PERFORATING GUNSHOT WOUNDS OF THE ABDOMEN
REMARKS ON A CONSECUTIVE SERIES OF TWENTY-SEVEN CASES WITH THREE DEATHS
BY LEGRAND GUERRY, M.D., F.A.C.S.

OF COLUMBIA, S. C.

THE management of penetrating gunshot wounds of the abdomen is the great branch of emergency surgery in which Southern surgeons have played a very conspicuous part. The late Dr. Hunter McGuire, in a paper read before the Virginia Medical Society in November, 1873, not only advised, but urged, the treatment of these cases by exploratory coeliotomy. As far back as i6o6 Fallopius advocated enlarging the external opening to expose intestinal injuries and to practise enterorrhaphy. Between i6o6 and I849 the same opinion occurs a number of times in the literature. In I849, however, Pirogoff definitely expressed himself in favor of a similar practice as being the only way to prevent death. He enlarged somewhat on the opinion of Fallopius and really advised more of a systematic operation. In I863 Legouest wrote as follows: "In lesions of the intestines by cutting weapons attended by extravasation of solid or liquid contents, and in shot wounds, it is then proper to enlarge the external wound with the bistoury, to draw the intestine outward and close the solution of continuity by suture." In I865 the very opposite opinion was expressed by Hamilton in his treatise on military surgery in which he says, " be assured that the patient will have a better chance for life if we let him entirely alone, and it surprises us that any good surgeon should think otherwise." Even Erichsen, as late as i873, subscribed to a very compromising attitude about the management of intestinal perforations. He was not at all convinced in his own mind that surgery furnished even the best, say nothing of the only way, out of the difficulty. I have mentioned only a few of the surgeons whose work led up to the modern treatment of such conditions. An excellent article by McRae, of Atlanta, Ga., will give a splendid resume of the history of this subject to those who are sufficiently interested to read it. As has already been indicated, the first real logical, clear-cut and sound statement of surgical principles and practice involved in the management of perforating gunshot wounds of the abdomen was given by the late Dr. Hunter McGuire before the Virginia Medical Society, in November, I873. Dr. McGuire wrote as follows: " The wound in the abdominal 694
wall should be enlarged, or the linea alba opened freely enough to allow a thorough inspection of the injured parts. Hemorrhage should be arrested. If intestinal wounds exist, they should be closed, trimming their edges first if they are lacerated or ragged, blood and other extraneous matter should be removed carefully, and then, in my opinion, provision should be made for drainage. If the original wound of entrance is dependent, drainage may be secured by keeping this open. If the wound is a dependent one and the aperture of exit dependent, the patency of this should be maintained, and, if necessary, a drainage of glass or other material inserted. When there is no wound of exit and the aperture of entrance is not dependent, then a dependent counteropening should be made and this kept open with a drainage tube. If it is urged that the means suggested are desperate, it can be said in reply that the peril is so extreme in cases as now treated that nearly all die, and I believe by the means I have pointed out in gunshot wounds of the abdomen the patient will exchange an almost certain prospect of death for at least a good chance of recovery." So we see that the principles of surgery as laid down by Dr. McGuire in I873 furnish to-day the real ground-work for modern practice. Certainly Dr. McGuire was a bold, free and original thinker, and I might add in passing that he really did pioneer work in establishing the rational treatment of abscess appendix cases. The next great impetus given to the management of gunshot wounds of the abdomen came from that truly creative genius and pioneer surgeon of the South, J. Marion Sims. We are in the habit of thinking of Dr. Sims's work as having to deal only with diseases of women. His work, of course, in this direction was extremely great. He was, however, a most accomplished surgeon. In i88i in an article which appeared in the British Medical Journal, Dr. Sims, in discussing the question of gunshot wounds of the abdomen, expressed the following opinion: " Given a case of penetrating abdominal wounds, one should open the abdomen promptly, clean out the peritoneal cavity, search for the wounded intestine, pare its edges and bring them together with suture and then treat the case as we now treat other cases of injury involving the peritoneum. Rest assured that the day will soon come when, with an accurate diagnosis in such cases, followed by prompt action, life will be saved that otherwise must quickly ebb away." Shortly after Dr. Sims's paper, there occurred an article by R. A. Kinloch of Charleston, S. C., on gunshot wounds of the abdomen treated by opening cavity and suturing intestine. This paper was published in the North Carolina Medical Journal of July, I882. This paper not only reported a success695

