ENTEROTOMY AND ENTERECTOMY 403 



especially upon and about the surgical field, should be sub- 

 mitted to a cleansing process of exceptional thoroughness; 

 the antiseptic solutions should be made of sterile water and 

 contained in clean white-enameled basins; the sponges or 

 cotton pledgets used for bailing must under no circumstances 

 be of doubtful purity; the instruments and needles must be 

 well boiled; and finally the asepsis of the sutures must be 

 absolute. 



While operating, all parts of the body except the sur- 

 gical field are kept well covered with sterilized cloth (towels) 

 to prevent the exposed viscera from resting upon unclean 

 parts, and especially to prevent them from becoming con- 

 taminated with shedding hairs which are always legion at 

 best. 



The wearing of rubber gloves, while not absolutely nec- 

 essary, is helpful in preventing infection, and in view of the 

 fact that the surgeon must generally occupy himself with 

 the task of handling, securing, and cleaning up the patient 

 just before the operation, the omission of gloves seems sin- 

 ful when much depends upon a successful result. 



Strong antiseptics are uncalled for, except possibly to 

 rinse the skin after it has been clipped, shaved and washed ; 

 elsewhere asepsis, and not antisepsis, is depended upon. 



TECHNIQUE.— First Step.— Laparotomy.— The ab- 

 dominal incision made for intestinal operations upon small 

 animals need not vary as to position under any circumstance. 

 It can be uniformly located across the umbilicus parallel to 

 the linea alba, from which position every abdominal organ 

 can be either inspected or palpated fruitfully. The incision 

 may vary in length according to the size of the patient or 

 nature of the lesion. An incision one and a half to two and 

 a half inches long is generally ample, and it should be located 

 so that five-eighths of its length overlaps the umbilicus an- 

 teriorly. By thus extending the incision well forward perfect 

 access is gained to all of the abdominal organs, from the 

 diaphragm to the pelvis. 



The incision is made a little to one side of the linea alba, 

 where the tissues are better nourished. The skin is first in- 

 cised by one carefully drawn stroke, then the underlying 

 muscles are divided down to the peritoneum, which is incised 

 either with a probe-pointed bistoury, cutting outward, or 

 else with the scalpel protected with a grooved director. 

 When the patient has been dieted there is little danger of 

 accidentally cutting an intestine, but often in diseased con- 

 ditions requiring operative intervention the intra-abdominal 



