Bacteriology m a Nutshell. Agric. Dt. Bacteriology in a Nutshell A Primer for Junior Nurses COMPILED AND ARRANGED BY GRADUATE NURSE, Late Superintendent Thomas Hospital Training School for Nurses, Charleston, W. Va.; Assistant Instructor in General Nursing, Woman's Branch of the German Hospital Cincinnati, O. ; Principal of the Training School and Superintendent of Nurses, Charles- ton General Hospital, Charleston, W. Va., 1905-07. REVISED AND ENLARGED 1907. DEDICATION : To Charlotte A. Aikens, Associate Editor The National Hospital Record, to whose suggestion this booklet owes its origin; to my dear friend and old Superintendent, Sister Emilie Koch, of the German Hospital, Cincinnati, Ohio; and to my sister nurses throughout the world "Bacteriology in a Nutshell" is most affectionately dedicated. ;INCINNATI, OHIO. JULY, 1904. LIBRARY of CONGRESS Two Ccoies Received JAN 13 1908 Cowiffu tntry t^V (-2, /ft/ 7 CLASS % XXc, No, iiin COHY A. COPYRIGHT 1904 BY MARY E. REID. BIOLOGY LIBRARY G COPYRIGHT 1907, BY MARY E. REID. DUPLICKfE CONTENTS. INTRODUCTORY 5-7 CHAPTER I. BRIEF HISTORY OF BACTERIOLOGY. Earliest days. Perfection of the single lens. The ''Dutch Microscopist." His discoveries. The compound microscope. First account of the germ theory of disease. A problem of ancient bacteriology. Men who have made valuable con- tributions to the science. Their discoveries. .9-23 CHAPTER II. THE RELATION OF BACTERIA TO DISEASE. BACTERIA IN PROCESSES OF -NATURE. Mysteries revealed by the microscope. Cell formation. The organs and systems of the body. Health dependence. Cell functions. Cell derangement. The term bacteria. Bacteria as friends. Bacteria as enemies. The first use of the term bacteria. Relative size of sapro- phytic and parasitic families' 23-33 CHAPTER III. DESCRIPTION OF THE MOST IMPORTANT BACTERIA. METHODS OF MULTIPLICATION, ETC. Morphology. Spore-forming bacteria. Non- spore-forming bacteria. Development. Multipli- cation. Dimensions. Coloring bacteria. Pha- gocytes. Phagocytosis. Opsonius. Resistive power of spores. Parent bacillus after spore formation ; its life or death. 33-44 CHAPTER IV. BACTERIAL INVASION. How BACTERIA GAIN AN ENTRANCE TO THE SYSTEM. Parke's list of communicable diseases. Period of incubation. Invasion. Channels of Entrance. Development of symptoms. How infection is thrown off. Sources whereby bacteria die within the body. Immunity, natural, acqiured, artificial. Antitoxins their preparation and uses. Koch's Circuit. The Opsonic Theory 44-64 CHAPTER V. COMMON COMMUNICABLE DISEASES. Why the term communicable has taken the place of the terms contagious and infectious. The bacteria found present in some of the diseases mentioned. Transmission of diseases. Seat of invasion or attack. Effects of invasion. Multi- plication or extermination of germs. Fresh air and ventilation in communicable diseases. Bac- teria in water, milk and so forth. Duties of the nurse in communicable diseases... __..., ,64-101 288439 CHAPTER VI. BACTERIA IN SURGERY. SEPSIS. ASEP- SIS. ANTISEPSIS. Bacteria most frequently found in surgery ; cases in which they occur. Sepsis. Asepsis. Antisepsis. Causes of sepsis. Why sepsis should not occur in the present age. Why surgeons and nurses dread sepsis. The debt the world owes to Lord Lister. The vigilant nurse. Sterilization. Dis- infection. Antiseptics. Germicides. Deodor- ants. Heat as a germicide. Intermittent steril- ization. Aseptic surgery. Hand disinfection. Disinfection of instruments, rooms, furniture, beds, bedding, etc 101-120 CHAPTER VII. SOLUTIONS, THEIR PREPARATION AND USES. FUMIGATION. Some of the drugs in common use for the prepar- ation of solutions, how prepared, how used. Normal salt solution, when and how used. Sterile water. Filtered water. Distilled water. Alcohol. Ether. Sulphur fumigation. For- maldehyde. Formalin. "Hospital Formulary" giving number of grains used in preparation of solutions of various strength. A common rule for the preparation of solutions from drugs in liquid form where absolute accuracy is not re- quired 120-128 CHAPTER VIII. HYGIENE FOR NURSES. The result of neglected hygienic laws. Civiliza- tion, fashion, and hygiene. Social restrictions no longer a menace to hygienic laws. Out of door recreation. Average length of days of the con- scientious nurse. How this period may be pro- longed. The successful nurse. Her duty toward her neighbor. Her duty toward herself. Muscu- lar exercise. Hygienic dress. Uniform should not be worn on the street. The reason why. Obedience to Nature's calls. Diet. Water sup- ply. Sunshine. Fresh air. Rest. Sleep. The nurse with "a Southern exposure" 128-153 BACTERIOLOGY IN A NUTSHELL. INTRODUCTORY. In compiling this small primer of bacteri- ology for junior nurses, the work along bacteri- ological lines prepared as one of the members of the class of students of 'The Graduate Nurses' Hospital Extension Course," in Oc^o- ber, 1903, has been used as a basis. Nothing new in the way of theory has been attempted. Much rather would the writer join the ranks of her sister nurses who so bravely have en- listed to help the noble army of physicians and surgeons fight a victorious warfare against that branch of the bacteria family called "disease germs." Most gladly would we all as nurses see these tiny foes to health destroyed forever. Superintendents of training schools have realized for some years that a few easily com- prehended lessons on bacteriology for junior nurses are necessary. The sole aim of "Bac- teriology in a Nutshell" is to present to young nurses just starting out in the study of the germ theory of disease some of its principal teachings as briefly and as simply as possible. If the contents of this booklet have been made sufficiently clear to be easily grasped by those for whose benefit it is intended, and if it serves as an incentive to further study and research into this most interesting and useful branch of 5 science, the result will be more than gratifying to the writer and of lasting benefit to student nurses. Much assistance has been obtained from a review of the work of hospital training school days and notes of lectures of Dr. E. Gustave Zinke, Dr. Magnus A. Tate and Dr. James W. Rowe, particularly lectures with regard to Sepsis, Asepsis, Antisepsis, Infection, Disin- fection, Sterilization, etc. In addition to these helps, my own experience of recent years as a teacher in training schools has proven of ma- terial benefit. My thanks are especially due to Dr. James W. Rowe for valuable information with regard to the discoverers of bacteria, given to me since beginning the preparation of the primer, and also for helpful suggestions during -the work of proof reading; to Miss Aikens, of the Na- tional Hospital Record, for assistance in out- lining the plan of the' book ; to Miss Susie L. Wanzer, one of the old pupils of the Thomas Hospital Training School for Nurses, Charles- ton, W. Va., who so efficiently assisted in preparing the manuscript for publication, and who also made for me the drawings for cuts representing the forms of bacteria mentioned in the text. MARY E. REID. Cincinnati, O., July, 1904. INTRODUCTION TO REVISED EDITION. The kindly reception given to the first edition of Bacteriology in a Nutshell, by Superintend- ents of training-schools for nurses and by graduate nurses throughout the United States, has been much appreciated by the author. In re- vising and enlarging the primer all authorities have been consulted. The book is again sent forth with the hope and expectation that teachers and pupils in training schools may find it more than ever helpful. My thanks are again due to Dr. Zinke, of Cincinnati, Ohio, for a careful review of the revised portions of the primer ; to Miss Aikens, of the National Hospital Record, and to Dr. John E. Cannaday, of Sheltering Arms Hos- pital, W. Va., for valuable advice during the work of revision, and to Dr. Charles O. Grady, of the Charleston General Hospital, Charles- ton, W. Va., for information and clipping concerning the opsonic theory. MARY E. REID. Charleston-on-Kanawha, W. Va., October, 1907. MODIFIED OATH. The principles set forth in the following "modified oath," which the nurses of the Brooks Memorial Hos- pital, Dunkirk, N. Y., are required to take at their graduating exercises, deserve a place opposite the initial page in every text-book written for nurses.: "I solemnly promise and swear that in the practice of my profession I will always be loyal to the patients entrusted to my care and to the physicians under whom I shall serve. That I will not make use of nor recom- mend any quack or secret nostrum. That I will be just and generous to members of my profession, aiding them when they shall need aid and I can do so without detriment to myself or to my patient. That I will lead my life and practice my profession in uprightness and honor. That I will not lend my aid to any criminal or illegal practice whatever. That into whatever house I shall enter it shall be for the good of the sick to the utmost of my power. That whatever I shall see or hear of the lives of men and women, whether they be my patients or members of their households, that will I hold inviolably secret and that I will continue to observe and to study and will strive in every way for the improvement of my profession; not regarding it as a means of livelihood alone, but as an honorable and upright calling." To be loyal, to be honorable, to be just, to be gen- erous, to be pure, to be upright, to be trustworthy and "not a meddler in other men's matters," to be ob- servant, to be tactful, to be studious, all these are prin- ciples which, if they do not already possess them, should be instilled into the minds of all young women from the day they enter the training school until they leave it. All are links of grave import in the chain of "qualifica- tions of a good nurse" as well as stepping-stones toward becoming "a perfect woman nobly planned." 8 Bacteriology in a Nutshell. CHAPTER I. BRIEF HISTORY OF BACTERIOLOGY. Bacteriology is that branch of science which teaches us the evils of disease producing micro- Definition. organisms, and the benefits derived by the ani- mal world from another class which are antag- onistic to disease. The history of bacteriology can be traced back to the seventeenth century. Some au- thorities, indeed, tell us that at as early a date as the time of Caesar, 116-27 B. C, there lived Earliest a Roman author, Varro by name, who wrote of very tiny living "creatures" which were invis- ible to the naked eye, and yet they by some means gained an entrance into the system and "caused diseases difficult to treat." Almost two thousand years roll by before we learn of the germ theory of disease being again touched upon, then, in the eighteenth century, it is ad- vocated by Plenciz, of Vienna. In the year 1675 we are tQ ld that Antonius Von Leeuwenhoek, of Holland,* proclaimed Perfection to the world the perfection of his single lens by |? n le Lens means of which he had brought to light "living, moving animalcules" in rainwater. So very * Leeuwenhoek was born in Delft, Netherlands, in. 1632; died in 1723. 9 BACTERIOLOGY IN A NUTSHELL. Leeuwenhoek's Announcement. Theory of Plenciz. tiny were these objects that millions of them were found to exist in a single drop. The researches of Leeuwenhoek were con- tinued and in 1683 the world received another announcement the discovery under the com- pound microscope of a special form of bacteria in the scrapings of teeth and in saliva. This scientist presented the results of his work of research to the * Royal Society of London, England; suitable engravings accompanied the gift. We are not told whether or not Leeuwenhoek in any way connected the germs he discovered with disease causation; the sup- position of authorities is that he did not. No attempt was made to classify, separate or identify the germs discovered by Leeuwen- hoek, although many noted scientists of that century believed them to be the cause of certain changes in the tissues of the human structure. It was not until the year 1762 that Antonius Plenciz, a physician of Vienna, began ascrib- ing to the micro-organisms discovered by Leeuwenhoek the power to produce the so- called infectious diseases. The theories advanced by Plenciz were these : I. That the material which caused the in- fection was a living substance ; II. That this living substance multiplied * Leeuwenhoek was chosen Fellow of the Royal So- ciety of London in 1685. 10 BRIEF HISTORY OF BACTERIOLOGY. within the system, and that it could be thrown off by individuals and carried by the air to others ; III. That each separate infectious disease was brought into existence by a special germ which could cause no other disease ; contending, in order to uphold his belief, that as only one kind of grain can grow from one kind of seed, so also only one disease can be produced by one form of germ or micro-organism. The theory that disease germs were living things capable of growth and reproduction did not, at this time, gain favorable consideration, and it is not again advanced until almost sixty years have elapsed. In the year 1821, *Henle, an anatomist and scientist of Germany, again gave expression to the conviction of the truth- fulness of the theory, but only to be met with the opposition which defeated Plenciz. Henle, however, is said to have successfully met and overcome all the objections of his opponents, and shortly after this time the relation of micro- organisms to disease was scientifically proven Theory 8 although many still remained sceptical. Accepted. One point over which there was a great deal of discussion during the century and a half between the discoveries of Leeuwenhoek and * F. Gustav Henle, born at Furth, Bavaria, 1798 ; died at Gottingen, 1885. Was professor at Zurich, 1824; Heidelburg, 1844, and at Gottingen, 1852. ii BACTERIOLOGY IN A NUTSHELL. the acceptance of the theories of Plenciz through the demonstrations of Henle, was the origin of these germs. "Do they generate spontaneously or are they the descendants of pre-existing creatures of the same kind? Theory of *Karl H. Schulze, also of Germany, was the first to throw any light on this rather mystify- ing question. In 1836 he demonstrated the fact that "if the air which gained access to the material which was being experimented upon could be made to pass through strong acid or alkaline solutions decomposition would not take place." Other scientists began to work along the same lines and obtained similar results. Their experiments, for the most part, were made upon wounds and their infections. They made no attempt to reproduce the infectious diseases by inoculation, which is the method used in our day. Numbers of scientific men of that period believed the presence of micro- organisms in the blood and tissues of individ- uals to be a normal condition. Others urged that the micro-organisms found in diseased conditions were the result of the disease and not its cause. A number of years passed before the work of discovering a special germ for each infectious disease made much progress. * Karl Heinrich Schulze, physician and anatomist, born at Ault, Ruppin, in 1798. Professor at Berlin in 1833- I2 BRIEF HISTORY OF BACTERIOLOGY. In 1847 Ignatius P. Semmelweis, a young Hungarian pursuing his studies in Vienna, pro- Ploclamation claimed to the world one of the greatest dis- Semmelweis. coveries ever made along bacteriological lines, namely, that puerperal sepsis is the result of the invasion of the puerperal genital tract by specific micro-organisms and from that year a new era in obstetrical practice is dated. Semmelweis, among other medical students, was allowed to assist at births in the maternity wards of a large general hospital where there were also a number of midwives employed. Semmelweis soon observed that a large mor- tality, about fifteen per cent (15%) occurred in the student's clinic, and almost invariably from puerperal fever. In the clinics in charge of the midwives the mortality rate was very low in comparison, only about 1.5 per cent. He began to study into the reason for the greater success of the midwives. He soon had cause to suspect that the dissecting-room work of the students was at the root of the trouble. One of his fellow-students died from the effects of an infected finger, which he had cut during a post-mortem. The symptoms in this case were so similar to those observed in the deaths due to puerperal fever in the maternity wards that Semmelweis's eyes were opened to the dangerous practice of the students who often went directly from the dissecting-room to their 13 BACTERIOLOGY IN A NUTSHELL. cases in the maternity wards, with little thought, apparently, as to the condition of their hands. Semmelweiss immediately began to scrub and disinfect his own hands before ap- proaching the beds of his maternity cases, and soon found his efforts crowned with success. Then he insisted upon his fellow-students practicing the same routine. The mortality rate in the students' clinic thereafter became much less than that of the midwives. The dis- infectant used by Semmelweis and his co- workers was chlorine solution. In spite of the success of this conscientious worker, there was much scepticism with regard to his theory, and he died in an insane asylum, his malady the re- sult of worry over unfriendly criticism. In 1849 the germ which causes anthrax was discovered by Pollender, of Germany, but it was not until the year 1863 that *Casimir Joseph Devaine, a Frenchman, by the process of inoculation proved that Pollender 's germ really produced anthrax. In 1862 * Louis Pasteur, of France, the fame of whose work at "Pasteur Institute," Paris, is world wide, first began his experiments to prove that living organisms are in the air we breathe, in the food we eat, upon the clothing * Casimir Joseph Devaine, born at St. Armand-les- Eaux, France, in 1812; died in 1882. * Pasteur was born at Dole, Jura, France, in 1822 ; died in 1895. 14 BRIEF HISTORY OF BACTERIOLOGY. we wear, in the dust we tread beneath our feet, and that they may be found any place where dust settles. It had long been contended that the processes of fermentation and putrefaction were purely chemical processes and not the work of micro-organisms. It was proven also through the experiments of Pasteur that the reproduction of bacteria takes place by pro- cesses similar to those which cause the repro- duction of larger vegetable or plant life and not by spontaneous generation. Many other im- portant discoveries are credited to the experi- ments of Pasteur. In fact, some scientific men of the present day go so far as to say that the real history of bacteriology dates no further back than to the experiments and discoveries of Pasteur ; that while it was not he who first dis- covered the existence of germ life, nor who first studied bacteria, nor who first suggested their connection with fermentative processes and with diseases, yet it is to his experiments we owe the placing of bacteriological study upon a firm basis, and that all the history of micro- Lessened by organisms which antedates the experiments and discoveries of Pasteur is merely theoretical, more likely to be erroneous than otherwise. In 1872 Klebs began to teach that general sepsis is caused by bacteria invading the blood. Klebs is of German birth; he was born in BACTERIOLOGY IN A NUTSHELL. Koenigsberg; he was educated at Berlin, and later in life ( 1882-92) was professor at Zurich. In 1873 tne micro-organism of relapsing fever was discovered. To Obermeier, of Gei- many, belongs the credit for this discovery. In 1875 the germ theory of disease was Antise ^is pretty generally accepted, at least by the scien- tific world. In that year Lord Lister, an English surgeon, who later (1877) was pro- fessor in King's College, London, began the use of antiseptics in surgery. He based his experiments upon the discoveries of Pasteur. Carbolic acid solution was the first substance used by Lister in his surgical operations, and thus was ushered in the era of antiseptic; surg- ery. Only thirty-two years have passed, and yet to what gigantic proportions has grown the use of substances to either destroy germs or to prevent their doing mischief by stopping their growth! Carbolic acid solutions still remain in common use. The bacillus of leprosy,* the bacillus leprac, was discovered by a German scientist, Hanson, in 1879, and in the same year the micro-coccus of gonorrhoea by Neisser. (Neisser is also of * In July, 1904, Rost, of the medical staff in India, reported that he had succeeded in cultivating the bacillus of leprosy and from the cultures had made a substance he called "leprolin," which, when injected into the tissues of lepers, had a marked beneficial effect. 16 BRIEF HISTORY OF BACTERIOLOGY. German birth, probably located at Munich at Later this time.) The bacillus typhosus, the germ of typhoid fever, was discovered by Eberth and Koch, of German, in 1880. And in that year (1880) came also the dis- covery of the germ of pneumonia. Some writers give the credit (or discredit) for causing this disease to the micro-organism observed by General Sternberg* of the United States Army; others to the diplococcus lanceolatus, discovered by *Frsenkel of Berlin, who was professor at Halle. Recent investigation has shown that the diplococcus discovered by Frsenkel is probably the sole cause of genuine acute, lobar pneumonia, although other germs, one of which is the "pneumo-bacillus of Fried- lander," are said to be sometimes found asso- ciated with this form of the disease. Several germs are believed to be capable of causing broncho-pneumonia. In 1882 the name of Robert Koch* sprang into fame when he made the greatest of his Kpch's Discoveries. many discoveries the germ which is the cause * Authorities assert that the germ observed by Stern- berg and the diplococcus lanceolatus are probably iden- tical. Fraenkel associated the germ with pneumonia causation; Sternberg apparently did not. * Koch, born at Klausthal, Germany, in 1843. Led the German expedition which in 1883 went to Egypt and India to investigate cholera. In 1890 announced a cure for tuberculosis, the power of which experience did not demonstrate. 17 BACTERIOLOGY IN A NUTSHELL. of all forms of tuberculosis. This discovery is not only to be considered the greatest of Koch's discoveries, but one of the greatest discoveries of the age, as to tuberculosis, in one or another of its forms, is due at least one-sixth of all the deaths which occur yearly in the human family. Had the remedy for this disease, prepared by Koch, proven a success, he would have im- mortalized his name in very deed. In 1884 Koch made another discovery, namely, the comma bacillus of cholera; so- called because of its peculiar shape. (Pasteur p discovered the germ of chicken cholera in of Other 1880.) In 1884, also, the germ of diphtheria, ltlsts * called the bacillus diphtherise, was discovered by Loeffler, and the bacillus of tetanus, called the bacillus tetani, by Nicolaier. The germ which causes "la grippe" was dis- covered in 1892 by Pfeiffer. Loeffler. Nico- laier, PfefTer, are all of German nationality. (Leudwig Pfeiffer, born at Eisenach in 1842, lives at Weimar. ) In 1894 came the discovery of the bacillus pestis, the germ of the Eastern bubonic plague by Yersin, of France, who was at this time pur- suing his scientific investigations in China. Kitasato, a Japanese, working independently of Yersin, during an epidemic of bubonic plague in Hongkong in 1893-4, discovered the same germ and the result of their researches 18 BRIEF HISTORY OF BACTERIOLOGY. was proclaimed to the world almost simultan- eously. In 1897, the discovery of the bacillus of yel- low fever was reported by Sanarelli, a Spaniard. This germ was not accepted be- cause it failed to comply with certain requisite scientific tests. (Koch's circuit, spoken of in chapter IV, was not proven.) The same is said of the germ found in carcinomatous speci- mens, and of the germ of small-pox reported by Dr. William T. Councilman, of Harvard College, in the spring of 1904. It is now definitely known that the spirochetae pallidae, discovered by Hoffman and Schaudinn, of Ger- many, in 1905, is the germ of syphilis. New methods of staining cultures used in 1906-07 by these and other scientists working independ- ently have brought to light the true relation- ship which this germ (hitherto considered doubtful), bears to the loathsome disease, syphilis, the micro-organism of which has for so many years remained a mystery to the med- ical profession and to other scientific workers. Authorities in both Europe and the United States are now satisfied as to the authenticity of the spirochetae pallidae. The germs which cause many of our most common cummunic- able diseases still continue to be undiscovered. We are in the dark as to what parasite is re- sponsible for small-pox, scarlet fever, measles, 19 BACTERIOLOGY IN A NUTSHELL. chicken-pox, etc. Rheumatism and arthritis deformans are believed by some authorities to be germ diseases, but as yet this theory has not been proven, although an antistreptoccic serum is in use in some parts of the United States which is said to be helpful in both of these incurable diseases. SUMMARY OF CHAPTER I. The earliest days of bacteriology said to be traceable to the time of Caesar, in whose day a Roman writer hinted at the invasion of the human structure by "creatures" invisible to the naked eye and of their power to produce dis- eases. The perfection of the single lens. Nation- ality of the perfector. Discoveries of this scientist during the seventeenth century under the single lens and by means of the compound microscope. The presentation of the results of his researches together with appropriate en- gravings to the Royal Society of London, England, of which society he was afterward Fellow. Power to produce the so-called infectious diseases ascribed to micro-organisms by a scientist of Vienna. Theories advanced by this scientist. Non-acceptance of his theories: The germ theory of disease again advanced 20 REVIEW. about sixty years later and its successful demon- stration. A short account of one of the subjects which caused much discussion during the century and a half between the discoveries of the Hollander and the acceptance of the theory of the scientist of Vienna. The man who first threw light upon the mystery surrounding this vexed question and the manner in which he carried on his experi- ments. Work and its results along the same lines by other scientific men of that period. Errors of some of the early students of bac- teriology. Slow progress in discovering a special germ for each infectious disease. Men who are considered to have made the most valuable contributions to bacteriology and their discoveries. QUESTIONS FOR REVIEW. I. Who perfected the "single lens" and what were the first discoveries made by its per- fector? In what year did he announce his discoveries ? Are these the earliest discoveries of which we have any account ? II. In what year were later discoveries an- nounced by this scientist? How were these discoveries made ? To whom were the results of his researches presented ? 