I130-1131. Dilating Contracted Nostrils.
1 132. Adams' Rhinopiastos.
1 133. Juracz's Compression Forceps.
1 134. Screw Wedge.
1 135. Konig-Roser's Mouth Gag.
1136. Heister's Mouth Gag.
1 137. Pitha's Mouth Wedge.
1138-1139. Whitehead's Oral Speculum. 273,
front view when applied; 274, closed
and viewed from above.
1 140. Tillmans's English Speculum.
1141. Bruns's Automatic Mouth Gag.
1 1 42. Tongue Spatula.
1 143. Tiirck's Tongue Spatula.
1144. Tongue Spatula of Glass.
1145. Rose's Operation on the Head hanging
down.
1 146. Tooth Key.
1 147. Lecluse'b Elevator.
1 148. Alveoli of the Upper Jaw. i, 2, incisors.
1 149. Skeleton of the Jaw with exposed teeth.
3, canine tooth; 4, 5, bicuspids; 6, 7,
molars.
1 1 50. Alveoli of the Lower Jaw. 8, wisdom
tooth.
1 15 1. Forceps for Teeth in the Upper Jaw:
(a) right molars, (^b) bicuspids, (c) in-
cisors and canine teeth, (1/) left molars.
1 152. Tooth Forceps for the Lower Jaw:
(«) right molars, (^b) molars on both
sides, (f) left molars.
1 153. L'niversal Forceps.
1 154. Instruments for Extracting Roots of the
Teeth : (<?) straight-root forceps, ((^)
curved, (<r, d) elevators (American),
(if) clawfoot.
1 155. (a) Root Screw; (1^) Roser's bone-cut
ting forceps.
1 156. Uranoplasty in Perforation of the Palate.
1 157. Double Hook, Tenaculum Forceps, and
Tonsillotome.
1 158. Tonsillotomy with Knife and Tenaculum
Forceps.
1 1 59. Circular Tonsillotome, before and after the
Operation.
1 160. Tonsillotomy performed with the Circular
Tonsillotome.
1161. Miculicz's Compressing Instrument for Ar-
resting Hemorrhage after Tonsillotomy.
1 162. External Incisions for Extirpation of the
Tonsil : {a) according to von Langen-
beck, {b) according to Miculicz.
1 1 63. Amputation of the Uvula.
1164-1167. Excision of a Wedge-shaped Portion
from the Tip of the Tongue.
1 164. Applying Silk Ligature.
XXXVl
ILLUSTRATIONS
FIG.
[165. Excision of the Tumor.
[166. Tying the Two Ends of the Thread.
[1 67. Suture.
:i68-ii69. Temporary Constriction of the Whole
Tongue at its Root.
;i70. Temporary Constriction of (3ne Side of the
Tongue.
171. Langenbuch's Temporary Constriction of
the Tongue.
[172-1173. \'on Langenbecl<.'s Temporary Re-
section of the Lower Jaw.
[1 72. Division of the Sliin and the Lower Jaw.
[1 73. Dividmg Floor of the Mouth; the Tongue
is drawn forward.
[1 74. Regnoli-Billroth's Extirpation of Tongue
from the Chin.
:i75. Kocher's Extirpation of Tongue from its
Base.
176. Ranula.
177-1178. Von Bruns's Anatomy of the Region
of the Parotid Gland.
179-1180. De Cuise's Operation for Salivary
Fistula.
[181-1182. Subhyoid Pharyngotomy : (u) an-
terior view, (d) sectional view.
1183. Opening a Retro-pharyngeal Abscess.
[184. Anterior View of Larynx and Trachea.
[185. Tracheotomy.
[186. (rt) Bose's retractor; {/', c, d) sharp
hooks ; (c) Von Langenbeck's double
hook ; (y") Sharp-toothed sliding for-
ceps.
1 187. Liier's Double Canula.
1 188. Wire Hook.
1 189. Instruments for Intubation of Larynx.
1 190. Trendelenburg's Tampon Canula.
