caused\\nby bacteria, suppuration is likely to follow. In that\\ncase the tissues will liquefy and the cells will be\\nthrown off suspended in a liquid (liquor puris), the\\nwhole being known as pus. In suppuration there is\\nalways loss of tissue, and healing, if it occurs, is\\nbrought about through the formation of a scar. In\\norder to produce healing granulation-tissue is formed.\\nGranulation-tissue consists of new cells and tiny\\ncapillary loops. It is sometimes called proud flesh,\\nand bleeds very easily. The scar has a marked ten-\\ndency to contract and may cause great deformity.\\nAmong the causes of inflammation are injuries,\\nchemical irritants, heat and cold, and bacteria.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0130.jp2"}, "131": {"fulltext": "CHAPTER XII.\\nCATHETERIZATION DOUCHES ENEMATA\\nWASHING OUT THE BLADDER; LAVAGE.\\nThe use of the catheter is ordinarily very simple,\\nand yet it may truthfully be said that there is no\\noperation which is performed with so little regard for\\nasepsis. Asepsis and antisepsis are as important\\nhere as they would be in preparing for an abdominal\\noperation.\\nCystitis is often caused by the introduction of germs\\ninto the bladder by means of a dirty catheter, or by\\nnot cleansing the external genitals, vestibule, and\\nmeatus before the operation. Normal urine is to be\\nconsidered sterile unless there is some disease of the\\nkidneys or bladder; and when infection occurs we\\nmay assume that the germs have gained entrance\\nfrom without. The catheter may be of glass. When\\na glass catheter is not at hand, a silver or rubber\\none may be used. When of glass or silver or rubber\\nit should be boiled twenty minutes before being\\nused.\\nGlass catheters are the best they are easily\\nrendered aseptic, and show whether they are or are\\nnot perfectly clean. Sterilization is most important\\nbefore using the catheter and immediately afterward.\\nThere is no danger of the catheter breaking, as so\\n123", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0131.jp2"}, "132": {"fulltext": "124 SURGICAL TECHNIC.\\nmany patients fear, if it is not cracked before being\\nintroduced. Besides the catheter, which is taken to\\nthe bedside in a basin of very hot water, there are\\nneeded a basin of corrosive-sublimate solution\\n(i iooo), sterilized gauze or cotton, and a vessel\\nto receive the urine. A lubricant of sterilized oil\\nto render the entrance of the instrument as easy as\\npossible is used only when a gum-elastic or rubber\\ncatheter is employed. A mixture of carbolic acid\\nsolution (i 40) and glycerin serves for this pur-\\npose.\\nIntroduction of the Catheter. The patient lies\\non her back with the knees drawn up and sepa-\\nrated, the upper clothing being divided over each\\nknee to guard against unnecessary exposure. The\\nlabia are separated with sterilized sponges and the\\nparts washed with the corrosive solution. The\\ncatheter is inserted into the urethra, the opening\\nof which is just above the vaginal entrance. If there\\nis any difficulty, the catheter should be withdrawn a\\nlittle, and gently pointed a little downward or up-\\nward, to the right or to the left. If the flow should\\ncease before enough urine has been drawn, the cathe-\\nter is withdrawn a little or is inserted a little farther\\nthan before. Before removing the catheter a finger\\nshould be placed over its end, to prevent any drops\\nof urine wetting the bed. After the operation the\\nparts are again washed, and the catheter boiled and\\nplaced in a bottle containing a solution of carbolic\\nacid (1 20), unless the catheter is of rubber; for car-\\nbolic acid ruins rubber.\\nWhen the bladder is partially paralyzed from result\\nof an operation, or otherwise, a rectal injection of", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0132.jp2"}, "133": {"fulltext": "EXAMINATION OF STOMACH-CONTENTS. I 25\\nvery warm water will often cause the bowel and\\nbladder to empty themselves at the same time, thus\\ndoing- away with the necessity of using a catheter.\\nThe urine for examination by the physician is best\\ndrawn with the catheter, to prevent contamination\\nfrom vaginal discharges.\\no o\\nA distended bladder must be emptied gradually,\\nand as the last amount of urine is being drawn the\\nflow should be slowed, to prevent any injury to the\\nmucous membrane of the bladder from drawing it\\ninto the eye of the catheter.\\nIrrigation of the Bladder.\u00e2\u0080\u0094 To irrigate the\\nbladder a fountain-svringe, cleansed with boiling\\nwater and a disinfectant, is needed also a glass\\ncatheter, which is sterilized in the same way as for\\ncatheterizing. The parts, of course, are cleansed in\\nthe manner described. The patient is first catheter-\\nized; the catheter is then rinsed with boiling water\\nand attached to the rubber tubing of the syringe\\nwhich contains the irrigation solution (boric acid or\\nsalt solution), the temperature of the latter being\\nabout ioo\u00c2\u00b0 F. The solution must run warm before\\nthe catheter is inserted. The rapidity of the flow is\\nregulated by raising or lowering the irrigator. The\\nquantity of solution introduced is governed by the\\nfeelings of the patient usually 200 c.c. is all that\\ncan be tolerated, after which the tube is disconnected\\nand the fluid is drawn off. If a double catheter is\\nused, the tubing is not removed. The irrigation is\\nrepeated until the washings come away perfectly clear\\nand clean.\\nExamination of Stomach-contents. Many\\ntimes the nurse is called upon to give a test-break-", "height": "4918", "width": "3002", "jp2-path": "bacteriologysur00ston_0133.jp2"}, "134": {"fulltext": "126 SURGICAL TECHNIC.\\nfast and to send the stomach-contents to the labora-\\ntory for examination.\\nA test-breakfast usually consists of a cup of tea\\nwithout milk or sugar, and two soda-crackers; or in-\\nstead of the crackers a small piece of rare steak or\\nsmall piece of bread without butter is given. One\\nhour after, the stomach-contents are obtained bypass-\\ning the stomach-tube. As soon as the tube comes in\\ncontact with the walls of the stomach they contract\\nand force out the contents. If vomiting does not\\noccur, it may be excited by pouring down the tube\\nabout two drams of lukewarm water. The contents\\nare measured, and placed in a clean bottle labelled with\\nthe patient s name, the date, quantity, and hour that\\nthe breakfast was given and contents secured the\\nbottle is then sent immediately to the laboratory.\\nDouches. Properly given, the vaginal douche\\nrelieves inflammation, checks hemorrhage, acts as a\\nstimulant and cleansing agent, and checks secretion.\\nThe amount of water used is from five to six quarts,\\nof a temperature of no\u00c2\u00b0 F. The temperature must\\nalways be tested with a bath-thermometer, not with\\nthe hand. The Baker douche apparatus is an excel-\\nlent contrivance. In its absence a fountain-syringe\\nmay be used.\\nWhen taking a douche the patient should lie on\\nher back, with the thighs flexed on the abdomen and\\nthe legs flexed on the thighs. In this position the\\nwater comes in contact with the whole vagina.\\nThe pail or fountain-syringe must be hung about\\nfour feet above the bed, so that it will take about\\ntwenty minutes for the water to run out. Air must\\nbe expelled, and the water must run warm before the", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0134.jp2"}, "135": {"fulltext": "DOUCHES.\\n127\\ntube is inserted into the vagina. The vaginal tube\\nmust always be sterilized before and after using, and\\nevery patient should have her own tube.\\nMany patients in private practice object to taking\\ndouches, and will neglect them 011 account of the in-\\nconvenience; but this they can overcome by taking\\nthe douches in the bath-tub. Half-way across the\\nbottom of the tub a piece of board is placed, on which\\nthe patient can lie. The douche-board designed by\\nProf. Byron Robinson, of Chicago, has proved very\\nbeneficial and convenient to patients by giving them\\na comfortable and simple method of taking a douche.\\nIt can be used without legs, on a bath-tub, and with\\nlegs (some twelve inches long) may be used in any\\nroom.\\nFlG. 22.- Douche-board.\\nAntiseptic Douches. Corrosive sublimate, car-\\nbolic acid, creolin, and boric acid are used for anti-\\nseptic douches; and to prevent absorption and irrita-\\ntion a plain water douche is often given after any of\\nthese antiseptics.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0135.jp2"}, "136": {"fulltext": "128 SURGICAL TECHNIC.\\nA patient should lie quietly for one hour after tak-\\ning a douche; if only one is used a day, it is best to\\ngive it at night, because then the uterus is most con-\\ngested and needs the hot water most, and the tempo-\\nrary weak feeling which follows a douche will be gone\\nbefore morning.\\nRectal Injections (Enteroclysis) and Irriga-\\ntion. The therapeutic range of this procedure is not\\nconfined to the treatment of local troubles. It has\\nlong been used as a means of cleansing the lower\\nbowel of accumulated feces. In the treatment of\\nrectal ulcers and inflammations it has been employed\\nboth to relieve the irritation produced by fecal matter\\nand to apply various medicaments to the parts. For\\nthe prevention of shock normal saline solution is\\ninjected one or two pints. This, by filling the\\nblood-vessels, enables the patient to withstand the loss\\nof blood from the nerve-centers. After the operation\\nshock and hemorrhage are counteracted by its use,\\nand at the same time the thirst is relieved and rest-\\nlessness quieted. In septic conditions, both local and\\ngeneral, by diluting the toxic materials in the circu-\\nlation and promoting their excretion by the skin,\\nkidneys, and bowels, saline rectal injections play an\\nimportant part in the treatment.\\nIn patients whose digestive tracts are too weak to\\nhold food or medicine rectal feeding or rectal medi-\\ncation is employed. The rectum should be washed\\nout thoroughly before the injection is given. If the\\nrectum is intolerant and will not retain what is in-\\njected, it is well to turn the patient on her left side\\nand raise the hips on a pillow or a folded blanket.\\nA long rectal tube should be used as for a high", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0136.jp2"}, "137": {"fulltext": "RECTAL INJECTIONS. \\\\2Q\\nenema. The physician will give directions as to the\\ntemperature of the solution. In fever patients and\\nin the hemorrhage of typhoid fever great relief and\\ncomfort are afforded by using very cold or iced water.\\nIn shock or hemorrhage a temperature of ioo\u00c2\u00b0 F. is\\nusually preferable. In long-continued lavage for\\nlocal trouble the patient s preference as to the tem-\\nperature is generally consulted.\\nA stimulating and nutrient enema, black coffee,\\nor hot saline solution is given when symptoms of\\nshock appear either during or after an operation\\nit should be injected high up into the colon. The\\nrectum should be thoroughly cleansed at least once\\ndaily with warm saline solution, which will also\\naid the absorption of the nutrient enema. When\\nfeeding by rectum in gynecologic cases, it should\\nbe remembered that tight tamponing of the vagina\\nmay interfere with absorption in the rectum. If the\\npresence of hemorrhoids is a drawback, a 2 per cent,\\nsolution of cocain may be used before injecting the\\nfluid.\\nStimtdating enema\\nWhiskey, 2 ounces.\\nAmmonium carbonate, 15 grains.\\nBeef-tea, 4 ounces.\\nOr\\nBrandy, 2 ounces.\\nTincture of digitalis, 20 minims.\\nMilk, 4 ounces.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0137.jp2"}, "138": {"fulltext": "130\\nSURGICAL TECHN1C.\\nFor tympanites\\nTincture of asafetida, 2 ounces.\\nSpirits of turpentine, i ounce.\\nMagnesium sulphate (Ep-\\nsom salt), 2 ounces.\\nWarm water, i pint.\\nPurgative enemata\\ni. Warm soap-suds, pint.\\n2. Common black molasses, 12 ounces.\\nWarm soap-suds,\\n16\\n3-\\nMolasses, black,\\n4 ounces\\nGlycerin,\\n4\\nMagnesium sulphate,\\n1 ounce.\\nSpirits of turpentine,\\n1\\nWarm soap-suds,\\n8 ounces.\\n4-\\nGlycerin,\\n4 ounces\\nTurpentine,\\n1 ounce.\\nMagnesium sulphate (Ep-\\nsom salt),\\n2 ounces.\\n5-\\nInspissated ox-gall,\\ny 2 ounce.\\nWarm water,\\n1 quart.\\n6.\\nSpirits of turpentine,\\n10 drops.\\nMucilage of acacia,\\ny 2 ounce.\\nTo be given high.\\n7-\\nSenna,\\ny 2 ounce.\\nMagnesium sulphate,\\nOlive oil,\\n1\\nBoiling water,\\n1 pint.\\nInfuse the senna in the water. Then dissolve\\nthe magnesia, add the oil, and thoroughly mix\\nby stirring.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0138.jp2"}, "139": {"fulltext": "CHAPTER XIII.\\nOPERATIONS PREPARATION OF THE OPERAT-\\nING=ROOM; THE SURGEON AND HIS\\nASSISTANTS.\\nSurgery has two objects, to prolong life and to\\nrelieve suffering. If it accomplishes either of these\\nobjects it succeeds. To prolong life or to relieve suf-\\nfering divides operations into several classes, because\\nthey occur with more or less urgency according to\\nthe condition the patient is in.\\nWe often hear it said of an operation that it is one\\nof necessity; of another, that it is one of emergency;\\nand of another, that it is one of expediency. For\\nconvenience, operations are divided into two classes.\\nFirst, operations of necessity; second, operations of\\nexpediency; and the first class may be subdivided\\ninto emergency and elective operations.\\nOperations of expediency are those which it would be\\nwell to perform for the health of the patient, as, for\\ninstance, the removal of a malignant growth of the\\nbreast. If left to itself, the growth will slowly and\\ngradually invade the internal organs and in a very\\nfew years will end life; while if removed, the patient\\nwill in all probability live a number of years, and\\nthere may be immunity for a long period before the\\ndisease returns.\\n131", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0139.jp2"}, "140": {"fulltext": "I32 SURGICAL TECHNIC.\\nOperations of necessity are performed to save the\\nlife of the patient, as, for example, in cases of intes-\\ntinal obstruction, in hemorrhage from rupture of an\\nextra-uterine pregnancy, etc.\\nEmergency operations are those which must be\\nperformed immediately, without any choice, such\\nas tracheotomy.\\nAn elective operation is at the choice of the patient;\\nif it is done at all, it can only be done as a last chance\\nand forlorn hope.\\nPreparation of the Operating-room. The op-\\nerating-room should be made as aseptic as possible;\\nthe walls and floor should be washed with corrosive-\\nsublimate solution (i 2000). The operating-table,\\nstands, chairs, and other furniture, which are usually\\nof glass and iron, should be washed with the subli-\\nmate solution. The sterilizer, which has been packed\\nwith the dressings, blankets (2), sheets (2), towels,\\ncaps, suits, and gowns for the operator, assistants,\\nand nurses, should be started two hours before the\\noperation. The instruments should boil half an hour\\nbefore the operation in a 1 per cent, soda solution.\\nEverything that will be needed for the operation and\\nfor possible accidents must be in the operating-room,\\nand within easy reach. The solutions used should be\\nquite warm, both for the surgeons and patient. We\\noften come across a nurse who when she has filled\\nthe basins will put in her dirty hand to see if the\\nwater is too hot or too cold. We can readily tell\\nfrom the outside of the basin if the water is of the\\nproper temperature.\\nAt all major operations four nurses are necessary\\nthe head nurse, who has charge of the instruments;", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0140.jp2"}, "141": {"fulltext": "Plate 3.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0141.jp2"}, "142": {"fulltext": "", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0142.jp2"}, "143": {"fulltext": "PREPARATION OF THE OPERATING-ROOM. I 33\\na second nurse, to take charge of the sponges; a third\\nnurse, to keep ready for the operator a basin of ster-\\nile water to enable him at any time to quickly rinse\\nhis hands to remove septic fluid or to free his fingers\\nfrom blood and clots, and attend to the irrigation,\\netc. a fourth nurse, to handle unsterilized articles.