THE USE OF ANTISEPTICS.
Here as elsewhere it is requisite to make our procedures as safe as possible, especially when, aside from laparotomy, it is a question of affections which of themselves do not endanger life. It is the physi cian's business to surround his methods with all the safeguards in his power, and fortunately this is in general the customary rule. Certainly, with the modern methods of wound treatment, the responsibility of the physician is increased, and after every mishap it is his duty to determine if he were at fault, and to ask the questions, Where lies the blame? Whence came the infection ? It is not only operations which carry with them the risk of infection: every one of our manipulations, in particular the instrumental, may be the source, and our care should be the greater seeing that our methods of examination, be it by the finger, the sound, or the speculum, must be need in a canal which cannot with certainty be completely disinfected. Seeing that we are not in the position to institute every gynecological examination in a hospital, or at least in the presence of a sufficient num ber of assistants, risks always accompany it which it is our business to reduce as far as possible to the minimum, by paying attention to strin gent cleanliness and by abstaining from every non-requisite manipulation.
At first sight it is surprising that in pre-antiseptic times there were relatively few infectious diseases, and true enough still severe cases of sepsis are rarely met. with after the majority of operations, but very fre quently do slighter degrees of infection, such as pelvic abscess, occur, and for these we must in general bear the blame. The real reason why infection is not of frequent occurrence lies in the fact that the vagina and the uterus are shut off naturally from the external atmosphere, and this is why polypraxis in after-treatment is so frequently followed by un toward results.
Prophylaxis is the basis of the aseptic treatment.
Major gynecological operations, whether bloody or not, require that the patient be placed in bed immediately afterwards. There are no oper
ative procedures which may not be undertaken in an ordinary private dwelling. One or two convenient, light, and airy rooms are requisite, as also experienced nurses, a table, the necessary dressings, disinfection means, the ready accessibility of a physician, these are always obtainable at the expense of time, care, and money. It is further true that the healing process may take place as readily in a private dwelling as in the best hospital, and this alone is sufficient reason why operations should be undertaken at the patient's home. There are numerous disadvantages, however, which render it essential that the majority of operations should be performed in a hospital. Many operations are of such importance that the choice of place for operation is of the greatest consequence, in partic ular in case of laparotomy and the major plastic operations, where the wounded surfaces are in particular prone to infection.
In many hospitals there are separate divisions for the diseases of women, but in a few countries the gynecological and the obstetrical ser vices are conjoined, and this is a dangerous state of affairs. Many of the diseases of women are associated with infectious material, as, for in stance, sloughing carcinoma, sarcoma, fibroma, as also pelvic abscesses and hEematoceles, and it is advisable that such patients should not be treated in the same wards as operative cases. The proper course is not only to separate such cases, but also to have distinct medical and nurse staffs, as is the case in Berlin. In obstetrical services, again, the puerperal dis eases are prolific sources of infection, and it is therefore advisable to fol low llegar's advice and to separate the gynecological cases from the obstetrical, as well as to sharply differentiate the former. In order, fur ther, to obtain as natural healing of wounds as possible, our wards should be far removed from all epidemic and endemic septic sources. Small pavilions, separated from the main hospital, are far preferable to large hospitals, whether public or pnvate.