Part 3

Few have more than the faintest conception of the minuteness of these organisms. Prof. Cohn, justifying himself for the unscientific method of comparison which he uses in class instruction by Prof. Tyndall’s argument on the scientific use of the imagination, says he compares man to the cheese mite, as the Strasburg cathedral to a sparrow. Of the animalcules which Leeuwenhoek discovered, they are to man as the bee is to the horse. As improvements have been made in microscopes, just so fast have we penetrated into the world of micro-organisms, until now the proportion between the smallest we can see and man, is as man is to Mont Blanc.

Of course, with these exceedingly minute structures, nothing can be made out except points. Among some of the larger forms, a few have been able to see cellia, and in some cases the growth of the spores; but in the present state of microscopical optics the work is slow, and progress in this direction is waiting an advance in the science of optics.

Like all living organisms, bacteria propagate themselves. The most usual method is by fission or by partition, though Magnin and Cohn have recorded their observations on the formation of spores and sporangia, and I have myself witnessed the last named method. It is of importance to note that while the bacterium is killed by continued exposure to temperatures of freezing or 176° F., the spores will germinate after protracted exposure to temperature as high as 205° F. or as low as °123 F. These spores will also withstand complete desiccation, and it is in this form, mixed with the air we breathe and move in, that present the conditions from which all zymotic diseases originate. Miguel has shown that, while the air contains very few adult bacteria, it contains myriads of their spores. To the researches of Koch, Pasteur, and others, we are indebted for the certain information that, while these omnipresent germs withstand such vicissitudes of temperature, they require certain food for their maintenance; and though we cannot as yet tell what that food is, we know that when nutrient material is submitted to their action they thrive for a time, and when the particular principle which supports them is exhausted they die. This is particularly true of pathogenic germs, and the accepted theory of the bacillus tuberculosis, or the germ of consumption, is a good illustration. It has been demonstrated by Koch, Klein, Pasteur, Frankell, Sternberg, and others, that they require some product of inflammatory action for their support within the body of their victim. This is also true of cholera, at least so far as their dietary requirements are concerned. The animal cannot be infected with tuberculosis by merely introducing the germ-laden material into the stomach or upon any of the mucous membranes; but if an inflammatory condition be present, either due to the puncture of the introducing needle or scalpel, or to extraneous causes, such as a catarrhal condition of the lungs, tuberculosis is as sure to follow as the sun is to rise again.

The human mind can scarcely comprehend the enormous numbers of these omnipresent atoms without a resort again to the legitimate use of the imagination. A computation of the increase from a parent germ shows as follows: We know that the parent grows until it reaches double its original size, when it constricts itself in the middle like a figure eight and breaks into two individuals. Each of these divides again, and, on account of the rapidity with which this is done, we find them usually in chains or squares. The warmer the air, the faster this proceeds, and at the temperature of the body the entire life history of a germ, from the time of fission of the parent to the time of his own subdivision into two new individuals occupies less than one hour. This gives us a known quantity for our problem. Let us look at the result. From a single germ increasing by the power of two each hour, we have at the end of twenty-four hours 16,777,220; at the end of two days the number has increased to 281 billions, and in three days to the enormous number of 48 trillions, and in one week the number can only be expressed by figures of fifty-places. In order to make this number comprehensible, let us figure the mass and weight of this, the result of a single bacterium. A single Bacterium Termo has an average width of 1/1,000 mm. A cubic mm. would therefore contain six hundred and thirty-three millions, and in one day would be one-fortieth full. At the end of the following day there would be required 444,570 such cubes to contain the product of the parent, or say half a litre. Suppose the seas of the earth cover two-thirds of its surface with a mean depth of one mile, the aqueous product would be 929 million miles. Now, our parent germ and its product would in five days completely fill this space. More wonderful still is a gravimetric estimation. Suppose we call the specific weight of the parent germ the same as water, which cannot be far from right, it would appear that the parent weighs, or his equal bulk of water weighs, 136 millionths of a gramme; in forty-eight hours, 442 grammes; in three days, nearly 7½ million kilograms; and, inside of thirty days, the weight of the earth itself.

Prof. Cohn, in offering these figures, says: “I don’t consider this idle play; without it we can form no conception of not only the enormous increase, but the tremendous destruction of these germs which is going on around us. Food is lacking to support more than a comparatively small proportion of the product of the parent, and, as it is demonstrated that they feed from their environment, one can readily understand that without a constant supply a given infectious germ will with its followers soon destroy its nidus or perish from starvation.”

Our breweries demonstrate the truth of this hypothesis; for, in twenty-four hours, a single yeast cell, which is 8/1,000 mm. in diameter, will yield one hundred-weight of yeast.

