The nurse is called to a case on account of her special qualifications, but also she should lead her patient in all things, even in gentility. It is her part to anticipate the wants of the patient, and regard it as a reproach if the patient has to remind her that it is time for food, medicine, bath, or for child to come to the breast. Regularity, promptness, and thoughtfulness must be supreme. Be on hand when the doctor calls and stay until he goes. Be as cheerful as Mark Tapley, however dreary the prospect, and do not make noises either by the swish of overstarched skirts, the squeak of shoes, or the moving of equipment. Above all things, the nurse must keep her patient’s room, her patient, and her own person rigorously clean. She should not allow her hands to touch infectious material without protection by rubber gloves. This is as necessary for her own safety as for the patient and family. Her hands should be manicured frequently, her hair shampooed at short intervals, and her teeth kept in order. If the hands get hard, take a teaspoonful of sodium carbonate and one of chloride of lime, mix in the palm of the hand with enough water to make a cream, and rub well into palms and about the nails. Rinse in clean water. (Weir.)

The nurse’s dress should be neat, always mended, and carefully adjusted. The nurse who is slovenly in appearance will be slovenly in her mind and slovenly in her work. She should not wear her uniform on the street. It is bad taste, unprofessional, and unsanitary.

She should bathe at least three times a week. There is always some odor of perspiration about the body, and especially around the axillary spaces which are filled with hair. Nothing is more offensive and nauseating than being leaned over and waited on by a person who has a strong body smell.

The prodigal use of warm water and soap will aid, but there are large sebaceous glands in the armpits and their decomposing excretions are retained by the hair so lastingly that more radical measures are necessary. The axillÆ should be shaved at least once a month, and then the soap and water becomes more efficacious. After thorough cleansing, the armpits should be dredged with Babcock’s Motiya powder, and the annoying and offensive odor will disappear.

If the patient is a refined and dainty woman, who may happen to be afflicted with the same misfortune, she will be deeply grateful to the nurse who tells her how to get rid of it.

That some doctors, unfortunately, have strong odors about the person—the mixed effluvia of tobacco, alcohol, bad teeth, and uncleanliness—is no excuse for the nurse. The doctor should know better, but at all events, his offense rarely needs to be suffered more than a few minutes at a time, while the nurse is in constant attendance.

The trained nurse should be polite to, but not familiar with servants, as she is looked upon as the highest type of the professionally educated gentlewoman, and she must be constantly alert that her reputation in this respect is not diminished.

Hot Baths.—Temperature from 98° F. to 120° F.

Water should be tepid at first and the hot water gradually added until the required degree is obtained.

Sedative Bath.—The patient is stripped and stands for an hour in the hydrotherapy room, while a hot spray is played up and down the spine. The temperature of the water is 104° F. to begin with, and gradually increased to the point of toleration.

An alkaline bath is prepared by adding an ounce of sodium carbonate to each gallon of water.

Bran Bath.—Add two ounces of bran to each gallon of water. Mix the bran in a small amount of boiling water and add to the bath water.

Mustard Bath.—To three gallons of water at a temperature of 105° F. add a tablespoonful of mustard. Leave the child in the water for five minutes, all the while rubbing and stroking the limbs and back. Then wrap naked in a warm blanket and leave for half an hour.

STERILE DRESSINGS—ANTISEPTIC SOLUTIONS—STERILIZATION OF INSTRUMENTS

The preparation of sterile dressings, antiseptic solutions and the sterilization of instruments, is particularly the work of the nurse, whether in the hospital or in a private home. The following directions are therefore desirable:

As soon as the nurse is sure her patient is in labor, she boils a milk bottle, fills it two-thirds full of 95 per cent alcohol, puts a pledget of sterile cotton in the bottom and then boils a pair of dressing forceps, which are placed, handle up, in the alcohol. (See Fig. 52, page 132.) With this forceps, she handles all clean dressings, instruments, and rubber goods that may be contaminated by touch.

Dressings and Supplies.—The necessary dressings and supplies may be prepared one or two weeks before labor according to the following instructions:

Five Yard Packing.—Draw threads at either end of five yard lengths of gauze to its full width. Fold the cut edge across until it lies one-third the distance from the opposite side. Next, fold the double edge over, and bring it to the outside edge of the first fold. Keep it perfectly straight. When folded full length, roll from the end and wrap in strong muslin wrappers. Sterilize in the autoclave or Arnold sterilizer.

Pads for the Vulva.—Unroll a whole bale of common cotton and cover it with a ½ inch thickness of absorbent cotton. Cut in lengths of 12 in. by 4 in. wide. Cover with gauze cut 12 by 14 inches, and fold the ends of gauze over absorbent cotton. Roll from the end, wrap in paper, seal, and sterilize.

Pledgets.—Tear two yard strips, lengthwise of the roll of absorbent cotton, pull from these, three inch pieces, roll them in the hands until round, place in clean bags, and sterilize.

