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The Future of
Global Affairs
Managing Discontinuity, Disruption
and Destruction
Edited by
Christopher Ankersen · Waheguru Pal Singh Sidhu
Foreword by Helen Clark and Vera Jelinek
The Future of Global Affairs
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the
Publisher, whether the whole or part of the material is concerned, specifically the rights
of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on
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now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc.
in this publication does not imply, even in the absence of a specific statement, that such
names are exempt from the relevant protective laws and regulations and therefore free for
general use.
The publisher, the authors and the editors are safe to assume that the advice and informa-
tion in this book are believed to be true and accurate at the date of publication. Neither
the publisher nor the authors or the editors give a warranty, expressed or implied, with
respect to the material contained herein or for any errors or omissions that may have been
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Foreword by Helen Clark
The United Nations (UN) was founded 75 years ago to advance peace,
human rights, and development—a mandate as relevant today as it was
in 1945. Its most remarkable year in recent times in achieving global
consensus on a better future for all was 2015. That year, agreement
was reached on Agenda 2030 and its seventeen Sustainable Develop-
ment Goals (SDGs), the Sendai Framework for Disaster Risk Reduc-
tion, the Addis Ababa Action Agenda on Financing for Development,
and the Paris Climate Agreement. The New Urban Agenda was agreed
the following year at the UN’s Habitat III Conference on Housing and
Sustainable Development. Taken together, these constitute an ambitious
agenda, which if implemented in full would transform the prospects of
the world’s peoples and ecosystems.
This ambition is consistent with the UN’s impressive track record of
agenda-setting—the UN was credited by the UN Intellectual History
Project for having been an incubator of new and powerful ideas which
have shaped norms, policies, and practice in many areas. It has been a
platform for the negotiation of a substantial body of international law,
and it has enabled much practical development, and humanitarian work.
In earlier years, it played a significant role in supporting decolonization,
which in turn led to the expansion of its membership from the 51 member
states present at its founding to the 193 of today.
That is not to say that the UN’s record has been without blemish.
The 1994 genocide in Rwanda and the 1995 massacre in Srebrenica—also
v
vi FOREWORD BY HELEN CLARK
neither equipped to act nor have a mandate to act to stem the violence
which greets them. In a number of the currently raging conflicts, there is
no mandate for UN peacekeepers to be present at all. All too often these
conflicts are in effect proxy wars, with the powerful patrons who back
warring parties having little interest in international mediation.
Additionally, the UN is largely a bystander as key parts of the nuclear
weapons control architecture are being dismantled. An egregious example
is that of the Iran nuclear deal which was endorsed by the UN Security
Council. The US withdrawal from the agreement was a direct challenge
to the authority of the Council which all UN member states are bound
to uphold. The expiry of the Intermediate-Range Nuclear Forces Treaty
between the United States and what is now Russia is a major threat to
peace and security, but one which the multilateral system in its current
state is not equipped to address.
Challenging as the outlook for the multilateral system currently is,
however, it would be wrong to walk away from it. Its institutions need to
be maintained for times when geopolitics are more conducive to making
them effective. Disengaging only contributes to their decline in rele-
vance. Meanwhile thought should be given to how to reinvigorate the
system. Not all parts of it are useful. Some need a fundamental over-
haul and reorientation. Some entities barely continue on life support, and
would be better absorbed or eliminated altogether. Others need radical
improvements to their efficiency and effectiveness.
To date, neither the UN nor the Bretton Woods Institutions have been
able to address the nature of their outdated governance systems compre-
hensively. For example, the UN Security Council configuration with its
five permanent members designated in 1945 does not remotely reflect
today’s geopolitics. When the World Bank and the International Mone-
tary Fund changed their leaders last year, there was no serious questioning
of where the new heads would come from. They were preordained to be
an American and a European, respectively. Obsolete governance structures
undermine the credibility of these institutions.
