to have a division of labor by association with another nurse.

It is so much more satisfactory for one nurse to manage a case throughout, that, unless it is imperative, such an arrangement for sharing work should be avoided. The assistance of some reliable member of the family, at times when the patient is not requiring very especial attention, will often permit a most trying case to be carried through with but one nurse's supervision.

The simplest and most wholesome food and drink, regular out-door exercise, sufficient sleep at a time when sleep is legitimate, good sense in the matter of dress, occasional change of scene and thought in the intervals between cases, will help to keep a nurse in good condition for duty.

"What is there in the world to distinguish virtues from dishonor, or that can make anything rewardable, but the labor and the danger, the pain and the difficulty?"-Jeremy Taylor.

CHAPTER II.

THE GERM THEORY OF DISEASE.

In order to thoroughly understand the importance of the minute details to be observed in surgical nursing, it is essential that the nurse should know something of the researches of modern science which have developed what is called the "germ theory of disease."

of "germs."

Germs" or "bacteria" are forms of vegetable Description, life so minute as to be singly invisible to the naked eye. Numerous forms of bacteria have, however, been carefully examined and studied through the microscope, and scientists have thus in recent years learned much of their nature and activities. These

research.

researches have proved a most valuable contri- Value of bution to the science of medicine, for through them scientific it has been found that many of the most deadly processes of disease are due to the irritating presence of special germs and to the changes which they bring about in the human body.

The causation of disease as induced by these minute organisms, and its prevention by suitable management, are subjects of such great import

ance that scientific workers all over the world are devoting time to the study of bacteria, with the hope of eventually exterminating some of the present most fatal maladies. Thus consumption, ditions due typhoid fever, cholera, diphtheria, and pneumonia

Diseases and dis

eased con

to germs.

Properties

of bacteria.

are due to germs, each disease having its own specific cause. The same may be said of surgical diseases, the complications which may arise in the healing of wounds; as, inflammations, abscesses, erysipelas and the various forms of blood-poisoning.

Bacteria exist almost everywhere. They have the power of nourishing themselves by using certain portions of dead organic material, leaving the rest in such form as to be used by other living things. They also have the power of moving and of reproConditions ducing their kind. Warmth, moisture, and a cerdevelopment tain amount of organic matter, are the conditions

necessary to

of germs.

Rapidity of increase.

Method of reproduction.

which favor their development. Most, but by no means all, forms of bacteria require air; some, however, can develop only in the absence of air.

Where the conditions are favorable they may increase with great rapidity. The process of reproduction is as follows: One of the bacteria grows a little longer, a constriction forms about the middle which finally becomes a complete partition, so that two distinct individuals are thus formed. These similarly divide to produce other bacteria, and their

number thus multiplies. These separate bacteria may fall apart or cling together in chains or in masses. Other forms of these organisms grow by spore-formation. A central spot, or spore, forms within the rod. The rod opens and the spore drops out and subsequently develops and propagates its kind. The figures giving us the estimate of the rapidity with which they reproduce themselves, seem almost fabulous. Thus it has been authentically stated that a single germ by this process of growth may in twenty-four hours give rise to more than sixteen and a-half millions.

der which

appear.

Bacteria are of various shapes; the most frequent Forms unare the round, oval-shaped, rod-shaped, or spiral- bacteria shaped. To give an idea of their size it has been Isaid that of one of the most common forms of bacteria (a little rod), were fifteen hundred of them put end to end, they would scarcely reach across the head of an ordinary pin.

ous.

Substances

ties in which

The different species of bacteria are very numer-Species. These organisms are to be found wherever any form of life can exist—in water, in the atmo- and localisphere, in the soil, in our food and drink, especially found. that which is uncooked; in all the orifices and canals of our own bodies which communicate with the air, wherever dust can go or collect, there are bacteria of various forms in greater or smaller numbers.

Condition

in which inactive.

Species

that infect wounds.

When the bacteria are dry they are said to be inactive, as they are not capable of increasing and multiplying as they do where moisture and the special food they need is present. Of the special forms of bacteria which are apt to infect wounds, it has been found that there are two particular species which give the most trouble in the majority of cases. These are round in shape and are called "micrococci." One species in growing forms Streptococ- chains and is called Streptococcus, the other forms clusters like bunches of grapes and is called Staphylococcus.

cus.

Staphylo

coccus.

Method of infection.

"Ptomaïnes."

Both these forms of bacteria exist very abundantly in dirty places, even where healthy people live, but especially where the sick are crowded together. Therefore they are especially to be guarded against in hospitals.

They are found floating in the air or resting with the dust upon any surface exposed to the air. When dust falls upon the open surface of a wound, or any object upon which bacteria rest comes in contact with such a surface, these living organisms lodge in the wound, and if not destroyed grow there, forming poisonous materials called "ptomaïnes," which interfere with the proper healing of the wound. Poisonous materials may even thus gain access to the blood and be carried to distant parts of the body, where they continue to develop.