\\nEach nurse should have a clear idea of her duties,\\nand discharge them without undertaking the duties\\nbelonging to another. If the dry technic is used, the\\nhead nurse can hand the sponges as well as the in-\\nstruments, and this gives a nurse to wait on her exclu-\\nsively. Under no consideration should the head\\nnurse be left alone for a single moment, as the\\noperator might call for something which she, being\\nsurgically clean, n could not touch, and so cause a\\nprobable delay in the operation.\\nThe duties of the nurses in the operating-room are\\nthe same for all operations. The dress must be of\\nwashable material, preferably white; it should be\\nfresh for the operation and as far as possible sterilized.\\nA dress that has been through the wards is not\\nclean; neither is one that has been worn a day or\\nhalf a day. The dress-sleeves should be unbuttoned,\\nso that they can be rolled up above the elbow, to allow\\nthe arms to be made as sterile as possible, and so\\nthat the sleeves may not come in contact with any-\\nthing used in the operation itself. The finger-nails\\nmust be cut short. On first going to the operating-\\nroom the hands and forearms should be scrubbed with\\na brush and green soap and running water as hot as can\\nbe borne for ten minutes by the clock. The cleaning\\nof the finger-nails is very important, as many of us\\nwould be surprised to find the large number of germs", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0143.jp2"}, "144": {"fulltext": "134 SURGICAL TECHNIC,\\ntaken from under the finger-nails as the result of one\\ncleansing.\\nThe hands and forearms are then rendered absolutely\\nsterile by putting them first into a saturated solution of\\npermanganate of potassium until they are of a deep-\\nbrown color from the tips of the fingers to the elbow,\\nthen into a hot saturated solution of oxalic acid until\\nall the permanganate stain has been removed they are\\nthen washed in sterilized hot water, and finally are\\nsoaked for three minutes in a solution of corrosive\\nsublimate (i iooo). The solutions reach those corners\\nand crevices in the finger-nails that cannot be reached\\nby the brush.\\nSome surgeons prefer ether and alcohol for cleans-\\ning the skin. After the hands have been scrubbed\\nthoroughly in hot soap-suds and the finger-nails\\ncleaned, the hands are washed in ether, which re-\\nmoves from the skin all oily and fatty substances;\\nthey are next washed in pure alcohol for one minute,\\nand finally soaked for three minutes in a solution of\\ncorrosive sublimate (i iooo). The field of operation\\nis cleansed in the same manner with ether, alcohol,\\nand the sublimate solution.\\nThe nail-brushes used should be absolutely sterile.\\nThey must be new, and need to be boiled for two\\nhours on the day before the operation, and then put\\ninto a glass jar containing corrosive sublimate\\n(i iooo). A dirty nail-brush is the haven of myriads\\nof germs and their spores, and by using such a one\\nwe place more germs on our hands than w 7 ere there\\nbefore they were touched.\\nIn some hospitals it is the custom to put on ster-\\nilized rubber gloves, to protect the hands from con-", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0144.jp2"}, "145": {"fulltext": "Plate 4.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0145.jp2"}, "146": {"fulltext": "", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0146.jp2"}, "147": {"fulltext": "PREPARATION OP THE OPERATING-ROOM. I 35\\ntamination until the operation begins. The nurses\\nnext put on sterile caps and gowns. After mak-\\ning the hands aseptic it is essential that they do not\\ncome in contact with anything that has not been\\nmade aseptic before the operation is commenced, for\\nsuch is very easy to occur unless the nurse is con-\\nstantly on her guard against it.\\nThe surgeon and his assistants prepare for the\\noperation very much the same as does the nurse.\\nMany surgeons before operating take a corrosive-\\nsublimate bath (1:5000), after which they put on\\nclean linen suits or long gowns and prepare their\\nhands and forearms, after which they put on sterilized\\nsuits. The suits, which have been sterilized in bags\\nor folded in a sheet, are taken from the sterilizer by\\nthe head nurse, and placed in the dressing-room about\\none hour before the arrival of the surgeons, so that they\\nmay be perfectly dry when required for use. They\\nshould not be hung over the back of a chair, or laid\\nover a table for dust to collect upon them. We must\\nbear in mind that after sterilization there is always\\nthe danger of contamination, and the articles must\\nbe carefully protected as soon as they are removed\\nfrom the sterilizer. To avoid confusion, each suit\\nand bag should be distinctly marked with the owner s\\nname, as should also the white canvas shoes which\\nsome surgeons wear. The caps must be laid in the\\ndressing-room, together with long strips of sterilized\\ngauze to cover the beard and mustache.\\nSpectators should remove their coats and wear long\\nlinen gowns. The nurses should not leave the\\noperating-room unless it is absolutely necessary, and\\nthere should be no unnecessary opening of doors,", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0147.jp2"}, "148": {"fulltext": "136 SURGICAL TECHNIC.\\nwhich allows cold air to enter. Constant moving\\nalso causes dust to become stirred up. The tem-\\nperature of the operating-room should be 8o\u00c2\u00b0 F., and\\nthe air kept perfectly pure by thorough ventilation,\\nwhich should be so arranged that draughts will be\\navoided.\\nWith the kind permission of Dr. F. W. Johnston,\\nof Boston, I extract the following from his paper on\\nu Two Years Work with the Sprague Sterilizer in\\nthe Gynecologic Department at St. Elizabeth s Hos-\\npital, Boston, Mass., n which shows the great neces-\\nsity of absolute cleanliness and how easily infection\\ntakes place from dust in the room\\nI was especially anxious to ascertain if any pus-\\nproducing organisms should be found in the dust.\\nThe operating-room is kept as clean as soap and\\nwater and corrosive sublimate can effect the cleanli-\\nness of its floor and walls.\\nu The following is the report of E. A. Darling,\\nAssistant in Bacteriology, Harvard Medical School\\nu Four Petri double dishes containing films of\\nsterilized and coagulated blood-serum were exposed\\nin various parts of the operating-room during a cel-\\niotomy, the period of exposure varying from one hour\\nand twenty minutes to one hour and fifty minutes.\\nu The plates were exposed during the middle of\\nthe forenoon of December 28, 1897.\\nu One dish was placed on the floor, where we sup-\\nposed the dust would be kept in the most active\\nmotion by our feet and the nurse s dress one was\\nplaced on the stand holding the sponge-pails; one\\nwas placed on the patient s knees raised in the Tren-\\ndelenburg position; and one was placed on the table", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0148.jp2"}, "149": {"fulltext": "PREPARATION OF THE OPERATING-ROOM, I 37\\nbeside the instrument-tray. The dishes were un-\\ncovered just as the knife went through the skin.\\nkW At the conclusion of the operation the dishes\\nwere covered, conveyed to the bacteriologic labora-\\ntory, and placed in the incubator at $j\u00c2\u00b0 C. for several\\ndays.\\nv% After twenty-four to seventy-two hours the plates\\nwere opened and the colonies counted.\\nkk At the same time an attempt was made to de-\\ntermine the varieties of bacteria present, and par-\\nticularly to demonstrate the presence or absence of\\nthe pyogenic forms.\\nvw Cover-glass preparations and cultures were made\\nfrom as many different kinds of colonies as could be\\ndistinguished.\\nThe results are, in brief, as follows\\nu Plate A. Sponge-table, exposed 1 hour 50 min-\\nutes: after 24 hours show T ed 216 colonies; 72 hours,\\n296 colonies.\\nPlate B. Knees of patient, exposed 1 hour 20\\nminutes: after 24 hours showed 156 colonies; 72\\nhours, 280 colonies.\\n11 Plate C. Floor, exposed 1 hour 50 minutes:\\nafter 24 hours showed 296 colonies 72 hours, 42S\\ncolonies.\\nPlate D. Instrument-table, exposed 1 hour 40\\nminutes: after 24 hours showed 216 colonies; 72\\nhours, 256 colonies.\\nu The varieties of bacteria present were studied\\nminutely on Plate B (the one on the patient s knee),\\nless carefully on Plate D (the one on the instrument-\\ntray). Of the recognized pyogenic cocci, two varie-\\nties were found the Staphylococcus albus (15 colo-", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0149.jp2"}, "150": {"fulltext": "I38 SURGICAL TECHNIC.\\nnies on Plate B, 20 colonies on Plate D) and the\\nStaphylococcus aureus (3 colonies on Plate B, 4 colo-\\nnies on Plate D).\\nThe remaining colonies on both plates were sar-\\ncinse of several kinds, yellow, orange, and white\\nmoulds, and several varieties of unrecognized bacilli\\nand cocci.\\nu As would be expected, the plate from the floor\\nshowed the largest number of colonies. Plate B (the\\none on the patient s knee) most interested me.\\nThe finding by Dr. Darling of fifteen colonies of\\nthe Staphylococcus albus and three colonies of the\\nStaphylococcus aureus on this small plate within a\\nfew inches of the opened abdominal cavity was cer-\\ntainly a grand object-lesson, and has given lots of\\nfood for reflection.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0150.jp2"}, "151": {"fulltext": "CHAPTER XIV.\\nPREPARATION OF PATIENT FOR OPERATION;\\nCARE OF PATIENT DURING AND AFTER\\nOPERATION.\\nThe methods given here for preparing the patient\\nfor abdominal operations may serve as a reliable\\nguide to the nurse, who is more or less responsible\\nfor preparatory treatment. The methods of prepara-\\ntion of all kinds are subject to change in detail,\\nbecause surgical methods are constantly advancing\\nand changing, though the general principles remain.\\nIt should be remembered that patients rally much\\nbetter from an operation when they have been\\nproperly prepared both externally and internally.\\nDay Before Operation.\u00e2\u0080\u0094 The patient receives a\\nfull bath and the hair is washed. A cathartic is\\ngiven castor oil, citrate of magnesium, or salts.\\nThe diet should be nourishing and light. Milk is not\\ngiven before an abdominal operation, because the\\nstomach may not digest it thoroughly, and its curds\\nmay remain in the intestines and act as an irritant.\\nGruel is nourishing and easily digested. No food is\\ngiven after midnight.\\nPREPARATION OF FIELD OF OPERATION.\\ni. Scrub the parts with green soap and stiff brush.\\n2. Shave from nipples to rectum.\\n139", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0151.jp2"}, "152": {"fulltext": "140 SURGICAL TECHNIC.\\n3. Scrub again and rinse thoroughly with sterile\\nwater.\\n4. Rub well with alcohol, followed with ether, to\\nremove fats.\\n5. Wash with corrosive sublimate (1 1000), and put\\non an antiseptic dressing, consisting of five dressing-\\npads, one layer of common cotton, one dressing over\\nthat, then abdominal binder. The patient must be\\ninstructed not to put her fingers underneath the\\ndressing nor to disturb it in any way.\\nPrepare the vaginal canal by giving a warm\\ndouche (lysol, 1 per cent.), and cover the vulva with\\na dressing. Use perineal straps to keep the dress-\\ning and abdominal binder in position. See that the\\ndressings are kept wet with the antiseptic ordered\\nuntil the patient is taken to the operating-room.\\nThis preparation should be made twelve hours before\\nan operation.\\nSome surgeons will direct the application of a\\npoultice of green soap which is removed early on the\\nmorning of the operation, the part being scrubbed\\nwith hot water and a brush to remove the soap, a\\nwarm corrosive-sublimate poultice (1 1000) being\\nthen applied. A green-soap poultice is a thin layer\\nof green soap spread over a pad of gauze, absorbent\\ncotton, or a towel, and covered with a dry towel and\\na bandage. The antiseptic pad, or the poultice,\\nthoroughly softens the scarf-skin, which in about\\ntwelve hours can be scrubbed off, leaving the true\\nskin.\\nBiniodid of mercury is sometimes dissolved in\\nthe ether, making a solution of 1 1000, which,\\nbesides removing all fatty substances from the skin, is", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0152.jp2"}, "153": {"fulltext": "ARRANGING THE PATIENT. 141\\nalso a disinfectant. When the skin is very dirty it is\\nscrubbed with turpentine, then with alcohol, and\\nthen with the biniodid solution. The nose and mouth\\nshould be thoroughly sprayed with a saturated solu-\\ntion of boric acid every three hours.\\nDay of Operation. Flush out the colon and\\ngive a bath; take off all flannels, put on a gown open\\nat the back, and cotton-flannel stockings. Cleanse\\nteeth, mouth, nose, and throat with a boric-acid solu-\\ntion and brush. Catheterize just before sending the\\npatient to the anesthetizing-room if the operation is\\non the uterus or its appendages. Always catheterize\\nin other operations if the patient is unable to urinate.\\nEnvelop the hair in a sterilized tow T el.\\nRemove all rings and ear-rings; also false teeth,\\nwhether a wdiole or a partial set, as there is danger\\nof their being swallowed, and put them in a tumbler\\nof cold w 7 ater. Envelop feet and lower limbs in a\\nw 7 arm blanket securely pinned around the hips with\\nsafety-pins. Besides preserving the heat, this ar-\\nrangement will prevent the patient from tossing the\\nlimbs about while taking the anesthetic. Manv\\noperators give morphin (grain and atropin (y-J-^\\nof a grain), hypodermically, half an hour before\\nthe operation, to stimulate the heart and prevent\\nvomiting.\\nArranging the Patient for the Operation.\\nThe patient having been placed on the operating-\\ntable, the clothes are removed from the part to be\\noperated upon, and sterilized blankets are tucked\\nabout the chest, the edges being tucked under the\\nback to reduce as far as possible the loss of body-\\nheat, and the bandage and pad are removed from", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0153.jp2"}, "154": {"fulltext": "142 SURGICAL TECH NIC.\\nthe field of operation, which is again thoroughly\\ncleansed with soap and water and disinfectants. An\\nassistant nurse hands the sterilized water, green soap,\\nand scrubbing-brush to the assistant surgeon. The\\nsoap-suds are rinsed off with sterile water, after which\\nthe part is sponged with permanganate of potassium,\\noxalic acid, lime-water, and sterile water, or with\\nether, alcohol, and bichlorid solution. This final\\nscrubbing- should be done in the anesthetizing-room\\nif possible, while the patient is being anesthetized,\\nto avoid delay in the operating-room. A sterilized\\nsheet, having an oval opening in the center through\\nwhich the section is made, and towels are then\\narranged around the field of operation. One towel is\\nlaid along the side, turned over and fastened with\\nclamps to the sheet, so as to form a pocket in which\\nthe surgeon places the instruments he needs to have\\nclose at hand. The instruments are taken from the\\nsterilizer and laid in trays containing sterile water or\\nlaid upon dry sterile towels.\\nSome surgeons use the prepared sponges. These\\nmust be reliably counted before the operation by the\\noperator and assistants, and the number written down,\\nso as not to trust to memory. Sponges must be\\nsqueezed almost dry before they are handed to the\\nsurgeon, because it is only in an almost dry condition\\nthat they are of service. The nurse should not,\\nwhile waiting to hand a fresh sponge, rest her hands\\nor forearms on the pail. She should count the\\nsponges before the surgeon begins to sew up the\\nwound, and should be very sure that she has the\\nexact number employed in the operation. The large\\nsquare sponges used for covering the intestines, or", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0154.jp2"}, "155": {"fulltext": "ARRANGING THE PATIENT.