Compliments of the Author. 
A NEW SURGICAL BAG. 
BY 
W. B. VAN LENNEP, A.M., M.D., 
PHILADELPHIA. 
Reprinted from the Hahnemannian Monthly, March, 1891. A NEW SURGICAL BAG. 
BY 
W. B. VAN LENNEP, A.M., M.D., PHILADELPHIA. 
An operating bag, systematically arranged and yet giving room 
for additions and alterations to suit the demands of different opera- 
tions, has always seemed to me a desideratum. This want has been 
met by a number of cases and bags, but they usually lack one of 
two important features which are necessary if they are to be gener- 
ally used, i.e., cheapness and adaptability for any operation. There 
are gynaecological, obstetric, abdominal, emergency bags, etc., but 
they are fitted with racks and fixtures which make it impossible to 
use any but the instruments and apparatus named by the designer. 
On the other hand, there are some very handsome bags, notably the 
one known as the Gerster, which, while they are more or less free 
from the drawbacks above named, are too expensive to be extensively 
used. 
In view of these facts, it has occurred to me that it might be well 
to call the attention of the profession to a bag which I have been 
using for several years; one which, while inexpensive, gives me 
room to carry everything necessary for any operation, the contents 
of which can be changed to suit any branch of surgical work, and 
one in which all the articles are either standard in the market or 
are easily and cheaply made (Fig. 1). 
The bag is of the kind known as the " Cabinet," and is the six- 
teen-inch size. There is a pocket at each end; two more are sewed 
into one side, two straps and two buckles into the other and six 
loops into the cover. A plain tin pan, about 12 by 6| by 3 inches 
(or a nest of two or three tin pans if desired) fits in the bottom, and 
the bag is ready to be filled. 
Under the straps at the side are buckled (1) a Kelly pad and (2) 
an irrigator, the well-known fountain syringe which holds, according 
to the size, from one to four quarts. A butter plate is tucked in on 
the other side of the pan. The needles are placed in this before an 
operation. Outside one end of the pan there is room for a folding, 
skeleton, Allis' inhaler. Stout wrapping paper and a towel are 
wrapped around this before using it. 2 
The loops in the cover hold (1) a needle holder for Hagedorn 
and ordinary needles. (2) Vulsellum, and (3) Long, thin, dressing 
forceps. (4) Razor. (5) Heavy bandage scissors. (6) A large nail 
brush. (7) A hard-rubber syringe that will fit the trocar canulae 
and answer for a sinus syringe as well as for general work. 
In the pockets at the side are (1) An Esmarch band or tubing (2) 
A Levis mouth gag. (3) An ether dropper (Fig. 2). Dr. Northrup, 
Fig .1. 
anaesthetist to the Hahnemann Hospital, has recently devised this very 
neat and simple dropper, which pays for itself very quickly by the 
ether it saves. It is pushed through a cork, and will therefore fit 
any can or bottle. From the larger tube the ether runs in a stream, 
and this is used until the patient is well anaethetized ; from the other 
it drops out slowly, and this is used to keep up the narcosis. The 
latter tube answers very well too for choloroform. (4) A needle 
box, with compartments of different sizes, for assorted needles, 3 
silver wire, hare lip pins, etc. (Fig. 3). (5) Hypodermic case, or the 
writer's hard-rubber, pocket, minor operating case, containing straight 
scissors; Pean artery forceps, which serve as a needle holder also ; 
two or three small artery clips; hypodermatic syringe and needle; 
trocar and canula ; grooved director; dissecting forceps with slide 
catch to serve as artery forceps; bottle containing spools of silk and 
catgut in alcohol; bottle of bichloride tablets ; two knife handles to 
Fig. 2. 
the end of one of which is attached a sharp Volkmann spoon ; 
assorted needles ; two or three probes, one arranged as a drainage- 
tube carrier; " Gross' instrument," with spud at one end and tena- 
culum at the other; perinseum needle; blades to fit the handles, 
i.e., amputating knife, saw, scalpel, two straight bistouries and two 
tenotomes, blunt and sharp pointed (Fig. 4). 
