Asepsis

“ He utilises every particle of the marvellously minute and intricate technique of asepsis to prevent the entrance through the wounded tissues of any disease elements before, during or after the operation. He fears sepsis equally with death, and yet, under the blighting and blinding influence of an ancient and venerated myth inherited from his ignorant and superstitious forbears of a pre-scientific age, he will deliberately inoculate the virulent infective products of diseased animal tissues into the circulation of a healthy person. ”

“ Much stress has been laid upon the subject of asepsis and antisepsis. The foot is peculiar in that conditions surrounding it are especially congenial to the development and multiplication of bacteria. Modern surgery has been built upon the recognition of the rôle of bacteria in the behaviour of wounds, and the greatest hazard to successful surgery lies in the ever-present possibility of bacterial invasion. Surgical safety, however, can be secured by the employment of a perfect technic for asepsis. ”

“ The triumphs of antisepsis and asepsis, or keeping the "bugs" out of the cuts, have been illustrated scores of times already by abler pens, and are a household word, but certain of its practical appliances in the wounds and scratches and trifling injuries of every-day life are not yet so thoroughly familiar as they should be. When once we know who our wound-enemies are, whence they came, and how they are carried, the fate of the battle is practically in our own hands. ”

“ The modern theory of asepsis has, to be sure, been widely accepted and is practiced so far as possible wherever obstetrical patients are attended, but only in the hospital can the underlying principles be applied with complete thoroughness and persistence. ”

“ Who can compute the relief from suffering and the saving of life which may be traced through Lister to Pasteur's laboratory experiments on fermentation?
The recognition of the principle of asepsis by the surgeons was, then, as we have seen, slow and grudging enough; among the profession at large the theory of infection as applied to acute diseases gained more slowly still. It was not until 1880 that advance in the knowledge of the bacterial etiology of infectious diseases assumed such definite shape as to attract general attention. ”

“ If there is any time in a nurse’s career when she should give scrupulous attention to establishing and maintaining asepsis, it is during labor, for the patient’s life may, and often does depend upon it. If there is any time when she should be watchful for developments and for symptoms of complications, it is during labor, for again the patient’s life may depend upon this. ”

“ In considerably less than a hundred years hence such makeshifts as drugging, and the fighting of one disease by the instalment in the organism of another, will certainly have gone by the board. Antisepsis and Asepsis (the latter almost infinitely the greatest invention in the history of therapeutics) will have pushed their way from surgery into medicine. There are numerous diseases which can be not merely cured, but ultimately abolished when we have once discovered how to use oxygen adequately. ”

“ Asepsis is an ideal condition which, although not always possible in animal surgery, is highly important in connection with the mechanical details of all surgical operations in proportion to the nature and seriousness of the same. ”

“ Treatment and Nursing Care. Preventive. There is so little that can be done toward curing a patient suffering from puerperal infection that the greatest effort should be made to prevent the disease. The nurse’s part in preventing this complication is an important one and consists of making such preparation for labor that it may be conducted with absolute cleanliness; maintaining the same asepsis during delivery as she would throughout a major surgical operation and protecting the perineum from infection after delivery. ”

“ The technique for cutis-grafting must be without a flaw, and the asepsis absolute; there must not only be a complete absence of movement, but there must be no traction on the flap that will endanger its blood supply. ”

“ They collect a number of victims, operate on them, and then move on before their sins can find them out. Both kinds of operators seem to be innocent of any attempt at securing asepsis or antisepsis; they use a dirty needle or a sharp wooden skewer ”

“ The first of these objects is to be arrived at by paring down the horn in a funnel-shaped fashion over the seat of the prick. It is, perhaps, even better to thin the horn down to the sensitive structures for some little distance round the injury. By this latter method pressure from inflammatory exudate is lessened, and the after-formation of pus, if unfortunate enough to occur, the more readily detected, and the less likely to spread upwards. The matter of asepsis may then be attended to. ”

