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EMERGENCY SURGERY, WITH ESPECIAL REFERENCE TO WORK IN HOMES OF THE POOR.

EMERGENCY SURGERY, WITH ESPECIAL REFERENCE TO WORK IN HOMES OF THE POOR. BY R.C. DUGAN, M.D. EYOTA, MINN. We have all heard the remark, and perhaps made it ourselves: "If we had the case in a hospital we would have operated, but could do nothing under the existing circumstances." The marvelously rapid improvement in hospitals and hospital equipments has made it possible to do a class of surgery that would be all but impossible in private houses, especially in those of the poor with small and perhaps dirty rooms. But, if we accept the responsibility of the care of the poor at all, it is our duty to do the very best for them that circumstances permit. Schiemelbusch and many others have shown that wound infection is caused by direct contact, and that we have little to fear from the air, unless large quantities of dust are flying. If, then, we carry with us, as we can, in a not very large satchel, previously-sterilized towels, sponge, pads, dressings, etc., we can do clean work almost anywhere that we can find a fire over which to boil instruments and heat water for toilet purposes. In an attempt to become as near independent of surroundings as possible I have arranged my emergency satchel somewhat after the pattern of McFatrich. In loops on the side of the satchel are bottles for ether, chloroform, alcohol, needles, rubber tissue drains, iodoform duster, safety pins, also in a bottle, one yard of iodoform gauze, and in a pocket at the end of the satchel a large fountain syringe and tin box containing dry sterilized catgut, silkworm gut and a couple of wire saws. In the body of the satchel I have an Esmarch bandage and Esmarch inhaler, instrument roll, containing the ordinary emergency instruments, and am particular to have plenty of hemostatic forceps, and sterilized towels and dressings prepared in the following manner: A package of six or eight towels; a package of cotton with box and paper removed, rolled in a towel; twenty or thirty gauze pads for sponges, in another towel; plain gauze cut in five-yard or six-yard pieces, folded twice and rolled up like a bandage. This puts the gauze in a very handy shape for either dressings or bandages. And in doing abdominal work, packing can be run off from one of these rolls after the manner of Deaver's continuous pack, thus avoiding the danger of leaving sponges in the abdomen. These dressings are put in Boeckmann's sterilizer for two hours, then packed in the satchel. Being in separate packages allows the opening of one without disturbing the rest, and if one becomes contaminated it can be thrown aside and a clean one opened. Strapped to the bottom of the satchel is a double pan for boiling instruments, and on one side a piece of table oil-cloth. As to an operating-table, an ordinary kitchen table folded up and the patient's legs over the end on a pillow on a chair does first-rate for any operations above the knees, and in abdominal work, if desired, the Trendelenburg position can be had by dropping the patient's legs off of the chair and putting some blocks of wood under the table legs, or by turning a chair upside-down on the table, with a quilt on it, and allowing the patient's legs to hang over the lower round of the chair, as described by Mixter. This outfit is within the reach of any country practitioner, and I do not think that environment ought to be an excuse for lack of surgical treatment of any case of depressed fracture of the skull, penetrating wounds of the chest or abdomen, appendicitis or intestinal obstruction from any cause, including strangulated hernia, and in any case of hernia operated on an attempt at radical cure should be made. Senn says all accidental wounds should be treated as septic wounds, and they are, I think, often best treated with moist dressings. For illustration, take a railroad crushing injury to a hand, covered with grease and dirt. After being scrubbed as clean as possible, if flaps are made, sutures placed without tying and the wound packed with moist boric gauze, a moist boric dressing outside covered with rubber or oiled silk protective, the patient or nurse given a bottle of boric acid solution with directions to keep moist through a hole in the protective, it may in a couple of days have the dressing removed and sutures ties with good clean union. On the other hand, if there had been immediate closure and dry dressing, we might have had extensive suppuration. Wounds already suppurating may be treated with moist dressings in the same manner; or, if deep, and requiring packing, gauze packs dipped in balsam of Peru and castor-oil, as suggested by the late Dr. Van Arsdale, quickly check suppuration and stimulate granulation so that in a short time, even in quite deep cavities, the packing may be left out and closure allowed. In wounds which do not need wet dressing, but require drainage, I prefer the folded rubber tissue of McBurney, to tubes, as it does not necessitate removing as early, and does not leave as much scar as when tubes are used. . . . JAMA. 1899;33:895-896 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

EMERGENCY SURGERY, WITH ESPECIAL REFERENCE TO WORK IN HOMES OF THE POOR.

JAMA , Volume 282 (13) – Oct 6, 1999

EMERGENCY SURGERY, WITH ESPECIAL REFERENCE TO WORK IN HOMES OF THE POOR.