I have endeavored to present the subject in a condensed but general way without burdening you with technical details of species, genera or life history. The subject is a vast one and to which the best minds of the scientific world are devoting themselves. To those who are or may become interested in bacteriology and particularly to those who study the relation of these germs to disease, is held forth the reward which is sure to come to those who work persistently and intelligently.

The method which I shall employ to-night is eclectic. Doubtless each investigator will find fault with some parts of the process and perhaps suggest a better one. The following, however, has in my hands worked well and given entire satisfaction, so far as I know, to those who were and are most interested.

The apparatus necessary is as follows:

One two-inch glass funnel.

One package filter papers to fit same.

Four medium size test tubes.

Two glass or porcelain staining glasses.

One glass or agate mortar and pestle.

One cover holder.

One pair pincetts.

One alcohol lamp.

Package of wooden toothpicks.

The cover holder may be easily made by taking a piece of thin platinum, two inches long and one-eighth wide, splitting one end for half an inch up and bending into a Y shape, then lashing to a small handle (I use a match). This little tool is most convenient for floating cover glasses in staining fluids.

The reagents necessary are as follows:

A five per cent. solution of nitric acid in alcohol (95 per cent.).

Saturated alcoholic solution of fuchsine.

Saturated alcoholic solution of methyl blue.

Small quantity of alcohol, 80 to 95 per cent.

Pure colorless aniline oil (anilin).

The method is as follows:

First pour enough aniline into a test tube to cover the bottom and half fill with water, shake violently for two minutes, and filter through funnel, which has previously had wet filter paper fitted. It is essential that the filter paper be saturated with water, else the aniline oil will separate during filtration. Our next step is to deposit specimen of sputum in mortar (if very viscid, add a few drops of water), and triturate thoroughly in order to break up encapsulated colonies, and distribute evenly through the specimen.

Now remove an amount which will just cover end of toothpick, and deposit it on a previously cleaned cover glass, which should not be over 1/100 inch thick, and thinner if possible; immediately cover with another cover glass, allowing sputum to spread by capillarity or slight pressure, and separate by sliding apart, and put aside to dry without heat. I have found that specimens dried without heat (and consequent coagulation of albumen) will show a much larger number of bacilli than when heat is used. I believe this is due to the fact that the fuchsine penetrates more thoroughly through the albumen when not coagulated, or that when it is coagulated by heat it to a greater or less extent it protects them from the action of the stain. While the covers are drying we will pour out a sufficient quantity of the aniline water, which by this time has filtered into one of the staining glasses, and add one or two drops (not more) fuchsine solution. Now, placing one of the cover glasses on our cover holder, sputum side down, we lower it into the staining fluid and withdraw holder from the side, and repeat the operation for the other cover glass. It is my habit to allow the covers to remain in this solution for at least eight hours or over night. The time may be reduced to ten or fifteen minutes by heating the red stain to about 140 or 150 F., but the result is not so brilliant, nor is it sure, as I have frequently failed to find the bacilli by the short method, but have been able to demonstrate their presence by the long one.

At the end of either of the above periods of time, the cover glass is lifted out of the staining solution and, without washing, immersed in our five per cent. solution of nitric acid and alcohol. It is this part of the process, if any, which will give trouble, as the time of immersion is governed by the thickness and general character of the sputum. My custom is to hold the first cover immersed until the color has just disappeared, or say fifteen seconds, and the second five seconds longer; but a very little experience will remove any difficulty from over-decolorizing.

From the decolorizing solution they are immediately immersed in water and thoroughly washed, when they may be again floated in the contra-stain, which is prepared by filling the other staining glass with water to which a few drops (three or four) of our methyl blue has been added. They should remain here for from five to eight minutes, when they are again removed with the pincetts, and a few drops of alcohol poured over them to wash off the surplus stain. Again wash in clean water, and dry by gentle heat (which will now do no harm) over the alcohol lamp, and place sputum side up on table.

A very small drop of thin benzole balsam is now placed in the centre of each cover, and a cleansed slide gently lowered over one in such a position that both covers may be mounted on a single slide. As soon as the slide has been sufficiently lowered to come in contact with the drop of balsam, it spreads by capillarity, and draws the cover close to the slide without the slightest danger from air bubbles being engaged, and the slide may at once be inspected by a _dry_ objective.

I have found it necessary to use an objective at least as high as one-fifth or one-sixth, with central illumination without diaphragm, as cases will frequently occur where the staining is so faint, that with a lower power they will escape observation, though a good, wide angle, four-tenths inch, will show them well when strongly stained.

I have endeavored to explain the method with perhaps too strict a regard to detail, but am sure that one who follows the various steps once or twice cannot fail to acquire the necessary technique without occupying more than fifteen minutes of working time; that is to say, five minutes to the first staining, and then the following morning to prepare and mount for observation.

