For twenty-four hours previous to operation the patient should be given broths every two hours, but neither milk nor solid food. A cathartic is given, if possible, thirty hours prior to operation, and repeated in six hours; a soap suds enema is given three hours after the first cathartic, and repeated twelve hours before operation. A bath is also given the afternoon before, and after the bath the field of operation is shaved, then thoroughly cleansed with green soap, and a compress wet with green soap solution, 25 per cent to 50 per cent, applied (the liquid green soap which is used for this purpose can be obtained at any druggist's) ; this is covered with a protector-oil muslin or oil paper-and left on from three to six hours, as the skin will bear. When removed, the surface is washed in the following order, with green soap, ether, alcohol, and solution bichloride of mercury, 1-1000; a compress wet in the latter is applied covered with a protector, and left on till an hour before operation, when the process is repeated and the fresh bichloride compress is left on till the doctor removes it on the operating table, after the patient is under the influence of the anaesthetic; then he re-scrubs it, and the ether, alcohol, and bichloride must be ready for him to use. All these precautions are taken to kill or remove every bacterium or spore.

For a vaginal operation the rules for diet, catharsis, enemata and bathing are the same as for any other. In addition a green soap douche is given on the preceding day, followed by one of bichloride of mercury, 1-5000. The vulva is then covered with a pad wet in solution of bichloride of mercury, 1-1000, until two hours before operation, when another bichloride douche is given, the parts cleansed and a fresh bichloride pad applied.

Just before the anaesthetic is given, the patient should void urine. If she has false teeth they should be removed.

The Room. In the choice of the room the light is one of the first considerations, a good light being a positive necessity. If possible the operation should take place in a different room from the one the patient is occupying beforehand. Remove rugs, carpets, all unnecessary furniture, curtains and draperies. A piece of cheesecloth tacked across the lower sash of the windows will keep the light from being too glaring and obstruct the view from outside.

The. day before the operation the walls should be dusted, especially the cornices and mouldings; the floor should be scrubbed if possible, or at least wiped with a damp cloth and it should be washed over again the morning of operation after the furniture is in place.

If the patient is to remain in the room after the operation, have the bed as nearly in the position it is to occupy later as possible, but out of the way.

Protect the floor under and around the operating table with several thicknesses of paper, covered with a sheet tacked down at the corners.

A kitchen table covered with a couple of old blankets protected by a rubber pinned or tacked under the table will answer for the operating table. Three small tables should be at hand, protected with papers, covered with large sterile towels. On one table, convenient to his right hand, the surgeon will need his instruments. On the second table have three bowls which have been well washed first with soap and hot water, then bichloride, 1-1ooo. The inside of the bowls should not be dried. One bowl is intended to hold the solution for the disinfection of the surgeon's and his assistant's hands, the other two for washing the sponges. The third table is required for the dressings and sterile towels. The former, the doctor will provide or tell you where to get them. Very reliable sterile dressings are now put up by Ellwood Lee, and can be procured at any drug store. They are really better than anything that can be prepared without a sterilizer. If it is impossible to obtain these, the dressings should be prepared in the same manner as the towels, namely, rolled in bundles not more than 9 inches square (or the heat will not penetrate) and steamed in the clothes boiler for at least one hour. If there is no tray to keep them out of the water a hammock of gauze will answer the purpose. They are then dried in the oven, which must not be hot enough to scorch them.

At least a dozen and a half towels will be required. The surgeon will bring the instruments and anaesthetic. If chloroform is administered, some vaseline will be required to grease the patient's face.

Sterile Dressings

An ether cone can be made out of paper, covered with a towel.

An irrigator or douche bag must be at hand for the irrigation. This should be sterilized by boiling for five minutes, as are also the surgical instruments.

There must be plenty of sterilized water prepared, six gallons at least, two gallons of which must be boiled long enough beforehand to be cold. This must be kept tightly covered after it is boiled, or it will not remain sterile. Water must boil at least thirty minutes to be properly sterilized.

Bichloride, carbolic and salt solutions may be needed and must be at hand, as well as two sterile pitchers, a pus basin, a chair, a blanket or two to cover the patient, two rubbers to protect the blanket, a slop jar, hypodermic syringe, and stimulants-the doctor will give definite instructions regarding the last.

The bed is made according to the directions already given for bedmaking, with the exception that no pillow will be required as the patient's head must be kept low. Instead, a small rubber covered by a towel is desirable to protect the bed if the patient is nauseated. A blanket is put over the patient, before the upper sheet; hot water bottles should be in the bed all the time she is on the table; a couple of towels and pus basin should be on a table near the bed in case of nausea, also small pieces of gauze to wipe the mucus out of the mouth, and a wedge-shaped piece of wood to put between the teeth if they become clenched.

If necessary to assist the surgeon during the operation, scrub the hands for ten minutes with hot water and soap, using a new stiff nail brush which has been soaked in carbolic, 1-20. Be particularly careful of the finger nails, which should be cut very short. After scrubbing, the hands should be soaked in bichloride,

Ether Cone, made from stiff paper, covered with a towel

Porcelain Bed Pan

Nobody, whose hands have not been so treated, must touch the dressings or instruments, and after washing nothing but the sterile things must be touched.

When the operation is over, if the patient's nightgown is wet it must be changed. She is then covered with a warmed blanket, and put into bed. She should lie on her back without pillows and be kept very quiet.

After the Operation

If she vomits, hold her head on one side to prevent strangulation.

Washing the mouth out, as previously directed, will help to relieve the thirst which is generally intense after an anaesthetic.

After a few hours either crushed ice or very hot water, in teaspoon doses, may be given.

The pulse must be watched carefully, and if its rate increases should be reported to the doctor, as this, together with pallor, restlessness, longing for fresh air, sighing respiration, and fall of temperature is a sign of hemorrhage. As the hemorrhage does not always show through the dressing these signs must be watched for.

For treatment of hemorrhage see the section on "Emergencies." As the after treatment depends altogether on the nature of the operation, and subsequent condition of the patient, no rules for it can be given here further than to emphasize the fact that the first requisite for success in surgical work is perfect cleanliness. The gauze used for dressing the wound after the operation, the instruments and the hands of those touching these things, must always be as carefully sterilized for the dressing as for the operation.

The diet, like the treatment, will depend upon circumstances. For the first day or two the patient is generally on fluid diet, and care must be taken that it is given slowly and in small quantities, but as soon as possible plenty of nourishing food should be given to build up the system.