1 191. Michael-Hahn's Compressed Sponge Ca-
nula.
1 192. Trendelenburg's Tampon Canula (in situ).
1193. Anatomy of the Region of the Larynx: on
the left, " in situ "; on the right, branches
of arteries.
II94-1195. Phonetic Canula (Artificial Larynx):
(«) according to Gussenbauer, {b) ac-
cording to von Bruns.
II96-I197. Kocher's Strumectomy (Extirpation
of Struma) : («) transverse incision;
{b) angular incision.
FIG.
1 198.
1 199.
1204-
1207.
1208.
1209.
1210.
121 1.
1212-
1216.
1 21 7.
1218.
I2ig.
1220.
1221.
1222.
1223.
1224.
1225.
1226.
1227-
1229.
1230.
1231.
1233-
1234.
Kocher's Director.
Right-sided Struma, showing Ramification
of Superficial Veins (Kocher).
Kocher's Diagram showing Ligation of
Large Veins required in extirpating
Goitre.
Posterior View of Larynx and Trachea with
Neighboring Trunks of Vessels (Course
of Recurrent Nerve).
Recurrent Nerve and Inferior Thyroid
Artery (Wolfler).
Diagram showing Arteries supplying Larynx
and Thyroid Gland.
1206. Scabbard-shaped Compressed Tra-
cheal (Demme).
Konig's Flexible Canula for Tracheotomy
in Goitre.
Stomach Pump.
Introducing (FLsophageal Tube.
Matthieu's Laryngeal Forceps.
Tiemann's Flexible Laryngeal Forceps.
121 5. Laryngeal Forceps.
Weiss's F"ish-bone Forceps.
Coin-catcher and Probang.
Collin's Adjustable Oesophagus Hook.
Elastic Bougies with Olive-shaped Tips.
Trousseau's Probe.
Leyden's Probe with Permanent Tube.
Trelat's (Esophagotome.
Collin's CEsbphagotome.
Kraske's Olive for Retrograde Dilata-
tion.
Lange's Three-edged Knives for Retrograde
Dilatation.
Von Hacker's Drainage Tubes carried over
a Probe and cut off laterally.
1228. External (F^sophagotomy : {a) Open-
ing the (£Sophagus, sheath of vessel is
drawn outward; {b) external incision.
Tenotomy of the Sternocleidomastoid.
Stromeyer's Oblique Extension Board.
Topographical Anatomy of Head and Neck
(Superficial Layer).
Topographical Anatomy of the Neck
(Deeper Layer), Heitzmann.
Lateral Ligature of Vein.
V. A. Branches of the Large Blood Ves-
sels behind the Sternum.
ILLUSTRATIONS
XXXVll
FIG.
1235. External Incisions for Ligating Innominate
Artery : von Langenbeck, Bardenheuer.
1 236- 1 237. Ligation of Internal Mammary Artery :
(«) external incision, (/>) wound.
1238. Resection of a Rib with Metacarpal Saw.
1239. Gluck's Costal Scissors (Costotome).
1240. American Prune Shears.
1241. Anterior View of Thorax. Intercostal Artery
and Internal Mammary Artery are visible.
1242-1243. Kussmaul's Trocar with Stop-cock.
1244. Reybard's Trocar.
1245. Frantzel's Trocar.
1246. Billroth's Trocar.
1247. Dieulafoy's Aspirator.
1248. Potain's Aspirator.
1249. Fiirbringer's Aspirator.
1250. Biilau's Permanent Aspirator.
1 25 1. Schede's Thoracoplasty.
1252. External Incision in Amputation of the
Breast, clearing out the Axilla.
1253. Clearing out the Axilla.
1254. Suture and Drainage after Amputation of
the Breast, clearing out the Axilla.
1255. Puncture of the Abdomen.
1256. Abdominal Supporter after Laparotomy.
1257. Gastrostomy (Suturing Wall of the Stom-
ach).
1258. Food administered to a Patient on whom
Gastrostomy had been performed (accord-
ing to Trendelenburg).
