alcohol after the parts have been thoroughly cleaned, and then a not too strong solution of bichloride-from 1/2000 to 1/5000 being sufficient. Great care is to be exercised by the nurse in not producing a dermatitis by the scrubbing and use of the bichloride. If the operation is not to be done at once, with a few hours to intervene, a warm pack of boric acid is applied by means of sterile gauze, with oiled muslin outside. In vaginal work, when the patient is brought to the

operating room, after etherization, and, as usual, placed in the lithotomy position, I have found a form of speculum, as shown in Fig. 4, of great service. This is made of hollow wire, perforated, as seen in Fig. 5, and the rubber tube of the irrigator attached to the larger cylinder conveys irrigation, in this manner, to every portion of the vagina thoroughly well.

My attention was called to this instrument by Dr. W. G. Macdonald, a few years since, as an invention of his own, and I have found it of great value.

Here, in cleaning the parts, is a point for some consideration in the matter of economy. I have seen much green soap and alcohol wasted by its being poured from the bottle; therefore, I make use of two measuring glasses (Fig. 6) each holding one-half ounce, just enough for thorough cleansing, pouring the soap into the vagina, and then using, with proper bullet forceps (Fig. 7. a) sterilized' bits of gauze. In this manner the parts are to be thoroughly cleansed and irrigation kept up until everything is entirely aseptic. After this alcohol is used in the same way, thereby doing away with unnecessary waste, and with a much greater appearance of neatness at least. Then by douching the parts thoroughly well with a bichloride solution, from a large measuring glass or pitcher, we are prepared to proceed in our surgical work.

Fig. 7 (b), illustrates a form of forceps that I have found of value in trachelorrhaphy. It will be noted that one lip is slightly curved and surface serrated. This is introduced into the cervical canal and the vulsellum blade outside. In this manner the proper width of the cervix is obtained, as you wish it after restoration is performed, using one for the anterior and one for the posterior lip, gives a good chance for taking out the V-shaped portion of tissue and bringing the parts together quickly and nicely for use of the sutures.

Fig. 7 (c and d) simply show a double vulsellum forcep and tenaculum, with good points, that may be used in various ways in operations about the vagina, but the fact I wish to make use of is not to apply the tenaculum in handling the bits, as the points will sometimes pass through, causing irritation, in scratching the vagina, and doing harm.

When the patient is brought on the table, having been provided with long stockings or leggings, I am very positive ali should have a clean undershirt of some form of flannel and outside a proper operation gown, but in covering the extremities instead of using two sheets, as is often done, or a sheet with an arbitrary opening in the center, which is apt to tear, and in being too small is sometimes an annoy

ance to the operator, I have instructed our operating nurse to prepare one sheet in the manner shown in Fig. 8, called a split sheet, leaving about two feet of the upper portion for

covering the abdomen, and then each lateral portion is employed for covering the thighs and buttocks of the patient, safety pins being used, in this manner giving us the field of

operation and leaving the patient well protected. This sheet is to be well hemmed and when properly made will pass through the laundry many times and not show much evidence of wear.

The patient is now ready for operation and instead of the wire speculum it is sometimes advisable to change to the ordinary self-retaining speculum, with wide retractor, or a Sim's speculum.

One word in regard to the preparation of the operator's nails: Every surgeon should see that his nails are kept well trimmed and they should be watched with care that no soft tissues collect to form what is understood by the ordinary term hang-nail. Here the nail brush is to be made use of and I am fond of a spud I have had made of steel, shown in Fig. 3 (e). This is made blunt at the point, will clean a short nail thoroughly well, and is sharp enough to trim off soft parts, if necessary. This is kept sterile by boiling with

other instruments, and I have found it very useful.

In connection with the Albany Hospital the following is about the manner in which we prepare our hands and arms, and this is done equally earnestly whether we are using gloves or not:

Ist. Scrub the hands and nails well with the scrubbing brush, the arms somewhat briskly with the gauze scrubbing ball, spending at least five minutes in doing this.

2nd. Apply to each arm and hand from one to two drams of spirits of turpentine, employ from two to three minutes more in using the gauze scrubbing ball, then plenty of hot sterile water and when all evidence of the turpentine has been removed make an application of alcohol before using the bichloride solution, 1/2000-in the basin. Applying gloves at this time we are ready for the operation. This is particularly so when the pelvis is to be opened from above.

In operations about the vaginal outlet the single tenaculum is made use of, more particularly for separating the vulva and for holding the mucous surfaces in cystocele and recto