detailed above, and should be thoroughly rubbed into the crevices around and under the finger-nails. The brown stain which it gives the skin is then removed by thorough washing in a saturated solution of oxalic acid. The oxalic acid solution is next rinsed off by water which has been made sterile by boiling, and the hands and arms finally washed in a solution of corrosive sublimate (1-1000 or I2000).

Finger rings, bracelets, bangles, and cuffs worn by the operator, assistants or nurses must be removed before the cleansing is begun, and the clothing covered with a clean white apron large enough to extend from neck to ankles and provided with short sleeves tied around the arm above the elbow.

The instruments should be similarly scrubbed with hot water and soap, and all particles of pus and blood from any previous operation removed from the joints. After this they should be boiled for at least fifteen minutes in a one per cent. solution of sodium carbonate, which must be sufficiently deep to cover every portion of the instruments. After cleansing the instruments with soap and water, baking in a temperature a little above the boiling point may be used as a method of sterilizing. During the operation the sterilized instruments should be kept in a beta-naphthol solution

(1-2500) or in sterilized water, and returned to it when the operator is not using them.

Sponges should be kept in a sterilized solution, or a corrosive sublimate solution, during the operation. After the blood from the wound has been sponged away, they should be put in another basin containing antiseptic solution and cleansed anew before being used again. The antiseptic sutures and ligatures should be similarly soaked in a betanaphthol solution, or a sublimate solution, during the process of the operation.

No one should touch the wound but the operator and his first assistant. No one should touch the sponges but the operator, his first assistant and the nurse having charge of them. No one should touch the already prepared ligatures or instruments except the surgeon and his first and second assistants. None but those assigned to the work are expected to handle instruments, sponges, dressings, etc., during the operation.

When any one taking part in an operation touches an object not sterilized, such as a table, a tray, or the ether towel, he should not be allowed to touch the instruments, the dressings or the ligatures until his hands have been again sterilized. It is important that the hands of the surgeon, his assistants and nurses should not touch any part of his own or of the patient's body, because infection may be

carried to the wound. Rubbing the beard or head, or wiping the nose, requires immediate disinfection of the hands to be practiced.

The trailing ends of ligatures and sutures should never be allowed to touch an assistant's or surgeon's dress, or to drag upon the operating table, because contact may occasionally, but not always, pick up bacteria, which may cause suppuration in the wound.

Instruments which fall upon the floor should not be again used until thoroughly disinfected. The clothing of the patient in the vicinity of the part to be operated upon, and the blankets and sheets used to keep him warm, should be covered with dry sublimate towels, and all dressings should be kept safe from infection by being stored in glass jars or wrapped in dry sublimate towels.

Personal cleanliness of nurse.

Arrange

ment of

operation.

CHAPTER X.

THE NURSE'S DUTIES DURING OPERATION.

After a careful preparation of the room and of the patient, according to the instructions laid down in the preceding chapters, the nurse will need to make the changes in her own toilet necessary to her attendance upon the operation. Her hands and fore-arms will need to be rendered thoroughly aseptic, and a clean apron with sleeves put on. The general bath and change of clothing should have been obtained before her preparation of the patient.

When ready herself the nurse should assist in patient for taking the patient into the operating room, placing her on the table and arranging the clothing and protectives. After doing this, if she is not otherwise directed by the surgeon in attendance, she can see to arranging such details as have had to be left to the last; as placing sterilized water of the proper temperature in the various vessels provided for the purposes of irrigation, cleansing of sponges and hands, etc. A good temperature to start with is 110° or 115° Fahr.

of bed.

She should see that hot bottles or foot-warmers Warming are placed in the bed which is to receive the patient after operation. She should take a careful survey of the room and see that everything is in its proper place, that is, where it may be most readily obtained when wanted.

ment of

After assuring herself that all is right, she should Managerecleanse her hands and take up her station at the sponges. stand where she is to manage the sponges.

As rapidly as the soiled sponges are thrown into the cold-water basin, she should cleanse them of blood, rinse them out of the hot water, and place them in the basin on the stand to the assistant's right.

duties.

She should keep her eyes open to the needs of Special the operator and his assistants, supplying sponges, clean towels, etc., as needed; keeping the water in the various basins changed as it becomes soiled, and finally assisting with the removal of the soiled clothing, the application of dressings, and the removal of the patient to the bed. While the surgeon is completing his application of the dressings the Preparanurse should turn back the covers from the bed, and remove the hot-water bottles, etc., temporarily, patient, placing them under the bed to be out of the way until the patient has been placed in bed, when they may be replaced around her.

The nurse's hands should be frequently cleansed

tion of bed for recep

tion of