The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
A. _From within_ they may enter the tissues either through the
inspired air, through food and drink, _i. e._, ingesta, or by means
of more direct inoculation, _e. g._, by foreign bodies or by venereal
contact. The danger through infection by inspired air is very small,
and concerns probably a limited number of organisms, of which the
tubercle bacillus is the most important. Foul air and air which
emanates from sewers, cesspools, etc., while most unpleasant to breathe
and deleterious in many other ways, do not necessarily contain any
microörganisms which can be injurious. This fact, in opposition to
general belief, is, nevertheless, proved by recent investigations. The
ingesta furnish the most fertile source of contagion from within, but
the diseases thereby produced fall for the most part into the domain of
medicine rather than that of surgery.
B. _Infection from without_ the body may come by actual contact with
previous skin or mucous lesions, and particularly from noxious insects
and certain parasites. Among surgeons the principal sources of contact
infection to be enumerated and guarded against are:
1. Skin and hair;
2. Instruments;
3. Sponges or their substitutes;
4. Suture materials;
5. The hands of the surgeon and his assistants;
6. Drainage materials;
7. Dressing materials;
8. From miscellaneous sources, _e. g._, drops of perspiration,
unclean irrigator nozzle, a contaminated nail-brush, the clothing of
the operator, etc.
While insisting here upon the recognition of these sources of danger,
the precautions to be taken against them are to be considered under
another heading, to which the reader is referred.
One of the greatest sources of possible infection has of late been
shown to be the presence of flies and other noxious insects, which act
as carriers of infection. The Egyptian ophthalmia, which ruins the
sight of 30 per cent. of the inhabitants of Egypt, has been shown by
Howe and others to be due to infection by this mechanism; and a simple
bacteriological experiment will suffice to show that the foot-tracks
of a single fly across a wound furnish abundant opportunities for
infection with organisms which are presumably virulent. In fact, the
danger of carriage of infection by this means is greater than from
almost all other sources, except the use of improper materials during
surgical operations.
CLASSIFICATION OF INFECTIONS.
We speak of infections as _primary_, _secondary_, and _mixed_; and it
is necessary, for purposes of accuracy at least, to make a reasonably
clear distinction between them.
=Primary Infection.=--By primary infection is meant infection with a
single form of organism whose effects are prompt and speedy. Of this,
erysipelas or syphilis may serve as illustrations. Most of the acute
infections belong to the primary type.
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