Vol. XXII. No. 9.] 



POPULAE SCIENCE NEWS. 



141 



ilttliicinc aria pi^armatp. 



[Original in Popular Science iV^ews.] 

 ILLUSTRATIONS OF ANTISEPTIC SURGERY. 



BY JOHN CROWKLL, M.D. 



The application of the antiseptic method to the 

 removal of malignant growths has proved satis- 

 factory, when we consider the dubious prospect of 

 success attending such surgical interference. In 

 new growths of a malignant character, there is 

 reasonable hope of complete removal of the disease; 

 and this is a potent reason for justifying the 

 operation. 



It is a well-known fact in such operations, that 

 the non-return of the malignant growth depends 

 entirely upon the complete extirpation of the dis- 

 eased mass. Of course, reference should be had 

 to the avoidance of danger to the life of the patient 

 by guarding against mechanical injury, and by 

 limiting the hemorrhage to a minimum. Among 

 the mechanical injuries, — the result of bungling 

 or carelessness, — may be mentioned the habit of 

 tearing the tumor from its adhesions in its capsule; 

 rough handling of cysts; plunging sharp retractors 

 into the tumor. These instruments .should be used 

 on the edge of the wound for dilatation, the tumor 

 itself being held with the hand during the entire 

 operation. Lateral tearing and slitting of a large 

 vein is another accident to be guarded against. 

 The rules laid down by Langenbeck must be care- 

 fully observed; and should this unfortunate lesion 

 occur in a vein of the .size and importance of the 

 deep jugular, the method of procedure, as given 

 by Gerster in his recent and valuable work (p. 5.5), 

 is worthy of consideration. 



In performing important amputations of limbs, 

 the antiseptic method should be carefully observed. 

 Every observing and unprejudiced surgeon will 

 admit that, since the adoption of the new process, 

 there has been a remarkable reduction in the rate 

 of mortality following major amputations. When 

 we consider that formerly one-third of all ca.ses 

 were absolutely lo.st through primary Septicfcmiaor 

 pyajmia, or indirectly to secondary hemorrhage 

 due to ulceration, we may well hesitate before we 

 condenm, or even slight, a process that practically 

 prevents death from blood-poisoning or secondary 

 hemorrhage, when the operation has been per- 

 formed under strict antiseptic conditions. Under 

 favorable conditions, and in cases that were not 

 moribund or hopeless, the death-rate does not ex- 

 ceed five per cent by a most careful estimate. In 

 amputations, every stage of the operation must be 

 covered by a-septic precautions. In mildly septic 

 cases, characterized by suppuration, the field of 

 operation should be prepared in the general manner 

 already indicated in a former article. After the 

 patient has been anesthetized, and Esmarch's con- 

 strictor applied, the whole surface of the limb, ex- 

 cepting the field of operation, is wrapped in clean 

 towels, the hands of the operators are finally disin- 

 fected, the irrigator is started, and the operation 

 commenced. By the exercise of a moderate amount 

 of care in the management of details, it is not very 

 difficult in such cases to prevent suppuration, and 

 secure primary union. 



But when the amputation has to be done through 

 ulcerating or suppurating portions of the limb, the 

 surgeon is confronted with a more difficult problem. 

 The precautions taken are more radical, and the 

 skin surrounding the sinus or ulcer must be treated 

 with soap and water, applied with the friction of 

 the brush: the ulcer or sinus must be thoroughly 

 washed with an eight per cent solution of chloride 

 of zinc, and the granulations scraped off with a 

 sharp-edged spoon. In septic cases of still greater 

 intensity, the difficulties encountered are more for- 



midable, and the traumatic lesion must be guarded 

 by the strongest antiseptic; an irrigation, I : 500, 

 to 1 : 1,000, of bichloride being justified. ■ 



In dealing with such filthy masses, the hands 

 coming in contact with the infected tissues must 

 be repeatedly washed in freshly prepared lotions, 

 and every article that has come in contact with the 

 focus of infection must be rejected. 



Amputation wounds of this description require 

 " open treatment," with loose packing and moist 

 dressing, but no sutures. 



In laparotomy, the aseptic method affords a 

 most interesting field of observation to the operator. 

 This department of surgery has been the most un- 

 satisfactory, aid perhaps the least scientific, of all 

 the wide range of surgical interference. Indeed, 

 many authorities have gone so far as to terra ova- 

 riotomy as simple butchery, and not worthy to be 

 dignified as surgery. When we consider the results 

 attending this operation, the risks of diagnosis, 

 the extended complications, and the dangers re- 

 sulting from the exposure of large portions of the 

 abdominal viscera, can we wonder at the unwill- 

 ingness of many surgeons to interfere with these 

 abnormal growths? Is it not strange that the 

 results have been so discouraging? It is more sur- 

 prising that so many victims have survived an 

 ordeal so severe and uncertain. 



Although the aseptic method has materially 

 reduced the dangers of exploratory laparotomy, 

 yet the gi'eatest caution and the wisest conser- 

 vatism should be observed in attempting operations 

 of this character. 



For no surgeon is absolutely sure of his ground. 