21 BACTERIOLOGY IN A NUTSHELL. III. What attempts were made to classify, separate and identify the germs discovered, and were they believed to be in any way connected with pathological changes in any particular part of the body ? IV. Who was -the first physician to ascribe to micro-organisms the power to produce the so-called infectious diseases? In what year was the announcement made ? Was the theory accepted ? V. Who is said to have been the first to successfully demonstrate that the germs dis- covered in the seventeenth century could pro- duce diseases? VI. Describe in detail one of the chief points of discussion during the years that elapsed between the discoveries mentioned and their acceptance as disease germs. Tell of the man who first threw a gleam of light on the vexed question, of the means used, of others who followed the same method of research, the results gained. VII. Mention some of the errors of early students of bacteriology with regard to the germ theory of disease. To whom do some bacteriologists ascribe most credit for the firm basis of this theory in the present day? VIII. By whom and in what years were antiseptics first used? In what class of cases 22 REVIEW. were they used? What were the first sub- stances used? Are they still in use and are they now considered valuable antiseptics? IX. By whom and in what year was it first taught that bacterial invasion is the cause of puerperal sepsis ? What became of this scientist? Who first taught the theory of general sepsis? X. By whom was the germ of typhoid fever discovered? In what year was the discovery made ? Mention other discoveries made by one of these men? Which is considered to be the most important of his discoveries and why ? XL Name some of the important dis- coveries made during later years and their dis- coverers. XII. Mention some diseases now consid- ered to be caused by bacteria and explain why the germs discovered in one or two instances have not been accepted as the originators of the trouble. CHAPTER II. Revelations of the Microscope. Cell Formation. Organs and System. THE RELATION OF BACTERIA TO DISEASE BAC- TERIA IN PROCESSES OF NATURE. Mysteries concerning the origin of numerous diseases, which must otherwise have remained mysteries forever, have been made more or less clear since the perfecting of the microscope. Prior to the revelations made by the use of this instrument, very little was positively known concerning the formation of the various ele- ments of which the machinery of the human structure is made up and by which it is kept in running order. Now scientists are able to trace the human body back to the time when it was but a single cell, from this single cell to watch its growth and development into in- numberable single cells, to see the single cells fold into layers, these in their turn to form the groups of cells out of which the various bones and muscles and nerves and tubes and tissues of the body are composed. These groups we call the organs and systems of the body. Each has its own work to perform, and each exists to a certain extent independently of the other. Yet all are so intimately related and connected in their efforts to maintain life and health that \vhen disease comes to one group of cells 24 BACTERIA AND DISEASE. posing a system, other groups composing other systems suffer also. The group of cells from which the muscular Action of system is made up, by their united action, called Various Cells. into play by nerves, produce our movements. Another group of cells forms the liver and har- monious action of this group is necessary in order that impurities be removed from the blood. Certain fluids which are essential to the welfare of the body are also manufactured by this group. The brain is composed of another group of cells of a different type; from these thought and intelligence emanate, and from still Nerve Cells, another group is composed the nerves which convey messages to and fro between the brain and the outer world and so on. When these various groups are all "in tune" then the human body is in a state of health, when they are "out of tune," we speak of the body as in a state of disease. In a state of disease our work is no longer a pleasure to us ; our hours of recreation are no longer a joy. Our days are filled with discomfort and our nights are robbed of rest and sweet sleep. As nurses, then, let us grasp this thought that "disease is a derangement of the structures or functions of the body," and in order that the 011 human structure remain healthy, there must be harmonious action between separate types or groups of cells. If one group fails to work 25 BACTERIOLOGY IN A NUTSHELL. harmoniously, then comes a disturbance of the harmony of the other groups, and because of this disturbance there comes disease. For ex- ample : If there is trouble in the nervous system, then, too, we find the digestive system is affected, and vice versa. So we may go on through the other systems and find them all more or less dependent one upon another. The causes of disease are many and varied. One of the most serious causes, as revealed by scientific research, is the invasion of the differ- Bacteria a en t or g ans anc j systems of the human structure Disease. by a species of bacteria; these it has been proven produce many of the so-called infectious diseases. Bacteriological research tends to the belief that certain forms of moulds and pro- tozoa the simplest form of animal life, and one which is distinguished from all other animal groups because it consists of but a single cell are also causes of some of the "infectious diseases." So much has been said and written , on "the relation of bacteria to disease" that many people fail to discriminate between the bacteria which are our friends and those which are our enemies. As pupils in the study of bacteriology we learn that the term bacteria is applied by scien- tists to the large group of minute vegetable micro-organisms, commonly called "germs" or "microbes." This name was first given to 26 BACTERIA AND DISEASE. them about the year 1869, after * Hoffman had Bacteria demonstrated that these tiny mysteries occu- Explained, pied a class by themselves, quite distinct from yeast plants and moulds with which they had been confused in earlier days of bacteriological research. For years scientists had been unable to decide as to whether bacteria were members M . Animals or of the plant family, or whether they were the plants. offspring of animal life, for the reason that they were found to possess characteristics of both families or kingdoms. When it was dis- covered under the microscope that some of the bacteria are spore-forming, their classification as members of the plant or vegetable kingdom was determined. Absence of chlorophyl, the name given to the green coloring matter of plants, caused doubt to arise in the minds of many; chlorophyl is the property in plant life, which enables them to cause decomposition of carbon dioxide and ammonia and to consume as food their products. Bacteria, lacking this property, feed upon the same forms of food as the higher animals consume. All forms of bacteria may be divided into two great classes in order to simplify for study. Saprophytic These two classes are called the saprophytes, and the parasites. The saprophytes, which are the friends of all animal life, are many times * Hoffman was a German botanist. Born at Roe- delsheim, 1819; died at Giessen, 1891. 27 BACTERIOLOGY IN A NUTSHELL. more numerous than the parasites. Parasites are enemies to animal life; they are the so- called "disease germs" or "microbes" ; they exist only at the expense of other living bodies. They invade various parts of the living body and under favorable conditions they weaken and sometimes destroy the parts they invade. They take away from us substances on which our health is dependent, and deposit in their place that which poisons and frequently com- pletely destroys. Because of their power to produce pathological changes in animal bodies, parasitic bacteria are also called pathogenic bacteria. Saprophytic bacteria are not only our friends, but they are of such benefit to mankind that we could not live without them. They live upon dead organic matter, and by their activities de- composition, fermentation and putrefaction are produced. Nourishment necessary to the sus- tenance of vegetable life is derived from car- bonic acid gas, ammonia and water, which are all produced by the action of saprophytic bacteria on dead animals and vegetables. Veg- etable and plant life would cease to exist if the carbon and nitrogen to which they owe their growth and development could not be obtained from this source. Animal life is sustained by the oxygen thrown off by trees and plants and to a certain extent by the food obtained from 28 BACTERIA IN PROCESS OF NATURE. the vegetable world ; therefore, the work of the saprophytes is necessary to the existence of all forms of life. With regard to the work of saprophytes as our friends in the processes of Nature, let us Bacteria in look a little farther into this phase as explained presses to us by scientists. Let us see why it is that they play so important a part in these processes, and how it is that they are so completely inter- woven with the vital powers of nature, that life in all its forms would vanish from the earth should their activities cease. When as children we explored the woods and perched ourselves upon fallen tree trunks and Decay of Trees saw them dropping into decay, how many of us a ants ' now studying bacteria in regard to their con- nection with our work as nurses ever associated the process of decay with the activities of germs? Today we are taught that bacteria play an important part in this process after the hard, woody substance of the tree has been softened and prepared for their work by moulds. Then, after the tree has been attacked by bacteria, it drops to pieces as a yellowish brown deposit, to mix with dead leaves and sink into the soil as a fertilizer to promote the growth of healthy plants and trees that inhabit the forest. The same thing happens in decay of dead plants and animals. In decomposition of ani- 29 BACTERIOLOGY IN A NUTSHELL. mals saprophytes play a still more important part, as it is by their agency alone that the work on every part of such bodies is accomplished, and the preparation made for mixing with the soil and the atmosphere. Whatever of the de- cayed substance of tree and plant and animal is not of use as a fertilizer is disseminated in the form of gases to be taken up by the air, to be returned to the elements from which they came again to be used in the formation of something else in the various processes of Nature. So plant and vegetable and animal life are renewed and sustained in a great measure through the fertilization of the soil by decomposition of dead plants and vegetables and animals, and by the gases they disseminate, none of which would come to pass without the activities of bacteria. We inhale from the atmosphere oxygen, Where which is absolutely necessary for the sustenance Obtained* 8 ^ an ^ ma ^ ^e, and which is thrown off for our use from growing plants and trees and other forms of vegetable life. We exhale carbonic acid gas, or "carbon dioxide," which, together with the influences of the sun and the rain, is necessary for the growth and sustenance of trees and plants and vegetables. This is one way, among others, in which the animal kingdom is necessary to the vegetable kingdom and vice versa, the plant and vegetable world giving off 30 SUMMARY AND REVIEW. oxygen for use of the animal world, and the animal world in its turn supplying the plant and vegetable world with carbon dioxide in a ceaseless round. All other foods used to sus- tain animal and plant life are so arranged by _* , Nature in the processes of Nature as to be used again and pood Supply. again in a continuous circle, first by plants and then by animals, and then over again by plants, the circle to endure so long as the sun shines and the rain falls to promote its continuance. Many of these processes require much thought in order to understand the intricate workings of Nature. Those who undertake the study in earnest find it of special interest. Not the least interesting phase is the way in which nitrogenous foods, so necessary to animal life, take their place in the continuous circle, and how, through the assistance of bacteria they are prepared to return to take part in the main- tenance of plant and vegetable life. Bacteria which assist in the sprouting of seeds and in other processes of Nature in farm and garden, form an interesting study, also. SUMMARY OF CHAPTER II. Mysteries with regard to diseases revealed by the miscroscope. Cell formation and the formation of the or- gans and systems. 31 BACTERIOLOGY IN A NUTSHELL. Health of the various organs and systems of the body dependent one upon another. Functions of some of the groups of cells. Derangement of the structure and its func- tions the cause of diseases. Bacteria as friends and as enemies. Application of the term bacteria. Length of time the term has been in use and the scientist who first distinguished the group from yeasts and moulds. His nationality. Difference in size of the saprophytic and parasitic families. What we understand by the term pathogenic bacteria. Saprophytic bacteria and the benefits derived from them by the animal and the vegetable kingdoms. QUESTIONS FOR REVIEW. CHAPTER II. I. How has the perfecting of the microscope been of benefit to mankind in a special way ? II. Give in detail some of the mysteries with regard to the human structure as revealed by the microscope since its perfection. III. Are the different systems of the body in any sense independent systems? Give one reason why they are not entirely independent. IV. Mention the functions of the groups of cells spoken of in this chapter. 32 SUMMARY AND REVIEW. V. Explain what you understand by the term "disease" and give the cause of one serious form of disease. VI. Into how many classes may bacteria be divided in order to simplify for study? VII. Define bacteria, pathogenic bacteria, saprophytic bacteria. VIII. Prove that pathogenic bacteria are foes to health. IX. In what way do saprophytes benefit mankind ? X. Explain what would happen to plant and vegetable and animal life if saprophytic bacteria should be destroyed or become inac- tive? Give reasons for your answer? 33 CHAPTER III. Morphology Defined. Micro-cocci. Bacilli. DESCRIPTION OF THE MOST IMPORTANT BAC- TERIA, METHODS OF MULTIPLICATION, ETC. MORPHOLOGY is that branch of science which treats of the classification of bacteria with re- gard to their shape, outline, structure and their methods of grouping. Placed in broth, bouillon or other substance they are cultivated, and much useful information has been gained with regard to the habits, etc., of these tiny specimens of vegetable life. It has been found by studying them under the microscope, that all bacteria of any import- ance are either "sphere," "rod," or "spiral" shaped, and so they are divided into these three classes. The spherical may be perfectly 41 round like a ball or marble, or they ^ may be oval or egg-like; they vary in size and many are imperfect in Spheres. . shape. The name - given to all bacteria of this formation is "cocci," or "mi- crococci. Rods. The rod-shaped may be long or short, square or round at the ends, thick or thin, but all bear the com- mon name of "bacilli." The larg- est number of disease germs are of this class. 34 MORPHOLOGY. The spiral-shaped somewhat resemble the twisted part of a Spirilla, corkscrew, and whether they have few or many curves, whether loosely or tightly twisted, the one name, "spirilla," covers all of this Spirals. variety. Modifications or subdivisions of the cocci have also been determined by watching their manner of forming into groups as seen in grow- ing cultures. Staphylococci is the term used to describe those which group in masses like grape- Staphylococci. clusters. Streptococci, to describe those with method 04 . Streptococci. of grouping into chain-like sections. Other forms of the micrococci are found to group in pairs, and to describe these the term diplococci is used. Those which form into groups of four are 11 j ^ j Tetrads. called tetrads. Still another form is seen to make up groups of eight and sixteen, and to describe these we Sarcinae. use the term sarcinae. There are two main subdivisions of the bacilli, namely ; bacilli which are spore-forming, and bacilli which are non-spore-forming. By the term spores we mean seeds or eggs of the bacilli. All forms of bacteria are dependent upon 35 BACTERIOLOGY IN A NUTSHELL. Food. Temperature. Size of Bacteria. certain conditions for their development ; these conditions are a certain temperature and food proper soil, and in some instances air. Pathogenic bacteria require organic matter to feed upon. Vegetable or animal matter, fluid or solid, fresh or decayed, all kinds are adapted to their use as food, but the blood and juices of the animal body tissues are specially favorable material for their growth and de- velopment. The temperature of the human body, viz., 98.6 F., is the most favorable for the multi- plication of pathogenic bacteria, although they will also multiply quite rapidly in a lower temperature; 70 F. (ordinary summer heat) is sufficiently high. Below 70 F. their growth is slower and has been found to cease at 60 F. A temperature of 110 F. is believed by many to prevent their growth. Size of bacteria is a part of their description difficult to determine. So tiny are they that it is only under the highest power of the micro- scope that scientists are able to study them at all. One of the largest of the bacilli is said to be about 1-12,000 of an inch in length, and 1,50,000 of an inch in thickness. We are told that it would take six thousand billions of the average sized bacilli to weigh one grain, and that fifteen hundred of the largest bacilli if placed end to end would not reach across a MORPHOLOGY. small pin head. Some forms of bacteria move about quickly, through flagella, an appendage which is lash-like in appearance and by means of which they are made to resemble a form of animal life. Other bacteria are very slow in their movements. Weigert* in the year 1877 discovered that micro-organisms could be colored by the use of Weigert's Discovery. aniline dyes, so as to be distinguished from the media in which they are cultivated. Up to that time great difficulties stood in the way of their successful study, because of their transparency as well as their minuteness. Since Weigert's discovery that they can be colored, many of the peculiarities by which their varieties are deter- mined have been pointed out. We have said that one condition necessary to the growth and development of bacteria is proper soil. A perfectly healthy body with normal resistive power is not favorable soil for the development of disease germs. In such a body certain cells exist which are foes to these germs ; they have the power either to absorb or destroy disease-producing bacteria. These cells are found in the white corpuscles of the blood, the leucocytes, and are called pha- gocytes; the process of destruction or absorp- tion is known as phagocytosis. The name * Professor Carl Weigert, anatomist at Frankfort, Germany. 37 BACTERIOLOGY IN A NUTSHELL. Function of phagocytes (from the Gk. phago "I eat") was Phagocytes. / . , ., ' A . } given to these cells by the man who discovered their province, the scientist, *Elie Metchnikoft", a Russian, one of the most distinguished bac- teriologists of the present day and who is carrying on his work at Pasteur Institute, Paris, France, as successor to Pasteur. While scientists differ as to the method of warfare as carried on between, the cells of the body, termed phagocytes, and the germs of disease, all agree that the healthy body has the power to overcome and exterminate such foes by their means. Scientists who are not associated with the school of Metchnikoff, teach us that there are properties contained in the serum of the blood known as opsonins, discovered by Sir Almoth Wright, of England, which assist the phagocytes very materially in their work. They prepare the pathogenic bacteria in some unexplained manner, making them more readily digested and absorbed and then attract them toward the phagocytes. The body which is not healthy, and in which normal resistive power is absent, on the other hand is not able successfully to fight disease- producing germs which invade it at one point or another, they overcome weakened resistive forces, increase and multiply within the body, * Metchnikoff was born in the government of Kharkoff in 1845. Was professor at Odessa in 1870. 38 MORPHOLOGY. and we become victims of the disease the special form of bacteria present produces. There are two methods of multiplication in the bacterial world fission and spore forma- tion. The method by which micro-cocci and spirilla multiply is termed fission; fission in Fission, common everyday language means simply di- vision. They rapidly separate or divide into a number of sections, each of which soon leaves the parent cell, and in turn divides into other sections or parts. The micro-cocci before fission takes place elongate or lengthen out, they then divide in the center, each half again divides and these new sections also repeat the process again, and again. In many instances they divide at right angles to the first division and again at right angles, forming in this man- ner the groups of two, four, eight and sixteen, which have been mentioned as the "diplococci" "tetrads" and "sarcinae." Those which upon division do not immediately become detached one from the other, but which form into chain- like sections have also been described as bear- ing the name of "streptococci." Others again that remain grouped in clusters, we have learned are called the "staphlo-cocci." The process of division and subdivision is kept up as long as the germs have proper soil to exist 39 Bacilli Method of Multiplication. Spore Forming Bacilli. BACTERIOLOGY IN A NUTSHELL. upon, and provided, also, the food temperature, air and moisture are such as they require. Bacilli multiply in much the same way and under conditions similar to those required by the micro-cocci and spirilla. This is especially true of the bacilli which are non-spore-forming. With regard to the spore-forming bacilli, when they can no longer obtain sufficient or proper food or surroundings, they shrivel or dry up and appear to be dead. They may keep up this semblance for months, but let conditions once more become favorable for their develop- ment and we soon find they not only are not dead, but are not even sleeping merely resting. Place them in suitable culture media, for in- stance, and immediately they begin to germi- nate and produce innumerable micro-organisms of the same variety as those from which they sprang. They do not reproduce other spores at once, but never fail to reproduce that char- acteristic variety of bacillus which is spore- forming. Fortunately for the human family the number of spore- forming bacteria is small, and not one is known to be instrumental in producing a pestilential, epidemic disease. There are certain changes which take place in the bacilli when the process of seed or spore development is about to begin. Spores, or seeds, are made up of tiny particles of the protoplasm or active, life-giving substance of 40 MORPHOLOGY. which bacilli are composed. They form some- times at one end of the rod, sometimes at the Spore r . 