Nursing: its principles and practice; for hospital and private use

Front matter

MEDICAL CENTER LIBRARY

SAN FRANCISCO

Nursing is an art . . . requiring as hard a preparation, as exclusive a devotion as any painter's or sculptor's work. For what is the having to deal with dead canvas or cold marble compared to the living body, the temple of God's Spirit? It is one of the fine arts, I had almost said the finest of the fine arts.

Prefatory Note to Third Edition

TN preparing the third edition the entire material has A been g-one over carefully and the book enlarged fifty-three pages. The arrangement has been altered somewhat, Chapters II and III having been combined to form Chapter II, and Chapters VIII and IX to form Chapter IV. Two new chapters have been added, and elsewhere new material has been substituted for old. The first chapter has been entirely changed. Instead of the schedule for a two years' course a suggestive outline for the division of work over the three years of instruction, which is made to include a six months' preliminary course, has been given. This preliminary course is so arranged that during this period a definite amount of practical and theoretical work is covered. A class of probationers is made up for the spring and autumn, each class being divided into five sections, (A, B, C, of group I, and D and E of group II) with an equal number of pupils in each section. At the end of a certain number of weeks the sections exchange work, until the entire course, lasting over a period of six months, is covered. Classes, lectures and demonstrations occupy the afternoon hours. It is not intended that the probationer shall do any actual nursing during the morning hours from 7 to 11, but from 5 to 7 in the afternoon she is required to perform certain domestic duties in the wards under the observation and criticism of regular instructors, who must be graduate nurses of experience. By this method the

8 PREFACE

probationers will become practically familiar with all the details of the methods employed in each department, and will be taught their relation to the care of the patient before they are called upon to undertake actual nursing: duties. This arrangement at the same time will relieve the nurses of much of the domestic side of their work and thus enable them to devote more time to the actual nursing, with the result that the patients will receive better care.

Prefatory Note to Second Edition

TN preparing the second edition very little has been -1 changed, but new matter has been added to bring the book up to the latest methods. A suggestive chapter has been added on the division of work over three years of instruction, and courses of lectures have been mapped out to cover this time. Some new figures have been added, of which the majority illustrate the appliances employed in surgical work, which have been tested and found of practical use.

My thanks are due to Dr. J. Whitridge Williams for his criticisms and suggestions on the obstetrical chapter; and to Dr. Booker, of Baltimore, and Dr. Edward Cushing, of Cleveland, for reviewing the chapter on children ; also to many of my friends among superintendents of training schools for suggestions and material. The form of marking the pupil nurses' standing was kindly supplied me by the Superintendent of the Lakeside Hospital Training School.

Chapter I

Suggestive Outline for the Three Years' Course — Examinations— The Preliminary Course — Classes, Lectures, etc., for (a) First Year, (Second Half) — (b) Second Year Students — (c) Third Year Students— Reference Library — Form of Report 17

Chapter II

Economics of the Hospital Ward, Free and Private — Construction — Furnishings — Hygienic Arrangements— Ward Supplies — Ward Work — Daily Sanitary Care of the Ward, of the Beds and Blankets — Care of the Ward Utensils — Personnel 42

Chapter VI

Care of New Patients — Treatment — What to Observe — Reporting to the Physician — Care of the Bed Patients — Frequency of Bathing — Care of the Teeth and Mouth — The Prevention and Treatment of Bed-sores — Care of Convalescents 120

Chapter VII

Baths — Classification — Temperature — Baths for Cleanliness— Tub-Baths — Foot-Baths — Baths as Therapeutic Agents — Mustard Baths — Simple Hot Baths — Hot-Air, Steam, or Vapor Baths — Salt-Water Baths — Bran and Starch Baths — Sponge-Baths and Tub-Baths in Typhoid Fever — The Cold Pack — The Continuous Bath 138

Chapter VIII

Enemata — Kinds — Methods of Preparation — Frequency and Modes of Administration — Care of Appliances — Douches — Catheterization — Lavage of the Bladder. 156

Chapter IX

Temperature — Pulse — Respiration — Care of the Thermometer— Charting and Recording Notes 171

Chapter X

External Applications (General and Local) — Dry Heat — Hot-Water Bags and Cans — Hot Bottles, Flannels, Salt-Bags — Moist Heat — Fomentations — Poultices — Moist-Air Tent — Cold Applications — Ice — Cold Water — Lotions 192