LEGRAND GUERRY

ful case, but in a straightforward and comprehensive way, advised treatment of such cases by exploratory cceliotomy. The paper of Kinloch's is entitled to rank with the work of McGuire and Sims. We think it but just and fair to say that the paper of Dr. McGuire before the Virginia Medical Society in I873, the paper by Dr. Sims in the British Medical Journad in i88i, and the paper by Dr. Kinloch in I882 really established the operation and placed it on a safe and sound surgical basis. The principles laid down by them furnished the basis of surgical work to-day. It is extremely interesting to note the reduction of mortality: According to Matthews, among the British soldiers in the Crimean War the mortality in penetrating wounds of the abdomen was 92.5 per cent., and in the small per cent. of recoveries the proof is not positive that all wounds were perforating. Chenu gives the mortality among the French soldiers as 91.7 per cent. Otis has collected 3717 cases of gunshot wounds of the abdomen during the late American War and gives the gross death-rate at 87.2 per cent., and in 2599 cases where positive visceral injuries had taken place 92.2 per cent. died. In Moynihan's " Abdominal Operations," I914 edition, you find the following paragraph: Dr. Fetner (ANNALS OF SURGERY, VOl. XXXV, P. 15) reports six cases. of penetrating wounds of the abdomen treated by operation and gives statistical tables of 152 cases treated at the Charity Hospital, New Orleans, between January, i8ga and January, igoi. There were 96 cases of gunshot wound of the abdomen with visceral injury. Of these 7i died-a mortality equivalent to 73.95 per cent. Such a death-rate is, of course, appalling. The mortality in cases
operated on under modern conditions, such as the character of the projectile, is considerably lower than those of the American War. The most striking thing in the whole situation has been the gradual lowering of the death-rate until now it is quite common in the literature to find series of cases operated on with the mortality ranging from 15 to 25 per cent. and in some instances possibly lower than this. About 3 per cent. of all gunshot wounds received in battle involve the abdominal cavity, and about o.8 per cent. of abdominal wounds fail to injure the intestines. In other words, o.8 per cent. only of penetrating wounds of the abdomen fail to produce perforation of either the hollow or solid viscera. The question raised by this statement as to which cases would be explored is so plain " that he who runs may read." In December, 1907, at the New Orleans meeting of the Southern Surgical and Gynaecological Association, I reported a series of eight consecutive, unselected cases of penetrating and perforating gunshot
wounds of the abdomen, with one death. Up to the present time I9 other cases have been added to this list with 2 more deaths and it is to this series of 27 cases with 3 deaths that I now particularly wish to direct your attention. A brief summary of these cases may be interesting. The youngest case operated on was seven years, the oldest fifty-seven years. The average length of time that elapsed between the shooting and operation was between 8 and 9 hours. The earliest case operated on was 3 hours, and the latest 36 hours after injury. The smallest number of perforations was 2, and the largest 22. The average number of perforations for the entire series about 9. In 5 cases the injury was confined to the upper abdomen (above the umbilicus), and in 3 other cases both lower and upper abdomen were involved. Of the 5 cases in which the upper abdominal cavity was the seat of injury, once there were two perforations only in the transverse colon; 3 times colon, stomach and liver were injured, and once spleen and stomach. Of the 3 in which both lower and upper abdomen was involved, twice, besides three perforations to the small intestines, both colon and stomach were injured, and in i case with two small intestinal holes both colon and spleen were penetrated. In the remaining I9 cases the projectile did not enter the upper abdomen. The ureter was divided low down in i case and we have been fortunate enough not to have had any of the great trunk vessels injured except in 2 cases that died. In about i,o cases there was a very serious hemorrhage from the injured mesenteric vessels. The element of shock was very much more marked in the white than in the colored cases; in more than half of the colored cases the amount of shock present was a negligible factor, while only 3 out of the 12 white cases were not in a condition of serious shock, there being I2 white and I5 colored cases. The only certain way to determine whether or not perforations have occurred is by operation and this should be done in practically every case. There should be no surmising whether the bullet has entered the abdomen and produced perforation or not. This question should be settled by exploratory cceliotomy. Contrary to the general belief our opinion is that one should not be too precipitate in operating on these patients. I do not wish to be misunderstood here, for certainly things being equal, the surgeon who operates promptly after injury, who gets into the abdomen and out of it quickly, will have the best results. There is a vast difference between an operation quickly done 697