The international system could strive to become more inclusive by
embracing a wider range of actors, beyond member states. A pioneer
in that was the International Labour Organization. From its inception
in 1919, it has had tripartite membership consisting of governments,
unions, and employer organizations. Other non-UN bodies, such as the
Global Fund to fight AIDS, Tuberculosis and Malaria, GAVI—the Vaccine
viii FOREWORD BY HELEN CLARK
The idea for a Center for Global Affairs at New York University had been
brewing in my head for many years prior to its establishment in 2004, but
gained momentum with the seismic and rapid shifts occurring in the field.
With the end of the Cold War, the events of 9/11, and the US invasion
of Iraq in 2003, it became increasingly evident that “international affairs”
was no longer an adequate rubric to describe, understand, and cope with
the rapidly changing landscape. The number of players, even in terms
of traditional states, were expanding exponentially from the 51 original
United Nations members to 193; Non-Governmental Organizations had
evolved to become contenders in shaping and influencing policies; the
private sector and international organizations were setting new norms.
And that speaks only to the actors shaping international relations.
The impact of horizontal forces that were either ignored or previ-
ously played a minor role was also coming to the forefront. The role of
gender, peacebuilding, refugee flows, climate change, energy, terrorism,
transnational security, the internet and communication, among many
other factors, begged for closer scrutiny and study. New trends became
evident: nonalignment lost its salience as the world moved first to unipo-
larity and then multipolarity, multilateralism flourished and gained an edge
over bilateral arrangements, regional organizations expanded, and global-
ization trumped borders and promoted a freer movement of capital, ideas,
people, and goods.
ix
x FOREWORD BY VERA JELINEK
Vera Jelinek
Divisional Dean
Center for Global Affairs, School of Professional Studies
New York University
New York, USA
Acknowledgments
The genesis of this edited book project was to celebrate the fifteenth
anniversary of the Center for Global Affairs (CGA), and be a festschrift
to honor the vision of its founder, Dean Vera Jelinek. CGA’s faculty
warmly embraced the idea and also provided ambitious and encouraging
inputs. Based on that, the initial conception further evolved into a volume
that would offer a glimpse into the future of global affairs across the
concentrations and specializations that the Center offers.
It is of course, one thing to plan an edited volume but quite another
to bring it to fruition; and we are deeply grateful and indebted for the
support and contributions of the many individuals who made it possible.
First, under the tutelage of Dr. Jelinek, CGA has become a home for
global scholars and citizen to hone their skills, and apply lessons from
the classroom into the policy world. Her enthusiastic support helped to
get this project off the ground. Second, our heartfelt thanks to faculty
colleagues who carved out time from their busy teaching, researching,
and engagement schedules to contribute insightful chapters.
The project came alive at workshop on September 13, 2019, which
allowed for a critical discussion of the overall theme of the book, as
well as critique of the individual chapters. It is no exaggeration to claim
that without the frank feedback of the discussants from the academic
and policy worlds, this book would be a shadow of what it is now.
For their constructive inputs and comments we are very grateful to
Franz Baumann, Visiting Research Professor, Program in International
xi
xii ACKNOWLEDGMENTS
Christopher Ankersen
Waheguru Pal Singh Sidhu
Contents
xiii
xiv CONTENTS
Index 321
Notes on Contributors
xv
xvi NOTES ON CONTRIBUTORS
xvii
xviii LIST OF FIGURES
Fig. 5.1 The impact organization (Source Author’s own creation) 113
Fig. 11.1 Estimated petroleum and natural gas production in
selected countries (Source U.S. Energy Information
Administration, based on International Energy Statistics.
Note Petroleum includes crude oil, condensate, and
natural gas plant liquids) 251
List of Tables
xix
CHAPTER 1
“The world,” according to, United States President Donald Trump, “is
a very dangerous place.”1 While this might be dismissed as character-
istic hyperbole from, perhaps, the most sciolistic leader of our times, it
inadvertently underlines the existential challenges posed by the multitude
of seismic shifts since the start of the twenty-first century. While Trump’s
sentiment is perceived by many as characteristic of the international arena,
the ways in which it is dangerous are changing. Three distinct trends
are discernable. First, there are growing intrastate conflicts, which range
from urban violence to terrorism, the takeover of ungoverned spaces
by extremist groups, secessionist movements, and civil wars. These have
erupted on every continent and have mostly been conducted with small
arms and light weapons, though some conflicts have also witnessed the
use of chemical and biological weapons. The period has also seen matura-
tion of the “Forever War” that started on 9/11, accelerated after the
invasion of Iraq, and now sees US forces continue to fight terrorism
violent age now than our ancestors.3 Billions of people have been lifted
out of absolute poverty, diseases like small pox and polio have been
eradicated or nearly so. Life expectancy for most of the world has been
extended. This has not come about automatically or by accident: it has
required dedicated planning and consistent efforts from a whole range
of actors, working top-down, bottom-up, and inside-out all at once.