CHAPTER XL

Counter-irritants — Mustard Poultices and Plasters — Turpentine — Iodine — Cupping — Cantharides — The Cautery 205

Chapter XXVI

Obstetrics — Pregnancy — Symptoms and Physical Signs —Development of the Fcetus — Abortion — Miscarriage— Premature Labor — Care of the Patient Before, During, and After Labor — Care of the Breasts — Care of the Child — The Puerperal State 483

CHAPTER XXVII. Disorders of the Special Senses — Nursing in Diseases

of the Eye, Throat, Nose, and Ear 513

CHAPTER XXVIII. Nursing in Nervous Diseases and Insanity — The Rest

Cure — Massage — Electricity 523

ILLUSTRATIONS.

PLATES.

PLATES.

I.— Nurses' Toilet-baskets for Patients .... Frontispiece

II.— Surgical Operation Bed Face Page 108

III.— Pneumonia Chart '< " 190

IV.— Typhoid Fever Chart " " 190

V.— Malaria Chart ' ' li 190

VI.— Bed-side Kecord " " 191 fig. page.

1.— Crane for Assisting the Patient to Move Himself

in Bed Ill

2.— Heel Cushion 114

3.— Kubber Protective Pad 118

4.— Form for Listing the Clothes of a Patient 124

5.— Stupe- wringer 199

6.— Paquelin Cautery ! . 214

7.— Heel-rest 343

8.— Buck's Extension Apparatus 355

9.— The Bradford Frame 356

10.— Modified Scultetus Bandage 405

ITS PRINCIPLES AND PRACTICE

Chapter I

Suggestive Outline for the Three Years' Course. — Examinations. — The Preliminary Course. — Classes, Lectures, etc., for (a) First Year, (Second Half). — (b) Second Year Students. — (c) Third Year Students. — Reference Library. — Form of Report.

A general outline of the plan that might be followed during a three years' course of instruction is given here. This may be of practical use as an aid to intending students, and at the same time may serve to impress upon them the fact that the work can not be done haphazard, that system and method must prevail throughout, and be cultivated as part of their training. A detailed account of the whole curriculum will be found elsewhere.

a Suggestive Outline for a Three Years' Course of Instruction.

The course of instruction is to be graded and extend over three years, including the time of probation. Practical work in the ward, demonstrations at the bedside, in the class-room and the laboratory, should be preceded and supplemented by a regular course of lec-

2 17 tures and recitations. As far as possible the work of any given year should be a necessary preparation for that of the succeeding one. Lectures and classes should extend throughout the entire first year, but in the second and third years they should be limited to the regular teaching months, from October until May. The pupils are divided into three classes, belonging to the first, second and third year respectively. During the three years' graded instruction, practical and theoretical, is given in the following subjects : bacteriology, hygiene, household and nursing economics including dietetics, anatomy, physiology, materia medica, the principles of nursing and their practical application to the care of medical, surgical, gynaecological and obstetrical patients, as well as in mental and infectious diseases. Special attention is also given to the subjects of surgical technique, massage and the ethics of nursing.

FIRST YEAR.

The first six months of the first year are devoted to a preliminary course for probationers. This course is given to the student before she is allowed to begin her practical nursing in the wards, and embraces the elements of anatomy, physiology, hygiene, bacteriology, household economics including invalid dietary, materia medica, the elements of nursing, and hospital ethics and etiquette for probationers. These subjects are taught by lectures, demonstrations, recitations and by practice.

During the second half of the year classes in the principles of nursing are held, the pupil is taught the practical care, in the wards, of the ordinary medical, surgical and gynaecological patients, and towards the end she can undertake her first term of night duty. During these months she attends lectures dealing with the various branches of medicine and surgery, the changes that take place in the various systems of the body when invaded by disease, the signs by which they may be recognized, together with the duties of a nurse in regard to them, and the ethics of nursing for first-year nurses.

Lectures. — A systematic course of didactic lectures in connection with the above subjects, is given by specialists in their various branches. Notes upon each lecture are to be taken and written up in full by the student later.

Second Year.

