PREPARATION OF mSTRUMENTS, ETC. 213 



is performed twelve hours later. Every case should be treated 

 for at least twenty-four hours before operation; preferably 

 forty-eight hours should be given, with at least two separate 

 periods of "rubbing in" for about ten minutes on each oc- 

 casion. (3) On the operating table the piece of gauze is re- 

 moved, and the superfluous ointment rubbed off with a piece 

 of sterile gauze. 



To Prepare the Field of Operation. — ^Wash with green 

 soap and water, scrubbing thoroughly and carefully, paying 

 particular attention not to scrub hard enough to render the 

 skin tender or to make abrasions. Shave parts with clean 

 razor. Wash with ether and alcohol, to remove debris and 

 epitheUum, and cover with a sterile towel. If the skin of the 

 patient is thick, a soap poultice may be left on, care being 

 taken to see that the skin does not become macerated. After 

 the patient is anesthetized the field is briskly scrubbed with 

 sterile brushes, soap and water, washed with i-iooo bichloride 

 of mercury solution and covered with sterile towels. 



It is important to remember that during an operation pa- 

 tient, operator and assistants may perspire and that in this 

 way fresh masses of bacteria from the deeper parts of the 

 glands may be brought to the surface of the skin. Careful 

 attention must be paid to maintaining cleanliness during an 

 operation. The patient's skin is kept covered with sterile 

 towels, changed as often as they become soiled. For the sur- 

 geon's and assistants' hands rubber gloves do this perfectly. 

 If an operator or assistant finds that the hands perspire dur- 

 ing an operation, the use of rubber gloves becomes essential. 

 Rubber gloves may be sterilized by boiling. 



Instruments are best steriHzed by contact with superheated 

 steam, or steam under pressure for ten minutes, or by boil- 

 ing in a I per cent, carbonate of soda solution. If soda is 

 unavailable, use water that is actively boiling, as this avoids 

 spotting and rusting of the instruments. Immediately after 