In the pocket at one end is a leather case, the "case tubes," which 
fits into a pair of photographic trays (4| by 5| inches), and will 
hold five one-ounce, or ten half-ounce screw-cap tubes or bottles. 
Fig. 3 
This is filled from the following list with such bottles as may be 
needed (Fig. 5): 
One ounce : (1) A screw-cap tube containing six to eight glass 
spools of assorted sizes of silk on a rod in plain or bichloride alcohol. 4 
(2) Carbolic acid ; this makes, with a quart of water, a 3 per cent, 
solution for the instruments. (3) Chloroform. (4) Hydrogen per- 
oxide, etc. 
Half ounce: (1) A dozen strands of kangaroo tendon, prepared 
with chromic acid according to the method of Lister and kept in a 
carbolized oil (1 to 10). It improves with age. (2) Catgut on 
glass spools (3 sizes) in a screw-cap tube. This is prepared and 
kept in the same way as the tendon, or the juniper-berry gut ordi- 
narily sold can be substituted. For ligating small vessels, or to use 
when it is desired that the gut should absorb rapidly, 1 sometimes 
Fig. 4. 
carry, in the silk bottle, a spool or two of gut which has been boiled 
in alcohol in a water-bath. (3) Bichloride tablets. (4) Powder 
duster containing iodoform, aristol, or iodoform one part and boric 
acid seven parts. (5) Brandy. (6) Solution of hydronaphthol in 
alcohol and glycerine; a teaspoonful to a quart makes a 1 to 1000 
solution. This I use when the water is "suspicious" and bichlor- 
ide is contra-indicated, or where continuous irrigation, especially of 
mucous membranes, as the vagina or rectum, is to be practiced, etc. 
Back of the bottles in the "case tubes" is a roomy pocket in 
which are carried a number of envelopes or packages of oiled paper 
containing such of the following articles as may be needed: (1) 5 
Lister protective. (2) Safety pins. (3) Silk-worm gut. (4) Horse- 
hair for drains. (5) If preferred the strands of kangaroo tendon 
can be wrapped in oiled paper and put in an envelope. (6) Cocaine 
powders, one to fl. 5ij- makes a two per cent, solution. This enables 
the surgeon to make his solutions fresh every time they are needed. 
Watery solutions are generally used, to which two per cent, of car- 
bolic acid is added. For mucous membranes, particularly the 
urethra, liquid cosmoline is the better vehicle, and a half-ounce 
bottle of this is substituted for such operations in the "case tubes." 
When freshly made, a two per cent, solution is sufficient to induce 
Fig. 5. 
complete anaesthesia, and is not likely to produce any unpleasant 
symptoms. (7) " Socin powders," i.e., zinc oxide ten grains, and 
zinc chloride one grain. To this ten drops (or less) of water are 
added and rubbed up into a paste which hardens rapidly and makes 
an ideal scab for hare-lip, scalp, hernia, or, in fact, any wounds to 
which it is inconvenient to apply an ordinary dressing. (8) Iodo- 
form powders, i.e., to make with an ounce of ether a saturated solu- 
tion. An ounce bottle or tube from the case, after being emptied, 
is filled with ether and the powder added. The solution is poured 
on the field of operation and on the wound before apylying the 
dressing. Iodoform decomposes if kept for any length of time in 
ether, etc., etc., etc. 6 
In the pocket at the other end of the bag is room for four four- 
ounce bottles, wide and narrow-mouthed, and, by placing the case 
of tubes in the other pocket on end, a fifth can be taken. These 
may be varied as desired: (1) Drainage-tubes, of soft and hard 
rubber and decalcified bone. The hard rubber drains I have found 
especially convenient. There is no danger of their breaking nor 
will they kink. They are made in lengths varying from one-half 
to six inches, and are No. 18 Charriere scale in circumference. (2) 
"Tampons" or cotton sponges, i.e., a ball of cotton wrapped in a 
piece of gauze. These are steamed and kept in strong antiseptic 
solution. They are thrown away after an operation. (3) Iodoform 
gauze (five to fifty per cent.). (4) Senn's intestinal bone plates, 
assorted sizes. (5) Decalcified bone and ivory pegs for bone opera- 
tions. (6) Chloroform. (7) Hydrogen peroxide. (8) Carbolic acid. 