Breast Covers.—Squares of old, soft muslin 4 by 4 inches, with all strings removed, make the best dressings for the nipple. Do not use gauze, because the papillÆ of the nipple may get caught in the mesh and when it is taken off, the tender nipple is irritated or abraded.

Breast Binders.—These are made of single material, because they would be too warm otherwise. They are sleeveless and jacket-shaped and measure 16 inches from shoulder to waist, 40 inches long, and 10 inches for the arm scallop. A binder of this size, if properly adjusted, will fit a patient of any size. Three will be sufficient for the case.

Abdominal Binders.—The abdominal and breast binders are worn during the bed period only. The abdominal binder is made of unbleached muslin, double material, 14 by 40 inches, and hemmed. In the center of the back, on the lower edge, a curved space, six inches wide, is cut out to prevent the binder from getting soiled. To this curved edge, the pad holder is attached by two safety pins, one on either side. The abdominal binder is adjusted by pinning firmly above the fundus, and loosely below.

Pad holders are made of unbleached muslin, and measure 6 by 16 inches.

Cord Dressings.—Cut squares of surgical lint 4 by 4 inches, and cut through to the center on one side. Gauze may be used, but it is not ideal.

Nursery Cotton.—Tear absorbent cotton into narrow lengths and pull out small one inch pieces. Roll them, place in a clean bag and sterilize.

Applicators.—Use absorbent cotton and toothpicks. Tear off small pieces of cotton, moisten the toothpick point with water, place in the middle of the cotton, and roll firmly.

Gauze Sponges.—Cut gauze into squares 6 by 6 inches, and fold from each side to the center. This brings all the ragged edges inside. Fold into squares, place in jars, and sterilize.

Sterilization of Instruments.—Place scalpels in carbolic acid 95 per cent for ten minutes. Lift with sterile forceps, and put in a basin of 95 per cent alcohol for ten minutes. In the absence of carbolic acid and alcohol, the scalpels may be dropped in a 2 per cent solution of lysol for twenty minutes. Cleanse with hot sterile water. (Do not boil scalpels; it dulls the sharp edges.)

All other instruments may be placed in a sterilizer (dishpan or wash boiler) with enough water to completely cover them; boil twenty minutes. Cool in sterile pan, which may be set in cold water. Do not use soda on the instruments during sterilization, as it makes a thick, gummy precipitate on the metal.

The sterile handling forceps must be immersed at all times for two-thirds their length in 95 per cent alcohol.

Brushes.—After using, all brushes should be thoroughly washed, boiled, and dried, wrapped in waxed papers, and sterilized in the autoclave. In the absence of the autoclave, boil thirty minutes.

Basins, pitchers, and douche pans are sterilized by wrapping in strong muslin bags and put to boil for forty-five minutes in the basin boiler or wash boiler. They will not remain sterile longer than one week, even when kept in a clean place and well wrapped. Bedpans should be washed in a strong solution of soap and water, rinsed every morning and boiled for thirty minutes.

Sterilization of Rubber Goods.—

Tracheal Catheters.—Drop in a solution of bichloride 1:5000 and leave for twenty minutes. Lift with sterile forceps into a basin of warm sterile water and leave for ten minutes, or until used.

Vorhees Bags.—Boil twenty minutes. The bags and catheters may be given a longer life by keeping them in a 25 per cent solution of glycerine and water when not in use. Kerosene vapor is also preservative.

Rubber Catheter.—Boil twenty minutes.

Hot Water Bags, Ice Caps, Rubber Bed Rings.—Soak in 10 per cent lysol solution for two hours, wash with warm water, and dry thoroughly. The inside of the ice caps can be dusted with powder.

Never leave rubber gloves in a damp place or lying in a solution. It stretches them and weakens the rubber. To sterilize, they must be washed in a strong solution of soap and water, dried, and paired. Then they are wrapped in a heavy cloth covering and put in the autoclave for twenty minutes.

Wet Process for Rubber Gloves.—Wrap in gauze or cloth and boil for thirty minutes. Lift with sterile forceps and place in lysol solution 1 per cent until used. They are easily drawn on by filling them with the solution as the hand goes in.

The autoclave is not always available, but an Arnold or Rochester sterilizer is readily portable, and takes the place of the hospital machine.

Fumigation of rooms is sometimes necessary. Remove all curtains, bed linen, and other washable fabrics from the room. Open the drawers of dressers, doors of closets, and loosen up and separate everything left so the air can get to it. Close the windows and seal the crevices with cotton and make the room as air-tight as possible. Place a large pan containing six ounces of potassium permanganate crystals in the center of the room. Pour over this twelve ounces of formalin, close and seal the outside doors of the room and leave for twelve hours. If the case has been a very septic one, it is always a good plan to wash the walls of the room before using again. The insides of the drawers and the bed should be thoroughly washed with water and green soap. A formaldehyde lamp is also quite satisfactory if obtainable.