171 GATES AVE., BROOKLYN.

ADDRESS TO THE GRADUATES OF THE LONG ISLAND COLLEGE HOSPITAL TRAINING SCHOOL FOR NURSES, DELIVERED JUNE 12, 1888.

BY GEORGE G. HOPKINS, A.M., M.D.

_Ladies and Gentlemen and Class of 1888_: We are apt to claim the trained female nurse as the outcome of the more rational treatment of disease, in modern times, but this is wide of the truth. So far as I can ascertain, in my researches among the ancient Vidas of Hindostan, and the literature of Egypt, Greece and Rome, I find no allusion to female nurses as a class, until the third century of the Christian era. Surgery and medicine had attained a high degree of perfection, many operations which to-day we claim as new to the nineteenth century were successfully performed 4,000 years ago; but the special nursing of them seems to have been done by the medical student, or by the practitioner himself. The earliest record I can find of women devoting themselves to the care of the sick, and attending to all the duties of a trained nurse, is that of Empress Helena, mother of Constantine the Great. This noble woman, who lived nearly fifteen hundred years ago, not only founded a hospital and endowed it, but herself, with the ladies of her court, there gave the most devoted and tender care to the sick poor. The Emperor Valens presented the most beautiful grounds and buildings in the neighborhood of Cæsarea to Archbishop Basil, “for the benefit of the poor whose bodies were afflicted with disease,” as being those who stood most in need of assistance. And as early as A. D. 373, the Archbishop had organized at Cæsarea an immense hospital, called the “Basilides,” which Gregory Nazienza thought worthy to be recorded among the wonders of the world; so numerous were the poor and sick who came thither, and so admirable was the care and order in which they were served. The charge of these sufferers was not at first assigned to humble hands; the most illustrious ladies of the empire participating in the offices of mercy.

At Constantinople the Empress Flacilla, wife of the elder Theodosius, in the year 380 was watching with solicitude over all those whose bodies were mutilated, or who had lost limbs. She visited them in their own dwellings, waited upon them herself, and supplied their wants. She repaired with the same zeal to the public hospitals of the church, where she attended the sick, made ready their culinary utensils, tasted their broth, carried the dish to them, broke the bread, divided the meal, washed the cups, and performed for them all the offices which usually devolve upon servants. One might justly be proud to be in such royal company, and regard, as she did, nothing degrading which is necessary to be done for a sick patient.

In modern times, the revival of nursing by trained women is due in great measure to that noble and accomplished woman, Florence Nightingale. As early as 1844, at the age of twenty-one years, she began to exhibit her interest in and the alleviation of suffering, and the improvement of the care of the sick poor in the hospitals of Great Britain. She visited and inspected the hospitals of Europe, and in 1851 entered into training as a nurse, in the institution of Protestant Deaconesses, at Kaiserworth on the Rhine. On her return to London she put into thorough order the Sanitarium for Governesses, in connection with the London Institute. She served ten years of apprenticeship before entering on her life work.

In the spring of 1854 war was declared with Russia, and an army of 25,000 men was despatched to the Crimea. The faulty arrangements of the British government for the care of the sick and wounded furnished the theatre in which Florence Nightingale was to win her first laurels. The hospitals were soon crowded, and the mortality in the wards so great that the casualties of the fiercest battles were as nothing in comparison.

The war office recognizing the condition of affairs, gladly accepted the offer of Miss Nightingale to go to the seat of war and organize a nursing department.

Her devotion to the sufferers can never be forgotten, she has stood twenty hours at a time, directing and assisting in the care of the sick and wounded. Her unfaltering devotion and incessant work undermined her health; but though sick and feeble, she never left the field of duty until Turkey was evacuated by the English troops. Major Delafield (who with Maj. Mordecai and Capt. Geo. B. McClellan, U. S. A., had been sent to Europe by our government, to study the art of war in the Crimea), in his report to the War Department, remarks, in speaking of the English hospital at Scutari, “It was in this well-arranged hospital that that most estimable lady, Miss Nightingale, exercised her powerful influence in alleviating the condition of the sick and wounded from the battle-field. Women as nurses were employed to attend upon the men in the wards, under the kind and beneficent guardianship of this good lady, with the many advantages that would naturally follow the most gentle, painstaking, and cleanly attendance of women as nurses. Miss Nightingale’s efforts have resulted in the establishing, in connection with the English army, an office known as the ‘Superintendant General of Army Nurses,’ the office to be always filled by a woman. She has under her a corps of female nurses, who take care of the sick in the military hospitals.” The Sanitary and Christian Commission of our late war was the outcome of the volunteer nursing in the English war of the Crimea and the fruit of these efforts in this country are the training schools for nurses which have sprung up all over this land.

