From the beginning of this preparatory treatment, the patient must be clothed in clean, fresh garments, and remain only in clean localities.
The use of the spray during the operations is generally, from their site, impracticable. Only in case of laparotomies and of operations on the perineum is it feasible. Even in these cases, however, the majority of operators have dispensed with it, although such authorities as Spencer Wells and Keith still favor it. With the majority I believe it theoretically correct not to disturb the atmosphere during an operation. In case all the essential aseptic rules have been enforced, we may well dispense with the spray, and this is an advantage, in particular, to those operators who wear spectacles. Still for one to two hours before the operation the room should be kept filled with 5 per cent. carbolic spray, but this step should never cause us to dispense with the slightest aseptic procedure.
In case of the major operations on the perineum and in the vaginal canal Schroder recommends highly permanent irrigation—that is to say, the field of operation is kept covered by a stream of weak disinfecting solution by means of an irrigator. Since the vagina has been thoroughly disinfected, however, I do not deem permanent irrigation essential, and I content myself with frequent douching of the field of operation, for by this means we can better cleanse the surface than by a slow permanent stream, and it must be slow else it will interfere with the vision of the operator.
There are many agents which may be utilized for disinfectants. To say nothing of those not generally used, menthol (MacDonald), naphthalin (Anschfitz, Fischer), sub-nitrate of bismuth (Kocher), the most valuable are carbolic acid, salicylic acid, thymol, chlorine water, permanganate of potass, zinc chloride, sublimate, iodoform.
The uses of carbolic are generally recognized. It forms the basis of Lister's method. For purposes of injections it is used in the strength of 1 to 2 per cent., for washing the hands and instruments 5 per cent., as also for the disinfection of silk, sponges, and utensils in general. Its long-continued use is destructive to the epithelium and the epidermis, and may cause toxic symptoms. Its effect on micro-organisms is further inferior to those of other agents, and it is not at present, therefore, so extensively used. When mixed with fat to form the carbolized oil its
disinfecting properties, as Koch has shown, are slighter. The mixture with vaseline (10 per cent.) is preferable. Anointing the finger with fat simply renders it slippery. The finger should be carefully disinfected beforehand.
Salicylic acid as a disinfecting agent is frequently used in dressings, or a solution may be made, as Fritsch recommends, by dissolving gr. 45 in a little alcohol and adding this to a quart of water.
Thymol is favored particularly by C. Braun, and is used in 1 per cent. solution for irrigation and for disinfection of the hands and instruments, and he prefers it to carbolic in that it does not give rise to eczema.
Zinc chloride is used by Kocher in .2 per cent. solution for irrigation, and in 1 per cent. solution for disinfecting septic wounds.
Permanganate of potass in 1 per cent. solution is an excellent disin fectant, since it gives up its oxygen for oxydizing organic bodies The change in the color, as long as this lasts, proves that oxydation is taking place. Dilute and mineral acid will remove the brown stain caused by the agent.
A valuable antiseptic agent, long used as a deodorant, is chlorine water, which Hegar and Kaltenbach recommend. The difficulty of trans porting it and its unpleasant odor are in the way of its general acceptance. I have used it in many unfavorable cases.
In 1881 Koch proved the destructive power of sublimate on micro organisms. Weak solutions (.1 per cent.) are sufficient to destroy them. Toporski, Brose, Kehrer, Kaltenbach, Hegar, Schatz, and others, at once introduced it into gynecology, and the general opinion is that it is superior to all other agents. Solutions of 1 to .2 per cent. are used for disinfecting the hands, and of 1 to .2 per cent. for purposes of irrigation. It cannot be used to disinfect metal instruments, however, not that it quickly destroys them, but the solution loses its strength and its virtue, seeing that the mercury is deposited on the metal. Only glass and porcelain vessels can be used with it, and the injection tubes must be of glass.