Lessons have been learned, forgotten or ignored, and relearned in the
process. This progress has been measurable and welcome, but should in
no way be regarded as permanent. Any hope for continued improvement
will rest on deliberate, and collective effort.
The fragility of progress is evident in the United Nations (UN) Secre-
tary General’s warning that the SDGs, hailed as the pinnacle of a desire for
global improvement for all, are in grave danger, as no country is on target
to reach them by 2030.4 Similarly, the erstwhile hope contained within
the wishy-washy 2015 Paris agreement and climate targets was revealed
just four years later in Madrid to have been insufficient, as several nations
clung to the illusion that incremental remedies in the face of a climate
emergency were still plausible. The global trade regime, embodied in the
World Trade Organization, is on the precipice of irrelevance: tariffs and
counter-tariffs look ready to resume, and its dispute resolution mechanism
has come under concerted attack from Washington. In the COVID-
19 era, the need for global responses seems apparent, but today the
centrality of the UN across a range of topics is seriously undermined by
the contempt for multilateralism shown by the current US administration
and other key governments around the world. Some believe that the very
world order—liberal, rule-based, or a vehicle for soft US-hegemony—
is, at the very least, set to shift or, in the extreme scenario, is likely to
entirely collapse. Within that world order, what was once regarded as
the “end of history”—the supremacy of the liberal democratic form of
governance—now appears more fragile than ever, with populism on the
rise everywhere and authoritarian regimes retrenching around the globe.
Ironically, the biggest threat to the liberal democratic order is coming
from within and is led by those who were until recently its custodians. In
2018 Freedom House, for instance, reported its twelfth consecutive drop
in overall freedom, noting a reduction in a number of rights.
What are we to make of this? Will the future of global affairs be the
extension of current trends? Or will we see more disruptions, discontinu-
ities, and even destruction of the existing world order? The complexity
6 C. ANKERSEN AND W. P. S. SIDHU
• Are there lessons we can learn from the past to help build a better
future?
Cold War. After decades of strict us versus them approaches, untidy prob-
lems began to be noticed; untidy because they did not fit into existing
organizational mandates or categories. And so foreign ministries began
creating new divisions and desks to deal with these so-called new or non-
traditional challenges. What was included in those miscellaneous bureaux
began modestly enough: things like human security, sustainable develop-
ment, post-conflict justice, etc. Rather than the black and white world of
war and peace, there was a recognition—long overdue—that global affairs
was far more complex than previously conceived.5
Building on this appreciation of complexity, Global Affairs,6 as an
academic field of study seeks to be more holistic, harnessing the special
knowledge contained in Economics, International Law, and Interna-
tional Relations (as examples), and amplifying their analytical power
through combination with other approaches. For instance, no discus-
sion of the global economy can be complete without reference to world
energy markets. And, as is increasingly clear, only looking at energy as
a commodity, and ignoring its effects on the environment and human
development is inadequate, to say the least. Indeed, a singular focus on
politics or economics, will yield a poorer result than a more well-rounded
approach, inclusive of social and cultural aspects of global affairs.
As such, this volume is committed to surveying the future of global
affairs from a number of perspectives, looking to point out connec-
tions where they occur. When looking at security, for example, we have
to consider the role of gender. When considering the UN, we have
to see it across all its facets, not just the Security Council, the Secre-
tariat, or any one of its specialized agencies. When considering global
actors, we must include more than just states, incorporating the needs
and contributions—both positive and negative—of corporations, NGOs,
and individuals.
