Indicators of quality in district hospital obstetrics

The critical indicators are the maternal and perinatal mortality rates, and indeed whether you have worked them out. Where obstetric care is good, mothers almost never die, so that almost any maternal death is likely to indicate care that is not as good as it might be.

Another useful indicator is the variety of procedures undertaken, and their proportion to one another. This is well shown in the figures for one district hospital, with a great reputation for the quality of its care, and which serves a disadvantaged population with poor communications. In one year 2031 babies were born there; 96 of these (about 5%[md]a good figure to aim for) were delivered by lower segment Caesarean section, none by classical Caesarean section, 55 by vacuum extraction, 16 with forceps (the superintendant is a skilled obstetrician), and 23 by symphysiotomy (the open method). There were 10 destructive operations, and 4 ruptured uteri. There were 6 deaths, only 2 related to delivery.

It is difficult to suggest a suitable ''target' for maternal mortality, so much depends on the circumstances; ideally, it should be almost zero. 50 per thousand is usually considered a good perinatal mortality for a district hospital in the developing world, and 30 a very good one; ideally, again, it should be much lower than this.

The earlier targets in the list below are from among those recommended by WHO after the 1985 conference at Fortazela, Brazil, which was concerned to reverse the trend towards high technology childbirth, and to promote more enlightened methods.

TARGETS FOR GOOD OBSTETRICS WHO'S TARGETS include:

The whole community is informed about the various kinds of birth care, so that each mother can choose the kind of birth she wants.

There is active collaboration with any traditional birth attendants in the community.

A chosen member of the family is present during birth, and during the postnatal period.

Immediate breast-feeding is encouraged, even before a mother leaves the delivery room.

The Caesarean section rate is in the region of 5%, and is certainly less than 8%.

A further Caesarean section is not automatic after a previous one, and suitable mothers are given a trial of labour. Ligation of the Fallopian tubes is not used an an indication for section.

The dorsal lithotomy position is not used routinely during labour and delivery. Walking is encouraged during labour, and each mother decides which position she will adopt during delivery.

Labour is induced for specific medical indications only, with an induction rate of [lt]10%.

Anaesthetic and analgesic drugs are not given routinely, but only when needed to prevent or treat some complication (this depends on the culture; some rural women are so tough, and put up with so much pain without complaining, that they may need to be encouraged to accept analgesia).

The membranes are not ruptured early as a matter of routine.

The perineum is protected wherever possible. Episiotomy is done on appropriate indications only, and is not done routinely.

OTHER TARGETS. The maternal mortality rate in the hospital and the community (15.1) is known, as is the hospital perinatal mortality rate.

Regular perinatal mortality meetings are held.

Antenatal cards are issued to all mothers. The blood pressure is measured and recorded at every antenatal visit.

A wide range of family-planning methods are available at all MCH clinics, in the hospital and outside.

Labour charts, including the cervicograph, are in regular use in the hospital and the clinics.

Destructive operations and symphysiotomies are done when necessary.

Chapter 35 Appendices Appendix A The equipment list Here is a summary of all the equipment discussed in both volumes. The quantities of the items listed are those suitable for the initial equipment of a district hospital. The list is deliberately generous, and there are sufficient haemostats, etc. to make all the sets described in section 4.12. Those items marked ''local pattern', as being suitable for local manufacture, may have to be imported if local manufacturing facilities are limited. Similarly, with those marked ''local purchase', if the local shops are very limited. Some of the more expensive items have been marked ''optional'.

Only a few items have been costed. Much depends on the quantity ordered and the country of manufacture. Forceps from West Germany will cost much more than those from Pakistan. Much equipment (retractors, etc.) is everlasting. A wide variety of some items (needles, etc.), does not necessarily increase the annual expenditure on them. The list assumes that the ordinary supplies of a hospital (antibiotics, etc.) will be available. If you want more details of the equipment, the number of the section where the items are discussed is printed in bold type after the first of the group of instruments in that particular section.

One of the most urgent items in need of standardization is bulbs for endoscopes. Unfortunately, we have been unable to find any standard fitting.]][+10][s8][d8][f09]