1 Formation, other end, and again they may form in the center of the rod. They at first appear to be just tiny spots, or dots in the protoplasm of the parent bacillus, but very soon they begin to divide off and are easily distinguished under the microscope as tiny seeds or eggs which scientists call "spores." They rapidly increase in size and break through the framework of the bacillus, the non-essential part of which usually dies and the seeds or spores are left behind in a protecting cover or capsule. This cover or capsule is said to enable spores to resist in- fluences that would very quickly destroy other forms of bacteria. The power possessed by _ / Resistive spores to resist heat and drying is found to be Power of almost incredible. Bacteriologists assert that s P res - some forms of spores live on after they have been exposed for a brief period to a tempera- ture of 360 F. Other forms have been treated to a bath of boiling water for a longer period, and yet both have come through these processes alive and have again germinated. While the parent bacillus, as a rule, is sup- posed to die during spore formation, because the spores use up the protoplasm of the parent for their own sustenance, this is believed not to be true in every instance. The functions of the parent cell are said sometimes to go on in the 41 BACTERIOLOGY IN A NUTSHELL. usual way during the process of spore-forma- tion, sufficient of its protoplasm being retained to sustain life and again to renew its activities after the spores have broken through its walls. SUMMARY OF CHAPTER III. Classification with regard to shape, out- line, etc. Definitions of various names descriptive of bacteria. Methods of grouping as seen in growing cultures. Terms used to designate methods of group- ing. Bacteria which form spores and those which do not. Development of bacteria dependent upon certain conditions. Why it is difficult to determine dimensions of bacteria. Discovery of Weigert. Power of phagocytes and opsinins. The discoverers of phagocytes and opsinins. Why bacteria sometimes conquer the phago- cytes. Methods whereby bacteria multiply. Process of spore-formation. Wonderful resistive power of spores. Parent bacillus after the process of spore- formation. 442 SUMMARY AND REVIEW. QUESTIONS FOR REVIEW ON CHAPTER III. I. Why is the study of morphology im- portant, and how is it best facilitated ? II. Describe each of the three forms of bac- teria. Which of these is most common? III. Is the process of multiplication of bac- teria rapid ? If so, in what manner and under what conditions are they propagated? IV. Are pure blood and healthy tissue con- ducive to the development of the various kinds of bacteria? V. Which method of antagonizing disease germs appeals to you resistance by a vigorous healthy body, or their destruction by the use of powerful drugs? VI. What is the meaning of spore-forming as applied to bacteria? VII. Are all varieties of bacteria spore- forming? About what is the size of the lar- gest known bacillus ? VIII. -In what manner do micro-cocci and spirilla mutiply? Give term applied and its meaning. IX. Are spores easily exterminated ? What can you say of their peculiar resistive powers ? X. Does the parent bacillus remain vigor- ous after propagating its kind ? 43 CHAPTER IV. DISEASES CAUSED BY BACTERIAL INVASION. HOW BACTERIA GAIN AN ENTRANCE TO THE SYSTEM. Parkes, in his "Manual of Hygiene and Pub- lic Health," gives the following table of dis- eases due to the invasion of the human struc- ture by bacteria. He divides these diseases into five classes, viz. : CLASS I. Smallpox, Influenza, Scarlet Fever, Relapsing Fever, Measles, Diphtheria, Mumps, Erysipelas, Chicken-pox, Typhus, Whooping Cough, Epidemic Pneumonia. CLASS II. Yellow Fever, Dysentery, Cholera, Diarrhoea. Enteric (Typhoid) Fever, CLASS III. Anthrax or Malignant Pustule, Vaccinia, Foot and Mouth Disease, Ophthalmia, Leprosy, Syphilis, Glanders, Gonorrhoea, Rabies, Tetanus. CLASS IV. Erysipelas, Hospital Gangrene, Septicaemia, Puerperal Fever. CLASS V. Tuberculosis, including Lupus and Scrofula. 44 PARKE'S LIST, ETC. I. Diseases placed in class one are desig- nated as air-borne, or, in other words, diseases which may be carried and communicated by floating dust. II. It is claimed that diseases placed in class two may be carried and communicated by floating dust or taken into the system in water. The "air or zvater borne" diseases, so-called. III. Inoculation, as a rule, is the means of communication of diseases mentioned in class three. IV. A surface lesion is said to be necessary for the communication of diseases in class four. When this lesion is present the disease is com- municable by direct inoculation or may be transmitted through the air. (By "lesion" we mean a wound, hurt, or other local alteration of tissue from a higher to a lower condition.) V. In class five a surface lesion is not neces- sary and the disease is communicable either by direct inoculation or through the air. It must be borne in mind, however, that authorities differ as to the mode of entrance Authorities of some of the bacteria and that theories change Differ - as new light is thrown on the subject. The science of bacteriology is still rapidly pro- gressing. The alimentary canal, the respiratory tract, the genital tract, the mucous membranes, 45 Channels of Entrance. Period of Incubation. Why Multiplication Ceases. BACTERIOLOGY IN A NUTSHELL. wounds and the skin, all form channels where- by infection is conveyed to the various parts of the body which are seats of attack for pathogenic bacteria. An incubation period, which varies in dura- tion, is common to all forms of disease caused by the invasion of bacteria. During the incu- bation period there are no symptoms of the disease. The germs have gained admission to the body by one or other channel of entrance and a war is being waged between the invaders and the antagonistic cells already spoken of as phagocytes and opsinius. Under favorable circumstances the invaders do no harm, they are destroyed by their foes and are thrown off from the body in the excretions. If the powers of resistance are weakened in any way, by the presence of any other disease, for instance, the influence of the phagocytes is lost and the period of incubation ends in another period wherein the power of the invading bacteria is made manifest and symptoms arise followed by more or less serious results. In each specific disease the infection is thrown off from that part of the body which is the seat of the invasion. During the course of a communicable or specific disease there comes a time when there is no longer any suitable nourishment for the growth and development of the micro-organ- 46 NATURAL IMMUNITY. isms and then the disease is starved out. Sometimes the action of the germs upon the cells of the body produces a condition which is poisonous to the germs themselves and thus they are destroyed by the products of their own vital activities. In either case the tissues are left in a state of immunity from that particular Immunity, disease for a longer or shorter period, some- times for life. We are told of three forms of immunity. I. Natural immunity, which is the natural and constant resistance of the antagonistic cells Natural or phagocytes to the development within the mmumt y- body of pathogenic bacteria. II. Acquired immunity, which is that im- munity given to the body, or which the body Acquired gains, by a single attack of a certain com- municable disease. III. Artificial immunity, which is that im- ., -11111 Artificial munity given to, or gained by the body, immunity. through the use of antitoxins. NATURAL IMMUNITY. Let us look into the subject of natural im- munity and the part played therein by several allies to the phagocytes. First, let us consider the protection afforded the healthy human body by its inner arid outer surfaces. 47 BACTERIOLOGY IN A NUTSHELL. We have said in another chapter that bac- teria exist everywhere. Our skin, finger-nails, hair follicles, etc., all harbor them. Their numbers are limited only by the cleanliness of the individual and even on the surface of the bodies of the most cleanly the existence of some pathogenic bacteria is a normal condition. It has long been an open question whether or not micro-organisms found upon the skin can gain admission, find their harmful camping ground and bring about diseases unless the skin has a broken surface, or is in some way in jured. In some instances it has been proven that in- jury or abrasion is not always necessary in order that germs of disease penetrate the skin and do us harm. Entrance through an abso- lutely unbroken skin is a rare occurrence, how- ever, and then it is believed that the portal of entry is either through the openings of the sweat glands or the hair follicles. When in- vasion takes place, we find as a result that such troubles as pustules, boils, carbuncles, etc., caused by pus-forming bacteria arise. As a rule, while the sebaceous glands, which are the appendages of the hair follicles, do not secrete germicides, the perspiration is of an acid nature, believed to be slightly germicidal and it also contains salts which cause it to be an enemy not easily overcome by certain forms of NATURAL IMMUNITY. disease germs. The unbroken skin does not absorb bacterial toxins. Subcutaneous connective tissue sometimes forms a formidable barrier to the entrance of pathogenic or disease germs even after they penetrate the skin, although there are excep- tions to this rule, also, as there are exceptions to all general rules. The mucous membranes by reason of their moist condition favor the growth and develop- Mucous ment of a number of bacteria ; yet, by a certain mechanical process, these are constantly ex- creted and removed without causing the per- fectly healthy any harmful result. Certain conditions of the conjunctiva favor the entrance of harmful germs, yet the con- The stant mechanical action of the eyebrows, the Conjunctiva. eyelids, the eyelashes, the tear irrigation of the surface of the conjunctiva and the germicidal power of the tear salts ; the rapidity with which the conjunctival epithelium is found to bring about the process of repair, all of these agents tend to protect this surface from infection, healthful conditions being equal. While it is true that the cavity of the nose is a common ground for the camping of such The germs as the staphylococci, the streptococci, ose * the bacillus of diphtheria, etc., they are for the most part held in abeyance owing to the filter- ing action of the small hairs on the inner sur- 49 BACTERIOLOGY IN A NUTSHELL. face of the nose which are kept in motion as we breath in the bacteria-laden air. The curves in the nasal cavity also catch dust laden with bacteria and deposit it in the moist sur- face of its walls where it is imbedded in mucous and thrown off by the nose blowing process, if our bodies are in a normal condition. Thirty or more different micro-organisms The are said to be normally present in the mouth; among these are found some that are patho- genic. The diplococcus pneumonia and the diphtheria bacillus are among the number. Yet in a condition of healthfulness these are expelled through the action of the saliva and the desquamating of the epidermis due to the process of mastication. While saliva is not a germicide, we are taught that it exerts some influence over disease-producing germs where- by their growth and virulence are lessened. In the passage of disease germs to the vital The portions of the lungs, we have seen that the surfaces of the nose and mouth play an im- portant part in reducing their harmfulness. The surfaces of the walls of the bronchi also serve as an impediment to their progress. Here they are imbedded in a coating of mucous to be, as a general rule, coughed up and ex- pectorated unless the system is in a condition to favor the development of bronchitis, pneu- NATURAL IMMUNITY. monia, tuberculosis, etc. A neglected cold often induces such conditions. The hydrochloric acid which the gastric juice contains is said to be able to deal a death-blow stomach, to the germs of typhoid fever, tuberculosis, cholera, dysentery, and some other pathogenic micro-organisms, when they reach the stomach in food or water. The gastric juice is believed by some authorities to render many disease- producing germs harmless by digesting their poisons. As nurses, we have learned by ex- perience that such germs are not by any means always destroyed by the juices which the sur- face of the stomach secretes and expels. They reach the intestines when such powers of re- sistance are weakened through our failure to take care of our health, and typhoid fever, cholera, dysentery, etc., flourish because of our negligence. Bacteria and their toxins are often thrown off from the stomach in the pro- cess of vomiting. The protective power possessed by the secre- tions of the intestinal surfaces is limited. Bile The is slightly germicidal; it also neutralizes some Intestmes - of the toxins. The pancreatic juice has the power to destroy some of the products of pathogenic bacteria. In a state of health, harmful germs are eliminated in fecal matter. The protection against disease germs afforded the healthy human body by the surface of the 51 BACTERIOLOGY IN A NUTSHELL, genito-urinary tract, is due to the acids thrown off from the vaginal walls and the irrigation due to voiding of urine. The discovery of the province of the phago- Phago-Cytosis. cytes we have already stated is due to the researches of Metchnikoff of the Pasteur Institute, Paris. The phagocytes are in reality the leucocytes or white corpuscles of the blood. Metchnikoff was the first to discover and demonstrate and announce that these cells of the body have the power not only to devour pathogenic bacteria, but also to destroy and digest them after they are devoured. Metch- nikoff also asserts that the leucocytes have the power to excrete germicidal substances into the plasma and serum of the blood giving to the serum greater power as a germicide than it is known to possess normally. Metchnikoff also believes that the phagocytes, the name he has given to the leucocytes, may also absorb the poisons or toxins of pathogenic bacteria, and in some manner cause these to be harmless. Other theories concerning substances said to be contained in the healthy human body, which by their action render us immune or protected from the inroads of disease germs, present difficulties too great for students just beginning to look into the science of bacte- riology, and are really of more benefit to 52 NATURAL IMMUNITY. physicians than to nurses. In our work, we only need such knowledge as will serve to help us to keep healthy ourselves and to aid us in our profession as care-takers of the sick. With regard to acquired immunity which comes to us as a result of one attack of a com- municable disease. It has already been stated that in some instances our recovery is due to the death from starvation of the germs of that disease, for the reason that they have consumed all the suitable norishment that existed within us. We not only recover, but are left pro- tected (immune), for a time from a recurrence of that particular disease. Or, instead of death arising from starvation, sometimes the germs have over-reached themselves in their work of destruction and have produced within us a toxin or poison which proves to be a source of death to themselves and of protection or im- munity to us. In some diseases we are im- mune for years, sometimes for life. In other diseases the state of being immune may be only short lived. Lasting immunity is usually af- forded by one attack of such diseases as small- pox, scarlet fever, measles, typhoid fever or plague. While in pneumonia, diphtheria, cholera, etc., the protection afforded us by one attack is often very brief, and seems rather to predispose to other attacks. In artificial immunity, Metchnikoff teaches 53 BACTERIOLOGY IN A NUTSHELL. that when antitoxins are injected into a subject, they stimulate the phagocytes into greater ac- tivity and also lend to them greater power for destruction and absorption of pathogenic bac- teria and of their toxins. The substance opsonin, is said by some authorities to act as an ally to the phagocytes by rendering them easier of digestion and of absorption. While opsonin is always normally present in the blood, it is now believed by many scientists to be increased in both acquired and artificial im- munity and is of great assistance to the action of the phagocytes, not only by rendering them easier to destroy, but by attracting them toward their destroyers, the phagocytes. THE OPSONIC THEORY. The following article, by L. B. Newell, M. D., copied from the May (1907) number of the North Carolina Medical Journal, gives a very clear explanation of the "Opsonic Theory." "The immortal Pasteur realizing the im- mensity of the subject of the causation of disease by germs and seeing the effect of the use of vaccine upon smallpox, uttered the prophecy that the day would come when we would treat all bacterial disease by vaccination. Nature takes ample care that we find out 54 THE OPSONIC THEORY. her secrets only after an infinity of work, yet as the years go by we begin to realize more and more how prophetic were the words of Pasteur. Step by step biologists, bacteriolo- gists, pathologists and therapeutists have been drawing nearer the goal, each investigator profiting by the errors of his predecessors each coming a step nearer the truth. Years ago Metchnikoff promulgated his theory of Phagocytosis. Since his time it has been known that when bacteria enter the tissues of the body the system at once en- deavors to combat their invasion by sending vast numbers of white blood cells to meet the enemy. To that mysterious power of attrac- tion which exists between the invading bac- teria and the leucocytes, or phagocytes, we have applied the term chemiotaxis. The pha- gocytes have the power under certain circum- stances of picking up the microbes, ingesting them and killing them. Metchnikoff, believ- ing that the leucocytes were the only active elements in the process of phagocytosis, held that the fluid portion of the blood was merely an indifferent medium. Others taking up the work found that the serum is far from being inactive or indifferent. They found that the invading bacteria are in many cases victorious and overcome the defensive leucocytes. And this led to the question why either the bacteria 55 BACTERIOLOGY IN A NUTSHELL. on the one hand or the white blood corpuscles on the other hand are not always victorious. Attempts to answer this have given rise to many theories and much theorizing. Over in one of the great English hospitals there is a man, Sir. A. E. Wright, who has asked this ques- tion and has answered it with such finality that the scientific world has almost accepted it as proved. He has found that there are in the blood serum or plasma certain substances which act upon bacteria in such a way as to prepare them to be ingested and destroyed by the leucocytes. Without this substance or these substances the leucocytes are powerless. To this power, substance or property of the blood has been applied the term Opsonic derived from the Latin word Opsono meaning "I pre- pare food for" or "I prepare for dinner." For our purposes it matters little what the proper- ties and characteristics of opsonins are. Ap- parently there is a different opsonin in the blood for each form of bacteria. It is a fact readily observed that an individual often succumbs to one infection more readily than to another; likewise the same individual at one time seems immune to a certain bacterial disease, at an- other he quickly falls a victim to the same affection. According to our opsonic theory we would explain these facts by the varying degree of opsonic power of the blood. Instead 56 THE OPSONIC THEORY. of saying that the infection is more virulent or that his vital resistance has been reduced we say the opsonic index is low. It is claimed by the discoverer that there actually is a variation at different times in the opsonic content of the blood. In other words the blood of an individual will be stronger or weaker in opsonic power, or the blood of the sa'me individual will be at different times stronger or weaker in opsonic power as regards each disease germ. That the leucocytes are powerless to fulfill their function as phagocytes without the help of opsonins is according to the advocates of the theory entirely established. Without de- scribing in detail the methods by which this is proved it is sufficient to say that the leucocytes isolated by appropriate methods and mixed with living germs in a liquid saline medium do not attack bacteria; but if blood serum be added to the mixture of leucocytes and bacteria the phagocytic activity begins at once. This undoubtedly proves that the serum contains some substance which enables the leu- cocytes to attack and destroy the micro-organ- isms. Wright has originated a very ingenious method of determining the opsonic power of the blood by comparing the opsonic potency of the blood of the individual under observation 57 BACTERIOLOGY IN A NUTSHELL. with that of the mixed blood of a number of normal persons. The degree of opsonic power as>determined by this method has been termed the opsonic index. Suppose a patient is suffering with an in- fectious disease like tuberculosis, acne, or ulcer- ative endocarditis. In such conditions why are the leucocytes unable to prevail in their battle with the invading germs ? It is because the opsonic index is below normal or those sub- stances which enable the leucocytes to fight the germs are diminished. The problem therefore naturally presents itself : increase the opsonins, raise the opsonic index to normal or above normal and the defenders will prevail ! For obvious reasons any description of laboratory processes in a paper of this kind is entirely out of place, but the practical applica- tion of this theory is about as follows : An individual is about to undergo treatment for infection by a certain germ. His blood is tested for its opsonic index, which indicates whether or not his vital resisting powers are above or below normal. If below normal he is given a hypodermic injection of a specially prepared culture of the germ which caused his disease the micro-organisms having previ- ously been rendered harmless by heat. As a result the opsonic power is at first diminished, but this is invariably followed by a positive 58 IMMUNITY ANTITOXINS. increase; this is repeated at suitable intervals as indicated by frequent blood examinations, the object being to keep the blood serum in a condition to prepare the bacteria for destruc- tion by the white blood cells, that is, in as high a state of opsonic power as possible. This principle is being put to very successful practical application in staphylococcic infection of the skin such as acne and boils; in tuber- culosis of the joints, glands and even in con- sumption; empyema due to presence of the pneumococcus, ulcerative endocarditis caused by the streptococcus and in various other forms of specific bacterial diseases. It is not ap- plicable except to those diseases of which the specific causative germ is known. In other words Opsonin treatment is an attempt to increase the power of resistance of the body to attacks by pathogenic organisms. The results of bacterial invasion are in part, impairment of digestion and assimilative func- tion, normal metabolism is interfered with, so that tissue waste must be repaired, nutrition fostered and strength conserved." ANTITOXINS are antidotes to bacterial poisons. These substances are obtained by in- Antitoxins, jecting into the body of one of the lower ani- mals, found subject to the disease, poisons produced by pathogenic bacteria while develop- 59 Protection. Testing. BACTERIOLOGY IN A NUTSHELL. ing in broth, bouillon or other culture media. After the bacteria have remained in the culture media for a stated period their poison per- meates it. Some of the bouillon is then taken and injected into the chosen animal (horses, goats, guinea pigs, rabbits, etc., are all experi- mented upon. The horse is preferred for the development of diphtheria antitoxin), with a special syringe, in very small doses at first which are gradually increased until the animal ceases to exhibit any symptoms of the disease, the poison of which has been used for the in- jections. Then he is said to be immune or protected from that particular disease. Some of the blood of this immunized animal is then procured and allowed to coagulate and the serum or fluid part is injected into other animals or into members of the human family, in the same way in which it was used in the first instance, until they too become immune from that specific disease for a longer or shorter period. Before using the blood serum of an im- munized animal on the human subject it is tested on another of the lower animals for the purpose of ascertaining its protecting power. If it stands the test, it is put up in small tubes and tightly sealed until required for use. Diphtheria, tuberculosis, tetanus, septicemia and other diseases are treated by antitoxin inoculations. The mortality rate in diphtheria, 60 IMMUNITY ANTITOXINS. which, until the use of antitoxin used to be fifty per cent and over, has through the instru- mentality of this agent been reduced to three per cent when used sufficiently early in the case. Antitoxins are said to have the power to render Power of inert bacteria that may already be present in Antitoxins - the subject treated, or to bring about such alter- ations in the tissues of the body as will prevent their development and a cure is the result. There are four steps necessary in the prepar- tion of antitoxins : I. The germs are obtained and grown in a proper substance under suitable conditions until the toxin or poison is produced. II. The poison is introduced in gradually increased doses until protection is obtained. (A dose, we are taught, can be borne toward the last of the treatment which if given at first would have caused instant death.) Some authorities tell us the process takes from three to six months. Others give the period as from six months to two years. III. Some of the blood of the immune ani- mal is next obtained; aseptic precautions are observed during its removal. After coagula- tion the serum is taken and its protecting power tested on other lower animals. IV. It is put up in sterile tubes and care- fully and aseptically sealed, ready for the use of the human subject. 