The nurse renews the supplies of gauze and cotton sponges. Hot solutions are prepared, and the patient brought into a position on table or _across the bed_ so that the best light may be had. The legs may be held by the husband or nurse, or both. If help is inadequate, a sheet sling can be utilized. This is made by twisting the sheet from corner to corner and passing it rope-like over the shoulders, and back of the neck. Then each end is tied above the patient’s knee on either side as the legs are flexed in an exaggerated lithotomy position. The sutures are now introduced and tied loosely from below upward and from within outward. If tied too tightly, they will cut through. The success of the operation depends on two things: the care with which the levator ani, if torn, is found and restored; and the scrupulous cleanliness obtained by the nurse in her after-care. If the stitches become sore, a few drops of sterile glycerine should be applied with an applicator. [Illustration: Fig. 58.—Sheet twisted into a sling. The patient lies on the unrolled portion. The rolled cords bearing against the shoulders are tied to the legs below the knees. See Fig. 102. (American Text Book.)] If catgut is used inside the vagina, the counting of the stitches is gratuitous, since they absorb without removal. If silkworm gut is used, the number of sutures must be recorded, lest one be overlooked in removal. Binding the legs together after repair is not required, but the sutures must be given aseptic care after each bowel movement, each urination, and when the pads are changed, if they have become contaminated. The sutures are removed on the tenth day. [Illustration: Fig. 59.—Repair of perineum. Sutures in place. (Hammerschlag.)] After _complete tears_, the bowels are kept constipated for two or three days, and then moved with a high enema of sweet oil, followed by castor oil by mouth. After the bowel movement, the nurse should wash out the rectum with normal saline solution. The nurse must look carefully at the stitches every time the pad is changed and note if the swelling is increasing or diminishing, if there is irritation or tenderness, or if they are cutting out through the tissues. The external sutures are usually left long and tied together in a knot, to prevent the ends from sticking into the patient. If she complains of this, the ends may be wrapped in sterile gauze. During the progress of the case the nurse must watch for and report any sign of fluid passing from bowel through the vagina.