(9) Boro-glycerite. (10) Sweet or castor oil, the latter being the 
better lubricant as it is such a sticky oil. (11) Solution of chloride 
of zinc (five per cent.), etc. 
Under the four bottles there is room for four one-ounce pots. 
These, too, can be varied to suit: (1) Vaseline, plain or medicated; 
(2) Zinc-oxide or any other ointment; (3) Sapo viridis. (4) Lead 
plates and perforated shot. (5) Brokaw's or the writer's intestinal- 
rings, of assorted sizes, made up. (6) Adhesive iodoform gauze, made 
with resin, alcohol, and glycerine, and well adapted for operations 
about the mouth, etc. (7) Horsley's putty, i.e., one part yellow wax 
and four parts vaseline, to which five per cent, of carbolic acid is 
added, and enough white wax to make it hard when cold and a putty 
when warmed with the fingers. This is used to stop the bleeding 
from the edges of the bone in the cranium, etc. 
The tin pan can be variously packed to take such of the following 
articles as may be needed: (1) A four-ounce roll of plain or medi- 
cated, absorbent cotton, which just fits across the end. Globe anti- 
septic wool can be substituted or added. (2) An eight-ounce roll of 
Hartmann's sublimated wood-wool. (3) A can of Am Ende's sub- 
limated or double-cyanide gauze. (4) A pound- or two half-pound 
cans of ether. (5) A canvas roll of instruments. I have, instead 
of the cases sold in the shops, which must constantly be made over 
as new instruments are bought, a number of canvass rolls, eight, ten 
and twelve inches wide. On a large card in my operating-room are 
written lists of the instruments necessary for the different opera- 
tions. Besides bulky instruments, which will not go into the roll, 
and are wrapped in a clean towel, there is a roll for each class of 7 
Fig. 6. 8 
operations; thus, "roll-general," "roll-abdominal," "roll-bone," 
" roll-genito-urinary," "roll-gynaecological," etc. The rolls are 
washed, immersed in strong antiseptic solution, and rough-dried. 
The instruments are steamed in an Arnold's steam-cooker, and put 
in the loops of the respective rolls. Before an operation, in private 
practice they are immersed for some time in boiling carbolic solu- 
tion (Fig. 6). (6) A spool of Mead's adhesive plaster. (7) Suitable 
Fig. 7. 
bandages of muslin, gauze, flannel, starch, or plaster of Paris com- 
plete the simplest bag. 
Besides these, there is room for such "extras" as (1) a linen 
coat (sheets can be used instead). (2) Overalls of white rubber, 
which I find indispensable in operations about the male perimeum, 
female genitals, rectum, etc., i.e., where the operator has to sit down. 
The irrigating fluid runs up the forearm to the elbow, and drips over 
the clothes, which no apron, sheet, or coat will protect (Fig. 7). The 9 
coat or overalls can be strapped in with the Kelly pad and irrigator. 
(3) Large flat sponges, in a bag dry, or in a bottle from carbolic solu- 
tion (1 to 20). (4) Battery, cautery, etc. (5) Special instruments, 
splints, apparatus, etc., as needed. (6) A pocket case of bottles, that 
can be conveniently carried by the etherizer, the a etherizer's case," 
containing additional restoratives, such as aromatic spirits of am- 
monia, glonoine, digitalis, amyl nitrite, camphor, etc.; such luxuries 
as collodion with iodoform, boric acid, or bichloride, tr. sapon. virid., 
and the overflow of short bottles from the " case-tubes." The pocket 
in this case will help carry some of the envelopes as well as a 
camel's-hair brush (for the collodion), etc. 