Practical Work. — A service in the dispensary and in the general surgical operating-rooms ; the care of the patient before and after operation ; special nursing in the public and private wards ; and a term of night duty.

Class-work. — Testing of urine ; nursing in medical and surgical diseases ; surgical technique ; anaesthesia ; the care of children ; nursing in infectious diseases, and the ethics of nursing. Lectures on the above subjects in connection with the class-work are given by physicians.

Third Year

Practical Work. — A service in the obstetrical ward, and the care of the nervous and insane. Class-work and lectures upon obstetrics, massage, nursing of the nervous and insane and upon special subjects — nursing in diseases of the eye, ear, throat and skin — and on scientific appliances, as electrical apparatus, the Roentgen Rays, the Finsen light, etc.

During the last six months students who wish to prepare for hospital positions are expected to act as head-nurses in the wards or as night head-nurses, as supervising nurses, as assistants in the superintendent's office, and to hold classes under the observation and criticism of the superintendent. Students who desire to qualify more especially for private practice should be given special advantages in whatever branches they may feel deficient.

Examinations.

Unless the probationer holds a high-school certificate or its equivalent, an examination in English branches of study should precede her acceptation as a pupil. At the end of the preliminary course the probationer should be examined in the subjects taught in thatcourse, namely, bacteriology, hygiene, household economics, dietetics, anatomy and physiology, the elements of nursing and materia medica. At the end of the first year the subjects for examination are: (i) The principles of nursing; (2) Medical nursing; (3) Surgical nursing. At the end of the second year: (1) The examination of urine; (2) Duties of the operating-room nurse with special reference to surgical technique; (3) Gynaecological nursing; (4) The care of sick children; (5) Nursing in infectious diseases. The subjects of the third year examination should include: (1) Nursing in obstetrics; (2) Nursing in nervous diseases and insanity; (3) Special nursing subjects; (4) Private nursing; (5) The ethics of nursing.

TABLE— SHOWING A SCHEME FOR INSTRUCTION EXTENDING OVER THREE YEARS.

Six Months Preliminary Course of Instruction

for Probationers.

(Subjects divided into two main groups.)

Group I — Household Economics.

A The hospital, and the practical care of its wards,

sick-rooms, lavatories, bath-rooms. B Care of the linen : in the central linen-room ; in

the ward ; in the laundry.

C Dietetics : in the general kitchen ; in the diet

kitchen ; in the ward kitchen.

Group II — Nursing Economics.

A Bacteriology.

B Practical chemistry ; hygiene and ventilation ;

methods of heating.

C Anatomy and physiology.

Classes and demonstrations in practical nursing. D Materia medica.

Pharmacy.

E The surgical supply room.

F Ethics and hospital etiquette.

General Plan of Practical Work.

The six months to be divided as follows :

Group I — Household Economics.

A Five weeks.

B Five weeks.

C Six weeks.

Group II— Nursing Economics.

D Five weeks.

E Five weeks.

The practical work to be done in the morning- under the instructors. Classes and demonstrations in the afternoons to precede the practical morning- work.

Daily Practical Morning Work.

Group I

A (i) The wards and sick-rooms; (2) bath-rooms

and lavatories. la Proper airing of room, beds and bedding :

Daily general care of room or ward: windows,

window shades, floors, furniture, rugs. b Cleaning of bed frames.

c The making of beds for convalescent patients. d Daily dusting and floor brushing ; care of fire and

fire-place ; registers ; flowers and plants ; daily care

of the sun-room ; of the patients' library ; method

of preparing room for weekly cleaning ; dusting

down walls ; cleaning windows and brasses ;

sweeping floors ; cleaning rugs and supervision of

maids' work- 2 Bath-rooms :

a Care of walls, floors, tubs, fittings. b Lavatories :

Care of stationary basins, slop-hoppers, refuse cans,

bed-pans, sputum cups, urine glasses, bed rubbers,

specimen utensils, etc. c Closets :

Care in the disinfection of closets and ventilation ;

cleanliness and order ; daily care of dust-cloths ;

cleaning vessels and housemaid's closets.

Daily Afternoon Class- Work and Demonstrations. Group I — A — Household Economics.

The hospital — location and surrounding's ; its buildings ; general plan ; methods of heating.

The sick-room — location, size, light, ventilation.