\\nH3\\nwalling off small areas, should have a long piece of\\nsilk attached, and to this a forceps, so that if one\\nshould slip out of sight it can be readily located and\\nrecovered without undue handling of the bowel.\\nAfter being used, the sponges are put into a pan or\\nbasin, and should not be disposed of until they have\\nbeen accounted for before the abdomen is closed.\\nWhatever has been removed from the body must be\\nplaced in a basin and laid aside in a safe place until\\nthe surgeon gives his directions as to whether or not\\nhe wishes it to be sent to the laboratory for examina-\\ntion to make sure of its character, with a view to\\nclearing up some obscure point about the nature of\\nthe disease.\\nThe head nurse attends to the instruments, sutures,\\nand ligatures. If the dry technic is used, a basin\\nof dry gauze sponges is placed on a table within easy\\nreach of the operator s assistants.\\nThe assistant nurses must be on the alert to change\\nthe hand solutions when necessary, and to wipe the\\nmoisture from the face of the operator and his assistant\\nwith a sterilized towel, to prevent drops falling\\ninto the wound, and this must be done at a moment\\nwhen the surgeons are not bending over the wound.\\nThey must move about the room very quietly but\\nquickly. If asked to do anything that they do not\\nunderstand, they should always inform the head nurse,\\nwho will make the duty clear. When emergencies\\narise and the operator is dealing with exceptional\\ndifficulties, the nurses must be on the alert to do\\nquickly anything they may be called upon to do,\\neach nurse discharging- her duties without under-\\ntaking those belonging to another. It is absolutely", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0155.jp2"}, "156": {"fulltext": "144 SURGICAL TECHNIC.\\nnecessary on such occasions to exercise self-control,\\nand to follow the directions given without excitement\\nor confusion.\\nJust before the wound is closed the soiled towels\\nare removed and replaced by fresh ones. After the\\ndressing has been applied the patient is raised, wiped\\nperfectly dry, and a bandage put on. While the\\npatient is waiting to be transferred to bed, hot-\\nwater bottles, well covered, should be applied to all\\nparts of the body. The blankets used to cover the\\nfeet and chest of the patient during the operation\\nshould be tucked closely about the body and under-\\nneath, and not merely be thrown over.\\nPneumonia and pleurisy after operation may follow\\nas the result of chilling when in the operating-\\nroom, or exposure during the removal from the oper-\\nating-room to the patient s room.\\nWhen the patient is replaced in bed, which has\\nbeen thoroughly warmed during the operation, the\\nnurse should be present to take charge. The pillow\\nshould be removed, and a towel placed for the head\\nto rest upon. The foot of the bed is elevated, this\\nposture being maintained for twenty-four hours, after\\nwhich the bed is lowered. The heaters are placed\\nabout the patient s body, one thing being kept con-\\nstantly in mind not to burn the patient. A towel\\nshould be placed under the chin of the patient, and\\na small basin should be at hand to receive the vomited\\nmucus, and this should be removed during quiet\\nintervals. Postanesthetic retching and vomiting may\\nbe relieved by saturating a towel w 7 ith fresh, strong\\nvinegar and holding it a few inches from the patient s\\nface, laying it over the nostrils, or hanging it from", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0156.jp2"}, "157": {"fulltext": "ARRANGING THE PATIENT FOR THE OPERATION. 145\\nthe bedstead so that it will be near the patient s\\nhead. Oxygen hastens the recovery of consciousness\\nand lessens the nausea. If administered with the\\nanesthetic, there is almost complete absence of nau-\\nsea usually none as soon as the patient is fully con-\\nscious.\\nDryness of the mouth and lips, and thirst (which\\nis often a troublesome feature), may be relieved by\\nplacing wet cloths on the lips, by allowing the patient\\nto rinse out the mouth with cool water, and by fre-\\nquent bathing of the hands and face with alcohol and\\ntepid water or with plain water. If thirst is extreme,\\nan enema of saline solution (one pint) is given\\nslowly.\\nThe patient should not be left alone for a single\\nmoment during the first thirty-six hours after an ab-\\ndominal section if it can be avoided. The patient\\ncan do nothing for herself, and every want should be\\ninstantly supplied. I have known patients so eager to\\nallay their thirst that they would get out of bed and\\ndrink water from the water-pitcher on the wash-stand\\nand reach down for the hot-water bottle at the feet and\\ndrink part of the contents. One ward patient drank the\\nwater from an irrigator standing by the side of the\\nnext bed another patient while in a semiconscious con-\\ndition took the drainage-tube out of the abdomen, and\\nwhen found by the nurse after a moment s absence\\nfrom the room was sitting up on the edge of the bed.\\nWatching a patient recover from anesthesia is often\\nmonotonous; but if this duty is closely attended to,\\nmany dreadful accidents will be avoided.\\nA roll should be placed under the knees, so as to\\nrelax the abdominal muscles and also to remove the\\n10", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0157.jp2"}, "158": {"fulltext": "146 SURGICAL TECHNIC.\\nstrain the patient would have to make in order to\\nkeep up the knees. A small flat pillow placed under\\nthe hollow of the back will relieve the backache of\\nwhich so many patients complain.\\nBladder and Bowels.\u00e2\u0080\u0094 The catheter should be\\npassed every six or eight hours if necessary, accord-\\ning to directions, the most rigid aseptic precautions\\nbeing taken. Flatulence may be very distressing;\\nconsequently passage of gas by the rectum is of good\\nomen, as it shows that the bowels have regained their\\nnormal tone and there is no obstruction. After an ab-\\ndominal operation the muscular walls of the intes-\\ntines share in the weakness of the patient, and are\\nnot strong enough to overcome the contraction of the\\nsphincter muscle. The accumulation of gas distends\\nthe muscular fiber of the intestines, and, if not re-\\nlieved, would soon result in paralysis of the intes-\\ntines. To prevent this a rectal tube is inserted to\\nkeep the sphincter dilated and to allow the gas to\\nescape when it reaches that point. Purgatives, such\\nas calomel (grain 1 every hour until 10 grains have\\nbeen taken), are usually given as soon as possible\\nafter the patient has recovered from the anesthetic,\\nto stimulate the intestines, and keep up peristaltic\\naction.\\nMuch fluid is not given for a certain number of\\nhours after the operation, as it might cause vomit-\\ning, and also because, as we have seen, bacteria\\nrequire heat and moisture for their development.\\nIf they can lie in a small pool of fluid, they will de-\\nvelop rapidly. We cannot deprive them of w T armth\\nunless we almost freeze the patient, but we can\\ndeprive them of moisture. Should any bacteria", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0158.jp2"}, "159": {"fulltext": "BLADDER AND BOWELS. 1 47\\nhave found their way during the operation into the\\nabdominal cavity, they will be rendered inert by\\nthe absence of moisture, and will be taken by the\\nleukocytes into the lymphatic vessels and glands and\\nbe devoured.\\nAfter twelve hours, if there is no vomiting, very\\nhot water, or toast-water is given in teaspoonful\\ndoses every fifteen or twenty minutes, the quantity\\nbeing gradually increased and the intervals length-\\nened. The familiar cup of freshly made tea is some-\\ntimes the best drink to begin with; it is always a\\npleasure under the circumstances to see the patient\\nenjoy it, since it is not only refreshing but stimu-\\nlating. If the stomach behaves well, tablespoonful\\ndoses of gruel or beef-essence may be given every\\nhalf hour. Milk is not given as a rule, as the curd\\nmay pass along the intestines and act as an irritant.\\nFor the first three days, and if there is no vomiting,\\nnothing but liquids is given; and after the third day\\nsoft and easily digestible food, which is gradually\\nchanged to a more solid diet.\\nThe external genitals should be kept perfectly\\nclean, the body bathed, the bed and body-linen kept\\nsweet and clean, the teeth brushed, and the hair\\ncombed. Every want of the patient should be an-\\nticipated, and she should be made as comfortable as\\npossible. Sponging the palms of the hands, the\\narms, and the legs will add to the comfort of the\\npatient. The luxury of a change into a fresh bed\\nwill often secure a good night s rest. Under no con-\\nsideration should morphin be given except by the\\nsurgeon s directions, and every moral influence should", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0159.jp2"}, "160": {"fulltext": "148 SURGICAL TECHNIC.\\nbe exerted to induce the patient to endure pain rather\\nthan resort to the drug.\\nThe nurse should not ascertain whether the patient\\nis comfortable by continual questioning, but by unob-\\ntrusive observation. Questioning may alarm a patient\\nand lead her to think too much about herself.\\nNo visitors should be admitted without the sur-\\ngeon s consent. The mind of the patient is to be\\nkept perfectly free from worry and excitement, and\\nthe whole atmosphere of the room should be bright,\\npleasant, and cheerful, no matter what trouble is\\ngoinor otl outside.\\nA slight rise of temperature the day following oper-\\nation usually marks reaction from shock. On the\\neighth day the dressings are removed and the stitches\\ntaken out. The following week the patient sits up,\\nand at the end of the third week she goes home.\\nThe following diet-list dating from the third day\\nwill be of assistance in varying the food.\\nFirst Day.\\nBreakfast. Mutton-broth with bread-crumbs.\\nLunch. Milk-punch.\\nDinner. Raw oysters, thin bread (with crust re-\\nmoved) and butter, sherry wine.\\nLunch. Cup of hot beef-tea.\\nSupper. Milk-toast, jelly.\\nSecond Day.\\nBreakfast. Oatmeal with sugar and cream, cup\\nof cocoa.\\nLunch. Soft custard.\\nDinner. Small piece of tenderloin steak, chewed\\nbut not swallowed, baked potato.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0160.jp2"}, "161": {"fulltext": "DIET- LIST. I49\\nLunch. Glass of milk.\\nSupper. Buttered milk-toast (crust removed),\\njelly, cocoa.\\nThird Day.\\nBreakfast. Soft-boiled egg, bread and butter,\\ncoffee.\\nLunch. Milk-punch.\\nDinner. Chicken-soup, tender sweetbreads, Ba-\\nvarian cream, light wine.\\nLunch. An egg-nog.\\nSupper. Tea, raw oysters, bread and butter.\\nFourth Day.\\nBreakfast. Oatmeal with sugar and cream, a ten-\\nder sweetbread, creamed potatoes, coffee, graham\\nbread and butter.\\nLunch. Glass of milk.\\nDinner. Chicken panada, baked potato, bread,\\ntapioca-cream.\\nLunch. Cup of hot chicken-broth.\\nSupper. Buttered dry toast (crust removed), wine\\njelly, banquet crackers, tea.\\nFifth Day.\\nBreakfast. An orange, scrambled cgg oatmeal\\nwith sugar and cream, soft buttered toast, coffee.\\nLunch. Milk-punch.\\nDinner. Cream of celery soup, a small piece of\\ntenderloin steak, baked potato, snow pudding, wine,\\nbread.\\nLunch. An egg-nog.\\nSupper. Calf s foot jelly, soft-boiled egg, bread\\nand butter, cocoa.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0161.jp2"}, "162": {"fulltext": "150 surgical technic.\\nSixth Day.\\nBreakfast. Oatmeal, poached eggs on toast, coffee.\\nLunch. Cup of chicken-broth.\\nDinner. Chicken-soup, small slice of tender roast\\nbeef, baked potato, rice-pudding, bread.\\nLunch. Glass of milk.\\nSlipper. Baked apples, raw oysters, bread and\\nbutter, orange-jelly, tea.\\nSeventh Day.\\nBreakfast. Orange, mush and milk, scrambled\\neggs, cream-toast, coffee.\\nLunch. Cup of soft custard.\\nDinner. Mutton-soup, small piece of tender beef-\\nsteak, creamed potatoes, sago-pudding, bread, wine.\\nLunch. Cup of beef-tea.\\nSupper. Sponge-cake with cream, buttered dry\\ntoast, wine-jelly, cocoa.\\nEighth Day.\\nBreakfast. Broiled fresh fish, oatmeal, graham\\nbread, coffee.\\nLunch. Chicken-broth.\\nDinner. Potato-soup, breast of roasted chicken,\\nmashed potatoes, macaroni, blanc mange.\\nLunch. Cup of mulled wine.\\nSupper. Cream-toast, lemon-jelly, chocolate.\\nThe diet for other days may be selected from pre-\\nvious ones. The change of diet may cause a tem-\\nporary rise in the temperature and pulse.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0162.jp2"}, "163": {"fulltext": "CHAPTER XV.\\nSEQUELAE OF OPERATIONS; SHOCK, HEMOR-\\nRHAGE, SEPTIC PERITONITIS, ACCIDENTS\\nDURING OPERATION, ETC.\\nAs a rule, the average abdominal case passes into\\nconvalescence, especially when the case is in skilled\\nhands and the operation has been performed in a\\nfinished surgical way. Complications, however, are\\nliable to arise in the simplest case, and throw great\\nresponsibility on both surgeon and nurse. It is in\\nthese cases that the knowledge and skill of the nurse\\nmean so much, and where the greatest triumphs of\\nsurgery are scored.\\nA nurse has no moral right to take charge of a\\nsurgical case unless she has at her finger-ends the\\ncomplications liable to arise, their symptoms and the\\nvarious means of meeting them until the arrival of\\nthe surgeon.\\nShock is great depression of the vital functions\\nof the body brought on by injury or surgical opera-\\ntion. It is produced through the agency of the ner-\\nvous system. The greater the injury, the longer the\\nanesthesia, the greater the shock. The anesthetic\\nenables the patient to undergo the operation without\\nconsciousness, but it does not prevent shock coming\\non afterward from the opening of the abdomen, the\\nuncovering of the viscera, the handling of the intes-\\ntines, and the exposure of the delicate sympathetic\\n151", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0163.jp2"}, "164": {"fulltext": "152 SURGICAL TECHNIC.\\nnerves in that part to the air and to touch. If to all\\nthis is added a long anesthesia, then the prostration\\nproduced by the anesthetic is added to the effects of\\nthe operation.\\nDifferent individuals are differently affected: most\\npersons are more susceptible to shock after months\\nof hard work, or when the system is run down after\\nan illness. Invalids stand shock very well, and in-\\ndifferent persons stand it better than those who are\\ndespondent. The mental influence is very great:\\nanything that depresses the mind aggravates shock.\\nIt is here that the offices of the Church have such\\nan effect on some patients, in quieting apprehension\\nand in adding fortitude.\\nAge modifies shock. In old people shock is\\nusually more severe and prolonged, especially if\\nthere is any organic disease. Children recover\\nreadily from shock if there has been very little loss\\nof blood. Shock is combated to a certain extent by\\nthe patient s drinking a large amount of fluid for\\nforty-eight hours before the operation, so that the\\nblood-vessels of the vital organs will be w 7 ell supplied\\nwith fluid during the operation. Experiments have\\nbeen made which show that when the abdomen is\\nopened the abdominal veins dilate, and as a conse-\\nquence a large amount of the blood in the body flows\\ninto them, thus leaving the heart and the vessels con-\\nveying blood to the important nerve-centers at the\\nbase of the brain with very little fluid to work upon,\\nand shock ensues. The output of the heart, as we\\nknow, is in proportion to the venous pressure, and\\nif this is lowered the heart and the important nerve-\\ncenters at the base of the brain will be supplied", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0164.jp2"}, "165": {"fulltext": "shock. 153\\nwith a diminished amount of blood. The intra-\\nvenous injection of saline solution causes a rise in\\nthe venous pressure and an increase in the output of\\nthe heart. The signs of shock may be and have been\\nmistaken for those of hemorrhage on account of the\\ntwo presenting so many points of likeness but in\\nshock the symptoms are present from the first, while\\nin hemorrhage they do not come on for some hours\\nafter the operation.