 He must work to some extent in the dark. He 

 may be thwarted in his attempts to prevent acci- 

 dental wound infection. lie may encounter the 

 dangers incidental to anaesthesia, and may be sur- 

 prised by those insidious conditions so often found 

 when least expected, — nephritis, thrombosis, and 

 emboli.sm. Exploratory incision is only justified 

 when, in a disorder threatening life, all other means 

 of diagnosis have failed, or when ocular inspec- 

 tion or digital examination can alone estimate the 

 extent and relations of mechanical disturbances. 

 In such cases, due observance of the rules against 

 infection will, with great certainty, exclude sup- 

 purative peritonitis. 



In the operation for the removal of abdominal 

 tumors, the usual preparation of hands, sponges, 

 instruments, and other uten.sils, makes it unneces- 

 sary to apply disinfectant lotions to the abdominal 

 cavity, where, by their corrosive properties, mis- 

 chief may result. Care should be taken against 

 unnecessary exposure of the body, for excessive 

 loss of heat i» a great factor in determining 

 collapse. And this principle of exposure applies 

 equally to the contents of the abdominal cavity; 

 and the greater the incision, the more attention 

 must be given to the protection of the intestines. 

 Hot, flat sponges or warm towels should hide from 

 view every thing except the spot to be operated 

 upon. Special care should be taken against un- 

 due cooling off of the peritonaeum, on account of 

 the collapse that may follow. Authorities differ 

 as to the use of the spray during the operation. 

 Some consider it essential, while others declare it 

 to bo "harmless but unnecessary." The use of 

 spray in general is really an objectionable feature 

 of the original Listerian method, and is abandoned 

 by most operators. De Gerster declares that he 

 has not used the spray apparatus since 1881. In 

 the removal of an abdominal tumor, an ample in- 

 cision is an important condition, in order that the 

 whole of the diseased mass may be easily manipu- 

 lated, especially in the complication of adhesions. 

 Of course, unnece'isarilij long incisions should be 

 avoided, because the exposure of a large peritoneal 



surface to the atmospheric air is attended with 

 risk; but this precaution has given rise to the habit 

 of making the incision too small. The surgeon's 

 discretion will guide him in this direction, and a 

 practised eye is better than any technical rule of 

 the books. The relations of the bladder to the 

 tumor should not be overlooked. Greig Smith 

 objects to emptying the bladder before operation, 

 because a full bladder is not in much danger of 

 receiving injury; and injury to an empty bladder 

 has not unfrequently occurred in the presence of 

 abnormal adhesions. The intervention of a solid 

 male urethral sound is u.seful in ascertaining the 

 extent of the adhesions of the bladder. 



After the removal of the tumor, and the thorough 

 antiseptic washings and cleansings have been care- 

 fully attended to, the abdominal wound should be 

 closed as rapidly as is consistent with thoroughness 

 in the management of the suture. This should 

 combine the elements of simplicity and solidity; a 

 Peaslee's needle being used in bringing together 

 the abdominal walls, including the perinreum, the 

 points of enti'ance and emergence being at least 

 two inches from the edges of the wound. Gerster 

 dnects that a piece of disinfected silver wire, or 

 stout silkworm gut, threaded through the eye of 

 the needle, be used, armed with a quill, or a leaden 

 plate or shot. This is then withdrawn, bringing 

 out the end of the thread from one side of the 

 wound to the other, where it is temporarily secured 

 by an artery forceps. These retentive sutures 

 are used at intervals of about an inch, until the 

 entire length of the incision is covered by them. 

 These are some of the details of an antiseptic 

 method, which, in the hands of several eminent 

 specialists, has shown admirable results, giving to 

 this phase of laparotomy the dignity of a surgical 

 operation. The guarding process cannot be too 

 rigidly enforced, for oftentimes an insidious septi- 

 caemia will vex and surprise the operator, which 

 can be traced to the careless use of sponges by 

 inexpert hands, or by having too mucli interference 

 by superfluous attendants. There is no disgui.sing 

 the ugly fact that many rapidly fatal cases, which 

 have been attributed to the convenient but vague 

 cause of " shock," or " exhaustion," were found 

 upon closer inquiry to be cases of acute septicemia. , 



And so through aJl operative surgery, the new 

 method commends itself as reasonable from a scien- 

 tific basis, clean and safe in its practical process, 

 humane in the desire to save life, and in the line of 

 that evolution which is opening the eyes of the con- 

 servative surgeon, and unfolding new sources of 

 power in every department of scientific investiga- 

 tion. 



[Original in Popular Science News.'] 

 SUCCESSFUL MODERN DENTISTRY. 



BY M. J. GASTON. 



Oculists, aurists, chiropodists, dentists, and 

 other specialists abound, and they are very useful 

 folk, and are each in his way as necessary to repair 

 or adjust the various impaired organs of the human 

 body when injured by disease or age as is the gen- 

 eral practitioner in legitimate medicine. 



No one of the professions mentioned is more 

 lucrative or more useful than the dentist, — he who 

 cares for the primal organs of digestion, to fit them 

 for service if diseased, or, if decay destroy the origi- 

 nals, to furnish substitutes so superior that art sup- 

 plies the lack of the natural organs. 



Classes of graduates leave their Alma Mater year 

 after year, and enter the profession, who become 

 prosperous and wealthy citizens through the prac- 

 tice of this specialty, and who have given their lives 

 to the study of the tooth, and the application and 

 manufacture of artificial teeth when the originals 



