Chinosol

CHINOSOL (Chinosolum), a combination of equivalent amounts of 8-hydroxyquinoline and cadmium bisulfate, the potassium salt of orthooxyquinoline-sulfonic acid (Formula VI). Empirical formula: C₉H₇ON KHSO₄. Structural formula: Literature before 1907 referred to Chinosol of the composition mentioned above (German patent No. 88520). Properties: crystalline powder of lemon-yellow color, sharp taste, characteristic odor somewhat resembling saffron. It dissolves in water in all proportions, forming a lemon-yellow solution of weakly acidic reaction. Insoluble in ether; alcohol after treatment with Na₂CO₃ extracts the hydroxyquinoline from it. According to another German patent No. 87493, it became known as Chinosol, or superol preparation, which is the sulfuric acid salt of 8-hydroxyquinoline with empirical formula (C₉H₇ON)₂·H₂SO₄ and structural formula: H₂SO₄. It is obtained by mixing calculated amounts of 8-hydroxyquinoline and sulfuric acid. Properties: crystalline substance of bright yellow color, with a faint saffron odor, burning taste, easily soluble in water, difficultly soluble in wine alcohol, insoluble in ether. The aqueous solution turns blue litmus paper red; pH of 1% solution is about 3. Melting point 175-177.5°. Chinosol was proposed as an antiseptic agent, not inferior to mercuric chloride, carbolic acid, lysol, etc., it does not precipitate proteins and does not cauterize. It is used in the form of powder for dusting against foot sweat (chinosol 2.0, starch 10.0, talc 88.0), as a baby powder (chinosol 0.5, starch 19.5, lycopodium 80.0). In the form of ointment for bedsores (wax ointment 43.0, lead acetate 4.0, chinosol 3.0). In the form of tablets weighing 1.0 for preparing solutions (1:1,000) for disinfecting hands and the operative field, for washing fresh wounds and burns (1:500). For injection into the urethra in fractures (1:500-250). In tablets of 0.1 for mouth and throat rinsing, for eye washing (1:2,000-5,000). As a preventive against pregnancy in the form of paste and suppositories. Tragacanth mucilage with 0.5% content of Chinosol—"neopreconsol"—in glass syringes with 4-5 g per syringe; in the form of suppositories: chinosol 0.01, boric acid 0.1, hydrogenated fat (with melting point 36.5-37°) 2.0—"contraceptin"; in the form of suppositories: chinosol 0.01, boric acid 0.1, hydrogenated fat 2.0—"vagilen"; melting rate of suppositories and suppositories at 37° is 4-5 minutes. Internally, Chinosol was proposed for typhoid, cholera, tuberculosis in doses of 0.06 to 1.0 several times a day. Chinosol withstands high temperature without change, for which dressings with Chinosol can be sterilized. In contact with iron, Chinosol turns green. For disinfection of steel instruments, Chinosol is unsuitable. Symptoms of poisoning: salivation, cough, sneezing, heart weakness, drop in temperature, unsteady gait, paralysis. Under the name Oxin or Hahn and Berg reagent in analytical chemistry, Chinosol or the base (8-hydroxyquinoline) is used as a reagent for aluminum, cadmium, iron, indium, cobalt, copper, magnesium, manganese, nickel, molybdenum, thorium, titanium, uranium, vanadium, bismuth and tungsten; also for their quantitative determinations.