\\nTwo very important points to be considered in case\\nof shock or of hemorrhage are the temperature and\\nthe condition of the patient s mind. In shock the\\ntemperature at first is normal or very little below nor-\\nmal, and the senses are dull in proportion to the degree\\nof shock present; in hemorrhage the temperature is\\nsubnormal, the mind is bright, keen, and alert, and\\nthere is an anxious expression on the face, as if the\\npatient were anticipating danger.\\nThe symptoms of shock are a weak, rapid, and ir-\\nregular pulse; sighing, rapid, irregular, and shallow\\nrespiration; a normal or slightly subnormal tem-\\nperature a pale face with a pinched look a cold,\\nclammy skin, and dulness of the mind. There\\nmay be involuntary movements of the bowels and\\nurine as a result of loss of muscular power nausea\\nand vomiting may also be present.\\nThe treatment of shock consists in lowering the\\npatient s head and raising the foot of the bed, to in-\\ncrease the supply of blood to the vital centers in\\nthe application of heat to all parts of the body,\\nparticularly the sides, between the legs, and to the\\nfeet; in placing a mustard-plaster over the heart;\\nin administering whiskey, brandy, or nitroglycerin", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0165.jp2"}, "166": {"fulltext": "154 SURGICAL TECHNIC.\\nhypodermically; in giving hot black coffee by the\\nrectum, or saline solution hypodermically or by\\nthe rectum. Strychnin is a powerful stimulant, and\\nshould be given in doses of 2V grain every half hour\\nfor four doses. Tincture of digitalis in 15-minim\\ndoses may be given every half hour for four doses.\\nAs a rule, in cases of shock there is a disposition\\non the part of nurses to do too much. Everything\\nmust be done in a prompt, quiet manner. For imme-\\ndiate stimulation in threatened collapse nitroglycerin\\nis valuable. It is used for quick effect only, and\\nnot for prolonged stimulation of the heart s action.\\nStimulants must be given carefully, and time\\nallowed to observe the effects produced, other meas-\\nures being determined accordingly. An enema of\\none-half ounce of turpentine, a well-beaten raw egg^\\nand three ounces of warm water constitutes a power-\\nful stimulant.\\nIt must be remembered that in severe shock the\\nfunction of absorption by the stomach and intestines\\nis almost wholly suspended, and anything given by\\nthe rectum must be introduced high up. When the res-\\npiration of the patient is fast failing, everything de-\\npends on maintaining the heart s action. To this\\nend artificial respiration must be persistently prac-\\ntised. A serious danger in performing artificial res-\\npiration is that in our hurry we may make the\\nmotions too rapidly and not give the lungs time to\\nfill thoroughly nor allow the air to be expelled before\\nfilling the lungs again. The motions should not be\\nmore frequent than sixteen to eighteen in the min-\\nute, so as to imitate as nearly as possible the nat-\\nural rhythm of respiration. External heat is a most", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0166.jp2"}, "167": {"fulltext": "IIEMORRHA GE. I 5 5\\npowerful heart-stimulant, and often when the heart s\\naction fails it may be restored by heat over the heart\\nand by hot fluids taken into the stomach.\\nRecovery may be rapid or very slow; it is mani-\\nfested by reaction the pulse becomes more full,\\nslow, and regular, the temperature rises, the body\\nbecomes warm, and a general improvement takes\\nplace. In rare cases the reaction becomes excessive\\nand develops into traumatic delirium, which may be\\nmild, low, and muttering, or of the wildest character.\\nThe skin is hot and flushed, the pulse full and regu-\\nlar, and the temperature above normal. This condi-\\ntion may subside and recovery take place, or it may\\nbe followed by collapse.\\nHemorrhage may be caused by the slipping of a\\nligature or by the displacement of clots, as the result\\nof restlessness or reaction of the circulation, and\\ngenerally occurs within the first twenty-four hours\\nafter the operation. The hemorrhage which comes\\nfrom torn adhesions and bleeding surfaces is a\\nfree oozing, and seldom affects the pulse. When a\\ndrainage-tube has been used, it will usually indicate\\nthat there is hemorrhage by a flow of blood\\nthrough the tube. This, however, cannot be relied\\nupon, as only a moderate quantity of blood may\\nflow through the tube, the abdomen being filled\\nwith clots.\\nThe symptoms of internal hemorrhage are restless-\\nness, thirst, faintness, an anxious expression, pale\\nface, dilated pupils, cold skin, frequent and irregular\\nor sighing respiration, subnormal temperature, and a\\nweak, rapid pulse (120-140). In rare cases the pulse\\nis not greatly accelerated.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0167.jp2"}, "168": {"fulltext": "156 SURGICAL TECHNIC.\\nTreatment. The patient must be kept perfectly\\nquiet 011 her back, the head being lowered and the\\nfoot of the bed elevated. If symptoms of shock\\nsupervene, heat is to be applied to all parts of the\\nbody by warm blankets and hot-water bottles.\\nStimulants are given only when the pulse is failing,\\nas they excite the heart s action and increase the\\nhemorrhage. When the hemorrhage has been exces-\\nsive, infusion of saline solution is resorted to, the\\nfluid that the body has lost being thus replaced.\\nBandaging the limbs from their extremities upward\\nis sometimes of use in keeping the blood in the vital\\norgans. When the hemorrhage comes from a slipped\\nligature with large vessels pouring blood into the\\nabdominal cavity, the abdomen is reopened and the\\nvessel ligated. Everything should be ready for\\noperative interference when the surgeon arrives, the\\nsame aseptic precautions being observed as in the\\noriginal operation. For the free oozing from torn\\nadhesions the tube is emptied frequently every ten\\nminutes. The drier the pelvic cavity is kept, the\\nsooner will the hemorrhage cease.\\nA noted surgeon has said that if an abdominal case\\nescapes shock or hemorrhage, there is still a third\\ndanger to which the patient is liable, that of septic\\nperitonitis. This is due to the entrance of germs\\ninto the peritoneal cavity, either from without or\\nfrom ruptured abscesses or wounds. It may set in\\nat any time from a few hours to six days after ope-\\nration. The symptoms are pain in the abdomen and\\nexquisite tenderness, distention, vomiting, constipa-\\ntion, icterus, restlessness, sleeplessness.\\nThe temperature rises a little, rarely going for a", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0168.jp2"}, "169": {"fulltext": "HEMORRHAGE. 1 57\\nfew days above ioo\u00c2\u00b0 or ioi\u00c2\u00b0 F. but the pulse creeps\\nup rapidly to 115, 120, or 130 beats per minute, and\\nis weak and thready; although sometimes it is hard\\nand u wiry n in the beginning. Then the temper-\\nature rises to 103 F. or above. The rectal or vag-\\ninal temperature may show a much higher rise than\\nthat of the mouth or axilla. In one typical instance\\nthe temperature taken in the mouth ranged between\\n101 and 102 F. the skin was cold and clammy,\\nand the patient complained of intense thirst and a\\nu burning up feeling. The vaginal temperature\\nwas 108 F. In some of the worst cases the writer\\nhas seen the temperature was below normal, but the\\nprostration was severe. The abdomen is distended,\\ndue to distention of the transverse colon by gas.\\nThere are nausea and vomiting. First the contents of\\nthe stomach are vomited, then bile, then a dark coffee-\\ncolored fluid which becomes more and more fecal in\\nodor; a cold perspiration appears; the patient has a\\nvery anxious, pinched expression, and is restless and\\ntalkative; the eyes are unusually bright, and there is\\na faint yellowish look about the skin and conjunc-\\ntivae. As the disease continues the general system\\nbecomes poisoned.\\nThe treatment consists in ridding the system of\\nthe poison through the skin, bowels, and kidneys.\\nHigh enemata of turpentine, glycerin, oil, salts, or\\nmolasses are usually given until the bowels are\\nthoroughly moved or large quantities of gas are\\npassed, because it is by putting the bowels into an\\nactive state that the threatened paralysis of the intes-\\ntines can be overcome, and they can take up from\\nthe peritoneal cavity the poisonous materials that", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0169.jp2"}, "170": {"fulltext": "158 SURGICAL TECHNIC.\\nare causing the disturbance. It is only when the\\nintestines are so paralyzed that they cannot be moved\\nthat a fatal result ensues. Strychnin, being a power-\\nful heart-stimulant, is given in doses of grain ^V\\nevery hour until its physiologic effects are pro-\\nduced. It must be stopped at the first appear-\\nance of twitching of the muscles of the face or\\nof the limbs and stiffness of the neck. Vomiting\\nmay be relieved by washing out the stomach, by\\nthe application of a mustard-plaster over the region\\nof the stomach, or by cocain in 3 (-grain doses for\\nfour doses. If improvement does not follow, the\\nsurface of the body becomes cold and clammy; the\\nface pinched and sunken and of a dusky hue the\\nrestlessness increases, also the thirst, which becomes\\nvery great, and to the last the patient calls for water,\\nwhich is vomited immediately after being taken, but\\nwhich it is cruel to withhold. The mind usually\\nremains clear to the end.\\nAntistreptococcic serum has been used with fairly\\no-ood results. It comes in odass tubes, sealed her-\\nmetically, and is injected hypodermically with an-\\ntiseptic precautions into the thigh or the side of the\\nbreast, where there is considerable loose subcuta-\\nneous connective tissue. Another procedure of value\\nis infusion of normal saline solution for the purpose\\nof diluting the toxins in the blood and of removing\\nthem by the increased flow of urine which infusion\\nbrings about.\\nTympanites is often one of the earliest signs of\\nsepticemia, and when accompanied with a high tem-\\nperature is usually a cause for anxiety, though it may\\nbe due to constipation, and in such cases is usually", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0170.jp2"}, "171": {"fulltext": "SINUS. 159\\nwithout significance. The treatment consists in the\\napplication of turpentine stupes, the use of brisk\\npurgatives or high enemata, and the insertion of the\\nrectal tube for about ten inches.\\nFermentation-fever is due to the absorption of\\nfibrin-ferment and the products of aseptic tissue-\\nnecrosis. It causes a slight rise in temperature\\nwhich need occasion no anxiety.\\nIntestinal obstruction may be due to strangula-\\ntion of a knuckle of intestine beneath inflammatory\\nbands, or to its enclosure between the sutures in the\\nwound. There is usually distention of the abdomen.\\nNote should always be made if gas is heard rumbling\\nin the intestines, and also if gas is passed and how\\noften also the result of the enemata which are ad-\\nministered to relieve the distention.\\nHernia is a sequel rather than a complication of\\nabdominal operations, and is due to a failure of union\\nbetween the cut edges of the muscles and fasciae.\\nAs a rule, it does not occur until some weeks after\\nthe patient has returned home. It is to prevent this\\naccident that such stress is laid upon not allowing\\nthe patients to help themselves in any way without the\\nsurgeon s permission, so that the abdominal muscles\\nmay have sufficient time to become firmly united.\\nThis is also the reason why patients should wear an\\nabdominal supporter for some months after their dis-\\ncharge. If hernia occurs, it is usually treated by a\\nsecondary operation.\\nA sinus is often caused by imperfectly sterilized lig-\\natures, which may cause an abscess around the point\\nof ligation. This abscess may discharge itself into\\nthe intestine or vagina, or into the tract occupied by", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0171.jp2"}, "172": {"fulltext": "160 SURGICAL TECHNIC.\\nthe drainage-tube through the abdominal wall. The\\nsinus keeps open until the ligature is discharged or\\nremoved by another operation.\\nAccidents during Operation. Many times in dif-\\nficult abdominal or vaginal operations the walls of the\\nbladder may be torn, or one of the ureters or the in-\\ntestine may be injured. When the ureter or bladder\\nis injured, the urine sometimes passes through the\\nincision to the dressing. This is called a urinary\\nfistula. When the intestines are injured, fecal matter\\nis discharged through the wound. This is a fecal fistula.\\nVaginal hysterectomy is the most serious of vagi-\\nnal operations, but the nursing is the same as every\\noperative case requires. If clamps are used, they\\nusually remain attached for forty-eight hours. The\\nhandles are usually supported on a pad of absorbent\\ncotton. In the handling of the clamps great care\\nmust be used, as, for instance, when the patient is\\nlifted on the bed-pan one nurse should lift the clamps.\\nHysterectomy is the complete removal of the\\nuterus and ovaries, either through the vagina (vagi-\\nnal hysterectomy) or through the abdomen. Regard-\\ning the question of insanity which may follow a hys-\\nterectomy or the removal of a large fibroid tumor,\\none must know that a large amount of blood is\\ntaken from the body that the cutting and tying of\\nthe large blood-vessels alter the circulation and that\\nthe operation is also more or less a shock to the\\nnervous system, and may affect the brain. Insanity\\nis not a complication of this operation, the recovery\\nfrom which is usually rapid but when insanity does\\nset in, this is commonly the cause, and the patient\\ngenerally recovers.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0172.jp2"}, "173": {"fulltext": "CHAPTER XVI.\\nOPERATIONS IN PRIVATE PRACTICE.\\nIn private practice the preparation of the patient is\\njust the same and should be carried out as thor-\\noughly as in a hospital. If it is not possible within\\ntwenty-four or thirty-six hours to make the prepa-\\nration, then we cannot say that our attempts, to\\nobtain asepsis approach perfection. In emergency\\ncases when there is not sufficient time to permit a\\nthorough cleansing, freedom from sepsis is not so\\ncertain, and these cases do not cause the same anxiety\\nas those that are sent to a hospital, where every effort\\nto obtain complete asepsis is made. We must remem-\\nber, in making the preparations, to make as little\\nbustle and noise as possible, and to carry on the\\npreparations in a quiet and cheerful manner, so as not\\nto frighten the patient and family. When the sur-\\ngeon and his assistants arrive they must be shown\\nto a room in which they can change their clothing.\\nThe patient is not anesthetized until everything is\\nin readiness.\\nOne difficulty which a nurse will have to encounter\\nin private practice is likely to trouble her a great deal,\\ninasmuch as she will find surgeons who conduct de-\\ntails of cases in a way to which she is not accus-\\ntomed, and which may appear to her wrong, and\\nwhich indeed may very often be crude and unscien-\\n11 161", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0173.jp2"}, "174": {"fulltext": "1 62 SURGICAL TECHNIC.\\ntific. In these cases she should not be too ready to\\nshow her superior wisdom and instruct the surgeon,\\nand inform him under whom she received her train-\\ning, because there is not the slightest likelihood that\\nhe will act upon her suggestions, but will naturally\\nbe offended.\\nThe directions for preparing for the operation\\nwill be given by the surgeon in charge. In some\\nhouses there may be a separate room for the opera-\\ntion, while in others the nurse will have to pre-\\npare the patient s bedroom. In the latter case the\\nbrightest end of the room must be selected for\\nthe operation, to afford the surgeons plenty of light.