Occlusion dressing.

the limbs and fastened before and behind to the lower edge of the abdominal bandage.

A folded towel or napkin, pinned by a safety-pin to the abdominal bandage, serves the purpose very well.

The antiseptic pad is usually made of one of the different kinds of antiseptic gauze, in which antiseptic jute, oakum, or cotton may be enclosed.

In the Woman's Hospital the Garrigues "Occlusion Dressing," somewhat modified, similar to that used for obstetric work in the Maternity connected with the Hospital, has been employed.

This consists of one or more pieces of dry patent lint, 6 x 8 inches, which have previously been rendered antiseptic by saturation in a solution of bichloride of mercury 1-1000.

These are placed over the vulva, doubled in their width so as to make a dressing 3 x 8 inches. The lint is then covered by a piece of gutta-percha tissue, 4 x 9 inches, which is wet in a 1-4000 solution of bichloride of mercury.

These dressings are kept in place by a napkin of sublimated cheese-cloth, 18 inches square, folded to form a diagonal 5 inches in width, within whose folds a pad of oakum is enclosed. The napkin is tightly fastened to an abdominal bandage, both anteriorly and posteriorly, by means of safety pins, and the access of air to the vagina is thus prevented.

These dressings are changed as they may require, according to the amount of discharge. Should the catheter have to be used at stated intervals, fresh dressings should be employed in again protecting the parts.

The nurse can obtain the cheese-cloth at any dry-goods store, and prepare it by first thoroughly washing with soft soap and boiling, and then wringing it out in a solution of bichloride of mercury I-1000. The patent lint, obtained in a drug store, may be rendered antiseptic in the same way. The gutta-percha tissue and oakum may also be obtained at a drug store, the former more advantageously, perhaps, at a rubber store, where also a good syringe should be obtained for use in the case, if required.

Although bichloride gauze is most commonly used, iodoform gauze may be preferred by some surgeons.

The preparation of ligatures and sutures, the threading of needles, etc., does not usually devolve upon the nurse, yet may be required of her. The same rules must be observed as in their preparation for abdominal operations. The needles vary much in size and shape, according to the character of the operation to be done. The surgeon, too, will have his own choice as to the kind of needle he prefers.

The nurse must, therefore, learn his preference and observe it.

A sterilized towel, containing a set of dressings neatly folded, the bandage, safety-pins, and box of iodoform or other powder to be used in the dressing of the wound, should be brought to the surgeon by the nurse at the proper time for their application, hence should be kept in readiness.

CHAPTER XVIII.

PREPARATION OF THE PATIENT, OPERATOR, AND

ASSISTANTS.

A good

dition.

First of all it is important to get the patient into mental cona good mental condition. She should have her thoughts, so far as possible, kept off the operation. The utmost tact will be necessary to manage this successfully.

It is well to make all the preparations for operation elsewhere than in the presence of the patient.

tion of

If the operation is to be on the pelvic organs, in- Preparavolving vagina, uterus, bladder, or rectum, it will be bowels. especially necessary to have a thorough evacuation of the bowels. The night before the operation a laxative or purgative may be given, and the morning following; the lower bowel may be further cleansed by an injection of soap and water.

from food.

The patient should not have any breakfast on the Abstinence morning of the operation. If the operation is not to be done before noon, she may receive a cup of coffee or tea or a cup of beef-tea early in the morning.

She should remain in bed, lest she should feel Rest. faint for want of food.

Bath.

Clothing.

Arrangement of

hair.

Vaginal injection.

A full bath should have been taken on the night previous to operation. She should wear, according to the weather, a merino or gauze vest, a pair of drawers and stockings, a long night-dress. When the vest is worn a chemise should be dispensed with, as it is an awkward garment to remove when a change is needed, especially where the patient must be kept as quiet as possible. The hair should be parted in the back and plaited in two braids, one behind each ear. This is most convenient when lying upon the back, and prevents matting of hair. A vaginal injection of bichloride of mercury or some other disinfectant will probably need to be Cleansing given just before the operation. The vulva and surrounding parts will need especial preparation by a thorough cleansing, first with soap, preferably green soap, and warm water, and then with some Shaving of disinfectant solutions. The hair about the vulva is often shaved up to a level with the "meatus urinarius," or entrance to the bladder. The choice of the surgeon regarding the shaving should be learned by the nurse previous to her attempting the same. Many surgeons prefer attending to the especial preparation of the site of operation after etherization.

disin

fection of vulva.

parts.

Administration of the anæs

thetic.

In private houses the anesthetic is generally administered in an adjoining room, and the patient afterward carried in and placed upon the operating table. The nurse aids the surgeon in carrying