M. Tsypkin.

The great diversity of methods adopted in surgery and in the disciplines that have branched off from it (orthopedics, otorhinolaryngology, ophthalmology, dentistry, urology, gynecology, experimental physiology, etc.) has led to the fact that a huge number of instruments are released onto the market, which often differ from each other only by insignificant modifications introduced by one or another surgeon. Many of these instruments, which usually bear the name of the author who proposed them or introduced his modification, are not widely circulated and are used only by the author himself or his students. There is no possibility, and hardly any need, to list all the instruments available for sale; it is sufficient to give only the most typical and most commonly used ones. Instruments used in general surgery. Scalpels, which in the pre-aseptic era had wooden or bone handles, are now made exclusively of solid metal. The length of ordinary scalpels is 12 to 15 cm (Fig. 1). The blades of scalpels have different shapes, differing from each other in length, width, or in the point (tip), which has either an almond-shaped (Fig. 1 b, c) or a pear-shaped (Fig. 1 d-f) shape. The latter is most commonly used for skin incisions. An elongated tip (Fig. 1 g, j) is used for punctures. For these same purposes, a double-edged scalpel (Fig. 2) can be used. For subcutaneous incisions of tendons, straight or curved scalpels equipped with a button at the end (Fig. 3, 4 and 5) are used, which protect adjacent tissues from damage. For plastic operations on the skin or mucous membranes, scalpels with short narrow (Fig. 6 and 7), double-edged (Fig. 8), elongated narrow (Fig. 9, 10 and 11) blades are used. In field medical kits, scalpels are stored in special metal boxes (Fig. 12 and 13), in special sockets with sliding metal covers. Figs. 14-16 show lancets used for puncturing superficial accumulations of pus, Figs. 17-21 show bisturies of various shapes, now rarely used, in a bone (Fig. 17-19) or metal (Fig. 20 and 21) handle. In recent years in Germany, certain attachments for illuminating deep wounds, equipped with a small electric light bulb, have gained some popularity. These attachments can be attached to scalpels, clamps, forceps, etc. For amputations of limbs, amputation knives (with blades) of various lengths, shapes, and thicknesses (Fig. 22-28) with long, massive, wide handles are used. The shape and length of scissors used in surgery are also very diverse. Basically, they are divided into straight and curved. Straight scissors are sometimes equipped with a small expansion on the end of one of the points (Fig. 29), allowing penetration into the depths of tissues without excessive damage to them. The ends of straight scissors are made either more (Fig. 30 and 31) or less sharp (Fig. 32). The most commonly used are curved scissors with blunt ends, Cooper's scissors, which in the closed position are also very convenient for bluntly separating tissues (Fig. 33 and 34). There are modifications of Cooper's scissors, consisting in that their ends are made sharper (Fig. 35). For blunt separation of tissues, however, these modifications are not applicable. Special scissors, usually equipped with a special flat surface on the end of one branch (protecting the skin from injury), are used for cutting bandages on the patient (Fig. 40 and 41). For cutting gauze with the aim of preparing bandages, straight massive scissors with wide rings are used, one of which is made more elongated (Fig. 42 and 43). For attaching sterile linen to the patient's body during operations, so-called Hausmann forceps (Fig. 44 and 45), spring forceps of Schedele (Fig. 46) or Doyen (Fig. 47) are used. The latter are especially convenient during laparotomies for attaching the peritoneum to gauze swabs, in order to protect the edges of the skin wound from contamination during manipulations in the abdominal cavity. A great role in surgical operations belongs to various kinds of forceps (see) and clamps (see). The most widespread and very convenient needle holders are Mathieu needle holders (Fig. 48 and 49) and Hegar needle holders (Fig. 50 and 51). The latter, due to their length, are especially preferred by gynecologists. Some surgeons (especially in France) prefer not to use needle holders, but to sew simply with large needles (Fig. 52) or with special instruments (needles) of Reverdin (Fig. 53 and 54), modified for operations on the perineum by Tiemann (Fig. 55), Ashton (Fig. 56) and other authors. Long-handled needles of Deschamps are widely used, existing in various modifications (blunt with a short end-Fig. 57, sharp with a long end-Fig. 58, with a short end-Fig. 59) and serving mainly for introducing ligatures under large vessels or for tying thick muscle