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On the morning of the fourth day the patient is to be given 1 oz. of castor oil followed by a soapsuds enema 4 hours later if necessary. The bowels are to be moved each day thereafter by cathartic or enema on order.

Pitcher Douche-The external genitals and anus are to be cleansed by the pitcher douche of a warm solution of 1:5,000 potassium permanganate after each micturition or defecation. No manual cleansing is to be permitted.

Vaginal Operations Alone Bowels-On the morning of the third day the patient is to be given a soapsuds


On the morning of the fourth day the patient is to be given 1 oz. of castor oil, followed by a soapsuds enema four (4) hours later if necessary.

Pitcher Douche-The external genitals and anus are to be cleansed by the pitcher douche of a warm solution of 1:5,000 potassium permanganate after each micturition or defecation. No manual cleansing is to be permitted.

Douches-After the seventh day a vaginal douche of 1:5,000 potassium permanganate solution, temperature 110° F., is to be given daily with a soft rubber catheter.


date they are to be removed must be charted in red ink on the order slip of the case history. The removal of the drains will be by special order of the attending surgeon or house staff.


All cases developing complications will receive special order from the attending surgeon or house staff.

Out of Bed

All cases will be allowed out of bed only on special order from attending surgeon or house staff.

The first day out of bed the patients are allowed to sit up for one hour.

The second day out of bed the patients are allowed to sit up one hour in the morning and one hour in the afternoon.

Thereafter the length of time out of bed is to be gradually increased, but no patient is to remain up longer than four hours in the morning and four hours in the afternoon until ready for discharge.

Standing Orders for the Recovery

Ward. Post-Operative Care The following orders will apply to all patients except emergency cases, complete lacerations of the sphincter ani, vesicovaginal fistulæ and rectal cases, for which special orders will be given by the attending surgeon or house staff.

Beds-The beds in recovery ward are to be prepared for the reception of patients from the operating room according to the Woman's Hospital rule.

The bed must be properly warmed for the reception of the patient by hot water bottles, but all hot water bottles are to be removed when the patient is placed in the bed, unless ordered to be retained by a written order from the attending surgeon or house staff.

When the cases are in shock or collapse heat is to be maintained by hot blankets, which are to be renewed as needed by blankets taken from the blanket-warmer in the small operating room.

pitcher and the temperature of the water must not exceed 120° F.

Hot water bottles are never to be applied to the patient except on a written order from the attending surgeon or house staff, and in every case they must be separated from the patient by a blanket.

As soon as the patient is placed in bed all wet clothing is to be removed.

The abdominal binder is to be adjusted and securely pinned.

Catheterization-Do not catheterize when curetting and cervix operations only have been done, unless compulsory. Catheterize every 8 hours or sooner for cause, unless the patient can void.

In extensive cystocele operations (also in Mayo and Watkins interposition operations), catheterize every 6 hours or sooner for cause.

Dip the point of the catheter in 25 per cent. Argyrol in all cases before introduc

All pins are to be removed from the ing it into the urethra. sleeves.

A draw-sheet is to be placed as a restraining sheet across the abdomen, but not so as to cause pressure or restrict breathing.

The head is to be turned on one side, with a towel and basin under the chin.

The pulse and respirations are to be taken every 15 minutes until the patient is conscious, or as long as she is in a condition of danger from shock or collapse, after which they are to be taken every hour until patient is removed from recovery room.

Hemorrhage-All patients are to be watched for hemorrhage from the incision and from the vagina, an inspection being made every half hour.

Temperature-All temperatures will be taken every 4 hours by rectum and indicated on the chart by an X (except in cases of complete laceration of the perineum and rectal and "drip" cases, when mouth temperature will be taken.

Pain-A hypodermic of morphine gr. 1/4 P. R. N. for pain and repeat Q. S. P. R. N.

After catheterization or micturition or defecation, the external genitals are to be freely flushed with a warm solution of potassium permanganate 1: 5,000 by pitcher douche.

No manual cleansing is allowed.

In vaginal operations a fresh sterile vulva pad is to be applied.

Thirst-Nothing is to be given by mouth for 24 hours after operation but sips of hot water (no ice or ice water is to be allowed.)

Drains-All drains with their location and the date they are to be removed must be charted in red ink on the order slip of the case history.

Urine-A specimen of urine must be sent to the laboratory the morning following the operation.

Complications--Any unusual condition of the patient is to be reported at once to the house surgeon in charge of the case and to the directress of nurses.

All cases developing complications will receive special orders from the attending surgeon or house staff.

Hot Air Hand Disinfection Exposure of hands and arms to hot air brings about a current in the secretions which carries the organisms of the skin to the surface where they can be removed mechanically or chemically. The virulence of the bacteria is also weakened by such treat


American Red Cross

The Red Cross Nurses' Conference


MERICA wants intelligent mothering -in other words, America needs


The acute lack of sufficient trained nurses in the United States and the grave necessity of graduating as many as possible in order to provide health safeguards during the shortage of doctors were the subjects of much spirited discussion at the Conference for Red Cross Public Health nurses. These women came from various parts of New York, New Jersey and Connecticut and the sessions were held at Mrs. Whitelaw Reid's residence in New York City.

