Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
In the modern aseptic operating room germicides and antiseptics do not
play so important a part as they formerly did. This is largely due to
the fact that heat is used wherever possible in the preparation of
sutures, ligatures, dressings and instruments, and to the farther fact
that in uninfected tissues no antiseptic solutions are employed. It
must also be remembered that the germicidal agents possess the
disadvantage of exercising a more or less destructive action on the
body cells, and consequently their use is not warranted in clean
wounds. We still, however, sufficiently often meet with infected
wounds that render the use of these agents necessary.
+Heat+ is the most valuable of all sterilizing agents, its only drawback
being that it is not universally applicable. Wherever possible it
should be employed in preference to chemical agents. It can be
employed either dry or moist. Moist heat is a much more efficacious
germicide than dry heat, for it destroys the organisms at a much
lower temperature. Boiling water at a temperature of 212°F. will
destroy nearly instantaneously all pus-producing organisms. Spores,
however, require a moist heat of 284°F. kept up for at least a
half-hour. A dry heat of 212°F. will not destroy pus-producing
organisms under an hour and a half of treatment, and spores will live
for three hours at a dry temperature of 284°F.
Although moist heat is very much quicker and more satisfactory in its
action, yet it is often inconvenient to employ it in the sterilization
of gowns, towels, operating suits, etc. However, sterilization by heat
has been greatly facilitated by the introduction of the autoclave, by
means of which a very high temperature under pressure can be obtained.
This is the most satisfactory method of sterilizing dressings, towels,
sheets, operating suits and aprons. A similar and less expensive
method of sterilizing these articles is by the use of one of the
simple steam sterilizers which are sold by all dealers. In an
emergency, an ordinary bake oven can be employed as a sterilizer. It
is best, however, where the temperature cannot be estimated, to boil
the articles and dry them between sheets moistened with bichloride
solution.
+Disinfection or Sterilization.+ Sterilization of a wound, or of the
substances coming in contact with it, may be accomplished by using the
aseptic or antiseptic method; by combining these two methods we obtain
the best results. The aseptic method, which employs antiseptic
substances for the purpose of sterilization of objects coming in
contact with the wound when their disinfection by heat is impossible,
is the method perhaps most generally favored by modern surgeons.
+Antiseptic Method.+ In the antiseptic method, the field of operation,
the hands of the operator and of his assistants, and the instruments,
must be treated in germicidal solution and, in addition, the wound
should be frequently irrigated during the operation with a solution
that has germicidal properties.
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