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which the soda has been added, its tensile wound, and it hardly is necessary to wear a

strength may be impaired.

The catgut should preferably be obtained from the manufacturer in sealed glass tubes. These tubes when handled become coated with a thin layer of grease from one's fingers, and in this thin film living organisms or spores may lie imbedded and perfectly protected from the action of antiseptic solutions. It is not enough, therefore, to place these tubes in a tray containing carbolic solution or formalin solution. The germs are not destroyed, and the nurse, when she takes up the tube in her gloved hands and breaks it protected in gauze, is very likely to contaminate her gloves and as she removes the strand of catgut and draws it out through her fingers, she may in turn carry the organisms along the catgut. Infection from the suture may result. This is avoided by boiling the glass tubes of catgut with the instruments. They are then placed in a tray of 1-20 carbolic solution or 3 per cent. formalin.

At the operation the nurse removes a tube of catgut from its tray by using a sterile forceps. She should never put her fingers into the tray. Silkworm gut is boiled with the instruments, also the rubber drainage tubes.

The white enamelled basins are sterilised in the utensil steriliser and a fresh set is used for each operation.

The large glass bowls which are seen in many operating rooms should not be used. There is no reliable way of cleaning them if they become contaminated during a septic operation. The few minutes intervening between one operation and the next do not give the operating-room nurse sufficient opportunity to render them surgically clean. Mouth guards are worn by the surgeon and his assistants. The speaking voice is capable of projecting minute particles of saliva which carry organisms a distance of three feet, a cough or a sneeze two or three times that far. It seems unlikely that quiet

to

mask which covers both mouth and nostrils. As the surgical nurse assists at the operation and sometimes finds it necessary speak to the surgeon or his assistant, she may speak directly upon the suture which she is holding at the moment only a few inches away from her mouth. It is quite important, therefore, that she also should wear a mouth guard. The same applies to the anaesthetist if the operation is upon the head or neck or shoulders.

And, finally, it is worth while to mention the very mild infection which may be carried by sweat. It has never seemed to me that this is a serious menace, and yet it is possible that our catgut ligatures sutures may become infected in this way and prevent the clean healing of the wound.

or

The sweat may come from the patient's skin as well as from the forearms of the operator or his assistants. No matter how carefully the surface of the patient's skin or the hands, forearms and arms of the operator and his assistants and nurses may be prepared, when the sweat glands begin pouring out their secretion until the sweat collects in droplets there is always a little risk of very mild wound infection.

The climate in Philadelphia is very hot in July and August, and it is not unusual to find ourselves working in an operating-room with the temperature near or even above 100 deg. F. The air, furthermore, is saturated with moisture. A leaking skin is inevitable under these conditions. The sleeves of one's gown may become saturated, or occasionally a drop of sweat may fall from the gauntlet of one's glove upon the field of operation. Under such uncomfortable conditions, I have found it an advantage to wear a gown with short sleeves and work with gloves and with the arms bare to above the elbows. During the operation I frequently rinse off my gloves and forearms to the elbow in the bichloride basin. The skin surrounding the immediate field of

Miss Bronson's Babies

FLORENCE SWIFT WRIGHT, R.N.

An attractive poster showing a smiling baby called my attention. to Newtown's Baby Keep Well Station. Seeing a nurse within I rang the bell, explained my interest. and was invited to go along with the nurse on her day's rounds.

Knowing the reputation of Newtown for child welfare work, I was very glad to have an opportunity to learn by observation how the wonderful results had been obtained and so I spent the day with Miss Bronson, the Public Health Nurse.

"The Baby Keep Well Station," said Miss Bronson, "is really a school for mothers. It is a good school, but it does not reach all mothers who need it. In this respect it is like the public schools of former days. There is no provision for the compulsory education of mothers."