OPERATING TABLE, simple pattern, (NES) each $240, one only. [f11]2.1[f09]]] ALTERNATIVE OPERATING TABLE, as Seward minor (SEW), or equivalent, one only.]] MATTRESS, for operating table, (a) one mattress only, with (b) three mackintosh covers only.]] ARM BOARD, for operating table, locally made, one only.]] STOOL, operating, adjustable for height, local manufacture, two only.]] LIGHT, operating theatre, simple pattern, with sockets to take bayonet or screw fitting domestic pattern light bulbs, in addition to special bulbs, state voltage, one only.]] CLOCK, wall, electric, with second hand, one only.]] SPOTLIGHT, free-standing on the floor, ''Anglepoise' type, to take ordinary domestic pattern bulbs, state voltage, two only. Also, high efficiency internally reflecting bulb to give a parallel beam, five only.]] SOLAR PANEL, CHARGER, and BATTERY, one only of each. Optional.]] BATTERY CHARGER, for the common sizes of dry batteries, together with five rechargeable batteries of each size, one outfit only.]] INSTRUMENT CABINET, glass door, sides and shelves, 1300[mu]600[mu]400 mm, local manufacture, one only.]] X-RAY VIEWING BOX, standard pattern, local manufacture, one only.]] TROLLEY, instrument, without guard rail, with two stainless steel shelves, antistatic rubber castors, (a) 600[mu]450 mm, three only. (b) 900[mu]450 mm, one only.]] STAND, solution, with antistatic rubber-tyred castors, complete with two 350 mm stainless steel bowls, side by side, one only.]] DRIP stands, telescopic, two only.]] SUITS, theatre, cotton, with short-sleeved shirt, and long trousers, assorted sizes, local manufacture, thirty only. [f11]2.3[f09]]] CLOGS, assorted sizes, ten pairs only.]] APRONS, mackintosh, assorted sizes, local manufacture, eight only.]] CAPS, cotton, thirty only.]] MASKS, theatre, one hundred only.]] GOWNS, cotton, fifty only.]] GLOVES, operating, reusable, (a) Size 6, twenty pairs. (b) Size 6[1/2], forty pairs. (c) Size 7, twenty pairs. (d) Size 7[1/2], forty pairs. (e) Size 8, twenty pairs only.]] GLOVES industrial, three pairs only.]] GLOVE POWDER, absorbable, 3 kg only.]] SOAP, hexachlorophene or carbolic, fifty tablets only.]] BRUSHES, nylon, nesting, fifty only.]] TOWELS, cotton, green, theatre. (a) Hand towels 25 cm square, one hundred only. (b) Theatre drapes 100[mu]75 cm, one hundred only. (c) Abdominal sheets, ten only.]] OTHER SUPPLIES (1) Pyjamas and pyjama trousers, twenty only. (2) Dresses, twenty only. (3) Mackintosh drapes 75[mu]100 cm, twenty only. (4) Squeegee, two only. (5) Bucket and mop, three only.]] AUTOCLAVE, vertical, 350 mm, 2[1/2] drum, electric, 6 kw, state voltage, manual operation, with 6 spare elements, 6 spare gaskets, and a triple set of other spares as necessary, one only. [f11]2.4[f09]]] Alternatively, AUTOCLAVE, vertical, 350 mm, 2[1/2] drum, for heating by kerosene or gas, manual operation, with 6 spare gaskets, and a triple set of other spares as necessary, one outfit only.]] AUTOCLAVE, vertical, ''pressure cooker', 47 l, UNICEF, as (WIS) No 1941, one only, optional.]] HEATER, kerosene, pressure, ''Primus' pattern or equivalent, 4-burner, with 20 spare jets, prickers and washers etc., two only. These are only required for the alternative autoclave.]] TAPE, autoclave testing, 25 rolls only.]] Alternatively, TUBES, Browne's, for testing autoclave, Type one (black spot), for use with ordinary steam sterilizers below 126 C, one hundred tubes only.]] DRUMS, 340[mu]230 mm, ten only.]] DRUMS, 340[mu]120 mm, ten only.]] DRESSING BOXES, stainless steel with hinged lid and perforated sliding shutters at front and back 250[mu]200[mu]150 mm, three only.]] TRAYS, dressing, without lids, stainless steel, 275[mu]320[mu]50 mm, twenty only.]] STERILIZER, boiling water, electric: (a) ''Bowl sterilizer', 450[mu]350[mu]380 mm, with counterbalanced lid, 6 kW, with 6 spare elements, state voltage, one only. (b) Instrument sterilizer, 350[mu]160[mu]120 mm, 1.2 kW, with 6 spare elements, state voltage, one only.]] Alternatively, STERILIZER, boiling water, for heating by kerosene or gas, one only.]] FORCEPS, sterilizer, Cheatle's, 267 mm, UNIPAC 0735200, two only.]] FORCEPS, sterilizer, Cheatle's extra large, 279 mm, complete with can of appropriate size for antiseptic fluid, two only.]] FORCEPS, bowl sterilizing, Harrison's double jawed, complete with can of appropriate size for antiseptic fluid, one only.]] IODINE, tincture USP, 1 l only. [f11]2.5[f09]]] CHLORHEXIDINE, gluconate solution BP, (''Hibitane'), 5 l only.]] GLUTARALDEHYDE, concentrate, 50% w/w in water, 5 l only.]] CRESOL and soap solution BP (''Lysol'), or some other phenolic antiseptic, 10 l only.]] DRESSING TRAYS, stainless steel, with lids, (a) 250[mu]200[mu]50 mm, six only. (b) 350[mu]300[mu]50 mm, three only.]] SODIUM NITRITE, tablets or powder, 100 g.]] GAUZE, haemostatic, surgical, ''Surgijel' or equivalent, 5 packs only. [f11]3.1, 3.2[f09]]] FORCEPS, artery, Spencer Wells. (a) 200 mm, straight, six only. (b) 150 mm, straight, twelve only. (c) 230 mm, curved, six only. (d) 200 mm, curved, eighteen only. (e) 150 mm, curved, six only. (f) 125 mm, curved, twelve only.]] FORCEPS, artery, Crile's, (a) straight, six only. (b) curved, box joint, 140 mm, eighteen only.]] FORCEPS, artery, Halstead's, ultrafine, mosquito, haemostatic, (a) straight, (b) curved, box joint, 120 mm, six only of each type.]] FORCEPS, artery, Kocher's, (a) straight, (b) curved, box joint 200 mm, six only of each type.]] PINS, safety, Mayo's, large, for storing artery forceps etc., ten only.]] TOURNIQUET, Conn, improved pneumatic with dial, in case complete, (a) adult, (b) child. One only of each size. [f11]3.9[f09]]] BANDAGE, rubber, Esmarch, 3 metres[mu]75[mu]1 mm, fitted with tapes, three metres, one only.]] SCALPEL, solid forged, size No. 1, 30 mm, and size No. 5, 40 mm, two scalpels only of each size. [f11]4.2[f09]]] HANDLE, scalpel, Bard Parker, No. 4, eight only]] HANDLE, scalpel, Swan Morton, No. 5, four only.]] BLADES, scalpel, disposable, Bard Parker or Swann Morton type, stainless steel in dispenser containing 100 blades. (a) Type 10, ten dispensers only. (b) Type 11, five dispensers only. (c) Type 15, five dispensers only. (d) Type 22, two dispensers only. (e) Type 24, two dispensers only.]] OILSTONE, hard Arkansas pattern, 150[mu]70[mu]30 mm, one only.]] DISSECTOR, MacDonald, one only.]] SCISSORS, operating, Mayo, straight, bevelled blades, 200 mm, one only. [f11]4.3[f09]]] SCISSORS, operating, Mayo, curved, bevelled blades, 170 mm, one only.]] SCISSORS, operating, McIndoe's, curved, with rounded tapering blades, 180 mm, one only.]] SCISSORS, operating, Metzenbaum, curved 275 mm, one only.]] SCISSORS, Aufrecht's, light, curved, 140 mm, one only.]] SCISSORS, straight with fine sharp points, Glasgow pattern, 100 mm, stainless steel, two only.]] SCISSORS, suture cutting, ''assistant's scissors', rounded ends, four only.]] SCISSORS, suture wire cutting, 130 mm, one only.]] SCISSORS, bandage angular, Lister 180 mm, one only.]] FORCEPS, dissecting, thumb, blunt, non-toothed, Bonney's, 180 mm, three only. [f11]4.4[f09]]] FORCEPS, dissecting, thumb, toothed, Treves', 1[mu]2 teeth, 130 mm, five only.]] FORCEPS, dissecting, thumb, fine, Adson's, (a) plain, (b) 1[mu]2 teeth, 120 mm, two only of each.]] FORCEPS, dissecting, thumb, Duval's, 150 mm, with non-traumatic teeth on triangular jaws, two only.]] FORCEPS, dissecting, thumb, toothed, 180 mm, one only.]] FORCEPS, dissecting, thumb, Maingot's, 280 mm, one only.]] FORCEPS, dissecting, McIndoe's, plain, 150 mm, one only.]] FORCEPS, dissecting, ophthalmic, Silcock's, 100 mm, one only. ]] FORCEPS, tissue, locking, Allis', box joint, 150 mm, 5[mu]6 teeth, eight only.]] FORCEPS, tissue, locking, Babcock's, box joint, 160 mm, two only.]] FORCEPS, tissue, Lane's, one only.]] FORCEPS, sinus, Lister, box joint 150, mm, one only.]] FORCEPS, cholecystectomy, curved jaws with longitudinal serrations, Lahey's, box joint, 200 mm, one only.]] FORCEPS, intestinal, Dennis Browne, 180 mm, one only.]] FORCEPS, Moynihan, box joint 220 mm, with box joint, four only.]] FORCEPS, Desjardin's, screw joint, one only.]] FORCEPS (clamps), hysterectomy, curved, box joint, 1[mu]2 teeth, Hunter or Maingot, four, preferably, six only.]] RETRACTOR, Volkmann's rake, sharp, 4-prong, 220 mm, two only. [f11]4.5[f09]]] RETRACTOR, Langenbeck, 13[mu]44 mm, two only.]] RETRACTOR, Czerny, double-ended, four only.]] RETRACTOR, Lane's modified by Kilner, double-ended, 150 mm, two only.]] RETRACTOR, Gelpie, 170 mm, two only.]] RETRACTOR, Morris, double-ended, three only.]] RETRACTOR, Deaver's, plain handles, set of five sizes, one set only.]] RETRACTOR, malleable copper, set of 4 sizes, one set.]] RETRACTOR, Meydering, 178 mm, two only.]] RETRACTOR, self-retaining, West's, straight, sharp pronged, one only.]] RETRACTOR, abdominal, self-retaining, two-blade, adult, Gosset's, one only.]] RETRACTOR, universal, Dennis Browne, with (a) one frame 300[mu]240 mm, (b) one frame 300[mu]240 mm, (c) 3 hook-on retractors 50[mu]65 mm, (d) ditto 80[mu]90 mm, (e) ditto 98[mu]50 mm, (f) ditto 105[mu]35 mm, one set only.]] Fig. 35-1 CARING FOR YOUR EQUIPMENT[md]ONE. A, B, C, you will need a grindstone, a razor, and a strop. D, if your razor is hollow-ground, lay it flat, so that both edges rest on the stone, and push it forwards. E, if it is ground on the flat, lift its heel slightly and push it forwards. F, light reflecting from the blunt edge of a razor. G, a sharp razor without such a facet. H, removing a burr. I, stropping a knife by pulling it towards you. J, feeling if there is a burr on a blade by drawing it backwards across your finger.]][+10][s8][d8][f09]]]