Construction — Composition of walls: wood, plaster, cement, tiles and marble. Furnishings : paint, paper, enamelling, hard cements.

Floors — Materials used : woods, cement, cork, tiles, marble. Finishings : oils, shellac, paint.

Furnishings :

Bedsteads — Materials : iron, brass, wood ; the frame : weight, height, width ; durability ; simplicity ; springs ; place in room.

Mattresses, pillows, and materials for making- bed: kinds, quality, weight.

Bed-linen : kind, amount necessary.

Chairs : different kinds, and use.

Floor coverings : rugs, linoleum, matting, carpeting, cork, rubber.

Tables, washstands, bureaus, wardrobes, lounges, screens, blinds, curtains, china.

Ornaments : flowers, plants, pictures.

Care of sick-room : general and special cleaning of walls, floors, windows, furnishings and ornaments, bath-rooms, lavatories, and closets ; materials employed.

Relative cost of sick-room : its walls, floors, furnishings, bed-linen, and cleaning- materials.

Personnel — The physicians, nurses, orderlies, maids, and the etiquette in relation to each.

Daily Afternoon Classes and Demonstrations. B — Household Economics, i The central linen-room : General plan and subdivisions.

List of materials kept in stock for general use in the wards ; amount and cost ; method of buying- linens and other materials ; method of sorting- and arranging on shelves ; method of counting, and of keeping stock-room books ; method of distributing.

2 Standard linen-list for a public ward ; standard

linen-list for the private ward; the ward linen-book ; the system of exchange ; mending ; the disinfection of linen ; removal of stains ; the economical use of linen in the wards; the systematic changing of soiled for fresh linen in the wards. Blankets : kind, quality, weight ; cleansing and sterilizing ; frequency of changing blankets in the ward ; removal of stains ; the care of ward linen-room ; cleanliness, order and ventilation.

3 The laundry — General plan and equipment ; mate-

rials used in the laundry and their cost ; method of counting soiled ward linen in laundry ; method of sorting for mending and counting fresh ward linen ; distribution of fresh linen to the wards ; the sewing room.

Daily Practical Morning Work.

General care of ward linen-room — counting, sorting, folding and placing fresh linen on shelves ; counting and disinfecting soiled ward linen in the laundry disinfecting room ; counting and sorting fresh linen in the laundry; the keeping of the ward \«nen supply book ; the listing and care of padei! ' clothes.

C — Household Economics Daily Afternoon Class - Work and Demonstrations

The general kitchen : plan and general equipment ; store-rooms, cold storage room; general diet lists; methods of food distribution.

The ward kitchen : furnishings ; daily care ; weekly care ; the counting of silver and china ; the serving of meals and special diets ; the prevention of water-bugs; kitchen linen.

The invalid diet kitchen : course of talks and demonstrations on foods and food principles; the physiology of the alimentary secretions; the assimilation of food.

Daily Practical Morning Work

General care of the ward kitchen and refrigerator; weekly care of the ward kitchen; weekly counting of the silver and china; care of the sinks and dish-towels ; the ward kitchen supply book; assisting in the serving of ward patients' meals.

Preparation of foods in the diet kitchen; the preparation and serving of trays; the serving of special diets to patients.

OUTLINE OF COURSE IN DIET KITCHEN

The kitchen: location, furnishings, care; stoves: kinds, management, fuels; care of refrigerator, cupboards, silver and china, kitchen towels and linen.

Composition of the body.

Foods : production and manufacture, preservation and adulteration. Bacteriology in relation to food. Foods in general : need, uses, conditions l6 NURSING

influencing the amount needed; classification of food-stuffs, with examples ; a balanced diet; the complete digestion of a perfect food, such as bread and butter.

4 Food principles :

a Water : use, amount needed by an average man, result of deficiency or total deprivation; test for hard water, and remedy; the effect of hot or cold water in cooking.

b Salts: effect on system; principal salts derived from foods; uses; excess; deprivation; classes.

c Proteids : why so called; need for; classification; sources ; characteristics; digestibility.

Special Proteids. (a) Milk: varieties; composition of cows' and human milk; digestibility; the modification of milk for infants and for children in disease; how to make lime-water and barley-water; methods of modifying milk; the preservation of milk; methods of sterilization; pasteurization; infected milk; ptomain poisoning; the predigestion of milk; peptonized; pancreatized; koumiss; junket; wine-whey.