1259. Gastrostomy.
1260. Witzel's Oblique Fistula.
1 261-1263. Kader's Gastrostomy.
1 264- 1 266. Frank's Gastrostomy.
1 267- 1 270. Intestinal Clamps: 1267, Billroth's;
1268, Hahn's; 1269, Rydygier's; 1270,
Wehr and von Heineke's.
1271-1272. Parallel Forceps: 1271, Gussen-
bauer's; 1272, Kiister's.
1273-1274. Billroth-Wolfler's Resection of the
Pylorus.
1273. Incisions.
1274. Suture: (a) occlusion suture, {b) circular
suture.
1275-1276. Rydygier's Resection of the Pylorus:
(rt) incisions, {b) suture.
1277. Resection of Pylorus and Gastro-enteros-
tomy (Billroth).
1 278-1 279. Kocher's Resection of the Pylorus
and Gastro-duodenostomy.
1280. Duodenojejunal Fold; Transverse Colon
and Omentum turned upward.
1281-1282. Gastro-enterostomy : («) incisions;
((^) coronary artery.
1 28 1. Wolfler's Method.
1282. Socin's Method.
1283. Von Hacker's Gastro-enterostomy.
1284-1286. Diagram of Gastro-enterostomy.
1 287-1 288. Wolfler's Gastro-enterostomy.
1289. Liicke's Gastro-enterostomy.
1290-1292. Kocher's Gastro-enterostomy: («)
incisions; (^h) suture.
1293-1295. Doyen's Gastro-enterostomy.
1 296-1 297. Von Heineke's Pyloroplasty (Dia-
gram of Suture).
1298. Gastroplasty: in Hour-glass Contraction of
the Stomach.
1299. Gastroanastomosis : in Hour-glass Con-
traction of the Stomach.
1300-1301. Inguinal Colostomy.
1300. Suturing Intestine.
1301. Method of applying Suture (Sectional
View).
1302-1303. Inguinal Colostomy.
(i) Intestinal loop drawn forward.
(2) Divided completely.
(«) proximal end, (1^) distal end.
1 304- 1 306. Von Esmarch's Needle Case for Intes-
tinal Suture.
1307-1309. Enterorrhaphy.
1307. Lembert's Method, (a) Interrupted Suture.
1308. (/'). Continuous Suture.
1309. Cushing's Method, (.r) Quilt Suture.
1310-1311. Diagram of Enterorrhaphy.
1 3 10. Lembert's Method.
131 1. Czerny's Method.
1312-1313. Wolfler's Internal Enterorrhaphy.
1314. Neuber's Decalcified Bone Tube.
1 31 5. Brokaw's Catgut Ring.
1316. Jobert's Enterorrhaphy (Invagination).
131 7-1320. Murphy's Intestinal Button.
1321-1322. Kocher's Method of detaching Mes-
entery.
(rt) cuneiform excision.
{b) Applying suture and forming longitu-
dinal fold.
XXXVlll
ILLUSTRATIONS
1323. Senn's Entero-anastomosis : (a) decalcified
boneplate, {l>) introducing plates, (c)
suture; bone plates in position.
1 324- 1 329. Various Methods of Local Enterec-
tomy (von Eiselsberg). 1347-
1324-1327. Exclusion of an Iliocffical Section; 1348.
in the caecum exists an abdominal fistula. 1349.
1325, 1328. Exclusion and Circular Suture of a 1350-
Section of the Small Intestine, firmly Adhe-
rent to Sigmoid Flexure. I350-
1329. Total Exclusion of an Ilioccecal Section. 1352.
1330. Csecal Incision. 1353-
1331. Dupuytren-Blasius's Intestinal Clamps. I354-
1332. Anus prjEternaturalis : (a) intestinal clamp
applied ; (i) sectional view of spur ; 1355-
(c) after operation.
1333-1334. Von Bergmann's Double Rubber Ball. 1358-
1335. German Truss.
1336-1337. German Truss applied. 1361.
