SURGICAL SUPPLIES.

TO STERILIZE INSTRUMENTS.

1. All instruments should be boiled for at least fifteen minutes in a 1 per cent soda solution. Wrap the blades of knives and scissors in cotton, put them in a separate towel, and in one corner stick the needles before folding it. Some surgeons prefer to have the latter simply washed and placed in absolute carbolic acid and then in alcohol for a few minutes. Water must boil before instruments are put in and the boiler must be kept closely covered.

2. In a German medical journal, published at Leipsic, Gerson corroborates his former assertions as to the efficacy of disinfection of instruments with tincture of soap, citing extensive bacteriologic tests in evidence. He wraps the blades in Brun’s cotton, impregnated with tincture of soap. The cotton protects them from the air and the tincture is an efficient disinfectant. The instruments are then ready for use at any moment. After using them he rubs them clean with cotton moistened with the same tincture, then wraps them in a fresh piece and lays them aside. No boiling or steaming is required, and the instruments are not harmed by the process. He recommends this method especially for military and other practice where steam disinfecting appliances are not available. He has found that instruments infected with pus, etc., and not even wiped off after having been used, proved perfectly sterile after a few days in the wet cotton wrapper. No colonies developed when they were rubbed on agar plates or soaked in bouillon.

To Arrange Instruments for the Convenience of the Operator.—Instruments for immediate use are laid in trays on a small movable table on the operator’s right hand. Instruments that may not be needed are kept in another tray. A separate tray is used for suturing material, needles, a pair of sharp-pointed scissors, and long forceps. Before placing instruments in the tray, dry with sterile towels.

TO CLEAN INSTRUMENTS.

First of all, the knives, scissors, and needles should be laid carefully aside and cleaned at once. Scrub all instruments in cold water to remove blood and pus, then in hot water with plenty of soap. Rinse thoroughly in hot water, then place in boiling water, take them out singly and dry; do not drain. Following pus cases all instruments must be boiled for at least fifteen minutes in 1 per cent. soda solution.

TO STERILIZE GLOVES.

Examine carefully to see that they are in perfect condition. Select a pair, then wrap each one in a separate piece of gauze, fasten together, and boil at least 15 minutes in salt solution.

TO DRY STERILE GLOVES.

Cover a table with a sterile sheet. Prepare hands and person as for an operation, and draw on a pair of sterile gloves. Then dry gloves with sterile towel, and powder them inside with sterile powdered talcum.

TO CLEAN GLOVES.

Soak in cold water, then wash with green soap and hot water. Rinse and dry. If used in pus cases, boil 15 minutes before laying away.

TO STERILIZE SILK-WORM GUT OR SILK THREAD.

Boil in sterile water 20 minutes and preserve in alcohol, 95 per cent., or first sterilize in steam sterilizer for 20 minutes, then boil in sterile water for 20 minutes and preserve in alcohol, 95 per cent.

TO STERILIZE HORSE-HAIR.

1. Wash thoroughly in green soap and water. Rinse several times. Soak in ether 24 hours. Boil in sterile water 20 minutes. Preserve in alcohol, 95 per cent.

2. Soak in bichlorid solution 1: 1000 for 6 hours. Then boil 3 minutes in sterile water. Place in alcohol, 50 per cent.

TO STERILIZE CATGUT (FORMALDEHYD METHOD).

Immerse in formaldehyd sol., 5 per cent., for 24 hours. Wash by soaking in sterile water for 24 hours, which must be changed every hour. Then boil in sterile water and basins about 10 minutes, according to size of the catgut. Lift out carefully, and place on a sterile towel until all moisture is absorbed. Prepare table, hands, and person as for an operation. Cut in required lengths, from 14 to 25 inches. Coil smoothly, and preserve in glass jars (which have been previously boiled for 20 minutes) containing the following solution:

Corrosive sublimate 1 part;

Boiled glycerin, 200 parts;

Alcohol, 95 per cent., 1000 “ .

CHROMIC CATGUT.