SUTURES, polyamide (''Nylon'), monofilament, strengths 5/0, 4/0, 3/0, 0 and 1, reels of 1000 metres, (PEA), preferably each size a different colour, two reels only of No. 1, one reel only of the other sizes. [f11]4.6[f09]]] SUTURES, catgut, plain, 3/0, in boxes of 12, five boxes only.]] SUTURES, catgut, chromic, strengths 3/0, 2/0, 0, and 1, boxes of 12, ten boxes only of each strength.]] SUTURES, catgut, chromic, atraumatic, (a) 2/0 on half-circle 30 mm needles, ten boxes only. (b) 2/0 on 5/8 circle 30 mm needles, ten boxes only. (c) 4/0 on 16 mm curved needle, ten boxes only.]] SUTURES, prolene, atraumatic, (a) 4/0 on 16 mm half-circle, round-bodied needle, (b) 8/0 on 3 mm 3/8 circle atraumatic needles, two boxes only of each size.]] SUTURES, linen, No. 1, five reels only.]] SUTURES, nylon or virgin silk, 8/0, one box only.]] WIRE, suture, monofilament, soft stainless steel, reel, (a) 5/0, (b) 0.35 mm, (c) 1.0 mm, one reel only of each thickness.]] WALL BRACKET, stainless steel, to hold rolls of monofilament, as in Fig. 4-5, one only.]] REELS, stainless steel, egg-shaped (''eggs'), for holding suture material, five only.]] NEEDLES, suture, Keith, triangular straight 64 mm, twenty-five needles only. [f11]4.7[f09]]] NEEDLES, suture, 3/8 circle curved, triangular point, sizes 4, 12 and 18, twenty-five needles of each size.]] NEEDLES, suture, 1/2 circle curved, triangular, sizes 2, 8, 14 and 20, fifty needles of each size only.]] NEEDLES, suture, round-bodied, 3/8-circle curved, sizes 4, 10 and 18, twenty-five needles of each size only.]] NEEDLES, Moynihan, 5/8-circle curved, round-bodied, fine, sizes 1, 4 and 6, fifty needles only of size 1, twenty- five needles only of sizes 4 and 6.]] NEEDLES, Mayo, intestinal, round-bodied, half-circle curved with sharp perforating ends, 23 mm, size 20, one hundred needles only.]] NEEDLES, suture, round-bodied, half-circle curved, sizes 1, 4, 10, 15, and 20, twenty-five needles of each size only.]] NEEDLES, suture, Moynihan, Lance point, 5/8-circle, 115 mm, twenty-five needles only.]] NEEDLES, suture, curved, tension, Colt, 102 mm, five needles.]] NEEDLES, straight triangular, cutting, 35 mm, twenty needles only.]] NEEDLES, suture, Jameson Evans, triangular, curved, 10 mm, twenty-five needles only.]] NEEDLES, suture, Dennis Brown, round-pointed, 5/8 circle, 16 mm, twenty-five needles only.]] NEEDLES, suture, 1/2circle, catgut, Mayo, sizes 1 and 3, twenty-five needles of each size only.]] NEEDLES, Deschamps, angled to the right, five needles only.]] NEEDLE-HOLDER, Boseman, 210 mm, ratchet and loose joint, tungsten carbide jaws, two only.]] NEEDLE-HOLDER, Mayo's, with ratchet and box joint, tungsten carbide jaws 185 mm, one only.]] NEEDLE-HOLDER, Mayo Dunhill, 160 mm, ratchet and box joint, tungsten carbide jaws, three only.]] NEEDLE-HOLDER, Mayo's with narrow serrated jaws, box joint tungsten carbide jaws and ratchet, 185 mm, three only.]] NEEDLE-HOLDER, Derf, box joint and rachet, tungsten carbide jaws, 115 mm, one only.]] TUBE, nasogastric, plastic, Ryle's, with several side holes near the tip, 14 Ch, 16Ch, and 18 Ch, ten only of each size. [f11]4.9[f09]]] TUBE, stomach, adult and child, assorted sizes, five only of each size.]] TUBING, red, rubber sterilizable, 2 mm wall, (a) 10 mm bore, (b) 15 mm bore, ten metres only of each size. [f11]4.10[f09]]] TUBING, drainage, Penrose, assorted sizes, 5 metres only.]] DRAIN, corrugated red rubber, sheets 1[mu]50[mu]300 mm, ten sheets only.]] SUMP DRAIN, rubber or plastic, five only.]] TUBE, rectal, rubber, (a) child's size 8 mm (24 Ch), five only; (b) adult's size 10 mm (30 Ch), five only. [f11]4.11[f09]]] CONNECTOR, end to end, polypropylene, external diameter (a) 4 mm, (b) 7 mm, (c) 10 mm, (d) 15 mm, (e) 19 mm, ten only of each size.]] CONNECTOR, 3 way, ''Y', assorted sizes, twenty only.]] CLIP, towel, cross action, 90 mm, twenty eight only.]] CLIP, towel, with ratchet, Backhaus, six only.]] FORCEPS, sponge-holding, Rampley, straight, box joint, (a) 240 mm, twenty two only. (b) 120 mm, two only.]] LOUPE, binocular, Bishop Harman, [mu]2 magnification, one only.]] TROCAR AND CANNULA, straight, with nickel silver or stainless steel cannula and metal handle, as (a) 4 mm (12 Ch). (b) 8 mm (24 Ch). (c) 12 mm (36 Ch), one only of each size.]] CANNULA WITH SIDE ARM for suction, one only.]] PROBE, malleable, with eye, nickel silver, 150 mm, as UNIPAC 0759915, one only.]] DIRECTOR, hernia, Key's, one only.]] DIRECTOR, probe-ended, Brodie, 165 mm, one only.]] RING CUTTER, one only.]] NEEDLE, aneurysm, Dupytren, (a) one needle curving right. (b) one needle curving left, one only of each kind.]] NEEDLE, aneurysm, small, with blunt point, three only.]] CATHETER, metal, female, three only.]] BRUSH, for cleaning instrument jaws, ten only.]] RAZOR, safety, for preoperative preparation, ten only.]] BUCKET, stainless steel, with handles, six only.]] KIDNEY DISHES, stainless steel, with half curled edges, 4 sizes 100 to 300 mm, two dishes of each size only.]] GALLIPOT, stainless steel or autoclavable plastic, set of six sizes 40 to 200 mm, two sets only.]] JAR, stainless steel with dropover lid, 150[mu]150 mm, two only.]] JUG, plastic, autoclavable, conical, 3 litre, one only.]] BIN, soiled, two only.]] JELLY, hydroxymethylcellulose, sterile, ''KY' jelly, 1 kg only.]] ''BIPP', bismuth, iodoform, and paraffin paste BPC, 1 kg only.]] CARPENTER'S EQUIPMENT (a) Saw, one only. (b) Twist drill, one only. (c) Hammer, claw head, one only.]] OTHER MATERIALS including gauze, cotton wool, bandages, adhesive tape, and laparotomy pads.]] ASPIRATOR, Martin's, with 3-way tap and needles, one only. [f11]6.1[f09]]] OSTEOTOME, Swedish model, solid forged stainless steel, (a) 6 mm. (b) 10 mm. One only of each size. [f11]7.2[f09]]] NIBBLER, 150 mm, Read Jensen, one only.]] GOUGES, Swedish model, solid forged stainless steel, (a) 6 mm, (b) 10 mm. One only of each size.]] NIBBLER, Read Jensen, 150 mm, one only.]] MALLET, stainless steel, 350 g, one only.]] BONE FILE or rasp, one only.]] FORCEPS, bone-cutting, Liston, angled on flat, 200 mm, one only.]] FORCEPS, bone-holding, Hey Groves, 210 mm, one only.]] FORCEPS, bone-holding, Lane's 390 mm, one only.]] FORCEPS, sequestrum, angled, 190 mm, one only.]] CURETTE, or scoop, Volkmann, double-ended, size C, two only.]] LEVERS, bone, Trethowan, 220 mm, four only.]] LEVERS, bone, heavy, four only.]] HOOK, bone, 220 mm, one only.]] ROUGINE, Faraboef, with curved end, chisel edge, one only.]] ELEVATOR, periosteal, one only.]]