\\nA screen must be put up before the bed, so that the\\npatient will not see the preparations. The nurse\\nshould remove from the room all movable furniture;\\nlay oilcloths or newspapers covered with a damp\\nsheet on the carpet, and pin them securely to it, and\\nfasten a curtain across the window, so that the opera-\\ntion cannot be viewed from the opposite side of the\\nstreet. The remaining furniture and window-frames\\nshould be washed with carbolic-acid solution (i 60),\\nand on the morning of the operation should be\\nmopped with a cloth wrung out of the solution. The\\narticles necessary for the operation can be placed on\\nthe operating-table, covered with a sterile sheet, and\\nbe left outside the room until the patient is partly\\netherized,, when they may be carried in.\\nIf a separate room can be had, one with a northern\\nlight is to be preferred; and if possible it should be\\nnear the bath-room. Unless the nurse has twenty-\\nfour hours notice in which to prepare the room", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0174.jp2"}, "175": {"fulltext": "OPERATIONS IN PRIVATE PRACTICE. 1 63\\nfor operation, it should not be disturbed, because\\nif swept and dusted immediately before the opera-\\ntion dust is stirred up and the air is so filled with\\ngerms that it would not be safe to open the ab-\\ndomen in the room. If the nurse has a few days in\\nwhich to prepare for the operation, all unnecessary\\nfurniture should be removed, the hangings taken\\ndown, the room thoroughly swept, and the walls and\\nremaining furniture washed with carbolic-acid solu-\\ntion (1:60) and exposed to the action of the sun and\\nair for about twelve hours, when the windows are to\\nbe closed, the room thoroughly dusted with a damp\\ncloth and not again disturbed. The kitchen, if not\\ntoo remote, makes the best operating-room it is\\nwarm, hot and cold water are close at hand, and\\nthere is no danger of soiling carpets or hangings.\\nA word regarding the bed. If possible, it should\\nbe an iron bedstead with a fresh horsehair mattress\\nand pillow. The tall wooden bedsteads which we\\nso often find are perhaps heirlooms which have wit-\\nnessed every illness that has visited the family, and\\nalso the deaths. They cannot be disinfected so\\nthoroughly as can iron bedsteads.\\nThe operating-table should not be wider than\\ntwenty-five inches nor higher than thirty-seven\\ninches, because if low and wide the surgeon will have\\nto stoop and bend forward. A kitchen-table, or a\\ndining-room table with the leaves hanging, and a\\nsmall table at one end for the patients head, or two\\ndressing-tables, one placed across the head of the\\nother, will make a good narrow operating-table; or\\nthree chairs, with two planks, a leaf from an exten-", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0175.jp2"}, "176": {"fulltext": "164 SURGICAL TECHNIC.\\nsion-table, or an ironing-board laid across them, may\\nsuffice.\\nThe table may be covered with rubber cloth, oil-\\ncloth, two sheets, and a blanket. A word of caution\\nhere the nurse should not use any old blanket or\\ncomforter to cover the operating-table, for it is likely\\nto be filled with germs.\\nTwo wooden chairs should be at hand in case the\\nTrendelenburg position is necessary, and two wooden\\nboxes for the surgeons to stand upon when using this\\nposition.\\nThe evening before the operation the nurse should\\nboil a washboiler full of water and then fill covered\\npitchers, the washboiler and pitchers having first been\\nmade thoroughly aseptic. The water is conveyed\\nfrom the boiler to the pitchers by means of a perfectly\\nclean pitcher or tin ladle.\\nOn the morning of the operation there should be\\nsterilized in the boiler or in an oven six sheets, two\\nblankets, twelve towels (not new). The heat should\\nbe kept up for fully one hour before the operation.\\nThe dry technic, by which is meant the use of dry\\nsponges and gauze, is usually employed in private\\npractice, especially when the water-supply is at all\\nquestionable.\\nThere will be needed several clean recently boiled\\nbasins for the various solutions, etc. Two tables will\\nbe needed one for the instruments, the other for the\\nassistant. They should be covered with freshly\\nwashed and ironed sheets or towels. There will also\\nbe needed a pail or a washtub for the soiled water,\\na tin dish or a fiat bake-pan for the instruments,", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0176.jp2"}, "177": {"fulltext": "OPERATIONS IN PRIVATE PRACTICE. 165\\nbrandy, a hypodermic syringe filled with the re-\\nquired solution, usually strychnin sulphate grain),\\na small tumbler, a Davidson or a fountain syringe,\\ntable-salt for salt-solution, safety-pins, two new nail-\\nbrushes, ready for use in a 1: 40 carbolic acid solu-\\ntion, castile soap, green soap, a razor, hot-water\\nbottles, two blankets, alcohol, vinegar, and matches.\\nThe surgeon will bring the necessary dressings with\\nthe instruments, which must be sterilized in the same\\nway as in the hospital.\\nThe instruments are to be wrapped in a towel and\\nallowed to boil for ten minutes in a saucepan, tin\\npail, or a fish-kettle of boiling water, to which have\\nbeen added two teaspoonfuls of washing-soda to each\\npint of water, to prevent rusting. One end of the\\ntowel must be left hanging out of the kettle as a\\nhandle by which to lift out the instruments. The\\npail of water should be on the fire and the water\\nboiling when the surgeon arrives, so that the instru-\\nments can be put in at once.\\nIf the nurse is asked to give the anesthetic, she\\nshould not attempt anything else. None but novices\\ngive the anesthetic and watch the operation. The\\nexperienced anesthetizer constantly watches the\\npatient. If the nurse is asked to assist the surgeon,\\nshe must be neither too enthusiastic, nor too quick,\\nnor too slow. When the operation is over her duties\\nwill have nothing peculiar about them. She must\\nsee the patient safely out of the anesthetic influence,\\nand carry the case along as she would any other.\\nSometimes a nurse is called to an emergency oper-\\nation in a very poor family, where there are no con-", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0177.jp2"}, "178": {"fulltext": "1 66 SURGICAL TECHNIC.\\nveniences. In such instances the kitchen can be\\ncleaned and prepared as an operating-room in a few\\nminutes. If she is called in the night and goes to\\nthe case with the surgeon, she should, while the sur-\\ngeon is making his examination of the patient, start\\na fire and put on the washboiler, to make sure of\\nplenty of boiling water. She should then get six\\nsheets and twelve towels, if possible. There may be\\nno clean towels, and the nurse will have to wash\\nsome dirty ones. The sheets and towels can be soaked\\nfirst in boiling water and afterward placed in corrosive-\\nsublimate solution (i: iooo), until the surgeon is ready\\nto use them. Boiling water is one of the best anti-\\nseptics, as it kills germs on contact. Unfortunately\\nit cannot be used in rendering our hands and the field\\nof operation aseptic, but it can be used in the prepa-\\nration of the sheets, towels, sponges, and instru-\\nments.\\nThe kitchen should be rendered as clean as pos-\\nsible. The kitchen-table should be prepared for the\\noperating-table, and there should be two small tables,\\none for the instrument-tray and one for the sponges.\\nIf small tables cannot be had, chairs covered with a\\nsheet or towels wrung out of the corrosive solution\\nwill answer the purpose. If there is no gaslight, as\\nmany lamps as can be obtained should be arranged\\nnear the surgeon, but not too near the ether, because\\nether is inflammable.\\nAfter the surgeon has made the examination the\\npart must be shaved, washed, and a towel wrung out\\nof corrosive sublimate solution applied, an enema\\ngiven to clear the bowels, and the urine drawn.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0178.jp2"}, "179": {"fulltext": "OPERATIONS IN PRIVATE PRACTICE. 167\\nWhile the patient is being anesthetized the nurse\\nmay arrange the tables and wash a flat bake-pan\\nor meat-pan for the instruments. If sponges have\\nbeen forgotten, a clean sheet can be torn up and\\nfolded into flat sponges. China basins can be used\\nfor the antiseptics, the sponges, and the surgeon s\\nhands; china pitchers for hot and cold water; a\\nwash tub for the soiled water; and hot bricks, plates,\\nor beer bottles for heaters.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0179.jp2"}, "180": {"fulltext": "CHAPTER XVII.\\nGYNECOLOGIC EXAMINATIONS AND\\nOPERATIONS.\\nPERFECT asepsis is of special importance in gyne-\\ncologic examinations and operations, because in many\\ninstances the peritoneal cavity, which is highly suscep-\\ntible to septic influences, is invaded by them. We must\\nbear in mind that the whole genital tract communi-\\ncates directly with the peritoneum, and infection at\\nany point may cause peritoneal sepsis. Infection has\\ntaken place through the introduction of a dirty\\nsound, and fatal peritonitis has followed perineor-\\nrhaphy and trachelorrhaphy.\\nThe technic for major operations is usually perfect,\\nbut for minor operations carelessness is liable to\\ncreep in. We have no right to expose a patient to-\\ndanger no matter how small the operation to be per-\\nformed; and if our technic is not as perfect as we can\\nmake it with the means at our command, then we\\nexpose the patient to the greatest of all dangers, that\\nof peritoneal sepsis, which usually means death. Suc-\\ncess in surgery is due to minute attention to a care-\\nful technic, and a careless nurse may be the means of\\nintroducing sepsis, which may result in death after a\\nmost brilliant and skilfully performed operation. The\\nmost skilful surgeon is dependent upon his assistants\\nfor the perfection of his technic, and only those nurses\\n168", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0180.jp2"}, "181": {"fulltext": "SIMS POSITION. 169\\nwho have been thoroughly instructed in the practice\\nof asepsis and antisepsis should be allowed to assist at\\nan operation or examination, however small.\\nGYNECOLOGIC EXAMINATIONS.\\nThe positions which a patient may occupy when\\nundergoing an examination are the knee-chest, dor-\\nsal, Sims, and the upright.\\nThe upright, or the erect, position is rarely used\\nfor the purpose of making a diagnosis, but is some-\\ntimes preferred in verifying a diagnosis, especially\\nthat of uterine displacement, previously made with\\nthe patient in another position. Around the w r aist is\\npinned a sheet, which extends to the floor, under\\nwhich the clothing of the patient is drawn up. The\\npatient stands with limbs separated, one foot resting\\non a stool or the rung of a chair.\\nDorsal Position.\u00e2\u0080\u0094 The patient lies on her back\\nwith the knees drawn up and separated; the hips\\nare brought down near the edge of the table, leaving\\nsufficient room for the heels to rest together comfort-\\nably, eight or ten inches apart, without slipping from\\nthe table. A sheet having an oval slit in the centre\\nlong and wide enough to expose the parts is thrown\\nover the patient. In this position there is naturally\\na certain amount of flexion of the pelvis upon the\\ntrunk, and almost complete relaxation of the abdomi-\\nnal muscles is secured.\\nSims Position (also called the Latero-abdominal\\nPosition). In the Sims position the patient lies on\\nthe left side of her chest, with her head and left\\ncheek resting on a low pillow, and the left arm is", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0181.jp2"}, "182": {"fulltext": "170 SURGICAL TECHNIC.\\ndrawn behind the body or hangs over the edge of the\\ntable. The hips are brought down to the left-hand\\ncorner of the table, so that her body lies diagonally\\nacross it, the head and shoulders being at the right-\\nhand side, with the right hand and arm hanging over\\nthe table-edge. The thighs are flexed upon the abdo-\\nmen, the right thigh being so flexed that it lies just\\nabove the left knee, and the feet rest upon a board ex-\\ntending from the right-hand corner of the table. This\\nposition is one in which there is a tendency for the\\nintestines to ascend, and this causes the vagina to be\\nfilled with air and thus brings the uterine cervix\\nwithin easy reach.\\nThe knee-chest, or genupectoral, position is much\\nused for inspection of the rectum, bladder, vagina,\\nand cervix of the uterus. In some cases of displace-\\nment of the uterus the patient may have to take\\nthis position many times daily. The patient first\\nkneels on the edge of the table, then bends forward\\nand rests her chest on a low pillow, her head lying\\njust beyond, so that her back slopes down evenly, her\\narms clasping the sides of the table. In this position\\nthe abdominal organs are thrown toward the dia-\\nphragm; the air enters the vagina and balloons it\\nout, so to speak, so that there is an unobstructed view\\nof the canal and the cervix.\\nExamination of the Rectum. The patient is\\nusually placed in the knee-chest position. Either the\\nrectal speculum, or in its absence a Sims speculum\\n(small blade), is used. When the instrument is intro-\\nduced the rectum becomes distended with air so that\\nits walls are well exposed. If the patient is not in", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0182.jp2"}, "183": {"fulltext": "PRE PARA TION FOR G YNECOLOGIC EXAMINA TION. I J I\\nsuch a position that the buttocks are in a good\\nlight, a head-mirror, or an electric headlight may be\\nneeded. It is well to have these at hand in case they\\nshould be called for.\\nFor an examination of the bladder the knee-chest\\nposition is sometimes used; though, as a rule, the dor-\\nsal position is chosen, with the hips elevated high\\nabove the abdomen by means of cushions of pillows,\\nwhich allows the intestines to gravitate toward the\\nchest; and when the urethra is opened the bladder\\nbecomes distended with air and its interior is thus\\neasily seen. Sometimes the patient is anesthetized for\\nthe examination, since it is usually very painful; but\\nlocal anesthesia of the urethra is often sufficient\\nPreparation for Gynecologic Examination.\u00e2\u0080\u0094\\nTo prepare a patient for examination the genital\\nparts should be cleansed, so that there will be no\\ndanger of carrying septic material to the upper part\\nof the genital tract; the bladder and bowels should\\nbe emptied. The uterus lies between the bladder and\\nthe rectum, and the distention of either of these\\norgans will alter the position of the uterus. As a\\nrule, no douche should be given before the examina-\\ntion, since the surgeon may want to see the character\\nof the discharge. All bands around the waist must\\nbe loosened, also the corsets a single tight band\\naround the waist will crowd down the contents of the\\nabdomen and displace the uterus. Around the patient\\nis thrown a sheet, beneath which she can raise her\\nclothing above the waist, and then step upon a chair\\nand thence to the operating-table without there being\\nthe slightest exposure.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0183.jp2"}, "184": {"fulltext": "172 SURGICAL TEC ff NIC.\\nFor examination in private practice the patient\\nmay lie on a small table covered with a shawl, a\\ncomforter, or blanket. There must be at hand a\\ntable, covered with a towel, on which are placed two\\nbowls, one containing corrosive-sublimate solution\\n(i iooo), and the other containing warm water,\\ngreen soap, vaselin, and towels.\\nThe speculum should be warmed by placing it in\\nthe warm sterile water. The same aseptic precau-\\ntions are used during an examination as during\\nan operation. The instruments should be sterilized.\\nSometimes a cleansing douche of corrosive sublimate\\n(i 2000) is administered after an examination.\\nPREPARATION FOR OPERATION.\\nThe preparation for gynecologic operations, such\\nas perineorrhaphy, etc., are the same as for an abdom-\\ninal operation, excepting the difference of the field\\nof operation to be prepared. In case the operation is\\na minor one upon the uterus or vagina, the prepara-\\ntions may be somewhat modified according to the\\nindividual preference of the operator; but the general\\nrules of asepsis are always the same; and they must\\nbe the more strictly observed in these operations be-\\ncause the dangers of infection are increased by our\\ninability to o-et the orenital tract thoroughly clean.