1336. Truss for Inguinal Hernia.
1337. Truss for Femoral Hernia. 1362-
1338. Truss with Glycerine Pad. 1362.
1 336- 1 340. English Truss. 1363.
1341-1343. Umbilical Trusses.
1344. Anatomy of the Inguinal Region: 1364.
Femoral vessels and epigastric artery; 1365.
external orifice of inguinal canal and 1366.
spermatic cord. 1367-
The femoral fascia and saphenous open-
ing (.fo), through which the saphen- 1368.
ous vein passes to join femoral vein. 1369.
1345. Anatomy of the Inguinal Region (Internal
Abdominal Side). B. bladder; P. Pou- 1370.
part's ligament ; G. Gimbernat's liga- 1371.
ment ; Oi. internal orifice of inguinal 1372.
canal ; A. V. femoral artery and vein ;
Ae. epigastric artery ; Ao. obturator \ 1373-
artery (taking its origin at the left ab- |
normally from the epigastric artery);
F5. spermatic vessels; ^'rz. vas deferens : 1373.
I, middle hypogastric fold ; 2, hypo- 1374.
gastric fold ; 3, epigastric fold. 1375-
Between l and 2 lies the internal inguinal
fossa ; between 2 and 3 the middle in- 1376.
guinal fossa; exteriorly to 3 the external
inguinal fossa.
1346. Frontal Section of the Crural Arch. 1377-
A^. crural nerve; A.V. femoral artery and 1380.
vein ; Ac. crural ring (place of exit of
femoral hernias-crural septum); G. (V\m-
bernat's ligament; P. Poupart's ligament;
7\ pubic spine.
Herniotomy (External incision).
Hernia Knives (Herniotomes).
Herniotomy (Relieving strangulation).
1353. Macewen's Radical Operation for In-
guinal Hernia.
External Incision.
Suturing the Hernial Sac.
Suturing Inguinal Canal.
Macewen's Radical Operation for Congeni-
tal Inguinal Hernia.
1357. Bassini's Radical Operation for In-
guinal Hernia.
1360. Kocher's Radical Operation for In-
guinal Hernia.
Anatomy of the Lower Surface of the Liver
(according to Henle).
1363. Nephrotomy.
Transverse Lumbar Incision.
Lateral Lumbar Incisions. I, according to
von Bergmann ; 2, according to Konig.
Simon's Position for Exposing Kidney.
Lange's Position for Exposing Kidney.
Topography of Renal Region. R, Kidney.
Horizontal Section of the Left Renal
Region.
Thiersch's Ivory Spindle.
(a) Lange's Forceps; (/') Thiersch's Spindle
for applying Ligatures in Deep ^^'ounds.
Male Urethra (Home's Wax Cast).
Triangular Ligament.
Triangular Ligament; M. Levator ani;
M. Perinei prof, according to Luschka.
1374. Musculus Compressor; Urethroe with-
in the Urogenital Diaphragm (Henle)
according to Maclise.
Lateral View.
Internal View.
Metallic Catheters, {n) common; (/') end-
ing in two tubes at the handle.
Prostatic Catheters, {a) strongly curved;
{b) with simple inflexion; {c) or double
inflexion according to Mercier.
1379. Various Modes of Catheterization.
Catheterization in the Female.
ILLUSTRATIONS
XXXIX
FIG.
1381. Flexible Catheters: (a) common, cone-
shaped or probe-pointed; (l>) inflexed,
according to Mercier.
1382. Clove Hitch.
1383-1384. Dittel's Method of fastening Reten-
tion Catheter.
1385. Otis's Scale for Urethral Instruments.
1386. Olive -pointed Bougies according to Otis.
1387. Urethrometer : («) open; (/?) closed;
(c) rubber cover.
1388. Filiform Bougies.
1389. Bougies: (i) probe-pointed; (2) with
conical end; (3) with common point.
1390. Catgut Strings with Curved Ends, according
to Leroy d'Etiolles.
1 39 1. Introducing Bougie into Stricture of Eccen-
tric Location.