surg142]] FORCEPS, intestinal, non-crushing, flexible blades, Kocher's or Doyen's, 250 mm, two only. [f11]9.2, 9.6, 10.5[f09]]] CLAMP, Payr's, intestinal crushing, lever action, medium size, 110 mm, two, preferably four, only.]] CLAMP, Payr, intestinal crushing, lever action, small size for pylorus, 60 mm, two only.]] CLAMP, enterostomy, crushing, Lloyd Davies parallel action to take apart, one only.]] DECOMPRESSOR, intestinal, Savage, one only.]] TUBE, Sengstaken, 18 to 21 Ch, two only of each size. [f11]11.5[f09]]] FORCEPS, Desjardins, gallstone, one only. [f11]13.3[f09]]] BISTOURIE, guarded, one only. [f11]14.1[f09]]] STETHOSCOPE, fetal, plastic, one only. [f11]15.1[f09]]] DOPPLER FETAL HEART DETECTOR, ''Sonicaid' pattern or equivalent, one only. Optional.]] SPECULUM, vaginal, Sims', double-ended, medium size, 27[mu]30 mm, three only of each size.]] SPECULUM, vaginal, Cusco's, duckbill, small and large, stainless steel, one of each size only.]] SPECULUM, vaginal, weighted, Auvard's, chromium plated, one only.]] FORCEPS, uterine vulsellum, curved, 1[mu]2 teeth and 3[mu]4 teeth, box joint, 230 mm, one only of each size.]] SOUND, uterine, malleable, metric, graduated shaft, two only.]] DILATORS, cervix, double-ended, Hegar's, 222 mm, set of 12 sizes, 1/2 mm to 23/24 mm, one, or preferably, two sets only.]] MANIPULATOR, uterine, one only.]] FORCEPS, ovum, curved, screw joint, McClintock 250 mm, one only.]] CURETTE, uterine, double ended, blunt and sharp, 8 mm and 5 mm, two only of each size.]] CURETTE, suction, stainless steel, reusable, sizes 8 and 10 Hegar, one only of each size.]] CURETTE AND SYRINGE, for menstrual regulation, sterile, plastic, disposable, five hundred only.]] CATHETER, Drew Smythe, one only.]] CANNULA, cervical Leech Wilkinson or Miller, one only.]] SCISSORS, episiotomy, Vant, one only.]] VACUUM EXTRACTOR, Bird's modification of Malmstrom's, complete with 3 suction cups 40, 50, and 60 mm, and one posterior cup, one traction handle, vacuum hand pump, chain, spare vacuum bottle and spare baskets, one only.]] FORCEPS, outlet, Wrigley, one only.]] FORCEPS, obstetric Neville Barnes, one only. Optional.]] FORCEPS, haemostasis, straight, Green-Armytage, 203 mm, six only.]] PERFORATOR, Simpson's one only.]] RETRACTOR, Doyen's, one only.]] RETRACTOR, Kirschner, one only.]] SCISSORS, embryotomy, Queen Charlotte's pattern, one only.]] SAW, decapitation, Blond-Heidler, complete with ring, thimble and blades, one only.]] Fig. 35-2 CARING FOR YOUR EQUIPMENT[md]TWO. A, to sharpen a cutting needle, put it on a stone and rotate it in two planes. B, sharpening a pair of scissors. C, tightening the rivet of a pair of scissors. D, the cutting edge of a scissors should look like this.]][+10][s8][d8][f09]]]