\\nIn abdominal surgery there is not this difficulty.\\nThe preparation of a patient in a private house for\\na minor gynecologic operation should be as thorough as\\nin a hospital. If the operation is to be performed\\nwith the patient in bed, there will be needed a wide\\nboard or an ironing-board for insertion between the", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0184.jp2"}, "185": {"fulltext": "AFTER-CARE. 1 73\\nmattress and sheet, thus making a hard surface for\\nthe patient to lie upon.\\nA piece of rubber cloth or oilcloth will serve for\\nthe pad. The material used is folded at the top and\\nsides, covered with a towel, -and the unfolded end\\ndraped into a pail or wash-tub. When the patient is\\nanesthetized the bed is turned toward the window to\\nafford the surgeon a good light a northern light if\\npossible. A bay window should be avoided, because\\nit gives cross-lights.\\nThe limbs are flexed, the hips brought to the\\nedge of the bed, and the pad placed under them, so\\nthat the water used in bathing the external parts\\nis conducted by the cloth into the pail or tub.\\nWhen holding the patient s limbs the nurse should\\nlet the heel of one foot rest in the palm of her hand;\\nthe knee of the patient will then rest against the\\nchest of the nurse, whose free hand is passed over\\nand holds the other limb in position at the knee.\\nIf the nurse is asked to hold the speculum, she\\nshould grasp the handle from below with her right\\nhand; the angle of the speculum will thus lie in the\\nhollow between the thumb and forefinger, and the\\nconvexity of the blade will rest on the dorsum of the\\nhand. The upper labia and buttocks are raised by\\nthe left hand. If the speculum or regular retractors\\ncannot be obtained in the emergency, retractors can\\nbe improvised by bending the handles of four large\\nspoons to the appropriate angle. Two are used to\\nretract the lateral walls, the other two being applied\\nto the anterior and posterior parts of the vagina.\\nAfter-care. After a vaginal operation, trachelor-", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0185.jp2"}, "186": {"fulltext": "174 SURGICAL TECHXIC.\\nrhaphy, etc., the patient will probably be catheterized\\nfor a few days. We must always remember the risk\\nof cystitis. Many patients have fully recovered from\\nthe operation proper, but convalescence has been\\ndelayed by this complication.\\nAfter passing the catheter the nurse should be care-\\nful that when removing it the urine does not drop\\non the stitches; the parts are afterward sprayed with\\nthe ordered solution and dried. When giving\\ndouches the nurse must insert the tube carefully\\naway from the stitches and after the douche is over\\nshe should separate the labia and wipe the vagina dry\\nwith sterilized cotton or or-auze held in dressing-for-\\nceps. The same care must be used when giving\\nenemas, in order that the rectal and vaginal stitches\\nbe not broken by the tube. The patient must be in-\\nstructed not to strain when the bowels are moved, or\\nthe stitches may break. When dressings are applied,\\nthey may require frequent changing in order to keep\\nthem clean and free from discharges. Strict antisep-\\nsis must be observed, the genital parts must be kept\\nperfectly clean, otherwise septic material will readily\\nfind access and probably result in infection of the\\nwound and suppuration, or a stitch-abscess. If the\\nuterus is packed with gauze, the pulse and tempera-\\nture are usually taken every two hours and should the\\ntemperature rise to ioi\u00c2\u00b0 F. the packing is removed.\\nDiet. A liquid diet is usually ordered until after\\nthe third day, when the bowels will have been\\nmoved; after which, if all is well, the amount of food\\nis increased until it attains its customary proportions.\\nThe patient is generally kept in bed two weeks,", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0186.jp2"}, "187": {"fulltext": "DIET. 1/5\\nand the sutures removed on the ninth day in the\\norder in which they were introduced. After the re-\\nmoval of the stitches many operators order a vaginal\\ndouche two or three times a day, the amount of water\\nvarying from four to six quarts. This treatment is\\nsuccessful only when the douches are given at the\\nproper time and temperature.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0187.jp2"}, "188": {"fulltext": "CHAPTER XVIII.\\nSIGNS OF DEATH; AUTOPSIES.\\nWiNSLOW, one of the professors at the University of\\nParis, and who had twice been taken for dead, was the\\nfirst to make a scientific investigation of the signs of\\ndeath. After Winslow came Louis, and since their\\ntime eminent men, especially in countries prescribing\\nrapid burial, have endeavored to find certain and\\nreliable signs of death before decomposition begins.\\nSIGNS OF DEATH.\\nAbsence of respiration is not a sure sign of death,\\nas it may be due to syncope or to the person being in\\na trance; nor is absence of the heart-beat, unless\\ndetermined by means of a stethoscope in experienced\\nhands. Coldness and rigidity may be due to collapse\\nor catalepsy or in persons who are frozen stiff.\\nIn doubtful cases of apparent death which occur\\nsuddenly or from external violence the following\\ntests are usually applied\\ni. The absence of the heart s action is carefully\\ndetermined by a stethoscope or phonendoscope.\\n2. Absence of the circulation is ascertained by\\ntying a string tightly around a finger or a toe; if the\\ntip becomes blue, life is not extinct, though this may\\noccur in cases where there has been great loss of\\n176", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0188.jp2"}, "189": {"fulltext": "SIGNS OF DEATH I J J\\nblood, and in other cases where the heart is too weak\\nto send the arterial blood into the capillaries of the\\nfingers.\\n3. Absence of respiration is determined by placing\\nthe surface of a mirror before the month; if the sur-\\nface becomes moist, respiration has not ceased.\\n4. If a subcutaneous injection of aqua ammonia is\\ngiven a red or purple spot will form if life still exists.\\n5. If a needle is inserted into the flesh of a living\\nperson blood will escape, but not if life is extinct\\nstill, if there has been a large loss of blood, there will\\nbe no escape of blood in the living.\\nRigor mortis (post-mortem rigidity or stiffness of\\ndeath) begins in the upper part of the body, usually\\nin the maxillary muscles, and spreads gradually from\\nabove downward. It disappears in the same order.\\nIt comes and goes quickly after great muscular effort\\nor excitement, and when once it has been broken\\nup it does not return. The time it sets in after death\\nvaries from ten minutes to twelve or even twenty-four\\nhours. Rigor mortis is considered the most positive\\nsign of death, because it indicates death of the mus-\\ncle itself.\\nDeath of the body as a whole takes place first, and\\nat intervals of an hour or even several hours death of\\none or other of the involuntary muscles follows.\\nHypostasis, or congestion of blood in the capil-\\nlaries, which forms in all the dependent parts of the\\nbody, is considered a valuable sign of death, but this\\npurple color may be due to contusion, and has been\\nseen in cholera patients before death.\\nThe body-temperature at and from one to two\\n12", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0189.jp2"}, "190": {"fulltext": "178 SURGICAL TECHNIC.\\nhours after death may be very high, 107 or 112 F.\\nPatients dying from cholera and yellow fever have\\nhigh temperatures for several hours after death; but,\\nas a rule, the body is cold to the touch in from six to\\nten hours.\\nAUTOPSIES.\\nEvery nurse should do all in her power to assist\\nthe physician or surgeon to obtain autopsies, and\\nwith a little tact the necessary permission can usually\\nbe obtained/ Every well-conducted autopsy adds\\nmore or less to medical knowledge. It verifies the\\ndiagnosis of the illness, and in many cases it explains\\nor shows the cause of symptoms the explanation of\\nwhich could not be determined before death. In\\nsurgical work, when a patient dies in less than\\ntwelve or fourteen hours after an operation, the au-\\ntopsy, when made by a competent bacteriologist and\\npathologist, will show whether death was due to\\nsepsis or to some organic disease over which the sur-\\ngeon had no control.\\nIn a private house the autopsy should be held in\\nthe room giving the best light, and if possible in the\\ndaytime in order to obtain the correct color-interpre-\\ntation; for if made in artificial light the observations\\nwill not be entirely trustworthy.\\nAt the present time an autopsy is perferably held\\nalmost immediately after death, and before putre-\\nfactive changes have taken place. The undertaker\\nshould always be warned not to inject the body, be-\\ncause the fluids usually employed, which contain\\namong other things corrosive sublimate and arsenic\\nin large quantities, change the color and consistency", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0190.jp2"}, "191": {"fulltext": "AUTOPSIES. 179\\nof the organs to such an extent that it is difficult to\\nrecognize the pathologic processes. Then, again, the\\npunctures made during the embalming process may\\nopen an abscess or other cavity, and thus distribute\\nthe contained pus or exudates. Embalming-fluid\\nhas been poured into the mouth, and having found\\nits way into the lungs and stomach, has greatly\\nchanged the appearance of those organs.\\nThe clothing on the body should be removed and\\na large sheet spread over it; or if preferred, a night-\\ndress or skirt open down the middle may be put on.\\nThe things a nurse should provide are:\\n1. Large rubber sheet, old oil-cloth, old quilts, or\\npapers to put under trestle to protect the floor.\\n2. Small table for instruments, a marble-top table\\nif possible, unless there is a marble-top stationary\\nbowl in the room.\\n3. Three washbowls: one for corrosive sublimate,\\none for dirty instruments, and one for organs re-\\nmoved.\\n4. Two pails for dirty water.\\n5. Old towels and a number of old sponges.\\n6. Plenty of hot and cold water.\\n7. About four quarts of fine sawdust, or oakum,\\nor excelsior packing, absorbent cotton, or common\\ncotton for filling up cavities, any one of which will\\nprevent fluid oozing through tlfe incisions. When\\nthese are not obtainable, bran, cloth, or newspapers\\nmay be used. Fine sawdust is the best material, as\\nit packs easily, does not interfere with the sewing\\nby getting into the stitches, and keeps the needle\\ndry.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0191.jp2"}, "192": {"fulltext": "ISO SURGICAL TECH NIC.\\n8. Six wide-mouthed bottles in which to place\\nspecimens from the various organs, and which can\\nbe securely corked.\\n9. Mucilage and labels on which to write the his-\\ntory of each specimen in the bottle.\\n10. About three yards of fine twine or carpet-\\nthread, and a large darning-needle or a large curved\\nneedle.\\nShould the autopsy take place in a house where\\nthere are no conveniences, the body can be left lying\\non the undertaker s stretcher covered with a sheet,\\nthe clothing removed, and a large napkin put on.\\nThere should be several old newspapers to protect\\nthe floor, and on which to place the dirty instru-\\nments and organs removed; an old sheet, a pail,\\na wash-bowl, and a pitcher of warm water can always\\nbe obtained.\\nThe sheet is torn into four pieces. Two pieces are\\nused, one for each side of the neck and trunk, cover-\\ning the arms, leaving the chest and abdomen free for\\nthe surgeon to operate; the third piece is placed be-\\nneath the head; and the fourth piece is tucked in\\nbelow the genitals, thus covering the lower extremi-\\nties. The bowl contains the large dampened sponge,\\nand, together with the pail, should be placed within\\nconvenient reach.\\nAbsolute cleanliness is essential at a private autopsy.\\nBlood-stains must be washed from the walls, floor,\\ndishes, the rubber or oil-cloth; the papers, old\\nsponges, and cloths should be burned, and the body\\nmust be washed perfectly clean. The room must be\\nleft in perfect order\u00e2\u0080\u0094just as it was before the post-", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0192.jp2"}, "193": {"fulltext": "AUTOPSIES. l8l\\nmortem. Ground coffee thrown on a few live coals\\nwill remove all odor from the room.\\nFor removing the odor from the hands, turpentine\\nwill be found serviceable, or a solution of per-\\nmanganate of potassium and oxalic acid, or a dilute\\nsolution of formaldehyd. The result of the autopsy\\nmust be kept secret and revealed to no one.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0193.jp2"}, "194": {"fulltext": "", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0194.jp2"}, "195": {"fulltext": "INDEX.\\nAbdominal operation, instruments\\nfor, 78\\nAbscess-stitch, 113\\nAbsorbent cotton, 99, 115\\nAccidents during operation, 160\\nAcclimatization immunity, 30\\nAcquired immunity, 29\\nActinomycosis, communication of, to\\nman, 14\\nAdhesive plaster, rubber, 102\\nAfter-care for gynecologic operations,\\nAlcohol as an antiseptic, 56\\nsterilization of hands with, 56\\nAllis s aseptic ether-inhaler, 90\\nAmmonia, subcutaneous injection of,\\nas test in supposed death,\\n177\\nAmputation of limb, instruments for,\\nSo\\nAnesthesia. S6-98\\nbronchorrhea in, 19\\ndilated pupils in, 92\\ninfiltration-, 97\\npreparation for accidents in, 89\\nprimary, 93\\nvomiting during production of, 91\\nAnesthetics, administration of, 86\\nchloroform, 94\\nether, administration of, 89\\nethyl bromid, 95\\ngeneral, 86\\nlocal, 86, 95\\ncocain, 95\\nhydrochlorate, 96\\nethyl chlorid, 97\\neucain, 96\\nice, 96\\nphenate of cocain, 97\\nJ Anesthetics, orthoform, 59\\nhydrochlorid, 60\\nSchleich s, 95\\nAnthrax, discovery of bacterial na-\\nture of, 15, 16\\nAntiseptic douches, 127\\ndressings, 99\\npowders, 104\\nsurgery, Lister s system, 12, 13\\nAntiseptics, 42-61\\nalcohol, 56\\naristol, 54\\nbalsam of Peru, 59\\nboiling water, 45\\nboracic acid, 55\\nboroglycerid, 56\\ncarbolic acid, 47\\nchlorinated lime, 58\\ncoal-tar derivatives, 47\\nCondy s fluid, 58\\ncorrosive sublimate, 48\\ncreolin, 49\\ndermatol, 61\\nformaldehyd, 52\\nformalin, 53\\nheat, 45\\nmoist, 45\\nhot air, 46\\nhydrochloric acid, 58\\nhydrogen peroxid, 55\\nichthyol, 59\\niodoform, 51\\niodol, 52\\nLabarraque s solution, 58\\nlisterine, 61\\nlysol, 50\\nmethyl-blue, 58\\nmethyl-violet, 58\\nmustard, 60\\n183", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0195.jp2"}, "196": {"fulltext": "1 84\\nINDEX.\\nAntiseptics, normal salt solution, 60\\northoform, 59\\nhydrochloric!, 60\\noxalic acid, 57\\npotassium permanganate, 57\\nprotargol, 61\\npyoktanin, 58\\nresorcin, 60\\nsaprol, 50\\nsodium bicarbonate, 61\\nsozal, 50\\nsteam, 45\\nlive, 46\\nsulphuric acid, 58\\nthymol iodid, 54\\nvinegar, sterilized, 60\\nx\\\\ntistreptococcic serum for septic\\nperitonitis, 158\\nAntitoxin, administration of, followed\\nby stimulation of body s ger-\\nmicidal powers, 39\\nin therapeutic practice, 35\\nmethod of injecting, 41\\nmixture of Coley, for tumors, 40\\nof diphtheria, preparation of, 36\\nstatus of, 39\\nstreptococcus, 40\\npreparation of, 37\\ntetanus, 40\\ntheory of, 35\\ntheory of immunity, 31\\ntherapeutic action of, 37\\ntuberculosis, 41\\npreparation of, 37\\nAristol, 54\\nArtificial immunity, 30\\nAsepsis in gynecologic operations,\\n168\\nAutopsies, 178\\ncleanliness in, 180\\ninstruments, etc., for, 179\\npreparation of body for, 179\\ntime for, 178\\nBacillus, 21\\naerogenes capsulatus,\\ncoli communis,\\ncomma, discovery of, 17\\ndiphtherias, 34\\ndiscovery of, 17\\nicteroides, discovery of, 18\\nmelitensis, discovery of, 18\\nBacillus of bubonic plague, discovery\\nof, 18\\nof glanders, discovery of, 17\\nof influenza, discovery of, 18\\nof leprosy, discovery of, 16\\nof Malta fever, discovery of, 18\\nof measles, discovery of, 18\\nof tetanus, 34\\ndiscovery of, 17\\nof yellow fever, discovery of, 18\\npyocyaneus, 3\\ntuberculosis,\\ndiscovery of, 17\\ntyphosus, discovery of, 16\\nBacteria, 20\\nas causes of disease, 20\\nchannels of entrance into body,\\n25, 26\\nconditions influencing growth of,\\n24\\ndisease-producing, 44\\ndistribution of, 9\\nentrance of, through alimentary\\ncanal, 25\\nthrough respiratory tract, 26\\nthrough skin, 25\\nforms of, 21\\nKoch s circuit, to prove specific\\npathogenic powers of, 27\\npyogenic, 22\\nreproduction of, 22\\nby binary division, 23\\nby fission, 22, 23\\nby sporulation, 22, 23\\nsizes of, 20, 21\\nBacteriology, 9\\nhistory of, 9\\nprogress of, 12\\nBalsam of Peru, 59\\nBandages, 103\\nScultetus, 103\\nT-, 103, 104\\nBed for private operations, 163\\nBicarbonate of sodium, 61\\nBichlorid gauze, 100\\nBinary division of bacteria, 23\\nBismuth gauze, 10 1\\nBladder, attention to, after opera-\\ntions, 146\\nirrigation of, 125\\noperations on, instruments for, 84\\nBoiling water as germicide, 45", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0196.jp2"}, "197": {"fulltext": "INDEX.