5j4 general therapeutic measures 



iodine treatment (or dichloramine-T) is the thing. On delicate skin and 

 mucous membranes the dilution of the official tincture with an equal 

 amount of alcohol is indicated. 



It is well for all participating in an operation to wear thin wet, or 

 better, dry sterilized rubber surgical gloves after thorough hand-disinfec- 

 tion — in pus cases, to prevent contamination of the hands; in clean cases, 

 to avoid infection of the wound from the hands. If gloves are not worn 

 in operating upon clean cases, they are all the more useful in dressing 

 or operating upon pus cases to avoid contamination of the hands which 

 later might give rise to wound infection when the naked hands come in 

 contact with a clean wound. Instruments are thoroughly scrubbed with 

 soap and water, and boiled for ten minutes in an aqueous solution of 

 sodium bicarbonate (1 teaspoonful to the quart), and then placed in a 

 solution of carbolic acid (1-40), or removed to a sterile towel. New 

 sponges only should be employed, which have been previously cleansed, 

 and then soaked in carbolic acid (1-40) solution, or pieces of sterile 

 gauze may be used. 



If irrigation is desirable, normal salt solution (1 heaping teaspoon- 

 ful to the quart of sterile water) is appropriate. Nothing else but this 

 is allowable within the non-infected abdominal cavitj^ Sutures of silk, 

 and needles, are prepared by boiling in water for thirty minutes. The 

 area about the operative field is to be surrounded with cloths, or towels, 

 which have been boiled or baked, and instruments and sponges may be 

 laid on these. 



Dressings may consist of gauze which has been exposed for three- 

 hours to dry heat at 140° C. (284° F.), or placed in an oven of an ordi- 

 nary cooking stove, in closed tin cans, until it becomes scorched and 

 slightly brown. The same gauze may be used for sponges. Unsterilized 

 articles are not to be suffered to come in contact with the operator, or 

 wound, during the operation. 



Wound infection from exposure to the air and other media, is pre- 

 vented by immediate dressing and bandaging, or by collodion applications. 



Venesection. 



Venesection, or blood-letting, formerly abused, has, for that reason, 

 fallen into almost complete disuse. This is unfortunate, since blood- 

 letting is a valuable and often life-saving measure. The indications for 

 venesection are chiefly limited to conditions associated with a general 

 high arterial pressure and local engorgement of some organ. 



In such cases venesection very rapidly reduces general blood-tension 

 to a point lower than that existing in the engorged region, so that con- 

 gestion is relieved. A full, incompressible pulse is said to indicate the 

 desirability of venesection in severe acute disorders — in accordance with 

 the above — but this is not by any means invariably the fact, as will be 

 shown. 



Venesection leads to a reduction of temperature, and vascular ten- 

 sion is lowered for from 3 to 48 hours, according to the quantity of blood 

 withdrawn, but the blood vessels quickly adjust themselves to the smaller 

 mass of blood, and the original quantity of this vital fluid is soon restored 



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