and one that is hurriedly done. I am also satisfied in my own mind that anything like an extensive soiling with peritonitis does not and cannot occur within 4 or 5 hours and there is strong evidence to show, owing to the paralysis of the bowel from the local and general shock of the trauma, that escape of intestinal contents does not occur markedly for 2 or possibly 3 hours. We are convinced, therefore, from a viewpoint both practical and theoretical, that while operation should be promptly done, it should not be hurriedly done. I am on dangerous ground right here; the point I wish to make is this: Not all, but quite a few, of these cases, especially where shock is present and hemorrhage not serious, will be made safer surgical risks by allowing them a reasonable time in which to react from the primary effects of the injury. Already some one has raised the question, how are you going to differentiate between shock and hemorrhage. My answer is, it cannot always be done, but, to the thoughtful man with training and experience, he will be able quite frequently to make the distinction. To me this is one of the very vital points in the paper, for we are convinced that a reasonable observance of this suggestion will occasionally turn the tide in our favor. After all, it reduces itself to a question of the surgical judgment, intuition and instinct of the individual operator. Within limits that are reasonable, barring unusually severe injuries, the ordinary case is a good surgical risk when operated on between four and twelve hours after the injury. Some one has made the statement that the elapse of 12 hours or more between the occurrence of the accident and performance of the operation constitutes a contra-indication to operation. We take sharp issue with this statement, and, in support of the contention, submit the following: One case was operated on 24, one 36, one I8, two I2 and one 17 hours after injury and only one of these cases died. This is considered a sufficient answer to the above. If a patient suffering from one of these injuries presents himself for operation and has only one chance in a thousand to recover under surgical treatment, he should be given that chance and any time limit up to the point of the patient being moribund should be considered artificial. Injuries above the umbilicus are more dangerous, harder to manage, and have a higher mortality than injuries to the lower abdomen; injuries to the large bowel we believe to be more dangerous than injuries to the small bowel, and for this reason, the contents of the small bowel are fluid and move rapidly, the fecal current reaches the caecum and ascending colon where fluids are rapidly absorbed. The current becomes very stagnant. In the caecum and that portion of the large intes698

