GIFT OF 
 
 
OUTLINES OF 
 
 GENERAL AND SURGICAL 
 NURSING 
 
 BY 
 
 WINIFRED FREDERICK LINDSAY 
 
 Superintendent of the Training School for Nurses 
 
 Of the Paradise Valley Sanitarium 
 
 National City, Cal. 
 
 LOMA LINDA, CAL. 
 
 THE COLLEGE PRESS 
 
 1912 
 
Copyright, 1912, by The College Press 
 Loma Linda, Cal. 
 
 
 
DEDICATED TO MY PUPILS 
 
 AT THE 
 
 PARADISE VALLEY SANITARIUM TRAINING SCHOOL 
 
 FOR 
 MISSIONARY NURSES 
 
PREFACE 
 
 No ATTEMPT has been made to present in this little book, 
 an exhaustive series of outlines, but to briefly and concisely give 
 the essentials, thus firmly impressing the main principles or 
 skeleton, as it were, of the various subjects. These should be 
 elaborated by the instructor. 
 
 Thanks are due Dr. George Knapp Abbott and Dr. Julia A. 
 White of Loma Linda for their many valuable suggestions and 
 criticisms. Also to Dr. Risley of Loma Linda is extended ap- 
 preciation for the chapter on ' ' Poisons. ' ' 
 
 W. F. L. 
 NATIONAL CITY 
 March, 1912 
 
CONTENTS 
 
 PART I 
 General Nursing 
 
 CLINICAL CONDITIONS AND RECORDS. Body Temperature, Pulse, Respira- 
 tion, Bedside Records. 1 11 
 
 THE SICK ROOM. Beds and Bed Making, Personal care of Patient.. 12 20 
 
 CLINICAL PROCEDURES. Lavage, Test Breakfast, Nasal Douche, Aural 
 Douche, Hypodermic Injections, Catheterization, Nasal Feeding, Nutrient 
 Enema, Poultices, Diet, Administration of Medicines, Examinations, Care 
 of the Dead "_ 2140 
 
 SPECIAL CONDITIONS AND EMERGENCIES. General Care of Infectious 
 Cases, Bed Sores, Common Emergencies, Poisons 41 54 
 
 PART II 
 Surgical Nursing 
 
 THE PATIENT. Preparation of Patient's Room, Preparation of Patient. 
 5575 
 
 THE OPERATING ROOM. Technique of Tables, Duties of Staff, Hand Dis- 
 infection, Sterilizing Room, Methods of Sterilization, Suggestive Operative 
 Record, Preparation for Operation in Private Home, Anesthetics and Anes- 
 thesia. ___76 89 
 
 SURGICAL AFTER TREATMENT. Major Operations, Surgical Complica- 
 tions, Special Procedures in Surgical Nursing. 
 
 ACCIDENTS AND MINOR SURGERY. Wounds, Burns, Boils, Ulcers and 
 Abscesses, Hemorrhages, Sprains, Fractures.-- __90 100 
 
 PART III 
 Solutions 
 
 CHEMICALS IN COMMON USE. Corrosive Sublimate, Carbolic Acid, Lysol, 
 Creolin, Formaldehyde, Potassium Permanganate, Boracic Acid, Oxalic 
 Acid, Salt, Alum, Alcohol, Peroxide of Hydrogen, Sodium Bicarbonate, 
 Chloride of Lime, lodoform, Argyrol. 101 105 
 
 THE METRIC SYSTEM - 106 
 
 PREPARATION OF SOLUTIONS. Coal Tar Products, Formaldehyde, Bichlor- 
 ide of Mercury, Potassium Permanganate, Boracic Acid, Salt, Cocain. 
 
 . 107114 
 
PART I 
 GENERAL NURSING 
 
 CLINICAL CONDITIONS AND RECORDS 
 
 Body Temperature 
 
 The average normal temperature of the body taken by 
 mouth is 98.6 F., but under certain conditions may range be- 
 tween 97.5 and 99.5 and still be considered normal. A tem- 
 perature above or below these points is abnormal. 
 
 The normal variations may be due to various causes, viz, 
 
 1. Part of body in which the temperature is taken: Axilla, 
 about 1 F. lower than by mouth. Rectum, about 1 F. higher 
 than by mouth. 
 
 2. The time of day. In a .healty adult the temperature 
 reaches its highest point between 5 and 8 P. M., and is at its low- 
 est point from 26 A. M. In young children and the aged the 
 variations are greater than in adults. 
 
 3. General and local causes, as, 
 
 a. Age. In infancy the temperature is about 1 F. higher 
 than in adults. 
 
 b. Highly seasoned, stimulating foods. 
 
 c. Profuse perspiration. 
 
 d. Exercise. 
 
 e. Water drinking. 
 
 f. Fasting. 
 
 g. Emotion. 
 
 The instrument for registering the bodily heat is called a 
 clinical thermometer. Do not fail to secure a good and reliable 
 thermometer. The best way to test a thermometer is to place 
 it along with one of known accuracy at the same moment, in 
 the mouth or rectum. As thermometers change with age they 
 should be tested frequently. 
 
NURSING 
 
 HOW TO TAKE THE TEMPERATURE 
 
 1. Mouth: 
 
 a. Before using, the mercury must be shaken down to a point 
 2 or 3 below the normal. 
 
 b. Rinse with clean, cold water. 
 
 c. See that the patient has not taken water or food within 
 20 minutes, as this causes quite a variation. 
 
 d. Place the thermometer under the tongue from 3 5 min- 
 utes, the time depending upon the kind of thermometer used. 
 
 e. Do not allow the patient to talk or open the mouth. 
 
 f. Remove, record, and wipe with a piece of cotton wet in 
 water, then disinfect. 
 
 g. It is not safe to take the temperature of children or un- 
 conscious persons by mouth as they are liable to bite the bulb 
 and swallow the mercury. 
 
 2. Axilla: 
 
 a. Remove clothing from under the arm and dry the skin. 
 
 b. Place the bulb between folds of the skin of the armpit. 
 
 c. Bend the elbow, so that the hand touches the opposite 
 shoulder. Leave in place from 710 minutes. 
 
 d. Remove, record, and disinfect. 
 
 3. Rectum: 
 
 a. Do not use the same thermometer for the mouth and 
 rectum. 
 
 b. Oil the bulb and insert about 1J inches. 
 
 c. Leave in place 5 minutes. 
 
 d. Remove, record, and disinfect. 
 
 CLASSIFICATION OF TEMPERATURE 
 
 Temperature of collapse _ . _ 94 96 F. 
 
 Subnormal tempera ture__ 96 98 F. 
 
 Normal 98.6 with variations 
 
 Subf ebrile '. '. 99. 5-100. 5 F. 
 
 Fever of moderate degree __ 100.5 103 F. 
 
 High fever. 103-105 F. 
 
 Hyperpyrexia _ Above 105 F. 
 
 A body temperature below 95 or above 109 F., if it per- 
 sists for any length of time, is likely to be followed by death. 
 
 The Fahrenheit scale is the one principally used in America 
 and England, but on the continent of Europe the Centigrade 
 
PULSE 3 
 
 and Reaumur scales are generally used. To convert Fahrenheit 
 into Centigrade, subtract 32, multiply by 5, and divide by 9. 
 
 Example: 
 
 104 F.-32=72 F. 
 
 72 F.X5/9=40C. 
 
 To convert Centigrade into Fahrenheit, multiply by 9, di- 
 vide by 5, and add 32 to the result. 
 
 Fever (pyrexia) is an elevation of bodily temperature. 
 
 1. Continuous. The temperature is uniformly above the 
 normal line, with but slight variations. Example: pneumonia. 
 
 2. Remittent. The temperature rises and falls, although it 
 never reaches the normal line. Example: typhoid. 
 
 3. Intermittent. A high temperature which at intervals 
 drops to the normal line, or even below it. Example: tertian 
 malarial fever. 
 
 A febrile temperature may fall by crisis or lysis. 
 
 a. Crisis. Sudden drop to or below normal (pneumonia). 
 
 b. Lysis. Gradual decline to (or below) normal (typhoid). 
 As a general rule the temperature becomes subnormal for 
 
 several days after a fever. 
 
 ITEMS TO BE OBSERVED BY THE NURSE 
 
 1. A sudden change in temperature, generally indicates 
 some complication and should be reported to the physician at 
 once. 
 
 2. Temperatures should be recorded neatly and accurately. 
 If you have any reason to doubt the accuracy place after the 
 record a (?). 
 
 3. Keep thermometers either in their cases with some cot- 
 ton at the bottom, or in a glass of disinfectant solution with 
 cotton at the bottom. 
 
 4. Thermometer disinfectants: Pure carbolic acid, 95% al- 
 cohol, formalin, lysol. 
 
 Pulse 
 
 Every contraction of the heart forces the blood into the 
 arteries, causing a distension of the arterial walls. It is this 
 distension at regular intervals corresponding to the contraction 
 of the heart that is known as the pulse. 
 
4 GENERAL NURSING 
 
 Systole. A term used to designate the contraction of the 
 heart. 
 
 Diastole. The interval between the contractions, during 
 which the ventricles are filling with blood. 
 
 NORMAL PULSE 
 
 Men_ 60 70 beats per minute 
 
 Women__ 65- 80 " " 
 Children 
 
 New-born . . 120140 " 
 
 1st year _ 100120 " 
 
 2nd " 90115 " " 
 
 3rd " 80110 " " 
 
 7th " 72 90 " " 
 
 HOW TO TAKE THE PULSE 
 
 Place two or three fingers (never the thumb) upon the 
 radial artery and count carefully for one minute. When one 
 becomes accustomed to counting the pulse, notice the number 
 of beats for 1/2 minute and then multiply by two. One can also 
 count the pulse easily over the temporal artery and the carotid 
 artery. When taking the pulse the patient should be either 
 sitting or lying never standing and should have been quiet 
 for a few minutes preceding. 
 
 THINGS WHICH QUICKEN THE PULSE 
 
 1. Exercise. 
 
 2. Change of position. 
 
 3. Food. 
 
 4. Emotion. 
 
 5. Hot baths. 
 
 6. Certain diseases as exophthalmic goiter in fever the 
 pulse rate increases about ten beats for every degree of rise in 
 temperature. 
 
 7. Certain drugs. 
 
 THINGS WHICH RETARD THE PULSE 
 
 1. Rest. 
 
 2. Reclining position. 
 
 3. Fasting. 
 
 4. Cold to the heart. 
 
PULSE 5 
 
 5. Certain disease conditions as jaundice and brain tumor. 
 
 6. Certain drugs. 
 
 7. A large amount of fluid introduced into the system. 
 The three general attributes of the pulse are time, tension, 
 
 and rhythm. 
 
 1. Time normal, fast, slow. The pulse is faster in child- 
 ren than in adults, and in women than in men. SO 110 fre- 
 quent. 110140 rapid. 140 and above very rapid or running. 
 
 2. Tension normal, high, low. A high tension pulse is a 
 hard, noncompressible pulse. In hardening of the arteries (ar- 
 terio-sclerosis) the artery may be rolled under the finger like a 
 cord. A low tension pulse is soft and easily compressible. 
 
 3. Rhythm, (a) Irregular. The beats differ in length, 
 force, and character, (b) Intermittent. The heart baats reg- 
 ularly for a time, then one beat is so weak as not to be per- 
 ceptible at the wrist, and it appears as if the beat were lost; or 
 the beat may actually be skipped. The rhythm is otherwise 
 regular. 
 
 TERMS USED TO DENOTE CHARACTER OF PULSE 
 
 1. Dicrotic. A secondary wave in the blood current pro- 
 duced by closure of the aortic valves. Less forcible than first 
 pulse wave, but sometimes resembles it so closely as to be 
 counted as an individual beat. The error becomes apparent by 
 holding one hand on the wrist and the other over the heart. 
 This type of pulse is found frequently in the acute fevers, 
 particularly in typhoid fever. 
 
 2. Water-hammer. Cause aortic regurgitation, i. e., the 
 aortic valves are incompetent to close the opening into the aorta 
 so that the pressure is not sustained. The artery suddenly and 
 entirely collapses after each beat. 
 
 3. The following terms are self-explanatory : bounding, 
 thready, wiry. A bounding pulse is almost always found in 
 blood-poisoning (septicemia). 
 
 A thready pulse indicates extreme weakness of the heart 
 or collapse. 
 
 The wiry pulse is present in arterio-sclerosis. 
 The character of the pulse depends upon, 
 1. Action of the heart. 
 
6 GENERAL NURSING 
 
 2. Condition of the arteries and capillaries. 
 
 3. Amount of blood in the vascular system. 
 
 The instrument for recording the pulse tracing is known 
 as a sphygmograph. 
 
 The character of the pulse reveals much to the intelligent 
 nurse. A good nurse will improve every opportunity to famil- 
 iarize herself with the normal pulse and the variations from 
 the normal. 
 
 Respiration 
 
 Rate in adult, 18 per minute. 
 
 Rate in children. Infants, 30-35. At 5th year, 2025. 
 At 8th year, same as adult. 
 
 NORMAL RATIO OF TEMPERATURE, PULSE, AND RESPIRATION 
 
 There are four beats of the heart to one respiration. As a 
 rule, every degree of elevation in temperature is accompanied 
 by an increase of ten heart beats. 
 
 Respiration consists of, 
 
 1. Inspiration. The act of taking air into the lungs. 
 
 2. Expiration. The act of expelling air from the lungs. 
 Since one expiration does not entirely empty the lungs, 
 
 there is always some air in them which is called residual air. 
 The current which is continually passing in and out of the 
 lungs is called tidal air. 
 
 In counting the respiration one should note, - 
 
 1. Frequency. 
 
 2. Regular or irregular. 
 
 3. Difficult or easy. 
 
 4. Noisy or quiet. 
 
 5. Deep or shallow. 
 
 6. Whether chest expands alike on both sides. 
 
 7. Abdominal or thoracic type. 
 
 The various types of respiration are, 
 
 1. Cheyne- Stokes'. This consists in an increase in the fre- 
 quency and force of respiration up to a certain point, and then 
 a gradual decrease until the movements entirely cease for a 
 short time, then the whole procedure is repeated. This type 
 may be found in certain diseases of the heart and kidneys. 
 
BEDSIDE RECORDS 7 
 
 2. Stertorous. A loud snoring sound with each inspiration. 
 
 3. Dyspnoea. Where the breathing is so difficult that the 
 patient can not lie with the head low. 
 
 4. Orthopncea. Where the breathing is so difficult that the 
 patient assumes the upright position. 
 
 5 Mouth Breathing. Common in children who have chronic 
 congestion of the nasal passages, adenoids, and enlarged tonsils. 
 
 The ear should be trained to detect differences in breath- 
 ing, so that even in the dark, these may be noticed. 
 
 In disease there are marked variations in the character of 
 the respiration. 
 
 1. Narcotic poisoning, shock, collapse slow and shallow. 
 
 2. Pleurisy, peritonitis restrained. 
 
 3. Cerebral hemor rage the cheeks are puffed out with 
 each breath. 
 
 4. Peritonitis, pneumonia very rapid, 40 50 per minute. 
 This is a very grave symptom. 
 
 In taking the respiration one must not allow the patient to 
 be aware of it, for he will unconsciously control it. After tak^ 
 ing the pulse leave the fingers on the wrist and count the res 1 
 pirations while seeming to count the pulse. 
 
 Bedside Records 
 
 A bedside record should be a complete picture of the con- 
 dition of the patient. Its object is to enable the physician to 
 gain accurate information in regard to the state of the patient, 
 and to facilitate a comparison of the condition from day to day. 
 
 Neatness, accuracy, and condensation should be observed 
 in making out charts. Enter the items that have a bearing on 
 the case. Do not record non-essentials. Be quick to observe 
 symptoms. These are classified as, subjective those things 
 observed by the patient; objective those things that are ob- 
 served by others. 
 
 In charting, the following abbreviations are much used, 
 and should be memorized by the nurse: 
 
GENERAL NURSING 
 
 aa equal parts of each, 
 ad. up to, to amount to. 
 ad. lib. as much as desired, 
 alt. dieb. every other day. 
 alt. hor. every other hour, 
 alt. noc. every other night. 
 
 a. c. before meals. 
 Aq. water. 
 
 Aq. dest, distilled water. 
 Aq. pur. pure water. 
 
 b. i. d. twice daily. 
 C. gallon. 
 
 c. c. cubic centimeter. 
 Decub. the lying position. 
 Dil. dilute. 
 
 Div. divide. 
 5 dram. 
 Emp. plaster. 
 En. enema. 
 Garg. a gargle, 
 Gr. grain. 
 Gm. - gram. 
 Gtt. a drop. 
 Inf. infusion. 
 Hg. mercury. 
 Inject. an injection. 
 lb. a pound. 
 L.- liter. 
 Liq. - liquor. 
 Lot. a lotion. 
 M. mix. 
 Mist. mixture. 
 
 N. night. 
 No. number. 
 
 0. a pint. 
 01. -oil. 
 
 01. oliv. olive oil. 
 Ov. an egg. 
 
 0. M. every morning. 
 
 p. c. after meals. 
 
 p. r. n. as occassion arises or 
 
 when necessary, 
 pulv. a powder, 
 q. s. a sufficient quantity, 
 qt. quart. 
 4. take. 
 S. or Sig. write, i. e., give the 
 
 following directions. 
 Sol. solution. 
 Sp. gr. specific gravity. 
 ss. a half. 
 Spr. spirit. 
 Syr. syrup. 
 
 T. i. d. three times a day. 
 T. tincture. 
 Ung. ointment. 
 5. ounce, 
 q. every. 
 
 q. i. d. four times daily, 
 q. 1. h. every hour, 
 q. 2. h. every 2 hours, 
 q. 3. h. every 3 hours, 
 q. 4. h. every 4 hours. 
 j. one. 
 
 THE FOLLOWING ITEMS SHOULD BE RECORDED 
 
 1. Note and record the temperature, pulse and respiration. 
 
 2. Defecations: 
 
 a. Amount large, medium, small. 
 
 b. Color brown, yellow, clay, green, black, tarry. 
 
 c. Consistency scybala, solid, semi-solid, liquid, watery. 
 
 d. Remarks. Mucus, pus, blood, stones, undigested food, 
 worms, odor, flatus, tenesmus. 
 
 3. Urine: 
 
 a. Quantity. 
 
 b. Color. 
 
 c. Remarks. Turbidity, sediment, blood, odor, tenesmus, re- 
 
BEDSIDE RECORDS 9 
 
 tention, suppression, constant dribbling (incontinence). All 
 abnormal discharges must be reported and described. 
 
 4. Skin: 
 
 a. Note condition of the skin as to color, rash, desquamation, 
 marks, swellings, whether hot, dry, or moist, waxy, edematous, 
 cyanotic or jaundiced, special odors as of typhoid, small pox, etc. 
 
 b. Note condition of nails discolored, blue, dry, or brittle. 
 
 c. Note condition of hair and scalp. 
 
 5. Cough: 
 
 a. Frequency and duration. 
 
 b. Character. Whether loose, dry, hard, hacking, or painful. 
 
 c. Worse when sitting or lying. 
 
 6. Expectoration: 
 
 a. Amount. 
 
 b. Character. Mucous, muco-purulent, tenacious (pneumo- 
 nia), frothy, rusty, odor, blood, pure pus. The sputum should 
 be saved for inspection by the physician. 
 
 c. Notice the way in which the sputum is brought up. 
 
 d. Hygiene. Have the patient expectorate in a square of tis- 
 sue paper and burn. A sputum cup may be used. If lined 
 with paper remove the paper and burn. Boil the cup daily. 
 
 7. Chills. Goose flesh, shivering, rigor. Stages shiver- 
 ing, pyrexia, sweating. 
 
 Record time of occurrence, length and T. P. R. 
 
 Always report a chill to physician or head nurse as soon as 
 possible. Unless otherwise ordered take the T. P. R. frequently 
 following a chill. 
 
 8. Delirium. Quiet, active, muttering, picking at bed- 
 clothes or imaginary objects, violent. Delirious patients must 
 not be left alone. 
 
 9. Consciousness: 
 
 a. Stupor. Partial unconsciousness from which a patient can 
 be aroused. 
 
 b. Coma. When the patient can not be aroused. 
 
 c. Coma vigil. Unconsciousness with the eyes open. 
 10. Special Organs: 
 
 Ear: a. Swelling or tenderness. 
 
 b. Discharge. 
 
 c. Ringing in the ears. 
 
10 GENERAL NURSING 
 
 d. Difficulty in hearing. 
 Eyes. a. Inflammation. 
 
 b. Presence of discharge, serous or purulent. 
 
 c. Swelling of the lids. 
 
 d. Oversecretion or lack of tears. 
 
 e. Unequal dilatation of the pupils may mean a very serious 
 condition of the eyes or brain. 
 
 f. Squinting or strabismus. 
 
 g. Photophobia. 
 
 Nose. a. Presence or absence of any discharge, and its char- 
 acter. 
 
 b. Dilatation of alae nasi in breathing. 
 Mouth, a. Condition of teeth and gums. 
 
 b. Tongue. Trembling, coated, furred, fissured, dry indenta- 
 tions of teeth, and color (light, gray, brown, red), strawberry 
 tongue as in scarlet fever. 
 
 c. Breath. Fetid or foul, sweetish, gangrenous, odor of drugs 
 or anesthetics. 
 
 11. Sleep: 
 
 Quiet, restful, broken, restless when asleep. 
 
 Does patient sleep all night but waken tired? 
 
 Is patient hard to waken? 
 
 Twitching of muscles, muttering, or any sign of delirium. 
 
 12. Pain: 
 
 a. Origin. Inflammatory increased by pressure. 
 
 Nervous relieved by pressure. 
 
 b. Character. Throbbing, steady, darting, dull, heavy, neu- 
 ralgic, grinding, colicy, 
 
 c. Time. When most severe. Items influencing character. 
 Constant, intermittent or paroxysmal. 
 
 d. Location. Pain in head frontal, occipital, one-sided as 
 in migraine accompanied by nausea or vomiting or by flashes 
 or spots before the eyes. 
 
 Pain in chest may be accompanied by rapid or labored 
 respiration and may be affected by change in position, or pre- 
 sent only on deep breathing. 
 
 Pain in abdomen continuous or spasmodic. In abdominal 
 inflammations the knees are drawn up to relieve the tension. 
 Note whether the pain in abdomen is localized; if so, notice 
 amount of tenderness, rigidity or distention. 
 
BEDSIDE RECORDS 11 
 
 13. Nausea and Vomiting. 
 
 a. Nausea continuous without vomiting. 
 
 b. Vomiting without nausea. 
 
 c. Vomiting after taking medicine or nourishment. 
 
 d. Color of ejected matter green, bloody, brown. 
 
 e. Odor of vomitus. 
 
 14- Hematemesis. Vomiting of blood from the stomach. 
 
 The ejected matter has the appearance of particles like cof- 
 fee grounds if it has been in stomach for some time; if fresh, 
 dark red clots with an acid reaction, and may be mixed with 
 food particles. 
 
 15. Hemoptysis. Spitting of blood from the lungs. 
 
 It is raised by coughing and is bright red in color, frothy, 
 and of an alkaline reaction. 
 
 16. Food. 
 
 a. Amount. 
 
 b. Is it relished? 
 
 c. Cravings 
 
 d. Difficulty in swallowing. 
 
 e. Does patient masticate thoroly? 
 
 17. Appetite. 
 
 a. Anorexia. Absence or loss of appetite. 
 
 b. Bulimia. Excessive, morbid hunger. Notice whether ap- 
 petite is good or capricious. 
 
 c. Thirst. Excessive or otherwise. 
 
 18. Facial Expression. Anxious, pinched, dull, listless, 
 tranquil. Hot flushes of face, paleness, cyanosis. 
 
 The visits of the physician should always be recorded. One 
 great point of distinction between the trained and untrained 
 nurse is the ability of the former to observe accurately and to 
 describe intelligently what comes under her notice. 
 
THE SICK - ROOM 
 
 Beds and Bed Making 
 
 Parts and materials. Bed-steads are made of iron, brass 
 or wood. The iron bed-stead is the best because it is easily 
 cleaned, simple, durable, and of medium weight. 
 
 The spring's should be made of woven wire, and supported 
 underneath by coiled springs. 
 
 Mattresses are made of wool, hair, felt, straw, or moss. In 
 some cases air or water mattresses have certain advantages. 
 
 MAKING THE BED. SURGICAL 
 
 1. The mattress should be turned daily or as often as pos- 
 sible. 
 
 2. Place a cotton pad the same dimensions of mattress as 
 to length and width. 
 
 3. Rubber draw sheet. The upper edge at lower edge of 
 where the pillow would come. The lower edge should reach 
 well below the hips. 
 
 4. The cotton sheet should be 3/4 yard longer than bed 
 and wide enough to tuck in well on both sides. Place wide hem 
 at the top, and tuck in well at the head of the bed. Draw 
 tightly and tuck firmly at the foot. Tuck in the sides, making 
 square corners. Be sure that the sheet is put on straight, for, 
 if not, it will form wrinkles. 
 
 5. Cotton draw sheet. Fold an ordinary sheet lengthwise 
 to make it the proper width. Place the folded edge at the 
 lower edge of the pillow. Tuck in at the sides snugly and firmly. 
 
 6. Upper cotton sheet. About 9 inches of the upper edge 
 should be allowed to turn over the blanket. Tuck in at the 
 foot, making square corners at the sides. 
 
 7. Blanket and spread. The folded edge of the blanket 
 should be placed at the foot. 
 
 Items to be heeded. 
 
 1. Avoid linen sheets. They absorb moisture from body 
 rapidly, and have a tendency to chill the patient. They are 
 good conductors of heat. 
 
BEDS AND BED MAKING 13 
 
 2. Air the bedding daily. 
 
 3. Exercise economy in the use of linen. 
 
 4. With a bed patient, generally a change of one sheet daily 
 is all that is needed. Take the under sheet for the draw sheet 
 and the top sheet for the under sheet. In this way the fresh 
 sheet will be at the top. 
 
 5. Fresh blood stains can be removed from the blankets 
 or ticking by spreading over the spot a paste of fine starch or 
 wheat flour and allowing it to dry. Upon rubbing it off, if the 
 stain is not entirely removed, a second application will generally 
 be effectual. 
 
 6. Remember that day or night an occasional smoothing 
 and tucking in tightly of the undersheet and draw sheet and a 
 straightening of the top sheet as well as the shaking and turn- 
 ing of pillows, adds much to the comfort of the patient. 
 
 7. Keep the bed free from crumbs and wrinkles. 
 
 8. When there is danger of the bed being soiled frequently, 
 place the rubber sheet directly under the draw sheet. 
 
 9. A neatly kept and fresh looking bed always speaks well 
 for the nurse. 
 
 THE OBSTETRICAL BED 
 
 1. Make the bed as for a surgical patient. 
 
 2. Pad with newspapers. 
 
 3. Pin over this a clean sheet. Have sterile if possible. 
 
 4. Kelly pad. This convenience often has to be dispensed 
 with in private practice. It can be substituted by hip pads 
 which should be changed as often as necessary. 
 
 5. After delivery the newspapers and pads are removed 
 and the patient is on a fresh, clean bed. 
 
 THE FRACTURE BED 
 
 Make up a bed as for a surgical patient. 
 
 Place under the mattress a fracture board made of slats 
 one inch thick and three inches wide. This will be lighter and 
 afford better ventilation than a board that is not perforated. 
 
 A fracture bed must be firm and unyielding. 
 
14 GENERAL NURSING 
 
 CHANGING BED LINEN 
 
 This should be done with as little fatigue and discomfort to 
 the patient as possible. 
 
 1. Losen the bedding on all sides. 
 
 2. Leave only the upper sheet or a single blanket over the 
 patient, who should be placed as near one edge of the bed as 
 possible. 
 
 3. The lower sheet and draw sheet are then folded separ- 
 ately on one side along their whole length as flatly as possible 
 until they are close to the patient. 
 
 4. Take the fresh sheet, fold it lengthwise, place on bed 
 with the folded edge as near the middle as possible, and tuck 
 in the under half at the ends and side. The remaining half is 
 folded lengthwise alternately backward and forward and placed 
 close to patient under the soiled sheet. 
 
 5. Fold the draw sheet and place over this the under sheet. 
 
 6. The nurse then goes to the opposite side of the bed and 
 turns the patient on the side with face toward her. She can 
 hold the patient in this position with one hand and tuck the 
 sheets to be removed as close to the back of the patient as 
 possible. The fresh sheets are brought over to cover the place 
 occupied by the soiled ones. 
 