\\nl8 5\\nBoric acid, 55\\nBoroglycerid, 56\\nBowels, attention to, after operations,\\n146\\nBrain, operations on, instruments for,\\n80\\nBroncborrhea in anesthesia, 91\\nBrushes, 115\\nBubonic plague, bacillus of, dis-\\ncovery of, 18\\nCanton-flannel roll for instru-\\nments, 75\\nCarbolic acid, 47\\nCatgut, 109\\npreparation of, no\\nsterilization of, no\\nwith formalin, 53\\nCatheterization, 123\\nCatheters, 123\\nglass, 123\\nintroduction of, 124\\nCautery, Paquelin, 104\\nCerebrospinal meningitis, epidemic,\\nspecific germ as cause of,\\n18\\nCervix, dilatation of, instruments for,\\n78\\nCharts, keeping of, 71\\nChicken-cholera, 16\\nChlorinated lime, 58\\nChloroform, 94\\nCholera, chicken-, 16\\nCirculation, absence of, as sign of\\ndeath, 176\\nCoal-tar derivatives, 47\\nCocain, 95\\nhydrochlorate, 96\\nphenate, 97\\nCocci, 21\\nmorphology of, 22\\nColey s antitoxin mixture for tumors,\\n40\\nCollodion dressing, 101\\nComma bacillus, discovery of, 17\\nCondy s fluid, 58\\nContinuous suture, 113\\nCorrosive sublimate, 48\\nswallowing of, 49\\nCotton, absorbent, 99, 115\\nCreolin, 49\\nCystoscopic examination, instruments\\nfor, 85\\nCysts or tumors, instruments for, 78-80\\nDam, rubber, 119\\nDeath, signs of, 176\\nabsence of circulation, 176\\nof heart-beat, 176\\nof respiration, 176, 177\\nhypostasis, 177\\ninsertion of needle, 177\\nrigor mortis, 177\\nsubcutaneous injection of am-\\nmonia, 177\\ntemperature, 177\\nstiffness of, 177\\nDelirium, traumatic, from shock, 155\\nDeodorants, 42\\nDependent pockets, 116\\nDermatol, 61\\nDiet after operations, 146-150\\ngynecologic, 174\\nDiphtheria antitoxin, preparation of,\\n36\\nstatus of, 39\\nbacillus of, 34\\ndiscovery of, 17\\nDiplococci, 22\\nDiplococcus pneumoniae, 34\\nDisease, bacteria as causes of, 20\\nconditions necessary for causation\\nof, 27\\nin man, fungi connected with, 21\\nDisinfectants, 42\\nDisinfection, 45\\nby steam, 46\\nDorsal position, 169\\nDouche-board, 127\\nDouches, 126\\nadministration of, 126\\nantiseptic, 127\\nDrainage, 116\\npostural, 117\\nDrainage-tubes, care of, 117\\nglass, 116, 119\\nrubber, preparation of, 118\\nDressing-rooms, 62\\nDressings, antiseptic, 99\\ncollodion, 101\\nsurgical, 99\\nDust, infection from, in operations,\\n136-138", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0197.jp2"}, "198": {"fulltext": "1 86\\nINDEX.\\nEar, operations on, instruments for,\\n82, 83\\nEmergency bundles, 115\\noperations, preparations in, 165,\\n166\\nEmulsion of iodoform, 100\\nEnema, 129, 130\\nfor tympanites, 1 30\\npurgative, 130\\nstimulating, 129\\nEnteroclysis, 128\\nEther, administration of, 89\\nnausea after, 93\\nto children, 93\\nvomiting after, 93\\ndeath from, 93\\nEther-inhaler, Allis s, 90\\nEthyl bromid, 95\\nchlorid, 97\\nEucain, 96\\nExaminations, gynecologic, 168, 169.\\nSee also Gynecologic exami-\\nnations.\\nof rectum, 170\\nExcretions, disinfectants for, 58\\nFermentation-fever, 159\\nFinger cots, 120\\nFission, 22, 23\\nFormaldehyd, 52\\nas dusting-powder, 53\\ninhalation of, 54\\nsterilization of instruments and\\ndressings with, 64\\nFormalin, 53\\npoisoning by, 54\\nsterilization of catgut with, 53\\nFungi connected with disease in\\nman, 21\\nGauze, 99, 115\\nbi chlorid, 100\\nbismuth, 101\\niodoform, 100\\npads, 114\\npotassium permanganate, 101\\nrequirements of, for dressings, 99\\nGenupectoral position, 170\\nGermicides, 42\\nGerms, incubation-period of, 29\\nGlanders, bacillus of, discovery of,\\n17\\nGlass ligature-box, 112\\nGloves, 119\\nrubber, 119, 120\\nGonococcus as cause of gonorrhea,\\n16\\ndiscovery of, 16\\nGonorrhea, gonococcus of, 16\\nGreen soap, 120\\nGynecologic examinations, 168, 169\\nasepsis in, 168\\npositions in, 169\\ndorsal, 169\\ngenupectoral, 170\\nknee-chest, 170\\nlatero-abdominal, 169\\nSims 169\\nupright, 169\\npreparations for, 171\\noperations, 168. See also Opera-\\ntions, gynecologic.\\ninstruments for dressing after, 84\\nHeart-beat, absence of, value of,\\nas sign of death, 176\\nHeat, germicidal powers of, 45\\nmoist, as germicide, 45\\nHemorrhage following operations,\\n155\\nsymptoms, 155\\ntreatment, 156\\nHernia, 159\\nFlorsley s wax, 102\\nHot air as germicide, 46\\nHydrochloric acid as disinfectant, 58\\nHydrogen peroxid, 55\\nFlydrophobia, first application of\\nPasteur s treatment, 17\\nHypostasis as sign of death, 177\\nHysterectomy, 160\\ninsanity after, 160\\nvaginal, 160\\ninstruments for, 78-80\\nIce as local anesthetic, 96\\nIchthyol, 59\\nImmunity, 29\\nacclimatization, 30\\nacquired, 29\\nantitoxin theory of, 3 1\\nartificial, 30\\nnatural, 29\\nracial, 30", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0198.jp2"}, "199": {"fulltext": "INDEX.\\nI8 7\\nImmunity, theories of, 30-32\\nphagocytosis, 31\\nIncubation-period of germs, 29\\nInfection from dust in operations,\\nI30-I3- S\\nInfiltration-anesthesia, 97\\nInflammation, 121\\ncauses of, 122\\nInfluenza, bacillus of, discovery of, 18\\nInjection of antitoxin, 41\\nInjections, rectal, 128\\nInsanity after hysterectomy, 160\\nInstruments and dressings, sterilizer\\nfor, 66\\ncanton-flannel roll for, 75\\nfor cystoscopic examination, S5\\nfor dressing after gynecologic\\noperations, 84\\nfor operations, 76-85\\nabdominal, 78\\namputation of limb, 80\\ncuretting of uterus, 78\\ncysts or tumors, 78-80\\ndilatation of cervix, 78\\non bladder, 84\\non brain, 80\\non ear, 82, 8^\\non mouth, 81\\non nose, 82\\non rectum, 8^\\non spine, 80\\non throat, 81\\non urethra, 84\\nperineorrhaphy, 76\\ntrachelorrhaphy, 77\\nvaginal hysterectomy, 78-80\\nsterilization of, 64\\napparatus for, 65\\nwith formaldehyd, 64\\nInstrument-trays, 67\\nagateware, 67\\nhard-rubber, 68\\nInterrupted suture, 113\\nIntestinal obstruction, 159\\nIodoform, 51\\nemulsion, 100\\ngauze, 100\\npoisoning, 51\\nlodol, 52\\nIrrigation, 107\\nof bladder, 125\\nof rectum, 128\\nJohnson s method for preparation\\nof catgut, 1 1 1\\nKangaroo-tendon, 109\\nKnee- chest position, 170\\nKoch s circuit to prove specific path-\\nogenic powers of microbe, 27\\nLabARRAQUE S solution, 58\\nLatero-abdominal position, 169\\nLeprous nodules, discovery of ba-\\ncilli of, 16\\nLigature, 109. See also Sutures.\\nLigature-box, glass, 112\\nLigature-tray, Robb s aseptic, 68\\nLimb, amputation of, instruments\\nfor, 80\\nLime, chlorinated, 58\\nListerine, 61\\nListerism, 13\\nLister s system of antiseptic surgery,\\n12, 13\\nLysol, 50\\nMalarial fever, cause of, 19\\nMalta fever, bacillus of, discovery of,\\n18\\nMeasles, bacillus of, discovery of, 18\\nMethyl-blue, 58\\nMethyl-violet, 58\\nMetschnikoff s theory of phagocyto-\\nsis, 31\\nMicrococcus lanceolatus, 34\\nPasteuri, discovery of, 16\\nMouth, dryness of, after operations,\\nH5\\noperation on, instruments for, 81\\nMustard as antiseptic, 60\\nNatural immunity, 29\\nNausea after etherization, 93\\nNeedles, 115\\ninsertion of, as test in supposed\\ndeath, 177\\nNodules of leprosy, discovery of ba-\\ncilli of, 16\\nNose, operations on, instruments for,\\n82\\nNurses, duties of, in operations, 132,\\n133, 142-144\\npreparations of, for operations, 133,\\n134", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0199.jp2"}, "200": {"fulltext": "i88\\nINDEX.\\nObstruction, intestinal. 159\\nOperating-room, eare of, 62\\npreparation of, 132\\nOperating-table for private opera-\\ntions, 163\\nOperation blank, 74\\nOperations, 131\\naccidents during, 160\\narranging of patient for, 14 1\\nattention to bladder after, 146\\nto bowels after, 146\\ncare of patient after, 144-150\\ndiet after, 146-150\\ndryness of mouth after, 145\\nduties of nurses in, 132, 133, 142-\\n144\\ngynecologic, 168\\nafter-care, 173\\nasepsis in, 168\\ndiet after, 174\\npreparations for, 172\\nhemorrhage after, 155. See also\\nHonor) -Ji age following opera\\nlions.\\ninfection in, from dust, 136-138\\nin private practice, 1 61\\nbed for, 163\\nfurniture, instruments, etc.,\\nfor. 164\\noperating-table for. 163\\npreparations for, 162\\nin emergencv cases, 165,\\n166\\nsterilization of instruments for.\\n165\\not sheets, towels, etc.. 164\\ninstruments for, 76. See also In-\\nstruments for operations.\\nof election, 132\\nof emergency, 132\\nof expediency, 131\\nof necessity, 132\\npleurisy after, 144\\npneumonia after, 144\\npreparation of field of, 139\\nof vaginal canal, 140\\nof nurses for, 133, 134\\nof patient for, 139\\nday before operation, 139\\nday of operation, 141\\nof surgeon and assistants for,\\n135\\nOperations, septic peritonitis after,\\n156. See also Peritonitis,\\nseptic, after opera:\\nsequelae of, 151\\nshock after, 15 1. See also Shock\\nfollowing operations.\\nthirst after, 1 45\\nOrthoform, 59\\nhydrochlorid, 60\\nOxalic acid, 57\\nP-ADS, gauze, 114\\nPaquelin cautery. 104\\nParasites as cause of malignant\\ntumors, 19\\nPatient, arranging of, for operations,\\n141\\ncare of, after operations, 144-150\\npreparation of. for operations, 139.\\nSee also Operations, prepara-\\ntion of patient for.\\nPerineorrhaphy, instruments for, 76\\nPeritonitis, septic, after operations,\\n156\\nsymptoms, 156\\ntreatment, 157\\nwith antistreptococcic se-\\nrum, 158\\nPeroxid of hydrogen, 55\\nPhagocytosis theory of immunity,\\n31\\nPhenate of cocain, 97\\nPlasmodium malaria? as cause of\\nmalaria, 19\\nPlaster, adhesive, rubber, 102\\nPleurisy after operations, 144\\nPneumococcus. 34\\ndiscovery of, 16\\nPneumonia after operations. 144\\ncroupous, bacillus of. 34\\nPost-mortem rigidity, 177\\nPotassium permanganate. 57\\ngauze, 101\\nPowders, antiseptic, 104\\nPrivate operations, 161. See also\\nOperations in private practice.\\nProtargol. 61\\nPuerperal fever, organic ferments as\\ncause of, 14\\nPupils, dilated, in anesthesia, 92\\nPurgative enemata, 130\\nPus, 122", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0200.jp2"}, "201": {"fulltext": "INDEX.\\n189\\nPushing lower jaw forward to pre-\\nvent obstruction to breathing,\\nPyogenic bacteria, 22\\nPyoktanin, 58\\nblue, 58\\nRacial immunity, 30\\nRectal injections, 128\\nRectum, examination of, 170\\nirrigation of, 128\\noperations on, instruments for, 83\\nResorcin, 60\\nRespiration, absence of, as sign of\\ndeath, 177\\nvalue of, 176\\nartificial, for shock following opera-\\ntions, 154\\nRigor mortis, 177\\nRobb s aseptic ligature-tray, 68\\nRobinson s douche-board, 127\\nRubber adhesive plaster, 102\\ndam, 119\\ndrainage-tubes, preparation of, 118\\ngloves, 119, 120\\nprotective, 102\\nSALT solution, normal, 106\\nas antiseptic, 60\\nSaprol, 50\\nSarcinoe, 22\\nSchleich s anesthetic, 95\\nScultetus bandage, 103\\nSequelce of operations, 151\\nShock following operations, 151\\nartificial respiration in, 154\\nsymptoms, 153\\ntreatment, 153\\ntraumatic delirium from, 155\\nShotted suture, 1 13\\nSigns of death, 176. See also\\nDeath, signs of.\\nSilk, protective, oiled, 102\\nsterilization of, 1 12\\nSilkworm-gut, 1 10\\nSilver wire, 113\\nSims position, 169\\nSinus, 159\\nSmall-pox, vaccination for, 30\\nSoap, green, 120\\nSodium bicarbonate, 61\\nSozal, 50\\nSpine, operations on, instruments for,\\n80\\nSpirillum, 21\\nSplenic fever, discovery of bacterial\\nnature of, 15, 16\\nSponges, 113\\ngauze, 113, 114\\nmarine, 113, 114\\nSpores, resistance of, 24, 44\\nSporulation, 22, 23\\nSpotted fever, specific germ as cause\\nof, 18\\nStaphylococci, 22\\nStaph vlococcus epidermidis albus,\\n33\\npyogenes albus, 33\\naureus, 32\\ncitreus, 1,3\\nSteam as germicide, 45\\ndisinfection by, 46\\nlive, as germicide, 46\\nSterilization, 45, 63\\ndry, 64\\nfractional, 46\\nintermittent, 46\\nmoist, 64\\nof catgut, no. See also Catgut.\\nof hands with alcohol, 56\\nof instruments, 64. See also In-\\nstruments, sterilization of.\\nof sheets, towels, etc., for private\\noperations, 164\\nof silk, 112\\nSterilizer for instruments, 65\\nand dressings, 66\\nStitch-abscesses, 113\\nStomach-contents, examination of,\\n125\\nStreptococci, 22\\nStreptococcus antitoxin, 40\\npreparation of, 37\\nlanceolatus, 34\\npyogenes, 32\\nStretcher, wheeled, 63\\nSulphuric acid as disinfectant, 58\\nSurgeon and assistants, preparations*\\nof, 135\\nSurgeon s kit, 73\\ncontents of, 73\\npacking of, 73\\nSurgery, antiseptic, Lister s system,\\n12, 13", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0201.jp2"}, "202": {"fulltext": "190\\nINDEX.\\nSurgical dressings, 99\\ntechnic, 62\\nSutures, 109\\nbutton, 113\\ncatgut, 109. See also Catgut.\\ncontinuous, 113\\ninterrupted, 113\\nkangaroo-tendon, 109\\nshotted, 113\\nsilk, 112\\nsilkworm -gut, no\\nsilver wire, 113\\nTampons, 102\\nT-bandage, 103, 104\\nTemperature in death, 177\\nTents, 102\\nTest-breakfast, 126\\nTetanus antitoxin, 40\\nbacillus of, 34\\ndiscovery of, 17\\nTetrads, 22\\nTheory of antitoxins, 35\\nThermocautery, 104\\nThiersch s solution, 56\\nThirst after operations, 145\\nThroat, operations on, instruments\\nfor, 81\\nThymol iodid, 54\\nTrachelorrhaphy, instruments for,\\nTraumatic delirium from shock, 155\\nTrays, instrument-, 67. See also\\nInstrument-trays.\\nligature-, Robb s aseptic, 68\\nTuberculin, 18\\nTuberculosis, antitoxin of, 41\\npreparation of, 37\\nbacillus of,\\ndiscovery of, 17\\nTubes, drainage-, 117. See also\\nDra in age-tu bes\\nTumors, malignant, parasites as\\ncause of, 19\\ntreatment of, by Coley s antitoxin\\nmixture, 40\\nTympanites, 158\\nenema for, 130\\nTyphoid fever, discovery of bacilli\\nof, 16\\nUpright position, 169\\nUrethra, operations on, instruments\\nfor, 84\\nUterus, curetting of, instruments for,\\nVaccination, 30\\nVaginal canal, preparation of, for\\noperation, 140\\nhysterectomy, 160\\ninstruments for, 78-80\\nVinegar, sterilized, as antiseptic, 60\\nVomiting after etherization, 93\\nduring anesthetization, 91\\nWheeled stretcher, 63\\nYellow fever, bacillus of, discovery\\nof, 18\\nZOOGLEA, 22", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0202.jp2"}, "203": {"fulltext": "", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0203.jp2"}, "204": {"fulltext": "", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0204.jp2"}, "205": {"fulltext": "CATALOGUE\\nOF\\nBooks on Nursing\\nAND BOOKS SPECIALLY IN-\\nTERESTING FOR NURSES\\nBooks sent to any address, prepaid, on receipt of\\nthe price herein given\\nPAGE\\nAmerican Pocket Medical Dictionary 2\\nAmerican Text-Book of Nursing 8\\nChapin s Compendium of Insanity 3\\nGrafstrom s Mechano-Therapy 4\\nGriffith s Care of the Baby 5\\nGriffith s Infant s Weight Chart 5\\nHampton s Nursing 4\\nHare s Essentials of Physiology 7\\nHart s Diet in Sickness and in Health 8\\nLaine s Temperature Chart 8\\nMartin s Essentials of Minor Surgery and Bandaging 7\\nMeigs s Feeding in Early Infancy 5\\nMorris s Essentials of Materia Medica, Therapeutics, and Prescrip-\\ntion-Writing 6\\nMorten s Nurses Dictionary 8\\nNancrede s Essentials of Anatomy 7\\nPye s Elementary Bandaging and Surgical Dressing 4\\nPyle s Personal Hygiene 5\\nStevens s Manual of Materia Medica and Therapeutics 6\\nStevens s Manual of Practice of Medicine 6\\nStoney s Materia Medica for Nurses 3\\nStoney s Practical Points in Nursing 2\\nW. B. SAUNDERS CO.\\n925 WALNUT STREET PHILADELPHIA", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0205.jp2"}, "206": {"fulltext": "Practical Points in Nursing, Stama EditIon\\nM rk r* Thoroughly Revised.\\nfor Nurses in Private Practice.