(b) Milk Products. Principles and mechanism of the cream-separator; cream; evaporated cream; skim milk; condensed milk; its objections as food for infants; buttermilk; whey; cheese; kinds; how made ; digestibility ; oleomargarine ; cottolene ; tests; experiments.

(c) The preparation of foods in which milk is chiefly or wholly used. Diseases in which milk is indicated as a food. The Walker-Gordon laboratory.

i

OUTLINE OF WORK 2J

Egg's : composition; test for freshness; how best kept; digestibility; uses; the best forms and preparation when indicated in disease; experiments.

Meats : comparative constituents of meats and vegetables; arguments for and against meat diet; uses and abuses; digestibility; difference between old and young animals; length of time for digestion, etc., for beef, lamb, mutton, veal, pork, poultry, fish, oysters.

The different cuts of each and method of preparing for the sick : (i) in solid, and (2) in liquid form. Soups, teas, extracts and jellies. Fish : boning, cooking; the garnishing and serving of meat in its various forms.

Carbohydrates : meaning. Principal carbohydrates; uses; digestibility; special carbohydrates.

Sugar: Varieties; sources; uses; tests for cane sugar, glucose, etc.; when to be avoided; saccharine and its uses.

Starch and Cereals : formula for starch; experiments; digestibility; the cooking of starch.

Cereals : wheat and flour; milling processes; gluten and wheat flour.

Flour: yeast plant and bread; starchy vegetables; chief flour mixtures and preparation.

Vegetables: chief vegetable proteids; digestibility; classification ; properties ; characteristics ; best methods of cooking. Fats and oils : why necessary ; amount needed. Salads : uses, preparation and serving.

Fruits : composition ; classification ; uses and properties ; digestibility ; preparation and serving of the various fruits.

6 Stimulants and beverages : tea, coffee, chocolate ;

how grown; adulteration; rules for making-; effects. Mineral waters : composition, uses, effects. Beverages of other kinds : uses and effects. Alcohol : as a food ; as a stimulant ; action upon bodily temperature ; absorption ; elimination ; clinical uses. Wines and malt liquors : composition and uses.

7 Desserts : all kinds of gelatine preparations ; their

nutritive value ; fruit, jellies, and puddings ; ices and creams.

Food in relation to disease ; menus for special diseases and method of preparation, as for diabetes. The proper food for infants, children, and convalescents.

How to set and serve trays; the planning of meals.

Group II — Nursing Economics.

Afternoon Classes, Lectures, Demonstrations, and Laboratory Work.

A — Bacteriology.

History : bacteria ; classification and characteristics ; infection and its sources ; culture media ; cultivation, sterilization and disinfection. The relation of bacteriology (i) to the nurse's daily hospital duties; (2) to cleanliness and sanitation; (3). to ward and laundry supplies; (4) to air, water, food; (5) to infectious diseases ; (6) to aseptic and antiseptic surgery, surgical fevers, etc. The prevention and limitation of certain diseases.

Microscopical demonstrations and methods of destroying bacteria.

B — Hygiene, Ventilation, Heating.

Afternoon Classes, Lectures, Demonstrations, and Laboratory Work.

A course in elementary physics and chemistry in relation to air, ventilation, soil, water, and food. (2) Hygiene in relation to hospitals. (3) Hygiene in relation to the home. (4) Personal hygiene.

Hygiene : air : chemistry of, influence of, amount required; changes it undergoes; causes of impurities ; detection of impurities ; method of testing the quality of air ; statistics of cultures from air breathed in the hospital at different hours.

Ventilation : principles, various methods, best methods. Heat : in relation to health ; dry and moist; methods of heating (a) institutions; (b) private dwellings ; amount of heat required in a sickroom ; how to maintain a proper temperature ; modes of measuring heat ; the ward thermometer. Bacteriology, ventilation and fresh air.

Home sanitation : the house; site, soil, surroundings ; drainage ; sanitary fittings ; main wastewater pipe : its care, foreign bodies in ; kitchenand pantry-sinks, laundry-tubs, bath-tubs, and slop-hoppers ; soil-pipe system ; location of water-closets ; dangers, and how detected ; garbage and its care.