61 Vaccination. Koch's Circuit. BACTERIOLOGY IN A NUTSHELL. The antitoxin treatment is somewhat similar in its effects to vaccination as a protection against small-pox. The theory has been ad- vanced that vaccination against diphtheria and other communicable diseases may come to be an established method during epidemics. It is claimed by Koch that in order to prove that a certain germ or micro-organism is the cause of a specific disease it must produce cer- tain effects. Briefly, these are as follows : I. Where the disease is present there the specified germ must always be found. II. The germ found in the diseased body must again grow and multiply in proper culture media outside of the body. III. 'The same disease must be reproduced in a healthy animal by using the poison or toxin obtained from the culture media in which the germ has multiplied. IV. The same germ must again be found in the serum of the blood of the animal thus in- oculated as a result of the process. Koch further states that it must be proven that no other germ is capable of producing the disease under consideration and that if the original micro-organism is not found all through the process the suspected disease does not exist. 62 SUMMARY AND REVIEW. SUMMARY OF CHAPTER IV. Parkes' list of diseases due to bacterial in- vasion. How they are communicable. Authorities have different opinions on this point. Manner in which bacteria gain an entrance to the human structure. The periods of incubation, invasion and de- velopment of disease if the bacteria are not overcome by the phagocytes. How infection is thrown off from the healthy body. Death of bacteria through lack of nourish- ment and other causes. Immunity: Natural, acquired, artificial and definitions. The opsonic theory. Antitoxins : Where they are obtained and how they are prepared. Koch's Circuit. QUESTIONS FOR REVIEW. CHAPTER IV. I. How are diseases designated in the classes mentioned? II. Define inoculation. Surface lesion. Air-borne. III. Mention channels through which in- fection is communicated to the body. 63 BACTERIOLOGY IN A NUTSHELL. IV. What do you understand by "period of incubation?" "Seat of invasion?" V. Explain the conditions under which symptoms of diseases due to bacteria arise ? VI. What becomes of the invading germs if overcome by the phagocytes ? VII. How do bacteria work their own de- struction ? VIII. In what other way may their multi- plication within the body be arrested, and their death result? Who discovered the province of the opsinins? IX. Describe antitoxins in detail, their de- velopment and use? What effects should be expected to follow the antitoxin treatment? X. What is Koch's germ theory? De- scribe the complete circuit in detail. CHAPTER V. COMMON COMMUNICABLE DISEASES. In former years communicable diseases were spoken of as either contagious or infectious Contagious diseases. The term contagious was applied to infectious. those diseases which are transmitted by direct contact or inoculation; infectious to those which are either air or water borne. It has been developed by experience that many of the diseases which were called infectious can also be transmitted by contact or inoculation and also that those diseases termed contagious are sometimes air or water borne, hence the apparent necessity for the change to the term communicable which is used to cover all dis- eases that may be transmitted or communicated from a sick to a well person without refer- ence to the method of transmission or com-, munication. Among the communicable diseases commonly communicable met with by the nurse we will first mention Diseases. TYPHOID FEVER. The invading micro- organism in this disease is the bacillus typhosus, Bacillus discovered by Eberth and Koch and sometimes Typhosus. called Eberth's bacillus in honor of one of its discoverers. The seat of invasion in typhoid fever is the small intestine in the lower part of 65 BACTERIOLOGY IN A NUTSHELL. iThe Peyerian Glands. Changes Produced. Hemorrhage. Perforation and Peritonitis. Absorption of Poison. what is known as the ilium, situated near the ileo-caecal valve. The bacillus first attacks cer- tain structures termed the Peyerian glands (also termed "Peyer's patches," after the an- atomist who first discovered or described them). These glands are small white look- ing patches, or groups of lymph follicles, (tiny sacs containing great numbers of small, round cells and some fluid) in the mucous and submucous layers of the lower part of the small and the beginning of the large intestine. As a result of the attack, the Peyerian glands in- flame, swell, thicken and frequently ulcerate. When ulceration occurs sloughing or casting off of dead particles of tissue follows and an open sore is left behind. Sometimes a blood vessel is punctured by an ulcer, when a hem- orrhage more or less severe in its effect takes place. An ulcer may, and frequently does, extend through the entire wall of the intestine, when perforation and the escape of the in- testinal contents into the abdominal cavity causes peritonitis and death, unless the perfora- tion is such as can be repaired and the patient is in a condition to warrant such a measure. While the small intestine is, said to be the chief seat of the bacterial invasion, the various systems of the human structure are also affected. There is elevation of temperature, owing to absorption of poison produced by the 66 COMMON COMMUNICABLE DISEASES. bacillus typhosus, and the patient frequently suffers from thirst. A disordered condition of the nervous system exists, manifested by headache, insomnia, and System in severe cases by delirium and unconscious- ness. The digestive system is affected and in con- sequence we observe loss of appetite, a furred The Digestive tongue and sometimes nausea and vomiting. At times there is a severe diarrhoea present, at other times constipation may exist. There are disturbances, too, of the circula- tory and respiratory systems. The heart beats The Circula- .,, . , . .. tory and more rapidly and there is a corresponding in- Respiratory crease in the pulse rate. There are character- Systems, istic changes in the respiration, also, very often. Changes in the skin are apparent, and it is The Skin. usually found to be hot and dry during the height of the fever. The changes in the muscular system are shown by their thin, flabby condition, which is J y \ e te 1 m USCUlar especially noticeable if the disease runs a pro- longed course. Changes are observed in the urine owing to an increase of the solids contained therein. It The Urine, is highly colored and diminished in quantity usually. The germs of typhoid fever are thrown off in the evacuations from the bowels, in the urine, Excretion of in vomited matter, in the dequamating skin, in Germs ' 67 BACTERIOLOGY IN A NUTSHELL. Common Methods of Communication. Contaminated Milk. Sterile Drinking Water. the rose spots, in pus from suppurative com- plications, and are sometimes found in the sputum and sordes (foul substance which col- lects on the teeth and gums of fever patients). Flies are said to distribute the infection. The common method of communication is through contaminated drinking water and food sup- plies. Milk has been found to contain the germs and they are said to multiply rapidly therein. *Milk may be contaminated ( i ) , be- cause the cows are not kept clean; (2), because milk pails, cans or other vessels in which milk is kept are not thoroughly cleansed and boil- ing water poured into and over them before using; (3), because the dairy is not kept pure or persons handling the milk are not careful; (4), because water, which some dishonest dealers are said to put in the milk they sell, may contain the germs. Epidemics of the disease are common and are often traced to a contam- inated water supply. Hence the necessity for filtering and boiling the water used for drink- * In the best dairies and creameries now-a-days the milk is Pasteurized in sterile receptacles. Water used to wash the butter is boiled in covered apparatus, and then cooled to the proper temperature in specially constructed refrigerators. Special care is taken to sterilize all cans, pails, etc., used for the milk and butter. The cows are kept clean, and the milkers' hands and clothing also, both in milking and in handling the milk afterwards. Butter made in these dairies and creameries, according to agricultural journals, keeps months longer than when made and taken care of 'in the old-fashioned way. COMMON COMMUNICABLE DISEASES. ing and in preparing- food, especially during epidemics. We cook our foodstuffs to make them safe, and use sterile water to cleanse fruits and vegetables which come to the table un- cooked. We keep milk* and meats, unless already contaminated when purchased, un- harmed by placing them on ice. An epidemic The Butler of typhoid fever occurred in Butler, Pennsyl- Epidemic. vania, in 1903, the horrors of which are still fresh in our memories. The death rate was enormous. Many nurses lost their lives. An infected water supply was the cause. Great care is necessary on the part of the nurse who attends typhoid fever patients to pr P h y laxis - guard all sources of infection under her im- mediate control. Separate dishes must be used for such patients, and these must be kept iso- lated and cleansed by themselves. They must be disinfected each time after using by pouring over them boiling water, and they must be boiled for at least ten minutes once daily also. Stools and urine and vomited matter must be thoroughly disinfected before they are emptied. Use a sufficient quantity of good disinfectant solution, boiling water, milk of lime, carbolic acid, etc. (See Chapter VII for disinfectants), to completely saturate the mass. Cover the * It is now considered much the safer plan to use pasteurized milk for all purposes. The difference in price between this and the raw product is very small. 69 BACTERIOLOGY IN A NUTSHELL. vessel and allow it to stand for an hour before disposing of its contents. Thoroughly cleanse and disinfect the vessel and its cover each time after using and as a matter of precaution keep a small quantity of a disinfectant solution in all vessels preparatory to using again. Use a separate thermometer for typhoid fever patients and also separate bed-pans, urinals, syringes and rectal tubes. Keep the thermometer in a bichloride solution, 1-1,000, renewed daily. Be very particular to cleanse the rectal tubes and syringes and boil them every day. Never turn syringe nozzles inside of syringes after using. Remove the nozzles; scrub well with soap and hot water before boiling. They should be kept in a carbolic acid solution, 1-40, with the rectal tubes. This solution must also be prepared anew once in twenty-four hours. See that bed and body linen and towels are dis- infected before placing in the laundry with the ordinary wash; these should be soaked for at least two hours in a 1-20 carbolic acid solution. Burn all pieces of old linen or absorbent cotton used to cleanse the mouth and teeth and lips. Use listerine, borolyptol or other good solution for this purpose. Give particular attention to disinfection of the sick room at the close of the case and of everything it contains. In nursing private cases outside the hospital The Patient's . . , . Room. when preparing your patient s room ask per- 70 COMMON COMMUNICABLE DISEASES. mission to remove all unnecessary furniture and draperies, etc., which may serve as lurking places for germs. Explain when you ask per- mission why you would like to have the room as nearly on the hospital order as possible. If you are allowed a choice of rooms, one on the south side of the house is preferable and as far removed from noise and disturbance as you can get it. TAKE CARE OF YOUR OWN HEALTH. Be very careful to thoroughly wash and scrub your Personal hands (particularly your nails, beneath which ygiei are favorite hiding places for germs), and dis- infect them each time you attend to the evacua- tions. Never touch your face with your hands after such work until they have been carefully cleansed and disinfected. A tiny speck of any one of the discharges may be deposited upon the face or lips and gain an entrance to the body with disastrous consequences to you. Be watchful of like dangers when giving baths, enemas and in cleansing the lips, the teeth, the mouth and the finger-nails of your patient. Pay strict attention to personal disinfection be- fore going from a communicable disease to an- other case. Keep your patient's person, bed, bedding and room absolutely neat and clean. Pay General . . . , , Precautions. special attention to cleansing the mouth and teeth and lips between the hours for feeding BACTERIOLOGY IN A NUTSHELL. and before administering food or stimulant or medicine, as well as after the bath, particularly in severe cases where sordes collects so rapidly on the teeth and lips. Wipe all woodwork and furniture with a cloth wrung out of a disin- fectant solution. Pay strict attention to venti- lation. Remember that neatness and cleanli- ness are necessities, and that an abundance of fresh air and sunshine are Nature's own disin- fectants. Two to three thousand cubic feet of fresh air are required in all sick rooms; the latter amount is obtainable in a room fifteen feet wide by twenty long, with a ceiling elevation of ten feet, but the current must be changed every hour in order to keep the atmosphere pure. Your patient can be protected by a screen from her possible fear of "catching cold" while you open up the windows from the bot- tom. They should be kept open a few inches at the top all the time. All "disease germs" multiply rapidly in a room kept dark, dingy and badly ventilated, and where papers, books, and rubbish are allowed to accumulate. The sick one takes these germs into the system again and the disease is both aggravated and lengthened. * Study to acquire right methods of bathing in * While it is not the purpose of the writer to speak of methods of treatment given in diseases caused by bacterial invasion, several years experience in training nurses has revealed the fact that many pupils fail to grasp the proper methods of applying hydrotherapeutics 72 COMMON COMMUNICABLE DISEASES. this disease. Do not forget the importance of the cleansing bath using warm water and good soap every morning, followed by an "alcohol rub" and careful powdering of the back and other parts of the body where pressure is ob- served or friction is noted due to contact with the mattress. Change your patient's position frequently from side to side unless the physician in charge instructs you otherwise. This will not only be a comfort to the sick one, but will in conjunction with the warm cleansing bath and alcohol rub, which should be fre- quently repeated, aid in the prevention of bed sores, the occurrence of which in almost all cases is due to lack of care and watchfulness on the part of the nurse. Turn your patient's pillows often and shake them up thoroughly be- fore replacing them under the head. If the physi- cian orders ice caps on the head and abdomen, when nursing typhoid fever. If the physician orders tub baths, they seem to fail to recognize the necessity for using friction systematically in order to bring about the requisite reaction. When they do use friction, they go about it in such a haphazard fashion that frequently there is an increased elevation of temperature instead of a decreased, and the nervous symptoms at the end of the treatment are more pronounced than before beginning it. (This does not refer to patients whose peculiarities of constitution are such as to contra- indicate "tubbing," but to those who, when properly handled, respond admirably). In giving sponge baths, also, very often the right method of sponging is not observed. It seems to be necessary for nurses who are training pupils to pay particular attention to practical teaching in this direction. 73 BACTERIOLOGY IN A NUTSHELL. see that they are kept filled with ice and not with hot water. To allow the ice to melt and become hot water does more harm than good. When the physician says "ice caps" he means ice caps and not hot water bottles. Do not forget to keep the finger-nails clean and the hair neat, if the physician does not order the hair clipped. The care and watchfulness necessary in nursing typhoid fever holds good in nursing all germ diseases. It will therefore be unneces- sary to speak of these at length when dealing with other communicable diseases. A BLOOD TEST. If there is reasonable doubt as to the disease from which a patient is suffer- ing being typhoid fever, a test discovered by Widal, of the University of Koenigsberg, is sometimes resorted to. WIDAL'S TEST is based upon the fact that the "Widal's blood serum of a person who has typhoid fever Test " is antagonistic to the bacillus typhosus. A drop of blood is obtained from the suspected 'patient by pricking the lobe of his ear. This drop is placed on a clean glass slide and covered immediately to prevent other germs which may be lurking about from getting into it, and it is then allowed to dry. A little of the bouillon, or other substance, in which the bacillus typhosus is being cultivated is then placed on another clean glass slide and covered. The 74 COMMON COMMUNICABLE DISEASES. dried blood of the suspected patient is made into a watery solution and added to the culture. From this mixture of dried blood and typhoid bacillus, what is known as a "hanging- drop" preparation is made under the miscroscope. If the patient has typhoid fever the bacilli will be seen rapidly to lose their power of motion and to form into tangled clumps, or masses, and so get away from the blood serum of the patient. If typhoid fever does not exist, this clumping and entanglement of the bacilli and arrest of their movements does not occur. There is said to be an exception to this rule in . . . .. Exception to cases where the patient has had the disease *widal's Test. recently, under which circumstance the reac- tion may occur without such evidence of the onset of a new attack. CHOLERA is caused by Koch's comma bacil- lus. Dysentery, a somewhat similar disease, is Cholera and , , . r Dysentery. caused by the bacillus dysentenae both of these diseases are contracted through the same sources as typhoid fever is contracted, and the same watchfulness against its spread must be. rigidly carried out; also the same precautions as to personal cleanliness and neatness with regard to the nurse, patient, and patient's room. Be especially careful to let the pure air and * German authorities spell this scientist's name Vidal, and assert that he is French and that the American spelling, "Widal," has arisen because of the German pronunciation of the letter V. 75 Sources of Infection. Intubation and Tracheotomy. BACTERIOLOGY IN A NUTSHELL. sunshine have free access at all times, and remember the danger from impure water. Epidemics of cholera from that source are not common here. An epidemic occurred in Ham- burg, Germany, in the months of August and September, 1892, when nearly nine thousand deaths were reported during the two months. The epidemic was believed to be due to the infection of the river from which that city ob- tains its water supply. Gipsies had camped on the river banks, and as they had a case of cholera in their midst, the trouble was thought to have arisen from that source. DIPHTHERIA. The bacillus diphtherise, the micro-organism of diphtheria, can be taken into the system in food. It may also be communi- cated from the sick to the well directly from the mouth, indirectly through the infected dishes, books, toys, spoons, or other similar articles, or the infection may be breathed in. The germs are found in the discharges from the nose and throat. The nurse must be careful to avoid having the patient cough in her face, as particles of membrane dislodged from the throat are a fruitful source of danger, especially so to both physicians and nurses during opera- tions on the throat (tracheotomy and intubation of the larynx), for the relief of patients suffer-? ing from this dread disease. While the seat of invasion in diphtheria is 76 COMMON COMMUNICABLE DISEASES. usually the throat, other parts of the body suffer also, which is always the state of affairs in severe germ diseases. A common sore throat forms a good camping ground for the diphtheria bacillus and the deadly work is accomplished very rapidly in many instances. Patients sometimes die before their danger is realized by the uninitiated. Suffocation, heart failure and exhaustion are immediate causes of sudden death. The nurse must be ever on the alert for symptoms of approaching danger from any of these sources. Disinfect all discharges from the throat and nose; all bed linen, towels, handkerchiefs, Disinfect and spoons, dishes and all sick-room utensils with boiling water, or with hot carbolic acid solution i -20. Wipe all woodwork, floors and walls with bichloride of mercury solution 1-1,000 and fumigate with formaldehyde or sulphur. Observe carefully the precautions with regard to patient and room, sunshine, ventilation and disinfection at the close of case. Be careful to protect your patients from any possibility of drafts striking them. Use a screen about the bed. No patient's bed should be so placed as to be in a current of air. A room properly ventilated is not "drafty" of necessity. Membranous croup and whooping cough are , Membranous contracted in the same way as diphtheria, and Croup and are spread by- the same means. Moist air is 77 BACTERIOLOGY IN A NUTSHELL. necessary in the patient's room in most cases of diphtheria, whooping cough and croup to re- lieve the throat symptoms. Various Forms. INFLUENZA OR LA GRIPPE. The bacillus of this disease finds an entrance to the system through the respiratory tract. Sources of infection are the discharges from the throat and nose, which should always be disinfected. There are several forms of "la grippe," notably the catarrhal, bronchial and intestinal forms. In the intestinal form, some physicians advise disinfection of the evacuations also. This is one of the few germ diseases which one is apt to contract very frequently. No num- ber of attacks will afford immunity. Epi- demics are common. Methods of Communica- tion. SCARLET FEVER, MEASLES, GERMAN MEASLES, CHICKEN POX. The germs causing scarlet fever, measles, German measles (Roseola) and chicken pox are found in the secretions from the nose and throat and in the desquamating (peeling or flaking) skin. The disease can be contracted through direct contact with the afflicted person, articles used in the sick room, such as books, toys, clothing, food cr dishes, and also in the 78 COMMON COMMUNICABLE DISEASES. dust and sweepings of the ward or room. This is especially true of scarlet fever and measles, and the nurse needs to be more than ordinarily cautious, as the disease can be communicated to the well just as long as any desquamating skin remains. Disinfection before desquama- tion ceases is practically a waste of time. Cats and dogs are believed to carry the germs in Domestic their coats and should be kept out of the sick Animals - room. Use carbolized oil as an inunction in all of these diseases to prevent or lessen the danger from floating particles of skin. Gowns and bed linen, which are full of these particles, should be removed carefully and placed at once in a disinfectant solution. Do not shake them about the room. Wipe all furniture and floors with a cloth wrung out of a disinfectant. Destroy all toys, books, etc., used by a scarlet fever patient, by fire preferably. When nurs- ing scarlet fever in a private home, if at all possible, obtain two sunny communicating rooms in the top story of the dwelling. Have everything you may need for the care of your patient and yourself in the room adjoining the sick room, in order to avoid the danger of carrying infection ta other parts of the home. If others must frequent the corridor outside the rooms you have chosen, keep a sheet wrung out of carbolic acid solution ( 1-20) spread over the outside of doors that communicate with 79 BACTERIOLOGY IN A NUTSHELL. that hallway or corridor. Place over any opening that may be at the bottom of the doors a towel or cloth saturated with the same solu- tion. Keep in the closet of the adjoining room a change of attire to be worn on the street when you go out for an airing, and