 7. The nurse then gently turns the patient on the back and 
 toward the opposite side of the bed. 
 
 8. The soiled sheets are quickly removed and the fresh 
 ones drawn into place. Tuck in snugly on all sides. 
 
 9. Place the fresh top sheet over the soiled one, and pull 
 the latter out from underneath. 
 
 If a patient is quite helpless it will take a second person to 
 assist. If the patient is not able to be turned, the bed linen 
 should be changed from the head of the bed toward the foot. 
 The fresh sheet is folded crosswise alternately backward and 
 forward. The shoulders and back must be raised and sheet 
 worked down. Then raise the hips and pull the sheet still far- 
 ther down. Continue until it is tucked under at the foot of 
 the bed. 
 
 CHANGING GOWN 
 All hospital patients should have gowns that are open in 
 
BEDS AND BED MAKING U 
 
 the back, as they are much more easily changed. However, a 
 nurse often has to change a gown opening in the front, which 
 is the kind ordinarily worn. 
 
 1. Removing the soiled gown. 
 
 a. Lift hips and slip the soiled gown above the hips. 
 
 b. Lift the shoulders and slip the gown above the shoulders. 
 
 c. Remove one sleeve and slip the gown over the head. 
 
 d. Then the last sleeve is easily removed. 
 
 2. To put on fresh gown. 
 
 a. Gather the gown up in such a way that it forms a circle. 
 
 b. Place on the chest, so that the folds in the center of the 
 back will be just beneath the chin. 
 
 c. Sleeves should then be carefully put on. Lift the head 
 gently. Slip the garment over it and draw it down over the 
 shoulders. 
 
 LIFTING THE PATIENT 
 
 1. To move a patient in bed, the nurse's right hand should 
 be placed well under the upper part of the patient's back, and 
 around the opposite shoulder. The "left hand is put over the 
 patient and slipped under the back. The patient places her arm 
 around the nurse's neck if she is able to assist. Otherwise the 
 nurse's left arm should be placed under the patient's back a 
 little below the shoulders and from the same side. Then lift 
 gently. The lower half of the body is now lifted in the same 
 way. 
 
 2. It is better that three nurses should do the lifting if the 
 patient is very heavy or feeble. These three nurses must stand 
 on the same side of the bed in this case at the patient's left. 
 
 Nurse No. 1. Place the right arm under the back of the 
 neck and the head of the patient in such a way as to support 
 the head (lifting pillow under the head), and place the left 
 hand under the lower part of the shoulders. 
 
 Nurse No. 2. Place the right arm under the back at the 
 waist line and the left arm under the hips. 
 
 Nurse No. 3. Place the right hand under the thighs just 
 above the knees, and with the left hand support the feet. 
 
 All should lift at the same time. Have the patient's arms 
 folded over the chest and see that she is covered with a sheet. 
 Many nurses complain of having strained their backs lifting; 
 
16 GENERAL NURSING 
 
 but this is, as a rule, unnecessary if the underlying principles 
 of "lifting" are observed. Remember the following: Always 
 bend from the hips, keeping the spine straight. Separate the 
 feet and bend the knees. Let the weight fall on the arms and 
 legs. In this way heavy people may be lifted with comparative 
 ease. 
 
 To lift patient toward the head of bed. The right hand is 
 placed well under the back, the heavy part of the shoulder 
 being supported with the upper part of the arm and shoulder. 
 The left hand is placed below the hip. Lift gently and firmly. 
 
 PREPARATION FOR GIVING DOUCHE AND ENEMA 
 
 Have in readiness at least six pillows, a newspaper pad 
 with a towel over it, a "perfection" bed pan which has been 
 warmed, also plenty of newspapers. If the patient is entirely 
 helpless three nurses should gently lift the patient as previously 
 described and the regular nurse from the opposite side of bed, 
 slip three pillows under the head, two under the shoulders and 
 one under the lower back. 
 
 The newspaper pad is then placed where the hips would 
 come, and the bed pan next with a small pad upon it. The pa- 
 tient is then gently lowered onto the pan and pillows. The 
 knees and feet are supported and a newspaper "dash board" 
 placed in the pan. The patient should be in as comfortable a 
 position as possible and the nurse be sure that the pan is on a 
 level. When thru, remove the pan, and cover it with a news- 
 paper. Cover the patient and remove the pan from the room 
 as quickly as possible. Finally wash the patient and remove 
 newspaper and surplus pillows. 
 
 WHEEL CHAIRS 
 
 Wheel chairs can be firmly padded with pillows and made 
 just as comfortable as a bed. 
 
 Place one large pillow lengthwise at the back, one cross- 
 wise in the seat of the chair, one lengthwise under the legs, 
 and one over the angle of the seat. Put a blanket over these 
 and lift the patient carefully from the bed to the chair. Place 
 extra pads and cushions where they seem to be needed to make 
 the patient comfortable. Special blankets should be provided 
 for the outer covering instead of bed blankets. Tuck the pa- 
 
BEDS AND BED MAKING 17 
 
 tient in snugly if going out of doors or if the chair is to be 
 placed where the patient will be exposed to cold in any way. 
 
 THE SICK ROOM ITSELF 
 
 Location. If possible choose a large room on the sunny side 
 of the house and as near conveniences as possible. It should be 
 airy and quiet. There should be a good dressing room where 
 all clothing, linen, dressings, medicines and appliances may be 
 kept. 
 
 Furnishings. The following may be considered ideal: 
 
 1. The walls and ceiling should be hard finished and of a 
 soft tint that will be restful to the eyes. 
 
 2. Bed An iron bed if possible, a regular surgical bed is 
 better. 
 
 3. Easy chair and a straight chair. 
 
 4. Screen. 
 
 5. Wheel chair at hand if possible. 
 
 6. Washstand. 
 
 7. Dresser. 
 
 8. Bedside table. 
 
 9. Center table. 
 
 10. Woolen and heavy draperies should be avoided. The 
 curtains should be of a light washable material 
 
 Sick room appliances: 
 
 1. Drinking tubes. 7. Bed rests. 
 
 2. Square cotton pads. 8. Bed cradle. 
 
 3. Long cotton pads. 9. Kidney pan. 
 
 4. Rubber air cushions. 10. Urinal. 
 
 5. Heel cushions. 11. "Perfection" bed pan. 
 
 6. Bed cushion. 
 
 Hygiene of the sick room: 
 
 The temperature must be kept as even as possible. From 
 65 to 70 F. The air must be kept pure and cool. The nurse 
 should be diligent in securing good ventilation. In the winter 
 time in almost every case the window can be dropped one and 
 one-half inches from the top. Hot air rises and displaces the 
 cold air, which becomes warm as it descends. 
 
 A board from four to six inches wide may be placed under 
 the lower sash and fresh air will enter between the sashes, 
 2 
 
18 GENERAL NURSING 
 
 thus preventing a draught. Opening a window widely at top 
 and bottom and covering patient, will air the room thoroly. If 
 the patient is afraid of draughts an umbrella may be held over 
 him or a screen placed before the bed. This may be done three 
 or four times a day. 
 
 A fire-place is an excellent ventilator. A small fire can 
 easily be made and it not only assists good ventilation but gives 
 a cheerful aspect to the room. 
 
 Three thousand cubic feet of air should be supplied each 
 person in an hour. 
 
 Place the bed so that the light will not shine directly in the 
 patient's eyes. At night the lights should be shaded and in the 
 day time the patient's eyes should be protected from the full 
 glare of light. 
 
 All excreta and soiled linen should be removed from the 
 room as soon as possible, as they are sources of contamination. 
 In removing vomited matter, evacuations from the bowels or 
 bladder, cover the vessel or pan with a towel or rubber cloth. 
 The room should be kept free from dust. Absolute cleanliness 
 should be the slogan of the sick room. 
 
 How to clean surgical room: 
 
 1. Dust all furniture daily with a cloth slightly oiled. 
 
 2. Keep the crockery clean and shining. 
 
 3. Wash the floor daily. 
 
 4. When dust accumulates on the floor during the day wipe 
 it up with a damp cloth or with a broom covered with a damp 
 cloth. 
 
 5. Keep fresh covers on the dresser and stands. 
 
 6. Provide yourself with a cloth for dusting furniture, and 
 one for washing crockery. A separate floor cloth should be 
 provided. 
 
 How to clean room of non-surgical patient: 
 
 1. If possible remove rugs and clean them outside. 
 
 2. If rugs are too large and heavy to be removed, use a 
 carpet sweeper and then wipe them with a damp cloth, or use 
 a vacuum cleaner. 
 
 3. If a carpet sweeper is annoying to patient, the rug will 
 have to be cleaned with a damp cloth, at least once a day, and 
 sometimes twice. 
 
BEDS AND BED MAKING 19 
 
 4. In other points the cleaning is the same as in a surgical 
 room. 
 
 5. If patient is able to be taken out in a wheel chair, the 
 room can be cleaned much more thoroly during her absence. 
 
 6. Wipe off all articles and place on the bed; cover with a 
 sheet. Then clean the entire room thoroly and replace the 
 articles. 
 
 7. Do not neglect the polishing of faucets if there is a sta- 
 tionary bowl in the room. 
 
 General items: 
 
 1. Put all waste and soiled linen in places provided for the 
 purpose. 
 
 2. Always line the waste basket with a newspaper. 
 
 3. Keep fresh flowers tastefully arranged in the room of 
 your patient. 
 
 4. Be careful to keep contents of bureau and washstand 
 drawers in proper order. The closet should also be kept in 
 perfect order. 
 
 5. Do not set glasses of fruit juice or other liquids that 
 may cause stains on dresser or stand covers, but see that a 
 plate is placed underneath them. Always rinse a drinking 
 tube after the patient takes anything but water. Keep the 
 pitcher of drinking water covered. 
 
 6. Provide yourself with the needed cleaning cloths, and 
 wash them when necessary. 
 
 7. Have a place for everything and keep everything in its 
 place. 
 
 8. Keep faucets in the room polished and scrub the bedpan 
 and urinal daily. Urinal brushes may be used to clean urinals. 
 
 9. Do not allow treatment bowls to become dark and 
 stained. If they are properly cleaned daily they can be kept 
 perfectly white. 
 
 10. Do not set bottles of alcohol or bowls or pails containing 
 hot substances on the furniture unless very well protected. 
 
 Proper attention to details characterizes the successful 
 nurse. Let each keep a high ideal in view and strive to make 
 progress each day. 
 
 PERSONAL CARE OF PATIENT 
 1. Morning and evening toilet. Wash the face, hands, 
 
20 GENERAL NURSING 
 
 neck and ears, clean the nails, comb the hair, brush the teeth 
 and wash the mouth. 
 
 2. Keep the bed fresh and free from wrinkles and crumbs. 
 
 3. See that the patient is as comfortable as possible. 
 
 4. Keep the toe nails clean and trimmed. 
 
 5. Give thoro and careful treatment. 
 
 6. See that the food is served properly. 
 
 7. Anticipate the needs of your patient. 
 
 8. Be neat and clean in your personal appearance, as this 
 is a duty you owe not only to your patient but also to yourself. 
 
 9. Properly ventilate the room. 
 
 10. Do not talk too much. Avoid gossip. 
 
 11. Endeavor to minister in the spirit of the Master. 
 
CLINICAL PROCEDURES 
 
 Lavage 
 
 1. Articles necessary: 
 
 a. Sheet. 
 
 b. One-half dozen napkins. 
 
 c. Pail of drinking water (105). 
 
 d. Quart pitcher. 
 
 e. Lavage tube. 
 
 f. Washbowl. 
 
 g. Slop jar. 
 
 2. Giving lavage: 
 
 a. Have the patient remove collar and loosen every constrict- 
 ing garment. Also remove false teeth. 
 
 b. Have the patient sit in a chair. 
 
 c. Fasten a folded sheet around the neck in such a way as to 
 protect the clothing perfectly. 
 
 d. Fold the napkin under the chin. 
 
 e. Place the slop jar in front of patient with bowl on top of it. 
 
 f . The pail of water, pitcher and napkins should be within 
 easy reach. 
 
 g. The tube should be wet in the drinking water before being 
 passed. 
 
 h. Placing left arm around patient's neck in such a way as 
 to support the tube, the patient is requested to open mouth and 
 swallow as the tube touches the back part of the throat. In- 
 struct patient to breath thru the mouth. 
 
 i. In the average case pass tube about 16 inches. 
 
 j. Coughing and cyanosis indicate that the tube has been 
 passed into the trachea. Withdraw it immediately. 
 
 k. After the tube is passed, pour in about a pint of water, 
 and when tube is about empty, quickly lower it over bowl and 
 allow the water to siphon out of the stomach. Empty the water 
 into the jar underneath. 
 
 1. If the water does not come quickly withdraw the tube 
 slightly and tell the patient to contract the abdominal muscles. 
 
 m. Repeat washing until the water returning is perfectly 
 clear. 
 
22 GENERAL NURSING 
 
 n. The napkin should be changed as often as needed to keep 
 mouth free from mucus and saliva. 
 
 o. Remove the tube quickly. Give the patient a napkin to 
 dry the mouth. 
 
 p. Encourage the patient and endeavor to allay all fears. 
 
 3. Cleansing of tube: 
 
 a. Rinse in clear water. 
 
 b. Wash in strong soap suds. 
 
 c. Rinse again. 
 
 d. Let stand one-half hour in a solution of formaldehyde, 
 using 25 c. c. of the formalin to a quart of water. 
 
 e. Rinse again and dry. 
 
 f. Place in a clean napkin. 
 
 g. The lavage outfit (pail, pitcher, and tube) should always 
 be returned to the cupboard in perfect order and ready for use. 
 
 The Test Breakfast 
 
 1. The breakfast itself: 
 
 a. No food or water should be taken after rising in the morn- 
 ing before the time for eating the meal. 
 
 b. At the time appointed for the meal, the patient should eat 
 1 1/2 oz. granose (dry), taking about 25 minutes to eat it, being 
 careful to masticate thoroly every particle. 
 
 c. The patient should then take 200 c. c. of water. 
 
 d. The patient should then lie on the left side until one hour 
 from beginning to eat the granose. 
 
 2. To take up the breakfast have the following articles in 
 readiness: 2 glasses, lavage tube, sheet, napkins, large bowl. 
 
 a. At the appointed time have the patient sit in a chair. 
 Place a sheet around him, with a bowl in front on the floor. 
 
 b. The nurse should scrub her hands thoroly. 
 
 c. Pass the tube as in giving a lavage. 
 
 d. Place a glass in the bowl. 
 
 e. Stand in front of the patient. Pinch tube above the bulb 
 with thumb and first finger and immediately compress bulb 
 with remaining fingers. 
 
 f. Immediately the air is pressed out of the bulb, pinch the 
 tube below the bulb and release the bulb. 
 
 g. Have the patient lean forward and contract the abdominal 
 muscles, pressing the hands over the stomach at the same time. 
 
THE TEST BREAKFAST 23 
 
 This generally fills the bulb; if not, draw tube out a few inches 
 and pass back again. When the bulb is full, grasp the tube 
 again above the bulb and press the contents into the glass. 
 
 h. Repeat the above procedure until the stomach is emptied 
 or until a sufficient amount has been gained for a test. 
 
 i. Next pour into the funnel 100 c. c. of distilled water. Al- 
 low sufficient time for the water to pass entirely out of the 
 stomach tube. 
 
 j. Instruct the patient to move the abdominal wall in and 
 out rapidly so as to mix the water with the remaining contents 
 of the stomach. 
 
 k. Remove as much as possible of this mixed fluid putting it 
 into the second glass. 
 
 1. Some prefer the use of a large suction bulb which is so 
 constructed as to be quickly attached to and removed from the 
 tube. The contents of the stomach is drawn out into this bulb 
 which is removed and emptied into the glass. 
 
 m. Remove the tube quickly and press out the remaining 
 contents into the glass. 
 
 n. Clean all articles as after a lavage. Reset the tray and 
 return to the cupboard. 
 
 o. Label the first taken up "Test Meal," the second "Lavage 
 Specimen." 
 
 Nasal Douche 
 
 1. Small irrigating can, placed one foot above the patient. 
 
 2. Temperature 100. 
 
 3. Saline solution (1 teaspoonful to 1 pint of water). Plain 
 water is more painful because more quickly absorbed, causing 
 fullness and pressure. 
 
 4. A nasal tube should be attached to the rubber tubing. 
 
 5. Care as to position. The patient should sit with the 
 head bent forward over a receptacle. The mouth should be 
 open so that air can pass thru it. 
 
 6. The tube should be inserted into one nostril. The water 
 will flow out thru the other nostril. 
 
 7. The patient should never swallow while taking the 
 douche, as this opens the Eustachian tube, and may injure 
 the ear. 
 
 8. The douche should be copious, one quart or more. 
 
24 GENERAL NURSING 
 
 Aural Douche 
 
 1. Same can as for the nasal douche, or a smaller one. 
 
 2. Attach the aural tube to the rubber tubing. 
 
 3. Solution as prescribed should be used. For earache or 
 pain, the temperature should be 105 to 108, as can be borne. 
 
 4. For softening and removing wax, the douche should be 
 given at low pressure, the can on a level with the auditory canal. 
 
 5. A tray should be held under the ear, and the water be 
 allowed to run in a continuous stream. 
 
 6. Patient may be in a sitting or reclining position. 
 
 7. Never introduce anything cold into the ear. 
 
 8. Do not be alarmed if the patient becomes dizzy simply 
 stop the water for a few minutes and remove the water in the 
 ear by a pledget of absorbent cotton. When thru, dry the ear 
 by applying cotton. 
 
 9. Never use medicines in the ear without a prescription, 
 and then be sure they are thoroly dissolved. 
 
 10. If a patient is going out after treatment, put a little 
 cotton into the outer ear and instruct the patient to remove it 
 on coming in. 
 
 Hypodermatic Injections 
 
 A hypodermatic injection is the introduction of a medicine 
 under the skin by a specially constructed syringe, designed 
 to produce a more rapid and certain effect than can be gained 
 if the medicine is given by mouth or per rectum. The most 
 convenient places for injection are the outside of the arms, the 
 forearms, the thighs, the chest, and the abdomen. Avoid bones, 
 large blood vessels, and nerves. Insert the needle into a fleshy 
 part. 
 
 1. Cleansing of needle and syringe: 
 
 a. Boil or otherwise thoroly disinfect the whole instrument at 
 frequent intervals. 
 
 b. At other times the barrel may be cleansed by washing in 
 alcohol and rinsing with boiled water. 
 
 c. Boil the needle or disinfect in alcohol before using. 
 
HYPODERMATIC INJECTIONS 25 
 
 2. The hypodermic tray contains the following articles: 
 
 a. alcohol lamp. e. small bottle of alcohol 95%. 
 
 b. a spoon. f. " " " boiled water. 
 
 c. matches. g. 2 small glasses. 
 
 d. a small jar filled with h. the medicine to be used. 
 
 cotton balls. 
 
 3. Technique of administration: 
 
 a. Pour alcohol into one glass, and boiled water into the other. 
 
 b. Cleanse the barrel of the syringe as directed. 
 
 c. Boil the needle in a teaspoon over the alcohol flame. 
 
 d. Pour off water carefully and place the needle on the barrel, 
 being careful not to touch the point. 
 
 e. Put the tablets ordered into the spoon and pour on the 
 proper amount of boiled water. Dissolve over flame and draw 
 the solution into the barrel of the syringe. 
 
 f. See that the air is expelled from the barrel. 
 
 g. Disinfect the skin with alcohol, grasp the fleshy part be- 
 tween the thumb and finger, and insert the needle in a slanting 
 direction. 
 
 h. Withdraw the needle slightly, and inject the fluid slowly, 
 i. Quickly remove the needle and place a cotton pledget over 
 the part, making a slight pressure. 
 
 j. Cleanse the needle and syringe with alcohol. 
 
 k. Put a small wire thru the needle to keep it from rusting. 
 
 1. Always leave the tray in perfect order. 
 
 4. Precautions. If the needle and solution are not clean, 
 abscesses are liable to develop. 
 
 Never give a hypodermic without an order from the phy- 
 sician, and do not repeat without definite order to do so. 
 
 Catheterization and Bladder Irrigation 
 
 The normal amount of urine secreted daily averages forty 
 ounces or 1200 c. c. 
 
 An absence of the urinary excretion, owing to a failure of 
 the kidneys to act, is known as suppression. 
 
 Retention is the failure to expel that which is contained in 
 the bladder. 
 
 Incontinence is the involuntary passing of urine. 
 
 Cystitis is an inflammation of the lining of the bladder. 
 
26 GENERAL NURSING 
 
 Whenever, from any cause, a patient is unable to pass urine 
 voluntarily, the catheter should be used every six or eight hours. 
 
 1. Articles needed for catheterization: 
 
 a. Two medium sized bowls. The first contains two catheters 
 of glass, metal, rubber, or lysle thread; the second a disinfect- 
 ant solution, HgCk 1 3000, boracic acid sat. sol, creasopeor 
 lysol 1/2%, green soap 2 1/2%. 
 
 b. A package of sterile sponges, or cotton pledgets. 
 
 c. Sterile lubricant vaseline or any good oil, if sterile. 
 
 2. General procedure: 
 
 a. Boil the catheter ten minutes. In the meantime the pa- 
 tient should be gotten ready. 
 
 b. Place a folded towel under the hips. Cover the limbs with 
 a sheet, if the room is cold, use a light blanket and also a sheet. 
 Do not unnecessarily expose the patient. Scrub your hands 
 thoroly. 
 
 c. After the catheter is boiled, place a tray between the limbs 
 of the patient, also a urinal or receptacle for receiving the urine. 
 
 d. Open a package of sponges, being careful not to touch 
 them. 
 
 e. Open the tube of lubricant, discard the first portion, and 
 then squeeze out a small portion onto a sterile sponge. 
 
 f . Dip the right hand into a disinfectant. Wet a clean sponge 
 in the disinfectant solution and wash thoroly the part all about 
 and over the meatus urinarius. 
 
 g. Dip the hand again in the desinfectant with a fresh sponge, 
 wash the meatus urinarius with sterile water. 
 
 h. Grasp the catheter below the part that will enter the blad- 
 der, lubricate it with the oil previously placed on the sterile 
 sponge, and insert into the urethra. Pass gently along until 
 the urine flows. If, after the catheter has been inserted the 
 necessary distance, the urine does not pass, withdraw slightly, 
 turn and then insert farther than before. 
 
 i. If the bladder is excessively distended do not empty at one 
 time, as undesirable symptoms are apt to follow Draw only a 
 portion and in a short time repeat the process. 
 
 j. When the urine has ceased to flow, compress the catheter 
 or put the finger over the end, so that no urine will escape and 
 soil the bed, while the catheter is being withdrawn. 
 
CATHETERIZATION 27 
 
 k. Sponge the meatus urinarius with boiled water. Measure 
 the urine and record the quantity and character of the same. 
 
 3. Special procedure in the male. The male urethra is from 
 7 to 8 inches in length and is divided into three portions; the 
 anterior or penile portion about six inches long, the membranous 
 portion about a half inch long, and the prostatic part one inch 
 in length. The posterior end of the penile portion is wider than 
 the anterior part, and the prostatic portion is the widest and 
 most variable in shape, size, and length. It is in these two 
 parts that a rubber catheter is most likely to double upon itself 
 and in the prostatic portion the obstruction of an enlarged pro- 
 state may make its passage difficult. 
 
 For use in the male urethra catheters are made of soft rub- 
 ber, semiflexible (black) rubber, metal or lysle thread. If dif- 
 ficulty is experienced in passing an ordinary rubber catheter, 
 an olivary tipped black rubber or lysle thread catheter should 
 be tried. In passing a metal catheter it must be specially di- 
 rected. This requires demonstration. 
 
 Before passing the catheter, grasp the organ with a napkin 
 just below the glans and wash thoroly the entire glans. Fol- 
 low by washing with a disinfectant. A sponge of absorbent 
 cotton dipped in the disinfectant should be left over the glans 
 while other preparation is being made. In passing the catheter 
 straighten the urethra by gentle traction, go slowly and with- 
 draw the catheter if an obstruction is met, turning it around 
 advance it again. If a reasonable amount of gentle careful 
 work does not succeed, summon the head nurse or the physician 
 in charge. ,i 
 
 4. Special procedure in the female. With the left hand sep- 
 arate the labia and hold apart during washing and disinfect- 
 ing the parts and inserting the catheter. 
 
 The meatus urinarius is variously located in different pa- 
 tients. In one you will discover it high. In another case it 
 may be much lower, even in the opening of the vagina. By 
 careful, close inspection the meatus will readily be found. 
 
 The urethra varies much in length. In a thin patient it 
 may be but one inch or more from the meatus to the bladder. 
 In a large, fleshy patient the urethra may be even three inches 
 in length. Govern the passing of the catheter accordingly. 
 
28 GENERAL NURSING 
 
 When you remove the catheter place a sponge over the va- 
 ginal opening to prevent the entrance of any urine. 
 
 5. After-care of tray. 
 
 a. Run plain water thru the catheter, then soapsuds, and 
 rinse again with plain water. Let it stand in a disinfectant 
 solution 15 minutes. Rinse in water and wipe dry. 
 
 b. Wash bowls and tray in soapsuds and disinfect in the sol- 
 ution used for the catheter. Wipe dry. 
 
 c. Place the catheter in one bowl with the other over it. Put 
 the lubricant on the tray and also a package of fresh sponges. 
 
 6. Irrigation. In case bladder irrigation is to be given, in 
 addition to the above preparation, prepare an irrigating can 
 containing a sterile solution (saline, permanganate, boracic 
 acid, or whatever may be ordered) . Attached to the irrigating 
 can is rubber tubing, at the end of which is inserted a sterile 
 glass irrigator point. 
 
 After the patient is catherized, the rubber catheter is not 
 removed but the tip of the glass tube is inserted into the cathe- 
 ter. Be sure that all air is expelled before this connection is 
 made. Allow about 200 c. c. of solution to enter the bladder, 
 unless the patient complains of pain, then disconnect the irri- 
 gator point and let the solution flow from the bladder. Repeat 
 same until the bladder is clean. Then remove the catheter ac- 
 cording to directions for catheterization. 
 
 Many prefer a glass funnel instead of the irrigating can in 
 giving irrigations, and some use a glass syringe. A small-size 
 glass funnel or small glass syringe is very much handier for the 
 instillation of medicaments into the bladder or urethra. 
 
 Carelessness on the part of the nurse in catherization has 
 often resulted in cystitis. One must be thoroly conscientious 
 in all details else weeks of needless suffering may result. 
 
 Nasal Feeding 
 
 When patients refuse food by the mouth, it is oftentimes 
 necessary to resort to nasal feeding. A nurse should never 
 attempt this unless she has at least seen it done, or has assisted 
 some one else. Never be afraid to say, "I don't know," for 
 otherwise you may bring much unnecessary suffering to a pa- 
 tient. 
 
THE NUTRIMENT ENEMA 29 
 
 If a patient resists at all, there should be two attendants 
 to hold him in the proper position either sitting or lying. 
 
 1. Articles needed: 
 
 a. A No. 8 catheter to which is attached a small glass tube. 
 To the end of this a small piece of rubber tubing is attached 
 and into this a glass funnel is inserted. 
 
 b. A towel to place around the patient. 
 
 c. Lubricant. 
 
 d. Liquid food in a pitcher. 
 
 2. Technique: 
 
 a. Oil the tube and insert into the nostril, passing it back- 
 ward thru the posterior nares into the upper part of the phar- 
 ynx. If it is passed farther it should be pushed on down into 
 oesophagus. If the catheter enters the trachea the patient 
 coughs, can not breathe, and becomes cyanotic. After the tube 
 is in place, be sure that the patient breathes normally. 
 
 b. When the tube is in place, pour the food down and remove 
 the tube quickly, pinching it as near the nose as possible. 
 
 c. The tube is then cleaned, using the same method as for 
 lavage tubes. 
 
 The Nutrient Enema 
 
 In various gastric disturbances the digestion of the food is 
 so imperfect that the body is poorly nourished, so that it be- 
 comes necessary to supply the needed nutriment by other avenues 
 than the mouth, one of these being per rectum by means of the 
 nutrient enema. This may also be resorted to in obstructive 
 conditions of the oesophagus or where it is desired to give the 
 stomach rest for a time. 
 
 1. Preparation of the patient. Before giving the nutrient 
 enema a thoro cleansing enema should be given as absorption 
 takes place much more rapidly when the lower bowel contains 
 no residue. If the nutritive enema is given frequently, as a 
 rule, the cleansing enema is necessary only once or twice daily. 
 
 2. Technique. The nutrient enema may be given with the 
 patient in either the dorsal, the right Sim's, or the knee chest 
 position. However, if the patient is able to take the knee chest 
 position, this is preferred. 
 
 The liquid for injection is then prepared by the nurse ac- 
 cording to the prescribed formula. 
 
SO GENERAL NURSING 
 
 The following articles are needed for the administration of 
 a nutrient enema: Colon tube, in the end of which a glass fun- 
 nel has been inserted, a small pitcher containing the liquid to 
 be injected, lubricant, bed sheet, newspaper or rubber sheet, 
 towel. 
 