“ The term _sepsis_ as now used in clinical surgery no longer retains its original meaning as synonymous with "putrefaction," but is employed to denote all conditions in which bacterial infection has taken place, and more particularly those in which pyogenic bacteria are present. In the same way the term _aseptic_ conveys the idea of freedom from all forms of bacteria, putrefactive or otherwise; and the term _antiseptic_ is used to denote a power of counteracting bacteria and their products. ”

“ PREFERRED ANTISEPTICS ANTISEPTIC SOLUTIONS
These are solutions used for the destruction of and to arrest the progress of microörganisms that have found their way into wounds—the cause of sepsis, as exhibited by fever, suppuration, and putrefaction. These preparations are called antiseptics and are used to render parts aseptic. They vary much in their destructive power, effect on tissue, and toxic properties. ”

“ Any tissue of the body may be the seat of an acute abscess, and there are many routes by which the bacteria may gain access to the affected area. For example: an abscess in the integument or subcutaneous cellular tissue usually results from infection by organisms which have entered through a wound or abrasion of the surface, or along the ducts of the skin; an abscess in the breast from organisms which have passed along the milk ducts opening on the nipple, or along the lymphatics which accompany these. ”

“ Antisepsis.—Cleanliness and antisepsis should be observed in the management of abortion as strictly as in that of labor or in surgical operations, as sepsis, either in the form of acute infection or an insidious undermining of the constitution, is among the more frequent of the dangerous consequences which follow in the wake of abortion. Circumstances permitting, it is desirable that carbolated vaseline or vaseline with iodoform, carbolated or some similarly prepared soap, be on hand, and also permanganate of potassium, carbolic or boracic acid, and iodoform. ”

“ But though the pendulum has swung so far in the direction of aseptic surgery, a very large proportion of operators still adhere to the antiseptic measures which had proved so highly beneficial. The judicious employment of weak solutions of carbolic acid, or of mercuric salts, and the application of unirritating dressings of an antiseptic nature cannot do any harm, and, on the other hand, they may be of great service in the case of there having been some flaw in the carrying out of what should have been an absolutely aseptic operation. ”

“ Active inflammatory action may, however, be excited at any time, as in other chronic abscess, by a new infection, septic organisms entering the abscess by way of the uterine cavity, an adherent loop of intestine, or the bladder. The woman will then have an attack of acute septic inflammation in the old pyosalpinx, and will be exposed to the various dangers that were imminent during the primary acute stages of the disease. ”

“ ABSCESS (from Lat. abscedere, to separate) , in pathology, a collection of pus among the tissues of the body, the result of bacterial inflammation. Without the presence of septic organisms abscess does not occur. At any rate, every acute abscess contains septic germs, and these may have reached the inflamed area by direct infection, or may have been carried thither by the blood-stream. ”

“ Formation of an Abscess.—When pyogenic bacteria are introduced into the tissue there ensues an inflammatory reaction, which is characterised by dilatation of the blood vessels, exudation of large numbers of leucocytes, and proliferation of connective-tissue cells. These wandering cells soon accumulate round the focus of infection, and form a protective barrier which tends to prevent the spread of the organisms and to restrict their field of action. ”

“ When the abscess is situated at the mouth of the womb, so as that it can be operated upon, we must not be in haste in having recourse to incision, nor until the disease be ripened, and the inflammation has increased to its utmost, and the vascular bodies which surround it have become attenuated, owing to the importance of the uterus in the system. In operating, the woman should be placed on a seat in a supine posture, having her legs drawn up to the belly, and her thighs separated from one another. ”

“ As regards the treatment of acute peritonitis, the first thing that the surgeon has to do is to assure himself that the disease is not due to some cause which itself should be dealt with, to a septic disease of appendix or Fallopian tube, for instance, or to a toxic condition of the uterus, the result, perhaps, of a criminal or innocent abortion, or to a perforated ulcer of stomach or intestine. ”