\\nBy Emily A. M. Stoney, late Superintendent of the Training-\\nSchool for Nurses, Carney Hospital, South Boston, Mass. 456\\npages, handsomely illustrated. Cloth. Price, #1.75 net.\\nIn this volume the author explains the entire range of private\\nnursing as distinguished from hospital nursing, and the nurse is\\ninstructed how best to meet the various emergencies of medical\\nand surgical cases when distant from medical or surgical aid or\\nwhen thrown on her own resources. An especially valuable feat-\\nure of the work will be found in the directions to the nurse how\\nto improvise everything ordinarily needed in the sick-room.\\nThe Appendix contains much information that will be found\\nof great value to the nurse, including Rules for Feeding the Sick\\nRecipes for Invalid Foods and Beverages Tables of Weights and\\nMeasures List of Abbreviations Dose-List and a complete\\nGlossary of Medical Terms and Nursing Treatment.\\nThis is a well-written, eminently practical volume, which covers the entire\\nrange of private nursing, and instructs the nurse how to meet the various emer-\\ngencies which may arise and how to prepare everything needed in the illness of\\nher patient. American Journal of Obstetrics and Diseases of Women and Children.\\nThe American Pocket Medical Dictionary.\\nThird Edition, Revised.\\nEdited by W. A. Newman Dorland, M.D., Assistant Obstet-\\nrician to the Hospital of the University of Pennsylvania Fellow\\nof the American Academy of Medicine, etc. Handsomely bound\\nin flexible leather, limp, with gold edges and patent thumb index.\\nPrice, #1.00 net; with patent thumb index, J1.25 net.\\nThis is the ideal pocket lexicon. It is an absolutely new book,\\nand not a revision of any old work. It gives the pronunciation\\nof all the terms. It contains a complete vocabulary, defining\\nall the terms of modern medicine. It makes a special feature\\nof the newer words neglected by other dictionaries. It con-\\ntains a wealth of anatomical tables of special value to students.\\nIt forms a volume indispensable to every medical man and nurse.\\nThis dictionary is, beyond all doubt, the best one among pocket diction-\\naries. St. Louis Medical and Surgical Journal.\\nThis is one of the handiest little dictionaries for the pocket that we have\\never seen. Its definitions are short, concise, and complete, so that it contains\\nwithin a small space as many words, satisfactorily defined, as are found in some\\nof the much larger volumes. American Medico- Surgical Bulletin.\\n2", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0206.jp2"}, "207": {"fulltext": "A Handbook for Nurses. just issued.\\nBy J. K. Watson, M.D., Edin., Assistant House-Surgeon,\\nSheffield Royal Hospital. American Edition, under the super-\\nvision of A. A. Stevens, A.M., M.D., Professor of Pathology,\\nWoman s Medical College, Philadelphia. i2mo, 413 pages, 73\\nillustrations. Cloth, J 1.50 net.\\nThis work aims to supply in one volume that information which so many\\nnurses at the present time are trying to extract from various medical works, and\\nto present that information in a suitable form. The book represents an entirely\\nnew departure in nursing literature, insomuch as it contains useful information\\non medical and surgical matters hitherto only to be obtained from expensive\\nworks written expressly for medical men.\\nMateria Medica for Nurses,\\nBy Emily A. M. Stoney, late Superintendent of the Training-\\nSchool for Nurses, Carney Hospital, South Boston, Mass. Hand-\\nsome octavo volume of 300 pages. Cloth. Price, $1.50 net.\\nThe present book differs from other similar works in several\\nfeatures, all of which are intended to render it more practical and\\ngenerally useful. The consideration of the drugs includes their\\nnames, their sources and composition, their various preparations,\\nphysiologic actions, directions for handling and administering,\\nand the symptoms and treatment of poisoning. The Appendix\\ncontains much practical matter, such as Poison-emergencies,\\nReady Dose-list, Weights and Measures, etc., as well as a Glossary,\\ndefining all the terms used in Materia Medica, and describing all\\nthe latest drugs and remedies, which have been generally ne-\\nglected by other books of the kind.\\nA Compendium of Insanity,\\nBy John B. Chapin, M.D., LL.D., Physician-in-Chief, Penn-\\nsylvania Hospital for the Insane. i2mo, 234 pages, illustrated.\\nCloth, $1.25 net.\\nThe author has given, in a condensed and concise form, a\\ncompendium of Diseases of the Mind, for the convenient use and\\naid of physicians and students. It contains a clear, concise state-\\nment of the clinical aspects of the various abnormal mental con-\\nditions, with directions as to the most approved methods of man-\\naging and treating the insane.\\nThe practical parts of Dr. Chapin s book are what constitute its distinctive\\nmerit. We desire especially, however, to call attention to the fact that in the\\nsubject of the therapeutics of insanity the work is exceedingly valuable. The\\nauthor has made a distinct addition to the literature of his specialty. Phila-\\ndelphia Medical Journal.\\n3", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0207.jp2"}, "208": {"fulltext": "Nursing: Its Principles and Practice.\\nSecond Edition, Revised and Enlarged.\\nBy Isabel Adams Hampton, Graduate of the New York\\nTraining-School for Nurses attached to Bellevue Hospital Su-\\nperintendent of Nurses and Principal of the Training- School for\\nNurses, Johns Hopkins Hospital, Baltimore, Md. Handsome\\ni2mo volume of 512 pages, illustrated. Price, Cloth, $2.00 net.\\nThis original work is at once comprehensive and systematic.\\nIt is written in a clear and readable style, suitable alike to the\\nstudent and the lay reader. Such a work is of especial value to the\\ngraduated nurse who desires to acquire a practical working knowl-\\nedge of the care of the sick and the hygiene of the sick-room.\\nA Text=Book of Mechanotherapy Ju8t\\n(Massage and Medical Gymnastics).\\nBy Axel V. Grafstrom, B. Sc, M.D., late Lieutenant in the\\nRoyal Swedish Army late House Physician, City Hospital,\\nBlackwell s Island, New York. i2mo, 139 pages, illustrated.\\nCloth, $1.00 net.\\nThis book is intended as a practical manual of the methods of\\nmassage and Swedish movements, so rapidly becoming popular in\\nthis country. It describes clearly and shows by illustration the\\nvarious movements of the system and their mode of application\\nto all parts of the body, and indicates definitely the particular\\nones applicable to the various conditions of disease.\\nElementary Bandaging and\\nSurgical Dressing.\\nWith Directions concerning the Immediate Treatment of Cases\\nof Emergency. By Walter Pve, F.R.C.S., late Surgeon to St.\\nMary s Hospital, London. Small i2ino, with over 80 illustra-\\ntions. Cloth, flexible covers, 75 cents net.\\nThis little book is chiefly a condensation of those portions of\\nPye s Surgical Handicraft which deal with bandaging, splint-\\ning, etc., and of those which treat of the management in the first\\ninstance of cases of emergency. The directions given are thor-\\noughly practical, and the book will prove extremely useful to\\nstudents, surgical nurses, and dressers.\\nThe author writes well, the diagrams are clear, and the book itself is small\\nand portable, although the paper and type are good. British Medical Journal.", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0208.jp2"}, "209": {"fulltext": "A Manual of Personal Hygiene. Just issued.\\nProper Living upon a Physiologic Basis. By American Authors.\\nEdited by Walter L. Pyle, A.M., M.D., Assistant Surgeon to\\nWills Eye Hospital, Philadelphia. Octavo, 350 pages. Pro-\\nfusely illustrated. Cloth, $1.50 net.\\nThe object of this manual is to set forth plainly the best means of develop-\\ning and maintaining physical and mental vigor. It represents a thorough exposi-\\ntion of living upon a physiologic basis. There are chapters upon the hygiene\\nof the digestive apparatus, the skin and its appendages, the vocal and respiratory\\napparatus, eye, ear, brain, and nervous system, and a chapter upon exercise.\\nThe book is the conjoint work of several well-known American physicians and\\nmedical teachers, each writing upon a subject to which he has given special\\nstudy, thus assuring for the book an originality and authority not possessed by\\nany similar treatise.\\nThe Care of the Baby. Second Edition\\nRevised.\\nBy J. P. Crozer Griffith, M.D., Clinical Professor of Dis-\\neases of Children, University of Pennsylvania Physician to the\\nChildren s Hospital, Philadelphia, etc. 404 pages, with 67 illus-\\ntrations in the text, and 5 plates. i2mo. Price, $1.50. net.\\nA reliable guide not only for mothers, but also for medical\\nstudents, nurses, and practitioners whose opportunities for observ-\\ning children have been limited.\\nThe whole book is characterized by rare good sense, and is evidently\\nwritten by a master hand. It can be read with benefit not only by mothers, but\\nby medical students and by any practitioners who have not had large oppor-\\ntunities for observing children. American Journal of Obstetrics.\\nInfant s Weight Chart.\\nDesigned by J. P. Crozer Griffith, M.D., Clinical Professor\\nof Diseases of Children in the University of Pennsylvania. 25\\ncharts in each pad. Price per pad, 50 cents net.\\nA convenient blank for keeping a record of the child s weight\\nduring the first two years of life. Printed on each chart is a\\ncurve representing the average weight of a healthy infant, so that\\nany deviation from the normal can readily be detected.\\nFeeding in Early Infancy.\\nBy Arthur V. Meigs, M.D. Bound in limp cloth, flush\\nedges. Price, 25 cents net.\\n5", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0209.jp2"}, "210": {"fulltext": "A Manual of Practice of Medicine.\\nFifth Edition, Revised and Enlarged.\\nBy A. A. Stevens, A.M., M.D., Instructor in Physical Diag-\\nnosis in the University of Pennsylvania, and Professor of Pathol-\\nogy in the Woman s Medical College of Pennsylvania. Post 8vo,\\n519 pages. Numerous illustrations and selected formulae. Price,\\nbound in flexible leather, $2.00 net.\\nIt is well-nigh impossible for the student, with the limited\\ntime at his disposal, to master elaborate treatises or to cull from\\nthem that knowledge which is absolutely essential. From an ex-\\ntended experience in teaching, the author has been enabled, by\\nclassification, to group allied symptoms, and to bring within a\\ncomparatively small compass a complete outline of the practice\\nof medicine.\\nManual of Materia Medica and Therapeutics.\\nSecond Edition, Revised.\\nBy A. A. Stevens, A.M., M.D., Instructor in Physical Diag-\\nnosis in the University of Pennsylvania, and Professor of Pathol-\\nogy in the Woman s Medical College of Pennsylvania. 445\\npages. Price, bound in flexible leather, $2.00 net.\\nThis wholly new volume, which is based on the last edition\\nof the Pharmacopoeia, comprehends the following sections Phys-\\niological Action of Drugs Drugs Remedial Measures other\\nthan Drugs Applied Therapeutics Incompatibility in Prescrip-\\ntions Table of Doses Index of Drugs and Index of Diseases,\\nthe treatment being elucidated by more than two hundred formulae.\\nThe author is to be congratulated upon having presented the medical\\nstudent with as accurate a manual of therapeutics as it is possible to prepare.\\nTherapeutic Gazette.\\nEssentials of Materia Medica, Thera= Fifth\\nEdition,\\npeutics, and Prescription Writing. Revised.\\nBy Henry Morris, M.D., late Demonstrator of Therapeutics,\\nJefferson Medical College, Philadelphia Fellow of the College\\nof Physicians, Philadelphia, etc. Crown octavo, 288 pages.\\nCloth, $1.00; net; interleaved for notes, $1^25 net.\\nThis work, already excellent in the old edition, has been largely improved\\nby revision. American Practitioner and News.\\n6", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0210.jp2"}, "211": {"fulltext": "Essentials of Anatomy,\\nJ Sixth\\nIncluding the Anatomy of the Viscera. Edition.\\nBy Charles B. Nancrede, M.D., Professor of Surgery and\\nof Clinical Surgery in the University of Michigan, Ann Arbor.\\nCrown octavo, 388 pages; 180 illustrations. With an Appendix\\ncontaining over 60 illustrations of the osteology of the human\\nbody. Based upon Graf s Anatomy. Cloth, $1.00 net; inter-\\nleaved for notes, $1.25 net.\\nFor self-quizzing and keeping fresh in mind the knowledge of anatomy\\ngained at school, it would not be easy to speak of it in terms too favorable.\\nAmerican Practitioner.\\nEssentials of Physiology. Fourth Edition\\nJ J Revised.\\nBy H. A. Hare, M.D., Professor of Therapeutics and Materia\\nMedica in the Jefferson Medical College of Philadelphia Physi-\\ncian to the Jefferson Medical College Hospital. Containing a\\nseries of handsome illustrations from the celebrated Icones Ner-\\nvorum Capitis of Arnold. Crown octavo, 239 pages. Cloth,\\n$1.00 net; interleaved for notes, $1.25 net.\\nThe best condensation of physiological knowledge we have yet seen.\\nMedical Record, New York.\\nContains the essence of its subject. No better book has ever been pro-\\nduced, and every student would do well to possess a copy. Pacific Medical\\nJournal.\\nEssentials of Minor Surgery,\\nSecond\\nBandaging, and Edition,\\nVenereal Diseases.\\nRevised.\\nBy Edward Martin, A.M., M.D., Clinical Professor of\\nGenito-Urinary Diseases, University of Pennsylvania, etc. Crown\\noctavo, 166 pages, with 78 illustrations. Cloth, $1.00 net; inter-\\nleaved for notes, $1.25 net.\\nA very practical and systematic study of the subjects, and shows the\\nauthor s familiarity with the needs of students. Therapeutic Gazette.", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0211.jp2"}, "212": {"fulltext": "The Nurse s Dictionary\\nof Medical Terms and Nursing Treatment.\\nBy Honnor Morten, author of How to Become a Nurse/\\nSketches of Hospital Life, etc. Containing Definitions of\\nthe Principal Medical and Nursing Terms, Abbreviations, and\\nPhysiological Names, and Descriptions of the Instruments, Drugs,\\nDiseases, Accidents, Treatments, Operations, Foods, Appliances,\\netc. encountered in the ward or the sick-room. i6mo, 140 pages.\\nPrice, Cloth, $1.00 net.\\nThis little volume is intended for use merely as a small refer-\\nence-book which can be consulted at the bedside or in the ward.\\nIt gives sufficient explanation to the nurse to enable her to com-\\nprehend a case until she has leisure to look up larger and fuller\\nworks on the subject.\\nDiet in Sickness and in Health,\\nBy Mrs. Ernest Hart, late Student of the Faculty of Medi-\\ncine of Paris and of the London School of Medicine for Women\\nwith an Introduction by Sir Henry Thompson, F.R.C.S., M.D.,\\nLondon. 220 pages; illustrated. Price, Cloth, 1.50 net.\\nUseful to those who have to nurse, feed, and prescribe for the\\nsick. In each case the accepted causation of the disease and the\\nreasons for the special diet prescribed are briefly described. Med-\\nical men will find the dietaries and recipes practically useful, and\\nlikely to save trouble in directing the dietetic treatment of patients.\\nTemperature Chart.\\nPrepared by D. T. Lain\u00c2\u00a3, M.D. Size 8x 13^ inches. Price,\\nper pad of 25 charts, 50 cents net. _\\nA conveniently arranged chart for recording Temperature, with\\ncolumns for daily amounts of Urinary and Fecal Excretions, Food,\\nRemarks, etc. On the back of each chart is given in full the\\nmethod of Brand in the treatment of Typhoid Fever.\\nIN PREPARATION*\\nAn American Text=Book of Nursing.\\nBy American Teachers. Edited by Roberta M. West, late\\nSuperintendent of Nurses in the Hospital of the University of\\nPennsylvania.\\n8", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0212.jp2"}, "213": {"fulltext": "", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0213.jp2"}, "214": {"fulltext": "9EP 15 1900", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0214.jp2"}, "215": {"fulltext": "", "height": "4910", "width": "3110", "jp2-path": "bacteriologysur00ston_0215.jp2"}, "216": {"fulltext": "I w$:y*", "height": "4926", "width": "3228", "jp2-path": "bacteriologysur00ston_0216.jp2"}}