Finally, it is vital that we expand our focus beyond the West and
acknowledge the truly global nature of global affairs. The ideas, aspi-
rations, and challenges of many states and peoples around the world
have tended to have been sidelined by International Relations, or, when
considered, shoe-horned into existing structures (e.g., East versus West,
North versus South), neglecting the needs of billions of people, rele-
gating countries to bit parts, with only significance if and when they
might further an agenda other than their own. A large part of this belated
recognition must include an appreciation that, while change may be a
global constant, it impacts us all in different ways. Beyond irresponsibly
1 INTRODUCTION: NAVIGATING UNCHARTERED WATERS 9
in scope and all three may overlap and coexist, with different outcomes
extant in different issues or geographic areas. While we are not confi-
dent in forecasting what comes next, we are reasonably confident that
tomorrow’s global affairs will not look like today’s.
One possibility is disruption. This implies a change—either tempo-
rary or permanent—in the way that global affairs are conducted, even
though the system remains mostly unchanged. Such disruptions could be
normative, political, economic, social, or technological. Previous exam-
ples of disruptive ideas might be the antislavery movement, communism,
and fascism, while today globalization is, clearly, a disruptive economic
phenomenon. Technological disruptions, such as the innovations of the
industrial revolution, advent of aviation, space travel, and artificial intel-
ligence are, clearly, dual use and could be used for both constructive or
destructive purposes. Indeed, disruptions possess both progressive and
regressive potential. However, they do not necessarily have a systemic
impact; they merely affect the way that key actors operate within it.
Another distinct possibility is discontinuity, which indicates a break
from the past, that may or may not result in a systemic change (depending
on the impact of disruption or destruction). At a minimum, disconti-
nuity might see the emergence of new powers within the existing system.
Thus, China’s growing profile and clout within the UN system might
reflect this discontinuity. At a maximum, discontinuity might also lead to
the cessation or suspension of some aspects of the global system and/or
the creation of alternative systems. Again, China’s establishment of the
Asian Infrastructure Investment Bank and its role in creating the New
Development Bank (along with Brazil, Russia, India, and South Africa),
partly in response to being dissatisfied with the limited role in the existing
international financial institutions, exemplifies longer-term discontinuity.
Similarly, the Group of 20 countries assuming a greater role in peace and
security issues, as an alternative to an unreformed Security Council, also
marks discontinuity.
Finally, there is destruction, which suggests the permanent demise of
the existing system of global order. Historically, such destruction was
prompted by great power conflict at a global level. Thus, the collapse
of the European ancien regime in the wake of the First World War and
the death of the League of Nations following the outbreak of the Second
World War are examples of institutional destruction. Until the end of the
Second World War, such man-made destruction was inevitably followed
by the construction of a new institution to manage global order, as
evidenced in the creation of the UN. However, after the advent of the
nuclear age in 1945, any future direct conflict among nuclear-armed great
14 C. ANKERSEN AND W. P. S. SIDHU
how they could best prepare their states for declining oil production. The
scarcity of supply was the risk, and the multitude of economic and polit-
ical sensitivities associated with energy security drove countries to seek
new ways of securing hydrocarbons. Kissane explores the energy transition
and examines how the geopolitics of energy is experiencing a new stage
of discontinuity, exposing both new risks and opportunities for producers
and consumers of global energy.
Great Thunberg’s high-profile Atlantic crossing by yacht highlighted
the potential climate risks associated with energy transition, and did so in
a highly personal way. Thus, Michael Shank argues that the response to
the climate crisis is no longer the purview of national policymakers only,
since presidents and prime ministers are backing out of the Paris climate
agreement—a pact that intended to locate the focus of greenhouse gas
emissions reduction in the hands of national governments. Increasingly,
subnational actors—cities, states, businesses, universities, hospitals, reli-
gious organizations, and other nonprofit sectors in both the global North
and South—are taking the lead and filling the void left by national govern-
ments. As part of this locus shift, personal behavior change is increasingly
discussed among these subnational actors—and by the storytellers within
society (e.g., media)—and, as a result, social norms encouraging sustain-
able consumption (e.g., plant-based diets, slow fashion) are becoming
more mainstream in the climate action space, complementing the more
traditional and expected environmental choices (e.g., recycling, LED
lightbulbs, carbon-light transit). While some frontiers continue to remain
stigmatized (e.g., family planning), the invigorated action among subna-
tional actors is ambitious and inspiring. Shank explores the systems-level
transformations happening within one particular sector of subnational
society—global cities in the global North and South that are taking
aggressive action on climate change—since the majority of the world’s
population resides in cities and since cities are responsible for the majority
of the world’s energy use and greenhouse gas emissions. Shank concludes
by tracing out the potential shift, within these cities, toward behavior
change strategy and how behavioral economics and social psychologies
may be useful in motivating residents within these cities to further reduce
subnational sector emissions.
