Retention

of catheter

the bladder as a guide during the operation. In this in bladder. case a shallow urinal or ordinary soap-dish may be slipped between the limbs to catch the urine as it flows out.

All this adjustment of clothing, protectives, etc., can be made in a very few minutes after etherization is complete.

CHAPTER IX.

PREPARATION OF OPERATOR AND ASSISTANTS.

-cleanliness.

Methods of

hands and

The operator, his assistants, and nurses should be thoroughly prepared for the grave work they are to undertake by especial attention to personal Personal cleanliness. A full bath with an entirely fresh suit of clothing, as described in the chapter on the Surgical Nurse, will be sufficient so far as concerns the general preparation of the person. The hands and arms will need further attention for their especial sterilization. The method which originated, I believe, in the Johns Hopkins Hospital and has cleansing since been employed in other institutions, has arms. been found very satisfactory. The hands and fore-arms being thoroughly scrubbed with soap and warm water for several minutes, the fingernails having previously been carefully cleaned and cut, the hands are immersed for about one minute in a saturated solution of permanganate of potassium, which is well rubbed into the skin. The hands are then bleached in a saturated solution of oxalic acid. The oxalic acid solution is then washed off with distilled boiled water and the

Surgical

aprons.

Avoidance

of contamination.

solution of bichloride 1-5000 for about one

hands finally immersed in a
of mercury from 1-1000 to
minute. It is claimed by the originators of this
method that cultures taken from beneath the finger-
nails of hands thus cleaned have been found to be
absolutely sterile.*

The staining effect of permanganate of potassium, which remains to some extent even after the use of oxalic acid, if the hands be thus frequently cleansed, is the chief objection to this method. It is well probably to employ it, should one be obliged to operate shortly after the handling of discharges of a foul nature. The immersion of the hands in alcohol, after a thorough cleansing with soap and water, and their subsequent immersion in a strong bichloride solution, is probably sufficient for producing an antiseptic condition in ordinary

cases.

Before beginning the operation, the operator and his assistants should put on long white linen. aprons, enveloping the whole person, which should previously have been sterilized by steaming in the Arnold apparatus for one hour before operation, or by superheating in the sterilizing oven for a similar length of time.

During the operation the surgeon and his assist

*The efficacy of the bichloride of mercury solution is said to be increased by a previous immersion of the hands in alcohol.

ants should carefully avoid touching anything that may contaminate their hands. Should they have to do so, the process of recleansing the hands should again be gone through with. A frequent dipping of the hands into the warm sterilized water provided will keep them free of blood and also conduce to greater safety in the performance of the operation.

A summary of directions to be observed in the preparation for all operations performed in his clinic in general surgery is given as follows, by Dr. J. B. Roberts, comprising in concise form the principles to be observed in all such work.

RULES TO BE OBSERVED IN OPERATIONS.

High temperature and suppuration after wounds or operations are usually due to blood poisoning, which is caused by infection with vegetable parasites called bacteria. These parasites ordinarily gain access to the wound from the skin of the patient, the finger-nails or hands of the operator or his assistants, the ligatures, sutures or dressings. Suppuration and high temperature, therefore, should not occur after operation wounds, if suppuration has not existed previously.

Bacteria exist almost everywhere as invisible particles in the dust; hence, everything that touches or comes into even momentary contact with the

wound must be germ free; technically called sterile." A sterilized condition of the operator, the assistant, the wound, instruments, etc., is obtained by removing all bacteria by means of absolute surgical cleanliness (asepsis,) and by the use of those chemical agents which destroy the bacteria not removed by cleanliness itself (antisepsis.) Surgical cleanliness differs from the housewife's idea of cleanliness, in that its details seem frivolous, because it aims at the removal of microscopic particles. Stains such as housewives abhor, if germ free, are not objected to in surgery. The hands, arms, which should be bare to the elbow, and especially the finger-nails of the surgeon, assistants and nurses should be well scrubbed immediately before the operation, with hot water and soap, by means of a nail-brush. The patient's body about the site of operation should be similarly scrubbed with a brush and cleanly shaven. Subsequently the hands of the operator, assistants and nurses, and the field of operation should be immersed in, or thoroughly washed with, corrosive sublimate solution (1-1000 or 1-2000.)

Sometimes the surgeon prefers to use for his hands and arms, and to have the assistants and nurses use for their hands and arms, a saturated solution of potassium permanganate. This is employed, after hot water and soap have been used as