Bacteriology in relation to the home.

Water : the chemistry of water in relation to health; characteristics of wholesome water; dangers of impure water ; organic and inorganic constituents to be found in water ; sources of water supply ; modes of supply ; sources of contamination ; method of purifying ; analysis of water.

3<D NURSING

Bacteriology in relation to water.

Climate : effects of altitude, location and soil on health. 4 Personal hygiene : food, sleep, bathing, exercise, recreation, minute care of the body; clothing for infants, adults, old age; protection of the feet; bacteriology in relation to the preservation of health; vaccination.

C— Anatomy and Physiology.

Daily Afternoon Classes and Demonstrations.

1 Embryology: study of cells and tissues: the cell,

its properties and functions, kinds, propagation, repair and death ; development of the human embryo ; outline of the human body.

2 The skeleton : gross, microscopic, and chemical

structure ; composition of bone, joints, cartilage, and muscle ; names of bones and their functions, nutrition, periosteal covering, divisions, and number.

Joints : varieties, divisions, motions, structural formation.

Muscles : varieties, functions, structure, origins and insertions ; tendons and fasciae.

3 Visceral anatomy: anatomy and position of viscera;

physiological laws governing the functions of the internal viscera, the circulatory, respiratory, and lymphatic systems ; the excretory organs : the generative organs ; the nervous system ; organs of special sense, and physiological laws governing them; the glandular system; the physiology of the secretions and excretions.

Classes and Demonstrations in Practical Nursing.

Training: in note-taking and in written and verbal reports. The general care of the hospital ward or private sick-room, comprising-: (a) the location, furnishing, and supplies ; (b) sanitary method of caring for the ward ; sweeping, damp-dusting, brushing, and cleaning beds ; care and cleaning of bath-rooms, lavatories, water-closets, drain-pipes, basins, and traps ; care of plants and flowers.

Nursing hygiene : ventilation, air ; methods of ventilating, flushing, and warming ; the thermometer ; methods of regulating the temperature ; protection of patients from draughts.

Disinfection and disposal of vessels, dust-cloths, brooms, brushes, soiled linen, soiled dressings, excreta, sputa, mouth-sponges, special dishes. The special disinfection of clothing, furniture, wards, or rooms. The use of disinfectant solutions ; of deodorizers.

Beds : bed-making for ordinary patients, for convalescents, for operation patients, for fractures ; the changing of linen ; the arrangement of mechanical appliances for the relief of bed patients ; lifting and moving ; mechanical restraints.

Care of patients : treatment ; what to observe and report; care of the bed patients; bathing in bed; care of the teeth, mouth, eyes, hair, nails, and back; prevention and treatment of bed-sores; care of delirious patients, of convalescents; care of the dead.

Baths : for cleanliness; as therapeutic agents.

5 Enemata: kinds; methods of preparation; mode of

administration. Lavage: of intestines, of stomach, of bladder; douches; catheterization.

6 Temperature: pulse; respiration; charting; record-

ing notes.

7 External applications (general and local); dry

heat; moist heat.

8 Counter-irritants; the cautery.

9 Medicines: methods of administration; dosage;

weights and measures; the metric system; medicine closets; medicine lists.

io How to observe, report, and record symptoms.

II Diet: its importance in disease; its classification' in disease; methods of administering food; stimulants; feeding in the acute stages of diseases; in convalescence; the diet in special diseases; the serving of food.

D — Materia Medica.

Afternoon Classes and Demonstrations

1 Medicines : the metric system; tables of weights

and measures. Drill in fractions arid percentages; approximate measures; abbreviations; symbols; various vessels used for administering medicines; their care ; labels ; stoppers ; medicine-bottles : kinds, size, shape, color.

2 The medicine-closet : its arrangement, care; preser-

vation of medicines.

3 The order-book : ordering medicines; the medicine-

sheet. Abbreviations for hours of giving medicines. Methods of handling, measuring, and administering medicines; precautions to observe; care of the hypodermic syringe.

4 Organic and inorganic drugs. The classification

of drugs. The various preparations of drugs. Drugs acting on the respiratory, circulatory, and excretory systems; their physiological action; incidental effects.

5 Poisons : kinds, doses, symptoms, antidotes, physi-

ological symptoms.