1392. Otis's Endoscope.
1393. Endoscope filled with Catgut Strings (see
also Fig. 1391,^/).
1394. Holt's Divulsor.
1395. Oberlander's Dilator.
1396-1397. Maisonneuve's Urethrotome : Civiale's.
1398. Otis's Dilating Urethrotome: (a) little
knife.
1399. Syme's Guide Staff.
1400. Wooden Yoke for Lithotomy Position.
1401. Lithotoiny Position.
1402. Anatomy of External Urethrotomy.
1403. Diagram of External Urethrotomy :
(a) transverse section; (/;) longitudinal
section; U, urethra; P, perineum.
1404. Dieffenbach's Urethroplasty.
1405. Nelaton's Urethroplasty.
1406. Von Esmarch's Urethroplasty with Under-
lining : (a) circumscribing with the knife
margins of fistula; (/.) turning margins
inward; (c) suture; (</) suturing ap-
proximated margins of skin with inter-
rupted and quilt sutures. The four lower
illustrations show their sectional view.
1407. Thompson's Urethral Forceps.
1408. Matthieu's Urethral Forceps (Alligator).
1409. Collin's Catheter Catcher.
1410. Nelaton's Lithotrite (for the Urethra).
141 1. Fleurant's Trocar for Puncture of Bladder:
(a) stylet; {d) external canula; (c) in-
ternal canula; ((/) plug.
FIG.
1412. Colpeurynter : (c) folded together ; (6) in-
flated by air.
1413-1414. Sectional Views of Pelvis.
1413. Bladder filled.
1414. Bladder and Rectum filled : (a) position of
the peritoneal fold (according to Fehl-
eisen).
141 5. Operating Table with Trendelenburg's Po-
sition.
14 1 6. Trendelenburg's Position.
141 7. Suprapubic Lithotomy. Bardenheuer's Ex-
ternal Incision.
Suturing the Bladder to the Wound of
the Skin: (a) seen from above; (^) sec-
tional view.
1418. Lithotomy Forceps.
1419. Spoon-shaped Forceps.
1420. Removing Stone with Extended Forefingers.
1421. Trendelenburg's Drainage Tube.
1422. Lithotomy Forceps.
1423. Luer's Lithotrite.
1424. Simon's Dilator for the Female Urethra.
1425. Thompson's Forceps for Tumors of the
Bladder.
1426. Watson's Hard Rubber Drainage Tube for
Hypertrophy of Prostate.
1427-1428. Zuckerkandl's Prerectal Incision.
1427. External Incision.
1428. Cavity of the Wound.
1429-1430. Kocher's Prerectal Pointed Arch In-
cision.
1429. External Incision.
1430. Cavity of the Wound.
1431. Beak of Prostatic Incisor.
1432. Civiale's Lithotriptor.
1433. Bigelow's Lithotriptor.
1434. Otis's Evacuator for Litholapaxy.
1435. Receptacle for Urine.
1436-1438. Wood's Cystoplasty.
1436. Forming Flaps.
1437. Suturing Lateral Flaps over Inverted Middle
Flap.
1438. Healing of Wound.
1439. Portable Urinal applied after Cystoplasty.
1440. Forming Glans Portion of Urethra.
1441-1443. Closure of Penile Portion of Gutter.
1442. Closure of Open Slit between Glans and
Penis.
xl
ILLUSTRATIONS
FIG.
1444. Closure of Funnel.
1445-1446. Rosenberger's Operation for Epi-
spadias.
1 44 7- 1 448. Operation for Phimosis (Roser's Dor-
sal Incision).
1449. Operation for Phimosis by suturing trans-
versely Two Lateral Incisions (von Es-
march).
1450-1451. Reduction of Prepuce (Taxis) in
Paraphimosis.
1452. Incising Strangulating Ring.
1453. Amputation of Penis.
1454. Wound Surface.
1455. Suture.
1456. High Amputation of the Penis. Division
of the Scrotum.
1457. Puncture for Hydrocele of the Tunica
Vaginalis.
