Necessity

for abdominal supporter.

The first sitting-up.

ing the muscles from time to time. It is not necessary to remove the clothing for this. There is generally no objection to slightly bending the limbs at the knees and supporting them on a pillow. Small pillows, 6 inches wide and 8 to 12 long, made of hair, are convenient for placing around the prtient to remove pressure and produce slight changes in the position which are restful.

Before sitting up-which is usually permitted about the close of the third week-the patient should be fitted with a bandage for the support of the abdominal walls. As a rule, this bandage should be worn for one year, being removed only at night or when the patient lies down. This is to prevent rupture at the site of the incision. The bandage usually employed in the "Woman's Hospital" is that known as the London Supporter. A modification of this has been employed in cases of long incision reaching above the umbilicus. When there is not much strain upon the abdominal walls the ordinary elastic abdominal bandage serves the purpose very nicely. Great circumspection should be employed regarding the patient's sitting up after she has sufficiently convalesced to do so.

The period at first should be short. It is better to lift the patient out on a sofa or reclining chair for a change, rather than allow her to over-exert

herself. The surgeon should be carefully consulted as to the amount and character of the exercise the patient may take.

tomies.

The treatment of hysterectomies, both before and Hysterecafter operation, is the same as that of an ordinary section, with the additional care of the clamp. This should be examined very frequently. If there is any oozing, the screw must be tightened as

directed by the surgeon. If the dressings are saturated with discharge they must be changed as often as needed. The stitches are usually removed in eight to ten days. The stump sometimes remains perfectly dry until it falls off, about the ninth or tenth day. When there has been oozing and the granular tissue around the stump is not

healthy in appearance a frequent dressing of the stump may be necessary.

A small syringe may be used for washing out around the stump with peroxide of hydrogen, bichloride solution, or such antiseptic as the surgeon may direct. After drying thoroughly fresh strips of gauze may be packed in around the stump. A drying powder is sometimes used to be dusted over it; as well. Thus, boric acid or iodoform

powder are sometimes used. The clamp usually needs to be tightened at every dressing. Hysterectomy patients are usually not permitted to be turned before the twelfth or fourteenth day, and not then unless the surgeon directs.

When the stump is thus treated outside of the abdomen the operation is said to be done by the extra-peritoneal method. Some surgeons drop the stump, and close the abdominal incision through

out. In this case the nursing is more like that of any ordinary abdominal section.

The general directions given in this chapter may be greatly modified by different surgeons. The nurse must be prepared to respond to the requirements of the surgeon in every case. A nurse Code of

ethics in

should never let it be known that her views differ nursing. from those of her superior officer. It is right always for the surgeon or physician to plan the campaign in the management of a case. The nurse, if she serves under him, has but one duty-to obey.

Signifi

cance of rise

ture.

CHAPTER XII.

MANAGEMENT OF COMPLICATIONS.

Rise of Temperature. This symptom always of tempera- should cause anxiety after an operation, especially when the temperature exceeds 102° Fahr., for it is so frequently the indication of blood-poisoning in one or another form. The rise, however, may be due to some other cause, as a cold, bronchitis, ague, or it may denote the approach of a menstrual period, or may accompany a discharge from the uterus, which is not infrequent a few days after operation upon the pelvic organs. Extreme excitement may similarly produce an elevation of the temperature for a time. The treatment of this fever must depend largely upon the cause.

Means for reduction

ture.

When the temperature rises above 102° and of tempera- there is a similar increase in the pulse, some means should be taken for its reduction. An ice-cap may be placed upon the head and should be kept on until the temperature has steadily gone down, remaining below 100°. The face, hands, and wrists may be frequently sponged with cold water. Wetpacking is sometimes employed where the temper