OPERATIONS. The purpose in view in designing operations is very variable and scarcely admits of formulation with any accuracy. They may be planned in case of injuries to close superficial or deep-seated wounds, to stop bleeding, to facili tate the adjustment of broken bones or the re duction of dislocated joints, to remove foreign bodies, or to make disinfection and drainage easier. In inflammations operations may be re quired to evacuate pus, to establish drainage, or to remove inflammatory tissue. In case of tu mors, operations are done for their removal. In deformities, operations may be required to re store the normal contour of the region. In the contemplation of a typical operation to be per formed under average circumstances several fac tors necessarily come up for consideration in detail: (1) The operating room, instruments, dressings. (2) Preparation of the patient. (3) Preparation of the surgeons. (4) The operation. (5) After-treatment.
(1) Time Operating Room.—This should be of good size, well lighted, and of a temperature of between 70° and 80° F. All furniture, car pets, and hangings should be removed, the walls and ceiling rubbed over with moist bread crumbs, and the floor scrubbed. The operating table should be made especially for the purpose. On each side of the table and at its head there should be one or two small tables, those on the operator's side for the instrument trays, those on the assistant's side for the sponges, towels, dressings, etc., and that at the head for the anesthetics, stimulants, etc. On each side of the table there should be a large basin in which the hands of the operator and his assistant may. be rinsed from time to time. The instruments vary with the character of the operation to be performed. They should be made entirely of metal to withstand the heating necessary for sterilization, and as smooth as possible to avoid lodgment for bacteria. They are sterilized im mediately before use by boiling for fifteen min utes in a 1 per cent. solution of sodium carbonate, and are then transferred to trays themselves sterilized by thorough washing in 0.2 per cent. solution of bichloride of mercury and lined by sterile towels. The suture and ligature ma terials are also sterilized, silk by being exposed to steam at about 250° F. for one hour, catgut
by boiling in absolute alcohol under pressure for one hour. Dressings composed of absor bent material (usually cheese-cloth and cot ton) and the pledgetg of gauze with which the wound is kept free from blood during the prog ress of the operation are sterilized by being ex posed to steam at 250° for one hour. The basins, trays, and other receptacles used during operations are sterilized by prolonged submer sion in strong (0:2 per cent.) solutions of corro sive sublimate. The solutions used are 0.1 per cent. bichloride of mercury for the hands and towels; for douching wounds 0.0 per cent. solutions of sodium chloride are employed, ster ilized by being boiled in cotton-plugged flasks for one hour on two occasions.
(2) Preparatitht of the Patient.—Twerty-four hours before operation the skin at the site chosen for incision and for a wide area around it is thoroughly scrubbed and shaven and then covered by a soap poultice. Immediately before the operation the skin is again scrubbed, wiped off with spirits of turpentine, ether, and a 0.1 per cent. solution of corrosive sublimate in alco hol. If local anaesthesia is sufficient it is se cured by the injection into the skin and sub cutaneous tissues of dilute solutions of cocaine. If general arnesthessia is necessary, ether, chloro form, or nitrous oxide may be used, the choice depending upon the duration of the operation and upon the presence or absence of certain physical changes in the heart. blood-vessels, lungs, and kidneys. In any case the necessary restoratives must be at hand.
(3) The Surgeons' Preparations.—The sur geons' preparations consist in sterilization of their hands and forearms and in the assumption of gowns designed to prevent dust from settling from the clothing upon the wound, instruments, etc. Such gowns are of coarse cotton or linen, and extend from the neck to the feet; the sleeves only reach the elbow. They are sterilized by steam before using. The hands and forearms of all persons likely to handle the wound, instru ments, dressings, etc., are thoroughly disinfected and the hands covered by thin rubber gloves previously sterilized by boiling.