Daily Practical Morning Work.

OUTLINE OF COURSE IN PHARMACY.

Apothecaries' weight and specific gravity ; methods of measuring heat ; thermometer.

Sterilization ; filtration.

Percolation and its application to the manufacture of tinctures. Solutions, simple and chemical ; official aqueous solutions and liquors. Simple solutions ; alcoholic solutions or spirits. Gaseous sortitions ; chemical reactions. Ethereal solutions ; collodions. The preparation of antiseptic and disinfectant solutions ; uses and precautions. Carbolic acid, bichloride of mercury, boric acid, normal salt solution, Labaraque's solution, chlorinated soda, lime, listerine.

Outline of process used in making tinctures. Outline of process used in making fluid extracts. Outline of process used in making syrups. Outline of process used in making ointments. Powders, pills, tablets, capsules and medicated wines. Hospital formulae for solutions.

The economical use of medicines. 3

E — The Central Surgical Supply Room.

Afternoon classes, lectures, demonstrations and laboratory work.

i. Bacteriology in its relation to the preparation of surgical dressings and solutions.

2. Surgical supplies, kinds, amount, cost.

3. Surgical cleanliness of hands, dressings, utensils ; management of the sterilizers.

4. The names and care of surgical appliances, the making and covering of splints, pads etc., the care of syringes, rubber goods, mending rubber gloves.

5. Bandaging — Materials, uses, preparation, practical application of all kinds.

6. Surgical suits for surgeons, for nurses ; shoes.

7. The etherizing rooms, the dressing rooms.

Practical Morning Work.

1. The preparation of dressings, sponges, iodoform gauze, ligatures, salt solution.

2. The packing of sterilizers, and sterilization of dressings and instruments for wards, for operating rooms.

3. The names and care of instruments.

4. The operating rooms — kinds of, general plan of the walls, floor, plumbing, furnishings, linen, care of.

Afternoon Classes.

F. Hospital etiquette and ethics for probationers.

1. Etiquette — The relation of the probationer to . other nurses, to physicians, patients, hospital officials, domestics, strangers.

Ethics — The probationer, object in entering school, history of nursing, qualifications, personal hygiene.

First Year (Second half).

Lectures, demonstrations, bedside-clinics and quizzes. The instruction to be given from the nursing standpoint '.

1 . Medical Nursing.

Temperature, pulse, respiration — the observation of symptoms.

Bacteriology in relation to the nursing of medical diseases. The blood, counting blood. The etiology of, and nursing in, the common diseases of the circulatory system, of the digestive organs, of the respiratory organs.

Medical emergencies.

Abdominal symptoms.

Hydrotherapy.

2. Surgical Nursing.

Bacteriology of the common surgical bacteria ; their relation to aseptic and to antiseptic surgery ; to surgical fevers and traumatic wounds ; sources of infection and methods of invasion ; means of prevention.

Surgical pathology; inflammation; process of repair.

Granulation tissue ; oedema.

Surgical fevers; erysipelas; septicaemia; pyaemia; tetanus; anthrax; fractures and dislocations, contusions and sprains.

Haemorrhage and shock.

3. Instruction and Practice in Physical Culture.

Second Year.

I. The Urine. — Elementary analysis (practical laboratory instruction to be given to the class in sections).

Diseases of the urinary system — Catheterization, bacteriology in relation to the urinary organs.

2. Surgical Technique. — Surgical operating-rooms. Care of patients before, during and after operations. Nursing in special surgical and genito-urinary cases. Infant surgery — joint diseases and apparatus. Surgical diseases — tumors, etc.

3. Gynaecology. — Pelvic anatomy — diseases of the organs of generation. Preparation of the patient for operation and after care: Preparation for major gynaecological operations and after care.

4. Anaesthetics and their administration, with practice.

5. Contagious and Infectious Diseases. — Channels of infection. Prevention and limitation. Immunity from disease. Isolation, disinfection, general treatment.

Typhoid fever, malarial fever, tuberculosis, pneumonia, pleurisy, influenza, meningitis, scarlet fever, measles, smallpox and other exanthemata, diphtheria and allied affections, hydrophobia, Asiatic cholera, amoebic dysentery, glanders and other less common infectious diseases. \