be careful not to place in this closet anything you have worn or used in the sick room. Keep in this room disinfectants for your own and the physician's hands and for disinfecting articles used in the sick room. The physician will also probably leave with you his gown, which he wears to protect his street garb when he makes his daily visits to the sick room. This you must also keep in the adjoining room where the physician dons it before seeing his. patient. If your meals are sent up to you from the general kitchen, be sure to disinfect the dishes and everything on the tray before placing it in the corridor to be carried down stairs. A small ice chest in which to keep articles of food, such as pasteurized milk, eggs, etc., is a great convenience, in fact almost a necessity, and should of course be placed in the room adjoining the sick room. After desquamation ceases your patient must be treated to several baths containing a disinfect- ant before mingling with other members of the family. Nothing worn in the sick room may be placed on your patient after his bath. Use 80 COMMON COMMUNICABLE DISEASES. the same routine in all diseases in which there is desquamation. Be very thorough in per- sonal disinfection before going to another case. MUMPS. In mumps it is deemed wise to dis- infect discharges from the throat and nose. Sources of A 1 i 1 1 *. t, t .LI Communication Although it has not yet been proven how the Unknown. disease is contracted, it is conceded by all to be a communicable disease. TETANUS, commonly called "lockjaw," is caused from the invasion of wounds by a germ Bacillus known as bacillus tetani, usually found in the soil near the surface. The poisonous matter is thrown off through the pus discharged from the wounds. We frequently meet with cases of tetanus caused by the patients having stepped on a nail protruding from a board lying in their pathway. The nail has penetrated the shoe, entered the foot and carried with it particles of soil containing the germs. The bacillus tetani is said to possess the power to do its deadly work in as short a period as twenty-four hours, and but rarely to cause mischief later than the tenth day after the accident. In the past few years a number of cases of tetanus have occurred after Fourth of July cele- Fourth of brations, arising in wounds caused by toy pis- pi s ?ols. y tols. Blank cartridges of these toys are said to contain the germs, although authorities are of the opinion that the germs are probably upon 81 Symptoms. Arching of the Back. Effect of Medicines. BACTERIOLOGY IN A NUTSHELL. the soiled hands of the child before the accident and that they cause trouble in the wound after- ward just as they do in other gunshot accidents in which tetanus arises. A law was passed in 1903 in many of the large cities of the United States prohibiting the sale of these pistols. The throat and jaws seem to be the parts most affected when the symptoms first appear. A feeling of stiffness and sometimes of pain in these parts is complained of. Rapidly the stiffening of the jaws increases. Severe muscular spasms develop, at first in the muscles of the jaw, but soon to spread over the entire muscular system. The spasms increase in rapidity and severity until they are kept up almost continuously. (The spasms seen in tetanus are somewhat similar to the spasms from strychnia poisoning.) Eventually the jaws become tightly clenched, the back is bowed and the patient is frequently found to rest only on the back of his head and his heels, the rest of the body arching upward from the bed. Death commonly occurs from exhaustion. The majority of cases prove fatal. Medicines seem to have no effect in arresting the progress of tetanus. Chloroform ami opiates are used by many physicians for the temporary relief they give from the violence of the spasms. In recent years the antitoxin treatment has saved some lives. In order to 82 COMMON COMMUNICABLE DISEASES. be of any marked value it must be administered early in the case. The nurse is instructed to keep the patient's room darkened and to guard him from all dis- turbances. Noises are said to aggravate the spasms, and she is cautioned to keep him quiet. He should be watched very closely and must not be left alone a minute. Strenuous efforts to give him nourishment must be made. As the jaws are tightly clenched, recourse is had to nutrient enemata. "Nose feeding" is not recommended by the best authorities, as it is believed to aggravate the spasms. Opiates are sometimes given by rectal injection also. The best authorities now recommend opening up accidental wounds as quickly as Preventive possible after they occur. A thorough irriga- easures - tion of the wound with an antiseptic solution then follows, such irrigation to be kept up at frequent intervals until all danger of the in- vasion of the bacillus tetani is over. Between the irrigations, the wound is protected by an aseptic dressing held in place by a bandage. Some advocate leaving the wound open to the air after irrigation, claiming that the bacillus tetani will not live in the presence of air. ERYSIPELAS, at one time regarded as an acute inflammation of the skin, is now attrib- cause of uted to the invasion of the system by the strep- Erysipelas. 83 BACTERIOLOGY IN A NUTSHELL. tococcus pyogenes* which gains an entrance through wounds, and sometimes through scratches or punctures of the skin so tiny as to be almost imperceptible to the naked eye. The disease is spread by means of small particles of desquamating skin from the affected part floating in the air and by pus from the wound Channels in some cases. It is carried from one person to another by actual contact, clothing, or other infected articles, such as dishes, bedding, towels, dressings, and anything used by patients. It may also be communicated by the hands of the physician or nurse or by instru- ments used in treating the case. All such out- lets and inlets of this most mischievous germ must be well guarded by the nurse. Burn all old dressings immediately and use disinfect- ants rigidly throughout the case and at the close of the case. All cases must be isolated and given to the care of a special nurse. The "eternal vigilance" ordered in the nursing of scarlet fever and other desquamating diseases must be rigidly adhered to in erysipelas. While the erysipelas germ is liable to attack wounds, the disease frequently appears where there is no perceptible wound. A rose-red blush of the skin is seen. The edges of the * When the streptococcus pyogenes invades the skin we have erysipelas; when it invades the blood, we have septicemia or "sepsis," and other inflammations in which suppuration occurs. 84 COMMON COMMUNICABLE DISEASES. affected area are clearly distinct from the healthy surroundings. There is usually a swollen condition and the sick one complains of a tightness and stiffness in the diseased region. Erysipelas spreads rapidly when it at- tacks loose tissues, such as those of the face, and preventive applications have to be made early in the case. It is a very severe disease in some instances, particularly so in persons ad- Subjects, dieted to the habit of using alcoholics to excess. Various parts of the system are affected as shown by elevation of temperature, nausea, and frequently vomiting, headache, rapid pulse, and after the disease is well advanced in bad cases there may be delirium and exhaustion. The disease sometimes proves fatal. TUBERCULOSIS. All forms of this disease, which attacks various parts of the human struc- ture, are caused by the bacillus tuberculosis. Tuberculosis of the lungs is called phthisis or consumption. When the germs attack the lymphatic glands the disease is spoken of as scrofula. Tuberculosis of the skin is termed lupus. The nurse meets with tubercular joint disease, tubercular disease of the kidneys, tubercular meningitis, tubercular peritonitis and so forth. The germ which is responsible for the de- , Methods of velopment of tuberculosis generally gains ad- Entrance, mission to the system through breathing in air 85 Predisposing Causes. Early Precautions. BACTERIOLOGY IN A NUTSHELL. in which they are circulating, but it may be taken in through other sources ; for instance, by drinking milk containing the germs. Jersey cows are said to be subject to tuberculosis and their milk apt to contain the germs. Wounds also admit the germs. Persons predisposed to tuberculosis are those whose chests are not well developed, whose cir- culation is poor and whose vitality is low, par- ticularly if their surroundings and occupations are unhealthy. Those who have to work in dusty, overheated, badly ventilated rooms, for example. Insufficient or poor food is given as another cause favoring the development of the disease. When one of these causes, or several of them, weaken the structure, power of re- sistance is lessened, and when the germs gain an entrance we fall an easy prey to the ravages of the disease, if they are not sought after and driven out at an early stage. The duties of the nurse when caring for a tubercular patient are to thoroughly disinfect all sputa, cleanse and disinfect all sputa cups, and to destroy by fire all dressings used on tubercular wounds. Many physicians demand that sputa be burned also, and special sputa cups are now in use with a detachable water- proof lining made of a sort of pasteboard. These linings are put up in packages which come with each sputa cup. They are easily 86 COMMON COMMUNICABLE DISEASES. slipped in and out and are changed several times a day. They are burned immediately on removal from the cup. Bed and personal clothing (particularly handkerchiefs) must be treated to a bath of boiling water or well soaked in a good disinfectant solution before placing in the general wash. Boil all dishes used for feeding purposes in a 2% sal soda solution at least once daily for ten minutes. While tubercular patients are not isolated in the same sense in which scarlet fever or diphtheria patients are, they should occupy separate bedrooms and the use by others of a tubercular patient's dishes should be FOR- BIDDEN. Keep your patient out of doors in the fresh air and sunshine as much as possible. "Out of Fresh Air doors all the time, and sleep and eat in the open air in a proper climate" is getting more and more to be the prescribed treatment. To which is added as indispensable, plenty of nourishing, easily-digested food, especially an abundance of milk and eggs, perfect cleanliness and neatness of person and surroundings and a cheerful atmosphere at all times. The nurse who pays strict attention to all of these re- quisites is a valuable and valued assistant to the physician fighting this disease. MALARIA. Malaria is now classed as a dis- ease of bacterial origin and is believed to be Anopheles!" 87 Plasmpdium Malariae. Length of Days and Multiplication. BACTERIOLOGY IN A NUTSHELL. carried from the sick to the well by a species of mosquito the anopheles. Those who live in low, damp localities or near "swampy" regions are more apt to be attacked. Tn such places window screens and doors with a very close mesh should be used to prevent the in- vasion of the anopheles. The germ to which the poison of malaria is said to be due is called plasmodium malariae. These germs get into the red corpuscles of the blood, live upon them, and destroy them. We are taught that there are three varieties of the malaria germ, as there are also three forms of the disease, one of which lives in the human structure seventy-two hours, and the other two forty-eight and twenty-four hours, respectively.* Their death, sad to say, does not mean the end of the mischief they accomplish, as when they cease to exist themselves they divide up into a number of tiny particles or segments each of which means a new life or germ. These new germs attack other red corpuscles and live upon them until they, too, die, but in dying they form new parasites, as their parent germs did * The names given to the three forms or species of the plasmodium are, (i) plasmodium praecox, found in aestivo-autumnal malaria, living twenty-four hours; (2) the plasmodium vivax of the tertian form of malaria, the life of which is forty-eight hours; (3) the plasmodium malariae, found in the quartan form of malaria, which has a seventy- two-hour life. COMMON COMMUNICABLE DISEASES. before them. Each fresh set of germs de- stroys a large number of the red corpuscles. Koch, and other scientists, who teach that the germ is carried by mosquitoes, believe they Mode of ,,,.,. r i 1 Communica- slake their thirst in infected pools in swamps t i on> and then alighting on healthy bodies they com- municate to them the disease producers by inoculation. They also teach that these mos- quitoes carry the poison in the same way from the sick to the well. Prevention is only pos- sible by destroying the mosquitoes. UNCINARIASIS, another disease caused by an animal parasite, the uncinaria duodenalis, is quite common in the United States as well as in other parts of the world, and is often diagnosed as malaria, some of the symptoms being similar. The seat of invasion in un- cinariasis is the duodenum, the jejunum and less frequently the colon. Other names given to uncinariasis are hook-worm disease, anchylo- ostomiasis, Egyptian chlorosis, etc. Hook- worm disease is its commonest title. This name has probably arisen because of the peculiar bending backward upon itself of the anterior portion of the parasite, giving to it a hook-like appearance when observed under the microscope. These germs are blood devourers and by means of peculiar tooth-like and suction appendages they cling to the mucous mem- brane that lines the intestine. In this position 89 BACTERIOLOGY IN A NUTSHELL. they suck the blood of their victims. A pro- nounced anaemia, of course, follows. This is one symptom found also in malaria. The plasmodium malariae causes anaemia by its power to destroy the red corpuscles of the blood. The germs of the uncinaria duodenalis enter the body in drinking water or from hands that have become soiled with dust containing the parasites. They are also said to be able to gain an entrance through the skin from whence they are carried by the blood into the right side of the heart and to the lungs. From the pulmonary blood-vessels they are thrown into the air spaces and carried upward to the bronchial tubes, larynx and into the oesophageal tract ; then they are swallowed and finally pass into the stomach and gain their camping ground, the intestine. The disease this micro-organism produces is frequently fatal. Diagnosis is made by examining a small particle of feces under the microscope. CEREBRO-SPINAL MENINGITIS is caused by The Germ a ^ ie diplococcus intracellularis meningitidis. Diplococcus. It is not communicated from the sick to the well in the same manner in which most com- municable diseases are, and the germs are not found in the excretions unless there are lesions formed either of the brain or spinal cord. The exact method by which the germs enter and leave the structure has not been fully decided 90 COMMON COMMUNICABLE DISEASES. upon by scientists, but nurses are instructed that it is safest to disinfect all discharges from the body, all personal clothing and bed linen; also to fumigate the room at the close of the case. The seat of invasion in cerebro-spinal men- ingitis is in the membranes which cover and Seat of Attack. enclose the brain and spinal cord. The germs set up an inflammation of these membranes, which are known as the meninges, but the poison is also distributed to other parts of the body. Inflammation of the meninges is a characteristic symptom by which the disease is made manifest. Sometimes only a small por- tion is affected, at other times the greater part of the cerebral surfaces are involved. This is one of the very few diseases in which the nurse is told that lack of strict personal cleanliness, so far as the patient is concerned, must some- times be permitted because of the necessity for absolute rest and freedom from all movement. About one-half of the number of cases of cerebro-spinal meningitis end in death, and about three-fourths of its victims are children under ten years of age. There have been epidemics of the disease in the United States. One of the most appalling occurred in a small town in Pennsylvania (population 6,000) in 1864, when it is said that some four hundred children lost their lives. The very best med- gi The Germ of the Disease. Why Named for Pneumonia. BACTERIOLOGY IN A NUTSHELL. ical attention and most careful nursing are necessary to bring about recovery. PNEUMONIA. Pneumonia is one of the most serious of all diseases due to the invasion of the human structure by bacteria. The special germ to which this disease owes its origin is the diplococcus pneumonia, or "Fraenkel's diplococcus lanceolatus," which is also said to produce meningitis, pleurisy and ulcerative endocarditis. The disease produced in all cases is an inflammation, the manifesta- tion of which is modified by the portion of the body invaded. Pneumonia is an inflammation of the lungs, sometimes of one or more of the lobes of one lung, sometimes of the lobes of both lungs, or it may be an inflammation of all of both lungs. Endocarditis is an inflammation of the endocardium or membrane lining the heart. Meningitis is an inflammation of the meninges or membranes which enclose and cover the brain and spinal cord. These various organs have various functions ; this function is interfered with when the organ becomes in- flamed and the symptoms are different, while the cause may be the same. The germ was discovered first in the lungs in pneumonia and took its name from that disease. As was men- tioned in Chapter I, broncho-pneumonia is often caused by other germs, but authorities are of the opinion that in genuine, acute, lobar 92 COMMON COMMUNICABLE DISEASES. pneumonia the diplococcus pneumonia is always present. The germ is a very common one. It is found in the dust and sweepings of rooms and is frequently present in the mouths of the healthy. Exposure to severe weather or dampness which has produced a heavy cold acts as a predisposing cause. The system is Predisposing invaded, resistive power weakened, and an at- Influences. tack of pneumonia follows. The germs enter the lungs through the respiratory tract often causing disastrous changes in these organs. The poison is eliminated from the system through the secretions from the seat of the Entrance and disease, usually the sputum, which should be disinfected or burned as in tuberculosis. Pneumonia has been called the "Captain of the Men of Death," because it carries off annu- Importance of ally more victims than any other disease. In few other forms of illness is such constant care and watchfulness on the part of the nurse de- manded as in pneumonia. The disease usually ends by crisis, when collapse or great prostra- tion of all the vital forces may occur. Or the .. , - Immediate patient may die during the course of a severe Causes of form of the disease from suffocation or heart Death - failure. Such patients must not be left alone under any consideration. Heart failure, is perhaps, a point especially to be impressed upon the nurse, as any sudden exertion or excitement on the part of the patient may bring about the 93 BACTERIOLOGY IN A NUTSHELL. Obermeier's Germ. Method of Communication Uncertain. Impure Water and Mosquitoes. dread calamity. One attack of pneumonia in- stead of affording immunity, seems to predis- pose to other attacks. RELAPSING FEVER. The micro-organism which causes relapsing fever, discovered by Obermeier in 1873, ' ls termed Spirocheta Obermeieri. Scientists are of the opinion that the disease is carried from the sick to the well by the bite of insects, although the actual method has not been fully determined. An epidemic of relapsing fever occurred in New York and Philadelphia in 1869. It i? not a common disease in recent years, and epidemics unheard of, owing to improved sanitary con- ditions. FILARIASIS is a disease due to the filiaria san- guinis hominis, a small worm-like parasite. It is admitted to the body, usually, through the alimentary canal in impure drinking water. Mosquitoes are believed by some authorities to cause a spread of the disease by the inoculation of their victims with the blood of diseased per- sons. The seat of the disease is the deeper lymphatics. Prominent symptoms are chyle in the urine, oedema of the skin (swelling due to effusion into connective tissue), and hyper- trophy (morbid enlargement) of the cellular tissues, known as "elephantiasis." Prevention consists in removing the sources 94 COMMON COMMUNICABLE DISEASES. whereby drinking water is contaminated and in pre . destroying the mosquito. YELLOW FEVER. The seat of invasion in yellow fever is the blood. While yellow fever is not a disease commonly met with by the nurse in this part of the country, we will speak of it briefly in this connection. It is a disease which is very rapidly spread by means of a species of mosquito, the stegomia fasciata. Dr. Carlos Finlay, of Cuba, in the year 1881, first pro- claimed positively that this species of mosquito carries the yellow fever germ, which as yet remains undiscovered. A number of Ameri- can physicians had been suspicious of the mosquito years prior to this time, having ob- served their prevalence during yellow fever epidemics. Dr. Rush, in 1793; Dr. Weight- man, in 1839; Drs. Wood and Barton, in 1853, all had given voice to this opinion. These insects transmit the germs by direct inocula- Q ause tion of blood from the sick to the well. The disease is not air borne, nor is it carried in clothing, books or other such articles. The mosquitoes must be destroyed in order to pre- vent the spread of the disease. In the Southern States and in Mexico, where epidemics of yellow fever occur every year, physicians surround the beds of patients sus- pected to be developing the disease with a net- ting to prevent the onslaughts of the mos- 95 Preventive Measures. The Bacillus Pestis. BACTERIOLOGY IN A NUTSHELL. quitoes. Dr. Walter Wyman, surgeon of the U. S. Marine Hospital, in speaking of the disease in Texas and in Mexico, says that it is necessary to screen the beds of "suspects" be- cause it is not possible to tell until the fifth day whether or not the disease is the "dread yellow variety" which is communicable only "during the first three days." Strenuous efforts are being made by the health officers in all parts of Texas and Mexico to exterminate the pestilence-breeding and disease-carrying mosquitoes. Water barrels, which are much used in these places and which form favorite haunts for the mosquitoes, are screened also. All pools and swamps are treated with oil and in some places drained and filled in. BUBONIC PLAGUE is caused by the bacillus pestis. The seat of invasion of this germ is the skin and subcutaneous tissues, the lym- phatics, the lungs and the intestinal tract. Authorities teach us that the pneumonic form is the most dangerous and the most readily communicable. All the discharges, clothing, etc., must be treated to a hot carbolic acid solu- tion bath, strength 1-20. Floors and wood- work must be washed daily with a solution of bichloride of mercury 1-1,000. Patients must be rigidly isolated and dead bodies cremated. While this disease is one commonly confined to Eastern countries, it may be carried into our 96 COMMON COMMUNICABLE DISEASES. ports on ships infested with rats, mice and other vermin. Adhere rigidly to personal dis- infection at the close of the case, and all through the case. This germ has the power to enter the body through wounds, the alimen- tary canal, or the respiratory tract. The in- fection is thrown off in the pus from wounds, in sputum and in discharges from the body. When a wound is invaded by the germs, a severe local inflammation results and quickly spreads to the lymphatic glands. Flies and other insects are said to transmit the disease. SMALLPOX. The micro-organism which causes smallpox was reported as discovered by Discovery of Dr. Wm. T. Councilman, of Harvard College, Boston, Mass., in the early spring of 1904. He made known his discovery during the course of a lecture given in that city on "The Aetiology of Smallpox." He described the germ of smallpox as a "protozoon," represent- ing the very lowest order of animal life and therefore quite different from the vegetable micro-organisms common to the majority of communicable diseases. Dr. Councilman is said to have proven that his germ will pro- duce smallpox by his experiments on rabbits and monkeys, but as it is not produced by cul- tures Koch's circuit is not traced. The small- pox infection is general. It invades the skin, BACTERIOLOGY IN A NUTSHELL. An Air-borne Disease. A Matter of Precaution. the conjunctiva, the mouth, the oesophageal tract, the rectum, and the blood. Smallpox is one of the air-borne diseases and enters the system through the respiratory tract and may also be introduced through the skin. The disease is so readily communicable that all discharges must at once be disinfected or burned. The chief factors in the spread of the disease are the secretions from the nose and throat and the desquamating skin, all of which contain the poison. Flies which alight on the patients spread the disease. Patients must be protected by screens about their beds. Great care should be observed to prevent particles of peeling skin from being carried by the air as floating dust. In giving the baths the water should contain a disinfectant. Antiseptic washes are used and also inunctions of anti- septic ointments or oils to lessen the danger from desquamation. Formaldehyde vapor is recommended for fumigation after disinfection at the close of the case. A lecturer* on "Specific Fevers" when speak- ing in the writer's presence on the subject of smallpox a few years ago, advised a class of pupil nurses as a matter of precaution to "burn everything but the patient at the close of the case." * Dr. Robert Saunders Henry, lecturer on Specific Fevers, Thomas Hospital, Charleston, West Virginia, '98 to '02. SUMMARY AND REVIEW. Preventive treatment in smallpox epidemics consists in the rigid carrying out of vaccina- Danger. 