 The liquid should be given at a temperature of 100 F. If 
 the enema is to be given in the knee chest position, place the 
 newspaper or rubber sheet, covered with a towel, under the 
 knees of the patient. Next drape the hips and thighs in a 
 sheet for protection from unnecessary exposure. The sheet is 
 held lengthwise, grasped in the center and this point placed on 
 the sacrum, each half being used to cover a limb. Next lubri- 
 cate the tube and insert it not more than four inches. Pour the 
 liquid into the funnel. After the liquid has passed into the 
 bowel, leave the colon tube in place a few moments, then slowly 
 remove, pinching the end next to the patient, in order to avoid 
 the expelling of any of the fluid. Assist the patient to the re- 
 cumbent position. 
 
 If there is an intense desire to eject the fluid, hold a com- 
 press over the rectum, making heavy pressure with the fist. 
 This, as a rule, will be effective. 
 
 Oftentimes a patient can not take the knee-chest position, 
 and experience has shown us that with some people the fluid is 
 injected with difficulty in the other two positions. In such 
 cases, the following may be used with success. 
 
 Take a 2-ounce glass syringe, a colon tube, and a pair of 
 artery forceps. Lubricate the colon tube and insert as before. 
 Fill the glass syringe and insert into the colon tube, forcing the 
 fluid thru it by pressure on the piston of the syringe. Before 
 removing the syringe to refill, clasp the tube with the forceps 
 as soon as the syringe is placed in the end of the tube. When 
 all the fluid has been injected, remove the tube as usual. 
 
 3. Formulae. As a rule the physician prescribes the for- 
 mula for the nutrient enema. The following are given as ex- 
 amples: 
 
 I. Milk 5 iv. 
 1 beaten egg. 
 8 gr. of salt. 
 
 II. The whites of 2 eggs. 
 Peptonized milk 3 ij. 
 8 gr. of salt. 
 
POULTICES AND CATAPLASMS 31 
 
 III. Malted milk broth 3 iv. 
 1 beaten egg. 
 
 8 gr. of salt. 
 
 IV. Thin barley gruel (thoroly cooked) 3 vi. 
 1 beaten egg. 
 
 8 gr. of salt. 
 
 Poultices or Cataplasms 
 
 1. Purpose: 
 
 a. To make application of moist heat. 
 
 b. To produce counter irritation. 
 
 2. Items to be observed: 
 
 a. A poultice should not be removed until a fresh one is ready 
 to apply. Always wipe the part dry before placing the poultice. 
 
 b. Poultices must be freshly made each time they are needed. 
 
 c. The poultice should be covered with flannel and rubber 
 cloth or oiled silk in order to retain the heat and keep the pa- 
 tient dry. 
 
 d. The spreading of the poultice is facilitated by the use of a 
 thin piece of board a poultice board upon which the cloth is 
 laid. 
 
 e. A poultice should be applied as hot as the patient can stand. 
 
 f. It should never be left on until cold. 
 
 g. Oil the skin before applying a poultice. 
 
 h. Take a piece of muslin twice the length of the poultice. 
 
 i. On one half spread the poultice ingredients leaving a mar- 
 gin of 1 1/2 inches. 
 
 j. Fold the other half over as a cover, turning the edges in. 
 
 k. Fold in a compress cloth or towel and carry to the patient 
 on a rubber bag filled with hot water. 
 
 Flaxseed poultice. Stir the meal little by little into boiling 
 water. When of the consistency of mush, remove from the 
 stove, beat well and spread about 1/2 inch thick on muslin and 
 apply in the usual way. 
 
 Mustard poultice, a. Make a flaxseed poultice as usual. 
 Take of mustard 1/8 to 1/4 of the amount of meal used, make 
 into a thick paste and stir this into the linseed that has been 
 prepared for the poultice. 
 
 b. Mix together 1 part flour and 2 parts mustard. Moisten 
 with water and add a small amount of oil. 
 
32 GENERAL NURSING 
 
 c. White of one egg lightly beaten. Add sufficient mustard 
 to make of proper consistency. If a very mild effect is desired, 
 use mustard and flour equal parts, with the white of egg. For 
 an infant use 1 part of mustard to 12 parts of flour. 
 
 Spice poultice: 
 
 Ginger 5 ij. 
 
 Clover 5 ij. 
 
 Cayenne Pepper 5 j. 
 
 Flour 5 ss. 
 
 Sufficient water to make a paste. 
 Spread between two layers of muslin. 
 
 Glycerin and clay poultice. This is sold under various 
 trade names, such as antiphlogistine, anti-thermoline, anti- 
 itis. Heat and spread about 1/2 inch thick on a muslin cloth 
 cut to fit the part. Over this place thin gauze. Apply the 
 gauze side to the part affected. Cover with a pad made of 
 cotton enveloped with gauze. This cotton pad can generally 
 be used several times. 
 
 Clay jacket. Take two pieces of muslin. Cut to fit the 
 anterior and posterior area of the upper trunk. Spread on the 
 antiphlogistine as directed above and also the gauze. Apply to 
 the surface and over this fit a jacket of cotton. 
 
 Diet 
 
 In such an outline as this only a few general items can be 
 given on diet, as this subject is a broad one and is always taken 
 up as a branch by itself. Special diets are often prescribed for 
 patients, and the general significance of the terms used to de- 
 scribe them should be understood by the nurse. 
 
 SPECIAL DIETS 
 
 1. Fruit diet. In following a fruit diet the nutriment given 
 the patient is very much reduced, while at the same time the 
 stomach is not put at complete rest; so that it is frequently bet- 
 ter than a total fast, especially as it furnishes a residue which 
 helps to prevent constipation. The sugars of the fruit do fur- 
 nish some energy and are also laxative. It is well to administer 
 only one or two kinds at a meal; a variety, however, may be 
 allowed over several meals. 
 
DIET 33 
 
 2. Liquid diet. Gruels, broths, soups, egg nogg, beaten 
 white or whole of the egg, curdled egg, milk, cream, butter milk, 
 clotted milk, Yogurt, malt honey, thin vegetable gelatin (agar- 
 agar), frozen cream, fruit juices, albumin water. 
 
 3. Soft or semi-solid diet. Eggs, raw, soft or boiled; jel- 
 lied egg, custards, soft toasts, cereals, flaked cereals, corn pulp, 
 purees, stewed fruits. 
 
 4. Solid diet. The articles allowed in solid diet are those 
 usually allowed when a general diet is prescribed. In selecting 
 foods for a general diet care should be taken about combina- 
 tions. 
 
 5. Dry diet. The articles constituting this diet are fre- 
 quently ordered in cases of defective digestion, particularly 
 where the hydrochloric acid is low in amount and also for the 
 purpose of encouraging thoro mastication. The following arti- 
 cles may be included in this diet: 
 
 Dextrinized grains, zwieback, thoroly toasted bread, toasted 
 crackers, granola, corn breads, baked potatoes, popped corn, 
 puffed rice and wheat berries, bananas, steamed figs, hard 
 boiled yolk of eggs, baked apples, butter, and in some cases 
 fresh nuts and nut foods may be allowed. 
 
 DIETS FOR SPECIAL DISEASES 
 
 1. Constipation. Fresh fruits, stewed fruits, stewed rais- 
 ins, steamed figs, fruit juices except blackberry, lemonade, 
 stewed prunes, flaked foods, buttermilk, Yogurt, graham gems, 
 bran crackers, gems or mush; butter, olive oil, ripe olives, malt 
 honey, most nuts, Irish potatoes, sweet potatoes, peas purree, 
 spinach and other greens, all fresh green vegetables, graham 
 bread, whole-wheat bread, coarse vegetables, berries. 
 
 2. Diarrhea. Hot boiled milk, brown flour gruel, arrow 
 root or gluten gruel, albumin water, soft poached or curdled 
 egg, rice, corn starch, toasted white bread. 
 
 3. Hypochlorhydria. Dextrinized cereals, baked potatoes, 
 fresh nuts sparingly, soft cooked eggs, hard-boiled yolk of 
 eggs, fruit of all sorts, grapefruit or orange before the meal, 
 Yogurt, fresh green vegetables, peas puree. 
 
 4. Hyperchlorhydria. This condition is especially benefit- 
 3 
 
S4 GENERAL NURSING 
 
 ted by the use of free or emulsified oils such as olive oil, cotton 
 seed oil, milk, cream, and unsalted butter; gluten gruel, eggs, 
 dextrinized cereals, nuts and nut foods very sparingly, sub-acid 
 fruits such as pears, baked apples, prunes, etc. 
 
 5. Diabetes. Avoid all starches especially those not thoroly 
 cooked. Avoid sugar. The following articles may be allowed: 
 
 Baked potatoes, nuts except the peanut and chestnut, nut 
 foods, butter, cream, fresh green vegetables, greens, gluten 
 breads, baked apples, grapefruit, lemons, strawberries, huckle- 
 berries, buttermilk, Yogurt, eggs, cauliflower, turnips, celery, 
 cabbage, lettuce, radishes, cucumbers, egg plant, tomatoes, 
 Jerusalem artichokes, Okra. 
 
 6. Bright' s disease. Dextrinized cereals, soups, broths and 
 gruels, rice, flaked cereals, zwieback, toasts, milk, cream, but- 
 ter, olive oil, fresh green vegetables, fruits of all kinds. Avoid 
 the following: Meats, nut foods, eggs, gluten, and all other 
 heavily proteid foods. 
 
 7. Fevers. In fevers the diet will vary according to the 
 nature of the fever and its duration. Broths, strained soups 
 and gruels, albumin water, fruit juices, soft pulp of fruit, but- 
 termilk, cereal waters, egg noggs. 
 
 RULES FOR EATING 
 
 1. Masticate the food thoroly. 
 
 2. Avoid over eating. 
 
 3. Eat slowly. 
 
 4. Do not wash the food down with a beverage. 
 
 5. Do not drink freely at meals. 
 
 6. Make the meal hour a pleasant one. 
 
 7. Do not worry over the food eaten or watch for unpleas- 
 ant symptoms to develop. 
 
 8. Do not eat when fatigued or worried. 
 
 9. Remember "a merry heart doeth good like a medicine." 
 
 FOOD COMBINATIONS 
 
 Persons having digestive disturbances frequently find it 
 impossible to take foods in certain combinations. Unless the 
 digestion is very good there are certain combinations which 
 should be avoided. 
 
ADMINISTRATION OF MEDICINES 35 
 
 1. Good combinations: 
 
 Cereals and nuts. 
 Cereals and milk. 
 Cereals and fruit. 
 Cereals and eggs. 
 Cereals and vegetables. 
 Cereals, milk and eggs. 
 Fruit and nuts. 
 Sub-acid fruit and cream. 
 
 2. Bad combinations: 
 
 Fruits and vegetables. 
 Acid fruit and milk. 
 Milk and sugar. 
 
 Administration of Medicines 
 
 METHODS OF INTRODUCING INTO SYSTEM 
 
 1. Stomach. When given in this way drugs take effect in 
 about 20 minutes. They are absorbed more quickly when given 
 on an empty stomach. 
 
 2. Rectum. The drug is absorbed in about 3/4 hour. 
 
 3. Cellular tissue (subcutaneous), i. e., by hypodermic. The 
 effect of the drug is evident in about five minutes. 
 
 4. Skin by inunction. 
 
 5. Lungs by inhalation. 
 
 Sometimes a drug produces symptoms that are very dif- 
 ferent from the ordinary. Patients manifesting such a pecu- 
 liarity are said to have an idiosyncrasy for the drug in question. 
 
 Some drugs have a "cumulative action, " i. e., the excretion 
 of the drug is so slow, that one dose is not entirely excreted 
 before another is taken. The drug thus accumulates, and after 
 a time symptoms of poisoning may develop thru the cumulative 
 action. 
 
 PRECAUTIONS IN HANDLING AND ADMINISTRATION OF MEDICINES 
 
 1. All medicines must be kept out of the reach of children 
 and delirious patients. 
 
 2. The label and directions should be read three times be- 
 fore giving the medicine. 
 
 3. See that the relief nurse thoroly understands the direc- 
 tions in regard to the medicine to be given the patient. 
 
36 GENERAL NURSING 
 
 4. Medicine glasses and spoons must be thoroly washed 
 after being used. Separate ones should be kept for strong 
 smelling medicine and oils. 
 
 5. When ordered before meals medicines should be given 
 one-half hour before, and those to be given after meals should 
 be given one-half hour after, unless otherwise ordered. 
 
 6. An unconscious patient should have the medicine dropped 
 far back on the tongue in order to compel swallowing. 
 
 7. Do not give powders by mouth to an unconscious pa- 
 tient, as they may cause suffocation. 
 
 Powders. 1. Generally given dry on the tongue and fol- 
 lowed by a drink of water. 
 
 2. They may be dissolved in water or milk. 
 
 3. Powders that are bitter may be enclosed in capsules or 
 wafers. The latter may be secured from any druggist. One 
 is moistened, the powder put in its center, another wafer is laid 
 over this and the two are pressed firmly together. Place on the 
 tongue and swallow by drinking water. 
 
 Pills. Place on the back part of the tongue and swallow 
 with water. For children who find it difficult to swallow a pill, 
 it may be crushed and mixed with honey. 
 
 Acids. These injure the teeth and so should be taken thru 
 a glass tube and the mouth thoroly rinsed after. 
 
 Oils. These may be taken in cereal coffee, milk, lemon 
 juice, or orange juice. 
 
 Suppositories. These are drugs incorporated in cacao but- 
 ter or other semi-solid substance and made up into conical 
 shapes for convenient introduction into the rectum or vagina. 
 To place in the rectum oil the suppository and finger. Insert 
 the suppository and push well up into the rectum until it can 
 not be felt by the finger. Place a napkin over the anus and 
 apply pressure to part until the desire to expel the suppository 
 has passed. 
 
 Inhalations. The administration of drugs in the form of 
 a vapor, or nebula (cloud). 
 
 INCOMPATIBILITIES 
 
 When medicines do not combine well or have opposite ef- 
 fects, they are said to be incompatible. There are three kinds 
 of incompatibility chemical, pharmaceutical, and physiologic. 
 
FULL EXAMINATION 37 
 
 Chemical incompatibilities. Medicines which react upon 
 each other, producing a new chemical substance. This is illus- 
 trated in the combining of acids and alkalies, such as hydro- 
 chloric acid and bicarbonate of soda which form common salt. < 
 
 Pharmaceutical. Substances that do not mix well mechani- 
 cally or do not dissolve in each other, such as oil and water. 
 
 Physiologic. When the effect of one drug neutralizes that 
 of another they are said to be physiologically incompatible; for 
 example, morphine and strychnin. 
 
 A medicine ordered in minims must not be measured by 
 drops. Use the minim glass. 
 
 Full Examination 
 
 1. Articles to be in readiness: 
 
 a. 2 large sheets. e. Lubricant. 
 
 b. 2 towels. f. Pitcher of drinking water 
 
 c. 1 napkin. and a glass. 
 
 d. Basin of warm water and g. Waste basket. 
 
 soap. 
 
 2. Instruments for examination. These should be warmed 
 before using. 
 
 | Sim's or modified Sim's. 
 
 a. Speculum g iv ^ e - 
 
 1 Rectal. 
 
 I Others as case may require. 
 
 b. Dressing forceps. 
 
 c. Spatula. 
 
 d. Applicator. 
 
 e. Stethoscope. 
 
 f. Tampons and absorbent cotton. 
 
 3. Full examination in office. Remove all clothing. Have 
 sheet folded lengthwise and placed around the patient's shoul- 
 ders, and another sheet for the lower limbs. 
 
 4. Pelvic examination. Place the patient on the table in 
 the dorsal position. Take a second sheet, place over the patient 
 so that the center fold comes to the center of the table between 
 the lower limbs. Pull the sheet down leaving only enough to 
 cover abdomen. Begin at crease in center of sheet, gather up 
 in folds, and push well up over abdomen. Take inside corners 
 and push well up under hips until it fits snugly around inside of 
 
88 GENERAL NURSING 
 
 thighs in such a way as not to expose the patient in any way. 
 Outside corners should be folded around the feet so as to give 
 a neat appearance, and the patient will not feel that she is un- 
 necessarily exposed. 
 
 Be sure that the patient is well down on the tafre and that 
 there is a fresh folded napkin under the hips, covering the edge 
 of the table. 
 
 For a_pelvic examination only, it is not necessary to remove 
 the clothing except closed drawers, which should be removed. 
 In all cases, be sure that all bands about the waist are loosened. 
 Place in dorsal posit'on as for full examination. 
 
 Vaginal speculum examination. A Sim's speculum, dres- 
 sing forceps, lubricant, and five or six tampons should be at 
 hand. The table should be so placed that the light will fall 
 directly into the speculum. In assisting the physician, be sure 
 that you stand where you will not interrupt the light. In hand- 
 ling the tampons to the physician, catch the cord close to the 
 last tampon so that the physician may easily grasp with for- 
 ceps. If the other hand is free the nurse may catch the free 
 end of the cord so that it may not become entangled around the 
 tampon. 
 
 5. External examination of abdomen. Separate the two 
 sheets so that the abdomen is exposed. 
 
 6. Examination of heart and lungs in the sitting posture. 
 Have the patient sit on the end of the table with the feet rest- 
 ing on a stool. Place a sheet about the shoulders. Hand the 
 stethoscope to the physician. 
 
 7. Rectal examination. Place on the table in the Sim's po- 
 sition. Adjust the sheet in the same way as for the dorsal po- 
 sition, except that center fold is at the back instead of the 
 front. Fold the upper corner of the sheet around the right 
 limb in such a way that the clothing and limbs are entirely 
 covered. The nurse should stand at the back of the patient and 
 place her hands one on either side of the rectum and separate 
 the buttocks in such a way that the physician can insert the 
 speculum. 
 
 8. Knee-chest or genu-pectoral position. Place the patient 
 on the knees with the hips elevated and chest brought as close 
 to the table as possible. Place the sheet so that the center fold 
 is at the sacrum. Adjust it as in the dorsal position. 
 
CARE OF THE DEAD 3$ 
 
 9. Examination in bed. a. If digital examination, place 
 patient on the side of bed in the dorsal position; sheet and nap- 
 kin are adjusted same as on a table in an office. 
 
 b. Speculum examination in bed. Place the patient crosswise 
 of the bed in the dorsal position, drawing hips well down to the 
 edge of the bed. Place a fresh napkin over edge of the bed for 
 protection. Adjust the sheet the same as in the dorsal position 
 on a table, being sure to keep the feet well covered. The list 
 of instruments is the same as for speculum examination in an 
 office. Be sure to have the bed in position to give the best light 
 possible. 
 
 The Care of the Dead 
 
 If there are signs of death notify the physician at once. 
 Never take the responsibility of being along with a dying pa- 
 tient. 
 
 1. Cool the room and remove all surplus of bedding at once. 
 
 2. Straighten limbs and close eyes. Place a shred of cotton 
 under the eyelid to keep it in proper place. 
 
 3. Pack the nostrils, mouth, back part of nose, rectum and 
 vagina with common cotton in order to prevent the escape of 
 post-mortem discharges. 
 
 4. Replace false teeth as soon as the mouth is packed. 
 
 5. Place a support under the chin. 
 
 6. Wash the body with soap and water. If the case is in- 
 fectious, wash in 2 1/2% carbolic solution and wrap in a 
 sheet wrung from 5% carbolic solution. 
 
 7. If there are any wounds, do not touch bandage without 
 instruction from physician or head nurse. 
 
 8. Place a triangular bandage around the hips, laying over 
 the rectum a layer of cotton and some salt. 
 
 9. Manicure the nails and comb the hair. 
 
 10. Bandage the knees together. Place stockings on the 
 feet and put on a simple nightgown. 
 
 11. Roll a small pillow and place under the hands. Also 
 bandage the arms together across the chest. 
 
 12. Put a clean sheet on the stretcher and then the body. 
 Elevate the head of the stretcher at least one foot. 
 
 13. Put a clean sheet over the body and remove all traces of 
 death from the room. 
 
40 GENERAL NURSING 
 
 14. Pack the belongings of the patient so that they can be 
 taken with the body. 
 
 15. Leave the room in order. 
 
 16. After the body is removed, fumigate the room if the 
 case has been infectious and the next morning return all sup- 
 plies that belong to the medical department. See that they are 
 all clean and ready for use. 
 
 CONTENTS OF DEATH BASKET 
 
 Two sheets. Common Cotton. 
 
 Two turkish towels. Disinfectant. 
 
 Two toilet towels. Safety pins medium. 
 
 Bandages for hands and knees. Nail cleaner. 
 
 Small pillow. Scissors. 
 
 Support for chin. Dressing forceps. 
 
 Large triangular bandage. Comb. 
 
 Salt. 
 

SPECIAL CONDITIONS AND EMERGENCIES 
 
 General Care of Infectious Cases 
 
 An infectious disease is one that is produced by the growth 
 of pathogenic microbes in the body or on its surface. A con- 
 tagious disease is an infectious disease that may be contracted 
 without immediate contact with the patient. 
 
 All infectious diseases are caused by specific germs. Care- 
 lessness on the part of the nurse may result in untold harm, as 
 success depends on diligent attention to minute details. 
 
 1. Isolate the patient. 
 
 2. Room: 
 
 a. Location upper part of house; south and south-east, or 
 south and south-west exposure preferred. 
 
 b. Remove rugs, draperies, and all unnecessary furniture. 
 
 c. Wipe woodwork and floor twice a day with 2% carbolic or 
 11000 HgCb solution. 
 
 d. When there is dust, germs are always present, so regard 
 dust as a deadly foe. The broom may be covered with dust bag 
 dipped in 3% carbolic. If possible, have two rooms, keeping 
 the patient in one room during the day and the other at night. 
 
 3. Linen. Disinfect all linen by soaking in 5% carbolic, 
 2 r /f formaldehyde, or any reliable disinfectant for at least one 
 hour. Wrap the disinfected linen in a sheet wrung from the 
 same solution. This clothing should be boiled within one hour 
 after leaving the room. 
 
 4. Waste basket. It is very convenient in the care of in- 
 fectious cases to have a stove in the room. Thus all waste ma- 
 terial ^an be burned. Otherwise- wrap the contents of the waste 
 basket in a paper, then dip in disinfectant solution and dispose 
 of as quickly as possible. If in a private home arrangements 
 can be made for some member of the family to get this at a 
 certain time each day and burn as soon as possible. 
 
 5. Dishes. Outside of the door there should be a small 
 table which the nurse will find useful in many ways. All dishes 
 
42 GENERAL NURSING 
 
 should be soaked, for one hour in 5% carbolic, or better still, 
 boiled for 1/2 hour, then placed on the table outside of the door 
 for some member of family to get. A sheet wrung* from the 
 disinfectant solution should be hung outside the door and kept 
 wet. 
 
 6. Discharges. Disinfect with chloride of lime or carbolic 
 acid, and let stand one hour. All water used in the room should 
 be disinfected before being emptied. 
 
 7. Nurse. Wear a surgical gown with cap of gauze over 
 the hair. If not on 24-hour duty, before leaving the room the 
 gown should be removed, hands disinfected and the uniform put 
 on outside in a small room or closet reserved for the purpose. 
 
 Never touch the face, hair, or lips without first disinfecting 
 the hands. The care of different infectious diseases varies con- 
 siderably and the special care of each will be carefully studied 
 in the course on diseases. If possible, take a walk in the fresh 
 air every day. 
 
 8. Before going into quarantine the nurse must not forget 
 to select and have taken to the isolation quarters all articles 
 that will be needed. 
 
 Suggestive list: 
 
 Bedding. Pails. 
 
 Clothing for patient. Whisk broom. 
 
 Towels. Tub. 
 
 Disinfectants. Measuring glasses. 
 
 Soap. Treatment articles. 
 
 Broom. Charts pen and ink. 
 Dust pan. 
 
 9. Allow nothing to go from the sick room without being 
 thoroly disinfected. 
 
 10. How to close a quarantine. 
 Patient: 
 
 a. Thoro bath of soap and water and hair shampoo. 
 
 b. Wrap the patient in a clean sheet and blanket and take to 
 another room previously prepared. Provide the patient with 
 clean clothing. 
 
 Room: . 
 a. Mattress, pillows and blankets are removed and placed so 
 
BED SORES 43 
 
 that the fumes of the disinfectant can find an easy access to 
 all parts. 
 
 b. All drawers, closets, and cupboards in the room should be 
 left open. 
 
 c. Cracks around the room are sealed to prevent escape of 
 the fumes. 
 
 d. Rooms may be disinfected with formaldehyde or sulphur. 
 
 Formaldehyde disinfection. Formula for 1000 cu. ft. of 
 space: Place newspapers on the floor covering a large space. 
 In the center of this place a large pail containing 8 oz. of 
 permanganate crystals. When everything is ready pour over 
 the crystals 20 oz. of formalin and make a rapid exit, sealing 
 the door and keyhole from the outside. Formaldehyde gas does 
 not tarnish or bleach articles. 
 
 Sulphur disinfection. This is not considered reliable but 
 may be used if nothing else is available. Required, 4 Ibs. of 
 sulphur for every 1000 cu. ft. of space. Place the sulphur in a 
 pan which is set upon several bricks in a tub containing water 
 enough to cover them, the water being provided to avoid danger 
 of fire from the burning sulphur. A liberal quantity of alcohol 
 is then poured over the sulphur, and at the last moment before 
 leaving the room a lighted match is applied, great care being 
 necessary to stand well back from the pan and to avoid inhaling 
 the sudden rise of fumes. Leave 24 hours. 
 
 The next day after fumigation when entering the room to 
 open windows, take the precaution of covering the mouth and 
 nose with a damp towel. 
 
 e. All infected dishes should be boiled 10 minutes. 
 
 f. Infected linen is put to soak in carbolic acid solution 1-20. 
 
 Nurse. Take a bath and hair shampoo. Put on clean clothes 
 in another apartment. All clothing and outfit exposed to infec- 
 tion are left behind to be disinfected or fumigated. 
 
 Bed Sores 
 
 A nurse should guard against bed sores. They can usually 
 be avoided. An exception to this may be found in the following 
 conditions: 
 
 1. Edema. 
 
 2. Paralysis. 
 
44 GENERAL NURSING 
 
 3. Spinal injuries. 
 
 4. Continuous discharge from any part of the body. 
 
 As a rule, the development of a bed sore gives good ground 
 for severe criticism of a nurse. 
 
 The first evidence to the patient of a bed sore is a stinging 
 sensation and a feeling as if he were lying on something rough. 
 The nurse should never wait for this report from the patient, 
 but should watch continually and inspect daily the parts liable 
 to be affected. 
 
 1. Exciting causes :- 
 
 a. Continuous pressure. 
 
 b. Friction between two surfaces. 
 
 c. Moisture. 
 
 d. Creases in under-sheet or night gown or rubber sheet. 
 
 e. Crumbs in the bed. 
 
 f. Lack of proper care or cleanliness. 
 
 2. Predisposing causes: 
 
 a. Malnutrition. 
 
 b. Fat, flabby condition of flesh. 
 
 c. Emaciation. 
 
 d. Poor circulation. 
 
 e. Old age. 
 
 f. Fevers. 
 
 g. Paralysis. 
 
 h. Long confinement in recumbent posture. 
 
 i. Edema. 
 
 j. Irritating discharges. 
 
 3. Parts susceptible: 
 
 a. Hips, lower part of back, shoulders, heels. In these loca- 
 tions the bed sore is generally caused by pressure. 
 
 b. Inner surfaces of knees, elbows, back of head. Generally 
 due to friction. 
 
 c. Those caused by malnutrition may appear any place where 
 there is undue pressure. Often first appear in the form of pus- 
 tules. 
 
 4. Preventive measures: 
 
 a. Absolute cleanliness. 
 
 b. Removal of pressure. 
 
 c. Light massage to parts. 
 
COMMON EMERGENCIES 45 
 
 d. Rub with 50% alcohol. 
 
 e. Dust with powder. 
 
 f. Hot and cold applications may be given. 
 
 g. If there is much moisture the part may be rubbed with 
 any kind of oil. 
 
 h. Keep the bed free from crumbs and wrinkles. Make it a 
 rule to brush crumbs out of the bed after each meal, 
 i. Place soft pads where there is friction. 
 
 5. Treatment. Report to the physician and follow his in- 
 structions in the case. If left to use your own judgment, the 
 following measures may be employed: 
 
 a. Hot and cold applications. 
 
 b. Wash with weak disinfectant solution, 
 
 Green soap 1%. 
 HgCl 2 15000. 
 Boracic acid sat. sol. 
 Carbolic 1%. 
 
 Fix cresol 1 tablet to four ounces of water. 
 Alcohol 95%, alum sat. sol., or picric acid sat. aqueous 
 sol. 
 
 c. Apply a soothing ointment (any of the following may be 
 used) : 
 
 1. Zinc ointment. 
 
 2. Bismuth ointment. 
 
 d. Apply sterile gauze and bandage. 
 
