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cleanliness.

be exercised in the selection of a suitable person to undertake the supervision and after-care of an operative case.

It is to be hoped that the training-schools of our country will greatly increase the number of nurses fitted to assume these important trusts.

Personal cleanliness is essential in every nurse. This does not imply a simple adherence to the ordinary rules for bathing and general care of the person. “Surgical cleanliness aims at the removal Surgical of microscopic particles,” hence requires a thorough appreciation of the principles of asepsis and antisepsis. The danger of a nurse's carrying disease from one patient to another makes it imperative that her entire body, including her hair, should receive a thorough cleansing between the different cases she may nurse. After the general bath of warm water and soap, the surface of the body should be washed with an antiseptic solution; as, corrosive sublimate (1-1000); Labarraque's solution of chlorinated soda (1 part to 8 of water); or carbolic solution (1-40). The chlorinated soda solution should not be used on the hair, because of its bleaching effect. The irritation of the skin produced by any of the antiseptic washes may be prevented by a subsequent plunge or sponge bath of simple warm water

The costume of a nurse is another matter of Costune of great importance. Apart from its being neat and clean, the entire costume should consist of wash materials, to insure its being free from contagion. Without previous washing no articles of dress should be worn in attendance upon two different

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Disinfection

Clothing worn at a contagious case should be of clothing

allowed to soak in an antiseptic solution from one to two hours before its subjection to the ordinary processes of the wash.

Care should be taken to rinse out the antiseptic solutions very thoroughly before boiling the clothing, as the chemical agents ordinarily used might otherwise produce discoloration. Corrosive sublimate (1-1000) and carbolic solution (1–20) are the agents usually employed. A preparation which has been satisfactorily employed in many hospitals for washing infected clothing is the following: Four ounces of sulphate of zinc, and two ounces common salt dissolved in I gallon of water. The clothing may be boiled in this for half an hour and lie in the solution from 4 to 5 hours.

The bleaching effect of chlorine prevents the use of this for colored clothing. Boiling the clothing for half an hour would cause its thorough disinfection, but as care should be taken not to subject those who attend to the washing to danger from infection, and since many laundresses cannot be

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trusted to boil the clothing, it is a safe plan to subject it to this double process of cleansing. The methods of disinfection for various articles will be more thoroughly dwelt upon in another chapter. I touch upon the matter here in order to impress the nurse with the fact that a thorough disinfection of herself is as important as that of her patient and his surroundings.

Preparation During an operation the nurse should wear an for operaentirely fresh suit of clothing, and, if she is obliged to handle sponges or so assist the surgeon as to come in contact with him or the patient, a large clean apron and fresh slip-sleeves should be put on after all things else are in readiness for the operation. The especial precautions to be taken in the preparation of her hands for her work are as follows:

The nails should be kept closely cut, the hands Cleansing smooth and soft, that they may not feel rough to the patient as they come in contact with his skin. Cold cream or a little glycerine rubbed over the hands at night; or, if the skin be irritated by pure glycerine, the use of a wash consisting of bay-rum (23) and glycerine (73), makes a nice lotion for the hands.

Work properly done need not spoil the hands, provided the precaution be taken after washing them to dry them thoroughly, and to anoint them as suggested, when rough.

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Should the nurse's hands come in contact with foul discharges, a first cleansing with soap and cold water will best help to remove the odor. Warm water with soap may then be used with a nail-brush for more thorough removal of all particles of dirt, and then some antiseptic, as chlorinated soda. In the special cleansing of the hands for surgical work, various methods may be followed. Thus after a thorough cleaning with soap and water for several minutes, the nail-brush being carefully used, the hands may be immersed in an antiseptic wash, which is similarly thoroughly applied by means of a nail-brush around the finger-nails, etc. Pure alcohol may be used, or corrosive sublimate solution 1-1000, or Labarraque's solution 1-8.

A method employed in some hospitals for sterilizing the hands is described as follows: Ten minutes are spent in washing the hands, fingernails, and fore-arms with brown (oleine) soap and warm water and a moderately stiff scrubbing brush. After washing thoroughly in water and soap, the hands are next immersed in a saturated solution of permanganate of potash, and held there until they are uniformly deeply stained; from this they are transferred to a saturated solution of oxalic acid, which removes the stain in one minute. They are then dipped in plain water, then in alcohol, and

finally laid in a bath of bichloride of mercury (1-1000) for a full minute.*

A nurse should keep her breath sweet. The Care of existence of a bad catarrh will incapacitate her for surgical nursing. *The mouth and teeth and the digestive organs should also receive the attention they demand, so that the patient may suffer no annoyance from their effect upon the breath. It should not be necessary to remind a nurse of Personal

hygiene. the importance of attention to her own health. An earnest purpose to attain the highest success in her work should lead every nurse to so dispose of her hours of leisure as to keep herself in the best working order. “This one thing I do,” should be her motto; and food and drink, clothing, rest, and recreation should be so adjusted as to train her for active duty, and for the strain which must often come to her in the long vigils of the sick-room, when every sense should be acute to discover the slightest change in the sufferer, and every faculty fully alive to the demands of the moment. Acute conditions demanding the almost constant presence Sole manof the nurse seldom last longer than a few days, desirable. and a well-trained nurse can ordinarily bear the strain very well for that length of time. Should the * critical condition be protracted, it may be necessary

agement

* Dr. H. Kelly.

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