1458. Von Volkmann's Incision for Hydrocele.
1459. Operation for Varicocele.
1460-1461. Castration: (a) external incision;
(/') ligation of the spermatic cord.
Vcf. vas deferens.
1462. Anatomy of Pelvic Organs.
1463. Fergusson's Rectal Speculum.
1464. Allingham's Rectal Speculum.
1465. Sims's Speculum.
1466. Simon's Speculum.
1467. Forcible Dilatation of Anus.
1468-1469. Proctoplasty.
1468. Fixing Blind Sac in the Wound.
1469. Opening 151ind Sac; tying Sutures.
1470. Bushe's Olive-pointed Rectal Bougie.
1471. Class Bougie.
1472. I'lstula Ani : (a) external incomplete fis-
tula; (/') internal incomplete fistula;
((â– ) complete tistula.
1473. Probe for Rectal Fistula.
1474-1475. Operation for Rectal Fistula.
1476. Tube for I)ressing in Rectal Fistula.
1477. Allingham's Probe and Scissors for dividing
Rectal Fistula.
1478. Division of an Incomplete Rectal Fistula.
1479. Rectal Supporter.
1480. Tenaculum Forceps for Hemorrhoids:
(a) Smith's clamps; (/') Curling's;
(<â– ) Hahn's; (</) Luer's.
1481. Allingham's Hemorrhoidal Scissors.
1482. Extirpation of a Hemorrhoid.
1483. Von Langenbeck's Hemorrhoidal Clamps.
1484. Resection of the Sacrum. (11) Kraske's
Method; {a — d') Bardenheuer's method;
(f) von Volkmann-Rose's method.
1485. Position for Sacral Operations.
1486-1493. Resection of the Sacrum.
1494-1495. Perineal Extirpation of Rectum.
1494. Zuckerkandl's Method.
1495. Von' Hueter's Method.
1496-1497. Zuckerkandl's Parasacral Incision.
SURGICAL TECHNIC
SURGICAL TECHNIC
THE TREATMENT OF WOUNDS
The scope of this branch of surgery is to keep off all injurious influences
that disturb the healing.
These deleterious influences are : —
1. Every infection of the wound through micro-organisms, since they
decompose the secretions of the wound and produce wound-fever, inflamma-
tion, suppuration, and all traumatic diseases incident to wounds.
In fresh wounds, infection is prcvejited by the utmost cleanliness (asepsis),
and is overcome in already unclean (infected) wounds by destroying the
germs of infection existing in them (antisepsis).
2. The collection and retention of blood or lymph in the wound {reten-
tion of the secretions of the luoiind), since they force apart the margins of
the wound and favor the development of any germs of infection that may be
present.
These noxious influences are prevented by carefully arresting hemor-
rhage, by perfectly draijiing the secretions of the wound (by desiccating the
wound), by avoiding dead spaces in the interior of the wound, and by prac-
tically applying good absorbent dressings (compressive bandages).
3. The gaping of the wonnd, because it prevents the healing by primary
intention.
This is guarded against by a timely and exact nnion of the surfaces and
the margins of the wound (suturing of the wound;.
4. Every disturbance of the wound (movement, unnecessary handling,
examination, squeezing), because it disturbs the healing and promotes the
setting in of hemorrhage and inflammation.
The means of protection against these occurrences are : —
A copious dressing for the wound, the secure fastening of the dressings
(protective dressings), the changing of the same as rarely as possible (per-
manent dressings), rest of the injured portion of the body (by suitable
2 SURGICAL TECHNIC
position, by bandages, splints, fixed dressings, protectors, etc.), constant
rest in bed in cases of serious wounds, etc. " Optimum remediiim qiiies
est'' (Celsus) (The best remedy is rest).
5. Every obstnietion of the circulation of blood and lymph (stasis) which
produces an increased flow of the wound secretions, even gangrene.
This is obviated by elevation of the injured parts and by avoiding all
strangulation caused by clothing or dressings.