How might any of these global challenges—marked as they are
by tension and contestation—be managed? Waheguru Pal Singh Sidhu
contends that, despite the advent of new challenges, actors, and insti-
tutions in the post-9/11 age, the United Nations (UN) still remains
20 C. ANKERSEN AND W. P. S. SIDHU
Notes
1. America First! 2018. Statement from President Donald J. Trump on
Standing with Saudi Arabia, White House, 20 November. https://
www.whitehouse.gov/briefings-statements/statement-president-donald-j-
trump-standing-saudi-arabia/.
2. Sidhu, W. P. S. 2018. “Global trends: disruptive, dangerous and disor-
derly”, Mint, 26 February.
3. Pinker, Steven. 2012. The Better Angels of Our Nature: Why Violence Has
Declined. New York: Penguin. Pinker’s thesis, of course, has been subject
of much discussion, including pointed critique. The best example of that
is Braumoeller, Bear. 2019. Only the Dead: The Persistence of War in the
Modern Age. Oxford: Oxford University Press.
1 INTRODUCTION: NAVIGATING UNCHARTERED WATERS 21
Michael F. Oppenheimer
M. F. Oppenheimer (B)
Center for Global Affairs, School of Professional Studies, New York University,
New York, NY, USA
e-mail: mo41@nyu.edu
Secular Stagnation
This unbrave new world has been emerging for some time, as US power
has declined relative to other states, especially China, global liberalism
has failed to deliver on its promises, and totalitarian capitalism has proven
effective in leveraging globalization for economic growth and political
legitimacy while exploiting technology and the state’s coercive powers to
maintain internal political control. But this new era was jumpstarted by
the world financial crisis of 2007, which revealed the bankruptcy of unreg-
ulated market capitalism, weakened faith in US leadership, exacerbated
economic deprivation and inequality around the world, ignited growing
populism, and undermined international liberal institutions. The skewed
distribution of wealth experienced in most developed countries, politi-
cally tolerated in periods of growth, became intolerable as growth rates
declined. A combination of aging populations, accelerating technology,
and global populism/nationalism promises to make this growth decline
very difficult to reverse. What Larry Summers and other international
political economists have come to call “secular stagnation” increases the
likelihood that illiberal globalization, multipolarity, and rising nationalism
will define our future. Summers11 has argued that the world is entering
a long period of diminishing economic growth. He suggests that secular
stagnation “may be the defining macroeconomic challenge of our times.”
Julius Probst, in his recent assessment of Summers’ ideas, explains:
…rich countries are ageing as birth rates decline and people live longer.
This has pushed down real interest rates because investors think these
trends will mean they will make lower returns from investing in future,
making them more willing to accept a lower return on government debt
as a result.
Other factors that make investors similarly pessimistic include rising
global inequality and the slowdown in productivity growth…
This decline in real interest rates matters because economists believe
that to overcome an economic downturn, a central bank must drive down
the real interest rate to a certain level to encourage more spending and
investment… Because real interest rates are so low, Summers and his
supporters believe that the rate required to reach full employment is so
far into negative territory that it is effectively impossible.