tine where the storage function is greatest, conditions are ideal for the multiplication of bacteria and the intestinal flora attain their greatest virulence. Wounds which involve both large and small intestine are particularly dangerous, especially is this true where the portion of big bowel involved is caecum or ascending colon. When such an injury accompanied by extensive hemorrhage is present, all the conditions necessary for a rapidly developing peritonitis are at hand and the highest mortality can be expected. Our practice is to bring the patient directly to the operating room, where he is warmly wrapped and prepared for operation. He is given enough morphine to keep him from suffering and to help him recQver from shock. Unless the patient is in first-class shape, he is given intravenously one or two pints of normal salt solution. When it is pot desirable to give the salt solution directly into the veins, it can be given subcutaneously. When a donor is available, the condition- of hemorrhage and shock can best be met by a direct transfusion of blood. When everything is in absolute readiness, we allow, according to indications, a reasonable time in which the patient can react before making the incision. The median abdominal incision is chosen under ordinary circumstances for reasons obvious to all. A very important matter in these cases is to get a correct idea of the track of the bullet, for in this way one is occasionally able to save much time and avoid a great deal of unnecessary handling of vital parts. Particularly should we be careful in handling the abdominal viscera which are painless to the sense of touch. It has been shown very recently in a splendid article in the British Journal of Surgery, for October, I914, by Charles A. Pannett of London, that "Afferent impulses resulting from manipulation of the viscera have in general a more pronounced effect on the vasomotor centre than those resulting from the opening of the abdomen and the retraction of the edges of the wound." It would seem, therefore, that the handling of the intestines, which is painless in the ordinary understanding of the term, is a more serious thing than handling of the parietal peritoneum and skin, which are extremely painful to injury. The principle, therefore, in all such work, should be as gentle manipulation as possible. It is extremely important to make a careful and systematic search of the entire intestinal tract. Our practice is to begin at some fixed point, generally at the junction of the small and large intestine, and while it is most unfortunate generally all of the small intestine has to be inspected. The large bowel can be treated with greater liberty. Each perforation is clamped as found and healthy intestine returned

to the abdomen. The large bowel is then gone over. Quite occasionally it is evident from the direction of the bullet that inspection of the entire cavity would not be necessary, but this question must be left to the surgical understanding of each individual surgeon. Whether or not to irrigate the abdomen is another point about which there is much difference of opinion. In practically all cases in this series general irrigation of the abdominal cavity through a Blake's two-way irrigator was practised. This instrument is so constructed that the entire cavity can be irrigated without losing any time whatever in the operation or exposing the viscera to any unnecessary handling. The position of the irrigator is simply changed from one point to another as desired. We have never been able to see where it was harmful to gently irrigate the abdomen with hot normal salt solution in the presence of extensive infection. The more diffuse the peritonitis the greater the necessity for irrigation. The advantages to be gained by it are more than one and must be apparent to all of us. Occasionally where there is very limited soiling, irrigation has been dispensed with. We do not practise irrigation in peritonitis from any other source. The question has been frequently asked, why do you irrigate in gunshot wounds of the abdomen and do not irrigate, for example, in a case of peritonitis from a ruptured appendix? This is a fair question and our answer is as follows: In a case of peritonitis from a ruptured appendix, there is, as a general rule, one orifice from which the infection comes. The soiling process is much slower and nature has a much greater opportunity to successfully localize and combat the spreading infection. There is, we believe, an unmistakable tendency towards successful localization of the infected area in peritonitis'coming from this source, owing to the relative smallness of the peritoneal soiling, the natural forces working in the patient's behalf; to wit, his opsonins, his leucocytes, his resistance and ability to overcome the infection and develop immunity are far greater than, for example, in a gunshot wound of the abdomen that penetrates transversely the abdomen, opens the intestinal tract in possibly twelve or fifteen places, which will surely in a very short while turn loose an overwhelming amount of infectious material into the peritoneal cavity. While such a patient does not develop, in the full meaning of the word, a general peritonitis at once, he will certainly very promptly have a general soiling of the cavity. To put the case in a sentence, nature has a chance in one instance against what is a very small chance in the second instance. In the first case, she can care for a limited amount of soiling, in the second case the amount of infectious material is so great that she is overwhelmed. This we 700