1. Soak in ether 1 to 2 weeks, according to size.

2. Wind on glass spools.

3. Soak in chromic acid solution, 5 gr. to 1 pint water, 3 to 6 hours, according to size.

4. Dry in sun 3 days.

5. Boil in 95 per cent. alcohol 1 hour, under 15 pounds pressure, in autoclave.

Use Mason fruit jars.

Do not screw the top down when in sterilizer.

TO STERILIZE LINEN THREAD.

Wind several yards of thread into coils. Boil for 30 minutes in a 1 per cent. solution of bicarbonate of soda. Wash in fresh cold water, and allow to stand in cold distilled water for 6 hours. Then boil in fresh water for 30 minutes. Place in absolute alcohol for 48 hours, then in a solution of Schering’s celloidin with equal parts of alcohol and ether. The mixture must stand for 12 hours, or until dissolved; keep tightly corked. When ready for use add 1 per cent. of sterile oleum ricini, and immerse thread for 48 hours. Then wind upon a frame to dry. This will require from 1 to 3 days. When dry, cut into lengths and coil or wind on glass slides. Boil for 1 hour in normal salt solution. Preserve in Chinesol solution, 1: 500.

To Sterilize Glycerin or Any Kind of Oil.—Place bottle uncorked in a vessel of boiling water for 2 hours.

TO PREPARE RUBBER TUBING.

Place different sizes in a deep dish of water. Add bicarbonate of soda to make a 10 per cent. solution. Let come to a boil over a slow fire, then with a stiff brush or cloth rub each piece well. This removes all sulphur, leaving a black surface. Rinse several times, then boil in clean water 15 minutes. Boil 15 minutes before immediate use.

TO PREPARE SIX YARDS OF IODOFORM GAUZE.

Prepare the following solution:

Sterile iodoform, ℥iij;

Sterile glycerin, ℥iij.

Mix thoroughly, gradually add alcohol (95 per cent.), f℥iij, then very quickly, ether, f℥vij. Have gauze ready in desired lengths, and drop into solution. Press gauze uniformly to preserve evenness of color. Work rapidly. Prepare table, hands, and person as for an operation. Roll strips, and place in sterile glass jars.

TO PREPARE IODOFORM GAUZE (GREEN-SOAP METHOD).

To saturated boric-acid solution Oj, add green soap to make a good suds. Boil half an hour. To this add iodoform ℥j, then boil 15 minutes. When cool add carbolic acid (95 per cent.) ʒj, stir solution, dip gauze, and roll in strips. Keep in sterile glass jars.

Castile soap is a good substitute for green soap.

IODOFORM EMULSION.

I. Nine parts sterile glycerin in 1 part of iodoform. Dissolve powder for eight hours in bichlorid solution (1: 500). Pour off solution and break up the iodoform after having rinsed it thoroughly in sterile water. Then mix with glycerin.

II. Iodoform, ℥j; sterile glycerin, ℥ix. Put the iodoform in a sterile basin. With a sterile spoon stir in glycerin, a few drops at a time, until a smooth paste has been made. Then add remainder of glycerin.

TO PREPARE PROTECTIVE STRIPS.

Scrub with green soap and rinse well in sterile water. Cut into strips. Disinfect in bichlorid (1: 500) for twenty-four hours. Keep in sterile water three hours. Then place in boric-acid solution. Put in normal salt solution when preparing for immediate use.

TO PREPARE TINCTURE OF GREEN SOAP.

Prepare the following solution:

Green soap, 3 parts;

Alcohol, 95 per cent., 2 “ ;

Ether, 1 part.

To prepare by cold process: Mix ingredients in a pitcher and stir briskly for a few minutes every hour until a solution is formed.

To prepare by warm process: Melt the soap over a slow fire; then remove it to a cool place and stir occasionally. Before it hardens add solutions and mix thoroughly.

Caution: Prepare where there is no danger of the ether igniting.

STERILIZING HAND-BRUSHES.

1. Clean with green soap and water; rinse thoroughly.

2. Place in saturated oxalic solution for 30 minutes.

3. Place in sterile water 30 minutes.

4. Change water twice.

5. Keep dry.