6. The subsequent infection by change of dressings.
This is prevented by changing the dressings as rarely as possible, and by
applying aseptic dressings under strictly aseptic precautions.
7. Inflammation of the injured parts, and its consequences.
This is combated by antiphlogistic treatment, which tends to check
inflammation by rest, elevated position, reducing the temperature, and, in
inflammation of the joints, by distraction of the articular ends by extension.
ASEPSIS
Asepsis purposes to prevent infection of the wound by excluding or by
destroying all pathogenic micro-organisms before they come in contact
with it.
Since they are present everyzvJiere, infection might take place through
the air (air-infection) and through the objects that come in contact with the
wound (hands, instruments, water, dressings) (contact-infection).
The prevention of wound-infection through the most painstaking cleanli-
ness and disinfection constitutes the principal object in the following
chapter.
PREPARATIONS FOR ASEPTIC OPERATIONS AND DRESSINGS
PURIFYING THE OPERATING ROOM
ZzV/i'r believed the bacteria floating in the air could be destroyed by an
atomized spray of antiseptic fluids (3^; carbolic solution). During the
operation and the dressing, he had a carbolic spray — created by means of
an atomicer — directed upon the wound and upon the hands of the surgeon.
He used either a small atomizer, operated by hand (Fig. i), or a larger one,
operated by steam.
If the carbolic spray had to be discontinued for some reason during the
operation, Zw/^r tried to protect the wound from the influence of the air by
temporarily covering it with carbolized gauze.
THE TREATMENT OF WOUNDS
The experience of many surgeons, however, has proved that, even with-
out using the spray, wounds often heal very satisfactorily ; hence, the car-
bolic spray, so greatly obnoxious to all who participate in the operation, may
be dispensed with. It is now hardly ever used during an operation, though
occasionally before an operation. The use of the spray is, however, no
longer necessary, since we know that in still air micro-organisms are gradu-
ally precipitated to the floor, thus leaving the air purified. For this reason,
for some time before the operation, care must be taken not to stir up the
dust by cleaning and arranging the room ; the necessary disinfection should
be made on the day before the operation, and, in the meantime, no one
should enter the room. The settled dust, however, may be removed slowly
with a moist cloth.
In modern institutions, operating rooms are all
arranged with a view to obtaining safe and easy
disinfection. The walls are painted in oil, the floor
is covered with waterproof material (terrazo, mar-
ble, mosaic, tiles), all unnecessary decorations,
corners, and niches are done away with. Disin-
fection before and after each operating session can
be easily obtained by thoroughly ivasJiing the rooms
zvith soap. 2ind water (irrigating walls and ceiling).
But if the operation has to be performed in
an ordinary room (in the house of the patient),
all unnecessary fur-
niture and all "dust
catchers ' ' (curtains,
carpets, uphol-
stered furniture)
are removed. The
floor is thoroughly
scrubbed, old wall papers are rubbed down with bread (E. von Esmarch),
and the room is locked up until the operation, which is to take place about
lo or 12 hours afterward. Strongly infected rooms may be disinfected as
follows: The doors and windows are closed as securely as possible, and a
few sticks of sjclphur are burned. Disinfection by means of sulphurous acid
is thus created. (Formalin gas is more reliable.)
During the operation, the room should be warm {66° to 'j'j° Fhr.).
The utensils used during the operation (tables, chairs, vessels) must be
free from unnecessary decorations ; they should be made of such material
Fig. I. Atomizer for Carbolated Spray
SURGICAL TECHNIC
that they can without injury be cleansed by thorough soaping with potash
soap, soda, and water — which should be as hot as possible; otherwise, they
must be sterilized in a larger disinfection apparatus by means of a jet of
steam. The most practical utensils are made of iron and glass (e.g: Figs. 2
and 3), and are constructed as
simply as possible.
The operating tabic, likewise,
consists preferably of the same
material, or of enamelled sheet-
iron (Fig. 4). Considerably
cheaper for practising physi-
cians, however, is a strong,
plain wooden table, with an ar-
rangement for elevating the head