235

pairs of mouse-tooth forceps are needed-one long and one short.

FIG. 106.-Hunter's forceps. I use these for applying dressings.

Hemostatic Forceps.-Four Sims' artery forceps (Fig. 107), eight pairs of Pryor's hysterectomy forceps

J.REYNDERS & CO

FIG. 107.-Sims's stout artery forceps.

90

(Fig. 108). These latter are strong, and have transverse serrations. The blades are one and a half inches long.

JOHN REYNDERS & CO NEW YORK.

FIG. 108.-The author's forceps. No handles are in the way of the patient's

movement.

I use the needle-holder of Sims, and any stout halfcurved needles (Fig. 109) with bayonet points. The best instrument for giving high enemata after operation

is a Wales bougie (Fig. 110). To secure the patient's legs I employ Ott's crutch.

LOHN REYNDERS CO.

FIG. 109.- Sims's needle-holder. The simplest and best.

JOHN REYNDERS-CO, NEW YORK.

FIG. 110.-Wales bougie for giving high saline injections.

OPERATING TABLE.

I have devised and for a long time used the one shown. It can be employed for any kind of gynecological work, and is portable. (See Figs. 56, 57, 58.) Without it, much of my pelvic work would be most difficult and tedious. The distances in America are so great that those of us who operate over the entire country must go prepared for any work. My table is strong enough for the heaviest woman, and weighs seventy pounds. It is dressed for the operation with blankets and a rubber sheet, or piece of oil cloth. The shoulder brace can. slide on the table, so as to support any size of body.

FORMULAE.

Thiersch Solution.-Boric acid crystals, 12 parts; salicylic acid crystals, 2 parts; water, 1000 parts. Tablets to make one quart are sold by Reeder Brothers, Thirty-first Street and Fourth Avenue, New York.

Normal Salt Solution.-This is a .7 per cent. of sodium chlorid in water.

Solution of Quinin.—Quin. sulph. grs. xx, acid tartaric grs. xvii, aquæ iii. Give warm by rectum.

Lysol. This is five times as antiseptic as carbolic acid, and but one-eighth as poisonous. I use it for my hands as a 2 per cent. solution, and on the patient in a I per cent. solution. It soponifies fat and cleanses

mechanically as well as chemically.

Iodoform Gauze.-The gauze is sterilized. It is then dipped in a 5 per cent. or 10 per cent. solution of iodoform, in ether, and laid on a sterile sheet to dry. When dry, it is blue and unfit for use. It is now dipped in a hot bichlorid of mercury solution, I : 4,000, when the yellow color returns. It is wrung as dry as possible and packed in glass jars. The mouths of these are stuffed with cotton, after which the jars are inverted in a steam sterilizer and sterilized for an hour. The dressing is expensive, but as it is non-poisonous, and requires renewal once where other dressings are changed three times, it is worth the difference. It can be readily made by a careful nurse or assistant. I am using the 2 per cent. and 5 per cent. strengths more than formerly, and find them as good as the stronger.

Chicken Broth.-A fowl is cleaned and skinned. It is chopped into pieces, bones and flesh. These are put into three quarts of water, and actively boiled for eight hours. As the water evaporates, the quantity is kept to three pints by adding boiling water. Strain into a clean

bowl and put on ice. This jelly is heated when needed. The flesh of fowl is the only flesh that dissolves in water. This is the first food my patients get after operation.

Beef Juice. The steak is broiled medium, chopped up and squeezed in a press or lemon squeezer. It is served warm.

Nutrient Enema.—One raw egg, two ounces squeezed beef juice, two ounces milk, one tube of Fairchild's peptonizing powder, warm to 100°. Give this once in four hours.

STERILIZATION.

The Surgeon. It is exceedingly important that the operator's hands be technically clean, even in dealing with pus cases; but it is difficult to obtain absolutely aseptic hands. The finger nails should be short. The sleeves are rolled up to the biceps, and the hands and arms are scrubbed with hot water and soap. At least five minutes should be devoted to this. This will soften the nail filth. A sterilized sharp steel nail cleaner is used to cleanse the nails. Particular attention should be paid to the base of the nails, as here the loose epithelium is most often found. Not only is all dirt under and behind the nails removed, but the nails should be scraped as well. They are again scrubbed with the brush. The operator hollows his left hand and fills it with chlorid of lime, "bleaching powder." He adds to this a little water and makes a paste in his hand. Selecting a stick of carbonate of soda, "washing soda," he rubs this into the lime paste, and over his hands and arms. The soda is

used much as a cake of soap would be. As he continues the process, he will notice that the grains of lime gradually disappear, and when no more grains are present, he puts aside the soda, and washes off the white paste. By this procedure he develops upon his hands. and arms nascent chlorin gas, a most powerful disinfecBoth the essentials can be procured at small cost

tant.

anywhere. After doing this, the hands are almost certainly clean; but I go further, and scrub the nails and hands in 2 per cent. lysol solution, after which they are rinsed in Thiersch solution. The operator now puts on a sterile gown, and is prepared to operate. While thus preparing himself, one of his assistants who has previously sterilized his hands, has been cleaning the patient's buttocks and vagina. (Vide "Preparation of Patient.") During the operation the surgeon frequently washes in Thiersch solution.

Instruments.-These are boiled in 5 per cent. carbonate of soda solution for fifteen minutes, the knives and scissors being given half this time. The boiling water is poured off, and the instruments allowed to cool or are cooled by cold boiled water. No instrument pans are used, but the instruments are laid out upon a sterile sheet and kept covered from dust. The boiling soda solution not only sterilizes them, but dissolves all fat, pus, and blood upon them. Chemical sterilization, as by formaldehyd gas, is uncertain. I usually boil the nail scrubs with the instruments.

Rubber Goods.-The rubber irrigator (fountain syringe) is half-filled with water and the clip loosened. It, together with the vaginal brush and self-retaining catheter, are boiled in plain water fifteen minutes.

Irrigating Fluids.-I use boiled normal salt solution or boiled boric acid solution 4 per cent. But I have about abandoned irrigation except to wash out large uteri after curettage.

Transfusion Fluid.-Ordinary table-salt is dissolved. in soft water to make a 1% of I per cent. solution. It is then filtered and boiled in a new kettle, the neck of which is plugged with cotton. This solution is cooled to about 105° F. In handling it, care should be taken not to agitate the contents of the kettle, lest sediment be put in suspension. Whenever there is sediment in the solution, it should be carefully strained through several thicknesses of sterile plain gauze into the transfusion funnel. The gauze may be tied over the spout of the kettle. This