Dr. William Loraine Bowdish of the New York State Department of Health, who addressed the conference, told a story to sharpen his moral: "Mike Murphy met Mrs. O'Flanigan, who had recently become a widow.

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'Oi understand, Delia,' said Murphy, that your owld man died av a tumor.' Faith, an' he did not,' retorted the bereaved one. He died av a Tuesday.' Thousands of babies have died of an August," said Dr. Bowdish, "merely because there were not enough Public Health nurses to teach mothers the importance of breast feeding. The old notion of a doctor's mission is rapidly dissolving.


as lately as twenty years ago, a doctor was expected to do nothing but hand out pills and powders. The function of a doctor was to administer drugs and nothing more. Nowadays a doctor is expected to dispense Health Promotion as well as drugs, and the Public Health nurse should be the medium by which the medical profession accomplishes this. She comes between the clientele and the physician."

The doctor shortage in the small towns. and country districts of New York State is

the doctors now practising, a very great number are old men. Fifty-eight communities in New York State are attended by physicians past 70. Many veteran practitioners succumbed during the last influenza epidemic. epidemic. Besides this, the recently increased requirements for matriculation in the medical schools have cut the number of applicants in half. Red Cross and other Public Health nurses must help to make up for the scarcity of physicians which is thus coming about."

The Nurse as Food Expert

The Public Health nurse will find herself forced into the nutrition field, in the opinion of Miss Margaret Sawyer, National Direc

tor of the Bureau of Dietitian Service of the American Red Cross. Since a multitude of duties clamor for the hand and brain of the Public Health nurse, when there is a Home Demonstration Agent in the community, the responsibility for putting out food information should be given to her. But when the nurse knows more about food than anyone else in her district, or when an additional instructor, as a dietitian, cannot be obtained, it is clearly up to the nurse to disseminate information about correct food habits.

"The Public Health nurse could arouse food interest among the mothers by introducing the hot school lunch, especially for youngsters who are obliged to come some distance. The Red Cross dietetics service hopes to be able to meet rural teachers in Institutes, to impress on them the child's need for the warm repast at noon or the hot drink to help out the cold viands the pupil brings from home. Thus the teacher will be more ready to co-operate with the nurse in the problems they meet in common.





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the most simple apparatus for the school culinary effort, unless the money for elaborate paraphernalia is easily available. Many a hot school lunch project has been smothered by a request for expensive double boilers, when two pails, one set inside the other, would have served the purpose as well. The Red Cross will supply printed suggestions on the school lunch to all who request them."

In many rural districts 25 per cent of the school children are malnourished, according to Mrs. Amy Storer, Dietitian for the Atlantic Division of the Red Cross.

"Children often eat little or no breakfast and country children frequently go through the entire day with no warm food until supper time, carrying the fatigue of the day on a cold sandwich at noon. These same youngsters leave home at 7 and do not return until 5 in the afternoon. Brain and body suffer, and the studies show it. "The nurse may enlist the assistance of women in the community in her hot soup or cocoa project. One nurse persuaded certain women in the community to make the beverage in two shifts, each worker serving two weeks at a time. Thus no extra burden was imposed on the teacher, and no great amount of time taken from the crowded study schedule."

One nurse told the conference of a school of four hundred pupils where both cocoa and baked potatoes were prepared on the furnace and the children paid three cents a cup for the drink. In this case the Junior Red Cross makes up the monthly deficit when one occurs.

Health Through the Library In spreading correct food information in her community no Public Health nurse should overlook the assistance of the town library. Miss Florence Bradley, librarian for the National Organization for Public Health Nursing, showed how the nurse can utilize this agency. Children are interested to a surprising extent in their own good

can be shown to contribute to athletic prowess.

"I first tried this thing out for Public School No. 64 in New York," said the librarian. "I procured books on muscle and food, of particular appeal to the East Side gamin, who above all things is anxious to outstrip his fellows in physical strength. It was amazing to see how the children demanded these books.

"A Public Health nurse should seek immediate co-operation with the town library, that she can direct children to some kind of reading on health subjects. Parents, too, often request books on how to bring up children, how to import sex information, etc. I would urge all Public Health nurses to find out what the town library lacks in nursing and health literature and make suggestions to the librarians. The nurse has a right to ask that part of the librarian's time shall aid nursing work.

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If you work in a strictly rural district, find out whether your county has a book truck, which brings reading matter to those who cannot patronize the town libraries. If not, you can all order literature from your State Library centers."

The speaker lamented that so few health posters are available for the nurses' work. Very few that are appropriate and technically correct have been brought out, except a small number whose price is prohibitive. Many nurses, she said, enlist the aid of the art teacher, who encourages her students to design bills and leaflets illustrating the use of milk, importance of fresh air and other health principles, with original captions.

Parents frequently seek works on sex instruction. For these, Miss Bradley recommended the pamphlets issued by the various State Boards of Health. On Guard (for girls), issued by the New Jersey Board of Health, is one of these. The State Boards of Oregon and California also put out some exceptionally good sex material, and no nurse should fail to see that her librarian

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