قراءة كتاب Surgery, with Special Reference to Podiatry

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Surgery, with Special Reference to Podiatry

Surgery, with Special Reference to Podiatry

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دار النشر: Project Gutenberg
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germicidal or antiseptic substances are brought into contact with the wound, sterilized salt solution or plain sterilized water being used, if necessary, to flush the wound, the dressings employed having been sterilized by dry heat or moist heat.

Sterilization of the Hands. Experimental investigation has shown that the failure of the surgeon’s efforts to render his hands absolutely aseptic, has been the productive cause of infection in many wounds.

The hands and finger nails may be best sterilized by first rubbing them with spirits of turpentine; then scrubbing them with soap and water; and then using a sterilized nail brush freely. The scrubbing should be done for several minutes. The hands should then be rinsed to remove the soap, and then soaked for about ten minutes in a solution of bichloride, strength, 1 to 2500. If turpentine has not been used before washing with the soap, strong alcohol or ether should be well rubbed over the hands before they are immersed in the bichloride solution. Perhaps the best way of rendering the hands sterile is to scrub them with green soap and water, then mix a tablespoonful of commercial chloride of lime and half a tablespoonful of carbonate of soda with enough water to make a paste. When this has assumed a thick creamy consistency, it should be rubbed into the hands until the grains of lime disappear and the skin feels cool; then rinse the hands in sterile water.

Sterilization of Instruments. Instruments may be sterilized by boiling them for fifteen minutes in water in which a tablespoonful of washing soda has been added for each quart. This prevents rusting of the instruments and also makes the water a better solvent for any fatty matter which may be upon the instruments, thus increasing the sterilizing effect of the heat.

Sterilization of the Feet. As most patients do not apply water as freely or as frequently to the feet as to other portions of the body, there is usually present an excessive amount of thickened epidermis, which is very difficult to render sterile. For operations in chiropody the feet should be thoroughly moistened with soap and water, scrubbed vigorously with a brush, then soaked in a solution of bichloride of mercury of 1 to 1000 strength, and then wrapped up in a towel soaked in the same solution while waiting for the operator.

AGENTS EMPLOYED TO SECURE ASEPSIS

Bichloride of Mercury is used for the disinfection of the hands and skin and for the irrigation of wounds. Biniodid of mercury is extensively employed and in the same strengths as the bichloride. It is, however, a more powerful germicide, while being less irritative, and neither forms a mercuric albuminate nor tarnishes metal instruments.

Carbolic Acid. This acid is derived from coal tar, and although known as early as 1834 as the first antiseptic recommended and used by Lister, is not so popular since the discovery that bichloride of mercury possesses more germicidal action.

Gangrene of the skin and subjacent tissues has often been traced to the long continued use of dilute solutions of carbolic acid or of ointments containing small quantities of the drug. Gangrene of the fingers and toes is by no means infrequent as a consequence of its use. Another condition frequently seen is the systemic poisoning through absorption. One of the first symptoms noticed from such absorption is irritation of the urinary tract and carboluria. This poisoning is more apt to take place when the weaker solutions are used than when the pure acid is used, as the destruction produced by the pure acid prevents its absorption.

The effect of carbolic acid upon the urine (See Chapter II, “Carbolic Acid”) is to cause it to become smoky a short time after it is voided. The urine shows a complete absence or diminution of the sulphates, and albumin is generally present. When these symptoms present themselves, the use of carbolic acid should be withdrawn, and the administration of sulphate of soda and atropin begun. If the condition has existed for any length of time and the patient is weak and exhausted, stimulants are indicated.

Lysol is a saponified phenol, and possesses some germicidal power. It is used in strengths of 1 to 3 per cent. solutions.

Creolin is mildly germicidal and is used a great deal in from 2 to 4 per cent. solutions.

Both lysol and creolin act very much like carbolic acid, but neither possess its irritating qualities.

Formaldehyde Gas is an active germicide and very valuable as a disinfectant. It is used in the shape of formalin which is a 4 per cent. solution of the gas in water. This agent is very irritating to the normal tissues in the stronger solution, but a 2 per cent. solution of formalin may be used for the sterilization of the hands, instruments, etc.

The formaldehyde fumes are employed for the disinfection of clothing, rooms, bedding, and also for the sterilization of catheters. The fumes of the gas are very irritating to the mucous membrane and when this agent is used for the disinfection of rooms, every crevice and crack must be tightly sealed to prevent the escape of the gas.

Iodoform. The action of iodoform is not due directly to its ability to destroy germs but to its undergoing decomposition in the presence of moisture, liberating iodin and thus rendering inert ptomains that have resulted from the growth.

Iodoform Powder is rapidly absorbed by the skin and fatal cases of iodoform poisoning have occurred from treating burns with it. Iodoform is also used in ointment form and in suppositories. As it is insoluble in water it is commonly used in a 10 per cent. emulsion. The gauze is also greatly used.

The symptoms of iodoform poisoning are: delirium; odor of iodoform on the breath; presence of iodoform in the urine; eruption over the skin, and finally, coma. Iodoform is also capable of producing a localized dermatitis, with great irritation, and must therefore be used with care on all delicate skins.

Aristol, a substitute for iodoform, is a compound of iodin and thymol, producing no toxic effects and having no disagreeable odor; it does not, however, possess the germicidal qualities of iodoform. Nosophen, iodol, and airol are among the more recent substitutes.

Iodin. This drug no doubt possesses more germicidal properties than was at one time supposed. It is probably the most powerful antipyogenic known. The 7 per cent. tincture is the one most frequently used.

Acetate of Aluminum, or more properly, aluminium, is prepared by adding five parts of sugar of lead to a solution of five parts of alum in 500 parts of distilled water. Burow’s solution, see page 35, is chiefly employed as a wet dressing.

Chloride of Zinc in a solution of 15 to 30 grains to the ounce, has marked antiseptic properties, but it blanches the tissues when applied to infected wounds.

Sulphocarbonate of Zinc is less irritating than the chloride of zinc and is of the same value as a germicide.

Peroxide of Hydrogen when used as a 15 volume mixture or diluted, seems to have a direct action upon pus generation by destroying microorganisms of the pus. It is frequently employed for sterilizing abscess cavities, and for hastening the separation of necrotic tissue.

This agent has also a marked hemostatic power and is used to some extent on this account in nose and throat work. Its hemostatic power is also observed in bone cavities. Care should be taken never to use it unless there is a free exit, as it increases rapidly in volume after coming in contact with dead tissue or pus, and serious accidents have happened from its improper use; for instance, if it is injected into an abdominal sinus where

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