LAPROCATOR, JHPIEGO pattern, with Verres gas needles, and carbon dioxide supply (JHP), in case complete one only. Optional [f11]15.4[f09]]] FORCEPS, vasectomy, two only [f11]15.6[f09]]] LARYNGOSCOPE, neonatal, straight-bladed, Seward, with two blades sizes 0 (80 mm) and 1 (110 mm), also 10 spare batteries and five spare bulbs, two laryngoscopes only.[f11]19.12[f09]]] TUBES, tracheal, neonatal, transparent, plastic or rubber, non-disposable (or disposable but reusable), either Coles pattern with neck and T-piece, or straight pattern with uniform diameter, sizes 2.0 mm (10 Ch), 2.5 mm (10 Ch), 3 mm (12 Ch), and 3.5 mm (14 Ch), ten only of each size.]] ADAPTOR, tracheal, neonatal, various sizes, 5 only.]] SUCTION CATHETERS, 4, 6, 8 and 10 Ch, 10 only of each size.]] AIRWAYS, neonatal, sizes 00 and 000, five only of each size.]] MASK, neonatal soft and clear, sizes 00, 0 and 1, Ambu (AMB) Laerdal, Bennet or Samson, two only of each size.]] BAG, self-inflating, neonatal or infant size 250 or 500 ml, Cardiff, Laerdal or Ambu (AMB), with resevoir or extension tube, and expiratory pressure release valve, one only.]] SUCTION DEVICE, electric, with overflow bottle and guage, maximum vacuum 20 mmHg (0.7 Bar), as ''de Vilbiss 721 Vacu Aide' (deV), one only.]] FOOTPUMP, ''minipump' (AMB), one only.]] MUCUS EXTRACTOR tube, and fluid trap, 10 Ch (CHI), five only.]] STETHOSCOPE, with small head, one only.]] PROCTOSCOPE, Gabriel, 64[mu]25 mm, one only. [f11]21.1[f09]]] SPECULUM, bivalve, preferably Goligher pattern with detachable third blade, one only.]] SIGMOIDOSCOPE, Strauss, 330 mm, Luer fitting, in case with bellows, cord, and standard endoscope lamp complete with biopsy forceps, etc., one only.]] SPONGE HOLDER, for sigmoidoscope, 430 mm, one only.]] FORCEPS, for biopsy through sigmoidoscope, Officer pattern, one only.]] SUCTION TUBE FOR SIGMOIDOSCOPE, one only.]] BELLOWS, spare for Strauss sigmoidoscope, Luer fitting, one only.]] LAMPS, endoscope, standard, small, fitting, ten only.]] BATTERY BOX, for endoscopes, holding D-type dry cells, one only.]] PROBE, medium-sized, malleable silver, one only.]] DIRECTOR, probe-pointed, one only.]] CATHETERS, latex or plastic, Jaques, 380 mm, (a) 8 Ch, ten only. (b) 10 Ch, twenty only. (c) 14 Ch, ten only. (d) 16 Ch ten only. (e) 20 or 24 Ch, ten only. [f11]22.1[f09]]] CATHETER, Tiemann, rubber or plastic, olive-tipped, (a) 16 Ch, twenty only. (b) 18 Ch, fifty only. (c) 20 Ch, fifty only.]] CATHETER, Gibbon, simple polythene, with removable nylon stylet, (a) 10 Ch, (b) 12 Ch. Five only of each size.]] CATHETER, de Pezzer, self retaining, rubber or plastic, 20 Ch, 26 Ch and 32 Ch. Twenty of each size.]] CATHETER, Malecot, self-retaining, rubber or plastic. (a) 20 Ch. (b) 26 Ch. (d) 32 Ch. Twenty of each size.]] CATHETERS, Foley, balloon, latex rubber, self-retaining, double channel, 30 ml balloon, (a) 14 Ch, twenty only. (b) 16 Ch, forty only. (c) 18 Ch, forty only. (d) 20 Ch, forty only. (e) 22 Ch, forty only.]] CATHETERS, Foley, balloon, silicone rubber, self-retaining, double-channel, 30 ml bag, (a) 14 Ch, five only. (b) 22 Ch, five only.]] CATHETER, plastic, Foley balloon, 3-way for continuous irrigation, 75 ml balloon, straight tip, 22 Ch, twenty only.]] INTRODUCER, catheter, two only.]] SPIGOTS, plastic, for catheters, (a) small, fifty only. (b) large, fifty only.]] BOUGIES, neoplex, Porges (POR), filiform, smaller sizes olive-tipped, larger sizes plain, sizes 1 to 20 Ch, two only of each size.]] SOUNDS, metal, large, blunt, straight, plain end, Powell's, sizes 12 to 20 Ch, one only of each size.]] SOUNDS, urethral, metal, Otis[nd]Clutton, curved with olive ends, 9/14 Ch, 11/15 Ch, 12/17 Ch, 14/18 Ch, 15/20 Ch, 17/21 Ch, and 18/23 Ch, one only of each size.]] TROCAR and cannula, gall-bladder, Ochsner, with metal piston and side branch, medium size, one only.]] SYRINGE, bladder, washout 50 ml, plastic, boilable, two only.]] RETRACTOR, Thomson[nd]Walker, with two pairs of detachable abdominal wall blades, and long blade for posterior wall, one only.]] URINE BAGS, simple pattern, with drainage outlet at the bottom, plastic reusable, five hundred only.]] CLAMP, penile without ratchet, twenty only.]] BIOPSY NEEDLE, Travenol ''Tru-cut', Code No 2N2704 (TRAV), one only. Optional.]] CYSTOSCOPE, simple pattern, Ringleb type, for examination only, 19 Ch, with single irrigating sheath, Albarran lever, and ''Autoface' pattern bulb, boilable, with battery box and rheostat, and 25 spare bulbs, one outfit only. Optional. [f11]22.3[f09]]] SYRINGE, bladder, Barrington's metal, one only.]] CAN, douche, metal, 3 litre, with rubber tubing, one only.]] CHARTS, visual acuity, (a) Snellen and (b) illiterate E charts, both for use at 6 metres; one chart only of each. [f11]24.1[f09]]] TEST TYPE, reading pattern, one set only. Optional.]] TORCH, for focal illumination, local