It is convenient to keep a card in the bag with the following list 
of its regular contents : 
Pockets: (1) Case tubes; trays; bottle. (2) Four bottles ; four 
pots. (3) Needle box; Esmarch band. (4) Pocket case; ether 
dropper; gag. 
Loops: Needle holder; nail brush; syringe; razor; vulsella; 
dressing forceps ; bandage scissors. 
At Sides and End: Kelly pad; irrigator; butter plate; Allis' 
inhaler. 
Pan: Cotton; wool; wood wool; ether; gauze; adhesive; band- 
ages; roll. 
Extras: Coat; overalls; battery; cautery ; sponges; etherizer's 
case; special instruments, splints, apparatus, etc. 
For minor operations, I use a similar smaller bag (12-inch size) 
which will hold the majority of the articles enumerated. In major 
operations, where the services of one or more assistants are available, 
bulky apparatus and things that will not go into the bag are carried 
in a long obstetric or cloth lawyer's bag. 
I have found it a good plan to write out on a card, for the use of 
my assistants and nurses, a " drill" to familiarize them with a sys- 
tematic method of preparing for an operation. 
On reaching the house they are to (1) open and empty the bag 
and sort its contents. (2) Scrub the hands and forearms, paying 
particular attention to the finger-nails. (3) Prepare bichloride solu- 
tion (1 to 1000) in a basin. (4) Disinfect the hands. (5) Immerse 
some towels in this solution. 
'Phen one assistant gets the patient ready, scrubbing, shaving and 
disinfecting the field of operation, if this has not been done already, 
and proceeds to administer the anaesthetic. Another goes on with 
the preparations. (6) Place the instruments in the pan in boiling 10 
carbolic solution (3 per cent.). (7) Make iodoform solution in ether 
if it is to be used. (8) Wrap the silk, catgut and tendon in a towel 
wrung out of bichloride solution. (9) Select the necessary needles, 
put them in the butter plate and cover them with the oil from the 
catgut bottle. (10) Put the tampons in a basin of bichloride solu- 
tion (1 to 2000) and have an extra basin to wash them in. For the 
large sponges (used in abdominal operations), boiled or distilled 
water or hydronaphthol solution is to be substituted. (11) Place 
the dressings and disinfected dressing scissors in a clean basin 
covered with a disinfected towel in the order in which they will be 
needed. (12) InHate and disinfect the Kelly pad. (13) Fill and 
hang up the irrigator, packing a bunch of cotton loosely into its 
mouth. (14) Pour some of the carbolic solution from the instru- 
ment pan into a photographic tray, adding boiling or boiled water 
to the former. This saves the hands from the action of carbolic 
acid. (15) Fill the other photographic tray with bichloride solution 
and put the protective, safety pins, silk-worm gut, horse hair, drains, 
etc., into the trays. (16) Bring in and arrange the patient, adjust- 
ing blankets, rubber cloths, disinfected towels (as dry as possible), 
Kelly pad, etc. Final scrubbing and disinfection of field of opera- 
tion if necessary. (17) Prepare basin for the hands (bichloride 1 to 
2000.) (18) Final scrub and disinfection of the hands. 
N.B. No person but the operator and one assistant can touch the 
wound or anything that is to come in contact with it, unless ordered 
to do so and duly prepared. 
With a little practice at home, these preparations can be made 
quietly, thoroughly and very quickly ; if the preparations at the 
house have been carried out with a like system the operator can get 
along successfully, in private practice, without the luxury of a well- 
appointed operating-room or amphitheatre. He can also control 
every detail, that absolute essential to aseptic success. Add to these 
a careful etherizer, a well-trained assistant and an intelligent nurse, 
or the first and the last only, and some of the most difficult problems 
of every-day surgery are practically solved.