 Common Emergencies 
 
 FAINTING 
 
 If one feels the approach of a fainting attack, it is a good 
 plan to bend from the waist lowering the head as far as pos- 
 sible. This position sends more blood to the brain. 
 
 Treatment: 
 
 1. The head lowered and feet raised the blood is thus sent 
 back to the brain. 
 
 2. Provide abundance of fresh, cool air. 
 
 3. Loosen clothing about neck, chest and waist. 
 
46 GENERAL NURSING 
 
 4. A little cold water dashed in face. 
 
 5. Smelling salts. 
 
 If consciousness does not soon return, external warmth 
 must be applied and a physician should be sent for. 
 
 To distinguish fainting from hysteria. In hysteria the pulse 
 is normal. The patient resists any attempt to raise the eyelids. 
 The body is warm. Practically no change of color in the face. 
 
 HYSTERIA 
 
 Dismiss the friends and spectators, as nothing is so con- 
 ducive to a prolonged and severe attack as an audience. 
 
 If serious symptoms appear suggestive of other difficulties, 
 send for the physician. Otherwise use such simple applications 
 as a hot foot bath, fomentations to abdomen or spine, or a full 
 warm bath to produce relaxation. 
 
 Suggestion is an efficient method of controlling attacks, but 
 this and governmental methods had best be left to the head 
 nurse or physician unless definite directions are given the nurse 
 for their use. 
 
 EPILEPSY 
 
 Place the patient on the ba^k with the head slightly raised. 
 Loosen any tight clothing and see that he does not hurt himself. 
 Provide abundance of fresh air. Place something between the 
 teeth to keep him from biting the tongue. No attempt should 
 be made to stop the movements. 
 
 DROWNING 
 
 1. Treatment, if the patient is still breathing when taken 
 from the water: 
 
 Remove, if possible, to a nearby house and give hot bath, 
 or apply heat over the abdomen. Rub body briskly. 
 
 2. To restore the patient when life is apparently gone: 
 
 a. Loosen clothing. 
 
 b. Open mouth, wipe it out. 
 
 c. Clear throat of mucus. 
 
 d. Turn patient face downward. Have the abdomen rest on 
 coat or shawl folded. Make pressure on both sides of the 
 throat, so as to force out any water that may have entered the 
 air passages. 
 
COMMON EMERGENCIES 47 
 
 e. Turn on back again and give artificial respiration. 
 
 f . Wet clothing should be removed as soon as possible and 
 warm blankets and bottles placed about patient. 
 
 g. Alternate hot and cold applications given to the chest are 
 good to aid in stimulating respiration. 
 
 h. Keep up the artificial respiration for an hour or more if 
 necessary. 
 
 SORDES 
 
 "Collections of brown or black material, consisting of ac- 
 cumulated debris from the epithelial layer of the mucous mem- 
 brane of the mouth, darkened by drying, or by admixture with 
 blood which oozes from the edges of the gums, form upon the 
 teeth and lips at the height of severe cases of fever, "i 
 
 It is the duty of the nurse to keep the mouth of the patient 
 clean. When the patient is helpless and not able to assist in 
 this procedure the nurse takes a small gauze sponge, or small 
 squares of soft muslin, wraps it about the finger, dips it in a 
 good mouth wash and cleanses the teeth and mouth thoroly. If 
 the gums are not too sensitive, instead of using the finger, the 
 artery forceps may be used to hold the sponge or cloth. After 
 this cloth is used it is dropped onto a piece of papt r and then 
 others used until the mouth is thoroly cleansed. Then the pieces 
 are wrapped in the paper and burned. The hands should then 
 be scrubbed. Special attention should be given to the mouth 
 at least three times daily, being especially careful that every 
 part of the cavity is gone over. 
 
 f ormulae for Mouth Washes 
 
 I. Lemon juice 3j. 
 
 Glycerine Sj. 
 II. Carbolic acid 5j. 
 
 Listerine 3ij. 
 
 M. and put 1 tsp. in a 1/3 of glass of warm water. 
 III. Essence of cinnamon gtt. x. 
 
 Water % iv. 
 
 CHILLS 
 
 Stages of, - 
 
 1. Cold shivering. Apply heat hot drinks. 
 
 1 "Fever Nursing," by Dr. J. C. Wilson. 
 
48 GENERAL NURSING 
 
 2. Hoi elevation of temperature. Gradually remove heaters 
 and extra coverings. 
 
 3. Perspiration. Wipe dry and avoid chilling. If perspi- 
 ration is profuse the bed and body linen will have to be changed. 
 Be sure that fresh linen is warmed. 
 
 Poisons 
 
 CLASSIFICATION: 
 
 1. Irritants. Those which burn or irritate the tissues. 
 
 2. Corrosives. Those which destroy the tissues. 
 
 3. Neurotics. Those which act on the nervous system. 
 
 ANTIDOTES: 
 
 1. Mechanical. Those which remove the poison entirely, 
 prevent its action by dilution, or prevent its absorption. 
 
 2. Chemical. Those which neutralize the poison or unite 
 with it to form a harmless compound. 
 
 3. Physiological. Those which counteract the effect of 
 poison on the system. 
 
 In case of an irritant poison give an emetic or lavage, but 
 where a corrosive has been swallowed there is danger in using 
 this method as perforation of the stomach or oesophagus may 
 occur. 
 
 Observe the following: 
 
 1. Burns on face, hands, lips, etc. 
 
 2. Odor of breath. 
 
 3. Hemorrhage. 
 
 4. Nervous twitching of face, hands, or feet. 
 
 5. Rigidity. 
 
 6. Paralysis. 
 
 7. Urine, if any. 
 
 Emetics: 
 
 1. Common salt 5i in Sviii of water. 
 
 2. Mustard Sss in a glass of water. 
 
 3. Syrup of Ipecac 5i or ij. 
 
 4. Zinc sulphate grs. x xxx in 1/2 glass water. 
 
 5. Apomorphine 1/10 gr. by hypodermic. 
 
COMMON EMERGENCIES 
 
 I. IRRITANT POISONS 
 
 NAME 
 
 SYMPTOMS 
 
 ARSENIC 
 Paris green 
 Scheele's green 
 Rough on rats 
 Fowler's solution 
 Insect powders 
 
 Pain in esophagus and 
 stomach, metallic taste, 
 nausea, vomiting and 
 purging. Often bloody 
 vomitus and fecal mat- 
 ter. Weak pulse, diffi- 
 Donovan's solution cult respiration, great 
 thirst, swollen face, cold 
 extremities, cyanosis, 
 convulsions, coma, and 
 death, 
 
 ANTIDOTES 
 
 Evacuate stomach by tube 
 or emetic. Freshly precipi- 
 tated ferric hydroxide or 
 ferric hydroxide with mag- 
 nesia. 
 
 Stimulants, artificial heat. 
 
 CHLORINE 
 
 Chlorinated lime 
 Labarraque's so- 
 lution 
 Javelle water 
 
 Inhaled, causes irrita- 
 tion of larynx with 
 edema which may result 
 in asphyxia, cough, dif- 
 ficult breathing, and dif- 
 ficult swallowing. Swal- 
 lowed, produces burning 
 in stomach. May per- 
 forate. 
 
 Get patient into fresh air, 
 Empty stomach by tube or 
 by emetic like zinc sulphate, 
 mustard, or ipecac. 
 
 Ammonia gas inhaled or 
 dilute ammonia by mouth. 
 Raw white of egg. 
 
 Stimulants, strong coffee. 
 
 COPPER 
 Copper sulphate 
 
 (blue vitriol) 
 Copper acetate 
 
 (verdigris) 
 Copper cooking 
 
 utensils 
 
 CROTON OIL 
 
 Metallic taste, pain in 
 abdomen with griping. 
 Nausea and vomiting. 
 Purging of green mater- 
 ial. Pulse weak and ra- 
 pid. Urine diminished 
 or suppressed. Coma. 
 
 Severe abdominal pain, 
 vomiting, purging. Pulse 
 weak. Skin moist, pros- 
 tration, collapse, death. 
 
 Empty stomach with tube, 
 using plenty of water. Em- 
 etic like mustard or ipecac. 
 
 Potassium ferrocyanide, 
 albumin, milk. 
 
 Empty stomach with tube. 
 Use emetic as zinc sulphate. 
 Gum arabic or white of egg, 
 to protect. 
 
 Artificial heat, camphor, 
 stimulants for heart. 
 
 FORMALDEHYDE 
 
 Formalin 
 
 Inhaled. Intense irri- 
 tation of mucosae, dys- 
 pnoea, pain in head, 
 sense of suffocation. 
 
 Swallowed. Pain, 
 nausea, vomiting, dys- 
 pnoea, vertigo, rapid 
 pulse, urine suppressed, 
 collapse. 
 
 Fresh air, stimulants. 
 Ammonia, apomorphin, de- 
 mulcents. 
 
 IODINE 
 Tincture iodine 
 Lugol's solution 
 
 Pain in throat and 
 stomach. Metallic taste, 
 thirst, vomiting, purg- 
 ing. Face pale, urine 
 suppressed. Pulse weak 
 and rapid. Cyanosis, 
 excitement, convul- 
 sions, collapse. 
 
 Empty stomach, demul- 
 scents. Starch paste, so- 
 dium thiosulphate. 
 
 Stimulants, artificial heat. 
 
50 
 
 GENERAL NURSING 
 
 LEAD 
 
 Sugar of lead 
 White lead 
 Red lead 
 Goulard's extract 
 
 Dry throat, thirst, 
 metallic taste. Pain in 
 abdomen, cramps. Nau- 
 sea, vomiting. May be 
 either purging or consti- 
 pation. Rapid, weak 
 pulse. Convulsions, 
 coma, death. In chronic 
 cases blue line on gums, 
 wrist drop, lead colic. 
 
 Empty stomach by tube. 
 
 Soluble sulphate, such as 
 magnesium sulphate or so- 
 dium sulphate. 
 
 Sulphur baths, potassium 
 iodide, electricity. 
 
 MERCURY 
 Bichloride 
 Red precipitate 
 White precipitate 
 
 Gastro-enteritis, me- 
 tallic taste. Salivation. 
 Pain in throat, esopha- 
 gus, stomach. Nausea 
 and vomiting, purging. 
 Bloody stools. Cold ex- 
 tremities, coma, col- 
 lapse, death. 
 
 In chronic form, line 
 on gums, teeth loose, 
 tongue swollen, breath 
 foul. 
 
 Empty stomach if vomit- 
 ing has not occurred. 
 
 White of one egg to four 
 grains of the bichloride. 
 
 Stimulants, external heat. 
 
 PHOSPHORUS 
 
 Matches 
 Rat poison 
 Phosphorus pills 
 
 Odor of Phosphorus, 
 garlic taste in mouth. 
 Burning pain in stomach. 
 Vomiting of luminous 
 material. Jaundice, 
 headache, dizziness, 
 scanty and albuminous 
 urine. Convulsions, 
 coma, death. Postmor- 
 tem shows fatty degener- 
 ation of liver and other 
 organs. 
 
 Empty stomach, avoid fats 
 and oils. 
 
 Copper sulphate, potas- 
 sium permanganate, hydro- 
 gen peroxide. 
 
 Oxygen, artificial heat. 
 
 PTOMAINS Variable. Thirst, nau- Empty stomach, demul- 
 
 sea, vomiting; convul- scents. Tannic acid, 
 
 sions by some, sleep by Combat symptoms as they 
 
 others. arise. 
 
 SILVER 
 
 Silver nitrate 
 Lunar caustic 
 
 Pain, nausea, and vom- 
 iting. Vomited mater- 
 ial turns black in light. 
 Purging, dizziness, con- 
 vulsions, paralysis, coma, 
 collapse. 
 
 Evacuate stomach by tube 
 or emetic. 
 
 Sodium chloride (common 
 salt), albumins. 
 
 Stimulants, external heat. 
 
 ZINC 
 
 Zinc sulphate 
 Zinc chloride 
 
 Corrosion of lips and 
 mouth. Pain and burn- 
 ing in digestive tract. 
 Vomiting and nausea. 
 Convulsions, paralysis, 
 
 collapse. 
 
 Empty stomach with tube 
 or emetic like ipecac. Albu- 
 min, alkaline carbonates. 
 External heat. 
 
COMMON EMERGENCIES 
 II. CORROSIVES 
 
 CARBOLIC ACID Pain and burning in 
 In various dilutions mouth and stomach, 
 and full strength. Sometimes vomiting, 
 whitening of lips and 
 mouth. Dyspnoea, diz- 
 ziness and loss of con- 
 sciousness. Urine small 
 amount and black. Col- 
 lapse, death. 
 
 Empty stomach by emetic 
 and tube. Avoid fats and 
 oils. 
 
 Alcohol, magnesium sul- 
 phate, syrup of lime, al- 
 bumin. 
 
 Atropin. Stimulants, 
 external heat, artificial res- 
 piration. 
 
 CAUSTlt ALKA- 
 LIES 
 
 Caustic soda 
 Caustic potash 
 Concentrated lye 
 Strong ammonia 
 
 water 
 Lime 
 
 Carbonate of soda 
 Carbonate of 
 potash 
 
 Pain in mouth and 
 stomach. Pain on swal- 
 lowing. Vomiting and 
 purging of mucus and 
 blood. Skin cold and 
 clammy. Feeble pulse, 
 stupor, coma, and death. 
 
 If signs of corrosion, avoid 
 use of stomach tube and 
 emetics. Use demulscents 
 to protect mucosa after giv- 
 ing chemical antidote. 
 
 Dilute vegetable acids 
 freely, such as citric and 
 tartaric, lemon and orange 
 juice, vinegar, milk, oil. 
 
 Stimulants, artificial heat. 
 
 MINERAL ACIDS Pain along entire di- 
 Hydrochloric acid gestive tract, thirst, dif- 
 Sulphuric acid ticult swallowing. Vom- 
 
 Nitric acid ited material dark co- 
 
 Nitro-hydrochloric lored and containing 
 acid shreds of membrane. 
 
 Feeble pulse, clammy 
 skin, collapse. Hydro- 
 chloric produces white 
 stain on tissue, sulphuric 
 acid a corroded black ap- 
 pearance, nitric and 
 nitro-hydrochloric a yel- 
 low stain. 
 
 Do not use stomach tube 
 or emetics. Avoid water in 
 case of sulphuric unless it 
 can be given in large amounts 
 as it generates heat and in- 
 creases injury. 
 
 Other cases use water 
 freely and demulscents. 
 
 Magnesia, soap, albumin, 
 lime water, whiting, wall 
 plaster. Avoid carbonates, 
 as they liberate carbon diox- 
 ide and may rupture stomach 
 wall. 
 
 Stimulants, external heat, 
 oil enemata. Protect ex- 
 ternal parts like ordinary 
 burn. 
 
 OXALIC ACID Hot, sour taste in 
 
 Oxalic acid mouth. Burning sensa- 
 
 Potassium oxalate tion in esophagus and 
 Potassium binox- stomach. Intense thirst, 
 alate Headache. Tongue swol- 
 
 len. Vomiting of acid, 
 bloody mucus. Cold skin, 
 coma, collapse, occasion- 
 ally convulsions. Urine 
 scanty and albuminous. 
 
 Avoid use of stomach tube. 
 Emetics may be used in most 
 cases. Safer to induce vo- 
 miting by irritating fauces 
 with feather. Castor oil and 
 magnesium sulphate to 
 empty intestinal tract. 
 
 Lime in any form such as 
 chalk, whiting or plaster. 
 Magnesia is also of value. 
 Caustic alkalies of no value 
 so far as poison is concerned. 
 
 Stimulants. 
 
ALCOHOL 
 
 Ethyl Alcohol 
 Whiskey 
 Brandy 
 Rum 
 
 GENERAL NURSING 
 III. NEUROTICS 
 
 Confusion, giddiness, 
 relaxation of body, hal- 
 lucinations, stupor, anes- 
 thesia, weak pulse, skin 
 cool and moist, pupils 
 dilated, breathing noisy, 
 may be convulsions. 
 Odor of alcohol on breath. 
 
 Fresh air. Empty stomach 
 by tube or emetic. 
 
 Chemical antidote, none. 
 
 Artificial heat. Support 
 by aromatic spirits of am- 
 monia. Galvanic currenr, 
 hot and cold applications, 
 oxygen. 
 
 ANTIPYRETICS, 
 
 COAL TAR 
 Acetanilid 
 Phenacetin 
 Antipyrin 
 
 Sweating, depression, 
 cyanosis, collapse. 
 
 Put patient in recumbent 
 position. Loo sen'clothing. 
 Evacuate stomach with tube 
 or emetic. 
 
 Chemical antidote, none. 
 
 Artificial heat. Artificial 
 respiration. 
 
 BELLADONNA 
 Tr. Belladonna 
 Extract Bella- 
 donna 
 Atropin 
 
 Dryness in mouth and 
 throat. Great thirst, 
 dilated pupils. Indis- 
 tinct vision, giddiness, 
 dry skin, nausea, vomit- 
 ing. Stupor. May be 
 excitement. Coma, 
 death. 
 
 Evacuate stomach by tube 
 or emetic. 
 Tannic acid. 
 External heat, stimulants. 
 
 CHLORAL 
 Chloral 
 Chloral hydrate 
 
 Loss of muscular 
 power. Sleep, coma, 
 weak respiration, weak 
 pulse, first slow then ra- 
 pid and thready. Face 
 white and sweaty. Tem- 
 perature low. May be 
 delirium. 
 
 Empty stomach by tube 
 or mustard emetic. 
 
 Liquor potassae 1-2 to 2 
 drams in glass of water 
 hourly as required. 
 
 Oxygen inhalation. Cold to 
 head. Inhalation of am- 
 monia. 
 
 ANESTHETICS 
 Chloroform 
 Ether 
 
 Stertorous breathing, 
 irregular and shallow. 
 Dilated pupils, conjunc- 
 tival reflex absent. Same 
 when taken by mouth as 
 when inhaled. 
 
 Remove anesthetic if being 
 inhaled. Artificial respira- 
 tion. Empty stomach by 
 tube. 
 
 Chemical antidote, none. 
 
 Cold water in face and on 
 chest. Atropin sulphate 
 1-100 gr. hypodermatically. 
 Friction and external heat. 
 
 CARBON 
 
 MONOXIDE 
 
 Dizziness, headache, 
 may be nausea and vom- 
 iting. Pupils dilated. 
 Choking, gasping, col- 
 lapse. 
 
 Remove to fresh air. Ar- 
 tificial respiration. 
 
 Chemical antidote, none. 
 
 Oxygen inhalation, heat to 
 extremities and body. Heart 
 stimulants like cold to chest. 
 
COMMON EMERGENCIES 
 
 53 
 
 COCAIN 
 
 Cocain hydro- 
 chlorate 
 
 Nervous excitement, 
 :-ense of oppression, and 
 falness in head. Some- 
 times nausea and vomit- 
 ing. Pulse slow, respi- 
 ration labored. Face 
 may be cyanotic. Pupils 
 dilated, cold extremities. 
 Convulsions, coma, 
 death. 
 
 Fresh air, patient in hori- 
 zontal position. Artificial 
 respiration. Empty stomach 
 if cocain was swallowed. 
 
 Chemical antidote, none. 
 
 Stimulants for heart and 
 respiration. Cold compress 
 to chest. External heat. 
 Oxygen inhalation. Cath- 
 artic and enema. 
 
 DIGITALIS 
 
 Tr. digitalis 
 Extract of digit- 
 alis 
 
 Infusion of digit- 
 alis 
 
 Vomiting, purging, 
 headache, eyes bulging. 
 Bl'ie sclerotic?; vertigo; 
 salivation; pulse small, 
 slow, irregular; face 
 pale. Suppression of 
 urine, delirium, convul- 
 sions. Coma, death sud- 
 denly. 
 
 In horizontal position. 
 Evacuate stomach by tube 
 or emetics. Wash stomach 
 with tannic acid solution. 
 
 Chemical antidote, none. 
 
 Epsom salts, stimulants 
 like ammonia. 
 
 HYDROCYANIC Breath odor of bitter 
 
 ACID almonds. Respiration 
 
 Hydrocyanic acid difficult, pulse imper- 
 Potassium cyanide ceptible. Eyes prom- 
 inent. Pupils dilated. 
 Convulsions, asphyxia, 
 cyanosis, paralysis, col- 
 lapse, coma, death. 
 
 Artificial respiration. 
 Evacuate stomach after 
 antidote. 
 
 Ferrous sulphate. Hydro- 
 gen peroxide. 
 
 Cold water over face. 
 Stimulate with ammonia. 
 Artificial heat, electricity. 
 
 IODOFORM Drowsiness, slight de- Remove iodoform dress- 
 
 lodoform lirium, high tempera- ings if in use. 
 
 ture, rapid pulse, menin- Chemical antidote, none, 
 geal symptoms. Stimulants. 
 
 NUX VOMICA 
 Tincture nux 
 
 vomica 
 Extract nux 
 
 vomica 
 Strychnin 
 
 Sense of suffocation. 
 Difficulty in breathing. 
 Stiffness about neck. 
 Tetanic convulsions. 
 Opisthotonos, great 
 anxiety. Jaw muscles 
 affected late. Death. 
 
 Empty stomach early be- 
 fore convulsion. 
 
 Tannic acid, potassium 
 permanganate. 
 
 Artificial respiration. 
 Chloroform for convulsions. 
 Neutral bath, bromides, 
 chloral. 
 
 NICOTIN 
 
 Nicotin 
 
 Languor, numb feel- 
 ing in head, confused 
 mind, nausea, cyanosis, 
 dilated pupils, ^convul- 
 sions, coma. 
 
 Evacuate stomach by tube 
 or emetic like syrup of 
 ipecac. 
 
 Chemical antidote, none. 
 
 Stimulants like caffeine 
 and ammonia, alternate hot 
 and cold douche, oxygen in- 
 halation, electricity. 
 
GENERAL NURSING 
 
 OPIUM 
 Tr. opium 
 Extract opium 
 Camporated tinct. 
 
 opium 
 Morphin 
 Codein 
 Heroin 
 
 Mental excitement, 
 headache, drowsiness 
 then sleep. Contracted 
 pupils, reflexes lost. 
 Cyanosis, muscular re- 
 laxation, clammy skin, 
 weak pulse, coma, 
 death. 
 
 Artificial respiration, 
 evacuate stomach. 
 
 Potassium permanganate, 
 tannic acid. 
 
 External heat. Keep pa- 
 tient awake by external 
 stimulation. 
 
 NOTE This table is compiled from Brundage on Toxicology. 
 
PART II 
 
 SURGICAL NURSING 
 
 This course in Surgical Nursing should be preceded by lec- 
 tures on the following topics: 
 I. History of Bacteriology. 
 II. Classification of Bacteria and their Relation to Surgery. 
 
 III. Immunization. 
 
 IV. Sterilization and Disinfection. 
 
 THE PATIENT 
 
 Preparation of the Patient's Room 
 
 Furniture. Iron surgical bed, a dresser, washstand, bed- 
 side table, stand, two chairs, and a screen. Curtains, if any, 
 should be of light, washable material. Rugs are never allowed. 
 
 If, in a private home, use the same directions in the selec- 
 tion of a room that are observed in medical nursing. The fol- 
 lowing is the ordinary daily routine in cleaning a surgical room 
 and keeping it in order: 
 
 1. Wipe woodwork and furniture with a lightly oiled cloth, 
 the object being to prevent dust in the air. 
 
 2. Wash crockery drinking glasses, drinking pitcher, 
 washbowl and pitcher, soap dish and slop jar. 
 
 3. Change bed linen generally one sheet daily is sufficient. 
 Air blankets. Turn mattress if patient can be moved to a cot 
 or a wheel chair. 
 
 4. Wash floor with a disinfectant or strong soapsuds of 
 laundry soap. During the day keep floor free from dust by oc- 
 casionally wiping' it with a broom that is covered with a cloth 
 or bag. 
 
 5. Do not forget to keep finger marks wiped off the bed. 
 Also do not forget to keep electric light bulb washed and shin- 
 ing, also the shade. 
 
56 SURGICAL NURSING 
 
 6. Change towels on stands and dresser as often as needed. 
 
 7. Remember that fresh flowers always bring good cheer 
 and sunshine into the sick room. 
 
 8. Use one of the dresser or washstand drawers for the 
 sterile bowls and dressings. 
 
 a. Put clean towel in the bottom. 
 
 b. Arrange dressings and bowls in an orderly manner and as 
 soon as the dressing wrappers are no longer needed return them 
 to their proper place. 
 
 9. The urinal and bedpans should be scrubbed thoroly and 
 disinfected daily. Also after using they should be thoroly 
 rinsed. If these utensils are not properly cared for they will 
 soon have a characteristic odor, and stains will be in evidence. 
 
 10. Bowls should be washed daily and those that come in 
 contact with a wound or raw surface, such as a repaired perin- 
 eum, should always be desinfected before using. 
 
 11. Have on hand a cloth for the floor, one for woodwork 
 and furniture, one for the crockery and one for the bedpan. 
 Those should be washed and dried and labeled after using, 
 otherwise a relief nurse is apt to use one of them for a wrong 
 purpose. These little precautions take very little time and re- 
 sult in quite a saving of linen and old cloth. 
 
 12. Do not neglect to clean drinking tube daily with a brush 
 especially made for that purpose. 
 
 13. A surgical nurse should systematize the daily routine. 
 If this is done much time and labor are saved. A patient ap- 
 preciates a nurse who is a good housekeeper. Avoid being 
 ' 'fussy" and ' 'puttering" in the performance of your duties. 
 Plan ahead and make every move count. 
 
 Preparation of the Patient 
 
 The routine of preparation varies in almost every hospital 
 in many details, but the general plan is practically the same. 
 The head nurse should receive from the surgeon in charge the 
 details of the preparation and see that his orders are carried out. 
 
 MAJOR OPERATIONS 
 
 1. General directions. Simple methods for the preparation 
 of the patient are now being considered very favorably. The 
 following is an example of such a plan: 
 
PREPARATION OF THE PATIENT 57 
 
 Pills, a saline cathartic, or two ounces of castor oil, also a 
 bath are given the afternoon or evening preceding the opera- 
 tion. A light supper is sometimes allowed. 
 
 The next morning the patient is shaved and at the appointed 
 hour walks to tht operating room, if able to do so. Here the 
 special preparation of the skin area involved in the incision is 
 made just before the operation. Perhaps a still better plan is 
 to shave the patient the afternoon or evening preceding the 
 operation, omitting enemas or other tedious procedures on the 
 morning of the operation. 
 
 If the iodine method of preparing the field of operation is 
 to be used, the bath should be given and the shaving done the 
 previous afternoon. The first coat of iodine may be applied in 
 the evening after the skin has thoroly dried. 
 
 2. Diet. The day before, the patient may be allowed to 
 partake of his ordinary diet, omitting highly proteid foods, pas- 
 tries and coarse vegetables. A light supper may be allowed the 
 night before unless the operation is of such a nature that this 
 would be inadvisable. No food should be given on the day of 
 the operation unless the work is to be done late in the afternoon. 
 
 3. Head nurse sees that a specimen of urine is saved and 
 examined one or two days before the operation. 
 
 4. Hair shampoos and other tedious procedures should be 
 given two days before the operation. 
 
 5. If the operation is gynecological and vaginal douching is 
 ordered, it is well to give this the previous night. Unless other- 
 wise ordered, employ a 1% green soap solution at 108, followed 
 by douching with plain water at the same temperature. 
 
 6. Shaving field of operation. Get the shaving tray from 
 surgical supply room. It should contain the following articles: 
 
 a. Shaving soap. 
 
 b. Small piece of gauze for applying soap before shaving. 
 
 c. Razor (safety preferred). 
 
 d. Pair of blunt end scissors. 
 
 e. Bowl of warm water. 
 
 Clip hair from the part. Make soap lather, .apply, and 
 shave. The head nurse will give directions as to the extent of 
 of the area to be shaved. 
 
 The skin should never be scrubbed to the point of irritation, 
 as a raw surface furnishes a good medium for the growth of 
 
r>8 SURGICAL NURSING 
 
 bacteria. Also in shaving, exercise great caution to avoid irri- 
 tating the skin. Strong disinfectants act as irritants, and are 
 to be used with care and never upon sensitive surfaces such as 
 the eye, labia, etc. When these surfaces are being prepared 
 for operation, special care should be observed not to overdo the 
 cleansing process. 
 
 7. Put on clean gown, slippers and bath robe; braid hair in 
 two braids; put to bed between clean sheets. 
 
 8. Give glass of fruit juice, gruel, or malted milk. 
 
 9. On the morning of the operation the following things are 
 to be observed just previous to the operation: 
 
 a. Record temperature, pulse, and respiration. 
 
 b. Remore the false teeth. 
 
 c. Have the patient urinate just before entering the operating 
 room. 
 
 d. In laparotomy catheterize if ordered. 
 
 e. Surgical jacket or gown, stockings, leggings, etc., should 
 be put on the patient before the anesthetic is begun. 
 
 f. The nurse must not fail to have the patient ready before 
 the hour appointed for the operation. 
 
 i 
 
 Special preparation to part, 
 
 This is generally done in the operating room. If done in the 
 patient's room the same aseptic precautions are observed. 
 
