The operation itself should be performed in a special room which con tains absolutely nothing not essential to the operative procedure. The floors should be constructed of non-absorbent material, asphalted, and with a gentle incline towards one corner or the centre for the purpose of surface drainage. Before every operation the walls and ceiling and floor should be thoroughly washed and the room well-aired. A few hours before the operation the room should be disinfected by chlorine or sul phurous acid fumes, or by the carbolic spray. Hegar recommends in particular the burning of sulphur for the purpose of thorough disinfec tion.
The operating table should be simple in construction, of iron or wood, so that it may be carefully scrubbed and disinfected. It should be cov ered with rubber cloth, which is folded in a large gutter at the anterior end of the table, whereby in operations on the perineum and vagina the blood and fluids are conducted to the floor. Before and after every oper ation this cloth should be well scrubbed with soap and water, and then washed with a 5 per cent. solution of carbolic. Everything in the opera ting room should be as simple, and such articles as curtains, etc., do not belong in it.
In order to assure absolute absence of sources of infection, the room to which the patient is taken after operation should be carefully cleansed and aired, and be as free from dust as possible so as to prevent infection when the dressings are changed.
All the instruments must be absolutely clean, and this we are able to obtain provided we use metal instruments with smoothly polished sur face. We should have at hand, further, only such instruments as we are likely to need, and such is my custom. The handles should be of steel, the wh'ole in one piece, polished and nickel-plated, or if they are thus too heavy, the handles may be of copper plate, nickled, as Thiirriegl has constructed them. Every unevenness, etc., may be a source of infec tion. The cutting instruments should be cleansed with soap and water, placed in 5 per cent. carbolic or in absolute alcohol, and then in a weaker carbolic solution. This prOcess is likely to damage them somewhat, but it cannot be helped. After every major operation every instrument should be sent to the maker for polishing. Blunt bent instruments, hooks, forceps, and scissors should be so articulated as to be readily taken part. Only thus is it possible to thoroughly cleanse the lock. Even the needle-holder I am in the habit of using has no grooved surface. Other
metal instruments, catheters, needles, dilators, can only efficiently be disinfected by means of heat.
Non-metallic instruments, those of hard rubber, and elastic catheters, cannot be subjected to such a process, and infection is very likely to occur through them owing to the great tenacity of the materiel+ morbi. They must be cleansed by means of one of the methods to be referred to, and then placed in carbolic solution. Whenever possible such instru ments should be dispensed with and those of glass or metal used in place of them.
The vessels which hold the solutions should be constructed of porce lain or of glass. Metal basins should be made of one piece, else edges may project and serve as a lodging-place for dirt. Glass and porcelain may be cleansed by means of mineral acids, and metal cannot.
The water used, especially in case of laparotomy, should be boiled, and then diluted by some antiseptic. Sponges should be rejected for ordinary use, and only in laparotomies must they still be endured. Ac cording to Fritsch they may be cleansed only through complicated disin fecting measures, and should then lie for a fortnight in 5 per cent. car bolic, and after each use they should be subjected to the same processes.
Absorbent cotton, carbolized, salicylicized or mineral wool, should be used for cleansing purposes. The towels and compresses must be changed after use. In operations, especially laparotomy and the major plastic, they should be counted and washed separately. Before using, the com presses should be placed in chlorine water, sublimate or carbolic solution, etc. For the dressings gauze, jute, wool, cotton, etc., should be used im pregnated with carbolic, salicylic acid, thymol, iodoform, etc.
An essential question is the suture material. Metal is the most read ily cleansed, and is, therefore, not apt to cause suppuration. It is not suitable for the purpose of ligature, however, for it readily breaks and the tissues are irritated by the broken ends. Surgical silk is suitable both for ligature and for suture, although it must be carefully disinfected. The silk should be wound on glass rods, and boiled for two hours (Czerny, Fritsch) in 5 per cent. carbolic, adding now and then sufficient concentrated acid. The rods are then to be permanently kept in glass jars containing 5 per cent. carbolic, and the silk may be unwound with out removing the rods.