Sims's position.

amination. The method of maintaining it by the leg-straps will be described later.

The Sims position, for bringing the uterine cervix within easy access, and for making rectal examinations. The patient lies on her left side, with her left arm drawn behind her, so as to let her rest on the left side of her chest. The right leg should be

so flexed as to let the right knee lie just above the left. This position is necessary for the use of Sims's speculum. The patient's clothing being well drawn up under her hips and a sheet thrown over the lower extremities for their protection, the physician introduces Sims's speculum, which the nurse holds in place with one hand, while with the other she

lifts the right buttock to aid in the exposure of the vulvar orifice and vagina.

toral, or

The knee-chest position is one which is frequently Genu-pecassumed for the replacement of the pelvic organs knee-chest or the appreciation of their mobility.

This is obtained by having the patient place herself upon her knees, and bend forward so that her

FIG. 59.

position.

chest may rest on a pillow placed upon the bed or table, her head resting beyond the pillow on one side or the other. The arms should be placed in an extended position at her side or may be clasped around the sides of the table, so that she may not be tempted to rest upon' her elbows. This brings the hips at a level considerably above the head, and

enables the abdominal and pelvic organs to gravitate toward the diaphragm. The patient's clothing should be pushed back from under her knees and lifted above her hips, the sheet being draped over her for the protection of the parts thus uncovered. A separation of the buttocks by the hands will allow of the entrance of air into the vagina, which will serve to force the pelvic organs forward.

In cases of displacement of the uterus the nurse may be called upon to assist the patient to take this position several times daily.

CHAPTER XVII.

PREPARATIONS FOR GYNECOLOGICAL OPERATIONS.

The divisions of this subject may be classified as follows:

1. Preparation of the room.

2. Preparation of the sponges, instruments, etc. 3. Preparation of the patient.

4. Preparation of operator and assistants.

5. Nurse's duty during operation and convales

cence.

PREPARATION OF THE ROOM.

Excepting for vaginal hysterectomy (removal of the uterus through the vagina), which is to be regarded as a major operation, it will not be necessary to remove carpets, furniture, etc., from a room which is clean and thoroughly well kept. It is well, however, in any operation, to have special provision made for the protection of the floor.

Prior to the operation the room should be thoroughly swept and dusted, and well aired. Superfluous furniture and hangings, because they interfere with ventilation, it is always desirable to

Protection for floor.

The table.

Position of table and

arrange

ments for

remove.

than on the bed.

All operations are better done on a table Therefore one should be prepared by the nurse. As in operations on the pelvic organs, the patient will have to lie with her hips close to the edge of the table, the knees being drawn up. One table, of the ordinary size of a kitchen table, will be sufficient, without the table placed transversely to this for the head, as in abdominal section.

The table should be placed before a window, so that there may be thoroughly good light. Some operation. protective, as a piece of oil-cloth or drugget, should be spread upon it. The arrangement of the dressings for the table should be the same as described for abdominal section-a blanket or comfortable spread over the table and tacked down round the edges. A piece of rubber should protect this covering, at least over the lower half of the table, when the operating pad is not used. A sheet should be spread over these and similarly fastened down at the sides. A blanket and sheet for covering the patient, and a pillow protected with rubber cloth fastened around it, under the slip, should be arranged on the table. A chair should be placed at the foot of the table for the operator. The stand for his instruments should be placed to his right, within easy reach. On this stand-beside the instrument trays-should also be found a tray or