pattern, preferably pencil type, with ''lens bulb', one only.]] LOUPE (magnifying spectacles), binocular, surgical, Bishop Harman headband type, [mu]2[nd][mu]8, one only.]] TONOMETER, Schi[um]otz, one only.]] OPHTHALMOSCOPE, simple pattern, Keeler type, battery handle, one only.]] SLIT LAMP MICROSCOPE, on stand, simple pattern, as Inami 911SX or equivalent, one only. Optional.]] NEEDLES, retrobulbar, 7 cm, blunt tip, very fine, one box only.]] SPECULUM, ophthalmic, lid, solid blades, hinged with screw adjustment, one only.]] SCISSORS, ophthalmic, lid, blunt points, one only.]] FORCEPS (clamp), tarsal cyst (chalazion), 8 mm ring, Lambert pattern, one only.]] CURETTE, chalazion (tarsal cyst), one only.]] CAUTERY, simple type, ball pattern, two only.]] CLAMP, eyelid, entropion, Desmarres or Snellen's, (a) medium and (b) large, one only of each.]] SCISSORS, ophthalmic, spring pattern, Westcott or Castroviejo's, two only.]] FORCEPS, fine, toothed, St Martin's, two only.]] RETRACTOR, eye, Desmarres, one only.]] NEEDLE-HOLDER, ophthalmic, curved with lock, Castroviejo pattern, (a) light, (b) heavy, one only of each type.]] TRIAL LENSES, basic set with trial frame, spherical lenses only, cylindrical lenses not required, one outfit only.]] GLASSES, simple frames, second hand if necessary, spherical lenses [+]1 to [+]3.50, the most commonly needed glasses are [+]2 and [+]2.50, several hundred assorted.]] EYE DRUGS. Enriched tetracycline (or chloramphenicol) eye ointment 1%, five hundred tubes. Gentamicin injection 40 mg/ml, 1 ml ampoules, five hundred ampoules. Cyclopentolate 1%, one hundred vials. Atropine ointment 1%, 3 g tubes, fifty tubes. Pilocarpine eye drops 4%, one hundred vials. Lignocaine hydrochloride 4%, or amethocaine hydrochloride 0.5%, one hundred vials. Vitamin A capsules 200,000 iu, ten thousand capsules (in Vitamin A deficient areas only). Fluorescein papers, twenty packets.]] HEADLIGHT, with forehead band and cords, 6 volt 3 watt bulb, and pin terminals to use with battery, one only. Also, 25 spare bulbs. [f11]24.1, 24.12, 24.14 [f09]]] HEAD MIRROR, with webbing or fibre head band, one only.]] EXAMINATION LAMP, Chiron, on base with castors, with Bedford Russell extending arm, one only (optional).]] OTOSCOPE, Keeler, new standard halogen type, with rechargeable handle, with: (a) 5 nylon specula, (b) mini-charger, state voltage (normally 240 volts), (c) adaptor for disposable specula, (d) box of disposable (but reusable) 3 mm specula, one outfit only.]] TUNING FORK, Hartmann's with foot, 512 Hz, one only.]] PROBE, Jobson Horne, 178 mm, with one serrated and one ring end, one only.]] HOOK, wax, St. Bartholomew's pattern, one only.]] HOOK, Quire's, one only.]] SYRINGE, aural, Bacon's, for one hand use, one only.]] FORCEPS, aural, alligator, Hartmann's, one pair only.]] FORCEPS, aural, Wilde, one only.]] FORCEPS, aural, Omerod, elongated cup, crocodile-action jaws, one only.]] FORCEPS, nasal, dressing, Tilley, one only.]] SPECULUM, nasal Thudichum, Mark Hovell modification, size 7, five only.]] SUCTION TUBE, Lempert, one only.]] TROCAR, antral, stainless steel with metal handle, Luer fitting, size 7, Tilley Lichwitz, one only. Also, rubber syringe with male mount for use with the antral trochar, one only.]] MIRROR, laryngeal, with metal stem, boilable, 24 mm, one only.]] MIRROR, rhinoscopic, with metal stem, St Clair Thompson boilable, 14 mm, one only.]] LAMP, spirit, one only.]] SNARE, polypectomy, nasal, Glegg's, (a) one snare only. (b) Spare wires for the snare, five only.]] FORCEPS, nasal turbinate, Luc's, one only.]] TONGUE DEPRESSOR, Lack, adult, one only.]] OESOPHAGOSCOPE, (a) infant, (b) child, (c) adult, with forceps and suckers that are long enough to go through them, one only of each. Optional.]] BOUGIES, oesophageal, neoprene, standard set, alternate sizes only, one set only. Optional.]] BRONCHOSCOPE, rigid, Negus, conventional lighting, distal illumination, complete with cords Wappler fitting, battery box, two lamp carriers and 2.5 v lamps with 10 BA thread, (a) infant lumen 5.4[mu]4.1 mm, (b) child 7[mu]5.7 mm, (c) adolescent small 8[mu]6.7 mm, one only of each size. Optional. ALSO, 25 spare bulbs. Optional.]] FORCEPS, for bronchoscope, (a) Chevalier Jackson, 2/2 teeth on 50 cm shaft, one only. (b) Haslinger tubular shaft, or sliding shaft type for small bronchoscopes, one only of each. Both optional.]] EAR DRUGS AND DRESSINGS. 5 mm selvage ribbon gauze, 50 metres only. Magnesium Sulphate Paste BPC, 1 kg only. Tabs prochlorperazine (''Stemetil') 5 mg, two thousand tablets. Prochlorperazine ampoules 12.5 mg in 2 ml, 500 ampoules. Cinnarizine (''Sturgeron') 15 mg tablets, one thousand tablets. Silver nitrate applicator stick, packet of 50 applicators, (AVO), one packet only. Ephedrine nasal drops BPC (ephedrine hydrochloride 1%) 10 ml, one hundred

