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A SIMPLE METHOD OF STERILIZING.—Put the articles (small articles) in an ordinary kitchen steamer; closely cover it and place it over a pot of boiling water. If you wish you can add two parts of carbonate of sodium to each ninety-eight parts of water.

Germicides are chemicals used to destroy germs.

Disinfectants are chemicals used to arrest and prevent their development.
These disinfectants should always be fresh.

Carbolic acid is one of the most efficient and most frequently employed of the known chemical disinfectants. It comes to us in the form of white crystals and dissolves in water, glycerin, or alcohol.

Watery solutions cannot be made stronger than five per cent. Solutions weaker than this will not destroy all germs, but on account of its irritating qualities the weaker solutions are employed when used for the skin and mucous membranes. How to make a five per cent or one to twenty solution:

A bottle containing the crystals is placed in hot water until they are melted (or you can buy this dissolved product). Then take one part of the acid and add it to nineteen parts of boiling water and shake this vigorously until all has been thoroughly dissolved and mixed. To make a 1, 2, 3 or 4 per cent solution, you take 1/100 or 1/50 or 1/33 or 1/25 of acid.

Corrosive Sublimate or Bichloride of Mercury.—Tablets can be bought at any drug store containing the desired strength, and are better to use. This is a powerful irritant poison and must be used carefully. Tablets of the strength of 1-1000 and 1-2000 are most often employed for germicide action. The weaker solutions 1-5,000 or 1-10,000 were used to wash out the cavities. It is not now used much for that purpose; it stains clothing and corrodes instruments.

Milk of Lime is considered very valuable and safe to use in vessels to receive evacuations from the bowels. It should be freshly made or it is useless. Equal parts should be stirred up with the contents of the bed pan and this must be let stand at least one hour. This is the best way to disinfect stools.

To Prepare Milk of Lime.—The milk of lime is made by adding one part of slaked lime to four parts water.

Chloride of Lime (Chlorinated lime) is also a very good disinfectant. It has a bad odor and unless it is very fresh, is not reliable.

[626 MOTHERS' REMEDIES]

Boric acid disinfectant. This property is not very marked, but it is not irritating. The standard solution is five per cent. The weaker solutions are used to clean cavities, for superficial wounds, and to wash out the bladder.

The standard or saturated solution is made by using one part of the acid in crystal form to nineteen parts of water; or, this saturated solution can be easily made by putting a large quantity of the crystals in a filter and pouring the quantity of boiling water over them slowly until all are dissolved. Strain the solution to get rid of the excess of crystals or it can be allowed to cool when the liquid can be poured off.

Normal salt solution is made by using one teaspoonful of salt to a pint of water.

CARE AND DISINFECTION OF AN INFECTED ROOM.—Carpets, upholstered furniture, hangings, bric-a-brac, or any personal clothing, the color of which may be destroyed by disinfection, should have been removed from the room at the beginning of the disease.

DAILY CARE OF THE ROOM BY THE NURSE.—The furniture should be wiped off with a damp cloth and the floor swept with a broom covered with a damp cloth wrung out of a 1-20 (five per cent) carbolic acid solution; besides this the floor must be rubbed thoroughly with a damp cloth every second or third day. If the disease is contagious a damp sheet kept moist should be hung in the line of the air currents. Cloths that are used daily should be washed in hot soap suds and when not in use left to soak in carbolic acid solution 1-20 (five per cent).

After the patient has recovered from an infectious disease he should receive a hot soap and water tub or sponge bath, thorough washing of the hair and irrigation of the ears included, followed by a thorough sponging with a one per cent carbolic acid or corrosive sublimate (1-10,000) solution. The finger-nails and toe-nails should be cut close and cleaned underneath.

A nasal douche is given, and the mouth should be washed with listerine or a saturated (five per cent) solution of boric acid. The patient is then wrapped in clean sheets or clothes and taken in another room. Then the bedding and clothing are made ready for sterilization.

DISINFECTION OF THE ROOM.—Brush off the mattress, wrap it in a damp sheet wrung out of a twenty per cent solution of carbolic acid, and send to the sterilizer. The clothes are steamed and sent to the wash room. When there is no sterilizer the bed must be soaked in a 1-20 (five per cent) carbolic solution, afterwards boiled and the mattress ripped apart and boiled or burned.

[NURSING DEPARTMENT 627]

DISINFECTING THE ROOM.—Arrange all articles that are left in the room so as to expose them the best to the fumigating substance. To disinfect with formalin, close the room tightly, seal all cracks and openings with paste and paper. Place an alcohol lamp in a metal dish in the center of the room. Put in a receptacle over the lamp three fluid ounces of a forty per cent solution of formaldehyde; have a dish of water in the room for some time; moisten the air of the room, light the lamp and then close the room up tight for twenty-four hours, until the dust has settled; then enter gently so as not to disturb the dust and wipe off everything in the room with a cloth wrung out of a corrosive sublimate (1-1000) solution. Floors, woodwork, furniture, bedstead must be so washed or wiped, and use for crevices pure carbolic acid, applying it with a brush. The walls should be washed down with the 1-1000 corrosive sublimate solution. Then leave the windows wide open. Sulphur fumigation is not considered so certain in its results.