believe to be the dividing line between irrigation and non-irrigation. At any rate, it is the basis of our reasoning and furnishes justification for the practice, bearing in mind always, with the method described above, the cleansing of the cavity and removing of infectious debris can be accomplished without handling of the viscera or, what is even worse, pulling on the mesentery or without unnecessary loss of time. We must also remember that hours and sometimes days will elapse between the onset of acute inflammatory process and the occurrence of perforation. All during this interval between the acute attack and perforation, nature is getting ready to take care of the perforation when it occurs. The whole natural armament has been called out. The peritoneal cavity is in a very real sense not taken by surprise, but is prepared for the attack. The omentum is on its way, the leucocytes, the turbid lymphatic exudate which we find in so many of these cases is purely a conservative process and in conjunction with the other helpers at hand in the great majority of instances will successfully localize the infection. Dr. Hunter McGuire and Dr. Sims both insisted on drainage. In our humble opinion this was a profoundly wise judgment on their part. We drain every case. I do not wish to appear dogmatic, but the rule should be-when in doubt, drain. A Keith's glass drainage tube is placed through the angle of the median incision into the Douglas pouch; depending on conditions a small Keith's tube is so placed as to drain' each loin. On the patients' returning to bed they are'placed in the exaggerated Fowler position unless the patient is so weak as to-contraindicate it. This position one can get very readily by using the ordinary hospital roller chair. The continuous rectal instillation of normal salt solution is practised unless the large intestine has been injured. We stress the point that it is necessary to be very careful about suturing any rent in the mesentery, as occasionally one can have through such a rent an incarcerated bowel with obstruction. About 5 per cent. of these injuries die from tetanus, consequently on the first, fourth and sixth days after injury they are given an immunizing dose of antitetanic serum. If in the course of operation a segment of bowel is found with a number of perforations occurring close together, it will be conservative and occasionally life-saving to resect the intestine instead of suturing the individual perforation. Quite occasionally we have had recourse to this expedient. In certain cases where. one finds a portion of intestine of doubtful vitality, the patient's condition being extreme, a good thing has been found to bring such a piece of intestine into the wound, isolate it from
the rest of the peritoneal cavity by gauze sheets, leaving it here in a safe position to watch until such time as it can be repaired should it become necessary. It is better to assume this risk than to force an already overtaxed patient to stand a prolonged operation that may be fatal. The late Dr. Homans, of Boston, once said that nine out of ten men knew what to do, but the tenth man knew what not to do. This statement is never more applicable than in relation to the subject under discussion. As to the length of time to be occupied in these operations: These cases shotild be operated on just as quickly as is commensurate with thorough and careful work and no quicker. While the work should be rapidly done, it should not be hurriedly done, for there are other questions at stake and other things to be considered than the number of minutes taken to do the work.

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PlexoTM
surface-mounting, supplied complete

Lamp d supplie

697 09

697 12

697 33

697 39

Mechanisms supplied complete, with back box and 2 membrane glands

Pack Cat.Nos

Switches 10 AX - 250 VA
IP 55 IK 07 Automatic connection Two-way switch Intermediate switch Two-way switch with indicator Supplied with 230 V lamp

Cat.Nos

Socket outlets
German standard 16 A 250 V
2P + E with earth lateral contact with screw terminals British standard 13 A 250 V

697 32

2P + E screw terminals

697 13

Illuminated two-way switch Supplied with 230 V lamp
2 x 2P + E screw terminals

697 15

Two-gang two-way switch

697 31

French standard 16 A 250 V 2P + E with shutters for child protection, automatic terminals

Push-buttons 10 A

IP 55 IK 07 Automatic connection
Socket outlets 20 and 32 A
Screw connection 20 A IP 55 IK 08

697 21

N/O contact Illuminated N/O contact Supplied with 230 V lamp

916 55

2P + E 230 V

Movement detectors

IP 55 - IK 04 Automatic connection Allows control of a lighting device as soon as the movement is detected Maximum load: - 2000 W for incandescent and halogen lamps 230 V and - 2000 W for ELV halogen lamps, - 1000 VA for fluorescent tubes and compact fluorescent lamps Detection range from 0 to 12 m Coverage pattern adjustable during installation process Temporization between 12 s and 16 min. Dim. 90x90x85 mm