vials only. Beclomethasone diproprionate in metered 50 [gm]g dose aerosol; 200-dose applicator, ten applicators only.]] CHAIR, operating dental, one only.[f11]25.2, 25.3 [f09]]] DENTAL MIRROR, serrated handle, with No. 4 size plane head, one only.]] DENTAL PROBE, single-ended, as Ash No. 14, one only.]] DENTAL DRESSING TWEEZERS, Guttman, as Ash No. 13, one only.]] ''PLASTIC INSTRUMENT', as Ash No. 6, one only.]] SPATULA, metal, for mixing filling material, one only.]] SCALER, dental, Cumine, as Ash No. 152, one only.]] FORCEPS, dental, set of six with the following Ash numbers: (a) Upper anteriors (Nos. 1 or 2). (b) Upper right molars (Nos. 17 or 94). (c) Upper left molars (Nos. 18 or 95). (d) Upper premolars and roots (No.7). (e) Lower molars (Nos. 73 or 22). (f) Lower anteriors and roots (No. 74N). One only of each.]] Alternatively, FORCEPS, dental, universal, set of two, upper universal (No. 36), and lower universal (No.74), one only of each.]] ELEVATORS, dental, (a) upper jaw, straight inclined plane, Coupland, (b) and (c) set of two lower jaw Cryer's, mesial and distal. One only of each.]] PROP, dental, one only.]] DENTAL MATERIALS. Clove oil for dental use, 100 ml only. Zinc oxide powder, 1 kg only.]] MICROCELLULAR RUBBER, 5 m['2][mu]10 mm only. [f11]30.5[f09]]] FOAMED POLYETHYLENE, 1 cm thick, as ''Plastazote' (S&N), 5 m['2] only.]] FOOTPRINT MAT, (DOW), one only. Optional.]] ONCOLYTIC DRUGS ''Basic drugs': Vincristine injection, 2 mg vials, one hundred vials. Cyclophosphamide, vials of 100 mg, 200 mg and 500, and 1 g, twenty-five vials of each size only; tablets of 10 and 50 mg, five hundred tablets of each size only. Methotrexate, tablets 2.5 mg, five hundred tablets only; powder for reconstitution, ampoules of 50 and 500 mg, fifty ampoules of each only. Actinomycin D, 0.5 mg vials, fifty vials only. [f11]32.2, 32.24 [f09]]] [em]''Other drugs': Nitrogen mustard, 10 mg vials, one hundred vials only. Doxorubicin, 10 and 50 mg vials, fifty vials of each. Melphalan, tablets 2 mg, one hundred tablets only; ampoules 100 mg, twenty-five ampoules only. 5 fluoruracil, 250 mg ampoules, twenty-five ampoules only. Etoposide, 100 mg vials, twenty vials only. Procarbazine, 50 mg capsules, fifty capsules only. All optional.]] [em]Also mesna, ampoules 400 mg, 50 ampoules. Folinic acid 15 mg, twenty-five tablets. Tamoxifen 20 mg, one hundred tablets. All optional.]] TUBES, oesophageal, Celestin, with guide, 20 assorted tubes only.]] Alternatively, TUBES, Procter[nd]Livingstone (POR) length 110, 150 and 190 mm, assorted, unflanged, twenty tubes only.[f11]32.24[f09]]] NEEDLE, liver biopsy, Menghini, 1.6 mm, normal Menghini point with adjustable stop, one only.[f11]32.26[f09]]] NEEDLE, liver biopsy, Vim-Silverman, adult size, 2.3 mm[mu]88.5 mm, with Franklin modification, one only.]] STRIPPER, varicose vein, Nabatoff in sterilizer case, complete with 3 metal olives, cable and handle, one only. Optional.[f11]34.1[f09]]] TROLLEY, resuscitation, tiltable at the head and foot, with a radio-translucent surface, a device to hold cassettes underneath, holders for an oxygen cylinder and a drip attachment, also a wire basket for the patient's clothes and his property. [f11]51.3[f09]]] DILATOR, tracheal, extra small for children, one only. [f11]52.2[f09]]] TUBE, tracheostomy, plain, uncuffed, reusable, with 15 mm termination, 15 Ch one, 18 Ch one, 21 Ch two, 24 Ch two, 27 Ch three, 30 Ch one, 36 Ch one, 42 Ch one, one carton of assorted tubes only.]] TUBE, tracheostomy, standard, cuffed, reusable complete with obturator and one-way valve, Ch two, 27 Ch two, 30 Ch two, 36 Ch two, 39 Ch one, 42 Ch one, one carton of 10 assorted tubes only.]] RETRACTOR, tracheotomy, single, sharp hook, blunt, one only]] RETRACTOR, tracheostomy, double hook, blunt, two only.]] CLAMP, bulldog for arteries, Blalock cross action, two only. [f11]55.6[f09]]] SAW, amputation, with hinged back, 230 mm, (a) saw, one only, (b) spare blades for the above, three only. [f11]56.1[f09]]] SAW, Gigli, (a) pair of handles, one pair only. (b) Saw blades, 30 cm, 4 only.]] KNIFE, amputation, Liston 180 mm, one only.]] KNIFE, skin graft, Humby, mode pair only. (b) Saw blades, 30 cm, 4 only.]] KNIFE, amputation, Liston 180 mm, one only.]] KNIFE, skin graft, Humby, modified by Blair and Watson, (a) knife only. (b) Set of 50 spare blades, five sets only. [f11]57.1[f09]]] Alternatively, SKIN GRAFT KNIFE MINIATURE, as developed by H. L. Silver of Toronto, to use ordinary safety razor blades.]] RAZOR, for skin grafting, Gillette, local manufacture, one only.]] HOOKS, skin, single point, Gilles, stainless steel, 200 mm, six only.]] SKIN GRAFT BOARD, teak, with bevelled edge, 6[mu]100[mu]200 mm, two only.]] ARCH BAR, stainless steel, five only. [f11]62.1[f09]]] BRACE, Hudson's, standard, 254 mm, one only. [f11]63.1[f09]]] PERFORATOR, Hudson's, with standard Hudson fittings, 12 mm, one only.]] BURRS, spherical, Hudson pattern, 11 mm, 13 mm, 16 mm, 19 mm, one only of each size.]] RONGEUR (bone nibbler), Cairns, with fine angled on flat jaws and curved handles, 152 mm, one only.]] RONGEUR, Sargent, or van Havre, double action, curved or flat, 229 mm, one only.]] ELEVATOR, skull, Penfield, double-ended, one only.]] TUBE, suction, fine, 4 mm diam, one only.]] HOOK, dural, Cairns, sharp, 130 mm each, one only.]] TRACTION TONGS, Gardner Wells, one only. [f11]64.1[f09]]] COLLAR orthopaedic, Zimmer pattern, two only of each of the three standards sizes. [f11]64.6[f09]]] NEEDLES, hypodermic, large for chest aspiration, 1.6[mu]100 mm, ''Luer-lok' mount each, five only. [f11]65.2[f09]]] STOPCOCK, for chest aspiration, ''Luer-lok' male to ''Luer-lok' female, with side are for tubing, two only.]] SYRINGES, 5 ml and 20 ml, both ''Luer-lok'.]] BOTTLE, Tudor-Edwards, 3 litres, chest drainage, including rubber bung and tubes, one only.]] CONNECTOR, for Tudor-Edwards chest drain, five only.]] Alternatively, CHEST DRAIN SET, plastic, disposable, sterile, in packet complete, five only.]] PLASTER BANDAGES, normal, slow-setting, best quality, 10 cm, 15 cm, and 20 cm wide. [f11]70.1[f09]]] CREPE BANDAGES, assorted sizes 100 only of each size.]] STOCKINETTE, woven tubular, orthopaedic, various widths.]] PADDING, cotton wool, orthopaedic, six rolls only.]] STIRRUPS, locally made.]] PLASTER SHEARS, Lorenz, 380 mm, nickel plated, one only.]] PLASTER SHEARS, Guy, with shaped bows and flattened probe end, 250 mm, nickel-plated, one only.]] PLASTER KNIFE, Esmarch, solid forged, two only.]] PLASTER SAW, Bergmans, hand, one only.]] PLASTER CAST SAW, electric, oscillating, with four extra blades 44 mm, and 64 mm, state voltage, one outfit only.]] PLASTER CAST SPREADER, one only.]] PLASTER CAST BENDING FORCEPS, B[um]ohler, one only.]] PENCILS, INDELIBLE, for writing on a cast, six only.]] STRAPPING, traction, adhesive, 50 mm[mu]10 mm, six rolls only. [f11]70.9[f09]]] NAIL, Denham, (Denham threaded Steinmann pin), stainless steel, 4 mm, tapered, self-tapping, with long coarse screw thread, triangular shank, packet of 5, two packs only.]] PIN, Steinmann, triangular shank, stainless steel, trocar pointed at one end, (a) 2[mu]180 mm, (b) 3[mu]180 mm. (c) 4[mu]180 mm, six only of each size.]] HANDLE, with Jacobs chuck, 4 mm capacity, and key attached by chain, fully cannulated, stainless steel, one only.]] STIRRUPS, B[um]ohler, for Steinmann pins, with rotating swivel fixation pieces, (a) 102[mu]89 mm, three only. (b) 165[mu]144 mm, three only. (c) 241[mu]152 mm, five only.]] PIN MOUNTS, Thomas, stainless steel with rotating collar for Perkins traction, four pairs only.]] STIRRUPS, for wire traction, adjustable, tensioning, Gissane, 216 mm, with two cord hooks, two only.]] WIRE, Kirschner, plain unthreaded, stainless steel, drill-pointed at one end, packet of 5. (a) 0.75[mu]254 mm, four packets only. (b) 1 mm[mu]254 mm, four packets only. (c) 1.5 mm[mu]254 mm, four packets only.]] INTRODUCER, for Kirschner wire, Pulvertaft's, one only.]] CUTTER, for Kirschner wire, one only.]] HAND DRILL, for Kirschner wires and drills, 4 mm capacity cannulated throughout, one only.]] DRILL BITS, twist, bone, 4 mm, six only.]] FORCEPS, wire-cutting, compound lever action with pliers jaws, 170 mm, one only.]] CORD, braided, for traction, twenty-five yards only, local purchase.]] PULLEYS, orthopaedic assorted, ten only]] BARS, for overhead traction, six outfits only.]] FINGER SPLINTS, aluminium, padded, 50 lengths only. [f11]75.1[f09]]] Appendix B Lists of suppliers These are the suppliers of surgical equipment whose catalogues have been quoted from. They are given as examples only, and their products may not be either the best, or the cheapest. See also ''Primary Anaesthesia', Appendix B.