bundles, various strands in the abdominal cavity, etc. Figs. 60 and 61 show modifications of these needles proposed by Billroth. However, most surgeons use special surgical needles of various curvatures, thicknesses, and lengths for suturing tissues (Fig. 62-65). The most convenient for quick threading of threads are needles with a spring eye (Fig. 66), although factories also produce needles with an ordinary needle eye. For operations on the intestines, round needles (Fig. 67 and 68) are preferable, while on other tissues it is more convenient to sew with sharp three-edged needles, which damage the tissues less. For operations on blood vessels, the thinnest sizes of needles are used (Fig. 69 and 70). Curved or straight. Zlotnik proposed a modification of a needle holder equipped with a special magazine in which a coil of surgical thread is placed, making it possible to sew wounds without the assistance of an operating room nurse (Fig. 70a). These needle holders are very convenient in the practice of outpatient clinics and reception rooms for providing first aid for various superficial skin injuries. For separating the edges of wounds during operations on soft tissues and bones, various kinds of hooks, retractors, etc., are used, differing from each other in the number of teeth [Volkmann hooks (Fig. 71), Murphy (Fig. 72), Sands (Fig. 73), Israel (Fig. 74)], in their nature (sharp or blunt), and in their greater or lesser curvature. Furthermore, there are a number of very convenient arcuate, pointed, and other forms of hooks (Middeldorff, Sauerbruch, Langenbeck, Czerny, etc., Fig. 75 and 76). Particularly convenient for various operations on superficially located soft tissues are paired two-sided hooks of Farabeef (Fig. 77). For suturing the edges of the skin, special metal clips of Michel (Fig. 78) of various lengths and widths or so-called spring wire clamps (Fig. 79) are convenient. The advantage of clips over sutures is that they remain on the surface of the skin - outside the wound, whereas sutures are passed through the thickness of the skin, where they remain for 6-8 days, and being a foreign body (although aseptic), they can contribute to suppuration, as they form a bridge connecting the surface of the skin with the depth of the wound. Metal clips are also completely disinfected by boiling, which is not always achievable with silk threads. In addition, clips leave less noticeable scars than silk sutures. Michel clips are usually kept on special wire frames (Fig. 80), from which they are easily removed with special forceps (Fig. 81 and 82), with which the clips are applied to the edges of the wound. For removing clips, special instruments (Fig. 83) are used, equipped with beak-shaped branches that compress the clip in the middle and thus straighten it. Each operating room must be equipped with a set of instruments for cleaning the nail bed (Fig. 85), the subungual space (Fig. 84) and for cutting nails (Fig. 86 and 87). For extracting sterilized brushes for washing hands from the vessel in which they are placed, a cornet is very convenient, one branch of which has the shape of a fork, the other - the shape of a tooth (Fig. 88). For this same purpose, however, cornets of various lengths and shapes can be used, whose branches are given various bends (Fig. 89). Cornets are especially widely used in purulent surgery, where they are used for bluntly separating the walls of abscesses after the skin has been cut with a knife. They are also convenient for extracting foreign bodies from deep tissues, although for this purpose instruments of the type of Schröder's bullet forceps (Fig. 90) or their modifications proposed by Schulze (Fig. 91), Martin (Fig. 92) and other authors are more commonly used. For puncturing cavities and emptying their contents, trocars with a removable mandrel (stylet) are used. They are produced in sets of various thicknesses, screwed into handles of one type or another (Fig. 93 and 94), in which they are stored, or in the form of a trocar soldered to a wide handle (Fig. 95).

The last modification is now more commonly used, as it is much more convenient for manipulation and aseptic (absence of screws, open cavity in the handle). It is sold in various calibers. - In conditions of field practice in rural areas and especially during war, instruments used in general (so-called minor) surgery and for providing first aid for wounds are sold in complete sets in leather or metal cases. These sets are produced in various configurations and depending on who they are intended for (sanitary orderly, feldsher, doctor), they contain either a simpler or more complex set of instruments (figs. 96 and 97). Instruments for plastic operations. For skin grafting operations, flat, wide, thin knives of Tirsch (fig. 