senses dulled, so that there is no desire to pass urine, even when the bladder is full, or there may be a nervous contraction of the urethra, resulting in an inability to do so, even when the inclination is felt. When no urine has been passed for some time, if there is pain on pressure, on percussion a dull instead of a clear sound, and if the outline of the bladder can be distinctly felt, it may be safely assumed to be full, and the use of the catheter to be indicated. Incontinence of urine arises from weakness of the neck of the bladder, rendering it unable to restrain its contents. It is most frequent in children. Apparent incontinence may be really retention with overflow caused by the overdistention of the bladder, and consequent muscular strain. Catheterization may be called for even when there is constant slight passage of urine. In all cases of incontinence, special care is needed to keep the parts clean, and prevent excoriation, by frequent bathing and the application of ointments. Rubber urinals are sometimes used.

Whenever, from any cause, a patient is unable to pass urine voluntarily, the catheter should be used every six or eight hours. If it is properly introduced, and no urine can be drawn, suppression may be inferred. This is a very serious symptom, for, if the system can not be relieved of its waste product, the urea is soon absorbed into the blood, and uræmia, a dangerous form of poisoning, results. Hot applications over the kidneys will sometimes excite them to action. So when the difficulty is retention only, hot applications over the bladder may relieve it; usually will with children. A hot sponge between the thighs may be effective. When the use of the catheter is imperative, proceed as follows: Oil the instrument with the finger. Have the patient flat on the back, if possible, with the thighs slightly separated.

Introduce one finger, also well oiled, into the vagina, and upon it, as a director, slide the point of the catheter till it enters the urethral opening, just below the pubic symphysis. It should not be pushed far enough to strike the walls of the bladder. As soon as the cavity is reached, the end of the catheter will move freely, and the urine will flow through it into the receptacle provided. If the flow ceases before a reasonable quantity has been passed, withdraw the instrument slightly, then push it a little further in than before, when it may begin again. After the bladder is emptied, withdraw the catheter as gently as it was introduced. In no case use force. While removing the catheter, keep a finger over the open end, so that the few drops which it contains will not fall on the bed.

A distended bladder should not be too rapidly emptied by catheter, as there is danger of cystitis from the sudden collapse of its walls. When it is very full, draw only a portion of the contents at first introduction of the catheter, and repeat the process soon.

To pass the catheter skillfully is an important acquisition. It should be done entirely under the bed-clothes; no exposure of the patient's person is necessary. Exception to this rule must be made in case of operation on the perinæum, vulva, vaginal walls, or urethra, when it becomes necessary to introduce the catheter by sight rather than by touch. In these cases the vulva should be washed with warm water after catheterization, or micturition, to prevent any urine from getting into the wound.

The flexible rubber catheter is the most convenient, and least likely to hurt the patient. No. 7 is a good size for ordinary cases. After each use it should be thoroughly cleaned and disinfected. Let a stream of water

run through it, first from the eye downward, that any sediment may not be driven down into the point.

In case of cystitis, the bladder will often have to be washed out. For this purpose a double catheter, or an especially designed syringe, is used. Or it may be equally well done by fitting a longer rubber tube tightly over the ordinary catheter, which is then introduced in the usual way. Pour into the tube, through a funnel, the water, or whatever fluid is ordered, not more than two fluid ounces at a time. Lower the tube, and let it run off, and repeat the process until it runs clear.

CHAPTER XIV.

Infectious diseases-Modes of propagation-Disinfectants-The care of a contagious case-How to keep the air pure-To prevent the spread of disease-The care of the dead-Final disinfection and fumigation.

AMONG the responsibilities which have been mentioned as pertaining to the nurse, there is none of greater gravity than the prevention of contagion.

Infectious diseases are supposed to be propagated by the agency of minute living particles, given off from the body of the sick, and conveying the specific poison. They may lie dormant for a time, but under suitable conditions develop and multiply, reproducing the original disease. In some cases the conditions of development are found within the body, and the disease can be directly transmitted from one person to another, while, in others, the germ only originates in the body, and requires to be developed outside before it becomes infectious. Of the latter class are typhoid, yellow fever, cholera, dysentery, and the plague, while all the other diseases commonly recognized as infectious are capable of direct transmission.

After exposure to contagion, some time is required for the development of the infectious germs before they actively manifest themselves. This interval, during which the poison remains latent, is known as the period of incubation. It varies in different diseases,

and even in different cases of the same disease, though each has its own characteristic type and mode of development. Small-pox is contagious even during the period of incubation. In measles and whooping-cough, the risk of infection is greatest early in the disease, before the appearance of the specific symptoms, rash and whoop. Scarlet fever is not infectious before the throat-symptoms are present, and is most dangerously so during the third and fourth weeks, when the skin is peeling. The poison of typhus appears to exert its influence only within a limited range; contact with the patient must be moderately close for infection to take place. But the germs of small-pox or scarlatina may be carried about indefinitely, or lie hidden in a room or in clothes for months, and then under suitable conditions manifest the greatest virulence.

Diseases which attack many people at the same time are termed epidemic; those confined to particular localities are endemic. Sporadic cases are such as occur singly, and independently of any recognized infectious influence.

Disinfectants are such substances as act upon the specific contagia of communicable disease, and destroy them, or render them inert. They are to be carefully distinguished from antiseptics, preventives of decomposition, and from deodorants, which merely subdue disagreeable smells. Some of the latter may be useful in absorbing deleterious gases, but they have no effect upon the solid particles which convey contagion.

Abundant oxygen is the best disinfectant; it decomposes the septic germs as it does all other animal organisms. Extremes of heat and cold are also fatal to them.

Whenever any directly communicable disease is