 1. Place blanket and clean sheet over limbs. 
 
 2. Place Kelly pad under patient. 
 
 3. Place some impervious material that has been disinfected 
 around edges of area to be scrubbed to protect the blanket and 
 gown from getting wet. 
 
 4. The clean nurse now places sterile towels over the imper- 
 vious material. Then she takes in each hand a sterile sponge. 
 The circulating nurse pours over these and also the part to be 
 scrubbed, sterile water and tincture of green soap. The clean 
 nurse scrubs thoroly but avoids scrubbing to the point of irrita- 
 tion, as this makes a fertile field for the growth of bacteria. 
 The green soap is rinsed off the part about 3 to 5 times during 
 the procedure. The clean nurse next scrubs the area with al- 
 cohol and then ether, special attention being given to the umbi- 
 licus. If alcohol and ether are applied when the patient is con- 
 scious, the process is apt to be very painful. After this is done 
 
PREPARATION OF THE PATIENT 59 
 
 a sterile towel is placed by the clean nurse over the disinfected 
 area and then the Kelly pad and rubber and wet towels are re- 
 moved. 
 
 5. A sterile sheet, folded so as to make four thicknesses, is 
 now placed over the limbs, folding several inches over the 
 blanket. A sterile half sheet is then folded and placed over the 
 arms, tucking in well over the gown. 
 
 6. The sterile laparotomy sheet is then placed over this. 
 
 7. Place sterile anaesthetic shield over frame provided for 
 that purpose. 
 
 Iodine preparation to part. Formula: 
 
 Iodine 30 gms. 
 
 Potassium iodid 40 gms. 
 Aq. Dest. 500 c.c. 
 
 Dilute with an equal volume of grain alcohol. For the sat- 
 isfactory action of the iodine, it is essential that the skin be 
 dry. If possible, shave the night before the operation. If shav- 
 ing is done just before the operation, or the day of, dry skin 
 thoroly with towel and apply ether; then dry again. In regular 
 cases, the iodine preparation is first done in the ward, the io- 
 dized area is then covered with a sterile pad or towel. Before 
 commencing the operation a second application of the iodine 
 solution is made, the skin then being in a thoroly dry condition. 
 If possible, it is well to make the first application of iodine the 
 the night before the operation. The second application is made 
 just before the patient enters the operating room or on the oper- 
 ating table. Some surgeons prefer to use 5% tincture of iodine. 
 
 Position of the patient on the table. 
 
 I. Dorsal. The patient is placed upon the back with pads 
 under the back and knees. Thus the strain that the lumbar 
 spine and sacro-iliac joints are generally subject to, is avoided. 
 The unnatural position of the body on an operating table often 
 causes post-operative back-aches and a subsequent weakening 
 of the sacro-iliac joints. 
 
 77. Trendelenburg position. Place the patient in the dorsal 
 position with the shoulders resting against shoulder supports. 
 Then lower the head of the table as much as required. The 
 arms should be fastened loosely across the chest. 
 
60 SURGICAL NURSING 
 
 III. The lithotomy position. Place the patient in the dor- 
 sal position. Flex the thighs on the abdomen and the legs on 
 the thigh with the knees separated. The buttocks should pro- 
 ject well over the edge of the table. 
 
 IV. The exaggerated lithotomy position. This is similar to 
 the above, except that the pelvis is elevated. This may be done 
 by placing a large flat sand-bag beneath the buttocks or by 
 combining with the Trendelenburg. 
 
 V. The kidney position. P : ace in either the right or the 
 left Sim's position as is needed. Then raise the * 'kidney lift" 
 of the table until the patient is in the proper position. If a 
 table has no "kidney lift," an oblong sand-pillow may be placed 
 between the table and the patient in the proper place. 
 
 THE OPERATING ROOM 
 
 The operating room should be on the top floor and have a 
 high ceiling. The sky-light should be double, air tight, and of 
 ribbed glass, and shaded so that the sunlight will not fall di- 
 rectly upon the operating table. A north exposure is considered 
 the best. 
 
 The floor, walls, and ceiling should be tiled, or the floor of 
 cement and the wall and ceiling of smooth, hard wall plaster. 
 The corners should be round and the heat should be either hot 
 water or steam. 
 
 General rules. There should be no confusion in an operat- 
 ing room. Avoid unnecessary talking. Each member of the 
 staff should have a thoro knowledge of his own duties and also 
 of the duties of others. Each movement should be executed 
 quickly and noislessly and without coming in contact with 
 others. 
 
 Preparation of the Operating Room 
 
 1. Every inch of space in the room is first washed thoroly 
 with soap and water. 
 
 2. All furniture is washed with a reliable disinfectant, e. g. 
 
 HgCl 2 1/1000. 
 Carbolic 2%. 
 Lysol 1%. 
 Formaldehyde 1%. 
 
TECHNIQUE OF TABLES 61. 
 
 In addition to this the glass of the tables may be washed 
 with 95% alcohol, also the electric light bulbs. It is preferable 
 to have two operating rooms one for aseptic and one for septic 
 cases. However, we do not always find this ideal arrangement. 
 Consequently, after each septic case the room should be sealed 
 up and thoroly fumigated. Full directions for this are given 
 elsewhere. 
 
 Technique of Tables 
 
 1. Anesthetic table (To the right of the anesthetist) : 
 
 a. Place towel over top. 
 
 b. Chloroform bottle. 
 
 c. Ether mask. 
 
 d. Two towels. 
 
 e. Mouth sponges. 
 
 f . Pus tray containing mouth gag, tongue forceps, and artery 
 forceps. 
 
 g. Bottle of vinegar (some anesthetists give inhalations of 
 this at the close of the anesthetic to prevent nausea) . 
 
 h. Tube of vaseline. 
 
 i. Such other articles as the anesthetist may require. 
 
 2. Table of clean nurse. The following classes of articles 
 should be arranged on the table according to some definite plan. 
 In one place put needles and sutures, near to this such special 
 instruments as scissors, needle holders, cervical, perineal, and 
 aneurysm needles. 
 
 Reserve a place for the instrument to be used in the parti- 
 cular operation to be done. These should be placed as needed 
 In the movable instrument tray, which is attached to a foot, 
 on another place on the table put the sponges and such sterile 
 dressings as may be needed. Have in a convenient location on 
 the table sterile safety pins, small sterile beakers or bottles 
 containing such liquids as tincture of iodine, tincture of benzoin, 
 carbolic acid, alcohol, and sterile vaseline. Also have a package 
 of sterile cotton pledgets and applicators. On the shelf under- 
 neath are kept sterile sheets, towels, napkins, and a reserve 
 supply of sponges and dressings, also sterile dishes and rubber 
 gloves. 
 
 3. An extra table in the corner contains supply bottles of 
 alcohol, carbolic, etc., a supply of packing of various sizes in 
 
62 SURGICAL NURSING 
 
 glass tubes, wide-mouthed bottles or other convenient recept- 
 acles, tray containing articles for final preparation of the field 
 of operation. These articles vary according to the technique 
 used. The following is a suggestive list. The tray should be 
 set up according to the order of the surgeon. 
 
 a. Large sponges. 
 
 b. Tincture of green soap or green soap solution. 
 
 c. Sterile water. 
 
 d. Alcohol. 
 
 e. Ether. 
 
 f. Tincture of iodine. 
 
 4. An adjustable standard for holding the irrigating appara- 
 tus is needed in every operating room. The irrigating cans and 
 tubing must be sterile before using. 
 
 5. A special stand holding one or two bowls of sterile hand 
 solutions are placed near the surgeon. These are used by him 
 for washing his hands as may be necessary during the operation. 
 
 Duties of Staff 
 
 After the operating room is thoroly cleaned according to 
 the outline given elsewere, one nurse scrubs and prepares her- 
 self according to one of the formulae given under "hand disin- 
 fection. " 
 
 Another nurse who does not have to be clean and who is 
 commonly called the "circulating nurse," places on the clean 
 nurse a cap. She also unpins and turns back the wrapper of a 
 surgical gown without touching the gown and nurse No. 1 takes 
 it out and puts it on, No. 2 tying the tapes in the back and pin- 
 ning the belt. 
 
 No. 1 does not touch anything that is not sterile and No. 2 
 is careful not to touch anything that is sterile. If this rule is 
 not adhered to, the whole operating room technique is rendered 
 imperfect, and as a result a life may be sacrificed. It is very 
 true that a chain is no stronger than its weakest link, so a sur- 
 gical technique is just as strong as its weakest point. 
 
 No. 1 and No. 2 are now ready for work in the operating 
 room. No. 2 unpins and turns back the outside wrapper of a 
 bundle and No. 1 unpins the second wrapper and removes it 
 when needed. 
 
DUTIES OF STAFF 63 
 
 First a sterile sheet is placed over the table used by clean 
 nurse. Then dressings, supplies and dishes are arranged so 
 that they may be readily secured. 
 
 While she is doing this No. 2 sets the anesthetic table and 
 the general table. 
 
 THE DUTIES OF THE ' 'CLEAN NURSE" (NO. 1) AT OPERATION 
 
 1. As a general rule No. 1 is the nurse in charge of the 
 operating room. 
 
 2. Places laparotomy sheet over the patient, after placing 
 sterile towels or sheets over the edges of the sheet and blanket 
 that are already on the patient. 
 
 3. Helps to hand instruments. 
 
 4. Washes soiled instruments. 
 
 5. Keeps plenty of sterile sponges on hand for the surgeon. 
 
 6. Counts laparotomy sponges and napkins. 
 
 7. Prepares sutures and threads all needles. 
 
 8. Anticipates the needs of the surgeon and his assistant. 
 
 9. Watches the whole staff to see that the surgical technique 
 is not broken. If it is, she sees that steps are at once taken to 
 mend the broken link. 
 
 THE DUTIES OF THE ' 'CIRCULATING NURSE" (NO. 2) 
 
 1. Changes solutions as needed. 
 
 2. Runs the irrigator. 
 
 3. Sees that all supplies are kept up. 
 
 4. Under No. 1, number 2 is responsible that everything 
 in operating room is kept in order during an operation. 
 
 5. Anticipates the needs of all the staff. 
 
 6. Should stand on the alert, ready to assist in any way 
 possible. 
 
 Hand Disinfection 
 
 1. Trim the nails as short as possible and clean them. 
 
 2. With green soap or some special brand of soap, selected 
 by the surgeon, the hands and arms to above the elbows are 
 to be thoroly scrubbed. This requires about ten minutes, during 
 which time the parts should be frequently rinsed (five or six 
 times). 
 
 3. Chemical disinfection follows the last rinsing. For this 
 various methods are in vogue. 
 
64 SURGICAL NURSING 
 
 I. a. Hot saturated solution of potassium permanganate, until 
 the parts are well stained. 
 
 b. Saturated oxalic acid solution to decolorization. 
 
 c. Warm sterile water. 
 
 //. a. Acid solution of bichloride of mercury for five minutes, 
 b. Sterile water. 
 
 ///. a. Cover parts with paste of chloride of lime and water. 
 
 b. Apply sodium carbonate. 
 
 c. Remove very carefully all this mixture with bichloride of 
 mercury 1/1000, using a piece of sterile gauze. 
 
 d. Immerse in alcohol. 
 
 e. Rinse in solution of 1% carbolic acid. 
 
 To facilitate the removal of lime and soda mixture, the 
 hands and arms may be immersed in a 2% solution of sodium 
 carbonate. 
 
 IV. Alcohol (70% or 75%) for two minutes. 
 
 There are various modifications of these methods. Some 
 prefer to finish any method by rinsing the hands in bichloride. 
 Others after simple scrubbing with green soap or mechanic's 
 soap, rinse the hands with sterile water and then immerse in 
 Harrington's solution 30 seconds to one minute, and finally 
 rinse in alcohol. 
 
 Formula for Harrington's solution, 
 Grain alcohol 640 c.c. 
 
 Water 300 c.c. 
 
 Hydrochloric acid C. P. 60 c.c. 
 Bichloride of mercury 0.8 gm. 
 
 Some surgeons find it impossible to use strong chemicals on 
 the hands because of the resulting irritation and dermatitis, 
 and hence use very simple methods, depending largely upon 
 mechanical cleanliness. 
 
 Sterilizing Room 
 
 1. General preparation the same as for the operating room. 
 
 2. A tripod or side table contains three or four bowls for 
 hand solutions also a bowl of nail brushes and files that are im- 
 mersed in a solution of formaldehyde 2% or green soap 2 1/2%, 
 and a package of sterile, surgeon's towels. 
 
METHODS OF STERILIZATION 65 
 
 3. The stationary bowls for the scrubbing of the hands are 
 scrubbed with bon ami, or some good cleaning preparation, and 
 the faucets and drain pipes are polished. This room contains a 
 general work table. 
 
 Instruments and Supply Room 
 
 The general preparation of this room is the same as the 
 sterilizing room. It contains the sterilizer, tanks containing 
 hot and cold sterile water, a tank for boiling bowls, etc., an 
 instrument boiler, also the instrument case, the cupboard for 
 surgical dressings, a cupboard for general supplies, and a work 
 table. 
 
 Methods of Sterilization 
 
 RUBBER GLOVES 
 
 No. 1. Dry method. Soak new gloves in soap and water 
 for twenty-four hours;- boil for five minutes. This is to render 
 them pliable: rinse, dry on both sides, powder on inside, being 
 careful to shake powder out of finger tips. Mate the gloves. 
 
 Inside the wrist of each glove place a piece of gauze, and a 
 piece lengthwise between each pair of gloves to prevent them 
 sticking. Put each pair up separately in muslin or towel, mark 
 with owner's name, and sterilize for twenty minutes under ten 
 pounds pressure. 
 
 After each operation, cleanse gloves on inside and outside 
 by scrubbing with soap and water, rinse, test, and mend. Boil 
 five minutes in 1/4% soda sol., rinse in ammonia water, dry on 
 inside and outside, powder and proceed as before. If seamless 
 gloves are used, it is best to powder them on both sides, as they 
 stick together. 
 
 To be used after thoroly disinfecting hands; dry with sterile 
 towel, powder hands (not gloves) with sterile talcum and draw 
 on gloves. 
 
 A T o. 2. Wash thoroly in green soap and water; rinse. Boil 
 5 minutes in saline or soda solution. Immerse in 5% green soap 
 solution or HgCl 2 13000. Fill gloves with solution so that they 
 may be easily and quickly put on. 
 
 BRUSHES 
 
 Hand brushes and nail cleaners are boiled 15 to 20 minutes 
 and then placed in a solution of 2% formaldehyde or 5% green 
 soap. 
 5 
 
66 SURGICAL NURSING 
 
 The Kelly pad is washed thoroly with soap and water and 
 disinfected in 5% carbolic or bichloride 1-1000. The objection 
 to the latter is that it blackens rubber. 
 
 Drainage tubes are washed thoroly in green soap and water 
 and rinsed. Boil one-half hour just before using. 
 
 Gutta percha tissue is immersed in HgCU 1-1000, one-half 
 hour before using. 
 
 Rubber sheets are disinfected in 5% carbolic acid solution. 
 
 SUTURES 
 
 Catgut is made from the intestines of sheep. It is softened 
 and absorbed by the fluids of the body and hence it is used 
 within the abdominal cavity or deeper layers of tissues. 
 
 In many hospitals this is purchased from firms who prepare 
 it for use and put it up in glass tubes containing alcohol 
 
 There are various formulae for preparing it. These may 
 be found in any text on surgical nursing. 
 
 Kangaroo tendon is prepared from the split sinews of the 
 tail of that animal. Its advantage over catgut consists in its 
 greater strength. 
 
 Silkworm gut is generally prepared by boiling one-half hour 
 before an operation. It is seldom employed as a buried suture, 
 but is much used in closing wounds with interrupted sutures. 
 
 Silk and linen are prepared for use in the same manner. 
 
 DRESSINGS 
 
 Small sponges 6x9 in. Fold each edge of the longest di- 
 mension to the center. Then bring the ends together at the 
 center. Fold again so that a perfect square is formed. 
 
 Large sponges 9x18 in. They are made the same as the 
 small sponges. 
 
 Large laparotomy napkins. Gauze, 36x36 in. When finished 
 the dimensions are 12x16 in. 
 
 Rollers. Gauze, 36x36 in. ; finished, 34x4 in. 
 
 Laparotomy napkins. Gauze, 36x18 in. ; finished, 16x8 in. 
 
 Abdominal dressing. Gauze, 30x36 in. ; folded, 16x8 in. 
 Combination. Gauze, 30x20; cotton, 16x12; finished, 16x12 in. 
 Fluff, 6 pieces, 18x18 in. 
 
 Perineal dressing. Cotton, 4x6 in. ; Gauze, 12x9 in. Fin- 
 ished, 4x6 in. 
 
METHODS OF STERILIZATION 67 
 
 Perineal pads. Gauze, 12x18 in. ; Cotton, 5x9 in. Finished, 
 5x9 in. 
 
 The towels, napkins, rollers, abdominal dressings, sheets, 
 perineal dressings and pads, are done up in packages containing 
 6, 12 and 24 each. The large sponges are done up in packages 
 of 12 and 24 each. 
 
 Surgical gowns, sheets, dressings, towels, napkins, lap- 
 arotomy sheets, are all wra ped in two heavy muslin wrappers- 
 and sterilized for one hour under fifteen pounds pressure. 
 This kills the spores as well as the bacteria, so that fractional 
 sterilization is unnecessary. 
 
 PACKING ' 
 
 One-fourth inch. Cut strip of gauze 1 inch wide. Pull a 
 thread to cut by, to make it perfectly even. Fold each edge to the 
 center lengthwise, then bring the outer edges together. This 
 makes a strip 1/2 of an inch in width and four thicknesses of 
 gauze. Pack in a glass test tube or a small wide-mouthed 
 bottle, and place a stopper of absorbent cotton. Label and 
 sterilize in the usual manner. 
 
 In making any width of packing, the strips are cut five 
 yards long. The width of the gauze should be four times the 
 width of the packing when finished. 
 
 IODOFORM GAUZE 
 
 Formula, 
 
 1. Alcohol 3 parts. 
 
 2. Glycerine 2 parts. 
 
 3. lodoform sufficient to make the consistency of cream. 
 One nurse scrubs up as for an operation. We will call her 
 
 No. 1 and her assistant No. 2. 
 
 No. 1 takes a sterile cotton pledget and No. 2 pours on it a 
 little alcohol. No. 1 then wipes the edges of the glycerine 
 bottle, being careful that her fingers touch nothing but the 
 pledget. 
 
 No. 2 measures out the glycerine and alcohol into a sterile 
 graduate and pours into a sterile bowl. She then pours in the 
 iodoform powder while No. 1 stirs with a steril^ spoon until the 
 solution is of the consistency of cream. No. 2 then removes the 
 plug from a tube of sterile packing while No. 1 with sterile for- 
 ceps removes the same and puts in the solution already made. 
 
68 SURGICAL NURSING 
 
 Here she saturates the gauze with the solution, being careful 
 that the iodoform is evenly distributed thru the gauze. Then 
 the gauze is wrung dry and packed into a sterile tube as before, 
 a sterile plug being placed. 
 
 INSTRUMENTS 
 
 Surgeons differ in regard to sterilization of instruments. 
 The following method is highly approved by many surgeons: 
 
 Have a 1% solution of sodium carbonate boiling in the in- 
 strument boiler. Wrap the instruments in a towel and drop in. 
 Boil for one-half hour. The sodium carbonate helps to prevent 
 rusting. 
 
 All edged instruments to be boiled should be wrapped in 
 cotton. Knives and scissors should be immersed in carbolic 
 95% for five minutes and then rinsed in sterile water and 
 dipped in boiling water. If left for a longer time in the carbolic 
 or if boiled, they lose their temper and are apt to rust. 
 
 When the instruments have boiled sufficiently, the clean 
 nurse dries them on sterile towels and places them on trays 
 ready for use. 
 
 If perchance an instrument should fall to the floor, the 
 "circulating" nurse picks it up, and if it happens to be one 
 that is much needed, it is washed and rinsed and then immersed 
 in carbolic for five minutes. It is then rinsed in sterile water 
 and is ready for use. 
 
 After the operation the instruments should be taken apart, 
 washed in cold water to remove blood and pus and any particles 
 that may be adherent. Scrub thoroly with green soap, being 
 careful not to neglect any crevices or niches. Boil for fifteen 
 minutes in 1% sol. of sodium carbonate. If the case has been 
 a ' 'clean" one, boiling is omitted, as this is done before the 
 the next operation anyway. Dry thoroly, wrap all knife blades 
 and sharp-edged instruments in absorbent cotton, and then put 
 away. 
 
 DISHES AND UTENSILS 
 
 Wash with soap and water and dry. Boil 20 minutes or 
 wrap in pillow cases or towels and sterilize in the usual manner 
 in the autoclave. 
 
 The "circulating nurse" should always handle dishes by 
 taking hold from the outside, never inside or over the edge. 
 
METHODS OF STERILIZATION 69 
 
 SOLUTIONS 
 
 In the part on ' 'Solutions" the system of calculating quan- 
 tity and proportion is fully taken up. In this connection only 
 the technique of sterilizing solutions will be considered. 
 
 NORMAL SALT 
 
 It is better to make this solution fresh whenever it is needed. 
 Keep sterile saturated solution on hand or the sterile tablets. 
 
 Take a sterile enamel bowl and measure out with a sterile 
 measure the required amount of sterile water needed. If the 
 tablets are to be used, with sterile forceps place in the water 
 the number of tablets needed to make a normal salt solution. 
 If the saturated solution is used, measure out of flask or bottle 
 the amount needed into a sterile graduate and pour into water. 
 Heat this to the proper temperature and pour into whatever 
 receptacle has been prepared. 
 
 In many hospitals the sterile normal salt is kept on hand 
 ready for immediate use Into a clean flask pour a normal salt 
 solution from which all particles and sediment have been re- 
 moved by steaming, filtering, or letting stand until all sediment 
 has settled to the bottom and then decant the upper portion. 
 
 Place stoppers of sterile cotton plugs and sterilize by boil- 
 ing one hour on three successive days. 
 
 STERILE SATURATED SOLUTION OF SALT 
 
 Salt saturates 1 2 1/2. Take an enamel pail. Place in It 1 
 part of salt and 21/2 times as much water. Skim often when 
 boiling. Boil 1 hour, after which let it stand until cool. Take 
 a sterile bottle and place in it a sterile funnel. With a sterile 
 dipper, put solution in the bottle, pouring from the dipper thru 
 the funnel. Place a sterile plug. 
 
 STERILE GLYCERINE 
 
 Place an uncovered glass jar filled with glycerine in the 
 sterilizer. Beside it put the lid. Sterilize for one hour under 
 fifteen pounds pressure. If no sterilizer is at hand, use a double 
 boiler and keep the water boiling under the glycerine two hours. 
 Sterile vaseline and other oils are prepared in the same manner. 
 
70 SURGICAL NURSING 
 
 TINCTURE OF GREEN SOAP 
 
 Green soap 3 parts. 
 Alcohol (95%) 2 parts. 
 Ether 1 part. 
 
 Mix ingredients in a pitcher and stir briskly for a few min- 
 utes every hour until a solution is formed. 
 
 Suggestive Operative Record 
 
 Name__ . Address 
 
 Friend or relative 
 Diagnosis 
 
 Operation proposed. _ 
 
 Preparations required Usual Special 
 
 Condition of patient on morning of operation 
 
 Urine amount Sp. Gr Urea gm Alb Sugar Casts 
 
 Blood Hem. _. _ R. C W. C Heart T P R 
 
 Anesthetic begun _ _ _ _ _ _ Anesthetic employed Anesthetist 
 
 Amount used -.Hypodermics given 
 
 Operation begun__ __ Completed Incision 
 
 , Sutures 
 
 Drainage Packing Dressings 
 
 Amount blood lost great considerable little none 
 
 Condition of patient at end of operation _ 
 
 Description of operation 
 
OPERATION IN PRIVATE HOME 71 
 
 Surgeon !___,. 
 
 Assistant ___L 
 
 Packing removed Drainage removed 
 
 Sutures removed 1 
 
 Daily record .. 
 
 Preparation for an Operation in a Private Home 
 
 LOCATION OF ROOM 
 
 1. Select a room that has an abundance of clear light. 
 
 2. Avoid if possible a room where sun will shine directly 
 upon the operating table during the operation. 
 
 Discuss the following with the surgeon beforehand: 
 
 a. The matter of the source of light. 
 
 b. The anesthetic. 
 
 c. Means of ventilation. t 
 
 4. Choose a room as near the bedroom of the patient as 
 possible. 
 
 5. If necessary to use patient's bedroom for an operating 
 room, prepare the bed and push it into the corner out of the - way. 
 
 PREPARATION OF ROOM 
 
 1. If there is sufficient time remove all hangings, draperies, 
 carpets, rugs, and all unnecessary furniture. 
 
 2. Thoroly scrub floor and walls. > 
 
 3. If there are just a few hours before the room is to be 
 made use of, it is better not to disturb anything not even to 
 sweep the floor. Cover all pictures, hangings and large pieces 
 of furniture with sheets wrung out of a solution of HgCl2 
 1-1000. The floor should be similarly covered. Under sheets 
 about operating table place newspapers or heavy papers to pre- 
 
72 SURGICAL NURSING 
 
 vent the floor underneath from getting stained with blood, etc. 
 Pin or tack sheets to side walls to a height of five or six feet. 
 
 FURNITURE 
 
 1. Operating table. Generally kitchen table or ironing 
 board is made use of. Two small tables can be placed together. 
 Pull apart an extension table and lay two boards on the leaves 
 lengthwise across the gap. Pad with blanket and cover with 
 rubber sheet and freshly laundered sheet. 
 
 2. Four small tables for instruments, anesthetics, dress- 
 ings, and solutions. 
 
 3. Place for surgeons to scrub up. This is preferably done 
 in a room adjoining, but of course this is not always possible. 
 
 Wipe all furniture with an oiled cloth. Scrub when old and 
 dirty. Cover tables with sterile towels. 
 
 SUPPLIES NEEDED 
 
 1. Dishes: 
 
 a. Three large basins. 
 
 b. Two large pitchers. 
 
 c. Three small basins. 
 
 d. One small pitcher. 
 
 e. Four small glasses. 
 
 Scrub thoroly with soapsuds. Rinse and boil one-half hour 
 before operation. If this is not possible, let them stand in 1-1000 
 HgCl 2 at least one hour before operation. 
 
 2. Fountain syringe. 
 
 3. Rubber sheeting for table. 
 
 4. Foot tub for soiled sponges. 
 
 5. Large pail for dirty solutions, etc. 
 
 6. Plenty of hot and cold sterile water. 
 
 7. Safety pins. 
 
 8. Absorbent cotton. 
 
 9. Alcohol. 
 
 10. Sterilized dressings, sheets, gowns, and plenty of towels. 
 
 11. Four wooden nail brushes. 
 
 12. Antiseptic solutions as ordered. 
 
 13. A Kelly pad can be improvised by tightly rolling a blanket 
 and covering with a rubber sheet, two ends of which are to be 
 pinned together and thus the solution will flow into the recept- 
 acle below. 
 
ANESTHETICS AND ANESTHESIA 73 
 
 The surgeon brings his own instruments and the anesthetic, 
 also rubber gloves. 
 
 AN EMERGENCY STEAM STERILIZER 
 
 Use an ordinary wash boiler. Place in bottom a crate made 
 of three light boards placed edgewise and a few slats nailed 
 across. The crate should be six inches above the bottom of the 
 boiler. Pack parcels in loosely so that the steam will circulate 
 freely in and around them. Have water boiling in bottom of 
 boiler and sterilize for 11/2 hours. Take parcels out and dry 
 either in the sun or in an oven. If placed in the latter they 
 will need to be watched very carefully as it is easy to scorch or 
 burn them. 
 
 Anesthetics and Anesthesia 
 
 As a rule nurses have very little to do with the giving of 
 anesthetics more than assistance, altho in some hospitals nurses 
 having had special preparation and experience are given charge 
 of administering anesthetics. It is, however, necessary that 
 the nurse understand the general effects of anesthetics and 
 something of their mode of administration and under what 
 circumstances they are used. 
 
 1. General anesthetics. Those most frequently employed 
 are ether and chloroform. They produce unconsciousness and 
 general insensibility to common sensations including pain. They 
 are used in nearly all major and many minor operations. 
 
 2. Local anesthetics. These are such substances as cocain 
 and ethyl chloride, which when applied locally produce anes- 
 thesia in the part to which they are applied. They are used in 
 minor surgery, operations upon the nose and throat, lancing of 
 boils, etc. 
 