…in the long run, more immigration might be a vital part of curing
secular stagnation. Summers also heavily prescribes increased government
spending, arguing that it might actually be more prudent than cutting back
26 M. F. OPPENHEIMER
Illiberal Globalization
Economic weakness and rising nationalism (along with multipolarity) will
not end globalization, but will profoundly alter its character and greatly
reduce its economic and political benefits. Liberal global institutions,
under American hegemony, have served multiple purposes, enabling
states to improve the quality of international relations and more fully
2 THE TURBULENT FUTURE OF INTERNATIONAL RELATIONS 27
satisfy the needs of their citizens, and provide companies with the legal
and institutional stability necessary to manage the inherent risks of global
investment. But under present and future conditions these institutions will
become the battlegrounds—and the victims—of geopolitical competition.
The Trump Administration’s frontal attack on multilateralism is but the
final nail in the coffin of the Bretton Woods system in trade and finance,
which has been in slow but accelerating decline since the end of the Cold
War. Future American leadership may embrace renewed collaboration in
global trade and finance, macroeconomic management, environmental
sustainability and the like, but repairing the damage requires the heroic
assumption that America’s own identity has not been fundamentally
altered by the Trump era (four years or eight matters here), and by the
internal and global forces that enabled his rise. The fact will remain that
a sizeable portion of the American electorate, and a monolithically pro-
Trump Republican Party, is committed to an illiberal future. And even
if the effects are transitory, the causes of weakening global collaboration
are structural, not subject to the efforts of some hypothetical future US
liberal leadership. It is clear that the US has lost respect among its rivals,
and trust among its allies. While its economic and military capacity is
still greatly superior to all others, its political dysfunction has diminished
its ability to convert this wealth into effective power.13 It will further-
more operate in a future system of diffusing material power, diverging
economic and political governance approaches, and rising nationalism.
Trump has promoted these forces, but did not invent them, and future
US Administrations will struggle to cope with them.
What will illiberal globalization look like? Consider recent events.
The instruments of globalization have been weaponized by strong states
in pursuit of their geopolitical objectives. This has turned the liberal
argument on behalf of globalization on its head. Instead of interde-
pendence as an unstoppable force pushing states toward collaboration
and convergence around market-friendly domestic policies, states are
exploiting interdependence to inflict harm on their adversaries, and even
on their allies. The increasing interaction across national boundaries that
globalization entails, now produces not harmonization and cooperation,
but friction and escalating trade and investment disputes.14 The Trump
Administration is in the lead here, but it is not alone. Trade and invest-
ment friction with China is the most obvious and damaging example,
precipitated by China’s long failure to conform to the World Trade
Organization (WTO) principles, now escalated by President Trump into
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polymerization of the formaldehyd is almost entirely prevented, and a
dry gas is insured and given off at the pipe (h).
The room should be left closed overnight and thoroughly aired
thereafter. The bare floor must then be scrubbed with hot water and
soda and flushed with a three-per-cent carbolic-acid solution.
As little furniture as possible should be found in an operating
room, and this preferably of undecorated enameled iron.
Instrument Cabinet.—For the instruments and dressings there
should be a dust-proof cabinet of iron and glass, such as is shown in
Fig. 4.
Fig. 4.—Instrument Cabinet.
CARE OF INSTRUMENTS
All instruments should be of modern make, devoid of clefts or
grooves, and having separating locks when possible. Wooden or
ivory handles should be entirely discarded. They should first be
rendered free of dirt or dried blood by
scrubbing briskly with a stiff nailbrush and
hot water; then dried and placed in the
sterilizer. The immersed instruments are
boiled for five or ten minutes. There are
many of such sterilizing apparatuses to
be obtained, all made on the same plan,
however, and consist of a copper or brass
box and cover well nickel plated. Folding
legs are placed beneath. A perforated
tray is placed within for the immersion of
instruments. An alcohol lamp with
asbestos wick furnishes the heat.
One per cent of carbonate of soda
added to the water prevents them from
rusting. The simple subjection of
instruments to carbolic-acid solutions or
antiseptics of like nature is useless.
(Gärtner, Kümmel, Gutch, Redard, and
Davidsohn.)
From the sterilizer the instruments are
placed in a glass tray containing a one-
per-cent lysol solution. Knives, needles,
and scissors should be immersed in a
tray with alcohol, as a great number of
antiseptics destroy their cutting edges.
