Operations lasting for more than a quarter of an hour seldom termi nate favorably.
5. Operations which require much exposure of vita] organs and tissues, even if of short duration, are badly borne. This refers chiefly to a large opening of the abdominal cavity. Intestinal operations, which are practically done extraperitoneally by pulling the intestine through a narrow abdominal incision, are borne well by the youngest infant.
The young child cannot stand a great loss of blood, but a slight loss is more easily overcome.
13. Surgical cleanliness of the hands and of the operating field are requirements that are self-evident.
After mechanically cleansing the hands with sand soap they should be washed with liquid green soap for minutes and dried with a sterile towel. The slap is that removed in one-tenth per rent. solution of benzin iodide not the hands are rinsed with a one per cent. biehloride solution. The hands are dried before the operation and anointed with sterile oil, in order to protect them from fissures and in order to have a separating layer between the hand and the field of operation. Gloves may be put on and direct contact with the wound avoided. In the case of infected wounds, rubber gloves should always be used.
The field of operation is cleansed in the usual way and covered with a biehloride dressing for 12 hairs before operation. This is removed immediately before the operation with a benzin-iodide solution, painted with tincture of iodine, and finally the entire region of operation is covered with a colloid solution.' This resinous layer has considerable advantages. It occludes the skin, the pores of which are difficult to cleanse, and if any germs should still be present or fall upon it, they will be fixed in the colloid layer which contains no nutritive substance, and are at least prevented from multiplying or spreading. Moreover,
the towels placed over it remain upon the skin without slipping off, which is a matter of considerable importance in restless children whose anesthesia is not profound.
The wound and sutures should be painted again with the same col loid mixture after the operation. Stitch abscesses are rare, especially the superficial ones, when this method is adopted. Another advantage is that the bandages cannot be shifted. This is a matter of importance in a child, moreover, as not as many bandages are required.
7. Care should be taken not to let the child grow cold during the operation (see anesthesia).
S. Preparations should be made beforehand for surgical emergencies. The after-treatment is important in these cases. Transfusions and enemas of normal salt solution rapidly raise the blood-pressure which will have sunk in the event of considerable loss of blood. In artificially fed children the milk should be somewhat reduced in composition during the first few (lays, but should be rapidly restored to normal. If breast-fed, the nursing should of course be continued, as this decidedly improves the prognosis.
9. The It:twinges must be arranged to provide for the passage of urine and stools. Small bandages fixed with colloid and adhesive plaster fit more snugly and ran be more easily controlled than thick dressings of wadding and gauze.
With these limitations and precautions the statistics of operations on the child do not show worse results than on the adult. They are fre quently better and there is less danger of relapse.
The advantages incidental to early operation on the infant can be secured by bearing in mind the fact that a child is not a miniature adult, hut a budding, growing organism, embodying many physiological laws of its own, the knowledge of which has to determine the plan of operation.