 3. Spinal anesthesia is carried out by means of such sub- 
 stances as stovain, tropacocain, etc. It produces anesthesia in 
 all parts below the region of injection. 
 
 ETHER 
 
 Ether by the modern drop method is considered the safest 
 of all general anesthetics. In many hospitals it is being used 
 almost exclusively. When begun slowly and given in an even, 
 uniform manner, there is less difficulty in securing prompt 
 anesthesia and much less disturbance on the part of the patient 
 
74 SURGICAL NURSING 
 
 than when given by the old closed inhaler system. As ether is 
 very inflammable, it is dangerous to have an open flame any- 
 where near while it is being administered. It is a stimulant to 
 the heart and respiration, so that the force of the pulse wave is 
 somewhat heightened. As with other anesthetics the patient 
 passes thru three stages, (a) the exciting stage, (b) light an- 
 esthesia, (c) profound (or surgical) anesthesia. The length of 
 the exciting stage will depend somewhat upon the condition 
 and cemperament of the patient. It is apt to be rather pro- 
 longed and troublesome in those addicted to alcohol. For major 
 operat ; ons the third stage must be attained. For this reason 
 this sta^e is often spoken of as that of surgical anesthesia. 
 
 Points relating to the elimination of ether are considered 
 under ' 'After Treatment. " 
 
 CHLOROFORM 
 
 Chloroform produces more prompt anesthesia, must be 
 given with more air, and is more depressing to the heart than 
 ether. While it is still used much as a general anesthetic for 
 adults, especially for brief operations, in some hospitals it is 
 being used only in infants for such operations as hare-lip, cleft 
 palate, etc. Chloroform is also much more toxic than ether, 
 and occasionally results in degeneration of the liver or kidneys, 
 i On the other hand ether is said to be somewhat more irritating 
 to the respiratory mucous membranes. 
 
 NITROUS OXIDE 
 
 Nitrous oxide, very commonly called laughing gas is used 
 mostly by dentists for such brief work as tooth extraction. 
 When mixed with oxygen it is comparatively safe, in even 
 somewhat longer operations and is often used for curettage. 
 
 COCAIN 
 
 For injection cocain is usually employed in a one or two per 
 cent solution. As an ingredient of Schleisch solution it is used 
 for what is called infiltration anesthesia. It is also often com- 
 bined with adrenalin for injection or application to the mucous 
 membrane. In applying alone to the mucous membrane it is used 
 in from 2 to 10 per cent solution. A pledget of cotton is dipped 
 in this, applied to the mucous membrane to be anesthetized, and 
 left in place for a few minutes. 
 
ANESTHETICS AND ANESTHESIA 75 
 
 Dry cocain powder is sometimes applied to the mucous mem- 
 brane after the application of adrenalin. This is frequently 
 done in operations upon the nose. Toxic effects are sometimes 
 observed, such as headache, nausea, vomiting, weak pulse, 
 talkativeness, or delirium. These are usually, however, of no 
 great consequence. 
 
 ETHYL CHLORIDE 
 
 This is a highly volatile substance which is sprayed upon 
 the part to be anesthetized. By a rapid evaporation it freezes 
 the part, and so may be used in lancing boils, carbuncles, etc. 
 
SURGICAL AFTER-TREATMENT 
 
 Kinds of Operations 
 
 The following are some of the more important operations 
 which are designated by special terms: The list is necessarily 
 very incomplete. 
 
 Arthrotomy. The incision of a joint cavity. 
 
 Arthrectomy. The excision of the articular ends of the 
 bones entering into the formation of the joint. 
 
 Appendectomy. Removal of the vermiform appendix. 
 
 Caesarean section. Removal of usually living child by ab- 
 dominal incision. 
 
 Cholecystectomy. Excision of the gall bladder. 
 
 Cholecystotomy. Incision of the gall bladder. 
 
 Cholecystostomy. Incision of the gall bladder with forma- 
 tion of a fistula. 
 
 Curettage. Scraping of a cavity, especially the uterine 
 cavity. 
 
 Enterorrhaphy. Suture of the intestines. 
 
 Gastroenterostomy. The formation of a fistula between the 
 stomach and intestines. 
 
 Herniotomy. The repair of a hernia. 
 
 Hysterectomy. Excision of the uterus. 
 
 Laparotomy. Abdominal incis'on for any operation on in- 
 ternal organs. 
 
 Lithotomy. Incision of the bladder for the removal of the 
 stone. 
 
 Mammectomy. Excision of the breast. 
 
 Nephrectomy. Excision of the kidney. 
 
 Nephropexy. Fixation of a floating kidney. 
 
 Nephrorrhaphy. Suture of the kidney. 
 
 Oophorectomy. Removal of ovary. 
 
 Oophorosalpingectomy. Excision of an oviduct and ovary. 
 
 Oophorohysterectomy. Excision of ovaries and uterus. 
 
 Panhysterectomy. Removal of uterus and all its append- 
 ages. 
 
 Perineorrhaphy. Suture of the perineum. 
 
 Prostatectomy. The removal of the prostate gland. 
 
MAJOR OPERATIONS 77 
 
 Salpingectomy. Excision of a Fallopian tube. 
 
 Salpingooophorectomy. Excision of an oviduct and ovary, 
 
 Thyroidectomy. Excision of the thyroid gland. 
 
 Tonsillectomy. Excision of the tonsils. 
 
 Trachelorrhaphy. Suturing of the neck of the uterus (cer- 
 vix uteri). 
 
 Transfusion. Transfer of blood directly into the veins from 
 one person to another. 
 
 Trephining. Making of an opening thru the bones of the 
 skull. 
 
 Turbinectomy. The excision of a portion of a turbinate 
 body. 
 
 Major Operations 
 
 GENERAL CARE 
 
 1. Keep patient quiet and warm. 
 
 2. Watch the pulse almost continuously for the first two or 
 three hours and record frequently. Later record T. P. R. every 
 three hours. 
 
 3. Measure and record the amount of urine. Save for the 
 first 24 hours for analysis, and afterwards as ordered. 
 
 4. Have a pus tray at hand in case of nausea. The nurse 
 may resort to the following measures for the relief of nausea 
 without an order from the physician: 
 
 a. Ice bag or cold compress to throat. 
 
 b. Inhalations of vinegar or camphor. 
 
 5. Place cotton pillows under the knees to relieve strain, 
 also have pillows of different shape and size to tuck in here and 
 there to make the patient comfortable. 
 
 6. Keep lips moist and cleanse mouth frequently. 
 
 7. Water drinking. It is now considered good therapy and. 
 in general highly advisable to give water freely in small amounts 
 as soon as the patient is conscious. A glass of hot water is 
 considered best at first, following this with hot or cold water 
 as the patient desires. Ice water or chipped ice should not be 
 given unless ordered. The first water given may produce vom- 
 iting, but as this washes out the stomach and hence relieves 
 nausea and vomiting, it is considered beneficial. The free use 
 of water aids in the elimination of the ether and helps to pre- 
 vent kidney complications. 
 
 8. Cathartics and enemata. The giving of cathartics soon 
 
78 SURGICAL NURSING 
 
 after operation is meeting with less favor than formerly. Cath- 
 artics and enemata should be given only as ordered. 
 9. Follow strictly all the orders of the physician. 
 
 10. Watch for symptoms of shock, or other complications 
 that are liable to arise. Watch for indications of hemorrhage, 
 and where this may be external, inspect the dressings over the 
 field of operation very frequently and, if the slightest evidence 
 is seen, report at once. 
 
 11. Do not fail to describe accurately all discharges. 
 
 12. See things to do and anticipate the needs of the patient. 
 Put yourself in his place, and do your best to make him just as 
 comfortable as possible. 
 
 13. Give sponge bath or similar treatment daily. Soap wash 
 three times per week. 
 
 14. Keep bedding dry and free from crumbs and wrinkles. 
 
 15. Give preventive treatment for bed sores. 
 
 16. Dressing of wounds. Before the hour appointed for the 
 dressing of a wound or the removal of stitches, see that a tray 
 containing the following articles is in readiness: 
 
 a. Package of sterile napkins. 
 
 b. Small bowl of disinfectant and one of sterile water or 
 normal saline, if needed. 
 
 c. Sterile instruments. Scissors, artery forceps, thumb for- 
 ceps. 
 
 d. Package of small sponges and also < ne of pledgets. 
 
 e. Package of dressings. 
 
 The nurse places a table by the bed of the patient. On this 
 she places newspapers and over these clean towels. On the 
 table she places the tray of disinfectant for the hands. She 
 then places a wastebasket by the table with a newspaper in the 
 bottom. 
 
 The nurse, after scrubbing her own hands, unpins the 
 bandage and turns it back. Then she unties the tapes holding 
 the dressing. Next she unpins the sterile packages on the tray, 
 turning back the wrapper containing the surgical napkins, so 
 that she can get them easily. She then scrubs her hands in 
 disinfectants on the table, places sterile napkins about the 
 wound, turns back the outer dressing (cotton pad), and is then 
 ready to assist the surgeon. She is very careful not to touch 
 anything that is surgically clean without disinfecting her hands. 
 
MAJOR OPERATIONS 79 
 
 After the dressing, the nurse ties the tapes and replaces 
 the bandages. All soiled dressings are tied up in the news- 
 papers at the bottom of the wastebasket and burned. The tray 
 is then returned to its proper place. 
 
 The above is a description of an average dressing. Under 
 certain conditions many other things may be needed and all 
 these are to be ascertained by the nurse. She must ever be on 
 the alert and quickly anticipate the needs of the surgeon. 
 
 17. To prepare the patient for removal of stitches or for the 
 changing of dressings, see first that all necessary articles are 
 in readiness. Move the patient near to the edge of the bed. 
 Unpin the bandage and turn it back. Untie the tapes over the 
 dressings, and surround the field with sterile towels. When 
 ready, it is usually the duty of the nurse to remove the outer 
 cotton pad so that the surgeon need touch nothing not likely to 
 be sterile. 
 
 18. In all major operations the patient should never be left 
 alone until thoroly conscious and responsible. 
 
 ABDOMINAL SECTION 
 
 1. Directly after operation many operators order a warm 
 enema of normal salt to be retained. It is very beneficial be- 
 cause it relieves the thirst which follows abdominal operation, 
 stimulates the kidneys, and has a general stimulating effect. 
 
 2. Do everything possible to encourage the passing of urine 
 without catheterization. Use the catheter only when ordered, 
 and always with the strict asccptic precautions as a cystitis fol- 
 lowing operation is unusually troublesome. 
 
 3. The accumulation of gas is quite common after laparo- 
 tomy. To relieve this, pass a rectal tube about four inches and 
 let it remain. In obstinate cases get orders from the surgeon. 
 For this condition the saline, asafoetida, or turpentine enema 
 is frequently used. 
 
 4. Allow no visitors except by order of surgeon. 
 
 5. Slight rise of temperature the day following is very com- 
 mon, and is spoken of as surgical fever. 
 
 6. Allow the patient to sit up in bed or to walk only by 
 order of the surgeon. 
 
 7. Food is withheld from twenty-four to thirty-six hours. 
 During the first week a liquid diet is generally used. 
 
 8. The bowels should move the third day. 
 
80 SURGICAL NURSING 
 
 9. When there is drainage in an abdominal wound the pa- 
 tient is obliged to stay in bed three or four weeks, or until heal- 
 ing takes place. When first allowed to get up he should be 
 cautioned against any exertion such as lifting or stooping, as 
 any strain on the scar may produce hernia. 
 
 PERINEORRHAPHY CASES 
 
 1. The first twenty-four hours' treatment is the same as for 
 abdominal section. 
 
 2. The bowels should move once daily after the second day. 
 
 3. Care should be taken that the stitches are not torn apart. 
 Keep the knees close together. 
 
 4. Never catheterize without orders. 
 
 5. Always cleanse the parts after urination. Spraying of 
 the stitches with hot saline solution or the alternate hot and 
 cold spray is very beneficial. Oftentimes the wound is washed 
 off with sterilized cotton held with forceps and dipped in a dis- 
 infectant solution. Wipe dry with bits of cotton held in the 
 same way, and apply some soothing and antiseptic powder. 
 
 6. Dress the wound according to the order of the surgeon. 
 The nurse should get explicit instruction in regard to this. 
 
 7. Watch the stitches for evidences of anything that may 
 need attention from the surgeon. 
 
 TRACHELORRHAPHY 
 
 1. Encourage urination without the use of the catheter. 
 
 2. The first packing is usually removed on the second day. 
 
 3. After the removal of the packing, hot disinfectant 
 douches should be given as ordered. 
 
 GALL BLADDER CASES 
 
 In cases of cholecystostomy, that is, where there is tempor- 
 ary drainage of the gall bladder, special care of the drainage 
 tube and bottle or other receptacle for the bile, is required. 
 See that the bottle is so placed that it will receive the bile with- 
 out soiling of the dressings or bed linen. See that it is not sus- 
 pended alone by the drainage tube but is fastened to the abdom- 
 inal bandage by tapes. The bottle should be emptied from 
 time to time as is necessary, and thoroly cleansed to prevent 
 the unpleasant odors of decomposing bile. After the removal 
 of the drainage tube, which usually occurs on the eighth to the 
 
SURGICAL COMPLICATIONS 81 
 
 eleventh day, the dressings have to be changed very frequently. 
 Large pads of absorbent cotton, covered with gauze, may be 
 provided for this purpose. The excoriation of the skin about 
 the biliary fistula may be prevented by gentle washing away of 
 the bile and the application of a very small amount of talcum 
 powder. In case there are additional drainage tubes beside that 
 going into the gall bladder, the patient must remain on the back 
 until the openings left by these latter have entirely closed. 
 
 PROSTATECTOMY CASES 
 
 Prostatectomy and lithotomy are done by either the perineal 
 or the suprapubic route. It is practically always necessary to 
 leave in the bladder a double flow drainage tube, thru which 
 the bladder is kept constantly irrigated for the first two or 
 three days, or until the return flow ceases to be bloody. In 
 case clots stop the opening in the larger return tube, it will be 
 necessary to aspirate them by the reverse action of a piston 
 syringe. The irrigating can should be just high enough to 
 secure an easy flow without undue pressure. At intervals the 
 bladder is irrigated with some antiseptic solution, such as 
 1 20,000 silver nitrate. In these cases about 15 gr. urotropin 
 daily is administered by mouth in divided doses. It is a very 
 efficient and practically the only reliable urinary antiseptic. 
 
 Because of the fact that this operation is always done in 
 old men, the patient is encouraged to sit up as soon as possible, 
 and even before that he should be allowed to turn from side to 
 side so as to prevent hypostatic pneumonia. 
 
 CASES OF ABSCESS DRAINAGE 
 
 In cases where an abdominal or pelvic abscess has been 
 drained, the use of continuous proctoclysis by the Murphy 
 method is highly recommended. If the constant presence of 
 the tube in the rectum is overly irritating, the saline solution 
 may be given by intermittent proctoclysis a half pint or more 
 at a time. This not only helps to maintain blood pressure, but 
 is said to have a very beneficial effect in flushing the drained 
 surfaces thru the absorbents. The directions for proctoclysis 
 are given elsewhere. 
 
 Surgical Complications 
 
 SURGICAL SHOCK 
 
 Surgical shock and hemorrhage are the two most serious 
 6 
 
82 SURGICAL NURSING 
 
 surgical complications which occur on the operating table. The 
 symptoms of the two are very much alike; that is, weak, thready 
 pulse and cold, clammy skin. With the treatment of hemor- 
 rhage on the operating table the nurse has very little to do, 
 with the exception of assisting in the giving of saline solution 
 by hypodermoclysis, or possibly very rarely by direct vein in- 
 fusion. Following the operation where the patient has lost 
 much blood, the surgeon frequently orders saline solution by 
 continuous proctoclysis. The method of giving this is described 
 elsewhere. 
 
 In case of surgical shock much of the treatment may be 
 carried out by the nurse directly under the physician's direc- 
 tion. The condition is said to be due most largely to a tempor- 
 ary paralysis of the vasomotor center. Various other theories 
 are given, with which we need not concern ourselves here. 
 Surgical shock very readily responds to vigorous cutaneous 
 stimulation by means of briefly applied hot applications quickly 
 followed by the cold mitten friction. This may be carried out 
 by the following plan: 
 
 "The effectual treatment of shock requires the attention 
 of two persons. On the appearance of the symptoms of shock, 
 immediately place the patient's feet in hot water, care being 
 taken that the water is not nearly hot enough to produce a 
 burn; or quickly apply well- wrapped fomentations so as to 
 cover both feet and legs to the knees. As soon as the parts 
 have been well warmed and reddened, remove the hot applica- 
 tion and quickly administer to the same parts a cold mitten 
 friction. The water used should be ice water, and the friction 
 most vigorously given. The mitts should be dipped 2 or even 
 3 times, another attendant holding the limb while it is being 
 treated. The skin is now dried and rubbed with a coarse 
 Turkish towel and immediately covered with a warm dry 
 blanket. The thighs should be treated in the same manner, 
 also the arms. While this is being done and beginning at the 
 same time as the first treatment to the limbs, intense and 
 quickly alternating hot and cold applications should be made to 
 the anterior surface of the chest and especially over the pre- 
 cordia. This may be done by removing the ice bag from the pre- 
 cordia, which should have been placed there when the pulse 
 first became unduly rapid, and after rubbing the skin briskly, 
 applying a very hot but well covered fomentation. This should 
 
SURGICAL COMPLICATIONS 83 
 
 not be left in contact with the skin longer than 15 or 30 seconds. 
 Next, rub the chest with a flat smooth piece of ice, using quick 
 to-and-fro movements and wiping away the water with a Turk- 
 ish towel. After this another fomentation is applied, again 
 followed by the ice. These alternations should be repeated 3 or 
 4 times, after which the well-covered ice bag should again be 
 placed over the heart, "i 
 
 In addition to the above, administer 8 oz. to 1 pint of hot 
 saline solution by hypodermoclysis or by rectal injection, or both. 
 
 The hypodermic use of strychnin and other ' 'heart stimu- 
 lants" has been shown to be productive of more harm than 
 good, and results in a deeper degree of shock. This is partic- 
 ularly true of strychnin, as it is an irritant to the vasomotor 
 center. 
 
 HEMORRHAGE 
 
 While the nurse has very little to do with the treatment of 
 hemorrhage on the operating table, in case the hemorrhage 
 occurs after the removal to the room, the life of the patient may 
 be dependent upon the keen observation and prompt action of 
 the nurse in charge. Hemorrhage following operation usually 
 occurs within the first few hours, altho it may occur later. 
 Those cases which are most serious are where the hemorrhage 
 is internal, so that the field of operation and dressings give 
 no indication of the condition. It is well, however, to keep 
 close watch of the dressings during the first six or eight hours 
 following operation. Internal hemorrhage is marked by a sud- 
 den fall in the temperature, rapid, thready pulse, and a profuse 
 cold sweat. There are also pallor, thirst, an anxious expres- 
 sion, and faintness. If the patient has come out from under the 
 anesthetic the eyes may be bright and the mind clear. If these 
 symptoms appear, the surgeon should be summoned at once. 
 In the mean time the head should be kept low, in some cases 
 the foot of the bed raised. The patient should be kept abso- 
 lutely quiet, and heat applied to the extremities. It is usually 
 best not to stimulate the circulation to any great degree until 
 after the hemorrhage is stopped. Following this a saline enema, 
 continuous proctoclysis, hypodermoclysis, and water drinking 
 are the measures necessary to supply the loss of fluid. In the 
 event of any serious complication, as hemorrhage, the nurse 
 should maintain the utmost quiet and calm. Nothing is to be 
 
 1. Abbott, "Hydrotherapy," p. 232. 
 
84 SURGICAL NURSING 
 
 gained by informing the patient of his condition or allowing 
 him to observe any anxiety on the part of the nurse. 
 
 WOUND INFECTION 
 
 1. Superficial infection and stitch abscess. Bacteria are prac- 
 tically always present in the epidermis, so that it is a very dif- 
 ficult matter to prepare a field that is absolutely devoid of bac- 
 teria. The most common germ is the staphylococcus albus. 
 Under certain conditions this germ multiplies and produces more 
 or less difficulty with healing. Among the conditions favoring 
 skin infection are bruising of the tissues either in the prepara- 
 tion of the operative field or in the operative technique. Very 
 tightly tied sutures are also sometimes responsible for an in- 
 fection. 
 
 Perhaps the most common cause of wound infection is low 
 vitality of the tissues themselves. The collection of blood un- 
 derneath the skin or between the edges of the wound may also 
 give rise to infection. Sometimes infection may be present 
 without giving rise to symptoms. Generally, however, there is 
 slight pain in the wound and a moderate rise of temperature. 
 Upon inspection of the wound surface swelling and redness are 
 usually detected. Infection generally occurs somewhere from 
 the third to the seventh day following operation. As wound 
 infections are always attended to by the surgeon, the nurse has 
 very little to do, with the exception of calling attention to any- 
 thing that may appear suspicious. Careful note of these items 
 should also be made on the record. 
 
 A stitch abscess may be due to germs present on the skin 
 surface, irritation caused by the suture material, or to imper- 
 fectly sterilized sutures. Where stitch abscess occurs, it is 
 necessary to remove the stitch. Stitch abscesses are usually of 
 no great consequence. 
 
 2. Deep infection. Of the various causes of deep infection 
 poorly prepared sutures, especially catgut, are frequent; also 
 the collection of blood or serum thru imperfect hemostasis or 
 wound drainage. In operations upon infected organs some of 
 the pus or secretions may soil the wound surface. In deep in- 
 fections there is a rise of temperature, usually between 101 and 
 103 degrees. There is greater pain and swelling than in super- 
 ficial infections. These may occur within 4 or 5 days, or even 
 as late as the second week. 
 
SURGICAL COMPLICATIONS 85 
 
 Deep infections are always to be cared for by the surgeon. 
 Usually the nurse in such event is only to follow very closely 
 any special instructions that may be given. 
 
 PNEUMONIA 
 
 Pneumonia was formerly supposed to be more frequent 
 after the use of ether than of chloroform, but with ether given 
 by the modern drop method this statement is hardly applicable. 
 The most important causes of pneumonia following an operation 
 are: congestion of the lungs due to the exposure of the patient 
 on the operating table or soon after, prolonged operations, opera- 
 tions upon aged patients, and long confinement in the dorsal 
 position following operation. It is perhaps unnecessary to men- 
 tion that pneumonia is very common in those patients who have 
 previously had some infection of the respiratory tract. Pneu- 
 monia should be very carefully guarded against by seeing that 
 the patients limbs and chest are well covered during the opera- 
 tion, and especially that the feet are warm; also that proper 
 jackets are used following the operation. After the patient has 
 been removed from the operating table it is an excellent plan 
 to make some hot application to the feet and legs, such as a hot 
 foot bath, fomentations, or the hot pack. Some surgeons highly 
 recommend the use of the ice bag or cold coil to the chest, 
 shoulders and all other parts being well covered during its ap- 
 plication. This other is not applicable in old people nor in those 
 under average vitality, and is best applied during the applica- 
 tion of the heat to the feet and legs. 
 
 The onset of pneumonia may be marked by frequent res- 
 piration, pain, and a rise of temperature, together with undue 
 rapidity of the pulse. It may occur within 24 or 36 hours after 
 the operation or be delayed as long as two or three weeks. 
 
 PERITONITIS 
 
 The onset of peritonitis is marked by pain and extreme 
 tenderness in the abdomen. The abdomen is likely to be dis- 
 tended with gas (tymanites), the limbs are drawn up, and the 
 pulse becomes rapid and wiry. The beginning of a rise of tem- 
 perature from 101 to 103 may be marked by chills or chilly sen- 
 sations. There is often vomiting, and the constipation is ob- 
 stinate. The patient is restless, and complains of feeling very 
 weak. 
 
86 SURGICAL NURSING 
 
 In all cases the treatment will be directed by the surgeon. 
 Among the measures that are used are the warm enema, and 
 in case of pelvic peritonitis a hot vaginal douche is frequently 
 prescribed. Perhaps the most efficient measure is the applica- 
 tion of the hot hip and leg pack, with one or more ice bags to 
 the abdomen. This usually lasts about thirty minutes and is 
 followed by a cold mitten friction to all parts covered by the hot 
 applications, with the exception of the abdomen. This may 
 need to be repeated two or three times a day. The ice bags to 
 the abdomen are often left in place between treatments. All 
 directions should be very carefully followed, as the mortality of 
 peritonitis following operation is very high. 
 
 INTESTINAL OBSTRUCTION 
 
 Intestinal obstruction is usually first indicated by pain in 
 the abdomen, or tympanites. The pulse may first be increased 
 in tension, but later becomes very rapid and weak. Soon after 
 the appearance of pain vomiting begins, first of food and later 
 of fecal matter. Obstipation is always present. The appear- 
 ance of pain and tympanites, and always the appearance of un- 
 controllable vomiting, should be indications for prompt notifica- 
 tion of the surgeon. In conditions where the character of the 
 operation does not make it inadvisable, the thoro cleansing of the 
 bowels by soapsuds enema followed by the giving of a glycerine 
 epsom salts enema by high bowel catheter, is usually ordered. 
 All these treatments should be very carefully but persistently 
 carried out. 
 
 SEPTICEMIA 
 
 Septicemia is a general toxic condition caused by the ab- 
 sorption of septic products. Its onset is marked by severe 
 chills, which may be repeated, high, irregular fever (intermit- 
 tent type), rapid, bounding pulse, sometimes also by vomiting. 
 The treatment varies according to the source and location of 
 the infection. Such hydriatic treatments as cold mitten friction, 
 which increases leucocytosis, are highly beneficial. Friction or 
 massage should never be applied to any part immediately in- 
 volved. 
 
 CYSTITIS 
 
 Cystitis is an inflammation of the bladder. It is often 
 caused by an infection carried in by a catheter, altho it may be 
 due to other causes, such as a pre-existing infection. 
 
SPECIAL PROCEDURES 87 
 
 Pain over the pubes, painful and frequent micturition, are 
 evidences of its existence. The urine is usually cloudy from 
 presence of bacteria, and in some cases may contain more than 
 small amounts of mucus and pus. When cystitis occurs, uro- 
 tropin is usually ordered, also hot boric acid, bladder irrigations, 
 or the use of other mild antiseptic. Fomentations to the lower 
 abdomen and pubic region afford much relief by relaxing the 
 the spasm of the bladder. 
 
 There are many other complications that may arise in sur- 
 gical cases. Among the more serious of these are uremia, teta- 
 nus, erysipelas, and pyemia. Fortunately, however, the latter 
 three are very rare. 
 
 Procedures of Special Use in Surgical Nursing 
 
 HYPODERMOCLYSIS 
 
 Definition. The hypodermic injection of large amounts of 
 fluid. Hypodermocbsis is usually given over the chest, ab- 
 domen, thigh, arm, or between the shoulder blades. 
 
 1. Articles needed: 
 
 a. Irrigator, preferably a glass one that is graduated. 
 
 b. Two long hypodermic needles. 
 
 c. Tubing. 
 
 d. Sterile normal salt solution. 
 
 e. Collodion. 
 
 f . Small beaker of alcohol. 
 
 g. Package of sterile cotton pledgets, 
 h. Package of sterile napkins. 
 
 i. Bowl of disinfectant for hands. 
 
 2. Procedure. It is absolutely necessary that all the ap- 
 paratus used be properly sterilized. This is generally kept 
 sterile and ready for use at a moment's notice. 
 
 After the tray is set and everything ready, the one who is 
 to give the hyyodermoclysis scrubs up thoroly. She then scrubs 
 with alcohol the part where the needle is to be inserted. Next 
 the hands are disinfected and the sterile napkins placed about 
 the area. Then the solution is allowed to run thru the needle 
 so as to exclude all air, and then the needle is inserted. 
 
 If given in the breasts, it is a good plan to connect the ap- 
 paratus so as to give it in both breasts simultaneously. For 
 this two needles will be required. From 500 to 1000 c.c. of 
 physiologic salt solution are generally injected at a time. 
 
88 SURGICAL NURSING 
 
 When the amount of solution desired has passed into the 
 tissues the needles are carefully withdrawn and the point of 
 insertion sealed with cotton and collodion. 
 
 INTRAVENOUS SALINE INFUSION 
 
 This is always done by a physician. 
 
 1. Indications: 
 
 a. Shock. 
 
 b. Loss of large amount of blood. 
 
 c. Suspension of the functions of the kidneys. 
 
 d. Toxins in the blood where rapid elimination is desired as 
 in septicemia and delirium tremens, also diabetic coma. 
 