916 56

3P + E 400 V

916 57

3P + N + E 400 V 32 A IP 55 IK 08

558 72

558 75

697 40

697 80

Detection angle : 360

558 77

3P + N + E 400 V

Accessories for socket outlets

919 15

Membrane glands for 20 A socket outlets Membrane glands for 32 A socket outlets
flush-mounting, supplied complete
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698 31

698 55

698 24

Rigid conduits: the solution that simplifies the installation process when you deal with weatherproof surface mounting wiring devices.
Mechanisms supplied complete

Switches 10 AX 250 VA

IP 55 - IK 07 Automatic connection

698 11

698 51

Two-way switch

698 21
IP 55 - IK 07 Automatic connection Illuminated changeover pushbutton (N/O + N/C contact) Supplied with 230 V lamp

698 64

Illuminated changeover pushbutton (N/O + N/C contact), with label holder Supplied with 12 V lamp Can be equipped with 230 V lamp
Socket outlets 16 A - 250 VA
Automatic connection French standard IP 55 IK 70 2P + E with shutters for child protection, automatic terminals

698 33

698 69
German standard IP 55 IK 07 2P + E with earth lateral contacts, with screw terminals

Socket outlets 20 A

IP 44 - IK 08 Screw connection 2P + E 230 V 3P + E 400 V 3P + N + E 400 V Surface-mounting box for 20 A sockets Cat.Nos 557 03/06/08 Dimensions : 79 x 86 x 40 mm
Surface mounting with an IP guaranteed

903 59

Rigid conduits: - a very simple, cost effective solution - the membrane of the end-cap compensates for any misalignment of the tube and ensures IP 55 - easy to install thanks to the integrated coupling - surface mounting for interior or exterior use - complete range of accessories

Surface-mounting box

Surface-mounting box for 20 A sockets Cat.Nos 557 03/06/08 Dimensions : 79 x 86 x 40 mm
These products are part of weatherproof wiring accessories > See p. 738-739

modular mechanisms

695 13

695 25

695 02

695 17

695 34

695 47

Mechanisms supplied with cover plate Installation with surface-mounting boxes or flush-mounting support frames (p. 746) Automatic connection

IP 55 - IK 07

Light sensitive switches, 230 VA
Light sensitive switch 1 function - IP 55 - IK 07 Can be used to switch a lighting circuit ON and OFF based on light conditions (nightfall, daybreak) Supplied in one piece, inlcuding photoelectric cell Maximum load: - 1400 W incandescent and halogen lamps 230 V - 400 VA fluorescent tubes Luminosity threshold: 0,5 to 1500 lux Photoelectric cell IP 55 For use with modular light sensitive switches Cat.Nos 037 21/23/25 (p. 178)

10 10|5

695 12

696 12

Two-way switch Two-way switch with indicator Supplied with 230 V lamp Illuminated two-way switch Supplied with 230 V lamp

696 13

695 18

695 30

Double pole switch
Key-operated switches 3 A - 250 VA
Automatic switches, 230 VA

Grey/White

695 00
Without neutral - 2-wire connection - IP 55 - IK 07 Can be used instead of a 1 way switch No additional wiring required Operates: 60 to 300 W incandescent and halogen lamps 230 V Temporization: 6 s to 6 min. Detection angle: 130 Luminosity threshold: 3 to 1000 lux Maximum detection range: 8 m (adjustable) With neutral - 3-wire connection - IP 55 - IK 07 Operates: 500 to 1000 W - incandescent and halogen lamps 230 V - ELV halogen lamps - fluocompact Temporization: 1 s to 16 min. Detection angle: 180 Luminosity threshold: 3 to 1000 lux Maximum detection range: 8 m (adjustable)
Supplied with RONIS key n 455 Key removable in all position 2 positions marked 0 I 2 N/O contacts 2 positions marked I 0 II 2 N/O contacts

695 35

Emergency stop functions 3 A 230 VA

Grey/Yellow

Supplied with emergency stop label in 8 languages. Yellow cover plate, red button Emergency stop button 1 N/C contact 1 pole Emergency stop with key for reset N/O + N/C contact Key RONIS n 455 supplied Key removable in 0 position Emergency stop - stay put 1/4 release Key removable in 0 position N/O + N/C contact