Next to our entrance into this world and our departure from it, occasions such as the present, when we have completed our education and are about to enter upon our chosen vocation, are the most important events in our lives. The calling which you have chosen, while not a new one, is comparatively new in having special schools, and courses of study provided for it. Nursing has always been considered peculiarly woman’s work—more or less adaptation to such work is inborn in woman. What man can smoothe the pillow of the sick, or soothe an aching brow as gently and acceptably as one of the gentler sex! Who can move as quietly, and approach the bed of pain so gently as woman!

I have seen sick men, absent from home and friends, sigh for a mother, sister, or wife who is not at hand.

Thanks to this school, and others, everyone can now have skilled female care when sickness and disease are upon them.

You who are about to go out from us to-day, are entering upon a calling which will require all the skill, faithfulness, courage, patience, forbearance, endurance, watchfulness, self-possession, tenderness, cheerfulness and tact, that a human being can possess, and above all, “a conscience void of offence toward God and man.” “To thine own self be true, and it doth follow as the night the day, thou canst not then be false to any other.” You have each and all of you received, at the hands of your admirable Superintendent, and the lecturers of the College, such definite and varied information in all the departments in which you may be called to act, that you ought to be prepared for most emergencies, and have shown by your examinations that you have heard and understood them.

The fault will be yours, and yours alone, if you do not treasure them in your minds, so that you may be not only trained but _skilled_ nurses. The responsibility for the proper management of a sick-room and the patient in it is a very high and grave position, and requires the utmost faithfulness on the part of the nurse. Unless you are willing to put aside everything that may interfere with your giving _yourself_ entirely and conscientiously to the care of your patient, do not assume the charge. But when you once receive that charge remember that you are dealing with that which disease can destroy by your negligence, and no human power can restore—a precious human life. You therefore owe to each case all that a faithful mind can suggest and the body endure; and such faithfulness has not been wanting in the former graduates of this school.

I can never forget the scene when one of our graduates, after having charge of over thirty cases of typhoid fever among some orphan children, and we had to lose one, whom she had nursed as faithfully and tenderly as its own mother could have done, how, when she had done her all and death claimed him, there were tears shed for one who had no mother to shed them. And it was due largely to her unremitting faithfulness that we were able to record but two deaths in thirty-three cases. That woman has not had an idle day to my knowledge in several years.

When any unexpected emergency arises, which to your educated eye teaches you that your patient is in extreme danger, do not alarm the friends unnecessarily; try not to show in your voice or conduct that you are demoralized and have lost courage. While doing the best you can (until the arrival of the physician, whom it was your first duty to have summoned), encourage those around you, and keep them busy if you can, as, unless they are occupied, the coming of the physician will seem to them unreasonably delayed, even though he be at hand when called. Above all, do not let every physician within reach be sent for, unless the situation is one of great urgency, as I believe many patients have been frightened to death by the demoralization of solicitous friends.

If you can show yourself capable and maintain your own composure of mind, you will be able in nearly every instance to avert a panic, and in many cases prevent disastrous results to your patient. But if you fail at times for want of proper courage, do not give up with a feeling that you are unequal to emergencies, only be the more determined not to show the white feather again.

It is a well known fact to military men, that veteran troops who have stood the brunt of the fight in many a battle, become demoralized unexpectedly and retreat, to the utter surprise of their officers. But in their next battle their courage and deeds of prowess again surprise every one. So be it with you.

In the sick-room nothing so distresses the helpless sufferer as a want of frankness on the part of the attendant. You may refuse or neglect to answer, or turn the subject if possible, but never tell what are called “white lies.” One lie always requires another to cover it, and sooner or later you will be caught. If it is not best to tell, say outright it is better for me not to answer that question; or it may be the least of two evils to answer it faithfully as patients often imagine that things are far worse than they are. I believe that we of the medical profession often err in withholding from patients that which it is best in the end that they should know. This is one of our most difficult lines to draw.

If you have not learned or are not determined to learn to endure the caprices and demands of unreasonable men and women in the most unreasonable hour of their lives, you have mistaken your calling; as without Christian patience, I do not believe it possible for a nurse to succeed for any length of time. The trials and vexations of a nurse’s life are so numerous and so constant, that it is a wonder to me that there are so many who are ready to enter this calling in life. There is no need since the revival of professional nursing for women to torture themselves or do penance. Be as ready to minister to disagreeable people as a person who two years ago wrote that she would take a fresh air child, saying “send me one of the dirtiest, most unattractive and unruly of the children, one whom nobody else wants.” An unreasonable, selfish and wilful patient is a purgatorial discipline for both nurse and doctor.