Abstract

BY R.C. DUGAN, M.D. EYOTA, MINN. We have all heard the remark, and perhaps made it ourselves: "If we had the case in a hospital we would have operated, but could do nothing under the existing circumstances." The marvelously rapid improvement in hospitals and hospital equipments has made it possible to do a class of surgery that would be all but impossible in private houses, especially in those of the poor with small and perhaps dirty rooms. But, if we accept the responsibility of...
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Publisher
American Medical Association
Copyright
Copyright © 1999 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.282.13.1210
Publisher site
See Article on Publisher Site

Abstract

BY R.C. DUGAN, M.D. EYOTA, MINN. We have all heard the remark, and perhaps made it ourselves: "If we had the case in a hospital we would have operated, but could do nothing under the existing circumstances." The marvelously rapid improvement in hospitals and hospital equipments has made it possible to do a class of surgery that would be all but impossible in private houses, especially in those of the poor with small and perhaps dirty rooms. But, if we accept the responsibility of the care of the poor at all, it is our duty to do the very best for them that circumstances permit. Schiemelbusch and many others have shown that wound infection is caused by direct contact, and that we have little to fear from the air, unless large quantities of dust are flying. If, then, we carry with us, as we can, in a not very large satchel, previously-sterilized towels, sponge, pads, dressings, etc., we can do clean work almost anywhere that we can find a fire over which to boil instruments and heat water for toilet purposes. In an attempt to become as near independent of surroundings as possible I have arranged my emergency satchel somewhat after the pattern of McFatrich. In loops on the side of the satchel are bottles for ether, chloroform, alcohol, needles, rubber tissue drains, iodoform duster, safety pins, also in a bottle, one yard of iodoform gauze, and in a pocket at the end of the satchel a large fountain syringe and tin box containing dry sterilized catgut, silkworm gut and a couple of wire saws. In the body of the satchel I have an Esmarch bandage and Esmarch inhaler, instrument roll, containing the ordinary emergency instruments, and am particular to have plenty of hemostatic forceps, and sterilized towels and dressings prepared in the following manner: A package of six or eight towels; a package of cotton with box and paper removed, rolled in a towel; twenty or thirty gauze pads for sponges, in another towel; plain gauze cut in five-yard or six-yard pieces, folded twice and rolled up like a bandage. This puts the gauze in a very handy shape for either dressings or bandages. And in doing abdominal work, packing can be run off from one of these rolls after the manner of Deaver's continuous pack, thus avoiding the danger of leaving sponges in the abdomen. These dressings are put in Boeckmann's sterilizer for two hours, then packed in the satchel. Being in separate packages allows the opening of one without disturbing the rest, and if one becomes contaminated it can be thrown aside and a clean one opened. Strapped to the bottom of the satchel is a double pan for boiling instruments, and on one side a piece of table oil-cloth. As to an operating-table, an ordinary kitchen table folded up and the patient's legs over the end on a pillow on a chair does first-rate for any operations above the knees, and in abdominal work, if desired, the Trendelenburg position can be had by dropping the patient's legs off of the chair and putting some blocks of wood under the table legs, or by turning a chair upside-down on the table, with a quilt on it, and allowing the patient's legs to hang over the lower round of the chair, as described by Mixter. This outfit is within the reach of any country practitioner, and I do not think that environment ought to be an excuse for lack of surgical treatment of any case of depressed fracture of the skull, penetrating wounds of the chest or abdomen, appendicitis or intestinal obstruction from any cause, including strangulated hernia, and in any case of hernia operated on an attempt at radical cure should be made. Senn says all accidental wounds should be treated as septic wounds, and they are, I think, often best treated with moist dressings. For illustration, take a railroad crushing injury to a hand, covered with grease and dirt. After being scrubbed as clean as possible, if flaps are made, sutures placed without tying and the wound packed with moist boric gauze, a moist boric dressing outside covered with rubber or oiled silk protective, the patient or nurse given a bottle of boric acid solution with directions to keep moist through a hole in the protective, it may in a couple of days have the dressing removed and sutures ties with good clean union. On the other hand, if there had been immediate closure and dry dressing, we might have had extensive suppuration. Wounds already suppurating may be treated with moist dressings in the same manner; or, if deep, and requiring packing, gauze packs dipped in balsam of Peru and castor-oil, as suggested by the late Dr. Van Arsdale, quickly check suppuration and stimulate granulation so that in a short time, even in quite deep cavities, the packing may be left out and closure allowed. In wounds which do not need wet dressing, but require drainage, I prefer the folded rubber tissue of McBurney, to tubes, as it does not necessitate removing as early, and does not leave as much scar as when tubes are used. . . . JAMA. 1899;33:895-896

Journal

JAMAAmerican Medical Association

Published: Oct 6, 1999

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