HOW TO TREAT SPUTUM FROM TUBERCULOUS PATIENTS.—Sputum is dangerous when it is dry. The sputum cups should be of china or paper, so that they may be either boiled or burned. There should be no crevices. The cup should be kept covered and the sputum moist so that none of the germs on the sputum becoming dry may escape into the air of the room. The china vessel should be frequently cleaned and, before the contents are thrown away, the germs must be destroyed by putting the sputum in a two per cent solution of carbonate of soda for one hour. The paper cups and contents must be burned before the contents have time enough to become dry. In infectious diseases, all discharges from the nose, mouth, bowels and bladder should be received in a china vessel containing carbolic acid or milk of lime.

In Diphtheria the expectoration, discharge from the nose and vomited matter should be received in paper napkins and burned at once in the room, or if this is impossible, boiled before being taken from the room.

Use the same treatment for the discharges in Scarlet fever. Two sets of cups should be kept and boiled in the soda solution before being used. All vessels, tubes or cups that are used for the mouth in diphtheria, syphilis, or cancer should be kept in a 1-40 solution of carbolic acid and boiled before being used by another patient.

Bed-pans used in cases of cancer, dysentery, typhoid fever and, in short, in all infectious diseases, are to be soaked in a 1-20 (five per cent) carbolic acid solution and boiled before again coming into general use.

Sheets and clothing stained with typhoid fever discharges must be washed out at once, or soaked in a disinfectant solution and steamed before being sent to the laundry. Also the bedding and clothing in any infectious or malignant disease should always be put to soak, at once, in a 1-20 (five per cent) carbolic acid solution, or else steamed or boiled before being brought again into general use.

The urine needs the same attention as the bowel discharges in typhoid fever.

Coughing in diphtheria, lung tuberculosis, scarlet fever, etc., sets free infectious germs. These may be received in the person of the attendant, or on the bedding and furniture. Care should be taken when attending such cases.

[628 MOTHERS' REMEDIES]

CARE OF THE MOUTH AND TEETH.—A weak solution of borax or listerine is very good. One-half ounce of listerine to a glass of water to be used by the patient as often as he desires to rinse his mouth. Lemon juice in solution is very good. For cracks in the mouth, vaselin or cold cream is good. A few drops of oil of peppermint can be added, or oil of wintergreen.

For spongy and sore gums.—A few drops of tincture of myrrh added to pure water may be used. Colorless golden seal in the same way is pleasant and successful.

Cloths for washing the teeth and mouth are made in small squares of gauze or old linen. They are best to use since they can be burned immediately after being used. Wrap one of the squares around the first finger, dip it into the mouth-wash and insert in the mouth. Go over the whole cavity, the cloth being passed along the gums and behind the wisdom teeth, thence over the roof of the mouth, inside the teeth and under the tongue. Use more than one piece for all this. This is very necessary in typhoid fever. If the tongue is badly coated, it can be soaked and gently scraped. A good mouth-wash for general use is the following:

Glycerin 1 dram Soda 10 grains 5% solution of Boric Acid 1 ounce

BED SORES. Prevention and care of.—Very fat flabby people or thin emaciated patients are liable to suffer from bed sores. They result from constant friction or pressure on a certain spot or spots and when the body is poorly nourished. Moisture, creases in the under sheets, night gown, crumbs in the bed and want of proper care and cleanliness also are causes.

Bed-sores due to pressure occur most frequently upon the hips and lower back, the shoulders and heels; those from friction, in the ankles, inner parts of the knees, or the elbows and back of the head. In patients suffering from dropsy, paralysis or spinal injuries, or when there is a continuous discharge from any part of the body, the utmost care must be taken to prevent bed sores.

Treatment. Preventive.—Cleanliness and relief from pressure. Bathe the back and shoulders with warm water and soap night and morning and afterwards rub with alcohol and water equal parts. Dust the parts with oxide of zinc or stearate of zinc powder, or bismuth mixed with borax; all are good. If there is much moisture due to sweating or involuntary stools or urine, castor oil should be well rubbed in addition. The sheets must be kept smooth and dry under the patient.

[ NURSING DEPARTMENT 629]

Redness of the skin may be the first symptom of this trouble. This may be followed by a dark color under the skin, and when the cuticle finally comes off the underlying tissues are found broken down and sloughing. Any skin scraped or worn off—abrasion—should be carefully washed and a small pad of cotton smeared with olive oil and stearate of zinc placed over it and kept there with collodion painted over it; or white of egg painted over the sore is sometimes very beneficial; also equal parts of castor oil and bismuth make an excellent dressing. Rubber rings or cotton rings over the part relieve the pressure. Changing the position is often beneficial.

Treatment of the Sore Proper.—Sponge with clean soft cloths, with a solution of boric acid or one per cent solution of carbolic acid and the cavity packed with iodoform gauze, or iodoform, or aristol ointment, over which apply a layer of borated cotton. Dress the sore daily. If it sloughs apply hot boric acid dressings every four hours and follow with an application of castor oil and

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