One interesting point is that the efforts of Ambroise Pare in the mid-1500s should be remembered in 1630, while they were largely forgotten by the 1800s. Mr. Pare, a barber-surgeon, was instrumental in developing techniques that allowed the French army to reduce the complications from field amputations by a large degree, mostly by avoiding the use of large-scale hot cautery to stop the bleeding of the stump, and an advanced understanding for his time of the value of cleanliness in wound healing. Add in the extra operating time allowed by the anesthesia to the benefits of aseptic technique, and Mr. Pare would have been ecstatic over up-time style care. Dr. Scultetus is in canon as having traveled to Jena and Grantville to learn these very techniques, and he was as honored in his time as Drs. Crile, Halsted, and Oschner are in OTL.
Baron Lister's ideas of "antiseptic surgery" included developing mechanisms to provide a fine mist of an antiseptic solution of carbolic acid (phenol) before and during the operation, ceasing the sprayers when the wound was finally dressed. Building on ideas put forth by Florence Nightingale on the need for clean, fresh air circulation to prevent disease, other physicians discovered that the baron's ideas, while good, caused problems for the patient and the operating team. A modified version of antiseptic surgery arose, where dust-catching filters and germ-killing ultraviolet lights were placed in the air ducts leading to the operating room. Air in surgical suites is constantly cycled through those ducts, preventing the airborne transmission of disease without exposing the operating team to the toxic germicide. Ultraviolet lights of this nature require a special type of glass that passes a higher percentage of those frequencies, but that is one of the few problems with reproducing them in the NTL.
Another place the ideas of Baron Lister and Florence Nightingale are likely to cross is in the construction the Operating Rooms and the insistence on thoroughly cleaning them after each use. Walls and floors of operating suites can be covered with closely set, well-glazed tile as was done in OTL from the 1920s to the early 1970s. Floor tiles may have a slightly roughened surface for the sake of better footing, or terrazzo floors may be used, with some of the up-time tricks making this application easier. Ceilings will probably be enamel-coated "tin" (galvanized steel), as these surfaces can better resist most common cleaning and disinfecting solutions. The tin ceilings will probably be very plain, with only enough embossing to increase the strength and help reduce some of the sound reflection, rather than the almost baroque pressed tin ceilings remaining from the Gilded Age here in the US. There will be one or more drains with "U" traps set in the floor, leading to a separate septic system, allowing for easy disposal of blood or other contaminated body fluids that might spill on the floor, as well as other spilled liquids.
The walls would be sprayed down using a pressure-pumped sprayer, similar to those that have been used by gardeners for fifty or more years before the RoF, and then wiped down with cloth pads on poles long enough to reach the ceiling. This same solution, probably a mixture of formaldehyde in alcohol and water (Formalin, also used as a preservative for tissues preparation) initially, later, one of several others as safer but still effective chemicals come out of the various laboratories, will be used on all environmental surfaces, not just the floor, walls and ceilings. Calcium hypochlorite solutions are another possibility, but this carries more risk of corrosion of various metal parts if not completely rinsed off. While the rooms will need to be completely aired out after the use of the Formalin protocol, the chances of corrosion are much lower.
As noted in Part 1, mild steel tends to rust if left wet. Salty solutions like blood and body fluids just accelerate that problem. Prompt cleaning with mild soap and water using a scrub brush, an initial acidic rinse to remove the last of the salts, followed by a clear distilled-water rinse and air-drying will reduce the chances of corrosion to an absolute minimum. Once dry, the instrument sets are re assembled according to standardized packing lists, wrapped with linen cover wraps, and then steam sterilized. This is again followed by adequate drying time to prevent corrosion. This means that the scrub nurse or technician in the OR will need to stop and lubricate the various hinges with sterilized mineral oil during set-up for the operation, but that is a relatively short procedure. As has been discussed on Baen's Bar, large amounts of high-chromium stainless steels are years, and the exotic alloys probably decades, down the road from the RoF. Doctors Nichols, Scultetus and their colleagues are stuck with mild steel for their new instruments at least through the end of 1636.
Baked, marinated, boiled or steamed: Instrument sterilization in the 1630s
The most common methods of sterilization after the Ring of Fire will include baking at 400°F for at least sixty minutes, the use of formaldehyde or glutaraldehyde[xvi] as cold sterilizing agents, or the use of small-scale steam sterilization. A twenty- to thirty-minute rolling boil in clean water will be a field expedient sterilization method, when a pressure cooker for steam sterilization is not available. I would expect that at least some of the medium sized (sixteen- to twenty-quart) pressure cookers that were to be found in many of the households of Grantville were purchased for use by the medical teams sent out from Grantville, but I did not find any mention of this in canon.
Of these methods, steam sterilization is the preferred method, due to its effectiveness and relative simplicity. It involves fifteen pounds of gauge pressure of steam for thirty minutes, followed by at least an hour to dry in the residual heat after the water and steam have been removed. This may be accomplished in a home pressure canning unit, as noted above, or in a small (six- to fifteen-inch diameter) commercial autoclave unit. Each of the physicians' and dentists' offices should have one of the smaller (six- to ten-inch diameter), and the veterinarians' office should have a larger (twelve- to fifteen-inch) model to handle the larger instruments used in large animal surgeries. Industrial-sized autoclaves (large enough to walk in, and capable of handling cart loads of instrument packs) will be developed by the time the Leahy Medical Center (LMC)is ready to use them, as they are a simple, relatively low pressure, extension of boiler technology. The only tricky part is designing and sealing a pressure tight door measuring up to six feet on a side. Smaller versions of the industrial model, measuring two to three feet on a side, will be commonly used in microbiology laboratories to prevent the spread of contamination from the used Petri dishes as the glassware is sterilized before cleaning and reuse. Almost as tricky will be reproducing the treated paper strips used to confirm that the steam (and therefore the heat) has penetrated to the center of the instrument packages. This will probably be a matter of the analysis of samples from existing stocks of those indicators at the RoF.
A positive demonstration of the sterilization will involve placing a paper packet of bacterial spores, most commonly one of the highly heat-resistant Bacillus species, in the middle of the autoclave load, and putting the spores on culture media (in the microbiology lab) to see if they will grow. If the sterilization is satisfactory, the spores will not show growth in the twenty-four hours after plating, and the load can safely be used. This does presuppose that the LMC will have enough equipment by that time to allow a load to sit for the needed day without being used. This was the industrial best practice when I was working in the sterile instrument department of St. Joseph's Hospital between the time I completed college, and went to basic training. Not much had changed by the late 1990s when I used similar but much smaller-scale techniques in my small town office.