695 48

695 49
IP 55 - IK 07 N/O contact Illuminated, N/O contact Supplied with 230 V lamp
Illuminated time lag switch - 250 V

695 04

695 42

696 04

Electronic - IP 55 2-wire connection Supplied with lamp Temporization: 25 s to 15 min. Maximum loads: - W incandescent and halogen 230 V - 400 W halogen 130 V - 400 VA ELV halogen lamps - 400 VA fluorescent lamps - 2300 W resistive (heating)

PlexoTM IP 55 - IK 07

695 71

695 76

695 60

695 80

6806 33
Mechanisms supplied with cover plate Installation with surface-mounting boxes or flush-mounting support frames (p. 746)

RJ 45 data socket

696 39
2P + E with earth lateral contact with screw termnals 2P + E with earth lateral contact with automatic terminals British standard 13 A 250 V
RJ 45 cat. 6 - FTP 9 contacts

695 70

696 40

Accessories

Can be equipped with any 2 modules Mosaic functions (except specific mechanisms with depth > 18 mm) in order to obtain an IP 55 wiring device Adaptor with smoked polycarbonate flap Adaptor with smoked polycarbonate flap lockable with special tool Cat.No Special tool for adaptor Cat.No Adaptor without flap (IP 20)

695 85

2P + E screw terminals French standard 16 A 20 V 2P + E with shutters for child protection, automatic terminals 2P + E tamperproof, screw terminals 2P + E automatic opening of the flap, automatic terminals Tamperproof insert for socket Fits directly into the plug

695 51

696 21

695 79

695 53

919 45

695 55

695 82

502 99

6806 32

Prewired socket outlets 16 A - 250 V
Automatic terminals One piece mechanism, only one connection required For two or three gang surface-mounting boxes or flush-mounting supports German standard 2 x 2P+E horizontal
For 3 Mosaic or Vela modules Weatherproof IP 55 frame with membrane Allows operations of switches without opening cover maintaining IP 55 rating Standard claws Long claws

100 50

849 01

695 77

2 x 2P+ E vertical

PlexoTM IP 55 IK 07

surface-mounting boxes and flush-mounting support frames

696 51

696 72

696 68

696 92

696 85

To be equipped with modular Plexo mechanisms (p. 744 - 745) The surface-mounting boxes are equipped with Nylbloc automatic connection terminals for 2 wires (optional use for junction)

Surface-mounting boxes with membrane glands
Equipped with removable membrane glands Direct entry of cables (No need to be cut) 1 gang 1 entry 2 gang No separation between compartments, in order to facilitate the cabling operations and to allow the installation of pre-wired socket outlets
Flush-mounting support frames

696 81

Used for flush-mounting version for French and German standard boxes only White 1 gang For 1 Plexo mechanism Can be equipped with claws Cat.No. / gang 71 mm fixing centres 2 gang, for 2 Plexo mechanisms, horizontal mounting 2 gang, for 2 Plexo mechanisms, vertical mounting

696 89

696 83

696 90

2 gang, 2 entries

696 61

696 91
2 gang, vertical mounting 2 entries
Surface-mounting boxes for cable glands

Grey ISO 20

696 56
1 gang 1 entry 2 gang, vertical mounting 2 entries (2 top)

696 78

2 gang, horizontal mounting 2 entries (2 top)
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German standard socket outlet with cover

10 A switch

IP 55 PlexoTM antibacterial

Artic white

707 61

707 83

707 11

707 22

707 92

707 72

Antibacterial range based on Ag + silver ions An additional way to ensure non-proliferation of bacteria, without interfering with cleaning protocols Particularly suited to small spaces with strict hygiene requirements: healthcare establishments, industrial kitchens, nurseries IP 55 - IK 07 Connection with automatic terminals