 2. Technique. Area. Median basilic or the median cephalic 
 vein at the bend of the elbow. 
 
 A constricting bandage is placed around the upper part of 
 the arm so as to obstruct the return flow thru the superficial 
 veins. The skin over inner surface of elbow is disinfected 
 thoroly and the vein is bared and cleared for about one inch. 
 Two ligatures are passed around it, one above the point of in- 
 tended opening and one below. A small valve-like opening is 
 then made in the vein, and a small irrigator point is introduced, 
 first allowing some of the fluid to pass thru it, in order to guard 
 against the entrance of air. The upper ligature is tightened 
 around the irrigator point, holding it in place and also prevent- 
 ing leakage. 
 
 The lower ligature is tied, closing the vein below. The 
 bandage is now removed. 
 
 The jar containing solution should be about three feet above 
 vein. The solution generally used is a physiologic salt so- 
 lution. 
 
 After a sufficient amount of solution has been introduced 
 into the blood, the skin is sutured and a sterile dressing applied 
 and held by adhesive. Every precaution is taken in this pro- 
 cedure to have all apparatus, field of operation, dresssings, etc., 
 surgically clean. 
 
 PROCTOCLYSIS 
 
 Proctoclysis is administered for the purpose of steady, 
 gradual introduction of fluid into the system. The large bowel 
 will absorb in the neighborhood of two to three pints in the 
 course of two hours. It is given chiefly after the institution of 
 pelvic or abdominal drainage for abscess, but is also of great 
 
SPECIAL PROCEDURES 89 
 
 benefit in hemorrhage and following shock. The fluid should 
 be administered thru a fountain syringe to which is attached a 
 three-eights inch rubber hose with a hard rubber or glass vagi- 
 nal douche tip with multiple openings. This tube should be 
 flexed almost to right angles, three inches from its tip. A 
 straight tube must not be used, as the tip produces pressure on 
 the posterior wall of the rectum when the patient is in the Fow- 
 ler's position. The tube is inserted into the rectum to the 
 flexion angle and secured in place by adhesive strips, binding it 
 to the side of the thigh so that it can not come out; the rubber 
 tubing is passed under the bedding to the head or foot of the 
 bed, to which the fountain is attached. 
 
 Two or three inches from the fountain syringe interpose a 
 Y-tube, and to the upper limb attach a piece of rubber hose of 
 the same size as the outlet tube. Fasten the free end of this to 
 the top of the fountain syringe so that what returns thru it 
 will fall into the container. When flatus is voided, the gas 
 passes more readily thru the upper tube than directly into the 
 fountain syringe. This reduces the pressure at such times and 
 so aids in preventing expulsion of the fluid onto the linen. 
 
 The fountain syringe should be suspended from six to 
 fourteen inches above the level of the buttocks and raised or 
 lowered to just overbalance hydrostatically the intra- abdominal 
 pressure, i. e., it must be just high enough to require from 
 forty to sixty minutes for one and one-half pints to flow in, the 
 usual quantity given every two hours. The flow must be con- 
 trolled by gravity alone, and never by a forceps or constriction on 
 the tube, sc that when the patient endeavors to void flatus or 
 strain, the fluid can rapidly flow back into the can, otherwise it 
 will be discharged in the bed. It is this ease of flow to and from 
 the bowel that insures against over-distension and expulsion onto 
 the linen. 
 
 The fountain had better be glass or graded can, so that the 
 flow can be estimated. The temperature of the water in the 
 fountain can be maintained at 100 by encasement in hot water 
 bags. The fountain is refilled every two hours with one and 
 one-half to two pints of solution. Instead of the usual solution, 
 a teaspoonful of calcium chloride may be added to the pint of 
 saline solution. The tube should not be removed for two or 
 three days if necessary, i 
 
 1 Abbott, "Hydrotherapy," pp. 294, 295. 
 
ACCIDENTS AND MINOR SURGERY 
 
 Wounds 
 
 Wounds are of various kinds, and according- to the instru- 
 ment causing the wound and the character of the wound itself, 
 they may roughly be classified as fellows: contusions, contused 
 wounds, incised wounds, lacerated wounds, punctured, poisoned, 
 infected, and gunshot wounds. 
 
 CONTUSIONS 
 
 Contusions are not necessarily associated with breaking or 
 opening of the skin. They are commonly spoken of as bruises, 
 and are wounds of soft tissues caused by blows, etc. If taken 
 early, these should be first treated by the application of the ice 
 bag or cold compress, to prevent the undue extravasation of 
 blood into the tissues. Later on, they are best treated by alter- 
 nate applications of heat and cold, in order to favor the absorp- 
 tion of the blood and restore the vitality of the tissues. In ap- 
 plying the cold in the first stage, it is often beneficial to use 
 running cold water, as it is more grateful than the cold com- 
 press. 
 
 CONTUSED WOUNDS 
 
 These are actual breaks in the tissue accompanied by bruis- 
 ing. There is always more or less hemorrhage into the surround- 
 ing tissues, while some tissue nearest the break in the skin has 
 been crushed and must be removed. It is also necessary to 
 thoroly cleanse the wound from dirt and foreign matter. It is 
 well also to apply some mild antiseptic at first, and it may be 
 necessary to wash with antiseptics at intervals to keep the 
 wound from suppurating. Applications of heat and cold may 
 be made in much the same manner as with simple contusions, 
 altho it is well in cleansing the wound to use warm or hot water. 
 Ointments are usually best omitted, and the wound dressed with 
 either very mild antiseptic solutions or dried and treated with 
 powder, etc. 
 
 INCISED WOUNDS 
 These are simply plain cuts without bruising or laceration 
 
WOUNDS 91 
 
 of the tissue. Where they are large and the edges gap, stitches 
 should be used. Before stitches are applied, or in case the 
 wound is too small to require sutures, the surface should be 
 thoroly cleansed and desinfected, after which they should be 
 dressed with plain sterile gauze. 
 
 LACERATED WOUNDS 
 
 A lacerated wound is a wound in which the tissues have 
 been torn and show many ragged edges. These are often so 
 poorly supplied with blood as to slough away in a few days. 
 Lacerated wounds are most frequently caused by accidents with 
 machinery, dull tools, etc. All ragged, torn edges should be 
 trimmed off with scissors or knife so that the surfaces are 
 smooth. They should then be washed and cleansed with anti- 
 septic solutions the same as with contused wounds. They may 
 also need to be dressed with very weak antiseptic solutions from 
 time to time, otherwise it is well to keep the parts as dry as 
 possible, as wounds heal better and the epithelium grows over 
 the surface much more rapidly where this is done. 
 
 Because of the laceration of the tissue there are often little 
 recesses where germs may lodge and grow. Where such lacer- 
 ated wounds are received because of blank cartridges and other 
 Fourth of July ' "paraphernalia," or where soiled with street 
 dust, it is best to wash thoroly with peroxide of hydrogen, in- 
 jecting it into all possible recesses so as to prevent growth of 
 the tetanus germ. 
 
 PUNCTURED WOUNDS 
 
 Punctured wounds are most frequently due to pins, nails, 
 tacks, thorns, etc. These are often harmless and require no 
 treatment whatever. On the other hand they are occasionally 
 the source of very grave difficulties such as blood poisoning and 
 lock jaw (tetanus). For this reason if the instrument or object 
 causing the wound is known or suspected to be dirty, the wound 
 should be most thoroly treated. Germs are carried into the 
 tissues often to quite a depth. Since the sharp point leaves 
 very little opening the germs grow very rapidly at the depth 
 away from the air, and in case of nail punctures of the foot are 
 very likely to be the cause of lock jaw. Since the germ of teta- 
 nus will not grow in the presence of oxygen, if the wound is 
 deep it is well to lay it open by means of a knife and thoroly 
 
92 SURGICAL NURSING 
 
 inject with peroxide of hydrogen. This liberates oxygen in 
 the wound and so prevents the growth of the tetanus germ. 
 Nail punctures acquired about a barn yard are especially dan- 
 gerous, as tetanus germs are much more numerous in such 
 places. If there seems to be the least danger from this source, 
 the person having the wound should be given injections of 
 tetanus antitoxin, as a prophylactic. 
 
 GUNSHOT WOUNDS 
 
 Whether received in the head, trunk, or limbs, these wounds 
 are always serious, and especially so when they involve vital 
 organs. The item of first importance is to stop all visible hem- 
 orrhage and use means to overcome shock, if it be present. The 
 person should be kept at rest and the surgeon summoned at 
 once. Internal hemorrhage often continues in these wounds 
 especially when received in the chest or abdomen. Where symp- 
 toms of internal hemorrhage make their appearance, and there 
 is no surgeon at hand, it is best to bandage the limbs next to 
 the body in order .to prevent undue loss of blood. Also lower 
 the head of the patient, to prevent enemia of the brain and 
 fainting. The application of ice directly over the wound may 
 in some cases stop the hemorrhage or prevent excessive hem- 
 orrhage. Foreign particles and pieces of clothing should be 
 removed from the wound, and antiseptics applied over the sur- 
 face to prevent further infection. 
 
 POISONED WOUNDS 
 
 This term may very conveniently be applied to wounds in- 
 flicted by insects, the bites of dogs, snakes, and other animals. 
 In case of bites by venomous snakes, return circulation should 
 be shut off by tight bandage close above the wound. As it will 
 take a few minutes to do this, the part should be quickly grasped 
 by the hands and held so tightly as to prevent all return of the 
 blood. At the same time the poison and blood should be sucked 
 out of the wound and this sucking repeated several times so as 
 to get rid of all the poison that it is possible to remove in. this 
 way. It is well to rinse out the mouth afterward, altho the 
 venoms are usually inert in the alimentary tract. The wound 
 may now be treated by peroxide of hydrogen or rubbing into it 
 crystals of permanganate of potash. These agents oxidize the 
 poisons and so render them harmless. Cauterization either 
 
WOUNDS 93 
 
 with a hot iron or chemical agents is always recommended in 
 order to destroy the venom. In the case of bites, the stings of 
 bees, wasps, centipeds, terantulas, spiders, etc., remove the 
 sting and apply ammonia water and then a cold compress. The 
 harmful effects are usually in proportion to the individual sus- 
 ceptibility. Some persons have a special predisposition to much 
 pain and excessive swelling following the bites of certain insects 
 or spiders. 
 
 INFECTED WOUNDS 
 
 The symptoms of infection usually appear in two, three, or 
 four days. Infection of wounds is most common where the 
 instrument or object inflicting the wound is dirty. Sometimes 
 these are found in spicules of bone, butchers' knives, etc., 
 where men are working in packing houses, nail punctures, and 
 scratches from thorns, etc. There is pain, redness, swelling, 
 and the feeling of heat in the part. This condition is usually 
 spoken of as blood poisoning, altho this term had perhaps better 
 be reserved for something more than local infection. Real blood 
 poisoning (septicemia) is indicated by the extension of red lines 
 centrally from the infected part. These are due to the spread 
 of the bacteria and the extension of the infection along the lym- 
 phatics. They are signals of immediate danger, and whenever 
 they appear the infected part should be most vigorously treated. 
 The wound should be kept open, and where there are indications 
 of pus it may be necessary to make additional incisions. The 
 part should then be treated by alternate hot and cold pours or 
 immersion. This should be carried out by means of the hottest 
 water that it is possible to be born on the skin, and the tem- 
 perature increased from time to time to the limit of duration. 
 Cold applications should consist of ice water; chunks of ice 
 should be kept in the water used. In the case of hot and cold 
 immersion, the part should be left in the hot water about two 
 minutes and placed in the cold for twenty or thirty seconds. It 
 should then be returned to the hot for two minutes and again 
 in the cold for twenty or thirty seconds. These alternations 
 should be kept up from thirty minutes to an hour at a time, and 
 repeated from one to four times daily until the infection is 
 under control. In case of the hot and cold pour, the duration 
 of each phase may be somewhat less than that mentioned above. 
 
94 SURGICAL NURSING 
 
 Burns 
 
 A burn is an injury or destruction of the skin or deeper 
 tissues caused by dry heat, chemical agents, or electricity. 
 Scald is the same kind of injury, differing from a burn by being 
 produced by hot vapors or hot liquids. Burns covering a small 
 area usually cause no great difficulty other than the immediate 
 pain and discomfort. Extensive burns, especially those cover- 
 ing more than 1/2 of the body surface are likely to be followed 
 by death. This is said to be due to the destruction of the nerves 
 in the skin which govern the production and elimination of heat, 
 also to internal congestion, and occasionally to ulcerations in the 
 internal organs. These latter, however, are the later results. 
 Ulcerations following burns are not uncommon in the stomach 
 and intestines. Sometimes the immediate shock of a severe 
 burn is the chief factor in the production of death. According 
 to their degree, they are classified as burns of the first, second, 
 or third degree. 
 
 1. First degree simple redness or inflammation of skin. 
 
 2. Second degree inflammation, accompanied by the forma- 
 tion of blebs or vesicles. 
 
 3. Third degree charring and destruction of the skin and 
 deeper tissues. 
 
 The treatment of burns differs according to the degree. 
 For burns of the first and second . degree the treatment is very 
 much the same, but third degree burns should always be treated 
 by the physician, as it is often necessary to trim out charred 
 tissue and later to remove sloughing portions. In the case of 
 the burns in the first degree, almost anything that produces an 
 impervious covering of the surface, is sufficient. This prevents 
 the entrance of air, and so aids in relieving the pain. It is 
 hardly advisable to immerse the part in cold water even tho 
 this does afford immediate relief, as pain is usually intensified 
 on removal and lasts longer than if it had been immersed in hot 
 water or some other application made. Vaseline, carron oil, and 
 ointment, usually afford relief; also the application of bicarbon- 
 ate of soda or flour; picric acid may also be used. In the burn 
 of the second degree and in extensive burns of the first degree, 
 the following is the plan now employed by the majority of phy- 
 sicians: 
 
 First fan the part until the serum has dried on the surface. 
 Blebs should be punctured at their dependant edges with a 
 
BURNS 95 
 
 sterile needle, the raised epidermis beino: allowed to fall back 
 and dry on the skin. Next apply, by means of cotton or gauze, 
 a saturate aqueous solution of picric acid. This should be ap- 
 plied so as to cover the entire surface, and the part again be 
 fanned or otherwise dried. Next cover by very light dusting 
 with stearate of zinc. This should be very lightly done so as 
 not to leave an amount which will favor the formation of cakes 
 or crusts. In case the area involved is small, it will do no harm 
 to apply a saturate solution of picric acid in 5070 % alcohol. 
 But the alcoholic solution should never be applied to an exten- 
 sive area, as it may be absorbed and cause poisoning. However, 
 the aqueous solution almost never produces any harmful results, 
 even tho applied where the epidermis has been entirely removed. 
 
 This so-called dry method of treating burns is to be most 
 highly recommended. Successive dressings are carried out in 
 the same manner. The chief item to be observed is the keep- 
 ing of the surface perfectly dry. This in itself favors the 
 growth of epithelium, and the picric acid also stimulates the 
 formation of epithelium This general plan should be digressed 
 from only in case of infection. If pus forms on the surface it 
 is necessary to apply a compress wet in a very weak solution of 
 some antiseptic for a few hours or a day or so. It is then us- 
 ually best to return to the dry dressings. Where it is necessary 
 to follow other methods of procedure, the directions of the phy- 
 sician should be very carefully followed in case the dressings 
 are left to the care of the nurse. Burns of the third degree 
 should be under the constant supervision of the physician. In 
 many cases, however, the same general plan may be followed 
 as for burns of the second degree. 
 
 General items. If clothing sticks to a burn, do not pull it 
 off, taking a part of the skin surface with it; but loosen it by 
 moistening with salt solution. Use a dressing that will exclude 
 the air and prevent friction. Do not use a dressing that will 
 stick in cakes as flour and cotton batting. 
 
 When the clothes are on fire, the wearer must not run 
 about as this fans the flames. Have him lie on the floor and 
 wrap in blankets, rugs, or anything that will smother the 
 flames. In burns of the fingers, bandage each separately, as 
 otherwise they may grow together. 
 
96 SURGICAL NURSING 
 
 Boils, Ulcers, and Abscesses 
 
 BOILS 
 
 A boil is a subcutaneous abscess having one sinus, or open- 
 ing. 
 
 1. Cause. Infection. 
 
 2. Symptoms. Redness, pain, swelling and local pointing. 
 
 3. Treatment, 
 
 a. Cold applications to abort. 
 
 b. Hot applications to hasten. 
 
 c. Wash with mild disinfectant. 
 
 d. Open. Generally the open cavity is swabbed with carbolic 
 and then with alcohol. If large, a small piece of 1/4-inch iodo- 
 form or sterile packing is put in to insure good drainage. Over 
 this apply sterile gauze and then bandage or fasten on with ad- 
 hesive strips. Before each dressing irrigate cavity with a dis- 
 infectant. Adhesive strips are easily removed by saturating 
 with alcohol, benzine or gasoline. 
 
 e. Avoid pressing or bruising tissue. 
 
 CARBUNCLE 
 
 A carbuncle is a subcutaneous abscess with two or more open- 
 ings. It is practically an extended boil. Symptoms and treat- 
 ment are the same as for boils. 
 
 ULCER 
 
 An ulcer is an open sore on the surface of the body or a 
 mucous membrane. The treatment consists first in cleansing 
 the surface by means of peroxide of hydrogen. If there is much 
 pus or secretion, that must be removed. It should then be 
 dried and treated with picric acid or some antiseptic powder. 
 Over this the usual sterile dressing and bandage are applied. 
 The special advantage in varicose and other chronic ulcers is 
 the alternate application of hot and cold, carried out in much 
 the same manner as recommended for infected wounds, altho 
 in the case of varicose ulcers the alternate hot and cold spray 
 is especially good, and often massage may be used in treating 
 the tissues about the ulcer. 
 
 ABSCESSES 
 
 An abscess is a localized collection of pus in some part of 
 the body. It is indicated by pain and rise of temperature, 
 
BOILS, ULCERS, ABSCESSES 97 
 
 swelling, local tenderness, and at its onset, often by chills. An 
 abscess is always to be treated by a physician, where one is 
 accessible. After it has been opened and surgically cared for, 
 the dressings are much the same as in the treatment of boils or 
 ulcers. In many cases, however, surgeons desire to irrigate 
 abscess cavities. The antiseptic solution used should be very 
 weak, so as to give rise to no danger from the absorption of 
 chemicals. The general condition of the patient should be 
 looked after by means of simple diet, tonic hydrotherapy, fresh 
 air, attention of the bowels, etc. 
 
 HEMORRHAGES 
 
 Hemorrhage from veins is generally slow and steady, and 
 the blood dark red. To stop hemorrhage, exert firm continu- 
 ous pressure both above and below the wound. In arterial 
 hemorrhage the blood is bright red and comes in spurts. Pres- 
 sure should be exerted over the artery between the cut and the 
 heart. Capillary hemorrhage is always present in evei y cut. 
 The color of the blood is bright red, the flow is slow and scanty. 
 
 1. Finger or toe. Grasp the part tightly between your 
 thumb and finger, making firm pressure against the bone at 
 the sides. 
 
 2. Arm or leg. Place a small pad over the bleeding artery; 
 by means of a handkerchief or firm strip of cloth, tie a bandage 
 about the limb, drawing it tighter by inserting a stick and 
 twisting the bandage. 
 
 To stop a hemorrhage from the brachial artery, make firm 
 pressure over this artery at the inner side of the biceps muscle. 
 
 To compress the axillary artery, grasp the arm just below 
 the shoulder with both hands. With the fingers in the axilla, 
 press firmly against the upper end of the humerus. 
 
 To stop hemorrhage from a large artery in the leg, make 
 firm pressure in the center of the popliteal space. 
 
 To compress the femoral artery, exert pressure just below 
 Pouparts ligament, 1/3 of the distance from the pubes to the 
 spine of the ilium. 
 
 3. Neck. In arterial hemorrhage about the neck, make 
 deep pressure at the side of the middle line just above the collar 
 
 7 
 
98 SURGICAL NURSING 
 
 bone. This will press the carotid artery back against the spinal 
 column. 
 
 4. Face. Exert direct pressure over the wound or press the 
 facial artery against the lower jaw bone. It will be found just 
 in front of the angle of the jaw. For scalp wound, apply ice or 
 very hot water directly to the wound itself. 
 
 EPISTAXIS 
 
 Snuff very cold water, salt and water, or a solution of alum 
 (dessert spoonful to the half pint of hot water). Hold the 
 arms up over the head, apply ice to the back of the neck and 
 over the nose, and have the patient hold his hands in cold water 
 or on a piece of ice. Where hemorrhage does not respond to 
 other measures, it may be necessary to plug the anterior and 
 posterior nares with cotton. This requires special skill, and is us- 
 ually to be carried out by a physician. 
 
 HEMORRHAGE AFTER TOOTH EXTRACTION 
 
 Plug the cavity with small pledget of cotton dipped in ad- 
 renalin solution, a solution of alum, or vinegar. 
 
 HEMATEMESIS 
 
 In hemorrhage from the stomach, blood is usually dark and 
 has the appearance of coffee grounds. If the hemorrhage is 
 very profuse and the vomiting immediate, the blood may be 
 bright red. The cause is usually cancer or ulcer of the stomach. 
 
 Treatment, 
 
 1. Keep quiet in recumbent position. 
 
 2. Ice bag over the stomach. 
 
 3. May swallow bits of ice. 
 
 4. Heat to feet. 
 
 5. Notify physician. 
 
 HEMOPTYSIS 
 
 In hemorrhage from the lungs the blood is bright red in 
 color and frothy. The most common cause is tuberculosis. 
 Other causes are strain, lifting, congestion of the lung. 
 
SPRAINS AND FRACTURES 99 
 
 DIFFERENCES IN~ 
 HEMOPTYSIS HEMATEMESIS 
 
 1. Pain in chest. 1. Tenderness over stomach. 
 
 2. Blood frothy, alkaline. 2. Not frothy, acid. 
 
 3. Bright red. 3. Dark red. 
 
 4. Mixed with phlegm. 4. Mixed with food. 
 
 5. Coughed up. 5. Vomited up. 
 
 6. Difficult breathing. 6. Nausea. 
 
 HEMORRHAGE FROM THE BOWELS 
 
 Hemorrhage from the bowels may be caused by hemor- 
 rho'ds, typhoid fever, tuberculosis, cancer, ulcer, and many 
 other conditions. In hemorrhage from the upper bowel the 
 blood is usually dark and mixed with feces. In hemorrhages 
 from the rectum, the blood will be passed by itself or may coat 
 the feces. 
 
 Treatment, 
 
 1. Cold to abdomen. 
 
 2. Heat to limbs. 
 
 3. Quiet and absolute rest. 
 
 4. Notify the physician. 
 
 SPRAINS 
 
 A sprain is due to the tearing or rupture of ligaments. It 
 is most frequently in the ankles. As far as possible the part 
 should be kept at rest for a few days. The alternate hot and 
 cold foot bath is an excellent means of preventing undue swell- 
 ing and of relieving the pain. The flowing cold foot bath may 
 be used. Continuous heat, such as the hot foot bath or fomen- 
 tation, is usually never as efficient as the measures just recom- 
 mended. Bandaging the part only prevents swelling without 
 in any wise overcoming the cause of the swelling. 
 
 FRACTURES 
 
 Fracture is the breaking of a bone. The following varieties 
 are distinguished: Simple, comminuted, green stick, and com- 
 pound or open fracture. 
 
 Comminuted fracture is one in which the bone is splintered, 
 several small pieces being formed. 
 
100 SURGICAL NURSING 
 
 Green stick fracture usually occurs in the bones of children. 
 It is a partial break, usually without displacement, in much 
 the same way as a green stick breaks when bent. 
 
 Compound or open fracture is one in which there is an open- 
 ing from the skin or the mucous membrane down to the seat 
 of fracture. Because of the opportunity for the entrance of 
 germs, infection is very likely to take place. 
 
 Treatment, 
 
 In the case of fracture, that which frequently devolves up- 
 on a nurse is treatment to relieve the pain while awaiting for 
 the arrival of the physician. The relief of the pain and the re- 
 laxation of the muscles is best accomplished by the use of the 
 fomentation. This should be applied as hot as can be borne, 
 care being taken that a burn is not produced. 
 
 In case of compound fracture, the break in the skin 
 should be thoroly cleaned and any dirt or foreign matter picked 
 out. If the ends of the bone protrude, it is well to leave them 
 until the physician arrives, at least they should not be replaced 
 until the parts have been thoroly disinfected. 
 
PART III 
 SOLUTIONS 
 
 CHEMICALS IN COMMON USE 
 
 Corrosive Sublimate (HgCl 2 ) 
 
 1. Properties. Strength of saturation: 1 part of bichloride 
 made up with cold water 16 parts. An equal amount of com- 
 mon salt added to the bichloride will hasten its solution. The 
 addition of HC1 or citric acid aids its disinfectant action. 
 
 Bichloride corrodes instruments. It is not a good disin- 
 fectant for clothing as it stains white materials yellow. 
 
 It is decomposed by alkalies and is precipitated by albumen. 
 
 2. Solutions. Solutions of this drug varying from 1 500 
 to 110,000 are used. Those most often employed are 1500, 
 1-1000, and 12000. 
 
 The weaker solutions are used for irrigating cavities. As 
 an absolute disinfectant, solutions weaker than 11000 should 
 not be used. 
 
 It is not an efficacious disinfectant for stools, bloody or pur- 
 ulent discharges as it hardens albumen, forming a coat or shell 
 within which germs retain their vitality. 
 
 Carbolic Acid (C 6 H 5 OH) 
 
 1. Properties. Strength of saturation: 1 part of acid to 15 
 parts water. However, the standard solution for ward use is 
 made with 20 parts of water. 
 
 It is a product derived from coal tar by distillation. Chem- 
 ically it is not an acid but a phenol. The pure acid is colorless. 
 If 5% water is added to the melted crystals, the solution will 
 not re-crystallize. Carbolic acid is freely soluble in glycerine, 
 alcohol, and ether. 
 
 2. Solutions. All solutions are preferably made with hot 
 water to insure the thoro dissolving of the globules, as these 
 
SOLUTIONS 
 
 are very corrosive. The solutions in common use are 1-20 (5% ) , 
 and 1 40 (2 1/2%). Solutions weaker than 5% will not destroy 
 all germs, but because of its irritating qualities it can not always 
 be used that strong. 
 
 It does not discolor instruments or clothing. Long contin- 
 ued submersion in the pure acid will deprive, knives and scis- 
 sors of their temper and edge. Five minutes in the pure acid 
 is sufficient to insure thoro disinfection. Clothing should stand 
 at least 1 hour in a 5% solution. 
 
 The odor of carbolic may be covered by using oil of pepper- 
 mint or cinnamon. 
 
 Lysol 
 
 1. Properties. Full strength or (100%) solution. It is a 
 coal tar product, brown, oily, saponified liquid, containing about 
 50 of cresols. It is less poisonous than carbolic acid. 
 
 2. Solutions. Solutions are used from 1 5%. Those in 
 most common use range from 1/2% 2%. It may be used for 
 the disinfection of anything in the sick room except rubber 
 goods that must stand in the solution a long time, as it softens 
 the rubber. 
 
 Creolin 
 
 1. Properties. Full strength (100%) solution. A black, 
 syrupy liquid. When mixed with water forms an opaque emul- 
 sion, which is a disadvantage in the disinfection of instruments, 
 since they can not easily be found in it. 
 
 It is not so poisonous as carbolic acid. 
 
 2. Solutions. 1% 5% are used. For cleansing hands a 
 5% solution is generally used. For vaginal irrigation a 1% so- 
 lution is used. 
 
 Formaldehyde (CH 2 O) 
 
 1. Properties. A colorless gas with a strong, pungent ir- 
 ritating odor. It is very irritating to the mucous membranes 
 and skin. Readily soluble in water. Formalin is an aqueous 
 solution containing about 40% of the gas. It is a good deodor- 
 izer. Used very extensively for the fumigation of rooms. Am- 
 monia will destroy the odor. Its antiseptic properties are con- 
 sidered superior to bichloride of mercury. It does not corrode 
 or tarnish metal or injure fabrics. 
 
COMMON CHEMICALS 103 
 
 2. Solutions. All aqueous solutions are made from for- 
 malin. Cold water should be used, as heat evolves gas, weak- 
 ening the solution. 
 
 For the disinfection of colon tubes or lavage tubes, use a 
 1% solution and allow to stand at least one-half hour. 
 
 For rubber irrigating points or articles to be used in an 
 operating room, a 5% solution should be used and the immersion 
 continued for about one hour. 
 
 Potassium Permanganate 
 
 1. Properties. Strength of saturation, 1 16. The crystals 
 are dark purple, slender prisms, inodorous. Solutions not made 
 with distilled water are likely to deteriorate, especially if ex- 
 posed to the light. 
 
 2. Solutions. It is used in varying strengths from 1 16 to 
 15000. 
 
 For hands, use a saturated solution. In weaker solutions it 
 is used on wounds, especially those having an offensive dis- 
 charge. A. 1 1000 solution may be used for gargles, douches or 
 sprays. 
 