A School for Mothers

The Station is sometimes called a clinic but this is a misnomer. According to Webster's dictionary, clinic has two meanings, i.e., one confined to bed by sickness and also a school or class in which medicine or surgery is taught by the examination and treatment of patients in the presence of the pupils.

Therefore, Miss Bronson prefers that her station be called the Baby Keep Well School. Even though sick babies often find their way there, its main object is to teach. the mother how to keep her normal, healthy baby well; how to guide her child to healthy, happy, useful maturity.

At her station Miss Bronson has the help of a well-known baby specialist twice a week, a man who, while tender, understanding and skillful with sick babies, is more interested in health than disease, and whose dream is of a country where no one is forced to suffer the handicap of ineffi

ciency because of the ignorance of mothers or of the indifference of the citizens.

How It All Happened

As we walked rapidly toward the few congested blocks comprising Miss Bronson's district, she outlined to me the plan by which

her work had been developed and conducted.

First a demonstration had been made in one block by a local charity organization. So many babies were saved and the general health of the block was so much better than that of the rest of the neighborhood that the local board of health finally took over the work and extended it throughout the congested wards of the city.

"But," I asked, "what about the mothers up on the hill. Don't they need instruction?"

"Yes," answered Miss Bronson, "I know they do, but the city has not come yet to think of our Well Baby Schools as they do of the Public Schools. All babies' needs are the same. All mothers, rich or poor, need the same knowledge. I hope to see the day. when mothers' schools become almost a part of the Public School system, so that the city sees it as a duty to teach all mothers in order that their children may grow up fit to be taught in the public schools.

Foreign Mothers Seldom Use Drugs

I asked Miss Bronson if the foreign mothers she taught gave their babies paregoric and patent medicines.

"Hardly ever here. You see, a nurse visits each new baby as soon as its birth is reported. She takes a birth certificate from the Board of Health and explains to the mother the importance of birth registration. Then she begins at once to teach that mother about babies."

My own experience as a public health nurse prevented my feeling any surprise. I

already knew that the reception of the public health nurse in any home, rich or poor, depends on the nurse herself. Knowing Miss Bronson, I knew that she would always be welcome anywhere, that the more upset the household the more helpful her good sense and skillful service would be. "You see," continued Miss Bronson, “when a mother is taught right so that she nurses her baby regularly and takes the right care of him, she never thinks of medicine because she has a good, happy, healthy baby."

Not Always Popular

"You know," laughed Miss Bronson, "there are a few people around here who wish I'd depart. I spoil business." Her eyes twinkled, and although I could guess where she was unpopular, I led her on. "You see, in this State, while the Federal Narcotic Law controls somewhat the sale of powerful narcotics, weak solutions of opium and morphine are obtainable nearly anywhere. The grocer sells paregoric still. The druggist sells it, too, and also a lot of patent medicines containing morphine, opium, ether, chloroform or alcohol. found sixteen different kinds, all being used by ignorant mothers to quiet poorly cared. for babies. That was when I began my work. I thought I'd never get started when I first came here. One poor baby died, drugged to death by his loving mother who could not bear to let him cry.

I

Drugged Baby Martyr to Cause "That baby died a martyr. The doctor who signed the death certificate wrote that the cause of death was 'numerous medicines containing opium administered in ignorance.' The mother was heart-broken, and told me she would do anything to remove such a danger to babies. I persuaded her to let me tell the story. (I never tell these things (I never tell these things with the names unless I have permission and can do some good by it). Then, with the poor mother's permission, I brought a sympathetic woman newspaper reporter to see

story and gave permission to have it printed in the biggest paper. It was well written and was copied by all the city papers, even to the little Polish Weekly.

Trade Disturbed

The

"That story certainly impressed the mothers in my district. It gave me my start against dope for babies. But some people don't like me. I saw a combination sale in the drug store the other day. sign stated that if you'd buy a pacifier, 6 bottles, 3 nipples, some talcum powder and soap they would include any one bottle of a basket full of patent medicines, free. Nothing much in demand with my mothers except the soap, a little talcum and a few bottles.