98), Kortum (fig. 99), and Rena (fig. 100) are used. For grafts of the buccal mucosa, Israel proposed a wide knife (fig. 101) resembling a spatula. For rhinoplasty, a series of instruments are used, including various elevators (Langenbeck-fig. 102, Trelat-fig. 103, Le Dentu-fig. 104 and 105), curved scissors of Virchow (fig. 106), and special needles on long handles (Lexer-fig. 107, Langenbeck-fig. 108, Sklifosovsky-fig. 109). Instruments used in operations on the skull, brain, and spine. Trephines of Gurlt (fig. 110), used mainly in the pre-antiseptic era for opening the skull cavity, creating a bone-plastic skin-muscle-periosteal-bone flap, etc., were later replaced by trephines or drills (borers) of various types, equipped with drills, Duvernay's (fig. 111) of different calibers and types (Stille drill-fig. 112, Hamilton drill). However, in recent times, manual instruments for trepanation of the skull have given way to trephines and burs driven by an electric motor. The most common of these are the electric trephine of Burkhart, equipped with 10 types of different drills and burs (figs. 113, 113a and 113b), and the electric trephine of de Martel. For expanding trepanation holes, there is a whole series of instruments for cutting bone edges: Luer's rongeur (fig. 114), Dalgren's (fig. 115), Duvernay's (fig. 116), Burkhart's (fig. 117), de Quervain's (fig. 118), Dalgren-Burkhart's (fig. 119), Lombard's (fig. 120), Hoffmann's (fig. 121), and Bacon's (fig. 122). However, in trepanations, it is not always possible to get by with only trephines and rongeurs—sometimes it is necessary to resort to chisels of various types. The most commonly used are chisels of König, Bergmann, and Mac Even (figs. 123, 124, 125). Trepanation with chisels is performed with the help of wooden or metal hammers of Bergmann and others (figs. 126, 127). For elevating the periosteum, straight and curved elevators of Farabeuf (fig. 128) or their modifications are used. For dislocating bone fragments—elevators of Langenbeck (fig. 129) or other authors. - For stopping bleeding from the skin-muscle flap, clamps of the Hoeve type (fig. 130) and Hudson's (fig. 131) are used. For measuring the thickness of the skull bone wall, Duvernay's instrument (fig. 132) is used; for protecting the dura mater from injuries during trepanation—Alexander's protector (fig. 133); for retracting the brain—spatulas of Lexer (fig. 134), Braatz (fig. 135), and a number of their modifications. For removal of the Gasserian ganglion, a special set of instruments (fig. 136) is used, consisting of forceps for pulling out the nerve, spatulas for retracting the brain hemisphere, special elevators of various curvatures and widths, hooks for plugging foram. spinosi (in bleeding from a. mening. med.), a silver, easily flexible probe for passing a ligature under a. mening. med., and two special short forceps for tying this ligature. For laminectomy, in addition to the usual instruments for bone operations (see below and Orthopedic Instrumentation) and the aforementioned bone rongeurs (figs. 114-122), special laminectomy scissors (forceps) of de Quervain (fig. 137) and especially convenient scissors of Exner (fig. 138) are also used. Instruments for operations on ribs. For ordinary resections of ribs in empyema of the pleura, rib scissors of Gluck (fig. 139), Stille (fig. 140), and other authors, and the well-known elevator of Duvernay (fig. 141) are used. For thoracoplasties, in addition to these instruments, it is also necessary to have scissors for resection of the first rib. The most convenient instruments for this purpose were proposed by the leading specialist in lung surgery, Sauerbruch, in the form of guillotine-type scissors (figs. 142 and 143).-Instruments for operations on blood vessels are essentially mostly copies of various types of clamps, forceps, knives, etc., accepted in general surgery, but, taking into account the delicacy and fragility of the vascular wall, they are made in significantly smaller sizes than the former, which allows for manipulation with the least risk of injuring the vascular wall. In figs. 144-150, various types of vascular clamps are shown; in fig. 151, a triple clamp for vascular anastomosis; in fig. 152, an instrument for pulling threads when applying an anastomosis to cause gaping of the vessel edges. For the same purpose, the triple expander shown in fig. 153 is used. In figs. 154 and 155, knives for cutting the vascular wall; in fig. 156, special, very delicate forceps for grasping the vascular wall; in fig. 157, a needle holder for applying vascular sutures. The American surgeon Carrel proposed a complete set containing all the necessary instruments for vascular sutures. The set of instruments necessary for the Trendelenburg operation in pulmonary