 It is not useful in disinfecting excreta, as the amount re- 
 quired to make it effectual would be a great expense. 
 
 Boracic Acid (H 3 BO 3 ) 
 
 1. Properties. Strength of saturation, about 125. The 
 crystals are pearly white and glistening, and non-irritating. 
 
 2. Solutions. It is much used in ophthalmic and aural prac- 
 tice, also for superficial wounds and bladder irrigation. As a 
 wash for the eyes, a 2% solution is commonly used. 
 
 Oxalic Acid (C 2 H 2 O 4 , 2H 2 O) 
 
 1. Properties. Strength of saturation, about 1 10. The 
 crystals are colorless and four sided. They closely resemble in 
 appearance those of magnesium sulphate and zinc sulphate. It 
 is a powerful germicide, and very irritating. It removes the 
 stain of potassium permanganate. 
 
 2. Solutions. The saturate solution is used for hand disin- 
 fection. Oxalic acid is never used for irrigating cavities, as it 
 is highly toxic. 
 
 Salt (NaCl) 
 
 1. Properties. Strength of saturation, 12 1/2. Exists in 
 
104 SOLUTIONS 
 
 the blood in the strength of 6/10%. Water alone is an irritant 
 to abraded tissue, but a weak solution of salt makes it non- 
 irritant. 
 
 2. Solutions. The solution most commonly used is the nor- 
 mal or physiologic saline solution. It is so-called because it ap- 
 proximates the density of blood serum. To make this, use one 
 of the following formulae: 
 
 (a) 6 grams of salt to 1000 c.c. of water, (b) 1 tsp. of salt 
 1 pt. of water, (c) 15 c.c. saturated solution to 1000 c.c. of 
 water. 
 
 Alum (KA1 (SO 4 ) 2 . 12H 2 O) 
 
 1. Properties. Strength of saturation, 1 9. It is an astrin- 
 gent and styptic. 
 
 2. Solutions. The saturated solution is often used to arrest 
 uterine hemorrhage or profuse flowing by giving a vaginal irri- 
 gation at a temperature of 120 F. 
 
 Alcohol (C 2 H 5 OH) 
 
 1. Properties. A colorless, volatile liquid of an agreeable 
 odor and burning taste. It is a solvent for many substances. 
 Mixes with water in all proportions. 
 
 2. Solutions. Grain alcohol, 95 %; proof spirit, 50%. 
 
 Peroxide of Hydrogen (H 2 O 2 ) 
 
 1. Properties. Slightly acid, watery solution of hydrogen 
 dioxide, containing when fresh about 3% the pure dioxide, cor- 
 responding to about 10 volumes of oxygen. It is an antiseptic, 
 deodorant and styptic. Its value depends upon the liberation of 
 oxygen. When poured into a wound, effervescence takes place 
 which carries off any tissue shreds that can not be easily 
 reached. It should not be relied upon as a disinfectant. 
 
 It must be kept in a cool, dark place, and readily decom- 
 poses on coming in contact with metals. 
 
 2. Solutions. Used for (1) gargles, (2) irrigating wounds 
 or ulcers where pus is present. 
 
 It is a direct antagonist of the tetanus germ, since the 
 latter can not live in the presence of oxygen. 
 
 Sodium Bicarbonate (NaHCO 3 ) 
 
 1. Properties. Strength of saturation, 112. It is com- 
 monly called baking soda. 
 
COMMON CHEMICALS 105 
 
 2. Solutions. A 1% solution is used in which to boil in- 
 struments. 
 
 Sodium Carbonate (Na 2 CO 3 ) 
 
 1. Properties. Strength of saturation, 1 2. Transparent, 
 colorless crystals, which break down into a white powder on 
 standing (effloresce). This chemical is commonly called sal 
 soda, or washing soda. It will remove the stains made by bi- 
 chloride of mercury on china or glass. 
 
 Chlorinated Lime (Chloride of Lime) 
 
 1. Properties. Made by the action of chlorine on slacked 
 lime. It contains about 35% of available chlorine. It should 
 be used fresh as its disinfectant properties are due to the action 
 of chlorine. 
 
 2. Solutions. The standard solution contains 6 ounces to 
 the gallon of water (4%). It is a good disinfectant for feces, 
 sputum, or urine. 
 
 lodoform (CHI 3 ) 
 
 1. Properties. It has no decided antiseptic properties. It 
 is useful because it inhibits the growth of bacteria and thus 
 prevents decomposition. When applied to raw surfaces it is 
 occasionally absorbed into the system, causing symptoms of 
 poisoning. Spirits of turpentine will remove the disagreeable 
 odor of the drug. It darkens upon exposure to a bright light, 
 and is likely to cake when it becomes moist. 
 
 2. Preparations. It is used for impregnating gauze dress- 
 ings, for dusting on ulcers or wounds. Dissolved in ether or 
 olive oil is often injected into sinuses or tubercular abscesses, 
 and is an ingredient of bone wax used for filling cavities in bone. 
 
 Argyrol 
 
 1. Properties. Strong, non-irritating and non-toxic disin- 
 fectant. Stains may be removed by immersion in 1 500 HgCk 
 
 2. Solutions. Better results will follow the use of freshly 
 prepared solutions. In cystitis, or an irritable bladder, one 
 ounce of 1025% is injected and allowed to remain in the blad- 
 der. It is used in ophthalmic surgery quite extensively. Is also 
 palliative or curative in many diseases of the rectum. 
 
THE METRIC SYSTEM 
 
 The metric system is employed almost universally in 
 Europe, and it is being rapidly adopted in America. Because 
 of its simplicity, it greatly facilitates the calculations incident 
 to the making up of solutions. The unit of length is called the 
 meter (39. 37 in. ) . The Subdivisions of the meter are expressed 
 by Latin prefixes while the multiples are designated by Greek 
 prefixes. The two arrangements are as follows: 
 
 DECREASING SCALE 
 
 Meter. 
 
 Decimeter one-tenth (1/10) of a meter. 
 Centimeter one-hundredth (1/100) of a meter. 
 Millimeter one thousandth (1/1000) of a meter. 
 
 INCREASING SCALE 
 
 Meter. 
 
 Decameter ten meters. 
 
 Hectometer hundred meters. 
 
 Kilo meter one thousand meters. 
 
 The cube of a centimeter is called a cubic centimeter (c.c. ). 
 
 The unit of capacity is called a liter, and is equivalent to 
 1000 c.c. 
 
 The unit of weight is called a gram, and is equivalent to 
 the weight of 1 c.c. of distilled water at 4 C. 
 
 The same prefixes used for the meter are used for the liter 
 and gram to denote their division and multiplication. However, 
 in the case of the liter the divisions are rarely spoken of as deci- 
 liter, centiliter, etc., but are generally designated 100 c.c. in- 
 stead of deciliter, 10 c.c. instead of centiliter, etc. 
 
 APPROXIMATE EQUIVALENTS 
 
 1 meter 39.37 in. 
 
 25 millimeters (mm) 1 in. 
 
 1 liter 33.81 fluid ounces or about 2 pts. 
 
 30c.c. 1 fluid ounce. 
 
 4 c.c. 1 dram. 
 
 5 c. c. 1 teaspoonf ul. 
 
 1 c.m. . 2/5 in. 
 
 1 gram___ 15 1/2 gr. 
 
 1 grain _ .065 gm. 
 
 1 kilometer _ 3/5 mile. 
 
 1 kilogram 21/5 pounds, avoirdupois. 
 
 The United States nickel (five cent piece) weighs 5 grams, 
 and is 2 centimeters in diameter. 
 
PREPARATION OF SOLUTIONS 
 
 LESSON I. 
 
 Coal Tar Products 
 
 Full strength (100%) chemicals: lysol, carbolic, creolin, 
 creosope. 
 
 Carbolic acid in liquid form is 95% but is always used as 
 tho it were 100%, as the difference is so slight. In making up 
 full strength solutions, it is a good plan to use a liter (1000 c.c.) 
 as a starting point. Since 1% of 1000 c.c. is 10 c.c., from this 
 any quantity and any per cent can readily be estimated. 
 
 Problems 
 
 One. Make up 1 liter of 2% lysol. 
 1 liter=1000 c.c. 
 
 1% =1/100 of 1000 c.c. or 10 c.c. 
 2% =2X10 c.c. or 20 c.c , the amount of lysol 
 it takes to make 1 liter of 2 % solution. 
 
 Two. How many c.c. of creolin does it take to make a 
 liter of 1/2% solution? 
 
 1 liter=1000 c.c. 
 
 1% =1/100 of 1000 c.c. or 10 c.c. 
 1/2% =10 c.c. -^2, or 5 c.c., the required amount. 
 
 Three. Disinfect 2 liters of sick room discharges with car- 
 bolic acid, using sufficient to make a 5% solution. 
 1% of 1000 c.c. (1 liter) =10 c.c. 
 5% =5X10 or 50 c.c., the amount of carbolic it 
 would take to make 1 liter of a 5% solution. 
 
 To make 2 liters it would take 2X50 c.c. or 100 c.c. (3 1/3 
 oz. ) of carbolic acid. 
 
 Four. Make up 1 pt. of 2% lysol. 
 1 liter=1000 c.c. 
 1% of 1000 c.c. =10 c.c. 
 
 2% =2X10 or 20 c.c., the amount of lysol to make 
 1 liter of 27c solution. 
 
 A pint=l/2 liter, thus 20 c.c. -^-2=10 c.c. (5 iiss) the amount 
 of lysol required to make 1 pint of solution. . 
 
108 SOLUTIONS 
 
 LESSON II. 
 
 Formaldehyde Solutions 
 
 All formaldehyde solutions are made from formalin which 
 is 40% formaldehyde. 
 
 1% =1/100 or in 100 parts, 1 part is the chemical. 
 
 2% =2/100 (1/50) or in 100 parts, 2 parts are the chemical. 
 
 There is one part of the chemical to every 50 of water. 
 
 4% =4/100 (1/25) or in 100 parts 4 parts are of the chem- 
 ical. Thus in every 25 parts of water there is one of the chem- 
 ical, making a solution of 1 25 which is equivalent to 4%. 
 
 5% =5/100 or 1 20. 
 
 6% =6/100 or 1162/3. 
 10% =10/100 or 110. 
 40%=40/100 or 12 1/2. 
 50% =50/100 or 12. 
 
 Thus we see that formalin (40%) is a 121/2 solution. 
 It takes 21/2 c.c. of the solution to contain 1 c.c. of the chem- 
 ical. Thus in making up solutions from formalin it takes 21/2 
 times as much as it would to make up a solution from a chemical 
 that is full strength. 
 
 Problems 
 One. Make up 1 liter of 1% formaldehyde. 
 
 1% of 1000 c.c. =10 c.c., full strength. 
 
 10 c.c. X2 1/2=25 c.c., the quantity of formalin it 
 requires to make a liter of a 1% solution, thus we deduce the 
 following rule: 
 
 'To make up solutions from formalin, proceed just as in 
 full strength solutions, multiplying the results by 2 1/2. " 
 
 Two. How much formalin will it take to make 2 liters of 
 
 1/2% solution? 
 
 1 liter=1000 c.c. 
 
 1% =1/100 of 1000 c.c. or 10 c.c. 
 1/2% =10 c.c. ^2, or 5 c.c. for 1 liter. 
 2 Iiters=2x5 c.c., or 10 c.c. of full strength. 
 10 c.c. X2 1/2=25 c.c., the amount of formalin re- 
 quired to make 2 liters of 1/2% solution. 
 
PREPARATION OF SOLUTIONS 109 
 
 LESSON III. 
 
 Bichloride of Mercury (HgCl 2 ) 
 
 Solutions of bichloride of mercury may be made up from 
 the following: 
 
 1. Tablets. 
 
 2. Saturated solution. 
 
 3. Stock solutions. 
 
 4. Crystals. 
 
 The nurse should familiarize herself with every form of a 
 chemical and in making up solutions she should be able to utilize 
 whichever form may be at hand. Each of the above will be 
 considered separately. 
 
 No. /., Tablets 
 
 The two most common forms of tablets are those containing 
 7.3 gr. and those containing 1.8 gr. 
 
 7.3 gr. (1/2 gm. approx. ) to aqua 1/2 liter (1 pt.) =1-1000 
 HgCb 4 of the small tablets are equivalent to one of the large 
 ones containing (7.3 gr.). The advantage of the smaller tablets 
 can readily be seen in the making of weak solutions, as other- 
 wise the large tablets would have to be divided (this is in- 
 accurate) or else there will be quite a waste. 
 
 1 tab. (7.3 gr. or 1/2 gm.) to aq. 1/2 liter or 1 pt 11000. 
 
 2 " (14.6 " "1 " ) " " 1 " " 2 " -11000. 
 1 " (7.3 " " 1/2 " ) " " 1 " " 2 " 12000. 
 
 1/2 " 2sm. tab. " " 1 " " 2 " -14000. 
 
 Problems 
 
 One. Make up 5 liters of 1-1000 HgCl 2 , using the large 
 tablets. 
 
 1 tab. to 1/2 liter 1-1000. 
 
 2 tab. to 1 liter -1-1000. 
 
 5 liters 2 tab. X5 or 10 tablets, the number of 
 tablets required. 
 
 Two. Make up 2 liters of 14000 using the small tablets. 
 4 sm. tablets to 1/2 liter 1-1000. 
 2 " <4 1 " -14000. 
 
 2 tab. X2 4 sm. tab., the number required for 2 
 liters of 1-1000. 
 
110 SOLUTIONS 
 
 Three. Make up 3 liters of 1500 from the large tablets. 
 To make 1 liter of 11000=2 large tablets. 
 To make 1 liter of 1-500 =4 large tablets. 
 To make 3 liters of 1-500 -=4X3 or 12 tablets. 
 
 LESSON IV. 
 
 Bichloride of Mercury 
 
 No. II., Saturated Solution 
 
 Bichloride of mercury saturates at 116. By this we mean 
 that every 16 c.c. of water contains 1 gm. of the chemical. 
 
 In making up solutions from the saturated solution always 
 find first of all how many grams of the chemical will be needed, 
 then if 16 c.c. of the sat. sol. is equivalent to 1 gm., the amount 
 needed can easily be calculated and measured. 
 
 Problems 
 
 One. Make up 2 liters of 1-1000 HgCl 2 from the saturated 
 solution. 
 
 To make 1 liter of 11000 requires 1 gm. of the chemical 
 and to make 2 liters, 2 gms. would be necessary. 
 
 If 1 gm. of the chemical is equivalent to 16 c.c. of the sat. 
 sol., 2 gms. would equal 32 c.c., or 5j, the amount of sat. sol. 
 required. 
 
 Two. Make up 3 liters of 14000 from the sat. sol. 
 To make 1 liter of 11000=1 gm. 
 " " 1 " " 1-4000=1/4 gm. 
 " " 3 " " 1-4000=3/4 gm. 
 3/4 of 16 c.c. =12 c.c. (5iii) of sat. sol. 
 
 LESSON V. 
 
 Bichloride of Mercury 
 
 No. III. , Stock Solutions 
 
 A stock solution is a solution of a certain per cent that is 
 always kept on hand to be used in making up weaker solutions. 
 The most common stock solutions are 120 and 1 40. 
 
 A 120 solution signifies that every 20 c.c. of the solution 
 contain 1 gm. of the chemical. The same method is used in 
 making up solutions from stock solutions that is observed in 
 using the saturated solution. 
 
PREPARA TION OF SOL UTIONS 111 
 
 Problems 
 
 One. Make up 2 liters of 13000 HgCh from the stock 
 solution 120. 
 
 1 liter of 1-1000 takes 1 gm. 
 1 " " 13000 " 1/3 gm. 
 
 3 " 1- 300 " 3X1/3 or 1 gm. 
 
 Since 1 gm. is equivalent to 200 c.c. of the stock solution, 
 just 20 c.c. will be needed. 
 
 Two. Make up 4 liters of 12000 from the stock sol. (140) . 
 1 liter of 1 1000 takes 1 gm. of crystals. 
 1 " " 1-2000 " 1/2 " " 
 
 4 " "1-2000 " 4Xl/2or2gms. 
 
 1 gm.=40 c.c. of stock sol. 
 
 2 " =2X40 or 80 c.c. stock sol. 
 
 No. IV., Crystals 
 
 In using the crystals to make up solutions it is necessary to 
 weigh them. This is often inconvenient, so when the 
 nurse is given crystals she generally makes up a sat. sol. and 
 uses that. However, a few problems will be given to demon- 
 strate the method of calculating the amount of crystals needed. 
 
 Problems 
 
 One. Make up 6 liters of 1-500. 
 
 To make up 1 liter of 1-1000=1 gm. 
 " 1 " " 1- 500=2 gm. 
 " 6 " " 1- 500=6 X 2 or 12 gm. 
 
 As the nurse very seldom has access to the metric scales, 
 it is necessary to convert the amount needed into the avoirdupois 
 equivalent, hence, 
 
 1 gm. 15 1/2 gr. 
 
 12 gm. 151/2 gr. X12 or 186 gr. (approx. 5iij as there 
 are 60 gr. to 5j.) 
 
 Two. Make up 3 liters of 15000 HgCk 
 1 liter of 11000=1 gm. 
 1 " " 1-5000=1/5 gm. 
 
 3 " " 15000=3/5 gm. 
 
 3/5 of 15 1/2 gr.=9 gr. (approximately). 
 
112 SOLUTIONS 
 
 LESSON VI. 
 
 Potassium Permanganate (KMnO 4 ) 
 
 As the strength of saturation of potassium permanganate 
 is the same as bichloride of mercury, its solutions are made up 
 in the same way. The only difference being in the size of the 
 tablets. The tablets of potassium permanganate most com- 
 monly used are the 1 gr. or the 5 gr. So if the amount of the 
 crystal needed is estimated in grams, it can quickly be con- 
 verted into grains, and then the number of tablets may be easily 
 estimated. 
 
 Boracic Acid (H 3 BO ;J ) 
 
 Strength of saturation 1 25, or 4%. 
 
 Problems 
 
 One. Make up 6 liters of 3% from the crystals. 
 To make 1 liter of 1% (1100) =10 gm. 
 " " 1 " "3% " -3X10 or 30 gm. 
 14 " 6 '* "3% =6X30 or 180 gm. 
 
 30 gm.=l ounce. 
 180 gm. 6 ounces. 
 
 Two. Make up 4 liters of 2% from the sat. sol. 
 1 gm. of crystal 25 c. c. of sat. sol. 
 To make 1 liter of 1% (1100) =-10 gm. 
 
 " " 1 " "2% " -2X10 or 20 gm. 
 
 " " 4 " "2% -20X4 or 80 gm. 
 
 25 c.c. X 80 amount of sat. sol. or 2000 c.c. (21.). 
 
 Three. Make up 1 liter of 1% from the sat. sol. 
 To make 1 liter of 1% 10 gm. 
 25 c.c. X 10 250 c.c. of sat. sol. (1/4 liter). 
 
 LESSON VII. 
 
 Salt Solutions 
 
 Strength of saturation 12 1/2, or 40%. 
 
 The solution of salt most commonly used is the normal 
 saline or 0.6%, so called because it contains the same amount 
 of salt as blood serum. 
 
PREPARATION OF SOLUTIONS US 
 
 Problems 
 
 One. Make up 3 liters of normal saline from the sat. sol. 
 To make 1 liter of 1100 (1%)=10 gm. 
 " " I " " 6/10% =6/10 of 10 or 6 gm. 
 Since 21/2 c.c. of sat. sol. is equivalent to 1 gm., 6 gms. 
 would=6x2 1/2 or 15 c.c. of sat. sol. to 1 liter. 
 
 3 liters would equal 3X15 or 45 c.c. (1 1/2 oz.). 
 
 Two. Make up 4 liters of normal sol. from the crystal. 
 1 liter =10 gm, salt for a 1%. 
 1 " =6/10 of 10 gm. salt or 6 gm. for 6/10%. 
 6 gm. 10=24 gm. (4/5 oz.) amount required. 
 There are also saline tablets of varying strenth on the 
 market, but full directions for their use are always found on 
 the label. 
 
 Cocain Solutions 
 
 In making up cocain solutions the use of the metric system 
 is not practical for the following reasons: 
 
 1. Solutions are often made from the crystals, which must 
 be weighed and the metric weights are not commonly used. 
 
 2. The solution is used in small quantities so that it is easier 
 to calculate in grains than in grams. 
 
 All cocain solutions are made with cold water. 
 
 Problems 
 
 One. Make up 1 oz. of 1% cocain from the crystals. 
 480gr.=l oz. 
 1% of 480=1/100 of 480 or 4.8 gr. amount required. 
 
 Two. Make up 3 dr. of 1/2% cocain from 1/2 gr. tablets. 
 480gr.=l oz. 
 60gr.=l dr. 
 180 gr. =3 dr. 
 1% of 180 gr. =1.8. 
 1/2% =1.8 gr.-^-2=0.9 gr. 
 0.9 gr.=2 tabl. approx. 
 
 Three. Make up 2 oz. of 1% sol. from the crystals. 
 480gr.=l oz. 
 960 gr.=2oz. 
 
114 SOLUTIONS 
 
 \ l /c of 960 gr. 9.6 gr. amount required. 
 How to make cocain solutions from a 4% sol. 
 l%=l/4of 4%. 
 
 2% =1/2 " " 
 3% 3/4 " " 
 
 Problems 
 
 One. Make up 1/2 oz. of 2% cocain. 
 
 1/2 of 1/2 oz. 1/4 oz. or 5ii. Hence it would 
 take 5ii of 4% cocain and 5ii of aqua. 
 
 Two. Make up 5ii of 3'# cocain. 
 5ii^-8 c.c. 
 
 3/4 of 8 c.c. 6 c.c., amount of 4% cocain required. 
 Add to this 2 c.c. of aqua. 
 
 The underlying principles to be observed in the making of 
 all solutions may be briefly summed up as follows: 
 
 1. In making up a solution from a chemical in the liquid 
 form, first find how many c.c. of the full strength chemical are 
 required for 1 liter of 1%, and if that is understood thoroly, any 
 strength can be easily and accurately computed from that. 
 
 2. In making up a solution from the chemical in the crys- 
 talline form, first determine how many grains will be required 
 to make 1 liter of either 1 100 or 11000, whichever is most 
 convenient, depending largely upon the chemical used. 
 
 3. All solutions from chemicals in common use are made 
 with hot water, except cocain and formaldehyde. 
 
INDEX 
 
 References are to the pages. 
 
 Abscesses, 96 
 
 Accidents and minor surgery, 90-100 
 
 Administration of medicine, 35 
 
 After-Treatment, 76-89 
 
 Alcohol, 104 
 
 poisoning from, 52 
 Alum, 104 
 Anesthetics, 73-75 
 
 poisoning from, 52 
 Antidotes for poisons, 48-54 
 Antipyretics, poisoning from, 52 
 Argyrpl, 105 
 Arsenic poisoning, 49 
 Aural douche, 24 
 
 Beds and bed making, 12-30 
 
 Bedside records, 7-11 
 
 Bed sores, 43 
 
 Belladonna, poisoning from, 52 
 
 Bichloride of mercury, 109-111 
 
 Bladder irrigation, 25 
 
 Bleeding; see Hemorrhage 
 
 Body temperature, 1-3 
 
 Boils, 96 
 
 Boracic acid, 103, 112 
 
 Brushes, 65 
 
 Burns, 94 
 
 Carbolic acid, 101 
 
 poisoning from, 51 
 Carbon monoxide, poisoning from, 52 
 Carbuncle, 96 
 Care of the dead, 39 
 Cataplasms; see Poultices 
 Catheterization and bladder irriga- 
 tion, 25 
 
 Caustic alkali poisoning, 51 
 Changing bed linen, 14 
 Chills, 47 
 
 Chloral, poisoning from, 52 
 Chlorinated lime, 105 
 Chlorine poisoning, 49 
 Coal tar, 107 
 
 poisoning from, 52 
 Cocain, 113 
 
 poisoning from, 52 * 
 
 Common emergencies, 45 
 Complications, surgical, 81 
 Contusions, 90 
 Copper poisoning, 49 
 Corrosive poisons, 51 
 Corrosive sublimate, 101 
 Croton oil poisoning, 49 
 Creolin, 102 
 Cystitis, 86 
 
 Dead, care of the, 39 
 Diet, 32-34 
 
 before operations, 57 
 Digitalis, poisoning from, 53 
 Dishes and utensils, 68 
 Disinfection, 63 
 Douche, preparation for, 16 
 Dressings, 66 
 Drowning, 46 
 Duties of staff, 62 
 
 Emergencies, common, 45 
 Emetics, 48 
 Enema, nutrient, 29 
 preparation for, 16 
 Epilepsy, 46 
 Epistaxis, 98 
 Examination, full, 37 
 
 Fainting, 45 
 
 Feeding, nasal, 28 
 
 Foods; see Diet 
 
 Formaldehyde, solutions, 102, 108 
 
 poisoning from, 49 
 Full examination, 37 
 
 Gloves, 65 
 Glycerine, 69 
 Gunshot wounds, 92 
 
 Hand disinfection, 63 
 Hematemesis, 98 
 Hemoptysis, 98 
 Hemorrhage, 83, 97-100 
 Hydrocyanic acid, poisoning from, 53 
 Hypodermic injections, 24 
 Hypodermoclysis, 87 
 Hysteria, 46 
 
 Incised wounds, 90 
 Incompatibilities, 36 
 Infection of wounds, 84, 93 
 Infectious cases, general care of, 41 
 Injections hypodermic, 24 
 Instruments and supply room, 65 
 
 sterilization of, 68 
 Intestinal obstruction, 86 
 Intravenous saline infusion, 88 
 Iodine poisoning, 49 
 lodoform, 105 
 
 gauze, 67 
 
 poisoning from, 53 
 Irrigation of bladder, 25 
 Irritant poisons, 49 
 
INDEX 
 
 Lacerated wounds, 91 
 Lav age, 21 
 Lead poisoning, 50 
 Lifting the patient, 15 
 Lysol, 102 
 
 Medicine, administration of, 35 
 Mercury poisoning, 50 
 Methods of sterilization, 65 
 Metric system, the, 106 
 Mineral acids, poisoning from, 51 
 Mouth washes, 47 
 
 Nasal douche, 23 
 
 Nasal feeding, 28 
 
 Neurotic poisons, 52-54 
 
 Nicotine poisoning, 53 
 
 Normal salt solution, 69 
 
 Nutrient enema, 29 
 
 Nux vomica, poisoning from, 53 
 
 Obstetrical bed making, 13 
 Obstruction, intestinal, 86 
 Operations, after-care of, 77 
 
 preparation for, 56-60, 71 
 Operating room, the, 60 
 Opium poisoning, 54 
 Oxalic acid, 103 
 
 poisoning from, 51 
 
 Packing, 67 
 
 Peritonitis, 85 
 
 Peroxide of hydrogen, 104 
 
 Phosphorus poisoning, 50 
 
 Pneumonia, 85 
 
 Poisoned wounds, 92 
 
 Poisons, 48-54 
 
 Potassium permanganate, 103, 112 
 
 Poultices, 31 
 
 Preparation of patient, 56 
 of patients room, 17, 55 
 for douche and enema, 16 
 
 Proctoslysis, 88 
 Ptomain poisoning, 50 
 Punctured wounds, 91 
 Pulse, 3-6 
 
 Records, bedside, 7-9 
 
 operative, 70 
 Respiration, 6 
 
 Room, preparation of, 17, 55, 71, 64 
 Rubber gloves, 65 
 
 Salt, 69, 103, 104, 112, 113 
 Septicemia, 86 
 Shock, 81-83 
 Sick room, the, 17, 55 
 Silver poisoning, 50 
 Sodium carbonate, 105 
 Sodium bicarbonate, 104 
 Solution, 69, 101-114 
 Sordes 47 
 
 Sterilization, methods of, 65 
 Sterilizing room, 64 
 Surgical bed making, 12 
 
 complications, 81 
 
 room, how to clean, 18 
 
 numng, 55-90 
 
 shock, 81-83 
 Sutures, 66 
 
 Technique of tables, 61 
 Temperature; see Body temperature 
 Test breakfast, the, 23 
 
 Ulcer?, 96 
 
 Wheel chairs, 16 
 Wound infection, 84 
 Wounds, 90 
 
 Zinc poisoning, 50 
 
UNIVERSITY OF CALIFORNIA LIBRARY 
 BERKELEY 
 
 Return to desk from which borrowed. 
 This book is DUE on the last date stamped below. 
 
 13Aug'5gJi 
 REC'D LD 
 
 OCT 19 1953 
 
 DtC 81953LU 
 
 DEC 1 5 1955 Lti 
 
 LD 21-100m-9,'47(A5702sl6)476 
 
 PEB 
 
 AUG9 1961 
 
YC M89& 
 
 UNIVERSITY OF CALIFORNIA LIBRARY