"I went in the other day to buy a tooth brush and the druggist gave me a black look and said he didn't have the kind I wanted. The basket was still full of bottles.

I

"I hope to make friends with him soon now, although he won't talk to me yet. already know Mrs. Druggist. She called me into her house one day last winter and Dr. Watkins and I have been teaching her how to take care of herself. She is a well educated, intelligent woman, a good pupil. Mr. Druggist won't hold out long, I'm sure. It's hard to have to go to so much trouble to protect people, but still we are educating these foreigners, along with their American neighbors, and some day they will vote for people who will make right laws."

The

We reached Mrs. Kovacs' door, which flew open in expectation of Miss Bronson. I was introduced as a friend who loved babies and Mrs. Kovacs, as well as every other mother that day, made me welcome. It was a warm day in early summer. three-room tenement was hot from the ironing day "fire, but Mrs. Kovacs led us proudly to a shaded window where, on the fire escape, safely caged in a screened frame. little Anastasia, four months old, lay in square diaper and knit band on a mattress. Her toes were a source of interest and occu

"Mrs. Kovacs," explained Miss Bronson, "is one of my old mothers." The blooming girlish Polish woman smiled. "Yes, Miss Bronson, she teach me for my Stanislowa. When he baby I not speak the English. I fraid all time. Summer hot. My country not hot. I put my baby in pillow Polish way. Baby cry all time. Have rash. I buy medicine at Emil Kiss' drug store. He speak my language. He say medicine fine, all right. I give to my baby. Baby no cry from then.

"Italian lady, my neighbor, one day she come my house for towel she drop on fire escape. She see my baby. She say, 'Sick?' I cry. She say, 'You come with me.' She take me to Miss Bronson. Doctor Watkins there. He say my baby all right, just too hot. He say baby need no medicine, just the mother's milk every three hours, the bath plenty, the fresh air all time. He say pillow no good for baby dress, it makes prickly heat. He say cap no good, it makes crust on baby's head. He say wash baby's head. He say fine baby.

Father Takes a Lesson

"Miss Bronson, she show me baby clothes. She see my husband. He talk English. She teach him. He teach me. Miss Bronson come many times. My baby not sick from before since. This baby not sick at all. Miss Bronson, now, she come just one time every month. She say I good mother. Now, me! I help Miss Bronson, too. I like."

"Indeed she does," broke in Miss Bron

son.

"She teaches all her neighbors. I have little to do in this house. Between Mrs. Kovacs and Mrs. Antonio, her Italian friend, I am never at a loss for an interpreter or an assistant teacher. They practice. what they preach, too. See these samples of their work."

Results of Care

without her? She make my Stanislowa play, she make him sleep, she make him eat. I say to my husband, 'Maria, she is Stanislowa's little mother.'"

We visited several mothers in this house, and I had the pleasure of meeting Mrs. Antonio, a portly, hospitable Italian woman stewing a savory mess on a well polished stove, while a graduated series of little Antonios romped in the cramped back yard and called for Maria to come presto and play with them.

As we left, I saw Maria, the little mother, herding her flock to the cool shady alley to play school. We had found happiness, health, ambition, wholesome family life, and old-fashioned neighborliness, all in cramped rooms on a littered street in a crowded industrial city, where only a short four years ago sixteen babies of every hundred died during the first year of life.

Foreign Babies Thrive Better Than
American

I asked Miss Bronson the record of her ward, the most congested in the city, and was told that last year only seven in each hundred babies died in their first year of life, a record superior to that of the fashionable residential district on the hill. "These mothers all nurse their babies. The druggist can't sell his nursing bottles," explained Miss Bronson. "Yes," I thought, "and they have at least one other advantage over their richer sisters. They are educated mothers. They have Miss Bronson."