(AES) Aesculap instruments. The Jetter and Scheerer Corp, Tuttlingen, West Germany.

(AOC) Americal Optical Corp., 41 Mechanic Street, Southbridge, MA 01550 USA (haemoglobinometer).

(ANT) Antec Internatinal Ltd. Chilton Industrial Estate, Sudbury, Suffolk CO10 6XD, UK. (''Virkon', virucidal agent)

(AVO) Avoca Pharmaceutical Products Ltd, Old Saw Mills Road, Farringdon, Oxon SN7 7DS, UK. (silver nitrate applicators)

(CHI) Chiltern Surgical Products, Beaconsfield, Bucks. UK.

(CYP) Cyprane, New Devonshire House, Scott Street, Keighley, Yorkshire, BD21 2NN, UK. (anaesthetic equipment)

(deV) DeVilbiss Co Ltd, Somerset, Pensylvania 15501, USA.

(ECO) ECHO, Ullswater Crescent, Coulsden, Surrey CR3 2HR, UK. (suppliers to voluntary agencies)

(ESC) Eschman Bros., 24 Church Street, Shoreham by Sea, Sussex, UK.

(ETH) Ethicon Ltd., Box 408, Barkhead Avenue, Edinburgh, EH11 4HE, UK. (sutures)

(FRA) J.G. Franklin Sons Ltd., Lane End Road, High Wycombe, Bucks, UK.

(GEN) Genito-urinary Co. Ltd., 28A Devonshire Street, London WIN 2AJ, UK.

(HOL) Holborn Surgical Instrument Co., Dolphin Works, Margate Road, Broadstairs CT10 2QQ, UK.

(JHP) The Johns Hopkins Program of International Education in Gynaecology and Obstetrics. The Department of Obstetrics and Gynaecology, Johns Hopkins Hospital, Baltimore, Maryland. (laparoscopes, 15.4)

(MER) E Merck. Four Marks, Alton, Hampshire, GU32 5HG, UK. (gentamicin-impregnated polymethylmethacrylate beads, 7.6).

(MIE) Medical and Industrial Equipment Ltd., 26-40 Broadwick Street, London WIA 2AD, UK.

(NES) J Nesbitt-Evans & Co Ltd, Bedstead Manufacturers, Holyhead Road, Wednesbury, West Midlands (operating tables)

(PEA) James Pearsall & Co. Ltd, The Silk Mills, Tancred Street, Taunton, Somerset TA1 1RY. (monofilament sutures in reels)

(PFA) Pfau-Wanfried, Box 110 D-3508 Melsungen, West Germany.

(POG) Porges Paris, 25 Quai Anatole France, 75007 Paris, France. (catheters).

(SAL) Salt and Son Ltd., 220 Corporation Street, Birmingham, UK. (needles).

(SCH) Schuler and Co, 250 West 18th Street, New York 11, USA.

(S&N) Smith and Nephew Ltd., Bessemer Road, Welwyn Garden City, Herts, UK. (dressings, plaster bandages, multicellular rubber, drugs)

(SEW) Seward Surgical, UAC House, Blackfriars Road, London SE1 9UG, UK.

(SHO) AW Showell, Britten Street, Redditch, Worcestershire B97 6HF. (needles)

(SHR) Shrimpton and Fletcher, Box 3, Redditch, Worcestershire B98 7AB, UK.

(SPE) Spencer and Sons, Arthur Street, Redditch, Worcestershire B98 8JY, UK. (needles)

(STO) Karl Storz and Co., Postfach 400-D-7200, Tuttlingen, West Germany.

(SUR) Surgical Medical Laboratory Ltd., Euro House, High Road, Whetstone, London N20 9LS, UK.

(TAL) Teaching Aids at Low Cost, Box 49 St Albans, Herts, AL1 4AX, UK. (teaching materials)

(THA) Thackray Ltd., Box 171, Park Street, Leeds LS1 1RQ, UK. (surgical equipment)

(TRA) Travenol Inc, Deerfield, Illinois, USA (biopsy needles).

(WAR) Warne Surgical Products Ltd., Walworth Road, Andover, Hampshire, UK.

(WHI) Jacob White, Riverside Industrial Estate, Riverside Way, Dartford, DAI 5bx, UK. (autoclaves)

(WIS) Wisconsin Aluminium Foundry Co. Inc., Box 246, 838 South 16th Street, Manitowoc, Wisconsin 54220, USA. (autoclaves)

[end]SKIPPUNG FILE NUMBER 104!