1 " 8 tion. It is not considered that a nurse who has been recently vaccinated incurs the slightest risk in nursing small pox. SUMMARY OF CHAPTER V. The terms contagious and infectious as formerly used have given place to the more accurate term "communicable." The specific invading micro-organism of some of the communicable diseases. Means of transmission methods of en- trance. Seat of invasion. Effects constitutional or local. Multiplication or extermination of germs. Cleanliness and fresh air as preventives of diseases termed communicable. The points demanding most careful atten- tion on the part of the nurse in all communic- able diseases. Disinfection, etc. QUESTIONS FOR REVIEW CHAPTER V. I. Give the nurse's duties, especially as ap- plied to the severe forms of infectious diseases. II. Give methods of entrance and means of communication in the diseases designated; typhoid fever, diphtheria, scarlet fever, tetanus, tuberculosis, smallpox. 99 BACTERIOLOGY IN A NUTSHELL. III. What location is named as the seat of invasion in typhoid fever? Describe the pro- gress of the disease resulting in hemorrhage and perforation. IV. In which of the communicable diseases do you consider most rigid disinfectant and antiseptic precautions necessary? V. Name some communicable diseases be- lieved to be due to impure water. VI. Describe symptoms of tetanus. State the usual cause of the disease. How long after injury may danger of the attack exist? What treatment is recommended as preventive? VII. What conditions are conducive to the development of tuberculosis? Give method adopted as preventive of its spread. Name treatment most in favor and state the nurse's duties. VIII. How is the mosquito responsible for the spread of malaria? What effect has the disease upon the blood of its victims ? Are the parasites long lived ? In what manner do they multiply ? IX. Which are most susceptible to menin- gitis, old or young people? Why are the methods of cleanliness so rigidly carried out in other infectious diseases not recognized in meningitis ? X. What conditions favor the develop- ment of pneumonia ? Show why constant vig- 100 SUMMARY AND REVIEW. i lance in caring for a pneumonia patient is so necessary. XL To what means of communication is yellow fever confined ? What preventive meas- ures are used? XII. How does the germ of smallpox dis- covered by Councilman differ from those of most other communicable diseases? What essential part of Koch's circuit is not carried out? XIII. Why should a strenuous use of dis- infectants be maintained in nursing smallpox? Name the principal preventive treatment. XIV. Does the nurse incur greater risk in nursing smallpox than in nursing other severe forms of communicable diseases ? ior BACTERIA IN SURGERY. CHAPTER VI. SEPSIS, ASEPSIS AND ANTISEPSIS. In surgical practice the bacteria met with most frequently are the following : THE STAPHYLOCOCCUS PYOGENES AUREUS, Germs t j ie streptococcus pyogenes, the bacilli coii Encountered. communis, the bacillus tuberculosis and the bacillus tetani. THE STAPHYLOCOCCUS * PYOGENES AUREUS. Water, dust and air are all means by which this micro-organism is distributed. It is found, also, in the mouth, under the finger-nails, and in superficial layers of skin. This is the germ most frequently found to be concerned in severe forms of inflammation confined to small areas in which pus *is found, described as "acute, suppurative circumscribed inflamma- tion." Whie the staphylococcus pyogenes aureus does not form spores, it is very difficult to destroy, resisting to a remarkable degree all means used for its extermination. THE STAPHYLOCOCCUS PYOGENES *ALBUS AND *CITREUS. These germs are found in the * Pyogenes signifies pus-forming ; Aureus, golden- yellow. * Albus means white. * Citreus, citron-yellow. These colors are assumed when seen in growing cultures. 1 02 SEPSIS ASEPSIS ANTISEPSIS. pus from acute abscesses, but are less virulent than the staphylococcus pyogenes aureus. STREPTOCOCCUS PYOGENES. One of the most frequent causes of peritonitis after sur- gical operations (post operative peritonitis) is said to be the germ streptococcus pyogenes. It is found also in puerperal endometritis ( inflam- mation of the mucous membrane lining the uterus after a child is born) ; in ulcerative en- docarditis (inflammation of the membrane lining the heart accompanied by ulceration), and is also believed to be the cause of general septicaemia (general poisoning of the system due to bacteria in the blood). DIPLOCOCCUS PNEUMONIA. This micro- organism, or germ, is found in empyema (formation of pus in a cavity), and in acute abscesses. BACILLUS TETANI. Surgeons always fear the bacillus of tetanus in accidental wounds, particularly those which have been exposed to danger of infection from the dust of streets, stables, or cellars. SEPSIS, ASEPSIS AND ANTISEPSIS. Sepsis is the result of the gathering of bacteria into the The Cause blood. Bacteria, as we. have already said in a epsis * previous chapter, is the name given by scientists to the large field or group of vege- table micro-organisms we commonly hear spoken of as "germs" or "microbes." 103 BACTERIOLOGY itf A NUtSHELL. We have also said that there are special bacteria for special diseases, as for example the "bacillus typhosus" in typhoid fever. In tu- berculosis the "bacillus tuberculosis," etc. The shape of the bacteria in many instances giving to it its name, viz. : bacillus, "rod-shaped or pencil-like," spirilla, "twisted or curved," cocci or micro-cocci, "sphere-shaped," or like a ball or marble, with modifications or subdivisions of these shapes as for experimental purposes they are cultivated in broth or other liquid, and their varied methods of forming into groups is seen under the microscope. These varied groups are spoken of as "clusters," "chains," "twos,"' "fours," "eights," and so forth. Sometimes the disease in which the germ is first found gives to it its name. The bacteria found in sepsis when seen under cultivation are grouped in "chains," and the name given to them is streptococcus pyogenes. SEPSIS means poisonous or putrid. Asepsis, free from poison or putrefaction. Antisepsis, against poison or putrefaction. Sepsis is found in general surgery, in gynecological surgery and in obstetrics. But it ought not to be found in any one of them. In these days of aseptic surgery when so much time arid thought and expense are given to the prepara- tion of the patient, operating-room, dressings, surgeon's gowns, caps, instruments, etc., so as 104 SEPSIS ASEPSIS ANTISEPSIS. to render all these, and surgeons, assistants and nurses as well, absolutely free from poison (aseptic) by the use of antiseptics no one Sepsis Should should suffer from so terrible a condition, a Not Occur - condition dreaded by all physicians and nurses. Following the preparation of dressings, ban- dages, gauze, sponges, etc., the utmost possible vigilance is necessary in order to be sure that all are kept aseptic after they have been made aseptic. Of what avail is the special process they undergo if the packages containing them are opened and the dressings passed to the surgeon by a nurse or assistant who has not been properly prepared by the free use of soap, .hot water, scrub-brush and the after thorough use of antiseptics, especially in "hand cleans- ing." Of what use is it to use an aseptic Blunders During brush, antiseptic solutions and so forth in pre- Operations. paring the area to be operated upon if the nurse who uses the solutions has been opening and closing windows and doors, or touching other things not aseptic, and then comes to take part in the work mentioned without first thoroughly scrubbing and sterilizing her hands? It is after just such blunders as these in operating rooms, or in private houses, that trouble with the patient often arises. There is great rea- son to wonder why trouble does not arise in every case carelessly handled. Frequently the patient comes through the operation well, and 105 BACTERIOLOGY IN A NUTSHELL. for a day or two seems to be doing nicely, then comes a chill, a sudden rise of tempera- ture, an increased pulse rate, the patient is rest- less and uneasy, and has a worn, anxious ex- pression; other symptoms more or less alarm- ing appear. The physician is hastily sum- moned, and with a grave face, which he vainly tries to brighten in the patient's presence, he examines the chart, then mutters beneath his breath "sepsis;" always a dread word even to physicians and nurses grown old in the work. He removes the bandages and dressings to find abscesses formed about the stitches he had put in with such care, or, worse still, pus oozing from between the stitches. Then, comes a hand to hand fight to overcome the effects of the poison and to save human life, which, sad to say, cannot always be accomplished, no matter how closely the physician's orders are carried out. In place of a surgical case we may have a case of ^obstetrics, perhaps a case in which it * In some of the best Maternity Hospitals of the present day all personal clothing, as well as bed linen, used for both mother and infant during the first week are sterilized, just as for a surgical case. This applies especially to the gowns, abdominal bandages, perineal pads, diapers, etc. These are put up in packages, sep- arate from those containing gauze for the cord, silk, etc. Each package contains sufficient clothing for one day. After sterilization they are not handled until needed. Infants so cared for are said to be less troubled with skin eruptions, and there are no infections of the cord. Sterilization of articles used for the mother serves as a further protection against sepsis. 106 STERILIZATION AND DISINFECTION. has been necessary to use instruments. The nurse in preparing them for the physician's use has not been sufficiently careful, or in some other way something containing the germs of disease has been carried into the puerperal genital tract. Again we have the character- istic symptoms observed in the surgical case, sepsis Cases and again the dread word "sepsis/' rings in our ears. Glad we are to be able to say that such cases are more rarely encountered as the years go by. A conscientious, well-trained nurse will watch every corner, and will let no source of infection escape her keen eye. She will use all antiseptic precautions herself, and she will also guard well her work against any such dis- asters (or worse) as have already been al- luded to. Surgeons, themselves, as a rule, realize very fully the grave responsibility of a life at stake ; The Debt We but seldom do we meet a careless one. They, as well as the world at large, owe a debt of gratitude to Lord Lister for the discovery of the possibility of the overthrow of the power of sepsis through the use of antiseptics. STERIIZATION AND DISINFECTION. We often hear the terms sterilization and disinfec- Sterilization. tion used interchangeably as expressive of the same meaning, which, strictly speaking, is not accurate. When we sterilize anything we are supposed completely to destroy the vitality of 107 Disinfection. Antiseptics. Germicides. Deodorants. BACTERIOLOGY IN A NUTSHELL. all bacteria present, either within, or upon the substance sterilized. The process of steriliza- tion is accomplished by the proper application for a stated period of either chemical agents or heat. In order to disinfect anything we do not necessarily destroy all the bacteria present, but only those that are harmful, because of their power to create disease power to infect, in other words. Certain substances used to prevent the growth of bacteria, but which may not neces- sarily destroy them are called antiseptics. An antiseptic does not always possess the power to disinfect, but a disinfectant is always an anti- septic. Germicides and disinfectants are inter- changeable terms because they both possess the power to destroy disease-producing germs. Deodorants are substances or agents used to destroy offensive odors; they are not of neces- sity disinfectants, but they may be. Creolin, lysol, formalin and carbolic acid are all both deodorants and disinfectants, while such de- odorants as Eau de Cologne and violet extract have no power to disinfect. 108 DISINFECTANTS HOW MOST EFFECTIVE. VARIOUS CONDITIONS MODIFY THE POWER OF DISINFECEANTS. I. The kind of bacteria we wish to destroy. Some are more difficult to kill or to render Conditions powerless to do mischief than others. Spores Powc?of g are found much harder to deal with, as was Disinfectants. spoken of in describing their formation, than the bacteria from which they spring. II. The number of bacteria to be destroyed. If a large number are present more of the solu- tion is necessary than for a small number. Completely saturate the mass always, for what- ever number. III. The temperature and strength of the solution. Hot disinfectants are more effective than warm or cold disinfectants; in fact, all disinfectants should be used hot. IV. Material with which a solution may come in contact. If some disinfectants come in contact with organic matter, they are rend- ered of little or no value thereby. The writer remembers seeing a pupil nurse sent three times to empty out and prepare anew a disinfectant An Assistant's solution because an assistant put his soiled Mistake - finger into the first two, in order to test the temperature, and was about to make the same blunder a third time when prevented by the whispered admonition of the head nurse. The lesson is plain. 109 BACTERIOLOGY IN A NUTSHELL. Plot air, steam or boiling water, are all dis- infectants or germicides. The value of hot air or dry heat as a disinfectant is limited, as there are so many things which cannot be disinfected by either without being injured. Moist heat is more penetrating than hot air, and mat- tresses, clothing, and surgical instruments can all be treated by moist heat without sustaining injury. Clothing stained with pus, or fecal matter, should not be disinfected with steam heat, as the stains will be found difficult, if not impossible, to remove afterward. Boiling water is warranted to destroy ail known bacteria or their spores if exposed to its power for a sufficient period, and provided, also, that a sufficient quantity is used. INTERMITTENT STERILIZATION. By inter- Definition, mitent sterilization we mean the exposure of articles to be sterilized to the action of live steam for one hour on three successive days. Certain spores are known to retain germinating powers after being treated to a bath of boiling water, and the end sought in intermittent steril- ization is to destroy all bacteria which may develop from spores after the first or second sterilization. The process is only rarely neces- sary, because exposure to live steam for one hour usually kills both bacteria and spores. In aseptic surgery many consider the use of both heat and chemicals necessary in order to no ASEPTIC MEASURES. insure freedom from all pathogenic bacteria and their spores. This applies only to the Aseptic. preparation of dressings, sponges and the skin, except in diseased conditions. "Clean healthy tissue contains no bacteria." ''Wounds in healthy tissue tend to heal spontaneously." "Antiseptics being all more or less irritant tend to interfere with the healing process." If a healthy wound is properly protected , .:.,. *'.* . Infection of from possible invasion of micro-organisms, the Healthy use of antiseptics is unnecessary and may be Wounds - injurious. Infection may reach the wound in several ways : I. Because the room in which the operation is performed is not properly prepared, or if sweeping or dusting is done just when the wound is to be uncovered for dressing. Dust must always be wiped up in sick-rooms with a cloth wrung out of a disinfectant solution. II. Use of water not sterilized, or not kept Never Dust covered after sterilization, when it asrain be- With a Dry "-- comes filled with micro-organisms. III. If the skin of the patient has not been made aseptic prior to the operation. No mat- ter how cleanly a person may be, the skin, the hair follicles, and sweat glands all harbor bac- teria, and if not properly attended to these may invade the wound. (Ordinary cleanliness is not "surgical cleanliness.") in BACTERIOLOGY IN A NUTSHELL. IV. The hands of the surgeon or nurse may cause the trouble. V. Instruments, drainage, the clothing of Responsibility patient, or operator or nurse, ligatures, sutures, of the Nurse. sponges, dressings, towels, any of which may be infected. The nurse's duty is to guard against danger of infection from whatever source. After careful cleansing, drainage tubes must be boiled for an hour on three successive days and kept between times and until needed for use in a 75% solution of alchohol. Boil again for ten minutes just prior to using. In- sert the sterile gauze packing required by most surgeons and fold the tubing in a sterile towel ready for use when called for. Gauze sponges, dressings, towels, gowns, etc., should be placed in separate packages, plainly marked and ex- posed to the influence of live steam in a high pressure sterilizer for thirty minutes on three successive days. They must not be opened until they are required for use. Ligatures and sutures should be loosely wound on glass spools and placed in test tubes plugged with sterile cotton before placing in the sterlizer. The cot- ton plugs, unless made too firm, will permit the entrance of sufficient heat to sterilize the material. Always keep sutures and ligatures in sterile tubes closely plugged when not in use, and place these in tightly closed sterile glass jars. Gauze sponges should have no raw 112 ASEPTIC MEASURES. edges exposed. When properly made they are folded upon themselves and all raw edges turned in. A careful nurse never makes a mistake in the number of abdominal sponges she has in use during an operation. Catgut requires much preparation in order to make it safe. Many surgeons prefer to use catgut which is scientifically prepared in large laboratories; this is put up in specially con- structed tubes, which are not opened until re- quired for use. Even these would better be sterilized again prior to the operation. DISINFECTION AND DISINFECTANTS. No. i. HAND DISINFECTION. First, cleanse the hands (including the arms above Precautions the elbows) with plenty of antiseptic soap and hot water, using a sterile brush vigorously for ten minutes, especially for the nails, beneath which germs lurk. Second, clean the nails thoroughly with a nail knife or file, to remove any bacteria the nail brush may have left be- hind. Third, wash the hands again, as the nail cleaning process may have deposited par- ticles of dirt containing germs on the hands. Fourth, soak the hands and arms for several minutes (3 to 5) in a solution containing about a nd Arms. S twenty grains potassium permanganate to each 113 BACTERIOLOGY IN A NUTSHELL. pint of water, and then in another solution of oxalic acid (saturated solution), soaking the hands for the same length of time. The po- tassium permanganate is a good germicide, un- less it comes in contact with organic matter, and oxalic acid is a still better one; it also removes from the hands the brown stain of the potassium permanganate. Fifth, soak the hands and arms in alcohol, and again in hot sterile water. The alcohol as a further pre- caution against bacteria, and the sterile water to relieve the irritation caused by the vigorous scrubbing and use of strong solutions. During operation use alcohol, bichloride of mercury solution, 1-8,000, and sterile water for further protection. No. 2. HAND DISINFECTION. Some sur- Alcohol and geons use alcohol, followed by bichloride solu- Bichloride * Preferred. tion and hot sterile water, applied in the same way as the permanganate and oxalic acid are used after the vigorous scrubbing with brush, soap and water and use of nail knife recom- mended in No. i. There are various other methods of hand disinfection. No. 3. HAND DISINFECTION. This method has given uniformly good results. I. Five to ten minutes thorough washing and scrubbing with green soap and hot water, using a sterile nail brush vigorously, especially 114 HANDS AND INSTRUMENTS, ETC. about the finger nails, and drying with a sterile towel. II. Careful cleaning and clipping of nails with nail file and knife. III. A second washing of hands with soap and hot water for further cleansing from nail deposits. IV. Chloride of lime paste is next well rubbed into hands and nails, and well rinsed off in a soda carbonate solution. V. Soaking of hands two to three (2 to 3) minutes in a bichloride of mercury solution 1-4,000, followed by hot sterile water. During operation use frequently for the hands a bichloride of mercury solution 1-4,000, followed by sterile water as a precautionary measure. In the most up-to-date hospitals surgeons and their assistants and the nurses who have charge of the instruments and dress- ings during surgical operations, are now-a- days using face masks as well as rubber gloves. Those who as yet have not adopted the face mask tie several folds of gauze over the mouth, the saliva, even of the most healthy, has been proven to contain pathogenic bacteria. A slight cough may eject the saliva upon the field of operation with disastrous consequences to the patient. To DISINFECT SURGEONS' SCALPELS AND INSTRUMENTS : First, cleanse instruments and BACTERIOLOGY IN A NUTSHELL. Thorough Cleansing Required. Watch Your Scalpels. Cover Instruments Quickly. scalpels thoroughly, paying particular atten- tion to all crevices and hollow parts. Wrap the blades of the scalpels in cotton and place in a separate tray above the tray in which you place the other instruments, as scalpels must only be boiled two minutes, to prevent dulling their edges. Place both trays in the sterilizer in which water is boiling (the water should contain a small quantity 2% of carbonate of soda). Boil all instruments except scalpels or bistouries twenty minutes. Remove from the sterilizer and place immediately in a five per cent ($%) solution of carbolic acid, covering the receptacle with a sterile towel, unless the surgeon prefers to use his instruments dry, which many do ; in this case they are placed in a sterile receptacle and covered as quickly as possible. The same process of cleansing and sterilizing should be adopted after an opera- tion ; they must be wiped dry with a sterile in- strument cloth before returning to the instru- ment closet. The method of sterilizing instruments adopted by some hospitals is to wrap the in- struments in a sterile towel after cleansing thoroughly, and then to expose them to the in- fluence of live steam for a stated period ; about thirty minutes. To DISINFECT SPUTA AND SPUTA CUPS: Pour into the cups sufficient hot five per cent 116 SPUTA, CLOTHING, BEDS, BEDDING, ETC. ( 5 % ) carbolic acid solution to saturate the Ug f contents of the cup. Add a small quantity of Carbonate. carbonate of soda (common washing soda) to loosen the sputa from the sides and bottom of the cup; cover and allow to stand until cold before emptying. The cups should be well cleansed and boiled once a day in a soda- c p s puta carbonate solution, particularly the sputa cups of tuberculosis patients. To DISINFECT CLOTHING, BEDS, BEDDING AND FURNITURE : Personal clothing, towels and bed linen used in the care of communicable diseases must be soaked for two o,r more hours in a proper disinfectant solution (carbolic acid, sol. five per cent ($%) is good), and then thoroughly washed. Dry in the outdoor air and sunshine. Mattresses and pillows should be exposed to the influence of live steam for a sufficient length of time to do good work. When there is no apparatus for the steaming process, wash the surfaces of pillows and outdoor Air mattresses with the disinfectant solution, turn in Disinfection, over the foot-boards of the beds in rooms or - wards to be fumigated, so that the substance used for fumigation may reach them from all sides. To complete the process, put them out in the fresh air and sunshine for twenty-four Exposure hours. Mattresses stained with typhoid fever from a11 Sides * defecations would better be burned. Beds, windows, walls, floors, woodzvork and 117 BACTERIOLOGY IN A NUTSHELL. Leave Bureau and Other Drawers Open. Removal of Odors. Reversible Rubber Sheeting. all pieces of furniture first must be cleansed with soap and hot water and then washed with the disinfectant solution. Bureau and stand drawers should be treated in a similar way, and left open for fumigation. If floor rugs are used they should be wiped off with the solu- tion, and both sides exposed to the fumes of formaldehyde or other substance just as recom- mended for mattresses. Then they should be hung up and well beaten in the open air, and left there for twenty- four hours also. To DISINFECT RUBBER SHEETS: First, wash clean in hot water with soap and brush, rinse in clear water and soak one hour in carbolic acid five per cent ($%) solution, or other good solution. Wipe dry and hang out in the fresh air and sunlight to remove any odor than that of rubber. Sheeting with the rubber preparation on either side (reversible), is the best and safest in nursing communicable diseases. The disinfecting can be more thoroughly accomplished, and the sheets look safe. This sheeting makes a good covering for all vessels used for evacuations, etc., to be disinfected. SUMMARY OF CHAPTER VI. Bacteria in surgery. Cases in which they are found. Sepsis, its cause, the germ found in sepsis. 