seated over a vessel. A convenient method is that of placing in a tub the water to be used—one or two gallons. The patient may seat herself over this on a board placed across it, or upon a stool placed in it, and inject the water by means of a hand-ball syringe. The long nozzle being used, the water may be thus made to bathe the cervix. When pessaries are worn, a daily cleansing injection is essential.

The

The Tampon.-Many pelvic maladies are treated tampon. by the use of a tampon, or pledget of cotton or wool saturated or anointed with some medicinal agent. These may be placed by the physician daily, or two or three times weekly. It will be the nurse's duty to have these tampons in readiness. They may be made by cutting strips in the length of a lap of cotton or wool, from six to eight inches long, doubling these strips and tying a piece of twine about six inches in length to one extremity.

for use of

Before the tampons are placed the vagina should Preparation be cleansed by an antiseptic injection, as bichloride tampon. of mercury 1-4000. As the medicinal applications used have frequently the effect of increasing the mucous discharge from the vagina, a napkin should be worn after these treatments. The cotton should be removed, at the time appointed by the physician, by drawing upon the string. It should be wrapped

Pessaries.

Counterirritation.

in a piece of paper and burned, or thrown down a privy vault-never in a water-closet, as it will cause stoppage of the waste pipes. The patient should then receive a thorough vaginal injection.

Pessaries. Should the patient have a pessary adjusted, that is a support for the displaced uterus, the nurse should not permit her to move about if it causes her pain, at least until the physician acquiesces in her doing so. Any unusual complaint of pain or increase of vaginal discharge from its pressure, should be reported to the physician. A patient should understand fully that it is unsafe to wear such a support without the supervision of a physician, who shall advise her as to the necessity of having it removed from time to time for cleansing and replacement or entire removal.

Counter-irritation over the lower part of the abdomen may occasionally be called for in the form of blisters, ointments, poultices, etc. In the management of these the nurse should follow the ordinary rules for their application elsewhere. Poultices of flaxseed, or hot-packs, should, if required for warmth, be applied frequently enough to keep up warmth, about once in two hours. The latter consist of pieces of flannel or several layers of soft muslin wrung out of boiling water, to which a little glycerine may or may not be added. These are applied as a poultice, being covered by a piece

of oiled silk or muslin, and to still more effectually prevent evaporation, by a layer of cotton wool. An abdominal binder, held in place by a perineal bandage or an ordinary T-bandage, will serve to keep these applications in place. Ointments are best applied on patent lint or soft Canton flannel. They should be spread the thickness of a knife-blade. The best means of keeping such applications in place is by strips of rubber adhesive plaster. A piece of oiled silk or cotton batting should be applied over this to prevent the greasing of the clothing.

A blister should be carefully watched and Blisters. removed as soon as the scarf-skin fills up with liquid beneath it. If it seems slow in rising, as it should in five or six hours, a flaxseed poultice applied over it will hasten the process. In dressing the blister, care should be taken not to remove the scarf-skin, but clipping a small opening in the most dependent part of the blister, the liquid may be soaked up by absorbent cotton or soft rags, and the blistered surface dressed with cold cream, cosmoline, etc., applied on lint. The fluid from the blister should not be allowed to run over the skin elsewhere, as it will produce irritation.

Mental Occupation.—The more entirely a nervous patient's mind can be kept occupied with other things than herself, the more successfully may she

Mental

occupation.

Value of tact.

be treated. Upon the nurse will devolve the duty of supplying wholesome for unwholesome thoughts. For this reason, if none other, a nurse should keep up, as far as possible, a knowledge of the events of the day. She should be able to talk to her patient about the world and its doings, and thus help to widen the horizon and prevent the fret and worry which result from a persistent contemplation of small woes. All gossip should be carefully avoided. It is necessary that the nurse should be a good reader, and should train herself to read aloud, for she may in this way while away many a weary hour which might otherwise be spent in profitless thought. An additional recreation for younger patients particularly are some of the card games, or puzzles, etc., which are interesting because of the incentive they give to thought.

With infinite tact a patient may be thus led, without knowing it, into a more wholesome mental atmosphere than that which she has been accustomed to breathe. The effect upon her general health when this state of things can be obtained. will be marvelous. The nurse will need to remember that each patient offers her a new problem, and that she must not attempt the same methods with all.

CHAPTER XVI.

PREPARATIONS FOR GYNECOLOGICAL

EXAMINATIONS.

History

The nurse is frequently called upon to aid the of disease. physician in obtaining a satisfactory history of a patient suspected of having pelvic trouble. The following plan is that generally adopted with us:—

I. A short sketch of the family history, health of parents, brothers and sisters; if any deaths among them, their cause. These facts are of importance as showing a predisposition to any especial class of diseases.

2. The personal history of the patient, her health in childhood, the diseases from which she may then have suffered. Date of first menstruation, character as to existence of pain at periods; amount of flow, regularity, etc. Date of marriage, number of pregnancies, number of miscarriages, number of labors, character of labors, character of convalescence. General health during marriage or since. puberty.

3. History of the special disease from which the