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long; usually three skeins of each size are prepared at a time. They are then wrapped in a towel and placed in boiling distilled water for ten minutes, after which they are transferred to a slow dry heat oven, never above body temperature, and allowed to dry for five or six hours. If this is carefully done the silk when dry does not "crumple" or untwist but presents a smooth, sort of translucent, waxy appearance. Ten feet of Nos. 2 and 3, fifteen feet of Nos. 00, o, and No. 1, are then wound on glass spools, and a spool of each size placed in a previously sterilized ignition tube (fig. 6), and a little slip with date of sterilization inserted at the same time.

[graphic]

Fig. 6.

A little loose cotton is used as a plug to prevent them rolling out, during the process of sterilization in the autoclav, which is the next step. The stoppers or cocks are made of cotton wool and gauze tied with a string. They are sterilized, and then placed permanently in the ignition tube with sterilized forceps, bacteriologically sealing them for an indefinite period. As one tube is sufficient for any ordinary abdominal case, we can wind from the frames as required. We generally prepare enough for ten or twelve cases at a time and keep them in a clean glass candy jar ready for use. When a tube is opened the silk unused is thrown away.

Silk Worm Gut. The 18 inch extra quality is preferable in abdominal cases where the patient has fat abdominal walls, and for cases in which the buried cat gut suture cannot be used, as with a draining tube. The ordinary 12 inch gut does very well for perineal and certain kinds of gynecological work. Two hundred strands of each are prepared at the same time and by a method that colors them black. This is a distinct advantage in perineal work for it enables them to be easily seen and removed. In an agate ware basin take (for 400 strands) of four per-cent nitrate of silver solution in which the gut has been put when cold. Allow it to heat over a slow Bunsen burner until it steams, or simmers for

twenty minutes, being careful not to let it boil, at any time. Stir the gut constantly with a glass rod, and turn it frequently. This must be done at night or in a dark room. A pound of ordinary Rochelle salt is now added as a reducing agent. This acts on the solution by reduction to metallic silver which is deposited but not on the silver absorbed by the silk worm. gut. By exposing the gut to the actinic rays of the sun in a large Petrie dish for an hour or so in the morning, it is colored a very dark brown which afterwards turns black. The color is permanent. It is now polished by means of a cloth or towel; six strands are made into a fig

STER

Fig. 7.

ure of eight bunch and two

of these bunches, enough for one case, are put into a clean test tube (fig. 7) and sealed with cotton wool. It is now subjected to the action of the autoclav the same as the silk.

Metallic sut

ures and silver

foil (fig. 8) are

sterilized in the

STERILIZED. NOW!

Fig. 8.

autoclav only.

Cat gut and other animal sutures can now be prepared so that they are beyond suspicion. Many plans have been devised for their sterilization but the cumol method of Kronig, modified by Clark, of the University of Pennsylvania, is the ideal one.

The Clark cumol sterilizer (fig. 9) is briefly a strong iron cylinder, supported in the vertical position by four legs; surrounding the cylinder is a nickle plated copper jacket. Interposed between the jacket and cylinder is a layer of sand which acts as a sand bath. The heat is obtained by means of a Bunsen burner from beneath. It has a solid cover, held in place by four thumb screws. The cover is perforated in the center to admit a high temperature thermometer. The cumol fills the cylinder more or less completely and can be drawn off by opening the little valve under the glass gauge. It is simple of operation but requires constant attention. Only the essential points of the process of preparation and sterilization of the gut will be mentioned, referring any who may be in

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terested further to Dr. Clark's article in the Johns Hopkins Hospital Bulletin, of February and March 1896, Nos. 59 and It is worth reading.

60.

Process. (1) Cut the gut into the desired lengths, roll into a figure of eight form and tie the isthmus with fine silk.

(2) Suspend the gut, in a wire gauze frame, (which will fit the interior of the sterilizer) taking care that the gut does not come in contact with the metal.

(3) Place the wire frames in a dry heat oven, raise the heat to 80° C. and hold it at that point one hour.

it thoroughly.

This dries

(4) Transfer the frames from the oven to the cumol in the sterilizer, which should show a temperature of 100° at the time. Gradually raise from this to 150° and hold at that point one hour.

(5) Take the frames out of the cumol with sterilized forceps, wrap in sterilized towels, and replace in dry oven (temperature 100°) for two hours. This evaporates the cumol and dries the gut and if properly done no odor of the cumol can be detected,

(6) Transfer the sutures with sterilized forceps, into pre

Size 3

Fig. 10.

with aseptic cotton wool plugs.

viously sterilized test tubes, mark sizes on these (fig. 10) and close them

By the above process no water comes in contact with the suture material, hence its strength is not in the least impaired. Rubber Gloves. Now that the fact is beyond controversy, that rubber gloves have come to stay, their sterilization without injury to the rubber becomes an important matter. Various methods are in use, but all, except the one below, tend to injure the rubber, so that their life is short and hence they are expensive. Formic aldehyde gas is a recognized surface germicide. Rubber being a glazed or non-pervious substance it struck me that the gas offered a solution of the problem of how to sterilize, without injuring the gloves. My experiments with it have proved it a success as bacteriological test will affirm. (N. Y. Med. Journal, June 24, 1899.) The method, which is very simple, is as follows: Wash the gloves thoroughly with soda solution, inside and out, and hold for a minute. or two over gas flame, or heater to dry. Dust liberally the

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inside with dry sterilized soap stone. Wrap each pair in a double layer of gauze. Two pairs of, say No. 8 for surgeon and assistant, and one pair No. 6, for nurse are laid on a towel and placed in a formic aldehyde sterilizer for two hours. Wrap in towel already at hand, mark sizes, with graphite, and they are ready at any and all times for hospital and out of town work. Four or five sets are usually prepared at the same time. They are sterile, dry, already powdered and can be put on in ten seconds. If the gloved hand is now dipped in sublimate solution 1-1000 for five minutes, and rinsed in normal salt solution, we have nothing to fear from the hands, now one of the most fertile sources of infection. The above assumes the proper cleansing of the hands before removing the gloves from the packet.

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Iodoform gauze. This material is now used in aseptic surgery only for packing cavities, and the control of hemorrhage, etc., but when it is used it should be aseptic. Iodoform will inhibit the growth of bacteria, but it is a germicide only to a mild degree. If infected iodoform gauze should be introduced into cavity, the bacteria finding there a good culture medium, would start to grow and so we might have primary infection, or, if used in a pus case, it might readily mix the infection and cause it to assume more serious proportions. Sufficient heat to sterilize sublimes the iodine and renders the guaze very irritating and unfit for use. It has been our custom for two or more years to sterilize our iodoform gauze by means of formic aldehyde gas, and we have never seen a single case primarily infected, or the infection mixed from the use of gauze so sterilized. It is cut into suitable lengths, enough for one dressing, loosely rolled, slipped into a glass ignition tube (fig. 11), and subjected to the gas, in a suit

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