Complete units

Mechanisms supplied complete Switches 10 A - 250 V

Modular units

Mechanisms supplied complete with cover plates Boxes and support frames supplied with pre-clipped plate Switches 10 AX - 250 V
2-way switch Push-buttons 10 A - 250 V Illuminated NO + NC push-button Supplied complete with 230 V lamp Illuminated NO + NC push-button with label-holder Supplied complete with 12 V lamp

707 26

2-way switch Double pole switch 2-gang two-way switch

707 82

5/50 5/50 5/50

Socket outlets 16 A - 250 V German standard 2P+E German standard 2P+E with claws French standard 2P+E 707 72

707 32

Pushbuttons 10 A - 250 V NO push-button Illuminated NO push-button Supplied complete with 230 V lamp Illuminated NO push-button with label-holder Supplied complete with 12 V lamp Socket outlets 16 A - 250 V French standard 2P+E with safety shutters With protective ap German standard 2P+E with safety shutters With protective ap

707 33

707 21
TV-R-SAT socket For terrestrial and satellite installation with individual demodulator For receiving analogue and digital programmes (DTT, satellite channels, etc) Fitted with an automatic connection terminal for connection of the coaxial cable Cable outlet 16 A - 250 V With cable grip Attaches to the frame with 82 mm xing centres Takes ush-mounting boxes 67 mm max. Plate supports For ush-mounting in boxes (p. 732) 1-gang Can be tted with claws Cat.Nos 849 00/01 (p. 745) 2-gang horizontal mounting - Fixing centres 71 mm 2-gang vertical mounting - Fixing centres 71 mm Boxes with membrane glands Membrane glands, removable and pierceable without cutting 1-gang 2-gang horizontal mounting 2-gang vertical mounting

707 49

707 43
Catalogue numbers in red: New products.

PlexoTM 66 IP 66 - IK 08

flush-mounting
mechanisms, boxes and accessories

6845 70

6846 28
White RAL 9010 Polypropylene/ABS housing Temperature rating: - 20 to + 40 C (+ 50 C for short periods) Supplied without back boxes Stainless steel captive terminal screws supplied in backed-off position Supplied with flush-mounting gasket Can mount directly on to standard metal flush boxes IP 66 - IK 08 Supplied without lamps
2 finishes: - Grey RAL 7016/TO 29.- White RAL 9010 Supplied with ISO 20 membrane glands and caps (for rear cabling) Stainless steel captive terminal screws supplied in backed-off position

20 A - 250 VA switches

Conform to BS EN 60669-1 Fitted with rear gasket with groove to deposit Grey silicone 1 gang Two-way switch - SP 2 gang Two-way switch - SP 1 gang 1 way switch - DP
Conform to BS EN 60669-1 Flush-mounting gasket is not required when fitting these mechanisms on to back boxes Cat.Nos 6845 89/90/gang 2 way switch - SP 2 gang 2 way SP

6846 02

6 A - 250 VA push-buttons

6845 56

1 gang 1 way DP + indicator

6846 11

1 gang Two-way switch - SP with "Bell"
13 A - 250 VA fused spur units 6 A - 250 VA push-button

6845 60

1 gang 2 way SP retractive switch
Conform to BS 1363: Part 4 Fitted with rear gasket with groove to deposit silicone 1 gang - DP switched

6846 45

13 A - 250 VA socket outlet
Conforms to BS 1363 : Part 2
13 A - 250 VA socket outlets
Conform to BS 1363: Part 2 Fitted with rear gasket with groove to deposit silicone 1 gang Switched socket with opaque lid 1 gang unswitched socket with opaque lid 1 gang unswitched Accepts moulded plugs with side outlet 2 gang unswitched

1 gang switched

Mosaic adaptor

6845 85

2 modules with opaque lid

6846 19

Mosaic adaptors

6846 38

2 module adaptor with semi-transparent lid 3 module adaptor with semi-transparent lid