artery embolism consists of 6 items (fig. 158): a-rubber tourniquet, b-special probe for passing the tourniquet around the artery, c-forceps for extracting emboli, d-forceps for spreading the edges of the incision in the artery, f-clamp for compressing this incision. Instruments for operations in the abdominal cavity. Among the huge number of hooks and retractors of various types used for spreading the edges of the abdominal wound, and retractors for retracting abdominal organs, the most commonly used are ordinary hooks of Kelly (fig. 159), Richardson (fig. 160), Duvernay (fig. 161), Albarran (fig. 162), and Zukerkandl (fig. 163); double retractors of Kocher (fig. 164), Legue (fig. 165), triple retractor of Kocher (fig. 166); retractors of Eiselsberg (fig. 167), Israel (fig. 163), Mikulicz (fig. 169), and Duvernay (fig. 170). For retracting the intestines when suturing the peritoneum, spoon-shaped retractors (figs. 171 and 172) are very convenient. The Murphy buttons for enterostomy (round) and gastroenteroanastomosis (oval) (figs. 173-175), equipped with special clamps for introducing these buttons into the intestinal or gastric lumen, are probably still used only by American surgeons. In American textbooks, at any rate, they are given such a prominent place that they do not deserve. The complications that their application often leads to (necrosis of the intestinal wall, perforation, obstruction) are very dangerous and in no way balance the speed with which they are applied, which, according to American authors, gives them a great advantage over the usual anastomosis applied by means of suture. Among the clamps (see) and clips used for operations on the gastrointestinal tract, the most typical are the soft clamps of Kocher (straight-fig. 176, curved-fig. 177), the awl-shaped clamp of Brunner (fig. 178), the gastric clamp of Graser (fig. 179), Payr (fig. 180), the enterotrib of Duvernay (fig. 181), which can also serve as an angiotrib used by gynecologists during hysterectomy, and the triple clamp of Linhardt for anastomosis (fig. 182). For operations on the bile ducts, a series of special instruments are used: forceps for extracting stones from the bile ducts: Cherny (fig. 183), Korte (fig. 184), Collin (fig. 185); probe for probing the bile ducts of Desjardins (fig. 186), although most surgeons use an ordinary uterine probe for this purpose. A whole series of spoons with blunt edges have been proposed for removing stones from the hepatic and common bile ducts; the most typical and widely used of these are shown in fig. 187. For grasping the d. cystici before removal of the gallbladder, a clamp with curved jaws of Moenigen (fig. 188) is used, although a curved-jawed Hegar needle holder is no less convenient for this purpose; the retractor of Sick (fig. 189) is very convenient for retracting the intestines during operations on the bile ducts.-For operations for hemorrhoids, there is a whole series of instruments for crushing the base of hemorrhoids: Langenbeck (fig. 190), Mac Lean (fig. 191), Dombrovsky (fig. 192), Pozzi (fig. 193). However, the most commonly used are the terminal clamps of Luer (figs. 194-196). Instruments for operations on bones and joints. For amputations of limbs, saws of various types are used (Satterlee-fig. 197, Charriere-fig. 198, Langenbeck-fig. 199). For sawing thin bones (e.g., metatarsal, metacarpal), a chain saw (fig. 200) is used, but for these purposes, the wire saw of Gillie (fig. 201), attached to 2 special handles (fig. 202), is much more convenient.

For retracting soft tissues during amputations of the extremities, retractors by Sweet (fig. 203), Herzenberg retractors, consisting of two identical, overlapping parts (fig. 204a), are used. An ordinary hammer can sometimes be conveniently replaced by a heavy mallet (Rawhide) (fig. 204). For holding the ends of bones during operations, Langenbeck bone forceps (fig. 205), Farabeef forceps (fig. 206) are used, and for removing bone sequestra—Mathieu sequester forceps with various bends of the jaws (fig. 207, 208, 209). For cutting off the edges of bone after amputations, resection of the rib, etc., bone scissors by Liston (fig. 210, 211), Mayo, Satterlee, Gorely are used. For scraping out bone cavities in osteomyelitis, creating a new joint socket in arthroplasty, etc., sharp Fodkman spoons—double-sided oval (fig. 212), König (fig. 213 and 214), single-sided circular Farabeef (fig. 215), Richard (fig. 216), Broca (fig. 217), Luer (fig. 218 and 219) and a Murphy set for arthroplasty of the hip joint in its ankylosis, consisting of one concave (fig. 220 a), one convex (fig. 220 b) burr and a handle for them (fig. 220 b) are used. Chisels, elevators, bone forceps, hammers, etc.—see figures 111-131, and also see Orthopedic instruments.