DISINFECTION OF INSTRUMENTS. 8i 



impossible to render the hands absolutely sterile for forty-eight hours. 

 The surgeon should bear this in mind when operating in regions like 

 the peritoneal cavity, and in performing laparotomy, ovariotomy, or 

 cryptorchid operations. He should either defer operation for some 

 days or redouble his precautions ; neglect in this respect explains 

 failure where apparently all the conditions for success have been 

 present. The nails should first be cut short, and all foreign material 

 mechanically removed from under and around them. The hands and 

 forearms should next be washed for some minutes with soap and warm 

 water, and scrubbed thoroughly with a brush or a Turkish flesh glove. 

 They are then washed with rectified spirit, a-nd lastly with i in looo 

 solution of sublimate. The alcohol dissolves fatty materials which 

 would otherwise impede the action of the antiseptic, and enables the 

 latter to penetrate some distance into sebaceous ducts, etc. More 

 complex methods have been suggested, but the above is sufficient. In 

 veterinary surger\' the precautions usually taken only extend to 

 thoroughly cleansing nails, washing the hands with hot water and 

 soap, and thoroughly rubbing them for some minutes with i in lOOO 

 sublimate solution or 3 per cent, solution of creolin. The hands must 

 be rendered aseptic and kept aseptic throughout the operation. For 

 this reason the operator should avoid touching the skin surrounding 

 the point of operation, the table, the straw or any object which has 

 not been disinfected. ^Even when nothing suspicious has been touched, 

 it is well during operation to plunge the hands from time to time in a 

 disinfectant; should the hands actually have been soiled, they must 

 immediately be cleansed again. The precaution must be rigorously 

 observed during operations in the peritoneal cavity, where an act of 

 forgetfulness may entail the patient's death. During operation the 

 surgeon and all his immediate assistants should wear linen operating 

 coats which can readily be washed. 



Disinfection of Instruments. — The handles of modern instru- 

 ments are generally made of German silver, nickel, or aluminium. 

 They should present no unnecessary ornamentation, depressions, 

 grooves, corrugations, or spots likeh' to hold dirt. Instruments like 

 scissors, forceps, etc., should be capable of disarticulation for cleansing 

 purposes, and complicated instruments difficult to clean should be dis- 

 carded. Wherever possible instruments should be in one piece, like 

 the retractors in Figs. 75, 76, and "]"] ; for more complicated instruments 

 the French joint, as shown in the lion forceps, Figs. 78 and 79, is the 

 best. For sutures, Larger's or Mooij's needles are preferable to 

 others, being simple and readily sterilised. For syringes with pistons 

 one can often substitute a simple glass tube carrying a rubber ball, the 



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