"This house is different. The people are all new. I'm afraid they will spoil our record," said Miss Bronson, as we entered a new six-story apartment house.

Here we found a sick baby. Mrs. Nolan, Italian-American wife of Patrick Nolan, a prosperous plumber, had been tempted to give her three-weeks-old baby a bottle of a mixture of a composition known only to the Italian grandmother, while she went back to her old job in the cigar factory. Now she was wringing her

A dark-eyed Italian girl of seven led in a shy, blond Polish youngster of two. Both looked like healthy, country-bred children. "She good girl, Maria," observed Mrs. Kovacs. "How I get my ironing done hands and wailing over a whining,

emaciated scrap of humanity two months She is the strong character in that house. old. Thank you for coming in, Nurse."

First Aid to Babies' Stomachs

It was a pleasure to watch Miss Bronson in action, alternately chiding and encouraging the foolish mother. As I undressed and bathed the baby, preparations were made by Miss Bronson and soon Mrs. Nolan was taught to give give a rectal irrigation of warm water containing a teaspoon of baking soda to each two glasses, was directed to give the baby a dose of castor oil and no food, only water for six hours. Examination revealed that Mrs. Nolan might still be able to nurse her baby and she was directed to do so regularly after the expiration of six hours. "This is our standard first aid treatment for babies whose stomachs are not right," explained Miss Bronson.

Family Doctor Approves

Having learned that Dr. Tempesto was the family doctor, I went with Miss Bronson to his office where she related the baby's history and told of her first aid treatment which was approved. "You're a great help, Nurse," commented Dr. Tempesto. "I'll look in on Mrs. Nolan in the morning. Will you keep an eye on her? Can she nurse that kid?" "I think so," was Miss Bronson's reply. "She thinks a lot of you and if we can make her try, she can do it."

Pointers from the Doctor "Well we may have to give him a formula for a week or so. Weigh him and let me know if he needs anything more. You'll see to Mrs. Nolan's diet, won't you? I told Pat to keep his wife at home but she said all the young mothers on Keasby Street work in the tobacco factory and she did not see why he wanted to make her stay home. There was pretty near a family row there and Pat is the good natured one. Stop at his shop some day. He's a good boy, but the family is too much for him. He gives in to Antoinetta every time she weeps. You'll have to teach him baby care too. Did you see Antoinetta's madre? If you get her

"I wish that man would learn my name," grumbled Miss Bronson as we left the doctor's door.

On our return in the afternoon, we stopped to see Mrs. Nolan. Her husband was smiling approval as little Pat took a scant meal from the one source of real baby food. Mrs. Nolan was told what to eat and how to secure rest. "He'll get enough until tomorrow," said Miss Bronson happily. "Dr. Tempesto says he'll be in. Be sure to bring the baby over to the Baby Keep Well School at two o'clock. We must weigh and measure him."

Mother-in-Law Submits

Just before we departed, Mrs. Nolan's madre lumbered in and sank weakly into a chair by the window. "Oh, Mama Mia! Mama, Mia! Bambino mio, malato " she cried hysterically as she swayed to and fro to the rhythm of her words.

Then rose Patrick Nolan, Irish, six feet tall, man of the house, able to support his family, proud, heretofore "Easy Pat." "Sure Granny," said Patrick, "me wife will be stopping in in the house now. She'll be giving Patsy American care. She'll be feeding him by herself. It's not dying he is. You give the bottles to some one as needs 'em." Bottles Saved

"No," said Miss Bronson, "we may need them ourselves. Boil them and put them in a box on the top shelf.'

As we approached the Baby School after a busy day, I wondered what Miss Bronson would do next, if she was always busy with babies.

"I must hurry," she said, "I commute to the shore all June and July. If I catch the five-fifteen, I can get a swim before supper. My sisters and mother have a little house and garden now. Tomorrow is a holiday and we're going to a dance."

So I caught the night train after promising to visit the Baby Keep Well School

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