118 SUMMARY AND REVIEW. Why there should be no cases of sepsis in the present age. Why sepsis is so much to be dreaded. The "everlasting and eternal vigilance" necessary in surgical work and nursing. The dangers to be guarded against. What may come of blunders in surgery and in obstetrics. Responsibility recognized by most surgeons as too great to be trifled with. The nurse's responsibility should be ever uppermost in her thoughts. Sterilization. Disinfection. Antiseptics. Germicides. Deodorants. Conditions which may lessen the power of disinfectants. Heat as a germicide. Intermittent steriliza- tion. Aseptic surgery. The precautions necessary to prevent infection from reaching healthy tissues. QUESTIONS FOR REVIEW CHAPTER VI. I. W'hat germs are most commonly met with in surgery? What cases are they most likely to attack? II. What germ do physicians most fear in a certain class of accidental wounds? III. Define sepsis, asepsis, antisepsis. What germ is said to be responsible for the disease sepsis? How does it gain an entrance to the BACTERIOLOGY IN A NUTSHELL. human structure ? Is it easily overcome ? De- scribe the symptoms of sepsis. Seat of in- vasion in sepsis. IV. Describe in detail the work of the nurse in guarding sources of infection before, during and after operations and in obstetrics. V. Define sterilization and disinfection. Antiseptics. Germicides. Deodorants. Are germicides and disinfectants interchangeable terms ? VI. Give an accurate explanation of the conditions modifying the power of disinfect- ants. VII. What do you know of intermittent sterilization? Explain where its use is ad- vised. VIII. Define aseptic surgery. What do many surgeons consider necessary adjuncts to safety in the practice of aseptic surgery. De- scribe in detail the precautions you would observe in protecting healthy wounds from in- fection. 120 CHAPTER VII. SOLUTIONS, THEIR USES AND PREPARATION. IODINE SOLUTION : Harrington's solution of iodine is an antiseptic rapidly growing r in popular favor. Strength used, i-ioo and 1-500. This solution is believed by many to be the best antiseptic now in use for any pur- pose. CARBOLIC ACID SOLUTION AS A DISINFECT- ANT : Carbolic acid solution may be safely used for the disinfection of personal clothing, bedding, excreta, surgical instruments and appliances. It cannot be relied upon to de- stroy spores, and therefore should not be used as a disinfectant in tetanus, anthrax, malignant oedema, or in any disease due to invasion, of spore-forming bacteria. A one per cent, strength solution is said to be sufficiently strong to destroy the germs of cholera, typhoid fever, diphtheria and erysipelas if used hot in suf- ficient quantity, and allowed to stand an hour, so as to completely saturate the material to be disinfected. A five per cent (1-20) solution is necessary in surgical practice, in order to be reliable. Fifty-one drams of liquid carbolic acid dis- solved in each gallon of water makes a five per 121 BACTERIOLOGY IN A NUTSHELL. cent solution. Pour boiling water over the carbolic acid and mix thoroughly. To make a small quantity of a five per cent (5%) sol. carbolic acid ( 1-20) add one dram of the liquid to nineteen drams of water. (See table at close of Chapter VII. for number of grains to each pint.) BICHLORIDE OF MERCURY solution will de- stroy all forms of bacteria and their spores. Strength 1-500 required for spores exposure one hour. Bichloride of mercury is not re- liable for the disinfection of excreta, sputum or pus, because of its power to precipitate an albuminous deposit, which forms a coating around the substance and prevents the solution from penetrating the mass. It is a good dis- infectant for rooms. It is also used in hand disinfection and as a wet pack or dressing in various forms of inflammation. It ruins in- struments or anything in the shape of metals. In making up bichloride of mercury solu- tions, tablets containing seven and a half grains are often used. One of these tablets added to one pint of water makes a 1-1,000 solution. One to a quart a 1-2,000 solution; 1-1,000 is the strongest solution used for almost any pur- pose. Water is added to obtain the weaker solutions generally used. For example, if you have a quart of 1-1,000 solution prepared and the doctor asks for three quarts of 1-4,000 so- 122 SOLUTIONS USES AND PREPARATION OF. lution, add three quarts of warm sterile water to your quart of 1-1,000 solution, and you will have the desired strength. If only a small quantity, say one pint of the solution 1-4,000 is needed, take four ounces of the 1-1,000 solu- tion and add to it twelve ounces of water of the required temperature. In using the bi- chloride of mercury powder (corrosive subli- mate), dissolve seven and one-fourth grains (grs. 7^4) in each pint of water. Sublimine, which is another preparation of mercury, called ethylenediamin-sulphate of mercury, is used for all purposes in which bichloride of mercury solutions are used. It is considered by some to be less irritating than bichloride of mercury and alcohol to remove oily substances from the skin prior to its use as a disinfectant is unnecessary. Strength of so- lutions from i- 10,000 up to 1-300. PEROXIDE OF HYDROGEN (Hydrogen Diox- ide), also called "dioxygen," is considered by many surgeons to have no equal either for safety or efficiency in treating cavities or sur- faces secreting pus. This preparation must be kept tightly corked, as it will otherwise deter- iorate in value very rapidly, and in a cool, dark place ; heat and light spoil the preparation. INTESTINAL EVACUATIONS may be safely disinfected by pouring upon them three times their quantity of boiling water. Cover and 123 BACTERIOLOGY IN A NUTSHELL. allow to get cold before disposing of them. Milk of lime made from freshly slaked lime is also a safe, cheap disinfectant for excreta. It should remain in contact with the exacuation for several hours. Freshly slaked lime must be used in preparing this solution. To slake the lime, pour one pint of water over two pounds of lime. When dissolved mix thor- oughly. This preparation is also called "hydrate of lime." To make the "milk of lime" solution, use one pound of hydrate of lime to eight pints of water. Contact with the air spoils this solution, renders it inert, and for this reason it should be made anew every two days. LYSOL is a good antiseptic, especially so as it is non-irritant. It can be used to disinfect almost everything in the sick-room. It is used also for irrigation purposes; for disinfection of skin prior to operations; for hand disinfection, e,tc. Usually a two per cent solution is required. When using the liquid lysol a two per cent solution can be made by dissolving two and one-half fluid ounces of the drug in one gallon of water. For dressings prior to operation, one-half per cent solution is used. (For number of grains required in making up solutions, see table.) Tricresol, solutol and solveol are among the most valuable disinfectants of the present day. They all de- 124 SOLUTIONS USES AND PREPARATION OF. stroy spores and are not open to the objection raised against bichloride of mercury with re- gard to albuminous deposits. They belong to the same family as lysol and are known as the creosols. Tricresol is accounted as 'the best disinfectant of the group, solutol, solveol and lysol following in value in the order named. i to 5% solutions are required in order to be effectual. CREOLIN is another antiseptic used as a dis- infectant for the hands, and also for the pur- pose of irrigation. A five per cent solution is sufficiently strong, as a rule. POTASSIUM PERMANGANATE is a fairly good disinfectant, but its application is limited, be- cause its action is so quickly rendered inert by contact with organic matter. It also stains a yellowish brown any object which it touches, and the stain requires the application of an acid to remove. It is used quite extensively as a deodorant in offensive wounds, for hand dis- infection and to irrigate cavities. Sixteen to twenty grains of the potassium permanganate crystals to each pint of water is the strength of the solution generally used. Oxalic acid (a saturated solution) is frequently used to re- move the stain of potassium permanganate. It is considered to be a more powerful germicide than permanganate of potassium, but it is de- cidedly irritant in its effects. BACTERIOLOGY IN A NUTSHELL. NORMAL SALT SOLUTION is a very valuable antiseptic. As a douche and enema it is well known. It is also used in intravenous, subcu- taneous and rectal injections, for its stimulat- ing effects after hemorrhage in various dis- eases ; in shock during or after surgical opera- tions; in toxemia from any cause. A pint of the solution is frequently given by rectal in- jection an hour or two before a surgical opera- tion, as its use serves to lessen the possibility of shock, and also assists in preventing the thirst from which patients so often suffer after surg- ical operations. 0.6 per cent is the strength used. The solution is made by dissolving one dram of common salt in each pint of hot water. Sterilize in a covered vessel before using, ex- cept where used as a rectal injection, when sterilization is not necessary. When used in- travenously, or subcutaneouslj, it must always be sterilized* The intravenous injections are never given by the nurse, as it is a method con- fined to the physician alone. It is used during operations very often, or immediately after operations, when there has been much loss of blood, or where the patient is suffering from shock, in order to "furnish sufficient fluid to * Sterilize the syringe, canula, suture, thermometer for testing the temperature of the solution (which should be 115 to 120 F.), scissors, and everything in the shape of instruments by boiling in soda carbonate solution. For the intravenous injections, thoroughly scrub and sterilize the area to be used. 126 SOLUTIONS USES AND PREPARATION OF. suspend the remaining red blood cells for cir- culation through the system, and to restore a normal amount of circulating fluid for the heart and arteries to act upon." For wet dress- ings, packs, purposes of irrigation and for soaking of wounds or incisions after surgical operation in septic and other cases, no better solution than normal saline has yet been dis- covered. In point of fact, it has few equals. WHEN PREPARING FOR AN OPERATION the nurse can make up a salt solution containing two ounces of common salt to one pint of hot water; sterilize the solution by boiling five to ten minutes, after filtering. Keep in a tightly closed sterile jar. One ounce of this solution added to each pint of sterile water is the re- quired strength for all injections necessary when the patient is suffering from shock, ex- haustion, or other causes in which normal salt is called for. It should be made anew for each operation. FORMALIN SOLUTION. A four per cent solution of formalin is considered to be as effec- tive as bichloride of mercury solution 1-1,000, or as carbolic acid solution 1-20 (5%). Formalin contains formaldehyde forty per cent and wood-alcohol ten per cent. Unlike bi- chloride of mercury it does not deposit album- inous substances in solution, but it destroys iron, steel or other metal quite as effectually. 127 BACTERIOLOGY IN A NUTSHELL. The four per cent solution is prepared by add- ing forty-one-drams to each gallon of water. It destroys spores and can be used safely, also, to disinfect excreta, urine, pus, etc. (For num- ber of grains to use for each pint of solution see table at close of Chapter VII.) BORACIC ACID is a mild, non-irritating anti- septic used freely in irrigation and in surgery of the eye and ear. Many surgeons use a sat- urated solution ; others prefer a solution of one dram to each pint of water. It is dissolved by pouring boiling water over the acid powder. It does not dissolve readily in warm water. In fact it would better be boiled. In making the saturated solution, it has been found that only about eighteen grains of the powder to each ounce of water is soluble in water alone. THE AMERICAN STANDARD. A solution known as the "American Standard" is made by dissolving six ounces of chloride of lime in one gallon of water. It is said to be valuable in the disinfection of excreta. Chloride of lime in order to be reliable must be purchased of a reliable mannufacturer. THIERSCH'S SOLUTION. In the preparation of this solution, which is often used as an anti- septic for purposes of irrigation, add one and a half ounces of boracic acid and two drams of salicylic acid to one gallon of water. Dissolve the acids in hot water and sterilize before using. 128 SOLUTIONS USES AND PREPARATION OF. BALSAM OF PERU. A five to ten per cent solu- tion of balsam of Peru is an antiseptic solution frequently used in dressing burns and other wounds. The balsam is combined with castor oil or glycerine as a base. Balsam of Peru, five per cent, and castor oil ninety-five per cent, is the common formula. These are a few of the best drugs for anti- septic and disinfectant purposes now 7 in use. New drugs for the same uses are being discov- ered every year. STERILE WATER. As sterile water alone is so frequently used in aseptic surgery, its prep- aration should be understood even by nurses just entering the work. The water should first be filtered and then boiled in vessels* which have also been made thoroughly clean by wash- ing and soaking in an antiseptic solution, or better still, by boiling. Distilled water ought to be aseptic, but as those who distill it are apt to handle it carelessly, nurses are advised to boil even distilled water before using it for aseptic sugery. FILTERED WATER. FILTERED WATER is not considered safe to use for drinking or surgical purposes without sterilizing. The parasitic bacteria filter * Filtered water and salt solutions are preferably sterilized in their containers and kept therein tightly closed until used. 129 BACTERIOLOGY IN A NUTSHELL. through any ordinary filtering apparatus, the process of filtration only ridding the water of other impurities and making it transparent. A system of sand filtration is in use in some cities. By means of the sand the parasitic bacteria are held in abeyance until destroyed by the sapro- phytic. ALCOHOL is used in skin sterilization for the purpose of removing oily substances, which prevent the penetration of some other disin- fectants. Ether is used for the same reason. SULPHUR DIOXIDE FUMIGATION. To use sulphur for fumigation, take about To Fumigate four pounds of rock sulphur (brimstone) for With Sulphur. each one thousand cubic feet of space An apertures and crevices about transoms, doors or windows, etc., must be well packed with damp absorbent cotton, or batting, or strips of old muslin, to prevent the escape of the gas. Paste paper over openings of grates or regis- ters, key holes and speaking tubes. Place an agate-ware, or other metal basin or tub, half- filled with water upon a firm foundation made of several bricks built near the center of the apartment. Have the required amount of sulphur on top of some paper in an iron kettle sitting in the basin or tub of water. Pour over the sulphur a few ounces of alcohol. Set fire 130 SULPHUR FORMALDEHYDE FORMALIN. to the outer edge of the paper and leave the room quickly, as the fumes of gas from sulphur are dangerous to many people.* Close and Danger from lock the door, and place a thick rug over any Inhalin s- crevice that may be at the bottom. Keep the room closed for twenty-four hours, then open up the doors and windows and ventilate thoroughly. Floors, woodwork, etc., should be again wiped over with a cloth wrung out of carbolic acid solution ($%) five per cent. FORMALDEHYDE FUMIGATION. FORMALDEHYDE is more reliable for fumiga- tion than sulphur, and is less dangerous to in- Advantages of spire. It is a gas made by burning methyl Formaldehyde, alcohol, commonly called wood-alcohol, in a specially constructed lamp. One and a half pints of alcohol are required for each one thousand cubic feet of air space. The process of converting this amount of alcohol into formaldehyde gas or vapor takes less than two hours, and the rooms or wards are ready for free ventilation at the expiration of eight hours. Observe the same method of packing crevices of doors, windows, transoms, etc., and of clos- ing grate openings and key holes as described in sulphur fumigation. * The writer remembers an instance in which a nurse was almost suffocated by inhaling sulphur gas. She thoughtlessly stepped back into the room for a forgotten article, and was almost overcome when rescued. BACTERIOLOGY IN A NUTSHELL. Moisture is always necessary during the pro- cess of fumigation when using sulphur dioxide. In some hospitals, potassium permanganate crystals are combined with formaldehyde solu- tion in order to liberate gas more readily and rapidly. The liquid formaldehyde is poured over the crystals.* It is also said to increase the germicidal properties of the formaldehyde. Formaldehyde and sulphur dioxide tapers are used with good result also. A wet sheet or other moisture must be present in the room or ward to be disinfected when using these tapers. Solidified formaldehyde is a preparation recom- mended by many. A very simple, specially constructed lamp is used for generating the gas which is liberated very rapidly. Moisture in the room or ward during its use is believed to be unnecessary ; the preparation itself being moist. It sometimes dries out, however, and then water must be added. As so many formaldehyde lamps are unre- liable, some have found it more satisfactory to use formalin solution, which contains forty per Some Lamps cent of formaldehyde. The formalin is boiled Unsatisfactory. . , in a special apparatus and the gas passed into the room to be fumigated by means of a tube inserted through a key-hole or other small *For a room fifteen feet square, five ounces of permanganate crystals and twenty ounces of formalde- hyde solution are used. 132 SULPHUR FORMALDEHYDE FORMALIN. opening. One gallon of the preparation will supply sufficient gas to purify about twelve hundred cubic feet of air space. THE SHEET METHOD OF FORMALDEHYDE FUMIGATION. After packing all crevices in the room or ward to be fumigated, place a dry sheet in a pail and over it pour one pint of liquid fromaldehyde for every one thousand (1,000) cubic feet of air space. Quickly spread the sheet over a line previously stretched across the room. Close and pack the crevices around door frames and transoms. It is asserted that the liberation of the fumes all at once accom- plishes the work of disinfection more thor- oughly than when they are liberated slowly and diluted with air. Liquid commercial ammonia sprinkled about a room after formal- dehyde fumigation will remove or neutralize the fumes remaining in the room. 133 BACTERIOLOGY IN A NUTSHELL. TABLE FOR PREPARATION OF SOLUTIONS. Using as a basis 7300 grains to the pint. From "Hospital Formulary." To Prepare One Pint of a Solution Required to contain of a certain substance. Take of the substance the below stated amount in Per cent, Or grains with enough water to make one pint. ..grains 0.73 . .grains . .grains . .grains . .grains . .grains . .grains i/ioo per cent. .. . in 1/50 per cent in 1/40 per cent in 1/30 per cent in 1/25 per cent. .. . in 1/20 per cent. .. . in I / I 5 P 6 *" cent. . . . in i/io per cent in J /5 per cent. . . . in 1/4 per cent in 1/3 per cent in 1/2 per cent in i per cent. . . . in i 1/3 per cent in 2 per cent in 2*/2 per cent in 3 per cent. . . . in 4 per cent. . . . in 5 per cent. . . . in 10 per cent in 20 per cent in 25 per cent. . . . in 50 per cent. .. . in m 4,000. in 3,000. in 2,500. in 2,000. in 1,500. in 1,000 grains 500. 400. (2/2) (3) 1.46 1.83 2.44 2.92 3.65 4.87 7-30 grains 14,60 (14^) grains 18.25 (i8j4) 300 grains 24.33 (24^) 200 grains 36.50 (36^) 100 grains 73.00 (73) 75.... grains 97.33 50 grains 146.00 40 grains 182.50 33^3-. grains 219.00 (219) 25 grains 292.00 (292) 20 grains 365.00 ( 365 ) 10 grains 730.00 (730) 5 grains 1460.00 (1460) 4. ...grains 1825.00 (1825) 2 grains 3650.00 (3650) (97) (146) (180) The following simple method of computing the amount of a liquid drug to be used may be found useful when preparing solutions for pur- poses in which absolute accuracy is not neces- sary. One pint, liquid measure, contains seventy- six hundred and eighty (7,680) minims (3) 16 X (3) 8 X (m) 60 (m) 7,680. 134 SUMMARY AND REVIEW. Multiply the number of minims by the per cent solution required and the result gained will be the amount of drug in minims for each pint of solution. Divide this sum by sixty (60), the number of minims in a dram, and you will have the quantity to be used in drams. Example. To make one pint (OI) of a five per cent solution : 7680 X .05 =384.00-^60=6.40, or about six and a quarter (6j4) drams of the drug to each pint of water. For a two per cent solution proceed as be- fore: 7680 X .O2=i53.6o-r-6o=2.5'6, or about two and a half (2^) drams to each pint of water. SUMMARY OF CHAPTER VII. Harrington's Solution Strength used. Carbolic Acid Solution its value as a dis- infectant. Its preparation and uses. Its un- certainty in destroying spores. Bichloride of Mercury Solution prepara- tion and uses. Its power to precipitate albu- minous deposits. Use and care of Peroxide of Hydrogen. Safe method of disinfecting excreta. The preparation of lime for such purposes. Lysol and Creolin as safe antiseptics. Advantages and disadvantages of Potassium 135 BACTERIOLOGY IN A NUTSHELL. Permanganate as a disinfectant. Oxalic Acid in comparison. Value of Normal Salt Solution. Its prepa- ration, when and how used. How Formalin may be as effective as bichlo- ride of mercury, or carbolic acid. Boracic Acid, mild, non-irritating, much used for the purpose of irrigation. American Standard and Thiersch's Solution their composition and uses. Balsam of Peru combined with an oil one of the best dressings for burns. Sterile Water process of sterilization. Distilled water. Filtered water not used with- out sterilizing in aseptic surgery. QUESTIONS FOR REVIEW. I. Is carbolic acid a complete germicide? In what class of diseases is it safest to employ other disinfectants rather than carbolic acid ? State accurately how to prepare a carbolic acid solution suitable for use in surgical prac- tice. II. Why is bichloride of mercury unsafe to use for disinfecting excreta? Surgical instru- ments? How would you prepare one pint of bichloride of mercury solution 1-4,000 from a solution 1-1,000 as a base? III. What can you say of the efficiency of 136 SUMMARY AND REVIEW. peroxide of hydrogen? What precautions should be taken to prevent its becoming inert? IV. What can you say of the value of lime as a disinfectant ? How would you prepare it for use? V. Name several points in favor of the use of lysol as an antiseptic. Also mention one or two disadvantages of potassium permanganate. VI. In what ways does the use of normal salt solution benefit the patient when used dur- ing or after operation ? VII. What advantage has formalin solu- tion over bichloride of mercury for disinfecting excreta ? VIII. Why is the free use of boracic acid safe? IX. How is the "American Standard" solu- tion prepared? Also "Thiersch's Solution?" What per cent solutions of the balsam of Peru are used ? Mention a common base. X. Describe the method of sterlizing water. Is it safe to sterilize water without filtering? And is distilled water safe to use in aseptic surgery without sterilizing? XL Describe the process of sulphur fumi- gation. What are its disadvantages ? XII. What is formaldehyde? State why it is a more reliable substance to use for fumi- gation than sulphur. Has its use any disad- vantages ? 