“ When in the latter mode, the ascites is usually combined with anasarca, and the disorder generally comes on suddenly, and has a rapid progress. The vascular system is excited, and there is more than usual thirst; the blood when drawn exhibits the buffy appearance; and the urine, when subjected to heat, is found to coagulate strongly, from the large quantity of serum contained in it. In some of the severer cases, the effusion into the abdomen takes place very suddenly, and yet, by a copious bleeding the disease may be at once arrested, and the water be afterwards absorbed. ”

“ The greatest advance here, as in all departments of surgery, has been made since the626 introduction of antiseptic and aseptic principles. To-day there is no disease or condition which, if seen early enough, cannot be cured, or essentially relieved at the hands of an expert abdominal surgeon. Thousands of women are now saved every year by these means who formerly would have certainly died or remained hopeless invalids. ”

“ The pyogenic membrane, like the granulations of a sore, which it resembles in nature, forms pus, not from any inherent disposition to do so, but only because it is subjected to some preternatural stimulation. In an ordinary abscess, whether acute or chronic, before it is opened, the stimulus which maintains the suppuration is derived from the presence of the pus pent up within the cavity. When a free opening is made in the ordinary way, this stimulus is got rid of ”

“ But suppose you have an abscess on your hand; that abscess is swarming with germs, and the lymph in its passage will carry away a vast number of these injurious microbes, and will take them to the glands of the armpit. The germs remain in the glands and give the glands extra work to do. The glands will enlarge and become inflamed. If the infection of the glands is very virulent, the glands may, as it were, die at their post and become abscesses. Now we can proceed. The commonest cause of inflamed glands in the axilla is inflammation and suppuration about the hand or arm. ”

“ Pyemia may be defined as a condition in which metastatic abscesses arise as a result of the existence of pyogenic bacteria in the circulating blood, either free or contained in pus cells or thrombi.
Symptoms. The symptoms of pyemia are a febrile movement with a severe chill and a sudden marked rise in the temperature which lasts for a few hours and passes off with profuse sweating. The chills recur every other day, every day, or oftener. The general symptoms of vomiting, wasting, etc., resemble those of septicemia. ”

“ When the slough gives way the pus escapes and, tension being relieved, pain ceases. A local necrosis or death of tissue takes place at that part of the inflammatory swelling farthest from the healthy circulation. When the attack of septic inflammation is very acute, death of the tissue occurs en masse, as in the core of a boil or carbuncle. Sometimes, however, no such mass of dead tissue is to be observed, and all that escapes when the skin is lanced or gives way is the creamy pus. ”

“ Sometimes, by the omission of bleeding in due quantity at the beginning, and sometimes in spite of all possible care, it terminates in an abscess, which, on bursting, may suffocate the patient; or, if the matter is coughed up, becomes an open ulcer, and produces the disease in question.
The third cause of the pulmonary consumption above mentioned, is, a spitting [227] of blood, from the bursting of vessels of the lungs, independent of external wound or bruise. People of a fair complexion, delicate skin, slender make, long neck, and narrow chest, are more subject to this than others. ”

“ The symptoms of sapremia depend upon the amount of intoxication.
In septic infection, or septicemia, only a small number of organisms may get into the blood, but they multiply rapidly. A drop of blood from a man with septic infection will reproduce the disease when injected into the blood of an animal; hence it is a true infective disease. The wound in such a case is often small, and is commonly punctured or lacerated. ”

“ Pyæmia is closely allied to septicæmia. It is due to the setting free of bacterial emboli or septic emboli from a broken-down, septic thrombus in the neighborhood of the wound, and the circulation of these emboli in the blood until they are arrested and form the characteristic metastatic abscesses, especially in the lungs, joints, abdominal viscera, and parotid gland. Almost always the source of infection is an infected wound. Granulation does not prevent the occurrence of pyæmia, which, as a rule, commences at a later stage than septicæmia. ”