PREPARATION FOR OPERATION.—The practitioner should make it his business to see that a suitable room is prepared for the operation if possible. Where there is a choice the room should be large and airy; there should be a good light, north by preference; if the operation is to be done at night a supply of artificial light should be seen to. If sufficient time, say 24 hours, is available, all hangings, pictures and superfluous furniture, carpets and rugs should be removed from the room, the floor and wood work dusted with damp cloths, a fire put on to remove dampness, and the windows well opened to secure ventilation. If the operation is one of urgency, it is best to disturb the room as little as possible, since the dust set in motion will not have time to settle, and to content oneself with the lighting of a fire and opening the windows to secure ventilation.
As regards furniture, unless a portable operation table is available, a strong plain wooden table, such as a kitchen table, should be provided, and covered with a clean folded double blanket, then a mackintosh sheet, and finally a clean linen or cotton sheet. Two half-blankets folded in clean sheets should be provided to cover the patient during the operation. if the Trendelenburg position is likely to be required, a table with cross-pieces between the legs should be selected, and a strong kitchen chair provided on which one end of the table may be elevated by resting the cross-piece on its seat. A smaller table will be required for instruments and dressings, and either small tables or kitchen chairs as stands for hand basins and lotion basins. Three hand basins, one for antiseptic lotion and two for plain water, will be required for the operator, and two more if he has an assistant. A chair and a small table should be provided for the anesthetist, and if the operation is a vaginal one a chair should he provided for the operator, and a suitable nail or hook fixed at a height of about 7 feet from the floor in order to support a douche can, with an additional basin for antiseptic lotion in which the end of the douche tube may repose. The basins should all be scrubbed with soap and water and scalded with boiling water in readiness for use.
At least 8 to 12 gallons of water should be boiled and set to cool in clean scalded jugs or buckets, covered with clean towels to protect the water from accidental contamination. It is a good plan to boil gallon tor gallon of water with two teaspoonfuls of common salt to the pint. This can be used after the necessary dilution as normal saline for trans fusion, &c., if required. It has been shown by Bayliss that a much more effectual solution for the treatment of shock by transfusion is one which contains 6 per cent. of gum arabic, or 2 per cent. of gelatin to the pint of •9 per rent. saline. The gum is dissolved in the saline solution, filtered through clean flannel and sterilised by boiling. The advantage of this solution is that the fluid remains permanently in the circulatory system and does not rapidly leave the vessels as normal saline does.
Soap, boiled nail-brushes and clean towels should be in readiness; a bottle of good brandy or whiskey should be at hand in case of need, and turpentine, methylated spirit and a fish-kettle are very useful accessories in case of any accident or omission in the surgeon's kit.
The patient, if time permits, should have an aperient, in the case of an abdominal operation repeated for two or three nights in succession; an enema of soap and water should be administered about two hours before the operation, and for four hours beforehand solid food, including milk, should be prohibited, but beef juice, clear soup or beef tea, or a cup of tea may be allowed up to within an hour of the operation. The skin of the operation area should be shaved, well washed with soap and water, swabbed with methylated spirit, and after being allowed to dry, painted with weak tincture of iodine, or with a saturated solution of picric acid in water or preferably in spirit. If the operation is to be a vaginal one, the vulva should be washed and shaved and a vaginal douche administered. Thirty minutes before operation the patient should be given gr. of morphine with gr. of atropine, unless some contra indication exists, as such an injection materially facilitates the adminis tration of the anxsthetic.