137 CHAPTER VIII. Result of Neglected Hygienic Laws Hygiene Defined. HYGIENE. Neglect of the laws of hygiene frequently brings upon the human structure troubles which so weaken its various organs and sys- tems that access and development of bacteria therein becomes an easy matter. It seems op- portune, therefore, to add a few thoughts along hygienic lines. Nurses, perhaps more than any other class of women, should not only understand but obey the laws of Nature as revealed to us in the study of hygiene. We are so often questioned by sick ones entrusted to our care as to why certain ills have come into their lives. Too often they suffer from diseases brought upon themselves through neglect or ignorance of hygienic laws. While it is not within the province of the nurse to take the place of the physician, whose duty it is to explain this pain- ful truth to his patient, she can very often afterward help the sufferer by suggestion, ad- vice and example, to guard against future troubles. In the first place, then, what do we mean by hygiene? Hygiene is that branch of science which teaches us how to keep healthy. In by- 138 HYGIENIC SUGGESTIONS. gone years, so-called civilization and the ac- companying customs of the day laid so many restrictions upon women that it was impossible to follow fashion's dictates and be healthy at one and the same time. Young girls were put into tight corsets, French-heeled shoes, etc., when scarcely beyond babyhood; at any rate, before they were fairly in their teens and while they should still have been at play, a thing quite out of the question for the poor little martyrs arrayed in such outlandish costumes. In fact, at the time when foolish mothers allowed them- selves to follow fashion's whims and so torture their young daughters, for half-grown girls to s oc i ety s romp and play games was considered a social Restrictions. outrage and if young women were to attempt to join in outdoor sports the offense was rated about next door neighbor to criminal. While there may be, and probably are, many who still cling to such erroneous and silly notions, the day has pretty well gone by when established fashions are so directly opposed to the laws of health. Woman now-a-days has just as good opportunities to be healthy as has her brother man. In this age young girls and young women may join with members of the "sterner sex" in games of tennis, golf and croquet without Outdoor being considered "Tom boys" or unladylike. Games No They learn to swim and to row, to climb to the Tabooed. hilltops, to ride horseback, to take cali.sthenic 139 BACTERIOLOGY IN A NUTSHELL. Hygiene and Length of Days. Duty Toward Our Neighbor. exercises, to go corsetless if they want to, and to wear skirts whose trains are not an impedi- ment to long, brisk walks in God's pure air and sunshine, all without danger of being called or thought of as either immodest or ahead of the age, and therefore objects for contempt. In our work as nurses so much of our every- day duty lies within doors that we are apt to become careless or forgetful of the laws which keep us healthy, the principal and most import- ant ones of which are the daily bath, fresh out- of-door air and sunshine and exercise, also sufficient rest and sleep and proper food taken at regular intervals. Without obedience to these laws at the right time and in the right way the nurse cannot satisfactorily fulfill her duty to those the physician entrusts to her care. If she attempts it she soon becomes a physical or mental wreck, sometimes both. The aver- age length of time the conscientious nurse is able to remain in active service as care-taker of the sick is said to be ten to fifteen years. The time must of necessity be much shorter if her health is neglected. This does not by any means signify that we may ever shirk duty. Oh, no ! There are frequently times of emerg- ency when the nurse, especially the nurse in private work, finds it impossible to have her hours "off duty." So often there is no one in 140 HYGIENIC SUGGESTIONS. the home who is sufficiently experienced in the- care of the sick to be trusted to relieve her even for a few hours of much needed rest. If the expense of a second trained nurse cannot be afforded, then the path of duty is obvious. These hours of danger, as a rule, do not last through many days. Then we must again take up our "sponge" and "plunge" baths, our brisk walks in the fresh air and sunshine more rigorously than ever, and so regain our lost tone. Let us decide right in the beginning as we enter nursing ranks to divide our time of recre- ation in cultivating all the aids to health and usefulness (not neglecting the mind), and so prolong the "length of days" we shall spend in pursuit of our high and noble calling. High and noble indeed to those who enter the work in the right spirit. Not for the sake alone of the money in it,* although the financial side of the question is important, "surely the laborer is worthy of his hire," and be assured that to the "worthy" are always given the fruits of their labor with all kindly appreciation. But * The writer once had the misfortune to hear a pupil nurse, who had been rebuked for neglect of duty, make this remark: "I don't care how I get through my work in training school. What I am thinking of is the $20 a week I am going to make when I am out for myself." Girls, do not enter the field in such a spirit ! The place for such nurses is outside the ranks with the nurses who cannot control temper. 141 BACTERIOLOGY IN A NUTSHELL. let us remember, also, that there is an inborn love of the work paramount in the heart of every nurse who ever becomes in any true sense The Successful of the word worthy and a success. Such nurses enter the training-school with heart and soul and mind aglow, with hands ready and willing accurately to perform the most trivial or the most difficult tasks with equal care and promptness. Physicians' orders are carried out promptly and accurately and are "charted" neatly and concisely. They never forget that the patient's chart is a history of the case to which at some future time the physician may need to refer; therefore, every symptom is ob- served carefully and is recorded faithfully. Their patients always look well cared for ; their hair, teeth, tongue, finger-nails and all parts of the body are immaculate ; their beds dainty and sweet, and every square inch of the sick rooms or wards over which they have charge is as neat and clean and trim as human hands and observant eyes can make them. These are the nurses who despise gossip, scorn deceit and all petty meanness, and who realize that personal responsibility is attached as a primary link in the chain of "qualifications of the good nurse." This realization keeps them ever on the alert to add to this primary link all the others neces- sary to make them not only good nurses, but the best nurses possible. 142 HYGIENIC SUGGESTIONS. While realizing our duty towards others, do not let us forget that we owe a duty to our- selves also ; that we are responsible to God for our own health. There are broken-down nurses in the world today who ought still to be in active service, but whose condition, through mistaken ideas of duty, renders them a burden to themselves and to others. A HEALTHY MUSCULAR SYSTEM. We are taught when studying the muscular system that Nature's Nature gives to each individual about the same kind and amount of muscle ; that the difference in strength as seen in different people is due in part to the manner in which they are taken care of, used, disused or abused. All of our organs must have proper exercise in order to be kept healthy, and in order also that we get from them that service for which they were intended. If we do not use our brains in study while we are young they become inactive and we R esu i ts O f grow dull and stupid. In later life we awaken Inactivity, to the fact that there are a great many things we would like to know which we do not know, and we find it a much more difficult task to get our brains to act as we desire them to than it used to be. Study then becomes a burden rather than a pleasure. In the same way, if we do not exercise the voluntary muscles (those muscles which our will controls) sufficiently, they become wasted and soft and flabby, and 143 BACTERIOLOGY IN A NUTSHELL. Results of Overwork. Walking Develops the Muscles. How to Walk. we feel the effects of their disuse in the in- voluntary muscles (those muscles over which our will has not control). The heart does not do its best work, the organs of respiration and of digestion and of excretion are impaired, and the whole structure is apt to suffer. On the other hand, if the voluntary muscles are abused by over-exercise and insufficient rest we have other evils to contend against. They wear out faster than Nature can supply the new material with which to rebuild them, and we have again the weak, flabby voluntary muscles, and suffering to endure also from a weakened condition of the involuntary. EXERCISE. Proper muscular exercise then is necessary if we preserve our health. Mus- cular development of the arms is often very noticeable in nurses who give massage treat- ment. Good, brisk walks in the open air are conducive to the development of all the muscles of the human structure. When walking do not drag along as if not quite sure what your limbs were given you for. It is necessary to walk briskly in order to keep the circulation just right. Keep your head erect; your shoulders well thrown back to give the inspired air a chance to expand the lungs and keep them in good working trim. Narrowchested people become such very often because they neglect to carry themselves erect and "square 144 HYGIENIC SUGGESTIONS. their shoulders" when they stand or walk. Narrow-chested people court tuberculosis. To walk several miles a day is necessary for those whose occupations keep them indoors most of the time. DRESS. There is nothing more hygienic in the way of dress than the nurses' uniform, but JJ OW to J Dress. it was never designed for street wear. It was designed to protect the sick from bacteria so frequently carried to them in the woolen dresses, as well as by the soiled hands, of those who used to care for them, and who knew noth ing of the laws of hygiene as trained nurses understand them today. In some cities nurses seem to be given to the habit of going about the streets and on street Keep the ,, - f , f Uniform cars m their uniforms when out for a con- Sacred. stitutional." This practice, if they but stop to think about it, must impress them as all wrong. We can never tell just where we may encounter a communicable disease, just as likely on the street cars as anywhere else. How dreadful to carry its germs back to some poor sufferer with already enough to bear! Let our uniform then be sacred to the sick-room alone, but let us always wear it there. Have a street dress which is simply but taste- fully made and quickly donned. Wear P res .l t * Sensibly, hygienic waists, and skirts suspended from the shoulders rather than from the hips. Wear H5 BACTERIOLOGY IN A NUTSHELL. sensible-looking, neat hats. Nothing is much more unprofessional than a nurse in a hat on the "flower garden" order, or who is adorned with neck chains, rings, "bangle" bracelets, and so forth, whose skirts sweep the streets and gather up dust and bacteria as they sweep. When it comes to exercising in garments that constrict the chest and abdominal muscles, it is quite out of the question. How can the abdominal or pelvic organs remain healthy when thrown into unnatural positions by pres- sure of tight corsets, waist bands or dragging skirts? How can the nurse who goes out in cold or wet weather only half clad expect to be healthy? Any young woman is deserving of censure who goes out in unseasonable weather in waists and skirts on the spider-web order over gossamer underclothing; who wears also flimsy, low-cut shoes and the thinnest of hosiery ; yet we try to excuse her on the plea of "poor judgment" or "a lack of common sense," but for the nurse there should be no excuse. In her daily avocation she comes in contact too majiy times with the fruits of just such errors in judgment. She sees in all their sadness the evils brought upon the human frame by just such indiscretions. The cold that developed after exposure to the elements ; the cough that never got well; the wasted pain-racked frame, all these are object lessons too familiar ever to 146 HYGIENIC SUGGESTIONS. be lightly overlooked or forgotten. It is the nurse's duty to dress so as to be healthy. Her work demands health. There is no room in the ranks for the nurse who "enjoys poor health/' Let us all try to be healthy. THE BATH. Nothing is more conducive to good vigorous health than proper and system- The Various atic bathing. Few things are more restful to Baths - the tired nurse when she comes off duty than a good warm salt bath before retiring. A pint of sea salt, or common salt, to each two gallons of water is a fair proportion. Take a good "rub" with a Turkish towel on emerging from the bath. A cold sponge bath should be taken in the morning when you rise. Many recom- mend a cold "plunge" bath and find it very healthful when taken quickly and followed by a brisk rubbing, but it is a bath not suited to all constitutions. Those who find a cold plunge too severe, often enjoy getting into a tepid bath and gradually lowering the temperature until it is cold. A good soap and water tub bath several times a week seems necessary to health- ful conditions, in addition to "salt" baths, "sponges" and "plunges." When taking a bath after a meal, allow two hours to elapse before beginning operations. THE HAIR, THE TEETH, THE NAILS, ETC. :- Take care of your hair and keep it well sham- Disinfect the pooed. Diseases can be communicated from air i47 Obey the Calls of Nature. A Mixed Diet. BACTERIOLOGY IN A NUTSHELL. one to another by bacteria which fasten upon the hair, as well as upon the skin, beneath the finger nails and within the mouth. Do not forget these points when carrying out personal disinfection at the close of nursing a commun- icable disease. The toilet is never complete until the hair, the teeth and the finger nails are as immaculate as the dress and the rest of the person. Do not forget that neglect of Nature's calls leads to habitual constipation, cystitis and other evils allied to these. Write this truth in cap- itals upon your memories. It will save you lots of trouble. FOOD AND WATER SUPPLY. In order to keep healthy, food should not only be taken at regular intervals and in proper quantities, but it should also be of the most nutritious, easily digested and assimilated character. Pastry and sweets should be partaken of very moder- ately, if at all. The heaviest meal of the day should not come in the evening when the diges- tive system is tired from the exertions of the day and needs rest. A mixed diet, consisting of meat, vegetables, fruit, bread, eggs and milk, will be found more valuable, when planning for a healthful diet, than the cranky idea of living entirely upon vegetables or going to the other extreme and cutting them out of the food list entirely. 148 HYGIENIC SUGGESTIONS. Do not drink cold water, particularly ice- cold water, with your meals. It chills the Water Supply. stomach and retards digestion. The human structure requires plenty of water to keep the wheels of its complex machinery in good run- ning order, but this water supply should be taken in between meals and should be as pure as filtering and boiling will make it. Put the pitcher containing the water on the ice instead of putting ice into the pitcher. Few germs, if any, are entirely destroyed by freezing. They usually thaw out and again renew their ac- tivities. Typhoid fever germs live all winter in pond ice and in the spring and following summer are just as powerful as ever to spread infection. REST AND SLEEP. Do not sleep or rest in a stuffy, dusty, badly ventilated room. Remem- Ventilate Your ber to have between two and three thousand Sleeping Rooms, cubic feet of fresh air in all sleeping rooms and especially in sick-rooms. This amount of air we have already said, when speaking of "com- municable diseases," is found in a room twenty feet long by fifteen feet wide with a ceiling ele- vation of ten feet, provided the current of air is changed frequently to keep it pure. The windows should always be open at the top and to aid in the regular changing of impure for pure air, open them up from the bottom for a while every day and open the doors also. Do 149 BACTERIOLOGY IN A NUTSHELL. Remove Day Garments. Untidy Nurses. Let the Sunshine In v The Sunny Nurse. not rest or sleep in a current of air. It is an injurious habit for even the most vigorous. Do not sleep in any garment worn during the day. Learn to relax the muscles when resting. Do not sleep with a pile of pillows beneath the head; use only a small pillow. Better no pil- low at all than to be held up in almost a sitting position all night, rounding the shoulders and making the chest hollow. Keep your own room clean and neat. It is a matter quite surprising to find any number of nurses whose rooms look as if "a cyclone had struck them/' and yet who would not be guilty of such negligence if they were more thoughtful of laws of health as applied per- sonally. SUNSHINE. Sleeping rooms and all rooms occupied by the delicate should be rooms with a southern exposure, so as to have the effects of the sun's rays for the greater part of the day. Not only should we live in the sunshine as much as possible, but we should ourselves be sunny. The only place for the gloomy nurse is with the mercenary nurse, the untrustworthy nurse and the nurse who "enjoys poor health" outside the ranks. This thought is par- ticularly applicable to those nurses who hon- estly desire to be successful. Those with a sunny disposition are always at a premium. What sick one can fail to love and desire to 150 HYGIENIC SUGGESTIONS. have about her the nurse with a "southern ex- posure." She fairly beams as she enters the sickrroom, and no matter how plain her face this nurse always looks beautiful in the eyes of the sufferer, to whom she invariably seems to communicate sunshine, the power of which dissolves and drives away all gloomy forebod- ings. She cannot fail to cure the "blues," for the sorriest grumbler in the "slough of de- spond" on the sick list must needs feel ashamed of such moods in the presence of the sunny nurse. Let us all learn to let the sunshine into our hearts as well as to let it shine upon us. "Let the sunshine in" and it will radiate from the eyes and the smile of the good nurse ; be felt in the touch of her gentle, kindly hand, and in the tones of her cheerful, hope-inspiring voice. It is not only the blessed privilege of each nurse to be the best nurse possible and to be all that is truest, purest and most perfect among women, but it is also her duty. May we each strive to grasp this duty as Heaven-born, so shall every nurse be beloved and in being be- loved do her best and noblest work. "The world may sound no trumpet, ring no bells, The Book of Life the shining record tells." BACTERIOLOGY IN A NUTSHELL. SUMMARY OF CHAPTER VIII. Ills brought upon the human structure by neglect of hygienic laws. Fashions of bygone days opposed to laws of health. Restrictions of society with regard to games, dress, and so forth, a thing of the past. Forgetfulness on the part of the nurse with regard to hygiene may be the cause of a short- ened period of usefulness. Following its pre- cepts may lengthen the period. How success is obtained by the good nurse. Walking and dressing sensibly. The sensi- ble dress the hygienic dress. Keeping the uniform sacred to the sick- room, and why. Bathing and when to bathe so as to be healthy. The care of the hair, the teeth and attention to Nature's calls. Proper diet and sufficient water supply necessary to health. Ventilation. Fresh air, sunshine and a sunny disposition and their effects. 152 HYGIENIC SUGGESTIONS. QUESTIONS FOR REVIEW. I. What is hygiene? II. Why is it necessary to both study and practice the teachings of hygiene ? III. How does manner of dress infringe upon laws of health? Explain why uniform should not be worn on the street. IV. Why should outdoor sports and ex- ercise be encouraged? V. Is the nurse responsible for the care of her own health as well as that of her patient? VI. Is she often excusable for neglecting outdoor exercise, baths, hours of sleep, Na- ture's calls? VII. Why should a mixed diet which is nutritious, easily assimilated and digested be adhered to? VIII. Explain why fresh air, sunshine and clean, well-ventilated apartments are necessary to health. IX. Is the nurse who does not try to keep healthy just as much out of place in the nursing world as the nurse who does not try to control her temper ? Give reasons for your answer. X. Why should a nurse above all other women aspire to be one of its purest, brightest and noblest types ? 153 INDEX. Acid, boracic, 128. " carbolic, 16, 121. " oxalic, 125. Air, 45, 72, 149. Aikens, Miss C. A., 6-7. Alcohol, 130. Alcohol "rub," 73. American Standard, 128. Ammonia, 28, 133. Animal life, 27-31. Antisepsis, 102-107. Antiseptics, 108. Antitoxins, 59-62. Arthritis deformans, 20. Asepsis, 102-107. Assistant, 105. " mistake of, 109. B. Bacilli, definition of, 34. Bacillus, cholera, 18, 75. diphtheriae, 18, 76. of Friedlander, 17. " of leprosy, 16. pestis, 96. tuberculosis, 17, 85. tetani, 18, 81, 103. typhosus, 17, 65. yellow fever, 19. Bacteria, classification, 34. coloring, 37. " definition, 31. destruction, 37, 38. in the diseased, 38. in the healthy, 37, 38. in natural processes, 29, 30, 31. most important, 34. movement, 37. multiplication, 36-37. parasitic, 27. saprophytic, 27. size of, 36. transparency, 37. 154 BACTERIOLOGY IN A NUTSHELL. Barton, Dr., 95. Bathing, 147. Bichloride of mercury, 122, 123. Brains, 143. Bread, 148. Bubonic, plague, 18, 19, 96. C. Capsule, 41. Caps, ice, 73. Carbon, 28. Carbonic acid gas, 30. Carbon dioxide, 30. Cells, 24, 26. Cerebro-spinal meningitis, 90. Cholera, 75. Chlorine solution, 14. Circuit, Koch's, 62. Cleanliness, 148. Communicable diseases, 65-101. " channels of entrance, 65-101. " methods of communication, 65-101 nursing in, 65-101. Compound microscope, 10. Contents, 3-4. Councilman, 19, 97. Creolin, 125. Croup, membraneous, 77. Cultures, 19, 34, 35. D. Dairy, the, 68. Dairies (note), 68. Decay, trees and plants, 29. " animals, 29, 30. Deodorants, 108. Desquamation, 78, 84, 98. Devaine, 14. Diet, 148. Dioxygen, 123. Diphtheria, 18, 76. Diplococci, 35, 90, 103. Diplococcus lanceolatus, 17, 92. Disease, definition, 25. Disinfectants, conditions modify, 108. Disinfection, 70, 107-108. of hands, etc., 113. Dress, 145. Dysentery, 75. 155 BACTERIOLOGY IN A NUTSHELL. E. Eberth, 17, 65. Epidemics, 68, 76, 78, 91, 94. Erysipelas, 83. Ether, 130. Elephantiasis, 94. F. Fever, 17. bathing in (note), 73. relapsing, 94. " specific (note), 98. " scarlet, 78-80. " typhoid, 17, 65-75, 149. " yellow, 95. Filariasis, 94. Finlay, Dr., 95. Fission, 39. Flies, 51, 96, 98. Flagella, 37. Formaldehyde, 132, 133. lamps, 133. Formalin, 127, 132. Fraenkel, 17, 92. Friedlander, 17. Fumigation, 130, 133. G. German measles (Roseola), 78. Germicides, 108. Glands, Peyerian, 66. Gonorrhoea, 16. H. Hemorrhage, 66. Hair, the, 148. Hanson, 16. Health, 71. Healthy exercise, 144. games, 139. muscle, 144. Henle, 11. Hoffman, 27. Hydrogen peroxide, 123. dioxide, 123. Hygiene, 138-153. denned 138. neglected, 138. personal, 71. Hygienic dress, 145. 156 BACTERIOLOGY IN A NUTSHELL I. Ice water, 149. Ilium, 66. Immunity, 49-54. Incubation, 46. Infection, 46. Influenza, 79. Inoculation, 14, 45. Introductory, 5-7. Invasion, 66. Iodine solution, 121. f K. Kitasato, 18. Klebs, 15. Koch, 17, 18, 19, 65, 89. Koch, Sister Emilie, 1. L. La grippe, 18, 78. Leeuwenhoek, 9, 11. Lens, single, 9. Leprosy, 16. Lesion, 45. Lister, Sir Joseph, 16 107. Loeffler, 18. Lysol, 124. M. Malaria, 88. Malariae, plasmodium, 88. Maternity, hopitals (note), 106. Measles, 78. Meat, 69, 148. Meningitis, 90. Metschnikoff, 38, 52, 53. Micrococci, 34. Micro-organisms, 26. Milk, 68, 148. Milk of Lime, 123. "Modified Oath," 8. Morphology, 34. Mosquitoes, 88, 95. Mumps, 81. N. Nails, the, 148. Nature's gifts, 143. Neisser. 16. Nicolaier, 18. Nitrogen, 28. 157 BACTERIOLOGY IN A NUTSHELL. Normal salt sol., 126. some uses of, 127. Nurse, the bad tempered, 142. ' " good, 142. ( healthy, 147. 1 mercenary, 141. ' neat, 145. ' successful, 142. ' sunny, 150-153. " some qualifications of, 8, 142. Nursing, 65-99. and gossip, 142. O. Obermeier, 16, 94. Opsonins, 38, 54. Opsonic Theory, 54-59. Oxygen, 30-31. P. Parkes' list, 44. Pasteur, 14, 15, 54. Pasteurized milk, 69, 80. Pastry, 148. Perforation, 66. Peritonitis, 66. Peru, balsam, 129. Pfeiffer, 18. Phagocytes, 38, 46. Plant life, 27-31. Plenciz, 9, 10. Pneumonia, 17, 92. Poisons, 28, 59. Pollender, 14. Potassium permanganate, 125. Protoplasm, 40. Protozoa, 26. "Protozoon," 97. Rest, 149. Rheumatism, 20. Roseola, 78. Rowe, Dr. J. W., 6. Rush, Dr., 95. S. Sanarelli, 19. Sarcinae, 39. Schaudinn, 19. 158 BACTERIOLOGY IN A NUTSHELL. Schulze, 12. Semmelweis, 13, 14. Sepsis, 104, 107. Smallpox, 19, 97. Solutal, 124. Solutions, 120, 124. table for preparation of, 134. Spirilla, 35. Spirochetae pallidae, 19. Spores, 35, 36, 39, 40. Staphylococci, 38, 39, 102. Sterilization, 107-110. Intermittant, 110. Sternberg, 17. Streptococci, 38, 39, 103. Sublamine, 123. Sulphur, 130. Surgery, bacterian in, 102. antiseptic, 16. aseptic, 110-113. Sunshine, 65, 150. Sweets, 148. Syphilis, 19. T. Tate, Dr. M. A., 6. Table for solutions, 134. Teeth, the, 148. Tetanus, 81. preventive measures, 82. Tetrads, 39. Thiersch's solution, 128. Tricresol, 124. Toy pistols, 81. Tuberculosis, 85. predisposition to, 86. nursing in, 87. U. Ulceration, 66. Uniform, 145. Uncinariasis, 89. Uncinaria duodenalis, 89. V. Vaccination, 54, 62, 99. Varro, 9. Vegetable life, 28-31. Vegetables, 68, 148. Ventilation, 72, 77. 159 BACTERIOLOGY IN A NUTSHELL. Vidal (note), 75. Water, distilled, 129. " filtered, 129. " sterile, 129. Weigert, 37. Weightman, Dr., 95. Whooping cough, 77. "Widal's Test," 74. Wright, Sir Almoth, 38, 56. Wood, Dr., 95. Wyman, Dr., 96. Y. Yersin, 18. Z. Zinke, Dr. E. 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