Glass or porcelain trays are best for this
purpose. A sterilized towel being placed
in the bottom of each for the better
placing of instruments.
Fig. 7.—Irrigator.
After operation all instruments should
again be scrubbed with soap and hot
water, immersed a moment in boiling
water or a jet of live steam, dried with an aseptic cloth, and returned
to the case.
A very effectual means of rendering instruments sterile is to place
them in a metal box and bake them in the ordinary oven (200° F.) for
one hour.
To preserve needles Dawbarn advises keeping them in a
saturated solution of washing soda. Albolene has an unpleasant
oiliness, but is otherwise good. Calcium chlorid in absolute alcohol is
efficacious, but expensive. All rust accumulating on instruments must
be carefully removed with fine emery cloth; this, however, is
unnecessary if the soda solution is used as previously mentioned. It
is well to occasionally dip the instruments (holding them with an
artery forceps) into boiling water as they are used during operation.
The entire stand can be moved away from the wall, to permit of
thorough cleaning of basins, supply pipes, etc. The basins are the
best annealed glass, and are supported by nickel-plated traps, with
connections for vent pipes. The water supply is controlled by foot
valves, which enable the operator to draw either cold, medium, or
hot water at will. The waste is also controlled by a foot valve, as
shown.
The systematic law of cleansing the hands should be insisted
upon at all times. Rules for the method followed might be displayed
in abbreviated form in the operating room by glass or enameled
signs hung on the wall over the basin and reading as follows:
YOUR HANDS
I. Clean nails.
II. Scrub with very hot water and soap for five minutes.
III. Wipe in sterile towel.
IV. Brush with eighty per cent alcohol.
V. Dip into antiseptic solution.
Gowns
The soiled sponges are thrown into a lower empty basin or one
placed at the operator’s feet. As they are removed from the solution
they are squeezed as dry as possible and pressed upon, rather than
wiped across, the operative field. It must be remembered that the
surgeon’s work must not be hampered by slow or inefficient
sponging, and that this procedure must be quick and timely. It is well
for the assistant to become accustomed to the habit of the operator.
The best assistant is one who has acquired a methodical and
regular manipulation, a result dependent upon constant individual
association; such a one is practically invaluable for the skillful
performance of plastic surgery. He becomes not only familiar with
the one thing, but cultivates a ready knowledge of the arrest of
hemorrhage by digital compression when hemostatic forceps would
hinder the ease of work, besides cultivating a happy manner of
holding retractors or spreading the edges of the incisions with the
free hand. As in most of these operations hemorrhage cannot be
controlled by the so-called bloodless method. The assistant must
control the constant oozing by the gentle pressure of the sponge
quickly applied at short intervals. When the sponges are squeezed
out in salt solution, as hot as the hand will bear comfortably, capillary
oozing is more readily overcome.
STERILIZATION OF DRESSINGS
All dressings to be used in covering wounds, post operatio, or
otherwise, must be as scrupulously clean and free from infection as
the hands and the instruments of the operator. This is done by
means of sterilization by dry heat or steam under pressure. For all
minor cases, small apparatuses only are needed. They are usually
made of copper, often nickel-plated, and so constructed as to contain
a lower perforated instrument tray and another, placed above it, for
dressings. The two are fitted into an outer copper receptacle with
snugly fitting cover. A folding stand is furnished upon which this
arrangement is placed, and an alcohol lamp with asbestos wick
furnishes the heating power. The lower tray is covered with water
which, by boiling, fills the upper compartment with steam evenly
distributed and with sufficient pressure to accomplish sterilization in
from thirty to sixty minutes. Metal hooks are provided with which the
trays can be removed. A complete and compact outfit, as designed
by Willy Meyer, is shown in Fig. 13.
In the above sterilizer, or in those of similar type, there is naturally
more or less saturation of the dressings and the possibility, in the
event of the entire conversion of the water contained therein into
steam, of injuring the instruments by excessive heat. To overcome
this defect the Wallace sterilizer may be advantageously employed.
Fig. 13.—Willy Meyer Sterilizer.